هام Clinical & chemical pathology mc qs-1

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Clinical & Chemical Pathology MCQs Classified, Reorganized And Updated To Shawual 1425 With Short Notes

By Dr Mohammad A. Emam

Contents Body fluids ................................................................................. 2 Clinical Chemistry .................................................................... 4

INSTRUMENTATION ...................................................................................................................4 BLOOD GASES, PH AND ELECTROLYTES. .............................................................................5 GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. ...............................................................7 CALCULATIONS, QC AND STATISTICS ..................................................................................9 CREATININE, UA, BUN AND AMMONIA ............................................................................... 10 PROTEINS, ELECTROPHORESIS AND LIPIDS ....................................................................... 11 CLINICAL ENZYMOLOGY........................................................................................................ 13 CLINICAL ENCOCRINOLOGY ................................................................................................. 14

General ..................................................................................... 17 Hematology .............................................................................. 19

BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES ................................ 19 NORMOCYTIC NORMOCHROMIC ANEMIAS ....................................................................... 20 HYPOCHROMIC MICROCYTIC ANEMIAS ............................................................................. 24 MACROCYTIC NORMOCHROMIC ANEMIA ......................................................................... 25 QUALITATIVE / QUANTITATIVE WBC DISOREDERS ........................................................ 26 LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS ................................. 29 COAGULATION AND PLATELETS .......................................................................................... 35

Immunohematology ................................................................ 40 Immunology ............................................................................. 41 Microbiology ............................................................................ 43

ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION ..................... 43 BASIC TECHNIQUES ................................................................................................................. 44 BASIC BACTERIOLOGY............................................................................................................ 46 GRAM POSITIVE COCCI ........................................................................................................... 47 GRAM NEGATIVE COCCI ......................................................................................................... 49 GRAM POSITIVE BACILLI ........................................................................................................ 49 ENTEROBACTERECIAE & PSEUDOMONAS ......................................................................... 50 RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA ............................................................. 52 SPIROCHETES ............................................................................................................................. 53 BORDETELLA & BORRELIA .................................................................................................... 53 ANEROBIC BACTERIA .............................................................................................................. 54 BRUCELLA .................................................................................................................................. 55 MYCOBACTERIA ....................................................................................................................... 55 MISCELLANEOUS ...................................................................................................................... 56 MYCOLOGY ................................................................................................................................ 57 VIROLOGY .................................................................................................................................. 60

26th Shawual 1425 .................................................................. 64

CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS

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BBody fluids

1. **Doctor sending a sample requesting for lecithin spingomyelin ratio what is the sample?

a. Blood. b. CSF c. Amniotic fluid. d. Urine

1. (c) Amniotic fluid sample is used to measure lecithin: sphingomyelin ratio (L/S). L/S > 2:1 (or 2.5:1) denotes acceptable lung maturity.

2. ***Cytological examination of pleural effusion in a 60 yrs old man revealed the presence of malignant cells. The most likely primary tumor will be:

a. Lymphoma. b. Mesothelioma. c. Cancer colon. d. lung cancer.

2. (d) Lung cancer: 75% of malignant pulmonary effusions are due to 3 causes; lung cancer (30%), breast cancer (25%) & lymphoma (20%). Practically, cytological examination only establishes the presence of malignant effusion, however, in most cases it cannot identify the primary site of the tumor. Regarding mesothelioma, it is a rather a rare tumor of the pleura.

3. *****Regarding Albustix: a. Useless if infected urine. b. Gives red color. c. Not useful if acid is added to urine. d. Depends on acid precipitation of urinary proteins

3. (c) Commercial strips for detecting albumin (Albustix) use the following formula: Tetrabromophenol blue (yellow at 3.0) shades of green in the presence of protein at the same pH. This reaction is sensitive to 0.03g/L albumin. A false negative result occurs with acidification of urine. Also, a markedly alkaline urine (pH or higher can give false +ve.

4. ****Which is not a reducing sugar in urine? a. Glucose. b. Galactose. c. Sucrose. d. Fructose.

4. (c) A reducing substance is the one that reduces alkaline cupric sulfate to red coprous oxide. Most important are glucose, lactose, fructose, galactoses and pentoses (e.g. ribose, xylose and arabinose) while sucrose will not reduce alkaline cupric sulfate.

5. ***Red urine is due to? a. INH b. Rifampicin c. Pyrizinamide.

5. b. Rifampicin is a well known drug to cause red urine.

6. **Urine strips detect all except

6. Fat droplets. Occur with glomerulonephritis and nephritic syndrome but are not detected by the routine urine strips.

7. **If urine is left for long time which is affected more?

7. Urea. The most labile constituent of urine is urea. Bacterial action decrease urea and increase ammonia and pH.

8. **Abnormal constituent of urine includes? a. Urea b. Glucose c. Cholesterol. d. Uric acid e. Protein.

8. (c) Although also glucose and protein are abnormal constituents of urine, yet they normally present in trace amounts below the detection limit of ordinary methods.

CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS

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9. ****Calcium in urine stone is present in all of the following except:

a. UTI b. Secondary hyperparathyroidism.

9. (b) In 2ry hyperparathyroidism, hypocalcemia due to e.g. chronic renal failure is the cause of increased parathormone. Stones due to hyperparathyroidism only occur with the 1ry or 3ry disease. Calcium is precipitated in stones with oxalate (at acid or neutral pH), or less commonly with urate (at acidic pH) or with phosphate (at normal urine pH). Causes of hypercalciurea include:

- intestinal calcium absorption ( P levelvit D Ca absorption Or in case of

hypervitaminosis D. - Lack of renal tubular reabsorption e.g. with furosamide. - Loss of Ca from bone (due to mobilization as in 1ry & 3ry hyperparathyroidism, due to bone destruction or due to Cushing's and thyrotoxicosis)

Otherwise, UTI causes stones at alkaline pH where ammonium is high and mixed stones form due to obstructing Ca stone which favors infection and precipitation of ammonia salts.

10. If urine is kept for a long time:

a. Becomes black. b. Urea increases. c. Urea decreases. d. Creatinine increases

10. See 7. Urine becomes black on standing in cases of alkaptonurea ( homogentesic acid) and methemoglobinurea.

11. Myoglobinuria is seen in:

11. Muscle injury (also known as rhabdomyolysis) e.g. in cases of crush injuries and strenuous exercise.

CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY

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CClinical Chemistry

INSTRUMENTATION 1. ******Difference between ELISA & RIA is ?

a. ELISA technique uses an enzyme. b. ELISA is used by bacteriologists while RIA by virologists

1.

(a) Both techniques apply almost the same methodology, .ELISA technique uses an enzyme label and RIA uses radioisotopic label.

2. The label in ELISA is? a. Enzyme b. Antibody c. Antigen.

2.

3. ***Which of the following not seen in chemistry lab? a. Analytic balance. b. Centrifuge c. Spectrophotometer d. Electron microscope, e. Turbidimeter.

3. (d) Electron microscope.

4. **The washing is must in all heterogenous ELISA techniques because?

a. It remove the excess binding b. Increase the specificity c. Increase the sensitivity.

4. (b) In ELISA, the first washing is used to remove the unbound (free) sample antigen. The second washing removes unreacted free label (not excess binding in either of the 2 washings) If washing is not complete, this will false high

specificity. If the question comes as It avoids excess binding, then this will be the choice.

5. **The enzyme in ELISA is present in the? a. Conjugate b. Microplate c. Buffer.

5. (a) The conjugate is the second antibody conjugated with the enzyme.

6. **A standard microplate in an ELISA has? a. 96 wells b. 98 wells c. 92 wells.

6. (a) 96 wells are present in the microplate (8 rows x 12 columns).of these, 1 is used for the blank, 2 for the –ve controls, 2 for the +ve 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. The absorbance of 10ml of the same colored solution will be:

a. 1.000 b. 0.500 c. 0.250

7. (b) According to Beer's law, absorbance is proportional to the final concentration (whatever the volume is)

8. a dichromatic analysis is carried to increase: a. Specificity b. Linearity c. Sensitivity.

8. (a) Di- (bi) chromatic photometry measures absorbance of the sample at 2 different wavelengths. This corrects for interfering substances increasing specificity of the method.


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BLOOD GASES, PH AND ELECTROLYTES. 9. ******PO2 (or gases) is measure in which unit?

a. Mmol b. umol c. mmHg

9. © mEq/L (mmol in SI) is used for electrolytes e.g. BE, bicarbonate and H+. While mmHg (or kpa in SI) is used for gases e.g. pCO2 and pO2.

11. Acidemia is associated with

11. Acid in urine and increased HCO2-.

Increased hydrogen ion in the blood is termed academia. If the cause is metabolic, there will be compensatory hyperventilation H+ back to normal while HCO3

- drops. Furthermore, if renal function is normal, H+ will be excreted. If the cause is respiratory, renal compensation will cause H+ excretion and HCO3

- retention and generation lowering H+ back to normal.

12. ***To correct acidosis, the kidneys: a. secrete more H+ in urine. b. Synthesis bicarbonate to ECF c. Both a and b

12. (c). See 11.

13. **A buffer is made of ? a. Strong acid & strong salt b. Strong acid & weak salt c. Weak acid & strong salt d. Weak acid & weak salt.

13. (c) A buffer system is made of a weak acid and its salt with a strong base of a weak base and its salt with a strong acid.

14. ****pH means:

14. Negative log H+ concentration

15. ***What is the base: acid ratio at pH 7 for acid of pK6? a. 0.01 b. 0.1 c. 1.0 d. 10 e. 100

15. (d) According to Henderson Hasselbalch's equation, pH = pK + Log base/acid. By compensation, Log (base / acid)= 1, thus base: acid = 10:1.1

16. ***Which is more serious? a. Glucose 15mmol/l b. pH 7.25 acidosis. c. Potassium 1.5 mmol/l d. Sodium 150 mmol/l

16. (c) Critical K+ values are <2.5 or > 6.5 mEq/L Critical glucose <40mg or >450mg (2.2 & 25mmol respectively), critical pH <7.2 or >2.6 critical Na+ <120 or > 160mEq/L

17. ******Metabolic acidosis can result from:

17. (a) Ingestion of certain medicines or chemicals e.g. metformin.(glucophage). Metformin causes lactic acidosis. Generally, metabolic acidosis is due to either addition of H+ ( AG), excretion of H+ or loss of HCO3

-

18. pH of the blood.

18.

19 Acid base balance.

19


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19. New

H+ homeostasis is altered by; a. Excessive change of pyruvate to lactate.

19. New

In actively contracting muscle, 8% of the pyruvate is utilised by the citric acid cycle and the remaining molecules are reduced to latctate. This lactate is oxidized by the liver to pyruvate which ,through gluconeogenesis, becomes glucose. If lactate is not efficiently reutilized in such a way, it accumulates in the blood causing lactic acidosis.

20,21, 22, 24, 25, 26.

***Main extracellular ions? a. Na & K b. Na & Cl

**Main electrolyte in blood is? ***Electrolytes in ECF

a. Na is a major cation b. Cl is a major cation d. HCO3 is a major anion.

***Main intracellular cation is; **In serum:

a. Sodium is the main cation. b. Bicarbonate.

***Intracellular fluid contains: a. More potassium less sodium than extracellular fluid.. b. Sodium and potassium in equal amount.

20, 21, 22, 24, 25, 26.

b. Na is the major ECF cation, Cl is the major ECF anion, K is the major ICF cation and proteins followed by phosphates are the major anions.

23. **All causes renal damage except

23. Hypocalcaemia. Causes of renal damage include; hypovolemia (hemorrhage or dehydration), myoglobulinurea, hypercalciurea, uricosuria, and drugs e.g. aminoglycosides and ACE inhibitors.

27. Renal tubular injury occurs in

27. See 23.

28. Hypernatremia occurs with a. Cushing disease b. Dehydration c. hypothalamic injury d. All of the above

28. (d) Hypernatremia occurs with: * body Na : due to extrarenal water loss or renal diuresis. * Normal body Na: due to extrarenal loss e.g. hyperthermia or renal loss e.g. DI. * Na retention e.g. steroids or Na intake.

28. New 1

Regarding concentration of urine; a. Proximal tubules return 75% of filtered water. b. Distal convoluted tubules deliver 40-60L of fluid to collecting tubules / day. c. Osmotic pressure in renal cortex is higher than in medulla. d. ADH acts on all parts of nephrone. e. Aldosterone increase Na excretion.

28. New1

a. Approximately 80% of the water and NaCl contenet together with glucose, phosphate, and amino acids are reabsorbed in the proximal tubule. About 20% of the tubular fluid enters the loop of Henle where water is passively aborbed; 6ml per minute of concentrated tubular fluid now enters the distal tubule, where there is an active reabsorption of sodium. The fluid leaves the distal tubule at a rate of approximately 1ml per minute passing into the collecting ducts in the form of urine. Aldosteron is relased due to ineffective arterial pressure in the kidney. It causes sodium reabsorption which raises plasma osmolality. ADH increases permeability of distal and collecting tubules to water urine concentration.


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28. New 2

Regarding excretion of Na+ a. Not dependent on aldosterone. b. Major share of GF osmolarity with associated ions. c. It passively diffuses in proximal tubules. d. In distal tubules it is exchanged for K+ e. Coupled with K+

28. New 2

b. Na+ excretion is influenced by mineralocorticoids (mainly aldosterone): reabsorption. The GF is isoosmolar with plasma i.e. Na is the major electrolyte. 90% of Na is actively (not passively) reabsorbed in the PCT. K is excreted from DCT in exchange with Na (not the reverse and not coupled with it).

28. New 3

Regarding buffer systems; b. An acid is a substance that releases H+ c. Buffering involves change of strong acid to base.

28. New 3

b. Acids are substances that tare capable of donating protons. When a strong acid is added to a buffer, the salt reacts with the acid forming weak acid, and its salt (not base).

GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. 10. Factors affecting glucose level in blood include:

10. Adrenaline, T4. These together with cortisol, GH

and glucagons are the hyperglycemic hormones causing 2ry diabetes in case of excessive secretion.

29. **Glucose level to diagnose hypoglycemia in newborn is.

29. - 25-30 g/dl In newborn babies, glucose tends to be lower than in adults. Critical low level in newborn is 30mg/dL

30. ***About GTT, which is correct according to WHO recommendations?

a. Should not be done in pregnant women, b. Should not be done after giving heavy carbohydrate diet for 3 days. c. Should be done after 4-6 hrs fasting.

30. (c) WHO recommendations for GTT include:

31. **With age renal threshold for glucose? a. Increased b. Decreased c. Not changed

31. (b) With age, the renal ability to reabsorb filtered glucose is decreased leading to appearance of glucose in the urine at lower plasma levels.

32. **All are inborn error of glycogen metabolism except? a. Essential fructosuria b. Phenyl ketonuria c. Galactosemia d. Glycogen storage disease

32. (b) Essential fructosuria is due to aldolase B defect leading to accumulation of fructose-1-P Galactosemia (serious) is due to decreased Galactose-6-P uridyl transferase leading to decreased glycogen synthesis. Types of glycogen storage diseases (GSD) include:

Type I (VonGierke's): G6P Type II (Pompe's): lysosomal maltase Type III (Cori's) : debranching enzyme. Type IV (Anderson's): Absent debranching enzyme Type V (McArdle's): muscles phosphorylation.


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33. *****HBA1c (Glycosylated hemoglobin) is? a. Not present in healthy normal individuals. b. in prolonged sustained hyperglycemia

33. (b) GlycHb (RR 4-6%) is formed by non enzymatic attachment of glucose to N-terminal valine of B-chain of Hb. Three types occur, HbA1a, HbA1b, HbA1c, Both total and HbA1a are used. Time averaged blood glucose = GlycHbx33.3-86 (mg/dL) GlycHb reflects 8-12 weeks of blood glucose while fructosamine reflects 2-4 weeks.

34. ***Glycogen differs from starch in:

34. It is a highly branched structure

35. **Cellulose is not metabolized in humans because of absence of which enzyme?

35. Glucose units in cellulose are combined by cellobiose bridges. These are hydrolyzed by cellobiase which is lacking in animal and human gut.

36. **Xylose test is done to detect the function of: a. Stomach. b. Pancreas. c. Upper small intestine. d. Lower small intestine. e. Large intestine

36. c. Xylose is absorbed from proximal small intestine independent on pancreas..

37. ****Von Gerke's disease is caused by deficiency of: a. Glucose 6 phosphatase b. Glucose 6 phosphate dehydrogenase

37. (a) See 32.

38. What happens if sucrose is given parentrally: 38. It will be secreted unchanged or metabolized

39. ***Which of these is not a ketone body? a. Acetone. b. Acetoacetic acid. c. Butyric acid. d. B-hydroxy butyric acid. e. None of the above.

39. (c) Ketone bodies are formed by condensation of 2 acetyl Co A Acetoacetic acid which gives B hydroxyl butyric acid by reduction or acetone by decarboxylation. Butyric acid is a fatty acid

40. ***In Gaucher's disease; a. Glycoprotein is accumulated. b. Glucocerebrosidase is deficient.

40. (b) Gaucher's is a glucosylceramide lipidosis (lysosomal storage disease). It is caused by glucocerebrosidase enzyme leading to accumulation of glucosylceramide HSM and pigmentation of exposed parts.

41. Bile duct obstruction can be diagnosed by: a. AST b. T. Bilirubin c. Bilirubin in urine d. Ester bilirubin

41. (c) Cholestatic hyperbilirubinemia is characterized by conjugated hyperbilirubinemia and hyperbilirubinuria (only the conjugated fraction appears in urine).

42. *** Increased jaundice is diagnosis by a. T. bilirubin b. AST c. ALT d. ALP

42. (a) Estimation of jaundice depends on serum bilirubin, other mentioned tests help to identify the cause of jaundice.


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CALCULATIONS, QC AND STATISTICS 43. **Most of the concentration are calculated using factor,

this factor is? a. Std absorbance / std value b. Std value / std absorbance c. Std value x std absorbance

43. (b) For methods obeying Beer's law, slope of the calibration curve (Cs/As) provides a constant to calculate the unknown concentration. Also depending on the formula: At x Cs = As x Ct, thus, Ct=(Cs/As)x As

44. **Ten microliters are? a. 0.01 L b., 0.001 L c. 0.0001 L d. 0.00001 L e. non of these.

44. (d) μL = 10-6L 10 μL = 10-5L = 0.00001L

45. **How much water should be added to 500ml of a solution of 10% NaOH to bring it to 75%?

a. 666ml b. 125ml c. 166ml d. 250ml e. 375ml

45. (c) Using the formula: C1 x V1 = C2 x V2 10 x 500 = 7.5 x V2 V2 = 666mL Thus, 166 mL of DW should be added.

46. When calculated osmolarity can not be accounted as a measurement for osmolarity?

a. per 100gm/l b. Urea 20 mm/l

46. Calculated osmolarity = 2 X Na + Glu + Urea (All in mmol/L) When calculated osmolarity is less than measurement for osmolarity, this denotes increased osmolar gap (OG). This occurs with:

- Factitious hyponatremia (due to decreased water)

- Unmeasured osmotically active compounds e.g. alcohols, sugars, and ketones.

47. **Calibrator sera are?

a. Primary std b. Secondary std c. Tertiary std d. Internal std.

47. (b) Secondary std? A primary Std is a reference standard. Secondary Std is standardized depending on the primary standard.

48. **External QC program means? a. An external person come & does the QC test b. A QC person goes to another lab & does the test..

48. (b) In EQC, participants receive QC material to be tested inside their labs. Results are sent to supplier to be compared to other labs' results. EQC will be most practically implemented during the regular visit of the lab coordinator. This will give opportunity for errors to be investigated on site and corrected rapidly (Monica)

49. **We select 2SD value to plot LJ curves because? a. They are easy to calculate, b. They cover 97.5% of normal population, c. Patient value rarely go beyond these limits.

49. (c) QC results follow a Gaussian distribution, thus 95% of these results normally fall within ±5% of the mean. Therefore, 2.5 out of 100 (1:40) are acceptable to be above +2s and 2.5 our of 100 are acceptable below -2s.


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50. Sensitivity and specificity are a. Directly related. b. Inversely related. c. They mean the same.

50. (b) Sensitivity & specificity can be adjusted according to cutoff level. Sensitivity can be increased by choosing a higher cutoff to include more TP, this meanwhile will include more FP thus specificity. However, this is not always the case as highly specific highly sensitive tests as well as poorly specific poorly sensitive exist.

51. A carryover in chemistry analyzer means a disturbance in readings because:

a. The analyzer was carried and placed at a different place. b. The previously measured solution was still in the cuvette c. The current solution is overflowing in the cuvette.

51. (b) Carryover is due to contamination by a previous sample. It is calculated by measuring a high standard and a low standard each 3 times then applying the following formula: Carry over = (contaminated low – actual low) / contaminated high – actual high)

52. STAT test means: a. Start at. b. Standardize and test. c. Short turn around time

52. (c) Stat refers to immediate or as initial dose.

CREATININE, UA, BUN AND AMMONIA 53. ***Which of the following result shows renal impairment?

a. urea 9 mmol b. creatinine 10 mmol/l c. urates d. cholesterol e. urine osmolarity less than 800 after 12 hrs of water deprivation.

53. (e) A urine osmolarity less than 800 after 12 hrs of water deprivation denotes renal impairment. Urea 9mmol is high normal (n: 2.9-8.2) and is not a very sensitive measure of GFR. Creatinine, although a sensitive measure of GF, 10umol is normal (n: 53-106) Cholesterol and urates are useless in this regard.

54. **Low GFR occurs in all except: a. Congestive heart failure. b. Urethral obstruction.

54. (b) low GFR occurs with: - Hemorrhage. - Dehydration. - Renal loss of fluids e.g. diuretics. - Ineffective blood volume, e.g. CO, systemic VD, renal vasoconstriction.

55. Diagnosis of RF

55. GFR is an index and a monitor of increased or decreased renal functions. It is practically estimated from serum creatinine and creatinine clearance.

56. ****Nephrotic syndrome is characterized by all except: a. Hypocholesterolemia. b. Hypoalbuminemia. c. Albuminuria. d. Hypertriglyceridemia. e. None of the above

56. (a) Nephrotic syndrome consists of: - Heavy proteinuria. - Hypoalbuminemia. - Oedema. - Hypercholesterolemia (Almost always present). Hypertriglyceridemia is present in 50% of cases.



57. ****Ureate excretion by the kidney is inhibited by: a. Probenecid. b. Thiazide diuretics.

57. (b) Thiazide diuretics cause relatively urate retention, glucose intolerance and hypokalemia and interfere with water excretion and may cause hyponatremia. Probenecid is a uricosuric agent like allopurinol.

58. Chronic glomerulonephritis is diagnosed by: a. Blood urea. b. Creatinine. c. Proteinuria d. All of the above

58. (d) In chronic glomerulonephritis, there is persistent deterioration of renal functions ending with renal failure.

PROTEINS, ELECTROPHORESIS AND LIPIDS 59. **The protein having molecular wt less then albumin is?

a. Beta protein b. B2-microglobulin. c. Lysozyme. d. Benze Jones protein.

59. (b) B2-microglobulin has a MW 11,800. Betalipoprotein is 380,000. BJ protein is the light chains of immunoglobulins. It's MW is variable from 11,000 for monomers, 22,0000 for dimmers or tetramers. Lysozyme is 14,000. It is used to differentiate AML M4 and M5 and appears as a far cathodal band on serum or urine EP.

60. ******In cystic fibrosis, which is deficient? a. Beta globulin b. Macroglobulin c. Albumin d. Alpha 1 antitrypsin e. Alpha 2 antitrypsin.

60. (d) Alpha 1 antitrypsin

61. ***Diet rich in phenylalanine should be restricted in? a. Phenyl ketonuria b. Tyrosinemia c. Maple syrup disease

61. (a) In phenylketonuria, there is phenylalanine hydroxylase leading to accumulation of phenylpuruvate and its derivatives and their excretion in urine. Diet rich in phenylalanine should be restricted to prevent brain damage.

62. ***In phenylketonuria, diet should be low in: a. Phenylalanine. b. Carbohydrate. c. Lipids.

62. (a) Phenylalanine (see 61)

62. Hypoalbuminemia is associated with all except? a. Tetanus b. hypocalcaemia c. oedema d. toxic effect of sulfonamide

62. (a) Tetanus is clostridial infection caused be C. tetani has nothing to do with albumin.

64. **Gluconic amino acids include: a. Alanine. b. Methionine. c. Valine. d. Glutamic acid. e. All of the above.

64. (a) Ketogenic amino acids are: Leucine and lysine, Mixed amino acids are: Isoleucine, phenylalanine, threonine, tryptophan and tyrosine. Gluconic amino acids are all the other amino acids.



65. **Lipoprotein related to hypertension?

65. . LDL

66. *****Which is important for atherosclerosis? a. HDL b. LDL c. Chylomicrons.

66. (b)

67. ***In plasma protein electrophoresis, the protein that will go first is (moves furthest from application)?

67. Albumin.

68. ***Based on behavior of lipoproteins in ultracentrifugation pre-B lipoprotein is?

a. HDL b. LDL. c. VLDL d. Chylomicron

68. On electrophoresis; Chylomicrons and its remnants stay at the origin. VLDL at preβ (=α2 globulin region) IDL at broad β LDL at β (= β globulin region) HDL at α (= α1 globulin region)/

69. **All of the following are lipoproteins except? a. Phospholipid b. VLDL d. Sphingomylin e. LDL f. HDL

69. (d) Although phospholipids are not lipoproteins, they are ingredients of lipoproteins, conferring the hydrophilic properties.

70. What is the proposition of pulmonary surfactant? a. Phospholipid acid b. Dipalmityl lecithin c. Phosphatidyl choline,

70. (b) Dipalmityl lecithin (a lecithin phospholipid with 2 palmetic acid residues) is the chemical composition of pulmonary surfactant.

71. **HDL is good cholesterol because? a. It has more protein & phospholipids in it b. It has no cholesterol in it,. c. It has less TG in it.

71. (a) HDL is composed of 20% cholesterol, 30% phospholipids and 50% proteins.

72. ***Which lipoprotein has highest concentration of cholesterol?

a. VLDL b. LDL c. IDL d. HDL

72. (b) VLDL are the TG rich lipoproteins HDL has 20% cholesterol. IDL has cholesterol and TG in equal amounts. LDL is the richest lipoprotein in cholesterol esters.

74. ****Which is not associated with abetalipoproteinemia: a. Acanthocytes in the peripheral blood. b. Hereditary spherocytosis. c. Malabsorption and fatty stools

74. (b) Hereditary spherocytosis is due to spectrin deficiency. Abetalipoproteinemia is a lipoprotein abnormality of absent LDL due to autosomal recessive abnormality in the synthesis of apoB + failure of chylomicron formation leading to malabsorption of fats + fat soluble vitamins + adrenal dysfunction. 50-70% of RBCs have spinal projections (acanthocytes)

75. Chylomicrons: a. Can cause thrombosis. b. Cannot cause thrombosis.

75. (a) Chylomicrons don't confer an excess cardiovascular risk, however, in LpL deficiency and apoC II deficiency, the patient presents with lipemia retinalis and retinal vein thrombosis.



76. Nature of apoproteins.

76. 5 major classes of proteins A to E

77. Saturated vs unsaturated fats (nutritional value)

77. Saturated Unsaturated e.g. Oleic a (50% of

body fat) Palmitic a (25% of body fat) Stearic a (5% of body fat) Acetic a. Butyric a.

Linoleic a Linolenic a (both are Essential) Arachidonic a.

Presence Adipose Vegitable oils. Suffix Anoic Enoic Significance Arachidonic

acid is precursor of Pgs. Although not essential, it depends on essential FA

Chemistry No double bonds

Double bonds

78. Which is best for parentral alimentation? a. FFA. b. AA c. lipoproteins

78. 79.

(b) Parentral nutrition is composed essentially of: a) Nitrogen source: synthetic valuable amino acids (9-17g/L N2) b) Energy source: Glucose (mainly) and fat emulsion (additional source to avoid EFA deficiency). c) Electrolytes and trace elements.

79. Protocol for IV nutrition?

80. **Regarding lipoprotein metabolism:

80. Although cholesterol can be synthesized by all nucleated cells, however, cholesterol in VLDL, IDL and LDL is of hepatic origin

82. Treatment of familial hypercholesterolemia.

82. These include general management of hypercholesterolemia + cholesterol lowering drugs + oestrogen replacement in postmenopausal women.

CLINICAL ENZYMOLOGY 83. ***The better for diagnosis of acute pancreatitis is?

a. Amylase b. Lipase c. ALP d. ACP

83. (b) Lipase elevation is of a greater magnitude (2-10 xN) and duration than amylase in acute pancreatitis. When lipase method is optimized, the test is more sensitive and specific than amylase for detection of acute pancreatitis.

84. **Activities of some enzyme increased in some disease conditions because they are?

a. Non functional enzymes b. Functional enzymes c. Neither

84. (b) That’s why enzymes are measured for the most part by their activity rather than concentration.



85. ***In MI, which is the last enzyme to be raised and lasts long?

a. CK b. CK-MB. c. AST. d. LDH

85. (d) Onset (h) Peak (h) Duration

(d) CK 6-12 20-30 2-6 CK-MB 3-10 12-24 1.5-3 AST 6-12 20-30 2-6 LDH 6-12 24-72 7-14

86. **Isoenzymes: a. Are physical types of one enzyme. b. Have different electrophoretic mobility. c. All of the above

86. © Isoenzymes have the same catalytic activities and differ in physicochemical properties.

87. **MI is diagnosed by: a. CKMB b. CKBB c. CKMM d. LDH

87. (a) CK-MB is specific for cardiac muscle, CK-BB for brain and CK-MM for skeletal muscle.

88. **Elevation of LDH is caused by: a. Myocardial disease b. Liver disease c. Prostatic disease d. many organ disease because it has many distribution

88. (d) LDH is present in the cells of the heart, liver, muscles, blood and malignancies.

89. ****Myoglobin in injury of: a. muscle. b. Liver

89. (a) muscle whether cardiac or skeletal is the source of myoglobin.

CLINICAL ENCOCRINOLOGY

90. *****ADH is? a. Produced by posterior pituitary b. Produced in the hypothalamus.

90. (b) ADH is produced by the hypothalamus and stored and secreted from the posterior pituitary.

91. **The method used to estimating insulin is? a. Electrophoresis b. Kinetic estimation. c. Spectrophotometer. d. Radioimmuno assay.

91. (d) Immunoassay (multiple labels) is used for the measurement of insulin.

92. *****After the insulin dose, the patient soon comatozed due to

a. Hyperglycemia b. Hypoglycemia (glucose <3mmol/l) c. ketonuria c. Ketoacidosis is the cause of coma d. Lactic acidosis,

92. (b) Hypoglycemia (glucose <3mmol/l)



93. **While using the pregnancy test we are measuring? a. B-HCG b. Total HCG c. B-HCG & LH d. B-HCG & FSH.

93. (b) α subunit of HCG is very similar to α subunit of TSH and FSH and identical to LH. Although β subunits of HCG and LH are very similar, antibodies can be made to the β subunit of HCG that do not cross react with LH or other pituitary hormones. Most EIA use 2 monoclonal antibodies against different sites of HCG molecule one for carboxyl terminal of β chain and the other to the α chain, i.e. react with intact HCG.

94. ****Water deprivation test is used in the diagnosis of: a. Anterior pituitary disease. b. Posterior pituitary disease. c. Hypothyroidism.

94. (b) Water intake is restricted the patient loses 3-5% of body weight or until 3 consecutive hourly determination of urine osmolarity are within 10% of each other. Measure urine osmolality, plasma vasopressin and increased urine osmolality with exogenous vasopressin.

Urine osmol

Pl. VP After VP

Normal >800 >2 DI <300 Undetectab

le

Nephrogenic DI

<300 >5 No change

95. ****24 hours urine for VMA is used for diagnosis of diseases of:

a. Adrenal cortex. b. Adrenal medulla

95. (b) Catecholamines are oxidized to VMA and metanephrins. 24hour urinary metanephrins is the best single test for pheochromocytoma. Specificity and sensitivity approach 100% when both VMA and metanephrines are measured.

96. ***Hypertension is found in all of the following endocrinal diseases except:

a. Cushing's syndrome. b. Pheochromocytoma. c. Adrenal medulla hyperplasia. d. Addisson's disease.

96. (d) Hypertension secondary to endocrinal causes occurs in:

- Pheochromocytoma. - Crohn's syndrome - Cushing's syndrome. Addison is associated with hypos (hypotension, hypokalemia, hyponatremia and hypocortisol)

97. Diabetic coma presents with:

a. Ketone bodies in urine b. Blood glucose may be 1000mg or more c. osmotic diuresis present

97. All. In diabetes, 2 types of coma may occur, DKA and nonDKA. Glucose levels in nonDKA are 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 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.

98. (a) different antibodies.



98. New

Carcinoid tumors secrete 98. New

5HIAA. Carcinoid tumors originate from the enterocromaffin cells (APUD cells) of the intestine and most commonly occurs in the appendix, terminal ilium and rectum. Presentation may be asymptomatic until metastasis (most cases), appendicitis (10%) or carcinoid syndrome (in5% when there is liver metastasis) as spontaneous flushing on the face and neck, abdominal pain and water diarrhea, cardiac abnormalities and hepatomegally. The tumor secretes a wide variety of amines an peptides including serotonin (5-hydroxytryptamine (5-HT) with its major metabolite 5-hydroxyindoleacetic acid (5-HIAA)), bradykinin, histamine and tachykinins and prostaglandins.

Neeman Peck disease is due to deficiency of sphengomylinase Cholesterol: In LDL, cell membrane, precursor of bile salts and steroid hormones.

CLINICAL & CHEMICAL PATHOLOGY MCQ General


GGeneral

1. ****The difference between plasma and serum is that plasma:

a. Contains fibrinogen. b. Doesn’t contain fibrinogen. c. Has more water. d. Has less water.

1. (a) Plasma contains fibrinogen which is consumed during the clot formation to separate serum.

2. ******Best way to separate the serum? a. leave the blood to clot at R.T for I hr, then centrifuge b. by adding citrate. c. by adding EDTA

2. (a) leave the blood to clot at R.T for I hr, then centrifuge

3. **Point of care testing means? a. Complete a test & make a point[interpret], b. Testing the patient at bed side c. Take care in testing

3. (c) Take care in testing

4. ****Error in the result is expected in which case? a. Glucose on fluoride. b. Glucose on EDTA c. Calcium on oxalate

4. (c) Oxalate is a divalent cation chelator.

5. **Cardiac anatomical anomalies associated with Fallot tetralogy include all of the following except:

a. VSD b. ASD

5. (b) Fallot's tetralogy is composed of PS+VSD + Rt aorta + RVH.

6. Hemolysed blood is unsuitable for performing which tests?

6. Hemolysis is visible at Hb> 3.1 μmol/L It increases LDH, K, ACP, cholesterol, ALT and AST. Hemolysis don’t increase serum albumin, bilirubin, ALP, amylase, lipase, Ca, Cl, P, Mg, Na, creatinine, glucose, UA or urea.

7. ****Hemolysis causes? a. Increased serum K b. Increased serum Na c. Increased HCO3- d. Decreased K

7. a.

8. After hemolysis: a. Sodium leaks out of RBCs. b. K leaks into cells. c. Bicarbonate gets into RBCs.

8.

9. Effects of fasting

9. Prolonged fasting increase TG, glycerol, FFA but not cholesterol.

10. ****Fluoride is used to get samples for? a. Blood sugar b. Coagulation c. Electrolyte d. CBC.

10. a. Blood sugar

CLINICAL & CHEMICAL PATHOLOGY MCQ General


11. ***Anticoagulant used for glucose is:

11. Fluoride

12. **Changes in blood stored more than 5 hrs at room temp. include? a. Decreased glucose & increased lactate. b. Increased glucose & decreased lactate c. Failure of Na & K pump,

13. (a) Storage of blood has the following effects: 1- CO2, ACP & Glucose 2- pH & ammonia 3- Changes in RBC permeability K,P &Mg 4- Na-K pump is inhibited at 4 °c but not at 25°c. leading to K in refrigerated samples. 5- Phosphorylation P released from organic P. 6- Loss of enzyme activity. 7- Light bilirubin, δALA and porphyrins.

14. Plasma or serum should be separated at the earliest for the estimation of glucose because: a. The glucose values decreases with time. b. Glucose value increases with time. c. Lysis of blood occurs.

14. a. Continued glycolysis cause glucose values to decreases with time unless cells are separated.

Best place to put a needle for blood collection is puncture proof container.

CLINICAL & CHEMICAL PATHOLOGY MCQ Hematology


HHematology

BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES 1 ** To stain the B/M other than Wright stain which stain

usually used? a. PAS stain b. Sudan black stain c. stain for iron.

1 (c) Bone marrow films should be stained with an iron stain e.g. Perl's, Prussian blue, as a routine to demonstrate iron (Dacie)

2 ***In addition to routine Romanowsky stain of bone marrow the following stain is also essential:

a. Chloroacetate estrase b. Prussian blue.

2 (b).Prussian blue: See 1

3 The needle used for bone marrow biopsy is? a. 18 gauge needle b. Jamshedi needle c. Menghini needle d. Westermani needle,

3 (b) Jamshedi trephine is used for biopsy.

4 **Hyperplastic B.M with M/E ratio 6:1 is seen in: a. Megaloblastic hyperplasia. b. Normoblastic hyperplasia c. Lymphoid hyperplasia

4 (c) Hyperplasia is diagnosed when fat>cells. In hyperplastic BM, an M/E ratio > 2:1 denotes myeloid hyperplasia and <2:1 denotes erythroid hyperplasia.

5 **Best method to assess BM cellularity is: a. Trephine biopsy b. M:E ratio is enough. c. By high power.

5 (a) Trephine biopsy is preferred over bone marrow aspiration in that it demonstrates the architecture of the bone marrow cellularity.

6 ***Which Hbs have the same electrophoretic mobility on alkaline cellulose acetate?

6 HbS, C, D and Hb Punjab (also Hb lepore) occur at the same position on cellulose acetate at pH8.6 . Also Hb C, E and C harlum occur at the position of Hb A2

7 Lymphokines & T-cell activation 7 Lymphocytosis promoting factor and histamine sensitizing factor.

8 ******When using and electronic cell coulter counter, which of the following results can occur in the presence of cold agglutinins:

a. MCV & MCHC b. MCV & MCHC c. MCV & MCHC d. MCV & MCHC e. MCV & decreased RBC f. MCV & normal RBC h. MCV and RBC

8 (d) A high titer of cold agglutinin cause falsely MCV, MCH and MCHC and falsely RBC

count. To correct, incubate at 37°c for 15-30 minutes and rerun the specimen.



9 ***Bone marrow aspiration needles: a. 18 gauge. b. Meninghi. c. Burtolin

9 a. 18 gauge.

10 **RDW is increased in

10 Iron deficiency anemia and megaloblastic anemia while normal in thalassemia.

11 **By coulter, TLC= 22.5x109/L If NRBC are 200 per 100 leucocytes, so corrected leucocytic count equals:

a. 11.5 x 109/L b. 22.3 x 109/L c. 22.7 x 109/L d. 7.5 x 109/L

11 (d) using the correction formula : Corrected WBC= WBC X 100 / (NRBC+100) Corrected WBC= 22.5 X 100 / (200 + 100 )

= 7.5 x 109/L

12 ****The main antioxidant in RBCs is: a. NADPH b. Reduced glutathione

12 b. Reduced glutathione acts as antioxidant through its SH group.

13 ***Newborn with MCV 100fl, is considered. a. Macrocytosis. b. Normal

13 b. MCV in the first week is normally 108fl. After 2 months, it is 96fl.

14 **Perl's stain

14 BM iron stores

14. New

Hemoglobin breakdown takes place in: a. RES b. Hepatocytes. c. Renal tubules.

14. New

a. Normally 6gm of Hb is broken down per day into; - Globin peptides: hydrolysed and the amino

acids enter into the body amino acid pool. - Iron: reutilized. - Porphyrin ring: broken down in the

reticuloendothelial cells of the liver, spleen and bone marrow to bile pigments.

NORMOCYTIC NORMOCHROMIC ANEMIAS 15 ***In Pyruvate Kinase deficiency all correct except?

a. Intermittent attach of anemia. b. Splenectomy is a choice of treatment. c. Autosomal recessive.

15 (a) PKA is an autosomal recessive enzymopathy. O2 dissociation curve is shifted to the right, so only mild symptoms occur. Splenectomy improves the condition.

16 **In A sickle cell disease patient under general anesthesia, all true except?

16 Tourniquet should not be avoided. A sickle cell patient needs transfusion to reduce HbS below 30% prior to general anesthesia. During anesthesia, the patient should be hyperoxygenated and rapidly induced. Limb tourniquet should be avoided.

17 **Organism causing osteomylitis in sickle cell patient is

17 Salmonella. In sickle syndrome, infarctions in the spleen leads to autosplenectomy causing more predisposition to pneumococcal infections. Infarctions in the intestine leads to passage of salmonella which infect the bones causing osteomyelitis.



18 **Skeletal abnormality present in?

18 Fanconi syndrome. Fanconi syndrome consists of:

- Congenital aplastic anemia. - Skeletal and urinary tract anomalies. - Microcephaly. - Altered skin pigmentation.

19 Fanconi's anemia

19

20 ***In G6PD decreased which is affected ?

20 NADP-H, reduced glutathione Being the first enzyme in HMP shunt which generates NADPH to maintain reduced glutathione, G6PD deficiency affects NADPH and reduced glutathione

21 **Sideroblastic.a seen in all except? a. Lead poisoning b. Alcohol c. Aspirin d. Chloramphenicol

21 (c) Sideroblastosis occurs due to; - Lead poisoning due to inhibition of enzyme of heme and globin synthesis. - Alcoholism, due to interference with heme and pyridoxal kinase. - Chloramphenicol; inhibits protoporphyrin. - Other causes: vit B6, thalassemia, excessive dietary Fe, anti-TB and cycloserine.

22 ****The least drug to cause acquired sideroblastic anemia is:

a. Aspirin. b. Lead.

22 a. Aspirin.

23 **In HUS, all are true except: a. occurs mainly in children. b. Is usually preceded by some sort of enteritis. c. Fragmented RBCs are seen. d. Uremia is usual. e. Anti IgG is positive in 10% of cases.

23 (e) HUS occurs in children following VTEC enteritis (also after salmonella, shigella, streptococcal infection, as an autoimmune disease and following drugs e.g. cycloserine. It is charectarized by:

- Thrombosis in small vessels. - Fragmentation of RBCs. - Reduced platelets (consumptive). - Uremia.

24 In HUS, all are present except:

a. ARF b. platelets. c. Microangiopathic HA d. Thrombocytosis

24 d. Thrombocytosis

25 HUS

25

26 **In intravascular hemolysis, all are present except:

26 Normal haptoglobin. In intravascular hemolysis serum haptoglobin is decreased or absent due to consumption.

27 ***Free plasma Hb is bound to:

27 Haptoglobin (also hemopexin)



28 **In favism, the defect is in

28 G6PD. In favism, hemolytic anemia develops whtn the RBCs are exposed to oxidant stress e.g. drugs, infection and favism.

29 **In hereditary spherocytosis all are true except: a. Autosomal dominant. b. Treated by splenectomy. c. Defect is in hemoglobinization of RBCs

29 c. Hereditary spherocytosis is an autosomal dominant membrane defect (anykrin) not due to a defect is in hemoglobinization of RBCs. Parts of the defective membrane is removed by the spleen leading to reduced cell surface and causing spherocytic cells. Splenectomy improves the condition.

30 ***Treatment of choice of spherocytosis is:

30 Splenectomy

31 **In sickle cell anemia patient with iron overload, this organism is isolated from blood:

a. Salmonella. b. Strept pneumoniae c. yersinia enterocolitica.

31 (c) Yersina enterocolitica occurs in iron overloaded patients treated with desferrioxamine (see p376 Kumar)

32 ***Thalassemia major with iron overload this organism can be isolated.

a. Streptococcus pneumoniae. b. Salmonella typhemureum c. Yersina enterocolitica.

32 (c).

33 *****Microangiopathic hemolytic anemia is present in all except:

a. TTP b. Meningococcal septicaemia. c. HUS

33 (b) In MAHA there is intravascular hemolysis and fragmentation of the RBCs due to abnormal microcirculation leading to fibrin deposition, platelet deposition and vasculitis e.g in; - HUS - TTP - Renal pathology - Preeclampsia - Autoimmune diseases e.g PAN, SLE. - Carcinomatosis. - Septicemia Meningococcal septicaemia.cause thrombosis of small blood vessels leading to petichiae and adrenal failure (Waterhouse-Fridrechson syndrome)

34 ****The following enzyme increases in hemolytic anemia: a. Total ACP b. LDH c. ALP

34 (b) LD1&2 are characteristically increased in HA. ACP although is present in high concentration inside RBCs (tartarate resistant) is not characteristically increased.



35 ****In G6PD deficiency avoid all the following drugs except:

a. Salicylic acid b. Primaquine. c. Dapsone. d. Trimethoprim. e. Folic acid

35 (e) Agents causing HA in G6PD deficiency include: - Antimalareals e.g. primaquine. - Sulphonamides and Sulphones (dapsone). - Analgesics e.g. salicylic acid - Antihelmenthics e.g. niridazol. - Miscellaneous e.g. vitamin K analogues, probanecid.

36 ***A patient with hemolytic anemia has all the following exept:

a. Bilirubinemia. b. Dark urine. c. Hypertension.

36 (c) In hemolytic anemia there is; - Hyperbilirubinemia and hemiglubinuria. - urobilinogen and stercobilinogen dark urine. - Haptoglin and hemopexin. - Hemosiderinemia and hemosiderinuria. - Methemoglobenemia.

37 ****Aplastic anemia cause

37 pancytopenia.

38 RAEB

38 Myelodysplastic syndromes (MDS) are classified into:

Peripheral blood BM Refractory anemia

<1%blasts <5%blasts

RA with sideroblasts

<1%blasts <5%blasts

RA with excess blasts (RAEB)

>5% 20-30%

CMML monocytes promonocytes

39 **Manifestations of HbSS a. Ischemia to femoral artery. b. Infarction of phalanges.

39 (b) Infarction of phalanges.

41 ****Major adult Hb is

41 HbA (97%) HbA2 (2.5%) and HbF (0.5%)

41. New

Which is true regarding DAT a. It is positive in all IHA. b. may detect complement attached to RBCs.

b. DAT involves testing patient's cells without prior exposure to antibody in vitro. For investigation of AIHA, antiglobulin reagents specific for IgG, IgM and IgA are available. Monoclonal antibodies specific for the complement C3d is also available. 2-6% of AIHA are DAT- negative. This may be due to nature of antibody or its presence in below detection levels. In such patients diagnosis depends on careful screening of a concentrated ether eluate made from the patient's RBCs or by manual polybrene test or by more complex techniques e.g. RIA, complement fixing antibody consumption (CFAC) test and ELISA and enzyme linked antiglobulin test (ELAT). A positive DAT does not necessarily mean that the patient has AIHA. Causes of positive DAT include; 1. An auto-antibody on the red cell surface with or without hemolytic anemia. 2. An allo-antibody on the red cell surface, e.g.



in HDN or after incompatible transfusion. 3. Antibodies against drugs or against normal globulins damaged by drugs adsorbed on RBCs e.g. cephalothin. 4. Interaction between the antiglobulin sera and anti-T, as with polyagglutinable RBCs. 6. Anti-albumin and anti-transferrin antibodies in antiglobulin sera giving rise to false-positive reaction. 7. adsorption of immune complexes to the cell surface in 8% of hospital patients in a wide variety of disorders. 8. Sensitization in vitro (due to incomplete cold antibodies and complement from normal serum obtained by clotting or defibrination (not EDTA or CDA).. 9. In apparently perfectly healthy individuals for unknown reason.

HYPOCHROMIC MICROCYTIC ANEMIAS 42 ***A case of iron deficiency under Microscope is

42 hypochromic, microcytic

43 **Iron deficiency anemia seen in all except? ***Iron stores are deficient in all except:

a. B-thalassemia major b. chronic disease,

43 d. B-thalassemia major

44 **Hb variant with fusion of delta and beta gene segments is:

44 Hb Lepore is the result of fusion of β & δ chains which combine with α chain (β δ2,α2) Other abnormal patterns include HbH (β4) and HbSS (Bs

, Bs)

45 **Normal Hb pattern?

45 HBA ( α2, β2) Other Hb patterns: HbA2 (α2, δ2), HbF (α2,γ2)

46 ****In iron deficiency anemia, all are present except: a. iron absorption. b. Microcytis hypochromic blood film,

46 None or choose something appropriate. Iron absorption is adjusted to body needs. It is increased in iron deficiency anemia and pregnancy.

47 ****Regarding iron

47 60-70 % of body iron is present in Hb. 15-30 % in bone marrow, 1% in transferring and 4% in myoglobulin.

48 Iron status in anemia of chronic disease.

48 In ACD there is: - serum iron and TIBC. - Normal ferritin and bone marrow iron.

49 **Iron deficiency anemia cause, except 49 Thrombocytopenia. Actually there is raised platelet count in IDA



50 **Anemia of chronic diseases includes: a. Vit B12.deficiency. b. Pernicious anemia c. Increased secretion of erythropoitic factors. d. All of the above. e. None of the above.

50 e. None of the above. Regarding erythropoietic factors, in ACD there is increased secretion of TNF and IL-1 reduce Epo production.

51 ***Hb H disease. 51 Choose Alpha thalassemia, or none HbH = β4 and occurs when 4α genes are deleted in α thalassemia.

51. New

In β-Thalassemia, which is true? a. It presents with severe anemia at the age of 6 months. b. Blood transfustion may be required as frequent as every 9-12 months.

a. In β thalassemia major, anemia presents at the age of 3-6 months when the switch from γ to β chain synthesis normally occurs. Milder cases present later (up to age of 4 years). The regularity of blood transfusiton depends on both the baby's general condition and pattern of development AND stability of hemoglobin level to avoid unnecessary overtransfusion of children who may be later categorized as having thalassemia intermedia OR undertransfusion in demanding cases with subsequent imparierd growth, failure to thrive, poor feeding and other symptoms of anemia (at hb <7g/dl) 1- If the hemoblibin remains at this level for several weeks, and there is clear evidence of disability, then a regular transfustion regime should be started.

2- Two four-weekly transfusions are given at a rate of 2-3h for each unit, to keep hemoglobin level > 9-10 g/dl but <14g/dl.

3- The mean yearly Hb should not be >12.5 g/dl. 4- Splenectomy should be considered if annual blood consumption > 200ml/kg (calculated by dividing total annual volume transfused by the wt in the mid of the year). In splenectomized patients, the rate of Hb fall is 1g/week, in non splenectomized patients it is 1.5g/week.

MACROCYTIC NORMOCHROMIC ANEMIA 52 **Folate store are enough for a period of

52 2-4 months.

Fr vitamin B12, stores are enough for 2-4 years.

53 **All are correct about magaloblastic anemia except

53 Defective Hb synthesis. Megaloblastic anemia is associated with delated nuclear development due to defective DNA synthesis not defective Hb synthesis.

54 **Folate is affected by

54 Cooking Steaming and frying causes loss of 90%, boiling for 8minutes causes loss of 80% of folate.



55 A patient after partial gastrectomy a. Has no nutritional deficiency. b. Has IF deficit.

55 IF deficiency. Total or partial gastrectomy causes vitamin B12 defeciency.

56 **Hypersegmented neutrophils present in?

56 Megaloblastic.a Hypersegmentation = shift to the right. Other causes include;

- liver disease. - Uremia. - Infection and toxemia.

Hyposegmentation = shift to the left occurs in; - Leucocytosis. - Thyroid disease. - Pelger Huet

57 ****Macrocytosis is present in: a. Alcoholism. b. Retics. c. All of the above.

57 c. All of the above. Macrocytosis occurs in; Alcoholism, aplastic anemia, liver disease, myxedema, MDS, retics, cytotoxic, MM and normally in neonates and pregnants.

58 Urinary excretion of radioactive Vit B12 after oral and parenteral administration

58 After a loading dose of IV B12, oral radioactive B12 is given and amount absorbed is measured by total body counting or 24h urine sample. Radioactive B12 may be given alone or + IF. Dicopac test uses 2 isotopic forms of B12, one bound to IF and one unbound. Interpretation: B12 aborbed is low and corrected by IF in PA. B12 abroption is low and not corrected by IF in intestinal causes.

59 Which drug causes megaloblastic anemia.

59 Vit B12 defeciency Folate deficiency - Cytotoxic. - Metformin. - Colchicin. - Anticonvulsants. - Paraaminosalicylic acid. - Neomycin.

Occurs with; - Salazopyrine. - Cholestyramine. - Triamterene. - Anticonvulsants. - Anti TB

QUALITATIVE / QUANTITATIVE WBC DISOREDERS 60 ***Regarding cold agglutinins:

a. it is IgM b. It has specific anti I ab. c. It works at 4 ْC d. None of the above e. a and c

60 e. a and c Cold agglutinins are IgM, work at 4°c. It is anti I in IMN and in idiopathic type, or both anti I and anti i in lymphocellular disorders.

61 ***T lymphocytes found in? a. Cortical area of L.N b. Germinal center c. spleen d. L.N sinusoid e. Paracortical area of LN

61 e. Paracortical area of LN Follicles and germinal center (B-cells)

Paracortex (T-cell)



62 ***Infectious mononucleosis al are ture except? a. Heterophil antibodies agglutinate Ox RBCs, b. Abnormal level of anti-1 specific IgG antibodies, c. Spontaneous rupture of spleen, d. Lymphadenopathy & atypical lymphocytes,

62 (c) or (b) In IMN the following occur; a. Heterophil antibodies agglutinate Ox RBCs, b. Abnormal level of anti-1 specific IgM (not IgG antibodies), c. Splenomegally: mild to moderate (spontaneous rupture unlikely). d. Lymphadenopathy & atypical lymphocytes,

63 Responsible for immunity for pneumocystis carinii

63 B cells (x) Impaired granulocytes staph. abscesses. Impaired antibody formation pneumonia by pyogenic organisms. Impaired cellular immunity mycobacteria, nocardia, fungi e.g. pneumocystis carinii & candida, viruses, parasites.

64 **Neutrophil inclusions of variable size + thrombocytopenia + neutropenia occur in a case of:

a. Chediak-Higashi syndrome b. Alder-Reilly syndrome. c. Pelger-Huet syndrome

64 a. Chediak-Higashi syndrome is an autosomal recessive diseases. WBCs show giant granules + neutropenia but normal neutrophil function. Also there is thrombocytopenia and albinism. Alder-Reilly syndrome is an autosomal recessive disease with prominent granules containing excessive polysaccharides. Pelger Hǔet is an autosomal dominant anomaly with hyposegmented neutrophils.

65 **In IMN, which is not present?

65 Neutrophilia. In IMN there is;

- TLC 12-18 - Atypical lymphocytes. - Neutrophilia (early) followed by

neuropenia). - ± Thromobytopenia.

66 **Activated T-cells secrete:

66 Lymphokines

67 Neutrophil deficiency =

67 Hereditary granulomatous disease of childhood.

68 ****Chronic granulomatous disease is due to immunodeficiency of which of the following?

a. T-cell member b. Defective neutrophil function. c. Hypocomplementemia. d. Defeceient immunoglobulins. e. neutrophils

68 b. Defective neutrophil function. Chronic granulomatous disease is an X-linked disease that manifests in the second year of life with susceptibility to organisms of low virulence e.g. staph. epidermidis, serratia, aspergillus, due to phagocytic disfunction. Complement may be elevated and neutrophils are usually elevated even without infection. There is hypergammaglobulinemia. T-cell function is normal

69 ****Regarding the function of T cells, which is correct?

69 regulates immunoglobulins production by B cells



70 Which is wrong : ***. Regarding the function of T-cell, which is correct?

a. IL-1 is produced early in the immune response. b. T cells donot respond to IL-2 early in the immune response.

70 b. T cells donot respond to IL-2 early in the immune response.

71 ***Large granulocytic lymphocytes act as:

71 NK cells These are not B nor T-cells, though are CD8+. They characteristically have prominent granules and are often large granular lymphocytes.

72 Where can you find hypogranular leucocytes?

72 In myeloid leukemia (M3 varient)

73 IL1 & 2.

73

74 Toxic granulation and Dohle bodies.

74 In toxic granulation, granules are heavy dark red. This occurs with infection, toxemia and irradiation. Dohle bodies are small round blue peripheral granules that occur with infection and May-Hegglin syndrome.

75 ***Pertussis infection, is associated with:

75 Marked leukocytosis with an absolute lymphocytosis. In pertussis, lymphocytosis is characteristic due to lymphocyte promoting factor produced by the organism.

76 **SAEP cause 76 Giant neutrophils

77 Granulocyte production is increased by:

77 GM-CFU Also G-CFU

78 Lymphocytes are derived from

78 Pleuripotent stem cells in thymus (x). T & B lymphocytes both arise from a subset of hemopoietic cells in the bone marrow. A committed marrow progenitor called lymphoid stem cell serves as a common precursor for T & B cells. B-cell development take place entirely in the bone marrow. T-cells develop from immature precursors that leave the marrow and mature in the thymus.



LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS 79 **Prognosis of M4 is

79 Poor (x)

Prognostic Factors in AML Favorable Unfavorable

young age

older age: Age >60 is usually considered a poor prognostic factor because older patients generally don't tolerate therapy & higher likelihood of having unfavorable prognostic factors e.g. special cytogenetic abnormalities.

FAB types M2, M3, M4 FAB type M7 t(8;21) and t(15;17) abnormality

bnormalities of chromosome 11 at band q23

inversion of chromosome 16: usually associated with type M4 and marrow eosinophilia. This syndrome has an excellent prognosis for remission induction and duration

deletion of all or part of chromosomes 5 and/or 7

trisomy 8

reactivity with CD2(T1): The presence of certain cell surface markers such as CD2 appears to be associated with a favorable prognosis.

Hyperleukocytosis prior treatment prior heamtologic disorder low labeling index/aneuoploidy

Infection Types M2, M3, and M4 have the best prognoses, types M5 and M6 have variable prognoses, and type M7 has the worst prognosis.

80 ****Chronic monocytic leukemia: a. better prognosis. b. bad prognosis

80 b. bad prognosis

81 *****Bone marrow transplant indicated in all except? a. ALL b. AML c. Acclertaed case of CML d. blast phase of CML e. Paget’s disease f. Osteogenesis imperfecta g. B thalassemia major

81 c. Paget’s disease Indications for BMT are:

- ALL. - AML - Chronic or accelerated phases of CML. - Severe aplastic anemia. - Selected cases of:

MDS, Lymphoma, MM, CLL Thalassemia major, sickle cell disease. Severe inherited metabolic disease e.g. adenosine deaminase deficiency and Hurler's syndrome.

82 **Bone marrow transplantation is not indicated in: a. CML phase. b. CML in chronic phase. c. B thalassemia major.

82



83 All are very bad prognostic factors in ALL except? a. Very high TLC count b. CNS involvement c. Children less than 1 year old

83 None Bad prognostic factors in ALL are;

a. TLC > 50x109/L b. CNS involvement c. Age <1 or >50 year old d. Boys. e. t(1;19) f. T immunophenotype in children and myeloid antigen in adults. g. Blasts in peripheral blood on day 7 h. >5% blasts in bone marrow on day 14 i. No complete response on day 28

84 **Acute monocytic leukemia is associated with?

a. Lymphadenopathy b. soft tissue involvement c. Good prognosis compared with other leukemias, d. More lysozyme level in urine & serum e. +ive for non specific estrase,

84 e. Monoblasts are +ve for NS & butyrate estrase. There is also tissue infiltration (gums with hypertrophy)

85 **All may cause leukemia except: a. Ionising radiation. b. Methotrexate. c. Down's syndrome. d. Benzene. e. Fungus.

85 (b) Alkylating agents (not methotrexate) are the chemotherapeutics known to predispose to leukemia. Ionising radiation predispose to AML. Down's syndrome is associated with increased incidence of ALL. Benzene & petroleum derivatives are associated with increased incidence e.g. showmakers. In 1999, three different children with leukemia suddenly go into remission upon receiving a triple antifungal drug cocktail for their secondary fungal infections. In 1997 a clue was found that leukemia, whether acute or chronic, is intimately associated with the yeast, Candida albicans. 50 years ago, it was stated that "it has been established that histoplasmosis and such reticuloendothelioses as leukemia, Hodgkin's disease, lymphosarcoma, and sarcoidosis are found to be coexistent much more frequently than is statistically justifiable on the basis of coincidence." It is believed by some that cancer is a "chronic, intracellular, infectious, biologically induced spore (fungus) transformation disease." Grains such as corn, wheat, barley, sorghum, and other foods such as peanuts, are commonly contaminated with cancer-causing fungal poisons, or "mycotoxins." One of them, called aflatoxin, just happens to be the most carcinogenic substance on earth. If this is indeed a problem, Kaufmann asserts, then cereal for breakfast and soda pop for dinner may not be conducive to a cancer-free lifestyle.



86 ****In FAB classification, M3 = 86 Promyelocytic leukemia FAB HISTOCHEMISTRY

M1 Occasional peroxidate+ granules, PAS- M2 Strongly peroxidase+, PAS- M3 Strongly peroxidase+, PAS-

M4 Strongly peroxidase+, some cells may be PAS+

M5 Many be peroxidase+ and PAS+, nonspecific esterase stains are strongly + and inhibited by NAF

M6 Red cell precursors are PAS+, ringed sideroblasts are seen with iron stains

M7 Variable, platelet peroxidase can be demonstrated by electron microscopy

87 ***In acute promyelocytic leukemia, which is wrong? a. In FAB classification it is M4 morphology. b. DIC. c. Multiple Auer rods.

87 b. In FAB classification promyelocytic leukemia is M3 not M4 morphology

M0 = Undifferentiated by morphology & cytochemistry, myeloid by immunophenotype. M1 = Little differentiation >90% blasts. M2 = Differentiated 30-90% blasts. M3 = Promyelocytic, hypergranular (M3) or hypogranular (M3variant). M4 = Myelomonocytic. M5 = Monocytic without differentiation (b) or with differentiation (a). M6 = Erythroid differentiation >50% are erythroid. M7 = Megakaryocytic.

88 ****Neutrophil ALP is increased in all except:

88 CML NAP occurs in mature neutrophils. High score (35-100) occurs in normal subjects and in liver diseases, Down's syndrome, PCV, aplastic anemia, HD, ALL) Intermediate score in M5, M4 and CLL. Low score occur in AML, lymphosarcoma and PNH

89 In acute promyelocytic leukemia: a. It belongs to M4 type. b. Abnormal coagulation. c. Leukocyte cell markers common.

89 b. Promyelocytic leukemia is M3, It is associated with DIC

90 Hairy cell leukemia.

90 HCL is a B lymphoid CLL characterized by; - Splenomegaly. - Lymphocytosis and hair cells with no

nucleoli. - Dry tap on aspiration. - Spaces around cells. - Immunologically mature (Normal Igs) - Strong SmIg - -ve mouse rousette. - CD25 +ve - Tartarate – ACP resistant (TRAP)



91 **Chromosomal abnormality of t(8:21) is associated with: a. CML, ALL. b. M1 c. M2 d. M4 with eosinophilia. e. M5b

91 c. M2 associates t(8:21), M3 associates t(15:17) and CML t(9:22) (9 becomes Philadelphia chromosome.

92 Chromosomal abnormality in M3 is:

92 t(15:17)

93 **Chromosomal translocation in case of CML is: a. t(8:21) b. t(9:22) c. t(11:14) d. t(8:22)

93 b. t(9:22)

94 **HTLV except

94 transmitted by blood transfusion (x). HTLV may be transmitted by blood transfusion. In UK, it is under consideration for serodetection in blood donors.

95 **Antigen used for the detection of leukemia:

95 CD antigen

96 **Blood malignancy least encountered in children: a. Wilm's b. Neuroblastoma

96 ALL constitutes 75% of childhood hematological malignancies followed by AML (20%) and CML (5%). Least common hematological malignancies in children are CLL followed by CML then AML. Wilm's is a renal tumor and neuroblastoma is a nervous tumor

97 ****Paraprotiens are? 97 A group of identical Ig moving as bumdle on electrophoresis.

98 **A 68 years old man with TLC of 23,000 has the following markers, CD1…%, CD2…% kappa chain +, what is the diagnosis?

a. Adult T cell leukemia b. CLL c. Lymphosarcoma cell leukemia

98 b. Adult T cell leukemia (CD25 and CD5)

99 ***In CLL: a. RAI classification III is either I or II with hemolytic anemia. b. 5% terminate by Richter's syndrome. c. 30% of lymphocytes agglutinate RBCs

99 ? According to RAI classification, III is 0 or I or II but Hb is < 11g/dl due to marrow failure not hemolysis.

100 ***TRAP stain is helpful in diagnosis of:

100 Hairy cell leukemia Tartarate resistant alkaline phosphatase (TRAP) is used for diagnosis of HCL

101 *****Bone marrow necrosis occurs with: a. Metastatic carcinoma. b. Chrome lymphoproliferative disorder. c. Hodgkin

101 c. Hodgkin or a. Metastatic carcinoma***?



102 *****In MM, extramedullary plasmacytoma is likely to be present in:

a. Lungs. b. CNS

102 b. Extramedullary plasmacytoma occurs most commonly in nasopharyngeal sinuses. Heart, lung and kidney (nodular glomerulosclerosis) originate from tissues underlying mm of GIT and URT.

103 *****In lymphocyte predominant CLL:

a. Reed Sternberg cells are abundant. b. Bad in prognosis. c. Lymph node effacement may be nodular or diffuse.

103 c. Lymph node effacement may be nodular or diffuse. In lymphocyte predominant HL according to Rye classification;

- Nodal architecture is lost - Small homogenous lymphocytes. - RS cells are little with no nucleoli.

***In CML *(AML)treatment, which is true: a. Folinic acid protects against the megaloblastic effects of methotrexate . b. Citrovorum and folinic acid are synonymous. c. Trimethoprim if used frequently causes folic acid deficiency or megaloblastic anemia. d. There is methyl THF in B12 deficiency.

a. Folinic acid protects against the megaloblastic effects of methotrexate .

105 ***According to international working formulation, poorly differentiated lymphoma is:

a. small cleaved cell lymphoma. b. small non-cleaved lymphoma. c. diffuse mixed cell diffuse lymphoma. d. Large cell follicular lymphoma.

b. b. small non-cleaved lymphoma. Working Formulation for Non-Hodgkin's Lymphomas (NHL) Classifiable non-Hodgkin's

lymphomas Unaccounted-for non-Hodgkin's

lymphomas Low-grade Small lymphocytic (CLL) Mucosa-associated lymphomas,

CD5–, CD10– Follicular, predemoninantly small-cleaved cell

Follicular mixed, small-cleaved and large-cell

Intermediate-grade Follicular, predominantly large-cell

Diffuse small-cleaved cell Mantle-cell lymphoma CD5+, CD23–, t11;14 PRAD1

Diffuse mixed small- and large-cell epithelioid component

Lennert's lymphoma T-cell+

Diffuse large-cell cleaved, T-cell variants, non-cleaved

Transformed from low grade NHL, t14;18+

High-grade Large-cell, immunoblastic plasmacytoid, clear-cell, polymorphous, epithelioid

Anaplastic large-cell lymphoma,T-cell (rare B), Ki-1(CD30)+, t2;5

Small non-cleaved cell, Burkitt's Follicular areas

Miscellaneous Composite Other T-cell NHL Mycosis fungoides/Sézary syndrome

HTLV-1 lymphoma T-cell CLL

Histiocytic Angioimmunoblastic lymphadenopathy with dysproteinemia

Unclassifiable Angiocentric-type

Polymorphic reticulosis Lymphomatoid granulamatosis



106 **BM transplantation and graft vs host disease

106 All (skin, liver, GIT damage) In GVHD, lymphocytes (allogenic) cause skin rash, liver damage, and diarrhea. Acute if occurs <100days chronic if after 100 days (scleroderma like syndrome).

107 Haploid transplantation.

107 Haploid identical match is when the donor is a parent and genetic match is at least 1/2 identical Synergic transplantation is an all allogenic transplant from identical twin. UBMT or MUD = unrelated BM transplant = matched unrelated donor.

108 Use of P32 for PRV.

108 P32 is a β emitter which is taken up by bone and may be used to give prolonged myelo-suppression (2yrs) in old patients. Effect may take 2-3 months and lasts 6-36 months. But due to side effects, it shouldn’t be used below 70 years. Single dose is sufficient to reduce spleen size. Little risk of neutropenia and thrombocytopenia.

109 Serum erythropoietin antibodies in PRV.

109

110 **Which kind of lymphoma occurs in children?

110 Burkitt's lymphoma. NHL is more common in children than HL. Burkitt's is a NHL.

111 Bone marrow transplantation

111

112 **Waldenstrom's macroglobulinemia: a. Proliferation of cells that resemble lymphocytes rather than plasma cells. b. They produce IgM molecules and often excess of light chains. c. All of the above

112 c. All of the above

113 In myelosclerosis all are ritght except: a. Hepatomegaly. b. Pancytopenia c. Hypocellular BM

113 c. Myelosclerosis is characterized by splenomegally, extramedullary hemopoiesis, leucoerythrocytic blood picture + replacement of BM by collagen fibrosis. Hepatomegally is requent. BM shows cellularity (not hypocellularity).

114 Myelofibrosis and myelosclerosis. 114 Same

115 CLL when reach LN resemble which type of LN?

115 Low grade small cell Hodgkin lymphoma. CLL are small mature uniform. Well differentiated lymphoma has small mature lymphocytes.

116 Mycosis fungoides:

116 seen in epidermis , dermis



117 **Sizary cell leukemia a. T-cell leukemia lymphoma b. Cutaneous T cell lymphoma

117 Both Sezary syndrome is a T-lymphoid leukemia, a skin lymphoma with leukemic phase. Seizary cells are small with highly convoluted nucleus. Epidermis is involved.

118 Binet clinical staging of lymphoma stage IIB

118 Lymphocytosis and Involvement of 2 or more chains. Lymphocytosis is not included.

118 New1

In Hodgkin disease all are true except 118 New1

Chest X ray is rarely helpful Staging in HL influences both treatment and prognosis. Clinical staging is followed by cervical, thoracic, abdominal and pelvic XR, CT or MRI scanning. BM aspirate and trephine are performed to detect marrow involvement.

118 New2

In Non Hodgkin disease, which is true? a. Most are T cells. b. Good risk patients are sensitive to chemotherapy. c. BM is uncommonly involved. d. Histological classification is not as important as in HD. e. None of the above.

118 New2

e. Most NHL are B cell in origin. Paradoxically, aggressive tumors respond more dramatically to treatmet and are more likely to be cured than indolent tumors. Bone marrow is commonly involved leading to BM failure. Treatment of NHL depends principally on the histological classification (more than six histological classifications for NHL).

118 New3

In CML, which is not present? a. NAP is highly positive. b. Splenometally is present in 80% of cases. c. WBC is commonly 500x109 at presentation. d. BCR +ve but Philadelphia negativecases may occur.

118 New3

a. In CML NAP score is low (<20, whereas an elevated or normal score (20-130) occurs in a leukemoid reaction), splenomegally (often massive) occurs in over 90% of cases, WBC are often greater than 100x109 or more at presentation. 5% of CML are Ph-negative and about half of these patients have a BCR-ABL gene that is molecularly identical to the BCR-ABL gene of Ph-positive CML.

COAGULATION AND PLATELETS 119 ******In Acute DIC there is?

119 Hypofibrinogenemia.

In DIC there is the triad of hypofibrinogenemia, thrombocytopenia and FDPs.



120 **The following inhibits thrombus formation except

120 thromboxan. Thromboxane is a platelet aggregator. Inhibitors of coagulation include;

Serpentines: ATIII Heparin co factor II α1 antitrypsin C1 estrase inhibitor α2 antiplasmin α2 macroblobulin

Protein C system Protein C Protein S Thrombomodulin C4b binding protein.

121 ***Thrombocytosis seen in all except? a. Hemolysis b. Hemorrage c. spleenectomy d. fanconi’s syndrome.

121 d. Fanconi’s syndrome. Fanconi syndrome is congenital aplastic anemia with pancytopenia and absent megakaryocytes.

122 **ITP affects

122 Females> males

123 ****In TTP all are present except

123 Leucopenia In TTP, there is absence of platelet protease that cleaves vW macro vW thrombosis in microcirculation + cell fragmentation (HA) + fever + liver dysfunction. It occurs in adults + AI or pregnancy. May be fatal.

124 ITP in child 124 Sudden remission. ITP follow infection. It is characterized by immune complexes absorbed on platelets aggregations which are removed by spleen. There is defective megakaryocytic budding. It is self limited.

125 ***Antiplatelet antibodies are present in a. SLE. b. scleroderma. c. Carcinomatosis d. CLL e. All of the above

125 e. All of the above 2ry auto immune thrombocytopenia occurs secondary to:

- Blood disease (evan's syndrome) - General AI disease (SLE, RA) - Lymphoprolyferative (CLL and

lymphoma) - Solid tumors. - HIV, chemoradiotherapy and BMT - Post viral infection.

126 Thrombocytopenia is immune mediated in: 126 SLE.



127 ****Qualitative disorder of platelets may be caused by:

127 Aspirin Platelet dysfunction are; adhesion:

- vW - Pseudo vW - Bernard Soulier syndrome.

release: - SPD:

SPD Wiscott Aldrich syndrome Hermanskey syndrome Chediak Hegashi syndrome TAR syndrome

- granules: Grey platelet syndrome. - TXA2

aggregation: - Glanzmans syndrome - Afibrinogenemia.

Aquired: - myeloproliferative - renal - FDPs - Drugs: Aspirin - Chronic hypoglycemia.

128 Effect of splenectomy on platelet count.

128 Increased

129 ***ITP occurs in all except: a. hypersplenism, b. Sarcoidosis. c. SLE. d. Quinidine. e. All of the above.

129 ??e. All of the above. ITP has no identifiable antecedent. The question may be about autoimmune thrombocytopenia not ITP See 124.

**In purpura: a. Hemorrhage in deep muscles. b. Hemorrhage in mucus membrane. c. Hemarthrosis.

b. Hemorrhage in mucus membrane.

131 In Bernar Soulier syndrome, all are right except: a. Normal aggregation with ristocetin b. Giant platelets c. glycoprotein

131 a. Normal aggregation with ristocetin In Bernard Soulier syndrome there is adhesion (due to GPIb receptor that binds FVIII ristocetin adhesion. On blood film there is large megathrombocytes. Swiss cheese platelets are seen on EM

132 **In vW disease, all are true except: a. BT is prolonged. b. PT is normal. c. PTT is normal d. Platelet aggregation is normal

132 c. In vW disease there is: PTT BT (variable) platelet aggregation with ristocetin



133 *****In Hemophilia A which is correct? a. APTT is prolonged. b. PT is prolonged. c. BT is prolonged. d. CT is prolonged.

133 a. APTT is prolonged.

134 *****Treatment of vW disease: a. Factor VIII b. Cryoprecipitate. c. FFP

134 b. Cryoprecipitate contains FVIII, vWF and FVIIIc stimulating factor. vW disease is also treated with DDAVP.

135 **Which test is used to diagnose factor XIII deficiency? a. PTT. b. PT c. Thrombin time d. Clot stability with urea

135 d. In FXIII deficiency there is normal clotting by extrinsic and intrinsic tests and TCT. However clots are friable and dissolve in 5M urea within few houls.

136 To differentiate between hemophilia A and B? a. Individual factor assay. b. PT c. PTT

136 a. Individual factor assay. Also, thromboplastin generation test (TGT) and plasma correction tests can be used.

137 ****Which is wrong regarding heparin? a. Acts on thrombin. b. its action can be reversed by vit K

137 b. its action can be reversed by vit K . Heparin acts on ATIII (potentiates its action and directly binds thrombin).

138 ****Regarding protein C. which is wrong? a. Acts on thrombomodulin. b. acts independent on protein S.

138 b. protein C inactivates FV and VIII and activates thrombolysis. Protein S is a cofactor of activated protein C.

139 Cumarin (Oral anticoagulant) acts by 139 factors II, VII, IX Vitamin K antagonism leads to synthesis of immunologically detectable but biologically inactive factors +50% the level of vitK dependent factors.

140 Regarding protein C all wrong except:

140 Its main function is inactivation of F Va and VIIIa

NB: Questions from 85 to 104 were found in papers named Anne/Hematology Quiz and may not be encountered in previous exams unless labeled by star (*)

A blood smear shows 80 nucleated red cells per 100 leukocytes. The total leukocytic count is 18 x 109 /μl. The true WBC expressed in SI units is:

a. 17.2 x 109 /L b. 9.0 x 109 /L c. 10.0 x 109 /L d. 13.4 x 109 /L

c. 10.0 x 109 /L

Which of the following tests is used to monitor red cell production?

a. PCV b. TIBC c. Schilling test. d. Reticulocytic count.

d. Reticulocytic count.



Which of the following conditions will increase ESR? a. Erythrocytosis. b. Increased fibrinogen level. c. Decreased IgG level. d. Reticulocytosis.

b. Increased fibrinogen level.

The formula for cell count using hemocytometer is?

When making a blood film by Wdge technique, increasing the angle of the spreader slide results in the film being:

a. Longer and thicker. b. Longer and thinner. c. Shorter and thicker. d. Shorter and thinner.

What information is required in order to calculate the MCHC? a. Hemoglobin and erythrocytic count. b. Hemoglobin, MCV and RBC c. Hematocrit and erythrocyte. d. Hemoglobin and MCV e. None of the above.

e. None of the above.

If a case of mismatched indices occurs on the electronic blood analyzer, which is the most sensitive parameter to be affected and why?

If your hematology electronic cell counter requires bleaching, which CBC parameters would be affected and why?

List the most common causes of an inaccurate automated platelet count.

Describe the principle of the latest hematology analyzer you have used.

If you suspect a cold agglutination is present in the specimen you are processing, which 2 parameters would be affected and what course of action could be taken to resolve the problem?

What are the major morphological features that distinquish P. falciparum from P. vivax?

.

What is your interpretation of mixing studies in coagulation testing?

Summarize the steps you would take before reporting patient results if your control was outside acceptable limits?

Explain the difference between suspect flags and definitive flags on your last hematology analyzer.

Briefly describe how to perform a WBC and platelet smear estimate.

How does RDW relate to RBC morphology? What are Auer rods? Define The following terms as it pertains to the hematology analyzers:

a. Histogram / Threshold.

What do we mean by hydrodynamic focusing and what is the advantage it gives in automated cell counting?

Hemophilia A male married normal female, incidence in offspring: females are carriers, normal males

CD antigens

CLINICAL & CHEMICAL PATHOLOGY MCQ Immunohematology


IImmunohematology

1. Serum of donner + RBC of patient is called: a. minor cross matching b. major cross matching

1. a. minor cross matching = donor serum + recipient cells. Major cross matching = donor cells + recipient serum.

2. **Acute intravascular hemolysis occur in blood in

2. ABO incompatibility.

3. ****A patient received 2 bags of blood intraoperatively, after 5 hours he developed fever and rigors. This is likely due to:

a. Platelet antibodies. b. Leucocyte antibodies c. Bacterial infection.

3. b. Febrile reactions due most frequently to WBC reactive antigens and rarely to platelet antiesn occur after 30min to 90 minutes after starting transfusion.

4. Unsuitable donor.

4.

5 ****All diagnose hemolytic disease of new born except:

a. Retics count. b. bilirubin c. DAT d. Porphyrins.

5 d. In HDN there is polychromasia and NRBCs in peripheral blood of the baby.

Tests done on cord blood Tests done on maternal blood - ABO & D group - DAT -Hb - Bilirubin

- ABO & D group - Ab screen - Kleinhauer test.

6 **For hemolytic disease all are true except? a. It is autoimmune disease, b. Child RBC have to cross the placenta to produce the antibody response, c. First born child unaffected. d. Can be diagnosed even in utero, d. Severity is proportional to antibody titer

6 a. HDN is an alloimmune (not autoimmune) disease.

7 ****Investigations useful in HDN: a. Retics count. b. Bilirubin. c. DAT (+ve in alloimmune antibodies)

7 All (see no 5)

8 HDN which is not of value?

8 Cord Hb (x see 5)

9 ****Blood transfusion can transmit: a. HIV b. HBV c. CMV d. All of the above

9 d. All of the above

10 The blood donor in KSA can not be with all of the following except:

a. donor infected with HIV b. donor infected with hepatitis c. donor infected with syphilis d. donor infected with malaria e. previous pregnancies

10 e. previous pregnancies Possibly transmissible infections not routinely tested are:

- B. burgdorferi. - Y. enterocolitica - P. falciparum.

CLINICAL & CHEMICAL PATHOLOGY MCQ Immunology


IImmunology

1. **Antigen & antibody reaction is? a. Agglutination b. precipitation c. immunodiffusion,

1. b. Immunodiffusion is the process of diffusion in semisolid media to detect amount of antibody to neutralize antigen. Agglutination necessitates an indicator system e.g. RBCs or latex particles.

2. **Hook effect in immune assay occurs because the concentration of antibodies in the well is?

a. Too low b. Too high c. Optimum

2. b. The hook effect is the result of very high antigen levels giving lower than expected result in a double antibody sandwich assay.

3. **Antigen & antibody complex are? a. Weakly bound b. strongly bound c. no bound at all.

3.

4. ***Reaginic antibody is: a. IgG b. IgM c. IgD d. IgE

4. d. Reagenic or anaphylactic mechanism refers to events following combination of antigen with IgE molecule specific for it upon the surface of mast cells.

5. Arthus phenomenon results from: a. Antigen excess. b. Antibody excess. c. Antigen and antibody in equal proportions.

5. ??b. Antibody excess. In arthus phenomenon, a high antigen concentration is attacked by a high antibody concentration excess antigen antibody complexes followed by local tissue damage.

6. **Lysis in complement fixation test means the test is? a. Positive b. negative c. invalid.

6. b. In CFT, absence of hemolysis indicates that complement was fixed in antigen antibody reaction so specific antibody was present.

7. **All tube for serial dilution for CRP test contain 0.5ml of saline & 0.5ml of serum is added to Tube 1 & 0.5ml is transferred through the row of tubes & agglutination is demonstrate in tube 7, If sensitivity of the test is 6mg/l the concentration of CRP in serum is?

a. 36mg b. 42mg c. 6mg d. 48mg e. 384mg..

7. None (something missed in the question). The titer in the 7th tube = 27 = 128 So, the concentration of CRP= 128x6= 768mg.

8. **CRP is tested because it is increased in? a. Bacterial infection b. viral infection c. other infection.

8. b. CRP is a sensitive non specific indicator of acute injury, bacterial infection or inflammation.

9. In infectious monopnucleosis antibodiesare? .________

9. Anti (I)

CLINICAL & CHEMICAL PATHOLOGY MCQ Immunology


10. ******Which of the following reagin test for syphilis? a. VDRL b. TPHA c. TPT

10. a. Reagin = Antibody against cardiolipin. Reagenic tests are VDRL, RPR and Wassermann (CFT).

11. **Antigenic detection is useful in diagnosis of all of the following escept:

a. B hemolytic Streptococci. b. H. influenza. c. Listeria monocytogenes.

11. c. Because L. monocytogens is an intracellular organism.

31. ****Antigenic methods are useful in diagnosis of all of the following cuases of meningitis except:

a. Strept B hemolyticus. b. H. influenza c. E. coli e. listeria

31.

12. **Autoimmune disease contain all except? a. Lesion in B/M b. low complement level in serum c. immune complex in serum d. low Ig in serum.

12. d. In AI diseases there is autoantibodies immune complex formation complement fixation complement. Also there is cell death or altered function.

13. ***Tuberculine test is type.

13. IV hypersensitivity

14. Cell mediated immunity = 14. Candida Defective CMI candidiasis.

15. ****Which of the following detects type IV cell mediated immunity?

15. Tuberculin

16. ***Mantox test is a method for

16. Tuberculin

17. Immune complex deposits.

17.

CLINICAL & CHEMICAL PATHOLOGY MCQ Microbiology


MMicrobiology

ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION 1. **Antibiotic used for each organism are

a. Pneumonia b. Legionella c. S. pyogens d. H.infuenza. e. P. enterocolitis

1. . a.-penicillin b-erythrocin c. penicillin d-ceftriaxone e- vancomycin

2. **Tetracycline is identical in action with –

2. Aminoglycoside Aminoglycosides act on 30s ribosomal subunit.as tetracyclines.

3. **Which is effective against penicillinase producing organism.

3. Nfcillin or dicloxacillin.

4. The best chemical disinfectant in a TB lab? a. Gluteraldehyde b. ethanol c. phenol d. hypochlorate,

4. a. Phenol, although effective against TB, is rarely used being too caustic. Ethanol is not effective (TB are alcohol resistant). Glutaraldehyde is used to sterilize respiratory equips and is effective against TB.

5. ***What is lab safety level you will employ for the culture of brucella?

a. Routine precaution b. bio safety level 1, c. bio safety level 2 d. bio safety level 3 e. no specific measure

5. d. Biosafety levels are designed according to risk group of the lab;

Risk group

Description Biosafety level

1 Organisms are low risk to lab workers and community (common organisms)

1

2 Moderate risk to lab workers limited risk to community e.g. staph, strept., vibrio

2

3 High risk to labo workers, low risk to community (don’t spread rapidly) e.g. brucella, TB, Salmonella

3

4 Viruses, high risk to lab and community

4

6. β-lactamase resistant penicillin for staph 6. Cloxacillin.

7. *****Sterility is achieved by: a. Pasteurization. b. Disinfection. c. asepsis. d. All of the above. e. None of the above

7. c. Sterilization means killing or removal of all microorganisms including spores e.g. autoclaving, ethylene oxide, filtration. Disinfection means killing of many (not all) microorganisms e.g. phenol, ethanol, iodine (antiseptics).

8. ***Intrinsic resistance for vancomycin is present in: a. Penicillin-resistant bacteria b. C. deficile. c. Staph sensitive to cloxacin.

8. a. Penicillin-resistant bacteria (both act on cell wall) Most important use of vancomycinis against staph aureus that are resistant to penicillinase resistant penicillin e.g. nafcillin.



9. ***Which of the following is not an aminoglycoside? a. amykacin. b. Erythromycin. c. Neomycin. d. Sissomycin

9. b. Erythromycin.

10 **Pasteurization gives guarantee of: a. Kills spores sterilization. b. Disinfection. c. Saponification. d. None of the above

10 a. Kills spores sterilization.

11. For penicillin resistant pneumococci, which is used? a. Ampicillin. b. Ceftriaxone. c. Cefuroxime + Rifampicin. d. Ampicillin + Rifampicin

11. b. Ceftriaxone.

12. Cephalosporin resistant bacteria producing beta lactamase is:

a. E.coli. b. Y. Enterocolitica

12. a. β lactamases are produced by; B. fragilis. N. gonorrhoea. H. influenza. Legionella Enterobactereceae

13. Which of the following denote sterilization?

13.

14. TB contamination can be disinfected by 14. Glutaraldehyde. Or phenolic

15. **A pre-operative medication of antibiotics is indicated in:

a. Acute appendicitis. b. Gangerous obstructed loop. c. Abdominal hernia.

15. b. Gangerous obstructed loop.

16. Bronchoscope

16. Glutaraldehyde

17. ***- Which is the best way to sterilize a bronchoscompe? a. Autoclave. b. Ethylene-oxide. c. Gamma rays. d. None

17. a. Autoclave.is used for heat resistant parts but ethylene-oxide may be used for heat labile parts.

BASIC TECHNIQUES 18. **Castanida medium for blood culture contain?

18. Both liquid & solid media in same bottle.

19. **Medium for each:

a. TB ***b. Gonoccoci c. C. Diphtheria d. Staph. Aureus

19. a. L.J medium b. Chocolate agar or Thayer martin media c. Löefflers media d. Blood agar



20. **If you forget iodine step in gram stain staph aureus will be seen?

20. Red

21. **Significant bacterial count is

21. 100,000. (105) 104-105 = Equivocal <104 and mixed = probable contamination

22. ***Anti-coagulant for blood culture ?

22. Na-phosphonaphthol sulpfonate Also known by abbreviation SPS

23. ***In CLED all bacteria grow except? a. Enterobacter, b. salmonella c. klebsiella d. enterococci.

23. None On CLED; Salmonella gives flat blue colonies. Klebsiella gives mucoid yellow colonies. Enterococci give yellow translucent colonies.

24. ***Gram stain best done in? a. Lag phase b. log phase c. static phase d. death phase.

24. b. Growth of bacteria on media follows the following phases; - Lag phase; phase of accommodation to medium. No net growth - Log phase; phase of maximum growth. - Stationary phase; growth equilibrates death - Decline phase; phase of exhaustion of medium components. Growth declines.

25. ***Microaerophilic atmosphere means? a. 10% CO2 b. anaerobic c. trace of free O2

25. c. trace of free O2

26. **Which agar concentration is the best to detect bacterial mobility?

a. 0.01% b. 0.5% c. 1.5% d. 2% e. 4%

26. b. 0.5% For solid medium 1.5-2% concentration is used.

27. ***Best time to read oxidase test is within: a. 5 seconds. b. 10 seconds. c. 1 minute. d. 2 minutes. e. 5 minutes.

27. b. 10 seconds

28. ***In ZN staining used for M. leprae, the decolorizing agent used is:

a. 5% acetone. b. 5% acid alcohol. c. 5% hydrochloric a. d. None of the above

28. d. None of the above. 5% H2SO4 or 3% acid alcohol.

29. ***Which of the following is a chemical fixative? a. Formalin. b. Mercuric chloride c. Methyl alcohol d. All of the above

29. c. Methyl alcohol



30. ****When urine is preserved for culture it should be: a. preserved at room temperature. b. Preserved in refrigerator. c. preserved with nitric acid. d. Preserved with sulfuric acid. e. Preserved with boric acid.

30. e. (check also for b.) If a delay > 1-2 hours is unavoidable multiplication of bacteria can be prevented by; - Storage in refrigerator at 4°c - Collected and transported in a container of boric acid at a concentration of 1.8%

31. Suitable medium for many pathogenic bacteria

31. Brain heart infusion.

32. Blood culture is indicated in the following: a. Mycobacterium b. Diphtheria c. Staph. Aureus d. None of the above

32. ??d. None of the above ?? c. Staph. aureus may cause septicemia.

33. Solid media include: a. Slant. b. Streak plates. c. Pour plates. d. All of the above

33. d. All of the above

BASIC BACTERIOLOGY 34. **Cell wall is absent in?

a. mycoplasma b. bacteria c. fungi c. viruses

34. a. Mycoplasma is the smallest organism capable of self replication. It possesses cell constituents of bacteria except cell wall. Instead, there is a triple layer cytoplasmic membrane.

35. **Sterol is the main constituent of cell wall of: a. Mycoplasma. b. Rickettsia. c. Chlamydia. d. Leptospira. e. Staph.

35. a. Unlike the cell wall of bacteria, mycoplasma cell membrane contains cholesterol or carotenol in addition to the usual mural and phospholipids.

36. ***Which of the following contains more peptidoglycan? a. G+ve bacilli. b. G-ve bacilli. c. Chlamydia. d. Richetsiae.

36. a. The peptidoglycan layer is much thicker in Gram positive than in Gram negative bacteria. Richetsia cell wall similar to that of Gram negative bacteria. Chalmydia cell wall is similar to that of Gram negative bacteria but no muramic acid.

37. ***Sedimentation constant of bacterial ribosomes is: a. 40s b. 60s c. 70s d. 80s

37. c. 70s Bacteria has 70s ribosomes with 30s &50s subunits. Mammalian ribosome has sedimentation coefficient of 80s with 60&40s subunits.

38. ***Endotoxins are chemically: a. Mucopeptides. b. Proteins. c. Lipopolysaccharides. d. Polysaccharides.

38. c. Endotoxins are integral part of G-ve bacteria. They are LPS whereas exotoxins are polypeptides.



39. ***L forms differ from parent cells in all of the following except:

a. Lack rigid cell wall. b. Lack regular shape. c. Cannot grow and multiply on nutrient medium. d. Lack regular size.

39. c.

40 ***Bacterial genes are transferred by all of the following means except:

a. Transformation. b. Transduction. c. Mutation. d. Conjugation.

40 c. The transfere of genetic information between bacterial cells can occur by 3 methods: conjugation, transduction and transformation (see table p16 Jawetz review).

41. **Sepsis cause 41. Toxic granulomas.

41. New

Which is not a super antigen? a. TSSA b. Psuedomonas exotoxin A. c. Tetanus toxin. d. Diphtheria toxin.

41. New

b. Psuedomonas exotoxin A.

GRAM POSITIVE COCCI 42. Cell wall of staph. 42. Teichoic acid

Gram posititve cell wall is composed of peptidoglycan and teichoic acid (no lipid A or polysaccharide as in gram negative cell wall)

43. **Food poisoning by staph aureus is due to.

43. Enterotoxin This acts by stimulating relase of IL1 and IL2.

44. **Enterotoxin of staph. Aureus is heat.

44. stable

45. ***Differentiate between pathogenic & non pathogenic staphylococci use

45. coagulase test. Pathogenic staph is aureus species.

46. **Most streptococcus infection to human is

46. A & B hemolyticus.

47. ***To differentiate A & B hemolytic streptococci we use a. bacitracin b. optochin c. ampicillin

47. a. Group A strept is bacitracin sensitive while group B is bacetracin resistant. Optochin is used to differentiate αhemolytic strept (pneumococci are sensitive and strept viridans is resistant)

48. **Commonest disease caused by streptococcus pyogenes is.

48. sore throat Strept pyogenes cause three types of diseases; - Pyogenic (pharyngitis and cellulites) - Toxigenic (TSS and scarlet fever) - Immunogenic (Rheumatic fever and AGN)



49. **Food poisoning symptom [vomiting] 4 hrs after ingestion of food seen in?

a. E.coli b. staph aureus enterotoxin c. salmonella typhi d. vibrio cholera

49. b. staph aureus enterotoxin

50. ***Strept pyogenes cause all except: 118. Streptococcus cause all except:

50. Toxic shock syndrome (check this answer because pyrogenic exotoxin A of strept pyogenes is similar to TSST of staph).

51. Pneumococci are typed by

51. Optochin, bile solubility, Quellung test Pneumococci are optichin sensitive, bile soluble and Guellung test positive.

52. Antigen protective for pneumococci is

52. Capsular polysaccharides. The capsular polysaccharides is antigenic. Other protective mechanisms of pneumococci include enzyme IgA protease, toxin and SSS.

53. **Diagnosis of metastatic staphylococcal lesions: a. Protein A Ab. b. Anti DNase. c. Endotoxins

53. a. Staph don’t produce endotoxins (being gram positive). Anti Dnase is used mainly for strept. Protein A antibody methods are diagnostic for staph disseminated lesions.

54. *****The following differentiates between staph. Pyogenes and strept epidermidis:

54. Novobiocin. Novobiocin is used to differentiate staph epidermidis (sensitive) from staph saprophyticus (resistant). To differentiate staph pyogenes

55. ***The epidemiological marker used most frequently in strain differentiation of Staph. aureus is:

a. Phage typing. b. Biotyping. c. Serotyping. d. Bacteriocin typing

55. a. Phage typing.

56. **All of the following species of streptococcus are B hemolytic except:

a. Strept. Pyogenes. b. Strept infrequens. c. Strept. avium d. Strept. salivarius

56. b. Strept. pyogenes is β hemolytic, Strept. avium is α hemolytic, Strept. salivarius is non-hemlytic.

57. **Which organism grow on NaCl concentration 6gm/L?

57. Streptococcus. Strept fecalis grows on 6% NaCl while strept bovis don’t.

58. Staph. 58. Catalase test Staph is catalase positive.

59. Test used to differentiate staph. aureus a. Catalase b. Coagulase c. Dnase d. ASOT

59. b. Coagulase is used to diagnose staph aureus (positive) from other staph and strept. Catalase is used to differentiate staph from strept., Dnase and ASOT are used to diagnose strept.



60. **ASOT is used to detect:

60. Strept. pyogenes.

GRAM NEGATIVE COCCI 61. ***Differenciation of N. gonorrhaea from N. Meningitis

by sugar fermentation?

61. N. Gono N.Menin Maltose - + Glucose + + Sucrose - -

62. ****In N. gonorrhoea causing dissiminated lesion (systemic manifestation), which of the following is incorrect.

a. Sensetive to penicillin (G+ve only) b. Resistant to ampicillin

62. a. Oral penicillin, cirprofloxacin or doxycycline are used in gonococal arthritis.

63. Meningococcemia causes: 63. Waterhouse Fredrichson syndrome.

64. Neisseria gonorrhoea can cause which of the following? a. Osteomyelitis. b. Artheritis. c. Septicemia.

64. b. N. gonorrhoea may cause septicemia and suppurativeartheritis and hemorrhagic skin papules.

GRAM POSITIVE BACILLI 65. **Gm +ve bacilli arrange in Chinese letter pattern is

65. Diptheria bacilli,

66. **Pseudomembrane cause by a

66. diphtheria

67. *******Which test is used to ascertain toxigenicity of C. iphtheria?

a. Dick test. b. Elick's test. c. Schick test. d. None of the above.

67. b. Elick's test is in vitro plate test for toxin production. Schick test in an ID test for susceptibility to diphtheria, if immune -ve (no reaction).

68. ******A memberane on the pharynx on removal it leaves a bleeding surface occurs with:

a. Diphtheria. b. IMN c. Vincent's angina. d. candida. e. streptococcal infection. f. All of the above. g. None of the above

68. a. Diphtheria.

69. ***A CSF culture revealed an organism that is G+ve at 37 ْc and no growth at room temperature. This is most likely to be:

69. Listeria. Something missed in this question; Listeria is motile at 25°c not at 37°c. It grows on a wide range of temperature (3-43°c)

70. Neonatal meningitis G+ve rods.

70. L. monocytogens.

71. Listeria monocytogens.

71.



72. **Growth of actinomyces israeli on gram stain shows

72. gm +ve branching rods with club ends.

73. **Actinomycosis is caused by?

73. Actinomyces israelii & arachnia propionica

74. **Madura foot have all except? a. Fever. b. bone involvement c. Draining sinus tract d. granules in discharge e. Caused by fungus or bacteria.

74. a. Madura food is a subcutaneous infection with fungi (e.g. eumycates) or actinomyces. There is discharge from sinus tract, bone involvement follow. Systemic symptoms are uncommon, and so is LN.

ENTEROBACTERECIAE & PSEUDOMONAS 75. **Mobile bacilli are?

75. E.coli, V.cholera, salmonella, pseudomonas,

proteus, 76. **Proteus is

76. Motile gm –ive bacilli, NLF, produce

swarming on BA.

77. **Most common agent causing UTI is? a. E.coli b. klebsiella c. proteus d. seudomonas,

77. a.

78. **IMViC reaction of E.coli & klebsella are?

78. E. coli is ++-- Klebsiella is --++

79. **Example of NLF colonies on MacConkey agar ? 28. Examples of LF colonis on MacConkey agar?

79. NLF (produce pale colored colonies): Salmonella, shegella, seudomonas, proteus LF (produce pink colored colonies):E.coli, Klebsiella.

80. **The following proteous are indole +ive except

80. P. mirabilis While M. morganii, P. vulgaris, and seudomonas are all positive.

81. **Klebsiella pneumoniae produces.

81. mucoid colonies

82. **IMViC reaction of E.coli is

82. .[++--]

83. **Which of the following is urease +ve

83. proteus. Also, Klebsieall and pseudomonas.

84. Urease present in all except? a. Brucella.abortus, b. Brucella.melitensis, c. shigella sonni,

84. c. Not only sh. Sonni, but also Shigella A,B and C.

85. **Which strain of E. coli cause HUS? a. VTEC O157, H7 b. EPEC O157:H7

85. a. EHEC 157 = VTEC 157

86. E. coli, Klebsiella and proteus are 86. Commensals of GIT

87. E.coli is indole? 87. Positive Also proteus is indole positive.



88. **Psuedomonas infections include?

88. May cause UTI, otitis media & eye infection, Bed sore, burns,

89. **Psuedomonas is?

89. Motile gm –ive bacilli, NLF, produce pigmented colonies

90. **Psuedomonas aerogenosa produce?

90. Blue green pigments, Pyocyanin & biovirdin.

91. Contamination of sterile fluid is

91. pseudomonas.

92. **An abscess with bluish green discharge caused by? a. Staphlococcus b. proteus c. seudomonas.

92. c.

93. ****Hospital fluids are usually contaminated by: ****120. Organism of medical fluids is:

a. Pseudomonas. b. Staph. c. Strept.

93. a. Pseudomonas are able to grow in water with traces of nutrients.

94. Pigments of pseudomonas aerogenosa 94. Both Fluorescin (pyovirdin) and pyocyanin

95. **Widal test used in the diagnosis of? a. Typhoid fever b. malaria c. malta fever d. brucellosis

95. a. Typhoid fever

96. **Enriched medium for salmonella is?

96. Salenite broth

97. **On Wilson Blair media salmonella produce?

97. S.typhi large black colonies with metallic sheen after 24hours, S.paratyphi produce green colonies after 48hours.

98. **Media used for the isolation of salmonella are?

98. MacConkey, DCA, Wilson blair, Also XLD and selenite broth.

99. ***Culture of choice in the first week of typhoid fever? a. Feces. b. urine. c. blood. d. CSF

99. c. Blood culture are usually positive 90% in the first week of fever, thereafter rate of posistivity decreases. Stool culture are positive throughout the course of disease. However, it is of less significant being positive in carriers and dignose gastroenteritis not enteric fever.

100. **Color of salmonella & shigella on MacConkey agar is?

100. NLF

101. *******Salmonella & shigella are differentiated by?

101. Motility

102. Seroprofile of salmonella typhi?

102. O-9,12, H-1,2

103. Diagnosis of typoid fever in 1st week is done by

103. blood culture

104. Differentiate between E. coli and salmonella

104. Salmonella is NLF and E.coli is LF



105. ****All of the following is correct regarding enteric fever except:

105. Localized gut disease.

106. **Microscopic appearance of Yersinia pestis is?

106. G-ve coccobacilli.

107. ******Dog bite G-ve bacilli isolated is propably: a. Pasteurella multucida b. H. influenza. c. B. Abortus d. toxocara cannis

107. a. Pasteurella multucida

108. **Cholera is caused by? a. V. cholera b. E.coli c. proteus d. seudomonas.

108. a. V. cholera

109. ***Enriched media for V.cholera is ?

109. Alkaline peptone water [pH8.6],

110. ****Loss of fluid in cholera is due to?

110. Adenyl cyclase system activation This leads to ++cAMP Chloride and water loss.

111. ***Mode of action of vibrio is by: a. irritation of intestinal mucosa by vibrio. b. attack of intestinal mucosa by the toxin. c. stimulation of membrane bound adenylecyclase

111. c. stimulation of membrane bound adenylecyclase

112. Vibrio vulnificus.

112. This is halophilic cholera i.e. lives in salted water, infects wounds of shellfish handlers causing cellulistis (may cause septicemia in immunocompromized patients).

RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA 113. **Rickettsial pox is transmitted by

113. mites.

Causative organism is R. akari.

114. **Stain for rickettsia is.

114. Giemsa stain Giemsa gives rickettsia blue to purple color, Gimenes stain it red, Machiavillo stain it red inside blue cells and IF gives better sensitivity and specificity.

115. Organism associated with atherosclerosis: 115. Richetssia (x) Chlamydia pneumoniae (see Kumar 686).

116. **Lymphogranuloma venerum is caused by.

116. Chlamydia Sero D-K hlamydia trachomatis

117. **Mycoplasma are resistant to action of

117. antimicrobial.



SPIROCHETES 118. **Specific or non specific test for syphilis?

118. Non-specific- RPR, VDRL

Specific- TPI, FTA-ABS, TPHA, MHA-TP

119. **Treponema pallidum is a?

119. Spirochate, can be demonstrate by dark field microscopy.

120. **Treponema pallidum causes? a. Syphilis b. TB c. meningitis d. AIDs

120. a. Syphilis

121. ***Bejel is characterized by all except? a. Non veneral transmission b. Caused by ariant of Treponema pallidum.

121. Both are OK. Bejel is non venereal disease caused by T. pallidum endemicum. It is a highly infectious skin in fection.

122. *****Which of the following accurately don't describe 3ry syphilis:

a. Ulcerative skin lesions. b. Gummas in internal organs. c. Rare spirochetes in lesions with limited tissue damage..

122. a. Ulcerative skin lesions.

123. **Yaws disease

123. Caused by Treponema pertenue Characterized by ulcerating papule, scar forming and may cause bone destruction.

HEMOPHILUS 124. **Hemophilus grows uxuriantly on?

124. Chocolate media.

125. ****Satellitism is exhibited by?

a. H. influenza. b. N. meningitides. c. mycobacteria

125. Hemophilus influenza around staph. Aureus

126. **Hemophelus influenza require?

126. X & V factors for their growth

127. **H Ducrii causes.

127. soft chancre Soft chancre is also called chancroid. H. Ducreii don’t require V factor

128. **Bacteria shows satellism.

128. H. Influnzae

129. **Factor V & X are essential for growth of.

129. H. Influenza

130. H. influenza meningitis occurs most frequently in :

130. children. 1/2 to 4 years old.

131. Satellism helps to diagnose?

131. H.influenza

BORDETELLA & BORRELIA 132. **Bordetella pertusis are?

132. Strictly aerobes.



133. Bordetella exotoxin =

133. Single Ag previously termed Islet activity protein. It resembles cholera toxin in structure and action.

134. ***What type of fever caused by borrelia? a. Relapsing fever. b. Q fever c. Rheumatic fever. d. enteric fever.

134. a. B. recurrentis and duttoni casue replapsing fever. B. burgdorferi cause lyme disease and Q fever is caused by coxiella burnetti.

ANEROBIC BACTERIA 135. **Gm +ve bacilli with terminal round spores resembling

match stick are

135. Clostridium welchii, Also called perfrengins.

136. **Nagler reaction used for

- Rapid identification of Cl. Welchii Lecithenase

(Negler's) L G

C. deficile & botulinum

- - + Lecithinase –ve Saccharolytic NLF

C. perfringens + + + Lecithinase +ve Saccharolytic LF

C. tetani - - - Lecithinase –ve asaccharolytic NLF

137. **Clostridia are 137. Gm +ve anaerobic bacilli 138. **Bacteroid is resistant to?

a. Penicillin b. metronidazole c. aminoglycoside d. chloramphenicol.

138. c. aminoglycoside. Also to penicillin (a), neomycin and kanamycin. Chloramphenicol is highly effective.

139. **Stormy fermentation is seen in? a. Cl. Histolyticum b. Cl.prefrenges c. Cl.septicum.

139. b. Cl. Perfringens in litumus milk medium produces A&G, the acid clots milk and the gas breaks the clot producing stormy fermentation.

140. **Bacteria that can be best identified best by direct Gram's film is?

a. Vincent bacillus b. campylobacter

140. a. Vincent bacillus

141. *****The following combination is isolated from pus from deep pyonidal sinus:

a. B. fragilis.and streptococcus milits. b. B. fragilis and B. abortus. c. Strept B.hymolitic and streptococcus.

141. a. B. fragilis.and streptococcus.

142. Suitable medium for anerobic bacteria 142. Blood (selective or non selective), others include;

- Cooked meat broth (CMB) - Thyoglycolate. - BHI



143. **Which one has non clostridium crepitation?

143. Cl. perfrengens (X) Clostridia producing gas gangarene are; - .Cl. perfringens (mainly). - Cl. Novyi. - Cl. septicum - Cl. histolyticum.

144. Crepitant cellulites is caused by:

144. Clostridia.

BRUCELLA 145. **Malta fever is caused by?

145. Brucella species

Also called undulant fever.

146. A young Saudi male came with fever & myalgia your diagnosis is?

a. Brucella b. staphylococcus c. streptococcus d. gonorrhea

146. a. Other symptoms and signs include; - Arthralgia - Sweating - Heptatosplenomegally.

147. **Bacteremia is seen in: a. Brucella. b. Tetanus. c. shigellosis

147. a. Both tetanus and shigellosis are localized infections. Brucella enters through the mouth, lung or skin to local lymph nodes to blood to liver, spleen and bone marrow to cause type IV hypersensitivity.

MYCOBACTERIA 148. **Mycobacterium Leprae

148. can not be culture artificially in the laboratory

149. **L.J medium is used for culturing?

149. T.B,

150. **Mycobacterium Leprae are?

150. Acid fast [5% H2SO4]

151. **Mycobacterium .T.B is?

151. Acid fast [20% H2SO4], alcohol fast,

152. ***TB culture takes a. 2-4 days. b. 12 days. c. 3-6 weeks. d. 6-10 weeks.

152. d. 3-6 weeks.

153. **Most sever form of leprosy is

153. Lepromatous

154. **Mycobacteria are acid-alcohol fast because

154. they resist to decolorized by acid & alcohol.

155. **In lepromatous leprosy immunity is

155. very low. Almost nil

156. *******Which of the following mycobacteria is related to MTB complex?

a. Mycobacterium Africanum. b. M. leprae

156. a. MTB complex include TB, M. africanum, M. bovis, BCG and M. microtti..



157. Acid fast bacilli in stool =

157. TB

158. *****Diagnosis by direct staining: a. TB b. Hemophylus

158. a. Acid fast smear is number one rapid test for mycobacterium TB. Positive smear has a predictive value of 96%.

159. Which of the following belongs to PTB family? a. M. Kanasasi. b. M. Bovis. c. M. intracellulare. d. M. africanum.

159. a. MOTT (mycobacteria other than TB) are classified into; - Photochromogens: M. kansasii, M. marinum. - Scotochromogens: M.scrofulucian, M. szulgai. - Nonpigmented:

M. avium cellular complex (MAC) M. phlei, M. fortuitum

MISCELLANEOUS 160. **Malignant pustule is caused by.

160. Bacillus anthracis

161. **Plague is by

161. rat flea.

162. ****Vaginal discharge is absent in? a. Gardnerella infection b. trichomonas vaginalis c. Chlamydia d. ryptococcus.

162. d. G.vaginalis produce fishy smelling discharge, TV produce thin bubbly fishy smelling discharge, Chlamydia produce thin discharge. Cryptococcus is a lung infection.

163. **Sterile pyuria not seen in? a. TB b. non specific urithritis c. urine collection by suprepubic puncture d. prior treatment with antibiotic

163. c. Causes of sterile pyuria; TB Mycoplasma Leptospirosis Vaginal contamination Antibiotics, L forms Abacterial cystitis Non infectious disease e.g. tumour, FB

164. **Diagnosis of bacterial endocarditis? a. Urine culture b. blood culture

164. b. blood culture

165. *****Aspergelloma: All correct except: a. Lungs are the most common site. b. no organism is present in lesion. c. Affect children.

165. b. Aspergelloma is a ball of aspergillous growth. It may affect children with preexisting pulmonary condition.

166. **Which combination is wrong?

166. Non-specific urethritis: Penicillin.

167. Zoonotic disease

167.



MYCOLOGY 168. ******Candida is identified by

168. germ tube test.

169. **An oval to spherical budding cause by.

169. C neoformans

170. **Tinea versicolor is caused by.

170. M.Furfur

171. *****Tenia capitis is caused by: a. Microsporum. b. Trichophyton. c. Candida

171. a. Microsporum ausdonii cause tenia capitis. Trychophyton causes tenia pedis or unguium.

172. *****T. vaginalis may be mistaken for: a. White cells. b. RBCs. c. Candida.

172. a. White cells.



PARASITOLOGY 173. **Malaria affecting large RBC-

173. P.vivax.

In P. vivax, infected cells are enlarged with schuffner's dots. In P. ovale infected RBCS are enlarged without Schuffner's dots. P. malariae cause normal or even reduced sized RBCs. In P. falciparum cells are normal with Maurer's clefts.

174. **Leishmania id transmitted by

174. Sand fly.

175. ****Dwarf tape worm is.

175. H.Nana

176. ***Hematuria in Egyption Patient think of,

176. Schistosoma hematobium.

177. **Sporozoites are present in

177. reticuloendothelial system (X). Sporozoits are the infective stage in the mosquito. The merozoit is the form inside the infected RBC. Such RBC is called schizont.

178. **A parasite can ingest RBC & present in stool-

178. E.Histolytica.

179. ***Entrobius vermicularis is diagnosed by.

179. anal swab

180. **Larva is present in fresh stool?

180. Strongyloid stercoralis.(rhabdatiform larva)

181. **Malaria with multiple infection?

181. P. Falciparum (X). Vivax and ovale due to preerythrocytic schizogony cause multiple infection.

182. **Anchovy sauce pus is ?

182. E. Histolytica

183. **Visceral leishmaniasis best diagnosed by? a. B//M biopsy b. Serology

183. a. B//M biopsy

184. **Cutaneous leishmaniasis diagnosis by? a. Skin biopsy b. Culture,

184. a. Skin biopsy

185. The following parasite doesn’t not involve GIT in man? a. Ascaris b. cysticercosis c. H.nana d. Tenia

185. b. cysticercosis

186. The cigar glycogen is in

186. I. buchlii, but if cigar shaped chromatoid it is E. histolytica (immature cyst)

187. **The arthropod vector of malaria is: a. Female anopheles mosquito. b. Culex mosquito. c. Tsetse fly. d. None of the above

187. a. Female anopheles mosquito.



188. Cryptosporidium 188. Intestinal coccidian infection with AIDS

189. A warm that infects man and pass eggs around the anus is

189. Oxyurius vermicularis.

190. Giardia lamblia is diagnosed in stool by the presence of 190. Cysts or trophozoit

191. **Which is caused by skin penetration: 191. Schistosoma hematobium. Also ankylostoma duodenal, strongyloides and N. americanus.

192. Serology of E.H except 192. IFAT Also, CFT, IHA & ELISA.

193. Stains for stool include: a. Iodine. b. Fluorescent. c. Trichrome d. All of the above

193. d. All of the above



VIROLOGY 194. *******HAV all are correct except:

a. Infection in adults is more severe than children, b. There is chronic carrier state in young children. c. Vaccination is recommended for high risk group.

194. b. There is chronic carrier state in young children.

195. **Best sample for the diagnosis for recovery of polio is

195. feaces. Also from throuat and spinal fluid.

196. **Virus & living cells resemble in

196. reproduction.

197. **Latent infection seen in all except? a. Herpes virus b. adeno virus c. coxsackie virus d. retorvirus.

197. a. Herpes virus (?? HS causes latent infection)

198. **Which of the following virus causes systemic effect? a. Poliovirus b. adenovirus c. rhinovirus d. Influenzea virus.

198. There may be a missing "except" in this question because adeno cause RTI and hemorrhagic cystitis and GE. Influenza and polio also cause systemic effect. Rhino is an exception.

199. ***Which is not correlating? 199. RSV keratitis in AIDS patients.

200. ****Which combination is wrong? a. Rubella: arthritis in young women. b. Mumps: Antigenic shift c. Coxsackie: Meningitis. d. EBV: Heterophil Abs.

200. b. Antigenic shift is a character of influenza virus

201. *****Which of the following can pass to fetus transplacentally? a. HSV. b. VZV. c. CMV

201. c. CMV

202. ***Who of the following is supposed to transmit CMV infection to hospital staff? a. pregnant woman having a skin rash in second trimester. b. HIV patient c. HCV patient. d. Neonate with congenital defect due to CMV infection

202. d. Neonate with congenital defect due to CMV infection.

203. **All diagnose viral infection except: **Which diagnose viral infection? a. IgM Ab is one serum only. b. High IgG titre in serum in acute and convalescent stage. c. 2 fold increase in IgG d. 4 fold increase in viral specific IgE in acute and convalescent stage. e. All of the above

203. a. IgM Ab is one serum only. A high IgG titre in serum in acute and convalescent stage may be due to immunization. 2 fold increase in IgG ??. IgE is regain of allerty not infection.



204. ****RSV all correct except: a. Rectal sample gives the highest yield of the virus. b. Form a syncetium in tissue. c. Causes lower respiratory illness in children. d. Related to paramyxoviruses.

204. a. RSV is a paramyxovirus. It is the most important cause of pneumonia and bronchiolitis in infants.

205. **In a patient with rabies infection, the main histological characteristic in the brain is: a. Lewi bodies. b. Durel bodies. c. Negri bodies. d. Amyloid plague

205. c. Negri bodies.

206. Enteroviruses cannot be isolated from which of the following specimens? a. Throat swab. b. Fecal specimens. c. Gastric fluid. d. Urine. e. CSF.

206. d. enteroviruses isolated from throat e.g. polio, from feces e.g. polio and hepatitis, from CSF e.g. coxsachie virus. Enteroviruses resist gastric acidity.

207. Herpes zoster 207. Localised

208. Regarding rotavirus, all are correct except: a. DS-RNA virus b. cause majority of infant diarrohea c. diagnosed in feses by ELISA

208. None Rota virus is a dsRNA virus, it is diagnosed in feces by ELISA. It causes a significant proportion of infant diarrohea.

209. Ebola virus causes 209. Fever, myalgia, diarrhea, rash, lymphadenitis, complicated with hemorrhage, encephalitis.

210. Polio virus is transmitted by which rout? 210. Feco-oral

211. **Which of these is not dangerous in contact with AIDS patient?

211.



If glucose is fermented , TSI reaction is: KIA Fungus with acid fast bacilli stain positive: Nocardia. Plague causative agent: Yersinia pestis Disinfection: Partial destruction of living organisms: All sporocidal except: Ethanol. Trophozoites on Wright's stained film: Signet ring. Ring form with gametocytes seen in F. falciparum. Best for collecting urine is dewling catheter, aseptically aspirate 5ml of urine from the catheter tubing. Best to disinfect tables contaminated with blood is: Phenol. 70% alcohol cause protein denaturation and cell membrane damage. Transmission of HIV: All Fungal infection is not diagnosed by culture because etiologic agent is difficult to grow Malaria donot grow in plasma Food poisoning is caused by S. enteretidis. Strept through all First line of body defence against strept is phagocytosis Renal impairment except galactosemia Don not produce B hemolysis on blood agar: Klebsiella and strept viridans. N. gonorrhea infect other than genital tract: vaginintis. UTL with indole +ve: E. coli Rota: not correct is hemorrhagic conjunctivitis and cardiac disease. Respiratury infection cause by: Coxacki B and parainfluenza. All G+ve except: Neisseria and mycobacterium Specimen examined directly: CSF BR that differentiate Neisseria species is sugar fermentation. Bacillary dysentery: Shigella. Transport media for stool: Carry Blair. For nosocomial outbreaks of pseudomonas: pyocin typing. Organism that gives metallic sheen on EMB Specimen for anerobic culture: Pleural fluid and --- abscess. Destruction of microbes except by: Centrifugation. Cause of opthalmia neonatorum: N. gonorrheae G+ve in cuboidal packages: Sarciniae For bacterial motility except: H*E BHI with addition of antibiotics for: N (histo.plasma and fungi) Choice of media depend on except: one selective plating medium TSI gives the following reactions: All (Provedentia K/AG, E. coli K/AG, Citrobacter K/AG, Proteus K/A In SS agar, source of carbon is lactose Tryptophan is the basis of Indole test. Antibiotic sensitivity tes commonly by disc diffusion Meningitis in neonates: L. monocytogens. New world hook worm: Necator americanus. High concentration of liquid or gaseous germicidal chemical sterilization. Routine bacterial culture is examined after 5-10 hr, 18-24 hr. Routine bacterial culture is incubated at 35 ْC. Rapid method for detecting significant bacteria is by microscopy. Mycoplasma media is PPLO Flukes = Trematodes Ribbon like worms = Nematodes Most common helminthes are nematodes. Largest protozon = B. coli Tape worm = cestodes. Asexual forms of malaria= Merozoite, asexual cycle in man, sexual cycle in Mosquito Ascaris egg migrate from lung to small intestine



Parasite in blood smear = plasmodium Thrush= C. Albicans. Flagellates except: S. mansoni. Toxo diagnosed by: Fluorescent antibody sera Swarming G+ve bacilli = Clostridium Protozoa of endemic and epidemic disease = G. lamblia. Entrobius diagnosed by Scotch tape method Schffner's dots = P. vivax Hemoflagellates = Leishmania and trypanosomes General term of worms = Helmenth

CLINICAL & CHEMICAL PATHOLOGY MCQ Shawual 1425 Exam


226th Shawual 1425

1. ****Calcium in urine stone is present in all of the follwing except: a. UTI b. Secondary hyperparathyroidism.

See Q9 body fluids

2. Acidemia is associated with

See Q 11 Chemistry.

3. ***To correct acidosis, the kidneys: a. secrete more H+ in urine. b. Synthesis bicarbonate to ECF c. Both a and b

See Q 12 Chemistry

4. ***What is the base: acid ratio at pH 7 for acid of pK6? a. 0.01 b. 0.1 c. 1.0 d. 10 e. 100

See Q 15 Chemistry

5. ******Metabolic acidosis can result from:

See Q 17 Chemistry

6. **All causes renal damage except

See Q 23 Chemistry

7.

***Main extracellular ions? a. Na & K b. Na & Cl **Main electrolyte in blood is? ***Electrolytes in ECF a. Na is a major cation b. Cl is a major cation d. HCO3 is a major anion. ***Main intracellular cation is; **In serum: a. Sodium is the main cation. b. Bicarbonate. ***Intracellular fluid contains: a. More potassium less sodium than extracellular fluid.. b. Sodium and potassium in equal amount.

See Q 20,21, 22, 24, 25, 26.Chemistry

8. Glycogen differs from starch in: a. Cellulose is not metabolized in humans because of absence of enzyme b. Repeating units.

See Q 34 & 35 chemistry

9. **Xylose test is done to detect the function of: a. Stomach. b. Pancreas. c. Upper small intestine. d. Lower small intestine. e. Large intestine

See Q 36 chemistry

10. ****Von Gerke's disease is caused by deficiency of: a. Glucose 6 phosphatase b. Glucose 6 phosphate dehydrogenase

See Q 37 chemistry

11. What happens if sucrose is given paretnrally: See Q 38 chemistry



12. ***Which of these is not a ketone body? a. Acetone. b. Acetoacetic acid. c. Butyric acid. d. B-hydroxy butyric acid. e. None of the above.

See Q 39 chemistry

13. ***Which of the following result shows renal improvement? a. urea 9 mmoll b. creatinine 10 mmol/l c. urates d. cholesterol e. urine osmolarity less than 800 after 12 hrs of water deprivation.

See Q 53 chemistry

14. **Low GFR occurs in all except: a. Congestive heart failure. b. Urethral obstruction.

See Q 54 chemistry

15. **Gluconic amino acids include: a. Alanine. b. Methionine. c. Valine. d. Glutamic acid. e. All of the above.

See Q 64 chemistry

16. ***Which lipoprotein has highest concentration of cholesterol? a. VLDL b. LDL c. IDL d. HDL

See Q 72 chemistry

17. ***In MI, which is the last enzyme to be raised and lasts long? a. CK b. CK-MB. c. AST. d. LDH

See Q 85 chemistry

18. **Isoenzymes: a. Are physical types of one enzyme. b. Have different electrophoretic mobility. c. All of the above

See Q 86 chemistry

19. *****ADH is? a. Produced by posterior pituitary b. Produced in the hypothalamus.

See Q 90 chemistry

20. ****Error in the result is expected in which case? a. Glucose on fluoride. b. Glucose on EDTA c. Calcium on oxalate

See Q 4 general

21. ***In Pyruvate Kinase deficiency all correct except? a. Intermittent attach of anemia. b. Splenectomy is a choice of treatment. c. Autosomal recessive.

See Q 15 hematology

22. **In A sickle cell disease patient under general anesthesia, all true except?

See Q 16 hematology



23. **In favism, a. The defect is in b. which is affected

See Q 20 & 28 hematology

24. ***Free plasma Hb is bound to:

See Q 27 hematology

25. **In hereditary spherocytosis which is false: a. It is autosomal dominant disease. b. Treated by splenectomy. b. Thin underhemoglobinized RBCs are seen in blood film.

See Q 29 hematology

26. **Normal Hb pattern?

See Q 45 hematology

27. ****Chronic granulomatous disease is due to immunodeficiency of which of the following? a. T-cell member b. Defective neutrophil function. c. Hypocomplementemia. d. Defeceient immunoglobulins. e. neutrophils

See Q 68 hematology

28. ****Paraprotiens are? See Q 97 hematology 29. ***In CLL, all are true except::

a. RAI classification III is either I or II with hemolytic anemia. b. 5% terminate by Richter's syndrome. c. 30% of lymphocytes agglutinate RBCs

See Q 99 hematology

30. ***In CML treatment, which is true: a. Folinic acid protects against the megaloblastic effects of methotrexate . b. Citrovorum and folinic acid are synonymous. c. Trimethoprim if used frequently causes folic acid deficiency or megaloblastic anemia. d. There is methyl THF in B12 deficiency.

See Q hematology

31. ****All diagnose hemolytic disease of new born except: a. Retics count. b. bilirubin c. DAT d. Porphyrins.

See Q 5 immunehematology

32. ***Tuberculine test is type.

See Q 13 immunology

33. Cell mediated immunity = See Q 14 immunology 34. β-lactamase resistant penicillin for staph See Q 6 Microbiology 35. **Sterol is the main constituent of cell wall of:

a. Mycoplasma. b. Rickettsia. c. Chlamydia. d. Leptospira. e. Staph.

See Q 35 Microbiology

36. **Which strain of E. coli cause HUS? a. VTEC O157, H7 b. EPEC O157:H7




37. Organism associated with atherosclerosis: a. Chalmydia trachomatis. b. Chlamydia pneumoniae d. Mycoplasma


38. ***TB culture takes a. 2-4 days. b. 12 days. c. 3-6 weeks. d. 6-10 weeks.


39. *****Aspergelloma: All correct except: a. Lungs are the most common site. b. no organism is present in lesion. c. Affect children.


40. ******Candida is identified by


41. *******HAV all are correct except: a. Infection in adults is more severe than children, b. There is chronic carrier state in young children. c. Vaccination is recommended for high risk group.


42. ***Which is not correlating?


43. ****Which combination is wrong? a. Rubella: arthritis in young women. b. Mumps: Antigenic shift c. Coxsackie: Meningitis. d. EBV: Heterophil Abs.


44. ***Who of the following is supposed to transmit CMV infection to hospital staff? a. pregnant woman having a skin rash in second trimester. b. HIV patient c. HCV patient. d. Neonate with congenital defect due to CMV infection


45. **All diagnose viral infection except: **Which diagnose viral infection? a. IgM Ab is one serum only. b. High IgG titre in serum in acute and convalescent stage. c. 2 fold increase in IgG d. 4 fold increase in viral specific IgE in acute and convalescent stage. e. All of the above


46. In β-Thalassemia, which is true? a. It presents with severe anemia at the age of 6 months. b. Blood transfustion may be required as frequent as every 9-12 months.

See Hematology 51 new

47. Which is true regarding DAT a. It is positive in all IHA. b. may detect complement attached to RBCs.

See Hematology 41 New



48. Regarding concentration of urine; a. Proximal tubules return 75% of filtered water. b. Distal convoluted tubules deliver 40-60L of fluid to collecting tubules / day. c. Osmotic pressure in renal cortex is higher than in medulla. d. ADH acts on all parts of nephrone. e. Aldosterone increase Na excretion.

See Chemistry 28 New

49. H+ homeostasis is altered by; a. Excessive change of pyruvate to lactate.

See Chemistry 19. New

50. Hemoglobin breakdown takes place in: a. RES b. Hepatocytes. c. Renal tubules.

- See Hematology 14.New

51. Carcinoid tumors secrete See chemistry 98 New

52. Which is not a super antigen? a. TSSA b. Psuedomonas exotoxin A. c. Tetanus toxin. d. Diphtheria toxin.

See microbiology 41. New

53. In Hodgkin disease all are true except See Hematology 118 New1

54. In Non Hodgkin disease, which is true? a. Most are T cells. b. Good risk patients are sensitive to chemotherapy. c. BM is uncommonly involved. d. Histological classification is not as important as in HD. e. None of the above.

See Hematology 118 New2

55. In CML, which is not present? a. NAP is highly positive. b. Splenometally is present in 80% of cases. c. WBC is commonly 500x109 at presentation. d. BCR +ve but Philadelphia negativecases may occur.

See Hematology 118 New3

56. In enzymopathies, which is false:

57. Regarding excretion of Na+ a. Not dependent on aldosterone. b. Major share of GF osmolarity with associated ions. c. It passively diffuses in proximal tubules. d. In distal tubules it is exchanged for K+ e. Coupled with K+

See Chemistry 28. New 2

58. Regarding buffer systems; b. An acid is a substance that releases H+ c. Buffering involves change of strong acid to base.

See Chemistry 28. New 3

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