clinical biochemisclinical revision
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7/28/2019 Clinical Biochemisclinical Revision
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Clinical biochemistry revision
Liver I-Choose ! most correct answer:1-! Following are ! mechanisms underlying hepatic disorder in acute hepatitis :
a- Liver cell damage b-cholestasis
c-liver cell mass reduction d-hepatic fibrosis
e- a & c f- a & bg- all except d
2-All ! following are among !metabolic roles of liver in lipid metabolism except:
a- lipogenesis in fed & fasting state b- uptake of VLDL & CM remnants from plasma
c-degradation of ketone bodies
d-synthesis of HDL & VLDL
3- All !following are among !metabolic roles of liver in protein metabolism except:
a- Deamination of amino acids
c- detoxification of ammonia by urea formation in urea cycle
d- Synthesis of γ-globulinse- synthesis of albumin ,clotting factors , α & β-globulins
4- !following is among !metabolic roles of liver in CHO metabolism :
a-removal of excess glucose in fed state & formation of glycogen b-Synthesis of glucose in later stages of fasting by gluconeogenesis
c-degradation of stored glycogen to glucose to maintain BGL in fasting state
d- All of ! above
5-Which of ! following statements is true about ! functions of liver:
a-it is involved in vitamin & hormone metabolism
b- it is ! only organ that can removes cholesterol from ! bodyc- ! major site of bilirubin synthesis
d-! only organ that carry out ketogenesis
e- bilirubin excretion in ! form of insoluble bilirubin in bile
f- a & b g- all except c & e
6-All of ! following are characteristics of cholestasis except:
a- increase in plasma ALP activity due to decreased excretion
b- slight increase of plasma ALT activity due to retention of phospholipidsc- increase in plasma GGT activity
d- prolonged prothrombin time due to vit K deficiency
e- a & b f- b & d
7-All ! following is true about Liver cirrhosis except:
a-it is an outcome of a progressive alcoholic hepatitis
b- Albumin synthesis decrease in advanced cases leading to ascites
c- prolonged prothrombin timed-gross increase in plasma ALT activity in early phase
8-Acute viral hepatitis is characterized by:
a- large increase of plasma ALP activity
b-plasma AST activity is relatively higher than plasma ALT activity
c- Slight post-hepatic cholestasisd- positive serological tests for viral antigen or antibody
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Clinical biochemistry revision
9-Which statement is not true about acute hepatitis:
a-Starts & resolves quickly
b-an element of cholestasis occurs due to inflammation of hepatocytesc- may be viral or alcoholic or drug –induced
d-dark urine & pale stools are excluded
e-total bilirubin increase due to increase in both IB & DB
10-In Liver cell mass reduction ,All ! following is correct except :a- affects ! synthetic ability of ! liver
b-Ascites occurs as a concequence of hypoalbuminemia
c- prolonged PT can be corrected by parentral adminstration of Vit K d- occurs in advanced cases of chronic active hepatitis & liver cirrhosis
e- c & d
11-Which of ! following statements is true:
a- Bilirubinuria is always pathological & dark urine may be an early sign of an inherited disorder in bilirubin
metabolism
b-Indirect bilirubin is partially carried on albumin in plasma & thus never appear in urinec-Urobilinigen in urine is normal in hemolytic jaundice & increased in Gilbert’s syndrome
d-! increased plasma GGT activity is not diagnostic for alcoholic hepatitis & ! diagnosis is mainly based on ! patient history
12-Which of ! following statements is not true about Gilbert’s syndrome :
a- characterized by unconjugated hyperbilirubinemia
b- characterized by normal liver function enzymes including GGT
c- characterized by normal hepatic histologyd- caused by ligandin deficiency
e- Non of ! above
13- Which of ! following statements is true about Crigler-Najjar syndrome :
a- characterized by conjugated hyperbilirubinemia
b- characterized by precence of DB in urine
c- ! onset of symptoms occurs after pubertyd- caused by decreased IB uptake
e- it is an inherited disorder of bilirubin metabolism
14-All ! following can lead to unconjugated hyperbilirubinemia except:
a- ineffective erythropoiesis b- glucorunyl transferase deficiency
c- ligandin deficiency
d- neonatal jaundicee- intrahepatic biliary obstruction
15-Which of ! following statements is true about conjugated hyperbilirubinemia :
a- characterized by increased urobilinogen in urine
b-pale stool is observed due to absence of bile pigmentsc- Cholestasis is ! sole interpretation
d- bilirubinuria is an early screening test & a negative bilirubin in urine is confirmative
16- Which of ! following statements is not true about serum liver function tests:
a- elevated 5’-nucleotidase is diagnostic for biliary obstruction
b- elevated ALP is sensitive but not specific for hepatobiliary obstruction
c- relative plasma activities of ALT & AST may differentiate between acute & chronic liver diseasesd- decreased serum albumin level is a specific indicator of chronic liver disease
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Clinical biochemistry revision
17-Among ! specific disorders that lead to liver disease :
a-Hemochromatosis b- Wilson’s disease c-1ry liver
cell cancer d- α1 antitrypsin deficiency
e-All of ! above
18-All ! following is true about chronic active hepatitis except :
a- SAST is largely higher than SALT
b-ALT & AST rarely exceed three times ! upper reference limits
c- increase in γ-globulin fraction is due to increase in SMA & ANAd- an early increase in IgG differentiates it from chronic benign hepatitis
e- ! disease is not symptomatic
f- All except d g- b & e
19-Which statement is incorrect about α-fetoprotein:
a- it is ! main plasma protein in fetus plasma
b- its gene is expressed normally only in fetus & expression ceases after birthc-its presence in adult serum indicates 1ry liver cell cancer due to re-expression by tumor cells
d- alcoholic cirrhosis & ulcerative colitis may cause induction of AFP synthesis
e-Non of ! above
20-Which of ! following statements is incorrect:
a-in hemochromatosis ,liver cirrhosis is due to deposition of hemosidirin in liver b- Willson’s disease is characterized low serum & urinary Cu & also serum ceruloplasmin is low
c-Hemochromatosis is characterized by high serum iron ,high serum ferritin & increased TIBCd- α1 antitrypsin deficiency leads to liver necrosis
21-In Viral hepatitis
a-serum ALT activity increase more than 10 folds ! upper reference limit b-conjugated hyperbilirubinemia occurs due to decreased conjugation
c- IB increase due to cholestatic element
d-a test for viral antigen or antibody is not always essential
22-Which statement is not true about cholestasis :
a-pruritis occurs due to deposition of bile salts in skin
b- large increase in both serum ALP & GGT activities is diagnosticc- 5’-NT level can differentiate between intrahepatic & extrahepatic cholestasis
d-prolonged PT is due to Vit K deficiency & can be corrected by Vit K injection
e-Hypercholesterolemia occurs due to cholesterol retention
23-In Chronic persistent hepatitis
a-Jaundice usually occurs
b-SALT & SAST activities only slightly increase
c- ! patient may remain asymptomatic for long periodd-! condition is benign & discovered by chance
e ALL of ! above is correct f- all except a
24-Unconjugated hyperbilirubinemia occurs due to:
a- increased production of IB in hemolytic jaundice b- decreased uptake of IB in Gilbert’s syndrome
c- impaired conjugation of IB in Crigler-Najjar syndrome
d- immature hepatic uptake & conjugation in physiological jaundicee-ALL of ! above
25-Which statement is correct:
a-1ry bile acids are formed from 2ry bile acids by oxidation in liver b- 2ry bile acids are obtained by oxidation of 1ry bile acids in liver
c-bile contain both 1ry & 2ry bile salts due to enterohepatic circulation
d- chenodeoxycholic acid is a 2ry bile acid
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Clinical biochemistry revision
26-All ! following statements are true about gall stones except:
a-pigment stones are formed in chronic hemolytic states
b-high serum cholesterol level can predispose to ! formation of cholesterol containing stones
c-Mixed stones are built on a cholesterol nucleusd-gall stones is rarely associated with cancer of gall bladder
27-gall stone formation can lead to all ! following except :
a- acute inflammation of gall bladder wall b-chronic cholecystitis
c- obstructive jaundice d- all except ae-All of ! above
28-Hepatic bile contains :
a- cholesterol b-2ry bile saltsc- phospholipids d- stercobilinogen
e- a & c f- all except d
g- all of ! above
29- Intrahepatic cholestasis can be caused by:
a-cholangitis b-1ry biliary cirrhosis
c-chloropromazine d-viral hepatitise-inflamation in common bile duct f-all of ! above
g-all except e30- In chronic liver disease, all ! following occurs Except :
a- albumin levels falls below ! normal b- plasma total protein may increase due to increase in immunoglobulins
c- SAST & SALT are slightly increased
d-Ascites is a characteristic feature of liver cell mass reductione- parentral admistration of Vit K can correct ! prolonged PT
31-Which statement is incorrect :
a-GGT is sensitive but not specific marker of cholestasis b-GGT measurement is inferior to 5’-nucleotidase measurement in diagnosis of cholestasis
c-GGT synthesis is generally induced by hepatic microsomal enzyme inducers
d-increase in plasma GGT activity is specifically diagnostic for alcoholic hepatitis
II-Mark true or false1- measurement of plasma ALP activity is ! most sensitive test for cholestasis. T F2- Urobilinogen increase in urine in complete biliary obstruction T F
3- Bilirubinuria is used for differential diagnosis of causes of jaundice T F
4- AFP is a tumor marker used for diagnosis of hepatic carcinoma T F5- α1-antitrypsin is responsible for 90% of protease inhibition in serum T F
6- ALT slightly increase in cholestasis due to acute inflammation of hepatocytes T F
7-In response to biliary obstruction ,proliferation of cells lining bile canaliculi occurs leading to increased
synthesis of ALP T F8-in hemolytic jaundice ,both IB & DB increases T F
9- Liver cirrhosis is ! terminal stage of chronic liver disease T F
10- presence of bilirubin in urine can differentiate between cholestasis & viral hepatitis T F11- Dark urine is not observed in Crigler-Najjar syndrome T F
12- Urine urobilinogen can differentiate between hemolytic jaundice & Gilbert’s syndrome T F
13-Cholangitis is a common cause of post-hepatic cholestasis T F14- Autoimmune antibodies can cause chronic persistent hepatitis T F
15- Chronic persistent hepatitis may be a consequence of previous acute hepatitis C T F
16- Jaundice usually occurs in chronic active hepatitis but not usually appears in chronic benign hepatitis T
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Clinical biochemistry revision
17- Bilirubinuria is always pathological & dark urine may be an early sign of some forms of hepatobiliarydiseases. T F
18-Dark urine & pale stools occurs in both acute hepatitis & cholestasis T F
19- ALP is elevated in cholestasis but not in acute viral hepatitis T F20-.! Gall-bladder bile is ten times more concentrated than hepatic bile T F
21-PT is prolonged in both reduced liver cell mass & cholestasis due to ! same reason T F
22-In acute viral hepatitis ,SALT is higher than SAST ,but in Chronic active hepatitis SAST is higher than
SALT T F23- GGT synthesis is induced by chronic use of HME inducers but 5’-NT is not T F
24-Prothrombin time is ! best index for ! progression of liver disease T F
25-in Advanced cases of cirrhosis ,liver cell mass reduction occurs leading to ascites T F26- AFP is replaced by albumin after birth T F
27-Gall stones may be rarely associated with carcinoma of ! gall bladder T F
28- There is no association between hypercholesterolemia & ! formation of cholesterol gall stones T F
III-Write short notes on ! following statements:1- Bilirubinuria is used for differential diagnosis of causes of jaundice
(2006)2- Differential diagnosis between cholestasis & liver cell mass reduction
3- Primary liver cell cancer
4- Gall-bladder bile is ten times more concentrated than hepatic bile
5- Relative plasma activities of AST & ALT may help to indicate ! type of cell damage6- Differential diagnosis between types of chronic hepatitis7- specific disorders affecting ! liver8- Inherited disorders of bilirubin metabolism
9- Mechanisms underlying hepatic diseases
Answers
1 6 11 16 21 26 312 7 12 17 22 27
3 8 13 18 23 28
4 9 14 19 24 29
5 10 15 20 25 30
1 5 9 13 17 21 252 6 10 14 18 22 263 7 11 15 19 23 274 8 12 16 20 24 28
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Clinical biochemistry revision
Investigation of renal function I-Choose ! most correct answer:1-Which statement is incorrect :a-AVP affects water reabsorption in ! kidney
b-renin is imp for ! synthesis of Ag II which is required in aldosterone synthesis
c-increase aldosterone leads to hypokalemia
d- PTH increases Ca reabsorption & has a phosphaturic effecte-ALL of ! above f-Non of ! above
2-Among hormones produced by ! kidney :
a- PTH b-renin c-calcitriol d- all e- all except a
3-All ! following are not true about ! endocrine functions of ! kidney except:
a-they remain clinically intact until ! end stages of renal failure.
b-erythropoetin hormone is produced by ! kidney in response to PTHc-Calcitriol acts on ! kidney to facilitate phosphate excretion
d- increase in AVP leads to polyuria
4-All ! following are tests for golumerular function except :
a- serum creatinine b-serum urea c-creatinine clearanced-proteinuria e- urine pH
5-Among ! tests used for assessment of tubular function :
a- serum uric acid b- serum ammonia c- urine osmolality /serum osmolality d-proteinuria
6-Which statement is incorrect :
a- Volume of ! glomerular filterate is affected by changes in ! blood supply to ! glomerulus
b- composition of ! glomerular filterate is affected by reduction of ! permeability of ! membrane to !filtrate.c-Composition of ! GF is affected by increased permeability of ! glomerulus
d- filteration of plasma proteins (proteinuria) by ! glomeruli indicates nephrotic syndrome
7-All of ! following are ! consequences of reduced GFR except :
a-hypokalemia b- low creatinine clearance c-prerenal uremia d-metabolic acidosis
8-Among factors that reduce glomelular filteration rate are:
a- congestive heart failure b-renal artery stenosisc-urethral stones d-Cd toxicitye-Acute glomerulonephritis f-ALL of ! above
g- all except d
9-Among prerenal factors that reduce GFR :
a-dehydration b- bladder tumors c-prostate enlargement d-glomerulonephritis
10-Hyperkalemia is a consequence of reduced GFR due to:
a- metabolic acidosis b-release of intracellular K c-decreased K excretion d-All of ! above e-all except a
11-Clinical findings in acute renal failure includes :
a-Oliguria b-decreased serum NPN c- metabolic alkalosis d-hypokalemia
e-All of ! above f-all except c g- a & d
12-About creatinine clearance ,which statement is not true :
a-it is most sensitive indicator of glomelular dysfunction b-minor changes in GFR affects creatinine clearance as well as serum creatinine & urea levels
c-creatinine is ! best substance for clearance measurement
d- urea is not used for clearance measurement as it is partially reabsorbed by renal tubules
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Clinical biochemistry revision
13-provided wz a sample of 600 ml urine collected during ! last 24 hrs wz a creatinine concentration of
200 mg/dl & a plasma creatinine concentration of 3 mg/dl ,so ! creatinine clearance for that patient is
equal to :
a-120 ml/min b-28 ml/min c-35 ml/min d-90 ml / min
14-In patients with hepatic failure in ! presence of renal diseases ,which statement is correct:
a-liver can’t synthesize urea so ! ratio between serum NPN to serum urea is approximately normal
b-! ratio of NPN level to urea nitrogen level is higher than normal
c-serum NPN increased due to renal failure & urea level is decreased due to decreased synthesisd-! ratio between serum urea to serum NPN increase due to decreased synthesis of urea in hepatic failure
e- b & c
15-serum osmolality increase in All of ! following except:
a-hemodilution b-diabetes mellitus c-prerenal ureamia d-dehydration
16-Polyuria wz low urine osmolality occurs in:
a-Ketosis b-diabetes mellitus c-nephrogenic diabetes insipidus d-All of ! above
17-All ! following are causes of polyuria except:
a-increased water intake b-acute renal failure c-diabetes mellitus d-diabetes insipidus
18-which statement is not true :
a-normally urine is more concentrated than plasma
b-urine osmolality is an indicator of ! ability of kidney to concentrate urinec-normally serum osmolality /urine osmolality is higher than 3
d-increase secretion of AVP leads to urine wz high osmolality
19-All ! following statements are correct about acute renal failure except:
a-abrubt impairment of renal function occurs but it can be reversed
b-metabolic acidosis is a characteristic biochemical findingc-hypokalemia occurs due to renal tubular damage
d-low creatinine clearance
20-chronic renal failure is characterized by all ! following except:
a-hypophosphatemia b-hypocalcemia c-hyperkalemia d-nucturia
21-Nephrotic syndrome is characterized by all ! following except:
a-2ry hyperlipidemia b-hypocalcemia c-hypergammaglobulinemiad-hyper β & α2 globulinemia e- b & c
22-All ! following are ! consequences of renal tubular damage except :
a-renal tubular acidosis b-aminoacid uria c-hyperphosphatemia d-hypokalemia
23-which statement is correct about fanconi’s syndrome :
a-it is a congenital defect in renal tubules
b-it is a multiple disorder leads to leads to general failure of reabsorption
c-renal tubular acidosis occursd- characterized by phosphaturia & hypouricemia
e-all of ! above
24-Hypertension & polyuria occurs in chronic renal failure due to :
a- water retention b-as !patient retain ! ability to reabsorb Na but renal tubules lose ! ability to reabsorb H2O
c-elevated phosphate level
d-all of ! above e- all except c
25-All ! following are used in ! assessment of tubular function except:
a-specific proteinuria b- urine osmolality c-renal glucosuria d-proteinuria
26-In urinary tract infection ,which statement is incorrect:
a- urine appearance is cloudy
b- formation of ammonium phosphate stones
c-urine is acidic due to increased proton excretion d- Non of ! above
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Clinical biochemistry revision
27-All ! following statements are correct about renal tubular acidosis except :a-occurs as a consequence of fanconi’s syndrome
b-leads to Ca phosphate stone formation
c- decrease ! binding between albumin & Ca so non ionized Ca increased- may be due to a defect of either hydrogen ion secretion in ! distal tubule or bicarbonate reabsorption in !
proximal tubule
e- Non of ! above
28-In chronic renal failure ,all ! following occurs except:a-pateint develops anemia due to erythropoiten deficiency
b- hypophosphatemia occurs due to tubular damage
c-increased ALP activity due to renal osteodystrophyd- hypocalcemia occure due to impaired calcitriol production
II-Mark true or false1 Alkaline urine is found in patients wz urinary tract infections or after ingestion of an alkali T F2-uretheral stones leads to increased serum urea T F
3-In acute renal failure hyperkalemia & metabolic acidosis occurs T F
4-renal artery stenosis & CHF leads to intra renal uremia T F
5- Nucturia occurs in acute renal failure due to inability of kidney to concentrate urine at night T F6- Urine / plasma osmolality ratio should be 1 in normal subjects T F
7-Increase secresion of AVP leads to urine formation wz low osmolality T F
8-! concentrations of serum creatinine & urea are used as convenient, but insensitive measures of !
glomerular functions T F
9-In acute renal failure ! rise in serum urea is more than serum creatinine as urea is reabsorbed at renaltubules T F
10- a normal serum creatinine doesn't necessarily mean all is well T F
11- In diabetes mellitus , polyuria wz low urine osmolality occurs T F12-Urea may be used in clearance measurement as its level is elevated markedly wz a minor change of GFR
13-Creatinine excretion is constant per day & its conc is constant during ! period of urine collection T F
14-Ammonia increase in hepatic coma while uric acid increases due to renal insufficiency T F15- Angiotensin II formed by ! action of rennin on angiotensin I & it has an imp role in aldosterone synthesis
III-Write short notes on ! following statements:1-Causes & consequences of reduced GFR
2-Biochemical findings in chronic renal failure
3-Endocrine function of ! kidney
4-Creatinine is used for clearance measurement but not urea
5-! concentrations of serum creatinine & urea are used as convenient, but insensitive
measures of ! glomerular functions (2006)
6-Biochemical findings in nephrotic syndrome7-Causes & consequences of tubular damage
8-Differential diagnosis between acute & chronic renal failure
9-Classifcation of acute renal failure
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Clinical biochemistry revision
Answers1 6 11 16 21 26
2 7 12 17 22 27
3 8 13 18 23 28
4 9 14 19 24
5 10 15 20 25
1 6 11
2 7 12
3 8 13
4 9 14
5 10 15
Disorders of CHO metabolism I-Choose ! most correct answer:1-All ! following is true about glucose homeostasis except:
a-regulated by insulin in fed state & glucagon in fasting state b-glucose is always maintained in normal levels by suppressing hepatic glucose production in fasting state
c-Insulin antagonist hormones act to increase blood glucose levels in response to hypoglycemia
d- Glucose utilization is stimulated by insulin in fed state
2- Insulin stimulates all ! following except:
a- lipogenesis b-ketogenesis c-protein synthesis d-K & PO4 uptake
3-All ! following are a consequence of long term diabetes except :
a-diabetic foot b-Cataract c-nephropathy d- diabetic ketoacidosis
4- All ! following can be used in ! management of DKA EXCEPT: a-insulin b-sodium carbonate c-potassium chloride d- b & c
5-Insulin overdose can lead to
a-Hypokalemia b-hyperphosphatemia c-Tachycardia d-All e-all except b6-OGTT is done in all ! following condition :
a-if ! diagnosis of diabetes is uncertain b- patients wz borderline fasting BGLc-children wz type I diabetes d- All e -all except c
7- Increased GT occurs in :
a- pancreatic tumour b- hyperfunction of adrenal ,pituitary & thyroid glandsc-obesity d-some infections e-all of ! above
8-Decreased GT occurs in all ! following except :
a-Diabetes mellitus b-liver damage c-insulin overdose d-obesity
9-Impaired glucose tolerance is characterized by :
a- fasting blood glucose level below 140 mg/dl
b- postprandial BGL below 7.8 mmol/Lc- ! patient is at high risk to develop type I diabetesd- negative tests of glucose in urine after 1 hr in OGTT
10- I.V glucose tolerance test is performed in case of :
a- poor absorption of oral glucose b- Patients can not tolerate large amount of CHO (vomiting )
c- Patients wz altered gastric physiology
d- all of ! above
11-Which statement is correct :
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Clinical biochemistry revision
a- presence of KBs in plasma is diagnostic for DM b-Some patients have Diabetes innocence have glucosuria due to increased BGL
c- elderly diabetics have diabetes wzout glucosuria
d-RT for glucose increase in renal glucosuria
12-Patient is diagnosed diabetic in ! following conditions except :
a-fasting BGL is higher than 140 mg % wz a postprandial BGL higher than 200 mg %
b-one of intermediate samples in OGTT is lower than 11.1 mmmol/L
c- normal fasting BGL wz a postprandial BGL higher than 200 mg %d- postprandial BGL excedds 11.1 mmol/L
13-In hypoglycemia ,all ! following occurs except :
a-ACTH & GH secretion increase b- insulin secretion is suppressed b- gluconeogenesis is inhibited c- Tachycardia
14-Hyperglycemic coma can be known by :
a-mydriasis in eye pupil test b-acetone smell in breath c- positive test for KBs in urined-All e- b & c
15-All of ! following are causes of hypoglycemia except :
a-Insulin overdose in type I diabetics b- Cushing syndromec- chronic liver disease d-Hypopitutirism
16-Which statement is incorrect :a-C-peptide level is high in insulinoma
b- C-peptide level determination is done to discover ! cause of hypoglycemiac- In type I diabetes C-peptide level is high to compensate for insulin deficiency
d-In type II diabetes ,C-peptide level is normal or high
17-Hypoglycemia in newborn infants occurs as a consequence of :
a-inborn error of metabolism b-maternal hyperglycemia c-Von Gierk’s disease d-all
18-! Following statements are not true except :
a- HbA1c it is an indicator of blood glucose level during ! previous 4-8 weeks b- HbA1c values of 8-9 % indicates very bad diabetic control
c-albumin has longer t ½ than Hb
d- Fructosamine is ! ketonamine product of non enzymatic glycation of serum proteins esp hemoglubine-serum Fructosamine is an index of BGL for ! previous 1-2 months
19-In type I diabetics ,All ! following occurs except :
a- coma may develops due to insulin overdose
b- plasma c-peptide level is very lowc- strenuous exercise may cause hypoglycemia if mismatched wz insulin dose
d- low level of islet cell antibodies may be observed in some patients
20-Galactosemia is due to deficiency of :
a-glucose-6-phosphatase b-gal-1-P uridyl transferase c-glycogen phosphorylase d-any of ! above
II-Mark true or false1-sever infections in especially in ! pancreas can lead to hypoglycemia2-Von Gierke's disease is caused by lack of glucose-6-Phosphatase in liver & kidney
3-Excercie decrease insulin requirement in type I diabetes
4- plasma C-peptide is high in Insulinoma & low in insulin overdose
5- mydriasis indicates hypoglycemia & Miosis indicates hyperglycemia6-HbA1c is used for long term monitoring of diabetes especially when associated wz hemolytic anemia 7- HbA1c level > 13 % indicates poor diabetic control
8- glucosuria is used as ! first line screening for DM9-Obesity ,liver disease can lead to impaired glucose tolerance
10-OGTT is done in children wz type I diabetes
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Clinical biochemistry revision
11-Hyperinsulinemia leads to decreased glucose tolerance
12- plasma C-peptide is a measure of endogenous insulin
13- postprandial BGL higher than 200 mg/dl indicates diabetic patient even if fasting BGL is normal
14- primary diabetes may result from pancreatic disease or Cushing syndrome
15-! Concentration of ! glycated protein badly reflects ! mean BGL during !half life of that protein as !
glycation Rn is reversible
III-Write short notes on ! following statements:1- HbA1C is used in long term monitoring of blood glucose level (2006)
2- Long term complications of diabetes mellitus
3- Diabetes mellitus leads to 2ry hypertriglyceridemia & hypercholesterolemia4- Inborn error of metabolism lead to hypoglycemia in neonates
5- OGTT in impaired glucose tolerance
6- Secondary diabetes mellitus7- Weight loss despite of polyphagia occurs in type I diabetes
8- Diabetes mellitus is characterized by polyuria wz high urine osmolality
9- Causes of fasting hypoglycemia10- Differential diagnosis between hypoglycemia due to insulinoma & insulin overdose
11- Differential diagnosis between hypoglycemic & hyperglycemic coma
Answers1 6 11 16
2 7 12 17
3 8 13 18
4 9 14 19
5 10 15 20
1 6 11
2 7 123 8 13
4 9 14
5 10 15
Molecular biology1-Illustrate by diagram ! steps of PCR ************2-IIlustrate by diagrams ! steps of DNA clonig in bacteria ***3-in brief how to proceed to obtain several copies of ! gene of interest (2006) (answer :draw steps of DNA cloning or PCR)4-draw ! lac operon in precence & absence of glucose (2006)
5-How to obtain ! gene of interest to be amplified (answer :by restriction endonuclease,chemical synthesis or reverse transcriptase)
6-essential properties of DNA vector7- Why Restriction endonucleases don't cut Bacterial DNA ?8-Advantages of RCR over recombinant DNA technology9-Uses of Hypridization tequeniques10-Probing DNA11-descripe ! steps of a technique used for detection of a specific DNA sequence(answer :southern blot)
12- Change in genes may regulate gene expression ***********11
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Clinical biochemistry revision
13-Gene rearrangement is a mechanism by which lymphocytes cansynthesize various types of Abs14-Illustrate by drawing Lac operon in ! presence & absence of lactose*****
Disorders of lipid metabolism I-Choose ! most correct answer:1-Familial hyperbetalipoproteinemia is characterized by :
a-Eruptive xansoma
b-xanselasma
c-risk for astherosclerosis is not striking
d-LDL & HDL is lower than normal
2-Familial hypertriglyceridemia is characterized by all ! following except :
a-increased levels of VLDL b-LDL & HDL is lower than normal
c- may be secondary to alcoholism
d-! plasma appearance appears turbid wz creamy layer on ! top
3-Familial hypercholesterolemia is characterized by all ! following except:
a- may by heterozygous or homozygous according to ! type of gene mutation
b-classified as type I hyperlipoprotenemia
c- severe atherosclerosis usually develops
d-decreased uptake of LDL due to apo B100 abnormality
e-All of ! above f- b & d
4-Xanthoma develops in all ! following lipoprotein disorders except :
a-Type IIb hyperlipoprotenemia
b-Type III hyperlipoprotenemia
c-Type IV hyperlipoprotenemiad- Mixed hypercholesterolemia
e-Type IIa hyperlipoprotenemia
5-Type V hyperlipoproteinemia is characterized by :
a- Increased beta lipoprotein b-Combined hypercholesterolemia & hypertriglyceridemia
c-Increased risk for severe atherosclerosisd-Xanselasma
e-increased Glucose tolerance
f- all except d g-Non of ! above
6-All of ! following are characteristic for exogenous hypertriglyceridemia except:
a-Caused due to mutation of apo C II gene
b-Eruptive xanthoma is a characteristic sign
c-recurrent episodes of pancreatitis is a common caused-elevated TGs is due to accumulation of CM
e-increased risk for CHD7-Which statement is not true :
a-Abetalipoprotenimia is due complete absence of apo B
b- tangier disease is due to increased catabolism of apo A1
c- remnant removal disease is due to apo E2 deficiencyd-CM & VLDL increase in mixed hypercholesterolemia
8-Which of ! following statements is incorrect :
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a-glycosylation of LDL receptor b- increased synthesis of LDL
c-increased interaction between LDL & LDL receptors
d- insulin resistance secondarily increase uptake of LDLe-Non of ! above
21-Combined hypertriglyceridemia & hypercholesterolemia.is observed in :
a-type IIb hyperlipoproteinemia b-type V hyperlipoproteinemia
c-Type III hyperlipoproteinemia d-Type I hyperlipoproteinemiae- all f-all except d g- b & c22-α-lipoprtotein deficiency is characterized by all ! following except:
a-very low plasma apoA-1 levels which results from increased its rate of catabolism.
b-Only traces of HDL are present in plasma
c-VLDL slightly decreased-excessive phagocytosis of abnormal chylomicrons & VLDL remnants due apo A1 deficiency.
23- About Familial hypobetalipoproteinemia,which statement is incorrect:
a-Chylomicron formation occurs but VLDL slightly decreases
b-LDL decrease markedly while HDL is normalc- !synthesis of Apo B is decreased
d-! patient fails to thrive
24-! incidence of atherosclerosis is apparently not striking in :
a- a-type II hyperlipoproteinemia b-type V hyperlipoproteinemia
c-Type III hyperlipoproteinemia d-Type I hyperlipoproteinemia25-xanthelasma is characteristic sign for :
a-hyperbetalipoproteinema b-hyperbeta-, and hyerprebetalipoproteinemia
c-Familial hypercholestelolemia d-Type II hyperlipoprotenemia e-any of ! above
26-! Following enzymes are important in lipoprotein metabolism :
a-LCAT b-LPL c-Hepatic lipase e-Hormone sensitive lipase d-CETP e-ALL
II-Mark true or false1-! harmful imbalance of high TGs with low HDL levels is associated with obesity2-Eruptive xanthomas are characteristic of hypercholesterolemia
3-Plasma appearance is grossly lipemic in Familial hypercylomicronaemia
4-Recurrent episodes of pancreatitis are common in Type I hyperlipoproteinaemia :5-Type IIa hyperlipoproteinemia characterized by elevated LDL cholesterol with normal triglycerides.6-! ↑ in lipoprotein remnant leads to xanthomas and atherosclerosis of both peripheral and coronary arteries7-Type IV hyperlipoproteinemia is secondary alcoholism, steroid therapy
8-In type II hyperlipoproteinemia there is an increased incidence of glucose intolerance &
hyperuricemia.
9-Xanthomas are frequent in hyperchylomicronemia wz hyper-prebeta lipoproteinamia & ! incidence of
atherosclerosis is apparently striking.10-lipoprotein lipase (LPL) synthesis is activated by insulin, so LPL deficiencies leading to Type I
hyperlipoproteinemia as a secondary outcome of diabetes mellitus.
11-chylomicrons, VLDL, IDL & LDL are absent in plasma in Familial hypobetalipoproteinemia12- A significant elevation in total cholesterol is usually associated with increased HDL.
13-A significant elevation in triglycerides is usually associated with increased VLDL or presence of
chylomicrons. .14- Elevation of CRP is also associated with hypertension, insulin resistance (type II diabetes), and obesity.
15- Tangier disease is associated wz increased incidence of atherosclerosis
16- Type I hyperlipoproteinaemia on standing overnight at 4'C develops creamy layer on ! top
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17 -exogenous hypertriglyceridemia is characterized by Recurrent episodes of pancreatitis
18-HDL prevents LDL oxidation so HDL acts as antioxidant
III-Write short notes on ! following statements:1-Hypercholesterolemia & increased risk of atherosclerosis associated are with uncontrolled diabetes
or hypothyroidism & nephrotic syndrome (2006)2-FH is an inherited disorder comprising 4 different classes of mutation in !LDL receptor gene
3-How do cholesterol & other lipids and lipoproteins affect ! heart (mechanism of atherosclerosis)4-Elevated plasma triglycerides may be troublemakers for the heart
5-Factors suggesting inflammation in ! arteries are proving to demonstrate a higher risk for CHD, even in
people wz abnormal lipids .6-plasma appearance can differentiate between type IIa & typer IIb hyperlipoprotenemia
7-Broad beta disease
Answers
1 6 11 16 21 26
2 7 12 17 22
3 8 13 18 23
4 9 14 19 24
5 10 15 20 25
1 5 9 13 172 6 10 14 183 7 11 154 8 12 16
Disorders of Ca & Mg & PO4 metabolism
I-Choose ! most correct answer:1-All of ! following are characteristics of pseudohypoparathyroidism except :
a-hypocalcemia b-hyper phosphatemia c-PTH is high d-Non of ! above
2-All ! following statements are true about 2ry hyperparathyroidism except:
a- caused by any condition which leads to chronic hypocalcaemia
b- occurs due to vitamin D renal failurec-easily differentiated from 1ry & 3ry hyperparathyroidism as ! serum Ca is low
d-on long standing hypocalcemia is converted to 1ry hyperparathyroidism
3-Which statement is incorrect :
a-in 1ry hyperthyroidism ,hypercalcemia & hypophosphatemia occurs b-steroid suppression test ,suppress elevated Ca level in malignancy
c-Hypercholeremic acidosis is observed in hyperparathyroidismd- serum gamma globulin level is suppressed in malignancye-Non of ! above
4-In differential diagnosis of hypercalcaemia due to malignant tumors ,which statement is not true
a- serum bences jones protein is diagnostic for multiple myeloma b- suppressed α2 globulin levels is due to immunosuppresiion in malignancy
c-increased urine monoclonal proteins diagnostic for multiple myeloma
d-serum PTH is inappropriately high
e- All of ! above
5-1ry hyperparathyroidism is characterized by :
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a- inappropriately high serum PTH for ! decreased serum Ca b-Hypocholerimic alkalosis
c-hyperphosphatemia
d- serum Ca is not suppressed by steroid administration
6-Which statement is correct :
a-increased αl- & α2-globulins is diagnostic for acute phase reaction that often present wz malignancy.
b-negative steroid suppression test is diagnostic for hypercalcemia due to 1ry hyperparathyroidism
c-increased serum paraproteins is diagnostic for multiple myelomad- all of ! above
7-Hypocalcemia & hyperphosphatemia occurs in :
a-3ry hyperparathyroidism b-2ry hyperparathyroidism c-1ry hyperparathyroidismd-all of ! above e-all exept c
8-All ! following statement are true about paget’s disease except:
a- It is disease of ! older subjects. b-Raised serum ALP
c- Normal serum calcium & phosphate
d-affects ! entire skeleton
9-Osteomalicia is characterized by all ! following except
a-! reduction in ! amount of bony tissue relative to !volume of anatomical bone b-Vit D defeicency
c. low serum calcium.d Low serum phosphate
e-non of ! above
10-All ! following statement are true about osteoporosis except:
a-occurs in Severe thyrotoxicosis
b- It is ! reduction in ! mineralization of previously formed bony tissue in adults
c-occurs 2ry to Cushing's syndromed-occurs due to hyperparathyroidism due to increased bone resorption
e-postmenopausal women are at high risk for developing it
11- All ! following statement are not true about Vitamin D resistance except :a-occurs due to Inadequate exposure to sunlight
b- Dietary deficiency is a causative factor
c-occurs in chronic liver diseases & vit D dependent rickets
d-leads to marked hyperphosphatemia
12-Among biochemical findings in hypoparathyroidism
a-low serum Ca b-undetectable PTH c-hyperphosphatemia d- All13-differentiatial diagnosis between hypoparathyroidism & pseudo hypoparathyroidism
a- serum PTH is high in pseudo hypoparathyroidism
b-serum Ca is low in both
c-serum phosphate is elevated in pseudo hypoparathyroidism but decrease in hypoparathyroidism
d- Non of ! above is true14- differential diagnosis between 1ry hyperparathyroidism & 3ry hyperparathyroidism
a-pateint history of previous hypocalcemia is diagnostic for 3ry hyperparathyroidism b-PTH is high in both
c- serum Ca is high in both
d-All of ! above
15-pateint wz total Ca of 2 mmol/L & albumin level of 50 g/L so ! corrected total Ca is equal to a- 1.8 mmol/L b- 2.2 mmol/L c-2.4 mol/L d-Non of ! above
16- pateint wz total Ca of 2 mmol/L & albumin level of 30 g/L so ! corrected total Ca is equal to
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a- a- 1.8 mmol/L b- 2.2 mmol/L c-2.4 mol/L d-Non of ! above
17-HyperCalecmia & Hypophosphatemia wz inappropriately high PTH is diagnostic for
a-Malignancy b-2ry hyperparathyroidism c-1ry hypepararthyroidism d-
thyrotoxicosis
18-Hypercalcemia in ! precence pf undetectable of PTH excludes :
a- Malignancy b-2ry hyperparathyroidism c-1ry hypepararthyroidism d-thyrotoxicosis e-b&c
19-Hypocalcemia may be due to
a-acute pancreatitis b-Acidosis d-Hyperparathyroidism c-Vit D intoxication20- Among causes of primary osteoporosis :
a-Cushing syndrome b-alcoholism c- hyperthyroidism d-bone metastasis
e-all of ! above f-Non of ! above
II-Mark true or false1- Total calcium should always be corrected for ! albumin changes2- When albumin concentration decrease ,! Corrected Ca is lower than ! measured total Ca
3- In familial hypocalciuric hypercalcemia ,PTH level is low due to elevated serum Ca
4- Positive steroid suppression test is confirmatory in ! diagnosis of hypercalcemia due to malignancy
5- In Chronic liver diseases ,osteomalicia may occur due to Impaired production of active vitamin Dmetabolites
6- In paget’s disease ,ALP is markedly high & hypercalcemia is observed
7- Hypermagnesemia & hypophosphatemia occurs in renal failure8- Calcitonin inhibits bone resorption so its action is antagonistic to PTH action on bone
9- Hyperthyroidism can lead to osteoporosis due to increased bone turn over rate
10- Tetany may be observed in Ca or Mg deficiency11- Increased serum paraprotein & urine bence jones protein is characteristic for multiple myeloma
12- Hypocholerimic alkalosis occurs in 1ry hyperparathyroidism
13- Parentral nutrition with insulin and glucose for treatment of diabetic coma leads to
hypophosphataemia & hyperkalemia14- primary hyperaldosteronism leads to hypokalemia & hypomagnesemia
15- Hypoparathroidism leads to hypocalcemia & hypophosphatemia
16- In osteoporosis ! volume of bony tissue relative to ! volume of anatomical bone is generally normalor even increased
III-Write short notes on ! following statements:1- diagnosis of hypercalcaemia due to malignant tumors (2006)
2-Severe thyrotoxicosis leads to hypercalcemia
3-differentil diagnosis between 1ry & 3ry hyperparathyroidism
4-Parentral nutrition with insulin and glucose for treatment of diabetic coma leads to
hypophosphataemia
5-Factors that lead to Vitamin D resistance
6-types of hyperparathyroidism7-differentil diagnosis between 1ry & 3ry hyperparathyroidism
8-Outline ! biochemical defect in ! following diseases :
a-Osteoporosis b-osteomalicia c-Paget’s disease
d-Fanconi’s syndrome e-Pseudohypoparathyroidism
Answers
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1 6 11 16
2 7 12 17
3 8 13 18
4 9 14 19
5 10 15 20
1 5 9 132 6 10 143 7 11 154 8 12 16
Organize your informations1) Hypercalcaemia associated with hypophosphataemia
a. Primary hyperparathyroidism:
b. Tertiary hyperparathyroidism:
2)Hypercalcaemia associated with hyperphosphataemia
hypercalcemia due to malignancy
3)Hypocalcaemia associated with hypophosphataemia
2ry hyperparathyroidism
4)Hypocalcaemia associated with hyperphosphataemia
1ry hypoparathyroidism or Pseudo-hypoparathyroidism
Disorders of ! Endocrine system I-Mark true or false1- Insulin stress test is carried out when hypopituitarism is suspected. T F2--Synacthen tests are used for detection of 1ry or 2ry adrenal insufficiency T F
3-Oral glucose tolerance test used to investigate ACTH response in Cushing syndrome T F
4- low dose dexamethasone suppression test are important in ! investigation of differential diagnosis of !
cause of Cushing syndrome T F5-Elderly patients wz Pituitary Insufficiency have symptoms of LH & FSH deficiency T F
6-!GH response to stimulation requires ! Presence of sex hormones during puberty & hypogonadism T F
7--IGF-I is produced in response to GH & used for diagnosis & monitoring for treatment of acromegaly T F
8-ACTH increased in ACTH-driven Cushing disease & In secondary adrenal cortical deficiency T F9-ACTH ,GH & prolactin secretion increase by stress T F
10-Congenital adrenal hyperplasia leads to severe hypernatraemia & hypokalaemia T F11-Primary adrenal insufficiency is due to ! defect in ! adrenal gland & plasma ACTH is high T F
12-Failure of adrenal cortisol response in synacthen test is an index of secondary adrenocortical failure T F
13-In Cushing syndrome due to ectopic ACTH production ,in high dose dexamethazone test cortisol level is
not suppressed T F14-in Pituitary dependent Cushing syndrome Plasma ACTH normal or high T F
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15-Urinary cortisol/creatinine ratio is high in Cushing syndrome & can used in differential diagnosis of itscause T F
16- elevated plasma TSH levels is diagnostic for Primary hypothyrodism T F
17-In T3 thyrotoxicosis total T4 is found normal but have T3 levels is high T F18-Hypergonadotrophic hypogonadism is due to testicular deficiency in males of ovarian failure in females
19-In kallmann's syndrome both gonadotrophins or only LH, is high T F
20-In testicular feminization syndrome , androgen receptors are inactive and/or 5α-reducase is deficient
21-Cushing 's syndrome can lead to Subfertiliy in females T F
II-Write short notes on ! following statements:1-Androgen screen in women (2006)
2-Why a single blood hormone measurement may have little clinical value ? (2006)
3-Hyperprolactenemia is a complication of primary hypothyroidism4-Total T4 concentration in serum sample doesn't always reflect metabolic status
5-Clinical presentation of Pituitary Insufficiency depends on ! age of ! patients
6-Differential diagnosis of growth hormone insufficiency
7-Factors regulating Growth hormone secretion
8- mechanisms that influence CRH secretion9-Causes of Cushing syndrome & its differential diagnosis
10-Differential diagnosis for acromegaly
11- Differential diagnosis for 1ry & secondary adrenal insufficiency
12-Outline ! biochemical defect in ! following diseases
a-Grave’s disease b-Conn’s syndrome c-Addison’s disease
d-Cushing syndrome e-Subfertility in women
f-Hypogonadotrophic hypogonadism in males
g- Congenital adrenal hyperplasia e- Acromegaly
h-testicular feminization syndrome
i- Isolated aldosterone deficiency1 6 11 16 21
2 7 12 17
3 8 13 18
4 9 14 19
5 10 15 20
Disorders of protein metabolism I-Mark true or false
1-Hypoproteinemia is always due to hypoalbuminemia but hyperproteinemia is usually due to increase oneor more of immunoglobulins T F
2-hypoalbuminemia is associated wz hypocalcaemia & oedema T F
3-Hemodilution lowers plasma albumin concentration but A/G ratio unaffected T F4-! most sensitive indicator of acute phase reaction is ! rise in CRP level T F
5-An increase in ESR is accompanied by decrease in plasma fibrinogen T F
6-In cirrhosis elevation in both γ & β-globulins & fusion of these bands due to↑ synthesis of IgG T F 7- Transferrin & Hemopexin are type of α2 globulins T F
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8-Mousy (musty)odour of urine is characteristic for PKU but fish smell of urine is characteristic for mypermethionenimia T F
9-CRP is increase after 24 hrs of AMI T F
II-Write short notes on ! following statements:1-Outline ! biochemical defect in ! following diseases
a-Alkaptonuria b-Phenylketonuria c-primary hyperoxaluria
d-Homocysteinuria e-Cystin-lysinuria f- Hartnupdiseaseg-Maple serum urine disease h-Albinism
2-Nephrotic syndrome leads to oedema (2006)
3-a lady found that her napkin has dark colored urine.COMMENT (2006)
(answer :write alkaptonuria)
4-Alpha 1 antitrypsin deficiency leads to emphysema
5-Overflow of filtered (low molecular mass) proteins may cause proteinuria
6-Mechanisms of proteinuria
7-Unusual smell of urine can indicate ! type of amino acid metabolic disorder
8-Write ! functions & reason for assay of ! following proteins
a- α1-antitrypsin b-α1-feto protein c-α2-macroglobin
d- C-reactive protein (CRP) e-Haptoglobin f-IgA g-IgG h-fibrinogen
9-Outline ! change in serum protein electrophoretic pattern in each of ! following
a-Cirrhosis b-Acute phase reaction c-hypogammaglobulinemia
d-Chronic hepatitis e-nephrotic syndrome
Answers
1 5 9 13
2 6 10 143 7 11 154 8 12 16
Clinical enzymology
Write short notes on ! following statements:1-Cardiac troponins & myoglobin are used as Non enzymatic indicators for AMI (2006)
2-Estimation of serum ALP activity alone is of limited value in bone disease
3-ALP level pathologically Increase in liver or bone disease,How to make differential
diagnosis ?4-GGT is sensitive but not specific indicator for liver disease
5-Clinical importance of LDH isoenzymes in diagnosis of AMI
6--Laboratory tests for acute pancreatitis
7-diagnosis of Pancreatic carcinoma
8- Difficulties in using enzymes as markers for management of cancer
9-Differential diagnosis between infective hepatitis & hepatic tumor
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