clinical biochemisclinical revision

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

1




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

2




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

3




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

4




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

5




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


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

6




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

7




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

8




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 :

9




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

10




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




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 :

12




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

14




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


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 :

15




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

16




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

17




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

18




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

19




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

20

clinical biochemisclinical revision

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