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Clinical & Chemical Pathology MCQs

Classified, Reorganized And Updated To Shawual 1425 With Short Notes


By Dr Mohammad A. Emam

Contents
Body fluids ................................................................................. 2
Clinical Chemistry .................................................................... 5
INSTRUMENTATION AND GENERAL ......................................................................................5
BLOOD GASES, PH AND ELECTROLYTES. .............................................................................8
GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. .............................................................12
CALCULATIONS, QC AND STATISTICS ................................................................................17
CREATININE, UA, BUN AND AMMONIA ...............................................................................19
PROTEINS, ELECTROPHORESIS AND LIPIDS .......................................................................20
CLINICAL ENZYMOLOGY........................................................................................................24
CLINICAL ENCOCRINOLOGY .................................................................................................26

General ..................................................................................... 32
Hematology .............................................................................. 35
BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES ................................35
NORMOCYTIC NORMOCHROMIC ANEMIAS .......................................................................38
HYPOCHROMIC MICROCYTIC ANEMIAS .............................................................................45
MACROCYTIC NORMOCHROMIC ANEMIA .........................................................................47
QUALITATIVE / QUANTITATIVE WBC DISOREDERS ........................................................49
LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS .................................52
COAGULATION AND PLATELETS ..........................................................................................62

Immunohematology ................................................................ 68
Immunology ............................................................................. 74
Microbiology............................................................................ 79
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION .....................79
BASIC TECHNIQUES .................................................................................................................82
BASIC BACTERIOLOGY............................................................................................................86
GRAM POSITIVE COCCI ...........................................................................................................90
GRAM NEGATIVE COCCI .........................................................................................................94
GRAM POSITIVE BACILLI ........................................................................................................95
ENTEROBACTERECIAE & PSEUDOMONAS .........................................................................96
RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA ...........................................................102
SPIROCHETES ...........................................................................................................................103
BORDETELLA & BORRELIA ..................................................................................................104
ANEROBIC BACTERIA ............................................................................................................105
BRUCELLA ................................................................................................................................106
MYCOBACTERIA .....................................................................................................................107
MISCELLANEOUS ....................................................................................................................108
MYCOLOGY ..............................................................................................................................111
PARASITOLOGY .......................................................................................................................112
VIROLOGY ................................................................................................................................118

5/3/2014

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CLINICAL & CHEMICAL PATHOLOGY MCQ

BODY FLUIDS

Body fluids
1

****Doctor sending a sample requesting for lecithin


spingomyelin ratio what is the sample?
a. Blood.
b. CSF
c. Amniotic fluid.
d. Urine

1.

(c) Amniotic fluid sample is used to measure


lecithin: sphingomyelin ratio (L/S). L/S > 2:1
(or 2.5:1) denotes acceptable lung maturity.

dipalmitoyl lecithin

lung surfactant consists of


2.

***Cytological examination of pleural effusion in a 60 yrs


old man revealed the presence of malignant cells. The
most likely primary tumor will be:
a. Lymphoma.
b. Mesothelioma.
c. Cancer colon.
d. lung cancer.

2.

(d) Lung cancer: 75% of malignant pulmonary


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

3.

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

3.

(c) Commercial strips for detecting albumin


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

**high protein with xanthochromia in csf


a. viral meningitis
b.T.B
c. Encephalitis
d.spinal canal obstruction
e. acute water intoxication
f. mid brain tumor

patient 35 years old loss of weight ,CSF examination


shows normal protein and decreased glucose
TLC in CSF 280 , increase protein content , decrease
glucose, loss of weight
a. bacterial infection
b.viral infection
c. fungal infection
d.T.B

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d.Froin's syndrome coexistence of


xanthochromia, high protein level and marked
coagulation of cerebrospinal fluid (CSF). It is
caused by meningeal irritation (e.g. during
spinal meningitis) and CSF flow blockage by
tumour mass or abscess.[1] Stagnation of the
CSF within the thecal sac facilitates exudation
from the tumour itself and activation of
coagulation factors.
The commonest causes are:
advanced spinal tumour
spinal meningitis
T.B

d.

CLINICAL & CHEMICAL PATHOLOGY MCQ

BODY FLUIDS

oligoclonal band in CSF

multiple sclerosis
4.

****Which is not a reducing sugar in urine?


a. Glucose.
b. Galactose.
c. Sucrose.
d. Fructose.

4.

(c) A reducing substance is the one that reduces


alkaline cupric sulfate to red coprous oxide.
Most important are glucose, lactose, fructose,
galactoses and pentoses (e.g. ribose, xylose and
arabinose) while sucrose will not reduce alkaline
cupric sulfate.

5.

***Red urine is due to?


a. INH
b. Rifampicin
c. Pyrizinamide.

5.

b. Rifampicin is a well known drug to cause red


urine.

6.

***Urine strips detect all except

6.

Fat droplets. Occur with glomerulonephritis and


nephritic syndrome but are not detected by the
routine urine strips.

7.

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

7.

Urea. The most labile constituent of urine is


urea. Bacterial action decrease urea and increase
ammonia and pH.

8.

**Abnormal constituent of urine includes?


a. Urea
b. Glucose
c. Cholesterol.
d. Uric acid
e. Protein.

8.

(c) Although also glucose and protein are


abnormal constituents of urine, yet they
normally present in trace amounts below the
detection limit of ordinary methods.

presence one from this substance in urine detect abnormal


codition;
a. calcium
b.phosphates
c. glucose
d.urates

c.normal urine constituent NA, CL , urea uric


creat, a.a. , ammonia, traces of protein, enzyme,
glycoprotein , purine, K,P. sulphate, bil., vit.
,hormones, Hb ,porphyrons.

protein normal present in urine


a. albumin
b.alpha globulin
c. beta globulin
d.bence jones protein

a.

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CLINICAL & CHEMICAL PATHOLOGY MCQ

BODY FLUIDS

9.

****Calcium in urine stone is present in all of the


following except:
a. UTI
b. Secondary hyperparathyroidism.

9.

(b) In 2ry hyperparathyroidism, hypocalcemia


due to e.g. chronic renal failure is the cause of
increased parathormone. Stones due to
hyperparathyroidism only occur with the 1ry or
3ry disease.
Calcium is precipitated in stones with oxalate (at
acid or neutral pH), or less commonly with urate
(at acidic pH) or with phosphate (at normal urine
pH). Causes of hypercalciurea include:
- intestinal calcium absorption (P level
vit DCa absorption Or in case of
hypervitaminosis D.
- Lack of renal tubular reabsorption e.g. with
furosamide.
- Loss of Ca from bone (due to mobilization
as in 1ry & 3ry hyperparathyroidism, due to
bone destruction or due to Cushing's and
thyrotoxicosis)
Otherwise, UTI causes stones at alkaline pH
where ammonium is high and mixed stones form
due to obstructing Ca stone which favors
infection and precipitation of ammonia salts.

10.

If urine is kept for a long time:


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

10.

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

11.

**Myoglobinuria is seen in:

11.

Muscle injury (also known as rhabdomyolysis)


e.g. in cases of crush injuries and strenuous
exercise.

***fluid with inflammatory cells, high ptn content & high


specific gravity
a. exudate
b.transudate

a.

***semen analysis absent fructose vol 4 ml


a. teratoma
b.chronic TB epididymitis
c.

c.

a semen specimen, contain sugar source of the


spermatozoa energy is:
a. glucose
b.mannose
c. glactose
d.fructose
e. sucrose

d.

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

Clinical Chemistry
INSTRUMENTATION AND GENERAL
1.

******Difference between ELISA & RIA is ?


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

1.

(a) Both techniques apply almost the same


methodology, .ELISA technique uses an enzyme
label and RIA uses radioisotopic label.

2.

**The label in ELISA is?


a. Enzyme
b. Antibody
c. Antigen.

2.

a.

3.

***Which of the following not seen in chemistry lab?


a. Analytic balance.
b. Centrifuge
c. Spectrophotometer
d. Electron microscope,
e. Turbidimeter.

3.

(d) Electron microscope.

4.

***The washing is must in all heterogenous ELISA


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

4.

(b) In ELISA, the first washing is used to


remove the unbound (free) sample antigen. The
second washing removes unreacted free label
(not excess binding in either of the 2 washings)
If washing is not complete, this will false high
specificity.
If the question comes as It avoids excess
binding, then this will be the choice.

5.

***The enzyme in ELISA is present in the?


a. Conjugate
b. Microplate
c. Buffer.

5.

(a) The conjugate is the second antibody


conjugated with the enzyme.

6.

***A standard microplate in an ELISA has?


a. 96 wells
b. 98 wells
c. 92 wells.

6.

(a) 96 wells are present in the microplate (8


rows x 12 columns).of these, 1 is used for the
blank, 2 for the ve controls, 2 for the +ve
controls and 4 for the cutoff control (COC). The
remaining 85 for tests.

7.

**Five ml of a colored solution has an absorbance of


0.500. The absorbance of 10ml of the same colored
solution will be:
a. 1.000
b. 0.500
c. 0.250

7.

(b) According to Beer's law, absorbance is


proportional to the final concentration (whatever
the volume is)

8.

**a dichromatic analysis is carried to increase:


a. Specificity
b. Linearity
c. Sensitivity.

8.

(a) Di- (bi) chromatic photometry measures


absorbance of the sample at 2 different
wavelengths. This corrects for interfering
substances increasing specificity of the method.

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

purpose of standard deviation :


a-to measure external quality control
b-to measure internal quality control
c-precise & accuracy
d-both a & b

d.

during reaction of two chemical substances , the color


produced asses by
a. spectrophotometer
b.flame photometer

a.

one is not found (involve) in colorimetric:


a. cuvett
b.light source
c. photo sensor and analyzer
d.fule source
e. filter

d.

not find in the flam photometry :


a. burner
b.filter
c. fuel source
d.cuvete for sample

d.

use O cell tube on lab for:


a. as control
b.to detect ag
c. to detect ab

a.

this symbol means, when you see in laboratory :


a. acute flammable
b.toxic
c. corrosive
d.explosive

b.

if you see this sign (symbol) in the lab it means:


a. flammable
b.corrosive
c. oxidizing
d.explosive
e. toxic

b.

alkali skin burn treatment by neutralization with:


a. sodium bicarbonate powder
b.boric acid
c. acetic acid 1%
d.cold water
e. hot water

c.check use of cold water in alkali and acid skin


burn

acid skin burn treatment by neutralization with:


a. sodium bicarbonate powder
b.boric acid
c. acetic acid 1%
d.cold water
e. hot water

a. check use of cold water in alkali and acid skin


burn

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

you do not take this stage for tratment small cut in


emergency :
a. clean with soap and water
b.do pressure with piece
c. immediately rinse mouth well and water
d.cover it with water dressing
e. sterilize

d.

latex rubber gloves used for:


a. protect aginst burninig chemicals
b.cleaning benches with disinfectants
c. protect aginst biohazardous materials
d.protect against chemical spills

c.

**an indicator is:


a. chaing color with chaing PH
b.resist acidic PH
c. resist alkaline PH
d.weak acid + weak base
e. strong acid + weak base

a. when it becomes red (acidic)


when it becomes blue (alkaline)

to detect PH from solution use :


a. PH meter
b.indicator
c. micrometer

?(b) and (a)are true

does not affected with slight hemolysis:

cholesterol

substance used in catalyse reaction :

H2O2

wave length visible to naked eye

400-700 nm. (380-750)

heparin is:
a. protein
b.enzyme
c. polysaccharide
d.oligosaccharide
e. non of the above

c.

cosnider ketose:
a. glucose
b.fructose
c. mannose

b.

prolonged fast cause:


a. hyperglycemia
b.keton in urine

b.

pyrimidin base:
a. adenine
b.guanine
c. thymine
d.uric acid
e. urea

c.
2 purine bases (adenine and guanine)
2 pyrimidin bases (thymine and cytosine)

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

purine associated with


a-adenine
b-guanine
c-uric acid
d-RNA

c.?

To get serum

Leave blood to clot before centrefugation

the atomic mass of an atom is the number of:


a. protons and neutrons
b.protons only
c. neutrons only
d.electrons
e. non of the above

a.

constricted pupil caused by


a. heroin
b.
c. methyl alcohol
d.

a.

**fluorescence with ultraviolet


a. coproporphyrin
b.protoporphyrin
c. porphoporphyrin
d.bilirubin

I think this question missed (except) and the


answer is c.

Biochemical reaction 1st occure in xenobiotics


a. Hydroxylation
b.Methylation
c. glucorynation

BLOOD GASES, PH AND ELECTROLYTES.


9.

*******PO2 (or gases) is measure in which unit?


a. Mmol
b. umol
c. mmHg

9.

c.mEq/L (mmol in SI) is used for electrolytes


e.g. BE, bicarbonate and H+. While mmHg (or
kpa in SI) is used for gases e.g. pCO2 and pO2.

11.

Acidemia is associated with

11.

Acid in urine and increased HCO2-.


Increased hydrogen ion in the blood is termed
academia. If the cause is metabolic, there will be
compensatory hyperventilation H+ back to
normal while HCO3- drops. Furthermore, if renal
function is normal, H+ will be excreted.
If the cause is respiratory, renal compensation
will cause H+ excretion and HCO3- retention and
generation lowering H+ back to normal.

12.

***To correct acidosis, the kidneys:


a. secrete more H+ in urine.
b. Synthesis bicarbonate to ECF
c. Both a and b

12.

(c). See 11.

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

13.

***A buffer is made of ?


a. Strong acid & strong salt
b. Strong acid & weak salt
c. Weak acid & strong salt
d. Weak acid & weak salt.

13.

(c) A buffer system is made of a weak acid and


its salt with a strong base of a weak base and its
salt with a strong acid.

e.

buffer solution is:


a. chaing color when chaing PH
b.resist acidic PH
c. resist alkaline PH
d.weak acid + weak base
e. strong acid + weak base
14.

****pH means:

14.

Negative log H+ concentration

15.

****What is the base: acid ratio at pH 7 for acid of pK6?


a. 0.01
b. 0.1
c. 1.0
d. 10
e. 100

15.

(d) According to Henderson Hasselbalch's


equation, pH = pK + Log base/acid. By
compensation, Log (base / acid)= 1, thus base:
acid = 10:1.1

16.

*****Which is more serious?


a. Glucose 15mmol/l
b. pH 7.25 acidosis.
c. Potassium 1.5 mmol/l
d. Sodium 150 mmol/l

16.

(c) Critical K+ values are <2.5 or > 6.5 mEq/L


Critical glucose <40mg or >450mg (2.2 &
25mmol respectively),
critical pH <7.2 or >2.6
critical Na+ <120 or > 160mEq/L

17.

******Metabolic acidosis can result from:

17.

(a) Ingestion of certain medicines or chemicals


e.g. metformin.(glucophage).
Metformin causes lactic acidosis.
Generally, metabolic acidosis is due to either
addition of H+ (AG), excretion of H+ or
loss of HCO3-

18.

pH of the blood.

18.

7.35 to 7.45

19

Acid base balance.

19

19.

H+ homeostasis is altered by;


a. Excessive change of pyruvate to lactate.

19.

New

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New

In actively contracting muscle, 8% of the


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

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

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

***Main extracellular ions?


a. Na & K
b. Na & Cl
**Main electrolyte in blood is?
***Electrolytes in ECF
a. Na is a major cation
b. Cl is a major cation
d. HCO3 is a major anion.
***Main intracellular cation is;
**In serum:
a. Sodium is the main cation.
b. Bicarbonate.
***Intracellular fluid contains:
a. More potassium less sodium than extracellular fluid..
b. Sodium and potassium in equal amount.

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

b. Na is the major ECF cation, Cl is the major


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

Na is the main?
a. intra cellular anion
b.intra cellular cation
c. extra cellular cation

c.

the normal value of (Na) in serum is?


a. 135-145 mg/dl
b.135-145 mmol/dl
c. 135-145 mmol/l

c.

23.

**All causes renal damage except

23.

27.

Renal tubular injury occurs in

27.

28.

Hypernatremia occurs with


a. Cushing disease
b. Dehydration
c. hypothalamic injury
d. All of the above

28.

Hypocalcaemia.
Causes of renal damage include; hypovolemia
(hemorrhage or dehydration), myoglobulinurea,
hypercalciurea, uricosuria, and drugs e.g.
aminoglycosides and ACE inhibitors.
See 23.
(d) Hypernatremia occurs with:
* body Na : due to extrarenal water loss or
renal diuresis.
* Normal body Na: due to extrarenal loss e.g.
hyperthermia or renal loss e.g. DI.
* Na retention e.g. steroids or Na intake.

elevated sodium &chloride is seen in?


a. shock
b.diabetic acidosis
c. severe dehydration

c.

hyperkalemia all except


a. resp failure
b.
c.
d.

c.causes hypokalemia

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

28.
New
1

28.
New
2

28.
New
3

**Regarding concentration of urine;


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

28.

Regarding excretion of Na+


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

28.

Regarding buffer systems;


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

28.

the most important buffer system in blood is?


a. acetic acid system
b.hemoglobin system
c. bicarbonates system

New1

New
2

New
3

a. Approximately 80% of the water and NaCl


contenet together with glucose, phosphate, and
amino acids are reabsorbed in the proximal
tubule. About 20% of the tubular fluid enters the
loop of Henle where water is passively aborbed;
6ml per minute of concentrated tubular fluid
now enters the distal tubule, where there is an
active reabsorption of sodium. The fluid leaves
the distal tubule at a rate of approximately 1ml
per minute passing into the collecting ducts in
the form of urine. Aldosteron is relased due to
ineffective arterial pressure in the kidney. It
causes sodium reabsorption which raises plasma
osmolality. ADH increases permeability of distal
and collecting tubules to water urine
concentration.
b. Na+ excretion is influenced by
mineralocorticoids (mainly aldosterone):
reabsorption. The GF is isoosmolar with plasma
i.e. Na is the major electrolyte. 90% of Na is
actively (not passively) reabsorbed in the PCT.
K is excreted from DCT in exchange with Na
(not the reverse and not coupled with it).

b. Acids are substances that tare capable of


donating protons. When a strong acid is added to
a buffer, the salt reacts with the acid forming
weak acid, and its salt (not base).
c.

one is not true about acid:


a. proton donor
b.turn litmus paper to blue
c. sour taste
d.react with alkaline to give water and salt
e. non of the above

b.acid turns litmus paper to red

**prolonged application of tourniquet venous stasis

increased calcium level

**ammonium chloride causes acidosis due to


a. ammonium chloride is a strong acid
b.ammonium chloride is metabolized in to strong acid
c. ammonium chloride is metabolized in to urea which is
strong acid
d.all of the above

b.converted by liver to urea and HCL


librating H & Cl

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CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

patient done sever exercise, headache, weakness, blood


pressure normal what is the cause
a. serum Na < 140 mmol
b.urine Na < 20
c. urine K < 20
d.serum K > 4.5

c.?
Potassium, serum: 3.5 - 5.0 mEq/L
Urine K 25-125 mmol/L
Sodium, serum: 135-145 mEq/L
Sodium, urine: 40-220 mEq/day

PH 7.6 , PCO2 50 , HCO3 50

metabolic alkalosis
blood gases

GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN.


10.

29.

30.

Factors affecting glucose level in blood include:

10.

Adrenaline, T4. These together with cortisol, GH


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

random blood glucose gives an idea?


a. to justify blood glucose
b.fasting patient
c. blood glucose in urgent cases

c.

insulin is regulating blood sugar by?


a. increase the influx of glucose into cells
b.activate glycogensis
c. all the previous

c.

**Glucose level to diagnose hypoglycemia in newborn is.

29.

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

normal glucose level

70 - 140 (random)

**comma of diabetic patient shows?


a. glucose grater than 200mg/dl
b.glucose less than 200mg/dl
c. glucose grater than 50mg/dl
d.glucose less than 50mg/dl

d.

diabetic keto acidosis.which is wrong


a. Hb=18 g/l
b.glocuse more than 15mmol
c. hyperkalemia

a.

***About GTT, which is correct according to WHO


recommendations?
a. Should not be done in pregnant women,
b. Should not be done after giving heavy carbohydrate
diet for 3 days.
c. Should be done after 4-6 hrs fasting.
for GGT in adults the dose of glucose is?
a. 50gram
b.100gram
c. 75gram

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30.

(c) WHO recommendations for GTT include:

c.

12

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

31.

for GGT in children the dose of glucose is?


a. 30mg
b.15gram
c. 30gram
d.non of above

d.for children the dose is 1.75 gm/kg max. 75gm

According to WHO may be performed

Using a mixture of glucose and polysaccarides

for glucose tolerance test?


a. collect 5 blood samples only
b.collect 5 urin samples only
c. collect 5 blood samples + 5 urine samples

c.

****With age renal threshold for glucose?


a. Increased
b. Decreased
c. Not changed

31.

a. is the true answer (important)

d.

sugar can not be detected in urine using copper reduction


test
a-fructose
b-galactose
c-arabinose
d-sucrose
32.

***All are inborn error of glycogen metabolism except?


All due to charbohydrate metabolism defect except
a. Essential fructosuria
b. Phenyl ketonuria
c. Galactosemia
d. Glycogen storage disease

32.

(b) Essential fructosuria is due to aldolase B defect


leading to accumulation of fructose-1-P
Galactosemia (serious) is due to decreased
Galactose-6-P uridyl transferase leading to
decreased glycogen synthesis.
Types of glycogen storage diseases (GSD) include:
**Type I (VonGierke's): G6P
Type II (Pompe's): lysosomal maltase
Type III (Cori's) : debranching enzyme.
Type IV (Anderson's): Absent debranching
enzyme
Type V (McArdle's): muscles
phosphorylation.

33.

*****HBA1c (Glycosylated hemoglobin) is?


a. Not present in healthy normal individuals.
b. in prolonged sustained hyperglycemia

33.

(b) GlycHb (RR 4-6%) is formed by non


enzymatic attachment of glucose to N-terminal
valine of B-chain of Hb. Three types occur, HbA1a,
HbA1b, HbA1c, Both total and HbA1a are used.
Time averaged blood glucose = GlycHbx33.3-86
(mg/dL)
GlycHb reflects 8-12 weeks of blood glucose
while fructosamine reflects 2-4 weeks.
long term follow up

HbA1C of diabetic patient is important for


34.

***Glycogen differs from starch in:


storage form of glucose

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34.

It is a highly branched structure


glycogen

13

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

glycogen is stored in?


a. liver
b. muscles
c. all the previous

c.

in which substance give blood glucose when hydrolysis :


a. muscle and liver glycogen
b.heart glycogen
c. unsaturated fat
d.triglyceride

a.

Galactosemia is due to diffeciency of

Galactose-1- phosphate uridyl transferase

35.

**Cellulose is not metabolized in humans because of


absence of which enzyme?

35.

36.

***Xylose test is done to detect the function of:


a. Stomach.
b. Pancreas.
c. Upper small intestine.
d. Lower small intestine.
e. Large intestine

36.

Glucose units in cellulose are combined by


cellobiose bridges. These are hydrolyzed by
cellobiase which is lacking in animal and human
gut.
c. Xylose is absorbed from proximal small
intestine independent on pancreas..
detects upper small intestine defect

lipase

most specific enzyme to detect pancreatitis is


37.

*****Von Gerke's disease is caused by deficiency of:


a. Glucose 6 phosphatase
b. Glucose 6 phosphate dehydrogenase

37.

(a) See 32.

38.

What happens if sucrose is given parentrally:

38.

It will be secreted unchanged or metabolized


c.

hydrolysis of sucrose result:


a. only glucose
b.galactose
c. fructose + glucose
d.glucose + glucose
e. maltose + glucose
39.

***Which of these is not a ketone body?


a. Acetone.
b. Acetoacetic acid.
c. Butyric acid.
d. B-hydroxy butyric acid.
e. None of the above.

39.

(c) Ketone bodies are formed by condensation of 2


acetyl Co A Acetoacetic acid which gives B
hydroxyl butyric acid by reduction or acetone by
decarboxylation.
Butyric acid is a fatty acid

found in hyperglycemic coma

(ketones in urine)

acute diabetic patient has?


a.blood sugar more than 150mg/dl
b.blood sugar more than 180mg/dl
c.glucose & acetone in urine

c.?

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14

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

diabetic patient has one of the following symptoms?


a. acidosis
b.alkalosis
c. dryness
d.all of above

d.?

one of the above not present in diabetic mellitus coma :


a. hyperglycemia
b.hypercholesterolemia
c. high number of ketene in urine
d.non of the above

b.

glycolysis done in :
a. nucleus
b.endoplasmic reticulum
c. mitochondrion
d.cytoplasm
e. non of the above

d.is the most propable answer (some sources say in


mitochondria and other in cytoplasm)

the most source of ATP in cell is :


a. mitochondria
b.cytoplasm
c. nucleus
d.cell wall

a.

40.

***In Gaucher's disease;


a. Glycoprotein is accumulated.
b. Glucocerebrosidase is deficient.

40.

(b) Gaucher's is a glucosylceramide lipidosis


(lysosomal storage disease). It is caused by
glucocerebrosidase enzyme leading to
accumulation of glucosylceramide HSM and
pigmentation of exposed parts.

41.

Bile duct obstruction can be diagnosed by:


a. AST
b. T. Bilirubin
c. Bilirubin in urine
d. Ester bilirubin

41.

(c) Cholestatic hyperbilirubinemia is characterized


by conjugated hyperbilirubinemia and
hyperbilirubinuria (only the conjugated fraction
appears in urine).

d.

**test used to diagnose obstructive bile duct


a-bilirubin
b-biliverdin
c-urobilinogen
d-ALP
e-none of the above
42.

*** Increased jaundice is diagnosis by


a. T. bilirubin
b. AST
c. ALT
d. ALP

42.

(a) Estimation of jaundice depends on serum


bilirubin, other mentioned tests help to identify the
cause of jaundice.

**AST (SGOT)

best for diagnosing both liver


damage & myocardial infarction

ALT (SGPT)
*specific diagnostic liver enzyme:SGPT

increase only in liver damage, not in myocardial


infarction

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15

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

the normal value of billrubin is?


a. 0.2-2.0mg/dl
b. less than 2.0mg/dl
c. less than 1.0mg/dl

c.

one jaundice patient has yellow skin, his billrubin is:


a. 2.5mg/dl
b. 1.2mg/dl
c. 5.0mg/dl

c.more than 3

causes of high serum bilirubin are?


a. overload on liver
b. haemolysis
c. all of the previous

c.

all of the following can asses the liver function except :a-AST
b-ALT
c-ALP
d-creatinine

d.

which of the following is liver function test?


a. liver enzymes
b. serum + urine billrubin
c. all of the previous

c.

to check the intestinal efficacy the following test is done?


a. pepsin
b. lipase
c. stool fats

c.

portal hypertension, splenomegaly,ERCP shows occlusion


in portal vein
a. venoocclusive disease
b.budd chiari syndrome

b.venoocclusive disease affect small veins

which of the following is protected from light :


light effects one of the following:
a-bilirubin
b-cholesterol
c-total protein
d-BUN ( blood urea nitrogen )

a.

case of 40y patient with fever, jaundice, pain in RT


hypochondrium, on examination gall bladder not palpable
increased T.bil, D.bil, LDH & Hb 8
a. acute cholycystitis
b.chronic cholycystitis
c. bile duct stone
d.cancer head of pancrease

c.? not sure

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16

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

Patient with G6PD take medication cause haemolysis


symptoms include all except
a. Palor
b.Abdominal pain
c. Dark urine
d.Hypertension

d.

in case of hemolytic jaundice one is not likely to be found:


a. total bilirubin is elevated
b.high bilirubin in urine
c. no chaing in color of urine
d.direct bilirubin is within the normal
e. normal color of stool

b.and (e)

in case of obstructive jaundice one is commonly not found:


a. total bilirubin is elevated
b.high bilirubin in urine
c. direct bilirubin is within the normal
d.dark color of urine
e. clay color of stool

c.

CALCULATIONS, QC AND STATISTICS


43.

**Most of the concentration are calculated using factor,


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

43.

(b) For methods obeying Beer's law, slope of the


calibration curve (Cs/As) provides a constant to
calculate the unknown concentration. Also
depending on the formula:
At x Cs = As x Ct, thus, Ct=(Cs/As)x As

44.

**Ten microliters are?


a. 0.01 L
b., 0.001 L
c. 0.0001 L
d. 0.00001 L
e. non of these.

44.

(d) L = 10-6L 10 L = 10-5L = 0.00001L

45.

***How much water should be added to 500ml of a


solution of 10% NaOH to bring it to 75%?
a. 666ml
b. 125ml
c. 166ml
d. 250ml
e. 375ml

45.

(c) Using the formula:


C1 x V1 = C2 x V2
10 x 500 = 7.5 x V2
V2 = 666mL
Thus, 166 mL of DW should be added.

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17

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

46.

When calculated osmolarity can not be accounted as a


measurement for osmolarity?
a. per 100gm/l
b. Urea 20 mm/l

46.

Calculated osmolarity = 2 X Na + Glu + Urea


(All in mmol/L)
When calculated osmolarity is less than
measurement for osmolarity, this denotes
increased osmolar gap (OG). This occurs with:
Factitious hyponatremia (due to
decreased water)
Unmeasured osmotically active
compounds e.g. alcohols, sugars, and
ketones.

47.

***Calibrator sera are?


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

47.

(b) Secondary std


Primary Standards
A primary standard is a reagent that is extremely
pure, stable, it not a hydrate/has no water of
hydration, and has a high molecular weight.
Secondary Standards
A secondary standard is a standard that is
prepared in the laboratory for a specific analysis.
It is usually standardized against a primary
standard.
(b) In EQC, participants receive QC material to
be tested inside their labs. Results are sent to
supplier to be compared to other labs' results.
EQC will be most practically implemented
during the regular visit of the lab coordinator.
This will give opportunity for errors to be
investigated on site and corrected rapidly
(Monica)
(c) QC results follow a Gaussian distribution,
thus 95% of these results normally fall within
5% of the mean. Therefore, 2.5 out of 100
(1:40) are acceptable to be above +2s and 2.5
our of 100 are acceptable below -2s.

48.

**External QC program means?


a. An external person come & does the QC test
b. A QC person goes to another lab & does the test..

48.

49.

**We select 2SD value to plot LJ curves because?


a. They are easy to calculate,
b. They cover 97.5% of normal population,
c. Patient value rarely go beyond these limits.

49.

50.

**Sensitivity and specificity are


a. Directly related.
b. Inversely related.
c. They mean the same.
d. no relation

50.

(b) Sensitivity & specificity can be adjusted


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

51.

A carryover in chemistry analyzer means a disturbance in


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

51.

(b) Carryover is due to contamination by a


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

52.

STAT test means:


a. Start at.
b. Standardize and test.
c. Short turn around time

52.

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

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18

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

CREATININE, UA, BUN AND AMMONIA


53.

***Which of the following result shows renal impairment?


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

53.

(e) A urine osmolarity less than 800 after 12 hrs


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

54.

***Low GFR occurs in all except:


a. Congestive heart failure.
b. Urethral obstruction.

54.

(b) low GFR occurs with:


- Hemorrhage.
- Dehydration.
- Renal loss of fluids e.g. diuretics.
- Ineffective blood volume, e.g. CO,
systemic VD, renal vasoconstriction.

55.

Diagnosis of RF

55.

GFR is an index and a monitor of increased or


decreased renal functions. It is practically
estimated from serum creatinine and creatinine
clearance.

56.

*****Nephrotic syndrome is characterized by all except:


a. Hypocholesterolemia.
b. Hypoalbuminemia.
c. Albuminuria.
d. Hypertriglyceridemia.
e. None of the above

56.

(a) Nephrotic syndrome consists of:


- Heavy proteinuria.
- Hypoalbuminemia.
- Oedema.
- Hypercholesterolemia (Almost always
present).
Hypertriglyceridemia is present in 50% of
cases.

57.

glomerular defect suffecient to cause increase s.urea


a. addison
b.urethral abstruction
c. early nephrotic s
d.cong.heart failure

c.

type l distal renal tubular acidosis (RTA) associated with


a. SLE
b.wilsons disease
c. s.jogren

a.

All cause RTA type I except

Wilsons which cause type II

urea is final product of catabolism of:


a. amino acid
b.triglyceride
c. cholesterol
d.polysaccharide

a.

*****Ureate excretion by the kidney is inhibited by:


a. Probenecid.
b. Thiazide diuretics.

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57.

(b) Thiazide diuretics cause relatively urate


retention, glucose intolerance and hypokalemia
and interfere with water excretion and may
cause hyponatremia.
Probenecid is a uricosuric agent like allopurinol.

19

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

58.

Chronic glomerulonephritis is diagnosed by:


a. Blood urea.
b. Creatinine.
c. Proteinuria
d. All of the above

58.

(d) In chronic glomerulonephritis, there is


persistent deterioration of renal functions ending
with renal failure.

**the best kidney function test?


a. urea
b.total protein
c. creatinine clearance

c.

in uric acid estimation?


a. its affected by carbohydrate meal
b.no need for fasting
c. the patient has to come fasting

c.

patient with specific gravity 1010 , polyuria, proteinuria


a. tubular defect
b.glomerular defect
c. acute tubular and glomerular defect
d.chronic tubular and glomerular defect

d.?

*All cause renal impairment except

galactosemia

PROTEINS, ELECTROPHORESIS AND LIPIDS


59.

**The protein having molecular wt less then albumin is?


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

59.

60.

*******In cystic fibrosis, which is deficient?


a. Beta globulin
b. Macroglobulin
c. Albumin
d. Alpha 1 antitrypsin
e. Alpha 2 antitrypsin.

60.

(b) B2-microglobulin has a MW 11,800.


Betalipoprotein is 380,000.
*Benze Jones protein protein is the light chains
of immunoglobulins. molecular weight of 2224.000 Da
Albumin is 66.000 Da
(d) Alpha 1 antitrypsin

cystic fibrosis

*Na Cl test is used in diagnosis of


61.

***Diet rich in phenylalanine should be restricted in?


a. Phenyl ketonuria
b. Tyrosinemia
c. Maple syrup disease

61.

(a) In phenylketonuria, there is phenylalanine


hydroxylase leading to accumulation of
phenylpuruvate and its derivatives and their
excretion in urine. Diet rich in phenylalanine
should be restricted to prevent brain damage.

62.

*****In phenylketonuria, diet should be low in:


a. Phenylalanine.
b. Carbohydrate.
c. Lipids.

62.

(a) Phenylalanine (see 61)

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20

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

d.

in alkaptonuria which of the following is significantly


increase
a. protein
b.cysteine
c. homocystein
d.increased urinary homogentisic acid
62.

Hypoalbuminemia is associated with all except?


a. Tetany
b. hypocalcaemia
c. oedema
d. toxic effect of sulfonamide

62.

(a) hypoalbuminemia alter serum Ca


(hypocalcemia) without affecting ionized Ca (no
tatany)

64.

**Gluconic amino acids include:


a. Alanine.
b. Methionine.
c. Valine.
d. Glutamic acid.
e. All of the above.

64.

(a) Ketogenic amino acids are: Leucine and


lysine,
Mixed amino acids are: Isoleucine,
phenylalanine, threonine, tryptophan and
tyrosine.
Gluconic amino acids are all the other amino
acids.

65.

**Lipoprotein related to hypertension?

65.

. LDL

66.

*****Which is important for atherosclerosis?


a. HDL
b. LDL
c. Chylomicrons.

66.

(b)

67.

***In plasma protein electrophoresis, the protein that will


go first is (moves furthest from application)?
= fastest migrating protein

67.

Albumin.

68.

****Based on behavior of lipoproteins in


ultracentrifugation pre-B lipoprotein is?
a. HDL
b. LDL.
c. VLDL
d. Chylomicron

68.

On electrophoresis;
Chylomicrons and its remnants stay at the
origin.
VLDL at pre (=2 globulin region)
IDL at broad
LDL at (= globulin region)
HDL at (= 1 globulin region)/

69.

**All of the following are lipoproteins except?


a. Phospholipid
b. VLDL
d. Sphingomylin
e. LDL
f. HDL

69.

(d) Although phospholipids are not lipoproteins,


they are ingredients of lipoproteins, conferring
the hydrophilic properties.

70.

What is the proposition of pulmonary surfactant?


a. Phospholipid acid
b. Dipalmityl lecithin
c. Phosphatidyl choline,

70.

(b) Dipalmityl lecithin (a lecithin phospholipid


with 2 palmetic acid residues) is the chemical
composition of pulmonary surfactant.

71.

**HDL is good cholesterol because?


a. It has more protein & phospholipids in it
b. It has no cholesterol in it,.
c. It has less TG in it.

71.

(a) HDL is composed of 20% cholesterol, 30%


phospholipids and 50% proteins.

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21

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

harmful cholesterol is carried on:


which is important for atherosclerosis:

LDL

useful cholesterol is carried on:


prevent atherosclerosis:

HDL

for lipid investigation patient has to fast

12-14h

72.

*****Which lipoprotein has highest concentration of


cholesterol?
most cholesterol present in:
a. VLDL
b. LDL
c. IDL
d. HDL

72.

(b) VLDL are the TG rich lipoproteins


HDL has 20% cholesterol.
IDL has cholesterol and TG in equal amounts.
LDL is the richest lipoprotein in cholesterol
esters.

74.

*****Which is not associated with abetalipoproteinemia:


a. Acanthocytes in the peripheral blood.
b. Hereditary spherocytosis.
c. Malabsorption and fatty stools

74.

(b) Hereditary spherocytosis is due to spectrin


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

75.

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

75.

76.

Nature of apoproteins.

76.

(a) Chylomicrons don't confer an excess


cardiovascular risk, however, in LpL deficiency
and apoC II deficiency, the patient presents with
lipemia retinalis and retinal vein thrombosis.
5 major classes of proteins A to E

77.

Saturated vs unsaturated fats (nutritional value)

77.
e.g.

Presence
Suffix
Significance

Chemistry

78.

Which is best for parentral alimentation?


a. FFA.
b. AA
c. lipoproteins

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78.
79.

Saturated
Oleic a (50% of
body fat)
Palmitic a (25%
of body fat)
Stearic a (5% of
body fat)
Acetic a.
Butyric a.
Adipose
Anoic

No double
bonds

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

Vegitable oils.
Enoic
Arachidonic
acid is precursor
of Pgs.
Although not
essential, it
depends on
essential FA
Double bonds

(b) Parentral nutrition is composed essentially


of:
a) Nitrogen source: synthetic valuable amino
acids (9-17g/L N2)
b) Energy source: Glucose (mainly) and fat
emulsion (additional source to avoid EFA
deficiency).
c) Electrolytes and trace elements.
22

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

79.

Protocol for IV nutrition?

80.

**Regarding lipoprotein metabolism:

80.

Although cholesterol can be synthesized by all


nucleated cells, however, cholesterol in VLDL,
IDL and LDL is of hepatic origin

82.

Treatment of familial hypercholesterolemia.

82.

These include general management of


hypercholesterolemia + cholesterol lowering
drugs + oestrogen replacement in
postmenopausal women.

**patient with increased LDL & VLDL

type ll B hyperlipidemia

exogenous triglecride is carried on?


a. VLDL
b.HDL
c. Chylomicron

c.

endogenous triglecride is carried on?


a. LDL
b.HDL
c. VLDL

c.

all of the following are affected by meal except?


a. glucose
b.albumin
c. creatininine

b.

Acute phase reactant

fibrinogen

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23

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

The planning for intravenous feeding should be based on


a. If food intake is withdrawn, hepatic glycogen will
satify for 7:10 days
b. As sourse of fat, free fatty acids are preferable to fat
emulsion
c. Amino acid infusion during the catabolic phase is likely
to ba ineffective
d.Infusion of fat emulsion increase risk of thrombosis

hereditary orotic aciduria diagnose by

increase orotic acid in urine

hartnup disease hartnup disease"pellagra-like dermatosis


an autosomal recessive metabolic disorder affecting the
absorption of nonpolar amino acids (particularly tryptophan
that can be, in turn, converted intoserotonin, melatonin and
niacin). niacin is a precursor to nicotinamide, a necessary
component of NAD+. hereditary pellagra-like skin rash with
temporary cerebellar ataxia, constant renal aminoaciduria and
other bizarre biochemical features, diarrhea, mood changes,
nervous system (neurologic) problems, such as abnormal
muscle tone, sensitivity to light (photosensitivity), short
stature the renal aminoaciduria is the hallmark of the disorder,
most if not all patients were diagnosed by urine analysis.

CLINICAL ENZYMOLOGY
83.

***The better for diagnosis of acute pancreatitis is?


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

83.

(b) Lipase elevation is of a greater magnitude (210 xN) and duration than amylase in acute
pancreatitis. When lipase method is optimized,
the test is more sensitive and specific than
amylase for detection of acute pancreatitis.

84.

**Activities of some enzyme increased in some disease


conditions because they are?
a. Non functional enzymes
b. Functional enzymes
c. Neither

84.

(b) Thats why enzymes are measured for the


most part by their activity rather than
concentration.

85.

****In MI, which is the last enzyme to be raised and lasts


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

85.

(d)

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

86.

86.

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CK
CK-MB
AST
LDH

Onset (h)

Peak (h)

6-12
3-10
6-12
6-12

20-30
12-24
20-30
24-72

Duration
(d)
2-6
1.5-3
2-6
7-14

Isoenzymes have the same catalytic activities


and differ in physicochemical properties.

24

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

87.

88.

**MI is diagnosed by:


a. CKMB
b. CKBB
c. CKMM
d. LDH

87.

one of the following heart enzymes is measured after 4-8hr


of chest pain?
a. GOT
b.LDH
c. CPK

c.

in myocardial infection?
a. level of LDH high
b. level of GOT high
c. level of CK-MB high

c.fastest.GOT is liver specific

**in cardiac infraction one of the measurements is not


benefited:

Creatinine
Serum protein electrophoresis

**Elevation of LDH is caused by:


a. Myocardial disease
b. Liver disease
c. Prostatic disease
d. many organ disease because it has many distribution

88.

one of the following enzymes is effected by hemolysis?


a. SGOT
b.SGPT
c. LDH

b.and (c) are true.

hemolysis increase
a. ALP
b.ACP
c. LDH
d...
****Myoglobin in injury of:
a. muscle.
b. Liver

(d) LDH is present in the cells of the heart, liver,


muscles, blood and malignancies.

c.? it may increase in renal diseases


LDH-1: heart and red blood cells
LDH-2: white blood cells
LDH-3: lungs
LDH-4: kidneys, placenta, and pancreas
LDH-5: liver and skeletal muscle
c.

serum LDH is elevated in all the following except?


a. skeletal disease
b.cardiac/ hepatic diseases
c. renal disease
d.

89.

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

89.

(a) muscle whether cardiac or skeletal is the


source of myoglobin.

**case of chest pain, which test is not indicated

protein electrophoresis

acid phosphates is?


a. heart enzyme
b.liver enzyme
c. prostatic enzyme
d...

c.

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25

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

alkline phosphates is the important enzyme to detect


function in :
a. liver
b.bone
c. liver and bone
d.non of the above

c.

amylase value is high in the following disease?


a. salivary glands
b.pancreas diseases
c. all of the previous

c.

one of the following is important before anesthesia?


a. alkaline phosphates
b.acidic phosphates
c. pseudocholine esterase

c.

the (u) unit used to evaluation of :


a. protein in serum
b.hemoglobin
c. hormone assay
d.enzymatic activity

d.

CLINICAL ENCOCRINOLOGY
90.

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

90.

(b) ADH is produced by the hypothalamus and


stored and secreted from the posterior pituitary.

91.

**The method used to estimating insulin is?


a. Electrophoresis
b. Kinetic estimation.
c. Spectrophotometer.
d. Radioimmuno assay.

91.

(d) Immunoassay (multiple labels) is used for


the measurement of insulin.

92.

*****After the insulin dose, the patient soon comatozed


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

92.

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

93.

hypersecretion of insulin cause:

hypoglycemia

hyperglycemia hormone

glucagon

****While using the pregnancy test we are measuring?


a. B-HCG
b. Total HCG
c. B-HCG & LH
d. B-HCG & FSH.

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93.

The true answer is (a)

26

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

a.

immunoglobulin pregnancy test related to:


a. IgG
b.IgM
c. human chorionic gonadotropin
94.

*****Water deprivation test is used in the diagnosis of:


a. Anterior pituitary disease.
b. Posterior pituitary disease.
c. Hypothyroidism.

94.

(b) Water intake is restricted the patient loses 35% of body weight or until 3 consecutive hourly
determination of urine osmolarity are within
10% of each other. Measure urine osmolality,
plasma vasopressin and increased urine
osmolality with exogenous vasopressin.
Normal
DI
Nephrogeni
c DI

Urine
osmol
>800
<300
<300

Pl. VP

After VP

>2
Undetectab
le
>5

No change

95.

******24 hours urine for VMA is used for diagnosis of


diseases of:
a. Adrenal cortex.
b. Adrenal medulla

95.

(b) Catecholamines are oxidized to VMA and


metanephrins. 24hour urinary metanephrins is
the best single test for pheochromocytoma.
Specificity and sensitivity approach 100% when
both VMA and metanephrines are measured.

96.

***Hypertension is found in all of the following endocrinal


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

96.

(d) Hypertension secondary to endocrinal causes


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

30y patient present with hypertension not responding to


antihypertensive drugs, Hb 8, increased glucose, increased
Na & attacks of nervousness
a. Essential hypertention
b.IDDM
c. Pheochromocytoma

c.

Case: patient suffer from weekness and pigmentation


Glucose 7.4 mol/l
Na 125 mol/l
K 4.2 mol/l
ACTH stimulation failure to rise
a. Cushing
b.Adisson
c. Chrons
d.Hypothyroidism

b.

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27

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

97.

Diabetic coma presents with:


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

97.

All.
In diabetes, 2 types of coma may occur, DKA
and nonDKA. Glucose levels in nonDKA are
typically <800 mg/dL. Once hyperglycemia is
established, ketonurea & pH should be looked
for to differentiate.

98.

**While anti-PSA is coated on to the well in total PSA


estimation, the antibodies coated in free PSA is?
a. The same antibodies that is coated for total PSA
b. Same antibodies in large amount
c. Same antibodies in very low amount
d. Different antibodies.

98.

98.

**Carcinoid tumors secrete

98.
New

(d) different antibodies.


Most PSA in the blood is bound to serum
proteins. A small amount is not protein bound
and is called 'free PSA'. In men with prostate
cancer the ratio of free (unbound) PSA to total
PSA is decreased. The risk of cancer increases if
the free to total ratio is less than 25%. (See
graph at right.) The lower the ratio is, the greater
the probability of prostate cancer. Measuring the
ratio of free to total PSA appears to be
particularly promising for eliminating
unnecessary biopsies in men with PSA levels
between 4 and 10 ng/mL.
5HIAA.
Carcinoid tumors originate from the
enterocromaffin cells (APUD cells) of the
intestine and most commonly occurs in the
appendix, terminal ilium and rectum.
Presentation may be asymptomatic until
metastasis (most cases), appendicitis (10%) or
carcinoid syndrome (in5% when there is liver
metastasis) as spontaneous flushing on the face
and neck, abdominal pain and water diarrhea,
cardiac abnormalities and hepatomegally. The
tumor secretes a wide variety of amines an
peptides including serotonin (5hydroxytryptamine (5-HT) with its major
metabolite 5-hydroxyindoleacetic acid (5HIAA)), bradykinin, histamine and tachykinins
and prostaglandins.

New

Case: Diabetic patient came with coma without


neurological manifestation. Family give history he was on
hypoglycemic
Glucose 41 mmol/l
Hco3 25 mmol/l
Na 165 mmol/l
a. Lactic acidosis
b.Non kitogenic hyperosmolar
c. Kitogenic hyperglycemia

b.

diagnosis of phemchromocytoma by measuring urinary


a. epinephrine
b.metanephrine

b.adrenaline and noradrenaline

Case: with high blood pressure and portal hypertention

phemchromocytoma

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28

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

**used in combined pituitary stimulation test:


a. insulin
b.glucagon
c. prolactin
d.somatostatin
e. TSH

in zollinger ellison syndrome what iss true


a. associated with increase in lipase
b.usually due to single benign pancreatic gastrinoma
c. diagnosed by increased ph
d.associated with parathyroid tumor

a. Three hormonesare injected to stimulate the


anterior pituitary gland:
1.insulin
2.gonadotropin-releasing hormone (GnRH)
3.thyrotropin-releasing hormone (TRH)
Hypofunction is confirmed by the lack of
response of the appropriate hormone:
GH, ACTH - lack of response to insulin
FSH, LH - lack of response to GnRH
TSH, prolactin - lack of response to TRH
d.

hypersecretion of cortisol cuase:


elevated serum cortisol may indicate:

cushing

in cushing syndrome
a. decrease glucose
b.lipolysis
c. decrease k

b.(decrease K is rare)

**thromboembolism, impaired glucose tolerance &


psychiatric troubles
a. thyroid tumor
b.
c. Cushing

c.

case CT or MRI shows pituitary mass, patient have


signs and symptoms of cushing , the test used to confirm is
a. measure urinary cortisol
b.over night dexamethasone suppression test

b.

one is not correctly paired:


a. - cells glucagon
b.- cells insulin
c. parathyroid calcium
d.corpus luteum progesterone
e. estrogen seminiferous tubules

e.

target of prolactin in female:


a. ovary
b.mammary glands

b.

prolactin is produced by

anterior pitutary gland

Prolactin increase in all except

Sheehan syndrome

oxytocine hormone function :


a. increase oogenesis
b.stimulate contraction of uterus
c. increase basal metabolic

b.

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29

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

Which is true about pregnancy

Placenta produce progesterone up to 14 week

function of thyroxin is:


a. increase oogenesis
b.stimulate contraction of uterus
c. increase basal metabolic

c.

increase in thyroxin stimulating hormone (TSH) causes:


a. cushing disease
b.gigantism
c. exophthalamic goiter
d.hypoglycemia

d.

function of estrogen:
a. increase oogenesis
b.stimulate contraction of uterus
c. increase basal metabolic

a.

estrogen is produced by

ovary

function of cortisol :
a. increase oogenesis
b.stimulate contraction of uterus
c. increase basal metabolic

c.

increase in growth hormone causes:


a. cushing disease
b.gigantism
c. exophthalamic goiter
d.hypoglycemia

b.

hypoparathyrodism hormone cause:


a. elevated ca level
b.decrease ca level

b.

regulation of calcium level in serum by:


a. calcitonine hormone only
b.parathyroid hormone only
c. calcionine with parathyroid hormone
d.vitamin D
e. parathyroid hormone +vitamin D+calcitonin

c.

most common method (technique) used to detect hormone


amount in the laboratories:
a. spectrophotometry
b.enzyme linked immuno surbant assay (ELISA)

b.

25 hydroxycholecalciferol synthesized in
a. liver
b.kidney
c.

b.

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30

CHEMISTRY

CLINICAL & CHEMICAL PATHOLOGY MCQ

**Patient with chemistry profile show


Increase Ca
Decrease P
Normal 1, 25 cholcalcefirol
Normal PTH

b.?

a. Hypophosphatemia
b. 1ry hyper parathyroidism
c. 2ry hyper parathyroidism

Hypothalamus affect pituitary hormone secretion:


a. In pulsatile manner
b.Throuph neuronal impulse
c. Through hormone secretion
d.

? c.There are two portions to any description of


the hypothalamic hormones:
The hypothalamus secretes tropic hormones
exclusively into the blood vessels within the
hypothalamus. that affect the anterior pituitary.
The hypothalamus also produces hormones that
have direct effects on body tissues. These
hormones are those that it secretes within the
posterior pituitary.

15 q deletion syndrome

21-hydroxylase deficiency

Neeman Peck disease is due to deficiency of


Cholesterol

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Seven tropic hormones are produced in the


hypothalamus: TRH, PRH, PIH, CRH, GnRH,
GHRH, SS
Two Hormones are Produced in the
Hypothalamus for Posterior Pituitary
The hypothalamus makes two additional
hormones: OT (oxytocin) and ADH
(antidiuretic hormone). The hypothalamus does
NOT secrete these hormones
The anterior pituitary secretes four tropic
hormones and two regular hormones TSH,
ACTH, LH, FSH, PRL, GH
Prader-Willi syndrome: Commonly associated
characteristics of this disorder include
diminished fetal activity, obesity, hypotonia,
mental retardation,short stature,
hypogonadotropic hypogonadism, strabismus,
and small hands and feet.
21-hydroxylase deficiency (21-OHD) is the
most common cause of congenit aladrenal
hyperplasia (CAH), a family of autosomal
recessive disorders involving impaired synthesis
of cortisol from cholesterol by the adrenal
cortex. results in virilization in all individuals
and salt wasting in some individuals. The
diagnosis is confirmed by biochemical findings.
Molecular genetic testing of CYP21A2
sphengomylinase
In LDL, cell membrane, precursor of bile salts
and steroid hormones.

31

General

CLINICAL & CHEMICAL PATHOLOGY MCQ

General
1.

*****The difference between plasma and serum is that


plasma:
a. Contains fibrinogen.
b. Doesnt contain fibrinogen.
c. Has more water.
d. Has less water.

1.

(a) Plasma contains fibrinogen which is


consumed during the clot formation to separate
serum.

2.

******Best way to separate the serum?


a. leave the blood to clot at R.T for I hr, then centrifuge
b. by adding citrate.
c. by adding EDTA

2.

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


centrifuge

3.

**Point of care testing means?


a. Complete a test & make a point[interpret],
b. Testing the patient at bed side
c. Take care in testing

3.

b.

4.

*****Error in the result is expected in which case (wrong


compination)?
a. Glucose on fluoride.
b. Glucose on EDTA
c. Calcium on oxalate

4.

(c) Oxalate is a divalent cation chelator.

5.

***Cardiac anatomical anomalies associated with Fallot


tetralogy include all of the following except:
a. VSD
b. ASD

5.

(b) Fallot's tetralogy is composed of PS+VSD +


Rt aorta + RVH.

6.

Hemolysed blood is unsuitable for performing which


tests?

6.

Hemolysis is visible at Hb> 3.1 mol/L


It increases aldolase, ACP, LDH, K, and AST
Hemolysis dont increase serum albumin,
bilirubin, ALP, amylase, lipase, Ca, Cl, P, Mg,
Na, creatinine, glucose, UA or urea.

7.

****Hemolysis causes?
a. Increased serum K
b. Increased serum Na
c. Increased HCO3d. Decreased K

7.

a.

slight haemolysis cause:


one of the following electrolytes is effected by hemolysis?
a. K
b. Ca
c. Mg

a.

8.

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

8.

c.

9.

Effects of fasting

9.

Prolonged fasting increase TG, glycerol, FFA


but not cholesterol.

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32

General

CLINICAL & CHEMICAL PATHOLOGY MCQ

10.

*****Fluoride is used to get samples for?


a. Blood sugar
b. Coagulation
c. Electrolyte
d. CBC.

10.

a. Blood sugar

d.

one of the following anticoagulant used for blood glucose :


a. EDTA
b. heparin
c. sodium oxalate
d. florida oxalate
e. sodium citrate
11.

***Anticoagulant used for glucose is:

11.

Fluoride

12.

**Changes in blood stored more than 5 hrs at room temp.


include?
a. Decreased glucose & increased lactate.
b. Increased glucose & decreased lactate
c. Failure of Na & K pump,

13.

(a) Storage of blood has the following effects:


1- CO2, ACP & Glucose
2- pH & ammonia
3- Changes in RBC permeability K,P &Mg
4- Na-K pump is inhibited at 4 c but not at
25c. leading to K in refrigerated samples.
5- PhosphorylationP released from organic
P.
6- Loss of enzyme activity.
7- Light bilirubin, ALA and porphyrins.
c.

plasma or serum should be separated at the earliest time


for estimation of glucose because?
a.glucose value increases with time
b. lyses of blood will occur
c. glucose value decreases with time
14.

Plasma or serum should be separated at the earliest for the


estimation of glucose because:
a. The glucose values decreases with time.
b. Glucose value increases with time.
c. Lysis of blood occurs.

14.

a. Continued glycolysis cause glucose values to


decreases with time unless cells are separated.

vit retinol

vit A

beri beri due to

deficit in Vitamin B1 (thiamine). May be


aggrevated by low Cho diet
drugs in the blood can be found in both free and
conjugates (bound) forms. Conjugation occurs
with blood proteins, mainly albumin,It is
demonstrated that correction of drug dosing
regimes is needed only for when there is a high
level of drug conjugation with blood proteins
and a high degree of hypoalbuminaemia.
Changes of free drug concentrations due to
hypoalbuminaemia can dramatically influence
the therapeutic effects and induce side-effects.
For example, proteins reduce the toxicity of antitumor drugs. Hypoalbuminemia increase side
effect of some antibacterial and antiviral drugs.

concentration of drug in relation to albumin level

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33

General

CLINICAL & CHEMICAL PATHOLOGY MCQ

digitalis toxicity
a. hypocalcemia increase its effect
b.hypokalemia increase its effect
c. hyperkalemia increase its effect
d..

b.People with heart failure who take digoxin are


commonly given diuretics, which can cause
potassium loss. Low blood potassium
(hypokalemia) or magnesium levels
(hypomagnesemia), or high calcium levels
(hypercalcemia), may increase risk for digoxin
toxicity.lowcalcium levels (hypocalcemia) can
make digoxin ineffective.
In acute toxicity, hyperkalemia is common
Chronic toxicity is often accompanied by
hypokalemia and hypomagnesemia

study the difference between quality assurances, Q.C,


Q.M
Best place to put a needle for blood collection is

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puncture proof container

34

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Hematology
BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES
1

** To stain the B/M other than Wright stain which stain


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

(c) Bone marrow films should be stained with


an iron stain e.g. Perl's, Prussian blue, as a
routine to demonstrate iron (Dacie)

****In addition to routine Romanowsky stain of bone


marrow the following stain is also essential:
a. Chloroacetate estrase
b. Prussian blue.

(b).Prussian blue: See 1

The needle used for bone marrow biopsy is?


a. 18 gauge needle
b. Jamshedi needle
c. Menghini needle
d. Westermani needle,

(b) Jamshedi trephine is used for biopsy.

**Hyperplastic B.M with M/E ratio 6:1 is seen in:


a. Megaloblastic hyperplasia.
b. Normoblastic hyperplasia
c. Lymphoid hyperplasia

(c) Hyperplasia is diagnosed when fat>cells. In


hyperplastic BM, an M/E ratio > 2:1 denotes
myeloid hyperplasia and <2:1 denotes erythroid
hyperplasia.
6: 1 Increased

M/E ratio in CML


5

**Best method to assess BM cellularity is:


a. Trephine biopsy
b. M:E ratio is enough.
c. By high power.

(a) Trephine biopsy is preferred over bone


marrow aspiration in that it demonstrates the
architecture of the bone marrow cellularity.

b.

bone marrow used in diagnosis of all except


a. granulomatous diseases
b.
c. .
6

***Which Hbs have the same electrophoretic mobility on


alkaline cellulose acetate?

HbS, C, D and Hb Punjab (also Hb lepore) occur


at the same position on cellulose acetate at
pH8.6 . Also Hb C, E and C harlum occur at the
position of Hb A2

Lymphokines & T-cell activation

Lymphocytosis promoting factor and histamine


sensitizing factor.

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35

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

******When using and electronic cell coulter counter,


which of the following results can occur in the presence of
cold agglutinins:
a. MCV & MCHC
b. MCV & MCHC
c. MCV & MCHC
d. MCV & MCHC
e. MCV & decreased RBC
f. MCV & normal RBC
h. MCV and RBC

(d) A high titer of cold agglutinin cause falsely


MCV, MCH and MCHC and falsely RBC
count.
To correct, incubate at 37c for 15-30 minutes
and rerun the specimen.
e.is the best answer

MCV 100 fl in neonate is

normal

**in cell counter,which parameter is calculated :


a. MCV
b.HCT
c. RBCs

b.Hct=MCVRBC

***Bone marrow aspiration needles:


a. 18 gauge.
b. Meninghi.
c. Burtolin

a. 18 gauge.

10

**RDW is increased in

10

Iron deficiency anemia and megaloblastic


anemia while normal in thalassemia.

11

***By coulter, TLC= 22.5x109/L If NRBC are 200 per 100


leucocytes, so corrected leucocytic count equals:
a. 11.5 x 109/L
b. 22.3 x 109/L
c. 22.7 x 109/L
d. 7.5 x 109/L
****The main antioxidant in RBCs is:
a. NADPH
b. Reduced glutathione

11

(d) using the correction formula :


Corrected WBC= WBC X 100 / (NRBC+100)
Corrected WBC= 22.5 X 100 / (200 + 100 )
= 7.5 x 109/L

12

b. Reduced glutathione acts as antioxidant


through its SH group.

13

***Newborn with MCV 100fl, is considered.


a. Macrocytosis.
b. Normal

13

b. MCV in the first week is normally 108fl.


After 2 months, it is 96fl.

14

**Perl's stain

14

BM iron stores

14.

*Hemoglobin breakdown takes place in:


a. RES
b. Hepatocytes.
c. Renal tubules.

14.

a. Normally 6gm of Hb is broken down per day


into;
- Globin peptides: hydrolysed and the amino
acids enter into the body amino acid pool.
- Iron: reutilized.
- Porphyrin ring: broken down in the
reticuloendothelial cells of the liver, spleen
and bone marrow to bile pigments.

12

New

normal range of leukocyte is:

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New

4-11 x 10^9

36

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

normal range of erythrocyte

4,5- 6,5x 10^9

defferential test for:

leukocyte

one of these leukocyte have 2:5 lobes in nucleus :


a. neutrophil
b.basophil
c. monocyte
d.lymphocyte
e. eosinophil

one of these cell the largest leukocyte cell:


a. neutrophil
b.basophil
c. monocyte
d.lymphocyte
e. eosinophil

the leukocyte that involve in adaptive and acquired


immunity:
which of white blood cell give immunoglobulin :
a. lymphocyte
b.neutrophil
c. monocyte
d.basophile
e. eosinophil

a.* neutrophil: most abundant in WBCS

neutrophil is acommn white blood cell present in blood


and the percentage of presence is :
a. 90%
b.15%
c. 75%

all cells are nucleated except :a-lymph


b-monocytes
c-RBCS
d-neutrophil

reticulocyte is immature:
a. RBC
b.WBC
c. Platelet

**anisocytosis

different size (variation in RBCS size)

hormone that cause replication of RBC:

erythropoietin

neutrophils are produced by:

GM-CSF

process in which phosphate is stored in RBC called

oxidative phosphorylation

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37

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Erythropoietin all except


a. 34 KD
b.found in urine
c. serum sample
d.act on pronormoblast

d.Erythropoietin is a heavily glycosylated


polypeptide of 165 amino acids with a molecular
weight of 34 kDa. Normally, 90% of the
hormone is produced in the peritubular
interstitial cells of the kidney and 10% in the
liver and elsewhere.It acts on RBC precursers

about intrinsic factor what is true


a. absorption of folate
b.phospholipid
c. 20 dalton
d. ?

d.?the three are false


intrinsic factor is for absorption of B12
it is glycoprotein. It is 45kd

one is not a romanowsky stain:


a. fields stain
b.gram stain
c. geimsa stain
d.leishman stain

romanowsky stain consists of:


a. eosin + alkaline methylene blue
b.eosin only
c. methylene blue only
d.indian ink

NORMOCYTIC NORMOCHROMIC ANEMIAS


15

***In Pyruvate Kinase deficiency all correct except?


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

15

(a) PKA is an autosomal recessive


enzymopathy. O2 dissociation curve is shifted to
the right, so only mild symptoms occur.
Splenectomy improves the condition.

16

**In A sickle cell disease patient under general anesthesia,


all true except?

16

Tourniquet should not be avoided.


A sickle cell patient needs transfusion to reduce
HbS below 30% prior to general anesthesia.
During anesthesia, the patient should be
hyperoxygenated and rapidly induced. Limb
tourniquet should be avoided.

17

**Organism causing osteomylitis in sickle cell patient is

17

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

18

**Skeletal abnormality present in?

18

Fanconi syndrome.
Fanconi syndrome consists of:
- Congenital aplastic anemia.
- Skeletal and urinary tract anomalies.
- Microcephaly.
- Altered skin pigmentation.

19

Fanconi's anemia

19

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38

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

20

***In G6PD decreased which is affected ?

20

e.

pentose phosphate metabolism cycle is important to the


cell because it give:
a. Acetyl COA
b.ADP
c. ATP
d.NADH
e. NADPH
21

***Sideroblastic.a seen in all except?


The least to cause Sideroblastic anaemia
a. Lead poisoning
b. Alcohol
c. Aspirin
d. Chloramphenicol

NADP-H, reduced glutathione


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

21

(c) Sideroblastosis occurs due to;


- Lead poisoning due to inhibition of enzyme of
heme and globin synthesis.
- Alcoholism, due to interference with heme and
pyridoxal kinase.
- Chloramphenicol; inhibits protoporphyrin.
- Other causes: vit B6, thalassemia, excessive
dietary Fe, anti-TB and cycloserine.
Stained BM film

Iron overload can be detected by


22

****The least drug to cause acquired sideroblastic anemia


is:
a. Aspirin.
b. Lead.

22

a. Aspirin.

23

***In HUS, all are true except:


a. occurs mainly in children.
b. Is usually preceded by some sort of enteritis.
c. Fragmented RBCs are seen.
d. Uremia is usual.
e. Anti IgG is positive in 10% of cases.

23

(e) HUS occurs in children following VTEC


enteritis (also after salmonella, shigella,
streptococcal infection, as an autoimmune
disease and following drugs e.g. cycloserine. It
is charectarized by:
- Thrombosis in small vessels.
- Fragmentation of RBCs.
- Reduced platelets (consumptive).
- Uremia.

24

***In HUS, all are present except:


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

24

d. Thrombocytosis

25

HUS contains all except


a. thrombosis
b.renal failure
c.
d.

25

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39

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

? a.and b. are true

Bacteria cause HUS


a. E coli O157
b.Shigella
c. Campylobacrer
d..
26

**In intravascular hemolysis, all are present except:


hemolytic anaemia all are true except:

26

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

Ptn attached to free Hb

haptoglobin

In intravascular hemolysis, all are present except:

haemosidrinurea

27

***Free plasma Hb is bound to:

27

Haptoglobin (also hemopexin)

28

***In favism, the defect is in

28

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

29

**In hereditary spherocytosis all are true except:


a. Autosomal dominant.
b. Treated by splenectomy.
c. Defect is in hemoglobinization of RBCs

29

c. Hereditary spherocytosis is an autosomal


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

In hereditary spherocytosis all are true except:


a. Autosomal dominant.
b. Treated by splenectomy.
c. Associated with colithiasis
d. Associated with phenotype Rh null

d.

Cause of shape changes in spherocytosis


a. Phagocyte
b.Complement

a.

In hereditary spherocytosis

Thin hypochromic RBC

30

***Treatment of choice of spherocytosis is:

30

Splenectomy

31

**In sickle cell anemia patient with iron overload, this


organism is isolated from blood:
a. Salmonella.
b. Strept pneumoniae
c. yersinia enterocolitica.

31

(c) Yersina enterocolitica occurs in iron


overloaded patients treated with desferrioxamine
(see p376 Kumar)

A2

Hb C the same band with


32

***Thalassemia major with iron overload this organism


can be isolated.
a. Streptococcus pneumoniae.
b. Salmonella typhemureum
c. Yersina enterocolitica.
mohammad_emam@hotmail.com

32

(c).

40

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

33

******Microangiopathic hemolytic anemia is present in


all except:
a. TTP
b. Meningococcal septicaemia.
c. HUS
d. SLE

33

microangiopath. hemolytic anemia all happened except:


a. RBCS fragment
b.prosthetic valves
c. +ve DAT

34

****The following enzyme increases in hemolytic anemia:


a. Total ACP
b. LDH
c. ALP

mohammad_emam@hotmail.com

34

(b) In MAHA there is intravascular hemolysis


and fragmentation of the RBCs due to abnormal
microcirculation leading to fibrin deposition,
platelet deposition and vasculitis e.g in;
- HUS
- TTP
- Renal pathology
- Preeclampsia
- Autoimmune diseases e.g PAN, SLE.
- Carcinomatosis.
- Septicemia
*Meningococcal septicaemia.cause thrombosis
of small blood vessels leading to petichiae and
adrenal failure (Waterhouse-Fridrechson
syndrome)
c. causes of red blood cell fragmentation
hemolysis
damaged microvasculature
thrombotic thrombocytopenic purpura
hemolytic uremic syndrome (TTPHUS)
associated with pregnancy: preeclampsia or
eclampsia; hemolysis plus elevated liver
enzymes plus low platelets (HELLP syndrome)
associated with malignancy, with or without
mitomycin c treatment
vasculitis: polyarteritis, wegener
granulomatosis, acute glomerulonephritis, or
rickettsia-like infections
abnormalities of renal vasculature: malignant
hypertension, acute glomerulonephritis,
scleroderma, or allograft rejection, with or
without cyclosporine treatment
disseminated intravascular coagulation
malignant hypertension
catastrophic antiphospholipid antibody
syndrome
atrioventricular malformations
kasabachmerritt syndrome
hemangioendotheliomas
atrioventricular shunts for congenital and
acquired conditions (e.g., stents, coils,
transjugular intrahepatic portosystemic shunt,
levine shunts)
cardiac abnormalities
replaced valve, prosthesis, graft, or patch
aortic stenosis or regurgitant jets (e.g., in
ruptured sinus of valsalva)
drugs: cyclosporine, mitomycin, ticlopidine,
tacrolimus, or cocaine
(b) LD1&2 are characteristically increased in
HA. ACP although is present in high
concentration inside RBCs (tartarate resistant) is
not characteristically increased.

41

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

35

******In G6PD deficiency avoid all the following drugs


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

35

(e) Agents causing HA in G6PD deficiency


include:
- Antimalareals e.g. primaquine.
- Sulphonamides and Sulphones (dapsone).
- Analgesics e.g. salicylic acid
- Antihelmenthics e.g. niridazol.
- Miscellaneous e.g. vitamin K analogues,
probanecid.

case study,child with history of antimalarial


drug,hemoglobinurea,heinz bodies:

G6PD

heinz body seen in:

G6PD

to measure G6PD we use?


a. plasma
b.serum
c. whole blood on EDTA

c.

36

****A patient with hemolytic anemia has all the following


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

36

(c) In hemolytic anemia there is;


- Hyperbilirubinemia and hemiglubinuria.
- urobilinogen and stercobilinogen dark
urine.
- Haptoglin and hemopexin.
- Hemosiderinemia and hemosiderinuria.
- Methemoglobenemia.

37

****Aplastic anemia cause


Different cases with depressed WBC, Pl, Hb
Case: patient with Hb 5 mol/l , PLT 50, WBC 3: after
medication

37

pancytopenia.
aplastic anemia

Barvovirus B18
all cause pancytopenia except
a. aplastic anemia
b.acute leukemia
c. hypersplenism
d.

b.?

All causes aplastic anaemia except


a. PNH
b. Hairy cell leukemia
c. Diamond blackfan anemia

c.cause pure red cell aplasia

mohammad_emam@hotmail.com

42

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

38

RAEB

38

Myelodysplastic syndromes (MDS) are


classified into:
Refractory
anemia
RA with
sideroblasts
RA with excess
blasts (RAEB)
CMML

39

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

39

*****Major adult Hb is

41.
New

BM
<5%blasts

<1%blasts

<5%blasts

>5%

20-30%

monocytes

promonocytes

(b) Infarction of phalanges.

d.it causes normocytic normochromic

sickle cell disease which is incorrect


a. osteomylitis
b.leg ulcers
c. autosplenectomy
d.microcyic hypochromic anemia
41

Peripheral blood
<1%blasts

41

HbA (97%) main Hb


HbA2 (2.5%) and HbF (0.5%)

Hb A2 is consisting of:
a. 3 chains and 2 chains
b.2 chains and 2 chains
c. 2 chains and 2 chains
d.2 chains and 3 chains
e. 3 chains and 2 chains

c.Hb A= 2 chains and 2 chains


Hb F= 2 chains and 2 chains
Hb A2= 2 chains and 2 chains

HbA

adult haemoglobin = dominant in adult

Hb F

infant heamoglobin

Which is true regarding DAT


a. It is positive in all IHA.
b. may detect complement attached to RBCs.

b. DAT involves testing patient's cells without


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

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43

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

globulins damaged by drugs adsorbed on RBCs


e.g. cephalothin.
4. Interaction between the antiglobulin sera and
anti-T, as with polyagglutinable RBCs.
6. Anti-albumin and anti-transferrin antibodies
in antiglobulin sera giving rise to false-positive
reaction.
7. adsorption of immune complexes to the cell
surface in 8% of hospital patients in a wide
variety of disorders.
8. Sensitization in vitro (due to incomplete cold
antibodies and complement from normal serum
obtained by clotting or defibrination (not EDTA
or CDA)..
9. In apparently perfectly healthy individuals for
unknown reason.
anti-human immunoglubin is:
a. coombs reagent
b.anti-ab
c. IgG
d.all of the above
e. non of the above

d.

in anti human globulin test do wash of RBC because all


serum contain :
a. albumin
b.alpha_glubulin
c. beta_ globulin
d.fibrinogen
e. immunoglobulin

e.

about comb test


a. it is quantitative and qualitative test
b.in direct comb patient serum tested against rbcs
c. in indirect comb patient rbc tested against test serum
d.

d.

direct anti-antibody test used to detect:


a. sensitized RBCS in patient blood
b.IgG
c. IgM
d.sensitized antibody in patient serum
e. non of the above

a.

indirect anti-antibody test used to detect:


a. sensitized RBCS in patient blood
b.IgG
c. IgM
d.sensitized antibody in patient serum
e. non of the above

d.

****in warm autoimmune hemolytic anemia


a. DAT +ve with IgG & C3 with non-reactive eluate
b.DAT +ve with IgG & C3 with reactive eluate
c. DAT +ve with IgG only
d.DAT +ve C3 only

b.

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44

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

****best example of cold agglutinin disease is

anti i IgM in infectious mononucleosis

serum of donner + RBC of patient is called:


a. minor cross matching
b.major cross matching
c. AB screening

a.(major cross matching include serum of patient


+ RBC of donner)

case study (MCV=82,MCH=28,Hb=5 mmol/l,high serum


bilirubin,polychromasia,basophilic stippling,low retic
count)abdominal pain since 11 months.
a. sideroblastic anaemia
b.anemia of chronic disease
c. iron diff due to celiac disease
d.lead poisoning

b.sideroblastic anaemia (microcytic


hypochromic)
anemia of chronic disease (normocytic
hypochromic)
iron diff due to celiac disease (microcytic
normochromic)
lead poisoning(microcytic hypochromic)

**PNH what is true


a. CD 55 normal
b.CD 59 normal
c.
d.sensitization to complement

HYPOCHROMIC MICROCYTIC ANEMIAS


42

***A case of iron deficiency under Microscope is

42

hypochromic, microcytic
in iron deficiency anaemia :
RBCS are smaller than normal

43

***Iron deficiency anemia seen in all except?


***Iron stores are deficient in all except:
a. B-thalassemia major
b. chronic disease
c. PRV
d. gastrointestinal bleeding

43

a.B-thalassemia major

44

***Hb variant with fusion of delta and beta gene segments


is:

44

Hb Lepore is the result of fusion of & chains


which combine with chain ( 2,2)
Other abnormal patterns include HbH (4) and
HbSS (Bs, Bs)

45

**Normal Hb pattern?

45

HBA ( 2, 2)
Other Hb patterns: HbA2 (2, 2), HbF (2,2)

46

*****In iron deficiency anemia, all are present except:


a. iron absorption.
b. Decrease iron absorption
c. Microcytis hypochromic blood film,

46

b.
Iron absorption is adjusted to body needs. It is
increased in iron deficiency anemia and
pregnancy.

about the cause of iron deficiency anemia all true except


a. women in childbearing period
b.after gasterctomy
c. increased hemosiderin in urine

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45

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

c.associated with small RBC

iron deficiency anemia is characterized by all except


a. decrease serum ferritin
b.
c. large sized RBC
d..
47

****Regarding iron

47

60-70 % of body iron is present in Hb.


15-30 % in bone marrow, 1% in transferring and
4% in myoglobulin.

48

Iron status in anemia of chronic disease.

48

In ACD there is:


- serum iron and TIBC.
- Normal ferritin and bone marrow iron.

49

**Iron deficiency anemia cause, except

49

Thrombocytopenia.
Actually there is raised platelet count in IDA

50

**Anemia of chronic diseases includes:


a. Vit B12.deficiency.
b. Pernicious anemia
c. Increased secretion of erythropoitic factors.
d. All of the above.
e. None of the above.

50

d. None of the above.


Regarding erythropoietic factors, in ACD there
is increased secretion of TNF and IL-1 reduce
Epo production.

51

***Hb H disease.

51

Choose Alpha thalassemia, or none


HbH = 4 and occurs when 4 genes are deleted
in thalassemia.

51.
New

In -Thalassemia, which is true?


a. It presents with severe anemia at the age of 6 months.
b. Blood transfustion may be required as frequent as
every 9-12 months.

mohammad_emam@hotmail.com

a. In thalassemia major, anemia presents at the


age of 3-6 months when the switch from to
chain synthesis normally occurs. Milder cases
present later (up to age of 4 years).
The regularity of blood transfusiton depends on
both the baby's general condition and pattern of
development AND stability of hemoglobin level
to avoid unnecessary overtransfusion of children
who may be later categorized as having
thalassemia intermedia OR undertransfusion in
demanding cases with subsequent imparierd
growth, failure to thrive, poor feeding and other
symptoms of anemia (at hb <7g/dl)
1-If the hemoblibin remains at this level for
several weeks, and there is clear evidence of
disability, then a regular transfustion regime
should be started.
2-Two four-weekly transfusions are given at a
rate of 2-3h for each unit, to keep hemoglobin
level > 9-10 g/dl but <14g/dl.
3-The mean yearly Hb should not be >12.5 g/dl.
4-Splenectomy should be considered if annual
blood consumption > 200ml/kg (calculated by
dividing total annual volume transfused by the
wt in the mid of the year). In splenectomized
patients, the rate of Hb fall is 1g/week, in non
splenectomized patients it is 1.5g/week.

46

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

-Thalassemia major all true except


a. early presented in life
b.
c. skull deformity
d.

d.associated with high incidence of infections

e.
all occur in .thalss.major except
a. -hair on end X ray skull
b.-isch.neck of femur
c. -easily bone fracture
d.-frontal bossing
e. -decrease susceptibility of infection
the defect of thalassemia occur in:
a. cycle of heme
b.glubin chain

b.

S hemoglobin is the same defect of thalassemia but the


different is :
a. long chain
b.glutamic acid on chain is substituted with valine
c. glutamic acid on alpha chain is substitutes with valine

b.

**CBC shows microcytic hypochromic anemia, HbA 93 %


, HbA2 7 %
a. thalassemia major
b. thalassemia minor
c. alpha thalassemia major
d.alpha thalassemia minor

b.

TIBC.which is true
a. decrease in females taking oral contraceptives
b.more labile than plasma iron
c. done only with normal serum iron
d.used as indirect indicator to plasma transferrin
saturation
e. it equals 6 times plasma iron con

d.

in alpha thalassemia what is true

decrease production of Hb F ( in alpha


thalassemia decrease A, A2, F )

hereditary persistence fetal Hb (HPFH)


due to
a. mutation in chromosome 16
b.deletion of b and genes
c. deletion of genes

?mutations in the -globin gene cluster

MACROCYTIC NORMOCHROMIC ANEMIA


52

**Folate store are enough for a period of

52

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

53

**All are correct about magaloblastic anemia except

53

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

mohammad_emam@hotmail.com

47

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

54

**Folate is affected by

54

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

55

A patient after partial gastrectomy


a. Has no nutritional deficiency.
b. Has IF deficit.

55

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

56

***Hypersegmented neutrophils present in?

56

Megaloblastic.a
Hypersegmentation = shift to the right. Other
causes include;
- liver disease.
- Uremia.
- Infection and toxemia.
Hyposegmentation = shift to the left occurs in;
- Leucocytosis.
- Thyroid disease.
- Pelger Huet

57

*****Macrocytosis is present in:


a. Alcoholism.
b. Retics.
c. liver disease
d. All of the above.

57

d. All of the above.


Macrocytosis occurs in; Alcoholism, aplastic
anemia, liver disease, myxedema, MDS, retics,
cytotoxic, MM and normally in neonates and
pregnants.

58

Urinary excretion of radioactive Vit B12 after oral and


parenteral administration

58

After a loading dose of IV B12, oral radioactive


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

Diagnosis of B12 deficiency


59

Which drug causes megaloblastic anemia.

in folic acid deficiency what happens to rbcs :a-enlarged RBCS


b-crenated RBCS
c-haemolyzed RBCS

mohammad_emam@hotmail.com

59
Vit B12 defeciency

Folate deficiency

- Cytotoxic.
- Metformin.
- Colchicin.
- Anticonvulsants.
- Paraaminosalicylic acid.
- Neomycin.

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

a.( megaloblastic anaemia )

48

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

QUALITATIVE / QUANTITATIVE WBC DISOREDERS


60

***Regarding cold agglutinins:


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

60

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

61

****T lymphocytes found in?


a. Cortical area of L.N
b. Germinal center
c. spleen
d. L.N sinusoid
e. Paracortical area of LN

61

e. Paracortical area of LN

c.

All are false except


a. T cells are predominantly located at the medullery aea
of LN
b.T cells are predominantly located at the germinal centre
of LN
c. T cells are predominantly located in the periarteriolar
region of the white pulp of spleen
d.T cells are predominantly located in the red pulp of
spleen

62

***Infectious mononucleosis all are ture except?


a. Heterophil antibodies agglutinate Ox RBCs,
b. Abnormal level of anti-1 specific IgG antibodies,
c. Spontaneous rupture of spleen,
d. Lymphadenopathy & atypical lymphocytes,

62

Responsible for immunity for pneumocystis carinii

mohammad_emam@hotmail.com

(c) or (b) In IMN the following occur;


a. Heterophil antibodies agglutinate Ox RBCs,
b. Abnormal level of anti-1 specific IgM (not
IgG antibodies),
c. Splenomegally: mild to moderate
(spontaneous rupture unlikely).
d. Lymphadenopathy & atypical lymphocytes,
d.it causes monocytosis, neutropenia, and
thrombocytopenia.

Infectious mononucleosis cause all except


a. Atypical lymphocytes
b.Lymphocytosis
c. Neutropenia
d.Thrombocytosis
63

Follicles and
germinal center
(B-cells)

Paracortex
(T-cell)

63

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

49

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

64

**Neutrophil inclusions of variable size +


thrombocytopenia + neutropenia occur in a case of:
a. Chediak-Higashi syndrome
b. Alder-Reilly syndrome.
c. Pelger-Huet syndrome

64

a. Chediak-Higashi syndrome is an autosomal


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

65

**In IMN, which is not present?

65

Neutrophilia.
In IMN there is;
- TLC 12-18
- Atypical lymphocytes.
- Neutrophilia (early) followed by
neuropenia).
- Thromobytopenia.

66

**Activated T-cells secrete:

66

Lymphokines

67

Neutrophil deficiency =

67

Hereditary granulomatous disease of childhood.

68

Child with long history of repeated infection.


Investigations show decrease superoxoid activity

Chronic granulomatous disease

neutrophil count is high in:


a. acute bacterial infection
b.iron deficiency anemia
c. megaloblastic anemia

a.

Neutrophil with toxic granulation seen in

sepsis

all cause lymphocytosis except


a. brucella
b.IMN
c. steroid therapy
d.adrenal insufficiency
e. pertussis

c.cause lymphopenia

lymphocyte is elevated in :
a. viral infection
b.acute bacterial infection
c. iron deficiency anemia
d.megaloblastic anemia
e. non of the above

****Chronic granulomatous disease is due to


immunodeficiency of which of the following?
a. T-cell member
b. Defective neutrophil function.
c. Hypocomplementemia.
d. Defeceient immunoglobulins.
e. neutrophils

mohammad_emam@hotmail.com

68

b. Defective neutrophil function.


Chronic granulomatous disease is an X-linked
disease that manifests in the second year of life
with susceptibility to organisms of low
virulence e.g. staph. epidermidis, serratia,
aspergillus, due to phagocytic disfunction.
Complement may be elevated and neutrophils
are usually elevated even without infection.
There is hypergammaglobulinemia. T-cell
function is normal
50

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

69

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

69

regulates immunoglobulins production by B


cells

70

Which is wrong :
***. Regarding the function of T-cell, which is correct?
a. IL-1 is produced early in the immune response.
b. T cells donot respond to IL-2 early in the immune
response.

70

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


immune response.

71

****Large granulocytic lymphocytes act as:

71

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

72

Where can you find hypogranular leucocytes?

72

In myeloid leukemia (M3 varient)

73

IL1 & 2.

73
b.

Which is wrong
a. IL-1 is produced early in immune response
b.T cell donot respond to IL2 early in immune response
74

Toxic granulation and Dohle bodies.

74

In toxic granulation, granules are heavy dark


red. This occurs with infection, toxemia and
irradiation.
Dohle bodies are small round blue peripheral
granules that occur with infection and MayHegglin syndrome.

75

***Pertussis infection, is associated with:

75

Marked leukocytosis with an absolute


lymphocytosis.
In pertussis, lymphocytosis is characteristic due
to lymphocyte promoting factor produced by the
organism.

76

**SAEP cause

76

Giant neutrophils

77

Granulocyte production is increased by:

77

GM-CFU
Also G-CFU

78

Lymphocytes are derived from

78

Pleuripotent stem cells in thymus (x).


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

content of neutrophil granules except


a. casepsin
b.lactoferin
c. perforins

c.perforine produced by NK cells (study 1ry and


2ry neutrophil granule content)

cytoplasmic granules in neutrophil + thrombocytopenia +


autosomal dominant disease

chediak hegashi syndrome

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51

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS


79

**Prognosis of M4 is

79

Poor (x)
Prognostic Factors in AML
Favorable

young age

Unfavorable
older age: Age >60 is usually
considered a poor prognostic
factor because older patients
generally don't tolerate
therapy & higher likelihood
of having unfavorable
prognostic factors e.g. special
cytogenetic abnormalities.
FAB type M7
bnormalities of
chromosome 11 at band q23

FAB types M2, M3, M4


t(8;21) and t(15;17)
abnormality
inversion of chromosome 16:
usually associated with type deletion of all or part of
M4 and marrow eosinophilia. chromosomes 5 and/or 7
This syndrome has an
excellent prognosis for
trisomy 8
remission induction and
duration
reactivity with CD2(T1): The Hyperleukocytosis
prior treatment
presence of certain cell
surface markers such as CD2 prior heamtologic disorder
appears to be associated with
low labeling
a favorable prognosis.
index/aneuoploidy
Infection

Types M2, M3, and M4 have the best prognoses,


types M5 and M6 have variable prognoses, and
type M7 has the worst prognosis.
80

****Chronic monocytic leukemia:


a. better prognosis.
b. bad prognosis

80

b. bad prognosis

81

******Bone marrow transplant indicated in all except?


a. ALL
b. AML
c. Acclertaed case of CML
d. blast phase of CML
e. Pagets disease
f. Osteogenesis imperfecta
g. B thalassemia major

81

82

**Bone marrow transplantation is not indicated in:


a. CML phase.
b. CML in chronic phase.
c. B thalassemia major.

82

e.Pagets disease
Indications for BMT are:
- ALL.
- AML
- Chronic or accelerated phases of CML.
- Severe aplastic anemia.
- Selected cases of:
MDS, Lymphoma, MM, CLL
Thalassemia major, sickle cell disease.
Severe inherited metabolic disease e.g.
adenosine deaminase deficiency and
Hurler's syndrome.
Not for CML blastic phase

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52

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

83

All are very bad prognostic factors in ALL except?


a. Very high TLC count
b. CNS involvement
c. Children less than 1 year old

83

None
Bad prognostic factors in ALL are;
a. TLC > 50x109/L
b. CNS involvement
c. Age <1 or >50 year old
d. Boys.
e. t(1;19)
f. T immunophenotype in children and
myeloid antigen in adults.
g. Blasts in peripheral blood on day 7
h. >5% blasts in bone marrow on day 14
i. No complete response on day 28

84

**Acute monocytic leukemia is associated with?


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

84

e. Monoblasts are +ve for NS & butyrate estrase.


There is also tissue infiltration (gums with
hypertrophy)

85

**All may cause leukemia except:


a. Ionising radiation.
b. Methotrexate.
c. Down's syndrome.
d. Benzene.
e. Fungus.

85

(b) Alkylating agents (not methotrexate) are the


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

all can cause acute leukemia except


a. benzene
b.
c. Fanconi
d.Feltys syndrome

mohammad_emam@hotmail.com

d. feltys syndrome is a rare disorder that


involves three conditions: rheumatoid arthritis
(RA), low white blood cell count, and an
enlarged spleen.

53

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

c.

Which is not of Felty syndrome


a. rheumatoid arthritis (RA)
b.neutropenia
c. neutrophilia
d.splenomegaly
86

****In FAB classification, M3 =

86

Promyelocytic leukemia
FAB
M1
M2
M3
M4
M5
M6
M7

HISTOCHEMISTRY
Occasional peroxidate+ granules, PASStrongly peroxidase+, PASStrongly peroxidase+, PASStrongly peroxidase+, some cells may be
PAS+
Many be peroxidase+ and PAS+,
nonspecific esterase stains are strongly +
and inhibited by NAF
Red cell precursors are PAS+, ringed
sideroblasts are seen with iron stains
Variable, platelet peroxidase can be
demonstrated by electron microscopy

87

***In acute promyelocytic leukemia, which is wrong?


a. In FAB classification it is M4 morphology.
b. DIC.
c. Multiple Auer rods.

87

a.In FAB classification promyelocytic leukemia


is M3 not M4 morphology
M0 = Undifferentiated by morphology &
cytochemistry, myeloid by immunophenotype.
M1 = Little differentiation >90% blasts.
M2 = Differentiated 30-90% blasts.
*M3 = Promyelocytic, hypergranular (M3) or
hypogranular (M3variant).
M4 = Myelomonocytic.
M5 = Monocytic without differentiation (b) or
with differentiation (a).
M6 = Erythroid differentiation >50% are
erythroid.
M7 = Megakaryocytic.

88

*****Neutrophil ALP (NAP) is increased in all except:

88

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

89

*In acute promyelocytic leukemia:


a. It belongs to M4 type.
b. Abnormal coagulation.
c. Leukocyte cell markers common.

89

b. Promyelocytic leukemia is M3, It is associated


with DIC

mohammad_emam@hotmail.com

54

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

90

Hairy cell leukemia.

90

HCL is a B lymphoid CLL characterized by;


- Splenomegaly.
- Lymphocytosis and hair cells with no
nucleoli.
- Dry tap on aspiration.
- Spaces around cells.
- Immunologically mature (Normal Igs)
- Strong SmIg
- -ve mouse rousette.
- CD25 +ve
- *Tartarate ACP resistant (TRAP)

91

****Chromosomal abnormality of t(8:21) is associated


with:
a. CML, ALL.
b. M1
c. M2
d. M4 with eosinophilia.
e. M5b

91

c. M2 associates t(8:21), M3 associates t(15:17)


and CML t(9:22) (9 becomes Philadelphia
chromosome.

92

Chromosomal abnormality in M3 is:

92

t(15:17)

93

**Chromosomal translocation in case of CML is:


a. t(8:21)
b. t(9:22)
c. t(11:14)
d. t(8:22)

93

b. t(9:22)

Case: 30y patient with sudden onset bilateral breast


swelling cytogenetics t(8.14)

burkitt lymphoma t(8,14)

**MDS cytogenetic all true except


a. monosomy 7
b.trisomy 5
c. trisomy 8
d.(8,14)

d.

94

**HTLV except

94

transmitted by blood transfusion (x).


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

95

**Antigen used for the detection of leukemia:

95

CD antigen

96

***Blood malignancy least encountered in children:


a. Wilm's
b. Neuroblastoma
c. hairy cell leukemia

96

c.ALL constitutes 75% of childhood


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

97

****Paraprotiens are?

97

A group of identical Ig moving as bumdle on


electrophoresis.

mohammad_emam@hotmail.com

55

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

98

99

**A 68 years old man with TLC of 23,000 has the


following markers, CD21 21%, CD20 56%, CD 5 89%,
kappa chain 78%, lambda -ve what is the diagnosis?
a. CML
b. CLL
c. ALL
d. AML
e. adult T cell leukemia lymphoma

98

b.(for diagnosis of CLL) coexpression of B cell


markers with CD5 (T cell marker) and S Ig
either kappa or lambda

marker for pre B ALL


a. CD 3
b.
c.
d.
e.

c.

CD3 is marker for


a. T lymphocyte
b.B lymphocyte
c. NK cell
d.Histocyte

a.

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

99

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

Commonest transformation of CLL

Richter transformation

All are poor prognostic features of ALL except


a. Presence of T cell marker
b.Leucocytic count more than 500.000
c. CNS involvement
d.Complete remission in the first 3: 4 weaks
e. Patient age less than 1 year

d.

mohammad_emam@hotmail.com

56

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

b.RAI classification
Stage 0: absolute lymphocytosis without
adenopathy, hepatosplenomegaly, anemia, or
thrombocytopenia.

***In CLL RAI classification II or (B)


a. Leucocytosis + splenomegaly
b.Lymphocytosis + splenomegaly
c. Leucocytosis+ anemia
d.Lymphocytosis + anemia

Stage I: absolute lymphocytosis with


lymphadenopathy without hepatosplenomegaly,
anemia, or thrombocytopenia.
Stage II: absolute lymphocytosis with either
hepatomegaly or splenomegaly with or without
lymphadenopathy.
Stage III: absolute lymphocytosis and anemia
(hemoglobin <11 g/dL) with or without
lymphadenopathy, hepatomegaly, or
splenomegaly.
Stage IV: absolute lymphocytosis and
thrombocytopenia (<100,000/mm3) with or
without lymphadenopathy, hepatomegaly,
splenomegaly, or anemia.
Binet Classification
stage A CLL is characterized by no anemia or
thrombocytopenia and fewer than three areas of
lymphoid involvement (Rai stages 0, I, and II).
stage B CLL is characterized by no anemia or
thrombocytopenia with three or more areas of
lymphoid involvement (Rai stages I and II).
stage C CLL is characterized by anemia and/or
thrombocytopenia regardless of the number of
areas of lymphoid enlargement (Rai stages III
and IV).
More than 3 lymph node region

**Binet classification (B)


100

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

100

Hairy cell leukemia


Tartarate resistant alkaline phosphatase (TRAP)
is used for diagnosis of HCL

101

*****Bone marrow necrosis occurs with:


a. Metastatic carcinoma.
b. Chrome lymphoproliferative disorder.
c. Hodgkin

101

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


If sickle cell is present it is the best answer

102

******In MM, extramedullary plasmacytoma is likely to


be present in:
a. Lungs.
b. CNS
c. GIT
d. ovaries

102

a.Extramedullary plasmacytoma occurs most


commonly in nasopharyngeal sinuses. Heart,
lung and kidney (nodular glomerulosclerosis)
originate from tissues underlying mm of GIT
and URT.
Oropharynx is best answer if present in the
question

mohammad_emam@hotmail.com

57

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

**multiple myeloma with skin and chest lesion followup


by
a. end stage organ failure
b.solitary plasmacytoma
103

******In lymphocyte predominant CLL:


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

***In CML *(AML)treatment, which is true:


a. Folinic acid protects against the megaloblastic effects
of methotrexate .
b. Citrovorum and folinic acid are synonymous.
c. Trimethoprim if used frequently causes folic acid
deficiency or megaloblastic anemia.
d. There is methyl THF in B12 deficiency.
105

*****According to international working formulation,


poorly differentiated lymphoma is:
a. small cleaved cell lymphoma.
b. small non-cleaved lymphoma.
c. diffuse mixed cell diffuse lymphoma.
d. Large cell follicular lymphoma.

CLL in lymph node biopsy

mohammad_emam@hotmail.com

103

c. Lymph node effacement may be nodular or


diffuse.
In lymphocyte predominant HL according to
Rye classification;
- Nodal architecture is lost
- Small homogenous lymphocytes.
- RS cells are little with no nucleoli.
a. Folinic acid protects against the megaloblastic
effects of methotrexate .

b.small non-cleaved lymphoma.


Working Formulation for Non-Hodgkin's Lymphomas (NHL)
Classifiable non-Hodgkin's Unaccounted-for non-Hodgkin's
lymphomas
lymphomas
Low-grade
Small lymphocytic (CLL)
Mucosa-associated lymphomas,
CD5, CD10
Follicular, predemoninantly
small-cleaved cell
Follicular mixed, small-cleaved
and large-cell
Intermediate-grade
Follicular, predominantly largecell
Diffuse small-cleaved cell
Mantle-cell lymphoma CD5+,
CD23, t11;14 PRAD1
Diffuse mixed small- and large- Lennert's lymphoma T-cell+
cell epithelioid component
Diffuse large-cell cleaved, TTransformed from low grade NHL,
cell variants, non-cleaved
t14;18+
High-grade
Large-cell,
Anaplastic large-cell lymphoma,Timmunoblastic plasmacytoid,
cell (rare B),
clear-cell, polymorphous,
Ki-1(CD30)+, t2;5
epithelioid
Small non-cleaved cell,
Burkitt's
Follicular areas
Miscellaneous
Composite
Other T-cell NHL
Mycosis fungoides/Szary
HTLV-1 lymphoma
syndrome
T-cell CLL
Histiocytic
Angioimmunoblastic
lymphadenopathy with
dysproteinemia
Unclassifiable
Angiocentric-type
Polymorphic reticulosis
Lymphomatoid granulamatosis

low grade lymphoma

58

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

106

**BM transplantation and graft vs host disease

106

All (skin, liver, GIT damage)


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

case study(bone marrow transplantation with mismatched


donor)
**25y patient received bone marrow transplantation after
20 week he develop fever ,pancytopenia
a. graft vs host reaction
b. non hemolytic febrile reaction
c. bacterial contamination
107

Haploid transplantation.

107

Haploid identical match is when the donor is a


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

108

Use of P32 for PRV.

108

P32 is a emitter which is taken up by bone and


may be used to give prolonged myelosuppression (2yrs) in old patients. Effect may
take 2-3 months and lasts 6-36 months. But due
to side effects, it shouldnt be used below 70
years. Single dose is sufficient to reduce spleen
size. Little risk of neutropenia and
thrombocytopenia.

109

Serum erythropoietin antibodies in PRV.

109

Serum erythropoietin is inhibited due to high


RBC count
d.

in polycyathemia rubra vera all true except


a. decrease iron level
b.
c. increase red cell mas
d.increase NAP score
110

**Which kind of lymphoma occurs in children?

110

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

112

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

112

c. All of the above

Case: 70 y, blurred vision , headache , hyper IgM


a. waldenstrom
b.
c. CLL
d.Hairy cell leukemia

mohammad_emam@hotmail.com

a.

59

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

113

Paraprotein is associated with


a. CLL
b.CML
c. ALL
d.hairy cell leukemia

a.

IgM monoclonal paraproteinemia


a. CML
b.ALL
c. 1ry amyloidosis
d.MM
e. Hairy cell leukemia

d. IgM paraproteinemia is seen in Waldenstrm


macroglobulinemia, B-cell lymphoma or
lymphoproliferative disorders, monoclonal
gammopathy of undermined significance
(MGUS), -heavy chain disease, and IgM
myeloma

In myelosclerosis all are ritght except:


a. Hepatomegaly.
b. Pancytopenia
c. Hypocellular BM

113

c. Myelosclerosis is characterized by
splenomegally, extramedullary hemopoiesis,
leucoerythrocytic blood picture + replacement of
BM by collagen fibrosis. Hepatomegally is
requent. BM shows cellularity (not
hypocellularity).
There is no anisopoikylocytosis

In myelosclerosis all are ritght except


114

Myelofibrosis and myelosclerosis.

114

Same

115

**CLL when reach LN resemble which type of LN?

115

Low grade small cell Hodgkin lymphoma.


CLL are small mature uniform. Well
differentiated lymphoma has small mature
lymphocytes.

116

**Mycosis fungoides which is wrong


a. T cell origin
b.Good prognosis 5 year in average
c. Reach deep dermis

116

c.seen in epidermis & upper dermis

117

****Sizary cell leukemia


a. T-cell leukemia lymphoma
b. Cutaneous T cell lymphoma

117

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

adult T-cell leukemia lymphoma associated with all except


a. LN rarely affected
b.highly convoluted nucleus
c. associated with HTLV III
d.
118

Binet clinical staging of lymphoma stage IIB

mohammad_emam@hotmail.com

118

Lymphocytosis and Involvement of 2 or more


chains.
Lymphocytosis is not included.

60

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

118
New
1

118
New
2

118
New
3

***In Hodgkin disease all are true except


a. The commonest presentation is painless cervical
lymphadenopathy
b.Chest X ray is rarely helpful
c. Patient with constitutional symptoms have poorer
prognosis
d.The only clinical feature may be splenomegaly
e. Anaemia is common

118
New
1

b.Chest X ray is rarely helpful


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

**mediastinal mass & biopsy shows binucleated cells

Hodgkin lymphoma

Hodgkin lymphoma pathology

Reed sternberg cells

In Non Hodgkin disease, which is true?


a. Most are T cells.
b. Good risk patients are sensitive to chemotherapy.
c. BM is uncommonly involved.
d. Histological classification is not as important as in HD.
e. None of the above.

118

In CML, which is not present?


a. NAP is highly positive.
b. Splenometally is present in 80% of cases.
c. WBC is commonly 500x109 at presentation.
d. BCR +ve but Philadelphia negativecases may occur.

118

**In CML NAP score is low

New
2

New
3

e. Most NHL are B cell in origin. Paradoxically,


aggressive tumors respond more dramatically to
treatmet and are more likely to be cured than
indolent tumors. Bone marrow is commonly
involved leading to BM failure. Treatment of
NHL depends principally on the histological
classification (more than six histological
classifications for NHL).
a. In CML NAP score is low (<20, whereas an
elevated or normal score (20-130) occurs in a
leukemoid reaction), splenomegally (often
massive) occurs in over 90% of cases, WBC are
often greater than 100x109 or more at
presentation. 5% of CML are Ph-negative and
about half of these patients have a BCR-ABL
gene that is molecularly identical to the BCRABL gene of Ph-positive CML.

**male 35 year, repeated infection, massive splenomegaly,


hepatomegaly,decreased NAP score, no jaundice, no
anemia, no purpura, CBC with marked
leucocytosis..diagnosis is
a. CML blastic phase
b.CML chronic phase
c. Myelofibrosis

b.

patient with huge hepatospleenomegaly & increase TLC


a. CML with chronic phase
b.CML with accelerated phase

b.

Radiotherapy use in all except

For ttt of testicular tumor to preserve sperm


viability
Increase mitotic figure

Follicular hyperplasia differentiated from follicular


lymphoma

mohammad_emam@hotmail.com

61

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

COAGULATION AND PLATELETS


119

*******In Acute DIC there is?

119

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

In DIC all true except

Hyperfibrinogenemia

DIC is a complication of

shigellosis

120

**The following inhibits thrombus formation except

120

thromboxan.
Thromboxane is a platelet aggregator.
Inhibitors of coagulation include;
Serpentines:
ATIII
Heparin co factor II
1 antitrypsin
C1 estrase inhibitor
2 antiplasmin
2 macroblobulin
Protein C system
Protein C
Protein S
Thrombomodulin
C4b binding protein.

121

****Thrombocytosis seen in all except?


a. Hemolysis
b. Hemorrage
c. spleenectomy
d. fanconis syndrome.

121

d. Fanconis syndrome.
Fanconi syndrome is congenital aplastic anemia
with pancytopenia and absent megakaryocytes.

Present with aplastic anaemia at 40 years: fanconi


d.Haemorrhage cause reactive thrombocytosis

Thrombocytopenia seen in all except


a. Radiotherapy
b.Aplastic anaemia
c. Cytotoxic druge
d.Haemorrhage
122

**ITP affects

mohammad_emam@hotmail.com

122

Females> males

62

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

123

******In TTP all are present except

123

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

124

***ITP in child

124

Sudden remission.(spontenous remission)


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

all true in ITP except


a. spont remission
b.mainly in adults
c. females more than males
d.plat turnover decreased

d.pl. turnover increase

Mechanism of ITP
a. Antibodies against PL surface antigen
b.Hypersplenism

a.

125

****Antiplatelet antibodies are present in


a. SLE.
b. scleroderma.
c. Carcinomatosis
d. CLL
e. All of the above

125

e. All of the above


2ry auto immune thrombocytopenia occurs
secondary to:
- Blood disease (evan's syndrome)
- General AI disease (SLE, RA)
- Lymphoprolyferative (CLL and
lymphoma)
- Solid tumors.
- HIV, chemoradiotherapy and BMT
- Post viral infection.

126

Thrombocytopenia is immune mediated in:

126

SLE.

mohammad_emam@hotmail.com

63

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

127

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

127

Aspirin
Platelet dysfunction are;
adhesion:
- vW
- Pseudo vW
- Bernard Soulier syndrome.
release:
- SPD:
SPD
Wiscott Aldrich syndrome
Hermanskey syndrome
Chediak Hegashi syndrome
TAR syndrome
- granules: Grey platelet syndrome.
- TXA2
aggregation:
- Glanzmans syndrome
- Afibrinogenemia.
Aquired:
- myeloproliferative
- renal
- FDPs
- Drugs: Aspirin
- Chronic hypoglycemia.
d.

**all are qualitative defect in platelet except


a. aspirin
b.glanzman syndrome
c. bernard solier syndrome
d.myelofibrosis
128

Effect of splenectomy on platelet count.

128

Increased

129

***ITP occurs in all except:


a. hypersplenism,
b. Sarcoidosis.
c. SLE.
d. Quinidine.
e. All of the above.

129

??e. All of the above.


ITP has no identifiable antecedent. The question
may be about autoimmune thrombocytopenia
not ITP See 124.

b. Hemorrhage in mucus membrane.

**In purpura:
a. Hemorrhage in deep muscles.
b. Hemorrhage in mucus membrane.
c. Hemarthrosis.
131

In Bernar Soulier syndrome, all are right except:


a. Normal aggregation with ristocetin
b. Giant platelets
c. glycoprotein

case study(def platelet adhesion defect with


macrothrombocytopenia)

mohammad_emam@hotmail.com

131

a. Normal aggregation with ristocetin


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

64

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

a.also thrombocytosis if present can cause small


pl

Cause small platelet


a. Wiscott Aldrich syndrome
b.Chediak Hegashi syndrome
c. Bernard Soulier syndrome
d.Grey pl syndrome
132

***In vW disease, all are true except:


a. BT is prolonged.
b. PT is normal.
c. PTT is normal
d. Platelet aggregation is normal

132

b.?

vWdisease pl aggregation enhanced by


a. fibrinogen
b.collagen
c. ristocitin
d..
133

*******In Hemophilia A which is correct?


a. APTT is prolonged.
b. PT is prolonged.
c. BT is prolonged.
d. CT is prolonged.

c. In vW disease there is:


PTT
BT (variable)
platelet aggregation with ristocetin

133

**hemophilia man married to normal woman the


incidence of his children is?
a. carrier male
b.diseased female
c. carrier female

a. APTT is prolonged.


All true except normal APTT

c. Hemophilia A male married normal female,


incidence in offspring: females are carriers,
normal males

134

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

134

b. Cryoprecipitate contains FVIII, vWF and


FVIIIc stimulating factor. vW disease is also
treated with DDAVP.

135

****Which test is used to diagnose factor XIII deficiency?


a. PTT.
b. PT
c. Thrombin time
d. Clot stability with urea (clot dissolved with 5 mol urea)

135

d. In FXIII deficiency there is normal clotting by


extrinsic and intrinsic tests and TCT. However
clots are friable and dissolve in 5M urea within
few houls.

Factor XII deficiency prolonges

PTT

**increased PT with normal PTT facor deficient is

VII deficency

thrombin time is:


a. extrinsic coagulation pathway (factors)
b.intrinsic coagulation pathway (factors)
c. the conversion of fibrinogen to fibrin in addition of
thrombin

c.

one stage prothrombin time (PT) used to detect (diagnose)


disorders in:
a. extrinsic coagulation pathway (factors)
b. intrinsic coagulation pathway (factors)

a.

mohammad_emam@hotmail.com

65

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

(intrinsic factor abnormalties)

PTT
136

**To differentiate between hemophilia A and B?


a. Individual factor assay.
b. PT
c. PTT
d. pl function test

136

a. Individual factor assay. Also, thromboplastin


generation test (TGT) and plasma correction
tests can be used.

137

**** **As regard heparin which is wrong


a. Act on thrombine
b.Action is mediated by antithrombin III
c. Its action can be reversed by vitamine K

137

c.Its action can be reversed by protamine sulfate

c.

antithrombin III inhibit factor


a. Va
b.VIIIa
c. Xa
d.All of above
138

*****Regarding protein C. which is wrong?


a. Acts on thrombomodulin.
b. acts independent on protein S.

138

Regarding protein C.
139

Cumarin (Oral anticoagulant) acts by

139

140

Regarding protein C all wrong except:

140

urticarial rash, arthritis, TLC 12 , ESR 90 what test to do


first
a. measure IgE
b.platelet function test
c. skin allergic test
d.skin biopsy

in presence of clotting defect one of this not measure:

b. protein C inactivates FV and VIII and


activates thrombolysis. Protein S is a cofactor of
activated protein C.
Its main action is inactivation of factor VIII and
V
factors II, VII, IX
Vitamin K antagonism leads to synthesis of
immunologically detectable but biologically
inactive factors +50% the level of vitK
dependent factors.
Its main function is inactivation of F Va and
VIIIa
d.it may be Henoch-Schnlein purpura (HSP) is
an acute immunoglobulin A (IgA)mediated
disorder characterized by a generalized
vasculitis involving the small vessels of the skin,
the gastrointestinal (GI) tract, the kidneys, the
joints, and, rarely, the lungs and the central
nervous system (CNS).it need skin biopsy
(check the answer)
leucocyte count

bleeding time test detect the abnormality in :


Ivy method of bleeding time detect the abnormality in :

defect in vessels and platelets

patient 24 years old with platelet adhesion defect


a. defect in GP1B
b. defect in GP 11B / 111A

a.

patient 1.2 years old with platelet adhesion defect


a. grey platelet syndrome
b. bernard soulier syndrome
c. glanzman syndrome

b.

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66

Hematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

A blood smear shows 80 nucleated red cells per 100 leukocytes.


The total leukocytic count is 18 x 10 9 /l. The true WBC
expressed in SI units is:
a. 17.2 x 109 /L
b. 9.0 x 109 /L
c. 10.0 x 109 /L
d. 13.4 x 109 /L
Which of the following tests is used to monitor red cell
production?
a. PCV
b. TIBC
c. Schilling test.
d. Reticulocytic count.

c. 10.0 x 109 /L

Which of the following conditions will increase ESR?


a. Erythrocytosis.
b. Increased fibrinogen level.
c. Decreased IgG level.
d. Reticulocytosis.
When making a blood film by Wdge technique, increasing the
angle of the spreader slide results in the film being:
a. Longer and thicker.
b. Longer and thinner.
c. Shorter and thicker.
d. Shorter and thinner.
What information is required in order to calculate the MCHC?
a. Hemoglobin and erythrocytic count.
b. Hemoglobin, MCV and RBC
c. Hematocrit and erythrocyte.
d. Hemoglobin and MCV
e. None of the above.

b. Increased fibrinogen level.

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d. Reticulocytic count.

c.

e. None of the above.

67

Immunohematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Immunohematology and transfusion


1.

**Serum of donner + RBC of patient is called:


a. minor cross matching
b. major cross matching

1.

a. minor cross matching = donor serum +


recipient cells.
Major cross matching = donor cells + recipient
serum.
to remove an excess antibody present in the
sample

why do we have to wash red blood cells in cross matching

2.

**Acute intravascular hemolysis occur in blood in

2.

ABO incompatibility.

3.

*******A patient received 2 bags of blood


intraoperatively, after 5 hours he developed fever and
rigors. This is likely due to: without hemolysis
a. Platelet antibodies.
b. Leucocyte antibodies
c. Bacterial infection.
d. malarial infection

3.

b. Febrile reactions due most frequently to WBC


reactive antigens and rarely to platelet antiesn
occur after 30min to 90 minutes after starting
transfusion.

4.

Unsuitable donor.

4.

*****All diagnose hemolytic disease of new born


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

d. In HDN there is polychromasia and


NRBCs in peripheral blood of the baby.

Tests done on cord blood


- ABO & D group
- DAT
-Hb
- Bilirubin

Tests done on maternal blood


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

***For hemolytic disease all are true except?


a. It is autoimmune disease,
b. Child RBC have to cross the placenta to produce the
antibody response,
c. First born child unaffected.
d. Can be diagnosed even in utero,
d. Severity is proportional to antibody titer

a. HDN is an alloimmune (not autoimmune)


disease.

****Investigations useful in HDN:


a. Retics count.
b. Bilirubin.
c. DAT (+ve in alloimmune antibodies)

All (see no 5)

HDN which is not of value?

Cord Hb (x see 5)
bilirubin and cord haematocrite

diagnose hemolytic disease of new born severity can be


diagnosed by
9

*****Blood transfusion can transmit:


a. HIV
b. HBV
c. CMV
d. All of the above

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d. All of the above

68

Immunohematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

10

*The blood donor in KSA can not be with all of the


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

10

e. previous pregnancies
Possibly transmissible infections not routinely
tested are:
- B. burgdorferi.
- Y. enterocolitica
- P. falciparum.

platelets are stored at

(20-24)room temprature

life span of red blood cells in the circulation (body):


a. 80 days
b. 120 day
c. 130 day
d. 20 day
e. 5- 7 days

b.

sensitized ab in serum detect by:

indirect antiglublin test

in RH-ve person , this ag not found :

D-antigen

CPD-A anticoagulant used to store blood for:


a. 35 days
b.45 days
c. 5 days
d.15 days
e. non of the above

a. blood medium commonly used in blood bank:


citrate phosphate dextrose adenine (CPD-A)

**plasma exchange gives result in

myasthenia gravis

plasma exchange used to decrease viscosity in


a. increased cholesterol
b.Dysprotien

all causes false negative ABO incomparability/ cross


matching except:a- deteriorated reagent
b-not putting antisera
c-under incubation

c.

**reason of false positive ABO incompatibility/cross


matching

cold agglutination

the most blood group forming ab in blood


a. ABO
b.RH
c. duffy
d.Kelly

store RBC at -80c:


a. 1year
b.1month
c. 4 year
d.2 year
e. 6year

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69

Immunohematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

**RH DU reported as
a. positive
b.negative

patient received 6 units of platelets, after 5 hours he


developed cough, dyspnea, tachycardia and lung oedema
a. acute respiratory distress
b.post transfusion respiratory distress
c. Transfusion dependent lung injury

patient received 6 units of platelets, after 5 hours he


developed fever, lesargy& dyspnea
a. wound infection.
b. acute lung injury
c. Bacterial contamination.
d. malarial infection

b.

blood component with bacterial contamination


a. packed RBCS
b.granulocytes
c. platelets
d.

c.

patient weight 50 kg max blood volume for donation is


a. 450 ml
b. 400 ml
c. 380 ml
b. 325 ml

a.50kg or Less =weight9

in O+ve person
a. no presence of ag
b.no presence of ab
c. .
d.

Blood group O has no antigen but has antibodies


to A and B. but Rh +ve mean that it has D
antigen. The answer it has antigens and
antibodies

antibody found in blood group AB individuals :


a- anti-A
b-anti-AB
c-anti-B
d-non

* Rh-ve patient means he dose not have: D


antigen
d.

***patient on antihypertensive drugs for blood donation


a. can donate (fit for donation)
b.deferral for donation 3 months
c. deferral for donation 1 year
d.perminant deferral

a. the blood pressure should be no higher than


180 mm hg systolic and 100 mm hg diastolic. If
higher can not donnate
pulse rate 50 : 100 beats per minute

patient have iron deficiency anemia & Hb decreased for


blood donation
a. deferral for 6 months
b.deferral for 12 months
c. wait until Hb reach acceptable level

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70

Immunohematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Adequate donor
a. Donor with HBV 9 months ago
b.Donor with thalassemia trait
c. Donor with previous 3 or more donation in the calendre
year
d.

b.?

plt transfusion is helpful in all except


a. -ITP
b.-hyperplenism
c. -DIC
d.leukemia

a.

**treatment of multiple factor def caused by liver disease


a. cryoprecipitate
b.FFP (fresh frozen plasma)
c. prothrombine comlex

b.

***FFP used to supply which of factor diffecency


a. I & II
b.V & X
c. IV & IX
d.IX & XI

b.used for multiple factor diffeciency


2,5,10,11, 12,13

to differentiate anti I from anti i


a-a1 cells
b-a2 cells
c-cord cells
d-none of the above

c.

preservative which could be added to plasma depleted


RBCS to keep its viable function

Citrate phosphate dextrose +/- adenine (CPDA)

Stored blood deffecient in

Factor V , VIII, XI & pl

in blood transfusion
a. HLA of donor react with recipient neutrophil MHC l
b.HLA of donor react with recipient neutrophil MHC ll
c. HLA of recipient react with donor neutrophil MHC l
d.HLA of recipient react with donor neutrophil MHC ll

c.

adding adenine and phosphate to blood collection bag to

maintain ATP in RBC

Active transport of substance across the membrane of


cells is said to be active if
a. Against the concentration gradient
b.Using ATP
c. From high concentration of Na to low
d.All of the above

d.

immunoglobulin is:
a. beta globulin
b.alfa globulin
c. gamma globulin

c.

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71

Immunohematology

CLINICAL & CHEMICAL PATHOLOGY MCQ

less than 50 kg = weight 9

mohammad_emam@hotmail.com

72

CLINICAL & CHEMICAL PATHOLOGY MCQ

mohammad_emam@hotmail.com

Immunohematology

73

Immunology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Immunology
1.

**Antigen & antibody reaction is?


a. Agglutination
b. precipitation
c. immunodiffusion,

1.

b. Immunodiffusion is the process of diffusion in


semisolid media to detect amount of antibody to
neutralize antigen. Agglutination necessitates an
indicator system e.g. RBCs or latex particles.

2.

**Hook effect in immune assay occurs because the


concentration of antibodies in the well is?
a. Too low
b. Too high
c. Optimum

2.

a. It occurs when extremely high concentrations


of an analyte, such as prolactin, occupy all the
sites on both the capture and detection
antibodies, and thus prevent the formation of a
sandwich immunoassay. The end result is that
few or no tracer antibody
b.

Prozone phenomenon
a. Excess Ag
b.Excess Ab
3.

***Antigen & antibody complex are?


a. Weakly bound
b. strongly bound
c. no bound at all.

3.

b.

4.

***Reaginic antibody is:


a. IgG
b. IgM
c. IgD
d. IgE

4.

d. Reagenic or anaphylactic mechanism refers to


events following combination of antigen with
IgE molecule specific for it upon the surface of
mast cells.

5.

Arthus phenomenon results from:


a. Antigen excess.
b. Antibody excess.
c. Antigen and antibody in equal proportions.

5.

c.
In arthus phenomenon, a high antigen
concentration is attacked by a high antibody
concentration excess antigen antibody
complexes followed by local tissue damage.

6.

**Lysis in complement fixation test means the test is?


a. Positive
b. negative
c. invalid.

6.

b. In CFT, absence of hemolysis indicates that


complement was fixed in antigen antibody
reaction so specific antibody was present.

7.

**All tube for serial dilution for CRP test contain 0.5ml
of saline & 0.5ml of serum is added to Tube 1 & 0.5ml is
transferred through the row of tubes & agglutination is
demonstrate in tube 7, If sensitivity of the test is 6mg/l
the concentration of CRP in serum is?
a. 36mg
b. 42mg
c. 6mg
d. 48mg
e. 384mg

7.

e.

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74

Immunology

CLINICAL & CHEMICAL PATHOLOGY MCQ

8.

**CRP is tested because it is increased in?


a. Bacterial infection
b. viral infection
c. other infection.

8.

b. CRP is a sensitive non specific indicator of


acute injury, bacterial infection or inflammation.

9.

In infectious monopnucleosis antibodiesare?

9.

Anti (i)

10.

******Which of the following reagin test for syphilis?


a. VDRL
b. TPHA
c. TPT

10.

a. Reagin = Antibody against cardiolipin.


Reagenic tests are VDRL, RPR and
Wassermann (CFT).

11.

**Antigenic detection is useful in diagnosis of all of the


following escept:
a. B hemolytic Streptococci.
b. H. influenza.
c. Listeria monocytogenes.

11.

c. Because L. monocytogens is an intracellular


organism.

31.

****Antigenic methods are useful in diagnosis of all of


the following cuases of meningitis except:
a. Strept B hemolyticus.
b. H. influenza
c. E. coli
e. listeria

12.

****Autoimmune disease contain all except?


a. Lesion in B/M
b. low complement level in serum
c. immune complex in serum
d. low Ig in serum.

12.

d. In AI diseases there is autoantibodies


immune complex formation complement
fixation complement.
Also there is cell death or altered function.

13.

***Tuberculine test is type.

13.

IV hypersensitivity

14.

Cell mediated immunity =

14.

Candida
Defective CMI candidiasis.

15.

*****Which of the following detects type IV cell


mediated immunity?

15.

Tuberculin

16.

****Mantox test is a method for

16.

Tuberculin

17.

Immune complex deposits.

17.

31.

inflammation of a tissue with more eosinophil and mast


cells:
biopsy found eosinophil & mast cell:

Type I hypersensitivity reaction

immune response to infection cause all except


a. rheumatic fever
b.
c. Glomerulonephritis
d.

d.?

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75

Immunology

CLINICAL & CHEMICAL PATHOLOGY MCQ

leukocyte responsible for cellular immunity:


a. T lymphocyte
b.B lymphocyte
c. monocyte
d.basophile
e. eosinophil

a.

the leukocyte that involve in adaptive and acquired


immunity
a. lymphocyte
b.monocyte
c. neutrophil
d.basophil
e. eosinophil

a.

leukocyte responsible for response to parasitic and


allergic infection:
a. lymphocyte
b.monocyte
c. neutrophil
d.basophil
e. eosinophil

e.

Monocyte

= macrophage

T cell function Which is correct

It regulates Ig production by B cell

unidirectional movement of WBCS directly to its target:


a. sliding
b.phagocytes
c. chemo taxis

c.

Ig not part of acquired immunity :a. IgG


b. IgM
c. IgA
d. IgE

c.

Ig can cause HDN :a. IgG


b. IgM
c. IgA
d. IgE

a.

the smallest molecular weight ig is:


a. IgG
b. IgM
c. IgA
d. IgE
a. IgD

a.

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76

Immunology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Heaviest Ig
a. IgG
b. IgM
c. IgA
d. IgE
a. IgD

b.

one of the immunoglobulin present in trace amount in


serum :
a. IgG
b. IgM
c. IgA
d. IgE
a. IgD

d.

firstly increased in bacterial infections

neutrophil
**pathology of rheumatic fever similar to
a. endocarditis
b.pericarditis
c. pancarditis
d.vasculitis

c.

**case of female with autoimmune disease & muscle


weakness which antibody is positive
a. anti jo
b.anti histone
c. ANA
d.Antimicrosomal
e. ANCA

a.Case of polymyositis for diagnosis anti jo

****presence of C4D in graft tissue capillaries


a. C4D is staple from classic pathway
b.C4D is unstaple from alternative pathway
c. C4D is unstaple from classic pathway
d.
t remain bound to
endothelium for more than a month

a.

First line of body defence against strept is

phagocytosis

blood group genotype d+ c+ e- c- ea. R1r


b.r1r
c.

? may be a.

HLA typing for patient need graft. Matching show 2:2:2


Means
a. HLA A negative
b.HLA B negative
c. HLA DR negative
d.HLA A, HLA B, HLA DR negative

?Most propaple (d)

graft rejection main mechanism is


a. action of APC of donor
b.

b.

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77

Immunology

CLINICAL & CHEMICAL PATHOLOGY MCQ

**case. patient is P.ANCA +ve


a. ulcerative colitis
b.
disease

a.

**sample for immunological investigation for multiple


myeloma is
a. clotted sample
b.sputum
c.
d.

a.because elechtrophoresis on serum sample

addin Ag to Ab until neutralization is called

titration

Patient with pain increase by rest decrease with


excersise. X ray show lesion in pelvic joints.
Recommended test
a. ANA
b.RF
c. .

b.a case of rheumatoid arthritis

mohammad_emam@hotmail.com

78

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Microbiology
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION
1.

**Antibiotic used for each organism are


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

1.

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

2.

**Tetracycline is identical in action with

2.

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

Ampicillin is effective in
a. Proteus mirabills
b.Proteus valgaris
3.

**Which is effective against penicillinase producing


organism.

3.

Nfcillin or dicloxacillin.

4.

**The best chemical disinfectant in a TB lab?


a. Gluteraldehyde
b. ethanol
c. phenol
d. hypochlorate,

4.

a. Phenol, although effective against TB, is


rarely used being too caustic. Ethanol is not
effective (TB are alcohol resistant).
Glutaraldehyde is used to sterilize respiratory
equips and is effective against TB.
C.phenol is the best

5.

***What is lab safety level you will employ for the culture
of brucella?
a. Routine precaution
b. bio safety level 1,
c. bio safety level 2
d. bio safety level 3
e. no specific measure

5.

d. Biosafety levels are designed according to


risk group of the lab;
Risk
group
1

Description
Organisms are low risk to lab
workers and community
(common organisms)
Moderate risk to lab workers
limited risk to community e.g.
staph, strept., vibrio
High risk to labo workers,
low risk to community (dont
spread rapidly) e.g. brucella,
TB, Salmonella
Viruses, high risk to lab and
community

Biosafety
level
1

6.

-lactamase resistant penicillin for staph

6.

Cloxacillin.

7.

******Sterility is achieved by:


a. Pasteurization.
b. Disinfection.
c. asepsis.
d. All of the above.
e. None of the above

7.

c. Sterilization means killing or removal of all


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

Disinfection

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Partial destruction of living organisms

79

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

8.

***Intrinsic resistance for vancomycin is present in:


a. Penicillin-resistant bacteria
b. C. deficile.
c. Staph sensitive to cloxacin.

8.

a. Penicillin-resistant bacteria (both act on cell


wall)
Most important use of vancomycinis against
staph aureus that are resistant to penicillinase
resistant penicillin e.g. nafcillin.
c.

internal vancomysin resistance caused by


a. clostridium difficile
b.staph
c. strept fecalis (enterococci)
9.

***Which of the following is not an aminoglycoside?


a. amykacin.
b. Erythromycin.
c. Neomycin.
d. Sissomycin

9.

b. Erythromycin.

10

**Pasteurization gives guarantee of:


a. Kills spores sterilization.
b. Disinfection.
c. Saponification.
d. None of the above

10

b.

11.

For penicillin resistant pneumococci, which is used?


a. Ampicillin.
b. Ceftriaxone.
c. Cefuroxime + Rifampicin.
d. Ampicillin + Rifampicin

11.

b. Ceftriaxone.

12.

bacteria producing beta lactamase is during ttt with


cafotaxime (claforan)
a. E.coli.
b. Y. Enterocolitica
c. citrobacter frendii
d. salmonella typhi
e. proteus mirabils

12.

b. Extended-Spectrum Beta-Lactamases
(ESBLs) are enzymes that can be produced by
bacteria making them resistant to
cephalosporins e.g. cefuroxime, cefotaxime
and ceftazidime

Which compination is wrong

Non specific urethritis: penicillin

antibiotic causing grey baby syndrome

chloramphenicol

13.

Which of the following denote sterilization?

13.

14.

TB contamination can be disinfected by

14.

Glutaraldehyde.
Or phenolic

15.

**A pre-operative medication of antibiotics is indicated


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

15.

b. Gangerous obstructed loop.

a pre-operative medication of antibiotics is indicated in:


a. gangrenous appendicitis.
b.ganglion removal.
c. abdominal hernia
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a.

80

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

16.

Bronchoscope

16.

Glutaraldehyde

17.

***- Which is the best way to sterilize a bronchoscompe?


a. Autoclave.
b. Ethylene-oxide.
c. Gamma rays.
d. None

17.

a. Autoclave.is used for heat resistant parts but


ethylene-oxide may be used for heat labile
parts.

All sporocidal except

Ethanol
70% alcohol cause protein denaturation and
cell membrane damage.

Best to disinfect tables contaminated with blood is

Phenol

dry air oven is used to sterilize?


a. water
b.culture media
c. sand
d.blood
e. all of the above

c.

does not sterile with hot air oven:


a. dry glassware
b.oil
c. powder
d.waxes
e. rubber gloves

e.

the temperature-time cycle when using the autoclave to


sterilize is :a-121 c for 15 - 20 minutes
b-112 c for 30 - 40 minutes
c-135 c for 25 - 40 minutes
d-100 c for15 - 35 minutes

a.

low effective sterilization with:


a. ethyl alcohol 70%
b.methyl alcohol
c. chloroform
d.5%phenol
e. 5% cresol

c.?

best sterilization of nutrient media done by:


a. hot air oven
b.autoclaving

b.

Which could prevent spreading of infection


a. Wear white coat
b.Wear face mask
c. Washing hands

c.? or b.

Destruction of microbes except by


High concentration of liquid or gaseous germicidal

Centrifugation
chemical sterilization

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81

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

BASIC TECHNIQUES
18.

**Castanida medium for blood culture contain?

18.

19.

**Medium for each:


a. TB
****N. Gonoccoci
c. C. Diphtheria
d. Staph. Aureus
e. haemophilus influenza
f.whopping cough ( bordetela pertusis)

19.

Both liquid & solid media in same bottle.

a. L.J medium
b. Chocolate agar or Thayer martin media
c. Lefflers media
d. Blood agar
e. chocolate agar
f.bordet gengo medium

selective and differential medium of entero pathogen is:


a. chocolate agar
b.blood agar
c. DCA medium
d.meat extract agar
e. non of the above

c.

the best media for urine culture is?


a. blood agar
b.chocolate agar
c. CLED agar

c.CLED (cystine lactose electrolyte deficient )

nuitrient agar is :a-selective media


b-differential media
c-special media
d-basic medium

d.

substance present in any agar plate that promotes the


bacterial growth :a-water ( h2o )
b-nitrogen
c-minerals
d-O2

c.

the following is ingredient of culture medium:


a. meat extract
b.minral salts
c. agar
d.peptone
e. non of the above
f. all of the above

f.

20.

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

20.

Red

21.

***Significant bacterial count is

21.

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

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82

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

22.

****Anti-coagulant for blood culture ?


a. Citrate
b.oxalate
c. sodium polyanesthol sulphonate
d.heparin

22.

c.
Also known by abbreviation SPS

23.

****on CLED all bacteria grow except?


a. Enterobacter,
b. salmonella
c. klebsiella
d. enterococci.
e. vibrio vulnificus

23.

e.

c.

xylose lysine deoxycholate (XLD) is:


a. selective media
b.simple media
c. differential media
d.enriched media
e. enrichment
24.

25.

***Gram stain best done in?


a. Lag phase
b. log phase
c. static phase
d. death phase.

24.

b. Growth of bacteria on media follows the


following phases;
- Lag phase; phase of accommodation to
medium. No net growth
- Log phase; phase of maximum growth.
- Stationary phase; growth equilibrates death
- Decline phase; phase of exhaustion of
medium components. Growth declines.

gram stain done in all except


a. sputum
b.stool
c. csf
d.urine
e. pus

b.

all the following parameters affecting gram staning


except?
a. use H2SO4
b.add absolute alcohol after washing
c. delaying the dryness of the slide

a.?

albert stain is good for

coryenbacterium diphteria

Which is negative stain


a. Methylene blue
b.Carbol fucsine
c. Eosine
d.Negrosine

d.

***Microaerophilic atmosphere means?


a. 10% CO2
b. anaerobic
c. trace of free O2

mohammad_emam@hotmail.com

25.

c. trace of free O2

83

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

26.

****Which agar concentration is the best to detect


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

26.

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

27.

***Best time to read oxidase test is within:


a. 5 seconds.
b. 10 seconds.
c. 1 minute.
d. 2 minutes.
e. 5 minutes.

27.

b. 10 seconds

28.

***In ZN staining used for M. leprae, the decolorizing


agent used is:
a. 5% acetone.
b. 5% acid alcohol.
c. 5% hydrochloric a.
d. None of the above

28.

d. None of the above.


5% H2SO4 or 3% acid alcohol.
z.n stain use for diagnose :
mycobateria

**all of the following are present in gram stain except?


a. safranine
b.iodine
c. malachite green
d.crystal violet

c.

gram stain starts with?


a. iodine
b.crystal green
c. methyl violet

c.

primary stain of gram stain :a-crystal violet


b-iodine
c-safranine

a.

29.

***Which of the following is a chemical fixative?


a. Formalin.
b. Mercuric chloride
c. Methyl alcohol
d. All of the above

29.

c. Methyl alcohol
best fixative for thin smear is ethyl alcohol

30.

****When urine is preserved for culture it should be:


a. preserved at room temperature.
b. Preserved in refrigerator.
c. preserved with nitric acid.
d. Preserved with sulfuric acid.
e. Preserved with boric acid.

30.

e. (check also for b.) If a delay > 1-2 hours is


unavoidable multiplication of bacteria can be
prevented by;
- Storage in refrigerator at 4c
- Collected and transported in a container of
boric acid at a concentration of 1.8%

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84

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

a.

All of these actions aim to valid quantitative urine culture


except
a. Adding boric acid to urine container
b.Using dislide culture technique
c. Collecting a MSU
d.Culture urine with 1 houre of collection
e. Keep urine specimen at room temppperrrature
31.

Suitable medium for many pathogenic bacteria

31.

Brain heart infusion.

32.

Blood culture is indicated in the following:


a. Mycobacterium
b. Diphtheria
c. Staph. Aureus
d. None of the above

32.

??d. None of the above


a.TB

33.

Solid media include:


a. Slant.
b. Streak plates.
c. Pour plates.
d. All of the above

33.

d. All of the above

citrate test assis :


a. mycobacterias
b.staph
c. strept
d.colistridia sp.

?d.citrate test differentiates ( gram negative


enterobacteriaceae).
example salmonella is citrate +ve

the only enrichment medium of the following is :a-blood agar


b-chocolate agar
c-CLED ( cystine lactose electrolyte deficient )
d-selenite-broth.

d.

which of the following is an enrichment medium :a-CLED


b-bap
c-MacConkey
d-thiocyanate broth
e-chocolate agar

d.or alkaline peptone water

which of the following culture media is suitable for semi


quantitative bacterial count in urine samples
a-mcConkey agar
b- blood agar
c-XLD medium
d-mannitol salt agar
e-CLED medium

b.some sourses answer (e) check the answer

blood culture is indicated in the following bacterial


diseases except
a-meningitis
b-endocarditis
c-gastroenteritis
d-pyelonephritis
e-pneumonia

c.

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85

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

the nutritive substance in culture media is?


a. sugar
b.starch
c. agar

a.

agar is characterized by all the following except?


a. freezing point is 42c & melting point is 100c
b.nutritive
c. un-nutritive

b.

**solidifying agent in culture media is?


a. wax
b.starch
c. agar

c.

the percentage of sodium chloride in agar culture is?


a. 0.058%
b.58.0%
c. 0.58%

c.

**to obtain an isotonic media, sodium chloride content


should be :a- 0.85 g %
b-0.085 g%
c- 8.5 g%
d- 6.5 g%
e- 0.50g

a.

the best anti coagulant in blood culture is


a. sodium oxalate
b.sodium citrates
c. sodium sulphate

c.

use for clean slide:


a. ethyle alcohol
b.methyle alcohol

a.

Transport media for stool


Specimen for anerobic culture
For bacterial motility except
BHI with addition of antibiotics for
In SS agar, source of carbon is
Tryptophan is the basis of
Antibiotic sensitivity test commonly by
Routine bacterial culture is examined after
Routine bacterial culture is incubated at
Rapid method for detecting significant bacteria is by
Choice of media depend on except

Carry Blair
Pleural fluid and --- abscess
H*E
(histo.plasma and fungi)
lactose
Indole test
disc diffusion
18-24 hr.
3 C
microscopy
one selective plating medium

BASIC BACTERIOLOGY
34.

**Cell wall is absent in?


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

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34.

a. Mycoplasma is the smallest organism


capable of self replication. It possesses cell
constituents of bacteria except cell wall.
Instead, there is a triple layer cytoplasmic
membrane.
86

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

35.

**Sterol is the main constituent of cell wall of:


a. Mycoplasma.
b. Rickettsia.
c. Chlamydia.
d. Leptospira.
e. Staph.

35.

a. Unlike the cell wall of bacteria,


mycoplasma cell membrane contains
cholesterol or carotenol in addition to the
usual mural and phospholipids.

36.

***Which of the following contains more peptidoglycan?


a. G+ve bacilli.
b. G-ve bacilli.
c. Chlamydia.
d. Richetsiae.

36.

a. The peptidoglycan layer is much thicker in


Gram positive than in Gram negative bacteria.
Richetsia cell wall similar to that of Gram
negative bacteria. Chalmydia cell wall is
similar to that of Gram negative bacteria but
no muramic acid.

one of these is prokaryotic cell:


a. fungi
b.bacteria
c. entameba histolytica
d.all of the above
e. non of the above

b.Fungi, along with animals, protozoans, algae


and plants, have eukaryotic cells. Only
bacteria are known to have prokaryotic cells.
Eukaryotic cells have a nuclear membrane that
holds all organelles together.

gram negative samples are stained with?


a. yellow color
b.blue color
c. red olor
d.green color

c.

function of pili of the bacteria:


a. attachment to the host tissue
b.movement
c. reproduction (multiplication)
d.engulf of food
e. all of the above

e.

bacteria can cause pathogenesis to human by:


a. capsullar
b.secret enzymes
c. endogenous toxins
d.exogenous toxins
e. all of the above

e.

37.

***Sedimentation constant of bacterial ribosomes is:


a. 40s
b. 60s
c. 70s
d. 80s

37.

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

38.

***Endotoxins are chemically:


a. Mucopeptides.
b. Proteins.
c. Lipopolysaccharides.
d. Polysaccharides.

38.

c. Endotoxins are integral part of G-ve


bacteria. They are LPS whereas exotoxins are
polypeptides.

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87

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

39.

***L forms differ from parent cells in all of the following


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

39.

c.

40

***Bacterial genes are transferred by all of the following


means except:
a. Transformation.
b. Transduction.
c. Mutation.
d. Conjugation.

40

c. The transfere of genetic information


between bacterial cells can occur by 3
methods: conjugation, transduction and
transformation (see table p16 Jawetz review).

41.

**Sepsis cause

41.

Toxic granulomas.

**Which is not a super antigen?


a. TSSA
b. Psuedomonas exotoxin A.
c. pyrogenic exotoxine.
d. Diphtheria toxin.

41.
New

b. Psuedomonas exotoxin A.

41.
New

serum bactericidal test used in


a. pneumonia
b.Endocarditis

b. and osteomilitis

the following organisms are encpsulated except :a. pseudomonas aeroginosa


b.E. coli
c. haemophilous influenzae
d.streptococcus pneumonia

a.

Capsulated organisms in CSF. Stain to distinguish capsule


a. Giemsa
b.H & E
c. Indian ink

c.

to examine a spicemen staied by ethidium bromide


(fluorochrome)
a. bright field microscope
b.polarized microscope
c. dark field microscope
d.flourescence microscope

d.

to investigate gram stained samples we use the following


microscope?
a. double phase microscope
b.florescent microscope
c. light microscope (brightfield)

c.

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88

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Phase contrast microscope

in the microscope when using objective lens 10 & eye lens


10 thee magnification power of the microscope is?
a. 10
b.1000
c. 100

It is a type of light microscopy that enhances


contrasts of transparent and colorless objects
by influencing the optical path of light. The
phase contrast microscope is able to show
components in a cell or bacteria, which would
be very difficult to see in an ordinary light
microscope.
It can produce high-contrast images of
transparent specimens, such as living cells
(usually in culture), microorganisms, thin
tissue slices, lithographic patterns, fibers, latex
dispersions, glass fragments, and subcellular
particles (including nuclei and other
organelles).
c.

when focusing a stained smear under oil immersion field


the magnification is?
a. 10
b.40
c. 100
d.1000

d.if the question about oil objective lens it is


100. It gives magnification 1000

the oil emertion lens is


a. 10
b.40
c. 100

c.

flurochrome staied TB seen by magnific.


a. 20
b.40
c. more than 100.000
d.400
e. 800

d.

flurochrome stained TB bacilli visualized at


a. 250 : 400
b.800 : 1000
c. 100000

a.

lense near the slide in light microscope :


a. objective eye lenses
b.subjective eye lenses

a.

**the resolution of the bright field microscope is :a-2.0 um


b-0.2 um
c-0.02um
d-0.002um

b.

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89

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

**serum can be sterilized using membrane filter of


porosity
a-0.22 um
b-2.3um
c-0.6 um
d-0.8 um

a.

some organisms are to said to be pathogenic if they are


containing the following features :a- coagulase
b-catalase
c-sugar
d-antibodies

a.

**micro-organisms that grow at 60 c are classified as :a-psychrophilic


b-mesophilic
c-halophilic
d-thermophilic
e-saprophilic

Specimen examined directly

CSF

Microaerophilic organisms atmosphere contain

Low oxygen tention

deionization of impure water means: (distilled water)


a. boiling (if and condensation is written)
b.filtration
c. exchange of protons and electrons

the microscope which used in investigate syphilis is?


a. light microscope
b.ultra-violet microscope
c. dark field microscope

mutation of micro organism detected by


a. western blotting
b.DNA probing
c.

b.

Enzyme used to ununion DNA helical in PCR


a. Helicase
b.Transcriptase
c. ..
d..

?a.

GRAM POSITIVE COCCI


42.

Cell wall of staph.

42.

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

43.

**Food poisoning by staph aureus is due to.

43.

Enterotoxin
This acts by stimulating relase of IL1 and IL2.

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90

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

44.

**Enterotoxin of staph. Aureus is heat.

44.

stable

45.

***Differentiate between pathogenic & non pathogenic


staphylococci use

45.

b.

Or specific test for staphylococcus aureus is


a-catalase test
b-coagulase test
c-optochin sensitivity test
d-bacitracin sensitivity test
e-CAMP test
b.CAMP test: The "lytic phenomenon"
between Staphylococcus aureus and
Streptococcus agalactiae (group B)

beta hemolysis is enhanced when group b streptococci is


streaked at an angle in blood agar plate with
a-streptococci
b-staph aureus
c-micrococcus
d-streptococcus epiedermidis
e-corynebacterim diphteriae
46.

**Most streptococcus infection to human is

46.

b.

streptococci responsible for the majority of human


infections are :a-group a
b-beta-haemolytic streptococci
c-bacitracin-s and camp ( - )
d-all of these
e-none of these
47.

48.

****To differentiate A & B hemolytic streptococci we use


a. bacitracin
b. optochin
c. ampicillin

A & B hemolyticus.

47.

a. Group A strept is bacitracin sensitive while


group B is bacetracin resistant.

optochin test is used to

Optochin is used to differentiate hemolytic


strept (pneumococci are sensitive and strept
viridans is resistant)

case patient with superfacial skin infection g+ve cocci


a. erysipelas
b.

b. erysipelas (organism in blood and vesicles)

**Commonest disease caused by streptococcus pyogenes


is.
disease caused by pyogen stereptococcus:
scarlet fever

Organism causes scalded skin syndrome

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48.

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

91

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

49.

***Food poisoning symptom [vomiting] 4 hrs after


ingestion of food seen in?
a. E.coli
b. staph aureus enterotoxin
c. salmonella typhi
d. vibrio cholera

49.

b. staph aureus enterotoxin

50.

***Strept pyogenes cause all except:


118. Streptococcus cause all except:

50.

Toxic shock syndrome (check this answer


because pyrogenic exotoxin A of strept
pyogenes is similar to TSST of staph).

51.

Pneumococci are typed by

51.

Optochin, bile solubility, Quellung test


Pneumococci are optichin sensitive, bile
soluble and Guellung test positive.

Confirmatory test of streptococcus pneumonia:


a. Catalase
b. Optochine disc
c. Coagulase
d. Bile insolubility
e. Bacitracin

Optochine for diagnosis bile solubility For


confirmation if the not insolubility
b

c

Confirmatory test for strept. pneumoniae :a-optochin sensitivity disc


b-bacitracin disc sensitivity
c-bile solubility
d-catalase test
**organism soluble in bile :a-staph
b-streptococci
c-pneumococci ( streptococcus pneumonia )
d-haemophilous influenza

c.

quellung test is positive with the following organisms


except :a-streptococcus pneumoniae
b-haemophilous influenzae
c-klebsiella pneummoniae
d-corynebacterium diphteriae

d.

the invasiveness of streptococcus pneumoniae is due to the


production of :a-haemolsins
b-endotoxins
c-extotoxins
d-polysaccharide capsule

a.check this answer

strept pneumonia destroy epithelium by

hyaluronidase

**one of these organisms are gram +ve cocci arranged in


pairs :
a. staphylococci
b.streptococci
c. meningococci
d.entrococci

d.

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92

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

52.

Antigen protective for pneumococci is

52.

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

53.

****Diagnosis of metastatic staphylococcal lesions:


a. Protein A Ab.
b. Anti DNase.
c. Endotoxins
d. serum teicoic acid

53.

a. Staph dont produce endotoxins (being


gram positive). Anti Dnase is used mainly for
strept. Protein A antibody methods are
diagnostic for staph disseminated lesions.
?d.may be true

54.

*****The following differentiates between staph.


Pyogenes and strept epidermidis:

54.

55.

***The epidemiological marker used most frequently in


strain differentiation of Staph. aureus is:
a. Phage typing.
b. Biotyping.
c. Serotyping.
d. Bacteriocin typing

55.

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

56.

**All of the following species of streptococcus are B


hemolytic except:
a. Strept. Pyogenes.
b. Strept infrequens.
c. Strept. avium
d. Strept. salivarius

56.

b. Strept. pyogenes is hemolytic, Strept.


avium is hemolytic, Strept. salivarius is nonhemlytic.

57.

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

57.

Streptococcus.
Strept fecalis grows on 6% NaCl while strept
bovis dont.

58.

Staph.

58.

Catalase test
Staph is catalase positive.

gram +ve cocci arranged in groups (clusters):


a. streptococci
b.staphylococci

b.

one is gram +ve oval (cocci):


a. bacillus anthracis
b.meningococci
c. pneumococci

c.

59.

Test used to differentiate staph. aureus


a. Catalase
b. Coagulase
c. Dnase
d. ASOT

59.

b. Coagulase is used to diagnose staph aureus


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

60.

****ASOT is used to detect:

60.

Strept. pyogenes.
rheumatic fever

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93

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

case of bilateral supurative skin infection catalase negative


G +ve cocci causitave organism
a. staph aureus
b.staph epidermidis
c. strept agalactia
d.strept mutans

d.?

***all can cause beta hemolysis on blood agar except


a. E-coli
b.Group A srept
c. Group B strept
d.enterococcus aerogenosus

d.
alpha hemolysis (-hemolysis)
Streptococcus pneumonia
Streptococcus viridans
Beta hemolysis (-hemolysis)
Streptococcus pyogenes
Staphylococcus
Streptococcus agalactiae
Clostridium perfringens
Listeria monocytogenes
E. coli
P. aurginosa
Neiseria
Aeromonas
Morganella
gamma hemolysis (-hemolysis).
Enterococcus faecalis
a.?

Strept pyogen action is by


a. Hyaluronidase
b.Streptokinase
c. Coagulse

GRAM NEGATIVE COCCI


61.

***Differenciation of N. gonorrhaea from N. Meningitis


by sugar fermentation?

61.
Maltose
Glucose
Sucrose

N. Gono
+
-

N.Menin
+
+
-

b.glucose or dextrose + maltose

to differentiate between nisseria gonorrhoea and nisseria


meningitidis :
a-fermentation of dextrose and lactose
b-fermentation of dextrose and maltose
c-fermentation of maltose and lactose
d-fermentation of maltose and sucrose
62.

****In N. gonorrhoea causing dissiminated lesion


(systemic manifestation), which of the following is
incorrect.
a. Sensetive to penicillin (G+ve only)
b. Resistant to ampicillin

62.

a. Oral penicillin, cirprofloxacin or


doxycycline are used in gonococal arthritis.

63.

Meningococcemia causes:

63.

Waterhouse Fredrichson syndrome.

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94

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

64.

Neisseria gonorrhoea can cause which of the following?


a. Osteomyelitis.
b. Artheritis.
c. Septicemia.

64.

b. N. gonorrhoea may cause septicemia and


suppurativeartheritis and hemorrhagic skin
papules.

which is incorrect in N.gonorrhea


a. sensetive to ampicillin
b. resistant to penicillin
c. causing dissiminated lesion

a.check this answer

Neisserae can be mistaken with this organism


a. Klebsiella
b.E. coli
c.
d..

Neisserae are Gram-negative coffee beanshaped diplococci bacteria


a.and b. are gram ve bacilli

N. gonorrhea infect other than genital tract


All G+ve except
Cause of opthalmia neonatorum
BR that differentiate Neisseria species is

vaginintis
Neisseria and mycobacterium
N. gonorrheae
sugar fermentation

GRAM POSITIVE BACILLI


65.

***Gm +ve bacilli arrange in Chinese letter pattern is

65.

Diptheria bacilli,

66.

**Pseudomembrane cause by a

66.

diphtheria

67.

*******Which test is used to ascertain toxigenicity of C.


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

67.

b. Elick's test is in vitro plate test for toxin


production

*Schick test

ID test for susceptibility to diphtheria

**strains of C.diphtherae producing toxin:


a. encapsulated
b.sucrose fermenting
c. glucose ferminting
d.lysing to beta-prophage

d.

which of the following indicates a blood agar plate?


a-corynebacterium diphteriae
b-mycobacterium tuberculosis
c-bordetella pertusis
d-francisella tularensis
e-none of the above

a.

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95

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

68.

********A memberane on the pharynx on removal it


leaves a bleeding surface occurs with:
a. Diphtheria.
b. IMN
c. Vincent's angina.
d. candida.
e. streptococcal infection.
f. All of the above.
g. None of the above

68.

a. Diphtheria.

69.

***A CSF culture revealed an organism that is G+ve at


37 c and no growth at room temperature. This is most
likely to be:
**CSF shows motile organism moves at room temp and
immotile at 37

69.

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

70.

Neonatal meningitis G+ve rods.

70.

L. monocytogens.

b.

2 years meningitis in vaccinated child against meningitis


a. neisseria
b.listeria
c. hepatitis
d.strep pneumonia
71.

Listeria monocytogens.

71.
listeria(intracellular organism)

antigen detection is useful in all except:


72.

gm +ve branching rods with club ends.

**Actinomycosis is caused by?

73.

Actinomyces israelii
& arachnia propionica

**Madura foot have all except?


a. Fever.
b. bone involvement
c. Draining sinus tract
d. granules in discharge
e. Caused by fungus or bacteria.

74.

a. Madura food is a subcutaneous infection


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

72.

**Growth of actinomyces

73.

74.

sraeli on gram stain shows

Swarming G+ve bacilli

Clostridium

ENTEROBACTERECIAE & PSEUDOMONAS


75.

**Mobile bacilli are?

75.

76.

**Proteus is

76.

Strong urease producers

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


proteus,
Motile gm ive bacilli, NLF, produce
swarming on BA.
proteus species

96

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

c.

**significant bacteruria , puria , and alkaline urine


probably indicate urinary tract infection due to::
a-staphylococcus epidermidis
b-E. coli
c-proteus vulgaris
d-pseudomonas aerginosa
e-enterococcus faecalis
77.

***Most common agent causing UTI is?


a. E.coli
b. klebsiella
c. proteus
d. seudomonas

77.

a.

78.

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

78.

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

79.

**Example of NLF colonies on MacConkey agar ?


28. Examples of LF colonis on MacConkey agar?

79.

NLF (produce pale colored colonies):


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

80.

gram-ve bacteria colonies color on MacConkey :


a. dark purple
b.pale to dark red
c. orange

b.

the following organisms are lactose fomenters except


a-E. coli
b-enterobacter cloacae
c-shigella sonnei (late lactose fermenter)
d-proteus spp.

d. shigella sonnei late lactose fermenter

Best sample to diagnose shigella

Proctoscopy + swab of rectum ulcer

shigella soni colored in maconkey & EMB?


a. colorless
b.red
c. pink

c.(late lactose fermenter)

**The following proteous are indole +ve except

80.

d.P. mirabils are indole negative

all statements are true about proteus mirabilis and


proteus vulgaris except :oxidase negative & liquefies gelatin
a-exhibits swarming on BAP and MacConkey's agar
b-urease positive
c-kcn and n2s positive
d-positive to indole test
81.

**Klebsiella pneumoniae produces.


one of the following is capsulated bacteria?
a. streptococci
b.E.coli
c. klebsiella

mohammad_emam@hotmail.com

P. mirabilis indole negative


While P. vulgaris positive.

81.

mucoid colonies
c.

97

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

82.

***IMViC reaction of E.coli is

82.

.[++--]

83.

**Which of the following is urease +ve

83.

84.

Urease present in all except?


a. Brucella.abortus,
b. Brucella.melitensis,
c. shigella sonni,

84.

proteus.
Also, Klebsieall and pseudomonas.
c. Not only sh. Sonni, but also Shigella A,B
and C.

85.

***Which strain of E. coli cause HUS?


a. VTEC O157, H7
b. EPEC O157:H7

85.

a. EHEC 157 = VTEC 157

86.

E. coli, Klebsiella and proteus are

86.

Commensals of GIT

87.

E.coli is indole?

87.

Positive
Also proteus is indole positive.
c.

which of the following causes UTI & indol positive?


a. klebsiella
b.staphylococci
c. E.coli
88.

**Psuedomonas infections include?

88.

May cause UTI, otitis media & eye infection,


Bed sore, burns,
DIFCO

Psuedomonas isolation agar

Motile gm ive bacilli, NLF, produce


pigmented colonies
Blue green pigments,
Pyocyanin & biovirdin.

89.

**Psuedomonas is?

89.

90.

**Psuedomonas aerogenosa produce?

90.

91.

Contamination of sterile fluid is

91.

pseudomonas.
*pseudomonas aeroginosa is oxidase +ve

92.

*****An abscess with bluish green discharge caused by?


a. Staphlococcus
b. proteus
c. seudomonas.

92.

c.

93.

****Hospital fluids are usually contaminated by:


****120. Organism of medical fluids is:
a. Pseudomonas.
b. Staph.
c. Strept.

93.

a. Pseudomonas are able to grow in water with


traces of nutrients.

94.

*Pigments of pseudomonas aerogenosa

94.

Both Fluorescin
Pyocyanin 50% and
pyovirdin
others
pyorubin
pyomelanin
Pseudomonas aeruginosa.

Cause malignant otitis externa in diabetics

mohammad_emam@hotmail.com

98

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Organism in sterilized saline


Choices not available

K. pneumoniae, C. albicans, A. fumigatus, and


P. variotii.

all are member of the family enterobacteriaceae except :a-klebsiella pneumonia


b-yersinia pestis
c-pseudomonas aeroginosa
d-shigella dysentriae
e-campylobacter jejuni

c.and e.

the following are members of the family


enterobacteriaceae except :a-klebsiella rhinoscleromatis
b-serratia liquefaciens
c-providencia alcalifaciens
d-yersinia pseudotuberculosis
e-campylobacter fetus

e.

all the following bacteria are interobacteresae except?


a. E.coli
b.proteus
c. klebseilla
d.non of the previous

d.

all is true about salmonella organism except:a- the main reservoir is human
b-contains O and H antigen
c-urease , KCN and phenylalanine negative
d-H2S positive with gas
e-indole +ve

e.

95.

**Widal test used in the diagnosis of?


a. Typhoid fever
b. malaria
c. malta fever
d. brucellosis

95.

a. Typhoid fever

96.

**Enriched medium for salmonella is?

96.

Salenite broth

Vi Ag is seen in :a. capsule


b.pili
c. spore
d.flagella

a.

H antigen present in :
a. pilli
b.capsule
c. flagella
d.cell membrane

c.

***serious that causes food poisoning?


a. staph albus
b.salmonella typhi
c. salmonella enteritidis
d..

c.salmonella food poisoning

mohammad_emam@hotmail.com

99

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Rose spotted rash on chest

Salmonella cause
97.

**On Wilson Blair media salmonella produce?

97.

S.typhi large black colonies with metallic


sheen after 24hours, S.paratyphi produce
green colonies after 48hours.

98.

**Media used for the isolation of salmonella are?

98.

MacConkey, DCA, Wilson blair,


Also XLD and selenite broth.

99.

***Culture of choice in the first week of typhoid fever?


a. Feces.
b. urine.
c. blood.
d. CSF

99.

c. Blood culture are usually positive 90% in


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

all of the following is true for salmonella except?


a. motile
b.produces H2S
c. oxidase positive
100.

101.

**Color of salmonella & shigella on MacConkey and EMB


agar is?
a-black
b-pink
c-yellow
d-brown
e-colorless
f-yellow-brown

100.

e.NLF
salmonella on XLD, brilliant green, SS (pink)
on bithmus sulfate (silver metalic with black
halo)

Salmonella ferment all suger except

lactose

Color of salmonella & shigella on CLED

blue

Bacteria can not grow on TCBS


a.Enterococci
b. Escherichia coli
c. V. cholera

?Both a. and b. inhibited

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

101.

Motility

org cause bloody in stool

shigella

one is always non motile gram ve rods:


haemophilus influenza
a. shigella
b.E.coli
c. salmonella
d.borditella pertusis

a.

mohammad_emam@hotmail.com

100

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

one is motile gram ve rods:


a. haemophilus influenza
b. bacillus anthracis
c. pseudomonas aerogenes
d. vibrio cholerae
e. yersinia pestis

102.

Seroprofile of salmonella typhi?

102.

d.and c.
motile
E.coli
Salmonella
Vibrio
Proteus
pseudomonas
Enterobactre
Citrobactre
Serratia
Morganella
providentia
O-9,12, H-1,2

Non motile
Shigella
K.pneumoniae
Acenito
Yersenia
anthrax

HLA B 27

Salmonella osteomylitis in
103.

**Diagnosis of typoid fever in 1st week is done by

103.

blood culture

104.

Differentiate between E. coli and salmonella

104.

Salmonella is NLF and E.coli is LF

105.

******All of the following is correct regarding enteric


fever except:

105.

Localized gut disease.

106.

**Microscopic appearance of Yersinia pestis is?

106.

G-ve coccobacilli.

107.

******Dog bite G-ve bacilli isolated is propably:


a. Pasteurella multucida
b. H. influenza.
c. B. Abortus
d. toxocara cannis

107.

a. Pasteurella multucida

108.

**Cholera is caused by?


a. V. cholera
b. E.coli
c. proteus
d. seudomonas.

108.

a. V. cholera

109.

***Enriched media for V.cholera is ?

109.

Alkaline peptone water [pH8.6],

110.

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

110.

Adenyl cyclase system activation


This leads to ++cAMP Chloride and water
loss.

111.

***Mode of action of vibrio is by:


a. irritation of intestinal mucosa by vibrio.
b. attack of intestinal mucosa by the toxin.
c. stimulation of membrane bound adenylecyclase

111.

c. stimulation of membrane bound


adenylecyclase

112.

Vibrio vulnificus.

112.

This is halophilic cholera i.e. lives in salted


water, infects wounds of shellfish handlers
causing cellulistis (may cause septicemia in
immunocompromized patients).

mohammad_emam@hotmail.com

101

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

a.sucrose non fermenter


vibrio parahemolyticus produce sucrose
fermenter green colonies
On CLED vibrio cholera can grow and vibrio
parahemolyticus can not grow

**growth of vibrio cholerae on TCBS medium produces


colonies :a-yellow colonies
b-blue colonies
c-green colonies
d-white colonies
e-red colonies

d.
all is true about enterobacteriaceae except :a-they are hemolytic and sorbitol
b-ferments mannitol
c-grow in methylene blue medium
d-inhibited growth with 6.5 % nacl and/or at temperature
which of the following statements about campylobacter
is false:a-gram negative curved bacilli
b-slow growth
c-grow on xld medium
d-arranged in pairs

d.

Helicobacter pylori cause

Chronic active gasteritis

Yersenia pestis

G ve bacilli with bibolar staining

Legionella

Intracellular uncapsulated gram negative


bacteria cause pneumonia type illness called
Legionnaires Disease and a mild flu like
illness called Pontiac fever. visualized with a
silver stain.
K/A
Yersinia pestis
dewling catheter, aseptically aspirate 5ml of
urine from the catheter tubing
Klebsiella and strept viridans
Shigella
pyocin typing.
E. coli
All (Provedentia K/AG, E. coli A/AG,
Citrobacter K/AG, Proteus K/A , Klebsiella
A/A)

If glucose is fermented , TSI reaction is:


Plague causative agent
Best for collecting urine is
Don not produce B hemolysis on blood agar
Bacillary dysentery
For nosocomial outbreaks of pseudomonas
Organism that gives metallic sheen on EMB
TSI gives the following reactions:

RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA


113.

**Rickettsial pox is transmitted by

113.

mites.
Causative organism is R. akari.

114.

**Stain for rickettsia is.

114.

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

mohammad_emam@hotmail.com

102

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

115.

***Organism associated with atherosclerosis:


a. Chlamydia pneumonia
b.Chlamydia psitasii
c. Legionella
d.ureaplasma

115.

a.Chlamydia pneumoniae

116.

***Lymphogranuloma venerum is caused by.

116.

Chlamydia
Sero D-K chlamydia trachomatis
chlamydia trachomatis

conjuctivitis trachoma
117.

**Mycoplasma are resistant to action of

117.

antimicrobial.

mother with genital infection give birth to baby with


respiratory infection and conjunctiva has inclusions best
diagnosed by
a. ELISA
b.isolation on macoy cells

b.

Mycoplasma media is

PPLO

SPIROCHETES
118.

**Specific or non specific test for syphilis?

118.

Non-specific- RPR, VDRL


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

what practical cardiolipin is applicable in laboratory work


a. FTA
b.VDRL & RPR
c. RPR only
d.VDRL only

b.

******which of the following reagin test for syphilis?


a. VDRL
b. TPHA
c. TPI

a.

in field survey of syphilis we use


a. RPR
b.VDRL

a.

119.

**Treponema pallidum is a?

120.

bacteria need dark field to detect

119.

Spirochate, can be demonstrate by dark field


microscopy.
T.pallidium

**gumma in 3ry $ not characterized by


a. present in internal organs
b.organism present in low amount
c. ulceration

c.

Condyloma lata

2ry $

Condyloma accuminata

Papiloma virus

mohammad_emam@hotmail.com

103

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

121.

*****Bejel is characterized by all except?


a. affect children
b. Caused by variant of Treponema pallidum.
c.sexually transmitted

121.

c.Bejel is non venereal disease caused by T.


pallidum endemicum. It is a highly infectious
skin in fection.

122.

*****Which of the following accurately don't describe 3ry


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

122.

a. Ulcerative skin lesions.

123.

**Yaws disease

123.

Caused by Treponema pertenue


Characterized by ulcerating papule, scar
forming and may cause bone destruction.

124.

Chocolate media.

125.

a.staphylococcus aureus produce NAD as a


metabolic byproduct when grow in a culture
media. Therefore, Haemophilus spp may grow
on sheep blood agar very close to the colonies
ofStaphylococcus aureus (as it produces
NAD-factor V); this phenomenon is known as
satelliting
a.*Haemophilus influenzae, need factor 'X'
(haem) and 'V' (NAD).
Haemophilus parainfluenzae, need factor 'V'
(NAD).
Haemophilus ducreyi, need factor 'X' (haem)

127.

soft chancre
Soft chancre is also called chancroid. H.
Ducreii dont require V factor

HEMOPHILUS
124.

**Hemophilus grows

uxuriantly on?

125.

****Satellitism is exhibited by?


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

126.

Satellitism Haemophilus influenza need factor


.. from staph
a. NAD
b.NADP
c. NADH
d.NADPH

127.

**H Ducrii causes.

Haemophilus Ducrii

Chancroid
128.

**Bacteria shows satellism.

128.

H. Influnzae

129.

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

129.

H. Influenza

130.

H. influenza meningitis occurs most frequently in :

130.

children.
1/2 to 4 years old.

131.

Satellism helps to diagnose?

131.

H.influenza

BORDETELLA & BORRELIA


132.

**Bordetella pertusis are?

132.

Strictly aerobes.

133.

Bordetella exotoxin =

133.

Single Ag previously termed Islet activity


protein.
It resembles cholera toxin in structure and
action.

mohammad_emam@hotmail.com

104

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

?a

pertussis virulence factor is


a. pertussis toxin
b.filaments
134.

****What type of fever caused by borrelia?


a. Relapsing fever.
b. Q fever
c. Rheumatic fever.
d. enteric fever.

a. *borrelia recurrentis and duttoni casue


replapsing fever.
*B. burgdorferi cause lyme disease and Q
fever is caused by coxiella burnetti.

134.

Oroya fever

Bartonella cause

ANEROBIC BACTERIA
135.

**Gm +ve bacilli with terminal round spores resembling


match stick are

136.

**Nagler reaction used for

Clostridium welchii,
Also called perfrengins.

135.

Rapid identification of Cl. Welchii


Lecithenase
(Negler's)
-

C. perfringens

C. tetani

C. deficile &
botulinum

137.
138.

**Clostridia are
**Bacteroid is resistant to?
a. Penicillin
b. metronidazole
c. aminoglycoside
d. chloramphenicol.

137.
138.

Lecithinase ve
Saccharolytic
NLF
Lecithinase +ve
Saccharolytic
LF
Lecithinase ve
asaccharolytic
NLF

Gm +ve anaerobic bacilli


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

b.

Not effective against Bacteroid fragilis


a. Clindamycin
b.Gentamycin
c. Cloramphenicol
d.Metronidazole
139.

**Stormy fermentation is seen in?


a. Cl. Histolyticum
b. Cl.prefrenges
c. Cl.septicum.

139.

b. Cl. Perfringens in litumus milk medium


produces A&G, the acid clots milk and the gas
breaks the clot producing stormy
fermentation.

140.

***Bacteria that can be best identified best by direct


Gram's film is?
a. Vincent angina
b. campylobacter
c. diphtheria

140.

a. Vincent angina

mohammad_emam@hotmail.com

105

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

141.

*****The following combination is isolated from pus from


deep pyonidal sinus:
a. B. fragilis.and streptococcus milits.
b. B. fragilis and B. abortus.
c. Strept B.hymolitic and streptococcus.

141.

a. B. fragilis.and streptococcus.

142.

Suitable medium for anerobic bacteria

142.

Blood
(selective or non selective), others include;
- Cooked meat broth (CMB)
- Thyoglycolate.
- BHI

143.

**Which one has non clostridium crepitation?

143.

Cl. perfrengens (X)


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

144.

Crepitant cellulites is caused by:

144.

Clostridia.

which of the following organisms is an anaerobic


bacterium :a-clostiridium spp.
b-haemophilus
c-E. coli
d-yersinia enterocolitica

a.

organisms produce gas gangrene :a-bacillus anthracis


b-clostiridium perfringens
c-streptococcus pneuoniae
d-haemophilos influenzae

b.

BRUCELLA
145.

**Malta fever is caused by?


Fever with history of contact with cattle

145.

Brucella species
Also called undulant fever.

146.

A young Saudi male came with fever & myalgia your


diagnosis is?
a. Brucella
b. staphylococcus
c. streptococcus
d. gonorrhea

146.

a. Other symptoms and signs include;


- Arthralgia
- Sweating
- Heptatosplenomegally.

147.

***Bacteremia is seen in:


a. Brucella.
b. Tetanus.
c. shigellosis

147.

a.brucella. Because both tetanus and


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

mohammad_emam@hotmail.com

106

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

MYCOBACTERIA
148.

**Mycobacterium Leprae

148.

can not be culture artificially in the laboratory

149.

**L.J medium is used for culturing?

149.

T.B,

150.

**Mycobacterium Leprae are?

150.

Acid fast [5% H2SO4]

151.

**Mycobacterium .T.B is?

151.

Acid fast [20% H2SO4], alcohol fast,


mycobacterium

strict aerobe bacteria


****TB culture takes
a. 2-4 days.
b. 12 days.
c. 3-6 weeks.
d. 6-10 weeks.
**Most sever form of leprosy is

152.

d. 3-6 weeks.

153.

Lepromatous

154.

**Mycobacteria are acid-alcohol fast because


a-it is easily stained by gram stain
b-once stained , it can not be remove by acid
c-it is easily decolorizes after staining.
d-it is very easy to stain
e-it is stained by an alkaline stain
f-none of the above
g-all of the above

154.

b.they resist to decolorized by acid & alcohol.

155.

**In lepromatous leprosy immunity is

155.

very low.
Almost nil

156.

********Which of the following mycobacteria is related to


MTB complex?
a. Mycobacterium Africanum.
b. M. leprae

156.

a. MTB complex include TB, M. africanum,


M. bovis, BCG and M. microtti..

157.

Acid fast bacilli in stool =

157.

TB

158.

*****Diagnosis by direct staining:


a. TB
b. Hemophylus

158.

a. Acid fast smear is number one rapid test for


mycobacterium TB. Positive smear has a
predictive value of 96%.

159.

Which of the following belongs to PTB family?


a. M. Kanasasi.
b. M. Bovis.
c. M. intracellulare.
d. M. africanum.

159.

a. MOTT (mycobacteria other than TB) are


classified into;
- Photochromogens: M. kansasii, M. marinum.
- Scotochromogens: M.scrofulucian, M.
szulgai.
- Nonpigmented:
M. avium cellular complex (MAC)
M. phlei, M. fortuitum

152.

153.

mohammad_emam@hotmail.com

107

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

d.acid fast
All Mycobacteria - M. tuberculosis, M.
leprae, M. smegmatis and atypical
Mycobacterium
Actinomyces (especially some aerobic ones)
with Mycolic acid in their cell wall (note
Streptomyces do NOT have) e.g.
Nocardia
Rhodococcus
Gordonia (Actinomycete)
Tsukamurella
Dietzia
Head of sperm

all are acid fast except


a. actinomyces series
b.nocardia
c. mycobacteria
d.streptomyses

Leprosy

MISCELLANEOUS
160.

**Malignant pustule is caused by.

160.

Bacillus anthracis

161.

**Plague is by

161.

rat flea.

162.

*******Vaginal discharge is absent in?


a. Gardnerella infection
b. trichomonas vaginalis
c. Chlamydia
d. cryptococcus neoformans.

162.

d. G.vaginalis produce fishy smelling


discharge, TV produce thin bubbly fishy
smelling discharge, Chlamydia produce thin
discharge. Cryptococcus is a lung infection.

163.

**Sterile pyuria not seen in?


a. TB
b. non specific urithritis
c. urine collection by suprepubic puncture
d. prior treatment with antibiotic

163.

c. Causes of sterile pyuria;


TB
Mycoplasma
Leptospirosis
Vaginal contamination
Antibiotics, L forms
Abacterial cystitis
Non infectious disease e.g. tumour, FB

mohammad_emam@hotmail.com

108

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

clue cells for diagnosis of

clue cells are epithelial cells densely covered


with bacilli in diagnosis of bacterial vaginosis
caused by gardenerella vaginalis. Treated by
metronidazole
b. blood culture

164.

***Diagnosis of bacterial endocarditis?


a. Urine culture
b. blood culture
c. ASOT
d. Throat swab culture

164.

165.

*****Aspergelloma: All correct except:


a. Lungs are the most common site.
b. no organism is present in lesion.
c. Affect children.
d. show increase in Ig G titre

165.

b. Aspergelloma is a ball of aspergillous


growth. It may affect children with preexisting
pulmonary condition.
d.?

166.

**Which combination is wrong?

166.

Non-specific urethritis: Penicillin.

167.

All are Zoonotic except


a. Puponic plague
b.Leprosy
c. Malignant pustule
d.Q fever

167.

b.

perichondrium covers all except


a. joint
b.costal margin
c.
d.

a.

connective tissue (collagen) intracellular substance


a. -abundant with fibres
b.-not abundant with fibres
c. -abundant with no fibres

a.

**interstitial pneumonia ch by
a. good prognosis
b.respiratory distress
c.

b.

breast pathology biopsy shows epithelial cells with


plasmacytoid shape
a. papillary carcinomas
b.follicular carcinoma

a.

BM tumor with pain increased at end of day. the tumor


surrounded by hyper vascular area. It containes nidus
inside

Osteoid osteoma

bone matrix formed of


a. osteon
b. elastin
c. chondrosulphuric acid
d. glucosaminoglycan

a.

mohammad_emam@hotmail.com

109

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

40 y male with mass in distal part of femur painful and


friable. Biopsy show multinucleated cell
a. Osteoplastoma
b.Chondroma
c. Giant cell tumor

c.

Patient with high lesion in mediastinum, biopsy show


necrotic granuloma. Tuberculine negative. diagnosis
a. T.B
b.Sarcoidosis
c. Upper interstisial pneumonia
d..

Dehydration for tissue preparation in histopathology


a. Ascending alcohol
b.Descending alcohol
c. Neutral phenol

a.

G+ve in cuboidal packages

Sarciniae

mohammad_emam@hotmail.com

110

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

MYCOLOGY
168.

*******Candida is identified by

168.

germ tube test.

169.

**An oval to spherical budding cause by.

169.

C neoformans

170.

**Tinea versicolor is caused by.

170.

M.Furfur

171.

******Tenia capitis is caused by:


a. Microsporum.
b. Trichophyton.
c. Candida

171.

a. Microsporum ausdonii cause tenia capitis.


Trychophyton causes tenia pedis or unguium.

172.

*****T. vaginalis may be mistaken for:


a. White cells.
b. RBCs.
c. Candida.

172.

a. White cells.

case study(resp inf with bronchoalveolar lavage showing


frothy discharge&inflamm cells
a. pnemocyctis
b.aspergilosi.
c.

a.

Fungal infection is not diagnosed by culture because

etiologic agent is difficult to grow

mohammad_emam@hotmail.com

111

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

PARASITOLOGY
173.

**Malaria affecting large RBC-

173.

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

best time for collection of blood for malaria :a-before and after paroxsym
b-shortly after paroxsym
c-later paroxsym
d-just before paroxsym

b.(the best time is between fever peaks)

detection of malaria parasite is by

thick blood film

identification of malarial parasites & RBCS morphology

thin smear

174.

**Leishmania id transmitted by
(leishmanya donovani ) kala zar

174.

Sand fly.

175.

*****Dwarf tape worm is.

175.

H.Nana

176.

***Hematuria in Egyption Patient think of,


the worm that causes blood in urine:
the causative parasite of egyptian bilharisiasis:
a-trichomonas vaginalis
b-schitosoma haematobium
c-schitosoma japonicum
d-schitosoma mansoni
e-all of the above

176.

b.

egg in urine with terminal spine

shistosoma hematobium diagnosis:


177.

**Sporozoites are present in

177.

c.sporozoite infect liver merozoite infect RBC

the malarial sporozoite in man invades:a-white blood cells


b-RBCS
c-reticulo-endothelial cells
d-all of the above
178.

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

178.

***Entrobius vermicularis is diagnosed by.

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E.Histolytica.
b.

the chromatoid bodies resemble cigar-shaped or sausageshaped in the cyst of :a-entamoeba coli
b-entamoeba histolytica
c-entamoeba gingivalis
d-none of the above
179.

reticuloendothelial system (X).


Sporozoits are the infective stage in the
mosquito. The merozoit is the form inside the
infected RBC. Such RBC is called schizont.

179.

anal swab
112

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

infective stage of entrobius vermicularis is:


a. larva
b. cercaria
c. egg
d. cyst
e. metacercaria

c.

autoinfection of human can caused in case of:


a. entrobius vermicularis
b. taenia sp.
c. anclystoma dudenal
d. ascaris lumbercoidis

a.

180.

**Larva is present in fresh stool?

180.

Strongyloid stercoralis.(rhabdatiform larva)

181.

**Malaria with multiple infection?

181.

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

most sever (serious) malaria infection caused by:


a. plasmodium falcibarum
b. plasmodium malaria
c. plasmodium ovale
d. plasmodium vivax
e. all of the above

a.

which of the following enlarges rbcs:


a-plasmodium vivax
b-plasmodium malariae
c-plasmodium falciprum
d-all of the above

a.(and oval)

which of the following causing enlargement of RBCS?


a. reticulocytes
b.leishmania
c. plasmodium

c.

182.

**Anchovy sauce pus is ?

182.

E. Histolytica

183.

**Visceral leishmaniasis best diagnosed by?


a. B//M biopsy
b. Serology

183.

a. B//M biopsy

lymph node aspirate.


(spleen , liver, BM , LN)

identification of leishmanya parasite

184.

**Cutaneous leishmaniasis diagnosis by?


a. Skin biopsy
b. Culture,
case study(+ve rk 39 ag)
a. sandfly bite
b. tsetse inf
c. invitro culture is diagnostic

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184.

a. Skin biopsy

a.Visceral leishmaniasis (Kala-azar)

113

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

185.

The following parasite doesnt not involve GIT in man?


a. Ascaris
b. cysticercosis
c. H.nana
d. Tenia

185.

b. cysticercosis

Loa loa

Parasite in eye
186.

The cigar glycogen is in

186.

I. buchlii, but if cigar shaped chromatoid it is


E. histolytica (immature cyst)

187.

***The arthropod vector of malaria is:


a. Female anopheles mosquito.
b. Culex mosquito.
c. Tsetse fly.
d. None of the above

187.

a. Female anopheles mosquito.

188.

Cryptosporidium

188.

Intestinal coccidian infection with AIDS

189.

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

189.

Oxyurius vermicularis.
adhesion tab around anus and examined for
egg

enterobius vermicularis diagnosed by

190.

*Giardia lamblia is diagnosed in stool by the presence of

190.

Cysts or trophozoit
c.

the diagnostic stage of amoeba is?


a. cyst
b. trophozoite
c. all previous
191.

**Which is caused by skin penetration:

191.

Schistosoma hematobium.
Also ankylostoma duodenal, strongyloides
and N. americanus.

192.

Serology of E.H except

192.

IFAT
Also, CFT, IHA & ELISA.

193.

Stains for stool include:


a. Iodine.
b. Fluorescent.
c. Trichrome
d. All of the above

193.

d. All of the above

the definitive host is an animal:


a. entamoeba histolitica
b. toxoplasma gondii
c. trypanosoma cruzi
d. E.coli
e. giardia lamblia

b. cat

best for identification of parasite if you can not see it in


stool ( negative in stool )

concentration technique

identification of fertilized eggs in feces

ascaris lumbricoides

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114

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

diagnostic stage of ascaris lumbericoidis:

finding of a typical fertilized egg in stool

bone marrow biopsy parasite seen.

Visceral leishmaniasis

dwarf tapeworm is known as :a-tania saginata


b-taenia solium
c-hymenolepis nana
d-diphilidium caninum
e-echinococcus granulosus

c.

c.
which of the following neither lays eggs nor deposites
larvae in the intestinal canal :a-hookworms
b-pinworm
c-trichinella spiralis
d-trichuris trichura
the following parasite doesnt not involve GIT in man?
a. ascaris
b. cysticercosis
c. H.nana
d. tenia

b.

infective stage of taenia:


a. larva
b. cercaria
c. embryonated egg
d. cyst
e. metacercaria

c.

amoeba moves by?


a. cilia
b. flagella
c. pseudopodia

c.

iodine stain of entamoeba cyst used to detect (diagnose):


a. chromatoidal bars
b. cell wall
c. nuclei

parasite can be detected in vaginal and urethral


discharge:

trichomonas vaginalis

parasite can cause fetal cerebral infection:


a. taenia
b. toxoplasma gondii

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115

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

non motile protozoa:


a. entamoeba coli
b. entamoeba histolytica
c. trypanosoma cruzi
d. giardia lamblia
e. trichomonas vaginalis

a.

non motile protozoa:


a. entamoeba.histolytica
b. entamoeba.coli
c. toxoplasma gondii
d. giaradia lamblia
e. typanosoma cruzi

c.

blood of microfilaria infection diagnostic with:

wuchereria bancrofti
*specimen blood

intracellular parasite:
oocyst benefited to diagnose:
a. entamoeba.histolytica
b. entamoeba.coli
c. toxoplasma gondii
d. giaradia lamblia
e. typanosoma cruzi

c.

malaria does not grow in?


a. EDTA blood
b. heparinized blood
c. plasma

c.

malaria chizonts are present in?


a. reticulo-endothelial
b. leukocyte
c. RBCS

c.

infective stage of ascaris lumbricodes :


a. larva
b. cercaria
c. egg
d. cyst
e. metacercaria

c.

generally diagnosed by recovery & identification of typical


larva in stool?
a. hook worms
b. t.trichura
c. s.stercoralis

c.

intermediate host of trypanosome

tse tse fly

Proglottids present in

cestoda

Trophozoites on Wright's stained film


Ring form with gametocytes seen in
Malaria donot grow in
New world hook worm
General term of worms

Signet ring.
F. falciparum.
plasma
Necator americanus.
Helmenth

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check the 2 answers

116

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

Flukes
Ribbon like worms (Tape worm)
round
Flagellates except
Hemoflagellates
Most common helminthes are
Largest protozon
Asexual forms of malaria
Ascaris egg

Trematodes
cestodae
Nematodes
S. mansoni
Leishmania and trypanosomes
nematodes
Balantidium coli
Merozoite, asexual cycle in man, sexual cycle
in Mosquito
migrate from lung to small intestine

Parasite in blood smear


Toxo diagnosed by
Protozoa of endemic and epidemic disease
Entrobius diagnosed by
Schffner's dots

plasmodium
Fluorescent antibody sera
G. lamblia.
Scotch tape method
P. vivax

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117

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

VIROLOGY
c.

virus is similar to live organisms in?


a. growth
b. movement
c. reproduction
194.

********HAV all are correct except:


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

194.

b. There is chronic carrier state in young


children.

195.

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

195.

feaces.
Also from throuat and spinal fluid.

196.

**Virus & living cells resemble in

196.

reproduction.

197.

**Latent infection seen in all except?


a. Herpes virus
b. adeno virus
c. coxsackie virus
d. retorvirus.

197.

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

198.

virus without latent period


a. varicella
b.
c. herpes

b.

virus with disseminated infection


a. influenza virus
b. rhinovirus
c. para influenza virus
d. rotavirus

?a.

Virus with respiratory infection


a. Para influenza
b. Coxacie B
c.

b.

**Which of the following virus causes systemic effect?


a. Poliovirus
b. adenovirus
c. rhinovirus
d. Influenzea virus.

198.

para influenza

virus cause croop (laryngitis) in children


199.

****Which is not correlating?


a. RSV keratitis in AIDS patients
b. Ebola: haemorrhagic fever
c. Rubella: arthritis
d. EBV: heterophil ab

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There may be a missing "except" in this


question because adeno cause RTI and
hemorrhagic cystitis and GE. Influenza and
polio also cause systemic effect. Rhino is an
exception.

199.

a.

118

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

200.

*****Which combination is wrong?


a. Rubella: arthritis in young women.
b. Mumps: Antigenic shift
c. Coxsackie: Meningitis.
d. EBV: Heterophil Abs.

200.

wrong combination.

b. Antigenic shift is a character of influenza


virus

Coxsackie: septic Meningitis

201.

******Which of the following can pass to fetus


transplacentally?
a. HSV.
b. VZV.
c. CMV

201.

c. CMV

202.

****Who of the following is supposed to transmit CMV


infection to hospital staff?
a. pregnant woman having a skin rash in second trimester.
b. HIV patient
c. HCV patient.
d. Neonate with congenital defect due to CMV infection

202.

d. Neonate with congenital defect due to CMV


infection.

203.

**All diagnose viral infection except:


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

203.

a. IgM Ab is one serum only.


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

204.

*****RSV all correct except:


a. Rectal sample gives the highest yield of the virus.
b. Form a syncetium in tissue.
c. Causes lower respiratory illness in children.
d. Related to paramyxoviruses.

204.

a. RSV is a paramyxovirus. It is the most


important cause of pneumonia and
bronchiolitis in infants.

205.

**In a patient with rabies infection, the main histological


characteristic in the brain is:
a. Lewi bodies.
b. Durel bodies.
c. Negri bodies.
d. Amyloid plague

205.

c. Negri bodies.

206.

*Enteroviruses cannot be isolated from which of the


following specimens?
a. Throat swab.
b. Fecal specimens.
c. Gastric fluid.
d. Urine.
e. CSF.

206.

d. enteroviruses isolated from throat e.g. polio,


from feces e.g. polio and hepatitis, from CSF
e.g. coxsachie virus. Enteroviruses resist
gastric acidity.

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119

Microbiology

CLINICAL & CHEMICAL PATHOLOGY MCQ

the best sample for the culture of children paralysis virus


is?
specimens from a polio victim for culture can be best
made on
a. anal swab
b. blood culture
c. stool culture

c.

the best specimen for recovery of poliomyelitis virus for


culture is :a-CSF
b-blood clot
c-throat swab
d-buffy coat
e-stool
f-none of the above
g-all of the above

?a.

polio myeletis is transmitted through?


a. skin
b. respiration
c. feco-oral

c.

207.

Herpes zoster

207.

Localised

208.

Regarding rotavirus, all are correct except:


a. DS-RNA virus
b. cause majority of infant diarrohea
c. diagnosed in feses by ELISA

208.

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

209.

Ebola virus causes

209.

Fever, myalgia, diarrhea, rash, lymphadenitis,


complicated with hemorrhage, encephalitis.

210.

Polio virus is transmitted by which rout?

210.

Feco-oral

211.

**Which of these is not dangerous in contact with AIDS


patient?

211.

patient with HIV, CD4 count is 30 , viral RNA 3 105


a. no need for triple therapy
b.
ve for hiv
c.

c. viral RNA 3 105 start triple therapy

Rota not correct


Respiratury infection cause by

hemorrhagic conjunctivitis and cardiac disease


Coxacki B and parainfluenza

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120