1. CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS
Clinical & Chemical Pathology MCQs
Classified, Reorganized And Updated To Shawual 1425 With Short Notes Body fluids
By Dr Mohammad A. Emam 1. **Doctor sending a sample requesting for lecithin 1. (c) Amniotic fluid sample is used to measure
spingomyelin ratio what is the sample? lecithin: sphingomyelin ratio (L/S). L/S > 2:1
a. Blood. (or 2.5:1) denotes acceptable lung maturity.
Contents b. CSF
Body fluids ................................................................................. 2 c. Amniotic fluid.
d. Urine
Clinical Chemistry .................................................................... 4
INSTRUMENTATION ...................................................................................................................4 2. ***Cytological examination of pleural effusion in a 60 yrs 2. (d) Lung cancer: 75% of malignant pulmonary
BLOOD GASES, PH AND ELECTROLYTES. .............................................................................5 old man revealed the presence of malignant cells. The effusions are due to 3 causes; lung cancer
GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. ...............................................................7 most likely primary tumor will be: (30%), breast cancer (25%) & lymphoma (20%).
CALCULATIONS, QC AND STATISTICS ..................................................................................9 a. Lymphoma. Practically, cytological examination only
CREATININE, UA, BUN AND AMMONIA ...............................................................................10 b. Mesothelioma. establishes the presence of malignant effusion,
PROTEINS, ELECTROPHORESIS AND LIPIDS .......................................................................11 c. Cancer colon. however, in most cases it cannot identify the
CLINICAL ENZYMOLOGY........................................................................................................13 d. lung cancer. primary site of the tumor.
CLINICAL ENCOCRINOLOGY .................................................................................................14 Regarding mesothelioma, it is a rather a rare
General ..................................................................................... 17 tumor of the pleura.
Hematology .............................................................................. 19 3. *****Regarding Albustix: 3. (c) Commercial strips for detecting albumin
BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES ................................19 a. Useless if infected urine. (Albustix) use the following formula:
NORMOCYTIC NORMOCHROMIC ANEMIAS .......................................................................20 b. Gives red color. Tetrabromophenol blue (yellow at 3.0)
HYPOCHROMIC MICROCYTIC ANEMIAS .............................................................................24 c. Not useful if acid is added to urine. shades of green in the presence of protein at the
MACROCYTIC NORMOCHROMIC ANEMIA .........................................................................25 d. Depends on acid precipitation of urinary proteins same pH.
QUALITATIVE / QUANTITATIVE WBC DISOREDERS ........................................................26 This reaction is sensitive to 0.03g/L albumin. A
LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS .................................29 false negative result occurs with acidification of
COAGULATION AND PLATELETS ..........................................................................................35 urine. Also, a markedly alkaline urine (pH or
Immunohematology ................................................................ 40 higher can give false +ve.
Immunology ............................................................................. 41 4. ****Which is not a reducing sugar in urine? 4. (c) A reducing substance is the one that reduces
a. Glucose. alkaline cupric sulfate to red coprous oxide.
Microbiology............................................................................ 43 b. Galactose. Most important are glucose, lactose, fructose,
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION .....................43 c. Sucrose. galactoses and pentoses (e.g. ribose, xylose and
BASIC TECHNIQUES .................................................................................................................44 d. Fructose. arabinose) while sucrose will not reduce alkaline
BASIC BACTERIOLOGY............................................................................................................46 cupric sulfate.
GRAM POSITIVE COCCI ...........................................................................................................47
GRAM NEGATIVE COCCI .........................................................................................................49 b. Rifampicin is a well known drug to cause red
5. ***Red urine is due to? 5.
GRAM POSITIVE BACILLI ........................................................................................................49 a. INH urine.
ENTEROBACTERECIAE & PSEUDOMONAS .........................................................................50 b. Rifampicin
RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA .............................................................52 c. Pyrizinamide.
SPIROCHETES .............................................................................................................................53
BORDETELLA & BORRELIA ....................................................................................................53
6. **Urine strips detect all except 6. Fat droplets. Occur with glomerulonephritis and
ANEROBIC BACTERIA ..............................................................................................................54
nephritic syndrome but are not detected by the
BRUCELLA ..................................................................................................................................55
routine urine strips.
MYCOBACTERIA .......................................................................................................................55
MISCELLANEOUS ......................................................................................................................56
7. **If urine is left for long time which is affected more? 7. Urea. The most labile constituent of urine is
MYCOLOGY ................................................................................................................................57
urea. Bacterial action decrease urea and increase
VIROLOGY ..................................................................................................................................60
ammonia and pH.
26th Shawual 1425 .................................................................. 64
8. **Abnormal constituent of urine includes? 8. (c) Although also glucose and protein are
a. Urea abnormal constituents of urine, yet they
b. Glucose normally present in trace amounts below the
c. Cholesterol. detection limit of ordinary methods.
d. Uric acid
e. Protein.
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CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY
9. ****Calcium in urine stone is present in all of the 9. (b) In 2ry hyperparathyroidism, hypocalcemia
following except:
a. UTI
due to e.g. chronic renal failure is the cause of
increased parathormone. Stones due to Clinical Chemistry
b. Secondary hyperparathyroidism. hyperparathyroidism only occur with the 1ry or
3ry disease.
Calcium is precipitated in stones with oxalate (at INSTRUMENTATION
acid or neutral pH), or less commonly with urate 1. ******Difference between ELISA & RIA is ? 1. (a) Both techniques apply almost the same
(at acidic pH) or with phosphate (at normal urine a. ELISA technique uses an enzyme. methodology, .ELISA technique uses an enzyme
pH). Causes of hypercalciurea include: b. ELISA is used by bacteriologists while RIA by label and RIA uses radioisotopic label.
- intestinal calcium absorption ( P level virologists
vit D Ca absorption Or in case of
hypervitaminosis D. 2. The label in ELISA is? 2.
- Lack of renal tubular reabsorption e.g. with a. Enzyme
furosamide. b. Antibody
- Loss of Ca from bone (due to mobilization c. Antigen.
as in 1ry & 3ry hyperparathyroidism, due to
bone destruction or due to Cushing's and 3. ***Which of the following not seen in chemistry lab? 3. (d) Electron microscope.
thyrotoxicosis) a. Analytic balance.
Otherwise, UTI causes stones at alkaline pH b. Centrifuge
where ammonium is high and mixed stones form c. Spectrophotometer
due to obstructing Ca stone which favors d. Electron microscope,
infection and precipitation of ammonia salts. e. Turbidimeter.
10. If urine is kept for a long time: 10. See 7. 4. **The washing is must in all heterogenous ELISA 4. (b) In ELISA, the first washing is used to
a. Becomes black. Urine becomes black on standing in cases of techniques because? remove the unbound (free) sample antigen. The
b. Urea increases. alkaptonurea ( homogentesic acid) and a. It remove the excess binding second washing removes unreacted free label
c. Urea decreases. methemoglobinurea. b. Increase the specificity (not excess binding in either of the 2 washings)
d. Creatinine increases c. Increase the sensitivity. If washing is not complete, this will false high
11. Myoglobinuria is seen in: 11. Muscle injury (also known as rhabdomyolysis) specificity.
e.g. in cases of crush injuries and strenuous If the question comes as It avoids excess
exercise. binding, then this will be the choice.
5. **The enzyme in ELISA is present in the? 5. (a) The conjugate is the second antibody
a. Conjugate conjugated with the enzyme.
b. Microplate
c. Buffer.
6. **A standard microplate in an ELISA has? 6. (a) 96 wells are present in the microplate (8
a. 96 wells rows x 12 columns).of these, 1 is used for the
b. 98 wells blank, 2 for the –ve controls, 2 for the +ve
c. 92 wells. controls and 4 for the cutoff control (COC). The
remaining 85 for tests.
7. Five ml of a colored solution has an absorbance of 0.500. 7. (b) According to Beer's law, absorbance is
The absorbance of 10ml of the same colored solution will proportional to the final concentration (whatever
be: the volume is)
a. 1.000
b. 0.500
c. 0.250
8. a dichromatic analysis is carried to increase: 8. (a) Di- (bi) chromatic photometry measures
a. Specificity absorbance of the sample at 2 different
b. Linearity wavelengths. This corrects for interfering
c. Sensitivity. substances increasing specificity of the method.
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3. CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY
CALCULATIONS, QC AND STATISTICS 50. Sensitivity and specificity are 50. (b) Sensitivity & specificity can be adjusted
a. Directly related. according to cutoff level. Sensitivity can be
43. **Most of the concentration are calculated using factor, 43. (b) For methods obeying Beer's law, slope of the b. Inversely related. increased by choosing a higher cutoff to include
this factor is? calibration curve (Cs/As) provides a constant to c. They mean the same. more TP, this meanwhile will include more FP
a. Std absorbance / std value calculate the unknown concentration. Also thus specificity. However, this is not always
b. Std value / std absorbance depending on the formula:
the case as highly specific highly sensitive tests
c. Std value x std absorbance At x Cs = As x Ct, thus, Ct=(Cs/As)x As
as well as poorly specific poorly sensitive exist.
44. **Ten microliters are? 44. (d) μL = 10-6L 10 μL = 10-5L = 0.00001L 51. A carryover in chemistry analyzer means a disturbance in 51. (b) Carryover is due to contamination by a
a. 0.01 L
readings because: previous sample. It is calculated by measuring a
b., 0.001 L
a. The analyzer was carried and placed at a different place. high standard and a low standard each 3 times
c. 0.0001 L
b. The previously measured solution was still in the cuvette then applying the following formula:
d. 0.00001 L
c. The current solution is overflowing in the cuvette. Carry over = (contaminated low – actual low) /
e. non of these.
contaminated high – actual high)
45. **How much water should be added to 500ml of a solution 45. (c) Using the formula:
52. STAT test means: 52. (c) Stat refers to immediate or as initial dose.
of 10% NaOH to bring it to 75%? C1 x V1 = C2 x V2
a. Start at.
a. 666ml 10 x 500 = 7.5 x V2
b. Standardize and test.
b. 125ml V2 = 666mL
c. Short turn around time
c. 166ml Thus, 166 mL of DW should be added.
d. 250ml
e. 375ml
CREATININE, UA, BUN AND AMMONIA
46. When calculated osmolarity can not be accounted as a 46. Calculated osmolarity = 2 X Na + Glu + Urea 53. ***Which of the following result shows renal impairment? 53. (e) A urine osmolarity less than 800 after 12 hrs
measurement for osmolarity? (All in mmol/L) a. urea 9 mmol of water deprivation denotes renal impairment.
a. per 100gm/l When calculated osmolarity is less than b. creatinine 10 mmol/l Urea 9mmol is high normal (n: 2.9-8.2) and is
b. Urea 20 mm/l measurement for osmolarity, this denotes c. urates not a very sensitive measure of GFR.
increased osmolar gap (OG). This occurs with: d. cholesterol Creatinine, although a sensitive measure of GF,
- Factitious hyponatremia (due to e. urine osmolarity less than 800 after 12 hrs of water 10umol is normal (n: 53-106)
decreased water) deprivation. Cholesterol and urates are useless in this regard.
- Unmeasured osmotically active
compounds e.g. alcohols, sugars, and 54. **Low GFR occurs in all except: 54. (b) low GFR occurs with:
ketones. a. Congestive heart failure. - Hemorrhage.
b. Urethral obstruction. - Dehydration.
47. **Calibrator sera are? 47. (b) Secondary std? - Renal loss of fluids e.g. diuretics.
a. Primary std A primary Std is a reference standard. - Ineffective blood volume, e.g. CO,
b. Secondary std Secondary Std is standardized depending on the systemic VD, renal vasoconstriction.
c. Tertiary std primary standard.
d. Internal std. 55. Diagnosis of RF 55. GFR is an index and a monitor of increased or
decreased renal functions. It is practically
48. **External QC program means? 48. (b) In EQC, participants receive QC material to estimated from serum creatinine and creatinine
a. An external person come & does the QC test be tested inside their labs. Results are sent to clearance.
b. A QC person goes to another lab & does the test.. supplier to be compared to other labs' results.
EQC will be most practically implemented 56. ****Nephrotic syndrome is characterized by all except: 56. (a) Nephrotic syndrome consists of:
during the regular visit of the lab coordinator. a. Hypocholesterolemia. - Heavy proteinuria.
This will give opportunity for errors to be b. Hypoalbuminemia. - Hypoalbuminemia.
investigated on site and corrected rapidly c. Albuminuria. - Oedema.
(Monica) d. Hypertriglyceridemia. - Hypercholesterolemia (Almost always
49. **We select 2SD value to plot LJ curves because? 49. (c) QC results follow a Gaussian distribution, e. None of the above present).
a. They are easy to calculate, thus 95% of these results normally fall within Hypertriglyceridemia is present in 50% of
b. They cover 97.5% of normal population, ±5% of the mean. Therefore, 2.5 out of 100 cases.
c. Patient value rarely go beyond these limits. (1:40) are acceptable to be above +2s and 2.5
our of 100 are acceptable below -2s.
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CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY
57. ****Ureate excretion by the kidney is inhibited by: 57. (b) Thiazide diuretics cause relatively urate 65. **Lipoprotein related to hypertension? 65. . LDL
a. Probenecid. retention, glucose intolerance and hypokalemia
b. Thiazide diuretics. and interfere with water excretion and may 66. *****Which is important for atherosclerosis? 66. (b)
cause hyponatremia. a. HDL
Probenecid is a uricosuric agent like allopurinol. b. LDL
c. Chylomicrons.
58. Chronic glomerulonephritis is diagnosed by: 58. (d) In chronic glomerulonephritis, there is
a. Blood urea. persistent deterioration of renal functions ending 67. ***In plasma protein electrophoresis, the protein that will 67. Albumin.
b. Creatinine. with renal failure. go first is (moves furthest from application)?
c. Proteinuria
d. All of the above On electrophoresis;
68. ***Based on behavior of lipoproteins in 68.
ultracentrifugation pre-B lipoprotein is? Chylomicrons and its remnants stay at the
a. HDL origin.
PROTEINS, ELECTROPHORESIS AND LIPIDS b. LDL. VLDL at preβ (=α2 globulin region)
59. **The protein having molecular wt less then albumin is? 59. (b) B2-microglobulin has a MW 11,800. c. VLDL IDL at broad β
a. Beta protein Betalipoprotein is 380,000. d. Chylomicron LDL at β (= β globulin region)
b. B2-microglobulin. BJ protein is the light chains of HDL at α (= α1 globulin region)/
c. Lysozyme. immunoglobulins. It's MW is variable from
d. Benze Jones protein. 11,000 for monomers, 22,0000 for dimmers or 69. **All of the following are lipoproteins except? 69. (d) Although phospholipids are not lipoproteins,
tetramers. a. Phospholipid they are ingredients of lipoproteins, conferring
Lysozyme is 14,000. It is used to differentiate b. VLDL the hydrophilic properties.
AML M4 and M5 and appears as a far cathodal d. Sphingomylin
band on serum or urine EP. e. LDL
f. HDL
60. ******In cystic fibrosis, which is deficient? 60. (d) Alpha 1 antitrypsin
a. Beta globulin 70. What is the proposition of pulmonary surfactant? 70. (b) Dipalmityl lecithin (a lecithin phospholipid
b. Macroglobulin a. Phospholipid acid with 2 palmetic acid residues) is the chemical
c. Albumin b. Dipalmityl lecithin composition of pulmonary surfactant.
d. Alpha 1 antitrypsin c. Phosphatidyl choline,
e. Alpha 2 antitrypsin.
71. **HDL is good cholesterol because? 71. (a) HDL is composed of 20% cholesterol, 30%
61. ***Diet rich in phenylalanine should be restricted in? 61. (a) In phenylketonuria, there is phenylalanine a. It has more protein & phospholipids in it phospholipids and 50% proteins.
a. Phenyl ketonuria b. It has no cholesterol in it,.
hydroxylase leading to accumulation of
b. Tyrosinemia c. It has less TG in it.
phenylpuruvate and its derivatives and their
c. Maple syrup disease excretion in urine. Diet rich in phenylalanine
should be restricted to prevent brain damage. 72. ***Which lipoprotein has highest concentration of 72. (b) VLDL are the TG rich lipoproteins
cholesterol? HDL has 20% cholesterol.
a. VLDL IDL has cholesterol and TG in equal amounts.
62. ***In phenylketonuria, diet should be low in: 62. (a) Phenylalanine (see 61)
b. LDL LDL is the richest lipoprotein in cholesterol
a. Phenylalanine.
c. IDL esters.
b. Carbohydrate.
d. HDL
c. Lipids.
74. ****Which is not associated with abetalipoproteinemia: 74. (b) Hereditary spherocytosis is due to spectrin
62. Hypoalbuminemia is associated with all except? 62. (a) Tetanus is clostridial infection caused be C.
a. Acanthocytes in the peripheral blood. deficiency.
a. Tetanus tetani has nothing to do with albumin.
b. Hereditary spherocytosis. Abetalipoproteinemia is a lipoprotein
b. hypocalcaemia
c. Malabsorption and fatty stools abnormality of absent LDL due to autosomal
c. oedema
recessive abnormality in the synthesis of apoB +
d. toxic effect of sulfonamide
failure of chylomicron formation leading to
malabsorption of fats + fat soluble vitamins +
64. **Gluconic amino acids include: 64. (a) Ketogenic amino acids are: Leucine and
adrenal dysfunction. 50-70% of RBCs have
a. Alanine. lysine,
spinal projections (acanthocytes)
b. Methionine. Mixed amino acids are: Isoleucine,
c. Valine. phenylalanine, threonine, tryptophan and
75. Chylomicrons: 75. (a) Chylomicrons don't confer an excess
d. Glutamic acid. tyrosine.
a. Can cause thrombosis. cardiovascular risk, however, in LpL deficiency
e. All of the above. Gluconic amino acids are all the other amino
b. Cannot cause thrombosis. and apoC II deficiency, the patient presents with
acids.
lipemia retinalis and retinal vein thrombosis.
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