هام -Clinical & Chemical Pathology MCQs

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

By Dr Mohammad A. Emam
Contents
Body fluids ................................................................................. 2
Clinical Chemistry .................................................................... 4
INSTRUMENTATION ...................................................................................................................4
BLOOD GASES, PH AND ELECTROLYTES. .............................................................................5
GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. ...............................................................7
CALCULATIONS, QC AND STATISTICS ..................................................................................9
CREATININE, UA, BUN AND AMMONIA ...............................................................................10
PROTEINS, ELECTROPHORESIS AND LIPIDS .......................................................................11
CLINICAL ENZYMOLOGY........................................................................................................13
CLINICAL ENCOCRINOLOGY .................................................................................................14
General ..................................................................................... 17
Hematology .............................................................................. 19
BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES ................................19
NORMOCYTIC NORMOCHROMIC ANEMIAS .......................................................................20
HYPOCHROMIC MICROCYTIC ANEMIAS .............................................................................24
MACROCYTIC NORMOCHROMIC ANEMIA .........................................................................25
QUALITATIVE / QUANTITATIVE WBC DISOREDERS ........................................................26
LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS .................................29
COAGULATION AND PLATELETS ..........................................................................................35
Immunohematology ................................................................ 40
Immunology ............................................................................. 41
Microbiology............................................................................ 43
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION .....................43
BASIC TECHNIQUES .................................................................................................................44
BASIC BACTERIOLOGY............................................................................................................46
GRAM POSITIVE COCCI ...........................................................................................................47
GRAM NEGATIVE COCCI .........................................................................................................49
GRAM POSITIVE BACILLI ........................................................................................................49
ENTEROBACTERECIAE & PSEUDOMONAS .........................................................................50
RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA .............................................................52
SPIROCHETES .............................................................................................................................53
BORDETELLA & BORRELIA ....................................................................................................53
ANEROBIC BACTERIA ..............................................................................................................54
BRUCELLA ..................................................................................................................................55
MYCOBACTERIA .......................................................................................................................55
MISCELLANEOUS ......................................................................................................................56
MYCOLOGY ................................................................................................................................57
VIROLOGY ..................................................................................................................................60
26th Shawual 1425 .................................................................. 64
mohammad_emam@hotmail.com
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.
2.
***Cytological examination of pleural effusion in a 60 yrs

old man revealed the presence of malignant cells. The
most likely primary tumor will be:
a. Lymphoma.
b. Mesothelioma.
c. Cancer colon.
d. lung cancer.
2.
(d) Lung cancer: 75% of malignant pulmonary

effusions are due to 3 causes; lung cancer
(30%), breast cancer (25%) & lymphoma (20%).
Practically, cytological examination only
establishes the presence of malignant effusion,
however, in most cases it cannot identify the
primary site of the tumor.
Regarding mesothelioma, it is a rather a rare
tumor of the pleura.
3.
*****Regarding Albustix:
a. Useless if infected urine.
b. Gives red color.
c. Not useful if acid is added to urine.
d. Depends on acid precipitation of urinary proteins
3.
(c) Commercial strips for detecting albumin

(Albustix) use the following formula:
Tetrabromophenol blue (yellow at 3.0)
shades of green in the presence of protein at the
same pH.
This reaction is sensitive to 0.03g/L albumin. A
false negative result occurs with acidification of
urine. Also, a markedly alkaline urine (pH or
higher can give false +ve.
4.
****Which is not a reducing sugar in urine?

a. Glucose.
b. Galactose.
c. Sucrose.
d. Fructose.
4.
(c) A reducing substance is the one that reduces

alkaline cupric sulfate to red coprous oxide.
Most important are glucose, lactose, fructose,
galactoses and pentoses (e.g. ribose, xylose and
arabinose) while sucrose will not reduce alkaline
cupric sulfate.
5.
***Red urine is due to?

a. INH
b. Rifampicin
c. Pyrizinamide.
5.
b. Rifampicin is a well known drug to cause red

urine.
6.
**Urine strips detect all except
6.
Fat droplets. Occur with glomerulonephritis and

nephritic syndrome but are not detected by the
routine urine strips.
7.
**If urine is left for long time which is affected more?
7.
Urea. The most labile constituent of urine is

urea. Bacterial action decrease urea and increase
ammonia and pH.
8.
**Abnormal constituent of urine includes?

a. Urea
b. Glucose
c. Cholesterol.
d. Uric acid
e. Protein.
8.
(c) Although also glucose and protein are

abnormal constituents of urine, yet they
normally present in trace amounts below the
detection limit of ordinary methods.
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.
CHEMISTRY
Clinical Chemistry
INSTRUMENTATION
(a) Both techniques apply almost the same
methodology, .ELISA technique uses an enzyme
label and RIA uses radioisotopic label.
1.
******Difference between ELISA & RIA is ?

a. ELISA technique uses an enzyme.
b. ELISA is used by bacteriologists while RIA by
virologists
1.
2.
The label in ELISA is?

a. Enzyme
b. Antibody
c. Antigen.
2.
3.
***Which of the following not seen in chemistry lab?

a. Analytic balance.
b. Centrifuge
c. Spectrophotometer
d. Electron microscope,
e. Turbidimeter.
3.
(d) Electron microscope.
4.
**The washing is must in all heterogenous ELISA

techniques because?
a. It remove the excess binding
b. Increase the specificity
c. Increase the sensitivity.
4.
(b) In ELISA, the first washing is used to

remove the unbound (free) sample antigen. The
second washing removes unreacted free label
(not excess binding in either of the 2 washings)
If washing is not complete, this will false high
specificity.
If the question comes as It avoids excess
binding, then this will be the choice.
5.
**The enzyme in ELISA is present in the?

a. Conjugate
b. Microplate
c. Buffer.
5.
(a) The conjugate is the second antibody

conjugated with the enzyme.
6.
**A standard microplate in an ELISA has?

a. 96 wells
b. 98 wells
c. 92 wells.
6.
(a) 96 wells are present in the microplate (8

rows x 12 columns).of these, 1 is used for the
blank, 2 for the ve controls, 2 for the +ve
controls and 4 for the cutoff control (COC). The
remaining 85 for tests.
7.
Five ml of a colored solution has an absorbance of 0.500.

The absorbance of 10ml of the same colored solution will
be:
a. 1.000
b. 0.500
c. 0.250
7.
(b) According to Beer's law, absorbance is

proportional to the final concentration (whatever
the volume is)
8.
a dichromatic analysis is carried to increase:

a. Specificity
b. Linearity
c. Sensitivity.
8.
(a) Di- (bi) chromatic photometry measures

absorbance of the sample at 2 different
wavelengths. This corrects for interfering
substances increasing specificity of the method.
CHEMISTRY
BLOOD GASES, PH AND ELECTROLYTES.

9.
******PO2 (or gases) is measure in which unit?

a. Mmol
b. umol
c. mmHg
9.
mEq/L (mmol in SI) is used for electrolytes

e.g. BE, bicarbonate and H+. While mmHg (or
kpa in SI) is used for gases e.g. pCO2 and pO2.
11.
Acidemia is associated with
11.
Acid in urine and increased HCO2-.

Increased hydrogen ion in the blood is termed
academia. If the cause is metabolic, there will be
compensatory hyperventilation H+ back to
normal while HCO3- drops. Furthermore, if renal
function is normal, H+ will be excreted.
If the cause is respiratory, renal compensation
will cause H+ excretion and HCO3- retention and
generation lowering H+ back to normal.
12.
***To correct acidosis, the kidneys:

a. secrete more H+ in urine.
b. Synthesis bicarbonate to ECF
c. Both a and b
12.
(c). See 11.
13.
**A buffer is made of ?

a. Strong acid & strong salt
b. Strong acid & weak salt
c. Weak acid & strong salt
d. Weak acid & weak salt.
13.
(c) A buffer system is made of a weak acid and

its salt with a strong base of a weak base and its
salt with a strong acid.
14.
****pH means:
14.
Negative log H+ concentration
15.
***What is the base: acid ratio at pH 7 for acid of pK6?

a. 0.01
b. 0.1
c. 1.0
d. 10
e. 100
15.
(d) According to Henderson Hasselbalch's

equation, pH = pK + Log base/acid. By
compensation, Log (base / acid)= 1, thus base:
acid = 10:1.1
16.
***Which is more serious?

a. Glucose 15mmol/l
b. pH 7.25 acidosis.
c. Potassium 1.5 mmol/l
d. Sodium 150 mmol/l
16.
(c) Critical K+ values are <2.5 or > 6.5 mEq/L

Critical glucose <40mg or >450mg (2.2 &
25mmol respectively),
critical pH <7.2 or >2.6
critical Na+ <120 or > 160mEq/L
17.
******Metabolic acidosis can result from:
17.
(a) Ingestion of certain medicines or chemicals

e.g. metformin.(glucophage).
Metformin causes lactic acidosis.
Generally, metabolic acidosis is due to either
addition of H+ (AG), excretion of H+ or
loss of HCO3-
18.
pH of the blood.
18.
19
Acid base balance.
19
CHEMISTRY
H+ homeostasis is altered by;

a. Excessive change of pyruvate to lactate.
19.
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.
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.
(d) Hypernatremia occurs with:

* body Na : due to extrarenal water loss or
renal diuresis.
* Normal body Na: due to extrarenal loss e.g.
hyperthermia or renal loss e.g. DI.
* Na retention e.g. steroids or Na intake.
28.
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.
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.
19.
New
New
1
New
New
1
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.
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.
Hypocalcaemia.
Causes of renal damage include; hypovolemia
(hemorrhage or dehydration), myoglobulinurea,
hypercalciurea, uricosuria, and drugs e.g.
aminoglycosides and ACE inhibitors.
See 23.
CHEMISTRY
28.
New
2
28.
New
3
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.
New
2
New
3
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).
GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN.

10.
Factors affecting glucose level in blood include:
10.
Adrenaline, T4. These together with cortisol, GH

and glucagons are the hyperglycemic hormones
causing 2ry diabetes in case of excessive secretion.
29.
**Glucose level to diagnose hypoglycemia in newborn is.
29.
- 25-30 g/dl
In newborn babies, glucose tends to be lower than
in adults. Critical low level in newborn is 30mg/dL
30.
***About GTT, which is correct according to WHO

recommendations?
a. Should not be done in pregnant women,
b. Should not be done after giving heavy carbohydrate
diet for 3 days.
c. Should be done after 4-6 hrs fasting.
30.
(c) WHO recommendations for GTT include:
31.
**With age renal threshold for glucose?

a. Increased
b. Decreased
c. Not changed
31.
(b) With age, the renal ability to reabsorb filtered

glucose is decreased leading to appearance of
glucose in the urine at lower plasma levels.
32.
**All are inborn error of glycogen metabolism except?

a. Essential fructosuria
b. Phenyl ketonuria
c. Galactosemia
d. Glycogen storage disease
32.
(b) Essential fructosuria is due to aldolase B defect

leading to accumulation of fructose-1-P
Galactosemia (serious) is due to decreased
Galactose-6-P uridyl transferase leading to
decreased glycogen synthesis.
Types of glycogen storage diseases (GSD) include:
Type I (VonGierke's): G6P
Type II (Pompe's): lysosomal maltase
Type III (Cori's) : debranching enzyme.
Type IV (Anderson's): Absent debranching
enzyme
Type V (McArdle's): muscles
phosphorylation.
CHEMISTRY
33.
*****HBA1c (Glycosylated hemoglobin) is?

a. Not present in healthy normal individuals.
b. in prolonged sustained hyperglycemia
33.
(b) GlycHb (RR 4-6%) is formed by non

enzymatic attachment of glucose to N-terminal
valine of B-chain of Hb. Three types occur, HbA1a,
HbA1b, HbA1c, Both total and HbA1a are used.
Time averaged blood glucose = GlycHbx33.3-86
(mg/dL)
GlycHb reflects 8-12 weeks of blood glucose
while fructosamine reflects 2-4 weeks.
34.
***Glycogen differs from starch in:
34.
It is a highly branched structure
35.
**Cellulose is not metabolized in humans because of

absence of which enzyme?
35.
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..
37.
****Von Gerke's disease is caused by deficiency of:

a. Glucose 6 phosphatase
b. Glucose 6 phosphate dehydrogenase
37.
(a) See 32.
38.
What happens if sucrose is given parentrally:
38.
It will be secreted unchanged or metabolized
39.
***Which of these is not a ketone body?

a. Acetone.
b. Acetoacetic acid.
c. Butyric acid.
d. B-hydroxy butyric acid.
e. None of the above.
39.
(c) Ketone bodies are formed by condensation of 2

acetyl Co A Acetoacetic acid which gives B
hydroxyl butyric acid by reduction or acetone by
decarboxylation.
Butyric acid is a fatty acid
40.
***In Gaucher's disease;

a. Glycoprotein is accumulated.
b. Glucocerebrosidase is deficient.
40.
(b) Gaucher's is a glucosylceramide lipidosis

(lysosomal storage disease). It is caused by
glucocerebrosidase enzyme leading to
accumulation of glucosylceramide HSM and
pigmentation of exposed parts.
41.
Bile duct obstruction can be diagnosed by:

a. AST
b. T. Bilirubin
c. Bilirubin in urine
d. Ester bilirubin
41.
(c) Cholestatic hyperbilirubinemia is characterized

by conjugated hyperbilirubinemia and
hyperbilirubinuria (only the conjugated fraction
appears in urine).
42.
*** Increased jaundice is diagnosis by

a. T. bilirubin
b. AST
c. ALT
d. ALP
42.
(a) Estimation of jaundice depends on serum

bilirubin, other mentioned tests help to identify the
cause of jaundice.
CHEMISTRY
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.
46.
When calculated osmolarity can not be accounted as a

measurement for osmolarity?
a. per 100gm/l
b. Urea 20 mm/l
46.
Calculated osmolarity = 2 X Na + Glu + Urea

(All in mmol/L)
When calculated osmolarity is less than
measurement for osmolarity, this denotes
increased osmolar gap (OG). This occurs with:
Factitious hyponatremia (due to
decreased water)
Unmeasured osmotically active
compounds e.g. alcohols, sugars, and
ketones.
47.
**Calibrator sera are?

a. Primary std
b. Secondary std
c. Tertiary std
d. Internal std.
47.
(b) Secondary std?

A primary Std is a reference standard.
Secondary Std is standardized depending on the
primary standard.
48.
**External QC program means?

a. An external person come & does the QC test
b. A QC person goes to another lab & does the test..
48.
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.
(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.
CHEMISTRY
50.
Sensitivity and specificity are

a. Directly related.
b. Inversely related.
c. They mean the same.
50.
(b) Sensitivity & specificity can be adjusted

according to cutoff level. Sensitivity can be
increased by choosing a higher cutoff to include
more TP, this meanwhile will include more FP
thus specificity. However, this is not always
the case as highly specific highly sensitive tests
as well as poorly specific poorly sensitive exist.
51.
A carryover in chemistry analyzer means a disturbance in

readings because:
a. The analyzer was carried and placed at a different place.
b. The previously measured solution was still in the cuvette
c. The current solution is overflowing in the cuvette.
51.
(b) Carryover is due to contamination by a

previous sample. It is calculated by measuring a
high standard and a low standard each 3 times
then applying the following formula:
Carry over = (contaminated low actual low) /
contaminated high actual high)
52.
STAT test means:

a. Start at.
b. Standardize and test.
c. Short turn around time
52.
(c) Stat refers to immediate or as initial dose.
CREATININE, UA, BUN AND AMMONIA

53.
***Which of the following result shows renal impairment?

a. urea 9 mmol
b. creatinine 10 mmol/l
c. urates
d. cholesterol
e. urine osmolarity less than 800 after 12 hrs of water
deprivation.
53.
(e) A urine osmolarity less than 800 after 12 hrs

of water deprivation denotes renal impairment.
Urea 9mmol is high normal (n: 2.9-8.2) and is
not a very sensitive measure of GFR.
Creatinine, although a sensitive measure of GF,
10umol is normal (n: 53-106)
Cholesterol and urates are useless in this regard.
54.
**Low GFR occurs in all except:

a. Congestive heart failure.
b. Urethral obstruction.
54.
(b) low GFR occurs with:

- Hemorrhage.
- Dehydration.
- Renal loss of fluids e.g. diuretics.
- Ineffective blood volume, e.g. CO,
systemic VD, renal vasoconstriction.
55.
Diagnosis of RF
55.
GFR is an index and a monitor of increased or

decreased renal functions. It is practically
estimated from serum creatinine and creatinine
clearance.
56.
****Nephrotic syndrome is characterized by all except:

a. Hypocholesterolemia.
b. Hypoalbuminemia.
c. Albuminuria.
d. Hypertriglyceridemia.
e. None of the above
56.
(a) Nephrotic syndrome consists of:

- Heavy proteinuria.
- Hypoalbuminemia.
- Oedema.
- Hypercholesterolemia (Almost always
present).
Hypertriglyceridemia is present in 50% of
cases.
10
CHEMISTRY
57.
****Ureate excretion by the kidney is inhibited by:

a. Probenecid.
b. Thiazide diuretics.
57.
(b) Thiazide diuretics cause relatively urate

retention, glucose intolerance and hypokalemia
and interfere with water excretion and may
cause hyponatremia.
Probenecid is a uricosuric agent like allopurinol.
58.
Chronic glomerulonephritis is diagnosed by:

a. Blood urea.
b. Creatinine.
c. Proteinuria
d. All of the above
58.
(d) In chronic glomerulonephritis, there is

persistent deterioration of renal functions ending
with renal failure.
PROTEINS, ELECTROPHORESIS AND LIPIDS

59.
**The protein having molecular wt less then albumin is?

a. Beta protein
b. B2-microglobulin.
c. Lysozyme.
d. Benze Jones protein.
59.
(b) B2-microglobulin has a MW 11,800.

Betalipoprotein is 380,000.
BJ protein is the light chains of
immunoglobulins. It's MW is variable from
11,000 for monomers, 22,0000 for dimmers or
tetramers.
Lysozyme is 14,000. It is used to differentiate
AML M4 and M5 and appears as a far cathodal
band on serum or urine EP.
60.
******In cystic fibrosis, which is deficient?

a. Beta globulin
b. Macroglobulin
c. Albumin
d. Alpha 1 antitrypsin
e. Alpha 2 antitrypsin.
60.
(d) Alpha 1 antitrypsin
61.
***Diet rich in phenylalanine should be restricted in?

a. Phenyl ketonuria
b. Tyrosinemia
c. Maple syrup disease
61.
(a) In phenylketonuria, there is phenylalanine

hydroxylase leading to accumulation of
phenylpuruvate and its derivatives and their
excretion in urine. Diet rich in phenylalanine
should be restricted to prevent brain damage.
62.
***In phenylketonuria, diet should be low in:

a. Phenylalanine.
b. Carbohydrate.
c. Lipids.
62.
(a) Phenylalanine (see 61)
62.
Hypoalbuminemia is associated with all except?

a. Tetanus
b. hypocalcaemia
c. oedema
d. toxic effect of sulfonamide
62.
(a) Tetanus is clostridial infection caused be C.

tetani has nothing to do with albumin.
64.
**Gluconic amino acids include:

a. Alanine.
b. Methionine.
c. Valine.
d. Glutamic acid.
e. All of the above.
64.
(a) Ketogenic amino acids are: Leucine and

lysine,
Mixed amino acids are: Isoleucine,
phenylalanine, threonine, tryptophan and
tyrosine.
Gluconic amino acids are all the other amino
acids.
11
CHEMISTRY
65.
**Lipoprotein related to hypertension?
65.
. LDL
66.
*****Which is important for atherosclerosis?

a. HDL
b. LDL
c. Chylomicrons.
66.
(b)
67.
***In plasma protein electrophoresis, the protein that will

go first is (moves furthest from application)?
67.
Albumin.
68.
***Based on behavior of lipoproteins in

ultracentrifugation pre-B lipoprotein is?
a. HDL
b. LDL.
c. VLDL
d. Chylomicron
68.
On electrophoresis;
Chylomicrons and its remnants stay at the
origin.
VLDL at 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.
72.
***Which lipoprotein has highest concentration of

cholesterol?
a. VLDL
b. LDL
c. IDL
d. HDL
72.
(b) VLDL are the TG rich lipoproteins

HDL has 20% cholesterol.
IDL has cholesterol and TG in equal amounts.
LDL is the richest lipoprotein in cholesterol
esters.
74.
****Which is not associated with abetalipoproteinemia:

a. Acanthocytes in the peripheral blood.
b. Hereditary spherocytosis.
c. Malabsorption and fatty stools
74.
(b) Hereditary spherocytosis is due to spectrin

deficiency.
Abetalipoproteinemia is a lipoprotein
abnormality of absent LDL due to autosomal
recessive abnormality in the synthesis of apoB +
failure of chylomicron formation leading to
malabsorption of fats + fat soluble vitamins +
adrenal dysfunction. 50-70% of RBCs have
spinal projections (acanthocytes)
75.
Chylomicrons:
a. Can cause thrombosis.
b. Cannot cause thrombosis.
75.
(a) Chylomicrons don't confer an excess

cardiovascular risk, however, in LpL deficiency
and apoC II deficiency, the patient presents with
lipemia retinalis and retinal vein thrombosis.
12
CHEMISTRY
76.
Nature of apoproteins.
76.
77.
Saturated vs unsaturated fats (nutritional value)
77.
5 major classes of proteins A to E

e.g.
Presence
Suffix
Significance
Chemistry
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
78.
79.
(b) Parentral nutrition is composed essentially

of:
a) Nitrogen source: synthetic valuable amino
acids (9-17g/L N2)
b) Energy source: Glucose (mainly) and fat
emulsion (additional source to avoid EFA
deficiency).
c) Electrolytes and trace elements.
**Regarding lipoprotein metabolism:
80.
Although cholesterol can be synthesized by all

nucleated cells, however, cholesterol in VLDL,
IDL and LDL is of hepatic origin
Treatment of familial hypercholesterolemia.
82.
These include general management of

hypercholesterolemia + cholesterol lowering
drugs + oestrogen replacement in
postmenopausal women.
78.
Which is best for parentral alimentation?

a. FFA.
b. AA
c. lipoproteins
79.
Protocol for IV nutrition?
80.
82.
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.
13
CHEMISTRY
85.
(d)
***In MI, which is the last enzyme to be raised and lasts

long?
a. CK
b. CK-MB.
c. AST.
d. LDH
85.
86.
**Isoenzymes:
a. Are physical types of one enzyme.
b. Have different electrophoretic mobility.
c. All of the above
86.
Isoenzymes have the same catalytic activities

and differ in physicochemical properties.
87.
**MI is diagnosed by:

a. CKMB
b. CKBB
c. CKMM
d. LDH
87.
(a) CK-MB is specific for cardiac muscle, CKBB for brain and CK-MM for skeletal muscle.
88.
**Elevation of LDH is caused by:

a. Myocardial disease
b. Liver disease
c. Prostatic disease
d. many organ disease because it has many distribution
88.
(d) LDH is present in the cells of the heart, liver,

muscles, blood and malignancies.
89.
****Myoglobin in injury of:

a. muscle.
b. Liver
89.
(a) muscle whether cardiac or skeletal is the

source of myoglobin.
*****ADH is?
a. Produced by posterior pituitary
b. Produced in the hypothalamus.
**The method used to estimating insulin is?
a. Electrophoresis
b. Kinetic estimation.
c. Spectrophotometer.
d. Radioimmuno assay.
90.
(b) ADH is produced by the hypothalamus and

stored and secreted from the posterior pituitary.
91.
(d) Immunoassay (multiple labels) is used for

the measurement of insulin.
*****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)
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
CLINICAL ENCOCRINOLOGY
90.
91.
92.
14
CHEMISTRY
93.
**While using the pregnancy test we are measuring?

a. B-HCG
b. Total HCG
c. B-HCG & LH
d. B-HCG & FSH.
93.
(b) subunit of HCG is very similar to

subunit of TSH and FSH and identical to LH.
Although subunits of HCG and LH are very
similar, antibodies can be made to the subunit
of HCG that do not cross react with LH or other
pituitary hormones. Most EIA use 2 monoclonal
antibodies against different sites of HCG
molecule one for carboxyl terminal of chain
and the other to the chain, i.e. react with intact
HCG.
94.
****Water deprivation test is used in the diagnosis of:

a. Anterior pituitary disease.
b. Posterior pituitary disease.
c. Hypothyroidism.
94.
(b) Water intake is restricted the patient loses 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)
97.
Diabetic coma presents with:

a. Ketone bodies in urine
b. Blood glucose may be 1000mg or more
c. osmotic diuresis present
97.
All.
In diabetes, 2 types of coma may occur, DKA
and nonDKA. Glucose levels in nonDKA are
typically <800 mg/dL. Once hyperglycemia is
established, ketonurea & pH should be looked
for to differentiate.
98.
**While anti-PSA is coated on to the well in total PSA

estimation, the antibodies coated in free PSA is?
a. The same antibodies that is coated for total PSA
b. Same antibodies in large amount
c. Same antibodies in very low amount
d. Different antibodies.
98.
(a) different antibodies.
15
CHEMISTRY
98.
Carcinoid tumors secrete
New
98.
New
5HIAA.
Carcinoid tumors originate from the
enterocromaffin cells (APUD cells) of the
intestine and most commonly occurs in the
appendix, terminal ilium and rectum.
Presentation may be asymptomatic until
metastasis (most cases), appendicitis (10%) or
carcinoid syndrome (in5% when there is liver
metastasis) as spontaneous flushing on the face
and neck, abdominal pain and water diarrhea,
cardiac abnormalities and hepatomegally. The
tumor secretes a wide variety of amines an
peptides including serotonin (5hydroxytryptamine (5-HT) with its major
metabolite 5-hydroxyindoleacetic acid (5HIAA)), bradykinin, histamine and tachykinins
and prostaglandins.
Neeman Peck disease is due to deficiency of sphengomylinase

Cholesterol: In LDL, cell membrane, precursor of bile salts and steroid hormones.
16
General
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
****Error in the result is expected in which case?
a. Glucose on fluoride.
b. Glucose on EDTA
c. Calcium on oxalate
3.
(c) Take care in testing
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 LDH, K, ACP, cholesterol, ALT 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.
8.
After hemolysis:
a. Sodium leaks out of RBCs.
b. K leaks into cells.
c. Bicarbonate gets into RBCs.
8.
9.
Effects of fasting
9.
10.
****Fluoride is used to get samples for?

a. Blood sugar
b. Coagulation
c. Electrolyte
d. CBC.
10.
4.
Prolonged fasting increase TG, glycerol, FFA

but not cholesterol.
a. Blood sugar
17
General
11.
***Anticoagulant used for glucose is:
11.
Fluoride
12.
**Changes in blood stored more than 5 hrs at room temp.

include?
a. Decreased glucose & increased lactate.
b. Increased glucose & decreased lactate
c. Failure of Na & K pump,
13.
(a) Storage of blood has the following effects:

1- CO2, ACP & Glucose
2- pH & ammonia
3- Changes in RBC permeability K,P &Mg
4- Na-K pump is inhibited at 4 c but not at
25c. leading to K in refrigerated samples.
5- PhosphorylationP released from organic
P.
6- Loss of enzyme activity.
7- Light bilirubin, ALA and porphyrins.
14.
Plasma or serum should be separated at the earliest for the

estimation of glucose because:
a. The glucose values decreases with time.
b. Glucose value increases with time.
c. Lysis of blood occurs.
14.
a. Continued glycolysis cause glucose values to

decreases with time unless cells are separated.
Best place to put a needle for blood collection is puncture proof container.
18
Hematology
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.
**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.
***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.
******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.
19
Hematology
***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
New
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.
20
Hematology
Fanconi syndrome.
Fanconi syndrome consists of:
- Congenital aplastic anemia.
- Skeletal and urinary tract anomalies.
- Microcephaly.
- Altered skin pigmentation.
18
**Skeletal abnormality present in?
18
19
Fanconi's anemia
19
20
***In G6PD decreased which is affected ?
20
NADP-H, reduced glutathione

Being the first enzyme in HMP shunt which
generates NADPH to maintain reduced
glutathione, G6PD deficiency affects NADPH
and reduced glutathione
21
**Sideroblastic.a seen in all except?

a. Lead poisoning
b. Alcohol
c. Aspirin
d. Chloramphenicol
21
(c) Sideroblastosis occurs due to;

- Lead poisoning due to inhibition of enzyme of
heme and globin synthesis.
- Alcoholism, due to interference with heme and
pyridoxal kinase.
- Chloramphenicol; inhibits protoporphyrin.
- Other causes: vit B6, thalassemia, excessive
dietary Fe, anti-TB and cycloserine.
22
****The least drug to cause acquired sideroblastic anemia

is:
a. Aspirin.
b. Lead.
22
a. Aspirin.
23
**In HUS, all are true except:

a. occurs mainly in children.
b. Is usually preceded by some sort of enteritis.
c. Fragmented RBCs are seen.
d. Uremia is usual.
e. Anti IgG is positive in 10% of cases.
23
(e) HUS occurs in children following VTEC

enteritis (also after salmonella, shigella,
streptococcal infection, as an autoimmune
disease and following drugs e.g. cycloserine. It
is charectarized by:
- Thrombosis in small vessels.
- Fragmentation of RBCs.
- Reduced platelets (consumptive).
- Uremia.
24
In HUS, all are present except:

a. ARF
b. platelets.
c. Microangiopathic HA
d. Thrombocytosis
24
d. Thrombocytosis
25
HUS
25
26
**In intravascular hemolysis, all are present except:
26
Normal haptoglobin.
In intravascular hemolysis serum haptoglobin is
decreased or absent due to consumption.
27
***Free plasma Hb is bound to:
27
Haptoglobin (also hemopexin)
21
Hematology
28
**In favism, the defect is in
28
G6PD.
In favism, hemolytic anemia develops whtn the
RBCs are exposed to oxidant stress e.g. drugs,
infection and favism.
29
**In hereditary spherocytosis all are true except:

a. Autosomal dominant.
b. Treated by splenectomy.
c. Defect is in hemoglobinization of RBCs
29
c. Hereditary spherocytosis is an autosomal

dominant membrane defect (anykrin) not due to
a defect is in hemoglobinization of RBCs. Parts
of the defective membrane is removed by the
spleen leading to reduced cell surface and
causing spherocytic cells. Splenectomy
improves the condition.
30
***Treatment of choice of spherocytosis is:
30
Splenectomy
31
**In sickle cell anemia patient with iron overload, this

organism is isolated from blood:
a. Salmonella.
b. Strept pneumoniae
c. yersinia enterocolitica.
31
(c) Yersina enterocolitica occurs in iron

overloaded patients treated with desferrioxamine
(see p376 Kumar)
32
***Thalassemia major with iron overload this organism

can be isolated.
a. Streptococcus pneumoniae.
b. Salmonella typhemureum
c. Yersina enterocolitica.
32
(c).
33
*****Microangiopathic hemolytic anemia is present in all

except:
a. TTP
b. Meningococcal septicaemia.
c. HUS
33
(b) In MAHA there is intravascular hemolysis

and fragmentation of the RBCs due to abnormal
microcirculation leading to fibrin deposition,
platelet deposition and vasculitis e.g in;
- HUS
- TTP
- Renal pathology
- Preeclampsia
- Autoimmune diseases e.g PAN, SLE.
- Carcinomatosis.
- Septicemia
Meningococcal septicaemia.cause thrombosis of
small blood vessels leading to petichiae and
adrenal failure (Waterhouse-Fridrechson
syndrome)
34
****The following enzyme increases in hemolytic anemia:

a. Total ACP
b. LDH
c. ALP
34
(b) LD1&2 are characteristically increased in

HA. ACP although is present in high
concentration inside RBCs (tartarate resistant) is
not characteristically increased.
22
Hematology
35
****In G6PD deficiency avoid all the following drugs

except:
a. Salicylic acid
b. Primaquine.
c. Dapsone.
d. Trimethoprim.
e. Folic acid
35
(e) Agents causing HA in G6PD deficiency

include:
- Antimalareals e.g. primaquine.
- Sulphonamides and Sulphones (dapsone).
- Analgesics e.g. salicylic acid
- Antihelmenthics e.g. niridazol.
- Miscellaneous e.g. vitamin K analogues,
probanecid.
36
***A patient with hemolytic anemia has all the following

exept:
a. Bilirubinemia.
b. Dark urine.
c. Hypertension.
36
(c) In hemolytic anemia there is;

- Hyperbilirubinemia and hemiglubinuria.
- urobilinogen and stercobilinogen dark
urine.
- Haptoglin and hemopexin.
- Hemosiderinemia and hemosiderinuria.
- Methemoglobenemia.
37
****Aplastic anemia cause
37
pancytopenia.
38
RAEB
38
Myelodysplastic syndromes (MDS) are

classified into:
Refractory
anemia
RA with
sideroblasts
RA with excess
blasts (RAEB)
CMML
Peripheral blood
<1%blasts
BM
<5%blasts
<1%blasts
<5%blasts
>5%
20-30%
monocytes
promonocytes
39
**Manifestations of HbSS
a. Ischemia to femoral artery.
b. Infarction of phalanges.
39
(b) Infarction of phalanges.
41
****Major adult Hb is
41
HbA (97%)
HbA2 (2.5%) and HbF (0.5%)
41.
Which is true regarding DAT

a. It is positive in all IHA.
b. may detect complement attached to RBCs.
New
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.
23
Hematology
in HDN or after incompatible transfusion.

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

hypochromic, microcytic
42
***A case of iron deficiency under Microscope is
42
43
**Iron deficiency anemia seen in all except?

***Iron stores are deficient in all except:
a. B-thalassemia major
b. chronic disease,
43
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. Microcytis hypochromic blood film,
46
None or choose something appropriate.

Iron absorption is adjusted to body needs. It is
increased in iron deficiency anemia and
pregnancy.
47
****Regarding iron
47
60-70 % of body iron is present in Hb.

15-30 % in bone marrow, 1% in transferring and
4% in myoglobulin.
48
Iron status in anemia of chronic disease.
48
In ACD there is:

- serum iron and TIBC.
- Normal ferritin and bone marrow iron.
49
**Iron deficiency anemia cause, except
49
Thrombocytopenia.
Actually there is raised platelet count in IDA
d.
B-thalassemia major
24
Hematology
50
**Anemia of chronic diseases includes:

a. Vit B12.deficiency.
b. Pernicious anemia
c. Increased secretion of erythropoitic factors.
d. All of the above.
50

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.
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.
MACROCYTIC NORMOCHROMIC ANEMIA

52
**Folate store are enough for a period of
52
2-4 months.
Fr vitamin B12, stores are enough for 2-4 years.
53
**All are correct about magaloblastic anemia except
53
Defective Hb synthesis.
Megaloblastic anemia is associated with delated
nuclear development due to defective DNA
synthesis not defective Hb synthesis.
54
**Folate is affected by
54
Cooking
Steaming and frying causes loss of 90%, boiling
for 8minutes causes loss of 80% of folate.
25
Hematology
55
A patient after partial gastrectomy

a. Has no nutritional deficiency.
b. Has IF deficit.
55
IF deficiency.
Total or partial gastrectomy causes vitamin B12
defeciency.
56
**Hypersegmented neutrophils present in?
56
Megaloblastic.a
Hypersegmentation = shift to the right. Other
causes include;
- liver disease.
- Uremia.
- Infection and toxemia.
Hyposegmentation = shift to the left occurs in;
- Leucocytosis.
- Thyroid disease.
- Pelger Huet
57
****Macrocytosis is present in:

a. Alcoholism.
b. Retics.
c. All of the above.
57
c. All of the above.

Macrocytosis occurs in; Alcoholism, aplastic
anemia, liver disease, myxedema, MDS, retics,
cytotoxic, MM and normally in neonates and
pregnants.
58
Urinary excretion of radioactive Vit B12 after oral and

parenteral administration
58
After a loading dose of IV B12, oral radioactive

B12 is given and amount absorbed is measured
by total body counting or 24h urine sample.
Radioactive B12 may be given alone or + IF.
Dicopac test uses 2 isotopic forms of B12, one
bound to IF and one unbound.
Interpretation: B12 aborbed is low and corrected
by IF in PA. B12 abroption is low and not
corrected by IF in intestinal causes.
59
Which drug causes megaloblastic anemia.
59
Vit B12 defeciency
Folate deficiency
- Cytotoxic.
- Metformin.
- Colchicin.
- Anticonvulsants.
- Paraaminosalicylic acid.
- Neomycin.
Occurs with;
- Salazopyrine.
- Cholestyramine.
- Triamterene.
- Anticonvulsants.
- Anti TB
QUALITATIVE / QUANTITATIVE WBC DISOREDERS

60
***Regarding cold agglutinins:

a. it is IgM
b. It has specific anti I ab.
c. It works at 4 C
d. None of the above
e. a and c
60
e. a and c
Cold agglutinins are IgM, work at 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
Follicles and
germinal center
(B-cells)
Paracortex
(T-cell)
26
Hematology
62
***Infectious mononucleosis al are ture except?

a. Heterophil antibodies agglutinate Ox RBCs,
b. Abnormal level of anti-1 specific IgG antibodies,
c. Spontaneous rupture of spleen,
d. Lymphadenopathy & atypical lymphocytes,
62
(c) or (b) In IMN the following occur;

a. Heterophil antibodies agglutinate Ox RBCs,
b. Abnormal level of anti-1 specific IgM (not
IgG antibodies),
c. Splenomegally: mild to moderate
(spontaneous rupture unlikely).
d. Lymphadenopathy & atypical lymphocytes,
63
Responsible for immunity for pneumocystis carinii
63
B cells (x)
Impaired granulocytes staph. abscesses.
Impaired antibody formation pneumonia by
pyogenic organisms.
Impaired cellular immunity mycobacteria,
nocardia, fungi e.g. pneumocystis carinii &
candida, viruses, parasites.
64
**Neutrophil inclusions of variable size +

thrombocytopenia + neutropenia occur in a case of:
a. Chediak-Higashi syndrome
b. Alder-Reilly syndrome.
c. Pelger-Huet syndrome
64
a. Chediak-Higashi syndrome is an autosomal

recessive diseases. WBCs show giant granules +
neutropenia but normal neutrophil function.
Also there is thrombocytopenia and albinism.
Alder-Reilly syndrome is an autosomal recessive
disease with prominent granules containing
excessive polysaccharides.
Pelger 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
****Chronic granulomatous disease is due to

immunodeficiency of which of the following?
a. T-cell member
b. Defective neutrophil function.
c. Hypocomplementemia.
d. Defeceient immunoglobulins.
e. neutrophils
68

Chronic granulomatous disease is an X-linked
disease that manifests in the second year of life
with susceptibility to organisms of low
virulence e.g. staph. epidermidis, serratia,
aspergillus, due to phagocytic disfunction.
Complement may be elevated and neutrophils
are usually elevated even without infection.
There is hypergammaglobulinemia. T-cell
function is normal
69
****Regarding the function of T cells, which is correct?
69
regulates immunoglobulins production by B

cells
27
Hematology
70
Which is wrong :
***. Regarding the function of T-cell, which is correct?
a. IL-1 is produced early in the immune response.
b. T cells donot respond to IL-2 early in the immune
response.
70
b. T cells donot respond to IL-2 early in the

immune response.
71
***Large granulocytic lymphocytes act as:
71
NK cells
These are not B nor T-cells, though are CD8+.
They characteristically have prominent granules
and are often large granular lymphocytes.
72
Where can you find hypogranular leucocytes?
72
In myeloid leukemia (M3 varient)
73
IL1 & 2.
73
74
Toxic granulation and Dohle bodies.
74
In toxic granulation, granules are heavy dark

red. This occurs with infection, toxemia and
irradiation.
Dohle bodies are small round blue peripheral
granules that occur with infection and 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.
28
Hematology
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
c. 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.
29
Hematology
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.
30
Hematology
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
In FAB classification promyelocytic

leukemia is M3 not M4 morphology
M0 = Undifferentiated by morphology &
cytochemistry, myeloid by immunophenotype.
M1 = Little differentiation >90% blasts.
M2 = Differentiated 30-90% blasts.
M3 = Promyelocytic, hypergranular (M3) or
hypogranular (M3variant).
M4 = Myelomonocytic.
M5 = Monocytic without differentiation (b) or
with differentiation (a).
M6 = Erythroid differentiation >50% are
erythroid.
M7 = Megakaryocytic.
88
****Neutrophil ALP is increased in all except:
88
CML
NAP occurs in mature neutrophils.
High score (35-100) occurs in normal subjects
and in liver diseases, Down's syndrome, PCV,
aplastic anemia, HD, ALL)
Intermediate score in M5, M4 and CLL.
Low score occur in AML, lymphosarcoma and
PNH
89
In acute promyelocytic leukemia:

a. It belongs to M4 type.
b. Abnormal coagulation.
c. Leukocyte cell markers common.
89
b. Promyelocytic leukemia is M3, It is associated

with DIC
90
Hairy cell leukemia.
90
HCL is a B lymphoid CLL characterized by;

- Splenomegaly.
- Lymphocytosis and hair cells with no
nucleoli.
- Dry tap on aspiration.
- Spaces around cells.
- Immunologically mature (Normal Igs)
- Strong SmIg
- -ve mouse rousette.
- CD25 +ve
- Tartarate ACP resistant (TRAP)
b.
31
Hematology
91
**Chromosomal abnormality of t(8:21) is associated with:

a. CML, ALL.
b. M1
c. M2
d. M4 with eosinophilia.
e. M5b
91
c. M2 associates t(8:21), M3 associates t(15:17)

and CML t(9:22) (9 becomes Philadelphia
chromosome.
92
Chromosomal abnormality in M3 is:
92
t(15:17)
93
**Chromosomal translocation in case of CML is:

a. t(8:21)
b. t(9:22)
c. t(11:14)
d. t(8:22)
93
b. t(9:22)
94
**HTLV except
94
transmitted by blood transfusion (x).

HTLV may be transmitted by blood transfusion.
In UK, it is under consideration for
serodetection in blood donors.
95
**Antigen used for the detection of leukemia:
95
CD antigen
96
**Blood malignancy least encountered in children:

a. Wilm's
b. Neuroblastoma
96
ALL constitutes 75% of childhood

hematological malignancies followed by AML
(20%) and CML (5%). Least common
hematological malignancies in children are CLL
followed by CML then AML. Wilm's is a renal
tumor and neuroblastoma is a nervous tumor
97
****Paraprotiens are?
97
A group of identical Ig moving as bumdle on

electrophoresis.
98
**A 68 years old man with TLC of 23,000 has the

following markers, CD1%, CD2% kappa chain +,
what is the diagnosis?
a. Adult T cell leukemia
b. CLL
c. Lymphosarcoma cell leukemia
98
99
***In CLL:
a. RAI classification III is either I or II with hemolytic
anemia.
b. 5% terminate by Richter's syndrome.
c. 30% of lymphocytes agglutinate RBCs
99
?
According to RAI classification, III is 0 or I or II
but Hb is < 11g/dl due to marrow failure not
hemolysis.
100
***TRAP stain is helpful in diagnosis of:
100
Hairy cell leukemia

Tartarate resistant alkaline phosphatase (TRAP)
is used for diagnosis of HCL
101
*****Bone marrow necrosis occurs with:

a. Metastatic carcinoma.
b. Chrome lymphoproliferative disorder.
c. Hodgkin
101
c. Hodgkin or a. Metastatic carcinoma***?
b.
Adult T cell leukemia (CD25 and CD5)
32
Hematology
102
*****In MM, extramedullary plasmacytoma is likely to be

present in:
a. Lungs.
b. CNS
102
b. Extramedullary plasmacytoma occurs most

commonly in nasopharyngeal sinuses.
Heart, lung and kidney (nodular
glomerulosclerosis) originate from tissues
underlying mm of GIT and URT.
103
*****In lymphocyte predominant CLL:

a. Reed Sternberg cells are abundant.
b. Bad in prognosis.
c. Lymph node effacement may be nodular or diffuse.
103
c. Lymph node effacement may be nodular or

diffuse.
In lymphocyte predominant HL according to
Rye classification;
- Nodal architecture is lost
- Small homogenous lymphocytes.
- RS cells are little with no nucleoli.
a. Folinic acid protects against the megaloblastic
effects of methotrexate .
***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.
b.
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
33
Hematology
106
**BM transplantation and graft vs host disease
106
All (skin, liver, GIT damage)

In GVHD, lymphocytes (allogenic) cause skin
rash, liver damage, and diarrhea. Acute if occurs
<100days chronic if after 100 days (scleroderma
like syndrome).
107
Haploid transplantation.
107
Haploid identical match is when the donor is a

parent and genetic match is at least 1/2 identical
Synergic transplantation is an all allogenic
transplant from identical twin.
UBMT or MUD = unrelated BM transplant =
matched unrelated donor.
108
Use of P32 for PRV.
108
P32 is a 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
110
**Which kind of lymphoma occurs in children?
110
111
Bone marrow transplantation
111
112
**Waldenstrom's macroglobulinemia:
a. Proliferation of cells that resemble lymphocytes rather
than plasma cells.
b. They produce IgM molecules and often excess of light
chains.
c. All of the above
112
c. All of the above
113
In myelosclerosis all are ritght except:

a. Hepatomegaly.
b. Pancytopenia
c. Hypocellular BM
113
c. Myelosclerosis is characterized by
splenomegally, extramedullary hemopoiesis,
leucoerythrocytic blood picture + replacement of
BM by collagen fibrosis. Hepatomegally is
requent. BM shows cellularity (not
hypocellularity).
114
Myelofibrosis and myelosclerosis.
114
Same
115
CLL when reach LN resemble which type of LN?
115
Low grade small cell Hodgkin lymphoma.

CLL are small mature uniform. Well
differentiated lymphoma has small mature
lymphocytes.
116
Mycosis fungoides:
116
seen in epidermis , dermis
Burkitt's lymphoma.
NHL is more common in children than HL.
Burkitt's is a NHL.
34
Hematology
117
**Sizary cell leukemia

a. T-cell leukemia lymphoma
b. Cutaneous T cell lymphoma
117
Both
Sezary syndrome is a T-lymphoid leukemia, a
skin lymphoma with leukemic phase. Seizary
cells are small with highly convoluted nucleus.
Epidermis is involved.
118
Binet clinical staging of lymphoma stage IIB
118
Lymphocytosis and Involvement of 2 or more

chains.
Lymphocytosis is not included.
118
In Hodgkin disease all are true except
118
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.
New
1
118
New
2
118
New
3
New
1
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.
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
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.
COAGULATION AND PLATELETS

119
******In Acute DIC there is?
119
Hypofibrinogenemia.
In DIC there is the triad of hypofibrinogenemia,
thrombocytopenia and FDPs.
35
Hematology
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.
122
**ITP affects
122
Females> males
123
****In TTP all are present except
123
Leucopenia
In TTP, there is absence of platelet protease that
cleaves vW macro vW thrombosis in
microcirculation + cell fragmentation (HA) +
fever + liver dysfunction. It occurs in adults +
AI or pregnancy. May be fatal.
124
ITP in child
124
Sudden remission.
ITP follow infection. It is characterized by
immune complexes absorbed on platelets
aggregations which are removed by spleen.
There is defective megakaryocytic budding. It is
self limited.
125
***Antiplatelet antibodies are present in

a. SLE.
b. scleroderma.
c. Carcinomatosis
d. CLL
e. All of the above
125
e. All of the above

2ry auto immune thrombocytopenia occurs
secondary to:
- Blood disease (evan's syndrome)
- General AI disease (SLE, RA)
- Lymphoprolyferative (CLL and
lymphoma)
- Solid tumors.
- HIV, chemoradiotherapy and BMT
- Post viral infection.
126
Thrombocytopenia is immune mediated in:
126
SLE.
36
Hematology
127
****Qualitative disorder of platelets may be caused by:
127
Aspirin
Platelet dysfunction are;
adhesion:
- vW
- Pseudo vW
- Bernard Soulier syndrome.
release:
- SPD:
SPD
Wiscott Aldrich syndrome
Hermanskey syndrome
Chediak Hegashi syndrome
TAR syndrome
- granules: Grey platelet syndrome.
- TXA2
aggregation:
- Glanzmans syndrome
- Afibrinogenemia.
Aquired:
- myeloproliferative
- renal
- FDPs
- Drugs: Aspirin
- Chronic hypoglycemia.
128
Effect of splenectomy on platelet count.
128
Increased
129
***ITP occurs in all except:

a. hypersplenism,
b. Sarcoidosis.
c. SLE.
d. Quinidine.
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
131
a. Normal aggregation with ristocetin

In Bernard Soulier syndrome there is
adhesion (due to GPIb receptor that binds
FVIII ristocetin adhesion.
On blood film there is large megathrombocytes.
Swiss cheese platelets are seen on EM
132
**In vW disease, all are true except:

a. BT is prolonged.
b. PT is normal.
c. PTT is normal
d. Platelet aggregation is normal
132
c. In vW disease there is:

PTT
BT (variable)
platelet aggregation with ristocetin
37
Hematology
133
*****In Hemophilia A which is correct?

a. APTT is prolonged.
b. PT is prolonged.
c. BT is prolonged.
d. CT is prolonged.
133
a. APTT is prolonged.
134
*****Treatment of vW disease:
a. Factor VIII
b. Cryoprecipitate.
c. FFP
134
b. Cryoprecipitate contains FVIII, vWF and

FVIIIc stimulating factor. vW disease is also
treated with DDAVP.
135
**Which test is used to diagnose factor XIII deficiency?

a. PTT.
b. PT
c. Thrombin time
d. Clot stability with urea
135
d. In FXIII deficiency there is normal clotting by

extrinsic and intrinsic tests and TCT. However
clots are friable and dissolve in 5M urea within
few houls.
136
To differentiate between hemophilia A and B?

a. Individual factor assay.
b. PT
c. PTT
136
a. Individual factor assay. Also, thromboplastin

generation test (TGT) and plasma correction
tests can be used.
137
****Which is wrong regarding heparin?

a. Acts on thrombin.
b. its action can be reversed by vit K
137
b. its action can be reversed by vit K . Heparin

acts on ATIII (potentiates its action and directly
binds thrombin).
138
****Regarding protein C. which is wrong?

a. Acts on thrombomodulin.
b. acts independent on protein S.
138
b. protein C inactivates FV and VIII and

activates thrombolysis. Protein S is a cofactor of
activated protein C.
139
Cumarin (Oral anticoagulant) acts by
139
factors II, VII, IX

Vitamin K antagonism leads to synthesis of
immunologically detectable but biologically
inactive factors +50% the level of vitK
dependent factors.
140
Regarding protein C all wrong except:
140
Its main function is inactivation of F Va and

VIIIa
NB: Questions from 85 to 104 were found in papers named Anne/Hematology Quiz and may not be encountered in previous
exams unless labeled by star (*)
c. 10.0 x 109 /L
A blood smear shows 80 nucleated red cells per 100 leukocytes.
9
The total leukocytic count is 18 x 10 /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
d. Reticulocytic count.
Which of the following tests is used to monitor red cell
production?
a. PCV
b. TIBC
c. Schilling test.
d. Reticulocytic count.
38
Hematology
Which of the following conditions will increase ESR?

a. Erythrocytosis.
b. Increased fibrinogen level.
c. Decreased IgG level.
d. Reticulocytosis.
The formula for cell count using hemocytometer is?
When making a blood film by Wdge technique, increasing the
angle of the spreader slide results in the film being:
a. Longer and thicker.
b. Longer and thinner.
c. Shorter and thicker.
d. Shorter and thinner.
What information is required in order to calculate the MCHC?
a. Hemoglobin and erythrocytic count.
b. Hemoglobin, MCV and RBC
c. Hematocrit and erythrocyte.
d. Hemoglobin and MCV
If a case of mismatched indices occurs on the electronic blood
analyzer, which is the most sensitive parameter to be affected
and why?
If your hematology electronic cell counter requires bleaching,
which CBC parameters would be affected and why?
List the most common causes of an inaccurate automated
platelet count.
Describe the principle of the latest hematology analyzer you
have used.
If you suspect a cold agglutination is present in the specimen you
are processing, which 2 parameters would be affected and what
course of action could be taken to resolve the problem?
What are the major morphological features that distinquish P.
falciparum from P. vivax?
b. Increased fibrinogen level.
What is your interpretation of mixing studies in coagulation

testing?
Summarize the steps you would take before reporting patient
results if your control was outside acceptable limits?
Explain the difference between suspect flags and definitive flags
on your last hematology analyzer.
Briefly describe how to perform a WBC and platelet smear
estimate.
How does RDW relate to RBC morphology?
What are Auer rods?
Define The following terms as it pertains to the hematology
analyzers:
a. Histogram / Threshold.
What do we mean by hydrodynamic focusing and what is the
advantage it gives in automated cell counting?
Hemophilia A male married normal female, incidence in offspring: females are carriers, normal males
CD antigens
39
Immunohematology
Immunohematology
1.
Serum of donner + RBC of patient is called:

a. minor cross matching
b. major cross matching
1.
a. minor cross matching = donor serum +

recipient cells.
Major cross matching = donor cells + recipient
serum.
2.
**Acute intravascular hemolysis occur in blood in
2.
ABO incompatibility.
3.
****A patient received 2 bags of blood intraoperatively,

after 5 hours he developed fever and rigors. This is likely
due to:
a. Platelet antibodies.
b. Leucocyte antibodies
c. Bacterial infection.
3.
b. Febrile reactions due most frequently to WBC

reactive antigens and rarely to platelet antiesn
occur after 30min to 90 minutes after starting
transfusion.
4.
Unsuitable donor.
4.
****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)
****Blood transfusion can transmit:

a. HIV
b. HBV
c. CMV
d. All of the above
d. All of the above
10
The blood donor in KSA can not be with all of the

following except:
a. donor infected with HIV
b. donor infected with hepatitis
c. donor infected with syphilis
d. donor infected with malaria
e. previous pregnancies
10
e. previous pregnancies
Possibly transmissible infections not routinely
tested are:
- B. burgdorferi.
- Y. enterocolitica
- P. falciparum.
40
Immunology
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.
b. The hook effect is the result of very high

antigen levels giving lower than expected result
in a double antibody sandwich assay.
3.
**Antigen & antibody complex are?

a. Weakly bound
b. strongly bound
c. no bound at all.
3.
4.
***Reaginic antibody is:

a. IgG
b. IgM
c. IgD
d. IgE
4.
d. Reagenic or anaphylactic mechanism refers to

events following combination of antigen with
IgE molecule specific for it upon the surface of
mast cells.
5.
Arthus phenomenon results from:

a. Antigen excess.
b. Antibody excess.
c. Antigen and antibody in equal proportions.
5.
??b. Antibody excess.

In arthus phenomenon, a high antigen
concentration is attacked by a high antibody
concentration excess antigen antibody
complexes followed by local tissue damage.
6.
**Lysis in complement fixation test means the test is?

a. Positive
b. negative
c. invalid.
6.
b. In CFT, absence of hemolysis indicates that

complement was fixed in antigen antibody
reaction so specific antibody was present.
7.
**All tube for serial dilution for CRP test contain 0.5ml
of saline & 0.5ml of serum is added to Tube 1 & 0.5ml is
transferred through the row of tubes & agglutination is
demonstrate in tube 7, If sensitivity of the test is 6mg/l
the concentration of CRP in serum is?
a. 36mg
b. 42mg
c. 6mg
d. 48mg
e. 384mg..
7.
None (something missed in the question).

The titer in the 7th tube = 27 = 128
So, the concentration of CRP= 128x6= 768mg.
8.
**CRP is tested because it is increased in?

a. Bacterial infection
b. viral infection
c. other infection.
8.
b. CRP is a sensitive non specific indicator of

acute injury, bacterial infection or inflammation.
9.
In infectious monopnucleosis antibodiesare? .________
9.
Anti (I)
41
Immunology
10.
******Which of the following reagin test for syphilis?

a. VDRL
b. TPHA
c. TPT
10.
a. Reagin = Antibody against cardiolipin.

Reagenic tests are VDRL, RPR and
Wassermann (CFT).
11.
**Antigenic detection is useful in diagnosis of all of the

following escept:
a. B hemolytic Streptococci.
b. H. influenza.
c. Listeria monocytogenes.
11.
c. Because L. monocytogens is an intracellular

organism.
31.
****Antigenic methods are useful in diagnosis of all of

the following cuases of meningitis except:
a. Strept B hemolyticus.
b. H. influenza
c. E. coli
e. listeria
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.
42
Microbiology
Microbiology
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION
1.
.
a.-penicillin
b-erythrocin
c. penicillin
d-ceftriaxone
e- vancomycin
Aminoglycoside
Aminoglycosides act on 30s ribosomal
subunit.as tetracyclines.
**Antibiotic used for each organism are

a. Pneumonia
b. Legionella
c. S. pyogens
d. H.infuenza.
e. P. enterocolitis
**Tetracycline is identical in action with
1.
3.
**Which is effective against penicillinase producing

organism.
3.
Nfcillin or dicloxacillin.
4.
The best chemical disinfectant in a TB lab?

a. Gluteraldehyde
b. ethanol
c. phenol
d. hypochlorate,
4.
a. Phenol, although effective against TB, is

rarely used being too caustic. Ethanol is not
effective (TB are alcohol resistant).
Glutaraldehyde is used to sterilize respiratory
equips and is effective against TB.
5.
***What is lab safety level you will employ for the culture
of brucella?
a. Routine precaution
b. bio safety level 1,
c. bio safety level 2
d. bio safety level 3
e. no specific measure
5.
d. Biosafety levels are designed according to

risk group of the lab;
2.
2.
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).
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.
43
Microbiology
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.
10
a. Kills spores sterilization.
11.
For penicillin resistant pneumococci, which is used?

a. Ampicillin.
b. Ceftriaxone.
c. Cefuroxime + Rifampicin.
d. Ampicillin + Rifampicin
11.
b. Ceftriaxone.
12.
Cephalosporin resistant bacteria producing beta

lactamase is:
a. E.coli.
b. Y. Enterocolitica
12.
a. lactamases are produced by;

B. fragilis.
N. gonorrhoea.
H. influenza.
Legionella
Enterobactereceae
13.
Which of the following denote sterilization?
13.
14.
TB contamination can be disinfected by
14.
Glutaraldehyde.
Or phenolic
15.
**A pre-operative medication of antibiotics is indicated

in:
a. Acute appendicitis.
b. Gangerous obstructed loop.
c. Abdominal hernia.
15.
b. Gangerous obstructed loop.
16.
Bronchoscope
16.
Glutaraldehyde
17.
***- Which is the best way to sterilize a bronchoscompe?

a. Autoclave.
b. Ethylene-oxide.
c. Gamma rays.
d. None
17.
a. Autoclave.is used for heat resistant parts but

ethylene-oxide may be used for heat labile
parts.
Both liquid & solid media in same bottle.
BASIC TECHNIQUES
18.
**Castanida medium for blood culture contain?
18.
19.
**Medium for each:

a. TB
***b. Gonoccoci
c. C. Diphtheria
d. Staph. Aureus
19.
a. L.J medium
b. Chocolate agar or Thayer martin media
c. Lefflers media
d. Blood agar
44
Microbiology
20.
**If you forget iodine step in gram stain staph aureus will
be seen?
20.
Red
21.
**Significant bacterial count is
21.
100,000. (105)
104-105 = Equivocal
<104 and mixed = probable contamination
22.
***Anti-coagulant for blood culture ?
22.
Na-phosphonaphthol sulpfonate
Also known by abbreviation SPS
23.
***In CLED all bacteria grow except?

a. Enterobacter,
b. salmonella
c. klebsiella
d. enterococci.
23.
None
On CLED;
Salmonella gives flat blue colonies.
Klebsiella gives mucoid yellow colonies.
Enterococci give yellow translucent colonies.
24.
***Gram stain best done in?

a. Lag phase
b. log phase
c. static phase
d. death phase.
24.
b. Growth of bacteria on media follows the

following phases;
- Lag phase; phase of accommodation to
medium. No net growth
- Log phase; phase of maximum growth.
- Stationary phase; growth equilibrates death
- Decline phase; phase of exhaustion of
medium components. Growth declines.
25.
***Microaerophilic atmosphere means?

a. 10% CO2
b. anaerobic
c. trace of free O2
25.
c. trace of free O2
26.
**Which agar concentration is the best to detect bacterial

mobility?
a. 0.01%
b. 0.5%
c. 1.5%
d. 2%
e. 4%
26.
b. 0.5%
For solid medium 1.5-2% concentration is
used.
27.
***Best time to read oxidase test is within:

a. 5 seconds.
b. 10 seconds.
c. 1 minute.
d. 2 minutes.
e. 5 minutes.
27.
b. 10 seconds
28.
***In ZN staining used for M. leprae, the decolorizing

agent used is:
a. 5% acetone.
b. 5% acid alcohol.
c. 5% hydrochloric a.
28.
d. None of the above.

5% H2SO4 or 3% acid alcohol.
29.
***Which of the following is a chemical fixative?

a. Formalin.
b. Mercuric chloride
c. Methyl alcohol
d. All of the above
29.
c. Methyl alcohol
45
Microbiology
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%
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
32.
??d. None of the above

?? c. Staph. aureus may cause septicemia.
33.
Solid media include:

a. Slant.
b. Streak plates.
c. Pour plates.
d. All of the above
33.
d. All of the above
BASIC BACTERIOLOGY
34.
**Cell wall is absent in?

a. mycoplasma
b. bacteria
c. fungi
c. viruses
34.
a. Mycoplasma is the smallest organism

capable of self replication. It possesses cell
constituents of bacteria except cell wall.
Instead, there is a triple layer cytoplasmic
membrane.
35.
**Sterol is the main constituent of cell wall of:

a. Mycoplasma.
b. Rickettsia.
c. Chlamydia.
d. Leptospira.
e. Staph.
35.
a. Unlike the cell wall of bacteria,

mycoplasma cell membrane contains
cholesterol or carotenol in addition to the
usual mural and phospholipids.
36.
***Which of the following contains more peptidoglycan?

a. G+ve bacilli.
b. G-ve bacilli.
c. Chlamydia.
d. Richetsiae.
36.
a. The peptidoglycan layer is much thicker in

Gram positive than in Gram negative bacteria.
Richetsia cell wall similar to that of Gram
negative bacteria. Chalmydia cell wall is
similar to that of Gram negative bacteria but
no muramic acid.
37.
***Sedimentation constant of bacterial ribosomes is:

a. 40s
b. 60s
c. 70s
d. 80s
37.
c. 70s
Bacteria has 70s ribosomes with 30s &50s
subunits.
Mammalian ribosome has sedimentation
coefficient of 80s with 60&40s subunits.
38.
***Endotoxins are chemically:

a. Mucopeptides.
b. Proteins.
c. Lipopolysaccharides.
d. Polysaccharides.
38.
c. Endotoxins are integral part of G-ve

bacteria. They are LPS whereas exotoxins are
polypeptides.
46
Microbiology
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. Tetanus toxin.
d. Diphtheria toxin.
41.
New
41.
New
GRAM POSITIVE COCCI

42.
Cell wall of staph.
42.
Teichoic acid
Gram posititve cell wall is composed of
peptidoglycan and teichoic acid (no lipid A or
polysaccharide as in gram negative cell wall)
43.
**Food poisoning by staph aureus is due to.
43.
Enterotoxin
This acts by stimulating relase of IL1 and IL2.
44.
**Enterotoxin of staph. Aureus is heat.
44.
stable
45.
***Differentiate between pathogenic & non pathogenic

staphylococci use
45.
coagulase test. Pathogenic staph is aureus

species.
46.
**Most streptococcus infection to human is
46.
A & B hemolyticus.
47.
***To differentiate A & B hemolytic streptococci we use

a. bacitracin
b. optochin
c. ampicillin
47.
a. Group A strept is bacitracin sensitive while

group B is bacetracin resistant.
Optochin is used to differentiate hemolytic
strept (pneumococci are sensitive and strept
viridans is resistant)
48.
**Commonest disease caused by streptococcus pyogenes

is.
48.
sore throat
Strept pyogenes cause three types of diseases;
- Pyogenic (pharyngitis and cellulites)
- Toxigenic (TSS and scarlet fever)
- Immunogenic (Rheumatic fever and AGN)
47
Microbiology
49.
**Food poisoning symptom [vomiting] 4 hrs after

ingestion of food seen in?
a. E.coli
b. staph aureus enterotoxin
c. salmonella typhi
d. vibrio cholera
49.
b. staph aureus enterotoxin
50.
***Strept pyogenes cause all except:

118. Streptococcus cause all except:
50.
Toxic shock syndrome (check this answer

because pyrogenic exotoxin A of strept
pyogenes is similar to TSST of staph).
51.
Pneumococci are typed by
51.
Optochin, bile solubility, Quellung test

Pneumococci are optichin sensitive, bile
soluble and Guellung test positive.
52.
Antigen protective for pneumococci is
52.
Capsular polysaccharides.
The capsular polysaccharides is antigenic.
Other protective mechanisms of pneumococci
include enzyme IgA protease, toxin and SSS.
53.
**Diagnosis of metastatic staphylococcal lesions:

a. Protein A Ab.
b. Anti DNase.
c. Endotoxins
53.
a. Staph dont produce endotoxins (being

gram positive). Anti Dnase is used mainly for
strept. Protein A antibody methods are
diagnostic for staph disseminated lesions.
54.
*****The following differentiates between staph.

Pyogenes and strept epidermidis:
54.
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.
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.
48
Microbiology
60.
**ASOT is used to detect:
60.
Strept. pyogenes.
GRAM NEGATIVE COCCI

61.
N. Gono
+
-
N.Menin
+
+
-
***Differenciation of N. gonorrhaea from N. Meningitis

by sugar fermentation?
61.
62.
****In N. gonorrhoea causing dissiminated lesion

(systemic manifestation), which of the following is
incorrect.
a. Sensetive to penicillin (G+ve only)
b. Resistant to ampicillin
62.
a. Oral penicillin, cirprofloxacin or

doxycycline are used in gonococal arthritis.
63.
Meningococcemia causes:
63.
Waterhouse Fredrichson syndrome.
64.
Neisseria gonorrhoea can cause which of the following?

a. Osteomyelitis.
b. Artheritis.
c. Septicemia.
64.
b. N. gonorrhoea may cause septicemia and

suppurativeartheritis and hemorrhagic skin
papules.
Maltose
Glucose
Sucrose
GRAM POSITIVE BACILLI

65.
**Gm +ve bacilli arrange in Chinese letter pattern is
65.
Diptheria bacilli,
66.
**Pseudomembrane cause by a
66.
diphtheria
67.
*******Which test is used to ascertain toxigenicity of C.

iphtheria?
a. Dick test.
b. Elick's test.
c. Schick test.
d. None of the above.
67.
b. Elick's test is in vitro plate test for toxin

production. Schick test in an ID test for
susceptibility to diphtheria, if immune -ve
(no reaction).
68.
******A memberane on the pharynx on removal it leaves

a bleeding surface occurs with:
a. Diphtheria.
b. IMN
c. Vincent's angina.
d. candida.
e. streptococcal infection.
f. All of the above.
g. None of the above
68.
a. Diphtheria.
69.
***A CSF culture revealed an organism that is G+ve at 37

c and no growth at room temperature. This is most likely
to be:
69.
Listeria.
Something missed in this question; Listeria is
motile at 25c not at 37c. It grows on a wide
range of temperature (3-43c)
70.
Neonatal meningitis G+ve rods.
70.
L. monocytogens.
71.
Listeria monocytogens.
71.
49
Microbiology
72.
**Growth of actinomyces israeli on gram stain shows
72.
gm +ve branching rods with club ends.
73.
**Actinomycosis is caused by?
73.
Actinomyces israelii
& arachnia propionica
74.
**Madura foot have all except?

a. Fever.
b. bone involvement
c. Draining sinus tract
d. granules in discharge
e. Caused by fungus or bacteria.
74.
a. Madura food is a subcutaneous infection

with fungi (e.g. eumycates) or actinomyces.
There is discharge from sinus tract, bone
involvement follow. Systemic symptoms are
uncommon, and so is LN.
E.coli, V.cholera, salmonella, pseudomonas,

proteus,
Motile gm ive bacilli, NLF, produce
swarming on BA.
ENTEROBACTERECIAE & PSEUDOMONAS

75.
**Mobile bacilli are?
75.
76.
**Proteus is
76.
77.
**Most common agent causing UTI is?

a. E.coli
b. klebsiella
c. proteus
d. seudomonas,
77.
a.
78.
**IMViC reaction of E.coli & klebsella are?
78.
E. coli is ++-- Klebsiella is --++
79.
**Example of NLF colonies on MacConkey agar ?

28. Examples of LF colonis on MacConkey agar?
79.
NLF (produce pale colored colonies):

Salmonella, shegella, seudomonas, proteus
LF (produce pink colored colonies):E.coli,
Klebsiella.
80.
**The following proteous are indole +ive except
80.
P. mirabilis
While M. morganii, P. vulgaris, and
seudomonas are all positive.
81.
**Klebsiella pneumoniae produces.
81.
mucoid colonies
82.
**IMViC reaction of E.coli is
82.
.[++--]
83.
**Which of the following is urease +ve
83.
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.
50
Microbiology
May cause UTI, otitis media & eye infection,

Bed sore, burns,
Motile gm ive bacilli, NLF, produce
pigmented colonies
Blue green pigments,
Pyocyanin & biovirdin.
88.
**Psuedomonas infections include?
88.
89.
**Psuedomonas is?
89.
90.
**Psuedomonas aerogenosa produce?
90.
91.
Contamination of sterile fluid is
91.
pseudomonas.
92.
**An abscess with bluish green discharge caused by?

a. Staphlococcus
b. proteus
c. seudomonas.
92.
c.
93.
****Hospital fluids are usually contaminated by:

****120. Organism of medical fluids is:
a. Pseudomonas.
b. Staph.
c. Strept.
93.
a. Pseudomonas are able to grow in water with

traces of nutrients.
94.
Pigments of pseudomonas aerogenosa
94.
Both Fluorescin (pyovirdin) and pyocyanin
95.
**Widal test used in the diagnosis of?

a. Typhoid fever
b. malaria
c. malta fever
d. brucellosis
95.
a. Typhoid fever
96.
**Enriched medium for salmonella is?
96.
Salenite broth
97.
**On Wilson Blair media salmonella produce?
97.
S.typhi large black colonies with metallic

sheen after 24hours, S.paratyphi produce
green colonies after 48hours.
98.
**Media used for the isolation of salmonella are?
98.
MacConkey, DCA, Wilson blair,

Also XLD and selenite broth.
99.
***Culture of choice in the first week of typhoid fever?

a. Feces.
b. urine.
c. blood.
d. CSF
99.
c. Blood culture are usually positive 90% in

the first week of fever, thereafter rate of
posistivity decreases. Stool culture are
positive throughout the course of disease.
However, it is of less significant being
positive in carriers and dignose gastroenteritis
not enteric fever.
100.
**Color of salmonella & shigella on MacConkey agar is?
100.
NLF
101.
*******Salmonella & shigella are differentiated by?
101.
Motility
102.
Seroprofile of salmonella typhi?
102.
O-9,12, H-1,2
103.
Diagnosis of typoid fever in 1st week is done by
103.
blood culture
104.
Differentiate between E. coli and salmonella
104.
Salmonella is NLF and E.coli is LF
51
Microbiology
105.
****All of the following is correct regarding enteric fever

except:
105.
Localized gut disease.
106.
**Microscopic appearance of Yersinia pestis is?
106.
G-ve coccobacilli.
107.
******Dog bite G-ve bacilli isolated is propably:

a. Pasteurella multucida
b. H. influenza.
c. B. Abortus
d. toxocara cannis
107.
a. Pasteurella multucida
108.
**Cholera is caused by?

a. V. cholera
b. E.coli
c. proteus
d. seudomonas.
108.
a. V. cholera
109.
***Enriched media for V.cholera is ?
109.
Alkaline peptone water [pH8.6],
110.
****Loss of fluid in cholera is due to?
110.
Adenyl cyclase system activation

This leads to ++cAMP Chloride and water
loss.
111.
***Mode of action of vibrio is by:

a. irritation of intestinal mucosa by vibrio.
b. attack of intestinal mucosa by the toxin.
c. stimulation of membrane bound adenylecyclase
111.
c. stimulation of membrane bound

adenylecyclase
112.
Vibrio vulnificus.
112.
This is halophilic cholera i.e. lives in salted

water, infects wounds of shellfish handlers
causing cellulistis (may cause septicemia in
immunocompromized patients).
RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA

113.
**Rickettsial pox is transmitted by
113.
mites.
Causative organism is R. akari.
114.
**Stain for rickettsia is.
114.
Giemsa stain
Giemsa gives rickettsia blue to purple color,
Gimenes stain it red, Machiavillo stain it red
inside blue cells and IF gives better sensitivity
and specificity.
115.
Organism associated with atherosclerosis:
115.
Richetssia (x)
Chlamydia pneumoniae (see Kumar 686).
116.
**Lymphogranuloma venerum is caused by.
116.
Chlamydia
Sero D-K hlamydia trachomatis
117.
**Mycoplasma are resistant to action of
117.
antimicrobial.
52
Microbiology
SPIROCHETES
118.
**Specific or non specific test for syphilis?
118.
Non-specific- RPR, VDRL

Specific- TPI, FTA-ABS, TPHA, MHA-TP
119.
**Treponema pallidum is a?
119.
120.
**Treponema pallidum causes?

a. Syphilis
b. TB
c. meningitis
d. AIDs
120.
Spirochate, can be demonstrate by dark field

microscopy.
a. Syphilis
121.
***Bejel is characterized by all except?

a. Non veneral transmission
b. Caused by ariant of Treponema pallidum.
121.
Both are OK. Bejel is non venereal disease

caused by T. pallidum endemicum. It is a
highly infectious skin in fection.
122.
*****Which of the following accurately don't describe 3ry

syphilis:
a. Ulcerative skin lesions.
b. Gummas in internal organs.
c. Rare spirochetes in lesions with limited tissue damage..
122.
a. Ulcerative skin lesions.
123.
**Yaws disease
123.
Caused by Treponema pertenue

Characterized by ulcerating papule, scar
forming and may cause bone destruction.
124.
Chocolate media.
HEMOPHILUS
124.
**Hemophilus grows
uxuriantly on?
125.
****Satellitism is exhibited by?

a. H. influenza.
b. N. meningitides.
c. mycobacteria
125.
Hemophilus influenza around staph. Aureus
126.
**Hemophelus influenza require?
126.
X & V factors for their growth
127.
**H Ducrii causes.
127.
soft chancre
Soft chancre is also called chancroid. H.
Ducreii dont require V factor
128.
**Bacteria shows satellism.
128.
H. Influnzae
129.
**Factor V & X are essential for growth of.
129.
H. Influenza
130.
H. influenza meningitis occurs most frequently in :
130.
children.
1/2 to 4 years old.
131.
Satellism helps to diagnose?
131.
H.influenza
132.
Strictly aerobes.
BORDETELLA & BORRELIA

132.
**Bordetella pertusis are?
53
Microbiology
133.
Bordetella exotoxin =
133.
Single Ag previously termed Islet activity

protein.
It resembles cholera toxin in structure and
action.
134.
***What type of fever caused by borrelia?

a. Relapsing fever.
b. Q fever
c. Rheumatic fever.
d. enteric fever.
134.
a. B. recurrentis and duttoni casue replapsing

fever. B. burgdorferi cause lyme disease and
Q fever is caused by coxiella burnetti.
135.
Clostridium welchii,
Also called perfrengins.
ANEROBIC BACTERIA
135.
**Gm +ve bacilli with terminal round spores resembling

match stick are
136.
**Nagler reaction used for
Rapid identification of Cl. Welchii

Lecithenase
(Negler's)
-
C. perfringens
C. tetani
C. deficile &
botulinum
Lecithinase ve
Saccharolytic
NLF
Lecithinase +ve
Saccharolytic
LF
Lecithinase ve
asaccharolytic
NLF
137.
138.
**Clostridia are
**Bacteroid is resistant to?
a. Penicillin
b. metronidazole
c. aminoglycoside
d. chloramphenicol.
137.
138.
Gm +ve anaerobic bacilli

c. aminoglycoside. Also to penicillin (a),
neomycin and kanamycin. Chloramphenicol is
highly effective.
139.
**Stormy fermentation is seen in?

a. Cl. Histolyticum
b. Cl.prefrenges
c. Cl.septicum.
139.
b. Cl. Perfringens in litumus milk medium

produces A&G, the acid clots milk and the gas
breaks the clot producing stormy
fermentation.
140.
**Bacteria that can be best identified best by direct

Gram's film is?
a. Vincent bacillus
b. campylobacter
140.
a. Vincent bacillus
141.
*****The following combination is isolated from pus from

deep pyonidal sinus:
a. B. fragilis.and streptococcus milits.
b. B. fragilis and B. abortus.
c. Strept B.hymolitic and streptococcus.
141.
a. B. fragilis.and streptococcus.
142.
Suitable medium for anerobic bacteria
142.
Blood
(selective or non selective), others include;
- Cooked meat broth (CMB)
- Thyoglycolate.
- BHI
54
Microbiology
143.
**Which one has non clostridium crepitation?
143.
Cl. perfrengens (X)

Clostridia producing gas gangarene are;
- .Cl. perfringens (mainly).
- Cl. Novyi.
- Cl. septicum
- Cl. histolyticum.
144.
Crepitant cellulites is caused by:
144.
Clostridia.
BRUCELLA
145.
**Malta fever is caused by?
145.
Brucella species
Also called undulant fever.
146.
A young Saudi male came with fever & myalgia your

diagnosis is?
a. Brucella
b. staphylococcus
c. streptococcus
d. gonorrhea
146.
a. Other symptoms and signs include;

- Arthralgia
- Sweating
- Heptatosplenomegally.
147.
**Bacteremia is seen in:

a. Brucella.
b. Tetanus.
c. shigellosis
147.
a. Both tetanus and shigellosis are localized

infections. Brucella enters through the mouth,
lung or skin to local lymph nodes to blood to
liver, spleen and bone marrow to cause type
IV hypersensitivity.
MYCOBACTERIA
148.
**Mycobacterium Leprae
148.
can not be culture artificially in the laboratory
149.
**L.J medium is used for culturing?
149.
T.B,
150.
**Mycobacterium Leprae are?
150.
Acid fast [5% H2SO4]
151.
**Mycobacterium .T.B is?
151.
Acid fast [20% H2SO4], alcohol fast,
152.
152.
d. 3-6 weeks.
153.
***TB culture takes

a. 2-4 days.
b. 12 days.
c. 3-6 weeks.
d. 6-10 weeks.
**Most sever form of leprosy is
153.
Lepromatous
154.
**Mycobacteria are acid-alcohol fast because
154.
they resist to decolorized by acid & alcohol.
155.
**In lepromatous leprosy immunity is
155.
very low.
Almost nil
156.
*******Which of the following mycobacteria is related to

MTB complex?
a. Mycobacterium Africanum.
b. M. leprae
156.
a. MTB complex include TB, M. africanum,

M. bovis, BCG and M. microtti..
55
Microbiology
157.
Acid fast bacilli in stool =
157.
TB
158.
*****Diagnosis by direct staining:

a. TB
b. Hemophylus
158.
a. Acid fast smear is number one rapid test for

mycobacterium TB. Positive smear has a
predictive value of 96%.
159.
Which of the following belongs to PTB family?

a. M. Kanasasi.
b. M. Bovis.
c. M. intracellulare.
d. M. africanum.
159.
a. MOTT (mycobacteria other than TB) are

classified into;
- Photochromogens: M. kansasii, M. marinum.
- Scotochromogens: M.scrofulucian, M.
szulgai.
- Nonpigmented:
M. avium cellular complex (MAC)
M. phlei, M. fortuitum
MISCELLANEOUS
160.
**Malignant pustule is caused by.
160.
Bacillus anthracis
161.
**Plague is by
161.
rat flea.
162.
****Vaginal discharge is absent in?

a. Gardnerella infection
b. trichomonas vaginalis
c. Chlamydia
d. ryptococcus.
162.
d. G.vaginalis produce fishy smelling

discharge, TV produce thin bubbly fishy
smelling discharge, Chlamydia produce thin
discharge. Cryptococcus is a lung infection.
163.
**Sterile pyuria not seen in?

a. TB
b. non specific urithritis
c. urine collection by suprepubic puncture
d. prior treatment with antibiotic
163.
c. Causes of sterile pyuria;

TB
Mycoplasma
Leptospirosis
Vaginal contamination
Antibiotics, L forms
Abacterial cystitis
Non infectious disease e.g. tumour, FB
164.
**Diagnosis of bacterial endocarditis?

a. Urine culture
b. blood culture
164.
b. blood culture
165.
*****Aspergelloma: All correct except:

a. Lungs are the most common site.
b. no organism is present in lesion.
c. Affect children.
165.
b. Aspergelloma is a ball of aspergillous

growth. It may affect children with preexisting
pulmonary condition.
166.
**Which combination is wrong?
166.
Non-specific urethritis: Penicillin.
167.
Zoonotic disease
167.
56
Microbiology
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.
57
Microbiology
PARASITOLOGY
173.
**Malaria affecting large RBC-
173.
P.vivax.
In P. vivax, infected cells are enlarged with
schuffner's dots. In P. ovale infected RBCS
are enlarged without Schuffner's dots.
P. malariae cause normal or even reduced
sized RBCs. In P. falciparum cells are normal
with Maurer's clefts.
174.
**Leishmania id transmitted by
174.
Sand fly.
175.
****Dwarf tape worm is.
175.
H.Nana
176.
***Hematuria in Egyption Patient think of,
176.
Schistosoma hematobium.
177.
**Sporozoites are present in
177.
reticuloendothelial system (X).

Sporozoits are the infective stage in the
mosquito. The merozoit is the form inside the
infected RBC. Such RBC is called schizont.
178.
**A parasite can ingest RBC & present in stool-
178.
E.Histolytica.
179.
***Entrobius vermicularis is diagnosed by.
179.
anal swab
180.
**Larva is present in fresh stool?
180.
Strongyloid stercoralis.(rhabdatiform larva)
181.
**Malaria with multiple infection?
181.
P. Falciparum (X).
Vivax and ovale due to preerythrocytic
schizogony cause multiple infection.
182.
**Anchovy sauce pus is ?
182.
E. Histolytica
183.
**Visceral leishmaniasis best diagnosed by?

a. B//M biopsy
b. Serology
183.
a. B//M biopsy
184.
**Cutaneous leishmaniasis diagnosis by?

a. Skin biopsy
b. Culture,
184.
a. Skin biopsy
185.
The following parasite doesnt not involve GIT in man?

a. Ascaris
b. cysticercosis
c. H.nana
d. Tenia
185.
b. cysticercosis
186.
The cigar glycogen is in
186.
I. buchlii, but if cigar shaped chromatoid it is

E. histolytica (immature cyst)
187.
**The arthropod vector of malaria is:

a. Female anopheles mosquito.
b. Culex mosquito.
c. Tsetse fly.
187.
a. Female anopheles mosquito.
58
Microbiology
188.
Cryptosporidium
188.
Intestinal coccidian infection with AIDS
189.
A warm that infects man and pass eggs around the anus is
189.
Oxyurius vermicularis.
190.
Giardia lamblia is diagnosed in stool by the presence of
190.
Cysts or trophozoit
191.
**Which is caused by skin penetration:
191.
Schistosoma hematobium.
Also ankylostoma duodenal, strongyloides
and N. americanus.
192.
Serology of E.H except
192.
IFAT
Also, CFT, IHA & ELISA.
193.
Stains for stool include:

a. Iodine.
b. Fluorescent.
c. Trichrome
d. All of the above
193.
d. All of the above
59
Microbiology
VIROLOGY
194.
b. There is chronic carrier state in young

children.
195.
*******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.
**Best sample for the diagnosis for recovery of polio is
195.
feaces.
Also from throuat and spinal fluid.
196.
**Virus & living cells resemble in
196.
reproduction.
197.
**Latent infection seen in all except?

a. Herpes virus
b. adeno virus
c. coxsackie virus
d. retorvirus.
197.
a. Herpes virus (?? HS causes latent infection)
198.
**Which of the following virus causes systemic effect?

a. Poliovirus
b. adenovirus
c. rhinovirus
d. Influenzea virus.
198.
There may be a missing "except" in this

question because adeno cause RTI and
hemorrhagic cystitis and GE. Influenza and
polio also cause systemic effect. Rhino is an
exception.
199.
***Which is not correlating?
199.
RSV keratitis in AIDS patients.
200.
****Which combination is wrong?

a. Rubella: arthritis in young women.
b. Mumps: Antigenic shift
c. Coxsackie: Meningitis.
d. EBV: Heterophil Abs.
200.
b. Antigenic shift is a character of influenza

virus
201.
*****Which of the following can pass to fetus

transplacentally?
a. HSV.
b. VZV.
c. CMV
201.
c. CMV
202.
***Who of the following is supposed to transmit CMV

infection to hospital staff?
a. pregnant woman having a skin rash in second trimester.
b. HIV patient
c. HCV patient.
d. Neonate with congenital defect due to CMV infection
202.
d. Neonate with congenital defect due to CMV

infection.
203.
**All diagnose viral infection except:

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

A 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.
194.
60
Microbiology
204.
****RSV all correct except:

a. Rectal sample gives the highest yield of the virus.
b. Form a syncetium in tissue.
c. Causes lower respiratory illness in children.
d. Related to paramyxoviruses.
204.
a. RSV is a paramyxovirus. It is the most

important cause of pneumonia and
bronchiolitis in infants.
205.
**In a patient with rabies infection, the main histological

characteristic in the brain is:
a. Lewi bodies.
b. Durel bodies.
c. Negri bodies.
d. Amyloid plague
205.
c. Negri bodies.
206.
Enteroviruses cannot be isolated from which of the

following specimens?
a. Throat swab.
b. Fecal specimens.
c. Gastric fluid.
d. Urine.
e. CSF.
206.
d. enteroviruses isolated from throat e.g. polio,

from feces e.g. polio and hepatitis, from CSF
e.g. coxsachie virus. Enteroviruses resist
gastric acidity.
207.
Herpes zoster
207.
Localised
208.
Regarding rotavirus, all are correct except:

a. DS-RNA virus
b. cause majority of infant diarrohea
c. diagnosed in feses by ELISA
208.
None
Rota virus is a dsRNA virus, it is diagnosed in
feces by ELISA. It causes a significant
proportion of infant diarrohea.
209.
Ebola virus causes
209.
Fever, myalgia, diarrhea, rash, lymphadenitis,

complicated with hemorrhage, encephalitis.
210.
Polio virus is transmitted by which rout?
210.
Feco-oral
211.
**Which of these is not dangerous in contact with AIDS

patient?
211.
61
Microbiology
If glucose is fermented , TSI reaction is: KIA

Fungus with acid fast bacilli stain positive: Nocardia.
Plague causative agent: Yersinia pestis
Disinfection: Partial destruction of living organisms:
All sporocidal except: Ethanol.
Trophozoites on Wright's stained film: Signet ring.
Ring form with gametocytes seen in F. falciparum.
Best for collecting urine is dewling catheter, aseptically aspirate 5ml of urine from the catheter tubing.
Best to disinfect tables contaminated with blood is: Phenol.
70% alcohol cause protein denaturation and cell membrane damage.
Transmission of HIV: All
Fungal infection is not diagnosed by culture because etiologic agent is difficult to grow
Malaria donot grow in plasma
Food poisoning is caused by S. enteretidis.
Strept through all
First line of body defence against strept is phagocytosis
Renal impairment except galactosemia
Don not produce B hemolysis on blood agar: Klebsiella and strept viridans.
N. gonorrhea infect other than genital tract: vaginintis.
UTL with indole +ve: E. coli
Rota: not correct is hemorrhagic conjunctivitis and cardiac disease.
Respiratury infection cause by: Coxacki B and parainfluenza.
All G+ve except: Neisseria and mycobacterium
Specimen examined directly: CSF
BR that differentiate Neisseria species is sugar fermentation.
Bacillary dysentery: Shigella.
Transport media for stool: Carry Blair.
For nosocomial outbreaks of pseudomonas: pyocin typing.
Organism that gives metallic sheen on EMB
Specimen for anerobic culture: Pleural fluid and --- abscess.
Destruction of microbes except by: Centrifugation.
Cause of opthalmia neonatorum: N. gonorrheae
G+ve in cuboidal packages: Sarciniae
For bacterial motility except: H*E
BHI with addition of antibiotics for: N (histo.plasma and fungi)
Choice of media depend on except: one selective plating medium
TSI gives the following reactions: All (Provedentia K/AG, E. coli K/AG, Citrobacter K/AG, Proteus K/A
In SS agar, source of carbon is lactose
Tryptophan is the basis of Indole test.
Antibiotic sensitivity tes commonly by disc diffusion
Meningitis in neonates: L. monocytogens.
New world hook worm: Necator americanus.
High concentration of liquid or gaseous germicidal chemical sterilization.
Routine bacterial culture is examined after 5-10 hr, 18-24 hr.
Routine bacterial culture is incubated at 35 C.
Rapid method for detecting significant bacteria is by microscopy.
Mycoplasma media is PPLO
Flukes = Trematodes
Ribbon like worms = Nematodes
Most common helminthes are nematodes.
Largest protozon = B. coli
Tape worm = cestodes.
Asexual forms of malaria= Merozoite, asexual cycle in man, sexual cycle in Mosquito
Ascaris egg migrate from lung to small intestine
62
Microbiology
Parasite in blood smear = plasmodium

Thrush= C. Albicans.
Flagellates except: S. mansoni.
Toxo diagnosed by: Fluorescent antibody sera
Swarming G+ve bacilli = Clostridium
Protozoa of endemic and epidemic disease = G. lamblia.
Entrobius diagnosed by Scotch tape method
Schffner's dots = P. vivax
Hemoflagellates = Leishmania and trypanosomes
General term of worms = Helmenth
63
Shawual 1425 Exam
26th Shawual 1425

1.
****Calcium in urine stone is present in all of the follwing except:

a. UTI
b. Secondary hyperparathyroidism.
See Q9 body fluids
2.
Acidemia is associated with
See Q 11 Chemistry.
3.
***To correct acidosis, the kidneys:

a. secrete more H+ in urine.
b. Synthesis bicarbonate to ECF
c. Both a and b
See Q 12 Chemistry
4.
See Q 15 Chemistry
5.
***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
******Metabolic acidosis can result from:
6.
**All causes renal damage except
See Q 23 Chemistry
***Main extracellular ions?

a. Na & K
b. Na & Cl
**Main electrolyte in blood is?
***Electrolytes in ECF
a. Na is a major cation
b. Cl is a major cation
d. HCO3 is a major anion.
***Main intracellular cation is;
**In serum:
a. Sodium is the main cation.
b. Bicarbonate.
***Intracellular fluid contains:
a. More potassium less sodium than extracellular fluid..
b. Sodium and potassium in equal amount.
See Q 20,21, 22, 24, 25, 26.Chemistry
8.
Glycogen differs from starch in:

a. Cellulose is not metabolized in humans because of absence of enzyme
b. Repeating units.
See Q 34 & 35 chemistry
9.
**Xylose test is done to detect the function of:

a. Stomach.
b. Pancreas.
c. Upper small intestine.
d. Lower small intestine.
e. Large intestine
See Q 36 chemistry
10.
****Von Gerke's disease is caused by deficiency of:

a. Glucose 6 phosphatase
b. Glucose 6 phosphate dehydrogenase
See Q 37 chemistry
11.
What happens if sucrose is given paretnrally:
See Q 38 chemistry
7.
See Q 17 Chemistry
64
Shawual 1425 Exam
12.
***Which of these is not a ketone body?

a. Acetone.
b. Acetoacetic acid.
c. Butyric acid.
d. B-hydroxy butyric acid.
See Q 39 chemistry
13.
***Which of the following result shows renal improvement?

a. urea 9 mmoll
b. creatinine 10 mmol/l
c. urates
d. cholesterol
e. urine osmolarity less than 800 after 12 hrs of water deprivation.
See Q 53 chemistry
14.
**Low GFR occurs in all except:

a. Congestive heart failure.
b. Urethral obstruction.
See Q 54 chemistry
15.
**Gluconic amino acids include:

a. Alanine.
b. Methionine.
c. Valine.
d. Glutamic acid.
See Q 64 chemistry
16.
***Which lipoprotein has highest concentration of cholesterol?

a. VLDL
b. LDL
c. IDL
d. HDL
See Q 72 chemistry
17.
***In MI, which is the last enzyme to be raised and lasts long?
a. CK
b. CK-MB.
c. AST.
d. LDH
See Q 85 chemistry
18.
**Isoenzymes:
a. Are physical types of one enzyme.
b. Have different electrophoretic mobility.
c. All of the above
See Q 86 chemistry
19.
*****ADH is?
a. Produced by posterior pituitary
b. Produced in the hypothalamus.
****Error in the result is expected in which case?
a. Glucose on fluoride.
b. Glucose on EDTA
c. Calcium on oxalate
See Q 90 chemistry
***In Pyruvate Kinase deficiency all correct except?

a. Intermittent attach of anemia.
b. Splenectomy is a choice of treatment.
c. Autosomal recessive.
**In A sickle cell disease patient under general anesthesia, all true except?
See Q 15 hematology
20.
21.
22.
See Q 4 general
See Q 16 hematology
65
Shawual 1425 Exam
**In favism,
a. The defect is in
b. which is affected
***Free plasma Hb is bound to:
See Q 20 & 28 hematology
25.
**In hereditary spherocytosis which is false:

a. It is autosomal dominant disease.
b. Treated by splenectomy.
b. Thin underhemoglobinized RBCs are seen in blood film.
See Q 29 hematology
26.
**Normal Hb pattern?
See Q 45 hematology
27.
****Chronic granulomatous disease is due to immunodeficiency of which of

the following?
a. T-cell member
c. Hypocomplementemia.
d. Defeceient immunoglobulins.
e. neutrophils
See Q 68 hematology
28.
29.
****Paraprotiens are?
***In CLL, all are true except::
a. RAI classification III is either I or II with hemolytic anemia.
b. 5% terminate by Richter's syndrome.
c. 30% of lymphocytes agglutinate RBCs
See Q 97 hematology
See Q 99 hematology
30.
***In CML treatment, which is true:

a. Folinic acid protects against the megaloblastic effects of methotrexate .
b. Citrovorum and folinic acid are synonymous.
c. Trimethoprim if used frequently causes folic acid deficiency or
megaloblastic anemia.
d. There is methyl THF in B12 deficiency.
See Q hematology
31.
****All diagnose hemolytic disease of new born except:

a. Retics count.
b. bilirubin
c. DAT
d. Porphyrins.
See Q 5 immunehematology
32.
***Tuberculine test is type.
See Q 13 immunology
33.
34.
35.
Cell mediated immunity =

-lactamase resistant penicillin for staph
**Sterol is the main constituent of cell wall of:
a. Mycoplasma.
b. Rickettsia.
c. Chlamydia.
d. Leptospira.
e. Staph.
See Q 14 immunology
See Q 6 Microbiology
36.
**Which strain of E. coli cause HUS?

a. VTEC O157, H7
b. EPEC O157:H7
23.
24.
See Q 27 hematology
66
Shawual 1425 Exam
37.
Organism associated with atherosclerosis:

a. Chalmydia trachomatis.
b. Chlamydia pneumoniae
d. Mycoplasma
38.
***TB culture takes

a. 2-4 days.
b. 12 days.
c. 3-6 weeks.
d. 6-10 weeks.
*****Aspergelloma: All correct except:
a. Lungs are the most common site.
b. no organism is present in lesion.
c. Affect children.
40.
******Candida is identified by
41.
*******HAV all are correct except:

a. Infection in adults is more severe than children,
b. There is chronic carrier state in young children.
c. Vaccination is recommended for high risk group.
42.
***Which is not correlating?
43.
****Which combination is wrong?

a. Rubella: arthritis in young women.
b. Mumps: Antigenic shift
c. Coxsackie: Meningitis.
d. EBV: Heterophil Abs.
44.
***Who of the following is supposed to transmit CMV infection to hospital

staff?
a. pregnant woman having a skin rash in second trimester.
b. HIV patient
c. HCV patient.
d. Neonate with congenital defect due to CMV infection
45.
**All diagnose viral infection except:

**Which diagnose viral infection?
b. High IgG titre in serum in acute and convalescent stage.
c. 2 fold increase in IgG
d. 4 fold increase in viral specific IgE in acute and convalescent stage.
e. All of the above
46.
In -Thalassemia, which is true?

a. It presents with severe anemia at the age of 6 months.
b. Blood transfustion may be required as frequent as every 9-12 months.
See Hematology 51 new
47.
Which is true regarding DAT

a. It is positive in all IHA.
b. may detect complement attached to RBCs.
See Hematology 41 New
39.
67
Shawual 1425 Exam
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.
H+ homeostasis is altered by;
a. Excessive change of pyruvate to lactate.
See Chemistry 28 New
Hemoglobin breakdown takes place in:

a. RES
b. Hepatocytes.
c. Renal tubules.
Carcinoid tumors secrete
- See Hematology 14.New
Which is not a super antigen?

a. TSSA
c. Tetanus toxin.
d. Diphtheria toxin.
In Hodgkin disease all are true except
See microbiology 41. New
54.
In Non Hodgkin disease, which is true?

a. Most are T cells.
b. Good risk patients are sensitive to chemotherapy.
c. BM is uncommonly involved.
d. Histological classification is not as important as in HD.
See Hematology 118 New2
55.
In CML, which is not present?

a. NAP is highly positive.
b. Splenometally is present in 80% of cases.
c. WBC is commonly 500x109 at presentation.
d. BCR +ve but Philadelphia negativecases may occur.
In enzymopathies, which is false:
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+
Regarding buffer systems;
b. An acid is a substance that releases H +
c. Buffering involves change of strong acid to base.
See Chemistry 28. New 2
48.
49.
50.
51.
52.
53.
56.
57.
58.
See Chemistry 19. New
See chemistry 98 New
See Chemistry 28. New 3
68

هام -Clinical &amp; Chemical Pathology MCQs

Enviado por

Dados do documento

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

هام -Clinical &amp; Chemical Pathology MCQs

Enviado por

Direitos autorais:

Formatos disponíveis

Clinical & Chemical Pathology MCQs

Classified, Reorganized And Updated To Shawual 1425 With Short Notes

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

CLINICAL & CHEMICAL PATHOLOGY MCQ

**Doctor sending a sample requesting for lecithin

(c) Amniotic fluid sample is used to measure

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

(d) Lung cancer: 75% of malignant pulmonary

(c) Commercial strips for detecting albumin

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

(c) A reducing substance is the one that reduces

***Red urine is due to?

b. Rifampicin is a well known drug to cause red

**Urine strips detect all except

Fat droplets. Occur with glomerulonephritis and

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

Urea. The most labile constituent of urine is

**Abnormal constituent of urine includes?

(c) Although also glucose and protein are

CLINICAL & CHEMICAL PATHOLOGY MCQ

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

(b) In 2ry hyperparathyroidism, hypocalcemia

If urine is kept for a long time:

Myoglobinuria is seen in:

Muscle injury (also known as rhabdomyolysis)

CLINICAL & CHEMICAL PATHOLOGY MCQ

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

The label in ELISA is?

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

(d) Electron microscope.

**The washing is must in all heterogenous ELISA

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

**The enzyme in ELISA is present in the?

(a) The conjugate is the second antibody

**A standard microplate in an ELISA has?

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

Five ml of a colored solution has an absorbance of 0.500.

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

a dichromatic analysis is carried to increase:

(a) Di- (bi) chromatic photometry measures

CLINICAL & CHEMICAL PATHOLOGY MCQ

BLOOD GASES, PH AND ELECTROLYTES.

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

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

Acidemia is associated with

Acid in urine and increased HCO2-.

***To correct acidosis, the kidneys:

(c). See 11.

**A buffer is made of ?

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

Negative log H+ concentration

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

(d) According to Henderson Hasselbalch's

***Which is more serious?

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

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

(a) Ingestion of certain medicines or chemicals

Acid base balance.

CLINICAL & CHEMICAL PATHOLOGY MCQ

H+ homeostasis is altered by;

***Main extracellular ions?

**All causes renal damage except

Renal tubular injury occurs in

Hypernatremia occurs with

هام -Clinical & Chemical Pathology MCQs

هام -Clinical & Chemical Pathology MCQs