Clinical Chemistry Trainee Council: RCPath Style Questions

1. Which of the following clinical conditions are often expected in a patient with multiple myeloma?
    a. anemia, thrombocytopenia, and leukopenia
    b. recurrent infections, obesity, and weakness
    c. renal failure, osteopenia, and visual disturbances
    d. fatigue, fever, and weight loss
    e. nosebleeds, bone pain, and heart failure

2.  A 77 year old male is brought into the Accident and Emergency department having been found at home collapsed. It was established from the history that the patient had been lying in the same place for over 14 hrs. His routine bloods on admission were as follows:
    Sodium          131 mmol/L 
    Potassium   5.2 mmol/L 
    Chloride            98 mmol/L 
    Urea   7.4 mmol/L 
    Creatinine    60 umol/L 
    C-Reactive Protein    96 mg/L 
   Troponin I       <0.04 ug/L

    a. Why was troponin I was measured in this case?
    Ans: To exclude myocardial infarction as a cause for the patient's collapse

    b. Using the information provided, what condition is the patient at risk of developing?
    Ans: Rhabdomyolysis

    c. Name one additional test that would be useful to check on this specimen to confirm the condition in (b) above. Give a reason for your choice.
    Ans: Total creatine kinase (CK)
           If the patient has rhabdomyolysis, then large amounts of CK will be released in response to breakdown of skeletal muscle tissue

    d. The patient's urine was noted to be brown in color. What compound is responsible for this? Suggest a simple test that could be carried out to confirm its presence?
    Ans: Myoglobin
           Urine dipstick for presence of heme (both myoglobin and hemoglobin will be positive)

    e. Suggest why routine laboratory tests for compound mentioned in (d) above are largely no longer available?
    Ans: Measurement of myoglobin has been largely replaced by serum total CK
           Total CK is representative of the degree of muscle damage and has a long half-life in serum

    f. What major complication is this patient at risk of developing?
    Ans: Acute renal failure

MCQs in Endocrine Biochemistry

1. Hormones
    a. Act as coenzyme
    b. Act as enzyme
    c. Influence synthesis of enzymes
    d. Belong to β-complex group

2. Hormone that binds to intracellular receptor is
    a. Adrenocorticotropic hormone
    b. Thyroxine
    c. Follicle stimulating hormone
    d. Glucagon

3. Hormone that bind to cell surface receptor and require the second messenger camp is
    a. Antidiuretic hormone
    b. Cholecystokinin
    c. Calcitriol
    d. Gastrin

4. A hormone secreted from anterior pituitary is
    a. Growth hormone
    b. Vasopressin
    c. Oxytocin
    d. Epinephrine

5. A hormone secreted from posterior pituitary is
    a. Vasopressin
    b. Thyrotropic hormone
    c. Prolactin
    d. Adrenocorticotropic hormone

6. The number of amino acids in human growth hormone is
    a. 91
    b. 151
    c. 191
    d. 291

7. Growth hormone causes hyperglycemia. It is a result of
    a. Decreased peripheral utilization of glucose
    b. Decreased hepatic production via gluconeogenesis
    c. Increased glycolysis in muscle
    d. Decrersed lipolysis

8. Acromegaly results due to excessive release of
    a. Thyroxine
    b. Growth hormone
    c. Insulin
    d. Glucagon

9. Growth hormone is released by
    a. Somatostatin
    b. Growth hormone releasing hormone
    c. Prolactin release inhibiting hormone
    d. Luteinizing releasing hormone

10. The number of amino acids in prolactin is
    a. 134
    b. 146
    c. 172
    d. 199

11. Adrenocorticotropic hormone (ACTH) is a single polypeptide containing
    a. 25 amino acid
    b. 39 amino acid
    c. 49 amino acid
    d. 52 amino acid

12. Thyroproxidase requires hydrogen peroxide as oxidizing agent. The H2O2 is produced by
    a. FADH2 dependent enzyme
    b. NADH dependent enzyme
    c. NADP dependent enzyme
    d. NADPH dependent enzyme

13. Thyroid stimulating hormone is a dimer. The α -subunits of TSH, LH, FSH are identical. Thus the biological specificity must therefore be β subunit in which the number of amino acids is
    a. 78
    b. 112
    c. 130
    d. 199

14. Following is a normal overnight fast and a cup of black coffee, a diabetic woman feels slightly nauseous and decides to skip breakfast. However she does take her shot of insulin. This may result in
    a. Heightened glycogenolysis
    b. Hypoglycemia
    c. Increased lipolysis
    d. Glycosuria

15. When thyroxine binding globulin and thyroxine binding pre-albumin are saturated with thyroxine, the excess hormone is transported by
    a. Albumin
    b. Gamma globulins
    c. Transcortin
    d. None of these

16. Hormonal stimulation of the formation of the second messenger inositol 1,4,5 triphosphate (IP3 ) quickly leads to the release of which other intracellular messenger?
    a. cAMP
    b. Prostaglandin
    c. Calcinon
    d. Leukotriene

17. Glucagon activates the enzyme adenylcyclase which causes the increase of blood sugar level. Hence this hormone is called
    a. Hypoglycemic factor
    b. Hyper glycemic factor
    c. Antidiauritic factor
    d. Thyrotropin-releasing factor

Ans: 1. C 2. B 3. A 4. A 5. A 6. C 7. A 8. B 9. B 10. D 11. B 12. D 13. B 14. B 15. A 16. C 17. B

MCQs: Australian Medical Council

1. An infant develops jaundice 6 hours after birth.

Which one of the following is the most likely diagnosis?

a. Hemolytic disease of the newborn.

b. Umbilical sepsis.

c. Physiological jaundice.

d. Atresia of the bile ducts.

e. Neonatal hepatitis.

2. A woman who is 16 weeks pregnant presents with symptoms suggestive of a urinary tract infection.

Which of the following is correct?

a. She should be assured that urinary tract infections are common in pregnancy and require no treatment.

b. A midstream urine should be collected and the bacteriology report awaited.

c. A midstream urine should be collected and a wide spectrum antibiotic prescribed.

d. A self-retaining catheter should be introduced to promote free drainage of urine.

e. A suprapubic bladder tap should be carried out to ensure the collection of an uncontaminated specimen of urine.

3. A 45-year-old man develops weakness and wasting of the right hand.

Which one of the following is least likely to be the cause?

a. Old injury to the elbow joint.

b. Bronchogenic carcinoma of the right upper lobe.

c. Multiple sclerosis.

d. Syringomyelia.

e. Motor neuron disease.

4. A 10-year-old boy presents with a history of central abdominal pain of a few hours’ duration. On examination he has minimal tenderness in the right iliac fossa and no abnormal findings on rectal examination.

Which of the following alternatives should be carried out?

a. Arrange a barium meal/follow through.

b. Arrange to see the patient later on in the day for review.

c. Send the patient away with instructions to return if the pain becomes worse.

d. Tell the patient to come back in a week.

e. Immediate appendectomy.

5. A 65-year-old woman has a two-year history of mucous diarrhea duet o a large villous adenoma of the rectum. She is also taking digoxin and diuretics for chronic congestive failure.

Which of the following investigations would be the most helpful prior to surgery?

a. Serum chloride.

b. Serum digoxin.

c. Serum calcium.

d. Serum potassium.

e. Hemoglobin.

6. A 38-year-old woman, who had a subtotal thyroidectomy 8 years previously, is again thyrotoxic.

Which one of the following is the most appropriate management?

a. Perform total thyroidectomy after preparation with carbimazole.

b. Radioactive iodine after preparation with oral iodine treatment.

c. Prescribe immunosuppressive treatment with azathioprine.

d. Control with cardimazole and then administration of radioactive iodine.

e. Short-term treatment with beta-blockers until remission occurs.

7. A patient, who has had three successive spontaneous abortions, reached the twelfth week of pregnancy on the fourth attempt, when she passed a moderate amount of blood with clots per vagina and complained of intermittent lower abdominal pain. On vaginal examination, the cervical canal admitted one finger readily and bimanual palpation revealed a uterus compatible in size with a pregnancy of only eight weeks duration. The menstrual cycle had been regular (5/28) before this pregnancy and the duration of pregnancy calculated from the first day of the last menstrual period was definitely known. 

Which one of the following is the most likely diagnosis?

a. Threatened abortion.

b. Cervical incompetence.

c. Incomplete abortion.

d. Ectopic pregnancy.

e. Missed abortion.

8. A primigravida patient at 34 weeks gestation presents with a history of not having felt fetal movements for 24 hours.

Which one of the following statements is most appropriate?

a. She probably has an intra-uterine fetal death.

b. You should immediately arrange transfer to labor ward for early induction labor, providing the baby is still alive.

c. She should have urgent antenatal cardiotocography (CTG).

d. She should have an ultrasound scan.

e. Urgent serum estriol assay should be arranged.

9. A 5-year-old presents with a history of urgency of micturition, occasional enuresis, and a slight, non-offensive vaginal discharge for 3 months. She has had no vaginal bleeding. Examination reveals some reddening of the labia majora.

Which one of the following is the most likely diagnosis?

a. Trichomonal infection.

b. Gonorrhoea.

c. Cystitis.

d. Foreign body.

e. Non-specific vulvo-vaginitis.

10. A 19-year-old woman, prescribed a triphasic oral contraceptive for the first time one month ago, complains of frequent spotting.

Which one of the following is the most appropriate management?

a. Increase the dose of estrogen.

b. Increase the dose of progestogen.

c. Advise alternative contraception.

d. Continue the medication and review in two months.

e. Change to biphasic pill.

11. A 5-year-old boy is diagnosed in the Emergency Department as having measles, the first symptoms having started 2 days previously. He has a 2-year-old sister, who has received the recommended immunization schedule.

Which one of the following is the most appropriate treatment?

a. Treat him symptomatically and send him home.

b. Refer him to the infectious diseases hospital.

c. Give him gamma globulin.

d. Give gamma goblin to the sister.

e. Reassure the mother that ‘he is over the worst of it’.

12. A 67-year-old woman recently noticed a non-painful lump in the right breast.

Which one of the following is the most likely diagnosis?

a. Subacute mastitis with early abscess formation.

b. Advanced adenocarcinoma of the breast.

c. Early intraduct carcinoma with obstruction of ductal ampullae.

d. Severe fibrocystic disease of the breast (fibroadenosis with multiple cysts).

e. Extensive fat necrosis of the breast.

CLINICAL PROBLEMS: Lipid Metabolism

1. A 7-year-old girl has a 1-month history of foul-smelling diarrhea. Upon further inquiry, the frequency seems to be 4–6 stools per day. She has also had trouble seeing at night in the past 2 weeks. Her WBC count is normal. Physical examination is entirely normal. Examination of a stool sample reveals that it is bulky and greasy. Analysis does not reveal any pathogenic microorganisms or parasites but confirms the presence of fats.

What condition would likely be revealed upon further evaluation of this patient?

a. Lactose intolerance
b. Biliary insufficiency
c. Ileal disease
d. Diabetes
e. Giardiasis

2. A 35-year-old man is brought to the emergency department in a confused and semicomatose state following a motor vehicle accident. His wife explains that he has type 1 diabetes mellitus. They were at a party earlier in the evening and both of them had two or three drinks. She is unsure whether he took his insulin before they left for the party. Physical examination reveals peripheral cyanosis and dehydration. While you are checking his abdomen, the patient doubles over and vomits. A fruity odor is detectable on his breath. A spot glucose reveals severe hyperglycemia.

Which substance would likely be revealed in abnormally high levels upon in the patient's urine test?
a. Protein
b. Hemoglobin
c. Acetoacetate
d. Lactate
e. Pyruvate

3. A 44-year-old Asian male is found to have a serum cholesterol of 350 mg/dL (normal <200 depending on criteria) after an overnight fast.

Which lipoprotein would contribute to plasma cholesterol in this man?
a. Very low density lipoproteins (VLDLs) and low-density lipoproteins (LDLs)
b. High-density lipoproteins (HDLs) and low-density lipoproteins (LDLs)
c. Chylomicrons and very low density lipoproteins (VLDLs)
d. Chylomicron remnants and very low density lipoproteins (VLDLs)
e. Low-density lipoproteins (LDLs) and adipocyte lipid droplets

4. A 12-year-old male presents with chest pain and xanthomas over his elbows and knees. His father died of a heart attack at age 34. His mother has high blood cholesterol. His physician suspects heterozygous familial hypercholesterolemia in the parents with homozygous disease in the son. This disease results from mutations in the receptor for low-density lipoprotein (LDL) or the ligand portion of its apoprotein coat.

Which apoprotein might be mutated?
a. AI
b. B100
c. B48
d. CII
e. E

5. Coronary artery disease is a multifactorial disorder involving occlusion of the coronary artery with atherosclerotic plaques. Several Mendelian disorders affecting lipid metabolism increase susceptibility for heart attacks, whereas environmental factors include smoking and high-fat diets. A 44-year-old woman has a mild heart attack and is placed on diet and statin therapy.

What will be the most likely result of this therapy?
a. High blood cholesterol
b. High blood glucose
c. Low blood glucose
d. Low blood LDLs
e. Low oxidation of fatty acids

6. Type III hyperlipidemia is caused by a deficiency of apoprotein E.

Which would be exhibited by analysis of the serum of patients with this disorder?
a. An absence of chylomicrons after eating
b. Higher than normal levels of VLDL after eating
c. Normal triglyceride levels
d. Elevated triglyceride levels
e. Lower than normal triglyceride levels

7. A molecule of palmitic acid, attached to carbon 1 of the glycerol moiety of a triacylglycerol, is ingested and digested. The fatty acid is stored in a fat cell and ultimately is oxidized to carbon dioxide and water in a muscle cell.

What would be the molecular complex in the blood in which the palmitate residue is carried from the lumen of the gut to the surface of the gut epithelial cell.
a. VLDL
b. Chylomicron
c. Fatty acid–albumin complex
d. Bile salt micelle
e. LDL

8. A patient with hyperlipoproteinemia would be most likely to benefit from a low-carbohydrate diet.

What lipoprotein likely elevated in blood of this patient?
a. Chylomicrons
b. VLDL
c. HDL
d. LDL
e. IDL

9. Major risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) are sedentary lifestyle, obesity, cigarette smoking, diabetes mellitus, hypertension, and hyperlipidemia.

Which one, if present, is the only risk factor in a given patient without a history of having had a myocardial infarction that requires that the therapeutic goal for the serum LDL cholesterol level be 100 mg/dL?
a. Obesity
b. Cigarette smoking
c. Diabetes mellitus
d. Hypertension
e. Sedentary lifestyle