12-Clinical and Chemical Pathology MCQs PDF

Clinical & Chemical Pathology MCQs
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
1
CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS
Body fluids
1. **Doctor sending a sample requesting for lecithin 1. (c) Amniotic fluid sample is used to measure
spingomyelin ratio what is the sample? lecithin: sphingomyelin ratio (L/S). L/S > 2:1
a. Blood. (or 2.5:1) denotes acceptable lung maturity.
b. CSF
c. Amniotic fluid.
d. Urine
2. ***Cytological examination of pleural effusion in a 60 yrs 2. (d) Lung cancer: 75% of malignant pulmonary
old man revealed the presence of malignant cells. The effusions are due to 3 causes; lung cancer
most likely primary tumor will be: (30%), breast cancer (25%) & lymphoma (20%).
a. Lymphoma. Practically, cytological examination only
b. Mesothelioma. establishes the presence of malignant effusion,
c. Cancer colon. however, in most cases it cannot identify the
d. lung cancer. primary site of the tumor.
Regarding mesothelioma, it is a rather a rare
tumor of the pleura.
3. *****Regarding Albustix: 3. (c) Commercial strips for detecting albumin

a. Useless if infected urine. (Albustix) use the following formula:
b. Gives red color. Tetrabromophenol blue (yellow at 3.0) →
c. Not useful if acid is added to urine. shades of green in the presence of protein at the
d. Depends on acid precipitation of urinary proteins 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? 4. (c) A reducing substance is the one that reduces
a. Glucose. alkaline cupric sulfate to red coprous oxide.
b. Galactose. Most important are glucose, lactose, fructose,
c. Sucrose. galactoses and pentoses (e.g. ribose, xylose and
d. Fructose. arabinose) while sucrose will not reduce alkaline
cupric sulfate.
5. ***Red urine is due to? 5. b. Rifampicin is a well known drug to cause red
a. INH urine.
b. Rifampicin
c. Pyrizinamide.
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? 8. (c) Although also glucose and protein are
a. Urea abnormal constituents of urine, yet they
b. Glucose normally present in trace amounts below the
c. Cholesterol. detection limit of ordinary methods.
d. Uric acid
e. Protein.
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CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS
9. ****Calcium in urine stone is present in all of the 9. (b) In 2ry hyperparathyroidism, hypocalcemia
following except: due to e.g. chronic renal failure is the cause of
a. UTI increased parathormone. Stones due to
b. Secondary hyperparathyroidism. 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 D→↑Ca 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: 10. See 7.

a. Becomes black. Urine becomes black on standing in cases of
b. Urea increases. alkaptonurea (↑homogentesic acid) and
c. Urea decreases. methemoglobinurea.
d. Creatinine increases
11. Myoglobinuria is seen in: 11. Muscle injury (also known as rhabdomyolysis)
e.g. in cases of crush injuries and strenuous
exercise.
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CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY
Clinical Chemistry
INSTRUMENTATION
1. ******Difference between ELISA & RIA is ? 1. (a) Both techniques apply almost the same
a. ELISA technique uses an enzyme. methodology, .ELISA technique uses an enzyme
b. ELISA is used by bacteriologists while RIA by label and RIA uses radioisotopic label.
virologists
2. The label in ELISA is? 2.

a. Enzyme
b. Antibody
c. Antigen.
3. ***Which of the following not seen in chemistry lab? 3. (d) Electron microscope.
a. Analytic balance.
b. Centrifuge
c. Spectrophotometer
d. Electron microscope,
e. Turbidimeter.
4. **The washing is must in all heterogenous ELISA 4. (b) In ELISA, the first washing is used to
techniques because? remove the unbound (free) sample antigen. The
a. It remove the excess binding second washing removes unreacted free label
b. Increase the specificity (not excess binding in either of the 2 washings)
c. Increase the sensitivity. 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? 5. (a) The conjugate is the second antibody
a. Conjugate conjugated with the enzyme.
b. Microplate
c. Buffer.
6. **A standard microplate in an ELISA has? 6. (a) 96 wells are present in the microplate (8
a. 96 wells rows x 12 columns).of these, 1 is used for the
b. 98 wells blank, 2 for the –ve controls, 2 for the +ve
c. 92 wells. controls and 4 for the cutoff control (COC). The
remaining 85 for tests.
7. Five ml of a colored solution has an absorbance of 0.500. 7. (b) According to Beer's law, absorbance is
The absorbance of 10ml of the same colored solution will proportional to the final concentration (whatever
be: the volume is)
a. 1.000
b. 0.500
c. 0.250
8. a dichromatic analysis is carried to increase: 8. (a) Di- (bi) chromatic photometry measures
a. Specificity absorbance of the sample at 2 different
b. Linearity wavelengths. This corrects for interfering
c. Sensitivity. substances increasing specificity of the method.
4
BLOOD GASES, PH AND ELECTROLYTES.

9. ******PO2 (or gases) is measure in which unit? 9. © mEq/L (mmol in SI) is used for electrolytes
a. Mmol e.g. BE, bicarbonate and H+. While mmHg (or
b. umol kpa in SI) is used for gases e.g. pCO2 and pO2.
c. mmHg
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: 12. (c). See 11.
a. secrete more H+ in urine.
b. Synthesis bicarbonate to ECF
c. Both a and b
13. **A buffer is made of ? 13. (c) A buffer system is made of a weak acid and
a. Strong acid & strong salt its salt with a strong base of a weak base and its
b. Strong acid & weak salt salt with a strong acid.
c. Weak acid & strong salt
d. Weak acid & weak salt.
14. ****pH means: 14. Negative log H+ concentration
15. ***What is the base: acid ratio at pH 7 for acid of pK6? 15. (d) According to Henderson Hasselbalch's
a. 0.01 equation, pH = pK + Log base/acid. By
b. 0.1 compensation, Log (base / acid)= 1, thus base:
c. 1.0 acid = 10:1.1
d. 10
e. 100
16. ***Which is more serious? 16. (c) Critical K+ values are <2.5 or > 6.5 mEq/L
a. Glucose 15mmol/l Critical glucose <40mg or >450mg (2.2 &
b. pH 7.25 acidosis. 25mmol respectively),
c. Potassium 1.5 mmol/l critical pH <7.2 or >2.6
d. Sodium 150 mmol/l 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
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19. H+ homeostasis is altered by; 19. In actively contracting muscle, 8% of the pyruvate
New a. Excessive change of pyruvate to lactate. New 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.
20, ***Main extracellular ions? 20, b. Na is the major ECF cation, Cl is the major ECF
21, a. Na & K 21, anion, K is the major ICF cation and proteins
22, b. Na & Cl 22, followed by phosphates are the major anions.
24, **Main electrolyte in blood is? 24,
25, ***Electrolytes in ECF 25,
26. a. Na is a major cation 26.
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.
23. **All causes renal damage except 23. Hypocalcaemia.

Causes of renal damage include; hypovolemia
(hemorrhage or dehydration), myoglobulinurea,
hypercalciurea, uricosuria, and drugs e.g.
aminoglycosides and ACE inhibitors.
27. Renal tubular injury occurs in 27. See 23.
28. Hypernatremia occurs with 28. (d) Hypernatremia occurs with:

a. Cushing disease * ↓body Na : due to extrarenal water loss or
b. Dehydration renal diuresis.
c. hypothalamic injury * Normal body Na: due to extrarenal loss e.g.
d. All of the above hyperthermia or renal loss e.g. DI.
* Na retention e.g. steroids or Na intake.
28. Regarding concentration of urine; 28. a. Approximately 80% of the water and NaCl
New a. Proximal tubules return 75% of filtered water. New contenet together with glucose, phosphate, and
1 b. Distal convoluted tubules deliver 40-60L of fluid to 1 amino acids are reabsorbed in the proximal tubule.
collecting tubules / day. About 20% of the tubular fluid enters the loop of
c. Osmotic pressure in renal cortex is higher than in medulla. Henle where water is passively aborbed; 6ml per
d. ADH acts on all parts of nephrone. minute of concentrated tubular fluid now enters
e. Aldosterone increase Na excretion. 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.
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28. Regarding excretion of Na+ 28. b. Na+ excretion is influenced by

New a. Not dependent on aldosterone. New mineralocorticoids (mainly aldosterone):↑
2 b. Major share of GF osmolarity with associated ions. 2
reabsorption. The GF is isoosmolar with plasma
c. It passively diffuses in proximal tubules. i.e. Na is the major electrolyte. 90% of Na is
d. In distal tubules it is exchanged for K+ actively (not passively) reabsorbed in the PCT. K
e. Coupled with K+ is excreted from DCT in exchange with Na (not
the reverse and not coupled with it).
28. Regarding buffer systems; 28. b. Acids are substances that tare capable of
New b. An acid is a substance that releases H+ New donating protons. When a strong acid is added to a
3 3
c. Buffering involves change of strong acid to base. 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 30. (c) WHO recommendations for GTT include:
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.
31. **With age renal threshold for glucose? 31. (b) With age, the renal ability to reabsorb filtered
a. Increased glucose is decreased leading to appearance of
b. Decreased glucose in the urine at lower plasma levels.
c. Not changed
32. **All are inborn error of glycogen metabolism except? 32. (b) Essential fructosuria is due to aldolase B defect
a. Essential fructosuria leading to accumulation of fructose-1-P
b. Phenyl ketonuria Galactosemia (serious) is due to decreased
c. Galactosemia Galactose-6-P uridyl transferase leading to
d. Glycogen storage disease 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.
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33. *****HBA1c (Glycosylated hemoglobin) is? 33. (b) GlycHb (RR 4-6%) is formed by non
a. Not present in healthy normal individuals. enzymatic attachment of glucose to N-terminal
b. ↑ in prolonged sustained hyperglycemia 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 35. Glucose units in cellulose are combined by
absence of which enzyme? cellobiose bridges. These are hydrolyzed by
cellobiase which is lacking in animal and human
gut.
36. **Xylose test is done to detect the function of: 36. c. Xylose is absorbed from proximal small
a. Stomach. intestine independent on pancreas..
b. Pancreas.
c. Upper small intestine.
d. Lower small intestine.
e. Large intestine
37. ****Von Gerke's disease is caused by deficiency of: 37. (a) See 32.
a. Glucose 6 phosphatase
b. Glucose 6 phosphate dehydrogenase
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? 39. (c) Ketone bodies are formed by condensation of 2
a. Acetone. acetyl Co A → Acetoacetic acid which gives B
b. Acetoacetic acid. hydroxyl butyric acid by reduction or acetone by
c. Butyric acid. decarboxylation.
d. B-hydroxy butyric acid. Butyric acid is a fatty acid
e. None of the above.
40. ***In Gaucher's disease; 40. (b) Gaucher's is a glucosylceramide lipidosis

a. Glycoprotein is accumulated. (lysosomal storage disease). It is caused by ↓
b. Glucocerebrosidase is deficient. glucocerebrosidase enzyme leading to
accumulation of glucosylceramide → HSM and
pigmentation of exposed parts.
41. Bile duct obstruction can be diagnosed by: 41. (c) Cholestatic hyperbilirubinemia is characterized
a. AST by conjugated hyperbilirubinemia and
b. T. Bilirubin hyperbilirubinuria (only the conjugated fraction
c. Bilirubin in urine appears in urine).
d. Ester bilirubin
42. *** Increased jaundice is diagnosis by 42. (a) Estimation of jaundice depends on serum
a. T. bilirubin bilirubin, other mentioned tests help to identify the
b. AST cause of jaundice.
c. ALT
d. ALP
8
CALCULATIONS, QC AND STATISTICS

43. **Most of the concentration are calculated using factor, 43. (b) For methods obeying Beer's law, slope of the
this factor is? calibration curve (Cs/As) provides a constant to
a. Std absorbance / std value calculate the unknown concentration. Also
b. Std value / std absorbance depending on the formula:
c. Std value x std absorbance At x Cs = As x Ct, thus, Ct=(Cs/As)x As
44. **Ten microliters are? 44. (d) μL = 10-6L → 10 μL = 10-5L = 0.00001L

a. 0.01 L
b., 0.001 L
c. 0.0001 L
d. 0.00001 L
e. non of these.
45. **How much water should be added to 500ml of a solution 45. (c) Using the formula:
of 10% NaOH to bring it to 75%? C1 x V1 = C2 x V2
a. 666ml 10 x 500 = 7.5 x V2
b. 125ml V2 = 666mL
c. 166ml Thus, 166 mL of DW should be added.
d. 250ml
e. 375ml
46. When calculated osmolarity can not be accounted as a 46. Calculated osmolarity = 2 X Na + Glu + Urea
measurement for osmolarity? (All in mmol/L)
a. per 100gm/l When calculated osmolarity is less than
b. Urea 20 mm/l 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? 47. (b) Secondary std?

a. Primary std A primary Std is a reference standard.
b. Secondary std Secondary Std is standardized depending on the
c. Tertiary std primary standard.
d. Internal std.
48. **External QC program means? 48. (b) In EQC, participants receive QC material to
a. An external person come & does the QC test be tested inside their labs. Results are sent to
b. A QC person goes to another lab & does the test.. supplier to be compared to other labs' results.
EQC will be most practically implemented
during the regular visit of the lab coordinator.
This will give opportunity for errors to be
investigated on site and corrected rapidly
(Monica)
49. **We select 2SD value to plot LJ curves because? 49. (c) QC results follow a Gaussian distribution,
a. They are easy to calculate, thus 95% of these results normally fall within
b. They cover 97.5% of normal population, ±5% of the mean. Therefore, 2.5 out of 100
c. Patient value rarely go beyond these limits. (1:40) are acceptable to be above +2s and 2.5
our of 100 are acceptable below -2s.
9
50. Sensitivity and specificity are 50. (b) Sensitivity & specificity can be adjusted
a. Directly related. according to cutoff level. Sensitivity can be
b. Inversely related. increased by choosing a higher cutoff to include
c. They mean the same. 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 51. (b) Carryover is due to contamination by a
readings because: previous sample. It is calculated by measuring a
a. The analyzer was carried and placed at a different place. high standard and a low standard each 3 times
b. The previously measured solution was still in the cuvette then applying the following formula:
c. The current solution is overflowing in the cuvette. Carry over = (contaminated low – actual low) /
contaminated high – actual high)
52. STAT test means: 52. (c) Stat refers to immediate or as initial dose.
a. Start at.
b. Standardize and test.
c. Short turn around time
CREATININE, UA, BUN AND AMMONIA

53. ***Which of the following result shows renal impairment? 53. (e) A urine osmolarity less than 800 after 12 hrs
a. urea 9 mmol of water deprivation denotes renal impairment.
b. creatinine 10 mmol/l Urea 9mmol is high normal (n: 2.9-8.2) and is
c. urates not a very sensitive measure of GFR.
d. cholesterol Creatinine, although a sensitive measure of GF,
e. urine osmolarity less than 800 after 12 hrs of water 10umol is normal (n: 53-106)
deprivation. Cholesterol and urates are useless in this regard.
54. **Low GFR occurs in all except: 54. (b) low GFR occurs with:
a. Congestive heart failure. - Hemorrhage.
b. Urethral obstruction. - 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: 56. (a) Nephrotic syndrome consists of:
a. Hypocholesterolemia. - Heavy proteinuria.
b. Hypoalbuminemia. - Hypoalbuminemia.
c. Albuminuria. - Oedema.
d. Hypertriglyceridemia. - Hypercholesterolemia (Almost always
e. None of the above present).
Hypertriglyceridemia is present in 50% of
cases.
10
57. ****Ureate excretion by the kidney is inhibited by: 57. (b) Thiazide diuretics cause relatively urate
a. Probenecid. retention, glucose intolerance and hypokalemia
b. Thiazide diuretics. and interfere with water excretion and may
cause hyponatremia.
Probenecid is a uricosuric agent like allopurinol.
58. Chronic glomerulonephritis is diagnosed by: 58. (d) In chronic glomerulonephritis, there is
a. Blood urea. persistent deterioration of renal functions ending
b. Creatinine. with renal failure.
c. Proteinuria
d. All of the above
PROTEINS, ELECTROPHORESIS AND LIPIDS

59. **The protein having molecular wt less then albumin is? 59. (b) B2-microglobulin has a MW 11,800.
a. Beta protein Betalipoprotein is 380,000.
b. B2-microglobulin. BJ protein is the light chains of
c. Lysozyme. immunoglobulins. It's MW is variable from
d. Benze Jones protein. 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? 60. (d) Alpha 1 antitrypsin
a. Beta globulin
b. Macroglobulin
c. Albumin
d. Alpha 1 antitrypsin
e. Alpha 2 antitrypsin.
61. ***Diet rich in phenylalanine should be restricted in? 61. (a) In phenylketonuria, there is ↓ phenylalanine
a. Phenyl ketonuria hydroxylase leading to accumulation of
b. Tyrosinemia phenylpuruvate and its derivatives and their
c. Maple syrup disease excretion in urine. Diet rich in phenylalanine
should be restricted to prevent brain damage.
62. ***In phenylketonuria, diet should be low in: 62. (a) Phenylalanine (see 61)
a. Phenylalanine.
b. Carbohydrate.
c. Lipids.
62. Hypoalbuminemia is associated with all except? 62. (a) Tetanus is clostridial infection caused be C.
a. Tetanus tetani has nothing to do with albumin.
b. hypocalcaemia
c. oedema
d. toxic effect of sulfonamide
64. **Gluconic amino acids include: 64. (a) Ketogenic amino acids are: Leucine and
a. Alanine. lysine,
b. Methionine. Mixed amino acids are: Isoleucine,
c. Valine. phenylalanine, threonine, tryptophan and
d. Glutamic acid. tyrosine.
e. All of the above. Gluconic amino acids are all the other amino
acids.
11
65. **Lipoprotein related to hypertension? 65. . LDL
66. *****Which is important for atherosclerosis? 66. (b)

a. ↑HDL
b. ↑LDL
c. ↑Chylomicrons.
67. ***In plasma protein electrophoresis, the protein that will 67. Albumin.
go first is (moves furthest from application)?
68. ***Based on behavior of lipoproteins in 68. On electrophoresis;

ultracentrifugation pre-B lipoprotein is? Chylomicrons and its remnants stay at the
a. HDL origin.
b. LDL. VLDL at preβ (=α2 globulin region)
c. VLDL IDL at broad β
d. Chylomicron LDL at β (= β globulin region)
HDL at α (= α1 globulin region)/
69. **All of the following are lipoproteins except? 69. (d) Although phospholipids are not lipoproteins,
a. Phospholipid they are ingredients of lipoproteins, conferring
b. VLDL the hydrophilic properties.
d. Sphingomylin
e. LDL
f. HDL
70. What is the proposition of pulmonary surfactant? 70. (b) Dipalmityl lecithin (a lecithin phospholipid
a. Phospholipid acid with 2 palmetic acid residues) is the chemical
b. Dipalmityl lecithin composition of pulmonary surfactant.
c. Phosphatidyl choline,
71. **HDL is good cholesterol because? 71. (a) HDL is composed of 20% cholesterol, 30%
a. It has more protein & phospholipids in it phospholipids and 50% proteins.
b. It has no cholesterol in it,.
c. It has less TG in it.
72. ***Which lipoprotein has highest concentration of 72. (b) VLDL are the TG rich lipoproteins
cholesterol? HDL has 20% cholesterol.
a. VLDL IDL has cholesterol and TG in equal amounts.
b. LDL LDL is the richest lipoprotein in cholesterol
c. IDL esters.
d. HDL
74. ****Which is not associated with abetalipoproteinemia: 74. (b) Hereditary spherocytosis is due to spectrin
a. Acanthocytes in the peripheral blood. deficiency.
b. Hereditary spherocytosis. Abetalipoproteinemia is a lipoprotein
c. Malabsorption and fatty stools 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: 75. (a) Chylomicrons don't confer an excess

a. Can cause thrombosis. cardiovascular risk, however, in LpL deficiency
b. Cannot cause thrombosis. and apoC II deficiency, the patient presents with
lipemia retinalis and retinal vein thrombosis.
12
76. Nature of apoproteins. 76. 5 major classes of proteins A to E
77. Saturated vs unsaturated fats (nutritional value) 77. Saturated Unsaturated

e.g. Oleic a (50% of Linoleic a
body fat) Linolenic a
Palmitic a (25% (both are
of body fat) Essential)
Stearic a (5% of Arachidonic a.
body fat)
Acetic a.
Butyric a.
Presence Adipose Vegitable oils.
Suffix Anoic Enoic
Significance Arachidonic
acid is precursor
of Pgs.
Although not
essential, it
depends on
essential FA
Chemistry No double Double bonds
bonds
78. Which is best for parentral alimentation? 78. (b) Parentral nutrition is composed essentially
a. FFA. 79. of:
b. AA a) Nitrogen source: synthetic valuable amino
c. lipoproteins acids (9-17g/L N2)
b) Energy source: Glucose (mainly) and fat
emulsion (additional source to avoid EFA
deficiency).
c) Electrolytes and trace elements.
79. Protocol for IV nutrition?
80. **Regarding lipoprotein metabolism: 80. Although cholesterol can be synthesized by all
nucleated cells, however, cholesterol in VLDL,
IDL and LDL is of hepatic origin
82. Treatment of familial hypercholesterolemia. 82. These include general management of

hypercholesterolemia + cholesterol lowering
drugs + oestrogen replacement in
postmenopausal women.
CLINICAL ENZYMOLOGY
83. ***The better for diagnosis of acute pancreatitis is? 83. (b) Lipase elevation is of a greater magnitude (2-
a. Amylase 10 xN) and duration than amylase in acute
b. Lipase pancreatitis. When lipase method is optimized,
c. ALP the test is more sensitive and specific than
d. ACP amylase for detection of acute pancreatitis.
84. **Activities of some enzyme increased in some disease 84. (b) That’s why enzymes are measured for the
conditions because they are? most part by their activity rather than
a. Non functional enzymes concentration.
b. Functional enzymes
c. Neither
13
85. ***In MI, which is the last enzyme to be raised and lasts 85. (d)
long? Onset (h) Peak (h) Duration
a. CK (d)
CK 6-12 20-30 2-6
b. CK-MB. CK-MB 3-10 12-24 1.5-3
c. AST. AST 6-12 20-30 2-6
d. LDH LDH 6-12 24-72 7-14
86. **Isoenzymes: 86. © Isoenzymes have the same catalytic activities

a. Are physical types of one enzyme. and differ in physicochemical properties.
b. Have different electrophoretic mobility.
c. All of the above
87. **MI is diagnosed by: 87. (a) CK-MB is specific for cardiac muscle, CK-
a. CKMB BB for brain and CK-MM for skeletal muscle.
b. CKBB
c. CKMM
d. LDH
88. **Elevation of LDH is caused by: 88. (d) LDH is present in the cells of the heart, liver,
a. Myocardial disease muscles, blood and malignancies.
b. Liver disease
c. Prostatic disease
d. many organ disease because it has many distribution
89. ****Myoglobin ↑ in injury of: 89. (a) muscle whether cardiac or skeletal is the
a. muscle. source of myoglobin.
b. Liver
CLINICAL ENCOCRINOLOGY
90. *****ADH is? 90. (b) ADH is produced by the hypothalamus and
a. Produced by posterior pituitary stored and secreted from the posterior pituitary.
b. Produced in the hypothalamus.
91. **The method used to estimating insulin is? 91. (d) Immunoassay (multiple labels) is used for
a. Electrophoresis the measurement of insulin.
b. Kinetic estimation.
c. Spectrophotometer.
d. Radioimmuno assay.
92. *****After the insulin dose, the patient soon comatozed 92. (b) Hypoglycemia (glucose <3mmol/l)
due to
a. Hyperglycemia
b. Hypoglycemia (glucose <3mmol/l)
c. ketonuria
c. Ketoacidosis is the cause of coma
d. Lactic acidosis,
14
93. **While using the pregnancy test we are measuring? 93. (b) α subunit of HCG is very similar to α
a. B-HCG subunit of TSH and FSH and identical to LH.
b. Total HCG Although β subunits of HCG and LH are very
c. B-HCG & LH similar, antibodies can be made to the β subunit
d. B-HCG & FSH. 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 β chain
and the other to the α chain, i.e. react with intact
HCG.
94. ****Water deprivation test is used in the diagnosis of: 94. (b) Water intake is restricted the patient loses 3-
a. Anterior pituitary disease. 5% of body weight or until 3 consecutive hourly
b. Posterior pituitary disease. determination of urine osmolarity are within
c. Hypothyroidism. 10% of each other. Measure urine osmolality,
plasma vasopressin and increased urine
osmolality with exogenous vasopressin.
Urine Pl. VP After VP
osmol
Normal >800 >2 ↑
DI <300 Undetectab ↑
le
Nephrogeni <300 >5 No change
c DI
95. ****24 hours urine for VMA is used for diagnosis of 95. (b) Catecholamines are oxidized to VMA and
diseases of: metanephrins. 24hour urinary metanephrins is
a. Adrenal cortex. the best single test for pheochromocytoma.
b. Adrenal medulla Specificity and sensitivity approach 100% when
both VMA and metanephrines are measured.
96. ***Hypertension is found in all of the following endocrinal 96. (d) Hypertension secondary to endocrinal causes
diseases except: occurs in:
a. Cushing's syndrome. - Pheochromocytoma.
b. Pheochromocytoma. - Crohn's syndrome
c. Adrenal medulla hyperplasia. - Cushing's syndrome.
d. Addisson's disease. Addison is associated with hypos
(hypotension, hypokalemia, hyponatremia and
hypocortisol)
97. Diabetic coma presents with: 97. All.

a. Ketone bodies in urine In diabetes, 2 types of coma may occur, DKA
b. Blood glucose may be 1000mg or more and nonDKA. Glucose levels in nonDKA are
c. osmotic diuresis present 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 98. (a) different antibodies.
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.
15
98. Carcinoid tumors secrete 98. 5HIAA.

New New 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 (5-
hydroxytryptamine (5-HT) with its major
metabolite 5-hydroxyindoleacetic acid (5-
HIAA)), 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
CLINICAL & CHEMICAL PATHOLOGY MCQ General
General
1. ****The difference between plasma and serum is that 1. (a) Plasma contains fibrinogen which is
plasma: consumed during the clot formation to separate
a. Contains fibrinogen. serum.
b. Doesn’t contain fibrinogen.
c. Has more water.
d. Has less water.
2. ******Best way to separate the serum? 2. (a) leave the blood to clot at R.T for I hr, then
a. leave the blood to clot at R.T for I hr, then centrifuge centrifuge
b. by adding citrate.
c. by adding EDTA
3. **Point of care testing means? 3. (c) Take care in testing

a. Complete a test & make a point[interpret],
b. Testing the patient at bed side
c. Take care in testing
4. ****Error in the result is expected in which case? 4. (c) Oxalate is a divalent cation chelator.
a. Glucose on fluoride.
b. Glucose on EDTA
c. Calcium on oxalate
5. **Cardiac anatomical anomalies associated with Fallot 5. (b) Fallot's tetralogy is composed of PS+VSD +
tetralogy include all of the following except: Rt aorta + RVH.
a. VSD
b. ASD
6. Hemolysed blood is unsuitable for performing which 6. Hemolysis is visible at Hb> 3.1 μmol/L
tests? It increases LDH, K, ACP, cholesterol, ALT and
AST.
Hemolysis don’t increase serum albumin,
bilirubin, ALP, amylase, lipase, Ca, Cl, P, Mg,
Na, creatinine, glucose, UA or urea.
7. ****Hemolysis causes? 7. a.
a. Increased serum K
b. Increased serum Na
c. Increased HCO3-
d. Decreased K
8. After hemolysis: 8.
a. Sodium leaks out of RBCs.
b. K leaks into cells.
c. Bicarbonate gets into RBCs.
9. Effects of fasting 9. Prolonged fasting increase TG, glycerol, FFA

but not cholesterol.
10. ****Fluoride is used to get samples for? 10. a. Blood sugar
a. Blood sugar
b. Coagulation
c. Electrolyte
d. CBC.
17
CLINICAL & CHEMICAL PATHOLOGY MCQ General
11. ***Anticoagulant used for glucose is: 11. Fluoride
12. **Changes in blood stored more than 5 hrs at room temp. 13. (a) Storage of blood has the following effects:
include? 1- ↓CO2, ACP & Glucose
a. Decreased glucose & increased lactate. 2- ↑pH & ammonia
b. Increased glucose & decreased lactate 3- Changes in RBC permeability →↑K,P &Mg
c. Failure of Na & K pump, 4- Na-K pump is inhibited at 4 °c but not at
25°c. leading to ↑K in refrigerated samples.
5- Phosphorylation→↑P released from organic
P.
6- Loss of enzyme activity.
7- Light→↓ bilirubin, δALA and porphyrins.
14. Plasma or serum should be separated at the earliest for the 14. a. Continued glycolysis cause glucose values to
estimation of glucose because: decreases with time unless cells are separated.
a. The glucose values decreases with time.
b. Glucose value increases with time.
c. Lysis of blood occurs.
 Best place to put a needle for blood collection is puncture proof container.
18
CLINICAL & CHEMICAL PATHOLOGY MCQ Hematology
Hematology
BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES

1 ** To stain the B/M other than Wright stain which stain 1 (c) Bone marrow films should be stained with
usually used? an iron stain e.g. Perl's, Prussian blue, as a
a. PAS stain routine to demonstrate iron (Dacie)
b. Sudan black stain
c. stain for iron.
2 ***In addition to routine Romanowsky stain of bone 2 (b).Prussian blue: See 1

marrow the following stain is also essential:
a. Chloroacetate estrase
b. Prussian blue.
3 The needle used for bone marrow biopsy is? 3 (b) Jamshedi trephine is used for biopsy.
a. 18 gauge needle
b. Jamshedi needle
c. Menghini needle
d. Westermani needle,
4 **Hyperplastic B.M with M/E ratio 6:1 is seen in: 4 (c) Hyperplasia is diagnosed when fat>cells. In
a. Megaloblastic hyperplasia. hyperplastic BM, an M/E ratio > 2:1 denotes
b. Normoblastic hyperplasia myeloid hyperplasia and <2:1 denotes erythroid
c. Lymphoid hyperplasia hyperplasia.
5 **Best method to assess BM cellularity is: 5 (a) Trephine biopsy is preferred over bone
a. Trephine biopsy marrow aspiration in that it demonstrates the
b. M:E ratio is enough. architecture of the bone marrow cellularity.
c. By high power.
6 ***Which Hbs have the same electrophoretic mobility on 6 HbS, C, D and Hb Punjab (also Hb lepore) occur
alkaline cellulose acetate? at the same position on cellulose acetate at
pH8.6 . Also Hb C, E and C harlum occur at the
position of Hb A2
7 Lymphokines & T-cell activation 7 Lymphocytosis promoting factor and histamine

sensitizing factor.
8 ******When using and electronic cell coulter counter, 8 (d) A high titer of cold agglutinin cause falsely
which of the following results can occur in the presence of ↑MCV, MCH and MCHC and falsely ↓ RBC
cold agglutinins: count.
a. ↑MCV & ↓MCHC To correct, incubate at 37°c for 15-30 minutes
b. ↓MCV & ↓MCHC and rerun the specimen.
c. ↓MCV & ↑MCHC
d. ↑MCV & ↑MCHC
e. ↑MCV & decreased RBC
f. ↑MCV & normal RBC
h. ↓MCV and RBC
19
9 ***Bone marrow aspiration needles: 9 a. 18 gauge.

a. 18 gauge.
b. Meninghi.
c. Burtolin
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 11 (d) using the correction formula :
leucocytes, so corrected leucocytic count equals: Corrected WBC= WBC X 100 / (NRBC+100)
a. 11.5 x 109/L Corrected WBC= 22.5 X 100 / (200 + 100 )
b. 22.3 x 109/L = 7.5 x 109/L
c. 22.7 x 109/L
d. 7.5 x 109/L
12 ****The main antioxidant in RBCs is: 12 b. Reduced glutathione acts as antioxidant
a. NADPH through its SH group.
b. Reduced glutathione
13 ***Newborn with MCV 100fl, is considered. 13 b. MCV in the first week is normally 108fl.
a. Macrocytosis. After 2 months, it is 96fl.
b. Normal
14 **Perl's stain 14 BM iron stores
14. Hemoglobin breakdown takes place in: 14. a. Normally 6gm of Hb is broken down per day
New a. RES New into;
b. Hepatocytes. - Globin peptides: hydrolysed and the amino
c. Renal tubules. 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.
NORMOCYTIC NORMOCHROMIC ANEMIAS

15 ***In Pyruvate Kinase deficiency all correct except? 15 (a) PKA is an autosomal recessive
a. Intermittent attach of anemia. enzymopathy. O2 dissociation curve is shifted to
b. Splenectomy is a choice of treatment. the right, so only mild symptoms occur.
c. Autosomal recessive. Splenectomy improves the condition.
16 **In A sickle cell disease patient under general anesthesia, 16 Tourniquet should not be avoided.
all true except? 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
18 **Skeletal abnormality present in? 18 Fanconi syndrome.

Fanconi syndrome consists of:
- Congenital aplastic anemia.
- Skeletal and urinary tract anomalies.
- Microcephaly.
- Altered skin pigmentation.
19 Fanconi's anemia 19
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? 21 (c) Sideroblastosis occurs due to;

a. Lead poisoning - Lead poisoning due to inhibition of enzyme of
b. Alcohol heme and globin synthesis.
c. Aspirin - Alcoholism, due to interference with heme and
d. Chloramphenicol 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 22 a. Aspirin.

is:
a. Aspirin.
b. Lead.
23 **In HUS, all are true except: 23 (e) HUS occurs in children following VTEC
a. occurs mainly in children. enteritis (also after salmonella, shigella,
b. Is usually preceded by some sort of enteritis. streptococcal infection, as an autoimmune
c. Fragmented RBCs are seen. disease and following drugs e.g. cycloserine. It
d. Uremia is usual. is charectarized by:
e. Anti IgG is positive in 10% of cases. - Thrombosis in small vessels.
- Fragmentation of RBCs.
- Reduced platelets (consumptive).
- Uremia.
24 In HUS, all are present except: 24 d. Thrombocytosis

a. ARF
b. ↓ platelets.
c. Microangiopathic HA
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
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: 29 c. Hereditary spherocytosis is an autosomal
a. Autosomal dominant. dominant membrane defect (anykrin) not due to
b. Treated by splenectomy. a defect is in hemoglobinization of RBCs. Parts
c. Defect is in hemoglobinization of RBCs 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 31 (c) Yersina enterocolitica occurs in iron
organism is isolated from blood: overloaded patients treated with desferrioxamine
a. Salmonella. (see p376 Kumar)
b. Strept pneumoniae
c. yersinia enterocolitica.
32 ***Thalassemia major with iron overload this organism 32 (c).

can be isolated.
a. Streptococcus pneumoniae.
b. Salmonella typhemureum
c. Yersina enterocolitica.
33 *****Microangiopathic hemolytic anemia is present in all 33 (b) In MAHA there is intravascular hemolysis
except: and fragmentation of the RBCs due to abnormal
a. TTP microcirculation leading to fibrin deposition,
b. Meningococcal septicaemia. platelet deposition and vasculitis e.g in;
c. HUS - 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: 34 (b) LD1&2 are characteristically increased in
a. Total ACP HA. ACP although is present in high
b. LDH concentration inside RBCs (tartarate resistant) is
c. ALP not characteristically increased.
22
35 ****In G6PD deficiency avoid all the following drugs 35 (e) Agents causing HA in G6PD deficiency
except: include:
a. Salicylic acid - Antimalareals e.g. primaquine.
b. Primaquine. - Sulphonamides and Sulphones (dapsone).
c. Dapsone. - Analgesics e.g. salicylic acid
d. Trimethoprim. - Antihelmenthics e.g. niridazol.
e. Folic acid - Miscellaneous e.g. vitamin K analogues,
probanecid.
36 ***A patient with hemolytic anemia has all the following 36 (c) In hemolytic anemia there is;
exept: - Hyperbilirubinemia and hemiglubinuria.
a. Bilirubinemia. - ↑urobilinogen and stercobilinogen→ dark
b. Dark urine. urine.
c. Hypertension. - ↓ Haptoglin and hemopexin.
- Hemosiderinemia and hemosiderinuria.
- Methemoglobenemia.
37 ****Aplastic anemia cause 37 pancytopenia.
38 RAEB 38 Myelodysplastic syndromes (MDS) are

classified into:
Peripheral blood BM
Refractory <1%blasts <5%blasts
anemia
RA with <1%blasts <5%blasts
sideroblasts
RA with excess >5% 20-30%
blasts (RAEB)
CMML ↑monocytes ↑promonocytes
39 **Manifestations of HbSS 39 (b) Infarction of phalanges.
a. Ischemia to femoral artery.
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 b. DAT involves testing patient's cells without
New a. It is positive in all IHA. prior exposure to antibody in vitro. For
b. may detect complement attached to RBCs. 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
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

42 ***A case of iron deficiency under Microscope is 42 hypochromic, microcytic
43 **Iron deficiency anemia seen in all except? 43 d. B-thalassemia major

***Iron stores are deficient in all except:
a. B-thalassemia major
b. chronic disease,
44 **Hb variant with fusion of delta and beta gene segments 44 Hb Lepore is the result of fusion of β & δ chains
is: which combine with α chain (β δ2,α2)
Other abnormal patterns include HbH (β4) and
HbSS (Bs, Bs)
45 **Normal Hb pattern? 45 HBA ( α2, β2)

Other Hb patterns: HbA2 (α2, δ2), HbF (α2,γ2)
46 ****In iron deficiency anemia, all are present except: 46 None or choose something appropriate.
a. ↑ iron absorption. Iron absorption is adjusted to body needs. It is
b. Microcytis hypochromic blood film, 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
24
50 **Anemia of chronic diseases includes: 50 e. None of the above.

a. Vit B12.deficiency. Regarding erythropoietic factors, in ACD there
b. Pernicious anemia is increased secretion of TNF and IL-1 reduce
c. Increased secretion of erythropoitic factors. Epo production.
d. All of the above.
51 ***Hb H disease. 51 Choose Alpha thalassemia, or none

HbH = β4 and occurs when 4α genes are deleted
in α thalassemia.
51. In β-Thalassemia, which is true? a. In β thalassemia major, anemia presents at the

New age of 3-6 months when the switch from γ to β
a. It presents with severe anemia at the age of 6 months.
b. Blood transfustion may be required as frequent as chain synthesis normally occurs. Milder cases
every 9-12 months. 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
55 A patient after partial gastrectomy 55 IF deficiency.

a. Has no nutritional deficiency. Total or partial gastrectomy causes vitamin B12
b. Has IF deficit. 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: 57 c. All of the above.

a. Alcoholism. Macrocytosis occurs in; Alcoholism, aplastic
b. ↑Retics. anemia, liver disease, myxedema, MDS, retics,
c. All of the above. cytotoxic, MM and normally in neonates and
pregnants.
58 Urinary excretion of radioactive Vit B12 after oral and 58 After a loading dose of IV B12, oral radioactive
parenteral administration 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. Occurs with;
- Metformin. - Salazopyrine.
- Colchicin. - Cholestyramine.
- Anticonvulsants. - Triamterene.
- Paraaminosalicylic acid. - Anticonvulsants.
- Neomycin. - Anti TB
QUALITATIVE / QUANTITATIVE WBC DISOREDERS

60 ***Regarding cold agglutinins: 60 e. a and c
a. it is IgM Cold agglutinins are IgM, work at 4°c. It is anti I
b. It has specific anti I ab. in IMN and in idiopathic type, or both anti I and
c. It works at 4 C anti i in lymphocellular disorders.
d. None of the above
e. a and c
61 ***T lymphocytes found in? 61 e. Paracortical area of LN

a. Cortical area of L.N Follicles and
b. Germinal center Paracortex germinal center
c. spleen (T-cell) (B-cells)
d. L.N sinusoid
e. Paracortical area of LN
26
62 ***Infectious mononucleosis al are ture except? 62 (c) or (b) In IMN the following occur;
a. Heterophil antibodies agglutinate Ox RBCs, a. Heterophil antibodies agglutinate Ox RBCs,
b. Abnormal level of anti-1 specific IgG antibodies, b. Abnormal level of anti-1 specific IgM (not
c. Spontaneous rupture of spleen, IgG antibodies),
d. Lymphadenopathy & atypical lymphocytes, 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 + 64 a. Chediak-Higashi syndrome is an autosomal

thrombocytopenia + neutropenia occur in a case of: recessive diseases. WBCs show giant granules +
a. Chediak-Higashi syndrome neutropenia but normal neutrophil function.
b. Alder-Reilly syndrome. Also there is thrombocytopenia and albinism.
c. Pelger-Huet syndrome Alder-Reilly syndrome is an autosomal recessive
disease with prominent granules containing
excessive polysaccharides.
Pelger Hǔet 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 68 b. Defective neutrophil function.

immunodeficiency of which of the following? Chronic granulomatous disease is an X-linked
a. T-cell member disease that manifests in the second year of life
b. Defective neutrophil function. with ↑susceptibility to organisms of low
c. Hypocomplementemia. virulence e.g. staph. epidermidis, serratia,
d. Defeceient immunoglobulins. aspergillus, due to phagocytic disfunction.
e. ↓ neutrophils 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
70 Which is wrong : 70 b. T cells donot respond to IL-2 early in the

***. Regarding the function of T-cell, which is correct? immune response.
a. IL-1 is produced early in the immune response.
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 May-
Hegglin 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
LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS

79 **Prognosis of M4 is 79 Poor (x)
Prognostic Factors in AML
Favorable Unfavorable
older age: Age >60 is usually
considered a poor prognostic
factor because older patients
generally don't tolerate
young age
therapy & higher likelihood
of having unfavorable
prognostic factors e.g. special
cytogenetic abnormalities.
FAB types M2, M3, M4 FAB type M7
t(8;21) and t(15;17) bnormalities of
abnormality chromosome 11 at band q23
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
remission induction and trisomy 8
duration
reactivity with CD2(T1): The Hyperleukocytosis
presence of certain cell prior treatment
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: 80 b. bad prognosis

a. better prognosis.
b. bad prognosis
81 *****Bone marrow transplant indicated in all except? 81 c. Paget’s disease

a. ALL Indications for BMT are:
b. AML - ALL.
c. Acclertaed case of CML - AML
d. blast phase of CML - Chronic or accelerated phases of CML.
e. Paget’s disease - Severe aplastic anemia.
f. Osteogenesis imperfecta - Selected cases of:
g. B thalassemia major MDS, Lymphoma, MM, CLL
Thalassemia major, sickle cell disease.
82 **Bone marrow transplantation is not indicated in: 82 Severe inherited metabolic disease e.g.
a. CML phase. adenosine deaminase deficiency and
b. CML in chronic phase. Hurler's syndrome.
c. B thalassemia major.
29
83 All are very bad prognostic factors in ALL except? 83 None

a. Very high TLC count Bad prognostic factors in ALL are;
b. CNS involvement a. TLC > 50x109/L
c. Children less than 1 year old 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? 84 e. Monoblasts are +ve for NS & butyrate estrase.
a. Lymphadenopathy There is also tissue infiltration (gums with
b. soft tissue involvement hypertrophy)
c. Good prognosis compared with other leukemias,
d. More lysozyme level in urine & serum
e. +ive for non specific estrase,
85 **All may cause leukemia except: 85 (b) Alkylating agents (not methotrexate) are the
a. Ionising radiation. chemotherapeutics known to predispose to
b. Methotrexate. leukemia.
c. Down's syndrome. Ionising radiation predispose to AML. Down's
d. Benzene. syndrome is associated with increased incidence
e. Fungus. 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 cancer-
causing 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
86 ****In FAB classification, M3 = 86 Promyelocytic leukemia

FAB HISTOCHEMISTRY
M1 Occasional peroxidate+ granules, PAS-
M2 Strongly peroxidase+, PAS-
M3 Strongly peroxidase+, PAS-
Strongly peroxidase+, some cells may be
M4
PAS+
Many be peroxidase+ and PAS+,
M5 nonspecific esterase stains are strongly +
and inhibited by NAF
Red cell precursors are PAS+, ringed
M6
sideroblasts are seen with iron stains
Variable, platelet peroxidase can be
M7
demonstrated by electron microscopy
87 ***In acute promyelocytic leukemia, which is wrong? 87 b. In FAB classification promyelocytic
a. In FAB classification it is M4 morphology. leukemia is M3 not M4 morphology
b. DIC. M0 = Undifferentiated by morphology &
c. Multiple Auer rods. 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: 89 b. Promyelocytic leukemia is M3, It is associated

a. It belongs to M4 type. with DIC
b. Abnormal coagulation.
c. Leukocyte cell markers common.
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)
31
91 **Chromosomal abnormality of t(8:21) is associated with: 91 c. M2 associates t(8:21), M3 associates t(15:17)

a. CML, ALL. and CML t(9:22) (9 becomes Philadelphia
b. M1 chromosome.
c. M2
d. M4 with eosinophilia.
e. M5b
92 Chromosomal abnormality in M3 is: 92 t(15:17)
93 **Chromosomal translocation in case of CML is: 93 b. t(9:22)

a. t(8:21)
b. t(9:22)
c. t(11:14)
d. t(8:22)
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: 96 ALL constitutes 75% of childhood

a. Wilm's hematological malignancies followed by AML
b. Neuroblastoma (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 98 b. Adult T cell leukemia (CD25 and CD5)
following markers, CD1…%, CD2…% kappa chain +,
what is the diagnosis?
a. Adult T cell leukemia
b. CLL
c. Lymphosarcoma cell leukemia
99 ***In CLL: 99 ?
a. RAI classification III is either I or II with hemolytic According to RAI classification, III is 0 or I or II
anemia. but Hb is < 11g/dl due to marrow failure not
b. 5% terminate by Richter's syndrome. hemolysis.
c. 30% of lymphocytes agglutinate RBCs
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: 101 c. Hodgkin or a. Metastatic carcinoma***?
a. Metastatic carcinoma.
b. Chrome lymphoproliferative disorder.
c. Hodgkin
32
102 *****In MM, extramedullary plasmacytoma is likely to be 102 b. Extramedullary plasmacytoma occurs most
present in: commonly in nasopharyngeal sinuses.
a. Lungs. Heart, lung and kidney (nodular
b. CNS glomerulosclerosis) originate from tissues
underlying mm of GIT and URT.
103 *****In lymphocyte predominant CLL: 103 c. Lymph node effacement may be nodular or
a. Reed Sternberg cells are abundant. diffuse.
b. Bad in prognosis. In lymphocyte predominant HL according to
c. Lymph node effacement may be nodular or diffuse. Rye classification;
- Nodal architecture is lost
- Small homogenous lymphocytes.
- RS cells are little with no nucleoli.
***In CML *(AML)treatment, which is true: a. Folinic acid protects against the megaloblastic
a. Folinic acid protects against the megaloblastic effects effects of methotrexate .
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, b. b. small non-cleaved lymphoma.

poorly differentiated lymphoma is: Working Formulation for Non-Hodgkin's Lymphomas (NHL)
a. small cleaved cell lymphoma. Classifiable non-Hodgkin's Unaccounted-for non-Hodgkin's
lymphomas lymphomas
b. small non-cleaved lymphoma. Low-grade
c. diffuse mixed cell diffuse lymphoma. Small lymphocytic (CLL) Mucosa-associated lymphomas,
d. Large cell follicular lymphoma. CD5–, CD10–
Follicular, predemoninantly
small-cleaved cell
Follicular mixed, small-cleaved
and large-cell
Intermediate-grade
Follicular, predominantly large-
cell
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, T- Transformed from low grade NHL,
cell variants, non-cleaved t14;18+
High-grade
Large-cell, Anaplastic large-cell lymphoma,T-
immunoblastic 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/Sézary HTLV-1 lymphoma
syndrome T-cell CLL
Histiocytic Angioimmunoblastic
lymphadenopathy with
dysproteinemia
Unclassifiable
Angiocentric-type
Polymorphic reticulosis
Lymphomatoid granulamatosis
33
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 β emitter which is taken up by bone and
may be used to give prolonged myelo-
suppression (2yrs) in old patients. Effect may
take 2-3 months and lasts 6-36 months. But due
to side effects, it shouldn’t 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 Burkitt's lymphoma.

NHL is more common in children than HL.
Burkitt's is a NHL.
111 Bone marrow transplantation 111
112 **Waldenstrom's macroglobulinemia: 112 c. All of the above

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
113 In myelosclerosis all are ritght except: 113 c. Myelosclerosis is characterized by

a. Hepatomegaly. splenomegally, extramedullary hemopoiesis,
b. Pancytopenia leucoerythrocytic blood picture + replacement of
c. Hypocellular BM 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
34
117 **Sizary cell leukemia 117 Both

a. T-cell leukemia lymphoma Sezary syndrome is a T-lymphoid leukemia, a
b. Cutaneous T cell lymphoma 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
New New Staging in HL influences both treatment and
1 1 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.
118 In Non Hodgkin disease, which is true? 118 e. Most NHL are B cell in origin. Paradoxically,
New a. Most are T cells. New aggressive tumors respond more dramatically to
2 b. Good risk patients are sensitive to chemotherapy. 2 treatmet and are more likely to be cured than
c. BM is uncommonly involved. indolent tumors. Bone marrow is commonly
d. Histological classification is not as important as in HD. involved leading to BM failure. Treatment of
e. None of the above. NHL depends principally on the histological
classification (more than six histological
classifications for NHL).
118 In CML, which is not present? 118 a. In CML NAP score is low (<20, whereas an
New a. NAP is highly positive. New elevated or normal score (20-130) occurs in a
3 b. Splenometally is present in 80% of cases. 3 leukemoid reaction), splenomegally (often
c. WBC is commonly 500x109 at presentation. massive) occurs in over 90% of cases, WBC are
d. BCR +ve but Philadelphia negativecases may occur. 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 BCR-
ABL 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
120 **The following inhibits thrombus formation except 120 thromboxan.

Thromboxane is a platelet aggregator.
Inhibitors of coagulation include;
Serpentines:
ATIII
Heparin co factor II
α1 antitrypsin
C1 estrase inhibitor
α2 antiplasmin
α2 macroblobulin
Protein C system
Protein C
Protein S
Thrombomodulin
C4b binding protein.
121 ***Thrombocytosis seen in all except? 121 d. Fanconi’s syndrome.

a. Hemolysis Fanconi syndrome is congenital aplastic anemia
b. Hemorrage with pancytopenia and absent megakaryocytes.
c. spleenectomy
d. fanconi’s syndrome.
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 125 e. All of the above

a. SLE. 2ry auto immune thrombocytopenia occurs
b. scleroderma. secondary to:
c. Carcinomatosis - Blood disease (evan's syndrome)
d. CLL - General AI disease (SLE, RA)
e. All of the above - Lymphoprolyferative (CLL and
lymphoma)
- Solid tumors.
- HIV, chemoradiotherapy and BMT
- Post viral infection.
126 Thrombocytopenia is immune mediated in: 126 SLE.
36
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
- ↓αgranules: 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: 129 ??e. All of the above.
a. hypersplenism, ITP has no identifiable antecedent. The question
b. Sarcoidosis. may be about autoimmune thrombocytopenia
c. SLE. not ITP See 124.
d. Quinidine.
e. All of the above.
**In purpura: b. Hemorrhage in mucus membrane.

a. Hemorrhage in deep muscles.
b. Hemorrhage in mucus membrane.
c. Hemarthrosis.
131 In Bernar Soulier syndrome, all are right except: 131 a. Normal aggregation with ristocetin
a. Normal aggregation with ristocetin In Bernard Soulier syndrome there is ↓
b. Giant platelets adhesion (due to ↓ GPIb receptor that binds
c. ↓glycoprotein 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: 132 c. In vW disease there is:
a. BT is prolonged. ↑PTT
b. PT is normal. ↑BT (variable)
c. PTT is normal ↓ platelet aggregation with ristocetin
d. Platelet aggregation is normal
37
133 *****In Hemophilia A which is correct? 133 a. APTT is prolonged.

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

a. Factor VIII FVIIIc stimulating factor. vW disease is also
b. Cryoprecipitate. treated with DDAVP.
c. FFP
135 **Which test is used to diagnose factor XIII deficiency? 135 d. In FXIII deficiency there is normal clotting by
a. PTT. extrinsic and intrinsic tests and TCT. However
b. PT clots are friable and dissolve in 5M urea within
c. Thrombin time few houls.
d. Clot stability with urea
136 To differentiate between hemophilia A and B? 136 a. Individual factor assay. Also, thromboplastin
a. Individual factor assay. generation test (TGT) and plasma correction
b. ↑PT tests can be used.
c. ↑PTT
137 ****Which is wrong regarding heparin? 137 b. its action can be reversed by vit K . Heparin
a. Acts on thrombin. acts on ATIII (potentiates its action and directly
b. its action can be reversed by vit K binds thrombin).
138 ****Regarding protein C. which is wrong? 138 b. protein C inactivates FV and VIII and
a. Acts on thrombomodulin. activates thrombolysis. Protein S is a cofactor of
b. acts independent on protein S. 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 (*)
A blood smear shows 80 nucleated red cells per 100 leukocytes. c. 10.0 x 109 /L
9
The total leukocytic count is 18 x 10 /μl. The true WBC
expressed in SI units is:
a. 17.2 x 109 /L
b. 9.0 x 109 /L
c. 10.0 x 109 /L
d. 13.4 x 109 /L
Which of the following tests is used to monitor red cell d. Reticulocytic count.
production?
a. PCV
b. TIBC
c. Schilling test.
d. Reticulocytic count.
38
Which of the following conditions will increase ESR? b. Increased fibrinogen level.
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? e. None of the above.
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?
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
CLINICAL & CHEMICAL PATHOLOGY MCQ Immunohematology
Immunohematology
1. Serum of donner + RBC of patient is called: 1. a. minor cross matching = donor serum +
a. minor cross matching recipient cells.
b. major cross matching 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, 3. b. Febrile reactions due most frequently to WBC
after 5 hours he developed fever and rigors. This is likely reactive antigens and rarely to platelet antiesn
due to: occur after 30min to 90 minutes after starting
a. Platelet antibodies. transfusion.
b. Leucocyte antibodies
c. Bacterial infection.
4. Unsuitable donor. 4.
5 ****All diagnose hemolytic disease of new born 5 d. In HDN there is polychromasia and
except: NRBCs in peripheral blood of the baby.
a. Retics count. Tests done on cord blood Tests done on maternal blood
b. bilirubin - ABO & D group - ABO & D group
- DAT - Ab screen
c. DAT -Hb - Kleinhauer test.
d. Porphyrins. - Bilirubin
6 **For hemolytic disease all are true except? 6 a. HDN is an alloimmune (not autoimmune)
a. It is autoimmune disease, 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
7 ****Investigations useful in HDN: 7 All (see no 5)

a. Retics count.
b. Bilirubin.
c. DAT (+ve in alloimmune antibodies)
8 HDN which is not of value? 8 Cord Hb (x see 5)
9 ****Blood transfusion can transmit: 9 d. All of the above

a. HIV
b. HBV
c. CMV
d. All of the above
10 The blood donor in KSA can not be with all of the 10 e. previous pregnancies
following except: Possibly transmissible infections not routinely
a. donor infected with HIV tested are:
b. donor infected with hepatitis - B. burgdorferi.
c. donor infected with syphilis - Y. enterocolitica
d. donor infected with malaria - P. falciparum.
e. previous pregnancies
40
CLINICAL & CHEMICAL PATHOLOGY MCQ Immunology
Immunology
1. **Antigen & antibody reaction is? 1. b. Immunodiffusion is the process of diffusion in
a. Agglutination semisolid media to detect amount of antibody to
b. precipitation neutralize antigen. Agglutination necessitates an
c. immunodiffusion, indicator system e.g. RBCs or latex particles.
2. **Hook effect in immune assay occurs because the 2. b. The hook effect is the result of very high
concentration of antibodies in the well is? antigen levels giving lower than expected result
a. Too low in a double antibody sandwich assay.
b. Too high
c. Optimum
3. **Antigen & antibody complex are? 3.

a. Weakly bound
b. strongly bound
c. no bound at all.
4. ***Reaginic antibody is: 4. d. Reagenic or anaphylactic mechanism refers to

a. IgG events following combination of antigen with
b. IgM IgE molecule specific for it upon the surface of
c. IgD mast cells.
d. IgE
5. Arthus phenomenon results from: 5. ??b. Antibody excess.

a. Antigen excess. In arthus phenomenon, a high antigen
b. Antibody excess. concentration is attacked by a high antibody
c. Antigen and antibody in equal proportions. concentration→ excess antigen antibody
complexes followed by local tissue damage.
6. **Lysis in complement fixation test means the test is? 6. b. In CFT, absence of hemolysis indicates that
a. Positive complement was fixed in antigen antibody
b. negative reaction so specific antibody was present.
c. invalid.
7. **All tube for serial dilution for CRP test contain 0.5ml 7. None (something missed in the question).
of saline & 0.5ml of serum is added to Tube 1 & 0.5ml is The titer in the 7th tube = 27 = 128
transferred through the row of tubes & agglutination is So, the concentration of CRP= 128x6= 768mg.
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..
8. **CRP is tested because it is increased in? 8. b. CRP is a sensitive non specific indicator of
a. Bacterial infection acute injury, bacterial infection or inflammation.
b. viral infection
c. other infection.
9. In infectious monopnucleosis antibodiesare? .________ 9. Anti (I)
41
CLINICAL & CHEMICAL PATHOLOGY MCQ Immunology
10. ******Which of the following reagin test for syphilis? 10. a. Reagin = Antibody against cardiolipin.
a. VDRL Reagenic tests are VDRL, RPR and
b. TPHA Wassermann (CFT).
c. TPT
11. **Antigenic detection is useful in diagnosis of all of the 11. c. Because L. monocytogens is an intracellular
following escept: organism.
a. B hemolytic Streptococci.
b. H. influenza.
c. Listeria monocytogenes.
31. ****Antigenic methods are useful in diagnosis of all of 31.

the following cuases of meningitis except:
a. Strept B hemolyticus.
b. H. influenza
c. E. coli
e. listeria
12. **Autoimmune disease contain all except? 12. d. In AI diseases there is ↑ autoantibodies →
a. Lesion in B/M immune complex formation → complement
b. low complement level in serum fixation → ↓ complement.
c. immune complex in serum Also there is cell death or altered function.
d. low Ig in serum.
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 15. Tuberculin

mediated immunity?
16. ***Mantox test is a method for 16. Tuberculin
17. Immune complex deposits. 17.
42
CLINICAL & CHEMICAL PATHOLOGY MCQ Microbiology
Microbiology
ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION

1. **Antibiotic used for each organism are 1. .
a. Pneumonia a.-penicillin
b. Legionella b-erythrocin
c. S. pyogens c. penicillin
d. H.infuenza. d-ceftriaxone
e. P. enterocolitis e- vancomycin
2. **Tetracycline is identical in action with – 2. Aminoglycoside
Aminoglycosides act on 30s ribosomal
subunit.as tetracyclines.
3. **Which is effective against penicillinase producing 3. Nfcillin or dicloxacillin.

organism.
4. The best chemical disinfectant in a TB lab? 4. a. Phenol, although effective against TB, is
a. Gluteraldehyde rarely used being too caustic. Ethanol is not
b. ethanol effective (TB are alcohol resistant).
c. phenol Glutaraldehyde is used to sterilize respiratory
d. hypochlorate, equips and is effective against TB.
5. ***What is lab safety level you will employ for the culture 5. d. Biosafety levels are designed according to
of brucella? risk group of the lab;
a. Routine precaution Risk Description Biosafety
group level
b. bio safety level 1,
1 Organisms are low risk to lab 1
c. bio safety level 2 workers and community
d. bio safety level 3 (common organisms)
e. no specific measure 2 Moderate risk to lab workers 2
limited risk to community e.g.
staph, strept., vibrio
3 High risk to labo workers, 3
low risk to community (don’t
spread rapidly) e.g. brucella,
TB, Salmonella
4 Viruses, high risk to lab and 4
community
6. β-lactamase resistant penicillin for staph 6. Cloxacillin.
7. *****Sterility is achieved by: 7. c. Sterilization means killing or removal of all

a. Pasteurization. microorganisms including spores e.g.
b. Disinfection. autoclaving, ethylene oxide, filtration.
c. asepsis. Disinfection means killing of many (not all)
d. All of the above. microorganisms e.g. phenol, ethanol, iodine
e. None of the above (antiseptics).
8. ***Intrinsic resistance for vancomycin is present in: 8. a. Penicillin-resistant bacteria (both act on cell
a. Penicillin-resistant bacteria wall)
b. C. deficile. Most important use of vancomycinis against
c. Staph sensitive to cloxacin. staph aureus that are resistant to penicillinase
resistant penicillin e.g. nafcillin.
43
9. ***Which of the following is not an aminoglycoside? 9. b. Erythromycin.

a. amykacin.
b. Erythromycin.
c. Neomycin.
d. Sissomycin
10 **Pasteurization gives guarantee of: 10 a. Kills spores sterilization.

a. Kills spores sterilization.
b. Disinfection.
c. Saponification.
11. For penicillin resistant pneumococci, which is used? 11. b. Ceftriaxone.

a. Ampicillin.
b. Ceftriaxone.
c. Cefuroxime + Rifampicin.
d. Ampicillin + Rifampicin
12. Cephalosporin resistant bacteria producing beta 12. a. β lactamases are produced by;
lactamase is: B. fragilis.
a. E.coli. N. gonorrhoea.
b. Y. Enterocolitica 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 15. b. Gangerous obstructed loop.
in:
a. Acute appendicitis.
b. Gangerous obstructed loop.
c. Abdominal hernia.
16. Bronchoscope 16. Glutaraldehyde
17. ***- Which is the best way to sterilize a bronchoscompe? 17. a. Autoclave.is used for heat resistant parts but
a. Autoclave. ethylene-oxide may be used for heat labile
b. Ethylene-oxide. parts.
c. Gamma rays.
d. None
BASIC TECHNIQUES
18. **Castanida medium for blood culture contain? 18. Both liquid & solid media in same bottle.
19. **Medium for each: 19.

a. TB a. L.J medium
***b. Gonoccoci b. Chocolate agar or Thayer martin media
c. C. Diphtheria c. Löefflers media
d. Staph. Aureus d. Blood agar
44
20. **If you forget iodine step in gram stain staph aureus will 20. Red
be seen?
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? 23. None

a. Enterobacter, On CLED;
b. salmonella Salmonella gives flat blue colonies.
c. klebsiella Klebsiella gives mucoid yellow colonies.
d. enterococci. Enterococci give yellow translucent colonies.
24. ***Gram stain best done in? 24. b. Growth of bacteria on media follows the
a. Lag phase following phases;
b. log phase - Lag phase; phase of accommodation to
c. static phase medium. No net growth
d. death phase. - 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? 25. c. trace of free O2

a. 10% CO2
b. anaerobic
c. trace of free O2
26. **Which agar concentration is the best to detect bacterial 26. b. 0.5%
mobility? For solid medium 1.5-2% concentration is
a. 0.01% used.
b. 0.5%
c. 1.5%
d. 2%
e. 4%
27. ***Best time to read oxidase test is within: 27. b. 10 seconds
a. 5 seconds.
b. 10 seconds.
c. 1 minute.
d. 2 minutes.
e. 5 minutes.
28. ***In ZN staining used for M. leprae, the decolorizing 28. d. None of the above.
agent used is: 5% H2SO4 or 3% acid alcohol.
a. 5% acetone.
b. 5% acid alcohol.
c. 5% hydrochloric a.
29. ***Which of the following is a chemical fixative? 29. c. Methyl alcohol

a. Formalin.
b. Mercuric chloride
c. Methyl alcohol
d. All of the above
45
30. ****When urine is preserved for culture it should be: 30. e. (check also for b.) If a delay > 1-2 hours is
a. preserved at room temperature. unavoidable multiplication of bacteria can be
b. Preserved in refrigerator. prevented by;
c. preserved with nitric acid. - Storage in refrigerator at 4°c
d. Preserved with sulfuric acid. - Collected and transported in a container of
e. Preserved with boric acid. 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: 32. ??d. None of the above
a. Mycobacterium ?? c. Staph. aureus may cause septicemia.
b. Diphtheria
c. Staph. Aureus
33. Solid media include: 33. d. All of the above

a. Slant.
b. Streak plates.
c. Pour plates.
d. All of the above
BASIC BACTERIOLOGY
34. **Cell wall is absent in? 34. a. Mycoplasma is the smallest organism
a. mycoplasma capable of self replication. It possesses cell
b. bacteria constituents of bacteria except cell wall.
c. fungi Instead, there is a triple layer cytoplasmic
c. viruses membrane.
35. **Sterol is the main constituent of cell wall of: 35. a. Unlike the cell wall of bacteria,
a. Mycoplasma. mycoplasma cell membrane contains
b. Rickettsia. cholesterol or carotenol in addition to the
c. Chlamydia. usual mural and phospholipids.
d. Leptospira.
e. Staph.
36. ***Which of the following contains more peptidoglycan? 36. a. The peptidoglycan layer is much thicker in
a. G+ve bacilli. Gram positive than in Gram negative bacteria.
b. G-ve bacilli. Richetsia cell wall similar to that of Gram
c. Chlamydia. negative bacteria. Chalmydia cell wall is
d. Richetsiae. similar to that of Gram negative bacteria but
no muramic acid.
37. ***Sedimentation constant of bacterial ribosomes is: 37. c. 70s

a. 40s Bacteria has 70s ribosomes with 30s &50s
b. 60s subunits.
c. 70s Mammalian ribosome has sedimentation
d. 80s coefficient of 80s with 60&40s subunits.
38. ***Endotoxins are chemically: 38. c. Endotoxins are integral part of G-ve
a. Mucopeptides. bacteria. They are LPS whereas exotoxins are
b. Proteins. polypeptides.
c. Lipopolysaccharides.
d. Polysaccharides.
46
39. ***L forms differ from parent cells in all of the following 39. c.
except:
a. Lack rigid cell wall.
b. Lack regular shape.
c. Cannot grow and multiply on nutrient medium.
d. Lack regular size.
40 ***Bacterial genes are transferred by all of the following 40 c. The transfere of genetic information
means except: between bacterial cells can occur by 3
a. Transformation. methods: conjugation, transduction and
b. Transduction. transformation (see table p16 Jawetz review).
c. Mutation.
d. Conjugation.
41. **Sepsis cause 41. Toxic granulomas.
41. Which is not a super antigen? 41. b. Psuedomonas exotoxin A.

New a. TSSA New
b. Psuedomonas exotoxin A.
c. Tetanus toxin.
d. Diphtheria toxin.
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 45. coagulase test. Pathogenic staph is aureus
staphylococci use species.
46. **Most streptococcus infection to human is 46. A & B hemolyticus.
47. ***To differentiate A & B hemolytic streptococci we use 47. a. Group A strept is bacitracin sensitive while
a. bacitracin group B is bacetracin resistant.
b. optochin Optochin is used to differentiate αhemolytic
c. ampicillin strept (pneumococci are sensitive and strept
viridans is resistant)
48. **Commonest disease caused by streptococcus pyogenes 48. sore throat

is. Strept pyogenes cause three types of diseases;
- Pyogenic (pharyngitis and cellulites)
- Toxigenic (TSS and scarlet fever)
- Immunogenic (Rheumatic fever and AGN)
47
49. **Food poisoning symptom [vomiting] 4 hrs after 49. b. staph aureus enterotoxin
ingestion of food seen in?
a. E.coli
b. staph aureus enterotoxin
c. salmonella typhi
d. vibrio cholera
50. ***Strept pyogenes cause all except: 50. Toxic shock syndrome (check this answer
118. Streptococcus cause all except: 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: 53. a. Staph don’t produce endotoxins (being
a. Protein A Ab. gram positive). Anti Dnase is used mainly for
b. Anti DNase. strept. Protein A antibody methods are
c. Endotoxins diagnostic for staph disseminated lesions.
54. *****The following differentiates between staph. 54. Novobiocin.

Pyogenes and strept epidermidis: Novobiocin is used to differentiate staph
epidermidis (sensitive) from staph
saprophyticus (resistant). To differentiate
staph pyogenes
55. ***The epidemiological marker used most frequently in 55. a. Phage typing.
strain differentiation of Staph. aureus is:
a. Phage typing.
b. Biotyping.
c. Serotyping.
d. Bacteriocin typing
56. **All of the following species of streptococcus are B 56. b. Strept. pyogenes is β hemolytic, Strept.
hemolytic except: avium is α hemolytic, Strept. salivarius is non-
a. Strept. Pyogenes. hemlytic.
b. Strept infrequens.
c. Strept. avium
d. Strept. salivarius
57. **Which organism grow on NaCl concentration 6gm/L? 57. Streptococcus.

Strept fecalis grows on 6% NaCl while strept
bovis don’t.
58. Staph. 58. Catalase test

Staph is catalase positive.
59. Test used to differentiate staph. aureus 59. b. Coagulase is used to diagnose staph aureus
a. Catalase (positive) from other staph and strept.
b. Coagulase Catalase is used to differentiate staph from
c. Dnase strept., Dnase and ASOT are used to diagnose
d. ASOT strept.
48
60. **ASOT is used to detect: 60. Strept. pyogenes.
GRAM NEGATIVE COCCI

61. ***Differenciation of N. gonorrhaea from N. Meningitis 61. N. Gono N.Menin
by sugar fermentation? Maltose - +
Glucose + +
Sucrose - -
62. ****In N. gonorrhoea causing dissiminated lesion 62. a. Oral penicillin, cirprofloxacin or
(systemic manifestation), which of the following is doxycycline are used in gonococal arthritis.
incorrect.
a. Sensetive to penicillin (G+ve only)
b. Resistant to ampicillin
63. Meningococcemia causes: 63. Waterhouse Fredrichson syndrome.
64. Neisseria gonorrhoea can cause which of the following? 64. b. N. gonorrhoea may cause septicemia and
a. Osteomyelitis. suppurativeartheritis and hemorrhagic skin
b. Artheritis. papules.
c. Septicemia.
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. 67. b. Elick's test is in vitro plate test for toxin
iphtheria? production. Schick test in an ID test for
a. Dick test. susceptibility to diphtheria, if immune →-ve
b. Elick's test. (no reaction).
c. Schick test.
d. None of the above.
68. ******A memberane on the pharynx on removal it leaves 68. a. Diphtheria.

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
69. ***A CSF culture revealed an organism that is G+ve at 69. Listeria.
37ْ c and no growth at room temperature. This is most Something missed in this question; Listeria is
likely to be: motile at 25°c not at 37°c. It grows on a wide
range of temperature (3-43°c)
70. Neonatal meningitis G+ve rods. 70. L. monocytogens.
71. Listeria monocytogens. 71.
49
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? 74. a. Madura food is a subcutaneous infection
a. Fever. with fungi (e.g. eumycates) or actinomyces.
b. bone involvement There is discharge from sinus tract, bone
c. Draining sinus tract involvement follow. Systemic symptoms are
d. granules in discharge uncommon, and so is LN.
e. Caused by fungus or bacteria.
ENTEROBACTERECIAE & PSEUDOMONAS

75. **Mobile bacilli are? 75. E.coli, V.cholera, salmonella, pseudomonas,
proteus,
76. **Proteus is 76. Motile gm –ive bacilli, NLF, produce
swarming on BA.
77. **Most common agent causing UTI is? 77. a.

a. E.coli
b. klebsiella
c. proteus
d. seudomonas,
78. **IMViC reaction of E.coli & klebsella are? 78. E. coli is ++-- Klebsiella is --++
79. **Example of NLF colonies on MacConkey agar ? 79. NLF (produce pale colored colonies):
28. Examples of LF colonis on MacConkey agar? 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. proteus.

Also, Klebsieall and pseudomonas.
84. Urease present in all except? 84. c. Not only sh. Sonni, but also Shigella A,B
a. Brucella.abortus, and C.
b. Brucella.melitensis,
c. shigella sonni,
85. **Which strain of E. coli cause HUS? 85. a. EHEC 157 = VTEC 157
a. VTEC O157, H7
b. EPEC O157:H7
86. E. coli, Klebsiella and proteus are 86. Commensals of GIT
87. E.coli is indole? 87. Positive

Also proteus is indole positive.
50
88. **Psuedomonas infections include? 88. May cause UTI, otitis media & eye infection,
Bed sore, burns,
89. **Psuedomonas is? 89. Motile gm –ive bacilli, NLF, produce
pigmented colonies
90. **Psuedomonas aerogenosa produce? 90. Blue green pigments,
Pyocyanin & biovirdin.
91. Contamination of sterile fluid is 91. pseudomonas.
92. **An abscess with bluish green discharge caused by? 92. c.
a. Staphlococcus
b. proteus
c. seudomonas.
93. ****Hospital fluids are usually contaminated by: 93. a. Pseudomonas are able to grow in water with
****120. Organism of medical fluids is: traces of nutrients.
a. Pseudomonas.
b. Staph.
c. Strept.
94. Pigments of pseudomonas aerogenosa 94. Both Fluorescin (pyovirdin) and pyocyanin
95. **Widal test used in the diagnosis of? 95. a. Typhoid fever
a. Typhoid fever
b. malaria
c. malta fever
d. brucellosis
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? 99. c. Blood culture are usually positive 90% in
a. Feces. the first week of fever, thereafter rate of
b. urine. posistivity decreases. Stool culture are
c. blood. positive throughout the course of disease.
d. CSF 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
105. ****All of the following is correct regarding enteric fever 105. Localized gut disease.
except:
106. **Microscopic appearance of Yersinia pestis is? 106. G-ve coccobacilli.
107. ******Dog bite G-ve bacilli isolated is propably: 107. a. Pasteurella multucida
a. Pasteurella multucida
b. H. influenza.
c. B. Abortus
d. toxocara cannis
108. **Cholera is caused by? 108. a. V. cholera

a. V. cholera
b. E.coli
c. proteus
d. seudomonas.
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: 111. c. stimulation of membrane bound

a. irritation of intestinal mucosa by vibrio. adenylecyclase
b. attack of intestinal mucosa by the toxin.
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
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. Spirochate, can be demonstrate by dark field

microscopy.
120. **Treponema pallidum causes? 120. a. Syphilis
a. Syphilis
b. TB
c. meningitis
d. AIDs
121. ***Bejel is characterized by all except? 121. Both are OK. Bejel is non venereal disease
a. Non veneral transmission caused by T. pallidum endemicum. It is a
b. Caused by ariant of Treponema pallidum. highly infectious skin in fection.
122. *****Which of the following accurately don't describe 3ry 122. a. Ulcerative skin lesions.
syphilis:
a. Ulcerative skin lesions.
b. Gummas in internal organs.
c. Rare spirochetes in lesions with limited tissue damage..
123. **Yaws disease 123. Caused by Treponema pertenue

Characterized by ulcerating papule, scar
forming and may cause bone destruction.
HEMOPHILUS
124. **Hemophilus grows uxuriantly on? 124. Chocolate media.
125. ****Satellitism is exhibited by? 125. Hemophilus influenza around staph. Aureus
a. H. influenza.
b. N. meningitides.
c. mycobacteria
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 don’t 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
BORDETELLA & BORRELIA

132. **Bordetella pertusis are? 132. Strictly aerobes.
53
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? 134. a. B. recurrentis and duttoni casue replapsing
a. Relapsing fever. fever. B. burgdorferi cause lyme disease and
b. Q fever Q fever is caused by coxiella burnetti.
c. Rheumatic fever.
d. enteric fever.
ANEROBIC BACTERIA
135. **Gm +ve bacilli with terminal round spores resembling 135. Clostridium welchii,
match stick are Also called perfrengins.
136. **Nagler reaction used for - Rapid identification of Cl. Welchii

Lecithenase L G
(Negler's)
C. deficile & - - + Lecithinase –ve
botulinum Saccharolytic
NLF
C. perfringens + + + Lecithinase +ve
Saccharolytic
LF
C. tetani - - - Lecithinase –ve
asaccharolytic
NLF
137. **Clostridia are 137. Gm +ve anaerobic bacilli
138. **Bacteroid is resistant to? 138. c. aminoglycoside. Also to penicillin (a),
a. Penicillin neomycin and kanamycin. Chloramphenicol is
b. metronidazole highly effective.
c. aminoglycoside
d. chloramphenicol.
139. **Stormy fermentation is seen in? 139. b. Cl. Perfringens in litumus milk medium
a. Cl. Histolyticum produces A&G, the acid clots milk and the gas
b. Cl.prefrenges breaks the clot producing stormy
c. Cl.septicum. fermentation.
140. **Bacteria that can be best identified best by direct 140. a. Vincent bacillus
Gram's film is?
a. Vincent bacillus
b. campylobacter
141. *****The following combination is isolated from pus from 141. a. B. fragilis.and streptococcus.
deep pyonidal sinus:
a. B. fragilis.and streptococcus milits.
b. B. fragilis and B. abortus.
c. Strept B.hymolitic and streptococcus.
142. Suitable medium for anerobic bacteria 142. Blood

(selective or non selective), others include;
- Cooked meat broth (CMB)
- Thyoglycolate.
- BHI
54
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 146. a. Other symptoms and signs include;
diagnosis is? - Arthralgia
a. Brucella - Sweating
b. staphylococcus - Heptatosplenomegally.
c. streptococcus
d. gonorrhea
147. **Bacteremia is seen in: 147. a. Both tetanus and shigellosis are localized
a. Brucella. infections. Brucella enters through the mouth,
b. Tetanus. lung or skin to local lymph nodes to blood to
c. shigellosis 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. ***TB culture takes 152. d. 3-6 weeks.

a. 2-4 days.
b. 12 days.
c. 3-6 weeks.
d. 6-10 weeks.
153. **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 156. a. MTB complex include TB, M. africanum,
MTB complex? M. bovis, BCG and M. microtti..
a. Mycobacterium Africanum.
b. M. leprae
55
157. Acid fast bacilli in stool = 157. TB
158. *****Diagnosis by direct staining: 158. a. Acid fast smear is number one rapid test for
a. TB mycobacterium TB. Positive smear has a
b. Hemophylus predictive value of 96%.
159. Which of the following belongs to PTB family? 159. a. MOTT (mycobacteria other than TB) are
a. M. Kanasasi. classified into;
b. M. Bovis. - Photochromogens: M. kansasii, M. marinum.
c. M. intracellulare. - Scotochromogens: M.scrofulucian, M.
d. M. africanum. 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? 162. d. G.vaginalis produce fishy smelling
a. Gardnerella infection discharge, TV produce thin bubbly fishy
b. trichomonas vaginalis smelling discharge, Chlamydia produce thin
c. Chlamydia discharge. Cryptococcus is a lung infection.
d. ryptococcus.
163. **Sterile pyuria not seen in? 163. c. Causes of sterile pyuria;
a. TB TB
b. non specific urithritis Mycoplasma
c. urine collection by suprepubic puncture Leptospirosis
d. prior treatment with antibiotic Vaginal contamination
Antibiotics, L forms
Abacterial cystitis
Non infectious disease e.g. tumour, FB
164. **Diagnosis of bacterial endocarditis? 164. b. blood culture

a. Urine culture
b. blood culture
165. *****Aspergelloma: All correct except: 165. b. Aspergelloma is a ball of aspergillous

a. Lungs are the most common site. growth. It may affect children with preexisting
b. no organism is present in lesion. pulmonary condition.
c. Affect children.
166. **Which combination is wrong? 166. Non-specific urethritis: Penicillin.
167. Zoonotic disease 167.
56
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: 171. a. Microsporum ausdonii cause tenia capitis.
a. Microsporum. Trychophyton causes tenia pedis or unguium.
b. Trichophyton.
c. Candida
172. *****T. vaginalis may be mistaken for: 172. a. White cells.

a. White cells.
b. RBCs.
c. Candida.
57
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? 183. a. B//M biopsy

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

a. Skin biopsy
b. Culture,
185. The following parasite doesn’t not involve GIT in man? 185. b. cysticercosis
a. Ascaris
b. cysticercosis
c. H.nana
d. Tenia
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: 187. a. Female anopheles mosquito.
a. Female anopheles mosquito.
b. Culex mosquito.
c. Tsetse fly.
58
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: 193. d. All of the above

a. Iodine.
b. Fluorescent.
c. Trichrome
d. All of the above
59
VIROLOGY
194. *******HAV all are correct except: 194. b. There is chronic carrier state in young
a. Infection in adults is more severe than children, children.
b. There is chronic carrier state in young children.
c. Vaccination is recommended for high risk group.
195. **Best sample for the diagnosis for recovery of polio is 195. feaces.
Also from throuat and spinal fluid.
196. **Virus & living cells resemble in 196. reproduction.
197. **Latent infection seen in all except? 197. a. Herpes virus (?? HS causes latent infection)
a. Herpes virus
b. adeno virus
c. coxsackie virus
d. retorvirus.
198. **Which of the following virus causes systemic effect? 198. There may be a missing "except" in this
a. Poliovirus question because adeno cause RTI and
b. adenovirus hemorrhagic cystitis and GE. Influenza and
c. rhinovirus polio also cause systemic effect. Rhino is an
d. Influenzea virus. exception.
199. ***Which is not correlating? 199. RSV keratitis in AIDS patients.
200. ****Which combination is wrong? 200. b. Antigenic shift is a character of influenza

a. Rubella: arthritis in young women. virus
b. Mumps: Antigenic shift
c. Coxsackie: Meningitis.
d. EBV: Heterophil Abs.
201. *****Which of the following can pass to fetus 201. c. CMV

transplacentally?
a. HSV.
b. VZV.
c. CMV
202. ***Who of the following is supposed to transmit CMV 202. d. Neonate with congenital defect due to CMV
infection to hospital staff? infection.
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
203. **All diagnose viral infection except: 203. a. IgM Ab is one serum only.
**Which diagnose viral infection? A high IgG titre in serum in acute and
a. IgM Ab is one serum only. convalescent stage may be due to
b. High IgG titre in serum in acute and convalescent stage. immunization. 2 fold increase in IgG ??. IgE
c. 2 fold increase in IgG is regain of allerty not infection.
d. 4 fold increase in viral specific IgE in acute and
convalescent stage.
e. All of the above
60
204. ****RSV all correct except: 204. a. RSV is a paramyxovirus. It is the most
a. Rectal sample gives the highest yield of the virus. important cause of pneumonia and
b. Form a syncetium in tissue. bronchiolitis in infants.
c. Causes lower respiratory illness in children.
d. Related to paramyxoviruses.
205. **In a patient with rabies infection, the main histological 205. c. Negri bodies.
characteristic in the brain is:
a. Lewi bodies.
b. Durel bodies.
c. Negri bodies.
d. Amyloid plague
206. Enteroviruses cannot be isolated from which of the 206. d. enteroviruses isolated from throat e.g. polio,
following specimens? from feces e.g. polio and hepatitis, from CSF
a. Throat swab. e.g. coxsachie virus. Enteroviruses resist
b. Fecal specimens. gastric acidity.
c. Gastric fluid.
d. Urine.
e. CSF.
207. Herpes zoster 207. Localised
208. Regarding rotavirus, all are correct except: 208. None

a. DS-RNA virus Rota virus is a dsRNA virus, it is diagnosed in
b. cause majority of infant diarrohea feces by ELISA. It causes a significant
c. diagnosed in feses by ELISA 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 211.

patient?
61
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
 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
CLINICAL & CHEMICAL PATHOLOGY MCQ Shawual 1425 Exam
26th Shawual 1425

1. ****Calcium in urine stone is present in all of the follwing except: See Q9 body fluids
a. UTI
b. Secondary hyperparathyroidism.
2. Acidemia is associated with See Q 11 Chemistry.
3. ***To correct acidosis, the kidneys: See Q 12 Chemistry

a. secrete more H+ in urine.
b. Synthesis bicarbonate to ECF
c. Both a and b
4. ***What is the base: acid ratio at pH 7 for acid of pK6? See Q 15 Chemistry
a. 0.01
b. 0.1
c. 1.0
d. 10
e. 100
5. ******Metabolic acidosis can result from: See Q 17 Chemistry
6. **All causes renal damage except See Q 23 Chemistry
***Main extracellular ions? See Q 20,21, 22, 24, 25, 26.Chemistry

7. 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.
8. Glycogen differs from starch in: See Q 34 & 35 chemistry

a. Cellulose is not metabolized in humans because of absence of enzyme
b. Repeating units.
9. **Xylose test is done to detect the function of: See Q 36 chemistry

a. Stomach.
b. Pancreas.
c. Upper small intestine.
d. Lower small intestine.
e. Large intestine
10. ****Von Gerke's disease is caused by deficiency of: See Q 37 chemistry

a. Glucose 6 phosphatase
b. Glucose 6 phosphate dehydrogenase
11. What happens if sucrose is given paretnrally: See Q 38 chemistry
64
12. ***Which of these is not a ketone body? See Q 39 chemistry

a. Acetone.
b. Acetoacetic acid.
c. Butyric acid.
d. B-hydroxy butyric acid.
13. ***Which of the following result shows renal improvement? See Q 53 chemistry
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.
14. **Low GFR occurs in all except: See Q 54 chemistry

a. Congestive heart failure.
b. Urethral obstruction.
15. **Gluconic amino acids include: See Q 64 chemistry

a. Alanine.
b. Methionine.
c. Valine.
d. Glutamic acid.
e. All of the above.
16. ***Which lipoprotein has highest concentration of cholesterol? See Q 72 chemistry

a. VLDL
b. LDL
c. IDL
d. HDL
17. ***In MI, which is the last enzyme to be raised and lasts long? See Q 85 chemistry
a. CK
b. CK-MB.
c. AST.
d. LDH
18. **Isoenzymes: See Q 86 chemistry

a. Are physical types of one enzyme.
b. Have different electrophoretic mobility.
c. All of the above
19. *****ADH is? See Q 90 chemistry

a. Produced by posterior pituitary
b. Produced in the hypothalamus.
20. ****Error in the result is expected in which case? See Q 4 general
a. Glucose on fluoride.
b. Glucose on EDTA
c. Calcium on oxalate
21. ***In Pyruvate Kinase deficiency all correct except? See Q 15 hematology
a. Intermittent attach of anemia.
b. Splenectomy is a choice of treatment.
c. Autosomal recessive.
22. **In A sickle cell disease patient under general anesthesia, all true except? See Q 16 hematology
65
23. **In favism, See Q 20 & 28 hematology

a. The defect is in
b. which is affected
24. ***Free plasma Hb is bound to: See Q 27 hematology
25. **In hereditary spherocytosis which is false: See Q 29 hematology

a. It is autosomal dominant disease.
b. Treated by splenectomy.
b. Thin underhemoglobinized RBCs are seen in blood film.
26. **Normal Hb pattern? See Q 45 hematology
27. ****Chronic granulomatous disease is due to immunodeficiency of which of See Q 68 hematology

the following?
a. T-cell member
b. Defective neutrophil function.
c. Hypocomplementemia.
d. Defeceient immunoglobulins.
e. ↓ neutrophils
28. ****Paraprotiens are? See Q 97 hematology

29. ***In CLL, all are true except:: See Q 99 hematology
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
30. ***In CML treatment, which is true: See Q hematology

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.
31. ****All diagnose hemolytic disease of new born except: See Q 5 immunehematology
a. Retics count.
b. bilirubin
c. DAT
d. Porphyrins.
32. ***Tuberculine test is type. See Q 13 immunology
33. Cell mediated immunity = See Q 14 immunology

34. β-lactamase resistant penicillin for staph See Q 6 Microbiology
35. **Sterol is the main constituent of cell wall of: See Q 35 Microbiology
a. Mycoplasma.
b. Rickettsia.
c. Chlamydia.
d. Leptospira.
e. Staph.
36. **Which strain of E. coli cause HUS? See Q 85 Microbiology

a. VTEC O157, H7
b. EPEC O157:H7
66
37. Organism associated with atherosclerosis: See Q 115 Microbiology

a. Chalmydia trachomatis.
b. Chlamydia pneumoniae
d. Mycoplasma
38. ***TB culture takes See Q 152 Microbiology

a. 2-4 days.
b. 12 days.
c. 3-6 weeks.
d. 6-10 weeks.
39. *****Aspergelloma: All correct except: See Q 165 Microbiology
a. Lungs are the most common site.
b. no organism is present in lesion.
c. Affect children.
40. ******Candida is identified by See Q 168 Microbiology
41. *******HAV all are correct except: See Q 194 Microbiology

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? See Q 199 Microbiology
43. ****Which combination is wrong? See Q 200 Microbiology

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 See Q 202 Microbiology
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: See Q 203 Microbiology

**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
46. In β-Thalassemia, which is true? See Hematology 51 new

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.
47. Which is true regarding DAT See Hematology 41 New

a. It is positive in all IHA.
b. may detect complement attached to RBCs.
67
48. Regarding concentration of urine; See Chemistry 28 New

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.
49. H+ homeostasis is altered by; See Chemistry 19. New
a. Excessive change of pyruvate to lactate.
50. Hemoglobin breakdown takes place in: - See Hematology 14.New

a. RES
b. Hepatocytes.
c. Renal tubules.
51. Carcinoid tumors secrete See chemistry 98 New
52. Which is not a super antigen? See microbiology 41. New

a. TSSA
b. Psuedomonas exotoxin A.
c. Tetanus toxin.
d. Diphtheria toxin.
53. In Hodgkin disease all are true except See Hematology 118 New1
54. In Non Hodgkin disease, which is true? See Hematology 118 New2
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.
55. In CML, which is not present? See Hematology 118 New3

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.
56. In enzymopathies, which is false:
57. Regarding excretion of Na+ See Chemistry 28. New 2

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+
58. Regarding buffer systems; See Chemistry 28. New 3
b. An acid is a substance that releases H +
c. Buffering involves change of strong acid to base.
68

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Clinical & Chemical Pathology MCQs

3. *****Regarding Albustix: 3. (c) Commercial strips for detecting albumin

10. If urine is kept for a long time: 10. See 7.

2. The label in ELISA is? 2.

BLOOD GASES, PH AND ELECTROLYTES.

14. ****pH means: 14. Negative log H+ concentration

18. pH of the blood. 18.

19 Acid base balance. 19

23. **All causes renal damage except 23. Hypocalcaemia.

28. Hypernatremia occurs with 28. (d) Hypernatremia occurs with:

28. Regarding excretion of Na+ 28. b. Na+ excretion is influenced by

GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN.

40. ***In Gaucher's disease; 40. (b) Gaucher's is a glucosylceramide lipidosis

CALCULATIONS, QC AND STATISTICS

44. **Ten microliters are? 44. (d) μL = 10-6L → 10 μL = 10-5L = 0.00001L

47. **Calibrator sera are? 47. (b) Secondary std?

CREATININE, UA, BUN AND AMMONIA

55. Diagnosis of RF 55. GFR is an index and a monitor of increased or

PROTEINS, ELECTROPHORESIS AND LIPIDS

65. **Lipoprotein related to hypertension? 65. . LDL

66. *****Which is important for atherosclerosis? 66. (b)

68. ***Based on behavior of lipoproteins in 68. On electrophoresis;

75. Chylomicrons: 75. (a) Chylomicrons don't confer an excess

76. Nature of apoproteins. 76. 5 major classes of proteins A to E

77. Saturated vs unsaturated fats (nutritional value) 77. Saturated Unsaturated

82. Treatment of familial hypercholesterolemia. 82. These include general management of

86. **Isoenzymes: 86. © Isoenzymes have the same catalytic activities

97. Diabetic coma presents with: 97. All.

98. Carcinoid tumors secrete 98. 5HIAA.

 Neeman Peck disease is due to deficiency of sphengomylinase

3. **Point of care testing means? 3. (c) Take care in testing

9. Effects of fasting 9. Prolonged fasting increase TG, glycerol, FFA

11. ***Anticoagulant used for glucose is: 11. Fluoride

BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES

2 ***In addition to routine Romanowsky stain of bone 2 (b).Prussian blue: See 1

7 Lymphokines & T-cell activation 7 Lymphocytosis promoting factor and histamine

9 ***Bone marrow aspiration needles: 9 a. 18 gauge.

10 **RDW is increased in 10 Iron deficiency anemia and megaloblastic

14 **Perl's stain 14 BM iron stores

NORMOCYTIC NORMOCHROMIC ANEMIAS

17 **Organism causing osteomylitis in sickle cell patient is 17 Salmonella.

18 **Skeletal abnormality present in? 18 Fanconi syndrome.

20 ***In G6PD decreased which is affected ? 20 NADP-H, reduced glutathione

21 **Sideroblastic.a seen in all except? 21 (c) Sideroblastosis occurs due to;

22 ****The least drug to cause acquired sideroblastic anemia 22 a. Aspirin.

24 In HUS, all are present except: 24 d. Thrombocytosis

26 **In intravascular hemolysis, all are present except: 26 Normal haptoglobin.

27 ***Free plasma Hb is bound to: 27 Haptoglobin (also hemopexin)

28 **In favism, the defect is in 28 G6PD.

30 ***Treatment of choice of spherocytosis is: 30 Splenectomy

32 ***Thalassemia major with iron overload this organism 32 (c).

37 ****Aplastic anemia cause 37 pancytopenia.

38 RAEB 38 Myelodysplastic syndromes (MDS) are

41 ****Major adult Hb is 41 HbA (97%)

in HDN or after incompatible transfusion.

HYPOCHROMIC MICROCYTIC ANEMIAS

43 **Iron deficiency anemia seen in all except? 43 d. B-thalassemia major

45 **Normal Hb pattern? 45 HBA ( α2, β2)

47 ****Regarding iron 47 60-70 % of body iron is present in Hb.

48 Iron status in anemia of chronic disease. 48 In ACD there is:

49 **Iron deficiency anemia cause, except 49 Thrombocytopenia.

50 **Anemia of chronic diseases includes: 50 e. None of the above.

51 ***Hb H disease. 51 Choose Alpha thalassemia, or none