Clinical Second

1. Patients with Criglar najjar's syndrome may have:

Unconjugated hyperbilirubinemia

Decreased number of reticulocytes

Decreased bilirubin excretion

G6PD deficiency

Hemolysis and rhabdomyolysis

2. All of the following are correct regarding parathyroid hormone (PTH) EXCEPT :

It increases osteoclastic bone resorption

It decrease renal calcium reabsorption

It decreases renal phosphate reabsorption

It decreases renal bicarbonate reabsorption causing mild acidosis

It increases alpha 1 hydroxylation of vitamin D

3. Which of the following may be associated with decreased plasma free ionized calcium?

Acidosis

Hyperkalemia

Alkalosis

Primary hyperparathyroidism

Hypermagnesemia

4. Which of the following is used to asses iron body stores ?

Transferrin

Haptoglobin

CRP

Ferritin

Prealbumin

5. Which of the following may cause hypocalcemia?

Primary hyperparathyroidism

Thiazide diuretics

Magnesium deficiency

Vitamin D intoxication

Thyrotoxicosis

6. Alpha 1 antitrypsin :

Concentration may increase in patients with nephrotic syndrome

Deficiency may result in edema

Is normally excreted in urine

Is an acute phase protein that is usually increased during infection

Concentration may increase in patient with liver disease

7. All of the following are correct regarding jaundice EXCEPT :

It may indicate the presence of liver disease

The drug rifampcin is among the causes of jaundice

Neonatal jaundice is almost pathological

It may result from reduced uptake of unconjugated bilirubin by the liver

Patients with jaundice may have increased serum level of either conjugated or unconjugated bilirubin.

8. All of the following are correct regarding osteoporosis EXCEPT:

Patients have normal alkaline phosphatase (ALP)

Bones become more fragile

Plasma calcium is usually high

Elderly persons have higher risk of osteoporosis compared toyoung persons

Females have higher risk of osteoprosis compared to males

9. All of the following are correct about Albumin EXCEPT:

It is used as a test for liver function

Patients with septicemia may develop hypoalbuminemia

It act as a carrier for free fatty acids(FFA)

Hyperalbuminemia may cause oedema

Albumin is a major protein in the blood

10. Patients with prolonged prothrombin time may have:

Increased risk of thrombosis

Defective hepatic excretory function

Acute phase response

Vitamin K deficiency

Increased synthesis of clotting factors

11. Which of the following may increase in hepatocellular carcinoma:

Alpha 1 antitrypsin

Alpha 1 fetoprotein

Alpha 2 macroglobulin

Transferrin

Haptoglobin

12. Caeruloplasmin level may decrease in all of the following EXCEPT:

Wilson's disease

Malnutrition and malabsorption

Decompensated liver cirrhosis

Acute phase response

Nephrotic syndrome

13. Patients with liver cirrhosis may develop ascites because of :

Reduced pre-albumin

Decreased renin secretion

Increased ammonia level

Decreased albumin synthesis

Esophageal bleeding.

14. Which of the following may cause secondary hyperparathyroidism

Hypocalcemia

Acidosis

Obesity

Hypermagnesmia

Hyperaldosteronism

15. All of the following are typical findings in multiple myeloma EXCEPT:

Increased creatinine

IgA or IgG paraproteins

Normal alkaline phosphatase (ALP) activity

Anemia

Decreased calcium

16. All of the following findings are expected in the icteric phase of acute hepatitis EXCEPT :

Increased ALT

Normal or increased ALP

Increased urinary urobilinogen

Normal albumin level

Marked elevation in plasma bilirubin

17. Alkaline phosphatase (ALP) activity is expected to be elevated in all of the following conditions EXCEPT:

Paget's diseas

Rickets

Cholestasis

Cirrhosis

Pre-icteric phase of acute hepatitis

18. Which of the following statements about uric acid is correct :

Excretion occurs mainly though kidneys and to less extent through intestine

In plasma, it is highly bound to protein , especially immunoglobulins

It is the end product of protein catabolism

In urine, it is excreted as urea , which is the most soluble form.

Allopurinol is a medication that enhances its renal excretion

19. Regarding transaminases (AST and ALT) , which of the following is TRUE:

AST is more liver specific compared to ALT

Both enzymes are usually highly elevated in crush injures and muscle diseases

Both enzymes are usually highly elevated in nonalcoholic fatty liver disease

ALT is one of the markers that are usually elevated in acute hepatitis

Both are highly elevated in myocardial infraction

20. Which of the following is CORRECT regarding C reactive protein (CRP):

It is decreased in acute phase response

It is decreased in bacterial infections

Its elevation is a marker of cardiovascular risk

It is increased in viral infection

It is a valuable marker of inflammatory conditions such as rheumatoid arthritis

21. Which of the following is an expected findings in hemolytic jaundice ?

Deep orange to brown urine

Decreased haptoglobin

Increased conjugated bilirubin

Marked elevation in AST

Marked increase in Lactate dehydrogenase (LDH)

22. In which condition this pattern is most likely: decreased calcium, decreasedphosphate, increased ALP and increased calcium excretion :

Hypoparathyroidism

Renal failure

Osteomalacia

Paget's disease

Fanconi syndrome

23. Which of the following may cause increased uric acid in blood (hyperuricemia)

Anemia

High dose of salicylates

Increased phosphoribosyl pyrophosphate synthase

Liver cirrhosis

Excess of dietary pyrimidine intake

24. Regarding bilirubin metabolism , which of the followingis NOT true:

Conjugation of bilirubin does occur in heptocytes and is mediated by glucuronyl transferase

Unconjugated bilirubin is water insoluble and is totally bound to plasma protein albumin

Conjugation of bilirubin is done with glucuronic acid to form mono- and di- glucuronides

Conjugated bilirubin is normally excreted in urine

Bilirubin is converted into urobilinogen in intestine by bacteria