CP SEM 2 - Final Ex Part 1 Flashcards
1
Q
1.True about C-peptides
A. It is a worse indicator of B-cell function than peripheral insulin
B. Used to differentiate between gestational and non-gestational diabetes
C. It is usually in extremely low amounts in diabetes insipidus
D. None of the Above
A
D. None of the Above
Rationale: C-peptide is actually a better indicator of B-cell function than peripheral insulin because it reflects endogenous insulin production without being affected by exogenous insulin administration. It is not used to differentiate between gestational and non-gestational diabetes; instead, it is used to distinguish between type 1 and type 2 diabetes. It is not relevant to diabetes insipidus, which affects the posterior pituitary’s production of antidiuretic hormone rather than insulin or C-peptide levels.
2
Q
2.Lactic acidosis is diagnosed by the presence of the following except:
A. High blood lactate levels (>45 mg/dl or >5.0 mmol/L)
B. An elevated anion gap
C. A low blood ph (<7.35)
D. None of the above
A
D. None of the above
Rationale: All of the options listed are actually correct indicators of lactic acidosis: high blood lactate levels indicate excess lactate production, an elevated anion gap is a result of excess acids in the blood, including lactate, and a low blood pH reflects the acidotic state.
3
Q
3.It is non – reducing sugar composed of glucose and fructose connected by a glycosidic band.
A. Maltose
B. Sucrose
C. Lactose
D. None of the above
A
B. Sucrose
Rationale: Sucrose is a non-reducing sugar composed of glucose and fructose connected by a glycosidic bond, specifically an α-1,β-2 bond. This type of bond prevents it from participating in reducing reactions, unlike maltose and lactose, which are reducing sugars.
4
Q
4.The following are functions of Insulin except:
A. Promotes glycolysis
B. Promotes lipolysis
C. Stimulates the synthesis of amino acids from pyruvate
D. Increases glucose entry into the cell
A
B. Promotes lipolysis
Rationale: Insulin is a hormone that promotes the storage of glucose and fat. It inhibits lipolysis (the breakdown of fats), which is the opposite of promoting it. The other options listed are functions of insulin: promoting glycolysis, stimulating amino acid synthesis from pyruvate, and increasing glucose entry into cells.
5
Q
5.The diagnosis of diabetes requires the following criteria except:
A. Fasting plasma glucose of 126 mg/dl (7.0 mmol/L) or greater on at least two occasions
B. Casual plasma glucose level of 200 mg/dl (11.1 mmol/L) or greater
C. Glycosalated hemoglobin (hba1c) of 6.5% or greater on at least two occasions
D. Fasting plasma glucose is less than 100 mg/dl (5.6 mmol/L)
A
D. Fasting plasma glucose is less than 100 mg/dl (5.6 mmol/L)
Rationale: A fasting plasma glucose less than 100 mg/dl is considered normal and does not meet the diagnostic criteria for diabetes. The other options listed are part of the criteria for diagnosing diabetes.
6
Q
6.True of glucagon except:
A. Synthesized in the pancreatic alpha cells and the L cells of the distal small bowel
B. Fasting plasma glucagon concentrations are normally 25-50 pg/ml
C. Released during stress and fasting states
D. Promotes glycogenesis
A
D. Promotes glycogenesis
Rationale: Glucagon primarily promotes glycogenolysis (the breakdown of glycogen into glucose) and gluconeogenesis (the production of new glucose), especially during stress and fasting states. It does not promote glycogenesis, which is the synthesis of glycogen, typically promoted by insulin.
7
Q
7.It is the most common methodology used to analyze glucose:
A. Glucose Dehydrogenase System
B. Glucose Oxidase System
C. Hexokinase System
D. None of the above
A
C. daw sabi ni gpt
B. Glucose Oxidase System
Rationale: The glucose oxidase system is one of the most common methodologies used in glucose meters for personal and clinical use due to its specificity and stability. The hexokinase system, while highly accurate, is more commonly used in laboratory settings.
8
Q
8.For Type 1 Diabetes, it is a single screening marker for detecting multiple antibody markers for beta cell destruction and more common in children.
A. Antibodies to glutamic acid decarboxylase (GAD65)
B. Insulin autoantibodies (IAA)
C. Autoantibodies to pancreatic alpha cells (APA1)
D. Autoantibodies to zinc transporter 8 (znt8)
A
A. Antibodies to glutamic acid decarboxylase (GAD65)
Rationale: Antibodies to GAD65 are a common screening marker for Type 1 Diabetes as they are frequently present in the autoimmune attack on pancreatic beta cells. The other antibodies listed also can be involved, but GAD65 is more common and widely tested in children and adults.
9
Q
9.True of Diabetes Mellitus Type 2 except:
A. C-peptide are normal to high in Type 2 DM
B. In general, it is recommended that adults ages 45 be screened for diabetes every 3 years, but Screening should be performed earlier and more frequently if the individual is at high risk.
C. The preferred test is a fasting plasma glucose and hba1c level.
D. Home blood glucose monitoring devices, are preferred compared to lab based plasma glucose determination
A
D. Home blood glucose monitoring devices, are preferred compared to lab based plasma glucose determination
Rationale: Lab-based plasma glucose and HbA1c tests are actually the preferred methods for diagnosing and managing diabetes mellitus type 2, as they are more accurate and standardized. Home monitoring is useful for daily management but not as a primary diagnostic tool.
10
Q
10.Which of the following is characteristic of type 1 diabetes mellitus?
A. Requires an oral glucose tolerance test for diagnosis
B. Is the most common form of diabetes mellitus
C. Usually occurs after age 40
D. Requires insulin replacement to prevent ketosis
A
D. Requires insulin replacement to prevent ketosis
Rationale: Type 1 diabetes mellitus results from the autoimmune destruction of insulin-producing beta cells in the pancreas, necessitating insulin replacement to manage blood glucose levels and prevent ketosis, a serious condition resulting from the body burning fat for fuel in the absence of sufficient insulin.
11
Q
11.Which statement regarding gestational diabetes mellitus (GDM) is correct?
A. Is diagnosed using the same oral glucose tolerance criteria as in nonpregnancy
B. Converts to diabetes mellitus after pregnancy in 60%–75% of cases
C. Presents no increased health risk to the fetus
D. Is defined as glucose intolerance originating during pregnancy
A
D. Is defined as glucose intolerance originating during pregnancy
Rationale: Gestational diabetes mellitus (GDM) is defined specifically as glucose intolerance that begins or is first recognized during pregnancy. This differentiates it from diabetes mellitus types 1 and 2, which may pre-exist or develop independently of pregnancy.
12
Q
12.Which statement regarding glycosylated Hgb is true?
A. It has as a sugar attached to the C-terminal end of the β chain
B. Is a highly reversible aminoglycan
C. Reflects the extent of glucose regulation in the 8- to 12-week interval prior to sampling
D. Will be abnormal within 4 days following an episode of hyperglycemia
A
C. Reflects the extent of glucose regulation in the 8- to 12-week interval prior to sampling
Rationale: Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the lifespan of red blood cells, typically 8-12 weeks, making it a valuable indicator of long-term glucose regulation. The other options contain incorrect information about the biochemical nature and behavior of HbA1c.
13
Q
13.Insulin is produced by
A. Alpha cells
B. Beta cells
C. Delta cells
D. PP or F cells
A
B. Beta cells
Rationale: Insulin is produced by the beta cells of the islets of Langerhans in the pancreas. These cells are primarily responsible for the regulation of glucose levels in the blood.
14
Q
14.glucagon is produced by
A. Alpha cells
B. Beta cells
C. Delta cells
D. PP or F cells
A
A. Alpha cells
Rationale: Glucagon, which works to increase blood glucose levels, is produced by the alpha cells of the pancreatic islets. It acts as a counter-regulatory hormone to insulin.
15
Q
15.somatostatin is produced by
A. Alpha cells
B. Beta cells
C. Delta cells
D. PP or F cells
A
C. Delta cells
Rationale: Somatostatin, which inhibits the secretion of many hormones including growth hormone, insulin, and glucagon, is produced by the delta cells of the pancreatic islets.
16
Q
16.In microscopic examination for sperm analysis, progressive motility (normal Range 32% or above) is expressed as the percentage of sperm that move, in Addition forward movement is graded. Sperm that move rapidly in a straight line With little yaw and lateral movement is graded as :
A. Grade 4
B. Grade 3
C. Grade 2
D. Grade 1
A
A. Grade 4
Rationale: In sperm motility grading, sperm that move rapidly in a straight line with minimal lateral movement are graded as Grade 4, indicating the highest quality of motility observed in sperm analysis.
17
Q
17.Which set of results is most likely in an adult male with primary testicular Failure?
A. Increased LH, FSH, and decreased testosterone
B. Decreased LH, FSH, and testosterone
C. Decreased testosterone, androstenedione, and FSH
D. Increased androstenedione, decreased testosterone, and normal FSH
A
A. Increased LH, FSH, and decreased testosterone
Rationale: In primary testicular failure, the testes are unable to produce normal amounts of testosterone due to intrinsic damage or dysfunction, leading to increased secretion of LH and FSH as the body tries to stimulate testosterone production.
18
Q
18.True of PROM except:
A. It may be followed by chorioamnionitis, fetal pulmonary hypoplasia, placental abruption, and Neonatal Respiratory distress
C. Amniotic fluid is alkaline, with pH of 7.0 to 7.5.
D. The vaginal pool aspirate can be tested with nitrazine paper to estimate pH visually.
E. A positive test is indicated by a yellow green color , and a negative one by a blue color
A
C. Amniotic fluid is alkaline, with pH of 7.0 to 7.5.
Rationale: Amniotic fluid is actually slightly acidic to neutral, typically with a pH closer to 7.0 or slightly below, rather than alkaline. The other statements are correct regarding PROM (premature rupture of membranes) and its associated risks and diagnostic tests.
19
Q
19.The following are true on sample collection for sperm analysis except:
A. The patient should be instructed to collect semen after 2 to 5 days of sexual abstinence
B. The bladder should be evacuated before ejaculation occurs.
C. The semen specimen should be delivered to the laboratory within 1 hour of collection and kept Warm during transportation.
D. Longer periods of abstinence usually result in a higher semen volume and improved sperm Motility.
A
D. Longer periods of abstinence usually result in a higher semen volume and improved sperm motility.
Rationale: Longer periods of abstinence can indeed increase semen volume, but they often result in decreased sperm motility, not improved. Sperm may become less viable the longer they remain stored in the reproductive tract.
20
Q
20.A female with severe excessive pubic and facial hair growth (hirsutism) should Be tested for which of the following hormones?
A. Estrogen and progesterone
B. Chorionic gonadotropin
C. Growth hormone
D. Testosterone
A
D. Testosterone
Rationale: Excessive hair growth (hirsutism) in women is often linked to elevated levels of androgens, such as testosterone. Testing for elevated testosterone levels can help identify conditions like polycystic ovary syndrome (PCOS) or other endocrine disorders contributing to hirsutism.
21
Q
21.Macroscopic examination for semen analysis should be performed after Liquefaction, which usually occurs in :
A. Less than 20 minutes at room temperature
B. Around 3 hours at room temperature
C. Exactly 12 hours at room temperature
D. None of the above
A
A. Less than 20 minutes at room temperature
Rationale: Liquefaction of semen typically occurs within 20 to 30 minutes of ejaculation at room temperature. This allows for more accurate assessment of viscosity and other characteristics necessary for a thorough semen analysis.
22
Q
22.The following statements are true about neural tube defects except:
A. Failure of the neural tube to close by the 27th day after conception.
B. Sporadic in 90% of cases and represent isolated defects with a multi- factorial origin, involving Both genetic and nongenetic factors.
C. Folic acid supplementation before conception reduces the recurrence of fetal NTDs
D. In NTDs, AFP is decreased
A
D. In NTDs, AFP is decreased
Rationale: In neural tube defects (NTDs), the level of alpha-fetoprotein (AFP) is actually increased in the amniotic fluid and maternal serum, not decreased. This marker is used for prenatal screening to identify potential NTDs.
23
Q
23.This is considered as the more potent androgen .
A. Testosterone
B. Dihydrotestosterone(DHT)
C. Androstenedione
D. Dehydroepiandrosterone (DHEA)
A
B. Dihydrotestosterone (DHT)
Rationale: Dihydrotestosterone (DHT) is a more potent androgen than testosterone. It is produced from testosterone by the action of the enzyme 5-alpha reductase, particularly in target tissues such as the skin, hair follicles, and prostate.
24
Q
24.This hormone induces Sertoli cells to synthesize and secrete androgen-binding Protein into the lumen of the seminiferous tubule, and this maintains the high Testosterone concentration required for normal spermatogenesis
A. FSH
B. LH
C. Inhibin
D. None of the above
A
A. FSH
Rationale: Follicle-stimulating hormone (FSH) induces Sertoli cells to synthesize and secrete androgen-binding protein, which maintains the high concentration of testosterone necessary for normal spermatogenesis within the seminiferous tubules.
25
25.This hormone induces Leydig cells to synthesize testosterone.
A. FSH
B. LH
C. Inhibin
D. None of the above
B. LH
Rationale: Luteinizing hormone (LH) stimulates Leydig cells in the testes to produce testosterone, which is crucial for the development and maintenance of male secondary sexual characteristics and reproductive function.
26
26.What is the most common cause of secondary amenorrhea?
A. A trophoblastic tumor
B. Turner Syndrome
C. Pregnancy
D. None of the above
C. Pregnancy
Rationale: Pregnancy is the most common cause of secondary amenorrhea, which is defined as the cessation of menstrual periods in women who have previously menstruated normally.
27
27.During an evaluation of a woman with amenorrhea, you have the following lab Results: hCG below 5mIU/mL, Prolactin High, T4 and TSH normal. What is an Appropriate next step?
A. Do another pregnancy test
B. Do imaging of the brain and surrounding structures
C. Treat for thyroid disease
D. None of the above
B. Do imaging of the brain and surrounding structures
Rationale: Given the high levels of prolactin and normal thyroid function, it is appropriate to investigate potential causes for hyperprolactinemia, such as a prolactinoma or other pituitary disorders. Imaging of the brain, specifically the pituitary region, would be a suitable next step.
28
28.During an evaluation of a woman with amenorrhea, you have the following lab Results: hCG below 5mIU/mL, Prolactin normal, T4 and TSH high. What is an Appropriate next step?
A. Do another pregnancy test
B. Do imaging of the brain and surrounding structures
C. Treat for thyroid disease
D. None of the above
C. Treat for thyroid disease
Rationale: With elevated T4 and TSH levels indicating a possible thyroid dysfunction (likely primary hypothyroidism with a compensatory rise in TSH), the appropriate next step is to address and treat the thyroid condition, which could be contributing to amenorrhea.
29
29.During an evaluation of a woman with amenorrhea, you have the following lab Results: hCG below 5mIU/mL, Prolactin, T4 and TSH normal, no withdrawal Bleeding observed. What is an appropriate next step?
A. Do imaging of the genital tract
B. Treat for thyroid disease
C. Evaluate for adrenal hyperplasia
D. None of the above
A. Do imaging of the genital tract
Rationale: With normal prolactin, thyroid function, and absence of withdrawal bleeding after progesterone challenge, imaging of the genital tract (such as ultrasound) is warranted to investigate possible anatomical or structural causes of amenorrhea.
30
30.During an evaluation of a woman with amenorrhea, you have the following lab Results: hCG below 5mIU/mL, Prolactin, T4 and TSH normal, no withdrawal Bleeding observed but with high FSH and LH. What is the probable cause of These findings?
A. The patient has a primary ovarian failure
B. The patient has a hydatidiform mole
C. The patient has an adrenal tumor
D. None of the above
A. The patient has primary ovarian failure
Rationale: High levels of FSH and LH with normal prolactin, T4, and TSH suggest primary ovarian insufficiency (failure), where the ovaries do not produce normal amounts of estrogen or release eggs regularly, leading to elevated gonadotropins as the feedback mechanism tries to stimulate ovarian function.
31
31.During an evaluation of a woman with amenorrhea, you have the following lab Results: hCG below 5mIU/mL, Prolactin, T4 and TSH normal, withdrawal bleeding is Present with high testosterone. What can be a probable cause of these findings?
A. A trophoblastic tumor
B. PCOS
C. Thyroid disease
D. None of the above
B. PCOS
Rationale: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism (high testosterone), irregular or absent menstrual periods, and often, polycystic ovaries. The presence of withdrawal bleeding indicates that the endometrium is responsive, which is consistent with PCOS.
32
32.During an evaluation of a man with infertility, you have the following lab Results: azoospermia, reduced testosterone, increased FSH and LH. What can be a Probable cause of these findings?
A. Thyroid disease
B. Primary testicular failure
C. Hypothalamic-pituitary necrosis
D. None of the above
B. Primary testicular failure
Rationale: Primary testicular failure is indicated by azoospermia (absence of sperm), reduced testosterone, and increased FSH and LH levels. This suggests that the testes are not responding to hormonal stimulation from the pituitary gland, which is compensating by increasing these hormones.
33
33.During an evaluation of a man with infertility, you have the following lab Results: oligospermia, reduced testosterone, normal FSH and LH, increased Prolactin. What can be a probable cause of these findings?
A. Thyroid disease
B. Primary testicular failure
C. A hypothalamic-pituitary problem
D. None of the above
C. A hypothalamic-pituitary problem
Rationale: Increased prolactin with reduced testosterone and normal FSH and LH levels suggest a possible issue with the hypothalamic-pituitary axis, potentially a prolactinoma or other disorder that elevates prolactin levels, which can inhibit gonadal function and reduce sperm production (oligospermia).
34
34.During an evaluation of a man with infertility, you have the following lab Results: azoospermia, reduced testosterone, increased FSH and LH. What is an Appropriate next step?
A. Chromosomal analysis
B. Orchiectomy
C. Vasectomy
D. None of the above
A. Chromosomal analysis
Rationale: With azoospermia and hormonal evidence of primary testicular failure (increased FSH and LH, reduced testosterone), a chromosomal analysis is an appropriate next step to determine if there is a genetic cause, such as Klinefelter syndrome.
35
35.During an evaluation of a man with infertility, you have the following lab Results: oligospermia, normal testosterone, FSH and LH, seminal fructose present, And normal spermatogenesis on biopsy. What is an appropriate next step?
A. Surgery
B. Antithyroid drugs
C. Administration of pituitary antagonists
D. None of the above
D. None of the above
Rationale: Given the findings of oligospermia, normal hormone levels, presence of seminal fructose, and normal spermatogenesis on biopsy, the infertility issue might be related to a post-testicular factor such as a blockage or other physical issue not addressed by surgery, antithyroid drugs, or pituitary antagonists.
36
36.A patient with seminiferous tubule failure would exhibit:
A. Polyspermia
B. Normal testosterone
C. Increased beta HCG
D. None of the above
D. None of the above
Rationale: Seminiferous tubule failure typically results in reduced sperm production leading to azoospermia or severe oligospermia, not polyspermia. It also generally results in altered hormone levels, particularly increased FSH due to the lack of feedback inhibition from inhibin, which is produced by Sertoli cells in the seminiferous tubules.
37
37.A surge of LH happens during:
A. Ovulation
B. Recruitment of oocytes
C. Selection of oocytes
D. None of the above
A. Ovulation
Rationale: A surge in LH (luteinizing hormone) triggers ovulation—the release of an egg from the ovary. This is a key event in the menstrual cycle.
38
38.The WHO 2010 standard method for counting sperms is:
A. Via a hematocytometer chamber
B. Via flow cytometric analysis
C. Via electron microscopy
D. None of the above
A. Via a hematocytometer chamber
Rationale: The WHO 2010 standard method for sperm counting is by using a hemocytometer chamber, which allows for accurate counting of sperm cells under a microscope.
39
39.During pregnancy, hCG levels start to plateau and decline during:
A. Sexual intercourse
B. The end of the first trimester
C. The end of the second trimester
D. Parturition
B. The end of the first trimester
Rationale: Human chorionic gonadotropin (hCG) levels typically rise rapidly in early pregnancy, peaking around the 10th week, then plateau and start to decline towards the end of the first trimester as the placenta takes over more of the hormone production functions.
40
40.The following statements about diabetes are true:
A. After testing for FBS, no further confirmatory test is needed
B. Wildly varying random glucose levels throughout the day is a worrisome issue
C. DKA is not an emergency and most cases are managed at home
D. Hypoglycemic symptoms with a plasma glucose level of ≤ 50 mg/dl (2.8 mmol/L) in an Individual who is not receiving medications for diabetes is not a concern.
B. Wildly varying random glucose levels throughout the day is a worrisome issue
Rationale: Wild fluctuations in random blood glucose levels can indicate poor glycemic control, which is a concern in diabetes management. The other options are incorrect: FBS alone may not be sufficient for diabetes diagnosis without confirmatory tests, DKA is a medical emergency requiring immediate care, and hypoglycemic symptoms with very low glucose are definitely a concern.
41
41.Which of the following is a non-organ specific autoimmune disease?
A. Pemphigus Vulgaris
B. Pernicious Anemia
C. Scleroderma
D. Hashimotos Thyroiditis
C. Scleroderma
Rationale: Scleroderma, also known as systemic sclerosis, is a non-organ specific autoimmune disease as it affects multiple systems including the skin, blood vessels, and internal organs such as the lungs and gastrointestinal tract. The other options are more organ-specific: Pemphigus vulgaris primarily affects the skin, Pernicious anemia targets the stomach’s ability to produce intrinsic factor, and Hashimoto's thyroiditis specifically affects the thyroid.
42
42.Which of the following laboratory test will NOT evaluate autoimmunity
A. Carcinoembryonic antigen
B. Indirect immunofluorescence
C. Enzyme-linked immunosorbent assay
D. Western blot
A. Carcinoembryonic antigen
Rationale: Carcinoembryonic antigen (CEA) is used primarily as a tumor marker, not for evaluating autoimmunity. The other tests listed (indirect immunofluorescence, enzyme-linked immunosorbent assay, Western blot) are commonly used to detect autoantibodies and evaluate autoimmune conditions.
43
43.Histologic hallmark of the pemphigus group and responsible for the clinical Presentation of flaccid blisters and erosions
A. Intraepidermal acantholysis
B. Subepidermal blister formation
C. Hyperkeratosis
D. Parakeratosis
A. Intraepidermal acantholysis
Rationale: Intraepidermal acantholysis is the histologic hallmark of pemphigus, characterized by the loss of cell-cell adhesion within the epidermis, leading to the formation of flaccid blisters and erosions. This is a distinguishing feature from other blistering diseases which might involve subepidermal blistering or other skin changes.
44
44.This is the most common variant of pemphigus
A. Pemphigus vulgaris
B. Pemphigus foliaceus
C. Paraneoplastic pemphigus
D. IgA pemphigus
A. Pemphigus vulgaris
Rationale: Pemphigus vulgaris is the most common variant of pemphigus, characterized by painful mucosal ulceration and flaccid cutaneous blisters. It is more prevalent than the other types listed.
45
45.Which of the following finding is associated with Autoimmune disease
A. Presence of humoral or cell mediated immunity
B. Ability to transfer the disease with antibodies
C. Disease recurrence with organ transplantation in the absence of immunosuppression
D. All of the above
D. All of the above
Rationale: All the options listed are associated with autoimmune diseases. Autoimmune disorders often involve both humoral (B-cells, antibodies) and cell-mediated immunity (T-cells), the ability to transfer disease with antibodies (e.g., neonatal lupus with anti-Ro/SSA antibodies), and disease recurrence in transplanted organs due to immune memory.
46
46.Which of the following is associated with antibodies against the dermal-Epidermal junction (BMZ)
A. Bullous pemphigoid
B. Pemphigus foliaceus
C. Paraneoplastic pemphigus
D. IgA pemphigus
A. Bullous pemphigoid
Rationale: Bullous pemphigoid is characterized by antibodies against the basement membrane zone (BMZ), leading to subepidermal blisters. It is distinguished by linear deposition of C3 and IgG along the BMZ on direct immunofluorescence.
47
47.Which of the following variant of pemphigus will not show IgG deposition and
C3 in Direct immunofluorescence
A. Pemphigus vulgaris
B. IgA pemphigus
C. Pemphigus foliaceus
D. Paraneoplastic pemphigus
B. IgA pemphigus
Rationale: IgA pemphigus will not show IgG deposition as it involves IgA autoantibodies, unlike other forms of pemphigus which typically involve IgG antibodies. Direct immunofluorescence in IgA pemphigus shows IgA deposition.
48
48.Which of the following immunologic feature will differentiate Bullous Pemphigoid from Dermatitis Herpetiformis
A. Granular IgA deposition in the dermal papilla
B. Circulating anti-BMZ autoantibodies
C. Serum IgA autoantibodies directed against endomysium can be detected
D. Serum IgA autoantibodies tTG and eTG can be detected
B. Circulating anti-BMZ autoantibodies
Rationale: Bullous pemphigoid can be differentiated from dermatitis herpetiformis by the presence of circulating anti-BMZ autoantibodies, indicative of an autoimmune response against structural components in the dermal-epidermal junction. Dermatitis herpetiformis involves granular IgA deposition, particularly in relation to gluten sensitivity.
49
49.This blister disorder is associated with Celiac disease
A. Bullous pemphigoid
B. Pemphigoid gestationis
C. Mucous membrane pemphigoid
D. Dermatitis Herpetiformis
D. Dermatitis Herpetiformis
Rationale: Dermatitis herpetiformis is closely associated with celiac disease and is characterized by intense itching and blistering skin lesions. It is linked to gluten sensitivity, and the skin symptoms typically improve with a gluten-free diet.
50
50.Which of the following is least associated with Autoimmune Gastritis
A. Known consequence is vitamin B12 deficiency
B. Leads to mucosal atrophy and achlorhydria
C. Presents with very high serum gastrin concentrations
D. Precedes with gastric hypertrophy
D. Precedes with gastric hypertrophy
Rationale: Autoimmune gastritis typically leads to gastric atrophy (thinning of the stomach lining), not hypertrophy (thickening). It is characterized by mucosal atrophy, achlorhydria (absence of hydrochloric acid in gastric secretions), high serum gastrin levels due to loss of negative feedback inhibition, and is a known cause of vitamin B12 deficiency due to the resultant lack of intrinsic factor.
51
51.Characteristic histologic finding of Celiac Disease include:
A. Increased intraepithelial CD8 T lymphocytes (>25/100 enterocytes)
B. Villous hyperplasia
C. Hypoplastic crypts
D. All of the above
A. Increased intraepithelial CD8 T lymphocytes (>25/100 enterocytes)
Rationale: Characteristic histologic findings of celiac disease include increased intraepithelial lymphocytes (usually CD8+ T cells), villous atrophy (not hyperplasia), and crypt hyperplasia (not hypoplasia). The correct features are thus increased lymphocytes and crypt hyperplasia, along with villous atrophy.
52
52.Confirmatory test for Celiac Disease
A. Traditional antigliadin antibody tests
B. IgA endomysial autoantibodies (anti-EMA)
C. IgG antideamidated gliadin peptide (DGP)
D. IgA antitissue transglutaminase autoantibodies (anti-tTG)
D. IgA antitissue transglutaminase autoantibodies (anti-tTG)
Rationale: The IgA anti-tissue transglutaminase autoantibody (anti-tTG) test is considered the primary serologic test for the diagnosis of celiac disease, due to its high sensitivity and specificity. IgA endomysial antibodies (anti-EMA) are also highly specific but are used less frequently due to higher costs and the need for operator-dependent interpretation.
53
53.Which of the following is mostly associated with Ulcerative colitis
A. Characterized by discontinuous transmural ulcerations
B. Found throughout the digestive tract
C. P-ANCA is present in 40% to 80% of patients
D. highly associated with anti–Saccharomyces cerevisiae mannan antibodies (ASCA)
C. P-ANCA is present in 40% to 80% of patients
Rationale: P-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies) are often associated with ulcerative colitis and can be detected in a significant number of patients. This form of colitis is characterized by continuous, superficial inflammation limited to the colon, not by transmural ulcerations or presence throughout the digestive tract.
54
54. Laboratory assessment for Autoimmune Hepatitis includes all of the following
EXCEPT:
A. Alanine(ALT), Aspartate (AST) aminotransferases
B. Alkaline phosphatase (ALP)
C. Albumin
D. IgM
D. IgM
Rationale: IgM is not typically a primary marker in the evaluation of autoimmune hepatitis. Key laboratory tests include elevated serum aminotransferases (ALT, AST), and often IgG levels, along with other liver function tests like albumin and alkaline phosphatase.
55
55. Which of the following is NOT a hallmark of Autoimmune Hepatitis
A. Serum ALT greater than five times the upper limit of the reference interval
B. Positive SMA
C. Histologic features of interface hepatitis
D. Positive AMA
D. Positive AMA
Rationale: Positive antimitochondrial antibodies (AMA) are a hallmark of primary biliary cholangitis, not autoimmune hepatitis. Autoimmune hepatitis is characterized by elevated ALT, positive smooth muscle antibodies (SMA), and histological features of interface hepatitis.
56
56.What is the serologic hallmark of Primary Biliary Cholangitis
A. ALP (Alkaline phosphatase)
B. AMA (Antimitochondrial autoantibodies)
C. ANA (Antinuclear autoantibody)
D. SMA (Anti–smooth muscle autoantibody)
B. AMA (Antimitochondrial autoantibodies)
Rationale: AMA is the serologic hallmark of primary biliary cholangitis, detected in approximately 90-95% of cases. This is distinct from other autoimmune liver diseases.
57
57.Common cause of the nephrotic syndrome in adults
A. Membranous Nephropathy
B. Membranous Glomerulonephritis
C. Membranous Glomerulopathy
D. All of the above
D. All of the above
Rationale: Membranous nephropathy, membranous glomerulonephritis, and membranous glomerulopathy are terms that can be used interchangeably to describe a common cause of nephrotic syndrome in adults, characterized by thickening of the capillary walls of the glomeruli due to immune complex deposition.
58
58.This glomerular disease is characterized by capillary wall thickening on LM, Prominent granular (“lumpy-bumpy”) capillary wall staining for IgG and C3 on IF, And subepithelial deposits on EM
A. Membranoproliferative glomerulonephritis (MPGN)
B. IgA nephropathy
C. Membranous nephropathy
D. anti-GBM disease
C. Membranous nephropathy
Rationale: Membranous nephropathy is characterized by thickening of the capillary walls on light microscopy (LM), granular deposits of IgG and C3 along the capillary walls on immunofluorescence (IF), and subepithelial deposits on electron microscopy (EM).
59
59.Which of the following is NOT associated with IgA Nephropathy?
A. The most common primary glomerulonephritis in the world
B. Pathogenesis involves abnormal IgA glycosylation
C. EM confirms the presence of subendothelial deposits
D. IgAN is essentially an IF diagnosis
C. EM confirms the presence of subendothelial deposits
Rationale: In IgA nephropathy, electron microscopy typically reveals mesangial deposits, not subendothelial deposits. It is indeed the most common primary glomerulonephritis globally and involves abnormal glycosylation of IgA. The diagnosis primarily involves demonstrating mesangial deposits of IgA on immunofluorescence.
60
60.Hashimoto Thyroiditis will likely show:
A. Elevated TSH
B. Presence of thyroperoxidase antibody
C. Elevated Thyroglobulin Autoantibodies
D. All of the above
D. All of the above
Rationale: Hashimoto's thyroiditis is typically characterized by elevated TSH (due to reduced thyroid function), the presence of thyroperoxidase antibodies, and elevated thyroglobulin autoantibodies. These markers help confirm the autoimmune nature of the disease.
61
61.One of the following is /are the parameters used in PGA index to assess the Cirrhosis
A. Gamma glutamyl transferase activity
B. Bilirubin level
C. INR ratio
D. Alkaline phosphatase level
C. INR ratio
Rationale: While both bilirubin level and INR ratio are used to assess liver function and cirrhosis, the INR ratio (which measures the liver's ability to produce blood clotting factors) is a key parameter in the PGA (prothrombin time, albumin, and bilirubin) index specifically designed to assess liver cirrhosis severity.
62
62.Dubin -Johnson syndrome is associated with one of the following
A. Mutation in UGAT1a1 gene
B. Defect in the deficit in the sinusoidal membrane of hepatocyte
C. Associated with viral infection
D. Associated increased plasma conjugated bilirubin
D. Associated increased plasma conjugated bilirubin
Rationale: Dubin-Johnson syndrome is characterized by an increase in plasma conjugated bilirubin due to a defect in the hepatic secretion of conjugated bilirubin into the bile. It is not associated with UGAT1a1 gene mutations, viral infections, or specific defects in the sinusoidal membrane of hepatocytes.
63
63. Stercobilin is a pigment responsible for normal color of stool which is a Product of one of the following
A. Urobilin
B. Urobilinogen
C. Both is correct
B. Urobilinogen
Rationale: Stercobilin, which gives stool its normal color, is a product of urobilinogen breakdown in the intestines. Urobilin is more associated with the color of urine.
64
64.PT (prothrombin time) measures the efficacy extrinsic clotting system by Activating one of the following factors
A. Factor III
B. Factor VII
C. Factor IX
D. Factor X
B. Factor VII
Rationale: Prothrombin time (PT) measures the efficiency of the extrinsic clotting pathway, which is initiated by the activation of Factor VII.
65
65.Which of the following enzymes is/are expected to be abnormally high in case Of acute hepatitis secondary to excessive alcohol intake
A. ALT
B. ALP
C. AST
D. GGT
C. AST
Rationale: In cases of acute hepatitis secondary to excessive alcohol intake, AST (Aspartate Aminotransferase) levels are typically higher than ALT (Alanine Aminotransferase) levels, often in a ratio greater than 2:1, which is a characteristic marker of alcoholic liver disease. GGT (Gamma Glutamyl Transferase) may also be elevated but AST is more specifically elevated in relation to ALT in alcohol-related liver damage.
66
66.This enzyme tends to be higher in obstructive disorders and in space Occupying lesions in the liver
A. Y-Glutamyl transferase
B. Alkaline phosphatase
C. ALT
D. AST
A. Y-Glutamyl transferase
67
67.The most important marker for liver malignancy
A. Alkaline phosphatase
B. Alpha-fetoprotein
C. Y-Glutamyl transferase
D. 5’nucleotidase
B. Alpha-fetoprotein
Rationale: Alpha-fetoprotein (AFP) is the most important marker for liver malignancy, particularly hepatocellular carcinoma. It is used as a diagnostic and monitoring tool for liver cancer.
68
68.The presence of elevated titers of IgM anti-HAV is considered to be of Diagnostic of
A. Recovery
B. Acute infection
C. Convalescent period
A. All are correct
B. Acute infection
Rationale: Elevated titers of IgM anti-HAV are diagnostic of acute hepatitis A infection. IgM antibodies are produced as an immediate response to infection and indicate recent exposure to hepatitis A virus.
69
69.Hepatitis A antigen occurs early on and no longer seen in one of the following
A. Early acute phase
B. Recovery phase
C. Acute phase
D. Incubation period
B. Recovery phase
Rationale: Hepatitis A antigen is typically detectable during the acute phase of the infection and disappears by the recovery phase. It is not found in the recovery phase, where antibody titers predominate.
70
70.Interpret this hepatitis B profile: positive HBsAg, positive IgG anti-HBC, positive
IgG-anti HBs
A. Chronic HBV infection
B. Acute HBV infection
C. Convalescent phase
D. Recovery phase
A. Chronic HBV infection
Rationale: The hepatitis B profile indicated by positive HBsAg (hepatitis B surface antigen), positive IgG anti-HBc (core antibody), and positive IgG-anti HBs (surface antibody) suggests a chronic HBV infection. In chronic HBV, HBsAg remains positive beyond six months, and the presence of both core and surface antibodies further supports this diagnosis.
71
71.Which of the following is the major mineralocorticoid?
A. Aldosterone
B. Cortisol
C. Corticosterone
D. Testosterone
A. Aldosterone
Rationale: Aldosterone is the major mineralocorticoid produced by the adrenal cortex. It regulates sodium and water balance by promoting sodium reabsorption and potassium excretion in the kidneys.
72
72.Which of the following statement is least associated with Prolactin?
A. It is responsible for the initiation and maintenance of lactation
B. It is a polypeptide produced by somatotroph of the pituitary gland
C. Secreted in a pulsatile fashion
D. Also acts at the hypothalamus to inhibit the secretion of gonadotropin-releasing hormone
B. It is a polypeptide produced by somatotroph of the pituitary gland
Rationale: Prolactin is produced by lactotroph cells of the pituitary gland, not somatotrophs. Somatotrophs produce growth hormone. The other statements correctly describe aspects of prolactin's function and regulation.
73
73.What is the Gold standard for diagnosing Growth hormone deficiency?
A. Glucagon stimulation test
B. Exercise testing
C. Insulin tolerance test
D. Growth hormone–releasing hormone
C. Insulin tolerance test
Rationale: The insulin tolerance test, which induces hypoglycemia and stimulates the secretion of growth hormone, is considered the gold standard for diagnosing growth hormone deficiency. It assesses the pituitary's capacity to respond appropriately with hormone release.
74
74.Which statement is least likely associated with Acromegaly?
A. Screening test for clinically suspected acromegaly is a randomly collected IGF-1.
B. Condition develops before closure of the epiphyses
C. The goal of therapy is to normalize IGF-1 and suppress the GH response
D. Treatment for acromegaly is lifetime monitoring
B. Condition develops before closure of the epiphyses
Rationale: Acromegaly typically develops in adults; in children, the analogous condition due to excess growth hormone is called gigantism, where growth occurs before the closure of epiphyses. The other statements accurately describe aspects of diagnosing and managing acromegaly.
75
75.Which of the following statement is associated with Oxytocin?
A. Secretion is stimulated by stretching of the cervix and vagina during parturition
B. Induces an increase in the production of cyclic adenosine monophosphate (camp),
C. Acts as a potent pressor by causing vasoconstriction
D. Secretion is modulated by changes in serum osmolality
A. Secretion is stimulated by stretching of the cervix and vagina during parturition
Rationale: Oxytocin secretion is indeed stimulated by stretching of the cervix and vagina during labor, and it promotes uterine contractions. It does not act as a potent pressor or cause vasoconstriction, nor is it modulated by serum osmolality.
76
76.Which statement is true regarding Chromogranin A?
A. Stored and secreted along with the catecholamines
B. Elevated in more than 80% of pheochromocytomas
C. Major use is to monitor tumor recurrence
D. All of the above
D. All of the above
Rationale: Chromogranin A is a protein co-stored and co-secreted with catecholamines in the chromaffin cells of the adrenal medulla. It is elevated in a majority of pheochromocytomas and is used primarily to monitor tumor presence and recurrence.
77
77.Which of the following is associated with Paraganglioma?
A. Lethal if not diagnosed and properly treated
B. Rarely produce catecholamine and do not cause hypertension
C. Arise from the chromaffin cells of the adrenal medulla
D. Can cause hypertension
D. Can cause hypertension
Rationale: Paragangliomas, which are tumors arising from chromaffin cells outside the adrenal medulla (not within, as stated in option C), can indeed produce catecholamines and cause hypertension. They can be lethal if untreated but are typically managed effectively with proper treatment.
78
78.Which of the following will cause false positive result in Pheochromocytoma?
A. Stressors such as MI
B. Alcohol intake
C. Acetaminophen intake
D. All of the above
D. All of the above
Rationale: Stressors such as myocardial infarction, alcohol intake, and certain medications like acetaminophen can cause false positive results in diagnostic tests for pheochromocytoma by elevating catecholamine levels or interfering with test assays.
79
79.Chief mineralocorticoid that promotes reabsorption of Na+ and H2O
A. Aldosterone
B. Corticosterone
C. cortisol
D. Epinephrine
A. Aldosterone
Rationale: Aldosterone is the chief mineralocorticoid that promotes the reabsorption of sodium and water in the kidneys, thereby playing a crucial role in regulating blood volume and pressure.
80
80.In a patient who is suspected of having pheochromocytoma, measurement of Which of the following would be most useful?
A. Metanephrine
B. Homovanillic acid
C. 5-Hydroxyindoleacetic acid
D. Homogentisic acid
A. Metanephrine
Rationale: In the diagnosis of pheochromocytoma, measurement of plasma-free metanephrines or urinary fractionated metanephrines is the most useful and recommended test due to its high sensitivity and specificity for detecting catecholamine-secreting tumors.
81
81.Which assay using 24-hour urine is considered the best single screening test For pheochromocytoma?
A. Total urinary catecholamines
B. VMA
C. Homovanillic acid (HVA)
D. Metanephrines
D. Metanephrines
Rationale: Measurement of metanephrines in a 24-hour urine collection is considered the best single screening test for pheochromocytoma due to its high sensitivity. Metanephrines are metabolites of catecholamines, and their measurement can detect tumors that intermittently secrete catecholamines.
82
82.The most common cause of congenital adrenal hyperplasia
A. 21-hydroxylase deficiency
B. 11-β-hydroxylase deficiency
C. 3-β-hydroxysteroid dehydrogenase deficiency
D. 17-hydroxylase deficiency
A. 21-hydroxylase deficiency
Rationale: The most common cause of congenital adrenal hyperplasia is 21-hydroxylase deficiency, accounting for approximately 90% of cases. This deficiency leads to impaired cortisol production and an overproduction of androgen precursors.
83
83.The goal of mineralocorticoid replacement therapy in children is to:
A. Attainment of normal growth
B. Attainment of normal weight
C. Attain normal pubertal development
D. All of the above
D. All of the above
Rationale: The goal of mineralocorticoid replacement therapy in children with conditions such as congenital adrenal hyperplasia is to ensure normal growth, weight, and pubertal development by correcting the hormonal imbalance.
84
84.Which of the following statement is associated with Congenital Lipoid Adrenal Hyperplasia?
A. Most severe form of Congenital Adrenal hyperplasia
B. A defect in the star or the P450 side chain cleavage maybe caused by shows extremely low cortisol and aldosterone concentrations and elevated ACTH and plasma
C. Renin activity
D. All of the above
D. All of the above
Rationale: Congenital Lipoid Adrenal Hyperplasia is the most severe form of congenital adrenal hyperplasia. It involves a defect in the STAR protein or P450scc enzyme, leading to extremely low concentrations of cortisol and aldosterone, with compensatory elevations in ACTH and plasma renin activity.
85
85.Which of the following statements about the diagnosis of Addison’s disease is True?
A. Patients with primary Addison’s disease show a normal response to ACTH stimulation
B. Primary and secondary Addison’s disease can often be differentiated by plasma ACTH
C. Twenty-four–hour urinary free cortisol is normal in Addison’s disease
D. Pituitary ACTH reserves are normal in secondary Addison’s disease
B. Primary and secondary Addison’s disease can often be differentiated by plasma ACTH
Rationale: In primary Addison’s disease (adrenal insufficiency), plasma ACTH levels are elevated due to the lack of negative feedback from cortisol. In secondary Addison’s disease (due to pituitary or hypothalamic dysfunction), ACTH levels are low or normal. The other statements are incorrect based on the pathophysiology of Addison's disease.
86
86.Which of the following condition is a Primary Osteoporosis?
A. Idiopathic
B. Calcium deficiency
C. Thyrotoxicosis
D. Immobilization
A. Idiopathic
Rationale: Idiopathic osteoporosis refers to osteoporosis without an identifiable cause and is classified as primary. The other options are associated with secondary osteoporosis, where there is an identifiable cause contributing to bone loss.
87
87.Failure to mineralize newly formed organic matrix (osteoid) in the mature Skeleton
A. Osteitis deformans
B. Osteogenesis Imperfecta
C. Osteomalacia
D. Renal osteodystrophy
C. Osteomalacia
Rationale: Osteomalacia involves the failure to mineralize the osteoid in mature bone, typically due to deficiencies in vitamin D, calcium, or phosphate, leading to softening of the bones.
88
88.This is characterized by the uncoupling of osteoclast and osteoblast function
A. Pagets disease of bone
B. Osteitis deformans
C. Osteogenesis Imperfecta
D. Both Pagets and Osteitis deformans
D. Both Pagets and Osteitis deformans
89
89.Which of the following diseases will produce osteomalacia or rickets?
A. Vitamin D deficiency states
B. Phosphate depletion
C. Systemic acidosis
D. All of the above
D. All of the above
Rationale: Osteomalacia and rickets can result from vitamin D deficiency, phosphate depletion, and systemic acidosis, all of which disrupt normal bone mineralization.
90
90.Which of the following statement is correct of Renal Osteodystrophy?
A. Affects both bone quality and quantity through metabolic and hormonal disturbances
B. Refers to the spectrum of bone abnormalities that occur in patients with ARF
C. Radiographs may show focal osteosclerosis
D. Renal transplantation may progress disease condition
A. Affects both bone quality and quantity through metabolic and hormonal disturbances
Rationale: Renal osteodystrophy refers to the spectrum of bone diseases that arise in chronic kidney disease (CKD), affecting bone quality and quantity due to disturbances in calcium, phosphate, parathyroid hormone, and vitamin D metabolism. Renal transplantation often ameliorates rather than progresses the disease condition.
91
91.Tunneling resorption refers to:
A. Manner in which osteoclasts gain access to mineralized bone
B. Osteoclasts dig cutting cones through mineralized surfaces into the mineralized cores of old Trabeculae
C. Both statement refers to tunneling resorption
D. Both statement is not associated with tunneling resorption
C. Both statement refers to tunneling resorption
Rationale: Tunneling resorption refers to the process by which osteoclasts dig cutting cones through mineralized surfaces into the mineralized cores of old trabeculae. This is a part of normal bone remodeling and turnover.
92
92.Antibodies are made up of:
A. 2 light chains and 2 heavy chains
B. 3 heavy chains and 1 light chain
C. 4 light chains
D. 2 light chains, a hinge region, one medium chain, and one heavy chain
A. 2 light chains and 2 heavy chains
Rationale: Antibodies (immunoglobulins) are made up of two light chains and two heavy chains, linked by disulfide bonds. This structure allows for the antigen-binding and effector functions of the antibody.
93
93.After eating a meal, a man develops hives all over the body, and has difficulty Breathing. The mechanism behind this particular reaction is mediated by:
A. IgA
B. IgM
C. IgG
D. IgE
D. IgE
Rationale: The symptoms described—hives and difficulty breathing after eating—are typical of an allergic reaction mediated by IgE. IgE antibodies bind to allergens and trigger mast cells to release histamine and other chemicals, leading to allergic symptoms.
94
94.The Nasal Provocation test:
A. Should be done as a first line test for all allergic patients
B. Is non-invasive
C. Is an example of an In Vitro test
D. none of the given choices are true
D. none of the given choices are true
Rationale: The Nasal Provocation test is invasive and is not a first line test for all allergic patients; it is specifically used to determine the nasal response to allergens. It is an in vivo, not an in vitro test.
95
95.In an intradermal test for allergens:
A. Allergen preparations can be stored at room temperature
B. The preparation has the same concentration as that used for skin tests.
C. Can be preserved with 50% glycerin
D. None of the given choices are true
D. None of the given choices are true
Rationale: Allergen preparations used in intradermal tests should not be stored at room temperature; they need to be refrigerated or frozen to maintain stability. The concentration used for intradermal tests is usually different (often more dilute) than that used for skin prick tests, and glycerin is not typically used as a preservative in these preparations due to potential irritation.
96
96.You do a skin prick test on a patient with a suspected allergy to hayseed. After A few minutes, a wheal and flare reaction appears on the skin. Which of the Following is true?
A. If the reaction measures 1mm, this is considered positive
B. Measuring the wheal and flare increases reproducibility
C. This test must be conducted with a positive and negative control
D. Recording the exact reaction size is not necessary
C. This test must be conducted with a positive and negative control
Rationale: Conducting skin prick tests with both a positive control (such as histamine) and a negative control (such as saline) is essential to interpret the results accurately, especially to differentiate true allergic reactions from non-specific skin reactivity.
97
97.A patient is highly suspected to have an allergy, but his skin prick test is Negative. What could be the cause of this?
A. There is nothing wrong, do a serum IgE immediately
B. The allergen concentration is too high
C. There are impurities that
D. The patient may be taking drugs that blunt the immune response
D. The patient may be taking drugs that blunt the immune response
Rationale: Medications such as antihistamines or corticosteroids can suppress the skin's reaction to allergens during skin prick testing, leading to false-negative results. It's important to consider the patient's medication history when interpreting test results.
98
98.Attaching to a poly-immunoglobulin receptor, secretory IgA finds its way into The lumens of glands via:
A. Phagocytosis
B. Transcytosis
C. Degranulation
D. Osmosis
B. Transcytosis
Rationale: Secretory IgA is transported into glandular lumens via transcytosis. It attaches to a poly-immunoglobulin receptor on the basolateral side of epithelial cells and is transported across the cell to the apical side, where it is released into the secretion.
99
99.Involved in the creation of protective barriers, the predominant Immunoglobulin in secretions is:
A. IgA
B. IgM
C. IgG
D. IgE
A. IgA
Rationale: IgA is the predominant immunoglobulin in secretions such as saliva, tears, and mucosal secretions. It plays a crucial role in mucosal immunity by forming protective barriers against pathogens.
100
100.When a person is first infected with something, the primary Immunoglobulin In this initial response is:
A. IgA
B. IgM
C. IgG
D. IgE
B. IgM
Rationale: IgM is the first immunoglobulin produced in response to an infection. It is the primary immunoglobulin in the initial response phase and is effective in forming complexes to neutralize pathogens.
101
11. Type of hepatitis virus that is commonly seen among Injection drug users
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
C. Hepatitis C
Rationale: Hepatitis C virus (HCV) is commonly seen among injection drug users due to its transmission through blood-to-blood contact, often occurring from the sharing of needles.
102
12. The following are genotypes of Hepatitis C virus that are more responsive to treatment
b. Types 1 and 2
a. Types 2 and 3
c. Types 2 and 4
d. All are correct
A. Types 2 and 3
Rationale: Genotypes 2 and 3 of the Hepatitis C virus are known to be more responsive to treatment compared to other genotypes, particularly with earlier forms of treatment regimens. This has implications for choosing the type and duration of antiviral therapy.
103
13. This hepatocytic enzyme seen in canalicular surface that is considered marker for biliary dysfunction
a. Alkaline phosphatase
b. AST
c. ALT
d. GGT
A. Alkaline phosphatase
Rationale: Alkaline phosphatase (ALP) is an enzyme located in several tissues throughout the body, including the liver, particularly in the bile canaliculi. It is considered a marker for biliary dysfunction because levels typically increase with bile duct obstruction and other cholestatic conditions.
104
14. The occurrence of HDV infection in the presence of HBV infection is called
a. Superinfection
b. Coinfection
c. Both
d. None of the above
a. Superinfection
105
15. What is the most common cause of acute liver injury?
a. Alcohol
b. Virus
c. Bacteria
d. Fungal
A. Alcohol
Rationale: Alcohol is the most common cause of acute liver injury, especially in Western countries. Alcohol-related liver disease can range from mild fatty liver to severe alcoholic hepatitis and cirrhosis.
106
16. It is a test good for detecting recent or current Hepatitis E infection
a. anti-HEV IgM
b. anti-HEV IgG
c. anti-HEV IgH
d. none of the above
A. anti-HEV IgM
Rationale: Anti-HEV IgM is a good marker for detecting recent or current Hepatitis E infection, as it indicates an immune response to a recent exposure to the Hepatitis E virus.
107
17. Marker for primary sclerosing cholangitis
a. c-ANCA
b. d-ANCA
c. p-ANCA
d. AMA-with M2
c. p-ANCA
PSC : p-ANCA
PBC : AMA with M2
Rationale: Antimitochondrial antibodies with specificity for the M2 antigen (AMA-M2) are a diagnostic marker for primary biliary cholangitis (PBC), not primary sclerosing cholangitis. P-ANCA may sometimes be associated with primary sclerosing cholangitis but is not a definitive marker.
108
18. Parenchymal fibrosis and hepatic nodular regeneration are features of the following hepatic disorder
a. Steatosis
b. fat liver disease
c. acute viral hepatitis
d. cirrhosis
D. cirrhosis
Rationale: Parenchymal fibrosis and hepatic nodular regeneration are hallmark features of cirrhosis. This condition involves the progressive development of scar tissue that disrupts the liver's normal structure and function.
109
19. The following are features of chronic hepatis disease
a. Detected by persistent HBsAg
b. Has the potential to develop into cirrhosis and hepatic CA
c. Mild elevation of aminotransferases
d. All of the above
D. All of the above
Rationale: Chronic hepatitis disease can be detected by the persistence of hepatitis surface antigen (HBsAg), has the potential to progress to cirrhosis and hepatocellular carcinoma, and often presents with a mild elevation of aminotransferases.
110
20. What does not cause rise in alkaline phosphatase?
a. Excretion of bilirubin
b. Bile salts
c. Intrahepatic bile ductules
d. Albumin
D. Albumin
Rationale: Alkaline phosphatase levels can rise due to issues related to bile ducts and liver cells but not due to albumin, which is a protein synthesized by the liver. Albumin levels are more typically reduced in liver disease due to decreased synthetic function.
111
21. Protein and Xenobiotic synthesis and are mainly involve in one of the following hepatic systems
a. Reticuloendothelial system (RES)
b. Biliary system
c. Hepatocytic system
d. All of the above
C. Hepatocytic system
Rationale: Protein and xenobiotic synthesis mainly occur within the hepatocytes, which comprise the hepatocytic system. This system is responsible for the majority of metabolic, detoxification, and synthetic functions of the liver.
112
22. Pre-hepatic bilirubin is also known as
a. unconjugated bilirubin
b. Water insoluble
с. B1
d. All of the above
D. All of the above
Rationale: Pre-hepatic bilirubin refers to unconjugated bilirubin, which is water-insoluble. This form of bilirubin is also sometimes represented as B1, indicating bilirubin before it has been processed by the liver.
113
23. Clay colored stool is most probably an indication of an impaired metabolism of one of the following substances
a. Stercobilin
b. Urobilin
c. Bilirubin
d. Urobilinogen
A. Stercobilin
Rationale: Clay-colored stools are typically indicative of a lack of stercobilin, which is the substance responsible for the normal brown color of stool. Stercobilin is derived from bilirubin metabolism; a lack of stercobilin suggests impaired bile flow or liver function.
114
24. Which of the following LDH Isoenzymes are majorly found in the liver and in skeletal muscle
a. LD4 and LD5
b. LD1 and LD2
c. LD2 and LD3
d. LD5 only
A. LD4 and LD5
Rationale: LDH isoenzymes LD4 and LD5 are predominantly found in the liver and skeletal muscle. They are elevated in conditions that affect these tissues.
115
25. A 55 year old woman who was clinically diagnosed to have sjogrens syndrome, with elevated alkaline phosphatase and cholesterol level, awaits immunofluorescence antibody testing, what is your clinical consideration at this point?
a. Hypertriglyceridemia
b. Primary sclerosing cholangitis
c. Cholestasis
d. Primary biliary cirrhosis
D. Primary biliary cirrhosis
Rationale: In the context of a patient with Sjogren's syndrome, which often associates with other autoimmune disorders, the elevated alkaline phosphatase and cholesterol level could indicate primary biliary cirrhosis (PBC). Immunofluorescence testing may confirm the presence of specific autoantibodies typical of PBC, such as antimitochondrial antibodies (AMA).
116
The principal sugar circulating in the bloodstream:
A. D-glucose
B. D-fructose
C. D-galactose
D. Glucose
D. Glucose
Rationale: Glucose is the principal sugar circulating in the bloodstream, providing energy for cells throughout the body.
117
This disease may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance:
A. Type I Diabetes
B. Type 2 Diabetes
C. Both
D. None of the above
B. Type 2 Diabetes
Rationale: Type 2 diabetes is characterized by a range that can vary from predominantly insulin resistance with a relative insulin deficiency to a predominantly secretory defect accompanied by insulin resistance.
118
True of Type 1 Diabetes except:
A. Frequency of 5% - 10%
B. C-peptide levels are very low or undetectable
C. Autoantibodies (GAD65, IA-2, IAA) may be present
D. Autoantibodies are absent
D. Autoantibodies are absent
Rationale: The statement that autoantibodies are absent is false for Type 1 diabetes. In fact, Type 1 diabetes is characterized by the presence of autoantibodies, such as those against GAD65, IA-2, and IAA, indicating an autoimmune process.
119
True of Diabetic Ketoacidosis except:
A. It is a serious and potentially fatal hyperglycemic condition requiring urgent treatment
B. The ratio of β-hydroxybutyric acid to acetoacetic acid is greatly decreased
C. It is frequently associated with nausea, vomiting, abdominal pain, electrolyte disturbances, and severe dehydration.
D. Type 2 diabetes patients who are poorly controlled, particularly in the presence of extreme stress or severe acute illness, can also develop DKA.
B. The ratio of β-hydroxybutyric acid to acetoacetic acid is greatly decreased
Rationale: In diabetic ketoacidosis (DKA), the ratio of β-hydroxybutyric acid to acetoacetic acid is greatly increased, not decreased, due to the preferential production of β-hydroxybutyric acid under the conditions of insulin deficiency.
120
Hypoglycemia from endogenous insulin secretion can be due to the following except:
A. Insulin-secreting beta cell tumors
B. Congenital hyperinsulinism
C. Autoantibodies to insulin in patients who have never been treated with insulin
D. None of the above
D. None of the above
Rationale: All options listed are potential causes of hypoglycemia due to endogenous insulin secretion. There is no option that does not fit as a cause of hypoglycemia in the context provided.
121
Which of the following laboratory findings is least likely associated with the diagnosis of Graves' disease?
A. Autoantibodies to the TSH receptor
B. Elevated TSH
C. Thyroid-stimulating immunoglobulins (TSI) positive
D. Thyrotropin-Binding Inhibitor Immunoglobulins positive
B. Elevated TSH
Rationale: Elevated TSH is unlikely in Graves' disease, where TSH is typically low due to negative feedback from high thyroid hormone levels. The presence of autoantibodies to the TSH receptor, TSI, and thyrotropin-binding inhibitor immunoglobulins are more characteristic of Graves' disease.
122
Which of the following laboratory findings will distinguish Graves' disease from Atrophic Thyroiditis:
A. Presence of Thyrotropin-Binding Inhibitor Immunoglobulins
B. Negative for thyroid-stimulating immunoglobulins (TSI)
C. Both
D. None of the above
D. None of the above
123
This disease is caused by autoantibodies directed against the nicotinic acetylcholine (Ach) receptor (AChR):
A. Myasthenia Gravis
B. Lambert-Eaton Myasthenia Syndrome
C. Multiple sclerosis
D. Stiff-person syndrome
A. Myasthenia Gravis
Rationale: Myasthenia gravis is caused by autoantibodies directed against the nicotinic acetylcholine (Ach) receptors at the neuromuscular junction, leading to muscle weakness.
124
Which immunofluorescence pattern is associated with CREST?
A. Homogenous pattern
B. Speckled pattern
C. Nucleolar pattern
D. Centromere/Peripheral pattern
D. Centromere/Peripheral pattern
Rationale: The CREST syndrome, part of the scleroderma spectrum, is associated with the centromere (or peripheral) pattern of immunofluorescence.
125
This autoimmune disease will show autoantibodies to desmoglein 3 and 1:
A. Dermatitis Herpetiformis
B. Pemphigus
C. Pemphigoid
D. Epidermolysis bullosa acquisita
B. Pemphigus
Rationale: Pemphigus is an autoimmune disease characterized by autoantibodies to desmoglein 3 and 1, which are components of the skin that help cells bind together, thus its involvement leads to blistering skin diseases.
126
Which of the following would be elevated in the blood in medullary carcinoma of the thyroid?
A. Calcitonin
B. Thyroxine
C. Catecholamines
D. Secretin
A. Calcitonin
Rationale: Calcitonin is a hormone produced by the parafollicular cells (C cells) of the thyroid gland and is elevated in medullary carcinoma of the thyroid, which arises from these cells.
127
What is the predominant form of thyroid hormone in the circulation?
A. Thyroxine
B. Triiodothyronine
C. Diiodotyrosine
D. Monoiodotyrosine
A. Thyroxine
Rationale: Thyroxine (T4) is the predominant form of thyroid hormone in the circulation, making up about 90% of the thyroid hormones released from the thyroid gland.
128
Thyroid hormones are derived from the amino acid:
A. Phenylalanine
B. Methionine
C. Tyrosine
D. Histidine
C. Tyrosine
Rationale: Thyroid hormones, including thyroxine and triiodothyronine, are derived from the amino acid tyrosine.
129
The serum TSH level is low to absent in:
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
A. Primary hyperthyroidism
Rationale: In primary hyperthyroidism, the thyroid gland produces excess thyroid hormones, which leads to a suppression of serum thyroid-stimulating hormone (TSH) levels due to negative feedback mechanisms.
130
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes:
A. Low serum vasopressin
B. Hypernatremia
C. Urine osmolality to be lower than plasma
D. Low serum electrolytes
D. Low serum electrolytes
Rationale: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes hyponatremia (low serum sodium levels) due to water retention and dilutional effects.
131
A female with severe excessive pubic and facial hair growth (hirsutism) should be tested for which of the following hormones?
A. Estrogen and progesterone
B. Chorionic gonadotropin
C. Growth hormone
D. Testosterone and dehydroepiandrosterone sulfate
D. Testosterone and dehydroepiandrosterone sulfate
Rationale: Hirsutism, or excessive hair growth, is typically associated with high levels of androgens, such as testosterone and dehydroepiandrosterone sulfate (DHEA-S), especially in women.
132
Which is normally the most abundant corticosteroid hormone secreted by the adrenal cortex?
A. Cortisol
B. Dehydroepiandrosterone
C. Aldosterone
D. Corticosterone
A. Cortisol
Rationale: Cortisol is the most abundant corticosteroid hormone secreted by the adrenal cortex, playing critical roles in stress response, metabolism, and inflammation.
133
The cause of Cushing's syndrome can be:
A. Pituitary adenoma
B. Adrenal hyperplasia
C. Overuse of corticosteroids
D. Ectopic adrenocorticotropic hormone (ACTH) production by tumors
D. Ectopic adrenocorticotropic hormone (ACTH) production by tumors
134
Which is the most widely used screening test for Cushing's syndrome?
A. Overnight low-dose dexamethasone suppression test
B. Corticotropin-releasing hormone stimulation test
C. Petrosal sinus sampling
D. Metyrapone stimulation test
A. Overnight low-dose dexamethasone suppression test
Rationale: The overnight low-dose dexamethasone suppression test is the most widely used screening test for Cushing's syndrome because it is simple, efficient, and highly effective at identifying abnormalities in cortisol regulation.
