path sciences 2 stolen Jan

methylmalonic acid can be employed to identify...

a. patients with a folate deficiency prior to their folate levels becoming abnormal

b. patients with iron deficiency prior to iron levels becoming abnormal

c. patients with homocysteine deficiency

d. patients with B12 deficiency prior to B12 levels becoming abnormal

e. general haematinic deficiency in patients with renal disease

Patients with B12 deficiency prior to B12 levels becoming abnormal

in a case of iron deficiency anaemia, which one of the following results could be raised above the upper limit of the reference range?

a.Total homocysteine

b.Total Iron Binding Capacity

c.Ferritin

d.Haemosiderin

e.Methylmalonic acid

Total iron binding capacity

A patient is assayed for G6PD deficiency using fluorescence assay. What is measured?

Question a.NADH

b.ATP

c.Glutathione

d.NADPH

e.6-phosphoglucono-δ-lactone

NADPH

in the folate cycle, the failure to convert deoxyuridine monophosphate to deoxythymidine monophosphate results in which of the following?

a.Methylation of alternative substrates to myelin

b.Folate deficiency

c.Increased cell proliferation

d.Failure of methylation events

e.The failure to maintain the integrity of DNA replication

The failure to maintain the integrity of DNA replication

A patient with pyruvate kinase deficiency can be expected to experience an increase in which one of the following?

a.2,3 DPG

b.Lactate

c.Production of NAD+

d.Pyruvate

e.ATP synthesis

2,3 DPG

Which one of the following haemoglobin constituents directly binds to molecular oxygen?

a.F8 histidine

b.H9 glycine

c.A6 Lysine

d.E7 histidine

e.G10 Glycine

E7 histidine

In order to produce 1 mole 2,3DPG, one mole of what is sacrificed?

a.NADPH

b.NAD+

c.ATP

d.NADH

e.ADP

ATP

A patient experiences acute sensitivity of oxidising agents. What is the likely cause?

a.G6PD deficiency

b.Phosphofructokinase deficiency

c.Pyruvate Kinase deficiency

d.Diphosphoglycerate mutase deficiency

e.Lactate dehydrogenase deficiency

G6PD deficiency

A 62 year-old Jamaican male with rheumatoid arthritis complains of feeling tired all the time. A full blood count is requested and his Haemoglobin result is returned with a value of 113g/L (RR: 133-167g/L) and his MCV is 75fl (RR: 77-98fL). What would be the next course of action?

a.Prescribe oral ferrous sulphate with vitamin C supplements

b.Check his ferritin and inflammatory markers

c.Investigate his B12 and folate status

d.Investigate for haemoglobinopathy

e.Crossmatch the patient and transfuse packed red cells

Check his ferritin and inflammatory markers

Myeloma cells are...

a. Naive B-cells

b. Post germinal centre plasma cells

c. Follicular dendritic cells

d. Post germinal centre memory cells

e. Activated B-cells

Post germinal centre plasma cells

Which one of the following causes left shift when plotted on the oxygen dissociation curve?

a.increased [H+]

b.increased [2,3DPG]

c.increased temperature

d.increased [HbF]

e.HbSS

Increased [HbF]

A patient, admitted to hospital with symptoms suggestive of acute DIC, has her DIC score calculated. Which of the following scores is threshold positive for overt DIC?

a. >1

b. >10

c. >20

d. >15

e. >5

>5

In the context of haemostasis testing, the terms of concordance and discordance relate to the:

a. similarity between platelet count and clotting result

b. similarity between bleeding risk and thrombotic risk

c. similarity between results and clinical symptoms

d. similarity between concentration and activity levels

e. similarity between structure and function

Similarity between concentration and activity levels

Which of the following types of Von Willebrand Disease is associated with prolonged APTT result?

a. Type IIB

b. Type IIM

c. Type IIN

d. Type I

e. Type IIA

type IIN

Which one of the following inhibitors is Vitamin K dependent?

a. Heparan Sulphate

b. TFPI

c. Plasminogen

d. Antithrombin

e. Protein S

Protein S

Dysfibrinogenaemia refers to abnormal fibrinogen structure. Which of the following most likely represents the outcome of clotting studies on a patient with dysfibrinogenaemia?

a. Normal PT, abnormal APTT

b. Abnormal PT, normal APTT

c. Mixing studies (50:50) that fails to correct

d. Normal PT, normal APTT

e. Abnormal PT, abnormal APTT

Abnormal pt abnormal aptt

What manifestation would you expect in a patient with Factor XIII deficiency?

a. Failure of Fibrin cross-linking

b. Failure of Tissue Factor Pathway Inhibitor

c. Failure of the Intrinsic Tenase complex

d. Delayed Fibrinolysis

e. Reduction in thrombin generation

Failure of fibrin cross-linking

When using the APTT test, what specific reagent is required to activate this test?

a. Platelet substitute

b. Calcium chloride

c. Kaolin

d. Thromboplastin

e. Plasma

Kaolin

Approximately, how many GIa domains are present on Vitamin K dependent clotting factors?

a. 5-8

b. 13-15

c. 1-4

d. 16-20

e. 9-12

9-12

R506Q mutation, found in factor V Leiden, results in resistance to which enzyme?

a. Factor Xa

b. Plasmin

c. Thrombin

d. Antithrombin

e. Protein C

protein c

In the Prothrombin Time test, which one of the following reagents enables the isolation of the Extrinsic pathway?

a. Calcium chloride

b. Plasma

c. Thromboplastin

d. Kaolin

e. Platelet substitute

Thromboplastin

Which of the following describes a complete deficiency of Von Willebrand Factor?

a. Type IIA

b. Type IIN

c. Type I

d. Type III

e. Type IIB

type III

A patient, admitted to hospital with symptoms suggestive of acute DIC, has her DIC score calculated. Which of the following scores is threshold positive for overt DIC?

a. >5

b. >10

c. >1

d. >15

e. >20

>5

A 2-year-old boy is presented to a paediatrician with a bright red, engorged, elbow following a small fall. A coagulation screen is performed which shows isolated prolonged APTT. Which of the following is the most likely cause?

a. Factor V deficiency

b. Thrombin deficiency

c. Factor XII deficiency

d. Thrombocytopenia

e. Factor IX deficiency

factor IX deficiency

A 12-year-old young boy is diagnosed with acute viral hepatitis. What is the likely route of his infection?

a. Urinary tract

b. Skin

c. Eye

d. Nose

e. Gastrointestinal tract

Gastrointestinal tract

Which one of the following is the best test for measuring pancreatic exocrine insufficiency?

a. Both amylase and lipase

b. Plasma lipase

c. Plasma amylase

d. Faecal elastase

e. Trypsinogen

faecal elastase

A 50-year-old male is admitted to the emergency department with abdominal pain. He has a long-standing history of alcohol use. His physical appearance indicated jaundice and his urine colour is dark yellow. What has led to dark yellow colour in his urine?

a. He is excreting high levels conjugated bilirubin

b. He is excreting high levels or urobilinogen

c. He is excreting high levels of unconjugated bilirubin

d. He has consumed a meal which contained yellow coloured pigments

e. He is dehydrated

He is excreting high levels of conjugated bilirubin

A 32-year-old male with a history of abdominal pain and heartburn which has not been relieved by antacids receives a pentagastrin test for the investigation of peptic ulcer. His basal acid secretion was 55 mmol/L and pentagastrin stimulation produces no change in the acid secretion. What is the likely underlying pathology in this patient?

a. Achlorhydria

b. Duodenal ulcer

c. Zollinger Ellison syndrome

d. Gastric ulcer

e. H. pylori infection

zollinger ellison syndrome

A 50-year-old male is admitted to the emergency department with abdominal pain. He has a long-standing history of alcohol use. His physical appearance indicated jaundice and his urine colour is dark yellow. Which of the following patterns of liver enzymes would most likely be seen in this patient?

a. Elevation of alkaline phosphatase (ALP) is greater that gamma glutamyltransferase (GGT)

b. Both alanine transaminase (ALT) and aspartate transaminase (AST) are elevated to the same extent.

c. Elevation of alanine transaminase (ALT) more than aspartate transaminase (AST)

d.Elevation of both alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT)

e. Elevation of aspartate transaminase (AST) in greater than alanine transaminase (ALT)

Elevation of aspartate transaminase (AST) in greater than alanine transaminase (ALT).

what is the subunit composition of foetal Hb?

α2γ2

what is the subunit composition of adult HbA?

α2β2

what is the subunit composition of adult HbA2?

α2δ2

what do goblet cells secrete?

mucus

what do perietal cells secrete?

HCl

what do chief cells secrete?

pepsinogen

What do enterochromaffin cells secrete?

histamine

what do g cells secrete?

gastrin

what do d cells secrete?

somatostatin

what are the levels of gastric acid secretion measured by pentagastrin test?

basal acid secretion: <10mmol/h in males, <6mmol/h in females

stimulated acid secretion:

<45mmol/h in males

<35 mmol/h in females

where is bile made and stored?

made in the liver and stored in the gall bladder

what does the presence of fat and protein in the duodenum do?

stimulates release of cholecystokinin and pancreatic acinar secretions

what is maldigestion?

inability to digest food

what is malabsorption?

inability for the intestine to absorb food

Which one of the following phenotypes does not represent carrier status of alpha thalassaemia?

a. αα/--

b. -α/-α

c. -α/ αα

d. αα/-α

e. -α/--

-α/--

The photomicrograph below is a typical representation of ...

Iron deficiency

A patient presents with the following results. He is known to have G6PD deficiency and has had an acute adverse event. Which one of the following results patterns would be unexpected?

Parameter	Result	Reference range	Units
Bilirubin	37	<17	μmol/L
LDH	320	100-250	U/L
Haptoglobin	3.6	0.5-2.0	g/L
Reticulocytes	175	25-125	X109/L
MCV	86	77-98	fL

a. MCV

b. Haptoglobin

c. LDH

d. Reticulocytes

e. Bilirubin

Haptoglobin

From the results shown in the table below, which haemoglobin structure is present in the lowest concentration?

a. α2βs2

b. α2δ2

c. α2β2

d. α2ε2

e. α2γ2

α2βs2

Which one of the following features isn’t apparent in these cells?

a. Eccentric nucleus

b. Prominent nucleoli

c. Basophilic cytoplasm

d. Perinuclear halo

e. Clock-face nucleus

Prominent nucleoli

Which one statement regarding  images A and B is incorrect?

a Neither figures A nor B show evidence of immune-paresis

b. Figure A shows a monoclonal protein

c. Figure B shows a monoclonal IgG with λ light chain restriction

d. Both figures A and B show a strong albumin band

e. Figure A, IgG and κ light chains predominate

Figure A shows a monoclonal protein

The following key results have been published for a patient with myeloma. According to the Revised International Staging System, which statement is correct?

Parameter/analyte	Result	Reference range	Units
Serum albumin	40	35-50	g/L
β-2-microglobulin	6.0	1.1-2.4	mg/L
Lactate dehydrogenase	370	240-480	μmol/L
t(4;14)	Negative
t(14;16)	Negative
del (17p)	Negative

a. Normal albumin levels are associated with a poor prognosis

b. Taken together, the β-2-microglobulin results and LDH indicate stage II disease

c. The β-2-microglobulin result alone means this patient has stage I disease

d. The patient cannot have stage III disease because the cytogenetics and albumin results are normal

e. This level of LDH alone means the patient has stage III myeloma

Taken together, the β-2-microglobulin results and LDH indicate stage II disease

Approximately, how many GIa domains are present on Vitamin K dependent clotting factors?

a. 9-12

b. 5-8

c. 16-20

d. 1-4

e. 13-15

9-12

What is  the likely condition associated with the following blood results in a 45-year -old female?

Aspartate aminotransferase	30 IU/L
Alanine aminotransferase	32 IU/L
Alkaline Phosphatase	280 IU/L
Gamma Glutamyl Transferase	150 IU/L
Albumin	40 g/L
Plasma bilirubin	90 μmol/L

a. Gall stones

b. Dubin Johnson Syndrome

c. Gilbert's syndrome

d. Sickle cell disease

e. Hepatic cirrhosis

Gall stones

A 38-year-old male presents to the emergency department reporting malaise, fever, chills, and right upper quadrant abdominal pain that started a few days ago. He had a similar presentation upon returning from vacation in Egypt a few months ago but it was not as severe at the time. His urine colour is dark yellow and patient appears jaundiced. He admits of drinking alcohol regularly. His laboratory studies shows the following results:

Aspartate aminotransferase	560 IU/L
Alanine aminotransferase	758 IU/L
Alkaline Phosphatase	140 IU/L
Gamma Glutamyl Transferase	55 IU/L
Plasma proteins	Normal
Albumin	Normal
Bilirubin	90 μmol/L

What is the likely cause of above results seen in the patient?

a. Alcohol hepatitis

b. Hepatitis C infection

c. auto-immune hepatitis

d. Hepatitis B infection

e. Influenza virus infection

Hepatitis C infection

A patient with an abnormality of any of the common pathway clotting factors would be expected to have which one of the following reaction patterns?

a. Abnormal PT, normal TT

b. Abnormal PT

c. Abnormal APTT, abnormal TT

d. Abnormal APTT

e. Abnormal PT, abnormal APTT

Abnormal PT, abnormal APTT

Which type of Von Willebrand disease is associated with a partial deficiency of vWF?

a. Type III

b. Type IIB

c. Type I

d. Type IIM

e. Type IIN

Type I

Heparin promotes:

a. thrombin activity

b. Tissue Factor Pathway Inhibitor activity

c. Tenase activity

d. fibrinolysis inhibitor activity

e. endothelial cell activity

thrombin activity

Vitamin K is required for which of the following?

a. Post translational farnesylation of glutamic acid residues

b. Post translational acetylation of glutamic acid residues

c. Post translational ubiqutination of glutamic residues

d. Post translational sumoylation of glutamic acid residues

e. Post translational gamma carboxylation of glutamic acid residues

Post translational gamma carboxylation of glutamic acid residues

In order to diagnose a patient with Haemophilia C, which of the following factor assays would be abnormal?:

a. Factor XII

b. Factor IX

c. Factor VIII

d. Factor XI

e. Factor X

Factor XI

An urgent serum sample is received to investigate a patient's clotting prior to emergency surgery. What pattern of results would you expect to find?

a. Abnormal PT and APTT

b. Abnormal APTT but normal PT

c. Abnormal PT

d. Abnormal APTT

e. Abnormal PT but normal APTT

Abnormal PT and APTT

Mixing studies (50:50 mix) are used to investigate a patient with a prolonged APTT but the clotting time fails to correct. This suggests:

a. The presence of a clotting factor deficiency

b. abnormal endothelial cell function

c. a clotting factor inhibitor

d. abnormal liver function

e. platelet dysfunction

a clotting factor inhibitor

Which of the following is required for enhanced Protein C activation?

a. Thrombomodulin-bound thrombin

b. Thrombin alone

c. Factor VIII-bound thrombin

d. Factor V-bound thrombin

e. EPCR-bound thrombin

Thrombomodulin-bound thrombin

A patient presents with dysfibrinogenaemia (abnormal fibrinogen structure). What pattern of laboratory results would you expect to find?

a. All clotting studies would be normal

b. Abnormal APTT only

c. Abnormal PT only

d. Abnormal TT only

e. Abnormal PT, APTT, TT

Abnormal PT, APTT, TT

Which of the following is not associated with haemophilia?

a Synovitis

b. Haemarthrosis

c. Disseminated Intravascular Coagulation

d. Pathological fracture of bones

e. Gastrointestinal bleeding

Disseminated Intravascular Coagulation

The common pathway begins with which of the following?

a. Factor X

b. Factor II

c. Factor XII

d. Factor VII

e. Factor IX

Factor X

Which of the following statements regarding GPIIb-IIIa is INCORRECT?

a. GPIIb-IIIa can be found in platelet granules containing the cofactors for the prothombinase and intrinsic Tenase complexes.

b. GPIIb-IIIa binds to the vWF C1 domain. 

c. GPIIb-IIIa is a marker of platelet activation.

d. GPIIb-IIIa can be found in platelet granules containing ATP.

e. GPIIb-IIIa deficiency can be identified by measuring CD markers CD51 and CD61.

GPIIb-IIIa deficiency can be identified by measuring CD markers CD51 and CD61.

A patient with a Factor V Leiden mutation would be resistant to the:

a. antithrombin pathway

b. protein C pathway

c. fibrinolytic system

d. tissue Factor pathway Inhibitor

e. effects of warfarin

protein C pathway

A patient has a Factor V inhibitor. Which one of the following results would be consistent with this finding?

a. The patient would have a prolonged APTT and prolonged PT.

b. The patient would have a normal APTT and prolonged PT.

c. The patients factor V antigen levels would be low.

d. Mixing studies on this patient's plasma correct to the reference range.

e. The patient would have a prolonged APTT and a normal PT.

The patient would have a prolonged APTT and prolonged PT.

Which of the following is found in endothelial cells?

a. Alpha granules

b. Lysosomes

c. Wiebel-Palade bodies

d. Dense bodies

e. Surface connecting open canalicular system

Wiebel-Palade bodies

The intrinsic pathway of the classical coagulation cascade begins with the activation of:

a.factor X

b.

factor XII

c.

thrombin

d.

factor VIII

e.

factor VII