MCQ

Question 1

25. Which of the following chemical analytes increase due to prolonged venous stasis during
    venipuncture?
    A. Total protein
    B. Cortisol
    C. Triglycerides
    D. Sodium
    E. Creatinine kinase

Answer 1

A

Question 2

26. Which of the following does not follow diurnal pattern or circadian rhythm?
    A. ACTH
    B. Cortisol
    C. Growth hormone
    D. Creatine kinase
    E. Iron

Answer 2

D

Question 3

14. A woman with chronic polydipsia, polyuria, low urine osmolarity & high serum osmolarity, What is the Dx?
    A. Diabetes insipidus
    B. Diabetes mellitus
    C. Syndrome of inappropriate ADH release
    D. Psychogenic polydipsia
    E. Diuretic abuse

Answer 3

A

Question 4

18. Ca 1.8 mmol/L, albumin 20 g/L, Which of the following is correct?
    A. Can exclude hypocalcemia after calculating the adjusted calcium concentration
    B. Measure ionized calcium instead
    C. hypercalcemia

Answer 4

B
(albumin correction of Ca only valid for albumin >20)

Question 5

69. A 73 year-old man with past history of hypertension now presents with headache. BP 160/110, Pulse 60 bpm, RR 25. Lab findings: increased renin & aldosterone, low plasma K and Na. What is the cause for his hypertension?
    A. Increased angiotensin II
    B. Increased cardiac output
    C. High salt diet
    D. Respiratory alkalosis
    E. Increased adrenaline

Answer 5

A

Question 6

7. The following is a consequence of protein-losing enteropathy:
   A. Prolonged bleeding time.
   B. Osteomalacia.
   C. Flat oral glucose tolerance curve.
   D. Steatorrhea.
   E. Recurrent infections.

Answer 6

E

Question 7

49. A 13-month-old boy presented with 2 days watery diarrhoea. He just back from Thailand. What is the most likely biochemical abnormality?
    A. Hyperkalaemia predisposed to cardiac arrhythmia
    B. Increased serum urea and creatinine due to volume depletion
    C. Partially compensated metabolic alkalosis due to excessive bicarbonate loss
    D. Increase urinary 5-HT due to carcinoid syndrome
    E. Increase urinary 5-HIAA due to bacteria overgrowth in the lower ileum

Answer 7

B

Question 8

20. Which of the following is true about daily sodium excretion in a chronic renal failure patient
    who has a GFR 25% of normal?
    A. Increased
    B. Decreased
    C. Unchanged
    A. A only
    B. B only
    C. C only
    D. A and C
    E. B and C

Answer 8

C

(daily sodium excretion != FENa)
(FENa is increased to achieve the same amount of Na excretion)

Question 9

40. Which of the following is true about daily urinary calcium excretion in a chronic renal failure
    patient who has a GFR 25% of normal?
    A. increased
    B. decreased
    C. unchanged
    A. A only
    B. B only
    C. C only
    D. A and C
    E. B and C

Answer 9

B
(hypoCa –> ↑ calcium reabsorption)

Question 10

50. Which of the following is a reliable assessment of the patient’s GFR?
    A. 1/Creatinine
    B. 1/Urea
    C. Fraction extraction of Na
    D. Fraction reabsorption of Na
    E. Total protein/albumin ratio

Answer 10

A

Question 11

51. There were two blood samples take in different time. The doctor decided there is one of the blood results incorrect. Which of the following can account for the result obtained in the wrong one?
    A. Patient has gastrointestinal bleeding
    B. Patient has blood transfusion
    C. Patient has IV infusion
    D. Wrong blood sampling tube had been used (the one for CBC)

Answer 11

C

Question 12

14. In which one of the following medical conditions should thyroxine replacement be started with caution in patients with newly diagnosed primary hypothyroidism?
    A. Bronchial asthma
    B. Epilepsy
    C. Liver cirrhosis
    D. Rheumatoid arthritis
    E. Ischaemic heart disease

Answer 12

E

Question 13

41. 23-year-old woman with irregular menses complains of facial hair increasing in amount over several years. She is sexually active but does not wish to conceive. Examination demonstrates hirsutism and obesity. The ovaries are bilaterally enlarged and cystic. Serum testosterone level is 1.2 ng/mL (normal; <0.8 ng/mL). Serum levels of DHEAS, 17-hydroxyprogesterone and prolactin are normal. The best single therapeutic agent for this patient is:
    A. Oral contraceptive
    B. Glucocorticoid
    C. Clomiphene citrate (an anti-estrogen).
    D. Cyproterone acetate (an anti-androgen).
    E. GnRH antagonist.

Answer 13

A
(estrogen in COP increases synthesis of SHBG –> reduce level of circulating testosterone)

Question 14

A guy with self-injection of testosterone (married and very young, like gym, well-build, already had a first child) and now present with gynecomastia and reduced testis volume.
13. Which of the following is the likely cause of the low sperm count?
A. Decrease intratesticular level of testosterone due to suppressed LH level
B. Decrease level of LH due to exogenous testosterone injection
C. Exercising too much hence increasing the temperature of the testis
D. Klinefelter syndrome
E. Undescended testis

14. For the above patient, which of the following biochemical results would be decreased?
    A. Oestradiol
    B. SHBG
    C. Prolactin
    D. LDL-C
    E. Testosterone

Answer 14

A, B

Question 15

16. A 17-year-old girl with primary amenorrhea with no menses but with breast development several years ago. Her height >90 percentile for female, Breast tanner stage 5, there is no pubic or axillary hair. Ultrasound showed no ovaries or uterus.
    A. 17-hydroxylase deficiency
    B. 5-alpha reductase deficiency
    C. Androgen insensitivity syndrome
    D. Klinefelter syndrome

Answer 15

C
(D is found in male)

Question 16

54. A 30-year-old male is being investigated for infertility. He has well-developed secondary sexual characteristics and claims to have good sexual drive. Which of the following would most likely to have an abnormal level?
    A. Testosterone
    B. Androgen binding protein
    C. GnRH
    D. FSH and LH
    E. LH only

Answer 16

B

good sexual drive –> normal testosterone
(inadequate secretion of FSH) –> abnormal level of androgen binding proteins –> failure to concentrate testosterone into seminiferous tubules –> infertility

Question 17

55. What factors regulates the rate of sperm production?
    A. FSH/LH
    B. FSH/Inhibin
    C. FSH/Testosterone
    D. LH/Testosterone
    E. LH/Inhibin

Answer 17

C

Question 18

5. Which of the following about hCG is incorrect?
   A. Glycoprotein hormone
   B. Produced during foetal development by trophoblast cell
   C. For diagnosis of ectopic pregnancy
   D. It is decreased in Down syndrome pregnancy
   E. It could be elevated in patients with heterophile antibodies

Answer 18

D
(increase)

Question 19

24. PCOS, which is correct?
    A. It is caused by bacterial infection
    B. It is only diagnosed in women > 50 years old
    C. The primary symptoms is weight gain
    D. It has high androgen and insulin resistance
    E. The treatment is surgery

Answer 19

D
(cause unclear, but usually associated with insulin resistance)

Question 20

17. Which of the following is not caused by numerical abnormalities in sex chromosome?
    A. Patau syndrome
    B. DiGeorge Syndrome
    C. Klinefelter syndrome
    D. Edward Syndrome
    E. Down syndrome

Answer 20

B

Question 21

7. Therapeutic drug monitoring for aminoglycoside antibiotics:
   A. typically involves measurement of the peak level only.
   B. typically involves measurement of the trough level only.
   C. should not be done in patients with impaired renal function.
   D. should not be done in patients with severe bacterial infections.
   E. can be used to govern the frequency of drug administration.

Answer 21

E

Question 22

24. Elderly on many drugs but develops confusion. Note on digoxin. Na 138 K 3.2 Calcium 1.5 Albumin 30. Which of the following is incorrect?
    A. Narrow therapeutic range of digoxin is an important determinant
    B. Hypokalemia would predispose to increased sensitivity to digoxin
    C. Albumin-corrected Calcium is 1.75
    D. Sample can be taken after 5 half lives which is about 8 days
    E. Sample should be taken at least 3 hours after the last dose

Answer 22

E (6 hour)

Question 23

15. Concerning cyclosporin A, which of the following is not true?
    A. It is normally excreted in the kidneys
    B. Whole blood is needed for drug monitoring
    C. It inhibits IL-2 secretion by T cells
    D. Can have adverse effects including gingival hyperplasia
    E. Includes measuring its trough level

Answer 23

A

Question 24

10. Serum cholinesterase activity will be reduced in:
    A. Thyrotoxicosis
    B. Paget’s disease
    C. Acute liver disease
    D. Ethylene glycol poisoning
    E. Organophosphorus poisoning

Answer 24

E

Question 25

3. What makes the large library of MHC?
   A. Somatic gene rearrangement
   B. Somatic hypermutation
   C. Random pairing of MHC peptide chains
   D. High no. of alleles
   E. All of the above

Answer 25

D

Question 26

29. Which of the following is responsible for activating naïve T cells?
    A. T helper cells
    B. B cells
    C. Macrophages
    D. Dendritic cells
    E. Plasma cells

Answer 26

D

Question 27

6. Lymph node and MALT, which is not correct?
   A. LN has afferent lymphatic and MALT does not
   B. LN has efferent lymphatic and MALT does not
   C. LN responsible for connective tissue and MALT for mucosal defence
   D. LN in chain and MALT scattered
   E. None of the above

Answer 27

B

Question 28

1. Which of the following is secreted from eosinophils?
   A. Histamine
   B. Eosinophil cationic protein
   D. Prostaglandin

Answer 28

B