3dr year Common Biochemistry MCQs

Revision questions (prepared by Professor M.S. Ardawi) Q1.Marasmus A) Is characterized by growth retardation, anaemia, hypoproteinaemia, oedema and fatty infiltration of the liver. B) Symptoms respond therapeutically to a high protein diet containing meat and milk products. C) Affects populations largely dependent on cereals and grains or other products of low biological value. D) Is a disease observed primarily in highly developed industrial areas. Q2.Regarding Potassium A) Its cellular influx is inhibited by intracellular acidosis. B) Its renal uptake is diminished by aldosterone. C) Hypokalaemia may occur in cases of nephrotic syndrome, malabsorption or congestive cardiac failure. D) Redistribution of 1C which occurs in cases of crush injuries could result in hyperkalaemia.

Q3.With reference to potassium; which of the following statements are correct? A) Changes in serum potassium concentration may reflect gains or losses in whole body potassium content, or shifts of potassium in and out of cells. B) Hyperkalaemia is potentially life-threatening and death may occur with no clinical warning signs. C) A high serum potassium is usually due to decreased renal function, or to a shift of potassium from cells in response to an acidosis. D) Hypokalaemia is usually caused by excessive gastrointestinal or renal loss of potassium. Q4.The causes of hyperkalaemia include: A) Renal failure. B) Mineralocorticoid deficiency. C) Acidosis D) Potassium release from damaged cells Q5. With reference to hyponatraemia; which of the following statements are correct: A) Hyponatraemia due to water retention is the commonest biochemical disturbance encountered in clinical practice. B) Hyponatraemic patients without oedema who have normal serum urea and

creatinine and blood pressure, have water overload. C) Hyponatraemic patients with oedema are likely to have both water and sodium overload. D) Hyponatraemia may occur in the patient with gastrointestinal or renal fluid losses which have caused sodium depletion. Q6. With reference to hypernatraemia; which of the following statements are correct? A) Hypernatraemia is most commonly due to water loss. B) Hypernatraemia may be due to failure to retain water as a result of impaired AVP secretion or action. C) Hypernatraemia may be the result of a loss of both sodium and water as a consequence of an osmotic diuresis. D) Hypernatraemia may be caused by excessive sodium intake, particularly from the use of intravenous solutions. Q7, Regarding Sodium A) Its renal retention increases with a decrease in intravascular volume. B) Its renal excretion via the collecting tubules is enhanced by atrial natriuretic peptide. C) Its concentration in blood is determined in serum or lithium-oxalate-plasma samples. D) Pseudohyponatraemia occurs due to a decrease in body sodium related to hyperlipidaemia or hyperproteinaemia. E. Its depletion mainly related to abnormal losses via the gastrointestinal tract. Q8. Regarding Magnesium A) Its body concentration is more widely distributed among soft tissues than that of calcium or phosphate. B) Its gastrointestinal absorption is stimulated only by parathyroid hormone and inhibited by calcitriol. C) Its renal absorption occurs mainly at the proximal part of renal tubules. D) Severe hypomagnasaemia is associated with coronary vasospasm, acute infarction and sudden death. Q9. Regarding Phosphate A) Approximately 75% of total plasma phosphate is found to be bound to organic molecules such as phospholjpids. B) Gastrointestinal absorption of phosphate is proportional to its dietary intake. C) Renal phosphate uptake is Na^ dependent with approximately 70-85% reabsorbed at the proximal tubules. D) Its plasma concentration could be measured using orthocresolphthalein colorimetric method.

Q10. Regarding total calcium: A) Is mainly found in plasma bound to albumin, globulins and lipoproteins. B) Its absorption from the gut is enhanced by the actions of calcidiol. C) Its efflux from bone is diminished via the actions of calcitonin. D) Its concentration in blood is determined in serum or EDTA-plasma collected without venous stasis. Q11. Which of the following statements are correct? A) Hypercalcaemia will most likely be due to the presence of a parathyroid adenoma. B) Serum calcium in excess of 3.5 mmol/L is life-threatening. C) Thyrotoxicosis very occasionally leads to decreased bone turnover and hypocalcaemia. D) Some tumours secrete a protein called PTHrP which has PTH-like properties. Q12. Symptoms of hypercalcaemia include: A) Cardiac arrhythmias. B) Thirst and polyuria and renal calculi. C) Abdominal pain and vomiting. D) Diarrhoea and weight loss. Q13. The causes of hypocalcaemia include: A) Hypoparathyroidism B) Vitamin D excess C) Renal disease D) Pseudohypoparathyroidism Q14. The clinical features of hypocalcaemia include: A) Neurologic features such as tingling and tetany B) Cardiovascular signs such as an abnormal ECG C) Cataracts D) Mental changes. Q15. Which of the following statements are correct: A) 'Adjusted calcium' should be used to avoid the problems of interpreting the total calcium concentration in patients who have abnormal serum albumin concentrations. B) If a hypocalcaemic patient has low or undetectable PTH in serum, he/she is hypoparathyroid. C) If PTH concentrations are appropriately elevated to the low calcium, then the reason for the hypocalcaemia is most likely to be vitamin D deficiency. D) Patients with CRF often have hypocalcaemia due to the inability of renal cells to synthesize calcitriol.

Q16. Which of the following statements are correct? A) Hyperphosphataemia is commonly a consequence of renal impairment. B) Hypophosphataemia may be due to the effects of a high circulating PTH level or to congenital disorders of renal phosphate reabsorption. C) PTH increases phosphate excretion by the kidneys in hyperparathyroidism. D) Ingestion of non-absorbable antacids (e.g. aluminium hydroxide) prevent phosphate absorption. Q17. With reference to magnesium, which of the following statements are correct? A) Hypermagnesaemia is uncommon, but is occasionally seen in renal failure. B) Magnesium deficiency results from a combination of poor dietary intake and increased urinary or intestinal losses. C) Magnesium deficiency may occur as a complication of intestinal disease or surgery,or renal damage. D) "Magnesium influences the secretion of PTH by the parathyroid glands and severe hypomagnesaemia may cause hypoparathyroidism. Q18. Given the information that a 20 year old female weighing 55 kg and engaged in light physical activity is consuming a daily average mixed diet; one can draw the following conclusions about her diet; A) The quantity of protein in the diet should be about 50-75 g/day. B) About 30% other calories should come from dietary fat. C) A lOOg/day of carbohydrate should be included in the diet to avoid ketosis. D) To maintain her weight of a normally active 55 Kg, female, the diet should contain about 3000 Kcal per day. ---------------------------DOOD LUCK Mark the TRUE and false answers fo r each of the following questions: 1. Recognized consequences of vitamin B, deficiency include : a. polyneuropathy b. cardiac failure c. decreased level ofpyruvate in the blood d. decreased erythrocyte transketolase activity 2. Vitamin D : a. deficiency is an important cause of osteoporosis b. is synthesized in the skin c. undergoes a-1-hydroxylation in the liver d. is present in large quantities in green vegetables

3. Vitamin K ; a. plays an essential role in preventing thrombosis b. decreases the coagulation time in newborn infant with haemorrhagic disease c. is present in high concentration in cow's or breast milk d. is synthesized by intestinal bacteria 4. Given the information that a 65-Kg man is consuming a daily average of 270g of carbohydrate, 70g of protein and 50g of lipid, one can draw the following conclusions : a. total energy intake per day is about 2450 Kcal b. about 50% of the calories are derived from protein c. the diet does not contain a sufficient amount of dietary fibers d. the diet contains sufficient amount of dietary protein needed by an adult man 5. Magnesium : a. deficiency can cause hypocalcaemia b. excretion is inhibited by PTH c. excretion occurs mainly in the urine d. in the body is mainly intracellular. 6. The following statements about trace nutrients are true : a. chromium deficiency predisposes to hypoglycaemia b. selerium is a component of vitamin E. c. copper deficiency is frequently seen in patients recieving total parenteral nutrition d. zinc is essential for the activity of red cell superoxide dismutase 7. Regarding sodium ; a. its renal retention increases with a decrease in intravascular volume b. its renal excretion via the collecting tubules is enhanced by atrial natriuretic peptide c. its concentration in blood is determined in serum or lithium-oxalate-plasma samples d. hypernatraemia is often accompanied by hypokalaemia 8. Plasma urea concentration : a. can decrease as a result of bleeding into the gut b. can increase as a result of dehydration c. tends to fall in patients on low protein diet d. within the reference range indicates normal renal function

9. Urinary calculi containing calcium may be the result of ; a. renal tubular acidosis b. secondary hyperparathyroidism c. vitamin D intoxication d. chronic renal infection 10. The following selected steps in the synthesis and maturation of collagen are correctly paired with appropriate correct description and factor : a. hydroxylation : intracellular and prolyl hydroxylase b. glycosylation : extracellular and glactosyi transferase c. hydrolysis of propeptides : extracellular and lysyi oxidase d. cross-linking of collagen fibers : extracellular and procollagen peptidase 11. A clinically dehydrated patient has a plasma Na concentration of 130 mmol/L; the urine Na concentration is 80 mmol/L, The likely causes include : a. adrenal failure b. pre-renal renal failure c. primary aldosteronism d. severe diarrhoea 12. The following vitamins are correctly paired with their functions : a. Riboflavin; coenzyme for metabolism of pyruvate to acetyl-CoA b. Vitamin E; antioxidant activity c. Vitamin B12; coenzyme for the enzyme N5-tetrahydrofolate homocysteine methyltransferase d. Vitamin B6; needed for cell-mediated immunity 13. A healthy fit elderly man has biochemical tests performed as part of a 'well-man' screen. The only abnormality is a serum alkaline phosphatase activity of 200 U/L (reference range 30-120) . Possible causes include : a. osteomalacia b. osteoporosis c. Paget's disease of bone d. tumour metastasis to the liver 14. Bilirubin : a. in the conjugated form is highly toxic to the nervous system b. is responsible for the normal colour of the urine c. in the plasma is normally mainly unconjugated d. when conjugated, is insoluble in water

15. Transferrin : a, makes up 3% of total plasma proteins which function is to bind and transport heme to different tissue b. regulate the concentration of heme in plasma c. has two (2) binding sites for iron d. high plasma level occurs in situation such as nephrotic syndrome/ liver dieseases, iron poisoning and repeated blood transfusions 16. In heme catabolism : a. heme is converted into biliverdin by the action of the enzyme heme oxygenase b. biliverdin is transported from the extrahepatic reticuloendothelial cells to the liver in combination with albumin c. In the liver, biliverdin is conjugated with glucuronic acid by the action of bilverdin-UDP glucuronyl transferase d. in the intestine/ further transformation of biliverdin take place by bacterial flora 17. ceruloplasmin : a. is a copper containing serum a-2-globulin b. regulate the level of copper in liver and other tissues c. its level increases markedly in the ra.fe inherited Wilson's disease d. its level may increase in inflammation, pregnancy and during administration of oral contraceptives. 18. in heme biosynthesis pathway ; a. all of the porphyrin nitrogen come from alanine b. the initial and last three enzymatic steps take place in the cytoplasm c. the intermediates (porphyrinogens) are colorless and unstable d. heme acts as a represser of the synthesis of ALA synthetase 19. Hereditary coproporphyria (Hepatic porphyria) : a. is a genetic disorder which results from derangements of heme catabolism b. resulted from increase in the activity of ALA synthetase c. resulted also from decrease in the activity of coproporphyrinogen oxidase d. may lead to extensive skin destruction

20. Crigler-Najjar syndrome : a. resulted from congenital deficiency of glucuronyl transferase b. present in the first few days of life as jaundice c. the plasma level of conjugated bilirubin is usually high d. may develop kernicterus