Chemical Pathology MCQs: Diabetes, Renal & OmpathStudy

--- MOUNT KENYA UNIVERSITY — UNIVERSITY EXAMINATION 2020/2021 Medical School Department of Human Physiology Bachelor of Pharmacy — Regular Unit Code: BPA2203 Unit Title: Chemical Pathology Date: Thursday 29th April, 2021 8:00 AM 2 Hours Instructions: Answer ALL questions --- PART A — MULTIPLE CHOICE QUESTIONS --- Question 1 A deficiency of one of the following hormones is likely in a patient with hypernatremia and high serum osmolality: A. Antidiuretic hormone B. Oxytocin C. Insulin D. Growth hormone Answer: A ADH (vasopressin) promotes water reabsorption in the collecting duct. Its deficiency leads to loss of free water → concentrated sodium (hypernatremia) and raised serum osmolality. This is the picture of diabetes insipidus. --- Question 2 The body responds to hypoglycemia by: A. Release of insulin and thyroxine B. Release of ketones and proteins C. Release of sorbitol and fructose D. Release of glucagon and epinephrine Answer: D Glucagon (from pancreatic alpha cells) and epinephrine (from adrenal medulla) are the primary counterregulatory hormones activated during hypoglycemia. They promote glycogenolysis and gluconeogenesis to restore blood glucose. --- Question 3 Nephrotic syndrome is characterized by all except: A. Hypocholesterolemia B. Hypoalbuminemia C. Albuminuria D. Hypertriglyceridemia Answer: A Nephrotic syndrome is characterised by massive proteinuria, hypoalbuminemia, oedema, and hyperlipidemia (raised cholesterol and triglycerides — not hypocholesterolemia). The liver compensates for protein loss by increasing lipoprotein synthesis. --- Question 4 Chronic renal failure is diagnosed by: A. Decreased blood urea B. Increased creatinine C. Hematuria D. Glucosuria Answer: B In chronic renal failure, reduced GFR leads to accumulation of creatinine and urea (both rise, not fall). Increased serum creatinine is the primary biochemical marker. Hematuria and glucosuria may occur but are not diagnostic of CRF. --- Question 5 Fluoride is the anticoagulant used in testing blood for: A. Blood sugar B. Coagulation C. Electrolyte D. CBC Answer: A Fluoride (sodium fluoride) inhibits glycolysis by blocking enolase, preventing ongoing glucose metabolism by red blood cells after collection. It is therefore used specifically for blood glucose (blood sugar) samples, often combined with potassium oxalate as anticoagulant. --- Question 6 In a 15-year-old male patient with polydipsia and polyuria, a fasting serum glucose of 13 mmol/L, the most likely diagnosis is: A. Gestational diabetes mellitus B. Type I diabetes mellitus C. Non-insulin dependent diabetes mellitus D. Pancreatic islet cell tumor (glucagonoma) Answer: B A young male with classic symptoms (polydipsia, polyuria) and markedly elevated fasting glucose points to Type 1 diabetes mellitus — autoimmune destruction of beta cells causing absolute insulin deficiency. Type 2 is uncommon at 15 years without obesity/metabolic syndrome context. Gestational diabetes only occurs in pregnancy. --- Question 7 In type 1 diabetes mellitus, insulin is: A. Increased B. Low C. Normal D. Correlated to age of patient Answer: B Type 1 DM is caused by autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency — insulin levels are very low or undetectable. --- Question 8 The test used to monitor the glycemic status of patients over a period of three to four months is: A. Uristix B. Fasting blood sugar C. Fructosamine D. HbA1c Answer: D HbA1c (glycated haemoglobin) reflects average blood glucose over the preceding 2–3 months, corresponding to the lifespan of red blood cells. Fructosamine reflects 2–3 weeks; fasting blood sugar is a point-in-time measurement. --- Question 9 One of the following enzymes shows the greatest specificity in liver damage: A. LDH B. ALP C. AST D. ALT Answer: D ALT (alanine transaminase) is found predominantly in the liver, making it the most liver-specific enzyme. AST is also found in cardiac muscle and skeletal muscle. ALP is found in bone, placenta, and intestine. LDH is found in many tissues. --- Question 10 One of the following enzymes may differentiate between liver disease and active bone growth in a teenage patient: A. ALP B. GGT C. ALT D. CK Answer: B ALP is elevated in both liver disease and active bone growth (physiologically high in teenagers due to growth). GGT is elevated in liver/biliary disease but not in bone disease, so a raised GGT alongside raised ALP confirms the hepatic origin of the ALP elevation. --- Question 11 A patient's blood gas results are: pH = 7.50, PCO2 = 55 mmHg, HCO3- = 40 mmol/L. These results indicate: A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis Answer: B pH is high (alkalosis). PCO2 is raised (expected compensation — hypoventilation retains CO2 to buffer the alkalosis). HCO3- is markedly elevated — the primary disturbance. High pH + high HCO3- = metabolic alkalosis with respiratory compensation. --- Question 12 Which set of results is c