Microbiology 532

Immunology Examination KEY

October 30, 2003

All questions have equal point value. You may keep the test questions.
Multiple Choice (choose the best answer)

1. Receptors associated with innate immunity recognize microbes by detecting:

a. insulin.
Correct b. pathogen associated molecular patterns (PAMPs).
c. Fc’s.
d. complement.
e. none of the above.

2. Immunoglobulin classes must distinguished by the type of:

a. light chains they possess.
b. carbohydrate on their light chains.
c. constant regions in their light chains.
Correct d. heavy chains they possess.
e. none of the above.

3. The variable regions in the light chains participate in:

a. Fc receptor binding.
Correct b. epitope binding.
c. affinity of the complement receptors.
d. interaction of the Fab with cytokines.
e. none of the above.

4. Plutonian immunoglobulin molecules follow the same rules of proportions that are found
in human immunoglobulins. If you were told that Plutonian light chains had a molecular
weight of 4 kDa (each), what would you expect the molecular weight of their IgG mole-
cules to be?
a. 150,000 kDa
b. 900,000 kDa
c. 12 kDa
d. 8 kDa
Correct e. none of the above.

5. J-chains are associated with:

a. IgG.
Correct b. polymeric immunoglobulins (more than two Fab’s).
c. serum IgA
d. IgE.
e. none of the above.
 Microbiology 532 Immunology Examination

6. Adoptive-acquired immunity may be the result of:

Correct a. transfer of bone marrow from one individual to another.
b. immunization with a vaccine.
c. exposure to an individual who has an infectious disease.
d. a physician administering a gamma globulin shot to someone who has had a needle
stick (immunoglobulins).
e. a and d.

7. IgG binding to neutrophils cells is mediated by:

a. Fc-dependent cellular homing mechanisms.
b. sensitization of Mast cells and basophils.
Correct c. Fc receptors specific for IgG.
d. ICAM’s.
e. none of the above.

8. IgD participates in antigen recognition by:

a. immature T cells.
b. NK cells.
c. macrophages.
Correct d. B cells.
e. none of the above.

9. Antibody affinity is not determined by the amino acid sequence in:

a. the constant regions of the immunoglobulin molecule.
b. the variable regions of the immunoglobulin molecule.
c. the Fc of the immunoglobulin molecule.
d. the J-chain.
Correct e. a, c and d.

10. Avidity is important because:

Correct a. it amplifies the binding strength of low affinity Fab’s.
b. Fc receptor binding depends on it.
c. G-protein-mediated signal transduction will not occur without it.
d. it result in the activation of high affinity antibody-producing clones.
e. none of the above.

True/False (Please use “a” for true and “b” for false on your answer sheet)

T 11. M-cells often enable pathogens to penetrate the epithelial cell layer of the mucosa.

T 12. Cross-reaction is the result of epitopes common between two different antigens.

T 13. In an ELISA, the use of a “second’ labeled antibody is required to detect patient serum
antibodies that bind to the antigen.

F 14. Agglutination requires complement activation and the production of chemotactic factors.

T 15. Agglutination generally occurs only with IgM antibodies.

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 Microbiology 532 Immunology Examination

F 16. The complement system is not responsible for the production of neutrophil chemoattrac-
tants.

T 17. Complement may be activated in the absence of an antibody/antigen reaction.

T 18. One would not expect to find SC associated with monomeric IgA in the serum.

F 19. Inflammatory reactions are often associated with mucosal immunity.

T 20. CD antigens are used to identify cell types and their functions.

Multiple Choice (choose the best answer)

21. Organized mucosa-associated lymphoid tissue is

a. found in the lymph nodes.
Correct b. associated with initial immune response to antigen.
c. filled with plasma cells that are producing antibodies.
d. composed primarily of M-cells and L-cells.
e. none of the above

22. B cells usually require T cell help to mature plasma cells because:
a. T cells present antigen to them.
b. most B cells in the circulation need thymic hormones secreted by the antigen pre-
senting cell to mature to plasma cells.
c. T cells are antigen presenting cells that are critical to immune recognition.
d. all of the above.
Correct e. none of the above.

23. The antigen presenting cell

Correct a. may be a dendritic cell in the skin.
b. may be a T cell.
c. does not produce cytokines which influence the adaptive response.
d. matures upon antigenic stimulation and becomes a plasma cell.
e. all of the above.

24. Mucosal immunity provides most of its protection by blocking

a. microbial receptors specific for colonization.
b. the complement cascade.
c. blocking penetration of undigested food products into the mucosal tissues.
Correct d. a and c
e. none of the above

25. Tissue macrophage are mature:

a. B cells
b. T cells
c. NK cells
Correct d. Monocytes
e. none of the above.

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 Microbiology 532 Immunology Examination

26. Hormone-like host peptides used for communications in innate and adaptive immunity
are known as:
a. PAMPs.
b. cell adhesion molecules.
c. ELISAs.
Correct d. cytokines.
e. none of the above.

27. Which of these is not associated with adjuvants?:

a. forms an antigen depot.
b. provides non-specific T cell stimulation.
c. activates antigen-presenting cells.
Correct d. activates the complement cascade.
e. none of the above.

28. Which is associated with apoptosis?

a. Regulates cell migration from O-MALT migrate to D-MALT.
Correct b. Used by T cells to kill target cells.
c. mediates necrotic cell death.
d. a and b.
e. all of the above are correct responses.

29. The lag phase of the secondary response is shorter than the primary response because:
a. the assays for detecting a primary response are not as sensitive.
Correct b. the primary response requires considerable cell proliferation and differentiation to
achieve a critical mass of cells to produce immunity.
c. of the lack of cytokines produced during the primary response.
d. a and d. (oops!)
e. none of the above.

30. The lag phase of the booster response is:

Correct a. very short, due to memory cells.
b. very short due to the lack of antigen presenting cells.
c. very short when dendritic cells are absent.
d. very short, due to the presence of accessory cells.
e. none of the above.

True/False (Please use “a” for true and “b” for false on your answer sheet)

Correct 31. Dendritic cells are antigen presenting cells.

Correct 32. Homing is a process by which cells leave the O-MALT and randomly migrate until they
encounter vascular addressins that bind to their cell surface receptors in D-MALT.

Correct 33. Affinity maturation is the result of clonal section over time.

Correct 34. The innate mechanisms of host immunity generally play a role in the defense of the body
prior to the activation of adaptive defense mechanisms.

False 35. Fc and complement receptors on phagocytic cells prevent opsonized bacteria from being
pulled into phagocytic vacuoles.

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 Microbiology 532 Immunology Examination

False 36. Atopic individuals are people who tend to make undetectable amounts of IgE antibodies.

Correct 37. Mast cell degranulation occurs as a result of cross-linkage of Fc receptors on Mast cells.

Correct 38. Serum sickness occurs when massive amounts of foreign proteins are introduced into the
body.

False 39. Genetic factors associated with atopy predict a specific allergies.

Correct 40. Desensitization injections are thought to increase T cell suppressor cell activity and
decrease IgE synthesis in atopic patients.

Multiple Choice (choose the best answer)

41. The location of complement activation is determined by:

a. the location of Fc receptors.
b. the location of dendritic cells.
Correct c. the location of specific antibody/antigen complexes.
d. b and c.
e. none of the above.

42. Complement damage is generally limited to the immediate area in which complement is
activated because of the:
Correct a. short half-lives of the activated complement components and their rapid inactiva-
tion.
b. very low concentrations of the inactivated complement components in serum.
c. the inability to activate the system in the presence of IgG antibodies.
d. once activated, the destructive activities of complement are non-specific.
e. none of the above

43. Sensitization to foods is minimized by secretory IgA antibodies by:

a. The inflammatory response that occurs in the presence of food, these antibodies and
complement.
b. Destroying the antigen presenting cells that would normally present the food
antigens to T cells in the gut.
Correct c. Blocking the penetration of intact food products into the gut.
d. All of the above
e. None of the

44. Serum from an O positive, Rh negative patient agglutinates red blood cells from a patient
who is Rh negative. What is the likely blood type is the second patient?
Correct a. It can’t be determined from the information provided.
b. Type A
c. Type B
d. Type O
e. Type AB

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 Microbiology 532 Immunology Examination

45.
Transepithelial transport of antigen is important because without it
a. antigen would only be detected by the lymphoid cells in O-MALT.
b. antigen would not be detected by the lymphoid cells in the alternate complement
pathway.
c. polymeric antibody would be pumped through the epithelial cells
d. vascular addressins would target the wrong cell types.
Correcte. none of the above

46. During serum sickness, kidney damage occurs as immune complexes form. Why?
Correct a. The immune complexes are filtered by the kidneys and damage results from
concomitant complement activation and neutrophil activity.
b. Antigen presenting cells rapidly bind all of the complexes in their MHC-encoded
receptors.
c. Free antigen activates PAMP receptors in the kidneys which rapidly activate adap-
tive immunity.
d. The immune complexes bind to Mast cells and are destroyed.
e. none of the above

47. Contact dermatitis generally occurs against substances that are too small to induce an
immune response. How do these substance induce an immune response?
a. These substances form depots and are then slowly released into the blood.
b. These low molecular weight substances react with liver enzymes and are difficult to
eliminate.
Correct c. These substances bind to tissues and cells, resulting in a larger total antigenic size
which can then stimulate an immune response.
d. The substances trigger the complement cascade and cause neutrophils to accumulate
and to serve as antigen presenting cells.
e. a and c.

48. Your patient tests positive for the tuberculin antigen. You send him for a chest x-ray
because:
Correct a. the tuberculin test is only presumptive, indicating that he has been exposed to a
tuberculosis antigen.
b. He may have other lung infections.
c. you are looking for fluid in his lungs due to inflammation caused by the bacillus
d. a and b.
e. none of the above

49. Microorganisms associated with periodontal disease, such as Porphyromonas gingivalis,

are thought to control the cytokine expression and affect TH1 and TH2 pathways by :
a. suppressing Mast cell activity.
Correct b. stimulating PAMP receptors of innate immunity to express cytokines that result in
an adaptive response that is not protective
c. avoiding PAMP receptors and, thereby, avoiding innate immunity.
d. stimulating adrenergic receptors.
e. none of the above

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 Microbiology 532 Immunology Examination

50. Innate host defense mechanisms are critical to the protection of the body because:
a. they utilize pre-committed antigen presenting cells that have already been induced
by other immune responses.
b. the antibodies derived from the innate response are critical to neutralize bacterial
toxins.
c. they are highly specific for the invading pathogens that avoid PAMP receptor
recognition.
Correct d. they provide immediate, continuous protection in the absence of a specific immune
response.
e. b and d

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 ‫االسئلة الجديدة‬

HEMATOLOGY

1- Vitamin K antagonist :
a- warfarin
b- Heparin
c- Protein C
d- Antithrombin III

2- One of the intrinsic pathway

a- factor XI
b- factor XIII
c- factor I
d- factor VII

3- Para hemophilia is the deficiency of

a- factor VIII
b- factor IX
c- factor V
d- factor VII

4- Eosinophilia is seen in :
a- food sensitivity
b- Drug sensitivity
c- Atopic dermatitis
d- all of the above

5- Multiple myeloma is a neoplastic proliferation of:

a- lymphocytes
b- Granulocytes
c- Plasma cells
d- Monocytes

6- Test for intrinsic pathway:

a- bleeding time
b- Thrombin time
c- Prothrombin time
d- Partial thromboplastin time PTT

7- Paul-Bunnel test is done to diagnose:

a- multiple myeloma
b- Hodgkin’s disease
c- Infectious mononucleosis
d- all of the above

8- increased platelet count is :

a- thrombocytopenia
b- thrombopoietin
c- thrombocytosis
d- all of the above

9- Decreased platelet count is:

a- thrombocytopenia
b- Thrombopoietin
c- Thrombocytosis
d- all of the above

10- All these are causes of thrombocytopenia except:

a- cytotoxic drugs
b- Aplastic anemia
c- Hemorrhage
d- Radiotherapy

11- Prothrombin time is done to test:

a- Intrinsic pathway only
b- Extrinsic pathway only
c- Extrinsic and common pathways
d- Intrinsic and common pathways

12- Normal bleeding time by Duke’s method:

a- 2-7 minutes
b- 2-7 seconds
c- 2-4 minutes
d- 2-4 seconds

13- Normal partial thromboplastin time (PPT) is :

a- 3-4 minutes
b- 30-45 seconds
c- 12-15 seconds
d- 12-15 minutes

14- Hemophilia A is the deficiency of :

a- factor V
b- factor VIII
c- factor IX
d- all of the above

15-the most common form of leukemia in children is:

a- acute lymphoblastic leukemia
b- Chronic lymphocytic leukemia
c- Acute myeloid leukemia
d- Chronic myeloid leukemia

16- Bence-Jones protein is present in cases of:

a- chronic myeloid myeloma
b-acute myeloid myeloma
c- Hodgkin’s lymphoma
d- multiple myeloma

17- Reed-Sternberg cells are found in cases of :

a- acute lymphoblastic leukemia
b- Non Hodgkin’s lymphoma
c- Hodgkin’s lymphoma
d- Multiple myeloma

18- Normal platelet count is :

a- 150,000 to 450,000/min3
b- 400,000 to 800,000/min3
c- 4,000 to 11,000 /min3
d- 50,000 to 100,000/min3

19- Antithrombin III inhibits:

a- factor Va
b- factor VIIIa
c- factor Xa
d- all of the above

20- Heparin potentiate the action of :

a- protein C
b- protein S
c- antithrombin III
d- warfarin
21- Factor II of blood clotting is:
a- Christmas factor
b- Fibrinogen
c- Prothrombin
d- Thromboplastin

22- One of fibrinogen group is : I V VIII XIII

a- II
b- V
c- VII
d- IX

23- Fibrinogen is converted to soluble fibrin by:

a- prothrombin
b- Thromboplastin
c- Thrombin
d- all of the above

24- Thrombopoitin control the formation of:

a- red blood cells
b- White blood cells
c- platelets
d- non of the above

25- Normal prothrombin time (PT) is:

a- 30-45 seconds
b- 30-45 minutes
c- 12-15 seconds
d- 12-15 minutes

26- Parasitic disease is associated with:

a- monocytosis - bacteria
b- Lymphocytosis - virus
c- Basophilia - sensitive
d- Eosinophilia

27- Philadelphia chromosome is diagnostic for:

a- acute lymphoblastic leukemia
b- Acute myeloid leukemia
c- Chronic lymphocytic leukemia
d- chronic myeloid leukemia
28- Normal fibrinogen level:
a- 150-400 gm%
b- 150-400 mg %
c- 15-40 mg %
d- 15-40 gm %

29-infectious mononucleosis is caused by:

a- echo virus
b- coxsaki virus
c- Epstein Barr virus EBV
d- Cytomegalo virus

30- Atypical lymphocytosis is seen in cases of:

a- Hodgkin’s lymphoma
b- Multiple myeloma
c- Infectious mononucleosis
d- Chronic lymphocytic leukemia

31-monospot test is done to diagnose:

a- Acute myeloid leukemia
b- Acute lymphoblastic leukemia
c- Infectious mononucleosis
d- Infectious lymphocytosis

32- The test which depend on blood platelets & capillary

fragility is:
a- prothrombin time
b- Thrombin time
c- Bleeding time
d- Clotting time

33- Fibrin is broken to fibrin degradation products by the action

of:
a- Prothrombin
b- Thrombin
c- Plasminogen
d- Plasmin

34- Acute myeloid leukemia is characterized by:

a- low neutrophil alkaline phosphatase
b- Myeloblast with Auer rods
c- Neutrophil with Pleger-Huet anomaly
d- all of the above

35- Plasminogen is converted to plasmin by :

a- Heparin
b-Histamine
c- Urokinase
d- Serotonin

36- Increase D-dimers and fibrin degradation products are seen

in cases of:
a- Hemophilia A
b- Vitamin K deficiency
c- Diffuse intravascular coagulation
d- Von Willebrand disease

37- Activated protein C degrades:

a- factor IXa
b- Factor VIIIa
c- Factor Xa
d- Factor Xia

38- Heparin is found in

a- Neutrophil
b- Basophil
c- Acidophil
d- all of the above

39- In hemophilia A the test which will be prolonged is

a- PT
b- PTT
c- Bleeding time
d- all of the above

40- Bleeding due to overdose of heparin is managed by giving:

a- Vit K
b- Vit C
c- Vit A
d- Protamin sulphate
41- Streptokinase and staphylokinase convert:
a- Prothrombin to thrombin
b- Fibrinogen to fibrin
c- Soluble fibrin to insoluble fibrin
d- Plasminogen to plasmin

42- Test for platelet function:

a- Clot retraction
b- Platelet aggregation
c- Platelet adhesion
d- all of the above

43- Prolonged PT occurs in cases of deficiency of:

a- Factor III
b- Factor IV
c- Factor V
d- all of the above

44- normal thrombin time (TT):

a- 30-45 sec
b- 2-4 min
c- 3-9 min
d- 10-20 sec

45- cause of vitamin K deficiency:

a- Obstructive jaundice
b- Prolonged use of antibiotics
c- Inadequate intake
d- all of the above

46- Cause of Hyper- Coagulable state:

a- Aplastic anemia
b- Cytotxic drugs
c- Polcythemia
d- Radiotherapy

47-Physiological cause of neutrophilia:

a- New born
b- Radiotherapy
c- Cytotoxic drugs
d- Prolonged use of antibiotics
48- Leucocytosis characterized by the presence of immature
cells and high neutrophil alkaline phosphatase:
a- chronic myeloid leukemia
b- Acute myeloid leukemia
c- Leukaemid reaction
d- non of the above

49- Normal coagulation time (CT):

a- 3-9 min
b- 3-9 sec
c- 30-40 sec
d- 30-40 min

50- The test which measures the clotting time of citrated plasma
accelerated by the addition of a clotting factor activator (kaolin)
, phospholipids and calcium:
a- coagulation time
b- Prothrombin time
c- Partial thromboplastin time
d- Thrombin time

51- The test which measures the clotting time of citrated plasma
to which thromboplastin and calcium has been added:
a- thrombin time
b- Prothrombin time
c- Coagulation time
d- Partial thromboplastin time

52- The test which is widely used as a control and follow up test
to control anticoagulant treatment:
a- APTT
b- PTT
c- PT
d- TT

53- A disease characterized by progressive neoplastic

proliferation of immature white cell precursor:
a- acute leukemia
b- Chronic leukemia
c- Lymphoma
d- Multiple myeloma
54- The absolute lymphocyte count may be up to 300,000 or
more between 70 and 90 % of white cells in the blood film
appear as small lymphocytes . THE CASE IS:
a- Acute myeloid leukemia
b- Acute lymphoblastic leukemia
c- Chronic myeloid leukemia
d- Chronic lymphocytic leukemia

55- Variation in red cells size:

a- Poikilcytosis
b- Anisocytosis
c- Reticulocytosis
d- Leukocytosis

56- Dark red cells with no area of central pallor:

a- Stomatocyte
b- Spherocyte
c- Acathocyte
d- Schistocyte

57- Microcytic hypochromic anemia

a- hereditary spherocytosis
b- Sickle cell anemia
c- Iron deficiency anemia
d- Vit B12 deficiency anemia

58- Target cells are seen in cases of:

a- folic acid deficiency
b- Iron deficiency anemia
c- Vit B12 deficiency anemia
d- Thalassemia

59- Red cells with elongated area of central pallor:

a- spherocyte
b- Schistocyte
c- Stomatocyte
d- Elliptocutes

60- ……………….. Symmetric, short , sharp projection from the

red cells and seen in iron deficiency anemia:
a- echinocyte
b- Acanthocyte
c- Elliptocyte
d- Ovalocyte

61- ……………… is a condition in which the absorption of vit

B12 is greatly impaired due to failure or marked reduction of
intrinsic factor secretion:
a- fauvism
b- fanconi’s anemia
c-sickle cell anemia
d- thalassemia
e- pernicious anemia

62- Hyperchromic cells are seen in:

a- iron deficiency anemia
b- Thalassemia
c- Hereditary spherocytosis
d- Sickle cell anemia

63- A prolonged low rate of bleeding results in:

a- normochromic anemia
b- Hypochromic anemia
c- Hyperchromic anemia
d- non of the above

64- Schilling test is done in diagnosis of:

a- iron deficiency anemia
b- Pernicious anemia
c- Aplastic anemia
d- folic acid deficiency

65- Defective synthesis of either alpha or beta chains of normal

hemoglobin
cause:
a- sickle cell anemia
b- Aplastic anemia
c- Pernicious anemia
d- Thalassemia

66- Neutrophils represent…………… of circulating leukocyte:

a- 2-8 %
b- 0-1 %
c- 50-70 %
d- 2-4 %

67- …………. are non nucleated, biconcave shaped cells:

a- platelet
b- Leukocyte
c- Erythrocyte
d- Macrophages

68- …………….. represent 50-70 % of total leukocytes

a- lymphocytes
b- Neutrophils
c- Monocytes
d- Eosinophilis

69- …………… have a characteristic biffed nucleus and their

cytoplasm is filled with large refractile granules that stain red in
blood smear
a- neutrophils
b- Eosinophilis
c- Basophiles
d- Lymphocytes

70- The cell which is responsible for antibody production is:

a- moncytes
b- T-lymphocytes
c- B-lymphocytes = plasma cell
d- Neutrophils

71- …… is a curved cell with sharp ends seen in

haemoglobinopathies (HBS)
a- sickle cell
b- Spherocyte
c- Ovalocyte
d- Stomatocyte

72- All of the following is correct about sickle cell anemia

except:
a- leg ulcers
b- Gall stones
c- Enlargement of spleen
d- Attacks of pain

73- ……….. is a single, large, rounded , dark , purple remnant

of nucleus
a- Heinz body
b- Howeel-Jolly body
c- Pappenheimer body
d- Cabot ring

74- Agranulocyte:
a- neutrophil
b- Lymphocyte
c- Basophile
d- Eosinophil

75- Pica ( craving to eat unusual substance such as clay or ice) is

one of the symptoms of:
a- G6PD deficiency
b- Thalassemia
c- Megaloblastic anemia
d- Iron deficiency anemia

76- In …………….. there’s a decreased or absent hemosiderin in

bone marrow
a- sideroblastic anemia
b- Iron deficiency anemia
c- Megaloblastic anemia
d- Hemolytic anemia

77- Chloramphenicol may cause …………. anemia in long term

therapy
a- iron deficiency
b- Vit B12 deficiency
c- folic acid deficiency
d- Aplastic anemia

78- ………. is the fluid (with anticoagulant) component of blood

, it contains salt & organic compounds:
a- plasma
b- Serum
c- Hemoglobin
d- Billirubin

79- Poikilocytosis is:

a- variation in red cell size
b- Variation in red cell color
c- Variation in red cell shape
d- non of the above

80- Red cell fragments:

a- echinocyte
b- Elliptocyte
c- Schistocyte
d- Stomatocyte

81- It is a defect of red cell member

a- Thalassemia
b- Sickle cell anemia
c- Hereditary spherocytosis
d- Megaloblastic anemia

82- All of the following is correct regarding spherocytosis

except:
a- normocytic normochromic anemia
b- Decreased reticulocyte count
c- Raised plasma bilirubin
d- Increased osmotic fragility

83- Heinz bodies are seen in cases of

a- hereditary spherocytosis
b- Hereditary elliplocytosis
c- G6PD deficiency
d- sickle cell anemia

84- ……………… is caused by substitution of amino acid

(valine) instead of glutamic acid at position No.#6 in the beta
chain of hemoglobin
a- Hb-A
b- Hb-A2
c- Hb –F
d- Hb –S sickle cell

85- Atrophy of the spleen is seen in cases of:

a- Thalassemia
b- Sickle cell anemia
c- G6PD deficiency
d- Hereditary elliplocytosis

86- iron deficiency lead to :

a- normocytic normochromic anemia
b- microcytic hypochromic anemia
c- macrocytic anemia
d- hemolytic anemia

87- Neurological symptoms are seen in cases of:

a- iron deficiency anemia
b- folic acid deficiency
c- Vit B12 deficiency
d- all of the above

88- Megaloplastic hematopoiesis is seen in cases of:

a- iron deficiency anemia
b- folic acid deficiency
c- Vit B12 deficiency
d- Vit C deficiency

89- Fanconi’s anemia is a type of :

a - vit B12 deficiency
b- aplastic anemia
c- Thalassemia
d- folic acid deficiency anemia

90- the most abundant leukocyte in a normal blood smear of

adult is :
a- lymphocyte
b- Monocyte
c- Eosinophil
d- Neutrophil

91- The first line of defense against parasites:

a- neutrophils
b- Basophile
c- Eosinophil
d- Lymphocyte

92- …………….. play a role in immediate and delayed

hypersensitivity:
a- monocyte
b- Lymphocyte
c- Eosinophil
d- Basophile

93- The largest leukocyte is :

a- neutrophils
b- Lymphocyte
c- Monocyte
d- Basophile

94- Cell which participate in cell mediated immunity:

a- monocyte
b- B- lymphocyte
c- T- lymphocyte
d- neutrophils

95- ……… promotes blood clotting and help to prevent blood

loss from damaged blood vessels:
a- platelets
b- WBCs
c- RBCs
d- all of the above

96-antibody induced hemolytic disease in new born that is

caused by blood group incompatibility between mother and
fetus:
a- hemolytic uremic syndrome
b- Erythroblastosis fetalis
c- Hereditary spherocytosis
d- Thromboloc thrombocytopenic purpurea
97- Young red blood cell with cytoplasmic RNA:
a- spherocyte
b- Reticulocyte
c- Stomatocyte
d- elliptocyte

98- Normal adult hemoglobin tetramer is:

a- 2 alpha : 2 gama
b- 2 alpha : 2 beta
c- 2 alpha : 2 delta
d- 2 beta : 2 gama

99- …………… represent 2-4 % of total leukocyte:

a- neutrophils
b- Basophile
c- Eosinophil
d- Monocyte

100- ………… are small cytoplasmic fragment derived from

megakaryocytic:
a- RBCs
b- WBCs
c- Platelet
d- non of the above

101 - ………….. is the reduction in the amount of circulating

hemoglobin , red blood cells or both:
a- polycythemia
b- Anemia
c- Hemophilia
d- Leucopenia

102- Thalassemia is :
a- microcytic anemia
b- Macrocytic anemia
c- Normocytic anemia
d- non of the above

103- Vit B12 deficiency lead to :

a- hemolytic anemia
b- Microcytic anemia
c- Normocytic anemia
d- Megaloblastic anemia

104- Lymphocyte represent ………….. of total leukocyte:

a- 20-40 %
b- 50-70 %
c- 2-8 %
d- 1-5 %

105- Plumer- Vinson syndrome may be seen in cases of:

a- iron deficiency anemia
b- Vit B12 deficiency anemia
c- Aplastic anemia
d- folic acid deficiency anemia

106- peripheral, pale inclusions that push out the cell membrane
and composed of hemoglobin:
a- cabot ring
b- Pappenheimer body
c- Howell-Jolly body
d- Heinz body

107- it’s an acute hemolytic anemia occurring after the ingestion

of broad bean in individual with deficiency of G6PD :
a-thalassemia
b- Favism
c- Fanconi’s anemia
d- Cooley’s anemia

108-………………. is a multiple small , peripheral grape like

purple clusters of iron:
a- cabot ring
b- Heinz body
c- Howell-Jolly body
d- Pappenheimer body
109- the blood smear gives the physician information
concerning:
a- morphology of RBCs and platelet
b- Presence of abnormal inclusion
c- Presence of immature cells
d- all of the above

110- hypersplenism is one of the causes of :

a- iron deficiency anemia
b- Hemolytic anemia
c- Aplastic anemia
d- Megaloblastic anemia

111- Increased reticulocytes count is seen in cases of:

a- hereditary spherocytosis
b- G6PD deficiency
c- Sickle cell anemia
d- all of the above

112- The antibody which can pass the placenta:

a- Ig M
b- Ig G
c- Ig D
d- Ig E

113- ……… is an autoimmune disease in which there is an

immune destruction of the acid and pepsin secreating cells of the
stomach:
a- fanconi’s anemia
b- cooley’s anemia
c-pernicious anemia
d- non of the above

114- All of these are laboratory features of aplastic anemia

except:
a- pancytopenia
b-markedly hypocellular marrow
c- Increased reticulocyte count
d- Markedly increase in serum erythropoietin

115- Secondary granules of neutrophils contain:

a- elastase
b- Myeloperoxidase
c- Lysozyme
d- Histamine

116- Monocytes represent ………………. of total leukocyte:

a- 0-1 %
b- 2-4 %
c- 2-8 %
d- 20-4 %

117- the reagent used for leukocyte count is :

a- citric acid
b- Acetic acid
c- Hydrochloric acid
d- Sulphoric acid

BACTERIOLOGY

118- All are Prokaryotic cells except:

a- Fungi
b- Bacteria
c - Chlamydia
d- Mycoplasma
119- Viruses:
a- Contain only DNA or RNA
b - They Contain ribosome
c- Did not affected by antibiotics
d- a+c

120- All of these are essential structure except:

a- Nuclear body
b- Spores
c- Cell wall
d- Plasma Membrane

121- ________ is giving the shape to the bacteria

a.- Cytoplasmic Membrane
b- Capsule
c- Cell Wall
d- All of the above

122- One of its functions is selective permeability

a- Cell wall
b- Plasma membrane
c- Capsule
d- Spores

123- They are responsible for Haemagglutination Phenomenon

a- Flagella
b- Fimbria
c- Capsule
d- Cell wall

124- Clostridium Tetani is:

a- Atrichous bacteria
b- Mono-trichous bacteria
c- Amphi-trichous bacteria
d- Peri-trichous bacteria

125- Short curved or straight rods, motile by single polar

flagellum
a- spirochaeta
b- Vibrio
c- Escherichia
d- Lactobacillus

126- Small gram negative cocci, occur in pairs

a- staphylococcus
b- streptococcus
c- neisseria
d- non of the above

127- Transfer of genetic information from one bacterium to

another by
bacteriophages is:
a. Transformation
b. Tansduction
c. Conjugation
d. Mutation

128- Salmonella are:

a- Obligatory Aerobic bacteria
b.- Obligatory Anaerobic bacteria
c- Facultative Anaerobic bacteria
d- Micro-aerophilic bacteria

129- According to pH, vibrio cholera is

a- Osmophilic bacteria
b- Basophilic bacteria
c- Acidophilic bacteria
d- Neutrophilic bacteria

130- Staphylococci are:

a- Atrichous bacteria
b- Mono-trichous bacteria
c- Amphi-trichous bacteria
d- Peri-trichous bacteria

131- During replication of DNA, copying errors may occur and

this is called
a- Conjugation
b- Transduction
c- Transformation
d- Mutation

132- Obligatory Anaerobic bacteria

a- grow only in presence of oxygen
b- grow only in absence of oxygen
c- grow either in presence or absence of oxygen
d- grow in presence of oxygen traces and 5 – 10% CO2

133- Neutrophilic bacteria grow well at

a- pH 8.5 – 9.0
b- pH 7.2 – 7.4
c- pH 5.0 – 5.5
d- pH 2.5 – 3.0

134- The rate of cell death increase and bacterial growth

stopped, this is
a- Adaptation phase
b- Exponential phase .
c- Stationary phase.
d- Decline Phase

135- Beta-hemolytic
a- Cause complete hemolysis of RBC’s
b- Cause chemical change of Hemoglobin in RBC’s
c- Do not cause hemolysis
d- None of them

146- Mesophilic bacteria grow at:

a- 37°C
b- 14°C
c- 60°C
d- 120°C

137- Circulation of Bacteria and its toxins in blood

a- Pyaemia
b- Toxemia
c.- Bacteremia - without toxins
d- Septicemia

138- Disinfections that applied on living or injured tissues:

a- Sterilization
b- Antiseptic
c- Sanitation
d- Decontamination

139- Hot air oven is used for sterilization of

a- Glass
b- Rubber Gloves
c.- Plastic Syringes
d- Catheters

140- Disinfectant for superficial fungal infection

a- Phenol
b- Potassium permanganate
c- Chlorine
d- Hypochlorite compounds

141- Rifampin
a- inhibit cell wall synthesis
b- inhibit protein synthesis
c- inhibit folic acid pathway
d- inhibit mRNA synthesis

142- Transacetylase inactivate

a- aminoglycosides
b- chloramphenicol
c- penicillin
d- cephalosporins

143- The color of gram positive bacteria is

a- Yellow
b- Black.
c- Pink
d- Violet

144- Selective media for fungi

a- blood agar
b- Mac Conkey agar
c- Nutrient agar
d- Sabourand’s dextrose agar

145- Histoplasma is a :
a- Systemic mycosis
b- Sub – Cutaneous mycosis
c- Cutaneous mycosis
d- Superficial mycosis

146- All are asexual spores produced by mould except

a- Conidio – spores
b- Sporangio – spores
c- Endospores
d- Arthro – spores

147- They reproduce only by Asexual reproduction

a- Blastomycosis
b- Deutromycosis
c- Ascomycetes
d- Zygomycetes

148- The functions of cell wall is all of the following except:

a- Giving the shape to the bacteria
b- Carrying somatic antigen
c-Selective permeability& transport of solutes = plasma membrane
d- Protect the bacteria from plasmolysis

149- Atrichous Bacteria are:

a- Bacteria contain one flagellum
b- Bacteria contain 2 flagella
c- Bacteria without flagella
d- Bacteria with a tuft of flagella

150-__________ are essential for host cell attachment:

a- Flagella
b- Fimbria
c- Spores
d- Capsules

151- Irregular clusters of spherical cells:

a- Streptococcus
b- Staphylococcus
c- Lactobacillus
d- Escherichia

152- Clostridium Botulinum is:

a- Obligatory Aerobic Bacteria
b- Facultative Anaerobic Bacteria
c- Obligatory Anaerobic Bacteria
d- Micro- aerophilic Bacteria

153- Basophilic Bacteria grow well at:

a- pH 8.5 – 9.0
b- pH 7.2 – 7.4
c- pH 5.0 – 5.5
d- None of the above

154- Cells are divided at high & constant rate:

a- Decline Phase
b- Stationary Phase
c- Log Exponential Phase
d- Adaptation Phase

155- The dominant bacterial species in dental plaque are:

a- Coagulase Negative Staphylococci
b- Lactobacillus
c- Bacteroides
d- Streptococcus Sanguis

156- The spread of Pyogenic Bacteria in blood stream to

different organs & produce multiple abscess is:
a- Septicemia
b- Bacteremia
c-Toxemia
d- Pyaemia
157- Inhibit the growth of micro organisms
a- Bacteriostatic
b- Bactericidal
c- Fungicidal
d- Germicidal

158- To sterilize fluid damaged by heat:

a- Gaseous Sterilization
b- Heat Sterilization
c- Filtration
d- Ionizing Radiation

159- For water disinfection we use:

a- Hydrogen peroxide
b- Formaldehyde
c- Chlorine
d- Hypochlorite compounds

160- Mechanism of action of penicillin:

a- Block peptidoglycan synthesis
b- Inhibit peptidyglycan cross – linking
c- inhibit folic acid pathway
d- inhibit protein synthesis

161- Sulfonamides:
a- inhibit cell wall synthesis
b- inhibit protein synthesis
c- inhibit DNA synthesis
d- inhibit folic acid pathway

162- Acetylase inactivates:

a- B – Lactam antibiotics
b- Aminoglycosides
c- Cloramphenicol
d- All of the above

163- Ringworm disease is caused by

a- Zygomycetes
b- Ascomycetes
c- Blastomycosis
d- None of the above

164- For wet – mount technique we add:

a- NaoH
b- K oH
c- H2 O2
d- All of the above

165- They are transmitted by arthropods

a- Chlamydia
b- Spirochetes
c- Mycoplasma
d- All of the above

166- In the past they were listed as large viruses

a- Richettsia
b- Mycoplasma
c- Chlamydia
d- None of the above

167- Bacteria multiply by:

a- Replication cycle
b- Simple binary fission
c- Sexual reproduction
d- All of the above

168- It protects bacteria from antibiotics

a- Capsule
b- Cell membrane
c- Flagella
d- Fimbria

169- Vibro cholera is:

a- Mono –trichous bacteria
b- Atrichous bacteria
c- Lopho-trichous bacteria
d- Peri-trichous bacteria

170- Short rods, motile by peritrichous flagella

a- Spirochaeta
b- Lactobacillus
c- Escherichia coli
d- Vibrio
171- To take up soluble DNA fragments derived from other,
closely related species is:
a. Mutation
b. Transformation
c. Transduction
d. Conjugation

172- Tuberculosis are

a- micro-airophilic
b- Facultative anaerobic
c- Obligatory anaerobic
d- Obligatory aerobic

173- According to pH, Lactobacillus is

a- Neutrophlic bacteria
b- Acidophilic bacteria
c- Basophilic bacteria
d- None of the above

174- Bacteria without cell Wall

a- Chlamydia
b- Rickettsia
c- Mycoplasma
d.- Spirochetes

175- Brucella Melitensis is

a- Obligatory aerobic bacteria
b- Obligatory anaerobic bacteria
c- Facultative anaerobic bacteria
d- Micro-aerophilic bacteria

176- Pseudomonas aeroginosa is

a- Peri-trichous bacteria
b- Lopho-trichous bacteria
c- Amphi-trichous bacteria
d- Monotrichous bacteria

177- Genetic information of bacteria is carried on

a- Messenger RNA
b- Transfer RN|A
c- Transcript RNA
d- Double – Stranded DNA
178- Thermophilic bacteria grow at
a- 60 – 80 °C
b- 0 - 20°C
c-. 37°C
d- 100 - 120°C

179- Acidophilic bacteria grow at

a- pH 7.2 – 7.4
b- pH 5.0 – 5.5
c- pH 8.5 – 9.0
d- None of the above

180- Mycoplasma is
a- Neutrophilic bacteria
b- Acidophilic bacteria
c- Basophilic bacteria
d- All of the above

181- It is the adaptation of bacteria to the fresh medium

a- Lag phase
b- Decline phase
c- Logarithmic Phase
d- Stationary phase

182- Bacteria which do not cause hemolysis is

a- Beta-Hemolytic
b- Alpha-Hemolytic
c- Gama Hemolytic
d- None of the above

183- Normal flora of Lower intestine are all of the following

except:
a- Staphylococci
b- Diphtheroids
c- Shigella
d- Lactobacillus

184- Opportunistic pathogens are all of the following except:

a- Cause a disease when the host defense are suppressed.
b- Are normal flora of healthy body
c- Are greatly harmful
d- Do not invade the body or tissue.
185- For disinfection of mattresses :
a- Hot air oven
b- Autoclave
c- Ethylene Oxide
d- Hydrogen Peroxide

186- Pyschrophilic bacteria grow at:

a- 10٠°C
b- 6٠°C
c- 14°C
d- 37°C

187- Bacteria which contain chlorophyll

a- Heterotrophic bacteria
b- Autotrophic bacteria
c- Photosynthetic bacteria
d- All of the above

188- Tricophyton is one of

a- Yeast
b- Moulds
c- Dermatophyte
d- Dimorphic Fungi

189- Plastomyces is one of

a- Dermatophytes
b- Dimorphic Fungi
c- Yeast
d- Moulds

190- Color of gram negative bacteria is

a- Violet
b- Green
c- Red
d- Black

191- Acid Fast Bacteria

a- Salmonella
b- Shigella
c- M. Tuberculosis
d- E – Coli
192- Spherical or avoid cells occurring in chains
a- Staphylococci
b- Streptococci
c- Lactobacillus
d- Spiro chaeta

193- ……………… carries the genetic information

a- the envelope
b- the capsid
c- the nucleic acid
d- the prion

194- …………………… may be seen under light microscope

a- rota virus
b- influenza virus
c- herps virus
d- pox virus

195- viruses may be:

a- monomorphic
b- pleomorphic
c- dimorphic
d- all of the above

196- viral capside is formed of:

a- protein
b- glycogen
c- lipoprotein bilayer
d- glycoprotein

197- class III in Baltimor classification is:

a- double stranded DNA viruses
b- single stranded DNA viruses
c- double stranded RNA viruses
d- single stranded RNA viruses

198- Hierarchial virus classification system use the following

characters except:
a- nature of nucleic acid
b- capside symmetry
c- diameter of viron & capside
d- virus molecular weight
199- in viral replication which is true:
a- penetration is the 1st step
b- assembly is the last step
c- relaease is the last step
d- all of the above

200- viron:
a- may be extracellular phase of virus
b- may be intracellular phase of virus
c- can grow and replicate
d- means “ virus – like “

201- pleomorphic viruses means :

a- virus which have constant shape
b- virus that may appear in 2 forms
c- virus that have not a constant morphology
d- virus that have spherical shape

202- vapor of gold is used in :

a- shadow casting technique
b- negative staining technique
c- positive staining technique
d- non of the above

203- direct diagnosis of virus :

a- ELISA Antibody
b- CFT
c- IFT
d- PCR virus

204- all of the following are required in cell culture except:

a- neutral PH
b- presence of buffer salts
c- presence of antibiotics
d- incubation at 20 C (( 30-37 C))

205- all of the following are diagnostic molecular biological

technique except:
a- PCR
b- ELISA
c- nucleic acid hyperdization
d- DNA finger printing
206- PCR require all of the following except:
a- extracted DNA template
b- 2 specific primers
c- reation buffer
d- RNA polymerase

207- bacteriophage is :
a- virus that can be killed by antibiotic
b- virus that act like a bacteria
c- bacteria that act like a virus
d- virus that infect bacteria

208- all of the following viruses are transmitted by blood except:

a- HIV
b- HBV
c- HCV
d- herps virus

209-all of the following are RNA viruses except:

a- corona viridase
b- reoviridase
c- picorona viridase
d- pox viridase

210- penetration of naked virus is by :

a- fusion
b- endocytosis
c- translocation
d- all of the above

211- amniotic cavity inoculation is one type of virus culture in:

a- tissue wall
b- lab animals
c- embryonated egg
d- non of the above

212- …………….. is an invitro method amplification of a short

sequence of target DNA
a- PCR
b- hyberdization
c- finger printing
d- all of the above

213- nucleic acid hyberdization means:

a- probe anneling or binding with it’s complementary
segment of NA
b- fragmentation of nucleic acid
c- amplification of nucleic acid
d- non of the above

214- DNA hyberdization is performed by:

a- primers
b- DNA labeled probe
c- restriction endonuclease
d- non of the above

215-PCR starts with :

a- annealing
b- denaturation of DNA
c-extension of primers
d- non of the above

216- ……………….. is a piece of DNA fragment of a particular

gene that can bind specially with it’s complementary piece of
DNA:
a- codon
b- probe
c- LCR
d- code

217- how many primers are used in PCR :

a- non
b- one
c- two
d- three

304-Lowenstein-Jensen media is used for the isolation for:

a- neisseria gonorrhea
b- mycobacterium tuberculosis
c- haemophilus influenza
d- staphylococcus aureus

305- Hekton-Enteric agar is the selective media for:

a- salmonella
b- streptococcus
c- staphylococcus
d- all of the above

306- the selective media for isolation of fungi is:

a- S-S agar
b- XLD agar
c- sabouraud glucose agar
d- Hekton-Enteric agar

307- gram positive rods with Chinese letter appearance:

a- mycobacterium tuberculosis
b- corynebacteria diphtheria
c- clostridium tetani
d- staphylococcus pneumonia

308- E lek test is done to diagnose :

a- streptococcus
b- staphylococcus aureus
c- clostridium tetani
d- corynebacteria diphtheria

309- all are lactose fermenter except:

a- E-COLI
b- proteus
c- klebsiella
d- enterobacter

310- produce pale colonies on MacConkey’s agar and have

tendency to swarm on blood agar:
a- salmonella
b- shigella
c- klebsiella
d- proteus

311- lactose frementer gram negative bacilli with mucoid

growth:
a- salmonella
b- shigella
c- klebsiella
d- proteus

312-non lactose fermenter gram negative bacilli produce H2S :

a- salmonella
b- shigella
c- klebsiella
d- proteus

313- Widal test is done for diagnosis of :

a- salmonella
b- shigella
c- E-coli
d- klebsiella

314- the causative agent of enteric fever:

a- salmonella
b- shigella
c- klebsiella
d- proteus

315- the most common cause of urinary tract infection :

a- E-coli
b- salmonella
c- shigella
d- streptococcus

316- an important cause of diarrhea in infant:

a- staphylococcus
b- E-coli
c- salmonella
d- shigella

317- the most common causative agent for peptic ulcer :

a- campylobacter
b- H-pylori
c- V-cholera
d- all of the above
318- TCBS is the selective media for isolation of:
a- H-pylori
b- V-cholera
c- E-coli
d- H influenza

319- gram negative bacilli strict aerobes grows on simple media

producing a characteristic greenish pigment:
a- campylobacter
b- pseudomonas
c- pasterulla
d- bordetella

320- the bacteria which cause scarlet fever:

a- staphylococcus
b- streptococcus
c- salmonella
d- shigella

321- antistreptolysin O titer (ASO) is done for the diagnosis of:

a- group A streptococcus
b- group B streptococcus
c- staphylococcus aureus
d- staphylococcus albus

323- Loffler’s serum is used for isolation of:

a- anthrax
b- clostridium
c- diphtheria
d- T.B

324- gas gangrene is caused by:

a- clostridium tetani
b- clostridium botulinum
c- clostridium welchii
d- non of the above (( clostridium perfinges ))

325- Bacillary dysentery is caused by:

a- salmonella
b- shigella
c- cholera
d- all of the above

326- the cause of plague:

a- Y-enterocolitica
b- Y-pestis
c- Y pseudotuberculsois
d- non of the above

327- treponema palladium is the cause of :

a- T.B
b- gonorrhea
c- syphilis
d- AIDS

328- the venereal disease research laboratory test (VDRL) is

done for diagnosis of:
a- T.B
b- gonorrhea
c- syphilis
d- AIDS

329- Trachoma is caused by:

a- mycoplasma
b- chlamydiae
c-richettsia
d- mycobacteria

391- M-tuberculsis bacilli stain with :

a- gram stain
b- Zheil Nelson stain
c- Gimesa stain
d- all of the above

392- AIDS is transmitted through :

a- food
b- blood
c- semen
d- (b) & (c)

393- bacteria which cause syphilis:

a- Neisseria gonorrhea
b- Viencent angina
c- Treponema palladium
d- Yersinia pestis

394- to diagnose syphilis:

a- RPR
b- VDRL
c- Wasserman
d- all of the above
395- streptococci secret:
a- streptolysin O
b- streptolysin S
c- streptokinase
d- all of the above

396- disease caused by streptococci:

a- scarlet fever
b- purperal sepsis
c- rheumatic fever
d- all of the above

397- staphylococci secrets:

a- coagulase enzyme
b- fibrinolysin
c- hyaluronidase
d- all of the above

398- gram positive bacilli:

a- Klebsilla
b- Salmonella
c- Proteus
d- C-diphtheria

399- meningeococcal meningitis is transmitted by :

a- food
b- droplet
c- touch
d- all of the above

400- dark field microscopy is used to diagnose :

a- T.B.
b- syphilis
c- gonorrhea
d- AIDS

401- it cause food poisining with flacid paralysis:

a- clostridium tetani
b- clostridium welchii
c- clostridium botulinium
d- all of the above
402- the infective stage of plasmodium vivax :
a-merozoites
b- sporozoites
c- schizont
d- trophozoite

403- Pirenella conica snail is the intermediate host of:

a- schistosoma haematobium
b- fasciola hiptica
c- heterphyes heterophyes
d- diphyllobothrium latum

404- Bulinus truncates snail is the intermediate host of :

a- fasciola hepatica
b- fasciola gigantica
c- schistosoma haematobium
d- schistosoma mansonii

405- to isolate meningiococci we have to culture the sample on:

a- Bordet Gengou
b- modified Thayer martin media
c- Lowenstein Jensen media
d- all of the above

406- to isolate fungi :

a- Brain-Heart infusion media
b- tissue culture
c- Lowenstein –Jensen media
d- chocolate agar

407- to isolate H- influenza:

a- blood agar
b- chocolate agar
c- mac Conkey media
d- all of the above

408- the bacteria which cause pseudomembrainous

conjunctivitis :
a- N.gonorrhea
b- C. diphtheria
c- staphylococcus
d- Chlamydia

409- the best sample to diagnose meningitis :

a- blood
b- sputum
c- CSF
d- urine

410- used to stain Chlamydia

a- gram stain
b- giemsa stain
c- wright stain
d- all of the above
411-……….. is used as transport medium for sample in which
cholera is suspected
a- Cary-Blair media
b- Stuart media
c- Alkaline peptone water
d- glycerol

412- the color of XLD medium:

a- green
b- red
c- yellow
d- blue

413- CIN medium is used to isolate:

a- E.coli
b- Vibrio cholera
c- yersinia
d- salmonella

414- to make wet mount preparation:

a- 10 % KOH
b- 10 % Na OH
c- 10 % Na CO3
d- 10% Na Cl

415- we do wet mount preparation for vaginal smear To

diagnose:
a- T.vaginalis
b- N.gonorrhea
c- streptococci
d- staphylococci

416- to isolate viruses:

a- Loeffler media
b- tissue culture
c- Bordet –Gengou media
d- Brain- Heart infusion

417- to diagnose whooping cough :

a- Bordet –Gengou media
b- Lowenstein –Jensen media
c- modified Thayer martin media
d- New York city agar

418- to diagnose systemic infection we do :

a- urine culture
b- CSF culture
c- blood culture
d- sputum culture

419- we give no growth for blood culture after:

a- 1 week
b- 8 weeks
c- 6 weeks
d- 3 weeks

420- to dissolve mucous in sputum sample :

a- 10% NaOH
b- 30 % NaOH
c- 10 % KOH
d- 10% NaCl

421- mutualism means:

a- one partener benefits , other unaffected
b- both partner benefit
c- one partner benefit , other damaged
d- living together
422- Commensalisms means:
a- living together
b- one partner benefit , other damaged
c- both partner benefit
d- one partner benefits , other unaffected

423- Balantidium coli moves by:

a- flagella
b- cilia
d- pseudopod
d- all of the above

424- Mouth inhabitant:

a- Trichomonas hominis
b- Trichomonas tenax
c- Trichomonas vaginalis
d- giardia lamblia

425- Transmitted by sexual intercourse:

a- toxoplasma
b- giardia lamblia
c- Trichomonas vaginalis
d- all of the above

465- citrate utilization test is done to assist identification of:

a- gram +ve bacteria
b- gram –ve bacteria
c- entrobacteria
d- enterococcus

466- the Kovac's reagent used in the following biochemical tests:

a- catalase
b- coagulase
c- indole
d- methyl red

467- positive results for H2S production appear as …. Colour:

a- black
c- yellow
c- red
d- green
468-………. Give positive coagulase test:
a- streptococci
b- staphylococcus aureus
c- staphylococcus saprophyticus
d- Escherichia coli

469- methyl red test is performed with:

a- Erlich reagent
b- Kovac's reagent
c- Voges proskaur
d- non of the above

470- ………… give positive result with urease test:

a- salmonella
b- shigella
c- Y. enterocolitica
d- all of the above

471-…………. test is used to differentiate between bacteroides

& brucella:
a- indole
b- methyl red
c- H2S production
d- nitrate reduction

472- DNAase test is positive with:

a- streptococcus pneumonia
b- E.coli
c- staphylococcus aureus
d- staphylococcus epidermis

473- ………… solution used in the gram stain technique acts as

a mordant:
a- crystal violet
b- safranine
c- iodine
d- alcohol

474- the counter stain in Ziehl- Neelson stain is :

a- malachite green
b- methylene blue
c- iodine
d- (a) & (b)

475- bile solubility test is positive with :

a- streptococcus viridans
b- streptococcus pneumonia
c- streptococcus agalectiae
d- streptococcus pyrogenes

476-litmus milk decolorization test assist the identification of :

a- entrobacteria
b- bacteroides
c- brucella
d- enterococci

CHEMISTRY
330- ………….. are substance produced by specialized cells of
the body and carried by blood stream where it affect other
specialized cells:
a- vitamins
b- enzymes
c- isoenzyme
d- hormones
331- …………… is a protein which catalyse one or more specific
biochemical reaction and not consumed during the reaction:
a- enzymes
b- hormones
c- vitamins
d- proteins

332- ………… is required in the hepatic synthesis of

prothrombin and the blood clotting factors and it’s deficiency is
observed in newborn infants:
a- vitamin E
b- vitamin A
c- vitamin K
d- vitamin D

333- there are enzymes that catalyze the same reaction but differ
in there physical properties:
a- vitamins
b- adjuvents
c- isoenzyme
d- hormones

334- it’s functionis to maintain adequate serum level of calcium:

a- vitamin E
b- vitamin A
c- vitamin K
d- vitamin D

335-the inhibitor and substrate bind at different sites on the

enzyme this type of inhibition is called:
a- competitive inhibition
b- non competitive inhibition
c- surface recognition
d- product concentration

336- ……….. found in cartilage consist of a core protein to

which the linear carbohydrates chain are covalently attached:
a- glycoprotein
b- proteoglycan
c- link protein
d- hyaluronic acid

337- …………… is synthesized only by micro-organism , it’s not

present in plants but present in liver , it’s deficiency leads to
pernicious anemia:
a- vit C
b- vit B12
c-vit B1
d- vit B2

338- the brown color of the stool is due to the presence of:
a- urobilinogen
b- urobilin
c- porphyrin
d- bilirubin

339- the degradation of heme takes place in the ………….

particularly in the liver and spleen
a- reticulocytes
b- erythrocytes
c- reticuloendothelial cells
d- non of the above

340- increased Hb destruction , the liver is unable to cup the

greater load of pigment and bilirubin level well rises this is
called :
a- hepatogenous jaundice
b- hemolytic jaundice
c- obstructive jaundice
d- non of the above

341- ………… plays a role in visual cycle it’s deficiency leads to

night blindness, β-carotene is the major precursor of this
vitamin in human:
a- vitamin E
b- vitamin A
c- vitamin K
d- vitamin D

342- a large percentage of the ……….. requirement in humans is

supplied by intestinal bacteria:
a- biotin
b- niacin
c- folic acid
d- thiamin

343- ………….. are organic compounds required by the body in

trace amount , can’t be synthesized by humans , but supplied by
diet:
a- enzymes
b- vitamins
c- hormones
d- proteins

344- it facilitate the absorption of iron by reducing it to ferrus

state in the stomach and it’s deficiency result in scurvy:
a- vit C
b- vit B
c- vit D
d- vit A

345- it’s function is to transport oxygen from the lung to the

tissue:
a- haptoglobin
b- hemoglobin
c- bilirubin
d- myoglobin

346- ………….. act as an antioxidant and it’s deficiency cause

liver degeneration:
a- vit E
b- vit A
c- vit K
d- vit D

347- it’s caused by liver parenchyma damage , the excretion of

bile greatly decreased and the concentration of bilirubin in the
blood rise :
a- hemolytic jaundice
b- hepatogenous jaundice
c- obstructive jaundice
d- non of the above

348- ……… play an essential role in body metabolism , a

deficiency or excess may lead to serious dearrangement of body
function:
a- enzymes
b- hormones
c- vitamins
d- isoenzymes

349- …………. will interfere with the chemical determination of

bilirubin , giving high variable results:
a- hemolysis
b- hemoglobin
c- vitamins
d- hormones

350- in hemolytic jaundice there will be increase ……………. in

serum:
a- direct bilirubin
b- indirect bilirubin
c- total bilirubin
d- all of the above

351- the inhibitor binds reversibly to the same site on the

enzyme that the substrate normally occupy , this type of
inhibition is called :
a- competitive inhibition
b- non competitive inhibition
c- surface recognition
d- product concentration

352- regulation of blood glucose level can be achieved by :

a- hormonal mechanism
b- hepatic and renal mechanism
c- (a) & (b)
d- non of the above
353- insulin is a hormone secretes by :
a- α cell of islet of langerhans in pancreas
b- β cell of islet of langerhans in pancreas
c- suprarenal cortex
d- non of the above

354- cholesterol is a component of all cell membrane and it’s the

precursor of :
a- bile acid
b- steroid hormones
c- vit D
d- all of the above

355- anti diuretic hormone ( ADH) secretion is controlled by:

a- rennin angiotensin
b- plasma osmlality
c- (a) & (b)
d- non of the above

356- the electrophoresis is based on differential migration of :

a- charged particles
b- uncharged particles
c- molecular weight
d- (a) & (b)

357- acid base balance is regulated by :

a- oxygen concentration
b- hydrogen ion concentration
c- nitrogen ion concentration
d- (a) & (b)

358- it’s an increase in hydrogen ion concentration of the blood:

a- acidosis
b- alkalosis
c- acid base balance
d- (a) & (b)

359- over production of acid associated with :

a- diabetes mellitus
b- lactic acidosis
c- methanol poisoning
d- all of the above

360- serum bicarbonate is decreased in:

a- respiratory acidosis
b- metabolic acidosis
c- renal tubular acidosis
d- all of the above

361- chronic deficiency in dietry calcium can lead to :

a- anemia
b- bronchial asthma
c- osteoporosis
d- non of the above

362- ………… is due to decrease blood CO2:

a- metabolic acidosis
b- respiratory acidosis
c- respiratory alkalosis
d- metabolic acidosis

363- …………. is the most important factor affecting body

sodium content:
a- aldosteron secretion
b- antidiuretic hormone
c- testosterone
d- all of the above
364- haemosiderosis is :
a- increase iron store
b- decrease iron store
c- increase hemoglobin
d- decrease hemoglobin

365- if there’s a mixture of protein ( colloids) and salt

( crystalloid) they can be separated by :
a- precipitation
b- dialysis
c- chromatography
d- electrophoresis
366- the predominant cation in intracellular fluid is :
a- sodium
b- potassium
c- calcium
d- phosphorus

367- metabolic acidosis is due to :

a- failure to secret acid
b- bronchial asthma
c- loss of bicarbonate
d- (a) &(c)

368- high level of plasma ferritin may occur due to :

a- inflammatory condition
b- malignant disease
c- liver disease
d- all of the above

369- gonadal hormones estimation is important in :

a- detection of ovulation
b- assessment of amenorrhea
c- evaluation of delayed puberty
d- all of the above

370- the secretion of gonadal hormone is controlled by :

a- LH
b- FSH
c- TSH
d- (a) & (b)
371- the intensity of the color is directly proportional to the
………. of the analyte in the solution:
a- dilution
b- contamination
c- concentration
d- observation

372- the ………… contain information of any health or safety

rich associated with use or exposure to hazardous chemicals:
a- MSDS
b- NFPA
c- POLT
d- OSHA
373- instraument used to measure color changes in the labs:
a- microscope
b- centrifuge
c- photometer
d- all of the above

374- the color coded signs used to identify flammable chemicals:

a- blue
b- yellow
c- white
d- red

375- quality assurance includes :

a- personal orientation
b- laboratory documentation
c- knowledge of laboratory istraumentation
d- all of the above

376- the laboratory procedure manual include:

a- patient preparation
b- specimen collection & processing
c- specimen preservation , storage & transport
d- all of the above

377- the principal of reflectance photometer

a- measure the amount of light that pass through the solution
b- measure the amount of light that the solution absorbs
c- (a) & (b)
d- non of the above

378- the blood cell counter include :

a- aperture impedence cell counter
b- Geiger counter
c- microscopes
d- all of the above
379- it is mession is to save lives , prevent injuries , and protect
health of all workers in the lab. :
a- MSDS
b- NFPA
c- POLT
d- OSHA

380- ……………. requires 3 hours at 140 C ْ or 1 hour at 160 C

ْ for complete sterilization
a- hot air oven
b- autoclave
c- filteration
d- all of the above

381- arterial blood samples are essential to do :

a- CBC
b- urea
c-blood glucose
d- blood gas analysis

382- vaccum tubes with green stopper contain:

a- EDTA
b- sodium citrate
c- heparin
c- no anticoagulant

383- serum separator tube is all of the following except:

a- contain gel that separate serum from cells during centrifugation
b- contain clot activator to speed clot formation
c- has red & black mottled top stopper
d- used for coagulation tests

384- for phlepotomy we use all of the following except:

a- the hypodermic needle & syringe
b- the vaccum tube system
c- the monolet lancets
d- the winged infusion set
385- lab. equipment should be cleaned and disinfected with :
a- hypochlorite
b- formaldehyde
c- glutaraldehyde
d- (b) & (c)

386- any blood split in the lab should be immediately swabbed

with :
a- hypochlorite
b- alcohol
c- soap
d- water

387- CBC is performed using:

a- serum
b- well mixed EDTA whole blood
c- plasma
d- non of the above

388- which tube should be filled first in blood collection:

a- tubes with anticoagulant
b- tube without anticoagulant
c- tubes for blood culture
d- non of the above

389- the monojector is designed to be used with :

a- the monolet lancet
b- tenderlett
c- tenderfoot
d- non of the above

390- the site of choice for capillary puncture in newborns is :

a- the earlobe
b- middle finger
c- the big toe
d- the lateral medial planter heel surface
 PARASITOLOGY
426- Intermediate host of Trypansom:
a- triatoma megista
b- sand fly
c- tse tse fly
d- anopheles

427- The cause of chaga's disease:

a- trypanosoma gambiense
b- trypansoma rhodesiense
c- trypansoma cruzi
d- leishmania braziliense

428- The cause of sleeping sickness:

a- trypanosoma gambiense
b- trypanosoma cruzi
c- trypanosoma rhodesiense
d- (a) & (c)

429- Cause Kala- azar:

a- leishmania tropica
b- leishmania braziliense
c- leishmania donovani
d- leishmania mexicana

430-cause oriental sore:

a- plasmodium ovale
b- leishmania tropica
c- leishmania donovani
d- trypanosoma rhodesiense

431- Its trophozite is shaped like a pear , has the 2 nuclei that
resembles eyes and 4 pairs of flagella that look like hair:
a- Trichomonas vaginalis
b- entameoba histolytica
c- giardia lamblia
d- endolimax nana

432- Pear shaped trophozite with 4 anterior flagella and a 5th

forming the outer edge of a short undulating membrane:
a- Trichomonas hominis
b- entameoba histolytica
c- entameoba coli
d- endolimax nana

433- sometimes it cause metastatic infection which involve liver,

lung, brain or other viscera:
a- giardia lamblia
b- Trichomonas vaginalis
c- entameoba histolytica
d- balantidium coli

434- Intestinal ciliate:

a- entameoba histolytica
b- entameoba coli
c- giardia lamblia
d- balantidium coli

435- Asexual multiplication of plasmodium vivax takes place in:

a- anopheles
b- sand fly
c- human
c- tse tse fly

436- Plasmodium falciparam is transmitted by :

a- triatoma megista
b- tse tse fly
c- anopheles
d- sand fly

437- Moves by pseudopods:

a- giardia lamblia
b- balantidium coli
c- entameoba histolytica
d- Trichomonas vaginalis

438- it's one of the round worms:

a- schistosoma mansoni
b- schistosoma haematobium
c- ascaris lumbricoides
d- fasciola hepatica

439- it's one of the tape worms:

a- ascaris lumbricoides
b- ancylostoma duodenal
c- trichuris tricura
d- taenia saginata

440- barrel shapped egg, yellow brown in color with a colorless

protruding mucoid plug in each end:
a- egg of ascaris lumbricoides
b- egg of ancylostoma duodenal
c- egg of trichuris tricura
d- egg of taenia saginata

441- large oval egg ,pale yellow brown in color has a

characteristic side spine & contain a fully developed
miracidium , the worm is:
a- S.mansoni
b- S. hematobium
c- A. duodenal
d- T. solium

442- large oval egg , pale yellow brown in color has an indistinct
operculum and contains unsegmented ovum:
a- S. hematobium
b- fasciola hepatica
c- heterophyes heterophyes
d- taenia solium

443- round egg , embryo is surrounded by a thick brown

radially striated wall , hooklets are present in the embryo:
a- S. hematobium
b- fasciola hepatica
c- A. duodenal
d- T. solium

444-oval colorless egg,flattened on one side & contains a larvae:

a- hymenelopis diminuta
b- dipylidium caninum
c- entrobius vermicularis
d- taenia saginata

445- the cause of malignant malaria:

a- plasmodium vivax
b- plasmodium ovale
c- plasmodium malaria
d- plasmodium falciparum

446- infection occur when infective filariform larvae penetrate

the skin:
a- ascaris lumbricoides
b- ancylostoma duodenal
c- fasciola hepatica
d- heterophyes heterophyes

447- ……..lives in the liver and bile ducts of sheep and cattle:
a- stronyloides stercoralis
b- schistosoma mansoni
c- fasciola hepatica
d- ancylostoma duodenal

448-segment found in stool which is white & opaque & measures

20 mm long by 6mm wide with uterus that has a central stem
and more than 13 side branches on each side…the worm is :
a- fasciola hepatica
b- trichuris trichuris
c- heterophyes heterophyes
d- taenia saginata

449- infection is by eating raw or under cooked fish:

a- fasciola hepatica
b- trichuris trichuris
c- heterophyes heterophyes
d- taenia solium

450- …… is transmitted by eating raw or under cooked beef:

a- heterophyes heterophyes
b- taenia saginata
c- schistosoma mansoni
d- ancylostoma duodenal

BODY FLUID
451- urine output < 400 ml/24 hours is :
a- polyuria
b- anuria
c- oligouria
d- non of the above

452- precipitation of urates takes place in:

a- acidic urine
b- alkaline urine
c- neutral urine
d- all of the above

453- it's one of the causes of persistently acidic urine:

a- urinary tract infection
b- phenylketonurea
c- excessive bicarbonate ingestion
d- excessive ingestion of soda

454- common cause of proteinuria:

a- alcoholism
b- fasting > 18 hours
c- diabetes mellitus
d- Bence- Jones proteins

455- dipstick detect acetoacetic acid & acetone which react with:
a- peroxides
b- nitroprusside
c- diazo compounds
d- indoxyl esters

456- in dipstick bilirubin reacts with :

a- nitroprusside
b- peroxides
c- indoxyl esters
d- diazo compounds

457- among the common cause of hematouria:

a- urogenital carcinoma
b- diabetes mellitus
c- heavy exercise
d- metabolic disorder

458- large number of hyaline cast indicated:

a- acute pyelonephritis
b- proliferative glomerulonephritis
c- heart failure
d- all of the above
459- red cell casts indicates:
a- acute pyelonephritis
b- proliferative glomerulonephritis
c- heart failure
d- all of the above

460- crystals which look like envelope :

a- triple phosphate
b- cystine
c- uric acid
d- calcium oxalate

461- Biuret test is done to determine:

a- glucose b- pentose
c- protein d- galactose

462- the 1st tube of synovial fluid is for:

a- hematology b- chemistry
c- microbiology d- microscopy

463- square plate like crystals with notched corners in synovial

fluid indicate:
a- uric acid b- calcium pyrophosphate
c- cholesterol d- monosodium urate

464- abnormal forms in semen should not exceed:

a- 10 % b- 5 %
c- 25 % d- 50 %

Lab.Management
477-The process of getting things done through and with people
operating in organized group toward a common goal is the
a- management
b- Organization
c- Planning
d- None of the above
478- Primary objectives in the planning are directed to
a- the laboratory as a whole
b- Increase the efficiency in the performance of the lab. test
c- Decrease the costs in the performance of the lab. test
d- All of the above

479- Forecasting needs for staff personnel means

a-Prediction in relation to the kind of technician and technologist
who will be working in the lab.
b- Plan for the full utilization of efficient use of instrument
c- Plan for the full use of space in the lab.
d- None of the above

480-An organization
a- Is formed when 2 or more persons are brought together to achieve
a common goal
b- Is closely related to planning
c- Involves structuring activities and functions within institutions to
achieve the goals and objects
d- all of the above

481- The real behavior and relationships of organization

members usually differ from their planned behavior and
relationships. It is
a- Formal organization
b- Informal organization
c- Space utilization
d- None of the above

482- The intra lab. System includes the following except

a- Calendar format
b- Histogram format
c- out of limits report sheet
d- Proficiency testing and computer program

483- The out of limits report form provides

a- Space for recording reagents changes
b- Control lot number changes
c- Serve as a general "dairy" of the test methodology
d- All of the above
484- Patient preparation, specimen collection and technical
performance of lab. test are general categories of…………..
a- Planning
b- Utilization of space
c- Work flow
d- Quality control

485-floor book manual includes the following except

a- Test name
b- Sample fluid
c- Minimum volume
d- Proper procedures for collecting routine and special tests

486- Collection procedure manual involve

a- Blood collection from pediatric patients
b- Intensive care blood collection
c- Isolation techniques for lab. Personnel
d- All of the above

487-On the container and \or lab requisition

a- Patient's full name should be put
b- Hospital number should be put
c- Date of collection should be put
d- All of the above

488 Accuracy referred to the following except

a- Correctness and exactness of the test
b- Closeness of the test to the true value
c- True value determined by comparison to a standard
d- reproducibility

489- Regarding precision the following is true except

a- Reproducibility
b- Closeness of the test results to one another when using the same
specimen
c- In the clinical lab it is expressed as (SD) and coefficient of
variation
d- The capability of the method to detect a small amount of
substance with some assurance

490- Reliability is
a- The ability of a method to measure only that substance being
tested
b- The ability of the test method to maintain its accuracy despite of
extraneous circumstances
c- The ability of the method to maintain accuracy, precision and
ruggedness
d- None of the above

491- …………….. This symbol in the flow chart means

a- Beginning process
b- Decision
c- Manual operation
d- Decision mod

492- This symbol in the flow chart means ( )

a-Beginning process
b- Decision
c- Direction flow
d- Document

493- Work load on which personnel requirements are usually

based is influenced by
a- changes in volume
b- Test mix
c- Patient population
d- All of the above

494- The physical features of the lab. one of the measures of

a- forecasting of personnel needs
b- Assessment of space utilization
c- Time management
d- None of the above

495- If P (E) is the probability of E we may express this

definition as
a- P (E) = m\N
b- P (E) = N\m
c- P (E) = m X N
d- None of the above

496- When a test indicates a positive status when the true status
is negative it is called
a- positive test
b- False positive test
c- Negative test
d- False negative test

497- The specificity of a test

a- The probability of a positive test results or (presence of the
symptoms) given the presence of the disease
b- The probability of a negative test results or (absence of the
symptoms) given the absence of the disease
c- a and b
d-None of the above

498- The largest collection of entities for which we have an

interest at a particular time is called
a- Population
b- Sample
c- Data
d-All of the above

499- A sample is
a- A part of a population
b- The whole population
c- Endless population
d- None of the above

500- If we have 100 students and they are ranked by age

beginning with the 4th student, every tenth student is chosen (the
student no. 4 then 14 and 24 and so on) this type of sample is
called
a- Systemically selected sample
b- A stratified selected sample
c- Simple random sample
d- Cluster selected sample

501-A point estimate is

a- A single numerical value used to estimate the corresponding
population parameter
b- Tow numerical values defining a range of values include the
parameter being estimated
c- a and b
d- None of the above

502-A statistical inference is

a- A procedure by which we reach a conclusion about population
based on the information obtained from the sample drawn from it
b- The cause behind estimation in the health science fields
c- Calculated data from the data of the sample that are
approximation of the corresponding parameter
d- None of the above

503- Estimator is
a- the rule that tells us how to compute the single value which is
called estimate
b- Two numerical values defining the range of values
c- a, b
d- None of the above

504 The table which shows the way in which values of the
variables are distributed among the specified class interval is
called
a- Relative frequency
b- Ordered array
c- Frequency table
c- None of the above

505- The following are the ages of 5 patients seen in the

emergency room in certain day 35, 30, 55, 40, 25 years the mean
of their ages is
a- 37 years
b- 30 years
c- 39 years
d- 40 years

506- A mathematical tool designed to facilitate complex clinical

decision in which many variables must be considered
spontaneously is called
a- Reference value
b- Decision analysis
c- Quality assurance
d- None of the above
 Microbiology 532
Immunology Examination KEY
October 30, 2003

All questions have equal point value. You may keep the test questions.
Multiple Choice (choose the best answer)

1. Receptors associated with innate immunity recognize microbes by detecting:

a. insulin.
Correct b. pathogen associated molecular patterns (PAMPs).
c. Fc’s.
d. complement.
e. none of the above.

2. Immunoglobulin classes must distinguished by the type of:

a. light chains they possess.
b. carbohydrate on their light chains.
c. constant regions in their light chains.
Correct d. heavy chains they possess.
e. none of the above.

3. The variable regions in the light chains participate in:

a. Fc receptor binding.
Correct b. epitope binding.
c. affinity of the complement receptors.
d. interaction of the Fab with cytokines.
e. none of the above.

4. Plutonian immunoglobulin molecules follow the same rules of proportions that are found
in human immunoglobulins. If you were told that Plutonian light chains had a molecular
weight of 4 kDa (each), what would you expect the molecular weight of their IgG mole-
cules to be?
a. 150,000 kDa
b. 900,000 kDa
c. 12 kDa
d. 8 kDa
Correct e. none of the above.

5. J-chains are associated with:

a. IgG.
Correct b. polymeric immunoglobulins (more than two Fab’s).
c. serum IgA
d. IgE.
e. none of the above.
 Microbiology 532 Immunology Examination

6. Adoptive-acquired immunity may be the result of:

Correct a. transfer of bone marrow from one individual to another.
b. immunization with a vaccine.
c. exposure to an individual who has an infectious disease.
d. a physician administering a gamma globulin shot to someone who has had a needle
stick (immunoglobulins).
e. a and d.

7. IgG binding to neutrophils cells is mediated by:

a. Fc-dependent cellular homing mechanisms.
b. sensitization of Mast cells and basophils.
Correct c. Fc receptors specific for IgG.
d. ICAM’s.
e. none of the above.

8. IgD participates in antigen recognition by:

a. immature T cells.
b. NK cells.
c. macrophages.
Correct d. B cells.
e. none of the above.

9. Antibody affinity is not determined by the amino acid sequence in:

a. the constant regions of the immunoglobulin molecule.
b. the variable regions of the immunoglobulin molecule.
c. the Fc of the immunoglobulin molecule.
d. the J-chain.
Correct e. a, c and d.

10. Avidity is important because:

Correct a. it amplifies the binding strength of low affinity Fab’s.
b. Fc receptor binding depends on it.
c. G-protein-mediated signal transduction will not occur without it.
d. it result in the activation of high affinity antibody-producing clones.
e. none of the above.

True/False (Please use “a” for true and “b” for false on your answer sheet)

T 11. M-cells often enable pathogens to penetrate the epithelial cell layer of the mucosa.

T 12. Cross-reaction is the result of epitopes common between two different antigens.

T 13. In an ELISA, the use of a “second’ labeled antibody is required to detect patient serum
antibodies that bind to the antigen.

F 14. Agglutination requires complement activation and the production of chemotactic factors.

T 15. Agglutination generally occurs only with IgM antibodies.

page 2 of 7
 Microbiology 532 Immunology Examination

F 16. The complement system is not responsible for the production of neutrophil chemoattrac-
tants.

T 17. Complement may be activated in the absence of an antibody/antigen reaction.

T 18. One would not expect to find SC associated with monomeric IgA in the serum.

F 19. Inflammatory reactions are often associated with mucosal immunity.

T 20. CD antigens are used to identify cell types and their functions.

Multiple Choice (choose the best answer)

21. Organized mucosa-associated lymphoid tissue is

a. found in the lymph nodes.
Correct b. associated with initial immune response to antigen.
c. filled with plasma cells that are producing antibodies.
d. composed primarily of M-cells and L-cells.
e. none of the above

22. B cells usually require T cell help to mature plasma cells because:
a. T cells present antigen to them.
b. most B cells in the circulation need thymic hormones secreted by the antigen pre-
senting cell to mature to plasma cells.
c. T cells are antigen presenting cells that are critical to immune recognition.
d. all of the above.
Correct e. none of the above.

23. The antigen presenting cell

Correct a. may be a dendritic cell in the skin.
b. may be a T cell.
c. does not produce cytokines which influence the adaptive response.
d. matures upon antigenic stimulation and becomes a plasma cell.
e. all of the above.

24. Mucosal immunity provides most of its protection by blocking

a. microbial receptors specific for colonization.
b. the complement cascade.
c. blocking penetration of undigested food products into the mucosal tissues.
Correct d. a and c
e. none of the above

25. Tissue macrophage are mature:

a. B cells
b. T cells
c. NK cells
Correct d. Monocytes
e. none of the above.

page 3 of 7
 Microbiology 532 Immunology Examination

26. Hormone-like host peptides used for communications in innate and adaptive immunity
are known as:
a. PAMPs.
b. cell adhesion molecules.
c. ELISAs.
Correct d. cytokines.
e. none of the above.

27. Which of these is not associated with adjuvants?:

a. forms an antigen depot.
b. provides non-specific T cell stimulation.
c. activates antigen-presenting cells.
Correct d. activates the complement cascade.
e. none of the above.

28. Which is associated with apoptosis?

a. Regulates cell migration from O-MALT migrate to D-MALT.
Correct b. Used by T cells to kill target cells.
c. mediates necrotic cell death.
d. a and b.
e. all of the above are correct responses.

29. The lag phase of the secondary response is shorter than the primary response because:
a. the assays for detecting a primary response are not as sensitive.
Correct b. the primary response requires considerable cell proliferation and differentiation to
achieve a critical mass of cells to produce immunity.
c. of the lack of cytokines produced during the primary response.
d. a and d. (oops!)
e. none of the above.

30. The lag phase of the booster response is:

Correct a. very short, due to memory cells.
b. very short due to the lack of antigen presenting cells.
c. very short when dendritic cells are absent.
d. very short, due to the presence of accessory cells.
e. none of the above.

True/False (Please use “a” for true and “b” for false on your answer sheet)

Correct 31. Dendritic cells are antigen presenting cells.

Correct 32. Homing is a process by which cells leave the O-MALT and randomly migrate until they
encounter vascular addressins that bind to their cell surface receptors in D-MALT.

Correct 33. Affinity maturation is the result of clonal section over time.

Correct 34. The innate mechanisms of host immunity generally play a role in the defense of the body
prior to the activation of adaptive defense mechanisms.

False 35. Fc and complement receptors on phagocytic cells prevent opsonized bacteria from being
pulled into phagocytic vacuoles.

page 4 of 7
 Microbiology 532 Immunology Examination

False 36. Atopic individuals are people who tend to make undetectable amounts of IgE antibodies.

Correct 37. Mast cell degranulation occurs as a result of cross-linkage of Fc receptors on Mast cells.

Correct 38. Serum sickness occurs when massive amounts of foreign proteins are introduced into the
body.

False 39. Genetic factors associated with atopy predict a specific allergies.

Correct 40. Desensitization injections are thought to increase T cell suppressor cell activity and
decrease IgE synthesis in atopic patients.

Multiple Choice (choose the best answer)

41. The location of complement activation is determined by:

a. the location of Fc receptors.
b. the location of dendritic cells.
Correct c. the location of specific antibody/antigen complexes.
d. b and c.
e. none of the above.

42. Complement damage is generally limited to the immediate area in which complement is
activated because of the:
Correct a. short half-lives of the activated complement components and their rapid inactiva-
tion.
b. very low concentrations of the inactivated complement components in serum.
c. the inability to activate the system in the presence of IgG antibodies.
d. once activated, the destructive activities of complement are non-specific.
e. none of the above

43. Sensitization to foods is minimized by secretory IgA antibodies by:

a. The inflammatory response that occurs in the presence of food, these antibodies and
complement.
b. Destroying the antigen presenting cells that would normally present the food
antigens to T cells in the gut.
Correct c. Blocking the penetration of intact food products into the gut.
d. All of the above
e. None of the

44. Serum from an O positive, Rh negative patient agglutinates red blood cells from a patient
who is Rh negative. What is the likely blood type is the second patient?
Correct a. It can’t be determined from the information provided.
b. Type A
c. Type B
d. Type O
e. Type AB

page 5 of 7
 Microbiology 532 Immunology Examination

45.
Transepithelial transport of antigen is important because without it
a. antigen would only be detected by the lymphoid cells in O-MALT.
b. antigen would not be detected by the lymphoid cells in the alternate complement
pathway.
c. polymeric antibody would be pumped through the epithelial cells
d. vascular addressins would target the wrong cell types.
Correcte. none of the above

46. During serum sickness, kidney damage occurs as immune complexes form. Why?
Correct a. The immune complexes are filtered by the kidneys and damage results from
concomitant complement activation and neutrophil activity.
b. Antigen presenting cells rapidly bind all of the complexes in their MHC-encoded
receptors.
c. Free antigen activates PAMP receptors in the kidneys which rapidly activate adap-
tive immunity.
d. The immune complexes bind to Mast cells and are destroyed.
e. none of the above

47. Contact dermatitis generally occurs against substances that are too small to induce an
immune response. How do these substance induce an immune response?
a. These substances form depots and are then slowly released into the blood.
b. These low molecular weight substances react with liver enzymes and are difficult to
eliminate.
Correct c. These substances bind to tissues and cells, resulting in a larger total antigenic size
which can then stimulate an immune response.
d. The substances trigger the complement cascade and cause neutrophils to accumulate
and to serve as antigen presenting cells.
e. a and c.

48. Your patient tests positive for the tuberculin antigen. You send him for a chest x-ray
because:
Correct a. the tuberculin test is only presumptive, indicating that he has been exposed to a
tuberculosis antigen.
b. He may have other lung infections.
c. you are looking for fluid in his lungs due to inflammation caused by the bacillus
d. a and b.
e. none of the above

49. Microorganisms associated with periodontal disease, such as Porphyromonas gingivalis,

are thought to control the cytokine expression and affect TH1 and TH2 pathways by :
a. suppressing Mast cell activity.
Correct b. stimulating PAMP receptors of innate immunity to express cytokines that result in
an adaptive response that is not protective
c. avoiding PAMP receptors and, thereby, avoiding innate immunity.
d. stimulating adrenergic receptors.
e. none of the above

page 6 of 7
 Microbiology 532 Immunology Examination

50. Innate host defense mechanisms are critical to the protection of the body because:
a. they utilize pre-committed antigen presenting cells that have already been induced
by other immune responses.
b. the antibodies derived from the innate response are critical to neutralize bacterial
toxins.
c. they are highly specific for the invading pathogens that avoid PAMP receptor
recognition.
Correct d. they provide immediate, continuous protection in the absence of a specific immune
response.
e. b and d

page 7 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The exam contain 100 Multiple Choice questions should be solved in 2h maximally
 don't forget ur Labcoat.
 say; ‫ بسم هللا‬and type ur Receipt No. in St no. column then press Enter to show ur name
 Press F9 and choose ur specialty

 Leishmania is transported by Sandfly, and mainly invade macrophage

 Leishmania chagasi doesn't found in Sudan
 H.nana is known as dwarf tapeworm, 4 cm, egg is the infective stage.
 A.lumbricoides is known as giant roundworm
 B.coli is the largest protozoa at all
 F.buski is an intestinal fluke and it is the largest flukes at all
 Variation in RBCs size is called Anisocytosis
 Variation in RBCs shape is called Poikilocytosis
 Netrophils represent 50 -70 % of total lymphocytes lymphocyte = 20 – 40 %,
monocyte = 4 – 6 %, eosinophile = 1 – 3 %, basophile = .4 – 1 %
 Plumer – Vinson syndrome may be seen in cases of IDA (Iron Deficiency Anemia)
 Chronic (low-rat) blood loss can cause IDA (microcytic hypochromic anemia)
 Favism is an acute haemolytic anemia occure in G6PD pts after ingestion of bean
 Erythrocytes are non-nucleated biconcave disk
 Eosinophils have a characteristic biffed (segmented) nucleus with red stained
granules in the cytoplasm
 B-lymphocytes (plasma cells) are responsible for Abs production
 Sickle cells are curved with sharp ends seen in Haemoglobinopathies
 Sickle cell anemia can cause; leg ulcer, gall stone, attacks of pain and spleen atrophy
(not enlargement of spleen)
 HbS in sickle cell anemia is caused by substitution of a.a (Valine) instead of (Glutamic
acid) at position no. 6 in the beta chain of Hb
 Red cell with elongated arm of central pallor = Stomatocye
 Symmetrical RBCs with many tiny spicules and projection, seen in IDA and uremia =
Ecchinocyte (burr cell) which seen in IDA
 Howeel-jolly bodies are small, dense, basophilic (purple) red cell inclusion (DNA
fragments) seen in spleenoctomized pts and in megaloblastic anemia
 Heinz bodies are small, round inclusion (Hb fragments) seen in haemolytic disorders
(G6PD and alpha thalassemia)
 Schistocye or schizocye is the fragmented part or RBCs
 Darkened and hyperchromic RBCs with no central pallor = Spherocye
 Spherocytosis is a heridetiry defect in RBCs membrane with high reticulocye count
4 any suggestion plz contact; [email protected]
Page 1 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Pica (craving to eat unusual substance such as clay or ice) is seen in IDA
 Chloramphenicol may cause Aplastic anemia in long term therapy
 Absolute lymphocyte count is up to 300.000, between 70 – 90 % appear as small
lymphocyte = CLL (chronic lymphocytic leukemia)
 Leukocytosis characterized by present of immature cells and high neutrophil alkaline
phosphotase = Leukomoid reaction
 In the atomic absorption method for Ca+2 measurment, lanthanum is added to the
sample to prevent the phosphate interference
 Disease characterized by progressive neoplastic proliferation of immature white cell
precursor, high neutrophil alkaline phosphatase mainly affect children = Acute
Lymphoblastic Leukemia
 Schilling test is used to diagnose Pernicious anemia (Vit B12 deficiency)
 Vit B12 deficiency can cause neurological symptoms
 Fanconi's anemia is a type of Aplastic anemia
 The first line of defense against parasites are Eosinophils, bacteria = neutrophil, virus
= lymphocytes
 Basophils play an important role in immediate and delay HSR (hyper sensitivity
reaction)
 Monocytes are the largest leukocyte
 T-lymphocyte = cell mediate immunity, B-lymphocyte = humoral mediated immynity
 Haemolytic disease in newborn = erythroblastosis fetalis
 Normal adult Hb tetramer (Hb A) is; 2 α and 2 β, (Hb A2 – 1-3%) is; 2 α and 2 δ (Hb F
fetous) is; 2 α and 2 γ
 Platlets are small megakaryocytic fragment responsible for blood clotting
 63 ml of CPDA (citrate phosphate dextrose adenine) is added to 450 ml of blood in
blood bags to be saved up to 35 days.
 Normal flora in the vagina = Lactobacillus acidophilus
 Pus cells in urine with variable gram bacilli does not prove the vaginal infection
 Compound affected by direct light = Bilirubin
 LDL (low density lipoprotein) is a Harmful Cholesterol (cause atherosclerosis)
 HDL (high density lipoprotein) is a Useful Cholesterol (remove excess cholesterol)
 HDL normal range = 30 – 60 mg/dl, LDL = 100 mg/dl
 VLDL (very low density lipoprotein) is an endogenous triglyceride
 T.solium gravid proglottid has fewer uterine branches than T.saginata
 The infective stage of T.saginata is cysticercus bovis and for T.solium cysticercus
cellulose

4 any suggestion plz contact; [email protected]

Page 2 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The scolex of T.saginata has 4 suckers and circle of hook while T.solium has 4 suckers
and no hook
 Intermediate host of T.saginata is cattle and for T.solium is pig
 The definitive host of both tenia is Human
 Syphilis is sexually transmitted disease and could be transferred from mother to the
fetus by birth (maternally)
 Inflamed eye caused by T.cruze is called Roman's sign
 Best time when w.bancrofti can be detected in blood sample; 10 p.m – 4 a.m
(nocturnal periodicity)
 The normal O.volvulus lifespan is up to 10 year
 Skin snip is the best sample to diagnose O.volvulus, the blood for loa loa
 Dogs are the most important definitive hosts of E.granulosus while the sheep and
man are the intermediate one
 Both herpes virus and pox virus are DNA enveloped viruses
 Cyst is the infective stage of G.lambilia while it's diagnostic stage both cyst and
trophozoyte
 No fasting sample is required to determine the uric acid conc. in blood
 The infective stage of D.latum is Plerocercoid or sparganum larvae
 The definitive host for D.latum is the human
 The eggs of D.latum are hatch in fresh water
 The infective stage of Fasciola hepatica is metacercariae
 Some of Liver flukes are (F.hepatica and C.sinensis) and F.buski is an intestinal fluke
 Intermediate host of W.bancrofi is female mosquito; anopheles and culex
 Intermediate host of O.volvulus is female blackfly, simulium
 Intermediate host of Loa Loa is the deer fly (Chrysops)
 Loa loa microfilaria have diurnal periodicity and sheathed
 Saliva is rich by the enzyme Amylase
 Creatine kinase or creatine phosphokinase (CK,CPK) has 3 isoenzymes CK-MM,
CK-MB and CK-BB
 Excersice increase the level of CK generally
 CK-MB is a great indicator and the first one to elevate in case of acute myocardial
infarction (AMI), it also increase with intravenous injection
 GTT (γ glutamyltransferase) is the most sensitive enzyme for hepatic disorders.
 Human semen contain high conc. of acid phosphatase; one of them is PAP (prostatic
acid phosphatase) which is used as an indicator for prostatic cancer
 Sodium Thymolphthalein Monophosphate is the most specific substrate for
prostatic acid Phosphatase
4 any suggestion plz contact; [email protected]
Page 3 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Apoenzyme is the protein potion of the enzyme

 Isoenzyme increase the specifity
 Patients with pseudocholinestrase deficiency are sensitive to anesthetic drugs
 Phenylketonurea is a metabolic disorder appear as a deficiency of the enzyme
responsible to metabolize the amino acid phenylalanine to tyrosin
 Renal gout and metabolic gout are different in the urine uric acid level
 Glycated Hb is used to measure the control of plasma glucose level and follow up
long treatment
 The dose of oral glucose given in GTT (glucose tolerance test) is 75g for adults and
30g for children
 Insulin antagonist is Glucagon
 -ve VDRL and +ve TPHA = Inactive syphilis
 Shigella does not live intracellulary and cause doudinitis
 E.coli cause diarrhea
 Proteus is G-ve rod swarm in agar cultur but the Cl.tetani also caue swarming
anaerobically and it have terminal spores.
 Most wound infections are caused by S.aureus
 Keratits causative agents; s.aureus, s.pneumoniae, pseudomonas and Chlamydia
 Otitis media causative agent; s.aureus, s.pneumoniae, H.influnzea and M.catarrhalis
 Chlamydia is diagnosed by its elementary body and reticulate body
 E.histolytica can cause liver abscess but never splenomegally
 Drugs contain beta lactam ring; pencillin, cephalosporin, crbapenems and
monobactams (Vancomycin does not)
 Aminoglycosides antibiotics like tetracycline act by inhibit protein synthesis of
bacteria (not cell wall)
 N.gonorrhoeae produce beta lactemase which resist beta lactam drugs
 N.gonorrhoeae virulence factors are; pili, IgA protease and endotoxin in
lipopolysaccharide membrane (but there is no Exotoxin)
 Stapping of gelatin culture with B.anthrax give a characteristic Inverted fir tree
appearance
 B.anthrax is capsulated non haemolytic in B.A while B.cerus is non capsulated and
haemolytic
 Food Intoxication can caused by; E.coli O157 , S.aureus, B.cerus and clostridium
(while Campylobacter cause food infection)
 G-ve cocci in sputum smear is mostly the organism Moraxila catarrhalis
 CAP (cellulose acetate precipitin) test is used for liver ameobiasis its result appear in
agarose gel as 2 precipitated line (it cannot detect the parasite DNA)
4 any suggestion plz contact; [email protected]
Page 4 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 E.coli is found in colon as normal flora

 Asthma, blood transfusion and allergy are examples of HSR (but not
glomeluronephritis)
 C3a ans C5a can cause symptoms of anaphylatoxin (degranulation of mast cell and
bronchospasm) and chemotaxis (but they don't activate WBCs)
 The test which measure clotting time of citrated plasma by adding thromboplastin
and Ca+2 and used as follow up test to control anticoagulant = Prothrombin time
(PT/PTT) (for extrinsic pathway) 11 -15 second
 Activated partial thromboplastin time (PTT/APTT) or KccT (Kaolin cephalin clotting
time) for intrinsic and common pathway and to monitor the treatment effect of
anticoagulated drug like heparin, 25 -35 second
 Normal bleeding time (coagulation time) is measured by Duke's method, 3 -9 min
 The microscope have two types of lenses; objective lenses which is near the slide and
eye lenses
 Dark field microscope is used to detect T.pallidum (cause of syphilis)
 Calibrated sera are the primary STD
 Autoclave sterilization temp. is 121 oC for 20 – 30 min
 Ruber gloves cannot be sterilized by hot air oven
 Neutrophile count is high in acute bacterial inflammation
 Listeria monocytogens is transmitted by birth (from mother to child)
 Hook worms are not a true filarial, they can cause megaloblastic anemia
 H&E dye stain the nuclei blue and the cytoplasm pink,, the dye depoit in tissue if not
filtrate
 Haematoxylin basic and the eosin is acidic
 Bloaking is not a step of tissue processing
 Shigella has the lesser infective dose among all bacteria and it is urease -ve
 Reticular fibers are stained with weigert stain
 Nuclear stain doesn't contain Alchol
 Pseudomonas can produce green pigment and it is the most common cause of
hospital acquired infection
 The infective stage of T.gondi is oocyst in domestic cat feaces which represent the
definitive host
 T.gondi doesn’t invade the central nervous system
 HMB 45 is a monoclonal Abs that react against an antigen present in melanoma
 O Ag is the somatic Ag of bacteria which is heat stable and found in all
enterobacterecia (not restricted on motile one)
 C.diphteriae reduce tellurite to metallic tellurium and produce exotoxins
4 any suggestion plz contact; [email protected]
Page 5 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Schistosoma belong to trematode and can cause hypertension

 Shistosoma egg doesn't contain operculum
 The complication of schistosomal infection is due to the presence of eggs that cause
granuloma and blockage (not the adult worm and there is no toxin produced)
 The adult worm of Schistosoma never appear in Stool sample
 Trophozoite of P. falciparum is called a ring
stage
 Schizont of P.vivax contain up to 24 merozoite
 There are three main viruses that cause AHC
(acute hemorrhagic conjunctivitis) enterovirus,
coxsakievirus and adenovirus
 Sickle cell anemic patients are most susceptible to get osteomylitis due to salmonella
infection
 Parathyroid hormone which is secreated from parathyroid gland increase the conc.
of calcium in the blood
 MIC (minimum inhibitory concentration) is the lowest concentration of
an antimicrobial that will inhibit the visible growth of a microorganism after
overnight incubation
 Bacillus cereus can cause food poisoning mainly in rice
 Exofoliatin toxin is produced by s.aureus and cause scalded skin syndrome
 ALP (alkaline phosphatase) level is significantly higher in children and pregnant
women
 Allograft is the transplantation of tissue from the same species
 Latex particles are used in agglutinin tests
 Chancroid (soft chancer) is a painful sore in the genitilia caused by H.ducreyi, while a
Chancre is a painless sore found in primary stage of syphilis
 H.pylori is diagnosed by GIT biopsy stained with H&E
 in post hepatic jaundice (obstructive) conjugated (direct) bilirubin is increased and
the unconjugated (indirect) one is normal
 Goiter disease = swelling of neck due to enlargement of thyroid gland (hypo/hyper)
 Potassium level in the blood is elevated in case of haemolysis
 Toxic shock syndrome reveal –ve blood culture
 E.histolytica, Blantidium coli can produce bloody stool
 ICT for malaria can detect HRP2 (histidin rich protein), pLDH (species-specific lactate
dehydrogenase and aldolase enzyme
 The precipitation line thickness of ICT is related to the level of parasitemia
 Plasmodium is a haemoparasite
4 any suggestion plz contact; [email protected]
Page 6 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Blackwater fever is caused by intensive Haemloysis (Rupture) of RBCs.

 Isoenzyme assay improve specifity
 Typhoid cannot be transmitted by aersol
 Target cells are seen in Thalassemia (Vit B12 deficiency)
 Thalassemia is caused by defective synthesis of either alpha or beta chain of normal
haemoglobin
 Pasturella multocida are transmitted by dog bite
 Yersinia pestis characterized by bipolar stain
 Bordetella bronchiseptica is an animal pathogen (dog)
 Calcium pyrophosphate dihydrate crystals are found in synovial fluid associated
with a range of clinical syndromes
 The term used to describe reproducibility is precision, while accuracy describe the
closeness to true value
 Spore forming, non motile, isolated from foot wound = Cl.perfrenges
 The causative agent of diarrhea associated with antibiotic (pseudomembranous
colitis) is Cl.difficile
 The fungi demonstrated by board based budding is Blantidium dermatiditis
 Candida albicans give +ve GTT (germ tube test)
 Stroglois stercolaris can cause autoinfection
 The examination of feces is of no help in case of E.granulosus
 Clue cells are epithelial cells of the vagina that get their distinctive stippled
appearance by being covered with bacteria (gardenella vaginallis)
 Hyaline casts can be found in healthy people
 Cutaneous larval migrans is caused by anclystoma brazilliansis/caninum
 Sexually active females are more suscebtiable to have UTI (urinary tract infection)
with S.saprophyticus
 Increased plts count = Thrombocytosis
 Decreased plts count = Thrombocytopenia
 Normal plts count = 150 – 450 cell/µl
 Fibrinogen is converted to fibrin by thrombin during blood clotting formation
 Newborns are normally with neutrophilia
 Character of cytoplasmic fixation is convertion from Sol to Gel


4 any suggestion plz contact; [email protected]

Page 7 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The exam contain 100 Multiple Choice questions should be solved in 2h maximally
 don't forget ur Labcoat.
 say; ‫ بسم هللا‬and type ur Receipt No. in St no. column then press Enter to show ur name
 Press F9 and choose ur specialty

 Leishmania is transported by Sandfly, and mainly invade macrophage

 Leishmania chagasi doesn't found in Sudan
 H.nana is known as dwarf tapeworm, 4 cm, egg is the infective stage.
 A.lumbricoides is known as giant roundworm
 B.coli is the largest protozoa at all
 F.buski is an intestinal fluke and it is the largest flukes at all
 Variation in RBCs size is called Anisocytosis
 Variation in RBCs shape is called Poikilocytosis
 Netrophils represent 50 -70 % of total lymphocytes lymphocyte = 20 – 40 %,
monocyte = 4 – 6 %, eosinophile = 1 – 3 %, basophile = .4 – 1 %
 Plumer – Vinson syndrome may be seen in cases of IDA (Iron Deficiency Anemia)
 Chronic (low-rat) blood loss can cause IDA (microcytic hypochromic anemia)
 Favism is an acute haemolytic anemia occure in G6PD pts after ingestion of bean
 Erythrocytes are non-nucleated biconcave disk
 Eosinophils have a characteristic biffed (segmented) nucleus with red stained
granules in the cytoplasm
 B-lymphocytes (plasma cells) are responsible for Abs production
 Sickle cells are curved with sharp ends seen in Haemoglobinopathies
 Sickle cell anemia can cause; leg ulcer, gall stone, attacks of pain and spleen atrophy
(not enlargement of spleen)
 HbS in sickle cell anemia is caused by substitution of a.a (Valine) instead of (Glutamic
acid) at position no. 6 in the beta chain of Hb
 Red cell with elongated arm of central pallor = Stomatocye
 Symmetrical RBCs with many tiny spicules and projection, seen in IDA and uremia =
Ecchinocyte (burr cell) which seen in IDA
 Howeel-jolly bodies are small, dense, basophilic (purple) red cell inclusion (DNA
fragments) seen in spleenoctomized pts and in megaloblastic anemia
 Heinz bodies are small, round inclusion (Hb fragments) seen in haemolytic disorders
(G6PD and alpha thalassemia)
 Schistocye or schizocye is the fragmented part or RBCs
 Darkened and hyperchromic RBCs with no central pallor = Spherocye
 Spherocytosis is a heridetiry defect in RBCs membrane with high reticulocye count
4 any suggestion plz contact; [email protected]
Page 1 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Pica (craving to eat unusual substance such as clay or ice) is seen in IDA
 Chloramphenicol may cause Aplastic anemia in long term therapy
 Absolute lymphocyte count is up to 300.000, between 70 – 90 % appear as small
lymphocyte = CLL (chronic lymphocytic leukemia)
 Leukocytosis characterized by present of immature cells and high neutrophil alkaline
phosphotase = Leukomoid reaction
 In the atomic absorption method for Ca+2 measurment, lanthanum is added to the
sample to prevent the phosphate interference
 Disease characterized by progressive neoplastic proliferation of immature white cell
precursor, high neutrophil alkaline phosphatase mainly affect children = Acute
Lymphoblastic Leukemia
 Schilling test is used to diagnose Pernicious anemia (Vit B12 deficiency)
 Vit B12 deficiency can cause neurological symptoms
 Fanconi's anemia is a type of Aplastic anemia
 The first line of defense against parasites are Eosinophils, bacteria = neutrophil, virus
= lymphocytes
 Basophils play an important role in immediate and delay HSR (hyper sensitivity
reaction)
 Monocytes are the largest leukocyte
 T-lymphocyte = cell mediate immunity, B-lymphocyte = humoral mediated immynity
 Haemolytic disease in newborn = erythroblastosis fetalis
 Normal adult Hb tetramer (Hb A) is; 2 α and 2 β, (Hb A2 – 1-3%) is; 2 α and 2 δ (Hb F
fetous) is; 2 α and 2 γ
 Platlets are small megakaryocytic fragment responsible for blood clotting
 63 ml of CPDA (citrate phosphate dextrose adenine) is added to 450 ml of blood in
blood bags to be saved up to 35 days.
 Normal flora in the vagina = Lactobacillus acidophilus
 Pus cells in urine with variable gram bacilli does not prove the vaginal infection
 Compound affected by direct light = Bilirubin
 LDL (low density lipoprotein) is a Harmful Cholesterol (cause atherosclerosis)
 HDL (high density lipoprotein) is a Useful Cholesterol (remove excess cholesterol)
 HDL normal range = 30 – 60 mg/dl, LDL = 100 mg/dl
 VLDL (very low density lipoprotein) is an endogenous triglyceride
 T.solium gravid proglottid has fewer uterine branches than T.saginata
 The infective stage of T.saginata is cysticercus bovis and for T.solium cysticercus
cellulose

4 any suggestion plz contact; [email protected]

Page 2 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The scolex of T.saginata has 4 suckers and circle of hook while T.solium has 4 suckers
and no hook
 Intermediate host of T.saginata is cattle and for T.solium is pig
 The definitive host of both tenia is Human
 Syphilis is sexually transmitted disease and could be transferred from mother to the
fetus by birth (maternally)
 Inflamed eye caused by T.cruze is called Roman's sign
 Best time when w.bancrofti can be detected in blood sample; 10 p.m – 4 a.m
(nocturnal periodicity)
 The normal O.volvulus lifespan is up to 10 year
 Skin snip is the best sample to diagnose O.volvulus, the blood for loa loa
 Dogs are the most important definitive hosts of E.granulosus while the sheep and
man are the intermediate one
 Both herpes virus and pox virus are DNA enveloped viruses
 Cyst is the infective stage of G.lambilia while it's diagnostic stage both cyst and
trophozoyte
 No fasting sample is required to determine the uric acid conc. in blood
 The infective stage of D.latum is Plerocercoid or sparganum larvae
 The definitive host for D.latum is the human
 The eggs of D.latum are hatch in fresh water
 The infective stage of Fasciola hepatica is metacercariae
 Some of Liver flukes are (F.hepatica and C.sinensis) and F.buski is an intestinal fluke
 Intermediate host of W.bancrofi is female mosquito; anopheles and culex
 Intermediate host of O.volvulus is female blackfly, simulium
 Intermediate host of Loa Loa is the deer fly (Chrysops)
 Loa loa microfilaria have diurnal periodicity and sheathed
 Saliva is rich by the enzyme Amylase
 Creatine kinase or creatine phosphokinase (CK,CPK) has 3 isoenzymes CK-MM,
CK-MB and CK-BB
 Excersice increase the level of CK generally
 CK-MB is a great indicator and the first one to elevate in case of acute myocardial
infarction (AMI), it also increase with intravenous injection
 GTT (γ glutamyltransferase) is the most sensitive enzyme for hepatic disorders.
 Human semen contain high conc. of acid phosphatase; one of them is PAP (prostatic
acid phosphatase) which is used as an indicator for prostatic cancer
 Sodium Thymolphthalein Monophosphate is the most specific substrate for
prostatic acid Phosphatase
4 any suggestion plz contact; [email protected]
Page 3 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Apoenzyme is the protein potion of the enzyme

 Isoenzyme increase the specifity
 Patients with pseudocholinestrase deficiency are sensitive to anesthetic drugs
 Phenylketonurea is a metabolic disorder appear as a deficiency of the enzyme
responsible to metabolize the amino acid phenylalanine to tyrosin
 Renal gout and metabolic gout are different in the urine uric acid level
 Glycated Hb is used to measure the control of plasma glucose level and follow up
long treatment
 The dose of oral glucose given in GTT (glucose tolerance test) is 75g for adults and
30g for children
 Insulin antagonist is Glucagon
 -ve VDRL and +ve TPHA = Inactive syphilis
 Shigella does not live intracellulary and cause doudinitis
 E.coli cause diarrhea
 Proteus is G-ve rod swarm in agar cultur but the Cl.tetani also caue swarming
anaerobically and it have terminal spores.
 Most wound infections are caused by S.aureus
 Keratits causative agents; s.aureus, s.pneumoniae, pseudomonas and Chlamydia
 Otitis media causative agent; s.aureus, s.pneumoniae, H.influnzea and M.catarrhalis
 Chlamydia is diagnosed by its elementary body and reticulate body
 E.histolytica can cause liver abscess but never splenomegally
 Drugs contain beta lactam ring; pencillin, cephalosporin, crbapenems and
monobactams (Vancomycin does not)
 Aminoglycosides antibiotics like tetracycline act by inhibit protein synthesis of
bacteria (not cell wall)
 N.gonorrhoeae produce beta lactemase which resist beta lactam drugs
 N.gonorrhoeae virulence factors are; pili, IgA protease and endotoxin in
lipopolysaccharide membrane (but there is no Exotoxin)
 Stapping of gelatin culture with B.anthrax give a characteristic Inverted fir tree
appearance
 B.anthrax is capsulated non haemolytic in B.A while B.cerus is non capsulated and
haemolytic
 Food Intoxication can caused by; E.coli O157 , S.aureus, B.cerus and clostridium
(while Campylobacter cause food infection)
 G-ve cocci in sputum smear is mostly the organism Moraxila catarrhalis
 CAP (cellulose acetate precipitin) test is used for liver ameobiasis its result appear in
agarose gel as 2 precipitated line (it cannot detect the parasite DNA)
4 any suggestion plz contact; [email protected]
Page 4 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 E.coli is found in colon as normal flora

 Asthma, blood transfusion and allergy are examples of HSR (but not
glomeluronephritis)
 C3a ans C5a can cause symptoms of anaphylatoxin (degranulation of mast cell and
bronchospasm) and chemotaxis (but they don't activate WBCs)
 The test which measure clotting time of citrated plasma by adding thromboplastin
and Ca+2 and used as follow up test to control anticoagulant = Prothrombin time
(PT/PTT) (for extrinsic pathway) 11 -15 second
 Activated partial thromboplastin time (PTT/APTT) or KccT (Kaolin cephalin clotting
time) for intrinsic and common pathway and to monitor the treatment effect of
anticoagulated drug like heparin, 25 -35 second
 Normal bleeding time (coagulation time) is measured by Duke's method, 3 -9 min
 The microscope have two types of lenses; objective lenses which is near the slide and
eye lenses
 Dark field microscope is used to detect T.pallidum (cause of syphilis)
 Calibrated sera are the primary STD
 Autoclave sterilization temp. is 121 oC for 20 – 30 min
 Ruber gloves cannot be sterilized by hot air oven
 Neutrophile count is high in acute bacterial inflammation
 Listeria monocytogens is transmitted by birth (from mother to child)
 Hook worms are not a true filarial, they can cause megaloblastic anemia
 H&E dye stain the nuclei blue and the cytoplasm pink,, the dye depoit in tissue if not
filtrate
 Haematoxylin basic and the eosin is acidic
 Bloaking is not a step of tissue processing
 Shigella has the lesser infective dose among all bacteria and it is urease -ve
 Reticular fibers are stained with weigert stain
 Nuclear stain doesn't contain Alchol
 Pseudomonas can produce green pigment and it is the most common cause of
hospital acquired infection
 The infective stage of T.gondi is oocyst in domestic cat feaces which represent the
definitive host
 T.gondi doesn’t invade the central nervous system
 HMB 45 is a monoclonal Abs that react against an antigen present in melanoma
 O Ag is the somatic Ag of bacteria which is heat stable and found in all
enterobacterecia (not restricted on motile one)
 C.diphteriae reduce tellurite to metallic tellurium and produce exotoxins
4 any suggestion plz contact; [email protected]
Page 5 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Schistosoma belong to trematode and can cause hypertension

 Shistosoma egg doesn't contain operculum
 The complication of schistosomal infection is due to the presence of eggs that cause
granuloma and blockage (not the adult worm and there is no toxin produced)
 The adult worm of Schistosoma never appear in Stool sample
 Trophozoite of P. falciparum is called a ring
stage
 Schizont of P.vivax contain up to 24 merozoite
 There are three main viruses that cause AHC
(acute hemorrhagic conjunctivitis) enterovirus,
coxsakievirus and adenovirus
 Sickle cell anemic patients are most susceptible to get osteomylitis due to salmonella
infection
 Parathyroid hormone which is secreated from parathyroid gland increase the conc.
of calcium in the blood
 MIC (minimum inhibitory concentration) is the lowest concentration of
an antimicrobial that will inhibit the visible growth of a microorganism after
overnight incubation
 Bacillus cereus can cause food poisoning mainly in rice
 Exofoliatin toxin is produced by s.aureus and cause scalded skin syndrome
 ALP (alkaline phosphatase) level is significantly higher in children and pregnant
women
 Allograft is the transplantation of tissue from the same species
 Latex particles are used in agglutinin tests
 Chancroid (soft chancer) is a painful sore in the genitilia caused by H.ducreyi, while a
Chancre is a painless sore found in primary stage of syphilis
 H.pylori is diagnosed by GIT biopsy stained with H&E
 in post hepatic jaundice (obstructive) conjugated (direct) bilirubin is increased and
the unconjugated (indirect) one is normal
 Goiter disease = swelling of neck due to enlargement of thyroid gland (hypo/hyper)
 Potassium level in the blood is elevated in case of haemolysis
 Toxic shock syndrome reveal –ve blood culture
 E.histolytica, Blantidium coli can produce bloody stool
 ICT for malaria can detect HRP2 (histidin rich protein), pLDH (species-specific lactate
dehydrogenase and aldolase enzyme
 The precipitation line thickness of ICT is related to the level of parasitemia
 Plasmodium is a haemoparasite
4 any suggestion plz contact; [email protected]
Page 6 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Blackwater fever is caused by intensive Haemloysis (Rupture) of RBCs.

 Isoenzyme assay improve specifity
 Typhoid cannot be transmitted by aersol
 Target cells are seen in Thalassemia (Vit B12 deficiency)
 Thalassemia is caused by defective synthesis of either alpha or beta chain of normal
haemoglobin
 Pasturella multocida are transmitted by dog bite
 Yersinia pestis characterized by bipolar stain
 Bordetella bronchiseptica is an animal pathogen (dog)
 Calcium pyrophosphate dihydrate crystals are found in synovial fluid associated
with a range of clinical syndromes
 The term used to describe reproducibility is precision, while accuracy describe the
closeness to true value
 Spore forming, non motile, isolated from foot wound = Cl.perfrenges
 The causative agent of diarrhea associated with antibiotic (pseudomembranous
colitis) is Cl.difficile
 The fungi demonstrated by board based budding is Blantidium dermatiditis
 Candida albicans give +ve GTT (germ tube test)
 Stroglois stercolaris can cause autoinfection
 The examination of feces is of no help in case of E.granulosus
 Clue cells are epithelial cells of the vagina that get their distinctive stippled
appearance by being covered with bacteria (gardenella vaginallis)
 Hyaline casts can be found in healthy people
 Cutaneous larval migrans is caused by anclystoma brazilliansis/caninum
 Sexually active females are more suscebtiable to have UTI (urinary tract infection)
with S.saprophyticus
 Increased plts count = Thrombocytosis
 Decreased plts count = Thrombocytopenia
 Normal plts count = 150 – 450 cell/µl
 Fibrinogen is converted to fibrin by thrombin during blood clotting formation
 Newborns are normally with neutrophilia
 Character of cytoplasmic fixation is convertion from Sol to Gel


4 any suggestion plz contact; [email protected]

Page 7 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The exam contain 100 Multiple Choice questions should be solved in 2h maximally
 don't forget ur Labcoat.
 say; ‫ بسم هللا‬and type ur Receipt No. in St no. column then press Enter to show ur name
 Press F9 and choose ur specialty

 Leishmania is transported by Sandfly, and mainly invade macrophage

 Leishmania chagasi doesn't found in Sudan
 H.nana is known as dwarf tapeworm, 4 cm, egg is the infective stage.
 A.lumbricoides is known as giant roundworm
 B.coli is the largest protozoa at all
 F.buski is an intestinal fluke and it is the largest flukes at all
 Variation in RBCs size is called Anisocytosis
 Variation in RBCs shape is called Poikilocytosis
 Netrophils represent 50 -70 % of total lymphocytes lymphocyte = 20 – 40 %,
monocyte = 4 – 6 %, eosinophile = 1 – 3 %, basophile = .4 – 1 %
 Plumer – Vinson syndrome may be seen in cases of IDA (Iron Deficiency Anemia)
 Chronic (low-rat) blood loss can cause IDA (microcytic hypochromic anemia)
 Favism is an acute haemolytic anemia occure in G6PD pts after ingestion of bean
 Erythrocytes are non-nucleated biconcave disk
 Eosinophils have a characteristic biffed (segmented) nucleus with red stained
granules in the cytoplasm
 B-lymphocytes (plasma cells) are responsible for Abs production
 Sickle cells are curved with sharp ends seen in Haemoglobinopathies
 Sickle cell anemia can cause; leg ulcer, gall stone, attacks of pain and spleen atrophy
(not enlargement of spleen)
 HbS in sickle cell anemia is caused by substitution of a.a (Valine) instead of (Glutamic
acid) at position no. 6 in the beta chain of Hb
 Red cell with elongated arm of central pallor = Stomatocye
 Symmetrical RBCs with many tiny spicules and projection, seen in IDA and uremia =
Ecchinocyte (burr cell) which seen in IDA
 Howeel-jolly bodies are small, dense, basophilic (purple) red cell inclusion (DNA
fragments) seen in spleenoctomized pts and in megaloblastic anemia
 Heinz bodies are small, round inclusion (Hb fragments) seen in haemolytic disorders
(G6PD and alpha thalassemia)
 Schistocye or schizocye is the fragmented part or RBCs
 Darkened and hyperchromic RBCs with no central pallor = Spherocye
 Spherocytosis is a heridetiry defect in RBCs membrane with high reticulocye count
4 any suggestion plz contact; [email protected]
Page 1 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Pica (craving to eat unusual substance such as clay or ice) is seen in IDA
 Chloramphenicol may cause Aplastic anemia in long term therapy
 Absolute lymphocyte count is up to 300.000, between 70 – 90 % appear as small
lymphocyte = CLL (chronic lymphocytic leukemia)
 Leukocytosis characterized by present of immature cells and high neutrophil alkaline
phosphotase = Leukomoid reaction
 In the atomic absorption method for Ca+2 measurment, lanthanum is added to the
sample to prevent the phosphate interference
 Disease characterized by progressive neoplastic proliferation of immature white cell
precursor, high neutrophil alkaline phosphatase mainly affect children = Acute
Lymphoblastic Leukemia
 Schilling test is used to diagnose Pernicious anemia (Vit B12 deficiency)
 Vit B12 deficiency can cause neurological symptoms
 Fanconi's anemia is a type of Aplastic anemia
 The first line of defense against parasites are Eosinophils, bacteria = neutrophil, virus
= lymphocytes
 Basophils play an important role in immediate and delay HSR (hyper sensitivity
reaction)
 Monocytes are the largest leukocyte
 T-lymphocyte = cell mediate immunity, B-lymphocyte = humoral mediated immynity
 Haemolytic disease in newborn = erythroblastosis fetalis
 Normal adult Hb tetramer (Hb A) is; 2 α and 2 β, (Hb A2 – 1-3%) is; 2 α and 2 δ (Hb F
fetous) is; 2 α and 2 γ
 Platlets are small megakaryocytic fragment responsible for blood clotting
 63 ml of CPDA (citrate phosphate dextrose adenine) is added to 450 ml of blood in
blood bags to be saved up to 35 days.
 Normal flora in the vagina = Lactobacillus acidophilus
 Pus cells in urine with variable gram bacilli does not prove the vaginal infection
 Compound affected by direct light = Bilirubin
 LDL (low density lipoprotein) is a Harmful Cholesterol (cause atherosclerosis)
 HDL (high density lipoprotein) is a Useful Cholesterol (remove excess cholesterol)
 HDL normal range = 30 – 60 mg/dl, LDL = 100 mg/dl
 VLDL (very low density lipoprotein) is an endogenous triglyceride
 T.solium gravid proglottid has fewer uterine branches than T.saginata
 The infective stage of T.saginata is cysticercus bovis and for T.solium cysticercus
cellulose

4 any suggestion plz contact; [email protected]

Page 2 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The scolex of T.saginata has 4 suckers and circle of hook while T.solium has 4 suckers
and no hook
 Intermediate host of T.saginata is cattle and for T.solium is pig
 The definitive host of both tenia is Human
 Syphilis is sexually transmitted disease and could be transferred from mother to the
fetus by birth (maternally)
 Inflamed eye caused by T.cruze is called Roman's sign
 Best time when w.bancrofti can be detected in blood sample; 10 p.m – 4 a.m
(nocturnal periodicity)
 The normal O.volvulus lifespan is up to 10 year
 Skin snip is the best sample to diagnose O.volvulus, the blood for loa loa
 Dogs are the most important definitive hosts of E.granulosus while the sheep and
man are the intermediate one
 Both herpes virus and pox virus are DNA enveloped viruses
 Cyst is the infective stage of G.lambilia while it's diagnostic stage both cyst and
trophozoyte
 No fasting sample is required to determine the uric acid conc. in blood
 The infective stage of D.latum is Plerocercoid or sparganum larvae
 The definitive host for D.latum is the human
 The eggs of D.latum are hatch in fresh water
 The infective stage of Fasciola hepatica is metacercariae
 Some of Liver flukes are (F.hepatica and C.sinensis) and F.buski is an intestinal fluke
 Intermediate host of W.bancrofi is female mosquito; anopheles and culex
 Intermediate host of O.volvulus is female blackfly, simulium
 Intermediate host of Loa Loa is the deer fly (Chrysops)
 Loa loa microfilaria have diurnal periodicity and sheathed
 Saliva is rich by the enzyme Amylase
 Creatine kinase or creatine phosphokinase (CK,CPK) has 3 isoenzymes CK-MM,
CK-MB and CK-BB
 Excersice increase the level of CK generally
 CK-MB is a great indicator and the first one to elevate in case of acute myocardial
infarction (AMI), it also increase with intravenous injection
 GTT (γ glutamyltransferase) is the most sensitive enzyme for hepatic disorders.
 Human semen contain high conc. of acid phosphatase; one of them is PAP (prostatic
acid phosphatase) which is used as an indicator for prostatic cancer
 Sodium Thymolphthalein Monophosphate is the most specific substrate for
prostatic acid Phosphatase
4 any suggestion plz contact; [email protected]
Page 3 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Apoenzyme is the protein potion of the enzyme

 Isoenzyme increase the specifity
 Patients with pseudocholinestrase deficiency are sensitive to anesthetic drugs
 Phenylketonurea is a metabolic disorder appear as a deficiency of the enzyme
responsible to metabolize the amino acid phenylalanine to tyrosin
 Renal gout and metabolic gout are different in the urine uric acid level
 Glycated Hb is used to measure the control of plasma glucose level and follow up
long treatment
 The dose of oral glucose given in GTT (glucose tolerance test) is 75g for adults and
30g for children
 Insulin antagonist is Glucagon
 -ve VDRL and +ve TPHA = Inactive syphilis
 Shigella does not live intracellulary and cause doudinitis
 E.coli cause diarrhea
 Proteus is G-ve rod swarm in agar cultur but the Cl.tetani also caue swarming
anaerobically and it have terminal spores.
 Most wound infections are caused by S.aureus
 Keratits causative agents; s.aureus, s.pneumoniae, pseudomonas and Chlamydia
 Otitis media causative agent; s.aureus, s.pneumoniae, H.influnzea and M.catarrhalis
 Chlamydia is diagnosed by its elementary body and reticulate body
 E.histolytica can cause liver abscess but never splenomegally
 Drugs contain beta lactam ring; pencillin, cephalosporin, crbapenems and
monobactams (Vancomycin does not)
 Aminoglycosides antibiotics like tetracycline act by inhibit protein synthesis of
bacteria (not cell wall)
 N.gonorrhoeae produce beta lactemase which resist beta lactam drugs
 N.gonorrhoeae virulence factors are; pili, IgA protease and endotoxin in
lipopolysaccharide membrane (but there is no Exotoxin)
 Stapping of gelatin culture with B.anthrax give a characteristic Inverted fir tree
appearance
 B.anthrax is capsulated non haemolytic in B.A while B.cerus is non capsulated and
haemolytic
 Food Intoxication can caused by; E.coli O157 , S.aureus, B.cerus and clostridium
(while Campylobacter cause food infection)
 G-ve cocci in sputum smear is mostly the organism Moraxila catarrhalis
 CAP (cellulose acetate precipitin) test is used for liver ameobiasis its result appear in
agarose gel as 2 precipitated line (it cannot detect the parasite DNA)
4 any suggestion plz contact; [email protected]
Page 4 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 E.coli is found in colon as normal flora

 Asthma, blood transfusion and allergy are examples of HSR (but not
glomeluronephritis)
 C3a ans C5a can cause symptoms of anaphylatoxin (degranulation of mast cell and
bronchospasm) and chemotaxis (but they don't activate WBCs)
 The test which measure clotting time of citrated plasma by adding thromboplastin
and Ca+2 and used as follow up test to control anticoagulant = Prothrombin time
(PT/PTT) (for extrinsic pathway) 11 -15 second
 Activated partial thromboplastin time (PTT/APTT) or KccT (Kaolin cephalin clotting
time) for intrinsic and common pathway and to monitor the treatment effect of
anticoagulated drug like heparin, 25 -35 second
 Normal bleeding time (coagulation time) is measured by Duke's method, 3 -9 min
 The microscope have two types of lenses; objective lenses which is near the slide and
eye lenses
 Dark field microscope is used to detect T.pallidum (cause of syphilis)
 Calibrated sera are the primary STD
 Autoclave sterilization temp. is 121 oC for 20 – 30 min
 Ruber gloves cannot be sterilized by hot air oven
 Neutrophile count is high in acute bacterial inflammation
 Listeria monocytogens is transmitted by birth (from mother to child)
 Hook worms are not a true filarial, they can cause megaloblastic anemia
 H&E dye stain the nuclei blue and the cytoplasm pink,, the dye depoit in tissue if not
filtrate
 Haematoxylin basic and the eosin is acidic
 Bloaking is not a step of tissue processing
 Shigella has the lesser infective dose among all bacteria and it is urease -ve
 Reticular fibers are stained with weigert stain
 Nuclear stain doesn't contain Alchol
 Pseudomonas can produce green pigment and it is the most common cause of
hospital acquired infection
 The infective stage of T.gondi is oocyst in domestic cat feaces which represent the
definitive host
 T.gondi doesn’t invade the central nervous system
 HMB 45 is a monoclonal Abs that react against an antigen present in melanoma
 O Ag is the somatic Ag of bacteria which is heat stable and found in all
enterobacterecia (not restricted on motile one)
 C.diphteriae reduce tellurite to metallic tellurium and produce exotoxins
4 any suggestion plz contact; [email protected]
Page 5 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Schistosoma belong to trematode and can cause hypertension

 Shistosoma egg doesn't contain operculum
 The complication of schistosomal infection is due to the presence of eggs that cause
granuloma and blockage (not the adult worm and there is no toxin produced)
 The adult worm of Schistosoma never appear in Stool sample
 Trophozoite of P. falciparum is called a ring
stage
 Schizont of P.vivax contain up to 24 merozoite
 There are three main viruses that cause AHC
(acute hemorrhagic conjunctivitis) enterovirus,
coxsakievirus and adenovirus
 Sickle cell anemic patients are most susceptible to get osteomylitis due to salmonella
infection
 Parathyroid hormone which is secreated from parathyroid gland increase the conc.
of calcium in the blood
 MIC (minimum inhibitory concentration) is the lowest concentration of
an antimicrobial that will inhibit the visible growth of a microorganism after
overnight incubation
 Bacillus cereus can cause food poisoning mainly in rice
 Exofoliatin toxin is produced by s.aureus and cause scalded skin syndrome
 ALP (alkaline phosphatase) level is significantly higher in children and pregnant
women
 Allograft is the transplantation of tissue from the same species
 Latex particles are used in agglutinin tests
 Chancroid (soft chancer) is a painful sore in the genitilia caused by H.ducreyi, while a
Chancre is a painless sore found in primary stage of syphilis
 H.pylori is diagnosed by GIT biopsy stained with H&E
 in post hepatic jaundice (obstructive) conjugated (direct) bilirubin is increased and
the unconjugated (indirect) one is normal
 Goiter disease = swelling of neck due to enlargement of thyroid gland (hypo/hyper)
 Potassium level in the blood is elevated in case of haemolysis
 Toxic shock syndrome reveal –ve blood culture
 E.histolytica, Blantidium coli can produce bloody stool
 ICT for malaria can detect HRP2 (histidin rich protein), pLDH (species-specific lactate
dehydrogenase and aldolase enzyme
 The precipitation line thickness of ICT is related to the level of parasitemia
 Plasmodium is a haemoparasite
4 any suggestion plz contact; [email protected]
Page 6 of 7
 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Blackwater fever is caused by intensive Haemloysis (Rupture) of RBCs.

 Isoenzyme assay improve specifity
 Typhoid cannot be transmitted by aersol
 Target cells are seen in Thalassemia (Vit B12 deficiency)
 Thalassemia is caused by defective synthesis of either alpha or beta chain of normal
haemoglobin
 Pasturella multocida are transmitted by dog bite
 Yersinia pestis characterized by bipolar stain
 Bordetella bronchiseptica is an animal pathogen (dog)
 Calcium pyrophosphate dihydrate crystals are found in synovial fluid associated
with a range of clinical syndromes
 The term used to describe reproducibility is precision, while accuracy describe the
closeness to true value
 Spore forming, non motile, isolated from foot wound = Cl.perfrenges
 The causative agent of diarrhea associated with antibiotic (pseudomembranous
colitis) is Cl.difficile
 The fungi demonstrated by board based budding is Blantidium dermatiditis
 Candida albicans give +ve GTT (germ tube test)
 Stroglois stercolaris can cause autoinfection
 The examination of feces is of no help in case of E.granulosus
 Clue cells are epithelial cells of the vagina that get their distinctive stippled
appearance by being covered with bacteria (gardenella vaginallis)
 Hyaline casts can be found in healthy people
 Cutaneous larval migrans is caused by anclystoma brazilliansis/caninum
 Sexually active females are more suscebtiable to have UTI (urinary tract infection)
with S.saprophyticus
 Increased plts count = Thrombocytosis
 Decreased plts count = Thrombocytopenia
 Normal plts count = 150 – 450 cell/µl
 Fibrinogen is converted to fibrin by thrombin during blood clotting formation
 Newborns are normally with neutrophilia
 Character of cytoplasmic fixation is convertion from Sol to Gel


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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 The exam contain 100 Multiple Choice questions should be solved in 2h maximally
 don't forget ur Labcoat.
 say; ‫ بسم هللا‬and type ur Receipt No. in St no. column then press Enter to show ur name
 Press F9 and choose ur specialty

 Leishmania is transported by Sandfly, and mainly invade macrophage

 Leishmania chagasi doesn't found in Sudan
 H.nana is known as dwarf tapeworm, 4 cm, egg is the infective stage.
 A.lumbricoides is known as giant roundworm
 B.coli is the largest protozoa at all
 F.buski is an intestinal fluke and it is the largest flukes at all
 Variation in RBCs size is called Anisocytosis
 Variation in RBCs shape is called Poikilocytosis
 Netrophils represent 50 -70 % of total lymphocytes lymphocyte = 20 – 40 %,
monocyte = 4 – 6 %, eosinophile = 1 – 3 %, basophile = .4 – 1 %
 Plumer – Vinson syndrome may be seen in cases of IDA (Iron Deficiency Anemia)
 Chronic (low-rat) blood loss can cause IDA (microcytic hypochromic anemia)
 Favism is an acute haemolytic anemia occure in G6PD pts after ingestion of bean
 Erythrocytes are non-nucleated biconcave disk
 Eosinophils have a characteristic biffed (segmented) nucleus with red stained
granules in the cytoplasm
 B-lymphocytes (plasma cells) are responsible for Abs production
 Sickle cells are curved with sharp ends seen in Haemoglobinopathies
 Sickle cell anemia can cause; leg ulcer, gall stone, attacks of pain and spleen atrophy
(not enlargement of spleen)
 HbS in sickle cell anemia is caused by substitution of a.a (Valine) instead of (Glutamic
acid) at position no. 6 in the beta chain of Hb
 Red cell with elongated arm of central pallor = Stomatocye
 Symmetrical RBCs with many tiny spicules and projection, seen in IDA and uremia =
Ecchinocyte (burr cell) which seen in IDA
 Howeel-jolly bodies are small, dense, basophilic (purple) red cell inclusion (DNA
fragments) seen in spleenoctomized pts and in megaloblastic anemia
 Heinz bodies are small, round inclusion (Hb fragments) seen in haemolytic disorders
(G6PD and alpha thalassemia)
 Schistocye or schizocye is the fragmented part or RBCs
 Darkened and hyperchromic RBCs with no central pallor = Spherocye
 Spherocytosis is a heridetiry defect in RBCs membrane with high reticulocye count
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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Pica (craving to eat unusual substance such as clay or ice) is seen in IDA
 Chloramphenicol may cause Aplastic anemia in long term therapy
 Absolute lymphocyte count is up to 300.000, between 70 – 90 % appear as small
lymphocyte = CLL (chronic lymphocytic leukemia)
 Leukocytosis characterized by present of immature cells and high neutrophil alkaline
phosphotase = Leukomoid reaction
 In the atomic absorption method for Ca+2 measurment, lanthanum is added to the
sample to prevent the phosphate interference
 Disease characterized by progressive neoplastic proliferation of immature white cell
precursor, high neutrophil alkaline phosphatase mainly affect children = Acute
Lymphoblastic Leukemia
 Schilling test is used to diagnose Pernicious anemia (Vit B12 deficiency)
 Vit B12 deficiency can cause neurological symptoms
 Fanconi's anemia is a type of Aplastic anemia
 The first line of defense against parasites are Eosinophils, bacteria = neutrophil, virus
= lymphocytes
 Basophils play an important role in immediate and delay HSR (hyper sensitivity
reaction)
 Monocytes are the largest leukocyte
 T-lymphocyte = cell mediate immunity, B-lymphocyte = humoral mediated immynity
 Haemolytic disease in newborn = erythroblastosis fetalis
 Normal adult Hb tetramer (Hb A) is; 2 α and 2 β, (Hb A2 – 1-3%) is; 2 α and 2 δ (Hb F
fetous) is; 2 α and 2 γ
 Platlets are small megakaryocytic fragment responsible for blood clotting
 63 ml of CPDA (citrate phosphate dextrose adenine) is added to 450 ml of blood in
blood bags to be saved up to 35 days.
 Normal flora in the vagina = Lactobacillus acidophilus
 Pus cells in urine with variable gram bacilli does not prove the vaginal infection
 Compound affected by direct light = Bilirubin
 LDL (low density lipoprotein) is a Harmful Cholesterol (cause atherosclerosis)
 HDL (high density lipoprotein) is a Useful Cholesterol (remove excess cholesterol)
 HDL normal range = 30 – 60 mg/dl, LDL = 100 mg/dl
 VLDL (very low density lipoprotein) is an endogenous triglyceride
 T.solium gravid proglottid has fewer uterine branches than T.saginata
 The infective stage of T.saginata is cysticercus bovis and for T.solium cysticercus
cellulose

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 Success Notes for Medical Laboratory Permanent Test
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 The scolex of T.saginata has 4 suckers and circle of hook while T.solium has 4 suckers
and no hook
 Intermediate host of T.saginata is cattle and for T.solium is pig
 The definitive host of both tenia is Human
 Syphilis is sexually transmitted disease and could be transferred from mother to the
fetus by birth (maternally)
 Inflamed eye caused by T.cruze is called Roman's sign
 Best time when w.bancrofti can be detected in blood sample; 10 p.m – 4 a.m
(nocturnal periodicity)
 The normal O.volvulus lifespan is up to 10 year
 Skin snip is the best sample to diagnose O.volvulus, the blood for loa loa
 Dogs are the most important definitive hosts of E.granulosus while the sheep and
man are the intermediate one
 Both herpes virus and pox virus are DNA enveloped viruses
 Cyst is the infective stage of G.lambilia while it's diagnostic stage both cyst and
trophozoyte
 No fasting sample is required to determine the uric acid conc. in blood
 The infective stage of D.latum is Plerocercoid or sparganum larvae
 The definitive host for D.latum is the human
 The eggs of D.latum are hatch in fresh water
 The infective stage of Fasciola hepatica is metacercariae
 Some of Liver flukes are (F.hepatica and C.sinensis) and F.buski is an intestinal fluke
 Intermediate host of W.bancrofi is female mosquito; anopheles and culex
 Intermediate host of O.volvulus is female blackfly, simulium
 Intermediate host of Loa Loa is the deer fly (Chrysops)
 Loa loa microfilaria have diurnal periodicity and sheathed
 Saliva is rich by the enzyme Amylase
 Creatine kinase or creatine phosphokinase (CK,CPK) has 3 isoenzymes CK-MM,
CK-MB and CK-BB
 Excersice increase the level of CK generally
 CK-MB is a great indicator and the first one to elevate in case of acute myocardial
infarction (AMI), it also increase with intravenous injection
 GTT (γ glutamyltransferase) is the most sensitive enzyme for hepatic disorders.
 Human semen contain high conc. of acid phosphatase; one of them is PAP (prostatic
acid phosphatase) which is used as an indicator for prostatic cancer
 Sodium Thymolphthalein Monophosphate is the most specific substrate for
prostatic acid Phosphatase
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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Apoenzyme is the protein potion of the enzyme

 Isoenzyme increase the specifity
 Patients with pseudocholinestrase deficiency are sensitive to anesthetic drugs
 Phenylketonurea is a metabolic disorder appear as a deficiency of the enzyme
responsible to metabolize the amino acid phenylalanine to tyrosin
 Renal gout and metabolic gout are different in the urine uric acid level
 Glycated Hb is used to measure the control of plasma glucose level and follow up
long treatment
 The dose of oral glucose given in GTT (glucose tolerance test) is 75g for adults and
30g for children
 Insulin antagonist is Glucagon
 -ve VDRL and +ve TPHA = Inactive syphilis
 Shigella does not live intracellulary and cause doudinitis
 E.coli cause diarrhea
 Proteus is G-ve rod swarm in agar cultur but the Cl.tetani also caue swarming
anaerobically and it have terminal spores.
 Most wound infections are caused by S.aureus
 Keratits causative agents; s.aureus, s.pneumoniae, pseudomonas and Chlamydia
 Otitis media causative agent; s.aureus, s.pneumoniae, H.influnzea and M.catarrhalis
 Chlamydia is diagnosed by its elementary body and reticulate body
 E.histolytica can cause liver abscess but never splenomegally
 Drugs contain beta lactam ring; pencillin, cephalosporin, crbapenems and
monobactams (Vancomycin does not)
 Aminoglycosides antibiotics like tetracycline act by inhibit protein synthesis of
bacteria (not cell wall)
 N.gonorrhoeae produce beta lactemase which resist beta lactam drugs
 N.gonorrhoeae virulence factors are; pili, IgA protease and endotoxin in
lipopolysaccharide membrane (but there is no Exotoxin)
 Stapping of gelatin culture with B.anthrax give a characteristic Inverted fir tree
appearance
 B.anthrax is capsulated non haemolytic in B.A while B.cerus is non capsulated and
haemolytic
 Food Intoxication can caused by; E.coli O157 , S.aureus, B.cerus and clostridium
(while Campylobacter cause food infection)
 G-ve cocci in sputum smear is mostly the organism Moraxila catarrhalis
 CAP (cellulose acetate precipitin) test is used for liver ameobiasis its result appear in
agarose gel as 2 precipitated line (it cannot detect the parasite DNA)
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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 E.coli is found in colon as normal flora

 Asthma, blood transfusion and allergy are examples of HSR (but not
glomeluronephritis)
 C3a ans C5a can cause symptoms of anaphylatoxin (degranulation of mast cell and
bronchospasm) and chemotaxis (but they don't activate WBCs)
 The test which measure clotting time of citrated plasma by adding thromboplastin
and Ca+2 and used as follow up test to control anticoagulant = Prothrombin time
(PT/PTT) (for extrinsic pathway) 11 -15 second
 Activated partial thromboplastin time (PTT/APTT) or KccT (Kaolin cephalin clotting
time) for intrinsic and common pathway and to monitor the treatment effect of
anticoagulated drug like heparin, 25 -35 second
 Normal bleeding time (coagulation time) is measured by Duke's method, 3 -9 min
 The microscope have two types of lenses; objective lenses which is near the slide and
eye lenses
 Dark field microscope is used to detect T.pallidum (cause of syphilis)
 Calibrated sera are the primary STD
 Autoclave sterilization temp. is 121 oC for 20 – 30 min
 Ruber gloves cannot be sterilized by hot air oven
 Neutrophile count is high in acute bacterial inflammation
 Listeria monocytogens is transmitted by birth (from mother to child)
 Hook worms are not a true filarial, they can cause megaloblastic anemia
 H&E dye stain the nuclei blue and the cytoplasm pink,, the dye depoit in tissue if not
filtrate
 Haematoxylin basic and the eosin is acidic
 Bloaking is not a step of tissue processing
 Shigella has the lesser infective dose among all bacteria and it is urease -ve
 Reticular fibers are stained with weigert stain
 Nuclear stain doesn't contain Alchol
 Pseudomonas can produce green pigment and it is the most common cause of
hospital acquired infection
 The infective stage of T.gondi is oocyst in domestic cat feaces which represent the
definitive host
 T.gondi doesn’t invade the central nervous system
 HMB 45 is a monoclonal Abs that react against an antigen present in melanoma
 O Ag is the somatic Ag of bacteria which is heat stable and found in all
enterobacterecia (not restricted on motile one)
 C.diphteriae reduce tellurite to metallic tellurium and produce exotoxins
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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Schistosoma belong to trematode and can cause hypertension

 Shistosoma egg doesn't contain operculum
 The complication of schistosomal infection is due to the presence of eggs that cause
granuloma and blockage (not the adult worm and there is no toxin produced)
 The adult worm of Schistosoma never appear in Stool sample
 Trophozoite of P. falciparum is called a ring
stage
 Schizont of P.vivax contain up to 24 merozoite
 There are three main viruses that cause AHC
(acute hemorrhagic conjunctivitis) enterovirus,
coxsakievirus and adenovirus
 Sickle cell anemic patients are most susceptible to get osteomylitis due to salmonella
infection
 Parathyroid hormone which is secreated from parathyroid gland increase the conc.
of calcium in the blood
 MIC (minimum inhibitory concentration) is the lowest concentration of
an antimicrobial that will inhibit the visible growth of a microorganism after
overnight incubation
 Bacillus cereus can cause food poisoning mainly in rice
 Exofoliatin toxin is produced by s.aureus and cause scalded skin syndrome
 ALP (alkaline phosphatase) level is significantly higher in children and pregnant
women
 Allograft is the transplantation of tissue from the same species
 Latex particles are used in agglutinin tests
 Chancroid (soft chancer) is a painful sore in the genitilia caused by H.ducreyi, while a
Chancre is a painless sore found in primary stage of syphilis
 H.pylori is diagnosed by GIT biopsy stained with H&E
 in post hepatic jaundice (obstructive) conjugated (direct) bilirubin is increased and
the unconjugated (indirect) one is normal
 Goiter disease = swelling of neck due to enlargement of thyroid gland (hypo/hyper)
 Potassium level in the blood is elevated in case of haemolysis
 Toxic shock syndrome reveal –ve blood culture
 E.histolytica, Blantidium coli can produce bloody stool
 ICT for malaria can detect HRP2 (histidin rich protein), pLDH (species-specific lactate
dehydrogenase and aldolase enzyme
 The precipitation line thickness of ICT is related to the level of parasitemia
 Plasmodium is a haemoparasite
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 Success Notes for Medical Laboratory Permanent Test
Date of release; 13/2/2014

 Blackwater fever is caused by intensive Haemloysis (Rupture) of RBCs.

 Isoenzyme assay improve specifity
 Typhoid cannot be transmitted by aersol
 Target cells are seen in Thalassemia (Vit B12 deficiency)
 Thalassemia is caused by defective synthesis of either alpha or beta chain of normal
haemoglobin
 Pasturella multocida are transmitted by dog bite
 Yersinia pestis characterized by bipolar stain
 Bordetella bronchiseptica is an animal pathogen (dog)
 Calcium pyrophosphate dihydrate crystals are found in synovial fluid associated
with a range of clinical syndromes
 The term used to describe reproducibility is precision, while accuracy describe the
closeness to true value
 Spore forming, non motile, isolated from foot wound = Cl.perfrenges
 The causative agent of diarrhea associated with antibiotic (pseudomembranous
colitis) is Cl.difficile
 The fungi demonstrated by board based budding is Blantidium dermatiditis
 Candida albicans give +ve GTT (germ tube test)
 Stroglois stercolaris can cause autoinfection
 The examination of feces is of no help in case of E.granulosus
 Clue cells are epithelial cells of the vagina that get their distinctive stippled
appearance by being covered with bacteria (gardenella vaginallis)
 Hyaline casts can be found in healthy people
 Cutaneous larval migrans is caused by anclystoma brazilliansis/caninum
 Sexually active females are more suscebtiable to have UTI (urinary tract infection)
with S.saprophyticus
 Increased plts count = Thrombocytosis
 Decreased plts count = Thrombocytopenia
 Normal plts count = 150 – 450 cell/µl
 Fibrinogen is converted to fibrin by thrombin during blood clotting formation
 Newborns are normally with neutrophilia
 Character of cytoplasmic fixation is convertion from Sol to Gel


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Page 7 of 7
 Clinical Enzymology

1. An IUof enzyme activity is the quantity of enzyme D. A competitive inhibitor will alter the apparent
that: Km of the reaction.
A. Converts 1 !-Lmolof substrate to product per liter Chemistry/Apply knowledge of fundamental biologi-
B. Forms 1 mg of product per deciliter cal characteristics/Enzymes/2
C. Converts 1 mmol of substrate to product per
minute
D. Forms 1 mmol of product per liter
Chemistry/Apply pn'nciples of basic laboratory
procedures/Enzymes/l
2. Which statement below describes a non kinetic
enzyme assay?
A. Initial absorbance is measured followed by a
second reading after 5 minutes.
B. Absorbance is measured at Io-second intervals
for 100 seconds. Answers to Questions 1-4
C. Absorbance is monitored continuously for 1
minute using a chart recorder. 1. C The IU is a rate expressed in micro moles per
D. Reflectance is measured from a xenon source
minute. Activity is reported as IUs per liter (lUlL)
lamp pulsing at 60 Hz: or mlUlmL. The SI unit for enzyme activity is the
Chemistry/Apply principles of basic laboratory katal (1 katal converts 1 mol of substrate to
procedures/Enzymes/2 product in 1 second).
3. Which of the following statements regarding 2. A A kinetic assay uses several evenly spaced
absorbance measurements to calculate the
enzymatic reactions is true?
A. The enzyme shifts the equilibrium of the change in absorbance per unit time. A constant
reaction to the right. change in absorbance per unit of time occurs
B. The enzyme alters the equilibrium constant of only when the rate of the reaction is zero order
the reaction. (independent of substrate concentration). Enzyme
C. The enzyme increases the rate of the reaction. activity is proportional to rate only under zero-
order conditions.
D. The enzyme alters the energy difference
between reactants and products. 3. C An enzyme will accelerate the rate of a
Chemistry/Apply knowledge of fundamental biologi- reaction, reducing the time required to reach equi-
librium. The concentration of reactants and
cal characteristics/ Enzymes/l
products at equilibrium will be the same with or
4. Which statement about enzymes is true? without the enzyme.
A. An enzyme alters the Gibb's free energy of the 4. D Enzymes alter the energy of activation by
reaction. forming a metastable intermediate, the enzyme
B. Enzymes cause a reaction with a positive free substrate complex. Enzymes do not alter the free
energy to occur spontaneously. energy or direction of a reaction. Competitive in-
C. An enzyme's natural substrate has the highest hibitors bind to the active site where the enzyme
Km. binds substrate and are overcome by increasing
the substrate concentration.

[!ill
I (194) Clinical Chemist!)'

5. Which substrate concentration is needed to Answers to Questions 5-10

achieve zero-order conditions?
A. Greater than 99 X Km
B. [S] = Km 5. A A zero-order reaction rate is independent of
C. Less than 10 x Km substrate concentration because there is sufficient
D. [S] = 0 substrate to saturate the enzyme. V = Vrnaxx
Chemistry/Seleet reagents/ Enzymes/3 [S]/Km + [S] where V = velocity, Vrnax=
maximum velocity, [S] = substrate concentration,
6. Which statement below is true? and Km = substrate concentration required to
A. Apoenzyme + prosthetic group = holoenzyme. give 1/2 VrnaJ,;"
If [S] »> Km, then the Km can be
B. A coenzyme is an inorganic molecule required ignored. V= Vrnaxx [S]/[S] or velocity approaches
for activity. maximum and is independent of substrate concen-
C. Cofactors are as tightly bound to the enzyme as tration.
a prosthetic group. 6. A A coenzyme is an organic molecule required
D. All of the above. for full enzyme activity. A prosthetic group is a
Chemistry/Apply fundamental biological charaeteris- coenzyme that is tightly bound to the apoenzyme
tics/Enzymes/2 and is required for activity. Cofactors are inorganic
atoms or molecules needed for full catalytic
7. Which of the following statements about enzymatic activity. Pyridoxyl-5'-phosphate is a prosthetic.
reactions is true? group for ALTand AST. Consequently, patients
A. NADHhas absorbance maximas at 340 and 366 with low levels of pyridoxal-S'-phosphate (P-5'-P)
nm. (vitamin B6deficiency) may have reduced
B. Enzyme .concentration must be in excess to transaminase activity in vitro.
achieve zero-order kinetics. 7. A Most enzymes are measured by monitoring the
C. Rate is proportional to substrate concentration rate of absorbance change at 340 nm as NADHis
in a zero-ordei' reaction. produced or consumed. This rate will be propor-
D. Accumulation of the product increases the tional to enzyme activity when substrate is in
reaction rate. excess. When the enzyme is present in excess, the
Chemistry/Apply principles of basic laboratory pro- initial reaction rate will be proportional to
cedures/Enzymes/2 substrate concentration. This condition, called a
first-order reaction, is needed when the enzyme is
8. The increase in the level of serum enzymes used to used as a reagent to measure a specific analyte.
detect cholestatic liver disease is caused mainly by: 8. D The amount of enzyme in the serum can be
A. Enzyme release from dead cells increased by necrosis, altered permeability,
B. Leakage from cells with altered membrane per- secretion, or synthesis. It is also dependent upon
meability tissue perfusion, enzyme half-life, molecular size,
C. Decreased perfusion of the tissue and location of the enzyme within the cell. Most
D. Increased production and secretion by cells enzymes are liberated by necrosis,but a few,such
Chemistry/Correlate laboratory data with physio- as ALP and 'Y-glutamyltransferase, are produced-
logic processes/Enzymes/2 and secreted at a greater rate in obstructive liver
disease.
9. Which enzyme below is consid~red most tissue- 9. D No enzyme is truly tissue specific and diagnos-
specific? tic accuracy depends upon recognizing the
A. CK pattern of change produced by different diseases.
B. Amylase This includes the quantity of enzyme released,
C. ALP characteristic rise and return to normal, the
D. Alcohol dehydrogenase isoenzyme(s) released, and the concomitant
Chemistry/Correlate clinical and laboratory changes of other enzymes. Alanine aminotrans-
datal Enzymes/2 ferase and alcohol dehydrogenase are primarily
increased in necrotic liver disease.
10. Which 0\ the fan owing enzymes is activated by lO. B Most enzymes require metals as activators or
ca\dmn \Gn'.'>? colactors. CK and ALPrequire Mg2+tor tu\\
A. CK activity, and amylase requires Ca2+.Meta(s
B. Amylase required for activity should be components o!
C. ALP substrate used for enzyme analysis. The subst
D. LD must also contain anions required (e.g., CI-~~
Chemistry/Apply knowledge of fundamental biologi- amylase) and should not contain inhibiting
cal characteristics/ Enzymes/2 cations or anions (e.g., Zn2+ and Mn2+forC
 .'"
Clinical Enzymology ( 19rr)

11. Which statement about methods for measuring LD Answers to Questions 11-16
is true?
A The formation of pyruvate from lactate (forward
reaction) generates NAD+. 11. B Although the rate of the reverse reaction (P ~ L)
B. The pyruvate to lactate reaction proceeds at is faster, the L ~ P reaction is more popular
about twice the rate as the forward reaction. because it produces a positive rate (generates
C. The lactate to pyruvate reaction is optimiz;~d at NADH), is not subject to product inhibition, and is
pH 7.4. highly linear. The pH optimum for the forward
D. The negative rate reaction is preferred. reaction is approximately 8.8.
Chemistry/Apply pn'nciples of basic laboratory 12. B Enzymes are identified by a numeric system
dehydrogenase/2 called the EC (Enzyme Commission) number. The
first number refers to the class of the enzyme.
12. Which of the following enzymes is a transferase? There are six classes; in order these are oxidore-
A. ALP
B. CK ' ductases, transferases, hydrolases, Iyases,
isomerases, and ligases. Dehydrogenases are oxi-
C. Amylase
D. LD doreductases whef{~askinases and transaminas@s
are transferases. CK is EC number 2.7.3.2, which
Chemistry/Apply knowledge of fundamental distinguishes it from other kinases.
biological characten'stics/Enzymes/2
13. A LD-l has a relatively Iow Km for the substrate a
13. Which LD isoenzyme was originally described as hydroxybutyrate, and oxidizes it, forming a keto-
a hydroxybutyrate dehydrogenase (HBDH)? butyrate and NADH.The HBDH activity was
A. LD-l measured as an aid to diagnosis of MIbut has
B. LD-2 been replaced by measurements of LD-1based
C. LD-4 upon electrophoresis or immunoassay.
D. LD-5 14. A Serum LD levels are highest in pernicious
Chemistry/Apply knowledge of fundamental anemia reaching 10-50 times the upper reference
biological characten'stics/ Lactate dehydrogenase/l limit (URL) as a result of intramedullary hemolysis.
Moderate elevations (2-10 X URL) are seen in
14. Which condition produces the highest elevation of acute myocardial infarction (AMI), necrotic liver
serum LD?
A. Pernicious anemia disease, and muscular dystrophy. Slight increases
(2-3 XURL) are seen in obstructive liver disease.
B. Myocardial infarction
15. D CK is the first enzyme to rise above the
C. Acute hepatitis
D. Muscular dystrophy reference range after an AMI,peaking 18-36 hours
and returning to normal within 3 days. ASTfollows,
Chemistry/Correlate clinical and laboratory peaking 24-48 hours postinfarction and returning to
data/Lactate dehydrogenasel2 normal in 4-5 days. This pattern of CK~ AST~ LD
15. Following an AMI,activity of LD usually peaks: is specific for AMIbut has been replaced by serial
A. Within 1 day postinfarction and returns to measurements of myoglobin, troponin I, and CK-
normal after 3 days MB,which usually can detect and confirm the AMI
B. Twenty-four to 36 hours postinfarction and within 6-8 hours. The troponins are three proteins
returns to normal after 3 days (T, I, and C) that comprise the thin filaments of
C. Forty-eight hours postinfarction and returns to cardiac and skeletal muscle fibers. Both troponin I
normal after 4 days (TNI) and troponin T(TNT) have unique sequences
D. Three days postinfarction and returns to normal that differ between cardiac and skeletal muscle. An-
after 1 week tibodies specific for the cardiac isoforms can be
used to measure their concentration in serum.
Chemistry/Correlate clinical and laboratory
data/Creatine kinase/2 16. C LD-l is not a specific marker for MIand is
increased in hemolytic anemia, renal infarction,
16. Which statement regarding LD isoenzymes is true? crush injury, and the late stages of muscular
A. An LD-l:LD-2ratio greater than 1.0 is specific dystrophy. Malignancy causes variable LD
evidence of AMI. isoenzyme increases appearing most often as a
B. Malignancy usually causes an increase in LD-2, zone 3 pattern (high LD-4and LD-5).Hepatic
LD-3,LD-4. injury causes increases in LD-4and LD-5,which
C. Hepatic injury is associated with increases in normally account for less than 15%of the total LD
LD-4and LD-S. activity. LD-2is the fraction in highest concentra-
D. LD-3is normally the isoenzyme in highest tion in normal serum, accounting for
concentration in serum. approximately 25%--40%of total LD activity.
Chemistry/Evaluate laboratory data to recognize
health and disease states/Lactate dehydrogenase/2
~ Clinical Chemistry

17. In which type of liver disease would you expect the Answers to Questions. 17-21
greatest elevation of LO?
A. Toxic hepatitis
B. Alcoholic hepatitis 17. A Liver disease produces an elevated LD-4and
C. Cirrhosis LD-5.Levels may reach up to 10 times the URLin
D. Acute viral hepatitis toxic hepatitis and in hepatoma. However, LD
Chemistry/Correlate clinical and laboratory levels are lower in viral hepatitis (2-5 X URL) and
data/Lactate dehydrogenase/2 only slightly elevated in cirrhosis (2-3 X URL).
18. D The LD activity of body fluids is normally less
18. The LD pleural fluid:serum ratio for a transudative than serum, and a fluid:serum LD greater than 1:2
fluid is usually: is highly suggestive of an exudative process. High
A. 3:1 or higher LD in chest fluid is often caused by lung malig-
B. 2:1 nancy, metastatic carcinoma, Hodgkin's disease,
C. 1:1 and leukemia.
D. 1:2 or less 19. A RBCs are rich in LD-l and LD-2,and even slight
Chemistry/Correlate clinical and laboratory hemolysis will falsely elevate results. Hemolytic,
data/Lactate dehydrogenase/2 megaloblastic, and pernicious anemias are associ-
ated with LD levels of 10-50 times the URL.LD is
19. Which of the following conditions will interfere stable for 2 days at room temperature or 1 week at
with the measurement of LO? 4°C; however, freezing causes deterioration of LD-
A. Slight hemolysis during sample collection S. The activity of LDis inhibited by EDTA,which
B. Storage at 4°C for 3 days binds divalent cations; serum or heparinized
C. Storage at room temperture for 16 hours plasma should be used.
D. Use of plasma collected in heparin 20. A The Oliver-Rosalki met1:!odfor CK is based upon
Chemistry/Apply knowledge to recognize sources of the formation of ATP from creatine phosphate.
error/Lactate dehydrogenase/3 Hexokinase catalyzes the phosphorylation of
glucose by ATP. This produces glucose-6-PO4 and
20. In the Oliver-Rosalki method the reverse reaction is adenosine diphosphate (ADP). The glucose-6-PO4
used to measure CK activity. The enzyme(s) used in is oxidized to 6-phosphogluconate as NADP+ is
the coupling reactions is (are): reduced to NADPH.
A. Hexokinase and G-6-PD
ATP + glucose Hexokin::e
ADP + glucose-6-PO4
B. Pyruvate kinase and LD
C. Luciferase glucose-6-PO4 + NADP+ ~ 6-phosphogluconate
D. Adenylate kinase
Chemistry/Apply knowledge of basic laboratory + NADPH + H+
procedures/Creatine kinase/2 21. A Positive interference in the Oliver-Rosalki
method can occur when adenylate kinase is
21. In the Oliver-Rosalki method for CK,adenosine present in the serum from hemolysis or damaged
monophosphate (AMP) is added to the substrate in tissue. Adenylate kinase hydrolyzes ADP, forming
order to: AMP and ATP (2 ADP ~ AMP + ATP). This
A. Inhibit adenylate kinase reaction is inhibited by adding AMPand diadeno-
B. Block the oxidation of glutathione sine pentaphosphate (APsA) to the substrate.
C. Increase the amount of ADP that is available
D. Block the action of diadenosine pentaphosphate
Chemistry/Apply principles of basic laboratory
procedures/Creatine kinase/2
 Clinical Enzymology (197 )

22. SITUATION:A specimen for CKperformed on an D. An elevated CK-MBis always accompanied by

automated analyzer using an optimized Oliver- an elevated total' CK.
Rosalki method gives an error flag indicating Chemistry/Correlate clinical and laboratory
substrate depletion. The sample is diluted 1:2 and data/Creatine kinase/2
1:4by the serial dilution technique and reassayed.
After correcting for the dilution, the results are as
follows:

1:2Dilution= 3000lUlL; 1:4Dilution = 3600lUlL --'

Dilutions are made a second time and assayed
again but give identical results. What is the most
likely explanation?
A. The serum became contaminated prior to
making the 1:4 dilution.
B. The wrong pipet was used to make one of the
dilutions.
Answers to Questions 22-25
C. An endogenous competitive inhibitor is present
in the serum.
D. An error has been made in calculating the 22. C When a competitive inhibitor is present in the
enzyme activity of one of the two dilutions. serum, a dilution of the sample will cause an
Chemistry/Apply knowledge to recognize sources of increase in the reaction rate by reducing the con-
error/Creatine kinase/3 centration of the inhibitor. Dilution of serum
frequently increases the activity of CKand
23. SITUATION: A physician calls to request a CKon a amylase. The same effect will occur when a
sample already sent to the laboratory for coagula- smaller volume of serum is used in the assay
tion studies. The sample is 4-hour-old citrated blood because less inhibitor will be present in the
and has been stored at 4°C. The plasma shows very reaction mixture.
slight hemolysis. What is the best course of action 23. D CK activity is lost with excessive storage, the
and the reason for it?
most labile isoenzyme being CK-1.However, CK in
A. Perform the CK assay on the sample because no serum is stable at room temperature for about 4
interferent is present. hours and up to 1 week at 4°C provided that an
B. Reject the sample because it is slightly optimized method is used. Slight hemolysis does
hemolyzed. not interfere because CKis absent from RBCs.
C. Reject the sample because it has been stored More significant hemolysis may cause positive in-
too long. ,
terference by contributing ATP, glucose-6-PO4' and
D. Reject the sample because the citrate will adenylate kinase to the serum. Calcium chelators
interfere.
remove magnesium as well as calcium and should
Chemistry/Apply knowledge to recognize sources of not be used.
error/Creatine kinase/3
24. C Total CK is neither sensitive nor specific for
AMI.An infarct can occur without causing an
24. Which of the statements below regarding total CKis elevated total CK.Exercise and intramuscular in-
true? jections cause a significant increase in total CK.
A. Levels are unaffected by strenuous exercise. Crush injuries and muscular dystrophy can
B. Levels are unaffected by repeated intramuscular increase the total CK up to 50 times the URL.
injections. 25. C Serum myoglobin becomes abnormal within 3
C. Highest levels are seen in Duchenne's muscular hours after an AMIbefore TNIand CK-MB.lm-
dystrophy. munochemical methods for measuring CK-MBare
D. The enzyme is highly specific for heart injury. more sensitive than electrophoresis (fluorescent
Chemistry/Evaluate laboratory data to recognize densitometry) and are as sensitive as TNI if a cutoff
health and disease states/Creatine kinase/2 of 6 J.Lg/Lis used. TNI and CK-MBbecome
abnormal 4-6 hours after an AMIand peak within
25. Which of the following statements regarding the 8 hours. TNI remains elevated for approximately 1
clinical use of CK-MB(CK-2) is true? week after an AMI,is not increased in crush injury,
A. CK-MBbecomes elevated before myoglobin and and is not as likely to be elevated by renal failure
TNI after an AMI. as is CK-MB.There is usually less than 5 UlL CK-MB
B. CK-MBlevels are normal in cases of cardiac in the serum of healthy adults, while the total CK
ischemia. ranges from 10 to 110 UlL. Consequently, an
C. Mass unit assays are more sensitive than elec- abnormal CK-MBcan occur in the absence of an
trophoretic methods. elevated total CK.
(198 ) Clinical Chemistry

26. Isoforms of CKare: Answers to Questions 26-30

A. Isoenzymes of CK formed from variants of the B
subunit
B. Formed in the circulation by hydrolysis of lysine 26. B Isoforms are modified forms of isoenzymes and
from CK-MMand CK-MB exist for CK-MMand MB.They result from the hy-
C. Formed only when blood is collected in heparin drolysis of lysine from the M peptide by
D. Artifacts of electrophoresis caused by attach- carboxypeptidases in the plasma. Removal of
ment to albumin lysine results in faster electrophoretic mobility.
Chemistry/Apply knowledge of Fundamental biologi- The isoforms of CK-MMare CK-MMl,CK-MM2,and
cal characteristics/Creatine kinase/2 CK-MM3.Isoforms of CK-MBare designated CK-
MB1 and CK-MB2.CK-MM3and CK-MB2are the
unmodified tissue isoforms and rise within 4 hours
27. A patient's CK-MBis reported as 18 f-Lg/Land the after AMI.
total CKas 560 lUlL. What is the CK relative index
CCKI)? 27. B The CKI is an expression of the percentage of
A. 0.10% the total CKthat is attributed to CK-MB.
B. 3.2%
C. 10.0% CKI = CK-MB in J..lg/Lor UlL X 100
D. 30.0% Total CKin lUlL
Chemistry/Correlate clinical and laboratory The reference range is 0%-4%. Values above 4%
data/Creatine kinase/2 point to an increase in CK-MBfrom cardiac
muscle.
28. Differentiation of MIand non-MI causes of 28. D CK-MBrises 4-6 hours postinfarction and peaks
increased serum CK-MBis based upon all of the in 16-20 hours. LD-l rises about 8-12 hours postin-
following except: farction and peaks within 2 days. CK-MBreturns to
A. Whether the increase is persistent or transient normal within 1-3 days, but LD-l remains elevated
B. Whether the percent as well as lUlL CK-MBis for 7-10 days. A sequential rise and fall of CK-MB
increased and LD-l is a specific marker for AMI.TNT and TNI
C. The presence of high levels of other cardiac are also cardiac specific markers. They may
markers become elevated sooner than CK-MBand remain
D. The serum level of total CK elevated for 7-14 days following an AMI.Absolute
Chemistry/Evaluate laboratory data to recognize CK-MBincreases are evaluated cautiously, when
health and disease states/Creatine kinasel2 CK-MBis less than 5% because noncardiac sources
may be responsible.
29. Which statement about the isoenzymes of CKis 29. D Atypical CK isoenzymes include macro and mi-
true? tochondrial forms. These have slower
A. Macro CK-l is formed by immunoglobulins electrophoretic mobility than CK-MBand do not
binding to CK-BB. interfere with electrophoretic assays. Macro CK-l
B. Macro CK-2is mitochondrial and composed of will interfere with isoenzyme separation by column
different subunits than CK-2. chromatography. CK-BBand adenylate kinase
C. Double antibody sandwich assays are specific interfere with immunoinhibition assays using only a
for CK-MB. single antibody that blocks the M subunit, but im-
D. All of the above. munologic assays using antibodies to two sites (one
to the Mand the other to the B subunit) are specific
Chemistry/Apply knowledge to identify sources of for CK-MB.
error/Creatine kinase/2
30. B ALTcatalyzes the transfer of an amino group
from alanine, a three-carbon amino acid, to a ke-
30. Which of the following statements about the amino- toglutarate C2-oxoglutarate), forming pyruvate.
transferases CASTand ALT) is true? ASTcatalyzes the transfer of an amino group from
A. Isoenzymes of ASTand ALTare not found in aspartate (four carbons) to a-ketoglutarate,
humans. forming oxaloacetate. The reactions are highly re-
B. Both transfer an amino group to a ketoglutarate. versible and regulate the flow of aspartate into the
C. Both require NADP+ as a coenzyme. urea cycle. Both transaminases require P-5'-Pas an
D. Both utili'ze'four carbon amino acids as sub- / intermediate amino acceptor (coenzyme). Cyto-
~srm~s. 1!nf5nir,-qnd.,rnitad1rul ct.riaLisnenZ\Plesare
Chemistry/Apply knowledge of Fundamental biologi- produced but are not differentiated in clinical
cal characteristics/ Aminotransferase/ 2 practice.
 Clinical Enzymology ( 201 J
43. Which enzyme is least useful in differentiating Answers to Questions 43-48
necrotic from obstructjve jaundice?
A. GGT
B. ALT 43. D GGT and 5' nucleotidase are markedly elevated
C. 5' Nucleotidase in both intra- and posthepatic obstruction. ALTis
D. LD slightly elevated in obstl1..\ctivejaundice but is
Chemistry/Correlate clinical and laboratory datal markedly elevated in necrotic jaundice. Although
Enzymes/2 LD is usually greater in necrotic jaundice (5-10 X
N) than in obstructive jaundice «2 X N), eleva-
44. Which of the statements below about the tions in these ranges overlap frequently in hepatic
phosphatases is true? disease and result from many other causes.
A. They hydrolyze adenosine triphosphate and 44. B Phosphatases are classified as either alkaline or
related compounds. acid depending upon the pH needed for optimum
B. They are divided into two classes based upon activity. The phosphatases hydrolyze a wide range
pH needed for activity. of monophosphoric acid esters. ALPis inhibited
C. They exhibit a high specificity for substrate. by phosphorus (product inhibition). The Interna-
D. They are activated by Pi, tional Federation of Clinical Chemistry (IFCC)
ChemistryIApply knowledge of fundamental recommended method employs 2-amino-2-methyl-
biological characteristicslPhosphatases/ I I-propanol, a buffer that binds Pi,
45. D ALP is higher in children than in adults due to
45. Which of the following statements regarding ALP is bone growth. Children and geriatric patients have
true? higher serum ALP due to increased bone
A. In normal adults the primary tissue source is isoenzyme. Serum ALP levels are often two- or
fast-twitch skeletal muscle. threefold higher than the URLin the third term of
B. Geriatric patients have a lower serum ALP than pregnancy. In nonpregnant normal adults serum
other adults. ALP is derived from liver and bone. Liver, bone;
C. Serum ALPlevels are lower in children than in
placental, renal, and intestinal isoenzymes of ALP
adults. can be separated by electrophoresis, and many
D. Pregnant women have a higher level of serum other ALP isoenzymes have been identified by iso-
ALP than other adults. focusing. RBCs,leukocytes, and the prostate are
Chemistry/Correlate clinical and laboratory datal the primary sources of acid phosphatase isoen-
Phosphatases/2 zymes.
46. A Liver and bone isoenzymes are difficult to
46. Which isoenzymes of ALPare inhibited by L-pheny- separate by agarose electrophoresis, and many
lalanine? laboratories use heat stability and selective in-
A. Intestinal and placerltal hibitors to help identify the tissue source when
B. Bone and intestinal ALP is elevated. Phenylalanine inhibits placental
C. Liver and placental and intestinal forms; 3Murea inhibits bone ALP.
D. Renal and liver
47. D Placental (and Regan isoenzyme associated
ChemistryIApply principles of special proceduresl with malignancy) is the only isoenzyme that
Phosphatasesll retains activity when serum is heated to 65°Cfor 10
minutes. Heat inactivation is used primarily to dis-
47. Which isoenzyme of ALP is most heat-stable? tinguish liver ALP from bone ALP. If less than 20%
A. Bone activity remains after heating serum to 56°C for 10
B. Liver minutes, then bone ALP is most likely present.
C. Intestinal
D. Placental 48. C Liver ALP isoenzymes migrate farthest toward
the anode, but fast and slow variants occur. The
ChemistryIApply knowledge of fundamental biologi- slow liver ALP band is difficult to distinguish from
cal characteristics/Phosphatases/ I placental and bone ALP.The order from cathode
to anode is:
48. Which isoenzyme of ALP migrates farthest toward -Renal~lntestinal~Bone~Placental~Liver +
the anode when electrophoresed at pH 8.6?
A. Placental
B. Bone
C. Liver
D. Intestinal
ChemistryIApply principles of special procedures/
Phosphatases/ I
(202 ) Clinical Chemistry

49. Which isoenzyme of ALP is inhibited by urea? Answers to Questio~s 49-54

A. Placental
B. Bone
C. Liver 49. B Bone ALP isoenzyme is inhibited by urea, and
D. Intestinal placental and intestinal ALP are inhibited by
Chemistry/Apply principles of special phenylalanine. Bone ALP can be distinguished
procedures/Phosphatases/l from liver ALP by coupling two methods. For
example, loss of ALP activity by heating to 56°e for
50. Which of the following statements regarding ALP is 10 minutes and by addition of 3M urea points to
true? ALP derived from bone.
A. Isoenzymes of ALPare antigenically distinct and 50. C ALP isoenzymes can result from different genes
can be identified by specific antibodies. or from modification of a common gene product
B. Highest serum levels are seen in intrahepatic ob- in the tissues. Some differ in carbohydrate content
struction. rather than protein content and cannot be identi-
C. Elevated serum ALPseen with elevated GGT fied by immunologic methods. Highest levels of
suggests a hepatic source. ALP are seen in Paget's disease of bone where ALP
D. When jaundice is present, an elevated ALP can be as high as 25 times the URL.GGT in serum ,
suggests acute hepatitis. is derived from the hepatobiliary system and is
Chemistry/Co"elate clinical and laboratory increased in alcoholic hepatitis and hepatobiliary
data/Phosphatases/2 obstruction. It is not increased in diseases of bone
or in pregnancy. When the increase in GGTis
51. In which condition would an elevated serum ALP twofold higher than the increase in ALP, the liver
be likely to occur? is assumed to be the source of the elevated ALP.
A. Squamous cell carcinoma Serum ALP is a sensitive marker for extrahepatic
B. Hepatoma obstruction, which causes an increase of approxi-
C. Leukemia mately 10 times the URL.A lesser increase is seen
D. All of the above in intrahepatic obstruction. ALP is only mildly
elevated in acute hepatitis as a result of accompa-
Chemistry/Co"elate clinical and laboratory datal
nying obstruction.
Phosphatases/2
51. D In addition to obstructive jaundice and bone
52. Which condition is least likely to be associated with diseases, ALP is a tumor marker for several malig-
increased serum ALP? nancies. In most cases the ALP is the product of
A. Osteomalacia fetal gene activation and resembles placental ALP
B. Pancreatic disease (e.g., Regan isoenzyme). Leukemia and Hodgkin's
C. Hyperparathyroidism and hyperthyroidism disease may cause an elevated leukocyte- or bone-
D. Osteoporosis derived ALP.
Chemistry/Co"elate clinical and laboratory 52. D ALP is elevated in osteomalacia (ricketts), bone
data/Phosphatases/2 cancer, and bone disease secondary to hyperthy-
roidism and hyperparathyroidism, but it is high in
53. Which substrate is used in the Bowers-McComb less than 30% of osteoporosis patients. Pancreatic
method for ALP? disease associated with biliary obstruction, such as
A. p-Nitrophenyl phosphate cancer at the head of the pancreas, is associated
B. (3-Glycerophosphate with elevated ALP.
C. Phenylphosphate 53. A The method of Bowers-McComb (Szasz modifi-
D. a-Naphthyl phosphate cation) is the IFCCrecommended method for ALP.
Chemistry/Applyprinciples of basic laboratory pro- This method uses 2-amino-2-methyl-l-propanol, pH
cedures/ Phosphatases/2 10.15, and measures the increase in absorbance at
405 nm as p-nitrophenyl phosphate is hydrolyzed
54. Whichof the followingis used in the fFCerecom- to p-nitrophenol.
mended method for ALP? 54. D As with most other enzymes, ALP should be
A. Multipoint or continuous measure of ab- measured by a kinetic (continuous monitoring)
sorbance increase at 405 nm method to ensure that the reaction rate is constant
B. Use of 2-amino-2-metl1yl-l-propanol buffer to and remains zero order. AMPbuffer ch elates phos-
chelate phosphorus phorus preventing product Inhibition; Zn2+ and
C. Addition of Zn2+ and HEDTAto chelate the Mg2+are added to the substrate to activate ALP.
excess Zn2+ HEDTAchelates the excess Zn2+, which is in-
D. All of the above hibitory at high concentrations.
Chemistry/Applyprinciplesof basic laboratorypro-
cedures/Phosphatases/2
( 204) ClinicalChemistl)'

60. Which of the following amylase methods is Answersto Questions 60-63

typically based upon a rate reaction?
A. Somogyi
B. Dye-starch 60. D The Somogyi method measures the formation of
C. Starch-Iodine maltose after incubating serum and starch for 30
D. Turbidimetric minutes at 37°C.Dye-starch or chromolytic methods
Chemistry/Apply knowledge of basic laboratory pro- measure the amount of dye released from starch
cedures/Enzyme/l after incubation with serum. The amount of dye
released is determined by comparison to pure dye
61. How soon following acute abdominal pain due to standards. Turbidimetric methods determine the
pancreatitis is the serum amylase expected to rise? clearing of starch as a negative rate reaction.
A. 1-2 hours
B. 2-12 hours 61. B Serum amylase usually peaks 2-12 hours
following acute abdominal pain resulting from
C. 3-4 days pancreatitis. Levels reach 2-6 times the URLand
D. 5-6 days return to normal within 3-4 days. Urinary amylase
Chemistry/Correlate clinical and laboratory peaks concurrently with serum but rises higher
data/Enzymes/2 and remains elevated for up to 1week.
62. Which of the statements below regarding the 62. B Serum lipase peaks about the same time as
diagnosis of pancreatitis is correct? amylase but remains abnormal for about 1 w~ek
A. Amylase and lipase are as predictive in chronic following an episode of acute pancreatitis. In acute
as in acute pancreatitis. pancreatitis the rate of urinary amylase excretion
B. Diagnostic sensitivity is increased by assaying increases, and the urinary amylase:creatinine ratio
both amylase and lipase. or the amylase:creatinine clearance ratio are
C. Measuring the urinary amylase:creatinine ratio helpful in diagnosing some cases of pancreatitis.
is useful only when patients have renal failure. The normal A:Cclearance ratio is 1%-4%. In acute
D. Serum lipase peaks several hours before pancreatitis the ratio is usually above 4% and can
amylase after an episode of acute pancreatitis. be as high as 15%.In chronic pancreatitis, acinar
cell degeneration often occurs, resulting in loss of
Cbemistry/Correlate clinical and laboratory datal amylase and lipase production. This lowers the sen-
Enzymes/2
sitivity of amylase and lipase in detecting chronic
63. Which of the following conditions is associated disease to below 50%. Patients with chronic disease
with a higb serum amylase? have pancreatic insufficiency giving rise to
A. Mumps abnormal triolein 1311 and 13carotene absorption,
B. Intestinal obstruction increased fecal fat, and decreased fecal trypsin.
C. Alcoholic liver disease 63. D Both salivary and pancreatic amylases desig-
D. All of the above nated S-type and P-type, respectively, are present
Chemistry/Correlate clinical and laboratory in normal serum. High amylase occurs in mumps,
data/Enzymes/2 ectopic pregnancy, biliary obstruction, peptic
ulcers, alcoholism, malignancies, and other non-
pancreatic diseases. Isoenzyme assay can be used
to rule out mumps, malignancy, and ectopic
pregnancy, which give rise to high S-type amylase.