D) Medications B) Viral Infections ). The following describes normal erythrocytes except? A) Contains iron granules B) Cell volume diameter between 75-100f1. C) Mean diameter of 6-8 um D) Lifespan of 100-120 days E) Can maneuver tiny capillaries Macrocytosis with a megaloblastic marrow can be accompanied by the following diagnostic characteristics except: A) Paneytopenia B) Folate deficiency ©) Increased ineffective erythropoiesis D) Reduced homocysteine levels, E) Pernicious anaei . Folic acid deficiency and vitamin B,2 deficiency both result in megaloblastic anemia with many of the same symptoms and laboratory test results. In the differential diagnosis of the two, which clinical symptom or laboratory test result is unique to the vitamin Biz deficiency associated with pernicious anemia, and can be used to distinguish it from folate deficiency; A) Macrocytosis. B) Neurological symptoms [Type text]©) Anaemia D) Mild Jaundice E) Fatigue and shortness of breath 13. Which form of iron can be visualized by the Prussian blue stain; A) Ferritin B) Hemosiderin ) Transferrin D) Heme E) Hemojuvelin 14, The following statements are true about Sideroblasticanaemiasexcept; A) Can be caused by drugs like Isoni B) Some can be inherited as autosomal dominant conditions C) Some patients may respond to pyridoxine therapy D) Majority of patients will present with low body iron stores E) The inherited forms of this disease are not curable 15, Hereditary Spherocytosis is a common hemolytic condition in some geographical regions. ‘The following statements about this condition are true except; A) Commonly caused by Ankyrin-spectrin mutations B) May present with clinical features soon after birth C) Gallstones may occur in teenage years and can lead to gall bladder inflammation D) Splenectomy is a viable treatment option [ype text) 1 enE) Low reticulocyte count is a common finding in this condition 16. The following are known causes of macrocytosis except: A) BI2/Folate deficiency B) Cytotoxic drugs C) Hypothyroidism D) Liver disease E) Lead poisoning 17, Key features of megaloblastic anemia include the following except: A) Hypersegmentation of neutrophils B) Low reticulocyte count C) Jaundice D) Hypothyroidism E) Neurological dysfunction 18, The following are features of Thalassemia except: A) Iron overload B) Poikilocytosis ©) Hypochromia D) Macrocytes E) Target cells Type text] |o™ ]19. The following statements are true about sickle cell patients except; A) Sickle cell patients are susceptible to infections caused by encapsulated gram negative bacteria B) It isan autosomal co-dominant condition €) It can be cured by hydroyurea D) Papillary necrosis is a known complication E) It is common in many malaria endemie areas 20. The following statements are true concerning G6PD, except; A) Pailure to generate adequate NADPH in this condition results in insufficient glutathione B) Denatured Hemoglobin forms pappeinheimer bodies C) Mainly affect males D) Some phenotypes ean be worsened by Fava beans E) Drugs and infections ean precipitate a hemolytic crisis 21, All can be associated with Sickle Cell Anemia except; A) Vaso-ocelusive crisis B) Recurrent Infections ©) Bleeding disease D) Priapism. ) Acute Chest Syndrome [Type text] a |For questions 22-28 please choose the best diagnosis that fits the various clinical scenarios provided below. Each option ean be chosen more than once. A. Myeloma, B. Acute promyelocytic leukaemia C. Burkitts lymphoma D. Follicular lymphoma E. Chrot lymphocytic leukaemia F. Chronic myeloid leukaemia G. Acute lymphoblastic leukaemia H. Waldenstrom’s macroglobulinaemia |. Monoclonal gammopathy of unknown significance (MGUS) J. Acute myeloid leukaemia H, Myelodysplastic syndrome. 22. A 70 year old presents with lymphadenopathy and splenomegaly and investigations reveal an IgM Paraprotein of 40g/L. Hb 10g/L.. Creatinine and calcium normal. Skeletal survey shows no bone lesions. 23. A 43 year old man presents with back pain, night sweats, weight loss and a 10cm retroperitoneal ‘mass. He has a markedly raised Lactate dehydrogenase (LDH) and his HIV result returns as positive. Histology demonstrates a ‘starry sky” pattern and most of the cells are in mitosis. [Type text] Se24. A 76 year old man presents with bruising and gingival bleeding and general lethargy. His clotting profile is normal. A blood film shows pancytopenia with immature hypogranular blasts, which stain positively for myeloperoxidase. Occasional Auer rods are seen. Cytogenetics shows (8;21) . A 25 year old presents with pancytopenia, Blood film examination shows the presence of Auer rods in blast cells. Cytogenetics shows translocation (15, 17), 26. An elderly man presents with Coomb’s test positive haemolytic anaemia. He has a lymphocytosis of 40 X 109/L. A blood film shows numerous small mature lymphocytes, smear/smudge cells and Spherocytes 27.A 75 year old who had chemotherapy for breast cancer 5 years ago has pancytopenia and macrocytosis. Bone marrow examination shows abnormal morphology and maturation in all 3 lineages. B12 and folate are normal. 28. A 25 year old presents with chronic fatigue and abdominal fullness. On examination, he is found to have mild pallor, enlarged spleen of 5 below costal margin, Hemogram shows marked leucocytosis of 100 x 10°/L and hemoglobin of 11.2 gidl. BCR-ABL{(Philadelphia chromosome) analysis is positive. For questions 29-34 please choose the best diagnosis that fits the various clinical scenarios provided below, Each option can be chosen more than once. A. Recurrent transfusion B. Exchange transfi C. Hydroxyurea D. Hydration, oxygen and analgesia E, Admit and give intravenous antibiotics F. Anticoagulation (Type text] |A™-]29, 30, 31 34, 35. G. Bone marrow transplantation H. Iron replacement therapy 1. No treatment required J. Iron chelation therapy A 10 year old child with sickle cell disease presents with right sided hemiparesis. The parents want to know how best a recurrence of the same (stroke) can be prevented, Beta thalassemia major patient who has been regularly transfused for 8 years. Otherwise well Ferritin level at 400. Hb 10.5 MCV 82, Ferritin greater than 2000ng/L. Liver function tests are normal ‘A 32 year old female is 30 weeks pregnant with Hb 9.5. MCV 56. Ferritin is <10. She has a positive sickle screening test High performance liquid chromatography, HPLC shows 40% HbS and 60% HbA. A pregnant lady presents with unilateral lower limb swelling for the past 2 days. Doppler ultrasound shows a clot in her leg veins extending into her thigh. ‘A known sickler has had 4 admissions in the past 8 months during to vaso-occlusive episodes. She only on folate and Paludrine. A 26 year old man presents with weight loss of 4kg night sweats and a persistent cough for 3weeks. His full blood count shows severe eosinophilia. He is HIV positive. The most likely cause is A. Excess 1 B, Malnutrition C. Malaria D, Strongyloidosis [Type text) aE, Vitamin supplements 36. An 18 year old woman has menorthagia and iron deficiency anaemia, She also has a long history of easy bruising and epistaxis since childhood requiring cautery, She bled excessively after n screen shows are normal PT and tonsillectomy at age 13, Her mother bruises easily. A coagul APTT. Her platelet count is normal. What is the most likely diagnosis? A. Haemophilia A/B B, Von Willebrand disease C. Drug induced coagulopathy D. Marked leukocytosis E. No significant bleeding disorder 37. A 78 year old woman is noted to have marked lymphocytosis and numerous basket cells on her blood film. She is currently admitted due to pneumococci pneumonia, What is the most likely diagnosis? A. Acute Leukemia B. Chronic Lymphoeytic Leukemia CC. Mantle cell lymphoma D.Post splenectomy E. Viral infection accompanying her pneumonia 38. Which of the: following are often associated with soft tissue haematomas and haemarthroses if untreated? A. Severe Haemophilia A B. Immune thrombocytopenia [Type text] ee |ful 39. 40, C. Thrombotic thrombocytopenic purpura D. Hemolytic Uremic Syndrome E, Congenital platelet defects A 43 year old female present with epistaxis, bruising and menorrhagia for I week. She is febrile and appears unwell. She is diagnosed with acute promyelocytic leukaemia, Which of the following is an important ASPECT of her initial chemotherapy management? A. Broa spectrum antibiotics B. Inform her family and her friends about her condition, C. Administer anti-cancer agents immediately D, All-trans retinoic acid E. Blood transfusion ‘A 45 year old man has a platelet count of 2000 X 10°/L and is diagnosed with essential thrombocytosis. Which of the following are recognized complications of this disorder except: A. Bleeding B. Deep venous thrombosis, C. Stroke D, Progression to Myelofibrosis E. progression to Multiple myeloma ype text] | o~ ]HAEMATOLOGY AND BLOOD TRANSFUSION (3 HOURS) INSTRUCTIONS 1. The exam consists of THREE (3) sections. (Total Marks - 100) 2. Answer ALL questions in EACH section. 3. Answer questions in the ANSWER SHEET and BOOKLET provided. 4. SECTION Ahas FOURTY (40) Multiple Choice Questions (MCQs). (40 Marks) 5. SECTION B has FOUR (4) questions each 10 marks (40 Marks) 6. SECTION C consists of a Long Essay Question (LEQ). (20 Marks) (Type text) : | eyCHEMICAL PATHOLOGY (2 HOURS) INSTRUCTIONS 1. The exam consists of TWO (2) sections. (Total Marks - 100) 2. Answer ALL questions in EACH section. 3. Answer questions in the ANSWER SHEET and BOOKLET provided 4, SECTION A has EIGHT (8) Short Answer Questions (SAQ)(80 Marks) 5. SECTION B consists of TWO (2) Long Essay Question (LEQ) (20 Marks) MASENO UNIVERSITY 1SO 9001:2008 CERTIFIED. Page 2SECTION A (SHORT ANSWER QUESTIONS) 1a) List two clinical conditions that can give rise to normal anion gap metabolic acidosis. (2Marks) b) Indicate the mechanism of metabolic acidosis in Renal Tubular Acidosis Type Il (Proximal RTA) (2Marks) ¢) List two precautions required to ensure that blood samples sent to the laboratory for blood gas analysis is appropriate and of good quality (2Marks) d) List two biochemical substances lost in urine in the Fanconi Syndrome (2Marks} e) List two indications for haemodialysis in a patient with severe acute renal failure (Marks) 2.a) Define micro-albuminuria and indicate its clinical significance (2marks) b) List two clinical conditions that may lead to hyperglycaemic coma if not properly managed (2Marks) ¢) Indicate briefly how you would distinguish exogenous insulin administration from insulinoma (2Marks) d) What is RANK-L and what is its physiological function? (2Marks) €) List and explain two mechanisms that may lead to tumor hypercalcaemia(2marks) MASENO UNIVERSITY 150 9001:2008 CERTIFIED Page 33 a) List FOUR lipid-related risk factors for the development of coronary artery disease (2Marks) b) List two criteria that would support the diagnosis of malignant paraproteinaemia (2marks) ¢) List FOUR clinical conditions in which oligoclonal bands may be visualized on electrophoresis of CSF (2marks) 4) List two causes of Ascities commonly associated with cirrhosis of the liver (2marks) ¢) List two conditions that will lead to impaired enterohepatic circulation of the bile ands (2marks) 4 a) How does EXCESS growth hormone production present clinically in childhood and adulthood and list two metabolic biochemical features that may be associated with excess growth hormone production in adulthood (2Marks) b) List three pituitary hormones (glycoproteins) in which the a-chain is identical in all the hormones, What does the B chain confer? (2Marks) c) What is the MAIN difference between cranial diabetes insipidus and nephrogenicdiabetes MASENO UNIVERSITY 1SO 9001:2008 CERTIFIED a Pacedidusin terms of aetiology? (2Marks) ) Name two fat soluble vitamins (2marks) e) List two gene mutations that may be involved in the Hereditary Haemochromatosis (2marks) 5 a] List TWO enzyme deficiency that may lead to Galactosaemia (2marks) b) List TWO biochemical features associated with Nephrotic Syndrome (2marks) ¢) List TWO biochemical features of acute tumor lysis syndrome (Marks) d) What is the toxic metabolite in methanol poisoning? What substance is administered in the treatment of methanol poisoning? (2Marks) ¢) List TWO plasma enzymes that would be elevated in obstructive jaundice(2Marks) 6 a) List TWO pathological mechanisms that may lead to hyperuricaemia and gout (2Marks) b) List TWO catecholamines elevated in a patient with phaeochromacytoma —_(2marks) ¢) List TWO classes of genes implicated in malignancy (2marks) [MASENO UNIVERSITY ISO 9001:2008 CERTIFIED Page 5d) List TWO negative acute phase proteins (2Marks) e) Name TWO conditions associated with production of oligoclonal proteins in the CSF (2Marks) 7 a) List TWO mechanisms that may lead to polyuria (2Marks) b) List TWO biochemical features associated with the Carcinoid Syndrome _(2Marks) c) List TWO causes of hyponatraemia (2marks} d) List TWO causes of inceasedanion gap metabolic acidosis (2Marks) e) What is galactorrhoea? List one cause of this condition (2marks) 8 a) Give a brief outline of the Renin-Angiotensin-Aldosterone system (amarks) b) List THREE causes of secondary hyperaldosteronismn (3Marks) ) List THREE endocrine causes of hypertension (8marks) [MASENO UNIVERSITY 150 900: Page 6SECTION B (LONG ANSWER QUESTIONS) 9) Briefly explain the complication that arises from the genetically inherited abnormal Pseudocholinesterase (SMarks) ii) Briefly outline the metabolic complications of ACUTE DIARRHOEA. (5Marks} 10 a) Briefly tabulate main differences between steroid and peptide hormones under the followingheadings: (SMarks) i Solubility ii, Stability ili, Mode of action on target cells iv. Storage in the endocrine cells v. Halflife b) What constitutes the High Dose Dexamethasone Suppression Test and what is the indication for doing this test? (5Marks) MASENO UNIVERSITY ISO 9001:2008 CERTIFIED Page 7MASENO UNIVERSITY UNIVERSITY EXAMINATIONS 2014/2015 THIRD YEAR THIRD SEMESTER EXAMINATIONS FOR THE DEGREE OF BACHELOR OF MEDICINE AND BACHELOR OF SURGERY (MBChB) WITH INFORMATION TECHNOLOGY (MAIN CAMPUS) MPS 304: CLINICAL CHEMISTRY Date: 26" November, 2014 Time: 9.00 - 12.00 noon MASENO UNIVERSITY 10 9001:2008 CERTIFIED ©) er 7CHEMICAL PATHOLOGY (3 HOURS) INSTRUCTIONS 1. The exam consists of THREE (3) sections. (Total Marks - 100) 2. Answer ALL questions in EACH section. 3. Answer questions in the ANSWER SHEET and BOOKLET provided. 4. SECTION A has FOURTY (40) Multiple Choice Questions (MCQs). (40 Marks) 5. SECTION B has FOUR (4) questions each 10 marks (40 Marks) 6. SECTION C consists of a Long Essay Question (LEQ). (20 Marks) 'MASENO UNIVERSITY ISO 9001:2008 CERTIFIED Page 2 |gSECTION A (MCQs) 40 marks 1. A woman of 40 years has a blood pressure of 200/130. Urinary Hydroxy-Methoxy- Mandelic-Acid (HMMA) was found to be 80mol/24hrs (n-5-35). Which one of the following is the most likely diagnosis a) Melanoma b) Hepatocellular carcinoma ©) Phaeochromacytoma 4) mesothelioma e) Retinoblastoma 2. Reliable indicator for thiamine deficiency is a) Low RBC pyruvate kinase b) Low RBC citrate dehydrogenase ©) Low RBC transketolase d) Low RBC lactate dehydrogenase e) Low RBC glutamate dehydrogenase 3. RBC glutathione reductase activity is used as a diagnostic test for a) Thiamine deficiency b) Riboflavin deficiency ©) Folate deficiency 4) Ascorbic acid deficiency ©) Vitamin D deficiency [MASENO UNIVERSITY ISO 9001:2008 CERTIFIED ‘Page 34, Keratomalacia is a typical feature of a) Vitamin D deficiency b) Vitamin B12 deficiency ©) Niacin deficiency d) Pyridoxine deficiency e) Vitamin A deficiency 5. Night blindness is an early sign of a) Over ingestion of vitamin A b) Lack of retinal ©) Vitamin K deficiency 4) Biotin deficiency ¢) Niacin deficiency 6. Following intensive exercise, whih one of the following is most likely to be markedly elevated in the blood a) Aspertated aminotransferase b) Creatine kinase ©) Lactate dehydrogenase 4) Gamma glutamyltransferase e) Alanine aminotransferase one of the following defines accuracy a) How close the result is to the mean b) How close the result is to the “true” value ©) The amount of variation in results