Biochemistry Situational or Pathological case examples – MCQ Questions

  1. A young woman (30 years old) has the following complaints: severe thirst, polyuria, and unexplained weight loss, the smell of acetone (mouth and urine). Laboratory studies indicate a high level of glycosylated hemoglobin (HbA1C) and a low level of C-peptide.
What is the probable diagnosis?
A. Non-insulin-dependent diabetes mellitus
B. Insulin-dependent diabetes mellitus
C. Steroid diabetes
D. Diabetes insipidus
E. Gestational diabetes
How is C-peptide formed?
A. Is formed with proinsulin as a result of splitting the insulin molecule
B. It is formed with insulin as a result of splitting the proinsulin molecule
C. Is formed with insulin as a result of the synthesis of the proinsulin molecule
D. Is formed with inulin as a result of the synthesis of an inulin molecule
E. Instead of proinsulin
In which reaction is formed HbA1C?
A. Carboxylation
B. Glycosylation
C. Acetylation
D. Dehydration
E. Hydrogenation
2. A 65-year-old man called an ambulance with complaints of sharp pain in the left half of the chest, dyspnea (shortness of breath), weakness, dizziness, and sweat. The laboratory samples were with following results:  high level of the CKs-MB (creatine kinase) and troponin I (cTnI) (more than 0.1 ng/ml).
What is your probable diagnosis?
A. Air embolism
B. Intercostal Myalgia
C. Mitral valve prolapse
D. Myocardial infarction
E. Coronary heart disease
Define the class of CKs-MB (creatine kinase) enzymes:
A. Oxidoreductase
B. Transferase
C. Ligase
D. Isomerase
E. Hydrolases
What reaction is catalyzed with creatine kinase?
A. Creatine Synthesis
B. Creatine Phosphate Synthesis
C. Creatinine synthesis
D. Creatinine catabolism
E. Creatine Phosphate Catabolism
3. An elderly 70 years old woman entered the hospital with a serious critical condition, who fainted in a turn for a pension. She has a history of tachycardia, low blood pressure ≥40 mm Hg, varicose veins in her legs. There is a triad of laboratory symptoms: high level of LDH-3 and bilirubin with a normal level of AST (aspartate aminotransferase).
What is required for bilirubin synthesis?
A. Fatty acid
B. Taurine
C. Cholesterol
D. Heme
E. Bile acids
Which reaction is catalyzed by AST (aspartate amino-transferase)?
A. Turning pyruvate into aspartate
B. Transformation of oxaloacetate to aspartate
C. The conversion of alanine to pyruvate
D. The conversion of alanine to glutamate
E. Turning alanine into aspartate
4. A student presented at the clinic with dyspnea, tiredness, headache, and tinnitus. Urine is dark brown due to urobilin, and feces are dark brown. On examination, the skin is yellow in color and dry. Laboratory investigation showed a decreased level of hemoglobin, increased level of LDG-2 level, and unconjugated bilirubin.
The probable diagnosis is:
A. Megaloblastic anemia
B. Hemolytic anemia
C. Hypoplastic anemia
D. Iron-deficiency anemia
E. Posthemorrhagic anemia
Name the normal place of hemoglobin synthesis:
A. Kidney
B. Pancreas
C. Bone marrow
D. Blood
E. Liver
Name the substrates of the first heme synthesis reaction:
A. Succinyl CoA, histidine
B. Succinyl CoA, glycine
C. Succinyl CoA, Succinate
D. Succinate, glycine
E. Succinate, histidine
5. A 43 years old woman had complained of increased thirst and appetite, polyuria, headache, irritability. Laboratory findings: glucose level is 6.1-6.5 mmol / l, high level of lactic acid in the blood, elevated excretion of 17-ketosteroids and 17-hydroxycorticosteroids, high level of ACTH.
The name of the probable diagnosis is:
A. Insulin-dependent diabetes mellitus
B. Steroid diabetes
C. Gestational diabetes
D. Non-insulin-dependent diabetes mellitus
E. Diabetes insipidus
The place of synthesis of ACTH (adrenocorticotropic hormone):
A. Epiphysis
B. Pituitary
C. Hypothalamus
D. Pancreas
E. Adrenal cortex
Substrate for the synthesis of 17-ketosteroids is:
A. Glycolipids
B. Phospholipids
C. Cholesterol
D. Fatty acid
E. Triacylglycerides
Place of synthesis of 17-ketosteroids:
A. Pancreas
B. Epiphysis
C. Hypothalamus
D. Adrenal cortex
E. Pituitary
6. The therapist prescribed Milgamma medicine to a patient with neurological manifestations of spinal osteochondrosis. Milgamma is a combination of vitamins B1, B12, and B6. After medicine using, the patient had angioedema (allergy).
Explain the reason for allergy:
A. Thiamine enhances the allergic effect of biotin
B. Cyanocobalamin enhances the allergic action of thiamine
C. Thiamine enhances the allergenic effect of folic acid
D. Biotin enhances the allergenic effect of cyanocobalamin
E. Folic acid enhances the allergic effect of thiamine
Name the coenzyme form of B1 vitamin:
A. Thiamine diphosphate
B. Nicotinamide adenine dinucleotide
C. Nicotinamide adenine dinucleotide phosphate
D. Flafinadenedinucleotide
E. Flufin mononucleotide
Name the metal part of B12vitamin:
A. Iron
B. Cobalt
C. Copper
D. Lead
E. Calcium
Specify an enzyme with B1 coenzyme:
A. Carboxylase
B. Decarboxylase
C. Dehydratase
D. Synthetase
E. Dehydrogenase
7. The patient has a poor appetite, nausea, abdominal distention, weight loss, emaciation. Laboratory investigation of gastric juice showed: total acidity = 20 units, there is no free hydrochloric acid, the smell of hydrogen sulfide is noted, and lactic acid was found.
Your probable diagnosis:
A. Dyspepsia
B. Hyperhydration
C. Hypochlorhydria
D. Achlorhydria
E. Hyperchlorhydria
Name the gastric juice enzyme:
A. Elastase
B. Pepsin
C. Trypsin
D. Pancreatin
E. Chymostrypsin
the pH of the stomach  normally is:
A. 8 – 12
B. 5 – 8
C. 7 – 7.2
D. 1.5 – 2
E. 3 – 5
8. A 63 years old woman presented with weakness, dizziness, and headache, fatigue with little exertion (climbing to the 2nd floor), frequent ARVI. The doctor notes the patient’s pallor of the skin and mucous, shallow
breathing, tachycardia, dryness oral cavity, and tongue. A blood sample was analyzed with the following results: leukocytes – 6.9 x109 / l, erythrocytes -2,7х1012 /l. The color indicator is low, the hemoglobin level is 82 g/l. The content of transferrin was 1 g /l (the norm is 2.0-4.0 g / l).
Identify the diagnosis:
A. Hemolytic anemia
B. Megaloblastic anemia
C. Posthemorrhagic anemia
D. Iron-deficiency anemia
E. Hypoplastic anemia
What is the name of hemoglobin with 3 valence state iron:
A. Oxyhemoglobin
B. Carbhemoglobin
C. Methemoglobin
D. Carboxyhemoglobin
E. Fetal hemoglobin
What are blood serum iron-binding proteins?
A. Lactoferrin, albumin
B. Ferulloplasmin, albumin
C. Lactoferrin, transferrin
D. Transferrin, albumin
E. Ferulloplasmin, transferrin
9. A newborn baby has the following symptoms – when breastfeeding are long breaks, the hypoglycemic syndrome is developed with loss of consciousness up to coma. Glucose introduction resulted in the coma goes away, but hyperglycemia persists for a long time.
What is the probable diagnosis?
A. Galactosuria
B. Aglycogenosis
C. Fructosuria
D. Diabetes
E. Girke disease
Define the class of carbohydrates of glycogen:
A. Heteropolysaccharides
B. Homopolysaccharides
C. Dextrans
D. Monosaccharides
E. Disaccharides
What is enzyme defect causes this disease?
A. Glycogen synthase
B. Glycogen synthase
C. Glycogen phosphorylase
D. Glycogendehydrogenase
E. Glycogendephosphorylase
10. A 67-year-old man has intense pain, redness, and “heat” in the joints. With palpation in the connective tissue, solid, cone-like painful buildups are found. Laboratory tests of blood revealed increased levels of uric acid, leukocytosis, and elevated levels of creatinine.
What is the probable diagnosis?
A. Osteoporosis
B. Gout
C. Osteosarcoma
D. Lesch-Nihena syndrome
E. Rheumatoid arthritis
Substrate for uric acid synthesis is:
A. Ammonia
B. Purine
C. Pyrimidines
D. Urea
E. Ketone bodies
11. A little girl was stung by a bee. Three minutes later it resulted in trouble breathing, coughing, hypotension, impaired consciousness, and edema.
What is medical care against anaphylactic shock?
A. Artificial respiration
B. Injection of antihistamine
C. Adrenaline injection
D. Dopamine injection
E. Insulin injection
What is the substrate for histamine synthesis?
A. Glutamate
B. Glycine
C. Histidine
D. Tyrosine
E. Glutathione
Define the class of histamine:
A. Biogenic imine
B. Biogenic amines
C. Amino Acid
D. Neuromodulators
E. Ketoacid
12. A 6-month-old child is hospitalized with frequent vomiting. It is known that vomiting occurs mainly after eating. The child has a low weight and physical development. After adding FeCl3 urine sample changes to green color. Phenyl lactate (high concentration) is found in the urine.
A probable diagnosis:
A. Alcaptonuria
B. MacArdla disease
C. Girke disease
D. Phenylketonuria
E. Measles disease
Phenyl lactate is synthesized from:
A. Phenylethylamine
B. Phenylalanine
C. Phenylserine
D. Lactate
E. Tyrosine
13. A man came to the ambulance with complaints of shingles, with localization in the right or left hypochondria. He has nausea, vomiting also. Bile was observed in the vomitus. The ambulance doctors recorded body hyperthermia (more than 38°C), heart rate is over 90 bpm, high respiration, low blood pressure (less than 90 mm / Hg). Laboratory tests showed increased activity of lipase (10 times more), amylase, and peptidase.
A probable diagnosis is:
A. Food poisoning
B. Acute pancreatitis
C. Cholelithiasis
D. Renal colic
E. Appendicitis
Specify class of endopeptidase:
A. Carboxypeptidase, aminopeptidase
B. Pepsin, trypsin, chymotrypsin
C. Pepsin, Trypsin, Aminopeptidase
D. Elastase, trypsin, aminopeptidase
E. Chymotrypsin, elastase, carboxypeptidase
Specify class of exopeptidase:
A. Pepsin, trypsin, chymotrypsin
B. Carboxypeptidase, aminopeptidase
C. Chymotrypsin, elastase, carboxypeptidase
D. Pepsin, Trypsin, Aminopeptidase
E. Elastase, trypsin, aminopeptidase
Name the place of amylase synthesis:
A. liver, pancreas
B. Saliva, liver
C. Saliva, pancreas
D. Pancreas, stomach
E. Intestine, liver
14. A 38-year-old woman was hospitalized at the clinic. She has a moonlike purple-blush face, abdominal obesity, but her limbs are thin. Examination of the body has shown acne on the skin. There are purple-bluish stretch bands on the abdomen, shoulder, and buttocks. Laboratory tests revealed a high level of glucose and glucocorticoid in the blood.
Your probable diagnosis:
A. Wernicke-Korsakov disease
B. Itsenko-Cushing syndrome
C. Measles disease
D. Wilson-Konovalov disease
E. Girke disease
Name the place of glucocorticoid synthesis:
A. Mesh area of the adrenal cortex
B. Hypothalamus
C. The glomerular zone of the adrenal cortex
D. Beam zone of the adrenal cortex
E. Pituitary
Specify glucocorticoids:
A. Aldosterone, cortisone
B. Cortisol, aldosterone
C. Cortisol, cortisone
D. Corticosterone, aldosterone
E. Aldosterone, desoxycortone
15. A woman was admitted to the hospital with irritability, irascibility, discontent with everything, and depression. There is a preference for salty and sour foods in history, thirst, drinking plenty of fluids, and tetany (especially after milk-drinking). The content of 17 hydroxy and 17 keto steroids, as well as aldosterone, is sharply reduced in the urine. The pressure is low. There is dehydration, hypoglycemia.
Your probable diagnosis:
A. Girke disease
B. Measles disease
C. Addison’s Disease
D. McArdle’s Disease
Itsenko-Cushing disease
Place of mineralocorticoid synthesis:
A. Beam zone of the adrenal cortex
B. Hypothalamus
C. The glomerular zone of the adrenal cortex
D. Mesh area of the adrenal cortex
E. Pituitary
Mineralocorticoids are:
A. Cortisol, cortisone
B. Aldosterone, desoxycortone
C. Cortisol, aldosterone
D. Corticosterone, aldosterone
E. Aldosterone, cortisone
16. A newborn child has dark urine upon contact with air, dark skin pigmentation, and sclera, osteoarthritis, nephrolithiasis, hoarseness, and dysphagia. There is a large amount of homogentisic acid in the urine.
Name the disease:
A. Phenylketonuria
B. Alcaptonuria
C. Girke disease
D. MacArdla disease
Measles disease
Specify the defective enzyme:
A. Homogentisic acid hydratase
B. Dehydratase homogentisic acid
C. Homogentisic acid oxidase
D. Homogentisic acid dehydrogenase
E. Homogentisinic acid decarboxylase
Homogentisic acid is synthesized from:
A. Valina
B. Glycine
C. Finalalanine
D. Tyrosine
E. Proline
17. At patient was found “abnormal proteins” in the blood plasma. The total protein content is 100-160 g/l. Proteins are also found in the urine, (called “Ben-Jones protein bodies”).
A probable diagnosis is:
A. Glomerulonephritis
B. Myeloma
C. Pyelonephritis
D. Cholecystitis
E. Pancreatitis
The increase of pathological proteins in plasma is named:
A. Hypoproteinemia
B. Paraproteinemia
C. Patoproteinemia
D. Normoproteinemia
E. Hyperproteinemia
18. Men presented with hypoacid gastritis and pancreatitis (inflammation of the pancreas). From the biochemical laboratory brought the results of the analysis of total protein in the blood.
What result will this patient have?
A. Hyperproteinemia (100 g / l)
B. Hypoproteinemia (30 g / l)
C. Hyperproteinemia (180 g / l)
D. Paraproteinemia
E. Protein content will be normal
19. The patient has extensive burns to the body. Biochemical examination revealed some amount of total protein in the blood.
What result will have this patient?
A. Hypoproteinemia (30 g / l)
B. Hyperproteinemia (100 g / l)
C. Hypoproteinemia (50 g / l)
D. Paraproteinemia
E. Protein content will be normal
20. The patient has a decreased level of serum albumin and fibrinogen. The content of beta and gamma globulins is increased as a result of irritation of the reticulo-endothelium. The total protein content increased by 9-10% (due to globulins).
Define the most likely cause of these symptoms:
A. Kidney pathology
B. Liver pathology
C. Intestinal pathology
D. Pathology of the blood coagulation system
E. Pathology of the pancreas
Beta globulin proteins are:
A. Transcortin, prothrombin, antiplasmin
B. Transferrin, hemopexin, lactoferrin
C. Albumin, immunoglobulins, transferrin
D. Albumin, hemopexin, lactoferrin
E. Immunoglobulins, hemopexin, lactoferrin
Gamma globulin proteins are:
A. Plasminogen
B. Immunoglobulins
C. Albumins
D. Vitamin B12 binding protein
E. Fibrinogen
21. Prozerin is used for myasthenia, after encephalitis, meningitis, CNS injuries. The protein binds with the active center of acetylcholinesterase and blocks it, which leads to enhancement of acetylcholine action on organs and tissues and neuromuscular conduction also.
Name the type of inhibitor:
A. Irreversible Inhibitor
B. Reversible inhibitor
C. Suicide inhibitor
D. Uncompetitive inhibitor
E. Competitive inhibitor
22. The patient has polyuria, polydipsia, and sleep disturbance. The relative density of urine -1,001 to 1,003 (is low). Urine excretion  – 5 to 20 liters/day (is high). The content of glucose in the blood is 5.0 mmol/l, there is no glucose in the urine. Computed tomography revealed damage in the hypothalamus.
A probable diagnosis is:
A. Gestational diabetes
B. Diabetes insipidus
C. Steroid diabetes
D. Insulin-dependent diabetes mellitus
E. Non-insulin-dependent diabetes mellitus
Polyuria is excessive urination volume:
A. up to 1000 – 1500 ml
B. over 1800 to 2000 ml
C. below 1000 – 1500 ml
D. below 200 ml
E. below 500 ml
23. An infant often has seizures and he has increased the size of the liver. There are elevated levels of lactate and pyruvate and hypoglycemia in the blood. With the injection of adrenaline glucose in the blood does not increase; the number of lactic acid increases. Liver biopsy revealed a reduced activity of glucose-6-phosphatase.
Your probable diagnosis:
A. Alcaptonuria
B. Girke disease
C. Phenylketonuria
D. MacArdla disease
E. Measles disease
What reaction is catalyzed with glucose-6-phosphatase?
A. glucose to glucose 6-phosphate
B. glucose-6-phosphate in fructose-6-phosphate
C. glucose-6-phosphate to glucose
D. glucose to glucose-1,6-biphosphate
E. fructose-6-phosphate to glucose-6-phosphate
24. A fire sufferer was taken from a burning house. He has no burn but was unconscious due to carbon monoxide poisoning.
Explain the cause of persistent unconsciousness. Carbon monoxide forms:
A. Oxyhemoglobin
B. Carboxyhemoglobin
C. Carbhemoglobin
D. Methemoglobin
E. Fetal hemoglobin
Which of hypoxia is formed due to carbon monoxide:
A. Tissue (histotoxic)
B. Respiratory (respiratory)
C. Hemic (blood)
D. Cardiovascular (circulatory)
E. Mixed
25. A patient was hospitalized with complaints of sharp abdominal pain, weakness, chills, and no stool for four days. Urine is green, with a high content of animal indican.
Indican is synthesized from:
A. Skala
B. Indole
C. Cresola
D. Putrescine
E. Cadaverine
Precursor amino acid of indicant is:
A. Tyrosine
B. Valin
C. Tryptophan
D. Glycine
E. Phenylalanine
26. The patient is hospitalized with generalized edema. Laboratory data of blood serum: hyperlipidemia (cholesterol is more than 6.5 mmol/l), total protein – 30 g/l (norm is 65-85 g/l), albumin – 10 g/l (norm is 35-50 g/l). Protein excretion with urine is 18 g/l (norm – less than 0.5 g/l).
What is the probable diagnosis?
A. Abstinence syndrome
B. Korsakov syndrome
C. Chinese Restaurant Syndrome
D. Nephrotic syndrome
E. Urinary syndrome
27. In a patient’s blood test   the following indicators are found: ALT activity (alanine aminotransferase) – 150 U/l (normal up to 53 U / l), AST activity (aspartate aminotransferase) – 40 U/l (normal up to 47 U/l), gamma activity – glutamyltranspeptidase (GGTP) – 92 U/l (the norm is up to 54 U/l).
A probable diagnosis is:
A. Nephrotic syndrome
B. Liver obstructive lesions
C. Abstinence syndrome
D. Urinary syndrome
E. Korsakov syndrome
28. A patient complains of fever, weakness, sweating, chest pain, short wind, cough with sputum (mucous and purulent). Laboratory tests showed: a high level of ESR (erythrocyte sedimentation rate), neutrophilic leukocytosis with left upper shift (the proportion of immature neutrophils increases due to proliferation), the elevation of monocytes, and decrease of lymphocytes. To confirm the inflammatory process, the diagnosis of “acute phase proteins” was assigned.
These proteins level ( means proteins of the acute phase of inflammation) will increase
1000 times more (for 6-10 hours):
A. C-reactive protein, albumin
B. C-reactive protein, serum amyloid
C. C-reactive protein, transferrin
D. Serum amyloid, transferrin
E. Serum amyloid, albumin

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