This Copy is for Dr.

Mohamed ElHodiby
 STRATOG 2015 SBA

Bio-Chemistry
Question 1 of 46

A 54yearold woman presents to her GP with malaise, a history of recent weight loss and
bloating. On examination the GP notes a large pelvic mass. He sends her for an urgent
abdminal ultrasound scan and initiates a 2weekwait referral. What tumour marker would be
most useful to aid the diagnosis in this case?

A aFP
B CA 153
C CA 199
D CA125 Correct
E HCG

The best answer is CA125

Question 2 of 46

Reduction of Fe3+ to Fe2+ is inhibited by which of the following.

A Gastric acid
B Tea Correct
C Vitamin B1
D Vitamin C
E Vitamin E

The correct answer is tea.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 3 of 46

Which of the following coagulation factor decreases in pregnancy.

A Factor I
B Factor VII
C Factor VIII
D Factor X
E Factor XI Correct

The correct answer is Factor XI.

Question 4 of 46

Which of the following best describes the complement system?

A It consists of a series of approximately 60 serum glycoproteins

B The major function of the complement system is to remove and destroy antigens Correct
C The most abundant complement is C4
D The alternative pathway is initiated by binding of antibody to antigen
E The classic pathway does not require any antibody

The correct answer is the major function of the complement system is to remove and destroy
antigens.

Question 5 of 46

With regards to vitamin D metabolism, what food is particularly high in D2?

A Bananas
B Beef
C Oily fish Correct
D Soya milk
E Wheat

The correct answer is oily fish.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 6 of 46
Where in the body is the major production of 1,20 (OH) D3 (calcitriol)?

A Bone
B Kidneys Correct
C Liver
D Lung
E Parathyroids

The correct answer is the kidneys.

Question 7 of 46

With regard to bound plasma calcium, what is the major carrier?

A Calciprotein transfer molecule 1 (CTM 1)

B Haemoglobin
C Neutrophils
D Plasma proteins Correct
E SHBG

The correct answer is plasma proteins.

Question 8 of 46

With regard to plasma calcium, what proportion is carried in an ionised form?

A 1%
B 5%
C 45% Correct
D 75%
E 78%

The correct answer is 45%.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 9 of 46

What is the major production mechanism of 2,3 DPG?

A Anaerobic metabolism in smooth muscle

B Gluconeogenesis
C Glycolysis Correct
D Only in the liver
E Suprarenal glands

The correct answer is glycolysis.

Question 10 of 46

What is the major hydrogen ion buffer in blood?

A Albumin
B Bicarbonate
C Haemoglobin Correct
D Phosphate
E Uric acid

The correct answer is haemoglobin.

Question 11 of 46

Where is the chloride shift phenomenon seen?

A Distal convoluted tubules

B Glomerulus
C Platelets
D Red blood cells Correct
E White blood cells

The correct answer is red blood cells.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 12 of 46

What coagulation factors are reduced in pregnancy?

A III, IV
B IX, X
C V, VII
D XI, XII
E XI, XIII Correct

The correct answers are XI and XIII. the main changes in haemostasis factors during pregnancy
are:

Question 13 of 46

What factor shifts the O2 dissociation curve to the right (i.e., reduces Hb affinity for 02)?

A Decreased CO2 concentration

B Decreased hydrogen ion concentration
C Increased 2,3 DPG Correct
D Increased sodium concentration
E Reduced temperature

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
The correct answer is increased 2,3 DPG.

Question 14 of 46

What is the average haemoglobin concentration in a newborn at term?

A 10 g/dl
B 12 g/dl
C 15 g/dl
D 17 g/dl Correct
E 25 g/dl

The correct answer is 17 g/dl.

Question 15 of 46

What is the coagulation factor number for fibrinogen?

A Factor I Correct
B Factor II
C Factor IV
D Factor V
E Factor X

The correct answer is factor I.

Question 16 of 46

What is the primary source of negatively charge ions in the blood?

A Ammonium and chloride

B Bicarbonate and ammonium
C Bicarbonate and chloride Correct
D Phosphate and bicarbonate
E Phosphate and chloride

The correct answer is bicarbonate and chloride.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 17 of 46

With regard to transport in the red blood cells, what ion enters the cell to maintain electrical
neutrality with the outward movement of bicarbonate?

A Ammonia
B Ammonium
C Chloride Correct
D Potassium
E Sodium

The correct answer is chloride.

Question 18 of 46

Bicarbonate is reabsorbed in what part of the kidney?

A Collecting ducts
B Distal convoluted tubules
C Glomerulus
D Loop of Henle
E Proximal convoluted tubules Correct

The correct answer is the proximal convoluted tubules.

Question 19 of 46

What is the main buffer in urine?

A Ammonia
B Bicarbonate
C Chloride
D Haemoglobin
E Phosphate Correct

The correct answer is phosphate.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
Question 20 of 46

Ammonia is made from what amino acid in the kidney?

A Arginine
B Glutamine Correct
C Histidine
D Lysine
E Serine

The correct answer is glutamine. Remember glutaminase!

Question 21 of 46

What is the most important buffer in the interstitial space?

A Ammonia
B Bicarbonate Correct
C Chloride
D Phosphate
E Plasma proteins

The correct answer is bicarbonate.

Question 22 of 46

What type of acid base disturbance is indicated by the following?

 pH: 7.2 (7.35 7.45)

 PaCO2: 4.2 kPa (4.5 6.0)
 BE: 18 (2+2)

A Bicarbonate renal excess

B Metabolic acidosis
C Metabolic alkalosis
D Respiratory acidosis Correct

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 STRATOG 2015 SBA
E Respiratory alkalosis

The correct answer is respiratory acidosis.

Question 23 of 46

With regard to Conns syndrome, what are the likely changes in pH, potassium and sodium
concentration?

A Hypernatraemia, hyperkalaemia, alkalosis Correct

B Hypernatraemia, hypokalaemia, acidosis
C Hypernatraemia, hypokalaemia, alkalosis
D Hyponatraemia, hyperkalaemia acidosis
E Hyponatraemia, hypokalaemia, acidosis

The correct answer is hypernatraemia, hypokalaemia, alkalosis.

Question 24 of 46

Where in the body is ATP found?

A Both intracellular and extracellular

B Only extracellular
C Only intracellular Correct
D Only within high energy output cells
E Only within mitochondria

The correct answer is only intracellular.

Question 25 of 46

What is the product of aerobic glycolysis?

A Free fatty acids

B Glycogen
C Lactate
D Pyruvate Correct

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 STRATOG 2015 SBA
E Urea

The correct answer is pyruvate.

Question 26 of 46

Which cells in the body are dependent upon anaerobic respiration?

A Cardiac muscle
B Hepatocytes
C Nephrons
D Red blood cells Correct
E White blood cells

The correct answer is red blood cells.

Question 27 of 46

What is the action of cytochrome P450 enzymes?

A Always acts an isomerase

B Always acts as a transferase
C Always adds an alcohol group
D Always adds a terminal electron
E Always catalyses hydroxylations

The correct answer is always catalyse hydroxylations.

Question 28 of 46

With regard to the oxygen dissociation curve, which factor increases the percentage of
oxygen saturation for the same partial pressure of oxygen available, shifting the curve to the
left?

A Hypoxia
B Hypercapnoea
C Heat
D Anaemia

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 STRATOG 2015 SBA
E Alkalosis Correct

The answer is Alkalosis. All the other options shift the curve to the right, in promoting the
release of oxygen to the tissues that need it.

Question 29 of 46

HbA1C is a marker of diabetic control over what time period?

A 10–12 weeks
B 8–10 weeks Correct
C 4–8 weeks
D Up to 1 week
E 48 hours

The answer is 8–10 weeks. Measurement of HbA1c is an indicator of glycaemic control over the
previous 8–10 weeks, and is used to monitor patients with type I diabetes. It should not be used
as a diagnostic test for type I diabetes.

Question 30 of 46

An active 70yearold woman is admitted to the gynaecology clinic for a sling procedure with
a known history of Paget’s disease of the bone. Which biochemical findings are most likely?

A Reduced calcium, reduced phosphate and elevated alkaline phosphatase

B Reduced calcium, elevated phosphate and elevated alkaline phosphatise
C Normal calcium, normal phosphate and elevated alkaline phosphatase Correct
D Elevated calcium, reduced phosphate and reduced alkaline phosphatise
E Elevated calcium, elevated phosphate and elevated alkaline phosphatise

The answer is Normal calcium, normal phosphate and elevated alkaline phosphatase. Calcium
and phosphate are usually normal but alkalaline phosphatase is often highly elevated.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

Question 31 of 46

Chronic renal failure can produce what effect on the parathyroid system?

A Tertiary hyperparathyroidism
B Secondary hyperparathyroidism Correct
C Pseuohypoparathyroidism
D Primary hyperparathyroidism
E Hypoparathyroidism

The answer is Secondary hyperparathyroidism. Chronic renal failure is the most common cause
of secondary hyperparathyroidism. Other causes include chronic pancreatitis and small bowel
disease.

Question 32 of 46

Which biochemical process creates pyruvate as an energy supply?

A The citric acid cycle

B Oxidative deamination
C Gluconeogenesis
D Glycolysis Correct
E Beta oxidation

The answer is Glycolysis. Glycolysis converts monosaccharides into pyruvate before conversion
to acetyl coenzyme A. This then fuels the citric acid cycle. It is particularly helpful because it
does not require oxygen. Gluconeogenesis is metabolic pathway resulting in generation of
glucose from noncarbohydrate substrates such as lactates,glycerol and aminoacids. Beta
oxidation involves fatty acid breakdown in mitochondria to generate acyl CoA .

Question 33 of 46

Which electrolyte has a role in maintaining intracellular fluids, helping the regulation of pH
and establishing resting membrane potential of the cells?

A Sodium
B Potassium Correct
C Chloride

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 STRATOG 2015 SBA
D Calcium
E Bicarbonates

The answer is Potassium. Hypokalaemia may be caused by inadequate replacement by

intravenous therapy, insulin therapy, vomiting and diarrhoea. It is commonly associated with
paralytic ileus. Sodium has a key role in fluid balance. It contributes half the osmolarity of the
extracellular fluid. Calcium has a main role in excitable cells, neurotransmitter release and
blood clotting.

Question 34 of 46

Which body fat has a major role in gene transcription?

A Triglycerides
B Phospholipids
C Membrane phospholipids
D Fatty acids Correct
E Eicosanoids

The answer is Fatty acids. The eicosanoids have a role in hormone synthesis. The phospholipids
are involved in membrane formation. Membrane phospholipids are broken down to second
messengers when the hormone binds to its receptor.

Question 35 of 46

Which structure synthesises alphafetoprotein in a fetus?

A Spleen
B Placenta
C Pancreas
D Kidney
E Gut Correct

The answer is the Gut. Alphafetoprotein is synthesised by three fetal structures: the gut, the
liver and the yolk sac. It is a glycol protein. It may be elevated in the case of an anterior
abdominal wall and neural tube defect. As these defects are not covered by skin, AFP freely
enters the amniotic fluid from the fetal circulation, thus leading to elevation of levels.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

Question 36 of 46

A 14yearold child presents to the adolescent gynaecology clinic. She has a history of virilisation
after undergoing pubertal changes. The karyotype reveals 46XY. An ultrasound scan does not
show the presence of a uterus and ovaries. Which enzyme deficiency may be associated with
these clinical features?

A Turner syndrome
B Polycystic ovary syndrome
C Kallmann syndrome
D Complete androgen insensitivity syndrome
E 5 alpha reductase deficiency Correct

The answer is 5alphareductase deficiency. Turner syndrome is 45 XO. Polycystic ovarian

syndrome has a normal female karyotype. The child described above is genetically male.
However, testosterone is not converted to dihydrotestosterone in target tissues.
Fivealphareductase deficiency prevents conversion of androgen to estrogen. The child may
have been born with ambiguous genitalia and raised as a female. At puberty, elevated levels of
androgen lead to masculinisation including virilisation. Complete androgen insensitivity is not
the answer because increased androgens are converted to estrogen and do not show any
virilisation. It involves phenotypic females and an unresponsiveness to androgens.Kalman's
syndrome is a form of hypogonadotropic hypogonadism and anosmia.

Question 37 of 46

In a pregnant woman with diabetes mellitus, target levels of HbA1C should be below what
level?
A 12.1%
B 10.1%
C 8.1%
D 6.1% Correct
E 4.1 %

The answer is 6.1%. Diabetic women should be managed by a specialised multidisciplinary

team. There should be an increased frequency of self monitoring and monthly checks of HbA1c

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 STRATOG 2015 SBA
levels. The aim is to achieve optimum control with the levels of HbA1c below 6.1%. Maternal
and fetal risks are reduced with decreasing HbA1c levels. However, rapid reduction is not
advisable. If the levels are above 10%, pregnancy is not recommended.

Question 38 of 46

Your consultant has asked you to send a urea and electrolytes test (U&E) for a
postoperative patient who had undergone transcervical resection of fibroids. Which
particular blood tests should you be specifically worried about?

A Increased serum osmolality

B Hypovolaemia
C Hyponatraemia Correct
D Hypokalaemia
E Hypernatremia

The answer is Hyponatraemia. Absorption of large amounts of glycine is associated with

hypervolaemia, hyponatraemia and reduced osmolality. The term was coined as TURP
syndrome. The patient initially becomes restless, and complains of headache. Sodium levels
below 120mEq/L cause cardiac depression. Level less than 115mEq/L is associated with
bradycardia, widening of QRS complex and T inversion. Level below 105mEq/L is associated
with respiratory and cardiac arrest. It is essential to log input versus output in transcervical
resection of fibroid cases. A loss of more than 1.5 L is associated strongly with TURP syndrome.

Question 39 of 46

You have been asked to review an asymptomatic patient in the early pregnancy unit.
Ultrasound scan is negative for pregnancy. βhCG levels over 48 hours are 550 and 350, and
serum progesterone levels are 17 nmol. What is the most likely finding?

A Viable pregnancy
B Nonviable pregnancy with the possibility of spontaneous resolution Correct
C High risk of ectopic pregnancy needing intervention for treatment
D Failing pregnancy
E Ectopic pregnancy

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA
The correct answer is Nonviable pregnancy with the possibility of spontaneous resolution.
Serum progesterone levels are useful adjuncts in the diagnosis of pregnancy of unknown
location. Levels below 1525 are indicative of non viable pregnancy. Results below 20nmol/l are
associated with spontaneous resolution with sensitivity of 93% and specificity of 94%. Levels
above 60 strongly indicate development into normal pregnancy in the future. Serum hCG levels
are useful in localising pregnancy while serum progesterone helps with the prognosis.

Question 40 of 46

Which ketone bodies can be used as an energy supply for the brain in starvation?

A Succinate
B Choline
C Acetoacetate Correct
D Acetone
E Acetyl CoA

The answer is Acetoacetate. Acetone is also a ketone body but is not used for energy. It is
excreted in urine and is also exhaled in the breath.

Question 41 of 46

Ribosomes are located in which part of the cell?

A Smooth endoplasmic reticulum

B Rough endoplasmic reticulum Correct
C Mitochondria
D Lysosomes
E Golgi complex

The answer is Rough endoplasmic reticulum. Ribosomes 'read' the messenger RNA created
from the nuclear DNA and translate it to create proteins via transfer RNA. There are free
ribosomes in the cytoplasm of cells but they are in abundance in the rough endoplasmic
reticulum.

Question 42 of 46

Which of the following molecules generates weak forces that can attract neutrophils to cell

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 STRATOG 2015 SBA
walls?

A Selectins Correct
B Integrins
C Hemidesmosomes
D Eicosanoids
E Cadhedins

The answer is Selectins. Selectins are molecules that are expressed in endometrial cell walls and
also leucocytes. They generate weak attraction forces. Inflammatory processes via interleukins
increase the amount of selectins present and hence, attract more leucocytes.

Question 43 of 46

Which biochemical technique is used to detect the presence and the amount of a protein?

A Xray-crystalography
B Western blotting Correct
C Southern blotting
D Polymerase chain reaction
E Northern blotting

The answer is Western blotting. Southern blotting (named after Edwin Southern) is used to
detect particular sequences to DNA. Northern blotting is used for the same reason but for RNA.
Polymerase chain reaction is used to amplify very small amounts of DNA (although it can be
used for RNA if converted to DNA). Xray crystallography is used to reveal the structure of
nucleic acids such as DNA and RNA.

Question 44 of 46

Which part of the cell cycle is noted for sister chromatids separating and moving to opposite
sides of the cell?

A Telophase
B Synthesis phase
C Prophase
D Metaphase
E Anaphase Correct

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 STRATOG 2015 SBA
The answer is Anaphase. Within the cell cycle DNA replication occurs in the synthesis phase
before entering the Gap 2 phase. Mitosis starts with chromosomes condensing (prophase)
follow by chromatids aligning (metaphase), following by sister chromatids separating and
moving (anaphase). Finally the cell membrane divides in telophase.

Question 45 of 46

Which of the following blood clotting factors activates fibrinogen in the common pathway?

A Prothrombin Correct
B Kinin
C Kallikrein
D Factor XIII
E Factor VIII

The answer is Prothrombin. Accelerin (V) stimulates activation of prothrombin (II) to thrombin
(II), which activates fibrinogen (I) to form fibrin clot. This is stabilised by cross linking with the
aid of fibrinstabilising factor (XIII). Remember heparin increases the rate of complex formation
of antithrombin III, which inactivates thrombin.

Question 46 of 46

Which of the following amino acid bases is not contained in RNA?

A Uracil
B Thymine Correct
C Guanine
D Cytosine
E Adenine

The answer is Thymine. In RNA the thymine is replaced by uracil. The other bases (adenine,
cystosine and guanine) remain the same.

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

This Copy is for Dr. Mohamed ElHodiby

 STRATOG 2015 SBA

This Copy is for Dr. Mohamed ElHodiby