Spotters MBBS II Nov6 2022

Department of Biochemistry
Kathmandu Medical College, Basic

Sciences, Duwakot
Practical Examination
MBBS II
-
Read the Instructions carefully
You will be given 10 spotter questions, each carrying
two marks
. For each question, the allocated time is 2 minutes
I. Maintenance of silence in the examination room as
well as in the laboratory is must
V. Mobile phones, if found, will not be returned.
V. The decisions taken by the department regarding
examination discipline are final and non-negotiable.
Spot 1
A 2-year old girl was brought to KMCTH by their parents with the
clinical features of vague ill health for the last 5 weeks. Now she is
anorexic, fatigue, has low grade fever, headache, drowsiness and
nuchal rigidity. CSF findings are as follows-
Lab test Patient’s report Normal range
CSF Clear, hazy Clear
Leucocyte count Raised 0-5/mm3
Proteins (lymphocytic)
450 mg/dL 15-45 mg/dL
Glucose 35 mg/dL 45-100 mg/dL
Formation of Cobweb when left over 12hrs
ZN stain revealed acid-fast bacilli.
i. Give the probable diagnosis
ii. Explain the basis for your diagnosis
Spot 2
• A 17-year-old women presented with a two month history of tiredness
and lethargy. She noticed that she has pigmentation of the buccal
- -
mucosa. Her blood pressure was 90/50 mmHg when she stood up. Her
-
biochemical findings are:

Reference range
Serum sodium: 128 mmol/L (135-145) de
Serum potassium: 5.4 mmol/L (2.5-3.5) A
Fasting blood glucose: 2.5 mmol/L (3.8-6.1) L
Plasma cortisol (at 8:00 AM): 150 nmol/L (280-720) ↓
Plasma ACTH (at 8:00 AM): 400 ng/L (<50 ng/L) M
(Anti-adrenal antibodies were detected at high concentration)
disease
i. What is the probable diagnosis? Addison's Hypothalamum
feedback
⑦
a cortisol - pituitary
ii. Why is there rise in plasma ACTH? ve
a
Spot 3
A bedridden patient has the following clinical
laboratory data.
Reference range
a)Serum total bilirubin = 8 mg% (0.2 – 1 mg%) E
b)Conjugated bilirubin = 5.2% (0.0 – 0.2 mg%) d
c)Serum ALP = 126 IU/L (40 – 125 IU/L) ⑰
d)Serum AST = 90 IU (8 – 20 IU/L) Ma Iliver damage
e)Serum ALT = 105 IU (10 – 35 IU/L) ↑*
f)Blood Albumin = 2.8 gm/dl (3.5- 5.5 gm/dl) ↓ chronic
• Name the condition. (0.5) chronic hepatitis

• Explain the decreased value of albumin (1.5) in this
case chronic damage- no
very less albumin production
or
Spot 4
Blood Lab Results Reference Range
Blood Glucose: 35 m mol\ L (3.6-6.0) ↑ - hyperglycemia
Acetoacetate: 2.8 m mol\ L (< 2.0) ↑ ketonemic
-
Urea: 7m mol\ L (2.9-8.4) I
Creatinine: 130 m mol\ L (60-132) *
Urine sample
Glucose: 4+ -> glycosuria
Ketone bodies: 3+ Ketonuria
->
Name the condition. Explain the presence of glucose

in urine. (0.5+1.5)
·
Diabetic ketoacidosis
seen in wine
Red
glucose, above venal threshold,
Spot 5
• A patient showed the following laboratory
findings.
a) HCO-3: 23.0m mol/L
b) K+ : 4.0 m mol/L
146
c) Cl-: 98.0 m mol/L 12 I
d) Na+: 142.0 m mol/L -
5 2
a. Calculate the anion gap from the following lab

findings. 142+ 4-98-23 25mmolk =
b. What does the value you obtained indicate? (1)

normal, metabolic
Antones present
than
(higher
(normal =
1214)
Spot 6
• A 7 year old boy is brought to a pediatrician with complaints of
episodes of fatigue, restlessness, and lightheadedness. His
symptoms appear when he does not eat frequent meals and
subside while he is eating. His lab report showed:
Hyperuricemia; Marked hypoglycemia; Hyperlipidemia; Lactic
acidosis;
Subcutaneous epinephrine administration: failed to increase
blood glucose
• What is the probable diagnosis? (0.5) WonGlenke's disease.
• Explain the hypoglycemia, and why it does not
respond to epinephrine administration? (1.5)
I
deficiency of glucose 6-phosphatase
-
& also can't occur.
glucose can't
-> be
synthesized from glycogen gluconeogenesis
liver & stimulates glycogenolysis, gluconeogenesis. Mes
->
Spinephrine binds with
Bradrenergicreceptor of here
glucagon, insulin.
O But, the enzyme
is deficient so, no use.
Spot 7
A 37 year old man presented with dark, blackened -
spots in his sclera and ear cartilage. He also

developed ochronosis as well as restriction of
-
motion. He added that his urine turned black if

left standing. His lab report :
Urine Homogentisate : high
a. Name the condition. Which pathway is affected?

Alkaptonuria, phenylalanine & tyrosine metabolism
b. Why does urine turn black on standing in the
accumulates, oxidized by polyphenol oxidase into
above case? -homogenticateacetate, &
benzoquinone polymerize form allaptone bodies
↓
blackcolor
Spot 8
Refer to the diagram right…
1. What is your diagnosis?

-> intolerance
lactose
2. Name the defective
enzyme in this case. lactase ->
3. What are the

confirmatory tests for the
diagnosis of this case. test
lactose intolerance test, He breath test, stool
acidity
->
4. Why is diarrhea caused

in this case?
-> lactose notabsorbed, so due to
bacterial action
Spot 9
• A young male of age 30 years was losing weight. He
was having rapid heart rate, nervousness, excessive
sweating, and sensitivity to heat. Blood analysis
showed very low level of TSH and high level of IgG.
- -
Free T3 was also found high.

-
Name the condition. Explain the observed levels of

TSH and T3. (0.5+1.5)
Grave's disease
Spot 10
1. Name the
instrument. (0.5)
colorimeter
2. What is its role in

Biochemistry
laboratory? (0.5)
absorbance value
-> finding the solutions
of diff
3. Write Beer’s law
(1.0) Absorbance concentration
path length
a
Absorbance &

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Department of Biochemistry

Kathmandu Medical College, Basic

biochemical findings are:

• Name the condition. (0.5) chronic hepatitis

Urea: 7m mol\ L (2.9-8.4) I

Creatinine: 130 m mol\ L (60-132) *

Name the condition. Explain the presence of glucose

a. Calculate the anion gap from the following lab

b. What does the value you obtained indicate? (1)

& also can't occur.

spots in his sclera and ear cartilage. He also

motion. He added that his urine turned black if

a. Name the condition. Which pathway is affected?

Refer to the diagram right…

1. What is your diagnosis?

3. What are the

4. Why is diarrhea caused

Free T3 was also found high.

Name the condition. Explain the observed levels of

2. What is its role in

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