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100+ Free CMSA FC Path(SA) Chemical Pathology Practice Questions

Fellowship of the College of Pathologists of South Africa — Chemical Pathology practice questions are available now; exam metadata is being verified.

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Sample CMSA FC Path(SA) Chemical Pathology Practice Questions

Try these sample questions to test your CMSA FC Path(SA) Chemical Pathology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 45-year-old male with severe diarrhoea presents with serum sodium 138 mmol/L, potassium 3.1 mmol/L, chloride 112 mmol/L, and bicarbonate 14 mmol/L. What is the serum anion gap in mmol/L?
A.8
B.12
C.16
D.20
Explanation: The serum anion gap is calculated as [Na+] − ([Cl-] + [HCO3-]). Substituting the given values: 138 − (112 + 14) = 138 − 126 = 12 mmol/L. A gap of about 12 mmol/L is normal and fits hyperchloraemic metabolic acidosis from gastrointestinal bicarbonate loss in severe diarrhoea.
2A 52-year-old man with type 2 diabetes presents with confusion. Serum sodium 128 mmol/L, glucose 38 mmol/L. Using the correction of 2.4 mmol/L per 10 mmol/L glucose above 5.6 mmol/L, what is the corrected sodium in mmol/L?
A.132
B.134
C.136
D.138
Explanation: Corrected Na+ = measured Na+ + 2.4 × (glucose − 5.6)/10 = 128 + 2.4 × 32.4/10 = 128 + 7.8 ≈ 136 mmol/L, indicating mild true hyponatraemia beyond pseudohyponatraemia from hyperglycaemia.
3A patient with ethylene glycol poisoning has serum sodium 140 mmol/L, glucose 5 mmol/L, urea 6 mmol/L, and measured serum osmolality 360 mOsm/kg. Estimated osmolality (2×Na + glucose + urea) is 292 mOsm/kg. What is the osmolal gap in mOsm/kg?
A.48
B.58
C.68
D.78
Explanation: Osmolal gap = measured osmolality − calculated osmolality = 360 − 292 = 68 mOsm/kg. An elevated osmolal gap (>10–15 mOsm/kg) with high anion gap metabolic acidosis suggests toxic alcohol ingestion.
4Arterial blood gas: pH 7.28, PaCO2 22 mmHg, HCO3− 10 mmol/L. Using Winter's formula, what is the expected PaCO2 (±2 mmHg)?
A.18–22 mmHg
B.22–26 mmHg
C.26–30 mmHg
D.30–34 mmHg
Explanation: Winter's formula: expected PaCO2 = 1.5 × [HCO3−] + 8 (±2) = 1.5 × 10 + 8 = 23 mmHg (range 21–25). Measured PaCO2 of 22 mmHg indicates appropriate respiratory compensation for primary metabolic acidosis.
5A patient with diabetic ketoacidosis has Na+ 140, Cl− 100, HCO3− 10 mmol/L. What is the serum anion gap in mmol/L?
A.20
B.24
C.28
D.30
Explanation: Anion gap = [Na+] − ([Cl−] + [HCO3−]) = 140 − 110 = 30 mmol/L, consistent with high anion gap metabolic acidosis in DKA.
6In metabolic acidosis, anion gap is 24 mmol/L (baseline 12) and bicarbonate fell from 24 to 12 mmol/L. What is the delta ratio (ΔAG/ΔHCO3−)?
A.0.5
B.1.0
C.1.5
D.2.0
Explanation: Delta ratio = (24−12)/(24−12) = 12/12 = 1.0, indicating pure high anion gap metabolic acidosis. Ratios <0.4 suggest concurrent normal AG acidosis; >2 suggest concurrent metabolic alkalosis.
7A 70-year-old on thiazides has Na+ 118 mmol/L, serum osmolality 250 mOsm/kg, urine osmolality 450 mOsm/kg. Which diagnosis is most likely?
A.Psychogenic polydipsia
B.SIADH
C.Diabetes insipidus
D.Addison disease
Explanation: Hyponatraemia with inappropriately concentrated urine (>100 mOsm/kg) in a euvolaemic patient suggests SIADH or thiazide-associated hyponatraemia. Psychogenic polydipsia causes dilute urine; DI causes hypernatraemia; Addison causes hyperkalaemia and volume depletion.
8Which finding best distinguishes renal tubular acidosis from diarrhoea as the cause of hyperchloraemic metabolic acidosis?
A.Urine pH >5.5 in type 1 RTA despite systemic acidosis
B.Urine anion gap >0 in diarrhoea
C.Urine potassium <20 mmol/L in all RTA types
D.Urine osmolality <100 mOsm/kg in RTA
Explanation: In distal (type 1) RTA, the kidney cannot acidify urine despite systemic acidosis (urine pH >5.5). In diarrhoea, appropriate renal acid excretion produces urine pH <5.5 and negative urine anion gap.
9A patient has potassium 6.8 mmol/L with peaked T waves. Which treatment lowers serum potassium fastest by intracellular shift?
A.Calcium gluconate IV
B.Insulin-dextrose infusion
C.Sodium polystyrene sulfonate
D.Calcium resonium enema
Explanation: Insulin with dextrose drives K+ intracellularly via Na+/K+-ATPase, producing the fastest reduction in extracellular K+. Calcium gluconate stabilises myocardium but does not lower K+. Resonium removes K+ via the gut over hours.
10Serum albumin 20 g/L, total calcium 1.95 mmol/L. Using correction (add 0.02 mmol/L per 1 g/L albumin below 40 g/L), what is corrected calcium in mmol/L?
A.2.15
B.2.25
C.2.35
D.2.45
Explanation: Corrected Ca = 1.95 + 0.02 × (40−20) = 1.95 + 0.40 = 2.35 mmol/L, revealing true hypocalcaemia masked by hypoalbuminaemia.

About the CMSA FC Path(SA) Chemical Pathology Practice Questions

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