Calcification MCQs With Answer

Calcification MCQs With Answer — This concise, SEO-focused introduction helps B.Pharm students master calcification concepts relevant to pharmacology, pathology, and clinical pharmacy. Covering mechanisms such as dystrophic and metastatic calcification, calcium-phosphate homeostasis, vascular smooth muscle cell osteogenic transformation, and regulatory inhibitors (pyrophosphate, fetuin-A, matrix Gla protein), these Calcification MCQs With Answer are ideal for exam prep and practical application. Expect questions on diagnostic staining (von Kossa, Alizarin red), imaging, drug-induced calcification (warfarin, calcium supplements), CKD-related mineral bone disorder, and therapeutic strategies like phosphate binders and vitamin K modulation. Clear answers reinforce learning and clinical reasoning. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What distinguishes dystrophic calcification from metastatic calcification?

• Occurs in dead or degenerated tissues with normal serum calcium
• Occurs due to high serum calcium and phosphate levels in normal tissues
• Always involves bone formation
• Is reversible with vitamin D

Correct Answer: Occurs in dead or degenerated tissues with normal serum calcium

Q2. Which histochemical stain is commonly used to detect calcium phosphate deposits in tissues?

• Periodic acid–Schiff (PAS)
• von Kossa
• Gram stain
• Prussian blue

Correct Answer: von Kossa

Q3. Which protein is a key inhibitor of vascular calcification and requires vitamin K–dependent carboxylation?

• Fetuin-A
• Matrix Gla protein (MGP)
• Osteopontin
• Alkaline phosphatase

Correct Answer: Matrix Gla protein (MGP)

Q4. In chronic kidney disease (CKD), which disturbance most directly promotes metastatic vascular calcification?

• Hypokalemia
• Hyperphosphatemia
• Low parathyroid hormone (PTH)
• Hypocalciuria

Correct Answer: Hyperphosphatemia

Q5. Which cell type can transdifferentiate into osteoblast-like cells contributing to vascular calcification?

• Endothelial cells
• Vascular smooth muscle cells (VSMCs)
• Neutrophils
• Macrophages only

Correct Answer: Vascular smooth muscle cells (VSMCs)

Q6. Which serum laboratory finding is most consistent with metastatic calcification?

• Normal calcium and phosphate
• Elevated serum calcium and/or phosphate
• Isolated elevated alkaline phosphatase with normal electrolytes
• Low serum phosphate only

Correct Answer: Elevated serum calcium and/or phosphate

Q7. Warfarin therapy can accelerate vascular calcification by inhibiting which process?

• Vitamin D activation in the kidney
• γ-carboxylation of vitamin K–dependent proteins like MGP
• Synthesis of fetuin-A in the liver
• Calcium absorption from the gut

Correct Answer: γ-carboxylation of vitamin K–dependent proteins like MGP

Q8. Which imaging modality is most sensitive for quantifying coronary artery calcification?

• Plain radiography
• Non-contrast cardiac CT (Agatston score)
• Ultrasound
• Contrast-enhanced MRI

Correct Answer: Non-contrast cardiac CT (Agatston score)

Q9. Alizarin red S staining in tissue sections indicates the presence of which substance?

• Lipid accumulation
• Calcium salts
• Iron deposits
• Collagen fibers

Correct Answer: Calcium salts

Q10. Elevated alkaline phosphatase (ALP) in the context of calcification typically reflects increased activity of which process?

• Matrix vesicle mineralization and hydrolysis of pyrophosphate
• Inhibition of calcium deposition
• Increased vitamin K levels
• Decreased osteoblast function

Correct Answer: Matrix vesicle mineralization and hydrolysis of pyrophosphate

Q11. Which of the following is a circulating systemic inhibitor of calcification produced by the liver?

• Osteocalcin
• Fetuin-A
• Bone morphogenetic protein
• Collagen type I

Correct Answer: Fetuin-A

Q12. Which genetic disorder is associated with accelerated arterial calcification due to defective elastin or connective tissue?

• Pseudoxanthoma elasticum (PXE)
• Marfan syndrome
• Hemophilia A
• Cystic fibrosis

Correct Answer: Pseudoxanthoma elasticum (PXE)

Q13. Which pharmacologic agent is used in CKD to lower serum phosphate and may reduce vascular calcification risk?

• Sevelamer
• Furosemide
• Vitamin D analogs exclusively
• Warfarin

Correct Answer: Sevelamer

Q14. Which mechanism best explains cellular nucleation of mineral in calcification?

• Formation of lipid-rich cores only
• Release of matrix vesicles that concentrate calcium and phosphate
• Direct crystallization exclusively in cytoplasm
• Immune complex deposition

Correct Answer: Release of matrix vesicles that concentrate calcium and phosphate

Q15. Valvular calcification, particularly of the aortic valve, is most closely linked to which pathological process?

• Infective endocarditis only
• Atherosclerotic-like inflammation with osteogenic differentiation
• Congenital viral infection
• Decreased mechanical stress

Correct Answer: Atherosclerotic-like inflammation with osteogenic differentiation

Q16. In histology, calcified areas often appear basophilic on H&E stain because of deposition of:

• Lipids
• Calcium salts
• Glycogen
• Melanin

Correct Answer: Calcium salts

Q17. Which laboratory intervention can acutely precipitate metastatic calcification in susceptible patients?

• Rapid infusion of phosphate binders
• Excessive calcium and vitamin D administration
• Administration of bisphosphonates
• Low-protein diet

Correct Answer: Excessive calcium and vitamin D administration

Q18. Which enzyme promotes calcification by degrading pyrophosphate, a natural inhibitor of mineralization?

• Alkaline phosphatase (TNAP)
• Matrix metalloproteinase-9
• Phospholipase A2
• Superoxide dismutase

Correct Answer: Alkaline phosphatase (TNAP)

Q19. In tumor pathology, dystrophic calcification commonly occurs in which circumstance?

• Metastatic bone-forming tumors only
• Areas of necrosis within tumors regardless of serum calcium
• Only benign tumors
• Only in tumors with hypercalcemia

Correct Answer: Areas of necrosis within tumors regardless of serum calcium

Q20. Which treatment strategy targets secondary hyperparathyroidism to reduce vascular calcification in CKD?

• Loop diuretics
• Cinacalcet (calcimimetic)
• Warfarin
• High-dose calcium supplements

Correct Answer: Cinacalcet (calcimimetic)

Q21. The calcium-phosphate product (Ca x P) is clinically important because values above a threshold increase the risk of:

• Hypocalcemia
• Soft tissue and vascular calcification
• Decreased bone turnover only
• Hyperkalemia

Correct Answer: Soft tissue and vascular calcification

Q22. Which signaling pathway is implicated in the osteogenic transformation of vascular smooth muscle cells?

• NF-κB exclusively
• Bone morphogenetic proteins (BMP) and Runx2 pathways
• Insulin signaling only
• Notch signaling exclusively

Correct Answer: Bone morphogenetic proteins (BMP) and Runx2 pathways

Q23. Which clinical condition is least likely to be associated with metastatic calcification?

• Primary hyperparathyroidism
• Chronic kidney disease with hyperphosphatemia
• Localized tissue necrosis after trauma
• Excess vitamin D intake

Correct Answer: Localized tissue necrosis after trauma

Q24. Which phosphate binder would be preferred in a patient with hyperphosphatemia but high risk of vascular calcification due to hypercalcemia?

• Calcium acetate
• Sevelamer hydrochloride
• Calcium carbonate
• Vitamin D analog

Correct Answer: Sevelamer hydrochloride

Q25. Which clinical test is most useful to monitor progression of calcific aortic stenosis noninvasively?

• Chest X-ray only
• Transthoracic echocardiography assessing valve area and gradient
• Serum calcium measurement
• Holter monitoring

Correct Answer: Transthoracic echocardiography assessing valve area and gradient

Q26. Which of the following molecules acts as an endogenous inhibitor of hydroxyapatite formation?

• Pyrophosphate (PPi)
• Calcium ion
• Alkaline phosphatase
• Phosphate ion

Correct Answer: Pyrophosphate (PPi)

Q27. In experimental models, deficiency of which liver-derived protein results in enhanced calcification?

• Fetuin-A
• Albumin
• Transferrin
• C-reactive protein

Correct Answer: Fetuin-A

Q28. Which drug class has been investigated for potential inhibition of vascular calcification via effects on bone metabolism?

• Statins only
• Bisphosphonates
• Beta-blockers
• ACE inhibitors

Correct Answer: Bisphosphonates

Q29. Which of the following best describes metastatic pulmonary calcification?

• Calcification confined to atherosclerotic plaques in pulmonary arteries
• Calcium deposition in normal lung tissue due to hypercalcemia
• Calcification only following pulmonary infarction
• Calcification secondary to chronic bronchitis

Correct Answer: Calcium deposition in normal lung tissue due to hypercalcemia

Q30. Which laboratory marker may be elevated in active calcific processes with bone formation activity?

• Alkaline phosphatase (bone isoform)
• Serum potassium
• C-peptide
• Amylase

Correct Answer: Alkaline phosphatase (bone isoform)

Q31. Which cellular structure is often the initial site of mineral nucleation during pathological calcification?

• Matrix vesicles released from cells
• Nucleus of fibroblasts only
• Mitochondria exclusively
• Lysosomes only

Correct Answer: Matrix vesicles released from cells

Q32. Which vitamin deficiency is mechanistically linked to increased vascular calcification due to impaired carboxylation?

• Vitamin C
• Vitamin K
• Vitamin B12
• Vitamin E

Correct Answer: Vitamin K

Q33. In arterial calcification, which extracellular matrix protein is frequently upregulated and promotes mineralization?

• Elastin
• Osteopontin
• Hemoglobin
• Albumin

Correct Answer: Osteopontin

Q34. Which of the following is true about soft tissue calcification in chronic kidney disease-mineral bone disorder (CKD-MBD)?

• Primarily driven by hypoalbuminemia
• Influenced by disturbed phosphate handling and PTH imbalance
• Unaffected by dialysis adequacy
• Prevented solely by calcium supplementation

Correct Answer: Influenced by disturbed phosphate handling and PTH imbalance

Q35. Which signaling molecule is commonly used as a marker of osteogenic differentiation in calcifying vascular cells?

• Runx2 (Cbfa1)
• VEGF only
• TNF-α exclusively
• Albumin

Correct Answer: Runx2 (Cbfa1)

Q36. Which therapeutic approach directly reduces circulating phosphate without increasing serum calcium?

• Calcium carbonate binder
• Sevelamer (non-calcium phosphate binder)
• Vitamin D analog supplementation
• High-dose calcium supplementation

Correct Answer: Sevelamer (non-calcium phosphate binder)

Q37. Which condition would most likely produce calcification visible on a plain chest X-ray?

• Small early atherosclerotic plaque in coronaries
• Lobar pneumonia without chronic change
• Healed granulomatous infection (e.g., tuberculosis)
• Acute bronchitis

Correct Answer: Healed granulomatous infection (e.g., tuberculosis)

Q38. Which laboratory finding differentiates metastatic from dystrophic calcification?

• Presence of tissue necrosis
• Elevated serum calcium/phosphate in metastatic calcification
• Basophilic deposits on H&E in dystrophic only
• von Kossa negativity in metastatic calcification

Correct Answer: Elevated serum calcium/phosphate in metastatic calcification

Q39. Which therapeutic agent reduces PTH secretion by increasing sensitivity of calcium-sensing receptors in the parathyroid?

• Cinacalcet
• Sevelamer
• Calcitriol only
• Furosemide

Correct Answer: Cinacalcet

Q40. Which feature on CT imaging indicates chronic vascular calcification rather than acute plaque rupture?

• Dense, well-demarcated calcific foci within the arterial wall
• Absence of any calcification
• High attenuation blood only
• Diffuse soft tissue swelling without focal calcification

Correct Answer: Dense, well-demarcated calcific foci within the arterial wall

Q41. In drug-induced calcification, which class of drugs has been associated with promoting calcific lesions due to interference with vitamin K–dependent processes?

• Calcium channel blockers
• Vitamin K antagonists (e.g., warfarin)
• ACE inhibitors
• Statins

Correct Answer: Vitamin K antagonists (e.g., warfarin)

Q42. Which pathological deposit stains black with von Kossa technique due to precipitation of silver salts?

• Neutral lipids
• Phosphate associated with calcium
• Glycogen
• Melanin pigment

Correct Answer: Phosphate associated with calcium

Q43. Which of the following interventions is most likely to reduce progression of vascular calcification in high-risk CKD patients?

• Using calcium-based phosphate binders liberally
• Controlling serum phosphate with non-calcium binders and managing PTH
• High dietary calcium intake
• Withholding dialysis

Correct Answer: Controlling serum phosphate with non-calcium binders and managing PTH

Q44. Atherosclerotic plaque calcification is often associated with which plaque characteristic?

• Thin fibrous cap and increased vulnerability when microcalcifications are present
• Always complete protection from rupture
• Absence of inflammatory cells
• Immediate plaque regression

Correct Answer: Thin fibrous cap and increased vulnerability when microcalcifications are present

Q45. Which molecule when upregulated in vascular tissue can act as a local promoter of calcification by nucleating hydroxyapatite?

• Osteocalcin
• Bone sialoprotein
• Albumin
• Hemoglobin

Correct Answer: Bone sialoprotein

Q46. In pathology, which description best fits calciphylaxis seen in end-stage renal disease?

• Painful skin necrosis with small vessel calcification and thrombosis
• Benign skin calcification without clinical significance
• Calcification limited to bone surface
• Superficial fungal infection

Correct Answer: Painful skin necrosis with small vessel calcification and thrombosis

Q47. Which process increases local concentration of phosphate, promoting calcium phosphate precipitation in tissues?

• Apoptosis of cells releasing phosphate-rich intracellular contents
• Decreased extracellular phosphate release
• Enhanced pyrophosphate synthesis only
• Inhibition of alkaline phosphatase

Correct Answer: Apoptosis of cells releasing phosphate-rich intracellular contents

Q48. Which dietary or supplemental practice can increase risk of metastatic calcification in susceptible individuals?

• Excessive vitamin D and calcium supplementation
• High intake of vitamin K–rich foods
• Low-phosphate diet
• Balanced calcium-phosphate intake

Correct Answer: Excessive vitamin D and calcium supplementation

Q49. Which laboratory parameter is most useful to evaluate ongoing bone turnover contributing to calcification risk in CKD?

• Serum albumin
• Parathyroid hormone (PTH) levels
• Serum sodium
• Urine specific gravity

Correct Answer: Parathyroid hormone (PTH) levels

Q50. Which preventive strategy addresses a mechanism-specific approach to reduce vascular calcification progression?

• Administration of vitamin K to promote MGP carboxylation
• Start high-dose calcium supplements indiscriminately
• Long-term vitamin D intoxication
• Chronic use of vitamin K antagonists without monitoring

Correct Answer: Administration of vitamin K to promote MGP carboxylation

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