Multiple Choice Questions (MCQ) on Veterinary Medicine (Part-1)
Multiple Choice Questions
- The tall ‘R’ wave in ECG denotes: a. Left ventricular enlargement b. Left atrial enlargement c. Bilateral atrial enlargement d. Right ventricular enlargement
- Lactation tetany in cattle is due to: a. Hypoglycemia b. Hypomagnesemia c. Hypocalcemia d. Hypophosphatemia
- Iron deficiency Anemia is more common in: a. Calves b. Lambs c. Piglet d. Puppies
- Hydrocyanic acid ( HCN) poisoning is result in: a. Anoxic anoxia b. Anaemic anoxia c. Histotoxic anoxia d. Stagnant anoxia
- The antidote for Organophosphate poisoning is: a. Atropine sulphate with oximes b. Calcium borogluconate c. methylene Blue d. Sodium thiosulphate
- Which of the following is having high therapeutics value in gastric ulcers of dog? a. Sucralfate b. H1 Blocker c. Cisapride d. Metoclopramide
- The most common cause of Urolithiasis in canine is: a. Weddellite urolith b. Xanthin Urolith c. Hydroxyapatite uroliths d. Struvite uroliths
- Which of the following has high therapeutics index in acute renal failure? a. Vasopressin b. Frusemide c. Spironolactone's d. Dopamine
- Inflammatory Bowel Disease in dog is suspected to be due: a. Defective immunoregulation b. Dietary allergens c. Eosinophilic gastroenteritis d. All
- Papple shaped abdomen is characteristics of: a. TRP b. Abomasal displacement c. Omasal impaction d. Vagal indigestion
- Acute Bovine Pulmonary Emphysema and Edema is due to: a. Dietary high L-tryptophan b. Lung worm infestation c. Prolonged transit d. Mycotoxins
- Ovine ketosis is also referred as: a. Pregnancy toxemia b. Twin lamb disease c. Acetonemia of sheep d. All
- Barker foal syndrome is due to: a. Antenatal or postnatal hypoxia b. Isoimmune hemolytic anemia c. Clostridial infection d. Premature foaling
- Bulk tank milk somatic cell count suggestive of mastitis in the herd is: a. 2 lakhs/ml b. 2.5lakhs/ml c. 3lakhs/ml d. 1.5lakhs/ ml
- Persistent ruminal tympany, bradycardia and displaced heart sound in cattle suggests: a. Traumatic pericarditis b. Traumatic reticulitis c. Diaphragmatic hernia d. TRP
- Palliative treatment of disease means: a. To prolong the life b. Specific therapy c. Eliminate etiology d. Symptomatic therapy
- Pollakyuria means: a. Excessive urination b. Frequent painful urination c. Constant dribbling of urine d. Decrease output of urine
- Paper crackling rales on auscultation is suggestive of: a. Pneumonia b. Bronchitis c. Pulmonary Emphysema d. Pulmonary edema
- Hydrothorax is commonly seen in horses suffering from: a. Strangles b. African Horse sickness c. Equine influenza d. Equine infectious anemia
- Systolic and diastolic murmur on auscultation is suggestive of: a. Myocarditis b. Pericarditis c. Patent ductus arteriosus d. Vegetative endocarditis
- Which of the following is considered a Standard Lead for ECG recording: a. Lead I b. Lead II c. Lead III d. None
- Case fatality rate is as high as 50% in: a. Type I Abomasal ulcer b. Type II Abomasal ulcer c. Type III Abomasal ulcer d. Type IV Abomasal ulcer
- Increased frequency, tenesmus with presence of abundant mucus in feces is suggestive of: a. Small bowel diarrhea b. Large bowel diarrhea c. Exocrine pancreatic insufficiency d. None
- Which among the following is an osmotic diuretics? a. Frusemide b. Spironolactone c. Dopamine d. Mannitol
- Which of the following is respiratory stimulant: a. Theophylline b. Guaifenesin c. Bromohexine d. Doxapram
- Which of the following is Opioid analgesics: a. Indomethacin b. Flunixin meglumine c. Acetaaminophen d. Pentazocine
- Which of the following is the promising ACE inhibitor for dilated Cardio- Myopathy in dogs: a. Digitalis b. Amiodipine besylate c. Atenolol d. Enalapril maleate
- Effective thyroxine dose for canine hypothyroidism is: a. 0.2-04mg/kg b. 0.02-0.04mg/kg c. 0.002-0.004mg/kg d. 2-4mg/ kg
- Diabetes Cataract is due to accumulation of which of the following in lens capsule: a. Insulin b. Sorbitol c. Isopropanol d. Ketoacids
- Trypsin like immunoreactivity (TLI) assay in dogs is highly sensitive and specific tests for: a. Inflammatory bowel disease b. Acute pancreatitis c. Exocrine pancreatic insufficiency d. Large bowel disease
Correct Answer is:
1
a. (Left ventricular enlargement)
The tall ‘R’ wave in ECG indicates left ventricular enlargement
ECG interpretation:
P wave represents Atrial depolarization
QRS complex represents Ventricular depolarization
T wave represents Ventricular repolarization
Notes:
n ECG, prolongation of P wave indicates left atrial enlargement
In ECG, increased P wave indicates right atrial enlargement
In ECG, tall R wave and prolonged QRS complex indicates left ventricular enlargement
In ECG, deepening of S wave indicates Right ventricular enlargement
In ECG, peaked T wave indicates hyperkalemia
2.
b. (Hypomagnesemia)
Lactation tetany in cattle is due to Hypomagnesemia while in horse is due to Hypocalcemia.
Eclampsia (Milk Fever) in bitches is due to Hypocalcemia and hypoglycemia.
Grass tetany, ( hypomagnesaemic tetany, grass staggers, lactation tetany, wheat pasture poisoning, or winter tetany) is a metabolic disease, occurs in ruminants (beef cattle, dairy cattle, sheep) usually growing on pasture of rapidly growing grass, especially in Early spring.
Hypophosphatemia (Post- parturient Hemoglobinuria in cattle; hemoglobinuria of pregnant buffaloes) is a metabolic hemolytic disease of lactating cattle and pregnant buffaloes, characterized clinically by hypophosphatemia and intravascular hemolysis of erythrocytes.
3.
c. (Piglet)
Iron deficiency Anemia is more common in Piglets.
-Piglet anemia is a condition of the piglets which occurs usually within 2-4weeks of birth, more common in suckling piglets, which makes them susceptible to diseases.
-Milk is a very poor source of iron due to which this deficiency causes piglet anemia, also adding
to the rapid growth of piglets and less amount of iron stores in the newborn.
Types of Anemia:
On the basis of Morphology:
-Normocytic Normochromic - (Mean Corpuscles size/volume- normal, Mean hemoglobulin concentration - Normal)
Macrocytic Normochromic (MCV- increases / MCHC- Normal)
Macrocytic Hypochromic- (MCV - Increase /MCHC- Decreases)
Microcytic Hypochromic - (MCV- decreases/ MCHC- Decreases)
On the basis of Etiology
Hemorrhagic anemia
Hemolytic anemia: Extrinsic and Intrinsic (Sickle cell anemia/ thalassemia)
-Aplastic anemia (Bone marrow)
Nutritional deficiency anemia (Iron deficiency, protein deficiency, Vit-B12 deficiency, Folic acid deficiency)
Disease Induced anemia
4.
c. (Histotoxic anoxia)
-Hydrocyanic acid (HCN) poisoning is result in histotoxic anoxia.
Different Types of Anoxia:
Anoxic Anoxia: When there is not enough oxygen available to breath in, seen when person is at high attitude.
Anaemic Anoxia: When there is not enough amount of blood or hemoglobulin to carry Oxygen, seen in case of hemorrhage.
Histotoxic Anoxia: Inability of cells to take or use Oxygen from blood despite normal delivery of Oxygen to such cells.
Stagnant Anoxia: (Hypoxic Ischemic Injury), occurs when blood doesn’t reach brain or other body parts that need it. Cardiovascular event is the most common cause of Stagnant anoxia.
5.
a. (Atropine sulphate with oximes)
| Poison | Antidote |
| Arsenic | BAL or Dimercaprol, Sodium thiosulfate |
| Copper | Ammonium molybdate+ sodium sulfate |
| Lead | Calcium -disodium EDTA |
| Molybdenum | Copper Sulphate |
| Nitrate/Nitrite | 1% Methylene blue |
| Cyanogenic Plant | Sodium Nitrite + Sodium thiosulfate |
| Oxalates | Lime water |
| Sweet clover | Vitamin K |
| Organo chlorine | Activated Charcoal |
| Organo phosphorus | Atropine sulfate |
| Snake bite | Mono or polyvalent antivenin therapy |
| Bromide | Chloride |
| Urea | Vineger or 5% acetic acid |
| Mimosine | Steam processing or FeSO4 salt |
6.
a. (Sucralfate)
-Sucralfate are used to treat or prevent ulcers in the GI tract.
Classification of Histamine receptors
-H1 receptor blockers: (Diphenhydramine, Mepyramine meleate, Promethazine hydrochloride, Pheniramine maleate) - To treat allergic reactions
-H2 receptor blocker: (Cimetidine, Ranitidine) -To reduce gastric acid release
-H3 receptor blocker: ( Theoperamide, Impromidine ) - To treat Neurodegenerative conditions
-Cisapride: Cisapride is used to treat gastric- emptying disorders, accelerates emptying the stomach and propulsion of food through intestine by increasing peristalsis. Cisapride is used in cats to manage Chronic constipation and megacolon.
-Metoclopramide:Metoclopramide is used to stimulates stomach and upper Small Intestinal movements to prevent Esophageal reflux.
7.
d. (Struvite uroliths)
The most common causes of Urolithiasis in canine is Struvite Uroliths. Struvite is the normal component of dog’s urine and will remain dissolved as long as the urine is acidic and is not too concentrated. If the urine becomes exceptionally concentrated or if it becomes alkaline, struvite crystals will precipitate or fall out of solution.
-Weddellite urolith is observed in patients who suffered from Hypercalciuria, Hyperoxaluria etc.
-Xanthine Uroliths are absolutely rare, caused by inborn defect of xanthine oxidase, due to which xanthine cannot be oxidized to uric acid, leads to excretion of hypoxanthine and xanthine increases. Since, Xanthine is poorly soluble, results in xanthine stone formations.
-Hydroxyapatite uroliths ( Calcium Phosphate stone) seen in dogs having metabolic disorders such as primary hyperparathyroidism, renal tubular acidosis, excessive dietary Calcium and Phosphorus.
8.
d. (Dopamine)
Dopamine is used in Acute renal failure as it dilates renal arteries, increases urine output, and protect the kidney from injury. At low dose, Dopamine stimulates D1 and D2 receptors inducing natriuresis(Sodium excretion), diuresis( urine excretion) and enhance renal blood flow by renal vasodilation.
Vasopressin ( ADH hormone), released from posterior pituitary, acts on kidney and promotes reabsorption of water and electrolyte from distal tubules, prevents water loss and dehydrations.
-Frusemide is the loop diuretics ( Acts on loop of Henle), promotes excretion of fluids medicated during heart failure, liver scarring or kidney disease.
-Spironolactones (Potassium - sparing diuretics), increases diuresis without loss of Potassium, acts as antagonist of aldosterone, promotes passes of sodium and water outside the body.
9.
d. (All)
Inflammatory Bowel disease in dog is due to all (Defective immunoregulation, Dietary allergens and Eosinophilic gastroenteritis).
-Inflammatory Bowel disease is characterized by an over- abundance of inflammatory cells located within parts of stomach, SI and Large Intestine, which disrupts the ability of the intestinal tract to function normally, often resulting in chronic and protracted diarrhea, malabsorption, weight loss, anemia and malnutrition.
10.
d.(Vagal indigestion)
Papple shaped abdomen ( When viewed from behind, the abdomen contour is apple -shaped on the left and pear shaped on the right, giving rise to term Papple, derived from pear and apple. The rumen may become overloaded and distended due to impaired passage of ingesta, and failure of eructation may lead to tympany. It occurs due to vagal nerve damage which hinder passage of ingesta in reticulorumen, abomasum or both ( cause due to TRP, Rumen acidosis, Oesophageal laceration, LDA).
-TRP ( Traumatic reticuloperitonitis)in cattle occurs when animals ingests nails, piece of wire, and other non- metallic material that injure the reticular wall. Sharp objects can puncture the reticulum, allowing ingesta and bacteria to leak into the peritoneal cavity, resulting in peritonitis and often leading to adhesion in the abdomen, characterized by clinical signs such as rumenoreticular atony, decrease milk production, and abdominal pain.
-Abomasal displacement: The abomasum, normally lies on the floor of the abdomen and it is displaced when it is filled with gas and rise to the top of the abdomen. More likely to displaced left side than right side. Causes of Abomasal displacement: Failure to return abomasum to normal place after displaced during pregnancy and floppiness of abomasum.
11.
a. (Dietary high L-tryptophan)
Acute Bovine Pulmonary Emphysema and Edema is due to high L- tryptophan in Diet.
Acute Bovine Pulmonary Emphysema and Edema (Fog Fever) is an acute pneumonia of adult cattle which occurs within 4-10days of moving from an overgrazed pasture or dry feed to a fresh lush green pasture.
Etio-pathogenesis:
The affected cattle have been fed on dry feed for an extended period of time and the rumen fermentation pattern has adopted to this situation.
With the sudden change to lush green pasture, dietary protein concentration increases dramatically
One of the amino acid in plant protein, L-tryptophan is converted by rumen bacteria to a substance, called 3-Methyllindole. This 3-MI is absorbed through the rumen wall and circulated around body. This 3-MI is toxic to primary cells that lines the interior surface of lungs. As, High level 3-MI moves to the lungs, more lung tissue is destroyed.
Clinical signs:
Difficulty in breathing, coughing, frothing at mouth, anxiety, collapse and death.
12.
d. (All)
Ovine ketosis is also referred as Pregnancy toxemia, Twin lamb disease, Acetonemia of sheep, ketosis, lambing paralysis, hypoglycemia etc.
Low blood sugar caused by an inadequate intake of energy during late gestation leads to breakdown of fat produces toxic ketone bodies, mostly affect fat, thin, old and female carrying twins, characterized by lethargy, sluggishness, lack of appetite, poor muscles control, inability to rise etc.
13.
a. (Antenatal or postnatal hypoxia)
Barker foal syndrome (Neonatal encephalopathy; Hypoxic Ischemic Encephalopathy; Dummy foal syndrome) is a behavioral disturbance in a newborn foal, occurs due to decreased oxygen reaching foal’s tissue during birth characterized by signs ranging from a slow suckling response at birth to hyperexcitability, aimless wandering, depression, lying prone, loss of muscle tone, and seizure. The foal may start vocalizing, sounding like a barking dog, thus termed ‘Barker foal’ has come.
14.
c. (3lakhs/ml)
Bulk tank milk somatic cell count suggestive of mastitis in the herd is 3lakhs/ml
Interpretation of CMT Score
| CMT Score | SCC range | Interpretation |
| Negative | 0- 2lakhs/ml | Healthy quarter |
| Trace | 2 lakhs - 4 lakhs | Subclinical mastitis |
| 1 | 4-12 lakhs/ml | Mild mastitis |
| 2 | 12-50 lakhs/ml | Moderate mastitis |
| 3 | Over 50 lakhs/ml | Serious mastitis |
15.
c. (Diaphragmatic hernia)
Persistent ruminal tympany, bradycardia and displaced heart sound in cattle suggests Diaphragmatic hernia.
Diaphragmatic hernia:
-Diaphragmatic hernia is a serious digestive disorder in buffaloes involving rupture of diaphragm through which abdominal contents passes from abdominal cavity to thoracic cavity. More common in buffalo than cattle.
Etiology: Congenitally weak diaphragm (Predisposing factors: Advanced pregnancy and parturition).
Typical clinical signs:
Anorexia
Persistent tympany
-Scanty pasty feces
Bradycardia and displaced heart sound
16.
a. (To prolong the life)
Palliative treatment of disease means To Prolong the life.
Different types of therapy/treatment:
Empirical therapy: Application of drug/treatment not derived from scientific method, but on mere experience gained by clinician.
-Rational therapy: It is application of drug/treatment based on scientific knowledge of pharmacology of drug and on pathology of disease.
Symptomatic therapy: Application of drugs for treatment of only symptoms with or without proper diagnosis.
-Palliative therapy: Application of drug/treatment to control the severity of diseases symptoms rather than to provide a cure.
-Supportive therapy: Application of drugs directed toward maintaining the patient’s physiological or functional intergrity until more definite treatment can be carried out.
Substitutive therapy: Application of drugs directed toward supplying an endogenous substance, which is normally present in body but deficient in patient because of disease, injury, congenital deficiencies etc.
-General therapy: Treatment of disease without use of drug, included mechanical therapy, physical therapy, heliotherapy, hydrotherapy, dietary therapy, psychotherapy, and placebo therapy.
17.
b. (Frequent painful urination)
Different Terms related to Urination
Pollakyuria : Frequent painful urination
Stranguria: Urination with abnormal constituents
Dysuria: Difficulty in Urination
Anuria: Complete lack of urine production and excretion
Enuresis: A condition of the involuntary discharge of urine during sleep
Cystorrhagia: Bleeding from the bladder
Cystoliths: Stone in the urinary bladder
Cystitis: Inflammation of the bladder
Cystalgia: Pain in the urinary bladder
18.
c. (Pulmonary Emphysema)
Abnormal Breathing sounds
Paper crackling rales on auscultation - Pulmonary Emphysema
Gurgle or Wheeze or Rhonchi on auscultation - Narrowing air passage such as in Asthma, COPD, foreign bodies, tumors etc.
Friction rub - Pericarditis
Stridor- (High pitched rapid airflow through obstructed airways, caused by inflammation) -Croup, epiglotitis
19.
b. (African Horse sickness)
Hydrothorax is commonly seen in horses suffering from African Horse sickness.
-Strangle (Equine distemper; Infectious adenitis) is an acute infectious disease of equines caused by Streptococcus equi (Gram-ve bacteria) characterized by catarrhal inflammation of the upper respiratory tract with suppuration and abscessation of associated lymph nodes.
African Horse Sickness is a life- threatening hemorrhagic disease of equine, (respiratory and circulatory impairments), caused by AHS( Orbivirus) of family Reoviridae, transmitted by midges ( Culicoides spp) characterized by pyrexia, edema of the lungs, pleura and S/C tissue as well as petechial and generalized hemorrhage.
Equine influenza is an acute infectious disease of horse, caused by Myxovirus -A/equi-1 and A/equi2, characterized by general septicemia, respiratory problems (watery to muco-purulent discharge from nostrils, pneumonia, distressed abdominal respiration), accompanied by severe persistent dry cough.
Equine infectious anemia is a non-contagious chronic infectious disease of eqines family, caused by lentivirus of family retroviridae (RNA virus), characterized by emaciation, anemia, intermittent fever and generalised lymphoproliferative changes and edema.
20.
c. (Patent ductus arteriosus)
Systolic and Diastolic murmur on auscultation is suggestive of Patent Ductus arteriosus.
Different types of Heart Murmur
| Condition | Murmur | Eponyms |
| Tricuspid Regurgitation | Systolic Murmur | Carvallo Murmur |
| Innocent Murmur | Systolic Murmur | Still’s Murmur |
| Ventricular Septal defect | Systolic Murmur | Roger’s Murmur |
| Aortic Regurgitation | Diastolic murmur | Austin Flint Murmur |
| Pulmonary Regurgitation | Diastolic murmur | Graham Steell Murmur |
| Rheumatic Heart Disease- Mitral stenosis | Diastolic murmur | Carry Comb’s Murmur |
| Patent Ductus Arteriosus | Continuous Murmur (Both Systolic and Diastolic Murmur) | Gibson murmur |
21.
b. (Lead II)
Lead II is considered as standard lead for ECG recording because It’s generally provided the best view and it’s most useful for monitoring as it lies close to the cardiac axis and allow the best view of P and R wave.
There are 12 leads in ECG machines, out of which Lead I, II, III are bipolar limbs and strandard limb leads
Three are Augmented Unipolar limbs leads (aVL, aVR, aVF) and six Chest or precardial leads (V1, V2, V3, V4, V5 and V6) are Unipolar leads.
22.
d. (Type IV Abomasal ulcer)
Case fatality rate is as high as 50% in Type IV Abomasal ulcer.
Abomasal ulcer is classified based on the depth of penetration or the degree of hemorrhage or peritonitis caused by the ulcer:
Type -I: Non- perforating without hemorrhage
Type -II: Non - perforating with significant blood loss (Hemorrhage)
Type -III: Perforating with localized peritonitis
Type -IV: Perforating with diffuse peritonitis
23.
b. (Large bowel diarrhea)
Clinical signs associated with diarrhea
| Small Bowel Diarrhea | Large Bowel Diarrhea |
| Large volume of feces | Small volume of feces |
| Normal or increased frequency of defecation | Increased frequency of defecation |
| Flatulence, Steatorrhea | Mucus in feces |
| Melena (tarry black feces) | Hematochezia (frank, red) |
| Weight loss | Tenesmus |
| Vomiting may occur | Pain |
Clinical signs associated with Exocrine Pancreatic Insufficiency
Weight loss, Abdominal pain, flatulence and bloating, oily diarrhea, deficiency of vitamin K and D, electrolyte deficiency.
24.
d. (Mannitol)
Mannitol is an example of Osmotic Diuretics
Different Types of Diuretics
| Types | Examples | Site of Action |
| Osmotic Diuretics | Mannitol | Proximal tubules Descending loop of Henle Collecting Duct |
| Carbonic anhydrase inhibitor | Acetazolamide | Proximal tubules |
| Thiazides | Hydrochlorothiazide | Distal convoluted tubules |
| Loop diuretics | Ethacrynic acid; Furosemide | Loop of Henle |
| K - Sparing | Spironolactone, Amiloride | Collecting ducts |
25.
d. (Doxapram)
Doxapram is used as respiratory stimulants (Also known as Analeptics) as they stimulate the respiration, used in condition of respiratory failure or respiratory distress by stimulates the chemoreceptors of carotid artery and aortic arch, leads to stimulates medulla oblongata (respiratory centre) results increasing breathing and heart rate.
-Theophylline is bronchodilators, which relax the muscles in the brochial tubes of lungs, used to treat the symptoms of Asthma, Bronchitis, Emphysema and other lung diseases.
Guaifenesin and Bromohexine (good for dry cough) are an expectorant, used to clear mucus or phlegm from respiratory tract.
26.
d. (Pentazocine)
-Pentazocine is opioid analgesics (Narcotics).
Analgesics are group of drugs, which provides reversible relief from pain.
Non- Steroidal Anti - Inflammatory Drug (NSAIDs): These are all Anti- inflammatory, Analgesics and Antipyretics. (Act by inhibiting cyclooxygenase enzymes)
Classification of NSAIDs:
Non - selective Cox- inhibitor: (Inhibits both Cox-1 and Cox-2 enzymes) Aspirin, Ibuprofen, ketoprofen, Mephenamic acid, Diclofenac, Piroxicam, Indomethacin Phenylbutazone etc.
Selective Cox-2 inhibitor: Meloxicam, Celecoxib
Opioids (Narcotics): Opioids are act by stimulating opioid receptors which are coupled with G - protein and their activation has number of actions: Closing of voltage sensitive Calcium channel, stimulates potassium efflux, leading to hyperpolarization and reduced cAMP production, overall, the effect is a reduction in neuronal cell excitability- reduced transmission of nociceptive impulses. Example: Fentanyl, Morphine Codeine etc.
27.
d. (Enalapril maleate)
Enalapril maleate, used to treat high blood pressure, by lowering blood pressure, it helps to prevent strokes, heart attack and kidney problems, acts by inhibiting ACE, blocking the conversion of Angiotension I to Angiotensin II, since Angiotensin II is vasoconstrictor, results in decrease in Blood pressure.
Digitalis, also known as Digitoxin, is a cardiotonic (Cardiac Glycosides), helps an injured and weakened heart to pump more efficiently, strengthens the force of heart muscle’s contractions, helps restore a normal, steady heart rhythm, and improves blood circulation. Digitalis inhibits the Na-K ATPase membrane pump, resulting in an increase in intracellular sodium and Calcium concentration.
Amiodipine besylate is long-acting Calcium channel blocker, used to treat symptoms of Hypertension, Chest pain and coronary artery disease.
Atenolol, beta- receptor blocker, used to treat high blood pressure.
28.
b. (0.02-0.04mg/kg)
-Effective thyroxine dose for canine hypothyroidism is 0.02-0.04mg/kg B.wt.
29.
b. (Sorbitol)
Intracellular accumulation of Sorbitol leads to osmotic change resulting in hydropic lens fibers that degenerates and form sugar (Diabetes) cataract.
30.
c. (Exocrine pancreatic insufficiency)
The radioimmunoassay (RIA) for trypsin- like immunoreactivity (TLI) is one of the most sensitive and specific tests for detecting Exocrine pancreatic insufficiency (EPI). An abnormally low serum TLI concentration (<2.5 ng/ml) indicates end- stage EPI.
