Clinical Chemistry 1 MCQS

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Final preparation (refer to past year questions & assignments)

Section B

1. Blood analysis

How is serum prepared (5)

Serum is the fluid portion that remains after blood has been allowed to clot
Serum is obtained from clotted blood that has not been mixed with anticoagulant
The sample is then centrifuged, yielding serum
Serum contains albumin and globulin
Serum can be collected in serum separator tubes that contain a substance that form a barrier between serum and cells during centrifuge

Steps to avoid hemolysis (5)

Do not collect a specimen in a hematoma
Do not centrifuge specimen for a prolonged period of time
Avoid contamination (allow collection site to dry after cleaning)
Allow specimen clot completely before centrifuge
Replace vacuum tube if air leakage around needle
Use 21 and 22 gauge needle for routine collections

Compare serum and plasma (4)

Serum lack of fibrinogen
Serum don't need anticoagulant
Serum used for diagnosis; Plasma used for blood transfusion
Serum preparation is more time-consuming
Serum is difficult to separate
Serum is more stable

Types of anticoagulant tubes (6)

Types of anticoagulant (20)

sodium fluoride

dry additive, weak anticoagulant, used for blood glucose, prevent glycolysis

oxalates

dry additive, form insoluble complex with Ca in blood, inhibit clotting

ammonium & potassium oxalate (balance/double oxalate)

dry additive, hematology, ammonium interferes chemistry

EDTA

dry/liquid additive, bind Ca in plasma, diNa/K salt, hematology, preserves morphology structure of BC elements

sodium citrate

coagulation, prothrombin*anticoagulant, inactivate Ca, prevent coagulation factor V & VII

heparin

best anticoagulant, Na, Li, ammonium salt, neutralize thrombin, prevent formation of fibrin from fibrinogen

Avoid common problem in plasma preparation (6)

collect specimen in correct additive
mix specimen immediately after collection
avoid hemolysis
label transport tubes as "plasma"
indicate type of anticoagulant
separate plasma from cells within 15~30 m of venipuncture
incomplete filling of tube will create dilution factor excessive for total specimen volume

Avoid common problem in serum preparation

separate serum within 15~30 m of venipuncture
allow specimens to clot before centrifuge
avoid hemolysis
avoid lipemia

Blood components and its function (8)

45% trace elements, 55% plasma
RBC transport oxygen and carbon dioxide
WBC defend against infection
platelet stop blood loss, perform blood clot
plasma transport blood cells throughout body

2. Kidney Function Test

Functions of kidney (10)

regulation of water and electrolyte
regulate acid base balance
regulate arterial blood pressure
sodium removal for blood pressure
excretion of metabolic waste such as urea, creatinine
secretion of erythropoietin for blood formation
site for gluconeogenesis
activation of angiotensinogen by renin
activation of vitamin D
calcitriol helps to maintain calcium

3 hormones produced by kidney (3)

erythropoietin
calcitriol
renin

Kidney Function Test (20)

Creatinine clearance formula (ml/min) = UV/P

Renal Function Test (20)

serum creatinine

normal: 55~120 umol/L
reduce GFR-reduce in urine, increase in plasma
end product of creatinine catabolism
98% in muscle-energy storage creatine phosphate
others convert to creatinine

Blood Urea Nitrogen

urea-waste product-protein breakdown-40% reabsorb in tubule
BUN rises in impaired renal function
high due to hypovolemia, congestive heart failure
low due to malnutrition, liver failure
measure amount of nitrogen & analyze waste products in blood

uric acid

N/A breakdown-excreted by kidney

Glomerular Filtration Rate

clearance test
determine filtration capacity of nephrons
decrease-kidney ds

urine analysis, physical and microscopic

screening
proteinuria, decrease volume, increase specific gravity

blood electrolytes

increasing concentration-renal disorder

Protenuria

Proteinuria refers to the abnormal presence of protein in urine.
At the glomerulus, blood is filtered, allowing small protein molecules to pass into the glomerular filtrate. Most of protein is reabsorbed by the renal tubules. The appearance of protein in urine gives rise to 4 different types of proteinuria, depending on the source of protein.
Glomerular proteinuria arising from glomerular disease. Most of the protein found in this disorder is albumin. There is an increase in glomerular permeability due to injurious effects upon the glomerular capillaries. This disorder can be progress and develop into nephrotic syndrome. If glomeruli are destroyed, then renal failure and proteinuria ceases.
Tubular proteinuria arising from tubular disease. This disorder results when the normal tubular protein reabsorptive functions are impaired. Common causes of tubular proteinuria include lupus erythematous, galactosemia, heavy metal poisoning (mercury, lead), antibiotics (penicillin, cephalosporins), muscle trauma, transfusion reaction and renal tuberculosis. This disorder can be diagnosed by identifying the presence of beta-2 and alpha-1 microglobulin.
Overflow proteinuria (pre-renal or overload proteinuria) arising from the overflow of high plasma concentrations of low molecular weight protein. Bence jones protein, haemoglobin and myoglobin are measured.
Secretory proteinuria arising from protein secreted by the kidney tubule. Tamm-Horsfall protein is measured.

3. Plasma enzyme

Define (4)

functional enzymes: actively secreted into plasma
nonfunctional enzymes: come out of cells due to normal wear and tear

How plasma enzyme increase in plasma (6)

cell or tissue damage
increased cell turnover
cellular proliferation
increased enzyme synthesis
obstruction to secretion
decreased clearance

CK as diagnostic enzyme (6)

normal: 15~100 U/L male, 10~80 U/L female
dimer
increased in myocardial infarction
within 3~6 hrs
detect early cases
not increased in hemolysis/congestive heart failure
500~1500 IU/L in muscle dystrophies
highly elevated in crush injury, fracture and acute cerebrovascular accident
BB brain, MB heart, MM skeletal

LDH

normal: 100~200 U/L
tetramer
M4 skeletal, M3H liver, M2H2 brain, MH3 RBC, H4 heart
hemolytic anemia, hepatocellular damge, muscle dystrophy, carcinomas, leukemias

ALP

normal: 40~125 U/L
produced by osteoblasts, associated with calcification
high concentration in liver, bone, placenta, intestinal epithelium

AST

normal: 8~20 U/L
liver, skeletal muscle, heart
mitochondria & cytosol of liver cell

ALT

normal: 13~35 U/L male, 10~30 U/L female
predominant in liver
cytosol of liver cells

GGT

synthesis of glutathione
11 isoenzyme
high concentration in liver, kidney, pancreas, intestinal cells, prostate gland
not in cardiac/skeletal muscle
increase before ALP in biliary obstruction
alcoholic liver disease

ACP

normal: 2.5~12 U/L
tumor marker
secreted by prostate cells, RBC, platelets and WBC
prostate gland
prostatic cancer

G6PD

produce NADPH
6~12 U/g of Hb

Amylase

normal: 50~120 IU/L
found in salivary gland, exocrine pancreas
starch to maltose
activated by calcium and chloride ions
increased 100X in acute pancreatitis

5 types of enzyme classification (5)

oxioreductases
transferases
hydrolases
lyases
ligases
isomerases
translocases

Section C

1. CSF

Chemistry test for CSF (20)

CSF protein

normal: 15~45 mg/dL
decreased result: CSF leakage, recent puncture, rapid CSF production

CSf glucose

60~70% of plasma glucose
normally glucose CSF: plasma comparison
hipoglysemia, meningtitis, carcinoma decreased

CSf lactate

meningitis, destruction of CNS tissue elevate >25 mg/dL

CSF glutamate

produce from ammonia
normal: 8~18 mg/dL

Functions of CSF (3)

protects the brain from damage by cushioning brain
lightens the load, modulates pressure changes
takes harmful substances or drugs away
helps to transport hormones
serves s chemical buffer to maintain ionic environment

Causes of elevated protein level in CSF (7)

production of Ig
decrease clearance of normal protein
degeneration of neural tissue
meningitis and hemorrhage
damage of BBB

CSF specimen collection (10)

lumbar puncture between 3 4 5 lumbar
measurement intracranial pressure and careful technique to prevent infection
3~4 tubes
tests performed on STAT basis
hematology: refrigerated
microbiology: room temp
chemistry & serology: frozen

Assessment of CSF (10)

2. water, electrolytes, acid-base

Respiratory and metabolism compensation of primary acid-base disorder (20)

Causes of primary acid-base disorder (20)

Causes of metabolic acidosis and respiratory acidosis (5)

Primary acid-base disorder with compensation (20)

metabolic acidosis

primary disturbance: low bicarbonate
secondary response: low pCO2
overproduction of hydrogen
compensatory hyperventilation
hyperkalemia
normal anion gap: renal failure, diarrhea
increased anion gap (>12): uremia, diabetes, starvation

metabolic alkalosis

primary disturbance: high bicarbonate
secondary response: high pCO2
loss of hydrogen
compensatory hypoventilation
hypokalemia
vomiting, hyperaldosteronism, antacid use

respiratory acidosis

primary disturbance: high pCO2
secondary response: high bicarbonate \
hypoventilation
hyperkalemia
hypoxia
inhibition of medullary respiratory center
pneumonia, anesthesia, acute & chronic lung disease

respiratory alkalosis

primary disturbance: low pCO2
secondary response: low bicarbonate
hyperventilation
hypokalemia
hypoxemia
stimulation of medullary respiratory center
mechanical ventilation
anxiety, pulmonary embolism

Compare types of water balance disorder (20)

Dehydration & Hypotonic hydration

dehydration excessive water loss from ECF
dehydration ECF osmotic pressure rises
dehydration cells loss water by osmosis
dehydration cells shrink, hypotonic hydration cells swell
dehydration increase ECF osmolarity
dehydration ECF hypertonic, hypotonic hydration ECF hypotonic

Mechanisms to control acid base balance (5)

buffer system (protein, carbonic acid-bicarbonate, phosphate)
lung regulate pH by changing rate of acid, eliminate CO2
kidney regulate pH by excretion of acid (H2PO4 & ammonium) and alkali (bicarbonate) into urine

Define

ECF: plasma+interstitial fluid
ICF: 2/3, in cells
IF: fluid in spaces between cells

List

electrolytes: inorganic salts, acid base, proteins (Na, K, Ca, Cl, HCO3-, Mg)
non electrolytes: glucose, lipid, creatinine, urea

Electrolytes imbalance

Hypernatraemia

draws water out of cells
not enough water in/out
too much salt (sea water drowning)
water loss>sodium loss
diuretics, diarrhea, heart failure, liver ds

Hyponatraemia

water drawn into cells
water retention
water loss<sodium loss
water gain>sodium gain
dehydration, vomiting, dementia, severe & watery diarrhea
diuretics, renal/heart/liver failure, Addison ds, Hypothyroidism, SIADH

K 3.5~5.5

Hyperkalemia: renal failure, acidosis, K released from damaged tissue, Addison ds

Hypokalemia: loss of GI secretion, excessive renal excretion of K, movement of K into cells, diuretics, prolonged fluid administration without K supplementation

3. Liver Function Test

Define jaundice (2)

yellow discoloration of skin and sclera
accumulation of bilirubin in the skin

Functions of liver

carbohydrate, lipid, hormone metabolism
urea & plasma protein synthesis
store glycogen
bile excretion
produce clotting factor
detoxification

Classification and major cause of jaundice (20)

Prehepatic/hemolysis jaundice

cause: hemolysis
hemolytic anemia, sickle-cell anemia
lab finding: increased plasma unconjugated bilirubin, bilirubin in urine, plasma enzyme, and urine urobilinogen

Hepatic/hepatocellular jaundice

cause: infective agents, drugs, toxins
cirrhosis, hepatitis
lab finding: increased conjugated & unconjugated bilirubin, AST & ALT, bilirubin in urine

Post-hepatic/obstructive jaundice

cause: bile duct obstruction
gallstone
cholestasis intra/extrahepatic
lab finding: increased conjugated bilirubin, ALP, AST & AL, urine bilirubin & urobilinogen
pale stool

Congenital jaundice

Gilbert's syndrome

activity UDPG transferase decrease
lab finding: increased unconjugated bilirubin

Crigler-Najjar syndrome

no UDPG transferase
lab finding: increased unconjugated bilirubin

Dubin Johnson syndrome

no transport protein for conjugated bilirubin
lab finding:increased conjugated bilirubin

Bilirubin metabolism (10)

Bilirubin is another blood test that can reflect injury to hepatocytes and/or the biliary system. That is, hyperbilirubinemia can result from both hepatocellular and cholestatic liver injury.

Bilirubin is a major breakdown product of hemoglobin and is derived from red blood cells that have died and removed by the spleen. Heme is converted to bilirubin through a series of enzymatic reactions. This bilirubin is initially water-insoluble bilirubin (unconjugated bilirubin) and is transported in blood bound to albumin. It is then taken up by hepatocytes where it becomes water-soluble through its conjugation with glucuronic acid. Conjugated bilirubin is then excreted into the bile canaliculus and is eventually secreted into the duodenum.

Hepatocytes transform bilirubin into a water soluble product by a process known as conjugation. Conjugated bilirubin can then be excreted into bile. Hyperbilirubinemia can result from either the conjugated or unconjugated fractions.

The conjugated fraction reacts directly with Ehrlich's diazo reagent and is thus called direct bilirubin. The unconjugated bilirubin requires the addition of alcohol to develop color reaction. It is also known as indirect bilirubin. Total bilirubin is the summation of the two fractions.

Similar to other common liver tests, abnormal bilirubin levels may or may not be caused by liver disease process. For example, hemolysis leads to indirect hyperbilirubinemia the liver is normal.

Heme, the substrate of bilirubin, is derived from red blood cells that have died.
Heme is degraded to biliverdin by heme oxygenase in the mononuclear phagocytes.
Biliverdin is subsequently reduced to bilirubin by biliverdin reductase.
Circulating bilirubin (insoluble/unconjugated) is bound to albumin and subsequently taken up by the hepatocytes.
To make it soluble, bilirubin undergoes conjugation, a reaction catalyzed by bilirubin UDPglucuronyl transferase (UDPG).
Conjugated bilirubin (soluble) is excreted into bile and reaches the bowel.
Bilirubin glucuronides are deconjugated by colonic bacteria and eliminated in the feces.

Parameters involved in liver function test (20)

serum bilirubin: elevated bilirubin, obstruction of bile flow
serum albumin: decreased albumin, chronic liver disoders
serum ALP alkaline phosphatase: elevated ALP, obstruction of bile flow, liver injury, cancers
serum aminotransferases: damaged liver cells
Prothrombin time: time needed for blood clot
ALT alanine transferase: damaged liver cells
AST asparate transferase: damaged liver, heart muscle, brain cells
Gamma-glutamyl Transpeptidase: injured liver, pancreas, kidney
Lactic dehydrogenase: injured liver, heart, lung, brain
5-Nucleotidase: released, obstruction of bile flow
Alpha-fetoprotein: produced by fetal liver & testes, indicate hepatitis/cancer
Mitochondrial Antibodies: indicate primary biliary cirrhosis, chronic active hepatitis, autoimmune disorders

Compare and contrast conjugated bilirubin and unconjugated bilirubin (10)

conjugated has less serum
conjugated is water-soluble
conjugated in bile, unconjugated in plasma
conjugated gives direct Van den Bergh
conjugated has small molecular weight
conjugated can be filtered through kidney
conjugated toxic to tissues

Clinical lab investigation to the baby that is suspected having jaundice (10)

September 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Analytical factor that affect the variation of clinical result is

(A) medical history

(B) reference range*--precision, accuracy, specificity, sensitivity, QA

(D) position of patient

2. Definition of specificity is

(A) a measure of the incidence of positive results in patients known to have the disease.--sensitivity

(B) a measure of incidence of negative results in patients known to be free of a disease.*

(D) a measure of incidence of negative results in patients known to be have the disease.

3. The result from clinical chemistry laboratory is used for

(A) dialysis

(B) sampling

(D) homeostasis

4. The difference between serum and plasma is that plasma contains

(A) albumin

(B) transferin

(D) haptoglobulin

5. The supernatant fluid present after a sodium fluoride blood tube has been centrifuged is

(A) serum

(B) plasma*--sodium fluoride is anticoagulant

(D) buffy coat

6. Which of the following play a significant role in maintaining acid base balance?

(A) lung*--kidney

(B) bone

(D) pancreas

7. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

8. What are the causes of hemoconcentration in blood collection?

(A) evaporation of blood sample

(B) overcentrifuged while preparing the sample

(D) blood hemolysis due to shaking of collection tube

9. Which ion is usually an exchange for bicarbonate absorption?

(A) kalium (K+)

(B) sodium (Na+)

(D) hydrogen (H+)*

10. The most electrolytes normally lost through

(A) urine*--60%

(B) feces--4%

(D) respiration

11. What is the most abundant extracellular anions?

(A) sodium

(B) chloride*

(D) magnesium

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) dehydration*--immune response, myeloma

(D) instestinal malabsorption

14. The serum protein that serves as antibodies is

(A) albumin

(B) beta globulin

(D) gamma globulin*

15. A plasma protein that involved in low density lipoprotein formation is

(A) α1 - globulin--antitrypsin, acid glycoprotein

(B) β - globulin*--transferrin

(D) α2 - globulin--haptogloblins, macroglobulin, caeruloplasmin

16. What is the type of enzyme specific for prostatic cancer?

(A) creatine kinase--myocardial infarction, CVA, muscular dystrophy

(B) acid phosphatase*

(D) lactate dehydrogenase--hemolytic anemia, carcinoma, leukemia, necrosis, muscular dystrophy, hepatocellular damage

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “MM” fraction of creatine kinase is most abundant in

(A) brain tissue--BB CK1

(B) liver tissue

(D) skeletal muscle*--CK3

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium--2.9

(B) sodium*--150

(D) chloride--130

bicarbonate 21, lactate 2.6, PO4- 0.5, protein 20, glucose 60

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated--haematology

(D) anticoagulant tube

21. Which of the following statement is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.*

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.--60~80%

(D) Decreased CSF glucose accompanied by decreased of white blood cells count.

22. Parameter for renal function test includes

(A) serum albumin

(B) serum bilirubin

(D) serum creatinine*--BUN, uric acid, GFR, urine, blood electrolytes

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis*

(D) impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) it prevents hemolysis.

(B) it prevents breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) storing glycogen

(B) synthesizing bile

(D) producing glucagon*

28. Which of the following condition shows the conjugated bilirubin as the major serum component?

(A) hemolysis--unconjugated

(B) neonatal jaundice--newborn, unconjugated

(D) biliary obstruction*

29. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney*

(B) stomach

(D) large intestine

30. Which of the following hormone is secreted by pancreas?

(A) insulin*--glucagon

(B) gastrin

(D) secretin

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. How is a serum prepared? (5 Marks)

b. Briefly explain FIVE (5) steps to avoid hemolysis. (5 Marks)

2. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

3. Briefly explain the functions of kidney. (10 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Explain the primary acid-base disorder with compensation. (20 Marks)

Question 2

Discuss the classification and major causes of jaundice. (20 Marks)

Question 3

Explain the chemistry test for cerebrospinal fluid (CSF). (20 Marks)

February 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Definition of sensitivity is

(A) a measure of the incidence of positive results in patients known to have the disease.*

(B) a measure of incidence of negative results in patients known to be free of a disease.

(D) a measure of incidence of negative results in patients known to be have the disease.

2. Biological factor that affect the variation of clinical result is

(A) accuracy

(B) reference range

(D) sensitivity of method

3. The result from clinical chemistry laboratory are used for

(A) dialysis

(B) sampling

(D) homeostasis

4. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

5. The supernatant fluid present after a heparin blood tube has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

6. Which of the following does not play a significant role in maintaining acid base balance?

(A) liver

(B) kidney*

(D) blood buffers

7. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

8. What are the causes of hemoconcentration in blood collection?

(A) evaporation of blood sample

(B) overcentrifuged while preparing the sample

(D) blood hemolysis due to shaking of collection tube

9. Which ion is usually an exchange for bicarbonate absorption?

(A) kalium (K+)

(B) sodium (Na+)

(D) hydrogen (H+)*

10. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. What is the most abundant extracellular anions?

(A) sodium

(B) chloride*

(D) magnesium

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. Which of the clinical conditions below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

14. The serum protein that serves as antibodies is

(A) albumin

(B) beta globulin

(D) gamma globulin*

15. A plasma protein that involved in low density lipoprotein formation is

(A) α1 - globulin

(B) β - globulin*

(D) α2 - globulin

16. What is the type of enzyme specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “BB” fraction of creatine kinase is most abundant in

(A) brain tissue*

(B) liver tissue

(D) skeletal muscle

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated.

(D) anticoagulant tube

21. Which of the following statement is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.*

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Decreased CSF glucose accompanied by decreased of white blood cells count.

22. Parameter for renal function test includes

(A) serum albumin

(B) serum bilirubin

(D) serum creatinine*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution*

25. Sample from patients suspected with jaundice should be protected from light because

(A) it prevents hemolysis.

(B) it prevents breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) storing glycogen

(B) synthesizing bile

(D) producing glucagon*

28. Which of the following hormones are secreted by pancreas?

(A) insulin*

(B) gastrin

(D) secretin

29. Which of the following condition shows the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

30. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney*

(B) stomach

(D) large intestine

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. List FIVE (5) functions of plasma protein. (5 Marks)

b. Briefly describe the causes of hypoalbuminemia. (5 Marks)

2. a. State the comparison between serum and plasma (4 Marks)

b. List the types of anticoagulant tubes. (6 Marks)

3. a. State the THREE (3) major functions of cerebrospinal fluid (CSF). (3 Marks)

b. Briefly explain the specimen collection of CSF for clinical laboratory test. (7 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Explain the renal function test. (20 Marks)

Question 2

Compare the types of water balance disorders. (20 Marks)

Question 3

Discuss the parameters involved in liver function test

(20 Marks)

September 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

2. The calculation for sensitivity of a test is

(A) True negative x 100--specificity, (FP+TN)X100

All without disease

(B) True positive x 100 * (TP+FN)X100

All with disease

All without disease

(D) False negative x 100

All with disease

3. Analytical factor that affect the variation of clinical result is

(A) diet

(B) exercise

(D) medical history

4. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

5. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

6. The purpose of buffer system is to

(A) decrease pH.

(B) increase acidity.

(D) maintain a pH range*

7. What are the causes of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking the collection tube.

8. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

9. Which of the following does not play a significant role in maintaining acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

10. Which ion is usually an exchange for kalium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate

11. What is the most abundant intracellular cations?

(A) Sodium--ECF

(B) Chloride

(D) Magnesium

12. What is the normal pH of the blood

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. A plasma protein that involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

14. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*--thyroid hormone, calcium, fatty acid, maintain osmotic pressure

(B) beta globulin

(D) gamma globulin

15. What is the type of enzyme that specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

16. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “MB” fraction of creatine kinase is most abundant in

(A) liver tissue

(B) brain tissue

(D) skeletal muscle

19. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated

(D) anticoagulant tube

20. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.*

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

23. Types of protein that present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin--glomerular

(B) microglobulin--tubular

(D) Tamm-Horsfall protein*

24. Sample from patients suspected with jaundice should be protected from light because

(A) prevent hemolysis.

(B) prevent breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

25. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

28. Which of the following statement is a metabolic function of the liver?

(A) detoxifying drug

(B) storing lactic acid

(D) producing glucagon*

29. The pancreas gland has a duct which opens into the:

(A) liver

(B) stomach

(D) large intestine

30. What of the following chemicals is released by the pancreas gland during and just after a meal?

(A) pepsin

(B) insulin*

(D) glucagon

https://wps.pearsoned.co.uk/ema_uk_he_wickens_biopsych_3/114/29279/7495633.cw/content/index.html

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

2. Briefly explain the primary Acid- Base Disorder. (10 Marks)

3. a. List the functions of cerebrospinal fluid. (4 Marks)

b. Briefly explain the causes of elevated protein level in cerebrospinal fluid. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Explain the metabolism of bilirubin and discuss the classification and major causes of jaundice. (20 Marks)

Question 2

Discuss the steps to avoid hemolysis blood samples (20 Marks)

Question 3

Discuss the classification of proteinuria. (20 Marks)

January 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Biological factor that affect the variation of clinical result is

(A) accuracy

(B) reference range

(D) sensitivity of method

2. The result from clinical chemistry laboratory are used for

(A) dialysis

(B) sampling

(D) homeostasis

3. Definition of sensitivity is

(A) a measure of the incidence of positive results in patients known to have the disease.*

(B) a measure of incidence of negative results in patients known to be free of a disease.

(D) a measure of incidence of negative results in patients known to be have the disease.

4. The supernatant fluid present after a heparin blood tube has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What are the causes of hemoconcentration in blood collection?

(A) evaporation of blood sample

(B) overcentrifuged while preparing the sample

(D) blood hemolysis due to shaking of collection tube

7. Which of the following does not play a significant role in maintaining acid base balance?

(A) liver*

(B) kidney

(D) blood buffers

8. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

9. Which ion is usually an exchange for bicarbonate absorption?

(A) kalium (K+)

(B) sodium (Na+)

(D) hydrogen (H+)*

10. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. What is the most abundant extracellular anions?

(A) sodium*

(B) chloride

(D) magnesium

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as antibodies is

(A) albumin

(B) beta globulin

(D) gamma globulin*

14. Which of the clinical conditions below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

15. A plasma protein that involved in low density lipoprotein formation is

(A) α1 - globulin

(B) β - globulin*

(D) α2 - globulin

16. What is the type of enzyme specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “BB” fraction of creatine kinase is most abundant in

(A) brain tissue*

(B) liver tissue

(D) skeletal muscle

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated.

(D) anticoagulant tube

21. Which of the following statement is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Decreased CSF glucose accompanied by decreased of white blood cells count.

22. Parameter for renal function test includes

(A) serum albumin

(B) serum bilirubin

(D) serum creatinine*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) it prevents hemolysis.

(B) it prevents breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) storing glycogen

(B) synthesizing bile

(D) producing glucagon*

28. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney

(B) stomach

(D) large intestine

29. Which of the following condition shows the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

30. Which of the following hormones are secreted by pancreas?

(A) insulin*

(B) gastrin

(D) secretin

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State the comparison between serum and plasma (4 Marks)

b. Briefly explain the steps to avoid common problem in plasma preparation in chemistry laboratory. (6 Marks)

2. a. State the THREE (3) major functions of cerebrospinal fluid (CSF). (3 Marks)

b. Briefly explain the specimen collection of CSF for clinical laboratory test. (7 Marks)

3. a. List FOUR (4) functions of plasma protein. (4 Marks)

b. Briefly describe the causes of hypoalbuminemia. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Compare the types of water balance disorders. (20 Marks)

Question 2

Discuss the parameters involved in liver function test. (20 Marks)

Question 3

Explain the renal function test. (20 Marks)

August 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

2. The calculation for sensitivity of a test is

(A) True negative x 100

All without disease

(B) True positive x 100*

All with disease

All without disease

(D) False negative x 100

All with disease

3. Analytical factor that affect the variation of clinical result is

(A) diet

(B) exercise

(D) medical history

4. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

5. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

6. The purpose of buffer system is to

(A) decrease pH.

(B) increase acidity.

(D) maintain a pH range*

7. What are the causes of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking the collection tube.

8. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

9. Which of the following does not play a significant role in maintaining acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

10. Which ion is usually an exchange for kalium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate

11. What is the most abundant intracellular cations?

(A) Sodium

(B) Chloride

(D) Magnesium

12. What is the normal pH of the blood

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. A plasma protein that involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

14. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*

(B) beta globulin

(D) gamma globulin

15. What is the type of enzyme that specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

16. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis

(B) acute pancreatitis

(D) muscular dystrophy

18. The “MB” fraction of creatine kinase is most abundant in

(A) liver tissue

(B) brain tissue

(D) skeletal muscle

19. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated

(D) anticoagulant tube

20. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

23. Types of protein that present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

24. Sample from patients suspected with jaundice should be protected from light because

(A) prevent hemolysis.

(B) prevent breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

25. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

28. Which of the following statement is a metabolic function of the liver?

(A) detoxifying drug

(B) storing lactic acid

(D) producing glucagon*

29. The pancreas gland has a duct which opens into the:

(A) liver

(B) stomach

(D) large intestine

30. What of the following chemicals is released by the pancreas gland during and just after a meal?

(A) pepsin

(B) insulin*

(D) glucagon

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

2. Briefly explain the primary Acid- Base Disorder. (10 Marks)

3. a. List the functions of cerebrospinal fluid. (4 Marks)

b. Briefly explain the causes of elevated protein level in cerebrospinal fluid. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Explain the metabolism of bilirubin and discuss the classification and major causes of jaundice. (20 Marks)

Question 2

Discuss the steps to avoid hemolysis blood samples (20 Marks)

Question 3

Discuss the classification of proteinuria. (20 Marks)

January 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. A blood sample for a glucose test may be drawn into which of the following tubes?

(A) red

(B) blue

(D) black

2. Which of the following is a specialized biochemistry test?

(A) vitamin*--hormone, specific protein, trace element, DNA

(B) amylase--core & emergency

(D) creatine kinase (CK)--core (creatine, albumin, glucose, bilirubin, ALP, AST)

3. Which of the following is associated with the analytical factor for a clinical laboratory test?

(A) medical history

(B) menstrual cycle

(D) posture of the patient

4. What is the purpose of a screening test in clinical chemistry?

(A) detection of sub clinical disease.*--simple test that is widely used

(B) used to detect complications of treatment--monitoring, natural history/response to tx, analyze as analyte

(C) information regarding the outcome of disease--prognosis, indicate risk of developing particular condition, not precise prediction

(D) confirmation or rejection of clinical diagnosis--diagnosis, H/O, result of investigation, response to tx

5. The supernatant fluid present in a centrifuged blood in a plain tube is

(A) serum

(B) plasma*

(D) buffy coat

6. The MOST abundant component in plasma is

(A) water* --91%

(B) waste

(D) nutrient--2%, hormones, electrolytes

7. Definition of specificity is

(A) a measure of the incidence of positive results in patients known to have the disease

(B) a measure of the incidence of negative results in patients known to have the disease

(D) a measure of the incidence of positive results in patients known to be free of a disease

8. Majority of the protein present in the plasma is the

(A) γ – globulin*

(B) β – globulin

(D) α1 – globulin

9. Which of the clinical conditions below can cause hypoprotenemia?

(A) myeloma

(B) dehydration

(D) bacterial meningitis

10. Which of the following protein that associated with Wilson’s disease?

(A) albumin

(B) transferrin--iton, haemocromatosis

(D) caeruloplasmin*--decrease in Wilson, copper, increased in pregnancy

11. The chief cation of intracellular fluid is

(A) sodium

(B) calcium

(D) magnesium

12. Which of the following statement is associated with dehydration?

(A) more H2O moves into cell by osmosis--cell loses H2O to ECF

(B) extracellular fluid osmotic pressure falls--hypotonic hydration

(D) excessive H2O enters the extracellular fluid--from ECF

13. Which of the following hormone is involved in water regulation?

(A) cortisol

(B) vasopressin*--output, ADH

(D) natriuretic peptides--sodium

14. The main waste product of protein metabolism is

(A) urea*

(B) creatine

(D) creatinine

15. The creatinine clearance is used to assess the

(A) dietary intake of protein

(B) glomerular and tubular mass

(D) glomerular filtration capabilities of the kidney*

16. What is the type of enzyme that is associated with pancreatic disease?

(A) amylase*--salivary gland, exocrine pancreas

(B) creatine kinase

(D) lactate dehydrogenase

17. The ‘MM’ fraction of creatine kinase is MOST abundant in the

(A) liver

(B) brain

(D) skeletal muscle*

18. Which of the following statement is TRUE about gamma glutamyl transferase?

(A) has eight isoenzymes--11

(B) used in synthesis of lactate--glutathoine

(D) present in high concentrations in cardiac muscle--liver, kidney, pancreas, intestinal cells, prostate gland

19. Samples from patients suspected with jaundice should be protected from light

(A) to prevent hemolysis

(B) to prevent breakdown of bilirubin*

(D) because the antibodies may be light sensitive

20. Cerebrospinal fluid (CSF) is classified as

(A) interstitial fluid

(B) intracellular fluid

(D) transcellular fluid

21. Which of the following condition shows elevated protein in CSF?

(A) meningitis*--hemorrhage, BBB damage, Ig produce, neural tissue degenerate, decrease clearance of normal protein from fluid

(B) CSF leakage

(D) rapid CSF production

22. In an individual with metabolic acidosis, a clue that the respiratory system is compensating is provided by

(A) rapid deep breathing*

(B) slow shallow breathing

(D) high blood bicarbonate levels

23. Respiratory alkalosis is the primary disorder with

(A) increase PCO2--respiratory acidosis

(B) decrease PCO2*

(D) decrease bicarbonate concentration--metabolic acidosis

24. Which of the following statement associated with metabolic alkalosis?

(A) too little hydrogen ion

(B) too much hydrogen ion--meyabolic acidosis

(D) too much bicarbonate ion*

25. Which of the following shown the laboratory finding of prehepatic jaundice?

(A) bilirubin present in urine--increase

(B) decrease urobilinogen in urine--increase

(D) increased unconjugated bilirubin in plasma*

26. Which of the following disease can cause post hepatic jaundice?

(A) cirrhosis--hepatic

(B) hepatitis

(D) anemia hemolytic--prehepatic

27. Disorder of the following organ can cause malabsorption EXCEPT

(A) stomach

(B) pancreas*

(D) large intestine

28. Which of the following statement indicates a metabolic function of the liver?

(A) synthesizing bile

(B) detoxifying drug

(D) producing glucagon*

29. Which of the following hormone is secreted by the pancreas?

(A) insulin*

(B) gastrin

(D) secretin

30. Which types of protein is present in urine due to secretion by kidney and epithelium of the urinary tract?

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State the comparison between serum and plasma (4 Marks)

b. Briefly explain the steps to avoid common problem in plasma

preparation in chemistry laboratory. (6 Marks)

2. a. List FOUR (4) functions of plasma protein. (4 Marks)

b. Briefly describe the causes of hypoalbuminemia. (6 Marks)

3. a. State the THREE (3) major functions of cerebrospinal fluid (CSF). (3 Marks)

b. Briefly explain the specimen collection of CSF for clinical laboratory test. (7 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Compare the types of water balance disorders. (20 Marks)

Question 2

Discuss the parameters involved in the liver function test. (20 Marks)

Question 3

Explain the renal function test (20 Marks)

August 2015

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. The supernatant fluid present after a heparin blood tube has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

2. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

3. What are the causes of hemoconcentration in blood collection?

(A) evaporation of blood sample

(B) use tourniquet for more than 2 minutes*

(D) blood hemolysis due to shaking of collection tube

4. The result from clinical chemistry laboratory are used for

(A) dialysis

(B) sampling

(D) homeostasis

5. Biological factor that affect the variation of clinical result is

(A) accuracy

(B) reference range

(D) sensitivity of method

6. Definition of sensitivity is

(A) a measure of the incidence of positive results in patients known to have the disease.*

(B) a measure of incidence of negative results in persons known to be free of a disease

(D) a measure of incidence of negative results in patients known to be have the disease.

7. Which of the following DOES NOT play a significant role in maintaining acid base balance?

(A) liver*

(B) kidney

(D) blood buffers

8. Which ion is usually an exchange for bicarbonate absorption?

(A) potassium

(B) sodium

(D) hydrogen*

9. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

10. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. What is the most abundant extracellular anion?

(A) sodium

(B) chloride*

(D) magnesium

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as antibodies is

(A) albumin

(B) beta globulin

(D) gamma globulin*

14. Which of the clinical conditions below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) intestinal malabsorption

15. A plasma protein that involved in low density lipoprotein formation is

(A) α1 - globulin

(B) β - globulin*

(D) α2 - globulin

16. What is the type of enzyme specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both

elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “H3M1” fraction of lactate dehydrogenase is most abundant in

(A) liver tissue*--LDH4

(B) brain tissue--H2M2 LDH3

(D) cardiac muscle--H4 LDH1

skeletal muscle M4 LDH5

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) potassium

(B) calcium

(D) sodium*

20. The CSF flows through the

(A) pia mater

(B) dura mater

(D) subarachnoid space*--lateral ventricle, third ventricle, Aqueduct of Sylvius, subarachnoid space, arachnoid villi, bloodstream (sagittal sinus)

21. Substances present in the CSF are controlled by the

(A) blood brain barrier*

(B) blood-CSF barrier

(D) presence of one-way valves

22. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

23. Parameter for renal function test is

(A) serum albumin

(B) serum bilirubin

(D) serum creatinine*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution

25. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

26. Sample from patients suspected with jaundice should be protected from light because

(A) to prevent hemolysis

(B) to prevent breakdown of bilirubin*

(D) the antibodies may be light sensitive

27. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney*

(B) stomach

(D) large intestine

28. Which of the following statement is a metabolic function of the liver?

(A) storing urobilin

(B) detoxifying drug*

(D) producing glucagon

29. Which of the following hormones is secreted by pancreas?

(A) insulin*

(B) gastrin

(D) secretin

30. Which of the following protein as knows as secretory proteinuria?

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. Discuss the steps to avoid hemolysis blood samples (10 Marks)

2. a. What are electrolytes? (2 Marks)

b. Compare the TWO (2) types of Water Balance Disorder. (8 Marks)

3. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain the creatine kinase (CK) as a diagnostic plasma enzyme. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the chemistry test for cerebrospinal fluid. (20 Marks)

Question 2

Explain the metabolism of bilirubin and discuss the classification and major causes of jaundice. (20 Marks)

Question 3

Describe the respiratory and metabolism compensation of primary acid base disorder. (20 Marks)

January 2015

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. The result from clinical chemistry laboratory are used for

(A) dialysis

(B) sampling

(D) homeostasis

2. Biological factor that affect the variation of clinical result is

(A) accuracy

(B) reference range

(D) sensitivity of method

3. Definition of sensitivity is

(A) a measure of the incidence of positive results in patients known to have the disease.*

(B) a measure of incidence of negative results in persons known to be free of a disease

(D) a measure of incidence of negative results in patients known to be have the disease.

4. The supernatant fluid present after a heparin blood tube has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What are the causes of hemoconcentration in blood collection?

(A) evaporation of blood sample

(B) overcentrifuged while preparing the sample

(D) blood hemolysis due to shaking of collection tube

7. Which of the following does not play a significant role in maintaining acid base balance?

(A) liver*

(B) kidney

(D) blood buffers

8. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

9. Which ion is usually an exchange for bicarbonate absorption?

(A) kalium (K+)

(B) sodium (Na+)

(D) hydrogen (H+)*

10. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. What is the most abundant extracellular anions?

(A) sodium

(B) chloride*

(D) magnesium

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as antibodies is

(A) albumin

(B) beta globulin

(D) gamma globulin*

14. Which of the clinical conditions below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

15. A plasma protein that involved in low density lipoprotein formation is

(A) α1 - globulin

(B) β - globulin*

(D) α2 - globulin

16. What is the type of enzyme specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

18. The “BB” fraction of creatine kinase is most abundant in

(A) brain tissue*

(B) liver tissue

(D) skeletal muscle

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated.

(D) anticoagulant tube

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.*

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. Parameter for renal function test is

(A) Serum albumin

(B) Serum bilirubin

(D) Serum creatinine*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) decreased calcitriol synthesis

(B) increased erythropoietin synthesis

(D) impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) it prevents hemolysis.

(B) it prevents breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) Storing glycogen

(B) Synthesizing bile

(D) Producing glucagon*

28. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney*

(B) stomach

(D) large intestine

29. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

30. Which of the following hormones are secreted by pancreas?

(A) insulin*

(B) gastrin

(D) secretin

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. Briefly explain the functions of plasma protein. (10 Marks)

2. Compare the laboratory findings according to the classification of jaundice.(10 Marks)

3. Briefly explain the cerebrospinal fluid (CSF) specimen collection for laboratory test. (10 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the steps to avoid hemolysis blood samples. (20 Marks)

Question 2

Elaborate the causes of Primary Acid Base Disorders. (20 Marks)

Question 3

Describe the types of proteinuria. (20 Marks)

August 2014

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

2. Analytical factor that affect the variation of clinical result is

(A) diet

(B) exercise

(D) medical history

3. The calculation for sensitivity of a test is

(A) True negative x 100

All without disease

(B) True positive x 100*

All with disease

All without disease

(D) False negative x 100

All with disease

4. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What are the causes of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking the collection tube.

7. The purpose of buffer system is to

(A) decrease pH.

(B) increase acidity.

(D) maintain a pH range*

8. Which of the following does not play a significant role in maintaining acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

9. What is the most abundant intracellular cations?

(A) Sodium

(B) Chloride

(D) Magnesium

10. Where are the most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. Which ion is usually an exchange for kalium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate\

12. What is the normal pH of the blood

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*

(B) beta globulin

(D) gamma globulin

14. A plasma protein that involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

15. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) renal disease

(D) instestinal malabsorption

16. What is the type of enzyme that specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. The “MB” fraction of creatine kinase is most abundant in

(A) brain tissue

(B) liver tissue

(D) skeletal muscle

18. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated.

(D) anticoagulant tube

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.*

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. Types of protein that present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) Decreased calcitriol synthesis

(B) Increased erythropoietin synthesis

(D) Impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) prevent hemolysis.

(B) prevent breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) Storing glycogen

(B) Synthesizing bile

(D) Producing glucagon*

28. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

29. Which of the following hormones are secreted by pancrease?

(A) gastrin

(B) cortisol

(D) glucagon*

30. Disorder of the following organ can cause malabsorption EXCEPT

(A) kidney*

(B) stomach

(D) large intestine

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. Compare the TWO (2) types of Water Balance Disorder. (10 Marks)

2. Briefly explain the primary Acid- Base Disorder. (10 Marks)

3. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the chemistry test for cerebrospinal fluid. (20 Marks)

Question 2

Explain the metabolism of bilirubin and discuss the classification and major causes of jaundice. (20 Marks)

Question 3

Elaborate the kidney function tests. (20 Marks)

January 2014

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

Choose ONE best statement to answer the questions.

1. The calculation of specificity of a test is

(A) True negative x 100*

All without disease

(B) True negative x 100

All with disease

All without disease

(D) False negative x 100

All with disease

2. Analytical factor that affect the variation of clinical results is

(A) diet

(B) exercise

(D) medical history

3. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

4. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What is the cause of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking of the collection tube.

7. The purpose of a buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

8. Which of the following does NOT play a significant role in maintaining acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

9. What is the most abundant extracellular cations?

(A) sodium*

(B) chloride

(D) magnesium

10. Where are most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. Which ion is usually an exchange for potassium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*

(B) beta globulin

(D) gamma globulin

14. The plasma protein involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

15. Which of the clinical conditions below causes hyperproteinuria?

(A) burns

(B) renal disease

(D) intestinal malabsorption

16. What is the type of enzyme specific for prostate cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. The “MM” fraction of creatine kinase is most abundant in

(A) brain tissue

(B) liver tissue

(D) skeletal muscle*

18. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

19. Which of the following is the highest substance found in cerebrospinal fluid (CSF)?

(A) sodium*

(B) calcium

(D) potassium

20. CSF specimen for chemistry and serology tests is usually maintained i

(A) frozen*

(B) refrigerated

(D) in an anticoagulant tube

21. Which of the following statements below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Decreased CSF glucose is accompanied with decreased in white blood cells count.

22. The protein which is present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) Decreased calcitriol synthesis

(B) Increased erythropoietin synthesis

(D) Impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) to prevent hemolysis

(B) to prevent breakdown of bilirubin*

(D) the antibodies may be light sensitive

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) storing glycogen

(B) synthesizing bile

(D) producing glucagon*

28. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

29. Disorder of the following organ can cause malabsorption EXCEPT

(A) liver*

(B) stomach

(D) large intestine

30. Which of the following hormones are secreted by pancreas?

(A) gastrin

(B) cortisol

(D) glucagon*

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

2. a. Briefly explain the functions of plasma protein. (5 Marks)

b. With the aid of diagram, show the separation of serum protein by electrophoresis (5 Marks)

3. a. List the functions of cerebrospinal fluid. (4 Marks)

b. Briefly explain the causes of elevated protein level in cerebrospinal fluid. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions ONLY.

Question 1

Describe the respiratory and metabolism compensation of primary acid base disorder.

(20 Marks)

Question 2

Explain the metabolism of bilirubin AND discuss the classification and major causes

of jaundice. (20 Marks)

Question 3

Discuss the classification of proteinuria. (20 Marks)

August 2013

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

Choose ONE best statement to answer the questions.

1. Analytical factor that affect the variation of clinical result is

(A) diet

(B) exercise

(D) medical history

2. The calculation of sensitivity of a test is

(A) True negative x 100

All without disease

(B) True positive x 100*

All with disease

All without disease

(D) False negative x 100

All with disease

3. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

4. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What is the cause of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking the collection tube.

7. The purpose of buffer system is to

(A) decrease pH

(B) increase acidity

(D) maintain a pH range*

8. Which of the following does not play a significant role in maintaining body acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

9. What is the most abundant intracellular cations?

(A) Sodium

(B) Chloride

(D) Magnesium

10. Where are most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. Which ion is usually an exchange for potassium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate

12. What is the normal pH of the blood?

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*

(B) beta globulin

(D) gamma globulin

14. A plasma protein that involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

15. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) dehydration*

(D) instestinal malabsorption

16. What is the type of enzyme that is specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. The “MM” fraction of creatine kinase is most abundant in

(A) brain tissue

(B) liver tissue

(D) skeletal muscle*

18. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) sodium*

(B) calcium

(D) potassium

20. CSF specimen for chemistry and serology test is usually maintained

(A) frozen*

(B) refrigerated.

(D) in an anticoagulant tube

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. Types of protein that present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin

(B) microglobulin

(D) Tamm-Horsfall protein*

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) Decreased calcitriol synthesis

(B) Increased erythropoietin synthesis

(D) Impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) to prevent hemolysis.

(B) To prevent breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) storing glycogen

(B) synthesizing bile

(D) producing glucagon*

28. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

29. Disorder of the following organ can cause malabsorption EXCEPT

(A) liver*

(B) stomach

(D) large intestine

30. Which of the following hormones are secreted by pancreas?

(A) gastrin

(B) cortisol

(D) glucagon*

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. List the functions of cerebrospinal fluid. (4 Marks)

b. Briefly explain the causes of elevated protein level in cerebrospinal fluid. (6 Marks)

2. a. List THREE(3) hormones that are produced by kidney. (3 Marks)

b. A 41 years old male with suspected kidney disease had a serum creatinine of 172 µmol/l. A 24-hours urine collection was made, which had a volume of 1990 ml and creatinine concentration of 6.8 mmol/l.

Calculate the creatinine clearance. (7 Marks)

3. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions ONLY.

Question 1

Explain the types of anticoagulant. (20 Marks)

Question 2

a. Explain the metabolism of bilirubin (10 Marks)

b. Discuss the classification and major causes of jaundice. (10 Marks)

Question 3

Describe the respiratory and metabolism compensation of primary acid base disorder. (20 Marks)

January 2013

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

Choose ONE best statement to answer the questions.

1. The calculation of specificity of a.test is

(A) True negative x 100*

All without disease

(B) True negative x 100

All with disease

All without disease

(D) False negative x 100

All with disease

2. Analytical factor that affect the variation of clinical result is

(A) diet

(B) exercise

(D) medical history

3. Clinical biochemical tests are used for

(A) dialysis

(B) sampling

(D) homeostasis

4. The supernatant fluid present after a clotted blood has been centrifuged is

(A) serum

(B) plasma*

(D) buffy coat

5. The difference between serum and plasma is that plasma contains

(A) albumin

(B) globulin

(D) fibrinogen*

6. What are the causes of hemoconcentration in blood collection?

(A) Evaporation of blood sample.

(B) Overcentrifuged while preparing the sample.

(D) Blood hemolysis due to shaking the collection tube.

7. The purpose of buffer system is to

(A) decrease pH.

(B) increase acidity.

(D) maintain a pH range*

8. Which of the following does not play a significant role in maintaining acid base balance?

(A) kidney

(B) stomach*

(D) blood buffers

9. What is the most abundant extracellular cations?

(A) Sodium*

(B) Chloride

(D) Magnesium

10. Where are most electrolytes normally lost?

(A) urine*

(B) feces

(D) respiration

11. Which ion is usually an exchange for kalium absorption?

(A) sodium*

(B) chloride

(D) bicarbonate

12. What is the normal pH of the blood

(A) 7.0 – 8.0

(B) 7.40 – 7.50

(D) 6.80 – 7.90

13. The serum protein that serves as a transport protein for a variety of substances is

(A) albumin*

(B) beta globulin

(D) gamma globulin

14. A plasma protein that involved in immunity is

(A) α1 - globulin

(B) β - globulin

(D) α2 - globulin

15. Which of the clinical condition below causes hyperproteinuria?

(A) burns

(B) renal disease

(D) instestinal malabsorption

16. What is the type of enzyme that specific for prostatic cancer?

(A) creatine kinase

(B) acid phosphatase*

(D) lactate dehydrogenase

17. The “MM” fraction of creatine kinase is most abundant in

(A) brain tissue

(B) liver tissue

(D) skeletal muscle*

18. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following disease?

(A) viral hepatitis*

(B) acute pancreatitis

(D) muscular dystrophy

19. Which of the following is the highest substance in cerebrospinal fluid (CSF)?

(A) kalium

(B) calcium

(D) sodium*

20. CSF specimen for chemistry and serology test usually maintained in

(A) frozen*

(B) refrigerated.

(D) anticoagulant tube

21. Which of the following statement below is TRUE regarding CSF glucose?

(A) Elevated CSF glucose values are a result of plasma elevations.

(B) Normal value for CSF glucose is 30-40% of the plasma concentration.

(D) Increased levels of CSF glucose are seen in patient with bacterial meningitis.

22. Types of protein that present in urine due to secretion by kidney or epithelium of the urinary tract is

(A) albumin

(B) microglobulin

(D) Bence Jones protein

23. The following are types of clearance test EXCEPT

(A) urea

(B) inulin

(D) glucose*

24. Which of the following statement is NOT a metabolic feature of end stage renal disease?

(A) Decreased calcitriol synthesis

(B) Increased erythropoietin synthesis

(D) Impairment of urinary concentration and dilution

25. Sample from patients suspected with jaundice should be protected from light because

(A) prevent hemolysis.

(B) prevent breakdown of bilirubin.*

(D) the antibodies may be light sensitive.

26. Urobilinogen is expected to be decreased or absent in a patient with

(A) liver disease*

(B) hypoalbuminemia

(D) posthepatic blockage

27. Which of the following statement is NOT a metabolic function of the liver?

(A) Storing glycogen

(B) Synthesizing bile

(D) Producing glucagon*

28. Which of the following condition shows that the conjugated bilirubin as the major serum component?

(A) hemolysis

(B) neonatal jaundice

(D) biliary obstruction*

29. Disorder of the following organ can cause malabsorption EXCEPT

(A) liver*

(B) stomach

(D) large intestine

30. Which of the following hormones are secreted by pancrease?

(A) gastrin

(B) cortisol

(D) glucagon*

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. Define the following term with example:

i. functional enzymes

ii. non-functional enzymes (4 Marks)

b. Briefly explain how plasma enzyme will increase in plasma. (6 Marks)

2. a. Briefly explain the functions of plasma protein. (5 Marks)

b. With the aid of diagram, show the separation of serum protein by electrophoresis (5 Marks)

3. a. List the functions of cerebrospinal fluid. (4 Marks)

b. Briefly explain the causes of elevated protein level in cerebrospinal fluid. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions ONLY.

Question 1

Describe the respiratory and metabolism compensation of primary acid base disorder. (20 Marks)

Question 2

a. Explain the metabolism of bilirubin (10 Marks)

b. Discuss the classification and major causes of jaundice. (10 Marks)

Question 3

Discuss the classification of proteinuria. (20 Marks)

2/2009/2010

PART A : OBJECTIVE QUESTION (30 Marks)

Choose the best option to answer the questions.

1. A vacutainer tube that contained EDTA can be used in all the following tests EXCEPT

A. hematological tests.

B. drugs analysis.

C. lipids and lipoproteins tests.*

D. trace elements tests.

2. Which of the following test CANNOT been done in clinical chemistry laboratory?

A. Electrolytes analysis.

B. Cerebrospinal fluid culture.*

C. Liver function tests.

D. Blood glucose.

3. The light reflected from the surface of colorimetric reaction is refer to

A. reflactance spectrophotomery.

B. fluorescence spectrophotometry.

C. absorbance spectrophotometry.

D. ultraviolet spectrophotometry.

4. Which of the following is NOT the function of liver?

A. Glycogen synthesis and breakdown.

B. Regulation of fluid & electrolyte balance.*

C. Metabolism and excretion of steroid hormones.

D. Synthesis of plasma proteins.

5. The following statements are true about bilirubin metabolism EXCEPT

A. heme ring is broken open and converted to unconjugated bilirubin.

B. hepatocytes conjugates bilirubin with gluconic acid and UDPG enzyme.

C. kernicterus is an abnormal accumulation of unconjugated bilirubin in liver tissue.

D. bilirubin bound with plasma and travels to the liver.

6. Which of the following is a characteristic of unconjugated bilirubin?

A. Water soluble.

B. Always reacts with diazo reagent.

C. Need accelerator to react with diazo reagent.

D. Direct bilirubin.

7. The following statements are true for specimen collection of cerebropinal fluid EXCEPT

A. specimen can be refrigerated in microbiology laboratory if testing cannot be done as soon as possible.*

B. specimen can be collected by lumbar puncture bet 3rd & 4th lumbar vertebrae.

C. specimen commonly collected in 3 sterile tubes.

D. traumatic tap may occur during the lumbar puncture procedure.

8. Brown colour of cerebrospinal fluid supernatant is usually due to

A. hyperbilirubinemia.

B. meningeal melanomatosis.

C. high carotenoid ingestion.

D. purulent cerebrospinal fluid.

9. Which of the following statements is TRUE for laboratory examination of cerebrospinal fluid?

A. The determination of lactate is valuable in meningitis cases.

B. Abnormal low value of protein is caused by degradation of neural tissue

C. The enzyme that usually measured is acid phosphatase.

D. It is not necessary to run a blood glucose test for comparison with cerebrospinal fluid glucose.

10. The primary disorder which is related with a decreased in bicarbonate concentration is refered to as

A. respiratory acidosis.

B. metabolic alkalosis.

C. respiratory alkosis.

D. metabolic acidosis.*

11. The cause of metabolic alkalosis may be due to

A. loss of bicarbonate from the gastrointestinal tract.

B. impaired excretion of hydrogen ions by the kidneys.*

C. potassium deficiency.

D. ingestion of drugs that are metabolize to acids.

12. The following are true for blood gas analysis EXCEPT

A. the blood specimen should be place in syringe without any anticoagulant.

B. arterial blood sample is the most suitable specimen.

C. the syringe that contain specimen should be placed in ice during transit.

D. exclude air from the syringe before and after blood is collected.

13. All the following are tests for the glomerular function of the kidneys EXCEPT

A. uric acid.

B. osmolality.

C. creatinine clearance.

D. urea.

14. The urea plasma test is

A. increased in excessive acid amino from protein converted to urea.

B. a concentrating test for the kidneys function.

C. most sensitive means for detecting early renal impairment.

D. done by method Jaffe’s reaction.

15. Given a plasma creatinine concentration of 150 mg/dl and 24 hour urine collection with a creatinine concentration of 14.5 mg/dl and volume of 1500 ml, calculate the creatinine clearance.

A. 1.45 mg/dl.

B. 145 mg/dl.

C. 10.78 mg/dl.

D. 0.1007 mg/dl.

16. Which of the following is NOT a component of gastric juice?

A. Electrolytes.

B. Mucus.

C. Glucose.

D. Pepsinogen.

17. Which of the following statement is FALSE for amylase?

A. P-isoamylase arise from salivary glands.

B. The most frequently method used are saccharogenic.

C. A conformation test for acute pancreatitis.

D. Being of relatively low molecular weight, it is excreted in the urine.

18. Which of the following can be use in clinical diagnosis of chronic pancreatitis?

A. The blood glucose test.

B. The secretin-cholecytokinin test .

C. Fecal fat analysis.

D. Sweet chloride analysis.

19. “Catalyze removal of groups from substrates without hydrolysis”. This statement is BEST describe

A. ligases.

B. isomerases.

C. lyases.

D. oxidoreductase.

20. Which of the following enzyme is markedly increased in myocardial infarction?

A. Alkaline phosphatase (ALP).

B. Acid phosphatase (ACP).

C. Amylase.

D. Creatinine kinase (CK).*

21. Which of the following is NOT increased in liver disease?

A. Alanine transaminase (ALT).

B. Alkaline phosphatase (ALP).

C. Lactate dehydrogenase (LDH).

D. Gamma-glutamyl transferase (GGT).

22. The albumin may become a carrier for all the following substance EXCEPT

A. carbon dioxide.

B. bilirubin.

C. steroid hormones.

D. drugs.

23. The following techniques can be used in the laboratory assessment of protein EXCEPT

A. electrophoresis.

B. spectrophotometry.

C. blood gas analyzer.

D. immunochemical.

24. A procedure used to collect cerebrospinal fluid is called

A. phlebotomy.

B. venepuncture.

C. bone marrow aspirate.

D. lumbar puncture.*

25. Which of the following statement correcly describe osmolality?

A. Measured in miligram per deciliter.

B. Measured in osmoles per liter of solution.

C. Measured in osmoles per kilogram of water.

D. Measured in mililiter per minute.

26. What is the result of indirect bilirubin when an asessment to a patient suspected jaundice shows total bilirubin is 5 mg/dl and conjugated bilirubin is 3.3 mg/dl?

A. 2 ml/dl.

B. 1.7 mg/dl.

C. 8.3 mg/dl.

D. 0.7 mg/dl.

27. The following are true about quality control EXCEPT

A. must use the reagent that did not reach expiry date.

B. the purpose is to ensure the reliability of the measurement performed for each sample.

C. if value is out of control, no corrected action must be taken and documented.

D. both control samples and patient samples must be assayed with the same testing.

28. Which of the following test is most suitable in the assessment of cystic fibrosis?

A. Sweet chloride analysis.

B. Fecal fat analysis.

C. Amylase test.

D. Fluorescein dilaurate test.

29. The following are regulatory protein EXCEPT

A. receptors

B. hormones

C. inhibitors

D. immunoglobulin

30. “Generally stabilized by non local interactions, most commonly the formation of a hydrophobic core”. This statement is refer to ____________________protein structure.

A. primary

B. secondary

C. tertiary

D. quaternary

PART B : SHORT ANSWER QUESTION (40 Marks)

Answer ALL questions.

1. Define the following terms.

a. Levey Jenning charts

b. Jaundice

c. Acid base balance

d. Electrophoresis

e. Xanthochromia

(10 marks)

2. Compare and contrast conjugated bilirubin with unconjugated bilirubin. (10 marks)

3. List FIVE (5) types of instruments commonly used in clinical chemistry laboratory. (5 marks)

4. List FIVE (5) types of enzymes classification. (5 marks)

5. List FIVE (5) types of protein that are measured in serum. (5 marks)

6. List FIVE (5) types of tests which can be used in the laboratory assessment of kidney function. (5 marks)

PART C : ESSAY QUESTION (30 Marks)

Choose only THREE (3) questions.

1. Write an essay on the mechanisms to controls acid base balance and the causes of metabolic acidosis and respiratory acidosis. (10 marks)

2. Write an essay on the assessment of cerebrospinal fluid in the clinical chemistry laboratory. (10 marks)

3. Write an essay on the clinical laboratory investigation to the baby that is suspected having jaundice. (10 marks)

4. Write an essay on types of electrolytes which presence in the body and the electrolytes imbalance. (10 marks)

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Clinical Chemistry 1 MCQS

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