EMQs on Enzymes and Chemistry

Question 1

Why does AST rise following an acute MI?

Answer 1

It is also found in cardiac myocytes.

Question 2

When does AST rise after an acute MI?

Answer 2

3 days, remains high for 14 days

Question 3

What is given for prevention of AKI in rhabdomyolysis?

Answer 3

IV bicarbonate - the patient will quickly urinate out all the creatine kinase which would damage the kidneys.

Question 4

AST:ALT in viral hepatitis

Answer 4

ALT > AST

Question 5

AST:ALT in alcoholic hepatitis

Answer 5

AST > ALT

Question 6

Which enzyme is responsible for low vitamin D levels in primary hyperparathyroidism?

Answer 6

1-alpha-hydroxylase

Question 7

If AKI is caused by dehydration, which blood marker will rise the most?

Answer 7

Urea

Question 8

What are the indications for dialysis in AKI/CKD?

Answer 8

Refractory hyperkalaemia
Refractory acidosis
Pulmonary oedema

Question 9

What is the best marker of glucose control over the last 3 weeks?

Answer 9

Fructosamine

Question 10

What two blood markers are raised in Paget’s disease?

Answer 10

ALP

Osteocalcin

Question 11

Which scan will be used to look for primary neuroendocrine tumours?

Answer 11

Gallium 68 dotatate CT scan

Question 12

Which scan will be used to look for phaeochromocytomas?

Answer 12

MIBG scan

Question 13

Which liver zone has the most ALP?

Answer 13

Zone 1 - because this is closest to the bile duct and ALP rises the most in obstructive jaundice