MLS 421 Clinical Chemistry II Exam II Flashcards
The formation of glucose from compounds like fatty acids, glycerol, and amino acids is called:
(a) Glycogenesis
(b) Glycogenolysis
(c) Glycolysis
(d) Gluconeogenesis
(d) Gluconeogenesis
An isomer of glucose with the OH group of the anomeric carbon C1 that is below the plane of the ring is:
(a) An aldose
(b) Alpha-glucose
(c) Beta-glucose
(d) A ketose
(b) Alpha-glucose
This pathway has a key role for glycolysis in the red blood cell, due to the lack of mitochondria.
(a) Kreb’s TCA Cycle
(b) Glycogenesis
(c) Hexose Monophosphate Pathway/Pentose Shunt
(d) Beta-Oxidation
(c) Hexose Monophosphate Pathway/Pentose Shunt
All of the following will increase blood glucose, EXCEPT:
(a) Glucagon
(b) Epinephrine
(c) Cortisol
(d) Insulin
(d) Insulin
Choose the statement that describes a common finding in Type I diabetes mellitus patients.
(a) Ketosis accompanied with hyperglycemia.
(b) High blood insulin levels.
(c) Initially, can be controlled by diet and exercise.
(d) Associated with obesity and common in persons >40 years old.
(a) Ketosis accompanied with hyperglycemia.
Which of the following is characteristic of Type 2 diabetes mellitus?
(a) High insulin
(b) Increased visceral, abdominal fat
(c) Ketosis
(d) Juvenile onset
(b) Increased visceral, abdominal fat
Laboratory tests are performed on a post-menopausal, 57-year-old women as part of an annual physical examination. The patient’s 2-hour post-prandial glucose is 220 mg/dL and serum insulin is 15 mU/mL (normal = 6-26 mU/mL). Based on this information, the patient would be classified as:
(a) Insulin-dependent diabetes mellitus (IDDM)
(b) Non-insulin-dependent diabetes mellitus (NIDDM)
(c) Gestational diabetes mellitus (GDM)
(d) Normal glucose tolerance (NGT)
(b) Non-insulin-dependent diabetes mellitus (NIDDM)
A diabetic patient is prescribed a daily regimen of insulin. Which of the following laboratory procedures would be of most value in determining the degree of glucose control over a 2-month period?
(a) Fasting blood glucose
(b) Fructosamine
(c) 2-hour PP glucose
(d) Glycated hemoglobin
(e) OGTT
(d) Glycated hemoglobin
The following glucose tolerance test results are indicative of what state? Glucose values as assayed by glucose oxidase method are fasting, 130 mg/dL; 60 minutes, 225 mg/dL; and 120 minutes, 205 mg/dL.
(a) Diabetes
(b) Hyperinsulinism
(c) Addison’s disease
(d) Normal
(a) Diabetes
In the hexokinase method for glucose determination, the actual end product measured is the:
(a) NADPH produced from the reduction of NADP+
(b) Condensation of glucose with an aromatic amine
(c) Amount of glucose coupled with a dye reagent
(d) Amount of hydrogen peroxide produced
(a) NADPH produced from the reduction of NADP+
Which statement is FALSE in regards to gestational diabetes?
(a) These women are at risk for developing diabetes.
(b) The affects on the mother is usually temporary insulin resistance.
(c) Screening is done during the 2nd trimester of pregnancy.
(d) Newborn complication is hyperglycemia.
(d) Newborn complication is hyperglycemia.
The serum glucose concentration of a normal patient undergoing a glucose tolerance test should peak and return to fasting within:
(a) 30 minutes - 1 hour
(b) >5 hours
(c) 2 - 3 hours
(c) 2 - 3 hours
Hemoglobin A1C-glycated hemoglobin
(a) Is a reflection of the average blood glucose over the lifespan of an erythrocyte.
(b) Levels change rapidly.
(c) Is usually 4 - 5% in a well controlled diabetic.
(d) In diabetics, this should be analyzed once a year.
(a) Is a reflection of the average blood glucose over the lifespan of an erythrocyte.
These enzymes are routinely analyzed in suspected cases of acute pancreatitis.
(a) Insulin, glucagon
(b) Chymotrypsin, trypsin
(c) Amylase, lipase
(d) Elastase, lipase
(e) Trypsin, amylase
(c) Amylase, lipase
Which of the following is NOT produced by the islets of Langerhans of the pancreas?
(a) Insulin
(b) Glucagon
(c) Gastrin
(d) Somatostatin
(c) Gastrin
How soon following acute abdominal pain due to pancreatitis is the serum amylase level expected to rise?
(a) 1 - 2 hours
(b) 5 - 6 days
(c) 3 - 4 days
(d) 2 - 12 hours
(d) 2 - 12 hours
Which of the following is a false statement?
(a) Pancreatic secretions are highly acidic to aid in digestion.
(b) The exocrine pancreas secretes enzymes into the duodenal lumen of the digestive tract.
(c) The pancreas secretes a fluid that is rich in digestive enzymes.
(d) CCK, cholecystokinin-pancreozymin, is a hormone that stimulates secretion of pancreatic enzymes.
(a) Pancreatic secretions are highly acidic to aid in digestion.
Triglycerides are composed of fatty acids linked to:
(a) Glycerol
(b) Protein
(c) Glycogen
(d) Cholesterol
(a) Glycerol
Which of the following is not a function of cholesterol?
(a) Active precursor to triglyceride synthesis.
(b) Component of membrane structure.
(c) Precursor of bile acids.
(d) Precursor of steroid hormones.
(a) Active precursor to triglyceride synthesis.
Bile acids are synthesized in the liver from which lipid?
(a) Fatty acids
(b) Triglycerides
(c) Cholesterol
(d) Phospholipids
(c) Cholesterol
Which of the following statements concerning chylomicrons if false?
(a) This lipoprotein is produced in the intestinal mucosa.
(b) Primary function is to carry dietary (exogenous) lipids to the liver.
(c) The major lipid transported by this lipoprotein is cholesterol.
(d) The significant apoprotein is ApoB.
(c) The major lipid transported by this lipoprotein is cholesterol.
Which lipoprotein fraction contains the highest concentration of endogenous (not dietary) triglyceride?
(a) VLDL
(b) Chylomicron
(c) HDL
(d) LDL
(a) VLDL
Which of the following lipoproteins is the major carrier of cholesterol to peripheral tissues?
(a) Chylomicrons
(b) VLDL
(c) HDL
(d) LDL
(d) LDL
Which of the following apolipoproteins, when present in an increased concentration, would be associated with a decreased risk of coronary artery disease?
(a) Apo CII
(b) Apo B-100
(c) Apo AI
(d) Apo B-48
(e) Apo EII
(c) Apo AI
In the coupled enzymatic/colorimetric determination of cholesterol, ________ is the agent that oxidizes the colorless organic compound, 4-aminoantipyrine, to a pink complex.
(a) Peroxidase
(b) Cholesterol oxidase
(c) Cholesterol esterase
(d) Hydrogen peroxide
(a) Peroxidase
A 52-year-old man went to his doctor for a physical examination. The patient was overweight and had missed his last two appointments because of business dealings. His blood pressure was elevated, his cholesterol was 250 mg/dL, and his triglyceride was 170 mg/dL. A high-density lipoprotein (HDL) cholesterol test was performed and the result was 30 mg/dL (20 - 60 mg/dL). Which of the following would be this patient’s calculated low-density lipoprotein (LDL) cholesterol value?
(a) 200 mg/dL
(b) Cannot be determined from information given.
(c) 157 mg/dL
(d) 186 mg/dL
(d) 186 mg/dL
The Friedwald formula for estimating LDL cholesterol should NOT be used when:
(a) HDL cholesterol is greater than 40 mg/dL.
(b) Total cholesterol is elevated based on age and sex of the patient.
(c) Triglyceride is greater than 400 mg/dL.
(d) Plasma shows no visible evidence of lipemia.
(c) Triglyceride is greater than 400 mg/dL.
Which of the following results would be the most consistent with high risk for coronary heart disease?
(a) 60 mg/dL HDL cholesterol and 170 mg/dL total cholesterol.
(b) 55 mg/dL HDL cholesterol and 180 mg/dL total cholesterol.
(c) 20 mg/dL HDL cholesterol and 250 mg/dL total cholesterol.
(d) 35 mg/dL HDL cholesterol and 200 mg/dL total cholesterol.
(e) 50 mg/dL HDL cholesterol and 190 mg/dL total cholesterol
(c) 20 mg/dL HDL cholesterol and 250 mg/dL total cholesterol.
Which of the following tests would be included in a routine lipid profile report?
(a) Triglycerides, fatty acids, LDL-cholesterol
(b) Cholesterol, LDL-cholesterol, HDL-cholesterol
(c) Cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides
(d) Cholesterol, triglycerides, phospholipids
(c) Cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides
Risk factors for coronary heart disease include all of the following EXCEPT:
(a) LDL >160 with additional risk factor
(b) Hypertension
(c) Diabetes mellitus
(d) High HDL
(d) High HDL
This is the most significant protein synthesized by the liver and is an indicator of overall function:
(a) Serum albumin
(b) Plasma ammonia
(c) Serum urea
(d) None of the above
(a) Serum albumin
Bilirubin is reduced to ________ by bacterial enzymes in the small intestine.
(a) Porphobilinogen
(b) Urobilin
(c) Urobilinogen
(d) Biliverdin
(c) Urobilinogen
The enzyme system that catalyzes the conjugation of bilirubin is known as:
(a) Uridine diphosphate (UDP) glucuronyl transferase
(b) Carbamoyl phosphate synthetase
(c) Leucine aminopeptidase
(d) Glucose-6-phosphate dehydrogenase
(a) Uridine diphosphate (UDP) glucuronyl transferase
This is a potentially highly toxic substance that is converted into urea by the liver to be excreted.
(a) Bile acids
(b) Ammonia
(c) Bilirubin
(d) Urobilinogen
(b) Ammonia
Choose the false statement.
(a) Bilirubin diglucuronide is soluble in water, and readily excreted in bile and urine.
(b) Bilirubin transport to the liver is in association with albumin.
(c) Heme is destroyed in the reticuloendothelial cells of the liver, spleen, and bone marrow.
(d) Jaundice occurs in liver disease only.
(e) The end product of bilirubin is excreted in the feces as urobilinogen/urobilin.
(d) Jaundice occurs in liver disease only.
Production of bilirubin occurs in the ________, and conjugation of bilirubin to glucuronide occurs in the ________.
(a) liver; intestine
(b) liver; reticuloendothelial system
(c) reticuloendothelial system; intestine
(d) reticuloendothelial system; liver
(d) reticuloendothelial system; liver
If a total bilirubin is 4.0 mg/dL, and the conjugated bilirubin is 2.5 mg/dL, the unconjugated bilirubin is:
(a) 2.5 mg/dL
(b) 1.0 mg/dL
(c) 2.0 mg/dL
(d) 1.5 mg/dL
(d) 1.5 mg/dL
In the Jendrassik-Grof bilirubin, what converts purple azobilirubin to blue azobilirubin measured at 600 nm?
(a) Methanol
(b) Hydrochloric acid
(c) Caffeine
(d) NaK (alkaline) tartrate
(d) NaK (alkaline) tartrate
Serum bilirubin is unstable because of:
(a) Light sensitivity
(b) Acid pH
(c) Precipitates on standing
(d) Digestion by proteolytic enzymes
(a) Light sensitivity
Which of the following would be classified as prehepatic jaundice?
(a) Congestive heart failure
(b) Hepatitis
(c) Cancer of the bile ducts
(d) Rotor syndrome
(a) Congestive heart failure
Post hepatic jaundice is associated with:
(a) Biliary tree obstruction
(b) Jaundice in newborns
(c) Gilbert’s disease
(d) Hemolytic anemia
(a) Biliary tree obstruction
The most sensitive enzymatic indicator for all types of liver damage and is an early marker for damage from ethanol intake is:
(a) AST
(b) ALT
(c) GGT
(d) Alkaline phosphatase
(c) GGT
The deficiency or inactivity of the following enzyme named in Crigler-Najjar syndrome is:
(a) UDP glucuronyl transferase
(b) Ligandin
(c) Amylase
(d) UDP phosphorylase
(a) UDP glucuronyl transferase
Kernicterus is the abnormal accumulation of bilirubin in:
(a) Heart tissue
(b) Kidney tissue
(c) Liver tissue
(d) Brain tissue
(d) Brain tissue
Which condition is caused by deficient secretion of bilirubin into the bile canaliculi?
(a) Crigler-Najjar syndrome
(b) Gilbert’s disease
(c) Neonatal hyperbilirubinemia
(d) Dubin-Johnson syndrome
(d) Dubin-Johnson syndrome
In obstructive liver disease, the following test results are found:
(a) Feces: urobilinogen decrease or negative; urine: bilirubin positive; serum: conjugated bilirubin increased.
(b) Feces: urobilinogen decrease or negative; urine: urobilinogen decreased or negative; serum: conjugated bilirubin decreased.
(c) Feces: urobilinogen decrease or negative; urine: urobilinogen decreased or negative; serum: conjugated bilirubin normal or slightly elevated.
(d) None of the above
(a) Feces: urobilinogen decrease or negative; urine: bilirubin positive; serum: conjugated bilirubin increased.
Interpret the following:
20Y Female, flu-like symptoms, pain in upper right abdomen.
Serum 7-15-16 7-22-16
BIL 2.2 mg/dL 8.5 mg/dL
CBILI 0.2 mg/dL 7.5 mg/dL
Albumin 4.0 g/dL 3.8 g/dL
AST 450 U/L 365 U/L
ALT 400 U/L 960 U/L
ALP 70 U/L 125 U/L
GGT 30 U/L 200 U/L
Urine 7-15-16 7-22-16
Bilirubin Positive Positive
Urobili Increased Increased
(a) Hemolytic anemia
(b) Drug induced hepatitis
(c) Hepatitis B
(d) Obstructive/gallstone
(c) Hepatitis B
Given the following results: ALP - marked increased; AST - slight increase; ALT - slight increase; GGT - marked increase.
(a) Osteitis fibrosa
(b) Acute hepatitis
(c) Obstructive liver disease
(d) Chronic hepatitis
(c) Obstructive liver disease
In which liver disease is the DeRitis ratio (AST:ALT ratio) usually less than or equal to 1?
(a) Acute viral hepatitis
(b) Cirrhosis
(c) Alcoholic hepatitis
(d) All of the above
(a) Acute viral hepatitis
Elevations of AST/ALT 10X the reference interval indicate the following:
(a) Post hepatic
(b) Hepatocellular
(c) Pre hepatic
(d) Fatty liver
(b) Hepatocellular
