Urinary Analysis Findings Confirmation Quiz

1. Select positive findings in urine analysis (urinary strips) that should be confirmed by investigation of urinary sediment: a) Glucose b) Leucocytes c) Blood d) Bilirubin

2. Select laboratory findings typical for NAFLD (non-alcoholic fatty liver disease)

a) Elevated aminotransferases with AST/ALT >1 b) Conjugated hyperbilirubinemia c) Increased TAG level d) Normal ALP, GMT

3. Which test for assessment of GFR would you chosen in diabetic patients:

a) Protein/ creatinine ratio b) Estimated GFR based on S – creatinine c) Estimated GFR from S-cystatin d) Creatinine clearance

4. Name 4 causes of hypocalcemia:

a) Capillary blood b) Venous blood with anticoagulant and NaF c) Venous blood without additives d) Arterial blood with anticoagulant

5. 25-year old woman was brought to the ED after 5 days of polyuria nad polydipsia. On admission, she was lehydrated and smelt strongly of fruits. Her blood analysis showed the following findings: Na 136 (135-145) nmol/L, K 5.9 (3.6-5.3) mmol/L, glucose 35 mmol/L (<7.8), urea 16 (2.5-8) mmol/L, creatinine 145 (55-90) mol/L, osmolality 341 (275-295) mmol/kg. What is the likely cause of high serum osmolality?

a) metabolic acidosis b) intoxication with an unknown drug c) uremia d) decompensated diabetes mellitus

6. Biochemical tests used for monitoring of short term and long term glycaemic control in diabetic patient:

7. Select laboratory findings which are typical for advanced stage chronic kidney disease:

a) Hyperphosphatemia b) Hypercalcemia c) Metabolic alkalosis d) Hyperkalemia

8. Posthepatic hyperbilirubinaemia occurs:

a) After alcohol abuse b) In cholecystolithiasis c) Physiologically in newborns d) In liver damage

Name lipid changes in blood in a patient with chronic increase of VLDL particles?

a) Concentration of TAG increases b) Concentration of CHOL decreases c) HDL concentration decreases d) HDL concentration increases

Hyperphosphatemia may be caused by all except:

a) Chronic kidney disease b) Refeeding syndrome c) Hemolysis d) Rhabdomyolysis

) In patients with NSTEMI, cardiac troponin concentration:

a) Does not increase b) Is increased without further dynamics c) Is increased with typical dynamics d) Increases slowly within a week

Transient proteinuria in a person with healthy kidneys may be caused by all except one:

a) Orthostasis (upright position) b) Extreme physical activity c) Fever d) Glomerulonephritis

Ionized Ca level decreases in:

a) Acidosis b) Alkalosis c) Hypoalbuminemia d) Hyperalbuminemia

A pathological increase of both aminotransferase with AST/ALT ratio higher than 1.0 are found in all except:

a) Liver cirrhosis b) Severe mushroom poisoning c) Uncomplicated viral hepatitis A d) Crush injury of skeletal muscles

Name laboratory test used for diagnosis for acute kidney failure (AKI):

Select possible cause of hypokalemia:

a) Primary hyperaldosteronism b) Systemic acidosis c) Hemolysis d) Prolonged vomiting

Fill diagnostic tests used in the following causes of secondary hypertension:

a) Phaeochromocytoma ............... b) Primary hyperaldosteronism ................

Select possible causes of elevated anion gap:

a) Lactic acidosis b) Addison disease c) Hypercalcemia d) Hypoalbuminemia

The combination of increased TSH + increased fT4, fT3 levels is consistent with diagnosis of:

a) Low T3 syndrome b) Secondary hyperthyroidism c) Primary hyperthyroidism d) Subclinical hypothyroidism

) In a patient with DKA the following laboratory findings are typically present:

a) Normal AG MAC, higher urea and creatinine b) HAGMAC, mostly hyperkalemia, dehydration, ketones elevated c) Normal pH, high urea, creatinine, hyperkalemia d) HAGMAC, extreme hyperosmolality, dehydration, ketones negative

Cushing´ s disease (pituitary tumor) has level of ACTH:

a) Normal b) Undetectable c) High and suppressible d) High and non-suppressible

1. Choose impossible cause of haemolysis:

a) Use of too thin or thick needle for sampling b) Manipulation with unclotted blood c) Too long applying of a tourniquet d) Blood collection after meal

2. Pathogenetics factor dominating in type 2 diabetes mellitus:

a) Absolute lack of insuline b) Insuline resistance c) Hyperlipidaemia d) Autoimmunity

3. Screening of diabetes mellitus is traditionally based on testing of:

a) Glycated hemoglobin b) Glucose in urine c) Fasting plasma glucose d) o-GTT

4. The finding of many leucocytes in urinary sediment may be sign of:

a) Massive proteinuria b) Bleeding into urinary tract c) Urinary tract infection d) Renal stones

5. Select the false statement concerning metabolic syndrome:

a) Abdominal type of obesity is present b) Low triglyceride level is typical finding c) Dyslipidemia belongs to diagnostic criteria d) There is high risk of cardiovascular diseases

6. Risk of hypoglycaemia in dental officie is higher in patients:

a) With DM type 1 b) With bad-controlled DM (high glycated hemoglobin) c) With type 2 DM d) Men

7. Haemolytical jaundice (icterus) is caused by:

a) Low uptake of bilirubin into the liver b) Damage of hepatocytes c) High offer of bilirubin from destroyed RBC d) Failure of liver to produce or excrete bile

8. Acitivity of alkaline phosphatase in serum of men and nonpregnant women is determined by content of next isoenzymes:

a) Liver and intestinal b) Mostly bone c) Liver and bone (1:1) d) Liver, bone, placental

9. Prolonged coagulation tests (PT, APTT) in liver failure is marker of:

a) Hemolysis b) Thrombosis c) Low liver synthesis of vitamin K-dependant clotting factors d) Thrombocytopenia due to hypersplenism

Increased D-dimers as the laboratory test informs about;

a) High rate of fibrinolysis b) Tendency to bleeding c) Low rate of fibrinolysis d) Renal failure

11. The general principle of coagulation test Is to measure:

a) Time needed to clotting whole blood b) Time needed for transforming of liquid plasma to gel after activation of coagulation c) time needed to forming of plasmin d) intensity of colour in the tube

Coagulopathies are common in patient with dysfunction of following organs (select the most fitting answer):

a) kidney, heart, lungs b) liver, kidney, bone marrow . c) liver, brain, bone marrow d) kidney, liver, heart

Select the false statement concerning leukocytosis

a) Is marker of bacterial infection b) Is marker of viral infection c) Is marker of tissue injury d) May be connected with cell shift to the left

Extrahepatic origin of elevated acitivity of ALP (alkaline phosphatase) may be confirmed by next tests:

a) Activity of GMT (GGT) in normal range b) Elevated activity of bone isoenzyme c) Elevated concentration of HCG d) Elevated activity of creatine kinase

Respiratory A-B disturbance is compensated by:

a) Detoxicating action of liver b) Hyperplasia of respiratory center c) Kidney functions d) Hypo – or hyperventilation

Name at least 3 examples for MAC with normal anion gap (= AG)

Select the type of A-B disturbance: pH = 7.49 (7.435 – 7.45), HCO3 = 33 ( 22-26) mmol/L, pCO = 6.1 (4.8 – 5.8)

a) MAL without compensation b) RAC compensated c) MAL compensated d) RAL compensated

Osmolality of serum depends on concentration of (select the best fitting choice)

a) Proteins, glucose b) Albumin, Na+, glucose c) Na, H+, HCO3- d) Na+, Cl-, HCO3-, urea, glucose

Explain how is possible to distinguish a glomerular and non-glomerular hematuria (which test, what criterium?)

Which electrolyte/electrolytes is depleted in DKA despite initial normal or even high levels in serum?

a) Sodium b) Potassium c) Chloride d) Phosphate

A 35 year – old woman with uncontrolled hypertension is suspected by an investigating endocrinologist of having Conn´s syndrome. Results of routine biochemistry were: N sodium 146 mmol/L, decreasing of potassium 2.1 mmol/ L , N CL 95 mmol/ L, N Ca 2.25 mmol/ L, urea, creatinine, LFTs normal.

Which lab results are in agreement with the provisional diagnosis and why? What further biochemistry investigations would you order?

Select the most probable cause of hypercalcemia in a 60-yo patient with pathological bone fracture:

a) Hyperparathyroidism b) Bone MTS of an undiagnosed cancer c) Granulomatous disorder (sarcoidosis, TBC) d) Multiple myeloma

The most common primary hyperlipidemia is:

a) Combined familiar hyperlipidaemia b) Polygenic hypercholesterolemia c) Familiar hypercholesterolaemia d) Familial dystbetalipoproteinemia

Characterize small dense LDL particles (composition, atherogenicity)

Select tests recommended in monitoring patients during initial phases of antithyroid therapy:

a) TSH b) fT3 + fT4 c) TSH + anti TPO d) TSH + fT4

In case, when Na-citrate is used as an anticoagulant, you cannot order following tests in plasma:

a) Calcium b) Potassium c) Sodium d) Lithium

Measuring of glycaemia in the whole capillary blood is not recommended

a) In monitoring of diabetes b) In diagnosis of hypoglycaemia c) In diagnosis of diabetes d) In patients with insulinoma

The most sensitive marker of glomerular damage in diabetic patient is:

a) Protein/ creatinine ratio b) Urinary sediment c) Albumin/ creatinine ratio d) HbA1c

Treatment of diabetic ketoacidosis results in:

a) Conversion of Beta-OHB to AcAc b) Conversion of AcAc to Beta – OHB c) More positive reaction on ketones in urine d) Disappearance of positive reaction for ketone on urine

Unconjugated bilirubin is:

a) Physiologically present in urine b) Not filtrated into urine c) Predominant form of bilirubin in the bile d) Elevated in serum in hemolytic iscterus

Elevation of gama-glutamyl transferase (GMT) activity is frequent in (at least 2 causes)

Ratio AST/ALT above 1 is typically present in:

a) Chronic hepatitis b) Alcoholic liver disease c) NAFLD d) Acute liver failure

8. Select the most sensitive biochemical markers of an impaired proteosynthesis in liver:

a) Albumin b) Prothrombin time c) Prealbumin d) Ammonia

9. Metabolic AB disturbances are compensated by:

a) Hyper – or hypoventilation b) Liver production of urea c) Kidney function d) Overproduction of thyroid hormones

10. Describe briefly a compensatory response in respiratory disorders

Diabetes insipidus may result in:

a) Losses of water + ions with hypoatraemia b) Hyperosmolality c) Losses of water with hypernatraemia d) Losses of ions with hypoosmolality

Severe hyponatraemia is concentration below:

a) 100 mmol/l b) 130 mmol/ l c) 120 mmol/l d) 110 mmol/l

Specify significance of albuminuria testing in DM and hypertension (what kind of information do you get from the test?)

1. Choose impossible cause of haemolysis

a) Use of too thin or thick needle for sampling b) Manipulation with unclotted blood c) Too long applying of a tourniquet d) Blood collection after meal

2. Renal glycosuria occurs:

a) In glomerular disease b) After high intake of sugar in food c) In renal tubular disorders d) In diabetes mellitus

3. In a healthy person, glycaemia in the 2nd hour of oGTT is:

a) Less than 7.8 mmol/L (140 mg/dL)) b) Less than 7.0 mmol/L (126) c) Less than 11.1 mmol/L (200) d) In the range of 7.8 – 11.1 mmol/L (140-200)

4. The finding of WBC in urinary sediment may be sign of:

a) Proteinuria b) Bleeding into urinary tract c) Urinary tract infection d) Inflammatory kidney disease

5. A 24- year- old man develops seizures following an emergent splenectomy after a car accident and massive hemorrhage. His serum sodium level is initially 116 mmol/L and is corrected to 120 mmol/L over the next 3 hours with hypertonic saline. Which of the following factors likely caused his hyponatremia?

a) Elevation of serum vasopressin (ADH) b) Loss into the third space c) Administration of hypotonic solutions d) Hypovolemia

6. Select possible causes of hypoproteinaemia:

a) Elevated synthesis of lipoproteins b) Urinary losses of proteins c) Liver cirrhosis d) Hemoconcentration

7. Name at least 4 possible causes of lactic acidosis

8. HbA1c (glycated haemoglobin) is:

a) An indicator of hyperglycaemias during last 2-3 months b) An indicatior for hypoglycaemias during last 1-2 weeks c) New diagnostic tests for t2DM d) New diagnostic tests for type 1 DM

9. Name the biochemical hallmarks for diabetic ketoacidosis and hyperosmolar hyperglycaemic state:

DKA: 1. 2. 3. HHS: 1. 2. 3.

10. activity of alkaline phosphatase in serum of healthy men and nonpregnant women consist of the following isoenzymes:

a) Only liver b) Mostly bone c) Liver and bone (50:50) d) Liver, bone and placental

11. The muscle origin of elevated activity AST, ALT is confirmed by:

a) Actvitiy of CK in normal range b) Elevated activity of creatinkinase c) Elevated activity of amylase d) Elevated concentration of myoglobin

12. Respiratory A-B disturbances are compensated by:

a) Detoxicating action of liver b) Hyperplasia of respiratory center c) Kidney functions d) Hypo- or hyperventilation

13. Diagnosis of acute myocardial necrosis is based on:

a) Typical changes on ECG b) Elevated cardiac troponins regardless dynamics c) Typical dynamic of cardiac troponins d) One elevated troponin level

Select the type of A-B disturbance: pH = 7.33 (7.35-7.45), pCO = 11 (4.8-5-8) kPa, HCO3 = 40 (22-26) mmol/L:

a) RAL without compensation b) RAC compensated c) MAC compensated d) RAC without compensation

Atherogenic dyslipidaemia means the following combination:

a) ^CHOL, ˆ TAG, ˆ Lp (a) b) ^TAG, dec HDLchol, ^ sdLDL c) ˆTAG, ˆ CHOL, ˆ sdLDL d) ˆTAG, dec, LDL, ˆ HDLchol

The value of LDL- Cholesterol is used:

a) For assessment of general CV risk b) In management of therapy with statins c) For monitoring of therapy of ˆTAG d) as an risk factor for T2DM

Positive urine analysis findings needing sediment confirmation

NAFLD laboratory findings (non-alcoholic fatty liver disease)

GFR assessment in diabetic patients

Causes of hypocalcemia (4 examples)

Cause of high serum osmolality in polyuria and polydipsia

Monitoring glycemic control in diabetes

Advanced CKD lab findings

Posthepatic hyperbilirubinaemia causes

Lipid changes with VLDL increases

Causes of hyperphosphatemia (excluding)

Cardiac troponin in NSTEMI

Transient proteinuria causes (excluding)

Ionized calcium level drop causes

Causes of elevated AST/ALT ratio (>1) excluding

Acute kidney failure diagnostic tests

Hypokalemia possible causes

Causes of Secondary Hypertension (2 examples)

Elevated anion gap causes

TSH and T4/T3 levels in thyroid diagnosis

DKA laboratory findings

ACTH levels in Cushing's Disease

Impossible haemolysis cause

Type 2 diabetes pathogenetic factor

Diabetes screening test

Leucocytes in urine sediment

Metabolic syndrome false statement

Dental hypoglycemia risk

Hemolytic jaundice cause

Alkaline Phosphatase isoenzymes