CC1 Review Questions.docx

**CLINICAL CHEMISTRY 1** **LECTURE -- FINALS** **QUIZ 4** **Disclaimer: This is for review purposes only.** 1. Which fatty acid contains 12 carbon atoms? A. Short chain B. Medium Chain C. Long-chain D. None of the above 2. Which type of fatty acid below lowers the risk of cardiovascul...

**CLINICAL CHEMISTRY 1** **LECTURE -- FINALS** **QUIZ 4** **Disclaimer: This is for review purposes only.** 1. Which fatty acid contains 12 carbon atoms? A. Short chain B. Medium Chain C. Long-chain D. None of the above 2. Which type of fatty acid below lowers the risk of cardiovascular disease? A. Unsaturated B. Saturated C. Monounsaturated D. Polyunsaturated 3. Which is the rate-limiting enzyme in the biosynthesis of cholesterol? A. HMG-CoA reductase B. Mevalonate kinase C. Cholesteryl esterase D. Acetoacetyl co-A synthetase 4. Which is the major protein of HDL? A. Apo A-I B. Apo A-IV C. Apo B-48 D. Apo B-100 5. Which protein is exclusively found in chylomicrons? A. Apo A-I B. Apo A-IV C. Apo B-48 D. Apo B-100 6. Which lipoprotein are the major carriers of endogenous triglycerides? A. Chylomicrons B. LDL C. VLDL D. HDL 7. Which specimen is most often used to determine total proteins? A. Plasma B. Serum C. Urine D. CSF 8. Which factors can increase test result of total protein determination? 1. Lipemia 2. Sample hemolysis 3. Dehydration 4. Pregnancy A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 9. Which statements are true of total protein level? 1. Serum total protein levels decrease in recumbent position. 2. As a person ages, there is slight increase in albumin levels. 3. At birth, total protein concentration is lower. 4. Adult levels of total protein start by age 3. A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 10. On which assumption is the Kjedahl method of protein determination done? A. On average of 6% nitrogen mass used to calculate protein concentration B. No significant concentration of protein is lost in the precipitation step C. Negligible error comes from use of protein standard of varying composition D. All non-protein nitrogen is removed in the process of digestion 11. Which is true of HDL particles? A. Discoidal are more common B. Spherical contain 3 apoA-1 molecules C. Discoidal is the more active form D. Spherical represent newly secreted HDL 12. Which lipoprotein principally carries exogenous cholesterol? A. Chylomicrons B. VLDL C. HDL D. LDL 13. Which is the normal adult cut-off point for triglycerides? A. 50-130 mg/dL B. 40-75 mg/dL C. 60-150 mg/dL D. 140-200 mg/dL 14. Which dyslipidemia is a result of imbalance between synthesis and clearance of VLDL in the circulation? A. Hypercholesterolemia B. Hypertriglyceridemia C. Combined hyperlipoproteinemia D. Hypobetalipoproteinemia 15. Which gene is defective in Tangier's disease? A. Apo B gene B. Apo CII gene C. ABCA1 gene D. ABCG 5 gene 16. Which fasting hour is preferred for total cholesterol testing? A. 8 hours B. 10 hours C. 12 hours D. 14 hours 17. Which is the reference method for total cholesterol measurement? A. Liebermann-Burchardt B. GCMS C. Isotope Dilution Mass Spectrometry D. Enzymatic-Cholesterol Oxidase Identify the lipid profile component being tested in the given method determination. Select from the following choices. A. VLDL B. HDL C. VLDL D. Cholesterol E. Triglyceride 18. Van Handel & Zilversmith 19. Liebermann-Burchardt Reaction 20. Magneic method 21. Which is the most common method to correct for endogenous glycerol present in triglyceride measurement? A. Single cuvette blank B. Double cuvette blank C. Designated calibrated blanking D. None of the above 22. Which characteristic below implicates combined hyperlipidemia? A. Increased LDL, decreased LDL receptors B. Decreased LPL or apo C C. Increased triglycerides and cholesterol D. Decreased VLDL and chylomicron remnants 23. Which principle is involved in cholesterol measurement using the Abell-Kendall method? A. Non-enzymatic, 2-step B. Non-enzymatic, 3-step C. Enzymatic, 2-step D. Enzymatic, 3-step **End of Quiz 4** **CLINICAL CHEMISTRY 1** **LABORATORY -- FINALS** **QUIZ 4** **Disclaimer: This is for review purposes only.** 1. Which are indication for cholesterol determination? 1. Screening 2. Pacreatitis 3. Management of CVD 4. Diabetes mellitus A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only 2. Which is the preferred sample for lipid determination? A. EDTA plasma B. Heparinized plasma C. Serum D. Whole blood 3. According to the NCEP ATP III guidelines, how would classify a triglyceride level of 300 mg/dL? A. Mild B. High C. Very high D. Extremely high 4. What is the desirable adult cholesterol level? A. 4.2 mmol/L B. 5.2 mmol/L C. 6.2 mmol/L D. 7,2 mmol/L 5. According to the NCEP ATP III guidelines, how would classify a cholesterol level of 300 mg/dL? A. Low risk B. Desirable C. Borderline risk D. High risk 6. What is the desirable cholesterol level? A. 100 mg/dL B. 150 mg/dL C. 200 mg/dL D. 250 mg/dL 7. What is the sensitivity of the cholesterol method found in the module? A. 0.05 mmol/L B. 0.06 mmol/L C. 0/07 mmol/L D. 0.08 mmol/L 8. Which are the causes of secondary triglyceridemia? 1. Drugs 2. Diet 3. LPL deficiency 4. Obesity A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only 9. Which causes hypertriglyceridemia? 1. Excess alcohol intake 2. Diabetes mellitus type 2 3. Use of beta-blocker drugs 4. Malnutrition A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only Identify which class of lipoprotein is described. Select from the following choices: A. Chylomicrons B. HDL C. LDL D. VLDL E. IDL 10. The lowest in terms of density 11. Formed in the liver and carries endogenous triglycerides 12. Major cholesterol carrier 13. Also known as good cholesterol 14. Referred to as the transitional form 15. Largest lipoprotein **Case A.** Compute for the serum HDL cholesterol of a 42 year old patient given the following values: Absorbance of the sample: 0.357; Absorbance of the standard/calibrator: 0.368; Concentration of the standard/calibrator: 50 mg/dL. After determining the correct level of total cholesterol, how would you interpret the cholesterol result? **Case B.** Compute for the serum triglyceride of an adult patient given the following values: Absorbance of the sample: 0.327; Absorbance of the standard/calibrator: 0.338; Concentration of the standard calibrator: 100 mg/dL. After determining the correct level of total triglyceride, how would you interpret the cholesterol result? **End of Quiz 4** **CLINICAL CHEMISTRY 1** **LECTURE -- MIDTERMS** **QUIZ 3** **Disclaimer: This is for review purposes only.** 1. Which actions are associated with the hormone insulin? 1. Increases glycolysis 2. Increases glycogenesis 3. Increases glycogenolysis 4. Decreases gluconeogenesis A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 2. Which findings are consistent with hyperglycemia? 1. Increased glucose in plasma and urine 2. Increased urine specific gravity 3. Increased urine ketones 4. Increase blood and urine pH A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 3. Which features characterize Type I diabetes mellitus? 1. Tendency for ketosis 2. Insulin resistance 3. No or low insulin level 4. Presence of autoantibodies A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 4. Which result below best indicates impaired glucose tolerance? A. 2 hr OGTT ≥ 120 mg/dL but ≤ 200 mg/dL B. 2 hr OGTT ≥ 140 mg/dL but ≤ 200 mg/dL C. FBS ≥ 100 mg/dL but ≤ 126 mg/dL D. FBS ≥ 120 mg/dL but ≤ 126 mg/dL 5. Which criteria are used to diagnose diabetes mellitus? 1. HbA1c of ≥ 6.5% 2. FPG of ≥ 2000 mg/dL 3. 2-hr OGTT ≥ 200 mg/dL 4. Random Plasma glucose ≥ 200 mg/dL A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 6. Which statements below correctly describe Von-Gierke disease? 1. Insufficient glycogen stored 2. Failed hepatic glycogenolysis 3. Metabolic acidosis 4. Growth retardation A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only 7. Which are true about glucose measurement? 1. Serum, plasma, urine, or whole blood can be used 2. Testing would be done in the morning 3. Generally, 8-10 hours fasting is required 4. Hexokinase method is the reference method A. 1, 2 & 3 only B. 2, 3 & 4 only C. 1, 2 & 4 only D. 1, 3 & 4 only Identify which method of glucose measurement is described. Select from the following choices: A. Ortho-toluidine B. Hagedorn Jensen C. Nelson Somogyi D. Glucose oxidase E. Hexokinase 8. Uses G6PD in the couplong reaction 9. Ferric reduction is indicated by yellow to colorless reaction 10. Primarily affected by increased uric and ascorbic acid 11. Based on condensation with aromatic amines to Schiff bases 12. Which is the preferred method to measure glycated hemoglobin? A. Cation exchange electrophoresis B. Isoelectric focusing C. Affinity chromatography D. Immunoassay 13. Which result below indicates persistent albuminuria? A. Albumin creatinine ratio of 30-300 mg/24 hour in 2 out of 3 urine collections B. Albumin creatinine ratio of 20-30 µg/mg in 3 out of 3 urine collections C. Albumin creatinine ratio of ≥ 300 mg/24 hour D. Albumin creatinine ratio of ≥ 300 µg/mg 14. Which principle is involved in measuring HbA1c using cation exchange chromatography? A. The negatively charged hemoglobins attached to the positively charged resin bed B. The positively charged hemoglobins attached to the negatively charged resin bed C. The glycosylated hemoglobin attaches to the boronate group of resin D. The glycosylated hemoglobin attaches to the boronate group of resin 15. Which HbA1c value translates to about 126 mg/dL of average plasma glucose? A. 5% B. 6% C. 7% D. 8% Answer A if the statement is correct, otherwise answer D. 16. Affinity chromatograph is NOT affected by hemoglobin F, S or C. 17. The coupled reaction is glucose oxidase measurement is known as the Trinder's reaction. 18. Type 1 constitutes 80-90% of the majority of cases of diabetes. 19. Patients with type 2 diabetes have a greater tendency to develop hyperosmolar, ketotic states. 20. Hypoglycemia causes brain fuel deprivation and can result to seizures even death. 21. The glucose concentration in whole blood is approximately 11% higher than in plasma. 22. Horseradish peroxidase is used in Hexokinase to catalyze the second reaction. 23. The glucose hexokinase method may be performed in plasma using EDTA, heparin, or citrate. 24. ADA recommends that a quarterly HbA1c test can be performed for patients not meeting treatment goals for diabetes. 25. No method can be used to determine ketones in urine or blood that react with all ketone bodies. **End of Quiz 3** **CLINICAL CHEMISTRY 1** **LABORATORY -- MIDTERMS** **QUIZ 3** **Disclaimer: This is for review purposes only.** 1. Which below are true of blood glucose measurement? 1. Sample can be serum, plasma or whole blood 2. Whole blood glucose is higher than in plasma 3. Serum or plasma must be separated within 1 hour 4. Fluoride inhibits glycolytic enzymes A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only 2. When is the best time to collect for fasting blood glucose? A. Morning B. After lunch C. Late afternoon D. Evening 3. Which of the enzymes fro the determination of blood sugar is most specific for B-D-glucose? A. Hexokinase B. G6PD C. Glucose oxidase D. Glucose dehydrogenase 4. Which glucose method is subject to falsely low results caused by uric acid? A. Hexokinase B. G6PD C. Glucose oxidase D. Glucose dehydrogenase 5. Which is used as the coupling enzyme in the Hexokinase method of glucose determination? A. G6PD B. Peroxidase C. GDH D. Glu-6-Phosphate 6. Which is currently the best method for measurement of blood glucose? A. Glucose oxidase B. Hexokinase C. Hagedorn-Jensen D. Ortho-toluidine 7. Which reagent in blood glucose measurement to convert α to β-D glucose? A. Glucose oxidase B. Gluconic acid C. Mutarotase D. Horseradish peroxidase Identify the method of blood glucose measurement with each given description. A. Alkaline copper reduction B. Hagedorn Jensen C. Dubowski D. Glucose oxidase E. Hexokinase 8. Formation of Schiff basses with aromatic amines 9. -- 10. -- 11. -- 12. Development of tallow orange neucuproine complex 13. Phosphomolybdate reacts with glucose ions 14. Which chromogen is commonly used in the Glucose oxidase method of blood glucose measurement? A. Dimethylaniline B. Dimethyl benzaldehyde C. Benzyl chloroformate D. Benzyl dichloroformate 15. Which copper reduction method of glucose measurement involeves the use of BaSO4 to remoce saccharoids? A. Folin-Wu B. Dubowski C. Nelson-Somogyi D. Neocuproine **Case 1.** Compute for the blood glucose level in serum sample from a 56 year old male patient with the following assay results: OD of the test/unknown = 0.029; OD of the standard = 0.032; concentration of the standard 100 mg/dL. What is the glucose value in the conventional unit? In SI unit? **Case 2.** A 36-year old pregnant with a previous history of GDM presented herself to the lab for a test request of HbA1c. Upon checking she also requested for serum blood glucose two days ago with a value of 212 mg/dL. What is the value of her blood glucose in SI unit? What is the approximate HbA1c based on the glucose value obtained 2 days ago? **CLINICAL CHEMISTRY 1** **LABORATORY -- MIDTERMS** **MIDTERM EXAMINATION** **Disclaimer: This is for review purposes only.** **Classify the given condition as to the type of kidney injury.** A. Pre-renal B. Renal C. Post-renal 1. Acute glomerulonephritis 2. Tubular necrosis 3. Increased protein catabolism 4. Obstruction 5. Cardiac decompensation 6. Water depletion 7. Chronic nephritis 8. Rupture of the urinary bladder **Answer A if the statement is correct, otherwise answer B.** 9. Serum creatinine is higher in females than in males 10. The glucose concentration in whole blood is approximately 11% higher than in plasma. 11. Horseradish peroxidase is used in Hexokinase to catalyze the second reaction. 12. The glucose hexokinase method may be performed in plasma using EDTA, heparin, or citrate. 13. ADA recommends that a quarterly HbA1c test be performed for patients not meeting goals for diabetes. 14. Increased plasma creatinine levels always indicate decreased excretion. 15. Nearly all of the uric acid in plasma is present as soluble monosodium urate. 16. Azotemia refers to the increased urea in the blood. Match items in the Column A with those in the Column B. Column B may be used more than once or not at all. **Column A** 17. Carbohydrates to fatty acids 18. Breakdown of fats 19. Glucose to glycogen for storage 20. Non-carbohydrate source to glucose-6-phosphate 21. Glycogen to glucose 22. Glucose to pyruvate or lactate **Column B** A. Glycolysis B. Glycogenesis C. Glycogenolysis D. Gluconeogenesis E. None of the above Match items in the Column C with those in the Column D. Column D may be used more than once or not at all. 23. Produced from deamination of amino acids 24. Formed from creatine phosphate 25. Readily oxidized to allantoin 26. Synthesized from arginine, glycine, and methionine 27. Formed in the liver from amino groups **Column D** A. BUN B. BUA C. Creatinine D. Ammonia E. None of the above Match items in the Column E with those in the Column F. Column F may be used more than once or not at all. **Column E** 28. Creatinine in patient's taking cephalosphorin 29. Blood uric acid in liver disease 30. Creatine in muscular dystrophy 31. BUN in congestive heart failure 32. BUA in gout 33. Creatine in hyperthyroidism 34. BUN in dehydration 35. BUA in chronic renal disease 36. Creatinine in muscular dystrophy 37. BUA in Faconi syndrome 38. BUN in pregnancy **Column F** A. Increased B. Decreased C. Normal Solve. A. Compute for the BUN sample from a 36-year old male patient with the test readings of 0.49 and 0.33 and standard readings of 0.46 and 0.40, first and second readings, respectively. Both readings are taken with 1-minute interval. The concentration of the standard used is 20 mg/dL. B. Compute for the BUA from a 74-year-old female patient with a history of septic arthritis. The following absorbance were taken from the analysis: OD of test 0.46; OD of standard 0.14; concentration of the standard, 5 mg/dL. C. Compute for the creatinine value of a sample from an adult male dialysis patient with the following results in the Jaffe method. Absorbance of the standard -- 0.19; Absorbance of the Test -- 0.43; concentration of the standard -- 2.5 mg/dL. D. Compute for the fasting glucose level of plasma sample with the following results obtained from O-toluidine method of determination. Absorbance of the standard -- 242; Absorbance of the test -- 187; concentration of the standard 100 mg/dL.