Clinical Chemistry - Stage 3 Past Paper PDF

College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 Question 1: Select the correct answer? Liver Functions and Liver Functions Tests 1. Which of the following is the function of the human liver? a) Production of bile b) Metabolization...

College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 Question 1: Select the correct answer? Liver Functions and Liver Functions Tests 1. Which of the following is the function of the human liver? a) Production of bile b) Metabolization of fats c) Metabolization of carbohydrates d) All of the above 2. Albumin is the most important protein in blood serum. It is produced by: a) Heart b) Lungs c) Liver d) None of the above 3. The hepatic duct transports bile to the gallbladder and duodenum and it is produced by the: a) Hepatocytes b) T-cells c) Kidney d) All of the above 4. Hepatocytes are optimized for function through their contact with: a) Sinusoids and gallbladder b) Sinusoids and bile ducts c) Bile canaliculi and bile ducts d) None of them 5. Bilirubin is: a) A potentially toxic catabolic product of haem metabolism b) Poorly soluble in water at physiologic pH c) Soluble in water after conversion to conjugated bilirubin d) All of the above 6. Bilirubin di-glucuronide is obtained when: a) Two molecules of glucuronic acid are covalently attached to bilirubin b) One molecule of glucuronic acid is covalently attached to bilirubin c) No relation with the number of glucuronic acid molecules 7. The normal GI bacterial flora convert the vast majority of conjugated bilirubin to: a) Urobilin and Stercobilin b) Colorless Urobilinogen and a brown-colored Urobilin c) Colorless Urobilin and a brown-colored Urobilinogen d) None of the above Dr. Yehya Mohsen Page 1 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 8. In protein catabolism, the amino nitrogen must be removed in the form of ammonia and: a) Converted to urea b) Converted to glycogen c) Storage in liver as fat d) Excreted by the adrenal gland e) None of the above 9. Considering the glucose–alanine cycle: in skeletal muscle, pyruvate is transaminated to: a) α-ketoglutarate b) Alanine c) Glucose d) Urea 10. In urea cycle, carbamoyl phosphate reacts with ornithine to form: a) Arginosuccinic acid b) Arginine c) Citrulline d) Urea 11. Which one of the following functions is a characteristic of the liver: a) Synthesis b) Excretion c) Storage d) All of the above 12. Which one of the following is not an indicator of liver damage/cholestasis: a) Aspartate transaminase b) Alkaline phosphatase c) Prothrombin time d) Alanine transaminase e) None of the above 13. The globulin level increases in the case of: a) Multiple myeloma b) Jaundice c) Hepatocellular disease d) Liver damage 14. In the severe hepatocellular disease: a) Albumin decreases b) Plasma ammonia increases c) Direct bilirubin increases d) None of the above 15. Prehepatic jaundice is caused by: Dr. Yehya Mohsen Page 2 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 a) Autoimmune hemolytic anemia b) Gallstones c) Cholangiocarcinoma d) Hepatitis e) None of the above 16. The serum bilirubin in the case of post-hepatic jaundice contains: a) High level of unconjugated bilirubin b) High level of conjugated bilirubin c) Increased urobilinogen d) None of the above 17. What is the color of urobilinogen? a) Brown b) Yellow c) Colorless d) Red e) None of them 18. The reason of yellow color of urine is the: a) Presence of urobilin b) Presence of bilirubin c) Presence of bile d) Presence of stercobilin e) All of them 19. What the reason for the brown color of stool? a) Presence of bilirubin b) Presence of bile c) Presence of stercobilin d) Presence of urobilin e) None of them 20. Urea cycle occurs in the: a) Heart b) Liver c) Kidney d) Pancreas e) None of them 21. Ammonia obtained from the protein catabolism is transferred to the: a) Liver b) Kidney c) GI tract Dr. Yehya Mohsen Page 3 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 d) Smooth muscle e) Heart 22. Detoxification marker of the liver is: a) Alanine transaminase b) Alkaline phosphatase c) Serum albumin d) Ammonia e) Alpha fetoprotein 23. Sickle cell anemia is one of the causes of: a) Prehepatic jaundice b) Hepatic jaundice c) Posthepatic jaundice d) b & c e) All of the above 24. The bile is secreted by the ……….. and deposited in the …………: a) Heart, gallbladder b) Liver, gallbladder c) Kidney, bladder d) Pituitary gland, bloodstream e) None of the above 25. Bile is a mixture of: a) Electrolytes b) Bile acids c) Cholesterol d) Phospholipids and bilirubin e) All of them 26. Urea cycle intermediates are: a) Carbamoyl phosphate, ornithine, citrulline, arginosuccinic acid and arginine b) Carbamoyl phosphate, ornithine, citrulline, fumaric acid and arginine c) Carbamoyl phosphate, ornithine, citrulline, malic acid and arginine d) Carbamoyl phosphate, thyrotropin, citrulline, arginosuccinic acid and arginine e) None of them 27. Arginine is an intermediate in the: a) TCA cycle b) Heart damage c) Urea cycle d) Nephrotic syndrome e) Alanine glucose cycle Dr. Yehya Mohsen Page 4 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 28. Glucuronyl transferase attaches one or two molecules of glucuronic acid to bilirubin: a) Covalently b) Forming ionic bond c) Via hydrogen bond d) b & c e) None of them 29. The enzyme involved in the attachment of glucuronic acid molecules to bilirubin is: a) Glucuronyl transferase UGT-1 b) Gamma glutamyl transferase c) Aspartate transaminase d) ADH e) Aldosterone 30. Concerning the alanine–glucose cycle, in the liver: a) Pyruvate is transaminated to alanine b) ALT transfers the ammonia to α-ketoglutarate and regenerates pyruvate c) Pyruvate is diverted into gluconeogenesis d) b & c e) All of them 31. The clinical significance of a decreased level of the total protein is: a) Cirrhosis of the liver b) Hemolytic jaundice c) Germ cell tumor d) Hepatocellular disease e) All of them 32. Elevation of one of the following is an indicator of severe hepatpcellular disease: a) GGT b) AFP c) Plasma ammonia d) Prothrombin time e) Urea 33. Estimation of serum ALT is an indicator of: a) Hepatocytes damage b) Toxicity c) Excretory function d) Synthetic function e) None of these 34. The clinical significance of globulin elevation is: a) HIV infection Dr. Yehya Mohsen Page 5 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 b) Jaundice c) Multiple myeloma d) a & b e) None of them 35. The excess nitrogen in the human body is eliminated from the body as: a) Urea b) Bile salt c) Amino acids d) Urate e) None of them 36. Hepatic jaundice can be caused as a result of: a) Hepatitis b) Impaired uptake c) Defect conjugation d) Defect secretion e) All of them 37. Liver is responsible for the synthesis of all of the following except: a) Albumin b) β- globulin c) Clotting factors d) Cholesterol e) Glycogen 38. Which of the following vitamins is stored in the liver? a) Vitamin K b) Vitamin D c) Vitamin E d) All of the above e) None of them 39. Drinking too much alcohol over long periods of time results in __________ a) Fascioliasis b) Fatty liver disease c) Alcoholic liver disease d) Primary sclerosing cholangitis e) All of the above 40. The best liver function test is: a) AST, ALT b) CA 19 c) CK Dr. Yehya Mohsen Page 6 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 d) RBS e) Both C and D 41. Yellowing of sclera is the most sensitive indicator of: a) Jaundice b) Renal failure c) Hypercholesterolemia d) Hypoglycemia e) Acidosis 42. Hepatic jaundice is: a) Impaired uptake, conjugation or excretion of bilirubin b) Caused by hepatitis c) Serum ALT and AST are markedly elevated d) All of them e) None of them 43. Liver function tests are used to: a) Detect and diagnose liver disease b) Evaluate the severity of liver disease c) Monitor response to therapy d) Assess the prognosis of liver disease e) All of them 44. The brown color of feces is due to: a) Stercobilin b) Urobilinogen c) Urobilin d) Bilirubin e) None of them 45. Albumin are produced by the: a) Kidney b) Liver c) Gastric mucosa d) Pancreatic e) None of them 46. Below are the functions of liver except: a) Synthesis of red blood cells b) Excretion of bilirubin, bile acids and bile salts c) Metabolism of carbohydrates, lipids and proteins d) Storage of glycogen, vitamins (A, D, B12) e) Detoxification and drug metabolism 47. The end product of protein catabolism is: a) Lipids b) Urea c) Angiotensin d) Triglycerids e) None of them 48. Congenital hyperbilirubinemia is a group of hereditary disorders of ……………. metabolism a) Bilirubin b) Albumin c) Immunoglobulin d) Globulin e) Total protein 49. Which of the following has less solubility in the bloodstream? a) Conjugated bilirubin b) Unconjugated bilirubin c) Albumin d) Glucose e) Globulin 50. At a concentration of more than 2 mg/dL, bilirubin diffuses into tissues, which then becomes: Dr. Yehya Mohsen Page 7 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 a) Black b) Brown c) Green d) Red e) Yellow 51. Elevated in pregnancy, liver disease (hepatitis, cirrhosis, GI tumors) a) AFP b) CEA c) CA 125 d) CA 15-3 e) None of them 52. In the duodenums alkaline environment, bile acids become: a) Bilirubin b) Cholestreol c) Bile salts d) Phospholipids e) None of these 53. Bilirubin glucuronides are hydrolyzed and reduced in the intestinal tract, by the action of: a) Liver enzymes b) Bacteria c) Bile d) Intestinal enzymes e) Blood enzymes 54. Urea production occur from TCA cycle in ……………. a) Renal b) Liver c) Brain d) Bone e) Intestine 55. The most common cause of cirrhosis of the liver is: a) Hepatitis C b) Cholestatic c) Gilberts syndrome d) Hyperlipidemia e) None of the above 56. Hepatic jaundice that is caused by impaired uptake, conjugation and excretion of ………. a) Lipoprotein b) Lipid c) Glucose d) Protein e) Bilirubin 57. Urea cycle occurs in ……….., and is responsible for the excretion of 80% of body nitrogen as urea a) Kidney b) Muscle c) RBC d) Liver e) None of them 58. Both of …………… are excreted in feces after being produced from conjugated bilirubin by GI bacterial flora a) Urobilin and bilirubin b) Urobilinogen and bilirubin c) Urobilin and urobilinogen d) Stercobilin and urobilinogen e) Stercobilin and bilirubin 59. After protein catabolism, ammonia is transported to…………….. a) Kidney b) Muscle c) Heart d) All body tissues e) Liver 60. ALT and AST are both elevated in: a) All kinds of jaundice b) Hemolytic jaundice c) Hepatic jaundice d) Peripheral tissue damage e) Obstructive jaundice 61. The main function of bile salts is: a) Filter the blood b) Waste extraction c) Produced hormones d) Breakdown fat e) None of the above 62. Estimation of serum alanine transaminase is an indicator of: a) Excretory functions b) Hepatocytes damage c) Synthetic function d) Toxicity e) None of the above 63. All of the following functions of the liver EXCEPT: a) Metabolism b) Excretion c) Synthesis d) Bone mineralization e) None of the above Dr. Yehya Mohsen Page 8 College of Health and Medical Technologies Department of Medical Laboratories Technology Clinical Chemistry – Stage 3 64. A liver disease case occurred when the bile reduced or blocked: a) Cholestasis b) Hepatitis c) Steatosis d) Homeostasis e) None of the above 65. A marked increase in the bilirubin lead to: a) Hepatitis b) Cirrhosis c) Jaundice d) Post-herpetic e) None of them 66. One of these liver tests is used as a synthetic function: a) Ammonia b) Albumin c) Bilirubin d) ALP e) GGT 67. Gamma glutamyl transferase GGT: a) Occurs mainly in the cells of the liver b) Occurs mainly in the cells of the stomach c) Occurs mainly in the cells of the pancreases d) Occurs mainly in the cells of the duodenum e) Occurs mainly in the cells of the spleen 68. Which of the following is the function of human liver? a) Production of bile b) Metabolization of fats c) Metabolization of carbohydrates d) All of the above e) None of the above 69. Which is the first amino group entering into urea cycle? a) Carbamoyl phosphate b) Ornithine c) Citrulline d) Argininosuccinate e) Aspartate 70. Which of the following enzymes is sensitive marker of alcoholic liver disease? a) Gamma glutamyl transferase b) AST c) Alkaline phosphatase d) Aspartate transaminase e) Alanine transaminase 71. …………. is catalyzing the transfer (ammonia) from protein to another substance: a) Proteinase b) Lipase c) Catalase d) Aminotransferase e) Alkaline phosphatase Dr. Yehya Mohsen Page 9