XLMC_FM_1.0 PDF Medical Biochemistry Past Paper

__1) Which statements are true about bilirubin metabolism? 1. One out of 3 liters of bile produced daily is excreted by the liver. 2. Ligandin transports unconjugated bilirubin. 3. Conjugation happens in the sinusoidal spaces...

__1) Which statements are true about bilirubin metabolism? 1. One out of 3 liters of bile produced daily is excreted by the liver. 2. Ligandin transports unconjugated bilirubin. 3. Conjugation happens in the sinusoidal spaces Page | 1 4. Esterification is done by UDPGT A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __2) Which liver tests are based on metabolic function? 1. Galactose tolerance test 3. GGT 2. Serum cholesterol 4. Serum proteins A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __3) Which liver chemistries indicate liver injury? 1. Serum albumin 2. ALT 3. ALP 4. AST A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __4) Which statements are true of liver chemistries? 1. They are used to detect liver diseases. 2. They are used to gauge the extent of liver injury. 3. They are used to differentiate among the type of liver problems. 4. They are used to suggest a specific diagnosis. A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only For numbers 5-8, identify which lipid is measured in the given test methodology. Select the correct answer from the following choices. A. Cholesterol C. LDL E. None of the above B. Triglyceride D. HDL __5) It is measured using lipase, glycerokinase and peroxidase enzymes B. __6) The assay consists of precipitating LDL and VLDL with dextran magnesium chloride D. __7) Its value is usually derive using the Friedewald formula C. __8) It is commonly measured by immunochemical methods A. __9) Which method of HDL-C estimation uses divalent cations and polyanions to remove unwanted lipoproteins? A. Precipitation B. Homogenous C. Magnetic D. Heterogenous __10) Which level of HDL-cholesterol is considered protective against heart disease? A. 20 mg/dL B. 40 mg/dL C. 50 mg/dL D. 60 mg/dL For numbers 11-16, identify the associated type of lipoprotein with the given description. Select the correct answer from the following choices. A. Chylomicrons B. VLDL C. LDL D. IDL E. HDL __11) Aid in reverse cholesterol transport from peripheral tissues to the liver E. __12) Cholesterol and phospholipid rich C. __13) Cholesterol rich particles formed from VLDL and IDL C.? __14) Triglyceride rich particles made in the liver B. __15) Large triglyceride rich particles made in the endoplasmic reticulum of enterocytes A. __16) Cholesterol rich particles that are created when triglycerides are removed from VLDL D. Page | 2 __17) Which below about glucose metabolism is false? A. Polymers of carbohydrates are converted to disaccharides by the action of amylase. B. Glucose is absorbed in the small intestine and transported to the liver. C. Galactose and fructose can be used directly for energy. D. Disaccharides are further broken down to glucose and galactose in the intestine. __18) Which is the main function of apolipoproteins? A. Help in lipid component exchange among lipoproteins B. Act as co-factors for enzyme that metabolize lipoproteins C. Serve as carrier proteins D. Absorb dietary fats and fat-soluble vitamins For numbers 19-23, determine the site of disorder in each given cause of jaundice. Select the correct answer from the following choices. A. Pre-hepatic B. Hepatic C. Post-hepatic __19) Criggler-Najjar syndrome B. __20) Malaria A. __21) Liver cirrhosis B. __22) Thalassemia A. __23) Bile duct cancer C. __24) Which below about lipids is NOT correct? A. Precursor for steroid hormones B. Energy storage for excess calorie C. Soluble in polar solvents D. Constituent of all living cells __25) Which findings are consistent with hyperglycemia? 1. Increased glucose in plasma and urine 3. Increased urine specific gravity 2. Increased urine ketones 4. Increased blood and urine pH A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __26) Which features characterize Type 1 diabetes mellitus? 1. Tendency for ketosis 3. Insulin resistance 2. No or low insulin level 4. Presence of autoantibodies A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __27) Which below are true about glucose measurement? 1. Serum, plasma, urine or whole blood can be used 2. Testing should be done in the morning 3. Generally, 8-10 hours of fasting is required 4. Hexokinase method is the reference method A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only  For numbers 28-32, identify the type of hyperlipoproteinemia according to Frederickson-Levy with the given description. Select the correct answer from the following choices. A. Type I C. Type III E. None of the above B. Type II D. Type IIb __28) Elevated chylomicrons A. __29) Increased LDL and VLDL D. Page | 3 __30) Increased VLDL and chylomicrons E. __31) Increased IDL C. __32) Increased VLDL E. __33) Which statement is consistent of gluconeogenesis? A. Synthesis of glucose from amino acids C. Conversion of glycogen to glucose B. Synthesis of glycogen from glucose D. Conversion of glucose to CO2 & H2O __34) Which actions are associated with glucagon? 1. Increases glycogenesis 3. Increases glycogenolysis 2. Increases lipogenesis 4. Increases gluconeogenesis A. 1 & 2 only B. 3 & 4 only C. 1 & 3 only D. 2 & 4 only __35) Which of the 2-hour OGTT value would be diagnostic of impaired glucose tolerance? A. 7.0 mmol/L B. 8.0 mmol/L C. 10.0 mmol/L D. 12 mmol/L __36) Which actions are associated with the hormone insulin? 1. Increases glycolysis 3. Increases glycogenolysis 2. Increases glycogenesis 4. Decreases gluconeogenesis A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __37) Which result below best indicates impaired glucose tolerance? A. 2 hr OGTT ≥ 120 mg/dL but ≤ 200 mg/dL C. FBS ≥ 100 mg/dL but ≤ 126 mg/dL B. 2 hr OGTT ≥ 140 mg/dL but ≤ 200 mg/dL D. FBS ≥ 120 mg/dL but ≤ 126 mg/dL __38) Which criteria are used to diagnose diabetes mellitus? 1. HbA1c of ≥ 6.5% 3. FPG of ≥ 200 mg/dL 2. 2-hr OGTT ≥ 200 mg/dL 4. Random plasma glucose ≥ 200 mg/dL A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __39) Which is the preferred method to measure glycated hemoglobin? A. Immunoassay C. Cation-exchange electrophoresis B. Isoelectric focusing D. Affinity chromatography __40) Which HbA1c value translates to about 126 mg/dL of average plasma glucose? A. 8% B. 7% C. 6% D. 5% __41) Which statements below about BUN are correct? 1. Used in the diagnosis of renal function diseases 2. Makes up the majority of the NPN wastes 3. Product of the oxidative catabolism of nucleic acids 4. Synthesized in the liver from ammonia A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __42) Which below are true of the hormone glucagon? 1. Increases glycogenolysis 3. Increases glycogenesis 2. Produced by the alpha cells 4. Increases gluconeogenesis A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __43) Which hormones below increase plasma glucose? Page | 4 1. Epinephrine 2. Glucocorticoids 3. Glucagon 4. Insulin A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __44) Which statements about creatinine are correct? 1. Has a molecular weight of 113 Da 3. Formed from muscle contractions 2. Produced in the body at a constant rate 4. Excretion depends on the diet A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __45) Which tests are appropriate for the diagnosis of diabetes mellitus? A. 3 Ps of DM, OGCT, RBS C. Urine glucose, OGTT, 3-hr OGTT B. 2-hr OGTT, FPG, HbA1c D. HbA1c, OGCT, POCT __46) Which characteristics are correct about type 1 diabetes mellitus? 1. There is absolute deficiency in insulin secretion 2. It is a result of cell-mediated autoimmune destruction 3. The disease is often initiated by viral infection or environmental factor 4. Most patients are obese or have increased body fat A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __47) According to ADA, which testing criteria for type 2 DM are recommended? 1. All adults should be tested for diabetes at the age of 40. 2. Frequent testing for diabetes should be done for individuals with BMI ≥ 25 kg/m2 3. HbA1c, FPG, or OGTT can be done for diabetes testing 4. Testing for diabetes should be done every 3 years A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __48) Which criteria satisfies GDM? 1. ≥ 92 mg/dL, FPG 3. ≥ 180 mg/dL, 1-hr OGTT 2. ≥ 153 mg/dL, 2-hr OGTT 4. ≥ 180 mg/dL, random plasma glucose A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __49) Which findings are usually present in type 2 DM? 1. Ketosis 2. Dehydration 3. Increased BUN 4. > 300 mOsm/dL A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __50) If the average plasma glucose is 269 mg/dL, what is the most probable value of HbA1c assay in percent? A. 8 B. 9 C. 10 D. 11 __51) Which substances may falsely decrease glucose oxidase result?  1. Ascorbic acid 2. Bilirubin 3. Bleach 4. Uric acid A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __52) Which preparations should be observed for 2-hr OGTT? 1. Patient should be fasting for at least 10 hours 2. The test should be done in the morning Page | 5 3. Patient should be on at least 200 kg diet of carbohydrates for 3 days 4. The adult glucose solution that should be administered is 75 grams A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __53) Which glycated hemoglobin measurements are affected by hemiglobinopathies? 1. Affinity chromatography 3. Ion-exchange chromatography 2. Isoelectric focusing 4. Electrophoresis A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __54) Which values implicate a “pre-diabetes” stage? 1. HbA1c of 5-6.4% 3. Impaired fasting glucose level 2. Impaired glucose tolerance level 4. 200 mg/dL, random plasma glucose A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __55) At which level is provisional diagnosis of diabetes made? A. FPG of 125 mg/dL C. 2-hr OGTT of 11.1 mmol/L B. FPG of 6.9 mmol/L D. 2-hr OGTT of 199 mg/dL __56) Which principle is involved in measuring HbA1c using cation exchange chromatography? A. The negatively charged hemoglobin attaches to the positively charged resin bed B. The positively charged hemoglobin attaches to the negatively charged resin bed C. The glycosylated hemoglobin attaches to the boronate group of resin D. The glycosylated hemoglobin attaches to the carbonate group of resin __57) Which characteristics differentiate LDL from Lp(a)? 1. Lipid content 2. Composition 3. Density 4. Kringles A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only __58) Which is the waste product of purine catabolism? A. BUN B. Creatinine C. BUA D. Ammonia __59) Which is the cut-off point for desirable total cholesterol? A. 199 mg/dL B. 200 mg/dL C. 239 mg/dL D. 240 mg/dL __60) Which is the waste product of protein catabolism? A. BUN B. Creatinine C. BUA D. Ammonia __61) In the enzymatic method of cholesterol determination, what is the purpose of the oxidase enzyme? A. To oxidize free cholesterol to peroxide B. To cleave fatty acid into free cholesterol C. To convert peroxide to a red dye D. To remove proteins and phospholipids __62) Which is the majority of the NPN waste excreted daily? A. BUN B. Creatinine C. BUA D. Ammonia __63) Which statements about BUN are correct? 1. Used in the diagnosis of renal function diseases 2. Makes up the majority of the NPN wastes 3. Product of the oxidative catabolism of nucleic acids Page | 6 4. Synthesized in the liver from ammonia A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only For numbers 64-69, classify the given condition as to the type of kidney injury. Select the correct answer from the given choices: A. Pre-renal B. Renal C. Post-renal __64) Acute glomerulonephritis B __65) Tubular necrosis B __66) Increased protein catabolism A __67) Obstruction C __68) Water depletion A __69) Rupture of the urinary bladder C __70) Which statements about creatinine are correct? 1. Has a molecular weight of 113 Da 2. Produced in the body at a constant rate 3. Formed from muscle contractions 4. Excretion depends on the diet A. 1, 2 & 3 only B. 1, 2 & 4 only C. 1, 3 & 4 only D. 2, 3 & 4 only I. Analyzing. Shade A if the statement is correct, otherwise shade B. __71) Conjugated bilirubin is reduced to a colorless urobilinogen by intestinal bacteria. A __72) Eighty percent of the urobilinogen formed from bilirubin will be absorbed via the extrahepatic circulation. A __73) The glucose concentration in whole blood is approximately 11% higher than in plasma. B __74) Horseradish peroxidase is used in Hexokinase to catalyze the second reaction. B __75) The glucose hexokinase method may be performed in plasma using EDTA, heparin or citrate. A __76) ADA recommends that a quarterly HbA1c test be performed for patients not meeting treatment goals for diabetes. A __77) Increased plasma creatinine levels always indicate decreased excretion. A __78) Nearly all the uric acid in plasma is present as soluble monosodium urate. A __79) Approximately 500-600 mg of bilirubin is formed daily. B __80) Most of the serum bilirubin is the unconjugated form. A __81) Any bilirubin in urine is indirect bilirubin. B II. Remembering & Understanding. Match items in the left column with those in the right. Items in the right column may be used more than once or not at all. Shade only the letter of the correct answer. Column A Column B __82) Increased bilirubin production A A. Unconjugated bilirubin increased __83) Impaired bilirubin uptake A B. Conjugated bilirubin increased __84) Obstruction to the bile flow B __85) Impaired bilirubin conjugation A __86) Pancreatitis A __87) Cholelithiasis B __88) Physiologic jaundice A Column C Column D __89) BUN in pregnancy B. A. Increased Page | 7 __90) Blood uric acid in liver disease B. B. Decreased __91) Creatinine in muscular dystrophy C. C. Normal __92) BUN in dehydration A. III. Evaluating. Read and assess the lipid profile results below for each patient and classify the type of Hyperlipoproteinemia. Write your answer/s at the back of the answer sheet. 4 points each. Case in point. Two patients presented themselves to an internist at OPD Clinic. Patient A is a 48- year-old, male and was found with symptoms of nausea, weakness, angina and tachycardia. Patient B is a 56-year-old male, diabetic and obese. The following are the results of their laboratory work- up. Assess and classify according to Frederickson-Levy. LIPID PROFILE Reference Range PATIENT A PATIENT B Total cholesterol 140-200 mg/dL 440 210 Triglyceride 60-150 mg/dL 100 400 HDL-C 40-75 mg/dL 30 29 LDL-C 50-130 mg/dL 390 101 VLDL 8-38 mg/dL 20 80 OTHERS Apo B-100 elevated Apo B 100 and Apo C-II elevated Patient A: Type IIB hyperlipoproteinemia, Type I hyperlipoproteinemia, Patient B: Type V hyperlipoproteinemia,