Examination test of Clinical biochemistry for students of General medicine (EN-pehled)

Name: ......................................................... date: ...........................................

1. The probability that a test result falls within the reference interval in the absence of disease
is called the tests
efficiency
negative predictive value
specificity
sensitivity
2. Causes of a prolonged thrombin time include all of the following except
D.I.C.
afibrinogenemia
decreased factor X
heparin
hypofibrinogenemia
3. Which of the following is not a cause of hyperuricemia?
Lesch-Nyhan syndrome
renal retention
organic acidemia
defects in pyrimidine metabolism
primary gout
4. Which of the following should not be included in the differential diagnosis of hypercal-
cemia?
vitamin D intoxication
vitamin D-dependent rickets
excess absorption secondary to the milk alkali syndrome
primary hyperparathyroidism
multiple myeloma
5. D.I.C. associated with infection is most frequently caused by
cytomegalovirus
HIV
gram-negative organisms
hepatitis B
infectious mononucleosis
6. Which of the following proteins is most useful in detecting rejection of transplanted kid-
neys?

2
-microglobulin

2
-macroglobulin
lysozyme
C-reactive protein
7. Postate-specific antigen (PSA) is an example of which type of marker
steroid
enzyme
oncofetal antigen
hormone
8. Type 1 diabetes is what percentage of all diabetes mellitus?
>20%
5-10%
16-20%
11-15%
9. An important renal response to acidemia is
increased potassium excretion
decreased excretion of H
2
PO

4
increased production of ammonia
increased production of HPO
2
4
10. All of the following statements are true of IgM except
is found in extravascular space
is synthesized by the neonate
is a pentamer
contains J chains
11. Effects of sodium fluoride as a stabilizing agent for glucose include all of the following
except
binds calcium
inhibits glycolysis
alters the first hour glucose decline
promotes faster clotting
inhibits urease
12. Urinary excretion of Bence Jones proteins are generally associated with
heavy chain gammopathy
cryoglobulinemia
multiple myeloma
cytomegalic viral disease
the dehydrated state
13. Increased urinary 5-hydroxyindoleacetic acid (5-HIAA) is a biochemical marker of
neuroblastoma
carcinoid tumors
depression
hepatoma
malabsorption
14. Proinsulin
1. is 40% physiologically active
2. yields equimolar amounts of insulin and C-peptide in the plasma
3. circulates in significant quantities in the plasma
4. is contained in a beta granule
2 and 4
1, 2, and 3
4 only
all of the above
1 and 3
15. A positive serum anion gap is
1. expected in lactate acidosis
2. an abnormality usually associated with renal disease
3. observed in hypercalcemia
4. normal
4 only
all of the above
1 and 3
1, 2 and 3
2 and 4
16. Serum ceruloplasmin concentration is generally lowest in
nephrotic syndrome
hepatitis
Hodgkins disease
Wilsons disease
17. Which of the following serologic markers can help distinguish hepatitis D coinfection from
superinfection?
HBcAb-IgM
HBsAg
HDVAb-IgM
HBsAb
18. Of the metabolic sequences below, which one represents the correct formation of heme
from porphobilinogen (PBG)?
coproporphyrinogen to uroporphyrinogen to protoporphyrinogen IXto protoporphyrin
IX to heme
protoporphyrin IX to uroporphyrin to coproporphyrin to heme
uroporphyrinogen to coproporphyrinogen to protoporphyrinogen IXto protoporphyrin
IX to heme
uroporphyrin to coproporphyrin to protoporphyrin IX to heme
19. What is the best explanation for the following set of results?
1. Myoglobin 13,190 ng/mL (normal 0-60)
2. CK-MB 68.1 ng/mL (normal 0-5.0)
3. cTnT 0.02 ng/mL (normal 0-0.1)
AMI within 6 hours after onset
chronic renal failure
AMI 96 hours after onset
acute rhabdomyolysis
acute renal failure
20. Which of the following is characterized by high urinary ketones with a normal urine glu-
cose?
1. diabetic ketoacidosis
2. starvation
3. renal tubular acidosis
4. alcoholic ketosis
1 and 3
4 only
all of the above
1, 2, and 3
2 and 4
21. Hyperamylasemia is commonly caused by administration of
antibiotics
diuretics
opiates
anticonvulsants
tricyclic antidepressants
22. A hypertensive, hypokalemic patient with urinary sodium excretion of 50 mmoles per day
and plasma renin activity below the analytical sensitivity limit of the assay has
1. pheochromocytoma
2. renal artery stenosis
3. benign hypertension
4. primary aldosteronism
2 and 4
all of the above
1 and 3
4 only
1, 2, and 3
23. Of the following, which is the first acute-phase protein to increase in the serum?
haptoglobin

1
-antichymotrypsin

1
-acid glycoprotein
C3
24. High concentrations of homocysteine are associated with increased risk for
1. myocardial infarction
2. peripheral vascular disease
3. stroke
4. pulmonary emboli
1, 2, and 3
all of the above
1 nad 3
2 and 4
4 only
25. Menopause is associated with continual elevation of
serum FSH and LH
serum estradiol
serum hCG
serum testosterone
serum prolactin
26. Which of the following tumors is incorrectly listed with the marker?
HCG: embryonal carcinoma
AFP: hepatic carcinoma
catecholamine metabolites: neuroblastoma
PSA: cervical carcinoma
CEA: colonic carcinoma
27. Elevation in total CSF protein may be seen in all the following states except
epilepsy
brain tumor
CNS trauma
stroke
bacterial meningitis
28. Which of the following is not a cause of hypoglycemia?
sepsis
acute liver failure
chronic renal failure
insulinoma
Tay-Sachs disease
29.
2
-Microglobulin levels are least useful in patients with
cadmium poisoning
skeletal muscle disease
rejected kidney transplant
acute leukemia
multiple myeloma
30. Pseudohypoparathyroidism is characterized by target tissues that are unresponsive to nor-
mal circulating levels of parathyroid hormone (PTH). Which of the following are expected
laboratory findings?
decreased calcium, elevated phosphorus, and elevated PTH
decreased calcium, elevated phosphorus, and decreased PTH
elevated calcium, decreased phosphorus, and elevated PTH
elevated calcium, decreased phosphorus, and decreased PTH
normal calcium, phosphorus, and PTH
31. In diabetes mellitus, glucagon levels are
elevated due to high insulin
lowered due to high conversion to glucose
lowered due to low insulin
elevated and not suppressed by carbohydrate loading
32. Regarding serum hCG concentrations, which of the following is not typically observed in
women who have an ectopic pregnancy?
1. doubling time of hCG exceeding 2 days
2. concentrations below 50mIU/mL
3. low hCG concentrations relative to expected based on gestational age
4. equimolar production of - and -subunits
1, 2, and 3
4 only
all of the above
1 and 3
2 and 4
33. In the diabetic patient, residual insulin secretion can be monitored by
glucose tolerance test
C-peptide levels
pancreatic polypeptide levels
insulin levels
34. Which of the following proteins is the best indicator of hemolysis?
ceruloplasmin
hemosiderin
transferrin
haptoglobin
ferritin
35. Hemoglobin Alc represents
1. 100% of HbA1
2. 50% of HbA1
3. the major serum hemoglobin
4. the most common aberrant hemoglobin
4 only
1, 2, and 3
none of the above
1 and 3
2 and 4
36. Which of the following congenital disorders is characterized by high indirect bilirubin?
1. Gilberts syndrome
2. Dubin-Johnson syndrome
3. Crigler-Najjar syndrome
4. Rotors syndrome
2 and 4
all of the above
4 only
1, 2, and 3
1 and 3
37. The protein electrophoresis pattern of a plasma sample reveals a fibrinogen peak in the
region containing

2
-globulins
albumin
-globulins
-globulins

1
-globulins
38. Which of the following most accurately describes release of pancreatic enzymes following
acute pancreatitis?
enzymes are released within 2-12 hours and return to normal after 7 days
peak lipase concentrations are higher than peak amylase concentrations
amylase and lipase are increased 2- to 4-fold over normal
enzymes are released within 2-12 hours and return to normal after 3-4 days
peak amylase concentrations are higher than peak lipase concentrations
39.
2
-Microglobulin is
found on the cell surfaces of all nucleated cells
found in high concentrations in platelets
a low-molecular-weight immunoglobulin
absent in urine
freely filterable by the glomerulus and secreted by the tubules
40. The presence of goiter with evidence of autonomous thyroid function, normal-to-low T
4
,
normal TBG-binding capacity, low TSH, and increased serum T
3
are indicative of
cretinism
pituitary carcinoma
iodine deficiency
T
3
toxicosis
Hashimotos thyroiditis
41. A male with elevated LH and FSH and low testosterone in serum may likely have
partial androgen resistance
primary germ cell failure
primary hypogonadism
secondary hypogonadism
42. The probability that disease is present when a test result falls outside the reference interval
is called the tests
specificity
sensitivity
positive predictive value
efficiency
43. Which of the following can cause urine to have a purple color?
homogentisic acid
bilirubin
hemoglobin
myoglobin
porphyrins
44. CEA reference intervals are
not available for normal populations
the same for both sexes
lower for nonsmokers
age and sex adjusted
45. Very-low-density lipoproteins are
1. derived from metabolism of IDL cholesterol
2. catabolized to IDL which accumulates in plasma
3. secreted by the liver and are rich in triglycerides and apo A-I
4. rich in apoprotein C that is transferred to HDL
1 and 3
2 and 4
all of the above
4 only
1, 2, and 3
46. All of the following statements are true regarding protein Sdeficiency except
therapy for protein Sdeficiency is similar to that for protein C deficiency
the disorder is inherited as an autosomal dominant trait
C4b protein is the principal binding protein for protein S
only the free form of protein Sis active
inflammation causes an increase in free protein Slevels
47. Microalbuminuria is
excretion of albumin metabolites
albumin concentrations that are slightly above normal
urine albumin concentrations below the reference intervals
high serum albumin, low urine albumin
normal serum albumin, high urine albumin
48. Which of the following will increase myoglobin concentrations in blood?
1. acute myocardial infarction 12 hours after onset
2. acute renal failure
3. skeletal muscle trauma
4. hemolysis
1 and 3
4 only
all of the above
1, 2, and 3
2 and 4
49. Patients with porphyria cutanea tarda have a deficiency of
protoporphyrinogen oxidase
uroporphyrinogen decarboxylase
coproporphyrinogen oxidase
ferrochelatase
uroporphyrinogen I synthase
50. In which of the following metabolic disorders would one not expect to find an increase in
blood ammonia?
hepatic encephalopathy
cirrhosis, terminal stage
urea cycle disorders
diabetic coma
Reyes syndrome
51. The protein dipstick is most sensitive to
albumin
all globulins equally
Bence Jones proteins
Tamm Horsfall mucoprotein
all proteins equally
52. Adrenogenital syndrome can be caused by all of the following corticosteroid aberrations
except
cholesterol side chain cleavage deficiency
3--hydroxysteroid dehydrogenase and isomerase deficiency
17-keto-reductase deficiency
21-hydroxylation deficiency
11-hydroxylation deficiency
53. An Lp(a) concentration exceeding 300mg/l indicates
high genetic risk for coronary heart disease
high acquired risk for coronary heart disease
high risk when present in the elderly
normal value
successful administration of lipid lowering drugs
54. Which is the correct order of cast degeneration?
cellular granular waxy
red cell broad narrow
granular waxy fatty
hyaline cellular broad
epithelial waxy broad
55. Which of the following is characterized by the presence of red blood cells in the urine, high
urinary urobilinogen, but no urine bilirubin?
sickle cell disease
gallstones
hepatitis
Gilberts syndrome
biliary cirrhosis
56. Which of the following does not cause prerenal azotemia?
1. congestive heart failure
2. sodium depletion
3. hypovolemia
4. malignant hypertension
1, 2, and 3
all of the above
1 and 3
2 and 4
4 only
57. The presence of which cast has the least clinical significance?
red cell
epithelial
waxy
granular
hyaline
58. Which of these is characterized by increased blood viscosity, Bence Jones proteins, and
enlarged lymph nodes and spleen?
hepatoma
multiple myeloma
Wilsons disease
Waldenstroms macroglobulinemia
59. Which of the following is true concerning the biochemistry of human chorionic gonadotropin?
the -subunit is unique to other hormones such as TSH, FSH, and LH
hCG is not a glycoprotein
the -subunit is biologically active
the -subunit is cleared more slowly than then intact hormone or the -subunit
leukocyte elastase nicks hCG, inactivating the hormone
60. The normal function of PSA is
totally unknown
liquefaction of seminal fluid
protection of the prostate by binding to bacterial receptors
an undefined function in reproduction
61. Possible causes of hypokalemia are
1. diarrhea
2. adrenal failure
3. diuretic drugs
4. hemolysis
1, 2 and 3
1 and 3
2 and 4
all of the above
4 only
62. Aldosteronism can be seen in all of the following conditions except
nephrotic syndrome
obesity
cirrhosis of the liver
adrenal hyperplasia
congestive cardiac failure
63. Hemoglobinuria occurs
1. following vigorous exercise
2. when hematuria occurs in isotonic urine
3. after saturation of haptoglobin binding following hemolysis
4. with accumulation of hemosiderin granules in tubular cells
1 and 3
1, 2, and 3
2 and 4
all of the above
4 only
64. In which metabolic bone disease are serum values of calcium, phosphorus, and alkaline
phosphatase generally all normal?
osteoporosis
osteomalacia
hypoparathyroidism
Pagets disease
osteitis fibrosa
65. Which of the following are major causes of interindividual variations in creatinine excre-
tion?
1. significant diurnal variation
2. age
3. dietary fluctuations (creatinine is found in leafy vegetables)
4. differences in lean body mass
1, 2, and 3
4 only
1 and 3
2 and 4
all of the above
66.
1
-Acid glycoprotein is also known as
Alc
none of these names
orosomucoid
glycosylated protein
67. All of the following conditions represent acquired causes of low protein C levels except
D.I.C.
sepsis
liver disease
heparin therapy
oral anticoagulant therapy
68. The hepatitis serology results listed below are most consistent with
1. HBsAg: negative
2. HBcAb-IgM: positive
3. HBsAb: negative
4. HAVAb-IgM: negative
past infection with hepatitis B
acute infection with hepatitis B
chronic infection with hepatitis B
acute infection with hepatitis A
69. If measured osmolality is 340 mOsm/kg and calculated osmolality is 295 mOsm/kg, one
should rule out
all of these diagnoses
ethanol poisoning
hyperglycemia
dehydration
70. Physiologically important buffers maintaining body pH include all of the following except
bicarbonate
lactate
phosphate
hemoglobin
protein
71. Antithyroglobulin antibodies can be detected in the serum of patients having which of the
following?
thyroid adenomas
multinodular goiter
thyroid carcinomas
Hashimotos thyroiditis
72. What is the fate of creatine produced in the kidneys, liver, and pancreas?
1. converted to phosphocreatine by creatine kinase
2. excreted into urine
3. spontaneously cyclized to creatinine
4. bound to proteins and metabolized in the liver
1 and 3
4 only
2 and 4
1, 2, and 3
all of the above
73. Cardiac troponin is useful for detection of minor myocardial injury because
1. troponin assays can be made highly sensitive
2. the normal concentration of troponin in blood is very low
3. troponin assays are highly specific for cardiac injury
4. of the high tissue content of troponin relative to other cardiac markers
1 and 3
all of the above
2 and 4
1, 2, and 3
4 only
74. Which of the following is false concerning chylomicrons?
derived predominately from the alimentary tract from exogenously absorbed fats
their apo B-100 and apo E components are transferred to LDL
are converted to a chylomicron remnant through lipolysis
their apoproteins A-I, A-II, and C components are transferred to HDL
they have a density that is less than that of water
75. Which of the following findings speaks against one of the erythropoietic porphyrias?
increased fecal coproporphyrin
increased urine coproporphyrin or uroporphyrin
increased erythrocyte coproporphyrin or uroporphyrin
increased erythrocyte protoporphyrin
increased urine ALA or PBG
76. Coproporphyrin excretion in urine is increased in all the following states except
lead poisoning
cirrhosis
chronic alcoholism
glomerulonephritis
77. What is the fate of amylase and lipase enzymes after release into the blood?
both are cleared by filtration, lipase is reabsorbed, and amylase is excreted
both are cleared by filtration, amylase is reabsorbed, and lipase is excreted
both are cleared by glomerular filtration and appear in urine
both are cleared by the reticuloendothelial system
both are cleared by filtration and reabsorbed (neither appear in urine)
78. A positive urine for bilirubin can be caused by the presence of
unconjugated bilirubin
any of these compounds
conjugated bilirubin
delta bilirubin
urobilinogen
79. The principal immunoglobulin that crosses the placental barrier is
IgA
IgE
IgG1
IgM
80. Which of the following is true concerning urine proteins?
tubular proteinuria is characterized by high-molecular-weight proteins
the concentration of urine protein is an accurate indicator of the severity of renal dis-
ease
the Tamm-Horsfall protein is a normal constituent of urine and serum
a negative dipstick for proteins indicates the absence of Bence Jones proteins
increased levels of urine proteins are observed following strenuous exercise
81. Disorders producing insulin antagonists, and therefore a secondary diabetes, include all of
the following except
acromegaly
pheochromocytoma
Cushings syndrome
glucagonoma
hypothyroidism
82. Pseudohyponatremia can result from
1. hyperglycemia
2. hyperlipidemia
3. hyperproteinemia
4. hyperchloridemia
1, 2, and 3
all of the above
1 and 3
4 only
2 and 4
83. Which of the hepatic porphyrias presents with acute abdominal pain, no skin photosensiti-
zation, large amount of ALA and PBG in urine, and symptoms exacerbated by steroids and
several other drugs?
porphyria cutanea tarda
acute intermittent porphyria
porphyria variegata
congenital cutaneous hepatic porphyria
84. What is a possible interpretation of a patient with an elevated ionized calciumwith a normal
total calcium level?
multiple myeloma and primary hyperparathyroidism
primary hyperparathyroidism and nephrotic syndrome
metastatic bone disease and hypoparathyroidism
secondary hyperparathyroidism and dehydration
vitamin D-dependent rickets and liver disease
85. All of the folowing substances are usually increased in lead poisoning except
urine ALA
urine PBG
urine porphyrins
erythrocyte protoporphyrin
86. With which parameter does creatinine excretion correlate best?
muscle mass
age
diet
body weight
surface area
87. Decreased cholesterol and LDL with normal triglycerides suggest
Lp(a)disease
a--lipoproteinemia
Tangier disease
hypo--lipoproteinemia
hyperlipoproteinemia
88. Which of the following are causes of homocysteinuria?
1. dietary deficiency of folate, vitamins B6 and B12
2. dietary deficincy of riboflavin
3. deficincy in cystathione -synthetase
4. deficiency in cystine reductase
4 only
2 and 4
1, 2 and 3
1 and 3
all of the above
89. Normal daily protein excretion in adult urine (nonexercising, nonpregnant) should not ex-
ceed
100 mg
10 g
10 mg
1 g
1 mg
90. Which condition can produce a calcium oxalate stone?
gout
urinary tract infection
high purine diet
renal tubular acidosis
hyperparathyroidism
91. In a patient with extensive skeletal muscle disease, which of the following most likely in-
dicates high risk for renal failure?
presence of a metabolic acidosis
urine myoglobin 30,000 ng/mL (normal: negative), serummyoglobin 150 ng/mL (nor-
mal < 80)
urine myoglobin 10,000 ng/mL, serum myoglobin 45,000 ng/mL
urea 9mmol/l, creatinine 75mol/l
total CK > 50,000 U/L (normal: <200 U/L)
92. Plasma progesterone concentration in a nonpregnant female
increases to maximum a few days postovulation, remains there for a few days, then
decreases to an initial low just before menstruation
remains fairly steady throughout the menstrual cycle
increases to a maximum during the menstrual follicular phase and decreases during
the luteal phase
increases to a maximum just before menstruation, remains steady during luteal phase,
and decreases during the follicular phase postovulation
93. Inappropriate ADH secretion can be associated with
1. hypernatremia
2. water intoxication
3. diabetes insipidus
4. some carcinomas
2 and 4
4 only
all of the above
1, 2, and 3
1 and 3
94. 1,25-Dihydroxyvitamin D is
1. produced in the liver
2. active in the intestine
3. a metabolite of 24,25-dihydroxyvitamin D
4. effective in increasing serum calcium concentration
1 and 3
2 and 4
4 only
all of the above
1, 2, and 3
95. All of the following are true of haptoglobin except
binds two molecules of hemoglobin
functions to conserve iron
has several sites of synthesis outside the liver
binds the chain of hemoglobin A, C, F, or S
can bind methemoglobin and heme
96. Absence or a large decrease in the
1
-globulin peak in a serum electrophoretic pattern sug-
gests
nephrotic syndrome
transferrin deficiency

1
-antitrypsin deficiency
chronic inflammation
97. Paraproteins will be evident in what percentage of multiple myeloma?
20-40
greater than 90
about 50
about 70
10-20
98. Serum calcium levels are
high in both primary and secondary hyperparathyroidism
low in both primary and secondary hyperparathyroidism
high in primary and low in secondary hyperparathyroidism
high in secondary and low in primary hyperparathyroidism
99. Increased thyroid-stimulating hormone (TSH), decreased T
3
, and decreased T
4
indicate
nonspecific hypothyroidism
secondary hypothyroidism
primary hypothyroidism
tertiary hypothyroidism
pseudohypothyroidism
100. Which of the following are not acute-phase reactants?
1. ceruloplasmin
2. haptoglobin
3.
1
-acid glycoprotein
4. -fetoprotein (AFP)
2 and 4
1, 2, and 3
all of the above
1 and 3
4 only
101. The probability that a test result falls outside the reference interval in the presence of disease
is called the tests
efficiency
specificity
positive predictive value
sensitivity
102. Of the gestational diabetics, what percentage will go on to type 2 later?
40%
20%
60%
10%
103. Which cast most indicates renal failure?
fatty
fine granular
hyaline
bilirubin casts
broad
104. Ketoacidosis is
associated with both type 1 and type 2 diabetes
not related to diabetes at all
associated with type 2 diabetes
associated with type 1 diabetes
105. Which of the following are the most common causes of acute pancreatitis?
gallstones or obstructing tumor
chronic alcohol use and biliary tract disease
hypertriglyceridemia
abdominal trauma
acute alcohol ingestion or drug use
106. Hypoproteinemia is seen in
1. diarrhea
2. diabetic acidosis
3. vomiting
4. salt-retention syndromes
1, 2, and 3
1 nad 3
all of the above
2 and 4
4 only