QUESTIONNAIRE ON CLINICAL CHEMISTRY B.

prior to the start as well as

5,10,15,20 and 30 mins later.
C.prior to the start as well as 5,10,15, 30
1.In diabetic patient, this provides information and 60 mins later
about the average blood glucose .D.prior to the start as well as 10,15, 30
concentration during the preceding 6-8 weeks: and 60 mins later
A. HbA1c 8. It is generally agreed that coronary heart
B. HbFD disease is infrequent at cholesterol level
C. HbB <160mg/dL and the value that constitutes a
D. Hbs threshold value beyond which the risk of
2. In the case of gestational diabetes disease rises at first:
mellitus, a normal diurnal glucose profile A. 200 mg/dL
performed on the 3rdto 4thpostpartum day B. 250mg/dL
rules out persistent diabetes mellitus. In C. 300mg/dL
women with macrosomic children, the D. 350mg/dL
diurnal glucose profile does not become 9. Glucose concentrations in heparinized plasma
valuable as an indicator until how many weeks are reported to be lower than in serum by
after delivery? A.2%
A. 3 weeks B. 6weeks B. 5%
C. 9 weeks D. 12 weeks C. 10%
3. What enzyme catalyzes the oxidation of D. 0.5%
glucose into gluconic acid and H2O2? 10. Which of the following enzymatic
A. glucose oxidase methods is least used for glucose
B. glucose hexokinase measurement?
C. glucose dehydrogenase A.Hexokinase
D. mutarotase B. Dehydrogenase
4. What enzyme catalyzes the oxidation of C.Oxidase
glucose to glucolactone? D. Isomerase
A. glucose oxidase 11. It is generally agreed that coronary heart
B. glucose hexokinase disease is infrequent at cholesterol level
C. glucose dehydrogenase <160mg/dL and the value that constitutes a
D. mutarotase threshold value beyond which the risk of
5. In OGTT, a loadof 75g of glucose (WHO disease rises at first
recommendation) is ingested within A. 200 mg/dL
A. 5mins B. 10 mins B. 250mg/dL
C. 20 mins D. 30mins C. 300mg/d
6.The screening test for gestational diabetes D. 350mg/dL
mellitus recommended between 24th to 28th 12. This apolipoprotein makes up more than
week of gestation requires 50g of glucose 95% of the protein coat of LDL
dissolved in 200ml of water and slowly drunk. A. apo A-I B. apo A-II
A blood sample is collected after C. apo B100 D. apo C
A. 30mins B. 60 mins 13. This apolipoprotein is the activator of LCAT:
C. 90 mins D. 120min A. apo A-I
7. In glucagon test, determination of B. apo A-II
glucose insulin, C-peptide and B- C. apo A-III
hydroxybutyrate are done in sample collected: D. apo A-IV
A.prior to the start as well as 1,5,10,15 13. Which apolipoprotein is associated with
and 30 mins later Tangier disease?
 A. apo A-I C. bound to lipoproteins
B. apo A-11 D. bound to albumin
C. apo A-III 21. All proteins are pure polypeptide chains
D. apo A-IV. whose molecular mass is composed of nitrogen
14. Which apolipoprotein is the cofactor of in approximately
lipoprotein lipase? A. 6%
A. apo C-I B. 16%
B. apo C-III C. 26%
C. apo C-III D. 36%
D. apo C-IV 22. Which of the following is used as the
15. Which of the following serves as the calibrator in the methods of determination
building block for triglyceride and for total protein?
phospholipids synthesis? A. bovine serum albumin
A. acetate B. plasma protein
B. cholesterol C. serum protein
C. amino acids D. hemoglobin
D. fatty acids 23. These proteins migrate in the alpha1 and
16. Which of the following lipids function as a alpha2 globulin band and are elevated by 50-
surfactant in the lungs? 300% in acute inflammatory conditions but
A. cholesterol are decreased in acute hepatitis, chronic
B. fatty acids active liver diseases, and protein-losing
C. phospholipids syndromes
D. triglycerides A. immunoglobulins
17. The secretion of pancreatic lipase into the B. transerythrin-transferrin group
small intestine is necessary for the hydrolysis C. acute phase protein
of: D. polyclonal gammopathies
A. cholesterol 24. The Kjeldahl procedure for total protein is
B. fatty acids based upon the premise that :
C. phospholipids A.proteins are negatively charged
D. triglycerides B.the pK of proteins is the same
18.Lipids are transported in the blood by: C.the nitrogen content of proteins is
A. albumin constant
B. amino acids D.proteins have similar tyrosine and
C. gamma globulin tryptophan content
D. lipoproteins 25. All of the following statements about total
19. The lipoprotein class involved in the protein assays are true, except?
transport of triglycerides from the small A.refractive index of serum correlates
intestine through the circulation to various with total protein, but is falsely high in
tissues is uremia
A. chylomicron B.the Folin-Lowry assay is subject to
B. VLDL interference from nonprotein
C. LDL reductants
D. HDL C.Turbidimetric assays are subject to
20. in what form must cholesterol be for it to positive interference from many drugs
react with cholesterol oxidase in the enzymatic D.Direct UV methods are based on
methods? the absorbance of peptide bonds at
A. esterified 254nm
B. free 26. The term biuret reaction refers to:
 A.the reaction of phenolic groups with C. creatinine clearance
CuSO4 D. uric acid clearance
B.coordinate bonds between Cu and 32. In order to accurately determine the GFR, a
carboxyl and amino groups of biuret substance must meet the following criteria:
C.the protein error of indicator 1. free glomerular filtration
effectproducing color when dyes bind 2. no tubular absorption or secretion
protein 3. inert
D.the reaction of phosphomolybdic acid 4. non toxic
with protein A. only 1 and3 are correct
27. Which protein is an acute phase protein and B. only 2 and 4 are correct
a transport protein. Its function is to transport C. only 1,2, and 3 are correct
intravascular, free hemoglobin to its D. 1,2,3 and 4 are correct.
degradation site in the reticulo-endothelial 33. Concerning glomerular filtration rate, which
system? of the following statements is not true?
A. haptoglobin A.In its early stage, type I diabetes
B. hemopexin mellitus results in a rise of the GRF as
C. ceruloplasmin well as the renal plasma flow
D. ferritin B.Following donation of a kidney, the
28. Which protein is important for the GFR in the organ donor stabilizes at 70-
estimation of extent of intravascular 80% of the level prior to removal of the
hemolysis if serum haptoglobin shows to kidney .
nonmeasurable levels? C.At the beginning of pregnancy the
A. hemoglobin GRF decreases, by the end of the
B. hemopexin first trimester it is decreased by 20-30%
C. ceruloplasmin D.A protein challenge, an amino acid
D. ferritin infusion or the administration of
29 Which of the following is true about dopamine cause the GFR to rise.
ceruloplasmin? 34. By definition hyperuricemia is present if the
1.transport copper in plasma serum uric acid concentration is >6.5mg/dL.
2.deficiency is associated with Wilson’s disease This definition is based on physico-chemical
3. contains about 9% carbohydrate factors taking into consideration that the
4.synthesized in the liver solutbility of sodium urate at 370C is
A. only 1and 3 are correct A. 6.4 mg/dL
B. only 2 and 4 are correct B. 6.0 mg/dL
C. only 1,2, and 3 are correct C. 6.6 mg/dL
D. 1,2,3 and 4 are correct D. 6.5 mg/dL
30. In comparison to upright position, plasma 35. The urea content of the blood is derived
albumin concentration declines by about 15% from the blood urea nitrogen level by
after a supine position has been assumed for at multiplying the latter by a factor of
least: A. 0.46
A. 5 mins B. 2.14
B. 10 mins C. 0.64
C. 15 mins D. 2.41
D. 20 mins 36. These reagents are added to stabilize the
31. This is the gold standard in for the color formed by the condensation of diacetyl
glomerular filtration : with urea to form the chromogen diazine in
A. urea clearance the diacetyl monoxime method:
B inulin clearance 1. thiosemicarbazide
 A. HDL
2-oxoglutarate B. VLDL
3. Fe2. C. LDL
4. ammonium heparinate B. Lipo B
A. only 1 and 3 are correct 41. Which of the following enzymes has the
B. only 2 and 4 are correct longest half-life?
C. only 1,2, and 3 are correct A.CK-MM
D. 1,2,3 and 4 are correct B. ALP
37. For the differentiation of renal acute renal C. Lipase
failure from renal acute renal failure from D. LD5.
prerenal acute renal failure and postrenal 42. Which of the following CK isoenzymes has
acute renal failure, the urea/creatinine ratio the longest half-life?
can be used as a diagnostic criterion in A.CK-MM
addition to the clinical symptoms. Which of B. CK-MB
the following statements are correct when a C. CK-BB
normal protein intake of healthy people D. CK4
of approximately 1g/kg body weight/day is 43. In enzymology, one international unit is
true? the quantity of enzyme which catalyzes one
1. 35, if both are determined in mmol/L micromole of substrate per minute. The
2. 25, if the determination is performed in catalytic enzyme activity of a sample is
mg/dL expressed in
3. 12, if urea is determined as BUN and if both A. Units per liter
are determined in mg/dL B. kilounits per liter
4.1 5, if urea is determined as BUN and if both C. Milliunits per liter
are determined in mmol/L D. all of these
A. only 1 and 3 are correct 44. Type 1 macroenzymes have been
B. only 2 and 4 are correct described for the following diagnostically
C. only 1,2, and 3 are correct relevant enzymes, except:
D. 1,2,3 and 4 are correct 1.ALT
38. The diacetyl monoxime method is 2. ALP
relatively unspecific. Which of the following 3. ACP
substances are measured as well? 4. AST
1. creatinine A. only 1 and 3 are correct
2. allantoin B. only 2 and 4 are correct
3. arginine C. only 1,2, and 3 are correct
4. glucose D. 1,2,3 and 4 are correct
A. only 1 and 3 are correct 45. These are individual-specific enzyme forms
B. only 2 and 4 are correct which are coded by allelic genes. The multiple
C. only 1,2, and 3 are correct forms of an enzyme are inherited according to
D. 1,2,3 and 4 are correct Mendelian laws
39. What is enzyme is more specific for acute A. Isoenzymes
pancreatitis? B. Alleloenzymes
a. AST C. Macroenzymes type 1
B. Amylase D. Macroenzymes type 2
C. GGT 46. Enzyme important in the diagnosis of
D. Lipase organophosphate poisoning and liver
40. What lipoprotein is also referred to as "pre- parenchymal damage:
beta" lipoprotein? A.LD
 B. Cholinesterase 54. Which of the following diseases can cause a
C. CK decrease in total ALP?
D. GGT 1.Pituitary dwarfism
47 Enzyme important for the diagnosis 3. Malnutrition
of liver parenchymal damage, myocardial 2.Liver metastases
infarction, hemolysis, ineffective erythropoiesis, 4. Rickets
lymphoma: A. only 1 and 3 are correct
A.ALT B. only 2 and 4 are correct
B. AST C. only 1,2, and 3 are correct
C. LD D. 1,2,3 and 4 are correct
D. CK 55. Which of the following migration patterns is
48. Which of the following enzyme patterns correct in the anodal separation of serum ALP at
is correct in severe cardiac muscle damage an alkaline pH on cellulose acetate strip?
with cell necrosis A.placental ALP>liver ALP>bone
A. CK>LDH>AST>ALT ALP>intestinal ALP>bile duct ALP
B. AST>ALT>CK>LDH B.bile duct ALP>liver ALP> bone ALP>
C.LDH>CK>ALT>AST intestinal ALP> placental ALP
D. ALT>CK>LDH>AST C.liver ALP>bone ALP> bile duct ALP>
49. Which of the following enzyme patterns is intestinal ALP> placental ALP
correct in severe skeletal muscle damage with D.intestinal ALP>liver ALP>placental
cell necrosis: ALP> bile duct ALP> bone ALP
A.CK>LDH>AST>ALT 56.In neonates, the amylase measured consists
C. AST>ALT>CK>LDH only of:
B.LDH>CK>ALT>AST A. Salivary isoenzyme
D. ALT>CK>LDH>AST B. Pancreatic isoenzyme
50. Which of the following enzyme ratios is used C. both salivary and pancreatic
for the differentiation between acute alcoholic D. none of these
hepatitis and acute viral hepatitis: 57. Which of the following methods are used
A.GGT/AST B. AST/ALT for ACE measurement?
C. LD/CK D. GGT/GLD 1.Liberman
51. The increase in ALP is particularly marked in 2. Neels
people of Lewis-positive blood group: 3. Ryan
A.A B. B 4. Silverstein
C. AB D. O_ A. only 1 and 3 are correct
52.. Which enzyme decreases markedly with B. only 2 and 4 are correct
age in men while increases with age are C. only 1,2, and 3 are correct
measured in women: D. 1,2,3 and 4 are correct
A.ALP B. ALT 58. Which of the following substrates are used
C. AST D. CK in ACE measurement?
53. Alcoholism leads to increased activities of 1.Benzoylglycine
1.GGT 3. Furylacrylic acid
2. ALT 2.Hippuryl-histidyl-lecuine
3. AST 4. Benzoyl-glycyl-glycine
4. GLD A. only 1 and 3 are correct
A. only 1 and 3 are correct B. only 2 and 4 are correct
B. only 2 and 4 are correct C. only 1,2, and 3 are correct
C. only 1,2, and 3 are correct D. 1,2,3 and 4 are correct
D. 1,2,3 and 4 are correct
59. De Ritis ratio for differentiation between B. CK
mild liver damage and severe liver disease is: C. GGT
A.GGT/AST D. AST
B. AST/ALT 66.. Differentiation between jaundice of
C. AST/LD hepatic or cholestatic origin can be based on
D. LD/GGT ALT activity and the:
60. This ratio is used as indicatorof cholestasis A.AST/ALT ratio
and alcoholic liver damage B. GGT/ALT ratio
A.GGT/AST C. GGT/AST ratio
B. AST/ALT D. ALT/ALP ratio
C. AST/LD 67. Which enzyme is used with
D. LD/GGT aminotransferases and mean cellular volume
61. Which of the following chemicals is/are of erythrocytes as indicators of excessive
associated with decrease in cholinesterase alcohol consumption?
activity? A. Cholinesterase
A.Muscle relaxants B. GLD
B. Carbamate esters C. GGT
C.Organophosphate ester D. AST
D. All of these 68. Which LD isoenzyme has the highest
62.. Determination of acylcholine acylhydrolase migration rate?
for evaluation of liver function is usually A.LD1
performed using what substrate? B. LD2
A.Glycin C. LD4
B Choline D. LD5
C.Phosphate 69. Which anticoagulant should not be used in
D. nitroanilide LD assay?
63. A CK-MB fraction of more than 6% of A. Oxalate
the total CK activity is regarded as diagnostic B. Flouride
for C. both
A. Myocardial infarction D. neither
B. Skeletal muscle damage 70. Which of the following conditions can
C. Muscular dystrophy falsely increase LD measurement?
D. Secondary myopathies A. Blood sample collection after
64. Which of the following findings can indicate exercise
the presence of macro CK? B. Use of capillary serum
A.Elevated total CK with a CK-MB C. Use of hemolyzed samples
fraction >25% D .All of these
B.Elevated total CK with a CK-BB 71. As ACP is released from erythrocytes, a
fraction >6% hemoglobin concentration of 3.4g/L in serum
C.Elevated total CK with a CK-MM may increase ACP by
fraction >5% A 50%
D.Elevated total CK with a CK-MiMi B. 40%
fraction >10% C. 30%
65. Which enzyme is specific for liver and D. 20%
bile duct and an increase of this enzyme is 72. ACP is unstable at pH above 7.0 and the pH
considered as one of the most sensitive of plasma or serum is adjusted to 4-5 by the
indicators of hepatobiliary disease? addition of:
A. Cholinesterase A.10% acetic acid(20uL/mL)
 B. Sodium bisulfate 5mg/mL serumC. B. Bilirubin oxidase
both C. Bilirubin diglucoronidas
C. Both D. BIlirubin dehydrogenase
D. neither 78. Which of the following statements
73. This is a specific cardiospecific marker about unconjugated bilirubin is not correct?
used to assess chronic or subacute graft A. It is practically insoluble in
rejection after heart transplantation water at physiologic pH and body
A. Cardiac troponin (cTnT) temperature
B. cardiac troponin I (cTnI) B. In plasma, it is present in a folded
C. Heart fatty acid binding protein(H- structure or so-called Z-Z(trans)
FABP) conformation loosely bound to albumin
D .glycoprotein phosphorylase C.I t is transported in plasma loosely
isoenzyme BB (GPBB) bound to albumin
74.This is highly sensitive to ischemia of D. It is covalently bound to albumin
cardiomyocytes so that the clinical sensitivity 79. Which measurement is a better criterion
of its measurement for diagnosing an acute for the differential diagnosis of jaundice?
coronary syndrome is higher than that of other A.Conjugated bilirubin
cardiac markers. B. Delta bilirubin
A. Cardiac troponin (cTnT C.Unconjugated bilirubin
B.cardiac troponin I (cTnI) D. Total bilirubin
C.Heart fatty acid binding protein(H- 80. What classification of hyperbilirubinemia
FABP is caused by ineffective erythropoiesis?
D.glycoprotein phosphorylase A. Prehepatic jaundice
isoenzyme BB (GPBB). B. Posthepatic jaundice
75 This is the most important natriuretic C. Intrahepatic jaundice
peptide of the ventricles and it is a more D. none of these_
sensitive and more specific indicator of 81. What classification of hyperbilirubinemia
ventricular overload. is caused by medication-induced parenchymal
A. Atrial natriuretic peptide and cholestatic liver damage as well as hepatic
B. brain natnriuretic peptide involvement in other primary diseases?
C. Cyclic guanosine monophosphate A.Prehepatic jaundice
D. CNP B. Posthepatic jaundice
76. In this method of bilirubin C.Intrahepatic jaundice
determination, unconjugated and conjugated D. none of these.
bilirubin interact with a specific charged 82. Which of the following conditions
polymer called mordant and the are associated with unco
concentrations of Buand B care calculated njugated hyperbilirubinemias?
from the measured reflection densities and 1.Crigler-Najjar syndrome
the predetermined molar reflectivities of the 3. Gilbert’s syndrome
two bilirubin species at two wavelengths and 2.Dubin-Johnson syndrome
use of simultaneous equations 4. Rotor syndrome
A. Jendrassik-Grof A. only 1 and 3 are correct
B. Multi-layer film slide technology B. only 2 and 4 are correct
C. Enzymatic method C. only 1,2, and 3 are correct
D. Direct spectrophotometry D. 1,2,3 and 4 are correct
77. This enzyme is used to oxidize bilirubin to 83. Which of the following conditions
biliverdin: are associated with conjugated
A. Bilirubin reductase hyperbilirubinemias?
1.Crigler-Najjar syndrome .A.Nicotinic acid
3. Gilbert’s syndrome B. sulfobromophthalein
2.Dubin-Johnson syndrome C.Trichloroethylene
4. Rotor syndrome D. dichlorobenzol
A. only 1 and 3 are correct 89.. This is a laboratory evaluation system for
B. only 2 and 4 are correct severity of cirrhosis.
C. only 1,2, and 3 are correct A. Sulfobromophthalein
D. 1,2,3 and 4 are correct B. Nicotinic acid test
84. Which of the following statements about C.Child-Pugh
bilirubin is true? D. Fasting
A. A decline in unconjugated bilirubin is 90. This chronic form of conjugated
a sensitive indicator of recovery hyperbilirubinemias is characterized by
B. An increase in delta bilirubin suggests deficient leukotriene elimination into the bile
a protracted disease course and therefore leukotrienes are excreted renally.
C. An increase of conjugated bilirubin A. Crigler-Najjar syndrome
>10% of total bilirubin suggest a C. Gilbert’s syndrome
hepatogenic cause B. Dubin-Johnson syndrome
D. In the differentiation of prehepatic to D. Rotor syndrome
hepatic jaundice, a LD/AST ratio of >2 is 91. Which of the following statements about
suggestive of hemolytic jaundice. serum calcium is not correct?
85. Per gram of degraded hemoglobin, how A. Free or ionized calcium accounts for
much bilirubin is produced? 50% of total calcium
A.3mg B. Protein bound calcium most of which
B. 15mg is bound to globulins with only small
C. 34mg portion bound to albumin.
D. 51mg C. Complex-bound calcium is bound to
86. . Approximately how much bilirubin are phosphates, citrate and bicarbonate.
synthesized daily due to physiological D. The protein-bound calcium accounts
breakdown of blood? for 45% of the total calcium
A.100mg 92. lkalosis or a rise in pH, after the blood
B. 150mg collection, causes a decrease in ionized
C. 200mg calcium due to the elimination of:
D. 250mg A.Oxygen
87. The normal daily urobilinogen excretion in B. Carbon dioxide
the urine is C.Hydrogen
A.1-2mg D. Chloride
B. 2-4mg 93. Which of the following diseases may cause
C. 5-10mg hypercalcemia?
D. 1gm A. Liver cirrhosis
87. What is the half-life of delta bilirubin? B chornic renal failure
A.2 days C. Addison’s disease
B. 8 days D. acute pancreatitis
C. 12 days 94. Which of the following diseases may cause
D. 18 days hypocalcemia?
88. This is used to induce a rise of A. Pseudohypoparathyroidism
unconjugated bilirubin by activating B. Sarcoidosis
hemoxygenase and increase spleenic C.Multiple myeloma
unconjugated bilirubin production D. Primary hyperparathyroidism
95. In the phosphate clearance test, the C. 20%
interval time for collection of two urine and D. 45%
blood samples is: 98. The extracellular fluid volume is directly
A.30 mins dependent on total body
B. 60 mins A.Sodium
C. 90 mins B. Phosphate
D. 120 mins C. Calcium
96. The percentage tubular reabsorption of D. Potassium..
phosphate, TRF%, is a test identical to the 99 The reference method for sodium and
determination of the phosphate clearance but potassium ions:
in addition this substance is measured in urine A. Flame photometry
and serum B. Ion Selective Electrode
A.Inulin C . Potentiometry
B. Urea D. Enzymatic-spectrophotometric
C. Creatinine 100. Which of the following conditions is not
D. Macroglobulin associated with hyponatremia?
97 Interstitial fluid constitutes how much A. Renal tubular acidosis
percentage of the total body water? B. Salt-losing nephritis
A.7.5% C. Congestive heart failure
B. 15% D. Diabetes insipidus.