CLINICAL CHEMISTRY PRETEST 2 Methodologies:

1. Which of the following LD (Lactate dehydrogenase) 1. Szass

isoenzymes is increased in pulmonary pneumonia and 2. Rosalki and Tarrow
lymphomas? 3. Orlowski
a. LD1 5’ Nucleotidase
b. LD2  Phosphoric monoester hydrolase; predominantly
c. LD3 secreted in the liver
d. LD4 Methodologies:
Tissue Sources 1. Dixon & Purdon
2. Campbell
LD1  Heart, RBC and kidneys
3. Belfield and Goldberg
LD2 3. Isoenzyme assays are performed to improve ______.
LD3  Lungs, Pancreas, Spleen a. accuracy
b. precision
LD4  c. sensitivity
LD5 d. specificity
Lactate Dehydrogenase (LD)
4. Which of the following is considered as the classic reference
 Highest serum levels are seen in pernicious anemia and method for determining AMS (Amylase) activity?
hemolytic disorders a. amyloclastic
 In AMI, LD levels begin to rise within 12-24 hrs, peak levels b. saccharogenic
within 48-72 hrs and remains elevated for 10-14 days c. chromogenic
 Hepatic carcinoma and toxic hepatitis will have 10 folds d. coupled enzymatic
 An elevated total LD is nonspecific result because of its
presence from several tissues AMS
 Concentration in serum: LD 2>1>3>4>5  Substrate for all methods: Starch
 LD1>LD2 – flipped pattern – associated with AMI  Saccharogenic
 LD4 and 5 are cold labile factors -Classic reference method expressed in somogyi units
 LD1 is the most negatively charged isoenzyme (SU/dL)
 LD 1 is the fastest to move toward the anode; LD5 is the -Measures the amount of reducing sugars produced by
slowest the hydrolysis of starch by the usual glucose methods
2. Which of the following enzyme assays involve monitoring the
decrease in turbidity or light scatter as the substrate is Amyloclastic
hydrolyzed?  Measures the activity by following the decrease in
a. lipase substrate concentration (degradation of starch)
b. amylase Chromogenic
c. Gamma glutamyl transferase  Measures the amylase activity by the increase in color
d. 5’ nucleotidase intensity of the soluble dye-substrate solution produced
in the reaction
Lipase Coupled-Enzyme
 Hydrolyzes the ester linkages of fats to produce alcohol  Measures the amylase activity by a continuous-
and fatty acids monitoring technique
Methodologies Heparin may inhibit the activity of AMS (no in green top tube;
may heparin na sya)
1. Cherry and Crandal
2. Turbidimetric TAG may inhibit the serum AMS activity
3. Colorimetric method Samples with high activity of AMS should be diluted with NaCl
to prevent inactivation.
Amylase (diastase) The administration of morphine and other opiated for pain
 Catalyzes breakdown of starch and glycogen into relief before blood sampling will lead to falsely elevated serum
smaller sugars AMS levels.
 Requires calcium and chloride for activation
Methodologies
1. Saccharogenic (sugar generating) 5. Which of the following sets of results would be consistent
2. Amyloclastic with macroamylasemia?
3. Chromogenic a. normal serum AMS and ↑ urine AMS
4. Continuous b. ↑ serum AMS and ↑ urine AMS
GGT c. ↑ serum AMS and normal urine AMS
 It catalyzes the transfer of glutamyl groups between d. normal serum AMS and normal urine AMS
peptides or amino acids through linkage at a gammyl Macroamylasemia
carboxyl group
  a condition characterized by a serum amylase activity  Recently a potential marker in detecting
increase due to complex macromolecules whose large impaired renal function, although no
size prevents its urinary excretion. more sensitive than cystatin C
 Macroamylasemia = AMS + immunoglobulin Cross-  Proteolytic fragments of collagen 1
6. In fixed time (ang chakto kinetic assays) assays, multiple linked C- formed during bone resorption
measurements (usually of absorbance change) are made during telopeptid (turnover)
the reaction either at specific time intervals. In the kinetic (fixed es  CTX is a biochemical marker of bone
time) assays method, the reactants are combined and the resorption that can be detected in serum
reaction proceeds for a designated time. and urine.
a. Both statements are CORRECT.  The bone turnover rate increases at
b. Both statements are INCORRECT. menopause
c. Only the first statement is CORRECT.
d. Only the second statement is CORRECT. 9. Glucose measurement using reducing substance approach
can erroneously elevate glucose value by _________ mg/dl
7. EC defined the international unit (IU) as the amount of compared to enzymatic method.
enzyme that will catalyze the reaction of 1 mol of substrate per a. 10-20
minute under specified conditions of temperature, pH, products b. 15-25
and activators. Enzyme concentration is usually expressed in c. 5-15
units per liter (IU/L). it should be 1umol per min. d. 25-30
a. Both statements are CORRECT.
b. Both statements are INCORRECT. 10. This process is important for tissue such as muscle, which
c. Only the first statement is CORRECT. often have important energy requirements even without an
d. Only the second statement is CORRECT. adequate oxygen supply.
Enzymes EC Enzymes EC a.Anaerobic glycolysis
Acid E.C. Creatine Kinase E.C. 2.7.3.2 b. Oxidative phosphorylation
Phosphatase 3.1.3.2 c. Embden Meyerhof pathway
d. Hexose Monophosphate Pathway
Alkaline E.C. Acetyl E.C. 3.1.1.7
Oxidative Oxygen as final acceptor of electron.
Phosphatase 3.1.3.1 Cholinesterase
phosphorylation Process in electron transport chain
Amylase E.C. Gamma Glutamyl E.C. 2.3.2.2
3.2.1.1 Transferase Hexose Pentose phosphate pathway
monophosphate Pathway parallel to glycolysis for the
Alanine E.C. G-6-PD E.C. pathway generation of pentose and NADH
Aminotrasferas 2.6.1.2 1.1.1.49 EMB Hexoses are used to produce ATP
e with lactic acid as by product
Aspartate E.C. Lipase E.C. 3.1.1.3
Aminotransfera 2.6.1.1
se 11. An energy pathway, hexose monophosphate shunt (HMP
Aldolase E.C. Lactate E.C. shunt), is a detour of glucose-6-phosphate from the glycolytic
4.1.2.13 Dehydrogenase 1.1.1.27 pathway to become 6-phosphogluconic acid. This oxidized
Angiotensin E.C. 5’nucleotidase E.C. 3.1.3.5 product permits the formation of ribose-5-phosphate and NADP
Converting 3.4.15.1 in its reduced form (NADPH). NADPH, as an intermediate
Enzyme important molecule has the following functions EXCEPT
a. it provides the source of energy to erythrocytes that lack
8. The variants of this protein show a wide range of cellular mitochondria and are therefore incapable of the TCA cycle.
interactions. b. it provides a reducing power required for the protection of
a. Adiponectin the cell from oxidative and free radical damage.
b. B trace protein c. it provides protection to the lipid bilayer membranes of the
c. cross-linked C-telopeptides cell.
d. fibronectin d. it provides direct source of ATP. (bcs it should be indirect
source of ATP)
Adiponecti  An inverse correlation between body
n mass index and adiponectin values 12. Determine the hormone associated with regulating the
 Lower levels of adiponectin correlate with glucose levels in the blood using the following descriptions.
an increase risk of heart dse, type 2 DM, *Released during fasting or stress.
metabolic syndrome and obesity *Inhibited when glucose levels are back to normal or
B Trace  Accurate marker of CSF leakage increased.
protein a. GH
b. Glucagon-hyperglycemic hormone
c. Thyroxine c. Low blood glucose concentration, irritability and symptoms
d. Glucocorticoids alleviated by glucose administration.
d. Low normal blood glucose concentration, hunger and signs
13. Interpret the result obtained from a healthy individual who alleviated by glucose administration.
had a Fasting Blood Sugar level of 116 mg/dl. Whipple’s Triad (Hypoglycemia)
a. The patient is Diabetic.  Low blood glucose concentration
b. The patient has impaired FBS.  typical symptoms
c. The patient has Gestational DM.  symptoms alleviated by glucose administration
d. The patient has transient hyperglycemia due to non-fasting
status. 17. Mr. Chen is nervous, anxious and profusely sweating. He has
Criteria for FBG tachycardia and confusion. The emergency doctor took his
capillary blood for RBS testing. The device yielded a result of 58
1. Non-diabetic (prediabetes) <100 mg/dL mg/dl. Interpret his result.
2. Impaired Plasma Glucose 100-125 mg/dL
3. DM ≥126 mg/dL a. Diagnostic hypoglycemia
b. Suggestive hypoglycemia
c. Symptomatic hypoglycemia
14. Explain how Cushing’s syndrome promotes Hyperglycemia. d. Hormone inducing hypoglycemia
a.It stimulates an increase in the release of a hormone that
antagonizes the action of insulin. Hypoglycemia
b.It stimulates an increase in the release of a hormone that 1. 50 mg/dL= symptomatic
increases the catabolism of glycogen. 2. ≤50 mg/dL=diagnostic
c.It stimulates an increase in the release of a hormone that 3. ≤60 mg/dL=suggestive
increases catabolism of fats and proteins. 4. 65-70 mg/dL=stimulates release of hyperglycemic
d.It stimulates an increase in the release of a hormone that hormones
increases the catabolism of fats, proteins and glycogen. 18. Modified Alternate response. Give the proper response to
the statements provided below.
15. Glycosylated hemoglobin is the term used to describe the 1. GH deficiency in children may be accompanied by
formation of a hemoglobin compound produced when glucose hypoglycemia.
(a reducing sugar) reacts with the amino group of hemoglobin 2. In adults, hypoglycemia may occur if both GH and ACTH are
(a protein). Select the HbA1c value with a corresponding deficient.
interpretation that is INCORRECTLY stated according to ADA a. Both statements are CORRECT.
standards. b. Both statements are INCORRECT.
c. Only the first statement is CORRECT.
a. HBA1c normal range: 3-6% d. Only the second statement is CORRECT.
b. 4.9-6-4%= pre DM state
c. > or equal to 6.5%= DM diagnostic 19. All of the following may induce hypoglycemia due to the
d. < or equal to 7% but known diabetic: Good glucose control. inhibition of Growth hormone secretion EXCEPT
Pre-diabetes 5.7-6.4% a. glucose loading.
DM ≥ 6.5% on at least 2 occasions b. epinephrine release.
c. phentolamine usage.
Older RBC and IDA have high HbA1C levels d. physiologic stressors.
For every 1% increase in HbA1C value, 35mg/dL is added to Physiologic stress induces cortisol and epinephrine production
plasma glucose leading to HYPERGLYCEMIA
20. HbA1c is to glycosylated hemoglobin and Fructosamine is to
Specimen: EDTA whole blood a. glycosylated albumin.
Methods: b. glycosylated collagen.
 Electrophoresis c. plasma protein ketoamine.
 Immunoassay d. glycosylated albumin and plasma protein ketoamine.
 HPLC Fructosamine
 Affinity Chromatography  Reflection of short-term glucose control (2-3 weeks or
3-6weeks)
16. Provide the CORRECT symptoms observed in the well- Methods:
known Whipple’s triad for Hypoglycemia. 1. affinity chroma
a. Low blood glucose concentration, cold, clammy hands and 2. HPLC
symptoms aggravated by glucose administration. 3. photometric
b. Low blood glucose concentration, light-headedness and Reference value: 205-285 umol/L
symptoms aggravated by glucose administration. Interferences:
1. high UA, TAG, Bili
 2. Presence of heparin or hemolysis Pre-diabetes Autoantibodies Autoantibodies absent
may be present
21. Examine the following results provided below and interpret
the patient result. Medication Insulin absolute Oral agents, insulin
OGTT-170 mg/dl therapy necessary, multiple commonly needed
FBS-120 mg/dl daily injections or
a. Impaired fasting glucose. pumps
b. Impaired Oral glucose tolerance.
c. Impaired Oral glucose tolerance and Fasting glucose.
d. Impaired Oral glucose tolerance and normal Fasting glucose. Therapy to None Lifestyle
Criteria for OGTT prevent delay
1. Normal/Non-diabetic (prediabetes) onset of
-2hr PG <140 mg/dL diabetes
2. Impaired GTT
-2hr PG 140-199 mg/dL Previous Insulin-dependent Non-insulin dependent
3. DM names DM DM
-≥200 mg/dL Juvenile-onset DM Adult-onset DM

22. Diabetes Mellitus is diagnosed in which of the following

results? Ketoacidosis Prone Not prone
a. FBS=125 mg/dl
b. OGTT=199 mg/dl 24. Which of the following is INCORRECT about OGTT
c. HBA1c=6.4% requirements?
d. None of these a. Patients must take at least 150g of carbohydrates per day for
Diagnostic Criteria for DM 3 days prior to testing.
1. RBS ≥ 200 mg/dL (w/ symptoms of DM) b. Smoking, eating, drinking and exercising must be avoided just
2. FBS ≥ 126 mg/dL
before and during the test.
3. 2hr post glucose load ≥200 mg/dL
c. Glucose solutions given must be taken by patients within 5
4. HbA1C ≥6.5%
minutes.
d. Patients must remain seated or must rest before (should be
23. Which of the following describes Type I Diabetes mellitus?
after) the entire test.
1 – Results from progressive insulin secretion deficit.
2 – Insulin receptors are damage.
25. This protein structure determines the identity of protein,
3 – Genetically inclined condition.
molecular structure, function and binding capacity.
a.3
a. Primary
b.1,3
b. Tertiary
c.2,3
c. Secondary
d.1,2
d. Quaternary
TYPE I DM TYPE II DM
Protein Structure
Frequency 5-10% 90-95%
Primary • Linear sequence
• Determines the identity of protein,
Age Onset Any (most More common in molecular structure, function binding
common in advancing age capacity and recognition ability
children and young Secondary • Winding of the polypeptide chain
adults) • Alpha helix, beta pleated and bend form
Risk Factor Genetic, Genetic, obesity, Tertiary • Actual 3-dimensional configuration
autoimmune, sedentary lifestyle, • Folding pattern of protein
environmental race/ethnicity, • Responsible for many physical and
hypertension,
chemical properties of protein
dyslipidemia, polycystic
ovarian syndrome Quaternary • 2 or more polypeptide chains to form a
Pathogenesis Destruction of beta No autoimmunity, insulin functional protein molecule
cells, usually resistance and • Albumin has no quaternary structure
autoimmune progressive insulin
deficiency 26. These winding protein structures demonstrate alpha-
C-peptide Very low or Detectable helices and beta-pleated sheet forms.
levels undetectable a. Primary
b. Secondary
c. Tertiary
d. Quaternary  Reference value: 3.5-5.9 g/dL (23-35g/L)
Sa globulin na rr 2.5-3.5 g/dL
27. How does the primary structure of proteins differ with the
secondary structures? CRP
a. In primary structures, individual proteins are bound with one  Binds to the C-polysaccharide of the pneumococcus
 Precipitates with the C-substance
another through peptide bonds; while in secondary structures,
 Undetected in the blood of healthy individuals
alpha helices are formed by the coiling of the peptide chain.
 Appears in the blood of patients with diverse
b. In primary structures, individual amino acids are bound with inflammatory disease
one another through peptide bonds; while in secondary  Cardiac marker
structures, beta pleated sheets are formed between protein  Increased: ARF, MI, RA, gout, bacterial and viral
strands. infection
c. In primary structures, individual proteins are bound with one  Reference value: <1.0 mg/dL
another through peptide bonds; while in secondary structures,
beta pleated sheets are formed between protein strands. 30. An inverse correlation exists between body mass index
d. In primary structures, individual amino acids are bound with (BMI) and this type of protein. Lower levels of this protein
one another through peptide bonds; while in secondary correlate with an increased risk to heart disease, Type 2 DM
structures, alpha helices are formed by the coiling of the and obesity.
peptide chain. a. Fibronectin
b. Adiponectin
28. Most plasma proteins are synthesized in the liver and c. B-trace protein
secreted by the hepatocyte into the circulation. The d. Cross-linked C-Telopeptides
immunoglobulins are exceptions because they are synthesized
in plasma cells. The production is related to a process known as 31. Select the protein that is described by the statements given
translation which uses RNA as intermediates. From the choices below.
given below, select the intermediates that directly participate in *Acute phase reactant
Protein synthesis. *Binds and inactivates PSA.
1. pre-mRNA (wla kay pre palang sya) 2. tRNA *Increased in Alzheimer’s disease, AMI, infection, malignancy
3. rRNA and burns.
a. 1,2,3 a. Alpha1-antichymotrypsin
b. 1,2 b. Orosomucoid
c. 2,3 c. Ceruloplasmin
d. 1,3 d. Haptoglobin

29. This analyte is the major protein for the maintenance of ɑ1-antitrypsin (AAT) • An acute phase reactant
Osmotic pressure. • Neutralizes trypsin-like enzymes
a. CRP • Major inhibitor of protease activity
b. Albumin • Increased: inflammation, pregnancy and
c. Pre-albumin contraceptive use
d. Transthyretin • Deficiency: emphysematous pulmonary
Pre-albumin (transethyrin) disease and juvenile hepatic cirrhosis
 Migrates ahead of albumin • Reference value: 145-270 mg/dL (CF:0.01
 Has half-life of only 2 days – g/L)
 Serves as transport protein for T4 and retinol ɑ1-antichymotrypsin • A serine proteinase with cathepsin G
 Used to detect malnutrition and individual’s response to • An acute phase reactant
dietary supplementation • Binds and inactivates PSA
 Used as a landmark to confirm that the specimen is CSF • It is the major form of PSA found in
 Increased: alcoholism, chronic renal failure, steroid human sera
treatment • Associated with the pathogenesis of
 Decreased: poor nutrition Alzheimer’s dse
 Reference value: 18-45 mg/dL • Increased: infection, malignancy, burn,
Albumin AMI, and Alzheimer’s dse
 Highest concentration in plasma • Deficiency: liver dse
 Synthesized in the liver • Reference value: 30-60 mg/dL (CF:0.01 –
 General transport protein g/L)
 Maintains osmotic pressure Ceruloplasmin • Copper-binding alpha-2 glycoprotein that
 An indicator of nutritional status has enzymatic activity
 Sensitive and highly prognostic marker in cases of • Synthesized in the liver
CYSTIC FIBROSIS • Imparts blue color to protein
 Lowest plasma albumin levels seen in active nephrotic • Marker for Wilson’s dse (0.1g/L of
syndrome ceruloplasmin)
 • Deposition of copper in skin, liver, brain, 3. Anemia Normal Low - - -
and cornea (Kayser-Fleisher rings) (not related
• Increased: inflammation, cancer, to RBC
pregnancy lysis)
• Decreased: Wilson’s disease, malnutrition, 4. Hepatic Low - - - -
malabsorption, nephrotic disease Dysfunction
• Reference value: 18-45 mg/dL (CF: 10 –
mg/L)
32. Which of the following proteins fits the descriptions
ɑ1-acid glycoprotein / • Contains high percentage of CHO and
orosomucoid sialic acid provided below?
• It has low pH (2.7) *Negative acute phase reactant
• Has great affinity for progesterone; binds *Major component of beta2-globulin fraction
quinidine *Causes Pseudoparaproteinemia in severe IDA
• Useful diagnostic tool for neonates with a. Fibrinogen
bacterial infection b. Transferrin
• Increased: pregnancy, cancer, pneumonia, c. Hemopexin
RA and cell proliferation d. Beta-2-microglobulin
• Reference Value: 30-60 mg/dL (0.01 – g/L)
ɑ1-fetoprotein (AFP) •An acute phase reactant; glycoprotein Fibrinogen • Synthesized in the liver
•Synthesized initially by the fetal yolk sac • Most abundant of the coagulation factor
and then by fetal parenchymal cells of the – forms fibrin clot when activated by
liver thrombin
•Most abundant protein in fetal serum
• It appears as distinct band between beta
•It peaks in fetus at 13 weeks of gestation
and gamma globulins
•Detectable in maternal blood up to 7th to 8th
month of pregnancy Hemopexin • Binds heme releases by degradation of
•Specimen: maternal serum, amniotic fluid, hemoglobin – has strongest affinity for
serum (cancer screening) heme
•Increased: hepatoma, NTDs, spina bifida, • Helps in the diagnosis of early hemolysis
atresia of the GIT, fetal distress, ataxia • Migrates in the beta region during
telangiectasia, tyrosinosis and HDN electrophoresis
•Decreased: Down syndrome and trisomy 18 Beta-2- • Light chain component of major HLA
•Reference value: 5ng/mL microglobulin • Found on the surface of most nucleated
Haptoglobin • Is an alpha-2-glycoprotein; an acute phase cells; highest conc – Lymphocytes
reactant • Needed in production of CD8 cells
• Synthesized in the hepatocytes
• Binds free hemoglobin by its alpha chain 33. Major elevations in Myoglobin levels occur in
• Prevents the loss of hemoglobin and its a. kidney disease.
constituent iron into the urine
b. muscle disease.
• Evaluates degree of intravascular
c. liver disease.
hemolysis (HTR and HDN)
• Plasma level slightly decreased after blood d. brain disease.
transfusion MYOGLOBIN
• Increased: stressful conditions,  Small heme protein found in skeletal and cardiac
myoglobinuria muscles
• Decreased: intravascular hemolysis and  Has higher affinity for oxygen than does hemoglobin
hemoglobinuria  Approx. 2% of the total muscle protein
• Reference value: 26-185 mg/dL (CF: 0.01  Myoglobin apparently leaks from damaged cells more
– g/L) rapidly than other proteins
 Its is a potential nephrotoxin
HAPTOGLOBIN AND OTHER BLOOD PARAMETERS 34. A decreased level of Fibrinogen may affect
a. collagen formation.
Haptoglobin Reticulocyte RBC Hgb Hct b. bone formation.
count c. muscle growth.
1. low high low low low d. blood clotting.
Hemolytic
FIBRINOGEN
Anemia
 One of the largest proteins in the blood
2. RBC Normal high - - -  It is synthesized in the liver; classified as glycoprotein
Lysis  Most abundant of the coagulation factors – I forms a
(spleen and fibrin clot when activated by thrombin
Liver)  High plasma levels may elevate ESR - by coating the
cells and allowing them to sediment faster in clumps
  Increased: inflammatory disorders, pregnancy and use b. Hepatic cirrhosis
of birth control pills b. Multiple Myeloma
 Decreased: extensive coagulation c. Chronic inflammation
 Reference value: 200-400 mg/dL
39. Select the stains commonly utilized in an Electrophoresis
35. In Nephrotic syndrome, this protein is usually elevated in procedure.
the serum. 1. Ponceau S
a. albumin 2. amido blue
b. Prealbumin 3. bromphenol blue
c. alpha1-antitrypsin 40. Coomassie brilliant blue
d. alpha2-macroglobulin a. 1,2,3,4
b. 1,2,3
alpha2-macroglobulin c. 2,3,4
 Largest major nonimmunoglobulin protein in the d. 1,3,4
plasma
 Inhibits proteases such as trypsin, pepsin, and plasmin 40. Arrange in proper order the speed/rate of migration in an
 Increases 10x in nephrosis – loss of AMG into urine is
electrophoretic field from fastest to slowest.
prevented by its large size
a. Albumin, alpha-2 globulin, alpha-1 globulin, beta globulin,
 Forms a complex with PSA
 Increased: nephrotic syndrome, diabetes, and liver dse gamma globulin
 Reference value: 150-420 mg/dL (CF: 0.01 g/L) b. Albumin, alpha-1 globulin, alpha-2 globulin, gamma globulin,
beta globulin
36. Cirrhosis may lead to a decrease in the production of c. Albumin, antitrypsin, ceruloplasmin, beta globulin, gamma
1. albumin. globulin
2. ketones. d. Albumin, AFP, alpha-2 globulin, orosomucoid, gamma
3. clotting factors. globulin

a. 1,2,3 41. Explain how proteins migrate in an electrophoretic field.

b. 1,2 a. At pH 8.6, proteins are negatively charged & move towards
c. 1,3 the anode.
d. 2,3 b. At pH 6.2, proteins are negatively charged & move towards
the anode.
37. Interpret the patient’s most probable condition basing on c. At pH 8.6, proteins are positively charged & move towards
the levels of major plasma proteins provided below. the cathode.
TP (Total Protein)- Decreased d. At pH 6.2, proteins are positively charged & move towards
Albumin- Decreased the cathode.
Globulin- Normal
a. Malabsorption 42. Which of the following conditions will produce this protein
b. Salt retention type that migrate the farthest towards the anode?
c. Immunodeficiency a. Waldenstrom’s Macroglobulinemia
d. Multiple Myeloma b. Hyperfibrinogenemia
TP Albumin Globulin c. Liver Cirrhosis
1. DECREASED D N d. Dehydration (kay ga increase sya)
Malabsorption
43. An increase in beta or unusual band between alpha-2 &
2. Salt Decreased D D
beta is usually seen in this situation or condition.
Retention
a. Hypogammaglobulinemia
3. Decreased N D
b. Nephrotic syndrome
Immunodefici
c. Hemolyzed specimen
ency
d. Emphysema
4. Multiple Increased N I
Condition Pattern
Myeloma
5. Dehydration Increased I I Polyclonal gammopathy Diffuse inc in gamma
6. Hepatic Normal/decrea D I Hypogammaglobulinemia Dec gamma
damage sed
Nephrotic syndrome Dec albumin, inc alpha-2

38. An inverted A/G (Albumin/Globulin) ratio is NOT seen in Alpha-1-antitrypsin Dec alpha-1
which of the following diseases or disorders? deficiency
a. Dehydration
 Hemolyzed specimen Inc beta or unusual band c. Liver disease.
between alpha-2 and beta d. Severe diarrhea.
Plasma Extra band (fibrinogen) Causes of Abnormal Plasma Urea
between beta and gamma Increased concentration
44. Select the principle for the indirect method of BUN
Prerenal gaaffect • CHF
determination.
sa blood flow • Shock, hemorrhage
a. BUN levels can be detected by observing for a change in
• Dehydration
conductivity and pH.
• Inc protein catabolism
b. BUN levels can be detected by observing for a change in the
• High-protein diet
pH only.
• Corticosteriod therapy
c. The higher the BUN levels, the lower the conductivity.
d. The higher the BUN levels, the higher the pH. Renal • Acute and chronic renal failure
• Renal dse
Methodologies for Urea Measurement Postrenal • Urinary tract obstruction
-obstuction
Direct Method – measures urea Diacetyl monoxime
Decreased • Low protein intake
directly condensation/method
concentration • Sever vomiting and diarrhea
O-phthaldehyde • Liver dse
• pregnancy
Isotope Dilutionn-Mass
Spectrophotometry–
48. Prerenal azotemia is commonly seen in
reference method
1.Shock. 4.Stress.
Indirect Method – measures urea Secondary reactions:
2.Hemorrhage. 5.Overhydration.
by converting it first into Nesslerization Rxn 3.Corticosteroid therapy. 6.Congestive heart failure.
ammonium ions, ammonium ions Berthlot RXn
formed are then measured
GLDH-coupled a. 1,2,3,4,6_dapat dehydration nd overdehydration
(glutamate b. 1,2,3,4,5
dehydrogenase) c. 2,3,4,5,6
Conductimetric d. 1,3,4,5,6
Indicator Dye
49. There are 3 general categories for the abnormal levels of
urea in the plasma. Among the given choices, which is
45. Read the statements given below and provide the most INCORRECTLY matched?
appropriate response. a. Prerenal azotemia: High protein diet
i. The NPN synthesized primarily in the liver is creatinine b. Pre-renal azotemia: Increased CHON catabolism
(creatine) c. Renal azotemia: Acute and chronic renal failure
ii. The NPN formed from the loss of phosphoric acid in d. Postrenal azotemia: Glomerular nephritis and tubular
creatine phosphate is creatine (creatinine) necrosis (ari dapat kay renal dse, daoat sa renal azotemia)

a. Both statements are CORRECT. 50. The major principle involved in Prerenal azotemia is
b. Both statements are INCORRECT. a. obstruction in the urinary tract.
c. Only the first statement is CORRECT. b. a decrease in the amount of blood flow.
d. Only the second statement is CORRECT. c. a disease process occurring in the kidneys.
d. a decrease in the amount of creatinine filtered.
46. Uric acid levels are usually increased in the plasma in cases
of 51. Lesch-Nyhan syndrome is an X-linked genetic disorder (seen
1. Increased destruction of cells. only in males) caused by the complete deficiency of
2. Cancer chemotherapy. hypoxanthine guanine phosphoribosyltransferase. In this
3. Tumor lysis syndrome. pattern of inheritance, males are affected because they are
4. Lesch Nyhan. a.hemizygously affected.
b.homozygously affected.
a. 1,2,3,4 c. heterozygously affected.
b. 1,2,3 d.both homozygously and heterozygously affected.
c. 2,3,4
d. 1,3,4 52. All, BUT ONE of the following choices correctly describes the
RIFLE classification of AKI (Acute Kidney Injury).
47. Increased urea is seen in a. Risk: 1.5x creatinine
a. CHF (congenital heart failure) b. Injury: 2x creatinine
b. malnutrition. c. Loss of function: No urination for 4 weeks. 5x creatinine
d. End stage renal disease: No urination for more than 3 d.AST/ALP
months.
59. Which of the following LD isoenzymes are greatly elevated
in a hemolysed sample?
A. LD1 and LD2
B. LD2 and LD3
C. LD3 and LD4
D. LD4 and LD5

60. The LD1/LD2 flipped pattern and the presence of the CK-MB
isoenzyme on electrophoresis are highly suggestive of
A. acute pancreatitis
B. cirrhosis
C. muscular dystrophy
53. The type of bond that forms lipids from fatty acids is
D. myocardial infarction
a. Phosphodiester bond.
b. Glycosidic bond.
61. Which of the following are considered primary tissue
c. Peptide bond.
sources of alkaline phosphatase?
d. Ester bond.
A. kidney, pancreas, heart
B. bone, liver, intestine
54. The only enzyme significant in decreased amounts in plasma
C. prostate, liver, bone
is
D. liver, heart, spleen
A. aldolase
B. pseudocholinesterase- secreted by liver-reflects synthetic fxn
rather than hepatocyte injury
62. The most heat-stable ALP isoenzyme is
C. G-6-PD A. placental
D. glutathione synthetase B. liver
C. bone
55. Which of the following is least useful in differentiating D. intestinal
hepatocellular from obstructive jaundice?
a.LD ALP
b.GGT Normal Intestinal, placental, bone, liver
c.5’-NT Isoenzyme * Liver and bone ALP are most
d.ALT predominant fractions
Carcinoplacental Regan, Nagao, Kasahara
56. The products formed from the forward reaction of ALT are isoenzymes
A. aspartate and alanine Electrophoresis I>P>B>L
B. alanine and α–ketoglutarate Heat P>I>L>B
C. pyruvate and glutamate Denaturation
D. glutamine and oxaloacetate Chemical • L-phenylalanine – inhibits P (pancreas)
Inhibition (Liver) R N
• Levamisol – inhibits L B
• L-homoarginine – inhibits L B
• 2M urea – inhibits B
• L-leucine – inhibits N(nagao)
• 20% ethanol – denatures L (liver)
rapidly than B (bone)

57. In the Reitman-Frankel method, the quantitation of enzyme 63. The reference method for ALP which uses p-
activity is based on the nitrophenylphosphate is
a. reaction of 2,4-DNPH with an amine A. King-Armstrong
b.increase in absorbance of NADH at 340 nm B. Bodansky
c. reaction of 2,4-DNPH with a ketoacid C. Moss
d. decrease in absorbance of NAD at 340 nm D. Bowers-McComb

58. The De Ritis ratio refers to the ratio between Methods Substrate used
a.ALT/GGT • Shinowara - Beta-glycerophosphate
b.AST/ ALT-ratio is 2:1 • Jones
c.ALP/GGT • Reinhart
 • Bodansky
70. Which of the following is/are another term/terms for
• King-Armstrong -Phenylphosphate POCT?
• Bessey, Lowry & Brock p-Nitrophenyl phosphate 1. Decentralized testing
• Bowers-McComb 2. Bedside testing
• Huggins and Talalay Phenolphthalein diphosphate
3. Alternate site testing
a. 1
• Moss Alpha-naphthol phosphate
b. 1,2
• Klein, Babson, & Read Buffered phenolphthalein c. 2,3
d. 1,2,3
64. Which of the following enzyme assays is useful in resolving
71. POCT usually relies on the same analytic techniques as
rape cases?
laboratory-based instrumentation:
A. cholinesterase
B. AST
1. spectrometry
C. ACP
2. electroanalytic techniques
D. LDH
3. nephelometry
4. chromatography
65. The most specific substrate for acid phosphatase is
A. thymolpthalein monophosphate
a. 1,2,3,4
B. alpha naphthol phosphate
b. 1,3,4
C. phenolphthalein diphosphate
c. 1,2,4
D. buffered phenolphthalein phosphate
d. None
Methods Substrate
Gutman and Gutman Phenyl phosphate
72. The most routinely used POCT device at bedside, in
Shinowara p-nitrophenyl phosphate physician offices, and at home are
a. the fingerstick blood glucose monitors.
Babson, Read, and Alpha napthol phosphate b. the pregnancy test kits.
Phillips c. both
Roy and Hillman Thymolphthalein monophosphate d. none of these

66. What is the effect of high triglyceride level on serum 73. Next generation POCT usually imply
amylase assay? a. AI
A. falsely increased b. Biosensors
B. falsely decreased c. Turbidimetry
C. variable d. ID-MS
D. no effect
74. The strip technology in POCT platforms can be used to
67. The uricase method for uric acid assay depends on measure
A. ultraviolet absorption at 293 nm before and after treatment 1. Proteins
with uricase 2. enzymes
B. collection of evolved gas after uricase treatment 3. cardiac markers
C. titration before and after uricase treatment a. 1,2,3
D. formation of a tungsten blue complex b. 1,2
c. 2,3
68. Which uric acid method is affected by turbidity? d. none
A. UV
B. Coupled enzymatic 75. Which of the following methods indirectly measures urea by
C. phosphotungstic acid measuring ammonia?
D. all of these A. IDMS
B. Fearon
69. A serum creatinine of 6.6 mg/dL correlates with which of C. DAM
the following findings? D. enzymatic
A. Urea = 85 mg/dL- bcs nag correlate sya sa serum crea which
is taas ti nagtaas man sya.
B. Urea nitrogen = 10 mg/dL (ari nubo mn)
C. Urea = 15 mg/dL (ari normal rr pa)
D. Urea nitrogen/creatinine ratio = 15