d.

Very high in catalyzed reactions

Cc Rodriguez Klubsy
7th 3. Enzyme reaction rates are increased by
Enzymology 262 98 - increasing
Electrolytes 346 117
Arterial Blood 375 129 temperatures until they reach the point of
Gas denaturation at
Liver Function 519 86 - a. 40–60°C
and 574
Endocrinology b. 25–35°C
Hormones
NPN? 246 c. 100°C
or d. 37°C
572
RENAL 568 75
4. An example of using enzymes as reagents in
the

clinical laboratory is

a. The hexokinase glucose method

b. The diacetyl monoxime blood urea nitrogen

Enzymes
(BUN) method
1. When a reaction is performed in zero-order
kinetics c. The alkaline picrate creatinine method

a. The rate of the reaction is independent of the d. The biuret total protein method

substrate concentration 5. Activity of enzymes in serum may be

determined
b. The substrate concentration is very low
rather than concentration because
c. The rate of reaction is directly proportional to
a. The amount of enzyme is too low to measure
the substrate concentration
b. The temperature is too high
d. The enzyme level is always high
c. There is not enough substrate

2. Activation energy is d. The amount of enzyme is too high to

measure
a. Decreased by enzymes
6. The isoenzymes LD-4 and LD-5 are elevated
b. The energy needed for an enzyme reaction in
to stop a. Liver disease
c. Increased by enzymes b. Pulmonary embolism

c. Renal disease
d. Myocardial infarction a. Total CK level that is 5 to 10 times the ULN

7. Which CK isoenzyme is elevated in muscle b. Total CK level that is 25 times the ULN

diseases? c. Total CK level that is 50 to 100 times the ULN

a. CK-MM d. Total CK level that is 1,000 times the ULN

b. CK-BB 12. Which of the following preanalytical errors

most
c. CK-MB
commonly causes false increases in serum
d. CK-NN
enzyme
8. Elevation of serum amylase and lipase is
measurements?
commonly
a. The patient was not fasting prior to blood
seen in
draw.
a. Acute pancreatitis
b. The blood sample was not maintained on ice
b. Acute appendicitis
upon collection and during transport to the
c. Gallbladder disease
laboratory.
d. Acid reflux disease
c. The serum was not separated from red blood
9. The saccharogenic method for amylase
determinations measures cells within 1 hour.

a. The amount of product produced d. The patient smoked three cigarettes just prior

b. The amount of substrate consumed to blood collection.

c. The amount of iodine present
d. The amount of starch present
10. Elevation of tissue enzymes in serum may be
used
e. The blood sample was not protected from
light
upon collection and during transport to the
laboratory.

to detect

a. Tissue necrosis or damage

b. Inflammation

c. Infectious diseases

d. Diabetes mellitus

11. Which of the following enzyme patterns is

MOST diagnostic of Duchenne-type muscular

dystrophy?
Electrolytes d. Hyperaldosteronism

1. What is the major intracellular cation? 6. Hyperkalemia may be caused by each of the
following EXCEPT
a. Potassium
a. Alkalosis
b. Calcium
b. Acute or chronic renal failure
c. Magnesium
c. Hypoaldosteronism
d. Sodium
d. Sample hemolysis
2. What is the major extracellular cation?
7. The main difference between a direct and
a. Sodium indirect
b. Chloride ISE is
c. Magnesium a. Sample is diluted in the indirect method, not
d. Calcium in the direct method
3. Osmolality can be defined as a measure of b. The type of membrane that is used
the
c. Direct ISEs use a reference electrode,
concentration of a solution based on the whereas
a. Number of dissolved particles indirect ISEs do not
b. Number of ionic particles present d. Whole blood samples can be measured with
c. Number and size of the dissolved particles the direct method and not with the indirect
d. Density of the dissolved particles method
4. Hyponatremia may be caused by each of the 8. Which method of analysis will provide the
following EXCEPT most

a. Hypomagnesemia accurate electrolyte results if a grossly lipemic

b. Aldosterone deficiency sample is used?

c. Prolonged vomiting or diarrhea a. Direct ISE

d. Acute or chronic renal failure b. Indirect ISE

5. Hypokalemia may be caused by each of the c. Flame emission photometry

following EXCEPT d. Atomic absorption
a. Acidosis 9. The most frequent cause of
b. Prolonged vomiting or diarrhea hypermagnesemia is

c. Hypomagnesemia due to
a. Renal failure blood osmolality and the normal expected
response
b. Increased intake of magnesium
by ADH is best described as a(n):
c. Hypoaldosteronism
a. Indirect relationship
d. Acidosis
b. Direct relationship
10. A hemolyzed sample will cause falsely
increased c. Logarithmic relationship

levels of each of the following EXCEPT d. There is no quantitative relationship

a. Sodium 14. The sample of choice for measuring blood

osmolality is:
b. Potassium
a. Serum
c. Phosphate
b. Plasma
d. Magnesium
c. Whole blood
11. The largest portion of total body water is
found in d. Serum or plasma may both be used

which tissue? 15. With increased water loss, burn patients are
most
a. Intracellular fluid
likely to also experience:
b. Extracellular fluid
a. Hypernatremia
c. Intravascular extracellular fluid
b. Hyponatremia
d. Interstitial cell fluid
c. Hypomagnesemia
e. Plasma
d. Hypoosmolality
12. Osmoreceptors in the hypothalamus are key
to regulating blood osmolality. Typically, a 1% to 16. Which plasma electrolyte has the most
2% shift narrow

in osmolality causes a ______ change in reference range and is MOST strictly regulated
circulating by

concentration of ADH. the body?

a. Twofold a. Sodium

b. Fourfold b. Magnesium

c. Eightfold c. Calcium

d. Tenfold d. Chloride

13. The quantitative relationship between e. Potassium

changes in
17. True or False? Red blood cells are key for
oxygen transport, carbon dioxide transport, and
maintaining electroneutrality in the blood
 b. Unconjugated bilirubin

LIVER FUNCTION c. Total bilirubin

1. Which of the following enzymes would d. Indirect bilirubin

best aid in
5. Which form of hepatitis is caused by a
identifying hepatobiliary disease? DNA virus?

a. Alkaline phosphatase (ALP) a. Hepatitis B

b. Aspartate aminotransferase (AST) b. Hepatitis A

c. Alanine aminotransferase (ALT) c. Hepatitis C

d. Ammonia d. Hepatitis D

2. In which of the following types of cells 6. Which of the following enzymes is most
does the useful in

conjugation of bilirubin take place? establishing the hepatic origin of an

elevated serum
a. Hepatocytes
alkaline phosphatase?
b. Kupffer cells
a. 5′-Nucleotidase
c. Macrophages
b. Alanine aminotransferase (ALT)
d. Phagocytic cells
c. Aspartate aminotransferase (AST)
3. Which of the following enzymes is
responsible for d. Lactate dehydrogenase

the conjugation of bilirubin? 7. Hepatitis E is likely to cause serious

consequences in
a. UDP-glucuronyl transferase
a. Pregnant women
b. Alkaline phosphatase
b. Children
c. Glutamate dehydrogenase
c. Travelers in Third World countries
d. Leucine aminopeptidase
d. Older people/
4. Which of the following fractions of
bilirubin is 8. Worldwide, most primary malignant
tumors of the
water soluble and reacts with a diazo
reagent without the addition of an liver are related to
accelerator?
a. Alcoholism
a. Conjugated bilirubin
b. Gallstones
c. Reye syndrome may interfere with achieving an accurate
result.
d. Malaria
Of the following preanalytical steps, which
9. The reagent p-
is
dimethylaminobenzaldehyde is used
incorrect?
to measure which of the following?
a. After phlebotomy, the patient’s blood
a. Urobilinogen
should
b. Total bilirubin
be immediately placed on ice.
c. Ammonia
b. The blood should be collected in a red
d. Alkaline phosphatase clot

10. Which of the following conditions would tube without anticoagulant.

result in
elevations in primarily conjugated bilirubin?
a. Dubin-Johnson syndrome
c. Hemolyzed samples should be rejected as
this interferes by falsely increasing
ammonia

b. Physiologic jaundice of the newborn levels.

c. Crigler-Najjar syndrome d. Lipemia may also interfere with plasma

d. Gilbert’s syndrome
11. A urinalysis dipstick test indicated that
urobilinogen was absent. Which condition
does this
ammonia measurements.
e. All of the above are correct.
13. A patient presents with elevated levels
of IgG

support? anti-HAV while levels of IgM anti-HAV are

nondetectable. This patient is likely to:
a. Biliary obstruction
a. Have an acute infection of HAV.
b. Hepatitis A acute infection
b. Have a chronic infection of HAV.
c. Defective liver cell function
c. Have an immunity to HAV.
d. Hepatocellular disease
d. Be a carrier of HAV.
e. This would support all of the above
conditions
12. Measuring serum ammonia levels has
the potential to be fraught with
preanalytical errors that
RENAL FUNCTION
1. Calculate creatinine clearance, given the
following
information: serum creatinine, 1.2 mg/dL;
urine
creatinine, 120 mg/dL; urine volume, 1750
mL/24 h;
body surface area, 1.80 m2.
2. Predict GFR in a 50-year-old woman who
weighs
60 kg using the Cockcroft-Gault equation.
Her
serum creatinine level is 2.5 mg/dL.
3. The measurement of serum cystatin C, a
small protein produced by nucleated cells,
is useful for
a. Detecting an early decrease in kidney
function
b. Calculating creatinine clearance
c. Diagnosing end-stage renal disease
d. Monitoring dialysis patients
4. Acute renal failure can be classified into
three
types. List each type and give an example of
each.
a.
____________________________________
__
b.
____________________________________
__
c.
____________________________________
__
5. The proximal tubule functions to
a. reabsorb 75% of salt and water.
b. concentrate salts.
c. form the renal threshold.
d. reabsorb urea.
6. Renal clearance is the
a. volume of plasma from which a
substance is
removed per unit of time.
b. volume of urine produced per day.
c. amount of creatinine in urine.
d. urine concentration of a substance
divided by
the urine volume per unit of time.
7. Renin release by the kidney is stimulated
by
a. a decrease in extracellular fluid volume or
pressure.
b. increased plasma sodium concentration.
c. increased dietary sodium.
d. renal tubular reabsorption.
8. The set of results that most accurately
reflects
severe renal disease is
a. serum creatinine, 3.7 mg/dL; creatinine
clearance,
44 mL/min; BUN, 88 mg/dL
b. serum creatinine, 1.0 mg/dL; creatinine
clearance,
110 mL/min; BUN, 17 mg/dL
c. serum creatinine, 2.0 mg/dL; creatinine
clearance,
120 mL/min; BUN, 14 mg/dL
d. serum creatinine, 1.0 mg/dL; creatinine
clearance,
95 mL/min; BUN, 43 mg/dL
9. Creatinine clearance results are corrected
using a
patient’s body surface area to account for
differences in
a. muscle mass.
b. age.
c. dietary intake.
d. sex.
10. A patient is suffering from an acute
bleed. What is
the most accurate way to describe the
subsequent
acute kidney injury?
a. Prerenal acute kidney injury
b. Renal acute kidney injury
c. Postrenal acute kidney injury
d. None of the above apply