MALAWI COLLEGE OF HEALTH SCIENCES.

CLINICAL CHEMISTRY EXAMINATION.

2HRS.
Answer all questions.

1. Explain the importance of clinical chemistry in health care? (8)

2. Name three main chemical buffer systems in the body? (3)
3. What are the two most commonly performed serum analyses to give information on
glomerular function? (2).
4. What is the significance of measuring protein in urine? (2)
5.Explain why when you request an acid-base or blood gas analysis, you put your sample in;
(a) a sealed syringe: (1) (b) on ice : (1)

6. What substances is the kidney normally working to (i) retain, (ii) get rid of? (4)
7. What factor(s) OTHER THAN RENAL FUNCTION affect serum urea levels? High and low (4)
8. List four causes for the presence of indirect bilirubin (4)

Case 1
A 42-year-old male came to the emergency department with complaints of upper abdominal
pains for the past 3 days, 2 episodes of vomiting in the past 3 days, yellowish discoloration of
urine and decreased urine output in the past 2 days. The following were the lab results.

Lab Report:
a. Serum Amylase: 1524 IU/L (40-140 IU/L)
b. Serum Lipase: 396 IU/L (Normal 0-50 IU/L)
c. Serum Creatinine: 5.1 mg/dl (Normal 0.5-1.2 mg/dl)
d. BUN: 18.9 mg/dl (3-20 mg/dl)

1. What would be the probable diagnosis? (2 Marks)

2. Give 2 reasons justifying your answer above in question ‘1’ (2 Marks)

3. Name any other 2 tests that you would order to validate your diagnosis. (2 Marks)

4. List any 4 possible etiologies that would lead to the condition above. (4 Marks)

Case 2
A Clinical Medicine student was persuaded by a psychologist to seek medical advice because
of his increasing bizarre behaviour. He had slowed up mentally, became indecisive and has
stopped playing his daily football game claiming that he no longer had energy to play. His
appearance has changed, his skin appearing sallow and his hair coarse and lacking lustre. He
has no goitre, but he was bradycardic.

■ The following were the lab results

– TSH Very high

– FT4 low

– Calcium low

1. Interpret the above results in light of the patient’s history, clinical findings and lab data.
(1 Mark)
2. List 2 possible causes of the condition mentioned above? (2 Marks)
3. Name 2 other lab tests you may order to confirm the condition named above? (2 Marks)
4. What was the clinician’s motive for requesting each of the above tests? (1 Marks)
5. What is the pathophysiology of the bizarre behaviour in this case? (2 Marks)
6. Why were the patient’s calcium levels low? (2 Marks)

Case 3
A well-trained marathon runner collapsed as he was approaching the finishing line. An ECG was
normal, the laboratory results were as follows
Total CK 9500U/L (30-200U/L)
CK-MB 14% of the total CK ( 3 to 5%)
Troponin undetectable
a) Interpret the laboratory results. (2 Marks)
b) List values of CK-MB and its normal range according to the presentation. (4)
c) List abnormal values (1)
d) What condition does the clinical and lab data suggest? (2 Marks)
e) List 2 other lab investigation can be performed to confirm the condition
mentioned above. (2 Marks)
f) What made the runner get collapsed? (2 Marks)
g) Why was the troponin level undetectable? (2 Marks)

Case 4
A 50 year-old man with a 2- week history of diarrhea. On examination he is dehydrated and his
breathing is deep and noisy.

Blood gas results:

[H+] 64 nmol/L (35 - 45)
pCO2 2.8kPa (4.6 - 6.0)
[HCO3-] 8 mmol/L (21 - 28)

a). What is the primary acid‐base disorder? (2)

b). What is the likely cause of the disorder named in (i) above? (2)
c). Explain the ‘deep’ breathing by the patient (4)

Case 5.
A 45 year old woman, was admitted to the OPD with complaints of nausea, vomiting, chills,
fever, and severe right upper quadrant pain. She had experienced similar symptoms a few times
in the last 6 months. The following laboratory results were obtained:

Reference range
Total Bilirubin 425 µmol/L 3.4 – 25.0
Conjugated Bilirubin 197 µmol/L 0 – 7.3
AST 100 IU/L 5 - 40
ALP 645 IU/L 30 - 157
ALT 105 IU/L 5 – 40
Albumin 40 g/L 35 – 50
Total Protein 74 g/L 60 – 80
γ-GT 400 IU/L 2 – 30

A. List the abnormal results. (2)

B. What is the most likely diagnosis? Provide evidence for your answer. (4)
C. What abnormal results would you likely find in urine and stool for this patient? (2)