Final Exam - Sample Questions
(1) Pick the correct answer for each of the following questions:
(1) Insulin antagonists include all of the following hormones EXCEPT:
a) PTH b) cortisol c) GH d) adrenaline e) glucagon
(2) Hyperglycemia is detrimental because:
a) increased glucose leads to a dramatic decrease in GH which would lead to growth retardation
b) increased glucose increases the osmotic pressure causing electrolyte imbalance and dehydration
c) increased glucose shuts off T4 release leading to ↓ metabolic rate d) all of the above e) b & c
(3) Spot the CORRECT statement regarding glucose testing methods:
a) the GO method is both far more sensitive and specific than the clinitest
b) the GO method is used as a confirmation to a (+) clinitest result
c) the pass through phenomenon may be bypassed by utilizing more amounts of urine
d) the clinitest requires a ½0 diluted urine while the GO method is applicable to concentrated urine
(4) Glycocylated haemoglobin (HbA1C):
a) is absent in the plasma of people without diabetes mellitus
b) common methods of analysis include ISE, nephelometry, and GC/MS
c) results from the combination of HbF and a sugar
d) gives a retrospective estimation of blood sugar levels over the past 3 months
e) is increased in diabetic patient with concurrent sickle cell disease
(5) Specimens for the following tests must be kept away from heat and/or light, EXCEPT:
a) bilirubin b) porphyrins c) semen analysis d) ammonia e) none of the above
(6) Why are infants born to malnourished mothers more prone to developing hypoglycemia?
a) inefficient gluconeogenesis b) insufficient glucose stores (glycogen)
c) both of the above d) neither one of the above
(7) As regards to galactosemia, which of the following statements is NOT true?
a) it results from GALT deficiency b) cataracts and neurodegenerative symptoms are quite common
c) IMR can be as high as 75% d) a fluorescent blood drop in Beutler test is a + result
(8) Secondary causes of hyperlipidemia include all of the following, EXCEPT:
a) hypothyroidism b) DM c) renal calculi d) cholestasis e) none of the above
(9) Calculate the blood concentration of LDL in a male patient with total cholesterol of 5.8 mmol/L, triglycerides of 2.6mmol/L, and an HDL of 1.3 mmol/L.
a) 3.3 mmol/L b) 2.8 mmol/L c) 4.3 mmol/L d) not enough info
(10) Absence of the α-band in serum protein electrophoresis MUST always be followed by testing:
a) serum albumin b) M-protein in urine c) serum α1-antitrypsin d) proteinuria
(11) The clinical utility of 5’-nucleotidase resides in its ability to:
a) differentiate hepatocellular injury from hepatobiliary disease
b) rise significantly earlier than transaminases
c) ascertain the cause of increased ALP levels
d) obviate confirmatory invasive tests (e.g. liver biopsy)
(12) Spot the CORRECT statement regarding ALP & GGT enzymes:
a) GGT is more liver-specific than ALP b) GGT is increased in 75% of cholestatic patients
c) Both are reflective of hepatocellular damage d) hepatotoxic drugs elevate GGT more than ALP
(13) Unconjugated hyperbilirubinemia with no evidence of hemolytic anemia or defective conjugation is most likely due to:
a) Criggler-Najjar syndrome b) Gilbert’s syndrome c) cirrhosis d) post-transfusion hemolytic episode
(14) Which statement is INCORRECT about renal physiology?
a) AVP affects water reabsorption in the kidney b) increase aldosterone leads to hypokalemia
b) renin is important for the synthesis of Ag II which promotes aldosterone release
d) PTH increases Ca reabsorption & has a phosphaturic effect e) all of the above f) None of the above
(15) The following test is useful to differentiate prerenal from renal failure:
a) urinary sodium b) BUN/Cr ratio c) creatinine clearance d) a & b e) none of the above
(16) All of the following tests assess glomerular function EXCEPT:
a) serum creatinine b) serum urea c) creatinine clearance d) proteinuria e) urine pH
(17) A patient was asked to collect urine over a 24 hour period. The volume was found to be 600 mL and the concentration of creatinine in an aliquot of this urine 200 mg/dL. What would be the creatinine clearance for this patient if they had a plasma creatinine concentration of 3 mg/dL?
a) 120 ml/min b) 28 ml/min c) 35 ml/min d) 90 ml/min
(18) ↑ pH, HCO3, & PCO2, with ↓ ECV and urinary Cl-:
a) vomiting-induced metabolic alkalosis b) diuretics-induced metabolic alkalosis
c) respiratory alkalosis + metabolic acidosis d) none of the above
(19) ↓ pH, ↑ HCO3, and PCO2 are indicative of:
a) metabolic acidosis b) respiratory alkalosis c) respiratory acidosis d) metabolic alkalosis
(20) The highest concentration of Fe is found in:
a) hemoglobin b) RES c) plasma d) bone
(21) Inside cells, iron is always bound to intracellular proteins because:
a) it’s required as a cofactor for their activity b) free iron is nonfunctional inside cells
c) free iron is toxic and is able to form cytotoxic free radicals d) it’s the only form in which it can be stored
(22) Spot the CORRECT statement regarding plasma iron levels:
a) they’re not affected by iron therapy b) physiologic decrease is seen during pregnancy
c) oxidizing agents are required for quantification d) correlate well with Fe poisoning
(23) Which of the following tests is most reflective of iron stores?
a) B12 & folate b) TIBC c) plasma iron d) urine homocysteine e) ferritin
(24) All of the following are acute-phase reactants EXCEPT:
a) CRP b) ferritin c) albumin d) rheumatoid factor
(25) Which of the following analytical methods are used to measure ferritin plasma level?
a) ISE b) electrophoresis c) GC/MS d) immuno-turbidimetry e) none of the above
(26) The low TIBC consistent with anemia of chronic disease is best explained by:
a) chronic effect of interleukin secretion b) ↑ RBC breakdown rate
c) diminished protein synthesis due to hepatic impairment d) consumption of ferritin by pathogens
(27) Which of the following tests is used to investigate fetal neural tube defects (NTD’s)?
a) serum folic acid b) serum AFP c) cord blood folic acid d) a & b e) b & c
(28) To confirm an inconclusive B12 result, which of the following tests would you refer to?
a) serum folic acid b) methylmalonic acid c) homocysteine d) a & c e) b & c
(29) Porphyria associated with lead toxicity is caused by inhibition of which of the following enzymes?
a) ALA synthetase b) ferrochelatase c) phenylalanine hydroxylase d) all of the above e) a & b
(30) The primary porphyrins include:
a) ALA & porphobilinogen b) uroporphyrin, coproporphyrin, & porphobilinogen
c) coproporphyrin, uroporphyrin, & protoporhyrin d) uroporphyrin, coproporphyrin, & ALA
(31) A blood sample has a total Ca of 2 mmol/L and albumin level of 35 g/L. What’s the corrected total Ca in this sample?
a) 1.8 mmol/L b) 2.1 mmol/L c) 2.4 mmol/L d) None of the above
(32) Among the biochemical abnormalities seen in rickets are:
a) ↑Ca, Pi, PTH & ALP b) ↑Ca, Pi, ↓PTH & ALP c) ↓Ca, ↑Pi, ↓PTH & ↑ALP d) ↓Ca, ↑Pi, PTH & ALP
(33) A needle-shaped crystal seen during synovial fluid microscopy indicates:
a) gout b) rickets c) rheumatoid arthritis d) osteoarthritis
(34) The most sensitive cardiac marker is:
a) CK-MB b) myoglobin c) troponin T d) GPBB
(35) The most specific cardiac marker is:
a) CK-MB b) myoglobin c) troponin T d) AST
(36) A serum protein electrophoresis for a sample from a multiple myeloma patient would show:
a) ↑ α & γ b) ↑ β & γ c) ↑ α & β d) ↑ albumin & γ e) none of the above
(37) Accumulation of 5HIAA in blood is a disorder of metabolism of which of the following AAs?
a) leucine b) phenylalanine c) tryptophan d) valine
(38) To screen a newborn for argentaffin cell cancer, which of the following reagents would you use?
a) ferric chloride b) DNPH c) 1-nitroso-2-naphthol d) nitroprusside
(39) The most sensitive test for thyroid status which also serves as a first-line investigative check is:
a) T3 b) FT4 c) TRH d) TSH
(40) The most common cause of hyperthyroidism is:
a) Hashimoto’s thyroiditis b) pituitary tumor c) Grave’s disease d) cretinism
(41) Measurement of anti-thyroid peroxidase (TPO) activity is confirmatory for:
a) Hashimoto’s thyroiditis b) pituitary tumor c) Grave’s disease d) cretinism
(42) The finding of ↓ ACTH and ↑ cortisol is most likely consistent with:
a) Cushing’s syndrome b) pituitary adenoma c) Addison’s disease d) small cell cancer
(43) A 33 year old stressed out housewife had a plasma cortisol level of 70 mg/dL after a low-dose DMX suppression test. All of the following tests would confirm your diagnosis EXCEPT:
a) high-dose DMX b) urinary free cortisol c) CRH stimulation test d) None of the above
(44) The lavender-top EDTA vacutainer tube, though rarely used in clinical chemistry, is required for the validity of each of the following tests EXCEPT:
a) blood ammonia b) blood lactate c) plasma ACTH d) plasma cortisol
(45) The short synacthen test is used to confirm a diagnosis of:
a) Cushing’s syndrome b) pituitary adenoma c) gonadal failure d) Addison’s disease
(46) A high rennin/ADH ratio is diagnostic of:
a) Conn’s syndrome b) 2ndry hyperaldosteronemia c) malignant hypertension d) renal artery stenosis
(47) Single out the INCORRECT statement about luteinizing hormone (LH):
a) a gonadotrpohin released from the anterior pituitary b) leads to estrogen release and ovulation
c) targets Sertoli cells to start spermatogenesis e) high blood levels could mean a pituitary disorder
(48) Spot the CORRECT statement regarding follicle-stimulating hormone (FSH):
a) a gonadotrophin released from the ovaries b) it stimulates Leydig cells to produce testosterone
c) leads to the development of corpus luteum d) high levels in males may lead to gynecomastia
(49) Spot the WRONG statement on testosterone:
a) a steroid hormone released from Leydig cells in the testes b) blood levels continue to rise throughout life
c) increased levels in females may lead to hirsutism d) production and release is controlled by LH
(50) Which of the following tests on seminal fluid would serve as the basis for determining the need for further endocrinology workup?
a) pH, viscosity, and color b) volume, motility, and viability c) sperm count d) all of these
(51) Glucose-Ringer’s solution is used in semen analysis for:
a) serial dilution before counting sperms b) fluid liquefaction and coagulum dissolution
c) vitality check to correct for motility d) all of the above e) none of the above
(52) Which of the following would you use to count viable sperm cells?
a) Glocuse-Ringer’s solution b) 0.5% yellow eosin solution c) normal saline d) HE stain
(53) A 45-year old male came to the Andrology Clinic with complaints of erectile dysfunction, decreased libido, and hypospermia. Upon P/E, the andrologist noticed atrophied testicles and ordered a seminal fluid analysis which came back with a low sperm count twice. The andrologist then checked blood levels of FH, FSH, and TES on a morning specimen, and the lab report came back with high results for LH and FSH and a low TES level. What’s your diagnosis?
a) gonadal failure b) pituitary dysfunction c) prostate hypertrophy d) varicocele
(54) Which of the following tests would rule in a diagnosis of polycystic ovary syndrome (POCT)?
a) no bleeding after progesterone challenge b) bleeding after progesterone challenge
c) ↑ prolactin & testosterone d) ↑ FSH and ↓ LH & estradiol e) a & d f) b & d
(55) A steady-state plasma concentration of a given drug is reached:
a) after 5 t ½ b) after 5 hrs from last dose c) immediately upon administration d) none of the above
(56) Supportive biochemical data in case of suspected Digoxin OD include:
a) hypothyroid; ↑Ca & K b) hyperthyroid; ↓Ca & K c) hypothyroid; ↑Ca; ↓K d) none of the above
(57) The following drugs are monitored just before the next dose is administered, EXCEPT:
a) Lithium b) Carbamazepine c) Tacrolimus d) Theophylline
(58) A weakly acidic toxin that’s ingested will:
a) not be absorbed because it’s ionized
b) be passively absorbed in the colon (pH = 7.5)
c) not be absorbed unless a specific transporter is present
d) be absorbed only if a weak base is ingested at the same time
e) be passively absorbed in the stomach (pH = 3)
(59) The reference method(s) applied in chemical toxicology is:
a) ISE b) GC/MS c) HPLC d) AAS e) b & c
(60) Which of the following reagents is used for investigating a case of carbon monoxide poisoning?
a) sodium chloride b) ferric chloride c) thiocyanate d) potassium ferricyanide
(61) Single out the INCORRECT statement as regards to lead toxicity:
a) it’s a common cause of porphyria due to its enzymatic inhibitory effects
b) can be assessed by measuring lead levels in whole blood
c) atomic absorption spectroscopy (AAS) is the method of choice for lead measurement
d) accumulation of uroporphyrin in urine may serve as an early sign
(62) Which of the following is consistent with an acute high-level oral exposure to inorganic Hg++?
a) positive occult blood in stool b) proteinuria
c) ↑ lead in whole blood and urine d) all of the above
(63) Tumor markers may be defined as:
a) analytic assays (e.g. immunoassays) used to mark cancer cells
b) radioactive substances and chemicals used to help localize and identify cancer cells
c) biologic substances released by cancer cells or host tissue
d) all of the above
(64) Spot the WRONG statement on hCG:
a) a glycoprotein released by ovarian trophoblasts b) can used to diagnose ovarian tumor
c) the β-subunit is quantified in pregnancy test d) can be measured by immunoassays
(65) Testicular tumor markers include:
a) hCG & AFP b) CA 19-9 c) CA 15-3 & CA 27-29 d) LH & Testosterone
(66) A stand-alone serum PSA level is used for each of the following EXCEPT:
a) monitoring response b) detecting recurrence c) diagnosis d) screening
(2) Link each item in column A to its counterpart in column B:
|
# |
COLUMN A |
# |
COLUMN B |
|
1 Total cholesterol |
|
Testosterone/Epitestosterone ratio Total bilirubin |
|
(3) Match each recreational drug with its urinary metabolite used for detection of abuse:
|
|
Drug |
|
Urinary Metabolite |
|
1 |
Cocaine |
|
6-acetylmorphine Benzoylecgonine Benzoic acid |
(4) The following plasma glucose results (mmol/L) were obtained on venous samples taken during a 75 g oral glucose tolerance test. Interpret the results in the light of the data provided for each case.
|
Case # |
Fasting |
2-Hour GTT |
Symptoms |
|
1 |
6.5 |
11.1 |
None |
|
2 |
6.3 |
7.5 |
None |
|
3 |
6.9 |
15.0 |
Polyuria/Polydipsia |
|
4 |
6.4 |
7.9 |
None |
(5) List the biochemical features for the following disorders:
I. Diabetic Ketoacidosis
II. Acute Renal Failure