Important Clinical chemistry questions for the SCFHS and the Board examinations in both the USA and UK.

Important Clinical chemistry questions for the SCFHS and the Board examinations in both the USA and UK.
Choose the most appropriate single answer.
1.      A patient has polyuria and polydipsia with a urine specific gravity of >1.040. Of the following possibilities, what is the most likely diagnosis?
a.      Alcohol intoxication
b.      ADH suppression from barbiturates
c.      Diabetes mellitus
d.      Li toxicity causing nephrogenic diabetes insipidus
e.      Central ADH deficiency

2.      Xanthochromia in CSF is due to the presence of
a.      Hemoglobin.
b.      Bilirubin.
c.      Glutathione.
d.      Oxidized glutathione
e.      Cysteine

3.      Synovial fluid from patients with gout typically contains
a.      Uric acid crystals.
b.      Calcium oxalate crystals.
c.      Hippuric acid crystals.
d.      Tyrosine crystals.
e.      Triple phosphate crystals.

4.      Water reabsorption from the renal tubules is stimulated by
a.      Relaxin
b.      Vasopressin
c.      Secretin
d.      Rennin
e.      Oxytocin

5.      The excretion of delta-aminolevulinic acid (ALA) and porphobilinogen (PBG) in urine is increased in which of the following?
a.      ALA dehydratase deficiency
b.      Acute intermittent porphyria
c.      Porphyria cutanea tarda
d.      Protoporphyria

6.      What is a normal fasting blood glucose level in mmol/L?
a.      1.9 – 3.5 mmol/L
b.      3.9 – 5.5 mmol/L
c.      4.5–7.2  mmol/L
d.       Less than 7.8  mmol/L

7.      What happens when human urine stands for a long time in room temperature?
a.      Creatinine  increased
b.      Urea decreased
c.      PH not changed
d.      Glucose increased

8.       Which of the following enzymes better used for diagnosis of acute pancreatitis?
a.      Amylase
b.      Lipase
c.      Trypsin
d.      Elastase

9.      25-hydroxycholecalciferol synthesis in
a.      Kidney
b.      Intestine
c.      Stomach
d.      Liver

10. low density lipoprotein rich in
a.      cholesterol
b.      bile acids
c.      Phospholipids
d.      Triacylglycerols

11. Hypoglycemic hormone is
a.      Insulin
b.      Glucagon
c.      TSH
d.      Somatostatin

12. Half life time of albumin is
a.      One week
b.      72 h
c.      48 h
d.      20 h

13. Heinz body testing is useful in the diagnosis of which of the following?
a.      Quantitative hemoglobin disorders
b.      Unstable hemoglobin disorders
c.      High-oxygen-affinity hemoglobins
d.      Methemoglobinemia
e.      Hereditary persistence of Hb F

14. Which is an example of a macrovascular complication of poorly controlled diabetes?
a.      Decreased sensation
b.      Blindness
c.      Renal disease
d.      Stroke

15. What is angiotensin?
a.      A hormone whose function is to communicate signals which control blood pressure.
b.      A molecule produced in the kidney as a hormone precursor.
c.      A hormone that signals blood vessels to expand.
d.      A hormone that prevents kidney tubules from concentrating the urine.

16. When can persistent microalbuminuria be diagnosed?
a.      When two consecutive urine specimens collected over 48 hours are abnormal for albumin.
b.      When two of three urine specimens collected within a three- to six-month period are abnormal for albumin.
c.      When a 24-hour urine specimen collected after a one-week restricted-protein diet is abnormal for albumin.
d.      When two of three abnormal urine specimens for albumin are obtained after all blood-pressure medications have been stopped for 72 hours.

17. When can microalbuminuria be said to be present?
a.      When urinary albumin excretion is less than 30 mg/day
b.       When urinary albumin excretion is greater than 300 mg/day
c.       When urinary albumin excretion is between 30 to 300 mg/day
d.       When urinary albumin is positive on a urine dipstick test

18. According to the American Diabetes Association (ADA) a Type I diabetic should be screened annually for microalbuminuria. When should this screening begin?
a.      Three to six months after diagnosis
b.      Immediately upon diagnosis
c.      One year after diagnosis
d.      Five years after diagnosis

19. What is the most common tool by which to detect the presence of massive acute UGI bleeding?
a.      Geiger counter
b.      BP cuff
c.      The eyeball
d.      Pulse oximeter
e.      Mass spectrophotometer

20. In patients presenting with acute UGI bleeding, what is the first order of business?
a.      Determining the site of bleeding
b.      Determining the porphyrin level
c.      Ordering a comprehensive metabolic profile laboratory test to check organ system functions
d.      Preventing cardiovascular collapse

21. Why is it important to screen for microalbuminuria?
a.      It can detect chronic kidney disease.
b.      It can identify an increased risk of proliferative retinopathy.
c.      It is the strongest independent risk factor of cardiovascular disease.
d.      All of the above

22. Which of the following groups is NOT at increased risk for microalbuminuria and thus does not require routine screening?
a.      Diabetics
b.      Hypertensives
c.      Athletes
d.      Patients with a family history of cardiovascular disease

23. The syndrome of antidiuretic hormone secretion (SIADH) is characterized by
a.      Hyponatremia
b.      Hypovolemia
c.      Urine sodium concentration <20 mmol/L
d.      Urine osmolality lower than serum osmolality

24. BCR-ABL fusion gene is present in approximately 90% of patients with which type of cancer:
a.      ALL (acute lymphocytic leukemia)
b.      CLL (chronic lymphocytic leukemia)
c.      CML (chronic myelogenous leukemia)
d.      Hodgkin's lymphoma
e.      AML (acute myelogenous leukemia)

25. Which Hb A1c percentage usually corresponds with a mean plasma glucose concentration of 100 mg/dL?
a.      4%
b.      5%
c.      6%
d.      7%
e.      8%

26. The predominate form of vitamin A is
a.      Retinoic acid
b.      Retinol
c.      Retinal
d.      Retinyl esters

27. Which of the following vitamins would be LEAST affected by long periods of fat malabsorption?
a.      vitamin A
b.      vitamin C
c.      vitamin D
d.      vitamin E
e.      vitamin K

28. Serum calcium levels are
a.      high in both primary and secondary hyperparathyroidism
b.      high in primary and low in secondary hyperparathyroidism
c.      high in secondary and low in primary hyperparathyroidism
d.      low in both primary and secondary hyperparathyroidism

29. The principle source of energy for the body is
a.      Proteins
b.      Lipids
c.      Carbohydrates
d.      Simple sugar
e.      None of the above

30. Drug screen for benzoylecgonine, positive alcohol and normal electrolytes. The patient's condition got worse in next hour when he started complaining of severe chest pain radiating to his arms in addition to profuse sweating. The clinical symptoms experienced by the patient is best explained by the effect of
a.      Stimulatory effect of benzoylecgonine a cocaine metabolite
b.      Excessive ethanol consumed by patient over short time period.
c.      Cocaethylene production by the liver.
d.      Atherosclerosis caused by excessive cocaine abuse.
e.      Gamma Hydroxybutyric Acid (GHB) consumption

31.  Most assays for hCG use a sandwich (immunometric) format. A laboratory offers two hCG assays in two different testing platforms, one of which is referred to as “tumor hCG”. What does that designation mean?
a.      FDA approval for use as a tumor marker
b.      It mostly detects the alpha subunit
c.      Uses an antibody for the alpha and an antibody for the beta subunits
d.      Equimolar detection of free alpha and beta subunits
e.      It detects intact hCG and the free beta subunit

32. A 55 year-old woman presents to the internal medicine department complaining of numbness in her feet, pale skin, dizziness, extreme fatigue and weakness. Blood is drawn for a complete blood count (CBC), comprehensive metabolic panel (CMP) and hemoglobin A1C (HbA1C). The CBC results are normal except for low blood count, hematocrit and hemoglobin (8.5 g/dL). The CMP results show an elevated fasting plasma glucose (195 mg/dL), while her HbA1C is on the lower end of normal (4.5%). Which one of the following conditions is(are) most likely present in this patient?
a.      Anemia
b.      Anemia and pre-diabetes
c.      Anemia and diabetes
d.      Pre-diabetes
e.      Diabetes

33. Calcium concentration in the serum is regulated by:
a.      Insulin
b.      Parathyroid hormone
c.      Thyroxine
d.      Vitamin C

34. Which of the following tests is useful for the diagnosis of neurosyphilis?
a.      Treponema pallidum particle agglutination (TP-PA)
b.      Rapid plasma regain (RPR)
c.      darkfield
d.      Venereal disease research laboratory (VDRL) test
e.      Flurescent treponemal antibody absorption (FTA-abs)

35. Which of the following is not associated with neutrophilia?
a.      Acute bacterial infections
b.      Aplastic anemia due to total body irradiation
c.      Cigarette smoking
d.      Lithium therapy
e.      Steroid therapy

36. Which of the following is associated with basophilia?
a.      A all acute infections
b.      Acute viral syndromes that produce “mononucleosis-type blood picture”
c.      Chronic myeloid leukemia
d.      Steroid therapy
e.      Artificial insemination

37. An amino acid that yields acetoacetyl CoA during the catabolism of its carbon skeleton would be considered:
a.      Glycogenic
b.      Ketogenic
c.      Glycogenic and ketogenic
d.      Neither glycogenic nor ketogenic
e.      Essential

38. Myoglobin in the urine could be an indicator of what?
a.      Body's hydration state
b.      Breakdown of RBCs
c.      Skeletal muscle injury
d.      Alkaptonuria

39.  Type 2 diabetes is characterized by:
a.      Insulin  resistance
b.      Insulin lack
c.      Beta cell destruction
d.      None of the above

40. What laboratory test evaluates kidney function and is a breakdown product of protein?
a.      Glucose
b.      SGTP (ALT)
c.      Creatinine
d.      BUN

41. Creatinine concentrations in serum are influenced by
a.      Hydration level
b.      Amylase concentration
c.      Liver disease
d.      Insulin Productions

42. An increase in unconjugated bilirubin may be the result of
a.      Either hepatic or posthepatic failure
b.      Either hepatic or biliary failure
c.      Either prehepatic or posthepatic failure
d.      Either hepatic or prehepatic failure

43. What serum component can be used as a screening test for hypothyroidism?
a.      ALT
b.      Cholesterol
c.      Total protein
d.      Creatine kinase

44. What ion is important in regulating blood pH and in transporting carbon dioxide from the tissue to the lungs?
a.      Sodium
b.      Potassium
c.      Chloride
d.      Bicarbonate

45. What ion increases with malignancy, particularly with lymphosarcoma?
a.      Magnesium
b.      Phosphorus
c.      Calcium
d.      Potassium

46. EDTA plasma cannot be used for testing ……… plasma levels because EDTA forms a complex with it.
a.      Calcium
b.      Phosphorus
c.      Magnesium
d.      Potassium

47. A good initial urinary screening test for suspected Cushings disease is
a.      Endogenous ACTH
b.      Low-dose dexamethasone supression test
c.      ACTH stimulation
d.      Cortisol/creatinine ratio

48. Determination of glycosylated hemoglobin is used for:
a.      Assessing present glucose control
b.      Assessing blood glucose control for the past 3 days
c.      Assessing long-term( 2 - 4 month) blood glucose control
d.      Adjusting daily insulin doses

49. Which of the following is NOT and indicator of dehydration:
a.      High urine specific gravity
b.      High cholesterol
c.      High BUN
d.      High hematocrit

50. The recommended method for diabetes diagnosis is:
a.      Oral glucose tolerance test
b.      Fasting blood glucose
c.      Post-prandial blood glucose
d.      None of the above


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