Clinical biochemistry revision

Liver
I-Choose ! most correct answer:
1-! Following are ! mechanisms underlying hepatic disorder in acute hepatitis : a- Liver cell damage b-cholestasis c-liver cell mass reduction d-hepatic fibrosis e- a & c f- a & b g- all except d 2-All ! following are among !metabolic roles of liver in lipid metabolism except: a- lipogenesis in fed & fasting state b- uptake of VLDL & CM remnants from plasma c-degradation of ketone bodies d-synthesis of HDL & VLDL 3- All !following are among !metabolic roles of liver in protein metabolism except: a- Deamination of amino acids c- detoxification of ammonia by urea formation in urea cycle d- Synthesis of -globulins e- synthesis of albumin ,clotting factors , & -globulins 4- !following is among !metabolic roles of liver in CHO metabolism : a-removal of excess glucose in fed state & formation of glycogen b-Synthesis of glucose in later stages of fasting by gluconeogenesis c-degradation of stored glycogen to glucose to maintain BGL in fasting state d- All of ! above 5-Which of ! following statements is true about ! functions of liver: a-it is involved in vitamin & hormone metabolism b- it is ! only organ that can removes cholesterol from ! body c- ! major site of bilirubin synthesis d-! only organ that carry out ketogenesis e- bilirubin excretion in ! form of insoluble bilirubin in bile f- a & b g- all except c & e 6-All of ! following are characteristics of cholestasis except: a- increase in plasma ALP activity due to decreased excretion b- slight increase of plasma ALT activity due to retention of phospholipids c- increase in plasma GGT activity d- prolonged prothrombin time due to vit K deficiency e- a & b f- b & d 7-All ! following is true about Liver cirrhosis except: a-it is an outcome of a progressive alcoholic hepatitis b- Albumin synthesis decrease in advanced cases leading to ascites c- prolonged prothrombin time d-gross increase in plasma ALT activity in early phase 8-Acute viral hepatitis is characterized by: a- large increase of plasma ALP activity b-plasma AST activity is relatively higher than plasma ALT activity c- Slight post-hepatic cholestasis d- positive serological tests for viral antigen or antibody

Clinical biochemistry revision 9-Which statement is not true about acute hepatitis: a-Starts & resolves quickly b-an element of cholestasis occurs due to inflammation of hepatocytes c- may be viral or alcoholic or drug induced d-dark urine & pale stools are excluded e-total bilirubin increase due to increase in both IB & DB 10-In Liver cell mass reduction ,All ! following is correct except : a- affects ! synthetic ability of ! liver b-Ascites occurs as a concequence of hypoalbuminemia c- prolonged PT can be corrected by parentral adminstration of Vit K d- occurs in advanced cases of chronic active hepatitis & liver cirrhosis e- c & d 11-Which of ! following statements is true: a- Bilirubinuria is always pathological & dark urine may be an early sign of an inherited disorder in bilirubin metabolism b-Indirect bilirubin is partially carried on albumin in plasma & thus never appear in urine c-Urobilinigen in urine is normal in hemolytic jaundice & increased in Gilberts syndrome d-! increased plasma GGT activity is not diagnostic for alcoholic hepatitis & ! diagnosis is mainly based on ! patient history 12-Which of ! following statements is not true about Gilberts syndrome : a- characterized by unconjugated hyperbilirubinemia b- characterized by normal liver function enzymes including GGT c- characterized by normal hepatic histology d- caused by ligandin deficiency e- Non of ! above 13- Which of ! following statements is true about Crigler-Najjar syndrome : a- characterized by conjugated hyperbilirubinemia b- characterized by precence of DB in urine c- ! onset of symptoms occurs after puberty d- caused by decreased IB uptake e- it is an inherited disorder of bilirubin metabolism 14-All ! following can lead to unconjugated hyperbilirubinemia except: a- ineffective erythropoiesis b- glucorunyl transferase deficiency c- ligandin deficiency d- neonatal jaundice e- intrahepatic biliary obstruction 15-Which of ! following statements is true about conjugated hyperbilirubinemia : a- characterized by increased urobilinogen in urine b-pale stool is observed due to absence of bile pigments c- Cholestasis is ! sole interpretation d- bilirubinuria is an early screening test & a negative bilirubin in urine is confirmative 16- Which of ! following statements is not true about serum liver function tests: a- elevated 5-nucleotidase is diagnostic for biliary obstruction b- elevated ALP is sensitive but not specific for hepatobiliary obstruction c- relative plasma activities of ALT & AST may differentiate between acute & chronic liver diseases d- decreased serum albumin level is a specific indicator of chronic liver disease

Clinical biochemistry revision 17-Among ! specific disorders that lead to liver disease : a-Hemochromatosis b- Wilsons disease c-1ry liver cell cancer d- 1 antitrypsin deficiency e-All of ! above 18-All ! following is true about chronic active hepatitis except : a- SAST is largely higher than SALT b-ALT & AST rarely exceed three times ! upper reference limits c- increase in -globulin fraction is due to increase in SMA & ANA d- an early increase in IgG differentiates it from chronic benign hepatitis e- ! disease is not symptomatic f- All except d g- b & e 19-Which statement is incorrect about -fetoprotein: a- it is ! main plasma protein in fetus plasma b- its gene is expressed normally only in fetus & expression ceases after birth c-its presence in adult serum indicates 1ry liver cell cancer due to re-expression by tumor cells d- alcoholic cirrhosis & ulcerative colitis may cause induction of AFP synthesis e-Non of ! above 20-Which of ! following statements is incorrect: a-in hemochromatosis ,liver cirrhosis is due to deposition of hemosidirin in liver b- Willsons disease is characterized low serum & urinary Cu & also serum ceruloplasmin is low c-Hemochromatosis is characterized by high serum iron ,high serum ferritin & increased TIBC d- 1 antitrypsin deficiency leads to liver necrosis 21-In Viral hepatitis a-serum ALT activity increase more than 10 folds ! upper reference limit b-conjugated hyperbilirubinemia occurs due to decreased conjugation c- IB increase due to cholestatic element d-a test for viral antigen or antibody is not always essential 22-Which statement is not true about cholestasis : a-pruritis occurs due to deposition of bile salts in skin b- large increase in both serum ALP & GGT activities is diagnostic c- 5-NT level can differentiate between intrahepatic & extrahepatic cholestasis d-prolonged PT is due to Vit K deficiency & can be corrected by Vit K injection e-Hypercholesterolemia occurs due to cholesterol retention 23-In Chronic persistent hepatitis a-Jaundice usually occurs b-SALT & SAST activities only slightly increase c- ! patient may remain asymptomatic for long period d-! condition is benign & discovered by chance e ALL of ! above is correct f- all except a 24-Unconjugated hyperbilirubinemia occurs due to: a- increased production of IB in hemolytic jaundice b- decreased uptake of IB in Gilberts syndrome c- impaired conjugation of IB in Crigler-Najjar syndrome d- immature hepatic uptake & conjugation in physiological jaundice e-ALL of ! above 25-Which statement is correct: a-1ry bile acids are formed from 2ry bile acids by oxidation in liver b- 2ry bile acids are obtained by oxidation of 1ry bile acids in liver c-bile contain both 1ry & 2ry bile salts due to enterohepatic circulation d- chenodeoxycholic acid is a 2ry bile acid 3

Clinical biochemistry revision 26-All ! following statements are true about gall stones except: a-pigment stones are formed in chronic hemolytic states b-high serum cholesterol level can predispose to ! formation of cholesterol containing stones c-Mixed stones are built on a cholesterol nucleus d-gall stones is rarely associated with cancer of gall bladder 27-gall stone formation can lead to all ! following except : a- acute inflammation of gall bladder wall b-chronic cholecystitis c- obstructive jaundice d- all except a e-All of ! above 28-Hepatic bile contains : a- cholesterol b-2ry bile salts c- phospholipids d- stercobilinogen e- a & c f- all except d g- all of ! above 29- Intrahepatic cholestasis can be caused by: a-cholangitis b-1ry biliary cirrhosis c-chloropromazine d-viral hepatitis e-inflamation in common bile duct f-all of ! above g-all except e 30- In chronic liver disease, all ! following occurs Except : a- albumin levels falls below ! normal b- plasma total protein may increase due to increase in immunoglobulins c- SAST & SALT are slightly increased d-Ascites is a characteristic feature of liver cell mass reduction e- parentral admistration of Vit K can correct ! prolonged PT 31-Which statement is incorrect : a-GGT is sensitive but not specific marker of cholestasis b-GGT measurement is inferior to 5-nucleotidase measurement in diagnosis of cholestasis c-GGT synthesis is generally induced by hepatic microsomal enzyme inducers d-increase in plasma GGT activity is specifically diagnostic for alcoholic hepatitis

II-Mark true or false

1- measurement of plasma ALP activity is ! most sensitive test for cholestasis. T F 2- Urobilinogen increase in urine in complete biliary obstruction T F 3- Bilirubinuria is used for differential diagnosis of causes of jaundice T F 4- AFP is a tumor marker used for diagnosis of hepatic carcinoma T F 5- 1-antitrypsin is responsible for 90% of protease inhibition in serum T F 6- ALT slightly increase in cholestasis due to acute inflammation of hepatocytes T F 7-In response to biliary obstruction ,proliferation of cells lining bile canaliculi occurs leading to increased synthesis of ALP T F 8-in hemolytic jaundice ,both IB & DB increases T F 9- Liver cirrhosis is ! terminal stage of chronic liver disease T F 10- presence of bilirubin in urine can differentiate between cholestasis & viral hepatitis T F 11- Dark urine is not observed in Crigler-Najjar syndrome T F 12- Urine urobilinogen can differentiate between hemolytic jaundice & Gilberts syndrome T F 13-Cholangitis is a common cause of post-hepatic cholestasis T F 14- Autoimmune antibodies can cause chronic persistent hepatitis T F 15- Chronic persistent hepatitis may be a consequence of previous acute hepatitis C T F 16- Jaundice usually occurs in chronic active hepatitis but not usually appears in chronic benign hepatitis T F 4

Clinical biochemistry revision 17- Bilirubinuria is always pathological & dark urine may be an early sign of some forms of hepatobiliary diseases. T F 18-Dark urine & pale stools occurs in both acute hepatitis & cholestasis T F 19- ALP is elevated in cholestasis but not in acute viral hepatitis T F 20-.! Gall-bladder bile is ten times more concentrated than hepatic bile T F 21-PT is prolonged in both reduced liver cell mass & cholestasis due to ! same reason T F 22-In acute viral hepatitis ,SALT is higher than SAST ,but in Chronic active hepatitis SAST is higher than SALT T F 23- GGT synthesis is induced by chronic use of HME inducers but 5-NT is not T F 24-Prothrombin time is ! best index for ! progression of liver disease T F 25-in Advanced cases of cirrhosis ,liver cell mass reduction occurs leading to ascites T F 26- AFP is replaced by albumin after birth T F 27-Gall stones may be rarely associated with carcinoma of ! gall bladder T F 28- There is no association between hypercholesterolemia & ! formation of cholesterol gall stones T F

III-Write short notes on ! following statements:

1- Bilirubinuria is used for differential diagnosis of causes of jaundice (2006) 2- Differential diagnosis between cholestasis & liver cell mass reduction 3- Primary liver cell cancer 4- Gall-bladder bile is ten times more concentrated than hepatic bile 5- Relative plasma activities of AST & ALT may help to indicate ! type of cell damage 6- Differential diagnosis between types of chronic hepatitis 7- specific disorders affecting ! liver 8- Inherited disorders of bilirubin metabolism 9- Mechanisms underlying hepatic diseases Answers 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4

5 6 7 8

9 10 11 12

13 14 15 16

17 18 19 20

21 22 23 24

25 26 27 28

Clinical biochemistry revision

Investigation of renal function

I-Choose ! most correct answer:
1-Which statement is incorrect : a-AVP affects water reabsorption in ! kidney b-renin is imp for ! synthesis of Ag II which is required in aldosterone synthesis c-increase aldosterone leads to hypokalemia d- PTH increases Ca reabsorption & has a phosphaturic effect e-ALL of ! above f-Non of ! above 2-Among hormones produced by ! kidney : a- PTH b-renin c-calcitriol d- all e- all except a 3-All ! following are not true about ! endocrine functions of ! kidney except: a-they remain clinically intact until ! end stages of renal failure. b-erythropoetin hormone is produced by ! kidney in response to PTH c-Calcitriol acts on ! kidney to facilitate phosphate excretion d- increase in AVP leads to polyuria 4-All ! following are tests for golumerular function except : a- serum creatinine b-serum urea c-creatinine clearance d-proteinuria e- urine pH 5-Among ! tests used for assessment of tubular function : a- serum uric acid b- serum ammonia c- urine osmolality /serum osmolality d-proteinuria 6-Which statement is incorrect : a- Volume of ! glomerular filterate is affected by changes in ! blood supply to ! glomerulus b- composition of ! glomerular filterate is affected by reduction of ! permeability of ! membrane to !filtrate. c-Composition of ! GF is affected by increased permeability of ! glomerulus d- filteration of plasma proteins (proteinuria) by ! glomeruli indicates nephrotic syndrome 7-All of ! following are ! consequences of reduced GFR except : a-hypokalemia b- low creatinine clearance c-prerenal uremia d-metabolic acidosis 8-Among factors that reduce glomelular filteration rate are: a- congestive heart failure b-renal artery stenosis c-urethral stones d-Cd toxicity e-Acute glomerulonephritis f-ALL of ! above g- all except d 9-Among prerenal factors that reduce GFR : a-dehydration b- bladder tumors c-prostate enlargement d-glomerulonephritis 10-Hyperkalemia is a consequence of reduced GFR due to: a- metabolic acidosis b-release of intracellular K c-decreased K excretion d-All of ! above e-all except a 11-Clinical findings in acute renal failure includes : a-Oliguria b-decreased serum NPN c- metabolic alkalosis d-hypokalemia e-All of ! above f-all except c g- a & d 12-About creatinine clearance ,which statement is not true : a-it is most sensitive indicator of glomelular dysfunction b-minor changes in GFR affects creatinine clearance as well as serum creatinine & urea levels c-creatinine is ! best substance for clearance measurement d- urea is not used for clearance measurement as it is partially reabsorbed by renal tubules

Clinical biochemistry revision 13-provided wz a sample of 600 ml urine collected during ! last 24 hrs wz a creatinine concentration of 200 mg/dl & a plasma creatinine concentration of 3 mg/dl ,so ! creatinine clearance for that patient is equal to : a-120 ml/min b-28 ml/min c-35 ml/min d-90 ml / min 14-In patients with hepatic failure in ! presence of renal diseases ,which statement is correct: a-liver cant synthesize urea so ! ratio between serum NPN to serum urea is approximately normal b-! ratio of NPN level to urea nitrogen level is higher than normal c-serum NPN increased due to renal failure & urea level is decreased due to decreased synthesis d-! ratio between serum urea to serum NPN increase due to decreased synthesis of urea in hepatic failure e- b & c 15-serum osmolality increase in All of ! following except: a-hemodilution b-diabetes mellitus c-prerenal ureamia d-dehydration 16-Polyuria wz low urine osmolality occurs in: a-Ketosis b-diabetes mellitus c-nephrogenic diabetes insipidus d-All of ! above 17-All ! following are causes of polyuria except: a-increased water intake b-acute renal failure c-diabetes mellitus d-diabetes insipidus 18-which statement is not true : a-normally urine is more concentrated than plasma b-urine osmolality is an indicator of ! ability of kidney to concentrate urine c-normally serum osmolality /urine osmolality is higher than 3 d-increase secretion of AVP leads to urine wz high osmolality 19-All ! following statements are correct about acute renal failure except: a-abrubt impairment of renal function occurs but it can be reversed b-metabolic acidosis is a characteristic biochemical finding c-hypokalemia occurs due to renal tubular damage d-low creatinine clearance 20-chronic renal failure is characterized by all ! following except: a-hypophosphatemia b-hypocalcemia c-hyperkalemia d-nucturia 21-Nephrotic syndrome is characterized by all ! following except: a-2ry hyperlipidemia b-hypocalcemia c-hypergammaglobulinemia d-hyper & 2 globulinemia e- b & c 22-All ! following are ! consequences of renal tubular damage except : a-renal tubular acidosis b-aminoacid uria c-hyperphosphatemia d-hypokalemia 23-which statement is correct about fanconis syndrome : a-it is a congenital defect in renal tubules b-it is a multiple disorder leads to leads to general failure of reabsorption c-renal tubular acidosis occurs d- characterized by phosphaturia & hypouricemia e-all of ! above 24-Hypertension & polyuria occurs in chronic renal failure due to : a- water retention b-as !patient retain ! ability to reabsorb Na but renal tubules lose ! ability to reabsorb H2O c-elevated phosphate level d-all of ! above e- all except c 25-All ! following are used in ! assessment of tubular function except: a-specific proteinuria b- urine osmolality c-renal glucosuria d-proteinuria 26-In urinary tract infection ,which statement is incorrect: a- urine appearance is cloudy b- formation of ammonium phosphate stones c-urine is acidic due to increased proton excretion d- Non of ! above 7

Clinical biochemistry revision 27-All ! following statements are correct about renal tubular acidosis except: a-occurs as a consequence of fanconis syndrome b-leads to Ca phosphate stone formation c- decrease ! binding between albumin & Ca so non ionized Ca increase d- may be due to a defect of either hydrogen ion secretion in ! distal tubule or bicarbonate reabsorption in ! proximal tubule e- Non of ! above 28-In chronic renal failure ,all ! following occurs except: a-pateint develops anemia due to erythropoiten deficiency b- hypophosphatemia occurs due to tubular damage c-increased ALP activity due to renal osteodystrophy d- hypocalcemia occure due to impaired calcitriol production

II-Mark true or false

1 Alkaline urine is found in patients wz urinary tract infections or after ingestion of an alkali T F
2-uretheral stones leads to increased serum urea T F 3-In acute renal failure hyperkalemia & metabolic acidosis occurs T F 4-renal artery stenosis & CHF leads to intra renal uremia T F 5-Nucturia occurs in acute renal failure due to inability of kidney to concentrate urine at night T F 6- Urine / plasma osmolality ratio should be 1 in normal subjects T F 7-Increase secresion of AVP leads to urine formation wz low osmolality T F 8-! concentrations of serum creatinine & urea are used as convenient, but insensitive measures of ! glomerular functions T F 9-In acute renal failure ! rise in serum urea is more than serum creatinine as urea is reabsorbed at renal tubules T F 10- a normal serum creatinine doesn't necessarily mean all is well T F 11- In diabetes mellitus , polyuria wz low urine osmolality occurs T F 12-Urea may be used in clearance measurement as its level is elevated markedly wz a minor change of GFR 13-Creatinine excretion is constant per day & its conc is constant during ! period of urine collection T F 14-Ammonia increase in hepatic coma while uric acid increases due to renal insufficiency T F 15- Angiotensin II formed by ! action of rennin on angiotensin I & it has an imp role in aldosterone synthesis

III-Write short notes on ! following statements:

1-Causes & consequences of reduced GFR 2-Biochemical findings in chronic renal failure 3-Endocrine function of ! kidney 4-Creatinine is used for clearance measurement but not urea 5-! concentrations of serum creatinine & urea are used as convenient, but insensitive measures of ! glomerular functions (2006) 6-Biochemical findings in nephrotic syndrome 7-Causes & consequences of tubular damage 8-Differential diagnosis between acute & chronic renal failure 9-Classifcation of acute renal failure

Clinical biochemistry revision

Answers
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 11 12 13 14 15 6 7 8 9 10 16 17 18 19 20 11 12 13 14 15 21 22 23 24 25 26 27 28

Disorders of CHO metabolism

I-Choose ! most correct answer:
1-All ! following is true about glucose homeostasis except: a-regulated by insulin in fed state & glucagon in fasting state b-glucose is always maintained in normal levels by suppressing hepatic glucose production in fasting state c-Insulin antagonist hormones act to increase blood glucose levels in response to hypoglycemia d- Glucose utilization is stimulated by insulin in fed state 2- Insulin stimulates all ! following except: a- lipogenesis b-ketogenesis c-protein synthesis d-K & PO4 uptake 3-All ! following are a consequence of long term diabetes except : a-diabetic foot b-Cataract c-nephropathy d- diabetic ketoacidosis 4- All ! following can be used in ! management of DKA EXCEPT: a-insulin b-sodium carbonate c-potassium chloride d- b & c 5-Insulin overdose can lead to a-Hypokalemia b-hyperphosphatemia c-Tachycardia d-All e-all except b 6-OGTT is done in all ! following condition : a-if ! diagnosis of diabetes is uncertain b- patients wz borderline fasting BGL c-children wz type I diabetes d- All e -all except c 7- Increased GT occurs in : a- pancreatic tumour b- hyperfunction of adrenal ,pituitary & thyroid glands c-obesity d-some infections e-all of ! above 8-Decreased GT occurs in all ! following except : a-Diabetes mellitus b-liver damage c-insulin overdose d-obesity 9-Impaired glucose tolerance is characterized by : a- fasting blood glucose level below 140 mg/dl b- postprandial BGL below 7.8 mmol/L c- ! patient is at high risk to develop type I diabetes d- negative tests of glucose in urine after 1 hr in OGTT 10- I.V glucose tolerance test is performed in case of : a- poor absorption of oral glucose b- Patients can not tolerate large amount of CHO (vomiting ) c- Patients wz altered gastric physiology d- all of ! above 11-Which statement is correct : 9

Clinical biochemistry revision a- presence of KBs in plasma is diagnostic for DM b-Some patients have Diabetes innocence have glucosuria due to increased BGL c- elderly diabetics have diabetes wzout glucosuria d-RT for glucose increase in renal glucosuria 12-Patient is diagnosed diabetic in ! following conditions except : a-fasting BGL is higher than 140 mg % wz a postprandial BGL higher than 200 mg % b-one of intermediate samples in OGTT is lower than 11.1 mmmol/L c- normal fasting BGL wz a postprandial BGL higher than 200 mg % d- postprandial BGL excedds 11.1 mmol/L 13-In hypoglycemia ,all ! following occurs except : a-ACTH & GH secretion increase b- insulin secretion is suppressed b- gluconeogenesis is inhibited c- Tachycardia 14-Hyperglycemic coma can be known by : a-mydriasis in eye pupil test b-acetone smell in breath c- positive test for KBs in urine d-All e- b & c 15-All of ! following are causes of hypoglycemia except : a-Insulin overdose in type I diabetics b- Cushing syndrome c- chronic liver disease d-Hypopitutirism 16-Which statement is incorrect : a-C-peptide level is high in insulinoma b- C-peptide level determination is done to discover ! cause of hypoglycemia c- In type I diabetes C-peptide level is high to compensate for insulin deficiency d-In type II diabetes ,C-peptide level is normal or high 17-Hypoglycemia in newborn infants occurs as a consequence of : a-inborn error of metabolism b-maternal hyperglycemia c-Von Gierks disease d-all 18-! Following statements are not true except : a- HbA1c it is an indicator of blood glucose level during ! previous 4-8 weeks b- HbA1c values of 8-9 % indicates very bad diabetic control c-albumin has longer t than Hb d- Fructosamine is ! ketonamine product of non enzymatic glycation of serum proteins esp hemoglubin e-serum Fructosamine is an index of BGL for ! previous 1-2 months 19-In type I diabetics ,All ! following occurs except : a- coma may develops due to insulin overdose b- plasma c-peptide level is very low c- strenuous exercise may cause hypoglycemia if mismatched wz insulin dose d- low level of islet cell antibodies may be observed in some patients 20-Galactosemia is due to deficiency of : a-glucose-6-phosphatase b-gal-1-P uridyl transferase c-glycogen phosphorylase d-any of ! above

II-Mark true or false

1-sever infections in especially in ! pancreas can lead to hypoglycemia
2-Von Gierke's disease is caused by lack of glucose-6-Phosphatase in liver & kidney 3-Excercie decrease insulin requirement in type I diabetes 4- plasma C-peptide is high in Insulinoma & low in insulin overdose 5- mydriasis indicates hypoglycemia & Miosis indicates hyperglycemia 6-HbA1c is used for long term monitoring of diabetes especially when associated wz hemolytic anemia 7- HbA1c level > 13 % indicates poor diabetic control 8- glucosuria is used as ! first line screening for DM 9-Obesity ,liver disease can lead to impaired glucose tolerance 10-OGTT is done in children wz type I diabetes 10

Clinical biochemistry revision 11-Hyperinsulinemia leads to decreased glucose tolerance 12- plasma C-peptide is a measure of endogenous insulin 13- postprandial BGL higher than 200 mg/dl indicates diabetic patient even if fasting BGL is normal 14- primary diabetes may result from pancreatic disease or Cushing syndrome 15-! Concentration of ! glycated protein badly reflects ! mean BGL during !half life of that protein as ! glycation Rn is reversible

III-Write short notes on ! following statements:

1- HbA1C is used in long term monitoring of blood glucose level (2006) 2- Long term complications of diabetes mellitus 3- Diabetes mellitus leads to 2ry hypertriglyceridemia & hypercholesterolemia 4- Inborn error of metabolism lead to hypoglycemia in neonates 5- OGTT in impaired glucose tolerance 6- Secondary diabetes mellitus 7- Weight loss despite of polyphagia occurs in type I diabetes 8- Diabetes mellitus is characterized by polyuria wz high urine osmolality 9- Causes of fasting hypoglycemia 10- Differential diagnosis between hypoglycemia due to insulinoma & insulin overdose 11- Differential diagnosis between hypoglycemic & hyperglycemic coma

Answers
1 2 3 4 5 1 2 3 4 5 6 7 8 9 10 6 7 8 9 10 11 12 13 14 15 11 12 13 14 15 16 17 18 19 20

1-Illustrate by diagram ! steps of PCR ************ 2-IIlustrate by diagrams ! steps of DNA clonig in bacteria *** 3-in brief how to proceed to obtain several copies of ! gene of interest (2006) (answer :draw steps of DNA cloning or PCR) 4-draw ! lac operon in precence & absence of glucose (2006) 5-How to obtain ! gene of interest to be amplified (answer :by restriction endonuclease ,chemical synthesis or reverse transcriptase) 6-essential properties of DNA vector 7- Why Restriction endonucleases don't cut Bacterial DNA ? 8-Advantages of RCR over recombinant DNA technology 9-Uses of Hypridization tequeniques 10-Probing DNA 11-descripe ! steps of a technique used for detection of a specific DNA sequence
(answer :southern blot)

Molecular biology

12- Change in genes may regulate gene expression *********** 11

Clinical biochemistry revision 13-Gene rearrangement is a mechanism by which lymphocytes can synthesize various types of Abs 14-Illustrate by drawing Lac operon in ! presence & absence of lactose*****

Disorders of lipid metabolism I-Choose ! most correct answer:

1-Familial hyperbetalipoproteinemia is characterized by : a-Eruptive xansoma b-xanselasma c-risk for astherosclerosis is not striking d-LDL & HDL is lower than normal 2-Familial hypertriglyceridemia is characterized by all ! following except : a-increased levels of VLDL b-LDL & HDL is lower than normal c- may be secondary to alcoholism d-! plasma appearance appears turbid wz creamy layer on ! top 3-Familial hypercholesterolemia is characterized by all ! following except: a- may by heterozygous or homozygous according to ! type of gene mutation b-classified as type I hyperlipoprotenemia c- severe atherosclerosis usually develops d-decreased uptake of LDL due to apo B100 abnormality e-All of ! above f- b & d 4-Xanthoma develops in all ! following lipoprotein disorders except : a-Type IIb hyperlipoprotenemia b-Type III hyperlipoprotenemia c-Type IV hyperlipoprotenemia d- Mixed hypercholesterolemia e-Type IIa hyperlipoprotenemia 5-Type V hyperlipoproteinemia is characterized by : a- Increased beta lipoprotein b-Combined hypercholesterolemia & hypertriglyceridemia c-Increased risk for severe atherosclerosis d-Xanselasma e-increased Glucose tolerance f- all except d g-Non of ! above 6-All of ! following are characteristic for exogenous hypertriglyceridemia except: a-Caused due to mutation of apo C II gene b-Eruptive xanthoma is a characteristic sign c-recurrent episodes of pancreatitis is a common cause d-elevated TGs is due to accumulation of CM e-increased risk for CHD 7-Which statement is not true : a-Abetalipoprotenimia is due complete absence of apo B b- tangier disease is due to increased catabolism of apo A1 c- remnant removal disease is due to apo E2 deficiency d-CM & VLDL increase in mixed hypercholesterolemia 8-Which of ! following statements is incorrect : 12

Clinical biochemistry revision a-Hypobetalipoprotenemia is characterized by normal HDL levels b-cholesterol esters accumulates in tissues in alpha lipoprotein deficiency c-TGs accumulates in liver & intestine in type V hyperlipoproteinimia d-HDL is below normal in familial hypertriglyceridemia e-Non of ! above 9-All ! following statements are correct except : a-CM formation is diminished in hypobetalipoproteinemia b-LDL level is below normal in type IV hyperlipoproteinemia c-CM & VLDL increases in mixed hypercholesterolemia d-VLDL & LDL increases in Type IIb Hyperlipoproteneimia 10-About ! consequences of atherosclerotic plaque formation a-endothilial injury is due to release of immune factors in response to oxidized LDL b-CRP increases due to endothelial inflammation in association with atherosclerotic plaque. c-Vasoconstriction occurs due to increased AgII in response to cardiac ischemia d-Heart attack may be deposited due to continous dissolution of clots formed on ! ruptured plaques e- All of ! above f- a & b g- a only 11-Among risk factors for atherosclerosis a-Hypertension b-genetic factor c-obesity d-fat rich diet e-All of ! above 12-All ! following statements are correct about primary hyperlipidemia except : a-caused by inherited defect of lipoprotein metabolism b-predisposed by genetic factors c-classified according to ! type of enzyme or receptor defected d- familial hypercholesterolemia is due to mutation in LDL receptor gene e- dietary control is a major factor in reducing elevated lipoprotein levels 13-2ry hyperlipidemia is caused by all ! following except: a-diabetes mellitus b-Graves disease c-nephrotic syndrome d-hypothyroidism 14-Which statement is incorrect : a-cholesterol rise in type IV hyperlipoproteinemia is due to increase in VLDL b-LDL & HDL is below normal in familial hypobetalipoproteinemia c-HDL deficiency occurs in Tangier disease d- Apo E abnormality leads to broad beta disease 15-Among risk factors for coronary heart disease : a-LDL b-CRP c-Homocysteine d-elevated TG e- ALL f- all except e 16-Which statement is correct : a- Blood homocysteine levels increase in vit B6 deficiency b- CRP level decreases by administration of statins c- CRP level is high in obesity d- elevated CRP indicates a higher risk for heart attack even in people with normal cholesterol levels e all of ! above 17- C-reactive protein level is elevated in : a- hypertension b-diabetes type II c-atherosclerosis e-insulin resistance f-inflammatory disorders g-All of ! above 18-Plasma appearance after standing is homogenously lipemic (turbid) due to : a- elevated VLDL alone b-elevated LDL & VLDL c-elevated CM & VLDL d- all e-all except c f-all except b 19-2ry hyperlipedemia occurs in hypothyroidism due to : a-thyroxine negatively affects ! uptake of LDL b-thyroxine stimulates synthesis of apoproteins c- T4 positevely affect ! interaction between LDL & LDL receptor d- decrease thyroxine leads to decreased hepatic uptake of LDL e- c & d f- c only 20- 2ry hyperlipedemia occurs in diabetes due to : 13

Clinical biochemistry revision a-glycosylation of LDL receptor b- increased synthesis of LDL c-increased interaction between LDL & LDL receptors d- insulin resistance secondarily increase uptake of LDL e-Non of ! above 21-Combined hypertriglyceridemia & hypercholesterolemia.is observed in :

a-type IIb hyperlipoproteinemia c-Type III hyperlipoproteinemia e- all f-all except d

b-type V hyperlipoproteinemia d-Type I hyperlipoproteinemia g- b & c

22--lipoprtotein deficiency is characterized by all ! following except: a-very low plasma apoA-1 levels which results from increased its rate of catabolism. b-Only traces of HDL are present in plasma c-VLDL slightly decrease d-excessive phagocytosis of abnormal chylomicrons & VLDL remnants due apo A1 deficiency. 23- About Familial hypobetalipoproteinemia,which statement is incorrect: a-Chylomicron formation occurs but VLDL slightly decreases b-LDL decrease markedly while HDL is normal c- !synthesis of Apo B is decreased d-! patient fails to thrive 24-! incidence of atherosclerosis is apparently not striking in :

a- a-type II hyperlipoproteinemia c-Type III hyperlipoproteinemia

b-type V hyperlipoproteinemia d-Type I hyperlipoproteinemia

25-xanthelasma is characteristic sign for : a-hyperbetalipoproteinema b-hyperbeta-, and hyerprebetalipoproteinemia c-Familial hypercholestelolemia d-Type II hyperlipoprotenemia e-any of ! above 26-! Following enzymes are important in lipoprotein metabolism : a-LCAT b-LPL c-Hepatic lipase e-Hormone sensitive lipase d-CETP e-ALL

II-Mark true or false

1-! harmful imbalance of high TGs with low HDL levels is associated with obesity 2-Eruptive xanthomas are characteristic of hypercholesterolemia 3-Plasma appearance is grossly lipemic in Familial hypercylomicronaemia 4-Recurrent episodes of pancreatitis are common in Type I hyperlipoproteinaemia : 5-Type IIa hyperlipoproteinemia characterized by elevated LDL cholesterol with normal triglycerides. 6-! in lipoprotein remnant leads to xanthomas and atherosclerosis of both peripheral and coronary arteries 7-Type IV hyperlipoproteinemia is secondary alcoholism, steroid therapy 8-In type II hyperlipoproteinemia there is an increased incidence of glucose intolerance & hyperuricemia. 9-Xanthomas are frequent in hyperchylomicronemia wz hyper-prebeta lipoproteinamia & ! incidence of atherosclerosis is apparently striking. 10-lipoprotein lipase (LPL) synthesis is activated by insulin, so LPL deficiencies leading to Type I hyperlipoproteinemia as a secondary outcome of diabetes mellitus. 11-chylomicrons, VLDL, IDL & LDL are absent in plasma in Familial hypobetalipoproteinemia 12- A significant elevation in total cholesterol is usually associated with increased HDL. 13-A significant elevation in triglycerides is usually associated with increased VLDL or presence of chylomicrons. . 14- Elevation of CRP is also associated with hypertension, insulin resistance (type II diabetes), and obesity. 15- Tangier disease is associated wz increased incidence of atherosclerosis 16- Type I hyperlipoproteinaemia on standing overnight at 4'C develops creamy layer on ! top 14

Clinical biochemistry revision 17 -exogenous hypertriglyceridemia is characterized by Recurrent episodes of pancreatitis

18-HDL prevents LDL oxidation so HDL acts as antioxidant

III-Write short notes on ! following statements:

1-Hypercholesterolemia & increased risk of atherosclerosis associated are with uncontrolled diabetes or hypothyroidism & nephrotic syndrome (2006) 2-FH is an inherited disorder comprising 4 different classes of mutation in !LDL receptor gene 3-How do cholesterol & other lipids and lipoproteins affect ! heart (mechanism of atherosclerosis) 4-Elevated plasma triglycerides may be troublemakers for the heart 5-Factors suggesting inflammation in ! arteries are proving to demonstrate a higher risk for CHD, even in people wz abnormal lipids . 6-plasma appearance can differentiate between type IIa & typer IIb hyperlipoprotenemia 7-Broad beta disease Answers 1 6 11 16 21 26 2 7 12 17 22 3 8 13 18 23 4 9 14 19 24 5 10 15 20 25

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Disorders of Ca & Mg & PO4 metabolism I-Choose ! most correct answer:

1-All of ! following are characteristics of pseudohypoparathyroidism except : a-hypocalcemia b-hyper phosphatemia c-PTH is high d-Non of ! above 2-All ! following statements are true about 2ry hyperparathyroidism except: a- caused by any condition which leads to chronic hypocalcaemia b- occurs due to vitamin D renal failure c-easily differentiated from 1ry & 3ry hyperparathyroidism as ! serum Ca is low d-on long standing hypocalcemia is converted to 1ry hyperparathyroidism 3-Which statement is incorrect : a-in 1ry hyperthyroidism ,hypercalcemia & hypophosphatemia occurs b-steroid suppression test ,suppress elevated Ca level in malignancy c-Hypercholeremic acidosis is observed in hyperparathyroidism d- serum gamma globulin level is suppressed in malignancy e-Non of ! above 4-In differential diagnosis of hypercalcaemia due to malignant tumors ,which statement is not true a- serum bences jones protein is diagnostic for multiple myeloma b- suppressed 2 globulin levels is due to immunosuppresiion in malignancy c-increased urine monoclonal proteins diagnostic for multiple myeloma d-serum PTH is inappropriately high e- All of ! above 5-1ry hyperparathyroidism is characterized by : 15

Clinical biochemistry revision a- inappropriately high serum PTH for ! decreased serum Ca b-Hypocholerimic alkalosis c-hyperphosphatemia d- serum Ca is not suppressed by steroid administration 6-Which statement is correct : a-increased l- & 2-globulins is diagnostic for acute phase reaction that often present wz malignancy. b-negative steroid suppression test is diagnostic for hypercalcemia due to 1ry hyperparathyroidism c-increased serum paraproteins is diagnostic for multiple myeloma d- all of ! above 7-Hypocalcemia & hyperphosphatemia occurs in : a-3ry hyperparathyroidism b-2ry hyperparathyroidism c-1ry hyperparathyroidism d-all of ! above e-all exept c 8-All ! following statement are true about pagets disease except: a- It is disease of ! older subjects. b-Raised serum ALP c- Normal serum calcium & phosphate d-affects ! entire skeleton 9-Osteomalicia is characterized by all ! following except a-! reduction in ! amount of bony tissue relative to !volume of anatomical bone b-Vit D defeicency c. low serum calcium. d Low serum phosphate e-non of ! above 10-All ! following statement are true about osteoporosis except: a-occurs in Severe thyrotoxicosis b- It is ! reduction in ! mineralization of previously formed bony tissue in adults c-occurs 2ry to Cushing's syndrome d-occurs due to hyperparathyroidism due to increased bone resorption e-postmenopausal women are at high risk for developing it 11- All ! following statement are not true about Vitamin D resistance except : a-occurs due to Inadequate exposure to sunlight b- Dietary deficiency is a causative factor c-occurs in chronic liver diseases & vit D dependent rickets d-leads to marked hyperphosphatemia 12-Among biochemical findings in hypoparathyroidism

a-low serum Ca

b-undetectable PTH

c-hyperphosphatemia

d- All

13-differentiatial diagnosis between hypoparathyroidism & pseudo hypoparathyroidism a- serum PTH is high in pseudo hypoparathyroidism b-serum Ca is low in both c-serum phosphate is elevated in pseudo hypoparathyroidism but decrease in hypoparathyroidism d- Non of ! above is true 14- differential diagnosis between 1ry hyperparathyroidism & 3ry hyperparathyroidism a-pateint history of previous hypocalcemia is diagnostic for 3ry hyperparathyroidism b-PTH is high in both c- serum Ca is high in both d-All of ! above 15-pateint wz total Ca of 2 mmol/L & albumin level of 50 g/L so ! corrected total Ca is equal to a- 1.8 mmol/L b- 2.2 mmol/L c-2.4 mol/L d-Non of ! above 16- pateint wz total Ca of 2 mmol/L & albumin level of 30 g/L so ! corrected total Ca is equal to 16

Clinical biochemistry revision a- a- 1.8 mmol/L b- 2.2 mmol/L c-2.4 mol/L d-Non of ! above 17-HyperCalecmia & Hypophosphatemia wz inappropriately high PTH is diagnostic for a-Malignancy b-2ry hyperparathyroidism c-1ry hypepararthyroidism dthyrotoxicosis 18-Hypercalcemia in ! precence pf undetectable of PTH excludes : a- Malignancy b-2ry hyperparathyroidism c-1ry hypepararthyroidism d-thyrotoxicosis e-b&c 19-Hypocalcemia may be due to a-acute pancreatitis b-Acidosis d-Hyperparathyroidism c-Vit D intoxication 20- Among causes of primary osteoporosis : a-Cushing syndrome b-alcoholism c- hyperthyroidism d-bone metastasis e-all of ! above f-Non of ! above

II-Mark true or false

12345Total calcium should always be corrected for ! albumin changes When albumin concentration decrease ,! Corrected Ca is lower than ! measured total Ca In familial hypocalciuric hypercalcemia ,PTH level is low due to elevated serum Ca Positive steroid suppression test is confirmatory in ! diagnosis of hypercalcemia due to malignancy In Chronic liver diseases ,osteomalicia may occur due to Impaired production of active vitamin D metabolites 6- In pagets disease ,ALP is markedly high & hypercalcemia is observed 7- Hypermagnesemia & hypophosphatemia occurs in renal failure 8- Calcitonin inhibits bone resorption so its action is antagonistic to PTH action on bone 9- Hyperthyroidism can lead to osteoporosis due to increased bone turn over rate 10- Tetany may be observed in Ca or Mg deficiency 11- Increased serum paraprotein & urine bence jones protein is characteristic for multiple myeloma 12- Hypocholerimic alkalosis occurs in 1ry hyperparathyroidism 13- Parentral nutrition with insulin and glucose for treatment of diabetic coma leads to hypophosphataemia & hyperkalemia 14- primary hyperaldosteronism leads to hypokalemia & hypomagnesemia 15- Hypoparathroidism leads to hypocalcemia & hypophosphatemia 16- In osteoporosis ! volume of bony tissue relative to ! volume of anatomical bone is generally normal or even increased

III-Write short notes on ! following statements:

1- diagnosis of hypercalcaemia due to malignant tumors (2006) 2-Severe thyrotoxicosis leads to hypercalcemia 3-differentil diagnosis between 1ry & 3ry hyperparathyroidism 4-Parentral nutrition with insulin and glucose for treatment of diabetic coma leads to hypophosphataemia 5-Factors that lead to Vitamin D resistance 6-types of hyperparathyroidism 7-differentil diagnosis between 1ry & 3ry hyperparathyroidism 8-Outline ! biochemical defect in ! following diseases : a-Osteoporosis b-osteomalicia c-Pagets disease d-Fanconis syndrome e-Pseudohypoparathyroidism

Answers 17

Clinical biochemistry revision 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

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Organize your informations

1) Hypercalcaemia associated with hypophosphataemia a. Primary hyperparathyroidism: b. Tertiary hyperparathyroidism: 2)Hypercalcaemia associated with hyperphosphataemia hypercalcemia due to malignancy 3)Hypocalcaemia associated with hypophosphataemia 2ry hyperparathyroidism 4)Hypocalcaemia associated with hyperphosphataemia 1ry hypoparathyroidism or Pseudo-hypoparathyroidism

Disorders of ! Endocrine system

I-Mark true or false
1- Insulin stress test is carried out when hypopituitarism is suspected. T F 2--Synacthen tests are used for detection of 1ry or 2ry adrenal insufficiency T F 3-Oral glucose tolerance test used to investigate ACTH response in Cushing syndrome T F 4- low dose dexamethasone suppression test are important in ! investigation of differential diagnosis of ! cause of Cushing syndrome T F 5-Elderly patients wz Pituitary Insufficiency have symptoms of LH & FSH deficiency T F 6-!GH response to stimulation requires ! Presence of sex hormones during puberty & hypogonadism T F 7--IGF-I is produced in response to GH & used for diagnosis & monitoring for treatment of acromegaly T F 8-ACTH increased in ACTH-driven Cushing disease & In secondary adrenal cortical deficiency T F 9-ACTH ,GH & prolactin secretion increase by stress T F 10-Congenital adrenal hyperplasia leads to severe hypernatraemia & hypokalaemia T F 11-Primary adrenal insufficiency is due to ! defect in ! adrenal gland & plasma ACTH is high T F 12-Failure of adrenal cortisol response in synacthen test is an index of secondary adrenocortical failure T F 13-In Cushing syndrome due to ectopic ACTH production ,in high dose dexamethazone test cortisol level is not suppressed T F 14-in Pituitary dependent Cushing syndrome Plasma ACTH normal or high T F 18

Clinical biochemistry revision 15-Urinary cortisol/creatinine ratio is high in Cushing syndrome & can used in differential diagnosis of its cause T F 16- elevated plasma TSH levels is diagnostic for Primary hypothyrodism T F 17-In T3 thyrotoxicosis total T4 is found normal but have T3 levels is high T F 18-Hypergonadotrophic hypogonadism is due to testicular deficiency in males of ovarian failure in females 19-In kallmann's syndrome both gonadotrophins or only LH, is high T F 20-In testicular feminization syndrome , androgen receptors are inactive and/or 5-reducase is deficient 21-Cushing 's syndrome can lead to Subfertiliy in females T F

II-Write short notes on ! following statements:

1-Androgen screen in women (2006) 2-Why a single blood hormone measurement may have little clinical value ? (2006) 3-Hyperprolactenemia is a complication of primary hypothyroidism
4-Total T4 concentration in serum sample doesn't always reflect metabolic status

5-Clinical presentation of Pituitary Insufficiency depends on ! age of ! patients 6-Differential diagnosis of growth hormone insufficiency 7-Factors regulating Growth hormone secretion 8- mechanisms that influence CRH secretion 9-Causes of Cushing syndrome & its differential diagnosis 10-Differential diagnosis for acromegaly 11- Differential diagnosis for 1ry & secondary adrenal insufficiency 12-Outline ! biochemical defect in ! following diseases a-Graves disease b-Conns syndrome c-Addisons disease d-Cushing syndrome e-Subfertility in women f-Hypogonadotrophic hypogonadism in males g- Congenital adrenal hyperplasia e- Acromegaly h-testicular feminization syndrome i- Isolated aldosterone deficiency
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Disorders of protein metabolism

I-Mark true or false
1-Hypoproteinemia is always due to hypoalbuminemia but hyperproteinemia is usually due to increase one or more of immunoglobulins T F 2-hypoalbuminemia is associated wz hypocalcaemia & oedema T F 3-Hemodilution lowers plasma albumin concentration but A/G ratio unaffected T F 4-! most sensitive indicator of acute phase reaction is ! rise in CRP level T F 5-An increase in ESR is accompanied by decrease in plasma fibrinogen T F 6-In cirrhosis elevation in both & -globulins & fusion of these bands due to synthesis of IgG T F 7- Transferrin & Hemopexin are type of 2 globulins T F 19

Clinical biochemistry revision 8-Mousy (musty)odour of urine is characteristic for PKU but fish smell of urine is characteristic for mypermethionenimia T F 9-CRP is increase after 24 hrs of AMI T F

II-Write short notes on ! following statements:

1-Outline ! biochemical defect in ! following diseases a-Alkaptonuria b-Phenylketonuria c-primary hyperoxaluria d-Homocysteinuria e-Cystin-lysinuria f- Hartnupdisease g-Maple serum urine disease h-Albinism 2-Nephrotic syndrome leads to oedema (2006) 3-a lady found that her napkin has dark colored urine.COMMENT (2006) (answer :write alkaptonuria) 4-Alpha 1 antitrypsin deficiency leads to emphysema 5-Overflow of filtered (low molecular mass) proteins may cause proteinuria 6-Mechanisms of proteinuria 7-Unusual smell of urine can indicate ! type of amino acid metabolic disorder 8-Write ! functions & reason for assay of ! following proteins a- 1-antitrypsin b-1-feto protein c-2-macroglobin d- C-reactive protein (CRP) e-Haptoglobin f-IgA g-IgG h-fibrinogen 9-Outline ! change in serum protein electrophoretic pattern in each of ! following a-Cirrhosis b-Acute phase reaction c-hypogammaglobulinemia d-Chronic hepatitis e-nephrotic syndrome
Answers

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13 14 15 16 Clinical enzymology

Write short notes on ! following statements:

1-Cardiac troponins & myoglobin are used as Non enzymatic indicators for AMI (2006) 2-Estimation of serum ALP activity alone is of limited value in bone disease 3-ALP level pathologically Increase in liver or bone disease,How to make differential diagnosis ? 4-GGT is sensitive but not specific indicator for liver disease 5-Clinical importance of LDH isoenzymes in diagnosis of AMI 6--Laboratory tests for acute pancreatitis 7-diagnosis of Pancreatic carcinoma 8- Difficulties in using enzymes as markers for management of cancer 9-Differential diagnosis between infective hepatitis & hepatic tumor
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Clinical biochemistry revision

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