Pretest Clinical Chemistry

COLLEGE OF MEDICAL TECHNOLOGY

CLINICAL CHEMISTRY A. CARBOHYDRATES

  _____1. Hypoglycemia comes about for various reasons and clinical clinical symptoms usually occur at blood glucose concentrations: A. AST D. ALT>CK>LDH>AST  _____104. Which of the following following enzyme patterns is correct in severe skeletal muscle muscle damage with cell necrosis: A. CK>LDH>AST>ALT C. AST>ALT>CK>LDH B. LDH>CK>ALT>AST D. ALT>CK>LDH>AST  _____105. Which of the following enzyme enzyme ratios is used for the differentiation between acute alcoholic hepatitis and acute viral hepatitis: A. GGT/AST C. AST/ALT B. LD LD/CK D. GGT/GLD  _____106. The increase in ALP is particularly marked in people of Lewis-positive blood group: A. A B. B C. AB D. O  _____107. Which enzyme decreases markedly markedly with age in men while increases with age are measured in women: A. A L P B. ALT C. AST D. CK   _____108. Alcoholism leads to increased activities of: 1. GGT 2. ALT 3. AST 4. GLD A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____109. Which of the following diseases can cause a decrease in total total ALP? 1. Pituitary dwarfism 3. Ma Malnutrition 2. Liver metastases 4. Ri Rickets A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are correct D. 1,2,3 and 4 are correct

 _____110. Which of the following migration migration patterns is correct in the anodal separation of serum ALP at an alkaline pH on cellulose acetate strip? A. placental placental ALP>liver ALP>liver ALP>bone ALP>bone ALP>intest ALP>intestinal inal ALP>bile ALP>bile duct ALP B.  bile duct ALP>liver ALP> bone ALP> intestinal ALP> placental ALP C. liver ALP>bone ALP>bone ALP> ALP> bile duct ALP> ALP> intestinal intestinal ALP> ALP> placental placental ALP D. intestinal intestinal ALP>liv ALP>liver er ALP>placent ALP>placental al ALP> bile bile duct ALP> bone ALP ALP  _____111. Which form of ALP can be differentiated on the basis of the greater inhibition inhibition of its activity activity by L-phenylalan L-phenylalanine, ine, lesser lesser inhibition inhibition by homoarginin homoargininee and its resistance to heat when heated at 65C for 10minutes? A. Placental B. liver C. bone D. bile duct  _____112. This form of ALP is thought to be a multienzyme multienzyme plasma membrane complex or a complex of the liver isoenzyme isoenzyme with lipoprotein lipoprotein X. This multiple form of ALP is found in cholestatic and metastatic liver disease even when total ALP is still normal. A. Liver ALP C. High-molecular mass ALP B. Germ cell ALP D. intestinal ALP  _____113.  _____113. This form of ALP is not normall normally y found in the serum of healthy healthy people and detect detectabl ablee in patien patients ts with with semino seminoma ma of the testes testes,, ovaria ovarian n carcin carcinoma oma,,  pituitary tumors and thymic tumors. A. Liver ALP C. High-molecular mass ALP B. Germ cell ALP D. intestinal ALP  _____114. This form of ALP is produced by the enterocytes and released released into the blood in large quantities, particularly in B and O secretors. A. Liver ALP C. High-molecular mass ALP B. Germ cell ALP D. intestinal ALP   _____11 _____115. 5. This This is a multi multiple ple ALP form which is biochemic biochemicall ally y a hetero heterodim dimer er of   placental  placental ALP and intestinal intestinal ALP. It is found in hepatocellular hepatocellular carcinoma carcinoma and renal cell carcinoma. A. Placental ALP C. Bone ALP B. Kasahara ALP D. germ cell ALP  _____116. Which of the following are inhibitors inhibitors of ALP? 1. Citrate 2. Oxalate 3. EDTA 4. Heparin A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____117. Which of the following drugs can decrease ALP activity? A. Oral contraceptives C. Valproic acid B. Allopurinol D. oxacillin  _____118. In amylase assays, assays, which of the following are measured as end products? 1. 2-chloro-4-nitrophenol 3. 4-nitrophenol 2. P-ni P-nitr trop ophe heny nyll malt maltoh ohep epta taos osid idee 4. Malt Maltot otet etra raos osee A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____119. In neonates, the amylase amylase measured consists consists only of: A. Salivary isoenzyme C. both salivary salivary and pancreatic B. Pancreatic isoenzyme D. no none of these

 _____120. Which of the following methods are used for ACE measurement? 1. Liberman 2. Neels 3. Ryan 4. Silverstein A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____121. Which of the following substrates substrates are used in in ACE measurement? 1. Benzoylglycine 3. Fu Furylacrylic acid 2. Hippuryl-histidyl-lecuine 4. Benzoyl-glycyl-glycine A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____122. An increased ACE activity is seen in: A. Sarcoidosis C. Endothelial dysfunction B. Toxic lung damage D. Hy Hypothyroidism  _____123. Which of the following can reduce/inhibit reduce/inhibit ACE activity? activity? 1. EDTA 2. Captopril 3. Enalapril 4. Zinc chelators A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____124. What is the EC number of AST? A. 2.6.1.1 B. 2.6.1.2 C. 3.1.1.7 D . 3 .1 .1 . 6  _____125. De Ritis ratio ratio for differentiation differentiation between mild mild liver damage and severe severe liver  disease is: A. GGT/ GT/AST B. AST/ALT C. AST/LD D. LD/GGT  _____126. This ratio is used used as indicator of cholestasis cholestasis and alcoholic liver damage. A. GGT/AST B. AST/ALT C. AST/LD D. LD/GGT  _____127. Which of the following methods are used for cholinesterase determination? 1. Inhibition test with dibucaine 3. Ro R o 2-0683 2. Determinati ation of fluoride num number ber 4. Photome ometric rate ate assay A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on only 2 and 4 are correct D. 1,2,3 and 4 are correct   _____12 _____128. 8. Which Which of the followi following ng chemicals chemicals is/are is/are associa associated ted with decrease decrease in cholinesterase activity? A. Muscle relaxants C. Ca Carbamate esters B. Organop Organophos hosphat phatee esters esters D. all of these  _____129. Determination of acylcholine acylcholine acylhydrolase for for evaluation of liver function is usually performed using what substrate? A. Glycine C. choline B. Phosphate D. nitroanilide   _____130. _____130. CK catalyzes catalyzes the reversible reversible transfer transfer of the phosphate phosphate group from creatine creatine  phosphate to Mg-ADP. The resulting Mg-ATP is determined in a combined optical test using what as coenzyme? A. Glucose-6-p Glucose-6-phosphat hosphatee dehydrogenas dehydrogenasee C. Hexokinase B. Oxidase D. Adenylate kinase  _____131.  _____131. A CK-MB fraction fraction of more than 6% of the total CK activity activity is regarded regarded as diagnostic for: A. Myocardial infarction C. Skeletal muscle damage B. Muscular dystrophy D. Se Secondary myopathies  _____132. Which of the following findings can indicate the presence presence of macro CK?

A. Eleva Elevated ted total total CK with with a CK-MB CK-MB fraction fraction >25% >25% B. Elevated Elevated total total CK with a CK-BB CK-BB fraction fraction >6% C. Elevated Elevated total total CK with a CK-MM CK-MM fraction fraction >5% D. Elevated Elevated total total CK with with a CK-MiMi CK-MiMi fracti fraction on >10%  _____133. The variant of CK with higher higher molecular mass formed when CK CK is bound by specific immunoglobulins: A. Macro CK type 1 C. CK-MiMi B. Macro CK type 2 D. CK C K-MT or CKMito   _____13 _____134. 4. Which Which enzyme enzyme is specifi specificc for liver liver and bile bile duct duct and an increase increase of this enzyme is considered as one of the most sensitive indicators of hepatobiliary disease? A. Cholinesterase C. CK   B. GGT D. AST  _____135. Differentiation between jaundice of hepatic or cholestatic origin can be based on ALT activity and the: A. AST/ALT ratio C. GGT/ALT ratio B. GGT/AST ratio D. AL ALT/ALP ratio  _____136.  _____136. Which enzyme enzyme is used with aminotrans aminotransferas ferases es and mean cellular cellular volume of  erythrocytes as indicators of excessive alcohol consumption? A. Cholinesterase C. GLD B. GGT D. AST  _____137. Which of the following anticoagulants may lead to falsely falsely low GGT activity? activity? 1. Citrate 2. Oxalate 3. Flouride 4. Heparin A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on o nly 2 and 4 are correct D. 1,2,3 and 4 are correct  _____138. This is the only enzyme which cleaves significant amount of gluthathione. A. Cholinesterase C. GLD B. GGT D. AST  _____139. A (ALT + AST)/GLD ratio ratio of 50 is is seen in: 1. Acute Acute episo episodes des of of chroni chronicc liver liver disea diseases ses 2. Acut Acutee vir viral al hepa hepati titi tiss 3. Choles Cholestat tatic ic hepati hepaticc diseas diseases es 4. Acut Acutee alcoh alcohol olic ic hepa hepati titi tiss A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are are correct D. 1,2,3 and 4 are correct  _____141. These reagents can be added to the LD assay mixture as a selective selective inhibitor  of the LD isoenzymes containing M sub-units so that only LD-1, which is composed of four H units, is measured. 1. Nitroanilide 3. Ro-0683 2. 1,6 hexanediol 4. Sodium perchlorate A. only 1 and 3 are correct C. only 1,2, and 3 are correct

 _____142.  _____143.   _____144. _____144.

  _____145. _____145.

 _____146.

 _____147.  _____148.

 _____149.

  _____15 _____150. 0.

 _____151.  _____151.

 _____152.

 _____153.

  _____154. _____154.

B. only 2 and 4 are are correct D. 1,2,3 and 4 are correct Which LD isoenzyme isoenzyme has the highest migration rate? A. LD1 B. LD2 C. LD4 D. LD5 In agarose gel, this Ld isoenzyme isoenzyme migrates to to the cathode: A. LD1 B. LD2 C. LD4 D. LD5 In cellulose cellulose acetate electroph electrophoresi oresiss the LD isoenzyme isoenzyme fractions fractions are made visible by coupling the enzymatically formed pyruvate with: A. NAD C. tetrazolium salt B. NA NADH D. Sodium perchlorate This ratio ratio is used to differentiate differentiate between between prehepatic prehepatic jaundice caused caused by hemolysis or dyserythropoiesis from hepatic jaundice. A. ALT/ ALT/AS AST T rat ratio io C. LD/CK ratio B. LD/AST ratio D. CK/AST ration Anodic LD isoenzyme pattern is associated associated with: 1. Muscular dystrophy 3. Re Renal infarction 2. Germ cell tumor 4. Ca Cardiac muscle damage A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on o nly 2 and 4 are correct D. 1,2,3 and 4 are correct Which anticoagulant should not be used in in LD assay? A. Oxalate B. Flouride C. both D. neither  Which of the following conditions can falsely increase increase LD measurement? A. Blood sample sample collection collection after after exercise exercise B. Use Use of capi capill llar ary y serum serum C. Use of hemoly hemolyzed zed sample sampless D. Al Alll of of the these se At a mean activity of 165U/L, hemolysis of 0.8g hb/L leads to an LD increase increase of: A. 36% B. 58% C. 360% D. 12% Which Which of the followi following ng Ld isoenzy isoenzymes mes is not seen seen mainly mainly in Duchenne Duchenne muscular dystrophy? A. LD1 B. LD2 C. LD3 D. LD5 The most reliable reliable method for lipase determinati determination on is the kinetic, kinetic, automatic automatic titration of oleic acid released from an emulsion of triolein or pure olive oil  by enzymatic hydrolysis hydrolysis with with sodium hydroxide at what pH? A. 8.6 B. 6.5 C. 9.0 D. 8.4 As ACP is released from erythrocytes, erythrocytes, a hemoglobin concentration concentration of 3.4g/L in serum may increase ACP by: A. 50% B. 40% C. 30% D. 20% ACP is unstable at pH above 7.0 and the pH of plasma or serum is adjusted adjusted to 4-5 by the addition of: A. 10% acet acetic ic acid( acid(20uL 20uL/mL /mL)) C. both B. Sodi Sodium um bisu bisulf lfat atee 5mg/ 5mg/m mL ser serum D. neit neithe her  r  Which of the following following diseases are associate associated d with elevations elevations of ACP in serum? 1. Prostatic carcinoma 3. Pa Paget’s disease 2. Multiple myeloma 4. Ga Gaucher’s disease

A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on o nly 2 and 4 are correct D. 1,2,3 and 4 are correct  _____155. Without acidification, acidification, ACP activity is decreased up to: A. 20% in 3h C. 50% in 2h B. 20 20% in 2h D. 5% in 2 h  _____156.  _____156. This protein protein participates participates in the uptake and the intracellu intracellular lar transport transport of the long-chain fatty acids in the cardiomyocytes. A. Cardiac troponin (cTnT) C. myoglobin B. Heart fatty acid binding protein(H-FABP) D. natriuretic peptide  _____157. This myofibrillar myofibrillar protein of the heart muscle muscle is released from the myocardium following injury and is used in the late diagnosis and monitoring of the course of acute myocardial infarction. A. Cardiac troponin (cTnT) C. myoglobin B. Heart fatty fatty acid binding binding protein(Hprotein(H-FABP) FABP) D. natriureti natriureticc peptide peptide  _____158.  _____158. This is a specific cardiospecif cardiospecific ic marker used to assess chronic or subacute subacute graft rejection after heart transplantation. A. Cardia Cardiacc tropon troponin in (cTn (cTnT) T) B. car cardia diacc tropon troponin in I (cT (cTnI) nI) C. Heart fatty fatty acid acid binding binding protei protein(H-F n(H-FABP) ABP) D. glycoprotei glycoprotein n phosphorylas phosphorylasee isoenzyme isoenzyme BB (GPBB) (GPBB)   _____159. _____159. This is highly sensitiv sensitivee to ischemia ischemia of cardiomyocytes cardiomyocytes so that the clinical clinical sensitivity of its measurement for diagnosing an acute coronary syndrome is higher than that of other cardiac markers. A. Cardia Cardiacc tropon troponin in (cTn (cTnT) T) B. cardia cardiacc tropon troponin in I (cTnI) (cTnI) C. Heart fatty fatty acid acid binding binding protei protein(H-F n(H-FABP) ABP) D. glyco glycoprotei protein n phosphorylas phosphorylasee isoenzyme isoenzyme BB (GPBB) (GPBB)  ______160.  ______160. This is the most important important natriuretic natriuretic peptide peptide of the ventricles ventricles and it is a more sensitive and more specific indicator of ventricular overload. A. Atrial natriuretic peptide C.  brain natriuretic peptide B. Cycl Cyclic ic guan guanos osin inee mono monoph phos osph phat atee D. CNP CNP

BILIRUBIN

  _____161. _____161.

In this method method of bilirubin determin determination, ation, unconjugated unconjugated and conjugated conjugated   bilirubin interact with a specific charged polymer called mordant and the concentrati concentrations ons of Bu and Bc are calculated from the measured reflection densit densities ies and the predet predeterm ermine ined d molar molar reflec reflectiv tiviti ities es of the two bilir bilirubi ubin n species at two wavelengths and use of simultaneous equations. A. Jendrassik-Grof C. Multi-layer film slide technology B. Enzymatic method D. Direct spectrophotometry  _____162. This enzyme is used to oxidize bilirubin to biliverdin: biliverdin: A. Bilirubin reductase C. Bilirubin oxidase B. Bilirubin diglucoronidase D. Bilirubin dehydrogenase

  _____16 _____163. 3.

Which Which of the follow following ing stateme statements nts about unconjugat unconjugated ed biliru bilirubin bin is not correct? A. It is prac practi tica call lly y inso insolu lubl blee in wate waterr at phys physio iolo logi gicc pH and and body body temperature B. In plas plasma ma,, it is presen presentt in a fold folded ed stru struct ctur uree or so-c so-cal alle led d Z-Z( Z-Z(tr tran ans) s) conformation loosely bound to albumin C. It is transpo transported rted in in plasma plasma loosely loosely bound bound to albumin albumin D. It is coval covalent ently ly bound bound to album albumin in   _____164. _____164. Which measureme measurement nt is a better better criterion criterion for the differential differential diagnosis diagnosis of   jaundice? A. Conjugated bilirubin C. Delta bilirubin B. Unconjugated bilirubin D. To T otal bilirubin   _____165. In adults and older children, hyperbilirubinemia hyperbilirubinemia causes jaundice if if bilirubin value is >2.5mg/dL, whereas in infants, jaundice is seen if bilirubin values is greater than: A. 2.5mg/dL B. 3.0mg/dL C. 3.5mg/dL D. 4.0mg/dL   ____ _____16 _166. 6. What What clas classi sifi fica cati tion on of hype hyperb rbil ilir irubi ubinem nemia ia is caus caused ed by inef ineffe fect ctiv ivee erythropoiesis? A. Prehepatic jaundice C. Posthepatic jaundice B. Intrahepatic jaundice D. no none of these  _____167.  _____167. What classificat classification ion of hyperbili hyperbilirubine rubinemia mia is caused by medication-induc medication-induced ed  parenchyma  parenchymall and cholestatic cholestatic liver damage as well as hepatic hepatic involvement involvement in other primary diseases? A. Prehepatic jaundice C. Posthepatic jaundice B. Intrahepatic jaundice D. none of these   _____16 _____168. 8. Which Which of the follow following ing conditio conditions ns are associa associated ted with unconjugat unconjugated ed hyperbilirubinemias? 1. Crigler-Najjar syndrome 3. Gilbert’s syndrome 2. Dubin-Johnson syndrome 4. Ro R otor syndrome A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are correct D. 1,2,3 and 4 are correct   ____ _____16 _169. 9. Whic Which h of the the foll follow owin ing g condi conditi tion onss are are asso associ ciat ated ed with with conju conjugat gated ed hyperbilirubinemias? 1. Crigler-Najjar syndrome 3. Gilbert’s syndrome 2. Dubin-Johnson syndrome 4. Ro R otor syndrome A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are are correct D. 1,2,3 and 4 are correct  _____170. Which of the following statements statements about bilirubin is true? A. A decline decline in unconjugated unconjugated bilirubin bilirubin is a sensiti sensitive ve indicator indicator of recovery recovery B. An increase increase in delta biliru bilirubin bin suggests suggests a protracted protracted disease disease course course C. An increase increase of conjugated conjugated biliru bilirubin bin >10% of total total bilirubi bilirubin n suggest a hepatogenic cause D. In the differenti differentiation ation of prehepati prehepaticc to hepatic jaundice, jaundice, a LD/AST LD/AST ratio ratio of >2 is suggestive of hemolytic jaundice.  _____171. Per gram of degraded hemoglobin, how much bilirubin bilirubin is produced? produced? A. 3mg B. 15mg C. 34mg D. 51mg

 _____172. Approximately how much bilirubin bilirubin are synthesized synthesized daily due to physiological  breakdown of blood? A. 10 100mg B. 150mg C. 200mg D. 250mg  _____173. The normal daily urobilinogen excretion in the urine is: A. 1-2mg B. 2-4mg C. 5-10mg D. 1gm  _____174. What is the half-life of delta bilirubin? bilirubin? A. 2 days B. 8 days C. 12 days D. 18 days   ____ _____17 _175. 5. This This is used used to indu induce ce a rise rise of uncon unconju juga gate ted d bili biliru rubi bin n by acti activat vatin ing g hemoxygenase and increase spleenic unconjugated bilirubin production. A.  Nicotinic acid C. sulfobromophthalein B. Trichloroethylene D. dichlorobenzol  _____176. This is a laboratory laboratory evaluation system for severity of cirrhosis. cirrhosis. A. Sulfobromophthalein C. Nicotinic acid test B. Child-Pugh D. Fasting   _____177. _____177. This chronic chronic form of conjugated hyperbili hyperbilirubine rubinemias mias is characterized characterized by deficient leukotriene elimination into the bile and therefore leukotrienes are excreted renally. A. Crigler-Najjar syndrome C. Gi G ilbert’s syndrome B. Dubin-Johnson syndrome D. Rotor syndrome  _____178. In case of intensive sun irradiation, bilirubin values decreases by up to: A. 10% 10% aaft fter er 1 hou hour  r  C. 30% after after 1 hour  B. 20% after 1 hour d. 50 50% after 1 hour    _____179. Bilirubin at room temperature, temperature, protected from light exposure is stable for: A. 1 day B. 2 days C. 3 days D. 4 days  _____180. Which bilirubin is measured to assess success following invasive invasive measures to remove cholestasis? A. Conjugated bilirubin C. Delta bilirubin B. Unconjugated bilirubin D. To T otal bilirubin ELECTROLYTES

 _____181. Which of the following statements about serum calcium is not correct? A. Free or ionized ionized calcium calcium account accountss for 50% of total total calcium calcium B. Prot Protein ein bound calcium calcium most most of which which is bound to to globulins globulins with only only small portion bound to albumin. C. Complex-boun Complex-bound d calcium calcium is bound bound to phosphat phosphates, es, citrate citrate and and  bicarbonate. D. The protein-bou protein-bound nd calcium calcium accounts for for 45% of the total total calcium. calcium.  _____182. Acidosis or a pH decrease, decrease, after the blood sample has been collected, collected, causes a rise in ionized calcium because of the metabolic activity of the blood cells, a  pH decrease by 0.1 leads to a reciprocal increase of ionized calcium by approximately: A. 0.05mmol/L C. 0.15mmol/L B. 0.10mmol/L D. 0.20mmol/L

  _____183. _____183. Alkalosis Alkalosis or a rise in pH, after the blood collection collection,, causes a decrease in ionized calcium due to the elimination of: A. Oxygen C. Carbon dioxide B. Hy Hydrogen D. Chloride  _____184. This term refers to to a state with serum total total calcium concentration of typically typically >14 mg/dL mg/dL that that is associ associate ated d with with sympt symptoms oms such such as volume volume deplet depletion ion,, metabolic metabolic encephalopathy encephalopathy and gastroint gastrointestin estinal al symptoms symptoms.. As soon as the hypercalcemia has been eliminated, the symptoms disappear. A. Primary Primary hyperparat hyperparathyroi hyroidism dism B. familial familial hypocalcemur hypocalcemuric ic hypercalce hypercalcemia mia C. hyp hyperc ercalc alcemi emicc cri crisis sis D. Milk-a Milk-alka lkali li syndro syndrome me   _____185. _____185. Pseudohypopa Pseudohypoparathy rathyroidi roidism sm represents represents a group of states with end-organ end-organ resi esistan stance ce to PTH. Which hich of the the foll ollowi owing stat tatemen ementts abou aboutt  pseudohypoparathyroidism is not correct? A. In type 1a, 1a, the gene that that encodes encodes the G protein protein is defectiv defectivee B. In type type 1b, the PTH PTH receptor receptor is defectiv defective. e. C. In type 2, the urinary urinary excreti excretion on of cAMP is increased increased in these these patients. patients. D. Type Type 1 is charac characte teri rized zed by a defe defect ct at a locu locuss befo before re the synthe synthesi siss of  cAMP while type 2 is associated with a defect at a locus beyond the synthesis of cAMP.  _____186. Which of the following diseases may cause hypercalcemia? hypercalcemia? A. Liver cirrhosis C. ch chornic renal failure B. Addison’s disease D. acute pancreatitis  _____187. Which of the following diseases may cause hypocalcemia? A. Pseudohypoparathyroidism C. Sarcoidosis B. Multiple myeloma D. Pr Primary hyperparathyroidism   _____18 _____188. 8. Which Which formula formula is correc correctt when adjusti adjusting ng total calcium calcium if the albumin albumin concentration is 4g/dL? A. Correc Corrected ted calcium( calcium(mg/dL) mg/dL) = measured measured Ca (mg/dL (mg/dL)-alb )-albumin( umin(g/dL) g/dL) + 4.0 B. Corrected Corrected calcium(mg calcium(mg/dL) /dL) = albumin(g/ albumin(g/dL) dL) - measured measured Ca (mg/dL) (mg/dL) + 4.0 C. Corrected Corrected calcium calcium(mg/dL (mg/dL)) = measured measured Ca (mg/dL) (mg/dL)+album +albumin(g/ in(g/dL) dL) / 4.0 D. Corrected Corrected calcium(m calcium(mg/dL) g/dL) = measur measured ed Ca (mg/dL) (mg/dL)-album -albumin(g/ in(g/dL) dL) / 4.0   _____189. _____189. How much increase increase in total calcium calcium is anticipat anticipated ed in the case of a change from supine to a standing position? A. 4.6% B. 1.7% C. 12% D. 5.4%  _____190.  _____190. How much increase increase in ionized calcium calcium is anticipated anticipated in the case of a change from supine to a standing position? A. 4. 4.6% B. 1.7% C. 12% D. 5.4%  _____191. Which of the following enzymes are used for phosphate measurement? 1. Purine-nucleoside phosphorylase 3. Sucrose phosphorylase 2. Xanthine oxidase 4. Phosphoglucomutase A. only 1 and 3 are correct B. on o nly 2 and 4 are correct

C. only 1,2, and 3 are correct D. 1,2,3 and 4 are correct

 _____192. What is the molar ratio of HPO4/H2PO4? A. 1:1 B. 1:2 C. 1:3 D. 1:4  _____193. Which of the following conditions are associated with hypophosphatemia? 1. Bodybuilding 3. On Oncogenic osteomalacia 2. Alcoholism 4. Diabetic ketoacidosis A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on o nly 2 and 4 are correct D. 1,2,3 and 4 are correct  _____194.  _____194. In the phosphate clearance clearance test, the interval interval time for collection collection of two urine and blood samples is: A. 30 mi mins B. 60 mins C. 90 mins D. 120 mins  _____195. The percentage tubular reabsorption of phosphate, TRF%, TRF%, is a test identical to the determination of the phosphate clearance but in addition this substance is measured in urine and serum: A. In Inulin B. Urea C. Creatinine D. Macroglobulin   _____19 _____196. 6. This This is also called called the renal phosphor phosphorous ous threshol threshold d which which descri describes bes the maximal maximal phosphate phosphate concentrati concentration on in the glomerular filtrate filtrate below which all of the filtered phosphate is reabsorbed in the tubules. A. TRF% C. TmP B. Ccr  D. C p  _____197. Transcellular fluid constitutes constitutes how much percentage of the total body water? A. 7.5% B. 15% C. 20% D. 45%  _____198. Interstitial fluid fluid constitutes how much percentage of the total body water? A. 7.5% B. 15% C. 20% D. 45%  _____199. The extracellular fluid fluid volume is directly dependent on total total body: A. Sodium B. Phosphate C. Calcium D. Potassium  _____200.  _____200. The regulatory regulatory systems systems of the water balance between between the ICF and ECF also referred to as tonicity are: 1. ADH concentration in plasma 3. Renal capacity 2. Thirst and water intake 4. Urea concentration in plasma A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. only 2 and 4 are correct D. 1,2,3 and 4 are correct  _____201.  _____201. An ECFV decline decline by >5% causes a reversible reversible decrease decrease in renal blood flow. This results in: 1. The The redu reduct ctio ion n of GFR  GFR  2. Increa Increase se in in the the secre secreti tion on of ADH 3. The activati activation on of the the rennin-an rennin-angioten giotensin-a sin-aldost ldosterone erone syste system m 4. A rise rise in in the filtra filtratio tion n fract fraction ion.. A. only 1 and 3 are correct C. only 1,2, and 3 are correct B. on o nly 2 and 4 are correct D. 1,2,3 and 4 are correct  _____202. Prerenal acute renal renal failure is associated with: 1. Oliguria Oliguria and and a urine urine osmolali osmolality ty of >600mosmol/k >600mosmol/kg g water  water  2. A disproport disproportional ional increas increasee of urea as compared compared to creati creatinine nine in plasma plasma 3. A urinar urinary y sodium sodium concen concentra trati tion on of 20 mmol/L. D. All of thes thesee are are correc correctt  ______215. This is a test for the determination of the excreted fraction of glomerularly glomerularly filtered sodium and is a measure for the tubular absorption of sodium and an effective test for the differential diagnosis of acute, oliguric renal failure. A. Anion gap C. urine pH B. Fractional excretion of sodium D. Sodium-selective ISE  ______216. In hyperkalemia, hyperkalemia, a potassium excretion: A. > 40 mmol/L mmol/L is indicat indicative ive of a renal cause B. < 40 mmol/ mmol/L L is indicat indicative ive of extrarenal extrarenal cause cause C. > 40 mmol/ mmol/L L is indicat indicative ive of extrar extrarenal enal cause cause D. < 40 mmol/L mmol/L is indicativ indicativee of renal and extrar extrarenal enal cause cause  ______217. Which of the following is associated with Type IV RTA? A. Plas Plasma ma potassium: potassium: > 5.5, anion anion gap in urine positive, positive, urine urine pH: normal normal,, anion anion gap in urine urine positive positive,, urine pH: >5.5 C. Plasma Plasma potassium: potassium: normal normal,, anion gap in in urine negative negative,, urine pH: >5.5 >5.5 D. Plasma Plasma potassium: potassium: normal, normal, anion anion gap in urine positiv positive, e, urine pH: 5.5, anion anion gap in urine positive positive,, urine pH: 5.5 C. Plasma Plasma potassium: potassium: normal normal,, anion gap in in urine negative negative,, urine pH: >5.5 >5.5 D. Plasma Plasma potassium: potassium: normal, normal, anion anion gap in urine positiv positive, e, urine pH: 5.5, anion anion gap in urine positive positive,, urine pH: 5.5 C. Plas Plasma ma potassium: potassium: normal normal,, anion gap in in urine negative negative,, urine pH: >5.5 >5.5 D. Plasma Plasma potassium: potassium: normal, normal, anion anion gap in urine positiv positive, e, urine pH: 5.5, anion anion gap in urine positive positive,, urine pH: 5.5 C. Plasma Plasma potassium: potassium: normal normal,, anion gap in in urine negative negative,, urine pH: >5.5 >5.5 D. Plas Plasma ma potassium: potassium: normal, normal, anion anion gap in urine positiv positive, e, urine pH: