GROUP 1

Leader:
Princess Jane B. Sulite

Members:
Amelia May Adlaon
Roanne Jane Bugas
Joshfil Harry Edulsora
Anthony M. Fullo II
Charlie Sheen Ganohay
 Clinical Chemistry 2
Set A

ITEM
QUESTIONS RATIONALE PAGE #
#
A 55-year-old man presents with chest pain. Labs:
CK 480 U/L (ref 38–174), CK-MB 38 U/L (ref 0–
25), Troponin I 0.02 ng/mL (ref 0–0.04). What is
the MOST likely interpretation?
1
A. Acute MI within 6 hours
B. Skeletal muscle injury
C. Recent MI (>48 h)
D. Lab error
A patient with jaundice shows: AST 140 U/L, ALT
85 U/L, ALP 450 U/L, GGT 450 U/L. Most likely
cause?
2 A. Hepatocellular injury
B. Cholestasis
C. Bone disease
D. Pancreatitis
A patient with suspected macroamylasemia has
serum amylase 250 U/L, urine amylase normal.
Which mechanism explains this?
3 A. Amylase bound to Ig → impaired renal excretion
B. Amylase isoenzyme lost in urine
C. Pancreatic overproduction
D. Amylase inhibitor present
LDH isoenzymes: LDH-1 > LDH-2. Best
interpretation?
A. Hepatocellular injury
4
B. Myocardial infarction
C. Skeletal muscle injury
D. Hemolysis artifact
CK-MB rises at 6 hours, peaks at 24 hours, returns
to baseline 48 hours. Which other marker peaks
later and stays elevated longer?
5 A. Troponin I
B. CK-MM
C. LDH-5
D. AST
A 60-year-old alcoholic shows AST 120, ALT 55,
AST/ALT ratio 2.2. What enzyme pattern is
characteristic?
6 A. AST > ALT, >2 → alcoholic hepatitis
B. ALT > AST → viral hepatitis
C. ALP dominant → cholestasis
D. LDH dominant → hemolysis
Amylase vs lipase in pancreatitis: which is more
specific and why?
A. Lipase; produced only by pancreas
7
B. Amylase; rises faster
C. Lipase; kidney clears slower
D. Amylase; rises higher
Which coenzyme is essential for aminotransferase
reactions?
A. Pyridoxal phosphate
8
B. NAD+
C. CoA
D. Biotin
 A patient has elevated ALP but normal GGT. Likely
source?
A. Liver
9
B. Bone
C. Pancreas
D. Kidney
Which enzyme is measured via NADH absorbance
change at 340 nm?
A. ALT
10
B. ALP
C. Amylase
D. CK
Serum sodium = 125 mmol/L, hyperlipidemia
present. Most likely explanation?
A. True hyponatremia
11
B. Pseudohyponatremia
C. Hypernatremia
D. Lab error
Serum K+ = 6.2 mmol/L. ECG: peaked T waves.
Patient has oliguria. Most likely cause?
A. Hyperaldosteronism
12
B. Renal failure
C. Vomiting
D. Diuretics
Which electrolyte is MOST responsible for resting
membrane potential?
A. Na+
13
B. K+
C. Ca2+
D. Mg2+
Corrected calcium formula for low albumin:
Ca_corrected = Ca_measured + 0.8*(4 – albumin
g/dL)
If Ca = 7.8 mg/dL, albumin = 2.5 g/dL,
14 Ca_corrected = ?
A. 8.9 mg/dL
B. 7.8 mg/dL
C. 9.6 mg/dL
D. 8.0 mg/dL
Hyperphosphatemia and hypocalcemia are MOST
likely caused by:
A. Hypoparathyroidism
15
B. Renal failure
C. Vitamin D deficiency
D. Hyperthyroidism
A patient presents with tetany, Chvostek sign
positive. Likely lab finding?
A. Hyperkalemia
16
B. Hypocalcemia
C. Hypernatremia
D. Hypermagnesemia
Patient with diarrhea and vomiting shows Na+ 135,
K+ 3.1, Cl- 100, HCO₃ 18. Acid-base disorder?
A. Metabolic acidosis, normal anion gap
17
B. Metabolic acidosis, high anion gap
C. Metabolic alkalosis
D. Respiratory alkalosis
Major intracellular cation?
18 A. Na+
B. K+
 C. Ca2+
D. Cl-
Which hormone increases renal Na+ reabsorption?
A. ADH
19 B. Aldosterone
C. Cortisol
D. PTH
Magnesium deficiency may cause:
A. Hypocalcemia
20 B. Hypercalcemia
C. Hypernatremia
D. Hyperphosphatemia
ABG: pH 7.28, pCO₂ 50 mmHg, HCO₃ 24.
Interpretation?
A. Respiratory acidosis
21
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
ABG: pH 7.50, pCO₂ 30 mmHg, HCO₃ 24.
Interpretation?
A. Respiratory alkalosis
22
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Metabolic acidosis with high anion gap is seen in:
A. Diarrhea
23 B. DKA
C. Renal tubular acidosis
D. Vomiting
Normal anion gap: 8–16 mmol/L. Formula?
A. Na – (Cl + HCO₃)
24 B. Na + K – Cl
C. Cl – HCO₃
D. Na – K
Base excess reflects:
A. Respiratory compensation
25 B. Metabolic component
C. Oxygenation
D. Hemoglobin binding
Lactic acidosis, ketoacidosis, renal failure → anion
gap?
A. Increased
26
B. Decreased
C. Normal
D. Variable
Primary renal compensation for chronic respiratory
acidosis:
A. Increase HCO₃ reabsorption
27
B. Increase pCO₂
C. Decrease HCO₃
D. Increase Cl–
Vomiting → metabolic alkalosis. Mechanism?
A. Loss of H+ from stomach
28 B. Loss of HCO₃
C. K+ retention
D. Renal failure
Hyperventilation → pH ↑. Mechanism?
29 A. ↓ pCO₂
B. ↑ HCO₃
 C. ↑ Cl-
D. ↑ K+
Phosphate buffer system is more effective in:
A. Intracellular fluid
30 B. Extracellular fluid
C. Plasma
D. Lung alveoli
Colon cancer monitoring: most useful marker?
A. CEA
31 B. AFP
C. CA 19-9
D. CA-125
Liver cancer in adult male: elevated AFP = ?
A. Hepatocellular carcinoma
32 B. Hepatitis
C. Colon cancer
D. Lung cancer
CA 125 elevated in:
A. Ovarian cancer
33 B. Breast cancer
C. Colon cancer
D. Thyroid cancer
PSA after prostatectomy rises: likely cause?
A. Recurrence
34 B. Normal fluctuation
C. Lab error
D. Infection only
CEA may rise falsely in:
A. Smokers
35 B. Non-smokers
C. Pregnancy
D. Hyperthyroidism
Beta-hCG high in male: likely tumor?
A. Testicular germ cell
36 B. Liver carcinoma
C. Lung carcinoma
D. Colon carcinoma
Calcitonin elevated in:
A. Medullary thyroid carcinoma
37 B. Papillary thyroid carcinoma
C. Follicular thyroid carcinoma
D. Anaplastic thyroid carcinoma
CA 19-9 high: common in:
A. Pancreatic cancer
38 B. Ovarian cancer
C. Prostate cancer
D. Lung cancer
Tumor markers are BEST used for:
A. Monitoring treatment
39 B. Screening general population
C. Diagnosis alone
D. Staging only
AFP is normally elevated in:
A. Pregnancy
40 B. Men
C. Elderly women
D. Children
Primary hypothyroidism labs:
41 A. ↑TSH, ↓T4
B. ↓TSH, ↑T4
 C. ↑TSH, ↑T4
D. ↓TSH, ↓T4
Graves disease: expected lab pattern?
A. ↓TSH, ↑T4/T3
42 B. ↑TSH, ↑T4/T3
C. ↑TSH, ↓T4/T3
D. ↓TSH, ↓T4/T3
Addison disease labs:
A. ↓Cortisol, ↑ACTH, ↑K+, ↓Na+
43 B. ↑Cortisol, ↓ACTH
C. ↓Cortisol, ↓ACTH
D. ↑Cortisol, ↑ACTH
Cushing syndrome labs:
A. ↑Cortisol
44 B. ↓Cortisol
C. ↑ACTH only
D. ↓ACTH only
Long-term glucose control:
A. Fasting glucose
45 B. OGTT
C. HbA1c
D. Random glucose
HbA1c 8.5% → approximate average glucose?
A. 120 mg/dL
B. 180 mg/dL
46
C. 200 mg/dL
D. 220 mg/dL
(Use formula: Avg glucose ≈ 28.7 × HbA1c – 46.7)
Excess GH in adults → diagnosis?
A. Acromegaly
47 B. Gigantism
C. Cretinism
D. Dwarfism
ADH deficiency → which lab abnormality?
A. Polyuria, hypernatremia
48 B. Oliguria, hyponatremia
C. Polyuria, hyponatremia
D. Oliguria, hyperkalemia
PTH effect on kidney:
A. ↑Ca reabsorption, ↓PO₄ reabsorption
49 B. ↓Ca reabsorption, ↑PO₄ reabsorption
C. ↑Ca and PO₄ reabsorption
D. ↓Ca and PO₄ reabsorption
Fasting glucose = 140 mg/dL → diagnosis?
A. Normal
50 B. Prediabetes
C. Diabetes mellitus
D. Lab error
A patient presents with severe muscle trauma after
an accident. Which enzyme would MOST likely
show the highest elevation?
51 A. CK
B. ALT
C. ALP
D. Amylase
Which CK isoenzyme is primarily found in skeletal
muscle?
52
A. CK-BB
B. CK-MB
 C. CK-MM
D. CK-MB2
In myocardial infarction, CK-MB typically peaks at:
A. 2–4 hours
53 B. 12–24 hours
C. 36–48 hours
D. 72 hours
Which enzyme remains elevated the longest after
myocardial infarction?
A. CK-MB
54
B. Troponin I
C. AST
D. LDH
AST is present in high concentrations in all
EXCEPT:
A. Liver
55
B. Heart
C. Kidney
D. Pancreas
Which enzyme is inhibited by fluoride in blood
collection tubes?
A. Amylase
56
B. CK
C. Enolase
D. ALT
Which enzyme assay method monitors change in
absorbance of NADH at 340 nm?
A. Fluorometric method
57
B. Kinetic UV method
C. Immunoassay
D. Turbidimetric assay
A patient with obstructive jaundice would most
likely have elevated:
A. AST and ALT only
58
B. ALP and GGT
C. CK and LDH
D. Amylase only
Which enzyme is responsible for converting
creatine phosphate to creatine?
A. CK
59
B. AST
C. ALT
D. LDH
Lipase is produced primarily by the:
A. Liver
60 B. Pancreas
C. Small intestine
D. Stomach
The reference interval for serum sodium is
approximately:
A. 120–130 mmol/L
61
B. 135–145 mmol/L
C. 145–155 mmol/L
D. 150–165 mmol/L
Which electrolyte imbalance is commonly seen in
diabetic ketoacidosis?
A. Hyperkalemia
62
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
 The major function of potassium in cells is:
A. Bone formation
63 B. Maintenance of membrane potential
C. Oxygen transport
D. Blood clotting
Which condition commonly causes hypokalemia?
A. Renal failure
64 B. Diuretic therapy
C. Addison disease
D. Hemolysis
Ionized calcium represents approximately:
A. 10% of total calcium
65 B. 25% of total calcium
C. 50% of total calcium
D. 75% of total calcium
Hypermagnesemia is MOST commonly associated
with:
A. Renal failure
66
B. Hyperthyroidism
C. Diarrhea
D. Malnutrition
Phosphate is primarily regulated by:
A. PTH
67 B. ACTH
C. Insulin
D. Prolactin
The largest reservoir of calcium in the body is:
A. Plasma
68 B. Muscle
C. Bone
D. Liver
69. Which electrolyte plays a major role in
neuromuscular transmission?
A. Magnesium
69
B. Sodium
C. Chloride
D. Phosphate
Hypercalcemia is commonly associated with:
A. Hypoparathyroidism
70 B. Hyperparathyroidism
C. Vitamin D deficiency
D. Renal osteodystrophy
Which parameter reflects the respiratory component
of acid-base balance?
A. HCO₃⁻
71
B. pH
C. pCO₂
D. Base excess
A patient has the following results:
pH = 7.50
pCO₂ = 30 mmHg
HCO₃⁻ = 24 mmol/L
72 Interpretation:
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Base excess primarily reflects:
73 A. Respiratory function
B. Metabolic component
 C. Oxygenation
D. Hemoglobin concentration
Which condition causes normal anion gap metabolic
acidosis?
A. Lactic acidosis
74
B. Diabetic ketoacidosis
C. Severe diarrhea
D. Renal failure
The formula for anion gap is:
A. Na – (Cl + HCO₃)
75 B. Na + K – Cl
C. Cl – HCO₃
D. Na – K
Which condition produces metabolic acidosis with
increased anion gap?
A. Vomiting
76
B. Ketoacidosis
C. Hyperaldosteronism
D. Antacid ingestion
In respiratory acidosis, compensation occurs by:
A. Increased bicarbonate retention
77 B. Hyperventilation
C. Decreased bicarbonate production
D. Increased chloride excretion
Which condition commonly causes respiratory
acidosis?
A. Anxiety attack
78
B. Pulmonary obstruction
C. High altitude
D. Fever
Which blood gas analyzer electrode measures pH?
A. Clark electrode
79 B. Severinghaus electrode
C. Glass electrode
D. Platinum electrode
The Severinghaus electrode measures:
A. pH
80 B. pCO₂
C. pO₂
D. Bicarbonate
Which tumor marker is most useful in monitoring
colorectal cancer recurrence?
A. CA 19-9
81
B. CEA
C. AFP
D. PSA
Elevated AFP in adults may indicate:
A. Liver cancer
82 B. Lung cancer
C. Brain tumor
D. Thyroid cancer
CA 15-3 is most associated with:
A. Breast cancer
83 B. Colon cancer
C. Lung cancer
D. Liver cancer
A rising PSA after prostatectomy suggests:
84 A. Treatment success
B. Tumor recurrence
 C. Laboratory error
D. Infection only
Which tumor marker is useful for monitoring
ovarian cancer therapy?
A. CA-125
85
B. CEA
C. AFP
D. PSA
Which marker may be elevated in pancreatic and
gastrointestinal cancers?
A. CA 19-9
86
B. CA-125
C. PSA
D. Calcitonin
Which tumor marker may increase in pregnancy?
A. AFP
87 B. PSA
C. CEA
D. CA 19-9
Tumor markers lack specificity because they:
A. Are produced by normal tissues
88 B. Are unstable in serum
C. Are destroyed in blood
D. Cannot be measured accurately
Beta-hCG is commonly elevated in:
A. Trophoblastic tumors
89 B. Colon cancer
C. Lung cancer
D. Thyroid carcinoma
Calcitonin measurement is useful for detecting:
A. Parathyroid tumors
90 B. Medullary thyroid carcinoma
C. Pancreatic cancer
D. Pituitary adenoma
Which hormone stimulates thyroid hormone
production?
A. ACTH
91
B. TSH
C. LH
D. FSH
T3 is primarily produced by:
A. Direct thyroid secretion only
92 B. Peripheral conversion of T4
C. Pituitary gland
D. Liver only
In primary hypothyroidism, laboratory findings
include:
A. High TSH, low T4
93
B. Low TSH, high T4
C. High TSH, high T4
D. Low TSH, low T4
Which hormone increases blood calcium?
A. Calcitonin
94 B. PTH
C. Insulin
D. Glucagon
Diabetes mellitus is diagnosed when fasting glucose
is:
95
A. ≥110 mg/dL
B. ≥126 mg/dL
 C. ≥140 mg/dL
D. ≥200 mg/Dl
HbA1c reflects glucose control over approximately:
A. 1 week
96 B. 1 month
C. 2–3 months
D. 6 months
Which hormone opposes insulin action?
A. Glucagon
97 B. Prolactin
C. TSH
D. Calcitonin
Excess growth hormone in adults causes:
A. Dwarfism
98 B. Acromegaly
C. Cretinism
D. Addison disease
Which endocrine disorder results from adrenal
cortex destruction?
A. Addison disease
99
B. Cushing syndrome
C. Hyperthyroidism
D. Diabetes insipidus
ADH primarily regulates:
A. Sodium secretion
100 B. Water reabsorption
C. Calcium metabolism
D. Glucose metabolism
A patient with acute chest pain has the following
results:
CK total: elevated
CK-MB: elevated
Troponin I: normal
Which interpretation is MOST appropriate?
A. Troponin I is less sensitive than CK-MB for
101
myocardial infarction
B. Myocardial infarction occurred more than 48
hours ago
C. Myocardial infarction occurred within the last 6
hours
D. Skeletal muscle injury is more likely than
myocardial injury
Which enzyme is MOST specific for hepatocellular
injury?
A. AST
102
B. LDH
C. ALT
D. ALP
A patient has markedly elevated ALP with normal
GGT. The MOST likely source is:
A. Liver
103
B. Bone
C. Pancreas
D. Cardiac muscle
Which LDH isoenzyme predominates in myocardial
tissue?
A. LDH-1
104
B. LDH-2
C. LDH-3
D. LDH-5
 A “flipped pattern” in LDH isoenzymes (LDH-1 >
LDH-2) suggests:
A. Myocardial infarction
105
B. Liver cirrhosis
C. Pancreatitis
D. Skeletal muscle injury
Which enzyme is MOST sensitive for detecting
early alcoholic liver disease?
A. AST
106
B. GGT
C. ALT
D. ALP
A patient with bone metastasis would MOST likely
show elevation of:
A. CK
107
B. ALP
C. LDH-1
D. Amylase
Which enzyme requires pyridoxal-5-phosphate as a
coenzyme?
A. ALT
108
B. Amylase
C. CK
D. ALP
Macroamylasemia typically causes:
A. Elevated serum amylase with normal urine
amylase
109
B. Low serum amylase
C. Elevated urine amylase
D. Increased lipase
Which enzyme measurement is MOST useful in
diagnosing acute pancreatitis?
A. Amylase
110
B. Lipase
C. ALP
D. CK
The primary intracellular cation is:
A. Sodium
111 B. Potassium
C. Calcium
D. Magnesium
Severe hyperkalemia is MOST commonly
associated with:
A. Addison disease
112
B. Hyperaldosteronism
C. Cushing syndrome
D. Hyperthyroidism
Pseudohyponatremia may occur in:
A. Hyperlipidemia
113 B. Dehydration
C. Metabolic acidosis
D. Respiratory alkalosis
Which electrolyte abnormality is MOST associated
with tetany?
A. Hypernatremia
114
B. Hypokalemia
C. Hypocalcemia
D. Hypermagnesemia
115 Ionized calcium is MOST affected by:
 A. Serum albumin concentration
B. Blood pH
C. Phosphate levels
D. Sodium levels
A patient with renal failure is MOST likely to
develop:
A. Hyperphosphatemia
116
B. Hypophosphatemia
C. Hypocalcemia with low phosphate
D. Hypernatremia
Which hormone directly increases renal sodium
reabsorption?
A. ADH
117
B. Aldosterone
C. Cortisol
D. Calcitonin
Magnesium deficiency may cause:
A. Hypocalcemia
118 B. Hypercalcemia
C. Hypernatremia
D. Hyperphosphatemia
Which electrolyte disturbance is associated with
prolonged QT interval?
A. Hyperkalemia
119
B. Hypocalcemia
C. Hypernatremia
D. Hypermagnesemia
Chloride levels typically move inversely with:
A. Sodium
120 B. Potassium
C. Bicarbonate
D. Calcium
The primary extracellular buffer system is:
A. Phosphate
121 B. Protein
C. Bicarbonate
D. Hemoglobin
Normal arterial blood pH is approximately:
A. 7.20–7.30
122 B. 7.35–7.45
C. 7.45–7.55
D. 7.30–7.50
A patient with:
pH = 7.28
pCO₂ = 50 mmHg
HCO₃⁻ = 24 mmol/L
123 The condition is:
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Which organ system primarily regulates bicarbonate
concentration?
A. Lungs
124
B. Liver
C. Kidneys
D. Pancreas
An increased anion gap is MOST associated with:
125 A. Diarrhea
B. Renal tubular acidosis
 C. Lactic acidosis
D. Vomiting
Which of the following represents the Henderson-
Hasselbalch equation variable?
A. pCO₂
126
B. Hemoglobin
C. Potassium
D. Sodium
In metabolic acidosis, compensation occurs via:
A. Renal hydrogen excretion
127 B. Hyperventilation
C. Hypoventilation
D. Increased bicarbonate reabsorption
The normal anion gap is approximately:
A. 24–32 mmol/L
128 B. 4–8 mmol/L
C. 8–16 mmol/L
D. 16–24 mmol/L
Vomiting commonly produces:
A. Metabolic acidosis
129 B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Which condition causes respiratory alkalosis?
A. COPD
130 B. Anxiety-induced hyperventilation
C. Diabetic ketoacidosis
D. Renal failure
PSA is primarily used for:
A. Diagnosis of prostate cancer
131 B. Monitoring prostate cancer therapy
C. Screening ovarian cancer
D. Diagnosing liver cancer
Alpha-fetoprotein is elevated in:
A. Hepatocellular carcinoma
132 B. Breast cancer
C. Lung cancer
D. Colon cancer
CA-125 is MOST associated with:
A. Pancreatic cancer
133 B. Ovarian cancer
C. Prostate cancer
D. Thyroid cancer
Carcinoembryonic antigen is commonly elevated in:
A. Colon cancer
134 B. Leukemia
C. Prostate cancer
D. Thyroid cancer
Which tumor marker is MOST specific for
pancreatic cancer?
A. CA-125
135
B. CA 19-9
C. AFP
D. PSA
hCG is used to monitor:
A. Testicular tumors
136 B. Colon cancer
C. Thyroid cancer
D. Lung cancer
137 Calcitonin is a tumor marker for:
 A. Papillary thyroid carcinoma
B. Medullary thyroid carcinoma
C. Follicular thyroid carcinoma
D. Anaplastic thyroid carcinoma
Which tumor marker is elevated in germ cell
tumors?
A. AFP
138
B. PSA
C. CA-125
D. CA 19-9
Tumor markers are BEST used for:
A. Cancer screening in general population
139 B. Monitoring treatment response
C. Confirming cancer diagnosis alone
D. Determining cancer stage
Which tumor marker may increase in smokers
without cancer?
A. CEA
140
B. PSA
C. CA-125
D. AFP
The hormone responsible for lowering blood
glucose is:
A. Growth hormone
141
B. Glucagon
C. Cortisol
D. Insulin
Which hormone is secreted by the anterior
pituitary?
A. Oxytocin
142
B. Calcitonin
C. ADH
D. TSH
93. Graves disease results in:
A. Pituitary failure
143 B. Normal thyroid function
C. Hyperthyroidism
D. Hypothyroidism
The MOST reliable screening test for thyroid
dysfunction is:
A. Reverse T3
144
B. T3
C. T4
D. TSH
Which hormone follows a circadian rhythm?
A. Glucagon
145 B. Insulin
C. TSH
D. Cortisol
Addison disease results from deficiency of:
A. Thyroxine
146 B. Insulin
C. Cortisol
D. Growth hormone
Cushing syndrome is characterized by:
A. Excess insulin
147 B. Excess cortisol
C. Low ACTH
D. Low cortisol
148 Which hormone stimulates milk production?
 A. Progesterone
B. Estrogen
C. Prolactin
D. Oxytocin
Parathyroid hormone increases:
A. Serum magnesium
149 B. Serum calcium
C. Serum potassium
D. Serum phosphate
Which test best evaluates long-term glucose
control?
A. OGTT
150
B. HbA1c
C. Fasting glucose
D. Random glucose