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?

4 A. Hepatocellular injury
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

6 A 60-year-old alcoholic shows AST 120, ALT 55,

AST/ALT ratio 2.2. What enzyme pattern is
characteristic?
 A. AST > ALT, >2 alcoholic hepatitis

B. ALT > AST viral hepatitis

Amylase vs lipase in pancreatitis: which is more

specific and why?

7 A. Lipase; produced only by pancreas

B. Amylase; rises faster
C. Lipase; kidney clears slower
D. Amylase; rises higher

Which coenzyme is essential for aminotransferase

reactions?

8 A. Pyridoxal phosphate
B. NAD+
C. CoA
D. Biotin

A patient has elevated ALP but normal GGT. Likely

source?

9 A. Liver
B. Bone
C. Pancreas
D. Kidney

Which enzyme is measured via NADH absorbance

change at 340 nm?

10 A. ALT
B. ALP
C. Amylase
D. CK

Serum sodium = 125 mmol/L, hyperlipidemia

present. Most likely explanation?

11 A. True hyponatremia
B. Pseudohyponatremia
C. Hypernatremia
D. Lab error

Serum K+ = 6.2 mmol/L. ECG: peaked T waves.

Patient has oliguria. Most likely cause?

12 A. Hyperaldosteronism
B. Renal failure
C. Vomiting
D. Diuretics

13 Which electrolyte is MOST responsible for resting

membrane potential?
 A. Na+
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:

15 A. Hypoparathyroidism
B. Renal failure
C. Vitamin D deficiency
D. Hyperthyroidism

A patient presents with tetany, Chvostek sign

positive. Likely lab finding?

16 A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypermagnesemia

Patient with diarrhea and vomiting shows Na+ 135,

K+ 3.1, Cl- 100, HCO₃ 18. Acid-base disorder?

17 A. Metabolic acidosis, normal anion gap

B. Metabolic acidosis, high anion gap
C. Metabolic alkalosis
D. Respiratory alkalosis

Major intracellular cation?

A. Na+
18 B. K+
C. Ca2+
D. Cl-

Which hormone increases renal Na+ reabsorption?

A. ADH
19 B. Aldosterone
C. Cortisol
D. PTH

20 Magnesium deficiency may cause:

 A. Hypocalcemia
B. Hypercalcemia
C. Hypernatremia
D. Hyperphosphatemia

ABG: pH 7.28, pCO₂ 50 mmHg, HCO₃ 24. pH 7.28 (acidemia), pCO₂ 50 mmHg (elevated), HCO₃ CC CHAP 12,
Interpretation? 24 (normal) p. 354

A. Respiratory acidosis
B. Metabolic acidosis
· Respiratory acidosis = decreased pH + increased
C. Respiratory alkalosis
21 pCO₂
D. Metabolic alkalosis
· Metabolic acidosis = decreased pH + decreased HCO₃

· Respiratory alkalosis = increased pH + decreased

pCO₂

· Metabolic alkalosis = increased pH + increased HCO₃

ABG: pH 7.50, pCO₂ 30 mmHg, HCO₃ 24. pH 7.50 (alkalemia), pCO₂ 30 mmHg (decreased), CC CHAP 12,
Interpretation? HCO₃ 24 (normal) p. 356

A. Respiratory alkalosis
B. Metabolic alkalosis
· Respiratory alkalosis = increased pH + decreased
C. Metabolic acidosis
22 pCO₂
D. Respiratory acidosis
· Metabolic alkalosis = increased pH + increased HCO₃

· Metabolic acidosis = decreased pH + decreased HCO₃

· Respiratory acidosis = decreased pH + increased

pCO₂

Metabolic acidosis with high anion gap is seen in: · Diarrhea = loss of HCO₃ (normal anion gap) CC CHAP 12,
p. 354
A. Diarrhea · DKA = excess production of acidic ketone bodies
B. DKA (high anion gap)
23 C. Renal tubular acidosis
· Renal tubular acidosis = impaired H⁺ excretion
D. Vomiting
(normal anion gap)

· Vomiting = loss of H⁺ (metabolic alkalosis, not

acidosis)

Normal anion gap: 8–16 mmol/L. Formula? · Anion gap = Na – (Cl + HCO₃) CC CHAP 12,
p. 354-355
A. Na – (Cl + HCO₃) · Na + K – Cl = includes K⁺ (not standard)
24 B. Na + K – Cl
· Cl – HCO₃ = omits Na⁺
C. Cl – HCO₃
D. Na – K · Na – K = omits Cl⁻ and HCO₃⁻

25 Base excess reflects: · Base excess = assesses metabolic (non-respiratory) CC CHAP 12,
component p. 363
A. Respiratory compensation
B. Metabolic component · Positive = metabolic alkalosis
C. Oxygenation
· Negative (base deficit) = metabolic acidosis
D. Hemoglobin binding
 · Respiratory compensation = reflected by pCO₂, not
base excess

· Lactic acidosis = excess lactate (unmeasured anion) CC CHAP 12,

Lactic acidosis, ketoacidosis, renal failure anion gap? p. 354
· Ketoacidosis = excess ketone bodies (unmeasured
A. Increased anion)
26
B. Decreased · Renal failure = retention of phosphates, sulfates,
C. Normal organic acids
D. Variable
· All three produce high anion gap metabolic acidosis

Primary renal compensation for chronic respiratory

acidosis:

27 A. Increase HCO₃ reabsorption

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?

A. pCO
29
B. HCO

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

33 CA 125 elevated in:

 A. Ovarian cancer
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

41 Primary hypothyroidism labs:

A. TSH, T4
 D. TSH, T4

Graves disease: expected lab pattern?

A. TSH, T4/T3
42
B. TSH, T4/T3

Addison disease labs:

A. Cortisol, ACTH, K+, Na+

43

Cushing syndrome labs:

A. Cortisol
44

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, PO reabsorption
49
B. Ca reabsorption, PO 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?

54 A. CK-MB
B. Troponin I
C. AST
D. LDH

AST is present in high concentrations in all

EXCEPT:

55 A. Liver
B. Heart
C. Kidney
D. Pancreas

56 Which enzyme is inhibited by fluoride in blood

collection tubes?
 A. Amylase
B. CK
C. Enolase
D. ALT

Which enzyme assay method monitors change in

absorbance of NADH at 340 nm?

57 A. Fluorometric method
B. Kinetic UV method
C. Immunoassay
D. Turbidimetric assay

A patient with obstructive jaundice would most

likely have elevated:

58 A. AST and ALT only

B. ALP and GGT
C. CK and LDH
D. Amylase only

Which enzyme is responsible for converting

creatine phosphate to creatine?

59 A. CK
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:

61 A. 120–130 mmol/L
B. 135–145 mmol/L
C. 145–155 mmol/L
D. 150–165 mmol/L

Which electrolyte imbalance is commonly seen in

diabetic ketoacidosis?

62 A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia

63 The major function of potassium in cells is:

A. Bone formation
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:

66 A. Renal failure
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?

69 A. Magnesium
B. Sodium
C. Chloride
D. Phosphate

Hypercalcemia is commonly associated with:

A. Hypoparathyroidism
70 B. Hyperparathyroidism
C. Vitamin D deficiency
D. Renal osteodystrophy

71 Which parameter reflects the respiratory component · pCO₂ = respiratory component (lung function) CC CHAP 12,
of acid-base balance? p. 353-354
· HCO₃⁻ = metabolic component (kidney function)
A. HCO₃⁻
· pH = dependent variable resulting from HCO₃⁻/pCO₂
B. pH
 C. pCO₂ ratio
D. Base excess
· Base excess = metabolic component

A patient has the following results: · pH 7.50 (alkalemia), pCO₂ 30 mmHg (decreased), CC CHAP 12,
HCO₃ 24 (normal) p. 356
pH = 7.50
pCO₂ = 30 mmHg · Respiratory alkalosis = increased pH + decreased
HCO₃⁻ = 24 mmol/L pCO₂
72 Interpretation: · Metabolic alkalosis = increased pH + increased HCO₃

A. Metabolic alkalosis · Metabolic acidosis = decreased pH + decreased HCO₃

B. Respiratory alkalosis
· Respiratory acidosis = decreased pH + increased
C. Metabolic acidosis
pCO₂
D. Respiratory acidosis

Base excess primarily reflects: · Base excess = assesses metabolic (non-respiratory) CC CHAP 12,
component p. 363
A. Respiratory function
B. Metabolic component · Positive = metabolic alkalosis
73 C. Oxygenation
· Negative (base deficit) = metabolic acidosis
D. Hemoglobin concentration
· Respiratory compensation = reflected by pCO₂, not
base excess

Which condition causes normal anion gap metabolic · Severe diarrhea = loss of HCO₃⁻ (normal anion gap / CC CHAP 12,
acidosis? hyperchloremic acidosis) p. 354

74 A. Lactic acidosis · Lactic acidosis = high anion gap

B. Diabetic ketoacidosis
· Diabetic ketoacidosis = high anion gap
C. Severe diarrhea
D. Renal failure · Renal failure = high anion gap

The formula for anion gap is: · Anion gap = Na – (Cl + HCO₃) CC CHAP 12,
p. 354-355
A. Na – (Cl + HCO₃) · Na + K – Cl = includes K⁺ (not standard)
75 B. Na + K – Cl
· Cl – HCO₃ = omits Na⁺
C. Cl – HCO₃
D. Na – K · Na – K = omits Cl⁻ and HCO₃⁻

Which condition produces metabolic acidosis with · Ketoacidosis = excess ketone bodies (high anion gap) CC CHAP 12,
increased anion gap? p. 354
· Vomiting = metabolic alkalosis
76 A. Vomiting
· Hyperaldosteronism = metabolic alkalosis
B. Ketoacidosis
C. Hyperaldosteronism · Antacid ingestion = metabolic alkalosis
D. Antacid ingestion

77 In respiratory acidosis, compensation occurs by: · Kidneys compensate for respiratory acidosis by: CC CHAP 12,
p. 354
A. Increased bicarbonate retention · Increasing H⁺ excretion
B. Hyperventilation
· Increasing HCO₃⁻ reclamation (retention)
C. Decreased bicarbonate production
D. Increased chloride excretion · Hyperventilation = would worsen respiratory acidosis

· Decreased HCO₃ production = opposite of

 compensation

Which condition commonly causes respiratory CC CHAP 12,

acidosis? · Pulmonary obstruction (COPD, asthma) = [Link]
354retention

A. Anxiety attack
B. Pulmonary obstruction · Anxiety attack = hyperventilation respiratory alkalosis
78 C. High altitude
D. Fever
· High altitude = hyperventilation respiratory alkalosis

· Fever = hyperventilation respiratory alkalosis

Which blood gas analyzer electrode measures pH? · Glass electrode = measures pH (H⁺-sensitive glass CC CHAP 12,
membrane) p. 361
A. Clark electrode
79 B. Severinghaus electrode · Clark electrode = measures pO₂ (amperometric)
C. Glass electrode
· Severinghaus electrode = measures pCO₂
D. Platinum electrode
· Platinum electrode = part of Clark electrode (cathode)

The Severinghaus electrode measures: · Severinghaus electrode = measures pCO₂ (modified CC CHAP 12,
pH electrode with CO₂-permeable membrane) p. 361
A. pH
80 B. pCO₂ · Glass electrode = measures pH
C. pO₂
· Clark electrode = measures pO₂
D. Bicarbonate
· Bicarbonate = calculated, not directly measured

Which tumor marker is most useful in monitoring

colorectal cancer recurrence?

81 A. CA 19-9
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

84 A rising PSA after prostatectomy suggests:

A. Treatment success
B. Tumor recurrence
C. Laboratory error
 D. Infection only

Which tumor marker is useful for monitoring

ovarian cancer therapy?

85 A. CA-125
B. CEA
C. AFP
D. PSA

Which marker may be elevated in pancreatic and

gastrointestinal cancers?

86 A. CA 19-9
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

90. 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?

91 A. ACTH
B. TSH
C. LH
D. FSH

92 T3 is primarily produced by:

A. Direct thyroid secretion only

B. Peripheral conversion of T4
 C. Pituitary gland
D. Liver only

In primary hypothyroidism, laboratory findings

include:

93 A. High TSH, low T4

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

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?

99 A. Addison disease
B. Cushing syndrome
C. Hyperthyroidism
D. Diabetes insipidus

100 ADH primarily regulates:

A. Sodium secretion
B. Water reabsorption
C. Calcium metabolism
D. Glucose metabolism