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HS/OCT 2009/MLT456

UNIVERSITI TEKNOLOGI MARA FINAL EXAMINATION

COURSE COURSE CODE EXAMINATION TIME

CLINICAL CHEMISTRY II MLT456 OCTOBER 2009 2 HOURS

INSTRUCTIONS TO CANDIDATES 1. This question paper consists of two (2) parts : PART A (50 Questions) PART B (3 Questions) 2. Answer ALL questions from all two (2) parts: i) Answer PART A in the Objective Answer Sheet. ii) Answer PART B in the Answer Booklet. Start each answer on a new page. Do not bring any material into the examination room unless permission is given by the invigilator. Please check to make sure that this examination pack consists of: i) the Question Paper ii) an Answer Booklet - provided by the Faculty iii) an Objective Answer Sheet - provided by the Faculty

3.

4.

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 11 printed pages
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PART A

(50 marks)

Answer ALL questions. Choose the MOST appropriate answer for each question.

1. What is the molarity of a 0.3N H 2 S0 4 solution? A. B. C. D. 0.015M. 0.15M. 1.5M 15M.

2. How many milliters are there in one liter? A. 10. B. 100

C. 1000.
D. 1000000.

3. What is normality of a 0.5M H3P04? A. B. C. D. 0.17N. 0.5N. 1.5N. 15N.

4. A 2% solution is diluted 1:100. What is the final concentration? A. B. C. D. 0.02%. 0.2%. 20%. 200%.

5. How much 85% alcohol is needed to make 500 ml of 60% alcohol? A. B. C. D. 35.9 ml. 352.9 ml. 52.5 ml. 525 ml.

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6. What is the concentration of a physiological saline solution? A. B. C. D. 1 % NaCI by weight/volume. 0.85% NaCI by weight/volume. 0.20M NaCI. 2.4M NaCI.

7. Serum phosphorus is 3.0 mg/dL. You have been asked to calculate the concentration in mmol/L. This would require further knowledge of which of the following? A. B. C. D. Serum osmolality. Serum sodium. Blood pH. Molecular weight of phosphorus.

8. 1 mg/dl is the same as A. B. C. D. 1 ug/ml. 10 ug/ml. 10 parts per million (ppm). 100 mg%.

9. Which of the following electrolytes BEST correlates with plasma osmolality? A. B. C. D. Sodium. Chloride. Bicarbonate. Calcium.

10. Which of the following electrolyte measurement is LEAST affected by hemolysis? A. B. C. D. Potassium. Calcium. Inorganic phosphorus. Magnesium.

11. A glucose determination was read on spectrophotometer. The absorbance reading of the standard was 0.30. The absorbance reading of the unknown was 0.20. The value of the unknown is A. B. C. D. one and a half times the standard. two thirds of the standard. the same as the standard. three fifths of the standard. CONFIDENTIAL

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12. Determine the anion gap given the following serum electrolytes data: Na 132 mmol/L; CI 90 mmol/L; HCCy 22 mmol/L A. B. C. D. 12 mmol/L. 20 mmol/L. 64 mmol/L. Cannot be determined from the information provided.

13. Osmolal gap is the difference between A. B. C. D. the ideal and real osmolality values. the calculated and measured osmolality values. plasma and water osmolality values. molarity and molality at 4C.

14. The osmolality of a urine or serum specimen is measured by a change in the. A. B. C. D. midpoint. freezing point. sedimentation point. osmotic pressure.

15. Which of the following battery of tests is MOST useful in evaluating a high anion gap? A. Ca2+I Mg2+' PO 4 ' and pH. B. BUN, creatinine.salicylate, methanol. C. Aspartateaminotranferase (AST), alanineaminotransferase dehydrogenase (LD), and amylase. D. Glucose, creatine kinase, myoglobin, and cryoglobulin.

(ALT),

lactate

16. The formula for calculating serum osmolality that incorporates a correction for the water content of plasma is A. B. C. D. 2 Na x (Glucose/20) x BUN/3). Na + [2 x Glucose)/20] x (BUN/3). 2 Na + Glucose/20 + (BUN/3). 2 Na + Glucose/3 + (BUN/20).

17. Which of the following values is closest to the average osmolal gap? A. B. C. D. 0. 2. 4. 6. CONFIDENTIAL

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18. A one molal solution is equivalent to A. B. C. D. a solution containing one mole of solute per kg of solvent. 1000 mL of solution containing one mole of solute. a solution containing one gram-equivalent weight of solute in one liter of solution. a 1-L solution containing 2 moles of solute.

19. An arterial blood specimen submitted for blood gas analysis was obtained at 8:30 AM but was not received in the laboratory until 11:00 AM. The technologist should A. B. C. D. perform the test immediately upon request. perform the test only if the specimen was submitted in ice water. request a venous blood specimen. request a new arterial specimen be obtained.

20. Specimens for blood gas determination should be drawn into a syringe containing A. B. C. D. no preservative. heparin. ethylenediaminetetraethylacetate. oxalate.

21. The term biuret reaction refers to A. B. C. D. the reaction of phenolic groups with CuS0 4 . coordinate bonds between Cu2+ and carboxyl and amino groups of biuret. the protein error of indicator effect producing color when dyes bind protein. the reaction of phosphomolybdic acid with protein.

22. At pH 8.6 proteins are A. B. C. D. negatively;anode positively;cathode positively;anode negatively;cathode

charged and migrate toward the

23. Which of the following support medium is used in electrophoresis to determine the molecular weight of a protein? A. B. C. D. Cellulose acetate. Polyacrylamide gel. Agar gel. Agarose gel.

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24. Which of the proteins listed below has the highest pH? A. B. C. D. Albumin. Transferrin. Ceruloplasmin. IgG.

25. One advantage of high-resolution (HR) agarose electrophoresis over lower-current electrophoresis is A. HR procedures detect monoclonal and oligoclonal bands at lowest concentration. B. a smaller sample volume is used. C. results are obtained more rapidly D. more samples can be applied to the support medium.

26. Maple syrup urine disease is characterized by an increase in which of the following urinary amino acids? A. B. C. D. Phenylalanine. Tyrosine. Valine, leucine, and isoleucine. Cystine and cysteine..

27. On electrophoresis of serum proteins, artifacts as the application point are most frequently caused by A. B. C. D. endosmosis. prestaining with tracer dye. overloading of serum sample. dirty applicators.

28. The enzyme that is present in almost all tissues and can be separated by electrophoresis into five components is A. B. C. D. lipase. transaminase. creatine kinase. lactate dehydrogenase.

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29. An International Unit (IU) of enzyme activity is the quantity of enzyme that A. B. C. D. converts 1 micromole of substance to product per liter. forms 1 mg of product per deciliter. converts one micromole of substrate to product per minute. forms one millimole of product per liter.

30. Which of the following is the MOST sensitive marker for alcoholic liver disease? A. B. C. D. Glutamate dehydrogenase. Alkaline phosphatase. Aspartate aminotransferase. Gamma glutamyltransferase.

31. Which isoenzyme of alkaline phosphatase (ALP) is inhibited by urea? A. B. C. D. Placental. Bone. Liver. Intestinal.

32. The level of which of the following enzymes is usually increased in acute lymphocytic leukemia (ALL)? A. B. C. D. Alanine aminotransferase. Acid phosphatase. Terminal deoxynucleotidyl transferase (TdT). Cholinesterase.

33. Which enzyme deficiency is responsible for phenylketonuria? A. B. C. D. Phenylalanine hydroxylase. Tyrosine transaminase. p-Hydroxyphenylpyruvic acid oxidase. Homogentistic acid oxidase.

34. The presence of which of the following isoenzymes MOST accurately indicates acute myocardial damage? A. B. C. D. Creatine Creatine Creatine Creatine kinase CK-MM. kinase CK-MB. kinase CK-BB. kinase.

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35. Measurement of the serum acid phosphatase is used to detect neoplastic disease of the

A. B. C. D.

liver lung ovary prostate

36. The MOST specific enzyme test for acute pancreatitis is A. B. C. D. acid phosphatase trypsin amylase lipase

37. Which of the following enzymes catalyzes the conversion of starch to glucose and maltose? A. B. C. D. Malate dehydrogenase. Amylase. Creatine kinase Lipase.

38. Which of the following formulas CORRECTLY estimates the VLDL cholesterol? A. B. C. D. Serum triglycerides divided by 5. Total cholesterol minus HDL cholesterol. Total cholesterol multiplied by 0.25. LDL cholesterol multiplied by 0.25.

39. Which of the following is the recommended cutpoint for serum total cholesterol screening? A. B. C. D. 200mg/dl. 250mg/dl. 300mg/dl. 300 mg/dl for adult males and 250 mg/dl for adult females.

40. Which apoprotein is INVERSELY related to risk for coronary heart disease? A. B. C. D. ApoA-l. ApoB. ApoC-ll. ApoE-IV. CONFIDENTIAL

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41. Which of the following lipoproteins is responsible for transportation of exogenous fat (from diet)? A. B. C. D. Chylomicrons. Very low density lipoproteins (VLDL). Low density lipoproteins (LDL). High density lipoproteins (HDL)..

42. Which of the following lipoproteins is responsible for transportation of endogenous fat? A. B. C. D. Chylomicrons. Very low density lipoproteins (VLDL). Low density lipoproteins (LDL). High density lipoproteins (HDL).

43. Which of the following is the physiologically active calcium? A. B. C. D. Total calcium. Protein bound. Ionized calcium. Complexed to oxalate.

44. Calcium and phosphate metabolism is regulated by the A. B. C. D. thyroid glands adrenal glands kidneys parathyroid glands

45. What percentage of total serum calcium is nondiffusible protein bound? A. 8 0 - 9 0 % . B. 51 - 60%.

C. 4 0 - 5 0 %
D. 1 0 - 3 0 %

46. A decrease in total serum calcium usually means that there is A. B. C. D. increased bound and decreased ionized. decreased bound and decreased ionized. decreased bound and normal ionized. normal bound and decreased ionized.

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47. Ionized calcium levels may be altered by A. B. C. D. hyperventilation. exposure of specimen to air. change in pH. diet.

48. The normal values for serum calcium in growing children is A. B. C. D. the same as adults. slightly lower than adults. slightly greater than adults. much greater than adults.

49. Serum to be used for calcium analysis should be separated from the clot within 30 minutes after specimen collection because A. B. C. D. calcium calcium calcium calcium leaks from the cells into the serum. diffuses into the cells. absorbs onto the cell surface. precipitates and is trapped in the clot.

50. Which of the following is typically a symptom of hypocalcemia? A. B. C. D. Stupor. Tetany. Vomitting. Dehydration.

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PART B

(50 marks)

Answer ALL questions.

QUESTION 1 Discuss how concentrated plasma volume is regulated in the human body. Illustrate your answer with a labeled diagram. (15 marks)

QUESTION 2 a) State the range of physiological pH. (2 marks) b) Define the following terms. i) ii) iii) iv) Metabolic acidosis, Respiratory acidosis, Metabolic alkalosis, Respiratory alkalosis. (8 marks) c) State the relationship among C0 2 H 2 0, HHC03", H+ and HC03" in reference to the bicarbonate buffer system. (3 marks)

d) What is the BEST specimen for blood gas analysis and state the requirements for transport to the laboratory. (2 marks)

QUESTION 3

a) Name the reference method for measuring serum glucose. Briefly discuss the reason for your answer. (6 marks) b) State ONE potential error for the method named in (a). Briefly discuss your answer. (4 marks) c) Describe the principle of the method named in (a). (10 marks)

END OF QUESTION PAPER

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