CHEM04 - Liver and Pancreatic function, lipids, cardiac markers

What lipid is the precursor to all steroid hormones?

A) cholesterol
B) triglycerides
C) fatty acids
D) phospholipids

Lipoprotein (a), or Lp(a), is significant when elevated in serum because it:

A)  Is linked closely to a gene for obesity
B)  indicates a diet high in saturated fatty acids
C)  displaces apoA1from HDLs
D)  competes with plasminogen for fibrinolytic sites, preventing lysis of small clots

Which of the following result sets would indicate a high risk for coronary artery disease?

A) 40 mg/dL HDL cholesterol and 240 mg/dL total cholesterol
B)  70 mg/dL HDL cholesterol and 250 mg/dL total cholesterol
C)  None indicate high risk
D)  20 mg/dL HDL cholesterol and 250 mg/dL total cholesterol
E)  50 mg/dL HDL cholesterol and 225 mg/dL total cholesterol

The turbid, or milky, appearance of serum in the hours after fat ingestion is termed postprandial lipemia. This lipemic appearance is caused by the presence of ?

A) VLDL
B) Phospholipids
C) chylomicrons
D) Cholesterol

All of the following statements about HDL cholesterol are true EXCEPT:

A)  HDL is involved in plaque formation
B)  HDL removes excess cholesterol from tissues
C)  Elevated HDL has a beneficial effect on the cardiovascular system
D)  HDL is considered antiatherogenic

Which of the following laboratory tests are included in the standard lipid panel?

A)  HDL cholesterol, LDL cholesterol, VLDL cholesterol
B)  Triglycerides, fatty acids, chylomicrons
C)  Total cholesterol, triglycerides, phospholipids
D)  Total cholesterol, triglycerides, HDL cholesterol

The apoprotein primarily associated with atherogenic lipoproteins is

A)  none of these
B)  apo A1
C)  apo B100
D)  apo B48
E)  apo E

Most assays for triglyceride measurement are based on the measurement of [select] after lipase hydrolysis of triglycerides.

A) fatty acids
B) pH change
C)  glycerol
D) ADP

(T/F) Substances which may interfere with most cholesterol methods include bilirubin, hemolysis and ascorbicacid.
True False

A patient presents to the ED with chest pain. A CKMB is ordered with a result of 8.3 ng/mL (reference interval <4.0 ng/mL). A medical student asks you if this is diagnostic of an acute coronary event. Which of the following would NOT be appropriate responses? (multiple choices)

(T/F) Unconjugated bilirubin is water soluble.
True False

A patient with elevated total serum bilirubin and a positive test for urine bilirubin could also be expected to have a(n) [select] serum direct bilirubin.

A) normal
B) increased 
C) decreased
D) cannot predict without further information

Bilirubin is conjugated in the liver by the action of the enzyme :

A)  bilirubin oxidase.
B)  bilirubin conjugase.
C)  glucuronyl transferase.
D)  glucuronidase.

In addition to the pancreas, amylase is produced in quantity by the

A) small intestine
B) stomach
C) large intestine
D) salivary glands

Samples collected for ammonia testing must be kept on ice and analyzed stat due to

A) production of ammonia by enzymatic action in the sample.
B)  consumption of ammonia by enzymatic activity in the sample.
C) volatility of the ammonia molecule.
D)  conversion of ammonia to ammonium ion by acid producing reactions.

(T/F) Total protein in serum is determined by the biuret method, which detects proteins by the specific binding of the dye biuret with a shift in its absorbance maximum.
True False

(T/F) Serum albumin is increased with dehydration and decreased in chronic liver disease.
True False

Unconjugated bilirubin

A)  corresponds to direct bilirubin
B)  requires an accelerator to react with diazotized sulfanilic acid
C)  is covalently bound to albumin
D)  corresponds to bilirubin monoglucuronide

Which of the following enzymes shows the greatest specificity for hepatocellular damage?

A) alanine aminotransferase (ALT)
B)  alkaline phosphatase (ALP)
C)  aspartate aminotransferase (AST)
D)  gamma glutamyl transferase (GGT)

The Friedewald equation is defined as

A)  VLDL cholesterol = LDL cholesterol ÷ 5
B)  LDL cholesterol = Total cholesterol - Triglycerides - HDL cholesterol ÷ 5
C)  LDL cholesterol = Total cholesterol - Triglycerides÷ 5 HDL cholesterol
D)  IDL cholesterol = Total cholesterol - HDL cholesterol - Triglycerides

Which of the following statements about chylomicrons (CM) is FALSE?

A)  Apo B48 is the primary apolipoprotein associated with CM.
B)  CM are produced in the intestinal mucosa.
C)  CM carry primarily esterified cholesterol.
D)  CM carry primarily triglycerides.

A patient presents to his physician with a chief complaint that his stool has become very pale in the last 5 days. He has not had any significant changes to his diet. The MD orders a standard liver function panel. For each test below, what would be the most likely significant abnormalities, if any?

+ALP (alkaline phosphatase)
+Total bilirubin
+ Direct bilirubin
+ALT

-Normal
-Elevated
-Decreased

The Friedewald equation should not be used if the :

A)  LDL cholesterol >190 mg/dL.
B)  HDL cholesterol >60 mg/dL.
C)  Triglycerides >400 mg/dL.
D)  HDL cholestrol <40 mg/dL.

The best single test for evaluating possible acute pancreatitis is :

A)  serum lipase.
B)  fecal elastase.
C)  serum trypsinogen.
D)  serum amylase.

An autoimmune disorder produced by ingestion of gluten and characterized by inflammatory damage to intestinal lining cells and malabsorption is:

A)  ulcerative colitis.
B)  lactose intolerance.
C)  Crohn's disease.
D)  celiac disease.

The LEAST useful test for active H. pylori infection is

A)  stool H. pylori antigen.
B)  serum H. pylori antibody.
C)  urea breath test.
D)  All are equally diagnostic.

Acute pancreatitis could commonly be associated with all the following findings EXCEPT:

A)  increased serum insulin.
B)  hypocalcemia.
C)  elevated serum lipase
D)  elevated serum amylase.

Which of the following biomarkers is elevated for the longest period of time following an acute myocardial infarction?

A)  Troponin
B)  hsCRP
C)  CKMB
D)  Myoglobin

The following LFT results are obtained from a patient with a complaint of left, lower quadrant pain. An intern calls and questions the results. You think to yourself:
Total protein: 3.4 gm/dL (RI 6.0‐8.0)
Albumin: 3.9 gm/dL (RI 3.5‐5.0)
Total bilirubin: 2.1 mg/dL (RI 0.3‐1.2)
Direct bilirubin: 0.4 mg/dL (RI 0.0‐0.3)
AST: <2 U/L (RI 0‐40)
ALT: 225 U/L (RI 0‐37)
ALP: 125 U/L (RI 39‐117)

A)  These results aren't right. I'll repeat the tests.
B)  These results are consistent with acute viral hepatitis
C)  These results are consistent with some form of cholestasis
D)  These results are consistent with alcoholic cirrhosis

A relatively common disorder of bilirubin conjugation that causes no adverse effects is

A)  Criglar-Najjar syndrome
B)  Dubin-Johnson syndrome
C)  Gilbert's syndrome
D)  Rotor syndrome

A form of acute coronary syndrome that is accompanied by a specific ECG abnormality is termed

A)  STEMI
B)  nonSTEMI
C)  unstable angina
D)  stable angina

A recommended scheme for the diagnosis of acute coronary syndromes is to test for

A)  troponin at presentation, then every 3 hrs for 6 hrs.
B)  CKMBand troponin at presentation, then every 6 hrs for 24 hours.
C)  myoglobin, CKMBand troponin at presentation, then every 8 hrs for 24 hrs.
D)  myoglobin and troponin at presentation, then troponin only every 8 hrs for 24 hrs.

A patient presents to their MD with a complaint of loose greasy stool that has a particularly foul odor. Which test would be LEAST likely to aid in the diagnosis?

A)  Fecal elastase
B)  Qualitative stool fat stain
C)  Lactose tolerance test
D)  72 hour fecal fat

In chronic liver failure, such as cirrhosis, there may be a significant impairment of normal ammonia metabolism and eventual hyperammonemia. Elevated ammonia can lead to:

A)  hepatic encephalopathy.
B) uremia
C)  chronic hepatitis.
D)  hepatocellular carcinoma.

A new intern calls the laboratory to ask which liver enzymes would be best to assess to differentiate between hepatocellular and cholestatic disease. You respond: "The best TWO would be " (no partial credit)

a) ALP
b) ALT
c) Amylase
d) AST
e) GGT
f) Lipase

For each lipoprotein, match the tissue site where it is formed.

+Chylomicron
+HDL
+IDL
+VLDL

-Liver
-Peripheral tissues
-Pancreas
-Intestine and Liver
-Intestine

The key element to a cardiac troponin indicating an acute coronary event is

A)  a rise and/or fall in sequential results
B)  any result >99th percentile
C)  two results above the 99th percentile
D)  an ROC area under the curve (AUC) >0.90

Which of the following IS NOT a potential cause of pancreatitis?

A) alcoholism
B) Hyperlipidemia
C) Biliary obstruction
D) All are potential causes

A patient presents with a positive antiHAV(total) and a negative antiHAV(IgM). The results are consistent with:

A)  immunity to HAV
B)  acute HAV infection
C)  laboratory error
D)  chronic HAV infection

A patient has the following test results. These are consistent with which clinical setting?
1. antiHBc(IgM) positive
2. antiHBs negative
3. HBsAg positive

A)  acute HBV infection
B)  unsuccessful HBV vaccination
C)  successful HBV vaccination
D)  chronic HBV infection

+May rule in or rule out congestive heart failure
+Predictor of coronary vascular inflammation
+CV risk marker poorly responsive to therapy
+Correlates well with HDL cholesterol

-hsCRP
-LDL cholesterol
-LP(a)
-apo-A1
-apo-B100
-BNP

The viral hepatitis most likely to become a chronic infection is

A) Hepatitis c
B) Hepatitis b
C) Hepatitis a
D) Hepatitis d

For each of the following clinical situations, matching it with the type of jaundice it represents.

+gall stone in bile duct
+severe GI bleeding
+Gilbert's syndrome
+Hemolytic transfusion reaction

-post-hepatic
-pre-hepatic
-hepatic
-none of these

Ability to hydrolyze this carbohydrate is often lost as people age.

A)  lactose
B) xylose
C)  amylose
D) glucose

Apolipoproteins are normally found in what region of the lipoprotein structure?

A) interior
B) exterior
C) interspersed throghout the lipoprotein