Prelim Examination in Clinical Chemistry 2- Lecture

Instructions: Shade the letter of your answer. No erasures allowed.

1. Which enzyme is most specific for liver injury?

A) Alanine aminotransferase (ALT) B) Aspartate aminotransferase (AST)
C) Lactate dehydrogenase (LDH) D) Creatine kinase (CK)
2. Which of the following is primarily elevated in obstructive jaundice?
A) ALT B) AST C) Alkaline phosphatase (ALP) D) Gamma-glutamyl transferase (GGT)
3. Which liver function test is most indicative of the liver’s synthetic ability?
A) Bilirubin B) Albumin C) AST/ALT ratio D) Ammonia
4. In which condition would both ALP and GGT be elevated?
A) Hemolytic anemia B) Bone disease C) Hepatobiliary obstruction D) Cirrhosis
5. Which of the following is most elevated in acute viral hepatitis?
A) ALP B) ALT C) GGT D) Bilirubin
6. In a healthy individual, the majority of bilirubin in the blood is in what form?
A) Direct (conjugated) B) Indirect (unconjugated) C) Both are equal D) Bilirubin is absent in
healthy individuals
7. Which enzyme is most indicative of cholestasis?
A) AST B) ALT C) ALP D) LDH
8. Which of the following enzymes is involved in the conjugation of bilirubin?
A) ALT B) Glucuronyl transferase C) AST D) ALP
9. Which substance is typically decreased in severe liver failure?
A) Bilirubin B) Ammonia C) Albumin D) GGT
10. Which test is used to assess the detoxification function of the liver?
A) ALT B) Ammonia C) Albumin D) Bilirubin
11. The liver is primarily responsible for the metabolism of:
A) Proteins B) Lipids C) Carbohydrates D) All of the above
12. Jaundice due to obstruction of the bile ducts will show an elevation in which of the following?
A) Indirect bilirubin B) Direct bilirubin C) AST and ALT only D) Both direct and indirect bilirubin

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13. Which form of bilirubin is water-soluble and excreted in urine?
A) Unconjugated bilirubin B) Conjugated bilirubin C) Both forms are water-soluble D) Neither form is
excreted in urine
14. The isoenzyme CK-MB is primarily found in:
A) Liver B) Heart C) Skeletal muscle D) Brain
15. Which enzyme is elevated in pancreatitis?
A) ALT B) Amylase C) CK D) AST
16. Which enzyme catalyzes the conversion of lactate to pyruvate?
A) ALT B) AST C) LDH D) ALP
17. In hemolytic anemia, which enzyme is often elevated?
A) AST B) LDH C) ALP D) GGT
18. Gamma-glutamyl transferase (GGT) is primarily elevated in:
A) Myocardial infarction B) Hepatobiliary disease C) Bone disease D) Pancreatitis
19. Which enzyme is indicative of prostate cancer when elevated?
A) Acid phosphatase B) ALP C) CK-MB D) LDH
20. The LDH isoenzyme LDH-1 is most specific for which organ?
A) Liver B) Heart C) Kidney D) Skeletal muscle
21. An international unit (IU) of enzyme activity is the quantity of enzyme that:
A) Converts 1 μmol of substrate to product per liter B) Forms 1 mg of product per deciliter
C) Converts 1 μmol of substrate to product per minute D) Forms 1 μmol of product per liter
22. . Which of the following statements regarding enzymatic reactions is true?
A) The enzyme shifts the equilibrium of the reaction to the right B) The enzyme alters the equilibrium
constant of the reaction
C) The enzyme increases the rate of the reaction D) The enzyme alters the energy
difference between reactants and products
23. Which of the following is used as a coenzyme in the measurement of aminotransferases like
ALT and AST?
A) Nicotinamide adenine dinucleotide (NAD) B) Pyridoxal phosphate (PLP)
C) Adenosine triphosphate (ATP) D) Coenzyme A
24. The increase in the level of serum enzymes used to detect cholestatic liver disease is caused
mainly by:
A. Enzyme release from dead cells B. Leakage from cells with altered membrane permeability
C. Decreased perfusion of the tissue D. Increased production and secretion by cells

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25. Which of the following enzymes is activated by calcium ions?
A) CK B) Amylase C) ALP D) LD
26. Which of the following enzymes is most indicative of alcohol-induced liver damage?
A) AST B) ALT C) GGT D) CK
27. Which enzyme is indicative of muscle damage when found in elevated levels in serum?
A) Amylase B) Lipase C) Creatine kinase (CK) D) Acid phosphatase
28. Which enzyme is commonly elevated in bone diseases, such as Paget's disease?
A) Aspartate aminotransferase (AST) B) Gamma-glutamyl transferase (GGT) C) Alkaline phosphatase
(ALP) D) Creatine kinase (CK)
30. GGT is often used to differentiate the source of an elevated ALP. An elevated GGT with ALP
suggests which of the following?
A) Bone disease B) Liver disease C) Muscle disease D) Kidney disease
31. What is the primary source of bilirubin in the body?
A) Breakdown of red blood cells B) Muscle degradation C) Dietary intake D) Renal excretion
32. Which of the following conditions is characterized by increased levels of unconjugated
bilirubin?
A) Gilbert's syndrome B) Dubin-Johnson syndrome C) Rotor syndrome D) Hepatitis
33. What is the primary clinical manifestation of elevated bilirubin levels in the blood?
A) Jaundice B) Cyanosis C) Edema D) Petechiae
34.Which test is commonly used to assess a possible issue in bilirubin levels?
A) Hemoglobin electrophoresis B) Liver function tests (LFTs)
C) Complete blood count (CBC) D) Urinalysis
35. In the metabolism of bilirubin, what is the role of the enzyme heme oxygenase?
A) Converts heme to biliverdin B) Conjugates bilirubin with glucuronic acid
C) Converts biliverdin to bilirubin D) Reduces bilirubin to urobilinogen
36. Which condition is characterized by a defect in the transport of conjugated bilirubin from
hepatocytes to the bile canaliculi?
A) Crigler-Najjar syndrome B) Dubin-Johnson syndrome C) Hemolytic anemia D) Wilson's disease
37. What is the fate of conjugated bilirubin in the intestine?
A) It is converted to stercobilinogen and excreted in feces B) It is reabsorbed and returned to the liver
C) It is converted to urobilinogen and excreted in urine D) It is metabolized to cholesterol
38.Which of the following is a common cause of neonatal jaundice?
A) Increased production of bilirubin B) Decreased conjugation of bilirubin
C) Obstruction of bile duct D) Liver cirrhosis

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39. Deficient UDPGT enzyme can result to:
A) Pre-hepatic jaundice B) Hepatic jaundice C) Post-hepatic jaundice
40. The formation of urobilinogen is done by _____.
A) Bacterial enzyme in the intestine B) UDPGT in the intestine C) Bacterial enzyme in the liver
D) UDPGT in the liver

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Date: DATE \@ "MMMM d, yyyy"
March 19, 2023