PathMD Quizes, Clinical Clinical Chemistry – 02 October 29, 2017 peferguson Author: Josh Bornhosrt, Ph.D. Make sure to subscribe to PathMD to stay up to date with new content and features!! 1. A 52-year-old man with a history of alcohol abuse presents with sudden severe abdominal pain associated with nausea and vomiting. Which of the following is true when considering serum testing for acute pancreatitis?Elevated Amylase and elevated lipase are equally specific for pancreatitis Lipase has both salivary and pancreatic isoforms, which reduces specificityElevated lipase is more specific than elevated amylase for pancreatitisElevated amylase levels appear well before elevated lipase levelsElevated amylase is more specific than elevated lipase for pancreatitis 2. Which of the following is the most specific serum marker for alcohol dependency?Lactate DehydrogenaseAFP-L3%Gamma-Glutamyl Transferase LipaseCarbohydrate Deficient Transferrin 3. A 63-year-old woman with weight loss is found to have a slightly elevated alanine aminotransferase level of 45 U/L (N=8-33 U/L) and an elevated aspartate aminotransferase level of 150 U/L (N=4-36 U/L). Which of the following is the most likely cause?Chronic Viral Hepatitis Acute Viral Hepatitis Reye’s Syndrome Acute Alcoholic Hepatitis Acute Mononucleosis 4. A 33-year-old jaundiced man is found to have the following serum laboratory values: Total Bilirubin of 3.0 mg/dL (normal <1.0), Direct bilirubin of 2.7 mg/dL (normal <0.2). Which of the following is the most likely cause?Gilberts SyndromeCrigler-Najjar syndrome Bile Duct Obstruction Hemolytic AnemiaFasting 5. A 53-year-old woman presents with chronic intermittent acute abdominal pain that is determined to stem from common bile duct obstruction. Which of the following liver function markers would one not expect to be highly elevated in the serum?Conjugated BilirubinTotal Bilirubin Aspartate AminotransferaseAlkaline Phosphatase Gamma-glutamyltransferase 6. Warfarin metabolism is mainly performed by:P450 CYP2C9N-Acetyl-Transferases (NATs) P450 CYP3A4 P450 CYP2D6 Thiopurine S-Methyltransferase (TPMT) 7. Which of the following is untrue in cases of toxic overdose of acetaminophen?Glutathione depletion in alcoholics can lead to increased acetaminophen hepatotoxicity Children are generally not at risk of developing Reye’s syndrome. Depression of P450 enzyme activities by other therapeutic drugs result in the increased production of the toxic metabolite: N-acetyl-p-benzoquinone immine Administration of N-acetylcystiene is a common antidotal therapy.The Rumack-Matthew nomogram can be used to estimate the probability of hepatic toxicity if the time of ingestion and acetaminophen plasma concentration is known. 8. Which of the following is not true of drug metabolism:Most Phase II reactions are mediated by the cytochrome P450 (CYP) enzymes Phase I reactions typically involve oxidation of compounds Glutathione and Acetyl CoA often serve as cofactors in Phase II reactions In general, metabolism serves to increase the water solubility of xenobiotic compoundsPhase II reactions typically involve enzyme-mediated congujation of compounds 9. An active form of an antidepressant is subsequently oxidized by P450 CYP2C9. Which patients would you generally expect to need the highest dose of antidepressants to maintain similar serum concentrations of active drug?FemalesUltrarapid metabolizers (UM)Poor Metabolizers (PM) Extensive metabolizers (EM) Intermediate Metabolizers (IM) 10. Macroamylase refers to:The presence of elevated serum amylase levels in acute pancreatitis The elevation of amylase levels in cases of biliary tract obstruction. The presence of complexes consisting of amylase and immunglobulins that result in elevated amylase levels. The elevation of serum salivary amylase isoform in cases of ectopic pregnancy or ovarian malignancy.The false elevation of amylase levels in lipemic specimens. Loading...
