Clinical Biochem MCQS

1. Quality Assurance of laboratory work is provided by which one of the following?

a) Internal Standardisation
b) External Standardisation
c) Automation
d) Increasing Sample Volume
2. Common tests carried out on blood samples do not include which one of the
following:
a) Aneamia
b) Diabetes
c) Leukaemia
d) Meningitis
3. During differential diagnosis, the differentiation stage means which one of the
following?
a) Monitoring Symptoms
b) Taking a family history
c) Proposal of a disease
d) Testing to diagnose disease
4. The neuroendocrine response in trauma results in which of the following?
a) Increased insulin levels, decreased adrenalin levels, decreased heart rate and
increased breathing rate
b) Decreased insulin levels, decreased adrenalin levels, decreased heart rate and
increased breathing rate
c) Decreased insulin levels, increased adrenalin levels, increased heart rate and
increased breathing rate
d) Increased insulin levels, increased adrenalin levels, increased heart rate and
increased breathing rate
5. During the ebb phase of trauma there is a gradual increase in the plasma
concentrations of lactate. Which one of the following best describes the reason for
this?
a) Increased glycogenesis and aerobic glycolysis in muscle
b) Increased glycogenolysis and anaerobic glycolysis in muscle.
c) Increased glycogenolysis and anaerobic glycolysis in liver.
d) Increased glycogenesis and anaerobic glycolysis in muscle
6. The alterations in protein metabolism associated with the flow phase of the
trauma response is due to which one of the following:
a) An increase in the insulin to glucagon ratio
b) An increase in the insulin to cortisol ratio
c) An decrease in the insulin to cortisol ratio
d) An decrease in the insulin to glucagon ratio

7. Tumours in patients with cachexia predominantly use glucose anaerobically, for

which one of the following reasons?
a) The tumour has a poor oxygen supply
b) The tumour is metabolically adapted to the anaerobic utilisation of glucose
c) Anaerobic utilisation of glucose is energetically more efficient

d) The patient also probably has anorexia and a vitamin deficiency

8. Which one of the following about cancer cachexia is not true?
a) It is reversed by the surgical removal of the tumour
b) The extent of the cachexia is not predicted by tumour size
c) Cachexia is overcome by total parenteral nutrition
d) Cachexia is often associated with anorexia, but this is not the cause
9. The weight loss in a cancer cachexia is a result of which one of the following:
a) Utilization of glycogen reserves
b) Utilization exclusively of fat reserves
c) Utilization exclusively of muscular protein
d) Utilization of both fat reserves and muscular protein
10. The Warburg effect identified which one of the following?
a) The metabolic adaptation of tumours for the aerobic utilization of glucose
b) The metabolic adaptation of tumours for the anaerobic utilization of glucose
c) The metabolic adaptation of tumours for the aerobic utilization of fat
d) The metabolic adaptation of tumours for the anaerobic utilization of fat
11. Protein tumour markers are routinely detected using which one of the following
techniques?
a) Western blotting
b) ELISA
c) Gel filtration
d) Electrophoresis
12. AFP and CEA are examples of which class of tumour markers?
a) Abnormally expressed enzymes
b) Abnormally expressed embryonic proteins
c) Abnormally expressed hormones
d) Abnormally expressed antibodies
13. Cancers are graded or staged by which one of the following systems:
a) The CMN staging system
b) The CML staging system
c) The TMN staging system
d) The TML staging system
14. Which one of the following statements best describes the negative nitrogen
balance after a surgical operation?
a) It is largely due to reduced N-intake
b) It is beneficial for wound-healing
c) It can be stimulated by parenteral nutrition
d) It is largely related to cortisol secretion
15. The tissue in the body with the highest basal metabolic rate (BMR) is:
a) Heart
b) Kidney
c) Brain
d) Muscle
16. Parenteral fluids provide the body with which one of the following?
a) Antibiotics
b) Saline
c) Sources of energy
d) Pain relief

17. Assuming no unusual losses, approximately what percentage of daily nitrogen

loss is represented by the 24h urea urinary concentration?
a) 100%
b) 95%
c) 90%
d) 85%
18. With reference
a) The kidneys
b) The kidneys
c) The kidneys
d) The kidneys

to renal function, which one of the following statements is correct?

excrete waste products of metabolism
produce 25-hydroxy vitamin D
excrete essential metabolites
secrete aldosterone

19. The kidneys do not reabsorb which one of the following:

a) Glucose
b) Amino Acids
c) Creatinine
d) Electrolytes
20. The Jaff reaction uses picric acid to monitor the amount of which component of a
urine sample?
a) Creatinine
b) Urea
c) Creatine
d) Ammonia
21. Renal clearance can be monitored using a filtration marker. Which one of the
following properties should the filtration marker have?
a) They should be readily absorbed by the tubules
b) They should be synthesised by the tubules
c) They should increase the filtration rate
d) They should have no effect on the renal function
22. Kidney tubular function is assessed by which one of the following criteria?
a) Ability to produce alkaline urea
b) Ability to concentrate urea
c) Ability to produce high volume of urea
d) Glomerular filtration rate
23. Which of the following statements is FALSE?
a) Urea is an ineffective osmole
b) Sodium is the main extracellular osmole
c) Potassium is the main extracellular osmole
d) Plasma proteins maintain oncotic pressure
24. Hypernatraemia is a high concentration of sodium chloride in the body. The most
common cause for this is?
a) Oedema
b) Hypertension
c) Water deficit
d) Polydipsia
25. Anti-diuretic hormone (ADH) is also known by which name?
a) Alanine vasopressin (AVP)
b) Arginine vasopressin (AVP)
c) Aspartate vasopressin (AVP)

d) Anti-diuretic vasopressin (AVP)

26. The criteria for acute, evolving or recent myocardial infarction include which one
of the following?
a) Symptoms of cardiac ishaemia
b) EEG changes
c) Typical rise and gradual fall of plasma amylase
d) Rise in atrial natriuretic peptide (ANP)
27. Release of which one of the following enzymes is NOT used to diagnose a
myocardial infarction?
a) AST
b) ALT
c) CKMB
d) Lactate dehydrogenase
28. The liver plays a central role in which one of the following:
a) Synthesis of immunoglobulins
b) Degradation of albumin
c) Urea excretion
d) Glucose homeostasis
29. Which one of the following is true with regards to alanine aminotransferase
(ALT):
a) ALT if found in both mitochondria and cytosol
b) Serum ALT activity is more liver specific than serum AST activity
c) Serum ALT activity is a true liver function test
d) An ALT-AST ration > 2.0 indicates alcohol abuse

30. Which one of the following is NOT an intrahepatic cause of liver damage?
a) Cirrhosis
b) Lesion
c) Hepatic tumour
d) Gall stones
31. Which one of the following is NOT a type of jaundice?
a) Haemolytic
b) Hyperkalaemic
c) Cholestatic
d) Hepatocellular
32. Familial hypercholesterolaemia (hyperlipidaemia) can be cause by which one of
the following?
a) A high fat diet
b) Obesity
c) Mutations in the LDL receptor
d) Mutations in the HDL receptor
33. Which one of the following proteins has the highest cholesterol contents?
a) VLDL
b) IDL
c) LDL
d) HDL

34. Why is electrophoresis of lipoproteins carried out at >pH 8?

a) To give all the lipoproteins a negative charge
b) To give all the lipoproteins a positive charge
c) To remove the lipid from the proteins
d) To precipitate the lipoproteins
35. The major site of biosynthesis of cholesterol is in which one of the following:
a) Small intestine
b) Blood
c) Liver
d) Kidney
36. Which one of the following describes the mode of action of the statin drugs?
a) They inhibit the cyclisation of squalene
b) They inhibit acetyl CoA conversion to acetoacetyl CoA
c) They inhibit HMG CoA conversion to mevalonate
d) They inhibit conversion of lanesterol to zimosterol
37. When assessing acid-base status of a patient, which one of the following must be
considered?
[H+] to [HCO3]
a)
PCO2
b)
[H+], [HCO3] and PCO2
c)
[H+] and [OH]
d)
38. Which one of the following is NOT a cause of metabolic acidosis?
a) Increased production of hydrogen ions
b) Decreased respiration rate
c) Impaired excretion function of kidneys
d) Loss of bicarbonate in the urine
39. Which one of the following correctly describes the anion gap?
a) It is the difference between the levels of sodium and potassium ions
b) It is the difference between the levels of chloride and bicarbonate ions
c) It is the sum of sodium and potassium ions, minus the sum of chloride and
bicarbonate ions
d) It is the sum of sodium and potassium ions plus the sum of chloride and
bicarbonate ions
40. Collagen is a fibrous protein. Which one of the following is NOT a property of
fibrous proteins?
a) The secondary structure is the dominant structural motif
b) The proteins have great tensile strength
c) The proteins must always be alpha-helical
d) The proteins often contain repeating amino acid sequences
41. Tropocollagen is defined as which one of the following levels of structure?
a) Primary structure
b) Secondary structure
c) Tertiary structure
d) Quaternary structure
42. Which type of Osteogenesis imperfecta produces normal collagen proteins, just
lower levels than normal?
a) Type l

b) Type ll
c) Type lll
d) Type lV
43. Which one of the following definitions best describes the structure of
haemoglobin?
a) It is a heptamer
b) It contains repeating amino acid sequences
c) It has some alpha-helical and some beta-sheet sub-units
d) It is all alpha-helical
44. The mutation of haemoglobin which causes sickle cell anaemia is best described
by which one of the following?
a) Replacement of a charged residue by a hydrophobic residue
b) Replacement of a hydrophobic residue by a charged residue
c) Substitution of a buried residue
d) A conserved surface mutation
45. In the diagnosis of Sickle Cell anaemia, BOTH the solubility test and sickling test
must contain which one of the following reagents?
a) A haemoglobin specific dye
b) A detergen
c) An oxidising reagent
d) A reducing agent
46. If a patient was diagnosed with Sickle Cell Trait, which one of the following would
describe their genotype?
a) HbAA
b) HbAS
c) HbSS
d) HbSc
47. Which one of the following is true?
a) Accuracy is a measure of closeness to the true value
b) Accuracy is a measure of precision of a measurement
c) Precision is a measure of closeness to the true value
d) Accuracy is a composite measure of reproducibility
48. The molar extinction coefficient for peroxynitrite is 1670. What is the
concentration of a solution of peroxynitrite with an absorbance value of 0.33?
a) 2mmol/l
b) 5mmol/l
c) 0.33mmol/l
d) 0.2mmol/l
49. You are provided with 174ml of 0.3% solution of sodium chloride. The molecular
weights of sodium and chlorine are 23 and 35 respectively. How many millimoles
of sodium chloride does your solution contain?
a) 50
b) 5
c) 0.5
d) 0.05
50. With respect to the metabolic affects of insulin, which one of the following is
FALSE:

a)
b)
c)
d)

Insulin
Insulin
Insulin
Insulin

inhibits gluconeogenesis
inhibits glycogenolysis
inhibits glycogen synthesis
activates glycolysis

51. Which one of the following of a tumour marker are essential?

a) It should have a fairly constant half life
b) It should correlate with tumour mass or progress of the tumour
c) It should be easily detected in a biopsy or blood sample
d) All of the above
52. Which one of the following patients is most likely to have a positive nitrogen
balance?
a) Elderly malnourished male
b) Burns victim
c) Pregnant female
d) Elderly female after surgery
53. An increase in serum levels of which one of the following enzymes would indicate
cholestatic liver disease?
a) Alkaline Phosphatase
b) Alanine Transaminase
c) Aspartate Transaminase
d) Creatine Kinase