MEDICAL CHEMISTRY FINAL EXAM 02 APRIL 2012 This Examen has beendesignedto be done in 2 hoursaproximately. NO copyingorcellphones are allowed.

. Answersshould be done in pen, no pencilorliquidpaperisallowed. NAMELUCIA JANETH SANDOVAL MUOZ.. 1. Conditionsassociatedwithelevatedtroponin in absence ischemicheartdiseasewill be thefollowingEXCEPT: (2 pts) a. Aorticdissection b. Severepulmonaryhypertension c. Respiratoryfailure d. CardiacHypertension e. Sepsis f. Burns g. Aortic valvular disease of

2. Youshouldcheckcardiacmarkersto EXCLUDE NSTEMI, whichoneis TRUE: (2 pts) a. A doble positive CK-MB ortroponinwhenpresenting at least 8-12 hrsaftersymptomonset b. A positive myoglobin in conjunctionwith a positive CK-MB ortroponinmeasured at 0 and 90 minutes whenpresentinlessthen 8 hrsaftersymptomonset c. A negative 2 hour delta CK-MB in conjunctionwith a negative 2 hour delta troponinwhenpresentinglessthen 8 hrsaftersymptomonset. 3. TRUE OR FALSE (6 pts) Duration of CK-MB isbetween 2-3 days Peak of Toponin T & I is 20 hrs Myoglobin has anonset of 1-2 hrs In MiocardialInfarction 4. Values in Hypokalemiawillrange in: a. 3.5-5.0 mEq/L b. 5.0- 6.5mEq/L c. 2.5 -3.5 mEq/L d. lessthen 3.5mEq/L e. just c f. a and b g. a and c h. c and d 5. Mr. Saavedra a chronicconsumer of NSAIDs, cametotheemergencydepartmentfeelingpalpitations, lethargy, weakness, TRUE TRUE TRUE FALSE FALSE FALSE

confusion, in thephysicalexam bradicardia, muscleweakness, hypotonicity, reduceddeeptendonreflexes, paralysis in advancedstages, altered mental status and shock wasfound. Patienthad ECG signsaltered. Themostlikely diagnosis would be: a. Hyperkalemia b. Hypocalcemia c. Hypernatremia 6. Mrs. Cuchinangais a Diabeticpatientwhopresentedyesterdayanepisode of seizures, at themomentwithpolyuria, thirst and neurologicsymptomslike focal deficitssuch as hemiparesis. Se reportedlastweek anorexia, restlessness, nausea and vomiting. Themostlikely diagnosis would be: a. Hyperkalemia b. Hypocalcemia c. Hypernatremia 7. Miss Oliveira a Chronicliverdiseasepatientwith a chronichistory of intestinal malabsorption and epilepsyrushedintotheemergencydepartmentforheartfailure, laryngospam, dementia and latenttetany. Herboyfriendsaidshefeltperioral and peripheralparesthesiasrecently. At thephysicalexamwefoundsomethinginteresting, shehad a Chvosteksign positive (percussion of theipsilateral facial muscle anterior totheear causes facial musclecontraction). Themostlikely diagnosis diagnosiswould be: a. Hyeprkalemia b. Hypocalcemia c. Hypernatremia 8. A 5-year-old boyisexpectedto be dischargedfromthepediatricintensivecareunitaftersustaininganintraventric ularhemorrhagefollowing a motor vehicleaccident. Maintenancefluidshavebeendiscontinued, and intravenousaccess has beenkept open byflushingwithheparin. Theinternasksthethird-year medical studenttodrawblood off thepatient'sintravenous line forcoagulationstudies. Thethird-yearstudent, however, neglectstodiscardthefirst 5 cc of bloodbeforecollectingbloodforthesample. He thensendsthissample off tothehematologylaboratoryfor a coagulation panel butneglectstotelltheinternaboutthe error. Which of thefollowinglaboratoryresultswould be expected in thispatient? A) Decreasedactivatedpartialthromboplastin time B) Decreasedinternationalnormalized ratio C) Decreasedprothrombin time D) Increasedactivatedpartialthromboplastin time E) Increasedinternationalnormalized ratio F) Increasedprothrombin time

9. A 44-year-old woman comes tothephysicianafterbeingtreated in theemergencydepartment 2 weeksagoforherfirstepisode of diverticulitis. Herconditionwasdiagnosedby CT scan of the abdomen and treatedwithanoutpatientcourse of ciprofloxacin and metronidazole. She has no previous medical history and receives no medications. Thepatient'srecoverywasuneventful, and sheiscurrentlywithoutany new complaints. Sheisnowconcernedaboutmultiplesmallgallstonesthatwereincidentallynote donthe CT scan. Of note, thegallbladderappearedotherwise normal, and therewasanabsence of dilatedducts. Shedeniesanyproblemswithcholelithiasis in thepastbutisworriedbecausehermotherhad a "gallstoneinfection" in thepastthatrequiredsurgery and intravenousantibiotics. Hertemperatureis 37.0 C (98.6 F), bloodpressureis 140/80 mmHg, pulse is 93/min, and respirations are 18/min. Sheis 60 inchestall and weighs 77 kg (169 lb). Her abdomen isnontender and nondistendedwith normal bowelsounds. Thereis no reboundorguarding. Murphy signisnegative. Herliveris normal sized. Laboratorystudies show: Hemoglobin: 11 mg/dL Leukocytecount: 5700/mm Platelets: 270,000/mm Hematocrit: 31% Sodium: 145 mEq/L Potassium: 4.5 mEq/L Chloride: 100 mEq/L Bicarboate: 24 mEq/L Glucose: 116 mg/dL Creatinine: 1.0 mg/dL BUN: 10 mg/dL Total protein: 6.0 g/dL Albuim: 3.5 g/dL Total bilirubin: 0.9 mg/dL Directbilirubin: 0.4 mg/dL Alkalinephosphatase: 59 U/L AST: 20 U/L ALT: 31 U/L Which of thefollowingisthemostappropriatemanagement of thispatient? A) Electivelaparoscopiccholecystectomy B) Endoscopicsphincterotomy C) Exercise and dietmodification D) Rightupperquadrant 10. A 53-year-old woman comes tothephysiciancomplaining of fatigue overthepast 6 months. Duringthis time, she has alsodevelopedgeneralizeditching and has lost 4 pounds. Herpast medical historyissignificantforrecurrent oral and vaginal candidalinfection and sinusitis. Sheissexually active withherhusband and deniesany use of IV

drugs. Shedenies smoking and drinks 2 to 3 beerseverynight. Hercurrentmedicationsincludebabyaspirin, multivitamins, and artificial tears, recommendedbyhereye doctor. Onphysicalexamination, sheisafebrile and has mildlyictericsclera. There are excoriationsnotedonallfourextremities and trunk and back. Theliveredgeissmooth and nontender and measures 9 cm at themidclavicular line. Thereis no ascites, splenomegaly, lymphadenopathy, orperipheral edema. Laboratoryresultsreveal a normal complete bloodcount and normal electrolytes. Liverfunctiontests show: Alkalinephosphatase: 260 U/L Bilirubin, total: 3.1 mg/dL Alanineaminotransferase (ALT): 42 U/L Aminotransferase (AST): 35 U/L Which of thefollowingisthemostlikely diagnosis? A) Alcoholic hepatitis B) Autoimmune hepatitis C) Hepatocellular carcinoma D) Primarybiliarycirrhosis E) Primarysclerosingcholangitis 11. A 39-year-old blackmanpresentswithcomplaints of anorexia, malaise, fatigue, darkurine, and upper abdominal discomfort. He admitstohomosexuality, butdeniesbloodtransfusions, alcohol intake, orintravenousdrug abuse. Onphysicalexamination, thepatient has a temperature of 100.2 degrees F, scleralicterus, and jaundice. Hisliveris palpable belowtheright costal margin, and thereis moderate rightupperquadranttenderness. Liverfunction test results are as follows: total bilirubin 12.4%, SGOT 980 units, SGPT 1200 units. Serologicfindings are as follows: anti-hepatitis A IgMnegative, HBsAg positive, anti-HBcIgM positive, HBeAg positive, anti-HBsAbnegative, hepatitis C negative. Whenthispatiententersthewindowperiod, whatwouldlikely be thefirstchange in hisserologicfindings? A) He willbecomeHBcAg positive B) He willbecomeHBcIgG positive C) He willbecomeHBeAgnegative D) He willbecomeHBsAb positive E) He willbecomeHBsAgnegative 12. A 33-year-old womangivesbirthto a babygirl. Thenextday, shebeginstobleedfromher vagina and fromvenipuncturesites. Laboratorystudiesdemonstratedecreasedplatelets, prolongedprothrombin time (PT) and partialthromboplastin time (PTT), and increasedfibrinsplitproducts. Thesefeatures are mostconsistentwithwhich of thefollowing?

A) Disseminatedintravascularcoagulation B) Hemophilia A C) Severeliverdisease D) Vitamin K deficiency E) Von Willebranddisease 13. A 35-year-old man comes totheemergencydepartmentwithmeningealsymptoms. He says he wastakento a trauma center in rural Ecuador 2 yearsagoafterexperiencingblunt abdominal trauma. He doesnotrememberexactlywhatwas done, but he believestheytookdrasticmeasuresto control intra-abdominal bleeding. Beforeleavingthe trauma center, he wascounseledabout a new susceptibilitytoencapsulatedorganisms. Laboratorytests show anincreasedplateletcount. Which of thefollowingfindingswould be likelyto be seen in a peripheralbloodsmearfromthispatient? A) Heinz bodies and target cells B) Megaloblastic anemia C) Schistocytes D) Sicklecells E) Spherocytes