CPC2 Exam 2

Quiz 5 Liver Function

1. The major risk factor for development of hepatocellular carcinoma is:

Infection with hepatitis B or C viruses.

2. The functional unit of the liver is the:

Acinus.

3. Bilirubin that is attached to albumin before it is transported across the hepatocyte membrane is called:

Unconjugated bilirubin.

4. The first protein marker to appear approximately 1 to 2 months after infection with the hepatitis B virus and also the last marker to disappear is the:

Hepatitis B surface antigen.

5. Which one of the following is not a consequence of portal hypertension in an individual?

Hemochromatosis.

6. A Model for End-Stage Liver disease staging system to predict prognosis in cirrhosis uses the following laboratory determinations EXCEPT:

Aspartate transaminase

7. Nonalcoholic steatohepatitis is characterized by all of the following EXCEPT:

No inflammation or scarring of the liver.

8. The liver is supplied by what major source(s) of oxygen-containing blood?

Both the hepatic artery and portal vein.

9. Which type of hepatitis is a leading cause of chronic hepatitis and is caused by a mutating RNA virus?

Hepatitis C.

10. Deficiency of which of the following vitamins will result in decreased heme synthesis?

Pyridoxal phosphate (PLP)

11. Which one of the following vitamins will aid in the absorption of iron by the intestine?

C

12. The most commonly used method of analysis for assessing vitamins A, K, and B6 is:

High performance liquid chromatography (HPLC).

13. Production of bilirubin occurs in the __________, and conjugation of bilirubin to glucuronide occurs in the __________.

RES; liver.

14. Serum bilirubin is unstable because of:

Light sensitivity.

15. The enzyme that conjugates bilirubin in the hepatocyte is:

UDP-glucuronyl transferase.

16. What reagent is used in the bilirubin method to shift the color reaction to a wavelength with less interference?

Alkaline tartrate

17. Acute intermittent porphyria (AIP) patients have a deficiency of:

PBG deaminase

18. The number of pyrrole rings found in the structure of all porphyrins is:

4.

19. Bile formed in the liver is stored in the:

Gall bladder

20. A breakdown product of bilirubin metabolism that is produced in the colon from the oxidation of urobilinogen by microorganisms is:

Stercobilin

21. Which of the statements regarding bilirubin metabolism is TRUE?

It is produced from the destruction of RBCs.

22. Which is a characteristic of unconjugated bilirubin?

It is not water-soluble.

23. The term δ-bilirubin (delta) refers to:

Bilirubin tightly bound to albumin

24. What is the most common cause of unconjugated hyperbilirubinemia?

Neonatal physiologic jaundice

25. In obstructive liver disease, the following test results are found:

Feces: urobilinogen decreased; urine: bilirubin positive; serum: conjugated bilirubin increased.

26. Alcoholic liver disease that follows six months to a year of moderate consumption, few lab abnormalities, and is reversible with abstinence from alcohol is termed:

Alcoholic fatty liver.

27. The reagent (accelerator) in the Jendrassik-Grof bilirubin procedure that makes indirect bilirubin water-soluble is:

Caffeine.

28. If a total bilirubin is 4.0 mg/dL and the conjugated bilirubin is 2.5 mg/dL, the unconjugated bilirubin is:

1.5 mg/dL.

29. In the Jendrassik-Grof bilirubin, what converts purple azobilirubin to blue azobilirubin measured at 600 nm?

Alkaline tartrate

30. Viral hepatitis that results in the largest percentage of chronic hepatitis is:

Hepatitis C.

31. The type of RNA virus that is considered to be the cause of the most common type of acute hepatitis that does not lead to chronic hepatitis is:

Hepatitis A virus.

32. In the liver, ammonia is metabolized to form:

urea.

33. Caffeine is used in bilirubin assays to:

Accelerate indirect bilirubin reaction

34. When elevated amounts of bilirubin are presented to the liver with elevated serum unconjugated bilirubin, what type of jaundice occurs?

Prehepatic.

Quiz 6 Hormones I

1. The placenta secretes numerous hormones, both protein and steroid. Which of the following hormones is not secreted by the placenta?

Luteinizing hormone (LH)

2. The FINAL metabolite of epinephrine that is measured in urine is:

Vanillylmandelic acid

3. The test for adrenal cortical hyperfunction that has the greatest diagnostic sensitivity is measurement of:

Urinary free cortisol

4. As a screening test for Cushing's syndrome, the physician wishes to see whether a patient exhibits normal diurnal rhythm of his cortisol secretion. At what time should the specimens be drawn for plasma cortisol determination?

8 AM, 8 PM

5. In a patient who is suspected of having pheochromocytoma, measurement of which of the following urinary compounds would be the most useful?

Metanephrines.

6. Measurement of urinary metanephrine and vanillylmandelic acid (VMA) assesses the amount of hormone secreted by the __________ and is done to detect the presence of __________.

adrenal medulla; pheochromocytoma

7. Which one of the following substances is measured in urine to determine the presence of a gastroenteropancreatic neuroendocrine tumor in an individual with carcinoid syndrome?

5-Hydroxyindole acetic acid (5-HIAA)

8. In the assessment of equivocal results in pheochromocytoma testing, the clonidine suppression test is used to differentiate between:

adrenal gland and sympathetic nervous system increases in catecholamine synthesis

9. Pheochromocytomas:

are benign in the majority of cases.

10. The amino acid precursor for the neurotransmitter serotonin (5HT) is:

tryptophan

11. Metabolism of norepinephrine and epinephrine in adrenal chromaffin cells requires the presence of which one of the following enzymes for conversion into normetanephrine and metanephrine?

Catechol-O-methyltransferase.

12. An overnight fast is recommended for individuals being tested for carcinoid syndrome because:

Dietary interference, particularly with foods that contain 5-hydroxyindoles, will produce a false increase in plasma 5-HIAA measurement.

13. The urinary metabolite measured as an indicator of dopamine synthesis is:

Homovanillic acid.

14. The rate-limiting step in the biosynthesis of catecholamines is the:

conversion of tyrosine to 3,4-dihydroxyphenylalanine by tyrosine hydroxylase.

15. Currently, the most common method of analysis for plasma catecholamines is:

liquid chromatography (LC) with electrochemical (EC) detection

16. All of the following represent metabolic effects caused by the action of epinephrine secreted from the adrenal gland except:

increased protein synthesis

17. The follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are important in the reproductive function of the male and female and are released in response to:

Gonadotropin-releasing hormone (GnRH)

18. Which one of the following hormones is classified as a glycoprotein?

Follicle-stimulating hormone

19. Androgen secretion by the testes is stimulated by:

Luteinizing hormone (LH)

20. A genetic disorder causing a deficiency of certain enzymes in the synthetic pathways leading to cortisol and aldosterone production is referred to as:

Congenital adrenal hyperplasia

21. The anterior portion of the pituitary gland synthesizes many protein hormones. Another name for this part of the pituitary gland is the:

adenohypophysis

22. The hypothalamic hormone that inhibits prolactin is referred to as prolactin-inhibiting hormone but is actually:

dopamine

23. Which one of the following hormones causes the hypothalamus to trigger the surge of luteinizing hormone (LH) from the anterior pituitary just before ovulation?

Estrogen

24. What would the laboratory results be in a male patient exhibiting characteristic symptoms of hypogonadotropic hypogonadism?

Decreased testosterone, decreased FSH.

25. During the luteal phase, which hormone, when decreased in the absence of conception, releases its inhibition on pituitary gland synthesis and release of FSH?

Estroadiol

26. Which one of the following hormones shuts off synthesis and release of LH from the male pituitary gland?

Testosterone.

27. Inhibin:

Inhibits release of FSH from the male pituitary gland.

28. For the past 3 weeks, serum estriol levels in a pregnant woman have been steadily increasing. This is consistent with:

A normal pregnancy.

29. Which of the following is secreted by the placenta and used for the early detection of pregnancy?

Human chorionic gonadotropin (HCG).

30. In nonpregnant women, progesterone is synthesized and secreted by the:

Corpus luteum.

31. Typical findings in a woman in menopause include:

Decreased estrogen and inhibin.

32. Which one of the following statements regarding FSH/LH is incorrect?

Progesterone produced by the corpus luteum causes LH levels to increase.

33. Early activation of the hypothalamic-pituitary-gonadal axis in a young child will lead to:

GnRH-dependent precocious puberty.

34. In measurement of testosterone in blood:

Morning specimens are preferred because of the diurnal release of testosterone.

35. Dehydroepiandrosterone sulfate (DHEA-S):

Is an important screening test used to evaluate women with hirsutism and virilization.

36. The analytical method that provides better analytical sensitivity in hormone detection than other methods such as immunoassay or receptor-based assays is:

Tandem mass spectrometry.

37. A man visits his physician complaining of hypertension (elevated heart rate and blood pressure), periodic bouts of profuse sweating, and occasional severe headaches. These symptoms are indicative of:

Pheochromocytoma.

38. Which one of the following statements concerning steroid hormones is correct?

Steroid hormones are hydrophobic when free and bind to intracellular receptors in the nucleus.

Quiz 7 Hormones II

1. Which one of the following hormones causes the hypothalamus to trigger the surge of luteinizing hormone (LH) from the anterior pituitary just before ovulation?

Estrogen.

2. Because of the biochemical properties of steroid hormones, the majority of these hormones, at physiological concentration:

Are bound with high affinity to a carrier protein in the circulation.

3. The urinary metabolite of cortisol and adrenal androgens is:

17-ketosteroid.

4. In the classic plasma renin activity assay that measures the main function of the enzyme and uses inhibitors of angiotensinase, what is actually measured at the end of the assay?

Angiotensin I.

5. Laboratory assessment of which of the following hormones is used to evaluate ovulation?

All of the above.

6. Which one of the following statements concerning androstenedione is incorrect?

In adrenal carcinoma, cortisol is greatly elevated, but androstenedione is greatly decreased.

7. A typical characteristic in a woman with polycystic ovary disease (PCOS) includes:

Increased serum LH concentration.

8. In nonpregnant women, progesterone is synthesized and secreted by the:

Corpus luteum.

9. Typical findings in a woman in menopause include:

Decreased estrogen and inhibin.

10. Which one of the following statements regarding FSH/LH is incorrect?

Progesterone produced by the corpus luteum causes LH levels to increase.

11. Renin is synthesized in the __________ and stimulates the production of angiotensin I, which eventually leads to __________.

Kidney; stimulation of aldosterone production.

12. Deficiency of which of the following enzymes can lead to congenital adrenal hyperplasia (CAH)?

Both a and b.

13. In measurement of testosterone in blood:

Morning specimens are preferred because of the diurnal release of testosterone.

14. How would CAH affect cortisol and adrenal androgen levels in blood?

Cortisol decreased, adrenal androgens increased.

15. Inhibin:

Inhibits release of FSH from the male pituitary gland.

16. A 14-year-old male comes to his physician with infantile genitalia and the lack of development of any secondary sex characteristics. The patient is short in stature. Upon discussion of family history, it was discovered that several male relatives had similar defects in testicular development. Based on this information, laboratory results would indicate:

Decreased testosterone and elevated FSH/LH.

17. Glucocorticoids:

Stimulate erythropoiesis.

18. A patient with Cushing syndrome has plasma cortisol measured at 8 AM. The nighttime cortisol level will be __________ from the 8 AM value.

Unchanged.

19. Regarding the phases of the menstrual cycle, the suppression of luteinizing hormone synthesis by progesterone occurs during which one of the following phases?

Luteal phase.

20. The parent substance in the biosynthesis of androgens and estrogens is:

Cholesterol.

21. The adrenal cortical hormone that promotes sodium resorption and potassium and hydrogen ion excretion by the renal tubules and thus affects water balance in the body is:

Aldosterone.

22. The formation of estriol in a pregnant woman is dependent on:

Fetal and placental function.

23. For the past 3 weeks, serum estriol levels in a pregnant woman have been steadily increasing. This is consistent with:

A normal pregnancy.

24. Which of the following is secreted by the placenta and used for the early detection of pregnancy?

Human chorionic gonadotropin (HCG).

25. Which of the following steroid hormones is synthesized and secreted by the zona reticularis of the adrenal cortex?

Androstenedione.