POLYTECHNIC OF NAMIBIA SCHOOL OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES BIOMEDICAL SCIENCES PROGRAMME

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1 セ POLYTECHNIC OF NAMIBIA SCHOOL OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES BIOMEDICAL SCIENCES PROGRAMME QUALIFICATION(S): Bachelor Of Biomedical Sciences QUALIFICATION CODE: 50BBMS NQF LEVEL: LEVEL 7 COURSE NAME: CLINICAL CHEMISTRY 3 COURSE CODE: CLC310S DATE: JUNE 2015 DURATION: 3 HOURS MARKS: 150 FIRST OPPORTUNITY QUESTION PAPER CHIEF EXAMINER: EXAMINER(S): MODERATOR: MR. MUKESI, M PROF KASVOSVE, I INSTRUCTIONS: 1. Answer all the questions in the booklet provided 2. Use of calculator is allowed 3. Show clearly all the steps used in the calculations 4. All written work MUST be done in blue or black ink and sketches must be done in pencils. 5. Mark all answers clearly with their respective question numbers ATTACHMENTS: No attachments This paper consists of 6 pages excluding this cover

2 CLC310S CLINICAL CHEMISTRY 3: 1sr OPPORTUNITY QUESTION PAPER SECTION A [36] QUESTION 1 [10] 1.0 Choose the correct answer for each part of the question and write only the question number and the letter corresponding to the correct answer Vasopressin secretion A. Causes excretion of dilute urine B. Is supressed by trauma C. Is a cause of hypernatraemia D. Is controlled by extracellular fluid tonicity E. Acts on the proximal convoluted tubule In the control of total body sodium ( 1 ) A. Aldosterone promotes sodium reabsorption at the proximal tubule B. Sodium retention leads to expansion of intracellular volume C. Angiotensin converting enzyme converts angiotensinogen to angiotensin 1 D. Renin is secreted in a response to a reduction in supply of sodium to the distal tubule E. Renin is secreted in response to a rise in renal afferent arteriolar pressure 1.3 Estimated GFR (egfr) ( 1 ) A. Is valid in all age groups B. Is a useful assessment of the progress of acute renal failure C. Can be used to assess renal function in pregnancy D. Is the basis for the classification of chronic kidney disease E. When it is within the reference range rules out chronic kidney disease 1.4 Plasma creatinine ( 1 ) A. Is a useful screening test for the presence of renal tubular disease B. Is often reduced in patience with hepatic failure C. Is unaffected by changes in diet D. Tends to rise with age E. Assays may be subject to interference 1.5 ln subclinical hyperthyroidism (1) A. TSH, FT. and FT3 are all increased B. TSH, FT. and FT3 are all decreased C. TSH is low but FT. and FT3 fall within the reference range D. TSH is suppressed but FT 4 and FT3 are raised E. It is always accompanied by iodine deficiency Page 1 of 6

3 CLC310S CLINICAL CHEMISTRY 3: 1 5 T OPPORTUNITY QUESTION PAPER 1.6 What measurement is made to assess if a patient had an ovulatory cycle (1) A. Progesterone taken 7 days prior to next expected menses B. Day 14 progesterone C. Day 21 oestradiol D. Day 21 testosterone E. Day 14 LH 1.7 Bilirubin: (1) A. Is very high in Gilbert's syndrome B. Unconjugated form is the common reason for neonatal jaundice C. Is present largely in conjugated form in haemolytic anaemia D. May appear in urine due to critical levels of unconjugated bilirubin E. Is usually normal in severe advanced biliary cirrhosis 1.8 With regards to liver function tests: (1) A. Raised GGT is specific for liver disease B. A low albumin is always an indicator of liver failure C. A high AL T with minor changes in ALP is consistent with hepatitis D. Normal GGT excludes alcohol excess E. A normal AST indicates normal liver function 1.9 Therapeutic drug monitoring is required for the following drugs except ( 1 ) A. Lithium B. Tacrolimus C. Acetaminophen D. Digoxin E. Aminoglycoside antibiotics 1.10 In the interpretation of biochemical tests in the elderly: A. Decreases in total protein and albumin with increases in glucose and cholesterol are often found B. Serum creatinine may progressively rise due to a reduced muscle mass and deteriorating renal function with age C. Abnormalities in serum calcium arise due to the development of osteoporosis D. Thyroid screening is not worthwhile as interpretation can be affected by non-thyroidal illness E. The renal threshold for glucose may rise with age, improving the value of glucose dipstix measurement for the detection of diabetes Page 2 of 6

4 CLC310S CLINICAL CHEMISTRY 3: 1sr OPPORTUNITY QUESTION PAPER QUESTION 2 [6] 2.0 When answering question 2, only write the letter and corresponding answer. 2.1 Identify the class of each of the following drugs: (6) a. b. C. d. e. f. Valproic acid Digoxin Kanamycin Carbamazepine Lithium Theophylline ( 1 ) (1) QUESTION 3 [20] 3.0 Write short notes on each of the following: 3.1 Creatinine clearance 3.2 Proteinuria 3.3 Proficiency testing 3.4 Internal quality control SECTION 8 [46] Analyse the following case studies and answer the respective questions: QUESTION 4 [12] 4.0 A 38-year old white male taxi driver was referred to a lipid clinic by the general practitioner for management of combined hyperlipidaemia. He was a smoker with a 20-year history. His father had died of myocardial infarction at age 55 years old. Examination of this patient revealed a blood pressure of 136/99 mmhg and a body mass index of 29 kg/m 2, with no clinical signs of hyperlipidaemia. Laboratory results were as follows: Page 3 of 6

5 セ M CLC310S CLINICAL CHEMISTRY 3: 1 5 r OPPORTUNITY QUESTION PAPER M LABORATORY REPORT セ M - M Serum analyte Patient result Reference range Cholesterol (mmoi/l) HDL (mmoi/l) Triglyceride (mmoi/l) 6.1 < CK total (IU/L) AL T (IU/L) 61 < ALP (IU/L) 95 <150 GGT (IU/L) 49 <50 - Urea (mmoi/l) ' セョZゥエ イcャ@ HセュッゥAlI@ M セ M 4.1 Outline the different isoenzymes of CK. (6) 4.2 Consider FOUR conditions that can cause an increase in serum CK levels.(4) 4.3 Given the patient's history, what is the single most likely diagnosis? (2) QUESTION 5 (24) 5.0 A 54-day old infant of Asian descent presented with jaundice. He first started appearing yellow a few weeks after birth. His paediatrician initially recommended increasing sunlight exposure. At subsequent visits, the paediatrician recommended stopping breastfeeding. Despite these interventions, the infant's jaundice persisted and the stools became pale. At 52 days of life he had a serum bilirubin measured. The laboratory report is presented below: Page 4 of 6

6 CLC310S CLINICAL CHEMISTRY 3: 1 8 r OPPORTUNITY QUESTION PAPER LABORATORY REPORT Day of Serum test Assay Instrument Result Reference life (1Jmoi/L) range (IJmoll_I-L_ 1 Neonatal Direct Vitros direct spectrophotometry bilirubin 52 Bilirubin Chemical reaction Roche direct (Diazo) 54 Bilirubin Direct Vitros conjuqated spectro[)hotometry 5.1 Elucidate the difference between neonatal direct bilirubin, bilirubin direct and bilirubin conjugated assays. (6) 5.2 Summarise the causes of neonatal jaundice. (8) 5.3 Explore other biochemical tests that can be performed to identify the cause of the increased bilirubin. (6) 5.4 Why are the reference intervals in the table different? (4) QUESTION 6 [1 0] 6.0 The laboratory manager has asked you to design a hormone testing profile for female infertility. 6.1 Identify the tests to be included in the testing profile and justify the choice of each test. (1 0) SECTION C [68] QUESTION 7 [14] 7.0 Outline the tests you would perform to differentiate the following and the expected resu Its: 7.1 Exudate and transudate 7.2 Maternal urine and amniotic fluid following amniocentesis (1 0) (4) Page 5 of 6

7 CLC310S CLINICAL CHEMISTRY 3: 1sr OPPORTUNITY QUESTION PAPER QUESTION 8 [14] 8.0 When handling toxicology specimens: 8.1 What measures are put in place in the laboratory to ensure the integrity of a toxicology sample and result? (4) 8.2 Document the criteria used in the clinical chemistry laboratory to classify a toxicology specimen as having been adulterated. (1 0) QUESTION 9 [20] 9.0 Discuss each of the following: 9.1 The qualities of a good tumor marker. 9.2 The indications for therapeutic drug monitoring. (1 0) (1 0) QUESTION 10 [20] 10.0 Concerning quality control, outline: 10.1 The steps taken in a routine clinical chemistry laboratory when introducing a new lot of control. (8) 10.2 Factors considered when selecting a new method. (12) THE END TOTAL 150 MARKS Page 6 of 6