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CLINICAL CHEMISTY (HARR) > Enzymes and Cardiac Markers > Flashcards

Enzymes and Cardiac Markers Flashcards

1
Q

An international unit (IU) of enzyme activity is the
quantity of enzyme that:
A. Converts 1 μmol of substrate to product per liter
B. Forms 1 mg of product per deciliter
C. Converts 1 μmol of substrate to product
per minute
D. Forms 1 μmol of product per liter

A

C

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2
Q

Which of the following statements describes a
nonkinetic enzyme assay?
A. Initial absorbance is measured followed by a
second reading after 5 minutes
B. Absorbance is measured at 10-second intervals
for 100 seconds
C. Absorbance is monitored continuously for
1 minute using a chart recorder
D. Reflectance is measured from a xenon source
lamp pulsing at 60 Hz

A

A

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3
Q

Which of the following statements regarding
enzymatic reactions is true?
A. The enzyme shifts the equilibrium of the reaction
to the right
B. The enzyme alters the equilibrium constant of
the reaction
C. The enzyme increases the rate of the reaction
D. The enzyme alters the energy difference between reactants and products

A

C

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4
Q

Which statement about enzymes is true?
A. An enzyme alters the Gibb’s free energy of the
reaction
B. Enzymes cause a reaction with a positive free
energy to occur spontaneously
C. An enzyme’s natural substrate has the highest Km
D. A competitive inhibitor will alter the apparent
Km of the reaction

A

D

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5
Q

Which substrate concentration is needed to
achieve zero-order conditions?
A. Greater than 99 × Km
B. [S] = Km
C. Less than 10 × Km
D. [S] =

A

A

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6
Q

Which of the following statements is true?
A. Apoenzyme + prosthetic group = holoenzyme
B. A coenzyme is an inorganic molecule required
for activity
C. Cofactors are as tightly bound to the enzyme as
prosthetic groups
D. All enzymes have optimal activity at pH 7.00

A

A

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7
Q

Which of the following statements about
enzymatic reactions is true?
A. NADH has absorbance maximas at 340
and 366 nm
B. Enzyme concentration must be in excess to
achieve zero-order kinetics
C. Rate is proportional to substrate concentration in a zero-order reaction
D. Accumulation of the product increases the
reaction rate

A

A

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8
Q

The increase in the level of serum enzymes used to
detect cholestatic liver disease is caused mainly by:
A. Enzyme release from dead cells
B. Leakage from cells with altered membrane
permeability
C. Decreased perfusion of the tissue
D. Increased production and secretion by cells

A

D

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9
Q

Which of the following enzymes is considered
most tissue specific?
A. Creatine kinase (CK)
B. Amylase
C. Alkaline phosphatase (ALP)
D. Alcohol dehydrogenase (ADH)

A

D

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10
Q

Which of the following enzymes is activated by
calcium ions?
A. CK
B. Amylase
C. ALP
D. LD

A

B

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11
Q

Which of the following enzymes is a transferase?
A. ALP
B. CK
C. Amylase
D. LD

A

B

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12
Q

Which statement about methods for measuring
LD is true?
A. The formation of pyruvate from lactate (forward
reaction) generates NAD+
B. The pyruvate-to-lactate reaction proceeds at
about twice the rate as the forward reaction
C. The lactate-to-pyruvate reaction is optimized at
pH 7.4
D. The negative-rate reaction is preferred

A

B

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13
Q

Which statement about methods for measuring
LD is true?
A. The formation of pyruvate from lactate (forward
reaction) generates NAD+
B. The pyruvate-to-lactate reaction proceeds at
about twice the rate as the forward reaction
C. The lactate-to-pyruvate reaction is optimized at
pH 7.4
D. The negative-rate reaction is preferred

A

B

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14
Q

Which condition produces the highest elevation
of serum lactate dehydrogenase?
A. Pernicious anemia
B. Myocardial infarction
C. Acute hepatitis
D. Muscular dystrophy

A

A

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15
Q

In which condition is the LD most likely to be
within normal limits?
A. Hepatic carcinoma
B. Pulmonary infarction
C. Acute appendicitis
D. Crush injury

A

C

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16
Q

The LD pleural fluid:serum ratio for a transudative
fluid is usually:
A. 3:1 or higher
B. 2:1
C. 1:1
D. 1:2 or less

A

D

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17
Q

In which type of liver disease would you expect the
greatest elevation of LD?
A. Toxic hepatitis
B. Alcoholic hepatitis
C. Cirrhosis
D. Acute viral hepatitis

A

A

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18
Q

Which of the following conditions will interfere
with the measurement of LD?
A. Slight hemolysis during sample collection
B. Storage at 4°C for 3 days
C. Storage at room temperature for 16 hours
D. Use of plasma collected in heparin

A

A

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19
Q

In the Oliver–Rosalki method, the reverse reaction
is used to measure CK activity. The enzyme(s)
used in the coupling reactions is (are):
A. Hexokinase and G-6-PD
B. Pyruvate kinase and LD
C. Luciferase
D. Adenylate kinase

A

A

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20
Q

In the Oliver–Rosalki method for CK, adenosine
monophosphate (AMP) is added to the substrate
in order to:
A. Inhibit adenylate kinase
B. Block the oxidation of glutathione
C. Increase the amount of ADP that is available
D. Block the action of diadenosine pentaphosphate

A

A

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21
Q

Which substance is used in the CK assay to
activate the enzyme?
A. Flavin adenine dinucleotide (FAD)
B. Imidazole
C. N-acetylcysteine
D. Pyridoxyl-5´-phosphate

A

C

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22
Q

SITUATION: A physician calls to request a CK
on a sample already sent to the laboratory for
coagulation studies. The sample is 2-hour-old
citrated blood and has been stored at 4°C. The
plasma shows very slight hemolysis. What is the
best course of action and the reason for it?
A. Perform the CK assay on the sample because no
interferent is present
B. Reject the sample because it is slightly hemolyzed
C. Reject the sample because it has been stored
too long
D. Reject the sample because the citrate will
interfere

A

D

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23
Q

Which of the following statements regarding total
CK is true?
A. Levels are unaffected by strenuous exercise
B. Levels are unaffected by repeated intramuscular
injections
C. Highest levels are seen in Duchenne’s muscular
dystrophy
D. The enzyme is highly specific for heart injury

A

C

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24
Q

Which of the following statements regarding the
clinical use of CK-MB (CK-2) is true?
A. CK-MB becomes elevated before myoglobin
after an AMI
B. CK-MB levels are usually increased in cases of
cardiac ischemia
C. CK-MB is more specific than myoglobin
D. An elevated CK-MB is always accompanied by
an elevated total CK

A

C

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25
Q

Which of the following statements regarding the
clinical use of CK-MB (CK-2) is true?
A. CK-MB becomes elevated before myoglobin
after an AMI
B. CK-MB levels are usually increased in cases of
cardiac ischemia
C. CK-MB is more specific than myoglobin
D. An elevated CK-MB is always accompanied by
an elevated total CK

A

C

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26
Q

A patient’s CK-MB is reported as 18 μg/L and the
total CK as 560 IU/L. What is the CK relative
index (CKI)?
A. 0.10%
B. 3.2%
C. 10.0%
D. 30.0%

A

B

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27
Q

In a nonmyocardial as opposed to a myocardial
cause of an increased serum or plasma CK-MB,
which would be expected?
A. An increase in CK-MB that is persistent
B. An increase in the percent CK-MB as well as
concentration
C. The presence of increased TnI
D. A more modest increase in total CK than
CK-MB

A

A

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28
Q

Which statement best describes the clinical utility
of plasma or serum myoglobin?
A. Levels greater than 100 μg/L are diagnostic
of AMI
B. Levels below 100 μg/L on admission and
2–4 hours postadmission help to exclude a
diagnosis of AMI
C. Myoglobin peaks after the cardiac troponins
but is more sensitive
D. The persistence of myoglobin > 110 μg/L for
3 days following chest pain favors a diagnosis
of AMI

A

B

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29
Q

What is the typical time course for plasma
myoglobin following an AMI?
A. Abnormal before 1 hour; peaks within 3 hours;
returns to normal in 8 hours
B. Abnormal within 3 hours; peaks within 6 hours;
returns to normal in 18 hours
C. Abnormal within 2 hours; peaks within
12 hours; returns to normal in 36 hours
D. Abnormal within 6 hours; peaks within
24 hours; returns to normal in 72 hours

A

C

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30
Q

What is the typical time course for plasma TnI or
TnT following an AMI?
A. Abnormal within 3 hours; peaks within
12 hours; returns to normal in 24 hours
B. Abnormal within 4 hours; peaks within
18 hours; returns to normal in 48 hours
C. Abnormal within 4 hours; peaks within
24 hours; returns to normal in 1 week
D. Abnormal within 6 hours; peaks within
36 hours; returns to normal in 5 days

A

C

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31
Q

Which of the following is the most effective serial
sampling time for ruling out AMI using both
myoglobin and a cardiac specific marker in an
emergency department environment?
A. Admission and every hour for the next 3 hours or until positive
B. Admission, 2 hours, 4 hours, and 6 hours or
until positive
C. Admission, 3 hours, 6 hours, and a final sample
within 12 hours
D. Admission and one sample every 8 hours for
48 hours

A

C

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32
Q

What is the recommended troponin T and I cutoff
(upper limit of normal) for detecting myocardial
infarction?
A. The cutoff varies with the method of assay but
should be no lower than 0.2 ng/mL
B. The upper 99th percentile or lowest level that
can be measured with 10% CV
C. The concentration corresponding to the lowest
level of calibrator used
D. The highest value fitting under the area of the
curve for the 95% confidence interval

A

B

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33
Q

Which of the following cardiac markers is
consistently increased in persons who exhibit
unstable angina?
A. Troponin C
B. Troponin T
C. CK-MB
D. Myoglobin

A

B

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34
Q

A patient has a plasma myoglobin of 10 μg/L at
admission. Three hours later, the myoglobin is
14 μg/L and the troponin I is 0.02 μg/L (reference
range 0–0.03 μg/L). These results are consistent
with which condition?
A. Skeletal muscle injury
B. Acute myocardial infarction
C. Unstable angina
D. No evidence of myocardial or skeletal muscle
injury

A

D

35
Q

A patient has a plasma myoglobin of 10 μg/L at
admission. Three hours later, the myoglobin is
14 μg/L and the troponin I is 0.02 μg/L (reference
range 0–0.03 μg/L). These results are consistent
with which condition?
A. Skeletal muscle injury
B. Acute myocardial infarction
C. Unstable angina
D. No evidence of myocardial or skeletal muscle
injury

A

D

36
Q

Which of the following laboratory tests is a marker
for ischemic heart disease?
A. CK-MB isoforms
B. Myosin light chain 1
C. Albumin cobalt binding
D. Free fatty acid binding protein

A

C

37
Q

Which test becomes abnormal in the earliest stage
of the acute coronary syndrome?
A. Myosin light chain 1
B. CK-MB isoforms
C. Myoglobin
D. High-sensitivity C-reactive protein

A

D

38
Q

Which statement best describes the clinical utility
of B-type natriuretic peptide (BNP)?
A. Abnormal levels may be caused by obstructive
lung disease
B. A positive test indicates prior myocardial
damage caused by AMI that occurred within
the last 3 months
C. A normal test result (<100 pg/mL) helps rule
out congestive heart failure in persons with
symptoms associated with coronary insufficiency
D. A level above 100 pg/mL is not significant if
evidence of congestive heart failure is absent

A

C

39
Q

Which statement best describes the clinical utility
of plasma homocysteine?
A. Levels are directly related to the quantity of LDL
cholesterol in plasma
B. High plasma levels are associated with
atherosclerosis and increased risk of thrombosis
C. Persons who have an elevated plasma
homocysteine will also have an increased
plasma Lp(a)
D. Plasma levels are increased only when there is an inborn error of amino acid metabolism

A

B

40
Q

Which of the following cardiac markers derived
from neutrophils predicts an increased risk for
myocardial infarction?
A. Phospholipase A2 (PLA2)
B. Glycogen phosphorylase BB (GPBB)
C. Soluble CD40 ligand (sCD40l)
D. Myeloperoxidase (MPO)

A

D

41
Q

Which of the following statements about the
aminotransferases (AST and ALT) is true?
A. Isoenzymes of AST and ALT are not found in
humans
B. Both transfer an amino group to α–ketoglutarate
C. Both require NADP+ as a coenzyme
D. Both utilize four carbon amino acids as substrates

A

B

42
Q

Select the products formed from the forward
reaction of AST.
A. Alanine and α–ketoglutarate
B. Oxaloacetate and glutamate
C. Aspartate and glutamine
D. Glutamate and NADH

A

B

43
Q

Select the products formed from the forward
reaction of ALT.
A. Aspartate and alanine
B. Alanine and α–ketoglutarate
C. Pyruvate and glutamate
D. Glutamine and NAD+

A

C

44
Q

Which of the statements below regarding the
methods of Henry for AST and ALT is correct?
A. Hemolysis will cause positive interference in
both AST and ALT assays
B. Loss of activity occurs if samples are frozen
at –20°C
C. The absorbance at the start of the reaction should not exceed 1.0 A
D. Reaction rates are unaffected by addition of
P-5´-P to the substrate

A

A

45
Q

Select the coupling enzyme used in the kinetic
AST reaction of Henry.
A. LD
B. Malate dehydrogenase
C. Glutamate dehydrogenase
D. G-6-PD

A

B

46
Q

What is the purpose of LD in the kinetic method
of Henry for AST?
A. Forms NADH, enabling the reaction to be
monitored at 340 nm
B. Rapidly exhausts endogenous pyruvate in the
lag phase
C. Reduces oxaloacetate, preventing product
inhibition
D. Generates lactate, which activates AST

A

B

47
Q

What is the purpose of LD in the kinetic method
of Henry for AST?
A. Forms NADH, enabling the reaction to be
monitored at 340 nm
B. Rapidly exhausts endogenous pyruvate in the
lag phase
C. Reduces oxaloacetate, preventing product
inhibition
D. Generates lactate, which activates AST

A

B

48
Q

Which of the following statements regarding the
naming of transaminases is true?
A. Serum glutamic oxaloacetic transaminase
(SGOT) is the older abbreviation for ALT
B. Serum glutamic pyruvic transaminase (SGPT) is
the older abbreviation for AST
C. SGPT is the older abbreviation for ALT
D. SGOT is the newer abbreviation for AST

A

C

49
Q

Which statement accurately describes serum
transaminase levels in AMI?
A. ALT is increased 5- to 10-fold after an AMI
B. AST peaks 24–48 hours after an AMI and
returns to normal within 4–6 days
C. AST levels are usually 20–50 times the upper
limit of normal after an AMI
D. Isoenzymes of AST are of greater diagnostic
utility than the total enzyme level

A

B

50
Q

Which condition gives rise to the highest serum
level of transaminases?
A. Acute hepatitis
B. Alcoholic cirrhosis
C. Obstructive biliary disease
D. Diffuse intrahepatic cholestasis

A

A

51
Q

In which liver disease is the DeRitis ratio
(ALT:AST) usually greater than 1.0?
A. Acute hepatitis
B. Chronic hepatitis
C. Hepatic cirrhosis
D. Hepatic carcinoma

A

A

52
Q

Which of the following liver diseases produces the
highest levels of transaminases?
A. Hepatic cirrhosis
B. Obstructive jaundice
C. Hepatic cancer
D. Alcoholic hepatitis

A

C

53
Q

Which of the following statements regarding
transaminases is true?
A. ALT is often increased in muscular disease,
pancreatitis, and lymphoma
B. ALT is increased in infectious mononucleosis,
but AST is usually normal
C. ALT is far more specific for liver diseases than
is AST
D. Substrate depletion seldom occurs in assays of
serum from hepatitis cases

A

C

54
Q

Select the most sensitive marker for alcoholic liver
disease.
A. GLD
B. ALT
C. AST
D. γ-Glutamyltransferase (GGT)

A

D

55
Q

Which enzyme is least useful in differentiating
necrotic from obstructive jaundice?
A. GGT
B. ALT
C. 5’ Nucleotidase
D. LD

A

D

56
Q

Which of the following statements about the
phosphatases is true?
A. They hydrolyze adenosine triphosphate and
related compounds
B. They are divided into two classes based upon pH
needed for activity
C. They exhibit a high specificity for substrate
D. They are activated by Pi

A

B

57
Q

Which of the following statements regarding ALP
is true?
A. In normal adults, the primary tissue source is
fast-twitch skeletal muscle
B. Geriatric patients have a lower serum ALP than
other adults
C. Serum ALP levels are lower in children than in
adults
D. Pregnant women have a higher level of serum
ALP than other adults

A

D

58
Q

Which isoenzyme of ALP is most heat stable?
A. Bone
B. Liver
C. Intestinal
D. Placental

A

D

59
Q

Which isoenzyme of ALP migrates farthest toward
the anode when electrophoresed at pH 8.6?
A. Placental
B. Bone
C. Liver
D. Intestinal

A

C

60
Q

Which statement regarding bone-specific ALP
is true?
A. The bone isoenzyme can be measured
immunochemically
B. Bone ALP is increased in bone resorption
C. Bone ALP is used for the diagnosis of
osteoporosis
D. There are two distinct bone isoenzymes

A

A

61
Q

Which of the following statements regarding ALP
is true?
A. All isoenzymes of ALP are antigenically distinct
and can be identified by specific antibodies
B. Highest serum levels are seen in intrahepatic
obstruction
C. Elevated serum ALP seen with elevated GGT
suggests a hepatic source
D. When jaundice is present, an elevated ALP
suggests acute hepatitis

A

C

62
Q

In which condition would an elevated serum
alkaline phosphatase be likely to occur?
A. Small cell lung carcinoma
B. Hemolytic anemia
C. Prostate cancer
D. Acute myocardial infarction

A

A

63
Q

Which condition is least likely to be associated
with increased serum ALP?
A. Osteomalacia
B. Biliary obstruction
C. Hyperparathyroidism and hyperthyroidism
D. Osteoporosis

A

D

64
Q

Which substrate is used in the Bowers–McComb
method for ALP?
A. p-Nitrophenyl phosphate
B. β-Glycerophosphate
C. Phenylphosphate
D. α-Naphthylphosphate

A

A

65
Q

Which of the following buffers is used in the IFCC
recommended method for ALP?
A. Glycine
B. Phosphate
C. 2-Amino-2-methyl-1-propanol
D. Citrate

A

C

66
Q

A serum ALP level greater than twice the elevation
of GGT suggests:
A. Misidentification of the specimen
B. Focal intrahepatic obstruction
C. Acute alcoholic hepatitis
D. Bone disease or malignancy

A

D

67
Q

In which condition is the measurement of acid
phosphatase clinically useful?
A. Measuring the prostatic isoenzyme to screen for
prostate cancer
B. Measuring the enzyme in a vaginal swab extract
C. The diagnosis of hemolytic anemia
D. As a marker for bone regeneration

A

B

68
Q

Which definition best describes the catalytic
activity of amylase?
A. Hydrolyzes second α 1–4 glycosidic linkages of
starch, glycogen, and other polyglucans
B. Hydrolyzes all polyglucans completely to
produce glucose
C. Oxidatively degrades polysaccharides containing
glucose
D. Splits polysaccharides and disaccharides by
addition of water
Chemistry/Apply knowl

A

A

69
Q

Which of the following amylase substrates is
recommended by the IFCC?
A. Starch
B. Maltodextrose
C. Maltotetrose
D. Blocked maltohepatoside

A

D

70
Q

How soon following acute abdominal pain due to
pancreatitis is the serum amylase expected to rise?
A. 1–2 hours
B. 2–12 hours
C. 3–4 days
D. 5–6 days

A

B

71
Q

Which of the following statements regarding the
diagnosis of pancreatitis is correct?
A. Amylase and lipase are as predictive in chronic as in acute pancreatitis
B. Diagnostic sensitivity is increased by assaying
both amylase and lipase
C. Measuring the urinary amylase:creatinine ratio is
useful only when patients have renal failure
D. Serum lipase peaks several hours before amylase after an episode of acute pancreatitis

A

B

72
Q

Which of the following conditions is associated
with a high level of S-type amylase?
A. Mumps
B. Intestinal obstruction
C. Alcoholic liver disease
D. Peptic ulcers

A

A

73
Q

Which of the following statements regarding
amylase methods is true?
A. Requires sulfhydryl compounds for full activity
B. Activity will vary depending on the method used
C. Amyloclastic methods measure the production of
glucose
D. Overrange samples are diluted in deionized water

A

B

74
Q

Which of the following statements regarding
amylase methods is true?
A. Dilution of serum may result in lower than
expected activity
B. Methods generating NADH are preferred
because they have higher sensitivity
C. Synthetic substrates can be conjugated to
p-nitrophenol (PNP) for a kinetic assay
D. The reference range is consistent from method
to method

A

C

75
Q

The reference method for lipase uses olive oil as
the substrate because:
A. Other esterases can hydrolyze triglyceride and
synthetic diglycerides
B. The reaction product can be coupled to NADH
generating reactions
C. Synthetic substrates are less soluble than olive oil
in aqueous reagents
D. Triglyceride substrates cause product inhibition

A

A

76
Q

Which statement about the clinical utility of
plasma or serum lipase is true?
A. Lipase is not increased in mumps, malignancy,
or ectopic pregnancy
B. Lipase is not increased as dramatically as amylase
in acute pancreatitis
C. Increased plasma or serum lipase is specific for
pancreatitis
D. Lipase levels are elevated in both acute and
chronic pancreatitis

A

A

77
Q

The reference method for serum lipase is based
upon:
A. Assay of triglycerides following incubation of
serum with olive oil
B. Rate turbidimetry
C. Titration of fatty acids with dilute NaOH
following controlled incubation of serum with
olive oil
D. Immunochemical assay

A

C

78
Q

The most commonly employed method of assay
for plasma or serum lipase is based on:
A. Hydrolysis of olive oil
B. Rate turbidimetry
C. Immunoassay
D. Peroxidase coupling

A

D

79
Q

Which of the following enzymes is usually
depressed in liver disease?
A. Elastase-1
B. GLD
C. Pseudocholinesterase
D. Aldolase

A

C

80
Q

Which of the following enzymes is usually
depressed in liver disease?
A. Elastase-1
B. GLD
C. Pseudocholinesterase
D. Aldolase

A

C

81
Q

Which enzyme is most likely to be elevated in the
plasma of a person suffering from a muscle wasting
disorder?
A. 5´-Nucleotidase
B. Pseudocholinesterase
C. Aldolase
D. Glutamate dehydrogenase

A

C

82
Q
A
82
Q

Which enzyme is measured in whole blood?
A. Chymotrypsin
B. Glucose-6-phosphate dehydrogenase
C. Glycogen phosphorylase
D. Lipase

A

B

82
Q

Which enzyme is most likely to be elevated in the
plasma of a person suffering from a muscle wasting
disorder?
A. 5´-Nucleotidase
B. Pseudocholinesterase
C. Aldolase
D. Glutamate dehydrogenase

A

C

CLINICAL CHEMISTY (HARR) (8 decks)

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