a. Dehydration of homogentisic acid

b.Hydrolysis of homogentisic acid

c.Oxidation of homogentisic acid

d. Reduction of homogentisic acid

1. Cystathionine B synthase

2. Cystathionase

3. Methionine adenosyl transferase

4. Methionine synthase

1. Hartnup disease

2. Phenylketonuria

3. Alkaptonuria

4. Cystinuria

1. Induction of enzymes of gluconeogenesis

2. Allosteric activation of fructose 1,6 bisphosphatase

3. Allosteric inhibition of glycogen synthase by glucose-6-phosphate

4. Increased production of acetyl CoA from pyruvate

Tyrosine

Tryptophan

Phenylalanine

Isoleucine

1. Insulin

2. Epinephrine s

3. Thyroid hormone

4. Glucagon

1. It does not have a very strong genetic predisposition

2. It is treated only with insulin

3. Frequency of ketosis is very common

4. Insulin levels are high early in the disease

a. Insulin

b. Epinephrine

C. Glucocorticoids

d. Glucagon

1. Ornithine transcarbamylase

2. Arginase I

3. Carbamoyl phosphate synthase I

4. Argino succinate synthase

1. Decreased activity of lipoprotein lipase

2. Decreased activity of hormone-sensitive lipase

3. Increased activity of pyruvate kinase

4. Increased activity of glycerol kinase

1. Aminopeptidase

2. Pepsin

3. Elastase

4. Carboxypeptidase

a. Ornithine transcarbamylase

b. Arginosuccinate lyase

C. Arginase

d. Arginosuccinate synthetase

1. Malonyl CoA inhibits carnitine palmitoyl transferase I

2. 2. Citrate activates carnitine palmitoyl transferase I

3. Malonyl CoA activates carnitine palmitoyl transferase I

4. Citrate inactivates Acetyl CoA carboxylase

1. Threonine

2. Tyrosine

3. Histidine

4. Tryptophan

1. Phosphoenolpyruvate carboxykinase

2. Pyruvate dehydrogenase

3. Phosphoructokinase 1

4. Glycogen phosphorylase in the muscles

1. GluT 4

2. GluT 1

3. GluT 2

4. GluT 3

1. Alanine

2. Arginine

3. Aspartate

4. Asparagine

1. Glutamate

2. Glutamine

3. Urea

4. Alanine

1. Increased lipolysis of TAG

2. Decreased glycogenolysis

3. Increased glycogenesis

4. Decreased gluconeogenesis

a. 7.3 to 8.2 %

b. 3.2 to 5. 6%

c. 5.7 to 6.4 %

d. 6.4 to 7.2 %

1. Brain

2. Liver

3. Muscles

4. Kidney

1. Beta-oxidation

2. Glycogenolysis

3. Glycolysis

4. Lipogenesis

a. Valine and Glutamine

b. Glutamate and Leucine

c. Alanine and Valine

d. Glutamine and Alanine

a.Induction and repression

b.Allosteric regulation

c. Covalent modification

d.Availability of substrate

a.Lysine

[b.Methionine

C.Glycine

d. Arginine

1. Required for transamination reaction

2. Can utilize either NADH or NADPH as coenzyme

   3. Present in the cytosol of the liver and kidney

a. Acetyl CoA from glucose

b. Pyruvate from glycolysis

C.Pyruvate from glucogenic amino acids

d. Acetyl CoA from beta-oxidation

1. Glucagon

2. 3-hydroxybutyrate

3. Acetoacetate

4. Chylomicrons

1. 1 a and 1 B

2. 2 a and 2 B

3. 1 a and 3 B

4. 3 a and 1 B

4. Glutamine

1. Alanine

2. Glutamate

3. Aspartate

1. Acetyl CoA

2. Succinyl coA

3. Fumarate

4. Oxaloacetate

a. Fructose 6 phosphate

b.Fructose 1-phosphate

c. Fructose 2,6 bisphosphate

d. Fructose 1,6 bisphosphate

1- Urea is a waste product derived from protein metabolism. Name the enzyme that converts urea to ammonia and carbon dioxide.

Ans: Urease

2-What is the device used to measure specific gravity?

Ans: Refractometer, NMultistrip, Ts meter

3-The ____ urinalysis test is done for kidney problems.

4-The _____ urinalysis test is done for ketones and starvation.

5- The ___ urinalysis test is done for infections in kidney.

6- The _________ urinalysis test done for

diabetes mellitus.

7- The ______ urinalysis test is done for biliary obstruction.

8- The ______ urinalysis test is done for Vitamin C

9- Creatinine reacts with ________ to form a color complex.

________________________

Q) Define the following:

1- Liver function test

2- Urinalysis

3- فيه ثالث بس نسيت

Q) Name the principle for serum urea

Q) Why would a doctor order a serum urea test?

Q) Why is the normal color of urine a pale yellow?

________________________

Q) Fill in the table with the appropriate comments:

Urine is blue to green-.

Ans: Biliverdin and Pseudomonas infection

Urine has acetone odor-.

Ans: Diabetes Mellitus

Urine is not clear; urine is turbid-.

Ans: Phosphates and carbonates, WBCs and RBCs,etc…

______________________

Q) Fill in the table and comment.

(كان كل الurinalysis factors موجودة حقت الchemical determination ونكتب الامراض الي يظهر فيه الfactor، مثلا

Nitrite was +, so that patient could have E.Coli.

______________________

Q)Calculations

Determine the concentration of the male patient’s serum creatinine.

Determine the concentration of the male patient’s urine creatinine.

What is the patient’s urine creatinine for a 24hr volume?

Discuss the results.

a. Diagnosis of Prostate cancer

b.Monitoring of treatment of choriocarcinoma

C.Follow-up of ovarian cancer

d. Screening of colorectal cancer

[CLO: 1.2] An 80-year-old male patient came to the emergency in a semi-conscious state with history of inability to pass urine. Blood tests showed high serum urea and creatinine. Investigations showed signs suggestive of prostatic cancer. What type of acute renal failure is the patient suffering from?

a. Renal failure .

Pre-renal failure

c. Post-renal failure

3. [CLO:1.3] Serum creatinine is commonly used to estimate the eGFR. What endogenously produced molecule is more sensitive and specific than creatinine to estimate the eGFR?

1. Uric acid

2. Cystatin C

3. Continuous Inulin infusion

4. Urea

4. [CLO:1.1] How is unconjugated bilirubin mostly transported in the blood?

1. It is freely transported

2. It binds with hemoglobin

3. It binds with albumin

4. It binds with globulin

5. [CLO:2.1] What condition is associated with low specific gravity in the urine?

1. Diabetes Insipidus

2. Diabetes Mellitus

3. Dehydration

4. Congestive cardiac failure

6. [CLO:1.3] A 30-year-old male presented with a painless, enlarged testicle. Ultrasound revealed a testicu mass, and further tests confirmed the diagnosis of a seminomatous germ cell tumor, following which treatment was started. What markers are the best to monitor the treatment in this patient?

a. AFP and PSA

HCG and Calcitonin

HCG and AFP

d.HCG and Acid phosphatase

1. Myoglobin

2. Serum LDH

3. Cardiac troponins

4. Total CK

1. [CLO:1.1] How many pyrrole rings are present in a porphyrin molecule?
   1

   2

   3

   4

2. [CLO:2.1] A newly born preterm infant developed jaundice after three days of birth. He was found to have unconjugated hyperbilirubinemia with a serum bilirubin level of 102 micro-mol/L. However, after 15 days, his bilirubin returned to normal levels. What is the most likely cause of this condition?

1. Viral hepatitis

2. Obstruction to biliary tract

3. C.Deficiency of glucuronyl transferase

d.Deficiency of glucose-6-phosphate dehydrogenase

10. [CLO: 1.1] What is the main site of the synthesis of hemoglobin?

1. Spleen

2. RBCs

3. Liver

4. Bone marrow

11. [CLO:1.2] A 24-hour urine sample collected from a patient showed the presence of Beta-2-macroglobulin.

What type of proteinuria is this?

1. Tubular proteinuria

2. Overflow proteinuria

3. Tamm-Horsefall proteinuria

4. Glomerular proteinuria

12. [CLO: 1.2) Name the enzyme that is defective in erythropoietic protoporphyria (EPP).

1. Uroporphyrinogen Ill synthase

2. Ferrochelatase

3ö-aminolevulinic synthase 1

4Protoporphyrin oxidase

13. [OLO 1.2] A newborn infant developed severe jaundice 12 hours after birth. After investigation, a diagnosis of Crigler Najjar syndrome was made. What metabolic defect is the cause of jaundice in this baby?

Formation of bilirubin

Uptake of bllirubin

Secretion of bilirubin

Conjugation of bilirubin

1. Less than 100 mL per day

2. More than 500 mL per day

3. More than 1000 mL per day

4. Less than 400 mL per day

15. [CLO: 1.3] A 60-year-old man came to the emergency room with complaints of retrosternal chest pain that started 18 hours earlier. What test is the best to exclude myocardial infarction?

Increased levels of serum myoglobin

Normal ECG

c. Normal levels of serum CK

d. Normal levels of cardiac troponin

16. [CLO: 1.3] What is the role of a-fetoprotein in assessing liver function test?

1. It indicates neonatal jaundice in premature infants

2. It indicates the presence of hepatocellular cancer

3. It is a marker of alcohol intake

4. High levels are seen in hemolytic jaundice

17. [CLO:1.2] What condition is associated with a decrease in serum urea level?

1. Chronic renal failure

2. Liver disease

3. 3. Severe dehydration

d. Acute renal failure

18. [CLO:1.2] An 18-year-old patient was brought to the emergency with paracetamol poisoning. What type of jaundice will be seen in this patient?

Obstructive jaundice

Hepatocellular jaundice

Hemolytic jaundice

19. [CLO:1.2] A 2-year-old child presents with irritability, abdominal pain, and developmental delay. Lab results show microcytic anemia with an elevated levels of lead in the blood. What cytosolic enzyme is affected in this baby?

1. Hydroxymethylbilane synthase

2. Uroporphyrinogen III decarboxylase

3. o-aminolevulenic acid dehydratase

4. Ferrochelatase

20. [CLO:1.1] Which tumor marker is a hormone?

CEA

CA-125

HCG

PSA

-Deposition of unconjugated bilirubin in the brain

- Deposition of conjugated bilirubin in the liver

-Deposition of conjugated bilirubin in the brain

-Deposition of unconjugated bilirubin in the liver

2. [CLO: 1.2] A patient with chronic kidney disease is being evaluated for anemia. What is the most likely cause of anemia in this patient? It is mainly due to: a.

Increased red blood cell destruction

Vitamin B12 deficiency

Decreased erythropoietin production

d. Iron deficiency

23. [CLO: 1. 1] What is the major site of conjugation of bilirubin?

1. Gall bladder

2. Intestine

C.Liver

d. Red blood cells

24. [CLO:2.1] Based on the Kidney Disease Improving Global Outcome (KDIGO) Guidelines, what is the range of eGFR in a patient with mild loss of renal function?

1. eGFR between 60 to 89%

2. eGFR between 15 to 29%

3. eGFR greater than 90

4. eGFR between 30 to 44%

25. [CLO:2.1] A 45-year-old female came to the clinic complaining of fever and pain in the lower abdomen. C urine analysis, her urine was alkaline with the presence of struvite crystals. What is the most probable cause of her condition?

1. Tumor lysis syndrome

2. Urinary tract infection

3. Ingestion of ethylene glycol

4. Cystinuria

6. [CLO:1.3] A 25-year-old patient presented with yellowish discoloration of the sclera and was diagnosec with hepatocellular jaundice. What changes will be seen in the serum of this patient?

1. Severe increase in both serum ALP and ALT

2. Severe increase in ALP and decreased ALT

3. Decrease in both serum ALP and ALT

4. Mild increase in serum ALP and severe increase in ALT

Porphyria Cutanea Tarda

Variegate Porphyria

Acute Intermittent Porphyria

Hereditary Coproporphyria

28. [CLO: 1.2] What defect is most commonly observed in a patient with Type 1 Renal Tubular Acidosis?

1. Defect in H* ion secretion in the proximal tubule

2. Decreased capacity to reabsorb bicarbonate in the proximal tubule

3. Defect in H* ion secretion in the distal tubule

4. Decreased capacity to reabsorb bicarbonate in the distal tubule

29. [CLO: 1.2] A known case of porphyria had an acute attack of symptoms. He was administered IV Hemin the hospital, after which his symptoms decreased. What enzyme production is decreased by Hemin in ti patient?

1. Protoporphyrinogen oxidase

2. -Aminolevulinic acid synthase 1

3. Ferrochelatase

4. Uroporphyrinogen Ill synthase

30. [CLO:1.3] A 45-year-old female presented with itching and jaundice. Investigation revealed obstructive jaundice due to the presence of gallstones. What abnormal laboratory finding is most diagnostic in this condition?

1. Increased prothrombin time

2. Increased serum albumin

3. Increased alanine transaminase

Increased alkaline phosphatase

31. [CLO:1.2] What abnormality is seen in the serum sample of a patient with Acute renal failure?

1. Increased serum urea and increased serum creatinine

2. Decreased serum urea and increased serum creatinine

C. Increased serum urea and decreased serum creatinine

d. Decreased serum urea and decreased serum creatinine

32. [CLO:1.3] What serum marker is used to assess the synthetic function of the liver?

Transaminases

b. a-fetoprotein

C. Albumin

Alkaline phosphatase

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