Holoenzyme define as?

• A. Whole enzyme molecule;

apoenzyme + cofactor
• B. Protein portion of enzymes
• C. Non-protein portion of enzymes,
can be organic or organic
• D. AOTA
• Ans. A

• APOENZYME- is the protein portion of

enzymes
• COFACTOR - is Non-protein portion of
enzymes, can be organic or organic
PEPSINOGEN defined as the
following, except;
A. Inactive form of enzyme pepsin
B. Promotes protein digestion
C. Produced by the zymogenic
cells
D. Produced by the liver
• Ans. D

LIVER is producing
PLASMINOGEN not
PEPSINOGEN
All enzymes rises when a patient is
suffering from a sudden heart
attack except :

A. CK
B. Troponin I
C. LDH
D. ALP
• Ans. B.

ALP is specific sa bones

( But TROPONIN I is the most
specific in heart)
CK and LDH also rises
What enzyme that is
photosensitive?

A. LDH
B. CK
C. ALP
D. NOTA
Ans. B.

CK are stored in the dark since

it has been found that CK is
inactivated by light
What is the most sensitive
enzymatic indicator of
hepatobiliary disease?

A. ACP
B. ALP
C. GGT
D. SGPT
• Ans. C.

• GGT ( Gamma Glutamyl Transferase)

ACP: elevated in Prostatic Carci,
Gaucher Dx- bone dxx.)
• ALP: highest in Paget’s dx- osteitis
deformans, hyperparathyroidism,
rickets, osteomalcia
• SGPT: highest in acute liver hepatitis
Which of the following is a non
metallic cofactor activator?

A. Zinc for amylase

B. Chloride for amylase
C. Magnesium for CK
D. Calcium for amylase
• Ans. B- CHLORIDE

• ALL ARE METALLIC

COFACTOR ACTIVATOR
Enzymatic activity can be expressed
either in IU or KU. What unit of
measurement used in as define as
“mole of subrate per second”

A. International Unit
B. SI unit
C. Katal unit
D. Convetional unit
• Ans. C

• IU: micromole of substrate per

minute ; Aka as U/L
• SI: a system of physical units ( SI
units ) based on the meter,
kilogram, second,
Highest elevation of LDH is
found in,
A. Megaloblastic anemia
(Pernicious anemia)
B. Most liver dxx
C. Nephrotic syndrome
D. Hypothyroidism
• Ans. A.
• Megalobastic anemia (also high in
carcinomas, hepatic metastases,
systemic shock, hypoxis hepat, renal
infaction)
• B to D are ALL slight elevation and
Moderate elev. myocardial, pulmoary
infaction, leukemia, hemolytic cond,
IM, Muscular dysthrophy.
True or false CK are
usually higher in males
than females?
• Ans. TRUE ( due to
different in muscle mass)
 LIPIDS AND
LIPOPROTEINS
1.Following ultracentrifugation of plasma,
which fraction correlates with pre-
βlipoprotein?

A.Very low-density lipoprotein (VLDL)

B. Low-density lipoprotein (LDL)
C. High-density lipoprotein (HDL)
D. Chylomicrons

Chemistry/Apply principles of special procedures/ Lipoproteins/2

A. Very low-density lipoprotein
(VLDL)
 The VLDL (very low-density lipoprotein) migrates in the
pre-β zone
 about 50% triglyceride, whereas LDL is only 10%
triglyceride by weight.
 LDL is formed from VLDL in the circulation. The process
is initiated by apoC-II on VLDL activating peripheral
lipoprotein lipase.
 Hydrolysis of triglycerides and transfer of apoproteins
from VLDL to HDL result in formation of IDL.
 Larger IDLs are returned to the liver as remnant
lipoproteins. Further hydrolysis of triglycerides, transfer
cholesterol esters from HDL, and transfer of apoproteins
to HDL convert IDL to LDL.
2.Select the lipoprotein fraction that carries
most of the endogenous triglycerides.

A.VLDL
B. LDL
C. HDL
D. Chylomicrons

Chemistry/Correlate laboratory data with physiological

processes/Lipoproteins/2
A.VLDL

The VLDL is formed in the liver largely

from chylomicron remnants and hepatic-
derived triglycerides.
Therefore, the VLDL transports the
majority of endogenous triglycerides,
while the triglycerides of chylomicrons are
derived entirely from dietary absorption.
3.The protein composition of HDL is what
percentage by weight?

A. Less than 2%
B. 25%
C. 50%
D. 90%

Chemistry/Correlate laboratory data with physiological

processes/Lipoproteins/1
C. 50%

About 50% of the weight of HDL is

protein, largely apo A-I and apo A-II.
The HDL is about 30% phospholipid and
20% cholesterol by weight.
The HDL binds and esterifies free
cholesterol from cells and transports it to
the liver, where it can be eliminated in the
bile.
4.Which apoprotein is inversely related to
risk of coronary heart disease?

A.Apoprotein A-I
B. Apoprotein B100
C. Apoprotein C-II
D. Apoprotein E4

Chemistry/Correlate clinical and laboratory data/ Lipoproteins/2

A.Apoprotein A-I
 Apoprotein A-I and apo A-II are the principal
apoproteins of HDL, and low apo A-I has a high
correlation with atherosclerosis. Conversely, apo-
B100 is the principal apoprotein of LDL, and an
elevated level is a major risk factor in developing
coronary heart disease.
 Apoprotein assays are not recommended as screening
tests because they are not as well standardized as LDL
cholesterol assays. However, apo-B100 assay is more
sensitive than LDL cholesterol in predicting coronary
artery disease risk.
 Apo-B100 may be abnormal in persons with increased
small dense LDL. Small dense LDL is more atherogenic
than large LDL molecules.
 In addition, persons with hyperapobetalipoproteinemia
overproduce apo-B100 without having significantly
elevated LDL cholesterol.
5.In familial βdyslipoproteinemia (formerly
type III hyperlipoproteinemia), which
lipoprotein accumulates?

A.Chylomicrons
B. VLDL
C. IDL
D. VLDL

Chemistry/Correlate clinical and laboratory data/ Lipoproteins/2

C. IDL
 IDLs have roughly equal amounts of cholesterol and
triglyceride
 has a density of about 1.006–1.020, causing it to float on
the 1.063 density potassium bromide solution used to
recover LDL by ultracentrifugation.
 has faster electrophoretic mobility on agarose than beta
lipoprotein.These observations gave rise to the terms
“floating beta” and “broad beta,” respectively.
 Familial dysbetalipoproteinemia is in part caused by a
polymorphism of apoE (apo-E2) that has poor affinity for
the apo-E receptor on hepatocytes. Not all persons with
the homozygous polymorphism develop the disease;
thus, other factors are necessary for the accumulation of
IDL.
6.Which of the following mechanisms
accounts for the elevated plasma level of
βlipoproteins seen in familial
hypercholesterolemia (formerly type II
hyperlipoproteinemia)?

A.Hyperinsulinemia
B. ApoB-100 receptor defect
C. ApoC-II activated lipase deficiency
D. ApoE3 deficiency

Chemistry/Apply knowledge of fundamental biological

characteristics/Lipoproteins/2
B. ApoB-100 receptor defect
 The production of excess insulin leads to
hypertriglyceridemia and is one mechanism
responsible for familial endogenous
hypertriglyceridemia.
 ApoC-II is an activator of lipoprotein lipase, and a
homozygous deficiency results in high plasma
chylomicrons and VLDL.
 ApoE3 deficiency is synonymous with inheritance of two
apo-E2 alleles that lead to βdyslipoproteinemia.
 Familial hypercholesterolemia is inherited as an
autosomal dominant trait. The classical form results
from one of many mutations affecting the LDL receptor
that cause it to have a lower affinity for LDL. A related
hypercholesterolemia common in people of European
ancestry results from a mutation of the apo-B100 gene
that causes LDL to have a lower affinity for the LDL
receptor. Together, they make familial
hypercholesterolemia the most common inherited
hyperlipoproteinemia with a frequency over 1:500.
7.Which enzyme deficiency is most
commonly associated with familial
hypertriglyceridemia associated with
fasting plasma cholomicrons (formerly
type I hyperlipoproteinemia)?

A.βGlucocerebrosidase deficiency
B. Post–heparin-activated lipoprotein lipase
deficiency
C. Apo-B deficiency
D. Apo-C-III deficiency

Chemistry/Correlate clinical and laboratory data/ Lipoproteins/2

B. Post–heparin-activated lipoprotein lipase
deficiency

 Deficiency of capillary endothelial lipase is the most

common cause of fasting chylomicronemia. This lipase is
also known as post–heparinactivated lipase and
apo C-II–activated lipase.
 β Glucocerebrosidase deficiency results in
accumulation of glucocerebrosides and is the cause of
Gaucher’s disease.
 ApoC-II deficiency results in decreased activity of
peripheral and hepatic lipases and is associated with
hypertriglyceridemia.
 Apo-B deficiency resulting from a point mutation in the
apo-B gene, is responsible for hypobetalipoproteinemia,
and is inherited as an autosomal dominant trait.
 LDL levels are about half normal in heterozygotes, and
this reduces their risk of coronary artery disease.
8.Which of the following conditions is most
consistently associated with secondary
hypercholesterolemia?

A.Hypothyroidism
B. Pancreatitis
C. Oral contraceptive therapy
D. Diabetes mellitus

Chemistry/Correlate clinical and laboratory data/Lipoproteins/2

A.Hypothyroidism

 The conditions listed are very commonly encountered

causes of secondary hyperlipoproteinemia.
 Oral contraceptives, pregnancy, and estrogens
may cause secondary hypertriglyceridemia owing to
increased VLDL and endogenous triglycerides.
 Hypothyroidism and obstructive hepatobiliary
diseases are usually associated with secondary
hypercholesterolemia owing to high LDL.
 Diabetes mellitus and chronic pancreatitis may
produce hypertriglyceridemia, chylomicronemia, or
mixed hyperlipidemia
9.Which of the following is associated with
Tangier disease?

A.Apoprotein C-II deficiency

B. Homozygous apo-B100 deficiency
C. Apoprotein C-II activated lipase
D. Apoprotein A-I deficiency

Chemistry/Correlate clinical and laboratory data/ Lipoproteins/2

D. Apoprotein A-I deficiency

 Deficiency of apo A-I is seen in Tangier disease, a

familial hypocholesterolemia. Heterozygotes have about
half of the normal level of HDL (familial
hypoalphalipoproteinemia) and homozygotes have
almost no detectable HDL.
 Tangier disease is caused by a mutation of the ATP-
binding cassette gene. The deficient gene prevents apo A-
I from binding lipids, and it is rapidly catabolized.
 Abetalipoproteinemia results from defective hepatic
transport of apo-B100, and is also inherited as an
autosomal recessive condition. LDL is absent, and the
condition is associated with hemolytic anemia and
central nervous system damage.
10. What is the lipid testing protocol for adults
recommended by the National Cholesterol
Education Program (NCEP) to evaluate risk for
atherosclerosis beginning at age 20?

A.Total cholesterol, fasting or nonfasting every

year
B. Total cholesterol, fasting, every 2 years
C. Lipid profile, fasting, every 5 years
D. LDL cholesterol, fasting, every 2 years

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/1

C. Lipid profile, fasting, every 5 years

 Because LDL cholesterol, HDL cholesterol,

VLDL cholesterol, and triglycerides are all risk
factors for coronary artery disease,
 NCEP recommends a fasting lipid profile to
include triglycerides, total cholesterol, HDL
cholesterol, and LDL cholesterol be performed
every 5 years beginning at age 20.
 However, because LDL cholesterol is the target
of treatment, therapeutic goals are based on the
LDL cholesterol.
 New guidelines recommend an LDL cholesterol
goal below 70 mg/dL for the highest-risk
persons.
11.What is the most appropriate fasting procedure
when a lipid study of triglyceride, total
cholesterol, HDL cholesterol, and LDL
cholesterol tests are ordered?

A. 8 hours; nothing but water allowed

B. 10 hours; water, smoking, coffee, tea (no sugar
or cream) allowed
C. 12 hours; nothing but water allowed
D. 16 hours; water, smoking, coffee, tea (no sugar
or cream) allowed

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/1

C. 12 hours; nothing but water allowed

Lipid orders that include triglyceride and

LDL cholesterol should always be
performed using a plasma or serum
specimen collected after a 12–14 hour
fast.
The patient should be instructed to drink
nothing but water during this period.
Fasting specimens are preferred for total
and HDL cholesterol as well, but
nonfasting specimens may be used for
initial screening purposes.
12. Treatment recommendations for patients
with coronary heart disease are based
upon measurement of which analyte?

A.HDL cholesterol
B. Apo-B100
C. LDL cholesterol
D. Total cholesterol

Chemistry/Evaluate laboratory data to recognize health and disease

states/Lipids/1
C. LDL cholesterol

 NECP has identified LDL cholesterol as the target of

therapy for reducing the risk of heart attack because
lowering LDL cholesterol has proven to be an effective
intervention.
 The greater the risk of coronary heart disease, the lower
the cutpoint for intervention.
 For persons at high risk (a 10-year risk of heart attack >
20%) the cutpoint is ≥ 100 mg/dL for initiation of statin
therapy.
 For highest-risk persons (those that have acute coronary
syndrome, and multiple or uncontrolled risk factors) the
treatment goal is LDL cholesterol below 70 mg/dL
13.What is the HDL cholesterol cutpoint
recommend by NCEP?

A.<30 mg/dL
B. <40 mg/dL
C. <30 mg/dL for males and < 40 mg/dL for
females
D. <45 mg/dL for males and < 50 mg/dL for
females

Chemistry/Evaluate laboratory data to recognize health and disease

states/Lipids/1
B. <40 mg/dL

 The HDL cholesterol cutpoint recommended by

NCEP is < 40 mg/dL regardless of sex.
 A result below 40 mg/dL counts as a risk factor
for coronary artery disease.
 Conversely, if the HDL cholesterol is ≥ 60
mg/dL, then one risk factor is subtracted from
the total number.
 The therapeutic goal for someone with low HDL
cholesterol is still reduction of LDL cholesterol
(if elevated), weight loss, and increased exercise.
14.An EDTA blood sample is collected from a
nonfasting person for a CBC. The physician
collected the sample from the femoral vein
because venipuncture from the arm was
unsuccessful. He called the lab 15 minutes after
the sample arrived and requested a lipid study
including triglyceride, total cholesterol, HDL
cholesterol, and LDL cholesterol. Which test
results should be used to evaluate the patient’s
risk for coronary artery disease?

A. Total cholesterol and LDL cholesterol

B. LDL cholesterol and triglyceride
C. Total cholesterol and HDL cholesterol
D. Total cholesterol and triglyceride

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/3

C. Total cholesterol and HDL cholesterol

 NCEP recommends a 12-hour fasting sample when

screening persons for risk of coronary artery disease.
However, if a fasting sample is unavailable,
 NCEP recommends performing the total cholesterol
and HDL cholesterol because these tests are least
affected by recent ingestion of food.
 If the total cholesterol is ≥ 200 mg/dL or the HDL
cholesterol is < 40 mg/dL, then testing for LDL
cholesterol and triglycerides should be performed when
a fasting sample can be obtained.
 An EDTA plasma sample is acceptable for most
enzymatic cholesterol and triglyceride assays.
15. Which method is considered the
candidate reference method for
triglyceride measurement?

A.Glycerol kinase-ultraviolet
B. CDC modification of van Handel and
Zilversmit
C. Hantzsch condensation
D. Glycerol kinase coupled to peroxidase

Chemistry/Apply principles of basic laboratory procedures/Lipids/1

B. CDC modification of van Handel and Zilversmit
 Enzymatic methods for triglyceride measurement are
widely used because they eliminate the need for
extraction and saponification. However, they are subject
to positive interference from endogenous glycerol and
variations in the efficiency of lipase, which can result in
under- or overestimation of triglycerides
 The most accurate method for triglyceride assay is the
nonenzymatic method based upon reaction of
formaldehyde with chromotropic acid. In this method,
extraction with silicic acid and chloroform separates
triglycerides from lipoproteins, phospholipids, and
glycerol
 Saponification with alcoholic potassium hydroxide
(KOH) produces glycerol, which is oxidized to
formaldehyde by periodate. The formaldehyde reacts
with chromotropic acid to form a pink product.
16.Which of the following enzymes is
common to all enzymatic methods for
triglyceride measurement?

A.Glycerol phosphate oxidase

B. Glycerol phosphate dehydrogenase
C. Glycerol kinase
D. Pyruvate kinase

Chemistry/Apply principles of basic laboratory procedures/Lipids/2

C. Glycerol kinase

All enzymatic triglyceride methods require lipase

to hydrolyze triglycerides, and glycerol kinase
to phosphorylate glycerol, forming glycerol-3-
phosphate. The most common method couples
glycerol kinase with glycerol phosphate oxidase
and peroxidase.
17.Select the reagent needed in the coupling
enzyme reaction used to generate a
colored product in the cholesterol oxidase
method for cholesterol.

A.Cholestahexaene
B. H2O2
C. 4-Aminoantipyrine
D. Cholest-4-ene-3-one

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/2

C. 4-Aminoantipyrine

 In the cholesterol oxidase method, cholesterol

ester hydrolase converts cholesterol esters to free
cholesterol by hydrolyzing the fatty acid from the
C3-OH group.
 Cholesterol oxidase catalyzes the oxidation of
free cholesterol at the C3-OH group forming
cholest-4-ene-3-one and hydrogen
peroxide. The peroxide is used in a peroxidase
reaction to oxidize a dye (e.g., 4-
aminoantipyrine), which couples to phenol,
forming a red quinoneimine complex.
18.What is the purpose of the saponification
step used in the Abell–Kendall method for
cholesterol measurement?

A.Remove phospholipids
B. Reduce sterol molecules structurally
similar to cholesterol
C. Convert cholesterol esters to free
cholesterol
D. Remove proteins that can interfere with
color formation

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/2

C. Convert cholesterol esters to free cholesterol

The Abell–Kendall method is the reference method for

cholesterol assay because differences in esterase activity
and interference in the peroxidase step are potential
sources of error in enzymatic assays.
Saponification is performed to hydrolyze the fatty acid
esters of cholesterol, forming free cholesterol. This is
required because the reagents react more intensely with
cholesterol esters than with free cholesterol.
Saponification is followed by extraction of cholesterol in
petroleum ether to separate it from proteins and
interfering substances.
The extract is reacted with sulfuric acid, acetic anhydride,
and acetic acid (Liebermann–Burchard reagent),
which oxidizes the cholesterol and forms a colored
product.
19.Which of the following methods for HDL
cholesterol is the reference method?

A.Manganese–heparin
B. Magnesium–phosphotungstate
C. Magnesium–dextran
D. Ultracentrifugation

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/1

D. Ultracentrifugation
 Ultracentrifugation of plasma in a potassium bromide
solution with a density of 1.063 is used to separate HDL
from LDL and VLDL.
 The HDL fraction is transferred from the bottom of the
tube and assayed for cholesterol content by the Abell–
Kendall method. The remaining three methods rely upon
selective precipitation of lipoproteins containing
apoprotein B using a polyanionic solution.
 All of these methods are subject to interference by very
high triglycerides and vary somewhat in specificity
depending on the efficiency of precipitation.
20. Which of the following reagents is used
in the direct HDL cholesterol method?

A.Sulfated cyclodextrin A.Sulfated

cyclodextrin
B. Magnesium sulfate and dextran sulfate
C. Anti-apoA-I
D. Manganese heparin

Chemistry/Apply knowledge of basic laboratory procedures/Lipids/2

A.Sulfated cyclodextrin

 The direct HDL cholesterol method most

commonly employed uses cholesterol esterase
and oxidase enzymes conjugated to
polyethylene glycol.

 In the presence of sulfated cyclodextrin, the

enzymes do not react with non-HDL cholesterol
molecules.

 Anti-apoA-I binds to HDL and is not used in

HDL assays.
Harr, Robert R. Medical laboratory science review / Robert R.
Harr. — 4th ed. p. ; cm. Rev. ed. of: Clinical laboratory
science review / [edited by] Robert R. Harr. c2007. Includes
bibliographical references. ISBN 978-0-8036-2828-1 — ISBN
0-8036-2828-5 I. Clinical laboratory science review. II. Title.
[DNLM: 1. Clinical Laboratory Techniques—Examination
Questions. 2. Biomedical Technology— Examination
Questions. 3. Chemistry, Clinical—methods—Examination
Questions. QY 18.2]
610.72´4—dc23
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