MALAWI COLLEGE OF HEALTH SCIENCES

CLINICAL CHEMISTRY EXAMINATION

2Hrs 30 minutes
Answer All Questions

1. What apparent acid-base disturbance will be present if a blood sample is submitted to the laboratory
incorrectly:
i. Not sealed? 2 marks
ii. Not on Ice? 2 Marks

2. What is the difference between metabolic alkalosis and respiratory alkalosis by giving a good
example in each disorder? 6marks
3. Explain what result you will expect if a blood sample for Random Glucose Test is brought to the
Laboratory 8Hrs after the collection time in a plain red tube specimen bottle 6marks

4. What picture of bilirubin would you normally see in neonatal Jaundice and why? 4marks

CHOOSE THE CORRECT ANSWER

(i). In haemolytic crisis, can you expect bilirubin levels to be? 1 mark

(a) Normal (b) increased (C) unchanged (d) deceased

(ii). In Prehepatic jaundice, Bilirubin/Urobilinogen is detected in urine 1 mark

(iii). In post-hepatic jaundice, Bilirubin/ Urobilinogen is in Urine 1 mark

(iv). Both Bilirubin/Urobilinogen are detected in urine in Hepatic/ Pos-thepatic jaundice. 1 mark

(v). ALT/ALP rises in obstructive liver disorder. 1 mark

(vi). ALT/ALP rises in Viral hepatitis 1 mark

(vii). AST/ALT would rise more in alcoholism 1 mark

(viii). PALE/DARK Coloured stools are observed in haemolytic Jaundice. 1 mark

(ix) Please match these biochemical tests with its Correct answers.

(i) Biochemical tests done determine whether a condition is present sub-clinically. b

(ii) Biochemical tests to follow the course of illness or response to therapy. c

(iii) Serial measurement of plasma cholesterol concentration. A

a. Prognosis

b. Screening

c. Monitoring
Case 1.

A 50-year-old man with a 2-week history of diarrhea. On examination he is dehydrated and his breathing
is deep and noisy.

Blood gas results:

[H+) 64nmol/L (35-45)

pCo2 2.8kPa (4.6- 6.0)

[HCO3-] 8mmol/L (21- 28)

a). What is the primary acid-base disorder? 2 marks

b). Explain the likely cause of the disorder named in (i) above? 4 marks

c). Explain the “deep” breathing by the patient 4 marks

Case 2

A 30-year-old woman presented with a 3-month history of palpitations and 5kg weight loss. She had not
any symptoms of neck pain. On examinations, she had a fine tremor, warm moist hands, lid retraction
and lid lag. The thyroid was diffusely enlarged: no bruit was heard.

rT4: 56 pmol/L (10-24) TSH: <0.01µu/mL (0.35-5.5)

a) What do the clinical findings and biochemical tests indicate? 2 marks

b) Explain three possible causes of the condition mentioned above? 6 marks

c) State other 2 test that would help to validate the diagnosis 2 marks

d) Discuss 3 treatment options available for this patient, and its disadvantage 9 marks
The patient agreed to have Radioactive Iodine therapy, and was seen at a follow up visit 2 months
later, with the following thyroid function tests

fT4: 7.2 (10-24), TSH :10.8 (0.35 - 5.5)

e) Explain what is happening to this patient now 2 marks

Case 3

A 63-year old woman complained of intermittent diarrhea, weakness, weight loss and fainting attacks.
On examination she appeared pale, there was no jaundice, clubbing or lymphadenopathy. The pulse rate
was 104 with a normal BP. The cardiac apex was hyperkinetic, but there were no signs of cardiac failure.

FBC: Hb 7.2g/dL, (10.9 – 17.3), MCV 55 (71.95), MCHC 19 (33.36)

NORMAL RANGES

Iron studies, Plasm Fe 7umol/L (9 - 30)

Plasma transferring 60 umol/L (2 - 3.6)

Saturation % …………….. (20 - 55)

Ferritin 8ug\L ( 15 – 300)

i. What is the cause of the Anaemia, and what is the evidence for this conclusion? 4 marks

ii. What further investigations will be required?

iii. Explain what the value of calculated saturation% mean in relate to iron in the body? 2 marks
Case 4.

A 45-year-old Woman, was admitted to the OPD with complaints of nausea, vomiting, chills, fever, and
severe right upper quadrant pain. She had experienced similar symptoms a few times in the last 6
months. The following laboratory results were obtained:

Reference Range

Total Bilirubin 425 µmol/L 3.4 – 25.0

Conjugated Bilirubin 197 µmol/L 0 – 7.3

AST 100 IU/L 5 – 40

ALP 645 IU/L 30 – 157

ALT 105 IU/L 5 – 40

Albumin 40g/L 35 – 50

Total Protein 74 g/L 60 – 80

ɏGT 400 IU/L 2 – 30

A. List the abnormal results. 2 marks

B. What is the most likely diagnosis? Provide evidence for your answer, 4 marks

C. What abnormal results would you likely find in Urine and Stool for this patient? 2 marks

D. What is the cause of Jaundice in this woman? 4 marks

END OF QUESTION PAPER