Cc2 Compilations

COMPILED BY:cam cabase
LONG QUIZ 3
DIRECTION. Choose the letter that correspond to the correct answer for numbers for all multiple choice
question. For matching type questions, match column A with column B and choose the letter that corresponds to
the correct answer. A letter can be used as answer more than once. Write all answers on a sheet of paper. You
are not allowed to change your answer.
1. What is a coenzyme?
a. Inorganic ions b. Organic molecules c. Organic molecules containing metals d. Both b and c
2. A coenzyme or metal ion that is very tightly or even covalently bound to the enzyme is called?
a. Holoenzyme b. Prosthetic group c. Apoenzyme d. None of these
3. A complete catalytically active enzyme together with its bound coenzyme is called?
a. Holoenzyme b. Prosthetic group c. Apoenzyme d. None of these
4. The protein part of holoenzyme is called?
a. Apoprotein b. Apoenzyme c. Coenzyme d. Both a and b
5. Which suffix is added to the name of the substrate or to a word or to a phrase describing the activity of
enzyme, to name an enzyme?
a. -Ise b. -Ase c. –Ic d. -Ace
6. Which enzyme transfers phosphate groups?
a. Glucose oxidase b. Hexokinase c. Transferase d. Nuclease
7. The site where enzyme catalyzed reaction takes place is called?

a. Active site b. Catalytic site c. Activity site d. Functional site
8. The molecule that is bound and acted upon by the enzyme is called?
a. Biomolecule b. Substance c. Reactant d. Substrate
9. Who proposed the existence of proteolytic enzymes as proteins?

a. Kuhne b. Hayden c. Sumner d. Northrop
10. What will happen to the enzyme-catalyzed reaction if temperature is increased?

a. Rate of reaction decrease c. Rate of reaction increases
b. Reaction equilibrium shifts forward d. Reaction equilibrium shifts backward
11. What will happen to reaction if more enzymes are added?

a. Rate of reaction decrease c. Rate of reaction increase
12. How metal ions participate in catalysis?
a. By causing reduction and oxidation reactions between enzyme and substrate
b. By causing ionic interactions between enzyme and substrate
c. All of the above
13. What is Vmax?
a. Maximum rate of reaction
b. Rate of reaction increase with increase in enzyme concentration
c. Both a and b
d. None of the above
14. What is Km in Michaelis-Menten equation?
a. Michaelis-Menten constant
b. Substrate
c. Enzyme
d. All of the above
15. Which enzymes are said to follow Michaelis-Menten kinetics?
a. Enzymes which show parabolic dependence of rate of reaction and substrate
b. Enzymes which show circular dependence of rate of reaction and substrate
c. Enzymes which show hyperbolic dependence of rate of reaction and substrate
16. Double-reciprocal plot is also called?

a. Michaelis plot c. Line plot
b. Lineweaver-Burk plot d. Inverse plot
17. Which scientist proposed lock and key model in 1894?
a. Daniel Koshland b . Emil Fischer c. Einstein d. Michael
18. What is induced fit?

a. when enzyme change shape due to absence of substrate
b. when enzyme do not change shape due to absence of substrate
c. when enzyme change shape due to presence of substrate
d. when enzyme do not change shape due to presence of substrate
19. Who postulated induced fit in year1958?
a. Daniel Koshland b. Emil Fischer c. Linus Pauling d. Einstein
20. A purely competitive enzyme inhibitor has which of the following kinetic effects?
A. increases Km without affecting Vmax C. decreases Km without affecting Vmax
B. increases Vmax without affecting Km D. decreases Vmax without affecting Km
E. decreases both Vmax and Km
21. Enzymes as classic catalysts accomplish which of the following energy effects?
A. raise the energy of activation C. lower the energy of activation
B. raise the energy level of the products D. lower the energy levels of the reactants
E. decrease the free energy of the reaction
22. Synthesis of an enzyme promoted by the substrate on which it acts, is characterized by the term
A. activation B. derepression C. gratuity D. induction E.
constitutivity
23. Which statement about the active site is incorrect?

A. It is composed of linearly arranged amino acid chain.
B. It is relatively small compared to the total bulk of the enzyme.
C. It does not generally form covalent interaction with substrates.
D. It is three-dimensional in quality.
E. none of these
24. Which statement about most enzymes is incorrect?
A. They increase the rapidity of the reactions they catalyze.
B. They are specific for the substrate as well as the reaction catalyzed.
C. They are large polypeptides with high molecular weight.
D. They are most active near neutral pH.
E. They are not affected by changes in temperature.
25. Michaelis & Menten did not make which of the following assumptions concerning analyses of enzyme action?
A. The initial reaction of velocity should be measured since most of the substrate has not been converted to product.
B. Maximal velocity is reached when the concentration of ES complex is equal to the total number of enzymes.
C. The formation of the ES complex does not appreciably decrease the [S].
D. For analysis of enzyme kinetics, the total [E] studied at each [S] is fixed.
E. Plotting the reciprocal of [V] and [S] will produce an ideal linear curve.
26. Which enzymes are used to diagnose liver diseases?
A. ACP & ALP C. AMS & LPS
B. AST & ALT D. CK & LDH

27. Which enzyme cannot be used to detect acute myocardial infarction (AMI)?
A. ACP C. AST
B. CK D. LDH
28. Which of the following enzyme pairs cannot be used in the diagnosis of liver disorders?
A. ALP & LAP C. LDH & AST
B. GGT & 5’-NT D. ACP & ALS
29. Using the choices in no. 28, which pair has clinical utility for AMI detection?
Answer: C
30. Which fraction is expected to be elevated in alcoholic cirrhosis of the liver?
A. ALP C. LDH
B. GGT D. ACP
31. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of
the following disease?
C. muscular dystrophy C. pulmonary emboli
D. viral hepatitis D. infectious mononucleosis
32. Which two physiologic conditions can greatly elevate blood alkaline phosphatase?
E. rickets, hyperparathyroidism
F. obstructive jaundice, biliary cirrhosis
G. growth, third trimester of pregnancy
H. viral hepatitis, infectious mononucleiosis
33. A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this disease?
A. Creatine kinase C. AST/ALT
B. LD isoenzymes D. Amylase
34. Which of the following chemical determinations may be of help in establishing the presence of seminal fluid?
A. Lactic dehydrogenase C. Acid phosphatase
B. Isocitrate dehydrogenase D. Alkaline
phosphatase
35. The most sensitive enzymatic indicator for liver damage from ethanol intake is
E. alanine aminotransferase (ALT)
F. aspartate aminotransferase (AST)
G. gamma-glutamyl transferase (GGT)
H. alkaline phosphatase (ALP)
36. A serum sample drawn in the emergency room from a 42-year-old man yielded the following laboratory
results:
CK 385 Units (Normal = 15-160)
AST 73 Units (Normal = 0-48)
CK-MB 106 Units (Normal = 2-12)
Which of the following conditions might account for these values?
A. Myocardial infarction C. Pulmonary infarction
B. Cerebrovascular accident D. Early acute hepatitis

37. In competitive inhibition of an enzyme reaction the
A. Inhibitor binds to the enzyme at the same site as the substrate
B. Inhibitor often has a chemical structure different from that of the substrate
C. Activity of the reaction can be decreased by increasing the concentration of the substrate
D. Activity of the reaction can be increased by decreasing the temperature
38. The presence increased CK-MB activity on a CK electrophoresis pattern is most likely found in a patient
suffering from A. Acute muscular stress following strenuous exercise
B. Malignant liver disease
C. Myocardial infarction
D. Severe head injury
39. Which of the following enzymes catalyzes the conversion of starch to glucose and maltose?
A. Malate dehydrogenase (MD) C. Creatine kinase (CK)
B. Amylase (AMS) D. Isocitric dehydrogenase (ICD)
40. Which of the following enzymes are used in the diagnosis of acute pancreatitis?
E. Amylase (AMS) and trypsin
F. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
G. 5’-nucleotidase (5’N) and gamma-glutamyl transferase (GGT)
H. Aspartate aminotransferase (AST) and lactate dehydrogenase (LD)
41. The specific activity of an enzyme would be reported in which of the following units of measure:
a. Micromoles per minute c. Milligrams per micromole
b. Millimoles per liter d. Units of activity per milligram of protein
e. Units of activity per minute
42. The Km value & Vmax in competitive inhibition are
43. The Km value & Vmax in noncompetitive inhibition are
44. The Km value & Vmax in uncompetitive inhibition are
Choices for nos. 42-44.
A. increased and decreased respectively.

B. decreased and increased respectively.
C. increased and unchanged respectively.
D. unchanged and decreased respectively.
E. both decreased.
45. The functions of many enzymes, membrane transporters, and other proteins can be quickly activated or
deactivated by phosphorylation of specific amino acid residues catalyzes by enzymes called:
a. Cyclases b. Kinases c. Phosphatases d. Proteases e. Zymogens
46. The chemotherapy drug fluorouracil undergoes a series of chemical changes in vivo that results in a
covalent complex such that it is bound to both thymidylate synthase and methylene-tetrahydrofolate. The
inhibition of deoxythymidilate formation and subsequent blockage of cell division is due to which of the
following:
a. Allosteric inhibition c. Competitive inhibition
b. Irreversible inhibition d. Noncovalent inhibition
e. Noncatalytic inhibition
47. The Lineweaver-Burk plot is used to graphically determine K m and Vmax for an enzyme that obeys classic
Michaelis-Menten Kinetics. When V is the reaction velocity at substrate concentration S, the Y axis
experimental data in the Lineweaver- Burk plot are expressed as:
a. V b. 1/V c. S d. 1/S e. V/Km
48. In the Lineweaver-Burk plot, the Vmax of an enzyme is:

a. Reciprocal of the absolute value of the intercept of the curve with the x axis
b. Reciprocal of the absolute value of the intercept of the curve with the y axis
c. Absolute value of the intercept of the curve with the x axis

d. Slope of the curve
e. Point of inflection of the curve
49. A noncompetitive inhibitor of an enzyme does which of the following:
a. Decreases Vmax c. Increase Vmax
b. Decrease Km and decreases Vmax d. Increases Km and increases Vmax
e. Increases Km with no or little change in Vmax
50. Digestive enzymes such a pepsin, trypsin, and chymotrypsin are synthesized as inactive precursors. The
preproteins of the active enzymes are termed :
a.Kinases b. Induces c. Isozymes d. Phosphatases e. Zymogens
51. Competitive inhibitors typically resemble the:

a. Enzyme b. Product(s) c. Substrate(s) d. Transition state
52-54. Choose the letters that corresponds to the enzymes used to detect hepatobiliary diseases:
a. GGT b. ALT c. ALP d. ALS e. LAP
52. A
53. C
54. E
55-57. Using the choices in nos. 52-54, choose the letters that corresponds to the enzymes used to detect
hepatic parenchymal disorders.
a. SDH b. LDH c. CPK d. AMS e. ALT
55. A
56. B
57. E
58-60. Choose the letters that corresponds to the diagnostic enzymes for acute myocardial infarction:
a. CK-MB b. ALT c. Troponin T d. AST e. HBD
58. A
59. D
60. E
61-62. Choose the letters that corresponds to the diagnostic enzymes for prostatic cancer:
a. LPS b. PSA c. ALP d. ACP e. ACE
61. B
62. D
63. Which enzyme is used to detect insecticide poisoning?

a. Creatine kinase
b. Acetylcholinesterase
c. Alkaline phosphatase
d. Lactate dehydrogenase
64. The graph that plots substrate concentration versus reaction rate is called
a. Michaelis-Menten plot c. Double reciprocal plot
b. X-Y plot d. Scatter plot
65. Which of the following is not the property of enzyme:

a. to be converted in the course of reaction
b. specificity towards a substrate or a group of substrates

c. alters the rate of reaction a thousand or a million-fold
d. protein with which a substrate can attach reversibly
66. On which organism or sample was the term enzyme literally associated?
a. Rice b. wheat c. meat d. yeast
67. In early 19the century, which scientist studied fermentation of sugar to alcohol using a cell-free extract?
a. Edward Buchner b. Louis Pasteur c. Alfred Joseph d. Willy Kuhne
68. What was the name given to enzymes by Louis Pasteur that he based from a process he himself
discovered?
a. Enzyme b. ferment c. catalyst d. ligand
69. In which year Edward Buchner discovered that yeast extract can cause the fermentation of sugar to
alcohol?
a. 1888 b. 1896 c. 1900 d. 1907
70. Who gave the word “enzymes” to catalytic molecules?
a. Pasteur b. Kuhne c. Buchner d. Harden
71. In which year James Sumner isolated and crystallized urease?
a. 1926 b. 1928 c. 1924 d. 1907
72. All enzymes are made up of which biomolecules (or, biomolecules)?
a. Proteins b. RNA c. Both a and b d. Neither a nor b
73. What is an inorganic cofactor?
a. Metal ions c. Vitamin-derived molecules
b. Both a and b d. None of the above
74. What is a coenzyme?
a. Inorganic ions c. Organic molecules
b. Organic molecules containing metalsd. Both b and c
75. Enzymes that differ in structure and origin but same reaction catalyzed are called:
a. Holoenzyme c. Prosthetic group
b. Apoenzyme d. Isoenzyme
76. A complete catalytically active enzyme together with its bound enzyme or metal ions is called?
a. Complex enzyme c. Prosthetic group
b. Apoenzyme d. Zymogen
77. The nonprotein part of holoenzyme is called?
a. Apolipoprotein c. Apoenzyme
b. Prosthetic group d. Both a and b
78. Which suffix is added to the name of the substrate or to a word or to a phrase describing inactivity?
a. -ise b. –ogen c. –pro d. -ase
79. In how many classes enzyme is divided by the IUBMB Enzyme Commission?
a. 4 b. 5 c. 2 d. 6
80. The site where enzyme catalyzed reaction takes place is called?
a. Active site b. Allosteric site c. Activity site d. Functional site
81. The molecule that is bound and acted upon by the enzyme but suppresses its function is termed:
a. Biomolecule b. Substance c. Inactivator d. Reactant e. Substrate
82. The action of a biocatalyst affects:
a. Rate of reaction c. Reaction equilibrium
b. pH of the reaction d. Active site structure
83. What will happen to reaction if temperature is increased?
84. What will happen to reaction if enzyme is added?
85. The enzyme that does not require a carbohydrate substrate is:
a. Catalase b . AMS c. Hexokinase d. Cellulase
86. The step which decides the rate of reaction is called?

a. Acceleration step c. Reaction inhibiting step
b. Rate limiting step d. Reaction enhancing step
87. Is it possible to have several steps with equal activation energy?
a. Yes
b. No
88. How metal ions participate in catalysis?

a. By causing reduction and oxidation reactions between enzyme and substrate
b. By causing ionic interactions between enzyme and substrate
c. Both a & b
d. Neither a nor b
89. What are the most common point group for protease enzymes?
a. Serine b. tryptophan c. tyrosine d. aspartate
90. The enzyme chymotrypsin has this number of point groups in its active site:
a. 1 b. 2 c. 3 d. 4
91. What is enzyme kinetics?
a. Studying the mechanism of rate of reaction of enzyme
b. Looking into the factors affecting enzyme activity
c. Both a and b
92. What is Vmax?
a. Maximum rate of reaction
b. Rate of reaction increase with increase in enzyme concentration
c. Associated with Michaelis constant
d. Amount of substrate converted to products per enzyme
93. Who gave the general theory of enzyme action and saturable plot between [S] and V in 1913?
a. Leonor Michaelis and Maud Menten
b. Alfred Michaelis
c. Maud Michaelis
d. Lineweaver and Burk
94. In an enzyme catalyzed reaction, enzyme exists in which form?
a. Free form
b. Combined form
c. ES form
d. All of the above
95. What does Km stand for in Michaelis-Menten equation?
a. Michaelis-Menten constant
b. Substrate concentration
c. Enzyme reaction constant
d. Competitive inhibition constant
96. Which enzymes are said to follow Michaelis-Menten kinetics?
a. Enzymes which show parabolic dependence of rate of reaction and substrate
b. Enzymes which show circular dependence of rate of reaction and substrate
c. Enzymes which show hyperbolic dependence of rate of reaction and substrate
d. Enzymes which show sigmoidal curve of rate of reaction and substrate
97. Double-reciprocal plot is also called?
a. Michaelis plot
b. Line plot
c. Lineweaver-Burk plot
d. Inverse plot
98. What is k1?
a. The rate constant of the enzyme-substrate complex formation
b. The rate constant equivalent to ½ Vmax
c. The rate constant of the separation of substrate from the enzyme

d. The rate constant of the conversion of substrate to new substances
99. What is the relationship between Km and enzyme affinity for substrate?
a. Direct
b. Inversely proportional
c. Indirect
d. Depends on parameters
100. A purely competitive enzyme inhibitor has which of the following kinetic effects?
A. increases Km without affecting Vmax C. decreases Km without affecting Vmax
B. increases Vmax without affecting Km D. decreases Vmax without affecting Km
E. decreases both Vmax and Km
101. Which statement about the active site is incorrect?

A. It is composed of linearly arranged amino acid chain.
B. It is relatively small compared to the total bulk of the enzyme.
C. It does not generally form covalent interaction with substrates.
D. It is three-dimensional in quality.
E. none of these
102. Which statement about most enzymes is incorrect?
A. They increase the rapidity of the reactions they catalyze.
B. They are specific for the substrate as well as the reaction catalyzed.
C. They are large polypeptides with high molecular weight.
D. They are most active near neutral pH.
E. They are not affected by changes in temperature.
103. The official name of an enzyme is accompanied by an EC followed by 4 numbers separated by dots.
What does EC stand for?
A. Enzyme Committee C. Enzyme Commission
B. Enzyme Company D. Enzyme Constitution
104. Which anticoagulant cannot be used for plasma collection for enzyme assays because it is regarded as
an enzyme poison?
A. heparin B. EDTA C. fluoride D. citrate
105. In enzyme analysis of serum substances, buffers actually

A. stabilize electrolytes C. act as a carrier for ions
B. maintain acidic pH D. affect protein configuration
106. A physician suspects his patient has acute hepatitis. Which test would be least indicative?
A. GOT C. ALT
B. LD isoenzymes D. Amylase
107. In competitive inhibition of an enzyme reaction the
A. Inhibitor binds to the enzyme at the same site as the substrate
B. Inhibitor often has a chemical structure different from that of the substrate
C. Activity of the reaction can be decreased by increasing the concentration of the substrate
D. Activity of the reaction can be increased by decreasing the temperature
109. The specific activity of an enzyme would be reported in which of the following units of measure:

A. Micromoles per minute C. Milligrams per micromole
B. Millimoles per liter D. Units of activity per milligram of protein
E. Units of activity per minute
110. The inactive form of an enzyme is called the
A. Apoenzyme C. Holoenzyme
B. Coenzyme D. Proenzyme
111. Aminotransferase enzymes (AST and ALT) catalyze the
A. Exchange of phosphate groups with sulfur-containing acids
B. Exchange of amino and keto groups between alpha-amino and alpha-keto acids
C. Hydrolysis of amino acids to ammonia and carbonate
D. Reversible transfer of hydrogen from amino acids to coenzymes
112. The apoenzyme-coenzyme complex is also regarded as
A. metalloenzyme C. proenzyme
B. holoenzyme D. zymogen
113. Enzyme activity can be measured via the following EXCEPT
A. decrease in substrate concentration C. appearance of products due to catalysis
B. extent of utilization of coenzyme D. increase in temperature due to catalysis
114. Biologic catalysts are characterized by all of the following EXCEPT
A. can either be organic or inorganic C. not consumed or altered in the reaction
B. decrease the energy of activation D. relatively high stereospecificity
115. Which of the following are surely derived from vitamin?
A. Activator C. Prosthetic group
B. Coenzymes D. Cofactors
116. The site where catalysis and conformational changes occur in an enzyme is the
A. active site C. cleavage site
B. allosteric site D. blocking site
117. The amount of enzyme that will convert 1 mole of substrate converted per second per liter of sample:
A. IU/L C. Katal unit
B. Turnover number D. Catalytic activity per mg. protein
118. The amount of enzyme that will convert 1 micromole of substrate converted per minute per liter
of sample:
A. IU/L C. Katal unit
B. Turnover number D. Catalytic activity per mg. protein
119. The prostatic ACP is characterized by the following, except:

A. It is tartrate-stable C. It is formol-stable
B. It is not affected by Cu++ ions D. It is associated with prostatic cancer

120. Select the polypeptide chain combination designated LD 5.
A. M4 C. M2H2
B. MH3 D. H4
121. A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this
disease? A.Creatinine C. B-hydroxybutyrate
B.LD isoenzymes D. amylase
122. One international unit of enzyme activity is the amount of enzyme that, under specified reaction
conditions of substrate concentration, pH, and temperature, causes utilization of substrate at the rate of:
A.1 mole/min C. 1 micromole/min
B.1 millimole/min D. 1 nanomole/min
123. Which of the following chemical determinations may be of help in establishing the presence of
seminal fluid?
A. Lactic dehydrogenase (LD) C. Acid phosphatase
B. Isocitrate dehydrogenase (ICD) D. Alkaline phosphatase
124. Increased total lactic dehydrogenase (LD) activity, confirmed to fraction 4 and 5 , is most likely to
be associated with:
A. Pulmonary infarction C. Myocardial infarction
B. Hemolytic anemia D. Acute viral hepatitis
125. Regan isoenzyme has the same properties as alkaline phosphatase that originates in the :
A. Skeleton C. intestine
B. Kidney D. placenta
126. Given the following results:
Alkaline phosphatase Slight increase
Alanine aminotransferase Marked increase
Aspartate aminotransferase Marked increase
Gamma-glutamyl transferase Slight increase
This is most consistent with:
A. acute parenchymal liver disease C. obstructive jaundice
B. chronic hepatitis D. liver hemangioma
127. Given the following results:
Alkaline phosphatase Marked increase
Alanine aminotransferase Slight increase
Aspartate aminotransferase Slight increase
Gamma – glutamyl transferase Marked increase
This is most consistent with:
A. Acute hepatitis C. Chronic hepatitis
B. Osteitis fibrosa D. Hepatobiliary disease
128. The presence increased CK-MB activity on a CK electrophoresis pattern is most likely found in a patient
suffering from:
A. Acute muscular stress following strenuous exercise C. Malignant liver disease
B. Myocardial infarction D. Severe head injury
129. A serum sample drawn in the emergency room from a 42-year-old man yielded the following laboratory
results:
CK 185 Units (Normal = 15-160)
AST 123 Units (Normal = 0-48)
CK-MB 6 Units (Normal = 2-12)
Which of the following conditions might account for these values?
A. Crush injury to the thigh C. Pulmonary infarction
B. Cerebrovascular accident D. Early acute hepatitis
130. When myocardial infarction occurs, the first enzyme to become elevated is:
A. CK C. AST

B. LD D. ALT
131. In the determination of lactate dehydrogenase at 340nm, using pyruvate as the substrate, one actually
measures the:
A. Decrease in pyruvate C. Increase in NADH
B. Decrease in NADH D. Increase in NADH
133. A scanning of a CK isoenzyme fractionation revealed two peaks: a slow cathodic peak (CK-MM) and an
intermediate peak (CK-MB). A possible interpretation for this pattern is:
A. Brain tumor C. Myocardial infarction
B. Muscular dystrophy D. Viral hepatitis
134. Which of the following enzymes are used in the diagnosis of acute pancreatitis?
A. Amylase (AMS) and lipase (LPS)
B. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
C. 5’-nucleotidase (5’N) and gamma-glutamyl transferase (GGT)
D.Aspartate aminotransferase (AST) and lactate dehydrogenase (LD)
135. Which of the following is a glycolytic enzyme that catalyzes the cleavage of fructose-1, 6-diphosphate to
glyceraldehyde-3-phosphate and dihydroxyacetone phosphate?
A. Aldolase C. Pyruvate kinase
B. Phosphofructokinase D. Glucose-6-phosphate dehydrogenase
136. The greatest activities of serum AST and ALT are seen in:
A. Acute hepatitis C. Metastatic hepatic carcinoma
B. Primary biliary cirrhosis D. Alcoholic cirrhosis
137. An electrophoretic separation of lactate dehydrogenase isoenzymes that demonstrates an elevation in
LD- 1 and LD-2 in a “flipped” pattern is consistent with:
A. Myocardial infarction C. Pancreatitis
B. Viral hepatitis D. Renal failure
138. Which of the following is a characteristic shared by lactate dehydrogenase, malate dehydrogenase,
isocitrate dehydrogenase and hydroxybutyrate dehydrogenase?
A. They are liver enzymes. C. They catalyze redox reactions.
B. They are cardiac enzymes. D. They are class III enzymes.
139. The most heat labile fraction of alkaline phosphatase is obtained from:
A. Liver C. Intestine
B. Bone D. Placenta
140. The aldehyde transport coenzyme is derived from:
A. Vitamin A C. Niacin
B. Vitamin C D. Thiamine
Column A Column B
Enzymes and their assay methods
141. LDH B A. Michel; Ellman
142. CHS A B. Wroblewski-LaDue; Wacker
143. LPS C C. Cherry-Crandall; Shihabi-Bishop
144. AST; ALT E D. Oliver-Rosalki-Hess; Tanzer-Gilvarg
145. CK D E. Reitman-Frankel; Babson
Coenzymes and their transported molecules

146. NAD+; FAD C A. amino
147. Biocytin E B. acyl
148. PLP A C. electrons

149. CoASH B D. hydroxyl
150. Ascorbate D E. carboxyl
LONG QUIZ 4
I) TUMOR MARKERS. For nos. 1-40, match column A with columns B. For nos. 41- 55, match column A with
columns B & then column A with column C. Write your answers on a whole sheet of paper. Letters only.
You are not allowed to change your answers. (70 points)
Column A Column B
Chemical Nature of Different Classes of Tumor Markers
A 01. PSA A. enzyme
B 02. calcitonin B. hormone
C 03. AFP C. oncofetal antigen
D 04. CA 125 D. carbohydrate marker
E 05. C-peptide E. nonenzyme protein
A 06. thymidine kinase
B 07. PRL
C 08. CEA
D 09. episialin
E 10. IgG
A 11. aryl sulfatase B
B 12. ACTH
C 13. squamous cell antigen
D 14. DU-PAN-2
E 15. 2-microglobulin
A 16. CK-BB
B 17. hCG
C 18. Tennessee antigen
D 19. CA-19
E 20. pregnancy specific antigen
Tumor Markers and associated Diseases

C 21. multiple myeloma A. CEA
E 22. hydatidiform mole B. AFP
B 23. liver CA C. BJP
A 24. intestinal CA D. PSA
D 25. prostatic CA E. hCG
Protein Markers of Tumor Types

26. A 26. Aldolase, Alcohol Dehydrogenase, Hexokinase A. Liver only
27. B 27. ACTH, Bombesin, Neurophysins B. Small-cell lung cancers
28. I 28. CA-125 C. Embyonal, choriocarcinomas
29. D 29. PSA, CK-BB D. Prostate
30. E 30. LDH, tdt, thymidine kinase E. Leukemias
31. J 31. CA-15-3, CA549, MCA F. Brain, lung, colon, GIT, breast
32. G 32. Alkaline Phosphatase G. Ovarian, Lung, Bone, Liver
33. L 33. CA-19-9, CA 19-5, CA 242, CA-50 H. Breast only
34. C 34. hCG I. Ovarian, endometrial
35. H 35. CA-27, CA-29 J. Ovarian, Breast
36. K 36. Aryl sulfatase B K. Colon, Breast
37. P 37. Catecholamine metabolites L. Pancreatic, GIT
38. M 38. Calcitonin M. Medullary thyroid
39. N 39. Tennessee antigen N. Colon, GIT, gall bladder
40. O 40. Amylase O. Pancreas only
Column A Column B Column C

Oncogenes & Tumor-suppressor Genes
Genes Types Cancer types
AH 41. N-ras A. Oncogene A. breast only
BJ 42. VHL B. Tumor suppressor B. T- & B-lymphoma,
lung
AI 43. K-ras, bcl-2 C. Combination of A&B C. bladder, melanoma,
glioblastoma
BE 44. DCC, APC D. Chronic myeloid
leukemia (CML)
AF 45. N-myc E. colorectal
BA 46. P16 E-cadheria, BRCA2, RB1 F. neuroendocrine
AL 47. c-erb B-2 G. meningioma,

neurofibromatosis 2
BN 48. p53 H. AML, neuroblastoma
BK 49. WT 1 I. lymphoma, leukemia
AB 50. c-myc J. kidneys
BC 51. cdk a2 K. Wilm’s tumor
AD 52. c-abl/bcr L. breast, ovarian, GIT
BG 53. NF 2 M. retinoblastoma,
osteosarcoma
B 54. RB 1 N. breast, liver,
M 55. p16 bladder,sarcomas
BC
II) ESSAY. Briefly discuss your answers to the following questions. All answers should be in sentence form.
Scoring depends on the number of correct answers/examples that you give per question. Each item requires
3 answers/examples. A point will be given if only 1 example/answer is correct, 3 points for 2 correct
answers/examples and 5 points if all 3 answers/examples are correct. (25 points)
1) What are the potential uses of tumor markers in the clinical setting? Cite three.
• Screening in general population
• Differential diagnosis in symptomatic patients
• Clinical staging of cancer

• Estimating tumor volume
• Prognostic indicator for disease progression
• Evaluating the success of treatment
• Detecting the recurrence of cancer
• Monitoring responses to therapy
• Radioimmunolocalization of tumor masses
• Determining direction for immunotherapy
2) Give three tumor markers and their discoverers.
Year Author Marker

1846 H. Bence-Jones Bence-Jones protein
1928 W.H. Brown Ectopic hormone syndrome
1930 B. Zondek hCG
1932 H. Cushing ACTH
1949 K. Oh-Uti Deletions of blood group antigens
1959 C. Market Isoenzymes
1963 G.I. Abelev AFP
1965 P. Gold and S. Freeman CEA
1969 R. Heubner and G. Todaro Oncogenes
1975 H. Kohler and G. Milstein Monoclonal antibodies
1980 G. Cooper, R. Weinberg, and M. Bishop Oncogene probes and transfection
1985 H. Harris, R. Sager, and A. Knudson Suppressor gene
3) Discuss three means of measuring tumor markers and provide examples.

Possible answers are as follows:
Enzyme markers - spectrophotometric assays, activity assays, colorimetric, UV Hormones, oncofetal
antigens & carb markers - immunoassay techniques like RIA, EMIT, IRMA, ELISA, etc.
Genetic markers like oncogenes and tumor-suppressor genes - PCR, fluorometric
4) What are the three mechanisms of how exposure to carcinogens lead to cancer?
Exposure to such an agent may cause cancer either by producing
1) direct genotoxic effects on deoxyribonucleic acid (DNA) (e.g., as with radiation) or 2) by increasing cell
proliferation (e.g., by a hormone), or 3) both 1 and 2 (e.g., through the use of tobacco).
Any other answers depends on the discretion of the teacher.
5) Cite three types of carcinogen with specific examples.

Carcinogens may be 1) physical (e.g., radiation), 2) chemical (e.g., a polycyclic hydrocarbon), or 3)
biological (e.g., a virus).

LONG QUIZ 5
Southwestern University Phinma - College of Medical Technology

LONG EXAM 5 on Endocrinology
I) IDENTIFICATION. Identify what each of the following describes or defines: (10 points)
1. The study of endocrine glands and their secretions
2. The chemical regulators that are produced by ductless glands
3. The medium which transports hormones to their target organs
4. The specific membrane proteins that bind hormones
5. The gland that regulates adenohypophyseal secretions
6. The target tissues of the hormone somatotropin
7. The largest endocrine gland in the body
8. The other name for the posterior lobe of pituitary gland
9. The term used for the constantly maintained internal equilibrium of the body
10. The only hormone produced by the adenohypophysis that exhibits a positive
feedback mechanism
II)MCQ: Select the best answer for each of the following questions. Shade the box that corresponds to the
correct answer. Final answers on the answer sheet. NO ERASURES / ALTERATIONS ALLOWED.
III) TSH is produced by the:
IV) A. Hypothalamus B. Pituitary gland C. Adrenal cortex D. Thyroid
V)
VI) The major control mechanism for serum calcium level is played by
VII) estrogen C. parathyroid hormone
VIII) growth hormone D. thyroid hormone
IX)
X) Persistent hypoglycemia is seen in which of the following conditions?
XI) insulinoma
XII) galactosemia A. 1,2,3,and 4 B. 1 and 3
XIII) Hyperthyroidism
XIV) Addison’s disease C. 1 and 2 D. 1,2,and 3
XV)
XVI) One of the following is NOT secreted by the anterior pituitary gland. Which one is it?
XVII) LH C. HGH
XVIII) VMA D. ACTH
XIX)
XX) Increased urinary catecholamine metabolites with intermittent hypertension may indicate which of the
XXI) following conditions:
XXII) idiopathic hypertension C. arteriosclerosis
XXIII) adrenal medullary disease D. Hyperthyroidism
XXIV) The major thyroid hormone is
XXV) A. Somatotropin B. Calcitonin C. Insulin D. Thyroxine
XXVI) Plasma renin activity is most useful in the differential diagnosis of:

A. Hypertension B. Diabetes mellitus C. Lead Poisoning D. Alcoholism
Assessments of primary & secondary hypothyroidism include the following EXCEPT:

T3 C. TSH
T4 D. Calcitonin
Hyperthyroidism has been associated with the following, EXCEPT BONUS
Decreased cholesterol C. Increased T 32
Increased sugar level D. Increased T 4
The reference method for pituitary secretions is the

A. RIA technique B. Spectrophotometry C. HPLC D. Dynamic testing
The secretion of anterior pituitary hormones is regulated by:

Hypothalamus C. Aldosterone
Serotonin D. ACTH
Which of the following is caused by oversecretion of the adrenal cortex?
Pagets disease C. Pheochromocytoma
Cushing’s disease D. Grave’s disease
The use of iodized salt serves to provide iodine for the synthesis of:
A. Sex hormones B. Insulin C. Thyroid hormone D. Growth hormone
Diurnal variations is important to consider when collection blood for the assay of:
Catecholamines C. Cortisol
Creatinine D. Thyroid hormones
The estrogen designated as E 2 whose urine concentration is the greatest is:

Estriol C. Estrone
Estradiol 17β D. Progesterone
What is the hormone which controls the reabsorption of sodium in the kidneys:
Aldosterone C. Estrogen
ADH D. Growth hormone
Catecholamines are secreted by the:

A. Kidney B. Pituitary C. Adrenal cortex D. Adrenal medulla
Which of the following is a metabolite of epinephrine?

17-ketosteroids C. Vanillylmandelic acid
Follicle stimulating hormone D. thyroid stimulating hormone
Patient has a TSH result markedly elevated. This maybe due to:
Hypothyroidism due to pituitary disorders
Primary aldosteronism C. Graves disease D. Hyperthyroidism
Patient’s value is normal T 3 , T 4 , what do you think is the value of TSH?

Increased C. Normal
Decreased D. None of the above

In which of the following are the thyroid hormones classified?
Amino acid derivatives
Steroid hormones
Fatty acid derivatives
Peptide hormone
When is the best time to get plasma cortisol samples:3

8 AM C. 12 PM
8 PM D. 12 AM
Why is it important to time samples for cortisol level:

Actually, there is no timing
The best period to get is from 10 PM to 2 AM
Because maximal secretion of cortisol has a diurnal pattern
None of the above
The relationship of a cholesterol and thyroid hormone is:

Directly proportional C. Inversely proportional
Not related D. none of the above
Diabetes insipidus is associated with deficiency in:

ACTH C. HCG
TSH D. ADH
TRH is produced by the:

Hypothalamus C. Adrenal cortex
Pituitary gland D. Thyroid
Calcium concentration in the serum is regulated by:

Insulin C. thyroxine
parathyroid hormone D. vitamin C
Which of the following steroids is an adrenal cortical hormone?

Angiotensinogen C. progesterone
CorticosteroneD. HCG
Which of these hormones are especially related in the delicate balance of production and utilization of glucose in
the body?
Growth hormone and cortisol
Epinephrine and thyroid hormones
Insulin and glucagon
Glucagon and thyroxine
Which of the reactions measures 17-ketosteroids?

Porter-Silber C. Murphy-Pattee
Zimmerman D. Kober
The net effect of calcitonin on the metabolism of calcium and calcium and phosphorus is:
Decreased calcium, increased phosphorus
Decreased calcium and phosphorus
Increased calcium and phosphorus

Increased calcium, decreased phosphorus
Patients with Cushing’s syndrome exhibit:

decreased plasma 17-hydroxysteroid concentration
decreased urinary 17-hydroxysteroid excretion
serum cortisol concentrations greater than 15 mg/dL
decreased cortisol secretory rate
Fasting serum phosphate concentration is controlled primarily by the :

Pancreas C. Parathyroid glands
Skeleton D. Small intestine
A patient has the following test results:

Decreased serum calcium levels Increased serum phosphorous levels Decreased levels of parathyroid hormone
This patient most likely has:

hyperparathyroidism C.nephrosis
hypoparathyroidism D. steatorrhea
The Porter-Silber reaction is used in the assay of:

Urinary estrogen C. Testosterone
Glucocorticoids D. Epinephrine
ACTH is produced in:

Pancreas C. Adenohypophysis
Adrenal cortex D. Adrenal medulla
This hormone is produced by the posterior pituitary gland:

Vasopressin C. Prolactin
Both A & D D. ADH
Serotonin is secreted by the:

A. Kidney B. Liver C. Adrenal cortex D. Small intestine
Dark-light cycle is an important function of:

Melatonin D. Thyroid hormones
Glucagon is produced by:

B-cell of the pancreas C. Alpha cell of the pancreas
Pituitary gland D. Adrenal Cortex
ACTH acts on the:

Pancreas
Adrenal cortex
Posterior pituitary gland
Adrenal medulla

The Zimmerman determination of 17-ketosteroid is based on reaction with:
Acetic anhydride C. Meta-dinitrobenzene
Ehrlich’s reagent D. Potassium ferricyanide
Which of these hormones lowers the blood glucose level?

Cortisol C. Glucagon
Epinephrine D. Insulin
At low or absent levels, which one of the following hormones has the ability to produce hyperglycemia:
Glucagon C. Thyroid hormone
Insulin D. Parathyroid hormone
Which of these have receptors for ADH?

DCT C. Adrenals
Thyroid D. Mammary gland
One of the following is NOT secreted by the adenohypophysis. Which one is it?
LH C. hCG
Somatotropin D. ACTH
The main thyroid hormone is

T 3 D. ACTH C. Insulin D. Calcitonin
Elevated serotonin metabolites may indicate which of the following?

A. Idiopathic hypertension B. Pheochromocytoma C. Diabetes mellitus D. Intestinal cancer
Hypothyroid test is shown in:

Normal T 3
Normal Free T 4 level
Decrease T 3 , increase T 4
Decrease resin T 3 T 4
The androgen whose urine concentration is the greatest is:

Estriol C. Estrone
Estradiol D. Testosterone
What is the hormone which controls the natriuresis in the Kidney:

Aldosterone C. ANF
Erythropoietin is secreted by the:

A. Kidneys B. Pituitary C. Adrenal cortex D. Adrenal medulla
Which of the following is a metabolite of serotonin:

5’-HIAA D. Tryptophan

Which is an advantage of RIA assay over other tests for hormones?
Lengthy analysis
Any volume for sample
Measures interferences as well
High specificity
Patient has a TRH result that is markedly elevated. This maybe due to:
Primary hypothyroidism
Primary aldosteronism
Tertiary thyroid hypofunction
Secondary hypothyroidism
Patient’s T 3 , & T 4 levels are low, what do you think is the value of TSH?
Increased C. Normal
Decreased D. None of the above
In which of the following are the eicosanoids classified?

Amino acid derivatives
Steroid hormones
Fatty acid derivatives
Peptide hormone
A deficiency of somatotropin will result in

Grave’s disease C. Cretinism
Dwarfism D. Hashimoto’s thyroiditis
The tumor marker associated with ovarian carcinoma is:

Parathormone C. Calcitonin
HCG D. ACTH
When is the best time to get plasma testosterone samples:

6 AM C. 12 PM
8 PM D. 12 AM
Which of these hormones are especially related in the delicate balance of production and utilization of glucose in
the body?
Growth hormone and cortisol
Epinephrine and thyroid hormones
Insulin and glucagon
Glucagon and thyroxine
Which of the reactions measures 17-OHcorticoteroids?

Porter-Silber C. Murphy-Pattee
Zimmerman D. Kober
The net effect of calcitonin on the metabolism of calcium and phosphorus is:
Decreased calcium, increased phosphorus
Decreased calcium and phosphorus
Increased calcium and phosphorus
Increased calcium, decreased phosphorus

The Kober reaction is used in the assay of:
Urinary estrogen C. Testosterone
Glucocorticoids D. Epinephrine
The estrogen whose urine concentration is elevated in gestation is:

Estriol C. Estrone
Estradiol D. Progesterone
What is the hormone which controls the reabsorption of water in the Kidney:
Aldosterone C. Estrogen
ACTH is produced in:

Pancreas
Adrenal cortex
Adenohypophysis
Adrenal medulla
This hormone is produced by the posterior pituitary gland:

Vasopressin C. Prolactin
Both A & D D. ADH
Catecholamines are secreted by the:

Kidney
Pituitary
Adrenal cortex
Adrenal medulla
The menstrual cycle is important to consider when collection blood for the assay of:
Gonadotropins D. Thyroid hormones
GHRH is produced in:

Hypothalamus
Pituitary gland
Alpha cell of the pancreas
Adrenal cortex
ACTH acts on the:

Pancreas
Zona fasciculata
Posterior pituitary gland
Adrenal gland
The Zimmerman determination of 17-ketosteroid is based on reaction with:

Acetic anhydride C. Meta-dinitrobenzene
Ehrlich’s reagent D. Potassium ferricyanide
Which of these hormones lowers the blood glucose level?

Cortisol C. Glucagon
Epinephrine D. Insulin

At low or absent levels, which one of the following hormones has the ability to produce hyperglycemia:
Glucagon C. Thyroid hormone
Insulin D. Parathyroid hormone
The major control mechanism for serum calcium level is played by

estrogen C. parathyroid hormone
growth hormone D. thyroid hormone
Persistent hypoglycemia is seen in which of the following conditions?

insulinoma 3. hypothyroidism
galactosemia 4. Addison’s disease
A. 1,2,3,and 4
C. 1 and 2
B. 1 and 3
D. 1,2,and 3
Normal thyroid function is termed

hypothyroidism C. thyrotoxicosis
hyperthyroidism D. Euthyroidism
Which of these have receptors for ADH?

A.DCT C. Adrenals
B. Thyroid D. Mammary gland
One of the following is secreted by the neurohypophysis. Which one is it?

LH C. HCG
Oxytocin D. ACTH
Increase values of Thyroxine (T 4 -RIA) is usually associated with the following, EXCEPT:
Hyperthyroidism C. Nephrosis
Acute thyroiditis D. Graves’ disease of the thyroid
Elevated serotonin metabolites may indicate which of the following?

Idiopathic hypertension8
Pheochromocytoma
Diabetes mellitus
Intestinal cancer
Plasma renin activity is most useful in the differential diagnosis of:

A.Hypertension C. Lead Poisoning
B. Diabetes D. Alcoholism
Following are thyroid function test, EXCEPT:

Free thyroxine T 4 C. Thyroglobulin
Free Triodothyronine D. Testosterone
Estrogen and progesterone receptor assays are useful in assessing prognosis in

which of the following:
Cancer of the uterus C. Breast cancer
Liver cirrhosis D. Cushing Syndrome
One of the following is NOT associated with hyperthyroidism;

Decreased calcium C. Increased protein-bound iodine
Increased T 3 D. Decreased Cholesterol
One of the following is not thyroid function test:

T 3 C. TSH
T 4 D. ACTH
Hyperthyroidism has been associated with the following, EXCEPT BONUS
Decreased cholesterol C. Increased T 3
Increased sugar level D. Increased T 4
Which hormone is responsible for calorigenesis and thermogenesis?

T4 and T3
Estrogens
Both
Neither
The secretion of anterior pituitary hormones is regulated by:

Hypothalamus C. Aldosterone
Serotonin D. ACTH
Which of the following is caused by versecretion of the thyroid gland?

Paget’s disease C. Pheochromocytoma
Addison’s disease D. Grave’s disease
The major nonspecific binding protein for hormones is:

Albumin
TBPA (thyroid-binding prealbumin)
TBG (thyroid binding globulin)
CRP
T 3 uptakes is actually a measurement of:

A. Thyrotoxicosis B. Cushing’s disease C. Pregnancy D. Dwarfism
The major androgen produced in adrenals is:

Estriol C. DHEA
Estradiol D. Testosterone
Which of the following is a metabolite of epinephrine:

5’-HIAA D. Tryptophan
Patient has a TSH result that is markedly elevated. This maybe due to:
Primary hypothyroidism
Primary aldosteronism
Graves disease
Primary hyperthyroidism

Patient’s T 3 , & T 4 levels are normal, what do you think is the value of TSH?
Increased C. Normal B.Decreased D. None of the above
In which of the following is melatonin hormone classified?

A. Amino acid derivatives B. Steroid hormones C.Fatty acid derivatives D.Peptide hormone
The deficiency of the thyroid hormone in children is known as

Grave’s disease C. Cretinism
Myxedema D. Hashimoto’s thyroiditis
What hormone is responsible for circadian rhythm:

ACTH
GH
Cortisol
Melatonin
III.) HORMONE TARGETS & ORIGINS. Match column A with columns B & C.
Letters only. You are not allowed to change your answers. (80 points)
IIIA)
Column A
1. TRH Origins: K. Hypothalamus Targets: I. Anterior pituitary lobe
2. ACTH G. Adenohypophysis A. Thyroid gland
3. Vasopressin Neurohypophysis C. Renal collecting ducts
4. T3 & T4 Thyroid gland E. All organs and tissues
5. PTH PTG Kidneys & Bones
6. Insulin Pancreas All organs and tissues
7. Aldosterone Adrenal cortex PCT of kidneys
8. Estradiol Ovaries Female gonads/accessory organs
9. Catecholamines Adrenal medulla Heart, blood vessels, liver
10. ANF Heart PCT of Kidneys
11. CRH Hypothalamus Anterior Pituitary Lobe
12. Testosterone Testes Male gonads/accessory organs
13. Thymosin Thymus Lymphoid tissues
14. Somatomedins Liver All organs & tissues
15. CCK-PZ Small intestine Common bile duct
16. EPO Kidneys Bone Marrow
17. Vitamin D3 Kidneys Small Intestine
18. hCG Placenta Female gonads/accessory organs
19. MSH Adenohypophysis Skin
20. Calcitonin Thyroid gland Kidneys and Bones
Match column A with column B. Should there be three columns, match the first column with both the
second and third columns. A letter may be used more than once.
IIIB). CHEMICAL NATURE OF HORMONES.
Column A Column B Column C
21. Amines C & B A. derived from fatty acid A. prostaglandins, leukotrienes
22. Steroids B & E B. derived from cholesterol B. melatonin, thyroxine

23. Eicosanoids A&A C. derived from amino acids C. ADH, insulin, glucagon
24. Glycoproteins E&D D. composed solely of amino acids D. FSH. LH. hCG, GH
25. Polypeptides D & C E. composed of amino acid and sugars E. androgen, estrogen, progestin
IIIC). HORMONE GROUPING.

26. lipophilic A A. Group I hormones
27. requires intracellular receptors A B. Group II hormones
28. generally orally given if treated as drug A
29. requires secondary messengers B
30. transported in blood not bound to proteins B
31. rapid initiation of chemical reaction A
32. plasma half-life of hours to days A
33. examples are catecholamines and insulin B
34. examples are androgens and thyroxine A
35. receptor-hormone complex formation is enough to produce cellular changes A
IIID) HORMONES & THEIR DESCRIPTIONS

T 36. CRH A. tryptophan-derived and induces sleep
P 37. TRH B. hypothalamic secretion also referred to as
somatostatin I 38. GnRHC. responsible for the maturation of ovarian follicles
S 39. PIF D. increases the blood levels of prolactin
D 40. PRF E. hyperglycemic glycogenolytic factor from the pancreas
R 41. GHRH F. major hormone derived from proopiomelanocortin gene
B 42. GHIH G. principal hormone in the maintenance of corpus
luteum K 43. MIF H. derived from mammotrophs
O 44. ADH I. stimulates the production of pituitary FSH &
LH N 45. Oxytocin J. stimulates the release of thyroid hormones
A 46. Melatonin K. decreases the level of the blood MSH
L 47. Serotonin L. source of urinary 5’-hydroxyindole acetic
acid E 48. Glucagon M. another name is somatotropin
H 49. PRL N. peptide hormone for milk ejection and uterine contraction
M 50. GH O. directly regulates the production of aquaporins in collecting
ducts C 51. FSH P. stimulates production of thyroid-stimulating hormne
J 52. TSH Q. cardiac peptide that decreases blood sodium levels
F 53. ACTH R. otherwise known as somatocrinin
G 54. LH S. believed as a dopamine-like inhibitor of
prolactin Q 55. ANF T. stimulates the production of beta-endorphins
LONG QUIZ 6
I. IDENTIFICATION. Identify what each of the following defines or describes: (15 points)
1. gland 1. a bilobed organ responsible in increasing the basal metabolic rate

2. thyroid follicles 2. the fundamental structural and functional unit of the thyroid gland

3. colloid 3. the proteinaceous fluid in the lumen bounded by the thyroid follicles
4. calcitonin 4. the hypocalcemic hormone produced by the thyroid gland
5. thyroglobulin 5. regarded as the prohormone of thyroid hormones T3 and T4
6. tyrosine 6. the amino acid precursor of thyroid hormones T3 and T4
7. reverse T3 7. the inactive type of triiodothyronine
8. 1.23-3 nM) 80- 8. the reference range of T3 in the plasma
200 ng/dl
9. 72-163 nM) 5.5 - 9. the reference range of T4 in the plasma
12.5 ug/dl
10. deiodinases 10. the enzymes responsible in the peripheral conversion of T4 to T3
11. t4 or thyroxine 11. another name for 3,5,3’,5’-tetraiodothyronine
12. 10:1 NOT 1:10 12. the normal T4 to T3 ratio
13. euthyroid 13. the state characterized by normal blood thyroid hormone levels
14. TRH or 14. the hypothalamic hormone that regulates thyroid hormone synthesis
thyrotropin
releasing hormone
15. negative 15. the type of feedback exhibited by the thyroid gland to the pituitary
feedback
II.) MULTIPLE CHOICE. On a whole sheet of paper, write the letter that corresponds to the correct answer for
each of the following items. You are not allowed to change your answer.
1. A patient shows the following data: T4 concentration of 8 ug/dL and T3 uptake of 30%. What is the
condition?
A. Hyperthyroidism B. Euthyroidism C. Hypothyroidism D. Euthyroidism with high TBG
2. Which secretion is involved in calcium homeostasis?

A. estrogen B. VIP C. androgen D. thyroid hormone
3. Which is an advantage of T4 assay over PBI (protein bound iodine) test?

A. Quicker analysis
B. Lesser volume for sample
C. Prevent contamination of extraneous iodine
D. Simpler
4. Cretinism in infants is caused by

A. hypothyroidism B. hyperthyroidism C. Thyrotoxicosis D. euthyroidism
5. Which of the parameters are decreased in hypothyroidism?

1. T4 2. T3 3. Resin T3 Uptake 4. TSH
A. 1 and 2 C. 1,2,3 and 4
B. 1,2 and 3 D. 3 and 4
6. Majority of the thyroid hormones in blood are bound with:
A. Thyroxine –binding albumin B. Glycerophosphate C. Phenolphthalein phosphate D. Disodium
phenyl phosphate
7. Majority of plasma thyroxine ( T4) is:

A. Bound to globulin B.Bound to prealbumin C. Free D. bound to albumin
8. Which of these antibodies are associated with auto-immune thyroiditis?

A. Neither microsomal nor thyroglobulin antibodies

B. Microsomal antibodies
C. Thyroglobulin antibodies
D. Both microsomal and thyroglobulin antibodies
9. The gold standard for the assessment of thyroid function is the measurement of
A. Both T3 and T4
B. TSH
C. TRH stimulation
D. RT3U
10. The metabolically active thyroid hormone is
A. T3 C. rT3
B. T4 D. Thyroxine
11. The methods for determining thyroid hormones are as follows, EXCEPT:
A. Ash method protein bound iodine C. Radioactive tracer method
B. Chromatography D. Colorimetric method
12. Increase values of Thyroxine (T4-RIA) is usually associated with the following, EXCEPT:
A. Hyperthyroidism C. Nephrosis
B. Acute thyroiditis D. Graves’ disease
13. The following are thyroid function tests, EXCEPT:

A. Free thyroxine B. Free Triiodothyronine C. Thyroglobulin D. Testosterone
14. One of the following is NOT associated with hyperthyroidism;

A. Decreased calcium B. Increased T3 C. Increased PBI D. Decreased Cholesterol
15. Thyroid function tests exclude:

A. T3 B. TSH C. T4 D. ACTH
16. Hyperthyroidism has been associated with the following, EXCEPT

A. Increased cholesterol B. Increased T3C. Increased sugar level D. Increased T4
17. Assay of T3 & T4 levels, and TSH maybe done by this method, EXCEPT:
A. Spectrophotometer B. Radioimmunoassay C. Flame photometer D. Gamma
counter
18. Hypothyroid test is shown in:

A. Normal T3 C. Decrease T3, increase T4
B. Normal Free T4 level D. Decrease resin T3 & T4
19. Test for T3 and T4 can be determined by

A. RIA technique B. EIA technique C. Both D. Neither
20. Methods for determining T3 and T4 exclude

A. EIA B. Spectrophotometer C. RIA D. Hemagglutination test
21. Patient has a TSH result markedly elevated. This maybe due to:
A. Hypothyroidism due to pituitary disorders
B. Primary hypothyroidism
C. Graves disease
D. Hyperthyroidism

22. Determine the free thyroxine index (FT4I) using the given data:
Total T4 = 10 microgram/dL
Resin T3 uptake of patient = 27%
Resin T3 uptake of serum pool = 30%
A. 2.7 C. 9.0
B. 11.0 D. 3.0
23. The use of iodized salt serves to provide iodine for the synthesis of:
A. Sex hormones B. Insulin C. Thyroid hormone D. Growth hormone
24. Normal T3 in serum and normal T4 is interpreted as:
A. Euthyroidism B. Thyrotoxicosis C. Hyperthyroidism D. Hypothyrodism
25. What is the primary purpose of thyroidal radioiodine uptake test?
A. Diagnosis of hypothyroidism
B. Diagnosis of hyperthyroidism
C. Differentiate hypothyroidism from euthyroidism
D. Differentiate the causes of hyperthyroidism
26. In hyperthyroidism, resin T3 uptake is:
A. Markedly decreased B. Increase C. Normal D. Slightly decreased
27. The radioactive count in RT3U test in hypothyroidism is expectedly:
A. Significantly lower B. Normal C. Slightly below than normal D. Higher
28. In which of the following are the thyroid hormones classified?
A. Amino acid derivatives B. Steroid hormones C. Fatty acid derivatives D. Peptide

hormone

29. Presence of a very high titer for long acting thyroid stimulator antibodies is highly suggestive of
what disorder:
A. Pernicious anemia B. Multinodular goiter C. Hashimoto’s thyroiditis D. Grave’s disease
30. The major function of thyroid gland is:

A. Production of thyroid hormones
B. Increase the BMR and Calcium in blood
C. Thermogenesis & calorigenesis
D. Negative feedbacking to pituitary gland secretion
31. The parent compound of steroid hormones is

A. acetate B. cholesterol C. sitosterol D. triglycerides
32. In the chemical tests for urinary steroids, the first step is hydrolysis using an
A. enzyme B. acid C. both A & B D. neither A nor B
33. The organic reagent used to hydrolyze steroid hormones in the sample is
A. acid B. enzyme C. salt D. alkali
34. The reference method for the assay of steroid hormones is

A. GC B. RIA C. ELISA D. HPLC
35. The method used to quantitate ketogenic steroids is

A. Porter-Silber B. Pisano C. Zimmermann D. Kober
36. Which adrenal tissue produces secretions which react with DNPH-sulfuric acid?
A. glomerular cells C. reticular cells
B. fascicular cells D. chromaffin cells
37. The major transport protein of cortisol which binds 90% of circulating cortisol is
A. SHBG B. albumin C. transcortin D. TBG
38. The best time to collect a blood sample for testosterone measurement is
A. 12 midnight B. 8 am C. 12 noon D. 4 pm
39. The hormones referred to as 18-carbon steroids with unsaturated A ring are
A. mineralocorticoids B. glucocorticoids C. estrogens D. androgens
40. The major androgen produced in the adrenal cortex is

A. testosterone C. androstenedione
B. dehydroepiandrosterone D. dihydroxytestosterone
41. In secondary hypocortisolism, plasma ACTH is

A. decreased B. increased C. normal D. out of range
42. The 17-ketosteroids include all of the following except

A. androsterone C. DHEA
B. androstenedione D. testosterone
43. Dexamethasone suppression test is used to

A. assess estrogen production by adrenals C. establish the cause of hypocortisolism

B. assess androgen production by adrenals D. establish the cause of hypercortisolism
44. The following are true regarding the Zimmerman reaction except
A. the reaction requires an acidic medium C. dinitrobenzene is the chromogen
B. red-purple product is measured at 520nm D. used to assess androgen production in adrenals
45. The Kober method is performed to

A. assess estrogen production by adrenals C. establish the cause of hypocortisolism
B. assess androgen production by adrenals D. establish the cause of hypercortisolism
46. Transcortin is able to bind all of the following hormones except

A. cortisol B. progesterone C. aldosterone D. estradiol
47. The predominant hormone in the menstrual luteal phase is

A. estrogen B. progesterone C. testosterone D. cortisol
48. Which hormone-function dyad is incorrect?

A. estrogen – stimulates uterine endometrium to proliferate or thicken and negative feedbacking
to the pituitary gland
B. FSH – stimulates meiosis in ovaries; release of the ovum
C. Progesterone – maintains levels of estrogen
D. LH – development of the ovum into a corpus luteum
49. The predominant estrogen in a gestating woman is

A. estrone B. estradiol C. estriol D. progesterone
50. The predominant estrogen in post-menopausal women is

A. estrone B. estradiol C. estriol D. progesterone
51. Pituitary secretion of ACTH is inhibited by levels of

A. cortisol B. progesterone C. estradiol D. corticosterone
52. In the Porter-Silber reaction, the 17,21-dihydroxy-20-ketone side chain reacts with
A. dinitrobenzene C. sodium metaperiodate
B. quinone imine D. phenylhydrazine
53. The most potent estrogen which is considered the true ovarian hormone is
A. estriol B. estradiol C. estrone D. 16-epiestriol
54. All of the following glands secrete steroid hormones except

A. ovaries B. pituitary gland C. placenta D. adrenal cortex
55. The placenta secretes numerous hormones both protein and steroid. Which of the
following hormones is not secreted by the placenta?
A. hCG B. progesterone C. estrogen D. LH

56. Because of infertility problems, a physician would like to determine when a woman ovulates. The
physician orders serial assays of plasma progesterone. From these assays the physician can tell
when ovulation occurs because
A. after ovulation, progesterone rapidly increases

B. right before ovulation progesterone spikes
C. after ovulation progesterone rapidly decreases
D. right before ovulation progesterone rapidly increases
57. Which of the following is the major mineralocorticoid?

A. aldosterone B. corticosterone C. cortisol D. testosterone
58. The adrenal medulla secretes which of the following in greatest quantity:
A. epinephrine B. norepinephrine C. HVA D. VMA
59. In a patient who is suspected of having pheochromocytoma, measurement of which of the following would
be most useful?
A. VMA B. 5’-HIAA C. HVA D. 9-THC
60. The highest levels of gonadotropins occur

A. during follicular phase of the menstrual cycle
B. during the luteal phase of the menstrual cycle
C. at the midpoint of the menstrual cycle
D. several days prior to ovulation
61. The reference method for the assay of catecholamines is

A. GC B. RIA C. ELISA D. HPLC
62. In a patient who is suspected of overproducing serotonin, the measurement of which of the following
would be most useful?
63. In a patient who is suspected of overproducing dopamine, measurement of which of the following would
be most useful?
64. In the Zimmerman reaction, the chromogen is

A. dinitrobenzene C. sodium metaperiodate
B. quinone imine D. phenylhydrazine
65. The determination of estrogens by the Kober reaction requires which clinical sample?
A. random urine B. 12-hour urine C. 24-hour urine D. pooled urine
III.) MATCHING TYPE. Match column A with column B. A letter may be used more than once. Place all
answers to the matching type test on the same answer sheet. You are not allowed to change your answer.
A.) SPECIAL THYROID TESTS I

B1. RAIU A. evaluates response to anti-thyroid drug therapy
A2. T3 suppression test B. differentiate causes of hyperthyroidism
D3. Needle biopsy C. diagnosis of hypothyroidism in borderline cases
E4. Thyroid antibodies D. remove thyroid mass to check for malignancy
C5. TSH measurement E. measured to assess presence of anti-thyroid antibodies

B.) SPECIAL THYROID TESTS II
D6. Thyroid-binding proteins A. thyroid scan and RAIU
E7. Thyroid stimulating antibodies B. PBI, BEI, CPB & RIA
A8. Radioactive thyroid tests C. RT3U & % uptake of labeled T3
C9. Tests for free T3 and free T4 D. TBG, TBPA, & TBA
B10. Tests for total T3 and T4 E. LATS & TBI
C.) REFERENCE RANGE

C11. Total T3 by RIA A. 5.5-12.5 µg/dl
A12. Total T4 by RIA B. 25-35%
E13. RT3U C. 80-200 ng/dl
B14. % T3 uptake D. 1:10
F15. T4 to T3 ratio E. 0.85-1.15
F. none of the above
D.) TERMS ON THYROID FUNCTION

D16. Murphy-Pattee method A. TBG
I17. Conjugating compounds for T4 B. sulfates
E18. Prohormone for thyroid hormones C. RIA
G19. Metabolically inactive triiodothyronine D. CPB assay
H20. Gold standard for thyroid function E. thyroglobulin
A21. Major thyroid hormone transport protein F. equilibrium dialysis
B22. Conjugating compound for T3 G. reverse T3
F23. Gold standard for free T3 and T4 assay H. TSH measurement
J24. Radioactive elements used in thyroid scan I. glucuronate
C25. Most sensitive method for TSH assay J. radioiodine and pertechnitate
E.) TBG LEVELS

A26. intake of anabolic steroids A. low TBG level
A27. advanced liver disease B. high TBG level
A28. advanced renal disease
B29. pregnancy
B30. increased estrogen level
F.) THYROID HORMONE LEVELS & DISEASE
B31. increased RT3U A. hypothyroidism

A32. decreased TBG B. hyperthyroidism
A33. liver cirrhosis C. euthyroidism
A34. renal failure
A35. starvation
A36. cystic fibrosis
B37. thyroid cancer
A38. decrease RT3U
A39. increased TBG
A40. iodine deficiency
IV) FILL IN THE TABLE. Write I if the hormone is increased and write D if the hormone is decreased
corresponding to the column headings and row labels. (20 points) COPY & ANSWER

HYPOTHYROIDISM HYPERTHYROIDISM
primary secondary tertiary primary secondary tertiary
TSH
I D D D I I
TRH
I I D D D I
T3 and T4
D D D I I I
V). FILL IN THE BLANKS. Fill in the blanks under A with the organ producing the hormone. Supply blanks under B with
the function of the hormones. (10 points)
A B
1. T3 thyroid gland increase BMR, calorigenesis, thermogenesis, prod. of thyroid hormones
2. T4 thyroid gland same as no. 1
3. TSH pituitary gland stimulate thyroid to prod. secretion
4. TRH hypothalamus stim. release of TSH from pitui. gland
5. Calcitonin thyroid gland decrease plasma Ca levels
VI). SEQUENCE OF THYROID PROCESSES. Assign a number before each step of the processes A (from 1 to 5) and B
(from 1 to 7) to come up with the correct sequence of each of the said processes occurring in the thyroid gland. Sample
answers are : A: 43521; B 7243165
A) Thyroid Hormone Synthesis……………………………34251 (score is either 5 or 0) 3

B) Release of Thyroid Hormones from the Follicle…….6427531 (score is either 7 or 0)
A) Thyroid Hormone Synthesis

Incorporation of iodine with the tyrosyl residues of the thyroglobulin
Coupling of iodinated precursors to produce T3 and T4
Oxidation of iodide to iodine via peroxidase action
Cleavage of thyroid hormones via protease action to release them
Iodide absorption by the thyroid gland from the plasma
B) Release of Thyroid Hormones from the Follicle

Lysosomal fusion
Formation of vesicles on apical membrane (endocytosis of thyroglobulin)
Activation of cAMP
Digestion of thyroglobulin to release thyroid hormones
Colloid droplets undergo phagocytosis
Phosphorylation of cellular proteins that mediate cellular processes
TSH binds to the basal side receptor of the follicular cell

LONG QUIZ 7
I) MATCHING TYPE: On one whole sheet of paper, match column A with column B from nos.1-90
regarding drugs of abuse, therapeutics, drug metabolites and antidotes. Letters only. You are not
allowed to change your answer.
Column A Column B
I) Drugs of abuse and their descriptions.
1. Only acidic group of drugs of abuse D. A. morphine

2. Tertiary amines with benzene rings J. B. amobarbital
3. Condensation product of urea and malonic acid N. C. phenytoin
4. Urinary metabolite of cocaine K. D. barbiturates
5. Popularly known as “shabu” S. E. met-enkephalin
6. Metabolite of marijuana I. F. diazepam
7. Also known as “hashish” causing red eyes R. G. MAO
8. Naturally produced opiate peptide in the brain E. H. phenobarbital
9. Opiate that is a powerful analgesic A. I. Δ9-tetrahydrocannabinol
10. Opiate that is used to treat cough O. J. opiates
11. Opiate that is the source of morphine & N-acetylmorphine Q. K. benzoylecgonine
12. Commercially available as Valium F. L. pentobarbital
13. Long-acting barbiturate H. M. LSD
14. Intermediate-acting barbiturate B. N. barbituric acid
15. Short-acting barbiturate L. O. codeine
16. Snorted drug derived from the Coca plant; known as “crack” T. P. phencyclidine
17. Enzyme inhibited by amphetamines G. Q. heroin
18. Also known as “angel dust” P. R. marijuana
19. Most commonly abused hallucinogen in the U.S. M. S. methamphetamine
20. Anticonvulsant structurally similar to phenobarbital; Dilantin C. T. cocaine
II) Drugs of abuse and their classes.
21. Codeine D. A. Sedative-hypnotics

22. Methaquaalone C. B. Dopaminergic stimulants
23. Methamphetamine B. C. Hallucinogens
24. Thiopental A. D. Opiates
25. Diazepam E. E. Tranquilizers
26. LSD C.
27. Propoxyphene D.
28. Methylphenidate B.
29. Morphine D.
30. Pentobarbital A.
31. Oxazepam E.
32. Benzoylecgonine B.
33. THC C.
34. Phenobarbital A.
35. Naloxone D.
36. Phencyclidine C.
37. Cocaine B.
38. Methadone D.
39. Amobarbital A.
40. Heroin D.

Column A Column B
THERAPEUTICS Part 1
41. cyclophosphamide, cyclosporin D. A. cardiotropic drug
42. phenobarbital, phenytoin B. B. anticonvulsant drug
43. chlorpromazine G. C. antiasthmatic drug
44. aspirin, acetaminophen E. D. immunosuppressive drug
45. theophylline, Ventolin C. E. antiphlogistic drug
46. methotrexate H. F. manic depressive drug
47. digitoxin, quinidine A. G. antipsychotic drug
48. lithium, doxepin F. H. chemotherapeutic drug
49. Haldol G.
50. Leucovorin H.
DRUGS & THEIR METABOLITES
51. Digitoxin E. A. salicylic acid and acetic acid

52. Procainamide H. B. PEMA
53. Primidone B. C. N-acetylmorphine
54. Ethosuximide I. D. benzoylecgonine
55. Theophylline J. E. digoxin
56. Aspirin A. F. THC
57. Heroin C. G. hydroxyquinidine
58. Cocaine D. H. NAPA
59. Marijuana F. I. desmethylmethosuximide
60. Quinidine G. J. 3-methylxanthine
THERAPEUTICS Part 2
61. cyclophosphamide D. A. cardiotropic drug

62. phenobarbital B. B. anticonvulsant drug
63. chlorpromazine G. C. antiasthmatic drug
64. aspirin E. D. immunosuppressive drug
65. theophylline C. E. antiphlogistic drug
66. methotrexate H. F. manic depressive drug
67. digitoxin A. G. antipsychotic drug
68. lithium carbonate F. H. chemotherapeutic drug
69. haloperidol G.
70. Leucovorin H.
71. cyclosporine D.
72. phenytoin B.
73. acetaminophen E.
74. ibuprofen E.
75. Ventolin C.
76. quinidine A.
77. doxepin F.
78. indiral A.
79. anti-histamine C.

80. Tylenol E.
DRUGS/TOXINS & ANTIDOTES
81. Acetaminophen J. A. Deferoxime

82. Aluminum A. B. Charcoal hemoperfusion
83. Arsenic C. C. Dimercaprol
84. Benzodiazepines G. D. Digibind
85. Cyanide F. E. Naloxone
86. Digoxin D. F. Amyl nitrite
87. Opioids E. G. Flumazenil
88. Organophosphorus H. H. Pralidoxime, atropine
89. Salicylates/TCAD I. I. Bicarbonate
90. Theophylline/Barbiturates B. J. N-acetylcysteine
II) MCQs: On the same answer sheet, write the letter that corresponds to the correct answer. You are
not allowed to change your answer.
1. The Trinder reaction is widely used for the colorimetric determination of

A. acetaminophen B. phenothiazine C. salicylate D. barbital
2. Reinsch test can detect poisoning from

A. carbon monoxide B. arsenic C. alcohol D. organophosphates
3. The confirmatory method for identification of drugs in body fluids is

A. AAS B. GC-MS C. HPLC D. FPIA
4. Which of the following serum components is able to alter the free drug level in plasma?
A. creatinine B. urea C. albumin D. calcium
5. All of the following statements are true regarding drug distribution patterns except
A. Drug metabolism is slower in newborn than adults.
B. Drug metabolism is more rapid for 6-year old children than for adults.
C. Renal clearance of drugs is faster in newborn than adults.
D. Drug metabolism often changes during pubescence.
6. When is a blood sample for the determination of the trough level of a drug appropriately drawn?
A. during the absorption phase of the drug
B. during the distribution phase of a drug
C. shortly before drug administration
D. two hours after drug administration
7. Free drug levels can generally be determined by analyzing what body fluid?
A. whole blood B. plasma ultrafiltrate C. urine D. PFF of plasma
8. An epileptic patient receiving phenytoin develops acute glomerulonephritis (AGN). What change, if any,
would be expected in the patient’s circulating drug level?
A. decrease in free drug C. increase in protein-bound drug

B. increase in free drug D. no change in circulating drug level
9. In what form must a drug be in order to elicit a pharmacologic response?

A. free C. bound to globulins
B. bound to albumin D. bound to fatty acids
10. What are the approximate half-life periods for a serum drug concentration to reach 97-99% of the steady-
state?
A. 1-3 B. 2-4 C. 5-7 D. 7-9
11. The first-pass effect after oral administration occurs in the

A. liver B. kidney C. colon D. intestine
12. The study of what the body does to the drug is

A. first-order kinetics C. pharmacokinetics
B. zero-order kinetics D. pharmacodynamics
13. The route of drug administration with 100% bioavailability is via

A. SQ B. IM C. IV D. intranasal
14. The study of what the drug does to the body is
A. first-order kinetics C. pharmacokinetics
B. zero-order kinetics D. pharmacodynamics
15. The route of drug administration with the least bioavailability is via
A. SQ B. IM C. rectal D. intranasal
16. The study of drug action or effects is
A. pharmacognosy C. pharmacokinetics
B. pharmacology D. pharmacodynamics
17. The painless route of drug administration is via
A. SQ B. IM C. IV D. intranasal
18. Which of the following drugs is used as bronchodilator?

A. Theophylline B. Phenytoin C. Amikacin D. Clozapine
19. What is the active metabolite of the antiarrhythmic drug procainamide?

A. Pronestyl B. Disopyramide C. PEMA D. NAPA
20. What is the recommended name for diphenylhydantoin?

A. Phenytoin B. Nalorphine C. Primidone D. Carbamazepine
21. Which of the following is an example of a phenothiazine drug?

A. Cyclosporine B. Theophylline C. Phenytoin D. Chlorpromazine
22. Which of the following is used to treat manic depression?

A. potassium B. lithium C. calcium D. chloride
23. What is the major active metabolite of the anticonvulsant drug primidone?
A. Phenytoin B. Acetazolamide C. NAPA D. PEMA
24. Which of the following is the most commonly encountered xanthine that could potentially interfere with the
determination of theophylline?
A. Nicotine B. Caffeine C. Amphetamine D. Procainamide
25. Which of the following drugs is used as an anti-cancer?

A. Methotrexate B. Amiodarone C. Tacrolimus D. Paroxetine
26. Acetaminophen is particularly toxic to what organ?

A. heart B. kidney C. spleen D. liver
27. Anticoagulated whole blood is the preferred specimen in determining exposure to what compound?
A. methanol C. acetaminophen
B. mercury D. carbon monoxide
28. Free erythrocyte protoporphyrin levels are useful as a screening method for exposure to which of the
following metals?
A. zinc B. lead C. iron D. mercury
29. The identification of the urinary metabolite ecgonine would be useful in determining exposure to which of
the following drugs?
A. Codeine B. Cocaine C. Amphetamine D. Propoxyphene
30. 9 THC is the principal active component of what drug?

A. Benzodiazepine B. Marijuana C. Morphine D. Codeine
31. Reinsch’s test is used to screen urine for toxic concentrations of all of the following except
A. bismuth B. arsenic C. mercury D. cyanide
32. Which of the following methods would yield reliable quantification of ethanol in the presence of other
alcohols?
A. reaction with permanganate and a chromotropic acid
B. Conway diffusion followed by dichromate reaction
C. Alcohol dehydrogenase reaction
D. Gas liquid chromatography
33. Levels of 8-9% Hb-CO saturation of whole blood are commonly found in which of the following situations?
A. fatal CO poisoning C. acute CO poisoning
B. nonsmoking residents of rural areas D. cigarette smokers
34. Bioavailability of a drug refers to the:

A. Availability of therapeutic administration.
B. Availability of the protein-bound fraction of the drug.
C. Drug transformation.
D. The fraction of the drug absorbed into the systemic circulation.
35. The drugs secobarbital & amobarbital are classified as:

A. Basic drugs C. Acidic drugs
B. Neutral drugs D. Unclassified
36. Zinc protoporphyrin or free erythrocyte protoporphyrin measurement are useful to assess blood
concentrations of:
A. Lead C. Arsenic
B. Mercury D. Beryllium
37. The most widely employed screening technique for drug abuse is:
A. High-performance liquid chromatography C. Thin layer chromatography
B. Gas-liquid chromatography D. UV spectrophotometry
38. Lithium therapy is widely used in the treatment of:

A. Hypertension C. Aggression
B. Hyperactivity D. Manic-depression
39. A drug that relaxes the smooth muscles of the bronchial passages is:
A. Acetaminophen C. Phenytoin
B. Lithium D. Albuterol
40. A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing
the force and velocity of myocardial contraction is:
A. Digoxin C. Lithium
B. Acetaminophen D. Phenytoin
For nos. 41-50, match the poison with their distinctive properties.
41. wood alcohol; produces metabolic acidosis B. A. ethanol

42. basophilic stippling in RBCs; produce hypochromic anemia D. B. methanol
43. presence of CaOx crystals in urine; anti-freeze C. C. ethylene glycol
44. the most common toxic substance A. D. lead
45. measurement of carboxyHb; cherry red face E. E. carbon monoxide
46. assay of CHS & AcCHS; affects parasympathetic nerves E. A. arsenic

47. garlic odor of breath; positive Reinsch test A. B. mercury
48. may result to hemosiderosis D. C. cyanide
49. measurement of HiCN; breath with odor of bitter almonds C. D. Iron
50. dimercaprol or penicillamine can be used as treatment B. E. organophosphate
51. Which of the following drugs is used as bronchodilator?

A. Leukotriene B. Phenytoin C. Amikacin D. Clozapine
52. What is the active metabolite of the primidone?

A. Pronestyl B. Disopyramide C. PEMA D. NAPA
53. Which of the following compounds has antitussive property?

A. Amphetamine B. Codeine C. Cannabinoids D. Benzodiazepine
54. What is the brand name for haloperidol?

A. Phenytoin B. Nalorphine C. Primidone D. Haldol
55. Which of the following is an example of antiepileptic drug?

A. Cyclosporine B. Carbamazepine C. Quinidine D. Chlorpromazine
56. Which of the following is used to treat manic depression?
A. La B. Li2CO3 C. Lu D. Le
57. Methylxanthine is the metabolite of which of the following drugs:

A. Amitriptyline B. Desipramine C. Imipramine D. Theophylline
58. Which of the following can be used to treat arrhythmias?

A. Phenytoin B. Acetazolamide C. NAPA D. Phenobarbital
59. Which of the following is the most commonly encountered xanthine that could potentially interfere with the
determination of theophylline?
A. Nicotine B. Caffeine C. Amphetamine D. Procainamide

60. Which of the following drugs is used as analgesic?
A. Methotrexate B. Amiodarone C. Morphine D. Paroxetine
61. Which of the following is an antiarrhythmic drug with a metabolite with the same function?
A. Quinidine B. Digoxin C. Procainamide D. Nortriptyline
62. Increased trough levels of aminoglycosides in the serum are often associated with toxic effects to what
organ?
A. heart B. kidney C. pancreas D. liver
63. Which of the following is an example of a intermediate -acting barbiturate?

A. Phenobarbital B. Amobarbital C. Secobarbital D. Pentobarbital
64. Acetaminophen is particularly toxic to what organ?

A. heart B. kidney C. spleen D. liver
65. Anticoagulated whole blood is the preferred specimen in determining exposure to what compound?
A. methanol C. acetaminophen
B. mercury D. carbon monoxide
66. Free erythrocyte protoporphyrin levels are useful as a screening method for exposure to which of the
following metals?
A. zinc B. lead C. iron D. mercury
67. Of the following specimens, which of the following would be appropriate for determining exposure to lead?
A. EDTA plasma B. serum C. whole blood D. CSF
68. The identification of the urinary metabolite ecgonine would be useful in determining exposure to which of
the following drugs?
A. Codeine B. Cocaine C. Amphetamine D. Propoxyphene
69. Heroin is synthesized from what drug?

A. Diazepam B. Morphine C. Ecgonine D. Chlorpromazine
70. 9 THC is the principal active component of what drug?

A. Benzodiazepine B. Marijuana C. Morphine D. Codeine
71. After absorption, codeine is metabolized to what compound?

A. Phencyclidine B. Morphine C. Methadone D. Propoxyphene
72. Reinsch’s test is used to screen urine for toxic concentrations of all of the following except
A. bismuth B. arsenic C. mercury D. cyanide
73. Which of the following tests would be particularly useful in determining exposure to isopropanol?
A. serum osmolality and urine acetone C. urine acetone and urine osmolality
B. urine osmolality and serum osmolality D. serum sodium and serum acetone
74. Which of the following methods would yield reliable quantification of ethanol in the presence of other
alcohols?
A. reaction with permanganate and a chromotropic acid
B. Conway diffusion followed by dichromate reaction
C. Alcohol dehydrogenase reaction
D. Gas liquid chromatography

75. Levels of 8-9% Hb-CO saturation of whole blood are commonly found in which of the following situations?
A. fatal CO poisoning C. acute CO poisoning
B. nonsmoking residents of rural areas D. cigarette smokers
76. A urine screening test for porphobilinogen is positive. The MOST likely disease state is:
A. lead poisoning C. lithium poisoning
B. arsenic poisoning D. Mercury poisoning
77. Bioavailability of a drug refers to the:

A. Availability of therapeutic administration.
B. Availability of the protein-bound fraction of the drug.
C. Drug transformation.
D. The fraction of the drug absorbed into the systemic circulation.
78. The cyclic antidepressants are classified as:

A. Basic drugs C. Acidic drugs
B. Neutral drugs D. Unclassified
79. Zinc protoporphyrin or free erythrocyte protoporphyrin measurement are useful to assess blood
concentrations of:
A. Lead C. Arsenic
B. Mercury D. Beryllium
80. Gas chromatography with the nitrogen/phosphorus detector is the most commonly used technique for the
analysis of:
A. Digoxin C. Ethyl alcohol
B. Acetysalicylic acid D. Cyclic antidepressants
81. The most widely employed screening technique for drug abuse is:
A. High-performance liquid chromatography C. Thin layer chromatography
B. Gas-liquid chromatography D. UV spectrophotometry
82. THC is a metabolite of:

A. Cocaine C. Opiate
B. Marijuana D. Phencyclidine
83. Lithium therapy is widely used in the treatment of:
A. Hypertension C. Aggression
B. Hyperactivity D. Manic-depression
84. The anticonvulsant used to control tonic-clonic (grand mal) seizures is:
85. A drug that relaxes the smooth muscles of the bronchial passages is:
A. Acetaminophen C. Phenytoin
B. Lithium D. Theophylline
86. A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing
the force and velocity of myocardial contraction is:
87. A carbonate salt used to control manic-depressive disorders is:

88. Which of the following elevates carboxyhemoglobin?
A. Nitrite poisoning C. sulfa drug toxicity
B. exposure to carbon monoxide D. sickle cell anemia
89. The reason carbon monoxide is so toxic is because it:

A. is a protoplasmic poison
B. combines with cytochrome oxidase
C. has 200 times the affinity of oxygen for hemoglobin binding sites
D. sensitizes the myocardium
90. When the clinical response does not agree with total drug concentration, free drug levels may be of
clinical use in all of the following cases, EXCEPT:
A. uremia C. ingestion of ther drugs
B. hypoalbuminemia D. patient noncompliance
91. Testing for the diagnosis of lead poisoning should include:

A. ion-exchanged analysis of urine for porphobilinogen
B. analysis of morning urine for delta-aminolevulinic acid
C. analysis of feces for porphyrin
D. ion-exchange analysis of feces for protoporphyrin
92. The main reason for suboptimal drug levels in therapeutic monitoring is:
A. Renal failure
B. Liver failure
C. Improper dosage prescribed
D. Patient noncompliance with dosage regimen.
93. About 90% of phenytoin is excreted in the urine as:
A. Phenobarbital C. Phenobarbital
B. Para-hydroxyphenyl phenylhydantoin D. N-acetylprocainamide
94. Nortriptyline is a metabolite of:

A. Amitriptyline C. Butriptyline
B. Protripyline D. Norbutriptyline
95. Cocaine is metabolized to:

A. Carbamazepine C. Hydrocodone
B. Codeine D. Benzoylecgonine
96. If a drug has a half-life of 7 hours, how many doses given at 7-hour intervals does it usually take to achieve
a steady state or plateau level?
A. One C. Five
B. Three D. Eight
97. An analgesic that alleviates pain without causing loss of consciousness is:
98. Thin-layer chromatography is of particular use in the identification of:

A. Lipids C. Inorganic ions
B. Drugs D. Enzyme inhibitors

99. A blood sample was received from the emergency room with a request for narcotic analysis. The request
slip indicated that the patient (a known heroin addict) responded to naloxone administration. The serum was
negative for morphine by EIA. What other tests should be performed in assessing suspected opiate abuse?
A. Heroin C. Alcohol
B. Salicylate D. Methaquaalone
100. After adding 8 drops of 10% ferric chloride to 5 ml of urine, the mixture develops a stable deep red purple
color. This is presumptive evidence of:
A. Lead C. Salicylates
B. Bromide D. Quinidine
101. The most common substance of abuse is

A. Acetone C. Distilled water
B. Ethanol D. Methyl alcohol
102. Four children are admitted with malaise, anorexia and abdominal pain. Further evaluations reveal mild
anemia, erythrocyte basophilic stippling and profound pica habits. Poisoning by which heavy metal is most
likely responsible?
A. Arsenic c. Mercury
B. Iron D. Lead
103. The most toxic among the alcohols is

A. Acetone C. Isopropyl alcohol
B. Ethanol D. Methyl alcohol
104. Production of alcoholic beverages by fermentation is probably among the first chemical processes
employed by humans. Alcohol concentration is commonly described as the proof number. Nineteenth-century
fur traders lacking testing equipment could determine proof of spirit. They would pour a small amount of black
gunpowder onto a stump, add some of the alcohol, and set it afire. If the alcohol were at least 50% (v/v), the
gunpowder would ignite after the liquid burned off and the preparation was described as 100 proof. Suppose
that a certain whiskey were 45% (v/v). The alcohol proof number would be:
A. 10 B. 20 C. 22.5 D. 45 E. 90
105. The most toxic among the arsenicals is the gaseous

A. tryparsamide C. arsenic sulfate
B. arsine D. organic arsenic
GOOD LUCK !!!

LONG QUIZ 8
1. What is the most important role of a DTL in solving societal problems?

The most important role of DTL in solving societal problems is to regulate the number of
illegal drug users to secure the safety and minimize the health concerns in the society brought
about by the usage of these prohibited drugs.
2. Why do people subject themselves to drug testing? Give three answers.

If they have been ordered by the court. If they are employees of public and private offices for
the company’s work rules and if they are secondary/tertiary students to prevent present and
future drug use.
3. Name three (3) governmental agencies that help in ensuring the smooth operation of DTL
in the Philippines.
Department of Health through Bureau of Health Facilities and Services, Department of Social
Welfare and Development and Philippine Drug Enforcement Agency.
4. Give two (2) differences between a screening lab and a confirmatory lab.
Screening lab provides presumptive test that determines + result and the type of drug used
while that of confirmatory is conclusive and more specific and confirms a + screening test.
5. Cite three (3) clinical sample-drug combinations that are commonly encountered in DTL.
MDMA or Methylenedioxymethamphetamine(ecstasy), Methamphetamine Hydrochloride
(Shabu) and Cannabis/ Synthetic Cannabis (Marijuana/Synthetic Marijuana).
6. What is the RA 9165 all about?

Mandates the prohibition of the usage of illegal drugs, includes the monitoring of the
integration of all drug rehabilitation, intervention, aftercare, follow-up programs as well as the
penalties of those involved in the usage and operation of drug establishments.
7. According to your group, what is the most menacing drug in the Philippines? Explain
For us, methamphetamine hydrochloride/shabu is the most menacing drug in the Philippines
because according to our research, it is the most used/prevalent one followed by marijuana.
Most of Filipino drug addicts were caught with “shabu’’ which has the capacity to cause
unsound mind and can contribute to insanity and mental disorders and destroying their lives as
a whole.
8. Cite three functions of the NRL for Toxicology Assay.

It provides laboratory reference for confirmatory testing, maintains quality assurance program
and trains laboratory personnel.
9. Name three individuals who can become a DTL Analyst.

Registered Medical Technologists, Chemical Engineers and Pharmacists.
10. What are the training requirements for the Authorized Specimen Collector? Give
three. Qualification training, Initial Proficiency Demonstration and Error Correction
Training.
11. Describe the best collection device for urine specimen in drug testing.
Multi-Drug Integrated Split Specimen Test Cup is a urine collection device with a built-in
qualitative test panel for the simultaneous detection of multiple drugs and metabolites in
human urine without specimen handling. It is intended for professional in vitro diagnostic only.
12. What are 3 out of the many functions of the Analyst of DTL?
Supervises the operations including collection and encoding of results; interprets, records and
releases results and ensures that all legal requirements are compiled.
13. In what two (2) ways do you think can the government solve the drug-related problems in
the Philippines based on the RA 9165?
It can be solved by pursuing intensive campaign against the use of illegal drugs through the
implementation of anti- drug abuse programs and enforcing penalties to those found guilty of
using it.
14. If you are chosen to be part of random drug testing, are you amenable to it? Reason out
why or why not.
As a righteous citizen of the country who understands well the purpose of having random drug
testing, I am willing to do it to follow my nation’s rules and regulations. As long as it is for the
betterment of the country, I am willing to support it.
15. What do you think is the worst drug-related problem that this country have and why?
I guess, it’s the Philippines’ War on Drugs the previous year. I can say that it’s worst because it
doesn’t follow proper due process which involves the killing of the innocent ones.
16. How can you help solve the drug-related problems in our country?
I would educate the people regarding the risks and health complications that these drugs will
cause them and giving them knowledge on how they could recover from it; institutions they
would go to and practices they can follow.
17. Give three characteristics of the prescribed Collection Site for urine in a DTL.
A restroom with toilet for the employee to have privacy while providing the urine specimen; a
source of water (if practical, external) for washing hands and a suitable, clean surface as a
work area.
18. Cite three testing reasons for Oral Fluid according to DTL.
Three testing reasons for oral fluid are for pre-employment, random testing and reasonable
suspicion/cause.
19. How is the integrity of the urine for drug testing ensured?

Procedures and protocols are strictly followed from the collection of the specimen, transport
and analysis in accredited testing laboratory and other precautions such as eliminating water
sources and prohibiting personal belongings in the collection room.
20. Compare and contrast a COC from an MFR.

Chain of Custody references a paper trail/ a course of action of documenting the manage of
storage of a specimen from the moment a donor provides the specimen to the final destination
of the specimen and review and reporting of the final test result while Memorandum for
Records contain information that is usually not recorded in writing during a process. Both are
essential in maintaining the integrity of the patient specimen in DTL as well as integrity of
evidence

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7. The site where enzyme catalyzed reaction takes place is called?

9. Who proposed the existence of proteolytic enzymes as proteins?

10. What will happen to the enzyme-catalyzed reaction if temperature is increased?

11. What will happen to reaction if more enzymes are added?

16. Double-reciprocal plot is also called?

18. What is induced fit?

23. Which statement about the active site is incorrect?

26. Which enzymes are used to diagnose liver diseases?

A. ACP & ALP C. AMS & LPS

B. AST & ALT D. CK & LDH

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A. ALP & LAP C. LDH & AST

B. GGT & 5’-NT D. ACP & ALS

30. Which fraction is expected to be elevated in alcoholic cirrhosis of the liver?

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43. The Km value & Vmax in noncompetitive inhibition are

44. The Km value & Vmax in uncompetitive inhibition are

Choices for nos. 42-44.

A. increased and decreased respectively.

48. In the Lineweaver-Burk plot, the Vmax of an enzyme is:

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51. Competitive inhibitors typically resemble the:

63. Which enzyme is used to detect insecticide poisoning?

65. Which of the following is not the property of enzyme:

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88. How metal ions participate in catalysis?

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101. Which statement about the active site is incorrect?

What does EC stand for?

A. Enzyme Committee C. Enzyme Commission

B. Enzyme Company D. Enzyme Constitution

A. heparin B. EDTA C. fluoride D. citrate

105. In enzyme analysis of serum substances, buffers actually

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113. Enzyme activity can be measured via the following EXCEPT

A. decrease in substrate concentration C. appearance of products due to catalysis

B. extent of utilization of coenzyme D. increase in temperature due to catalysis

114. Biologic catalysts are characterized by all of the following EXCEPT

A. can either be organic or inorganic C. not consumed or altered in the reaction

B. decrease the energy of activation D. relatively high stereospecificity

115. Which of the following are surely derived from vitamin?

A. Activator C. Prosthetic group

A. active site C. cleavage site

B. allosteric site D. blocking site

B. Turnover number D. Catalytic activity per mg. protein

B. Turnover number D. Catalytic activity per mg. protein

119. The prostatic ACP is characterized by the following, except:

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Coenzymes and their transported molecules

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Tumor Markers and associated Diseases

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Column A Column B Column C

AL 47. c-erb B-2 G. meningioma,

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2) Give three tumor markers and their discoverers.

Year Author Marker

3) Discuss three means of measuring tumor markers and provide examples.

5) Cite three types of carcinogen with specific examples.