Bilirubin levels used to treat neonatal jaundice are best measured as:

Total bilirubin on direct spectrophotometry

Dubin-Johnson syndrome is characterized by:

Conjugated hyperbilirubinaemia and a dark liver

Unconjugated hyperbilirubinaemia with fasting rise

Absent glucuronyl transferase in infants

Renal and liver function tests

65 Lab technician recruitment practice questions on Renal and liver function tests, part of Clinical Biochemistry. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Bilirubin levels used to treat neonatal jaundice are best measured as:
1. AUrine bilirubin by dipstick
2. BUrobilinogen in urine
3. CTotal bilirubin on direct spectrophotometry
4. DConjugated bilirubin only
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Answer: C · Total bilirubin on direct spectrophotometry
In neonates most bilirubin is unconjugated and there is little carotene, so total bilirubin can be read directly at 454 nm with a haemoglobin correction. Treatment charts use total serum bilirubin. Urine tests miss unconjugated bilirubin. Samples must be shielded from light.
- A: Unconjugated bilirubin does not appear in urine.
- B: Urobilinogen does not measure serum bilirubin.
- D: Neonatal treatment depends on total, mostly indirect, bilirubin.
Question 2 · Hard
ALT 3200 U/L, AST 2800 U/L, PT prolonged, 36 hours after a large paracetamol ingestion. The best interpretation is:
1. ABiliary obstruction
2. BHaemolysis
3. CChronic alcoholic disease
4. DAcute hepatocellular necrosis
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Answer: D · Acute hepatocellular necrosis
Paracetamol overdose depletes glutathione and the toxic NAPQI metabolite destroys hepatocytes. Transaminases in the thousands with prolonged PT show severe necrosis. N-acetylcysteine is the antidote. Bilirubin rises later.
- A: Obstruction gives ALP-dominant patterns.
- B: Haemolysis does not give thousands of ALT.
- C: Alcohol gives AST:ALT over 2 and lower values.
Question 3 · Medium
Dubin-Johnson syndrome is characterized by:
1. AUnconjugated hyperbilirubinaemia with fasting rise
2. BConjugated hyperbilirubinaemia and a dark liver
3. CHigh ALP from bone
4. DAbsent glucuronyl transferase in infants
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Answer: B · Conjugated hyperbilirubinaemia and a dark liver
A defect in the canalicular transporter MRP2 blocks excretion of conjugated bilirubin. Conjugated bilirubin rises and appears in urine. The liver contains dark pigment. Enzymes are usually normal.
- A: Fasting unconjugated rise describes Gilbert.
- C: Bone ALP is unrelated.
- D: Absent enzyme describes Crigler-Najjar type I.
Question 4 · Easy
The biuret method for total protein depends on a colour complex formed between copper ions and:
1. ADisulphide bonds
2. BAromatic amino acids
3. CPeptide bonds
4. DFree amino groups
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Answer: C · Peptide bonds
In alkaline solution, cupric ions form a violet complex with compounds having two or more peptide bonds. Colour depends on the number of peptide bonds, so all proteins react nearly equally. It is the reference method for serum total protein. Lipaemia and haemolysis can interfere.
- A: Disulphide bonds play no role in the biuret reaction.
- B: Aromatic residues are the basis of the Lowry phenol reagent and UV 280 nm reading.
- D: Free amino groups react with ninhydrin.
Question 5 · Hard
A 60-year-old man of 72 kg has serum creatinine 2.0 mg/dL. By Cockcroft-Gault his clearance is about:
1. A80 mL/min
2. B20 mL/min
3. C40 mL/min
4. D34 mL/min
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Answer: C · 40 mL/min
CrCl = (140 - age) × weight ÷ (72 × creatinine) = 80 × 72 ÷ 144 = 40 mL/min. The 0.85 factor applies only to women. This value guides drug dosing.
- A: 80 leaves creatinine out of the denominator.
- B: 20 divides by creatinine twice.
- D: 34 applies the female factor of 0.85.
Question 6 · Medium
An AST:ALT ratio above 2 most suggests:
1. AAcute viral hepatitis
2. BParacetamol overdose early
3. CGallstone obstruction
4. DAlcoholic liver disease
Answer and explanation in LearnFree account
Question 7 · Medium
Ammonia samples must be:
1. APlaced on ice and analysed promptly
2. BMixed vigorously and refrigerated overnight
3. CLeft to clot at room temperature
4. DCollected in fluoride tubes and stored
Answer and explanation in LearnFree account
Question 8 · Hard
A dehydrated patient has blood urea 120 mg/dL and creatinine 1.8 mg/dL. The BUN:creatinine ratio and interpretation are:
1. AAbout 67; prerenal
2. BAbout 15; renal
3. CAbout 31; renal
4. DAbout 31; prerenal
Answer and explanation in LearnFree account
Question 9 · Hard
A neonate has total bilirubin 18 mg/dL, direct 0.6 mg/dL, Hb 12 g/dL and reticulocytes 8%. Mother is O Rh-positive, baby A Rh-positive. The likely cause is:
1. ABiliary atresia
2. BPhysiological jaundice
3. CABO haemolytic disease
4. DDubin-Johnson syndrome
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Question 10 · Medium
A raised ALP with normal GGT in a growing teenager most likely reflects:
1. AHepatitis
2. BAlcohol use
3. CBone growth
4. DBiliary obstruction
Answer and explanation in LearnFree account
Question 11 · Easy
Creatinine is formed non-enzymatically in muscle from:
1. AUric acid
2. BAmmonia
3. CUrea
4. DCreatine phosphate
Answer and explanation in LearnFree account
Question 12 · Medium
In the Jaffe reaction, which substance causes a positive interference?
1. AHaemoglobin F
2. BAcetoacetate
3. CBilirubin
4. DUrea
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Question 13 · Hard
A jaundiced patient has ALP 40 U/L, below the reference range. The tube was lavender-topped. The cause is:
1. AHaemolysis of red cells
2. BEDTA chelating metal cofactors
3. CDelayed serum separation
4. DLipaemic sample turbidity
Answer and explanation in LearnFree account
Question 14 · Medium
A blood urea to creatinine ratio well above normal with modest creatinine rise most suggests:
1. ALiver failure
2. BAcute tubular necrosis
3. CPrerenal azotaemia
4. DChronic glomerulonephritis
Answer and explanation in LearnFree account
Question 15 · Medium
Delta bilirubin is:
1. AUnconjugated bilirubin bound to albumin
2. BConjugated bilirubin covalently bound to albumin
3. CBilirubin bound to haptoglobin
4. DA photo-isomer of bilirubin
Answer and explanation in LearnFree account
Question 16 · Medium
Which serum protein rises in nephrotic syndrome because its large size stops urinary loss?
1. ATransferrin
2. BIgG
3. CAlbumin
4. DAlpha-2 macroglobulin
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Question 17 · Hard
A child has edema, urine protein 4+, serum albumin 1.8 g/dL and cholesterol 380 mg/dL with normal creatinine. The likely diagnosis is:
1. ACirrhosis
2. BAcute glomerulonephritis
3. CMinimal change nephrotic syndrome
4. DAcute tubular necrosis
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Question 18 · Medium
Which test is preferred to screen early diabetic kidney disease?
1. AUrine specific gravity
2. BDipstick protein
3. CSerum urea
4. DUrine albumin:creatinine ratio
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Question 19 · Easy
Gamma-glutamyl transferase (GGT) is a sensitive marker of:
1. AMuscle injury
2. BMyocardial infarction
3. CAlcohol intake and cholestasis
4. DBone formation
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Question 20 · Easy
IFCC transaminase reagents add which compound so B6-deficient patients do not read falsely low?
1. AFlavin adenine dinucleotide
2. BPyridoxal phosphate
3. CNAD+
4. DBiotin
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Question 21 · Medium
Cystatin C is useful as a GFR marker because it is:
1. ASecreted by the renal tubules
2. BCarried bound to albumin
3. CMade at a steady rate by nucleated cells
4. DDerived from muscle creatine
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Question 22 · Hard
Serum calcium 7.6 mg/dL with albumin 2.0 g/dL. The corrected calcium is:
1. A6.0 mg/dL
2. B7.6 mg/dL
3. C10.4 mg/dL
4. D9.2 mg/dL
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Question 23 · Easy
Which aminotransferase exists as both cytoplasmic and mitochondrial isoenzymes?
1. AALT
2. BAST
3. CGGT
4. DALP
Answer and explanation in LearnFree account
Question 24 · Easy
Serum albumin is most commonly measured by dye binding with:
1. APhenol red
2. BBromocresol green
3. CMethyl red
4. DBromophenol blue
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Question 25 · Hard
Serum total bilirubin reads low on a sample left on the bench in sunlight for 4 hours. The correct action is:
1. AReport with a correction factor
2. BWarm the sample to 37 °C and repeat
3. CRe-run with methanol added
4. DReject and request a fresh protected sample
Answer and explanation in LearnFree account

40 more Renal and liver function tests questions

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Study Clinical Biochemistry

Renal and liver function tests

Bilirubin levels used to treat neonatal jaundice are best measured as:

ALT 3200 U/L, AST 2800 U/L, PT prolonged, 36 hours after a large paracetamol ingestion. The best interpretation is:

Dubin-Johnson syndrome is characterized by:

The biuret method for total protein depends on a colour complex formed between copper ions and:

A 60-year-old man of 72 kg has serum creatinine 2.0 mg/dL. By Cockcroft-Gault his clearance is about:

An AST:ALT ratio above 2 most suggests:

Ammonia samples must be:

A dehydrated patient has blood urea 120 mg/dL and creatinine 1.8 mg/dL. The BUN:creatinine ratio and interpretation are:

A neonate has total bilirubin 18 mg/dL, direct 0.6 mg/dL, Hb 12 g/dL and reticulocytes 8%. Mother is O Rh-positive, baby A Rh-positive. The likely cause is:

A raised ALP with normal GGT in a growing teenager most likely reflects:

Creatinine is formed non-enzymatically in muscle from:

In the Jaffe reaction, which substance causes a positive interference?

A jaundiced patient has ALP 40 U/L, below the reference range. The tube was lavender-topped. The cause is:

A blood urea to creatinine ratio well above normal with modest creatinine rise most suggests:

Delta bilirubin is:

Which serum protein rises in nephrotic syndrome because its large size stops urinary loss?

A child has edema, urine protein 4+, serum albumin 1.8 g/dL and cholesterol 380 mg/dL with normal creatinine. The likely diagnosis is:

Which test is preferred to screen early diabetic kidney disease?

Gamma-glutamyl transferase (GGT) is a sensitive marker of:

IFCC transaminase reagents add which compound so B6-deficient patients do not read falsely low?

Cystatin C is useful as a GFR marker because it is:

Serum calcium 7.6 mg/dL with albumin 2.0 g/dL. The corrected calcium is:

Which aminotransferase exists as both cytoplasmic and mitochondrial isoenzymes?

Serum albumin is most commonly measured by dye binding with:

Serum total bilirubin reads low on a sample left on the bench in sunlight for 4 hours. The correct action is: