Organ function tests – ESSAYS

1. a. Enumerate the renal function tests done in the lab to assess the renal function (2)
b. What is the normal GFR? Add a note on the markers of GFR & add a note on
Proteinuria (1+5+2)
c. Discuss the tubular function tests in detail (5) (15 marks)"

2. An 18-year-old man who had suffered a flu-like illness for the previous two weeks is seen by his
GP. Clinical examination includes urinalysis which indicates that his urine is strongly positive
for protein on dipstick testing. A 24-hour urine collection done to confirm the dipstick finding
shows proteinuria of 1.5 g/24hours. The patient has oedema of both ankles and his blood
pressure is 142/84 mmHg.
He is referred urgently for renal review and his baseline urea and electrolytes are as follows:
Blood test report
Na+ =127 mEq/L (135-145)
K+ = 4.8 mEq/L (3.4-4.9)
Urea = 208 mg/dl
Creatinine = 3.5 mg/dl
Urine report
Protein = 2+
RBCs = 10-15/HPF
Pus cells = 5-6
Renal biopsy confirmed an acute glomerulonephritis.
a. What are the normal serum urea & creatinine levels?(1)
b. ---------------& ----------tests are done in the laboratory to identify the presence of proteins &
RBCs in urine respectively.(1)
c. ---------------- is the normal plasma osmolality. The urine osmolality ranges from------ to -----
-----mOsm/kg in a normal individual. (2)
d. What is the formula used to calculate the creatinine clearance (1)
e. What are the tests done to assess the glomerular function? Explain them in detail. (1+4)
f. Name the tests done to assess the tubular function and add a brief note on any 2 tests. (1+4)

3. Mr. Raman is a 60 year-old diabetic male has become increasingly lethargic and fatigued
over the past several days. On physical exam the patient is a well-developed, obese male.
Blood pressure =160/98, pulse= 76, respirations= 20 and he was afebrile. His breath had an
acetone smell. Cardiac and respiratory system examination within normal limits. The
abdomen was benign. Extremities were without abnormality. Laboratory Data
pH = 7.30
PCO2= 22 mmHg
PO2 = 108 mmHg
Sodium 142 ( Normal level 136-146 mmol/L)
Potassium 4.4 mmol/L (Normal 3.5-5.3 mmol/L )
Chloride 105 mmol/L (Normal level 98-108 mmol/L )
Bicarbonate 10 mmol/L ( Normal level 23-27 mmol/L )
BUN 22 (Normal level 7-22 mg/dl )
Creatinine 1.5 (Normal level 0.7-1.5 mg/dl )
Glucose 265 (Normal level 70-110 mg/dl )
Urine – • Sugar = +++ • Rothera’s test = +ve
 a. What is the primary acid base abnormality? (1)
b. What clinical condition is responsible for the acid-base disturbance in this patient? (1)
c. Calculate the anion gap & Give your interpretation. Name any two conditions where anion
gap is increased. (2+1)
d. Enlist the blood buffers. Name one major extracellular buffer & one major intracellular buffer.
(1+2)
e. Explain the renal regulation of acid base balance in detail with pictures (7)"

4. The biochemical laboratory parameters of a new born child born who was jaundiced and admitted
in the neonatal ICU are given below.
• Serum total Bilirubin : 10 mgs%
• Conjugated : 0.5 mgs%
• Unconjugated : 9.5 mgs%
• Serum alkaline phosphatase : 8 KA units
• Aspartate transaminase (AST) : 30 units
• Alanine Transaminase (ALT) : 26 units
• Urine Bile salts : Negative
• Urine Urobilinogen : +++
a. Interpret the result and give a probable diagnosis. (1+1)
b. What type of jaundice is this? (1) What could be the causes for this condition? (2)
c. What are the types of jaundice? (3) Write briefly the causes, clinical and laboratory findings of
each type (7)

5. a. What are the major liver functions? (3) Give a brief note on each one of them. (3)
b. Add a note on the liver function tests which help to assess these functions. (6)
c. Give the normal values of LFT. (3) (15 marks)

6. a. What is jaundice? What are its types? (1+2)

b. What are the causes of each type of jaundice? (6)
c. What are the laboratory tests to diagnose the types of jaundice (6) (15 marks)

7. A student hosteller presented to the casualty with recurrent episodes of vomiting and fever.
Examination revealed that he is dehydrated and jaundiced with enlarged liver. Biochemical findings
were follows: Give your probable diagnosis and cause?
• Serum Bilirubin: 10 mgs%
• Conjugated : 5.5 mgs%
• Unconjugated : 4.5 mgs%
• Serum alkaline phosphatase: 160 KA units
• Aspartate transaminase (AST) : 260 units
• Alanine Transaminase (ALT) : 290 units
• Urine Bile salts: ++
• Urine Bile pigments: ++

a. Interpret the result and give a probable diagnosis. (1+1)

b. What type of jaundice is this? (1) What could be the causes for this condition? (2)
c. What are the types of jaundice? )3) Write briefly the causes, clinical and laboratory findings of
each type (7)
 8. A 56 years old lady with nausea, vomiting and epigastric pain for the past 2 days with fever was
admitted in the medical ward. She was deeply jaundiced. Abdominal ultrasound was taken and
revealed few gallstones.The following are her laboratory findings :
Serum Bilirubin : 20 mgs%
• Conjugated : 18 mg%
• Unconjugated : 0.4mgs%
• Serum alkaline phosphatase: 200 U/L
• Aspartate transaminase (AST) : 60 units
• Alanine Transaminase (ALT) : 90 units
• Urine Bile salts : ++
• Urine Bile Pigments : ++
• Urine Urobilinogen : negative
• Faeces Stercobilinogen : Negative (Clay colored)
• Blood coagulation time : Prolonged
a. Interpret the result and give a probable diagnosis. (1+1)
b. What type of jaundice is this? (1)What could be the causes for this condition?(2)
c. Classify jaundice.(2) Write briefly the causes, clinical and laboratory findings of each type (7)

9. A 3 days old baby boy of Mrs. Ramya from Calcutta presented with yellowish discoloration of the
body and eyes for 1 day duration. During the first two days stools were said to be dark in colour
which has turned yellowish by the 3rd day but it was not pale. Baby was on triple phototherapy in
NICU. • Yellow discolouration of the skin and sclera was observed. In the evening of the 3rd day
after birth, the baby was brought to the hospital and the baby was severely jaundiced. The blood
was sent for FBC,CRP,SBR,GP,DCT and started on triple phototherapy. After 1 hr serum bilirubin
level was found out to be 18.46mg/dl.
a. What is the probable diagnosis? (1)
b. How does phototherapy help in treating the above child?(1)
c. Explain the synthesis & transport of bilirubin (3)
d. Explain the bilirubin metabolism & excretion in detail with a diagram.(4)
e. What is kernicterus?(1)
f. Write the normal levels of Bilirubin – total & fractions? (2)
g. Discuss the congenital & acquired types of hyperbilirubinemias, in detail (4)

10. Write the metabolic functions of thyroid hormones & the normal levels of T3, T4 & TSH (2+ 1.5)
b. Explain the various thyroid function tests (TFT) in detail (7.5)
c. Add a brief note on hypothyroidism & hyperthyroidism (2+2) (15 marks)

11. A 45 year old female presented with complaints of puffiness of face, fatigue, weight gain, and
constipation. She lacks motivation to do anything during the weekend, and notes that she does not
feel like herself. Upon questioning, the patient reports the following changes: thinning of her scalp
hair, brittle nails, dry skin, and cold intolerance.Physical examination confirmed her complaints. •
Presence of neck swelling,• Dry skin, brittle nails, coarse and dry hair, and abdominal distension.The
following were her blood test reports.
Patient’s result Reference range
Hb 9.5 g/dl (14- 17 g/dl)
 TSH 134 µIU/L (0.5-4.7 µIU/L)
T3 0.17 ng/ml (0.17 ng/ml)
T4 0.6 µg/dl (4.2 -12 µg/dl)
a. What is the probable diagnosis? (1)
b. The hormones produced by the gland are ----------& ------------. They are regulated by the ---------
-& ------------. (2)
c. Enumerate the metabolic effects of these hormones in our body. (2)
d. Explain the laboratory assessment of this endocrine gland’s functions, in detail (7)
e. Describe briefly the disorders caused , due to the hypo functioning & hyperfunctioning of the
gland. (3)

5 marks questions

1. What is creatinine clearance? Explain the clinical significance and calculation of creatinine
clearance (1+2+2).
2. Enumerate the endogenous and exogenous markers of GfR. what are the characteristics of an ideal
marker? Which is the gold standard marker of GFR? (2+2+1)
3. Discuss the different types of proteinuria and their clinical significance (3+2).
4. Enumerate the renal tubular tests. Explain any two of them in detail. (1+ 4)
5. Describe 4 tests based on synthetic functions of liver. (5 Marks)
6. A 14 year old girl was admitted to the medical ward after she developed yellowish discoloration
of the eye, marked loss of appetite, low grade fever (100 – 101oF) nausea and occasional
vomiting in the last one week. She had pain in the right hypochondrium and the urine was highly
coloured. She looked weak and malnourished also. Serum LFTs were done and following were the
results :Total Bilirubin – 8 mg/dL, Direct Bilirubin – 4.8 mg/dL, Serum AST – 980 IU/L, Serum
ALT – 1210 IU/L, Serum ALP – 20 KAU/dL.
a. What is the probable diagnosis? And justify your answer. (1m)
b. What are the common cases of this condition? (1m)
c. List out the lab findings in this condition & add a note on Van denBergh reaction (2+1)
7. A 4 days old female baby was admitted for phototherapy in NICU as yellowish discoloration of
baby’s conjunctiva was noticed. Investigations revealed total bilirubin 15 mg/dl, direct bilirubin 1
mg/dl and indirect bilirubin 14 mg/dl.
a. What is the basis for physiological jaundice? (1mark)
b. What is the biochemical basis of this condition? (1 mark)
c. Explain the basis for photo therapy? (1 mark)
d. List the disorders leading to congenital jaundice with their enzyme defects. (2 marks)"
8. Name the different types of jaundice. Explain the laboratory diagnosis of these types (1+4)
9. Enumerate the liver function tests. Explain Van denbergh's test in the diagnosis of differnt types of
jaundice (3+2).
10. Enumerate the liver function tests. Explain the tests done to assess synthetic fucntion of the liver
(3+2).
11. Enumerate the liver function tests. Explain the tests done to assess excretory fucntion of the liver
(3+2).
12. Explain the role of serum enzyme levels and prothrombin time in assessing a case of jaundice
13. What are the tests done to assess the function of thyroid gland with special emphasis on thyroid
auto antibodies. (2+3=5 Marks)
14. a. What are common causes of hypothyroidism?
b. What is the role of TSH estimation in evaluating hypothyroid patients? (3+2 )
15. a. What are common causes of hyperthyroidism? write tne clinical features
b. What is the role of TSH estimation in evaluating hypothyroid patients? (1+1+3)
16. Explain the synthesis and secretion of thyroid hormones in detail
17. What is Cushing's syndrome? Write the clinical features and explain the tests done to diagnose
Cushing's syndrome (1+1+3).
18. What is Addison's disease? Write the clinical features and explain the tests done to diagnose
Addison's disease (1+1+3).
19. Enumerate the biological effects of mineralocorticoids and add a brief note on Primary
hyperaldosteronism.
20. Explain the laboratory findings in adrenal hypofucntion and add a brief note on Adrenogenital
syndrome.

2 marks questions
1. Define microalbuminuria and write its clinical significance.
2. Define clearance. Enumerate the criteria required for an ideal marker used for clearance test.
3. Calculate the creatinine clearance in a person with following parameters.
a. Serum creatinine: 0.8 mg/dl Urinary creatinine: 1 mg/dl.
b. Urine output in 24 hours: 240 ml. Put 720 ml
c. Calculate the Creatinine clearance and interpret your results."
4. Write briefly on the detection and significance of Bence Jones proteins.
5. Name an endogenous clearance that is an accurate measure of GFR. Explain
6. Define microalbuminuria and write its clinical significance.
7. Name one glomerular function test and one test to assess tubular function. What is the normal
albumin- creatinine ratio in males & females.
8. Urine of a patient with hyperbilirubinemia is positive for Ehrlich’s test and negative for both
Fouchet’s test and Hay’s test. What is your probable diagnosis? What could be the causes for the
disorder?
9. The following are some of the biochemical findings in a patient. Serum Bilirubin :10 mg%
Conjugated : 8.5 mg% Unconjugated : 1.5mg% ALT : 90 IU/L AST : 80 IU/L ALP : 40 KA
Urine Bile pigments:++ Bile salts : ++ Urobilinogen: -ve units
Feces Stercobilinogen : - ve (clay coloured). Blood Coagulation time: Prolonged.
What is your probable diagnosis? Explain.
10. Write the principle of Van Den Berg test.
11. Compare the plasma enzyme parameters in hemolytic, hepatocellular and obstructive jaundice.
12. Urine of a patient with hyperbilirubinemia is positive for Ehrlich’s test and negative for both
Fouchet’s test and Hay’s test. What is your probable diagnosis? What could be the causes for the
disorder?
13. Comment on the significance of plasma alkaline phosphatase level in disease diagnosis
14. How will you differentiate between primary and secondary hypothyroidism?
15. Write the normal serum levels of Thyroid hormones.
16. Name the thyroid hormones. Write 2 lab findings in hypothyroidism.
17. Write the normal levels of serum total T4,total T3 and TSH in serum.
18. What are the expected changes in serum sodium and potassium in a case of Addison’s disease?
19. Write briefly on the functions of glucocorticoids
20. Write briefly about Conn's syndrome
21. Write breifly on dexamethasone suppression test.
22. How urinary 17-Ketosteroids are measured? What is its significance?