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Clinical Chemistry - Bishop WITH Answers
Clinical Chemistry 1 (University of Perpetual Help System DALTA)
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
ANALYTIC TECHNIQUES
e. Charge used to separate solutes instead of size
1. Which of the following is not necessary for
obtaining
the spectrum of a compound from 190 to 500
nm?
a. Tungsten light source
b. Deuterium light source
c. Double-beam spectrophotometer
d. Quartz cuvettes
e. Photomultiplier
9. Which of the following is not an advantage of
CE?
a.
Multiple
samples
can
be
assayed
simultaneously
on one injection
b. Very small sample size
c. Rapid analysis
d. Use of traditional detectors
e. Cations, neutrals, and anions move in the same
direction at different rates
2. Stray light in a spectrophotometer places limits
on
a. Upper range of linearity
b. Sensitivity
c. Photometric accuracy below 0.1 absorbance
units
d. Ability to measure in the UV range
e. Use of a grating monochromator
3. Which of the following light sources is used in
atomic absorption spectrophotometry?
a. Hollow-cathode lamp
b. Xenon arc lamp
c. Tungsten light
d. Deuterium lamp
e. Laser
4. Which of the following is true concerning
fluorometry?
a. Fluorescence is an inherently more sensitive
technique than absorption.
b. Emission wavelengths are always set at lower
wavelengths than excitation.
c. The detector is always placed at right angles to
the excitation beam.
d. All compounds undergo fluorescence.
e. Fluorometers require special detectors.
5. Which of the following techniques has the
highest
potential sensitivity?
a. Chemiluminescence
b. Fluorescence
c. Turbidimetry
d. Nephelometry
e. Phosphorescence
6. Which electrochemical assay measures current
at
fixed potential?
a. Amperometry
b. Anodic stripping voltammetry
c. Coulometry
d. Analysis with ISEs
e. Electrophoresis
7. Which of the following refers to the movement
of
buffer ions and solvent relative to the fixed
support?
a. Electroendosmosis
b. Isoelectric focusing
c. Iontophoresis
d. Zone electrophoresis
e. Plasmapheresis
8. Reverse-phase liquid chromatography refers to
a. A polar mobile phase and nonpolar stationary
phase
b. A nonpolar mobile phase and polar stationary
phase
c. Distribution between two liquid phases
d. Size used to separate solutes instead of charge
10. Tandem mass spectrometers
a. Are two mass spectrometers placed in series
with each other
b. Are two mass spectrometers placed in parallel
with each other
c. Require use of a gas chromatograph
d. Require use of an electrospray interface
e. Do not require an ionization source
11. Which of the following is false concerning the
principles of point-of-care testing devices?
a. Devices do not require quality control testing.
b. They use principles that are identical to
laboratory- based instrumentation.
c. Biosensors
have enabled miniaturization
particularly amendable for point-of-care testing.
d. Onboard microcomputers control instrument
functions and data reduction.
e. Whole blood analysis is the preferred
specimen.
12. Which is the most sensitive detector for
spectrophotometry?
a. Photomultiplier
b. Phototube
c. Electron multiplier
d. Photodiode array
e. All are equally sensitive
13. Which of the following is Beer’s law?
a. A = e × b × c
b. %T = I/I0 × 100
c. E = hν
d. e = ΔpH × 0.59 V
e. Osmolality = j × n × C
14. Which of the following correctly ranks
electromagnetic
radiation from low energy to high energy?
a. Microwaves, infrared, visible, UV, x-rays,
gamma, cosmic
b. Cosmic, gamma, x-rays, UV, visible, infrared,
microwaves
c. UV, visible, infrared, microwaves, x-rays,
cosmic, gamma
d. UV, visible, infrared, cosmic, gamma,
microwaves, x-rays
e. Visible, UV, infrared, cosmic, gamma,
microwaves, x-rays
15. What is the purpose of the chopper in an
atomic
absorption spectrophotometer?
a. Correct for the amount of light emitted by the
flame
b. Correct for the fluctuating intensity of the light
source
c. Correct for the fluctuating sensitivity of the
detector
d. Correct for differences in the aspiration rate of
the sample
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
e. Correct for the presence of stray light
16. Which of the following best describes the
process of fluorescence?
a. Molecules emit a photon at lower energy when
excited electrons return to the ground state.
b. Atoms emit a photon when the electrons are
excited.
c. Molecules emit a photon when the electrons
are excited.
d. Molecules emit a photon at the same energy
when excited electrons return to the ground
state.
e. Molecules emit a photon at higher energy when
excited electrons return to the ground state.
17. Which is most accurate concerning ISEs?
a. Gas-specific membranes are necessary for
oxygen
and carbon dioxide electrodes.
b. The pH electrode uses a solid-state membrane.
c. The calcium electrode does not require a
reference electrode.
d. The sodium electrode uses an ion-selective
carrier (valinomycin).
e. The ISE for urea uses immobilized urease.
18. Which of the following regarding MS is false?
a. Mass spectrometers can be used to sequence
DNA.
b. Ions are formed by the bombardment of
electrons.
c. Quadrupole and ion trap sectors separate ions
according to their mass-to-charge ratio.
d. Each chemical compound has a unique mass
spectrum.
e. MS detects for gas and liquid chromatography.
19. Which of the following is not an objective of
proteomics
research?
a. Identifying specific gene mutations
b. Identifying novel proteins as potential new
biomarkers for disease
c. Identifying posttranslational modifications of
proteins
d. Understanding the mechanism of diseases
e. Determining which genes are expressed and
which genes are dormant
20. Which of the following procedures is not
currently or routinely used for point-of-care
testing devices?
a. Polymerase chain reaction
b. Immunochromatography
c. Biosensors
d. Colorimetric detection
e. Electrochemical detection
CHROMATOGRAPHY AND MASS SPECTROMETRY
1. Which of the following statements is TRUE?
a. Partition chromatography is most appropriate
to identifying analytes that may be distributed
between two liquid phases.
b. Steric exclusion chromatography is best suited
for separating analytes based on their solubility in
the mobile solvent.
c. In liquid–solid chromatography, the stationary
phase separates analytes based on size, shape,
and polarity.
d. Ion-exchange chromatography has a resin
phase that is soluble to water and separation of
the mixture is based on magnitude and charge of
ionic species.
e.
The partition coefficient is measured and
compared with standards in thin layer
chromatography.
2. In high-performance thin-layer chromatography
(HPTLC), developed bands are compared with
reference standard concentrations. Each band is
measured by:
a. Mass spectrometer
b. Densitometer
c. Ruler
d. Buiret protein assay
e. Two-dimensional electrophoresis
3. In which of the following components of a
chromatography instrument does selective
separation of a mixture occur?
a. Sample injection port
b. Column
c. Spectrometer
d. Quadrupole
e. Mass analyzer
4. True or False? In chromatography, the
stationary
phase is always of a solid matrix.
a. True
b. False
5. Mass spectrometry identifies analytes based
on:
a. Mass to charge ratio
b. Retention factor
c. Density of the band
d. Molecular weight
e. Solubility in the mobile phase
6. Drugs of abuse are typically measured by:
a. Thin-layer chromatography
b. Liquid/liquid chromatography
c. Gas/liquid chromatography
d. Steric exclusion chromatography
e. HPLC
7. PCR/ESI-TOF has the distinct advantage in
pathogen
identification because:
a. Requires the patient sample to be cultured and
then analysis can be performed.
b. Can be used directly from patient specimens.
c. Uses the protein “finger print” to identify the
pathogen.
AUTOMATION
1. Which of the following is NOT a driving force for
more automation?
a. Increased use of chemistry panels
b. High-volume testing
c. Fast turnaround time
d. Expectation of high-quality, accurate results
2. Which of the following approaches to analyzer
automation can use mixing paddles to stir?
a. Discrete analysis
b. Centrifugal analysis
c. Continuous flow
d. Dry chemistry slide analysis
3. Which of the following types of analyzers offers
random-access capabilities?
a. Discrete analyzers
b. Continuous-flow analyzers
c. Centrifugal analyzers
d. None of these
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
e. All of the above phases
4. All of the following are primary considerations
in the selection of an automated chemistry
analyzer EXCEPT
a. How reagents are added or mixed
b. The cost of consumables
c. Total instrument cost
d. The labor component
5. An example of a modular integrated chemistry/
immunoassay analyzer would be the
a. Aeroset
b. Dimension Vista 3000T
c. Paramax
d. Vitros
6. Dwell time refers to the
a. Time between initiation of a test and the
completion of the analysis
b. Number of tests an instrument can handle in a
specified time
c. Ability of an instrument to perform a defined
workload in a specified time
d. None of these
7. The first commercial centrifugal analyzer was
introduced in what year?
a. 1970
b. 1957
c. 1967
d. 1976
8. All of the following are advantages to
automation
EXCEPT
a. Correction for deficiencies inherent in
methodologies
b. Increased number of tests performed
c. Minimized labor component
d. Use of small amounts of samples and reagents
in comparison to manual procedures
9. Which of the following steps in automation
generally
remains a manual process in most laboratories?
a. Preparation of the sample
b. Specimen measurement and delivery
c. Reagent delivery
d. Chemical reaction phase
10. Which of the following chemistry analyzers
uses
slides to contain the entire reagent system?
a. Vitros analyzers
b. ACA analyzers
c. Synchron analyzers
d. None of these
11. Reflectance spectrometry uses which of the
following?
a. Luminometer
b. Tungsten–halogen lamp
c. Photomultiplier tube
d. UV lamp
e. Thermometer to monitor temperature in
reaction vessel
12. Modifications in microsampling and reagent
dispensing improve which of the following phases
in clinical testing?
a. Physician ordering phase
b. Preanalytical phase
c. Analytical phase
d. Postanalytical phase
13. Bidirectional communication between the
chemistry
analyzer and the laboratory information system
has had the greatest impact on which of the
following
phases of clinical testing?
a. Preanalytical
b. Analytical
c. Postanalytical
d. All of the above
e. None of the above
IMMUNOCHEMICAL TECHNIQUES
1. The strength of binding between an antigen
and antibody is related to the:
a. Goodness of fit between the epitope and the
F(ab)
b. Concentration of antigen and antibody
c. Source of antibody production, because
monoclonal
antibodies bind better
d. Specificity of the antibody
2. In monoclonal antibody production, the
specificity of the antibody is determined by the:
a. Sensitized B lymphocytes
b. Myeloma cell line
c. Sensitized T lymphocytes
d. Selective growth medium
3. Which unlabeled immune precipitation method
in
gel is used to quantitate a serum protein?
a. Radial immunodiffusion
b. Double diffusion
c. Counterimmunoelectrophoresis
d. Immunofixation electrophoresis
4. In immunofixation electrophoresis, discrete
bands appear at the same electrophoretic
location, one reacted with antihuman IgA (α chain
specific) reagent and the other reacted with
antihuman λ reagent. This is best described as:
a. An IgA λ monoclonal protein
b. An IgA λ polyclonal protein
c. IgA biclonal proteins
d. Cross-reactivity
5. In nephelometry, the antigen–antibody
complex
formation is enhanced in the presence of:
a. Polyethylene glycol
b. High-ionic-strength saline solution
c. Normal saline
d. Complement
6. Which homogeneous immunoassay relies on
inhibiting
the activity of the enzyme label when bound to
antibody reagent to eliminate separating
freelabeled from bound-labeled reagent?
a. EMIT
b. CEDIA
c. MEIA
d. ELISA
7. In flow cytometry, the side scatter is related to
the:
a. Granularity of the cell
b. DNA content of the cell
c. Size of the cell
d. Number of cells in G0 and G1
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
8. You analyze the DNA content on a sample of
breast
tissue for suspected malignancy using flow
cytometry
and get the following results: DI = 2.5 and %
cells in S phase = 29%. Based on these results
you
can conclude:
a. These results are likely indicative of a
malignant
breast tumor
b. This is normal breast tissue
c. These results are consistent with a mostly
diploid population
d. The results are not consistent with one
another; no information is gained
An immunofixation protein electrophoresis is
performed
on serum from a patient with the most common
type of multiple myeloma. The resulting pattern
revealed
a. Monoclonal bands of the IgG type
b. Oligoclonal bands
c. 𝗉-γ bridging
d. Monoclonal bands of the IgM type
9. The nucleic acid technique in which RNA is
converted
to cDNA, which is then amplified, is known as:
a. RT-PCR
b. PCR
c. RFLP
d. In situ hybridization
9. The following pattern of serum protein
electrophoresis
is obtained:
albumin: decreased
α1- and α2-globulins: increased
γ -globulins: normal
This pattern is characteristic of which of the
following
conditions?
a. Acute inflammation (primary response)
b. Cirrhosis
c. Nephrotic syndrome
d. Gammopathy
AMINO ACIDS AND PROTEINS
1. The acute-phase reactant proteins include all
of the
following EXCEPT
a. Transferrin
b. α1-antitrypsin
c. Haptoglobin
d. Fibrinogen
2. The three-dimensional spatial configuration of
a single polypeptide chain as determined by
disulfide linkages, hydrogen bonds, electrostatic
attractions, and van der Waals forces is referred
to as the
a. Tertiary structure
b. Primary structure
c. Secondary structure
d. Quaternary structure
3. The plasma protein mainly responsible for
maintaining
colloidal osmotic pressure in vivo is
a. Albumin
b. Hemoglobin
c. Fibrinogen
d. α2-macroglobulin
4. A peptide bond is
a. Amino group and carboxyl group bonded to the
alpha-carbon
b. A double carbon bond
c. A tertiary ring of amino group and carboxyl
group bonded to the alpha-carbon
d. Two amino groups bonded to the alpha-carbon
5. Nutritional assessment with poor proteincaloric status is associated with
a. A decreased level of prealbumin
b. A low level of γ-globulins
c. An elevated ceruloplasmin concentration
d. An increased level of α1-fetoprotein
6. In which of the following conditions would a
Normal level of myoglobin be expected?
a. Multiple myeloma
b. Acute myocardial infarction
c. Renal failure
d. Crushing trauma received in a car accident
7.
8. The protein electrophoretic pattern of plasma,
as compared with serum, reveals a
a. Fibrinogen peak between the 𝗉- and γ-globulins
b. Broad increase in the γ -globulins
c. Fibrinogen peak with the α2-globulins
d. Decreased albumin peak
10. Distinct oligoclonal bands in the γ zone on
CSF
protein electrophoresis are diagnostic of
a. Multiple sclerosis
b. Multiple myeloma
c. Waldenström’s macroglobulinemia
d. Myoglobinemia
11. When a protein is dissolved in a buffer
solution, the pH of which is more alkaline than the
pI, and an electric current is passed through the
solution, the protein will act as
a. An anion and migrate to the anode
b. A cation and migrate to the cathode
c. An anion and migrate to the cathode
d. An uncharged particle and will not move
12. High serum total protein with high levels of
both albumin and globulins is usually seen in
a. Dehydration
b. Waldenström’s macroglobulinemia
c. Glomerulonephritis
d. Cirrhosis
13. In a patient with nephrotic syndrome, the
total protein levels in urine would be:
a. Normal.
b. Lower than normal.
c. Higher than normal.
d. Similar to levels in CSF total protein levels.
e. Lower albumin levels and higher levels of IgG.
14. Isoelectric focusing is the type of
electrophoresis used to phenotype for α1antitrypsin deficiencies. When the protein is
electrophoresed, it migrates to:
a. The site where the pH is the same as its pI.
b. The site where the molecular weight of the
protein correlates with the pI.
c. The site where the protein’s net charge
exceeds the pI.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
d. The site where the protein’s net charge is less
than the pI.
e. The site where the gel pore size inhibits further
migration.
15. A CSF albumin–serum albumin ratio was
reported
at 9.8 in a patient. How is this best interpreted?
a. This ratio is in the normal range for the patient.
b. The blood–brain barrier may be compromised
leading to increased plasma albumin present in
the CSF.
c. There is an analytical error as it is biologically
unlikely to achieve this value.
d. This is diagnostic of fungal meningitis.
e. This is diagnostic of multiple sclerosis.
16. Which of the following CSF proteins would be
measured when investigating active
demyelination in multiple sclerosis?
a. CSF albumin to serum albumin ratio
b. α1-Antitrypsin
c. Myelin basic protein
d. Ceruloplasmin
e. IgG
NONPROTEIN NITROGEN COMPOUNDS
1. Which one of the following is not an NPN
substance?
a. Allantoin
b. Ammonia
c. Creatinine
d. Urea
2. Which compound constitutes nearly half of the
NPN substances in the blood?
a. Ammonia
b. Creatine
c. Urea
d. Uric acid
3. An urea N result of 9 mg/dL is obtained by a
technologist. What is the urea concentration?
a. 3.2 mg/dL
b. 4.2 mg/dL
c. 18.0 mg/dL
d. 19.3 mg/dL
4.
a.
b.
c.
d.
Prerenal azotemia is caused by
Acute renal failure
Chronic renal failure
Congestive heart failure
Urinary tract obstruction
5. A technologist obtains a urea N value of 61
mg/dL and a serum creatinine value of 2.5 mg/dL
on apatient. These results indicate
a. Congestive heart failure
b. Dehydration
c. Glomerular nephritis
d. Urinary tract obstruction
6. Uric acid is the final product of
a. Allantoin metabolism
b. Amino acid metabolism
c. Purine metabolism
d. The urea cycle
8. In the Jaffe reaction, a red-orange chromogen
is formed when creatinine reacts with
a. Aluminum magnesium silicate
b. Creatininase
c. Phosphocreatine
d. Picric acid
9. Substances known to increase results when
measuring
creatinine by the Jaffe reaction include all of the
following EXCEPT
a. Ascorbic acid
b. Bilirubin
c. Glucose
d. α-Keto acids
10. Ammonia concentrations are usually
measured to evaluate
a. Acid–base status
b. Glomerular filtration
c. Hepatic encephalopathy
d. Renal failure
11. A complete deficiency of hypoxanthine
guanine phosphoribosyltransferase results in
which disease?
a. Lesch-Nyhan syndrome
b. Modification of diet in renal disease
c. Maple syrup urine disease
d. Reye’s syndrome
e. Megaloblastic anemia
12. When calculating creatinine clearance using
the
MDRD equation, which of the following factors are
considered?
a. Verification that the patient has been fasting
b. Identification of ethnicity
c. Body mass
d. Time of day of blood collection
e. Physical workout schedule of the patient
13. True or False? Serum creatinine levels may be
falsely elevated when a patient is taking
cephalosporin.
a. True
b. False
14. When measuring ammonia blood levels,
which of
the following might cause a false increase in this
analyte?
a. The patient had two cigarettes 15 minutes
prior to blood draw.
b. The patient was fasting for hours prior to blood
collection.
c. Immediately after phlebotomy, the blood
sample was maintained on ice.
d. The patient had a steak dinner the night before
the blood draw.
e. None of the above will falsely increase the
blood ammonia levels.
ENZYMES
7. Which one of the listed conditions is not
associated
with elevated plasma uric acid concentration?
a. Allopurinol overtreatment
b. Gout
c. Lesch-Nyhan syndrome
d.
Renal disease
1. When a reaction is performed in zero-order
kinetics
a. The rate of the reaction is independent of the
substrate concentration
b. The substrate concentration is very low
c. The rate of reaction is directly proportional to
the substrate concentration
d. The enzyme level is always high
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
Total CK level that is 1,000 times the ULN
2. Activation energy is
a. Decreased by enzymes
b. The energy needed for an enzyme reaction to
stop
c. Increased by enzymes
d. Very high in catalyzed reactions
3. Enzyme reaction rates are increased by
increasing
temperatures until they reach the point of
denaturation at
a. 40–60°C
b. 25–35°C
c. 100°C
d. 37°C
4. An example of using enzymes as reagents in
the
clinical laboratory is
a. The hexokinase glucose method
b. The diacetyl monoxime blood urea nitrogen
(BUN) method
c. The alkaline picrate creatinine method
d. The biuret total protein method
5. Activity of enzymes in serum may be
determined
rather than concentration because
a. The amount of enzyme is too low to measure
b. The temperature is too high
c. There is not enough substrate
d. The amount of enzyme is too high to measure
6. The isoenzymes LD-4 and LD-5 are elevated in
a. Liver disease
b. Pulmonary embolism
c. Renal disease
d. Myocardial infarction
7. Which CK isoenzyme is elevated in muscle
diseases?
a. CK-MM
b. CK-BB
c. CK-MB
d. CK-NN
8. Elevation of serum amylase and lipase is
commonly seen in
a. Acute pancreatitis
b. Acute appendicitis
c. Gallbladder disease
d. Acid reflux disease
9. The saccharogenic method for amylase
determinations measures
a. The amount of product produced
b. The amount of substrate consumed
c. The amount of iodine present
d. The amount of starch present
10. Elevation of tissue enzymes in serum may be
used to detect
a. Tissue necrosis or damage
b. Inflammation
c. Infectious diseases
d. Diabetes mellitus
11. Which of the following enzyme patterns is
MOST diagnostic of Duchenne-type muscular
dystrophy?
a. Total CK level that is 5 to 10 times the ULN
b. Total CK level that is 25 times the ULN
c. Total CK level that is 50 to 100 times the ULN
d.
12. Which of the following preanalytical errors
most
commonly causes false increases in serum
enzyme
measurements?
a. The patient was not fasting prior to blood draw.
b. The blood sample was not maintained on ice
upon collection and during transport to the
laboratory.
c. The serum was not separated from red blood
cells within 1 hour.
d. The patient smoked three cigarettes just prior
to blood collection.
e. The blood sample was not protected from light
upon collection and during transport to the
laboratory.
ENZYMES
1. Which of the following hormones promotes
gluconeogenesis?
a. Growth hormone
b. Hydrocortisone
c. Insulin
d. Thyroxine
2. Glucose oxidase oxidizes glucose to gluconic
acid and
a. H2O2
b. CO2
c. HCO3
d. H2O
3. From glucose and ATP, hexokinase catalyzes
the formation of
a. Acetyl-CoA
b. Fructose-6-phosphate
c. Glucose-6-phosphate
d. Lactose
4. What is the preferred specimen for glucose
analysis?
a. EDTA plasma
b. Fluoride oxalate plasma
c. Heparinized plasma
d. Serum
5. Hyperglycemic factor produced by the
pancreas is
a. Epinephrine
b. Glucagon
c. Insulin
d. Growth hormone
6. Polarographic methods of glucose assay are
based on which principle?
a. Nonenzymatic oxidation of glucose
b. Rate of oxygen depletion measured
c. Chemiluminescence caused by the formation of
ATP
d. Change in electrical potential as glucose is
oxidized
7. Select the enzyme that is most specific for 𝗉d- glucose:
a. Glucose oxidase
b. Glucose-6-phosphate dehydrogenase
c. Hexokinase
d. Phosphohexose isomerase
8. Select the coupling enzyme used in the
hexokinase method for glucose:
a. Glucose dehydrogenase
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
b. Glucose-6-phosphatase
c. Glucose-6-phosphate dehydrogenase
d. Peroxidase
9. All of the following are characteristic of von
Gierke disease EXCEPT
a. Hypoglycemia
b. Hypolipidemia
c. Increased plasma lactate
d. Subnormal response to epinephrine
10. The preferred screening test for diabetes in
nonpregnant adults is measurement of
a. Fasting plasma glucose
b. Random plasma glucose
c. Glycohemoglobin
d. Depends on the patient factors
11. Following the 2012 ADA guidelines, the times
of measurement for plasma glucose levels during
an OGTT in nonpregnant patients are
a. Fasting, 1 hour, and 2 hours
b. Fasting and 60 minutes
c. 30, 60, 90, and 120 minutes
d. Fasting, 30, 60, 90, and 120 minutes.
12. Monitoring the levels of ketone bodies in the
urine via nitroprusside reagents provides a semiquantitative measure of
a. Acetoacetate
b. 3-𝗉-Hydroxybutyrate
c. Acetone
d. All three ketone bodies
13. A factor, other than average plasma glucose
values,
that can affect the HbA1c level is
a. Serum ketone bodies level
b. Red blood cell life span
c. Ascorbic acid intake
d. Increased triglyceride levels
14. Monitoring the levels of ketone bodies in the
urine is
a. Considered essential on a daily basis for all
diabetic patients
b. A reliable method of assessing long-term
glycemic control
c. Recommended for patients with type 1
diabetes on sick days
d. Not recommended by the ADA
15. A urinalysis identifies a positive result for
reducing sugars, yet the test for glucose (glucose
oxidase reaction) was negative on the dipstick.
What do these results suggest?
a. This is commonly observed with ascorbic acid
interference.
b. This may suggest the patient has a deficiency
in galactose-1-phosphate uridyl transferase.
c. This may suggest a pancreatic beta cell tumor.
d. This may suggest a deficiency in glycogen
debrancher enzyme.
e. It is not possible to obtain these results and
there is an analytic error in testing.
16. Urinalysis of a diabetic patient identified the
following:
Year 1: Urine albumin was 15 mg/24 h
Year 2: Urine albumin was 56 mg/24 h
Year 3: Urine albumin was 156 mg/24 h
What do these clinical data suggest?
a.
These levels of albumin in the urine are normal
and no follow-up is necessary.
b. These levels of albumin in the urine suggest
that kidney function is compromised and followup is necessary.
c. As these values of urinary albumin are not
greater than 300 mg/24 h, the patient is not likely
to have compromised kidney function.
d. An additional urinary albumin test is required in
Year 4 to verify diminishing kidney function.
LIPIDS AND LIPOPROTEINS
1. Which of the following methods for lipoprotein
electrophoresis depends on charge and molecular
size?
a. Polyacrylamide gel
b. Paper
c. Cellulose acetate
d. Agarose
2. Which of the following statements concerning
chylomicrons is FALSE?
a. The major lipid transported by this lipoprotein
is cholesterol.
b. This lipoprotein is produced in the intestinal
mucosa.
c. The primary function is to carry dietary
(exogenous) lipids to the liver.
d. It remains at the origin (point of application)
during lipoprotein electrophoresis.
3. The lipoprotein that contains the greatest
amount of protein is called
a. HDL
b. Chylomicrons
c. VLDL
d. LDL
4. True or False? Pre-beta (VLDL) lipoproteins
migrate further toward the anode on
polyacrylamide gel than they do on cellulose
acetate or agarose.
a. True
b. False
5. Several enzymatic triglyceride methods
measure
the production or consumption of
a. NADH
b. Fatty acids
c. Glycerol
d. Diacetyl lutidine
6. The most likely cause for serum/plasma to
appear
“milky” is the presence of
a. Chylomicrons
b. VLDL
c. LDL
d. HDL
7. In the colorimetric determination of cholesterol
using the enzyme cholesterol oxidase, the agent
that oxidizes the colorless organic compound 4aminoantipyrine to a pink complex is
a. Hydrogen peroxide
b. Cholest-4-ene-3-one
c. NAD
d. Phenol
8. Which lipoprotein is the major carrier of
cholesterol to peripheral tissue?
a. LDL
b. Chylomicrons
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c. VLDL
d. HDL
9. True or false? Increased levels of apo A-I are
associated
with increased risk of CAD.
a. True
b. False
10. A patient is admitted to the hospital with
intense
chest pains. The patient’s primary care physician
requests the emergency department doctor
to order several tests, including a lipid profile
with cholesterol fractionation. Given the patient’s
results provided below, what would be the LDL-C
for this patient?
Total cholesterol = 400 mg/dL; triglycerides =
300 mg/dL;
HDL-C = 100 mg/dL; LP electrophoresis, pending
a. 240 mg/dL
b. 160 mg/dL
c. 200 mg/dL
d. 300 mg/dL
11. A patient is admitted to the hospital with
intense chest pains. The patient’s primary care
physician requests the emergency department
doctor to order several tests, including a lipid
profile with cholesterol fractionation. Given the
patient’s results provided below, what would be
this patient’s LDL-C status?
Total cholesterol = 400 mg/dL; triglycerides =
300 mg/
dL; HDL-C = 100 mg/dL; LP electrophoresis,
pending
a. High
b. Optimal
c. Desirable
d. Borderline
12. As part of a lipoprotein phenotyping, it is
necessary to perform total cholesterol and
triglyceride determinations, as well as lipoprotein
electrophoresis.
The test results obtained from such studies were
• Triglyceride, 340 mg/dL (reference range,
<150 mg/dL)
• Total cholesterol, 180 mg/dL (reference range,
<200 mg/dL)
• Pre-beta-lipoprotein fraction increased
• Beta-lipoprotein fraction normal
• No chylomicrons present
• Serum appearance turbid
The best explanation for these results would be
that the
patient exhibits a phenotype indicative of
a. Type IV hyperlipoproteinemia
b. Type I hyperlipoproteinemia
c. Type II hyperlipoproteinemia
d. Type III hyperlipoproteinemia
e. Type V hyperlipoproteinemia
13. Which of the following results is the most
consistent
with high risk of CHD?
a. 20 mg/dL HDL-C and 250 mg/dL total
cholesterol
b. 35 mg/dL HDL-C and 200 mg/dL total
cholesterol
c. 50 mg/dL HDL-C and 190 mg/dL total
cholesterol
d.
55 mg/dL HDL-C and 180 mg/dL total
cholesterol
e. 60 mg/dL HDL-C and 170 mg/dL
totalcholesterol
14. What is the presumed defect in most cases of
familial type IIa hyperlipoproteinemia?
a. Defective receptors for LDL
b. Deficiency of hydroxymethylglutaryl (HMG)CoA reductase
c. Deficiency of cholesterol esterase
d. Deficiency of LPL
e. Defective esterifying enzymes LCAT and ACAT
15. Hyperchylomicronemia (type I) in childhood
has
been associated with which of the following?
a. A deficiency of apo C-II
b. A deficiency of LCAT
c. A deficiency of LPL
d. A deficiency of apo A-I
ELECTROLYTES
1. What is the major intracellular cation?
a. Potassium
b. Calcium
c. Magnesium
d. Sodium
2. What is the major extracellular cation?
a. Sodium
b. Chloride
c. Magnesium
d. Calcium
3. Osmolality can be defined as a measure of the
concentration of a solution based on the
a. Number of dissolved particles
b. Number of ionic particles present
c. Number and size of the dissolved particles
d. Density of the dissolved particles
4. Hyponatremia may be caused by each of the
following
EXCEPT
a. Hypomagnesemia
b. Aldosterone deficiency
c. Prolonged vomiting or diarrhea
d. Acute or chronic renal failure
5. Hypokalemia may be caused by each of the
following
EXCEPT
a. Acidosis
b. Prolonged vomiting or diarrhea
c. Hypomagnesemia
d. Hyperaldosteronism
6. Hyperkalemia may be caused by each of the
following
EXCEPT
a. Alkalosis
b. Acute or chronic renal failure
c. Hypoaldosteronism
d. Sample hemolysis
7. The main difference between a direct and
indirect ISE is
a. Sample is diluted in the indirect method, not in
the direct method
b. The type of membrane that is used
c. Direct ISEs use a reference electrode, whereas
indirect ISEs do not
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d. Whole blood samples can be measured with
the direct method and not with the indirect
method
8. Which method of analysis will provide the most
accurate electrolyte results if a grossly lipemic
sample is used?
a. Direct ISE
b. Indirect ISE
c. Flame emission photometry
d. Atomic absorption
9.
is
a.
b.
c.
d.
The most frequent cause of hypermagnesemia
due to
Renal failure
Increased intake of magnesium
Hypoaldosteronism
Acidosis
10. A hemolyzed sample will cause falsely
increased
levels of each of the following EXCEPT
a. Sodium
b. Potassium
c. Phosphate
d. Magnesium
11. The largest portion of total body water is
found in which tissue?
a. Intracellular fluid
b. Extracellular fluid
c. Intravascular extracellular fluid
d. Interstitial cell fluid
e. Plasma
12. Osmoreceptors in the hypothalamus are key
to regulating blood osmolality. Typically, a 1% to
2% shift in osmolality causes a
change in
circulating concentration of ADH.
a. Twofold
b. Fourfold
c. Eightfold
d. Tenfold
13. The quantitative relationship between
changes in blood osmolality and the normal
expected response by ADH is best described as
a(n):
a. Indirect relationship
b. Direct relationship
c. Logarithmic relationship
d. There is no quantitative relationship
14. The sample of choice for measuring blood
osmolality is:
a. Serum
b. Plasma
c. Whole blood
d. Serum or plasma may both be used
15. With increased water loss, burn patients are
most likely to also experience:
a. Hypernatremia
b. Hyponatremia
c. Hypomagnesemia
d. Hypoosmolality
16. Which plasma electrolyte has the most narrow
reference range and is MOST strictly regulated by
the body?
a. Sodium
b. Magnesium
c. Calcium
d.
Chloride e.
Potassium
17. True or False? Red blood cells are key for
oxygen
transport, carbon dioxide transport, and
maintaining
electroneutrality in the blood.
a. True
b. False
BLOOD GASES, pH, AND BUFFER SYSTEMS
1. The presence of dyshemoglobins will cause a
calculated % SO2 result to be falsely (elevated,
decreased) and a pulse oximeter % Spo2 value to
be falsely (elevated, decreased).
a. Elevated, elevated
b. Decreased, decreased
c. Elevated, decreased
d. Decreased, elevated
2. The anticoagulant of choice for arterial blood
gas
measurements is
in the
state.
a. Lithium heparin; dry
b. EDTA; dry
c. Potassium oxalate; liquid
d. Sodium citrate; dry
3. At a pH of 7.10, the H+ concentration is equal
to
a. 80 nmol/L
b. 20 nmol/L
c. 40 nmol/L
d. 60 nmol/L
4. The kidneys compensate for respiratory
alkalosis by (excretion, retention) of bicarbonate
and (increased, decreased) excretion of NaH2PO4.
a. Excretion, decreased
b. Excretion, increased
c. Retention, increased
d. Retention, decreased
5. The normal ratio of carbonic acid to
bicarbonate in
arterial blood is
a. 1:20
b. 7.4:6.1
c. 0.003:1.39
d. 20:1
6. When arterial blood from a normal patient is
exposed to room air:
a. pco2 increases; po2 decreases
b. pco2 decreases; po2 increases
c. pco2 decreases; po2 decreases
d. pco2 increases; po2 increases
7. A patient’s arterial blood gas results are as
follows:
pH 7.37; pco2, 75 mm Hg; HCO3–, 37 mmol/L.
These values are consistent with
a. Compensated respiratory acidosis
b. Compensated nonrespiratory acidosis
c. Uncompensated respiratory alkalosis
d. Uncompensated nonrespiratory alkalosis
8. A patient’s arterial blood gas results are as
follows:
pH 7.48; pco2, 54 mm Hg; HCO3–, 38 mmol/L.
These values are consistent with
a. Compensated nonrespiratory alkalosis
b. Compensated respiratory alkalosis
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c. Uncompensated respiratory alkalosis
d. Uncompensated nonrespiratory alkalosis
To shorten the run time of the measurement
d. To lower the coefficient of variation for total
arsenic measurements
9. In the circulatory system, bicarbonate leaves
the
red blood cells and enters the plasma through an
exchange mechanism with
to maintain
electroneutrality.
a. Chloride
b. Carbonic acid
c. Lactate
d. Sodium
4. Select the answer that designates three
techniques widely used for elemental analysis,
identified according to the initials for the
techniques.
a. AAS, ICP-MS, AES
b. NMR, ICP-MS, AES
c. GC-MS, ICP-MS, AES
d. HPLC-ICP-MS, AAS, FTIR
10. Hypoventilation can compensate for
a. Nonrespiratory acidosis
b. Mixed alkalosis
c. Mixed acidosis
d. Nonrespiratory alkalosis
11. The hemoglobin oxygen binding capacity for a
blood sample that is 100% saturated with O2 and
has a total hemoglobin value of 12 g/dL is
approximately
a. 17 mL O2/dL
b. 4 mL O2/dL
c. 8 mL O2/dL
d. 34 mL O2/dL
5. One of the calcium isotopes (40Ca) has an
atomic weight of 40. At what positions in a mass
spectrum would singly and doubly charged ions of
this isotope of calcium appear? Assume that
singly charged Ca is listed first.
a. 40 and 20
b. 40 and 60
c. 40 and 80
d. 40 and 40
12. Carbonic acid concentration in blood plasma
equals
a. 0.0307 mmol/L/mm Hg times the pco2 value in
mm Hg
b. Apparent pKa of carbonic acid, 6.1, plus the
pco2 value in mmHg
c. pco2 value in mm Hg plus HCO3 – value in mm
Hg
d. Bicarbonate concentration divided by the pco2
value in mm Hg
6. What primary purposes does the torch serve in
ICP-MS?
a. Vaporization, atomization, and ionization
b. Vaporization, atomization, and electronic
excitation
c. Nebulization, atomization, and photon
absorption
d. Droplet transport, vaporization, and ion
detection
7. Manganese toxicity resembles the following
disease:
a. Parkinson’s disease
b. Wilson’s disease
c. Alzheimer’s disease
d. Menkes disease
13. Oxygen content in blood reflects
a. po2 value
b. O 2Hb only
c. O 2 dissolved in blood plasma only
d. The patient’s total hemoglobin value
e. All of these
8. Iron is physiologically active only in the ferrous
form in
a. Hemoglobin
b. Cytochromes
c. Ferritin
d. Transferrin
TRACE AND TOXIC ELEMENTS
1. Extreme copper deficiency is seen in what fatal
condition?
a. Menkes disease
b. Klinefelter’s syndrome
c. Meese disease
d. Kayser-Fleischer rings
2. Suppose the controller on a GFAAS is defective
and the furnace is running cold. What effect will
this likely have on the number of photons
absorbed in the measurements?
a. It will decrease the number of photons
absorbed
b. It will increase the number of photons
absorbed
c. It will have little effect
d. It is not a relevant question because AAS relies
on emission of light from electronically excited
atoms
3. Why would a clinical chemist develop an
arsenic method that combines liquid
chromatography with ICP-MS?
a. To separate and quantitate several different
arsenic-containing species in the same sample
b. To eliminate interference by sodium from the
analysis
c.
9. A metal ion required for optimal enzyme
activity is best termed a(an)
a. Cofactor
b. Accelerator
c. Coenzyme
d. Catalyst
10. Which trace metal is contained in glucose
tolerance factor?
a. Chromium
b. Copper
c. Selenium
d. Zinc
11. What metal may be used as a treatment for
Wilson’s disease?
a. Zinc
b. Copper
c. Molybdenum
d. Fluorine
12. The metal ion essential for the activity of
xanthine oxidase and xanthine dehydrogenase is
a. Molybdenum
b. Iron
c. Zinc
d. Manganese
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PORPHYRIN AND HEMOGLOBIN
1. The main purpose of porphyrins in the body is
to
a. Contribute to the synthesis of heme
b. Carry oxygen to the tissue
c. Transport iron
d. Combine with free hemoglobin
2. The two main sites in the body for
accumulation of excess porphyrins are
a. Liver and bone marrow
b. Heart and lung
c. Muscle and blood
d. Liver and spleen
3. The two main classes of porphyrias, according
to symptoms, are
a. Neurologic and cutaneous
b. Erythropoietic and hepatic
c. Congenital and acquired
d. Hematologic and muscular
4. Porphobilinogen is most commonly quantitated
in the urine by
a. Ion-exchange column
b. The Watson-Schwartz method
c. Thin-layer chromatography
d. Electrophoresis
5. Extremely high levels of ALA and PBG in the
urine with normal porphyrin levels in the feces
and blood most likely indicate
a. Acute intermittent porphyria (AIP)
b. Erythropoietic porphyria (EP)
c. Hereditary coproporphyria (HCP)
d. Porphyria cutanea tarda (PCT)
6. Inherited disorders in which a genetic defect
causes abnormalities in rate and quantity of
synthesis of structurally normal polypeptide
chains of the hemoglobin molecule are called
a. Thalassemias
b. Hemoglobinopathies
c. Porphyrias
d. Molecular dyscrasias
7. Increased intravascular hemolysis is indicated
by a decrease in
a. Haptoglobin
b. Methemoglobin
c. Methemalbumin
d. Hemopexin
8. Which of the following abnormal hemoglobins,
found frequently in individuals from Southeast
Asia, migrates with hemoglobin A2 on cellulose
acetate electrophoresis?
a. Hemoglobin E
b. Hemoglobin D
c. Hemoglobin C
d. Hemoglobin Lepore
9. Which type of alpha-thalassemia results from
deletion
of three genes and produces a moderate
hemolytic
anemia?
a. Hemoglobin H disease
b. Hemoglobin Bart’s
c. Hydrops fetalis
d. Thalassemia trait
10. The most effective way to quantitate
hemoglobin
A2 is by
a. Column chromatography
b. Densitometry
c. Citrate agar electrophoresis
d. Alkali denaturation test
11. Serum or plasma myoglobin levels are used
as
a. An early marker of acute myocardial infarction
b. Liver function tests
c. Lead poisoning indicator
d. Indicator of congestive heart failure
12. Which of the following is the best test to
differentiate
beta-thalassemia minor from iron deficiency
anemia?
a. Hemoglobin A2 quantitation
b. Hemoglobin electrophoresis (cellulose acetate,
alkaline pH)
c. Solubility test
d. Complete blood count
13. Which is the correct sequence of
electrophoretic migration of hemoglobins from
slowest to fastest on cellulose acetate at an
alkaline pH?
a. C, S, F, A
b. C, A, S, F
c. C, S, A, F
d. A, F, S, C
14. The primary route(s) of excretion for
protoporphyrin
(PROTO), uroporphyrin (URO), and coproporphyrin
(COPRO) are
a. URO is excreted primarily in the urine, PROTO
in the feces, and COPRO in either.
b. URO is excreted primarily in the feces, PROTO
in the urine, and COPRO in either.
c. URO is excreted primarily in the urine, PROTO
and COPRO in the feces.
d. URO is excreted primarily in the feces, PROTO
and COPRO in urine.
15. Control of the rate of heme synthesis in the
liver cells is achieved largely through regulation
of the enzyme
a. ALA synthase
b. ALA dehydratase
c. PBG deaminase
d. Ferrochelatase
16. The two main sites of production of heme are
a. Liver and bone marrow
b. Heart and lung
c. Muscle and blood
d. Liver and spleen
17. The relationship between precursors in the
heme
synthesis pathway and the type of porphyria
resulting
from excess buildup of these precursors is
a. Excess of early precursors causes neurologic
porphyrias and excess of late precursors causes
cutaneous porphyrias.
b. Excess of early precursors causes cutaneous
porphyrias and excess of late precursors causes
neurologic porphyrias.
c. Excess of early precursors causes both
neurologic and cutaneous porphyrias, whereas
excess of late precursors causes only cutaneous
porphyrias.
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d. Excess of early precursors causes both
neurologic and cutaneous porphyrias whereas
excess of late precursors causes only neurologic
porphyrias.
18. Secondary porphyrias not due to an inherited
biochemical defect in heme synthesis can be
distinguished from true porphyrias by measuring
levels of
a. Urinary ALA and PBG
b. Urinary COPRO and blood lead
c. Urinary URO and COPRO
d. Fecal URO and urinary COPRO
19. Which hemoglobin is resistant to alkali
denaturation in NaOH?
a. Hb F
b. Hb A
c. Hb C
d. Hb S
20. A patient has an abnormal hemoglobin band
that
migrates with Hb S on cellulose acetate (pH 8.4)
hemoglobin electrophoresis. The solubility test is
negative. What test should be performed next?
a. Citrate agar (pH 6.2) electrophoresis
b. HbA2 quantitation
c. Acid elution stain
d. Blood film evaluation
21. Silent carriers of alpha-thalassemia are
missing how many alpha genes?
a. 1
b. 2
c. 3
d. 4
22. Which hemoglobin contains four gamma
chains
and has an extremely high affinity for oxygen?
a. Hb Barts
b. Hb Gower I
c. Hb Portland I
d. Hb F
23. A patient with Southeast Asian heritage is
found
to have a mild microcytic anemia and a few
target cells. Hemoglobin electrophoresis on
cellulose acetate at pH 8.4 reveals a major band
that migrates with Hb A2 and no HbA. On citrate
agar electrophoresis, the band travels in the
position of Hb A. What is the most probable
abnormal hemoglobin present?
a. Hb E
b. Hb A
c. Hb C
d. Hb D
HYPOTHALAMIC AND PITUITARY FUNCTION
1. Open-loop negative feedback refers to the
Phenomenon of
a. Negative feedback with a modifiable set point
b. Blood flow in the hypothalamic–hypophyseal
portal system
c. Blood flow to the pituitary via dural-penetrating
vessels
d. Negative feedback involving an unvarying,
fixed set point
Progesterone
d. Estradiol
3. Which anterior pituitary hormone lacks a
stimulatory
hypophysiotropic hormone?
a. Prolactin
b. Growth hormone
c. Vasopressin
d. ACTH
4. The definitive suppression test to prove
autonomous
production of growth hormone is
a. Oral glucose loading
b. Somatostatin infusion
c. Estrogen priming
d. Dexamethasone suppression
5. Which of the following is influenced by growth
hormone?
a. All of these
b. IGF-I
c. IGFBP-III
d. Lipolysis
6. What statement concerning vasopressin
secretion is NOT true?
a. All of these
b. Vasopressin secretion is closely tied to plasma
osmolality.
c. Changes in blood volume also alter vasopressin
secretion.
d. A reduction in effective blood volume overrides
the effects of plasma osmolality in regulating
vasopressin secretion.
7. What are the long-term sequelae of untreated
or
partially treated acromegaly?
a. An increased risk of colon and lung cancer
b. A reduced risk of heart disease
c. Enhanced longevity
d. Increased muscle strength
8. TRH stimulates the secretion of
a. Prolactin and TSH
b. Prolactin
c. Growth hormone
d. TSH
9. Estrogen influences the secretion of which of
the
following hormones?
a. All of these
b. Growth hormone
c. Prolactin
d. Luteinizing hormone
10. What is the difference between a tropic
hormone and a direct effector hormone?
a. Tropic and direct effector hormones are both
similar in that both act directly on peripheral
tissue.
b. Tropic and direct effector hormones are both
similar in that both act directly on another
endocrine gland.
c. Tropic hormones act on peripheral tissue while
direct effector hormones act on endocrine glands.
d. Tropic hormones act on endocrine glands
while direct effector hormones act on peripheral
tissues.
2. The specific feedback effector for FSH is
a. Inhibin
b. Activin
c.
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11. A deficiency in vasopressin can lead to which
of the
following?
a. Euvolemic hypokalemia
b. Euvolemic hyponatremia
c. Diabetes insipidus
d. Primary hypothyroidism
ADRENAL FUNCTION
1. When considering an endocrine cause for a
patient’s
hypertension, the
is the usual
suspect.
ADRENAL GLAND
2. When hypertension results from an endocrine
disorder, what hormonal state is usually found:
hormone underproduction or overproduction?
OVERPRODUCTION
3. True or false? Major warning signs of adrenal
disease
include abnormal blood pressure, abnormal
electrolytes (potassium, acid–base status, urine
dilution), and unexplained weight change.
TRUE
4.
is the common substrate from which all
adrenal steroids are produced.
CHOLESTEROL
5. True or false? When produced, free
catecholamines
(NE and EPI) are short-lived. They are best
measured in the urine, though catecholamine
metabolites are best measured in the serum.
FALSE
6.
is responsible for epinephrine
production.
CORTISOL
7. A primary hyperaldosteronemic state is
characterized
by:
a. A urine potassium of 35 mmol/d.
b. A urine potassium of 21 mmol/d.
c. A spot urine test where the sodium levels are
greater than potassium levels.
d. Within 3 hours of taking 50 mg of captopril,
plasma aldosterone was low.
e. All of the above are characteristic of
hypoaldosteronism.
8. During a low dose (1 mg) dexamethasone
suppression
test, total cortisol levels measured in a patient at
8:35 am was 2.8 μg/dL. How is this interpreted?
a. The patient is normal.
b. The patient has Cushings’ syndrome.
c. The patient has a nonpituitary tumor causing
ectopic ACTH syndrome.
d. The patient has an ACTH-secreting pituitary
adenoma.
9. The most biologically active androgen in this
list is:
a. DHEA
b. DHEAS
c. LH
d. FSH
e. Estrone
10. Which amino acid is needed for the
biosynthesis of norepinephrine and epinephrine?
a. Alanine
b. Phenylalanine
c. Isoleucine
d. Leucine
e. Serine
11. Which of the following describes
catecholamines?
a. Hydrophobic
b. Degraded rapidly in nonneuronal cells by
monamine reductase
c. Have long half-lives
d. Circulating blood catecholamines are 99%
bound to albumin.
e. None of the above accurately describes
catecholamines.
12. The collection of a 24-hour urine is used for
measuring:
a. Creatinine clearance
b. Norepinephrine
c. Dopamine
d. All of the above may be measured in a 24-hour
urine
e. All but one of the above may be measured in a
24-hour urine
GONADAL FUNCTION
1. If serum levels of estradiol do not increase
after
injection of hCG, the patient has
a. Primary ovarian failure
b. Pituitary failure
c. Tertiary ovarian failure
d. Secondary ovarian failure
2. If a patient had a luteal phase defect, which
hormone
would most likely be deficient?
a. Progesterone
b. Estrogen
c. hCG
d. FSH
e. Prolactin
3. Which of the following is the precursor for
estradiol
formation in the placenta?
a. Fetal adrenal DHEAS
b. Maternal testosterone
c. Maternal progesterone
d. Placental hCG
e. Fetal adrenal cholesterol
4. Which of the following target tissues is
incapable
of producing steroidal hormones?
a. Adrenal medulla
b. Placenta
c. Ovary
d. Testis
e. Adrenal cortex
5. The parent substance in the biosynthesis of
Androgens and estrogens is
a. Cholesterol
b. Cortisol
c. Catecholamines
d. Progesterone
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6. The biologically most active, naturally
occurring androgen is
a. DHEA
b. Androstenedione
c. Epiandrosterone
d. Testosterone
7. For the past 3 weeks, serum estriol levels in a
pregnant woman have been steadily increasing.
This is consistent with
a. A normal pregnancy
b. Hemolytic disease of the newborn
c. Fetal death
d. Congenital cytomegalovirus infection
8. Which of the following is secreted by the
placenta
and used for the early detection of pregnancy?
a. hCG
b. FSH
c. LH
d. Progesterone
9. Chronic fetal metabolic distress is
demonstrated by
a. Decreased urinary estriol excretion and
decreased maternal serum estriol
b. Decreased estrogen in maternal plasma and
increased estriol in amniotic fluid
c. Increased estradiol in maternal plasma, with a
corresponding increase of estriol in amniotic fluid
d. Increased urinary estriol excretion and
increased maternal serum estriol
10. Androgen secretion by the testes is
stimulated by
a. LH
b. FSH
c. Testosterone
d. Gonadotropins
11. A deficiency in estrogen during the follicular
phase
will result in:
a. A failure of embryo implantation.
b. An increased length of the menstrual cycle.
c. A lack of Graafian follicle release from the
ovary.
d. An incomplete development of the
endometrium.
12. Which hormone is responsible for an increase
in body temperature at the time of ovulation?
a. Progesterone
b. Estrogen
c. LH
d. FSH
e. Estradiol
13. A midcycle LH surge will stimulate which
series of events?
a. An increase in FSH
b. A decrease in FSH
c. Anovulation
d. Amenorrhea
e. A decrease in progesterone production
THYROID GLAND
1. All of the following statements about iodine are
true EXCEPT
a. Radioactive iodine treatment of Graves’
disease
is effective in less than 40% of patients treated
with this agent.
b.
Iodine deficiency is one of the most common
causes of hypothyroidism in the world.
c. T4 has 4 iodine molecules.
d. RAIU is often useful in determining the cause
of thyrotoxicosis.
2. The fetus
a. Is dependent on thyroid hormone for normal
neurologic development
b. Does not develop a thyroid gland until the
third trimester
c. Is not susceptible to damage from radioactive
iodine therapy given to the mother
d. Will be born with hypothyroidism in
approximately 1 of 400 births in developed
countries
3. The thyroid gland
a. Depends on TPO to permit iodination of the
tyrosyl residues to make MIT and DIT
b. Is an ineffective iodine trap
c. Depends on TPO to permit the joining of two
DIT residues to form T3
d. Usually functions independent of TSH levels
4. The thyroid gland produces all of the following
EXCEPT
a. TSH
b. Thyroglobulin
c. T3
d. T4
5. Hypothyroidism is generally associated with all
of the following EXCEPT
a. TSH receptor antibodies
b. Depression
c. An elevation of TSH levels
d. TPO antibodies
6. A 34-year-old woman presents with goiter,
tachycardia,
and weight loss of 2 months duration. TSH is
undetectable and free T 4 is high. All of the
following tests are useful in diagnosing the cause
of the hyperthyroidism EXCEPT
a. FNA biopsy of the thyroid gland
b. TSH receptor antibodies
c. RAIU
d. TSH
7. A 65-year-old woman presents with fatigue,
hypothermia, pericardial effusions, and hair loss.
Her
thyroid function tests show a significantly
elevated
TSH and a low free T4. All of the following
laboratory
test abnormalities may be associated with her
underlying condition EXCEPT
a. Elevated WBC
b. An elevated cholesterol level
c. Anemia
d. Elevated CPK levels
8. A 26-year-old man presents with a 3-cm, right
lobe,
thyroid nodule and a normal TSH. What is the
next
test that should be performed?
a. FNA of the nodule
b. Free T4 level
c. Thyroid ultrasound
d. Thyroid scan
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9. The following are treatment options for
hyperthyroidism associated with Graves’ disease
EXCEPT
a. Thyroid hormone
b. PTU
c. Beta-blockers
d. Radioactive iodine
10. All of the following abnormalities might be
expected in a severely ill patient EXCEPT
a. Low rT3
b. Low T4
c. Low T3
d. Low TSH
11. Of the following thyroid hormones, which is
considered
the most biologically active?
a. T3 bound to TBG
b. T4 bound to TBG
c. Free T4
d. Free T3
e. rT3
12. The primary serum test to screen for thyroid
disease is:
a. Free T4
b. rT3
c. Total T4
d. Autoimmune antibodies to thyroid tissue
e. TSH
13. Of the following, which will MOST likely
interfere with quantitation of thyroglobulin?
a. Antithyroglobulin autoantibodies
b. Thyroid-stimulating antibodies
c. TSH receptor antibodies
d. Thyroid peroxidase antibodies
1. True or false? PTH and 1,25(OH)2D (vitamin D)
are the principal hormones involved in the normal
physiologic regulation of calcium homeostasis.
TRUE
, and
3. Skin,
, and kidneys are involved in the
Production of the active metabolite of vitamin D.
LIVER
4. True or false? Cod liver oil (ugh!) is a source of
vitamin D.
TRUE
5. True or false? 1,25(OH)2D is the best blood test
for
determining adequacy of vitamin D stores in the
body.
FALSE
6. True or false? PTHrP is produced by some
cancers
and often leads to cancer-associated
hypercalcemia.
TRUE
7.
8. In PHPT, the defect primarily lies in
. In
secondary hyperparathyroidism, the defect
primarily lies with the threat of
to the body.
PARATHYROID, HYHPOCALCEMIA
9. Development of
is the primary
complication of hypercalciuria (increased urinary
excretion of calcium).
KIDNEY STONES
10.
is the most common cause of
hypoparathyroidism.
NECK SURGERY
11.
is a type of bone most rapidly lost in
response
to hypogonadism and glucocorticoid therapy.
TRABECULAR BONE
12.
cells in bone are responsible for bone
resorption, and
cells are responsible for
bone formation.
OSTEOCLASTS, OSTEOBLASTS
13.
is the most prevalent metabolic bone
disease
in the United States.
OSTEOPOROSIS
14. True or false? Hormone replacement does not
inhibit bone resorption in osteoporotic patients.
FALSE
CALCIUM HOMEOSTASIS AND HORMONAL
REGULATION
2. The primary organs involved in the
maintenance of
calcium homeostasis are the intestine,
kidney.
BONE
True or false? 1,25(OH)2D, due to 1hydroxylase
activity in macrophages, may be produced to
excess in granulomatous diseases and lymphoid
disorders, leading to hypercalcemia.
FALSE
15. True or false? Teriparatide is the only drug
currently approved by the FDA for the treatment
of osteoporosis that directly stimulates bone
formation(i.e., it is not an antiresorptive drug).
TRUE
LIVER FUNCTION
1. Which of the following enzymes would best aid
in identifying hepatobiliary disease?
a. Alkaline phosphatase (ALP)
b. Aspartate aminotransferase (AST)
c. Alanine aminotransferase (ALT)
d. Ammonia
2. In which of the following types of cells does the
conjugation of bilirubin take place?
a. Hepatocytes
b. Kupffer cells
c. Macrophages
d. Phagocytic cells
3. Which of the following enzymes is responsible
for the conjugation of bilirubin?
a. UDP-glucuronyl transferase
b. Alkaline phosphatase
c. Glutamate dehydrogenase
d. Leucine aminopeptidase
4. Which of the following fractions of bilirubin is
water soluble and reacts with a diazo reagent
without the addition of an accelerator?
a. Conjugated bilirubin
b. Unconjugated bilirubin
c. Total bilirubin
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d. Indirect bilirubin
5. Which form of hepatitis is caused by a DNA
virus?
a. Hepatitis B
b. Hepatitis A
c. Hepatitis C
d. Hepatitis D
6. Which of the following enzymes is most useful
in
establishing the hepatic origin of an elevated
serum
alkaline phosphatase?
a. 5′-Nucleotidase
b. Alanine aminotransferase (ALT)
c. Aspartate aminotransferase (AST)
d. Lactate dehydrogenase
7. Hepatitis E is likely to cause serious
consequences in
a. Pregnant women
b. Children
c. Travelers in Third World countries
d. Older people/
8. Worldwide, most primary malignant tumors of
the liver are related to
a. Alcoholism
b. Gallstones
c. Reye syndrome
d. Malaria
9. The reagent p-dimethylaminobenzaldehyde is
used to measure which of the following?
a. Urobilinogen
b. Total bilirubin
c. Ammonia
d. Alkaline phosphatase
10. Which of the following conditions would result
in
elevations in primarily conjugated bilirubin?
a. Dubin-Johnson syndrome
b. Physiologic jaundice of the newborn
c. Crigler-Najjar syndrome
d. Gilbert’s syndrome
11. A urinalysis dipstick test indicated that
urobilinogen
was absent. Which condition does this support?
a. Biliary obstruction
b. Hepatitis A acute infection
c. Defective liver cell function
d. Hepatocellular disease
e. This would support all of the above conditions
12. Measuring serum ammonia levels has the
potential
to be fraught with preanalytical errors that may
interfere with achieving an accurate result. Of the
following preanalytical steps, which is incorrect?
a. After phlebotomy, the patient’s blood should be
immediately placed on ice.
b. The blood should be collected in a red clot tube
without anticoagulant.
c. Hemolyzed samples should be rejected as this
interferes by falsely increasing ammonia levels.
d. Lipemia may also interfere with plasma
ammonia
measurements.
e. All of the above are correct.
A patient presents with elevated levels of IgG
anti-HAV while levels of IgM anti-HAV are
nondetectable. This patient is likely to:
a. Have an acute infection of HAV.
b. Have a chronic infection of HAV.
c. Have an immunity to HAV.
d. Be a carrier of HAV.
MARKERS OF CARDIAC DAMAGE AND FUNCTION
1. A serum TnT concentration is of most value to
the patient with an MI when
a. The CK-MB has already peaked and returned
to normal concentrations
b. The onset of symptoms is within 3 to 6 hours of
the sample being drawn
c. The myoglobin concentration is extremely
elevated
d. The TnI concentration has returned to normal
concentrations
2. A normal myoglobin concentration 8 hours
after the onset of symptoms of a suspected MI
will
a. Essentially rule out an acute MI
b. Provide a definitive diagnosis of acute MI
c. Be interpreted with careful consideration of the
TnT concentration
d. Give the same information as a total CK-MB
3. Which of the following analytes has the highest
specificity for cardiac injury?
a. TnI
b. CK-MB mass assays
c. Total CK-MB
d. AST
4. Which of the following newer markers of
inflammation
circulates in serum bound to LD and HDL?
a. Lipoprotein-associated phospholipase A2
b. CK-MB
c. cTnI
d. hsCRP
5. A person with a confirmed blood pressure of
125/87 would be classified as
a. Prehypertension
b. Normal
c. Stage 1 hypertension
d. Stage 2 hypertension
6. Rheumatic heart disease is a result of infection
with which of the following organisms?
a. Group A streptococci
b. Staphylococcus aureus
c. Pseudomonas aeruginosa
d. Chlamydia pneumoniae
7. Which of the following defects is the most
common type of congenital CVD encountered?
a. Ventricular septal defects (VSD)
b. Tetralogy of Fallot
c. Coarctation of the aorta
d. Transposition of the great arteries
8. Which of the following cardiac markers is the
most useful indicator of congestive heart failure?
a. BNP
b. TnI
c. CK-MB
d. Glycogen phosphorylase isoenzyme BB
13.
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9. Which of the following is the preferred
biomarker for the assessment of myocardial
necrosis?
a. CK
b. AST
c. CK-MB
d. TnI
10. Which of the following is NOT a feature of an
ideal cardiac marker?
a. Ability to predict future occurrence of cardiac
disease
b. Absolute specificity
c. High sensitivity
d. Close estimation of the magnitude of cardiac
damage
RENAL FUNCTION
1. Calculate creatinine clearance, given the
following
information: serum creatinine, 1.2 mg/dL; urine
creatinine, 120 mg/dL; urine volume, 1750 mL/24
h;
body surface area, 1.80 m2.
117 mL/min
2. Predict GFR in a 50-year-old woman who
weighs 60 kg using the Cockcroft-Gault equation.
Her serum creatinine level is 2.5 mg/dL.
2.26mL/min
3. The measurement of serum cystatin C, a small
protein produced by nucleated cells, is useful for
a. Detecting an early decrease in kidney function
b. Calculating creatinine clearance
c. Diagnosing end-stage renal disease
d. Monitoring dialysis patients
4. Acute renal failure can be classified into three
types. List each type and give an example of
each.
a.
b.
c.
5. The proximal tubule functions to
a. reabsorb 75% of salt and water.
b. concentrate salts.
c. form the renal threshold.
d. reabsorb urea.
6. Renal clearance is the
a. volume of plasma from which a substance is
removed per unit of time.
b. volume of urine produced per day.
c. amount of creatinine in urine.
d. urine concentration of a substance divided by
the urine volume per unit of time.
7. Renin release by the kidney is stimulated by
a. a decrease in extracellular fluid volume or
pressure.
b. increased plasma sodium concentration.
c. increased dietary sodium.
d. renal tubular reabsorption.
8. The set of results that most accurately reflects
severe renal disease is
a. serum creatinine, 3.7 mg/dL; creatinine
clearance,
44 mL/min; BUN, 88 mg/dL
b.
serum creatinine, 1.0 mg/dL; creatinine
clearance,
110 mL/min; BUN, 17 mg/dL
c. serum creatinine, 2.0 mg/dL; creatinine
clearance,
120 mL/min; BUN, 14 mg/dL
d. serum creatinine, 1.0 mg/dL; creatinine
clearance,
95 mL/min; BUN, 43 mg/dL
9. Creatinine clearance results are corrected
using a
patient’s body surface area to account for
differences in
a. muscle mass.
b. age.
c. dietary intake.
d. sex.
10. A patient is suffering from an acute bleed.
What is
the most accurate way to describe the
subsequent
acute kidney injury?
a. Prerenal acute kidney injury
b. Renal acute kidney injury
c. Postrenal acute kidney injury
d. None of the above apply
PANCREATIC FUNCTION AND GASTROINTESTINAL
FUNCTION
1. Laboratory findings in pancreatitis include all of
the following EXCEPT
a. Increased cortisol
b. Increased amylase
c. Increased lipase
d. Increased triglycerides
2. Which of the following tests is a direct
determination
of the exocrine secretory capacity of the
pancreas?
a. Secretin/CCK test
b. Amylase
c. Quantitative fecal fat analysis
d. d-Xylose test
e. Lactose tolerance test
3. Which of the following statements concerning
cystic
fibrosis is NOT correct?
a. Affects males and females about equally
b. Occurs predominantly in populations of
Northern European extraction
c. Frequently diagnosed by measurement of
sweat chloride
d. Caused by a variety of mutations on
chromosome 7
e. Genetic screening is usually unsuccessful
4. The proper time period for the collection of a
fecal
fat specimen is
a. 72 hours
b. 24 hours
c. 36 hours
d. 48 hours
e. 96 hours
5. Which of the following tests is only of the
absorptive
ability of the intestine?
a. d-Xylose test
b. Lactose tolerance test
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c. Fecal fat (72-hour collection)
d. Serum carotenoids
e. Serum albumin
Bacterial meningitis
d. Viral meningitis
e. Multiple sclerosis
6. A serum albumin of less than 2.5 g/dL would be
most indicative of
a. Intestinal disease
b. Pancreatitis
c. Peptic ulcer
d. Pancreatic carcinoma
5. CSF glucose is measured to assess
a. Infection
b. Transport efficiency
c. Diabetes
d. Traumatic tap
e. Hemochromatosis
7. Which of the following is accurate when
describing
or diagnosing Zollinger-Ellison syndrome?
a. Extreme hyposecretion of gastrin in the
stomach
b. Extreme hypersecretion of gastrin in the
duodenum
c. An increase in serum gastrin levels of 100
pg/mL following intravenous exposure to secretin
d. A decrease in serum gastrin levels of 100 pg/
mL following intravenous exposure to secretin
e. Is confirmed when the hydrogen breath test is
positive
6. An IgG index of 0.8 is indicative of
a. Multiple sclerosis
b. CSF leakage
c. Fungal infection
d. Malignancy
e. Normal CSF
8. The d-xylose absorption test is particularly
helpful in differentiating malabsorption of
intestinal etiology from exocrine pancreatic
insufficiency because:
a. d-Xylose is mostly absorbed in the stomach and
then secreted via the kidney in its unaltered
monosaccharide form.
b. d-Xylose is mostly altered in the small intestine
to facilitate its absorption across this membrane
and metabolized by the liver so its metabolites
may be excreted via the kidney.
c. d-Xylose is mostly absorbed, not typically found
in the blood, unaltered in the small intestine, and
excreted unaltered via the kidney.
d. None of the above describe why the d-xylose
test is useful in identifying malabsorption
diseases
BODY FLUID ANALYSIS
1. Laboratory testing for the assessment of fetal
lung
maturity includes all of the following tests except
a. Acetylcholinesterase
b. L/S ratio
c. Fluorescence polarization
d. Foam stability
e. Lamellar body count
2. Amniotic fluid
a. Provides a cushion for the fetus and is a
mixture
of maternal and fetal fluids
b. Provides a cushion for the fetus
c. Is a mixture of maternal and fetal fluids
d. Is assessed by umbilical catheterization
e. Provides a cushion for the fetus, is a mixture
of maternal and fetal fluids, and is assessed by
umbilical catheterization
3.
a.
b.
c.
d.
e.
Lamellar body counts reflect
Surfactant phospholipid packets
Platelet count of the fetus
Platelet count of the mother
Meconium count of the fetus
All of these
4. A xanthochromic CSF indicates
a. Cerebral hemorrhage
b. Traumatic tap
c.
7. CF is characterized by
a. Elevated sweat chloride levels
b. Homozygous expression of an autosomal
recessive trait
c. Pancreatic insufficiency
d. All of these
e. None of these
8. Synovial fluid
a. Is formed by plasma ultrafiltration and is rich in
hyaluronic acid
b. Is formed by plasma ultrafiltration
c. Lubricates the pneumocytes
d. Is rich in hyaluronic acid
e. All of these
9. Serous fluids
a. Are derived from serum
b. Provide lubrication and protection
c. Fill the potential space
d. Are derived from serum and provide lubrication
and protection only
e. All of these
10. Pleural fluid exudates
a. Are characterized by a total protein F/P ratio of
0.7
b. Reflect primary involvement of the pleura
c. Are characterized by an increased LD F/P ratio
d. Are characterized by an increased cholesterol
F/P ratio
e. All of these
11. Analysis of paracentesis fluid is performed to
a. Determine the cause of fluid presence and
assess infection risk
b. Determine the cause of fluid presence
c. Assess infection risk
d. Determine lung involvement
e. All of these
12. The most common cause of ascites is
a. Portal hypertension
b. Venous return
c. Parietal cell differentiation
d. Eccrine infection
e. Malignancy
13. When assessing the lipid profile to determine
fetal
lung maturity, it is critical to
a. Centrifuge the amniotic fluid at low speeds to
properly avoid fractionation of the lipids.
b. Centrifuge the amniotic fluid at high speeds to
properly fractionate the lipids.
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c. Avoid centrifugation of amniotic fluid for this
test.
TUMOR MARKERS
1. What percentage of women will have invasive
cancer
at some time in their life?
a. 33%
b. 25%
c. 50%
d. 75%
2. Tumor marker tests are used to
a. All of these
b. Aid in staging of cancer
c. Monitor response to therapy
d. Detect recurrent disease
3. Tumor markers may be defined as
a. Biologic substances synthesized and released
by cancer cells or substances produced by the
host in response to cancer cells
b. Analytic tests (e.g., immunoassays) used to
mark cancer cells
c. Radioactive substances and chemicals used to
help the physician identify cancer cells
d. None of these
4. Which of the following is an oncofetal antigen?
a. AFP
b. CA-125
c. 𝗉-hCG
d. PSA
5. What are the major limitations of tumor
markers?
a. Sensitivity and specificity
b. Cost
c. Turnaround time
d. Imprecision
Diagnosis
b. Screening
c. Monitoring response
d. Detecting recurrence
11. The following serum PSA measurements were
obtained from two male patients that were being
monitored over an 18-week period.
Which of the following statements most
accurately
describes these data?
a. Patient A may have a more aggressive prostate
cancer based on the velocity of these
measurements.
b. Patient A is most likely to have benign prostate
cancer.
c. Patient B is most likely to be experiencing an
inflammatory reaction and this is largely
contributing
to the elevated PSA above 100 ng/mL.
d. Patient B may have a more aggressive prostate
cancer based on the velocity of these
measurements.
e. Answers a and c most accurately describe
these
data.
12. When measuring tumor markers in the clinical
laboratory, which of the following has been
reported
to contribute to 30% to 70% of the total amount
of measurement error?
a. Preanalytical errors
b. Analytical errors
c. Hook effect
d. Using different immunoassay methods
e. Not comparing lot numbers between ELISA kits
6. The major clinical use for CA-125 is monitoring
treatment response of
a. Ovarian carcinoma
b. Colorectal cancer
c. Prostatic cancer
d. Breast cancer
7. The most common immunoassays used to
measure
PSA detect which form of the enzyme?
a. Total PSA
b. Free PSA
c. PSA complexed with α1-antichymotrypsin
d. PSA complexed with α2-macroglobulin
8. Which of the following enzymes is commonly
used
as a tumor marker?
a. LD
b. Lipase
c. Aldolase
d. Catalase
9. A tumor marker used in the assessment of
choriocarcinoma
or hydatidiform mole is
a. 𝗉-hCG
b. CEA
c. AFP
d. IgG
10. A serum PSA is used for all of the following
except
a.
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