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
0
8. Reverse-phase liquid chromatography refers to
a. A polar mobile phase and nonpolar stationary
phase
b. A nonpolar mobile phase and polar stationary
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
0
phase
c. Distribution between two liquid phases
d. Size used to separate solutes instead of charge
d. Correct for differences in the aspiration rate of
the sample
1
0
0
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
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
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
0
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
0
3. Which of the following types of analyzers offers
random-access capabilities?
a. Discrete analyzers
b. Continuous-flow analyzers
the mixture is based on magnitude and charge of
ionic species.
0
c. Centrifugal analyzers
d. None of these
0
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
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
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
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
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
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
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
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
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
0
c. Analytical phase
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
0
7. In flow cytometry, the side scatter is related to
the:
a. Granularity of the cell
b. DNA content of the cell
c. Analytical phase
d. Postanalytical phase
c. Size of the cell
d. Number of cells in G0 and G1
0
0
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
7. 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. β-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
0
8. The protein electrophoretic pattern of plasma,
as compared with serum, reveals a
a. Fibrinogen peak between the β- 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
0
exceeds the pI.
exceeds the pI.
c. Renal failure
d. Crushing trauma received in a car accident
0
0
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
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
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
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
4. Prerenal azotemia is caused by
a. Acute renal failure
b. Chronic renal failure
c. Congestive heart failure
d. 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
7. Which one of the listed conditions is not
associated
with elevated plasma uric acid concentration?
a. Allopurinol overtreatment
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
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
NONPROTEIN NITROGEN COMPOUNDS
6. Uric acid is the final product of
a. Allantoin metabolism
b. Amino acid metabolism
c. Purine metabolism
d. The urea cycle
d. Renal disease
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
0
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
0
b. Gout
c. Lesch-Nyhan syndrome
the substrate concentration
d. The enzyme level is always high
0
0
CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
d. 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
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
8. Elevation of serum amylase and lipase is
commonly seen in
a. Acute pancreatitis
b. Acute appendicitis
c. Gallbladder disease
d. Acid reflux disease
5. Hyperglycemic factor produced by the
pancreas is
a. Epinephrine
b. Glucagon
c. Insulin
d. Growth hormone
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
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.
0
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 β-dglucose:
a. Glucose oxidase
b. Glucose-6-phosphate dehydrogenase
c. Hexokinase
d. Phosphohexose isomerase
0
8. Select the coupling enzyme used in the
b. Total CK level that is 25 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
0
hexokinase method for glucose:
a. Glucose dehydrogenase
0
CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
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.
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-β-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.
0
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
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
0
8. Which lipoprotein is the major carrier of
cholesterol to peripheral tissue?
Year 3: Urine albumin was 156 mg/24 h
What do these clinical data suggest?
a. LDL
b. Chylomicrons
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
d. 55 mg/dL HDL-C and 180 mg/dL total
cholesterol
e. 60 mg/dL HDL-C and 170 mg/dL
totalcholesterol
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
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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
0
cholesterol
indirect ISEs do not
0
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
d. Chloride
e. Potassium
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
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
9. The most frequent cause of hypermagnesemia
is due to
a. Renal failure
b. Increased intake of magnesium
c. Hypoaldosteronism
d. Acidosis
10. A hemolyzed sample will cause falsely
increased
levels of each of the following EXCEPT
a. Sodium
b. Potassium
c. Phosphate
d. Magnesium
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
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
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
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
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
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
0
16. Which plasma electrolyte has the most narrow
reference range and is MOST strictly regulated by
the body?
a. Sodium
b. Magnesium
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
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
0
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
b. Magnesium
c. Calcium
a. Compensated nonrespiratory alkalosis
b. Compensated respiratory alkalosis
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
c. To shorten the run time of the measurement
d. To lower the coefficient of variation for total
arsenic measurements
c. Uncompensated respiratory alkalosis
d. Uncompensated nonrespiratory alkalosis
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
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 O 2 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
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
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
0
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
0
d. Manganese