Chem TB Flashcards Unit 4
1) In uncontrolled diabetes mellitus, excess ketones are present
in the blood and urine because of:
2) Glucagon
-cells in the pancreas and when
released causes elevated blood glucose. By what mechanism
does glucagon promote hyperglycemia?
3) What is characteristic of type 1A diabetes mellitus?
4) Glycated hemoglobins are formed by the addition of glucose
to the ___-terminal _____ residue.
5) Determining urinary albumin excretion (UAE) is critical in
type 1 and type 2 diabetics because:
6) The role of the clinical laboratory in diagnosis of diabetes
mellitus involves initial diagnostic criteria. For many years,
the only diagnostic criterion required was demonstration of
hyperglycemia in two or more fasting plasma glucose tests.
What other laboratory analysis is now considered to be
useful as a diagnostic criterion?
7) The syndrome that is considered a collection of associated
clinical and laboratory findings that include insulin
resistance, hyperinsulinemia, obesity, high triglyceride and
low high-density lipoprotein (HDL) cholesterol, and
hypertension is the:
8) Type 2 diabetes mellitus:
9) A pregnant woman at 27 weeks gestation is screened for
gestational diabetes mellitus. Plasma venous glucose was
measured at 1 hour following a 50 g oral glucose load. What
value must this glucose be above or equal to for a glucose
tolerance test to be performed?
10) Insulin regulates blood glucose levels by:
11) Factors identified as associated with (and possibly causing)
type 1 diabetes mellitus include all of the following except:
12) A woman visits her physician with a complaint of polyuria
and polydipsia. She has a family history of type 2 diabetes
mellitus and is concerned that she is developing the disease.
The physician notes that her previous hemoglobin A1c (Hb
A1c) value was 6% (considered within healthy reference
interval in the physician’s practice) with a fasting plasma
glucose of 95 mg/dL. At this visit, her Hb A1c value is 8.5%.
Why would the physician be correct to order an oral glucose
increased breakdown of lipids
(lipolysis).
Glucagon stimulates
glycogenolysis and
gluconeogenesis.
Circulating autoantibodies formed
against pancreatic insulinsecreting cells.
N; valine
increased UAE is highly predictive
of and is thought to precede
diabetic nephropathy and endstage renal disease.
Demonstration of elevated
hemoglobin A1c
insulin resistance syndrome.
is associated with resistance to the
action of insulin.
The value must be 140 mg/dL
glucose.
stimulating the translocation of a
glucose transporter and promoting
glucose uptake into skeletal
muscle and fat.
insulin resistance.
The Hb A1c result indicates an increase in
average blood glucose and possible
onset of type 2 diabetes. An OGTT
would help to confirm this.
1
Chem TB Flashcards Unit 4
tolerance test (OGTT) for this individual?
13) Hb A1c makes up approximately what percentage of total Hb
A1?
14) Retinopathy, neuropathy, microvascular, and macrovascular
changes are all chronic complications of both type 1 and type
2 diabetes mellitus. One theory as to the cause of these
chronic problems is the elevation of advance glycation end
(AGE) products. These AGE products consist of:
15) Insulin deficiency in diabetes mellitus will cause:
16) What 2-hour plasma glucose oral glucose tolerance test
(OGTT) results would be classified as diagnostic for
impaired glucose tolerance if an individual’s fasting blood
glucose value is 120 mg/dL (healthy glucose reference
interval is 74 to 99 mg/dL)?
17) A fingerstick glucose value was 120 mg/dL. If unhemolyzed
serum or plasma were tested from the same individual at the
same time, what might the glucose value be?
18) The development of ketoacidosis in an uncontrolled diabetic
is caused by the:
19) An individual with a severe, uncontrolled case of type 1
diabetes mellitus will exhibit all of the following laboratory
results except:
20) As a counter-regulator of glucose metabolism in a healthy
individual, epinephrine has the effect of _____ blood
glucose.
21) High albuminuria is defined as:
22) Although not a routine clinical laboratory screening test,
measurement of insulin secretion in a potential diabetic is
important because:
23) The hyperglycemia observed in a diabetic causes many toxic
effects such as retinopathy and nephropathy. Although it is
unclear how these outcomes are caused by elevated blood
sugar, it is thought that hyperglycemia:
24) What antibodies is found most commonly in over 90% of
children who develop type 1 diabetes before 5 years old?
25) What cardiac biomarkers is elevated about 50 times the
upper limit of normal at 24 hours after onset of an acute
myocardial infarction?
26) Why would high-sensitivity C-reactive protein (CRP) be an
80%
proteins that have been
irreversibly modified by
nonenzymatic attachment of
glucose.
increased glucagon concentration,
which contributes to
hyperglycemia and ketosis.
195 mg/dL
Approximately 132 mg/dL
hydroxybutyric acid.
hyperinsulinemia.
stimulating glycogenolysis to
increase
increased urinary albumin
excretion between the range of 20
to 200 µg/min that is measured by
the laboratory in the chronic
management of diabetes mellitus.
a decrease in glucose-stimulated
insulin secretion is the first
functional abnormality in both
types of diabetes.
causes increased production of
advanced glycation end products,
which might contribute to
microvascular complications.
Insulin autoantibodies
Troponin
It is an acute phase reactant
2
Chem TB Flashcards Unit 4
indicator of a potential myocardial infarction?
27) An ideal cardiac marker should be elevated in the
circulation for how long following a cardiac event?
28) A 55-year-old man is taken to a hospital emergency
department by helicopter following a rural automobile
accident that occurred approximately 3 hours ago. The man,
who is having difficulty speaking to the EMTs, is clutching
his chest. Upon the man’s arrival, the emergency room
physician orders a cardiac marker panel that includes serum
CK, CK-2 (CK-MB), troponin, and myoglobin. The CK-2
value was less than 2% of total CK, which was slightly
increased; troponin was normal; and the myoglobin was
increased 3 times the upper limit of normal. The physician
has asked the laboratory to explain the findings. What
represents the lab’s explanation?
29) What cardiac markers is elevated for the longest period of
time after a myocardial infarction?
30) What is considered to be the most specific marker for
adverse ventricular remodeling following an acute
myocardial infarction?
31) In regard to cardiac anatomy, the myocardium:
32) What specimen types and collection methods is best for
laboratory assessment of brain natriuretic peptide (BNP) in
the evaluation of congestive heart failure?
33) Laboratory measurements for brain natriuretic peptide
(BNP) be reported in:
34) A cardiac marker that increases progressively with
increasing severity of disease and is not increased (or
decreased) in conditions that mimic congestive heart failure
is:
35) The most common laboratory method used to assess brain
natriuretic peptides is:
36) What troponins appears as uncomplexed or free following
myocardial injury?
37) In a point-of-care (POC) test for a cardiac biomarker used in
the evaluation of an individual with possible acute coronary
syndrome, what is a Laboratory Medicine Practice guideline
of the National Academy of Clinical Biochemistry (NACB)?
38) Chest pain that is associated with a decrease in oxygen
supply to the heart muscle but that exhibits no cellular
necrosis based on cardiac troponin value and is considered a
less severe event is referred to as:
39) In the process of atherosclerotic plaque formation, what is
plasma protein that rises in
response to inflammation and the
atherosclerotic process.
At least several days
Trauma caused by the accident
with possible crush injury to the
chest caused elevated myoglobin
with normal troponin and CK-MB.
Troponins
Brain natriuretic peptide (BNP)
contains bundles of striated muscle
fibers.
EDTA-anticoagulated whole blood
or plasma in plastic blood
collection tubes only
nanograms/liter.
B-type natriuretic peptide.
immunoassay.
Cardiac troponin I
POC assays should provide
quantitative results.
angina.
Damage to the endothelium of
3
Chem TB Flashcards Unit 4
the typical precipitating event?
40) The protein in cardiac muscle fibers that regulates
contraction is:
41) Regarding assessment of congestive heart failure, NTproBNP can be measured. This protein is:
42) In your clinical chemistry laboratory, you use an
immunoassay to detect blood levels of NT-proBNP. You
receive a filled green-top anticoagulant-containing plastic
blood collection tube with a request for NT-proBNP. What is
your next step?
43) What are the laboratory results for CK-MB and cardiac
troponin in the following conditions: muscular dystrophy,
polymyositis, and extreme physical activity?
44) A 36-year-old individual visits her physician with a
complaint of nausea, loss of appetite, weakness, and an
inability to concentrate. Laboratory results indicate increased
serum urea and creatinine, increased potassium, reduced
glomerular filtration rate (GFR), low blood pH, anemia (low
red blood cell count), and hypocalcemia. What is the likely
diagnosis?
45) The portion of a nephron considered the most metabolically
active and that is involved in the reabsorption of 60% to 80%
of the glomerular filtrate and that secretes 90% of hydrogen
ion excreted by the kidney is the:
46) A patient with elevated serum nitrogen compounds,
markedly reduced GFR, increased serum sodium and
potassium, and metabolic acidosis is diagnosed with acute
kidney injury (AKI). What is a likely cause?
47) What laboratory results would point to a diagnosis of acute
nephritic syndrome in an individual who exhibits
hypertension and edema?
48) The functional unit of the kidney is the:
49) If a physician requests a creatinine clearance on an
individual, what is the physician attempting to determine?
50) What components of the renal system is most important for
regulation of plasma electrolytes and acid-base balance?
51) In homeostatic regulation of plasma acid-base
concentrations, sodium is both actively and passively
exchanged in the tubules for what ions?
52) What statements regarding creatinine is correct?
53) Secretion of renin and aldosterone is induced by low blood
pressure and volume. Renin is synthesized in the _____ and
aldosterone is made in the _____.
54) Secretion of renin and aldosterone is induced by low blood
cardiac blood vessels
troponin.
the N-terminal fragment of proBNP.
Proceed, because this tube
contains heparin and provides
plasma after centrifugation, which
is acceptable for the NT-proBNP
assay.
CK-MB elevated, troponin normal
Uremia
proximal tubule.
Decreased cardiac output
Hematuria, sodium retention,
decreased GFR, proteinuria
nephron.
Glomerular filtration rate (GFR)
Distal convoluted tubule
Hydrogen
Normal plasma creatinine does not
always indicate normal kidney
function.
kidney; adrenal gland
Antidiuretic hormone
4
Chem TB Flashcards Unit 4
pressure and volume. What other hormone would be released
in the event of low blood pressure and volume?
55) A 45-year-old man visits his physician with complaints of
insatiable thirst, sudden onset of fatigue, polydipsia, and
polyuria. Laboratory results indicate a normal fasting blood
sugar. Serum sodium was slightly elevated. Urine was clear
and had low specific gravity (hypotonic). The most likely
cause of these symptoms and laboratory results would be:
56) Upon microscopic examination, an individual’s urine shows
many bacteria, white blood cells, and cellular casts composed
of polymorphonuclear leukocytes. It is likely that this
individual has:
57) If an individual has a normal GFR and a hyperchloremic
normal anion gap metabolic acidosis with a freshly voided
early morning urine specimen which has a pH of 6.5, what is
the likely diagnosis?
58) Damage to the glomerulus would be suspected when the
urine sediment contains:
59) Why is bone disease a consequence of chronic kidney
disease (CKD)?
60) You have been asked what laboratory tests should be
requested to assess the electrolyte balance regulatory
function of an individual’s kidneys. What is your reply?
61) The major artery that expands into the capillary bed that
forms the glomerulus is the:
62) The most common glomerular disease worldwide is:
63) A 46-year-old patient visits her physician with a complaint
of chest pain, blood in her urine, and oliguria. She states that
these symptoms have gotten worse over the past 2 to 3
months. Urine and blood samples are collected. Urine GFR is
calculated to be 40 mL/min/1.73 m2 and hemoglobin is 8
g/dL. Urine protein was elevated, with the presence of red
blood cell casts. Upon review of her health history, it was
noted that she was a cigarette smoker with hypertension. The
most likely diagnosis in this case would be:
64) In an individual with chronic kidney disease, what might be
the predominant cause of the low hemoglobin value and
anemia?
65) An individual presents to his physician with generalized
weakness and fatigue. Blood is collected and an elevated
WBC count with lymphocytosis is noted. Serum protein is
moderately decreased, but the urine reagent dipstick does not
indicate proteinuria. Upon confirmatory testing with a
diabetes insipidus.
pyelonephritis.
There is likely the onset of distal
renal tubular acidosis (RTA).
red blood cell casts.
When glomerular filtration
declines, vitamin D activation
decreases resulting in reduced
calcium, which further leads to
resorption of calcium from bone.
Serum sodium and potassium, and
arterial blood pH
renal artery.
IgA nephropathy.
chronic kidney disease (CKD).
Decreased erythropoietin synthesis
Reagent dipsticks respond mostly
to urine albumin and not to other
proteins.
5
Chem TB Flashcards Unit 4
precipitation test, the urine protein is 4+. Based on other
symptoms, the physician suspects multiple myeloma. What
might be the cause of the discrepancy in urine protein
values?
66) In multiple myeloma, what protein is likely causing an
elevated value in the urine protein confirmatory test?
67) The volume of plasma from which a substance is
completely removed by the kidneys per unit of time is the
definition of:
68) What is the correct formula for determining glomerular
filtration rate?
69) An individual is brought to the emergency department of a
local hospital with signs of narcotic overdose and respiratory
depression. What acid-base status would this individual
have?
70) A person suspected of having chloride responsive
metabolic alkalosis caused by prolonged vomiting would
exhibit what?
71) In regard to respiration, peripheral chemoreceptors located
in the carotid arteries and aorta are stimulated by:
72) An overweight 55-year-old single woman from a rural
farming area was brought to the emergency department by
her neighbor. The woman had a large abscess on the bottom
of her foot; she was irritable and complained of blurred
vision and of being thirsty. Her breathing was rapid. The
neighbor said that the only medication the woman was using
was for blood pressure and sometimes an aspirin. Blood and
urine samples were collected. Arterial blood gas results were:
pH 7.2; PCO2 47 mm Hg; HCO3 8 mmol/L. Blood glucose
was 340 mg/dL and a high anion gap was calculated. Urine
glucose and ketones were markedly increased. Based on the
laboratory values, what state of acid-base balance is this
patient in?
73) An overweight 55-year-old single woman from a rural
farming area was brought to the emergency department by
her neighbor. The woman had a large abscess on the bottom
of her foot; she was irritable and complained of blurred
vision and of being thirsty. Her breathing was rapid. The
neighbor said that the only medication the woman was using
was for blood pressure and sometimes an aspirin. Blood and
urine samples were collected. Arterial blood gas results were:
pH 7.2; PCO2 47 mm Hg; HCO3 8 mmol/L. Blood glucose
was 340 mg/dL and a high anion gap was calculated. Urine
glucose and ketones were markedly increased. Based on the
laboratory values and symptoms of the woman, what is the
Bence Jones protein
clearance.
GFR = ([urine concentration of the
concentration of the substance]
Respiratory acidosis
Primary bicarbonate excess
pH and PO2 content of blood.
Metabolic acidosis
Diabetic ketoacidosis
6
Chem TB Flashcards Unit 4
most likely cause of her acid-base disorder?
74) Hypernatremia commonly occurs with:
75) Hypokalemia may be seen in all of the following except:
76) What is the anion gap given the following serum
electrolyte data: Na = 132 mmol/L, Cl– = 90 mmol/L, HCO3–
= 22 mmol/L, K = 4 mmol/L?
77) Determine the anion gap given the following serum
electrolyte data: Na = 132 mmol/L, Cl = 90 mmol/L, HCO3–
= 22 mmol/L, K = 4 mmol/L. Is the anion gap you calculated
within the healthy reference interval?
78) What conditions will cause an increased anion gap?
79) All of the following are causes of hyponatremia with
concomitant decreased plasma osmolality and normal
volume status except:
80) Metabolic organic acidoses typically present with an
increased anion gap. In contrast to these, inorganic acidosis
with a normal anion gap is typically caused by:
81) An individual visits a physician with the complaint of
nausea, mental confusion, and needing an excessive amount
of salt all the time. Laboratory results indicate decreased
serum sodium and low serum osmolality. Physical
examination reveals hypovolemia with low orthostatic blood
pressure and tachycardia. A urine sodium analysis was
suggested by a laboratorian and urine sodium was found to
be increased; the physician diagnoses a salt-losing
nephropathy (a renal tubule disease). What type of
electrolyte disorder is this?
82) A hospitalized patient in the ICU has cirrhosis. After a
period of time, the heart and kidneys begin to fail and the
patient develops edema. What type of electrolyte disorder
would develop from this situation?
83) How do healthy kidneys compensate for the excess
hydrogen ions and concurrent low pH observed in metabolic
acidosis?
84) How do healthy lungs compensate for the decrease in pH in a
state of metabolic acidosis?
85) Physiologically important buffers maintaining body pH
include all of the following except:
86) At physiological pH of 7.4, what contributes most to the
total serum CO2 (think about the equilibrium of the reaction
in the formula)?
87) Hypokalemia (<3.0 mmol/L) is considered a serious health
threat because
decreased synthesis of antidiuretic
hormone (ADH).
decreased glucocorticoid
concentration in blood.
20 mmol/L
No
Salicylate intoxication
diarrhea.
loss of bicarbonate-rich fluid via
the kidneys or gastrointestinal
tract.
Depletional hyponatremia
Dilutional hyponatremia
Increasing excretion of acid
Stimulating hyperventilation
lactate.
Carbonic acid
the heart rate increases, leading to
weakness, difficulty in breathing,
and eventual cardiac arrest.
7
Chem TB Flashcards Unit 4
88) The most important buffer of plasma is the _____ system.
89) The metabolic component of acid-base regulation is the
renal system. What statements concerning this component is
incorrect?
90) What hormones is an active regulator of water
retention/reabsorption in the kidney?
91) What hormones is an active regulator of sodium (and
passive controller of water) in the kidney?
92) A 17-year-old woman was brought by her friends to the
emergency room in an agitated state. She stated that she had
broken up with her boyfriend and he had threatened her. Her
temperature was 101° F, and she was breathing rapidly. She
claimed that she could not slow her breathing down despite
attempts to have her breathe deeply. An arterial blood gas
revealed a pH of 7.54, HCO3 of 18 mmol/L, and PCO2 of 28
mm Hg. What is occurring in this patient?
93) The major risk factor for development of hepatocellular
carcinoma is:
94) __ In chronic liver failure, such as cirrhosis, there is a
significant impairment of normal ammonia metabolism and
eventual hyperammonemia. Elevated ammonia can lead to:
95) _ The functional unit of the liver is the:
96) _ You operate a laboratory that receives many serum
specimens from the Billy Rubin Memorial Liver Clinic next
door. The patients who go to this clinic have serious acute
and chronic liver diseases. Would you expect to see
increased or decreased plasma albumin from the liver
patients who go to this clinic?
97) _ Bilirubin that is attached to albumin before it is transported
across the hepatocyte membrane is called:
98) The type of RNA virus that is considered to be the cause of
the most common type of acute hepatitis that does not lead to
chronic hepatitis is:
99) _ A 53-year-old man notices the whites of his eyes seem a bit
yellow, there is swelling in his abdomen, and he is often
fatigued. He tells his physician that he enjoys “a few”
martinis every night. Upon physical examination, the
physician notes decreased weight, elevated blood pressure,
jaundice, and ascites, and laboratory results indicate
decreased albumin, low platelet count, increased prothrombin
time, and increased serum liver enzymes with AST activity
higher than ALT. All viral hepatitis and cholestasis testing is
negative. What is the likely diagnosis?
100) In the liver, ammonia is metabolized to form:
101) An autoimmune disease caused by an antibody directed
toward the mitochondria of biliary epithelial cells that results
bicarbonate/carbonic acid
In the metabolic component, the
renal system responds immediately
to a change in acid-base status.
Antidiuretic hormone
Aldosterone
Excess elimination of acid via the
respiratory route
infection with hepatitis B or C
viruses.
hepatic encephalopathy.
acinus.
Decreased
unconjugated bilirubin.
hepatitis A virus.
Chronic alcoholic hepatitis
transitioning to cirrhosis
urea.
primary biliary cirrhosis.
8
Chem TB Flashcards Unit 4
in hepatic inflammation and portal hypertension is:
102) The first protein marker to appear approximately 1 to 2
months after infection with the hepatitis B virus and also the
last marker to disappear is the:
103) What is not a consequence of portal hypertension in an
individual?
104) A new intern calls the laboratory to ask which liver
enzymes would be best to assess to differentiate between
hepatocellular and cholestatic disease. You respond:
105) Which type of hepatitis is a leading cause of chronic
hepatitis and is caused by a mutating RNA virus?
106) What is considered a mechanism by which a membranebound enzyme, such as alkaline phosphatase, is released
from a hepatocyte into blood?
107) A 30-year-old man sees his physician with complaints of
pruritus, fever, and pain around his abdomen and right side
that he says “have been there a while but suddenly got really
bad.” Laboratory results on his blood sample indicate
elevated conjugated and unconjugated bilirubin and elevated
alkaline phosphatase activity. There are no signs of chronic
hepatitis or ascites. Gallstones are ruled out, and the
physician notes that a previous diagnosis of ulcerative colitis
had been made. What is the likely current diagnosis?
108) Prognosis in cirrhosis is based on a MELD score, which is
also used to prioritize cases for liver transplantation. What
laboratory values are used to calculate the MELD score of an
individual?
109) Liver disease is classified as either acute or chronic. Acute
liver disease takes the general form of either acute hepatitis
or:
110) Regarding the gastrointestinal (GI) tract, the function of
gastrin is to:
111) What peptide hormones acts to increase intestinal motility
and stimulate gallbladder contractions?
112) What substances is not synthesized by the pancreas?
113) Extremely elevated serum levels of gastrin are typically
indicative of:
114) What special specimen requirements must be met when
collecting and preparing a sample for gastrin analysis?
115) What statements concerning secretin is correct?
116) A problem with the use of noninvasive testing for
hepatitis B surface antigen.
Hemochromatosis
AST, ALT, and ALP.
Hepatitis C
Bile acids solubilize membranebound enzymes.
Primary sclerosing cholangitis
Bilirubin, creatinine, and INR
cholestasis.
stimulate release of GI hormones,
such as secretin and insulin.
Cholecystokinin (CCK)
Vasoactive intestinal polypeptide
(VIP)
Zollinger-Ellison syndrome.
Blood must be collected into a
heparin-containing tube, separated
in a refrigerated centrifuge, and
frozen within 15 minutes of
collection.
Secretin stimulates release of
pancreatic hormones.
lacks the clinical sensitivity and
9
Chem TB Flashcards Unit 4
assessing pancreatic exocrine function is that this type of
testing:
117) An autoimmune disorder produced by ingestion of gluten
and characterized by inflammatory damage to intestinal
lining cells and malabsorption is:
118) The use of the urea breath test for detection of H. pylori
involves:
119) A consequence of Crohn disease is bacterial overgrowth of
the small bowel that normally contains few bacteria.
Bacterial overgrowth further leads to:
120) Secondary acquired lactose intolerance can occur from
reduced lactase activity following diffuse intestinal damage
caused by, for example, inflammatory bowel disease (IBD).
What IBDs affects the large bowel in particular?
121) During the gastric phase of the digestive process, HCl will
be released from parietal cells following the _____ of gastrin
from the mucosal endocrine cells in the stomach.
122) Chronic pancreatic damage leads to pancreatic
insufficiency. In children, this is most commonly associated
with:
123) A peptide secreted by the upper intestinal mucosa that
causes gallbladder contraction and release of digestive
enzymes from the pancreas, and is also localized in the
nervous system, is:
124) Mucosal inflammation of the stomach that is associated
with peptic ulcer disease or gastric carcinoma is referred to
as:
125) Fecal osmot Fecal osmotic gap measurements are done to:
126) Gastrointestinal neuroendocrine tumors are either carcinoid
tumors of enterochromaffin cells or, as in the case of
somatostatinoma, tumors of the:
127) A 23-year-old man visits his physician with symptoms of
abdominal discomfort and diarrhea. The man states that the
diarrhea has been present off and on for approximately 6
weeks. He especially notes symptoms after a breakfast of
wheat cereal and milk. His physician considers the
possibility of two disorders, celiac disease and lactose
intolerance. What pairs of laboratory tests would provide a
definitive answer?
128) What statements concerning insulin is incorrect?
specificity for early disease
detection.
celiac disease.
bacterial hydrolysis of ingested
labeled urea producing labeled
bicarbonate, which is absorbed
into the blood and exhaled as
14
CO2 or 13CO2.
bile salt deficiency and fat
malabsorption.
Ulcerative colitis
release
cystic fibrosis.
CCK.
nonerosive gastritis.
distinguish between osmotic and
secretory diarrhea.
pancreatic endocrine cells.
Analysis of tissue
transglutaminase IgA antibodies
and breath hydrogen testing
Glucose-dependent insulinotropic
peptide (GIP) inhibits insulin
release.
10
Chem TB Flashcards Unit 4
129) A test that is considered diagnostic for cystic fibrosis in
infants over the age of 2 weeks and for other assessment of
pancreatic insufficiency is:
130) The primary physiological regulator of parathyroid
hormone (PTH) synthesis and secretion is:
131) Rickets is sometimes associated with deficiency of what
vitamins?
132) Hypoparathyroidism is most commonly caused by:
133) What makes up the organic matrix component of bone?
134) In bone:
135) The major cause of the decrease in total bone mass in an
aging osteoporotic woman is:
136) An individual’s serum phosphate level is decreased but his
physician cannot determine a physiological basis for this
abnormal result. What could possibly have caused this
result?
137) Telopeptides:
138) An individual has the following laboratory test results:
increased serum calcium, decreased serum phosphorus,
increased parathyroid hormone. This individual most likely
has:
139) Total serum calcium:
140) In a case of severe osteomalacia, would bone-specific
alkaline phosphatase be increased, decreased, or remain
unchanged?
141) A noncollagenous protein marker of bone formation that is
released from bone during bone resorption, regulated by
1,25-dihydroxyvitamin D, and synthesized by osteoblasts and
that regulates insulin secretion and sensitivity is:
142) Hypercalcemia occurs in humoral hypercalcemia of
malignancy (HHM) because:
143) The clinical usefulness of calcitonin measurement is:
144) What diseases is characterized by a loss in bone mass?
145) What analytes is most useful in distinguishing primary
from secondary hyperparathyroidism?
146) In a case of osteomalacia related to vitamin D deficiency,
would serum calcium be increased, decreased, or remain
unchanged?
147) A blood specimen is collected in a heparin-containing tube
for calcium and magnesium determination. Upon
centrifugation, the plasma appeared hemolyzed. How would
fecal elastase-1
the concentration of free calcium
in blood or extracellular fluid.
Vitamin C
parathyroid gland destruction.
Calcium, protein, and collagen
osteoblasts are the bone-forming
cells.
being postmenopausal and
estrogen deficient.
Use of IV carbohydrate therapy to
stimulate insulin secretion
are proteins found in bone whose
serum level can reflect bone
formation.
hyperparathyroidism.
hyperparathyroidism.
Increased
osteocalcin.
PTH-related protein (PTHrP) is
synthesized by tumors and
stimulates bone resorption.
as a tumor marker for medullary
thyroid carcinoma.
Osteoporosis
Vitamin D
Decreased
Because erythrocytes contain
magnesium, hemolysis would
increase its apparent value.
11
Chem TB Flashcards Unit 4
this affect the magnesium value?
148) Hypophosphatemia is seen in all of the following except:
149) Magnesium:
150) Hypermagnesia may be observed in all of the following
except:
151) A factor that would alter protein binding of calcium and its
redistribution among the three plasma pools would be:
152) What is a recognized clinical feature of hypercalcemia?
153) Specimen requirements for assessing free calcium using
ion-selective electrode methodology include:
a. heparinized whole blood.
b. heparinized plasma.
c. serum.
d. all of the above.
154) Pseudohypoparathyroidism is characterized by tissues that
are resistant to the effects of circulating levels of parathyroid
hormone (PTH). What sets of values presents expected
laboratory findings in this disorder?
155) The release of thyrotropin-releasing hormone from the
hypothalamus stimulates thyrotropin release from the
pituitary, which further leads to synthesis and secretion of
thyroid hormone from the thyroid gland. When the
concentration of thyroid hormone in the blood turns off the
release of thyrotropin from the pituitary, this is referred to as
what type of feedback?
156) The follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) are important in the reproductive function of
the male and female and are released in response to:
157) A 35-year-old man visits his physician with complaints of
sudden onset of fatigue, polydipsia, and polyuria. Laboratory
results indicate a normal fasting blood sugar. Serum sodium
was slightly elevated. The most likely cause of these
symptoms and laboratory results would be:
158) What hormones is classified as a glycoprotein?
159) An example of a hypothalamic hormone would be:
160) The insulin tolerance test is used to assess what hormones?
161) Inhibition of growth hormone (GH) occurs through the
action of:
162) The anterior portion of the pituitary gland synthesizes
many protein hormones. Another name for this part of the
pituitary gland is the:
163) The hypothalamic hormone that inhibits prolactin is
referred to as prolactin-inhibiting hormone but is actually:
164) What is not a function of thyrotropin?
hyperparathyroidism.
decrease produces neuromuscular
excitability.
gastrointestinal disorders.
liver disease.
Muscle weakness
D
Decreased calcium, elevated
phosphorus, elevated PTH
Negative feedback
gonadotropin-releasing hormone
(GnRH).
diabetes insipidus due to
hypothalamic dysfunction.
Follicle-stimulating hormone
antidiuretic hormone (ADH).
Growth hormone
somatostatin release-inhibiting
hormone.
adenohypophysis.
dopamine.
Action as a carrier protein of
circulating thyroid hormones
12
Chem TB Flashcards Unit 4
165) What statements concerning hormonal regulation via the
feedback loop is correct?
166) What statements regarding FSH/LH is incorrect?
167) The most common hypothalamic-pituitary disorder in
clinical endocrinology is:
168) A 45-year-old female complains of fatigue, heat
intolerance, and hair loss. Serum thyroxine is abnormally
low. What test would confirm that this might be a pituitary
disorder?
169) What hormones is responsible for normal development of
cartilage bone, mobilizing fat stores, and stimulation of
protein synthesis?
170) Oxytocin is:
When a stimulating hormone
induces production of a hormone,
elevated levels of that hormone
shut off further release of the
stimulating hormone. This is
referred to as negative feedback.
LH triggers release of the ovum
from the ovarian follicle and
produces an initial decrease in
estrogen.
hyperprolactinemia.
Thyrotropin
GH
released upon stimulation of cell
bodies in the hypothalamic
paraventricular nucleus.
Decreased prolactin (PRL)
171) A 28-year-old man and his wife visit a fertility clinic. His
sperm count is low, but his wife’s tests (LH/FSH, estrogen, etc.)
all fall within the healthy reference intervals. His history
indicates that he had a motor vehicle accident one year
previously and was suffering from visual problems. What might
be the cause of his oligospermia?
172) Use of the cosyntropin stimulation test:
is indicated when a morning
cortisol result is low in addition to
indications of adrenal
insufficiency.
173) The most common assay used to assess serum concentration immunoassay.
of adenohypophyseal hormones is:
174) An individual using antidepressants visited her physician Syndrome of inappropriate ADH
with a complaint of water retention. Laboratory results indicated secretion (SIADH)
decreased urine volume, low serum sodium, low plasma
osmolality, decreased serum uric acid, and urea. Antidiuretic
hormone was measured and found to be elevated. What is the
likely diagnosis?
175) What steroid hormones is (are) synthesized and secreted
Androstenedione
by the zona reticularis of the adrenal cortex?
176) Following multiple-day cosyntropin stimulation, an
fail to demonstrate increased
individual with Addison disease (primary adrenal insufficiency)
cortisol production.
will:
177) The most reliable screening test for _____ is
Cushing syndrome
13
Chem TB Flashcards Unit 4
measurement of 24-hour urinary free cortisol.
178) The primary glucocorticoid is:
179) During an evaluation of adrenal function, a patient had
plasma cortisol determinations in the morning after awakening
and in the evening at approximately 7:30 PM. Laboratory results
indicated that the evening value was approximately half as high
as the morning concentration. This is indicative of:
180) The adrenal cortical hormone that promotes sodium
resorption and potassium and hydrogen ion excretion by the renal
tubules and thus affects water balance in the body is:
181) Glucocorticoids:
182) A patient with Cushing syndrome has plasma cortisol
measured at 8 AM. The nighttime cortisol level will be _____ from
the 8 AM value.
183) Renin is synthesized in the _____ and stimulates the
production of angiotensin I, which eventually leads to _____.
184) The major site of cortisol synthesis is the _____ of the
adrenal gland.
185) What statement concerning cortisol is incorrect?
186) A hypertensive, hypokalemic patient with increased
aldosterone production and decreased plasma renin activity likely
has:
187) Deficiency of what enzymes can lead to congenital adrenal
hyperplasia (CAH)?
188) How would CAH affect cortisol and adrenal androgen
levels in blood?
189) What statements concerning androstenedione is incorrect?
.
cortisol.
a normal finding.
aldosterone.
repress inflammatory genes.
unchanged
kidney; stimulation of aldosterone
production
zona fasciculata
A cortisol-secreting tumor can lead to
Cushing disease.
Conn syndrome.
17-Ketosteroidase
Cortisol decreased, adrenal
androgens increased
In adrenal carcinoma, cortisol is
greatly elevated, but
androstenedione is greatly
decreased.
190) In the classic plasma renin activity assay that measures the Angiotensin I
main function of the enzyme and uses inhibitors of angiotensinase,
what is actually measured at the end of the assay?
191) Because of the biochemical properties of steroid hormones, are bound with high affinity to a
the majority of these hormones, at physiological concentration:
carrier protein in the circulation.
192) The urinary metabolite of cortisol and adrenal androgens is:
17-ketosteroid.
193) In the corticotropin-releasing hormone stimulation test, an
Decreased plasma ACTH and
individual with secondary adrenal insufficiency (pituitary ACTH decreased serum cortisol response
deficiency) will have what laboratory test results?
times
194) Thyroid-stimulating hormone (TSH) receptor antibodies can Graves disease
be detected in serum of patients having what disorder?
195) What causes the total thyroxine (T4) levels to be increased
hCG-induced thyrotoxicosis
in pregnant women?
196) Serum thyroid-stimulating hormone (TSH) level is
hyperthyroidism.
decreased in individuals with:
14
Chem TB Flashcards Unit 4
197) An amorphous material enclosed within each follicle of the
thyroid gland and that is composed mainly of thyroglobulin is:
198) What is not a function of the thyroid hormones?
199) Regarding thyroid hormones, the primary secretory product
of the normal thyroid gland is in the form of:
200) Thyroid hormones are derived from the amino acid:
201) A 45-year-old woman visits her physician with complaints of
fatigue, heat intolerance, goiter, and unusual hair loss. Blood is
collected and serum T4 value is below the healthy reference
interval. What laboratory assay would confirm that this might be a
pituitary disorder?
202) What statements is correct regarding reverse T3 (rT3)?
203) Increased TSH, decreased T3, and decreased T4 with the
presence of goiter indicate:
204) An individual’s thyroid-binding globulin (TBG)
concentration is 2.8 mg/dL, T3 value is 10.5 µg/dL, and T4 value
is 12.5 µg/dL. What is the estimate of free T4 value?
205) Another term used to describe hyperthyroidism is:
206). A 30-year-old man visits his physician for an annual health
check. He complains that he has been feeling fatigued of late and
has lost weight. Blood is collected and the following laboratory
results are noted: total T3, elevated; total T4, elevated; free T4,
elevated; TSH, slightly elevated. Magnetic resonance imaging
indicates a mass in the area of his pituitary gland. What disorder
do the results suggest?
207) Severe hypothyroidism that develops during the newborn
period is referred to as:
208) What hormones require transport proteins to move them
through the circulation and are more than 99% bound to these
proteins?
209) Myxedema is a skin and tissue mucopolysaccharide
disorder caused by severe and prolonged:
210) What is required for normal thyroxine synthesis?
211) The limited clinical information that is available from the
results of a total T4 measurement is a due to:
212) The secretory unit of the thyroid gland is the:
213) A woman with thyroid cancer has her thyroglobulin (Tg)
level checked to assess return of thyroid function following
surgery. The Tg value was markedly decreased. Her physician
calls the laboratory asking for an explanation of the result. You
respond that:
214) What effect does exercise have on blood glucose?
215) What effect does C-Peptide have on blood glucose?
216) What effect does Somatostatin have on blood glucose?
For each of the cardiac biomarkers, match the biochemical
colloid.
Removal of defective RBCs
free thyroxine (T4).
tyrosine.
Thyroid-stimulating hormone
(TSH)
rT3 is formed in the blood by central
deiodination of T4.
primary hypothyroidism.
4.3
thyrotoxicosis.
Central hyperthyroidism
cretinism.
T3 and T4
hypothyroidism.
TSH, iodine, and thyroglobulin
total T4 measurements reflect
inactive, protein-bound hormone.
thyroid follicle.
your laboratory uses a Tg assay that likely
has been interfered with by Tg
autoantibodies, which limits the accurate
measurement of Tg.
increases
no effect
decreases
15
Chem TB Flashcards Unit 4
classification:
a) BNP b) CK-MB c) Troponin d) Myoglobin
217) Protein involved in muscle fiber contraction
218) Protein hormone
219) Enzyme isoform
220) Oxygen-binding protein
Match the action of acid-base balance regulation with the correct
component of acid-base balance:
a) metabolic component b) respiratory component c) both
component
221) Hydrogen ions are exchanged for sodium or potassium
222) Hydrogen ion are attached to hemoglobin
223) Can alter blood pH
Match the disorder with the correct cause of that condition:
a) decreased flow of bile b) inflammation of bile ducts
c) gallstones in the bile duct d) fibrosis of the liver
224) Cirrhosis
225) Choledocholithiasis
226) Cholestasis
227) Cholangitis
228) True or False? The most common cause of toxic hepatitis in
North America leading to direct damage of hepatocytes is
acetaminophen overdose.
229) True or False? Alkaline phosphate is a soluble enzyme
localized in the cytosol of hepatocytes.
230) True or False? The principal site of steroid metabolism is
the liver
B
C
A
D
A
B
C
D
C
A
B
True
False
True
16