Analytical Techniques in Clinical Chemistry
Exam Answer Key
Course Introduction
This course provides a comprehensive exploration of the principles, methodologies, and applications of analytical techniques used in clinical chemistry laboratories. Students will learn about the selection, operation, and interpretation of key analytical instruments such as spectrophotometers, chromatographs, and electrophoretic apparatus. Emphasis is placed on the qualitative and quantitative analysis of biological fluids, with topics covering sample preparation, quality control, method validation, and data interpretation. The course also addresses the clinical significance of various biochemical analytes, the role of instrumentation in disease diagnosis, and emerging technologies in laboratory medicine.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Chapter 1: Basic Laboratory Principles and Techniques
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Q1) How many mL of 0.819 M acetic acid (MW = 60; pK = 4.76) should be added to 350 mL of 0.368 M sodium acetate (MW = 82) to produce a final pH of 4.89?
A)95.41 mL
B)116.5 mL
C)128.8 mL
D)130.6 mL
Answer: B
Q2) What dilution is necessary to make an 18 mg/L solution from a 30 mg/L solution?
A)1:5 dilution
B)3:5 dilution
C)2:3 dilution
D)1:3 dilution
Answer: B
Q3) The units for specific gravity are:
A)g/mL
B)mol/L
C)mg/L
D)%
Answer: A
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Chapter 2: Spectral Techniques
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Q1) The wavelength of electromagnetic radiation is:
1)directly proportional to the energy of a photon
2)inversely proportional to the energy of a photon
3)directly proportional to the frequency of a photon
4)inversely proportional to the frequency of a photon
A)1, 3
B)2, 4
C)1, 4
D)2, 3
Answer: B
Q2) What would happen to the percent transmittance of a sample that was read in a cuvette with fingerprints on the optical surface?
A)%T would increase
B)%T would decrease
C)%T of quartz cuvettes would not be affected by fingerprints
D)%T of glass cuvettes would not be affected by fingerprints
Answer: B
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Suppose drug A and drug B are to be separated by anion-exchange chromatography.Drug A is an acid with a pK of 8.0, and drug B is an acid with a pK of 4.0.Following the proper steps to place the mixture of drugs onto the anion-exchange phase, the pH of the mobile phase should be adjusted to ______ to elute drug A only.Then the pH of the mobile phase should be adjusted to _____ to elute drug B from the stationary phase.
A)4.0, 8.0
B)8.0, 4.0
C)10.0, 6.0
D)6.0, 2.0
Answer: D
Q2) Which of the following molecular characteristics forms the basis for chromatographic retention in adsorption and partition chromatography?
A)molecular size and shape
B)polarity
C)molar absorptivity
D)all of the above
Answer: B
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Chapter 4: Chromatographic Techniques
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Q1) Suppose there is the need to separate the components of a mixture in which the components are known to have a molecular weight of less than 1000 D, not be ionizable, and be relatively nonpolar with limited hydrogen-bonding potential.Which chromatographic method should be selected?
A)adsorption chromatography
B)partition chromatography
C)ion-exchange chromatography
D)gel-permeation chromatography
Q2) What is meant by the phrase isocratic analysis in liquid chromatography?
A)chromatographic analysis in which the mobile phase composition constantly changes during the chromatographic analysis
B)chromatographic analysis in which the mobile phase composition remains constant during the chromatographic analysis
C)chromatographic analysis in which the temperature of the stationary phase constantly changes during the chromatographic analysis
D)chromatographic analysis in which the temperature of the stationary phase remains constant during the chromatographic analysis
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Which of the following is considered the most powerful analytical tool in the laboratory analysis of hemoglobin variants?
A)electrophoresis
B)high-pressure liquid chromatography
C)radial immunodiffusion
D)densitometry
Q2) Quantification of Hb A2 following separation by cation-exchange HPLC produced a result of 15% in an Hb AA patient.Which of the following describes a concern the technologist should have regarding this result?
A)There may be other hemoglobin variants co-eluting with Hb A2, causing the Hb A2 result to be falsely elevated.
B)The low Hb A2 result may be falsely decreased because of an integration error caused by a rising baseline.
C)Quantification of Hb A2 by HPLC is no longer recognized by CAP because of significant intralaboratory variation in Hb A2 measurements.
D)Glycation of Hb A2 may cause its concentration to vary significantly, based on the extent to which Hb A2 is glycated.
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Chapter 6: Electrophoresis
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Q1) The net charge of a macromolecule is determined by the total number of charged groups within the macromolecule.The charge associated with the zeta potential of a macromolecule in an electrophoretic environment compares in which of the following ways to the net charge on the macromolecule itself?
A)The zeta potential is greater than the net charge.
B)The zeta potential is less than the net charge.
C)The zeta potential is equal to the net charge.
D)The zeta potential has no relationship to the net charge.
Q2) One advantage of capillary electrophoresis over other types of electrophoresis is the potential to separate uncharged analytes.The separation of uncharged analytes is made possible in this technique by:
A)the very short migration distance, which allows diffused uncharged analytes to be isolated along with charged analytes
B)the lack of electro-osmosis, allowing the migration of uncharged analytes
C)the use of micelles
D)the use of more powerful methods of detection
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Chapter 7: Immunological Reactions
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Q1) Considering the noncovalent forces that contribute to antigen and antibody attraction, ________ are the strongest and most important contributors to antigen and antibody attraction, whereas ________ are the weakest contributors to this attraction.
A)electrostatic forces, van der Waals forces
B)hydrogen bonds, electrostatic forces
C)van der Waals forces, hydrogen bonds
D)electrostatic forces, hydrogen bonds
Q2) Which immunoglobulin can cross the placental membrane?
A)IgA
B)IgD
C)IgM
D)IgG
Q3) Considering the precipitation curve shown in Figure 7-5 in your textbook, which phase could result in reporting falsely low results?
A)the antibody excess phase
B)the antigen-antibody equivalence phase
C)the antigen excess phase
D)none of the above; all phases would result in accurate laboratory analysis
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Chapter 8: Immunochemical Techniques
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Q1) Often when performing immunoassays, it is important to know the titer of the antibody.The titer defines:
A)the amount of specific antibody present
B)the affinity of the antibody for the antigen being measured
C)the avidity of the antibody for the antigen being measured
D)the specificity of the antibody for the antigen being measured
Q2) Suppose your laboratory uses a competitive binding assay with a labeled antigen that incorporates spectrophotometry for the measurement of a particular antigen.As the amount of measured antigen ________ in the patient sample, the absorbance of the test solution will ________.
A)increases, increase
B)increases, decrease
C)decreases, decrease
D)both a and c are correct
Q3) Which one of the following sample conditions would be acceptable in complement fixation testing?
A)a hemolyzed sample
B)a lipemic sample
C)plasma collected in EDTA
D)plasma collected in heparin
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) In competitive-binding assays, the relationship between concentration of unlabeled ligand and percent labeled ligand bound can be described in which of the following ways?
A)logarithmic and direct
B)linear and direct
C)logarithmic and inverse
D)linear and inverse
Q2) Which of the following labels is attached to the ligand in the EMIT system?
A)a lanthanide metal such as europium
B)an enzyme
C)the antibody to the ligand
D)a chromophore or fluorophore
Q3) All of the following are important aspects of competitive-binding assays except:
A)There must be non-covalent and reversible binding of the antigen to the antibody.
B)The antigenic determinant of the labeled antigen must not be altered by the addition of the label.
C)There must be a limited number of binding sites on the antibody used in the assay.
D)The antigen being measured must be large enough to provoke an immune response.
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Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Which of the following clinical laboratory techniques is most commonly used to identify HIV and Lyme disease infections?
A)ELISA
B)Western blot
C)hemagglutinin inhibition
D)indirect fluorescent antibody
Q2) Multiplex serological assays are techniques that measure multiple antibody specificities in a single assay.The basic concept for these assays is a ______ assay that is read by ______.
A)inhibition, nephelometry
B)sandwich, nephelometry
C)inhibition, flow cytometry
D)sandwich, flow cytometry
Q3) The standard laboratory screening test for HIV is _____, and the most widely used confirmation test for HIV is the ______.
A)ELISA, Western blot
B)ELISA, dark-field microscopy
C)complement fixation, Western blot
D)complement fixation, dark-field microscopy
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Chapter 11: Measurement of Colligative Properties
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Q1) Suppose a lab measured serum osmolality on the same patient sample by freezing-point and vapor-pressure methods, and the osmolality measurement by the freezing-point method was found to be greater than the osmolality measurement by the vapor-pressure method.Which of the following is the most likely explanation for this discrepancy?
A)The difference in the two methods will always result in significantly different osmolalities.
B)overhydration of the patient
C)technologist error
D)the presence of unexpected volatile solutes in the patient sample
Q2) The major measured contributor to serum osmolality is:
A)sodium
B)glucose
C)BUN
D)protein
Q3) Osmolality measurements depend on:
A)the molecular weight of particles in solution
B)the kind of particles in solution
C)the number of particles in solution
D)all of the above
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Chapter 12: Electrochemistry: Principles and Measurement
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Q1) Sodium measurements made by nondilutional ion-selective electrode methods may yield different results from those obtained by dilutional methods.Results determined by _____ methods are altered by specimens that have high lipid or protein levels.An advantage of the ______ method is that this method brings all samples to a constant ionic strength.Changes in the electrode surface are possible with ______ methods.
A)dilutional, dilutional, nondilutional
B)dilutional, nondilutional, dilutional
C)nondilutional, dilutional, nondilutional
D)nondilutional, nondilutional, dilutional
Q2) The typical pH ion-selective phase utilized in a clinical laboratory is subject to which of the following problems?
A)acid error
B)alkaline error
C)interference from calcium and other divalent ions
D)lack of reproducibility
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14
Chapter 13: Molecular Diagnostics
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Q1) The mutation-detection technique designed to amplify only one of the alleles present at the locus of interest by the use of primers that are substantially mismatched at one allele but have sufficient complementarity to anneal to and amplify the other allele is known as:
A)PCR-mediated site-directed mutagenesis (PSM) technique
B)amplification refractory mutation system (ARMS) technique
C)allele-specific oligonucleotide hybridization (ASO or dot blot) technique
D)reverse dot blot technique
Q2) Select the order of processes in the Southern blot transfer technique.(Steps are listed in order performed, with the first step listed first.)
A)RNA isolation, electrophoresis under denaturing conditions, transfer, hybridization, detection
B)electrophoresis under denaturing conditions, transfer, RNA isolation, hybridization, detection
C)DNA isolation, restriction enzyme digestion, electrophoresis, denaturation, transfer, hybridization, detection
D)electrophoresis, denaturation, transfer, DNA isolation, restriction enzyme digestion, hybridization, detection
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Chapter 14: Therapeutic Drug Monitoring
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Q1) The primary driving force for drugs to move from the point of absorption to the site of action is ______, and the primary driving force for drugs to leave the site of action following a single dose is ______.
A)active transport, active transport
B)active transport, passive transport
C)passive transport, active transport
D)passive transport, passive transport
Q2) In general consideration of drug blood level and the time a drug spends in the body before elimination under normal physiological conditions, which of the statements below is true following a single dose of a drug?
A)The more rapidly the peak concentration is attained, the longer the period of time the drug will spend in the body.
B)The more rapidly the peak concentration is attained, the higher the peak concentration.
C)The more rapidly the peak concentration is attained, the longer the duration at the peak concentration.
D)The longer it takes for the drug to reach its peak concentration, the shorter the period of time the drug will spend in the body.
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Chapter 15: Clinical Enzymology
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Q1) The purpose of an enzyme is to:
A)alter the energy difference between the substrate and product
B)increase the rate of a chemical reaction
C)prevent the reversal of chemical reactions
D)protect the substrate during the addition of heat or energy
Q2) The loss of enzyme activity is known as ______ and is typically a result of changes in the enzyme's _____ structure.
A)inactivation, secondary
B)denaturation, primary
C)inactivation, primary
D)denaturation, tertiary
Q3) Which type of enzyme inhibitor is associated with an increased Km in order to maintain maximal velocity?
A)competitive inhibitor
B)noncompetitive inhibitor
C)uncompetitive inhibitor
D)allosteric inhibitor
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) Posttranslational modification of proteins will have the greatest impact on which method of protein analysis?
A)fluorometric analysis
B)turbidimetric analysis
C)immunoassay
D)spectrophotometric analysis
Q2) All of the following statements are true about the LD isoenzyme except:
A)LD preferably catalyzes the conversion of lactate to pyruvate.
B)LD predominates in tissues that receive a high oxygen supply.
C)LD is found in high concentration in postpubertal testes.
D)LD is found in high concentration in cardiac muscle and erythrocytes.
Q3) The method of isoenzyme analysis where antibody reacts specifically with one subunit to render that isoenzyme catalytically inactive or remove the isoenzyme altogether is known as:
A)immunoassay technique
B)substrate specificity technique
C)catalytic inhibition
D)immunoinhibition
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18
Chapter 17: Interferences in Chemical Analysis
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Q1) The most common source of interference in spectrophotometric analyses results from:
A)the presence of drugs in the patient sample
B)the presence of unexpected increases of compounds associated with disease processes in the patient sample
C)the presence of hemolysis, icteria, or lipemia in the patient sample
D)the anticoagulant used to collect the patient sample
Q2) Which of the following techniques would be useful for the correction of protein buildup on a spectrophotometer flow cell in an automated analyzer?
A)two-point kinetic analysis
B)bichromatic analysis
C)sample dilution
D)both a and b
Q3) The interference in a hemolyzed sample results from the presence of ______, which results in ______ of incident light in colorimetric assays.
A)hemoglobin, absorbance
B)hemoglobin, scatter
C)hemopexin, absorbance
D)hemopexin, scatter
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Page 19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Which of the following is typically used as a measure of the completeness of a 24-hour urine collection?
A)creatinine
B)urea nitrogen
C)calcium
D)protein
Q2) Why is glucose typically not considered to be an analyte suitable for delta-check monitoring?
A)Glucose methodology does not provide sufficiently reproducible results.
B)Glucose tests are ordered too frequently.
C)Glucose shows pronounced intra-individual variation.
D)Glucose levels can be measured in serum, plasma, urine, and spinal fluid.
Q3) Which of the following may result in an elevated serum/plasma potassium level?
A)use of a needle diameter that is too small during specimen collection
B)use of a needle diameter that is too large during specimen collection
C)re-centrifugation of tubes with separator gels
D)both a and b
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Chapter 19: Laboratory Management
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Q1) What is the most important management skill/ability that should be utilized by a laboratory director when planning changes in laboratory services?
A)communication
B)technical knowledge
C)background research
D)financial restraint
Q2) What is the purpose of a pro forma analysis?
A)to evaluate the performance of an employee
B)to justify capital equipment purchases requested for the laboratory
C)to review a laboratory's readiness for an inspection
D)to establish normal reference ranges for a laboratory assay
Q3) CLIA '88 defines a ______ supervisor as the immediate bench supervisor who reviews daily work and quality control and a ______ supervisor as one who acts as the principle laboratory supervisor.______ are required for high-complexity testing.
A)technical, general, general supervisors
B)technical, general, both supervisors
C)general, technical, both supervisors
D)general, technical, technical supervisors
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Chapter 20: Laboratory Automation
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Q1) In most cases, automated incubation is performed under conditions of a specified, constant temperature, which is most frequently achieved by the use of_______________.
A)heating blocks
B)air
C)water baths
D)any of the above
Q2) The laboratory process can be broken down into these components: test ordering, sample acquisition (phlebotomy), ______, front-end sample processing, ______, result acquisition, ______, archiving, and retrieval and disposal of samples.
A)sample transport, sample analysis, result reporting
B)sample analysis, sample transport, result reporting
C)sample transport, result reporting, sample analysis
D)none of the above
Q3) The error rate in clinical laboratories has been estimated to be in what range?
A)10.0% to 32 %
B)1.0% to 2.4 %
C)0.1% to 2.5%
D)2.5% to 10.0 %
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Page 22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Most errors with point-of-care testing occur at which of the following times?
A)before analysis, in the preanalytical phase
B)during analysis
C)at the time of reporting and recording of test results
D)none of the above
Q2) Any analytical system approved by the U.S.Food and Drug Administration to be sold as an over-the-counter test (i.e., in a store or pharmacy, without the need for a prescription) is automatically placed into the ______________ category of POCT testing.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
Q3) _______________ is/are sensitive to device malfunction, reagent storage and stability, and operator technique.
A)quality control
B)quality assurance
C)external controls
D)internal controls
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Chapter 22: Laboratory Information Systems
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Q1) Which of the following situations would be acceptable when considering autoverification?
A)autoverification of a WBC differential if the WBC count is below 1000
B)autoverification of a platelet count of 20,000 on a patient in an oncology clinic
C)autoverification of both creatinine and BUN if the creatinine value is out of range
D)All are acceptable situations for autoverification.
Q2) Interfacing a high-volume automated instrument to an LIS has what effect on productivity and errors?
A)increases productivity and decreases errors
B)decreases productivity and increases errors
C)decreases productivity and decreases errors
D)increases productivity and increases errors
Q3) HIPAA stands for:
A)the Health Insurance Privacy and Accountability Act.
B)the Health Insurance Portability and Accountability Act.
C)the Health Insurance Privacy and Assurance Act.
D)the Health Insurance Portability and Assurance Act.
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Chapter 23: Laboratory Statistics
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Q1) Which of the following measures of central tendency identifies the true central tendency for all types of distributions?
A)mean
B)median
C)mode
D)frequency
Q2) Degrees of freedom may be defined as:
A)the freedom allowed when selecting data from a dataset.
B)the number of independent observations in a dataset.
C)N - 1.
D)all of the above
Q3) The F-test is considered a measure of ______ between two sets of data, and the t-test is considered a measure of ______ between two sets of data.______ is/are considered as a parametric comparison.
A)accuracy, precision, the F-test
B)precision, accuracy, both tests
C)accuracy, precision, both tests
D)precision, accuracy, the t-test
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25
Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Some medical facilities are known for their cerebrovascular centers that provide immediate care for stroke victims.Which of the following attributes is the most desirable for laboratory tests utilized in this environment?
A)laboratory tests with the highest sensitivity
B)laboratory tests with the highest specificity
C)laboratory tests with the highest predictive value for a positive test
D)laboratory tests with the highest efficiency
Q2) CLSI guidelines recommend that the reference interval be estimated by the nonparametric method and that a minimum of _______ reference values be utilized for reference-interval determination.
A)75
B)120
C)200
D)300
Q3) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
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Page 26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) Which of the following mechanisms utilized by clinical laboratories will help detect misidentification of an individual patient specimen?
A)quality-control procedures
B)autoverification
C)comparison with reference intervals
D)delta checks
Q2) The most common graphical plot used as a visual tool for evaluating quality-control data is the:
A)Gaussian distribution
B)Levey-Jennings plot
C)cusum plot
D)Tonks-Youden plot
Q3) An abrupt and sustained change of control values in one direction is known as a ______, and a gradual change of control values in one direction is known as a ______.
A)random error, trend
B)trend, shift
C)shift, trend
D)shift, random error
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Chapter 26: Evaluation of Methods
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Q1) Which of the following factors can contribute to random analytical errors?
A)instability of the instrument
B)variability in handling techniques such as pipetting
C)variations in the reagents and calibrators
D)all of the above
Q2) The within-run component of variation is caused by:
1)sampling and pipetting precision.
2)short-term variations in temperature of the instrument.
3)instability of the calibration curve.
4)short-term variations in the stability of the instrument.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
Q3) It has been proposed that allowable error be either ______ or ______ of the reference range for an analyte, whichever is less.For enzymes, the limit is ______.
A) ¹/ , 10%, 20%
B) ¹/ , 20%, 10%
C) ¹/ , 20%, 10%
D) ¹/ , 10%, 20%
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) Pyranoses are formed from monosaccharides with a/an ______, and furanoses are formed from monosaccharides with a/an ______.
A)aldehyde function at carbon-1, ketone function at carbon-2
B)ketone function at carbon-1, aldehyde function at carbon-2
C)aldehyde function at carbon-2, ketone function at carbon-1
D)ketone function at carbon-2, aldehyde function at carbon-1
Q2) The three-dimensional spatial arrangement of multiple polypeptide chains forming larger, more stable complexes is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q3) Which of the following statements is not true of triglycerides?
A)Triglycerides are esters that are formed during the reaction of an alcohol function and a carboxylic acid function.
B)Triglycerides are easily hydrolyzed into glycerol and free fatty acids.
C)The dietary fats we ingest are mostly triglycerides.
D)The fatty acids that are found in a single triglyceride molecule are always the same.
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Given the following patient results, which statement is true?
Sodium = 136 mEq/L
Potassium = 4.3 mEq/L
Chloride = 99 mEq/L
Bicarbonate = 22 mEq/L
Measured serum osmolality = 283 mOsm/kg
Glucose = 288 mg/dL
BUN = 45 mg/dL
A)The electrolytes are in balance, and the value obtained for osmolality correlates with the other data.
B)The electrolytes are not in balance, but the value obtained for osmolality correlates with the other data.
C)The electrolytes are in balance, but the value obtained for osmolality does not correlate with the other data.
D)The electrolytes are not in balance, and the value obtained for osmolality does not correlate with the other data.
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Sample Questions
Q1) The base excess in a blood sample at a pH of 7.40, a pCO of 40 mm Hg, a hemoglobin of 150 g/L, and a temperature of 37°C is equal to:
A)-2.5 mEq/L
B)0 mEq/L
C)1.2 mEq/L
D)2.5 mEq/L
Q2) Which of the following normal reference intervals is incorrect for an arterial blood sample?
A)pH = 7.35 - 7.45
B)pCO = 24 - 28 mmHg
C)HCO = 22 - 26 mmol/L
D)TCO = 23 - 27 mmol/L
Q3) Calculate the bicarbonate concentration, given the following information. PH = 7.10
PCO = 78 mm Hg
A)19 mmol/L
B)21 mmol/L
C)24 mmol/L
D)26 mmol/L
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Chapter 30: Renal Function
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Q1) Which of the following is an/are important function(s) of the kidney?
A)regulation of acid-base balance
B)hormonal function
C)protein conservation
D)all of the above
Q2) Normal urine output is approximately _____________ per day.
A)500 mL
B)1000 mL
C)1500 mL
D)2500 mL
Q3) In stage 4 of chronic kidney disease, the glomerular filtration rate is:
A)between 15 and 30
B)between 30 and 60
C)between 60 and 90
D)greater than 90
Q4) Body pH is controlled by:
A)acid-base buffers
B)the lungs
C)the kidneys
D)all of the above
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Chapter 31: Liver Function
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Q1) The bile duct carries bile from the ______ to the ______, which when stimulated by cholecystokinin, contracts and releases bile through its duct, termed the ______.This joins the common hepatic duct to form the ______.
A)gall bladder, liver, common bile duct, cystic duct
B)liver, gall bladder, cystic duct, common bile duct
C)gall bladder, liver, cystic duct, common bile duct
D)liver, gall bladder, common bile duct, cystic duct
Q2) Which of the following functions are performed by hepatocytes?
1)metabolism
2)synthesis of critical components
3)formation of bile
4)endocrine functions
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) Which of the following is characteristic of the icteric phase of an acute, symptomatic, viral hepatitis infection?
1)yellowing of the sclera of the eye
2)decreased ability of the injured liver to clear conjugated bilirubin into the bile duct
3)increasing serum levels of conjugated bilirubin
4)dark yellow urine
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
Q2) Typically, serum levels of HBsAg peak around _____ after infection, _____ during the recovery phase, and generally become undetectable within ______ of the onset of acute infection.
A)8 to 12 weeks, decrease, 6 months
B)4 to 6 weeks, increase, 3 months
C)8 to 12 weeks, decrease, 3 months
D)4 to 6 weeks, increase, 6 months
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Chapter 33: Bone Disease
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Sample Questions
Q1) Long bone:
1)are confined to the limbs.
2)consist of a diaphysis, epiphyses, and metaphysis.
3)consist of cortical bone that encloses a layer of trabecular bone.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following diseases and conditions are associated with calcidiol (25-hydroxy-cholecalciferol) excess?
1)vitamin D intoxication
2)nephrotic syndrome
3)excessive sunlight exposure
4)sarcoidosis
A)1, 3, 4
B)1, 3
C)2, 4
D)2, 3, 4
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35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) The pancreas is an elongated, flattened pyramidal organ, located mostly behind the ______; the tail points to the ______, and the head is nestled in the ______.
A)stomach, duodenal loop, spleen
B)stomach, spleen, duodenal loop
C)spleen, stomach, duodenal loop
D)spleen, duodenal loop, stomach
Q2) Complex carbohydrates are digested by which pancreatic product?
A)elastase
B)lipase
C)a-amylase
D)trypsin
Q3) C-reactive protein (CRP) has been used to evaluate prognosis of pancreatitis.CRP levels of ______ at 48 hours after onset of symptoms are associated with a positive predictive value of about ______ for severe disease and a negative predictive value of _____ for severe disease.
A)>100 mg/L, 86%, 67%
B)>100 mg/L, 67%, 86%
C)>150 mg/L, 86%, 67%
D)>150 mg/L, 67%, 86%
Page 36
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Chapter 35: Gastrointestinal Function
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Sample Questions
Q1) The following statements are true of what major intestinal hormone?
1)It has 22 amino acids.
2)It is produced by the upper small intestine.
3)Its stimulating factor is a high-fat meal and duodenal acidification.
4)Its function is to stimulate motility of the small intestine.
A)glucagon
B)motilin
C)gastrin
D)secretin
Q2) The breath test and the CLO test used to determine the presence of Helicobacter pylori are based on H.pylori's production of what substance?
A)excess hydrochloric acid
B)carcinoembryonic antigen (CEA)
C)bombesin
D)urease
Q3) What analyte is measured in a lactose tolerance test?
A)lactose
B)lactase
C)D-xylose
D)glucose
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Chapter 36: Cardiac and Muscle Disease
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Q1) In which of the following situations would cTnI be elevated?
A)acute skeletal muscle injury following marathon racing
B)chronic myopathy of Duchenne muscular dystrophy
C)myocardial infarction
D)all of the above
Q2) An increased level of which of the following analytes serves as laboratory evidence of cardiac ischemia?
A)lactate
B)CK-MB
C)cTnT
D)BNP
Q3) Troponin remains elevated in blood for how long after a myocardial infarction?
A)4 to 10 days
B)4 to 10 hours
C)3 to 7 days
D)3 to 7 hours
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) A patient has a triglyceride level of 234 mg/dL.This would be what when converted to mmol/L?
A)2.64 mmol/L
B)2.70 mmol/L
C)3.40 mmol/L
D)3.50 mmol/L
Q2) During fasting, the blood glucose concentration is expected to ______, insulin concentration is expected to ______, and hepatic VLDL triglyceride synthesis is expected to ______.
A)increase, decrease, decrease
B)decrease, decrease, decrease
C)increase, increase, increase
D)decrease, increase, increase
Q3) Which of the following lipoprotein profiles would be indicative of the laboratory presentation of Tangier disease?
A)increased VLDL, increased LDL, increased HDL
B)absent VLDL, increased LDL, normal HDL
C)normal VLDL, absent LDL, normal HDL
D)normal VLDL, normal LDL, absent HDL
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Page 39
Chapter 38: Diabetes Mellitus
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Q1) In diabetic ketoacidosis, plasma sodium levels are ______, plasma potassium levels are ______, and plasma bicarbonate levels are ______.
A)decreased, decreased, decreased
B)increased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
Q2) Which of the following laboratory results provide provisional laboratory diagnosis of diabetes mellitus?
1)2-hour postprandial glucose = 175 mg/dL
2)fasting plasma glucose = 140 mg/dL
3)casual (random) glucose = 210 mg/dL
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) Which of the following is considered the most appropriate method for quantifying porphyrins in blood or urine?
A)spectrophotometry
B)nephelometry
C)turbidity
D)fluorometry
Q2) Data below provide laboratory evidence of which pathological condition?
Red cell morphology - hypochromia, microcytosis
Serum iron - decreased
TIBC - increased
Percent saturation - decreased
Serum ferritin - decreased
A)iron deficiency anemia
B)thalassemia
C)sideroblastic anemia
D)hemochromatosis
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Chapter 40: Hemoglobin
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Sample Questions
Q1) The reaction of iron in hemoglobin binding to oxygen is known as a/an _________ reaction.
A)oxidation
B)reduction
C)oxygenation
D)complexation
Q2) Which of the following causes hemolysis in association with thalassemia?
A)the free iron available in the red cell due to a deficiency of protoporphyrin
B)the presence of an excess of one globin chain pair
C)the presence of hemichromes
D)the free heme available in the red blood cell due to the presence of variant hemoglobins
Q3) Oxygen binds directly to which component of hemoglobin?
A)the four pyrrole nitrogens in the core of protoporphyrin
B)the ferrous iron in the core of protoporphyrin
C)the ferric iron in the core of protoporphyrin
D)2,3-BPG bound in the central cavity of the hemoglobin tetramer
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Chapter 41: Human Nutrition
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Q1) For infants, essential amino acids should make up ______ of the total amino-acid intake; for children 10 to 12 years of age, it should make up ______; and for adults, essential amino acids should make up ______ of the total amino-acid intake.
A)36%, 43%, 10%
B)43%, 36%, 10%
C)36%, 10%, 43%
D)43%, 10%, 36%
Q2) Which of the following factors is most important to consider when selecting the most useful protein for the laboratory assessment of nutritional supplementation?
A)concentration of the protein
B)size of the protein
C)half-life of the protein
D)degree of protein saturation
Q3) A patient with a body mass index of 27 is said to be ________________.
A)underweight
B)at a healthy weight
C)overweight
D)obese
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Chapter 42: Trace Metals
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Q1) Metallothionein binds copper, zinc and cadmium.Which of the following sequences relates the strength of the interaction between metallothionein and these metals? (answer format: the most firmly bound metal listed first and least firmly bound metal listed last)
A)cadmium, copper, zinc
B)zinc, cadmium, copper
C)copper, zinc, cadmium
D)None of the above; all metals bind equally.
Q2) What is the laboratory method of choice in the analysis of essential trace metals?
A)spectrophotometry
B)fluorometry
C)atomic absorption spectrophotometry
D)nephelometry
Q3) Which of the following correctly compares the relative toxicity of the various forms of mercury (most toxic first and least toxic last)?
A)elemental mercury, inorganic mercury, organic mercury
B)organic mercury, inorganic mercury, elemental mercury
C)inorganic mercury, organic mercury, elemental mercury
D)inorganic mercury, elemental mercury, organic mercury
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Page 44
Chapter 43: Vitamins
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Q1) The in-vivo synthesis of the active form of vitamin D begins with 7-dehydrocholesterol being converted to cholecalciferol in the ______.Cholecalciferol is next hydroxylated in the ______, followed by a second hydroxylation in the ______ to form 1,25-dihydroxycholecalciferol.
A)liver, kidney, skin
B)skin, liver, kidney
C)kidney, liver, skin
D)skin, kidney, liver
Q2) The major function(s) of water-soluble vitamins in the body is/are:
A)as sources of energy
B)as coenzymes
C)as acute-phase reactants
D)all of the above
Q3) Wernicke-Korsakoff syndrome is commonly seen in ______ and is associated with a ______ deficiency.
A)pellagra, niacin
B)alcoholism, thiamine
C)wet beriberi, carnitine
D)rickets, vitamin D
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Page 45
Chapter 44: Pregnancy and Fetal Development
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Sample Questions
Q1) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
Q2) Which of the following clotting factors are increased during pregnancy?
1)VII
2)VIII
3)IX
4)XII
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q3) The fluorescent polarization method for assessing fetal lung maturity measures which of the following ratios?
A)lecithin to sphingomyelin ratio
B)lecithin to phosphatidylglycerol ratio
C)phosphatidylglycerol to lecithin ratio
D)lung surfactant to albumin ratio
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Chapter 45: The Newborn
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Q1) Late (>72 hours) neonatal hypocalcemia arises from which of the following?
1)neonatal hypoparathyroidism
2)high phosphate intake
3)phototherapy
4)hypoalbuminemia
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) A postnatal rise in TRH induces a(n) ______ in blood TSH levels and a(n) ______ in blood T levels as the fetus transitions from the in-utero environment to the postnatal delivery-room environment.
A)increase, decrease
B)increase, increase
C)decrease, increase
D)decrease, decrease
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Chapter 46: Extravascular Biological Fluids
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Q1) Which of the following statements are true of normal synovial fluid?
1)It acts as a lubricant to minimize the friction between bones during movement or weight bearing.
2)It provides the sole nutrition for cartilage.
3)It is a dialysate of plasma mixed with hyaluronic acid.
4)It contains fibrinogen, and spontaneous clotting can occur.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Why is the measurement of uric acid in synovial fluid considered to be of no diagnostic value in gout?
A)Uric acid is not found in synovial fluid.
B)Uric acid exists as crystals in synovial fluid and cannot be quantified.
C)Uric acid in synovial fluid is approximately the same as in serum.
D)Uric acid is not important in the diagnosis of gout.
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Chapter 47: Nervous System
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Q1) Which of the following are characteristics of a normal spinal fluid?
1)specific gravity of 1.007
2)glucose of 50 mg/dL
3)protein of 7.0 g/dL
4)sodium of 140 mmol/L
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Based on electrophoretic results, prealbumin makes up what percentage of spinal fluid proteins?
A)2% to 7%
B)56% to 76%
C)3.5% to 12%
D)8% to 18%
Q3) Which of the following compounds most readily enters the central nervous system?
A)albumin
B)calcium
C)alcohol
D)aspartic acid
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Chapter 48: General Endocrinology
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Q1) Which of the following laboratory tests is most useful in distinguishing between hypothalamic and pituitary causes of thyroid dysfunction?
A)TRH stimulation test
B)TSH
C)T
D)T
Q2) Which of the following statements are true of steroid hormones?
1)They interact with their target cells by binding to specific receptors located in both the intracellular cytoplasmic and nuclear fractions of the cells.
2)They enter the cell primarily through diffusion.
3)Transport proteins are necessary to carry steroids from the organ of synthesis, through the blood stream, to their site of action.
4)They utilize the second messenger signaling system.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 49: Thyroid
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Q1) Given the following characteristics, which disease state is most likely?
TSH - decreased
FT - increased
FT - increased
T RU - increased
TSI - positive
TPO-ab - may be positive
Thyroid scan uptake - uniformly increased
A)Graves' disease
B)autoimmune thyroiditis
C)secondary hyperthyroidism
D)primary hypothyroidism
Q2) Which of the following thyroid hormones is considered to be the most active physiologically?
A)MIT
B)DIT
C)T
D)T
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Chapter 50: The Gonads
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Q1) Which of the following laboratory test results of a semen analysis is associated with impaired fertility?
A)25 million/mL total sperm count
B)sperm motility of 45%
C)oval morphology of 55%
D)semen volume 0.7 mL
Q2) Which androgens are capable of interacting with the androgen receptor?
1)testosterone
2)dihydrotestosterone
3)dehydroepiandrosterone
4)androstenedione
A)1, 2
B)2, 3
C)3, 4
D)1, 4
Q3) Which laboratory test is commonly used to assess luteal function?
A)LH
B)FSH
C)progesterone
D)estradiol
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) In patients with suspected primary aldosteronism, screening can be accomplished by measuring a morning ambulatory paired random aldosterone and renin activity.A positive test result is defined as the combination of ______ aldosterone-to-plasma renin activity ratio and ______ aldosterone.
A)increased, increased
B)increased, decreased
C)decreased, increased
D)decreased, decreased
Q2) The predominant androgens secreted by the adrenal cortex are:
1)dehydroepiandrosterone sulfate (DHEA-S)
2)dehydroepiandrosterone (DHEA)
3)androstenedione
4)dihydrotestosterone (DHT)
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 52: Diseases of Genetic Origin
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Q1) Sickle cell disease is the prototypical ______ single gene disorder.It occurs with an incidence of approximately 1 in 600 ______.
A)autosomal recessive, African Americans
B)autosomal recessive, Caucasian Americans
C)autosomal dominant, African Americans
D)autosomal dominant, Caucasian Americans
Q2) Which of the following statements is true of Klinefelter syndrome?
1)Its chromosome abnormality is 45,X.
2)It has an incidence of 1 in 500 males.
3)It has an incidence of 1 in 500 females.
4)It has clinical features that involve learning difficulties and tall stature.
A)1, 3, 4
B)2, 4
C)1, 3
D)1, 2, 4
Q3) What chromosome abnormality occurs in Turner Syndrome?
A)Trisomy 18
B)Trisomy 21
C)45,X
D)47,XXY
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Chapter 53: Neoplasia
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Q1) Which class of tumors is the most aggressive and has the worst prognosis?
A)well differentiated
B)moderately well differentiated
C)moderately differentiated
D)poorly differentiated
Q2) Apoptosis:
1)serves two functions in the body, cell termination and homeostasis
2)can occur when a cell is damaged beyond repair
3)can occur when a cell undergoes stress conditions such as starvation
4)the signal for apoptosis can only come from within the cell
A)1, 2, 3, 4
B)1, 3, 4
C)1, 2, 3
D)2, 3, 4
Q3) Protein electrophoresis is helpful when what disease state is suspected?
A)multiple myeloma
B)Waldenstrom's macroglobulinemia
C)MGUS
D)all of the above
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Page 55
Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) When is the risk of allograft rejection and infection the most intense?
A)7-14 days
B)1-3 months
C)3-6 months
D)6-12 months
Q2) What test ensures that a potential transplant recipient has no preformed antibodies against a donor's proteins?
A)ABO blood type
B)cytotoxic T-cell crossmatch
C)protein electrophoresis
D)immunofixation electrophoresis
Q3) Once a patient progresses to brain death, frequent monitoring of which of the following is/are essential for the successful maintenance of healthy organs?
A)serum electrolytes
B)blood gas
C)blood pH
D)all of the above
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Chapter 55: Toxicology
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Q1) Cocaine has what window of detection?
A)1 to 6 hours
B)<72 hours
C)<12 to 24 hours
D)2 to 5 days
Q2) Which type of toxin induces genetic changes that become inheritable?
A)mutagens
B)teratogens
C)carcinogens
D)both a and b
Q3) Most toxins enter the body through what route?
A)skin
B)lungs
C)gastrointestinal tract
D)all of the above
Q4) Ginseng can cause toxicity in which of the following sites?
A)heart
B)liver
C)kidney
D)gastrointestinal tract
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Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following tests has recently emerged as a new biochemical marker to measure excessive alcohol consumption?
A)gammaglutamyltransferase
B)carbohydrate-deficient transferrin
C)mean corpuscular volume
D)aspartate aminotransferase
Q2) Which of the following would best help a physician determine that a patient is escalating a dose of prescribed medication?
A)a single qualitative drug screen
B)a single quantitative drug screen
C)quantitative drug screens over a period of time
D)none of the above
Q3) _____________ is defined as the central nervous system adjustment to the relatively sudden cessation of regular psychoactive substance use.
A)Withdrawal
B)Craving
C)Recovery
D)Rehabilitation
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