Chemical Pathology Exam Review
Course Introduction
Chemical Pathology explores the biochemical basis of disease by examining the alterations in body chemistry associated with various medical conditions. The course covers fundamental concepts such as metabolism, enzyme function, and the biochemical mechanisms underlying organ dysfunction and disease states. Students will learn to analyze laboratory results, interpret biochemical tests, and understand the clinical significance of abnormalities in fluids such as blood and urine. Emphasis is placed on the integration of laboratory data with pathophysiological processes to support clinical diagnosis, management, and monitoring of diseases, including diabetes, renal disorders, and electrolyte imbalances.
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) The force produced by centrifugation is relative centrifugal force (RCF).The units for RCF are expressed as:
A)rpm
B)radius
C)number of times greater than gravity
D)there are no units for RCF
Answer: C
Q2) Which of the following water purification techniques is most effective in removing dissolved ionized gases?
A)distillation
B)deionization
C)reverse osmosis
D)ultrafiltration
Answer: B
Q3) How would you prepare 400 mL of 0.85% NaCl?
A)place 0.85 g of NaCl in a flask and dilute to 400 mL
B)place 3.4 g of NaCl in a flask and dilute to 400 mL
C)place 8.5 g of NaCl in a flask and dilute to 400 mL
D)place 34 g of NaCl in a flask and dilute to 400 mL
Answer: B
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Chapter 2: Spectral Techniques
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Q1) What are the units for a (absorptivity) in Beer's law when c (concentration) is expressed in g/dL, and b (path length) is expressed in cm?
A)cm/g dL
B)g/dL cm
C)dL/g cm
D)absorptivity is a unitless term
Answer: C
Q2) In comparing nephelometry and turbidity, nephelometric measurements should demonstrate ______ sensitivity, and turbidimetric measurements should demonstrate ______ sensitivity.In practice, turbidimetric measurements have been found to demonstrate ______ sensitivity.
A)high, limited, high
B)high, limited, limited
C)limited, high, high
D)limited, high, limited
Answer: A
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Chromatographic attractive forces involving molecules that have a permanent dipole are known as:
A)dispersive (van der Waals) forces
B)dipolar forces
C)hydrogen bonding forces
D)dielectric forces
Answer: B
Q2) In reversed-phase chromatography, the mobile phase is relatively ______, and the stationary phase is relatively ______.______ solute molecules are least retained in this type of chromatography.
A)polar, nonpolar, polar
B)polar, nonpolar, nonpolar
C)nonpolar, polar, polar
D)nonpolar, polar, nonpolar
Answer: A
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Chapter 4: Chromatographic Techniques
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Q1) Suppose there is a desire to analyze a series of compounds by gas chromatography because of their similarity in polarity and lack of hydrogen-bonding potential.The compounds of interest are known to have low volatility.How should the technologist proceed?
A)Consider analysis of these compounds by liquid chromatography.
B)Consider analysis of these compounds by gas chromatography at significantly elevated temperatures.
C)Consider chemical derivatization of these compounds prior to gas chromatography.
D)Report that these compounds cannot be analyzed by gas chromatography because of the lack of volatility.
Q2) The chromatographic method based on biologically related interactions by immobilizing one of a pair of interacting biomolecules onto a solid support and placing it in a column is known as:
A)affinity chromatography
B)ion-suppression chromatography
C)ion-pair chromatography
D)gel-permeation chromatography
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Isoelectric focusing (IEF) may be utilized to investigate unresolved HPLC hemoglobin results.What advantage of this technique makes it useful in this situation?
A)IEF is a technique that is readily adaptable to automation, resulting in a quick and simple method to resolve questionable HPLC hemoglobin results.
B)IEF is a technique that does not depend on the charge of the hemoglobin fractions, providing a method that complements HPLC analysis of hemoglobin fractions.
C)IEF results in the formation of discrete sharp bands, allowing clear separation of the various hemoglobins present in the patient sample.
D)IEF provides an enhanced method of detection that may allow the technologist to see fractions not detected by HPLC.
Q2) Normal hemoglobin fractions seen in HPLC include all but which of the following?
A)Hb A
B)Hb A2
C)Hb C
D)Hb F
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Chapter 6: Electrophoresis
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Q1) The discontinuous solvent system used to enhance electrophoretic resolution in which movement comes to a stop because of a lack of net charge is:
A)isotachophoresis
B)disk electrophoresis
C)isoelectric focusing
D)gel electrophoresis
Q2) It is known that pH influences the charge of an analyte and, if set appropriately, can enhance electrophoretic mobility.In an attempt to improve separation of serum proteins, the analyst set the pH of the buffer at an extremely basic level.Following electrophoresis, it was determined that the desired results were not achieved.Which of the following explains why the modification was not successful?
A)At the very basic pH, the proteins may have been denatured.
B)At the very basic pH, the proteins may have been dissociated.
C)At the very basic pH, the fraction of current carried by buffer hydroxyl ions resulted in poorer separation.
D)All of the above are possible explanations.
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Chapter 7: Immunological Reactions
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Q1) In radial immunodiffusion, calibrators of known concentration are analyzed along with the patient sample to allow for the quantification of antigens as illustrated in Figure 7-9 in your text book.Suppose the diameter of the precipitation ring for the highest calibrator was less than the diameter for the next highest calibrator.Which of the following statements describes the likely cause for this problem?
A)The incubation temperature was not kept constant.
B)The concentration of the antibody in the gel was too high for the concentration of the highest calibrator.
C)Because the concentration of the highest calibrator is so high, diffusion through the pores of the gel was restricted.
D)The concentration of the highest calibrator was greater than the concentration of the antibody in the gel.
Q2) Antibodies are ______ that are produced by the _______.
A)lipids, adipose cells
B)carbohydrates, bone marrow cells
C)nucleic acids, hepatocytes
D)proteins, B lymphocytes
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Page 9
Chapter 8: Immunochemical Techniques
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Q1) Which of the following provides the correct explanation for a decrease in light scatter as concentration of hapten (such as a drug) increases in nephelometric inhibition immunoassay (NINIA)?
A)As the concentration of hapten (drug) increases, the excess of antibody decreases, resulting in less light scatter.
B)As the concentration of hapten (drug) increases, more soluble hapten (drug)-antibody complexes form, reducing the amount of light scatter.
C)As the concentration of hapten (drug) increases, more hapten (drug)-antibody complexes form, which fix complement and destroy the complex, reducing the amount of light scatter.
D)As the concentration of hapten (drug) increases, more insoluble hapten (drug)-antibody complexes form, resulting in less light scatter.
Q2) Which of the following best describes the visualization step in the Western blot technique?
A)use of a stain specific for the antigen separated
B)reaction with a labeled antihuman immunoglobulin antibody
C)the presence of a fluorescent pigment in the transfer medium
D)the UV/Vis light-absorption properties of the separated antigen
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) ELISA is considered a ______ assay, and EMIT is considered a ______ assay.______ assay would be considered more suitable for automated chemistry analyzers.
A)homogeneous, heterogeneous, homogeneous
B)homogeneous, heterogeneous, heterogeneous
C)heterogeneous, homogeneous, heterogeneous
D)heterogeneous, homogeneous, homogeneous
Q2) What is the purpose of the "label" used in competitive-binding assays?
A)to aid the technologist in knowing which reagents have been added to the assay
B)to aid the technologist in knowing which patient samples have been added to the assay
C)to aid in assay detection and quantification
D)to aid in the identification of free ligand and ligand bound to endogenous protein
Q3) In a competitive-binding heterogeneous assay, the captive phase involves:
A)the removal of endogenous binding proteins that interfere with the immunoassay
B)the binding of the labeled reactant in the assay
C)the capture of free, unlabeled ligands from the patient sample for use in the assay of free ligand alone
D)the initial step in the assay where the antibody binds with the ligand
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Chapter 10: Laboratory Approaches to Serology Testing
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Q1) 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
Q2) 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
Q3) Which of the following assays would be useful in distinguishing between recent primary infection and later secondary immune response?
A)ELISA
B)Western blot
C)hemagglutinin inhibition
D)indirect fluorescent antibody
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Chapter 11: Measurement of Colligative Properties
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Q1) The major clinical use for measuring urine osmolality is to evaluate ______, and the major clinical use for measuring colloid osmotic pressure is to detect conditions leading to ______.
A)the kidney's ability to dilute the urine, the kidney's ability to concentrate the urine
B)the kidney's ability to dilute the urine, pulmonary edema
C)the kidney's ability to concentrate the urine, the kidney's ability to dilute the urine
D)the kidney's ability to concentrate the urine, pulmonary edema
Q2) Calculate the osmolal gap, given the following data: measured osmolality = 366 mOsm/kg; sodium = 144 mEq/L; glucose = 5.0 mmol/L; BUN = 9.0 mg/dL.
A)64 mOsm/kg
B)70 mOsm/kg
C)74 mOsm/kg
D)208 mOsm/kg
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13
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) In the coulometric titration of chloride, the titration end-point is measured in terms of the:
A)time required to complete the titration
B)amount of product (silver chloride) formed
C)amount of silver ion produced at the anode
D)number of electrons detected at the cathode
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14
Chapter 13: Molecular Diagnostics
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Q1) Which of the following statements are correct regarding mutations?
1)Mutations are changes in the base sequence in DNA and may include insertion, deletion, or replacement.
2)Mutations may result in no effect on protein expression or functional activity.
3)Mutations may result in partial or total loss of protein function.
4)Mutations always result in disease.
A)1, 2, 3
B)1, 3, 4
C)1, 2
D)3, 4
Q2) The mutation-detection technique that incorporates a set of immobilized DNA probes for different sequence variants to which PCR amplified DNA is added 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
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Chapter 14: Therapeutic Drug Monitoring
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Q1) Kinetic processes related to the fate of a drug in the body, where the drug concentration exceeds the capacity of the system, is known as:
A)zero-order kinetics
B)first-order kinetics
C)Michaelis-Menten kinetics
D)compartmental kinetics
Q2) Which of the following statements are true regarding drug half-life?
A)Doubling the dose of a drug will reduce the half-life by one half.
B)Half-life is equal to the time required to change the drug blood level by 50%.
C)Doubling the dose of a drug will double the half-life.
D)both b and c
Q3) Considering the administration of a single dose of a hypothetical drug by different routes, which of the following gives the correct order of attaining peak concentration of the drug in the blood stream?
A)intramuscular, oral, intravenous
B)oral, intravenous, intramuscular
C)intravenous, intramuscular, oral
D)intramuscular, intravenous, oral
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Chapter 15: Clinical Enzymology
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Q1) An enzyme activity of 50 IU/L is equal to _____ nK/L.
A)3.0
B)16.7
C)416
D)835
Q2) Which of the following factors that influence enzymatic activity demonstrate a bell-shaped curve when relating the factor to enzyme activity?
A)pH
B)temperature
C)noncompetitive inhibitors
D)both a and b
Q3) A/An ______ is a non-protein organic material that is one type of cofactor that may be needed for the ______form of the enzyme being measured.
A)activator, apoenzyme
B)coenzyme, holoenzyme
C)activator, holoenzyme
D)coenzyme, apoenzyme
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) 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
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) CK-MM isoforms result from the action of ______ cleaving terminal ______ amino acid residues.
A)aminopeptidase, histidine
B)aminopeptidase, lysine
C)carboxypeptidase, histidine
D)carboxypeptidase, lysine
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18
Chapter 17: Interferences in Chemical Analysis
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Q1) Suppose the result for a particular analyte by HPLC was much higher than anticipated, and the patient's physician questioned the result.Which of the following analytical modifications would be most useful in investigating the reason for the unexpectedly high patient result?
A)Reanalyze the patient sample with the use of a refractive index detector.
B)Reanalyze the patient sample with the use of a photo diode array (PDA) detector.
C)Dilute the patient sample and reanalyze with the current HPLC system.
D)Verify linearity and reanalyze the patient sample.
Q2) The interference in a lipemic sample results from the presence of excessive ______, which results in ______ of incident light in colorimetric assays.
A)carbohydrates, absorbance
B)carbohydrates, scatter
C)lipoproteins, absorbance
D)lipoproteins, scatter
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Chapter 18: Sources and Control of Preanalytical Variation
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Q1) An important preanalytical variable is associated with the use or non-use of anticoagulants.Which of the following statements related to use or non-use of anticoagulants are correct?
1)The measured total protein level is the same in serum and heparinized plasma.
2)Platelets release potassium during clotting.
3)The use of EDTA plasma will falsely decrease plasma calcium.
4)Heparinized plasma is preferred over serum for cardiac marker evaluation.
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
Q2) Cyclic variations refer to changes in concentration of analytes that occur in a predictable manner.______ variation is a phrase used to describe reproducible variation that occurs during the course of a single day, and ______ variation is a phrase used to describe reproducible variation that occurs over a period of greater than one day.
A)circannual, circadian
B)circadian, infradian
C)infradian, circannual
D)circadian, circannual
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Chapter 19: Laboratory Management
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Q1) ________ regulations serve to ensure the operation of a safe laboratory.
A)CLIA '88
B)OSHA
C)HIPAA
D)LRN
Q2) A Laboratory Response Network is:
A)a network of safety professionals that will respond to a chemical or biological incident in a clinical laboratory
B)a network of laboratory directors and managers that will respond to regulatory compliance concerns in clinical laboratories
C)a network of public health, local, state, and federal laboratories that will ensure an effective laboratory response to bioterrorism or public health outbreaks
D)a network of laboratory personnel within a given laboratory that will be available to respond to an emergency
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Chapter 20: Laboratory Automation
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Q1) Commonly the following steps are performed during the course of chemical analysis: mix an aliquot of sample with reagents, ______, ______, ______, and provide an appropriate readout for the permanent record.
A)monitor the result of the reaction, incubate the reaction mixture, quantify the extent of the reaction
B)quantify the extent of the reaction, incubate the reaction mixture, monitor the result of the reaction
C)monitor the result of the reaction, quantify the extent of the reaction, incubate the reaction mixture
D)incubate the reaction mixture, monitor the result of the reaction, quantify the extent of the reaction
Q2) Studies have shown that automating front-end specimen processing has ______ sample processing time, ______ labor cost, and ___ __ specimen pour-off, labeling, and sorting errors.
A)decreased, decreased, decreased
B)decreased, increased, decreased
C)increased, decreased, increased
D)increased, increased, increased
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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Which of the following is not considered an analytical interference?
A)lipemia
B)drugs
C)interstitial fluid contamination
D)icterus
Q2) Gram stains are sometimes performed as POCT and are classified as _____________.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
Q3) Given that hemoglobin A1c levels are consistent for approximately 3 months, performance of POCT in the physician's office has been demonstrated to ______patient counseling and ______ hemoglobin A1c levels, improving both patient and physician satisfaction.
A)misdirect, decrease
B)enhance, increase
C)misdirect, increase
D)enhance, decrease
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Page 23
Chapter 22: Laboratory Information Systems
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Q1) Which of the following statements are true of an LIS?
1)The LIS structures tasks and assists in the management of data produced by the lab.
2)The LIS requires reconfiguration as instrumentation and testing changes.
3)The LIS is the same throughout every laboratory.
4)The LIS affects the preanalytical and postanalytical parts of the laboratory.
A)1, 2, 3, 4
B)1, 2, 4
C)2, 3, 4
D)1, 3, 4
Q2) Which of the following would be considered allowable in an LIS order entry and not be alerted as a probable duplicate test?
A)two glucose orders on a patient in the intensive care unit within an hour interval
B)two electrolyte panel orders from an outpatient clinic an hour apart
C)a daily testosterone level on an outpatient
D)All of the above requests are acceptable.
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Chapter 23: Laboratory Statistics
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Q1) Suppose a large laboratory is interested in a comparison of the means for glucose run on two different analyzers in the laboratory.To conduct this comparison, the same specimen is analyzed on each analyzer, and data are collected.Which statistical method should be selected to perform this comparison?
A)t-test
B)unpaired t-test
C)paired t-test
D)F-test
Q2) In the evaluation of how well data fit a normal distribution, ______ serves as a measure of how steep or flat the distribution is when compared to a true normal distribution.______ serves as a measure of the asymmetry of the data distribution.For data that reasonably follow a Gaussian distribution, skewness and kurtosis coefficients should be between ___ ___.
A)skewness, kurtosis, 0 and 1
B)skewness, kurtosis, -1 and 1
C)kurtosis, skewness, 0 and 1
D)kurtosis, skewness, -1 and 1
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) 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
Q2) Which of the following statements correctly compares and contrasts a-priori and a-posteriori methods of reference individual selection?
1)In both methods, exclusion and partitioning take place after sampling and analyte testing.
2)A-priori methods require fewer reference individuals to be studied than a-posteriori methods.
3)Questionnaires for potential reference individuals must be more detailed for a-posteriori methods than for a-priori methods.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) Westgard control rules utilize a shorthand system in which the first designation indicates _____, and the second designation, usually subscripted, indicates ______.
A)the number of observations to be considered, the acceptable limits
B)the number of observations to be considered, the probability of false rejection at that number of observations
C)the allowable error before the run is rejected, the acceptable limits
D)the allowable error before the run is rejected, the probability of false rejection at that level of error
Q2) Violation of which of the following Westgard control rules would be associated with the greatest degree of imprecision?
A)12
B)22
C)R4
D)1
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Chapter 26: Evaluation of Methods
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Q1) Calculate the percentage recovery given the following information:
Baseline sample preparation: 1.5 mL serum + 0.25 mL water
Spike sample preparation: 1.5 mL serum + 0.25 mL 5000 mg/L standard
Baseline sample measured concentration: 950 mg/L
Spiked sample measured concentration: 1621 mg/L
A)89%
B)94%
C)98%
D)106%
Q2) Even when a method's performance is well documented by published evaluation studies, the new laboratory considering use of the method should evaluate ______ and perform ______ to verify acceptable performance in that laboratory.
A)random analytical error, the comparison-of-methods experiment
B)random analytical error, the recovery experiment
C)constant systematic error, the comparison-of-methods experiment
D)constant systematic error, the recovery experiment
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) 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.
Q2) The lipid that serves as the precursor of many hormones such as androgens, estrogens, and progesterones is:
A)triglycerides
B)cholesterol
C)gangliosides
D)cephalins
Q3) Which of the following lipids plays an important role in the esterification of free cholesterol and serves as an important constituent of functional lung surfactant?
A)cerebrosides
B)lecithins
C)sphingomyelins
D)plasmalogens
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Which of the following changes will be seen in dehydration?
1)increase in aldosterone
2)increase in antidiuretic hormone
3)increase in atrial natriuretic peptide
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following describes the correct meaning of anion gap = 15 mEq/L?
A)There is a 15 mEq/L gap between the major measured cations and major measured anions.
B)There is a 15 mEq/L gap between the physiologically active cations in the body and the physiologically active anions in the body.
C)There are 15 mEq/L more cations than anions in the plasma sample tested.
D)There are 15 mEq/L more anions than cations in the plasma sample tested.
Q3) A sweat chloride of 70 mEq/L is indicative of which of the following diseases?
A)cystic fibrosis
B)myasthenia gravis
C)Cushing's syndrome
D)syndrome of inappropriate ADH secretion
Page 30
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) Why is the bicarbonate buffer system chosen for the laboratory monitoring of physiological pH?
A)The bicarbonate buffering system has an immediate buffer response.
B)The bicarbonate buffering system has the greatest buffering capacity in the body.
C)The bicarbonate buffering system is the only buffer system located outside of cells.
D)The components of the bicarbonate buffer system are the easiest to measure.
Q2) A normal total CO , increased pCO , and decreased pH is most correctly classified as:
A)uncompensated metabolic acidosis
B)compensated metabolic acidosis
C)uncompensated respiratory acidosis
D)compensated respiratory acidosis
Q3) Calculate the pH of a blood sample, given a pK = 6.1 and a bicarbonate-to-dissolved-carbon-dioxide ratio of 18:1.
A)6.10
B)7.36
C)7.47
D)Cannot be determined from the information provided
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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) Each kidney is made up of approximately 1 million nephrons.The nephron begins with the ______.This is surrounded by ______, which is formed by the blind, dilated end of the ______.
A)Bowman's capsule, glomerulus, renal tubule
B)renal tubule, Bowman's capsule, glomerulus
C)renal tubule, glomerulus, Bowman's capsule
D)glomerulus, Bowman's capsule, renal tubule
Q3) 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) 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
Q2) All of the following are common causes of acute hepatitis except:
A)non-alcoholic fatty liver disease (NAFLD)
B)hepatitis A virus (HAV)
C)hepatitis B virus (HBC)
D)hepatitis C virus (HCV)
Q3) The liver is supplied by what major source(s) of oxygen-containing blood?
A)the hepatic artery
B)the portal vein
C)the hepatic vein
D)both a and b
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Page 33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) What is the correct order for the four phases of an acute, symptomatic, viral hepatitis infection?
A)convalescence, pre-icteric, icteric, incubation
B)incubation, pre-icteric, convalescence, icteric
C)convalescence, incubation pre-icteric, icteric
D)incubation, pre-icteric, icteric, convalescence
Q2) Which of the following is true of hepatitis E virus (HEV)?
A)Five major genotypes have been identified.
B)The prevalence of HEV infection is highest in young adult males.
C)HEV causes mild hepatitis.
D)All of the above are true.
Q3) Laboratory indicators of acute liver disease are serum bilirubin levels that are ______, serum AST that is ______, and serum ALT that is ______.
A)decreased, increased, increased
B)decreased, increased, decreased
C)increased, increased, increased
D)increased, increased, decreased
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Chapter 33: Bone Disease
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Q1) Parathyroid hormone (PTH) acts on the bone and kidney to produce three major effects: ______ in serum calcium concentrations, ______ in serum phosphorus concentrations, and ______ in the active hormonal form of vitamin D (calcitriol).
A)increase, decrease, increase
B)increase, increase, decrease
C)decrease, increase, decrease
D)decrease, decrease, increase
Q2) Which of the following is not a biochemical marker of bone formation?
A)serum osteocalcin
B)serum alkaline phosphatase (ALP)
C)serum tartrate-resistant acid phosphatase
D)serum procollagen I extension peptides
Q3) In the blood stream, calcium exists in three forms: ______ of total serum calcium is the biologically active ionized calcium, ______ is protein bound, mainly to albumin, and ______ is complexed to anions.
A)10%, 45%, 45%
B)45%, 45%, 10%
C)35%, 10%, 55%
D)10%, 55%, 35%
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Page 35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Complex carbohydrates are digested by which pancreatic product?
A)elastase
B)lipase
C)a-amylase
D)trypsin
Q2) The principal cations in pancreatic fluid are:
1)sodium
2)potassium
3)calcium
4)magnesium
5)chloride
A)1, 2, 3, 4
B)1, 2, 3, 5
C)2, 3, 4, 5
D)1, 3, 4, 5
Q3) Which of the following can cause acute pancreatitis?
A)cystic fibrosis
B)alcohol abuse
C)biliary tract obstruction by gallstones
D)both b and c
Page 36
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Chapter 35: Gastrointestinal Function
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Q1) Which of the following is a function of chief cells?
A)to produce hydrochloric acid and intrinsic factor
B)to produce the proenzyme pepsinogen
C)to secrete a protective layer of mucus to protect stomach mucosa from attack by acid and enzymes
D)to produce the hormone gastrin
Q2) Which of the following statements are true of the D-xylose absorption test?
1)The amount of D-xylose excreted over a 5-hour period is closely correlated with the amount absorbed in the GI tract.
2)Most persons demonstrate plasma levels greater than 300 mg/L in one of the samples collected.
3)Low levels of urine or plasma D-xylose are suggestive of an absorptive defect in the jejunum.
4)High levels of D-xylose are seen in ascites, vomiting, delayed gastric emptying, improper urine collection, and high-dose aspirin therapy.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
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Page 37
Chapter 36: Cardiac and Muscle Disease
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Q1) Troponin ______ is found in cardiac and skeletal muscles and is not utilized in laboratory testing for evidence of a myocardial infarction.Although there are skeletal muscle forms of troponin ______, cardiac-specific isoforms have been identified and are the focus of laboratory testing.Only one form of troponin ______ has been identified, and it has never been found in skeletal muscle.
A)C, I, T
B)I, T, C
C)C, T, I
D)T, I, C
Q2) The resting heart's fuel of choice is ______, but upon the imposition of a heavy workload, the heart will greatly increase its rate of ______ consumption.
A)free fatty acids, glucose
B)glucose, lactate
C)lactate, free fatty acids
D)glucose, free fatty acids
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Which of the following statements is incorrect regarding apoproteins?
A)Apoprotein A-1 is essential for the formation and secretion of chylomicrons.
B)Apoprotein B-100 serves as a ligand for LDL binding to receptors.
C)Apoprotein C-II serves as an activator of LPL activity.
D)Apoprotein E serves as a ligand for chylomicron and VLDL remnant binding to receptors.
Q2) The following data provide laboratory evidence of which lipoprotein abnormality?
Total cholesterol - decreased, triglycerides - decreased
Apoprotein B - decreased
Vitamin E - decreased
Red blood cell morphology - acanthocytosis
A)Tangier disease
B)Familial lipoprotein lipase deficiency
C)Familial dysbetalipoproteinemia
D)Abetalipoproteinemia
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Chapter 38: Diabetes Mellitus
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Q1) A person who has a 2-hour oral glucose tolerance test result between 140 mg/dL and 200 mg/dL would be classified in which of the following categories?
A)impaired fasting glucose
B)impaired glucose tolerance
C)potential abnormality of glucose tolerance
D)secondary diabetes mellitus
Q2) Insulin ______ proteolysis, biolysis, gluconeogenesis, and glycogenolysis and ______ lipid synthesis and glycogenesis in the liver; ______ protein synthesis in muscle; and ______ triglyceride synthesis in fat cells.
A)inhibits, stimulates, increases, accelerates
B)stimulates, inhibits, decreases, decelerates
C)inhibits, inhibits, increases, decelerates
D)stimulates, stimulates, decreases, accelerates
Q3) Which of the following metabolic pathways provides the greatest amount of ATP per mole of glucose?
A)anaerobic glycolysis
B)aerobic glycolysis
C)tricarboxylic acid cycle and linked oxidative phosphorylation
D)glycogenesis
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Page 40
Chapter 39: Iron and Porphyrin Metabolism
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Q1) In hepatic porphyria cutanea tarda, which of the following will show the greatest increase?
A)urinary porphobilinogen
B)urinary uroporphyrin
C)fecal coproporphyrin
D)fecal protoporphyrin
Q2) Iron in the Fe² state is known as ______ iron, and iron in the Fe³ state is known as ______ iron.The conversion of Fe³ to Fe² is known as ______.
A)ferric, ferrous, oxidation
B)ferric, ferrous, reduction
C)ferrous, ferric, oxidation
D)ferrous, ferric, reduction
Q3) Which of the following would be expected in association with kidney disease?
A)increased serum iron
B)decreased TIBC
C)both a and b
D)neither a or b
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Chapter 40: Hemoglobin
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Q1) The relationship between partial pressure of oxygen and percent hemoglobin saturation with oxygen is described by a ______ curve.This curve shape results from the fact that ______.
A)hyperbolic, each heme molecule is oxygenated independently
B)hyperbolic, oxygenation of one heme group increases the oxygen affinity of others
C)sigmoid, each heme molecule is oxygenated independently
D)sigmoid, oxygenation of one heme group increases the oxygen affinity of others
Q2) M-hemoglobins are derived from:
A)methemoglobin
B)sulfhemoglobin
C)carboxyhemoglobin
D)glycosylated hemoglobin A
Q3) Synthesis of hemoglobin is normally stimulated by hypoxia causing the ______ to produce ______.
A)hypothalamus, hemopexin
B)adrenal gland, haptoglobin
C)kidneys, erythropoietin
D)lungs, angiotensin
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Chapter 41: Human Nutrition
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Q1) Which of the following proteins considered for laboratory use in nutritional assessment is present in highest concentration in the blood stream and has the longest half-life?
A)albumin
B)transferrin
C)prealbumin
D)retinol-binding protein
Q2) Phosphorus:
1)is a major component with calcium in skeletal and dental tissue
2)when deficient, causes rickets in children and osteomalacia in adults
3)when deficient, symptoms include muscle weakness
4)is a component of nucleic acids
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)1, 2, 4
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Chapter 42: Trace Metals
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Q1) Hair would be an appropriate sample for the laboratory detection and measurement of which of the following toxic trace elements?
A)aluminum
B)arsenic
C)cadmium
D)lead
Q2) Which of the following cations is important in enzymes associated with nucleic acid and protein synthesis?
A)aluminum
B)zinc
C)selenium
D)molybdenum
Q3) The most abundant essential trace element in the body is ______, and the second most abundant is ______.
A)iodine, selenium
B)fluorine, copper
C)iron, zinc
D)chromium, manganese
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Page 44
Chapter 43: Vitamins
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Q1) Biotin acts as a coenzyme that participates in which metabolic pathway?
1)gluconeogenesis
2)fatty acid synthesis
3)amino acid catabolism
A)1, 2, 3
B)1, 2
C)1, 3
D)2, 3
Q2) Considering characteristics of lipid-soluble vitamins, ______ can be stored in liver parenchymal cells for a year or longer, ______ can be stored in body fat for several months, and ______ appears to only be stored for a period of days or weeks.
A)vitamin E, vitamin A, vitamin K
B)vitamin A, vitamin E, vitamin D
C)vitamin E, vitamin K, vitamin A
D)vitamin A, vitamin D, vitamin E
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Chapter 44: Pregnancy and Fetal Development
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Q1) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
Q2) High-density lipoprotein/low-density lipoprotein ratios ______ with increasing duration of pregnancy, and HDL levels will be ______ up to 1 year after pregnancy.
A)increase, increased
B)decrease, decreased
C)increase, decreased
D)decrease, increased
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) Which tests will identify both neonatal primary and secondary hypothyroidism?
A)TSH
B)free T<sub>4</sub>
C)total T<sub>3</sub>
D)total T<sub>4</sub>
Q2) At 36 weeks gestation, fetal hemoglobin accounts for about ______ of total hemoglobin in the fetus; approaching term, the percentage of HbF is approximately ______ of total hemoglobin.
A)90%, 70%
B)70%, 90%
C)50%, 60%
D)60%, 50%
Q3) Which laboratory test has been recognized as an early sensitive marker of sepsis in neonates?
A)high-sensitivity C-reactive protein
B)pro-calcitonin
C)serum amyloid A protein
D)hypoglycemia
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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) Which of the following factors are important in the production of serous fluid?
1)hydrostatic pressure
2)colloid osmotic pressure
3)capillary permeability
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 47: Nervous System
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Q1) The following laboratory results were obtained on a patient suffering from depression, fatigue, and apathy.These data provide laboratory evidence of which disease?
Serum cortisol - decreased
Serum sodium - decreased
Serum potassium - increased
A)Addison's disease
B)hypothyroidism
C)Cushing's syndrome
D)liver failure
Q2) Which type of meningitis is most likely indicated by the following laboratory data on a spinal fluid sample?
WBC - 400 cells/mm³, primarily lymphocytes
Protein: 35 mg/dL
Glucose: 55mg/dL
A)bacterial
B)fungal
C)cryptococcal
D)viral
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Chapter 48: General Endocrinology
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Q1) Which of the following are true of the second messenger signaling system?
1)This system requires the availability of energy in the form of ATP.
2)This system is utilized by steroid and peptide hormones.
3)An example of a second messenger is cyclic-AMP.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Trophic hormones are produced by the ______, and releasing factors are produced by the ______.
A)hypothalamus, pituitary
B)pituitary, hypothalamus
C)specific endocrine glands, hypothalamus
D)specific endocrine glands, pituitary
Q3) Under normal physiological conditions, what process functions to maintain relatively constant levels of circulating hormones?
A)circadian rhythm
B)feedback control
C)hypothalamic stimulation
D)second messenger control
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Chapter 49: Thyroid
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Q1) During pregnancy, serum TBG concentration ______, total thyroid hormone levels are ______, and free thyroid hormone levels are ______.
A)increases, increased, unaffected
B)is unaffected, increased, increased
C)decreases, decreases, unaffected
D)is unaffected, decreased, decreased
Q2) After treatment with medication or radioactive iodine is initiated for hyperthyroidism, disease activity is best initially monitored with ______, because ______ will take several weeks or more to return to the reference interval.
A)TSH, T and T3
B)TSH, fT and fT
C)fT and fT , TSH
D)serum iodine, TSH
Q3) Thyroid hormones exert influence in most areas of the body.How do thyroid hormones influence the heart?
A)They affect cardiac gene expression.
B)They influence the sensitivity of the heart to the sympathetic nervous system.
C)They cause peripheral hemodynamic alterations that influence cardiac function.
D)All of the above
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Page 51
Chapter 50: The Gonads
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Q1) Which of the following series of laboratory results may be observed in an infertile man?
A)normal LH, FSH, and testosterone
B)elevated serum gonadotropins and a low testosterone level
C)elevated FSH, normal LH, and low/normal testosterone
D)all of the above
Q2) In the negative-feedback regulation of androgens, which of the following functions to inhibit the production of FSH?
A)testosterone
B)5- -aromatase
C)LH
D)inhibin
Q3) Sex hormone-binding globulin (SHBG) is a b-globulin synthesized by the liver and exhibits _________ binding of testosterone and estradiol in the blood stream.
A)low-affinity and low-capacity
B)low-affinity and high-capacity
C)high-affinity and high-capacity
D)high-affinity and low-capacity
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) In normal individuals, four main factors control the secretion of aldosterone from the zona glomerulosa.Under normal circumstances, which factor predominates?
A)potassium levels
B)natriuretic peptides
C)the renin-angiotensin system
D)ACTH levels
Q2) Which of the following is considered the most sensitive test for the diagnosis and exclusion of pheochromocytoma?
A)plasma free metanephrines
B)the low-dose dexamethasone suppression test
C)plasma ACTH
D)plasma epinephrine
Q3) When is cortisol usually at its lowest concentration in the circulation?
A)4:00 pm
B)Midnight
C)4:00 am
D)8:00 am
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Chapter 52: Diseases of Genetic Origin
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Q1) Identify which statement is not true regarding predictive genetic testing.
A)An abnormal presymptomatic genetic test result indicates that a person will develop the disease at some point in their lifetime.
B)An abnormal presymptomatic genetic test result will specify when a person's symptoms of a disease will appear.
C)An abnormal predisposition genetic test result indicates that an individual has an increased risk of developing a disease.
D)None of the above are true.
Q2) Which of the following is true of structural chromosomal abnormalities?
1)They are usually the result of aneuploidy.
2)They include translocations, deletions, inversions, and duplications.
3)They may be balanced or unbalanced.
4)They usually result from DNA damage due to exposure to radiation and toxic chemicals.
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
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Chapter 53: Neoplasia
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Q1) Which gene(s) has/have been identified as most likely to contribute to an inherited susceptibility to breast and ovarian cancer?
A)BRCA1
B)BRCA2
C)BRCA3
D)both a and b
Q2) The only tumor marker currently approved for screening of the general population is
A)PSA
B)CEA
C)PAP
D)AFP
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) Which of the following is a bacterial agent commonly seen in transplant recipients?
1)Nocardia species
2)Aspergillus fumigatus
3)Serratia marcescens
4)Proteus rettgeri
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) A patient with severe head trauma is a potential organ donor.He has no history of diabetes but is now hyperglycemic.Does this exclude him from being a pancreas donor? Why?
A)Yes, the patient's history is irrelevant now that he is hyperglycemic.
B)Yes, even though the head trauma could have caused the hyperglycemia, there is no way to know for sure.
C)No, the head trauma could have caused the hyperglycemia, but a glycated hemoglobin should be measured for confirmation.
D)No, hyperglycemia is not related to the pancreas.
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Chapter 55: Toxicology
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Q1) Ginseng can cause toxicity in which of the following sites?
A)heart
B)liver
C)kidney
D)gastrointestinal tract
Q2) Which of the following chelating agents are used to bind and remove metals?
A)ethylenediaminetetraacetate
B)deferoxamine
C)British anti-Lewisite
D)all of the above
Q3) Which of the following individuals would have the highest metabolism of a drug based strictly on age?
A)a newborn
B)a 20-year-old
C)a 60-year-old
D)an 80-year-old
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Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following is a symptom of withdrawal from cocaine?
1)hypersomnia
2)hyperphagia
3)depressed mood
4)sweating
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Chronic abuse of opiates is associated with which of the following conditions?
1)viral infections
2)seizures
3)hepatitis
4)insomnia
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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58