Clinical Biochemistry Exam Practice Tests
Course Introduction
Clinical Biochemistry is a branch of laboratory medicine that focuses on the analysis of bodily fluids, primarily blood and urine, for diagnostic and therapeutic purposes. This course covers the principles and techniques involved in detecting, quantifying, and interpreting various biochemical substances, such as enzymes, hormones, electrolytes, and metabolic byproducts. Students learn about the pathophysiological basis of common diseases, the selection and interpretation of laboratory tests, and the integration of biochemical data into clinical decision-making. Emphasis is placed on quality control, laboratory management, and the ethical considerations associated with clinical testing.
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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Sample Questions
Q1) Which laboratory glassware should be selected to ensure accuracy in the preparation of a 100 mL of 0.5 N HCl solution?
A)a beaker
B)a graduated cylinder
C)an Erlenmeyer flask
D)a volumetric flask
Answer: D
Q2) What is the molarity (M) of a solution prepared by placing 10 g of NaOH (MW = 40) in a flask and diluting to 500 mL?
A)0.25 M
B)0.5 M
C)1.0 M
D)2.5 M
Answer: B
Q3) 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
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Chapter 2: Spectral Techniques
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Sample Questions
Q1) The light source most frequently used for spectrophotometric analysis in the UV region is a ______ lamp and in the visible region, a _____ lamp.
A)tungsten, mercury vapor
B)deuterium, tungsten
C)mercury vapor, deuterium
D)tungsten, deuterium
Answer: B
Q2) Absorbance is _________ related to percent transmittance.
A)directly
B)inversely
C)directly and logarithmically
D)inversely and logarithmically
Answer: D
Q3) The percent transmittance of a solution is 50%.Calculate the absorbance.
A)3.7
B)1.7
C)0.7
D)0.3
Answer: D
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Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Sample Questions
Q1) Given the following data, calculate the capacity factor for the solute.
Chart speed for recording the chromatogram is 1 cm/min
Mobile phase flow rate is 1.6 mL/min
Migration distance of the void volume indicator is 1.3 cm
Migration distance of the solute of interest is 13.2 cm
A)2.08
B)9.15
C)21.12
D)Cannot determine from data provided
Answer: B
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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Sample Questions
Q1) Which of the following gas chromatographic detectors requires that the analyte be flammable for detection to occur?
A)thermal-conductivity detector
B)flame-ionization detector
C)electron-capture detector
D)mass-spectrometer detector
Q2) Match the following statements with normal-phase chromatography or reversed-phase chromatography.
1)The more polar the mobile phase, the weaker the mobile phase.
2)The more polar the mobile phase, the stronger the mobile phase.
3)The more nonpolar the mobile phase, the weaker the mobile phase.
4)The more nonpolar the mobile phase, the stronger the mobile phase.
A)1 and 4 are correct for normal-phase chromatography
B)2 and 3 are correct for normal-phase chromatography
C)1 and 3 are correct for reversed-phase chromatography
D)2 and 4 are correct for reversed-phase chromatography
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Sample Questions
Q1) Perhaps the most significant disadvantage of HPLC analysis of hemoglobins is:
A)the technique is only qualitative and not quantitative
B)the technique is associated with a high degree of imprecision
C)the minor differences between the various hemoglobin fractions cause hemoglobins to elute in very narrow, overlapping windows
D)post-translational modification of hemoglobins produces fractions that often elute with the same retention time as other hemoglobin fractions
Q2) In the chromatographic analysis of variant hemoglobins, it is the retention time that determines the _________ and the absorbance that determines the _________.
A)percent concentration, hemoglobin identity
B)need for further testing, hemoglobin purity
C)hemoglobin purity, need for further testing
D)hemoglobin identity, percent concentration
Q3) 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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Sample Questions
Q1) Which of the following chemicals is used for fixation following serum protein electrophoresis?
A)dilute acetic acid
B)Ponceau S
C)sodium dodecyl sulfate
D)saturated sodium hydroxide
Q2) Considering only the effect of time on electrophoretic separation, the separation of bands ________ with time, and diffusion of bands _______ with time.
A)increases, increases
B)increases, decreases
C)decreases, increases
D)decreases, decreases
Q3) 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
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8
Chapter 7: Immunological Reactions
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Sample Questions
Q1) Antibodies are ______ that are produced by the _______.
A)lipids, adipose cells
B)carbohydrates, bone marrow cells
C)nucleic acids, hepatocytes
D)proteins, B lymphocytes
Q2) Haptens are:
A)low-molecular-weight compounds that are unable to induce an antibody response alone
B)low-molecular-weight compounds that can induce an immune response when coupled to higher-molecular-weight immunogenic carriers
C)low-molecular-weight compounds that can react with antibodies
D)all of the above
Q3) Which immunoglobulin can cross the placental membrane?
A)IgA
B)IgD
C)IgM
D)IgG
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Chapter 8: Immunochemical Techniques
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Q1) Suppose your laboratory uses a sandwich immunoassay to measure a specific hormone.Following release of a patient's results, the physician questioned the results because they did not match with the patient's symptoms; the results appear falsely elevated.What steps should be taken to evaluate the physician's concerns?
A)Rerun the assay on the original patient sample specimen with fresh reagent.
B)Pre-incubate the patient sample with non-immune globulins before running the sandwich immunoassay.
C)Rerun the assay with fresh controls.
D)Decrease the temperature of the reaction to decrease the results to a more suitable level.
Q2) Which of the following situations would produce a false increase in light scatter, causing falsely elevated results by immunonephelometry?
A)experimental conditions where the antibody is not in excess
B)hyperlipidemia using end-point immunonephelometry
C)hyperlipidemia using rate immunonephelometry
D)use of a hemolyzed sample with rate immunonephelometry
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Chapter 9: Principles for Competitive-Binding Assays
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Sample Questions
Q1) In the EMIT system, the absorbance of the product is ______ proportional to the concentration of the unlabeled ligand in the reaction.In the FPIA system, the amount of polarized fluorescent light produced by the reaction is ______ proportional to the concentration of the unlabeled ligand in the reaction.
A)directly, directly
B)directly, inversely
C)inversely, inversely
D)inversely, directly
Q2) 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
Q3) 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
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Page 11
Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Agglutination reactions are used to demonstrate the presence of ______.The prozone phenomenon is a ______ reaction that occurs when the concentration of this immune component is too high.
A)antigen, false-positive
B)antibody, false-positive
C)antigen, false-negative
D)antigen, false-negative.
Q2) Suppose a serum VDRL gave a positive result, and CSF showed 8 nucleated cells/mm³.What follow up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested positive, and what follow-up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested negative?
A)T.pallidum particle agglutination test, no follow-up testing is required
B)fluorescent treponemal antibody test, no follow-up testing is required
C)no follow-up testing is required, T.pallidum particle agglutination test
D)no follow-up testing is required, fluorescent treponemal antibody test
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12
Chapter 11: Measurement of Colligative Properties
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Sample Questions
Q1) Determine the calculated osmolality given the following data: sodium = 135 mEq/L; glucose = 95 mg/dL; BUN = 10 mg/dL.
A)240 mOsm/kg
B)279 mOsm/kg
C)375 mOsm/kg
D)480 mOsm/kg
Q2) 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
Q3) Determine the calculated osmolality, given the following data: sodium = 140 mEq/L; glucose = 32 mmol/L; BUN = 30 mmol/L.
A)202 mOsm/kg
B)292 mOsm/kg
C)342 mOsm/kg
D)404 mOsm/kg
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13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) The primary application for coulometric analysis of chloride is:
A)the measurement of chloride in urine
B)the measurement of chloride in sweat
C)the measurement of chloride in serum
D)the measurement of chloride in whole blood
Q2) 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
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Chapter 13: Molecular Diagnostics
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Sample Questions
Q1) ____________ forms the basis for almost all types of DNA detection methods.
A)denaturation
B)hybridization
C)restriction fragment length polymorphism (RFLP)
D)amplification
Q2) What is the current detection limit for test systems available to measure HIV RNA viral loads?
A)40 to 50 copies/mL
B)500 to 750 copies/mL
C)10,000 copies/mL
D)100,000 copies/mL
Q3) The most commonly used DNA polymerase is Taq polymerase, which has an optimal activity at ______ but can survive short periods of exposure to temperatures up to ______.
A)60°C, 72°C
B)60°C, 95°C
C)72°C, 95°C
D)72°C, 112°C
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15
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) Suppose a patient has been taking a medication for a significant period of time with good results.Recently the patient has begun experiencing toxic side effects after dose administration that subside approximately an hour later.The blood sample that should be collected for an initial evaluation is ______.When this blood level is found to have a drug concentration higher than desired, a laboratory test to evaluate ______ would be advised.
A)trough blood sample, liver function
B)peak blood sample, kidney function
C)trough blood sample, gastrointestinal function
D)peak blood sample, cardiac function
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16
Chapter 15: Clinical Enzymology
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Sample Questions
Q1) 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
Q2) Which of the following is necessary for maximal enzyme velocity?
A)The enzyme concentration must be in excess of the substrate concentration.
B)The substrate concentration must be in excess of the enzyme concentration.
C)The substrate and enzyme concentrations must be equal.
D)The enzyme and substrate reaction must be reversible.
Q3) 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
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) The most common enzyme group associated with posttranslational proteolytic cleavage of enzymes is:
A)oxidoreductases
B)peptidases
C)transferases
D)isomerases
Q2) What is the limitation of LD isoenzyme measurement in diagnostic enzymology?
A)Since LD catalyzes a reversible reaction, it is difficult to get a true measurement of LD activity.
B)Since LD is found in virtually every tissue, the clinical usefulness in pinpointing areas of disease is extremely limited.
C)LD is found primarily in cells and tissue, making its measurement difficult.
D)all of the above
Q3) Which of the following characteristics of isoenzymes result in the difference in catalytic activity seen between different isoenzymes?
A)the organ location of the different isoenzymes
B)the prosthetic group attached to the different isoenzymes
C)the amino-acid sequence difference between isoenzymes
D)all of the above
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Page 18
Chapter 17: Interferences in Chemical Analysis
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Q1) 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
Q2) It is recommended that fluorescence intensity measurements be made below what absorbance level?
A)0.100
B)0.500
C)1.000
D)none of the above
Q3) Suppose a colorimetric analysis that utilizes a highly colored reagent is to be performed.Which type of blank should be prepared to ensure the correct sample results?
A)sample blank
B)reagent blank
C)instrument blank
D)diluent blank
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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) For the specimen collection tubes listed below, select the proper order of use during specimen collection.
A)heparin-containing tube, tube for coagulation testing, EDTA-containing tube, tube with no anticoagulant
B)EDTA-containing tube, heparin-containing tube, tube with no anticoagulant, tube for coagulation testing
C)tube with no anticoagulant, EDTA-containing tube, tube for coagulation testing, heparin-containing tube
D)tube for coagulation testing, tube with no anticoagulant, heparin-containing tube, EDTA-containing tube
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Chapter 19: Laboratory Management
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Questions
Q1) 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
Q2) Laboratory procedures are billed to insurance companies or organizations according to which system of coding?
A)Hospital Information System (HIS) coding
B)Diagnosis Related Group (DRG) coding
C)Common Procedure Terminology (CPT) coding
D)Health Insurance Portability and Accountability Act (HIPAA) coding
Q3) Which of the following usually accounts for the majority of a laboratory's annual budget?
A)labor and supplies
B)new equipment
C)repair and maintenance
D)referred testing
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Chapter 20: Laboratory Automation
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Q1) The majority of laboratory errors occur during ______ and ______.
A)test ordering, sample transport
B)phlebotomy, front-end processing of the sample
C)phlebotomy, result reporting
D)front-end processing of the sample, result reporting
Q2) Total laboratory automation systems do not automate which section of the laboratory?
A)immunochemistry
B)hematology
C)coagulation
D)immunohematology
Q3) 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
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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Considering a patient's physiological status, which of the following factors can affect a specimen used for POCT?
A)hypervolemia
B)hypovolemia
C)poor peripheral circulation
D)all 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) Which of the following is not considered an analytical interference?
A)lipemia
B)drugs
C)interstitial fluid contamination
D)icterus
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Page 23
Chapter 22: Laboratory Information Systems
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Q1) Software maintenance may:
1)repair software defects or design problems.
2)support new hardware or operating systems.
3)occur once a year.
4)include changes in the user environment.
A)1, 2, 3, 4
B)2, 3, 4
C)1, 3, 4
D)1, 2, 4
Q2) Before an instrument can be interfaced to an LIS, what conditions need to be satisfied?
A)The LIS and the instrument must be linked by a physical connection.
B)Interface software must be available on the LIS to allow it to receive data from and transmit data to the instrument.
C)Both a and b
D)Neither a nor b
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Chapter 23: Laboratory Statistics
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Q1) 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
Q2) The difference between parametric and nonparametric statistics is based on:
A)the assumption of a normal (Gaussian) distribution of the data.
B)the method used to consider outliers.
C)the assumption that only systematic error is present.
D)the equivalency of the mean, median, and mode.
Q3) 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
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Page 25
Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Which of the following laboratory considerations are not necessary factors to consider for the transfer of a reference interval from one laboratory to another?
A)preanalytical considerations
B)analytical considerations
C)postanalytical considerations
D)both a and c
Q2) Endocrinologists typically encounter patients with hormonal abnormalities such as Cushing's disease (i.e., hyperadrenocorticism).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
Q3) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
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Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) A field method is:
A)the most commonly used method.
B)the scientifically most accurate method.
C)a method that can be used for qualitative screening only.
D)a method that has demonstrated similar but slightly less accuracy than a definitive method.
Q2) Which of the following are CLIA '88 requirements for the use of quality-control materials?
1)At least two control samples of different concentrations must be tested every 24 hours.
2)At least one blood-gas control sample must be tested every 8 hours.
3)Both high and low blood-gas control materials must be tested every 24 hours.
4)At least one calibrator or control must be tested each time a patient sample is tested.
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)1, 3
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27
Chapter 26: Evaluation of Methods
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Q1) Interference should be evaluated for all commonly encountered interferents such as:
A)hemolysis
B)lipemia
C)icterus
D)all of the above
Q2) Which of the following is the correct sequence to follow in method selection?
A)define requirements, review literature, determine need, select candidate methods
B)determine need, define requirements, review literature, select candidate methods
C)select candidate methods, determine need, define requirements, review literature
D)determine need, review literature, define requirements, select candidate methods
Q3) Usually a method-evaluation study is performed to:
A)test all methods to determine the method with the smallest error.
B)determine whether the selected method has acceptably small analytical errors.
C)both a and b
D)neither a nor b
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) Which of the following best describes the makeup of phospholipids?
A)glycerol and three fatty acid residues
B)glycerol, two fatty acid residues, and a phosphoric acid residue
C)glycerol and three phosphoric acid residues
D)glycerol, two fatty acid residues, one phosphoric acid residue, and a nitrogen-containing residue
Q2) The spatial arrangement of a linear chain of amino acids from which folding results in specific three-dimensional patterns such as the beta-pleated sheet and the alpha helix is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q3) 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
Page 29
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Which electrolyte is most significantly affected by hemolysis?
A)sodium
B)potassium C)chloride
D)bicarbonate
Q2) Acute metabolic acidosis resulting from acid with an associated anion promotes an increase in the plasma level of which electrolyte?
A)sodium
B)potassium
C)chloride
D)bicarbonate
Q3) The renin-angiotensin-aldosterone system is initiated by the release of renin from which organ?
A)brain
B)lungs
C)liver
D)kidney
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Page 30
Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) 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
Q2) Which of the following is the normal reference interval for arterial pH?
A)7.31 - 7.41
B)7.33 - 7.43
C)7.35 - 7.45
D)7.45 - 7.55
Q3) An increased total CO , increased pCO , and increased pH is most correctly classified as:
A)partially compensated metabolic acidosis
B)partially compensated metabolic alkalosis
C)partially compensated respiratory acidosis
D)partially compensated respiratory alkalosis
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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) When following the urinary system, the renal pelvis rapidly diminishes in caliber and merges into the ______.Each of these descends in the abdomen alongside the vertebral column to join the ______, which provides temporary storage for urine, which is eventually voided through the _____ to the exterior.
A)urethra, kidney, ureter
B)ureter, kidney, urethra
C)ureter, bladder, urethra
D)urethra, bladder, ureter
Q3) Underneath the capsule of fibrous tissue that encloses the kidney lies the renal cortex, which contains the ______ and the ______.
A)collecting ducts, glomeruli
B)glomeruli, renal tubules
C)tubules, collecting ducts
D)none of the above
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Page 32
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) Select the cause for liver disease indicated by the laboratory data provided below.
AST - slightly above the upper reference limit (URL)
ALT - slightly above URL
AST/ALT ratio - less than 1
GGT - three times URL
ALP - normal
A)acute viral hepatitis
B)drug-induced hepatitis
C)cirrhosis
D)autoimmune liver disease
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Chapter 32: Diagnosis of Viral Hepatitis
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Q1) The following information is characteristic of which hepatitis virus?
Viral classification - Deltaviridae
Viral envelope - present
Incubation time (days to clinical symptoms) - 21 to 50 days
Route of transmission - blood, fluids
Genome - particle G-negative ssRNA
Size of genome - 1.7 kbases
A)HAV
B)HBV
C)HCV
D)HDV
Q2) Which of the following are characteristics of hepatitis C virus (HCV)?
1)HCV is transmitted through blood, needle sharing, sexually.
2)HCV is the primary cause of chronic liver disease such as cirrhosis.
3)HCV currently has a vaccine available.
4)The majority of HCV-infected patients are asymptomatic.
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Page 34
Chapter 33: Bone Disease
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Q1) Select the proper order for the following stages of Paget's Disease.
1)Bone formation predominates; the pagetic bone is coarse-fibered, dense, trabecular bone.
2)Resorption predominates, and the bone marrow is replaced with a highly vascular fibrous connective tissue.
3)The rate of bone resorption declines, and continued bone formation produces hard, dense bone.
A)1, 2, 3
B)2, 1, 3
C)1, 3, 2
D)2, 3, 1
Q2) Zollinger-Ellison syndrome will show which of the following laboratory observations?
A)They all show an abnormal serum calcitonin concentration deficiency.
B)They all show an abnormal serum calcitonin concentration excess.
C)They all show an abnormal serum alkaline phosphatase deficiency.
D)They all show an abnormal serum alkaline phosphatase excess.
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Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Excess production of ______ produces Zollinger-Ellison syndrome, whereas excess production of ______ produces the syndrome of watery diarrhea, hypokalemia, and achlorhydria.
A)gastrin, vasoactive intestinal peptide
B)vasoactive intestinal peptide, gastrin
C)gastrin, somatostatin
D)vasoactive intestinal peptide, somatostatin
Q2) 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%
Q3) Nerve fibers in pancreatic tissue stimulate production of:
A)vasoactive intestinal peptide
B)somatostatin
C)enkephalin-related peptides
D)all of the above
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Chapter 35: Gastrointestinal Function
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Q1) Crohn's disease:
1)presents with abdominal pain, diarrhea, and malabsorption.
2)affects the small intestine.
3)produces antibodies to Saccharomyces cerevisiae.
4)produces perinuclear antineutrophil cytoplasmic antibodies.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
Q2) When considering the lactose tolerance test, a healthy person will demonstrate a glucose of ______, but those with lactase deficiency will exhibit a peak plasma glucose of ______.
A)> 2000 mg/L over the baseline sample, < 1000 mg/L
B)< 2000 mg/L over the baseline sample, > 1000 mg/L
C)> 1000 mg/L over the baseline sample, < 2000 mg/L
D)< 1000 mg/L over the baseline sample, > 2000 mg/L
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Chapter 36: Cardiac and Muscle Disease
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Q1) The first myocardial marker to elevate following the onset of MI symptoms is ______.The concern with this marker is ______.
A)cTnI, this may return to normal before a blood sample can be collected
B)CK-MB, this may return to normal before a blood sample can be collected
C)myoglobin, this marker is considered nonspecific
D)cTnT, this marker is considered nonspecific
Q2) The energy for muscle contraction is generated by the hydrolysis of ATP by myosin.The amount of ATP hydrolyzed during muscle contraction depends on what factors?
1)the duration of contraction
2)the strength of contraction
3)the amount of work done by the muscle
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Which of the following components of a lipoprotein profile is most affected by a nonfasting specimen?
A)total cholesterol
B)HDL cholesterol
C)LDL cholesterol measured by a direct method
D)triglycerides
Q2) Which plasma lipoprotein has the following physical and chemical characteristics?
Electrophoretic mobility - pre-beta
Cholesterol composition - 22%
Triglycerides composition - 52%
Phospholipid composition - 18%
Apoprotein - 2%
A)Chylomicrons
B)VLDL
C)LDL
D)HDL
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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) Once glucose enters the cell, it is trapped in the cell as glucose-6-phosphate (G6P).G6P serves as the starting point for four metabolic pathways.G6P is converted by ______ to pyruvate.G6P is also oxidized by ______ to ribose and carbon dioxide.Additionally, G6P is converted by ______ to glucuronic acid.Finally, G6P is incorporated into glycogen by ______.
A)the uronic acid pathway, glycogenesis, the hexose monophosphate shunt, glycolysis
B)the uronic acid pathway, glycolysis, the hexose monophosphate shunt, glycogenesis
C)glycolysis, the hexose monophosphate shunt, the uronic acid pathway, glycogenesis
D)glycogenesis, the uronic acid pathway, the hexose monophosphate, shunt, glycolysis
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) In variegate hepatic porphyria, which of the following would show the greatest increase?
A)urinary uroporphyrin
B)urinary coproporphyrin
C)fecal protoporphyrinogen
D)decal protoporphyrin
Q2) Which of the following is/are true of hepcidin?
A)It controls the flow of iron out of the intestinal cells by inhibiting iron release.
B)High levels promote release of iron into the circulation.
C)Low levels restrict the release of iron from intestinal cells into the circulation.
D)all of the above
Q3) At present, the one heme enzyme that is routinely measured in clinical laboratories is:
A)porphobilinogen deaminase
B)uroporphyrinogen III synthase
C)coproporphyrinogen oxidase
D)ferrochelatase
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Chapter 40: Hemoglobin
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Q1) A hexokinase deficiency would result in a shift to the ______of the oxygen dissociation curve, and a pyruvate kinase deficiency would result in a s(answer format: blank 1, blank 2)
A)right, right
B)right, left
C)left, left
D)left, right
Q2) Which of the following laboratory findings would be expected when a hemoglobinopathy causes the oxygen dissociation curve to shift to the left?
A)hypochromic microcytic red blood cells
B)erythrocytosis
C)acidosis
D)increased serum iron and TIBC
Q3) 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
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Page 42
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) A patient with a body mass index of 27 is said to be ________________.
A)underweight
B)at a healthy weight
C)overweight
D)obese
Q3) Increased irritability of cardiac muscle may be associated with a decreased plasma concentration of which of the following macrominerals?
A)sodium
B)potassium
C)chloride
D)calcium
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Chapter 42: Trace Metals
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Q1) The following laboratory results are associated with which toxic trace element?
Delta-aminolevulinic acid - increased
Free erythrocyte protoporphyrin (zinc protoporphyrin) - increased
Anemia screen - positive
A)aluminum
B)arsenic
C)mercury
D)lead
Q2) An aluminum measurement may be requested in which of the following situations?
A)a patient receiving long-term total parenteral nutrition therapy
B)a patient recovering from a liver transplant
C)a patient developing frequent kidney stones
D)a patient diagnosed with type 2 diabetes
Q3) 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
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Page 44
Chapter 43: Vitamins
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Q1) The need for laboratory evaluation of vitamin E status may be indicated by which of the following diets?
A)a diet high in vegetable oils
B)a diet high in fresh, green vegetables
C)a diet high in unsaturated fats
D)a diet low in unsaturated fats
Q2) The active form of vitamin K is important in which of the following steps of the coagulation pathway?
A)the conversion of glutamic acid to delta-carboxyglutamic acid
B)the binding of calcium
C)the formation of an ionic bridge for clot formation
D)the binding with phospholipids
Q3) 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
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45
Chapter 44: Pregnancy and Fetal Development
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Q1) 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
Q2) Human chorionic gonadotropin (hCG:
1)regulates ovulation and subsequent formation of the corpus luteum
2)provides continued stimulation of the corpus luteum to ensure uninterrupted progesterone production
3)can be detected in maternal serum 6 to 9 days following conception
4)concentrations peak between 10 and 12 weeks
A)1, 2
B)2, 3
C)3, 4
D)2, 4
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Chapter 45: The Newborn
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Q1) Which of the following Apgar scores for a neonate would be indicative of the need for immediate resuscitation?
A)7
B)5
C)4
D)2
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
Q3) A newborn is 3 days old, weighs 6 pounds, and has failed to pass meconium.Which of the following tests should be performed and under what conditions?
A)Immediately perform a sweat test for cystic fibrosis.
B)Immediately perform a blood culture for infection.
C)Perform a blood culture when the newborn is 10 days old.
D)Perform a sweat test when the newborn is 14 days old and weighs 6.8 pounds.
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Page 47
Chapter 46: Extravascular Biological Fluids
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Q1) A laboratory analysis of pleural fluid should include:
1)total protein level
2)glucose level
3)amylase level
4)lipase level
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) A ______ is a surgical procedure in which pleural fluid is obtained by a puncture of the chest wall.______ is aspiration of fluid from a cavity.______ refers to pus in the pleural cavity.
A)paracentesis, Empyema, Thoracentesis
B)thoracentesis, Paracentesis, Empyema
C)paracentesis, Thoracentesis, Empyema
D)thoracentesis, Empyema, Paracentesis
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Chapter 47: Nervous System
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Q1) Calculate the IgG index, given the data below.
IgG (CSF) = 0.2 mg/dL
IgG (serum = 0.5 g/dL
Albumin (CSF) = 1.7 mg/dL
Albumin (serum) = 3.5 g/dL
A)0.19
B)0.29
C)0.41
D)0.82
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) What hormone has the following characteristics?
Source - anterior pituitary
Target organ - ovary/testis
Circulating level - 5 to 25 mIU/mL
Biological effect - corpus luteum, ovary, Leydig cells, testis
A)prolactin
B)ACTH
C)FSH
D)LH
Q2) Which of the following best describes a hormone?
A)a chemical produced in one part of the body that acts in a distant part of the body
B)a chemical produced in one part of the body that acts in close proximity to its production
C)a chemical produced whose action may be either close or distant to the site of production
D)a chemical that must enter the blood stream to be transported to its site of action
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Chapter 49: Thyroid
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Q1) There is concern that the upper reference interval value for TSH is set too high to detect subtle hypothyroid disease.It is suggested that the upper reference interval value be reduced to what level to address this concern?
A)5.0 mU/L
B)4.0 mU/L
C)3.0 mU/L
D)2.0 mU/L
Q2) When free thyroxine cannot be measured directly, the free thyroxine index (FT I) may be calculated by using which measured laboratory data?
A)TSH and T resin uptake
B)T and T resin uptake
C)TSH and T
D)T and T resin uptake
Q3) 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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Page 51
Chapter 50: The Gonads
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Q1) The clinical problem of amenorrhea may be defined by which of the following criteria?
1)no period by age 14 in the absence of growth or development of secondary sex characteristics
2)no period by age 16, regardless of the presence of normal growth and development with the appearance of secondary sex characteristics
3)in a woman who has been menstruating, the absence of periods for a length of time equivalent to a total of at least 3 of the previous cycle intervals or 6 months of amenorrhea
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Gonadotropin-releasing hormone (GnRH) regulates which of the following?
A)the synthesis and storage of gonadotropins
B)movement of gonadotropins from a reserve pool ready for secretion
C)immediate release of FSH and LH
D)all of the above
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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) 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
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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Page 53
Chapter 52: Diseases of Genetic Origin
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Q1) A patient with a1-antitrypsin deficiency would receive what treatment with the hopes of being cured?
A)liver transplant
B)bone marrow transplant
C)hematopoietic stem cell transplant
D)gene replacement therapy
Q2) Which factors alter the predicted patterns of Mendelian inheritance?
1)penetrance
2)expressivity
3)pleiotropy
4)phenocopy
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 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) CA-125 is elevated in the serum of patients with __________.
A)colorectal cancer
B)breast cancer
C)ovarian cancer
D)prostate cancer
Q2) What test is used to assess the prognosis of patients with breast cancer?
A)estrogen receptor assay
B)CA-125
C)progesterone receptor assay
D)both a and c
Q3) The only tumor marker currently approved for screening of the general population is
A)PSA
B)CEA
C)PAP
D)AFP
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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) Laboratory assessments are conducted to monitor bacterial, viral, and fungal complications posttransplant for recipients of what type of organ?
A)heart
B)liver
C)kidney
D)all of the above
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Chapter 55: Toxicology
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Q1) Which of the following is the correct antidote for iron or aluminum poisoning?
A)Digibind
B)dimercaprol
C)deferoxamine
D)naloxone
Q2) Hemodialysis or hemoperfusion may be effective in removing water-soluble toxins that have which of the following characteristics?
1)high molecular weight
2)low volume of distribution
3)low protein binding
A)1, 2, 3
B)2, 3
C)1, 3
D)1, 2
Q3) Most toxins enter the body through what route?
A)skin
B)lungs
C)gastrointestinal tract
D)all of the above
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Page 57
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) Which of the following is an aspect of addiction?
1)craving
2)withdrawal
3)dependence
4)denial
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
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