Clinical Chemistry
Solved Exam Questions
Course Introduction
Clinical Chemistry is a branch of laboratory medicine focused on the analysis of bodily fluids, primarily blood and urine, to diagnose and monitor diseases, assess organ function, and guide clinical decision-making. The course encompasses the principles and techniques used to measure biochemical analytes such as enzymes, electrolytes, hormones, lipids, and metabolic waste products. Students will explore the pathophysiological basis of test results, quality control procedures, instrumentation, and laboratory safety. The course emphasizes interpretation of laboratory data in relation to normal and abnormal health states, thereby serving as a critical foundation for healthcare professionals involved in patient diagnosis and management.
Recommended Textbook
Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 7th Edition by Carl A. Burtis
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Chapter 1: Clinical Chemistry, molecular Diagnostics, and Laboratory Medicine
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Sample Questions
Q1) A male laboratorian works in the clinical chemistry laboratory of a large hospital.He is approached by his friend,who is a representative of a drug company,and asked to analyze some patient samples for drug levels of a specific drug that the representative's company sells and that these patients use.The representative wants to publish a report on the rate of drug absorption and distribution of this drug and tells his laboratorian friend that he will personally reimburse him for his time.What ethical issues come into play here?
A) Resource allocation and conflict of interest
B) Maintenance of confidentiality and publishing issues
C) Maintenance of confidentiality,conflict of interest,and publishing issues.
D) Resource allocation,maintenance of confidentiality,conflict of interest,and publishing issues.
Answer: D
Q2) Molecular diagnostics testing is only used by the clinical chemistry laboratory.
A)True
B)False
Answer: False
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3
Chapter 2: Selection and Analytical Evaluation of
Methodswith Statistical Techniques
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Sample Questions
Q1) You are performing a precision study on a new chemistry analyzer in your hospital lab by analyzing a single sample many times.The study involves performing the analysis on different shifts using different calibrators and analysis by different laboratorians.This aspect of precision is referred to as:
A) repeatability.
B) reproducibility
C) validity.
D) reliability.
Answer: B
Q2) Following a precision study in which repeatability and reproducibility of 20 samples are assessed,which one of the following formulae would be used to determine the total standard deviation (\(\sigma\)<sup>2</sup><sub>T</sub>)?
A) .\(\sigma\)<sup>2</sup><sub>within-run</sub>/2 + \(\sigma\)<sup>2</sup><sub>between-run</sub>
B) (x2<sub>i</sub><sub> </sub>- x1<sub>i</sub>)
C) .\(\Sigma\)(x<sub>1</sub> -\(\mu\))<sup>2</sup>/N
D) .\(\Sigma\)<sup>2</sup><sub>within-run </sub>+ \(\Sigma\)<sup>2</sup><sub>between-run</sub>
Answer: D
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Chapter 3: Clinical Evaluation of Methods
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Sample Questions
Q1) To calculate the predictive value of a positive test,which of the following should be known?
A) Sensitivity only
B) Specificity and prevalence only
C) Sensitivity and specificity only
D) Sensitivity,specificity,and prevalence
Answer: D
Q2) A method that can be used to calculate the probability of a disease after new information is added to previously obtained information involves:
A) likelihood analysis.
B) sensitivity analysis.
C) Bayes theorem.
D) combination testing.
Answer: C
Q3) In regard to clinical evaluation of method,a high clinical sensitivity means few false negatives.
A)True
B)False
Answer: True
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Chapter 4: Evidence-Based Laboratory Medicine
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Q1) In a randomized control trial,the use of a new vaccine was observed to reduce the number Chlamydia trachomatis infections in a population of college-aged women.This finding is referred to as a(n):
A) clinical audit.
B) systematic review.
C) patient outcome.
D) internal validator.
Q2) Another way that "bias" can be defined is as _____ error.
A) random
B) systematic
C) analytical
D) clinical
Q3) Systematic reviews are used to assess and answer very specific clinical questions in an unbiased way.The most important of the steps in conducting a systematic review is the:
A) formulation of the clinical question that will form the basis of the review.
B) choosing of the reviewer who will perform the work.
C) primary literature search and review.
D) data extraction from the literature.
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Chapter 5: Establishment and Use of Reference Values
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Q1) Even if somewhat impractical,which one of the following preanalytical factors should be standardized when establishing a reference interval for an analyte?
A) Location (building,city,etc.)in which the venipuncture is performed
B) The method of specimen collection
C) Reagents used in analyte analysis
D) The specific method used for analysis
Q2) Calculate the clinical sensitivity for the following data: in a group of 80 patients diagnosed with sickle cell disease,72 had positive test results.The clinical sensitivity of this test is:
A) 111%.
B) 100%.
C) 90%.
D) 75%.
Q3) The proportion of a population (or of those being tested)with the disease being studied is referred to as the:
A) prevalence.
B) clinical sensitivity.
C) clinical specificity.
D) predictive value.
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Chapter 6: Specimen Collection, processing, and Other
Preanalytical Variables
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Q1) Which one of the following analytes shows no difference in composition between a serum and a plasma specimen?
A) Lactate dehydrogenase
B) Potassium
C) Cholesterol
D) Total protein
Q2) Which one of the following anticoagulants is considered unacceptable for a blood sample that will be used for DNA amplification in the polymerase chain reaction?
A) Heparin
B) EDTA
C) Iodoacetate
D) Acid citrate dextrose
Q3) When a coagulated blood sample is separated by centrifugation,the liquid component is separated from the cells.This "serum" is the:
A) liquid component with all clotting factors present in it.
B) liquid component with no clotting factors in it.
C) unclotted cellular component.
D) clot.
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Chapter 7: Quality Management
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Q1) You have received your proficiency test results from the accrediting agency and note that your creatinine result was unacceptable at greater than 2 SDI from the group mean.The value that was entered on your survey report form was 15 mg/dL.The group method mean was 1.3 mg/dL,with a method standard deviation of 0.3 mg/dL.You realize that your laboratory made an error in entering the result.If you had entered 2.0 mg/dL as the result on your survey report,what would the correct SDI be?
A) 45.6 SDI
B) 4.56 SDI
C) 1.08 SDI
D) 0.67 SDI
Q2) Which one of the following would be considered a cost of nonconformance?
A) Performing preventive maintenance on analyzers
B) Employee training
C) Repeating an analytical run because the QC is out of range
D) Sending an employee to a fire safety class
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Chapter 8: Principles of Basic Techniques and Laboratory Safety
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Sample Questions
Q1) Regarding centrifugation,what is the formula for calculating relative centrifugal force (RCF)?
A) RCF = 1.118 * r (in cm) * rpm<sup>2</sup>
B) RCF = 1.118 * 10<sup>-</sup><sup>5</sup> * r (in cm) * rpm<sup>2</sup>
C) RCF = 1.118 * 10<sup>-</sup><sup>5</sup> * r<sup>2</sup> (in cm) * rpm
D) RCF = 1.118 * r (in inches)* rpm<sup>2</sup>
Q2) How many grams of NaCl (MW = 58.5 g)are required to prepare 250 mL of a 6 mol/L solution of NaCl?
A) 87.75 g
B) 58.5 g
C) 585 g
D) 877.5 g
Q3) Chemicals with the designation _____ are suitable for use in most clinical chemistry laboratory analyses.
A) technical grade
B) analytical reagent grade
C) USP (United States Pharmacopeia)
D) NF (National Formulary)
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Chapter 9: Optical Techniques
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Q1) Which two optical techniques are combined operationally in a flow cytometer?
A) Laser-induced fluorometry and light scattering techniques
B) Atomic absorption spectrophotometry and light scattering techniques
C) Spectrophotometry and fluorescence polarization techniques
D) Fluorescence polarization and laser-induced fluorometry
Q2) There are several interferences that can affect or limit fluorescence measurements.For example,the inner filter effect:
A) occurs when the solution absorbs greater than 2% of the exciting light,producing a nonlinear response between concentration and fluorescence emission.
B) involves fluorophores that have overlapping excitation and emission spectra and that are susceptible to loss of detection because of background light scatter.
C) involves solvents such as ethanol that cause appreciable fluorescence due to the interaction of the fluorophore with the solvent.
D) is caused by light scattering of proteins and other macromolecules in the sample matrix,which might cause unwanted background fluorescence.
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Chapter 10: Electrochemistry and Chemical Sensors
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Q1) Which one of the following voltage potentials occurs as the result of chemical equilibrium involving electron transfer reactions?
A) Electrode potential
B) Positive potential
C) Hydrogen potential
D) Redox potential
Q2) An electrochemical technique used to measure chloride in serum or plasma is:
A) conductometry.
B) amperometry.
C) coulometry.
D) voltammetry.
Q3) A commonly used electrode also used as an internal reference electrode in ion-selective electrode measurements is which one of the following?
A) Silver/silver chloride
B) Mercury vapor
C) Platinum
D) Gas permeable
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Chapter 11: Electrophoresis
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Q1) The isoelectric point (pI)of a protein is the pH at which the protein:
A) has a positive charge.
B) has a negative charge.
C) has no net charge.
D) migrates best in electrophoresis.
Q2) If the viscosity of the support medium used in a protein electrophoresis system is too high (thick),the migration rate will:
A) increase.
B) decrease.
C) not be affected.
Q3) What stains are used to stain a serum protein electrophoresis gel?
A) Coomassie Blue and ethidium bromide
B) Oil Red O and Amido Black
C) Amido Black and Coomassie Brilliant Blue
D) Crystal Violet and Sudan Black
Q4) In an electrophoresis system,the _____ is the negative electrode.
A) anode
B) optode
C) diode
D) cathode
Page 13
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Chapter 12: Chromatography
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Q1) In clinical applications using gas chromatography,which one of the following column temperature techniques will cause the more volatile analytes to elute first and therefore produce the best separation of complex mixtures of analytes with a range of volatilities?
A) Isothermal operation
B) Refrigerator (4° to 8° C)temperature operation
C) Temperature programmed operation
D) Room temperature operation
Q2) A type of detector used in GC that is universal in its detection of compounds but has low sensitivity compared with other detectors is a(n)_____ detector.
A) flame ionization
B) thermal conductance
C) electron capture
D) photoionization
Q3) In column chromatography,analytes are identified by their retention times.
A)True
B)False
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14
Chapter 14: Enzyme and Rate Analyses
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Q1) Varying different factors and studying their effects on an enzymatic reaction rate in the assessment of most favorable reaction conditions for an enzyme assay is referred to as:
A) optimization.
B) standardization.
C) quality control.
D) variable control.
Q2) How does pH alter an enzymatic reaction rate?
A) By affecting key amino acids in the enzyme protein at the active center and other sites
B) By causing thermal inactivation through reconfiguration of the prosthetic group
C) By promoting the formation of the most active state of the enzyme
D) By decreasing the K<sub>m</sub> needed for maximum velocity to be reached
Q3) In a continuous-monitoring assessment of an enzyme reaction rate,which one of the following is the preferable measurement?
A) Measurement of the decreasing concentration of substrate
B) Measurement of the increasing concentration of product
C) Direct measurement of enzyme protein
D) Calculation of K<sub>m</sub> and V<sub>max</sub>
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Chapter 15: Immunochemical Techniques
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Q1) What information does crossed immunoelectrophoresis provide that basic immunofixation does not?
A) It provides a qualitative immunologic assessment of specific myeloma protein fractions.
B) It provides better resolution of closely related proteins.
C) It specifically traps the immune precipitate within the gel for quantification.
D) It involves initial electrophoresis with transfer of proteins to nitrocellulose and specific antibody binding to each fraction.
Q2) Which immunoassay uses a label that was susceptible to making serum cause a false positive because of background fluorescence?
A) Enzyme
B) Radioactive
C) Chemiluminescent
D) Fluorescent
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Chapter 16: Automation
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Q1) In an automated laboratory workstation with a bidirectional laboratory information system interface,the laboratory's bar-coded label on an individual specimen contains information regarding identification and the laboratory tests requested.The processor reads the bar code and the analyzer performs the analyses.Where can a preanalytical error still occur in this automated system?
A) When the instrument's calibration is not successful
B) When the quality control materials are out of the recommended range
C) When a data entry person enters incorrect laboratory test requests
D) When the equipment operator ignores equipment diagnostic messages
Q2) The most significant improvement in the quality of laboratory test results can be attributed to the ability of automation to:
A) reduce costs.
B) increase work capacity.
C) reduce error and variability caused by manual manipulation.
D) reduce sample volumes and laboratory involvement.
Q3) If programmed appropriately,a multiple-channel analyzer could assess samples as a single-channel analyzer.
A)True
B)False
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Chapter 17: Point-Of-Care Instrumentation
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Q1) An example of in vivo POCT technology would be:
A) optical fluorescence.
B) lateral flow immunoassay.
C) light scattering such as nephelometry.
D) spectrophotometry.
Q2) The final step in the documentation of satisfactory training of an individual in the use of a POCT device is:
A) observation of that individual's performance of the entire procedure on three different occasions.
B) submission of a certificate of completion of training to an appropriate accrediting agency.
C) performance by that individual of correlation studies using the POC test and a complex piece of lab equipment.
D) the formal designation of that individual as "POCT-competent."
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Chapter 18: Amino Acids, peptides, and Proteins
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Q1) Serum proteins or protein complexes that precipitate at temperatures lower than normal core body temperature and that,if precipitated in tissues,result in vasculitis and ischemic injury to peripheral tissues are referred to as:
A) essential amino acids.
B) paraproteins.
C) amyloids.
D) cryoglobulins.
Q2) At a pH of 4.0,the:
A) carboxyl and amino groups of an amino acid become unprotonated,causing the amino acid to have a net negative charge.
B) carboxyl and amino groups of an amino acid become protonated,causing the amino acid to have a net positive charge.
C) carboxyl group of an amino acid is dissociated and the amino group is protonated,giving the amino acid no net charge.
D) amino group of an amino acid is dissociated and the carboxyl group is protonated,giving the amino acid no net charge.
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Chapter 19: Serum Enzymes
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Q1) If you were asked by your laboratory director to set up an enzyme profile (group of tests)specifically to assess hepatobiliary (biliary obstruction)disease,which one of the following sets of enzymes would be most appropriate?
A) NTP,ALP,and \(\gamma\)-glutamyltransferase (GGT)
B) ALP,GGT,and CK
C) CHE,NTP,and CK
D) LD,CK,ALT,and AST
Q2) What transferase enzyme is involved in the conversion of the stored form of energy to usable energy (adenosine triphosphate [ATP])within cardiac myocytes?
A) Creatine kinase
B) Aspartate aminotransferase
C) Lactate dehydrogenase
D) Troponinase
Q3) Which of the following statements is incorrect concerning creatine kinase (CK)?
A) CK catalyzes the conversion of creatine and ADP to creatine phosphate and ATP.
B) Total CK activity can be elevated in skeletal muscle disease.
C) The subunits of CK can combine to form three different CK isoenzymes.
D) CK is classified as a transferase enzyme.
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Chapter 20: Tumor Markers and Cancer Genes
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Q1) The loss of a gene that codes for a tumor suppressor protein would predispose certain cells to cancerous transformation and unchecked proliferation.This class of genetic alteration is referred to as:
A) point mutation.
B) aneuploidy.
C) translocation.
D) deletion.
Q2) A 65-year-old man has been diagnosed with prostate cancer and is being prepared for radiation therapy.His physician is concerned that the cancer may have metastasized to the patient's skeletal system.Which one of the following laboratory analytes would give this information to the physician?
A) ALP
B) Calcitonin
C) AFP
D) Growth hormone
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22
Chapter 21: Kidney Function Test-Screatinine, Urea, and Uric Acid
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Q1) A hemolyzed serum sample from an individual is assayed for creatinine and a result is obtained that is decreased compared to the normal reference interval.If this individual has a normal glomerular filtration rate,which one of the following statements is true?
A) The individual's diet contains high levels of protein.
B) The individual must be receiving chemotherapy.
C) The assay must be subject to interference from bilirubin.
D) The assay must be subject to interference from ketones.
Q2) An individual's laboratory results indicate increased serum creatinine and urea values,and his physician's diagnosis indicates a postrenal obstruction.What would the glomerular filtration rate in this individual likely be?
A) Decreased
B) Increased
C) No change
Q3) Urea:
A) biosynthesis is carried out exclusively in the renal system.
B) is 100% reabsorbed (thus not excreted)by the kidney.
C) is decreased in plasma by a variety of renal diseases.
D) concentration in plasma is increased by a high-protein diet.
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Chapter 22: Carbohydrates
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Q1) What effect does septicemia have on blood glucose value?
A) Increases
B) Decreases
Q2) A type 1 diabetic who is in the early stages of the disease is taken to the emergency room with symptoms of hypoglycemia.Which one of the following endogenous hormones might be the cause of this?
A) Epinephrine
B) Glucagon
C) Cortisol
D) Lactate
Q3) In an individual with a normal hematocrit,whole-blood glucose values are approximately what percent different from plasma glucose values?
A) 20% higher
B) 10% lower
C) 50% higher
D) There is no difference between whole blood glucose and plasma glucose values.
Q4) What effect does glucagon have on blood glucose value?
A) Increases
B) Decreases
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Chapter 23: Lipids, lip-Oproteins, apolipoproteins, and
Other Cardiac Risk Factors
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Q1) The lipoprotein that,because it is considered proatherogenic,is often measured by the laboratory to assess the likelihood of CHD in an individual with normal lipid values but a strong family history of cardiovascular disease is:
A) LDL.
B) HDL.
C) lipoprotein(a).
D) chylomicrons.
Q2) The lipoprotein with the smallest diameter and that has a 50:50 lipid:lipoprotein ratio is the:
A) LDL.
B) chylomicron.
C) HDL.
D) VLDL.
Q3) The high-sensitivity detection method for CRP (hs-CRP)used to detect low concentrations of this protein is typically a(n):
A) colorimetric assay.
B) immunoassay.
C) light-scattering technique.
D) HPLC assay.
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Chapter 24: Electrolytes and Blood Gases
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Q1) Although aqueous fluid control materials are the most commonly used commercial controls for blood gas and pH measurements,what is their main disadvantage?
A) They are dissimilar to blood by having lower viscosity and surface tension.
B) They must be shaken vigorously before being opened.
C) The buffer that is used contains high levels of lead.
D) They overestimate pH because the buffer is a weak base.
Q2) The specimen of choice for measurement of potassium (K<sup>+</sup>)is plasma because:
A) anticoagulants preserve the potassium ionic activity better than serum.
B) platelets release potassium during the coagulation process in a serum sample.
C) hemolysis is easily avoided when obtaining a plasma sample.
D) the electrolyte exclusion effect is avoided in a plasma sample.
Q3) The high extracellular concentration of which cation contributes to the osmotic strength of extracellular fluid?
A) Chloride
B) Potassium
C) Sodium
D) Bicarbonate
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26
Chapter 25: Hormones
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Q1) An example of a protein hormone synthesized in the hypothalamus,with the principal action to control the release of thyroid-stimulating hormone,is:
A) prolactin.
B) thyroid stimulating hormone.
C) ACTH.
D) thyrotropin releasing hormone.
Q2) As part of homeostatic control by hormones,the metabolism of electrolytes and water balance is controlled in part by the renal system.What hormone synthesized by the kidneys affects water and electrolyte balance?
A) Aldosterone
B) Renin
C) Vasopressin; antidiuretic hormone (ADH)
D) Insulin
Q3) Considering the classification of hormones by structure,an example of a steroid hormone would be:
A) testosterone.
B) parathyroid hormone (PTH).
C) cortisol.
D) all of the above.
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Chapter 26: Catecholamines and Serotonin
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Q1) In the diagnosis of pheochromocytoma,what hormone is being assessed by measuring urine metanephrine?
A) Epinephrine
B) Dopamine
C) Serotonin
D) Norepinephrine
Q2) Measurement of urinary metanephrine and vanillylmandelic acid (VMA)assesses the amount of hormone secreted by the _____ and is done to detect the presence of
A) gastrointestinal (GI)tract; carcinoid tumor
B) adrenal medulla; pheochromocytoma
C) adrenal cortex; Cushing syndrome
D) medulla of the brain; neuroblastoma
Q3) Metabolism of norepinephrine and epinephrine in adrenal chromaffin cells requires the presence of which one of the following enzymes for conversion into normetanephrine and metanephrine?
A) Catechol-O-methyltransferase
B) Dopamine-\(\beta\)-hydroxylase
C) Tyrosine hydroxylase
D) Monoamine oxidase
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Chapter 27: Vitamins, Trace Elements, and Nutritional Assessment
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Q1) What is the common cause of vitamin B<sub>12 </sub>deficiency?
A) Hyperkeratosis
B) Scurvy
C) Pernicious anemia
D) Rickets
Q2) Chromium
A)Menkes disease
B)Lung cancer
C)Loss of immunocompetence
D)Parkinson disease-like symptoms
Q3) Copper
A)Menkes disease
B)Lung cancer
C)Loss of immunocompetence
D)Parkinson disease-like symptoms
Q4) Which vitamin is given to a newborn within minutes of birth?
A) D
B) B<sub>12</sub>
C) A
D) K
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Chapter 28: Hemoglobin, Iron, and Bilirubin
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Q1) Increased total iron in serum is common in all of the following except:
A) iron intoxication.
B) hemosiderosis.
C) chronic inflammation.
D) sideroblastic anemia.
Q2) What is the percent transferrin saturation given the following data: serum iron 150 \(\mu\)g/dL,TIBC 350 \(\mu\)g/dL,transferrin 300 mg/dL,and ferritin 65 ng/mL?
A) 43%
B) 55%
C) 233%
D) 500%
Q3) The two pairs of globin chains in normal HbA hemoglobin are:
A) alpha and gamma.
B) beta and gamma.
C) alpha and beta.
D) beta and delta.
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Chapter 29: Porphyrins and Porphyrias
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Q1) In the analysis of plasma porphyrins,porphyrins at neutral pH fluoresce between 610 to 640 nm.
A)True
B)False
Q2) The skin lesions observed in individuals with nonacute porphyria are caused by:
A) brain dysfunction and peripheral neuropathy.
B) excessive production of retinoic acid in the eye.
C) the excess of porphyrin intermediates in the liver.
D) the excess presence of porphyrins in the skin that generate oxygen radicals.
Q3) Moderate elevations of which of the following occur secondary to lead toxicity or iron-deficiency anemia?
A) Porphobilinogen
B) Protoporphyrin IX
C) ALA
D) Heme
Q4) An important amino acid in the synthesis of ALA is:
A) glutamine.
B) glycine.
C) cysteine.
D) methionine.
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Chapter 30: Therapeutic Drugs and Their Management
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Q1) A hospitalized patient is being given gentamicin to treat a gram-negative bacterial infection.The patient's physician contacts you regarding monitoring of this antibiotic because this patient is beginning to exhibit signs of hearing loss and renal failure.When you assess the patient's 10-hour postinfusion trough antibiotic concentration,it is increased.You learn from the physician that he has been dosing the patient to keep the antibiotic concentration high,"at a steady state" he tells you.You state that:
A) it would be better to change antibiotics because the patient is obviously allergic to gentamicin.
B) you have made an error in the method of assessment of this antibiotic and need to repeat the analysis.
C) with aminoglycoside antibiotics,trough concentrations must be allowed to decrease because of the postantibiotic effect.
D) aminoglycosides display peak level concentration-dependent killing of microorganisms and the dosage should be increased even more.
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Chapter 31: Clinical Toxicology
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Q1) Morphine
A)Ethanol
B)Barbiturate
C)Heroin
D)Ethylene glycol
Q2) In a chronic user of marijuana,the metabolite will remain in urine for what period of time?
A) 2 to 7 days
B) 3 to 4 weeks
C) Up to 73 days
D) 3 to 4 months
Q3) An individual who appears to be very inebriated is brought to a hospital emergency department by the police.Laboratory blood gas results indicate metabolic acidosis with an increased serum osmol gap,the presence of serum acetone,and many urine oxalate crystals.Which alcohol did this individual ingest?
A) Isopropanol
B) Ethanol
C) Methanol
D) Ethylene glycol
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Page 33
Chapter 32: Toxic Metals
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Q1) The occurrence of cell membrane damage causing normal cells to be replaced with fibroblasts occurs in the heart because of a deficiency of which one of the following metals?
A) Selenium
B) Chromium
C) Silica
D) Copper
Q2) What is the specimen of choice for determining arsenic exposure in an individual and why?
A) Urine is the specimen of choice because arsenic is concentrated in and excreted predominantly by kidneys.
B) Whole blood is the specimen of choice because blood concentrations remain elevated for at least 48 hours after exposure.
C) Serum is the specimen of choice because arsenic moves into the serum phosphate pool and is easily measured with phosphate.
D) Plasma is the specimen of choice because arsenic attaches to coagulation factors and affects clotting times best assayed in a plasma sample.
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Chapter 33: Diabetes
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Q1) Glucagon is made by the \(\alpha\)-cells in the pancreas and when released causes elevated blood glucose.By what mechanism does glucagon promote hyperglycemia?
A) Glucagon promotes hypoglycemia,not hyperglycemia.
B) Glucagon stimulates insulin release.
C) Glucagon promotes glycogenesis in all cells.
D) Glucagon stimulates glycogenolysis and gluconeogenesis.
Q2) Which of the following is characteristic of type 1A diabetes mellitus?
A) Normal blood insulin levels
B) Lack or decrease of functional insulin receptors on cells
C) Circulating autoantibodies formed against pancreatic insulin-secreting cells.
D) Individuals with this type of diabetes are not prone to ketosis.
Q3) Which one of the following antibodies is found most commonly in over 90% of children who develop type 1 diabetes before 5 years old?
A) Islet cell cytoplasmic antibodies
B) Insulin autoantibodies
C) Insulinoma-associated antigens
D) Zinc transporter ZnT8
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Chapter 34: Cardiovascular Disease
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Q1) In your clinical chemistry laboratory,you use an immunoassay to detect blood levels of NT-proBNP.You receive a filled green-top anticoagulant-containing plastic blood collection tube with a request for NT-proBNP.What is your next step?
A) Because this is an incorrect specimen type,contact the physician/nurse immediately and request a serum specimen.
B) Proceed,because this tube contains heparin and provides plasma after centrifugation,which is acceptable for the NT-proBNP assay.
C) Proceed,because this tube will provide serum after centrifugation,which is acceptable for the NT-proBNP assay.
D) Because only whole blood is acceptable,go ahead and run the test on the green-top tube.
Q2) Which one of the following cardiac markers is elevated for the longest period of time after a myocardial infarction?
A) Troponins
B) hs-CRP
C) CK-2 (CK-MB)
D) Myoglobin
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Page 36
Chapter 35: Kidney Disease
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Q1) In homeostatic regulation of plasma acid-base concentrations,sodium is both actively and passively exchanged in the tubules for which one of the following ions?
A) Bicarbonate
B) Carbon dioxide
C) Hydrogen
D) Potassium
Q2) Which of the following laboratory results would point to a diagnosis of acute nephritic syndrome in an individual who exhibits hypertension and edema?
A) Increased serum protein,increased GFR,hematuria
B) Increased white blood cells (WBCs)in the urine,bacteriuria,decreased GFR,proteinuria
C) Hematuria,sodium retention,decreased GFR,proteinuria
D) Normal serum urea and creatinine,increased GFR,massive proteinuria
Q3) The most common glomerular disease worldwide is:
A) acute proliferative glomerulonephritis.
B) acute pyelonephritis.
C) IgA nephropathy.
D) chronic kidney disease.
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Chapter 36: Physiology and Disorders of
Water,Electrolyte,and Acid-Base Metabolism
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Q1) Hypokalemia (<3.0 mmol/L)is considered a serious health threat because:
A) the heart rate increases,leading to weakness,difficulty in breathing,and eventual cardiac arrest.
B) the heart rate slows because of the lowered excitability of cardiac smooth muscle,leading to possible cardiac standstill.
C) the body gains water through the kidney reabsorption,leading to severe edema.
D) arterial pH will decrease (increased H<sup>+ </sup>concentration),leading to metabolic acidosis.
Q2) Hydrogen ions are exchanged for sodium or potassium
A)Metabolic component
B)Respiratory component
C)Both components
Q3) Which of the following conditions will cause an increased anion gap?
A) Salicylate intoxication
B) Controlled diabetes mellitus
C) Decreased albumin concentration
D) Severe diarrhea
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Page 38
Chapter 37: Liver Disease
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Q1) Alkaline phosphatase is a soluble enzyme localized in the cytosol of hepatocytes.
A)True
B)False
Q2) The type of RNA virus that is considered to be the cause of the most common type of acute hepatitis that does not lead to chronic hepatitis is:
A) hepatitis A virus.
B) hepatitis B virus.
C) hepatitis C virus.
D) Reye syndrome.
Q3) Cholangitis
A)Decreased flow of bile
B)Inflammation of bile ducts
C)Gallstones in bile ducts
D)Fibrosis of the liver
Q4) Cholestasis
A)Decreased flow of bile
B)Inflammation of bile ducts
C)Gallstones in bile ducts
D)Fibrosis of the liver
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Chapter 38: Gastrointestinal and Pancreatic Diseases
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Q1) A consequence of Crohn disease is bacterial overgrowth of the small bowel that normally contains few bacteria.Bacterial overgrowth further leads to:
A) bile salt deficiency and fat malabsorption.
B) excess hydrogen in the intestine and acid reflux disease.
C) lactase deficiency.
D) chronic pancreatitis and pancreatic islet destruction.
Q2) Which one of the following substances is not synthesized by the pancreas?
A) Gastrin
B) Somatostatin
C) Vasoactive intestinal polypeptide (VIP)
D) Insulin
Q3) During the gastric phase of the digestive process,HCl will be released from parietal cells following the _____ of gastrin from the mucosal endocrine cells in the stomach. A) release
B) inhibition
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Chapter 39: Disorders of Bone and Mineral Metabolism
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Q1) A blood specimen is collected in a heparin-containing tube for calcium and magnesium determination.Upon centrifugation,the plasma appeared hemolyzed.How would this affect the magnesium value?
A) There would be no effect on the magnesium value.
B) The magnesium would form complexes with the hemoglobin and the results would indicate a false negative value.
C) The magnesium would be incorporated into the bilirubin molecule,leading to a false negative value.
D) Because erythrocytes contain magnesium,hemolysis would increase its apparent value.
Q2) The primary physiological regulator of parathyroid hormone (PTH)synthesis and secretion is:
A) PTH releasing hormone from the pituitary gland.
B) the concentration of free calcium in blood or extracellular fluid.
C) the concentration of PTH in blood.
D) PTH stimulating hormone.
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Chapter 40: Disorders of the Pituitary
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Q1) Use of the cosyntropin stimulation test:
A) determines whether the hypothalamic-pituitary-thyroid axis is intact and functional.
B) involves measurement of serum gonadotropins and sex steroid hormones.
C) is indicated when a morning cortisol result is low in addition to indications of adrenal insufficiency.
D) assesses adequacy of GH secretion.
Q2) Which one of the following hormones is responsible for normal development of cartilage and bone,mobilizing fat stores,and stimulation of protein synthesis?
A) ADH
B) ACTH
C) GH
D) Prolactin
Q3) Inhibition of growth hormone (GH)occurs through the action of:
A) acetylcholine.
B) somatostatin release-inhibiting hormone.
C) norepinephrine.
D) gonadotropin-releasing inhibiting hormone.
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Chapter 41: Disorders of the Adrenal Cortex
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Q1) Because of the biochemical properties of steroid hormones,the majority of these hormones,at physiological concentration:
A) are bound with high affinity to a carrier protein in the circulation.
B) remain free in the circulation.
C) are conjugated to glucuronides.
D) are bound with low affinity to albumin.
Q2) Which one of the following statements concerning cortisol is incorrect?
A) Cushing syndrome is the syndrome of hypercortisolism.
B) A cortisol-secreting tumor can lead to Cushing disease.
C) Plasma cortisol levels show a diurnal variation,with the highest level present in the morning and the lowest level in the late afternoon.
D) Hypocortisolism due to primary adrenal disease is referred to as Addison disease.
Q3) How would CAH affect cortisol and adrenal androgen levels in blood?
A) Cortisol increased,adrenal androgens increased
B) Cortisol decreased,adrenal androgens increased
C) Cortisol increased,adrenal androgens decreased
D) Cortisol decreased,adrenal androgens decreased
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Page 43
Chapter 42: Thyroid Disorders
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Q1) Severe hypothyroidism that develops during the newborn period is referred to as:
A) thyrotoxicosis.
B) myxedema.
C) cretinism.
D) euthyroid sick syndrome.
Q2) Which of the following hormones require transport proteins to move them through the circulation and are more than 99% bound to these proteins?
A) TSH
B) Thyrotropin-releasing hormone
C) Calcitonin
D) T<sub>3</sub> and T<sub>4</sub>
Q3) Increased TSH,decreased T<sub>3</sub>,and decreased T<sub>4 </sub>with the presence of goiter indicate:
A) primary hypothyroidism.
B) secondary hypothyroidism.
C) tertiary hypothyroidism.
D) pseudohypothyroidism.
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44
Chapter 43: Reproduction-Related Disorders
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Q1) A 14-year-old male comes to his physician with infantile genitalia and the lack of development of any secondary sex characteristics.The patient is short in stature.Upon discussion of family history,it was discovered that several male relatives had similar defects in testicular development.Based on this information,laboratory results would indicate:
A) decreased testosterone and decreased follicle-stimulating hormone (FSH)/luteinizing hormone (LH).
B) decreased testosterone and elevated FSH/LH.
C) elevated testosterone and elevated FSH/LH.
D) elevated testosterone and decreased FSH/LH.
Q2) Prolactin
A)Occurrence of ovulation
B)Assesses ovarian function
C)Screens for fetal Down syndrome
D)Assesses amenorrhea
Q3) Estriol (E<sub>3</sub>)
A)Occurrence of ovulation
B)Assesses ovarian function
C)Screens for fetal Down syndrome
D)Assesses amenorrhea
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Chapter 44: Pregnancy and Prenatal Testing
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Q1) A pregnant woman,who has been previously diagnosed with preeclampsia,develops edema,headaches,and nausea over several weeks.She complains about a band of pain around the upper part of her abdomen.Her eyes and skin are yellow.Her obstetrician orders a full blood workup,including coagulation studies,CBC,liver enzyme profile,and electrolyte panel.Her serum appears hemolyzed.If this woman was diagnosed with preeclampsia originally,what might these laboratory results reveal?
A) Elevated liver enzymes,abnormal coagulation results,low platelet count,elevated sodium
B) Normal liver enzymes,elevated red blood cell count,elevated white blood cell count,normal coagulation studies,hypoproteinemia
C) Decreased liver enzymes,decreased albumin,decreased bilirubin,normal electrolytes,abnormal coagulation times
D) These symptoms are normal in a pregnant woman,so all lab results would be within healthy reference intervals.
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Chapter 45: Newborn Screening and Inborn Errors of Metabolism
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Q1) A newborn screening test using a dried blood spot is positive for congenital adrenal hyperplasia (CAH).What laboratory testing would be done next?
A) No next step as this test is the confirmatory analysis
B) DNA analysis of genetic mutation
C) A stimulating hormone test
D) A second-tier test for CAH,such as an MS/MS steroid profile
Q2) Of the following,what is the inborn error of metabolism for maple syrup urine disease?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
Q3) The disorder that is identified by increased serum carnitine and urine glutaric acid on newborn screening is:
A) PKU.
B) tyrosinemia.
C) glutaric acidemia type 1.
D) glycine encephalopathy.
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Chapter 46: Pharmacogenetics
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Q1) The enzyme that metabolizes 5-fluorouracil is:
A) DPD.
B) TMPT.
C) CYP2D6.
D) NAT1.
Q2) A drug substrate for the metabolizing enzyme CYP2D6 is:
A) tamoxifen.
B) codeine.
C) diazepam.
D) irinotecan.
Q3) A pharmacogenetic drug-gene target would be most successful when clinically implemented when it:
A) is associated with a clinically significant effect on the relationship between drug dose and plasma concentration.
B) does not involve a major metabolic pathway but instead is involved in alternate pathways.
C) indicates alternative drugs that are much more efficient than conventional drugs in producing a dose-response.
D) allows for an extended period of time for changes to be made in drug dosing.
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Page 48
Chapter 47: Principles of Molecular Biology
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Q1) The most basic level of chromatin organization that is present as repeated units along the full length of each chromosome is represented by the:
A) histone.
B) nucleosome.
C) purine.
D) spliceosome.
Q2) Which one of the following statements concerning the difference between DNA and RNA is correct?
A) The four nucleotide building blocks of RNA include thymosin,cytosine,guanine,and adenine.
B) RNA exists typically as a single-stranded polymer that is much shorter than DNA.
C) DNA is composed of a sugar unit,ribose,with an added hydroxyl group at the 2' position.
D) DNA molecules can interact to form complex tertiary structures related to the novel functions of DNA.
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Chapter 48: Nucleic Acid Techniques and Applications
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Q1) An example of a signal amplification technique (as opposed to a target or probe amplification technique)would be:
A) polymerase chain reaction.
B) branched-chain amplification.
C) ligase chain reaction.
D) real-time PCR.
Q2) You have prepared a restriction enzyme digest of DNA from an individual who might have a genetic disorder.On the gel,you note that the digest from this individual produces one fragment,whereas the digest from a normal healthy individual produces two fragments.All controls worked correctly and you used the same reagents for all testing.What is your interpretation?
A) The enzymes were not working.
B) The diseased individual's DNA is missing a restriction site.
C) You must have skipped the amplification step.
D) The normal individual's DNA is missing a restriction site.
Q3) The annealing step in a PCR involves:
A) binding of the primers to the single-stranded DNA.
B) unwinding and separating the double-stranded DNA.
C) adding nucleotides to primed sites of the DNA strands.
D) making a cDNA from an mRNA strand.
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Chapter 49: Genomes and Nucleic Acid Alterations
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Q1) On average,how much of a gene sequence is removed as introns,leaving the exons to be spliced together and translated into protein?
A) 100%
B) 95%
C) 50%
D) 1%
Q2) In the following sequences,the normal amino acid sequence is given first followed by a sequence that is produced by a sequence alteration.Identify the type of sequence alteration that most likely causes the altered amino acid sequence. Normal Sequence: Phe-Asn-Pro-Thr-Arg
Mutated Sequence: Phe-Asn-Pro
What type of sequence alteration most likely caused the mutation?
A) Indel
B) Missense
C) Nonsense
D) There is no alteration.
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