Clinical Laboratory Science Exam Review
Course Introduction
Clinical Laboratory Science is a multidisciplinary field focused on the analysis of bodily fluids and tissues to aid in the diagnosis, treatment, and monitoring of diseases. This course covers the theoretical foundations and practical skills necessary for laboratory testing, including hematology, microbiology, clinical chemistry, immunology, and molecular diagnostics. Students learn about laboratory instrumentation, quality assurance, safety protocols, and the interpretation of laboratory results. Emphasis is placed on the critical role of clinical laboratory professionals in the healthcare system, as well as ethical considerations and effective communication with healthcare teams.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Chapter 1: Basic Laboratory Principles and Techniques
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Q1) 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
Q2) Which of the following water purification techniques is most effective in removing dissolved ionized gases?
A)distillation
B)deionization
C)reverse osmosis
D)ultrafiltration
Answer: B
Q3) How many mL of a 10 mg/L solution must be diluted to 100 mL to produce 100 mL of a 0.1 mg/dL solution?
A)1 mL
B)5 mL
C)10 mL
D)50 mL
Answer: C
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Chapter 2: Spectral Techniques
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Q1) In the clinical laboratory, the primary problem with the use of fluorescent techniques is that:
A)this technique is not a very sensitive technique as compared to other spectrophotometric techniques.
B)the flame may not be hot enough to totally dissociate some of the complexes.
C)many compounds do not fluoresce in their natural state.
D)all of the stray light produced in the instrument cannot be filtered out.
Answer: C
Q2) Holmium oxide and didymium filters are used to perform which of the following quality-control checks on spectrophotometers?
A)wavelength accuracy
B)linearity of detector response
C)stray light
D)photometric accuracy
Answer: A
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Chromatographic attractive forces that result from one molecule inducing a temporary separation of charges in an adjacent molecule are known as:
A)dispersive (van der Waals) forces
B)dipolar forces
C)hydrogen bonding forces
D)dielectric forces
Answer: A
Q2) 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
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Chapter 4: Chromatographic Techniques
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Q1) Given that the base peak (m/z = 112) in a mass spectrum has an initial relative abundance of 75% and the peak at m/z 125 has an initial relative abundance of 30%, what will be the relative abundance of the two peaks following normalization? (answer format: relative abundance for m/z 112, relative abundance for m/z 125)
A)22.5%, 100%
B)250%, 100%
C)100%, 22.5%
D)100%, 40%
Q2) Which of the following identifies a purpose for the use of internal standardization in chromatography?
A)It compensates for loss during sample preparation, injection imprecision, and detector variation.
B)It allows for analyte quantification.
C)It serves as a quality-control check.
D)All of the above
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6
Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Given that Hb Barts elutes first and Hb C elutes last using cation exchange HPLC, which of the following statements most accurately describes the charge of these hemoglobins under chromatographic conditions?
A)Hb C is more positively charged than Hb Barts.
B)Hb Barts is more positively charged than Hb C.
C)Hb C has no positive charge, whereas Hb Barts has a positive charge, D)Hb C is more negatively charged than Hb Barts
Q2) Hb A2 is often falsely elevated in the presence of __________ and falsely reduced in the presence of ________.
A)Hb S, Hb D-Punjab
B)Hb F, Hb D-Punjab
C)Hb S, Hb C
D)Hb F, Hb C
Q3) Which of the following is considered the most powerful analytical tool in the laboratory analysis of hemoglobin variants?
A)electrophoresis
B)high-pressure liquid chromatography
C)radial immunodiffusion
D)densitometry
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Page 7
Chapter 6: Electrophoresis
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Q1) Considering serum protein electrophoresis using an agarose gel medium, the main purpose of the medium is:
A)to allow electrophoretic migration of proteins to occur
B)to provide a site to bind the protein to, once separation is complete
C)to bind the stain for visualization of the separated proteins
D)to prevent other macromolecules, such as lipids, from interfering with serum protein electrophoresis
Q2) When considering the factors that influence the mobility of macromolecules, the relaxation effect would tend to ________ electrophoretic mobility, because there is a momentary ________.
A)lower, formation of a double layer of charge about the macromolecule
B)increase, neutralization of charge around the macromolecule
C)lower, electrical field that acts in the opposite direction to the applied field
D)increase, enhanced electrical field that acts in the same direction as the applied field
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Chapter 7: Immunological Reactions
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Q1) Is the following statement true or false? If false, identify the part of the statement that causes it to be false.
Kappa and lambda light chains differ in the amino-acid sequence of their constant regions.A given antibody always has two identical kappa light chains or two identical lambda light chains.An antibody molecule can never have both a kappa and a lambda chain.
A)true
B)false, light chains have the same amino-acid sequence in their constant regions
C)false, a given antibody can have different kappa or lambda light chains in the same molecule
D)false, an antibody can have both a kappa and lambda light chain in the same molecule
Q2) Antibodies are ______ that are produced by the _______.
A)lipids, adipose cells
B)carbohydrates, bone marrow cells
C)nucleic acids, hepatocytes
D)proteins, B lymphocytes
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Chapter 8: Immunochemical Techniques
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Q1) Which of the following provides the correct explanation for a decrease in light scatter as concentration of hapten (such as a drug) increases in nephelometric inhibition immunoassay (NINIA)?
A)As the concentration of hapten (drug) increases, the excess of antibody decreases, resulting in less light scatter.
B)As the concentration of hapten (drug) increases, more soluble hapten (drug)-antibody complexes form, reducing the amount of light scatter.
C)As the concentration of hapten (drug) increases, more hapten (drug)-antibody complexes form, which fix complement and destroy the complex, reducing the amount of light scatter.
D)As the concentration of hapten (drug) increases, more insoluble hapten (drug)-antibody complexes form, resulting in less light scatter.
Q2) The direct Coombs' test measures the presence of antibody _______, and the indirect Coombs' test measures _______.
A)in the serum, antigens on cells
B)on cells, antigens on cells
C)in the serum, free antibodies in the serum
D)on cells, free antibodies in the serum
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) In ____________ competitive-binding assays, paramagnetic particles are used to capture and concentrate bound label on the surface of an electrode.
A)luminescent oxygen channeling
B)microparticle-based light-scattering
C)enzyme multiplied
D)electrochemiluminescent
Q2) The use of avidin-biotin systems in ELISA serve to:
A)improve the time requirements of the assay
B)overcome diminished antibody capturing capacity in the assay
C)improve the fluorogenic nature of the assay
D)overcome the need for sample extraction prior to performing the assay
Q3) In the fluorescence polarization immunoassay (FPIA) technique, the amount of polarized fluorescent light detected when the fluorophore is excited with polarized light is higher for:
A)low-molecular-weight fluorescence-labeled ligands not bound to antibody
B)low-molecular-weight non-labeled ligands not bound to antibody
C)low-molecular-weight fluorescence-labeled ligands bound to antibody
D)low-molecular-weight non-labeled ligands bound to antibody
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Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Select the causative agent for the following diseases: peptic ulcer, syphilis, herpes, Lyme disease.
A)Treponema pallidum, Borrelia burgdorferi, Helicobacter pylori, Epstein-Barr virus
B)B.burgdorferi, Epstein-Barr virus, T.pallidum, H.pylori
C)H.pylori, T.pallidum, Epstein-Barr virus, B.burgdorferi
D)Epstein-Barr virus, H.pylori, B.burgdorferi, T.pallidum
Q2) Which immunoglobulin will dominate the later portion of the primary immune response and subsequent amnestic response?
A)IgG
B)IgM
C)IgA
D)IgE
Q3) The classic technique used in the laboratory for detection of the Epstein-Barr virus is the:
A)hemagglutinin inhibition test
B)complement fixation test
C)temperature solubility test
D)heterophile antibody test
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Chapter 11: Measurement of Colligative Properties
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Sample Questions
Q1) Osmometers utilizing the freezing point colligative property of solutions are based on what principle?
A)1 osmole of nonionizing substance dissolved in 1 kilogram of water raises the freezing point 1.86°C.
B)1 osmole of nonionizing substance dissolved in 1 kilogram of water lowers the freezing point 1.86°C.
C)Increased solute concentration will raise the freezing point of water in direct proportion to a NaCl standard.
D)Deceased solution concentration will lower the freezing point of water in direct proportion to a NaCl standard.
Q2) What is the purpose for calculating an osmolal gap?
A)This serves as a quality-control measure of osmolality measurement.
B)This serves as an indication of abnormal concentrations of unmeasured substances in the blood stream.
C)This is the method utilized to calibrate the osmometer.
D)This removes the need for direct measurement of osmolality.
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13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) What is the most important variable to control during the measurement of ionized calcium by ion-selective electrode methodology?
A)the degree of oxygen exposure
B)the pH of the sample
C)the response time of the instrument
D)all of the above
Q2) Carbon dioxide and ammonia electrodes are identical in that they utilize the same ______ and are different in that they utilize different ______.
A)pH electrode for measurement, gas-selective membranes
B)pH electrode for measurement, ionophores
C)gas-selective membranes, reference electrodes for quantification
D)gas-selective membranes, filling solutions around the electrode
Q3) In potentiometric measurements, the voltage difference between the indicator and reference electrodes is proportional to:
A)ion activity
B)ion concentration
C)the logarithm of ion activity
D)the logarithm of ion concentration
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Chapter 13: Molecular Diagnostics
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Q1) The mutation-detection technique that incorporates a set of immobilized DNA probes for different sequence variants to which PCR amplified DNA is added is known as:
A)PCR-mediated site-directed mutagenesis (PSM) technique
B)amplification refractory mutation system (ARMS) technique
C)allele-specific oligonucleotide hybridization (ASO or dot blot) technique
D)reverse dot blot technique
Q2) Select the order of processes in the polymerase chain reaction cycle.(Steps are listed in the order performed with the first step listed first.)
A)denaturation, primer annealing, polymerase extension
B)primer annealing, denaturation, polymerase extension
C)polymerase extension, denaturation, primer annealing
D)polymerase extension, primer annealing, denaturation
Q3) ____________ forms the basis for almost all types of DNA detection methods.
A)denaturation
B)hybridization
C)restriction fragment length polymorphism (RFLP)
D)amplification
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Chapter 14: Therapeutic Drug Monitoring
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Q1) 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
Q2) Different formulations of drugs from different manufacturers may influence the blood level-time curves following the administration of a single dose of medication.If all of the drug is eventually released from the different formulations, which of the following statements describes the correlation between these different formulations?
A)The time the drug spends in the body will be the same for all formulations.
B)The peak concentration will be the same for all formulations.
C)The duration of the peak concentration will be the same for all formulations.
D)The area under the blood level-time curve for each formulation will be the same.
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Chapter 15: Clinical Enzymology
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Q1) A/An ______ is a non-protein organic material that is one type of cofactor that may be needed for the ______form of the enzyme being measured.
A)activator, apoenzyme
B)coenzyme, holoenzyme
C)activator, holoenzyme
D)coenzyme, apoenzyme
Q2) Calculate the enzyme activity in IU/L, given the following information.
Change in absorbance over 7 minutes = 0.350
Molar absorptivity = 6.22 × 10³ L/mol cm
Light path = 1 cm
Total assay volume = 3.0 mL
Total sample volume = 0.5 mL
A)0.3 IU/L
B)1.3 IU/L
C)48 IU/L
D)338 IU/L
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) All of the following statements are true about the LD isoenzyme except:
A)LD preferably catalyzes the conversion of lactate to pyruvate.
B)LD predominates in tissues that receive a high oxygen supply.
C)LD is found in high concentration in postpubertal testes.
D)LD is found in high concentration in cardiac muscle and erythrocytes.
Q2) All of the following statements are true about the LD isoenzyme except:
A)LD has approximately a 10-fold greater affinity for pyruvate than does LD<sub>1</sub>.
B)LD is a tetramer that consists of four H subunits.
C)LD predominates in tissues that are primarily anaerobic.
D)LD is found in high concentration in skeletal muscle and liver.
Q3) The most common enzyme group associated with posttranslational proteolytic cleavage of enzymes is:
A)oxidoreductases
B)peptidases
C)transferases
D)isomerases
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Chapter 17: Interferences in Chemical Analysis
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Q1) 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
Q2) Which of the following techniques would be useful for the correction of protein buildup on a spectrophotometer flow cell in an automated analyzer?
A)two-point kinetic analysis
B)bichromatic analysis
C)sample dilution
D)both a and b
Q3) Which of the following interferences will have the greatest impact on nephelometric and turbidimetric measurements?
A)hemolysis
B)lipemia
C)icterus
D)both a and c
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19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Given that all of the following analytes show circadian variation, which one is known to be higher in the afternoon and evening than in the morning?
A)cortisol
B)ACTH
C)TSH
D)iron
Q2) Cyclic variations refer to changes in concentration of analytes that occur in a predictable manner.______ variation is a phrase used to describe reproducible variation that occurs during the course of a single day, and ______ variation is a phrase used to describe reproducible variation that occurs over a period of greater than one day.
A)circannual, circadian
B)circadian, infradian
C)infradian, circannual
D)circadian, circannual
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20
Chapter 19: Laboratory Management
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Q1) Based on CLIA '88 regulations, which of the following are permitted to evaluate the competency of all testing personnel?
1)the laboratory director
2)the technical consultant
3)the technical supervisor
4)the general supervisor
A)1, 2, 3, 4
B)1, 2, 4
C)2, 3, 4
D)3, 4
Q2) A quality-assurance program is designed to:
1)monitor and evaluate the ongoing quality of the total testing process
2)identify and correct problems
3)ensure accurate, reliable, and prompt reporting of results
4)ensure adequacy and competency of the staff
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
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Chapter 20: Laboratory Automation
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Q1) In almost all systems, sample is introduced into an analyzer with a thin, stainless-steel probe.A potential problem with these probes is the risk of clots.As the amount of sample to be introduced into the analyzer decreases, the diameter of the probe ______, and the risk of clots ______.
A)increases, increases
B)decreases, increases
C)increases, decreases
D)decreases, decreases
Q2) Which of the following is/are advantages of the middleware concept over the use of a LIS alone?
A)Middleware can be connected to a number of analyzers and provide a central workstation in the laboratory to monitor quality functions.
B)Middleware may allow reduction of staff assigned to instruments.
C)Middleware allows for information to flow from laboratory analyzers to the software where decision rules are applied.
D)All of the above are advantages of the middleware concept.
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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Gram stains are sometimes performed as POCT and are classified as
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
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 a CLIA '88 Provider-Performed Microscopy test?
A)urine sediment examination
B)fecal leukocyte examination
C)trichomonas
D)fern testing
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Chapter 22: Laboratory Information Systems
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Q1) 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
Q2) 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
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Chapter 23: Laboratory Statistics
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Q1) Suppose there is a set of normally distributed data from which a normal reference interval for health is to be determined.If the reference interval is set as 0 ± 2s , what percentage of normal healthy individuals will fall outside the normal reference interval for health?
A)0 (none)
B)0.28%
C)2.14%
D)4.56%
Q2) The F-test is considered a measure of ______ between two sets of data, and the t-test is considered a measure of ______ between two sets of data.______ is/are considered as a parametric comparison.
A)accuracy, precision, the F-test
B)precision, accuracy, both tests
C)accuracy, precision, both tests
D)precision, accuracy, the t-test
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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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
Q2) An urologist's office has a high likelihood of encountering patients with prostate cancer.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) CLSI guidelines recommend that the reference interval be estimated by the nonparametric method and that a minimum of _______ reference values be utilized for reference-interval determination.
A)75
B)120
C)200
D)300
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Page 26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) 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
Q2) An abrupt and sustained change of control values in one direction is known as a ______, and a gradual change of control values in one direction is known as a ______.
A)random error, trend
B)trend, shift
C)shift, trend
D)shift, random error
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Chapter 26: Evaluation of Methods
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Q1) Which of the following factors can contribute to random analytical errors?
A)instability of the instrument
B)variability in handling techniques such as pipetting
C)variations in the reagents and calibrators
D)all of the above
Q2) When considering application characteristics, emphasis may be placed on ______ for pediatric applications, on ______ for stat applications, and on ______ for high-volume screenings.
A)sample size, turnaround time and interrupt features, sample throughput rate
B)turnaround time and interrupt features, sample throughput rate, sample size
C)sample throughput rate, sample size, turnaround time and interrupt features,
D)turnaround time and interrupt features, sample size, sample throughput rate
Q3) All of the following describe the within-run replication experiment except:
A)It is the simplest type of study.
B)It measures the constant systematic error caused by the presence of a substance suspected of interfering with the test method.
C)It allows assessment of precision over a very short time.
D)It should be performed with samples whose matrix is as similar as possible to that of the intended patient samples.
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Page 28
Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) Which of the following statements is not true of triglycerides?
A)Triglycerides are esters that are formed during the reaction of an alcohol function and a carboxylic acid function.
B)Triglycerides are easily hydrolyzed into glycerol and free fatty acids.
C)The dietary fats we ingest are mostly triglycerides.
D)The fatty acids that are found in a single triglyceride molecule are always the same.
Q2) 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
Q3) The three-dimensional spatial arrangement of multiple polypeptide chains forming larger, more stable complexes is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Given the following patient results, which statement is true?
Sodium = 136 mEq/L
Potassium = 4.3 mEq/L
Chloride = 99 mEq/L
Bicarbonate = 22 mEq/L
Measured serum osmolality = 283 mOsm/kg
Glucose = 288 mg/dL
BUN = 45 mg/dL
A)The electrolytes are in balance, and the value obtained for osmolality correlates with the other data.
B)The electrolytes are not in balance, but the value obtained for osmolality correlates with the other data.
C)The electrolytes are in balance, but the value obtained for osmolality does not correlate with the other data.
D)The electrolytes are not in balance, and the value obtained for osmolality does not correlate with the other data.
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Sample Questions
Q1) 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
Q2) Which of the following normal reference intervals is incorrect for an arterial blood sample?
A)pH = 7.35 - 7.45
B)pCO = 24 - 28 mmHg
C)HCO = 22 - 26 mmol/L
D)TCO = 23 - 27 mmol/L
Q3) A normal total CO , increased pCO , and decreased pH is most correctly classified as:
A)uncompensated metabolic acidosis
B)compensated metabolic acidosis
C)uncompensated respiratory acidosis
D)compensated respiratory acidosis
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Chapter 30: Renal Function
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Sample Questions
Q1) The kidney is able to carry out its complex functions because approximately ______of the volume of blood pumped by the heart into the systemic circulation is circulated through the kidneys.Therefore, the kidneys, which constitute about ______ of total body weight, receive ______ of the cardiac output.
A)25%, 0.5%, 1/4
B)0.5%, 25%, 1/4
C)25%, 0.5%, 1/2
D)50%, 25%, 1/2
Q2) The following are findings in a microscopic urinalysis.What is the laboratory diagnosis?
4+ protein
0 to 10 RBCs per high power field
0 to 5 WBCs per high power field
0 bacteria
Oval fat bodies
Hyaline casts
A)glomerulonephritis
B)nephrotic syndrome
C)pyelonephritis
D)these are normal urine findings
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Page 32
Chapter 31: Liver Function
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Sample Questions
Q1) Which of the following sets of screening tests and confirmatory tests would be best when diagnosing Wilson's disease?
A)screening tests: serum iron, iron-binding capacity, ferritin; confirmatory test: HFE gene analysis
B)screening tests: ANA, anti-smooth muscle; confirmatory test: liver biopsy
C)screening tests: serum iron, serum/urine copper; confirmatory test: HFE gene analysis, liver biopsy
D)screening test: ceruloplasmin, serum/urine copper; confirmatory test: liver biopsy; genetic studies
Q2) The liver is supplied by what major source(s) of oxygen-containing blood?
A)the hepatic artery
B)the portal vein
C)the hepatic vein
D)both a and b
Q3) All of the following are common causes of acute hepatitis except:
A)non-alcoholic fatty liver disease (NAFLD)
B)hepatitis A virus (HAV)
C)hepatitis B virus (HBC)
D)hepatitis C virus (HCV)
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Page 33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) What would be the laboratory interpretation of the following laboratory data for a hepatitis B serology profile?
HBsAg - negative
AHBcT - negative
AHBs - negative
A)susceptible
B)immune due to natural infection
C)immune due to vaccination
D)acutely infected
Q2) The following information is characteristic of which hepatitis virus?
Viral classification - Picornaviridae
Viral envelope - absent
Incubation time (days to clinical symptoms) - 10 to 50 days
Route of transmission - oral/enteral
Genomen - positive ssRNA
Size of genome - 7.5 kbases
A)HAV
B)HBV
C)HCV
D)HDV
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Page 34
Chapter 33: Bone Disease
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Sample Questions
Q1) Which of the following qualify as criteria for a female patient to have a bone-density scan?
A)over 65 years old
B)postmenopausal with at least one risk factor besides menopause, or with a fracture
C)on prolonged hormone-replacement therapy
D)all of the above
Q2) In the blood stream, calcium exists in three forms: ______ of total serum calcium is the biologically active ionized calcium, ______ is protein bound, mainly to albumin, and ______ is complexed to anions.
A)10%, 45%, 45%
B)45%, 45%, 10%
C)35%, 10%, 55%
D)10%, 55%, 35%
Q3) 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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35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) The principal cations in pancreatic fluid are:
1)sodium
2)potassium
3)calcium
4)magnesium
5)chloride
A)1, 2, 3, 4
B)1, 2, 3, 5
C)2, 3, 4, 5
D)1, 3, 4, 5
Q2) In cystic fibrosis, pancreatic secretions are of a/an ______ viscosity and a/an ______ volume, which leads to a greatly ______ pancreatic flow.
A)increased, decreased, decreased
B)decreased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
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36
Chapter 35: Gastrointestinal Function
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Q1) Which of the following hormones is produced by the mucosa of the upper small intestine and functions to stimulate gall bladder and stomach contraction?
A)cholecystokinin
B)gastrin
C)secretin
D)motilin
Q2) Which of the following is a function of parietal cells?
A)to produce hydrochloric acid and intrinsic factor
B)to produce the proenzyme pepsinogen
C)to secrete a protective layer of mucus to protect stomach mucosa from attack by acid and enzymes
D)to produce the hormone gastrin
Q3) Which of the following is not a function of gastrin?
A)stimulates stomach acid secretion
B)stimulates stomach contraction
C)stimulates intestinal motility
D)stimulates growth of small bowel mucosa
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Chapter 36: Cardiac and Muscle Disease
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Q1) The resting heart's fuel of choice is ______, but upon the imposition of a heavy workload, the heart will greatly increase its rate of ______ consumption.
A)free fatty acids, glucose
B)glucose, lactate
C)lactate, free fatty acids
D)glucose, free fatty acids
Q2) Troponin remains elevated in blood for how long after a myocardial infarction?
A)4 to 10 days
B)4 to 10 hours
C)3 to 7 days
D)3 to 7 hours
Q3) Of the drugs used to treat cardiac muscle disease, which of the following requires the closest laboratory monitoring of drug concentration in the body?
A)lidocaine
B)digoxin
C)quinidine
D)procainamide
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) 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
Q2) At birth, serum cholesterol levels are approximately ______, and the level steadily increases with age at a rate of approximately ______ per year.
A)65 mg/dL, 1.5 mg/dL
B)50 mg/dL, 2.5 mg/dL
C)65 mg/dL, 2.5 mg/dL
D)50 mg/dL, 1.5 mg/dL
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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) According to the Carpenter-Coustan OGTT for gestational diabetes, a fasting value of greater than ______ or a random value of greater than ______ suggests gestational diabetes, if subsequently confirmed.
A)100 mg/dL, 150 mg/dL
B)126 mg/dL, 200 mg/dL
C)100 mg/dL, 200 mg/dL
D)126 mg/dL, 150 mg/dL
Q3) Which of the following metabolic pathways provides the greatest amount of ATP per mole of glucose?
A)anaerobic glycolysis
B)aerobic glycolysis
C)tricarboxylic acid cycle and linked oxidative phosphorylation
D)glycogenesis
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Page 40
Chapter 39: Iron and Porphyrin Metabolism
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Q1) In hepatic porphyria cutanea tarda, which of the following will show the greatest increase?
A)urinary porphobilinogen
B)urinary uroporphyrin
C)fecal coproporphyrin
D)fecal protoporphyrin
Q2) In which of the following neurological porphyrins is a parallel increase in -aminolevulinic (ALA) acid and porphobilinogen (PBG) not seen?
A)acute intermittent porphyria
B)variegate porphyria
C)hereditary coproporphyria
D)porphyria cutanea tarda
Q3) Which of the following is considered the most appropriate method for quantifying porphyrins in blood or urine?
A)spectrophotometry
B)nephelometry
C)turbidity
D)fluorometry
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Chapter 40: Hemoglobin
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Q1) The problem with methemoglobin is:
A)it cannot bind oxygen reversibility.
B)it has a higher affinity for carbon monoxide than carbon dioxide.
C)it has a much higher affinity for carbon monoxide than oxygen.
D)it has a much higher affinity for carbon dioxide than oxygen.
Q2) A shift of the oxygen dissociation curve to the left indicates:
A)increased oxygen-binding capacity of hemoglobin at a given oxygen tension and increased oxygen release to tissues
B)increased oxygen-binding capacity of hemoglobin at a given oxygen tension and decreased oxygen release to tissues
C)decreased oxygen-binding capacity of hemoglobin at a given oxygen tension and decreased oxygen release to tissues
D)decreased oxygen-binding capacity of hemoglobin at a given oxygen tension and increased oxygen release to tissues
Q3) M-hemoglobins are derived from:
A)methemoglobin
B)sulfhemoglobin
C)carboxyhemoglobin
D)glycosylated hemoglobin A
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Page 42
Chapter 41: Human Nutrition
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Q1) Which nutritionally important macromineral plays a major role in fluid and electrolyte balance, is the major extracellular fluid anion, and contributes to osmolality? A deficiency of this macromineral may occur as result of vomiting and diarrhea.
A)calcium
B)magnesium
C)chloride
D)phosphorus
Q2) The hypermetabolic state can be associated with all of the following except:
A)major burns
B)peritonitis
C)bone fractures
D)starvation
Q3) Which of the following proteins considered for laboratory use in nutritional assessment is present in highest concentration in the blood stream and has the longest half-life?
A)albumin
B)transferrin
C)prealbumin
D)retinol-binding protein
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Page 43
Chapter 42: Trace Metals
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Sample Questions
Q1) Treatment of lead poisoning involves the use of a chelating agent.The effectiveness of this treatment is monitored in the laboratory by measuring lead levels in which of the following specimens?
A)serum
B)plasma
C)red blood cell hemolysate
D)urine
Q2) Which of the following correctly compares the relative toxicity of the various forms of mercury (most toxic first and least toxic last)?
A)elemental mercury, inorganic mercury, organic mercury
B)organic mercury, inorganic mercury, elemental mercury
C)inorganic mercury, organic mercury, elemental mercury
D)inorganic mercury, elemental mercury, organic mercury
Q3) Which of the following elements is an important component of thyroid hormones?
A)fluorine
B)iodine
C)manganese
D)molybdenum
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44
Chapter 43: Vitamins
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Sample Questions
Q1) It is reasonable to expect a request for the laboratory analysis of fat-soluble vitamins in which of the following conditions?
A)pancreatic insufficiency
B)alcoholic liver disease
C)presence of steatorrhea
D)all of the above
Q2) In the general comparison of fat-soluble and water-soluble vitamins, ______ vitamins are generally expected to be stored longer in the body, and a deficiency of ______ vitamins may develop in a short period of time.
A)fat-soluble, fat soluble
B)fat-soluble, water-soluble
C)water-soluble, fat-soluble
D)water-soluble, water-soluble
Q3) Vitamin A toxicity:
A)can occur as a result of overmedication with vitamin supplements.
B)can result from the use of topical retinoids for acne.
C)can cause dry skin, bone pain, fatigue, and renal disorders.
D)all of the above
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Chapter 44: Pregnancy and Fetal Development
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Q1) Physiological jaundice occurs in the newborn as a result of which of the following actions being slow to develop after birth?
A)the ability of the liver to remove unconjugated bilirubin from the blood stream
B)the ability of the liver to conjugate bilirubin
C)the ability of the liver to excrete bilirubin
D)all of the above
Q2) Given the following laboratory data, which is most likely associated with fetal lung immaturity in a blood-contaminated amniotic fluid sample?
A)L/S ratio = 1.5, PG = negative
B)L/S ratio = 2.0, PG = positive
C)L/S ratio = 2.7, PG = negative
D)L/S ratio = 1.0, PG = positive
Q3) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
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Chapter 45: The Newborn
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Q1) Which of the following are potential problems with the use of whole blood for laboratory analyses?
1)the presence of undetected hemolysis in a whole-blood sample
2)the continuation of glycolysis after whole-blood collection
3)the interference of the anticoagulant with the laboratory analysis of analytes in whole blood
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following begin to accumulate in the developing fetus during the third trimester of pregnancy?
1)calcium
2)phosphate
3)glucose
4)iron
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
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Page 47
Chapter 46: Extravascular Biological Fluids
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Q1) Which of the following statements are true of normal synovial fluid?
1)It acts as a lubricant to minimize the friction between bones during movement or weight bearing.
2)It provides the sole nutrition for cartilage.
3)It is a dialysate of plasma mixed with hyaluronic acid.
4)It contains fibrinogen, and spontaneous clotting can occur.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) 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
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Chapter 47: Nervous System
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Q1) Which of the following statements describe the ability of penicillin to cross the blood-brain barrier?
A)Penicillin freely crosses the intact blood-brain barrier.
B)Penicillin does not cross the intact blood-brain barrier.
C)Penicillin crosses the blood-brain barrier once the permeability of the barrier is altered by inflammation.
D)both b and c
Q2) The following laboratory results were obtained on a patient suffering from depression, fatigue, and apathy.These data provide laboratory evidence of which disease?
Serum cortisol - decreased
Serum sodium - decreased
Serum potassium - increased
A)Addison's disease
B)hypothyroidism
C)Cushing's syndrome
D)liver failure
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Chapter 48: General Endocrinology
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Q1) Which of the following laboratory tests is most useful in distinguishing between hypothalamic and pituitary causes of thyroid dysfunction?
A)TRH stimulation test
B)TSH
C)T
D)T
Q2) The most commonly utilized challenge test to assist in evaluating a potential growth hormone deficiency is the:
A)insulin challenge test
B)dexamethasone suppression test
C)oral glucose tolerance test
D)LH-RH challenge test
Q3) Under normal physiological conditions, what process functions to maintain relatively constant levels of circulating hormones?
A)circadian rhythm
B)feedback control
C)hypothalamic stimulation
D)second messenger control
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Chapter 49: Thyroid
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Q1) In patients with developing subclinical hyperthyroidism, TSH levels will likely be ______, and fT will likely be ______.
A)decreased, increased
B)increased, decreased
C)decreased, normal
D)increased, normal
Q2) Thyroid hormones exert influence in most areas of the body.How do thyroid hormones influence the heart?
A)They affect cardiac gene expression.
B)They influence the sensitivity of the heart to the sympathetic nervous system.
C)They cause peripheral hemodynamic alterations that influence cardiac function.
D)All of the above
Q3) 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
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Chapter 50: The Gonads
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Q1) Which androgens are capable of interacting with the androgen receptor?
1)testosterone
2)dihydrotestosterone
3)dehydroepiandrosterone
4)androstenedione
A)1, 2
B)2, 3
C)3, 4
D)1, 4
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
Q3) The central medulla region of the ovary consists of which of the following?
A)stroma
B)germinal epithelium
C)follicles
D)all of the above
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Page 52
Chapter 51: Adrenal Hormones and Hypertension
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Q1) Primary autonomous hypersecretion of aldosterone by the zona glomerulosa is mainly caused by:
A)Conn's syndrome
B)idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia
C)Addison's disease
D)both a and b
Q2) Which of the following are characteristic of ketosteroids?
1)contain 21 carbon atoms
2)contain a hydroxyl group at the carbon 17 position
3)contain 19 carbon atoms
4)contain a ketone group at the carbon 17 position
A)1, 2
B)3, 4
C)1, 4
D)2, 3
Q3) When is cortisol usually at its lowest concentration in the circulation?
A)4:00 pm
B)Midnight
C)4:00 am
D)8:00 am
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Chapter 52: Diseases of Genetic Origin
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Sample Questions
Q1) Which of the following statements is true of Klinefelter syndrome?
1)Its chromosome abnormality is 45,X.
2)It has an incidence of 1 in 500 males.
3)It has an incidence of 1 in 500 females.
4)It has clinical features that involve learning difficulties and tall stature.
A)1, 3, 4
B)2, 4
C)1, 3
D)1, 2, 4
Q2) Which of the following is considered a transversion?
A)the substitution of a pyrimidine for a purine
B)the substitution of a purine for a purine
C)the substitution of a pyrimidine for a pyrimidine
D)all of the above
Q3) Sickle cell disease is the prototypical ______ single gene disorder.It occurs with an incidence of approximately 1 in 600 ______.
A)autosomal recessive, African Americans
B)autosomal recessive, Caucasian Americans
C)autosomal dominant, African Americans
D)autosomal dominant, Caucasian Americans
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Chapter 53: Neoplasia
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Q1) Which of the following statements are true of oncogenes?
A)When activated inappropriately, it will result in the transition from normal cells to a wildly proliferating, uncontrolled cell mass that characterizes cancer.
B)Oncogenes act in a dominant fashion.
C)The majority of oncogenes are the result of mutations of normal cell regulatory genes.
D)All of the above
Q2) Apoptosis:
1)serves two functions in the body, cell termination and homeostasis
2)can occur when a cell is damaged beyond repair
3)can occur when a cell undergoes stress conditions such as starvation
4)the signal for apoptosis can only come from within the cell
A)1, 2, 3, 4
B)1, 3, 4
C)1, 2, 3
D)2, 3, 4
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Which of the following statements are true of kidney donation and transplants?
1)Kidney allograft survival rates are greater when the graft is obtained from a living donor.
2)There is improved potential for increased immunological match if the recipient is genetically related.
3)A live donor transplant spares the recipient the long waiting period on dialysis that frequently occurs when one is waiting for a suitable deceased donor transplant.
4)Deceased donor allografts are associated with an improved long-term graft survival.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q2) Cyclosporine toxicity manifests as which of the following?
A)increased renal blood flow
B)decreased GFR
C)increased urine output
D)decreased sodium retention
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56
Chapter 55: Toxicology
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Q1) In which of the following situations would an individual not experience a high from cocaine use?
1)smoking
2)snorting
3)applying to skin
4)drinking
A)1, 2, 3, 4
B)1, 4
C)3, 4
D)2, 3
Q2) Cadmium can be found in what sample types?
1)blood
2)urine
3)hair
4)nails
A)1, 2, 3
B)2, 3
C)1, 4
D)2, 4
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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) By law, individuals employed by the federal government or who are under the authority of the Department of Transportation will be screened for which drugs?
1)cocaine
2)marijuana
3)alcohol
4)opioids
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
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