

Clinical Pathology
Chapter Exam Questions
Course Introduction
Clinical Pathology is the branch of medicine that focuses on the diagnosis of diseases based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates. This course introduces students to fundamental concepts of analytical techniques, specimen collection, and the interpretation of laboratory results. Emphasis is placed on understanding common pathological conditions, including hematological disorders, infections, metabolic imbalances, and organ dysfunction, through the lens of laboratory data. Students also explore the principles of laboratory management, quality control, and the role of clinical pathologists in multidisciplinary healthcare teams, preparing them to contribute effectively to patient care and disease management.
Recommended Textbook Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 7th Edition by Carl A. Burtis
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2
Chapter 1: Clinical Chemistry, molecular Diagnostics, and Laboratory Medicine
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Q1) John works in a molecular diagnostics laboratory and receives a blood sample that has the name of a close friend printed on the bar-coded label.The genetic test that is ordered on the friend's sample would provide diagnostic information about a disorder that has a poor prognosis,and the test is usually performed by John.He asks a fellow employee to analyze the sample for him and not divulge the results.This ethical issue concerns:
A) confidentiality of patient genetic and medical information.
B) a conflict of interest.
C) resource allocation.
D) diagnostic accuracy.
Answer: A
Q2) Molecular diagnostic testing methods and results can be:
A) qualitative only.
B) quantitative only.
C) either qualitative or quantitative.
Answer: C
Q3) Molecular diagnostics testing is only used by the clinical chemistry laboratory.
A)True
B)False
Answer: False

Page 3
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Chapter 2: Selection and Analytical Evaluation of
Methodswith Statistical Techniques
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Q1) In the calibration hierarchy,a reference measurement procedure,which is a fully understood procedure of highest analytical quality,is at the top.This procedure is associated with which one of the following types of error?
A) Calibration error
B) Specificity error
C) Pure random error
D) Systematic error
Answer: C
Q2) Two types of error may be encountered during analysis of a substance.The type of error that occurs with a constant or predictable difference or trend,either positive or negative,and thus is related to bias,is a(n)_____ error.
A) systematic
B) random
C) analytical
D) All of the above are correct.
Answer: A
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Chapter 3: Clinical Evaluation of Methods
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Q1) In regard to the number of true-positive and negative,and false-positive and negative,results in laboratory testing,the prevalence times the sensitivity is equal to the number of:
A) true positives.
B) false positives.
C) true negatives.
D) false negatives.
Answer: A
Q2) The probability of occurrence of a specific test value given that the disease is present divided by the probability of the same test value if the disease was absent is the: A) odds ratio.
B) likelihood ratio.
C) prevalence.
D) predictive value.
Answer: B
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5

Chapter 4: Evidence-Based Laboratory Medicine
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Q1) In a research study,a physician asks if the results from the therapeutic drug assay will be able to predict the patient's eventual health outcome.A study to determine this is referred to as a:
A) patient outcome study.
B) case-control study.
C) systematic review.
D) prognostic value study.
Q2) Internal validity is the:
A) degree to which the variables in the study apply to all individuals in the study.
B) degree to which the results of your sample can be inferred to the general population outside of your study.
C) equivalent of consistency.
D) calculation of mean and variance from repeated measures.
Q3) When developing clinical practice guidelines,what is the critical first step?
A) Requesting input from health insurance companies and government officials
B) Preparing a cost analysis based on patient needs
C) Determining the intended group that will be directly involved with implementation
D) Selecting and refining the topic upon which the investigation will center
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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) Which one of the following is an example of an exclusion criterion when establishing a healthy population-based reference interval?
A) Use of oral contraceptives
B) Sex
C) Age
D) Ethnicity
Q3) What is the statistical range of the following distribution of data?
21 25 18 20 19 21 23 26
A) 18 to 26
B) 21.6
C) 8
D) .-8
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Chapter 6: Specimen Collection, processing, and Other
Preanalytical Variables
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Q1) Acid citrate dextrose
A)Yellow
B)Lavender
C)Gray
D)Green
Q2) A skin puncture of an individual's finger is ordered for hematocrit analysis and is to be collected into a capillary tube.It is cold in the phlebotomy area,and the phlebotomist notices that the individual appears cold and pale.What should the phlebotomist do to stimulate blood circulation to the finger so an acceptable fingerstick specimen will be obtained?
A) Slap the individual's hand to warm it up.
B) Tie a tourniquet around the individual's finger.
C) Warm the finger for 3 minutes using a warming device.
D) Massage the finger and hand.
Q3) An example of a preanalytical error would be:
A) mislabeling a tube of blood with an incorrect name.
B) using expired reagents in an analysis.
C) sending the test results to the incorrect physician.
D) failing to run controls with unknown samples.
Page 8
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Chapter 7: Quality Management
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Q1) The first step in the development of an in-service training program using an instructional system for employee competency in the laboratory is:
A) direct observation of routine patient test performance.
B) preparation of a written procedure.
C) implementation of a schedule.
D) a needs assessment or gap analysis.
Q2) You arrive at the clinical chemistry laboratory one morning and discover that personnel from the third shift left you the QC sheet from the thyroid-stimulating hormone (TSH)run.The technician has circled the level I TSH control values,and you realize that all six of the level I control values are +3 s from the mean.No results have been released.Now it's your decision regarding what to do next.First,which Westgard rule(s)has (have)been violated?
A) 2<sub>2s</sub>
B) 4<sub>1s</sub>
C) 1<sub>3s</sub>
D) All of the above rules have been broken.
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Chapter 8: Principles of Basic Techniques and Laboratory Safety
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Q1) You have seen another laboratorian collecting blood from a patient without using any barrier protection.What safety mandate is this employee ignoring?
A) Chemical hygiene plan
B) Universal Precautions
C) Clinical laboratory plan
D) Tuberculosis exposure plan
Q2) What is the normality of a solution containing 20 g of H<sub>2</sub>SO<sub>4</sub> (MW = 98)in 500 mL of buffer?
A) 8.2 N
B) 2.8 N
C) 0.82 N
D) 176.8 N
Q3) What is the relative centrifugal force (RCF)for a centrifuge spinning at 1200 rpm with a rotor head radius of 8 inches?
A) 32.7 g
B) 3200 g
C) 130 g
D) 1300 g
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Chapter 9: Optical Techniques
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Q1) The visible spectrum is composed of those wavelengths between 380 and 750 nm.
A)True
B)False
Q2) Which one of the following wavelengths is within the "near" ultraviolet region of the electromagnetic spectrum?
A) 320 nm
B) 450 nm
C) 540 nm
D) 690 nm
Q3) 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
Q4) A light-beam chopper in a double-beam-in-time spectrophotometer is used to:
A) isolate light of a desired wavelength.
B) compensate for light source variation.
C) atomize a sample on a carbon rod in an enclosed chamber.
D) provide polarized light.
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Chapter 10: Electrochemistry and Chemical Sensors
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Q1) 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
Q2) The type of ion-selective electrode mentioned in the preceding question is in a category of electrodes referred to as _____ electrodes.
A) glass
B) inert metal
C) polymer membrane
D) participating metal
Q3) A commonly used glass electrode that is used as a reference electrode in pH measurements is the _____ electrode.
A) calomel
B) mercury vapor
C) silver/silver chloride
D) platinum
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Chapter 11: Electrophoresis
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Q1) A separation technique that can detect proteins in a complex mixture with the use of antibodies directed against a protein of interest is:
A) Northern blotting.
B) Western blotting.
C) capillary electrophoresis.
D) electrokinetic chromatography.
Q2) Endosmosis:
A) can be eliminated from an electrophoretic system if a charged gel is used.
B) is the movement of solvent along with highly hydrated ions to produce the driving force in capillary electrophoresis.
C) is the movement of water toward the center of an electrophoresis gel or strip to replace water lost by evaporation.
D) is a type of electrophoresis where separation is conducted in fluid channels.
Q3) The main advantage of capillary electrophoresis over standard gel electrophoresis is:
A) the increased amount of time required for separation.
B) the small sample size required.
C) more efficient heat dissipation for better separation.
D) the ability to use a variety of buffers in the system.
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Page 13
Chapter 12: Chromatography
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Q1) A toxicology screen is set up using thin layer chromatographic plates.Four positive controls/standards are used with the following distance of migration from application point results: Std A = 8 cm; Std B = 15 cm; Std C = 22.The acetone solvent front moved 35 cm.After processing an unknown sample,a solute had a migration distance of 16 cm.What are the retention factors (R<sub>f</sub>)of standards A,B,and C?
A) 8,15,22
B) 8,12,18
C) 4.4,2.3,1.5
D) 0.23,0.43,0.63
Q2) 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
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Page 14

Chapter 13: Mass Spectrometry
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Q1) In which one of the following mass spectrometers does the fragmentation of ions take place after they have been separated by their m/z value in a first stage?
A) In an inductively coupled plasma mass spectrometer
B) In a mass spectrometer interfaced with a gas chromatograph
C) In a quadrupole-trapping spectrometer
D) In a tandem mass spectrometer
Q2) What type of mass spectrometer uses radio frequency-generated fields to confine ions in three dimensions?
A) Quadrupole ion trapping-mass spectrometer
B) Time-of-flight mass spectrometer
C) Tandem mass spectrometer
D) Ion cyclotron resonance mass spectrometer
Q3) An example of a clinical application of an HPLC coupled to a tandem mass spectrometer would be:
A) determining the presence of trace elements in blood.
B) screening and confirming the presence of inborn errors of metabolism.
C) identifying specific protein.
D) quantifying drugs of abuse.
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Chapter 14: Enzyme and Rate Analyses
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Q1) Immobilized enzymes are used analytically in various electrochemical techniques.The use of an ion-selective electrode that is coated with an enzyme that produces ions when placed in a substrate solution is a type of:
A) potentiometric measurement.
B) immunoassay.
C) equilibrium method.
D) consecutive enzymatic reaction.
Q2) An example of a posttranslational modification of an enzyme that produces an enzyme isoform would be:
A) association of different types of subunits in various combinations in an oligomer.
B) modification of genes at different loci.
C) alteration of carbohydrate side chains.
D) the existence of different allelic genes.
Q3) In an enzyme immunoassay such as ELISA,the specificity of the labeled enzyme is the most important aspect of the measurement.
A)True
B)False
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16

Chapter 15: Immunochemical Techniques
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Q1) Which one of the following is considered a quantitative immunoassay?
A) Immunofixation electrophoresis
B) Crossed immunoelectrophoresis
C) Electroimmunoassay
D) Western blotting
Q2) Certain immunoassays require separation of bound reactant from free-labeled reactant for determination of analyte concentration.Which one of the following immunoassays requires this separation step?
A) Fluorescence polarization immunoassay (FPIA)
B) EMIT
C) Cloned enzyme donor immunoassay
D) ELISA
Q3) A homogeneous fluorescence immunoassay that involves the speed of the rotation of molecules,which is then related to analyte concentration in a patient sample,is known as:
A) ELISA.
B) reflectance immunoassay.
C) enzyme-multiplied immunoassay technique.
D) fluorescence polarization immunoassay.
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Page 17

Chapter 16: Automation
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Q1) A tray of clear sample cups sits on a laboratory bench top for an extended period of time.Which one of the following analytes might be affected?
A) Protein
B) Cholesterol
C) Glucose
D) Bilirubin
Q2) 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
Q3) If programmed appropriately,a multiple-channel analyzer could assess samples as a single-channel analyzer.
A)True
B)False
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Page 18

Chapter 17: Point-Of-Care Instrumentation
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Q1) Regarding internal quality control (QC)for a bench top analyzer:
A) it is safe to assume that the manufacturer has performed all necessary QC.
B) at least one QC sample should be run a minimum of once per shift.
C) one QC sample should be analyzed whenever there is a change to the testing system.
D) QC samples can be assessed once a day for frequently used devices.
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) The addition of sulfosalicylic acid for a qualitative turbidimetric protein determination of a urine specimen is done to:
A) dilute the protein in the specimen,because it is typically high and beyond the range of standards.
B) remove interfering substances from the specimen.
C) increase the volume of the specimen,because it is difficult to obtain adequate volume.
D) precipitate a protein in the specimen that might be missed by albumin urine dipstick methods.
Q2) A tumor of plasmacytoid cells that is diagnosed as Waldenström macroglobulinemia produces a paraprotein that is an:
A) IgA.
B) IgE.
C) IgG.
D) IgM.
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Chapter 19: Serum Enzymes
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Q1) A 37-year-old woman who thinks she might be pregnant visits her physician with a complaint of upper right quadrant pain.Blood samples are obtained.Increased enzyme activity was seen for ALP,AST,lactate dehydrogenase (LD),and GGT.The ALP was 10 times higher than the upper reference limit.A hepatitis panel and a pregnancy test had negative results.Gel electrophoresis was done to separate ALP isoenzymes,with a dense liver band and what appeared to be a diffuse placental band.If this woman's physician has ruled out pregnancy,activity of what other serum enzyme could be measured to differentiate between hepatobiliary disease and liver disease?
A) NTP
B) ALT
C) Aldolase
D) CHE
Q2) All of the statements below about the clinically significant phosphatases are true except they:
A) catalyze the transfer of amine groups to ketoacids.
B) are divided into two classes based upon pH required for their respective reactions.
C) are isoenzyme forms of the phosphatases.
D) are classified as hydrolases.
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Chapter 20: Tumor Markers and Cancer Genes
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Q1) Upon receipt of a test request for assay of human chorionic gonadotropin (hCG)on a 60-year-old male,you would:
A) refuse the request because hCG is a pregnancy test and not performed on men.
B) assume the physician wanted a prostate-specific antigen (PSA)test.
C) perform the test because hCG can be elevated in testicular germ cell tumors.
D) contact the physician.
Q2) Follicular lymphoma occurs when the:
A) c-abl proto-oncogene and the BCR gene on a chromosome reciprocally translocate.
B) HER-2/neu gene is overamplified,causing excess p105 to be released.
C) c-myc gene becomes juxtaposed to the heavy-chain locus on chromosome 14.
D) bcl-2 gene on chromosome 18 is translocated to the immunoglobulin heavy chain locus on chromosome 14.
Q3) Proteins found in normal fetal tissue and also in certain tumors are referred to as:
A) embryonic proteins.
B) tumor-associated antigens.
C) oncogenes.
D) oncofetal antigens.
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Chapter 21: Kidney Function Test-Screatinine, Urea, and Uric Acid
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Q1) Which of the following is the primary reagent used in the Jaffe reaction for creatinine?
A) Alkaline copper sulfate
B) Phosphotungstic acid
C) Alkaline picric acid
D) Diacetyl monoxime
Q2) Plasma urea concentration:
A) is a more reliable indicator of renal function than creatinine.
B) can increase because of decreased renal perfusion.
C) is decreased in intrinsic renal failure.
D) is not affected by diet.
Q3) In the measurement of urea,urea is initially hydrolyzed by urease to form ammonium ions.This assay combined with the spectrophotometric measurement of the resulting ammonia is referred to as the:
A) ammonia-selective electrode method.
B) Berthelot reaction.
C) Jaffe reaction.
D) urea method.
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Chapter 22: Carbohydrates
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Q1) The glucose assay on an analyzer uses hexokinase as the enzyme that phosphorylates glucose.What are the initial products formed from the first step of this reaction?
A) Nicotinamide adenine dinucleotide and NADH
B) 6-Phosphogluconate and hydrogen ions
C) Glycosylated hemoglobin
D) Glucose-6-phosphate and adenosine diphosphate (ADP)
Q2) What effect does glucagon have on blood glucose value?
A) Increases
B) Decreases
Q3) By what mechanism does glucagon promote hyperglycemia?
A) Glucagon promotes glycogenesis.
B) Glucagon stimulates insulin release.
C) Glucagon stimulates glucose synthesis by gluconeogenesis.
D) Glucagon promotes hypoglycemia,not hyperglycemia.
Q4) What effect does ethanol 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 with the smallest diameter and that has a 50:50 lipid:lipoprotein ratio is the:
A) LDL.
B) chylomicron.
C) HDL.
D) VLDL.
Q2) An individual visits his physician with splenomegaly,enlarged and orange-colored tonsils,and tingling feelings in the extremities,indicating peripheral neuropathy.Upon examination of the blood smear for a white blood cell differential,many foamy-appearing cells were noted.Normal triglyceride and total cholesterol values were noted; however,a marked decrease of HDL was also noted.What is the cause of this disorder?
A) Mutations in the apo B-100 gene
B) Defects in the expression or function of the LDL receptor
C) Genetic mutations in the apo E gene
D) Mutations in the ABCA1 transporter gene
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Chapter 24: Electrolytes and Blood Gases
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Q1) The most commonly measured colligative property of urine or plasma that is tested in the clinical laboratory to determine osmolality is:
A) vapor pressure.
B) the boiling point.
C) osmotic pressure.
D) the freezing point.
Q2) The "electrolyte exclusion effect" is:
A) an underestimation of electrolyte concentration by indirect ISE methods when hyperproteinemia is present.
B) an overestimation of electrolyte concentration by direct ISE measurements only when serum is used.
C) the exclusion of certain solids by increased activity of electrolytes when determining concentration of those solids.
D) the exclusion of electrolytes in certain measurements when pH,PCO<sub>2</sub>,and PO<sub>2</sub> are elevated in arterial blood.
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Chapter 25: Hormones
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Q1) 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
Q2) Which one of the following statements concerning steroid hormones is correct?
A) Steroid hormones attach to a receptor on the surface of a cell,which eventually induces enzyme phosphorylation within the cell.
B) Steroid hormones are hydrophobic when free and bind to intracellular receptors in the nucleus.
C) Steroid hormones,because of their structure,are not bound to carrier proteins as they circulate in the blood.
D) Steroid hormones have a very short half-life (usually <30 minutes)in the circulation.
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Chapter 26: Catecholamines and Serotonin
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Q1) 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
Q2) Regarding catecholamines,the amino acid from which dopamine is synthesized?
A) Threonine
B) Tryptophan
C) Tyrosine
D) Cytosine
Q3) The urinary metabolite measured as an indicator of dopamine synthesis is:
A) metanephrine.
B) homovanillic acid.
C) vanillylmandelic acid.
D) catechol-O-methyltransferase.
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Chapter 27: Vitamins, Trace Elements, and Nutritional Assessment
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Q1) The vitamin that is an antioxidant that acts as a scavenger for lipid Peroxyl-free radicals and that has a role in RBC protection from hemolysis is:
A) A.
B) B<sub>6.</sub>
C) E.
D) K.
Q2) The trace element that is thought to mimic insulin because of its activation of the cellular insulin response is:
A) boron.
B) silicon.
C) fluoride
D) vanadium.
Q3) The ease with which iron can move from a reduced form to an oxidized form in its metalloprotein transferrin is important because:
A) only the reduced form of iron can be stored as transferrin.
B) transport of iron in transferrin occurs only in the oxidized state.
C) it can block the excessive uptake of copper in hepatocytes.
D) the oxidized form of iron reacts best when binding oxygen.
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Chapter 28: Hemoglobin, Iron, and Bilirubin
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Q1) Which one of the following is formed by the reduction of unconjugated bilirubin in the intestines,is found in urine,and is further oxidized to form urobilin?
A) Hemoglobin
B) Conjugated bilirubin
C) Iron
D) Urobilinogen
Q2) Increased total iron in serum is common in all of the following except:
A) iron intoxication.
B) hemosiderosis.
C) chronic inflammation.
D) sideroblastic anemia.
Q3) 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%
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Chapter 29: Porphyrins and Porphyrias
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Q1) Protoporphyrin that contains iron is known as:
A) ferrochelatase.
B) heme.
C) porphyrin.
D) porphyria.
Q2) An individual visits his physician with porphyria-like symptoms.The results of porphyrin analysis are as follows: urine 5-aminolevulinic acid (ALA),positive; urine coproporphyrin III,increased; RBC zinc protoporphyrin (ZPP),increased.What laboratory test should the physician order to determine the exact diagnosis?
A) Blood lead
B) Urinary PBG
C) Hemoglobin and hematocrit
D) Blood alcohol
Q3) Which one of the following cofactors is required for heme synthesis?
A) Ascorbic acid
B) Pyridoxal phosphate
C) Cobalamin
D) Niacin
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Chapter 30: Therapeutic Drugs and Their Management
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Q1) Which one of the following therapeutic drugs is used in the management of acute lymphoblastic leukemia and inhibits DNA synthesis by decreasing methylation of pyrimidine nucleotides and their synthesis?
A) Mycophenolic acid
B) Cyclosporine
C) Tacrolimus
D) Methotrexate
Q2) When a drug concentration exceeds the available metabolic capacity of the body,what does the drug's metabolism become dependent on?
A) The health of the renal system
B) The number of doses given per hour
C) The drug concentration itself
D) The amount of metabolizing enzyme
Q3) The therapeutic range of a drug is:
A) dependent on renal function.
B) the range of concentrations within which the drug is effective yet not toxic.
C) the range of concentrations at which there are no drug interactions.
D) dependent on the route of drug administration.
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Chapter 31: Clinical Toxicology
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Q1) An example of a nonbenzodiazepine sedative-hypnotic that is used in drug-facilitated sexual assault that interacts with a subtype of the GABA<sub>A</sub> receptor complex is:
A) diazepam.
B) zolpidem.
C) chloral hydrate.
D) .\(\gamma\)-hydroxybutyrate.
Q2) Meconium is a difficult substance to analyze in a clinical laboratory for drug assessment because:
A) there is a shorter window of detection for drugs compared to urine.
B) it is a difficult material to work with,and drug testing is far less standardized than for a urine specimen.
C) external environmental exposure to drugs causes them to be falsely detected in this substance.
D) contains analytes that cross-react with most drug tests.
Q3) The long elimination half-life of marijuana that affects the duration of detection is due to the reentry of THC from tissue fat stores into the circulation.
A)True
B)False
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Page 33

Chapter 32: Toxic Metals
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Q1) Lead
A)Reduced to a nontoxic form in biological specimens
B)Blood specimens are not especially useful; urine is best
C)Requires a lymphocyte proliferation test; serum or urine quantification is not useful
D)To examine erythrocytes,EDTA-anticoagulated blood is specimen of choice
Q2) Beryllium
A)Reduced to a nontoxic form in biological specimens
B)Blood specimens are not especially useful; urine is best
C)Requires a lymphocyte proliferation test; serum or urine quantification is not useful
D)To examine erythrocytes,EDTA-anticoagulated blood is specimen of choice
Q3) 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
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Chapter 33: Diabetes
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Q1) Hb A<sub>1c</sub> makes up approximately what percentage of total Hb A<sub>1</sub>?
A) 10%
B) 25%
C) 50%
D) 80%
Q2) The role of the clinical laboratory in diagnosis of diabetes mellitus involves initial diagnostic criteria.For many years,the only diagnostic criterion required was demonstration of hyperglycemia in two or more fasting plasma glucose tests.What other laboratory analysis is now considered to be useful as a diagnostic criterion?
A) Demonstration of impaired glucose tolerance in the OGTT
B) Consistent hyperglycemia after a 72-hour fast
C) Presence of ketones in urine on more than one occasion
D) Demonstration of elevated hemoglobin A<sub>1c</sub>
Q3) Exercise
A)Increases
B)Decreases
C)Has no effect
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Chapter 34: Cardiovascular Disease
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Q1) A cardiac marker that increases progressively with increasing severity of disease and is not increased (or decreased)in conditions that mimic congestive heart failure is:
A) troponin I.
B) CK-2.
C) B-type natriuretic peptide.
D) myoglobin.
Q2) Protein hormone
A)BNP
B)CK-MB
C)Troponin
D)Myoglobin
Q3) Which one of the following is considered to be the most specific marker for adverse ventricular remodeling following an acute myocardial infarction?
A) CK-2
B) Troponin
C) Myoglobin
D) Brain natriuretic peptide (BNP)
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Chapter 35: Kidney Disease
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Q1) A 45-year-old man visits his physician with complaints of insatiable thirst,sudden onset of fatigue,polydipsia,and polyuria.Laboratory results indicate a normal fasting blood sugar.Serum sodium was slightly elevated.Urine was clear and had low specific gravity (hypotonic).The most likely cause of these symptoms and laboratory results would be:
A) diabetes mellitus.
B) acute tubular necrosis.
C) polycystic kidney disease.
D) diabetes insipidus.
Q2) If an individual has a normal GFR and a hyperchloremic normal anion gap metabolic acidosis with a freshly voided early morning urine specimen which has a pH of 6.5,what is the likely diagnosis?
A) The pH It is increased above the reference interval due to the conversion of urea to ammonia.
B) This pH is within the healthy reference interval for this specimen.
C) The pH has decreased below the reference interval due to the urea content.
D) There is likely the onset of distal renal tubular acidosis (RTA).
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Page 37

Chapter 36: Physiology and Disorders of
Water,Electrolyte,and Acid-Base Metabolism
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Q1) Hypernatremia commonly occurs with:
A) decreased synthesis of antidiuretic hormone (ADH).
B) decreased aldosterone.
C) edema.
D) hyperkalemia.
Q2) An overweight 55-year-old single woman from a rural farming area was brought to the emergency department by her neighbor.The woman had a large abscess on the bottom of her foot; she was irritable and complained of blurred vision and of being thirsty.Her breathing was rapid.The neighbor said that the only medication the woman was using was for blood pressure and sometimes an aspirin.Blood and urine samples were collected.Arterial blood gas results were: pH 7.2; PCO<sub>2</sub> 47 mm Hg; HCO<sub>3</sub> 8 mmol/L.Blood glucose was 340 mg/dL and a high anion gap was calculated.Urine glucose and ketones were markedly increased.Based on the laboratory values and symptoms of the woman,what is the most likely cause of her acid-base disorder?
A) Abscess formation and infection
B) Diabetic ketoacidosis
C) Pneumonia
D) Hysteria
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Chapter 37: Liver Disease
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Q1) The first protein marker to appear approximately 1 to 2 months after infection with the hepatitis B virus and also the last marker to disappear is the:
A) antihepatitis B core antigen.
B) antihepatitis B surface antigen.
C) hepatitis B surface antigen.
D) hepatitis B immune globulin.
Q2) Which type of hepatitis is a leading cause of chronic hepatitis and is caused by a mutating RNA virus?
A) Hepatitis A
B) Fulminant hepatitis
C) Hepatitis B
D) Hepatitis C
Q3) Which one of the following is not a consequence of portal hypertension in an individual?
A) Bleeding esophageal varices
B) Increased prothrombin time
C) Altered estrogen metabolism
D) Hemochromatosis
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Chapter 38: Gastrointestinal and Pancreatic Diseases
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Q1) A 23-year-old man visits his physician with symptoms of abdominal discomfort and diarrhea.The man states that the diarrhea has been present off and on for approximately 6 weeks.He especially notes symptoms after a breakfast of wheat cereal and milk.His physician considers the possibility of two disorders,celiac disease and lactose intolerance.Which of the following pairs of laboratory tests would provide a definitive answer?
A) Analysis of tissue transglutaminase IgA antibodies and breath hydrogen testing
B) Serum gastrin and fecal alpha<sub>1</sub>-antitrypsin analysis
C) Breath hydrogen testing and fecal osmotic gap determination
D) Fecal elastase-1 and tissue transglutaminase IgA antibody analysis
Q2) Which one of the following statements concerning secretin is correct?
A) Secretin is produced by the parietal cells in the stomach.
B) The release of secretin is controlled by the presence of glucose in the blood.
C) The function of secretin is to relax smooth muscle of the gut.
D) Secretin stimulates release of pancreatic hormones.
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Chapter 39: Disorders of Bone and Mineral Metabolism
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Q1) Magnesium:
A) concentration is present mostly in the complexed state.
B) decrease produces neuromuscular excitability.
C) is the second most abundant intracellular cation.
D) concentration is decreased with excessive intake of antacids.
Q2) Total serum calcium:
A) consists of an equal mix of free and protein-bound calcium.
B) contains a 10% fraction that is complexed to small anions.
C) is 80% bound to albumin.
D) contains a 25% fraction that is free and unbound.
Q3) 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) Which one of the following is not a function of thyrotropin?
A) Action as a carrier protein of circulating thyroid hormones
B) Induction of iodine uptake by the thyroid gland
C) Stimulation of the growth of thyroid follicular cells
D) Stimulation of the release of thyroid hormones from thyroglobulin
Q2) An example of a hypothalamic hormone would be:
A) growth hormone (GH).
B) thyroid-stimulating hormone (TSH).
C) antidiuretic hormone (ADH).
D) adrenocorticotropic hormone (ACTH).
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.
Q4) The most common hypothalamic-pituitary disorder in clinical endocrinology is:
A) hyperprolactinemia.
B) hyperthyroidism.
C) Cushing disease.
D) infertility.

Page 42
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Chapter 41: Disorders of the Adrenal Cortex
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Q1) A hypertensive,hypokalemic patient with increased aldosterone production and decreased plasma renin activity likely has:
A) Cushing syndrome.
B) Addison disease.
C) Conn syndrome.
D) congenital adrenal hyperplasia.
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) The primary glucocorticoid is:
A) glucose.
B) cortisol.
C) aldosterone.
D) epinephrine.
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43

Chapter 42: Thyroid Disorders
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Q1) Which one of the following statements is correct regarding reverse T<sub>3 </sub>(rT<sub>3</sub>)?
A) rT<sub>3</sub> is physiologically active,but less so than T<sub>3</sub>.
B) rT<sub>3</sub> is formed in the blood by central deiodination of T<sub>4</sub>.
C) rT<sub>3</sub> is decreased in patients with the "euthyroid sick syndrome."
D) Renal failure is associated with elevated rT<sub>3</sub> concentrations.
Q2) A 45-year-old woman visits her physician with complaints of fatigue,heat intolerance,goiter,and unusual hair loss.Blood is collected and serum T<sub>4</sub> value is below the healthy reference interval.What laboratory assay would confirm that this might be a pituitary disorder?
A) Free T<sub>3</sub>
B) Thyroid-binding globulin (TBG)
C) Thyrotropin-releasing hormone (TRH)
D) Thyroid-stimulating hormone (TSH)
Q3) Thyroid hormones are derived from the amino acid:
A) phenylalanine.
B) threonine.
C) theophylline.
D) tyrosine.
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Page 44

Chapter 43: Reproduction-Related Disorders
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Q1) Laboratory assessment of which of the following hormones is used to evaluate ovulation?
A) FSH
B) Estradiol
C) Progesterone
D) All of the above
Q2) A 30-year-old female visits her physician with a complaint of excess facial and body hair,weight gain,and oligomenorrhea.She has read online that her symptoms indicate possible Cushing syndrome.Laboratory values indicate plasma cortisol levels within the reference intervals,elevated estrogen and LH,and decreased FSH.What other disorder might this patient have?
A) Polycystic ovarian syndrome (PCOS)
B) Conn syndrome
C) Ovarian tumor
D) Adult onset congenital adrenal hyperplasia
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 in her second trimester visits her obstetrician with elevated blood pressure.A urine sample reveals normal glucose,elevated protein,and a small number of red and white blood cells.The woman is recommended for bed rest for the remaining term of her pregnancy.This condition is known as:
A) eclampsia.
B) preeclampsia.
C) hydramnios.
D) oligohydramnios.
Q2) Concerning alpha-fetoprotein (AFP),which one of the following statements is correct?
A) A decrease in AFP in a pregnant woman's serum indicates the presence of possible spina bifida in the fetus.
B) An appropriate time to measure AFP in maternal serum is at 16 weeks gestation when it is approximately 3.5 µg/dL.
C) An increase in AFP in a pregnant woman's serum indicates the presence of Down syndrome in the fetus.
D) AFP in maternal serum rapidly decreases to a low point at 11 weeks and then increases to reach a second maximum at 13 weeks.
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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 glycogen storage disease?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
Q3) Of the following,what is the inborn error of metabolism for medium chain acyl-CoA dehydrogenase deficiency?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
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Chapter 46: Pharmacogenetics
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Q1) The metabolizing enzyme that catalyzes the transfer of an acetyl moiety from acetyl-CoA to homocyclic and heterocyclic arylamines and hydrazines in,for example,substrates related to cigarette smoke is:
A) CYP2C6.
B) CYP2D9.
C) NAT1.
D) UGT1A1.
Q2) Tamoxifen is a drug that is used to prevent or treat some forms of breast cancer.Before it can have a physiological effect,tamoxifen must be metabolized to an active metabolite called endoxifen.Tamoxifen is therefore considered to be a:
A) metabolizer.
B) prodrug.
C) transferase.
D) cytochrome.
Q3) A drug substrate for the metabolizing enzyme UGT1A1 is:
A) tamoxifen.
B) codeine.
C) diazepam
D) irinotecan.
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Page 48

Chapter 47: Principles of Molecular Biology
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Q1) 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.
Q2) In regard to DNA structure,a sugar/phosphate group with its attached base is referred to as a(n):
A) base pair.
B) codon.
C) anticodon.
D) nucleotide.
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Chapter 48: Nucleic Acid Techniques and Applications
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Q1) In a pyrosequencing reaction,the incorporation of a nucleotide releases _____.Eventually,visible light is produced by an enzyme reaction.
A) pyrophosphate
B) ATP
C) luciferase
D) a primer
Q2) Which of the following procedures can be used to avoid contamination with PCR reaction product (amplicon)when performing a PCR procedure?
A) Use of positive displacement pipettes
B) Use of closed-tube methods
C) Physical separation of preamplification and postamplification rooms
D) All of the above
Q3) Which one of the following is the name given to the probe types used in real-time PCR that change fluorescence through fluorescence resonance energy transfer (FRET)upon duplex formation?
A) Hybridization
B) Hydrolysis
C) Mixed mechanism
D) Primer
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Page 50

Chapter 49: Genomes and Nucleic Acid Alterations
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Q1) If you were interested in studying plasmid structure,which one of the following cell types would be appropriate for you to examine?
A) Human cells
B) Fungal cells
C) Bacterial cells
D) All cell types
Q2) Copy number variants comprise approximately what percent of the human genome?
A) 75%
B) 50%
C) 10%
D) 0.5%
Q3) A single nucleotide variant (SNV)that produces a misplaced termination codon in a polypeptide chain is called a:
A) missense variant.
B) transposon.
C) copy number variant.
D) nonsense variant.
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