Clinical Pathology
Midterm Exam
Course Introduction
Clinical Pathology focuses on the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue extracts. This course covers the principles and techniques used to assess abnormalities in hematology, clinical chemistry, microbiology, immunopathology, and molecular diagnostics. Students gain an understanding of test selection, interpretation of laboratory results, and the clinical relevance of findings in the context of patient care. Emphasis is placed on the correlation between laboratory data and disease processes, quality assurance, and the role of clinical pathologists in multidisciplinary 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) How many mL of 0.819 M acetic acid (MW = 60; pK = 4.76) should be added to 350 mL of 0.368 M sodium acetate (MW = 82) to produce a final pH of 4.89?
A)95.41 mL
B)116.5 mL
C)128.8 mL
D)130.6 mL
Answer: B
Q2) The force produced by centrifugation is relative centrifugal force (RCF).The units for RCF are expressed as:
A)rpm
B)radius
C)number of times greater than gravity
D)there are no units for RCF
Answer: C
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Chapter 2: Spectral Techniques
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Q1) In comparing nephelometry and turbidity, nephelometric measurements should demonstrate ______ sensitivity, and turbidimetric measurements should demonstrate ______ sensitivity.In practice, turbidimetric measurements have been found to demonstrate ______ sensitivity.
A)high, limited, high
B)high, limited, limited
C)limited, high, high
D)limited, high, limited
Answer: A
Q2) A solution of chloramphenicol (MW 323.1) in water gave an absorbance of 0.610 at 278 nm in a 1-cm cuvette; the concentration was 0.02 mg/mL.What is the molar absorptivity of chloramphenicol?
A)30.5 L/mol cm
B)3050 L/mol cm
C)9855 L/mol cm
D)11241 L/mol cm
Answer: C
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Given that adsorption chromatography is being utilized with a polar adsorbent such as silica, predict the order of elution of the following three compounds with the first to elute being listed first.
Compound A - nonpolar compound with minimal potential for hydrogen bonding
Compound B - polar compound with intermediate potential for hydrogen bonding
Compound C - polar compound with high potential for hydrogen bonding
A)compound A, compound B, compound C
B)compound A, compound C, compound B
C)compound B, compound C, compound A
D)compound C, compound B, compound A
Answer: A
Q2) The desired resolution for good quantitative or qualitative chromatographic analysis is ______ or greater.
A)0.4
B)0.8
C)1.0
D)1.25
Answer: D
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Chapter 4: Chromatographic Techniques
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Q1) Which of the following is the correct order of sensitivity for HPLC detectors? (most sensitive to least sensitive)
A)absorbance, fluorescence, electrochemical
B)fluorescence, absorbance, electrochemical
C)electrochemical, fluorescence, absorbance
D)absorbance, electrochemical, fluorescence
Q2) Combining selected ion monitoring (SIM) with isotope dilution in electron-ionization mass spectrometry allows:
A)for the removal of extraneous ions that produce complicating peaks in the mass spectrum
B)for quantification utilizing an internal standard
C)for confirmation of results obtained by electron-ionization mass spectrometry alone
D)for quality control checks on the mass spectrometry procedure
Q3) In mass spectrometry, the molecular ion is:
A)the ion of highest relative abundance in the spectrum
B)the ion from which all other fragment ions are derived
C)always observed in the mass spectrum
D)all of the above
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Which of the following steps are performed automatically by HPLC systems used in hemoglobin analysis?
A)dilution of the blood sample
B)hemolysis of the blood sample
C)injection of the blood sample in the HPLC system
D)all of the above are performed by automated HPLC systems
Q2) 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
Q3) The Singer 1-minute denaturation test and the Betke 2-minute alkali denaturation test is useful for measuring Hb ________ and is based on this hemoglobin's
A)A, resistance to alkaline solutions
B)A, denaturation by alkaline solutions
C)F, resistance to alkaline solutions
D)F, denaturation by alkaline solutions
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Page 7
Chapter 6: Electrophoresis
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Q1) Which of the following chemicals is used for fixation following serum protein electrophoresis?
A)dilute acetic acid
B)Ponceau S
C)sodium dodecyl sulfate
D)saturated sodium hydroxide
Q2) It is known that pH influences the charge of an analyte and, if set appropriately, can enhance electrophoretic mobility.In an attempt to improve separation of serum proteins, the analyst set the pH of the buffer at an extremely basic level.Following electrophoresis, it was determined that the desired results were not achieved.Which of the following explains why the modification was not successful?
A)At the very basic pH, the proteins may have been denatured.
B)At the very basic pH, the proteins may have been dissociated.
C)At the very basic pH, the fraction of current carried by buffer hydroxyl ions resulted in poorer separation.
D)All of the above are possible explanations.
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Chapter 7: Immunological Reactions
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Q1) The most potent antigens are macromolecules with molecular weights greater than:
A)1000 daltons
B)10,000 daltons
C)50,000 daltons
D)100,000 daltons
Q2) Which of the following antigenic determinants would be the most reactive?
A)an antigenic determinant located in the core of a spatially folded molecule
B)a sequential antigenic determinant
C)an antigenic determinant located on the surface of a spatially folded molecule
D)the exposed antigenic determinant of a denatured protein
Q3) Antibodies are ______ that are produced by the _______.
A)lipids, adipose cells
B)carbohydrates, bone marrow cells
C)nucleic acids, hepatocytes
D)proteins, B lymphocytes
Q4) The portion of the immunoglobulin molecule that binds to antigens is:
A)the Fab-fragment portion
B)the Fc-fragment portion
C)the hinge portion
D)the disulfide-linkage portion
Page 9
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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) In the Western blot technique, antigens separated by the electrophoretic step are blotted onto a strip of:
A)nitrocellulose paper
B)polyacrylamide gel
C)agarose gel
D)neutral agar
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) _______ measures the decrease of incident light transmission as a function of light scatter as the size of the aggregated particles increase, and the use of a ________ detection system increases the analytical sensitivity of these measurements.
A)Nephelometry, coupled enzymatic
B)A competitive-binding assay, nephelometric
C)Turbidity, near-infrared spectrophotometric
D)Turbidity, UV/Visible spectrophotometric
Q2) Which of the following data-reduction methods would convert a curved relationship for competitive protein-binding, dose-response relationships to a linear relationship?
A)Take the inverse of the dosage data, and replot the graph.
B)Take the inverse of the response data, and replot the graph.
C)Take the logarithm of the dosage data, and replot the graph.
D)Change the axes on which the dosage data and the response data are plotted.
Q3) Which of the following labels is attached to the ligand in the EMIT system?
A)a lanthanide metal such as europium
B)an enzyme
C)the antibody to the ligand
D)a chromophore or fluorophore
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11
Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Which immunoglobulin is primarily associated with allergic reactions?
A)IgG
B)IgM
C)IgA
D)IgE
Q2) The TORCH acronym represents:
A)a series of progressive laboratory tests to identify HIV antibody isotypes
B)a group of pathogens that pose the greatest risk to a developing fetus
C)cellular membrane antigens to which antibodies are directed in Lyme disease
D)the order of reagent addition to prepare a sample for fluorescent-labeled microscopy
Q3) Laboratory diagnosis of this disease is based on a two-tiered approach, with initial screening by IFA or ELISA and confirmation by Western blot.It is important that testing evaluate for IgM and IgG in order to increase chances of detecting and identifying this disease.
A)HIV
B)syphilis
C)herpes
D)Lyme disease
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Chapter 11: Measurement of Colligative Properties
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Q1) 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.
Q2) In the equation to estimate osmolality by calculation, why are glucose and BUN divided by 18 and 2.8, respectively?
A)to provide an estimate of the contribution of glucose and BUN to the total number of particles of each
B)to convert each from mg/L to mmol/L
C)to account for the number of charges on each molecule
D)both a and b
Q3) Calculate the osmolal gap, given the following data: measured osmolality = 366 mOsm/kg; sodium = 144 mEq/L; glucose = 5.0 mmol/L; BUN = 9.0 mg/dL.
A)64 mOsm/kg
B)70 mOsm/kg
C)74 mOsm/kg
D)208 mOsm/kg
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Page 13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) The primary application for coulometric analysis of chloride is:
A)the measurement of chloride in urine
B)the measurement of chloride in sweat
C)the measurement of chloride in serum
D)the measurement of chloride in whole blood
Q2) The oxygen electrode is designed as a complete electrochemical cell which includes a platinum cathode at which oxygen is ______ by the reaction ______, utilizing electrons produced at the anode.
A)oxidized, O + H+ + e- H O
B)reduced, O + H+ + e- H O
C)oxidized, Ago Ag+ + e-
D)reduced, Ago Ag+ + e-
Q3) 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
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Chapter 13: Molecular Diagnostics
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Q1) Fluorescent probes that hybridize to PCR products during amplification change fluorescence by two mechanisms._____ probes change fluorescence by breaking covalent bonds between the probes, and _____ probes change fluorescence based on the proximity of the two probes.Melting curve profiles are only possible with _____ probes.
A)TaqMan, FRET, TaqMan
B)TaqMan, FRET, FRET
C)FRET, TaqMan, TaqMan
D)FRET, TaqMan, FRET
Q2) The assumption underlying real-time PCR is that the amount of fluorescence in the reaction chamber is:
A)directly proportional to the amount of amplicon present in the PCR vessel
B)inversely proportional to the amount of amplicon present in the PCR vessel
C)directly proportional to the amount of target template present at the beginning of the reaction
D)both a and c
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Chapter 14: Therapeutic Drug Monitoring
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Q1) The primary driving force for drugs to move from the point of absorption to the site of action is ______, and the primary driving force for drugs to leave the site of action following a single dose is ______.
A)active transport, active transport
B)active transport, passive transport
C)passive transport, active transport
D)passive transport, passive transport
Q2) Considering the administration of a single dose of a hypothetical drug by different routes, which of the following gives the correct order of attaining peak concentration of the drug in the blood stream?
A)intramuscular, oral, intravenous
B)oral, intravenous, intramuscular
C)intravenous, intramuscular, oral
D)intramuscular, intravenous, oral
Q3) Which of the following statements are true regarding drug half-life?
A)Doubling the dose of a drug will reduce the half-life by one half.
B)Half-life is equal to the time required to change the drug blood level by 50%.
C)Doubling the dose of a drug will double the half-life.
D)both b and c
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Page 16
Chapter 15: Clinical Enzymology
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Q1) Considering the active site of an enzyme, which of the following statements is not correct?
A)The active site of an enzyme involves a relatively small percentage of the total number of amino acids in the enzyme.
B)The active site of an enzyme is the location where allosteric inhibitors bind to the enzyme.
C)The attraction between enzyme and substrate is typically non-covalent.
D)The active site of an enzyme takes on a three-dimensional orientation for specific binding with the substrate.
Q2) The loss of enzyme activity is known as ______ and is typically a result of changes in the enzyme's _____ structure.
A)inactivation, secondary
B)denaturation, primary
C)inactivation, primary
D)denaturation, tertiary
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) CK-MM isoforms result from the action of ______ cleaving terminal ______ amino acid residues.
A)aminopeptidase, histidine
B)aminopeptidase, lysine
C)carboxypeptidase, histidine
D)carboxypeptidase, lysine
Q2) The method of isoenzyme analysis where antibody reacts specifically with one subunit to render that isoenzyme catalytically inactive or remove the isoenzyme altogether is known as:
A)immunoassay technique
B)substrate specificity technique
C)catalytic inhibition
D)immunoinhibition
Q3) What is the order of electrophoretic migration of the CK-MM isoforms?
A)CK-MM , CK-MM , CK-MM
B)CK-MM , CK-MM , CK-MM
C)CK-MM , CK-MM , CK-MM
D)CK-MM , CK-MM , CK-MM
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18
Chapter 17: Interferences in Chemical Analysis
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Q1) Suppose the result for a particular analyte by HPLC was much higher than anticipated, and the patient's physician questioned the result.Which of the following analytical modifications would be most useful in investigating the reason for the unexpectedly high patient result?
A)Reanalyze the patient sample with the use of a refractive index detector.
B)Reanalyze the patient sample with the use of a photo diode array (PDA) detector.
C)Dilute the patient sample and reanalyze with the current HPLC system.
D)Verify linearity and reanalyze the patient sample.
Q2) 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
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19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Blood samples for therapeutic drug monitoring that are collected in evacuated tubes with stoppers containing tris-(2-butoxyethyl) phosphate (TBEP) as the plasticizer are subject to which of the following?
A)falsely decreased serum concentrations of monitored drugs due to the plasticizer's ability to displace drugs from transport proteins
B)falsely increased serum concentrations of monitored drugs due to the plasticizer's ability to displace drugs from transport proteins
C)falsely decreased serum concentrations of monitored drugs due to the dilutional effect of plasticizer being released into the blood sample
D)falsely increased serum concentrations of monitored drugs because the plasticizer is measured as part of the drug concentration
Q2) A postprandial rise is expected with many analytes.Which of the following will show a postprandial decrease?
A)triglycerides
B)potassium
C)glucose
D)gastrin
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Chapter 19: Laboratory Management
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Q1) Which of the following would be a negative aspect of a reagent rental plan for acquiring a piece of equipment, as compared to leasing equipment?
A)Equipment least costs and reagent costs may be less than the complete reagent rental costs.
B)Next-generation equipment from a different company may become available before the contract expires.
C)The test volume may decrease for the equipment before the reagent rental contract expires.
D)all of the above
Q2) A laboratory test is considered a ____________ test until the test is classified by the FDA.
A)waived
B)moderately complex
C)highly complex
D)experimental
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Chapter 20: Laboratory Automation
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Q1) Which type of laboratory automated system is usually a turnkey system that contains the components for each step in the process, including sample sorters, aliquoters, centrifuges, and analyzers that are interconnected by the track system?
A)modular integrated system
B)stand-alone systems
C)total laboratory automation
D)none of the above
Q2) The majority of laboratory errors occur during ______ and ______.
A)test ordering, sample transport
B)phlebotomy, front-end processing of the sample
C)phlebotomy, result reporting
D)front-end processing of the sample, result reporting
Q3) Studies have shown that automating front-end specimen processing has ______ sample processing time, ______ labor cost, and ___ __ specimen pour-off, labeling, and sorting errors.
A)decreased, decreased, decreased
B)decreased, increased, decreased
C)increased, decreased, increased
D)increased, increased, increased
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Page 22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) _______________ is/are sensitive to device malfunction, reagent storage and stability, and operator technique.
A)quality control
B)quality assurance
C)external controls
D)internal controls
Q2) Which of the following is not considered an analytical interference?
A)lipemia
B)drugs
C)interstitial fluid contamination
D)icterus
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) Most LISs can produce epidemiology reports that support which of the following?
1)quality assurance
2)accreditation
3)CLIA
4)public health
A)1, 2, 3, 4
B)1, 2, 4
C)1, 2, 3
D)1, 3, 4
Q2) When considering bar codes, what characters make up a Code 128?
1)uppercase alphabets
2)lowercase alphabets
3)numbers
4)special symbols
A)1, 2, 3, 4
B)2, 4
C)1, 3
D)2, 3, 4
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Page 24
Chapter 23: Laboratory Statistics
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Q1) Which statistical method should be selected in the following situation?
"Suppose a laboratory is interested in determining the prognostic ability of selected laboratory tests to predict patient outcomes following severe head trauma, based on a comparison of survivors versus non-survivors at predetermined times following the head trauma."
A)t-test
B)unpaired t-test
C)paired t-test
D)chi-square analysis
Q2) Suppose a laboratory is interested in changing from a manual assay for a given analyte to an automated assay for the analyte.Data collected by each of the two methods are unrelated, and the number of observations differs for each dataset.Which statistical method should be selected to determine if a significant difference exists between the means of the two methods?
A)t-test
B)unpaired t-test
C)paired t-test
D)standard error of the mean
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25
Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Some medical facilities are known for their cerebrovascular centers that provide immediate care for stroke victims.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
Q2) 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
Q3) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
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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) The most common graphical plot used as a visual tool for evaluating quality-control data is the:
A)Gaussian distribution
B)Levey-Jennings plot
C)cusum plot
D)Tonks-Youden plot
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Chapter 26: Evaluation of Methods
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Q1) Regression analysis of two methods produced the equation y = 0.137 + 0.813x.The proportionality between the two methods is:
A)the calculated value for y given the value for x
B)the calculated value for x given the value for y
C)0.137
D)0.813
Q2) 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
Q3) New analytical methods are usually developed to:
1)improve accuracy over existing methods.
2)allow automation.
3)increase labor in the laboratory.
4)reduce reagent costs.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) The overall three-dimensional structure and folding pattern of the complete protein that confers on the protein its specific biological properties is known as the protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q2) Monosaccharides can be linked to other monosaccharides or other biomolecules through the formation of:
A)peptide linkages
B)hydrogen bond linkages
C)glycosidic linkages
D)ester linkages
Q3) The order or sequence of amino acids in a protein as determined by genetic code 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 laboratory data, calculate the anion gap.
Sodium = 133 mEq/L
Potassium = 4.9 mEq/L
Chloride = 98 mEq/L
Bicarbonate = 20 mEq/L
A)5 mEq/L
B)10 mEq/L
C)15 mEq/L
D)20 mEq/L
Q2) Which of the following electrolytes is likely to be found decreased in metabolic alkalosis?
A)sodium
B)potassium
C)chloride
D)bicarbonate
Q3) A sweat chloride of 70 mEq/L is indicative of which of the following diseases?
A)cystic fibrosis
B)myasthenia gravis
C)Cushing's syndrome
D)syndrome of inappropriate ADH secretion
30
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) The base excess or base deficit is useful to the physician, because this value:
A)provides an indirect measure of the hemoglobin concentration in whole blood.
B)identifies the state of compensation of the acid-base imbalance.
C)permits estimation of the number of milliequivalents of acid or base that would be required to correct the pH to 7.4.
D)provides a direct measure of base available in the body, irrespective of the amount of acid present in the body.
Q2) A decreased total CO , decreased pCO , and a normal pH is correctly classified as:
1)compensated metabolic acidosis
2)compensated metabolic alkalosis
3)compensated respiratory acidosis
4)compensated respiratory alkalosis
A)1, 4
B)2, 3
C)3 only
D)4 only
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Chapter 30: Renal Function
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Q1) Each kidney is made up of approximately 1 million nephrons.The nephron begins with the ______.This is surrounded by ______, which is formed by the blind, dilated end of the ______.
A)Bowman's capsule, glomerulus, renal tubule
B)renal tubule, Bowman's capsule, glomerulus
C)renal tubule, glomerulus, Bowman's capsule
D)glomerulus, Bowman's capsule, renal tubule
Q2) Normal urine output is approximately _____________ per day.
A)500 mL
B)1000 mL
C)1500 mL
D)2500 mL
Q3) Underneath the capsule of fibrous tissue that encloses the kidney lies the renal cortex, which contains the ______ and the ______.
A)collecting ducts, glomeruli
B)glomeruli, renal tubules
C)tubules, collecting ducts
D)none of the above
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Chapter 31: Liver Function
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Q1) Which of the following syndromes has a mutation in the upstream promoter region of the gene for UDP-glucuronyl transferase 1 (UGT1) and results in reduced production of the enzyme?
A)Crigler-Najjar syndrome
B)Dubin-Johnson syndrome
C)Gilbert's syndrome
D)Wilson's disease
Q2) Autoimmune hepatitis:
1)is characterized by increased immunoglobulin production.
2)is characterized by the presence of autoantibodies.
3)leads to rapid progression of cirrhosis if untreated.
4)is associated with iron accumulation in parenchymal organs.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
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33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) __________ is a point mutation in a highly antigenic determinant of HBsAg that allows the person infected with this viral genotype to escape passive or active immunization against hepatitis B.
A)Stop code mutant
B)Escape mutant
C)Hepatitis mutant
D)None of the above
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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34
Chapter 33: Bone Disease
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Q1) Long bone:
1)are confined to the limbs.
2)consist of a diaphysis, epiphyses, and metaphysis.
3)consist of cortical bone that encloses a layer of trabecular bone.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following is not a risk factor associated with low bone density and fracture?
A)high weight and body mass index
B)low endogenous estrogen
C)hypogonadism
D)smoking and alcohol use
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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Page 35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) C-reactive protein (CRP) has been used to evaluate prognosis of pancreatitis.CRP levels of ______ at 48 hours after onset of symptoms are associated with a positive predictive value of about ______ for severe disease and a negative predictive value of _____ for severe disease.
A)>100 mg/L, 86%, 67%
B)>100 mg/L, 67%, 86%
C)>150 mg/L, 86%, 67%
D)>150 mg/L, 67%, 86%
Q2) The principal cations in pancreatic fluid are:
1)sodium
2)potassium
3)calcium
4)magnesium
5)chloride
A)1, 2, 3, 4
B)1, 2, 3, 5
C)2, 3, 4, 5
D)1, 3, 4, 5
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Chapter 35: Gastrointestinal Function
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Q1) Suppose there is a need to differentiate a situation of true malabsorption due to damage to intestinal mucosa from maldigestion due to pancreatic insufficiency.Given that one of these two situations is suspected, the patient is given a 25-gram dose of D-xylose dissolved in 300 mL of water.A blood sample is obtained 2 hours after the D-xylose administration, and a 5-hour urine is collected.The results of the D-xylose analysis are: blood xylose = 400 mg/L; urine xylose = 7 g/5 hr.These results provide laboratory evidence of:
A)malabsorption due to damage to the intestinal mucosa
B)maldigestion due to pancreatic insufficiency
C)both malabsorption and maldigestion
D)The D-xylose test alone cannot evaluate for either malabsorption or maldigestion.
Q2) When considering the lactose tolerance test, a healthy person will demonstrate a glucose of ______, but those with lactase deficiency will exhibit a peak plasma glucose of ______.
A)> 2000 mg/L over the baseline sample, < 1000 mg/L
B)< 2000 mg/L over the baseline sample, > 1000 mg/L
C)> 1000 mg/L over the baseline sample, < 2000 mg/L
D)< 1000 mg/L over the baseline sample, > 2000 mg/L
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Chapter 36: Cardiac and Muscle Disease
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Q1) The first myocardial marker to elevate following the onset of MI symptoms is ______.The concern with this marker is ______.
A)cTnI, this may return to normal before a blood sample can be collected
B)CK-MB, this may return to normal before a blood sample can be collected
C)myoglobin, this marker is considered nonspecific
D)cTnT, this marker is considered nonspecific
Q2) 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) Usually _________ are required after the onset of chest pain before CK-MB or the troponins become elevated in the serum of patients suffering from a myocardial infarction.
A)1 to 2 hours
B)2 to 4 hours
C)4 to 6 hours
D)6 to 8 hours
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) A patient has a triglyceride level of 234 mg/dL.This would be what when converted to mmol/L?
A)2.64 mmol/L
B)2.70 mmol/L
C)3.40 mmol/L
D)3.50 mmol/L
Q2) The following data provide laboratory evidence of which lipoprotein abnormality?
Total cholesterol - decreased, triglycerides - decreased
Apoprotein B - decreased
Vitamin E - decreased
Red blood cell morphology - acanthocytosis
A)Tangier disease
B)Familial lipoprotein lipase deficiency
C)Familial dysbetalipoproteinemia
D)Abetalipoproteinemia
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Chapter 38: Diabetes Mellitus
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Q1) In addition to hyperglycemia, which of the following are typical laboratory indicators of diabetes mellitus?
1)glucosuria
2)polyuria
3)hyperinsulinemia
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) The following data provide laboratory evidence of:
Glucose - 650 mg/dL
Urinalysis - polyuria with 3+ glucose
Serum osmolality - 365 mOsm/kg
PH - 7.39
Anion gap - 10 mEq/L
A)diabetic ketoacidosis
B)hyperglycemic hyperosmolar nonketotic coma
C)lactic acidosis
D)both a and c
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) The rate-limiting step in heme synthesis in the liver is regulated by which enzyme?
A)ALA synthase
B)ALA dehydratase
C)PBG deaminase
D)Ferrochelatase
Q2) 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
Q3) Which of the following would be expected in association with kidney disease?
A)increased serum iron
B)decreased TIBC
C)both a and b
D)neither a or b
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Chapter 40: Hemoglobin
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Q1) Oxygen binds directly to which component of hemoglobin?
A)the four pyrrole nitrogens in the core of protoporphyrin
B)the ferrous iron in the core of protoporphyrin
C)the ferric iron in the core of protoporphyrin
D)2,3-BPG bound in the central cavity of the hemoglobin tetramer
Q2) A hexokinase deficiency would result in a shift to the ______of the oxygen dissociation curve, and a pyruvate kinase deficiency would result in a s(answer format: blank 1, blank 2)
A)right, right
B)right, left
C)left, left
D)left, right
Q3) In which of the following conditions is Hb A elevated?
A)alpha thalassemia trait
B)beta thalassemia trait
C)Hb SC disease
D)HB S trait
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Chapter 41: Human Nutrition
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Q1) What is the body mass index of a patient who weighs 250 pounds and is 1.828 meters tall?
A)31 kg/m<sup>2</sup>
B)34 kg/m<sup>2</sup>
C)38 kg/m<sup>2</sup>
D)There is insufficient information provided to solve this problem.
Q2) For infants, essential amino acids should make up ______ of the total amino-acid intake; for children 10 to 12 years of age, it should make up ______; and for adults, essential amino acids should make up ______ of the total amino-acid intake.
A)36%, 43%, 10%
B)43%, 36%, 10%
C)36%, 10%, 43%
D)43%, 10%, 36%
Q3) Increased irritability of cardiac muscle may be associated with a decreased plasma concentration of which of the following macrominerals?
A)sodium
B)potassium
C)chloride
D)calcium
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Page 43
Chapter 42: Trace Metals
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Q1) 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
Q2) The most common food source of mercury is:
A)beef
B)milk
C)fish
D)poultry
Q3) What is the laboratory method of choice in the analysis of essential trace metals?
A)spectrophotometry
B)fluorometry
C)atomic absorption spectrophotometry
D)nephelometry
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Chapter 43: Vitamins
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Q1) The need for laboratory evaluation of vitamin E status may be indicated by which of the following diets?
A)a diet high in vegetable oils
B)a diet high in fresh, green vegetables
C)a diet high in unsaturated fats
D)a diet low in unsaturated fats
Q2) The active form of vitamin K is important in which of the following steps of the coagulation pathway?
A)the conversion of glutamic acid to delta-carboxyglutamic acid
B)the binding of calcium
C)the formation of an ionic bridge for clot formation
D)the binding with phospholipids
Q3) Considering characteristics of lipid-soluble vitamins, ______ can be stored in liver parenchymal cells for a year or longer, ______ can be stored in body fat for several months, and ______ appears to only be stored for a period of days or weeks.
A)vitamin E, vitamin A, vitamin K
B)vitamin A, vitamin E, vitamin D
C)vitamin E, vitamin K, vitamin A
D)vitamin A, vitamin D, vitamin E
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Page 45
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) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
Q3) The method of choice for the laboratory measurement of phospholipids such as lecithin, sphingomyelin, and phosphatidylglycerol in evaluating fetal lung maturity is:
A)UV/visible spectrophotometry
B)nephelometry
C)thin-layer chromatography
D)ion-selective electrodes
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Chapter 45: The Newborn
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Q1) Late (>72 hours) neonatal hypocalcemia arises from which of the following?
1)neonatal hypoparathyroidism
2)high phosphate intake
3)phototherapy
4)hypoalbuminemia
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Maturation of the renal system normally occurs during which stage(s) of fetal development?
A)first trimester
B)second trimester
C)third trimester
D)both b and c
Q3) Which tests will identify both neonatal primary and secondary hypothyroidism?
A)TSH
B)free T<sub>4</sub>
C)total T<sub>3</sub>
D)total T<sub>4</sub>
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Chapter 46: Extravascular Biological Fluids
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Q1) Which of the following is/are associated with inflammatory joint disease?
A)decreased viscosity of synovial fluid
B)presence of clots in synovial fluid
C)increased number of neutrophils in synovial fluid
D)all of the above
Q2) A pleural fluid with a pH of ______ is indicative that the cause for the exudate will resolve spontaneously, whereas a pH of ______ indicates a need for intervention.
A)>7.30, <7.20
B)<7.20, >7.30
C)>7.40, <7.30
D)<7.30, >7.40
Q3) A ______ is a surgical procedure in which pleural fluid is obtained by a puncture of the chest wall.______ is aspiration of fluid from a cavity.______ refers to pus in the pleural cavity.
A)paracentesis, Empyema, Thoracentesis
B)thoracentesis, Paracentesis, Empyema
C)paracentesis, Thoracentesis, Empyema
D)thoracentesis, Empyema, Paracentesis
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48
Chapter 47: Nervous System
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Q1) When blood is present from a traumatic lumbar puncture or there is bleeding within the CNS, how is the CSF protein level corrected for the amount of blood present?
A)subtracting 1 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
B)subtracting 2 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
C)subtracting 1 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
D)subtracting 2 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
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 test(s) is/are used to determine if hypothalamic or pituitary dysfunction are the cause of hypogonadal disease and hypergonadal disease?
A)FSH
B)LH
C)prolactin
D)both a and b
Q2) Which of the following forms of thyroxine would be the least available to tissue receptors?
A)thyroxine free in the circulation
B)thyroxine bound to albumin in the circulation
C)thyroxine bound to prealbumin in the circulation
D)thyroxine bound to thyroxine-binding globulin in the circulation
Q3) 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
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Chapter 49: Thyroid
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Q1) In primary hyperthyroidism, fT will be ______, and TSH will be _____.
A)increased, decreased
B)increased, increased
C)decreased, decreased
D)decreased, increased
Q2) Given the following characteristics, which disease state is most likely?
TSH - increased
FT - increased
FT - increased
T RU - decreased
TSI - negative
TPO-ab - unlikely to be positive
Thyroid scan uptake - increased
A)Graves' disease
B)autoimmune thyroiditis
C)secondary hyperthyroidism
D)primary hypothyroidism
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Chapter 50: The Gonads
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Q1) In the negative-feedback regulation of androgens, which of the following functions to inhibit the production of FSH?
A)testosterone
B)5- -aromatase
C)LH
D)inhibin
Q2) Of the circulating testosterone in normal men, the majority is ______________.
A)loosely bound to albumin
B)free
C)bound to cortisol-binding globulin
D)bound with high affinity to sex hormone-binding globulin
Q3) The ovary is composed of what cell types?
1)coelomic epithelial cells
2)granulosa cells
3)mesenchymal cells
4)primordial germ cells
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) Which of the following is considered the most sensitive test for the diagnosis and exclusion of pheochromocytoma?
A)plasma free metanephrines
B)the low-dose dexamethasone suppression test
C)plasma ACTH
D)plasma epinephrine
Q2) Which of the following patients should undergo screening for Cushing's syndrome?
A)a patient with osteoporosis
B)a woman with polycystic ovary syndrome
C)a patient with poorly controlled diabetes
D)all of the above
Q3) The predominant androgens secreted by the adrenal cortex are:
1)dehydroepiandrosterone sulfate (DHEA-S)
2)dehydroepiandrosterone (DHEA)
3)androstenedione
4)dihydrotestosterone (DHT)
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 52: Diseases of Genetic Origin
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Q1) Which of the following is a type of prenatal genetic test?
A)chorionic villus sampling
B)percutaneous umbilical blood sampling
C)amniocentesis
D)all of the above
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 gene(s) has/have been identified as most likely to contribute to an inherited susceptibility to breast and ovarian cancer?
A)BRCA1
B)BRCA2
C)BRCA3
D)both a and b
Q2) Select the correct order for the four phases of cancer.
1)dissemination
2)invasion
3)induction
4)in situ
A)3, 4, 2, 1
B)4, 3, 1, 2
C)1, 2, 3, 4
D)1, 3, 4, 2
Q3) Which class of tumors is the most aggressive and has the worst prognosis?
A)well differentiated
B)moderately well differentiated
C)moderately differentiated
D)poorly differentiated
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Which of the following is a bacterial agent commonly seen in transplant recipients?
1)Nocardia species
2)Aspergillus fumigatus
3)Serratia marcescens
4)Proteus rettgeri
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Kidney donors who have been monitored for up to 20 years after donation exhibit a slight ______ in glomerular filtration rate and a mild ______ in urine protein excretion, without an increase in hypertension.
A)decrease, increase
B)decrease, decrease
C)increase, increase
D)increase, decrease
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Chapter 55: Toxicology
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Q1) Most toxins enter the body through what route?
A)skin
B)lungs
C)gastrointestinal tract
D)all of the above
Q2) Which of the following individuals would have the highest metabolism of a drug based strictly on age?
A)a newborn
B)a 20-year-old
C)a 60-year-old
D)an 80-year-old
Q3) Which of the following drugs shows a relationship between the concentration of the toxin found in the circulation and toxicity?
A)acetaminophen
B)salicylate
C)carbon monoxide
D)all of the above
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Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following is an aspect of addiction?
1)craving
2)withdrawal
3)dependence
4)denial
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
Q2) The heaviest alcohol use occurs in what age group?
A)ages 13 to 18 years
B)ages 18 to 25 years
C)ages 21 to 28 years
D)ages 25 to 32 years
Q3) Which of the following situations could produce withdrawal symptoms?
A)chronic regular use of narcotics for pain
B)chronic regular use of sedatives for anxiety
C)chronic regular use of sedatives for insomnia
D)all of the above
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