Diagnostic Laboratory Methods
Exam Answer Key
Course Introduction
Diagnostic Laboratory Methods is a comprehensive course designed to introduce students to the fundamental techniques used in clinical and research laboratories for the detection, identification, and analysis of disease-causing agents and biomarkers. The course covers essential laboratory practices including specimen collection, processing, and storage, as well as methodologies such as microscopy, immunoassays, molecular diagnostics, and biochemical testing. Emphasis is placed on quality assurance, safety protocols, interpretation of results, and the role of laboratory findings in patient diagnosis and management. Through a combination of lectures, hands-on laboratory sessions, and case studies, students gain practical skills and critical thinking abilities necessary for effective laboratory practice in medical and scientific environments.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Page 2
Chapter 1: Basic Laboratory Principles and Techniques
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Q1) Which of the following water purification techniques is most effective in removing dissolved ionized gases?
A)distillation
B)deionization
C)reverse osmosis
D)ultrafiltration
Answer: B
Q2) Which of the following laboratory containers should be selected to store an organic hydrocarbon solvent?
A)borosilicate glass
B)polyethylene
C)polycarbonate
D)polyvinyl chloride (PVC)
Answer: A
Q3) A material that is used to absorb and remove water from the air is known as a:
A)teratogen
B)desiccant
C)carcinogen
D)reference material
Answer: B
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Chapter 2: Spectral Techniques
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Q1) Any radiant energy that is measured by the detector but outside the spectral region isolated by the monochromator of the instrument is referred to as ______.As this increases, Beer's law linearity will ______.
A)Rayleigh scatter, increase
B)stray light, decrease
C)transmitted light, increase
D)polychromatic light, decrease
Answer: B
Q2) In the clinical laboratory, the primary problem with the use of fluorescent techniques is that:
A)this technique is not a very sensitive technique as compared to other spectrophotometric techniques.
B)the flame may not be hot enough to totally dissociate some of the complexes.
C)many compounds do not fluoresce in their natural state.
D)all of the stray light produced in the instrument cannot be filtered out.
Answer: C
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Given the following data, calculate the column selectivity ( ).
Chart speed for recording the chromatogram is 1 cm/min
Mobile phase flow rate is 1.6 mL/min
Migration distance of the void volume indicator is 1.3 cm
Migration distance of the first solute of interest is 14.8 cm
Migration distance of the second solute of interest is 15.8 cm
A)0.93
B)1.07
C)10.38
D)11.15
Answer: B
Q2) The type of chromatography in which separation occurs by differential distribution of solutes between two immiscible liquids is known as:
A)adsorption chromatography
B)partition chromatography
C)ion-exchange chromatography
D)gel-permeation chromatography
Answer: B
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Chapter 4: Chromatographic Techniques
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Q1) Which of the following techniques is the most advantageous technique for separating enantiomers by chromatography?
A)use of a chiral stationary phase specifically designed for the enantiomeric pair
B)use of a mobile phase containing a chiral complexing agent which forms diastereomeric complexes during the chromatographic analysis
C)chemical derivatization of the enantiomeric pair, forming diastereomers prior to chromatographic analysis
D)chemical derivatization of the enantiomeric pair, forming diastereomers following chromatographic analysis
Q2) Which of the following are required characteristics of the carrier gas used in gas chromatography?
A)It must be chemically and chromatographically inert.
B)It must be pure and dry.
C)It must be matched with the appropriate gas-chromatographic detector.
D)All of the above
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Isoelectric focusing (IEF) may be utilized to investigate unresolved HPLC hemoglobin results.What advantage of this technique makes it useful in this situation?
A)IEF is a technique that is readily adaptable to automation, resulting in a quick and simple method to resolve questionable HPLC hemoglobin results.
B)IEF is a technique that does not depend on the charge of the hemoglobin fractions, providing a method that complements HPLC analysis of hemoglobin fractions.
C)IEF results in the formation of discrete sharp bands, allowing clear separation of the various hemoglobins present in the patient sample.
D)IEF provides an enhanced method of detection that may allow the technologist to see fractions not detected by HPLC.
Q2) Which of the following variations between hemoglobins allows for their separation by electrophoresis and chromatography?
A)variations in the amino acid composition of hemoglobins
B)variations in the heme composition of hemoglobins
C)variations in the amount of oxygen carried by hemoglobins
D)variations in the concentration of hemoglobins in the sample under analysis
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Chapter 6: Electrophoresis
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Q1) Is the following statement true or false? Why?
"A thinner electrophoretic support is associated with a greater sensitivity."
A)true because a thinner support will require less sample to produce a detectable spot
B)true because a thinner support will allow more exposure to air
C)false because a thinner support can hold less sample
D)false because a thinner support can hold more solvent and effectively dilute the sample
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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Page 8
Chapter 7: Immunological Reactions
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Q1) The portion of an antigen involved in a reaction with an antibody is known as the ____ site, and the number of these sites on an antigen is known as the antigen's
A)equivalence, valency
B)equivalence, complexity
C)antigenic determinant, valency
D)antigenic determinant, complexity
Q2) Considering the noncovalent forces that contribute to antigen and antibody attraction, ________ are the strongest and most important contributors to antigen and antibody attraction, whereas ________ are the weakest contributors to this attraction.
A)electrostatic forces, van der Waals forces
B)hydrogen bonds, electrostatic forces
C)van der Waals forces, hydrogen bonds
D)electrostatic forces, hydrogen bonds
Q3) 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
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Chapter 8: Immunochemical Techniques
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Q1) One of the factors that influences agglutination reactions is the presence of a zeta potential, a negative surface charge, which must be overcome to permit cross-linking and agglutination.Which of the following steps can assist in overcoming the zeta potential?
A)Increase the ionic strength of the medium.
B)Adjust the pH of the medium to physiological pH.
C)Increase the viscosity of the medium.
D)All of the above will assist in overcoming charge repulsion.
Q2) Which one of the following sample conditions would be acceptable in complement fixation testing?
A)a hemolyzed sample
B)a lipemic sample
C)plasma collected in EDTA
D)plasma collected in heparin
Q3) The direct Coombs' test measures the presence of antibody _______, and the indirect Coombs' test measures _______.
A)in the serum, antigens on cells
B)on cells, antigens on cells
C)in the serum, free antibodies in the serum
D)on cells, free antibodies in the serum
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) _______ 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 are the two most important characteristics of the fluorophore utilized as the label in fluorescence immunoassays?
A)the wavelength of light absorption and the molecular weight of the fluorophore
B)the extinction coefficient and the magnitude of the Stokes shift
C)the wavelength of light emission and the chemical reactivity of the fluorophore
D)the specificity of the immunoglobulin for the fluorophore and the heterogeneous nature of the immunoassay
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11
Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Serological testing is typically not the method of choice for this disease.
A)syphilis
B)Lyme disease
C)peptic ulcer
D)herpes
Q2) Indirect fluorescent antibody (IFA) techniques measure ______ in the patient sample, using fluorescent ______.
A)antigen, spectrophotometry
B)antibody, spectrophotometry
C)antigen, microscopy
D)antibody, microscopy
Q3) Suppose a serum VDRL gave a positive result, and CSF showed 8 nucleated cells/mm³.What follow up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested positive, and what follow-up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested negative?
A)T.pallidum particle agglutination test, no follow-up testing is required
B)fluorescent treponemal antibody test, no follow-up testing is required
C)no follow-up testing is required, T.pallidum particle agglutination test
D)no follow-up testing is required, fluorescent treponemal antibody test
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Page 12
Chapter 11: Measurement of Colligative Properties
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Q1) The two methods used in the clinical laboratory to determine osmolality are:
A)osmotic pressure and boiling point
B)boiling point and freezing point
C)vapor pressure and osmotic pressure
D)freezing point and vapor pressure
Q2) All of the following variables are needed to calculate a stool osmolal gap except:
A)stool glucose level
B)stool sodium level
C)stool potassium level
D)measured stool osmolality
Q3) Osmolality measurements depend on:
A)the molecular weight of particles in solution
B)the kind of particles in solution
C)the number of particles in solution
D)all of the above
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13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) Which of the following may result in errant sodium results being reported by the laboratory when using a glass ion-selective electrode?
A)standards used for calibration and sample for analysis are not analyzed at the same temperature
B)electrode fouling by serum, plasma, or whole blood
C)analysis of highly acidic urine samples
D)all of the above
Q2) In the coulometric titration of chloride, the titration end-point is measured in terms of the:
A)time required to complete the titration
B)amount of product (silver chloride) formed
C)amount of silver ion produced at the anode
D)number of electrons detected at the cathode
Q3) The typical pH ion-selective phase utilized in a clinical laboratory is subject to which of the following problems?
A)acid error
B)alkaline error
C)interference from calcium and other divalent ions
D)lack of reproducibility
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Page 14
Chapter 13: Molecular Diagnostics
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Q1) Single-stranded conformational polymorphism analysis (SSCP) and heteroduplex analysis are two mutation scanning techniques that have which of the following in common?
A)Conformational changes resulting from mutations are detected by electrophoretic differences.
B)Conformational changes resulting from mutations are detected by changes in fluorescence intensity.
C)The presence of mutations is detected in these techniques by scanning UV/visible spectrophotometry identifying changes in wavelengths of maximum absorbance.
D)The presence of mutations is detected in these techniques by variations in melting temperature.
Q2) In denaturing high-performance liquid chromatography, what is the purpose of adding triethylammonium acetate (TEAA) to the mobile phase?
A)to adjust the pH of the mobile phase to that appropriate for DNA analysis
B)to denature DNA during chromatography
C)to serve as an ion-pairing reagent
D)to adjust the chromatographic environment to the appropriate ionic strength
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Page 15
Chapter 14: Therapeutic Drug Monitoring
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Q1) Kinetic processes related to the fate of a drug in the body, where the drug concentration exceeds the capacity of the system, is known as:
A)zero-order kinetics
B)first-order kinetics
C)Michaelis-Menten kinetics
D)compartmental kinetics
Q2) Kinetic processes related to the fate of a drug in the body, where the rate of change of drug concentration is independent of the concentration of a particular drug, is known as:
A)zero-order kinetics
B)first-order kinetics
C)Michaelis-Menten kinetics
D)compartmental kinetics
Q3) Where will an acidic drug with a pK of 3.5 have the greatest chance for absorption by passive diffusion?
A)the stomach
B)the skin
C)the intestine
D)the rectum
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Page 16
Chapter 15: Clinical Enzymology
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Q1) Which type of enzyme inhibitor is associated with an increased Km in order to maintain maximal velocity?
A)competitive inhibitor
B)noncompetitive inhibitor
C)uncompetitive inhibitor
D)allosteric inhibitor
Q2) Most clinical laboratory assays measure concentration of analyte in the blood stream.Why do most enzyme analyses measure enzyme activity instead of enzyme concentration?
A)The assays utilized to measure enzymes involve equilibrium reactions where the reaction can proceed in both directions during the assay.
B)The enzyme being analyzed may be present in such a large concentration that it is difficult to maintain linearity, causing activity measurements to be more suitable.
C)Enzymes are not consumed during the reactions in which they are involved, requiring analysis by activity instead of concentration.
D)The products formed by enzymatic reactions are not sufficiently chromophoric to be measured by traditional spectrophotometric techniques.
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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) All of the following statements are true about the LD isoenzyme except:
A)LD has approximately a 10-fold greater affinity for pyruvate than does LD<sub>1</sub>.
B)LD is a tetramer that consists of four H subunits.
C)LD predominates in tissues that are primarily anaerobic.
D)LD is found in high concentration in skeletal muscle and liver.
Q3) 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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Chapter 17: Interferences in Chemical Analysis
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Q1) It is recommended that spectrophotometric measurements be made in which of the following absorbance ranges?
A)0.100 - 1.100
B)0.200 - 0.500
C)0.500 - 1.500
D)0.100 - 2.000
Q2) Suppose a colorimetric analysis that utilizes a highly colored reagent is to be performed.Which type of blank should be prepared to ensure the correct sample results?
A)sample blank
B)reagent blank
C)instrument blank
D)diluent blank
Q3) Suppose you have a lipemic patient sample for analysis by a colorimetric technique.Which of the following actions should be taken to eliminate the interference caused by the lipemia?
A)Use a sample blank.
B)Dilute the patient sample.
C)Convert the method of analysis to a nephelometric technique.
D)Convert the method of analysis to a fluorometric technique.
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Page 19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) An important preanalytical variable is associated with the use or non-use of anticoagulants.Which of the following statements related to use or non-use of anticoagulants are correct?
1)The measured total protein level is the same in serum and heparinized plasma.
2)Platelets release potassium during clotting.
3)The use of EDTA plasma will falsely decrease plasma calcium.
4)Heparinized plasma is preferred over serum for cardiac marker evaluation.
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
Q2) Which of the following would be recommended to a physician who is concerned about getting an overall picture of analyte production for a material that is known to exhibit circadian variation in a patient who has unpredictable sleep/wake patterns?
A)random blood level
B)8 a.m.fasting blood level
C)8 a.m.and 8 p.m.blood levels
D)24-hour urine level
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Page 20
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) What is the most important management skill/ability that should be utilized by a laboratory director when planning changes in laboratory services?
A)communication
B)technical knowledge
C)background research
D)financial restraint
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Chapter 20: Laboratory Automation
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Q1) Commonly the following steps are performed during the course of chemical analysis: mix an aliquot of sample with reagents, ______, ______, ______, and provide an appropriate readout for the permanent record.
A)monitor the result of the reaction, incubate the reaction mixture, quantify the extent of the reaction
B)quantify the extent of the reaction, incubate the reaction mixture, monitor the result of the reaction
C)monitor the result of the reaction, quantify the extent of the reaction, incubate the reaction mixture
D)incubate the reaction mixture, monitor the result of the reaction, quantify the extent of the reaction
Q2) 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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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Tests performed by clinicians on their own patients, using samples that are so fragile it is impractical to send them to a central laboratory, are ____________.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
Q2) _____________ is clinical laboratory testing conducted close to the site of patient care.
A)ex-vivo testing
B)point-of-care testing
C)in-vivo testing
D)diagnostic testing
Q3) Most errors with point-of-care testing occur at which of the following times?
A)before analysis, in the preanalytical phase
B)during analysis
C)at the time of reporting and recording of test results
D)none of the above
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Chapter 22: Laboratory Information Systems
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Q1) What bar code is normally used for the labeling of blood products?
A)Code 128
B)Code 139
C)Code 39
D)Code ISBT-128
Q2) Software maintenance may:
1)repair software defects or design problems.
2)support new hardware or operating systems.
3)occur once a year.
4)include changes in the user environment.
A)1, 2, 3, 4
B)2, 3, 4
C)1, 3, 4
D)1, 2, 4
Q3) Which of the following is not considered a patient demographic?
A)patient sex
B)referring physician
C)age or birthdate
D)All of the above are part of patient demographics.
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Page 24
Chapter 23: Laboratory Statistics
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Q1) The F-test is considered a measure of ______ between two sets of data, and the t-test is considered a measure of ______ between two sets of data.______ is/are considered as a parametric comparison.
A)accuracy, precision, the F-test
B)precision, accuracy, both tests
C)accuracy, precision, both tests
D)precision, accuracy, the t-test
Q2) If data are non-Gaussian distributed, steps are typically taken to transform data by taking the logarithm of the data to produce a Gaussian distribution.Why are laboratories interested in data existing in a Gaussian distribution?
A)NCCLS standards require that only Gaussian-distributed data be utilized in laboratory statistics and quality control.
B)Transformation to a Gaussian distribution will allow the utilization of applications useful to the clinical laboratory.
C)Transformation to a Gaussian distribution will correct data points causing the initial data to not be Gaussian distributed.
D)All of the above
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Which of the following statements correctly compares and contrasts a-priori and a-posteriori methods of reference individual selection?
1)In both methods, exclusion and partitioning take place after sampling and analyte testing.
2)A-priori methods require fewer reference individuals to be studied than a-posteriori methods.
3)Questionnaires for potential reference individuals must be more detailed for a-posteriori methods than for a-priori methods.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following attributes is the most desirable for a laboratory test utilized in the diagnosis of diseases such as cystic fibrosis that are currently not curable?
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
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26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) A definitive method is:
A)the most commonly used method.
B)the scientifically most accurate method.
C)a method that can be used for qualitative screening only.
D)a method that has demonstrated similar but slightly less accuracy than a reference method.
Q2) Suppose a laboratory expands its acceptable limits for quality-control results from 0 Âħ 2 to 0 Âħ 2.5 .What is the potential negative aspect of this change?
A)There may not be sufficient error detection.
B)There may be too many false rejections of acceptable test results.
C)The control limits for rejecting an analytical run will become too narrow.
D)There will be improved detection of method failure.
Q3) Which of the following would likely not be detected by quality-control procedures in a laboratory assay performed manually?
A)deteriorated reagent
B)improper reaction temperature
C)pipetting error
D)spectrophotometer set at the wrong wavelength
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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) Usually a method-evaluation study is performed to:
A)test all methods to determine the method with the smallest error.
B)determine whether the selected method has acceptably small analytical errors.
C)both a and b
D)neither a nor b
Q3) Which of the following is the correct sequence to follow in method selection?
A)define requirements, review literature, determine need, select candidate methods
B)determine need, define requirements, review literature, select candidate methods
C)select candidate methods, determine need, define requirements, review literature
D)determine need, review literature, define requirements, select candidate methods
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) Which of the following compounds lack water solubility and require transport molecules for movement through the blood stream?
A)proteins
B)lipids
C)carbohydrates
D)both a and b
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 lipid that serves as the precursor of many hormones such as androgens, estrogens, and progesterones is:
A)triglycerides
B)cholesterol
C)gangliosides
D)cephalins
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Given the following patient results, which statement is true?
Sodium = 136 mEq/L
Potassium = 4.3 mEq/L
Chloride = 99 mEq/L
Bicarbonate = 22 mEq/L
Measured serum osmolality = 283 mOsm/kg
Glucose = 288 mg/dL
BUN = 45 mg/dL
A)The electrolytes are in balance, and the value obtained for osmolality correlates with the other data.
B)The electrolytes are not in balance, but the value obtained for osmolality correlates with the other data.
C)The electrolytes are in balance, but the value obtained for osmolality does not correlate with the other data.
D)The electrolytes are not in balance, and the value obtained for osmolality does not correlate with the other data.
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Sample Questions
Q1) 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) Which of the following is the normal reference interval for arterial pH?
A)7.31 - 7.41
B)7.33 - 7.43
C)7.35 - 7.45
D)7.45 - 7.55
Q3) A normal total CO , increased pCO , and decreased pH is most correctly classified as:
A)uncompensated metabolic acidosis
B)compensated metabolic acidosis
C)uncompensated respiratory acidosis
D)compensated respiratory acidosis
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Chapter 30: Renal Function
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Q1) ___________ is the major cation found in extracellular fluid, and therefore regulation of this is the critical factor in the maintenance of body fluid volume.
A)Sodium
B)Chloride
C)Potassium
D)Phosphorus
Q2) Potassium is freely filtered at the ______, and ______ occurs throughout the nephron, except in the ______.
A)descending loop of Henle, active tubular reabsorption, glomerulus
B)ascending loop of Henle, active tubular reabsorption, glomerulus
C)glomerulus, active tubular reabsorption, descending loop of Henle
D)glomerulus, active tubular reabsorption, ascending loop of Henle
Q3) All filtered glucose and most of the filtered amino acids are normally reabsorbed in
A)the ascending loop of Henle
B)the descending loop of Henle
C)the proximal tubule
D)the distal convoluted tubule
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32
Chapter 31: Liver Function
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Sample Questions
Q1) Warfarin blocks the activation of what clotting factors?
1)II
2)VII
3)IX
4)X
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
Q2) The liver is supplied by what major source(s) of oxygen-containing blood?
A)the hepatic artery
B)the portal vein
C)the hepatic vein
D)both a and b
Q3) All of the following are common causes of acute hepatitis except:
A)non-alcoholic fatty liver disease (NAFLD)
B)hepatitis A virus (HAV)
C)hepatitis B virus (HBC)
D)hepatitis C virus (HCV)
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Chapter 32: Diagnosis of Viral Hepatitis
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Q1) The combination of test results of the hepatitis B virus serological markers can be used to:
1)identify carrier status.
2)identify vaccination status.
3)differentiate the stage of an active infection.
4)estimate the clinical outcome of the disease.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
Q2) For hepatitis delta virus to be present, what other hepatitis virus must the patient have?
A)HAV
B)HBV
C)HCV
D)HEV
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Chapter 33: Bone Disease
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Q1) Estrogen increases bone mass and bone mineral density by:
1)reducing bone resorption by directly preventing osteoclast differentiation, activity, and survival and indirectly by stimulating the secretion of calcitonin.
2)increasing collagen synthesis and osteoid formation.
3)enhancing the absorption of calcium across the intestines.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Primary hyperparathyroidism:
1)causes an increased serum phosphorus.
2)causes an increased serum calcium.
3)is usually discovered in adulthood.
4)is predominantly seen in postmenopausal women.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
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Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Excess production of ______ produces Zollinger-Ellison syndrome, whereas excess production of ______ produces the syndrome of watery diarrhea, hypokalemia, and achlorhydria.
A)gastrin, vasoactive intestinal peptide
B)vasoactive intestinal peptide, gastrin
C)gastrin, somatostatin
D)vasoactive intestinal peptide, somatostatin
Q2) 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) Which of the following vitamins are not water soluble and must be absorbed with lipids?
1)Vitamin A
2)Vitamin C
3)Vitamin D
4)Vitamin K
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q2) Which of the following processes occurs in the large intestine?
A)Selective water and electrolyte absorption occur.
B)Pancreatic secretions enter the intestine.
C)Components of micelles are absorbed.
D)All of the above
Q3) Which of the following is not a function of gastrin?
A)stimulates stomach acid secretion
B)stimulates stomach contraction
C)stimulates intestinal motility
D)stimulates growth of small bowel mucosa
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Chapter 36: Cardiac and Muscle Disease
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Q1) The troponin complex is a set of three proteins that participate in the regulation of muscle contraction.Troponin ______ functions as the tropomyosin-binding component, troponin ______ functions as the inhibitory component, and troponin ______ functions as the calcium-binding component.
A)C, I ,T
B)I, T, C
C)C, T, I
D)T, I, C
Q2) Which of the following laboratory tests would be the most useful in assisting the physician in differentiating congestive heart failure from other conditions that have similar clinical presentations?
A)lactate
B)CK-MB
C)cTnI
D)BNP
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Cholesterol is essential for normal functioning of the body because
1)it is an essential structural component of cell membranes.
2)it is an important source of immediate energy for the heart and brain.
3)it is an important precursor of bile acids.
A)1, 2, 3
B)1, 2
C)1, 3
D)2, 3
Q2) Which of the following statements is incorrect regarding apoproteins?
A)Apoprotein A-1 is essential for the formation and secretion of chylomicrons.
B)Apoprotein B-100 serves as a ligand for LDL binding to receptors.
C)Apoprotein C-II serves as an activator of LPL activity.
D)Apoprotein E serves as a ligand for chylomicron and VLDL remnant binding to receptors.
Q3) At birth, serum cholesterol levels are approximately ______, and the level steadily increases with age at a rate of approximately ______ per year.
A)65 mg/dL, 1.5 mg/dL
B)50 mg/dL, 2.5 mg/dL
C)65 mg/dL, 2.5 mg/dL
D)50 mg/dL, 1.5 mg/dL
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Chapter 38: Diabetes Mellitus
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Sample Questions
Q1) 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
Q2) Which of the following laboratory results provide provisional laboratory diagnosis of diabetes mellitus?
1)2-hour postprandial glucose = 175 mg/dL
2)fasting plasma glucose = 140 mg/dL
3)casual (random) glucose = 210 mg/dL
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) The following data provide laboratory evidence of which disorder of porphyrin metabolism?
Urinary -aminolevulinic acid (ALA) - elevated
Urinary porphobilinogen (PBG) - normal
Free erythrocyte protoporphyrin (zinc protoporphyrin) - elevated
A)acute intermittent porphyria
B)porphyria cutanea tarda
C)hereditary coproporphyria
D)lead poisoning
Q2) Which of the following characteristics is true of hemosiderin that differentiates it from ferritin?
A)Hemosiderin may contain up to approximately 4500 iron atoms.
B)Hemosiderin is a readily mobilized storage form of iron.
C)Hemosiderin is derived from ferritin that has lost some of its surface protein, causing insolubility.
D)Hemosiderin is too small to be observed by light microscopy, whereas ferritin can be observed in tissue stained with Prussian blue dye.
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Chapter 40: Hemoglobin
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Q1) It has been observed that the organism causing __________ fails to grow in Hb
S-containing red blood cells.
A)meningitis
B)rubella
C)syphilis
D)malaria
Q2) Synthesis of hemoglobin is normally stimulated by hypoxia causing the ______ to produce ______.
A)hypothalamus, hemopexin
B)adrenal gland, haptoglobin
C)kidneys, erythropoietin
D)lungs, angiotensin
Q3) The problem with methemoglobin is:
A)it cannot bind oxygen reversibility.
B)it has a higher affinity for carbon monoxide than carbon dioxide.
C)it has a much higher affinity for carbon monoxide than oxygen.
D)it has a much higher affinity for carbon dioxide than oxygen.
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Chapter 41: Human Nutrition
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Q1) Select the correct order of events for the refeeding syndrome.
1)water and salt retention
2)patient is treated with excessive glucose
3)fluid overload and stress to heart
4)increased vascular space
5)exaggerated insulin response
A)2, 5, 1, 4, 3
B)5, 2, 3, 4, 1
C)1, 3, 5, 2, 4
D)3, 5, 4, 1, 2
Q2) Response to protein supplementation is reflected most rapidly by an increase in ______, but ______ has been found to be more useful for the laboratory indications of improved nutritional status.
A)transferrin, prealbumin
B)prealbumin, retinol-binding protein
C)retinol-binding protein, prealbumin
D)prealbumin, transferrin
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Chapter 42: Trace Metals
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Q1) An aluminum measurement may be requested in which of the following situations?
A)a patient receiving long-term total parenteral nutrition therapy
B)a patient recovering from a liver transplant
C)a patient developing frequent kidney stones
D)a patient diagnosed with type 2 diabetes
Q2) The most common food source of mercury is:
A)beef
B)milk
C)fish
D)poultry
Q3) Which of the following elements is an important component of thyroid hormones?
A)fluorine
B)iodine
C)manganese
D)molybdenum
Q4) Which of the following essential trace elements exhibits antioxidant properties?
A)chromium
B)manganese
C)molybdenum
D)selenium
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Chapter 43: Vitamins
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Sample Questions
Q1) Vitamin A toxicity:
A)can occur as a result of overmedication with vitamin supplements.
B)can result from the use of topical retinoids for acne.
C)can cause dry skin, bone pain, fatigue, and renal disorders.
D)all of the above
Q2) Absolute vitamin deficiencies can be the result of:
1)a nutritional deficit
2)an inability to properly absorb a vitamin
3)an increased metabolism and clearance
4)a markedly increased utilization
A)1, 2, 3, 4
B)1, 2, 4
C)1, 2, 3
D)2, 3, 4
Q3) Wernicke-Korsakoff syndrome is commonly seen in ______ and is associated with a ______ deficiency.
A)pellagra, niacin
B)alcoholism, thiamine
C)wet beriberi, carnitine
D)rickets, vitamin D
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Chapter 44: Pregnancy and Fetal Development
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Q1) Which of the following tests is used in the diagnosis of neural tube defects?
A)human chorionic gonadotropin
B)follicle-stimulating hormone
C)luteinizing hormone
D)acetylcholinesterase
Q2) Given the following laboratory data, which is most likely associated with fetal lung immaturity in a blood-contaminated amniotic fluid sample?
A)L/S ratio = 1.5, PG = negative
B)L/S ratio = 2.0, PG = positive
C)L/S ratio = 2.7, PG = negative
D)L/S ratio = 1.0, PG = positive
Q3) Amniotic-fluid bilirubin serves as an important indicator of hemolytic disease in the developing fetus.Which of the following laboratory techniques is used to measure amniotic-fluid bilirubin levels?
A)fluorometry
B)spectrophotometry
C)chromatography
D)fluorescence polarization
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Chapter 45: The Newborn
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Q1) Which of the following are potential problems with the use of whole blood for laboratory analyses?
1)the presence of undetected hemolysis in a whole-blood sample
2)the continuation of glycolysis after whole-blood collection
3)the interference of the anticoagulant with the laboratory analysis of analytes in whole blood
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following series of hormones have low or undetectable blood levels in the newborn and have no known role in normal neonatal physiology?
A)prolactin, FSH, and LH
B)insulin and cortisol
C)growth hormone and ACTH
D)TRH, TSH, T
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Chapter 46: Extravascular Biological Fluids
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Q1) Which of the following statements are true of transudates?
1)They are caused by inflammation.
2)They are caused by disturbances of hydrostatic pressure.
3)They are caused by disturbances of colloid osmotic pressure.
4)They are caused by increased capillary permeability.
A)1, 2
B)2, 3
C)3, 4
D)1, 4
Q2) The following diseases are associated with what classification of synovial fluid?
Gout
Pseudogout
Rheumatoid arthritis
Systemic lupus erythematosus
A)noninflammatory
B)inflammatory
C)septic
D)hemorrhagic
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Chapter 47: Nervous System
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Q1) Which of the following are characteristics of a normal spinal fluid?
1)specific gravity of 1.007
2)glucose of 50 mg/dL
3)protein of 7.0 g/dL
4)sodium of 140 mmol/L
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Which type of meningitis is most likely indicated by the following laboratory data on a spinal fluid sample?
WBC - 400 cells/mm³, primarily lymphocytes
Protein: 35 mg/dL
Glucose: 55mg/dL
A)bacterial
B)fungal
C)cryptococcal
D)viral
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Chapter 48: General Endocrinology
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Q1) The posterior lobe of the pituitary is also known as the ______, and the anterior lobe of the pituitary is also known as the ______.The ______ is the lobe that releases trophic hormones.
A)adenohypophysis, neurohypophysis, anterior
B)neurohypophysis, adenohypophysis, anterior
C)adenohypophysis, neurohypophysis, posterior
D)neurohypophysis, adenohypophysis, posterior
Q2) Which of the following best describes a hormone?
A)a chemical produced in one part of the body that acts in a distant part of the body
B)a chemical produced in one part of the body that acts in close proximity to its production
C)a chemical produced whose action may be either close or distant to the site of production
D)a chemical that must enter the blood stream to be transported to its site of action
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Chapter 49: Thyroid
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Q1) 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
Q2) After treatment with medication or radioactive iodine is initiated for hyperthyroidism, disease activity is best initially monitored with ______, because ______ will take several weeks or more to return to the reference interval.
A)TSH, T and T3
B)TSH, fT and fT
C)fT and fT , TSH
D)serum iodine, TSH
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Chapter 50: The Gonads
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Q1) In the postmenopausal state, there is a 10- to15-fold increase in circulating ______, a 4- to 5-fold increase in ___ __, and a more than 90% decrease in circulating
A)FSH, LH, estradiol
B)LH, FSH, estradiol
C)estradiol, LH, FSH
D)estradiol, FSH, LH
Q2) Which laboratory test is commonly used to assess luteal function?
A)LH
B)FSH
C)progesterone
D)estradiol
Q3) Which of the following statements are true regarding cell types involved in the formation of the testes?
A)mesenchymal cells which differentiate into the Sertoli cells
B)coelomic epithelial cells which give rise to the interstitial (Leydig) cells
C)primordial germ cells which remain quiescent until puberty, when they divide by mitosis to form spermatogonia
D)all of the above
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Page 52
Chapter 51: Adrenal Hormones and Hypertension
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Q1) 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
Q2) Which of the following patients could have a false-positive late-night salivary cortisol?
1)a patient with hypertension
2)a patient with advanced age
3)a patient with psychiatric problems
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 52: Diseases of Genetic Origin
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Q1) What chromosome abnormality occurs in Turner Syndrome?
A)Trisomy 18
B)Trisomy 21
C)45,X
D)47,XXY
Q2) 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
Q3) Which disease would benefit from enzyme replacement therapy?
1)Gaucher disease
2)Fabry disease
3)Pompe disease
4)mucopolysaccharidosis type II
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
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Chapter 53: Neoplasia
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Q1) Which of the following play a role in determining a cancer's ability to invade surrounding tissue?
A)decreased motility of cells
B)decreased pressure within the tumor caused by active multiplication of the cells
C)decreased cohesiveness between cells
D)all of the above
Q2) 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
Q3) Protein electrophoresis is helpful when what disease state is suspected?
A)multiple myeloma
B)Waldenstrom's macroglobulinemia
C)MGUS
D)all of the above
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Which of the following is not involved in the transport of cyclosporine in the blood stream?
A)white blood cells
B)red blood cells
C)albumin
D)lipoproteins
Q2) 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
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56
Chapter 55: Toxicology
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Q1) In which of the following situations would an individual not experience a high from cocaine use?
1)smoking
2)snorting
3)applying to skin
4)drinking
A)1, 2, 3, 4
B)1, 4
C)3, 4
D)2, 3
Q2) Which of the following chelating agents are used to bind and remove metals?
A)ethylenediaminetetraacetate
B)deferoxamine
C)British anti-Lewisite
D)all of the above
Q3) Which of the following is the correct antidote for iron or aluminum poisoning?
A)Digibind
B)dimercaprol
C)deferoxamine
D)naloxone
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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) What is the most commonly abused substance in Western civilization?
A)opioids
B)cocaine
C)marijuana
D)alcohol
Q3) Which of the following is a type of change that occurs during withdrawal?
A)physical
B)psychological
C)behavioral
D)all of the above
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Page 58