Laboratory Medicine Exam Preparation
Guide
Course Introduction
Laboratory Medicine explores the principles and practice of diagnostic testing within a clinical laboratory setting. This course covers the fundamental techniques and technologies used to analyze blood, urine, and other bodily fluids, emphasizing quality control, specimen handling, and data interpretation. Students will learn about the role of laboratory medicine in disease diagnosis, monitoring, and prevention, as well as the ethical and safety considerations critical to the laboratory environment. By integrating theoretical knowledge with practical skills, the course prepares students to understand the connection between laboratory findings and patient care.
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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Sample Questions
Q1) 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
Q2) Which of the following water purification techniques is most effective in removing dissolved ionized gases?
A)distillation
B)deionization
C)reverse osmosis
D)ultrafiltration
Answer: B
Q3) The units for specific gravity are:
A)g/mL
B)mol/L
C)mg/L
D)%
Answer: A
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Chapter 2: Spectral Techniques
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Q1) What are the units for a (absorptivity) in Beer's law when c (concentration) is expressed in g/dL, and b (path length) is expressed in cm?
A)cm/g dL
B)g/dL cm
C)dL/g cm
D)absorptivity is a unitless term
Answer: C
Q2) The light source most frequently used for spectrophotometric analysis in the UV region is a ______ lamp and in the visible region, a _____ lamp.
A)tungsten, mercury vapor
B)deuterium, tungsten
C)mercury vapor, deuterium
D)tungsten, deuterium
Answer: B
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Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) 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
Q2) What is the correct interpretation of column selectivity ( ) = 1.0?
A)The separation of the solutes has been optimized, and no further improvement can be made in chromatographic conditions.
B)The solutes are adequately separated by the chromatographic system.
C)The solutes are partially separated by the chromatographic system.
D)The solutes are not separated by the chromatographic system.
Answer: D
Q3) Chromatographic methods may be characterized according to:
A)the physical state of the mobile phase
B)the physical apparatus associated with the stationary phase
C)the mechanism of separation
D)all of the above
Answer: D
Page 5
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Chapter 4: Chromatographic Techniques
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Q1) Match the following statements with normal-phase chromatography or reversed-phase chromatography.
1)The more polar the mobile phase, the weaker the mobile phase.
2)The more polar the mobile phase, the stronger the mobile phase.
3)The more nonpolar the mobile phase, the weaker the mobile phase.
4)The more nonpolar the mobile phase, the stronger the mobile phase.
A)1 and 4 are correct for normal-phase chromatography
B)2 and 3 are correct for normal-phase chromatography
C)1 and 3 are correct for reversed-phase chromatography
D)2 and 4 are correct for reversed-phase chromatography
Q2) Given that the base peak (m/z = 112) in a mass spectrum has an initial relative abundance of 75% and the peak at m/z 125 has an initial relative abundance of 30%, what will be the relative abundance of the two peaks following normalization? (answer format: relative abundance for m/z 112, relative abundance for m/z 125)
A)22.5%, 100%
B)250%, 100%
C)100%, 22.5%
D)100%, 40%
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) 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
Q2) Many HPLC systems utilize "windows" to aid in the interpretation of hemoglobin chromatographic analyses.Which of the following best describes chromatographic windows?
A)time intervals associated with changes in mobile phase ionic strength during gradient analysis
B)time intervals associated with detector measurement at two different wavelengths
C)time intervals during which specific hemoglobin fractions are expected to elute
D)time interval between the analysis of two different samples during which the chromatograph re-equilibrates
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Chapter 6: Electrophoresis
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Sample Questions
Q1) The discontinuous solvent system used to enhance electrophoretic resolution in which movement comes to a stop because of a lack of net charge is:
A)isotachophoresis
B)disk electrophoresis
C)isoelectric focusing
D)gel electrophoresis
Q2) An increase in which of the following would increase the movement of particles through a solution in electrophoresis?
A)voltage applied to the electrophoretic system
B)viscosity of the solvent
C)size and symmetry of the particles
D)all of the above
Q3) Which of the following proteins will show the greatest net negative charge in a pH 8.6 buffer?
A)protein A with an isoelectric point of 7.5
B)protein B with an isoelectric point of 8.0
C)protein C with an isoelectric point of 8.6
D)protein D with an isoelectric point of 9.6
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Chapter 7: Immunological Reactions
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Sample Questions
Q1) In radial immunodiffusion, calibrators of known concentration are analyzed along with the patient sample to allow for the quantification of antigens as illustrated in Figure 7-9 in your text book.Suppose the diameter of the precipitation ring for the highest calibrator was less than the diameter for the next highest calibrator.Which of the following statements describes the likely cause for this problem?
A)The incubation temperature was not kept constant.
B)The concentration of the antibody in the gel was too high for the concentration of the highest calibrator.
C)Because the concentration of the highest calibrator is so high, diffusion through the pores of the gel was restricted.
D)The concentration of the highest calibrator was greater than the concentration of the antibody in the gel.
Q2) Which immunoglobulin is the predominant immunoglobulin in body secretions such as saliva and sweat?
A)IgE
B)IgA
C)IgD
D)IgG
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Chapter 8: Immunochemical Techniques
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Q1) Suppose your laboratory uses a noncompetitive labeled-antibody immunometric technique that incorporates spectrophotometry for the measurement of a particular antigen.As the amount of measured antigen present in the patient sample ________, the absorbance of the test solution will ________.
A)increases, increase B)increases, decrease C)decreases, decrease D)both a and c are correct
Q2) 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.
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) In ____________ competitive-binding assays, paramagnetic particles are used to capture and concentrate bound label on the surface of an electrode.
A)luminescent oxygen channeling
B)microparticle-based light-scattering
C)enzyme multiplied
D)electrochemiluminescent
Q2) In competitive-binding assays, the relationship between concentration of unlabeled ligand and percent labeled ligand bound can be described in which of the following ways?
A)logarithmic and direct
B)linear and direct
C)logarithmic and inverse
D)linear and inverse
Q3) The advantage of using europium chelates, as compared to fluorescein, in time-resolved fluorescence competitive-binding assays is:
A)the stability of the europium-chelate complex
B)the ease of the complexation of europium with ligands and antibodies
C)the magnitude of fluorescence produced by europium chelates
D)the fluorescence lifetime of europium chelates
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Chapter 10: Laboratory Approaches to Serology Testing
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Q1) The specimen of choice in serological testing is ______.If the specimen is to be stored for 1 week prior to analysis, the specimen should be ______.
A)serum, frozen at -20°C
B)plasma, frozen at -20°C
C)serum, refrigerated
D)plasma, refrigerated
Q2) Select the causative agent for the following diseases: peptic ulcer, syphilis, herpes, Lyme disease.
A)Treponema pallidum, Borrelia burgdorferi, Helicobacter pylori, Epstein-Barr virus
B)B.burgdorferi, Epstein-Barr virus, T.pallidum, H.pylori
C)H.pylori, T.pallidum, Epstein-Barr virus, B.burgdorferi
D)Epstein-Barr virus, H.pylori, B.burgdorferi, T.pallidum
Q3) Indirect fluorescent antibody (IFA) techniques measure ______ in the patient sample, using fluorescent ______.
A)antigen, spectrophotometry
B)antibody, spectrophotometry
C)antigen, microscopy
D)antibody, microscopy
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Chapter 11: Measurement of Colligative Properties
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Q1) Osmometers utilizing the vapor-pressure colligative property of solutions are based on what principle?
A)An increase in the concentration of dissolved solutes decreases the vapor pressure generated because of a lack of volatility of the typical solutes.
B)An increase in the concentration of dissolved solutes increases the vapor pressure generated because of a lack of volatility of the typical solutes.
C)An increase in the concentration of dissolved solutes decreases the vapor pressure generated because of an increased volatility of the typical solutes.
D)An increase in the concentration of dissolved solutes increases the vapor pressure generated because of an increased volatility of the typical solutes.
Q2) The major measured contributor to serum osmolality is:
A)sodium
B)glucose
C)BUN
D)protein
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13
Chapter 12: Electrochemistry: Principles and Measurement
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Sample Questions
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) Which of the following describes the measurement of glucose by selective electrode methodology?
A)The glucose-selective phase will bind the glucose present in the patient sample, allowing the development of a potential across the membrane for measurement.
B)Glucose will selectively diffuse across its selective phase and establish an equilibrium with the internal filling solution prior to direct measurement.
C)Glucose will interact with an immobilized enzyme, producing a product that will be oxidized at the platinum electrode, resulting in measurement.
D)Glucose will selectively pass through a membrane and be titrated, with the time required for titration equated to glucose concentration.
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Chapter 13: Molecular Diagnostics
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Sample Questions
Q1) Which of the following statements are correct regarding mutations?
1)Mutations are changes in the base sequence in DNA and may include insertion, deletion, or replacement.
2)Mutations may result in no effect on protein expression or functional activity.
3)Mutations may result in partial or total loss of protein function.
4)Mutations always result in disease.
A)1, 2, 3
B)1, 3, 4
C)1, 2
D)3, 4
Q2) Of the viral load assay systems currently available, which is the only FDA-approved system for the diagnosis of HIV infection?
A)Procleix HIV-1/HCV Assay
B)APTIMA HIV-1 RNA Qualitative Test
C)Abbott RealTime HIV-1 Viral Load Test
D)NucliSens HIV-1 QT
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Chapter 14: Therapeutic Drug Monitoring
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Sample Questions
Q1) Suppose a patient has been taking a medication for a significant period of time with good results.Recently the patient has begun experiencing toxic side effects after dose administration that subside approximately an hour later.The blood sample that should be collected for an initial evaluation is ______.When this blood level is found to have a drug concentration higher than desired, a laboratory test to evaluate ______ would be advised.
A)trough blood sample, liver function
B)peak blood sample, kidney function
C)trough blood sample, gastrointestinal function
D)peak blood sample, cardiac function
Q2) Which of the following are considered goals of metabolism?
1)to make the drug more water soluble
2)to make the drug less active
3)to prepare the drug for greater distribution into adipose tissue
4)to increase the half-life of the drug
A)1, 2, 3
B)1, 3, 4
C)1, 2
D)3, 4
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Page 16
Chapter 15: Clinical Enzymology
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Sample Questions
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) Enzymes are a subgroup of ______ that can be distinguished from other members of the group by the enzyme's ______.
A)carbohydrates, catalytic activity
B)lipids, lipid solubility
C)proteins, catalytic activity
D)nucleic acids, lipid solubility
Q3) Which of the following is necessary for maximal enzyme velocity?
A)The enzyme concentration must be in excess of the substrate concentration.
B)The substrate concentration must be in excess of the enzyme concentration.
C)The substrate and enzyme concentrations must be equal.
D)The enzyme and substrate reaction must be reversible.
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) All of the following statements are true about the LD isoenzyme except:
A)LD 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.
Q2) The CK-MB isoenzyme is typically associated with cardiac muscle.In a situation where there is cardiac muscle damage, what is the approximate maximum level that can be attained by CK-MB?
A)approximately 95% of the total CK activity
B)approximately 70% of the total CK activity
C)approximately 40% of the total CK activity
D)approximately 33% of the total CK activity
Q3) With which tissue are each of the CK isoenzymes most frequently associated?
A)brain, cardiac muscle, skeletal muscle
B)cardiac muscle, skeletal muscle, brain
C)skeletal muscle, cardiac muscle, brain
D)skeletal muscle, brain, cardiac muscle
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Chapter 17: Interferences in Chemical Analysis
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Q1) Given the following data for bichromatic analysis in which the analytical wavelength is 510 nm, determine the concentration of analyte in the patient sample.
Patient sample absorbance at 510 nm = 0.715
Patient sample absorbance at 550 nm = 0.113
Standard absorbance at 510 nm = 0.500
Standard absorbance at 550 nm = 0.113
Standard concentration = 25 mg/L
A)25 mg/L
B)112.5 mg/L
C)134 mg/L
D)602 mg/L
Q2) It is recommended that fluorescence intensity measurements be made below what absorbance level?
A)0.100
B)0.500
C)1.000
D)none of the above
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19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) 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
Q2) Which of the following analytes is found decreased in a hemolyzed serum specimen?
A)sodium
B)potassium
C)magnesium
D)lactate dehydrogenase
Q3) Which of the following may result in an elevated serum/plasma potassium level?
A)use of a needle diameter that is too small during specimen collection
B)use of a needle diameter that is too large during specimen collection
C)re-centrifugation of tubes with separator gels
D)both a and b
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20
Chapter 19: Laboratory Management
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Q1) 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
Q2) What is the purpose of a pro forma analysis?
A)to evaluate the performance of an employee
B)to justify capital equipment purchases requested for the laboratory
C)to review a laboratory's readiness for an inspection
D)to establish normal reference ranges for a laboratory assay
Q3) Laboratory procedures are billed to insurance companies or organizations according to which system of coding?
A)Hospital Information System (HIS) coding
B)Diagnosis Related Group (DRG) coding
C)Common Procedure Terminology (CPT) coding
D)Health Insurance Portability and Accountability Act (HIPAA) coding
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21
Chapter 20: Laboratory Automation
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Q1) 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
Q2) 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
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Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) ______ may enhance detection of random errors, because they are performed with each test, whereas ______ detect(s) the sum of all processes in the testing system and does/do not require prior knowledge of a potential error.
A)quality control, external controls
B)internal controls, external controls
C)internal controls, quality control
D)quality control, internal controls
Q2) Which of the following do not perform point-of-care testing?
A)laboratory personnel
B)physicians
C)nurses
D)patients
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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23
Chapter 22: Laboratory Information Systems
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Q1) Which of the following is not considered an analytical function of the LIS?
A)manual worklist
B)instrument worklist
C)phlebotomy draw list
D)manual result entry
Q2) Which of the following situations would be acceptable when considering autoverification?
A)autoverification of a WBC differential if the WBC count is below 1000
B)autoverification of a platelet count of 20,000 on a patient in an oncology clinic
C)autoverification of both creatinine and BUN if the creatinine value is out of range
D)All are acceptable situations for autoverification.
Q3) 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
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Chapter 23: Laboratory Statistics
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Q1) Which statistical method should be used to answer the following question? "The published mean for albumin for young adult males is 4.7 mg/dL.A laboratory tested 25 young adult males and found a mean albumin of 4.6 mg/dL ±0.15 mg/dL.Is the mean for the laboratory different from the published mean at the 5% probability level?"
A)t-test
B)unpaired t-test
C)paired t-test
D)linear regression
Q2) The F-test is considered a measure of ______ between two sets of data, and the t-test is considered a measure of ______ between two sets of data.______ is/are considered as a parametric comparison.
A)accuracy, precision, the F-test
B)precision, accuracy, both tests
C)accuracy, precision, both tests
D)precision, accuracy, the t-test
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Which of the following best explains why the phrase reference interval is preferred over the phase normal interval when associated with clinical laboratory test results?
A)The phrase reference interval portrays a more professional image of the clinical laboratory profession.
B)The word normal can be interpreted several different ways in laboratory medicine, resulting in potential confusion.
C)Use of the word normal is coupled with use of the abnormal, which raises objection by many individuals.
D)The phrase reference interval implies that statistical methodology was used to establish the interval.
Q2) An urologist's office has a high likelihood of encountering patients with prostate cancer.Which of the following attributes is the most desirable for laboratory tests utilized in this environment?
A)laboratory tests with the highest sensitivity
B)laboratory tests with the highest specificity
C)laboratory tests with the highest predictive value for a positive test
D)laboratory tests with the highest efficiency
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Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) Which of the following statements are correct regarding controls and calibrators?
1)Controls may not be used as calibrators.
2)Calibrators may not be used as controls.
3)Controls establish correspondence of instrument output signal with known concentration.
4)Calibrators establish correspondence of instrument output signal with known concentration.
A)2, 4
B)1, 3
C)2, 3
D)1, 4
Q2) 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.
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Chapter 26: Evaluation of Methods
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Q1) It has been proposed that allowable error be either ______ or ______ of the reference range for an analyte, whichever is less.For enzymes, the limit is ______.
A) ¹/ , 10%, 20%
B) ¹/ , 20%, 10%
C) ¹/ , 20%, 10%
D) ¹/ , 10%, 20%
Q2) 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
Q3) Interference should be evaluated for all commonly encountered interferents such as:
A)hemolysis
B)lipemia
C)icterus
D)all of the above
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28
Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) 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
Q2) Which of the following statements is not true of triglycerides?
A)Triglycerides are esters that are formed during the reaction of an alcohol function and a carboxylic acid function.
B)Triglycerides are easily hydrolyzed into glycerol and free fatty acids.
C)The dietary fats we ingest are mostly triglycerides.
D)The fatty acids that are found in a single triglyceride molecule are always the same.
Q3) Which of the following best describes the makeup of phospholipids?
A)glycerol and three fatty acid residues
B)glycerol, two fatty acid residues, and a phosphoric acid residue
C)glycerol and three phosphoric acid residues
D)glycerol, two fatty acid residues, one phosphoric acid residue, and a nitrogen-containing residue
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Which of the following changes will be seen in dehydration?
1)increase in aldosterone
2)increase in antidiuretic hormone
3)increase in atrial natriuretic peptide
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) 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
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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) An increased total CO , increased pCO , and increased pH is most correctly classified as:
A)partially compensated metabolic acidosis
B)partially compensated metabolic alkalosis
C)partially compensated respiratory acidosis
D)partially compensated respiratory alkalosis
Q3) The base excess in a blood sample at a pH of 7.40, a pCO of 40 mm Hg, a hemoglobin of 150 g/L, and a temperature of 37°C is equal to:
A)-2.5 mEq/L
B)0 mEq/L
C)1.2 mEq/L
D)2.5 mEq/L
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Page 31
Chapter 30: Renal Function
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Q1) The kidney is able to carry out its complex functions because approximately ______of the volume of blood pumped by the heart into the systemic circulation is circulated through the kidneys.Therefore, the kidneys, which constitute about ______ of total body weight, receive ______ of the cardiac output.
A)25%, 0.5%, 1/4
B)0.5%, 25%, 1/4
C)25%, 0.5%, 1/2
D)50%, 25%, 1/2
Q2) The following are findings in a microscopic urinalysis.What is the laboratory diagnosis?
4+ protein
0 to 10 RBCs per high power field
0 to 5 WBCs per high power field
0 bacteria
Oval fat bodies
Hyaline casts
A)glomerulonephritis
B)nephrotic syndrome
C)pyelonephritis
D)these are normal urine findings
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Page 32
Chapter 31: Liver Function
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Q1) Which of the following functions are performed by hepatocytes?
1)metabolism
2)synthesis of critical components
3)formation of bile
4)endocrine functions
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) 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
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Chapter 32: Diagnosis of Viral Hepatitis
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Q1) ______ is the current diagnostic marker for hepatitis B virus infection, with detection being less than ______ after infection.
A)HBcAg, 2 weeks
B)aHBsAg, 2 weeks
C)HBsAg, 4 weeks
D)aHBsAg, 4 weeks
Q2) The clinical significance of virus genotypes is that they sometimes play an important role in determining treatment.Which hepatitis virus has genotypes 1 through 6?
A)HAV
B)HBV
C)HCV
D)HEV
Q3) Typically, serum levels of HBsAg peak around _____ after infection, _____ during the recovery phase, and generally become undetectable within ______ of the onset of acute infection.
A)8 to 12 weeks, decrease, 6 months
B)4 to 6 weeks, increase, 3 months
C)8 to 12 weeks, decrease, 3 months
D)4 to 6 weeks, increase, 6 months
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Page 34
Chapter 33: Bone Disease
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Q1) Which of the following tests can be used to rule out secondary osteoporosis?
1)serum alkaline phosphatase
2)serum total protein
3)serum calcium
4)serum testosterone
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q2) 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
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Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) In cystic fibrosis, pancreatic secretions are of a/an ______ viscosity and a/an ______ volume, which leads to a greatly ______ pancreatic flow.
A)increased, decreased, decreased
B)decreased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
Q2) Both amylase and lipase rise rapidly with the onset of pancreatic injury.Amylase will remain increased an average of ______; lipase typically remains increased for ______ after injury.
A)3 to 5 days, 5 to 7 days
B)5 to 7 days, 3 to 5 days
C)7 to 9 days, 3 to 5 days
D)10 to 12 days, 5 to 7 days
Q3) Complex carbohydrates are digested by which pancreatic product?
A)elastase
B)lipase
C)a-amylase
D)trypsin
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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) Which of the following laboratory test results is not consistent with a diagnosis of carcinoid syndrome?
A)increased fecal fat
B)negative stool occult blood
C)normal lactose tolerance
D)increased 5-hydroxyindoleacetic acid (5-HIAA)
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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) The resting heart's fuel of choice is ______, but upon the imposition of a heavy workload, the heart will greatly increase its rate of ______ consumption.
A)free fatty acids, glucose
B)glucose, lactate
C)lactate, free fatty acids
D)glucose, free fatty acids
Q3) 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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Page 38
Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Which plasma lipoprotein has the following physical and chemical characteristics?
Electrophoretic mobility - pre-beta
Cholesterol composition - 22%
Triglycerides composition - 52%
Phospholipid composition - 18%
Apoprotein - 2%
A)Chylomicrons
B)VLDL
C)LDL
D)HDL
Q2) 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.
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Chapter 38: Diabetes Mellitus
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Q1) A person who has a 2-hour oral glucose tolerance test result between 140 mg/dL and 200 mg/dL would be classified in which of the following categories?
A)impaired fasting glucose
B)impaired glucose tolerance
C)potential abnormality of glucose tolerance
D)secondary diabetes mellitus
Q2) 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) In which of the following neurological porphyrins is a parallel increase in -aminolevulinic (ALA) acid and porphobilinogen (PBG) not seen?
A)acute intermittent porphyria
B)variegate porphyria
C)hereditary coproporphyria
D)porphyria cutanea tarda
Q2) Which of the following is/are true of hepcidin?
A)It controls the flow of iron out of the intestinal cells by inhibiting iron release.
B)High levels promote release of iron into the circulation.
C)Low levels restrict the release of iron from intestinal cells into the circulation.
D)all of the above
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) M-hemoglobins are derived from:
A)methemoglobin
B)sulfhemoglobin
C)carboxyhemoglobin
D)glycosylated hemoglobin A
Q2) 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
Q3) The formation of hemichromes has been considered an indicator of:
A)hemoglobin glycosylation
B)hemoglobin oxygenation
C)hemoglobin deoxygenation
D)hemoglobin denaturation
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Chapter 41: Human Nutrition
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Sample Questions
Q1) A patient with a body mass index of 27 is said to be ________________.
A)underweight
B)at a healthy weight
C)overweight
D)obese
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
Q3) Aldosterone antagonist diuretics may produce which of the following changes in mineral status?
A)hypernatremia
B)hyperkalemia
C)hypocalcemia
D)hypomagnesemia
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43
Chapter 42: Trace Metals
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Q1) Why are the essential trace elements fluorine and iodine not measured by atomic absorption spectrophotometry (AAS), as are all other essential trace elements?
A)The concentration of fluorine and iodine are too high to be measured by AAS.
B)The concentration of fluorine and iodine are too low to be measured by AAS.
C)Fluorine and iodine cannot be differentiated by AAS, therefore measurement of either element is the sum of both elements.
D)Fluorine and iodine are not metals and cannot be measured by AAS.
Q2) 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
Q3) The most abundant essential trace element in the body is ______, and the second most abundant is ______.
A)iodine, selenium
B)fluorine, copper
C)iron, zinc
D)chromium, manganese
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Page 44
Chapter 43: Vitamins
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Q1) 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
Q2) Which vitamin is known chemically as pyridoxine?
A)vitamin B
B)vitamin B
C)vitamin B
D)vitamin B
Q3) 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
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Chapter 44: Pregnancy and Fetal Development
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Q1) Intrahepatic cholestasis of pregnancy is most frequently identified by the complaint of mild to severe ______ by the expectant mother.Laboratory diagnosis can be made by an increased level/activity of serum ______, which is the cause for the complaint.
A)headaches, glucose
B)itching, bile acids
C)hypertension, potassium
D)edema, hepatic enzymes
Q2) Infants with hemolytic disease of the newborn should have which hematological and biochemical tests performed on the cord blood?
1)direct bilirubin
2)direct Coombs
3)hemoglobin
4)total bilirubin
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
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Chapter 45: The Newborn
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Q1) Which laboratory test has been recognized as an early sensitive marker of sepsis in neonates?
A)high-sensitivity C-reactive protein
B)pro-calcitonin
C)serum amyloid A protein
D)hypoglycemia
Q2) The amplitude of a postnatal ADH surge reflects birth-related factors such as:
1)C-section delivery
2)vaginal delivery
3)hypoxia
4)increased intracranial pressure
A)1, 2, 4
B)1, 3, 4
C)2, 3, 4
D)3, 4
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 statements are true of normal synovial fluid?
1)It acts as a lubricant to minimize the friction between bones during movement or weight bearing.
2)It provides the sole nutrition for cartilage.
3)It is a dialysate of plasma mixed with hyaluronic acid.
4)It contains fibrinogen, and spontaneous clotting can occur.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) A 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
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Chapter 47: Nervous System
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Q1) 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
Q2) Guillain-Barré syndrome is a neuromuscular disease that has a characteristic CSF finding of an elevated ______ without an elevated ______.
A)white cell count, protein
B)protein, white cell count
C)protein, glucose
D)glucose, protein
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Chapter 48: General Endocrinology
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Q1) An elevated serum insulin-like growth factor 1 (IGF-1) is useful in the diagnosis of which disease?
A)Cushing's syndrome
B)diabetes
C)acromegaly
D)pituitary adenoma
Q2) 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
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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Page 50
Chapter 49: Thyroid
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Q1) There is concern that the upper reference interval value for TSH is set too high to detect subtle hypothyroid disease.It is suggested that the upper reference interval value be reduced to what level to address this concern?
A)5.0 mU/L
B)4.0 mU/L
C)3.0 mU/L
D)2.0 mU/L
Q2) The following laboratory data are suggestive of which clinical situation?
TSH - decreased
T - decreased
T - decreased
RT - increased
A)development of a goiter
B)euthyroid sick syndrome
C)Hashimoto's thyroiditis
D)Graves' disease
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Chapter 50: The Gonads
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Q1) The clinical problem of amenorrhea may be defined by which of the following criteria?
1)no period by age 14 in the absence of growth or development of secondary sex characteristics
2)no period by age 16, regardless of the presence of normal growth and development with the appearance of secondary sex characteristics
3)in a woman who has been menstruating, the absence of periods for a length of time equivalent to a total of at least 3 of the previous cycle intervals or 6 months of amenorrhea
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) The central medulla region of the ovary consists of which of the following?
A)stroma
B)germinal epithelium
C)follicles
D)all of the above
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) A patient with intermittent hypertension has an elevated urinary vanillylmandelic acid (VMA).This result suggests:
A)hyperaldosteronism
B)hypercortisolism
C)idiopathic hypertension
D)pheochromocytoma
Q2) Which of the following is the most common pattern of urine free catecholamine findings in patients with pheochromocytoma?
A)pronounced increase in both norepinephrine and epinephrine, with a smaller increase in dopamine
B)increased levels of norepinephrine, with smaller increases or normal levels of epinephrine and dopamine
C)a pronounced increase in epinephrine, with smaller increases or normal levels of norepinephrine and dopamine
D)none of the above
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Chapter 52: Diseases of Genetic Origin
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Q1) Citrullinemia, homocystinuria, phenylketonuria, and maple syrup urine disease are all what type of disorders that are commonly included in newborn screening programs?
A)endocrinopathies
B)amino acid disorders
C)fatty acid oxidation disorders
D)carbohydrate disorders
Q2) What chromosome abnormality occurs in Turner Syndrome?
A)Trisomy 18
B)Trisomy 21
C)45,X
D)47,XXY
Q3) Which of the following is not true of autosomal dominant inheritance?
A)The disease occurs with equal frequency in males and females.
B)The disease can occur in the absence of family history.
C)An individual must inherit two copies of a mutant allele in a particular locus, one from each parent, to be affected.
D)All of the above
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54
Chapter 53: Neoplasia
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Q1) Select the correct sequence of steps that must occur for the development of colorectal cancer.
1)Mutations of tumor suppressor gene 53 and deletions on chromosome 18q coincide with transition to malignancy.
2)Mutations in the adenomatous polyposis coli (AOC) tumor-suppressor gene occur early in the development of polyps.
3)Oncogenic K-ras mutations arise during the adenomatous stage.
A)1, 2, 3
B)2, 3, 1
C)3, 1, 2
D)2, 1, 3
Q2) The only tumor marker currently approved for screening of the general population is
A)PSA
B)CEA
C)PAP
D)AFP
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Page 55
Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) A patient who received a liver transplant 2 days ago has started rejecting the organ.This is which type of rejection?
A)hyperacute
B)acute accelerated
C)acute
D)chronic
Q2) A recipient's preformed antibodies against what HLA class are responsible for immunological destruction of the allograft once implanted and can signal the cellular immune system to induce additional tissue destruction?
A)I
B)II
C)both a and b
D)neither a or b
Q3) Which group of drugs has the longest half-life and therefore has a lower monitoring frequency?
A)cyclosporine
B)tacrolimus
C)sirolimus
D)everolimus
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Chapter 55: Toxicology
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Q1) Which of the following is the correct antidote for iron or aluminum poisoning?
A)Digibind
B)dimercaprol
C)deferoxamine
D)naloxone
Q2) What type of toxicology focuses on the pathological processes that are caused by the exposure of a patient to a toxin and includes subsequent medical evaluation and treatment of the patient?
A)clinical
B)forensic
C)environmental
D)occupational
Q3) Most toxins enter the body through what route?
A)skin
B)lungs
C)gastrointestinal tract
D)all of the above
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Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following are true of addiction?
1)It is a chronic deteriorating process.
2)Alcohol or other drug use by itself is addiction.
3)Abstinence from the addictive agent allows the mind and body to recover.
A)1, 2, 3
B)1, 2
C)1, 3
D)2, 3
Q2) Lacrimation, rhinorrhea, piloerection, sweating, diarrhea, yawning, and tachycardia are all withdrawal symptoms of which of the following drugs?
A)caffeine
B)marijuana
C)opiates
D)tobacco
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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