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Laboratory Medicine is a comprehensive course that explores the principles and practices of clinical laboratory diagnostics essential for patient care. Students will examine the techniques, methodologies, and instrumentation used in various laboratory settings, including hematology, clinical chemistry, microbiology, immunology, and molecular diagnostics. The course emphasizes the interpretation of laboratory results, quality assurance, laboratory management, and the role of laboratory professionals in the healthcare team. Through lectures, hands-on practice, and case studies, students gain the skills necessary to accurately process specimens and contribute to effective clinical decision-making.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Q1) Which laboratory glassware should be selected to ensure accuracy in the preparation of a 100 mL of 0.5 N HCl solution?
A)a beaker
B)a graduated cylinder
C)an Erlenmeyer flask
D)a volumetric flask
Answer: D
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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Q1) In comparing nephelometry and turbidity, nephelometric measurements should demonstrate ______ sensitivity, and turbidimetric measurements should demonstrate ______ sensitivity.In practice, turbidimetric measurements have been found to demonstrate ______ sensitivity.
A)high, limited, high
B)high, limited, limited
C)limited, high, high
D)limited, high, limited
Answer: A
Q2) As part of the development of a new spectrophotometric assay, an absorption spectrum was recorded.Which of the following describes the purpose for this absorption spectrum?
A)to determine the appropriate wavelength of analysis for the assay
B)to determine the maximal concentration that can be accurately measured for the assay
C)to check for stray light
D)to check for linearity
Answer: A
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Q1) Considering the chromatographic separation of two solutes that are present in a mixture at the same concentration and produce the same detector response (i.e., have the same molar absorptivity), the solute that has a higher affinity for the stationary phase will have a ______ retention time and a ______ detector response than the solute that has a higher affinity for the mobile phase.
A)greater, greater
B)lesser, greater
C)greater, lesser
D)lesser, lesser
Answer: C
Q2) Chromatography is best characterized as a separation technique in which the components of a mixture are separated based on:
A)how the components distribute between the mobile phase and stationary phase
B)how well the components dissolve in the mobile phase
C)the chromophoric nature of the components
D)the varying concentrations of the components
Answer: A
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Q1) In mass spectrometry, the molecular ion is:
A)the ion of highest relative abundance in the spectrum
B)the ion from which all other fragment ions are derived
C)always observed in the mass spectrum
D)all of the above
Q2) 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
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Q1) Consider the separation of Hb 1, Hb 2, and Hb 3 by cation-exchange HPLC.The initial mobile phase pH causes Hb 1 to have the greatest positive charge, Hb 2 to have minimal positive charge, and Hb 3 to be neutral.Predict the order of elution from the stationary phase as the chromatographic run continues from the initial mobile phase to mobile phases with increasing concentrations of cations.(first to elute to last to elute)
A)Hb 1, Hb 2, Hb 3
B)Hb 1, Hb 3, Hb 2
C)Hb 2, Hb 1, Hb 3
D)Hb 3, Hb 2, Hb 1
Q2) The Singer 1-minute denaturation test and the Betke 2-minute alkali denaturation test is useful for measuring Hb ________ and is based on this hemoglobin's
A)A, resistance to alkaline solutions
B)A, denaturation by alkaline solutions
C)F, resistance to alkaline solutions
D)F, denaturation by alkaline solutions
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Q1) What will be the effect on the final electrophoretic pattern when horizontal electrophoresis is used and the surface of the medium is open to air?
A)All electrophoretic bands will remain on the side of the medium to which the sample was applied.
B)All electrophoretic bands will appear on the opposite side of the medium to which the sample was applied.
C)Convective flow will result in a distorted final electrophoretic pattern.
D)The final electrophoretic pattern will be compressed.
Q2) Considering only the effect of time on electrophoretic separation, the separation of bands ________ with time, and diffusion of bands _______ with time.
A)increases, increases
B)increases, decreases
C)decreases, increases
D)decreases, decreases
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Q1) IgG is known to fix complement, which aids in the lysis or elimination of foreign materials.Molecules in the IgG subclasses differ in their ability to fix complement.Which IgG subclass is the most active in complement fixation?
A)IgG-1
B)IgG-2
C)IgG-3
D)IgG-4
Q2) Which immunoglobulin is associated with the physiological manifestations of allergy?
A)IgG
B)IgA
C)IgE
D)IgM
Q3) Which of the following antigenic determinants would be the most reactive?
A)an antigenic determinant located in the core of a spatially folded molecule
B)a sequential antigenic determinant
C)an antigenic determinant located on the surface of a spatially folded molecule
D)the exposed antigenic determinant of a denatured protein
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Q1) 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
Q2) Considering the principles of agglutination reactions, which of the following statements is incorrect?
A)Antigens with single antigenic determinant sites will not result in agglutination.
B)IgG is more efficient at agglutination than IgM.
C)Agglutination reactions are generally used to detect antibody.
D)Reverse agglutination reactions are generally used to detect soluble antigens.
Q3) Often when performing immunoassays, it is important to know the titer of the antibody.The titer defines:
A)the amount of specific antibody present
B)the affinity of the antibody for the antigen being measured
C)the avidity of the antibody for the antigen being measured
D)the specificity of the antibody for the antigen being measured
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Q1) In a competitive-binding heterogeneous assay, the captive phase involves:
A)the removal of endogenous binding proteins that interfere with the immunoassay
B)the binding of the labeled reactant in the assay
C)the capture of free, unlabeled ligands from the patient sample for use in the assay of free ligand alone
D)the initial step in the assay where the antibody binds with the ligand
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
Q3) The use of avidin-biotin systems in ELISA serve to:
A)improve the time requirements of the assay
B)overcome diminished antibody capturing capacity in the assay
C)improve the fluorogenic nature of the assay
D)overcome the need for sample extraction prior to performing the assay
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Q1) Which of the following assays would be useful in distinguishing between recent primary infection and later secondary immune response?
A)ELISA
B)Western blot
C)hemagglutinin inhibition
D)indirect fluorescent antibody
Q2) The TORCH acronym represents:
A)a series of progressive laboratory tests to identify HIV antibody isotypes
B)a group of pathogens that pose the greatest risk to a developing fetus
C)cellular membrane antigens to which antibodies are directed in Lyme disease
D)the order of reagent addition to prepare a sample for fluorescent-labeled microscopy
Q3) Which immunoglobulin will dominate the later portion of the primary immune response and subsequent amnestic response?
A)IgG
B)IgM
C)IgA
D)IgE
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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) 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
Q3) As the osmolality of a sample increases, the osmotic pressure ______, the boiling point _____, the freezing point ______, and the vapor pressure ______.
A)increases, increases, decreases, decreases
B)increases, decreases, increases, decreases
C)decreases, increases, decreases, increases
D)decreases, decreases, increases, increases
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Q1) Suppose a new pH electrode was attached to a pH meter.During calibration, the pH meter had a slow response time and continued to drift after adjustments.What should be the technologist's next step?
A)contact the supplier and request a replacement electrode
B)replace the pH meter
C)calibrate with a new set of standards
D)allow the pH electrode to soak for a few hours in buffer
Q2) The use of ion-selective phases in potentiometric measurements is based on the potential that develops:
A)across the ion-selective phase once the ion has been captured in the ion-selective phase
B)after the ion passes through the ion-selective phase into the internal filling solution
C)across the liquid junction located between the tip of the reference electrode and the solution being measured
D)at the Ag/AgCl interface of the reference electrode
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Q1) Select the order of processes in the polymerase chain reaction cycle.(Steps are listed in the order performed with the first step listed first.)
A)denaturation, primer annealing, polymerase extension
B)primer annealing, denaturation, polymerase extension
C)polymerase extension, denaturation, primer annealing
D)polymerase extension, primer annealing, denaturation
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
Q3) The real-time PCR technique that utilizes two fluorophores where the emission spectrum of one fluorophore overlaps the excitation spectrum of the second fluorophore is known as the:
A)TaqMan technique
B)fluorescence resonance energy transfer (FRET) technique
C)multiplex ligation probe amplification (MLPA) technique
D)heteroduplexing technique
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Q1) Considering the administration of a single dose of a hypothetical drug by different routes, which of the following gives the correct order of attaining peak concentration of the drug in the blood stream?
A)intramuscular, oral, intravenous
B)oral, intravenous, intramuscular
C)intravenous, intramuscular, oral
D)intramuscular, intravenous, oral
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) Which of the following statements are true regarding drug half-life?
A)Doubling the dose of a drug will reduce the half-life by one half.
B)Half-life is equal to the time required to change the drug blood level by 50%.
C)Doubling the dose of a drug will double the half-life.
D)both b and c
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Q1) An enzyme activity of 50 IU/L is equal to _____ nK/L.
A)3.0
B)16.7
C)416
D)835
Q2) Which type of enzyme inhibitor binds to the active site and is considered to be a reversible inhibitor?
A)competitive inhibitor
B)noncompetitive inhibitor
C)uncompetitive inhibitor
D)allosteric inhibitor
Q3) A convenient method for assaying enzyme activity is based on measuring the conversion between the oxidized and reduced forms of nicotinamide adenine dinucleotide (NAD/NADH).Which form of nicotinamide adenine dinucleotide has a unique wavelength of absorption, and what is the wavelength at which is unique absorption is at its maximum?
A)oxidized, 260 nm
B)oxidized, 340 nm
C)reduced, 260 nm
D)reduced, 340 nm
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Q1) Normal protein degradation by posttranslational modification serves which of the following functions in vivo?
A)to eliminate abnormal proteins that could become harmful at high concentrations
B)to remove enzymes that appear outside their normal cellular location
C)to permit the regulation of cellular metabolism by eliminating superfluous isoenzymes
D)all of the above
Q2) All of the following statements are true about the LD isoenzyme except:
A)LD has approximately a 10-fold greater affinity for pyruvate than does LD<sub>1</sub>.
B)LD is a tetramer that consists of four H subunits.
C)LD predominates in tissues that are primarily anaerobic.
D)LD is found in high concentration in skeletal muscle and liver.
Q3) The most common enzyme group associated with posttranslational proteolytic cleavage of enzymes is:
A)oxidoreductases
B)peptidases
C)transferases
D)isomerases
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Q1) One method to eliminate many nonspecific chemical interferents involves increasing the specificity of the reaction used for measurement.This can be accomplished by:
A)the use of specific buffers to maintain the correct reaction pH
B)the use of specific immunoassays for the material being measured
C)the use of reagent and sample blanks in the same assay
D)all of the above
Q2) The most common source of interference in spectrophotometric analyses results from:
A)the presence of drugs in the patient sample
B)the presence of unexpected increases of compounds associated with disease processes in the patient sample
C)the presence of hemolysis, icteria, or lipemia in the patient sample
D)the anticoagulant used to collect the patient sample
Q3) Which of the following interferences will have the greatest impact on nephelometric and turbidimetric measurements?
A)hemolysis
B)lipemia
C)icterus
D)both a and c
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Q1) Over 99% of specimen identification errors that occur by laboratory personnel result from:
A)improper patient identification
B)failure to label specimens before leaving the room
C)errors in data entry
D)selection of the wrong patient sample on which to perform laboratory analyses
Q2) A postprandial rise is expected with many analytes.Which of the following will show a postprandial decrease?
A)triglycerides
B)potassium
C)glucose
D)gastrin
Q3) Which of the following analytes is found decreased in a hemolyzed serum specimen?
A)sodium
B)potassium
C)magnesium
D)lactate dehydrogenase
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Q1) Frequent budget analysis is an important function of the laboratory manager.The type of budget analysis that involves a comparison of the current month's actual dollars spent versus the budgeted dollars is known as a ______ analysis.A budget analysis that compares the current month's actual dollars spent per test with the budgeted dollars per test is a ______ analysis.Of these two, the ______ analysis excludes variances in test volumes.
A)static, flexible, static
B)static, flexible, flexible
C)flexible, static, static
D)flexible, static, flexible
Q2) Following first-year evaluations of individuals performing moderate- and high-complexity testing, under CLIA '88 regulations, how often must reevaluation be performed, given that there are no procedural or instrumentation changes?
A)every 3 months
B)every 4 months
C)every 6 months
D)every 12 months
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Q1) Total laboratory automation systems do not automate which section of the laboratory?
A)immunochemistry
B)hematology
C)coagulation
D)immunohematology
Q2) What is the primary driving force for automation in the laboratory?
A)expansion of laboratory testing to generate more revenue
B)reduction of costs
C)reduction of turnaround time
D)reduction of laboratory errors
Q3) In most cases, automated incubation is performed under conditions of a specified, constant temperature, which is most frequently achieved by the use of_______________.
A)heating blocks
B)air
C)water baths
D)any of the above
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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 statements is not true regarding POCT?
A)POCT analyzers tend to have higher disposable and reagent costs than traditional laboratory systems.
B)Results from a POCT device will match results from a central laboratory for the same test.
C)Results of POCT can be seen and acted upon before any control checks or other external mechanisms of ensuring test result reliability can be applied to the result.
D)Most POCT errors are unintentional.
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Q1) When considering bar codes, what characters make up a Code 128?
1)uppercase alphabets
2)lowercase alphabets
3)numbers
4)special symbols
A)1, 2, 3, 4
B)2, 4
C)1, 3
D)2, 3, 4
Q2) Most LISs can produce epidemiology reports that support which of the following?
1)quality assurance
2)accreditation
3)CLIA
4)public health
A)1, 2, 3, 4
B)1, 2, 4
C)1, 2, 3
D)1, 3, 4
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Q1) Suppose a comparison of variation is required between analytical methods, one of which is reported in mg/dL and the other reported in mmol/L.Which of the following measures of variation would be most appropriate?
A)variance
B)standard deviation
C)correlation coefficient
D)coefficient of variation
Q2) 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
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Q1) Considering normal reference intervals utilized, ______ percent of the time, well (healthy) patients will fall outside this range, and ______ percent of the time, well (healthy) patients will fall within this range.
A)5, 95
B)10, 90
C)15, 85
D)20, 80
Q2) It has been shown that significant differences between the standard deviations of subclasses of subjects, even when the means are identical, can lead to deviations in diagnostic sensitivity and diagnostic specificity for disease detection.Thus in these situations, there may be the need for separate reference intervals.What statistical test should be selected to determine the need for different reference intervals in this situation?
A)t-test
B)F-test
C)z-test
D)Dixon's Q
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Q1) Violation of which of the following Westgard control rules would be associated with the greatest degree of imprecision?
A)12
B)22
C)R4
D)1
Q2) Which of the following mechanisms utilized by clinical laboratories will help detect misidentification of an individual patient specimen?
A)quality-control procedures
B)autoverification
C)comparison with reference intervals
D)delta checks
Q3) A reference 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 definitive method.
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Q1) Which of the following statements is/are true regarding the correlation coefficient?
A)A value of zero indicates that there is no correlation between the methods.
B)A value of +1 indicates perfect positive correlation.
C)This coefficient is extremely sensitive to the range of analyte concentrations of the patient specimens in the comparison-of-methods experiment.
D)All of the above are true of the correlation coefficient.
Q2) When considering application characteristics, emphasis may be placed on ______ for pediatric applications, on ______ for stat applications, and on ______ for high-volume screenings.
A)sample size, turnaround time and interrupt features, sample throughput rate
B)turnaround time and interrupt features, sample throughput rate, sample size
C)sample throughput rate, sample size, turnaround time and interrupt features,
D)turnaround time and interrupt features, sample size, sample throughput rate
Q3) 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
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Q1) 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
Q2) 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
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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Q1) Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are released into the bloodstream from the ______ and are used clinically to evaluate the possibility of
A)heart, congestive heart failure
B)brain, hydrocephalus
C)heart, myocardial infarction
D)brain, congestive heart failure
Q2) The urine level of which electrolyte will distinguish excess diuretic use or self-induced vomiting from Barter's syndrome?
A)sodium
B)potassium
C)chloride
D)bicarbonate
Q3) Which of the following electrolytes is likely to be found decreased in metabolic alkalosis?
A)sodium
B)potassium
C)chloride
D)bicarbonate
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Q1) Why is the bicarbonate buffer system chosen for the laboratory monitoring of physiological pH?
A)The bicarbonate buffering system has an immediate buffer response.
B)The bicarbonate buffering system has the greatest buffering capacity in the body.
C)The bicarbonate buffering system is the only buffer system located outside of cells.
D)The components of the bicarbonate buffer system are the easiest to measure.
Q2) Calculate the pH of a blood sample, given a pK = 6.1 and a bicarbonate-to-dissolved-carbon-dioxide ratio of 18:1.
A)6.10
B)7.36
C)7.47
D)Cannot be determined from the information provided
Q3) An increased total CO , normal pCO , and increased pH is most correctly classified as:
A)uncompensated metabolic alkalosis
B)compensated metabolic alkalosis
C)uncompensated respiratory alkalosis
D)compensated respiratory alkalosis
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Q1) In stage 4 of chronic kidney disease, the glomerular filtration rate is:
A)between 15 and 30
B)between 30 and 60
C)between 60 and 90
D)greater than 90
Q2) When following the urinary system, the renal pelvis rapidly diminishes in caliber and merges into the ______.Each of these descends in the abdomen alongside the vertebral column to join the ______, which provides temporary storage for urine, which is eventually voided through the _____ to the exterior.
A)urethra, kidney, ureter
B)ureter, kidney, urethra
C)ureter, bladder, urethra
D)urethra, bladder, ureter
Q3) 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
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Q1) 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)
Q2) When considering hemochromatosis, those with ferritin levels _____ almost never have liver damage, whereas the likelihood of progressive liver fibrosis is high if ferritin is ______.This can be managed by therapeutic phlebotomy of up to 1 unit of blood per week until serum ferritin is _____.
A)<300 ng/mL, >1000 ng/mL, <50 ng/mL
B)<50 ng/mL, >750 ng/mL, <300 ng/mL
C)<300 ng/mL, >750 ng/mL, <50 ng/mL
D)<50 ng/mL, >1000 ng/mL, <300 ng/mL
Q3) 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
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Q1) Which of the following are characteristics of hepatitis C virus (HCV)?
1)HCV is transmitted through blood, needle sharing, sexually.
2)HCV is the primary cause of chronic liver disease such as cirrhosis.
3)HCV currently has a vaccine available.
4)The majority of HCV-infected patients are asymptomatic.
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) 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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Q1) Which of the following qualify as criteria for a female patient to have a bone-density scan?
A)over 65 years old
B)postmenopausal with at least one risk factor besides menopause, or with a fracture
C)on prolonged hormone-replacement therapy
D)all of the above
Q2) Which of the following is not a biochemical marker of bone formation?
A)serum osteocalcin
B)serum alkaline phosphatase (ALP)
C)serum tartrate-resistant acid phosphatase
D)serum procollagen I extension peptides
Q3) 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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Q1) 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
Q2) Diabetes mellitus:
1)can be caused by autoimmune islet cell destruction.
2)can be caused by insulin resistance.
3)can show an abnormal serum amylase in the absence of pancreatitis.
4)is commonly caused by inflammation of the pancreas.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
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Q1) The following statements are true of what major intestinal hormone?
1)It has 22 amino acids.
2)It is produced by the upper small intestine.
3)Its stimulating factor is a high-fat meal and duodenal acidification.
4)Its function is to stimulate motility of the small intestine.
A)glucagon
B)motilin
C)gastrin
D)secretin
Q2) Which of the following is a function of parietal cells?
A)to produce hydrochloric acid and intrinsic factor
B)to produce the proenzyme pepsinogen
C)to secrete a protective layer of mucus to protect stomach mucosa from attack by acid and enzymes
D)to produce the hormone gastrin
Q3) What analyte is measured in a lactose tolerance test?
A)lactose
B)lactase
C)D-xylose
D)glucose
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Q1) Organize the following events of the acute coronary syndromes in the correct order.
1)myocardial infarction
2)angina
3)unstable angina, frequently associated with minor myocardial damage
4)extensive tissue necrosis
5)reversible tissue injury
A)3, 1, 4, 2, 5
B)1, 3, 5, 4, 2
C)2, 5, 3, 1, 4
D)4, 5, 2, 3, 1
Q2) 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
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Q1) A plasma sample with triglycerides at a level of 100 mg/dL is expected to have a ______ appearance, a level of 175 mg/dL is expected to have a ______ appearance, and a level of 350 mg/dL is expected to have a ______ appearance.
A)clear, hazy, opaque
B)clear, clear, hazy
C)hazy, hazy, opaque
D)hazy, opaque, opaque
Q2) Which of the following enzymes catalyzes the rate-determining step of endogenous cholesterol synthesis?
A)acyl CoA:cholesterol acyltransferase (ACAT)
B)lecithin:cholesterol acyltransferase (LCAT)
C)3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase
D)Cholesteryl ester transferase (CEsT)
Q3) Dietary-derived and newly synthesized hepatic triglycerides are coupled with which of the following to form VLDL?
A)phospholipid
B)cholesterol
C)proteins
D)all of the above
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Q1) Which of the following metabolic pathways provides the greatest amount of ATP per mole of glucose?
A)anaerobic glycolysis
B)aerobic glycolysis
C)tricarboxylic acid cycle and linked oxidative phosphorylation
D)glycogenesis
Q2) Metabolically useful carbohydrates are monosaccharides which are derived through digestive mechanisms from polysaccharides and disaccharides.In addition to glucose, which of the following are also metabolically useful monosaccharides?
A)lactose and maltose
B)fructose and galactose
C)starch and glycogen
D)sucrose and amylase
Q3) In diabetic ketoacidosis, plasma sodium levels are ______, plasma potassium levels are ______, and plasma bicarbonate levels are ______.
A)decreased, decreased, decreased
B)increased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
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Q1) 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
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) ______ is the porphyrin most likely to be exclusively excreted in urine, and ______ is the porphyrin most likely to be exclusively excreted in feces.______ has the greatest chance of appearing in either urine or feces.
A)Protoporphyrin, coproporphyrin, uroporphyrin
B)Uroporphyrin, protoporphyrin, coproporphyrin
C)Coproporphyrin, uroporphyrin, protoporphyrin
D)Protoporphyrin, uroporphyrin, coproporphyrin
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Q1) M-hemoglobins are derived from:
A)methemoglobin
B)sulfhemoglobin
C)carboxyhemoglobin
D)glycosylated hemoglobin A
Q2) A hexokinase deficiency would result in a shift to the ______of the oxygen dissociation curve, and a pyruvate kinase deficiency would result in a s(answer format: blank 1, blank 2)
A)right, right
B)right, left
C)left, left
D)left, right
Q3) 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
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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) Increased irritability of cardiac muscle may be associated with a decreased plasma concentration of which of the following macrominerals?
A)sodium
B)potassium
C)chloride
D)calcium
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Q1) The most common food source of mercury is:
A)beef
B)milk
C)fish
D)poultry
Q2) Which of the following essential trace elements exhibits antioxidant properties?
A)chromium
B)manganese
C)molybdenum
D)selenium
Q3) What is the laboratory method of choice in the analysis of essential trace metals?
A)spectrophotometry
B)fluorometry
C)atomic absorption spectrophotometry
D)nephelometry
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Q1) Which vitamin is known chemically as pyridoxine?
A)vitamin B
B)vitamin B
C)vitamin B
D)vitamin B
Q2) 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
Q3) 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
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Q1) Which of the following clotting factors are increased during pregnancy?
1)VII
2)VIII
3)IX
4)XII
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q2) 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
Q3) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
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Q1) Which of the following are the most common respiratory problems in premature neonates?
1)meconium aspiration syndrome
2)persistent pulmonary hypertension
3)respiratory distress syndrome
4)apnea of prematurity
A)1, 2
B)2, 3
C)3, 4
D)1, 4
Q2) Which of the following tests have reference intervals that are lower in the newborn than in the adult?
1)vitamin
2)protein
3)trace elements
4)inflammation markers
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
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Q1) Why is the measurement of uric acid in synovial fluid considered to be of no diagnostic value in gout?
A)Uric acid is not found in synovial fluid.
B)Uric acid exists as crystals in synovial fluid and cannot be quantified.
C)Uric acid in synovial fluid is approximately the same as in serum.
D)Uric acid is not important in the diagnosis of gout.
Q2) The major distinguishing factor between transudates and exudates is the _________ content of the fluid.
A)glucose
B)protein
C)lipid
D)sodium
Q3) Which of the following factors are important in the production of serous fluid?
1)hydrostatic pressure
2)colloid osmotic pressure
3)capillary permeability
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Q1) The following laboratory results were obtained on a patient suffering from depression, fatigue, and apathy.These data provide laboratory evidence of which disease?
Serum cortisol - decreased
Serum sodium - decreased
Serum potassium - increased
A)Addison's disease
B)hypothyroidism
C)Cushing's syndrome
D)liver failure
Q2) When blood is present from a traumatic lumbar puncture or there is bleeding within the CNS, how is the CSF protein level corrected for the amount of blood present?
A)subtracting 1 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
B)subtracting 2 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
C)subtracting 1 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
D)subtracting 2 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
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Q1) Somatostatin exerts a negative influence on which of the following hormones?
1)TSH
2)glucagon
3)GH
4)testosterone
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Which test(s) is/are used to determine if hypothalamic or pituitary dysfunction are the cause of hypogonadal disease and hypergonadal disease?
A)FSH
B)LH
C)prolactin
D)both a and b
Q3) An increased TSH and decreased T provide laboratory evidence of which disease?
A)primary hypothyroidism
B)secondary hypothyroidism
C)tertiary hypothyroidism
D)quaternary hypothyroidism
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Q1) What tests are used as part of newborn screening programs to identify congenital hypothyroidism?
A)T and/or TSH
B)T and/or TSH
C)T and/or T
D)fT and/or T
Q2) Given the following characteristics, which disease state is most likely?
TSH - decreased
FT - increased
FT - increased
T RU - increased
TSI - positive
TPO-ab - may be positive
Thyroid scan uptake - uniformly increased
A)Graves' disease
B)autoimmune thyroiditis
C)secondary hyperthyroidism
D)primary hypothyroidism
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Q1) Which of the following are true of progestagens?
1)They promote the development of the female secondary sex characteristics.
2)They are the precursor of all the ovarian steroid hormones.
3)They are the primary secretory product of the corpus luteum
4)They are required for the induction of secretory activity in an estrogen-primed uterus..
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Which androgens are capable of interacting with the androgen receptor?
1)testosterone
2)dihydrotestosterone
3)dehydroepiandrosterone
4)androstenedione
A)1, 2
B)2, 3
C)3, 4
D)1, 4
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Q1) Which of the following is considered a definitive laboratory finding for congenital adrenal hyperplasia?
A)increased testosterone in serum
B)increased pregnanetriol in urine
C)increased 17-hydroxyprogesterone in serum
D)increased 17-ketosteroid in urine
Q2) Which of the following patients should undergo screening for Cushing's syndrome?
A)a patient with osteoporosis
B)a woman with polycystic ovary syndrome
C)a patient with poorly controlled diabetes
D)all of the above
Q3) Primary autonomous hypersecretion of aldosterone by the zona glomerulosa is mainly caused by:
A)Conn's syndrome
B)idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia
C)Addison's disease
D)both a and b
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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) Tay-Sachs Disease is:
A)autosomal recessive
B)autosomal dominant
C)X-linked recessive
D)X-linked dominant
Q3) Identify which statement is not true regarding predictive genetic testing.
A)An abnormal presymptomatic genetic test result indicates that a person will develop the disease at some point in their lifetime.
B)An abnormal presymptomatic genetic test result will specify when a person's symptoms of a disease will appear.
C)An abnormal predisposition genetic test result indicates that an individual has an increased risk of developing a disease.
D)None of the above are true.
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Q1) CA-125 is elevated in the serum of patients with __________.
A)colorectal cancer
B)breast cancer
C)ovarian cancer
D)prostate cancer
Q2) Protein electrophoresis is helpful when what disease state is suspected?
A)multiple myeloma
B)Waldenstrom's macroglobulinemia
C)MGUS
D)all of the above
Q3) Which class of tumors is the most aggressive and has the worst prognosis?
A)well differentiated
B)moderately well differentiated
C)moderately differentiated
D)poorly differentiated
Q4) Which of the following tests may be selected for screening for cancers?
A)mammography
B)PSA
C)occult blood
D)all of the above
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Q1) The binding of glucocorticoids to their receptors blocks the synthesis or release of lymphokines and cytokines.This results in which of the following?
1)an inhibition of T-cell response to stimulation
2)a redistribution of lymphocytes from the vascular to the lymphatic system
3)an increase in the number of circulating T-cells
4)a decrease in the number of circulating B-cells
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) 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
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Q1) Hemodialysis or hemoperfusion may be effective in removing water-soluble toxins that have which of the following characteristics?
1)high molecular weight
2)low volume of distribution
3)low protein binding
A)1, 2, 3
B)2, 3
C)1, 3
D)1, 2
Q2) Which of the following binds sulfhydryl groups of enzymes and proteins, uncouples oxidative phosphorylation, and can be found in urine, hair, nail, and blood samples?
A)cadmium
B)iron
C)lead
D)arsenic
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Q1) Which of the following is a type of change that occurs during withdrawal?
A)physical
B)psychological
C)behavioral
D)all of the above
Q2) Which of the following is considered a reason that a person will fail a drug screen even though he was given advanced warning?
A)The person did not understand the physiological aspects of drug testing.
B)The individual is in denial about his addiction.
C)The addicted individual has no intention of using drugs at the time of the drug screen but loses control and uses the drug at an inopportune moment.
D)All of the above
Q3) 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
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