Laboratory Medicine
Review Questions
Course Introduction
Laboratory Medicine is a comprehensive course that explores the essential role of laboratory testing in the diagnosis, management, and prevention of diseases. Students will learn about the principles and techniques of various laboratory disciplines, including clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. The course emphasizes the interpretation of laboratory findings, quality assurance, and the integration of laboratory data with clinical information to optimize patient care. Through a combination of theoretical instruction and practical laboratory experience, students will develop the critical skills necessary for accurate test selection, result interpretation, and communication with healthcare professionals.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Chapter 1: Basic Laboratory Principles and Techniques
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Q1) How many mL of a 10 mg/L solution must be diluted to 100 mL to produce 100 mL of a 0.1 mg/dL solution?
A)1 mL
B)5 mL
C)10 mL
D)50 mL
Answer: C
Q2) How many mL of 0.819 M acetic acid (MW = 60; pK = 4.76) should be added to 350 mL of 0.368 M sodium acetate (MW = 82) to produce a final pH of 4.89?
A)95.41 mL
B)116.5 mL
C)128.8 mL
D)130.6 mL
Answer: B
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Chapter 2: Spectral Techniques
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Q1) A system in which the light intensity of the wavelength produced by each atom is directly proportional to the number of atoms emitting energy, which in turn is directly related to the concentration of the compound being measured, describes:
1)atomic absorption spectrophotometry
2)atomic emission flame photometry
3)UV/Visible spectrophotometry
4)fluorometry
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3
D)2, 4
Answer: D
Q2) What would happen to the percent transmittance of a sample that was read in a cuvette with fingerprints on the optical surface?
A)%T would increase
B)%T would decrease
C)%T of quartz cuvettes would not be affected by fingerprints
D)%T of glass cuvettes would not be affected by fingerprints
Answer: B
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) The type of chromatography in which separation occurs by differential distribution of solutes between two immiscible liquids is known as:
A)adsorption chromatography
B)partition chromatography
C)ion-exchange chromatography
D)gel-permeation chromatography
Answer: B
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
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5
Chapter 4: Chromatographic Techniques
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Q1) Combining selected ion monitoring (SIM) with isotope dilution in electron-ionization mass spectrometry allows:
A)for the removal of extraneous ions that produce complicating peaks in the mass spectrum
B)for quantification utilizing an internal standard
C)for confirmation of results obtained by electron-ionization mass spectrometry alone
D)for quality control checks on the mass spectrometry procedure
Q2) Which of the following components of the gas chromatograph does not require close temperature control?
A)the carrier gas
B)the injector port
C)the column
D)the detector
Q3) __________ is the most important parameter influencing separation in gas chromatography.
A)carrier gas flow rate
B)column temperature
C)injection volume
D)analyte polarity
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Page 6
Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) 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
Q2) Hb A2 is often falsely elevated in the presence of __________ and falsely reduced in the presence of ________.
A)Hb S, Hb D-Punjab
B)Hb F, Hb D-Punjab
C)Hb S, Hb C
D)Hb F, Hb C
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Chapter 6: Electrophoresis
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Q1) Electro-osmosis is the migration of supporting medium counterions and solvent toward the appropriate electrode.This net flow of counterions and solvent is in the opposite direction to the migration of the macromolecules of interest.Which of the following statements best describes the effect of electro-osmosis?
A)Electro-osmosis will only affect the final positions of the macromolecules but not their separation.
B)Electro-osmosis will prevent macromolecule separation from occurring.
C)Electro-osmosis is the mechanism by which electrophoretic separation of macromolecules occurs.
D)Electro-osmosis only occurs in capillary electrophoresis and is the mechanism of separation in the relatively new technique.
Q2) An increase in the ionic strength of the electrophoretic buffer while operating at constant current will cause the voltage to ________, the electrophoretic migration of macromolecules to ________, and the separation of macromolecules to _______.
A)increase, increase, increase
B)increase, increase, decrease
C)decrease, decrease, increase
D)decrease, decrease, decrease
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Page 8
Chapter 7: Immunological Reactions
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Q1) Considering the noncovalent forces that contribute to antigen and antibody attraction, ________ are the strongest and most important contributors to antigen and antibody attraction, whereas ________ are the weakest contributors to this attraction.
A)electrostatic forces, van der Waals forces
B)hydrogen bonds, electrostatic forces
C)van der Waals forces, hydrogen bonds
D)electrostatic forces, hydrogen bonds
Q2) The portion of the immunoglobulin molecule that binds to antigens is:
A)the Fab-fragment portion
B)the Fc-fragment portion
C)the hinge portion
D)the disulfide-linkage portion
Q3) Haptens are:
A)low-molecular-weight compounds that are unable to induce an antibody response alone
B)low-molecular-weight compounds that can induce an immune response when coupled to higher-molecular-weight immunogenic carriers
C)low-molecular-weight compounds that can react with antibodies
D)all of the above
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Chapter 8: Immunochemical Techniques
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Questions
Q1) Suppose your laboratory uses a sandwich immunoassay to measure a specific hormone.Following release of a patient's results, the physician questioned the results because they did not match with the patient's symptoms; the results appear falsely elevated.What steps should be taken to evaluate the physician's concerns?
A)Rerun the assay on the original patient sample specimen with fresh reagent.
B)Pre-incubate the patient sample with non-immune globulins before running the sandwich immunoassay.
C)Rerun the assay with fresh controls.
D)Decrease the temperature of the reaction to decrease the results to a more suitable level.
Q2) Which one of the following sample conditions would be acceptable in complement fixation testing?
A)a hemolyzed sample
B)a lipemic sample
C)plasma collected in EDTA
D)plasma collected in heparin
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) In the fluorescence polarization immunoassay (FPIA) technique, the amount of polarized fluorescent light detected when the fluorophore is excited with polarized light is higher for:
A)low-molecular-weight fluorescence-labeled ligands not bound to antibody
B)low-molecular-weight non-labeled ligands not bound to antibody
C)low-molecular-weight fluorescence-labeled ligands bound to antibody
D)low-molecular-weight non-labeled ligands bound to antibody
Q2) ELISA is considered a ______ assay, and EMIT is considered a ______ assay.______ assay would be considered more suitable for automated chemistry analyzers.
A)homogeneous, heterogeneous, homogeneous
B)homogeneous, heterogeneous, heterogeneous
C)heterogeneous, homogeneous, heterogeneous
D)heterogeneous, homogeneous, homogeneous
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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Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Flocculation and precipitation agglutination reactions differ by:
A)Flocculation reactions result from the detection of antibody, and precipitation reactions result from the detection of antigen.
B)Flocculation reactions result from the detection of antigen, and precipitation reactions result from the detection of antibody.
C)Flocculation-reaction complexes float in solution, and precipitation-reaction complexes settle to the bottom of the solution.
D)Flocculation-reaction complexes can only be observed microscopically, and precipitation-reaction complexes can be observed macroscopically.
Q2) Suppose a serum VDRL gave a positive result, and CSF showed 8 nucleated cells/mm³.What follow up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested positive, and what follow-up test should be used in the laboratory diagnosis of neurosyphilis if the CSF VDRL tested negative?
A)T.pallidum particle agglutination test, no follow-up testing is required
B)fluorescent treponemal antibody test, no follow-up testing is required
C)no follow-up testing is required, T.pallidum particle agglutination test
D)no follow-up testing is required, fluorescent treponemal antibody test
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Page 12
Chapter 11: Measurement of Colligative Properties
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Q1) Determine the calculated osmolality, given the following data: sodium = 140 mEq/L; glucose = 32 mmol/L; BUN = 30 mmol/L.
A)202 mOsm/kg
B)292 mOsm/kg
C)342 mOsm/kg
D)404 mOsm/kg
Q2) What is the purpose for calculating an osmolal gap?
A)This serves as a quality-control measure of osmolality measurement.
B)This serves as an indication of abnormal concentrations of unmeasured substances in the blood stream.
C)This is the method utilized to calibrate the osmometer.
D)This removes the need for direct measurement of osmolality.
Q3) In the equation to estimate osmolality by calculation, why are glucose and BUN divided by 18 and 2.8, respectively?
A)to provide an estimate of the contribution of glucose and BUN to the total number of particles of each
B)to convert each from mg/L to mmol/L
C)to account for the number of charges on each molecule
D)both a and b
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Page 13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) Which of the following may result in errant sodium results being reported by the laboratory when using a glass ion-selective electrode?
A)standards used for calibration and sample for analysis are not analyzed at the same temperature
B)electrode fouling by serum, plasma, or whole blood
C)analysis of highly acidic urine samples
D)all of the above
Q2) In the coulometric titration of chloride, the titration end-point is measured in terms of the:
A)time required to complete the titration
B)amount of product (silver chloride) formed
C)amount of silver ion produced at the anode
D)number of electrons detected at the cathode
Q3) Carbon dioxide and ammonia electrodes are identical in that they utilize the same ______ and are different in that they utilize different ______.
A)pH electrode for measurement, gas-selective membranes
B)pH electrode for measurement, ionophores
C)gas-selective membranes, reference electrodes for quantification
D)gas-selective membranes, filling solutions around the electrode
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Page 14
Chapter 13: Molecular Diagnostics
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Q1) Single-stranded conformational polymorphism analysis (SSCP) and heteroduplex analysis are two mutation scanning techniques that have which of the following in common?
A)Conformational changes resulting from mutations are detected by electrophoretic differences.
B)Conformational changes resulting from mutations are detected by changes in fluorescence intensity.
C)The presence of mutations is detected in these techniques by scanning UV/visible spectrophotometry identifying changes in wavelengths of maximum absorbance.
D)The presence of mutations is detected in these techniques by variations in melting temperature.
Q2) What is the current detection limit for test systems available to measure HIV RNA viral loads?
A)40 to 50 copies/mL
B)500 to 750 copies/mL
C)10,000 copies/mL
D)100,000 copies/mL
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Chapter 14: Therapeutic Drug Monitoring
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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) Where will an acidic drug with a pK of 3.5 have the greatest chance for absorption by passive diffusion?
A)the stomach
B)the skin
C)the intestine
D)the rectum
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Chapter 15: Clinical Enzymology
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Q1) A/An ______ is a non-protein organic material that is one type of cofactor that may be needed for the ______form of the enzyme being measured.
A)activator, apoenzyme
B)coenzyme, holoenzyme
C)activator, holoenzyme
D)coenzyme, apoenzyme
Q2) Considering the active site of an enzyme, which of the following statements is not correct?
A)The active site of an enzyme involves a relatively small percentage of the total number of amino acids in the enzyme.
B)The active site of an enzyme is the location where allosteric inhibitors bind to the enzyme.
C)The attraction between enzyme and substrate is typically non-covalent.
D)The active site of an enzyme takes on a three-dimensional orientation for specific binding with the substrate.
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17
Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) 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
Q2) Isoenzymes of an enzyme can differ in which of the following ways?
1)heat stability
2)amino acid composition
3)Michaelis-Menten constants
4)isoelectric points
A)1, 2, 3, 4
B)1, 3, 4
C)1, 2, 3
D)2, 3, 4
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18
Chapter 17: Interferences in Chemical Analysis
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Q1) 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
Q2) Suppose a colorimetric analysis that utilizes a highly colored reagent is to be performed.Which type of blank should be prepared to ensure the correct sample results?
A)sample blank
B)reagent blank
C)instrument blank
D)diluent blank
Q3) 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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Page 19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Which of the following is not an advantage of the use of serum/plasma separator tubes?
A)Tubes can be centrifuged without removal of the stopper.
B)Tubes can be centrifuged using swinging buckets or fixed-angle rotors.
C)Continued red cell metabolism does not alter serum or plasma.
D)Storage with stoppers in place prevents evaporation.
Q2) 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
Q3) 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
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Chapter 19: Laboratory Management
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Q1) Based on CLIA '88 regulations, which of the following are permitted to evaluate the competency of all testing personnel?
1)the laboratory director
2)the technical consultant
3)the technical supervisor
4)the general supervisor
A)1, 2, 3, 4
B)1, 2, 4
C)2, 3, 4
D)3, 4
Q2) Which of the following would be a negative aspect of a reagent rental plan for acquiring a piece of equipment, as compared to leasing equipment?
A)Equipment least costs and reagent costs may be less than the complete reagent rental costs.
B)Next-generation equipment from a different company may become available before the contract expires.
C)The test volume may decrease for the equipment before the reagent rental contract expires.
D)all of the above
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Chapter 20: Laboratory Automation
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Q1) Spectrophotometric instruments often have the capability of automatically sensing the presence of common interferents except:
A)icterus
B)hemolysis
C)clots
D)lipemia
Q2) The majority of laboratory errors occur during ______ and ______.
A)test ordering, sample transport
B)phlebotomy, front-end processing of the sample
C)phlebotomy, result reporting
D)front-end processing of the sample, result reporting
Q3) The error rate in clinical laboratories has been estimated to be in what range?
A)10.0% to 32 %
B)1.0% to 2.4 %
C)0.1% to 2.5%
D)2.5% to 10.0 %
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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Given that hemoglobin A1c levels are consistent for approximately 3 months, performance of POCT in the physician's office has been demonstrated to ______patient counseling and ______ hemoglobin A1c levels, improving both patient and physician satisfaction.
A)misdirect, decrease
B)enhance, increase
C)misdirect, increase
D)enhance, decrease
Q2) Which of the following do not perform point-of-care testing?
A)laboratory personnel
B)physicians
C)nurses
D)patients
Q3) ______ 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
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Chapter 22: Laboratory Information Systems
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Q1) HIPAA stands for:
A)the Health Insurance Privacy and Accountability Act.
B)the Health Insurance Portability and Accountability Act.
C)the Health Insurance Privacy and Assurance Act.
D)the Health Insurance Portability and Assurance Act.
Q2) 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
Q3) Before an instrument can be interfaced to an LIS, what conditions need to be satisfied?
A)The LIS and the instrument must be linked by a physical connection.
B)Interface software must be available on the LIS to allow it to receive data from and transmit data to the instrument.
C)Both a and b
D)Neither a nor b
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Chapter 23: Laboratory Statistics
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Q1) Degrees of freedom may be defined as:
A)the freedom allowed when selecting data from a dataset.
B)the number of independent observations in a dataset.
C)N - 1.
D)all of the above
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
Q3) Suppose there is a set of normally distributed data from which a normal reference interval for health is to be determined.If the reference interval is set as 0 ± 2s , what percentage of normal healthy individuals will fall outside the normal reference interval for health?
A)0 (none)
B)0.28%
C)2.14%
D)4.56%
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Which of the following laboratory considerations are not necessary factors to consider for the transfer of a reference interval from one laboratory to another?
A)preanalytical considerations
B)analytical considerations
C)postanalytical considerations
D)both a and c
Q2) 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.
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Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) 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
Q2) A delta check is a check of the difference between:
A)two consecutive control observations
B)the mean of the control material and the control value observed
C)two consecutive measurements of the same analyte on the same patient
D)the mean of the normal reference interval for the analyte and the patient result
Q3) A field 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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Page 27
Chapter 26: Evaluation of Methods
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Q1) Which of the following is the correct sequence to follow in method selection?
A)define requirements, review literature, determine need, select candidate methods
B)determine need, define requirements, review literature, select candidate methods
C)select candidate methods, determine need, define requirements, review literature
D)determine need, review literature, define requirements, select candidate methods
Q2) All of the following describe the within-run replication experiment except:
A)It is the simplest type of study.
B)It measures the constant systematic error caused by the presence of a substance suspected of interfering with the test method.
C)It allows assessment of precision over a very short time.
D)It should be performed with samples whose matrix is as similar as possible to that of the intended patient samples.
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) The biuret reaction is the most common technique for measuring total serum protein.The biuret reaction is directed toward what part of the protein complex?
A)the secondary structure
B)the tertiary structure
C)the peptide linkage
D)the prosthetic group
Q2) Monosaccharides can be linked to other monosaccharides or other biomolecules through the formation of:
A)peptide linkages
B)hydrogen bond linkages
C)glycosidic linkages
D)ester linkages
Q3) The spatial arrangement of a linear chain of amino acids from which folding results in specific three-dimensional patterns such as the beta-pleated sheet and the alpha helix is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Which of the following describes the correct meaning of anion gap = 15 mEq/L?
A)There is a 15 mEq/L gap between the major measured cations and major measured anions.
B)There is a 15 mEq/L gap between the physiologically active cations in the body and the physiologically active anions in the body.
C)There are 15 mEq/L more cations than anions in the plasma sample tested.
D)There are 15 mEq/L more anions than cations in the plasma sample tested.
Q2) 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
Q3) Which electrolyte is most significantly affected by hemolysis?
A)sodium
B)potassium
C)chloride
D)bicarbonate
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) Given the following arterial blood-gas results, which choice best describes the expected base excess/deficit and total CO results for the sample?
PH = 7.32
PCO = 65 mm Hg
HCO = 24 mEq/L
A)a base excess (above normal) and a normal total CO
B)a base deficit (below normal) and a normal total CO
C)a base excess (above normal) and a significantly decreased total CO
D)a base deficit (below normal) and a significantly increased total CO
Q2) Which of the following normal reference intervals is incorrect for an arterial blood sample?
A)pH = 7.35 - 7.45
B)pCO = 24 - 28 mmHg
C)HCO = 22 - 26 mmol/L
D)TCO = 23 - 27 mmol/L
Q3) The major physiological buffer is:
A)bicarbonate
B)hemoglobin
C)phosphate
D)protein
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Chapter 30: Renal Function
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Sample Questions
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) Which of the following is an/are important function(s) of the kidney?
A)regulation of acid-base balance
B)hormonal function
C)protein conservation
D)all of the above
Q3) ___________ is the major cation found in extracellular fluid, and therefore regulation of this is the critical factor in the maintenance of body fluid volume.
A)Sodium
B)Chloride
C)Potassium
D)Phosphorus
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Chapter 31: Liver Function
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Q1) Select the cause for liver disease indicated by the laboratory data provided below.
AST - slightly above the upper reference limit (URL)
ALT - slightly above URL
AST/ALT ratio - less than 1
GGT - three times URL
ALP - normal
A)acute viral hepatitis
B)drug-induced hepatitis
C)cirrhosis
D)autoimmune liver disease
Q2) Within the hepatocyte's cytoplasm, there is normally more AST than ALT by a factor of about ______; however, the amount of cytoplasmic ALT ______ with alcohol abuse, pyridoxine deficiency, and in cirrhosis, which ______ the cellular ratio of AST to ALT.
A)1.2, decreases, increases
B)1.5, increases, decreases
C)1.5, decreases, increases
D)1.2, increases, decreases
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33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) 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
Q2) The following information is characteristic of which hepatitis virus?
Viral classification - Deltaviridae
Viral envelope - present
Incubation time (days to clinical symptoms) - 21 to 50 days
Route of transmission - blood, fluids
Genome - particle G-negative ssRNA
Size of genome - 1.7 kbases
A)HAV
B)HBV
C)HCV
D)HDV
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Chapter 33: Bone Disease
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Q1) Long bone:
1)are confined to the limbs.
2)consist of a diaphysis, epiphyses, and metaphysis.
3)consist of cortical bone that encloses a layer of trabecular bone.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following diseases and conditions are associated with calcidiol (25-hydroxy-cholecalciferol) excess?
1)vitamin D intoxication
2)nephrotic syndrome
3)excessive sunlight exposure
4)sarcoidosis
A)1, 3, 4
B)1, 3
C)2, 4
D)2, 3, 4
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35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Alpha cells:
1)constitute 20% to 30% of the islet cells
2)constitute 60% to 70% of the islet cells
3)produce glucagon
4)produce pro-insulin
A)1, 3
B)2, 3
C)1, 4
D)2, 4
Q2) The exocrine acini are drained by ductules that combine into a single ______.In most individuals, this joins the common bile duct at the ______, which opens through the duodenal papilla.This orifice is encircled by the ______, so that pancreatic exocrine secretions can flow into the gastrointestinal tract.
A)pancreatic duct, ampulla of Vater, sphincter of Oddi
B)ampulla of Vater, pancreatic duct, sphincter of Oddi
C)pancreatic duct, sphincter of Oddi, ampulla of Vater
D)ampulla of Vater, sphincter of Oddi, pancreatic duct
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Page 36
Chapter 35: Gastrointestinal Function
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Q1) Which of the following explains an increased prothrombin time in patients with malabsorption syndrome?
A)decreased intestinal absorption of thrombin
B)decreased intestinal absorption of vitamin K
C)decreased intestinal absorption of carbohydrates
D)decreased intestinal absorption of electrolytes
Q2) The breath test and the CLO test used to determine the presence of Helicobacter pylori are based on H.pylori's production of what substance?
A)excess hydrochloric acid
B)carcinoembryonic antigen (CEA)
C)bombesin
D)urease
Q3) Which of the following is a function of chief 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
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Chapter 36: Cardiac and Muscle Disease
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Q1) 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
Q2) Troponin ______ is found in cardiac and skeletal muscles and is not utilized in laboratory testing for evidence of a myocardial infarction.Although there are skeletal muscle forms of troponin ______, cardiac-specific isoforms have been identified and are the focus of laboratory testing.Only one form of troponin ______ has been identified, and it has never been found in skeletal muscle.
A)C, I, T
B)I, T, C
C)C, T, I
D)T, I, C
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Which of the following are optimal fasting levels, based on Adult Treatment Panel III guidelines?
1)total cholesterol of less than 200 mg/dL
2)LDL cholesterol of greater than 100 mg/dL
3)HDL cholesterol of less than 40 mg/dL
4)triglycerides of less than 150 mg/dL
A)1, 2
B)2, 3
C)3, 4
D)1, 4
Q2) Atherosclerotic plaque formation occurs in three progressive states.What is the correct order of these stages?
1)the complicated lesion
2)the fatty streaks
3)the fibrous plaque
A)1, 2, 3
B)2, 3, 1
C)3, 1, 2
D)3, 2, 1
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Chapter 38: Diabetes Mellitus
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Q1) 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
Q2) The following laboratory data may be explained by:
Blood glucose level - below normal
Insulin level - above normal
C-peptide level - low to normal
A)hypoglycemia caused by alcoholism
B)overtreatment with insulin
C)pregnancy
D)errant test results
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) Iron in the Fe² state is known as ______ iron, and iron in the Fe³ state is known as ______ iron.The conversion of Fe³ to Fe² is known as ______.
A)ferric, ferrous, oxidation
B)ferric, ferrous, reduction
C)ferrous, ferric, oxidation
D)ferrous, ferric, reduction
Q2) 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
Q3) The following data provide laboratory evidence of which disorder of porphyrin metabolism?
Urinary -aminolevulinic acid (ALA) - elevated
Urinary porphobilinogen (PBG) - normal
Free erythrocyte protoporphyrin (zinc protoporphyrin) - elevated
A)acute intermittent porphyria
B)porphyria cutanea tarda
C)hereditary coproporphyria
D)lead poisoning
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Chapter 40: Hemoglobin
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Q1) Which of the following causes hemolysis in association with thalassemia?
A)the free iron available in the red cell due to a deficiency of protoporphyrin
B)the presence of an excess of one globin chain pair
C)the presence of hemichromes
D)the free heme available in the red blood cell due to the presence of variant hemoglobins
Q2) Synthesis of hemoglobin is normally stimulated by hypoxia causing the ______ to produce ______.
A)hypothalamus, hemopexin
B)adrenal gland, haptoglobin
C)kidneys, erythropoietin
D)lungs, angiotensin
Q3) Which of the following characteristics differentiates methemoglobin and sulfhemoglobin?
A)the production of anoxia and cyanosis
B)the ability to be reduced back to hemoglobin
C)the ability to transport oxygen
D)both a and b
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Chapter 41: Human Nutrition
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Q1) What is the body mass index of a patient who weighs 250 pounds and is 1.828 meters tall?
A)31 kg/m<sup>2</sup>
B)34 kg/m<sup>2</sup>
C)38 kg/m<sup>2</sup>
D)There is insufficient information provided to solve this problem.
Q2) Phosphorus:
1)is a major component with calcium in skeletal and dental tissue
2)when deficient, causes rickets in children and osteomalacia in adults
3)when deficient, symptoms include muscle weakness
4)is a component of nucleic acids
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)1, 2, 4
Q3) A patient with a body mass index of 27 is said to be ________________.
A)underweight
B)at a healthy weight
C)overweight
D)obese
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Chapter 42: Trace Metals
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Q1) Metallothionein binds copper, zinc and cadmium.Which of the following sequences relates the strength of the interaction between metallothionein and these metals? (answer format: the most firmly bound metal listed first and least firmly bound metal listed last)
A)cadmium, copper, zinc
B)zinc, cadmium, copper
C)copper, zinc, cadmium
D)None of the above; all metals bind equally.
Q2) Which of the following elements is an important component of thyroid hormones?
A)fluorine
B)iodine
C)manganese
D)molybdenum
Q3) Which of the following essential trace elements is important for the function of xanthine oxidase activity and for uric acid production?
A)molybdenum
B)manganese
C)chromium
D)selenium
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Chapter 43: Vitamins
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Q1) The major function(s) of water-soluble vitamins in the body is/are:
A)as sources of energy
B)as coenzymes
C)as acute-phase reactants
D)all of the above
Q2) Hemolytic anemia may be associated with which vitamin deficiency?
A)vitamin A
B)vitamin D
C)vitamin E
D)vitamin K
Q3) Vitamin B is usually measured in the laboratory at the same time as which other vitamin, owing to their clinical similarities of deficiency and metabolic interactions?
A)thiamine
B)niacin
C)folic acid
D)carnitine
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Page 45
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) The fluorescent polarization method for assessing fetal lung maturity measures which of the following ratios?
A)lecithin to sphingomyelin ratio
B)lecithin to phosphatidylglycerol ratio
C)phosphatidylglycerol to lecithin ratio
D)lung surfactant to albumin ratio
Q3) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
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Chapter 45: The Newborn
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Q1) 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
Q2) Which of the following biochemical compounds in neonatal CSF parallels that of the serum concentration?
1)glucose
2)bilirubin
3)lactate
4)protein
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
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Chapter 46: Extravascular Biological Fluids
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Q1) Given the following laboratory data, determine the classification of synovial fluid. Volume: 3.8 mL
Color: yellow green
Viscosity: low
Leukocytes (cells/µL): 59,000
Neutrophils (%): 81
Culture: positive
A)noninflammatory
B)inflammatory
C)septic
D)hemorrhagic
Q2) Of the laboratory tests that may be used to make a diagnosis of rheumatoid arthritis, which shows the greatest diagnostic sensitivity?
A)erythrocyte sedimentation rate
B)C-reactive protein
C)rheumatoid factor
D)antinuclear antibodies
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Page 48
Chapter 47: Nervous System
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Q1) Which of the following laboratory abnormalities are identified in patients with multiple sclerosis?
1)an elevation of up to 40 white blood cells/mm³
2)an increase in serum myelin basic protein
3)a decreased spinal fluid IgG
4)observation of oligoclonal bands in the immunoglobulin region on electrophoresis
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Which of the following compounds most readily enters the central nervous system?
A)albumin
B)calcium
C)alcohol
D)aspartic acid
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Chapter 48: General Endocrinology
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Q1) Trophic hormones are produced by the ______, and releasing factors are produced by the ______.
A)hypothalamus, pituitary
B)pituitary, hypothalamus
C)specific endocrine glands, hypothalamus
D)specific endocrine glands, pituitary
Q2) Which of the following are true of the second messenger signaling system?
1)This system requires the availability of energy in the form of ATP.
2)This system is utilized by steroid and peptide hormones.
3)An example of a second messenger is cyclic-AMP.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q3) Which of the following laboratory tests is most useful in distinguishing between hypothalamic and pituitary causes of thyroid dysfunction?
A)TRH stimulation test
B)TSH
C)T
D)T
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Chapter 49: Thyroid
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Q1) 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
Q2) Which amino acid residue of thyroglobulin is responsible for binding iodine in the formation of thyroid hormones?
A)tyrosine
B)phenylalanine
C)histidine
D)guanidine
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Chapter 50: The Gonads
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Q1) Gonadotropin-releasing hormone (GnRH) regulates which of the following?
A)the synthesis and storage of gonadotropins
B)movement of gonadotropins from a reserve pool ready for secretion
C)immediate release of FSH and LH
D)all of the above
Q2) All patients with elevated _______________ in association with amenorrhea and/or galactorrhea require radiological imaging of the pituitary.
A)FSH
B)LH
C)estradiol
D)prolactin
Q3) Of the circulating testosterone in normal men, the majority is ______________.
A)loosely bound to albumin
B)free
C)bound to cortisol-binding globulin
D)bound with high affinity to sex hormone-binding globulin
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) In normal individuals, four main factors control the secretion of aldosterone from the zona glomerulosa.Under normal circumstances, which factor predominates?
A)potassium levels
B)natriuretic peptides
C)the renin-angiotensin system
D)ACTH levels
Q2) The predominant androgens secreted by the adrenal cortex are:
1)dehydroepiandrosterone sulfate (DHEA-S)
2)dehydroepiandrosterone (DHEA)
3)androstenedione
4)dihydrotestosterone (DHT)
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q3) Which of the following conditions results from excess cortisol production?
A)Cushing's syndrome
B)primary hyperaldosteronism
C)Conn's syndrome
D)pheochromocytoma
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Chapter 52: Diseases of Genetic Origin
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Q1) Sickle cell disease is the prototypical ______ single gene disorder.It occurs with an incidence of approximately 1 in 600 ______.
A)autosomal recessive, African Americans
B)autosomal recessive, Caucasian Americans
C)autosomal dominant, African Americans
D)autosomal dominant, Caucasian Americans
Q2) 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
Q3) Tay-Sachs Disease is:
A)autosomal recessive
B)autosomal dominant
C)X-linked recessive
D)X-linked dominant
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54
Chapter 53: Neoplasia
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Q1) Which gene(s) has/have been identified as most likely to contribute to an inherited susceptibility to breast and ovarian cancer?
A)BRCA1
B)BRCA2
C)BRCA3
D)both a and b
Q2) Select the correct 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
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Kidney donors who have been monitored for up to 20 years after donation exhibit a slight ______ in glomerular filtration rate and a mild ______ in urine protein excretion, without an increase in hypertension.
A)decrease, increase
B)decrease, decrease
C)increase, increase
D)increase, decrease
Q2) Elevations in ______ are suggestive of hepatocellular necrosis, and elevations in ______ are suggestive of cholestasis.
A)ALP and bilirubin, AST and ALT
B)AST and ALT, ALP and bilirubin
C)ALP and AST, ALT and bilirubin
D)ALT and bilirubin, ALP and AST
Q3) When is the risk of allograft rejection and infection the most intense?
A)7-14 days
B)1-3 months
C)3-6 months
D)6-12 months
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Chapter 55: Toxicology
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Q1) What is the primary means by which most drugs and toxins cross membranes?
A)active transport
B)facilitated transport
C)passive diffusion
D)passage through membrane pores
Q2) 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
Q3) Ginseng can cause toxicity in which of the following sites?
A)heart
B)liver
C)kidney
D)gastrointestinal tract
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Page 57
Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following is a symptom of withdrawal from cocaine?
1)hypersomnia
2)hyperphagia
3)depressed mood
4)sweating
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) _____________ is defined as the central nervous system adjustment to the relatively sudden cessation of regular psychoactive substance use.
A)Withdrawal
B)Craving
C)Recovery
D)Rehabilitation
Q3) The heaviest alcohol use occurs in what age group?
A)ages 13 to 18 years
B)ages 18 to 25 years
C)ages 21 to 28 years
D)ages 25 to 32 years
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