Laboratory Medicine Review
Questions
Course Introduction
Laboratory Medicine is a comprehensive course that explores the principles, techniques, and applications of clinical laboratory testing in the diagnosis, monitoring, and management of disease. Students will learn about various laboratory disciplines, including clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. The course covers specimen collection and handling, quality assurance, interpretation of laboratory results, and the role of laboratory data in patient care. Emphasis is placed on the integration of laboratory findings with clinical information to support effective healthcare decision-making.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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Chapter 1: Basic Laboratory Principles and Techniques
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Q1) How many mL of 0.819 M acetic acid (MW = 60; pK = 4.76) should be added to 350 mL of 0.368 M sodium acetate (MW = 82) to produce a final pH of 4.89?
A)95.41 mL
B)116.5 mL
C)128.8 mL
D)130.6 mL
Answer: B
Q2) Which of the following laboratory containers should be selected to store an organic hydrocarbon solvent?
A)borosilicate glass
B)polyethylene
C)polycarbonate
D)polyvinyl chloride (PVC)
Answer: A
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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) The flame in atomic absorption spectrophotometry is used to:
A)provide excitation energy for the atom being measured
B)dissociate the ionic form of the element from its chemical bonds
C)place the ionic form of the element in the atomic ground state
D)both b and c
Answer: D
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Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Chromatographic attractive forces resulting when the small atom size approaches very close to the negative end of a dipole are known as:
A)dispersive (van der Waals) forces
B)dipolar forces
C)hydrogen bonding forces
D)dielectric forces
Answer: C
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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Chapter 4: Chromatographic Techniques
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Q1) The chromatographic method based on biologically related interactions by immobilizing one of a pair of interacting biomolecules onto a solid support and placing it in a column is known as:
A)affinity chromatography
B)ion-suppression chromatography
C)ion-pair chromatography
D)gel-permeation chromatography
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) In mass spectrometry, the molecular ion is:
A)the ion of highest relative abundance in the spectrum
B)the ion from which all other fragment ions are derived
C)always observed in the mass spectrum
D)all of the above
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Perhaps the most significant disadvantage of HPLC analysis of hemoglobins is:
A)the technique is only qualitative and not quantitative
B)the technique is associated with a high degree of imprecision
C)the minor differences between the various hemoglobin fractions cause hemoglobins to elute in very narrow, overlapping windows
D)post-translational modification of hemoglobins produces fractions that often elute with the same retention time as other hemoglobin fractions
Q2) Suppose HPLC results suggest Hb S trait.Why should this be confirmed with the sickle solubility test?
A)Retention characteristics of hemoglobins vary significantly between chromatographic runs, requiring this confirmation step.
B)With chromatography, there is always the possibility of unknown hemoglobins co-eluting with the suspected hemoglobin.
C)The use of chromatographic windows has been associated with a high degree of imprecision.
D)The sickle solubility test is the only technique available to quantify Hb S.
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Chapter 6: Electrophoresis
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Q1) 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
Q2) 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.
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Page 8
Chapter 7: Immunological Reactions
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Q1) The portion of an antigen involved in a reaction with an antibody is known as the ____ site, and the number of these sites on an antigen is known as the antigen's
A)equivalence, valency
B)equivalence, complexity
C)antigenic determinant, valency
D)antigenic determinant, complexity
Q2) Which immunoglobulin exists primarily as a pentamer and is the predominate immunoglobulin in the initial immune response to an antigen?
A)IgM
B)IgE
C)IgA
D)IgD
Q3) Antibodies are ______ that are produced by the _______.
A)lipids, adipose cells
B)carbohydrates, bone marrow cells
C)nucleic acids, hepatocytes
D)proteins, B lymphocytes
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9
Chapter 8: Immunochemical Techniques
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Q1) Which of the following provides the correct explanation for a decrease in light scatter as concentration of hapten (such as a drug) increases in nephelometric inhibition immunoassay (NINIA)?
A)As the concentration of hapten (drug) increases, the excess of antibody decreases, resulting in less light scatter.
B)As the concentration of hapten (drug) increases, more soluble hapten (drug)-antibody complexes form, reducing the amount of light scatter.
C)As the concentration of hapten (drug) increases, more hapten (drug)-antibody complexes form, which fix complement and destroy the complex, reducing the amount of light scatter.
D)As the concentration of hapten (drug) increases, more insoluble hapten (drug)-antibody complexes form, resulting in less light scatter.
Q2) In the Western blot technique, antigens separated by the electrophoretic step are blotted onto a strip of:
A)nitrocellulose paper
B)polyacrylamide gel
C)agarose gel
D)neutral agar
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) What is the purpose of the "label" used in competitive-binding assays?
A)to aid the technologist in knowing which reagents have been added to the assay
B)to aid the technologist in knowing which patient samples have been added to the assay
C)to aid in assay detection and quantification
D)to aid in the identification of free ligand and ligand bound to endogenous protein
Q2) 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
Q3) In ____________ competitive-binding assays, paramagnetic particles are used to capture and concentrate bound label on the surface of an electrode.
A)luminescent oxygen channeling
B)microparticle-based light-scattering
C)enzyme multiplied
D)electrochemiluminescent
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11
Chapter 10: Laboratory Approaches to Serology Testing
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Q1) The difference between treponemal and non-treponemal serological tests for the laboratory detection of syphilis is based on:
A)the stage of syphilis (primary versus latent)
B)the antigen specificity tested
C)the specimen tested
D)the causative bacteria
Q2) 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.
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Chapter 11: Measurement of Colligative Properties
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Q1) In the equation to estimate osmolality by calculation, why is the sodium multiplied by two?
A)Sodium is present in body fluids in twice the concentration of other ions.
B)Sodium has a valence of two.
C)The equation accounts for sodium and its corresponding anion.
D)This factor accounts for the fact that sodium may be bound to chloride (NaCl) or to bicarbonate (NaHCO<sub>3</sub>).
Q2) Osmometers utilizing the freezing point colligative property of solutions are based on what principle?
A)1 osmole of nonionizing substance dissolved in 1 kilogram of water raises the freezing point 1.86°C.
B)1 osmole of nonionizing substance dissolved in 1 kilogram of water lowers the freezing point 1.86°C.
C)Increased solute concentration will raise the freezing point of water in direct proportion to a NaCl standard.
D)Deceased solution concentration will lower the freezing point of water in direct proportion to a NaCl standard.
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Page 13
Chapter 12: Electrochemistry: Principles and Measurement
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Q1) Liquid and polymer membranes for ion-selective electrodes utilize a hydrophobic organic ion exchanger or neutral carrier molecule which is known as a/an ______, an example of which is ______ that is selective for potassium ions.
A)potentiostat, tridodecylamine
B)potentiostat, valinomycin
C)ionophore, tridodecylamine
D)ionophore, valinomycin
Q2) One of the characteristics of a reference electrode is that it must produce a constant and reproducible half-cell reaction.For the saturated calomel reference electrode, which component ensures the development of this constant potential?
A)elemental mercury
B)calomel (Hg Cl )
C)saturated potassium chloride
D)silver chloride
Q3) The primary application for coulometric analysis of chloride is:
A)the measurement of chloride in urine
B)the measurement of chloride in sweat
C)the measurement of chloride in serum
D)the measurement of chloride in whole blood
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Page 14
Chapter 13: Molecular Diagnostics
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Q1) A ______ mutation is one that is present in all cells of the body and is passed from generation to generation.A ______ mutation is one that arises in tissue cells generally as a result of an environmental insult or DNA replication error.The majority of cancers result from ______ mutations.
A)germline, somatic, germline
B)germline, somatic, somatic
C)somatic, germline, germline
D)somatic germline, somatic
Q2) The assumption underlying real-time PCR is that the amount of fluorescence in the reaction chamber is:
A)directly proportional to the amount of amplicon present in the PCR vessel
B)inversely proportional to the amount of amplicon present in the PCR vessel
C)directly proportional to the amount of target template present at the beginning of the reaction
D)both a and c
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Chapter 14: Therapeutic Drug Monitoring
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Q1) Kinetic processes related to the fate of a drug in the body, where the rate of change of drug concentration is dependent upon the drug concentration, is known as:
A)zero-order kinetics
B)first-order kinetics
C)Michaelis-Menten kinetics
D)compartmental kinetics
Q2) A situation where the amount of drug excreted between two doses is equal to the previous dose administered is known as:
A)a steady-state
B)a half-life
C)maintenance dosing
D)therapeutic drug monitoring
Q3) Given that a drug has a half-life of 10 hours and is administered at a dosing interval of slightly less than the half-life, approximately how long will it take to reach the steady-state level?
A)5 hours
B)10 hours
C)40 hours
D)100 hours
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Page 16
Chapter 15: Clinical Enzymology
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Q1) Most clinical laboratory assays measure concentration of analyte in the blood stream.Why do most enzyme analyses measure enzyme activity instead of enzyme concentration?
A)The assays utilized to measure enzymes involve equilibrium reactions where the reaction can proceed in both directions during the assay.
B)The enzyme being analyzed may be present in such a large concentration that it is difficult to maintain linearity, causing activity measurements to be more suitable.
C)Enzymes are not consumed during the reactions in which they are involved, requiring analysis by activity instead of concentration.
D)The products formed by enzymatic reactions are not sufficiently chromophoric to be measured by traditional spectrophotometric techniques.
Q2) What substrate concentration is typically utilized in enzymatic analyses to ensure zero-order kinetics?
A)substrate concentration equal to ½ Km
B)substrate concentration equal to Km
C)substrate concentration of less than 10 × Km
D)substrate concentration of 10 - 100 × Km
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) All of the following statements are true about the LD isoenzyme except:
A)LD has approximately a 10-fold greater affinity for pyruvate than does LD<sub>1</sub>.
B)LD is a tetramer that consists of four H subunits.
C)LD predominates in tissues that are primarily anaerobic.
D)LD is found in high concentration in skeletal muscle and liver.
Q2) All of the following statements are true about the LD isoenzyme except:
A)LD preferably catalyzes the conversion of lactate to pyruvate.
B)LD predominates in tissues that receive a high oxygen supply.
C)LD is found in high concentration in postpubertal testes.
D)LD is found in high concentration in cardiac muscle and erythrocytes.
Q3) 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
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Chapter 17: Interferences in Chemical Analysis
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Q1) Suppose you have a lipemic patient sample for analysis by a colorimetric technique.Which of the following actions should be taken to eliminate the interference caused by the lipemia?
A)Use a sample blank.
B)Dilute the patient sample.
C)Convert the method of analysis to a nephelometric technique.
D)Convert the method of analysis to a fluorometric technique.
Q2) The interference in a lipemic sample results from the presence of excessive ______, which results in ______ of incident light in colorimetric assays.
A)carbohydrates, absorbance
B)carbohydrates, scatter
C)lipoproteins, absorbance
D)lipoproteins, scatter
Q3) The most difficult type of immunochemical interference to detect is the presence of:
A)heterophilic anti-immunoglobulin antibodies
B)iatrogenic antibodies
C)rheumatoid factor
D)complement
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Chapter 18: Sources and Control of Preanalytical Variation
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Q1) For the specimen collection tubes listed below, select the proper order of use during specimen collection.
A)heparin-containing tube, tube for coagulation testing, EDTA-containing tube, tube with no anticoagulant
B)EDTA-containing tube, heparin-containing tube, tube with no anticoagulant, tube for coagulation testing
C)tube with no anticoagulant, EDTA-containing tube, tube for coagulation testing, heparin-containing tube
D)tube for coagulation testing, tube with no anticoagulant, heparin-containing tube, EDTA-containing tube
Q2) Given that all of the following analytes show circadian variation, which one is known to be higher in the afternoon and evening than in the morning?
A)cortisol
B)ACTH
C)TSH
D)iron
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Chapter 19: Laboratory Management
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Q1) A quality-assurance program is designed to:
1)monitor and evaluate the ongoing quality of the total testing process
2)identify and correct problems
3)ensure accurate, reliable, and prompt reporting of results
4)ensure adequacy and competency of the staff
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
Q2) 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
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Chapter 20: Laboratory Automation
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Q1) Commonly the following steps are performed during the course of chemical analysis: mix an aliquot of sample with reagents, ______, ______, ______, and provide an appropriate readout for the permanent record.
A)monitor the result of the reaction, incubate the reaction mixture, quantify the extent of the reaction
B)quantify the extent of the reaction, incubate the reaction mixture, monitor the result of the reaction
C)monitor the result of the reaction, quantify the extent of the reaction, incubate the reaction mixture
D)incubate the reaction mixture, monitor the result of the reaction, quantify the extent of the reaction
Q2) 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
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Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) In several states, such as California and Florida, training and/or licensure is required for waived testing.When personnel documentation is reviewed, all of the following criteria must be met except:
A)Staff responsible for testing and direction are identified.
B)Staff responsible for supervision are identified.
C)Adequate training specific to the device is required to perform the test.
D)Competency is checked at least every 18 months.
Q2) Which of the following is not considered an analytical interference?
A)lipemia
B)drugs
C)interstitial fluid contamination
D)icterus
Q3) 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
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Chapter 22: Laboratory Information Systems
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Q1) Interfacing a high-volume automated instrument to an LIS has what effect on productivity and errors?
A)increases productivity and decreases errors
B)decreases productivity and increases errors
C)decreases productivity and decreases errors
D)increases productivity and increases errors
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) Which statistical method should be selected in the following situation?
"Suppose a laboratory is interested in determining the prognostic ability of selected laboratory tests to predict patient outcomes following severe head trauma, based on a comparison of survivors versus non-survivors at predetermined times following the head trauma."
A)t-test
B)unpaired t-test
C)paired t-test
D)chi-square analysis
Q2) Suppose a 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
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25
Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) To construct receiver-operating characteristic curves, which of the following plots is prepared?
A)specificity versus sensitivity
B)true-negative rate versus false-negative rate
C)false-positive rate versus true-positive rate
D)false-negative rate versus false-positive rate
Q2) 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
Q3) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
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26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) Which of the following statements are correct regarding controls and calibrators?
1)Controls may not be used as calibrators.
2)Calibrators may not be used as controls.
3)Controls establish correspondence of instrument output signal with known concentration.
4)Calibrators establish correspondence of instrument output signal with known concentration.
A)2, 4
B)1, 3
C)2, 3
D)1, 4
Q2) Utilizing 95% confidence limits for quality-control materials, one would expect how many valid quality-control test results to fall outside the established limits?
A)one in 95
B)one in 5
C)one in 10
D)one in 20
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Chapter 26: Evaluation of Methods
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Q1) Random error is associated with ______, and systematic error is associated with ______.The degree of ______ is described by the standard deviation or the coefficient of variation.
A)imprecision, inaccuracy, imprecision
B)imprecision, inaccuracy, inaccuracy
C)inaccuracy, imprecision, imprecision
D)inaccuracy, imprecision, inaccuracy
Q2) A method that falls in the six Sigma region of the Medical Decision Chart indicates that the relationship between the performance of the method and quality control is such that:
A)one to two quality-control measures per run are required.
B)two to three quality-control measures per run are required.
C)three to four quality-control measures per run are required.
D)four to six quality-control measures per run are required.
Q3) Regression analysis of two methods produced the equation y = 0.137 + 0.813x.The proportionality between the two methods is:
A)the calculated value for y given the value for x
B)the calculated value for x given the value for y
C)0.137
D)0.813
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) _____ is the physiological glucose storage form.
A)amylase
B)amylopectin
C)glycogen
D)starch
Q2) Which of the following are characteristics of denatured proteins?
1)Denatured proteins lose their biological activity.
2)Denatured proteins lose their water solubility.
3)Denatured proteins lose their tertiary structure.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q3) 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
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) As the concentration of macromolecules such as lipids and proteins increases:
A)methods that measure ions in plasma water will show an increase in the concentration/activity measured, although the physiological activity is normal.
B)methods that measure ions in plasma water will show a decrease in the concentration/activity measured, although the physiological activity is normal.
C)methods that measure ions in total plasma volume will show an increase in the concentration/activity measured, although the physiological activity is normal.
D)methods that measure ions in total plasma volume will show a decrease in the concentration/activity measured, although the physiological activity is normal.
Q2) 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.
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) 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
Q2) 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.
Q3) Calculate the pH of a blood sample that has a total CO of 26.1 mmol/L and a pCO of 40.5 mm Hg.
A)7.31
B)7.39
C)7.47
D)7.52
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Chapter 30: Renal Function
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Q1) The following are findings in a microscopic urinalysis.What is the laboratory diagnosis?
0 to 1+ protein
0 to 10 RBCs per high power field
>30 WBCs per high power field
2+ bacteria
Granular white blood cell casts
A)glomerulonephritis
B)nephrotic syndrome
C)pyelonephritis
D)these are normal urine findings
Q2) Underneath the capsule of fibrous tissue that encloses the kidney lies the renal cortex, which contains the ______ and the ______.
A)collecting ducts, glomeruli
B)glomeruli, renal tubules
C)tubules, collecting ducts
D)none of the above
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Chapter 31: Liver Function
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Q1) In hemolytic jaundice, urine urobilinogen will be ______, urine bilirubin will be ______, and the predominate form of bilirubin in the blood stream will be ______.
A)increased, detectable, conjugated
B)increased, not detectable, unconjugated
C)decreased, detectable, unconjugated
D)decreased, not detectable, conjugated
Q2) The bile duct carries bile from the ______ to the ______, which when stimulated by cholecystokinin, contracts and releases bile through its duct, termed the ______.This joins the common hepatic duct to form the ______.
A)gall bladder, liver, common bile duct, cystic duct
B)liver, gall bladder, cystic duct, common bile duct
C)gall bladder, liver, cystic duct, common bile duct
D)liver, gall bladder, common bile duct, cystic duct
Q3) All of the following are common causes of acute hepatitis except:
A)non-alcoholic fatty liver disease (NAFLD)
B)hepatitis A virus (HAV)
C)hepatitis B virus (HBC)
D)hepatitis C virus (HCV)
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Chapter 32: Diagnosis of Viral Hepatitis
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Q1) What would be the laboratory interpretation of the following laboratory data for a hepatitis B serology profile?
HBsAg - negative
AHBcT - positive
AHBs - positive
A)susceptible
B)immune due to natural infection
C)immune due to vaccination
D)acutely infected
Q2) Laboratory indicators of acute liver disease are serum bilirubin levels that are ______, serum AST that is ______, and serum ALT that is ______.
A)decreased, increased, increased
B)decreased, increased, decreased
C)increased, increased, increased
D)increased, increased, decreased
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Chapter 33: Bone Disease
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Q1) In the blood stream, calcium exists in three forms: ______ of total serum calcium is the biologically active ionized calcium, ______ is protein bound, mainly to albumin, and ______ is complexed to anions.
A)10%, 45%, 45%
B)45%, 45%, 10%
C)35%, 10%, 55%
D)10%, 55%, 35%
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) Parathyroid hormone (PTH) acts on the bone and kidney to produce three major effects: ______ in serum calcium concentrations, ______ in serum phosphorus concentrations, and ______ in the active hormonal form of vitamin D (calcitriol).
A)increase, decrease, increase
B)increase, increase, decrease
C)decrease, increase, decrease
D)decrease, decrease, increase
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Page 35
Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) In cystic fibrosis, pancreatic secretions are of a/an ______ viscosity and a/an ______ volume, which leads to a greatly ______ pancreatic flow.
A)increased, decreased, decreased
B)decreased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
Q2) Which of the following can cause acute pancreatitis?
A)cystic fibrosis
B)alcohol abuse
C)biliary tract obstruction by gallstones
D)both b and c
Q3) 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
36
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Chapter 35: Gastrointestinal Function
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Q1) Crohn's disease:
1)presents with abdominal pain, diarrhea, and malabsorption.
2)affects the small intestine.
3)produces antibodies to Saccharomyces cerevisiae.
4)produces perinuclear antineutrophil cytoplasmic antibodies.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
Q2) Which of the following processes occurs in the large intestine?
A)Selective water and electrolyte absorption occur.
B)Pancreatic secretions enter the intestine.
C)Components of micelles are absorbed.
D)All of the above
Q3) Which of the following laboratory test results is not consistent with a diagnosis of carcinoid syndrome?
A)increased fecal fat
B)negative stool occult blood
C)normal lactose tolerance
D)increased 5-hydroxyindoleacetic acid (5-HIAA)
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Chapter 36: Cardiac and Muscle Disease
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Q1) 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) Usually _________ are required after the onset of chest pain before CK-MB or the troponins become elevated in the serum of patients suffering from a myocardial infarction.
A)1 to 2 hours
B)2 to 4 hours
C)4 to 6 hours
D)6 to 8 hours
Q3) Troponin remains elevated in blood for how long after a myocardial infarction?
A)4 to 10 days
B)4 to 10 hours
C)3 to 7 days
D)3 to 7 hours
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Page 38
Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) The following laboratory data is associated with which lipoprotein electrophoretic pattern?
Standing plasma test - normal
Total cholesterol - 3+ increase
Triglycerides - normal
A)increase in chylomicrons
B)increase in beta lipoprotein
C)increase in pre-beta lipoprotein
D)increase in beta and pre-beta lipoproteins with bridging
Q2) Which of the following statements is true of fat absorption?
A)In the intraluminal phase, dietary fats are modified both physically and chemically before absorption.
B)During the cellular phase, absorbed lipids are carried from the mucosal cell to other tissues through the lymphatics and blood.
C)During the transport phase, digested material is transported into intestinal mucosal cells, where it is reassembled into its preabsorptive form.
D)All of the above statements are true of fat absorption.
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Chapter 38: Diabetes Mellitus
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Q1) Incretins:
1)are a group of hormones that are released from the intestinal mucosa upon the ingestion of glucose.
2)act on islet beta receptor sites, resulting in insulin release.
3)are a group of hormones that include gastric inhibitory peptide and glucagon-like peptide-1.
4)raise glucose levels by inhibiting insulin secretion, stimulating glucagon secretion, stimulating glycogenolysis, and inhibiting gluconeogenesis.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
Q2) 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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Chapter 39: Iron and Porphyrin Metabolism
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Q1) Free erythrocyte protoporphyrin is somewhat of a misnomer.This form of protoporphyrin that is found elevated in the erythrocyte in certain disorders is actually bound to ________ instead of being free in the erythrocyte.
A)calcium
B)magnesium
C)albumin
D)zinc
Q2) Percent saturation is a useful expression that relates:
A)iron to ferritin
B)iron to transferrin
C)iron to hemosiderin
D)iron to total iron stores
Q3) Which of the following is considered the most appropriate method for quantifying porphyrins in blood or urine?
A)spectrophotometry
B)nephelometry
C)turbidity
D)fluorometry
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Chapter 40: Hemoglobin
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Q1) The level of 2,3-biphosphoglycerate (2,3-BPG) exerts a significant influence on the oxygen dissociation curve.The level of 2,3-BPG production is regulated by which of the following glycolytic enzymes?
A)lactate dehydrogenase
B)phosphofructokinase
C)glucose-6-phosphatase
D)beta-hydroxybutyrate dehydrogenase
Q2) Which of the following provides the primary advantage of Hb F for the developing fetus?
A)Hb F has a higher oxygen affinity than Hb A.
B)Hb F has a lower oxygen affinity than Hb A.
C)Hb F is resistant to oxidation to methemoglobin.
D)Hb F is resistant to alkali denaturation.
Q3) Which of the following laboratory findings would be expected when a hemoglobinopathy causes the oxygen dissociation curve to shift to the left?
A)hypochromic microcytic red blood cells
B)erythrocytosis
C)acidosis
D)increased serum iron and TIBC
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Page 42
Chapter 41: Human Nutrition
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Q1) Which of the following factors is most important to consider when selecting the most useful protein for the laboratory assessment of nutritional supplementation?
A)concentration of the protein
B)size of the protein
C)half-life of the protein
D)degree of protein saturation
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
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43
Chapter 42: Trace Metals
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Q1) Which of the following describes the mechanism by which fluoride is believed to provide protection against dental caries?
A)Fluoride neutralizes tooth-damaging acid by-products produced by bacteria.
B)Fluoride anions substitute for hydroxyl anions in the hydroxyapatite crystal structure, causing the crystal structure to be harder.
C)Fluoride serves as an activator of an enzyme which functions to replenish the hydroxyapatite crystal structure to keep teeth strong.
D)Fluoride is a natural component of tooth enamel that is easily dissolved and must be replenished to provide protection against tooth decay.
Q2) Which of the following cations is important in enzymes associated with nucleic acid and protein synthesis?
A)aluminum
B)zinc
C)selenium
D)molybdenum
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Chapter 43: Vitamins
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Q1) Which of the following statements are true regarding the laboratory analysis of vitamin status?
1)Measurement of urinary metabolites of a vitamin is one approach utilized for determining vitamin status.
2)Measurement of a biochemical function requiring the vitamin, with and without in-vitro addition of the cofactor form, is one approach utilized for determining vitamin status.
3)Detection of reduced serum concentrations of a vitamin is utilized to indicate a deficiency that interrupts cellular function.
4)Detection of vitamin values within a reference interval defined by population studies is utilized to indicate an adequate supply of that vitamin.
A)1, 2, 3, 4
B)2, 3, 4
C)3, 4
D)1, 2
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Chapter 44: Pregnancy and Fetal Development
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Q1) Intrahepatic cholestasis of pregnancy is most frequently identified by the complaint of mild to severe ______ by the expectant mother.Laboratory diagnosis can be made by an increased level/activity of serum ______, which is the cause for the complaint.
A)headaches, glucose
B)itching, bile acids
C)hypertension, potassium
D)edema, hepatic enzymes
Q2) Physiological jaundice occurs in the newborn as a result of which of the following actions being slow to develop after birth?
A)the ability of the liver to remove unconjugated bilirubin from the blood stream
B)the ability of the liver to conjugate bilirubin
C)the ability of the liver to excrete bilirubin
D)all of the above
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) Which laboratory test has been recognized as an early sensitive marker of sepsis in neonates?
A)high-sensitivity C-reactive protein
B)pro-calcitonin
C)serum amyloid A protein
D)hypoglycemia
Q2) The amplitude of a postnatal ADH surge reflects birth-related factors such as:
1)C-section delivery
2)vaginal delivery
3)hypoxia
4)increased intracranial pressure
A)1, 2, 4
B)1, 3, 4
C)2, 3, 4
D)3, 4
Q3) Hyperkalemia in the neonate may result from which of the following situations?
A)physiological anemia
B)physiological jaundice
C)impaired renal excretion
D)all of the above
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Chapter 46: Extravascular Biological Fluids
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Q1) A ______ is a surgical procedure in which pleural fluid is obtained by a puncture of the chest wall.______ is aspiration of fluid from a cavity.______ refers to pus in the pleural cavity.
A)paracentesis, Empyema, Thoracentesis
B)thoracentesis, Paracentesis, Empyema
C)paracentesis, Thoracentesis, Empyema
D)thoracentesis, Empyema, Paracentesis
Q2) The major distinguishing factor between transudates and exudates is the _________ content of the fluid.
A)glucose
B)protein
C)lipid
D)sodium
Q3) In pleural fluid, a transudate would have a specific gravity of:
A) 1.015
B) 1.020
C)<1.015
D)<1.020
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Chapter 47: Nervous System
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Q1) Guillain-Barré syndrome is a neuromuscular disease that has a characteristic CSF finding of an elevated ______ without an elevated ______.
A)white cell count, protein
B)protein, white cell count
C)protein, glucose
D)glucose, protein
Q2) Based on electrophoretic results, prealbumin makes up what percentage of spinal fluid proteins?
A)2% to 7%
B)56% to 76%
C)3.5% to 12%
D)8% to 18%
Q3) Which of the following statements describe the ability of penicillin to cross the blood-brain barrier?
A)Penicillin freely crosses the intact blood-brain barrier.
B)Penicillin does not cross the intact blood-brain barrier.
C)Penicillin crosses the blood-brain barrier once the permeability of the barrier is altered by inflammation.
D)both b and c
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Page 49
Chapter 48: General Endocrinology
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Q1) The laboratory measurement of bioavailable testosterone includes measurement of:
A)testosterone bound to circulating sex hormone-binding globulin (SHBG)
B)testosterone that is free in the circulation
C)testosterone that is bound to albumin in the circulation
D)both b and c
Q2) What term refers to direct cell-to-cell communication elicited by growth factors that are anchored to each cell's membrane?
A)autocrine factor
B)paracrine factor
C)juxtacrine factor
D)intracrine factor
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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Chapter 49: Thyroid
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Q1) Which of the following characteristics are true of Graves' disease?
1)It is the most common cause of hyperthyroidism.
2)It is more prevalent in men than in women.
3)It is an autoimmune disorder.
4)Patients often have high serum concentration of antibodies against thyroglobulin and thyroid peroxidase.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) There is concern that the upper reference interval value for TSH is set too high to detect subtle hypothyroid disease.It is suggested that the upper reference interval value be reduced to what level to address this concern?
A)5.0 mU/L
B)4.0 mU/L
C)3.0 mU/L
D)2.0 mU/L
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Chapter 50: The Gonads
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Q1) Which laboratory test is commonly used to assess luteal function?
A)LH
B)FSH
C)progesterone
D)estradiol
Q2) The clinical problem of amenorrhea may be defined by which of the following criteria?
1)no period by age 14 in the absence of growth or development of secondary sex characteristics
2)no period by age 16, regardless of the presence of normal growth and development with the appearance of secondary sex characteristics
3)in a woman who has been menstruating, the absence of periods for a length of time equivalent to a total of at least 3 of the previous cycle intervals or 6 months of amenorrhea
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Page 52
Chapter 51: Adrenal Hormones and Hypertension
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Q1) Which of the following are characteristic of ketosteroids?
1)contain 21 carbon atoms
2)contain a hydroxyl group at the carbon 17 position
3)contain 19 carbon atoms
4)contain a ketone group at the carbon 17 position
A)1, 2
B)3, 4
C)1, 4
D)2, 3
Q2) When is cortisol usually at its lowest concentration in the circulation?
A)4:00 pm
B)Midnight
C)4:00 am
D)8:00 am
Q3) Adrenal androgens can be converted by peripheral tissues to which primary sex hormone(s)?
A)testosterone
B)dihydrotestosterone
C)estradiol
D)all of the above
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Chapter 52: Diseases of Genetic Origin
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Q1) Which of the following is a type of prenatal genetic test?
A)chorionic villus sampling
B)percutaneous umbilical blood sampling
C)amniocentesis
D)all of the above
Q2) Which of the following statements is true of Klinefelter syndrome?
1)Its chromosome abnormality is 45,X.
2)It has an incidence of 1 in 500 males.
3)It has an incidence of 1 in 500 females.
4)It has clinical features that involve learning difficulties and tall stature.
A)1, 3, 4
B)2, 4
C)1, 3
D)1, 2, 4
Q3) Tay-Sachs Disease is:
A)autosomal recessive
B)autosomal dominant
C)X-linked recessive
D)X-linked dominant
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Page 54
Chapter 53: Neoplasia
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Q1) Select the correct sequence of steps that must occur for the development of colorectal cancer.
1)Mutations of tumor suppressor gene 53 and deletions on chromosome 18q coincide with transition to malignancy.
2)Mutations in the adenomatous polyposis coli (AOC) tumor-suppressor gene occur early in the development of polyps.
3)Oncogenic K-ras mutations arise during the adenomatous stage.
A)1, 2, 3
B)2, 3, 1
C)3, 1, 2
D)2, 1, 3
Q2) CA-125 is elevated in the serum of patients with __________.
A)colorectal cancer
B)breast cancer
C)ovarian cancer
D)prostate cancer
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Cyclosporine toxicity manifests as which of the following?
A)increased renal blood flow
B)decreased GFR
C)increased urine output
D)decreased sodium retention
Q2) Kidney donors who have been monitored for up to 20 years after donation exhibit a slight ______ in glomerular filtration rate and a mild ______ in urine protein excretion, without an increase in hypertension.
A)decrease, increase
B)decrease, decrease
C)increase, increase
D)increase, decrease
Q3) Once a patient progresses to brain death, frequent monitoring of which of the following is/are essential for the successful maintenance of healthy organs?
A)serum electrolytes
B)blood gas
C)blood pH
D)all of the above
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Chapter 55: Toxicology
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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) Ginseng can cause toxicity in which of the following sites?
A)heart
B)liver
C)kidney
D)gastrointestinal tract
Q3) Cocaine has what window of detection?
A)1 to 6 hours
B)<72 hours
C)<12 to 24 hours
D)2 to 5 days
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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) Which of the following statements is true of drug screens?
1)Drug screens can be critical in the confrontation of active denial in patients.
2)Drug screens are performed most often on untimed specimens.
3)Current technology for drug screens can detect most drugs, including LSD.
4)Drug screening is a legal requirement of the treatment in methadone maintenance clinics.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)2, 3, 4
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