Medical Laboratory Science
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Course Introduction
Medical Laboratory Science is a multifaceted course that explores the scientific principles, techniques, and technologies used in clinical laboratories to diagnose, monitor, and prevent diseases. Students gain a comprehensive understanding of laboratory testing in areas such as clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. Emphasis is placed on the practical application of laboratory methods, quality control, laboratory safety, data interpretation, and the ethical responsibilities of medical laboratory professionals. The course prepares students for roles in healthcare settings, ensuring proficiency in analytical procedures and fostering critical thinking essential for accurate patient diagnosis and management.
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) Which of the following water purification techniques is most effective in removing dissolved ionized gases?
A)distillation
B)deionization
C)reverse osmosis
D)ultrafiltration
Answer: B
Q2) A fire associated with actively operating electrical equipment is classified as a ______ fire.The most appropriate type of fire extinguisher for this type of fire would be
A)Class A, halotron
B)Class B, carbon dioxide
C)Class C, halotron
D)Class A and B, dry chemical
Answer: C
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3
Chapter 2: Spectral Techniques
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Q1) 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
Q2) In comparing nephelometry and turbidity, nephelometric measurements should demonstrate ______ sensitivity, and turbidimetric measurements should demonstrate ______ sensitivity.In practice, turbidimetric measurements have been found to demonstrate ______ sensitivity.
A)high, limited, high
B)high, limited, limited
C)limited, high, high
D)limited, high, limited
Answer: A
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Q1) Which of the following molecular characteristics forms the basis for chromatographic retention in adsorption and partition chromatography?
A)molecular size and shape
B)polarity
C)molar absorptivity
D)all of the above
Answer: B
Q2) The advantage of reporting column chromatography results in terms of capacity factor is that capacity factor does not vary with:
A)mobile phase flow rate
B)chromatography column dimensions
C)sample volume injected
D)any of the above
Answer: D
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5
Chapter 4: Chromatographic Techniques
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Q1) Suppose there is the need to separate the components of a mixture in which the components are known to have a molecular weight of less than 1000 D, not be ionizable, and be relatively nonpolar with limited hydrogen-bonding potential.Which chromatographic method should be selected?
A)adsorption chromatography
B)partition chromatography
C)ion-exchange chromatography
D)gel-permeation chromatography
Q2) __________ is the most important parameter influencing separation in gas chromatography.
A)carrier gas flow rate
B)column temperature
C)injection volume
D)analyte polarity
Q3) 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
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Q1) Hb F is the major hemoglobin fraction present in neonates and is found elevated in various hematologic conditions.Which of the following problems may be encountered in the HPLC analysis of Hb F when it is greatly elevated?
A)The measured retention time may fall outside the Hb F window, causing the peak to be labeled as "unknown."
B)Hb F will be measured as part of the background and produce no discernable chromatographic peak
C)Hb F will crystallize and block flow through the chromatographic column.
D)Hb F will break into fragments, producing multiple peaks for detection.
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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Page 7
Chapter 6: Electrophoresis
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Q1) Which support medium is most used in immunoelectrophoresis?
A)polyacrylamide gel
B)agarose
C)agar
D)starch gel
Q2) Serum used as the sample for electrophoretic analysis in clinical laboratories contains many groups of macromolecules.Examples include amino acids, serum proteins, lipoproteins, glycoproteins, and others.Suppose an analyst is interested in performing serum protein electrophoresis.How does the analyst prevent other groups of macromolecules from interfering with the analysis of serum proteins?
A)by selecting a medium that will only allow the electrophoretic migration of serum proteins
B)by selecting an electrophoresis voltage that will only cause migration of serum proteins
C)by selecting an electrophoresis time that will allow all other macromolecules to migrate completely off the medium and leave only serum proteins
D)by selecting a stain that will only visualize the desired serum proteins
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Page 8
Chapter 7: Immunological Reactions
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Q1) 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
Q2) 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
Q3) The most potent antigens are macromolecules with molecular weights greater than:
A)1000 daltons
B)10,000 daltons
C)50,000 daltons
D)100,000 daltons
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Page 9
Chapter 8: Immunochemical Techniques
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Q1) Suppose your laboratory uses a noncompetitive labeled-antibody immunometric technique that incorporates spectrophotometry for the measurement of a particular antigen.As the amount of measured antigen present in the patient sample ________, the absorbance of the test solution will ________.
A)increases, increase B)increases, decrease C)decreases, decrease D)both a and c are correct
Q2) Which one of the following sample conditions would be acceptable in complement fixation testing?
A)a hemolyzed sample
B)a lipemic sample
C)plasma collected in EDTA
D)plasma collected in heparin
Q3) What is the sensitivity range typically seen with indicator-labeled immunoassays?
A)g/L
B)mg/L
C)mg/dL
D)ng/mL
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Page 10
Chapter 9: Principles for Competitive-Binding Assays
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Q1) In competitive-binding assays, the relationship between concentration of unlabeled ligand and percent labeled ligand bound can be described in which of the following ways?
A)logarithmic and direct
B)linear and direct
C)logarithmic and inverse
D)linear and inverse
Q2) 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
Q3) The advantage of using europium chelates, as compared to fluorescein, in time-resolved fluorescence competitive-binding assays is:
A)the stability of the europium-chelate complex
B)the ease of the complexation of europium with ligands and antibodies
C)the magnitude of fluorescence produced by europium chelates
D)the fluorescence lifetime of europium chelates
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Page 11
Chapter 10: Laboratory Approaches to Serology Testing
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Q1) Serological testing is typically not the method of choice for this disease.
A)syphilis
B)Lyme disease
C)peptic ulcer
D)herpes
Q2) The specimen of choice in serological testing is ______.If the specimen is to be stored for 1 week prior to analysis, the specimen should be ______.
A)serum, frozen at -20°C
B)plasma, frozen at -20°C
C)serum, refrigerated
D)plasma, refrigerated
Q3) Which immunoglobulin will dominate the later portion of the primary immune response and subsequent amnestic response?
A)IgG
B)IgM
C)IgA
D)IgE
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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) 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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Chapter 12: Electrochemistry: Principles and Measurement
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Q1) 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
Q2) Suppose a new pH electrode was attached to a pH meter.During calibration, the pH meter had a slow response time and continued to drift after adjustments.What should be the technologist's next step?
A)contact the supplier and request a replacement electrode
B)replace the pH meter
C)calibrate with a new set of standards
D)allow the pH electrode to soak for a few hours in buffer
Q3) What is the most important variable to control during the measurement of ionized calcium by ion-selective electrode methodology?
A)the degree of oxygen exposure
B)the pH of the sample
C)the response time of the instrument
D)all of the above
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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) Fluorescent probes that hybridize to PCR products during amplification change fluorescence by two mechanisms._____ probes change fluorescence by breaking covalent bonds between the probes, and _____ probes change fluorescence based on the proximity of the two probes.Melting curve profiles are only possible with _____ probes.
A)TaqMan, FRET, TaqMan
B)TaqMan, FRET, FRET
C)FRET, TaqMan, TaqMan
D)FRET, TaqMan, FRET
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Page 15
Chapter 14: Therapeutic Drug Monitoring
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Q1) Different formulations of drugs from different manufacturers may influence the blood level-time curves following the administration of a single dose of medication.If all of the drug is eventually released from the different formulations, which of the following statements describes the correlation between these different formulations?
A)The time the drug spends in the body will be the same for all formulations.
B)The peak concentration will be the same for all formulations.
C)The duration of the peak concentration will be the same for all formulations.
D)The area under the blood level-time curve for each formulation will be the same.
Q2) 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
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Chapter 15: Clinical Enzymology
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Q1) A convenient method for assaying enzyme activity is based on measuring the conversion between the oxidized and reduced forms of nicotinamide adenine dinucleotide (NAD/NADH).Which form of nicotinamide adenine dinucleotide has a unique wavelength of absorption, and what is the wavelength at which is unique absorption is at its maximum?
A)oxidized, 260 nm
B)oxidized, 340 nm
C)reduced, 260 nm
D)reduced, 340 nm
Q2) What is the relationship between the Michaelis-Menten plot and the Lineweaver-Burk plot?
A)The Lineweaver-Burk plot is a double reciprocal transformation of the Michaelis-Menten plot.
B)The Lineweaver-Burk plot is a logarithmic transformation of the Michaelis-Menten plot.
C)The Lineweaver-Burk plot is a semilogarithmic transformation of the Michaelis-Menten plot.
D)The Lineweaver-Burk plot is an inverse logarithmic transformation of the Michaelis-Menten plot.
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Q1) What is the basic difference between isoenzymes and isoforms?
A)Isoenzymes originate at the gene level, and isoforms originate from the posttranslational modification of the enzyme.
B)Isoforms originate at the gene level, and isoenzymes originate from the posttranslational modification of the enzyme.
C)Isoenzymes are homodimers, and isoforms are heterodimers.
D)Isoenzymes are heteropolymers, and isoforms are homopolymers.
Q2) What is the limitation of LD isoenzyme measurement in diagnostic enzymology?
A)Since LD catalyzes a reversible reaction, it is difficult to get a true measurement of LD activity.
B)Since LD is found in virtually every tissue, the clinical usefulness in pinpointing areas of disease is extremely limited.
C)LD is found primarily in cells and tissue, making its measurement difficult.
D)all of the above
Q3) With which tissue are each of the CK isoenzymes most frequently associated?
A)brain, cardiac muscle, skeletal muscle
B)cardiac muscle, skeletal muscle, brain
C)skeletal muscle, cardiac muscle, brain
D)skeletal muscle, brain, cardiac muscle
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Page 18
Chapter 17: Interferences in Chemical Analysis
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Q1) Which of the following techniques would be useful for the correction of protein buildup on a spectrophotometer flow cell in an automated analyzer?
A)two-point kinetic analysis
B)bichromatic analysis
C)sample dilution
D)both a and b
Q2) It is recommended that spectrophotometric measurements be made in which of the following absorbance ranges?
A)0.100 - 1.100
B)0.200 - 0.500
C)0.500 - 1.500
D)0.100 - 2.000
Q3) 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
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Page 19
Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Which of the following should be required of ambulatory patients to minimize the preanalytical effect of posture on laboratory test results?
A)The patient should be seated for 15 minutes prior to blood collection.
B)The patient should be allowed to stand quietly or be seated for 15 minutes prior to blood collection.
C)The patient should be allowed to stand quietly, be seated, or lie down for 15 minutes prior to blood collection.
D)There should be no restrictions on ambulatory patients.
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) Why is glucose typically not considered to be an analyte suitable for delta-check monitoring?
A)Glucose methodology does not provide sufficiently reproducible results.
B)Glucose tests are ordered too frequently.
C)Glucose shows pronounced intra-individual variation.
D)Glucose levels can be measured in serum, plasma, urine, and spinal fluid.
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Page 20
Chapter 19: Laboratory Management
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Q1) Laboratory procedures are billed to insurance companies or organizations according to which system of coding?
A)Hospital Information System (HIS) coding
B)Diagnosis Related Group (DRG) coding
C)Common Procedure Terminology (CPT) coding
D)Health Insurance Portability and Accountability Act (HIPAA) coding
Q2) What is the most important management skill/ability that should be utilized by a laboratory director when planning changes in laboratory services?
A)communication
B)technical knowledge
C)background research
D)financial restraint
Q3) A laboratory test is considered a ____________ test until the test is classified by the FDA.
A)waived
B)moderately complex
C)highly complex
D)experimental
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21
Chapter 20: Laboratory Automation
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Q1) 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
Q2) In most cases, automated incubation is performed under conditions of a specified, constant temperature, which is most frequently achieved by the use of_______________.
A)heating blocks
B)air
C)water baths
D)any of the above
Q3) _______________ is defined as the maximum number of samples or tests that can be processed in an hour.
A)Throughput
B)Dwell time
C)Stat testing
D)Test repertoire
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22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Which of the following statements is not true regarding POCT?
A)POCT analyzers tend to have higher disposable and reagent costs than traditional laboratory systems.
B)Results from a POCT device will match results from a central laboratory for the same test.
C)Results of POCT can be seen and acted upon before any control checks or other external mechanisms of ensuring test result reliability can be applied to the result.
D)Most POCT errors are unintentional.
Q2) Tests performed by clinicians on their own patients, using samples that are so fragile it is impractical to send them to a central laboratory, are ____________.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
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Chapter 22: Laboratory Information Systems
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Q1) Most LISs can produce epidemiology reports that support which of the following?
1)quality assurance
2)accreditation
3)CLIA
4)public health
A)1, 2, 3, 4
B)1, 2, 4
C)1, 2, 3
D)1, 3, 4
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) 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.
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Page 24
Chapter 23: Laboratory Statistics
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Q1) Which of the following measures of central tendency identifies the true central tendency for all types of distributions?
A)mean
B)median
C)mode
D)frequency
Q2) Suppose a laboratory is interested in changing from a manual assay for a given analyte to an automated assay for the analyte.Data collected by each of the two methods are unrelated, and the number of observations differs for each dataset.Which statistical method should be selected to determine if a significant difference exists between the means of the two methods?
A)t-test
B)unpaired t-test
C)paired t-test
D)standard error of the mean
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) The process of separating reference intervals based on criteria such as age, sex, and race, as well as statistical analysis showing significant differences between these subclasses, is known as:
A)partitioning
B)transference
C)diagnostic specificity
D)diagnostic sensitivity
Q2) Which of the following attributes is the most desirable for a laboratory test utilized in the diagnosis of diseases such as cystic fibrosis that are currently not curable?
A)laboratory tests with the highest sensitivity
B)laboratory tests with the highest specificity
C)laboratory tests with the highest predictive value for a positive test
D)laboratory tests with the highest efficiency
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 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) Which of the following would likely not be detected by quality-control procedures in a laboratory assay performed manually?
A)deteriorated reagent
B)improper reaction temperature
C)pipetting error
D)spectrophotometer set at the wrong wavelength
Q3) Suppose a test procedure has been determined to be out of control.What is the first step that should be taken by the technologist to correct the problem?
A)recalibrate the instrument
B)retest using fresh aliquots of control materials
C)replace reagents
D)perform instrument maintenance
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Chapter 26: Evaluation of Methods
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Q1) Calculate the percentage recovery given the following information:
Baseline sample preparation: 1.5 mL serum + 0.25 mL water
Spike sample preparation: 1.5 mL serum + 0.25 mL 5000 mg/L standard
Baseline sample measured concentration: 950 mg/L
Spiked sample measured concentration: 1621 mg/L
A)89%
B)94%
C)98%
D)106%
Q2) Even when a method's performance is well documented by published evaluation studies, the new laboratory considering use of the method should evaluate ______ and perform ______ to verify acceptable performance in that laboratory.
A)random analytical error, the comparison-of-methods experiment
B)random analytical error, the recovery experiment
C)constant systematic error, the comparison-of-methods experiment
D)constant systematic error, the recovery experiment
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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) The three-dimensional spatial arrangement of multiple polypeptide chains forming larger, more stable complexes is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q3) The order or sequence of amino acids in a protein as determined by genetic code is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) Which electrolyte is most significantly affected by hemolysis?
A)sodium
B)potassium C)chloride
D)bicarbonate
Q2) The urine level of which electrolyte will distinguish excess diuretic use or self-induced vomiting from Barter's syndrome?
A)sodium
B)potassium C)chloride
D)bicarbonate
Q3) Which of the following electrolytes is likely to be found decreased in metabolic alkalosis?
A)sodium B)potassium C)chloride
D)bicarbonate
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Page 30
Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) A decreased total CO , decreased pCO , and decreased pH is most correctly classified as:
A)partially compensated metabolic acidosis
B)partially compensated metabolic alkalosis
C)partially compensated respiratory acidosis
D)partially compensated respiratory alkalosis
Q2) The base excess in a blood sample at a pH of 7.40, a pCO of 40 mm Hg, a hemoglobin of 150 g/L, and a temperature of 37°C is equal to:
A)-2.5 mEq/L
B)0 mEq/L
C)1.2 mEq/L
D)2.5 mEq/L
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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Q1) Potassium is freely filtered at the ______, and ______ occurs throughout the nephron, except in the ______.
A)descending loop of Henle, active tubular reabsorption, glomerulus
B)ascending loop of Henle, active tubular reabsorption, glomerulus
C)glomerulus, active tubular reabsorption, descending loop of Henle
D)glomerulus, active tubular reabsorption, ascending loop of Henle
Q2) When the human body needs to conserve water, as in dehydration, the concentration mechanism operates maximally, and the urine osmolality will change to about ______.When there is excess water in the body, urine flow ______, and the diluting mechanism can change urine osmolality to approximately ______.
A)50 mOsm/kg, decreases, 1200 mOsm/kg
B)1200 mOsm/kg, increases, 50 mOsm/kg
C)1200 mOsm/kg, decreases, 1200 mOsm/kg
D)50 mOsm/kg, increases, 1200 mOsm/kg
Q3) Normal urine output is approximately _____________ per day.
A)500 mL
B)1000 mL
C)1500 mL
D)2500 mL
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Page 32
Chapter 31: Liver Function
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Q1) Which of the following statements is true of jaundice?
A)Jaundice can be detected when serum bilirubin reaches 5 mg/L in adults and 10 mg/L in neonates.
B)Jaundice can be detected when serum bilirubin reaches 10 mg/L in adults and 20 mg/L in neonates.
C)Jaundice can be detected when serum bilirubin reaches 20 mg/L in adults and 40 mg/L in neonates.
D)Jaundice can be detected when serum bilirubin reaches 30 mg/L in adults and 50 mg/L in neonates.
Q2) Which of the following sets of screening tests and confirmatory tests would be best when diagnosing Wilson's disease?
A)screening tests: serum iron, iron-binding capacity, ferritin; confirmatory test: HFE gene analysis
B)screening tests: ANA, anti-smooth muscle; confirmatory test: liver biopsy
C)screening tests: serum iron, serum/urine copper; confirmatory test: HFE gene analysis, liver biopsy
D)screening test: ceruloplasmin, serum/urine copper; confirmatory test: liver biopsy; genetic studies
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Chapter 32: Diagnosis of Viral Hepatitis
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Q1) The clinical significance of virus genotypes is that they sometimes play an important role in determining treatment.Which hepatitis virus has genotypes 1 through 6?
A)HAV
B)HBV
C)HCV
D)HEV
Q2) Which of the following are characteristics of hepatitis C virus (HCV)?
1)HCV is transmitted through blood, needle sharing, sexually.
2)HCV is the primary cause of chronic liver disease such as cirrhosis.
3)HCV currently has a vaccine available.
4)The majority of HCV-infected patients are asymptomatic.
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 33: Bone Disease
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Q1) Select the proper order for the following stages of Paget's Disease.
1)Bone formation predominates; the pagetic bone is coarse-fibered, dense, trabecular bone.
2)Resorption predominates, and the bone marrow is replaced with a highly vascular fibrous connective tissue.
3)The rate of bone resorption declines, and continued bone formation produces hard, dense bone.
A)1, 2, 3
B)2, 1, 3
C)1, 3, 2
D)2, 3, 1
Q2) Which of the following qualify as criteria for a female patient to have a bone-density scan?
A)over 65 years old
B)postmenopausal with at least one risk factor besides menopause, or with a fracture
C)on prolonged hormone-replacement therapy
D)all of the above
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Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Which of the following best summarizes the usefulness of the Ranson criteria for predicting the severity of acute pancreatitis?
A)high positive predictive value, high negative predictive value
B)high positive predictive value, low negative predictive value
C)low positive predictive value, high negative predictive value
D)low positive predictive value, low negative predictive value
Q2) A 56-year-old female presents with glucose intolerance, gallbladder disease, and diarrhea.A large, malignant tumor was found in the head of the pancreas and was causing bile duct obstruction.What is the most probable type of tumor?
A)insulinoma
B)glucagonoma
C)somatostatinoma
D)PPoma
Q3) Nerve fibers in pancreatic tissue stimulate production of:
A)vasoactive intestinal peptide
B)somatostatin
C)enkephalin-related peptides
D)all of the above
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Chapter 35: Gastrointestinal Function
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Q1) Which of the following hormones is produced by the mucosa of the upper small intestine and functions to stimulate gall bladder and stomach contraction?
A)cholecystokinin
B)gastrin
C)secretin
D)motilin
Q2) The following statements are true of what major intestinal hormone?
1)It has 22 amino acids.
2)It is produced by the upper small intestine.
3)Its stimulating factor is a high-fat meal and duodenal acidification.
4)Its function is to stimulate motility of the small intestine.
A)glucagon
B)motilin
C)gastrin
D)secretin
Q3) Which of the following is not a function of gastrin?
A)stimulates stomach acid secretion
B)stimulates stomach contraction
C)stimulates intestinal motility
D)stimulates growth of small bowel mucosa
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Chapter 36: Cardiac and Muscle Disease
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Q1) Which of the following statements is true of the troponin polypeptides?
A)Troponin T binds to actin and inhibits the activity of actomyosin ATPase.
B)Troponin I is responsible for tropomyosin-binding activity.
C)Troponin C is responsible for calcium-binding activity of muscle contraction.
D)All of the above
Q2) Which of the following laboratory tests would be the most useful in assisting the physician in differentiating congestive heart failure from other conditions that have similar clinical presentations?
A)lactate
B)CK-MB
C)cTnI
D)BNP
Q3) Cardiac output is determined by which of the following:
A)volume of blood pumped
B)the contractile force developed in the wall of the left ventricle
C)systemic blood pressure
D)all of the above
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) Dietary-derived and newly synthesized hepatic triglycerides are coupled with which of the following to form VLDL?
A)phospholipid
B)cholesterol
C)proteins
D)all of the above
Q2) Which of the following lipoprotein profiles would be indicative of the laboratory presentation of Tangier disease?
A)increased VLDL, increased LDL, increased HDL
B)absent VLDL, increased LDL, normal HDL
C)normal VLDL, absent LDL, normal HDL
D)normal VLDL, normal LDL, absent HDL
Q3) A patient has a triglyceride level of 234 mg/dL.This would be what when converted to mmol/L?
A)2.64 mmol/L
B)2.70 mmol/L
C)3.40 mmol/L
D)3.50 mmol/L
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Chapter 38: Diabetes Mellitus
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Q1) Which of the following laboratory results provide provisional laboratory diagnosis of diabetes mellitus?
1)2-hour postprandial glucose = 175 mg/dL
2)fasting plasma glucose = 140 mg/dL
3)casual (random) glucose = 210 mg/dL
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) In addition to hyperglycemia, which of the following are typical laboratory indicators of diabetes mellitus?
1)glucosuria
2)polyuria
3)hyperinsulinemia
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) Which of the following is/are true of hepcidin?
A)It controls the flow of iron out of the intestinal cells by inhibiting iron release.
B)High levels promote release of iron into the circulation.
C)Low levels restrict the release of iron from intestinal cells into the circulation.
D)all of the above
Q2) The rate-limiting step in heme synthesis in the liver is regulated by which enzyme?
A)ALA synthase
B)ALA dehydratase
C)PBG deaminase
D)Ferrochelatase
Q3) 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
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Chapter 40: Hemoglobin
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Q1) The relationship between partial pressure of oxygen and percent hemoglobin saturation with oxygen is described by a ______ curve.This curve shape results from the fact that ______.
A)hyperbolic, each heme molecule is oxygenated independently
B)hyperbolic, oxygenation of one heme group increases the oxygen affinity of others
C)sigmoid, each heme molecule is oxygenated independently
D)sigmoid, oxygenation of one heme group increases the oxygen affinity of others
Q2) 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
Q3) 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.
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Page 42
Chapter 41: Human Nutrition
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Q1) 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
Q2) The hypermetabolic state can be associated with all of the following except:
A)major burns
B)peritonitis
C)bone fractures
D)starvation
Q3) All of the following laboratory observations are associated with a hypermetabolic state except:
A)hyperglycemia
B)hypertriglyceridemia
C)increased C-reactive protein
D)increased urine urea nitrogen
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Chapter 42: Trace Metals
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Q1) Which of the following essential trace elements exhibits antioxidant properties?
A)chromium
B)manganese
C)molybdenum
D)selenium
Q2) An aluminum measurement may be requested in which of the following situations?
A)a patient receiving long-term total parenteral nutrition therapy
B)a patient recovering from a liver transplant
C)a patient developing frequent kidney stones
D)a patient diagnosed with type 2 diabetes
Q3) A deficiency of __________ may be associated with hyperglycemia, glucosuria, and glucose intolerance in a nondiabetic patient.
A)chromium
B)copper
C)manganese
D)molybdenum
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Chapter 43: Vitamins
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Q1) Absolute vitamin deficiencies can be the result of:
1)a nutritional deficit
2)an inability to properly absorb a vitamin
3)an increased metabolism and clearance
4)a markedly increased utilization
A)1, 2, 3, 4
B)1, 2, 4
C)1, 2, 3
D)2, 3, 4
Q2) Hemolytic anemia may be associated with which vitamin deficiency?
A)vitamin A
B)vitamin D
C)vitamin E
D)vitamin K
Q3) The active form of vitamin K is important in which of the following steps of the coagulation pathway?
A)the conversion of glutamic acid to delta-carboxyglutamic acid
B)the binding of calcium
C)the formation of an ionic bridge for clot formation
D)the binding with phospholipids
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Chapter 44: Pregnancy and Fetal Development
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Q1) Human chorionic gonadotropin (hCG:
1)regulates ovulation and subsequent formation of the corpus luteum
2)provides continued stimulation of the corpus luteum to ensure uninterrupted progesterone production
3)can be detected in maternal serum 6 to 9 days following conception
4)concentrations peak between 10 and 12 weeks
A)1, 2
B)2, 3
C)3, 4
D)2, 4
Q2) The units for -fetoprotein measurements are:
A)mg/L
B) g/L
C)mmol/L
D)MoM
Q3) Which of the following tests is used in the diagnosis of neural tube defects?
A)human chorionic gonadotropin
B)follicle-stimulating hormone
C)luteinizing hormone
D)acetylcholinesterase
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Chapter 45: The Newborn
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Q1) Which tests will identify both neonatal primary and secondary hypothyroidism?
A)TSH
B)free T<sub>4</sub>
C)total T<sub>3</sub>
D)total T<sub>4</sub>
Q2) Given that there is no common standard for maximum blood-collection volume for newborns, which of the following is an appropriate guideline for newborns under 7 kg of body weight?
A)Single collections should be under 0.1 mL/kg body weight.
B)Single collections should be under 1.0 mL/kg body weight.
C)Single collections should be under 5.0 mL/kg body weight.
D)Single collections should be under 10.0 mL/kg body weight.
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) The major distinguishing factor between transudates and exudates is the _________ content of the fluid.
A)glucose
B)protein
C)lipid
D)sodium
Q2) Why is the measurement of uric acid in synovial fluid considered to be of no diagnostic value in gout?
A)Uric acid is not found in synovial fluid.
B)Uric acid exists as crystals in synovial fluid and cannot be quantified.
C)Uric acid in synovial fluid is approximately the same as in serum.
D)Uric acid is not important in the diagnosis of gout.
Q3) Which of the following factors are important in the production of serous fluid?
1)hydrostatic pressure
2)colloid osmotic pressure
3)capillary permeability
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 47: Nervous System
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Q1) Which of the following occurs in Alzheimer's disease?
A)a large decrease in choline acetyltransferase activity, along with degeneration of neurons using acetylcholine
B)a degeneration of cholinergic neurons in the basal ganglia
C)dysfunction of GABA-ergic systems
D)dopaminergic neuron dysfunction
Q2) When blood is present from a traumatic lumbar puncture or there is bleeding within the CNS, how is the CSF protein level corrected for the amount of blood present?
A)subtracting 1 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
B)subtracting 2 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
C)subtracting 1 mg/dL of protein for every 1000 RBCs per mm<sup>3</sup>
D)subtracting 2 mg/dL of protein for every 2000 RBCs per mm<sup>3</sup>
Q3) The normal ratio of serum protein to CSF protein is ________________.
A)150:1
B)200:1
C)250:1
D)300:1
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Chapter 48: General Endocrinology
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Q1) Under normal physiological conditions, what process functions to maintain relatively constant levels of circulating hormones?
A)circadian rhythm
B)feedback control
C)hypothalamic stimulation
D)second messenger control
Q2) Which of the following statements are true of steroid hormones?
1)They interact with their target cells by binding to specific receptors located in both the intracellular cytoplasmic and nuclear fractions of the cells.
2)They enter the cell primarily through diffusion.
3)Transport proteins are necessary to carry steroids from the organ of synthesis, through the blood stream, to their site of action.
4)They utilize the second messenger signaling system.
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 49: Thyroid
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Q1) Given the following characteristics, which disease state is most likely?
TSH - increased
FT - increased
FT - increased
T RU - decreased
TSI - negative
TPO-ab - unlikely to be positive
Thyroid scan uptake - increased
A)Graves' disease
B)autoimmune thyroiditis
C)secondary hyperthyroidism
D)primary hypothyroidism
Q2) The T resin uptake test is used to measure:
A)total T
B)free T
C)thyroxine binding globulin (TBG)
D)TSH
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Page 51
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) What hormone controls the conversion of androgens to estrogens?
A)LH
B)FSH
C)testosterone
D)dihydrotestosterone
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Chapter 51: Adrenal Hormones and Hypertension
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Q1) Which of the following is considered the most sensitive test for the diagnosis and exclusion of pheochromocytoma?
A)plasma free metanephrines
B)the low-dose dexamethasone suppression test
C)plasma ACTH
D)plasma epinephrine
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) Given the following information, identify which disease is being described.
Gene - GBA
Protein - acid beta glucosidase
Gene locus - 1q21
Inheritance and incidence - autosomal recessive; 1 in 100,000 among general population; 1 in 900 among Ashkenazi Jews
Clinical features - Type 1: Hepatosplenomegaly, bone lesions, hematological abnormalities,
Survival into adulthood.Type 2: Severe neuronopathic disease, hepatosplenomegaly, death in early childhood
A)Gaucher disease
B)cystic fibrosis
C)sickle cell disease
D)phenylketonuria
Q2) Which of the following is considered a transversion?
A)the substitution of a pyrimidine for a purine
B)the substitution of a purine for a purine
C)the substitution of a pyrimidine for a pyrimidine
D)all of the above
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Chapter 53: Neoplasia
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Q1) Which of the following statements are true of oncogenes?
A)When activated inappropriately, it will result in the transition from normal cells to a wildly proliferating, uncontrolled cell mass that characterizes cancer.
B)Oncogenes act in a dominant fashion.
C)The majority of oncogenes are the result of mutations of normal cell regulatory genes.
D)All of the above
Q2) Which class of tumors is the most aggressive and has the worst prognosis?
A)well differentiated
B)moderately well differentiated
C)moderately differentiated
D)poorly differentiated
Q3) Protein electrophoresis is helpful when what disease state is suspected?
A)multiple myeloma
B)Waldenstrom's macroglobulinemia
C)MGUS
D)all of the above
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) 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
Q2) The binding of glucocorticoids to their receptors blocks the synthesis or release of lymphokines and cytokines.This results in which of the following?
1)an inhibition of T-cell response to stimulation
2)a redistribution of lymphocytes from the vascular to the lymphatic system
3)an increase in the number of circulating T-cells
4)a decrease in the number of circulating B-cells
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 55: Toxicology
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Q1) Which of the following drugs shows a relationship between the concentration of the toxin found in the circulation and toxicity?
A)acetaminophen
B)salicylate
C)carbon monoxide
D)all of the above
Q2) Most toxins enter the body through what route?
A)skin
B)lungs
C)gastrointestinal tract
D)all of the above
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 situations could produce withdrawal symptoms?
A)chronic regular use of narcotics for pain
B)chronic regular use of sedatives for anxiety
C)chronic regular use of sedatives for insomnia
D)all of the above
Q2) Lacrimation, rhinorrhea, piloerection, sweating, diarrhea, yawning, and tachycardia are all withdrawal symptoms of which of the following drugs?
A)caffeine
B)marijuana
C)opiates
D)tobacco
Q3) Which of the following is considered a reason that a person will fail a drug screen even though he was given advanced warning?
A)The person did not understand the physiological aspects of drug testing.
B)The individual is in denial about his addiction.
C)The addicted individual has no intention of using drugs at the time of the drug screen but loses control and uses the drug at an inopportune moment.
D)All of the above
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