Pathology
Exam Materials
Course Introduction
Pathology is the study of the mechanisms, causes, and effects of diseases, providing a critical foundation for understanding how normal physiological processes are altered in illness. This course covers major topics such as cellular injury, inflammation, neoplasia, hemodynamic disorders, genetic and immune factors in disease, and the pathology of key organ systems. Through lectures, case studies, and laboratory experience, students gain insight into the structural and functional changes associated with various diseases, preparing them for clinical decision-making and research in medical and allied health professions.
Recommended Textbook
Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 7th Edition by Carl A. Burtis
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Chapter 1: Clinical Chemistry, molecular Diagnostics, and Laboratory Medicine
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Q1) A patient visits her physician stating that her prescribed painkiller is not working to reduce the pain following her recent surgery.A friend of the patient claims that the same painkiller "worked wonders" to reduce her pain after the same surgery.The physician states that the difference in the effect of the drug might be caused by ____,which is studied in pharmacogenetics.
A) epidemiology
B) an inherited disease
C) a conflict of interest
D) a genetic variation in drug-metabolizing enzymes
Answer: D
Q2) Clinical epidemiology,which is the study of the patterns,causes,and effects of health and disease in certain populations,has provided the clinical laboratory with methods that evaluate the effects and outcomes of laboratory testing.This allows for a more effective:
A) process of determining the cost of the testing methods.
B) selection and interpretation of laboratory tests.
C) determination of the boundaries between the components of the clinical lab.
D) conduct assessment.
Answer: A
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Chapter 2: Selection and Analytical Evaluation of
Methodswith Statistical Techniques
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Q1) The type of method comparison that compares the average results between two analyses with the differences between varying concentration values of the two analyses is referred to as a(n):
A) Deming analysis.
B) linear regression plot.
C) ordinary least-squares plot.
D) Bland-Altman difference plot.
Answer: D
Q2) Two types of error may be encountered during analysis of a substance.The type of error that occurs with a constant or predictable difference or trend,either positive or negative,and thus is related to bias,is a(n)_____ error.
A) systematic
B) random
C) analytical
D) All of the above are correct.
Answer: A
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Chapter 3: Clinical Evaluation of Methods
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Q1) What is the positive predictive value of a test in which 220 tested individuals with positive test results actually have the disease and 45 tested individuals with positive test results do not have the disease?
A) 16.9%
B) 66%
C) 83%
D) 120%
Answer: C
Q2) A laboratory analysis that produces quantitative results with an infinite number of sensitivity and specificity pairs is referred to as a _____ test.
A) predictive
B) qualitative
C) dichotomous
D) continuous
Answer: D
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Chapter 4: Evidence-Based Laboratory Medicine
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Q1) A research study was prepared to assess the diagnostic accuracy of a therapeutic drug monitoring assay for HMG-CoA reductase inhibitors (statins).The study was flawed with poor design.Which of the following statements are correct?
A) Random error decreased.
B) Systematic error decreased.
C) Systematic error increased.
D) Both a and b are correct.
Q2) In reading a research article,you determine that the study design was flawed because there was no control group.This is an example of a weakness in:
A) internal reliability.
B) internal validity.
C) external reliability.
D) external validity.
Q3) When developing clinical practice guidelines,what is the critical first step?
A) Requesting input from health insurance companies and government officials
B) Preparing a cost analysis based on patient needs
C) Determining the intended group that will be directly involved with implementation
D) Selecting and refining the topic upon which the investigation will center
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Chapter 5: Establishment and Use of Reference Values
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Q1) To reduce workload in your chemistry laboratory,you are setting up a small laboratory on the opposite side of your large city from the main laboratory.When preparing the new laboratory's chemistry analyzer,you decide to use the reference values that have been generated by the main laboratory's chemistry analyzer,which is a larger model (but similar in all other respects)than yours.Can this be justified?
A) No,because each analyzer will produce completely different results from the other laboratory.
B) No,because the populations that will be tested are completely different.
C) Yes,if certain conditions have been fulfilled,such as population matching,data comparison,analytical performance agreement,and specimen standardization.
D) Yes,because you cannot afford to perform reference value determinations in your laboratory.
Q2) The proportion of a population (or of those being tested)with the disease being studied is referred to as the:
A) prevalence.
B) clinical sensitivity.
C) clinical specificity.
D) predictive value.
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Chapter 6: Specimen Collection, processing, and Other
Preanalytical Variables
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Q1) Arthrocentesis is a technique used to collect:
A) pleural fluid.
B) blood.
C) synovial fluid.
D) amniotic fluid.
Q2) An individual has several laboratory tests ordered and is having blood collected.After applying the tourniquet,the phlebotomist has to answer the phone and write down a message,leaving the tourniquet in place for approximately 3 minutes.How will this affect this individual's serum composition of total protein and potassium?
A) Both will be increased.
B) Total protein will be increased and potassium will be decreased.
C) Total protein will be decreased and potassium will be increased.
D) Both will be decreased.
Q3) When a coagulated blood sample is separated by centrifugation,the liquid component is separated from the cells.This "serum" is the:
A) liquid component with all clotting factors present in it.
B) liquid component with no clotting factors in it.
C) unclotted cellular component.
D) clot.
Page 8
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Chapter 7: Quality Management
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Q1) In regard to a Gaussian distribution,±2 s from the mean encompasses _____ of values.
A) 99.7%
B) 98.0%
C) 95.5%
D) 68.2%
Q2) Upon examination of the week's analytical run of plasma glucose tests,you notice that four consecutive normal control values are +1 s (standard deviation)from the mean.In your QC report,you note that a Westgard multirule has been broken and realize that this rejection rule is sensitive to a specific type of error.An example of this type of error would be:
A) poor pipetting technique.
B) incubator temperature change.
C) improper calibrator preparation.
D) unstable photometer.
Q3) Which one of the following would be considered a cost of nonconformance?
A) Performing preventive maintenance on analyzers
B) Employee training
C) Repeating an analytical run because the QC is out of range
D) Sending an employee to a fire safety class
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Chapter 8: Principles of Basic Techniques and Laboratory
Safety
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Q1) Reverse osmosis is:
A) the process of vaporizing and condensing a liquid to purify or concentrate a substance or to separate a volatile substance from less volatile substances.
B) a process by which water is forced through a semipermeable membrane that acts as a molecular filter.
C) a process that removes ions to produce mineral-free deionized water.
D) a process used to convert a liquid or a volatile solid into vapor.
Q2) The one technical aspect of a clinical laboratory that has received considerable attention in the need for ergonomic design to decrease musculoskeletal stress would be:
A) pipetting.
B) chair design.
C) lighting.
D) flooring.
Q3) Fifty milligrams (mg)per 1000 mL is equal to:
A) 0.005 g/mL.
B) 0.050 g/mL.
C) 0.050 g/L.
D) 0.50 mg/mL.
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Chapter 9: Optical Techniques
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Q1) The light source in an atomic absorption spectrophotometer is typically a:
A) prism.
B) tungsten light.
C) laser light.
D) hollow cathode tube.
Q2) Atomic absorption spectrophotometry is an emission technique that is used frequently in clinical laboratories to measure:
A) complex antigen-antibody reactions.
B) rotational relaxation of bound fluorophores.
C) elements.
D) high-molecular-weight compounds.
Q3) In a fluorometric measurement,the difference between the maximum wavelength of the excitation light and the maximum wavelength of the emitted fluorescence light is a constant referred to as:
A) Beer law.
B) chemiluminescence.
C) polarization.
D) the Stokes shift.
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Chapter 10: Electrochemistry and Chemical Sensors
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Q1) Which one of the following is not measured with an enzyme-based biosensor,with a light sensing fiber optic probe?
A) Cholesterol
B) PO<sub>2</sub>
C) Bilirubin
D) DNA segments
Q2) A commonly used glass electrode that is used as a reference electrode in pH measurements is the _____ electrode.
A) calomel
B) mercury vapor
C) silver/silver chloride
D) platinum
Q3) An electrochemical technique used to measure chloride in serum or plasma is:
A) conductometry.
B) amperometry.
C) coulometry.
D) voltammetry.
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Chapter 11: Electrophoresis
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Q1) The theory of electrophoresis states that:
A) components of a sample mixture are separated by differential distribution of analytes between stationary and mobile phases.
B) the exquisite specificity and high affinity of antibodies for specific antigens,coupled with the unique ability of antibodies to cross-link antigens,allows for the identification and quantification of specific substances.
C) the concentration of a substance is directly proportional to the amount of light absorbed or inversely proportional to the logarithm of the transmitted light.
D) ionized chemical species having an electrical charge move toward either the cathode (negative electrode)or the anode (positive electrode).
Q2) In capillary electrophoresis,hydrodynamic sample injection:
A) involves sample injection into the capillary by applying a positive pressure to the sample inlet.
B) is best for analytes that have a higher electrophoretic mobility.
C) involves sample injection into the capillary by applying a voltage.
D) is sometimes considered to be a "biased" type of sample injection.
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Chapter 12: Chromatography
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Q1) Which one of the following improvements could be made to increase the chromatographic (separation)efficiency of a poorly resolved HPLC separation?
A) Using a shorter column
B) Changing the composition of the mobile phase
C) Using smaller particles in the stationary phase
D) Increasing the dead volume
Q2) A measure of peak separation in a chromatographic method that equals the difference in retention time for two components divided by the average of their peak widths is the definition of:
A) retention factor.
B) derivatization.
C) resolution.
D) affinity.
Q3) In column chromatography,analytes are identified by their retention times.
A)True
B)False
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14
Chapter 13: Mass Spectrometry
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Q1) In which one of the following mass spectrometers does the fragmentation of ions take place after they have been separated by their m/z value in a first stage?
A) In an inductively coupled plasma mass spectrometer
B) In a mass spectrometer interfaced with a gas chromatograph
C) In a quadrupole-trapping spectrometer
D) In a tandem mass spectrometer
Q2) Because of the ability to identify and quantify proteins in a complex mixture,mass spectrometry combined with separation methods is an excellent analytical tool used specifically in the field of:
A) genomic research.
B) inborn errors of metabolism.
C) trace metal analysis.
D) proteomics.
Q3) What is the function of the vacuum system in a mass spectrometer?
A) To produce an ion from a neutral atom or molecule in the initial step
B) To keep ions from colliding during interactions with the magnetic or electric fields
C) To detect,identify,and quantify ion mass in a compound
D) To separate the negative ions from the positive ions with a magnetic field
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Chapter 14: Enzyme and Rate Analyses
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Q1) Regarding measurement of a property related to substrate concentration such as fluorescence production,the assay that,although more technically demanding,theoretically provides the most accurate measurement of enzyme activity is the:
A) fixed-time assay.
B) equilibrium method.
C) discontinuous-monitoring assay.
D) two-point kinetic method.
Q2) Varying different factors and studying their effects on an enzymatic reaction rate in the assessment of most favorable reaction conditions for an enzyme assay is referred to as:
A) optimization.
B) standardization.
C) quality control.
D) variable control.
Q3) In an enzyme immunoassay such as ELISA,the specificity of the labeled enzyme is the most important aspect of the measurement.
A)True
B)False
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Chapter 15: Immunochemical Techniques
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Q1) In a noncompetitive immunoassay reaction format,a very high concentration of analyte antigen in the unknown sample might produce a falsely:
A) decreased result because the high concentration of antigen binds both the capture and labeled antibody,reducing the number of complexes formed.
B) increased result because the rate of the forward reaction of antigen-antibody binding is too fast,leading to a high equilibrium constant.
C) decreased result because of the free excess antigen-binding all antibody sites and not allowing any unlabeled antigen to bind.
D) increased result because the second labeled antibody will be able to react with the substrate by itself since excess antigen will interfere with any binding.
Q2) An antibody that has very strong affinity to a single antigenic epitope is referred to as a(n)_____ antibody.
A) affinity-purified
B) monoclonal
C) polyclonal
D) multiclonal
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Chapter 16: Automation
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Q1) The most commonly used method of reducing carryover in most automated analytical systems is to use:
A) extensive system flushing between specimens and sample probe washing.
B) plastic reagent containers with closed lids.
C) disposable cuvets.
D) a specific measurement approach that eliminates any possibility of carryover.
Q2) The point of interaction between the instrument operator and an automated analyzer that is dedicated to a defined task and is monitored by integrated computers is the:
A) instrument cluster.
B) work cell.
C) conveyor belt.
D) workstation.
Q3) An ion-selective electrode system for electrolyte analysis that uses a peristaltic pump to move liquid reagents and samples through a system of tubing is called a _____ analyzer.
A) random access
B) batch
C) discrete
D) continuous flow
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Chapter 17: Point-Of-Care Instrumentation
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Q1) To assess the presence of (not the concentration of)a specific cardiac marker,such as myoglobin in a blood sample,the best POCT analysis to use would be a(n):
A) immunochromatographic technique that is part of a single-use qualitative cartridge test strip.
B) reflectance spectrophotometric technique that is part of a single-use quantitative cartridge with a reader.
C) electrochemical technique that is part of a panel of tests in a multiple-use quantitative bench top device.
D) single use,colorimetric dipstick that is read visually.
Q2) One of the problems with performing conventional quality control (QC)testing on a single-use disposable POCT device is that:
A) it is a waste of time and product.
B) qualitative devices will not give appropriate values when tested in this way.
C) it does not assess the competency of each operator.
D) only that single testing unit is monitored.
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19
Chapter 18: Amino Acids, peptides, and Proteins
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Q1) Albumin concentration in blood can be analyzed in an empty blood collection tube containing no anticoagulant.This means that you are analyzing:
A) serum that has been obtained when no anticoagulants are mixed with whole blood and then centrifuged.
B) plasma that has been obtained when no anticoagulants are mixed with whole blood and then centrifuged.
C) serum that has been obtained by mixing anticoagulants with whole blood and then centrifuged.
D) plasma obtained by mixing anticoagulants with whole blood and then centrifuging the sample.
Q2) Elevated serum C-reactive protein
A)Wilson disease
B)Intravascular hemolysis
C)Inflammation
D)Chronic renal disease
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Chapter 19: Serum Enzymes
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Q1) A hydrolase enzyme important during digestion that catalyzes the hydrolysis of starches while food is still in the mouth is:
A) lipase.
B) lactate dehydrogenase.
C) S-type amylase.
D) P-type amylase.
Q2) The usefulness of analyzing lipoprotein-associated phospholipase A<sub>2</sub> for the identification of individuals at risk for future cardiovascular events is because of its:
A) release of granules that destabilize complex plaque.
B) ability to transform stable coronary artery plaques to unstable ones.
C) release during inflammatory events such as coronary artery blockage.
D) upregulation in atherosclerotic lesions,particularly complex plaque.
Q3) Hydrolase
A)Creatine kinase
B)Lactate dehydrogenase
C)Alkaline phosphatase
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21
Chapter 20: Tumor Markers and Cancer Genes
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Q1) A translocation between chromosomes 9 and 22 produces the BCR-ABL fusion gene.This is the transforming event in 90% of individuals with chronic myelogenous leukemia (CML).Which one of the following statements regarding the protein product of this fusion gene is correct?
A) It is a nuclear phosphoprotein that deregulates DNA syntheses and increases cellular proliferation.
B) It is a cytoplasmic tyrosine kinase that activates a number of signaling pathways leading to growth and inhibition of apoptosis.
C) It is a mitotic control gene that allows cells to move through the cell cycle and contribute to the autonomous growth of cancer.
D) It interacts with other proteins,such as \(\alpha\)- and \(\beta\)-catenin,involved in cell-cell interactions in epithelial cells to form polyps.
Q2) The properties of an ideal tumor marker include all of the following,except it should:
A) be able to distinguish between benign and malignant tumors.
B) be produced by tumor cells and detectable in body fluids.
C) not be present in healthy people.
D) be specific for a given type of cancer.
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22
Chapter 21: Kidney Function Test-Screatinine, Urea, and Uric Acid
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Q1) An individual's laboratory results indicate increased serum creatinine and urea values,and his physician's diagnosis indicates a postrenal obstruction.What would the glomerular filtration rate in this individual likely be?
A) Decreased
B) Increased
C) No change
Q2) The major nonprotein nitrogen degradation product of endogenous purines is:
A) urea.
B) creatinine.
C) uric acid.
D) ammonia.
Q3) Which of the following is the primary reagent used in the Jaffe reaction for creatinine?
A) Alkaline copper sulfate
B) Phosphotungstic acid
C) Alkaline picric acid
D) Diacetyl monoxime
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Page 23
Chapter 22: Carbohydrates
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Q1) What effect does salicylate have on blood glucose value?
A) Increases
B) Decreases
Q2) The breakdown of glycogen stores in the liver to increase serum glucose is referred to as:
A) glycogenolysis.
B) glycolysis.
C) gluconeogenesis.
D) glycogenesis.
Q3) The glucose assay on an analyzer uses hexokinase as the enzyme that phosphorylates glucose.What are the initial products formed from the first step of this reaction?
A) Nicotinamide adenine dinucleotide and NADH
B) 6-Phosphogluconate and hydrogen ions
C) Glycosylated hemoglobin
D) Glucose-6-phosphate and adenosine diphosphate (ADP)
Q4) What effect does ethanol have on blood glucose value?
A) Increases
B) Decreases
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Chapter 23: Lipids, lip-Oproteins, apolipoproteins, and
Other Cardiac Risk Factors
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Q1) An individual visits a physician,who notes that the patient has splenomegaly,enlarged and orange-colored tonsils,and tingling feelings in the extremities,indicating peripheral neuropathy.Upon examination of the blood smear for a white blood cell differential,many foamy-appearing cells were noted.Normal triglyceride and total cholesterol values were noted; however,a marked decrease of HDL was also noted.What is the name of this disorder?
A) Familial hypercholesterolemia
B) Tangier disease
C) Dysbetalipoproteinemia
D) Coronary heart disease
Q2) An individual visits his physician with splenomegaly,enlarged and orange-colored tonsils,and tingling feelings in the extremities,indicating peripheral neuropathy.Upon examination of the blood smear for a white blood cell differential,many foamy-appearing cells were noted.Normal triglyceride and total cholesterol values were noted; however,a marked decrease of HDL was also noted.What is the cause of this disorder?
A) Mutations in the apo B-100 gene
B) Defects in the expression or function of the LDL receptor
C) Genetic mutations in the apo E gene
D) Mutations in the ABCA1 transporter gene
Page 25
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Chapter 24: Electrolytes and Blood Gases
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Q1) Uptake of O<sub>2</sub> by the blood in the lungs is controlled primarily by:
A) the hemoglobin binding capacity of blood.
B) how much hemoglobin A is available to bind O<sub>2</sub>.
C) the amount of total CO<sub>2</sub> bound to hemoglobin.
D) the PO<sub>2</sub> of alveolar air.
Q2) Although aqueous fluid control materials are the most commonly used commercial controls for blood gas and pH measurements,what is their main disadvantage?
A) They are dissimilar to blood by having lower viscosity and surface tension.
B) They must be shaken vigorously before being opened.
C) The buffer that is used contains high levels of lead.
D) They overestimate pH because the buffer is a weak base.
Q3) The PO<sub>2</sub> at which the hemoglobin of the blood is half saturated with O<sub>2</sub> is referred to as:
A) oxygen saturation.
B) oxygen dissociation.
C) P50.
D) the half-life of oxygen.
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26
Chapter 25: Hormones
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Q1) An example of a protein hormone synthesized in the hypothalamus,with the principal action to control the release of thyroid-stimulating hormone,is:
A) prolactin.
B) thyroid stimulating hormone.
C) ACTH.
D) thyrotropin releasing hormone.
Q2) An example of a polypeptide hormone that is part of the complex integrative function of many hormones involved in development of the human organism is:
A) growth hormone.
B) estrogen.
C) cortisol.
D) thyroxine.
Q3) Considering the classification of hormones by structure,an example of a steroid hormone would be:
A) testosterone.
B) parathyroid hormone (PTH).
C) cortisol.
D) all of the above.
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27
Chapter 26: Catecholamines and Serotonin
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Q1) Plasma/urine metanephrines
A)Gastroenteropancreatic endocrine tumor
B)Tumor of adrenal medullary chromaffin cells
C)Pineal gland tumor
D)Neuroblastoma
Q2) Dopamine in the central nervous system functions as a neurotransmitter important for regulating an overall state of attention and vigilance.
A)True
B)False
Q3) In the diagnosis of pheochromocytoma,what hormone is being assessed by measuring urine metanephrine?
A) Epinephrine
B) Dopamine
C) Serotonin
D) Norepinephrine
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28
Chapter 27: Vitamins, Trace Elements, and Nutritional Assessment
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Q1) Thiamine
A)Impaired blood coagulation
B)Megaloblastic anemia
C)Night blindness
D)Beriberi
Q2) Retinol
A)Impaired blood coagulation
B)Megaloblastic anemia
C)Night blindness
D)Beriberi
Q3) Chromium
A)Menkes disease
B)Lung cancer
C)Loss of immunocompetence
D)Parkinson disease-like symptoms
Q4) Quinone
A)Impaired blood coagulation
B)Megaloblastic anemia
C)Night blindness
D)Beriberi
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Chapter 28: Hemoglobin, Iron, and Bilirubin
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Q1) In a certain hemoglobin structural variant,a deletion in the coding gene results in a reduction of the production of the beta globin chain.This will result in:
A) decreased quantity of HbA.
B) hemolysis of red blood cells due to unstable hemoglobin.
C) a sickling disorder due to insoluble hemoglobin.
D) an \(\alpha\)-thalassemia due to overproduction of alpha-globin chains.
Q2) Which one of the following statements concerning TIBC is not correct?
A) TIBC is decreased in chronic inflammatory disorders.
B) TIBC is proportional to the amount of transferrin present.
C) TIBC is decreased in an iron deficiency anemia.
D) Transferrin saturation = (serum iron/TIBC) * 100.
Q3) High levels of unconjugated bilirubin that accumulate in the brain are called:
A) hyperbilirubinemia.
B) Crigler-Najjar syndrome.
C) hemolysis.
D) kernicterus.
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Page 30
Chapter 29: Porphyrins and Porphyrias
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Q1) A group of compounds containing four monopyrrole rings connected by methane bridges is the:
A) porphyrins.
B) porphyrias.
C) porphobilinogens.
D) heme precursors.
Q2) An individual with jaundice reports to the emergency department with symptoms of an acute porphyric attack,including severe abdominal pain,pain in her thighs,vomiting,and muscle weakness.A hepatitis screen is negative and unconjugated bilirubin and urobilinogen are increased.Your laboratory receives a dark orange-colored urine sample for qualitative PBG analysis,results of which are difficult to interpret.When you contact the physician with this information,the physician informs you that this patient is an alcohol abuser and asks you to run a quantitative urine porphyrin analysis.Results of this analysis show an increased uroporphyrin and coproporphyrin III.Why was the PBG difficult to interpret?
A) In individuals with congenital erythrocytic porphyria,PBG is negative.
B) There was interference from elevated urobilinogen in the urine sample.
C) PBG only demonstrates an increase in fecal samples,not in urine.
D) Alcohol in the urine sample produced a false-negative value for PBG.
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Chapter 30: Therapeutic Drugs and Their Management
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Q1) Which of the following therapeutic drugs is considered to be a selective serotonin reuptake inhibitor?
A) Fluoxetine
B) Imipramine
C) Lithium
D) Both a and b
Q2) What is occurring in phase I metabolism of a therapeutic drug?
A) Conjugation to a different moiety
B) Elimination
C) Chemical modification such as hydrolysis
D) First-pass metabolism
Q3) For a therapeutic drug that has a short half-life,for example levetiracetam,when is the appropriate time to collect a blood sample for therapeutic drug assessment?
A) Immediately after a dose of the drug is given
B) Immediately before a dose of the drug is given
C) At 8 AM,when liver metabolism is highest
D) There is no specific time that is the best for blood collection.
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Chapter 31: Clinical Toxicology
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Q1) Diazepam
A)Ethanol
B)Barbiturate
C)Heroin
D)Ethylene glycol
Q2) Methamphetamine
A)Central nervous system depressant
B)Central nervous system stimulant
C)Blocks oxygen binding to hemoglobin
D)Interferes with enzyme action
Q3) Anticholinergic agents
A)Flumazenil
B)Physostigmine
C)Ethanol
D)Methylene blue
Q4) Activated charcoal
A)Salicylic acid
B)Acetaminophen
C)Cyanide
D)Organophosphates
Page 33
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Chapter 32: Toxic Metals
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Q1) Lead
A)Reduced to a nontoxic form in biological specimens
B)Blood specimens are not especially useful; urine is best
C)Requires a lymphocyte proliferation test; serum or urine quantification is not useful
D)To examine erythrocytes,EDTA-anticoagulated blood is specimen of choice
Q2) A four-member family of fish-loving vegetarians has become ill and visits their family practitioner.Their symptoms include stumbling (ataxia),visual field loss,and urinary difficulties.No Mees' lines are observed.Being environmentally conscious,they have their home examined for toxic gases.All tests are negative.Based on their history and symptoms,what toxic metal might be to blame?
A) Cadmium
B) Iron
C) Arsenic
D) Mercury
Q3) Lead produces a serious toxic effect when ingested because it:
A) irreversibly binds to heme iron in hemoglobin.
B) vasoconstricts cardiac blood vessels and vasodilates peripheral vessels.
C) depresses the central nervous system and induces coma.
D) does not allow for the incorporation of heme into the porphyrin molecule.
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Page 34
Chapter 33: Diabetes
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Q1) A pregnant woman at 27 weeks gestation is screened for gestational diabetes mellitus.Plasma venous glucose was measured at 1 hour following a 50 g oral glucose load.What value must this glucose be above or equal to for a glucose tolerance test to be performed?
A) The value must be remain within healthy glucose reference interval.
B) The value must be 140 mg/dL glucose.
C) The value must be 200 mg/dL glucose.
D) The value must be
Q2) C-peptide
A)Increases
B)Decreases
C)Has no effect
Q3) Which one of the following antibodies is found most commonly in over 90% of children who develop type 1 diabetes before 5 years old?
A) Islet cell cytoplasmic antibodies
B) Insulin autoantibodies
C) Insulinoma-associated antigens
D) Zinc transporter ZnT8
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Chapter 34: Cardiovascular Disease
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Q1) A 55-year-old man is taken to a hospital emergency department by helicopter following a rural automobile accident that occurred approximately 3 hours ago.The man,who is having difficulty speaking to the EMTs,is clutching his chest.Upon the man's arrival,the emergency room physician orders a cardiac marker panel that includes serum CK,CK-2 (CK-MB),troponin,and myoglobin.The CK-2 value was less than 2% of total CK,which was slightly increased; troponin was normal; and the myoglobin was increased 3 times the upper limit of normal.The physician has asked the laboratory to explain the findings.Which of the following represents the lab's explanation?
A) The assays used to determine these results were nonspecific and not sensitive enough to detect the troponin.
B) Trauma caused by the accident with possible crush injury to the chest caused elevated myoglobin with normal troponin and CK-MB.
C) The use of serum as a specimen interfered with troponin and CK-MB immunoassays giving falsely low results.
D) It is expected that in someone who has had a myocardial infarction in the past that all cardiac biomarker values except myoglobin to have returned to normal.
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Chapter 35: Kidney Disease
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Q1) The most common glomerular disease worldwide is:
A) acute proliferative glomerulonephritis.
B) acute pyelonephritis.
C) IgA nephropathy.
D) chronic kidney disease.
Q2) Which one of the following components of the renal system is most important for regulation of plasma electrolytes and acid-base balance?
A) Bladder
B) Loop of Henle
C) Proximal convoluted tubule
D) Distal convoluted tubule
Q3) The volume of plasma from which a substance is completely removed by the kidneys per unit of time is the definition of:
A) renal threshold.
B) prerenal acute kidney injury.
C) glomerular filtration rate.
D) clearance.
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Chapter 36: Physiology and Disorders of
Water,Electrolyte,and Acid-Base Metabolism
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Q1) How do healthy lungs compensate for the decrease in pH in a state of metabolic acidosis?
A) Releasing bicarbonate into urine
B) Stimulating hyperventilation
C) Decreasing urinary excretion of acid
D) Increasing excretion of acid
Q2) An overweight 55-year-old single woman from a rural farming area was brought to the emergency department by her neighbor.The woman had a large abscess on the bottom of her foot; she was irritable and complained of blurred vision and of being thirsty.Her breathing was rapid.The neighbor said that the only medication the woman was using was for blood pressure and sometimes an aspirin.Blood and urine samples were collected.Arterial blood gas results were: pH 7.2; PCO<sub>2</sub> 47 mm Hg; HCO<sub>3</sub> 8 mmol/L.Blood glucose was 340 mg/dL and a high anion gap was calculated.Urine glucose and ketones were markedly increased.Based on the laboratory values,what state of acid-base balance is this patient in?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
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Chapter 37: Liver Disease
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Q1) A new intern calls the laboratory to ask which liver enzymes would be best to assess to differentiate between hepatocellular and cholestatic disease.You respond:
A) ALP,GGT,and LD.
B) AST,ALT,and ALP.
C) ALP and GGT only.
D) AST and ALT only.
Q2) A 30-year-old man sees his physician with complaints of pruritus,fever,and pain around his abdomen and right side that he says "have been there a while but suddenly got really bad." Laboratory results on his blood sample indicate elevated conjugated and unconjugated bilirubin and elevated alkaline phosphatase activity.There are no signs of chronic hepatitis or ascites.Gallstones are ruled out,and the physician notes that a previous diagnosis of ulcerative colitis had been made.What is the likely current diagnosis?
A) Primary sclerosing cholangitis
B) Acute hepatitis attack from fulminant hepatitis
C) Hemolytic anemia caused by tumor
D) Liver injury caused by obstruction of the portal vein
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Page 39
Chapter 38: Gastrointestinal and Pancreatic Diseases
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Q1) Mucosal inflammation of the stomach that is associated with peptic ulcer disease or gastric carcinoma is referred to as:
A) celiac disease.
B) Zollinger-Ellison syndrome.
C) nonerosive gastritis.
D) erosive gastritis.
Q2) Which one of the following peptide hormones acts to increase intestinal motility and stimulate gallbladder contractions?
A) Secretin
B) Glucagon
C) Insulin
D) Cholecystokinin (CCK)
Q3) Gastrointestinal neuroendocrine tumors are either carcinoid tumors of enterochromaffin cells or,as in the case of somatostatinoma,tumors of the:
A) gastric parietal cells.
B) cells in the brush border of the small intestine.
C) small bowel mucosal cells.
D) pancreatic endocrine cells.
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Chapter 39: Disorders of Bone and Mineral Metabolism
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Q1) An individual's serum phosphate level is decreased but his physician cannot determine a physiological basis for this abnormal result.What could possibly have caused this result?
A) Individual not fasting when blood was drawn
B) Specimen hemolysis
C) Use of IV carbohydrate therapy to stimulate insulin secretion
D) Diurnal variation
Q2) Which one of the following analytes is most useful in distinguishing primary from secondary hyperparathyroidism?
A) Parathyroid hormone
B) Serum calcium
C) Vitamin D
D) Serum phosphorus
Q3) An individual has the following laboratory test results: increased serum calcium,decreased serum phosphorus,increased parathyroid hormone.This individual most likely has:
A) hyperparathyroidism.
B) hypoparathyroidism.
C) hyperthyroidism.
D) renal failure.
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Chapter 40: Disorders of the Pituitary
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Q1) Which one of the following hormones is responsible for normal development of cartilage and bone,mobilizing fat stores,and stimulation of protein synthesis?
A) ADH
B) ACTH
C) GH
D) Prolactin
Q2) The hypothalamic hormone that inhibits prolactin is referred to as prolactin-inhibiting hormone but is actually:
A) thyrotropin.
B) dopamine.
C) adrenaline.
D) interleukin 1.
Q3) A 45-year-old female complains of fatigue,heat intolerance,and hair loss.Serum thyroxine is abnormally low.What test would confirm that this might be a pituitary disorder?
A) Free T<sub>3</sub>
B) Thyroid binding globulin (TBG)
C) Thyroid hormone binding ratio (THBR)
D) Thyrotropin
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42
Chapter 41: Disorders of the Adrenal Cortex
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Q1) In the corticotropin-releasing hormone stimulation test,an individual with secondary adrenal insufficiency (pituitary ACTH deficiency)will have which of the following laboratory test results?
A) Plasma ACTH peak at 30 minutes and serum cortisol peak at 60 minutes
B) Decreased plasma ACTH and decreased serum cortisol response times
C) Prolonged ACTH response time and decreased cortisol response time
D) Excessive increase in plasma response
Q2) The adrenal cortical hormone that promotes sodium resorption and potassium and hydrogen ion excretion by the renal tubules and thus affects water balance in the body is:
A) androstenedione.
B) cortisol.
C) aldosterone.
D) calcium.
Q3) A patient with Cushing syndrome has plasma cortisol measured at 8 AM.The nighttime cortisol level will be _____ from the 8 AM value.
A) increased
B) decreased
C) unchanged
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Page 43
Chapter 42: Thyroid Disorders
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Q1) An individual's thyroid-binding globulin (TBG)concentration is 2.8 mg/dL,T<sub>3 </sub>value is 10.5 µg/dL,and T<sub>4</sub> value is 12.5 µg/dL.What is the estimate of free T<sub>4</sub> value?
A) 37.5
B) 4.3
C) 1.35
D) The approximate free T<sub>4</sub> value cannot be determined from the given values.
Q2) Which of the following hormones require transport proteins to move them through the circulation and are more than 99% bound to these proteins?
A) TSH
B) Thyrotropin-releasing hormone
C) Calcitonin
D) T<sub>3</sub> and T<sub>4</sub>
Q3) The secretory unit of the thyroid gland is the:
A) colloid.
B) thyroid follicle.
C) parafollicular cell.
D) thymus.
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Page 44
Chapter 43: Reproduction-Related Disorders
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Q1) Dehydroepiandrosterone sulfate (DHEA-S):
A) concentrations exhibit a circadian rhythm that reflects the secretion of adrenocorticotropic hormone (ACTH).
B) is an important screening test used to evaluate women with hirsutism and virilization.
C) concentration is increased in 17\(\alpha\)-hydroxylase deficiency-caused amenorrhea.
D) analysis is performed using heparinized plasma.
Q2) What would the laboratory results be in a male patient exhibiting characteristic symptoms of hypogonadotropic hypogonadism?
A) Elevated testosterone,decreased FSH
B) Decreased testosterone,decreased FSH
C) Elevated testosterone,elevated FSH
D) Decreased testosterone,elevated FSH
Q3) Typical findings in a woman in menopause include:
A) increased progesterone.
B) decreased serum LH/FSH.
C) hirsutism.
D) decreased estrogen and inhibin.
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45
Chapter 44: Pregnancy and Prenatal Testing
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Q1) The placental peptide hormone that has exceptional homology with growth hormone and that has aldosterone-stimulating effects is:
A) estriol.
B) chorionic gonadotropin.
C) progesterone.
D) estrone.
Q2) Concerning alpha-fetoprotein (AFP),which one of the following statements is correct?
A) A decrease in AFP in a pregnant woman's serum indicates the presence of possible spina bifida in the fetus.
B) An appropriate time to measure AFP in maternal serum is at 16 weeks gestation when it is approximately 3.5 µg/dL.
C) An increase in AFP in a pregnant woman's serum indicates the presence of Down syndrome in the fetus.
D) AFP in maternal serum rapidly decreases to a low point at 11 weeks and then increases to reach a second maximum at 13 weeks.
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Chapter 45: Newborn Screening and Inborn Errors of Metabolism
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Q1) Of the following,what is the inborn error of metabolism for glycogen storage disease?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
Q2) An autosomal recessive disorder:
A) is characterized by a 50% chance of an individual having the disease phenotype if the parents are heterozygous for the trait.
B) is defined as one in which there is a mutation in both alleles encoding for a specific enzyme/transporter.
C) affects males approximately 25% more than females because the allele is present on the X chromosome.
D) is one in which parents of diseased offspring are carriers of the condition in that they carry two mutant alleles.
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Chapter 46: Pharmacogenetics
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Q1) Bilirubin is an important endogenous substrate of which one of the following enzymes?
A) N-acetyltransferase
B) Thiopurine methyltransferase
C) UGT1A1
D) CYP3A4
Q2) The metabolizing enzyme that catalyzes the transfer of an acetyl moiety from acetyl-CoA to homocyclic and heterocyclic arylamines and hydrazines in,for example,substrates related to cigarette smoke is:
A) CYP2C6.
B) CYP2D9.
C) NAT1.
D) UGT1A1.
Q3) Which two of the following metabolizing enzymes are involved in metabolism of warfarin?
A) TPMT and CYP2D9
B) CYP2D9 and CYP2D19
C) VKORC1 and CYP2C9
D) NAT1 and VKORC1
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Page 48
Chapter 47: Principles of Molecular Biology
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Q1) A noncoding RNA is one that:
A) is involved in the synthesis of protein by acting as an intermediate.
B) encodes for amino acids only.
C) has a biological function but does not code for a protein.
D) contains an anticodon.
Q2) DNA methylation as a means of regulating gene expression is restricted to which of the following bases?
A) Guanine bases in the dinucleotide sequence GC
B) Cytosine bases in the base pair CG
C) Cytosine bases in the dinucleotide sequence CG
D) Guanine bases in the base pair GC
Q3) Regarding transcription,the proteins that help to position eukaryotic RNA polymerase II at the core promoter region are referred to as:
A) activators.
B) elongation factors.
C) general transcription factors.
D) site-specific positioning proteins.
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Chapter 48: Nucleic Acid Techniques and Applications
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Q1) Which one of the following is the name given to the probe types used in real-time PCR that change fluorescence through fluorescence resonance energy transfer (FRET)upon duplex formation?
A) Hybridization
B) Hydrolysis
C) Mixed mechanism
D) Primer
Q2) An enzyme that hydrolyzes one or more phosphodiester bonds in nucleic acid polymers is called a:
A) polymerase.
B) nuclease.
C) ligase.
D) reverse transcriptase.
Q3) When performing a PCR procedure,what is the best control to run to assess the presence of amplicon?
A) Positive control
B) Blank control
C) Oligoligated control
D) dTTP control
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Chapter 49: Genomes and Nucleic Acid Alterations
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Q1) Polymorphic repeated DNA sequences that are sometimes referred to as minisatellite sequences and are between 14 and 500 base pairs in length are called: A) transposons.
B) a variable number of tandem repeats.
C) a restriction endonuclease.
D) short tandem repeats.
Q2) On average,how much of a gene sequence is removed as introns,leaving the exons to be spliced together and translated into protein?
A) 100%
B) 95%
C) 50%
D) 1%
Q3) An example of epigenetic variation that affects gene expression would be: A) heteroplasmy.
B) chromosomal translocation.
C) copy number alteration.
D) histone modifications.
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