Pathology Practice Questions
Course Introduction
Pathology is the study of the structural and functional changes in cells, tissues, and organs that underlie disease processes. This course introduces students to the fundamental concepts of pathology, including mechanisms of cell injury and death, inflammation, healing, and neoplasia. Through the examination of both general and systemic pathology, students will learn to correlate clinical symptoms with underlying pathophysiological changes. The course also emphasizes the importance of pathological diagnoses in guiding medical decisions and treatment strategies, preparing students for further studies in medicine, biomedical sciences, and related fields.
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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Sample Questions
Q1) The discipline involved in the selection,provision,and interpretation of diagnostic testing that uses primarily samples from patients is:
A) clinical chemistry.
B) hematology.
C) laboratory medicine.
D) molecular diagnostics.
Answer: C
Q2) An individual working in a clinical chemistry laboratory is married to a sales representative who works for a company that sells chemistry laboratory supplies.When the laboratory manager requests a list of needed supplies,cost of supplies,and vendors,this individual only recommends the spouse's company as the vendor.This is considered to be a(n):
A) accounting issue.
B) possible conflict of interest.
C) maintenance of confidentiality issue.
D) problem with resource allocation.
Answer: B
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3
Chapter 2: Selection and Analytical Evaluation of
Methodswith Statistical Techniques
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Sample Questions
Q1) How is the formula for population standard deviation (\(\sigma\))stated?
A) The positive square root of the mean ÷ sum of squared differences between mean and individual values
B) Square root of the mean ÷ (N - 1)
C) The positive square root of the [(sum of squared differences between mean and individual values)÷ N]
D) The sum of squared differences ÷ the positive square root of the mean
Answer: C
Q2) Comparisons of measurement values between clinical laboratories require a hierarchical approach that obliges routine clinical chemistry measurements to be referred back to a reference measurement procedure.This concept is known as: A) uncertainty.
B) error.
C) traceability.
D) reliability.
Answer: C
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Chapter 3: Clinical Evaluation of Methods
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Sample Questions
Q1) A method that can be used to calculate the probability of a disease after new information is added to previously obtained information involves:
A) likelihood analysis.
B) sensitivity analysis.
C) Bayes theorem.
D) combination testing.
Answer: C
Q2) To calculate the predictive value of a positive test,which of the following should be known?
A) Sensitivity only
B) Specificity and prevalence only
C) Sensitivity and specificity only
D) Sensitivity,specificity,and prevalence
Answer: D
Q3) A receiver operating characteristic (ROC)curve is a plot of:
A) systematic error against random error.
B) tumor marker decision levels versus upper limit of reference intervals.
C) true positives versus false positives.
D) specificity of one method against the specificity of another method.
Answer: C
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Chapter 4: Evidence-Based Laboratory Medicine
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Sample Questions
Q1) QALY:
A) is associated with a quality systematic review of literature.
B) assesses the quality of a diagnostic accuracy study.
C) is an outcome achieved in cost-utility analysis.
D) relates to the implementation of the findings of a clinical audit.
Q2) In a research study,a physician asks if the results from the therapeutic drug assay will be able to predict the patient's eventual health outcome.A study to determine this is referred to as a:
A) patient outcome study.
B) case-control study.
C) systematic review.
D) prognostic value study.
Q3) Another way that "bias" can be defined is as _____ error.
A) random
B) systematic
C) analytical
D) clinical
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Chapter 5: Establishment and Use of Reference Values
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Sample Questions
Q1) Which one of the following is an example of an exclusion criterion when establishing a healthy population-based reference interval?
A) Use of oral contraceptives
B) Sex
C) Age
D) Ethnicity
Q2) True negatives ÷ (false positives + true negatives) * 100 is the formula for determining:
A) clinical sensitivity.
B) clinical specificity.
C) analytical sensitivity.
D) analytical specificity.
Q3) Visually inspecting the distribution of reference values can provide a safeguard against misinterpretation of statistical methods,and it may provide valuable information about the data.Which of the following observations might represent erroneous values?
A) Skewed distributions
B) Outlier values
C) Partition criteria
D) Bimodal distributions
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Chapter 6: Specimen Collection, processing, and Other
Preanalytical Variables
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Sample Questions
Q1) Arthrocentesis is a technique used to collect:
A) pleural fluid.
B) blood.
C) synovial fluid.
D) amniotic fluid.
Q2) A skin puncture of an individual's finger is ordered for hematocrit analysis and is to be collected into a capillary tube.It is cold in the phlebotomy area,and the phlebotomist notices that the individual appears cold and pale.What should the phlebotomist do to stimulate blood circulation to the finger so an acceptable fingerstick specimen will be obtained?
A) Slap the individual's hand to warm it up.
B) Tie a tourniquet around the individual's finger.
C) Warm the finger for 3 minutes using a warming device.
D) Massage the finger and hand.
Q3) As an anticoagulant,heparin acts to:
A) chelate calcium.
B) inhibit platelet aggregation.
C) antagonize vitamin K.
D) activate antithrombin.
Page 8
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Chapter 7: Quality Management
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Sample Questions
Q1) You have received your proficiency test results from the accrediting agency and note that your creatinine result was unacceptable at greater than 2 SDI from the group mean.The value that was entered on your survey report form was 15 mg/dL.The group method mean was 1.3 mg/dL with a method standard deviation of 0.3 mg/dL.You realize that your laboratory made an error in entering the result.If you had entered 2.0 mg/dL as the result on your survey report,would the recalculated SDI now be in agreement with the rest of the laboratories in the testing program?
A) Yes
B) No
C) Cannot determine from information given
Q2) Upon examining a Levey-Jennings control chart for analyte X,you notice that on day 6 the one control was -2.5 s from the mean and the duplicate control was +3.3 s from the mean.Which of the following Westgard control rules was/were broken?
A) 4<sub>1s </sub>and 2<sub>2s</sub>
B) R<sub>4s</sub> and 1<sub>3s</sub>
C) R<sub>4s</sub> and 2<sub>2s</sub>
D) 2<sub>2s</sub> only
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Chapter 8: Principles of Basic Techniques and Laboratory
Safety
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Sample Questions
Q1) The type of pipette that is a piece of glass tubing drawn out to a tip and graduated uniformly along its length and is used for reagent measurement is referred to as a:
A) transfer pipette.
B) volumetric pipette.
C) micropipette.
D) measuring pipette.
Q2) The class of fire that involves flammable liquids and gases is class and the recommended extinguisher agent is:
A) A; water.
B) B; water.
C) B; dry chemical or carbon dioxide.
D) C; Halon 1211 foam.
Q3) You have seen another laboratorian collecting blood from a patient without using any barrier protection.What safety mandate is this employee ignoring?
A) Chemical hygiene plan
B) Universal Precautions
C) Clinical laboratory plan
D) Tuberculosis exposure plan
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Chapter 9: Optical Techniques
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Sample Questions
Q1) Which one of the following optical techniques is not considered an emission technique?
A) Phosphorimetry
B) Nephelometry
C) Luminometry
D) Fluorometry
Q2) In regard to absorption photometry,absorbance is calculated from transmittance by which one of the following formulae?
A) A = log %T - 2
B) A = log T
C) A = -log T
D) A = abc
Q3) A light-beam chopper in a double-beam-in-time spectrophotometer is used to:
A) isolate light of a desired wavelength.
B) compensate for light source variation.
C) atomize a sample on a carbon rod in an enclosed chamber.
D) provide polarized light.
Q4) The visible spectrum is composed of those wavelengths between 380 and 750 nm.
A)True
B)False
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Chapter 10: Electrochemistry and Chemical Sensors
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Sample Questions
Q1) Incorporation of _____,a neutral antibiotic,into a polyvinyl chloride membrane allows for the manufacture of an ion-selective electrode that is highly selective for potassium.
A) tetracycline
B) nonactin
C) valinomycin
D) erythromycin
Q2) In an optical sensing (optode)system for the measurement of PO<sub>2</sub> using fluorescence,what is being measured?
A) The increase in the intensity of the oxygen's natural fluorescence
B) The amount of charge passing between the optical sensing electrodes,which is directly proportional to the PO<sub>2</sub>
C) The decrease in intensity of an organic dye's fluorescence in the presence of molecular oxygen,which is proportional to the PO<sub>2</sub>
D) The ability of oxygen in solution to carry current under the influence of a potential difference
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Chapter 11: Electrophoresis
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Sample Questions
Q1) The component of an electrophoresis system that carries the applied current and establishes the pH at which electrophoresis is performed is the:
A) power supply.
B) buffer.
C) support media.
D) stain.
Q2) The process of transferring the electrophoresed DNA fragments out of a gel and onto a special nylon paper is referred to as:
A) Southern blotting.
B) Northern blotting.
C) Western blotting.
D) hybridization.
Q3) What would the concentration of albumin be if the total protein value was 8.5 g/dL and the densitometer measured the albumin fraction as 55% of the total?
A) Albumin values cannot be calculated using densitometry.
B) 15.4 g/dL
C) 0.065 g/dL
D) 4.68 g/dL
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13
Chapter 12: Chromatography
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Sample Questions
Q1) A toxicology screen is set up using thin layer chromatographic plates.Four positive controls/standards are used with the following distance of migration from application point results: Std A = 8 cm; Std B = 15 cm; Std C = 22.The acetone solvent front moved 35 cm.After processing an unknown sample,a solute had a migration distance of 16 cm.What are the retention factors (R<sub>f</sub>)of standards A,B,and C?
A) 8,15,22
B) 8,12,18
C) 4.4,2.3,1.5
D) 0.23,0.43,0.63
Q2) Thin layer chromatography is a type of planar chromatography with separation based on the principles of partition chromatography.
A)True
B)False
Q3) In column chromatography,analytes are identified by their retention times. A)True
B)False
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Chapter 13: Mass Spectrometry
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Sample Questions
Q1) In regard to mass spectrometry,what is a molecular ion?
A) It is a component of a compound in solution.
B) It is the sum of all ions produced displayed as a function of time.
C) It is the unfragmented ion of the original molecule being studied.
D) It is the ion with the highest abundance in the mass spectrum of a compound.
Q2) 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
Q3) 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
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Chapter 14: Enzyme and Rate Analyses
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Sample Questions
Q1) Immobilized enzymes are used analytically in various electrochemical techniques.The use of an ion-selective electrode that is coated with an enzyme that produces ions when placed in a substrate solution is a type of:
A) potentiometric measurement.
B) immunoassay.
C) equilibrium method.
D) consecutive enzymatic reaction.
Q2) In regard to the expression of enzyme activity,a katal is:
A) a unit that describes the amount of substrate in moles converted to product in 1 minute.
B) a unit that describes the amount of enzyme that is consumed in 1 minute.
C) a unit that describes the amount of enzyme that will catalyze a mole of substrate in 1 second.
D) the substrate concentration at which the enzyme yields half the maximum velocity of the reaction.
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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Sample Questions
Q1) An immunoassay contains an antidigoxin antibody,a digoxin-enzyme conjugate,a substrate,and the sample containing an unknown concentration of digoxin.These components are used in which one of the following immunoassays?
A) ELISA
B) FPIA
C) EMIT
D) Electroimmunoassay
Q2) A substance that cannot elicit an immune response alone but that must be conjugated to a carrier molecule to cause antibody production is referred to as a(n):
A) antigen.
B) immunogen.
C) hapten.
D) conjugate.
Q3) In an enzyme immunoassay with an enzyme-labeled antigen,if there is a high concentration of patient antigen,will there be _____ enzyme available to bind substrate.
A) more
B) less
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Chapter 16: Automation
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Q1) Using whole blood as the specimen of choice in an automated analytical system: A) essentially eliminates specimen preparation time.
B) allows the operator to use a secondary tube for analysis.
C) keeps the specimen from undergoing degradation.
D) allows for the avoidance of carryover.
Q2) In an automated laboratory workstation with a bidirectional laboratory information system interface,the laboratory's bar-coded label on an individual specimen contains information regarding identification and the laboratory tests requested.The processor reads the bar code and the analyzer performs the analyses.Where can a preanalytical error still occur in this automated system?
A) When the instrument's calibration is not successful
B) When the quality control materials are out of the recommended range
C) When a data entry person enters incorrect laboratory test requests
D) When the equipment operator ignores equipment diagnostic messages
Q3) Specimen bar coding has allowed for the ability of a system operator to place specimens in random sequence,thereby eliminating the need for specimen load lists.
A)True
B)False
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18
Chapter 17: Point-Of-Care Instrumentation
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Sample Questions
Q1) The final step in the documentation of satisfactory training of an individual in the use of a POCT device is:
A) observation of that individual's performance of the entire procedure on three different occasions.
B) submission of a certificate of completion of training to an appropriate accrediting agency.
C) performance by that individual of correlation studies using the POC test and a complex piece of lab equipment.
D) the formal designation of that individual as "POCT-competent."
Q2) One of the most important benefits of connectivity between a POCT device and information systems is:
A) the reduction of time that a laboratorian has to spend transcribing results.
B) the ability of any user to interface with their physician or healthcare provider.
C) the ease of comparing POCT device results with routine laboratory methods.
D) facilitation of the transfer and capture of patient POCT and quality-related data into permanent medical records.
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19
Chapter 18: Amino Acids, peptides, and Proteins
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Q1) Refractometry is a rapid,semiquantitative method of total protein determination.Which of the following will lead to a faulty interpretation of protein values obtained by refractometry?
A) Serum protein less that 3.5 g/dL
B) Lipemia
C) Bilirubinemia
D) All of the above
Q2) Decreased serum ceruloplasmin
A)Wilson disease
B)Intravascular hemolysis
C)Inflammation
D)Chronic renal disease
Q3) Which one of the following proteins is the most abundant plasma protein in early embryonic life and is also measured to assess hepatocellular carcinoma in adults?
A) Alpha-fetoprotein
B) Transferrin
C) .\(\alpha\)<sub>1</sub>-Antitrypsin
D) Ceruloplasmin
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Chapter 19: Serum Enzymes
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Q1) Magnesium
A)Creatine kinase
B)Aspartate aminotransferase
C)Amylase
Q2) A phosphotransferase enzyme that has increased activity when injury,inflammation,or necrosis of skeletal muscle occurs is:
A) ALP.
B) ACP.
C) CK.
D) LD.
Q3) Pyridoxal phosphate
A)Creatine kinase
B)Aspartate aminotransferase
C)Amylase
Q4) Transferase
A)Creatine kinase
B)Lactate dehydrogenase
C)Alkaline phosphatase
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Chapter 20: Tumor Markers and Cancer Genes
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Q1) The primary clinical usefulness of assessing alpha-fetoprotein (AFP)as a tumor marker is for:
A) monitoring patients with pancreatic cancer.
B) assessing patients with colon cancer.
C) monitoring therapy in patients with liver cancer.
D) assessing chemotherapy response in patients with breast cancer.
Q2) An individual with a history of miscarriage visits her physician to discuss her positive hCG test done with a qualitative point-of-care device.The patient says she "feels pregnant" but wants to be certain.Following an ultrasound analysis,she is diagnosed with a germ cell tumor of unknown type.What two tumor markers are useful in classifying germ cell tumors?
A) CEA and AFP
B) AFP and hCG
C) hCG and CEA
D) CEA and CA 125
Q3) Activated forms of normal cellular genes are termed:
A) oncogenes.
B) proto-oncogenes.
C) pre-oncogenes.
D) oncofetal antigens.
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Chapter 21: Kidney Function Test-Screatinine, Urea, and Uric Acid
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Sample Questions
Q1) Creatininase reactions for creatinine assessment:
A) yield sarcosine and urea.
B) require the addition of potassium ferricyanide to reduce interference.
C) catalyze the conversion of creatinine to creatine.
D) catalyze the conversion of creatinine to N-methylhydantoin and ammonia.
Q2) Creatinine clearance is used to assess the _____ of a patient.
A) glomerular filtration rate
B) creatine concentration
C) renal threshold
D) renal hormonal function
Q3) In the measurement of urea,urea is initially hydrolyzed by urease to form ammonium ions.This assay combined with the spectrophotometric measurement of the resulting ammonia is referred to as the:
A) ammonia-selective electrode method.
B) Berthelot reaction.
C) Jaffe reaction.
D) urea method.
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Chapter 22: Carbohydrates
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Q1) In an individual with a normal hematocrit,whole-blood glucose values are approximately what percent different from plasma glucose values?
A) 20% higher
B) 10% lower
C) 50% higher
D) There is no difference between whole blood glucose and plasma glucose values.
Q2) What effect does septicemia have on blood glucose value?
A) Increases
B) Decreases
Q3) An example of a monosaccharide would be:
A) glucose.
B) maltose.
C) sucrose.
D) starch.
Q4) What effect does ethanol have on blood glucose value?
A) Increases
B) Decreases
Q5) What effect does salicylate 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) In addition to unesterified cholesterol,what is the second constituent of the outer coating of a lipoprotein,labeled with a question mark and represented by a white circle in this diagram?
A) Protein
B) Phospholipid
C) Lipoprotein A
D) Chylomicrons
Q2) What distinguishes lipoprotein(a),or Lp(a),from LDL?
A) Lp(a)contains more core lipids,triglyceride,and cholesteryl ester and a smaller percent of protein.
B) Lp(a)interacts with ABCA1 in peripheral cells,such as the macrophages,to remove additional cholesterol.
C) Lp(a)contains a carbohydrate-rich protein called apo(a)that is covalently bound to apo B-100 through a disulfide linkage.
D) Lp(a)does not contain any apo B-100.
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Chapter 24: Electrolytes and Blood Gases
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Q1) Historically,chloride was measured in blood by spectrophotometry.Now the methods of choice for chloride measurement include ion-selective electrodes and:
A) enzymatic measurement of acidified chloride.
B) atomic absorption spectrophotometry.
C) immunoassay.
D) coulometric-amperometric titration.
Q2) In the Henderson-Hasselbalch equation,the term "pK'" is the:
A) coefficient for oxygen in blood.
B) solubility coefficient for potassium.
C) negative log of hydrogen ion activity.
D) negative log of the combined dissociation constant for carbonic acid.
Q3) 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.
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Chapter 25: Hormones
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Q1) The analytical method that provides better analytical sensitivity in hormone detection than other methods such as immunoassay or receptor-based assays is:
A) tandem mass spectrometry.
B) bioassay.
C) immunometric assay.
D) spectrophotometry.
Q2) Which of the following protein hormones produces a decrease in blood glucose by causing glucose to enter cells for energy production?
A) Insulin
B) Aldosterone
C) Thyroid hormone
D) Cortisol
Q3) The half-life of a protein hormone in plasma is:
A) long,usually greater than 90 minutes.
B) long,at least 24 hours.
C) short,more than 1 hour but less than 3 hours.
D) short,approximately 10 to 30 minutes.
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Chapter 26: Catecholamines and Serotonin
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Q1) The use of tricycle antidepressants by an individual may produce incorrect results in the measurement of norepinephrine and normetanephrine during testing for pheochromocytoma.How will results be affected and why?
A) The results will be falsely elevated because of inhibition of monoamine reuptake.
B) The results will be falsely decreased because of increased synthesis of monoamine oxidase.
C) The results will be falsely elevated because these drugs increase synthesis of dopamine.
D) The results will be falsely decreased because these drugs inhibit tyrosine hydroxylase.
Q2) Plasma/urine metanephrines
A)Gastroenteropancreatic endocrine tumor
B)Tumor of adrenal medullary chromaffin cells
C)Pineal gland tumor
D)Neuroblastoma
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Chapter 27: Vitamins, Trace Elements, and Nutritional Assessment
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Q1) The trace element that is important in the stabilization of the surface of a regenerating tooth is:
A) copper.
B) boron.
C) fluoride.
D) manganese.
Q2) Copper
A)Menkes disease
B)Lung cancer
C)Loss of immunocompetence
D)Parkinson disease-like symptoms
Q3) Chromium
A)Menkes disease
B)Lung cancer
C)Loss of immunocompetence
D)Parkinson disease-like symptoms
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29
Chapter 28: Hemoglobin, Iron, and Bilirubin
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Q1) Which one of the following is formed by the reduction of unconjugated bilirubin in the intestines,is found in urine,and is further oxidized to form urobilin?
A) Hemoglobin
B) Conjugated bilirubin
C) Iron
D) Urobilinogen
Q2) What soluble iron-protein complex is the form in which iron is stored in tissues?
A) Ferritin
B) Transferrin
C) Hemosiderin
D) Hemoglobin
Q3) Regarding serum iron analysis,the maximum concentration of iron that transferrin can bind is reflected in what laboratory measurement?
A) Transferrin saturation
B) Hemoglobin
C) Serum iron
D) Total iron binding capacity (TIBC)
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Chapter 29: Porphyrins and Porphyrias
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Q1) 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.
Q2) A group of compounds containing four monopyrrole rings connected by methane bridges is the:
A) porphyrins.
B) porphyrias.
C) porphobilinogens.
D) heme precursors.
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Chapter 30: Therapeutic Drugs and Their Management
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Q1) Phenobarbital
A)Antiarrhythmic
B)Tricyclic antidepressant
C)Immunosuppressant
D)Antiepileptic
Q2) The period of time during which the concentration of a therapeutic drug decays by 50% is referred to as the drug's:
A) subtherapeutic range.
B) dosing curve.
C) volume of distribution.
D) half-life.
Q3) The steady state of a drug is defined as the:
A) point at which the body concentration of the drug is in equilibrium with the rate of dose administered and the rate of elimination.
B) time required for one-half of an administered drug to be lost through metabolism and elimination.
C) metabolism of a drug with a high hepatic extraction rate by the liver before it reaches the systemic circulation.
D) action of one drug on another.
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Chapter 31: Clinical Toxicology
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Q1) An 18-year-old man who had been found unresponsive and face down in his bed after spending the day working in his garage is brought to the hospital emergency department.He had not responded to naloxone administration given by the paramedics.His history reveals that he was despondent over the recent death of his father,with whom he enjoyed restoring antique automobiles.Laboratory results indicate negative serum acetone,elevated serum urea and creatinine,normal PO<sub>2</sub>,decreased bicarbonate,increased PCO<sub>2</sub>,and increased osmol gap (corrected for ethanol)and anion gap.Urinalysis indicated many oxalate crystals.Based on these laboratory results,what is the likely compound that has affected this individual?
A) Carbon monoxide
B) Methanol
C) Ethylene glycol
D) Codeine
Q2) Ethanol
A)Central nervous system depressant
B)Central nervous system stimulant
C)Blocks oxygen binding to hemoglobin
D)Interferes with enzyme action
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Page 33
Chapter 32: Toxic Metals
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Q1) 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.
Q2) When reporting the results of a urine metal analysis,such as urine chromium,how are the results reported?
A) In millimoles of drug per liter of urine per 24 hours
B) As micrograms of metal per milliliter of urine in a random specimen
C) In concentration units of the metal of interest per gram of creatinine
D) As milligrams of metal/deciliter of urine
Q3) In blood collection for chromium or other trace metal analysis,what aspect of specimen collection is critical?
A) Timing of the blood draw,whether morning or afternoon
B) Use of serum and not plasma
C) Using specially manufactured collection tubes with unique stoppers
D) Using a special tourniquet that does not cause hemolysis
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Chapter 33: Diabetes
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Q1) The hyperglycemia observed in a diabetic causes many toxic effects such as retinopathy and nephropathy.Although it is unclear how these outcomes are caused by elevated blood sugar,it is thought that hyperglycemia:
A) causes increased serum osmolarity,which leads to decreased blood flow in the microvascular compartments in peripheral tissues.
B) causes increased production of advanced glycation end products,which might contribute to microvascular complications.
C) induces secretion of glucagon,which antagonizes insulin secretion and leads to destruction of the microvessels in the retina and kidney.
D) causes a hemolytic disease with shortened red blood cell survival,thus not providing enough oxygen to peripheral tissues.
Q2) Exercise
A)Increases
B)Decreases
C)Has no effect
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Chapter 34: Cardiovascular Disease
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Q1) An ideal cardiac marker should be elevated in the circulation for how long following a cardiac event?
A) At least several days
B) 1 to 2 months
C) 1 to 3 hours
D) 1 to 3 years
Q2) Protein hormone
A)BNP
B)CK-MB
C)Troponin
D)Myoglobin
Q3) Oxygen-binding protein
A)BNP
B)CK-MB
C)Troponin
D)Myoglobin
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Page 36
Chapter 35: Kidney Disease
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Q1) Which one of the following statements regarding creatinine is correct?
A) Serum creatinine levels are elevated early in all renal disease.
B) Normal plasma creatinine does not always indicate normal kidney function.
C) Creatinine levels fluctuate in a diurnal manner.
D) Creatinine is completely reabsorbed by the renal tubules.
Q2) You have been asked what laboratory tests should be requested to assess the electrolyte balance regulatory function of an individual's kidneys.Which of the following is your reply?
A) Serum creatinine,serum urea,serum uric acid,and creatinine clearance
B) Serum sodium and potassium,and arterial blood pH
C) Serum renin and erythropoietin
D) Serum and urine protein
Q3) Upon microscopic examination,an individual's urine shows many bacteria,white blood cells,and cellular casts composed of polymorphonuclear leukocytes.It is likely that this individual has:
A) pyelonephritis.
B) rapidly progressing glomerulonephritis.
C) urinary tract infection.
D) end-stage renal disease.
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Page 37
Chapter 36: Physiology and Disorders of
Water,Electrolyte,and Acid-Base Metabolism
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Q1) How do healthy kidneys compensate for the excess hydrogen ions and concurrent low pH observed in metabolic acidosis?
A) Releasing bicarbonate into urine
B) Stimulating hyperventilation
C) Decreasing urinary excretion of ammonia
D) Increasing excretion of acid
Q2) The most important buffer of plasma is the _____ system.
A) bicarbonate/carbonic acid
B) protein/albumin
C) phosphoric acid/phosphate
D) hemoglobin erythrocyte
Q3) At physiological pH of 7.4,which one of the following contributes most to the total serum CO<sub>2</sub> (think about the equilibrium of the reaction in the formula)?
A) Dissolved CO<sub>2</sub>
B) Carbaminohemoglobin
C) HCO<sub>3</sub><sup>-</sup>
D) Carbonic acid
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Page 38
Chapter 37: Liver Disease
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Q1) Which type of hepatitis is a leading cause of chronic hepatitis and is caused by a mutating RNA virus?
A) Hepatitis A
B) Fulminant hepatitis
C) Hepatitis B
D) Hepatitis C
Q2) Which one of the following is not a consequence of portal hypertension in an individual?
A) Bleeding esophageal varices
B) Increased prothrombin time
C) Altered estrogen metabolism
D) Hemochromatosis
Q3) Cholangitis
A)Decreased flow of bile
B)Inflammation of bile ducts
C)Gallstones in bile ducts
D)Fibrosis of the liver
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Chapter 38: Gastrointestinal and Pancreatic Diseases
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Q1) A consequence of Crohn disease is bacterial overgrowth of the small bowel that normally contains few bacteria.Bacterial overgrowth further leads to:
A) bile salt deficiency and fat malabsorption.
B) excess hydrogen in the intestine and acid reflux disease.
C) lactase deficiency.
D) chronic pancreatitis and pancreatic islet destruction.
Q2) A 23-year-old man visits his physician with symptoms of abdominal discomfort and diarrhea.The man states that the diarrhea has been present off and on for approximately 6 weeks.He especially notes symptoms after a breakfast of wheat cereal and milk.His physician considers the possibility of two disorders,celiac disease and lactose intolerance.Which of the following pairs of laboratory tests would provide a definitive answer?
A) Analysis of tissue transglutaminase IgA antibodies and breath hydrogen testing
B) Serum gastrin and fecal alpha<sub>1</sub>-antitrypsin analysis
C) Breath hydrogen testing and fecal osmotic gap determination
D) Fecal elastase-1 and tissue transglutaminase IgA antibody analysis
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Chapter 39: Disorders of Bone and Mineral Metabolism
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Q1) In a case of osteomalacia related to vitamin D deficiency,would serum calcium be increased,decreased,or remain unchanged?
A) Increased
B) Decreased
C) Remain unchanged
Q2) In a case of severe osteomalacia,would bone-specific alkaline phosphatase be increased,decreased,or remain unchanged?
A) Increased
B) Decreased
C) Remain unchanged
Q3) What makes up the organic matrix component of bone?
A) Calcium,protein,and collagen
B) Cells and collagen only
C) Minerals and cells only
D) Cells only
Q4) The clinical usefulness of calcitonin measurement is:
A) in the assessment of primary hyperparathyroidism.
B) in the determination of sources of vitamin D deficiency.
C) the differential diagnosis of multiple endocrine neoplasia (MEN).
D) as a tumor marker for medullary thyroid carcinoma.
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Chapter 40: Disorders of the Pituitary
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Q1) The most common assay used to assess serum concentration of adenohypophyseal hormones is:
A) chromatography.
B) immunoassay.
C) electrophoresis.
D) spectrometry.
Q2) Oxytocin is:
A) synthesized by the somatotropic cells of the adenohypophysis and is stored within intracellular granules.
B) released upon stimulation of cell bodies in the hypothalamic paraventricular nucleus. C) found in the pituitary gland but is mostly localized in the catecholamine-synthesizing cells of the adrenal medulla.
D) the principal hormone that controls the initiation and maintenance of lactation.
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Chapter 41: Disorders of the Adrenal Cortex
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Q1) Which one of the following statements concerning androstenedione is incorrect?
A) In adrenal carcinoma,cortisol is greatly elevated,but androstenedione is greatly decreased.
B) The precursor molecule in the formation of androstenedione is dihydroepiandrostenedione (DHEA).
C) Androstenedione metabolites are measured as 17-ketosteroids.
D) 11\(\beta\)-Hydroxylase deficiency leads to elevated plasma androstenedione.
Q2) In the classic plasma renin activity assay that measures the main function of the enzyme and uses inhibitors of angiotensinase,what is actually measured at the end of the assay?
A) Plasma renin
B) Angiotensin-converting enzyme
C) Angiotensin I
D) Angiotensin II
Q3) The urinary metabolite of cortisol and adrenal androgens is:
A) renin.
B) 17-hydroxyprogesterone.
C) 11-desoxycortisol.
D) 17-ketosteroid.
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Page 43
Chapter 42: Thyroid Disorders
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Q1) Which one of the following is not a function of the thyroid hormones?
A) Control of metabolic rate
B) Removal of defective RBCs
C) Increasing cholesterol synthesis and breakdown
D) Stimulation of neural development
Q2) 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.
Q3) Which one of the following statements is correct regarding reverse T<sub>3 </sub>(rT<sub>3</sub>)?
A) rT<sub>3</sub> is physiologically active,but less so than T<sub>3</sub>.
B) rT<sub>3</sub> is formed in the blood by central deiodination of T<sub>4</sub>.
C) rT<sub>3</sub> is decreased in patients with the "euthyroid sick syndrome."
D) Renal failure is associated with elevated rT<sub>3</sub> concentrations.
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Page 44
Chapter 43: Reproduction-Related Disorders
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Q1) A 30-year-old female visits her physician with a complaint of excess facial and body hair,weight gain,and oligomenorrhea.She has read online that her symptoms indicate possible Cushing syndrome.Laboratory values indicate plasma cortisol levels within the reference intervals,elevated estrogen and LH,and decreased FSH.What other disorder might this patient have?
A) Polycystic ovarian syndrome (PCOS)
B) Conn syndrome
C) Ovarian tumor
D) Adult onset congenital adrenal hyperplasia
Q2) In nonpregnant women,progesterone is synthesized and secreted by the:
A) corpus luteum.
B) placenta.
C) pituitary gland.
D) Both a and b are correct.
Q3) LH
A)Precocious puberty
B)Polycystic ovary syndrome
C)Galactorrhea
D)Inability to maintain endometrium
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Page 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) A hormone that is monitored to assess conditions associated with intrauterine (vs.ectopic)fetal growth is:
A) progesterone.
B) placental lactogen (PL).
C) estrogen.
D) chorionic gonadotropin (CG).
Q3) Which one of the following statements concerning maternal endocrine changes during the first 12 weeks (first trimester)of pregnancy is correct?
A) Cortisol gradually decreases
B) Free thyroxine values remain unchanged
C) TSH remains unchanged
D) 1,25-Dihydroxyvitamin D decreases
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Chapter 45: Newborn Screening and Inborn Errors of Metabolism
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Q1) Hyperphenylalaninemia due to classic phenylketonuria (PKU)is accompanied by all the following except:
A) elevation of blood tyrosine.
B) elevation in urinary phenylketones.
C) elevation in blood phenylalanine correctable by dietary phenylalanine restriction.
D) mental retardation if left untreated.
Q2) Of the following,what is the inborn error of metabolism for medium chain acyl-CoA dehydrogenase deficiency?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
Q3) Of the following,what is the inborn error of metabolism for alkaptonuria?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
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Page 47
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) A drug substrate for the metabolizing enzyme UGT1A1 is:
A) tamoxifen.
B) codeine.
C) diazepam
D) irinotecan.
Q3) Which one of the following metabolizing enzymes is considered a phase 1 enzyme?
A) CYP2C6
B) VKORC1
C) NAT1
D) UGT1A1
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Chapter 47: Principles of Molecular Biology
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Q1) Which one of the following sequences contains a signal that indicates the end of a protein?
A) 5' GUG ACU AGG UGG CGA CCC UAU 3'
B) 5' AAC CGA CUC AUC CAG GUA UAA 3'
C) 5' ACC CGA CCA UCC AGG CUG AGG 3'
D) 5' AGC CGA CUC AUC AGG UUU GAU 3'
Q2) The conversion of mRNA nucleotide sequences and the tRNA-attached amino acids into a polypeptide is referred to as:
A) replication.
B) transcription.
C) translation.
D) restriction.
Q3) If 30% of the nucleotides in a genome are A (adenine),what would be the percentage of nucleotides that are G (guanine)?
A) 20%
B) 30%
C) 40%
D) 60%
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Chapter 48: Nucleic Acid Techniques and Applications
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Q1) What type of assay is hybrid capture?
A) Solid-phase hybridization
B) Signal amplification
C) Transcription-mediated amplification
D) Solution-phase hybridization
Q2) In the dideoxy-termination sequencing method,what causes the termination of the newly synthesized DNA strand?
A) Addition of a dideoxynucleotide
B) Deletion of a deoxyribonucleotide
C) Addition of a deoxyribonucleotide
D) Addition of a ribonucleotide
Q3) Gene expression microarrays quantify:
A) a single copy of a nucleic acid target.
B) relative amounts of different messenger RNAs in samples.
C) RNA promoter regions that are adjacent to an inserted DNA sequence.
D) the number of specific base pairs in a DNA target.
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Chapter 49: Genomes and Nucleic Acid Alterations
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Q1) In the following sequences,the normal amino acid sequence is given first followed by the sequence that is produced by a sequence alteration.Identify the type of sequence alteration that most likely causes the altered amino acid sequence. Normal Sequence: Phe-Asn-Pro-Thr-Arg
Mutated Sequence: Phe-His-Pro-Thr-Arg
What type of sequence alteration most likely caused the mutation?
A) Indel
B) Missense
C) Nonsense
D) There is no alteration.
Q2) 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.
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