Clinical Chemistry Flashcards
A solution that has a transmittance of 1.0 %T would have an absorbance of:
A. 1.0
B. 2.0
C. 1%
D. 99%
B.
Absorbance= 2-log%T
A= 2-log 1
A= 2
Which formula correctly describes the relationship between absorbance and %T ?
A. A = 2 – log %T
B. A = log 1/T
C. A = –log T
D. All of these options
D
In absorption spectrophotometry:
A. Absorbance is directly proportional to transmittance
B. Percent transmittance is directly proportional to concentration
C. Percent transmittance is directly proportional to the light path length
D. Absorbance is directly proportional to concentration
D
Which wavelength would be absorbed strongly by a red-colored solution?
A. 450 nm
B. 585 nm
C. 600 nm
D. 650 nm
A
Red colored solution TRANSMITS light proportional to its wavelength but ABSORBS light of wavelength complementary to its color.
A green-colored solution would show highest transmittance at:
A. 475 nm
B. 525 nm
C. 585 nm
D. 620 nm
B
A technologist is performing an enzyme assay at 340 nm using a visible-range spectrophotometer. After setting the wavelength and adjusting the readout to zero %T with the light path blocked, a cuvette with deionized water is inserted. With the light path fully open and the 100%T control at maximum, the instrument readout will not rise above 90%T. What is the most appropriate first course of action?
A. Replace the source lamp
B. Insert a wider cuvette into the light path
C. Measure the voltage across the lamp terminals
D. Replace the instrument fuse
A
Which type of monochromator produces the purest monochromatic light in the UV range?
A. A diffraction grating and a fixed exit slit
B. A sharp cutoff filter and a variable exit slit
C. Interference filters and a variable exit slit
D. A prism and a variable exit slit
D
Diffraction grating and prisms both produce a continous range of wavelength but using a prism and a variable exit slit can produce a UV light of a very narrow bandpass
Which monochromator specification is required in order to measure the true absorbance of a compound having a natural absorption bandwidth of 30 nm?
A. 50-nm bandpass
B. 25-nm bandpass
C. 15-nm bandpass
D. 5-nm bandpass
D
A bandpass refers to range of wavelengths passing through the sample. The narrower the bandpass the better the resolution. Accurate absorbance measurement requires a bandpass of LESS THAN 1/5 OF THE NATURAL BANDPASS OF CHROMOPHORE.
Which photodetector is most sensitive to low levels of light?
A. Barrier layer cell
B. Photodiode
C. Diode array
D. Photomultiplier tube
D
Which condition is a common cause of stray light?
A. Unstable source lamp voltage
B. Improper wavelength calibration
C. Dispersion from second-order spectra
D. Misaligned source lamp
C
Which type of filter is best for measuring stray light?
A. Wratten
B. Didymium
C. Sharp cutoff
D. Neutral density
C
1Which of the following materials is best suited for verifying the wavelength calibration of a spectrophotometer?
A. Neutral density filters
B. Potassium dichromate solutions traceable to the National Bureau of Standards reference
C. Wratten filters
D. Holmium oxide glass
D
Why do many optical systems in chemistry analyzers utilize a reference light path?
A. To increase the sensitivity of the measurement
B. To minimize error caused by source lamp fluctuation
C. To obviate the need for wavelength adjustment
D. To reduce stray light effects
B
Which component is required in a spectrophotometer in order to produce a spectral absorbance curve?
A. Multiple monochromators
B. A reference optical beam
C. Photodiode array
D. Laser light source
C
The half-band width of a monochromator is defined by:
A. The range of wavelengths passed at 50% maximum transmittance
B. One-half the lowest wavelength of optical purity
C. The wavelength of peak transmittance
D. One-half the wavelength of peak absorbance
A
The reagent blank corrects for absorbance caused by:
A. The color of reagents
B. Sample turbidity
C. Bilirubin and hemolysis
D. All of these options
A
A plasma sample is hemolyzed and turbid. What is required to perform a sample blank in order to correct the measurement for the intrinsic absorbance of the sample when performing a spectrophotometric assay?
A. Substitute deionized water for the sample
B. Dilute the sample 1:2 with a standard of known concentration
C. Substitute saline for the reagent
D. Use a larger volume of the sample
C
Which instrument requires a highly regulated DC power supply?
A. A spectrophotometer with a barrier layer cell
B. A colorimeter with multilayer interference filters
C. A spectrophotometer with a photomultiplier tube
D. A densitometer with a photodiode detector
C
Which statement regarding reflectometry is true?
A. The relation between reflectance density and concentration is linear
B. Single-point calibration can be used to determine concentration
C. 100% reflectance is set with an opaque film called a white reference
D. The diode array is the photodetector of choice
C
Bichromatic measurement of absorbance can correct for interfering substances if:
A. The contribution of the interferent to absorbance is the same at both wavelengths
B. Both wavelengths pass through the sample simultaneously
C. The side band is a harmonic of the primary wavelength
D. The chromogen has the same absorbance at both wavelengths
A
Which instrument requires a primary and secondary monochromator?
A. Spectrophotometer
B. Atomic absorption spectrophotometer
C. Fluorometer
D. Nephelometer
C
Which of the following statements about fluorometry is accurate?
A. Fluorometry is less sensitive than spectrophotometry
B. Fluorometry is less specific than spectrophotometry
C. Unsaturated cyclic molecules are often fluorescent
D. Fluorescence is directly proportional to temperature
C
Which of the following components is not needed in a chemiluminescent immunoassay analyzer?
A. Source lamp
B. Monochromator
C. Photodetector
D. Wash station
A
Which substance is used to generate the light signal in electrochemiluminescence?
A. Acridinium
B. Luminol
C. Dioxetane phosphate
D. Ruthenium
D
Light scattering when the wavelength is greater than 10 times the particle diameter is described by:
A. Rayleigh’s law
B. The Beer–Lambert law
C. Mie’s law
D. The Rayleigh–Debye law
A
Which statement regarding nephelometry is true?
A. Nephelometry is less sensitive than absorption spectrophotometry
B. Nephelometry follows Beer’s law
C. The optical design is identical to a turbidimeter except that a HeNe laser light source is used
D. The detector response is directly proportional to concentration
D
The purpose of the nebulizer in an atomic absorption spectrophotometer that uses
a flame is to:
A. Convert ions to atoms
B. Cause ejection of an outer shell electron
C. Reduce evaporation of the sample
D. Burn off organic impurities
A
A flameless atomic absorption spectrophotometer dehydrates and atomizes a sample using:
A. A graphite capillary furnace
B. An electron gun
C. A thermoelectric semiconductor
D. A thermospray platform
A
When measuring lead in whole blood using atomic absorption spectrophotometry, what reagent is required to obtain the needed sensitivity and precision?
A. Lanthanum
B. Lithium
C. Triton X-100
D. Chloride
C
Interference in atomic absorption spectrophotometry caused by differences in viscosity is called:
A. Absorption interference
B. Matrix effect
C. Ionization interference
D. Quenching
B
All of the following are required when measuring magnesium by atomic absorption spectrophotometry except:
A. A hollow cathode lamp with a magnesium cathode
B. A chopper to prevent optical interference from magnesium emission
C. A monochromator to isolate the magnesium emission line at 285 nm
D. A 285-nm reference beam to correct for background absorption
D
When measuring calcium by atomic absorption spectrophotometry, which is required?
A. An organic extraction reagent to deconjugate calcium from protein
B. An internal standard
C. A magnesium chelator
D. Lanthanum oxide to chelate phosphates
D
Ion selective analyzers using undiluted samples have what advantage over analyzers that use a diluted sample?
A. Can measure over a wider range of concentration
B. Are not subject to pseudohyponatremia caused by high lipids
C. Do not require temperature equilibration
D. Require less maintenance
B
Select the equation describing the potential that develops at the surface of an ion-selective electrode.
A. van Deemter equation
B. van Slyke equation
C. Nernst equation
D. Henderson–Hasselbalch equation
C
The reference potential of a silver–silver chloride electrode is determined by the:
A. Concentration of the potassium chloride filling solution
B. Surface area of the electrode
C. Activity of total anion in the paste covering the electrode
D. The concentration of silver in the paste covering the electrode
A
The term RT/nF in the Nernst equation defines the:
A. Potential at the ion-selective membrane
B. Slope of the electrode
C. Decomposition potential
D. Isopotential point of the electrode
B
The ion-selective membrane used to measure potassium is made of:
A. High-borosilicate glass membrane
B. Polyvinyl chloride dioctylphenyl phosphonate ion exchanger
C. Valinomycin gel
D. Calomel
C
The response of a sodium electrode to a 10-fold increase in sodium concentration should be:
A. A 10-fold drop in potential
B. An increase in potential of approximately 60 mV
C. An increase in potential of approximately 10 mV
D. A decrease in potential of approximately 10 mV
B
Which of the electrodes below is a current- producing (amperometric) rather than a voltage-producing (potentiometric) electrode?
A. Clark electrode
B. Severinghaus electrode
C. pH electrode
D. Ionized calcium electrode
A
Which of the following would cause a “response” error from an ion-selective electrode for sodium when measuring serum but not the calibrator?
A. Interference from other electrolytes
B. Protein coating the ion-selective membrane
C. An overrange in sodium concentration
D. Protein binding to sodium ions
B
In polarography, the voltage needed to cause depolarization of the cathode is called the:
A. Half-wave potential
B. Isopotential point
C. Decomposition potential
D. Polarization potential
C
Persistent noise from an ion-selective electrode is most often caused by:
A. Contamination of sample
B. Blocked junction at the salt bridge
C. Overrange from high concentration
D. Improper calibration
B
Which element is reduced at the cathode of a Clark polarographic electrode?
A. Silver
B. Oxygen
C. Chloride
D. Potassium
B
Which of the following statements accurately characterizes the coulometric titration of chloride?
A. The indicator electrodes generate voltage
B. Constant current must be present across the generator electrodes
C. Silver ions are formed at the generator cathode
D. Chloride concentration is inversely proportional to titration time
B
In the coulometric chloride titration:
A. Acetic acid in the titrating solution furnishes the counter ion for reduction
B. The endpoint is detected by amperometry
C. The titrating reagent contains a phosphate buffer to keep pH constant
D. Nitric acid (HNO3) is used to lower the solubility of AgCl
B
Which of the following compounds can interfere with the coulometric chloride assay?
A. Bromide
B. Ascorbate
C. Acetoacetate
D. Nitrate
A
All of the following compounds contribute to the osmolality of plasma except:
A. Lipids
B. Creatinine
C. Drug metabolites
D. Glucose
A
All of the following compounds contribute to the osmolality of plasma except:
A. Lipids
B. Creatinine
C. Drug metabolites
D. Glucose
A
What component of a freezing point osmometer measures the sample temperature?
A. Thermistor
B. Thermocouple
C. Capacitor
D. Electrode
A
What type of measuring circuit is used in a freezing point osmometer?
A. Electrometer
B. Potentiometer
C. Wheatstone bridge
D. Thermal conductivity bridge
C
Which measurement principle is employed in a vapor pressure osmometer?
A. Seebeck
B. Peltier
C. Hayden
D. Darlington
A
The freezing point osmometer differs from the vapor pressure osmometer in that only the freezing point osmometer:
A. Cools the sample
B. Is sensitive to ethanol
C. Requires a thermoelectric module
D. Requires calibration with aqueous standards
B
The freezing point osmometer differs from the vapor pressure osmometer in that only the freezing point osmometer:
A. Cools the sample
B. Is sensitive to ethanol
C. Requires a thermoelectric module
D. Requires calibration with aqueous standards
B
The term isocratic is used in high-performance liquid chromatography (HPLC) to mean the:
A. Mobile phase is at constant temperature
B. Stationary phase is equilibrated with the mobile phase
C. Mobile phase consists of a constant solvent composition
D. Flow rate of the mobile phase is regulated
C
The term reverse phase is used in HPLC to indicate that the mobile phase is:
A. More polar than the stationary phase
B. Liquid and the stationary phase is solid
C. Organic and the stationary phase is aqueous
D. A stronger solvent than the stationary phase
A
What is the primary means of solute separation in HPLC using a C18 column?
A. Anion exchange
B. Size exclusion
C. Partitioning
D. Cation exchange
C
The most commonly used detector for clinical gas–liquid chromatography (GLC) is based upon:
A. Ultraviolet light absorbance at 254 nm
B. Flame ionization
C. Refractive index
D. Thermal conductance
B
What type of detector is used in high-performance liquid chromatography with electrochemical detection (HPLC–ECD)?
A. Calomel electrode
B. Conductivity electrode
C. Glassy carbon electrode
D. Polarographic electrode
C
In gas chromatography, the elution order of volatiles is usually based upon the:
A. Boiling point
B. Molecular size
C. Carbon content
D. Polarity
A
Select the chemical that is used in most HPLC procedures to decrease solvent polarity.
A. Hexane
B. Nonane
C. Chloroform
D. Acetonitrile
D
In thin-layer chromatography (TLC), the distance the solute migrates divided by the distance the solvent migrates is the:
A. tR
B. Kd
C. Rf
D. pK
C
Which reagent is used in thin-layer chromatography (TLC) to extract cocaine metabolites from urine?
A. Acid and sodium chloride
B. Alkali and organic solvent
C. Chloroform and sodium acetate
D. Neutral solution of ethyl acetate
B
What is the purpose of an internal standard in HPLC and GC methods?
A. To compensate for variation in extraction and injection
B. To correct for background absorbance
C. To compensate for changes in flow rate
D. To correct for coelution of solutes
A
What is the confirmatory method for measuring drugs of abuse?
A. HPLC
B. Enzyme-multiplied immunoassay technique (EMIT)
C. Gas chromatography with mass spectroscopy (GC-MS)
D. TLC
C
The fragments typically produced and analyzed in methods employing mass spectroscopy are typically:
A. Of low molecular size ranging from 10–100 daltons
B. Cations caused by electron loss or proton attachment
C. Anions caused by bombarding the molecule with an electron source
D. Neutral species formed after excited molecules form a stable resonance structure
B
What component is used in a GC-MS but not used in an LC-MS?
A. Electron source
B. Mass filter
C. Detector
D. Vacuum
A
What process is most often used in LC-MS to introduce the sample into the mass filter?
A. Electrospray ionization
B. Chemical ionization
C. Electron impact ionization
D. Fast atom bombardment
A
In mass spectroscopy, the term base peak typically refers to:
A. The peak with the lowest mass
B. The peak with the most abundance
C. A natural isotope of the molecular ion
D. The first peak to reach the mass detector
B
Which method is the most useful when screening for errors of amino and organic acid metabolism?
A. Two-dimensional thin-layer chromatography
B. Gas chromatography
C. Electrospray ionization tandem-mass spectroscopy
D. Inductively charged coupled-mass spectroscopy
C
In tandem-mass spectroscopy, the first mass filter performs the same function as:
A. The ion source
B. The chromatography column
C. Extraction
D. The vacuum system
B
A GC-MS analysis using nitrogen as the carrier gas shows an extensively noisy baseline. A sample of the solvent used for the extraction procedure, ethyl acetate, was injected and showed the same noise. Results of an Autotune test showed the appearance of a base peak at 16 with two smaller peaks at 17 and 18. These results indicate:
A. The solvent is contaminated
B. The carrier gas is contaminated
C. There is electrical noise in the detector
D. The ion source is dirty
B
Why is vacuum necessary in the mass filter of a mass spectrometer?
A. Ionization does not occur at atmospheric pressure
B. It prevents collision between fragments
C. It removes electrons from the ion source
D. It prevents contamination
B
What method is used to introduce the sample into a mass spectrometer for analysis of a trace element?
A. Electrospray ionization
B. Laser desorption
C. Inductively charged plasma (ICP) ionization
D. Direct injection
C
Which component is needed for a thermal cycler to amplify DNA?
A. Programmable heating and cooling unit
B. Vacuum chamber with zero head space
C. Sealed airtight constant-temperature chamber
D. Temperature-controlled ionization chamber
A
In real-time PCR, what value is needed in order to determine the threshold?
A. Background signal
B. Melt temperature
C. Maximum fluorescence
D. Threshold cycle
A
In addition to velocity, what variable is also needed to calculate the relative centrifugal force (g force) of a centrifuge?
A. Head radius
B. Angular velocity coefficient
C. Diameter of the centrifuge tube
D. Ambient temperature in degrees Centigrade
A
Which of the following situations is likely to cause an error when weighing with an electronic analytical balance?
A. Failure to keep the knife edge clean
B. Failure to close the doors of the balance before reading the weight
C. Oxidation on the surface of the substitution weights
D. Using the balance without allowing it to warm up for at least 10 minutes
B
When calibrating a semiautomatic pipet that has a fixed delivery of 10.0 μL using a gravimetric method, what should be the average weight of deionized water transferred?
A. 10.0 μg
B. 100.0 μg
C. 1.0 mg
D. 10.0 mg
D
Which of the following represents the
Henderson–Hasselbalch equation as applied
to blood pH?
A. pH = 6.1 + log HCO3–/PCO2
B. pH = 6.1 + log HCO3–/(0.03 × PCO2)
C. pH = 6.1 + log dCO /HCO – 23–
D. pH = 6.1 + log (0.03 × PCO2)/HCO3
B
What is the PO 20.0% O2, when the barometric pressure is 30 in.?
A. 60 mm Hg
B. 86 mm Hg
C. 143 mm Hg
D. 152 mm Hg
C
What is the blood pH when the partial pressure of carbon dioxide (PCO2) is 60 mm Hg and the bicarbonate concentration is 18 mmol/L?
A. 6.89
B. 7.00
C. 7.10
D. 7.30
C
Which of the following best represents the reference (normal) range for arterial pH?
A. 7.35–7.45
B. 7.42–7.52
C. 7.38–7.68
D. 6.85–7.5
A
What is the normal ratio of bicarbonate to dissolved carbon dioxide (HCO3–:dCO2) in arterial blood?
A. 1:10
B. 10:1
C. 20:1
D. 30:1
C
What is the PCO2 if the dCO2 is 1.8 mmol/L?
A. 24 mm Hg
B. 35 mm Hg
C. 60 mm Hg
D. 72 mm Hg
C
In the Henderson–Hasselbalch expression pH = 6.1 + log HCO3–/dCO2, the 6.1 represents:
A. The combined hydration and dissociation constants for CO2 in blood at 37°C
B. The solubility constant for CO2 gas
C. The dissociation constant of H2O
D. The ionization constant of sodium bicarbonate (NaHCO3)
A
Which of the following contributes the most to the serum total CO2?
A. PCO2
B. dCO2
C. HCO3–
D. Carbonium ion
C
In addition to sodium bicarbonate, what other substance contributes most to the amount of base in the blood?
A. Hemoglobin concentration
B. Dissolved O2 concentration
C. Inorganic phosphorus
D. Organic phosphate
A
Which of the following formulas for O2 content is correct?
A. O2 content = %O2 saturation/100 × Hgb g/dL × 1.39 mL/g + (0.0031 × PO2)
B. O2 content = PO2 × 0.0306 mmol/L/mm
C. O2 content = O2 saturation × Hgb g/dL × 0.003 mL/g
D. O2 content = O2 capacity × 0.003 mL/g
A
The normal difference between alveolar and arterial PO2 (PAO2–PaO2 difference) is:
A. 3 mm Hg
B. 10 mm Hg
C. 40 mm Hg
D. 50 mm Hg
B
A decreased PAO2–PaO2 difference is found in:
A. A/V (arteriovenous) shunting
B. V/Q (ventilation/perfusion) inequality
C. Ventilation defects
D. All of these options
C
The determination of the oxygen saturation of hemoglobin is best accomplished by:
A. Polychromatic absorbance measurements of a whole-blood hemolysate
B. Near infrared transcutaneous absorbance measurement
C. Treatment of whole blood with alkaline dithionite prior to measuring absorbance
D. Calculation using PO2 and total hemoglobin by direct spectrophotometry
A
Correction of pH for a patient with a body temperature of 38°C would require:
A. Subtraction of 0.015
B. Subtraction of 0.01%
C. Addition of 0.020
D. Subtraction of 0.020
A
Select the anticoagulant of choice for blood gas studies.
A. Sodium citrate 3.2%
B. Lithium heparin 100 U/mL blood
C. Sodium citrate 3.8%
D. Ammonium oxalate 5.0%
B
Which of the following will shift the O2 dissociation curve to the left?
A. Anemia
B. Hyperthermia
C. Hypercapnia
D. Alkalosis
D
In which circumstance will the reporting of calculated oxygen saturation of hemoglobin based on PO2, PCO2, pH, temperature, and hemoglobin be in error?
A. Carbon monoxide poisoning
B. Diabetic ketoacidosis
C. Patient receiving oxygen therapy
D. Assisted ventilation for respiratory failure
A
Which condition results in metabolic acidosis with severe hypokalemia and chronic alkaline urine?
A. Diabetic ketoacidosis
B. Phenformin-induced acidosis
C. Renal tubular acidosis
D. Acidosis caused by starvation
C
Which of the following mechanisms is responsible for metabolic acidosis?
A. Bicarbonate deficiency
B. Excessive retention of dissolved CO2
C. Accumulation of volatile acids
D. Hyperaldosteronism
A
Which of the following disorders is associated with lactate acidosis?
A. Diarrhea
B. Renal tubular acidosis
C. Hypoaldosteronism
D. Alcoholism
D
Which of the following is the primary mechanism of compensation for metabolic acidosis?
A. Hyperventilation
B. Release of epinephrine
C. Aldosterone release
D. Bicarbonate excretion
A
The following conditions are all causes of alkalosis. Which condition is associated with respiratory (rather than metabolic) alkalosis?
A. Anxiety
B. Hypovolemia
C. Hyperaldosteronism
D. Hypoparathyroidism
A
Which of the following conditions is associated with both metabolic and respiratory alkalosis?
A. Hyperchloremia
B. Hypernatremia
C. Hyperphosphatemia
D. Hypokalemia
D
In uncompensated metabolic acidosis, which of the following will be normal?
A. Plasma bicarbonate
B. PCO2
C. p50
D. Total CO2
B
Which of the following conditions is classified as normochloremic acidosis?
A. Diabetic ketoacidosis
B. Chronic pulmonary obstruction
C. Uremic acidosis
D. Diarrhea
A
Which PCO2 value would be seen in maximally compensated metabolic acidosis?
A. 15 mm Hg
B. 30 mm Hg
C. 40 mm Hg
D. 60 mm Hg
A
Apatienthasthefollowingarterialbloodgasresults:
pH = 7.56 PCO2 = 25 mm Hg
PO = 100 mm Hg
HCO – = 22 mmol/L 23
These results are most likely the result of which condition?
A. Improper specimen collection
B. Prolonged storage
C. Hyperventilation
D. Hypokalemia
C
Why are three levels used for quality control of pH and blood gases?
A. Systematic errors can be detected earlier than with two controls
B. Analytical accuracy needs to be greater than for other analytes
C. High, normal, and low ranges must always be evaluated
D. A different level is needed for pH, PCO2, and PO2
A
A single-point calibration is performed between each blood gas sample in order to:
A. Correct the electrode slope
B. Correct electrode and instrument drift
C. Compensate for temperature variance
D. Prevent contamination by the previous sample
B
In which condition would hypochloremia be expected?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. All of these options
C
Which of the following conditions will cause an increased anion gap?
A. Diarrhea
B. Hypoaldosteronism
C. Hyperkalemia
D. Renal failure
D
Alcoholism, liver failure, and hypoxia induce acidosis by causing:
A. Depletion of cellular NAD+
B. Increased excretion of bicarbonate
C. Increased retention of PCO2
D. Loss of carbonic anhydrase
A
Which of the following is the primary mechanism causing respiratory alkalosis?
A. Hyperventilation
B. Deficient alveolar diffusion
C. Deficient pulmonary perfusion
D. Parasympathetic inhibition
A
Which condition can result in acidosis?
A. Cystic fibrosis
B. Vomiting
C. Hyperaldosteronism
D. Excessive O2 therapy
D
Which of the following conditions is associated with an increase in ionized calcium (Cai) in the blood?
A. Alkalosis
B. Hypoparathyroidism
C. Hyperalbuminemia
D. Malignancy
D
Which of the following laboratory results is consistent with primary hypoparathyroidism?
A. Low calcium; high inorganic phosphorus Pi
B. Low calcium; low Pi
C. High calcium; high Pi
D. High calcium; low Pi
A
Which of the following conditions is associated with hypophosphatemia?
A. Rickets
B. Multiple myeloma
C. Renal failure
D. Hypervitaminosis D
A
Which of the following tests is consistently abnormal in osteoporosis?
A. High urinary calcium
B. High serum Pi
C. Low serum calcium
D. High urine or serum N-telopeptide of type 1 collagen
D
Which of the following is a marker for bone formation?
A. Osteocalcin
B. Tartrate resistant acid phosphatase (TRAP)
C. Urinary pyridinoline and deoxypyridinoline
D. Urinary C-telopeptide and N-telopeptide crosslinks (CTx and NTx)
A
What role do CTx and NTx play in the management of osteoporosis?
A. Increased urinary excretion is diagnostic of early stage disease
B. Increased levels indicate a low risk of developing osteoporosis
C. Decreased urinary excretion indicates a positive response to treatment
D. The rate of urinary excretion correlates with the stage of the disease
C
What role does vitamin D measurement play in the management of osteoporosis?
A. Vitamin D deficiency must be demonstrated to establish the diagnosis
B. Vitamin D is consistently elevated in osteoporosis
C. A normal vitamin D level rules out osteoporosis
D. Vitamin D deficiency is a risk factor for developing osteoporosis
D
Which statement best describes testing recommendations for vitamin D?
A. Vitamin D testing should be reserved only for those persons who demonstrate hypercalcemia of an undetermined cause
B. Vitamin D testing should be specific for the 1,25(OH)D3 form
C. Testing should be for total vitamin D when screening for deficiency
D. Vitamin D testing should not be performed if the patient is receiving a vitamin D supplement
C
The serum level of which of the following laboratory tests is decreased in both VDDR and VDRR?
A. Vitamin D
B. Calcium
C. Pi
D. Parathyroid hormone
C
Which of the following is the most accurate measurement of Pi in serum?
A. Rate of unreduced phosphomolybdate formation at 340 nm
B. Measurement of phosphomolybdenum blue at 680 nm
C. Use of aminonaptholsulfonic acid to reduce phosphomolybdate
D. Formation of a complex with malachite green dye
A
What is the percentage of serum calcium that is ionized (Cai)?
A. 30%
B. 45%
C. 60%
D. 80%
B
Which of the following conditions will cause erroneous Cai results? Assume that the samples are collected and stored anaerobically, kept at 4°C until measurement, and stored for no longer than 1 hour.
A. Slight hemolysis during venipuncture
B. Assay of whole blood collected in sodium oxalate
C. Analysis of serum in a barrier gel tube stored at 4°C until the clot has formed
D. Analysis of whole blood collected in sodium heparin, 20 U/mL (low-heparin tube)
B
Which of the following conditions is associated with a low serum magnesium?
A. Addison’s disease
B. Hemolytic anemia
C. Hyperparathyroidism
D. Pancreatitis
D
When measuring calcium with the complexometric dye o-cresolphthalein complexone, magnesium is kept from interfering by:
A. Using an alkaline pH
B. Adding 8-hydroxyquinoline
C. Measuring at 450 nm
D. Complexing to EDTA
B
Which electrolyte measurement is least affected by hemolysis?
A. Potassium
B. Calcium
C. Pi
D. Magnesium
B
Which of the following conditions is associated with hypokalemia?
A. Addison’s disease
B. Hemolytic anemia
C. Digoxin intoxication
D. Alkalosis
D
Which of the following conditions is most likely to produce an elevated plasma potassium?
A. Hypoparathyroidism
B. Cushing’s syndrome
C. Diarrhea
D. Digitalis overdose
D
Which of the following values is the threshold critical value (alert or action level) for low plasma potassium?
A. 1.5 mmol/L
B. 2.0 mmol/L
C. 2.5 mmol/L
D. 3.5 mmol/L
C
Which electrolyte is least likely to be elevated in renal failure?
A. Potassium
B. Magnesium
C. Inorganic phosphorus
D. Sodium
D
Which of the following is the primary mechanism for vasopressin (ADH) release?
A. Hypovolemia
B. Hyperosmolar plasma
C. Renin release
D. Reduced renal blood flow
B
Which of the following conditions is associated with hypernatremia?
A. Diabetes insipidus
B. Hypoaldosteronism
C. Burns
D. Diarrhea
A
Which of the following values is the threshold critical value (alert or action level) for high plasma sodium?
A. 150 mmol/L
B. 160 mmol/L
C. 170 mmol/L
D. 180 mmol/L
B
Which of the following conditions is associated with total body sodium excess?
A. Renal failure
B. Hyperthyroidism
C. Hypoparathyroidism
D. Diabetic ketoacidosis
A
Which of the following conditions is associated with hyponatremia?
A. Diuretic therapy
B. Cushing’s syndrome
C. Diabetes insipidus
D. Nephrotic syndrome
A
Which of the following conditions involving electrolytes is described correctly?
A. Pseudohyponatremia occurs only when undiluted samples are measured
B. Potassium levels are slightly higher in heparinized plasma than in serum
C. Hypoalbuminemia causes low total calcium but does not affect Cai
D. Hypercalcemia may be induced by low serum magnesium
C
Which of the following laboratory results is usually associated with cystic fibrosis?
A. Sweat chloride greater than 60 mmol/L
B. Elevated serum sodium and chloride
C. Elevated fecal trypsin activity
D. Low glucose
A
When performing a sweat chloride collection, which of the following steps will result in analytical error?
A. Using unweighed gauze soaked in pilocarpine nitrate on the inner surface of the forearm to stimulate sweating
B. Collecting more than 75 mg of sweat in 30 minutes
C. Leaving the preweighed gauze on the inside of the arm exposed to air during collection
D. Rinsing the collected sweat from the gauze pad using chloride titrating solution
C
Which electrolyte level best correlates with plasma osmolality?
A. Sodium
B. Chloride
C. Bicarbonate
D. Calcium
A
Which formula is most accurate in predicting plasma osmolality?
A. Na + 2(Cl) + BUN + glucose
B. 2(Na) + 2(Cl) + glucose + urea
C. 2(Na) + (glucose ÷ 18) + (BUN ÷ 2.8)
D. Na + Cl + K + HCO3
C
Which of the following biochemical processes is promoted by insulin?
A. Glycogenolysis
B. Gluconeogenesis
C. Lipolysis
D. Uptake of glucose by cells
D
Which of the following hormones promotes hyperglycemia?
A. Calcitonin
B. Growth hormone
C. Aldosterone
D. Renin
B
Which of the following is characteristic of type 1 diabetes mellitus?
A. Requires an oral glucose tolerance test for diagnosis
B. Is the most common form of diabetes mellitus
C. Usually occurs after age 40
D. Requires insulin replacement to prevent ketosis
D
Which of the following is characteristic of type 2 diabetes mellitus?
A. Insulin levels are consistently low
B. Most cases require a 3-hour oral glucose tolerance test to diagnose
C. Hyperglycemia is often controlled without insulin replacement
D. The condition is associated with unexplained weight loss
C
Which of the following is characteristic of type 2 diabetes mellitus?
A. Insulin levels are consistently low
B. Most cases require a 3-hour oral glucose tolerance test to diagnose
C. Hyperglycemia is often controlled without insulin replacement
D. The condition is associated with unexplained weight loss
C
Select the most appropriate adult reference range for fasting blood glucose.
A. 40–105 mg/dL (2.22–5.82 mmol/L)
B. 60–140 mg/dL (3.33–7.77 mmol/L)
C. 65–99 mg/dL (3.61–5.50 mmol/L)
D. 75–150 mg/dL (4.16–8.32 mmol/L)
C
When preparing a patient for an oral glucose tolerance test (OGTT), which of the following conditions will lead to erroneous results?
A. The patient remains ambulatory for 3 days prior to the test
B. Carbohydrate intake is restricted to below 150 g/day for 3 days prior to test
C. No food, coffee, tea, or smoking is allowed8 hours before and during the test
D. Administration of 75 g of glucose is given to an adult patient following a 10–12-hour fast
B
Which of the following 2-hour glucose challenge results would be classified as impaired glucose tolerance (IGT)?
Two-hour serum glucose:
A. 130 mg/dL
B. 135 mg/dL
C. 150 mg/dL
D. 204 mg/dL
C
Which statement regarding gestational diabetes mellitus (GDM) is correct?
A. Is diagnosed using the same oral glucose tolerance criteria as in nonpregnancy
B. Converts to diabetes mellitus after pregnancy in 60%–75% of cases
C. Presents no increased health risk to the fetus
D. Is defined as glucose intolerance originating during pregnancy
D
Which of the following findings is characteristic of all forms of clinical hypoglycemia?
A. A fasting blood glucose value below 55 mg/dL
B. High fasting insulin levels
C. Neuroglycopenic symptoms at the time of low blood sugar
D. Decreased serum C peptide
C
Which statement regarding glycated (glycosylated) Hgb (G-Hgb) is true?
A. Has a sugar attached to the C-terminal end of the β chain
B. Is a highly reversible aminoglycan
C. Reflects the extent of glucose regulation in the 8- to 12-week interval prior to sampling
D. Will be abnormal within 4 days following an episode of hyperglycemia
C
What is the American Diabetes Association recommended cutoff value for adequate control of blood glucose in diabetics as measured by glycated hemoglobin?
A . 5%
B. 6.5%
C. 9.5%
D. 11%
B
Which statement regarding measurement of Hgb A1c is true?
A. Levels do not need to be done fasting
B. Both the labile and stable Hgb A1c fractions are measured
C. Samples should be measured within 2 hours of collection
D. The assay must be done by chromatography
A
Which stationary phase is used for the measurement of hemoglobin A1c by high performance liquid chromatography?
A. Octadecylsilane (C18)
B. Cation exchanger
C. Anion exchanger
D. Polystyrene divinylbenzene
B
Evaluate the following chromatogram of a whole-blood hemolysate, and identify the cause and best course of action.
A. Result is not reportable because hemoglobin F is present and interferes
B. The result is not reportable because hemoglobin C is present and interferes
C. The result is not reportable because labile hemoglobin A1c is present
D. The result is reportable; neither hemoglobin F or C interference
D
What is the recommended cutoff for the early detection of chronic kidney disease in diabetics using the test for microalbuminuria?
A. >30 mg/g creatinine
B. >80 mg/g creatinine
C. >200 mg/g creatinine
D. >80 mg/L
A
In addition to measuring blood glucose, Hgb A1c, and microalbumin, which test should be done on diabetic persons once per year?
A. Urine glucose
B. Urine ketones
C. Plasma fructosamines
D. Estimated glomerular filtration rate
D
Which testing situation is appropriate for the use of point-of-care whole-blood glucose methods?
A. Screening for type 2 diabetes mellitus
B. Diagnosis of diabetes mellitus
C. Monitoring of blood glucose control in type 1 and type 2 diabetics
D. Monitoring diabetics for hyperglycemic episodes only
C
Which of the following is the reference method for measuring serum glucose?
A. Somogyi–Nelson
B. Hexokinase
C. Glucose oxidase
D. Glucose dehydrogenase
B
Polarographic methods for glucose analysis are based upon which principle of measurement?
A. Nonenzymatic oxidation of glucose
B. The rate of O2 depletion
C. Chemiluminescence caused by formation of adenosine triphosphate (ATP)
D. The change in electrical potential as glucose is oxidized
B
In addition to polarography, what other electrochemical method can be used to measure glucose in plasma?
A. Conductivity
B. Potentiometry
C. Anodic stripping voltammetry
D. Amperometry
D
Select the enzyme that is most specific for β-D-glucose.
A. Hexokinase
B. G-6-PD
C. Phosphohexisomerase
D. Glucose oxidase
D
Select the coupling enzyme used in the hexokinase method for glucose.
A. Glucose-6-phosphate dehydrogenase
B. Peroxidase
C. Glucose dehydrogenase
D. Glucose-6-phosphatase
A
Which glucose method is subject to falsely low results caused by ascorbate?
A. Hexokinase
B. Glucose dehydrogenase
C. Trinder glucose oxidase
D. Polarography
C
Which of the following is a potential source of error in the hexokinase method?
A. Galactosemia
B. Hemolysis
C. Sample collected in fluoride
D. Ascorbic acid
B
Which statement about glucose in cerebrospinal fluid (CSF) is correct?
A. Levels below 40 mg/dL occur in septic meningitis, cancer, and multiple sclerosis
B. CSF glucose is normally the same as the plasma glucose level
C. Hyperglycorrhachia is caused by dehydration
D. In some clinical conditions, the CSF glucose can be greater than the plasma glucose
A
In peroxidase-coupled glucose methods, which reagent complexes with the chromogen?
A. Nitroprusside
B. Phenol
C. Tartrate
D. Hydroxide
B
Point-of-care-tests (POCTs) for whole-blood glucose monitoring are based mainly on the use of:
A. Glucose oxidase as the enzyme
B. Amperometric detection
C. Immunochromatography
D. Peroxidase coupling reactions
B
What effect does hematocrit have on POCT tests for whole-blood glucose monitoring?
A. Low hematocrit decreases glucose readings on all devices
B. High hematocrit raises glucose readings on all devices
C. The effect is variable and dependent on the enzyme/coenzyme system
D. Low hematocrit raises readings and high hematocrit lowers readings unless corrected
D
Which of the following is classified as a mucopolysaccharide storage disease?
A. Pompe’s disease
B. von Gierke disease
C. Hers’ disease
D. Hurler’s syndrome
D
Identify the enzyme deficiency responsible for type 1 glycogen storage disease (von Gierke’s disease). A. Glucose-6-phosphatase
B. Glycogen phosphorylase
C. Glycogen synthetase
D. β-Glucosidase
A
Which of the following abnormal laboratory results is found in von Gierke’s disease?
A. Hyperglycemia
B. Increased glucose response to epinephrine administration
C. Metabolic alkalosis
D. Hyperlipidemia
D
The D-xylose absorption test is used for the differential diagnosis of which two diseases?
A. Pancreatic insufficiency from malabsorption
B. Primary from secondary disorders of glycogen synthesis
C. Type 1 and type 2 diabetes mellitus
D. Generalized from specific carbohydrate intolerance
A
Which of the following statements about carbohydrate intolerance is true?
A. Galactosemia results from deficiency of galactose-1-phosphate (galactose-1-PO4) uridine diphosphate transferase
B. Galactosemia results in a positive glucose oxidase test for glucose in urine
C. Urinary galactose is seen in both galactosemia and lactase deficiency
D. A galactose tolerance test is used to confirm a diagnosis of galactosemia
A
Which of the following statements regarding iron metabolism is correct?
A. Iron absorption is decreased by alcohol ingestion
B. Normally, 40%–50% of ingested iron is absorbed
C. The daily requirement is higher for pregnant and menstruating women
D. Absorption increases with the amount of iron in the body stores
C
Which of the following processes occurs when iron is in the oxidized (Fe3+) state?
A. Absorption by intestinal epithelium
B. Binding to transferrin and incorporation into ferritin
C. Incorporation into protoporphyrin IX to form functional heme
D. Reaction with chromogens in colorimetric assays
B
Which of the following is associated with low serum iron and high total iron-binding capacity (TIBC)?
A. Iron deficiency anemia
B. Hepatitis
C. Nephrosis
D. Noniron deficiency anemias
A
Which condition is associated with the lowest percent saturation of transferrin?
A. Hemochromatosis
B. Anemia of chronic infection
C. Iron deficiency anemia
D. Noniron deficiency anemia
C
Which condition is most often associated with a high serum iron level?
A. Nephrosis
B. Chronic infection or inflammation
C. Polycythemia vera
D. Noniron deficiency anemias
D
Which of the following is likely to occur first in iron deficiency anemia?
A. Decreased serum iron
B. Increased TIBC
C. Decreased serum ferritin
D. Increased transferrin
C
Which formula provides the best estimate of serum TIBC?
A. Serum transferrin in mg/dL × 0.70 = TIBC (μg/dL)
B. Serum transferrin in mg/dL × 1.43 = TIBC (μg/dL)
C. Serum iron (μg/dL)/1.2 + 0.06 = TIBC (μg/dL)
D. Serum Fe (μg/dL) × 1.25 = TIBC (μg/dL)
B
Which statement regarding the diagnosis of iron deficiency is correct?
A. Serum iron levels are always higher at night than during the day
B. Serum iron levels begin to fall before the body stores become depleted
C. A normal level of serum ferritin rules out iron deficiency
D. A low serum ferritin is diagnostic of iron deficiency
D
Which statement about iron methods is true?
A. Interference from Hgb can be corrected by a serum blank
B. Colorimetric methods measure binding of Fe2+ to a ligand such as ferrozine
C. Atomic absorption is the method of choice for measurement of serum iron
D. Serum iron can be measured by potentiometry
B
Which of the following statements regarding the TIBC assay is correct?
A. All TIBC methods require addition of excess iron to saturate transferrin
B. All methods require the removal of unbound iron
C. Measurement of TIBC is specific for transferrin- bound iron
D. The chromogen used must be different from the one used for measuring serum iron
A
Which of the following statements regarding the metabolism of bilirubin is true?
A. It is formed by hydrolysis of the α methene bridge of urobilinogen
B. It is reduced to biliverdin prior to excretion
C. It is a by-product of porphyrin production
D. It is produced from the destruction of RBCs
D
Bilirubin is transported from reticuloendothelial cells to the liver by:
A. Albumin
B. Bilirubin-binding globulin
C. Haptoglobin
D. Transferrin
A
In the liver, bilirubin is conjugated by addition of:
A. Vinyl groups
B. Methyl groups
C. Hydroxyl groups
D. Glucuronyl groups
D
Which enzyme is responsible for the conjugation of bilirubin?
A. β-Glucuronidase
B. UDP-glucuronyl transferase
C. Bilirubin oxidase
D. Biliverdin reductase
B
The term δ-bilirubin refers to:
A. Water-soluble bilirubin
B. Free unconjugated bilirubin
C. Bilirubin tightly bound to albumin
D. Direct-reacting bilirubin
C
Which of the following processes is part of the normal metabolism of bilirubin?
A. Both conjugated and unconjugated bilirubin are excreted into the bile
B. Methene bridges of bilirubin are reduced by intestinal bacteria forming urobilinogens
C. Most of the bilirubin delivered into the intestine is reabsorbed
D. Bilirubin and urobilinogen reabsorbed from the intestine are mainly excreted by the kidneys
B
Which of the following is a characteristic of conjugated bilirubin?
A. It is water soluble
B. It reacts more slowly than unconjugated bilirubin
C. It is more stable than unconjugated bilirubin
D. It has the same absorbance properties as unconjugated bilirubin
A
Which of the following statements regarding urobilinogen is true?
A. It is formed in the intestines by bacterial reduction of bilirubin
B. It consists of a single water-soluble bile pigment
C. It is measured by its reaction with p-aminosalicylate
D. In hemolytic anemia, it is decreased in urine and feces
A
Which statement regarding bilirubin metabolism is true?
A. Bilirubin undergoes rapid photo-oxidation when exposed to daylight
B. Bilirubin excretion is inhibited by barbiturates
C. Bilirubin excretion is increased by chlorpromazine
D. Bilirubin is excreted only as the diglucuronide
A
Which condition is caused by deficient secretion of bilirubin into the bile canaliculi?
A. Gilbert’s disease
B. Neonatal hyperbilirubinemia
C. Dubin–Johnson syndrome
D. Crigler–Najjar syndrome
C
In hepatitis, the rise in serum conjugated bilirubin can be caused by:
A. Secondary renal insufficiency
B. Failure of the enterohepatic circulation
C. Enzymatic conversion of urobilinogen to bilirubin
D. Extrahepatic conjugation
B
Which of the following is a characteristic of obstructive jaundice?
A. The ratio of direct to total bilirubin is greater than 1:2
B. Conjugated bilirubin is elevated, but unconjugated bilirubin is normal
C. Urinary urobilinogen is increased
D. Urinary bilirubin is normal
A
Which of the following would cause an increase in only the unconjugated bilirubin?
A. Hemolytic anemia
B. Obstructive jaundice
C. Hepatitis
D. Hepatic cirrhosis
A
Which form of hyperbilirubinemia is caused by an inherited absence of UDP-glucuronyl transferase?
A. Gilbert’s syndrome
B. Rotor syndrome
C. Crigler–Najjar syndrome
D. Dubin–Johnson syndrome
C
Which statement regarding total and direct bilirubin levels is true?
A. Total bilirubin level is a less sensitive and specific marker of liver disease than the direct level
B. Direct bilirubin exceeds 3.5 mg/dL in most cases of hemolytic anemia
C. Direct bilirubin is normal in cholestatic liver disease
D. The ratio of direct to total bilirubin exceeds 0.40 in hemolytic anemia
A
Which statement best characterizes serum bilirubin levels in the first week following delivery?
A. Serum bilirubin 24 hours after delivery should not exceed the upper reference limit for adults
B. Jaundice is usually first seen 48–72 hours postpartum in neonatal hyperbilirubinemia
C. Serum bilirubin above 5.0 mg/dL occurring 2–5 days after delivery indicates hemolytic or hepatic disease
D. Conjugated bilirubin accounts for about 50% of the total bilirubin in neonates
B
Which form of jaundice occurs within days of delivery and usually lasts 1–3 weeks, but is not due to normal neonatal hyperbilirubinemia or hemolytic disease of the newborn?
A. Gilbert syndrome
B. Lucey –Driscoll syndrome
C. Rotor syndrome
D. Dubin–Johnson syndrome
B
A lab measures total bilirubin by the Jendrassik–Grof bilirubin method with sample blanking. What would be the effect of moderate hemolysis on the test result?
A. Falsely increased due to optical interference
B. Falsely increased due to release of bilirubin from RBCs
C. Falsely low due to inhibition of the diazo reaction by hemoglobin
D. No effect due to correction of positive interference by sample blanking
C
Which reagent is used in the Jendrassik–Grof method to solubilize unconjugated bilirubin?
A. 50% methanol
B. N-butanol
C. Caffeine
D. Acetic acid
C
Which statement about colorimetric bilirubin methods is true?
A. Direct bilirubin must react with diazo reagent under alkaline conditions
B. Most methods are based upon reaction with diazotized sulfanilic acid
C. Ascorbic acid can be used to eliminate interference caused by Hgb
D. The color of the azobilirubin product is independent of pH
B
Which statement regarding the measurement of bilirubin by the Jendrassik–Grof method is correct?
A. The same diluent is used for both total and direct assays to minimize differences in reactivity
B. Positive interference by Hgb is prevented by the addition of HCl after the diazo reaction
C. The color of the azobilirubin product is intensified by the addition of ascorbic acid
D. Fehling’s reagent is added after the diazo reaction to reduce optical interference by hemoglobin
D
A neonatal bilirubin assay performed at the nursery by bichromatic direct spectrophotometry is 4.0 mg/dL. Four hours later, a second sample assayed for total bilirubin by the Jendrassik–Grof method gives a result of 3.0 mg/dL. Both samples are reported to be hemolyzed. What is the most likely explanation of these results?
A. Hgb interference in the second assay
B. δ-Bilirubin contributing to the result of the first assay
C. Falsely high results from the first assay caused by direct bilirubin
D. Physiological variation owing to premature hepatic microsomal enzymes
A
In the enzymatic assay of bilirubin, how is measurement of both total and direct bilirubin accomplished?
A. Using different pH for total and direct assays
B. Using UDP glucuronyl transferase and bilirubin reductase
C. Using different polarity modifiers
D. Measuring the rate of absorbance decrease at different time intervals
A
What is the principle of the transcutaneous bilirubin assay?
A. Conductivity
B. Amperometric inhibition
C. Multiwavelength reflectance photometry
D. Infrared spectroscopy
C
How many grams of sodium hydroxide (NaOH) are required to prepare 150.0 mL of a 5.0% w/v solution?
A. 1.5 g
B. 4.0 g
C. 7.5 g
D. 15.0 g
C
How many milliliters of glacial acetic acid are needed to prepare 2.0 L of 10.0% v/v acetic acid?
A. 10.0 mL
B. 20.0 mL
C. 100.0 mL
D. 200.0 mL
D
A biuret reagent requires preparation of a stock solution containing 9.6 g of copper II sulfate (CuSO4) per liter. How many grams of CuSO4 • 5H2O are needed to prepare 1.0 L of the stock solution?
Atomic weights: H = 1.0; Cu = 63.6; O = 16.0; S = 32.1
A. 5.4 g
B. 6.1 g
C. 15.0 g
D. 17.0 g
C
How many milliliters of HNO3 (purity 68.0%, specific gravity 1.42) are needed to prepare 1.0 L of a 2.0 N solution?
Atomic weights: H = 1.0; N = 14.0; O = 16.0
A. 89.5 mL
B. 126.0 mL
C. 130.5 mL
D. 180.0 mL
C
Convert10.0mg/dLcalcium(atomicweight=40.1) to International System of Units (SI).
A. 0.25
B. 0.40
C. 2.5
D. 0.4
C
Convert 2.0 mEq/L magnesium (atomic weight = 24.3) to milligrams per deciliter.
A. 0.8 mg/dL
B. 1.2 mg/dL
C. 2.4 mg/dL
D. 4.9 mg/dL
C
How many milliliters of a 2,000.0 mg/dL glucose stock solution are needed to prepare 100.0 mL of a 150.0 mg/dL glucose working standard?
A. 1.5 mL
B. 7.5 mL
C. 15.0 mL
D. 25.0 mL
B
What is the pH of a solution of HNO3, if the hydrogen ion concentration is 2.5 × 10–2 M?
A. 1.0
B. 1.6
C. 2.5
D. 2.8
B
Calculate the pH of a solution of 1.5 × 10–5 M NH4OH.
A. 4.2
B. 7.2
C. 9.2
D. 11.2
C
How many significant figures should be reported when the pH of a 0.060 M solution of nitric acid is calculated?
A. 1
B. 2
C. 3
D. 4
B
What is the pH of a 0.05 M solution of acetic acid? Ka = 1.75 × 10–5, pKa = 4.76
A. 1.7
B. 3.0
C. 4.3
D. 4.
B
What is the pH of a buffer containing 40.0 mmol/L NaHC2O4 and 4.0 mmol/L H2C2O4? (pKa = 1.25) A. 1.35
B. 2.25
C. 5.75
D. 6.12
B
A solvent needed for HPLC requires a 20.0 mmol/L phosphoric acid buffer, pH 3.50, made by mixing KH2PO4 and H3PO4. How many grams of KH2PO4 are required to make 1.0 L of this
buffer?
Formula weights: KH2PO4 = 136.1; H3PO4 = 98.0; pKa H3PO4 = 2.12
A. 1.96 g
B. 2.61 g
C. 2.72 g
D. 19.2 g
B
A glycerol kinase method for triglyceride calls for a serum blank in which normal saline is substituted for lipase in order to measure endogenous glycerol. Given the following results, and assuming the same volume of sample and reagent are used for each test, calculate the triglyceride concentration in the patient’s sample.
A. 119 mg/dL
B. 131 mg/dL
C. 156 mg/dL
D. 180 mg/dL
B
A procedure for aspartate aminotransferase (AST) is performed manually because of a repeating error code for nonlinearity obtained on the laboratory’s automated chemistry analyzer; 0.05 mL of serum and 1.0 mL of substrate are used. The reaction rate is measured at 30°C at 340 nm using a 1.0 cM light path, and the delta absorbance (-ΔA) per minute is determined to be 0.382. Based upon a molar absorptivity coefficient for NADH at 340 nm of 6.22 X 103 M–1 cM–1 L–1, calculate the enzyme activity in international units (IUs) per liter.
A. 26 IU/L
B. 326 IU/L
C. 1228 IU/L
D. 1290 IU/L
D
When referring to quality control (QC) results, what parameter usually determines the acceptable range?
A. The 95% confidence interval for the mean
B. The range that includes 50% of the results
C. The central 68% of results
D. The range encompassed by ±2.5 standard deviation
A
Which of the following quality control (QC) rules would be broken 1 out of 20 times by chance alone? A. 12s
B. 22s
C. 13s
D. 14s
A
Which of the following conditions is cause for rejecting an analytical run?
A. Two consecutive controls greater than 2 s above or below the mean
B. Three consecutive controls greater than 1 s above the mean
C. Four controls steadily increasing in value but less than ±1 s from the mean
D. One control above +1 s and the other below –1 s from the mean
A
One of two controls within a run is above +2s and the other control is below –2s from the mean. What do these results indicate?
A. Poor precision has led to random error (RE)
B. A systematic error (SE) is present
C. Proportional error is present
D. QC material is contaminated
A
Two consecutive controls are both beyond –2s from the mean. How frequently would this occur on the basis of chance alone?
A. 1:100
B. 5:100
C. 1:400
D. 1:1,600
D
The term R4S means that:
A. Four consecutive controls are greater than ±1 standard deviation from the mean
B. Two controls in the same run are greater than 4s units apart
C. Two consecutive controls in the same run are each greater than ±4s from the mean
D. There is a shift above the mean for four consecutive controls
B
A trend in QC results is most likely caused by:
A. Deterioration of the reagent
B. Miscalibration of the instrument
C. Improper dilution of standards
D. Electronic noise
A
In most circumstances, when two controls within a run are both greater than ±2s from the mean, what action should be taken first?
A. Recalibrate, then repeat controls followed by selected patient samples if quality control is acceptable
B. Repeat the controls before taking any corrective action
C. Change the reagent lot, then recalibrate
D. Prepare fresh standards and recalibrate
A
When establishing QC limits, which of the following practices is inappropriate?
A. Using last month’s QC data to determine current target limits
B. Exclusion of any QC results greater than ±2s from the mean
C. Using control results from all shifts on which the assay is performed
D. Using limits determined by reference laboratories using the same method
B
Which of the following plots is best for detecting all types of QC errors?
A. Levy–Jennings
B. Tonks–Youden
C. Cusum
D. Linear regression
A
Which of the following plots is best for comparison of precision and accuracy among laboratories?
A. Levy–Jennings
B. Tonks–Youden
C. Cusum
D. Linear regression
B
Which plot will give the earliest indication of a shift or trend?
A. Levy–Jennings
B. Tonks–Youden
C. Cusum
D. Histogram
C
All of the following are requirements for a QC material except:
A. Long-term stability
B. The matrix is similar to the specimens being tested
C. The concentration of analytes reflects the clinical range
D. Analyte concentration must be independent of the method of assay
D
When the magnitude of error increases with increasing sample concentration, it is called:
A. Constant error
B. Proportional error
C. Random error
D. Bias
B
In addition to the number of true negatives (TN), which of the following measurements is needed to calculate specificity?
A. True positives
B. Prevalence
C. False negatives
D. False positives
D
A new tumor marker for ovarian cancer is evaluated for sensitivity by testing serum samples from patients who have been diagnosed by staging biopsy as having malignant or benign lesions.
The following results were obtained:
Number of malignant patients who are positive for
CA 125 = 21 out of 24
Number of benign patients who are negative for
CA 125 = 61 out of 62
What is the sensitivity of the new CA 125 test?
A. 98.4%
B. 95.3%
C. 87.5%
D. 85.0%
C
A new test for prostate cancer is found to have a sensitivity of 80.0% and a specificity of 84.0%. If the prevalence of prostate cancer is 4.0% in men over 42 years old, what is the predictive value of a positive test result (PV+) in this group?
A. 96.0%
B. 86.0%
C. 32.4%
D. 17.2%
D
What measurement in addition to true negatives and prevalence is required to calculate the predictive value of a negative test result (PV–)?
A. False negatives
B. Variance
C. True positives
D. False positives
A
A laboratory is establishing a reference range for a new analyte and wants the range to be determined by the regional population of adults age 18 and older. The analyte concentration is known to be independent of race and gender. Which is the most appropriate process to follow?
A. Determine the mean and standard deviation of the analyte from 40 healthy adults and calculate the ±2s limit
B. Measure the analyte in 120 healthy adults and calculate the central 95th percentile
C. Measure the analyte in 120 healthy adults and use the lowest and highest as the reference range limits
D. Measure the analyte in 60 healthy adults and 60 adults with conditions that affect the analyte concentration; calculate the concentration of least overlap
B
When comparing the laboratory’s monthly mean to its peer group to determine if bias is present, what statistic is most appropriate?
A. F test
B. Linear regression analysis
C. Correlation coefficient
D. Standard deviation index
D
Which of the following methods is most useful in order to detect sample misidentification?
A. Cumulative summation
B. Critical limit
C. Delta limit
D. Significant change limit
C
Which of the following total quality management tools can be used to calculate the analytical error rate for an analyte in the clinical laboratory?
A. LEAN
B. Six sigma
C. ISO 9000
D. Laboratory information system
B
In which circumstances is a validation study (versus performing routine quality control) required?
A. Instrument recalibration
B. Source lamp or ion selective electrode change
C. Change in reagent lot
D. Change in calibrator lot
C
Creatinine is formed from the:
A. Oxidation of creatine
B. Oxidation of protein
C. Deamination of dibasic amino acids
D. Metabolism of purines
A
Creatinine is considered the substance of choice to measure endogenous renal clearance because:
A. The rate of formation per day is independent of body size
B. It is completely filtered by the glomeruli
C. Plasma levels are highly dependent upon diet
D. Clearance is the same for both men and women
B
Which statement regarding creatinine is true?
A. Serum levels are elevated in early renal disease
B. High serum levels result from reduced glomerular filtration
C. Serum creatine has the same diagnostic utility as serum creatinine
D. Serum creatinine is a more sensitive measure of renal function than creatinine clearance
B
Which of the following formulas is the correct expression for creatinine clearance?
A. Creatinine clearance = U/P X V X 1.73/A
B. Creatinine clearance = P/V X U X A/1.73
C. Creatinine clearance = P/V X U X 1.73/A
D. Creatinine clearance = U/V X P X 1.73/A
A
Which of the following conditions is most likely to cause a falsely high creatinine clearance result?
A. The patient uses the midstream void procedure when collecting his or her urine
B. The patient adds tap water to the urine container because he or she forgets to save one of the urine samples
C. The patient does not empty his or her bladder at the conclusion of the test
D. The patient empties his or her bladder at the start of the test and adds the urine to the collection
D
The modification of diet in renal disease (MDRD) formula for calculating eGFR requires which four parameters?
A. Urine creatinine, serum creatinine, height, weight
B. Serum creatinine, age, gender, race
C. Serum creatinine, height, weight, age
D. Urine creatinine, gender, weight, age
B
What substance may be measured as an alternative to creatinine for evaluating GFR?
A. Plasma urea
B. Cystatin C
C. Uric acid
D. Potassium
B
Which of the following enzymes allows creatinine to be measured by coupling the creatinine amidohydrolase (creatininase) reaction to the peroxidase reaction?
A. Glucose-6-phosphate dehydrogenase
B. Creatinine iminohydrolase
C. Sarcosine oxidase
D. Creatine kinase
C
Select the primary reagent used in the Jaffe method for creatinine.
A. Alkaline copper II sulfate
B. Saturated picric acid and NaOH
C. Sodium nitroprusside and phenol
D. Phosphotungstic acid
B
Interference from other reducing substances can be partially eliminated in the Jaffe reaction by:
A. Measuring the product at 340 nm
B. Measuring the product with an electrode
C. Measuring the timed rate of product formation
D. Performing a sample blank
C
Which of the following statements is true?
A. Cystatin C is measured immunochemically
B. The calibrator used for cystatin C is traceable to the National Bureau of Standards calibrator
C. Cystatin C assays have a lower coefficient of variation than plasma creatinine
D. Enzymatic and rate Jaffe reactions for creatinine give comparable results
A
In which case would eGFR derived from the plasma creatinine likely give a more accurate measure of GFR than measurement of plasma cystatin C?
A. Diabetic patient
B. Chronic renal failure
C. Post–renal transplant
D. Chronic hepatitis
C
A sample of amniotic fluid collected for fetal lung maturity studies from a woman with a pregnancy compromised by hemolytic disease of the newborn (HDN) has a creatinine of 88 mg/dL. What is the most likely cause of this result?
A. The specimen is contaminated with blood
B. Bilirubin has interfered with the measurement of creatinine
C. A random error occurred when the absorbance signal was being processed by the analyzer
D. The fluid is urine from accidental puncture of the urinary bladder
D
Which analyte should be reported as a ratio using creatinine concentration as a reference?
A. Urinary microalbumin
B. Urinary estriol
C. Urinary sodium
D. Urinary urea
A
Urea is produced from:
A. The catabolism of proteins and amino acids
B. Oxidation of purines
C. Oxidation of pyrimidines
D. The breakdown of complex carbohydrates
A
Urea concentration is calculated from the BUN by multiplying by a factor of:
A. 0.5
B. 2.14
C. 6.45
D. 14
B
Which of the statements below about serum urea is true?
A. Levels are independent of diet
B. Urea is not reabsorbed by the renal tubules
C. High BUN levels can result from necrotic liver disease
D. BUN is elevated in prerenal as well as renal failure
D
A patient’s BUN is 60 mg/dL and serum creatinine is 3.0 mg/dL. These results suggest:
A. Laboratory error measuring BUN
B. Renal failure
C. Prerenal failure
D. Patient was not fasting
C
Urinary urea measurements may be used for calculation of:
A. Glomerular filtration
B. Renal blood flow
C. Nitrogen balance
D. All of these options
C
BUN is determined electrochemically by coupling the urease reaction to measurement of:
A. Potential with a urea-selective electrode
B. The timed rate of increase in conductivity
C. The oxidation of ammonia
D. Carbon dioxide
B
In the ultraviolet enzymatic method for BUN, the urease reaction is coupled to a second enzymatic reaction using:
A. AST
B. Glutamate dehydrogenase
C. Glutamine synthetase
D. Alanine aminotransferase (ALT)
B
Which product is measured in the coupling step of the urease-UV method for BUN?
A. CO2
B. Dinitrophenylhydrazine
C. Diphenylcarbazone
D. NAD+
D
Which enzyme deficiency is responsible for phenylketonuria (PKU)?
A. Phenylalanine hydroxylase
B. Tyrosine transaminase
C. p-Hydroxyphenylpyruvic acid oxidase
D. Homogentisic acid oxidase
A
Which of the following conditions is classified as a renal-type aminoaciduria?
A. Fanconi syndrome
B. Wilson’s disease
C. Hepatitis
D. Homocystinuria
A
Which aminoaciduria results in the overflow of branched chain amino acids?
A. Hartnup’s disease
B. Alkaptonuria
C. Homocystinuria
D. Maple syrup urine disease
D
In addition to phenylketonuria, maple syrup urine disease, and homocystinuria, what other aminoaciduria can be detected by tandem MS?
A. Alkaptonuria
B. Hartnup disease
C. Citrullinemia
D. Cystinuria
C
Of the methods used to measure amino acids, which is capable of measuring fatty acids simultaneously?
A. Tandem-mass spectroscopy
B. High-performance liquid chromatography
C. Capillary electrophoresis
D. Two-dimensional thin-layer chromatography
A
Blood ammonia levels are usually measured in order to evaluate:
A. Renal failure
B. Acid–base status
C. Hepatic coma
D. Gastrointestinal malabsorption
C
Which statement about ammonia is true?
A. Normally, most of the plasma ammonia is derived from peripheral blood deamination of amino acids
B. Ammonia-induced coma can result from salicylate poisoning
C. Hepatic coma can result from Reye’s syndrome
D. High plasma ammonia is usually caused by respiratory alkalosis
C
A sample for ammonia assay is taken from an IV line that had been capped
and injected with lithium heparin (called a heparin lock). The sample is drawn in a syringe containing lithium heparin, and immediately capped and iced. The plasma is separated and analyzed within 20 minutes of collection, and the result is 50 μg/dL higher than one measured 4 hours before. What is the most likely explanation of these results?
A. Significantly greater physiological variation is seen with patients having systemic, hepatic, and gastrointestinal diseases
B. The syringe was contaminated with ammonia
C. One of the two samples was collected from the wrong patient
D. Stasis of blood in the line caused increased ammonia
D
Uric acid is derived from the:
A. Oxidation of proteins
B. Catabolism of purines
C. Oxidation of pyrimidines
D. Reduction of catecholamines
B
Which of the following conditions is associated with hyperuricemia?
A. Renal failure
B. Chronic liver disease
C. Xanthine oxidase deficiency
D. Paget’s disease of the bone
A
Orders for uric acid are legitimate stat requests because:
A. Levels above 10 mg/dL cause urinary tract calculi
B. Uric acid is hepatotoxic
C. High levels induce aplastic anemia
D. High levels cause joint pain
A
Which uric acid method is associated with negative bias caused by reducing agents?
A. Uricase coupled to the Trinder reaction
B. Ultraviolet uricase reaction coupled to catalase and alcohol dehydrogenase reactions
C. Measurement of the rate of absorbance decrease at 290 nm after addition of uricase
D. Phosphotungstic acid using a protein-free filtrate
A
Kjeldahl’s procedure for total protein is based upon the premise that:
A. Proteins are negatively charged
B. The pKa of proteins is the same
C. The nitrogen content of proteins is constant
D. Proteins have similar tyrosine and tryptophan content
C
Upon which principle is the biuret method based?
A. The reaction of phenolic groups with CuIISO4
B. Coordinate bonds between Cu+2 and carbonyl and imine groups of peptide bonds.
C. The protein error of indicator effect producing color when dyes bind protein
D. The reaction of phosphomolybdic acid with protein
B
Which statement about the biuret reaction for total protein is true?
A. It is sensitive to protein levels below 0.1 mg/dL
B. It is suitable for urine, exudates, and transudates
C. Polypeptides and compounds with repeating imine groups react
D. Hemolysis will not interfere
C
Which of the following protein methods has the highest analytical sensitivity?
A. Refractometry
B. Folin–Lowry
C. Turbidimetry
D. Direct ultraviolet absorption
B
Which of the following statements regarding proteins is true?
A. Total protein and albumin are about 10% higher in ambulatory patients
B. Plasma total protein is about 20% higher than serum levels
C. Albumin normally accounts for about one-third of the cerebrospinal fluid total protein
D. Transudative serous fluid protein is about two-thirds of the serum total protein
A
Hyperalbuminemia is caused by:
A. Dehydration syndromes
B. Liver disease
C. Burns
D. Gastroenteropathy
A
High serum total protein but low albumin is usually seen in:
A. Multiple myeloma
B. Hepatic cirrhosis
C. Glomerulonephritis
D. Nephrotic syndrome
A
Which of the following conditions is most commonly associated with an elevated level of total protein?
A. Glomerular disease
B. Starvation
C. Liver failure
D. Malignancy
D
Which of the following dyes is the most specific for measurement of albumin?
A. Bromcresol green (BCG)
B. Bromcresol purple (BCP)
C. Tetrabromosulfophthalein
D. Tetrabromphenol blue
B
Which of the following factors is most likely to cause a falsely low result when using the BCG dye-binding assay for albumin?
A. The presence of penicillin
B. An incubation time of 120 seconds
C. The presence of bilirubin
D. Lipemia
A
At pH 8.6, proteins are _________ charged and migrate toward the _________.
A. Negatively, anode
B. Positively, cathode
C. Positively, anode
D. Negatively, cathode
A
Electrophoretic movement of proteins toward the anode will decrease by increasing the:
A. Buffer pH
B. Ionic strength of the buffer
C. Current
D. Voltage
B
At pH 8.6, the cathodal movement of γ globulins is caused by:
A. Electroendosmosis
B. Wick flow
C. A net positive charge
D. Cathodal sample application
A
Which of the following conditions will prevent any migration of proteins across an electrophoretic support medium such as agarose?
A. Using too high a voltage
B. Excessive current during the procedure
C. Loss of contact between a buffer chamber and the medium
D. Evaporation of solvent from the surface of the medium
C
Which of the following proteins has the highest pI?
A. Albumin
B. Transferrin
C. Ceruloplasmin
D. IgG
D
Which of the following proteins migrates in the β region at pH 8.6?
A. Haptoglobin
B. Orosomucoprotein
C. Antichymotrypsin
D. Transferrin
D
Which of the following is one advantage of high-resolution (HR) agarose electrophoresis over lower-current electrophoresis?
A. High-resolution procedures detect monoclonal and oligoclonal bands at a lower concentration
B. A smaller sample volume is used
C. Results are obtained more rapidly
D. Densitometric scanning of HR gels is more accurate
A
Which of the following conditions is associated with “β-γ bridging”?
A. Multiple myeloma
B. Malignancy
C. Hepatic cirrhosis
D. Rheumatoid arthritis
C
Which support medium can be used to determine the molecular weight of a protein?
A. Cellulose acetate
B. Polyacrylamide gel
C. Agar gel
D. Agarose gel
B
Which of the following stains is used for lipoprotein electrophoresis?
A. Oil Red O
B. Coomassie Brilliant Blue
C. Amido Black D. Ponceau S
A
Which of the following conditions is usually associated with an acute inflammatory pattern?
A. Myocardial infarction (MI)
B. Malignancy
C. Rheumatoid arthritis
D. Hepatitis
A
What is the clinical utility of testing for serum prealbumin?
A. Low levels are associated with increased free cortisol
B. High levels are an indicator of acute inflammation
C. Serial low levels indicate compromised nutritional status
D. Levels correlate with glomerular injury in patients with diabetes mellitus
C
Which serum protein should be measured in a patient suspected of having Wilson’s disease?
A. Hemopexin
B. Alpha-1 antitrypsin
C. Haptoglobin
D. Ceruloplasmin
D
A patient with hemolytic-uremic syndrome associated with septicemia has a haptoglobin level that is normal, although the plasma free hemoglobin is elevated and hemoglobinuria is present. Which test would be more appropriate than haptoglobin to measure this patient’s hemolytic episode?
A. Hemopexin
B. Alpha-1 antitrypsin
C. C-reactive protein
D. Transferrin
A
Quantitative determination of Hgb A2 and Hgb F are best performed by:
A. High-performance liquid chromatography
B. Alkali denaturation
C. Electrophoresis
D. Direct bichromatic spectrophotometry
A
Select the correct order of Hgb migration on agarose or cellulose acetate at pH 8.6.
A. – C→F→S→A +
B. – S→C→A→F +
C. – C→S→F→A +
D. – S→F→A→C +
C
Which of the following abnormal types of Hgb migrates to the same position as Hgb S on agarose or cellulose acetate at pH 8.6?
A. Hgb C
B. Hgb D Punjab
C. Hgb OArab
D. Hgb E
b
Which Hgb is a β-δ chain hybrid and migrates to the same position as Hgb S at pH 8.6?
A. Hgb CHarlem
B. HgbLepore
C. Hgb GPhiladelphia
D. Hgb DPunjab
B
Select the correct order of Hgb migration on citrate agar at pH 6.2.
A. – F→S→C→A +
B. – F→A→S→C +
C. – A→S→F→C +
D. – A→C→S→F +
B
Which Hgb separates from Hgb S on citrate (acid) agar, but not agarose or cellulose acetate?
A. Hgb DPunjab
B. Hgb E
C. Hgb CHarlem (Georgetown)
D. Hgb OArab
A
Which statement best describes immunofixation electrophoresis (IEF)?
A. Proteins are separated by electrophoresis followed by overlay of monospecific anti-immunoglobulins
B. Proteins react with monospecific antisera followed by electrophoresis
C. Antisera are electrophoresed, then diffused against patient’s serum
D. Serum is electrophoresed; the separated immunoglobulins diffuse against specific antisera placed into troughs
A
In double immunodiffusion reactions, the precipitin band is:
A. Invisible before the equivalence point is reached
B. Concave to the protein of greatest molecular weight
C. Closest to the well containing the highest level of antigen
D. Located in an area of antibody excess
B
Which of the following statements regarding the identification of monoclonal proteins by IFE is true?
A. The monoclonal band must be present in the γ region
B. When testing for a monoclonal gammopathy, both serum and urine must be examined
C. A diagnosis of monoclonal gammopathy is based upon quantitation of IgG, IgA, and IgM
D. A monoclonal band always indicates a malignant disorder
B
Which of the following statements regarding paraproteins is true?
A. Oligoclonal banding is seen in the CSF of greater than 90% of multiple sclerosis cases
B. The Bence–Jones protein heat test is confirmatory for monoclonal light chains
C. Light chains found in urine are always derived from monoclonal protein
D. The IgA band is usually cathodal to the IgG precipitin band
A
Which statement regarding IFE is true?
A. Serum containing a monoclonal protein should have a κ:λ ratio of 0.5
B. A monoclonal band seen with monospecific antiserum should not be visible in the lane where polyvalent antiserum or sulfosalicylic acid was added
C. CSF should be concentrated 50- to100-fold before performing IFE
D. When oligoclonal bands are seen in the CSF, they must also be present in serum to indicate multiple sclerosis
C
Which test is the most sensitive in detecting early monoclonal gammopathies?
A. High-resolution serum protein electrophoresis
B. Urinary electrophoresis for monoclonal light chains
C. Capillary electrophoresis of serum and urine
D. Serum-free light chain immunoassay
D
Which test is the most useful way to evaluate the response to treatment for multiple myeloma?
A. Measure of total immunoglobulin
B. Measurement of 24-hour urinary light chain concentration (Bence–Jones protein)
C. Capillary electrophoresis of M-protein recurrence
D. Measurement of serum-free light chains
D
Which of the following is more commonly associated with a nonmalignant form of monoclonal gammopathy (MGUS)?
A. Bone marrow plasma cells comprise 20% of nucleated cells
B. Monoclonal protein (M-protein) concentration is 3.5 g/dL
C. M-protein is IgG
D. Age greater than 60 at the time of monoclonal protein discovery
D
Capillary electrophoresis differs from agarose gel electrophoresis in which respect?
A. A stationary support is not used
B. An acidic buffer is used
C. A low voltage is used
D. Electroendosmosis does not occur
A
Select the order of mobility of lipoproteins electrophoresed on cellulose acetate or agarose at pH 8.6.
A. – Chylomicrons→pre-β →β→α+
B. – β→pre-β→α→chylomicrons +
C. – Chylomicrons →β→pre-β→α +
D. – α→β→pre-β→chylomicrons +
C
Following ultracentrifugation of plasma, which fraction correlates with pre-β lipoprotein?
A. Very low-density lipoprotein (VLDL)
B. Low-density lipoprotein (LDL)
C. High-density lipoprotein (HDL) D. Chylomicrons
A
Select the lipoprotein fraction that carries most of the endogenous triglycerides.
A. VLDL
B. LDL
C. HDL
D. Chylomicrons
A
The protein composition of HDL is what percentage by weight?
A. Less than 2%
B. 25%
C. 50%
D. 90%
C
Which apoprotein is inversely related to risk of coronary heart disease?
A. Apoprotein A-I
B. Apoprotein B100
C. Apoprotein C-II
D. Apoprotein E4
A
In familial β dyslipoproteinemia (formerly type III hyperlipoproteinemia), which lipoprotein accumulates?
A. Chylomicrons
B. VLDL
C. IDL
D. VLDL
C
Which of the following mechanisms accounts for the elevated plasma level of β lipoproteins seen in familial hypercholesterolemia (formerly type II hyperlipoproteinemia)?
A. Hyperinsulinemia
B. ApoB-100 receptor defect
C. ApoC-II activated lipase deficiency
D. ApoE3 deficiency
B
Which enzyme deficiency is most commonly associated with familial hypertriglyceridemia associated with fasting plasma cholomicrons (formerly type I hyperlipoproteinemia)?
A. β Glucocerebrosidase deficiency
B. Post–heparin-activated lipoprotein lipase deficiency
C. Apo-B deficiency
D. Apo-C-III deficiency
B
Which of the following conditions is most consistently associated with secondary hypercholesterolemia?
A. Hypothyroidism
B. Pancreatitis
C. Oral contraceptive therapy
D. Diabetes mellitus
A
Which of the following is associated with Tangier disease?
A. Apoprotein C-II deficiency
B. Homozygous apo-B100 deficiency
C. Apoprotein C-II activated lipase
D. Apoprotein A-I deficiency
A
Which of the following statements is correct?
A. Both HDL and LDL are homogenous
B. There are several subfractions of LDL but not HDL
C. There are several subfractions of HDL but not LDL
D. There are several subfractions of both HDL and LDL
D
What is the lipid testing protocol for adults recommended by the National Cholesterol Education Program (NCEP) to evaluate risk for atherosclerosis beginning at age 20?
A. Total cholesterol, fasting or nonfasting every year
B. Total cholesterol, fasting, every 2 years
C. Lipid profile, fasting, every 5 years
D. LDL cholesterol, fasting, every 2 years
C
What is the most appropriate fasting procedure when a lipid study of triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol tests are ordered?
A. 8 hours; nothing but water allowed
B. 10 hours; water, smoking, coffee, tea (no sugar or cream) allowed
C. 12 hours; nothing but water allowed
D. 16 hours; water, smoking, coffee, tea (no sugar or cream) allowed
C
Treatment recommendations for patients with coronary heart disease are based upon measurement of which analyte?
A. HDL cholesterol
B. Apo-B100
C. LDL cholesterol
D. Total cholesterol
C
What is the HDL cholesterol cutpoint recommend by NCEP?
A. <30 mg/dL
B. <40 mg/dL
C. <30 mg/dL for males and < 40 mg/dL for females
D. <45 mg/dL for males and < 50 mg/dL for females
B
An EDTA blood sample is collected from a nonfasting person for a CBC. The physician collected the sample from the femoral vein because venipuncture from the arm was unsuccessful. He called the lab 15 minutes after the sample arrived and requested a lipid study including triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol. Which test results should be used to evaluate the patient’s risk for coronary artery disease?
A. Total cholesterol and LDL cholesterol
B. LDL cholesterol and triglyceride
C. Total cholesterol and HDL cholesterol
D. Total cholesterol and triglyceride
C
Which of the following diseases is caused by a deficiency of sphingomyelinase?
A. Gaucher disease
B. Fabry disease
C. Niemann–Pick disease
D. Tay–Sachs disease
C
Which method is considered the candidate reference method for triglyceride measurement?
A. Glycerol kinase-ultraviolet
B. CDC modification of van Handel and Zilversmit
C. Hantzsch condensation
D. Glycerol kinase coupled to peroxidase
B
Which of the following enzymes is common to all enzymatic methods for triglyceride measurement?
A. Glycerol phosphate oxidase
B. Glycerol phosphate dehydrogenase
C. Glycerol kinase
D. Pyruvate kinase
C
Select the reagent needed in the coupling enzyme reaction used to generate a colored product in the cholesterol oxidase method for cholesterol.
A. Cholestahexaene
B. H2O2
C. 4-Aminoantipyrine
D. Cholest-4-ene-3-one
C
What is the purpose of the saponification step used in the Abell–Kendall method for cholesterol measurement?
A. Remove phospholipids
B. Reduce sterol molecules structurally similar to cholesterol
C. Convert cholesterol esters to free cholesterol
D. Remove proteins that can interfere with color formation
C
Which of the following methods for HDL cholesterol is the reference method?
A. Manganese–heparin
B. Magnesium–phosphotungstate
C. Magnesium–dextran
D. Ultracentrifugation
D
Cholesterol esterase is used in enzymatic assays to:
A. Oxidize cholesterol to form peroxide
B. Hydrolyze fatty acids bound to the third carbon atom of cholesterol
C. Separate cholesterol from apoproteins A-I and A-II by hydrolysis
D. Reduce NAD+ to NADH
B
Which of the following reagents is used in the direct HDL cholesterol method?
A. Sulfated cyclodextrin
B. Magnesium sulfate and dextran sulfate
C. Anti-apoA-I
D. Manganese heparin
A
What do “direct” or homogenous methods for LDL cholesterol assay have in common?
A. They are inaccurate when plasma triglyceride is above 250 mg/dL
B. All use a detergent to facilitate selective reactivity with reagent enzymes
C. All use monoclonal antibodies to apo A1 and C
D. All are free of interference from abnormal lipoproteins
B
Lipoprotein (a), or Lp(a), is significant when elevated in serum because it:
A. Is an independent risk factor for atherosclerosis
B. Blocks the clearance of VLDLs
C. Displaces apo-AI from HDLs
D. Is linked closely to a gene for obesity
A
Which type of dietary fatty acid is not associated with an increase in serum LDL cholesterol production?
A. Monounsaturated trans fatty acids
B. Saturated fatty acids
C. Monounsaturated cis fatty acids
D. Monounsaturated trans Ω-9 fatty acids
C
A lipemic specimen collected from an adult after a 12-hour fast was assayed for total cholesterol, triglycerides, and HDL cholesterol using a direct HDL method. Following are the results:
Total cholesterol = 220 mg/dL HDL cholesterol = 40 mg/dL Triglyceride = 420 mg/dL
The physician requests an LDL cholesterol assay after receiving the results. How should the LDL cholesterol be determined?
A. Dilute the specimen 1:10 and repeat all tests; calculate LDL cholesterol using the Friedewald equation
B. Perform a direct LDL cholesterol assay
C. Ultracentrifuge the sample and repeat the HDL cholesterol on the infranate. Use the new result to calculate the LDL cholesterol
D. Repeat the HDL cholesterol using the manganese heparin precipitation method. Use the new result to calculate the LDL cholesterol
B
A person has a fasting triglyceride level of 240 mg/dL. The physician wishes to know the patient’s non-HDL cholesterol level. What cholesterol fractions should be measured?
A. Total cholesterol and HDL cholesterol
B. Total cholesterol and LDL cholesterol
C. HDL cholesterol and LDL cholesterol
D. Total cholesterol and chylomicrons
A
An international unit (IU) of enzyme activity is the quantity of enzyme that:
A. Converts 1 μmol of substrate to product per liter
B. Forms 1 mg of product per deciliter
C. Converts 1 μmol of substrate to product per minute
D. Forms 1 μmol of product per liter
C
Which of the following statements describes a nonkinetic enzyme assay?
A. Initial absorbance is measured followed by a second reading after 5 minutes
B. Absorbance is measured at 10-second intervals for 100 seconds
C. Absorbance is monitored continuously for 1 minute using a chart recorder
D. Reflectance is measured from a xenon source lamp pulsing at 60 Hz
A
Which of the following statements regarding enzymatic reactions is true?
A. The enzyme shifts the equilibrium of the reaction to the right
B. The enzyme alters the equilibrium constant of the reaction
C. The enzyme increases the rate of the reaction
D. The enzyme alters the energy difference between reactants and products
C
Which statement about enzymes is true?
A. An enzyme alters the Gibb’s free energy of the reaction
B. Enzymes cause a reaction with a positive free energy to occur spontaneously
C. An enzyme’s natural substrate has the highest Km
D. A competitive inhibitor will alter the apparent Km of the reaction
D
Which substrate concentration is needed to achieve zero-order conditions?
A. Greater than 99 × Km
B. [S] = Km
C. Less than 10 × Km
D. [S] = 0
A
Which of the following statements is true?
A. Apoenzyme + prosthetic group = holoenzyme
B. A coenzyme is an inorganic molecule required for activity
C. Cofactors are as tightly bound to the enzyme as prosthetic groups
D. All enzymes have optimal activity at pH 7.00
A
Which of the following statements about enzymatic reactions is true?
A. NADH has absorbance maximas at 340 and 366 nm
B. Enzyme concentration must be in excess to achieve zero-order kinetics
C. Rate is proportional to substrate concentration in a zero-order reaction
D. Accumulation of the product increases the reaction rate
A
The increase in the level of serum enzymes used to detect cholestatic liver disease is caused mainly by:
A. Enzyme release from dead cells
B. Leakage from cells with altered membrane permeability
C. Decreased perfusion of the tissue
D. Increased production and secretion by cells
D
Which of the following enzymes is considered most tissue specific?
A. Creatine kinase (CK)
B. Amylase
C. Alkaline phosphatase (ALP)
D. Alcohol dehydrogenase (ADH)
D
Which of the following enzymes is activated by calcium ions?
A. CK
B. Amylase
C. ALP
D. LD
B
Which of the following enzymes is a transferase?
A. ALP
B. CK
C. Amylase
D. LD
B
Which statement about methods for measuring LD is true?
A. The formation of pyruvate from lactate (forward reaction) generates NAD+
B. The pyruvate-to-lactate reaction proceeds at about twice the rate as the forward reaction
C. The lactate-to-pyruvate reaction is optimized at pH 7.4
D. The negative-rate reaction is preferred
B
Which condition produces the highest elevation of serum lactate dehydrogenase?
A. Pernicious anemia
B. Myocardial infarction
C. Acute hepatitis
D. Muscular dystrophy
A
In which condition is the LD most likely to be within normal limits?
A. Hepatic carcinoma
B. Pulmonary infarction
C. Acute appendicitis
D. Crush injury
C
The LD pleural fluid:serum ratio for a transudative fluid is usually:
A. 3:1 or higher
B. 2:1
C. 1:1
D. 1:2 or less
D
In which type of liver disease would you expect the greatest elevation of LD?
A. Toxic hepatitis
B. Alcoholic hepatitis
C. Cirrhosis
D. Acute viral hepatitis
A
Which of the following conditions will interfere with the measurement of LD?
A. Slight hemolysis during sample collection
B. Storage at 4°C for 3 days
C. Storage at room temperature for 16 hours
D. Use of plasma collected in heparin
A
In the Oliver–Rosalki method, the reverse reaction is used to measure CK activity. The enzyme(s) used in the coupling reactions is (are):
A. Hexokinase and G-6-PD
B. Pyruvate kinase and LD
C. Luciferase
D. Adenylate kinase
A
In the Oliver–Rosalki method for CK, adenosine monophosphate (AMP) is added to the substrate in order to:
A. Inhibit adenylate kinase
B. Block the oxidation of glutathione
C. Increase the amount of ADP that is available
D. Block the action of diadenosine pentaphosphate
A
Which substance is used in the CK assay to activate the enzyme?
A. Flavin adenine dinucleotide (FAD)
B. Imidazole
C. N-acetylcysteine
D. Pyridoxyl-5 ́-phosphate
C
A specimen for CK performed on an automated analyzer using an optimized Oliver–Rosalki method gives an error flag indicating substrate depletion. The sample is diluted 1:2 and 1:4 by the serial dilution technique and reassayed. After correcting for the dilution.
The results are as follows: 1:2 Dilution = 3,000 IU/L 1:4 Dilution = 3,600 IU/L
Dilutions are made a second time and assayed again but give identical results. What is the most likely explanation?
A. The serum became contaminated prior to making the 1:4 dilution
B. The wrong pipet was used to make one of the dilutions
C. An endogenous competitive inhibitor is present in the serum
D. An error has been made in calculating the enzyme activity of one of the two dilutions
C
A physician calls to request a CK on a sample already sent to the laboratory for coagulation studies. The sample is 2-hour-old citrated blood and has been stored at 4°C. The plasma shows very slight hemolysis. What is the best course of action and the reason for it?
A. Perform the CK assay on the sample because no interferent is present
B. Reject the sample because it is slightly hemolyzed
C. Reject the sample because it has been stored too long
D. Reject the sample because the citrate will interference
D
Which of the following statements regarding total CK is true?
A. Levels are unaffected by strenuous exercise
B. Levels are unaffected by repeated intramuscular injections
C. Highest levels are seen in Duchenne’s muscular dystrophy
D. The enzyme is highly specific for heart injury
C
Which of the following statements regarding the clinical use of CK-MB (CK-2) is true?
A. CK-MB becomes elevated before myoglobin after an AMI
B. CK-MB levels are usually increased in cases of cardiac ischemia
C. CK-MB is more specific than myoglobin
D. An elevated CK-MB is always accompanied by an elevated total CK
C
A patient’s CK-MB is reported as 18 μg/L and the total CK as 560 IU/L. What is the CK relative index (CKI)?
A. 0.10%
B. 3.2%
C. 10.0%
D. 30.0%
B
In a nonmyocardial as opposed to a myocardial cause of an increased serum or plasma CK-MB, which would be expected?
A. An increase in CK-MB that is persistent
B. An increase in the percent CK-MB as well as concentration
C. The presence of increased TnI
D. A more modest increase in total CK than CK-MB
A
Which statement best describes the clinical utility of plasma or serum myoglobin?
A. Levels greater than 100 μg/L are diagnostic of AMI
B. Levels below 100 μg/L on admission and 2–4 hours postadmission help to exclude a diagnosis of AMI
C. Myoglobin peaks after the cardiac troponins but is more sensitive
D. The persistence of myoglobin > 110 μg/L for 3 days following chest pain favors a diagnosis of AMI
B
What is the typical time course for plasma myoglobin following an AMI?
A. Abnormal before 1 hour; peaks within 3 hours; returns to normal in 8 hours
B. Abnormal within 3 hours; peaks within 6 hours; returns to normal in 18 hours
C. Abnormal within 2 hours; peaks within 12 hours; returns to normal in 36 hours
D. Abnormal within 6 hours; peaks within 24 hours; returns to normal in 72 hours
C
What is the typical time course for plasma TnI or TnT following an AMI?
A. Abnormal within 3 hours; peaks within 12 hours; returns to normal in 24 hours
B. Abnormal within 4 hours; peaks within 18 hours; returns to normal in 48 hours
C. Abnormal within 4 hours; peaks within 24 hours; returns to normal in 1 week
D. Abnormal within 6 hours; peaks within 36 hours; returns to normal in 5 days
C
Which of the following is the most effective serial sampling time for ruling out AMI using both myoglobin and a cardiac specific marker in an emergency department environment?
A. Admission and every hour for the next 3 hours or until positive
B. Admission, 2 hours, 4 hours, and 6 hours or until positive
C. Admission, 3 hours, 6 hours, and a final sample within 12 hours
D. Admission and one sample every 8 hours for 48 hours
C
What is the recommended troponin T and I cutoff (upper limit of normal) for detecting myocardial infarction?
A. The cutoff varies with the method of assay but should be no lower than 0.2 ng/mL
B. The upper 99th percentile or lowest level that can be measured with 10% CV
C. The concentration corresponding to the lowest level of calibrator used
D. The highest value fitting under the area of the curve for the 95% confidence interval
B
Which of the following cardiac markers is consistently increased in persons who exhibit unstable angina?
A. Troponin C
B. Troponin T
C. CK-MB
D. Myoglobin
B
A patient has a plasma myoglobin of 10 μg/L at admission. Three hours later, the myoglobin is
14 μg/L and the troponin I is 0.02 μg/L (reference range 0–0.03 μg/L). These results are consistent with which condition?
A. Skeletal muscle injury
B. Acute myocardial infarction
C. Unstable angina
D. No evidence of myocardial or skeletal muscle injury
D
A patient has a plasma CK-MB of 14 μg/L at admission and a total CK of 170 IU/L. Serum myoglobin is 130 μg/L and TnI is 1.6 μg/L. Three hours later, the TnI is 3.0 μg/L. Which statement best describes this situation?
A. This patient has had an AMI and further testing is unnecessary
B. A second CK-MB and myoglobin test should have been performed at 3 hours postadmission to confirm AMI
C. These results are consistent with skeletal muscle damage associated with a crush injury that elevated the CK-MB
D. Further testing 6–12 hours postadmission is required to establish a diagnosis of AMI
A
An EDTA sample for TnI assay gives a result of 0.04 ng/mL (reference range 0–0.03 ng/mL). The test is repeated 3 hours later on a new specimen and the result is
0.06 ng/mL. A third sample collected 6 hours later gives a result of 0.07 ng/mL. The EKG showed no evidence of ST segment elevation (STEMI). What is the most likely explanation?
A. A false-positive result occurred due to matrix interference
B. Heparin should have been used instead of EDTA, which causes false positives
C. The patient has suffered cardiac injury
D. The patient has had an ischemic episode without cardiac injury
C
Which of the following laboratory tests is a marker for ischemic heart disease?
A. CK-MB isoforms
B. Myosin light chain 1
C. Albumin cobalt binding
D. Free fatty acid binding protein
C
Which test becomes abnormal in the earliest stage of the acute coronary syndrome?
A. Myosin light chain 1
B. CK-MB isoforms
C. Myoglobin
D. High-sensitivity C-reactive protein
D
Which statement best describes the clinical utility of B-type natriuretic peptide (BNP)?
A. Abnormal levels may be caused by obstructive lung disease
B. A positive test indicates prior myocardial damage caused by AMI that occurred within the last 3 months
C. A normal test result (<100 pg/mL) helps rule out congestive heart failure in persons with symptoms associated with coronary insufficiency
D. A level above 100 pg/mL is not significant if evidence of congestive heart failure is absent
C
Which statement best describes the clinical utility of plasma homocysteine?
A. Levels are directly related to the quantity of LDL cholesterol in plasma
B. High plasma levels are associated with atherosclerosis and increased risk of thrombosis
C. Persons who have an elevated plasma homocysteine will also have an increased plasma Lp(a)
D. Plasma levels are increased only when there is an inborn error of amino acid metabolism
B
Which of the following cardiac markers derived from neutrophils predicts an increased risk for myocardial infarction?
A. Phospholipase A2 (PLA2)
B. Glycogen phosphorylase BB (GPBB)
C. Soluble CD40 ligand (sCD40l)
D. Myeloperoxidase (MPO)
D
Which of the following statements about the aminotransferases (AST and ALT) is true?
A. Isoenzymes of AST and ALT are not found in humans
B. Both transfer an amino group to α–ketoglutarate
C. Both require NADP+ as a coenzyme
D. Both utilize four carbon amino acids as substrates
B
Select the products formed from the forward reaction of AST.
A. Alanine and α–ketoglutarate
B. Oxaloacetate and glutamate
C. Aspartate and glutamine
D. Glutamate and NADH
B
Select the products formed from the forward reaction of ALT.
A. Aspartate and alanine
B. Alanine and α–ketoglutarate
C. Pyruvate and glutamate
D. Glutamine and NAD+
C
Which of the statements below regarding the methods of Henry for AST and ALT is correct?
A. Hemolysis will cause positive interference in both AST and ALT assays
B. Loss of activity occurs if samples are frozen at –20°C
C. The absorbance at the start of the reaction should not exceed 1.0 A
D. Reaction rates are unaffected by addition of P-5 ́-P to the substrate
A
Select the coupling enzyme used in the kinetic AST reaction of Henry.
A. LD
B. Malate dehydrogenase
C. Glutamate dehydrogenase
D. G-6-PD
B
What is the purpose of LD in the kinetic method of Henry for AST?
A. Forms NADH, enabling the reaction to be monitored at 340 nm
B. Rapidly exhausts endogenous pyruvate in the lag phase
C. Reduces oxaloacetate, preventing product inhibition
D. Generates lactate, which activates AST
B
Which of the following statements regarding the naming of transaminases is true?
A. Serum glutamic oxaloacetic transaminase (SGOT) is the older abbreviation for ALT
B. Serum glutamic pyruvic transaminase (SGPT) is the older abbreviation for AST
C. SGPT is the older abbreviation for ALT
D. SGOT is the newer abbreviation for AST
C
Which statement accurately describes serum transaminase levels in AMI?
A. ALT is increased 5- to 10-fold after an AMI
B. AST peaks 24–48 hours after an AMI and returns to normal within 4–6 days
C. AST levels are usually 20–50 times the upper limit of normal after an AMI
D. Isoenzymes of AST are of greater diagnostic utility than the total enzyme level
B
Which condition gives rise to the highest serum level of transaminases?
A. Acute hepatitis
B. Alcoholic cirrhosis
C. Obstructive biliary disease
D. Diffuse intrahepatic cholestasis
A
In which liver disease is the DeRitis ratio (ALT:AST) usually greater than 1.0?
A. Acute hepatitis
B. Chronic hepatitis
C. Hepatic cirrhosis
D. Hepatic carcinoma
A
Which of the following liver diseases produces the highest levels of transaminases?
A. Hepatic cirrhosis
B. Obstructive jaundice
C. Hepatic cancer
D. Alcoholic hepatitis
C
Which of the following statements regarding transaminases is true?
A. ALT is often increased in muscular disease, pancreatitis, and lymphoma
B. ALT is increased in infectious mononucleosis, but AST is usually normal
C. ALT is far more specific for liver diseases than is AST
D. Substrate depletion seldom occurs in assays of serum from hepatitis cases
C
Select the most sensitive marker for alcoholic liver disease.
A. GLD
B. ALT
C. AST
D. γ-Glutamyltransferase (GGT)
D
Which enzyme is least useful in differentiating necrotic from obstructive jaundice?
A. GGT
B. ALT
C. 5’ Nucleotidase
D. LD
D
Which of the following statements about the phosphatases is true?
A. They hydrolyze adenosine triphosphate and related compounds
B. They are divided into two classes based upon pH needed for activity
C. They exhibit a high specificity for substrate
D. They are activated by Pi
B
Which of the following statements regarding ALP is true?
A. In normal adults, the primary tissue source is fast-twitch skeletal muscle
B. Geriatric patients have a lower serum ALP than other adults
C. Serum ALP levels are lower in children than in adults
D. Pregnant women have a higher level of serum ALP than other adults
D
Which isoenzyme of ALP is most heat stable?
A. Bone
B. Liver
C. Intestinal
D. Placental
D
Which isoenzyme of ALP migrates farthest toward the anode when electrophoresed at pH 8.6?
A. Placental
B. Bone
C. Liver
D. Intestinal
C
Which statement regarding bone-specific ALP is true?
A. The bone isoenzyme can be measured immunochemically
B. Bone ALP is increased in bone resorption
C. Bone ALP is used for the diagnosis of osteoporosis
D. There are two distinct bone isoenzymes
A
Which of the following statements regarding ALP is true?
A. All isoenzymes of ALP are antigenically distinct and can be identified by specific antibodies
B. Highest serum levels are seen in intrahepatic obstruction
C. Elevated serum ALP seen with elevated GGT suggests a hepatic source
D. When jaundice is present, an elevated ALP suggests acute hepatitis
C
In which condition would an elevated serum alkaline phosphatase be likely to occur?
A. Small cell lung carcinoma
B. Hemolytic anemia
C. Prostate cancer
D. Acute myocardial infarction
A
Which condition is least likely to be associated with increased serum ALP?
A. Osteomalacia
B. Biliary obstruction
C. Hyperparathyroidism and hyperthyroidism
D. Osteoporosis
D
Which substrate is used in the Bowers–McComb method for ALP?
A. p-Nitrophenyl phosphate
B. β-Glycerophosphate
C. Phenylphosphate
D. α-Naphthylphosphate
A
Which of the following buffers is used in the IFCC recommended method for ALP?
A. Glycine
B. Phosphate
C. 2-Amino-2-methyl-1-propanol
D. Citrate
C
A serum ALP level greater than twice the elevation of GGT suggests:
A. Misidentification of the specimen
B. Focal intrahepatic obstruction
C. Acute alcoholic hepatitis
D. Bone disease or malignancy
D
In which condition is the measurement of acid phosphatase clinically useful?
A. Measuring the prostatic isoenzyme to screen for prostate cancer
B. Measuring the enzyme in a vaginal swab extract
C. The diagnosis of hemolytic anemia
D. As a marker for bone regeneration
B
Which definition best describes the catalytic activity of amylase?
A. Hydrolyzes second α 1–4 glycosidic linkages of starch, glycogen, and other polyglucans
B. Hydrolyzes all polyglucans completely to produce glucose
C. Oxidatively degrades polysaccharides containing glucose
D. Splits polysaccharides and disaccharides by addition of water
A
Which of the following amylase substrates is recommended by the IFCC?
A. Starch
B. Maltodextrose
C. Maltotetrose
D. Blocked maltohepatoside
D
How soon following acute abdominal pain due to pancreatitis is the serum amylase expected to rise? A. 1–2 hours
B. 2–12 hours
C. 3–4 days
D. 5–6 days
B
Which of the following statements regarding the diagnosis of pancreatitis is correct?
A. Amylase and lipase are as predictive in chronic as in acute pancreatitis
B. Diagnostic sensitivity is increased by assaying both amylase and lipase
C. Measuring the urinary amylase:creatinine ratio is useful only when patients have renal failure
D. Serum lipase peaks several hours before amylase after an episode of acute pancreatitis
B
Which of the following conditions is associated with a high level of S-type amylase?
A. Mumps
B. Intestinal obstruction
C. Alcoholic liver disease
D. Peptic ulcers
A
Which of the following statements regarding amylase methods is true?
A. Requires sulfhydryl compounds for full activity
B. Activity will vary depending on the method used
C. Amyloclastic methods measure the production of glucose
D. Overrange samples are diluted in deionized water
B
Which of the following statements regarding amylase methods is true?
A. Dilution of serum may result in lower than expected activity
B. Methods generating NADH are preferred because they have higher sensitivity
C. Synthetic substrates can be conjugated to p-nitrophenol (PNP) for a kinetic assay
D. The reference range is consistent from method to method
C
The reference method for lipase uses olive oil as the substrate because:
A. Other esterases can hydrolyze triglyceride and synthetic diglycerides
B. The reaction product can be coupled to NADH generating reactions
C. Synthetic substrates are less soluble than olive oil in aqueous reagents
D. Triglyceride substrates cause product inhibition
A
Which statement about the clinical utility of plasma or serum lipase is true?
A. Lipase is not increased in mumps, malignancy, or ectopic pregnancy
B. Lipase is not increased as dramatically as amylase in acute pancreatitis
C. Increased plasma or serum lipase is specific for pancreatitis
D. Lipase levels are elevated in both acute and chronic pancreatitis
A
The reference method for serum lipase is based upon:
A. Assay of triglycerides following incubation of serum with olive oil
B. Rate turbidimetry
C. Titration of fatty acids with dilute NaOH following controlled incubation of serum with olive oil
D. Immunochemical assay
C
The most commonly employed method of assay for plasma or serum lipase is based on:
A. Hydrolysis of olive oil
B. Rate turbidimetry
C. Immunoassay
D. Peroxidase coupling
D
Which of the following enzymes is usually depressed in liver disease?
A. Elastase-1
B. GLD
C. Pseudocholinesterase
D. Aldolase
C
Which enzyme is most likely to be elevated in the plasma of a person suffering from a muscle wasting disorder?
A. 5 ́-Nucleotidase
B. Pseudocholinesterase
C. Aldolase
D. Glutamate dehydrogenase
C
Which enzyme is measured in whole blood?
A. Chymotrypsin
B. Glucose-6-phosphate dehydrogenase
C. Glycogen phosphorylase
D. Lipase
B
Which of the following hormones is often decreased by approximately 25% in the serum
of pregnant women who have a fetus with Down syndrome?
A. Estriol (E3)
B. Human chorionic gonadotropin (hCG)
C. Progesterone
D. Estradiol (E2)
A
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) causes:
A. Low serum vasopressin
B. Hypernatremia
C. Urine osmolality to be lower than plasma
D. Low serum electrolytes
D
Select the hormone which when elevated is associated with galactorrhea, pituitary adenoma, and amenorrhea.
A. E2
B. Progesterone
C. Follicle-stimulating hormone (FSH)
D. Prolactin
D
Zollinger–Ellison (Z–E) syndrome is characterized by great (e.g., 20-fold) elevation of:
A. Gastrin
B. Cholecystokinin
C. Pepsin
D. Glucagon
A
Which statement about multiple endocrine neoplasia (MEN) is true?
A. It is associated with hyperplasia or neoplasia of at least two endocrine organs
B. Insulinoma is always present when the pituitary is involved
C. It is inherited as an autosomal recessive disorder
D. Plasma hormone levels from affected organs are elevated at least 10-fold
A
Select the main estrogen produced by the ovaries and used to evaluate ovarian function.
A. Estriol (E3 )
B. Estradiol (E2 )
C. Epiestriol
D. Hydroxyestrone
B
Which statement best describes the relationship between luteinizing hormone (LH) and follicle- stimulating hormone (FSH) in cases of dysmenorrhea?
A. Both are usually increased when there is pituitary adenoma
B. Increases in both hormones and a decrease in estrogen signal a pituitary cause of ovarian failure
C. Both hormones normally peak 1–2 days before ovulation
D. In menopause, the LH level at the midcycle peak is higher than the level of FSH
C
When pituitary adenoma is the cause of decreased estrogen production, an increase of which hormone is most frequently responsible?
A. Prolactin
B. FSH
C. LH
D. Thyroid-stimulating hormone (TSH)
A
Which set of results is most likely in an adult male with primary testicular failure?
A. Increased LH, FSH, and decreased testosterone
B. Decreased LH, FSH, and testosterone
C. Decreased testosterone, androstenedione, and FSH
D. Increased androstenedione, decreased testosterone, and normal FSH
A
When should progesterone be measured when evaluating an adult female for anovulation?
A. At the onset of menses
B. During the first 7 days of the menstrual cycle
C. At the midcycle just after LH peaks
D. At the end of the menstrual cycle
C
A female with severe excessive pubic and facial hair growth (hirsutism) should be tested for which of the following hormones?
A. Estrogen and progesterone
B. Chorionic gonadotropin
C. Growth hormone
D. Testosterone and dehydroepiandrosterone sulfate
D
Which set of results is most likely in a female with hypogonadotropic ovarian failure?
A. Increased LH, FSH, and estrogen
B. Decreased LH, FSH, and estrogen
C. Decreased prolactin and estrogen
D. Increased LH and FSH, and decreased estrogen
B
The onset of menopause is usually associated with what hormone changes?
A. Decreased estrogen, testosterone, and androgens
B. Decreased estrogen, FSH, LH, and progesterone
C. Decreased estrogen and progesterone, and increased LH and FSH
D. Decreased estrogen and progesterone, normal LH and FSH
C
Which of the following statements is correct in assessing GH deficiency?
A. Pituitary failure may involve one, several, or all adenohypophyseal hormones; but GH deficiency is usually found
B. A normal random serum level of GH in a child under 6 years old rules out GH deficiency
C. Administration of arginine, insulin, or glucagon will suppress GH release
D. GH levels in the blood show little variation within a 24-hour period
A
Which statement best describes the level of GH in patients with pituitary adenoma associated with acromegaly?
A. The fasting GH level is always elevated at least twofold
B. Some patients will require a glucose suppression test to establish a diagnosis
C. A normal fasting GH level rules out acromegaly
D. Patients produce a lower concentration of insulin-like growth factor I (IGF-1) than expected from their GH level
B
Hyperparathyroidism is most consistently associated with:
A. Hypocalcemia
B. Hypocalciuria
C. Hypophosphatemia
D. Metabolic alkalosis
C
Which statement regarding the use of PTH is true?
A. Determination of serum PTH level is the best screening test for disorders of calcium metabolism
B. PTH levels differentiate primary and secondary causes of hypoparathyroidism
C. PTH levels differentiate primary and secondary causes of hypocalcemia
D. PTH levels are low in patients with pseudohypoparathyroidism
C
The best method of analysis for serum PTH involves using antibodies that detect:
A. The amino-terminal fragment of PTH
B. The carboxy-terminal end of PTH
C. Both the amino-terminal fragment and intact PTH
D. All fragments of PTH as well as intact hormone
C
Which of the following is most often elevated in hypercalcemia associated with malignancy?
A. Parathyroid-derived PTH
B. Ectopic PTH
C. Parathyroid hormone–related protein (PTHRP)
D. Calcitonin
C
Which is normally the most abundant corticosteroid hormone secreted by the adrenal cortex?
A. Cortisol
B. Dehydroepiandrosterone
C. Aldosterone
D. Corticosterone
A
Which of the following statements regarding adrenal cortical dysfunction is true?
A. Patients with Cushing’s syndrome usually have hyperkalemia
B. Cushing’s syndrome is associated with glucose intolerance
C. Addison’s disease is associated with hypernatremia
D. Addison’s disease is caused by elevated levels of cortisol
B
Which of the following statements about cortisol in Cushing’s syndrome is true?
A. Twenty-four–hour urinary free cortisol is a more sensitive test than plasma total cortisol
B. Patients with Cushing’s disease show pronounced diurnal variation in serum cortisol
C. Free cortisol is increased by a high-serum cortisol-binding protein concentration
D. An elevated serum total cortisol level is diagnostic of Cushing’s syndrome
A
Which of the following conditions is characterized by primary hyperaldosteronism caused by adrenal adenoma, carcinoma, or hyperplasia?
A. Cushing’s syndrome
B. Addison’s disease
C. Conn’s syndrome
D. Pheochromocytoma
C
Which of the following is the most common cause of Cushing’s syndrome?
A. Pituitary adenoma
B. Adrenal hyperplasia
C. Overuse of corticosteroids
D. Ectopic adrenocorticotropic hormone (ACTH) production by tumors
C
Which of the following is the mechanism causing Cushing’s disease?
A. Excess secretion of pituitary ACTH
B. Adrenal adenoma
C. Treatment with corticosteroids
D. Ectopic ACTH production by tumors
A
In which situation is the plasma or 24-hour urinary cortisol not consistent with the clinical picture?
A. In pregnant patients
B. In patients with a positive overnight dexamethasone suppression test
C. In congenital adrenal hyperplasia
D. In Cushing’s syndrome caused by ectopic ACTH producing tumors
C
Which test is used to distinguish Cushing’s disease (pituitary Cushing’s) from Cushing’s syndrome caused by adrenal tumors?
A. Low-dose overnight dexamethasone suppression
B. Petrosal sinus sampling
C. Serum ACTH
D. Twenty-four–hour urinary free cortisol
C
Which is the most widely used screening test for Cushing’s syndrome?
A. Overnight low-dose dexamethasone suppression test
B. Corticotropin-releasing hormone stimulation test
C. Petrosal sinus sampling
D. Metyrapone stimulation test
A
Which test is the most specific for establishing a diagnosis of Cushing’s disease (pituitary Cushing’s)?
A. Low-dose dexamethasone suppression
B. High-dose dexamethasone suppression
C. Twenty-four–hour urinary free cortisol
D. Petrosal sinus sampling following corticotropin-releasing hormone stimulation
D
Which of the following statements about the diagnosis of Addison’s disease is true?
A. Patients with primary Addison’s disease show a normal response to ACTH stimulation
B. Primary and secondary Addison’s disease can often be differentiated by plasma ACTH
C. Twenty-four–hour urinary free cortisol is normal in Addison’s disease
D. Pituitary ACTH reserves are normal in secondary Addison’s disease
B
Which of the following statements regarding the catecholamines is true?
A. They are derived from tryptophan
B. They are produced by the zona glomerulosa of the adrenal cortex
C. Plasma levels show both diurnal and pulsed variation
D. They are excreted in urine primarily as free catecholamines
C
Which assay using 24-hour urine is considered the best single screening test for pheochromocytoma? A. Total urinary catecholamines
B. VMA
C. Homovanillic acid (HVA)
D. Metanephrines
D
Which metabolite is most often increased in carcinoid tumors of the intestine?
A. 5-Hydroxyindolacetic acid (5-HIAA)
B. 3-Methoxy-4-hydroxyphenylglycol (MHPG)
C. 3-Methoxydopamine
D. HVA
A
Which statement regarding the measurement of urinary catecholamines is true?
A. An increased excretion of total urinary catecholamines is specific for pheochromocytoma
B. Twenty-four–hour urinary catecholamine assay avoids pulse variations associated with measurement of plasma catecholamines
C. Total urinary catecholamine measurement provides greater specificity than measurement of urinary free catecholamines
D. Total urinary catecholamines are not affected by exercise
B
Which method is most often used to measure fractionated catecholamines (epinephrine, norepinephrine, and dopamine)?
A. Measurement of fluorescence following oxidation by potassium ferricyanide
B. Measurement by HPLC with electrochemical detection
C. Measure of radioactivity after conversion by catechol-O-methyltransferase (COMT) to
tritiated metanephrines
D. Measurement by HPLC with fluorescence detection
D
Which statement about sample collection for catecholamines and metabolites is true?
A. Blood for catecholamines is collected in the usual manner following a 12-hour fast
B. Twenty-four–hour urine for vanillylmandelic acid, catecholamines, or metanephrines is collected in 1 mL of boric acid
C. Twenty-four–hour urine creatinine should be measured with vanillylmandelic acid, homovanillic acid, or metanephrines
D. There is no need to discontinue medications if a 24-hour urine collection is used
C
Which of the following statements applies to both measurement of VMA and metanephrines in urine?
A. Both can be oxidized to vanillin and measured at 360 nm without interference from dietary compounds
B. Both can be measured immunochemically after hydrolysis and derivatization
C. Both require acid hydrolysis prior to measurement
D. Both can be measured by specific HPLC and MS assays
D
Urinary HVA is most often assayed to detect:
A. Pheochromocytoma
B. Neuroblastoma
C. Adrenal medullary carcinoma
D. Psychiatric disorders such as manic depression
B
Thyroid hormones are derived from the amino acid:
A. Phenylalanine
B. Methionine
C. Tyrosine
D. Histidine
C
Which statement regarding thyroid hormones is true?
A. Circulating levels of T3 and T4 are about equal
B. T3 is about 10-fold more active than T4
C. The rate of formation of monoiodotyrosine and diiodotyrosine is about equal
D. Most of the T3 present in plasma is from its direct release from thyroid storage sites
B
Which of the following statements regarding thyroid hormones is true?
A. Both protein-bound and free T3 and T4 are physiologically active
B. Total T3 and T4 are influenced by the level of thyroxine-binding globulin
C. Variation in thyroxine-binding protein levels affects both free T3 and T4
D. An elevated serum total T4 and T3 is diagnostic of hyperthyroidism
B
Which of the following conditions will increase total T4 by increasing TBG?
A. Acute illness
B. Anabolic steroid use
C. Nephrotic syndrome
D. Pregnancy or estrogens
D
Select the most appropriate single screening test for thyroid disease.
A. Free thyroxine index
B. Total T3 assay
C. Total T4
D. TSH assay
D
The serum TSH level is almost absent in:
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
A
Which assay is used to confirm difficult cases of hypothyroidism?
A. Free T3 assay
B. Free thyroxine index
C. Thyrotropin-releasing hormone (TRH) stimulation test
D. TBG assay
C
Which of the following statements is true regarding reverse T3 (rT3)?
A. Formed in the blood by degradation of T4
B. Physiologically active, but less than T3
C. Decreased in euthyroid sick syndrome
D. Interferes with the measurement of serum T3
A
A patient has an elevated serum T3 and free T4 and undetectable TSH. What is the most likely cause of these results?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Euthyroid with increased thyroxine-binding proteins
D. Euthyroid sick syndrome
A
A serum thyroid panel reveals an increase in total T4, normal TSH, and normal free T4. What is the most likely cause of these results?
A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Euthyroid with increased thyroxine-binding protein
D. Subclinical hypothyroidism
C
Which statement about TSH and T4 in early pregnancy is correct?
A. TSH and thyroid hormones fall
B. TSH falls and thyroid hormones rise
C. TSH and thyroid hormones both rise
D. TSH rises and thyroid hormones fall
B
In which case might a very low plasma TSH result not correlate with thyroid status?
A. Euthyroid sick syndrome
B. Congenital hypothyroidism
C. When TBG is elevated
D. After high-dose corticosteroid treatment
D
In which of the following cases is qualitative analysis of the drug usually adequate?
A. To determine whether the dose of a drug with a low therapeutic index is likely to be toxic
B. To determine whether a patient is complying with the physician’s instructions
C. To adjust dose if individual differences or disease alter expected response
D. To determine whether the patient has been taking amphetamines
D
The term pharmacokinetics refers to the:
A. Relationship between drug dose and the drug blood level
B. Concentration of drug at its sites of action
C. Relationship between blood concentration and therapeutic response
D. The relationship between blood and tissue drug levels
A
The term pharmacodynamics is an expression of the relationship between:
A. Dose and physiological effect
B. Drug concentration at target sites and physiological effect
C. Time and serum drug concentration
D. Blood and tissue drug levels
B
The study of pharmacogenomics involves which type of testing?
A. Family studies to determine the inheritance of drug resistance
B. Testing drugs with cell cultures to determine the minimum toxic dosage
C. Testing for single nucleotide polymorphisms known to affect drug metabolism
D. Comparison of dose-response curves between family members
C
Select the five pharmacological parameters that determine serum drug concentration.
A. Absorption, anabolism, perfusion, bioactivation, excretion
B. Liberation, equilibration, biotransformation, reabsorption, elimination
C. Liberation, absorption, distribution, metabolism, excretion
D. Ingestion, conjugation, integration, metabolism, elimination
C
Which route of administration is associated with 100% bioavailability?
A. Sublingual
B. Intramuscular
C. Oral
D. Intravenous
D
The phrase “first-pass hepatic metabolism” means that:
A. One hundred percent of a drug is excreted by the liver
B. All drug is inactivated by hepatic enzymes after one pass through the liver
C. Some drug is metabolized from the portal circulation, reducing bioavailability
D. The drug must be metabolized in the liver to an active form
C
Which formula can be used to estimate dosage needed to give a desired steady-state blood level?
A. Dose per hour = clearance (milligrams per hour) × average concentration at steady state ÷ f
B. Dose per day = fraction absorbed – fraction excreted
C. Dose = fraction absorbed × (1/protein-bound fraction)
D. Dose per day = half-life × log Vd (volume distribution)
A
Which statement is true regarding the volume distribution (Vd) of a drug?
A. Vd is equal to the peak blood concentration divided by the dose given
B. Vd is the theoretical volume in liters into which the drug distributes
C. The higher the Vd, the lower the dose needed to reach the desired blood level of drug
D. The Vd is the principal determinant of the dosing interval
B
For drugs with first-order elimination, which statement about drug clearance is true?
A. Clearance = elimination rate ÷ serum level
B. It is most often performed by the liver
C. It is directly related to half-life
D. Clearance rate is independent of dose
A
Which statement about steady-state drug levels is true?
A. The absorbed drug must be greater than the amount excreted
B. Steady state can be measured after two elimination half-lives
C. Constant intravenous infusion will give the same minima and maxima as an oral dose
D. Oral dosing intervals give peaks and troughs in the dose-response curve
D
If too small a peak–trough difference is seen for a drug given orally, then:
A. The dose should be decreased
B. Time between doses should be decreased
C. Dose interval should be increased
D. Dose per day and time between doses should be decreased
C
If the peak level is appropriate but the trough level too low at steady state, then the dose interval should:
A. Be lengthened without changing the dose per day
B. Be lengthened and dose rate decreased
C. Not be changed, but dose per day increased
D. Be shortened, but dose per day not changed
D
If the steady-state drug level is too high, the best course of action is to:
A. Decrease the dose
B. Decrease the dose interval
C. Decrease the dose and decrease the dose interval
D. Change the route of administration
A
When should blood samples for trough drug levels be collected?
A. 30 minutes after peak levels
B. 45 minutes before the next dose
C. 1–2 hours after the last dose
D. Immediately before the next dose is given
D
Blood sample collection time for peak drug levels:
A. Varies with the drug, depending on its rate of absorption
B. Is independent of drug formulation
C. Is independent of the route of administration
D. Is 30 minutes after a bolus intravenous injection is completed
A
Which could account for drug toxicity following a normally prescribed dose?
A. Decreased renal clearance caused by kidney disease
B. Discontinuance or administration of another drug
C. Altered serum protein binding caused by disease
D. All of these options
D
Select the elimination model that best describes most oral drugs.
A. One compartment, linear first-order elimination
B. Michaelis–Menton or concentration-dependent elimination
C. Two compartment with a biphasic elimination curve
D. Logarithmic elimination
A
