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***Medical Lab science review- Robert Harr 4th > Clinical Chemistry- Glucose, Hbg,Iron and Bilirubin > Flashcards

Clinical Chemistry- Glucose, Hbg,Iron and Bilirubin Flashcards

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1
Q
  1. Which of the following biochemical processes is
    promoted by insulin?
    A. Glycogenolysis
    B. Gluconeogenesis
    C. Lipolysis
    D. Uptake of glucose by cells
A

D. Uptake of glucose by cells

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2
Q
  1. Which of the following hormones promotes
    hyperglycemia?
    A. Calcitonin
    B. Growth hormone
    C. Aldosterone
    D. Renin
A

B. Growth hormone

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3
Q
  1. 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
A

D. Requires insulin replacement to prevent ketosis

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4
Q
  1. 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
A

C. Hyperglycemia is often controlled without
insulin replacement

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5
Q
  1. Which of the following results falls within the
    diagnostic criteria for diabetes mellitus?
    A. Fasting plasma glucose of 120 mg/dL
    B. Two-hour postprandial plasma glucose of
    160 mg/dL
    C. Two-hour plasma glucose of 180 mg/dL
    following a 75 g oral glucose challenge
    D. Random plasma glucose of 250 mg/dL and
    presence of symptoms
A

D. Random plasma glucose of 250 mg/dL and
presence of symptoms

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6
Q
  1. 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)
A

C. 65–99 mg/dL (3.61–5.50 mmol/L)

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7
Q
  1. 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 allowed
    8 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
A

B. Carbohydrate intake is restricted to below
150 g/day for 3 days prior to test

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8
Q
  1. 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
A

C. 150 mg/dL

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9
Q
  1. 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
A

D. Is defined as glucose intolerance originating
during pregnancy

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10
Q
  1. 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
A

C. Neuroglycopenic symptoms at the time of low blood sugar

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11
Q
  1. 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
A

C. Reflects the extent of glucose regulation in the
8- to 12-week interval prior to sampling

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12
Q
  1. 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%
A

B. 6.5%

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13
Q
  1. 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

A. Levels do not need to be done fasting

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14
Q
  1. 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
A

B. Cation exchanger

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15
Q
  1. 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 interfere
A

D. The result is reportable; neither hemoglobin F
or C interfere

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16
Q
  1. Which statement best describes the use of the
    Hgb A1C test?

A. Should be used for monitoring glucose control
only
B. May be used for both diagnosis and monitoring
C. Should be used only to monitor persons with
type 1 diabetes
D. May be used only to monitor persons with
type 2 diabetes

A

B. May be used for both diagnosis and monitoring

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17
Q
  1. According to American Diabetes Association
    criteria, which result is consistent with a diagnosis
    of impaired fasting glucose?
    A. 99 mg/dL
    B. 117 mg/dL
    C. 126 mg/dL
    D. 135 mg/dL
A

B. 117 mg/dL

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18
Q
  1. 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

A. >30 mg/g creatinine

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19
Q
  1. 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
A

D. Estimated glomerular filtration rate

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20
Q
  1. 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
A

C. Monitoring of blood glucose control in type 1
and type 2 diabetics

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21
Q
  1. Which of the following is the reference method
    for measuring serum glucose?
    A. Somogyi–Nelson
    B. Hexokinase
    C. Glucose oxidase
    D. Glucose dehydrogenase
A

B. Hexokinase

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22
Q
  1. 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
A

B. The rate of O2 depletion

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23
Q
  1. 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
A

D. Amperometry

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24
Q
  1. Select the enzyme that is most specific for
    β-D-glucose.
    A. Hexokinase
    B. G-6-PD
    C. Phosphohexisomerase
    D. Glucose oxidase
A

D. Glucose oxidase

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25
Q
  1. 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

A. Glucose-6-phosphate dehydrogenase

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26
Q
  1. Which glucose method is subject to falsely low
    results caused by ascorbate?
    A. Hexokinase
    B. Glucose dehydrogenase
    C. Trinder glucose oxidase
    D. Polarography
A

C. Trinder glucose oxidase

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27
Q
  1. 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
A

B. Hemolysis

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28
Q
  1. 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

A. Levels below 40 mg/dL occur in septic
meningitis, cancer, and multiple sclerosis

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29
Q
  1. In peroxidase-coupled glucose methods, which
    reagent complexes with the chromogen?
    A. Nitroprusside
    B. Phenol
    C. Tartrate
    D. Hydroxide
A

B. Phenol

30
Q
  1. 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
A

B. Amperometric detection

31
Q
  1. 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
A

D. Low hematocrit raises readings and high
hematocrit lowers readings unless corrected

32
Q
  1. 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
A

D. Hurler’s syndrome

33
Q
  1. 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

A. Glucose-6-phosphatase

34
Q
  1. 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
A

D. Hyperlipidemia

35
Q
  1. 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

A. Pancreatic insufficiency from malabsorption

36
Q
  1. 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

A. Galactosemia results from deficiency of
galactose-1-phosphate (galactose-1-PO4)
uridine diphosphate transferase

37
Q
  1. 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
A

C. The daily requirement is higher for pregnant and
menstruating women

38
Q
  1. 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
A

B. Binding to transferrin and incorporation into
ferritin

39
Q
  1. 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

A. Iron deficiency anemia

40
Q
  1. 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
A

C. Iron deficiency anemia

41
Q
  1. 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
A

D. Noniron deficiency anemias

42
Q
  1. 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
A

C. Decreased serum ferritin

43
Q
  1. 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)
A

B. Serum transferrin in mg/dL × 1.43 = TIBC
(μg/dL)

44
Q
  1. 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
A

D. A low serum ferritin is diagnostic of iron
deficiency

45
Q
  1. 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
A

B. Colorimetric methods measure binding of Fe2+
to a ligand such as ferrozine

46
Q
  1. 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 transferrinbound iron
    D. The chromogen used must be different from the
    one used for measuring serum iron
A

A. All TIBC methods require addition of excess
iron to saturate transferrin

47
Q
  1. 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
A

D. It is produced from the destruction of RBCs

48
Q
  1. Bilirubin is transported from reticuloendothelial
    cells to the liver by:
    A. Albumin
    B. Bilirubin-binding globulin
    C. Haptoglobin
    D. Transferrin
A

A. Albumin

49
Q
  1. In the liver, bilirubin is conjugated by addition of:
    A. Vinyl groups
    B. Methyl groups
    C. Hydroxyl groups
    D. Glucuronyl groups
A

D. Glucuronyl groups

50
Q
  1. Which enzyme is responsible for the conjugation
    of bilirubin?
    A. β-Glucuronidase
    B. UDP-glucuronyl transferase
    C. Bilirubin oxidase
    D. Biliverdin reductase
A

B. UDP-glucuronyl transferase

51
Q
  1. The term δ-bilirubin refers to:
    A. Water-soluble bilirubin
    B. Free unconjugated bilirubin
    C. Bilirubin tightly bound to albumin
    D. Direct-reacting bilirubin
A

C. Bilirubin tightly bound to albumin

52
Q
  1. 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
A

B. Methene bridges of bilirubin are reduced by
intestinal bacteria forming urobilinogens

53
Q
  1. 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

A. It is water soluble

54
Q
  1. 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

A. It is formed in the intestines by bacterial
reduction of bilirubin

55
Q
  1. 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

A. Bilirubin undergoes rapid photo-oxidation when
exposed to daylight

56
Q
  1. 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
A

C. Dubin–Johnson syndrome

57
Q
  1. 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
A

B. Failure of the enterohepatic circulation

58
Q
  1. 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

A. The ratio of direct to total bilirubin is greater
than 1:2

59
Q
  1. 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

A. Hemolytic anemia

60
Q
  1. 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
A

C. Crigler–Najjar syndrome

61
Q
  1. 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

A. Total bilirubin level is a less sensitive and specific
marker of liver disease than the direct level

62
Q
  1. 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
A

B. Jaundice is usually first seen 48–72 hours
postpartum in neonatal hyperbilirubinemia

63
Q
  1. 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
A

B. Lucey –Driscoll syndrome

64
Q
  1. 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
A

C. Falsely low due to inhibition of the diazo
reaction by hemoglobin

65
Q
  1. Which reagent is used in the Jendrassik–Grof
    method to solubilize unconjugated bilirubin?
    A. 50% methanol
    B. N-butanol
    C. Caffeine
    D. Acetic acid
A

C. Caffeine

66
Q
  1. 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
A

B. Most methods are based upon reaction with
diazotized sulfanilic acid

67
Q
  1. 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
A

D. Fehling’s reagent is added after the diazo reaction
to reduce optical interference by hemoglobin

68
Q
  1. 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

A. Hgb interference in the second assay

69
Q
  1. 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

A. Using different pH for total and direct assays

70
Q
  1. What is the principle of the transcutaneous
    bilirubin assay?
    A. Conductivity
    B. Amperometric inhibition
    C. Multiwavelength reflectance photometry
    D. Infrared spectroscopy
A

C. Multiwavelength reflectance photometry

***Medical Lab science review- Robert Harr 4th (63 decks)

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