Contemporary Flashcards
(178 cards)
1
Q
Why are QC or PT results not used to evaluate agreement between different methods?
a. The concentrations are different in different samples.
b. The within-peer group SD and CV include calibration variability between laboratories.
c. The peer groups may not have enough participants for reliable statistics.
d. The specimens used are frequently noncommutable with native clinical samples.
A
Why are QC or PT results not used to evaluate agreement between different methods?
a. The concentrations are different in different samples.
b. The within-peer group SD and CV include calibration variability between laboratories.
c. The peer groups may not have enough participants for reliable statistics.
d. The specimens used are frequently noncommutable with native clinical samples.
2
Q
- In order to measure complement activation fragments in circulation, the best specimen type is:
a. EDTA plasma
b. Citrate plasma
c. Serum
d. Urine
A
- In order to measure complement activation fragments in circulation, the best specimen type is:
a. EDTA plasma
b. Citrate plasma
c. Serum
d. Urine
3
Q
Phase 1 metabolic reactions include which of the following?
a. Acetylation
b. Hydrolysis
c. Glucuronidation
d. Methylation
A
Phase 1 metabolic reactions include which of the following?
a. Acetylation
b. Hydrolysis
c. Glucuronidation
d. Methylation
4
Q
What is the biochemical action of α-amylase?
a. Breaks down triglycerides into glycerol and fatty acids
b. Degrades proteins at the N-terminal end
c. Degrades carbohydrates at the α-1,4 linkage
d. Degrades carbohydrates at the α-1,6 linkage
A
What is the biochemical action of α-amylase?
a. Breaks down triglycerides into glycerol and fatty acids
b. Degrades proteins at the N-terminal end
c. Degrades carbohydrates at the α-1,4 linkage
d. Degrades carbohydrates at the α-1,6 linkage
5
Q
Which ionization technique is often used for the analysis of intact proteins?
a. MALDI
b. Electron ionization
c. Fast-atom bombardment
d. Atmospheric pressure chemical ionization
A
Which ionization technique is often used for the analysis of intact proteins?
a. MALDI
b. Electron ionization
c. Fast-atom bombardment
d. Atmospheric pressure chemical ionization
6
Q
Which is the preferred method for testing for urine albumin?
a. first morning specimen to test for urine ACR
b. first morning specimen to test for urine albumin
c. random spot urine to test for urine ACR
d. timed urine specimen to test for urine ACR
A
Which is the preferred method for testing for urine albumin?
a. first morning specimen to test for urine ACR
b. first morning specimen to test for urine albumin
c. random spot urine to test for urine ACR
d. timed urine specimen to test for urine ACR
7
Q
Which of the following are possible sources of preanalytical variation?
a. season of the year
b. working in the night shift
c. sunlight
d. all of the above
A
Which of the following are possible sources of preanalytical variation?
a. season of the year
b. working in the night shift
c. sunlight
d. all of the above
8
Q
The thyroid generates approximately ___% of circulating T4 and ___% of circulating T3.
a. 80%, 20%
b. 100%, 80%
c. 100%, 20%
d. 20%, 20%
e. 80%, 80%
A
The thyroid generates approximately ___% of circulating T4 and ___% of circulating T3.
a. 80%, 20%
b. 100%, 80%
c. 100%, 20%
d. 20%, 20%
e. 80%, 80%
9
Q
A patient has the following laboratory results (mmol/ L): Na 141, K 5.4, Cl 106, and HCO3 7. The differential for this acidbase abnormality includes all of the following, EXCEPT:
a. lactate acidosis
b. diabetic ketoacidosis
c. severe vomiting
d. ethylene glycol ingestion
e. acute renal failure
A
A patient has the following laboratory results (mmol/ L): Na 141, K 5.4, Cl 106, and HCO3 7. The differential for this acidbase abnormality includes all of the following, EXCEPT:
a. lactate acidosis
b. diabetic ketoacidosis
c. severe vomiting
d. ethylene glycol ingestion
e. acute renal failure
10
Q
What is an essential property for a matrix-based secondary reference material?
a. commutability with clinical samples
b. adequate volume to be used for several calibrations
c. sufficient quantity to be available for at least 3 years
d. commutability for at least one-half of the commonly used measurement procedures
A
What is an essential property for a matrix-based secondary reference material?
a. commutability with clinical samples
b. adequate volume to be used for several calibrations
c. sufficient quantity to be available for at least 3 years
d. commutability for at least one-half of the commonly used measurement procedures
11
Q
Which laboratory test is used most to monitor warfarin therapy?
a. aPTT
b. PT
c. D-dimer
d. Fibrinogen
A
Which laboratory test is used most to monitor warfarin therapy?
a. aPTT
b. PT
c. D-dimer
d. Fibrinogen
12
Q
The platelet count may be falsely increased due to which of the following?
a. platelet clumping
b. cryoglobulinemia
c. large platelets
d. low white blood cell count
A
The platelet count may be falsely increased due to which of the following?
a. platelet clumping
b. cryoglobulinemia
c. large platelets
d. low white blood cell count
13
Q
What is the effect of eating a vegetarian diet on the concentration of serum creatinine and measured GFR, respectively?
a. lower and higher
b. higher and higher
c. lower and lower
d. no change in either
A
What is the effect of eating a vegetarian diet on the concentration of serum creatinine and measured GFR, respectively?
a. lower and higher
b. higher and higher
c. lower and lower
d. no change in either
14
Q
The most cost-efficient, reliable test for H. pylori is:
a. Culture
b. H. pylori PCR
c. H. pylori stool antigen
d. Serum antibody to H. pylori
e. Urea breath test
A
The most cost-efficient, reliable test for H. pylori is:
a. Culture
b. H. pylori PCR
c. H. pylori stool antigen
d. Serum antibody to H. pylori
e. Urea breath test
15
Q
Why might it be necessary to adjust QC target values following a reagent lot change?
a. The calibration could be incorrect.
b. The matrix interaction between the QC material and the new reagent could be different than with the old reagent.
c. The method could have changed.
d. The original target value could have been incorrect.
A
Why might it be necessary to adjust QC target values following a reagent lot change?
a. The calibration could be incorrect.
b. The matrix interaction between the QC material and the new reagent could be different than with the old reagent.
c. The method could have changed.
d. The original target value could have been incorrect.
16
Q
Which of the following factors can influence analyte stability?
a. temperature
b. buffer composition
c. light exposure
d. time
e. all of the above
A
Which of the following factors can influence analyte stability?
a. temperature
b. buffer composition
c. light exposure
d. time
e. all of the above
17
Q
- The synthetic functions of the liver are dependent on all of the following EXCEPT:
a. Number of hepatocytes
b. Blood flow from the portal vein
c. Sufficient absorption of nutrients from the gastrointestinal tract
d. Diameter of intrahepatic bile ducts
e. Nutritional status
A
- The synthetic functions of the liver are dependent on all of the following EXCEPT:
a. Number of hepatocytes
b. Blood flow from the portal vein
c. Sufficient absorption of nutrients from the gastrointestinal tract
d. Diameter of intrahepatic bile ducts
e. Nutritional status
18
Q
A patient is admitted to the hospital with the following laboratory results: AST 280, ALT 95, alkaline phosphatase 85 (all IU/L), total and direct bilirubin 220 and 123 umol/L, respectively, and prothrombin time of 12.0s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
b. Acute biliary tract obstruction
c. Acute viral hepatitis
d. Cirrhosis
e. Toxic or ischemic hepatitis
A
A patient is admitted to the hospital with the following laboratory results: AST 280, ALT 95, alkaline phosphatase 85 (all IU/L), total and direct bilirubin 220 and 123 umol/L, respectively, and prothrombin time of 12.0s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
b. Acute biliary tract obstruction
c. Acute viral hepatitis
d. Cirrhosis
e. Toxic or ischemic hepatitis
19
Q
Prolonged use of the tourniquet can lead to increases in which analyte?
a. calcium
b. digoxin
c. phosphate
d. triglycerides
A
Prolonged use of the tourniquet can lead to increases in which analyte?
a. calcium
b. digoxin
c. phosphate
d. triglycerides
20
Q
Which of the following is considered a biomarker for inflammatory bowel disease (IBD)?
a. Gliadin
b. Neutrophil cytoplasmic antigens
c. Nuclear antigens
d. Calprotectin
e. C-reactive protein
A
Which of the following is considered a biomarker for inflammatory bowel disease (IBD)?
a. Gliadin
b. Neutrophil cytoplasmic antigens
c. Nuclear antigens
d. Calprotectin
e. C-reactive protein
21
Q
A urine specimen tests positive for bilirubin but negative for urobilinogen. Both tests use a diazoniumbased method. What is the most likely clinical scenario?
a. Obstruction of the common bile duct
b. Cirrhosis
c. Acute viral hepatitis
d. Administration of rifampin
A
A urine specimen tests positive for bilirubin but negative for urobilinogen. Both tests use a diazoniumbased method. What is the most likely clinical scenario?
a. Obstruction of the common bile duct
b. Cirrhosis
c. Acute viral hepatitis
d. Administration of rifampin
22
Q
Which of the following statements is false?
a. The retention factor is related to the retention time of a compound.
b. The van Deemter equation shows how the retention of a compound changes with linear velocity.
c. The resolution between two peaks will increase with their degree of retention.
d. The retention factor is affected by the amount of stationary phase in the column.
A
Which of the following statements is false?
a. The retention factor is related to the retention time of a compound.
b. The van Deemter equation shows how the retention of a compound changes with linear velocity.
c. The resolution between two peaks will increase with their degree of retention.
d. The retention factor is affected by the amount of stationary phase in the column.
23
Q
What is the primary mechanism that regulates prolactin secretion?
a. stimulation by prolactin releasing hormone from the hypothalamus
b. cleavage of macroprolactin from the anterior pituitary
c. heterodimerization of prolactin with dopamine from the anterior pituitary
d. suppression by dopamine from the hypothalamus
A
What is the primary mechanism that regulates prolactin secretion?
a. stimulation by prolactin releasing hormone from the hypothalamus
b. cleavage of macroprolactin from the anterior pituitary
c. heterodimerization of prolactin with dopamine from the anterior pituitary
d. suppression by dopamine from the hypothalamus
24
Q
What is the relationship between turbidimetric and nephelometric measurements?
a. Nephelometry is the inverse of turbidimetry.
b. Turbidimetry is more sensitive.
c. Nephelometry can be measured with a conventional spectrophotometer.
d. Both measure light scatter.
A
What is the relationship between turbidimetric and nephelometric measurements?
a. Nephelometry is the inverse of turbidimetry.
b. Turbidimetry is more sensitive.
c. Nephelometry can be measured with a conventional spectrophotometer.
d. Both measure light scatter.
25
Which of the following statements are true regarding selection of reference individuals?
a. According to CLSI, reference intervals should be based on indirect sampling of healthy individuals from the age group(s) of interest.
b. Use of a posteriori selection criteria is not recommended by the CLSI.
c. The quality of the reference interval is not affected by the reference population.
d. Lack of appropriate inclusion/exclusion criteria can jeopardize the validity of the reference interval.
e. In indirect sampling, partitioning takes place after sample collection and analyte testing.
Which of the following statements are true regarding selection of reference individuals?
a. According to CLSI, reference intervals should be based on indirect sampling of healthy individuals from the age group(s) of interest.
b. Use of a posteriori selection criteria is not recommended by the CLSI.
c. The quality of the reference interval is not affected by the reference population.
**d. Lack of appropriate inclusion/exclusion criteria can jeopardize the validity of the reference interval.**
e. In indirect sampling, partitioning takes place after sample collection and analyte testing.
26
7. What is the complement defect associated with hereditary angioedema?
a. C1 qrs
b. C1 inhibitor
c. C4 concentration
d. C2 concentration
7. What is the complement defect associated with hereditary angioedema?
a. C1 qrs
**b. C1 inhibitor**
c. C4 concentration
d. C2 concentration
27
NKDEP recommends to report eGFR because
1. It is easier to interpret a patient’s kidney function from the eGFR than from serum creatinine.
2. Physicians do not know how to perform the calculation.
3. Patients with CKD are inadequately identified by serum creatinine.
4. It gives a correct assessment of kidney function in all pathologic conditions.
a. 1-2
b. 1-2-4
c. 1-2-3
d. 1-3
NKDEP recommends to report eGFR because
1. It is easier to interpret a patient’s kidney function from the eGFR than from serum creatinine.
2. Physicians do not know how to perform the calculation.
3. Patients with CKD are inadequately identified by serum creatinine.
4. It gives a correct assessment of kidney function in all pathologic conditions.
a. 1-2
b. 1-2-4
c. 1-2-3
**d. 1-3**
28
Reference intervals are specific for the _____ from which they were determined:
a. instrument
b. analytical method
c. population
d. instrument and analytical method
e. instrument, analytical method, and population
Reference intervals are specific for the _____ from which they were determined:
a. instrument
b. analytical method
c. population
d. instrument and analytical method
**e. instrument, analytical method, and population**
29
Which of the following items is NOT desired for a good separation in chromatography?
a. a large value for the number of theoretical plates, N
b. a large value for the peak resolution, Rs
c. a large value for the plate height, H
d. a large value for the separation factor, α
Which of the following items is NOT desired for a good separation in chromatography?
a. a large value for the number of theoretical plates, N
b. a large value for the peak resolution, Rs
**c. a large value for the plate height, H**
d. a large value for the separation factor, α
30
A 32-year-old woman with a history of irregular periods presents to the fertility clinic after being unable to conceive for 2 years. Physical exam shows an obese woman with excess hair growth on the upper lip and chin, and acne on her chin and back. A pelvic ultrasound shows ovaries with multiple small cysts. What pattern of laboratory tests is consistent with this case?
a. increased estrogen, increased FSH, and decreased LH
b. increased testosterone, decreased FSH, and increased LH
c. increased GnRH and decreased FSH and LH
d. increased prolactin and decreased TSH
A 32-year-old woman with a history of irregular periods presents to the fertility clinic after being unable to conceive for 2 years. Physical exam shows an obese woman with excess hair growth on the upper lip and chin, and acne on her chin and back. A pelvic ultrasound shows ovaries with multiple small cysts. What pattern of laboratory tests is consistent with this case?
a. increased estrogen, increased FSH, and decreased LH
**b. increased testosterone, decreased FSH, and increased LH**
c. increased GnRH and decreased FSH and LH
d. increased prolactin and decreased TSH
31
Which of the following is not a type of mass analyzer?
a. MALDI
b. quadrupole ion trap
c. linear ion trap
d. ion cyclotron resonance
e. TOF
Which of the following is not a type of mass analyzer?
**a. MALDI**
b. quadrupole ion trap
c. linear ion trap
d. ion cyclotron resonance
e. TOF
32
A patient with elevated salivary cortisol underwent a low-dose dexamethasone suppression test and no reduction in serum cortisol was observed. A follow-up high-dose dexamethasone suppression test was performed and a .50% reduction was observed in both plasma ACTH and serum cortisol concentrations. This is consistent with which of the following:
a. ectopic ACTH
b. Cushing’s disease
c. primary adrenal disease
d. normal response
A patient with elevated salivary cortisol underwent a low-dose dexamethasone suppression test and no reduction in serum cortisol was observed. A follow-up high-dose dexamethasone suppression test was performed and a .50% reduction was observed in both plasma ACTH and serum cortisol concentrations. This is consistent with which of the following:
a. ectopic ACTH
**b. Cushing’s disease**
c. primary adrenal disease
d. normal response
33
A SAAG \>= 1.1 g/dL and a total protein \>2.5 g/dL is most consistent with which of the following etiologies of the ascites:
a. cirrhosis
b. heart failure
c. malignancy
d. pancreatitis
e. tuberculosis
A SAAG \>= 1.1 g/dL and a total protein \>2.5 g/dL is most consistent with which of the following etiologies of the ascites:
a. cirrhosis
**b. heart failure**
c. malignancy
d. pancreatitis
e. tuberculosis
34
What is the definition for CKD?
a. GFR \<60 mL/min/1.73 m2 or evidence of kidney damage that is present for \>=3 months
b. eGFR \<60 mL/min/1.73 m2 and proteinuria that is present for \>=3 months
c. eGFR \<60 mL/min/1.73 m2 and evidence of kidney damage that is present for \>=3 months
d. eGFR \<60 mL/min/1.73 m2 or evidence of kidney damage
What is the definition for CKD?
**a. GFR \<60 mL/min/1.73 m2 or evidence of kidney damage that is present for \>=3 months**
b. eGFR \<60 mL/min/1.73 m2 and proteinuria that is present for \>=3 months
c. eGFR \<60 mL/min/1.73 m2 and evidence of kidney damage that is present for \>=3 months
d. eGFR \<60 mL/min/1.73 m2 or evidence of kidney damage
35
What type of interference cannot be corrected with a bichromatic measurement?
a. bilirubin
b. turbidity
c. bilirubin and turbidity in the same sample
d. nonchromogenic drugs
What type of interference cannot be corrected with a bichromatic measurement?
a. bilirubin
b. turbidity
**c. bilirubin and turbidity in the same sample**
d. nonchromogenic drugs
36
A metrological traceability calibration hierarchy describes \_\_\_\_\_\_.
a. a sequence of steps that transfer values from certified reference materials to the calibrators used in clinical laboratory measurement procedures
b. a sequence of steps that should be followed when calibrating a clinical laboratory measurement procedure
c. calibration and quality control procedures for a clinical laboratory measurement procedure
d. how a manufacturer assigns values to each lot of calibrator for a clinical laboratory measurement procedure
A metrological traceability calibration hierarchy describes \_\_\_\_\_\_.
**a. a sequence of steps that transfer values from certified reference materials to the calibrators used in clinical laboratory measurement procedures**
b. a sequence of steps that should be followed when calibrating a clinical laboratory measurement procedure
c. calibration and quality control procedures for a clinical laboratory measurement procedure
d. how a manufacturer assigns values to each lot of calibrator for a clinical laboratory measurement procedure
37
Immunoassays based on the EMIT detection technology usually utilize b-galactosidase as the enzyme label.
a. True
b. False
Immunoassays based on the EMIT detection technology usually utilize b-galactosidase as the enzyme label.
a. True
**b. False**
38
Your method comparison was done with 50 specimens spanning the medical decision points. Least-squares linear regression gives a slope of 1.20, an intercept of 0.1, and a correlation coefficient of 0.99. Which of the following best describes this analysis?
a. Additional specimens throughout the linear range are necessary.
b. The correlation coefficient indicates that the new method should be accepted.
c. A proportional bias of 20% between the methods exists.
d. The intercept suggests a significant constant bias between the methods.
Your method comparison was done with 50 specimens spanning the medical decision points. Least-squares linear regression gives a slope of 1.20, an intercept of 0.1, and a correlation coefficient of 0.99. Which of the following best describes this analysis?
a. Additional specimens throughout the linear range are necessary.
b. The correlation coefficient indicates that the new method should be accepted.
**c. A proportional bias of 20% between the methods exists.**
d. The intercept suggests a significant constant bias between the methods.
39
Which of the following can be a potential source of error for potentiometric measurements in plasma?
a. hyperlipidemia
b. multiple myeloma
c. dilution of specimen with water
d. all of the above
Which of the following can be a potential source of error for potentiometric measurements in plasma?
a. hyperlipidemia
b. multiple myeloma
c. dilution of specimen with water
**d. all of the above**
40
A clinically hydrated patient is found to have a urine specific gravity of 1.050. Which of the following potentially explains this scenario?
a. The patient recently received radiocontrast media.
b. This is a normal result for a hydrated patient.
c. The patient has diabetes insipidus.
d. The patient has acidic urine.
A clinically hydrated patient is found to have a urine specific gravity of 1.050. Which of the following potentially explains this scenario?
**a. The patient recently received radiocontrast media.**
b. This is a normal result for a hydrated patient.
c. The patient has diabetes insipidus.
d. The patient has acidic urine.
41
Which of the following is/are not an advantage of mass spectrometry analysis?
a. increased selectivity
b. fully automated instrument systems
c. few interferences
d. lack of matrix effects
e. all of the above
f. b and d
g. a and c
Which of the following is/are not an advantage of mass spectrometry analysis?
a. increased selectivity
b. fully automated instrument systems
c. few interferences
d. lack of matrix effects
e. all of the above
**f. b and d**
g. a and c
42
All of the following findings in a person with chronic hepatitis would suggest progression to cirrhosis EXCEPT:
a. AST/ALT ratio of \>1
b. Albumin of 40 g/L
c. Serum globulins of 65 g/L
d. Prothrombin time of 18.3 s
e. Platelet count of 75,000/mm3
All of the following findings in a person with chronic hepatitis would suggest progression to cirrhosis EXCEPT:
a. AST/ALT ratio of \>1
**b. Albumin of 40 g/L**
c. Serum globulins of 65 g/L
d. Prothrombin time of 18.3 s
e. Platelet count of 75,000/mm3
43
Potentiometric analysis involves measurement of:
a. potential while as current is varied
b. conductance of material under an applied potential
c. magnitude of current at a fixed potential
d. electromotive force while current is zero
Potentiometric analysis involves measurement of:
a. potential while as current is varied
b. conductance of material under an applied potential
c. magnitude of current at a fixed potential
**d. electromotive force while current is zero**
44
Currently, screening for colorectal cancer is usually done by means of:
a. Colonoscopy yearly
b. Fecal DNA tests yearly
c. Fecal occult blood tests yearly
d. Fecal occult blood tests yearly, followed by colonoscopy or sigmoidoscopy if abnormal
e. X-ray examination of the abdomen
Currently, screening for colorectal cancer is usually done by means of:
a. Colonoscopy yearly
b. Fecal DNA tests yearly
c. Fecal occult blood tests yearly
**d. Fecal occult blood tests yearly, followed by colonoscopy or sigmoidoscopy if abnormal**
e. X-ray examination of the abdomen
45
Which hormone is associated with galactorrhea, pituitary adenoma, and amenorrhea?
a. estradiol
b. progesterone
c. FSH
d. prolactin
Which hormone is associated with galactorrhea, pituitary adenoma, and amenorrhea?
a. estradiol
b. progesterone
c. FSH
**d. prolactin**
46
Which type of liquid chromatography uses a nonpolar stationary phase?
a. normal-phase chromatography
b. reversed-phase chromatography
c. ion-exchange chromatography
d. size-exclusion chromatography
Which type of liquid chromatography uses a nonpolar stationary phase?
a. normal-phase chromatography
**b. reversed-phase chromatography**
c. ion-exchange chromatography
d. size-exclusion chromatography
47
In a patient with signs and symptoms of malabsorption, the best initial test to document malabsorption is:
a. Carotene in serum with the patient on usual diet
b. D-Xylose test
c. Fecal fat excretion
d. Lactose tolerance test
e. Schilling test
In a patient with signs and symptoms of malabsorption, the best initial test to document malabsorption is:
a. Carotene in serum with the patient on usual diet
b. D-Xylose test
**c. Fecal fat excretion**
d. Lactose tolerance test
e. Schilling test
48
The Classical Pathway recognition molecule is
a. C1 qrs complex
b. C1 inhibitor
c. Mannose binding lectin
d. Pathogen associated molecular patterns
The Classical Pathway recognition molecule is
**a. C1 qrs complex**
b. C1 inhibitor
c. Mannose binding lectin
d. Pathogen associated molecular patterns
49
Which of the following does not add specificity to lipase measurements?
a. The presence of colipase
b. The presence of bile salts
c. Reaction conditions in an emulsion
d. The concentration of substrate
Which of the following does not add specificity to lipase measurements?
a. The presence of colipase
b. The presence of bile salts
c. Reaction conditions in an emulsion
**d. The concentration of substrate**
50
Which protein cross-links fibrin strands?
a. FX
b. FXI
c. FXII
d. FXIII
Which protein cross-links fibrin strands?
a. FX
b. FXI
c. FXII
**d. FXIII**
51
What is harmonization?
a. having equivalent results among different measurement procedures
b. having a suitable reference interval for all measurement procedures
c. having calibration traceable to a secondary reference material
d. having calibration traceable to a reference measurement procedure
What is harmonization?
**a. having equivalent results among different measurement procedures**
b. having a suitable reference interval for all measurement procedures
c. having calibration traceable to a secondary reference material
d. having calibration traceable to a reference measurement procedure
52
The SD is:
a. the average difference between any value and the mean
b. the variance divided by 2
c. the square root of the variance
d. the mean squared difference between individual values and the mean
e. the mean difference between any value and the mean
The SD is:
a. the average difference between any value and the mean
b. the variance divided by 2
**c. the square root of the variance**
d. the mean squared difference between individual values and the mean
e. the mean difference between any value and the mean
53
The primary route of elimination for most drugs is:
a. Exhalation
b. Biliary
c. Renal
d. Mucosal secretion
The primary route of elimination for most drugs is:
a. Exhalation
b. Biliary
c. **Renal**
d. Mucosal secretion
54
Which of the following is routinely measured using conductometry?
a. hematocrit
b. lipid content of blood
c. sodium ion concentration
d. bone density
Which of the following is routinely measured using conductometry?
**a. hematocrit**
b. lipid content of blood
c. sodium ion concentration
d. bone density
55
Which of the following sources of measurement variability need to be included in the SD used to evaluate a method’s performance? (select all that apply)
a. instrument maintenance cycles
b. reagent and calibrator lot changes
c. QC material open-vial stability
d. instrument parameters such as pipette stability, temperature stability, and dirt accumulation
Which of the following sources of measurement variability need to be included in the SD used to evaluate a method’s performance? (select all that apply)
## Footnote
**a. instrument maintenance cycles**
**b. reagent and calibrator lot changes**
**c. QC material open-vial stability**
**d. instrument parameters such as pipette stability, temperature stability, and dirt accumulation**
56
A patient is brought into the ED with the following symptoms: coma, respiratory depression, and pinpoint pupils. He is given naloxone and responds. The expected result on the urine toxicology screen is that it will be positive for:
a. PCP
b. cocaine
c. amphetamine
d. opiates
e. marijuana
A patient is brought into the ED with the following symptoms: coma, respiratory depression, and pinpoint pupils. He is given naloxone and responds. The expected result on the urine toxicology screen is that it will be positive for:
a. PCP
b. cocaine
c. amphetamine
**d. opiates**
e. marijuana
57
8. The most common acquired autoantibody to complement components, present in atypical hemolytic syndrome and C3 glomerulopathies is:
a. Antibodies to Factor B
b. Antibodies to Factor H
c. C4 nephritic factors
d. Antibodies to C1q
8. The most common acquired autoantibody to complement components, present in atypical hemolytic syndrome and C3 glomerulopathies is:
a. Antibodies to Factor B
**b. Antibodies to Factor H**
c. C4 nephritic factors
d. Antibodies to C1q
58
If the laboratory changes the clinically reportable range (CRR) of an FDA-approved assay, it is now considered to be an FDA-modified test and must be validated using LDT parameters.
a. True, if the new CRR is outside of the manufacturer’s defined AMR.
b. True, if the new CRR is within the manufacturer’s defined AMR.
c. True, if the new CRR is either within or outside the manufacturer’s defined AMR.
If the laboratory changes the clinically reportable range (CRR) of an FDA-approved assay, it is now considered to be an FDA-modified test and must be validated using LDT parameters.
**a. True, if the new CRR is outside of the manufacturer’s defined AMR.**
b. True, if the new CRR is within the manufacturer’s defined AMR.
c. True, if the new CRR is either within or outside the manufacturer’s defined AMR.
59
Nonstandardized immunoassay kits are produced when:
a. reagent antibodies from different manufacturers recognize different epitopes
b. there is no primary reference material for the immunoassays
c. neither A or B
d. both A and B
Nonstandardized immunoassay kits are produced when:
a. reagent antibodies from different manufacturers recognize different epitopes
b. there is no primary reference material for the immunoassays
c. neither A or B
**d. both A and B**
60
Which of the following tests is considered the best test for diagnosis of celiac disease?
a. Antibody to gliadin
b. Antibody to tissue transglutaminase
c. D-Xylose test
d. Fecal fat excretion
e. Lactose tolerance test
Which of the following tests is considered the best test for diagnosis of celiac disease?
a. Antibody to gliadin
**b. Antibody to tissue transglutaminase**
c. D-Xylose test
d. Fecal fat excretion
e. Lactose tolerance test
61
Which of the following can occur due to delayed analysis of an unpreserved, unrefrigerated urine specimen?
a. Decreased bilirubin, urobilinogen, ketones, glucose, and nitrites
b. Increased bacterial count, turbidity, pH, ketones, and nitrites
c. Decreased bilirubin, urobilinogen, ketones, glucose, pH, and casts
d. Increased bacterial count, turbidity, pH, ketones, and darkened color
Which of the following can occur due to delayed analysis of an unpreserved, unrefrigerated urine specimen?
a. Decreased bilirubin, urobilinogen, ketones, glucose, and nitrites
b. Increased bacterial count, turbidity, pH, ketones, and nitrites
c. Decreased bilirubin, urobilinogen, ketones, glucose, pH, and casts
**d. Increased bacterial count, turbidity, pH, ketones, and darkened color**
62
A patient has a COHb of 15%. Which parameter would an increase in COHb affect most?
a. sO2
b. pO2
c. pH
d. %O2Hb
e. pCO2
A patient has a COHb of 15%. Which parameter would an increase in COHb affect most?
a. sO2
b. pO2
c. pH
**d. %O2Hb**
e. pCO2
63
Acute porphyria can be identified by laboratory testing for \_\_\_\_\_\_.
a. abnormal heme biosynthesis
b. decreased activity of porphyrin decarboxylation enzymes
c. increased porphobilinogen in a random urine specimen
d. spontaneous production of functional porphyrin isomers
Acute porphyria can be identified by laboratory testing for \_\_\_\_\_\_.
a. abnormal heme biosynthesis
b. decreased activity of porphyrin decarboxylation enzymes
**c. increased porphobilinogen in a random urine specimen**
d. spontaneous production of functional porphyrin isomers
64
Which of the following describes the cathode in an electrochemical cell?
a. loss of electrons occurs; reduction
b. gain of electrons occurs; reduction
c. loss of electrons occurs, oxidation
d. gain of electrons occurs; oxidation
Which of the following describes the cathode in an electrochemical cell?
a. loss of electrons occurs; reduction
**b. gain of electrons occurs; reduction**
c. loss of electrons occurs, oxidation
d. gain of electrons occurs; oxidation
65
Which group of factors is most directly affected by treatment by warfarin?
a. Vitamin K-dependent factors
b. Liver-dependent factors
c. Protease-activated factors
d. Propagation pathway factors
Which group of factors is most directly affected by treatment by warfarin?
**a. Vitamin K-dependent factors**
b. Liver-dependent factors
c. Protease-activated factors
d. Propagation pathway factors
66
Which hormonal profile summarizes the changes observed during menopause?
a. reduced plasma estradiol and progesterone, and increased inhibin and FSH
b. increased plasma estradiol and progesterone, and diminished inhibin and FSH
c. reduced plasma estradiol, progesterone and inhibin, and increased FSH
d. increased plasma estradiol, progesterone and inhibin, and diminished FSH
Which hormonal profile summarizes the changes observed during menopause?
a. reduced plasma estradiol and progesterone, and increased inhibin and FSH
b. increased plasma estradiol and progesterone, and diminished inhibin and FSH
**c. reduced plasma estradiol, progesterone and inhibin, and increased FSH**
d. increased plasma estradiol, progesterone and inhibin, and diminished FSH
67
Which of the following is NOT an advantage of capillary electrophoresis?
a. It has low band-broadening due to effective removal of Joule heating.
b. It can provide faster separations than gel electrophoresis.
c. It can be used with large sample volumes.
d. It can be used with an on-line detector.
Which of the following is NOT an advantage of capillary electrophoresis?
a. It has low band-broadening due to effective removal of Joule heating.
b. It can provide faster separations than gel electrophoresis.
**c. It can be used with large sample volumes.**
d. It can be used with an on-line detector.
68
Antibodyantigen binding is based on _______________ interactions.
a. electrostatic (polar/nonpolar)
b. hydrogen bonding
c. ionic binding
d. all of the above
Antibodyantigen binding is based on _______________ interactions.
a. electrostatic (polar/nonpolar)
b. hydrogen bonding
c. ionic binding
**d. all of the above**
69
Which of the following is NOT true regarding pediatric reference intervals?
a. The pediatric population differs from adults in regards to organ maturity, developmental stages, and immune responsiveness.
b. The pediatric population always requires their own reference interval.
c. Recruiting a sufficiently large and healthy pediatric reference population can be a challenge.
d. Growth and sexual maturation during puberty can affect the levels of many analytes.
Which of the following is NOT true regarding pediatric reference intervals?
a. The pediatric population differs from adults in regards to organ maturity, developmental stages, and immune responsiveness.
**b. The pediatric population always requires their own reference interval.**
c. Recruiting a sufficiently large and healthy pediatric reference population can be a challenge.
d. Growth and sexual maturation during puberty can affect the levels of many analytes.
70
Successive measurements with a pCO2 electrode will be continuously lower due to consumption of the analyte during the analytical process. True or False?
a. True
b. False
Successive measurements with a pCO2 electrode will be continuously lower due to consumption of the analyte during the analytical process. True or False?
a. True
**b. False**
71
How will increased temperature affect the reaction between antibodies and antigens?
a. Increase rate, decrease binding affinity
b. Decrease rate, increase binding affinity
c. Increase rate, increase binding affinity
d. Decrease rate, decrease binding affinity
How will increased temperature affect the reaction between antibodies and antigens?
**a. Increase rate, decrease binding affinity**
b. Decrease rate, increase binding affinity
c. Increase rate, increase binding affinity
d. Decrease rate, decrease binding affinity
72
An adult with a normal hemoglobin profile would be expected to have the following hemoglobin species detected:
a. HbA only
b. HbA and HbA2 only
c. HbA and HbF only
d. HbA, HbF, and HbA2 only
An adult with a normal hemoglobin profile would be expected to have the following hemoglobin species detected:
a. HbA only
b. HbA and HbA2 only
c. HbA and HbF only
**d. HbA, HbF, and HbA2 only**
73
Which description is characteristic of Addison’s disease?
a. ACTH excess, hypercortisolism, and hirsutism
b. ACTH deficiency, hypocortisolism, and fatigue
c. hypercortisolism, hyperglycemia, and central obesity
d. hypocortisolism, hypoglycemia, and weight loss
Which description is characteristic of Addison’s disease?
a. ACTH excess, hypercortisolism, and hirsutism
b. ACTH deficiency, hypocortisolism, and fatigue
c. hypercortisolism, hyperglycemia, and central obesity
**d. hypocortisolism, hypoglycemia, and weight loss**
74
A newborn screen is positive for cystic fibrosis. Follow-up sweat chloride testing was resulted as 40 mmol/L. This is interpreted as \_\_\_\_\_\_.
a. Negative for cystic fibrosis
b. Negative for cystic fibrosis, but positive for pulmonary atresia
c. Positive for cystic fibrosis
d. Indeterminate
A newborn screen is positive for cystic fibrosis. Follow-up sweat chloride testing was resulted as 40 mmol/L. This is interpreted as \_\_\_\_\_\_.
a. Negative for cystic fibrosis
b. Negative for cystic fibrosis, but positive for pulmonary atresia
c. Positive for cystic fibrosis
**d. Indeterminate**
75
Which one of the following assays is least helpful in diagnosing Cushing syndrome?
a. Cortisol following 1 mg of dexamethasone given the previous evening
b. Cortisol drawn at midnight
c. 24-hour urine-free cortisol
d. a.m. cortisol
Which one of the following assays is least helpful in diagnosing Cushing syndrome?
a. Cortisol following 1 mg of dexamethasone given the previous evening
b. Cortisol drawn at midnight
c. 24-hour urine-free cortisol
**d. a.m. cortisol**
76
Potassium can be measured using which of the following techniques?
a. glass membrane ion-selective electrode
b. coulometric titration
c. gentamicin-based ion-exchange electrode
d. none of the above
Potassium can be measured using which of the following techniques?
a. glass membrane ion-selective electrode
b. coulometric titration
c. gentamicin-based ion-exchange electrode
**d. none of the above**
77
Qualitative assays must follow the same validation parameters as quantitative assays.
a. True
b. False
Qualitative assays must follow the same validation parameters as quantitative assays.
a. True
**b. False**
78
ESI is characterized by which of the following correctly ordered steps?
a. Taylor cone formation-voltage applied-ions enter MS inlet-desolvation/evaporation
b. Voltage applied-ions enter MS inlet-desolvation/ evaporation-Taylor cone formation
c. Voltage applied-Taylor cone formation-ions enter MS inlet-desolvation/evaporation
d. Ions enter MS inlet-voltage applied-desolvation/ evaporation-Taylor cone formation
e. Voltage applied-Taylor cone formation- desolvation/evaporation-ions enter MS inlet
ESI is characterized by which of the following correctly ordered steps?
a. Taylor cone formation-voltage applied-ions enter MS inlet-desolvation/evaporation
b. Voltage applied-ions enter MS inlet-desolvation/ evaporation-Taylor cone formation
c. Voltage applied-Taylor cone formation-ions enter MS inlet-desolvation/evaporation
d. Ions enter MS inlet-voltage applied-desolvation/ evaporation-Taylor cone formation
**e. Voltage applied-Taylor cone formation- desolvation/evaporation-ions enter MS inlet**
79
Oval fat bodies, fatty, waxy renal tubular casts, and cholesterol crystals are seen in which of the following diseases?
a. Nephrotic syndrome
b. Chronic glomerulonephritis
c. Acute renal allograft rejection
d. Chronic pyelonephritis
Oval fat bodies, fatty, waxy renal tubular casts, and cholesterol crystals are seen in which of the following diseases?
**a. Nephrotic syndrome**
b. Chronic glomerulonephritis
c. Acute renal allograft rejection
d. Chronic pyelonephritis
80
In flow cytometry, the forward scatter is proportional to which cellular parameter?
a. cytoplasmic complexity
b. volume
c. autofluorescence
d. CD45 expression
In flow cytometry, the forward scatter is proportional to which cellular parameter?
a. cytoplasmic complexity
**b. volume**
c. autofluorescence
d. CD45 expression
81
A possible explanation for an adult male with increased concentrations of the gonadotropins and decreased total testosterone is \_\_\_\_\_\_.
a. primary hypogonadism
b. secondary hypogonadism
c. tertiary hypogonadism
d. complete androgen resistance
A possible explanation for an adult male with increased concentrations of the gonadotropins and decreased total testosterone is \_\_\_\_\_\_.
**a. primary hypogonadism**
b. secondary hypogonadism
c. tertiary hypogonadism
d. complete androgen resistance
82
Which of the following factors affect the reference interval for BNP and NT-proBNP?
a. Age
b. Body mass index
c. Biological Sex
d. All of the above
e. None of the above
Which of the following factors affect the reference interval for BNP and NT-proBNP?
a. Age
b. Body mass index
c. Biological Sex
**d. All of the above**
e. None of the above
83
Acylcarnitine analysis is most commonly used to identify which class of disorders?
a. urea cycle disorders
b. glycogen storage disorders
c. lysosomal storage disorders
d. fatty acid oxidation disorders
Acylcarnitine analysis is most commonly used to identify which class of disorders?
a. urea cycle disorders
b. glycogen storage disorders
c. lysosomal storage disorders
**d. fatty acid oxidation disorders**
84
The typical barcode format used in clinical laboratory environments is \_\_\_\_\_.
a. Code 39
b. Code 128
c. Code 28
d. Codabar
The typical barcode format used in clinical laboratory environments is \_\_\_\_\_.
a. Code 39
**b. Code 128**
c. Code 28
d. Codabar
85
A lean, nondiabetic 45-year-old hypertensive male who is on no therapies has a potassium concentration of 3.0 meq/L or lower on multiple occasions (reference interval: 3.5-5.0 meq/L). Which one of the following tests is likely to be of the greatest diagnostic assistance?
a. Cortisol following 1 mg of dexamethasone given the previous evening
b. Antidiuretic hormone measurement (vasopressin)
c. Renin and aldosterone measurements
d. Plasma-free metanephrine measurement
e. 24-hour urinary HVA and VMA measurements
A lean, nondiabetic 45-year-old hypertensive male who is on no therapies has a potassium concentration of 3.0 meq/L or lower on multiple occasions (reference interval: 3.5-5.0 meq/L). Which one of the following tests is likely to be of the greatest diagnostic assistance?
a. Cortisol following 1 mg of dexamethasone given the previous evening
b. Antidiuretic hormone measurement (vasopressin)
**c. Renin and aldosterone measurements**
d. Plasma-free metanephrine measurement
e. 24-hour urinary HVA and VMA measurements
86
Which statements are true regarding the concentration of soluble serum transferrin receptor (sTfR)? Its level
1. Increases rapidly when iron stores are deficient;
2. Falls long before additional biomarkers upon normalization of the iron status;
3. Is influenced by acute phase responses
a. 1
b. 1-2
c. 2-3
d. 1-3
d. all
Which statements are true regarding the concentration of soluble serum transferrin receptor (sTfR)? Its level
1. Increases rapidly when iron stores are deficient;
2. Falls long before additional biomarkers upon normalization of the iron status;
3. Is influenced by acute phase responses
a. 1
**b. 1-2**
c. 2-3
d. 1-3
d. all
87
A patient is noted to be hypovolemic, with pH 7.49 and the following electrolyte results (mmol/L): Na 135, K 4.8, Cl 90, and HCO3 35. What is the most likely diagnosis and appropriate treatment?
a. Contraction alkalosis; administer intravenous NaCl solution.
b. Diarrhea; administer HCO3 solution.
c. Prolonged vomiting; administer dilute HCl solution.
d. Respiratory alkalosis; induce hyperventilation.
e. Respiratory alkalosis; rebreath exhaled air to increase pCO2.
A patient is noted to be hypovolemic, with pH 7.49 and the following electrolyte results (mmol/L): Na 135, K 4.8, Cl 90, and HCO3 35. What is the most likely diagnosis and appropriate treatment?
**a. Contraction alkalosis; administer intravenous NaCl solution.**
b. Diarrhea; administer HCO3 solution.
c. Prolonged vomiting; administer dilute HCl solution.
d. Respiratory alkalosis; induce hyperventilation.
e. Respiratory alkalosis; rebreath exhaled air to increase pCO2.
88
Which one of the following plasma assays is most helpful in diagnosing pheochromocytoma?
a. Total catecholamines
b. Plasma free metanephrines
c. Epinephrine
d. Norepinephrine
e. Dopamine
Which one of the following plasma assays is most helpful in diagnosing pheochromocytoma?
a. Total catecholamines
**b. Plasma free metanephrines**
c. Epinephrine
d. Norepinephrine
e. Dopamine
89
Which laboratory test is used most to monitor heparin therapy?
a. aPTT
b. PT
c. D-dimer
d. Fibrinogen
Which laboratory test is used most to monitor heparin therapy?
a. **aPTT**
b. PT
c. D-dimer
d. Fibrinogen
90
An obese, diabetic 58-year-old hypertensive male who is on no diuretics has a potassium concentration of 3.0 meq/L or lower on multiple occasions (reference interval: 3.5-5.0 meq/L). He has problems with poor wound healing and infections. He has had a collapsed vertebra in the past. Which one of the following tests is likely to be of the greatest diagnostic assistance?
a. Cortisol following 1 mg of dexamethasone given the previous evening
b. Antidiuretic hormone measurement (vasopressin)
c. Renin and aldosterone measurements
d. Plasma-free metanephrine measurement
e. 24-hour urinary HVA and VMA measurements
An obese, diabetic 58-year-old hypertensive male who is on no diuretics has a potassium concentration of 3.0 meq/L or lower on multiple occasions (reference interval: 3.5-5.0 meq/L). He has problems with poor wound healing and infections. He has had a collapsed vertebra in the past. Which one of the following tests is likely to be of the greatest diagnostic assistance?
**a. Cortisol following 1 mg of dexamethasone given the previous evening**
b. Antidiuretic hormone measurement (vasopressin)
c. Renin and aldosterone measurements
d. Plasma-free metanephrine measurement
e. 24-hour urinary HVA and VMA measurements
91
Measurement of pancreatic-specific amylase activity is achieved through \_\_\_\_.
a. addition of antipancreatic amylase antibodies to determine salivary activity
b. use of antisalivary amylase antibodies in a sandwich immunoassay format
c. addition of antisalivary amylase antibodies to inhibit this isoenzyme activity
d. use of a pancreatic-amylase specific substrate that cannot be hydrolyzed by salivary amylase
Measurement of pancreatic-specific amylase activity is achieved through \_\_\_\_.
a. addition of antipancreatic amylase antibodies to determine salivary activity
b. use of antisalivary amylase antibodies in a sandwich immunoassay format
**c. addition of antisalivary amylase antibodies to inhibit this isoenzyme activity**
d. use of a pancreatic-amylase specific substrate that cannot be hydrolyzed by salivary amylase
92
You are asked to consult on a case involving a 4-yearold boy who presents with xanthomas on his arms and legs. Laboratory results reveal total cholesterol of 740 mg/dL, an LDL-C of 240 mg/dL, an HDL-C of 52 mg/dL, and a triglyceride of 100 mg/dL. At first glance, you are suspicious of:
a. FH
b. lipoprotein lipase deficiency
c. LCAT deficiency
d. familial combined hyperlipidemia
You are asked to consult on a case involving a 4-yearold boy who presents with xanthomas on his arms and legs. Laboratory results reveal total cholesterol of 740 mg/dL, an LDL-C of 240 mg/dL, an HDL-C of 52 mg/dL, and a triglyceride of 100 mg/dL. At first glance, you are suspicious of:
a. **FH**
b. lipoprotein lipase deficiency
c. LCAT deficiency
d. familial combined hyperlipidemia
93
A hyperpigmented patient presents with hypotension, hypoglycemia, hyponatremia, hyperkalemia, and acidosis. What is the most likely diagnosis?
a. Cortisol resistance
b. Addison disease
c. Isolated mineralocorticoid deficiency
d. ACTH deficiency
e. Apparent mineralocorticoid excess
A hyperpigmented patient presents with hypotension, hypoglycemia, hyponatremia, hyperkalemia, and acidosis. What is the most likely diagnosis?
a. Cortisol resistance
**b. Addison disease**
c. Isolated mineralocorticoid deficiency
d. ACTH deficiency
e. Apparent mineralocorticoid excess
94
Which of the following laboratory findings provides supportive evidence that a pleural fluid is an exudate:
a. fluid LDH activity that is \<2/3 the upper limit of a normal serum LDH activity
b. fluid-to-serum LDH ratio of \<0.6
c. fluid-to-serum protein ratio of \>0.5
d. serum-to-fluid albumin gradient (serum albumin minus fluid albumin) \>1.2 g/dL
e. serum-to-fluid protein gradient (serum protein minus fluid protein) \>3.1 g/dL
Which of the following laboratory findings provides supportive evidence that a pleural fluid is an exudate:
a. fluid LDH activity that is \<2/3 the upper limit of a normal serum LDH activity
b. fluid-to-serum LDH ratio of \<0.6
**c. fluid-to-serum protein ratio of \>0.5**
d. serum-to-fluid albumin gradient (serum albumin minus fluid albumin) \>1.2 g/dL
e. serum-to-fluid protein gradient (serum protein minus fluid protein) \>3.1 g/dL
95
What is a primary reference material?
a. the best available material to use for calibration
b. a pure chemical that meets American Chemical Society specifications
c. a pure substance that is characterized for identity and mass balance
d. a pure substance that can be added to a pool of clinical samples to prepare a calibrator
What is a primary reference material?
a. the best available material to use for calibration
b. a pure chemical that meets American Chemical Society specifications
**c. a pure substance that is characterized for identity and mass balance**
d. a pure substance that can be added to a pool of clinical samples to prepare a calibrator
96
Which of the following infectious agent is not commonly associated with an increased cancer risk?
a. syphilis (Treponema pallidum)
b. human papillomavirus (HPV)
c. Helicobacter pylori
d. hepatitis B virus (HBV)
Which of the following infectious agent is not commonly associated with an increased cancer risk?
**a. syphilis (Treponema pallidum)**
b. human papillomavirus (HPV)
c. Helicobacter pylori
d. hepatitis B virus (HBV)
97
Which amino acid is pathognomonic for MSUD?
a. valine
b. leucine
c. isoleucine
d. alloisoleucine
Which amino acid is pathognomonic for MSUD?
a. valine
b. leucine
c. isoleucine
**d. alloisoleucine**
98
The classical pathway is dependent on two metals to activate the cascade and proceed until the formation of the terminal complement complex. Which are they?
a. Aluminum and lead
b. Sodium and Potassium
c. Calcium and Magnesium
d. Calcium and Potassium
The classical pathway is dependent on two metals to activate the cascade and proceed until the formation of the terminal complement complex. Which are they?
a. Aluminum and lead
b. Sodium and Potassium
**c. Calcium and Magnesium**
d. Calcium and Potassium
99
A GC detector that is selective for compounds with electronegative groups is \_\_\_\_\_\_.
a. a thermal conductivity detector
b. a flame ionization detector
c. a nitrogenphosphorus detector
d. an electron capture detector
A GC detector that is selective for compounds with electronegative groups is \_\_\_\_\_\_.
a. a thermal conductivity detector
b. a flame ionization detector
c. a nitrogenphosphorus detector
**d. an electron capture detector**
100
Which of the following statements is most correct regarding the relative concentration and half-life of T4 vs T3 in circulation?
a. T3 is present at lower concentrations and has comparable half-life with T4
b. T3 is present at lower concentrations and has a shorter half-life than T4
c. T3 is present at higher concentrations but has a shorter half-life than T4
d. T4 is present at higher concentrations but has shorter half-life than T3
e. T4 is present at lower concentrations and has a shorter half-life than T3
Which of the following statements is most correct regarding the relative concentration and half-life of T4 vs T3 in circulation?
a. T3 is present at lower concentrations and has comparable half-life with T4
**b. T3 is present at lower concentrations and has a shorter half-life than T4**
c. T3 is present at higher concentrations but has a shorter half-life than T4
d. T4 is present at higher concentrations but has shorter half-life than T3
e. T4 is present at lower concentrations and has a shorter half-life than T3
101
A patient is admitted to the hospital with the following laboratory results: AST 12,500, ALT 7300, alkaline phosphatase 125 (all IU/L), total and direct bilirubin 33 and 21 umol/L, respectively, and prothrombin time of 22.0 s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
b. Acute biliary tract obstruction
c. Acute viral hepatitis
d. Cirrhosis
e. Toxic or ischemic hepatitis
A patient is admitted to the hospital with the following laboratory results: AST 12,500, ALT 7300, alkaline phosphatase 125 (all IU/L), total and direct bilirubin 33 and 21 mmol/L, respectively, and prothrombin time of 22.0 s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
b. Acute biliary tract obstruction
c. Acute viral hepatitis
d. Cirrhosis
**e. Toxic or ischemic hepatitis**
102
Which of the following statements is the most correct?
a. decreased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, FT4, and thyroid function
b. decreased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, but often normal FT4, and thyroid function
c. increased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, FT4, and hyperthyroid state.
d. increased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, but often normal FT4, and thyroid function
e. increased concentration of thyroid hormone binding protein is rarely observed during pregnancy
Which of the following statements is the most correct?
a. decreased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, FT4, and thyroid function
b. decreased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, but often normal FT4, and thyroid function
c. increased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, FT4, and hyperthyroid state.
**d. increased concentration of thyroid hormone binding proteins during pregnancy may lead to increased total T4, but often normal FT4, and thyroid function**
e. increased concentration of thyroid hormone binding protein is rarely observed during pregnancy
103
Which laboratory measure below is most affected by the patient’s fasting status?
a. Total Cholesterol
b. HDL Cholesterol
c. Triglycerides
d. Apolipoprotein B
Which laboratory measure below is most affected by the patient’s fasting status?
a. Total Cholesterol
b. HDL Cholesterol
c. **Triglycerides**
d. Apolipoprotein B
104
What sources of bias or error can be corrected for by calibration?
a. wavelength inaccuracy
b. autopipettor imprecision
c. absorbance inaccuracy
d. spectrophotometric interferences
e. a and c
f. a, b and c
What sources of bias or error can be corrected for by calibration?
a. wavelength inaccuracy
b. autopipettor imprecision
c. absorbance inaccuracy
d. spectrophotometric interferences
**e. a and c**
f. a, b and c
105
A patient is admitted to the hospital with the following laboratory results: AST 140, ALT 150, alkaline phosphatase 380 (all IU/L), total and direct bilirubin 65 and 41 umol/L, respectively, and prothrombin time of 12.8 s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
b. Acute biliary tract obstruction
c. Acute viral hepatitis
d. Cirrhosis
e. Toxic or ischemic hepatitis
A patient is admitted to the hospital with the following laboratory results: AST 140, ALT 150, alkaline phosphatase 380 (all IU/L), total and direct bilirubin 65 and 41 umol/L, respectively, and prothrombin time of 12.8 s. The most likely cause of these abnormalities is:
a. Alcoholic hepatitis
**b. Acute biliary tract obstruction**
c. Acute viral hepatitis
d. Cirrhosis
e. Toxic or ischemic hepatitis
106
Which of the following does not occur as part of the pathophysiological events that lead to Type 2 MI?
a. Atherosclerosis and oxygen supply/demand imbalance
b. Plaque rupture
c. Vasospasm or coronary mircovascular dysfunction
d. Nonatherosclerotic coronary dissection
e. Oxygen supply/demand imbalance alone
Which of the following does not occur as part of the pathophysiological events that lead to Type 2 MI?
a. Atherosclerosis and oxygen supply/demand imbalance
**b. Plaque rupture**
c. Vasospasm or coronary mircovascular dysfunction
d. Nonatherosclerotic coronary dissection
e. Oxygen supply/demand imbalance alone
107
How should the target value for a QC material be assigned?
a. by assaying one bottle 10 times over 5 days
b. by assaying 10 bottles on each of 10 days
c. by assaying several bottles on each of 10 days while allowing the open-vial stability to age
d. by using the manufacturer’s assigned value
How should the target value for a QC material be assigned?
a. by assaying one bottle 10 times over 5 days
b. by assaying 10 bottles on each of 10 days
**c. by assaying several bottles on each of 10 days while allowing the open-vial stability to age**
d. by using the manufacturer’s assigned value
108
What is the most common congenital factor deficiency?
a. FVII
b. FVIII
c. FIX
d. FX
What is the most common congenital factor deficiency?
a. FVII
b. **FVIII**
c. FIX
d. FX
109
The conventional standard method for indirect determination of exocrine pancreatic insufficiency is \_\_\_\_.
a. quantitative fecal fat
b. elastase-1
c. chymotrypsin
d. trypsin
The conventional standard method for indirect determination of exocrine pancreatic insufficiency is \_\_\_\_.
**a. quantitative fecal fat**
b. elastase-1
c. chymotrypsin
d. trypsin
110
What is the most common fatty acid oxidation disorder?
a. VLCAD
b. LCAD
c. MCAD
d. SCAD
What is the most common fatty acid oxidation disorder?
a. VLCAD
b. LCAD
**c. MCAD**
d. SCAD
111
All of the following are methods used to determine the complete blood count except:
a. impedance
b. mass spectrometry
c. flow cytometry
d. conductivity
All of the following are methods used to determine the complete blood count except:
a. impedance
**b. mass spectrometry**
c. flow cytometry
d. conductivity
112
Which laboratory results would most likely be associated with nonthyroidal illness (NTI, syndrome basse T3)?
a. normal TSH, normal total and FT4, low FT3, and high rT3
b. normal TSH, normal total and FT4, normal FT3, and low rT3
c. normal TSH, normal total T4, high FT4, normal FT3, and high rT3
d. low TSH, normal total and FT4, high FT3, and high rT3
e. low TSH, high total and FT4, high FT3, and high rT3
Which laboratory results would most likely be associated with nonthyroidal illness (NTI, syndrome basse T3)?
**a. normal TSH, normal total and FT4, low FT3, and high rT3**
b. normal TSH, normal total and FT4, normal FT3, and low rT3
c. normal TSH, normal total T4, high FT4, normal FT3, and high rT3
d. low TSH, normal total and FT4, high FT3, and high rT3
e. low TSH, high total and FT4, high FT3, and high rT3
113
Which of the following detectors might be used in LC to record an absorbance spectrum?
a. photodiode array detector
b. evaporative light scattering detector
c. conductivity detector
d. electrochemical detector
Which of the following detectors might be used in LC to record an absorbance spectrum?
**a. photodiode array detector**
b. evaporative light scattering detector
c. conductivity detector
d. electrochemical detector
114
Correctly list major lipoproteins in order from largest to smallest:
a. VLDL, chylomicrons, IDL, HDL, LDL
b. Chylomicrons, VLDL, IDL, HDL, LDL
c. VLDL, IDL, chylomicrons, LDL, HDL
d. Chylomicrons, VLDL, IDL, LDL, HDL
Correctly list major lipoproteins in order from largest to smallest:
a. VLDL, chylomicrons, IDL, HDL, LDL
b. Chylomicrons, VLDL, IDL, HDL, LDL
c. VLDL, IDL, chylomicrons, LDL, HDL
**d. Chylomicrons, VLDL, IDL, LDL, HDL**
115
Which of the following statements are NOT true regarding reference intervals and clinical decision limits?
a. In some cases, only one side of the reference distribution is clinically significant.
b. Reference limits represent cut points associated with disease.
c. HbA1c is an example of an analyte for which clinical decision limits are used.
d. For some analytes, the 99th percentile may be used to calculate reference intervals when greater specificity is required.
e. For the majority of biochemical markers, reference intervals are used to interpret laboratory test results.
Which of the following statements are NOT true regarding reference intervals and clinical decision limits?
a. In some cases, only one side of the reference distribution is clinically significant.
**b. Reference limits represent cut points associated with disease.**
c. HbA1c is an example of an analyte for which clinical decision limits are used.
d. For some analytes, the 99th percentile may be used to calculate reference intervals when greater specificity is required.
e. For the majority of biochemical markers, reference intervals are used to interpret laboratory test results.
116
What criteria are considered when evaluating TAT of automated instrumentation?
a. The total number of samples tested in the laboratory
b. The number of test requests associated with each specimen
c. Instrument type and complexity
d. All of the above
What criteria are considered when evaluating TAT of automated instrumentation?
a. The total number of samples tested in the laboratory
b. The number of test requests associated with each specimen
c. Instrument type and complexity
**d. All of the above**
117
Of the following causes of hyponatremia, which would most likely present with a high serum osmolality?
a. renal fluid and electrolyte losses
b. psychogenic polydipsia
c. syndrome of inappropriate antidiuresis (SIADH)
d. edematous states such as congestive heart failure
e. diabetes mellitus with extreme hyperglycemia
Of the following causes of hyponatremia, which would most likely present with a high serum osmolality?
a. renal fluid and electrolyte losses
b. psychogenic polydipsia
c. syndrome of inappropriate antidiuresis (SIADH)
d. edematous states such as congestive heart failure
**e. diabetes mellitus with extreme hyperglycemia**
118
The presence of CSF in a nasal fluid specimen can be evaluated by which of the following tests:
a. alpha-1 antitrypsin
b. alpha-2 macroglobulin
c. beta-2 glycoprotein
d. beta-2 transferrin
e. beta-2 microglobulin
The presence of CSF in a nasal fluid specimen can be evaluated by which of the following tests:
a. alpha-1 antitrypsin
b. alpha-2 macroglobulin
c. beta-2 glycoprotein
**d. beta-2 transferrin**
e. beta-2 microglobulin
119
Which term is used to describe the pH at which a zwitterion has no net charge?
a. electrophoretic mobility
b. size or mass
c. isoelectric point
d. amino acid composition
Which term is used to describe the pH at which a zwitterion has no net charge?
a. electrophoretic mobility
b. size or mass
**c. isoelectric point**
d. amino acid composition
120
In an adult woman, hypoglycemia is confirmed during a 72-hour fast. At the time of hypoglycemia, insulin and C-peptide are both elevated above the reference intervals for a normal FPG. What drug ingestion should be excluded before the workup for insulinoma begins in earnest?
a. Ethanol
b. Metformin
c. Sulfonylureas
d. Statins
e. Cocaine
In an adult woman, hypoglycemia is confirmed during a 72-hour fast. At the time of hypoglycemia, insulin and C-peptide are both elevated above the reference intervals for a normal FPG. What drug ingestion should be excluded before the workup for insulinoma begins in earnest?
a. Ethanol
b. Metformin
c. **Sulfonylureas**
d. Statins
e. Cocaine
121
A deficiency of the enzyme 5α-reductase \_\_\_\_\_\_.
a. results in female pseudohermaphroditism
b. can be identified by a decreased testosterone:dihydrotestosterone ratio
c. results in individuals with normal physical but impaired mental development
d. results in intersex genitalia at birth with eventual masculinization at puberty
A deficiency of the enzyme 5α-reductase \_\_\_\_\_\_.
a. results in female pseudohermaphroditism
b. can be identified by a decreased testosterone:dihydrotestosterone ratio
c. results in individuals with normal physical but impaired mental development
**d. results in intersex genitalia at birth with eventual masculinization at puberty**
122
Timing of sample collection is most important for drugs with which of the following?
a. Very short half-lives
b. Variable bioavailability
c. Active metabolites
d. No recognized circadian rhythm effects
e. Very long half-lives
Timing of sample collection is most important for drugs with which of the following?
**a. Very short half-lives**
b. Variable bioavailability
c. Active metabolites
d. No recognized circadian rhythm effects
e. Very long half-lives
123
Eculizumab is a monoclonal antibody therapy that targets and blocks a component of the complement cascade. Which is it?
a. C3
b. C5
c. C5b-9
d. C4
Eculizumab is a monoclonal antibody therapy that targets and blocks a component of the complement cascade. Which is it?
**a. C3**
b. C5
c. C5b-9
d. C4
124
Which of the following hepatitis viruses is transmitted through the fecaloral route?
a. HCV
b. HBV
c. HDV
d. HEV
e. HGV
Which of the following hepatitis viruses is transmitted through the fecaloral route?
a. HCV
b. HBV
c. HDV
**d. HEV**
e. HGV
125
Exudates are fluid accumulations that are most often due to membrane damage, infection, inflammation, or malignancy.
a. true
b. false
Exudates are fluid accumulations that are most often due to membrane damage, infection, inflammation, or malignancy.
**a. true**
b. false
126
When there is no primary reference material or reference measurement procedure for a measurand, \_\_\_\_\_\_.
a. a laboratory should use a PT/EQA material for calibration traceability.
b. a laboratory should use any calibrator as long as a proper reference interval is established.
c. the calibrator from the manufacturer of a measurement procedure defines the calibration.
d. a secondary reference material should be the basis for calibration traceability when available.
When there is no primary reference material or reference measurement procedure for a measurand, \_\_\_\_\_\_.
a. a laboratory should use a PT/EQA material for calibration traceability.
b. a laboratory should use any calibrator as long as a proper reference interval is established.
c. the calibrator from the manufacturer of a measurement procedure defines the calibration.
**d. a secondary reference material should be the basis for calibration traceability when available.**
127
A 48-h-old term infant has a serum bilirubin of 280 umol/L. According to the bilirubin nomogram, this puts the infant in which risk category?
a. Low risk
b. High-intermediate risk
c. High risk
d. The nomogram cannot be used to predict risk in term infants.
A 48-h-old term infant has a serum bilirubin of 280 umol/L. According to the bilirubin nomogram, this puts the infant in which risk category?
a. Low risk
b. High-intermediate risk
**c. High risk**
d. The nomogram cannot be used to predict risk in term infants.
128
The CKD-EPI equation results in improved performance for estimation of measured GFR compared with the MDRD study equation in which of the following groups?
a. people with CKD
b. amputees
c. people with rapidly changing kidney function
d. people with higher GFRs
The CKD-EPI equation results in improved performance for estimation of measured GFR compared with the MDRD study equation in which of the following groups?
a. people with CKD
b. amputees
c. people with rapidly changing kidney function
**d. people with higher GFRs**
129
Which disease is associated with increased unconjugated bilirubin concentrations at birth due to a complete loss of UDP-GT activity?
a. CriglerNajjar Type I
b. CriglerNajjar Type II
c. LuceyDriscoll
d. Gilbert
e. DubinJohnson
Which disease is associated with increased unconjugated bilirubin concentrations at birth due to a complete loss of UDP-GT activity?
**a. CriglerNajjar Type I**
b. CriglerNajjar Type II
c. LuceyDriscoll
d. Gilbert
e. DubinJohnson
130
Of the following applications, which would be most appropriate for analysis by ICP-MS?
a. Illicit drugs
b. Testosterone
c. Phenylalanine
d. Copper
Of the following applications, which would be most appropriate for analysis by ICP-MS?
a. Illicit drugs
b. Testosterone
c. Phenylalanine
**d. Copper**
131
Two tests, A and B, are compared for the screening of left ventricular dysfunction in a primary care clinic. Cutoffs selected show diagnostic sensitivities of 80% for A and 50% for B; diagnostic specificities are 20% for A and 40% for B. The area under the ROC curve is 0.75 for test A and 0.70 for test B.
Which test is likely better as a screening test for left ventricular dysfunction?
a. Test A is likely better.
b. Test B is likely better.
c. Test A and B are likely to be equivalent.
d. There is insufficient information to determine which is likely better.
Two tests, A and B, are compared for the screening of left ventricular dysfunction in a primary care clinic. Cutoffs selected show diagnostic sensitivities of 80% for A and 50% for B; diagnostic specificities are 20% for A and 40% for B. The area under the ROC curve is 0.75 for test A and 0.70 for test B.
Which test is likely better as a screening test for left ventricular dysfunction?
**a. Test A is likely better.**
b. Test B is likely better.
c. Test A and B are likely to be equivalent.
d. There is insufficient information to determine which is likely better.
132
Which is appropriate for initial screening for acromegaly?
a. random-draw serum IGF-1 measurement
b. random-draw serum GH measurement
c. glucose challenge followed by timed serum IGF-1 measurement
d. glucose challenge followed by timed serum GH measurement
Which is appropriate for initial screening for acromegaly?
**a. random-draw serum IGF-1 measurement**
b. random-draw serum GH measurement
c. glucose challenge followed by timed serum IGF-1 measurement
d. glucose challenge followed by timed serum GH measurement
133
A 6-year-old male is brought to the Emergency Room by his mother. The child has been nauseous and vomiting for 2 days and complains his stomach hurts. His physical exam showed the following: T598.6F, blood pressure5110/70 mm Hg, heart rate5103 bpm, and respiratory rate522 breaths/min. He was jaundiced and diaphoretic. The most likely diagnosis/treatment for the child is:
a. salicylate overdose/activated charcoal
b. acetaminophen overdose/N-acetylcysteine
c. alcohol overdose/dialysis
d. digoxin overdose/Digibind
e. warfarin overdose/vitamin K
A 6-year-old male is brought to the Emergency Room by his mother. The child has been nauseous and vomiting for 2 days and complains his stomach hurts. His physical exam showed the following: T598.6F, blood pressure5110/70 mm Hg, heart rate5103 bpm, and respiratory rate522 breaths/min. He was jaundiced and diaphoretic. The most likely diagnosis/treatment for the child is:
a. salicylate overdose/activated charcoal
**b. acetaminophen overdose/N-acetylcysteine**
c. alcohol overdose/dialysis
d. digoxin overdose/Digibind
e. warfarin overdose/vitamin K
134
What is the immunoglobulin that activates the complement system most efficiently? And what is the one that does not activate complement, respectively?
a. IgG and IgA
b. IgD and IgM
c. IgM and IgG1
d. IgM and IgG4
What is the immunoglobulin that activates the complement system most efficiently? And what is the one that does not activate complement, respectively?
a. IgG and IgA
b. IgD and IgM
c. IgM and IgG1
**d. IgM and IgG4**
135
Age-dependent reference curves:
a. can be established using direct or indirect methods
b. can more easily be implemented into laboratory information systems
c. can be established using several statistical methods, including fractional polynomials and nonparametric quantile regression
d. A and C
e. all of the above
Age-dependent reference curves:
a. can be established using direct or indirect methods
b. can more easily be implemented into laboratory information systems
c. can be established using several statistical methods, including fractional polynomials and nonparametric quantile regression
**d. A and C**
e. all of the above
136
2. The alternative pathway is triggered by
a. C1 qrs
b. C3 spontaneous hydrolysis
c. Ficolins
d. Factor B
2. The alternative pathway is triggered by
a. C1 qrs
**b. C3 spontaneous hydrolysis**
c. Ficolins
d. Factor B
137
Ion fragmentation can occur within which region(s) of a mass spectrometer?
a. ion source
b. vacuum
c. detector
d. collision cell
e. b and c
f. a and d
Ion fragmentation can occur within which region(s) of a mass spectrometer?
a. ion source
b. vacuum
c. detector
d. collision cell
e. b and c
**f. a and d**
138
Which of the following symptoms is least likely to be observed in a patient diagnosed with hypothyroidism?
a. weight gain
b. eyelid retraction
c. decreased metabolism
d. goiter
e. lethargy
f. cold intolerance
Which of the following symptoms is least likely to be observed in a patient diagnosed with hypothyroidism?
a. weight gain
**b. eyelid retraction**
c. decreased metabolism
d. goiter
e. lethargy
f. cold intolerance
139
Which of the following is a diagnostic criterion for asymptomatic (smoldering) myeloma?
a. \<10% plasma cells in bone marrow aspirate
b. No evidence of lytic bone lesions
c. No reduction in uninvolved serum immunoglobulins
d. No light chains excreted in urine
Which of the following is a diagnostic criterion for asymptomatic (smoldering) myeloma?
a. \<10% plasma cells in bone marrow aspirate
**b. No evidence of lytic bone lesions**
c. No reduction in uninvolved serum immunoglobulins
d. No light chains excreted in urine
140
What is the principle that governs time-of-flight analyzers?
a. Heavy ions do not move (fly) as fast as light ions.
b. Ion flight is measured one ion at a time.
c. Ion flight time is independent of the ion m/z.
d. Switching voltages allows only selected ions to reach the detector.
e. Ions following an unstable trajectory will be eliminated.
What is the principle that governs time-of-flight analyzers?
**a. Heavy ions do not move (fly) as fast as light ions.**
b. Ion flight is measured one ion at a time.
c. Ion flight time is independent of the ion m/z.
d. Switching voltages allows only selected ions to reach the detector.
e. Ions following an unstable trajectory will be eliminated.
141
Statin drugs (lovastatin, simvastatin, pravastatin, etc.) lower cholesterol by:
a. activating HMG-CoA reductase
b. activating lipoprotein lipase
c. inhibiting HMG-CoA reductase
d. inhibiting lipoprotein lipase
Statin drugs (lovastatin, simvastatin, pravastatin, etc.) lower cholesterol by:
a. activating HMG-CoA reductase
b. activating lipoprotein lipase
**c. inhibiting HMG-CoA reductase**
d. inhibiting lipoprotein lipase
142
Most amino acid disorders are identified in which matrix?
a. serum
b. plasma
c. urine
d. CSF
Most amino acid disorders are identified in which matrix?
a. serum
**b. plasma**
c. urine
d. CSF
143
To distinguish between an HbS carrier and an HbS carrier with concurrent beta-thalassemia, it is important to evaluate which of the following?
a. the ratio of HbS to HbF
b. the absolute value of HbS
c. the ratio of HbA to HbS
d. the relative percent of HbA2
To distinguish between an HbS carrier and an HbS carrier with concurrent beta-thalassemia, it is important to evaluate which of the following?
a. the ratio of HbS to HbF
b. the absolute value of HbS
**c. the ratio of HbA to HbS**
d. the relative percent of HbA2
144
Measurement of serum cystatin C
a. is clearly superior to serum creatinine as a marker of kidney function
b. may be a useful biomarker in conditions when serum creatinine is a less reliable indicator of kidney function
c. is standardized so any method can be used with any equation to calculate eGFR
d. should become part of the basic metabolic profile
Measurement of serum cystatin C
a. is clearly superior to serum creatinine as a marker of kidney function
**b. may be a useful biomarker in conditions when serum creatinine is a less reliable indicator of kidney function**
c. is standardized so any method can be used with any equation to calculate eGFR
d. should become part of the basic metabolic profile
145
Which of the following pairs is incorrectly matched?
a. electron ionization: hard ionization
b. quadrupole: corkscrew ion path
c. chemical ionization: soft ionization
d. MALDI: soft ionization
e. APCI: pulsed laser beam
Which of the following pairs is incorrectly matched?
a. electron ionization: hard ionization
b. quadrupole: corkscrew ion path
c. chemical ionization: soft ionization
d. MALDI: soft ionization
**e. APCI: pulsed laser beam**
146
In which of the following scenarios should the CKDEPI creatinine equation not be used?
1. pregnant women
2. people with amputations
3. people with CKD
4. people with muscular dystrophy
a. all of the above
b. 1-2-4
c. 1-2-3
d. 1-2
In which of the following scenarios should the CKDEPI creatinine equation not be used?
1. pregnant women
2. people with amputations
3. people with CKD
4. people with muscular dystrophy
a. all of the above
b. 1-2-4
c. 1-2-3
d. 1-2
147
An infant has a palpable abdominal mass. The blood pressure is normal. Which one of the following tests, if normal, would be most helpful in excluding adrenal pathology?
a. 24-hour urinary HVA and VMA
b. Aldosterone after salt loading
c. 24-hour urinary metanephrines
d. Cortisol after cosyntropin injection
e. Plasma-free metanephrines
An infant has a palpable abdominal mass. The blood pressure is normal. Which one of the following tests, if normal, would be most helpful in excluding adrenal pathology?
**a. 24-hour urinary HVA and VMA**
b. Aldosterone after salt loading
c. 24-hour urinary metanephrines
d. Cortisol after cosyntropin injection
e. Plasma-free metanephrines
148
The D-dimer assay has a high negative predictive value for what patient presentation?
a. High pretest probability of PE
b. Low pretest probability of PE
c. High pretest probability MI
d. Low pretest probability MI
The D-dimer assay has a high negative predictive value for what patient presentation?
a. High pretest probability of PE
**b. Low pretest probability of PE**
c. High pretest probability MI
d. Low pretest probability MI
149
Which of the following is the most common cause of chronic pancreatitis?
a. Pancreatic cancer
b. Alcohol abuse
c. Genetic mutation
d. α1-Antitrypsin deficiency
Which of the following is the most common cause of chronic pancreatitis?
a. Pancreatic cancer
**b. Alcohol abuse**
c. Genetic mutation
d. α1-Antitrypsin deficiency
150
Which best describes the biological source and function of oxytocin?
a. posterior pituitary hormone that stimulates follicular maturation
b. posterior pituitary hormone that stimulates smooth muscle contraction
c. anterior pituitary hormone that stimulates ovulation
d. anterior pituitary hormone that stimulates cortisol production
Which best describes the biological source and function of oxytocin?
a. posterior pituitary hormone that stimulates follicular maturation
**b. posterior pituitary hormone that stimulates smooth muscle contraction**
c. anterior pituitary hormone that stimulates ovulation
d. anterior pituitary hormone that stimulates cortisol production
151
What is generally the preferred sample type for detection of circulating tumor DNA (ctDNA)?
a. plasma
b. serum
c. urine
d. CSF
What is generally the preferred sample type for detection of circulating tumor DNA (ctDNA)?
**a. plasma**
b. serum
c. urine
d. CSF
152
The red blood cell or platelet distribution width is a measure of which of the following?
a. variation in size
b. variation in shape
c. variation in cytoplasmic complexity
d. circumference
The red blood cell or platelet distribution width is a measure of which of the following?
**a. variation in size**
b. variation in shape
c. variation in cytoplasmic complexity
d. circumference
153
Liquid chromatography is different from gas chromatography in that \_\_\_\_\_\_.
a. it has less band-broadening
b. it has a liquid mobile phase that affects analyte retention
c. it requires volatile analytes
d. it can use a gas or liquid as the mobile phase
Liquid chromatography is different from gas chromatography in that \_\_\_\_\_\_.
a. it has less band-broadening
**b. it has a liquid mobile phase that affects analyte retention**
c. it requires volatile analytes
d. it can use a gas or liquid as the mobile phase
154
Which method for measuring total bilirubin concentrations uses caffeine as an accelerant?
a. EvelynMalloy
b. JendrassikGrof
c. Van den Bergh and Muller
d. Ehrlich
e. An accelerant is not required for the measurement of total bilirubin concentrations.
Which method for measuring total bilirubin concentrations uses caffeine as an accelerant?
a. EvelynMalloy
**b. JendrassikGrof**
c. Van den Bergh and Muller
d. Ehrlich
e. An accelerant is not required for the measurement of total bilirubin concentrations.
155
Which protein’s action is potentiated by heparin?
a. Antithrombin
b. Protein C
c. Protein S
d. Protein Z-dependent protease inhibitor
Which protein’s action is potentiated by heparin?
**a. Antithrombin**
b. Protein C
c. Protein S
d. Protein Z-dependent protease inhibitor
156
A routine urinalysis is performed on a young child suffering from diarrhea. The reagent test strip is negative for glucose but positive for ketones. These results may be explained by which of the following statements?
a. The child has Type I diabetes mellitus.
b. The child is suffering from lactic acidosis, and the lactic acid has falsely reacted with the impregnated reagent area for ketones.
c. The child is suffering from increased catabolism of fat because of decreased intestinal absorption.
d. The reagent area for ketones was read after the maximum reading time allowed.
A routine urinalysis is performed on a young child suffering from diarrhea. The reagent test strip is negative for glucose but positive for ketones. These results may be explained by which of the following statements?
a. The child has Type I diabetes mellitus.
b. The child is suffering from lactic acidosis, and the lactic acid has falsely reacted with the impregnated reagent area for ketones.
**c. The child is suffering from increased catabolism of fat because of decreased intestinal absorption.**
d. The reagent area for ketones was read after the maximum reading time allowed.
157
A patient has the following laboratory results: Na 139, K 4.4, Cl 85, HCO3 42 (all mmol/L), pH 7.35, and pCO2 79 mmHg. What is the most likely cause of these results?
a. diabetic ketoacidosis
b. metabolic alkalosis
c. acute respiratory acidosis
d. chronic respiratory acidosis
e. respiratory alkalosis
A patient has the following laboratory results: Na 139, K 4.4, Cl 85, HCO3 42 (all mmol/L), pH 7.35, and pCO2 79 mmHg. What is the most likely cause of these results?
a. diabetic ketoacidosis
b. metabolic alkalosis
c. acute respiratory acidosis
**d. chronic respiratory acidosis**
e. respiratory alkalosis
158
Which of the following contribute the most to the minimum volume required for an assay?
a. Patient total blood volume
b. Analytical volume
c. Dead volume
d. The need for duplicate testing
Which of the following contribute the most to the minimum volume required for an assay?
a. Patient total blood volume
b. Analytical volume
**c. Dead volume**
d. The need for duplicate testing
159
Which of the following criteria should be used to select materials to use for QC? (select all that apply)
a. analyte stability after opening
b. analyte concentrations at low and high values relative to the analytical measurement range
c. a matrix similar to that of clinical samples
d. number of analytes in the same vial
Which of the following criteria should be used to select materials to use for QC? (select all that apply)
## Footnote
**a. analyte stability after opening**
**b. analyte concentrations at low and high values relative to the analytical measurement range**
**c. a matrix similar to that of clinical samples**
**d. number of analytes in the same vial**
160
The pathogenesis of renal osteodystrophy involves all of the following processes except:
a. phosphate retention, depressed calcium, and increased PTH.
b. decreased conversion of 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D.
c. hyperparathyroidism.
d. resistance to the effects of PTH on bone.
e. decreased intestinal calcium absorption.
The pathogenesis of renal osteodystrophy involves all of the following processes except:
a. phosphate retention, depressed calcium, and increased PTH.
b. decreased conversion of 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D.
c. hyperparathyroidism.
**d. resistance to the effects of PTH on bone.**
e. decreased intestinal calcium absorption.
161
Commutability means \_\_\_\_\_\_.
a. results for patient samples agree among different measurement procedures.
b. results for PT/EQA samples agree among different measurement procedures.
c. results for a reference material are the same as the results for clinical samples when measured by different measurement procedures.
d. the same reference interval can be used for all measurement procedures.
Commutability means \_\_\_\_\_\_.
a. results for patient samples agree among different measurement procedures.
b. results for PT/EQA samples agree among different measurement procedures.
**c. results for a reference material are the same as the results for clinical samples when measured by different measurement procedures.**
d. the same reference interval can be used for all measurement procedures.
162
What is the correct relationship between BNP and NT-proBNP?
a. Both are derived from proBNP
b. NT-proBNP is a metabolite of BNP
c. BNP is a metabolite of NT-proBNP
d. Both BNP and NT-proBNP are biologically active
e. Neither BNP nor NT-proBNP are biologically active
What is the correct relationship between BNP and NT-proBNP?
**a. Both are derived from proBNP**
b. NT-proBNP is a metabolite of BNP
c. BNP is a metabolite of NT-proBNP
d. Both BNP and NT-proBNP are biologically active
e. Neither BNP nor NT-proBNP are biologically active
163
Which of the following is a condition that must be fulfilled for reference intervals established in one laboratory to be used in another laboratory?
a. The reference interval to be transferred must have been obtained properly.
b. The analytical systems must be comparable between laboratories.
c. The test subject populations must be comparable.
d. Full documents must be available on the generation of the reference interval to be transferred.
e. All of the above conditions must be fulfilled.
Which of the following is a condition that must be fulfilled for reference intervals established in one laboratory to be used in another laboratory?
a. The reference interval to be transferred must have been obtained properly.
b. The analytical systems must be comparable between laboratories.
c. The test subject populations must be comparable.
d. Full documents must be available on the generation of the reference interval to be transferred.
**e. All of the above conditions must be fulfilled.**
164
Drug X is a highly protein-bound drug, primarily bound (\>95%) to albumin. Which of the following will result in an increase in the free drug concentration?
a. Hemolysis
b. Hyperlipidemia
c. Hypoglycemia
d. Hyperbilirubinemia
Drug X is a highly protein-bound drug, primarily bound (\>95%) to albumin. Which of the following will result in an increase in the free drug concentration?
a. Hemolysis
b. Hyperlipidemia
c. Hypoglycemia
**d. Hyperbilirubinemia**
165
Which of the following best describes the clinical sensitivity and specificity of cardiac markers for AMI?
a. CK-MB has the highest sensitivity and cardiac troponin the highest specificity
b. Cardiac troponin has the highest sensitivity and CK-MB the highest specificity
c. CK-MB has the highest sensitivity and specificity
d. Myoglobin has the highest sensitivity and troponin the highest specificity
e. Cardiac troponin has the highest sensitivity and specificity
Which of the following best describes the clinical sensitivity and specificity of cardiac markers for AMI?
a. CK-MB has the highest sensitivity and cardiac troponin the highest specificity
b. Cardiac troponin has the highest sensitivity and CK-MB the highest specificity
c. CK-MB has the highest sensitivity and specificity
d. Myoglobin has the highest sensitivity and troponin the highest specificity
**e. Cardiac troponin has the highest sensitivity and specificity**
166
Which of the following antibodies is NOT associated with autoimmune hepatitis?
a. Anti-LKM1
b. ASMA
c. AMA-M2
d. ANA
e. All are associated with autoimmune hepatitis.
Which of the following antibodies is NOT associated with autoimmune hepatitis?
a. Anti-LKM1
b. ASMA
**c. AMA-M2**
d. ANA
e. All are associated with autoimmune hepatitis.
167
What is actually measured to determine the absorbance of a chromogen?
a. light energy hitting a detector
b. decrease in light intensity hitting a detector
c. increase in light intensity hitting a detector
d. ratio of light intensity hitting a detector between the chromogen and the blank
What is actually measured to determine the absorbance of a chromogen?
a. light energy hitting a detector
b. decrease in light intensity hitting a detector
c. increase in light intensity hitting a detector
**d. ratio of light intensity hitting a detector between the chromogen and the blank**
168
What is the primary analyte used for direct assessment of exocrine pancreatic function after secretin stimulation?
a. Phospholipase A2
b. IRT
c. Bicarbonate
d. Gastrin
What is the primary analyte used for direct assessment of exocrine pancreatic function after secretin stimulation?
a. Phospholipase A2
b. IRT
**c. Bicarbonate**
d. Gastrin
169
Which fraction of bilirubin is found in systemic circulation in a healthy individual?
a. Conjugated bilirubin
b. Unconjugated bilirubin
c. Biliprotein
d. Equal amounts of conjugated and unconjugated bilirubin
e. Equal concentrations of biliprotein and unconjugated bilirubin
Which fraction of bilirubin is found in systemic circulation in a healthy individual?
a. Conjugated bilirubin
**b. Unconjugated bilirubin**
c. Biliprotein
d. Equal amounts of conjugated and unconjugated bilirubin
e. Equal concentrations of biliprotein and unconjugated bilirubin
170
For a patient who has an elevated Lp(a), the abnormality most likely to be detected by a basic lipid panel is:
a. elevated VLDL cholesterol
b. low HDL cholesterol
c. elevated LDL cholesterol
d. elevated fasting triglycerides
For a patient who has an elevated Lp(a), the abnormality most likely to be detected by a basic lipid panel is:
a. elevated VLDL cholesterol
b. low HDL cholesterol
**c. elevated LDL cholesterol**
d. elevated fasting triglycerides
171
All of the following changes in normal laboratory values occur in pregnancy except:
a. exponential increases in progesterone, estradiol, and cortisol
b. decreases in BUN and creatinine
c. increased hemoglobin and hematocrit
d. increased liver enzymes
All of the following changes in normal laboratory values occur in pregnancy except:
a. exponential increases in progesterone, estradiol, and cortisol
b. decreases in BUN and creatinine
**c. increased hemoglobin and hematocrit**
d. increased liver enzymes
172
The hook effect in immunometric assays causes:
a. falsely low patient results
b. patient results to drop in a nonlinear fashion upon dilution
c. reagent antibodies to bind irreversibly (i.e., “hook”) to the antigen
d. all of the above
The hook effect in immunometric assays causes:
**a. falsely low patient results**
b. patient results to drop in a nonlinear fashion upon dilution
c. reagent antibodies to bind irreversibly (i.e., “hook”) to the antigen
d. all of the above
173
Which of the following is not a component of current microbiology laboratory automation systems?
a. Specimen inoculation
b. Automated track
c. Anaerobic incubation
d. Digital imaging
Which of the following is not a component of current microbiology laboratory automation systems?
a. Specimen inoculation
b. Automated track
**c. Anaerobic incubation**
d. Digital imaging
174
Which urine specific gravity results are characteristic of water balance disorders?
a. low urine specific gravity in SIADH and high urine specific gravity in DI
b. low urine specific gravity in SIADH and low urine specific gravity in DI
c. high urine specific gravity in SIADH and low urine specific gravity in DI
d. high urine specific gravity in SIADH and high urine specific gravity in DI
Which urine specific gravity results are characteristic of water balance disorders?
a. low urine specific gravity in SIADH and high urine specific gravity in DI
b. low urine specific gravity in SIADH and low urine specific gravity in DI
**c. high urine specific gravity in SIADH and low urine specific gravity in DI**
d. high urine specific gravity in SIADH and high urine specific gravity in DI
175
4. In order to measure the classical pathway complement function or activity, the best specimen type is:
a. EDTA plasma
b. Citrate plasma
c. Serum
d. Urine
4. In order to measure the classical pathway complement function or activity, the best specimen type is:
a. EDTA plasma
b. Citrate plasma
c. **Serum**
d. Urine
176
5. Which of the following is a feature of betathalassemia minor?
a. decreased HbA2
b. hypochromic RBC
c. increased HbF
d. microcytic RBC
5. Which of the following is a feature of betathalassemia minor?
a. decreased HbA2
b. hypochromic RBC
**c. increased HbF**
d. microcytic RBC
177
A patient presents to the ED with a DVT. A PT and aPTT are ordered, and they show an isolated increase in aPTT. What testing should be ordered next?
a. Antiphospholipid antibody testing
b. Platelet aggregometry
c. D-dimer
d. Serotonin release assay
A patient presents to the ED with a DVT. A PT and aPTT are ordered, and they show an isolated increase in aPTT. What testing should be ordered next?
**a. Antiphospholipid antibody testing**
b. Platelet aggregometry
c. D-dimer
d. Serotonin release assay
178
Which of the following associations is incorrect?
a. Mousy odor due to phenylketonuria
b. Sweet smell due to maple syrup urine disease
c. Fruity odor due to tyrosinuria
d. Fetid odor due to urinary tract infection
Which of the following associations is incorrect?
a. Mousy odor due to phenylketonuria
b. Sweet smell due to maple syrup urine disease
**c. Fruity odor due to tyrosinuria**
d. Fetid odor due to urinary tract infection
