elsevier CC Flashcards
According to the National Cholesterol Education Program, which lipid or lipoprotein class is more important for therapeutic decision making (diet and medication decisions)?
a. hdl
b.ldl
c. chylomicron
d. apolipoprotein
LDL
In the laboratory procedure for the quantification of
HDL, the purpose of the dextran sulfate is to:
A. Precipitate all Apo B 48 containing proteins
B. Precipitate all Apo B containing proteins
C. Evaporate all Apo II containing proteins
D. Evaporate all Apo B100 containing proteins
Precipitate all Apo B containing proteins
Which of the following would be most adversely affected by a nonfasting sample?
A. CHOLESTEROL
B. SODIUM
C. POTASSIUM
D. TRIGYLCERIDE
TRIGYLCERIDE
Which of the following apoproteins is responsible for receptor binding for IDL and the chylomicron rem- nant produced in fat transport?
A. APO B48
B. APO III
C. APO E
D. NONE OF THE ABOVE
APO E
Which of the following enzymes is found bound to
HDL and LDL in blood plasma and acts to convert free cholesterol into cholesteryl esters?
A. LECITHINASE
B. GLYCEROL
C. CHOLESTEROL KINASE
D. Lecithin-cholesterol acyltransferase
Lecithin-cholesterol acyltransferase
Which of the following blood samples would serve best to assay lipoproteins because this anticoagulant acts to preserve lipoproteins?
A. SODIUM FLOURIDE
B. OXALATE
C. HEPARIN
D. EDTA
EDTA
Exogenous triglycerides are transported in the plasma in which of the following forms?
a. hdl
b.ldl
c. chylomicron
d. apolipoprotein
chylomicron
A patient presents to his physician for a lipid profile. The following results are received:HDL 1⁄4 50 mg/dL
A. 200
B. 210
C. 220
D. 250
210
Which of the following lipoproteins is the smallest of all the lipoproteins and is composed of 50% protein?
a. hdl
b.ldl
c. chylomicron
d. apolipoprotein
a. hdl
Which of the following mechanisms accounts for the elevated plasma level of b-lipoproteins seen in hyperbetalipoproteinemia (Fredrickson’s type II lipoproteinemia)?
A. Apo B-100 receptor defect
B. Apo B-48 receptor defect
C. Apo E receptor defect
D. Apo I receptor defect
Apo B-100 receptor defect
Which enzyme is common to all enzymatic methods for triglyceride measurement?
A. LECITHINASE
B. GLYCEROL
C. CHOLESTEROL KINASE
D. GLYCEROL KINASE
GLYCEROL KINASE
A patient sample is assayed for fasting triglycerides and a triglyceride value of 1036 mg/dL. This value is of immediate concern because of its association with which of the following conditions?
a. an acute viral hepatitis infection.
b. cholestasis.
c. a chronic hepatitis B infection.
d. Pancreatitis
Pancreatitis
Which of the following apoproteins is inversely related to risk for coronary heart disease and is a sur- surrogate marker for HDL?
A. APO B48
B. APO III
C. APO E
D. APO A-I
APO A-I
John Smithers (21 years of age) is in to see his phy- sician for a pre-college physical and checkup. John has always been extremely healthy. The following laboratory results are received:
AStandard = 0.679 ASmithers = 0.729
Control range 190-195 mg/dL
AControl= 0.650 CStandard =200 mg/dL
A. 209mg/dL
B. 219mg/dL
C. 210mg/dL
D. 229 mg/dL
209mg/dL
Sucrose is considered a disaccharide that on hydrolysis yields which of the following sugars?
A. Fructose ONLY
B. Glucose ONLY
C. Fructose and Glucose
D. NONE OF THE ABOVE
Fructose and Glucose
Laboratory tests are performed for a postmeno- pausal, 57-year-old woman as part of an annual physical examination. The patient’s random serum glucose is 220 mg/dL, and the glycated hemoglobin (HbA1c) is 11%. Based on this information, this patient would mostly likely be classified as:
A. GDM
B. DIABETES INSIPIDUS
C. TYPE 1 DIABETES
D. TYPE 2 DIABETES
TYPE 2 DIABETES
Laboratory results for a patient with type 2 diabetes are as follows:
Analyte
Glucose
Total cholesterol
HDL
LDL
BUN
Creatinine
Microalbuminuria
AST
ALT
Result
128 mg/dL
195 mg/dL
45 mg/dL
105 mg/dL
38 mg/dL
2.1 mg/dL
54 mg/Ml
28 U/L
38 U/L
A. Patient is at increased risk for diabetic nephropathy
B. Patient is at increased risk for diabetic Ketoacidosis
C. Hepatitis B
D. Insulinoma
Patient is at increased risk for diabetic nephropathy
At what serum glucose concentration would glucose begin to appear in the urine?
A. 150
B. 160
C. 170
D. 180
170
Which of the following methods is virtually specific
for glucose and employs G6PD as a second coupling step requiring magnesium?
A. LIPASE
B. HEXOKINASE
C. AMYLASE
HEXOKINASE
A 62-year-old patient presents to the physician with report of increased thirst and increased urination, particularly at night. The physician requests a series of tests over the next few days. The following data are received:
Analyte
Random
glucose
Fasting glucose
2-Hour OGTT
HbA1c
Result
186 mg/dL
114 mg/dL
153 mg/dL
5.9%
A. PREDIABETIC STATUS
B. TYPE 2 DIABETES
C. IMPAIRED GLUCOSE STATUS
IMPAIRED GLUCOSE STATUS
The kidney is responsible for acid-base balance through the removal of H ions via four major mech- anisms. Which of the following describes one of those mechanisms?
Reaction of H ions with filtered bicarbonate ions
Given the data below, the calculated creatinine clear-
ance corrected for body surface area approximates __________.
Analyte
Serum creatinine
Urine creatinine
Urine volume
Surface area
Result
1.2 mg/dL
120 mg/dL
1.75 L/day
1.80 m2
A. 125
B. 135
C. 115
D. 105
115
Which formula is most accurate in predicting plasma osmolality?
2(Na)+Glucose/18+BUN/2.8
Which of the following statements regarding serum urea is true?
BUN is elevated in prerenal as well as renal failure
Osmolality can be defined as a measure of the concentration of a solution based on:
The number of particles present
An increased osmole gap is most commonly seen in which of the following?
Presence of toxins such as ethanol and ethylene glycol
A patient with type 2 diabetes is in for a routine
examination with the physician. A series of labora- tory tests are performed, including calculation of an eGFR. The patient’s calculated eGFR is 64 mL/ min. This result is most indicative of:
Mild kidney damage
A healthy 28-year-old female sees her physician for a routine examination and receives a “relatively” clean bill of health except for the results below.
Total bilirubin 2.8 mg/dL
Direct bilirubin 0.1 mg/dL
Indirect bilirubin 2.7 mg/dL
These results most likely indicate which of the following?
Gilberts disease
Which of the following is measured using glutamate dehydrogenase and is a measure of advanced stages, poor prognosis, and coma in liver disease?
Ammonia
In which of the following disease states would you see an elevation in total bilirubin and conjugated bil- irubin only?
Biliary obstruction
which of the following conditions does no activity of glucuronyl transferase result in increased unconju- gated bilirubin and kernicterus in neonates and even- tual death within 18 months?
Crigler-Najjar syndrome
As a reduction product of bilirubin catabolism, this compound is partially reabsorbed from the intestines through the portal circulation for reexcretion by the liver. What is this compound?
A. UROBILIN
B. BILIRUBIN
C. UROBILINOGEN
UROBILINOGEN
In the liver, bilirubin is conjugated in the presence of which of the following?
Uridine diphosphate (UDP)-glucuronyl transferase
Hepatocellular damage may be best assessed by which of the following parameters?
A. ACP AND ALP LEVELS
B. CREATINE AND SODIUM LEVEL
C. AST AND ALT LEVELS
D. NONE OF THE ABOVE
Serum AST and ALT levels
Which of the following conditions is caused by deficient secretion of bilirubin into the bile canaliculi
A. WILSON DISEASE
B. GILBERT DISEASE
C. Crigler-Najjar syndrome
D. Dubin- Johnson syndrome
Dubin- Johnson syndrome
Which of the following analytes is the best indicator of hepatobiliary damage
A. ALP
B. AST
C. ALT
ALP
Which of the following fractions of bilirubin in high concentrations is associated with kernicterus in newborns?
A. CONJUGATED BILIRUBIN
B. MIXED HYPERBILIRUBINURIA
C. UNCONJUGATED BILIRUBIN
UNCONJUGATED BILIRUBIN
The characteristic laboratory finding in alcoholic cirrhosis includes
A. marked elevations in AST and ALT (AST>ALT), marked elevations in GGT, slight elevations
in ALP
B. Slight elevations in AST and ALT (AST>ALT), marked elevations in GGT, marked elevations
in ALP
C. Slight elevations in AST and ALT (AST>ALT), marked elevations in GGT, slight elevations
in ALP
D. Slight elevations in AST and ALT (AST<ALT), marked elevations in GGT, slight elevations
in ALP
Slight elevations in AST and ALT (AST>ALT), marked elevations in GGT, slight elevations
in ALP
Which of the following liver conditions shows an increase in both conjugated bilirubin and ALP, man- ifests with antimitochondrial antibodies, and shows a characteristic lipoprotein X on electrophoresis
a. Primary biliary cirrhosis
b. Secondary biliary cirrhosis
Primary biliary cirrhosis
Which set of results is consistent with uncompen- sated metabolic acidosis
pH 7.25, HCO3 15 mmol/L, PCO2 37 mm Hg
A patient with emphysema who has fluid accu- mulation in the alveolar sacs (causing decreased ventilation) is likely to be in which of the following acid-base clinical states?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
Respiratory acidosis
Which of the following buffer systems is the
most important physiologic buffer system in the body
Bicarbonate/ Carbonic acid
To maintain electrical neutrality in the red blood cell, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with which of the following?
a. sodium
b. potassium
c. chloride
d. bicarbonate
chloride
Increased PCO2 in a patient most commonly results in which of the following primary acid-base abnormalities?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
Respiratory acidosis
Which of the following changes will occur with a blood gas sample exposed to room air?
a. pH decrease
b. pH increase
c. PCO2 increase
d. PCO2 decrease
pH increase
What is the normal ratio of bicarbonate to dissolved carbon dioxide in arterial blood?
a. 40:10
b. 20:1
c. 1:20
d. 10:40
20:1
Which of the following blood gas disorders is most commonly associated with an abnormal anion gap?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
Metabolic acidosis
The following laboratory results are from a 54-year- old woman complaining of weight gain, intolerance to heat, fatigue, and not being able to stay awake.
Analyte
Na
K
Glucose
Aldosterone
Ionized Ca
Mg
Phos
TSH
FT4
Cortisol
Result
140 mmol/L
4.0 mmol/L
75 mg/dL8 ng/dL
4.8 mg/dL
2.0 mEq/L
3.0 mg/dL
7.2 mU/mL
1.0 ng/dL
10 mg/dL
Hyperthyroidism OR Hypothyroidism
Hypothyroidism
A 42-year-old woman presents to her physician with truncal obesity, bruising, hypertension, hyperglyce- mia, and increased facial hair. The physician suspects an endocrine disturbance. Significant test results are as follows:
Analyte
TSH
FT4
Glucose
Serum cortisol (8 AM)
Plasma ACTH (8 AM)
Urine free cortisol
Dexamethasone suppression tests
Overnight
High dose
Result
3.0 mU/mL
1.0 ng/dL
90 mg/dL
45 mg/dL
152 pg/mL
Increased
300 nmol/L
>50% suppression
Pituitary tumor or Adrenal tumor
Pituitary tumor
The release of thyroid-releasing hormone (TRH) would result in which of the following actions from the HPT axis?
a. decrease
b. increased
c. stays the same
increased
A serum thyroid panel reveals an increase in total T4, normal TSH, and a normal fT4. What is the most likely cause of these results?
Increased thyroxine-binding protein
In patients with developing subclinical hyperthyroid- ism, TSH levels will likely be ______, and fT4 will likely be ______.
a. decreased, increase
b. increase, increase
c. normal increase
d. decreased, normal
decreased, normal
A 30-year-old woman is admitted to the hospital. She has truncal obesity, buffalo humpback, moon face, purple striae, hypertension, hyperglycemia, increased facial hair and amenorrhea. The physi- cian orders endocrine testing. The results are as fol- lows:
Analyte
Urine free cortisol
Serum cortisol (8 AM)
Plasma ACTH
Dexamethasone
suppression test
Result
Increased
Increased
Decreased
Overnight: No suppression
High dose: No suppression
What is the most probable condition?
Cushing’s syndrome
Trophic hormones are produced by the ______, and releasing factors are produced by the ______.
Pituitary; hypothalamus
When free thyroxine cannot be measured directly, the free thyroxine index (FT4I) may be calculated by using which measured laboratory data?
T4 and T3 resin uptake
Symptoms of primary adrenal insufficiency (Addison’s disease) include which of the following?
Hypokalemia or Hyperkalemia
Hypokalemia
A TRH stimulation test is performed, and a flat response is received from this test procedure. This most likely indicates:
a. Primary hypothyroidism
b. Secondary hypothyroidism
Secondary hypothyroidism
Which of the following enzymes is the best indicator of pancreatic function?
a. amylase
b. aldolase
c. lipase
c. aldosterone
lipase
Which of the following enzymes catalyzes the con- version of p-nitrophenyl phosphate to a colored p- nitrophenol product?
a. AST
b. ALT
c. ALP
ALP
Which of the following conditions can “physiologi- cally” elevate serum alkaline phosphatase?
a. Second trimester pregnancy
b. Third trimester pregnancy
c. Fourth trimester pregnancy
Third trimester pregnancy
Kinetic enzymatic assays are best performed during which phase of an enzymatic reaction?
linear phase or plateu phase
linear phase
Which of the following enzymes catalyzes the con- version of starch to glucose and maltose?
Lipase or Amylase
Amylase
What percentage of serum calcium is in the ionized form?
60% or 50%
50%
Which of the following best describes the action of parathyroid hormone?
PTH increases calcium reabsorption and decreases phosphorous reabsorption in the kidney
Which of the following electrolytes is the chief plasma cation whose main function is maintaining osmotic pressure?
a. chloride
b. potassium
c. sodium
d. phosphate
sodium
The major intracellular cation is
a. chloride
b. potassium
c. sodium
d. phosphate
potassium
The major extracellular cation is
a. chloride
b. potassium
c. sodium
d. phosphate
sodium
The major extracellular anion is
a. chloride
b. potassium
c. sodium
d. phosphate
chloride
The major intracellular anion is
a. chloride
b. potassium
c. sodium
d. phosphate
reference value of CK
a. female: 15 to 130 U/L
male: 15 to 160 U/L
b. female: 15 to 160 U/L
male: 15 to 130 U/L
female: 15 to 130 U/L
male: 15 to 160 U/L
reference value of LDH
A. 125 - 225 U/L
B. 100 - 225 U/L
C. 115 - 220 U/L
D. 100 - 220 U/L
100 - 225 U/L
reference value of AST
A. 7 - 45
B. 5 - 35
C. 7 - 35
D. 5 - 45
5 - 35
reference value of ALT
A. 7 - 45
B. 5 - 35
C. 7 - 35
D. 5 - 45
7 - 45
reference value of Amylase
a. serum: 25 to 130
urine: 1 to 15
b. serum 1 to 15
urine: 25 to 130
c. serum: 15 to 110
urine: 1 to 15
b. serum 1 to 15
urine: 15 to 110
serum: 25 to 130
urine: 1 to 15
Lipase ref value
a. <38
b. >38
c. <48
d. >48
<38
all are hepatobiliary marker except
a. GGT
b. AST
c. ALP
d. 5’NT
AST
ALL ARE HEPATOCELLULAR EXCEPT
A. AST
B. ALT
C. ALP
ALP
CARCINOPLACENTAL ISOENZYME DETECTED IN LUNGS
A. NAGAO
B. REGAN
C. KASAHARA
D. INTESTINAL ALP
REGAN
REFERENCE METHOD FOR ALP
A. WALKER
B. OLIVER
C, BOWERS
D. BESSY
BOWERS
LDH FORWARD REFERNCE METHOD
A. WROBLEWSKI
B. OLIVER
C. WACKER
D. REITMAN FRANKEL
WACKER
SODIUM RENAL THRESHOLD
A. 100 TO 130 MMOL/L
B. 110 TO 130 MMOL
C. 115 TO 150 MMOL/L
D. 115 TO 130 MMOL/L
110 TO 130 MMOL
↑ Na+ Intake or retention
Absolute Hypernatremia OR Relative Hypernatremia
Absolute Hypernatremia
↑ water loss
Absolute Hypernatremia OR Relative Hypernatremia
Relative Hypernatremia
Characterized by either: ↓ Osmotic pressure or ↑ Hydrostatic
pressure or both
-Renal failure
- Congestive heart failure
- Nephrotic syndrome
- Hepatic cirrhosis
Depletional Hyponatremia OR Dilutional Hyponatremia
- ↑ Na+ loss
- ↑ water retention
- water imbalance
HYPONATEREMIA OR HYPERNATREMIA
HYPONATEREMIA
® Alkalosis, Insulin overdose
® Some potassium ions enter the cells (INFLUX)
® Indicates the decrease of the Plasma level
® Alkalosis
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hyponatremia
Hypokalemia
® Acidosis, Chemotherapy, Muscle injury, Leukemia, Hemolysis
§ They are common/characterized by Cell destruction/Cell
injury/Rupture of cells
® Potassium ions out to the cells (EFFLUX)
® Indicates the increase of the Plasma level
® Acidosis
® To maintain the electric neutrality
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hyponatremia
Hyperkalemia
Uses pilocarpine iontophoresis to stimulate sweat production, followed
by sweat collection and analysis. Main indication of Cystic fibrosis
a. Cotlove Chloridometry
b.Gibson And Cooke’s Method
c. ISE
Gibson And Cooke’s Method
Increased of HCO3-
Hypochloremia OR Hyperchloremia
Hypochloremia
Magnesium ref values normal
a. 1.26-2.1 mEq/L
b. ≤ 1 mg/dL
c. ≥4.7 mg/dL
1.26-2.1 mEq/L
