Q&A self assessement Flashcards

Question

Hyperphosphatemia can be caused by which of the following disease states? a. renal failure, chronic, and acute b. decreased glomerular filtration rate c. leukemia d. rhabdomyolysis e. all of the above

Answer 1

Hyperphosphatemia can be caused by which of the following disease states? a. renal failure, chronic, and acute b. decreased glomerular filtration rate c. leukemia d. rhabdomyolysis **e. all of the above**

Answer 2

Match the following gastrointestinal endocrine tumors with their corresponding associated syndrome or presentation: 1. glucagonoma : migratory necrolytic erythema, mild diabetes mellitus 2. somatostatinoma : mild diabetes mellitus, diarrhea, steatorrhea 3. gastrinoma : Zollinger-Ellison syndrome 4. VIPoma : Verner-Morrison WDHA syndrome 5. insulinoma : Whipples triad

Answer 3

Vasopressin and oxytocin are a. secreted by the adenohypophysis b. secreted by the neurohypophysis c. stored in the adenohypophysis **d. stored in the neurohypophysis**

Answer 4

Pheochromocytoma is a. characterized by decreased levels of cortisol. b. the cause of potentially lethal secondary hypotension. c. associated with a slow heartbeat and decreased body temperature. d. a tumor associated with the adrenal cortex. **e. diagnosed through fractionated catecholamines and/or their metabolites.**

Answer 5

Which of the following hemoglobins are due to a mutation in an α-globin gene? a. hemoglobin S b. hemoglobin C c. hemoglobin E d. hemoglobin Lepore **e. hemoglobin Constant Spring**

Answer 6

Methods found to be particularly useful for improved identification and characterization of CSF proteins include 1. **high-sensitivity mass spectrometry (MS)** 2. gas chromatography 3. **two-dimensional liquid and gel electrophoresis** 4. atomic absorption a. 1, 2, and 3 **b. 1 and 3** c. 2 and 4 d. 4 only e. all of the above

Answer 7

Which form of a drug is best suited for passive gastrointestinal absorption? a. basic environment of an acidic drug b. pinocytosis c. bound to albumin or α1-acid **d. nonionized form** e. hydrophilic form

Answer 8

According to the International Federation of Clinical Chemistry, which epitopes within the troponin protein should the antibodies be directed toward? **a. Two antibodies directed toward the central part** b. One antibody directed toward the C-terminus and one toward the N-terminus c. One antibody directed toward the C-terminus and one toward the central part d. One antibody directed toward the N-terminus and one toward the central part e. Three antibodies, one at the C-terminus, N-terminus, and one toward the central part

Answer 9

Which protein is the most common underlying defect for amyloidosis? **a. light chain** b. heavy chain c. hereditary transthyretin d. wild-type transthyretin e. apolipoprotein

Answer 10

CSF glucose usually is elevated when the patient has 1. acute pyogenic meningitis 2. **CNS syphilis or epidemic encephalitis** 3. primary or metastatic tumors of the meninges 4. **high blood glucose** a. 1, 2, and 3 b. 1 and 3 **c. 2 and 4** d. 4 only e. all of the above

Answer 11

Syndrome of antidiuretic hormone secretion (SIADH) is characterized by **a. hyponatremia** b. hypovolemia c. urine sodium concentration \<20mmol/L d. urine osmolality lower than serum osmolality

Answer 12

Cylindre cireux

Answer 13

Which assays demonstrate inference from icterus? (Choose all that apply) **a. glucose** **b. triglycerides** **c. uric acid** d. magnesium

Answer 14

Which of the following is incorrect about phosphorus homeostasis? **a. it is not absorbed by passive transport** b. it is freely filtered in the glomerulus c. PTH induces phosphaturia by inhibition of Na-P cotransport d. vitamin D increases intestinal absorption and renal reabsorption of phosphorus e. administration of growth hormone increases phosphate levels in the serum.

Answer 15

All of the following are true concerning D-xylose and the D-xylose absorption test except: **a. D-xylose is absorbed mainly in the gastrin antrum** b. D-xylose is excreted by the kidney into the urine c. D-xylose absorption can be evaluated using either a blood or urine sample d. low absorption of D-xylose is observed in some cases of malabsorption e. D-xylose absorption is typically normal in patients with pancreatic insufficiency

Answer 16

Which of the following is not an etiology of kernicterus? a. prematurity b. Rh incompatibility c. glucose-6-phosphate dehydrogenase deficiency **d. liver cirrhosis of the mother** e. hemolytic disease

Answer 17

The diagnosis of multiple sclerosis (MS) is supported by finding 1. **myelin basic protein (MBP) in CSF** 2. **elevated IgG index in CSF** 3. **oligoclonal banding in CSF** 4. paraprotein in serum **a. 1, 2, and 3** b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

Answer 18

An increased percentage of free phenytoin is most likely in which of the following clinical conditions: **a. uremia** b. hyperalbuminemia c. hypoglycemia d. hypernatremia e. all of the above

Answer 19

Select the biomarker that is NOT lowered by statin treatment. a. cholesterol b. LDL-C c. hsCRP **d. lipoprotein(a)** e. non-HDL-C

Answer 20

Which of the following are most consistent with hypoparathyroidism? a. hyperphosphatemia b. hypophosphatemia c. hypocalcemia d. hypercalcemia **e. a & c**

Answer 21

Which of the following is true when comparing reference intervals to clinical decision points? **a. Only clinical decision points are based on clinical outcome studies.** b. Both are considered the gold standard/highest quality for interpreting laboratory tests. c. Only clinical decision points are intended to distinguish individuals with disease from individuals without. d. Only reference intervals require partitioning by age, sex, and other demographics. e. Clinical decision points are only used when reference intervals are not preestablished.

Answer 22

Inhibin a. inhibits FSH secretion by adenohypophysis b. produced by Sertoli cells c. inhibits LH secretion by adenohypophysis **d. a,b only**

Answer 23

For noninvasive prenatal testing (NIPT), what follow-up confirmatory testing should be performed? a. none necessary **b. amniocentesis if positive** c. amniocentesis if negative d. follow-up testing is always performed

Answer 24

All of the following concerning CA 19-9 are true except: a. CA19-9 is a carbohydrate antigen glycolipid. **b. the antigen is only expressed in subjects that are blood group antigen Kell positive.** c. the antigen is a sialylated derivative of the Lea blood group antigen. d. may be elevated in pancreatitis. e. CA19-9 levels correlate with pancreatic cancer staging.

Answer 25

When developing a quantitative LC-MS/MS assay what measure can be taken to help control for matrix impacts on the sample analysis? a. the use of calibrants and QCs. **b. the use of a stable isotope labeled internal standard.** c. a qualitative assessment of the potential interferences. d. a longer LC column.

Answer 26

Which one of the following conditions is unlikely associated with elevated beta-human chorionic gonadotropin (β-hCG)? a. nonseminomatous testicular cancer **b. prostate carcinoma** c. gestational trophoblastic disease d. normal pregnancy e. ovarian germ cell tumors

Answer 27

Triple phosphate

Answer 28

Which disorder is not associated with an increase in urine specific gravity? a. syndrome of inappropriate ADH b. use of contrast agents c. dehydration **d. psychogenic polydipsia** e. diarrhea

Answer 29

Which is the correct definition of commutability? a. The ability to link the calibration of a laboratory test result back to a reference measurement procedure. **b. A reference material’s ability to react in the same way as patient specimens.** c. A reference method’s ability to produce the same result as a clinical assay. d. The manner by which a reference material is certified as a reference material. e. The assignment of the value of a reference material.

Answer 30

Which of the following statistical approaches is used for data where the distribution of results is nonparametric and skewed to the left? a. calculation of the mean2SD b. calculation of the mean3SD c. calculation of the median2SD **d. determination of the central 95th percentile of results** e. only an upper reference limit can be determined as the lower limit produces a negative result

Answer 31

What is the minimum fraction of fetal cell-free DNA generally required for noninvasive prenatal testing (NIPT) testing? a. 1% **b. 4%** c. 10% d. 15%

Answer 32

The following are indicative of normal maternal adaptation during pregnancy. 1. **decreased hemoglobin and hematocrit** 2. elevated BUN and creatinine 3. **increased hormone binding proteins** 4. decreased free and total cortisol a. 1, 2, and 3 **b. 1 and 3** c. 2 and 4 d. 4 only e. all of the above

Answer 33

Respiratory depression, slurred speech, diplopia, nystagmus, hypotension, and ataxia are characteristic of what toxidrome? a. anticholinergic b. cholinergic **c. opioid** d. sedative-hypnotic e. sympathomimetic

Answer 34

Which of the following is an acceptable strategy for establishing a cutoff for a tumor marker? a. use of the 95th percentile of a healthy population b. use of the 99th percentile of a healthy population **c. use of a cutoff concentration derived from ROC curve analysis plotting disease vs relevant benign conditions** d. guidelines established by the National Cancer Institute e. values that predict cancer mortality

Answer 35

Which tumor marker is most likely to be elevated in a patient with an irregular infiltrating mass in the body of the pancreas? **a. CA19-9** b. CA242 c. Calcitonin d. AFP e. CA125

Answer 36

Certain micro-RNAs (miRNA) play a role in the pathophysiology of cardiovascular disease. Which of the following statements is TRUE regarding miRNA? a. miRNAs are coding RNAs. **b. Majority of miRNAs suppress target protein synthesis.** c. miRNAs regulate gene transcription. d. miRNAs are most abundant in erythrocytes. e. Most miRNAs are circulating extracellularly.

Answer 37

Mechanisms of in vitro hemolysis include (choose all that apply): **a. mechanical destruction** **b. glucose exhaustion** c. autoimmune disease **d. freezing**

Answer 38

The following figure represents the thin filament of muscle fiber. What is the correct labeling? **a. A.actin, B.troponin complex, C.tropomyosin** b. A.myosin, B.troponin complex, C.tropomyosin c. A.actin, B.myosin, C.troponin complex d. A.troponin complex, B.myosin, C.actin e. A.troponin complex, B.tropomyosin, C.actin

Answer 39

When designing a next-generation sequencing (NGS) test for detection of resistance mutations to targeted cancer therapies from cell-free DNA, what is the minimum allele frequency that should be detected? **a. 0.1%** b. 1% c. 5% d. 10%

Answer 40

Which of the following statement is correct about organic acid analysis? **a. Organic acids (OA) analysis is mostly done by organic acids (OA) extraction from a _urine_ sample by liquid-liquid extraction.** b. Organic acids (OA) analysis is mostly done by organic acids (OA) extraction from a Plasma sample by liquid-liquid extraction. c. Organic acids (OA) analysis is mostly done by organic acids (OA) extraction from a serum sample by liquid-liquid extraction. d. Organic acids (OA) analysis is mostly done by organic acids (OA) extraction from a CSF sample by liquid-liquid extraction.

Answer 41

Which of the following properties applies to lipoprotein (a)? a. Lipoprotein(a) has density close to high-density lipoprotein (HDL). **b. Apolipoprotein (a) is covalently linked to apoB in lipoprotein(a).** c. Dietary pattern is a critical determinant of lipoprotein(a) levels. d. Assays of lipoprotein(a) are standardized and are expressing lipoprotein(a) levels in the preferred mass concentration unit. e. None of the above.

Answer 42

Which of the following statements is FALSE regarding small dense LDLcholesterol? a. Small dense LDL-cholesterol is associated with risk of cardiovascular disease independently of traditional lipid risk factors. b. Elevated level of small dense LDL-cholesterol is associated with raised triglyceride and decreased HDL-C levels in diabetes, obesity, and metabolic syndrome. c. Measurement of small dense LDL-cholesterol is available through electrophoresis, automated immunoassay, or ultracentrifugation. **d. Smaller LDL particles are less atherogenic than their larger, more buoyant counterparts.** e. Circulating small dense LDL undergoes atherogenic modifications including desialylation, glycation, and oxidation.

Answer 43

The expression of which of the following proteins is induced by the action of interleukin 6 on hepatocytes, as part of the innate immune system function of this cytokine? a. Amyloid beta protein b. Alanine aminotransferase c. Immunoglobulin G **d. C-reactive protein** e. Albumin f. None of the above

Answer 44

Which of the following conditions are likely to present with an isolated prolongation of the activated partial thromboplastin time (aPTT)? a. coumadin therapy **b. presence of a Lupus Anticoagulant** c. severe vitamin K deficiency d. intravenous fluid contamination of the sample e. Factor V deficiency

Answer 45

Patients with a buildup of serum phosphate (i.e., due to renal failure), high PTH, and chronically low serum calcium are classified as having the follows: **a. secondary hyperparathyroidism** b. vitamin D intoxication c. tertiary hyperparathyroidism d. primary hyperparathyroidism e. ectopic PTH-producing tumor

Answer 46

Which is true regarding the biochemistry of unconjugated estriol (uE3)? **a. synthesized by the fetoplacental unit with participation from the fetal liver** b. _decrease_ in maternal serum (MS) with increasing gestational age c. MS-uE3 MoM values are significantly _affected_ by maternal weight. d. MS-uE3 MoM values are _not affected_ by diabetes status. e. MS-uE3 is _increased_ in trisomy 18.

Answer 47

What is the best explanation for the negative urine immunoassay result of a patient taking methylphenidate (Ritalin)? a. The patient is noncompliant with the methylphenidate. b. The patient missed taking the last daily dosage of methylphenidate. c. The patient is a fast metabolizer of methylphenidate which results in a negative immunoassay test. **d. Methylphenidate and its primary metabolite does not cross-react with the amphetamine/methamphetamine immunoassay.** e. The cutoff for the amphetamine/methamphetamine immunoassay was too high.

Answer 48

While of the following CBC parameters exhibit lower counts in capillary blood vs venous? a. hemoglobin b. hematocrit c. RBC count d. WBC count **e. platelet count**

Answer 49

Which autoantibodies are expressed in scleroderma (positive in at least 20% of cases)? 1. **antitopoisomerase I (anti-scl-70) antibody** 2. **anticentromere antibody** 3. **anti-topoisomerase antibody** 4. anti-PM/Scl antibody a. 1,3 **b. 1,2,3** c. 2,4 d. 4 only e. All of the above

Answer 50

Which of the following conditions will tend to increase the erythrocyte sedimentation rate? a. decreased fibrinogen **b. anemia** c. the presence of sickle cells d. high serum albumin e. microcytic erythrocytes

Answer 51

A distinguishing feature to differentiate anticholinergic findings from sympathomimetic findings is: **a. Anticholinergic agents produce warm, flushed, dry skin, but sympathomimetic agents produce diaphoresis.** b. Anticholinergic agents produce agitation, but sympathomimetic agents produce lethargy. c. Anticholinergic agents produce hallucinations, but sympathomimetic agents do not. d. Anticholinergic agents produce bradycardia, but sympathomimetic agents produce tachycardia. e. none of the above

Answer 52

The recommended screening tests for celiac disease in symptomatic individuals involve the following laboratory tests: a. Serum tissue transglutaminase IgG and IgA antibodies **b. Serum tissue transglutaminase IgA antibodies and total IgA concentration** c. Serum tissue transglutaminase IgA antibodies and endomysial IgA antibodies d. Serum tissue transglutaminase IgA antibodies and HLA-DQ2 and HLA-DQ8 genotyping e. Serum tissue transglutaminase IgA antibodies and gliadin (deamidated) IgG antibodies

Answer 53

What is true about serum proteins? a. α1 acid glycoprotein is exclusively synthesized by the liver. b. In massive in vitro hemolysis the major component in α1 region may completely disappear. c. The primary physiologic role for ceruloplasmin is transporting the copper from the liver to the brain. **d. β-Lipoprotein produces “feathery edge” in the β region on the serum electrophoresis.**

Answer 54

CSF lactate often is elevated in all of the following cases except **a. aseptic (viral) meningitis** b. cerebrovascular accidents (CVA) c. fungal or bacterial CNS infections d. CNS tumors e. head trauma

Answer 55

A provisional diagnosis made by PCP has been deficiency of 17-hydroxylase. What is true about clinical presentation of this deficiency? a. increase synthesis of cortisol, androgens, and estrogens **b. increased synthesis of progesterone, corticosterone, and DOC** c. hypotension at birth d. male pseudo-hermaphroditism

Answer 56

An abnormal serum chloride (135mmol/L) with a normal sodium is reported on a patient who has epilepsy and a normal calcium. a. The patient is dehydrated. **b. Bromide interferes with ion-selective electrodes for chloride.** c. The sample is contaminated with intravenous normal saline. d. The patient has primary hyperparathyroidism. e. The patient has pseudohyponatremia due to multiple myeloma

Answer 57

Which of the following statement is incorrect about phenylalanine? a. Phenylalanine is an essential amino acid. b. Dietary intake in excess of anabolic needs is converted to tyrosine by phenylalanine hydroxylase and further degraded via a ketogenic pathway. c. A primary or cofactor-related defect of phenylalanine hydroxylase activity causes accumulation of phenylalanine, phenylketones, and phenylamine. **d. Dietary intake in excess of anabolic needs is converted to tyrosine by phenylalanine oxidase and further degraded via a ketogenic pathway.**

Answer 58

Markedly increased total CSF protein may occur in case(s) of 1. **encephalomyelitis** 2. **xanthochromia** 3. **meningitis** 4. Alzheimer disease (AD) **a. 1, 2, and 3** b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

Answer 59

Which of the following combinations of blood and bone marrow findings are compatible with a deficiency of cobalamin (vitamin B12)? **a. hypersegmented neutrophils, macrocytic anemia, hypercellular bone marrow** b. hyposegmented neutrophils, macrocytic anemia, hypocellular bone marrow c. hyposegmented neutrophils, macrocytic anemia, hypercellular bone marrow d. hypersegmented neutrophils, microcytic anemia, hypercellular bone marrow e. hypersegmented neutrophils, microcytic anemia, hypocellular bone marrow

Answer 60

Molecular point-of-care testing (POCT) devices employ either polymerase chain reaction (PCR) or isothermal nucleic acid amplification techniques. Isothermal methods are often faster than traditional PCR. What is the underlying reason for isothermal methods to be faster? **a. lack of thermocycling** b. faster polymerases c. simple assay/instrument design d. more sensitive detection of amplicons e. none of the above

Answer 61

**True** ou false : Galectin-3 and soluble ST-2 are novel heart failure biomarkers.

Answer 62

Which of the following disorders is the primary reason for conducting fetal fat analysis? **a. investigation of fat malabsorption** b. when high, indicates hepatic steatosis c. determine the proper therapeutic for Shwachman–Diamond syndrome d. determine the presence of excess small bowel bacteria e. diagnostic of Crohn’s disease

Answer 63

In the immunofixation electrophoresis (IFE) the antibodies precipitate specific proteins in the gel. What is true about IFE? **a. The analytical sensitivity of IFE is higher than conventional urine electrophoresis but it still requires preconcentration of the urine.** b. The analytical specificity of IFE is significantly higher than conventional urine electrophoresis. c. The main goal to perform IFE on CSF is to detect multiple bands of the IgM in the gamma region. d. The antisera used in IFE contain antibody against IgG/kappa, IgG/ lambda, IgM/kappa, IgM/lambda, IgA/kappa, and IgA/lambda antibodies.

Answer 64

What is the approximate length of cell-free DNA fragments? a. 85 base pairs **b. 170 base pairs** c. 340 base pairs d. 680 base pairs

Answer 65

Which of the following transporters is responsible for transporting iron out of the enterocyte to the circulatory system? a. DMT-1: the divalent metal transporter **b. ferroportin** c. ferritin d. heme e. transferrin

Answer 66

Concerning testing for H. pylori, which of the following statements are true (K-format) 1. **Recent administration of proton pump inhibitors may lead to false negative urea breath testing.** 2. **Urea breath testing may be performed using either 14C or 13C labeled urea.** 3. **The stool test detects H. pylori antigens using immunoassay techniques.** 4. Serology is useful to confirm eradication following treatment. 5. Infection by H. pylori stimulates both gastric and pancreatic urease production. **a. 1,2,3** b. 1,3 c. 2,4 d. 4 only e. all of the above

Answer 67

All of the following concerning cystic fibrosis are true except: a. An autosomal recessive disorder characterized by a nonfunctional transmembrane conductance regulator protein. b. The majority of cases are due to a three base pair deletion at position 508 of the CFTR protein (△F508). **c. Typically shows low levels of chloride in the sweat chloride test.** d. Cystic fibrosis affects multiple types of exocrine glands. e. Cystic fibrosis is the most common lethal genetic disorder in Caucasian populations.

Answer 68

Usually the urine and blood pH are abnormal in the same direction. For which of the following is there a discrepancy between urine pH and blood pH? a. lactate acidosis b. diabetic ketoacidosis c. hyperventilation d. chronic obstructive pulmonary disease **e. renal tubular acidosis (type II)**

Answer 69

How quickly is cell-free DNA cleared from circulation? **a. minutes to 1–2h** b. 6–24h c. 24–72h d. days to weeks

Answer 70

All of the following are true of gastrin except: a. stimulates secretion of gastric acid and pepsinogen b. molecular forms include big gastrin, little gastrin, and mini gastrin c. produced and stored by G cells in the gastric antrum d. gastrin secretion is inhibited by direct action of acid G cells **e. gastrin is very stable at 4ºC for up to a week or more**

Answer 71

The process of ensuring that the results of different laboratories using different clinical laboratory tests to measure the same substance are equivalent within clinically meaningful limits is termed **a. harmonization.** b. standardization. c. calibration. d. commutability. e. traceability.

Answer 72

Cortisol a. is water soluble. b. is unessential for human life. c. is transported in circulation unbound to carrier proteins. d. peaks in the late afternoon in those with a normal sleep/wake cycle. **e. is derived from cholesterol and classified as a steroid.**

Answer 73

Oxalate de calcium

Answer 74

Which of the following statement is incorrect about maple syrup urine disease (MSUD)? a. Cornerstones of treatment are dietary restriction of branched-chain amino acids and high dose thiamine. b. Leucine, isoleucine, and valine are the three essential branched-chain amino acids involved in MSUD. **c. Main laboratory presentations of MSUD include marked elevation of leucine, isoleucine, and valine and _decreased_ level of plasma L-alloisoleucine.** d. Marked elevation of leucine, isoleucine, and valine plus the pathognomonic presence of L-alloisoleucine is seen in most MSUD cases.

Answer 75

Which of the following differential diagnose is consistent with high calcium and low PTH? a. bone metastasis b. multiple myeloma c. sarcoidosis d. PTH-related peptide **e. all of the above**

Answer 76

What is the best interpretation of the following serum immunofixation electrophoresis gel? a. free light chain disease b. IgD or IgE myeloma c. monoclonal gammopathy of undetermined significance d. pentameric IgM lambda **e. either answer A or B**

Answer 77

Which of the following statement is correct about maple syrup urine disease (MSUD)? a. Leucine, isoleucine, and valine are the three essential branched-chain amino acids involved in MSUD. b. A defect on any component of the branched-chain α-keto acid dehydrogenase complex causes maple syrup urine disease (MSUD). c. Maple syrup urine disease (MSUD) is autosomal recessive. d. At the bedside, mixing urine with a solution of 2,4-dinitrophenylhydrazine (DNPH) is a simple and rapid test to confirm a clinical suspicion. **e. all of the above**

Answer 78

The following figure shows the electrophoresis scan of patient with a large monoclonal band and a high total protein concentration. This serum sample will interfere with what other tests? **a. phosphorus** b. direct reading sodium measurement c. indirect reading potassium measurement d. glucose e. none of the above

Answer 79

What are the three main components of the mass spectrometer? a. LC, mass analyzer, and source b. mass analyzer, LC, and detector **c. source, mass analyzer, and detector** d. source, detector, and LC

Answer 80

Which is (are) true of a positive Amniotic Fluid (AF)-AFP result for diagnosis of an open neural tube defect (ONTD)? 1. **The MoM is generally \>2.0 or 2.5 (depending on the laboratory).** 2. **The presence of fetal blood can cause a false positive result.** 3. **A measurement of amniotic fluid acetylcholinesterase activity is the recommended confirmatory test.** 4. AF and MS have similar concentrations of AFP throughout pregnancy. **a. 1, 2, and 3** b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

Answer 81

Prior to next-generation sequencing of patient samples, the DNA is: **a. barcoded** b. demethylated c. probed d. ligated

Answer 82

All of the following cause hypercalcemia except: a. hyperparathyroidism b. malignancy **c. 1, 25(OH)2D deficiency** d. endocrine disorders e. drugs

Answer 83

Which protein does not travel with α2 fraction on the agarose gel electrophoresis? a. haptoglobin b. β lipoprotein c. ceruloplasmin **d. transferrin**

Answer 84

A 2-year-old boy had eaten some rodenticide (warfarin). The best test to monitor the effect of the rodenticide would be: **a. prothrombin time** b. serum vitamin K1 concentrations c. plasma warfarin concentrations d. activated partial thromboplastin time e. thrombin Time

Answer 85

Parametric distributions a. are analyzed identically to nonparametric distributions. **b. indicate that 95% of values lie within 1.96 standard deviations of the mean.** c. must be how the data are distributed in order to calculate a clinical decision point. d. usually require transformation before the reference interval can be calculated. e. indicate that the analyte of interest has a small physiological concentration range.

Answer 86

Which of the following is true about methanol? a. Causes an increase in blood pH b. The CNS effects of methanol are substantially less severe than those of ethanol. c. Will lead to the formation of the toxic metabolite formic acid d. Lowers osmolar gap with the formation of ethanol e. all of the above **f. b. and c.** g. a. and d.

Answer 87

Noninvasive prenatal testing (NIPT) is most commonly used to detect which of the following genetic abnormalities? a. trisomy 21, trisomy 18, and trisomy 16 **b. trisomy 21, trisomy 18, trisomy 13, and sex chromosome imbalances** c. balanced chromosomal translocations and large deletions d. rare microdeletion syndromes

Answer 88

Which of the following statements is FALSE regarding lipoprotein? a. Triglyceride-rich lipoproteins include very-low-density lipoprotein and chylomicrons. b. Lipoprotein lipase converts triglyceride-rich lipoprotein into cholesterol-rich lipoproteins. c. LDL population is heterogeneous in size and density. **d. Very-low-density lipoprotein contains ApoA and ApoCIII.** e. Triglyceride levels are a causal biomarker of cardiovascular disease risk.

Answer 89

What is the standard blood:anticoagulant ratio for coagulation test specimens? a. 1:2 b. 2:1 c. 4:1 d. 9:1 e. 20:1

Answer 90

Why have some studies recommended correction for hematocrit when performing therapeutic drug monitoring for tacrolimus? a. Patients with low hematocrit appear to have decreased clearance of tacrolimus. **b. Patients with low hematocrit appear to have increased clearance of tacrolimus.** c. Target concentrations were established using a standardized matrix of 45% hematocrit. d. Posttransplant patients generally have elevated hematocrit, especially in pediatrics. e. Variations in hematocrit affect TDM interpretation in adults, but only rarely in pediatrics.

Answer 91

Which of the following does not require a fasting specimen for accuracy? a. glucose b. triglycerides **c. direct LDL cholesterol** d. lipid panel e. insulin and C-peptide

Answer 92

Hyperprolactinemia could be due to all except a. macroprolactinemia b. prolactinoma **c. use of dopamine agonists** d. renal failure

Answer 93

Which of the following disorders can produce a negative urine bilirubin and positive urobilinogen? a. hepatic cirrhosis **b. hemolytic anemia** c. urolithiasis d. alcoholism e. liver cancer

Answer 94

Which of the following is the most frequent cause of hypermagnesemia? a. increased intake b. hypoaldosteronism c. acidosis **d. renal failure** e. none of the above

Answer 95

When establishing the Medians used to calculate Multiples of the Median (MoM) for prenatal screening markers, which are valid statements? a. Medians for each specific marker are the same regardless of assay manufacturer. **b. Medians must be established for each relevant gestational day for each specific population being evaluated.** c. Medians can be shared among different laboratories performing prenatal screening. d. There is no need to reestablish medians once they are determined. e. An MoM is calculated by dividing the individual test result by a nationally published median for that gestational week.

Answer 96

Transferrin a. is an α1 globulin b. increases with acute inflammation c. binds 4 ferric (Fe3+. ions per molecule) **d. binds 2 ferric (Fe3+. ions per molecule)** e. binds 20% of serum iron. The remainder is free iron.

Answer 97

Therapeutic monoclonal antibodies have been shown to interfere with the following clinical laboratory assays a. Serum free light chains b. Serum total protein c. Serum protein electrophoresis d. Nephelometric immunoassays e. Serum immunofixation electrophoresis **f. c and e.**

Answer 98

Which iron profile is may be seen in thalassemia major or megaloblastic anemias? a. ↓ Fe, N TIBC, N % Sat, N ferritin b. ↓ Fe, N TIBC, ↓ % Sat, N ferritin c. ↓ Fe, ↑ TIBC, ↓↓ % Sat, ↓↓ ferritin **d. ↑ Fe, ↓TIBC, ↑% Sat, ↑↑ ferritin** e. N Fe, N TIBC, N % Sat, ↓↓ ferritin

Answer 99

Which of the following statements concerning vitamin D are true ? 1. **Cholecalciferol (vitamin D3) is produced in the skin whereas ergocalciferol (vitamin D2) is obtained in the diet.** 2. 25 (OH) is the most active form of the vitamin. 3. **25 (OH)D is produced in the liver and 1,25(OH)2D in the kidney.** 4. Vitamin D status is best assessed by measurement of 1,25(OH)2D. 5. Measurement of 24,25(OH)2D is useful to assess vitamin D status in patients with renal failure. a. 1,2,3 **b. 1,3** c. 2,4 d. 4 only e. all

Answer 100

Investigation of GH deficiency is usually by a. stimulation of GH production by exercise alone **b. stimulation of GH production by exercise and pharmacological studies** c. stimulation of GH production by pharmacological studies alone d. none of the above

Answer 101

Control of prolactin release differs from that of other pituitary hormones in that **a. it is under negative feedback inhibition** b. it is under positive feedback inhibition c. it is secreted in pulsatile fashion from pituitary d. none of the above

Answer 102

Which of the following statement is correct about BH4 deficiency? a. In about 2% of cases of hyperphenylalaninemia is due to a deficiency of either biosynthesis or recycling of BH4. b. BH4 is the phenylalanine hydroxylase enzyme cofactor. c. BH4 deficiency cases are clinically indistinguishable from classical PKU when detected by newborn screening at birth. d. Measurement of urinary neopterin and biopterin provides a tool for the differential diagnosis of BH4 deficiency cases. **e. all of the above**

Answer 103

Hyperandrogenism a. has the clinical features of androgen insufficiency. b. presents as ambiguous genitalia in the male infant. **c. presentation depends upon the age of onset and the degree of androgen excess.** d. is associated with increased levels of estrogens. e. causes hirsutism in the adult male and gynecomastia in the adult female.

Answer 104

An elevated serum concentration of calcitonin is usually associated with which of the following diseases? a. parathyroid gland tumors b. ovarian carcinoma **c. medullary carcinoma of the thyroid** d. sarcoma e. carcinoid tumors

Answer 105

Which of the following is not correct regarding types of AMIs? a. Type I is associated with plaque rupture b. Cocaine use can produce a type II AMI **c. Cardiac troponin testing can be used to differentiate between types** d. Type 1 and type 2 are treated differently e. Demand ischemia characterizes type 2 AMI

Answer 106

The enzyme deficiency of the adrenal steroid synthesis pathway that is the most common cause of congenital adrenal hyperplasia is a. 3-β-hydroxysteroid dehydrogenase b. 11-β-hydroxylase c. 17-α-hydroxylase d. 18-hydroxylase **e. 21-hydroxylase**

Answer 107

Which of the following is the most accurate regarding the origin of the natriuretic peptides (BNP and ANP) in blood? a. BNP originates from the brain and cardiac ventricles **b. BNP originates from the cardiac ventricles, ANP from the cardiac atria** c. BNP originates from the left ventricles, ANP from the right ventricles d. BNP originates from the cerebral ventricles e. BNP originates from the heart, ANP from the kidneys

Answer 108

A patient undergoing an insurance physical has the following hepatitis marker results: * HBsAg: negative * Total anti-HBc: positive * Total anti-HBs: positive How would you interpret these results? a. This patient has chronic hepatitis B and should be tested for HBeAg. b. This patient is immune to hepatitis B following immunization. **c. This patient is immune to hepatitis B following natural infection.** d. This patient may have early hepatitis B infection and should be tested for IgM anti-HBc. e. The testing should be repeated since total anti-HBc and total anti-HBs are both positive.

Answer 109

Which of the following best describes Dixon’s test for outlier exclusion (n.16 observations)? a. Outlier removal is an iterative process; once the first outlier is removed the data should be inspected for additional outliers and the test reapplied, as needed. **b. A value can be considered an outlier if the gap between the suspected result and the range of results is greater than 33%.** c. A value can be considered an outlier if it exceeds the 25% or 75% boundaries by 1.5 times the interquartile range. d. A value can be considered an outlier if it exceeds the 25% or 75% boundaries by two times the interquartile range.

Answer 110

All of the following are true of G6PD deficiency EXCEPT… a. Heinz bodies, which are denatured globin chains, may form in this condition. b. Oxidative stress may provoke a hemolytic episode. c. Antimalaria drugs are a well-described possible trigger of hemolytic episodes. **d. The optimal time for quantitative measurement of G6PD is during an acute hemolytic episode.** e. The ascorbate cyanide test is not specific for G6PD deficiency.

Answer 111

Match the following vitamins with the corresponding deficiency syndrome: 1. vitamin B6 : seizures 2. thiamine (B1) : beriberi 3. vitamin B2 : angular stomatitis, dermatitis 4. niacin (B3) : pellagra

Answer 112

Match autoantigens to the systemic autoimmune diseases they are associated with **_Autoantigen_** * Double-stranded DNA : **Systemic lupus erythematosus** * Cardiolipin and β2 glycoprotein 1 : **Antiphospholipid syndrome** * Jo 1 (histidyl tRNA synthetase) : **Polymyositis** * Citrullinated proteins : **Rheumatoid arthritis** * Scl 70 (topoisomerase 1) : **Scleroderma** * Ro/SSA and La/SSB : **Sjogren syndrome** * Centromere : **CREST syndrome/limited cutaneous form of systemic sclerosis**

Answer 113

Match autoantigens to the organ-specific autoimmune diseases they are associated with **_Autoantigens_** * Glutamic acid decarboxylase (GAD65) : **Type 1 diabetes mellitus** * Tissue transglutaminase : **Celiac disease** * Thyroperoxidase : **Autoimmune thyroiditis** * Anti-mitochondrial antibodies : **Primary biliary cirrhosis**

Answer 114

What is the earliest stage of pregnancy that cell-free DNA testing can be performed to detect fetal abnormalities? **a. 10 weeks** b. 13 weeks c. 16 weeks d. 21 weeks

Answer 115

Which of the following produces significantly different reference ranges relative to arterial when a venous sample is tested for blood gases? a. pH **b. PO2** c. PCO2 d. bicarbonate e. all of the above tests are interchangeable

Answer 116

A patient with abnormal liver function tests has the following hepatitis marker profile: * HBsAg: positive * IgM anti-HBc: positive * IgM anti-HAV: negative * Anti-HCV: negative This patient has which of the following? a. chronic hepatitis B infection b. recent hepatitis A infection **c. acute hepatitis B infection** d. recent hepatitis C infection e. concurrent hepatitis B and C infection

Answer 117

IGF-I is produced by a. adenohypophysis b. neurohypophysis **c. hepatocytes** d. adipocytes

Answer 118

The following is true about IGFs except **a. IGF I levels are not affected by age** b. IGF-I is \>75% bound to IGF-BP-3 c. random IGF-I has a better diagnostic test than random GH d. there are six IGF-Binding Proteins

Answer 119

Which of the following is a primary cause of lipemic interference? a. HDL b. IDL c. LDL **d. VLDL**

Answer 120

During a water deprivation tests, patients with hypothalamic or nephrogenic diabetes insipidus will show a. weight increase b. hyponatremia **c. increased plasma osmolality** d. increased urine osmolality

Answer 121

What is not the mechanism that hemolysis interferes with routine chemistry test results? a. release of analytes found in high concentrations in red blood cells b. hemoglobin color overlaps with the spectrophotometric measurement of testing **c. disturb the binding of antigen-antibody binding** d. the oxidation–reduction chemical reactivity of the iron in hemoglobin

Answer 122

Which of the following mechanisms could explain the cause of a patient’s cyanosis? a. maternal smoking during pregnancy **b. decreased activity of NADH-cytochrome-b5 reductase** c. increased activity of NADPH-methemoglobin reductase d. abundance of reduced glutathione e. in utero exposure to high levels of ascorbic acid

Answer 123

A patient presents to the Emergency Department with significant metabolic acidosis with a large anion gap not accounted for by lactate and without ketosis. The patient also has a positive osmolal gap and his urine contains envelope-shaped crystals. The most likely ingestant was: a. ethyl alcohol **b. ethylene glycol** c. acetone d. salicylate e. propylene glycol

Answer 124

Which of the following tests would yield a falsely decreased results after a N-acetylcysteine dose? a. prothrombin Time b. triglycerides c. lactate dehydrogenase d. enzymatic creatinine **e. b. and d. (réagit avec les quinones, rxn avec H2O2)** f. a. and b.

Answer 125

Which of the following statement is incorrect about phenylketonuria (PKU)? a. Patients with classic PKU are clinically silent at birth and neurological manifestations typically do not become evident until a few months of age. b. To treat a PKU cases, infants should be screened within first couple of days of life. c. PKU infants may lose about 50 points in their adult IQ if left untreated until the end of the first year of life. **d. PKU is inherited as autosomal dominant traits.**

Answer 126

Which of the following biomarker contains apolipoprotein B100? a. oxidized phospholipids **b. lipoprotein(a)** c. triglyceride d. secretory phospholipase A2 e. high-density lipoprotein

Answer 127

The excess of terminal hair in the androgen-dependent areas, such as inner thigh, chest, face, etc., in women, may be a symptom of endocrine pathology. What is true about this condition? a. Idiopathic hirsutism is only a working diagnosis, and it is always a symptom of an underlying pathology. **b. Hyperprolactinemia-related hirsutism may be accompanied by amenorrhea and/or galactorrhea.** c. Hirsutism is always the first symptom of early onset of the congenital adrenal hyperplasia. d. hCG-secreting ovarian tumors are the main cause of hirsutism.

Answer 128

A 23-year-old female presents to the ED with an intrauterine pregnancy at 27 weeks 3 days gestation. The patient complains of abdominal pain, contractions, and mild vaginal spotting for the past 24h. The patient has a history of chlamydia 3 months ago and 3 previous preterm deliveries. Cervicovaginal fetal fibronectin (fFN) testing was negative. How should this patient be treated? a. Give patient antenatal corticosteroids to induce fetal lung maturity. b. Admit the patient and treat with a tocolytic agent, like terbutaline. **c. Discharge patient with recommendation of pelvic rest and follow-up in one to two weeks.** d. Induce delivery immediately. e. fFN testing is inaccurate in the presence of a chlamydia infection.

Answer 129

Loop-mediated isothermal amplification (LAMP) is one form of isothermal nucleic acid amplification that is used in certain point-of-care molecular diagnostics. Other than being isothermal, which is NOT attribute of traditional LAMP. a. lower instrument cost b. faster analytical turnaround time **c. qualitative results only** d. simplified instrument design e. none of the above

Answer 130

In Cushing’s syndrome, a. the ectopic form is primarily caused by a cortisol-producing tumor, usually located in the lungs, pancreas, or thymus. b. the primary form is related to an ACTH-secreting pituitary tumor. c. the primary form results in bilateral adrenal hyperplasia because of excessive ACTH stimulation. **d. the secondary form is referred to as Cushing’s disease.** e. differentiation between primary and secondary Cushing’s is through serum cortisol determination.

Answer 131

A patient with an increased potassium and lactate dehydrogenase exhibits the following SPE (lane 1). What is a possible explanation for this electrophoretogram? a. liver disease **b. hemolysis** c. kidney failure d. lipemia e. hyperbilirubinemia

Answer 132

Monoclonal or oligoclonal bands are often or characteristically present in CSF specimens in association with all of the following cases except a. cerebral lymphoma **b. xanthochromia** c. multiple sclerosis (MS) d. elevated IgG index e. viral and postviral encephalitis (e.g., human immunodeficiency virus [HIV] encephalitis, post-polio syndrome)

Answer 133

Which of the following could falsely shorten the clotting time of coagulation assays? a. underfilled collection tube b. polycythemia c. use of a discard tube d. heparin or iv fluid contamination **e. improper phlebotomy tube collection order**

Answer 134

Assessment of excess GH status in early stages is best by a. measuring serum GH levels at random b. monitoring serum GH levels during dynamic testing stimulation **c. monitoring serum GH levels during a dynamic testing following suppression** d. observing physical changes

Answer 135

What is noninvasive prenatal testing (NIPT)? **a. A screening genetic test of fetal DNA in maternal blood to determine the probability of certain chromosomal abnormalities in the fetus.** b. A diagnostic genetic test of fetal DNA in maternal blood to determine the probability of certain chromosomal abnormalities in the fetus. c. A diagnostic genetic test to determine carrier status in the fetus. d. A diagnostic genetic test to determine carrier status in both the mother and the fetus.

Answer 136

Which of the following porphyrias is commonly associated with both photosensitivity and hemolytic anemia? a. acute intermittent porphyria (AIP) **b. congenital erythropoietic porphyria (CEP)** c. variegate porphyria (VP) d. hereditary coproporphyria (HCP) e. X-linked porphyria

Answer 137

Match the common name of the following vitamins with their corresponding trivial chemical name: 1. vitamin B1 : thiamine 2. vitamin B2 : riboflavin 3. vitamin B6 : pyridoxine 4. folic Acid : pteroylglutamic acid 5. vitamin B12 : cyanocobalamin

Answer 138

Which attribute of a biological variation parameter determines if reference ranges are appropriate? a. reference change value b. preanalytical variation **c. index of individuality** d. homeostatic set point e. reference values needed for all tests

Answer 139

Ghrelin a. inhibits GH secretion b. inhibits GHRH secretion **c. stimulates GH secretion** d. stimulates somatostatin secretion

Answer 140

Which iron profile is seen frequently in iron deficiency? a. ↓ Fe, N TIBC, N % Sat, N ferritin b. ↓ Fe, N TIBC, ↓ % Sat, N ferritin **c. ↓ Fe, ↑ TIBC, ↓↓ % Sat, ↓↓ ferritin** d. ↑ Fe, ↓ TIBC, ↑ % Sat, ↑↑ ferritin e. N Fe, N TIBC, N % Sat , ↑↑ ferritin

Answer 141

Beta 2 microglobulin is the tumor marker for which disease state? a. testicular cancer b. ovarian carcinoma c. medullary carcinoma of the thyroid **d. multiple myeloma** e. sarcoma

Answer 142

With respect to nonheme iron absorption from the gastrointestinal tract: a. Only heme iron can be absorbed from the diet. Nonheme iron is NOT absorbed. b. Transferrin is required for iron uptake into the enterocyte. c. Iron enters the enterocyte (from the lumen. via passive diffusion. d. Iron is absorbed in the ferric (Fe3+) state. **e. Iron is absorbed in the ferrous (Fe2+) state.**

Answer 143

Which of the following conditions are likely to show isolated prolongation of the prothrombin time (PT)? **a. Factor VII deficiency** b. unfractionated heparin therapy c. disseminated Intravascular coagulation d. hemophilia A e. liver failure

Answer 144

The following figure is a plot of cardiac biomarker release vs time after myocardial infarction. Label the curves appropriately. a. A.myoglobin, B.CK-MB, C.troponin I, D.lactate dehydrogenase, E.troponin T b. A.CK-MB, B.myoglobin, C.lactate dehydrogenase, D.troponin I, E.troponin T **c. A.myoglobin, B.CK-MB, C.troponin I, D.troponin T, E.lactate dehydrogenase** d. A.lactate dehydrogenase, B.aspartate aminotransferase, C.CKMB, D.troponin I, E.troponin T e. A.CK-MB, B.myoglobin, C.troponin C, D.troponin I, E.lactate dehydrogenase

Answer 145

Which of the following is not an interferent with glucose meters? a. ascorbic acid b. acetaminophen c. uric acid d. mannitol **e. ibuprofen**

Answer 146

Secondary osteoporosis results from all of the following conditions except: **a. vitamin D overdose** b. Cushing syndrome c. hyperthyroidism d. acromegaly e. chronic heparin administration

Answer 147

Which of the following reference intervals have been harmonized? a. testosterone b. sodium c. albumin d. hemoglobin **e. none of these**

Answer 148

Which of the following drugs may cause a false positive on an amphetamine immunoassay drug screen, but will give a negative confirmatory result? a. methylphenidate (Ritalin) : -/- **b. bupropion (Wellbutrin, Zyban) : +/-** c. MDMA (Ecstasy) : +/+ d. lisdexamfetamine (Vyvanse) : +/+ e. all of the above

Answer 149

Match each immunosuppressive drug with its molecular target: _Drug_ * Cyclosporine A * Everolimus * Mycophenolic acid * Sirolimus * Tacrolimus _Target_ * Calcineurin * Inosine monophosphate dehydrogenase (IMPDH) * Mammalian target of rapamycin (mTOR) a. Calcineurin: tacrolimus and mycophenolic acid; IMPDH: cyclosporine; mTOR: sirolimus and everolimus. **b. Calcineurin: cyclosporine and tacrolimus; IMPDH: mycophenolic acid; mTOR: sirolimus and everolimus.** c. Calcineurin: cyclosporine; IMPDH: mycophenolic acid; mTOR: sirolimus, everolimus, and tacrolimus. d. Calcineurin: sirolimus and everolimus; IMPDH: mycophenolic acid; mTOR: cyclosporine and tacrolimus. e. None of the above correctly match immunosuppressive drugs with their targets.

Answer 150

Which of the statements for beta-human chorionic gonadotropin (β-hCG) is correct? a. has an identical B-subunit to luteinizing hormone (LH), folliclestimulating hormone (FSH), and thyroid-stimulating hormone (TSH). b. it is homogenous and has only one molecular form of hCG **c. different immunoassays may measure different forms of hCG** d. is only elevated in pregnancy. e. is not elevated in malignancies

Answer 151

All of the following clinical or laboratory findings can contribute to the diagnosis of preeclampsia except: a. Two incidents of Systolic blood pressure of \>140mmHg and/or Diastolic pressure of \>90mmHg at least 4 h apart. b. Increased circulating antiangiogenic factors such as sFlt-1. **c. Proteinuria of \>100mg/24h on one occasion.** d. Proteinuria of \>300mg/L in a spot urine sample or \>1+on a urine dipstick on at least two occasions. e. Elevated serum AST and ALT.