Clinical Biochemistry Test Preparation
Course Introduction
Clinical Biochemistry is the study of the chemical processes and substances that occur within the human body, with a focus on their roles in health and disease. This course explores the principles and applications of biochemical analyses in medical diagnostics, including the interpretation of laboratory tests for blood, urine, and other body fluids. Emphasis is placed on understanding metabolic pathways, enzyme functions, and the biochemical basis of diseases such as diabetes, liver disorders, and renal dysfunction. Students will gain knowledge of laboratory techniques, quality control, and the clinical relevance of biochemical markers, preparing them for roles in healthcare and research settings.
Recommended Textbook
Clinical Chemistry Theory Analysis Correlation 5th Edition by Lawrence A. Kaplan
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56 Chapters
996 Verified Questions
996 Flashcards
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Chapter 1: Basic Laboratory Principles and Techniques
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Sample Questions
Q1) How many mL of 0.819 M acetic acid (MW = 60; pK = 4.76) should be added to 350 mL of 0.368 M sodium acetate (MW = 82) to produce a final pH of 4.89?
A)95.41 mL
B)116.5 mL
C)128.8 mL
D)130.6 mL
Answer: B
Q2) A material that is used to absorb and remove water from the air is known as a: A)teratogen
B)desiccant
C)carcinogen
D)reference material
Answer: B
Q3) How would you prepare 400 mL of 0.85% NaCl?
A)place 0.85 g of NaCl in a flask and dilute to 400 mL
B)place 3.4 g of NaCl in a flask and dilute to 400 mL
C)place 8.5 g of NaCl in a flask and dilute to 400 mL
D)place 34 g of NaCl in a flask and dilute to 400 mL
Answer: B
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Page 3
Chapter 2: Spectral Techniques
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Sample Questions
Q1) The wavelength of electromagnetic radiation is:
1)directly proportional to the energy of a photon
2)inversely proportional to the energy of a photon
3)directly proportional to the frequency of a photon
4)inversely proportional to the frequency of a photon
A)1, 3
B)2, 4
C)1, 4
D)2, 3
Answer: B
Q2) A solution of chloramphenicol (MW 323.1) in water gave an absorbance of 0.610 at 278 nm in a 1-cm cuvette; the concentration was 0.02 mg/mL.What is the molar absorptivity of chloramphenicol?
A)30.5 L/mol cm
B)3050 L/mol cm
C)9855 L/mol cm
D)11241 L/mol cm
Answer: C
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4
Chapter 3: Chromatography and Mass Spectrometry:
Theory, Practice, and Instrumentation
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Sample Questions
Q1) Chromatographic attractive forces that result from one molecule inducing a temporary separation of charges in an adjacent molecule are known as:
A)dispersive (van der Waals) forces
B)dipolar forces
C)hydrogen bonding forces
D)dielectric forces
Answer: A
Q2) In reversed-phase chromatography, the mobile phase is relatively ______, and the stationary phase is relatively ______.______ solute molecules are least retained in this type of chromatography.
A)polar, nonpolar, polar
B)polar, nonpolar, nonpolar
C)nonpolar, polar, polar
D)nonpolar, polar, nonpolar
Answer: A
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5
Chapter 4: Chromatographic Techniques
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Sample Questions
Q1) What is the purpose of adding an amine modifier (such as triethylamine) to the mobile phase when using a silica-based reversed-phase stationary phase for the chromatography of basic compounds?
A)to help dissolve the basic compounds in the mobile phase
B)to adjust the pH of the mobile phase to the desired basic pH
C)to block free silanol sites on the stationary phase from reacting with the basic solutes
D)to establish a flat baseline for spectrophotometric measurements
Q2) Combining selected ion monitoring (SIM) with isotope dilution in electron-ionization mass spectrometry allows:
A)for the removal of extraneous ions that produce complicating peaks in the mass spectrum
B)for quantification utilizing an internal standard
C)for confirmation of results obtained by electron-ionization mass spectrometry alone
D)for quality control checks on the mass spectrometry procedure
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Chapter 5: Laboratory Analysis of Hemoglobin Variants
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Sample Questions
Q1) Many HPLC systems utilize "windows" to aid in the interpretation of hemoglobin chromatographic analyses.Which of the following best describes chromatographic windows?
A)time intervals associated with changes in mobile phase ionic strength during gradient analysis
B)time intervals associated with detector measurement at two different wavelengths
C)time intervals during which specific hemoglobin fractions are expected to elute
D)time interval between the analysis of two different samples during which the chromatograph re-equilibrates
Q2) Perhaps the most significant disadvantage of HPLC analysis of hemoglobins is:
A)the technique is only qualitative and not quantitative
B)the technique is associated with a high degree of imprecision
C)the minor differences between the various hemoglobin fractions cause hemoglobins to elute in very narrow, overlapping windows
D)post-translational modification of hemoglobins produces fractions that often elute with the same retention time as other hemoglobin fractions
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Chapter 6: Electrophoresis
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Sample Questions
Q1) Which support medium is most used in immunoelectrophoresis?
A)polyacrylamide gel
B)agarose
C)agar
D)starch gel
Q2) Following electrophoresis, it was determined that the desired results were not obtained.All of the expected zones showed very slow migration.Which of the following would be a likely solution for this slow migration?
A)change to a support medium with a smaller pore size
B)decrease the voltage used for the analysis
C)change the pH of the buffer to a value closer to the isoelectric point of the analytes
D)decrease the ionic strength of the buffer
Q3) Considering only the effect of time on electrophoretic separation, the separation of bands ________ with time, and diffusion of bands _______ with time.
A)increases, increases
B)increases, decreases
C)decreases, increases
D)decreases, decreases
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8
Chapter 7: Immunological Reactions
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Sample Questions
Q1) Considering the noncovalent forces that contribute to antigen and antibody attraction, ________ are the strongest and most important contributors to antigen and antibody attraction, whereas ________ are the weakest contributors to this attraction.
A)electrostatic forces, van der Waals forces
B)hydrogen bonds, electrostatic forces
C)van der Waals forces, hydrogen bonds
D)electrostatic forces, hydrogen bonds
Q2) The portion of an antigen involved in a reaction with an antibody is known as the ____ site, and the number of these sites on an antigen is known as the antigen's _______.
A)equivalence, valency
B)equivalence, complexity
C)antigenic determinant, valency
D)antigenic determinant, complexity
Q3) Which of the following antigenic determinants would be the most reactive?
A)an antigenic determinant located in the core of a spatially folded molecule
B)a sequential antigenic determinant
C)an antigenic determinant located on the surface of a spatially folded molecule
D)the exposed antigenic determinant of a denatured protein
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Chapter 8: Immunochemical Techniques
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Sample Questions
Q1) Monoclonal antibodies are antibodies that are:
A)derived from a single line of cells that are directed toward multiple epitopes on an antigen
B)derived from a single line of cells that are directed toward a specific single epitope on an antigen
C)derived from multiple cell lines that are directed toward multiple epitopes on an antigen
D)derived from multiple cell lines that are directed toward a specific single epitope on an antigen
Q2) Suppose your laboratory uses a noncompetitive labeled-antibody immunometric technique that incorporates spectrophotometry for the measurement of a particular antigen.As the amount of measured antigen present in the patient sample ________, the absorbance of the test solution will ________.
A)increases, increase
B)increases, decrease
C)decreases, decrease D)both a and c are correct
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Chapter 9: Principles for Competitive-Binding Assays
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Q1) _______ measures the decrease of incident light transmission as a function of light scatter as the size of the aggregated particles increase, and the use of a ________ detection system increases the analytical sensitivity of these measurements.
A)Nephelometry, coupled enzymatic
B)A competitive-binding assay, nephelometric
C)Turbidity, near-infrared spectrophotometric
D)Turbidity, UV/Visible spectrophotometric
Q2) In a competitive-binding heterogeneous assay, the captive phase involves:
A)the removal of endogenous binding proteins that interfere with the immunoassay
B)the binding of the labeled reactant in the assay
C)the capture of free, unlabeled ligands from the patient sample for use in the assay of free ligand alone
D)the initial step in the assay where the antibody binds with the ligand
Q3) Which of the following labels is attached to the ligand in the EMIT system?
A)a lanthanide metal such as europium
B)an enzyme
C)the antibody to the ligand
D)a chromophore or fluorophore
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11
Chapter 10: Laboratory Approaches to Serology Testing
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Sample Questions
Q1) Laboratory detection of T.pallidum can occur by:
A)direct detection by typical microscopic examination
B)direct isolation by culture under standard laboratory conditions
C)serological testing
D)all of the above
Q2) Laboratory diagnosis of this disease is based on a two-tiered approach, with initial screening by IFA or ELISA and confirmation by Western blot.It is important that testing evaluate for IgM and IgG in order to increase chances of detecting and identifying this disease.
A)HIV
B)syphilis
C)herpes
D)Lyme disease
Q3) The specimen of choice in serological testing is ______.If the specimen is to be stored for 1 week prior to analysis, the specimen should be ______.
A)serum, frozen at -20°C
B)plasma, frozen at -20°C
C)serum, refrigerated
D)plasma, refrigerated
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Page 12
Chapter 11: Measurement of Colligative Properties
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Sample Questions
Q1) Suppose a lab measured serum osmolality on the same patient sample by freezing-point and vapor-pressure methods, and the osmolality measurement by the freezing-point method was found to be greater than the osmolality measurement by the vapor-pressure method.Which of the following is the most likely explanation for this discrepancy?
A)The difference in the two methods will always result in significantly different osmolalities.
B)overhydration of the patient
C)technologist error
D)the presence of unexpected volatile solutes in the patient sample
Q2) Which of the following anticoagulants will contribute the least to plasma osmolality?
A)indoacetic acid
B)sodium fluoride-potassium oxalate
C)heparin
D)EDTA
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13
Chapter 12: Electrochemistry: Principles and Measurement
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Sample Questions
Q1) Which of the following techniques would be the method of choice for measuring Pb ² in urine?
A)potentiometric electrochemical analysis
B)amperometric electrochemical analysis
C)anodic stripping voltammetric electrochemical analysis
D)coulometric electrochemical analysis
Q2) The use of ion-selective phases in potentiometric measurements is based on the potential that develops:
A)across the ion-selective phase once the ion has been captured in the ion-selective phase
B)after the ion passes through the ion-selective phase into the internal filling solution
C)across the liquid junction located between the tip of the reference electrode and the solution being measured
D)at the Ag/AgCl interface of the reference electrode
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14
Chapter 13: Molecular Diagnostics
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Sample Questions
Q1) ____________ forms the basis for almost all types of DNA detection methods.
A)denaturation
B)hybridization
C)restriction fragment length polymorphism (RFLP)
D)amplification
Q2) Which of the following statements are correct regarding mutations?
1)Mutations are changes in the base sequence in DNA and may include insertion, deletion, or replacement.
2)Mutations may result in no effect on protein expression or functional activity.
3)Mutations may result in partial or total loss of protein function.
4)Mutations always result in disease.
A)1, 2, 3
B)1, 3, 4
C)1, 2
D)3, 4
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Chapter 14: Therapeutic Drug Monitoring
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Sample Questions
Q1) Kinetic processes related to the fate of a drug in the body, where the rate of change of drug concentration is independent of the concentration of a particular drug, is known as:
A)zero-order kinetics
B)first-order kinetics
C)Michaelis-Menten kinetics
D)compartmental kinetics
Q2) Which of the following statements are true regarding drug half-life?
A)Doubling the dose of a drug will reduce the half-life by one half.
B)Half-life is equal to the time required to change the drug blood level by 50%.
C)Doubling the dose of a drug will double the half-life.
D)both b and c
Q3) The primary driving force for drugs to move from the point of absorption to the site of action is ______, and the primary driving force for drugs to leave the site of action following a single dose is ______.
A)active transport, active transport
B)active transport, passive transport
C)passive transport, active transport
D)passive transport, passive transport
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Page 16
Chapter 15: Clinical Enzymology
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Sample Questions
Q1) A convenient method for assaying enzyme activity is based on measuring the conversion between the oxidized and reduced forms of nicotinamide adenine dinucleotide (NAD/NADH).Which form of nicotinamide adenine dinucleotide has a unique wavelength of absorption, and what is the wavelength at which is unique absorption is at its maximum?
A)oxidized, 260 nm
B)oxidized, 340 nm
C)reduced, 260 nm
D)reduced, 340 nm
Q2) Which type of enzyme inhibitor binds to the active site and is considered to be a reversible inhibitor?
A)competitive inhibitor
B)noncompetitive inhibitor
C)uncompetitive inhibitor
D)allosteric inhibitor
Q3) The purpose of an enzyme is to:
A)alter the energy difference between the substrate and product
B)increase the rate of a chemical reaction
C)prevent the reversal of chemical reactions
D)protect the substrate during the addition of heat or energy
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Chapter 16: Protein Isoforms: Isoenzymes and Isoforms
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Sample Questions
Q1) Which of the following characteristics of isoenzymes result in the difference in catalytic activity seen between different isoenzymes?
A)the organ location of the different isoenzymes
B)the prosthetic group attached to the different isoenzymes
C)the amino-acid sequence difference between isoenzymes
D)all of the above
Q2) The method of isoenzyme analysis where antibody reacts specifically with one subunit to render that isoenzyme catalytically inactive or remove the isoenzyme altogether is known as:
A)immunoassay technique
B)substrate specificity technique
C)catalytic inhibition
D)immunoinhibition
Q3) The most common enzyme group associated with posttranslational proteolytic cleavage of enzymes is:
A)oxidoreductases
B)peptidases
C)transferases
D)isomerases
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Page 18
Chapter 17: Interferences in Chemical Analysis
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Sample Questions
Q1) Given the following data for bichromatic analysis in which the analytical wavelength is 510 nm, what is the most likely interference?
Patient sample absorbance at 510 nm = 0.715
Patient sample absorbance at 550 nm = 0.113
Standard absorbance at 510 nm = 0.500
Standard absorbance at 550 nm = 0.113
Standard concentration = 25 mg/L
A)spectrophotometer flow-cell contamination
B)hemolysis
C)the matrix in which the standard is dissolved
D)non-visual interference in the patient sample
Q2) It is recommended that spectrophotometric measurements be made in which of the following absorbance ranges?
A)0.100 - 1.100
B)0.200 - 0.500
C)0.500 - 1.500
D)0.100 - 2.000
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Chapter 18: Sources and Control of Preanalytical Variation
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Q1) Which of the following is not an advantage of the use of serum/plasma separator tubes?
A)Tubes can be centrifuged without removal of the stopper.
B)Tubes can be centrifuged using swinging buckets or fixed-angle rotors.
C)Continued red cell metabolism does not alter serum or plasma.
D)Storage with stoppers in place prevents evaporation.
Q2) Given that all of the following analytes show circadian variation, which one is known to be higher in the afternoon and evening than in the morning?
A)cortisol
B)ACTH
C)TSH
D)iron
Q3) Which of the following may result in an elevated serum/plasma potassium level?
A)use of a needle diameter that is too small during specimen collection
B)use of a needle diameter that is too large during specimen collection
C)re-centrifugation of tubes with separator gels
D)both a and b
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Chapter 19: Laboratory Management
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Q1) Which of the following would be a negative aspect of a reagent rental plan for acquiring a piece of equipment, as compared to leasing equipment?
A)Equipment least costs and reagent costs may be less than the complete reagent rental costs.
B)Next-generation equipment from a different company may become available before the contract expires.
C)The test volume may decrease for the equipment before the reagent rental contract expires.
D)all of the above
Q2) What is the most important management skill/ability that should be utilized by a laboratory director when planning changes in laboratory services?
A)communication
B)technical knowledge
C)background research
D)financial restraint
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Chapter 20: Laboratory Automation
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Sample Questions
Q1) Spectrophotometric instruments often have the capability of automatically sensing the presence of common interferents except:
A)icterus
B)hemolysis
C)clots
D)lipemia
Q2) Which type of laboratory automated system is usually a turnkey system that contains the components for each step in the process, including sample sorters, aliquoters, centrifuges, and analyzers that are interconnected by the track system?
A)modular integrated system
B)stand-alone systems
C)total laboratory automation
D)none of the above
Q3) A/An ____________ is an instrument that performs the same test simultaneously on all samples.
A)random-access analyzer
B)batch analyzer
C)automated clinical chemistry analyzer
D)none of the above
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Page 22
Chapter 21: Point-Of-Care Near-Patient Testing
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Q1) Any analytical system approved by the U.S.Food and Drug Administration to be sold as an over-the-counter test (i.e., in a store or pharmacy, without the need for a prescription) is automatically placed into the ______________ category of POCT testing.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
Q2) Tests performed by clinicians on their own patients, using samples that are so fragile it is impractical to send them to a central laboratory, are ____________.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
Q3) Gram stains are sometimes performed as POCT and are classified as _____________.
A)waived
B)provider-performed microscopy
C)moderate-complexity
D)high-complexity
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Chapter 22: Laboratory Information Systems
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Q1) The major impact of CLIA '88 on the LIS lies in data-retention requirements.Records of test requests and results must be retained in a conveniently retrievable manner for ______ years for anatomical pathology and cytology results, ______ years for blood bank and immunohematology (HLA typing) results, and ______ years for all other results.
A)10, 5, 2
B)5, 2, 10
C)10, 2, 5
D)2, 10, 2
Q2) Which of the following is not considered an analytical function of the LIS?
A)manual worklist
B)instrument worklist
C)phlebotomy draw list
D)manual result entry
Q3) What bar code is normally used for the labeling of blood products?
A)Code 128
B)Code 139
C)Code 39
D)Code ISBT-128
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Page 24
Chapter 23: Laboratory Statistics
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Q1) The two more useful measures of variation in the distribution of data are the variance and standard deviation.Which of the following best explains why standard deviation is the more commonly reported measure of variation?
A)Standard deviation is easier to calculate than variance.
B)Standard deviation provides information on how close together or far apart values are in the sample of data, whereas variance does not provide this information.
C)The units for standard deviation are the same as sample data, whereas the units for variance differ from that of the sample data.
D)Variance is primarily based on the highest and lowest value of the sample data, whereas standard deviation is based on all sample data.
Q2) The difference between parametric and nonparametric statistics is based on:
A)the assumption of a normal (Gaussian) distribution of the data.
B)the method used to consider outliers.
C)the assumption that only systematic error is present.
D)the equivalency of the mean, median, and mode.
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Chapter 24: Reference Intervals and Clinical Decision Limits
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Q1) Which of the following best explains why the phrase reference interval is preferred over the phase normal interval when associated with clinical laboratory test results?
A)The phrase reference interval portrays a more professional image of the clinical laboratory profession.
B)The word normal can be interpreted several different ways in laboratory medicine, resulting in potential confusion.
C)Use of the word normal is coupled with use of the abnormal, which raises objection by many individuals.
D)The phrase reference interval implies that statistical methodology was used to establish the interval.
Q2) Reference interval determinations should follow the guidelines established by:
A)CDC
B)CMS
C)CLSI
D)IFCC
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26
Chapter 25: Quality Control for the Clinical Chemistry Laboratory
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Q1) An abrupt and sustained change of control values in one direction is known as a ______, and a gradual change of control values in one direction is known as a
A)random error, trend
B)trend, shift
C)shift, trend
D)shift, random error
Q2) Suppose a test procedure has been determined to be out of control.What is the first step that should be taken by the technologist to correct the problem?
A)recalibrate the instrument
B)retest using fresh aliquots of control materials
C)replace reagents
D)perform instrument maintenance
Q3) A definitive method is:
A)the most commonly used method.
B)the scientifically most accurate method.
C)a method that can be used for qualitative screening only.
D)a method that has demonstrated similar but slightly less accuracy than a reference method.
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Chapter 26: Evaluation of Methods
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Q1) When considering application characteristics, emphasis may be placed on ______ for pediatric applications, on ______ for stat applications, and on ______ for high-volume screenings.
A)sample size, turnaround time and interrupt features, sample throughput rate
B)turnaround time and interrupt features, sample throughput rate, sample size
C)sample throughput rate, sample size, turnaround time and interrupt features, D)turnaround time and interrupt features, sample size, sample throughput rate
Q2) Calculate the percentage recovery given the following information:
Baseline sample preparation: 1.5 mL serum + 0.25 mL water
Spike sample preparation: 1.5 mL serum + 0.25 mL 5000 mg/L standard
Baseline sample measured concentration: 950 mg/L
Spiked sample measured concentration: 1621 mg/L
A)89%
B)94%
C)98%
D)106%
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Chapter 27: Classification and Description of Proteins, Lipids, and Carbohydrates
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Q1) The overall three-dimensional structure and folding pattern of the complete protein that confers on the protein its specific biological properties is known as the protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q2) The three-dimensional spatial arrangement of multiple polypeptide chains forming larger, more stable complexes is known as a protein's _____ structure.
A)primary
B)secondary
C)tertiary
D)quaternary
Q3) Monosaccharides can be linked to other monosaccharides or other biomolecules through the formation of:
A)peptide linkages
B)hydrogen bond linkages
C)glycosidic linkages
D)ester linkages
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Chapter 28: Physiology and Pathophysiology of Body Water and Electrolytes
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Q1) The combination of hyponatremia and hypo-osmolality could be caused by which of the following?
A)adrenocortical insufficiency such as hypoaldosteronism
B)excessive vomiting and diarrhea
C)syndrome of inappropriate ADH secretion (SIADH)
D)both a and c
Q2) Which electrolyte is most significantly affected by hemolysis?
A)sodium
B)potassium
C)chloride
D)bicarbonate
Q3) Which of the following changes will be seen in dehydration?
1)increase in aldosterone
2)increase in antidiuretic hormone
3)increase in atrial natriuretic peptide
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
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Chapter 29: Acid-Base Control and Acid-Base Disorders
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Q1) Which of the following is the normal reference interval for arterial pH?
A)7.31 - 7.41
B)7.33 - 7.43
C)7.35 - 7.45
D)7.45 - 7.55
Q2) Which of the following normal reference intervals is incorrect for an arterial blood sample?
A)pH = 7.35 - 7.45
B)pCO = 24 - 28 mmHg
C)HCO = 22 - 26 mmol/L
D)TCO = 23 - 27 mmol/L
Q3) A normal total CO , increased pCO , and decreased pH is most correctly classified as:
A)uncompensated metabolic acidosis
B)compensated metabolic acidosis
C)uncompensated respiratory acidosis
D)compensated respiratory acidosis
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Chapter 30: Renal Function
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Q1) When following the urinary system, the renal pelvis rapidly diminishes in caliber and merges into the ______.Each of these descends in the abdomen alongside the vertebral column to join the ______, which provides temporary storage for urine, which is eventually voided through the _____ to the exterior.
A)urethra, kidney, ureter
B)ureter, kidney, urethra
C)ureter, bladder, urethra
D)urethra, bladder, ureter
Q2) The kidney is able to carry out its complex functions because approximately ______of the volume of blood pumped by the heart into the systemic circulation is circulated through the kidneys.Therefore, the kidneys, which constitute about ______ of total body weight, receive ______ of the cardiac output.
A)25%, 0.5%, 1/4
B)0.5%, 25%, 1/4
C)25%, 0.5%, 1/2
D)50%, 25%, 1/2
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Chapter 31: Liver Function
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Q1) Within the hepatocyte's cytoplasm, there is normally more AST than ALT by a factor of about ______; however, the amount of cytoplasmic ALT ______ with alcohol abuse, pyridoxine deficiency, and in cirrhosis, which ______ the cellular ratio of AST to ALT.
A)1.2, decreases, increases
B)1.5, increases, decreases
C)1.5, decreases, increases
D)1.2, increases, decreases
Q2) Which of the following functions are performed by hepatocytes?
1)metabolism
2)synthesis of critical components
3)formation of bile
4)endocrine functions
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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33
Chapter 32: Diagnosis of Viral Hepatitis
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Q1) Which of the following statements is not true of hepatitis A virus?
A)Prophylactic treatment with immune globulin has been recommended after exposure.
B)The peak of infectivity occurs during the 2 weeks before the onset of symptoms.
C)Serum ALT levels peak 2 to 3 weeks after infection.
D)HAV can be detected in the stools of patients 3 to 4 weeks before symptoms develop.
Q2) Which of the following are characteristics of hepatitis C virus (HCV)?
1)HCV is transmitted through blood, needle sharing, sexually.
2)HCV is the primary cause of chronic liver disease such as cirrhosis.
3)HCV currently has a vaccine available.
4)The majority of HCV-infected patients are asymptomatic.
A)1, 2, 3, 4
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
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Chapter 33: Bone Disease
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Q1) Which of the following qualify as criteria for a female patient to have a bone-density scan?
A)over 65 years old
B)postmenopausal with at least one risk factor besides menopause, or with a fracture
C)on prolonged hormone-replacement therapy
D)all of the above
Q2) Given the following laboratory information, what is the most probable metabolic bone disease?
Calcium - decreased
Phosphorus - decreased
PTH - increased
Alkaline phosphatase - increased
Calcidiol - decreased or normal
Calcitriol - decreased or normal
A)osteoporosis
B)osteomalacia
C)osteitis fibrosa
D)none of the above
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Chapter 34: The Pancreas: Function and Chemical Pathology
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Q1) Nerve fibers in pancreatic tissue stimulate production of:
A)vasoactive intestinal peptide
B)somatostatin
C)enkephalin-related peptides
D)all of the above
Q2) A 45-year-old patient presents with hyperglycemia, weight loss, and a peculiar skin rash.This distinctive combination of symptoms is consistent with _______________.
A)insulinoma
B)glucagonoma
C)somatostatinoma
D)PPoma
Q3) Which of the following can cause acute pancreatitis?
A)cystic fibrosis
B)alcohol abuse
C)biliary tract obstruction by gallstones
D)both b and c
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Chapter 35: Gastrointestinal Function
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Q1) When considering the lactose tolerance test, a healthy person will demonstrate a glucose of ______, but those with lactase deficiency will exhibit a peak plasma glucose of ______.
A)> 2000 mg/L over the baseline sample, < 1000 mg/L
B)< 2000 mg/L over the baseline sample, > 1000 mg/L
C)> 1000 mg/L over the baseline sample, < 2000 mg/L
D)< 1000 mg/L over the baseline sample, > 2000 mg/L
Q2) Suppose there is a need to differentiate a situation of true malabsorption due to damage to intestinal mucosa from maldigestion due to pancreatic insufficiency.Given that one of these two situations is suspected, the patient is given a 25-gram dose of D-xylose dissolved in 300 mL of water.A blood sample is obtained 2 hours after the D-xylose administration, and a 5-hour urine is collected.The results of the D-xylose analysis are: blood xylose = 400 mg/L; urine xylose = 7 g/5 hr.These results provide laboratory evidence of:
A)malabsorption due to damage to the intestinal mucosa
B)maldigestion due to pancreatic insufficiency
C)both malabsorption and maldigestion
D)The D-xylose test alone cannot evaluate for either malabsorption or maldigestion.
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Chapter 36: Cardiac and Muscle Disease
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Q1) Cardiac output is determined by which of the following:
A)volume of blood pumped
B)the contractile force developed in the wall of the left ventricle
C)systemic blood pressure
D)all of the above
Q2) Which of the following laboratory tests would be the most useful in assisting the physician in differentiating congestive heart failure from other conditions that have similar clinical presentations?
A)lactate
B)CK-MB
C)cTnI
D)BNP
Q3) An increased level of which of the following analytes serves as laboratory evidence of cardiac ischemia?
A)lactate
B)CK-MB
C)cTnT
D)BNP
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Chapter 37: Coronary Artery Disease: Lipid Metabolism
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Q1) The following data provide laboratory evidence of which lipoprotein abnormality?
Total cholesterol - decreased, triglycerides - decreased
Apoprotein B - decreased
Vitamin E - decreased
Red blood cell morphology - acanthocytosis
A)Tangier disease
B)Familial lipoprotein lipase deficiency
C)Familial dysbetalipoproteinemia
D)Abetalipoproteinemia
Q2) Which of the following components of a lipoprotein profile is most affected by a nonfasting specimen?
A)total cholesterol
B)HDL cholesterol
C)LDL cholesterol measured by a direct method
D)triglycerides
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Chapter 38: Diabetes Mellitus
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Q1) Which of the following is considered one of the earliest indicators of impending glomerular nephropathy associated with diabetes mellitus?
A)glycated hemoglobin
B)microalbuminuria
C)urine osmolality
D)BUN/creatinine
Q2) All of the following laboratory results suggest the presence of secondary diabetes except:
A)increased growth hormone level
B)increased cortisol level
C)increased epinephrine level
D)increased insulin level
Q3) In diabetic ketoacidosis, plasma sodium levels are ______, plasma potassium levels are ______, and plasma bicarbonate levels are ______.
A)decreased, decreased, decreased
B)increased, increased, increased
C)increased, decreased, increased
D)decreased, increased, decreased
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Chapter 39: Iron and Porphyrin Metabolism
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Q1) Which of the following is/are true of hepcidin?
A)It controls the flow of iron out of the intestinal cells by inhibiting iron release.
B)High levels promote release of iron into the circulation.
C)Low levels restrict the release of iron from intestinal cells into the circulation.
D)all of the above
Q2) Which of the following characteristics is true of hemosiderin that differentiates it from ferritin?
A)Hemosiderin may contain up to approximately 4500 iron atoms.
B)Hemosiderin is a readily mobilized storage form of iron.
C)Hemosiderin is derived from ferritin that has lost some of its surface protein, causing insolubility.
D)Hemosiderin is too small to be observed by light microscopy, whereas ferritin can be observed in tissue stained with Prussian blue dye.
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Chapter 40: Hemoglobin
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Q1) The level of 2,3-biphosphoglycerate (2,3-BPG) exerts a significant influence on the oxygen dissociation curve.The level of 2,3-BPG production is regulated by which of the following glycolytic enzymes?
A)lactate dehydrogenase
B)phosphofructokinase
C)glucose-6-phosphatase
D)beta-hydroxybutyrate dehydrogenase
Q2) Synthesis of hemoglobin is normally stimulated by hypoxia causing the ______ to produce ______.
A)hypothalamus, hemopexin
B)adrenal gland, haptoglobin
C)kidneys, erythropoietin
D)lungs, angiotensin
Q3) In which of the following conditions is Hb A elevated?
A)alpha thalassemia trait
B)beta thalassemia trait
C)Hb SC disease
D)HB S trait
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Chapter 41: Human Nutrition
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Q1) For infants, essential amino acids should make up ______ of the total amino-acid intake; for children 10 to 12 years of age, it should make up ______; and for adults, essential amino acids should make up ______ of the total amino-acid intake.
A)36%, 43%, 10%
B)43%, 36%, 10%
C)36%, 10%, 43%
D)43%, 10%, 36%
Q2) What is the body mass index of a patient who weighs 250 pounds and is 1.828 meters tall?
A)31 kg/m<sup>2</sup>
B)34 kg/m<sup>2</sup>
C)38 kg/m<sup>2</sup>
D)There is insufficient information provided to solve this problem.
Q3) Increased irritability of cardiac muscle may be associated with a decreased plasma concentration of which of the following macrominerals?
A)sodium
B)potassium
C)chloride
D)calcium
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Page 43
Chapter 42: Trace Metals
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Q1) A deficiency of __________ may be associated with hyperglycemia, glucosuria, and glucose intolerance in a nondiabetic patient.
A)chromium
B)copper
C)manganese
D)molybdenum
Q2) Which of the following describes the mechanism by which fluoride is believed to provide protection against dental caries?
A)Fluoride neutralizes tooth-damaging acid by-products produced by bacteria.
B)Fluoride anions substitute for hydroxyl anions in the hydroxyapatite crystal structure, causing the crystal structure to be harder.
C)Fluoride serves as an activator of an enzyme which functions to replenish the hydroxyapatite crystal structure to keep teeth strong.
D)Fluoride is a natural component of tooth enamel that is easily dissolved and must be replenished to provide protection against tooth decay.
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Chapter 43: Vitamins
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Q1) The active form of vitamin K is important in which of the following steps of the coagulation pathway?
A)the conversion of glutamic acid to delta-carboxyglutamic acid
B)the binding of calcium
C)the formation of an ionic bridge for clot formation
D)the binding with phospholipids
Q2) Vitamin B is usually measured in the laboratory at the same time as which other vitamin, owing to their clinical similarities of deficiency and metabolic interactions?
A)thiamine
B)niacin
C)folic acid
D)carnitine
Q3) Hemolytic anemia may be associated with which vitamin deficiency?
A)vitamin A
B)vitamin D
C)vitamin E
D)vitamin K
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45
Chapter 44: Pregnancy and Fetal Development
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Q1) A patient's initial plasma hCG level is 2250 IU/L, but 48 hours later it is 3375 IU/L, and another 48 hours later it is 4500 IU/L.These data provide laboratory evidence of which type of pregnancy?
A)molar pregnancy
B)ectopic pregnancy
C)normal pregnancy
D)There is not enough information to make a distinction.
Q2) Infants with hemolytic disease of the newborn should have which hematological and biochemical tests performed on the cord blood?
1)direct bilirubin
2)direct Coombs
3)hemoglobin
4)total bilirubin
A)1, 2, 3, 4
B)1, 2, 3
C)1, 2, 4
D)1, 3, 4
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Chapter 45: The Newborn
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Q1) At 36 weeks gestation, fetal hemoglobin accounts for about ______ of total hemoglobin in the fetus; approaching term, the percentage of HbF is approximately ______ of total hemoglobin.
A)90%, 70%
B)70%, 90%
C)50%, 60%
D)60%, 50%
Q2) Which of the following tests have reference intervals that are lower in the newborn than in the adult?
1)vitamin
2)protein
3)trace elements
4)inflammation markers
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
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Page 47
Chapter 46: Extravascular Biological Fluids
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Q1) Which of the following statements are true of transudates?
1)They are caused by inflammation.
2)They are caused by disturbances of hydrostatic pressure.
3)They are caused by disturbances of colloid osmotic pressure.
4)They are caused by increased capillary permeability.
A)1, 2
B)2, 3
C)3, 4
D)1, 4
Q2) Which of the following markers are helpful in the differential diagnosis of a ruptured urinary bladder after abdominal trauma?
1)urea nitrogen
2)alkaline phosphatase
3)lipase
4)creatinine
A)1, 2
B)2, 3
C)3, 4
D)1, 4
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Chapter 47: Nervous System
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Q1) Which of the following are true of cerebrospinal fluid?
1)The total volume of CSF in adults is about 350 mL.
2)The total amount of CSF is replaced every 6 to 8 hours.
3)CSF is produced by the choroid plexus.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q2) Which of the following laboratory tests would be selected to assess the integrity of the blood-brain barrier?
A)CSF osmolality
B)IgG index
C)CSF lactic acid
D)kappa to lambda light chain ratio
Q3) Which of the following compounds most readily enters the central nervous system?
A)albumin
B)calcium
C)alcohol
D)aspartic acid
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Page 49
Chapter 48: General Endocrinology
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Q1) Which test(s) is/are used to determine if hypothalamic or pituitary dysfunction are the cause of hypogonadal disease and hypergonadal disease?
A)FSH
B)LH
C)prolactin
D)both a and b
Q2) Which of the following are true of the second messenger signaling system?
1)This system requires the availability of energy in the form of ATP.
2)This system is utilized by steroid and peptide hormones.
3)An example of a second messenger is cyclic-AMP.
A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3
Q3) Trophic hormones are produced by the ______, and releasing factors are produced by the ______.
A)hypothalamus, pituitary
B)pituitary, hypothalamus
C)specific endocrine glands, hypothalamus
D)specific endocrine glands, pituitary
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Chapter 49: Thyroid
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Q1) In patients with developing subclinical hyperthyroidism, TSH levels will likely be ______, and fT will likely be ______.
A)decreased, increased
B)increased, decreased
C)decreased, normal
D)increased, normal
Q2) The T resin uptake test is used to measure:
A)total T
B)free T
C)thyroxine binding globulin (TBG)
D)TSH
Q3) Thyroid hormones exert influence in most areas of the body.How do thyroid hormones influence the heart?
A)They affect cardiac gene expression.
B)They influence the sensitivity of the heart to the sympathetic nervous system.
C)They cause peripheral hemodynamic alterations that influence cardiac function.
D)All of the above
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Chapter 50: The Gonads
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Q1) The ovary is composed of what cell types?
1)coelomic epithelial cells
2)granulosa cells
3)mesenchymal cells
4)primordial germ cells
A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4
Q2) Which laboratory test is commonly used to assess luteal function?
A)LH
B)FSH
C)progesterone
D)estradiol
Q3) Gonadotropin-releasing hormone (GnRH) regulates which of the following?
A)the synthesis and storage of gonadotropins
B)movement of gonadotropins from a reserve pool ready for secretion
C)immediate release of FSH and LH
D)all of the above
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Page 52
Chapter 51: Adrenal Hormones and Hypertension
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Q1) A patient with intermittent hypertension has an elevated urinary vanillylmandelic acid (VMA).This result suggests:
A)hyperaldosteronism
B)hypercortisolism
C)idiopathic hypertension
D)pheochromocytoma
Q2) Which of the following are characteristic of ketosteroids?
1)contain 21 carbon atoms
2)contain a hydroxyl group at the carbon 17 position
3)contain 19 carbon atoms
4)contain a ketone group at the carbon 17 position
A)1, 2
B)3, 4
C)1, 4
D)2, 3
Q3) Which of the following patients should undergo screening for Cushing's syndrome?
A)a patient with osteoporosis
B)a woman with polycystic ovary syndrome
C)a patient with poorly controlled diabetes
D)all of the above
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Chapter 52: Diseases of Genetic Origin
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Q1) Sickle cell disease is the prototypical ______ single gene disorder.It occurs with an incidence of approximately 1 in 600 ______.
A)autosomal recessive, African Americans
B)autosomal recessive, Caucasian Americans
C)autosomal dominant, African Americans
D)autosomal dominant, Caucasian Americans
Q2) Which of the following is not true of autosomal dominant inheritance?
A)The disease occurs with equal frequency in males and females.
B)The disease can occur in the absence of family history.
C)An individual must inherit two copies of a mutant allele in a particular locus, one from each parent, to be affected.
D)All of the above
Q3) Which of the following is considered a transversion?
A)the substitution of a pyrimidine for a purine
B)the substitution of a purine for a purine
C)the substitution of a pyrimidine for a pyrimidine
D)all of the above
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Chapter 53: Neoplasia
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Q1) Which of the following play a role in determining a cancer's ability to invade surrounding tissue?
A)decreased motility of cells
B)decreased pressure within the tumor caused by active multiplication of the cells
C)decreased cohesiveness between cells
D)all of the above
Q2) During which phase of cancer does the transformed cell actually develop into a cancer, but the cancer remains in the original site?
A)dissemination
B)invasion
C)induction
D)in situ
Q3) Why are cancers of white blood cells more common than heart cancers?
A)White blood cells proliferate.
B)White blood cells have less protection against cancer development than heart cells.
C)Blood flow through the heart prevents heart cancers.
D)The heart has natural immunity to cancer development.
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Chapter 54: Laboratory Evaluation of the Transplant
Recipient
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Q1) Which of the following statements are true of kidney donation and transplants?
1)Kidney allograft survival rates are greater when the graft is obtained from a living donor.
2)There is improved potential for increased immunological match if the recipient is genetically related.
3)A live donor transplant spares the recipient the long waiting period on dialysis that frequently occurs when one is waiting for a suitable deceased donor transplant.
4)Deceased donor allografts are associated with an improved long-term graft survival.
A)1, 2, 3, 4
B)1, 2, 3
C)1, 3, 4
D)2, 3, 4
Q2) Cyclosporine toxicity manifests as which of the following?
A)increased renal blood flow
B)decreased GFR
C)increased urine output
D)decreased sodium retention
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56
Chapter 55: Toxicology
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Q1) Which of the following individuals would have the highest metabolism of a drug based strictly on age?
A)a newborn
B)a 20-year-old
C)a 60-year-old
D)an 80-year-old
Q2) Which of the following binds sulfhydryl groups of enzymes and proteins, uncouples oxidative phosphorylation, and can be found in urine, hair, nail, and blood samples?
A)cadmium
B)iron
C)lead
D)arsenic
Q3) Which of the following chelating agents are used to bind and remove metals?
A)ethylenediaminetetraacetate
B)deferoxamine
C)British anti-Lewisite
D)all of the above
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Chapter 56: Addiction and Substance Abuse
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Q1) Which of the following is an aspect of addiction?
1)craving
2)withdrawal
3)dependence
4)denial
A)1, 2, 3, 4
B)1, 2, 3
C)2, 3, 4
D)1, 3, 4
Q2) Which of the following is considered a reason that a person will fail a drug screen even though he was given advanced warning?
A)The person did not understand the physiological aspects of drug testing.
B)The individual is in denial about his addiction.
C)The addicted individual has no intention of using drugs at the time of the drug screen but loses control and uses the drug at an inopportune moment.
D)All of the above
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