Clinical
Chemistry
1. Sodium fluoride is used in specimen
collection to:
a.
Prevent glycolysis
b.
Prevent conversion of prothrombin to thrombin
c.
Chelate calcium
d.
Bind calcium
2.
Serum iron should be drawn at the same time on successive days to avoid:
a. Diurnal variation
b. Chance of consumption of dietary iron
c. Effect of medication
d. Gastrointestinal absorption of iron
3.
The venipuncture site for a routine puncture is commonly cleaned with:
a. 90% alcohol
b. Betadine
c. 70% alcohol
d. Quarternary ammonium compounds
4.
Which of these substances cannot be preserved by freezing?
a. BUN
b. CK isoenzymes
c. LDH
d. Prostatic ACP
5.
Which of the following is an appropriate sample for blood ammonia
determination?
a. Arterial blood immediately chilled for
12 hours
b. Arterial blood immediately chilled for 8
hours
c. Arterial blood immediately chilled for 4
hours
d. Freshly drawn blood
6.
Which statement about wavelength calibration is true?
a.
A didymium filter will have an absorbance maximum at 585 nm
b.
Holmium oxide glass gives an absorbance maximum at 361 nm
c.
The line emission of a hydrogen lamp at 656 nm can be used for calibration
d.
All of these
7.
In spectrophotometric analysis, what is the purpose of the reagent blank?
a. Correct for interfering chromogens
b. Correct for lipemia
c. Correct for protein
d. Correct for color contribution of the
reagents
8.
Nephelometry is based on the measurement of light that is:
a. Blocked by particles in suspension
b. Scattered by particles in suspension
c. Produced by fluorescence
d. Produced by excitation of ground state
atoms
9.
When measuring K+ with an ion-selective electrode by means of a liquid
ion-exchange membrane, what antibiotic will be incorporated into the membrane?
a. Vancomycin
b. Streptomycin
c. Valinomycin
d. Nonactin
10.
The purpose of the glass coils in a continuous flow system is to:
a. Provide proper mixing
b. Prevent carry-over of sample
c. Allow visual inspection
d. Allow close packing of tubing
11.
The theoretic pH of pure water is:
a. 6.0
b. 7.0
c. 7.4
d. 8.0
12.
How many mL of 95% alcohol do you need to make 1 liter of a 70% solution?
a. 74 mL
b. 138 mL
c. 737 mL
d. 1360 mL
13.
If 0.5 mL serum is diluted to a volume of 10 mL with normal saline, what
dilution is achieved?
a. 1:40
b. 1:10
c. 1:5
d. 1:20
14.
An explosion could result if:
a. Acid is added to water
b. Water is premixed with a weak salt
c. Acid is neutralized and water added
d. Water is added to concentrated acid
15.
Given the following laboratory data:
Serum creatinine = 4.0 mg/dL
Urine creatinine = 80 mg/dL
24 hour volume = 360 mL
The
creatinine clearance is:
a. Normal for an adult
b. Low for an adult
c. High for an adult
d. Unable to calculate with data given
16.
All emergency (STAT) laboratory analyses should be reported to the ordering
physician within:
a. 30 mins to 1 hour
b. 10 to 20 minutes
c. 1 to 2 hours
d. 3 hours
17.
A properly labeled specimen will include all of the following EXCEPT:
a. Name of patient
b. Unique identification number
c. Date of collection
d. Date of birth of patient
18.
Which of the following is caused by a random error?
1.
R:4s 3. 1:2s 5. 10:x
2.
4:1s 4. 1:3s 6. 2:2s
a.
1, 2, 3, and 6
b. 1, 4 and 6
c. 1 and 4
d. 2, 3 and 5
19.
It is defined as the proportion of individuals without a condition who have a
negative test for that condition
a. Diagnostic sensitivity
b. Diagnostic specificity
c. Positive predictive value
d. Negative predictive value
20.
It refers to the ability of a method to measure only the analyte of interest
a. Accuracy
b. Precision
c. Specificity
d. Sensitivity
21.
What term applies to the sum of all the values in a set of numbers divided by
the number of values in that set?
a. Median
b. Mode
c. Mean
d. Standard deviation
22.
What does the preparation of a Levey-Jennings QC chart for any single
constituent of serum require?
a. Analysis of control serum over a period
of 20 consecutive days
b. 20 to 30 analyses of the control serum
on 1 day, in one batch
c. Analyses consistently performed by one
person
d. Weekly analyses of the control serum for
1 month
23.
A group of physicians consistently complains that they are not receiving STAT
patient results quickly enough. The supervisor is likely to refer to which
quality assessment variable?
a. Test utilization
b. Turnaround time
c. Specimen separation and aliquoting
d. Analytical methodology
24.
It refers to the ability of an analytical method to maintain both accuracy and
precision over an extended period of time?
a. Probability
b. Practicability
c. Reliability
d. Validity
25.
Which Westgard multirole applies to a situation where one control point exceeds
the mean by +2SD and a second control point exceeds the mean by -2SD?
a. 1:2s
b. 2:2s
c. 4:1s
d. R:4s
26.
Hemolysis releases intracellular ions into the serum. Therefore, even slight
hemolysis will cause erroneous results for the following:
1.
Na++ 3. Mg++ 5. Cl-
2.
K+ 4. HCO3- 6. Fe++
a.
1, 2 and 3 c. 2
b.
2, 3, 4 and 5 d. 2, 3, 6
27.
Symptom of hypocalcemia is typically:
a. Stupor
b. Tetany
c. Tremors
d. Dehydration
28.
The Fiske-Subbarow method is based upon the reaction of inorganic phosphorus
with:
a. Ammonium molybdate
b. Oxalic acid
c. Mercuric nitrate
d. p-dimethylaminobenzaldehyde
29.
Determine the anion gap from the given serum electrolyte data:
Na++
= 132 mmol/L HCO3-
= 22 mmol/L
Cl-
= 90 mmol/L
a. 12 mmol/L
b. 64 mmol/L
c. 20 mmol/L
d. Cannot be determined from the information
provided
30.
Major extracellular anion
a. Sodium
b. Potassium
c. Chloride
d. Bicarbonate
31.
Which of the following conditions will cause an increased osmolal gap?
a. Drug overdose
b. Diabetic ketoacidosis
c. Renal failure
d. All of these
32.
Hyperaldosteronism will cause ____ serum sodium and ___ serum potassium levels
a. Increased; Decreased
b. Increased; Increased
c. Decreased; Increased
d. Decreased; Decreased
33.
Which of the following is the primary mechanism for antidiuretic hormone (ADH)
release?
a. Hypovolemia
b. Hyperosmolar plasma
c. Renin release
d. Reduced renal blood flow
34.
Which of the following clearance tests offers the most accurate measure of
glomerular filtration?
a. Inulin
b. Creatinine
c. p-aminohippurate (PAH)
d. Urea
35.
All but one of the following matches is correct:
a. Urea – product of protein catabolism
b. Creatine – product of muscle catabolism
c. Uric acid – product of pyrimidine
catabolism
d. Bilirubin – product of heme catabolism
36.
The classic creatinine reaction is that of:
a. Jaffe
b. Lloyd
c. Kjeldahl
d. Nessler
37.
To determine if a 24 hour urine collection is complete, which of the following
determinations may be helpful?
a. BUN
b. Osmolality
c. Protein
d. Creatinine
38.
A condition in which the metabolism of uric acid, but not of other nitrogenous
urinary constituents, is impaired:
a. Uremia
b. Azotemia
c. Gout
d. Nephritis
39.
The cause(s) of prerenal azotemia is (are):
a. Dehydration
b. Congestive heart failure
c. Shock of hemorrhage
d. All of the above
40.
The urea nitrogen method using diacetyl monoxime measures:
a. Urea nitrogen only
b. Urea nitrogen and ammonia
c. Urea nitrogen and amino acids
d. Urea nitrogen and peptide bonds
41.
Urea concentration is calculated from the blood urea nitrogen (BUN) by
multiplying by the factor of:
a. 0.5
b. 2.14
c. 6.45
d. 14
42.
Which of the following is classified as a mucopolysaccharide storage disease?
a. Pompe’s disease
b. von Gierke’s disease
c. Andersen’s disease
d. Hurler’s syndrome
43.
Which of the following is the reference method for measuring serum glucose?
a. Somogyi-Nelson
b. Hexokinase
c. Glucose oxidase
d. Glucose dehydrogenase
44.
Which of the following hormones does not promote an increase in blood glucose
levels?
a. Growth hormone
b. Cortisol
c. Insulin
d. Glucagon
45.
Which of the following does not properly describe type I diabetes mellitus?
a. Insulin deficiency
b. Associated with autoimmune destruction
of pancreatic beta-cells
c. Ketoacidosis prone
d. Occurs more frequently in adults
46.
For every 1% change in the HbA1c value, ___ mg/dL is added to plasma glucose
a. 15
b. 25
c. 35
d. 50
47.
According to WHO, what is the standard glucose load for OGTT procedure?
a. 75g
b. 150g
c. 50g
d. 100g
48.
Type I and V hyperlipoproteinemia are characterized by large increase in:
a. Chylomicrons
b. Low density lipoproteins (LDL)
c. Very low density lipoproteins (VLDL)
d. High density lipoproteins (HDL)
49.
Serum turbidity is due to:
a. Proteins
b. Glucose
c. Triglycerides
d. Cholesterol
50.
To produce reliable results, at which time should blood specimens for lipid
studies be drawn?
a. 2-4 hour fasting
b. 6-8 hour fasting
c. 8-10 hour fasting
d. 12-16 hour fasting
51.
Which of the following is the Friedewald formula by which LDL cholesterol can
be estimated?
a.
LDL cholesterol = Total cholesterol – (Triglycerides/5 + HDL cholesterol)
b.
LDL cholesterol = Total cholesterol – (Triglycerides + Phospholipids)
c.
LDL cholesterol = HDL – Total cholesterol
d.
LDL cholesterol = Total cholesterol – ½ HDL cholesterol
52.
Which of the following matches is incorrect?
a. LpX – Obstructive jaundice and LCAT
deficiency
b. Lp(a) – Sinking pre-beta lipoprotein
c. β-VLDL – Floating beta lipoprotein
d. IDL – Migrates in the alpha region
(electrophoresis)
53.
Which of the following lipoproteins is composed of 45-50% of cholesterol
esters?
a. HDL
b. VLDL
c. LDL
d. Chylomicrons
54.
This is the reference method for quantitation of lipoproteins
a. Chemical precipitation
b. Ultracentrifugation
c. Electrophoresis
d. Abell, Levy and Brodie method
55.
It is an autosomal recessive disorder characterized by defective apo B
synthesis and absence of VLDL, LDL and chylomicrons in the plasma
a. Tangier’s disease
b. Lipoprotein lipase deficiency
c. Lecithin Cholesterol Acyl Transferase
(LCAT) deficiency
d. Basses-Kornzweig syndrome
56.
Hyperalbuminemia is caused by:
a. Gastroenteropathy
b. Dehydration syndromes
c. Burns
d. Liver disease
57.
Which of the following conditions is associated with “beta-gamma bridging”?
a. Multiple myeloma
b. Malignancy
c. Liver cirrhosis
d. Rheumatoid arthritis
58.
During serum electrophoresis, which of the following proteins migrate in the
alpha-2 region?
1.
Alpha-feto protein 3. Haptoglobin 5. Transferrin
2.
Hemopexin 4. Ceruloplasmin 6. Complement
a. 1, 2, 5 and 6 c. 3 and 4
b. 1, 3, 4, and 6 d. 2 and 3
59.
Which of the following statements is true of albumin?
a.
Compared to globulin, it makes up the lesser portion of total protein
b.
Its size prevents its passage through even a damaged glomerular barrier
c.
It is produced in the liver
d.
Clinical problems are usually related to high serum values
60.
Which reagent is employed in the serum protein determination?
a. Molybdenum blue
b. Ferriferrocyanide
c. Resorcinol-HCl
d. Biuret
61.
The most sensitive marker of acute phase inflammation is probably:
a. C3 complement
b. C-reactive protein
c. ESR
d. Fever
62.
Falsely elevated ammonia levels on blood could be caused by:
1.
Not chilling blood & analyzing immediately 3.
Poor venipuncture technique
2.
Ammonia contamination from glassware 4.
Cigarette smoking
a. 1, 2 and 3 c.
1, 2 and 4
b. 2, 3 and 4 d.
1, 2, 3 and 4
63.
Pre-hepatic jaundice is caused by:
a. Hemolytic anemia
b. Cirrhosis
c. Bile duct obstruction
d. Hepatitis
64.
Kernicterus is caused by:
a. Deposits of ferric iron in brain tissue
b. Elevation of bilirubin in serum
c. Deposits of unconjugated bilirubin in
brain cells
d. Deposits of conjugated bilirubin in
brain cells
65.
This is characterized by an inability to transport bilirubin from the
sinusoidal membrane into the hepatocyte:
a. Dubin Johnson syndrome
b. Crigler-Najjar syndrome
c. Gilbert syndrome
d. Rotor syndrome
66.
As the red blood cells disintegrate, hemoglobin is released and converted to
the pigment bilirubin. Which organ is primarily responsible for this function?
a. Spleen
b. Kidneys
c. Intestines
d. Liver
67.
Possibly the most sensitive enzyme indicator of liver function, particularly in
obstructive jaundice is:
a. Alkaline phosphatase
b. Alanine aminotransferase
c. Acid phosphatase
d. Lactate dehydrogenase
68.
In acute viral hepatitis, which of the following would NOT be suspected?
a. Lactate dehydrogenase – 5x increase
b. Alkaline phosphatase - increase is
greater than aspartate aminotransferase
c. Gamma-glutamyl transferase – mild
increase
d. Aspartate aminotransferase and alanine
aminotransferase – 10- to 200-fold increase
69.
Which of the following markers will remain elevated for 48-72 hours after the
onset of myocardial infarction?
a. CK-MB
b. AST
c. LDH
d. Troponin I
70.
Which of the following enzymes are expected to be on peak activity 24 hours
after the onset of acute pancreatitis?
a. Amylase
b. Lipase
c. Both of these
d. None of these
71.
Which of the following match(es) is (are) correct?
1.
CK = Tanzer-Gilbarg and Oliver-Rosalki method
2.
LD = Wacker and Wrobleuski La Due method
3.
LPS = Cherry Crandal method
4.
AST & ALT = Karmen & Reitman-Frankel method
a. 1, 2 and 3
b. 2, 3 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4
72.
Which of the following match(es) is (are) incorrect?
1.
AMS = Saccharogenic method
2.
GGT = Ellman method
3.
CHS = Szass method
4.
5’NT = Dixon & Purdon and Campbell, Belfield & Goldberg method
a. 1 and 4
b. 1 and 3
c. 2 and 4
d. 2 and 3
73.
Hemolysis affects which of the following enzymes?
1.
CK-MB 3. LDH
2.
ACP 4. AMS
a. 1, 2 and 3
b. 1, 2 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4
74.
An International Unit (IU) of enzyme activity is the quantity of enzyme that:
a. Converts 1 micromole of substrate to
product per liter
b. Forms 1 mg of product per deciliter
c. Converts 1 micromole of substrate to
product per minute
d. Forms 1 millimole of product per liter
75.
Which isoenzyme of ALP is most heat stable?
a. Bone
b. Liver
c. Intestinal
d. Placental
76.
Which of the following conditions will increase total T4 by increasing TBG?
a. Pregnancy or estrogens
b. Acute illness
c. Nephrotic syndrome
d. Anabolic steroid use
77.
Select the most appropriate single screening test for thyroid disease
a. Free thyroxine index
b. TSH assay
c. Total T3 level assay
d. Total T4 level assay
78.
What is the predominant form of thyroid hormone in the circulation?
a. Thyroxine
b. Triiodothyronine
c. Diiodotyrosine
d. Monoiodotyrosine
79.
The presence of a very high titer for anti-thyroglobulin antibodies and the
detection of anti-thyroid peroxidase antibodies is highly suggestive of what
disorder?
a. Graves’ disease
b. Hashimoto’s thyroiditis
c. Pernicious anemia
d. Thyroid adenoma
80.
The Kober reaction is a test for:
a. Catecholamines
b. 17-Ketogenic steroids
c. Estrogens
d. 17-Hydroxycorticosteroids
81.
Human chorionic gonadotropin (hCG) is secreted by the:
a. Thymus gland
b. Placenta
c. Ovary
d. Ureter
82.
Which of the following is the most potent androgen?
a. Androstenedione
b. Dehydroepiandrosterone
c. Androsterone
d. Testosterone
83.
The chief urinary metabolite of norepinephrine and epinephrine is:
a. Metanephrine
b. Vanillylmandelic acid
c. Homovanillic acid
d. 5-HIAA
84.
A high urine catecholamine level would be expected in:
a. Argentaffinoma
b. Pheochromocytoma
c. Addison’s disease
d. Cushing’s disease
85.
Acromegaly is caused by:
a. Overproduction of growth hormone
b. Deficiency in growth hormone
c. Galactorrhea
d. Stimulation by GnRH
86.
For what colorimetric determination is the Trinder reaction widely used?
a. Acetaminophen
b. Salicylate
c. Barbiturate
d. Benzodiazepines
87.
Acetaminophen is particularly toxic to what organ?
a. Heart
b. Kidney
c. Spleen
d. Liver
88.
THC (Δ-tetrahydrocannabinol) is the principal active component of what drug?
a. Benzodiazepine
b. Cocaine
c. Marijuana
d. Morphine
89.
What is the major urinary metabolite of cocaine?
a. Morphine
b. Benzoylecgonine
c. NAPA
d. Primidone
90.
Which of the following metals has a characteristic “odor of garlic” and
“metallic taste”?
a. Cyanide
b. Arsenic
c. Lead
d. Mercury
91.
A blood alcohol level of 0.35-0.50 (% w/v) is associated with:
a. Unable to stand/walk, vomiting, and
impaired consciousness
b. Decreased inhibitions, loss of critical
judgment, memory impairment & decreased reaction time
c. Coma and possible death
d. Mild euphoria, decreased inhibitions,
and some impairment of motor skills
92.
The ratio of bicarbonate: carbonic acid in normal plasma is:
a. 1:20
b. 1:10
c. 20:1
d. 10:1
93.
What will happen if blood is exposed to air during collection for pH and blood
gas studies?
a. CO2 content increases
b. pH decreases
c. pO2 decreases
d. pCO2 decreases
94.
Emphysema, pneumonia and other pulmonary diseases are associated with which
acid-base disorders?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Metabolic acidosis
95.
For each degree of fever in a patient, pO2 values will decrease by
___ % and pCO2 values will increase by ___%
a. 7; 3
b. 3; 7
c. 3; 3
d. 7; 7
96.
Which biological samples should be regarded as potential hazards?
a. Urine specimens from AIDS patients
b. Stool specimens
c. All biological samples
d. Sputum specimens from TB patients
97.
Flammable liquids may be stored
a. In an ordinary refrigerator with a
flammable storage label affixed
b. In any refrigerator within the
laboratory department
c. In an explosion-proof refrigerator
d. Only in an explosion-proof refrigerator
in a remote area
98.
Food and drink may be stored in a refrigerator if:
a. Placed in a special sealed container
b. Marked as a consumable material
c. Food and drink may not be placed in a
laboratory refrigerator
d. Stored for short periods of time
99.
Laboratory supplies should NOT be stored
a. In cabinets and drawers
b. On the floor
c. On shelving
d. At floor level if placed upon a raised
platform
100.
This class of fire is usually allowed to burn out and nearby materials
protected
a. Type A (Ordinary Combustibles)
b. Type B (Flammable Liquids)
c. Type D (Flammable Metals)
d. Type E (Arsenal Fire)
ANSWER KEY: Clinical Chemistry
1.
A
2.
A
3.
C
4.
C
5.
D
6.
D
7.
D
8.
B
9.
C
10. A
11. B
12. C
13. D
14. D
15. B
16. A
17. D
18. D
19. B
20. C
21. C
22. A
23. B
24. C
25. D
26. D
27. B
28. A
29. C
30. C
31. D
32. A
33. B
34. A
35. C
36. A
37. D
38. C
39. D
40. A
41. B
42. D
43. B
44. C
45. D
46. C
47. A
48. A
49. C
50. D
51. A
52. D
53. C
54. B
55. D
56. B
57. C
58. C
59. C
60. D
61. B
62. D
63. A
64. C
65. C
66. A
67. A
68. B
69. A
70. C
71. D
72. D
73. A
74. C
75. D
76. A
77. B
78. A
79. B
80. C
81. B
82. D
83. B
84. B
85. A
86. B
87. D
88. C
89. B
90. B
91. C
92. C
93. D
94. C
95. A
96. C
97. C
98. C
99. B
100.
D
