Chemistry - Proteins and Enzymes
38. Which of the following enzymes is associated with conditions affecting skeletal muscles? A. Aldolase B. Alkaline phosphatase (ALP) C. Gamma-glutamyltransferase D. 5'-nucleotidase
A
46. When measuring enzyme activity, if the instrument is operating 5ºC lower than the temperature prescribed for the method, how will the results be affected? A. Lower than actual B. Higher than actual C. Varied, showing no particular pattern D. No effect
A
55. Which of the following tumor markers is widely used for the detection of colorectal cancers? A. CEA B. PSA C. Alpha-fetoprotein D. Beta hCG
A
79. An increased serum level of which of the following analytes is MOST commonly associated with decreased glomerular filtration? A. Creatinine B. Uric acid C. Urea D. Ammonia
A
80. Which analyte should be increased in the presence of gout? A. Uric acid B. Aldolase C. Amylase D. Troponin
A
37. What function in the body does GGT have? A. Transfer of gamma-glutamyl peptides amino acids, water, and other peptides B. Transfer of amino acid residues to other compounds C. Transfer of gamma-glutamyl peptides to cholesterols D. Transfer of water from amino acids to gamma-glutamyl
A
72. Why might serum ferritin (SF) alone be considered a less than optimal screening test for hereditary hemochromatosis (HH)? A. It is an acute phase reactant that is frequently elevated in a variety of clinical conditions. B. It does not assess an individual's iron status. C. It is an expensive test to perform. D. It is only performed in laboratories doing molecular assays.
A
88. All of the following hormones stimulate gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids, EXCEPT? A. Insulin B. Thyroxine (T4) C. Cortisol D. Glucagon
A
99. Which one of the following serum constituents is increased following strenuous exercise? A. Creatinine B. Total lipids C. Sodium D. Iron
A
63. A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1 mg/L) may indicate which of the following? A. Low risk for cardiovascular disease (CVD) B. High risk for future CVD C. Acute inflammatory condition D. No risk for future CVD
B
66. After complaining to her physician about persistent pelvic pain and abdominal pressure, Mrs. Smith, had laboratory testing ordered. Since her physician would like to rule-out ovarian cancer, which of the following assays would be most helpful? A. CEA B. CA125 C. CA19-9 D. PSA
B
67. Which of the following tumor markers is associated with the colon? A. PSA B. CEA C. Beta hCG D. AFP
B
75. Which of the following tests would be useful in the assessment of glomerular filtration: A. 24 hour urine protein B. Creatinine clearance C. PSP test D. Urea clearance
B
81. Which of the following sets of results is indicative of stage 3 iron deficiency (iron deficiency anemia)? A. Decreased ferritin, normal soluble transferrin receptor (sTfR), slightly increased total iron-binding capacity (TIBC) B. Decreased ferritin, increased sTfR, increased TIBC C. Decreased ferritin, increased sTfR, decreased TIBC D. Increased ferritin, normal sTfR, increased TIBC
B
96. Which of the following is found in plasma but absent in serum? A. Proteins B. Fibrinogen C. Electrolytes D. Gamma globulin
B
97. Given the following laboratory results, what is the most likely diagnosis? HBsAg: Negative Anti-HBc: Negative Anti-HBs: Negative A. Acute Hepatitis B infection B. Susceptible to Hepatitis B infection C. Immune to Hep B due to past infection D. Immune to Hep B due to vaccination
B
74. Which condition is caused by the increased Plasminogen Activator Inhibitor 1 (PAI-1) and fibrinogen often present in metabolic syndrome? A. Hyperglycemia B. Proinflammatory state C. Prothrombotic state D. Atherogenic dyslipidemia
C
76. Creatinine excretion correlates best with which of the following parameters: A. Age B. Sex C. Muscle mass D. Body weight
C
40. The LD (lactate dehydrogenase) molecule is made of a combination of polypeptides that can be separated into isoenzymes that help determine the location of an elevated LD. LD 3 is found primarily in the lung, lymphocytes, spleen, and pancreas but what polypeptides make up LD 3? A. HMMM B. MMMM C. HHMM D. HHHM
C
43. What is the function of LD in the body? A. Interconversion of lactate to glucose B. Non-reversible conversion of pyruvate to lactate C. Interconversion of lactate and pyruvate D. Conversion of glucose to lactate
C
54. Troponin I is used frequently to assess acute myocardial infarctions (AMI). If a patient has experienced an AMI, at what point (approximately) will the troponin I begin to increase and how long will it stay increased? A. 12-24 hours, 5-10 days B. 6-10 hours, 1-2 days C. 3-12 hours, 7-14 days D. 3-6 hours, 1-2 days
C
56. Tumor markers are especially valuable when used to: A. Rule out cancer B. Screen the general population for cancer C. Monitor response to cancer therapy D. Confirm other assays
C
58. Which of the following tumor markers is associated with testicular cancer? A. PSA B. CEA C. Beta hCG D. CA-125
C
121. Ammonia is BEST characterized as being: A. A waste product of amino acid and protein metabolism B. Obtained from hydrolysis of urea in the kidney C. Obtained from ingested carbohydrates D. An odor common to urine
A
122. A physician calls the lab wanting to order a Hepatitis A IgG test but cannot find the code. What do you tell the physician? A. There are no IgG-only tests for Hepatitis A, only a total with/without reflex to IgM B. Which IgG test are you looking for: surface antigen, envelope, or core IgG? C. It depends on where the patient is coming back from with travel history. D. We only have tests for antigens not antibodies for IgG
A
128. Acute phase proteins generally fall into which category? A. Glycoproteins B. Immunoglobulins C. Lipoproteins D. Microglobulins
A
130. A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min. A. 100 B. 144 C. 56 D. 225
A
133. Which of the following analytes would be increased due to delay in centrifugation? A. Creatinine B. Ionized Calcium C. Folate D. Bicarbonate
A
134. Given the following information, calculate the results in mg/24 hrs for a 24 hour urine protein.Total volume for 24 hours = 2400 mL Urine protein = 2.7 mg/dL A. 64.8 mg/24 hrs B. 10.87 mg/24 hrs C. 57.5 mg/24 hrs D. 5.89 mg/24 hrs
A
137. Proteins in a buffer that sets the pH at 8.6 will become ___________ charged and migrate to the ____________. A. Negatively; Anode B. Negatively; Cathode C. Positively; Anode D. Positively; Cathode
A
35. A hepatic function panel A consists of which of the following tests? A. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin B. Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium C. Cholesterol, Lipoprotein, HDL, Triglycerides D. Potassium, Sodium, Chloride, CO2
A
65. Which one of the following analytes usually shows a decrease during an acute phase response? A. Transferrin B. Ceruloplasmin C. Alpha-1 Antitrypsin D. Fibrinogen
A
123. Select the primary reagent components used in the Jaffe reaction for creatinine. A. Alkaline copper (II) sulfate B. Saturated picric acid and sodium hydroxide C. Sodium nitroprusside and phenol D. Phosphotungstic acid
B
125. Where are most acute phase proteins synthesized? A. Bone Marrow B. Hepatocytes C. Intestines D. Spleen
B
132. Which of the following are markers currently used to differentiate heart failure from lung disease? A. TnI and TnT B. BNP and NT-proBNP C. Myoglobin and LD D. hs-CRP and homocysteine
B
139. Which dye-binding method uses an increase of absorbance at 595 nm to determine the total protein concentration of the specimen? A. Bromophenol blue B. Coomassie brilliant blue 250 C. Amido black 10B D. Ponceau S
B
141. A 56-year-old woman with a history of high blood pressure and cardiovascular disease is evaluated by her physician due to her recent loss of appetite. The doctor reviews the following test results: Plasma creatinine = 2.4 mg/dL Urine creatinine = 65 mg/dL Urine volume (24 hrs) = 1400 mL What is the estimated glomerular filtration rate for this patient? A. 65 mL/min B. 26.32 mL/min C. 51.69 mL/min D. 37,916 mL/min
B
142.The property MOST responsible for the migration of proteins in an electrical field is: A. Molecular weight B. Net surface charge C. Endosmotic flow D. Voltage
B
146. The migration rate of proteins on cellulose acetate is primarily the result of: A. Molecular content of the protein B. Ionic charge on the proteins C. Concentration of the proteins D. Type of proteins
B
32. An important metallic activator of alkaline phosphatase and creatine kinase is: A. Iron B. Zinc C. Potassium D. Magnesium
D
158. What is the purpose of the BUN test? A. Rules out acute heart failure in the emergency setting. B. Determines the amount of urea in blood. C. Evaluates abnormalities in the extrinsic coagulation pathway and monitors coumarin therapy. D. Evaluates abnormalities in the intrinsic coagulation pathway and monitors heparin therapy.
B
159. What is the purpose of the BUN test? A. Rules out acute heart failure in the emergency setting. B. Determines the amount of urea in blood. C. Evaluates abnormalities in the extrinsic coagulation pathway and monitors coumarin therapy. D. Evaluates abnormalities in the intrinsic coagulation pathway and monitors heparin therapy.
B
4. Which clinical situation below is GGT elevation most often associated with? A. Bone Disease B. Alcohol Consumption C. Pancreatic Disease D. Nephrotic Syndrome
B
61. Which of the following blood tests is used to evaluate kidney function? A. Alkaline phosphatase (ALP) B. Creatinine C. Amylase D. Uric acid
B
26. What role does lipase play in the body? A. Transferring animo acid groups between compounds B. Catalyzing the breakdown of glucose to pyruvate C. Hydrolyzes fat esters to produce water D. Hydrolyzes fat esters to produce alcohol and fatty acids
D
33. What are the two polypeptide chains that comprise the LD molecule? A. M and B B. M and B C. H and B D. M and H
D
36. Elevation of serum creatine kinase may be associated with: A. Cerebrovascular accident (stroke) or vigorous exercise B. Vigorous exercise or Duschenne muscular dystrophy C. Duschenne muscular dystrophy or cerebrovascular accident (stroke) D. Duschenne muscular dystrophy or cerebrovascular accident (stroke) or vigorous exercise.
D
41. All of the following statements concerning CK-MB (CK-2) are true EXCEPT: A. Greater than 5% or 10 IU/L followed by an LDH-1: LDH-2 flip is specific evidence of myocardial infarction (MD). B. CK-MB levels can be normal with an elevated total CK. C. CK-MB and troponin levels can be elevated after an AMI. D. CK-MB levels are normal in cardiac ischemia.
D
45. That portion of an enzyme which when separated from its cofactor is called a(n): A. Holoenzyme B. Isoenzyme C. Coenzyme D. Apoenzyme
D
5. Serum alkaline phosphatase (ALP) activity is derived from all of the following organs EXCEPT: A. Bone B. Intestine C. Placenta D. Brain
D
136. What causes polyacrylamide gels to have greater resolution of proteins than agarose gels? A. Polysaccharide composition B. Electroendosmosis C. Transparency D. Varying pore size in each polyacrylamide layer
D
143. Which of the following tests confirms the presence of Bence-Jones proteinuria: A. Protein electrophoresis B. Sulfosalicylic acid precipitation C. Cryoprecipitation D. Immunoelectrophoresis
D
149.Which of the following GFR (glomerular filtration rate) values is considered to be in renal failure? A. 120 mL/min B. 95 mL/min C. 35 mL/min D. 14 mL/min
D
94. Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine: A. Urine protein electrophoresis or immunoelectrophoresis B. Benedict qualitative test C. Ictotest D. Watson-Schwartz test
A
95. Which one of the following usually shows a decrease during an acute phase response? A. Albumin B. Alpha-1 Antitrypsin C. Fibrinogen D. Ceruloplasmin
A
98. Which of the following is currently considered to be a good test for screening persons for hereditary hemochromatosis (HH) due to its sensitivity and specificity for iron overload? A. Transferrin saturation B. Liver biopsy C. Phlebotomy D. Serum iron alone
A
18. Which one of the following cardiac biomarkers could detect a recent reinfarction? A. Troponin I (TnI) B. Troponin T (TnT) C. Lactate dehydrogenase (LD) D. Creatine kinase MB (CK-MB)
D
51. A markedly elevated 5-hydroxyindole acetic acid (5-HIAA) determination is presumptive evidence for: A. Lead poisoning B. Pheochromocytoma C. Porphyria D. Carcinoid tumor
D
14. Lipase is predominately produced in what organ/tissue? A. Lungs B. Skeletal muscle C. Pancreas D. Liver
C
44. The De Ritis ratio is the calculation of AST/ALT and is used for evaluating liver disease. What should the ratio be when ethanol-related liver disease is expected? A. <1.0 B. 1.0 -2.0 C. >2.0 D. The De Ritis ratio is not used for liver disease
C
89. What is the largest constituent of plasma nonprotein nitrogen: A. Ammonia B. Creatinine C. Ketones D. Urea
D
22. The Emergency Department has collected blood test tubes for potassium, albumin, plasma hemoglobin, and acid phosphatase. Which of these test results will NOT be negatively affected if the blood tube is sent by the hospital's pneumatic tube system? A. Albumin B. Plasma hemoglobin C. Potassium D. Acid phosphatase
A
27. Isoenzymes of alkaline phosphatase occur in: A. Kidney, bone, intestines, liver B. Bone, brain, liver, pancreas C. Liver, brain, spleen, intestines D. Brain, kidney, intestines, bone
A
62. A male patient's urea nitrogen value is 15 mg/dL and his creatinine is 5 mg/dL. If this patient is not undergoing dialysis, what conclusion would you draw from these results? A. Patient's laboratory results are normal B. Patient is in early stage of renal disease C. One of the values is in error D. Patient has suffered muscle deterioration
C
92. Which purine base is found in RNA and not in DNA? A. Thymine B. Guanine C. Uracil D. Cytosine
C
50. Which of the following tumor markers is associated with the prostate? A. CEA B. PSA C. Alpha-fetoprotein D. Beta HCG
B
60. What transferrin saturation level would be indicative to investigate further for hereditary hemochromatosis (HH)? A. 40% B. 45% C. 35% D. 25%
B
53. C-reactive protein (CRP) is often used as a marker of inflammation. However, it has a low _________. A. Sensitivity B. Specificity C. Accuracy D. Precision
B
47. According to the Michaelis-Menton kinetics theory, when a reaction is performed in zero-order kinetics: A. The substrate concentration is very low and the reaction rate is dependent on the substrate concentration B. The substrate concentration is in excess and the reaction rate is dependent on the enzyme concentration C. The enzyme concentration is in excess and the reaction rate is dependent on the substrate concentration D. The substrate concentration is equal to Km and the reaction rate is dependent on the enzyme concentration
B
48. The recommended storage temperature for the preservation of activity for MOST enzymes is: A. 0ºC B. 4ºC C. 25ºC D. 37ºC
B
49. Which type of kinetic reactions are reactions in which the enzyme is in excess and the substrate concentration is the limiting factor? A. Zero order B. First order C. Second order D. Third order
B
100. Which protein is also known a prealbumin because it migrates before albumin in the customary electrophoresis of serum or plasma proteins? A. Transferrin B. Transthyretin C. Retinol-binding protein D. Fibronectin
B
11. The properties of enzymes are CORRECTLY described by which of the following statements? A. Enzyme activity is not altered by heat denaturation B. Enzymes are protein catalysts of biological origin C. Enzymes are stable proteins and unaffected by pH changes D. Enzymes affect the rate of a chemical reaction by raising the activation energy needed
B
17. Which of the following analytes would be increased due to delay in centrifugation? A. Bicarbonate B. AST C. Glucose D. Ionized Calcium
B
19. An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of: A. A normal LD isoenzyme pattern B. Myocardial infarction C. Pancreatitis D. Diabetes mellitus
B
2. Which of the following blood tests is used in the evaluation of hepatic disease? A. Amylase B. Alanine aminotransferase (ALT or SGPT) C. Creatinine D. Alkaline phosphatase (ALP)
B
20. High levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) are associated with: A. Decreased cardiovascular risk B. Increased cardiovascular risk C. Increased renal failure risk D. Increased liver failure risk
B
23. GGT (gamma glutamyltransferase) is an enzyme found in many body tissues including kidney, prostate, brain, pancreas and liver, however, its clinical applications is confined to evaluation of what system? A. Pancreas B. Liver C. Kidney D. Brain
B
25. Which of the following blood tests is used to evaluate liver function? A. Amylase B. Alkaline phosphatase (ALP) C. Creatinine D. Uric acid
B
3. What accelerates the rate of lipase activity in the body? A. Presence of water B. Presence of bile salt C. Absence of bile salt D. Presence of alcohol
B
31. What coenzyme does LD use when converting lactate to pyruvate? A. FAD+ B. NAD+ C. NADH D. FADH2
B
34. An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of: A. A normal LD isoenzyme pattern B. Hemolysis C. Pancreatitis D. Hepatic injury
B
39. Which of the statements below regarding the diagnosis of pancreatitis is CORRECT? A. Amylase and lipase are as predictive in chronic as in acute pancreatitis. B. Diagnostic sensitivity for acute pancreatitis is increased by assaying both amylase and lipase. C. Chronic pancreatitis occurs more often in women. D. Increased amylase levels stay increased after the cause of the pancreatitis is removed.
B
10. The normal De Ritis ratio (AST/ALT) should be: A. Equal or < 1 B. 2:1 C. 3:1 D. 4:1
A
129. Which one of the following is the MOST specific biochemical marker of myocardial infarction? A. CK B. LD C. Troponin D. Myoglobin
C
110. Which of the following is the EARLIEST biochemical marker of myocardial infarction? A. CK B. LD C. Troponin D. Myoglobin
D
126. All of the following are currently used to diagnose acute coronary syndrome and/or acute myocardial infarction, EXCEPT? A. CK-MB B. TnI C. TnT D. BNP
D
154. Which of the following is the principle for the biuret method for total protein analysis? A. Digestion of protein; measurement of nitrogen content B. Formation of violet-colored chelate between Cu2+ ions and peptide bonds C. Globulins are precipitated in high salt concentrations D. Proteins separated based on electric charge
B
101. A characteristic of a good cardiac biomarker is that: A. It can be detected only if it is present in a HIGH concentration in the peripheral blood. B. It can be detected even if it is present in a LOW concentration in the peripheral blood. C. It can be detected only if it is present in a HIGH concentration in urine. D. It can be detected even if it is present in a LOW concentration in urine.
B
107. Which cardiac biomarker is a regulator of myocyte contraction? A. Myoglobin B. cTnT C. CK-MB D. CK-MB isoforms
B
114. The tumor marker associated with ovarian cancer is: A. CA15-3/CA27.29 B. CA-125 C. PSA D. CEA
B
117. All of the following statements are characteristic of the role of C-reactive protein (CRP) except? A. Activates complement. B. Binds with factor H to initiate alternate complement pathway. C. Exhibits pro-inflammatory characteristics. D. Initiates opsonization.
B
118. A 56-year-old woman with a history of high blood pressure and cardiovascular disease is evaluated by her physician due to her recent loss of appetite. The doctor reviews the following test results: Plasma creatinine = 2.4 mg/dL Urine creatinine = 65 mg/dL Urine volume (24 hrs) = 1400 mL What is the estimated glomerular filtration rate for this patient? A. 65 mL/min B. 26.32 mL/min C. 51.69 mL/min D. 37,916 mL/min
B
131. Which of the following parts of the body synthesizes and secretes BNP? A. Kidney B. Liver C. Heart D. Adrenal gland
C
13. Increases in the MB fraction of CK is associated with: A. Liver disease B. Bone disease C. Kidney failure D. Myocardial infarction
D
112. Plasma creatinine concentration is dependent on all of the following EXCEPT: A. Relative muscle mass B. Renal function C. Rate of creatinine turnover D. Sodium concentration
D
77. What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)? A. The serum ferritin decreases to between 20 and 50 ng/mL B. The hepatic iron index returns to normal C. The transferrin saturation drops below 20% D. The serum iron falls to below 35 µg/dL.
A
86. Which of the following is true of C-reactive protein (CRP) when being used to assess the risk of cardiovascular disease? A. CRP levels are high in cardiovascular disease. B. CRP levels are not affected by cardiovascular disease. C. CRP levels are low in cardiovascular disease. D. CRP has little clinical utility for assessing cardiovascular disease.
A
102. Which of the following statements is FALSE regarding troponin as a marker of myocardial infarction (MI)? A. It rises much sooner after a myocardial infarction than CK-MB B. It stays elevated much longer than CK-MB C. It is potentially more specific as a cardiac marker than CK-MB D. Troponin T is often elevated in renal failure patients
A
106. All of the following specimen processing examples are considered processing errors that can have a negative impact on the test results, EXCEPT? A. Transporting an ammonia specimen to the laboratory in an ice slurry. B. Centrifuging a plasma specimen 4 hours after collection. C. Rimming the clot in a serum collection tube prior to centrifugation. D. A blood specimen that is frozen and thawed a few times before testing.
A
109. Which of the following tests should be collected in serum gel tube and goes to the chemistry department? A. BUN B. Zinc C. White blood cell (WBC) count D. Reticulocyte count
A
12. Following a myocardial infarction which of the following enzymes will be the first to become elevated: A. CK B. LDH C. GGT D. ALT
A
120. All of the following conditions would be associated with an increased level of alpha-fetoprotein, EXCEPT? A. Prostate Cancer B. Hepatocellular Carcinoma C. Viral Hepatitis D. Testicular Tumors
A
15. A reaction is in ____________ kinetics when the reaction rate depends only on enzyme concentration. A. Zero order B. First order C. Second order D. Mixed order
A
150. Which of the following proteins has the FASTEST electrophoretic mobility? A. Albumin B. Alpha globulins C. Beta globulins D. Gamma globulins
A
157. Which of the following contributes to specific gravity but does NOT contribute to osmolality? A. Protein B. NaCl C. Urea D. Glucose
A
152. Select the primary reagent components used in the Jaffe reaction for creatinine. A. Alkaline copper (II) sulfate B. Saturated picric acid and sodium hydroxide C. Sodium nitroprusside and phenol D. Phosphotungstic acid
B
42. The results which would be MOST consistent with macro-amylasemia are? A. Normal serum amylase and elevated urine amylase values B. Increased serum amylase and normal to low urine amylase values C. Increased serum and increased urine amylase values D. Normal serum and normal urine amylase values
B
59. When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: A. Decreased urine copper B. Increased urine copper C. Normal urine copper D. Increased serum copper
B
103. What additional fraction would be seen if plasma rather than serum was subjected to electrophoresis: A. Alpha-1 antitrypsin B. Alpha-2 macroglobulin C. Fibrinogen D. Gamma globulins
C
104. Uric acid is the final breakdown product of what two purines? A. Adenine and thymine B. Thymine and cytosine C. Adenine and guanine D. Guanine and thymine
C
115. Which of the following cardiac biomarkers rises within 1 - 3 hours after chest pain, peaks in 2 - 6 hours, and is usually normal within 24 hours. A. TnT B. CK-MB C. Myoglobin D. TnI
C
138. The pI of a protein is 9.2. This protein is placed in an electrical field where a buffer sets the pH at 10.0. Select the correct statement regarding the electrophoretic migration of this protein. A. This protein will have a net positive charge and will migrate to the anode, the positively charged electrode B. This protein will have a net positive charge and will migrated toward the cathode, the negatively charged electrode C. This protein will have a net negative charge and will migrate toward the anode, the positively charged electrode D. This protein will have a net negative charge and will migrate to the cathode, the negatively charged electrode
C
140. Using the formula for creatinine clearance, calculate the clearance based on the values given below: Urine creatinine: 100 mg/dL Plasma creatinine: 1.9 mg/dL Urine volume: 1375 mL/24hrs Surface Area: 1.2 m2 Round to 1 decimal place. A. 1.04 x 105 mL/min/m^2 B. 1.04 x 105 mL/min C. 72 mL/min/m^2 D. 72 mL/min
C
144. All of the following are quantitative methods for the determination of albumin EXCEPT? A. Serum protein electrophoresis B. Nephelometry C. Sulfosalicyclic acid precipitation D. Colorimetric spectrophotometry
C
145. Which substance is used in the Jendrassik-Grof method to accelerate the reaction of unconjugated bilirubin with the diazo reagent? A. NADH B. N-butanol C. Caffeine-benzoate D. Acetic acid
C
147. The biuret reaction for the analysis of serum protein depends on the number of: A. Free amino groups B. Free carboxyl groups C. Peptide bonds D. Protein molecules
C
151. There are several different types of media that can be used in electrophoresis. Most methods today use a gel - cellulose acetate, agarose, or polyacrylamide gel. Which one of the following statements is true regarding these gels? A. The compounds used to make cellulose acetate gels are carcinogenic B. Polyacrylamide gels are composed of polysaccahrides and acrylamides C. Polyacrylamide gels have the greatest resolution or separation of solutes D. Cellulose acetate and agarose gels are the more commonly used gels
C
84. All of the following conditions are associated with a polyclonal (broadbased) increase in gamma globulins except? A. Liver disease B. Chronic inflammation C. Immune reaction D. Immunodeficiency
D
85. All of the following are currently used to diagnose acute coronary syndrome and/or acute myocardial infarction, EXCEPT? A. CK-MB B. TnI C. TnT D. BNP
D
153. All of the following have an impact on electrophoresis techniques in the clinical laboratory EXCEPT? A. Amount of light present in electrophoresis box B. Support medium C. pH D. Voltage
A
16. All of the statements below regarding amylase and lipase in pancreatitis are TRUE EXCEPT: A. Amylase and lipase are as predictive in chronic as in acute pancreatitis. B. Diagnosis sensitivity is increased by assaying both amylase and lipase. C. Urinary amylase: creatinine ratio is the most sensitive test for acute pancreatitis. D. Serum lipase peaks at 24 hours after an episode of acute pancreatitis and remains high for 7-8 days.
A
160. In an standard electrophoretic separation, what zone appears first (anodal end) on the densitometric pattern? A. Albumin B. a1-globulins C. a2-globulins D. ß-globulins
A
148. Which statement is correct for a protein with an isoelectric point (pI) of 7.0? A. At pH < 7.0, this protein will migrate to the anode. B. At pH < 7.0, this protein will be positively charged. C. At pH < 7.0, this protein will be negatively charged. D. At pH > 7.0, this protein will migrate to the cathode.
B
1. After experiencing extreme jaundice, abdominal pain, and vomiting from extensive hepatocelluar damage, a patient's hepatic function panel is analyzed in the laboratory. The result of the ALT is too high for the instrument to read. Since the instrument does not perform automatic dilutions for ALT, the laboratorian performs a dilution using 100 microliters of patient sample to 400 microliters of diluent. The result now reads 369 U/L. How should the laboratorian report this patient's ALT result? A. 369 U/L B. 1476 U/L C. 1845 U/L D. 738 U/L
C
113. What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs? A. 9.5 mL/min B. 13.6 mL/min C. 95 mL/min D. 136 mL/min
C
127. Which troponin protein binds the troponin complex to tropomyosin? A. Troponin I (TnI) B. Troponin C (TnC) C. Troponin T (TnT) D. Troponin P (TnP)
C
108. Which amino acid is the precursor for catecholamines as well as thyroid hormones? A. Glycine B. Proline C. Tryptophan D. Tyrosine
D
111. In a normal CSF the protein concentration as compared to that in the plasma is generally: A. Less than 50% B. Less than 30% C. Less than 10% D. Less than 1%
D
116. While serum elevations are NOT generally seen in early stages, which of the following tumor markers are elevated in more advanced stages of breast cancer? A. CEA and AFP B. AFP and CA 125 C. PSA and CA 15-3 D. CA 15-3 and CA 549
D
155. In serum protein electrophoresis all of the following proteins reside in the band closest to the anodal end EXCEPT: A. Retinol-binding protein (RBP) B. Transthyretin C. Albumin D. Haptoglobin
D
156. TIBC (total iron-binding capacity) is an indirect measurement of which of the following: A. Ferritin B. Hemoglobin C. Ceruloplasmin D. Transferrin
D
161. When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: A. Decreased urine copper B. Increased serum copper C. Normal urine copper D. Decreased serum copper
D
52. Which one of the following is considered to be the most specific marker for adverse ventricular remodeling or volume overload of the heart? A. CKMB B. Troponin C. Myoglobin D. BNP
D
57. Which of the following is NOT required for a diagnosis of hereditary hemochromatosis (HH)? A. >50% transferrin saturation in females or >60% saturation in males B. Presence of HFE mutations or other genetic mutations associated with iron metabolism C. Increased ferritin D. Biopsy of liver and/or bone marrow
D
How many distinct bands are separated during a standard serum protein electrophoresis? A. 4 B. 5 C. 6 D. 7
B
105. A patient who previously had an hs-CRP of 4 mg/L was put on statin and daily aspirin medication. She returns to the laboratory a month later, and her repeat hs-CRP is 2.3 mg/L. Which of the following is the most likely reason for the decrease in the test value? A. The patient probably had an infection at the time of the first visit that confounded the initial result. B. The laboratory test was probably performed incorrectly the first time. C. The medications lowered the hs-CRP value. D. hs-CRP values fluctuate throughout the day with higher values early in the morning and lower values in the evening.
C
119. Which assay is recommended by the American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC) as the inflammatory marker of choice in the evaluation of cardiac heart disease risk? A. CRP B. BNP C. hs-CRP D. NT-proBNP
C
124. Which one of the following statements about urea is false? A. It accounts for 75% of nonprotein nitrogen excreted B. It is elevated in a variety of glomerular, tubular, interstitial, and vascular renal diseases C. It is decreased in dehydration D. The reference range for normal individuals is 7 to 18 mg/dL when expressed as blood urea nitrogen
C
24. All of the following laboratory tests are used to determine kidney function, EXCEPT? A. Creatinine B. Blood urea nitrogen (BUN) C. Amylase D. Phosphorus
C
21. Which of the following blood tests is used in the determination of prostate cancer? A. Acid phosphatase B. Alkaline phosphatase (ALP) C. Alanine aminotransferase (ALT or SGPT) D. Creatinine
A
71. Increased concentration of alpha-fetoprotein (AFP) in adults are most characteristically associated with: A. Hepatocellular carcinoma B. Alcoholic cirrhosis C. Megaloblastic anemia D. Multiple myeloma
A
70. What is the role of albuminuria testing? A. Monitor diabetic patient carbohydrate management. B. Detect serum albumin levels in early renal disease. C. Detect small urinary concentrations of albumin before there is irreparable renal damage. D. Diagnose renal failure in a type 1 diabetic patient.
C
64. Increases in blood ammonia levels would be expected in which of the following conditions: A. Diabetes B. Obstructive jaundice C. End stage cirrhosis D. Myocardial infarction
C
68. Which of the following tests would be employed in order to detect neural tube defects? A. Bilirubin B. L/S ratio C. Alpha fetoprotein D. Creatinine
C
28. Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that she has had an acute myocardial infarction (AMI), but did not feel the severe chest pain because of diabetic neuropathy. She has not felt well since November 20th and her physician believes she possibly had an AMI on November 20th.Assuming that the infarct was uncomplicated, which of the following cardiac biomarkers would most likely still be elevated and would assist in an AMI diagnosis? A. Myoglobin B. Creatine kinase MB (CK-MB) C. Troponin T D. All of the above
C
29.A patient presents with an elevation of unconjugated bilirubin, normal serum alkaline phosphatase, normal liver enzymes, and no bilirubin in the urine. This combination would suggest: A. Viral infection of the liver. B. Chemical damage to the liver. C. Increased rate of hemolysis. D. Obstruction of common bile duct.
C
30. Which of the following blood tests is used to determine acute pancreatitis? A. Acid phosphatase B. Uric acid C. Amylase D. Alkaline phosphatase (ALP)
C
6. Which of the following conditions would be suggested by a jaundiced patient experiencing a marked rise in alkaline phosphatase (ALP), conjugated bilirubin, and a slight rise in alanine aminotransferase (ALT)? A. Cardiovascular disease B. Hepatitis C. Post-hepatic cholestasis D. Renal failure
C
73. A 45-year-old African American female has been diagnosed and treated for type 2 diabetes for the past five years. She maintains good control of her blood glucose with medication but does not exercise and has gained 12 pounds over the past year. At her next appointment, her physician orders hs-CRP along with blood assays to monitor her diabetes. Laboratory Result: hs-CRP 2.8 mg/L A. At no risk for cardiovascular disease B. Low risk for cardiovascular disease C. Moderate risk for cardiovascular disease D. High risk for cardiovascular disease
C
78. Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak? A. Lymphoproliferative disorder B. Viral meningitis C. Multiple sclerosis D. Traumatic lumbar puncture
C
8. Which one of the following is a TRUE statement concerning alkaline phosphatase? A. It is optimally active at pH 5 B. It is decreased in bone disorders involving the osteoblasts C. It is increased in obstructive jaundice D. It is increased in myocardial infarctions
C
82. Which risk marker has both positive and negative cardiovascular risk integrated into its measurement? A. LpPLA2 B. Oxidized LDL C. Apo B-100/Apo A-1 D. hs-CRP
C
87. Which of the following is a biomarker in acute coronary syndrome? A. Smoking B. Obesity C. High sensitivity-C-reactive protein (hsCRP) D. Hypertension
C
9. Isoenzymes of CK include all of the following EXCEPT: A. MB B. MM C. MBM D. BB
C
90. Which of the following viral families contains DNA as its nucleic acid? A. Paramyxoviridae B. Rhabdoviridae C. Poxviridae D. Orthomyxoviridae
C
91. Select the statement that best describes high sensitivity CRP (hs-CRP) testing? A. hs-CRP is a measurement of acute inflammation and is used to monitor these type of conditions B. hs-CRP is an anti-inflammatory adipokine synthesized by adipocytes C. hs-CRP is a marker of chronic inflammation and measured to predict the risk of cardiovascular disease D. hs-CRP is decreased in inflammatory conditions and measured to predict a return of inflammation
C
93. Which one of the following is not an acute phase protein? A. Alpha-1 Antitrypsin B. C-Reactive Protein C. Protein S D. Fibrinogen
C
69. Which of the following tumor markers is associated with the liver? A. PSA B. CEA C. Beta hCG D. AFP
D
7. Which of the following statements is true regarding CYP450 enzymes? A. They are the only hepatic enzymes involved in drug metabolism. B. They are few in number but very important in metabolism. C. They are very specific in the substrates they accept. D. They are able to make compounds more water-soluble and therefore enhance excretion. Feedback
D
83. Which of these blood levels will decrease during intravascular hemolysis? A. Serum (plasma) LDH B. Serum (plasma) bilirubin C. Reticulocytes D. Haptoglobin
D
