Clin Chem mult. choice ques.
Acute renal failure can be classified into three types. List each type and give an example of each.
1. Prerenal failure: disorders causing decreased blood flow to the kidneys, including congestive heart failure, hemorrhage, and shock 2. Primary renal failure: diseases affecting the kidneys, including glomerulonephritis, tubular necrosis, and inflammation 3. Postrenal failure: caused by obstruction or inflammation of the urinary tract after it leaves the kidney
Calculate creatinine clearance, given the following information: serum creatinine, 1.2 mg/dL; urine creatinine, 120 mg/dL; urine volume, 1,750 mL/24 h; body surface area, 1.80 m2
114 mL/min
The most frequent cause of hypermagnesemia is due to a. Renal failure b. Increased intake o fmagnesium c. Hypoaldosteronism d. Acidosis
a
The proximal tubule functions to a. Reabsorb 75% of salt and water b. Concentrate salts c. Form the renal threshold d. Reabsorb urea
a
Predict GFR in a 50 year old woman who weighs 60 kg using the Cockcroft-Gault equation. Her serum creatinine level is 2.5 mg/dL.
26 mL/min
The reagent p-dimethylaminobenzaldehyde is used to measure which of the following? a. Urobilinogen b. Total bilirubin c. Ammonia d. Alkaline phosphatase
a
The sample of choice for measuring blood osmolality is: a. Serum b. Plasma c. Whole blood d. Serum or plasma may both be used
a
True or False? RBCs are key for oxygen transport, carbon dioxide transport, and maintaining electro-neutrality in the blood.
True
The set of results tha tmost accurately reflects severe renal disease is a. Serum creatinine, 3.7 mg/dL; creatinine clearance, 44 mL/min; BUN, 88 mg/dL b. Serum creatinine, 1.0 mg/dL; creatinine clearance, 110 mL/min; BUN, 17 mg/dL c. Serum creatinine, 2.0 mg/dL; creatinine clearance 120 mL/min; BUN, 14 mg/dL d. serum creatinine, 1.0 mg/dL; creatinine clearance, 95 mL/min; BUN, 43 mg/dL
a
What is the major extracellular cation? a. Sodium b. Chloride c. Magnesium d. Calcium
a
What is the major intracellular cation? a. Potassium b. Calcium c. Magnesium d. Sodium
a
Which form of hepatitis is caused by a DNA virus? a. Hep B b. Hep A c. Hep C d. Hep D
a
Which method of analysis will provide the most accurate electrolyte results if a grossly lipemic sample is used? a. Direct ISE b. Indirect ISE c. Flame emission photometry d. Atomic absorption
a
Which of the following analytes has the highest specificity for cardiac injury? a. TnI b. CK-MB mass assays c. Total CK-MB d. AST
a
Which of the following cardiac markers is the most useful indicator of congestive heart failure? a. BNP b. TnI c. CK-MB d. Glycogen phosphorylase isoenzyme BB
a
Which of the following conditions would result in elevations in primarily conjugated bilirubin? a. Dubin-Johnson syndrome b. Physiologic jaundice of the newborn c. Crigler-Najjar syndrome d. Gilbert's syndrome
a
Which of the following defects is the most common type of congenital CVD encountered? a. Ventricular septal defects (VSD) b. Tetralogy of Fallot c. Coarctation of the aorta d. Transposition of the great arteries
a
Which of the following enzymes is most useful in establishing the hepatic origin of an elevated serum alkaline phosphatase? a. 5'-Nucleotidase b. Alanine aminotransferase (ALT) c. Aspartate aminotransferase (AST) d. Lactate dehydrogenase
a
Which of the following enzymes would best aid in identifying hepatobiliary disease? a. Alkaline phosphatase (ALP) b. Aspartate aminotrasferase (AST) c. Alanine aminotransferase (ALT) d. Ammonia
a
Which of the following fractions of bilirubin is water soluble and reacts with a diazo reagent without the addition of an accelerator? a. Conjugated bilirubin b. Unconjugated bilirubin c. Total bilirubin d. Indirect bilirubin
a
Which of the following is NOT a feature of an ideal cardiac marker? a. Ability to predict future occurrence of cardiac disease b. Absolute specificity c. High sensitivity d. Close estimation of the magnitude of cardiac damage
a
Osmoreceptors in teh hypothalamus are key to regulating blood osmolality. Typically, a 1% to 2% shift in osmolality causes a ___ change in circulating concentration of AVP a. Twofold b. Fourfold c. Eightfold d. Tenfold
b
Which of the following enzymes is responsible for the conjugation of bilirubin? a. UDP-glucuronosyltransferase b. Alkaline phosphatase c. Glutamate dehydrogenase d. Leucine aminopeptidase
b
Which of the following is measured and using glutamate dehydrogenase and is a measure of advanced stages, poor prognosis, and coma in liver disease? a. Total bilirubin b. Ammonia c. Unconjugated bilirubin d. Urea
b
The quantitative relationship between changes in blood osmolality and the normal expected response by AVP is best described as a(n): a. Indirect relationship b. Direct relationship c. Logarithmic relationship d. There is no quantitative relationship
c
A normal myoglobin concentration 8 hours after the onset of symptoms of a suspected MI will a. Essentially rule out an acute MI b. Provide a definitive diagnosis of acute MI c. Be interpreted with careful consideration of the TnT concentration d. Give the same information as a total CK-MB
c
A patient presents with elevated levels of IgG anti-HAV, while levels of IgM anti-HAV are nondetectable. This patient is likely to a. Have an acute infection of HAV b. Have a chronic infection of HAV c. Have an immunity to HAV d. Be a carrier of HAV
c
The product produced and measured when reacting with bilirubin with a diazo reagent is a. NADPH b. NAD Azobilirubin d. Bilirubin diglucuronide
c
A healthy 28 year old female sees her physician for a routine examination and has received a "relatively" clean bill of health except for the following results: Total bilirubin: 2.8 mg/dL Direct bilirubin: 0.1 mg/dL Indirect bilirubin: 2.7 mg/dL These results most likely indicate: a. Normal bilirubin metabolism b. Extrahepatic obstruction c. Dubin-Johnson syndrome d. Gilbert's disease
d
You are the technologist on duty and you are performing the following assay: Pct sample+Diazo reagent+accelerator-->Product Which fraction (s) of bilirubin will react in the above reaction? a. Conjugated b. Delta c. Unconjugated d. All of the above
d
Which Plasma electrolyte has the most narrow reference range and is MOST strictly regulated by the body? a. Sodium b. Magnesium c. Calcium d. Chloride e. Potassium
e
Creatinine clearance results are corrected using a patient's body surface area to count for differences in a. Muscle mass b. Age c. Dietary intake d. Sex
a
Hepatitis E is likely to cause serious consequences in a. Pregnant women b. Children c. Travelers in Third World countries d. Older people
a
Hyperkalemia may be caused by each of the following EXCEPT: a. Alkalosis b. Acute or chronic renal failure c. Hypoaldosteronism d. Sample hemolysis
a
Hypokalemia may be caused by each of the following EXCEPT: a. Acidosis b. Prolonged vomiting or diarrhea c. Hypomagnesemia d. Hyperaldosteronism
a
Hyponatremia may be caused by each of the following EXCEPT: a. Hypomagnescemia b. Aldosterone deficiency c. Prolonged vomiting or diarrhea d. Acute or chronic renal failure
a
In which of the following disease states would you see an elevation in total bilirubin and conjugated bilirubin only? a. Biliary obstruction b. Hemolysis c. Neonatal jaundice d. Gilbert's diasese
a
In which of the following types of cells does the conjugation of bilirubin take place? a. Hepatocytes b. Kupffer cells c. Macrophages d. Phagocytic cells
a
Osmolality can be defined as a measure of the concentration of a solution based on the a. Number of dissolved particles b. Number of ionic particles present c. Number and size of the dissolved particles d. Density of the dissolved particles
a
Renal clearance is the a. Volume of plasma from which a substance is removed per unit of time b. Volume of urine produced per day c. Amount of creatinine in urine d. Urine concentration of a substance divided by the urine volume per unit of time
a
Renin release by the kidney is stimulated by a. A decrease in extracellular fluid volume or pressure b. Increased plasma sodium concentration c. Increased dietary sodium d. Renal tubular reabsorption
a
Rheumatic heart disease is a result of infection with which of the following organisms? a. Group A stret b. Staph. aureus c. Pseudomonas aeruginosa d. Chlamydia pneumonia
a
The largest portion of total body water is found in which tissue? a. Intracellular fluid b. Extracellular fluid c. Intravascular extracellular fluid d. Interstitial cell fluid e. Plasma
a
Measuring serum ammonia levels has the potential to be fraught with preanalytic al errors that may interfere with achieving an accurate result. Of the following preanalytical steps, which is incorrect? a. After phlebotomy, the patient's blood should be immediately placed on the ice. b. The blood should be collected in a red clot tube without anticoagulant. c. Hemolyzed samples should be rejected as this interferes by falsely increasing ammonia levels. d. Lipemia may also interfere with plasma ammonia measurements. e. All of the above
`b
A hemolyzed sample will cause falsely increased levels of each of the following EXCEPT a. Sodium b. Potassium c. Phosphate d. Magnesium
a
A patient is suffering from an acute bleed. What is the most accurate way to describe the subsequent acute kidney injury? a. Prerenal acute kidney injury b. Renal acute kidney injury c. Postrenal acute kidney injury d. None of the above
a
A person with a confirmed blood pressure of 125/87 would be classified as a. prehypertension b. Normal c. Stage 1 hypertension d. Stage 2 hypertension
a
A serum TnT concentration is of most value of the patient with an MI when: a. The CK-MB has already peaked and returned to normal concentrations b. The onset of symptoms is within 3-6 hours of the sample being drawn c. The myoglobin concentration is extremely elevated d. the TnI concentration has returned to normal concentrations
a
A urinalysis dipstick test indicated that urobiliinogen was absent. Which condition does this support? a. Biliary obstruction. b. Hep A acute infection c. Defective liver cell function d. Hepatocellular disease e. This would support all of the above conditions.
a
As a reduction product of bilirubin catabolism, this compound is partially reabsorbed from the intestine through the portal circulation for reexcretion by the liver. What is this compound? a. Urobilinogen b. Azobilirubin c. Biliverdin d. Urobilin e. Bilirubin
a
Choose the diagnosis most consistent with the following laboratory findings: Serum: total bilirubin 5.8 mg/dL Direct bilirubin: 0.1 mg/dL Indirect bilirubin 5.7 mg/dL a. Physiologic jaundice of the newbo5rn b. Posthepatic bile obstruction c. Dubin-Johnson syndrome d. Rotor's syndrome e. None of the above
a
The main difference between a direct and indirect ISE is a. Sample is diluted in the indirect method, not in the direct method b. The type of membrane that is used c. Direct ISEs use a reference electrode, whereas indirect ISEs do not d. Whole blood samples can be measured with the direct method and not with the indirect method
a
The measurement of serum cystatin C, a small protein produced by nucleated cells, is useful for a. Detecting an early decrease in kidney function b. Calculating creatinine clearance c. Diagnosing end-stage renal disease d. Monitoring dialysis patients
a
Which of the following is the preferred biomarker for the assessment of myocardial necrosis? a. CK b. AST c. CK-MB d. TnI
a
Which of the following newer markers of inflammation circulates in serum bound to LD and HDL? a. Lipoprotein-associated phospholipase A2 b. CK-MB c. cTnI d. hsCRP
a
With increased water loss, burn patients are most likely to also experience: a. Hypernatremia b. Hyponatremia c. Hpomagnesemia d. Hypoosmolality
a
Worldwide, most primary malignant tumors of the liver are related to a. Alcoholism b. Gallstones c. Reye's syndrome d. Malaria
a
