BOC Chemistry

A patient has the following test results: increased serum calcium levels, decreased serum phosphorus levels, and increased levels of parathyroid hormone. This patient most likely has: A. Hyperparathyroidism B. Hypoparathyroidism C. Nephrosis D. Steatorrhea

A

A patient is admitted to the emergency room in a state of metabolic alkalosis. Which of the following would most likely be consistent with this diagnosis? A. High pCO2, increased HCO3 B. Low pCO2, increased HCO3 C. High pCO2, decreased HCO3 D. Low pCO2, decreased HCO3

A

A patient sample for uric acid gave an absorbance reading of 0.4; the 50 mg/dL standard used in the test gave an absorbance reading of 0.1. What is the concentration of uric acid in the patient's sample in grams per deciliter? A. 0.2 B. 12.5 C. 125 D. 200

A

An example of a marker of bone formation is: A. Alkaline phosphatase B. Urinary N-telopeptide C. Urinary hydroxyproline D. Acid phosphatase

A

Anion Gap is normally A. plus or minus 12 B. plus or minus 25 C. plus or minus 5 D. 32 below zero

A

Convert 10 mg/dL of calcium to mmol/L. (mw = 40) A. 2.5 B. 5.0 C. 10 D. 25

A

Elevations in which of the following are MOST likely to indicate liver disease? A. AST, ALT and ALK phosphatase B. ALK phosphatase, creatinine, and uric acid C. ALK phosphatase, creatinine, and serum potassium D. Amylase, AST, ALT, and glucose

A

If serum proteins were immersed in a buffer of pH 8.6, which protein, albumin (pI = 4.7) or gamma globulin (pI = 7.6) would migrate the farthest by electrophoresis, and toward which electrode? A. Albumin/anode B. Albumin/cathode C. Gamma globulin/anode D. Gamma globulin/cathode

A

In the Jaffe reaction, creatinine react with A. Alkaline picrate solution to yield to an orange red complex B. Sodium nitroferricyanide to yield to a reddish brown color C. Potassium iodide to form a reddish purple complex D. Colorless NAPA solution at 340 nm

A

Measurement of the sodium and chloride concentration of sweat is the most useful test for the diagnosis of: A. Cystic fibrosis B. Diabetes mellitus C. Zollinger-Ellison syndrome D. Thyroiditis

A

Serum bilirubin is unstable because of: A. Light sensitivity B. Precipitation due to acid pH C. Digestion by proteolytic enzymes D. Precipitates on standing

A

Serum glucose determinations are done on samples from a control pool each day for 30 days. Quality control statistics are then calculated. The mean is 100 mg/dL and the standard deviation is 4 mg/dL. These statistics are used to label a quality control chart for the mean and +2 SD. Samples from the same control pool are then assayed each day along with patient samples, and control results are plotted on the chart. Results for the first 10 days are as follows: Day Result 1 96 2 97 3 95 4 107 5 106 6 107 7 89 8 103 9 106 10 105 The coefficient of variation for these statistics is: A. 4% B. 8% C. 12.5% D. 25%

A

The majority of the iron in whole blood is: A. Bound to hemoglobin B. In the free ionized form in plasma C. Bound to transferrin in plasma D. Bound to ferritin

A

The most common hemoglobinopathy in the United States is due to a defect in A. Hgb S B. Hgb C C. Hgb SC D. Hgb D

A

The most specific tumor marker for prostatic cancer is: A. Prostate specific antigen B. Prostatic acid phosphatase C. Alpha-fetoprotein D. Human chorionic gonadotropin

A

The solute that contributes the most to serum osmolality is A. Sodium B. Water C. Glucose D. Chloride

A

Very high AFP is most characteristically associated with A. Hepatocellular carcinoma B. Alcoholic cirrhosis C. Multiple myeloma D. Active hepatitis

A

What condition does the following set of results represent pH = 7.26 pC02 = 56 HCO3- = 24 A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A

When myocardial infarction occurs, the first enzyme to reach peak elevation is: A. CK B. LD C. AST D. ALT

A

Which of the following electrolytes would be increased in the serum if the blood specimen was hemolyzed? A. Potassium only B. Potassium, chloride and phosphate C. Chloride and sodium D. Bicarbonate, potassium, and phosphate E.

A

Which of the following has the highest incidence of infectious risk in the clinical laboratory? A. Hepatitis B. Infectious mononucleosis C. Acquired immunodeficiency syndrome (AIDS) D. Rubella

A

Which of the following is considered to be a waived test procedure? A. Rapid Strep A Screen B. Enzyme-linked immunosorbent assay (ELISA) C. Blood typing D. KOH prep

A

Which of the following results would be the most consistent with high risk for coronary heart disease? A. 20 mg/dL HDL cholesterol and 250 mg/dL total cholesterol B. 35 mg/dL HDL cholesterol and 200 mg/dL total cholesterol C. 50 mg/dL HDL cholesterol and 190 mg/dL total cholesterol D. 55 mg/dL HDL cholesterol and 180 mg/dL total cholesterol E. 60 mg/dL HDL cholesterol and 170 mg/dL total cholesterol

A

Which of the following statements most appropriately describes proficiency testing as it applies to POCT? A. It allows for the detection of technical or analytical errors B. It ensures that the laboratory quality assurance policies are being followed C. It ensures that specimens are being properly collected and processed D. None of these

A

3 mg/dL is equivalent to ______ grams per liter. A. 0.003 B. 0.03 C. 0.3 D. 3

B

3 mls of water is added to 1 ml of serum. This represents which of the following serial dilution A. 1:3 B. 1:4 C. 1:5 D. 1:6

B

A toxic condition involving a very high serum level of urea and creatinine accompanied by failure of the three main functions of the renal system is referred to as: A. Acute glomerulonephritis B. Uremia C. Azotemia. D. Acute renal failure

B

An analgesic that alleviates pain without causing loss of consciousness is: A. Digoxin B. Acetaminophen C. Lithium D. Phenytoin

B

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases? A. Muscular dystrophy B. Viral hepatitis C. Myocardial infarction D. Obstructive liver disease

B

Calcium concentration in the serum is regulated endogenously by: A. Insulin B. Parathyroid hormone C. Thyroxine D. Vitamin D

B

Clinical assays for tumor markers are most important for: A. Screening for the presence of cancer B. Monitoring the course of a known cancer C. Confirming the absence of disease D. Identifying patients at risk for cancer

B

Hypernatremia commonly occurs in: A. Burns, syndrome of inappropriate ADH, and excessive sweating without water intake B. Burns and excessive sweating without water intake C. Syndrome of inappropriate ADH and nephrotic syndrome D. Nephrotic syndrome only E. Burns, syndrome of inappropriate ADH, excessive sweating without water intake, and nephrotic syndrome

B

If the BUN of a patient high the creatinine would be A. Low B. High C. Normal value D. There is no connection between BUN and creatinine

B

Of the following drug therapies, which is MOST likely to interfere with the Jaffe chemistry for measuring creatinine? A. Aspirin B. Cephalosporin C. Acetaminophen D. High water intake E. Low water intake

B

Reference range for Sodium in a serum sample A. 125-135 mmol/L B. 135-145 mmol/L C. 110-140 mmol/L D. 75-100 mmol/L

B

Serum glucose determinations are done on samples from a control pool each day for 30 days. Quality control statistics are then calculated. The mean is 100 mg/dL and the standard deviation is 4 mg/dL. These statistics are used to label a quality control chart for the mean and +2 SD. Samples from the same control pool are then assayed each day along with patient samples, and control results are plotted on the chart. Results for the first 10 days are as follows: Day Result 1 96 2 97 3 95 4 107 5 106 6 107 7 89 8 103 9 106 10 105 On day 4 above, the light source was changed in the spectrophotometer used for this procedure. The results seen in the quality control after that day are called: A. A trend B. A shift C. Random D. Run variation

B

A carbonate salt of which drug is used to control manic-depressive disorders? A. Digoxin B. Acetaminophen C. Lithium D. Phenytoin

C

A creatinine clearance is done on a patient with the following results: serum creatinine, 0.6 mg/dL; urine creatinine, 102 mg/dL; urine volume, 1650 mL/24 hours; body surface area, 1.93 m2. This patient's creatinine clearance, corrected for body surface area, is: A. 93 mL/min B. 130 mg/dL C. 175 mL/min D. 195 mL/min E. 217 mL/min

C

A patient is admitted to the hospital with intense chest pains. The patient's primary care physician requests that the emergency room doctor order several tests, including a lipid profile with cholesterol fractionation. The patient's results are as follows: Total Cholesterol = 400 mg/dL Triglycerides = 300 mg/dL HDL Cholesterol = 100 mg/dL LP Electrophoresis - pending The LDL cholesterol for this patient would be ____________ mg/dL. A. 160 B. 200 C. 240 D. 300

C

A physician calls the laboratory and asks what lab tests should be requested to assess the acid-base balance function of a patient's renal system. You reply: A. Serum creatinine, serum urea, serum uric acid, and creatinine clearance B. Serum bilirubin (conjugated and total), urine urobilinogen C. Serum bicarbonate and blood pH D. Serum rennin and erythropoietin

C

A serum specimen for glucose measurement was allowed to stand unseparated on the clot for 6 hours at room temperature before testing. If the original glucose concentration was 200 mg/dL, what approximate results would be expected after 3 hours? A. 240 mg/dL B. No change in results C. 160 mg/dL D. 45 mg/dL

C

An electrolyte panel was performed on a patient in the emergency room. The following values were reported: Sodium: 150 mEq/L Potassium: 5 mEq/L Chloride: 110 mEq/L Bicarbonate: 30 mEq/L The anion gap (without using K) for this patient is: A. 5 B. 8 C. 10 D. 15 E. 17

C

CA125 is likely produced by a malignancy of A. Colon B. Liver C. Breast D. Pancreas

C

CEA is most commonly associated with: A. Breast cancer B. Ovarian cancer C. Colon cancer D. Myelocytic leukemia

C

In a spectrophotometric determination, which one of the following is the formula for calculating the absorbance of a solution? A. (Absorptivity × concentration) / light path in cm B. (Absorptivity × light path in cm) / concentration C. Absorptivity × light path in cm × concentration D. (Light path in cm × concentration) / absorptivity

C

In addition to pancreatitis, an increase in serum lipase activity may be observed in: A. Acute myocardial infarction B. Renal insufficiency C. Cystic fibrosis D. Viral hepatitis

C

Serum pH reference range A. 7.10-7.40 B. 6.55-7.75 C. 7.35-7.45 D. 7.45-7.55

C

The "gold standard" confirmation method for positive drug screens is: A. Immunoassay B. High-performance liquid chromatography C. Gas chromatography/mass spectrometry D. Ultraviolet absorption spectroscopy

C

The buffering capacity of blood is maintained by the reversible exchange process between bicarbonate and A. Sodium B. Potassium C. Chloride D. p02

C

The carcinoma-associated tumor antigen most useful for following patients with ovarian cancer is: A. CA 72-4 B. CA 15-3 C. CA 125 D. CEA

C

The glucose value of a NORMAL 2-hour post-prandial serum specimen, as compared to the reference range for a fasting serum glucose, should be: A. Significantly greater than the normal fasting glucose level B. Significantly lower than the normal fasting glucose level C. Approximately the same as the normal fasting glucose level D. Unrelated to each other

C

The most sensitive enzymatic indicator for liver damage from ethanol intake is: A. Alanine aminotransferase (ALT) B. Aspartate aminotransferase (AST) C. Gamma-glutamyl transferase (GGT) D. Alkaline phosphatase

C

Which isoenzyme of creatine kinase (CK) is primarily found in cardiac muscle? A. CK-MM B. CK-BB C. CK-MB D. CK-BC

C

Which of the following conditions is associated with a low serum magnesium determination? A. Addison's disease B. Hemolytic anemia C. Hypothyroidism D. Overuse of laxatives or antacids

C

Which of the following is likely to occur first in iron deficiency anemia? A. Decreased serum iron B. Increased TIBC C. Decreased serum ferritin D. Increased transferrin

C

Which of the following lipoproteins is the major carrier of cholesterol to peripheral tissues? A. Chylomicrons B. VLDL C. LDL D. HDL

C

Which of the following set of wavelengths is most representative of the visible region? A. Greater than 950 nm B. 600-950 nm C. 350-750 nm D. 190-350 nm

C

A 21-year-old man with nausea, vomiting, and jaundice has the following laboratory findings: Total serum bilirubin 8.5 mg/dL (normal 0-1.0 mg/dL) Direct serum bilirubin 6.1 mg/dL (normal 0-0.5 mg/dL) Urine urobilinogen Increased Urine bilirubin Positive AST 200 U/L (normal 0-50 μ/L) ALP 160 U/L (normal 0-150 μ/L) What disease state are these findings consistent with? A. Chronic liver disease B. Obstructive jaundice C. Hemolytic anemia D. Early hepatitis

D

A blood sample for determination of the trough level of a drug is appropriately drawn: A. During the absorption phase of the drug B. Immediately after drug administration C. During the distribution phase of the drug D. Immediately before drug administration E. Two hours after drug administration

D

A diabetic patient is prescribed a daily regimen of insulin. Which of the following laboratory procedures would be of most value in determining the degree of glucose control over a 2-month period? A. Fasting blood glucose B. 2-h PP glucose C. OGTT D. Glycated hemoglobin E. Fructosamine

D

A drug that relaxes the smooth muscles of the bronchial passages is: A. Acetaminophen B. Lithium C. Phenytoin D. Theophylline

D

A patient is admitted to the hospital with intense chest pains. The patient's primary care physician requests that the emergency room doctor order several tests, including a lipid profile with cholesterol fractionation. The patient's results are as follows: Total Cholesterol = 400 mg/dL Triglycerides = 300 mg/dL HDL Cholesterol = 100 mg/dL LP Electrophoresis - pending This patient's LDL cholesterol is: A. Optimal B. Desirable C. Borderline D. High

D

All of the following are characteristic of severe hyperglycemia EXCEPT: A. Polyuria B. Ketonuria C. Glycosuria D. Hyponatremia

D

An LD flip, in assessing a possible myocardial infarction, refers to: A. LD2 > LD1 B. LD5 > LD1 C. LD1 > LD5 D. LD1 > LD2

D

Face masks and protective eyewear are designed to offer protection from: A. Needlesticks B. Clothing contamination C. Skin contact D. Mucous membrane contact

D

Metabolic acidosis is described as a(n): A. Increase in HCO3 and pCO2 with a decreased pH B. Decrease in HCO3 with an increased pH C. Increase in HCO3 with an increased pH D. Decrease in HCO3 and pCO2 with a decreased pH

D

Monitoring of _______ in patients on chemotherapy due to leukemia, lymphoma or multiple myeloma is necessary to avoid nephrotoxicity. A. Serum creatinine B. Urine creatinine C. BUN D. Serum uric acid E. Urea in urine

D

Of the following, which is NOT one of the top 10 causes of death in people older than 65 years of age? A. Alzheimer's disease B. Pneumonia C. Diabetes mellitus D. Diverticulitis

D

The most likely cause for serum/plasma to appear "milky" is the presence of: A. VLDL B. LDL C. HDL D. Chylomicrons

D

The regulation of calcium and phosphorus metabolism is accomplished by which of the following glands? A. Thyroid B. Adrenal glands C. Pituitary D. Parathyroid E.

D

Universal Precautions should be observed when working with: A. Hemophiliacs B. Patients with AIDS C. Drug users D. All patients

D

What condition does the following results represent pH = 7.52 pCO2 = 44 HCO3- = 39 A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

D

What is AIDS? A. A protozoan B. A bacterium C. A fungus D. A virus

D

Which MI marker is the most specific and sensitive and remains elevated for 14 days or more? A. CK-MB B. Troponin T C. LD1 D. CK-MB isoform

D

Which of the following does the most to minimize aerosol production during centrifugation? A. Using a refrigerated centrifuge B. Using centrifuge tubes with tapered bottoms C. Selecting centrifuge tube sizes that will fit securely into the centrifuge rack D. Using stoppered centrifuge tubes or a cover over the rotor chamber

D

Which of the following is NOT commonly used as a tumor marker? A. Prostate specific antigen B. Alpha-fetoprotein C. Carcinoembryonic antigen D. Cortisol

D

Which of the following methods for glucose results in the formation of NADPH for measurement? A. Glucose oxidase B. Glucose dehydrogenase C. Ortho-toluidine D. Hexokinase E.

D

Which of the following procedures is most basic and effective in preventing the spread of infectious diseases in the hospital environment? A. Wearing face masks and gloves in the presence of patients B. Wearing laboratory coats in patient rooms C. Wearing laboratory coats in the laboratory D. Washing hands between each patient contact

D

True or false? Blood is drawn into a Vacutainer tube and allowed to clot. If the serum is not separated from the cells, the serum potassium will tend to decrease and the serum sodium will tend to increase

False

True or false? Serum urea levels are less affected by diet and metabolism than are serum creatinine levels.

False

True or false? Chloride is the major extracellular anion in plasma.

True

True or false? Serum uric acid levels may be elevated in patients undergoing cancer chemotherapy.

True

Serum glucose determinations are done on samples from a control pool each day for 30 days. Quality control statistics are then calculated. The mean is 100 mg/dL and the standard deviation is 4 mg/dL. These statistics are used to label a quality control chart for the mean and +2 SD. Samples from the same control pool are then assayed each day along with patient samples, and control results are plotted on the chart. Results for the first 10 days are as follows: Day Result 1 96 2 97 3 95 4 107 5 106 6 107 7 89 8 103 9 106 10 105 On day 7, the control results are more than two standard deviations from the mean. The first thing you would do is: A. Make new reagents and run the control and patients for that day again B. Rerun the control with the same reagents C. Discipline the technologist who was responsible for the unacceptable work D. Call the company to repair the instrument

B

The coefficient of variation (CV) is: A. The square root of the standard deviation B. Standard deviation expressed as % of the average of the values used to calculate the standard deviation C. Standard deviation expressed as % of the range of values used to calculate the standard deviation D. Standard deviation expressed as % of the correlation coefficient E. Summation of duplicate differences expressed as % of the mean value

B

The federal regulation most cited and the one with which most laboratories must comply when implementing a POCT system is the: A. National Accrediting Agency for Clinical Laboratory Science B. Clinical Laboratory Improvement Amendment C. National Committee for Clinical Laboratory Standards D. American Society for Clinical Laboratory Science

B

The first step in analyzing a 24 hour urine for any analyte A. Add the appropriate preservative B. Measure the total volume C. Screen for albumin using a dipstick D. Subculture the urine for bacteria

B

The preferred collection tube for preservation of glucose is: A. Calcium oxalate B. Sodium fluoride C. Lithium heparin D. Sodium citrate

B

The reference method for glucose determination is: A. Glucose dehydrogenase B. Hexokinase C. Glucose oxidase D. Copper-reduction

B

The sweat test for chloride is used as a screening test for: A. Parkinson's disease B. Cystic fibrosis C. Pancreatitis D. Hyper- or hypochloremia E. Hyperkinetic disorders

B

The three hormones that regulate serum calcium are: A. PTH, vitamin D, and estrogen B. PTH, vitamin D, and calcitonin C. PTH, renin, and calcitonin D. Erythropoietin, calcitonin, and estrogen

B

What is reference range for Potassium A. 135-145 mmol/L B. 3.5-5.0 mmol/L C. 5.0-6.0 mmol/L D. 12-15 mmol/L

B

When finished with lab exercises for the day, which order of events should be followed? A. Remove gloves, disinfect area, wash hands, remove lab coat B. Disinfect area, remove gloves, remove lab coat, wash hands C. Disinfect area, remove gloves, wash hands, remove lab coat D. Remove gloves, wash hands, remove lab coat, disinfect area

B

Which activity can spread HIV or HBV from one person to another outside of the laboratory? A. Using a toilet B. Sexual contact C. Giving blood D. Shaking hands

B

Which of the following best describes the correct collection and handling conditions for a blood ammonia measurement? A. Fasting patient, draw clot tube, separate serum immediately, test immediately B. Draw sodium heparin tube, place in ice bath immediately, separate cells and plasma in refrigerated centrifuge, immediately remove plasma and freeze if analytical testing is delayed C. Draw clot tube, separate serum from clot in refrigerated centrifuge, protect from light, freeze if not tested immediately D. Fasting patient, draw lithium heparin tube, place tube on an ice pack, centrifuge at 20° C, test immediately

B

Which of the following does not have to be included in the written procedure for a test system? A. Step-by-step instructions B. Cost of the procedure C. Panic values D. Reference range

B

Which of the following elevates carboxyhemoglobin? A. Nitrite poisoning B. Exposure to carbon monoxide C. Sulfa drug toxicity D. Sickle cell anemia

B

Which of the following forms of the Henderson-Hasselbalch equation is (are) correct? A. pH = 6.1 + log HCO3/H2CO3, pH = 6.1 + S x pCO2/HCO3, and pH = pKa + log HCO3/H2CO3 B. pH = 6.1 + log HCO3/H2CO3 and pH = pKa + log HCO3/H2CO3 C. pH = 6.1 + S x pCO2/HCO3 and pH = pKa - log HCO3/H2CO3 D. pH = pKa - log HCO3/H2CO3

B

Which of the following genetic markers is associated with breast cancer? A. Rb B. BRCA-1 and -2 C. WT1 D. CA-125

B

Which of the following proteins binds ferric iron and is increased in iron-deficiency anemia? A. Ferritin B. Transferrin C. Bilirubin D. Ceruloplasmin

B

Which of the following statements describes optimal conditions for transport, handling, and storage of blood specimens for clinical chemistry testing? A. Specimen brought to lab within 6 hours after collection, stored at room temperature before centrifugation for up to 24 hours B. Specimen brought to lab immediately, permitted to clot, serum separated and tested as soon as possible C. Specimen brought to lab immediately, spun down and serum left to stand on clot until tested D. None of these represent optimal conditions

B

Which of the following statements is NOT TRUE of capillary blood? A. May be used in place of arterial blood when blood gases are done on an infant B. Is more similar to venous than arterial blood for concentrations of analytes C. May be collected from the fingertip of an adult or heel of an infant D. Most chemistry analytes are similar to venous blood values except glucose

B