Clin Chem Unit 2
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
A 55-year-old male with early stage prostate cancer diagnosed by biopsy had his prostate removed (simple prostatectomy). His PSA prior to surgery was 10 ng/mL. If the surgery was successful in completely removing the tumor cells, what would the PSA result be 1 month after surgery? A. Less than 4 ng/mL B. 1-3 ng/mL C. Undetectable D. Less than 10 ng/mL
C
A serum PSA is used for all of the following except A. Monitoring response B. Detecting recurrence C. Diagnosis D. Screening
C
Acetaminophen is particularly toxic to what organ? A. Heart B. Kidney C. Liver D. Spleen
C
Although 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. CA 15-3 and CA 549 D. PSA and CA 15-3
C
Which of the following tests would be particularly useful in determining isopropanol exposure? a. Urine osmolality and serum osmolality b. Urine acetone and urine osmolality c. Serum sodium and serum acetone d. Serum osmolality and urine acetone
D
Which of the following tumor suppressors can be used to determine the risk of developing cancer? A. Squamous cell carcinoma antigen (SCC) B. Epidermal growth factor receptor (EGFR) C. c-erb B-2 gene expression D. p53 gene mutation
D
Which route of administration is associated with 100% bioavailability? A. Intramuscular B. Oral C. Sublingual D. Intravenous
D
Which of the following classes of compounds has a sedative effect and as such is used to treat anxiety?
benzodiazepines
Lithium therapy is widely used in the treatment of:
bipolar disorder
Which of the following is a commonly encountered xanthine that could potentially interfere with the determination of theophylline?
caffeine
Anti coagulated whole blood is the preferred specimen in determining exposure to what compound?
carbon monoxide
A malignant growth arising from skin/organ tissue epithelium
carcinoma
Which of the following statements best describe the TD50 of a compound?
cause toxic effect in 50% of population
Which of the following is an example of a phenothiazine drug?
chlorpromazine
Levels of 8-9% carboxyhemoglobin saturation of whole blood are commonly found in which of the following situations?
cigarette smokers
When screening urine for toxic concentrations of certain substances, which of the following will not be identified by the reinsch test?
cyanide
In which of the following cases is qualitative analysis of the drug usually adequate?
determine if patient has been taking amphetamines
A cardiac glycoside that is used in the treatment of CHF and arrhythmias by increasing the force and velocity of myocardial contraction is:
digoxin
The term pharmacodynamics is an expression of the relationship between
drug concentration at target sites and physiological effect
forms of PSA
free and complexed (bound to alpha-1-antichymotrypsin)
tumor marker trophoblastic
hCG
AFP is useful for diagnosis and staging of:
hepatocellular carcinoma and testicular cancer
An epileptic patient receiving phenytoin develops acute glomerulonephritis. What change, if any, would be expected in the patient's circulating drug level?
increase in free drug
Increased trough levels of aminoglycosides in the serum are ofter associated with toxic to which organ:
kidney
After absorption, codeine is rapidly metabolized to what compound?
morphine
heroin is synthesized from what drug?
morphine
An active metabolite of amitriptyline is:
nortriptyline
An anti epileptic (anticonvulsant) used to control seizure disorder:
phenytoin
phenobarbital is a metabolite of:
primidone
The term pharmacokinetics refers to
relationship between drug dose and drug level
For what colorimetric determination is the Trinder reaction widely used?
salicylate
A drug that relaxes smooth muscles of the bronchial passages is:
theophylline
Which of the following drugs is used as a bronchodilator?
theophylline
Blood specimens for digoxin assays should be obtained between 8 hours or more after drug administration because:
tissue and serum levels need to reach equilibrium
Free drug levels can generally be determined by analyzing what body fluid?
ultra filtrate of plasma
Which of the following statements concerning cyanide toxicity is true? A. Inhalation of smoke from burning plastic is a common cause of cyanide exposure, and cyanide expresses its toxicity by inhibition of oxidative phosphorylation. B. Inhalation of smoke from burning plastic is a common cause of cyanide exposure C. Cyanide is a relatively nontoxic compound that requires chronic exposure to produce toxic effect D. Cyanide expresses its toxicity by inhibition of oxidative phosphorylation E. all of the above
A
Which of the following tumor markers is used to monitor persons with breast cancer for recurrence of disease? A. CA 15-3 B. Retinoblastoma gene C. Estrogen receptor D. Cathepsin-D
A
The best explanation for higher rates of cancer in older population is: A. The development of cancer requires several mutations over time B. Aging cells are more susceptible to mutation. C. Older individuals have higher rates of tabacco use D. The elderly show increased rates of apoptosis
A
What is the active metabolite of the antiarrhythmic drug procainamide? A. NAPA (N-acetylprocainmide) B. Dispyramide C. Pronestyl D. PEMA (phenylethylmalonamide)
A
When should a medication be given based on it's half life? A. Very near the half life B. Longer than the half life C. Shorter than the half life
A
Which of the following is a primary liver function? A. Transform a non-polar drug to a polar metabolite B. Aid in elimination C. Liberate the drug D. Aid in absorption
A
Which of the following is useful in the detection and management of carcinoma of prostate? A. Total prostate-specific antigen B. Human chorionic gonadotropin C. Prostatic acid phosphatase D. Alpha-fetoprotein
A
Which substance has the longest detection time? A. Marijuana B. Cocaine C. Benzodiazepines D. Amphetamines
A
Why are drug like aminoglycosides and glycopeptides given by IV? A. They are very polar drugs and poorly absorbed in the intestine B. They are poorly absorbed in the intestine C. They are very irritating to the intestines D. They are very polar drugs
A
elevated PSA free/total ratio:
BPH (benign prostatic hyperplasia)
A tumor marker used in the assessment of choricarcinoma or hydatiform mole is A. AFP B. CEA C. IgG D. beta-hCG
D
In general, in which of the following situation is the analysis of a tumor marker most useful? A. Prognosis B. Diagnosis C. Screening D. Testing for recurrence
D
Of the following analytical methods, which is most commonly used as the confirmatory method for identification of drugs of abuse? A. ion-specific electrode B. immunoassay C. nephelometry D. GC with mass spectrometry
D
Which of the following is FALSE about PSA? A. Serum quantified using immunoassays B. Single-chain glycoprotein C. Used as a tumor marker D. Not elevated in benign prostatic hyperplasia
D
Which of the following is a sialylated Lewis blood group antigen associated with colorectal carcinoma? A. CEA B. CA 549 C. CA 15-3 D. CA 19-9
D
Which of the following is an example of a long-acting barbiturate? A. Amobarbital B. Secobarbital C. Pentobarbital D. Phenobarbital
D
Which of the following is an example of a long-acting barbiturate? A. Secobarbital B. Pentobarbital C. Amobarbital D. Phenobarbital
D
In what form must a drug be in order to elicit a pharmacological response? A. Free B. Bound to albumin C. Bound to globulins D. Bound to fatty acids
A
Which of the following is an example of an antiarrhythmic drug that has a metabolite with the same action? A. Quinidine B. Digoxin C. Nortryptyline D. Procainamide
D
Which of the following is the best analyte to monitor for recurrence of ovarian cancer? A. CEA B. CA 15-3 C. CA 19-9 D. CA 125
D
Which of the following serum components is able to alter the free drug level in plasma? A. Creatinine B. Urea C. Calcium D. Albumin
D
Increased concentration of alpha-fetoprotein (AFP) in adults are most characteristically associated with: A. Hepatocellular carcinoma B. Alcoholic cirrhosis C. Multiple myeloma D. Chronic active hepatitis
A
A weakly acidic toxin (pka=4.0) that is ingested will: A. Be passively absorbed in the stomach (pH=3.0) B. Not be absorbed because it is ionized C. Be passively absorbed in the colon (pH=7.5) D. Be absorbed only if a weak base is ingested at the same time
A
Peak values for digoxin are not measured until____hours after administration
8
A patient enters the emergency department in a coma. The physician suspects a drug overdose. Immunoassay screening tests for opiates, barbiturates, benzodiazepines, THC, amphetamines, and PCP were all negative. No ethanol was detected in serum. Can you rule out drug overdose as the cause of this coma with these results? A. No B. Yes C. Maybe
A
If a drug is administered orally, how many half lives are usually necessary to reach steady state? A. 5-7 B. 3-5 C. 2-4 D. 1-2 E. 7-9
A
Which tumor marker is associated with hepatocellular carcinoma?
AFP
tumor marker hepatocellular
AFP
Compound A is reported to have an oral LD50 of 5 mg/kg body weight. Compound B is reported to have an LD50 of 50 mg/kg body weight. Of the following statements regarding the relative toxicity of these two compounds, which is TRUE? A .Compound B would be predicted to be more toxic than compound A if the exposure route were transdermal. B. Ingestion of low amounts of compound A would be predicted to cause more death than an equal dose of compound B. C. Ingestion of compound B would be predicted to produce nontoxic effects at a dose greater than 100 mg/kg body weitgh. D. Compound A is more rapidly absorbed from gastrointestinal tract than compound B.
B
Estrogen and progesterone receptor assays are useful in assessing prognosis in which of the following: A. Ovarian cancer B. Breast cancer C. Endometriosis D. Amenorrhea
B
Identification of the urinary metabolite benzoylecgonine would be useful in determining exposure to which of the following drugs? A. codeine B. cocaine C. amphetamine D. Propoxyphene
B
Proto-oncogenes A. are the same as oncogenes. B. are normal cellular genes that promote growth. C. always code for viral proteins. D. result from severe mutation events.
B
The phrase "first-pass hepatic metabolism" means that: A. The drug must be metabolized in the liver to an active form B. Some drugs is metabolized from portal circulation, reducing bioavailability C. One hundred percent of a drug is excreted by the liver D. All drug is inactivated by hepatic enzymes after one pass through the liver
B
What are the major limitations of tumor markers? A. Cost B. Sensitivity and specificity C. Imprecision D. Turnaround time
B
What is one of the important facts concerning Primidone? A. A major metabolite is valproic acid B. A major metabolite is phenobarbital C. Drawing a blood sample 2 hours after dosing D. It is an antiarrhythmic drug
B
What is the primary product of methanol metabolism by ADH and ALDH system? A. acetaldehyde B. formic acid C. acetone D. oxalic acid
B
When should blood samples for trough drug levels be collected? A. 1-2 hours after the last dose B. Immediately before the next dose is given C. 45 minutes before the next dose D. 30 minutes after peak levels
B
Which of the following drugs is used as an immunosuppressant in organ transplantation, especially in liver transplants? A. Paroxetine B. Tacrolimus C. Methotrexate D. Amiodarone
B
Which of the following methods would yield reliable quantification of ethanol in the presence of isopromanol? a. Reaction with permanganate and chromotropis acid b. Gas-liquid chromotography c. Alcohol dehydrogenase reaction d. Conway diffusion followed by dichromate reation
B
Which of the following tumor markers is classified as a tumor suppressor gene? A. Nuclear matrix protein B. BRCA-1 C. Human chorionic gonadotropin (hCG) D. Carcinoembryonic antigen (CEA)
B
Which of the primary clinical utility of measuring CEA? A. Diagnosis of liver cancer B. Monitoring for treatment therapy and recurrence of cancer C. Screening for cancers of endodermal origin D. Diagnosis of colorectal cancer
B
In which of the following conditions is PSA least to be increased? A. Benign prostatic hypertrophy B. Postprostate biopsy C. Post-digital rectal examination D. Cancerous lesions of the prostate
C
THC is the principal active component of what drug? A. Benzodiazepine B. Morphine C. Marijuana D. Codeine
C
What is the approximate number of half-life periods required for a serum drug concentration to reach 97-99% of the steady state? A. 1-3 B. 2-4 C. 5-7 D. 7-9
C
What is the primary product of ethanol metabolism by ADH and ALDH system? A. acetone B. oxalic acid C. acetic acid D. formaldehyde
C
Which of the following drug is used to treat manic-depressive (bi-polar) patients? A. Cyclosporin B. Methotrexate C. Lithium D. Tricyclic drugs
C
Which of the following drugs is used as an immunosuppressant in organ transplantation, especially in liver transplant? A. Methotrexate B. Amiodarone C. Tacrolimus D. Paroxetine
C
Which of the following would be classified as a DEA Schedule I drug? A. Valium B. Acetaminophen C. Heroin D. Phencyclidine (PCP)
C
Which type of cancer is associated with the highest level of AFP? A. Breast cancer B. Ovarian cancer C. Hepatoma D. Testicular cancer
C
Select the five pharmacological parameters that determine serum drug concentration A. Liberation, equilibration, biotransformation, reabsorption, and elimination B. Ingestion, conjugation, integration, metabolism, and elimination C. Absorption, anabolism, perfusion, bioactivation, and excretion D. Liberation, absorption, distribution, metabolism, and excretion
D
When a therapeutic drug is suspected of causing toxicity, which specimen is the most appropriate for initial investigation? A. Trough blood sample B. Urine a the time of symptoms C. Gastric fluid at the time of symptoms D. Peak blood sample
D
Which of the following drugs would be classified as an analgesic? A. Nicotine B. PCP C. Dilantin D. Morphine
D
tumor marker ovarian
CA 125
main tumor markers breast cancer
CA 15-3, BRCA1 and 2
Ovarian and endometrial cancer is detected and monitored by:
CA-125
main tumor marker colorectal
CEA
main tumor marker gastric
CEA
tumor marker pancreatic
CEA
Active metabolite of procainamide
NAPA
What is the active metabolite of the anti arrhythmic drug procainamide?
NAPA
glycoprotein secreted by epithelium, serine protease, enters serum in disease and trauma states
PSA
tumor marker prostate
PSA
benign growth arising from glandular epithelium
adenoma
A salicylate level is performed to detect toxicity caused by ingestion excess:
aspirin