Chemistry

Pheochromocytoma is a tumor of the adrenal medulla that results in elevated urinary levels of all the following EXCEPT: Select one: a.Cortisol b.Free catecholamines c.Metanephrines d.Vanillylmandelic acid

*Free catecholamines NOT Vanillylmandelic acid

Which of the following enzymes is the most sensitive indicator of long term liver damage associated with alcohol ingestion: Select one: a.Gamma-glutamyl transpeptidase (GGT) b.Alanine transaminase (ALT) c.Aspartate transaminase (AST) d.Lactate dehydrogenase (LDH)

*Gamma-glutamyl transpeptidase (GGT) NOT Aspartate transaminase (AST)

All of the following are characteristics of type 2 diabetes mellitus EXCEPT: Select one: a.Insulin levels may or may NOT be abnormal b.More common than type 1 diabetes c.Requires insulin therapy to control hyperglycemia d.It commonly occurs in adults

*Requires insulin therapy to control hyperglycemia NOT Insulin levels may or may NOT be abnormal

Which of the following statements about diagnosing gestational diabetes is true? Select one: a.Gestational diabetes is diagnosed with the same testing and criteria used for the diagnosis of diabetes for a non-pregnant adult. b.All non-diabetic pregnant women should be screened at 24 to 28 weeks of gestation. c.Only diabetic pregnant women should be screened at 24 to 28 weeks of gestation. d.None of the above criteria are correct.

*b. All non-diabetic pregnant women should be screened at 24 to 28 weeks of gestation. NOT a.Gestational diabetes is diagnosed with the same testing and criteria used for the diagnosis of diabetes for a non-pregnant adult.

pH alteration of normal blood in a closed vessel standing at 37 degrees C for 1 hour is approximately: Select one: a.to 0.02 pH units b.to 0.04 pH units c.to 0.08 pH units d.0.08 to 0.12 pH units

*to 0.08 pH units NOT to 0.04 pH units

The accuracy of an immunoassay is its ability to discriminate between results that are true positive and results that are true negative. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with high specificity? Select one: a.Accurately identifies the presence of disease b.Accurately identifies the absence of disease c.Has many false-positives d.Has few false-negatives

Accurately identifies the absence of disease

Creatinine excretion correlates best with which of the following parameters: Select one: a.Age b.Sex c.Muscle Mass d.Body weight

Muscle Mass

A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had a myocardial infarction (MI)? Select one: a.LD b.CK c.Myoglobin d.Troponin

Myoglobin

The measurement of total glycosylated hemoglobin A1C is an effective means of assessing the average blood glucose levels: Select one: a.Over the past few days b.Over the past 1-2 week c.Over the past 2-3 months d.Only the past 24 hours

Over the past 2-3 months

Hemoglobin A1C (HbA1C) percent can be used as an assay to diagnose which of the following conditions? Select one: a.Diabetes b.Cirrhosis c.Myocardial infarction d.Leukemia

Diabetes

Which of the following will give the best overall picture of a patient's iron stores: Select one: a.Albumin b.Transferrin c.Haptoglobin d.Ferritin

Ferritin

What additional fraction would be seen if plasma rather than serum was subjected to electrophoresis: Select one: a.Alpha-1 antitrypsin b.Alpha-2 macroglobulin c.Fibrinogen d.Gamma globulins

Fibrinogen

An adult's plasma cortisol of 22 ug/dL at 8:00 a.m. and 10 ug/dL at 4:00 p.m. would be: Select one: a.Consistent with Addison's disease b.Consistent with Cushing's syndrome c.Found in a healthy individual d.Consistent with pheochromocytoma

Found in a healthy individual

Bioavailability of an oral drug refers to the : Select one: a.Availability for therapeutic administration b.Ratio of protein bound to free drug c.Amount of drug transformation d.Fraction of the drug that is absorbed into systemic circulation

Fraction of the drug that is absorbed into systemic circulation

The following urine test results were obtained from a 6-month-old African American infant who experiences vomiting and diarrhea after milk ingestion and has failed to gain weight: pH:5.0 Protein: Negative Glucose: Negative Ketones: Negative Blood: Negative Bilirubin: Negative Nitrite: Negative Urobilinogen: 0.1 EU/dL Clinitest: 2+ These results are clinically significant in which of the following disorders? Select one: a.Diabetes mellitus b.Lactose intolerance c.Galactosemia d.Cystic fibrosis

Galactosemia

Currently the MOST common method for the confirmation of serum barbiturates is: Select one: a.Immunoassay b.Thin-layer chromatography c.Gas-liquid chromatography, mass spectrometry d.Ultraviolet absorption spectroscopy e.Atomic Absorption

Gas-liquid chromatography, mass spectrometry

Which of the following is true of genotype screening in pharmacogenomics? Select one: a.Genotype screening gives a better overall picture of drug metabolism than measureing metabolism with probe drugs. b.Genotyping does not take into account drug interactions which can affect metabolism. c.Genotyping typically involves measuring only one mutation site or polymorphism. d.None of the above

Genotyping does not take into account drug interactions which can affect metabolism.

Fetal lung maturity can be determined from amniotic fluid because the surfactant is PRIMARILY composed of: Select one: a.Protein b.Cholesterol c.Glycerol d.Phosphatidylcholine and other phospholipids

Phosphatidylcholine and other phospholipids

A liquid ion-exchange membrane electrode using the antibiotic valinomycin is MOST selective for: Select one: a.Sodium b.Glucose c.Chloride d.Potassium

Potassium

Which of the following electrolytes is most likely to be spuriously elevated in a hemolyzed specimen: Select one: a.Sodium b.Potassium c.Chloride d.BUN

Potassium

The selectivity of an ion-selective electrode is determined by the: Select one: a.Properties of the membrane used b.Magnitude of the potential across the membrane c.Both choices are correct d.None of the above

Properties of the membrane used

Which one of the following is not an acute phase protein? Select one: a.Alpha-1 Antitrypsin b.C-Reactive Protein c.Protein S d.Fibrinogen

Protein S

The measurement of 17-ketosteroids (17-KSs) in urine is performed to assess PRIMARILY which organ(s)? Select one: a.Testes b.Adrenal cortex c.Testes and adrenal cortex d.Anterior pituitary

Testes and adrenal cortex

Which of the following cardiovascular risk markers is a more sensitive version of a test that is used to assess inflammation? Select one: a.Oxidized-LDL b.Hs-CRP c.ApoB/ApoA1 d.LpPLA2

Hs-CRP

What is the largest constituent of plasma nonprotein nitrogen: Select one: a.Ammonia b.Creatinine c.Ketones d.Urea

Urea

A deficiency in which of these vitamins leads to increased clotting time and may result in hemorrhagic disease? Select one: a.Riboflavin b.Pyridoxine c.Vitamin C d.Vitamin K

Vitamin K

The results which would be MOST consistent with macro-amylasemia are? Select one: 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

Increased serum amylase and normal to low urine amylase values

Which of the following hormones is mainly responsible for the entry of glucose into the cell for energy production? Select one: a.Epinephrine b.Glucagon c.Cortisol d.Insulin

Insulin

Which of the following is necessary for the absorption of Vitamin B12 Select one: a.Intrinsic factor b.Folic acid c.Gastrin d.Insulin

Intrinsic factor

Which one of the following statements about acetaminophen metabolism is false? Select one: a.It is metabolized in the kidney b.It is largely metabolized in the liver to glucuronide and sulfonate conjugates c.A small amount is metabolized via cytochrome oxidase to a reactive benzoquinoneimine intermediate d.The benzoquinoneimine intermediate becomes toxic to the liver once tissue glutathione becomes depleted

It is metabolized in the kidney

Isoenzymes of alkaline phosphatase occur in: Select one: a.Kidney, bone, intestines, liver b.Bone, Brain, liver, pancreas c.Liver, brain, spleen, intestines d.Brain, kidney, intestines, bone

Kidney, bone, intestines, liver

Which of the following is used primarily for the treatment of manic-depression: Select one: a.Phenobarbital b.Lithium c.Digoxin d.Ascorbic acid

Lithium

Isoenzymes of CK include all of the following except: Select one: a.MB b.MM c.MBM d.BB

MBM

Which of the following would NOT be considered a normal part of a routine electrolyte panel (profile)? Select one: a.Sodium b.Potassium c.Magnesium d.Chloride

Magnesium

Serum calcitonin is typically elevated in which of the following conditions? Select one: a.Medullary carcinoma of the thyroid b.Hyperthyroidism c.Glioblastoma d.Adrenal adenoma

Medullary carcinoma of the thyroid

Tumor markers are especially valuable when used to: Select one: a.Rule out cancer b.Screen the general population for cancer c.Monitor response to cancer therapy d.Confirm other assays

Monitor response to cancer therapy

Calculate LDL cholesterol concentration if total cholesterol is 280 mg/dL, triglyceride is 100 mg/dL, and the HDL cholesterol is 40.0 mg/dL. Select one: a.172 mg/dL b.140 mg/dL c.238 mg/dL d.220 mg/dL

220 mg/dL LDL = Total cholesterol - HDL - (Triglycerides ÷ 5)

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? Select one: 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

3-12 hours, 7-14 days

What weight of H2SO4 is contained in 200 ML of a 4 molar H2SO4 solution? (Atomic weight: H=1;S=32;0=16) Select one: a.78.4 g b.156.8 g c.39.2 g d.15.68 g

78.4 g

A patient's electrolyte results are the following:Sodium = 145 mmol/LChloride = 113 mmol/LBicarbonate = 24 mmol/LCalculate the anion gap for this patient and choose the correct answer below. Select one: a.32 mmol/L b.8 mmol/L c.27.7 mmol/L d.3.7 mmol/L

8 mmol/L

Elevation of serum creatine kinase may be associated with: Select one: a.Cerbrovascular accident (stroke) b.Vigorous exercise c.Duschenne muscular dystrophy d.All of the above

All of the above

Which analyte measurement is used to detect early nephropathy in a diabetic patient? Select one: a.Lactic Acid b.Albumin c.Ketones d.HbA1C

Albumin

Which of the following enzymes is associated with conditions affecting skeletal muscles? Select one: a.Aldolase b.Alkaline phosphatase c.Gamma-glutamyltransferase d.5'-nucleotidase

Aldolase

Albuterol is a fast-acting bronchodilator used acutely during asthma attacks. Which reasons below explains why TDM for albuterol is not available or common? Select one: a.It is not a chronically used drug so toxicity is less likely. b.The half-life is short, and the drug is cleared quickly. c.It has a wide therapeutic window. d.All of the above e.None of the above

All of the above

All of the following have an impact on electrophoresis techniques in the clinical lab EXCEPT? Select one: a.Amount of light present in electrophoresis box b.Support medium c.pH d.Voltage

Amount of light present in electrophoresis box

A physician needs to prescribe a drug to a patient but the drug has a narrow therapeutic window. He is concerned about possible toxic effects. To assess the upper concentration of such a drug, which time for drawing the specimen do you think makes the most sense? Select one: a.Approximately one hour after an oral dose b.2-4 hours after an IV injection of a drug c.Before any drug is given d.Right before the next dose of the drug is given

Approximately one hour after an oral dose

Estriol levels in conjunction with hCG, inhibin A (inhA), and alpha-fetoprotein (AFP) can be obtained during pregnancy to: Select one: a.Assess the risk of Down's syndrome b.Assess the fetomaternal function c.Assess for multiple gestations d.Assess for maternal diabetes mellitus

Assess the risk of Down's syndrome

Which assay is performed to diagnose congestive heart failure (CHF)? Select one: a.Homocysteine b.Hs-CRP and Ischemia Modified Albumin c.B-type natriuretic peptide (BNP) d.cTnl and cTnT

B-type natriuretic peptide (BNP)

The immunoassay procedure for serum hCG utilizes antisera against which subunit of hCG? Select one: a.Alpha b.Gamma c.Epsilon d.Beta

Beta

MOST of the carbon dioxide present in the blood is in the form of: Select one: a.Bicarbonate b.Carbonate c.Carbonic acid d.Dissolved CO2

Bicarbonate

Carbon dioxide is predominately found in blood in the form of: Select one: a.Bound CO2 b.Bicarbonate ions c.Sodium carbonate d.pCO2

Bicarbonate ions

Atherosclerosis is due to which of the following? Select one: a.Build up of plaque b.Arregation of platelets c.Hypercalcemia d.All of the above

Build up of plaque

Which one of the following serum constituents is increased following strenuous exercise: Select one: a.Creatinine b.Total lipids c.Sodium d.Iron

Creatinine

Which of the following cardiac biomarkers could detect a recent reinfarction? Select one: a.Troponin I (TnI) b.Troponin T (TnT) c.Lactate dehydrogenase (LD) d.Creatine kinase MB (CK-MB)

Creatine kinase MB (CK-MB)

Which two of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle? Select one: a.cTnl and cTnT b.CK-MB and myoglobin c.cTnT and CK-MB d.Myoglobin and cTnl

CK-MB and myoglobin

8-Hydroxyquinoline and Ortho-Cresolphthalein complexone (CPC) reagent is commonly used in the determination of: Select one: a.Phosphorus b.Magnesium c.Chloride d.Calcium

Calcium

Which of the following lipid tests is least affected by the fasting status of the patient? Select one: a.Cholesterol b.Triglycerides c.Fatty acids d.Lipoproteins

Cholesterol

An increased serum level of which of the following analytes is MOST commonly associated with decreased glomerular filtration? Select one: a.Creatinine b.Uric acid c.Urea d.Ammonia

Creatinine

Which nitrogen base would bind with a guanine nucleotide in forming double-stranded DNA? Select one: a.Cytosine b.Uracil c.Thymine d.Adenine

Cytosine

Which of the following substances is conjugated with the "indirect" bilirubin to form "direct" bilirubin? Select one: a.Ascorbic acid b.Glucuronic acid c.Uric Acid d.Salicylic Acid

Glucuronic acid

Which enzyme is responsible for the conjugation of bilirubin? Select one: a.Beta-Glucuronidase b.Bilirubin oxidase c.Bilirubin reductase d.Glucuronyl transferase

Glucuronyl transferase

Which test is performed to assess the average plasma glucose level that an individual maintained during the previous 10 week to 12 week period? Select one: a.Plasma glucose b.Two-hour postprandial glucose c.Oral glucose tolerance d.Glycosylated hemoglobin

Glycosylated hemoglobin

Which of the following parts of the body synthesizes and secretes BNP? Select one: a.Kidney b.Liver c.Heart d.Adrenal gland

Heart

An electrophorectic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of: Select one: a.A normal LD isoenzyme pattern b.Hemolysis c.Pancreatitis d.None of the above

Hemolysis

Which of the following anticoagulants will not produce a significant effect on calcium levels in plasma? Select one: a.EDTA b.Heparin c.Oxalates d.Citrates

Heparin

Where are most acute phase proteins synthesized? Select one: a.Bone Marrow b.Hepatocytes c.Intestines d.Spleen

Hepatocytes

To assess drug concentrations during the trough phase, blood should be drawn: Select one: a.About one 15 minutes after the administration of an oral dose of the drug. b.Immediately before the next dose is given. c.About three hours after the administration of an oral dose of the drug. d.About an hour before the administraion of an oral dose of the drug.

Immediately before the next dose is given.

Which of the following methods may be employed to definitively identify Bence-Jones proteins? Select one: a.Immunoelectrophoresis b.Sulfosalicyclic acid precipitation c.Heat precipitation at 40-60 degrees C d.Urine dipstick

Immunoelectrophoresis

A three-year old boy was brought unconscious to the emergency room. Arterial blood gas results were as follows:This patient is most likely suffering from: Select one: a.Metabolic alkalosis b.Metabokic acidosis c.Respiratory acidosis d.Respiratory alkalosis

Respiratory acidosis

Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis? Select one: a.Large buoyant LDL b.Small dense LDL c.LDL phenotype 'A' d.VLDL

Small dense LDL

Why are small dense LDL molecules more atherogenic? Select one: a.Small dense LDL molecules contain less cholesterol and phospholipid. b.Small dense LDL molecules increase the concentration of HDL-C in the blood. c.Small dense LDL molecules increase the concentration of adiponectin and inflammatory cytokines. d.Small dense LDL molecules have greater mobility in the endothelium and arterial wall.

Small dense LDL molecules have greater mobility in the endothelium and arterial wall.

C-reactive protein (CRP) is often used as a marker of inflammation. However, it has a low______. Select one: a.Sensitivity b.Specificity c.Accuracy d.Precision

Specificity

A 14 year old male was taken to the emergency room in a coma by his school nurse. He had lost 15 pounds in 3 months. His teacher said he was always thirsty and that he spent a lot of time running between the water fountain and the bathroom. Considering the patient's results and symptoms, what could be the cause for the osmolality result, and increased thirst? Results: pH=7.11 (7.35-7.45) pCO2= 20mm Hg (35-45 mm Hg) Glucose 1050 mg/dL (60-110 mg/dL) Serum osmolality 385 mOsm/Kg (275-295 mOsm/Kg) Urine ketone strongly positive Urine glucose strongly positive Select one: a.Because the patient is in a coma, it has been prolonged period since he has eaten or drank water. b.The increased glucose level causes a more concentrated extracellular solution, stimulating the thirst center of the hypothalamus. c.The increased glucose levels causes water to go inside the cell to equilibrate with the extracellular fluid. d.None of the above

The increased glucose level causes a more concentrated extracellular solution, stimulating the thirst center of the hypothalamus.

Which of the following is a bronchodilator used to treat a 39-year-old male asthmatic patient? Select one: a.Theophylline b.Digoxin c.Phenobarbital d.Amitriptyline

Theophylline

In healthy individuals, calcitonin is synthesized by which cells in the body? Select one: a.Hepatocytes b.Leukocytes c.Thyroid C cells d.Red blood cells

Thyroid C cells

Circulating organic iodine is found primarily in the form of: Select one: a.Triiodothyronine b.Parathyroid hormone c.Thyroglobulin d.Thyroxine

Thyroxine

Total iron-binding capacity measures the serum iron transporting capacity of : Select one: a.Hemoglobin b.Transferrin c.Ferritin d.Ceruloplasmin e.Haptoglobin

Transferrin

Which of the following is the MOST specific biochemical marker of myocardial infarction? Select one: a.CK b.LD c.Troponin d.Myoglobin

Troponin

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? Select one: a.Myoglobin b.Creatine kinase MB (CK-MB) c.Troponin T d.All of the above

Troponin T