Lab CE Clinical Chemistry

Iontophoresis is used in the diagnosis of:

Cystic Fibrosis

A patients. electrolyte results are the following. sodium= 145 mmol/L Chloride=113mmol/l bicarbonate=24mmol/l Calculate the anion gap for this patient and choose the correct answer below.

8mmol/l (anion gap= sodium- (chloride+bicarbonate))

Ph alteration of normal blood in a closed vessel standing at 37 degrees Celsius for one hour is approximately.

0.04 to 0.08 pH units

Calculate LDL cholesterol concentration if total cholesterol is 280 mg/dl triglyceride is 100 mg/dl and the HDL cholesterol is 40 mg/dl

220mg/dl

A patient has the following serum results: Na = 130 mEq/L K = 4.9 mEq/L Cl = 107 mEq/L Glucose = 300 mg/dL BUN = 18 mg/dL Creatinine = 1.1 mg/dL Which osmolality result is consistent with these results?

281 mosmol/kg

The American Diabetes Association (ADA) guidelines recommend screening all asymptomatic individuals age 45 and older for diabetes. If the screen is negative:

3 years

Which of the following patients is most at risk for hyperosmolar nonketotic coma?

70 year old type 2 diabetic

the of neutral 17 kit steroids is a measure of which of the following

Androgen production

Which 2 of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle.

Ck MB and myoglobin.

Which test is performed to assess the average plasma glucose level that an individual maintained during the previous 10 weeks to 12 week period

Glycosylated hemoglobin

The most likely cause of an elevated serum potassium level in an apparently normal individual is:

Hemolysis

A drug that is administered through which of the following routes will reach peak level the quickest?

IV

A 46 year old known alcoholic with liver damage is brought in the er unconscious one would expect his lipid values to be affected in what way

Increased

Lipemia in a fasting serum sample is most likely caused by an increase in serum levels of:

Triglycerides

Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine:

Urine protein electrophoresis or immunoelectrophoresis

Which of the following hormones does not increase plasma glucose concentration by converting glycogen to glucose

cortisol.

An increased serum level of which of the following analytes is most commonly associated with decreased glomerular filtration

creatinine

Which nitrogen base would bind with a guanine nucleotide in forming double-stranded DNA?

cytosine

In patients with suspected primary hypothyroidism associated with Hashimoto's thyroiditis, one would expect the following laboratory test results: T4 ___? TSH ___? TRH stimulation ___?

decreased, increased, increased

Which of the following will give the best overall picture of a patient's iron stores:

ferritin

Which of the following is found in plasma but absent in serum?

fibrinogen

Which of the following forms of calcium is biologically active

free ionized calcium

Which of the following substances is conjugated with the "indirect" bilirubin to form "direct" bilirubin?

glucuronic acid

Acute phase proteins generally fall into which category?

glycoproteins

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 low sensitivity?

has many false-negative results

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.

myoglobin

Human chorionic gonadatropin (hCG) is used in the determination of:

pregnancy

The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following electrolytes?

Potassium

The selectivity of an ion-selective electrode is determined by the:

Properties of the membrane used

Which of the following would most likely occur as the result of hemodilution:

Low serum electrolyte values

Isoenzymes of CK include all of the following except:

MBM

The following results were obtained on arterial blood: pH = 7.51 pCO2= 49 mm Hg HCO3- = 38.7 mmol/L pO2= 85 mm Hg These results are compatible with:

Metabolic alkalosis

Which one of the following statements about lipoproteins is false

elevated LDL causes a decreased risk of atherosclerosis

which of the following anticoagulants will not produce a significant effect on calcium levels in plasma

heparin

Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring?

immunoassay

All of the following conditions are associated with a polyclonal increase in gamma globulins except.

immunodeficiency

Which of the following tests confirms the presence of Bence-Jones proteinuria:

immunoelectrophoresis

With a development of fetal lung maturity, which of the following phospholipid concentrations in amniotic fluid increases.

lecithin

Which one of the following adipocyte products is an important messenger in metabolism, signaling the hypothalamus that there are changes in fat stores.

leptin

Which of the following is true with respect to uncompensated metabolic alkalosis?

pH will be elevated without an elevation of pCO2

Fetal lung maturity can be determined from amniotic fluid because the surfactant is primarily composed of.

phosphatidylcholine and other phospholipids

Which of the following contributes to specific gravity but does NOT contribute to osmolality?

protein

Which of the following would be considered a normal value for a glucose level in cerebrospinal fluid

60mg/dl

The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and

Chloride

A lipid panel is composed of which of the following tests

Cholesterol, lipoprotein, high density cholesterol, triglycerides.

Which of the following is the earliest biochemical marker of myocardial infarction

Ck

Which of the following drug examples would be a good candidate for therapeutic drug monitoring

A drug that has a narrow therapeutic window.

Which one of the following statements best describes hemoglobinA1c

A glycated protein that is an index of carbohydrate management over 2 to 3 months.

a cytochrome p450 2d6 (cyp2d6) ultrarapid metabolizer would require _____ dose of an active drug that is metabolized by cyp2d6 than a cyp2d6 extensive metabolizer

A higher

When the body compensates for a respiratory or metabolic disorder, the main goal is to achieve.

A normal Ph

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= 2.4mg/dl urine creatinine=65mg/dl urine volume 24 hours = 1400ml What is the estimated glomerular filtration rate for this patient

26.32 ml/min

Which of the following is a cause of metabolic alkalosis

Excessive vomiting

Which of the following tests would be used in the assessment of glomerular filtration?

creatinine clearance

in healthy individuals calcitonin is synthesized by which cells in the body.

thyroid c cells

Total iron binding capacity measures the serum iron transporting capacity of

transferrin

That portion of an enzyme which when separated from its cofactor is called a(n):

apoenzyme

An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD greater than LD could be indicative of

Hemolysis

Which of the following additives should be used for the collection of a sample for blood gas analysis?

Heparin

Increased concentration of alpha fetoprotein in adults or most characteristically associated with

Hepatocellular carcinoma

Increased concentrations of alpha fetoprotein in adults are most characteristically associated with.

Hepatocellular carcinoma

A patient has the following test results: Increased serum phosphorus level, decreased serum calcium level, and decreased serum parathyroid hormone (PTH) level. This patient MOST likely has:

Hypoparathyroidism

Serum calcitonin is typically elevated in which of the following conditions

Medullary carcinoma of the thyroid.

Which of the following conditions would make a sample unsuitable for lactic acid testing?

Movement of hand or arm during specimen collection.

Patients who develop severe sepsis or septic shock commonly have __________ plasma lactate values.

Increased

The results, which would be most consistent with macro-amylasemia are?

Increased serum amylase and normal to low urine amylase values.

which nitrogen base would bind with a guanine nucleotide forming double stranded dna

Cytosine

Hydrogen ion concentration in blood is usually determined by means of which of the following electrodes.

Glass

Which of the following statements is true concerning apolipoproteins

apolipoproteins are essential for lipid metabolism.

Carbon dioxide is predominately found in blood in the form of:

bicarbonate ions

Which analyte measurement is used to detect early nephropathy in a diabetic patient

Albumin

Which one of the following usually shows a decrease during an acute phase response.

Albumin

Ionized calcium is currently most commonly measured using which of the following method?

Calcium ion selective electrodes

Which of the following would be considered a normal cerebrospinal fluid glucose level if the serum glucose is 70 mg/dL?

About 45 mg/dL

Which of the following is used primarily for the treatment of manic-depression:

Lithium

The immunoassay procedure for serum hCG utilizes antisera against which subunit of hCG?

Beta

All of the following are sources of serum alkaline phosphatase except:

Brain

Atherosclerosis is due to which of the following

Build up of plaque

The National Heart lung and Blood Institute and American heart association have created a set of parameters to define the presence of metabolic syndrome, select a set of laboratory assays that are utilized in the NHLBI and aha criteria for metabolic syndrome diagnosis.

Fasting blood glucose triglycerides, HDL c.

Bio availability of an oral drug refers to the

Fraction of the drug that is absorbed into systemic circulation

Bioavailability of an oral drug refers to the:

Fraction of the drug that is absorbed into systemic circulation

a 56 year old female was taken to the emergency room in a coma by her employers nurse she had lost 35 pounds in 3 months, she was always thirsty drinking a lot of water and running to the bathroom. The following are her laboratory results Ph:7.11 PCO2: 21 Glucose: 950 Serum osmolality: 365 urine ketone: strongly positive urine glucose: strongly positive What is the most likely cause of this patient's symptoms?

Insulin dependent diabetes mellitus.

What is the most significant cause of decreased haptoglobin levels?

Intravascular hemolysis

The migration rate of proteins on cellulose acetate is primarily the result of

Ionic charge on the protein

A characteristic of a good cardiac biomarker is that:

It can be detected even if it is present in a LOW concentration in the peripheral blood.

Which of the following statements about the test for C-reactive protein (CRP) is TRUE?

It is an indicator of an inflammatory condition

Which one of the following statements about acetaminophen metabolism is false.

It is metabolized in the kidney

From the groups of analytes below, which set would most likely be increased in a type one diabetic patient in crisis?

Ketone bodies and blood glucose

isoenzymes of alkaline phosphates occur in

Kidney, bone, intestines, liver.

Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak.

Multiple sclerosis

Creatinine excretion correlates best with which of the following parameters?

Muscle Mass

Increases in the MB fraction of CK is associated with:

Myocardial infarction

A patient presents with the following test results. Total bilirubin 3.0. Conjugated bilirubin 1.2. urine urobilinogen decreased. stool color, clay colored.

Obstructive jaundice

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?

One of the values is an error

Follicle stimulating hormone is produced by

Pituitary

All of the following are characteristics of type 2 diabetes mellitus EXCEPT:

Requires insulin therapy to control hyperglycemia

A young man is experiencing difficult breathing after fainting. The physician orders an arterial blood gas analysis which shows the following results: pH = 7.25 pCO2 = 62 mmHg pO2 = 70 mmHg HCO3- = 23 mmol/L Which condition is most likely afflicting this patient?

Respiratory Acidosis

A 3 year old boy was brought unconscious to the emergency room. Arterial blood gas results were as follows. Ph 7.07 pco2: 90 hco3: 23 The patient is most likely suffering from.

Respiratory acidosis

When evaluating a 2 hour glucose tolerance test report performed on a pregnant woman, which of the following result is considered normal.

Say 2 hour glucose level is less than 140mg/dl

Which of the following about lead poisoning is false?

Serum lead level is a good inexpensive screening test for lead tox

Which of the following is most likely to interact with arterial walls leading to deposition of cholesterol and initiating or worsening atherosclerosis?

Small dense LDL

Which statement best describes small, dense LDL particles that can occur in atherogenic dyslipidemia.

Small, dense LDL molecules are more atherogenic because they can more easily move into the endothelium and vessel wall.

C-reactive protein (CRP) is often used as a marker of inflammation. However, it has a low _________.

Specificity

Deviations from beers law are caused by

Stray light

The measurement of 17 keto steroids in urine is performed to assess primarily which organ.

Testes and adrenal cortex

Which of the following conditions would argue in favor of therapeutic drug monitoring for a given drug?

The drug is given chronically.

A patient who previously had an HS CRP of 4 was put on statins and daily aspirin medication she returns to the laboratory a month later and her repeat hs crp is 2.3. Which of the following is the most likely reason for the decrease in the test value?

The medications lowered the HS CRP value.

Patient has optimal LDL and HDL cholesterol values. But a HS CRP test shows a value of 12. Which of the following situations is most likely.

The patient has an underlying acute inflammation process.

The following diagram demonstrates two Serum Protein Electrophoresis (SPEP) patterns from different patients. The pattern on the left is from a normal, healthy patient. The pattern on the right is from a patient with a particular disorder. What abnormality is suggested by the pattern on the right?

X-linked agammaglobulinemia

All of the following statements are characteristic of the role of CRP except

binds with factor h to initiate alternate complement pathway.

Which cardiac biomarker is a regulator of myocyte contraction?

cTnT

The formula for conversion of hemoglobin a1c to glucose in mg/dl is eAG=(28.7*a1c)-46.7 The HbA1c measured on a patient is reported as 7.5 %. What would be reported as an estimated average glucose for this % a1c

169

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?

Approximately one hour after an oral dose

Which substance is used in the jendrassik-grof method to accelerate the reaction of unconjugated bilirubin with the diazo reagent.

Caffeine benzoate

Most common methods for measuring bilirubin are based on the reaction of bilirubin with:

Diazo reagent

A patient has a fasting plasma glucose is performed at an outpatient laboratory. He has fasted, as instructed fpg 135. What does this result in the case and what, if any, further action is recommended by the ada?

Elevated FPG needs further evaluation by a repeat or alternative test.

Which of the following would you find in a primary hyperparathyroidism case

Elevated serum calcium and decrease serum phosphorus.

Increases in blood ammonia levels would be expected in which of the following conditions:

End stage cirrhosis

The function of the very low density lipoproteins is to transport

Endogenous triglycerides

Select the true statement regarding lipids and heart disease

Increased level of LDL-C indicates an increased risk for cardiovascular disease

Which of the following statements is true regarding cardiovascular disease and adipose tissue.

Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease.

Metabolic acidosis is characterized by

Low Ph

A 32 year old teacher is seeing her internist for her yearly physical because her great grandmother suffered from cardiac disease, she is concerned about her own risk for cardiac disease, she is not a smoker nor hypertensive and is not overweight, she is physically active and maintain a good diet and nutrition per physician orders a lipid panel and hsCRP to evaluate her cardiac disease risk

Low risk

Which of the following would not be considered a normal part of a routine electrolyte panel

Magnesium

A urine specimen which was collected in a dark container, stored in the dark, has a ph of 7.5, and whose sample aliquot is wrapped in foil, is most likely being sent for.

Porphyrins

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)?

Post-hepatic cholestasis

hydroxyquinoline and ortho-cresolphtalein complexone reagent is commonly used in the determination of

calcium

A HbA1C result for a diabetic patient is 6.0%. What conclusion can be made regarding this patient's carbohydrate management?

The patient is compliant with diet and medication

A disease or disorder causes serum binding proteins, such as albumin to decrease what may occur if the dose of a highly protein bound drug with a narrow therapeutic window is not adjusted.

The patient may experience toxic effects. High free drug fraction.

Which of the following factors would least affect an orally administered drugs absorption and or distribution in the body

The position of the patient when the drug is taken.

Which of the following is a bronchodilator used to treat a 39 year old male asthmatic patient?

Theophyline

The ultimate end product of both epinephrine and norepinephrine metabolism is.

Vanillymandellic acid.

The term pharmacokinetic best describes.

What the body does to the drug

Which of the following statements regarding the ls ratio is true

a ratio of 2 to 1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome.

Ammonia is best characterized as being

a waste product of amino acid and protein metabolism.

All of the statements below regarding amylase and lipase and pancreatitis are true except.

amylase and lipase are as predictive in chronic as in acute pancreatitis.