Chemistry - General Chemistry
109. A patient is seen in the ER for abdominal pain and jaundice (yellowing of the skin and sclera). A quick urinalysis is performed and it is noted there is an increase in urine urobilinogen. All of the following are likely causes EXCEPT: A. Hepatitis B. Hemolytic episode C. Cholelithiasis D. Chronic liver disease
C
120. A patient presents with an elevation of unconjugated bilirubin, normal serum alkaline phosphatase, normal liver enzymes, and no bilirubin in the urine. This combination would suggest: A. Viral infection of the liver. B. Chemical damage to the liver. C. Increased rate of hemolysis. D. Obstruction of common bile duct.
C
121. What is the primary oxygen-carrying protein found in muscle? A. Hemoglobin B. Troponin C. Myoglobin D. BNP
C
123. A patient presents with the following test results: Total Bilirubin: 3.0 mg/dL Conjugated Bilirubin : 1.2 mg/dL Urine urobilinogen: decreased Stools color: clay colored The MOST probable cause is: A. Viral infection of liver B. Chemical damage to liver C. Obstructive jaundice D. Hepatitis
C
53. Atherosclerosis is due to which of the following? A. Build up of plaque B. Aggregation of platelets C. Hypercalcemia D. Hypocalcemia
A
75. 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? A. Increased B. Decreased C. Normal D. Unaffected by the alcoholism
A
77. Which one of the following adipocyte products is an important messenger in metabolism, signaling the hypothalamus that there are changes in fat stores? A. Leptin B. Resistin C. IL-6 D. Angiotensinogen
A
14. Below are the laboratory results on a 20-year-old overweight male. His waist circumference is 41 inches blood pressure is 105/70. Fasting Blood Glucose: 130 mg/dL Triglycerides: 190 mg/dLHDL: 50 mg/dL The National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA) have created a set of parameters to define the presence of metabolic syndrome. Does this patient meet the criteria for metabolic syndrome diagnosis? A. No, because his HDL is > 40 mg/dL B. No, because he is not hypertensive C. Yes, he meets the NHLBI and AHA criteria for metabolic syndrome D. No, since height and weight were not reported, his BMI cannot be calculated
C
106. Glucuronic acid is used in the liver for conjugating what compound from hemoglobin degradation? A. Unconjugated bilirubin B. Conjugated bilirubin C. Urobilinogen D. Urobilin
A
108. Which compound normally contains the majority of the body's total iron? A. Hemoglobin B. Enzymes C. Myoglobin D. Cytochromes
A
116. Which porphyria has a defect in the ferrochetalase enzyme within the RBC, causing redness, edema and burning when exposed to light? A. Erythropoietic protoporphyria B. Congenital erythropoietic porphyria C. X-linked protoporphyria D. Variegate porphyria
A
118. Kernicterus can cause brain damage in newborns suffering from severe HDFN. This is due to a buildup of: A. Unconjugated bilirubin B. Hematocrit C. Haptoglobin D. Hemoglobin
A
16. According to the American Diabetes Association recommendations, which of the following statements is TRUE with regards to the following findings? Fasting glucose = 130 mg/dL 2-hour post prandial glucose = 210 mg/dL A. The patient may be diagnosed as having diabetes mellitus B. The patient is diagnosed as having impaired glucose tolerance C. The patient is diagnosed as having diabetes insipidus D. The patient is normal
A
19. Glucose is considered an aldose because: A. It contains a terminal carbonyl group, called an aldehyde group. B. It contains a carbonyl group in the middle linked to two other carbon atoms, called a ketone group. C. It contains a terminal carbonyl group, called a ketone group. D. It contains a carbonyl group in the middle linked to two other carbon atoms, called an aldehyde group.
A
27. All of the following hormones increase or decrease plasma glucose concentration by regulating glycogenolysis (converting glycogen to glucose) EXCEPT? A. Cortisol B. Glucagon C. Epinephrine D. Insulin
A
28. Recently the American Diabetes Association (ADA) recommended reporting which of these values to correlate with hemoglobin A1C (HbA1C) as a further indicator of glycemic control? A. Estimated average glucose B. Blood urea nitrogen C. Microalbumin D. Insulin
A
35. Which analyte may be falsely decreased due to a delay in transport time to the laboratory? A. Glucose B. Potassium C. Magnesium D. LD
A
4. A low CSF glucose level is associated with all the following EXCEPT: A. Hyperglycemia B. Fungal meningitis C. Amebic meningitis D. Trichinosis meningitis
A
1. Sodium fluoride is an excellent preservative for collecting glucose specimens because it does which of the following? A. Prevents interference with other substances B. Inhibits glycolysis C. Enhances chemical reactions D. Inhibits certain clotting factors
B
101. All of the following are considered cutaneous porphyrias, EXCEPT? A. Porphyria cutanea tarda B. Acute intermittent porphyria C. Congenital erythropoietic porphyria D. Erythropoietic protoporphyria
B
102. 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? A. cTnI and cTnT B. CK-MB and myoglobin C. cTnT and CK-MB D. Myoglobin and cTnI
B
104. 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: A. Aldosterone B. Porphyrins C. Catecholamines D. Metanephrines
B
105. Which of the following blood tests requires to be protected from light? A. Total protein B. Bilirubin C. Sodium D. Glucose
B
112. A 17-year old African-American male had the following laboratory results: Sickle cell screen = positive Hemoglobin Electrophoresis: Hb S = 45% Hb A = 53% HbA2 = 2% Which of the following is the PROBABLE hemoglobin genotype? A. SS B. AS C. SC D. AC
B
114. In hemoglobin synthesis, which enzyme is responsible for adding iron in the last step? A. ALA Synthase B. Ferrochelatase C. PBG Synthase D. Protoporphyrinogen oxidase
B
78. Chylomicrons are primarily composed of: A. Cholesterol B. Triglycerides C. Phospholipids D. Proteins
B
85. Which of the following is true concerning atherosclerosis? A. Atherosclerosis is the same as arteriosclerosis. B. Atherosclerosis is the deposition of plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries. C. Atherosclerosis is the main outcome that is assessed in risk marker studies. D. Most humans do not have significant atherosclerosis.
B
87. Which analyte measurement is used to detect early nephropathy in a diabetic patient? A. Lactic acid B. Albumin C. Ketones D. HbA1C
B
9. Which of the following would be considered a normal cerebrospinal fluid glucose level if the serum glucose is 70 mg/dL? A. About 100 mg/dL B. About 45 mg/dL C. About 60 mg/dL D. About 70 mg/dL
B
90. Electrophoretic separation of hemoglobin fundamentally relies on: A. Weight differences of molecules B. Electrical charge differences of molecules C. Concentration differences of molecules D. Shape variations of molecules
B
92. An increase is total bilirubin with a normal conjugated bilirubin is most likely indicative of: A. Acute liver disease B. Hemolytic disease C. Post-hepatic jaundice D. Obstruction
B
93.Which of the following substances is conjugated with the "indirect" bilirubin to form "direct" bilirubin? A. Ascorbic acid B. Glucuronic acid C. Uric acid D. Salicylic acid
B
84. Which statement best describes small dense LDL particles that can occur in atherogenic dyslipidemia? A. Small dense LDL molecules are less atherogenic than larger, less dense or buoyant LDL particles because they are metabolized faster B. Small dense LDL molecules transport more cholesterol and thus are more atherogenic C. Small dense LDL molecules are more atherogenic because they can more easily move into the endothelium and vessel wall D. Small dense LDL molecules are just as atherogenic as the larger ones
C
88. An obese adult with premature arteriosclerosis is seen in the clinic. When her serum is tested no chylomicrons are present, LDL levels are normal, and VLDL levels are increased. There is an increase in triglycerides and slight increase in cholesterol. Lipoprotein electrophoresis reveals a heavy pre-beta band. She has no skin rash and uric acid is increased. This patient most likely has what type of hyperlipoproteinemia? A. Type I B. Type III C. Type IV D. Type V
C
91. A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions: A. Neural tube defects B. Maternal hypertension C. Hemolytic disease of the newborn D. Maternal diabetes
C
103. Myoglobin concentration testing is routinely used for all of the following conditions, EXCEPT? A. Acute myocardial infarction (AMI) B. Rhabdomyolysis C. Seizures D. Pulmonary edema
D
107. The following polypeptide chains are found in normal adult hemoglobin A: A. Alpha and gamma B. Alpha and delta C. Beta and delta D. Alpha and beta
D
110. After an acute myocardial infarction (AMI), myoglobin levels will rise within 3 hours and peak at 8-12 hours. When will they return to normal? A. 10-20 hours B. 5-10 hour C. 3-4 days D. 18-30 hours
D
111. Most common methods for measuring bilirubin are based on the reaction of bilirubin with: A. Methyl alcohol B. Neural salts C. Bilirubin oxidase D. Diazo reagent
D
113. How is the majority of urobilinogen that is produced daily removed from the body? A. Through urine excretion B. Through sweat C. Through saliva D. Through fecal excretion
D
115. In post-hepatic jaundice, why is urobilinogen decreased? A. Because there is a decrease in bilirubin being metabolized B. Because there is an increase in bilirubin being metabolized C. Because the liver is not conjugating bilirubin D. Because there is a blockage of conjugated bilirubin being excreted from the liver to intestine
D
117. Fecal urobilinogen level may be markedly decreased because of: A. Hemolysis B. Decreased intestinal reabsorption of urobilinogen C. Increased serum bilirubin D. Biliary obstruction
D
119. Which of the following is most likely to interfere with the measurement of hemoglobin? A. Leukocytopenia B. EDTA C. Heparin D. Lipemia
D
12. Which adipokine is decreased in obesity, is anti-inflammatory, and increases insulin sensitivity? A. Leptin B. Resistin C. TNF-a D. Adiponectin
D
122. All cells can synthesize heme, what two organs are the main sites of hemoglobin synthesis for the body? A. Liver and spleen B. Spleen and bone marrow C. Bone marrow and thymus D. Bone marrow and liver
D
124. In heme synthesis, how many molecules of delta-aminolevulinic acid (ALA) are needed to form one molecule of heme? A. 2 B. 4 C. 6 D. 8
D
13. Which of the following serum constituents is unstable if a blood specimen is left standing at room temperature for eight hours before centrifugation and processing? A. Cholesterol B. Triglyceride C. Creatinine D. Glucose
D
17. When in the Fisher Projection, which carbon is used to determine if the molecule is in D or L formation? A. Anomeric carbon B. First chiral carbon C. Central Carbon D. Penultimate carbon
D
23. Which of the following is a liver enzyme that is instrumental in allowing glucose to enter the blood stream? A. Glucose oxidase B. Glucose-6-isomerase C. Glucose-6-convertase D. Glucose-6-phosphatase
D
3. Which of the following is the most commonly abused substance in the US? A. Marijuana B. Heroin C. LSD D. Alcohol
D
5. Which analyte is MOST useful for monitoring long-term (~12 weeks) stability of blood glucose? A. Lactic acid B. Urinary ketone bodieS C. Insulin D. Glycosylated hemoglobin (HbA1C)
D
51. Which of the following are considered two of the positive risk factors for coronary heart disease as determined by the National Cholesterol Education Program (NCEP)? A. LDL-C concentration < 100 mg/dL; HDL-C concentration = 60 mg/dL B. LDL-C concentration = 100 mg/dL; HDL-C concentration = 60 mg/dL C. LDL-C concentration < 100 mg/dL; HDL-C concentration < 40 mg/dL D. LDL-C concentration = 100 mg/dL; HDL-C concentration < 40 mg/dL
D
54. The function of the very low density lipoproteins (VLDL) is to transport: A. Cholesterol from peripheral cells to the liver B. Cholesterol and phospholipids to the peripheral cells C. Exogenous triglycerides D. Endogenous triglycerides
D
6. You are working in a clinical chemistry laboratory and are analyzing a plasma glucose sample. The sample is flagged by the analyzer for being "outside of linear range." You manually dilute the sample 1:2 and rerun it. Again, you receive an "outside linear range" alert. You decide to perform a different manual dilution. This time you manually dilute the original sample again; this time using a 1:3 dilution. The instrument gives you a glucose value of 150 mg/dL from this diluted sample. What is the actual patient glucose result that you should report to the physician? A. 100 mg/dL B. 400 mg/dL C. 600 mg/dL D. 450 mg/dL
D
71. Fetal lung maturity can be determined from amniotic fluid because the surfactant is PRIMARILY composed of: A. Protein B. Cholesterol C. Glycerol D. Phosphatidylcholine and other phospholipids
D
11. All of the following carbohydrates are considered reducing sugars EXCEPT: A. Lactose B. Sucrose C. Glucose D. Ribose
B
99. 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)? A. Cardiovascular disease B. Hepatitis C. Post-hepatic cholestasis D. Renal failure
C
40. A patient has a fasting plasma glucose (FPG) performed at an outpatient laboratory. He has fasted as instructed. FPG: 135 mg/dL What does this result indicate and what, if any, further action is recommended by the ADA? A. Elevated FPG; needs further evaluation by a repeat or alternative test B. Decreased FPG; a repeat of the test is recommended in one year C. Sufficient documentation for diagnosis of diabetes D. Needs no further evaluation; this is a normal FPG
A
41. When evaluating a 2-hour glucose tolerance test report performed on a pregnant woman, which of the following results is considered NORMAL (within range for this test)? A. A 2-hour glucose level is less than 140 mg/dL B. A 2-hour glucose level is less than 10 mg/dL C. A 2-hour glucose level greater than 153 mg/dL D. No change in glucose values during 2-hour glucose tolerance test
A
42. ß-hydroxybutyric acid is formed as the result of an accumulation of which of the following? A. Acetyl-CoA B. Oxaloacetic acid C. Uric acid D. Alpha-hydroxybutyric acid
A
47. Which of the following conditions would make a sample unsuitable for lactic acid testing? A. Movement of hand or arm during specimen collection. B. Received in the laboratory on ice. C. Centrifuged in a refrigerated centrifuge. D. Specimen centrifuged and plasma separated from cells less than 15 minutes after collection.
A
48. A test for microalbuminuria is used most often to monitor patients with which of the following diseases or conditions? A. Diabetes B. Bacterial infection C. Multiple myeloma D. Hepatitis C
A
49. Which of the following methods for long-term diabetic monitoring is recommended for patients with sickle cell anemia? A. Fructosamine B. Hemoglobin A1c (HbA1c) C. Both methods are acceptable. D. Neither method is acceptable.
A
56. Which of the following apolipoproteins contributes the greatest mass to the structure of high-density lipoprotein (HDL)? A. Apo A B. Apo B C. Apo C D. Apo G
A
59. Which of the following is the correct calculation using the Friedewald calculation for LDL? A. LDL = total cholesterol - HDL - triglycerides/5 B. LDL = triglycerides/5 + HDL - total cholesterol C. LDL = total cholesterol + HDL - triglycerides/5 D. LDL = total cholesterol + HDL + triglycerides/5
A
64. Which type of lipoprotein is the least dense? A. Chylomicrons B. VLDL C. LDL D. HDL
A
67. Which of the following statements is true regarding cardiovascular disease and adipose tissue? A. Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease. B. Increased synthesis and secretion of PAI-1 in metabolic syndrome contributes to cardiovascular disease by increasing blood pressure. C. Obesity in metabolic syndrome contributes to the development of cardiovascular disease by increased synthesis and secretion of adiponectin. D. There is no correlation between the amount of adipose tissue and cardiovascular disease.
A
68. A routine laboratory workup is ordered for an outpatient. The patient's lipid results are as follows: Total cholesterol = 295 mg/dL HDL = 30 mg/dL Triglycerides = 200 mg/dL What is the LDL cholesterol level for this patient? A. 225 mg/dL B. 65 mg/dL C. 365 mg/dL D. 255 mg/dL
A
73. Select the true statement regarding lipids and heart disease. A. Increased level of LDL-C indicates an increased risk for cardiovascular disease B. Increased level of HDL-C indicates an increased risk for cardiovascular disease C. Lipids are not involved in atherosclerotic plaque formation D. Lipids are no longer measured in evaluating cardiac disease risk
A
76. Which one of the following statements about lipoproteins is FALSE: A. Elevated LDL causes a decreased risk of atherosclerosis B. Reduced LDL causes a decreased risk of atherosclerosis C. Elevated HDL causes a decreased risk of atherosclerosis D. Elevated total cholesterol causes an increased risk of atherosclerosis
A
82. Which of the following lipid tests is LEAST affected by the fasting status of the patient? A. Cholesterol B. Triglyceride C. Fatty acids D. Lipoproteins
A
83. 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 maintains a good diet and nutrition. Her physician orders a lipid panel and hs-CRP to evaluate her cardiac disease risk. Cholesterol - 189 mg/dL(< 200 mg/dL) Triglyceride - 140 mg/dL(< 150 mg/dL) LDL- cholesterol - 98 mg/dL (< 100 mg/dL (optimal)) HDL-cholesterol - 60 mg/dL(> 59 mg/dL (optimal)) hs-CRP - 0.9 mg/dL (< 1 mg/dL (low risk)) Based on age, history, and laboratory results, what is her risk of cardiac disease at this point? A. Low risk B. Moderate risk C. High risk D. No risk
A
10. A Comprehensive Metabolic Panel (CMP) consists of which group of tests? A. Cholesterol, Lipoprotein, HDL, Triglycerides B. Albumin, Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, AST, ALT, Alkaline Phosphatase, Total Protein, Total Bilirubin, Calcium C. Potassium, Sodium, Chloride, CO2 D. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin
B
100. What is the group of diseases called where there is a deficiency in the enzyme(s) involved in hemoglobin synthesis? A. Sideroblastic anemia B. Porphyrias C. Iron deficiencies D. Hemochromatosis
B
15. A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose? A. 65 mg/dL B. 93 mg/dL C. 120 mg/dL D. 180 mg/dL
B
18. The American Diabetes Association (ADA) guidelines recommend screening all asymptomatic individuals age 45 and older for diabetes. If the screen is negative: A. This patient will never require another screening. B. The screening should be repeated every 3 years. C. The screening should be repeated every 3 months. D. The screening should be repeated every year.
B
20. Review patient vital signs and laboratory assay results to decide if a diagnosis of metabolic syndrome is appropriate using the NCEP: ATP III Diagnostic Criteria shown on the right. Height: 5' 7' Weight: 192 lbs BMI: 30.1 Waist Circumference: 37 inches Blood Pressure: 108/70 Fasting Blood Glucose: 92 mg/dL Total Cholesterol: 172 mg/dL LDL-C: 112 mg/dL HDL-C: 46 mg/dL Triglycerides: 70 mg/dL hs-CRP: <1.0 mg/L Which of these statements regarding this patient is true? A. This patient meets the criteria for diagnosis of metabolic syndrome. B. This patient does not meet the criteria for diagnosis of metabolic syndrome. C. There is not enough information provided in order to assess such diagnosis. D. The patient does not meet the age requirements for assessing the diagnosis of metabolic syndrome.
B
21. Whole blood glucose values are ____________ plasma glucose values. A. About 40% higher B. About 11% lower C. About 80% lower D. Equal to
B
24. A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose test at time of evaluation and a HbA1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes. What would be the best course of action if these are the blood glucose test results? Casual Plasma Glucose: 208 mg/dL HbA1C one week later: 7.2% A. Order insulin levels; if decreased, diagnose diabetes B. Patient meets criteria for diagnosis of diabetes C. Order a C-peptide for diagnosis D. The patient is at risk for diabetes (pre-diabetic); monitor for diabetes with yearly FPG levels
B
25. Which of the following would be considered a normal value for a glucose level in cerebrospinal fluid? A. 30 mg/dL B. 60 mg/dL C. 120mg/dL D. 150 mg/dL
B
26. A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/µL Differential: 88% neutrophils 12% lymphocytes Glucose: 15 mg/dL Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider? A. Brain tumor B. Bacterial meningitis C. Viral meningitis D. Subdural hematoma
B
29. After experiencing extreme fatigue and polyuria, a patient's basic metabolic panel is analyzed in the laboratory. The result of the glucose is too high for the instrument to read. The laboratorian performs a dilution using 0.25 mL of patient sample to 750 µL of diluent. The result now reads 325 mg/dL. How should the techologist report this patient's glucose result? A. 325 mg/dL B. 1300 mg/dL C. 975 mg/dL D. 1625 mg/dL
B
30. Which of the following statements about diagnosing gestational diabetes is true? 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. All pregnant women (diabetic or non-diabetic) should be screened at 24 to 28 weeks gestation.
B
31.At medical examination, a 50-year-old Caucasian male expressed concern regarding diabetes. There is a history of type 2 diabetes, hypertension, and cardiovascular disease in his family. He has gained a few pounds each year and his physician notes abdominal obesity. His physician orders laboratory tests to evaluate his risk of cardiovascular disease. Vital Signs and Pertinent Laboratoy Results: Blood Pressure: 128/82 mm Hg Weight: 230 lbs Height: 5' 11'' Calculated BMI: 32.1 Waist Circumference: 45 inches Fasting Blood Glucose: 120 mg/dL Triglycerides: 170 mg/dL HDL-C: 42 mg/dL Which one of the following statements regarding this patient is true if the physician uses the guidlines of American Heart Association (AHA) and National Heart, Lung, Blood Institute (NHLBI) for metabolic syndrome evaluation? A. Diagnosis of metabolic syndrome; waist circumference, HDL-C, and fasting blood glucose meet the criteria B. Diagnosis of metabolic syndrome; waist circumference, triglyceride level, and fasting blood glucose meet the criteria C. Does not meet the criteria for diagnosis of metabolic syndrome because the HDL-C is not <40 mg/dL D. Cannot make conclusion regarding metabolic syndrome because the LDL-C was not assayed
B
32. Which of the following conditions is associated with a positive ketone test on the urine test strip? A. Renal calculi B. Diabetes mellitus C. Hepatitis/cirrhosis D. Urinary tract infection
B
33. 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 was 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 = 20 mm 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 (negative) Urine glucose strongly positive (negative) *Reference ranges in ( ) A. Because the patient is in a coma, it has been a 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 level causes water to go inside the cell to equilibrate with the extracellular fluid. D. None of the above
B
34. The formula for conversion of hemoglobin A1C (HbA1C) to glucose in mg/dL is eAG = (28.7 x A1C) - 46.7. The HbA1C measured on a patient is reported as 7.5%. What would be reported as the estimated average glucose (eAG) for this % A1C (rounded to the nearest whole number)? A. 142 mg/dL B. 169 mg/dL C. 200 mg/dL D. 262 mg/dL
B
36. Which of the following patients is most at risk for hyperosmolar nonketotic coma? A. A 60-year-old type 1 diabetic patient B. A 70-year-old type 2 diabetic patient C. A 15-year-old type 1 diabetic patient D. A 25-year-old type 2 diabetic patient
B
44. In which of the following condition(s) would an increased serum osmolality be an expected finding? A. Increased arginine vasopressin hormone (AVP formerly ADH) secretion B. Diabetes insipidus C. Hyponatremia D. Acute myocardial infarction
B
58. Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis? A. Large buoyant LDL B. Small dense LDL C. LDL phenotype 'A' D. VLDL
B
62. The lecithin to sphingomyelin ratio (L/S) is used to assess: A. Fetal neurological development B. Fetal lung maturity C. Fetal viability D. Fetal liver development
B
65. Which of the following tests require a 72 hour stool (fecal) collection? A. Occult blood B. Quantitative fecal fat C. Ova and Parasite (O&P) D. Stool culture
B
66. What conclusion can be made if a person has a cardiovascular risk marker that is abnormal? A. The person will have a cardiovascular event within the next 12 - 24 months. B. The person has an increased probability of developing cardiovascular disease. C. The person has a decreased probability of developing cardiovascular disease. D. With only one abnormal marker, the person is not at risk of developing cardiovascular disease.
B
70. Which of the following lipid results would be expected to be FALSELY elevated on a serum specimen from a non-fasting patient? A. Cholesterol B. Triglyceride C. HDL D. LDL (not calculated)
B
79. Which lipid does not serve as a source of fuel, but can be converted to steroid hormones? A. Fatty acids B. Cholesterol C. Triglycerides D. Phospholipids
B
80. Which of the following statements is true concerning apolipoproteins? A. All lipoprotein particles contain the same apolipoproteins. B. Apolipoproteins are essential for lipid metabolism. C. Apolipoproteins are the reason lipoproteins are atherogenic. D. Apolipoproteins are a type of cholesterol
B
81. Lipemia in a fasting serum sample is most likely caused by an increase in serum levels of: A. Cholesterol B. Triglycerides C. Protein D. Phospholipids
B
95. What is the name of the colorless end product of bilirubin catabolism? A. Urobilin B. Urobilinogen C. Mesobilirubin D. Mesobilirubinogen
B
96. A normal hemoglobin molecule is comprised of the following: A. Ferrous iron and four globin chains B. Four heme and four globin chains C. Four heme and one globin chains D. One heme and four globin chains
B
97. Which condition is caused by deficient secretion of bilirubin into the bile canaliculi? A. Gilbert's disease B. Neonatal hyperbilirubinemia C. Dubin-Johnson syndrome D. Crigler-Najjar syndrome
C
2. All of the following are characteristics of type 2 diabetes mellitus EXCEPT: 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
C
22. What is a hemiacetyl? A. A compound with a carbonyl group B. A compound with an alcohol C. A compound with both a carbonyl and alcohol group. D. A compound that is part ketone
C
37. From the groups of analytes below, which set would most likely be INCREASED in a type 1 diabetic patient in crisis? A. Insulin and blood glucose B. Insulin and ketone bodies C. Ketone bodies and blood glucose D. Ketone bodies and blood pH
C
38. The National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA) have created a set of parameters to define the presence of metabolic syndrome. Select the set of laboratory assays that are utilized in the NHLBI and AHA criteria for metabolic syndrome diagnosis. A. LDL-C, triglycerides, HDL-C, and fasting blood glucose B. Fasting blood glucose, triglycerides, insulin, and VLDL C. Fasting blood glucose, triglycerides, HDL-C D. Fasting blood glucose, triglycerides, HDL-C, and VLDL
C
43. A 56-year old female was taken to the emergency room in a coma by her employer's 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: Results: (indicates reference range) pH: 7.11 (7.35-7.45) pCO2: 21 mm Hg (35-45 mm Hg) Glucose: 950 mg/dL (60-110 mg/dL) Serum osmolality: 365 mOsm/Kg (275-295 mOsm/Kg) Urine ketone: strongly positive (negative) Urine glucose: strongly positive (negative) What is the MOST likely cause of this patient's symptoms? A. Gestational diabetes B. Diabetes insipidus C. Insulin dependent diabetes mellitus D. Type II diabetes mellitus
C
45. A Basic Metabolic Panel (BMP) consists of which group of tests? A. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin B. Cholesterol, Lipoprotein, HDL, Triglycerides C. Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium D. Potassium, Sodium, Chloride, CO2
C
46. Maltose, lactose and sucrose are all: A. Reducing substances B. Oligosaccharides C. Disaccharides D. Monosaccharides
C
50. Which lipid abnormality is most closely linked to heart disease? A. Hypobetalipoproteinemia B. Hypertriglyceridemia C. Hypercholesterolemia D. Abetalipoproteinemia
C
52. Which of the following lipoproteins will form a creamy layer at the top of stored, non-fasting plasma specimens? A. High-density lipoproteins B. Low-density lipoproteins C. Chylomicrons D. Very low-density lipoproteins
C
55. Which type of lipoprotein transports the MAJORITY of cholesterol to cells for steroid hormone synthesis or cell membrane incorporation? A. Chylomicrons B. Very low density lipoproteins (VLDL) C. Low density lipoproteins (LDL) D. High density lipoproteins (HDL)
C
57. A patient has optimal LDL and HDL cholesterol values but a hsCRP test shows a value of 12 mg/L (low cardiovascular risk < 1.0 mg/L). Which of the following situations is most likely? A. The patient has a masked lipid problem such as metabolic syndrome. B. The patient has not been fasting. C. The patient has an underlying acute inflammation process. D. The patient has been drinking too much water before the specimen was collected, therefore diluting the LDL and HLD values.
C
63. Cholesterol is used by the body for which of the following functions? A. Carrying dietary triglycerides to the cells through the blood B. Maintaining acid-base balance C. Precursor of hormone synthesis D. Major source of fuel for the body
C
69. Which of the following statements is true regarding cardiovascular disease and adipose tissue? A. Obesity in metabolic syndrome contributes to the development of cardiovascular disease by increased synthesis and secretion of adiponectin B. Increased synthesis and secretion of PAI-1 in metabolic syndrome contributes to cardiovascular disease by increasing blood pressure C. A state of abnormal lipids and lipid levels found in metabolic syndrome contribute to the development of cardiovascular disease D. None of the above
C
7. A HbA1C result for a diabetic patient is 6.0%. What conclusion can be made regarding this patient's carbohydrate management? A. The results are inconclusive and should be repeated with a different method. B. The patient is probably not following dietary recommendations. C. The patient is compliant with diet and medication. D. The result is critical and patient should be immediately treated for hyperglycemia.
C
74. The Lecithin/Sphingomyelin (L/S) ratio determination of amniotic fluid is useful in assessing the probability of: A. Cystic fibrosis B. Phenylketonuria C. Respiratory distress syndrome D. Chromosomal abnormalities
C
8. Which one of the following statements best describes hemoglobin A1c (HbA1c)? A. A glycated protein formed from the reversible addition of a glucose molecule to HbA. B. A glycated protein that is an index of carbohydrate management over a 24-hour period. C. A glycated protein that is an index of carbohydrate management over 2 - 3 months. D. A glycated protein formed from the nonenzymatic addition of a glucose molecule to albumin.
C
94. A jaundiced newborn's bilirubin values are as follows: 12/28/2015 7:45 am 14 mg/dL 12/29/2015 7:15 am 13 mg/dL 12/30/2015 8:00 am 4 mg/dL What is the explanation for these test results? A. This is a case of diurnal variation, the specimens should have been collected at the exactly the same time for all three days. B. The ultraviolet light placed on the newborn broke down the bilirubin and dramatically decreased the value. C. The specimen was not protected from light and bilirubin broke down resulting in a false decreased value. D. These are normal test results, there should be no concern.
C
39. A Renal Function Panel consists of which of the following tests? A. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin B. Cholesterol, Lipoprotein, HDL, Triglycerides C. Potassium, Sodium, Chloride, CO2 D. Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus
D
60. Why are small dense LDL molecules more atherogenic? 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.
D
61. What are apolipoproteins? A. Small spheres that carry lipids through the blood that aid in lipid transport to their sites of metabolism. B. Proteins that are found on only high-density lipoproteins. C. Pseudo-proteins, since lipid particles are not alive and thus cannot make proteins. D. Proteins that are on the surface of lipoprotein molecules that bind enzymes or transport specific proteins and direct lipoproteins to their sites of metabolism.
D
72. With the development of fetal lung maturity, which of the following phospholipid concentrations in amniotic fluid increases? A. Sphingomyelin B. Phosphatidyl ethanolamine C. Phosphatidylinositol D. Lecithin
D
86. 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. A. 172 mg/dL B. 140 mg/dL C. 238 mg/dL D. 220 mg/dL
D
89.Which enzyme is responsible for the conjugation of bilirubin? A. Beta-Glucuronidase B. Bilirubin oxidase C. Bilirubin reductase D. Glucuronyl transferase
D
98. Elevation in conjugated bilirubin is most likely to be found in which of the following conditions? A. Transfusion reactions B. Erythroblastosis fetalis C. Crigler-Najjar syndrome D. Biliary obstruction
D
