exam 5 clin chem
Which of the following is an oncofetal antigen? a. AFP b. CA-125 c. β-hCG d. CEA
AFP
6. Which of the following conditions are related to acidosis in the newborn? a. Anoxia and trauma during delivery b. Respiratory distress syndrome c. Hyperammonemia caused by liver disease d. Hyperventilation
a. Anoxia and trauma during delivery
2. How much blood should be drawn at any one time from a 7-lb baby? a. No more than 2.5 mL b. No more than 10 mL c. No more than 20 mL d. No more than 1.0 mL
a. No more than 2.5 mL
5. Point-of-care testing is helpful when a. Results are needed quickly b. Only small sample sizes are available c. The device can be linked to the hospital LIS d. Quality control samples are not needed
a. Results are needed quickly
cerebrospinal fluid perform which of the following functions? -buoyant cushion for the brain -supplies nutrients to the central nervous system -removes waste -intracerebral and extracerebral transport -all of the above
all
4. High blood ammonia levels result in a. Respiratory acidosis b. Metabolic acidosis c. Metabolic alkalosis d. Respiratory alkalosis
d. Respiratory alkalosis
Of the following statements concerning lithium, which is TRUE? a. All of these are true. b. Lithium concentration in serum is most commonly evaluated by ion-specific electrode. c. Lithium is an element d. Lithium is an element,and the lithium concentration in serum is most commonly evaluated by ion-specific electrode. e. Lithium is used as a drug to treat depression and mania.
(A) All of these are true.
4. A weakly acidic toxin (p K a = 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. Not be absorbed unless a specific transporter is present d. Be passively absorbed in the colon (pH = 7.5) e. Be absorbed only if a weak base is ingested at the same time
(A) Be passively absorbed in the stomach (pH = 3.0)
5. What is the primary product of methanol metabolism by the ADH and ALDH system? a. Formic acid b. Acetone c. Acetaldehyde d. Oxalic acid e. Formaldehyde
(A) Formic acid
Compound A is reported to have an oral LD 50 of 5 mg/kg body weight. Compound B is reported to have an LD 50 of 50 mg/kg body weight. Of the following statements regarding the relative toxicity of these two compounds, which is TRUE? a. Ingestion of low amounts of compound A would be predicted to cause more deaths than an equal dose of compound B. b. Ingestion of compound B would be expected to produce nontoxic effects at a dose greater than 100 mg/kg body weight. c. Neither compound A nor compound B is toxic at any level of oral exposure. d. Compound A is more rapidly adsorbed from the gastrointestinal tract than compound B. e. Compound B would be predicted to be more toxic than compound A if the exposure route were transdermal.
(A) Ingestion of low amounts of compound A would be predicted to cause more deaths than an equal dose of compound B.
Of the following statements concerning procainamide, which is TRUE? a. All of these are true. b. N-Acetylprocainemide is an active product of procainamide metabolism c. Procainamide is an antibiotic d. Procainamide is an antibiotic and the primary toxicity of procainamide is bone marrow suppression. e. The primary toxicity of procainamide is bone marrow suppression.
(B) N-Acetylprocainemide is an active product of procainamide metabolism
7. Primidone is an inactive preform of which of the following antiepileptic drugs? a. Gabapentin b. Clozapine c. Phenobarbital d. Ethosuximide
(C) Phenobarbital
4. Which of the following statements concerning procainamide is TRUE? a. Procainamide should be administered intravenously due to poor absorption. b. Procainamide is an antibiotic used to treat gram-positive bacterial infections. c. Procainamide is metabolized into an active metabolite with similar antiarrhythmic activity. d. Procainamide is eliminated entirely through renal filtration.
(C) Procainamide is metabolized into an active metabolite with similar antiarrhythmic activity.
A patient who has been successfully receiving genatamycin for the past 2 weeks has suddenly developed a renal condition in which the glomerular filtration rate has significantly decreased. What would be the expected dose adjustment in response to this? a. No dose adjustment is required. b. Phenobarbital should be coadministered to stimulate hepatic metabolism. c. The dosage should be increased. d. The drug should be discontinued. e. The time interval between dosages should be increased.
(D) The drug should be discontinued.
What is the lifetime risk for women dying of cancer? a. 19% b. 23% c. 43% d. 59%
19%
3. Of the following analytic methods, which is most commonly used as the confirmatory method for identification of drugs of abuse? a. GC with mass spectrometry b. Scanning differential calorimetry c. Ion-specific electrode d. Immunoassay e. Nephelometry
(A) GC with mass spectrometry
6. 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 a toxic effect. d. Cyanide expresses its toxicity by inhibition of oxidative phosphorylation. e. All of these are 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.
5. Which of the following statements concerning lithium is TRUE? a. Lithium is used to treat depression, self-mutilating behavior, and bipolar disorder. b. Lithium toxicity has been associated with ototoxicity and nephrotoxicity. c. Lithium is completely metabolized in the liver with no renal elimination. d. Lithium is used in conjunction with cyclosporine to prevent transplant rejection.
(A) Lithium is used to treat depression, self-mutilating behavior, and bipolar disorder.
10. 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 the physician rule out drug overdose as the cause of this coma with these results? a. No b. Yes c. Maybe
(A) No
9. A patient with suspected organophosphate poisoning presents with a low SChE level. However, the confirmatory test, erythrocyte acetylcholinesterase, presents with a normal result. Excluding analytic error, which of the following may explain these conflicting results? a. The patient has late-stage hepatic cirrhosis or the patient has a variant of SChE that displays low activity. b. The patient has late-stage hepatic cirrhosis. c. The patient was exposed to low levels of organophosphates. d. The patient has a variant of SChE that displays low activity. e. All of these are correct.
(A) The patient has late-stage hepatic cirrhosis or the patient has a variant of SChE that displays low activity.
8. A child presents with microcytic, hypochromic anemia. The physician suspects iron deficiency anemia. Further laboratory testing reveals a normal total serum iron and iron-binding capacity; however, the zinc protoporphyrin level was very high. A urinary screen for porphyrins was positive. Erythrocytic basophilic stippling was noted on the peripheral smear. Which of the following laboratory tests would be best applied to this case? a. Whole blood lead b. Urinary thiocyanate c. COHb d. Urinary anabolic steroids e. Urinary benzoylecgonine
(A) Whole blood lead
1. If drug X has a half-life ( T 1/2 ) of 2 days (48 hours) and the concentration at 12:00 today was 10 μg/mL, what would the expected concentration of drug X be at 12:00 tomorrow? a. 7 μg/mL b. 7.5 μg/mL c. 5 μg/mL d. 3.5 μg/mL
(B) 7.5 μg/mL
8. Bilirubin competes with some drugs for the same binding site on plasma proteins. What effect would an increased concentration of bilirubin in the blood (bilirubinemia) have on the potential activity of this drug? a. The fraction of bound drug would increase thereby increasing potential activity. b. The fraction of bound drug would decrease thereby decreasing potential activity. c. The fraction of bound drug would decrease thereby increasing potential activity. d. The fraction of bound drug would increase thereby decreasing potential activity.
(C) The fraction of bound drug would decrease thereby increasing potential activity.
9. Twenty milligrams (mg) of drug Y is injected intravenously. One hour after the injection, blood is collected and assayed for the concentration of drug Y. If the concentration of drug Y in this specimen was 0.4 mg/L, what is the volume of distribution for this drug? a. 0.8 L b. 8 L c. 20 L d. 50 L
(D) 50L
2. If a drug is administered orally, which of the following would affect the efficiency of its absorption in the gastrointestinal tract? a. Dissociation of the drug from its administered form b. The drug's solubility in gastrointestinal fluid c. Diffusion of the drug across gastrointestinal membranes d. All of the above
(D) All of the above
10. A new orally administered drug has been introduced in your institution. It is unclear whether TDM is needed for this drug. What factors should be taken into consideration when addressing this question? a. Proximity of the toxic range to the therapeutic range. b. Consequences of a subtherapeutic concentration. c. Predictability of serum concentrations after a standard oral dose. d. All of the above should be taken into consideration.
(D) All of the above should be taken into consideration.
3. If a trough specimen is required for therapeutic drug monitoring, the most appropriate time to collect the specimen would be: a. Eight hours after the last dose was given b. Three days after the dose was administered c. Immediately after the dose is administered d. Immediately before the next dose is given
(D) Immediately before the next dose is given
6. Which of the following is the primary purpose for measuring serum concentrations of methotrexate? a. To determine the optimum dosage for oral administration of methotrexate b. To ensure that serum concentrations are within the therapeutic range c. To confirm serum concentrations toxicity is suspected d. To determine the amount of leucovorin needed to halt methotrexate action
(D) To determine the amount of leucovorin needed to halt methotrexate action
Salicylate and bilirubin compete for the same binding sites on serum albumin. What effect would prehepatic jaundice have on salicylate? a. All of these b. A decrease in the pharmacologic response to salicylate. c. An increase in the free concentration of salicylate. d. An increase in the rate of clearance of salicylate e. An increase in the rate of clearance of salicylate and an increase in the free concentration of salicylate.
(E) An increase in the rate of clearance of salicylate and an increase in the free concentration of salicylate.
7. Which of the following laboratory results would be consistent with acute high-level oral exposure to an inorganic form of mercury (Hg 2+ )? a. All of these b. High concentrations of mercury in whole blood and urine c. Proteinuria d. Positive occult blood in stool e. None of these
(E) None of these
Tumor marker tests are used to: a) Aid in staging of cancer b) Monitor response to therapy c) Detect recurrent disease Correct Response d) All of the above
(all) Aid in staging of cancer, monitor response to therapy, Detect recurrent disease
SA measurements were obtained from two male patients who were being monitored over an 18-week period.Which of the following statements most accurately describes these data? a. Patient A may have a more aggressive prostate cancer based on the velocity of these measurements. b. Patient A is most likely to have benign prostate cancer. c. Patient B is most likely to be experiencing an inflammatory reaction, and this is largely contributing to the elevated PSA above 100 ng/mL. d. Patient B may have a more aggressive prostate cancer based on the velocity of these measurements. e.Answers a and c most accurately describe these data
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2. Which of the following statements best describes the TD 50 of a compound? a. The dosage of a substance that would be predicted to cause a toxic effect in 50% of the population b. The dosage of a substance that is lethal to 50% of the population c. The dosage of a substance that would produce therapeutic benefit in 50% of the population d. The percentage of individuals who would experience a toxic response at 50% of the lethal dose e. The percentage of the population who would experience a toxic response after an oral dosage of 50 mg
A (The dosage of a substance that would be predicted to cause a toxic effect in 50% of the population )
which of the following methods is commonly used to measure endocrine metabolites? a. Protein electrophoresis b. Immunoassays c. HPLC d. Electrochemistry e. Gas chromatography
B maybe ?????
Tumor markers may be defined as: a. Biologic substances synthesized and released by cancer cells or substances produced by the host in response to cancer cells b. Analytic tests (e.g., immunoassays) used to mark cancer cells c. Radioactive substances and chemicals used to help the physician identify cancer cells d. none
Biologic substances synthesized and released by cancer cells or substances produced by the host in response to cancer cells
Assessing the integrity of the blood-brain barrier can be accomplished using which of the following ratios? -CSF IgG/CSF albumin -CSF albumin/serum albumin -CSF albumin/CSF IgG -Serum albumin/CSF albumin
CSF albumin/serum albumin
Lamellar body counts indicate a. Surfactant phospholipid packets b. A ratio of lecithin to sphingomyelin c. Direct measure of phosphatidylglycerol levels d. Amniotic fluid bilirubin levels e. Meconium count of the fetus
D//maybe
A serum PSA is used for all of the following except: a. Diagnosis b. Screening c. Monitoring response d. Detecting recurrence
Diagnosis
Which of the following enzymes is commonly used as a tumor marker? a. LD b. Lipase c. PSA d. ALT
LD
The most clinical use for CA-125 is monitoring treatment response of:
Ovarian carcinoma
When measuring tumor markers in the clinical laboratory. Which of the following has been reported to contribute to 30% to 70% of the total amount of measurement error? a. Preanalytical errors b. Analytical errors c. Hook effect d. Using different immunoassay methods e. Not comparing lot numbers between ELISA kits metabolites?
Pre-analytical errors
What are the major limitations of tumor markers a. Sensitivity and specificity b. Cost c. Turnaround time
Sensitivity and specificity
The most common immunoassays used to measure PSA detect which form of the enzyme? a. Total PSA b. Free PSA c. PSA complexed with α1-antichymotrypsin d. PSA complexed with α2-macroglobulin
Total PSA
Pleural fluid is collected via a. Thoracentesis b. Paracentesisc. c. Pericardiocentesis d. Spinal tape. e.None of the above
a
8. Tandem mass spectrometry can be used to detect a. 25 to 30 metabolic diseases b. Cystic fibrosis c. Combined immune deficiency d. Panhypopituitarism
a. 25 to 30 metabolic diseases
9. Aminoglycoside drug levels, such as gentamicin, should be measured a. 30 minutes after a dose b. 3 hours after a dose c. At steady state d. At any time
a. 30 minutes after a dose
13. Given the following information, calculate the creatinine clearance using the Cockcroft-Gault formula: Age = 85; weight = 70 kg; sex = male Serum creatinine = 1.0 mg/dL a. 53 b. 72 c. 47 d. 35
a. 53
3. Under normal conditions, what is the maximum amount of blood that should be drawn from a 30-kg child during a single blood draw? a. 60 mL b. 80 mL c. 40 mL d. 20 mL
a. 60 mL
12. Hearing loss is common among the elderly and may cause embarrassment. What should be done to facilitate the specimen collection process? a. Adjust your position to speak into the ear with the best hearing. b. Speak very loud and forcefully. c. Don't speak at all. Just give the patient printed instructions. d. Use a microphone.
a. Adjust your position to speak into the ear with the best hearing.
11. Which could account for drug toxicity following a normally prescribed dose? a. All of these b. Decreased renal clearance by the kidney c. Altered serum protein binding d. Liver impairment
a. All of these
3. When choosing a chemistry analyzer for a pediatric laboratory, it is necessary to a. Be able to analyze from small volumes b. Have rapid turnaround c. Have an extensive menu d. Have front-end automation
a. Be able to analyze from small volumes
1. Which of the following occurs in an infant immediately after birth? a. Closure of the ductus arteriosus and adult respiration b. Normal hepatic function and bilirubin metabolism c. Adult rates of glomerular filtration by the kidneys d. Normal water homeostasis
a. Closure of the ductus arteriosus and adult respiration
5.The most commonly used method for determination of vitamin B12 is a. Competitive protein-binding RIA b. Chemiluminescence assay c. Magnetic separation immunoassay d. HPLC
a. Competitive protein-binding RIA
7. Which of the following are characteristics of renal development and function during the neonatal period? a. Control the rate of salt and water loss and retention b. GFR about 50% of the rate seen in older children c. Completelydevelopedby24weeksofgestation d. Have a maximum solute concentrating power of approximately 30% of an adult kidney
a. Control the rate of salt and water loss and retention
9. Laboratory monitoring of the patient on TPN therapy is important to avoid possible complications. Which of the following trace elements should be monitored on a weekly basis? a. Copper b. Selenium c. Molybdenum d. Chromium
a. Copper
7. Metabolic syndrome is a complex disorder with many parameters to measure. Which of the following is NOT needed to assess metabolic syn- drome? a. Elevated HDL cholesterol b. Elevated triglyceride levels c. Elevated fasting glucose d. Elevated blood pressure
a. Elevated HDL cholesterol
7. The pituitary secretes which of the following hormones (more than one answer is possible)? a. Growth hormone b. Testosterone c. Insulin-like growth factor d. Thyroid-stimulating hormone
a. Growth hormone
6. Which of the following immunoglobulins is provided to a new baby by the mother? a. IgG b. IgD c. IgM d. IgA
a. IgG
14. Glucose intolerance, abnormal cholesterol level, high blood pressure, and upper body obesity are characteristics of a. Insulin resistance b. Chronic inflammatory disease c. Coronary heart disease d. Cerebrovascular disease
a. Insulin resistance
6. The term describing patients who are chronically calorie malnourished and lose both adipose and muscle tissue, but who do not demonstrate a pro- tein deficiency, is a. Marasmus b. Kwashiorkor c. Debilitated d. None of these
a. Marasmus
10. Which condition is least likely to be associated with increased alkaline phosphatase levels? a. Osteoporosis b. Paget's disease c. Hyperparathyroidism d. Osteomalacia
a. Osteoporosis
5.Which of the following is true regarding POCT? a. Results are generally available more rapidly than with traditional laboratory tests. b. POCT is usually less expensive than tradi- c. The device cannot be linked to the hospital information system. d. Quality control samples are not needed.
a. Results are generally available more rapidly than with traditional laboratory tests.
Which of the following statements about the neo- natal thyroid system is true? a. Secondary hypothyroidism is usually diag- nosed by measuring a low TSH level. b. Thyroid hormones (T4 and T3) are less than 50% bound to thyroid-binding globulins. c. CH is a very rare and untreatable disorder. d. A low measured TSH level may be due to a global pituitary gland dysfunction (panhypo- pituitarism).
a. Secondary hypothyroidism is usually diagnosed by measuring a low TSH level.
2. Which of the following choices is false concerning blood obtained by heel stick (capillary) and veni- puncture (venous)? a. The chemical composition of the sera derived from each is identical. b. The capillary specimen is likely contaminated with interstitial fluid and tissue debris. c. Venous blood contains higher bilirubin and calcium concentrations. d. Capillary blood contains less concentrated proteins due to mixing with interstitial fluid.
a. The chemical composition of the sera derived from each is identical.
1. Which of the following describes the correct source, function, and deficient state of the vitamin listed? a. Thiamine (B1)—whole grains, carbohydrate metabolism, beriberi b. Vitamin E—plant tissues, antioxidant, osteo- malacia c. Niacin—meat, oxidation-reduction reactions, scurvy d. Folic acid—dairy products, myelin formation
a. Thiamine (B1)—whole grains, carbohydrate metabolism, beriberi
8. Which of the following nutritional markers has been found to be the most sensitive and helpful indicator of nutritional status in very ill patients? a. Transthyretin b. Transferrin c. Albumin d. Somatomedin C
a. Transthyretin
3. Which vitamin is a powerful antioxidant, protects the erythrocyte membrane from oxidative stress, and is found primarily in vegetable oils? a. Vitamin E b. Vitamin K c. Vitamin C d. Folic acid
a. Vitamin E
2. Which vitamin would be affected if a patient was diagnosed with a disorder involving fat absorption? a. Vitamin K b. Vitamin B12 c. Ascorbic acid d. Thiamine
a. Vitamin K
4. A 70-year-old man presented to his physician with a broken arm. Laboratory work indicated an elevated prothrombin time, with all other labora- tory results being normal. The man was also taking an antibiotic for an earlier respiratory infection. Which, if any, of the following vitamins might be involved? a. Vitamin K b. Vitamin D c. Biotin d. None of these
a. Vitamin K
1. All of the following represent normal physiology of the newborn except a. Weight of 2.4 kg b. Immature liver function and inability to eliminate excess bilirubin c. Closure of the ductus arteriosus and a shift of blood flow through the heart d. 4 to 6 months for the infant's body weight to double
a. Weight of 2.4 kg
Cystic fibrosis a.Is diagnosed by the measurement of elevated chloride concentration in sweat following iontophoresis b.Is a very uncommon genetic disease c.Is caused by only a single type of mutation in the CF transmembrane regulator (CFTR) gene d.Is characterized by thin, watery mucous secretional laboratory measurements tions in the lungs and pancreatic ducts
a.Is diagnosed by the measurement of elevated chloride concentration in sweat following iontophoresis
Clinical chemistry laboratory testing for the assessment of infectious meningitis may include all of the following test on CSF sample EXCEPT: -Glucose -Total Protein -Lactate -Glutamine -All of the above are good tests to run on CSF
all good tests
An exudative pleural effusion would exhibit which of the following laboratory results? e. F/P total protein ratio of 0.4 F/P LD ratio of 0.7 Fluid cholesterol of 35 mg/dL F/P cholesterol ratio of 0.1 F/P bilirubin ratio of 0.3
b
4. When choosing a chemistry analyzer for a pediatric laboratory, it is necessary to a. Incorporate total laboratory automation b. Be able to analyze from small volumes c. Have a rapid turnaround time d. Ensure a minimum specimen dead volume
b. Be able to analyze from small volumes
A tumor marker used in the assessment of chorio-carcinioma or hydatidiform mole is: a. β-hCG b. CEA c. AFP d. IgG
beta-hCG
a red CSF indicates what a. Cerebral hemorrhage b. Traumatic tap c. Bacterial meningitis d. cerebral hemorrhage or traumatic tap
cerebral hemorrhage or traumatic tap
CF is characterized by a. Elevated sweat chloride levels b. Homozygous expression of an autosomal recessive trait c. Pancreatic insufficiency d. All of these e. None of these
d
The major clinical use for CA 15-3 is monitoring treatment response of a. Ovarian carcinoma b. Colorectal cancer c. Prostatic cancer d. Breast cancer
d
the high viscosity characteristic of normal synovial fluid samples is cause by a. Hyaluronic acid b. Hyaluronidase c. Elevated white blood cell counts d. The presence of crystals
hyaluronic acid
a transudate could be causes by all of the following except -CHF -lymphoma -renal failure -hepatic cirrosis -nephrotic syndrome
lymphoma
