MLT Clinical Chemistry Final

mean 6.9, median 7, mode 7

Calculate the mean, median, and mode for the following data set: 7, 9, 9, 5, 8, 7, 5

2:1

Carbohydrate are composed of carbon, hydrogen, and oxygen, what is the ratio of hydrogen to carbon?

filtration in the glomerulus

Clearance tests such as creatinine or inulin are best to measure what aspect of the kidney?

water excess

During states of ___________________ the tubules and collecting duct reabsorb very little water creating urine with a low osmolality.

urobilinogen

Ehrlich's reagent is commonly used to test for which compound?

ability to filter the blood

Creatinine clearance is a test used to evaluate what aspect of the kidneys?

albumin

Damage to the blood-brain barrier can be assessed by comparing the serum/CSF ratio of which protein?

Fanconi syndrome

Decreased levels of uric acid are seen with this condition? a. starvation b. chronic renal disease c. Fanconi's syndrome d. megaloblastic anemia

modification

Detoxification of substances, such as drugs or ammonia, by chemically changing the substance so it can be excreted is called_________________________.

Zymogens

Digestive enzymes circulate in inactive forms called __________________.

gluconeogenesis

During an extended fast (>1 day), the liver helps to maintain blood glucose levels by which process?

spina bifida

Elevated levels of a1 (alpha one)- fetoprotein in the fetus are indicative of what condition?

Jaffe reaction

The most common reaction used for the determination of creatine is the _____________________________.

ALP

A patient with osteitis deformans would be expected to have elevations in which enzyme?

biliary obstruction

A possible cause of posthepatic bilirubin elevation and jaundice would be:

falsely decreased

A sample for a blood urea nitrogen (BUN) level was drawn in a sodium fluoride anti-coagulated tube, what effect would this have on the test result? a. falsely increased b. no change c. falsely decreased d. all of the above

Unchanged lipase, decreased amylase

A patient comes to the ER with abdominal pain, the physician ordered an amylase, lipase, and lipid panel. The triglyceride result is significantly elevated, how might this effect the amylase and lipid levels? (thrown out)

ketones

A 17-year old female went on a starvation diet, after one week what substance would most likely be found in her urine?

Falsely increased

A grossly hemolyzed sample is received in the lab, what effect would this have on the total CK determination?

past infection

A high rubella IgG avidity indicates a __________________________.

sodium & potassium

Aldosterone helps to control the excretion and reabsorption of which ion to maintain electrolyte balance in the collecting duct? (not on final b/c 2 answers correct)

storage of genetic material

All of the following are functions of proteins except? a. acid-base balance b. catalysts c. energy d. storage of genetic material

synthesis of immunoglobulins

All of the following are functions of the liver except: a. synthesis of carbohydrates b. detoxification c. excretion and secretion d. synthesis of immunoglobulins

patient samples run along with QC

All of the following are reason for failed calibration except: a. dirty or damaged lamp b. significantly increased variance c. patient samples run along with QC d. blank results out of range

hypotension

All of the following are risk factors for developing chronic renal failure except: a. diabetes b. increase age c. hypertension d. hypotension

decreased urination

All of the following are symptoms of hyperglycemia except. a. excessive thirst b. dry skin c. drowsiness d. decreased urination

formalin

All of the following can give a false negative result for leukocyte esterase except: a. antibiotics b. high protein level c. formalin d. high levels of ascorbic acid

c. Myocardial infarction

All of the following conditions may result in a rise in CKBB levels except. a. Child birth b Spinal chord injury c. Myocardial infarction d. Brain tumor

liver failure

Ammonia levels can be used to monitor which condition? a. chronic kidney disease b. liver failure c. HIV d. brain tumors

shift

An abrupt change in the control mean is a:

cirrhosis

An irreversible scarring of the liver tissue blocking blood flow is a condition known as:

bilirubin

An orange color in a urine sample is most likely caused by which of the following? a. bacteria b. melanin c. bilirubin d. leukocyte esterase

45 years old

At what age does the ADA recommend beginning screening for diabetes every three years?

low birth rate

Babies born to mothers with uncontrolled gestational diabetes may be at risk for all of the following except. a. low birth rate b. hypocalcemia c. hyperbiliruinemia d. respiratory distress

inflammation

C-reactive protein is one of the first indicators of what?

creatine phosphate

Creatine is converted in the tissues to which high energy compound?

glomerulonephritis

Elevated levels of creatinine may be seen with all of the following except. a. pregnancy b. exercise c. glomerulonephritis d. high meat diet

LD

Elevation in this enzyme can be useful in diagnosing patients with hemolytic anemia?

Absolute binding

Enzymes that can bind only one substrate and catalyze one reaction exhibit which type of binding specificity?

storing the specimen protected from light until analysis can be done

Erroneous ammonia levels can be eliminated by all of the following except? a. assuring water and reagent are ammonia free b. drawing the specimen in a pre-chilled tube and immersing the tube in ice c. storing the specimen protected from light until analysis can be done d. separating plasma from the cells and performing analysis as soon as possible

tubular damage

Finding abnormal elevation of beta2-microglobulin in a urine sample is suggestive of what?

recovering alcoholics

GGT is an enzyme that can be used to help monitor the treatment of which patient population?

vitamin D

Gc_globulin is a major carrier protein for which compound?

moderate RBCs, rare WBCs, rare squamous epithelial cells

Given the following urine test results what would be expected in the urine sediment: -Color - amber -Clarity - cloudy -SG - 1.021 -pH-5.0 -Protein - trace -Glucose - negative -Ketones - negative -Blood- 2+ -Bilirubin - negative -Nitrate - negative -Luekocyte esterase - trace -Urobilinogen - 0.2mg/dL a. many bacteria, rare WBCs, rare mucus b. moderate RBCs, rare WBCs, rare squamous epithelial cells c. many WBCs, hyaline casts, few amorphous phosphate crysals d. few RBCs, moderate calcium carbonate crystals

growth hormone

High levels of glucose can inhibit this hormone and lead to delayed growth and development in children.

thrombolytic event

Homocystine levels are used to assess a patient's risk of what?

precision

How closely the points of a data set agree with each other is the definition for:

oral-fecal

How is hepatitis A transmitted?

2 hours

How long is an unpreserved urine sample good for when left at room temperature?

ammonium biurate

Identify the crystals in the urine sediment in photo: a. bilirubin b. ammonium biurate c. uric acid d. calcium oxalate

starch

Identify the following urine sediment artifact shown: a. fiber b. starch c. leucine d. dye crystal

yeast

Identify the sediment constituent pictured (arrows) a. uric acid b. calcium oxalate c. yeast d. red blood cells

white blood cell cast

Identify the urine sediment constituent pictured (arrow) a. hyaline cast b. white blood cell cast c. red blood cells d. oval fat bodies

decreased

In a patient with bacterial meningitis, the glucose levels would be ________________________. a. normal b. increased c. decreased

anti-HBe

In chronic cases of hepatitis B, the presence of which antibody predicts a favorable recovery?

all of the above

In the US, most illnesses presenting with a fever and rash are not measeles but ______________________. a. human herpesvirus-6 b. parvovirus B19 c. enterviruses d. all of the above

substrate

In the presence of a competitive inhibitor, what would need to be increased to reach VMax?

bilirubin

Jaundice is a condition usually caused by elevations in which molecule?

the plasma concentration of a solute that exceeds the reabsorptive capabilities of the kidney

Maximal reabsorptive capacity (Tm) is most appropriately described as:

early glomerular damage

Microalbumin is a test used for what clinical purpose?

myocardial infarction

Myoglobin is a heme protein that has found usefulness in diagnosing what?

turbidity

Nephelometry is an analytical technique to measure what?

increased urine output at night

Nocturia is defined as:

nucleic acids

Non-protein nitrogen compounds are waste products from the catabolism of proteins and _________________________.

16%

On average how much of a protein's mass is attributed to nitrogen?

albumin, alpha-1, alpha-2, beta, gamma

On standard electrophoresis the major serum proteins travel in what pattern? (fastest - slowest)

1₃s

On the Levy-Jenning chart below, which Westgard rule is being violated by the data point indicated by the arrow?

leucine, isoleucine, and valine

Patients suffering from maple syrup urine disease have a build-up of which amino acids? a. leucine, isoleucine, and valine b. serine, tyrosine, and cysteine c. glycine, alanine, and tryptophan d. leucine, alanine, and serine

sometimes

Patients with a history of receiving the mumps vaccine will _______________________have detectable levels of mumps IgM with a current infection

diabetes

Polyuria is most commonly associated with what pathological condition?

throxyine

Prealbumin is a carrier protein for what in the serum?

brings materials from the tubules back into the capillaries

Reabsorption is the process that:

blood pressure

Renin, angiotensin, and aldosterone are all hormones that help to regulate what in the kidney?

myoglobin

Rhabdomyolysis is a condition that causes renal failure due to the accumulation of what?

excretion

Sodium balance in the body is only controllable by which process?

reabsorption

Specific gravity and osmolality are two tests used to evaluate which function of the kidneys?

freezing point

The _______________________ is the temperature at which the vapor pressures of the liquid and the solid are the came

bringing the blood supply to the glomerulus

The afferent arteriole is responsible for what?

phenylalanine

The aminoacidpathy phenylketonuria (PKU) is an inability of the body to metabolize which amino acid?

creatinine

The concentration of this analyte is inversely proportional to the rate of clearance by the kidneys?

water

The descending loop of henle is impermeable to all molecules except:

first-pass

The liver uses this type of metabolism to remove some of the active substance (ex. medication) from the blood before it enters the body's circulation:

hepatocytes

The majority of liver tissue is made of what cell type?

protein error of indicators

The principle of the reagent strip test for urine protein depends on:

a. Type 1

The production of autoantibodies against the insulin producing cells in the pancreas is seen with what form of diabetes? a. Type 1 b. Type 2

albumin

The protein reagent test strip is most sensitive for which of the following? a. albumin b. mucuprotein c. Bence Jones protein d. globulin

Double

The rate of an enzymatic reaction will ___________________ for every 10 degrees C temperature increase until the enzyme denatures.

acetoacetic acid

The test pad for ketones is most sensitive for:

10, 10

There are ___________ non-essential and __________ essential amino acids.

uric acid

This non-protein nitrogen becomes saturated at plasma levels over 6.8mg/dL leading to crystalline deposits in the joints and tissues.

White blood cells

Trichomonas is easily confused with which urine sediment constituent?

12-18 hours

Troponin is a protein released by the heart tissue after damage (MI), how long after the onset of cardiac symptoms will you see a peak in the protein level?

must be analyzed in-house to determine the mean and SD

Unassayed controls: a. have a manufacturer defined SD, but user defined mean b. must be analyzed in-house to determine the mean and SD c. do not require a mean or SD d. have a manufacturer determine the mean and SD

albumin

Unconjugated bilirubin is transported in the blood stream to the liver by which protein?

0.54

Using the following formula, what is the standard deviation for the data set? Data set: 12.7, 13.3, 11.9, 12.7, 13.1 a. 0.76 b. 1.0 c. 0.54 d. 0.05

it is not made by the body

What makes an amino acid "essential"?

thin-layer chromatography (TLC) & high-performance liquid chromatography (HPLC)

What methodology is used to test for amino acids?

7.35-7.45

What pH range is required fro proteins in the body to remain soluble?

Gluconeogenesis

What process converts non-sugar molecules into glucose to be used for energy?

secondary

What structural level consists of a(alpha)-helixes and B(beta)-pleasted sheets?

Copper reduction test (clinitest)

What additional test must be performed on infants under one year of age to look for potential inborn errors of metabolism?

red blood cells that have released their hemoglobin

What are ghost cells?

macroamylasemia

What condition is characterized by elevated serum amylase levels and decrease urinary amylase levels due to amylase binding to immunoglobulins?

acidosis

What condition, characterized by high H+ concentration, requires the kidneys to excrete H+ and reabsorb K+ to maintain charge balance?

Reye's syndrome

What disease in children is preceded by a viral infection and treatment with aspirin and has severely elveted ammonia levels?

Von Gierke's Disease

What disease, where patients cannot convert glycogen to glucose, is caused by a deficiency in glucose-6-phosphatase?

enzyme-linked immunosorbent assay

What does ELISA stand for?

HBsAg

What does the hepatitis D virus require for replication?

prostaglandins

What group of molecules released by the kidney work to inhibit vasoconstriction caused by angiotensin and norepinephrin?

stinky, sweaty feet

What is a characteristic symptom of isovaleric acadamia?

controlled diet

What is a general treatment method for aminoacidpathies?

liver disease

What is a possible cause of hypoproteinemia? a. increased intake b. inflammation c. liver disease d. dehydration

1,25-dihydroxy vitamin-D3

What is the active form of vitamin-D?

inherited genes

What is the cause of most aminacidpathies?

a drug-induced allergic reaction

What is the clinical significance of increased numbers of eosinophils in the urine?

metabolic disorder

What is the disease state associated with the crystals seen in photo (arrow). The urine pH is 5.0: a. renal failure b. UTI c. liver Cirrhosis d. metabolic disorder

urobilin

What is the final product of bilirubin metabolism that is excreted in the feces?

anti-HBc

What is the first antibody to develop after an acute hepatitis B infection?

stimulates RBC production

What is the function of erythropoietin?

collects urine from the renal pyramid and drains into the major calyx

What is the function of the minor calyx?

the pH of a solution where a molecule is neutral

What is the isoelectric point?

current acute infection

What is the most likely interpretation of the following results: HBsAg+ anti-HBc IgM+ anti-HBs- a. immune due to natural infection b. immune due to vaccination c. succeptable (non-immune) d. current acute infection

immune due to vaccination

What is the most likely interpretation of the following results: HBsAg- Total anti-HBc- anti-HBs+ a. immune due to natural infection b. immune due to vaccination c. succeptable (non-immune) d. current acute infection

renin-aniotensin-aldosterone system

What is the name for the hormonal control system that is initiated by a drop in blood pressure?

juxtaglomerular apparatus

What is the name of the group of cells in the kidney responsible fir monitoring changes in blood pressure?

water

What is the only substance reabsorbed in the descending loop of henle?

Tamm-Horsfall protein

What is the primary component that makes up hyaline casts?

Pressure gradient

What is the primary driving force behind filtration in the glomerulus?

concentrating the urine

What is the primary responsibility of the juxtamedullary nephrons?

liver

What is the primary site for glycogenesis?

albumin

What is the serum protein that is present in the highest concentration?

it is made by the body

What make and amino acid "non-essential"?

hepatitis B immune globulin

What treatment should be given as a prophylaxis after an exposure to hepatitis B virus?

conservation of bicarbonate ions and excretion of acid waste

What two mechanisms are used by the kidney to maintain pH?

old urine, improper storgage

What would a pH of 9.0 for a urine specimen indicate?

2004

What year was rubella eliminated in the United States?

ketones

When a patient with diabetes mellitus begins to use lipids for energy, which of the following analytes will be elevated? a. HDL b. lactose c. ketones d. growth factor

cystineuria

Which aminoacidpathy is not caused by an enzyme deficiency, but is due to problems with absorption?

atomic absorption spectrophotometry

Which analytical technique is commonly used for testing trace materials? a. liquid chromatography b. ion selective electrode c. atomic absorption spectrophotometry d. nephelometry

Cirrhosis

Which condition may have a decrease level of urea? a. high protein diets b. Cirrhosis c. dehydration d. hemorrhage

Lipase

Which enzyme is most specific for the diagnosis of acute pancreatitis?

ACP

Which enzyme may be useful in diagnosing metastatic carcinomas of the prostate?

ALP

Which enzyme would be most significantly elevated with a hepatic obstruction?

tryptophan

Which essential amino acid helps to induce sleep and is a precursor for serotonin?

direct bilirubin

Which form of bilirubin is water soluble and travels to the small intestine?

Type 2

Which form of diabetes mellitus is caused by a decreased cellular response to insulin?

complement

Which group of proteins migrates to the beta-region and are involved in cell lysis?

insulin

Which hormone is referred to as a hypoglycemic and increases glycolysis and glycogenesis?

glucagon

Which hormone works to increase blood sugar levels by increasing glycogenolysis and the amount of monosaccharides in circulation?

chloride

Which ion is reabsorbed (follows) along with sodium in the nephron?

Beer-lambert law

Which law is used to calculate the concentration of an analyte?

quadrate

Which lobe of the liver wraps around the gallbladder?

Biuret method

Which method is most commonly used for the colorimetric analysis of protein?

urea

Which non-protein nitrogen is found in the highest concentration in the blood?

2₂s

Which of the Westgard rules has been broken if you observe two consecutive data points that are +2 standard deviation from the mean?

1₂s

Which of the following Westgard rules is a warning rule? a. 1₃s b. 2₂s c. R₄s d. 1₂s

selenocycstine

Which of the following amino acids is found in higher concentration in HIV patients? a. pyroleucine b. serine c. selenocycstine d. guanine

homocysteinuria

Which of the following aminoacidpathies is caused by a cystathionine-Beta-synthase deficiency: a. homocysteinuria b. maple syrup urine disease c. alkaptonuria d. PKU

ion-selective electrodes

Which of the following are commonly used to measure the electrolytes? a. enzyme binding assays b. gas chromatography c. ion-selective electrodes d. spectrophotometry

all of the above

Which of the following are components of urinalysis? a. physical analysis b. microscopic analysis c. chemical analysis d. all of the above

antidiuretic hormone

Which of the following hormones is responsible for increasing water reabsorption in the collecting duct? a. epinephrine b. antidiuretic hormone c. testosterone d. aldosterone

increase bilirubin

Which of the following is NOT a change observed in unpreserved urine? a. increase bacteria b. increased bilirubin c. increase turbidity d. increased nitrite

all of the above

Which of the following is a cause of hepatitis? a. viral b. bacterial/parasitic c. autoimmune d. all of the above

increased glucagon production

Which of the following is a cause of hypoglycemia? a. increased glucagon production b. decreased activity level c. increased food intake d. decreased insulin production

all of the above

Which of the following is a complication of rubeoloa infections? a. diarrhea b. ear infections c. pneumonia d. all of the above

a. prevents RBC lysis

Which of the following is a function of glucose-6-phosphate dehydrogenase (G6PD) a. prevents RBC lysis b. inhibits CK c. stimulates insulin secretion d. catalyzes the conversion of glutamate

all of the above

Which of the following is a function of the kidney? a. secretes waste products b. manufacture erythropoietin c. filters the blood d. all of the above

all of the above

Which of the following is a function of the kidney? a. secretion b. blood pressure regulation c. urine production d. all of the above

red blood cells

Which of the following is a pathological cause of turbidity in a urine specimen? a. squamous epithelial cells b. clothing fibers c. red blood cells d. amorphous urates

congestive heart failure

Which of the following is a pre-renal cause of elevated urea levels? a. UTI b. congestive heart failure c. decreased protein diet d. tubular necrosis

improves consistency between measurements

Which of the following is a reason for calibrating an instrument? a. reduces work flow b. improves consistency between measurements c. increase instrument to instrument error d. decreases sample volume

plasma drawn in a sodium heparin tube

Which of the following is an acceptable sample for amino acid analysis? a. sweat collected in a strerile cup b. whole blood in an EDTA tube c. plasma drawn in a sodium heparin tube d. serum drawn in a marble top tube

hemoglobin SA1C of 8%

Which of the following is considered diagnostic for diabetes mellitus? a. random plasma glucose of 100mg/dL b. 2hr tolerance test of less than 50mg/dL c. fasting plasma glucose of 100mg/dL d. hemoglobin SA1C of 8%

c. sucrose

Which of the following is not a reducing substance? a. lactose b. glucose c. sucrose d. fructose

rash beginning on the face

Which of the following is not a symptom of the mumps? a. parotitis b. rash beginning on the face c. fever and fatigue d. pain while chewing

tranferrin

Which of the following is not an a2(alpha)-globulin? a. ceruloplasmin b. tranferrin c. haptoglobulin d. a2(alpha)

theriosine

Which of the following is not an amino acid? a. leucine b. serine c. proline d. theriosine

low levels of anti-HEV IgG

Which of the following is not diagnostic for a current hepatitis E virus infection? a. high levels of anti-HEV IgG without IgM b. low levels of anti-HEV IgG c. both anti-HEV IgM and IgG d. anti-HEV IgM without IgG

rash beginning on the face

Which of the following is the most classic rubella symptom?

Schistosoma haematobium

Which of the following is the only true urinary parasite?

HDL

Which of the following lipoproteins contains very few triglycerides and functions to remove excess cholesterol from circulation?

spectrophotometry

Which of the following methodologies measures absorbed light? a. liquid chromatography b. ELISA c. electrophoresis d. spectrophotometry

fluorometry

Which of the following methodologies measures emitted light? a. nephelometry b. mass spectrometry c. fluorometry d. spectrophotometry

haptoglobin

Which of the following proteins functions to bind free hemoglobin and iron in the blood: a. haptoglobin b. fibrinogen c. albumin d. ceruloplasmin

positive reagent strip test for bilirubin

Which of the following results does not meet the criteria for doing a microscopic examination? a. turbid specimen b. positive reagent strip test for leukocyte esterase c. positive reagent strip test for blood d. positive reagent strip test for bilirubin

Hansel stain

Which of the following stains can help identify eosinophils in urine?

specific gravity

Which of the following tests is most closely associated with the kidneys ability to concentrate the urine? a. pH b. 24hr urine output c. the estimated glomerular filtration rate (eGFR) d. specific gravity

polarizing microscopy

Which of the following types of microscopy aids in the identifications of oval fat bodies, cholesterol, and fatty casts? a. polarizing microscopy b. dark field microscopy c. bright field microscopy d. phase contrast microscopy

oxidizing agents

Which of the following will give a false positive on the glucose reagent strip? a. old urine b. high specific gravity c. high ketones d. oxidizing agents

IgM

Which of the gamma globulins is responsible for the primary immune response?

Hexose monophosphate shunt

Which pathway allows for pentose sugars, like ribose, to enter the glycolytic process?

glycogenesis

Which process converts glycogen back into glucose?

HCV RNA

Which test is used to confirm hepatitis C virus infection?

electrophoresis

Which test methodology uses an agarose gel to separate molecules based on size and charge?

muscle

Which tissue is responsible for producing creatinine?

Arginosuccinic Aciduria and Citrullemia

Which two aminoacidpathies can lead to the build up of ammonia?

AST & ALT

Which two enzymes will show significant elevations with viral hepatitis?

Methyl red and bromthymol blue

Which two indicators are used on the pH reagent strip test to give a pH range between 5 and 9?

zero order

Which type of enzyme kinetics assay is ideal fro the clinical laboratory setting where the amount of enzyme produced by the patient is unknown?

juxtamedullary

Which type of nephron is responsible for concentrating the urine?