Clinical Chemistry4

You answered the question correctly.
Metabolic acidosis is characterized by:
The correct answer is highlighted below
Increased pCO2
Hypoventilation
Low pH
High pH
Feedback
Metabolic acidosis is the result of either: 1) accumulation of abnormal levels of

organic acids, often secondary to diabetic ketoacidosis, or lactic acidosis, 2) excessive
loss of bicarbonate as in severe diarrhea, or 3) reduced excretion of acids as in renal
failure. All these conditions result in a decrease in pH. The body compensates by
hyperventilating, and lowering pCO2, in an attempt to restore normal pH, resulting in
a compensated or partially compensated metabolic acidosis.
Question Difficulty: Level 4
Insulin is a pancreatic hormone that plays a vital role in carbohydrate and lipid
metabolism. Insulin inhibits the formation of glucose from noncarbohydrates
(gluconeogenesis). Which two of the following processes are also INHIBITED by
insulin?
The correct answers are highlighted below
Lipolysis- The release of non-esterified fatty acids (NEFAs) from triglycerides.

Glycogenesis- The conversion of excess glucose to stored glycogen.
Glycogenolysis- The conversion of stored glycogen back to glucose.
Glycolysis- The uptake of glucose in muscle and other body cells.
Feedback
Insulin increases lipid synthesis in the liver and fat cells and inhibits lipolysis, the
release of NEFAs from triglycerides in fat and muscle cells. Insulin also inhibits
glycogenolysis.
Glycolysis and glycogenesis are stimulated by insulin, not inhibited.
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 NCEP: ATP III Diagnostic Criteria for metabolic syndrome
evaluation?
Diagnosis of metabolic syndrome; waist circumference, HDL-C, and fasting

blood glucose meet the criteria
Diagnosis of metabolic syndrome; waist circumference, triglyceride level, and
fasting blood glucose meet the criteria
Does not meet the criteria for diagnosis of metabolic syndrome because the
HDL-C is not <40 mg/dL
Cannot make conclusion regarding metabolic syndrome because the LDL-C was
not assayed
Feedback
In this scenario, waist circumference, triglyceride level, and fasting blood glucose
meet the criteria for diagnosis of metabolic syndrome.
NCEP: ATP III criteria for diagnosis of metabolic syndrome is the presence of three
or more of these components:
Component Criteria
Abdominal obesity: Men: > 40 inches
Increased waist circumference Women: > 35 inches
> 150 mg/dL or
Elevated triglycerides
drug treatment for elevated triglycerides
Men: < 40 mg/dL
Reduced HDL-Cholesterol (HDL-C)
Women: < 50 mg/dL
> 130/85 mm Hg or
Elevated blood pressure
drug treatment for elevated blood pressure
> 100 mg/dL or
Elevated fasting glucose
drug treatment for elevated glucose
LDL-C is not used as a determining factor in diagnosis of metabolic syndrome with

the NCEP guidelines.

Which of the following conditions would make a sample unsuitable for lactic acid
testing?
Hemolyzed sample
Received in the lab on ice
Centrifuged in a refrigerated centrifuge
Specimen centrifuged and plasma separated from cells less than 15 minutes after
collection
Feedback
Hemolysis will falsely increase lactic acid concentration. A hemolyzed specimen

should be recollected.
A blood sample for lactic acid testing should be placed on ice immediately after
collection, centrifuged within 15 minutes of collection, and plasma immediately
separated from cells following centrifugation. If possible, a refrigerated centrifuge
should be used.
Iontophoresis is a technique used in the diagnosis of:
phenylketonuria
cystic fibrosis
pernicious anemia
Addison’s disease
multiple myeloma
Feedback
Iontophoresis is the introduction of ionizable drugs through intact skin by the

administration of continuous, direct electrical current into the tissues of the body. The
sweat test by pilocarpine iontophoresis is the only practical and reliable laboratory test
for confirmation of the diagnosis of cystic fibrosis.
Which one of the following are not associated with a polyclonal (broadbased) increase
in gamma globulins?

Liver disease
Chronic inflammation
Immune reaction
Immunodeficiency
Feedback
Immunodeficiency would, of course, generally be associated with a decrease in serum

immunoglobulin levels, and an associated decreased gamma band.
Which one of the following are not associated with a polyclonal (broadbased) increase
in gamma globulins?
Liver disease
Immune reaction
Immunodeficiency
Feedback
Immunodeficiency would, of course, generally be associated with a decrease in serum

immunoglobulin levels, and an associated decreased gamma band.

Which of the following hormones is mainly responsible for the entry of glucose into
the cell for energy production?
Epinephrine
Glucagon
Cortisol
Insulin
Feedback
Insulin is the hormone that is mainly responsible for the entry of glucose into the cell
for energy production
Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to

glucose, which increases plasma glucose. Cortisol, along with glucagon, increases
gluconeogenesis, formation of glucose from noncarbohydrates, which also raises
plasma glucose concentration.
Patients with Cushing syndrome typically exhibit:
Decreased plasma 17-hydroxysteroid concentration

Decreased urinary 17-hydroxysteroid excretion
Serum cortisol concentrations greater than 15 mg/dL
Decreased cortisol secretion rate
Decreased ACTH levels
Feedback
Cushing syndrome is a hormone disorder caused by exposure to high levels of cortisol

for a prolonged period. Serum cortisol may be greater than 15 mg/dL. The serum
reference range for cortisol is approximately 0.006 - 0.023 mg/dL, which is usually
expressed as 6 - 23 micrograms per deciliter (µg/dL).
Which risk marker has both positive and negative cardiovascular risk integrated into
its measurement?
LpPLA2
Oxidized LDL
ApoB/ApoA1
hs-CRP
Feedback
The ApoB/ApoA1 ratio has a positive risk marker (ApoB-100) and a negative risk
marker (ApoA1). Risk diminishes as ApoA1 goes up (a negative marker) and risk
increases in proportion to ApoB concentrations (a positive risk marker). This 'double-
edged sword' provides good risk prediction. The other risk markers in question do not
have this dual-advantage.
A patient’s BUN 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?
patient is normal
patient is in early stage of renal disease
patient protein intake is quite low
patient has suffered muscle deterioration
one of the values is in error
Feedback
The patient's BUN is within normal range (5-20 mg/dL) while the creatinine is about
five times the upper normal range (0.6-1.2 mg/dL). Gross elevations in creatinine are
almost always accompanied by elevations in BUN when there is kidney impairment.
Either the BUN or creatinine value in this case is incorrect. Both tests should be
repeated.
Which of the following statements regarding the L/S ratio is TRUE?
A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to

prevent respiratory distress syndrome (RDS)
A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with
diabetes mellitus.
Sphingomyelin levels increase during the 3rd trimester causing the L/S ratio to
fall slightly during the last two weeks of gestation.
A phosphatidylglycerol (PG) spot indicates the presence of meconium in the
amniotic fluid
Lecithin is in direct ratio with sphingomyelin
Feedback
L/S ratio <2.0 indicates an increased risk of respiratory distress syndrome (RDS) at
delivery. L/S ratio <1.5 indicates a very high risk of developing RDS.

The American Diabetes Association (ADA) guidelines recommend screening all

asymptomatic individuals age 45 and older for diabetes. If the screen is negative, this
patient will never require another screening.
True
False
Feedback
The ADA guidelines recommend screening all asymptomatic individuals age 45 and
older. If the screen is negative, it should be repeated every three years.
After complaining to her physician about persistent pelvic pain and abdominal
pressure, Mrs. Smith, had laboratory testing ordered. Since her physician would like
to rule-out ovarian cancer, which of the following assays would be most helpful?
CEA
CA125
CA19-9
PSA
Feedback
CA125 is an antigen present on approximately 80% of ovarian carcinomas. CA125 is

often elevated in patients with ovarian cancer and its concentration follows the course
of disease. It is important to note that CA125 is not completely specific for ovarian
carcinomas, it can be found in increased levels in other cancers including endometrial,
pancreatic, lung, breast, and colon cancer, along with other conditions such as
pregnancy.
CEA (carcinoembryonic antigen) is typically utilized for colon cancer screening and
prognosistic purposes. CA19-9 is typically found in increased levels in conditions
such as gastrointestinal adenocarcinoma and pancreatic cancers. Finally, PSA
(prostate specific antigen) is specific to the prostate gland. This tumor marker is
increased in conditions such as prostate cancer and prostatitis.
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 ( )
Because the patient is in a coma, it has been a prolonged period since he has
eaten or drank water.
The increased glucose level causes a more concentrated extracellular solution,
stimulating the thirst center of the hypothalamus.
The increased glucose level causes water to go inside the cell to equilibrate with
the extracellular fluid.
Feedback
The hypothalamus controls various body functions including: temperature, hunger,

thirst,and fatigue. This organ is very sensitive to concentrations of certain hormones,
sugars, etc. in our bloodstream. If the hypothalamus detects the high glucose level, as
in this case, the stimulation for thirst will occur to attempt to dilute out the high
glucose concentrations in the blood.
When should blood samples for trough drug levels be collected?
30 minutes after peak levels

45 minutes before the next dose
1-2 hours after the last dose
immediately before the next dose is given
Feedback
The trough drug level is drawn immediately before the next dose is given as the drug
level is expected to be the lowest in the body at this point.
Calcium and phosphorus levels were determined for a 4-year-old patient as follows:
Ca - 14mg/dl
Phosphorus - 1mg/dl
These results are MOST compatible with:
hyperparathyroidism
renal failure
rickets
hypervitaminosis
hypothyroidism
Feedback
The calcium is elevated (child N = 8.8 – 10.8 mg/dL). The main cause of
hypercalcemia is almost always over activity in one or more of the parathyroid glands,
which regulate calcium. The phosphorus level is decreased (child N = 3.2 – 5.8
mg/dL). High calcium levels usually result in decreased phosphorus levels.
Hypervitaminosis can lead to elevations in calcium, but since this is a child that
scenario is not likely.
A specimen for potassium was drawn in a tube without anticoagulant at 6 AM during

a traumatic patient stick. The results were 6.0 mmol/L. Why are the results elevated?
Specimen should have been drawn with anticoagulant

Exposure to light
Hemolysis of the RBC’s
Specimen should have been frozen
Analyzer systematic error
Feedback
During a traumatic stick, the red blood cells often become severly hemolyzed, or
break apart, during the blood collection process. When this occurs, the potassium will
leak out of red blood cells into the plasma causing a falsely elevated potassium result.

Which of the following is necessary for the absorption of Vitamin B12:
Intrinsic factor
Folic acid
Gastrin
Insulin
Feedback
Intrinsic factor is necessary for the proper absorption of vitamin B12. With a
deficiency of intrinsic factor, individuals can develop a megaloblastic anemia if their
bodies become deficient in vitamin B12, which plays a large role in cellular nuclear
development.
The following urine test results were obtained from a 6-month-old African American
infant who experiences vomiting and diarrhea after milk ingestion and has failed to
gain weight:
pH: 5.0
Protein: Negative
Glucose: Negative
Ketones: Negative
Blood: Negative
Bilirubin: Negative
Nitrite: Negative
Urobilinogen: 0.1 EU/dL
Clinitest: 2+
These results are clinically significant in which of the following disorders?

Diabetes mellitus
Lactose intolerance
Galactosemia
Cystic fibrosis
Feedback
Galactosemia is an inherited metabolic disorder that affects an individual's ability to

metabolize the sugar galactose effectively. Infants affected by galactosemia typically
present with symptoms of lethargy, vomiting, diarrhea, failure to thrive, and jaundice.
The presence of galactose in the urine sample is not picked up by the glucose pad on
the urine test strip, however, the clinitest result is positive since it can detect different
sugars in the urine, including galactose. Diabetes mellitus, and cystic fibrosis would
not be associated with the findings in this case; especially the positive clinitest result.
In addition, the clinical symptoms and patient age differentiates lactose intolerance
from galactosemia. True lactose intolerance will usually not become symptomatic in
children until they are at least 3 years old (usually after age 7). Also, lactose
intolerance is associated with diarrhea, but not closely associated with vomiting.
Circulating organic iodine is found primarily in the form of:
Triiodothyronine
Parathyroid hormone
Thyroglobulin
Thyroxine
Feedback
Iodine circulates as thyroxine (T4) and to a lesser extent as Triiodothyronine (T3).

Which of the following is true of genotype screening in pharmacogenomics?
Genotype screening gives a better overall picture of drug metabolism than

measuring metabolism with probe drugs.
Genotyping does not take into account drug interactions which can affect
metabolism.
Genotyping typically involves measuring only one mutation site or
polymorphism.
Feedback
Genotyping, while more robust and definitive, cannot factor in environmental or

health variables that could affect drug metabolism. Probe drug analysis does factor in
these variables, but it is more complex and tedious.
Genotyping typically involves measuring many polymorphisms. For example, a

laboratory that offers CYP2D6 profiling may measure twelve of the most common
and significant mutation sites on this enzyme.
Which of the following methods is not a quantitative method for the determination of
albumin?
Serum protein electrophoresis

Nephelometry
Sulfosalicyclic acid precipitation
Colorimetric spectrophotometry
Feedback
The sulfosalicylic acid method is a semiquantitative method and not a quantitative
method. It is also not specific for albumin.
Which of the following is TRUE of a fully compensated metabolic acidosis?
pH will be decreased without a decrease in PCO2

pH will be decreased with a decrease in PCO2
pH will be decreased with an increase in PCO2
pH will be normal with a decrease in PCO2
pH will be normal with normal O2
Feedback
The pH will be normal in a fully compensated form of any alkalsis or acidosis. In this
case, the problem is metabolic, meaning a decrease in bicarbonate (alkaline)
production which has lead to an acid pH of the blood. To compensate for this, the
body uses the respiratory system to decrease the amount of acid, or PCO2 in the
system to balance the pH into normal range.
Which one of the following terms does not describe a significant elevation of a single
immunoglobulin class:
Paraprotein
Monoclonal protein
Polyclonal protein
M protein
Feedback
Polyclonal proteins do not describe a significant elevation of a single immunoglobulin

class but are usually present due to hypergammaglobulinemia, resulting from an
increased production of several different immunoglobulins and usually associated
with infectious, inflammatory, and immune-mediated diseases such as HIV.
Paraproteins, monoclonal proteins, and M proteins all refer to the abnormal
monoclonal proteins of a single immunoglobulin class, seen in patients with multiple
myeloma, and various lymphomas.
Estriol levels in conjunction with hCG and AFP can be obtained during pregnancy to:
Assess the risk of Down's syndrome

Assess fetomaternal function
Assess for multiple gestations
Assess for maternal diabetes mellitus
Feedback
Estriol "the estrogen of pregnancy" is synthesized by the placenta from precursor

substances synthesized in the fetal adrenal, and modified in the fetal liver. Measuring
of maternal serum estriol in conjunction with AFP and hCG during the 16th week of
pregnancy can be used to help predict the risk of Down's syndrome (Triple Screen),
although sometimes only hCG and AFP are used to assess this risk, since the addition
of estriol to the screen is only marginally cost effective.

All of the following concerning CK-MB (CK-2) are true EXCEPT:
Greater than 5% or 10 IU/L followed by an LD-1: LD-2 flip is specific evidence

of myocardial infarction (MD).
CK-MB levels can be normal with an elevated total CK.
CK-MB and troponin levels can be elevated after an AMI.
CK-MB levels are normal in cardiac ischemia.
Feedback
CK-MB would be abnormal in cases of cardiac ischemia since CK-MB is released in

higher amounts from cardiac muscle when the heart is damages or overworked due to
various conditions.
Carbon dioxide is predominately found in blood in the form of:
Bound CO2
Bicarbonate ions
Sodium carbonate
pCO2
Feedback
In the body, most of the CO2 is in the form of a substance called bicarbonate (HCO3-
). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level.
You answered the question incorrectly.
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?
Elevated FPG; needs further evaluation by a repeat or alternative test

Decreased FPG; a repeat of the test is recommended in one year
Sufficient documentation for diagnosis of diabetes
Needs no further evaluation; this is a normal FPG
Feedback
The result is elevated. Hyperglycemia is demonstrated by this one FPG. The ADA
recommends that the hyperglycemia be demonstrated a second time by repeating the
FPG or by using one of the other recommended diagnostic tests.
Hyperglycemia should be demonstrated a second time by any of the four criteria

unless the glucose level is significantly high and diabetes is unquestionable.
8-Hydroxyquinoline and 0-Cresolphthalein complexone reagent is commonly used in

the determination of:
phosphorus
magnesium
chloride
calcium
Feedback
Calcium forms a purple-coloured complex with ortho-cresolphthalein complexone in

an alkaline medium. The actual color reagent used in this method contains 8-
Hydroxyquinoline and 0-Cresolphthalein complexone. The intensity of the color is
measured spectrophotometrically.
The following results were obtained on arterial blood:
pH = 7.51
pCO2= 49 mmHg
HCO3 = 38.7 mEq/L
pO2= 85 mmHg
These results are compatible with:
metabolic acidosis
respiratory acidosis
metabolic alkalosis
respiratory alkalosis
Feedback
The pH of this patient sample is alkaline (>7.45), which is indicative of alkalosis.

Since the HCO3 is increased (reference range 22-26 mEq/L) and is the alkaline buffer
component of the body produced by our metabolic system, the condition is called
Metabolic Alkalosis.
Which of the following would be considered normal for a glucose level in

cerebrospinal fluid:
30 mg/dL
60 mg/dL
120mg/dL
150 mg/dL
Feedback
CSF glucose levels should be approximately 60 to 70% of plasma levels.
Which of the following conditions is associated with elevated serum uric acid levels:
Cushing's syndrome
Pancreatitis
Hyperthyroidism
Gout
Feedback
Gout is a disease manifested by the deposition of crystalline uric acid in joints and
soft tissues, with secondary inflammation and pain.

The accuracy of an immunoassay is its ability to discriminate between results that are
true positives and results that are true negatives. Two parameters of test accuracy are
specificity and sensitivity. Which of these statements apply to an immunoassay with
high specificity, but low sensitivity?
Accurately identifies the presence of disease

Accurately identifies the absence of disease
Has few false-positives
Has few false-negatives
Feedback
A test with high specificity accurately detects the absence of disease. The more
specific a test is, the fewer false-positive results will occur. A test with high
sensitivity accurately identifies the presence of disease. The more sensitive a test, the
fewer false-negative results it produces. In the case stated in this question, the
immunoassay has high specificity, so it has few false-positives and will accurately
detect those individuals who do not have the disease or condition that is being tested
for. However, the test has low sensitivity, so it may not identify all individuals who
actually have the disease; it may produce many false-negative results.
Which of the following is the EARLIEST biochemical marker of myocardial

infarction?
AST
LD
Troponin
myoglobin
CK
Feedback
Myoglobin is found in elevated levels when muscle tissue is damaged but it lacks
specificity. It does, however, respond very rapidly after myocardial infarctions
and rises within 2 hours, faster than CK, troponin, LD, or AST.
Which of the following conditions should be suspected given the following set of
serum laboratory results?
Amylase 650 U/L
Lipase 1200 U/L
Cystic Fibrosis
Pancreatitis
Myocardial Infarction
Multiple Myeloma
Feedback
Both acute and chronic pancreatitis are associated with increased serum amylase and
lipase levels, often 5-10 times the normal range. Since the reference ranges for
amylase and lipase are approximately: 53 - 123 U/L and 10 - 150 U/L respectively,
the values shown in this case are increased.
Cystic Fibrosis can actually cause a decreased serum lipase level, while myocardial
infarctions and multiple myeloma will have little effect on serum amylase and lipase
levels.
A patient who previously had an hs-CRP of 4 mg/L was put on statin and daily aspirin
medication. She returns to the laboratory a month later, and her repeat hs-CRP is 2.3
mg/L. Which of the following is the most likely reason for the decrease in the test
value?
The patient probably had an infection at the time of the first visit that
confounded the initial result.
The laboratory test was probably performed incorrectly the first time.
The medications lowered the hs-CRP value.
Feedback
The medications (a cholesterol-lowering statin and the anti-inflammatory aspirin) can

lower hs-CRP. A single hs-CRP value does not neccessarily reflect risk.
It is not likely that the test was performed incorrectly the first time and the initial hs-
CRP test result was not indicative of an infection.
A hospitalized patient has a decreased serum copper level and increased urine copper
level. This is MOST consistent with:

Wilson's disease
Addison's disease
Parathyroid disease
not clinically significant
Feedback
Wilson disease is a rare inherited disorder that causes your body to retain copper.
Serum copper is paradoxically low but urine copper is elevated in Wilson's disease.
Addison's disease is an endocrine disorder where the adrenal glands do not produce
enough steroid hormones. Parathyroid disease is categorized as hyper or hypo
parathyroidism, which effects parathyoid hormone and calcium levels. Increased urine
copper and decreased serum copper are clinically significant findings.
A drug that is administered through which of the following routes will reach peak
level the quickest?
Oral
Intravenous (IV)
Intramuscular (IM)
Feedback
A drug that is administered IV will reach peak level the quickest (15 - 30 minutes
after injection/infusion).
A drug that is injected IM will reach peak level at 30 minutes to one hour after
injection; a drug that is taken orally will reach peak level approximately one hour
after the drug is taken (if the half-life is > two hours).
Fetal lung maturity can be determined from amniotic fluid because the surfactant is
PRIMARILY composed of:
protein
cholesterol
glycerol
triglycerides
phosphatidylcholine and other phospholipids
Feedback
Assessment of the status of amniotic fluid phospholipids has become important in

determining fetal lung maturity. During pregnancy, it has been documented that the
ratio of lecithin to sphingomyelin (L/S ratio), with respect to pediatric gestational age,
is a reliable predictor of maturity.
An increased serum level of which of the following analytes is MOST commonly

associated with decreased glomerular filtration?
Creatinine
Uric acid
Urea
Ammonia
Glucose
Feedback
Plasma concentrations of creatinine are used to assess renal function. Creatinine

clearance is based on the serum creatinine level and is used to measure glomerular
filtration rate, or GFR.
Which of the following is a cause of metabolic alkalosis?
Late stage of Salicylate poisoning

Uncontrolled diabetes mellitus
Renal failure
Excessive vomiting
Polyuria
Feedback
Metabolic alkalosis may be caused by several conditions, of which one is excessive

vomiting. Other causes are (1) loss of hydrogen ions in renal acid losses that exceed
acid production from cellular metabolism, (2) disproportionate chloride loss compared
with HCO3 loss (ie, the plasma concentration of HCO3 increases upon restriction to a
smaller space of distribution), and (3) HCO3 administration (unusual because
additional HCO3 is very quickly eliminated by the kidneys).

Select the primary reagent components used in the Jaffe reaction for creatinine.
Alkaline copper (II) sulfate

Saturated picric acid and sodium hydroxide
Sodium nitroprusside and phenol
Phosphotungstic acid
Feedback
Saturated picric acid and sodium hydroxide are the main reagents used in the Jaffe
reaction for creatinine determination. These chemical components usually cause the
creatinine reagent to have a bright yellow color.
The formula for conversion of 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)?
142 mg/dL
169 mg/dL
200 mg/dL
Feedback
The eAG for a HbA1C of 7.5% would be reported as 169 mg/dL eAG. Remember, the
formula for conversion of HbA1C to glucose in mg/dL is eAG = (28.7 x A1C) – 46.7.
So, in this case, the calculation is: eAG = (28.7 x 7.5) - 46.7 = 168.55 mg/dL.
TIBC (total iron-binding capacity) is an indirect measurement of which of the

following:
Ferritin
Hemoglobin
Ceruloplasmin
Transferrin
Feedback
Transferrin binds iron in the serum, and is proportional to total iron-binding capacity
(TIBC). Transferrin(mg/dl) = 0.7 X TIBC (ug/dl)
A young man is experiencing difficult breathing after fainting. The physician orders a
blood gas analysis which shows the following results:
pH = 7.25
pCO2 = 62 mmHg
pO2 = 70 mmHg
HCO3 = 23 mEq/L
Which condition is most likely afflicting this patient?

metabolic alkalosis
metabolic acidosis
respiratory alkalosis
respiratory acidosis
Feedback
Judging by the pH, which is acidic, this patient is experiencing acidosis. Recall that
the reference range for blood pH is 7.35-7.45. The patient's carbon dioxide (pCO2)
level is increased while the bicarbonate (HCO3) level is still within reference range.
This indicates that the acidosis is respiratory in nature. The fact that the bicarbonate is
not increased in response to the increase in acid, indicates that the respiratory acidosis
is uncompensated.
Reference Range Recap:

pH = 7.35-7.45
pCO2 = 35-45 mmHg
HCO3 = 22-28 mmol/L
pO2 = 80-100 mmHg
Total iron-binding capacity measures the serum iron transporting capacity of:
hemoglobin
transferrin
ferritin
ceruloplasmin
haptoglobin
Feedback
Transferrin is a glycoprotein that reversibly binds iron. Total iron binding capacity
measures the amount of transferrin that is available to bind with iron in the serum.
Total iron-binding capacity does not measure hemoglobin, ferritin, ceruloplasmin, or
haptoglobin.
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
Decreased
Normal
Unaffected by the alcoholism
Feedback
High triglycerides may be caused by disorders such as type 2 diabetes,

hypothyroidism, Cushing's sydnrome, liver disease, uremia, dysglobulinemia,
nephrotic syndrome, and alcoholism can cause hypertriglyceridemia.
Chylomicrons are primarily composed of:
Cholesterol
Triglycerides
Phospholipids
Proteins
Feedback
Chylomicrons are synthesized in the intestine. They are responsible for transporting
triglycerides from the gut to the rest of the body. They are composed primarily of
triglycerides, but also contain small amounts of cholesterol, phopholipid, and proteins
in the form of apoproteins. They travel via lymphatics from the gut to the systemic
circulation, where they are acted upon by lipoprotein lipases to release glycerol and
free fatty acids to the tissues. Apolipoproteins are also removed from the
chylomicron, leaving a chylomicron remnant, which is rapidly removed by the liver.
Electrophoretic separation of hemoglobin fundamentally relies on:
Size differences of molecules

Net charge differences of molecules
Concentration differences of molecules
Shape variations of molecules
Feedback
Hemoglobin electrophoresis uses an electric field to separate hemoglobin molecules

based on differences in net electrical charge. The rate of electrophoretic migration is
also dependent on the ionic radius of the molecule, the viscosity of the solution
through which it is migrating, the electrical field strength, temperature, and the type of
supporting medium used.
Which of the statements below regarding the diagnosis of pancreatitis is CORRECT?

Amylase and lipase are as predictive in chronic as in acute pancreatitis.
Diagnostic sensitivity is increased by assaying both amylase and lipase.
Chronic pancreatitis occurs more often in women.
Increased amylase levels stay increased after the cause of the pancreatitis is
removed.
Feedback
Increased levels of amylase and lipase are very useful for detecting acute pancreatitis.
In chronic pancreatitis, amylase and lipase levels may not be elevated and, in fact, can
decrease over time, so these test are not as predictive for chronic pancreatitis as they
are for acute. Chronic pancreatitis actually occurs more often in men. Amylase levels
decrease when the cause of the pancreatitis is removed.
Which assay is performed to diagnose congestive heart failure (CHF)?
Homocysteine
hs-CRP
BNP
cTnI
Ischemia Modified Albumin
cTnT
Feedback
BNP is elevated in CHF patients. Cardiac troponins are measured to diagnose an AMI
and homoscysteine, hs-CRP, and ischemia modified albumin are markers of risk for
cardiac disease.

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

between bicarbonate and:
Sodium
Potassium
Calcium
Chloride
Feedback
Bicarbonate and Chloride form an exchanger to help regulate and buffer the body's
pH.
If a drug is given at intervals that are the same as its half-life, approximately how long
will it take the drug to reach steady state?

It will be at steady state from the first dose.
It will take about two half-lives to reach steady state.
It will take about 5 half-lives to reach steady state.
It will never reach a steady state.
Feedback
If a drug is given at intervals that are the same as its half-life, it will take about 5 half-
lives to reach steady state.
A 32-year-old teacher, is seeing her internist for her yearly physical. Because of a
family history of heart disease, she is concerned about her 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.
Test Patient Result Reference Range

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?
Low risk
Moderate risk
High risk
Feedback
The individual would be at low risk for cardiac disease. She does not have any risk
factors, her lipid levels are in the recommended ranges, and her hs-CRP is in low risk
range.
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.
172 mg/dL
140 mg/dL
238 mg/dL
220 mg/dL
240 mg/dL
Feedback
The equation for calculating the concentration of LDL cholesterol (known as the
Friedewald formula) is:
[LDL cholesterol] = [total cholesterol] - [HDL cholesterol] - [VLDL] (where VLDL is

calculated as [triglyceride]/5).
In this case, [LDL cholesterol] = 280 mg/dL - 40 mg/dL- (100/5)
[LDL cholesterol = 220 mg/dL

What conclusion can be made if a person has a cardiovascular risk marker that is
abnormal?
The person will have a cardiovascular event within the next 12 - 24 months.
The person has an increased probability of developing cardiovascular disease.
The person has a decreased probability of developing cardiovascular disease.
Feedback
The fact that a patient has a particular risk marker which is abnormal simply increases
the probability of developing cardiovascular disease, it does not mean that he or she is
certain to develop cardiovascular disease. Conversely, if an individual does not have a
particular cardiovascular risk marker present it does not guarantee protection against
cardiovascular disease. We must always remember that some percentage of
individuals who have heart attacks or strokes will not have abnormal risk markers
present.
Risk markers are just that, markers of risk. They are not used to diagnose a pathology.
An abnormal marker does not mean that a person will experience a cardiovascular
event, much less that a person will experience a cardiovascular event within a specific
time period.
When three tubes of cerebrospinal fluid are received in the laboratory they should be
distributed to the various laboratory sections as follows:
#1 Hematology, #2 Chemistry, #3 Microbiology

#1 Chemistry, #2 Microbiology, #3 Hematology
#1 Microbiology, #2 Hematology, #3 Chemistry
#1 Chemistry, #2 Hematology, #3 Microbiology
Feedback
The last tube (#3) should always be used for hematology studies in order to minimize
the effect of any peripheral blood contamination which may have occurred during the
insertion of the spinal needle.
Which adipokine is synthesized and released by adipocytes and many other body cell
types, is an inflammatory cytokine that stimulates the liver to produce C-reactive
protein (CRP), and is increased in obesity and insulin resistance?
Leptin
IL-6
Adiponectin
Angiotensinogen
Feedback
IL-6 is synthesized and released by adipocytes and many other body cell types, is an
inflammatory cytokine that stimulates the liver to produce C-reactive protein (CRP),
and is increased in obesity and insulin resistance.
Zollinger-Ellison syndrome is characterized by a large (usually 20-fold) elevation of:
cholecystokinin
pepsin
glucagon
gastrin
Feedback
Zollinger-Ellison syndrome, or ZES, is a rare disorder where one or more tumors in

the pancreas, duodenum cause the stomach to make too much gastric acid, leading to
peptic ulcers. Cholecystokinin plays a key role in facilitating digestion within the
small intestine and is not found in elevated levels in ZES. Pepsin is an enzyme that is
released by the chief cells in the stomach to degrade food proteins into peptides and is
not found in elevated levels in ZES. Finally, glucagon is a hormone involved in
carbohydrate metabolism which is also not associated with ZES.
Which of the following methods may be employed to definitively identify Bence-

Jones proteins:
Immunoelectrophoresis
Sulfosalicyclic acid precipitation
Heat precipitation at 40-60oC
Urine dipstick
Feedback
Bence Jones protein is a protein that is excreted by persons with multiple myeloma, a
myeloproliferative disorder of the immunoglobulin-producing plasma cells. The
protein, which is markedly elevated in blood serum, is filtered through the kidneys in
quantities that exceed the tubular reabsorption capacity. Consequently, it is excreted
in the urine. All suspected cases shoud have protein and immunoelectrophoresis
performed on both serum and urine.

Which one of the following statements about serum ferritin are true:
It is a sensitive indicator of iron deficiency

Elevation of serum ferritin is specific for hemochromatosis
It is synonymous with transferrin
It is a better test for bone marrow iron stores than a Prussian blue stain of
marrow particles
Feedback
Serum ferritin is a good indicator of iron deficiency. However, it acts like an acute
phase reactant, being elevated in a large number of conditions. Patients who have iron
deficiency as well as another condition that elevates serum ferritin levels may
therefore have normal or even elevated serum ferritin levels.
Which of the following methods would be used to confirm the presence of Bence-
Jones protein in the urine:
Urine protein electrophoresis

Sulfosalicylic acid
Isoelectric focusing
Immunofixation
Feedback
Either immunofixation or immunoelectrophoresis can be used to confirm Bence-Jones

proteinuria.
A semen sample for semen analysis should generally be received at the testing site
within what period of time?
One hour
Two hours
Three hours
Four hours
Feedback
It is recommended that a semen analysis sample be delivered within one hour to

ensure accurate testing results. The semen specimen is examined under a microscope
to determine the concentration, motility (movement) and morphology (appearance and
shape) of the sperm. Since it is important to observe the sperm while they are still
active, samples must be received for analysis within an hour.
Which of the following hormones inhibits gluconeogenesis, the formation of glucose

from noncarbohydrate sources such as amino acids, glycerol, and fatty acids?
Insulin
Epinephrine
Cortisol
Glucagon
Feedback
Gluconeogenesis is the formation of glucose from noncarbohydrates when

carbohydrate intake is absent, a fasting state. The hormone cortisol along with
glucagon and epinephrine all stimulate this metabolic pathway. Insulin; however,
inhibits this pathway and is therefore the correct answer.
Which one of the following statements about TSH is true:
It is decreased in primary hyperthyroidism

It is decreased in primary hypothyroidism
A sensitive TSH assay is not a good screening test for thyroid function
Diffuse toxic goiter is associated with elevated TSH levels.
Feedback
A sensitive TSH assay is now considered the most cost effective method of screening
for thyroid disorders. In the absence of pituitary and hypothalamic disease, TSH is
decreased in hyperthroidism. and increased in hypothyroidism, with few exceptions.
Diffuse toxic goiter is a cause of primary hyperthyroidism, and would be associated
with decreased TSH.
The estimation of hyaluronic acid concentration by measurement of viscosity is useful

in evaluating which type of fluid?
Cerebrospinal
Peritoneal
Pleural
Synovial
Seminal
Feedback
Hyaluronic acid is a substance found in synovial fluid. This allows for the thicker
consistency of the fluid for cushioning and protection from friction during movement.
The presence of only slightly visible hemolysis will significantly increase the serum
level of which of the following electrolytes?
Sodium
Potassium
Chloride
Bicarbonate
CO2
Feedback
Potassium, since it is a major intracellular cation, is spilled into the blood when red
blood cells are ruptured and broken, such as during hemolysis.

A major action of angiotensin II is:
Increased pituitary secretion of petressin

Increased vasoconstriction
Increased parathormone secretion by the parathyroid
Decreased adrenal secretion of aldosterone
Feedback
Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased

blood pressure, and release of aldosterone from the adrenals.
Isoenzymes of CK include all of the following except:
MB
MM
MBM
BB
Feedback
 CPK-BB is found mainly in the brain and lungs.

 CPK-MB is found mainly in the heart.
 CPK-MM is found mainly in skeletal muscle.
There is no such thing as CK-MBM

Which of the following is found in plasma but absent in serum:
Proteins
Fibrinogen
Red blood cells
White blood cells
Feedback
Fibrinogen, is, of course, consumed during the clotting process.
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?
Cholesterol
Triglyceride
Creatinine
Glucose
Feedback
Glucose is utlized by red blood cells even after blood collection. Therefore, the
glucose levels will decline over time if left standing for extended periods of time.
Which one of the following statements about acetaminophen metabolism is false?
It is metabolized in the kidney

It is largely metabolized in the liver to glucuronide and sulfonate conjugates
A small amount is metabolized via cytochrome oxidase to a reactive
benzoquinoneimine intermediate
This intermediate becomes toxic to the liver once tissue glutathione becomes
depleted
Feedback
The benzoquinoneimine intermediate produced in the liver as a result of hepatic

cytochrome oxidase metabolism of acetaminophen is responsible for hepatic necrosis
via acylation of hepatic tissue. The treatment of acetaminophen toxicity includes the
use of N-acetylcysteine (Mucomyst), which acts as a glutathione substitute. The risk
of hepatotoxicity is predicted with the Rumack-Matthew nomogram, which uses the
hours after ingestion and plasma acetaminophen level to predict the probability of
hepatotoxicity. Severe hepatotoxicity can be fatal.
Fecal urobilinogen level may be markedly decreased because of:
hemolysis
decreased intestinal reabsorption of urobilinogen
increased serum bilirubin
biliary obstruction
pancreatitis
Feedback
In the intestines, bilirubin is converted to urobilinogens. Most urobilinogen, which

gives feces their dark color, is excreted in the feces. An absence of bilirubin in the
intestine, such as may occur with bile duct obstruction, blocks the conversion of
bilirubin to urobilinogen,which causes clay-colored stools and a decreased fecal
urobilinogen level.
Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that
she has had an AMI but did not feel the severe chest pain because of diabetic
neuropathy. She has not felt well since November 20th and her physician believes she
possibly had an AMI on November 20th.
Assuming that the infarct was uncomplicated, which of the following cardiac
biomarkers would most likely still be elevated and would assist in an AMI diagnosis?
Myoglobin
Creatine kinase MB (CK-MB)
Troponin T
Feedback
Troponin T remaisn elevated after an AMI for 10-14 days, with an initial elevation
within 2-4 hours after onset of myocardial necrosis. Myoglobin returns to normal
range within 24-36 hours and CK-MB is back to normal range in 48-72 hours, so
neither could be used in this case.

A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma
glucose 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 results?
Casual Blood Glucose: 208 mg/dL
HbA1C one week later: 7.2%
Order insulin levels; if decreased, diagnose diabetes

Patient meets criteria for diagnosis of diabetes
Order a C-peptide for diagnosis
The patient is at risk for diabetes (pre-diabetic); monitor for diabetes with yearly
FPG levels
Feedback
A casual blood glucose >/= 200 mg/dL on a patient with symptoms and an A1C >/=
6.5% meet diagnostic criteria for diabetes.
The term pharmacokinetic BEST describes:
what the drug does to the body

Concentration of drug at its sites of action
what the body does to the drug
Feedback
Pharmacokinetics desribes what the body does to a drug after it has been introduced
into the body; specifically describing absorption, distribution, chemical changes,
excretion, etc. Pharmacodynamics describes what the drug does to the body in terms
of physiological response.
\ You answered the question correctly.
Elevation of serum creatine kinase may be associated with:
cerebrovascular accident (stroke).

vigorous exercise
Duschenne muscular dystrophy
intramuscular injections
all of the above
Feedback
Since CK is associate with cardiac, muscle, and brain tissue, it is expected that
increased values would be noted in any of the conditions above.
Which of the following represents a diagram of a spectrophotometer?
hollow cathode - cuvette - monochromator - detector – readout

cuvette - light source - monochromator – detector - readout
monochromator - light source - cuvette - detector - readout
light source - monochromator - cuvette - detector – readout
flame – light source – monochromator - printout
Feedback
A light source is used to emit light through a sample for measurement in

spectrophotometry. The monochromator selects a narrow band of light that can pass
through which will reach the sample cuvette. The detector detects how much light was
reflected from or transmitted through the sample. Finally, the intensity of the
transmitted light is measured with a photodiode or other light sensor/detector, and the
transmittance value for this wavelength is then compared with the transmission
through a reference sample, allowing for the readout of the result.
Which one of the following is a TRUE statement concerning alkaline phosphatase?
It is optimally active at pH 5
It is decreased in bone disorders involving the osteoblasts
It is increased in obstructive jaundice
Feedback
The only correct answer is choice 3, as increased levels of alkaline phosphatase are
found in patients suffering from obstructive jaundice. This enzyme is optimally
active around a pH of 8.0-8.5 and in increased in bone disorders involving osteoblasts
such as Paget's disease.

Which assay using 24-hour urine is considered the BEST single screening test for
pheochromocytoma?
catecholamines
vanillylmandelic acid (VMA)
Homovallic acid (HVA)
Metanephrines
5-hydroxyindole acetic acid
Feedback
The most reliable screening tests for diagnosis of pheochromocytoma is measurement

of plasma-free fractionated metanephrines and urinary fractionated metanephrines.
An electrolyte panel (lytes, chem-4) consists of:
Potassium, Sodium, Chloride, Carbon dioxide

Potassium, Sodium, Chloride, Glucose
Potassium, Sodium, Chloride, Creatinine
Potassium, Sodium, Chloride, BUN
Feedback
The electrolyte panel consists of potassium, sodium, chloride, carbon dioxide. These
analytes are also typically ordered within other panels as well, including the basic
metabolic and complete metabolic panels.
Metabolic acidosis is characterized by:
Increased pCO2
Hypoventilation
Low pH
High pH
Feedback
Metabolic acidosis is the result of either: 1) accumulation of abnormal levels of

organic acids, often secondary to diabetic ketoacidosis, or lactic acidosis, 2) excessive
loss of bicarbonate as in severe diarrhea, or 3) reduced excretion of acids as in renal
failure. All these conditions result in a decrease in pH. The body compensates by
hyperventilating, and lowering pCO2, in an attempt to restore normal pH, resulting in
a compensated or partially compensated metabolic acidosis.
B-hydroxybutyric acid is formed as the result of an accumulation of which of the

following?
acetyl Co A
oxaloacetic acid
uric acid
alpha-hydroxybutyric acid
Feedback
B-hydroxybutyric acid is produced from the breakdown of acetyl-CoA which mainly

occurs in liver hepatocytes.
Which of the following will give the best overall picture of a patient's iron stores:
Albumin
Transferrin
Haptoglobin
Ferritin
Feedback
The concentration of circulating ferritin is proportional to the size of iron stores.

When is a trough blood sample for therapeutic drug monitoring usually obtained?
Just after the dose is administered

Just before the next scheduled dose
At the peak time calculated after a dose
After one half-life of the drug
Feedback
A trough blood sample for therapeutic drug monitoring is usually obtained just before
the next scheduled dose.
Acute phase proteins generally fall into which category?
Glycoproteins
Immunoglobulins
Lipoproteins
Microglobulins
Feedback
Acute phase proteins are a large group of glycoproteins found in the blood that are not
related to immunoglobulins. Acute-phase proteins are generally a class of
glycoproteins whose plasma concentrations increase, known as positive acute-phase
proteins, or decrease, known as negative acute-phase proteins, in response to
inflammation.
When the body compensates for a respiratory or metabolic disorder, the MAIN goal is
to achieve:
correct carbonic acid level, since it is the most important system in the body
a normal pH
normal p02 and pCo2 for normal respiration
correct bicarbonate level, since it is the most important system in the body
Feedback
The body compensates for alkalosis or acidosis of the blood PRIMARILY to regain a
normal pH, between 7.35 - 7.45.
An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates

elevation in LD-1 greater than LD-2 could be indicative of:
myocardial infarction
Hemolysis
pancreatitis
a normal LD isoenzyme pattern
A and B
Feedback
LD-1 and LD-2 are both increased during myocardial infarction since they are both
present in heart muscle. Hemolysis, both in vivo and in vitro, can also cause
elevations in LD-1 and LD-2. Also in normal conditions, LD-2 is present in higher
concentrations than LD-1. The reverse is true in myocardial infarction and during
states of hemolysis. This term is referred to as the LD flip. Pancreatitis does cause
increased levels of LD, but the LD-4 type is the most affected in this condition.

Serum calcitonin is typically elevated in which of the following conditions:
Medullary carcinoma of the thyroid

Hyperthyroidism
Glioblastoma
Adrenal adenoma
Feedback
Serum calcitonin is normally produced by the C cells of the thyroid. It functions to

reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with
a molecular weight of 3400, and has a half life of approximately 12 minutes. It is
characteristically elevated in medullary carcinoma of the thyroid. Since medullary
carcinoma often occurs as an autosomal disorder, family members of patients with
this condition should be screened for serum calcitonin.
Which of the following statements is TRUE with respect to uncompensated metabolic

alkalosis?
pH will be elevated without an elevation of PCO2

pH will be elevated with an elevation of PCO2
pH will be elevated with a decrease in PCO2
pH will be normal with an elevation of PCO2
pH will be normal with a normal PCO2
Feedback
Metabolic alkalosis is associated with alkaline pH, which is greater than the normal
reference range of 7.35 - 7.45 as expected by the definition of
alkaline. Uncompensated refers to the body's compensation to this condition with the
increase in respiratory CO2 to counteract the metabolic bicarbonate being produced
which is causing the alkaline state, in this case the question states that the condition is
uncompensated. If the metabolic alkalosis were compensated, it would be expected
that the CO2 would be increased to counteract the alkalosis.
An automated method for measuring chloride which generates silver ions in the
reaction is called:
Coulometry
Potentiometry
Chromatography
Polarography
Densitometry
Feedback
Coulometry operates on the principle of Faraday's law in which a silver anode

releases silver ions (titration) at a constant rate when a constant potential is
applied. The silver ions react with chloride in a fixed volume of solution to form
silver chloride. The time it takes for the chloride in the unknown solution to react
with the silver ions is proportional to the chloride activity in the sample.
================

All of the following are sources of serum alkaline phosphatase except:
Liver
Placenta
Intestine
Brain
Feedback
The source of elevated alkaline phosphatase can be identified by electrophoresis of

tissue specific isoenzymes at alkaline pH. Liver and bone are the most commonly
identified isoenzymes.
A HbA1C result for a diabetic patient is 6.0%. What conclusion can be made regarding
this patient's carbohydrate management?
The results are inconclusive and should be repeated with a different method.
The patient is probably not following dietary recommendations.
The patient is compliant with diet and medication.
Feedback
The results demonstrate compliance with diet and medication. A HbA1C result that is
<7.0% indicates glycemic control for most adults with diabetes.

A drug that is administered through which of the following routes will reach peak
level the quickest?
Oral
Intravenous (IV)
Intramuscular (IM)
Feedback
A drug that is administered IV will reach peak level the quickest (15 - 30 minutes
after injection/infusion).
A drug that is injected IM will reach peak level at 30 minutes to one hour after
injection; a drug that is taken orally will reach peak level approximately one hour
after the drug is taken (if the half-life is > two hours).

This serum protein electrophoresis scan most likely represents which condition?
Myocardial infarction
Liver disease
Monoclonal gammopathy
Feedback
There is a broad based increase in the gamma band, corresponding to polyclonal

hypergammaglobulinemia, as seen in chronic inflammation as well as an increase in
the alpha-1 and alpha-2 regions.
======================
Which of the following would not be considered a normal part of a routine electrolyte
panel?
Sodium
Potassium
Magnesium
Chloride
Feedback
A routine electrolyte panel typically consists of sodium, potassium, choride, and

bicarbonate.
Which of the following disorders is characterized by increased production of chloride

in sweat?
Multiple myeloma
Hypoparathyoidism
Cystic fibrosis
Wilson’s disease
Down Syndrome
Feedback
In cystic fibrosis, individuals have problems with decreased salt, and hence, water
levels in their lung surfactent. They also have problems with salt absorption in the
sweat ducts which causes them to produce extremely salty sweat, with a high chloride
level. Sweat chloride testing is still the gold standard for screening for cystic fibrosis.
Which of the following is the most common technique that is used by clinical
laboratories for therapeutic drug monitoring?
Immunoassay
Electrophoresis
Atomic absorption
Ion selective electrode voltimetry
Feedback
Immunoassay is the most common technique that is used by clinical laboratories for
therapeutic drug monitoring.
Most of the drugs commonly assessed with TDM can be measured on analytical
platforms which utilize antibodies (in some form) for detection. Antibodies can be
developed that recognize drugs. Although most drugs are much too small to evoke an
immune response, scientists can conjugate drugs to immunogenic proteins to produce
antibodies that recognize drug-specific epitopes.
Which of the following lipid results would be expected to be MOST falsely elevated
on a serum specimen from a non-fasting patient?
Cholesterol
Triglyceride
HDL
LDL
Feedback
Triglycerides show marked elevation after an individual eats. So a non-fasting

specimen will show a falsely high triglyceride level. Cholesterol does not show much
fluctuation after eating. HDL and LDL may be slightly elevated due to a non-fasting
sample, but not to the same extent as the triglycerides.
Two CSF specimens were sent to the Lab with the following results:
Tube #1 = 11,200 rbc/µL
Tube #2 = 300 rbc/µL
The results on these CSF specimens are indicative of:
an infection
a recent subarachnoid hemorrhage
a traumatic tap
an old intracranial bleeding episode
faulty lab equipment
Feedback
Traumatic taps are described as spinal fluid taps where blood vessels are pierced with
the needle during aspiration, causing a contamination of the spinal fluid sample with
blood or bone marrow. Traumatic taps are easily differentiated from true
hemmorhages as in traumatic taps, each subsequent container of spinal fluid drawn
will have a smaller amount of red and white cells present. In a true hemorrhage, the
red and white cell counts will remain steady in each subsequent tube of spinal fluid
drawn.

A 45-year-old African American female has been diagnosed and treated for type 2
diabetes for the past five years. She maintains good control of her blood glucose with
medication but does not exercise and has gained 12 pounds over the past year.
At her next appointment, her physician orders hs-CRP along with blood assays to
monitor her diabetes.
Laboratory Result:
hs-CRP 2.8 mg/L
At no risk for cardiovascular disease

Low risk for cardiovascular disease
Average risk for cardiovascular disease
High risk for cardiovascular disease
Feedback
A hs-CRP of 2.8 mg/L indicates an average risk of cardiovascular disease (1.0-3.0

mg/L).
With the development of fetal lung maturity, which of the following phospholipid
concentrations in amniotic fluid increases?
Sphingomyelin
Phosphatidyl ethanolamine
Phosphatidylinositol
Lecithin
Feedback
When testing for fetal lung maturity, often the L/S ratio is determined. The L in the
L/S ratio stands for Lecithin, which is one of the pulmonary surfactants needed to
reduce the surface tension of the air-liquid interface of the alveolar lining, so that
alveoli don't collapse upon expiration; the other stands for Sphingomyelin, another
pulmonary surfactant. Until about 32-33 weeks of gestation, the concentration of
these two substances are quite similar; thereafter the concentration of lecithin
increases significantly compared with the relatively constant concentration of
sphingomyelin. In the absence of complications, the ratio of these two components
reaches 2.0 at about 35 weeks gestation. Infants delivered after attaining an L/S ratio
of 2.0 or higher rarely develop RDS. This value of 2.0 has become the commonly
accepted standard value indicating maturity in the fetus of a non-diabetic woman.
Which one of the following adipocyte products is an important messenger in

metabolism, signaling the hypothalamus that there are changes in fat stores?
Leptin
Resistin
IL-6
Angiotensinogen
Feedback
Leptin signals the hypothalamus that there are changes in fat stores.
Resistin increases insulin resistance and enhances adhesion molecules present on

endothelial cells.
IL-6 responds to tissue injury. IL-6 increases insulin resistance by inhibiting insulin
receptor signal transduction in liver cells. It also increases other inflammatory
cytokines, interleukin-1 (IL-1) and TNF-, and stimulates the liver to produce C-
reactive protein (CRP).
Adipose tissue and liver cells produce angiotensinogen, a precursor of angiotensin II.
Besides increasing blood pressure, angiotensin II may stimulate adipose cell
formation and thus increase adipose mass.
Which of the following is characteristic of an exudates effusion?
Leukocyte count greater than 1000 WBC/uL

Clear appearance
Protein concentration less than 3.0 g/dL
Absence of fibrinogen
Feedback
Exudate effusion characteristics:
 Leukocyte count greater than 1000 WBC/uL

 Protein > 3g/100mL
 yellow or cloudy appearance
Creatinine excretion correlates best with which of the following parameters:

Age
Sex
Muscle mass
Body weight
Feedback
Creatinine excretion is related to muscle mass and is fairly constant from day to day
for a given individual.
Which of the following contributes to specific gravity but does NOT contribute to
osmolality?
protein
NaCl
urea
glucose
Feedback
The presence of large amounts of protein and glucose will alter the specific gravity
and should be considered when interpreting specific gravity results. Osmolality
measures the analytes in the following equation- note that protein is not included in
the calculation of osmolality. Osmolality = 1.86 Na + (Glucose/18) + (BUN/2.8) + 9
(or) 1.91 Na + (Glucose/15) + (BUN/2.25).

Which of the following tests would be used in the assessment of glomerular filtration:
24 hour urine protein

Creatinine clearance
PSP test
Urea
Feedback
Creatinine is filtered by the glomerulus and is not reabsorbed; therefore it can be used
to estimate the GFR (glomerular filtration rate).
The production of neutral 17-ketosteroids is a measure of which of the following?
cholesterol production
androgen production
estrogen production
growth hormone
Feedback
17-ketosteroids are metabolites of male steroid sex hormones, or androgens, and other
hormones released by part of the adrenal gland in males and females, and in the testes
in males.

Which of the following forms of calcium is biologically active:
Protein-bound calcium
Non-ionized calcium
Calcium carbonate
Free ionized calcium
Feedback
Ionized calcium is important in physiologic functions such as coagulation and

neuromuscular conductivity.
If 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 not realize a therapeutic benefit (low free drug fraction).
The patient may experience toxic effects (high free drug fraction).
The serum level of the drug will most likely remain in the therapeutic range.
Feedback
If serum protein levels fall, as can occur in liver failure or nephrotic syndrome, less
protein (specifically albumin) will be available for drug binding; a subsequent dose
may produce a toxic concentration of free drug.
Doses of drugs that are highly protein-bound may need to be adjusted in patients with
lower drug-binding protein levels.
Follicle stimulating hormone (FSH) is produced by:
adrenal cortex
adrenal medulla
pituitary
thyroid
Feedback
The pituitary gland produces FSH. The adrenal cortex produces corticosteroid
hormones, androgens, aldosterone, etc. The adrenal medulla produces catecholamines
such as epinephrine and norepinephrine. The thryoid gland produces thyroid
hormones such as T3 and T4.
A patient has optimal LDL and HDL cholesterol values but an hsCRP test shows a
value of 12 mg/L (low cardiovascular risk < 1.0 mg/L). Which is likely?
The patient has a masked lipid problem such as metabolic syndrome.

The patient has not been fasting.
The patient has an underlying acute inflammation process.
Feedback
hsCRP values >10 mg/L usually signify an underlying acute inflammation such as
infection. The cardiovascular risk value of hsCRP is void and uninterpretable when
levels reach this high. The optimal HDL and LDL may indicate that the patient has
been fasting. However, fasting does not affect the hsCRP test.
Which of the following is used as an indicator of inflammation?
C-Reactive Protein (CRP)

RPR
Complement
Alpha fetoprotein
Feedback
C-Reactive Protein (CRP) is used as an indicator of inflammation.
RPR, or rapid plasma reagin, is a technique utilized for syphilis testing. Complement
is not an indicator of inflammation; instead it plays a role in our immune system.
Alpha fetoprotein is a protein made by the fetus and is also used for liver cancer
screening.
What is the role of microalbuminuria testing?

Monitor diabetic patient carbohydrate management

Detect small-sized urinary albumin molecules in early renal disease
Detect small urinary concentrations of albumin before there is irreparable renal
damage
Diagnose renal failure in a type 1 diabetic patient
Feedback
HbA1C is the recommended test for monitoring diabetic carbohydrate management.

Microalbuminuria, low concentrations of urinary albumin, is measured to detect early
renal impairment, at a stage where it is reversible with treatment.
Which of the following are markers of myocardial necrosis but are not widely
measured in evaluating chest pain and ACS due to the labor-intensive method that is
needed to measure them?
CK-MB
CK-MB isoforms
Myoglobin
cTnT and cTnI
Feedback
CK-MB isoforms are markers of myocardial necrosis, but are not widely measured in
evaluating chest pain and ACS due to the labor-intensive method that is needed to
measure them. Detection of CK-MB isoforms requires a special electrophoresis
technique.

Which condition is caused by deficient secretion of bilirubin into the bile canaliculi?
Gilbert’s disease
neonatal hyperbilirubinemia
Dubin-Johnson syndrome
Crigler-Najjar syndrome
Feedback
Dubin-Johnson syndrome is an autosomal recessive disorder that causes an increase

of conjugated bilirubin without elevation of liver enzymes (ALT, AST). This
condition is associated with a defect in the ability of hepatocytes to secrete conjugated
bilirubin into the bile. Gilbert's syndrome causes an otherwise harmless jaundice,
which does not require treatment, caused by hyperbilirubinemia. Neonatal
hyperbilirubinemia is associated with jaundice and is a condition marked by high
levels of bilirubin in the blood. Crigler-Najjar syndrome is associated with increased
levels of bilirubin in the blood as the disorder affects the metabolism of bilirubin.
The Lecithin/Sphingomyelin ratio determination of amniotic fluid is useful in

assessing the probability of:
cystic fibrosis
phenylketonuria
respiratory distress syndrome
chromosomal abnormalities
Feedback
The lecithin-sphingomyelin ratio is a test for assessing fetal lung maturity that is
useful in determining risk of an infant born with respiratory distress syndrome.
Exposing serum or plasma to a high magnetic field is neccessary for which of the
following technologies or tests?
NMR particle count

LDL electrophoresis
Immunoassay
Feedback
NMR (nuclear magnetic resonance) uses high energy magnetic fields and radio
waves. This technology involves the absorption of electromagnetic energy (radio
waves) by the nuclei of atoms placed in a strong magnetic field. The nuclei of
different atoms absorb unique frequencies of radiation. By observing which
frequencies are absorbed and emitted, it is possible to identify analytes like lipids. The
other tests listed do not require magnetic radiation.
Which one of the following is the MOST specific biochemical marker of myocardial
infarction?
CK
LD
Troponin
myoglobin
Feedback
Troponin is a very specific biomarker that is released during cardiac injury or

stress. CK is found not only in cardiac tissue, but also in muscle and brain tissue. LD
levels can be elevated in cardiac events, tissue breakdown, and
hemolysis. Myoglobin is elevated when muscle tissue is damaged and is not specific
for the heart muscle.
Which of the following is true concerning atherosclerosis?
Atherosclerosis is the same as arteriosclerosis.

Atherosclerosis is the deposition of plaques containing cholesterol and lipids on
the innermost layer of the walls of large and medium-sized arteries.
Atherosclerosis is the main outcome that is assessed in risk marker studies.
Most humans do not have significant atherosclerosis.
Feedback
The deposition of plaques containing cholesterol and lipids on the innermost layer of
the walls of large and medium-sized arteries is the defintion of atherosclerosis.
Arteriosclerosis is a more general term that describes a thickening and loss of

elasticity of the walls of the arteries (hardening of the arteries). Atherosclerosis is a
type of arteriosclerosis but is not synonymous with it.
Atherosclerosis is not the most common outcome for risk marker studies because it
can be hard to measure. Infarcts, cardiac procedures, death, and 'events' are more
common. Most humans have visible or measureable atherosclerosis by early middle
age.
Which of the following is an autoantibody that binds to TSH receptor sites on thyroid
cell membranes preventing thyroid-stimulating hormone binding?
Antithyroglobulin
Antimicrosomal antibodies
Thyroid-stimulating immunoglobulins
Thyroxin-binding globulins
Lupus erythematosus
Feedback
Thyroid-stimulating immunoglobulins, or TSI's, are IgG antibodies that can bind to

thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH,
causing excess secretion of thyroxine and triiodothyronine. The TSI level is
abnormally high in persons with hyperthyroidism due to Graves' disease.
An important metallic activator of alkaline phosphatase and creatine kinase is
Iron
Zinc
Potassium
Magnesium
Nickel
Feedback
Magnesium is often employed as a reaction activator for certain enzymes in

commercial analytical test kits such as ALP and CK.
Which of the statements below regarding the diagnosis of pancreatitis is CORRECT?

Diagnostic sensitivity is increased by assaying both amylase and lipase.
Chronic pancreatitis occurs more often in women.
Increased amylase levels stay increased after the cause of the pancreatitis is
removed.
Feedback
Increased levels of amylase and lipase are very useful for detecting acute pancreatitis.
In chronic pancreatitis, amylase and lipase levels may not be elevated and, in fact, can
decrease over time, so these test are not as predictive for chronic pancreatitis as they
are for acute. Chronic pancreatitis actually occurs more often in men. Amylase levels
decrease when the cause of the pancreatitis is removed.
Hydrogen ion concentration (pH) in blood is usually determined by means of which

of the following electrodes?
silver
glass
platinum
gold
Feedback
pH electrodes that measure hydrogen ion concentrations are actually glass electrodes.
The National Heart, Lung, and Blood Institute initiated the National Cholesterol
Education Program (NCEP) in 1985. The goal was to reduce the number of
Americans with elevated cholesterol and thus reduce illnesses and deaths in the
United States due to coronary heart disease. Three adult treatment panels have been
published since then with clinical practice guidelines for managing cholesterol levels
in adults.
The most recent panel, Adult Treatment Panel III (ATP III), was published in 2001
and updated in 2004. The NCEP: ATP III also includes criteria for the diagnosis of
metabolic syndrome.
Select the set of laboratory assays that are utilized in the NCEP: ATP III criteria for
metabolic syndrome diagnosis.
LDL-C, triglycerides, HDL-C, and fasting blood glucose

Fasting blood glucose, triglycerides, insulin, and VLDL
Fasting blood glucose, triglycerides, HDL-C
Fasting blood glucose, triglycerides, HDL-C, and VLDL
Feedback
Fasting blood glucose, triglycerides, HDL-C along with waist circumference and
blood pressure are the measurements used in the NCEP: ATP III criteria.
===========
According to the National Diabetes Data Group 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
The patient may be diagnosed as having diabetes mellitus

The patient is diagnosed as having impaired glucose tolerance
The patient is diagnosed as having diabetes insipidus
The patient is normal
Feedback
The National Diabetes Data group recommends that the diagnosis of diabetes mellitus
be based on two fasting plasma glucose levels of 126 mg per dL (7.0 mmol per L) or
higher. Other options for diagnosis include two two-hour postprandial plasma glucose
(2hrPPG) readings of 200 mg per dL (11.1 mmol per L) or higher after a glucose load
of 75 g or two casual glucose readings of 200 mg per dL or higher. Measurement of
the fasting plasma glucose level is the preferred diagnostic test, but any combination
of two abnormal test results can be used.
Deviations from Beer’s Law are caused by:
very low concentration of absorbing material

polychromatic light
very high concentrations of substance being measured in a colorimetric reaction
stray light
Feedback
Beer's law is based on the fact that absorbance is directly proportional to the
concentration of a solution. Therefore, stray light can alter the absorbance results in
this type of assay.
All of the following concerning CK-MB (CK-2) are true EXCEPT:
Greater than 5% or 10 IU/L followed by an LD-1: LD-2 flip is specific evidence

of myocardial infarction (MD).
CK-MB levels can be normal with an elevated total CK.
CK-MB and troponin levels can be elevated after an AMI.
CK-MB levels are normal in cardiac ischemia.
Feedback
CK-MB would be abnormal in cases of cardiac ischemia since CK-MB is released in

higher amounts from cardiac muscle when the heart is damages or overworked due to
various conditions.
Which of the following parts of the body synthesizes and secretes BNP?
Kidney
Liver
Heart
Adrenal gland
Feedback
BNP (or B-Type Natriuretic Peptide) is secreted by the heart, and acts as an indicator
of the heart's relative functionality. A higher BNP level signifies worsening symptoms
of heart failure, as the left ventrical myocardium releases BNP in response to
ventricular wall stress or tension, which occur in chronic heart failure.
The ultimate end product of both epinephrine and norepinephrine metabolism is:
metanephrine
vanillylmandellic acid (VMA)
homovanillic acid (HVA)
cortisol
Feedback
Vanillylmandelic acid (VMA) is a metabolite of the catecholamines, epinephrine and

norepinephrine. VMA is found in the urine, along with other catecholamine
metabolites, including homovanillic acid (HVA), metanephrine and
normetanephrine. Urinary VMA is elevated in patients with tumors that secrete
catecholamines.

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 = 2.4 mg/dL
Urine creatinine = 65 mg/dL
Urine volume (24 hrs) = 1400 mL
What is the estimated glomerular filtration rate for this patient?
65 mL/min
26.32 mL/min
51.69 mL/min
37,916 mL/min
Feedback
The general glomerular filtration rate calculation is as follows:
Urine creatinine / plasma creatinine x volume per minute = glomerular filtration rate
(mL/min)
*in order to solve this problem, the 24 hour urine must be converted into minutes.
1440 minutes should be used as the denominator in the volume component.
So...for this patient, the calculation would be:
( 65 mg/dL / 2.4 mg/dL ) X ( 1400 mL / 1440 min ) =
26.32 mL/min

Which statement best describes small dense LDL particles that can occur in
atherogenic dyslipidemia?
Small dense LDL molecules are less atherogenic than larger, less dense or
buoyant LDL particles because they are metabolized faster
Small dense LDL molecules transport more cholesterol and thus are more
atherogenic
Small dense LDL molecules are more atherogenic because they can more easily
move into the endothelium and vessel wall
Feedback
In excess triglycerides, the triglycerides reduce the amount of cholesterol in LDL

particles producing small dense LDL molecules. Because of size and density, these
molecules more easily enter damaged endothelium and vessel walls and are more
easily incorporated as plaque is formed.
A patient’s BUN 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?
patient is normal
patient is in early stage of renal disease
patient protein intake is quite low
patient has suffered muscle deterioration
one of the values is in error
Feedback
The patient's BUN is within normal range (5-20 mg/dL) while the creatinine is about
five times the upper normal range (0.6-1.2 mg/dL). Gross elevations in creatinine are
almost always accompanied by elevations in BUN when there is kidney impairment.
Either the BUN or creatinine value in this case is incorrect. Both tests should be
repeated.
A drug that is readily cleared and has a wide therapeutic window, such as ampicillin,
should always be monitored by TDM.
True
False
Feedback
For some drugs, such as ampicillin, the range between the minimum effective
concentration and the toxic concentration is large. These drugs are thus relatively safe.
Drugs that have a very narrow therapeutic window need to be monitored by TDM.
Which of the following cardiovascular risk markers is a more sensitive version of a

test that is used to assess inflammation?
Oxidized-LDL
hs-CRP
ApoB/ApoA1
LpPLA2
Feedback
hs-CRP is a more sensitive version of the C-reactive protein (CRP) test, a test that has
been used for many years to assess inflammation in settings such as lupus,
transplantation, infection, etc.

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 microliters of diluent. The result now reads 325
mg/dL. How should the techologist report this patient's glucose result?
325 mg/dL
1300 mg/dL
975 mg/dL
1625 mg/dL
Feedback
The correct answer for this question is 1300 mg/dL. The laboratorian performed a 1:4 dilution by
adding 0.25 mL (or 250 microliters) of patient sample to 750 microliters of diluent. This creates a total
volume of 1000 microliters. So, the patient sample is 250 microliters of the 1000 microliter mixed
sample, or a ratio of 1:4. Therefore, the result given by the chemistry analyzer must be multiplied by a
dilution factor of 4. 325 mg/dL x 4 = 1300 mg/dL.
=================
What is the largest constituent of plasma nonprotein nitrogen:
Ammonia
Creatinine
Ketones
Urea
Feedback
During the metabolism of protein in the body, the liver creates ammonia, which is
broken down into a by-product called urea. Urea comprises the largest percentage of
nonprotein nitrogen in plasma.
Which is true concerning apolipoproteins?
All lipoprotein particles contain the same apolipoproteins.

Apolipoproteins are essential for lipid metabolism.
Apolipoproteins are the reason lipoproteins are atherogenic.
Feedback
Apolipoproteins are essential for lipid metabolism; this is the only true statement of
the three choices. The apolipoproteins on a particle contribute to the identity of the
particle; not all lipoprotein particles contain the same apolipoproteins.
Apolipoproteins are not atherogenic.
What weight of H2SO4 is contained in 200 ml of a 4 molar H2SO4 solution? (Atomic

weight: H= 1; S = 32; 0 = 16)
78.4 gm
156.8 gm
39.2 gm
15.68 gm
84 gm
Feedback
x (grams needed)
(4 M) (0.2 L) =
98 (formula weight)
Therefore:
x (grams needed)
0.8 =
98 (formula weight)
= 78.4 g
Molarity x Molecular Weight x Volume = Grams
Six months ago, a 55-year-old female had a fasting plasma glucose (FPG) greater than
200 mg/dL on two occasions. She was diagnosed as having type 2 diabetes and
treatment was started. Along with routine FPG's which of the following tests would
most likely be used to monitor glycemic control?
HbA1C
Insulin
C-peptide
Urine glucose
Feedback
FPG is performed to monitor diabetes, often weekly or even daily. The ADA also
recommends that a HbA1C be tested at least twice a year to monitor long-term
glycemic control.
Recently the American Diabetes Association (ADA) recommended reporting which

of these values to correlate with HbA1C as a further indicator of glycemic control?
Estimated average glucose

Blood urea nitrogen
Microalbumin
Insulin
Feedback
In 2008, the ADA recommended calculating and reporting the estimated average
glucose (eAG) with HbA1C measurement results.
The immunoassay procedure for serum hCG utilizes antisera against which subunit of
hCG?
alpha
gamma
epsilon
beta
Feedback
The hCG molecule consists of two combined, dissimilar subunits designated alpha
and beta. Immunoassays utilize antibodies specific to the beta subunit of the hCG
glycoprotein.
Select the true statement regarding lipids and heart disease.
Increased level of LDL-C indicates an increased risk for cardiovascular disease

Increased level of HDL-C indicates an increased risk for cardiovascular disease
Lipids are not involved in atherosclerotic plaque formation
Lipids are no longer measured in evaluating cardiac disease risk
Feedback
It is now known that atherosclerosis formation is primarily an inflammatory process

but lipids do play a role in the process. Increased blood levels of LDL-C indicates a
greater risk for atherosclerosis. An increased level of HDL-C is not associated with an
increased risk for cardiovascular disease. In fact, the HDL lipoprotein plays a role in
reducing lipid levels in the blood."
Serum TSH levels five-times the upper limit of normal in the presence of a low T4
and low T3 uptake could mean which of the following:
The thyroid has been established as the cause of hypothyroidism

The thyroid is ruled-out as the cause of hypothyroidism
The pituitary has been established as the cause of hypothyroidism
The diagnosis is consistent with secondary hyperthyroidism
Feedback
During primary hypothyroidism, where a defect in the thryoid gland is producing low
levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities
in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback
mechanism.
Which one of the following serum constituents is increased following strenuous

exercise:
Creatinine
Total lipids
Sodium
Iron
Feedback
Reduced renal blood flow causes a small increase in serum creatinine. The other
analytes mentioned stay the same or decrease after strenuous exercise.

The measurement of total glycosylated hemoglobin A1c is an effective means of

assessing the average blood glucose levels:
Over the past few days

Over the past 1-2 weeks
Over the past 2-3 months
Only the past 24 hours
Feedback
The concentration of hemoglobin A1c is directly proportional to the average plasma

glucose level that the RBCs are exposed to during their 120 day life span. The
glycosylated hemoglobins result from glycosylation of serine, asparagine, and
hydroxylysine residues in hemoglobin. There are three glycosylated hemoglobins: Hb
A1a, Hb A1b, and Hb A1c, of which Hb A1c constitutes 80%. Most methods measure
total gycosylated hemoglobin, which has a high degree of correlation to Hb A1c, and
may be reported as such after making the appropriate conversion.
Which of the following proteins has the FASTEST electrophoretic mobility?
albumin
alpha-1 globulins
beta globulins
gamma globulins
alpha-2 globulins
Feedback
The plasma globulins can be separated into five fractions by serum protein
electrophoresis. In order of decreasing electrophoretic mobility these fractions are
the: serum albumin, alpha-1 globulins, alpha-2 globulins, beta globulins, and gamma
globulins.
Low values of plasma ceruloplasmin are MOST associated with:
Hepatolenticular regeneration
High plasma copper values
Hypoparathyroidism
Kidney stones
Feedback
Ceruloplasmin is the main copper transporting protein in the blood. Although there
are other conditions (not listed) that can cause a low ceruloplasmin value (i.e.,
Menkes disease, Wilson’s disease, overdose of Vitamin C), the best answer of those
given for this question is “High plasma copper values.”
Human chorionic gonadatropin (hCG) is used in the determination of:
Liver function
Fetal maturity
Pregnancy
Steroid levels
Feedback
Human chorionic gonadatropin (hCG) is a hormone produced in pregnancy that is

made by the developing embryo and later produced by the placenta. Its role is to
maintain progesterone production that is critical for a healthy pregnancy.
Serum proteins can be separated by cellulose acetate electrophoresis into how many
basic fractions:
4 fractions
5 fractions
6 fractions
7 fractions
Feedback
The five basic fractions are albumin, alpha-1, alpha-2, beta, and gamma globulins.
Match each of the definitions shown below with the term from the drop-down box
that it defines.
Your answers are on the left. The correct answers are on the right and highlighted.
Pharmacokinetics The study of drug disposition in the body - how and

when drugs enter the circulation, how long they stay
there, and how they are eliminated
Drug half-life The amount of time it takes for a drug's concentration in
the body to decrease by 50%
Pharmacogenomics The study of how variations in the human genome affect
(Pharmacogenetics) a given individual's response to medications
Therapeutic window The range between a drug's effective dose and its toxic
dose
Feedback
Drug half-life- The amount of time it takes for a drug's concentration in the body to
decrease by 50%
Therapeutic window- The range between a drug's effective dose and its toxic dose
Pharmacokinetics- The study of drug disposition in the body - how and when drugs
enter the circulation, how long they stay there, and how they are eliminated
Pharmacogenomics (Pharmacogenetics)- The study of how variations in the human

genome affect a given individual's response to medications
Which one of the following statements about lipoproteins is FALSE:
Elevated LDL causes a decreased risk of atherosclerosis

Reduced LDL causes a decreased risk of atherosclerosis
Elevated HDL causes a decreased risk of atherosclerosis
Elevated total cholesterol causes an increased risk of atherosclerosis
Feedback
Increased LDL levels increase the risk of atherosclerosis. LDL can penetrate the
vascular endothelium and contribute to the creation of lipid foam, which forms the
core of an atherosclerotic plaque. Oxidized LDL cholesterol also triggers an
inflammatory process within the vessel wall that accelerates atherosclerosis. HDL
diverts cholesterol away from your arteries, providing an antiatheroschlerotic effect.
Finally, elevated total cholesterol levels are associated with an increased risk of
atheroschlerosis. Therefore, the answer which is false is A.
Most common methods for measuring bilirubin are based on the reaction of bilirubin
with:
Methyl alcohol
Neural salts
Bilirubin oxidase
Diazo reagent
Feedback
Diazotized sulfanilic acid (diazo reagent) reacts with bilirubin to produce colored
azodipyrroles, which are measured spectrophotometrically.
All of the statements below regarding amylase and lipase in pancreatitis are TRUE
EXCEPT:

Diagnosis sensitivity is increased by assaying both amylase and lipase.
Urinary amylase: creatinine ratio is the most sensitive test for acute pancreatitis.
Serum lipase peaks at 24 hours after an episode of acute pancreatitis and remains
high for 7-8 days.
Feedback
Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis, but
not diagnostic enough to predict chronic pancreatitis; wheras high levels are found
only during acute pancreatitis episodes. In the later stages of chronic pancreatitis,
normal to decreased levels of amylase and lipase are caused by the gradual inability of
the pancreas to secrete the enzymes.
Which of the following thyroid function assays is affected least by pregnancy:
Total T3
Total T4
Free T4
Feedback
Free T4 is affected the least by changes in plasma proteins during pregnancy.
The most likely cause of an elevated serum potassium level in an apparently normal
individual is:
Contamination
Hemolysis
Acute renal failure
Interfering substances
Feedback
Hemolysis could result from improper specimen collection technique, or improper

storage.
Which of the following conditions would be suggested by a jaundiced patient

experiencing a marked rise in alkaline phosphatase, conjugated bilirubin, and a slight
rise in ALT:
Cardiovascular disease
Hepatitis
Post-hepatic obstruction
Renal failure
Feedback
Post-hepatic obstruction is characterized by a marked increase in alkaline

phosphatase, GGT, conjugated bilirubin, as well as other hepatic enzymes. The slight
rise of ALT suggests that the issue is not hepatitis. Renal and cardiovascular failure
do not match the symptom of jaundice or the abnormal laboratory values.

Which of the following analytes would not be significantly increased in a plasma

sample as a result of hemolysis:
Potassium
LDH
Uric acid
AST
Feedback
Potassium, LDH, and AST are found in much higher concentration in intact RBCs
than in serum.
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?
cTnI
CK-MB
cTnT
Myoglobin
Feedback
Myoglobin and CK-MB are present in skeletal muscle and can be elevated in injury to
these cells. Other causes of increased myoglobin and CK-MB levels include:
 Severe injury to skeletal muscle

 Strenuous exercise
 Extremely difficult breathing (increased use of chest muscles)
 Kidneys failure
 Chronic muscle disease
 Alcohol abuse
Troponin T and I tests are much more specific to cardiac muscle than myoglobin and
CK-MB assays.
While serum elevations are NOT generally seen in early stages, which of the
following tumor markers are elevated in more advanced stages of breast cancer?
CEA and AFP

AFP and CA 125
PSA and CA 15-3
CA 15-3 and CA 549
Feedback
CA 15-3 is also known as CA-breast as it is specifically associated with breast cancer.

CA 549 is a glycoprotein found in the serum of breast cancer patients as well. CEA,
or carcinoembryonic antigen, is used mainly to monitor the treatment of cancer
patients, particularly those with colon cancer. AFP, or alphafetoprotein, is found in
elevated levels in primary liver cancer or germ cell tumor. CA 125 is usually used to
detect ovarian cancer and also used to monitor therapy. PSA, or prostate specific
antigen, is used in the detection of prostate cancer.

Which of the following contributes most to serum osmolality:
Magnesium
Albumin
Potassium
Sodium
Feedback
Osmolality of a solution is dependent on the number of particles in solution, often

determined by measuring the freezing point depression. Sodium ions are the major
cation in plasma, and thus contribute most to the plasma osmolality of the substances
listed. Chloride is the major anion, and thus also contributes significantly to
osmolality.
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:
Aldosterone
Porphyrins
Catecholamines
Metanephrines
Feedback
Porphyrins are unstable when exposed to light.

A patient presents with the following test results:
T. Bili: 3.0 ng/dl

D Bili: 1.2 ng/dl
Urine urobilinogen: decreased
Stools color: clay colored
The MOST probable cause is:
viral infection of liver

chemical damage to liver
obstructive jaundice
hepatitis
hepatic carcinoma
Feedback
Obstructive jaundice, also called posthepatic jaundice, is associated with an

obstruction located after the conjugation of bilirubin in the liver. Laboratory results in
this condition usually include: increased conjugated bilirubin, normal unconjugated
bilirubin, decreased or negative urobilinogen, and pale stool color. The pale stool
color is very indicative of obstructive or post-hepatic cause since normal feces get
their color from bile pigments, which are not incorporated into the stool if they are
obstructed.
An increased serum level of which of the following analytes is MOST commonly

associated with decreased glomerular filtration?
Creatinine
Uric acid
Urea
Ammonia
Glucose
Feedback
Plasma concentrations of creatinine are used to assess renal function. Creatinine

clearance is based on the serum creatinine level and is used to measure glomerular
filtration rate, or GFR.
Isoenzymes of alkaline phosphatase occur in:
Kidney, bone, intestines, liver

Bone, brain, liver, pancreas
Liver, brain, spleen, intestines
Brain, kidney, intestines, bone
Feedback
Alkaline phosphatase, or ALP, is present in kidneys, liver, intestines, bone, and the
placenta. The liver makes the largest amount of ALP. Some of the conditions
associated with increased levels of ALP include: damaged liver cells, rapid bone
growth (during puberty), bone diseases, or a disease that affects how much calcium is
in the blood (hyperparathyroidism), and vitamin D deficiency.

A markedly elevated 5-hydroxyindole acetic acid (5-HIAA) determination is

presumptive evidence for:
Lead poisoning
Pheochromocytoma
Porphyria
Carcinoid tumor
Adrenal hyperplasia
Feedback
5-Hydroxyindoleacetic acid, or 5-HIAA, is the main metabolite of serotonin and

testing is most frequently performed for the diagnosis of carcinoid tumors.
What condition is indicated by the following blood gas results: Bicarbonate = 32

mmol/L (Normal = 22 - 26 mmol/L); pCO2 = 65 mm Hg (Normal = 35 - 45 mmHg);
pH = 7.28 (normal = 7.35 - 7.45)
Healthy condition
Uncompensated metabolic acidosis
Compensated metabolic acidosis
Uncompensated respiratory acidosis
Feedback
The normal pH of blood is 7.40. In order for most metabolic processes to take place,
the pH must remain within a narrow range close to this value. The range is usually
defined in adults as 7.35-7.45. If blood pH falls below 7.35, the blood becomes too
acidic (acidosis). If blood rises above 7.45, the blood is too alkaline (alkalosis).
As blood pH decreases, the kidneys will retain bicarbonate (HCO3-) from the
glomerular filtrate; therefore, bicarbonate is increased. However, in this case, the
increased HCO3- could not compensate for the markedly elevated pCO2 (the
respiratory component) and the condition that results is uncompensated respiratory
acidosis.
An obese adult with premature arteriosclerosis is seen in the clinic. When her serum is
tested no chylomicrons are present, LDL are normal and VLDL 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 has a hyperlipoproteinemia with the MOST likely type of:
II
III
IV
V
VI
Feedback
Type I hyperlipoproteinemia is a form of hyperlipoproteinemia associated with

deficiencies of lipoprotein lipase. Hyperlipoproteinemia type II is the most common
form and is classified into type IIa and type IIb, depending on whether there is
elevation in the triglyceride level in addition to LDL cholesterol.
Hyperlipoproteinemia type III is associated with high chylomicrons and IDL.
Hyperlipoproteinemia type IV is assoicated with high triglycerides. It is also known
as hypertriglyceridemia. Hyperlipoproteinemia type V is similar to type I, but with
high VLDL in addition to chylomicrons.
==========================================================
Match the tumor markers below with their corresponding sites of tumor origin.
Your answers are on the left. The correct answers are on the right and highlighted.
Colon CEA
Prostate PSA
Liver Alpha-fetoprotein
Testicles Beta HCG
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PSA, or prostate specific antigen = Prostate
CEA, or Carcinoembryonic Antigen = Colon
beta hCG, or Human chorionic gonadotropin = Testicles
AFP, or Alpha-fetoprotein = Liver
Which of the following action describes the MAJOR property of antidiuretic

hormone?
acts on proximal tubules.

changes distal tubule water permeability
Acts on Na/K/(H‘) pump
cannot be affected by diuretics
controls thirst
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Antidiuretic hormone, or ADH, has the important role of conserving body water by
reducing the loss of water in urine by changing the water permeability of the distal
tubule and collecting duct. An increase in ADH causes a concentrated urine since the
water is retained and absorbed through the permeable membrane. An decrease in
ADH causes the collecting ducts to retain very little water, instead it is excreted as
urine.
A patient has the following test results: Increase serum phosphorus level, decreased
serum calcium level, and decreased serum parathyroid hormone level. This patient
MOST likely has:
hyperparathyroidism
hypoparathyroidism
nephrosis
bone disease
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The decreased serum parathyroid hormone level indicates that the parathyroid gland is
not secreting this hormone adeqately. This condition is called hypoparathryroidism, as
the hypo- represents inadequacy of the parathyroid's production.
What is the most significant cause of decreased haptoglobin levels?

Acute infection
Intravascular hemolysis
Liver disease
Myoglobinuria
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Decreased haptoglobin levels occur when intravascular hemolysis causes free

hemoglobin to be released from the broken red cell. The free hemoglobin then binds
to haptoglobin, leaving decreased haptoglobin levels.
Which of the following statements best describe HbA1C?
A glycated protein formed from the reversible addition of a glucose molecule to

Hb A.
A glycated protein that is an index of carbohydrate management over a 24-hour
period.
A glycated protein that is an index of carbohydrate management over 2 - 3
months.
A glycated protein formed from the nonenzymatic addition of a glucose
molecule to albumin.
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HbA1C is the nonenzymatic addition of a glucose molecule to Hb A. After a

rearrangement, the addition is irreversible. The concentration of HbA1C relates to the
individual's average glucose concentration over 2 - 3 months.

All of the following are characteristics of Type II diabetes mellitus EXCEPT:
Insulin levels may or may NOT be abnormal.

more common than Type I diabetes.
requires insulin therapy to control hyperglycemia.
associated with obesity and more common in persons greater than 40 years old.
a and d
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In type I diabetes mellitus, patients have deficiency in producing insulin from the beta
cells in the islets of Langerhans of the pancreas. In this type of diabetes, patients are
often given exogenous insulin therapy to control hyperglycemia. Type II diabetes
mellitus involves the body's unresponsiveness to insulin, in which exogenous insulin
therapy does not commonly treat the condition.
Which of the following is not a component of a basic single beam spectrophotometer:
Beam splitter
Cuvette
Prism
Light source
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A beam splitter is employed in a dual beam spectrophotometer.

Select the statement that best describes hs-CRP?
hs-CRP is a measurement of acute inflammation and is used to monitor these

conditions
hs-CRP is an anti-inflammatory adipokine synthesized by adipocytes
hs-CRP is a marker of chronic inflammation and measured to predict the risk of
cardiovascular disease
hs-CRP is decreased in inflammatory conditions and measured to predict a return
of inflammation
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hs-CRP is a recent marker of chronic inflammation. New measurements of CRP in

lower levels (hs-CRP) are now measured to monitor risk of cardiovascular disease.
The buffering capacity of blood is maintained by a reversible exchange process

between bicarbonate and:
Sodium
Potassium
Calcium
Chloride
Feedback
Bicarbonate and Chloride form an exchanger to help regulate and buffer the body's
pH.
High levels of LpPLA2 are associated with DECREASED cardiovascular risk.
True
False
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LpPLA2 plays a corrective role in removing oxidized phospholipids. Thus, it might

seem that having high levels of LpPLA2 would be good. However, although LpPLA2
has a positive role in removing oxidized lipids, it also generates inflammatory
products in the process. So in fact, high levels of LpPLA2 are associated with
INCREASED cardiovascular risk.
Researchers have identified high amounts of LpPLA2 in human atherosclerotic

lesions. The LpPLA2 that accumulates in the vessel wall can come from LDL (which
can carry LpPLA2 on its surface) or it can come from immune cells that have invaded
the vessel wall.
Which of the following enzymes is the most sensitive indicator of liver damage
associated with alcohol ingestion:
GGT
ALT
AST
LDH
Feedback
GGT elevations precede those of other liver enzymes in cases of chronic ingestion of
drugs or alcohol.
Which type of lipoprotein transports the MAJORITY of cholesterol to cells for steroid
hormone synthesis or cell membrane incorporation?
chylomicrons
very low density lipoproteins
low density lipoproteins
high density lipoproteins
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The majority of cholesterol is transported by LDL to the various cells in the body, and
the rest is transported by HDL through reverse cholesterol transport for excretion
purposes, ultimately through bile or bile salts. VLDL transports endogenous products,
whereas chylomicrons transport exogenous (dietary) products."

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

Small dense LDL
LDL phenotype 'A'
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Small, dense LDL is most likely to interact with arterial walls, leading to deposition
of cholesterol, and initiating or worsening atherosclerosis. Small, dense LDL is
associated with more than a three-fold increase in the risk of coronary heart disease.
Large, buoyant LDL is less atherogenic than small, dense LDL.
The LDL phenotype A is normal. It is the so called 'B' pattern that is associated with
increased risk.
An increase in CEA levels is most closely associated with which of the following
organs:
Heart
Bone
Colon
Liver
Feedback
Carcinoembryonic antigen (CEA) is a widely used tumor marker for gastrointestinal

cancer; however, nonspecific elevations are common, and it is therefore not useful for
screening, but is useful for following response to therapy, and detecting recurrences
after surgery.
Which cardiac biomarker is a regulator of myocyte contraction?
Myoglobin
cTnT
CK-MB
CK-MB isoforms
Feedback
Both cTnI and cTnT are components of the regulation of myocyte contraction.
From the groups of analytes below, which set would most likely be INCREASED in
a type 1 diabetic patient in crisis?
Insulin and blood glucose

Insulin and ketone bodies
Ketone bodies and blood glucose
Ketone bodies and blood pH
Feedback
A type 1 diabetic with an elevated blood glucose and lack of insulin production in a
crisis can become ketotic and go into a ketoacidosis coma. Excess ketone bodies are
produced along with increased blood glucose. The acidosis results in a decreased pH.

Clinical Chemistry4

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Clinical Chemistry4

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Metabolic acidosis is characterized by:

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Metabolic acidosis is the result of either: 1) accumulation of abnormal levels of

Question Difficulty: Level 4

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Lipolysis- The release of non-esterified fatty acids (NEFAs) from triglycerides.

Glycolysis and glycogenesis are stimulated by insulin, not inhibited.

Question Difficulty: Level 7

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At medical examination, a 50-year-old Caucasian male expressed concern regarding

Vital Signs and Pertinent Laboratoy Results:

Blood Pressure: 128/82 mm Hg

Fasting Blood Glucose: 120 mg/dL

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Diagnosis of metabolic syndrome; waist circumference, HDL-C, and fasting

LDL-C is not used as a determining factor in diagnosis of metabolic syndrome with

Question Difficulty: Level 6

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Hemolysis will falsely increase lactic acid concentration. A hemolyzed specimen

Question Difficulty: Level 5

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Iontophoresis is a technique used in the diagnosis of:

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Iontophoresis is the introduction of ionizable drugs through intact skin by the

Question Difficulty: Level 5

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Immunodeficiency would, of course, generally be associated with a decrease in serum

Question Difficulty: Level 6

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Immunodeficiency would, of course, generally be associated with a decrease in serum

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Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to

Question Difficulty: Level 5

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Patients with Cushing syndrome typically exhibit:

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Decreased plasma 17-hydroxysteroid concentration

Cushing syndrome is a hormone disorder caused by exposure to high levels of cortisol

Question Difficulty: Level 5

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Question Difficulty: Level 6

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Question Difficulty: Level 7

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Which of the following statements regarding the L/S ratio is TRUE?

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A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to

Question Difficulty: Level 5

The American Diabetes Association (ADA) guidelines recommend screening all

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Question Difficulty: Level 3

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CA125 is an antigen present on approximately 80% of ovarian carcinomas. CA125 is

Question Difficulty: Level 5