Clinical Chemistry3

You answered the question correctly.
Which of the following conditions is associated with elevated serum uric acid levels:
The correct answer is highlighted below
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.
Question Difficulty: Level 3

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 characteristic of a good cardiac biomarker is that it is normally present in a HIGH

concentration in the peripheral blood.
True
False
Feedback
A biomarker that is a good indicator of cardiac damage is normally in low

concentrations in peripheral blood.

You answered the question incorrectly.
Which of the following statements is true regarding CYP450 enzymes?
They are the only hepatic enzymes involved in drug metabolism.

They are few in number but very important in metabolism.
They are very specific in the substrates they accept.
They are able to make compounds more water-soluble and therefore enhance
excretion.
Feedback
CYP450s are able to make compounds more water-soluble and therefore enhance
excretion.
CYP450s are the primary, but not the only, hepatic enzymes involved in drug
metabolism.
There are many CYP450s (at least 18 with possible isoenzymes of each). CYP450s
are found primarily in the liver. They accept a variety of substrates and so are able to
metabolize diverse compounds.
Each CYP450 can metabolize several different drugs, making the CYP450 family
versatile and able to address the wide range of chemical substances encountered by an
individual.

Which of the following is used primarily for the treatment of manic-depression:
Phenobarbital
Lithium
Digoxin
Ascorbic acid
Feedback
Lithium is commonly used in the treatment of manic depressive patients. Lithium

exerts a dual effect on receptors for the neurotransmitter glutamate; acting to keep the
amount of glutamate active between cells at a stable, healthy level, neither too much
nor too little. This allows for a mood stabilization for these patients.

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

A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1

mg/L) may indicate which of the following?
Low risk for cardiovascular disease (CVD)

High risk for future CVD
Acute inflammatory condition
Feedback
High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and

treatment of cardiovascular disease (CVD). At low levels, it can detect those at risk
for cardiac heart disease. At high levels in those with no history of heart disease, it
indicates a high risk for acute myocardial infarction (AMI), stroke, or peripheral
vascular disease. For patients with acute coronary syndrome (ACS) or stable coronary
disease, hs-CRP is used to predict future coronary events.
Ranges of hs-CRP in prediction of risk for CVD are:
o <1.0 mg/L Low CVD risk

o 1.0-3.0 mg/L Average risk for CVD
o >3.0 mg/L High risk for future CVD
If results are >10.0 mg/L, the patient should be evaluated for an acute inflammatory
condition.

A patient diagnosed with sepsis (based on clinical assessment and laboratory testing),
whose procalcitonin was 2.0 ng/mL and 12 hours later is 10.0 ng/mL, is showing
signs of improvement.
True
False
Feedback
An increase in procalcitonin in a patient that has been diagnosed with sepsis indicates
deterioration in the patient's condition, perhaps to severe sepsis or septic shock.

Which of the following choices is correct when describing the principles of

competitive radioimmunoassay procedures?
antibody will react preferentially with the labeled antigen

antibody will react preferentially with the unlabeled antigen
antibody will react with labeled antigen only
antibody will react equally with labeled and unlabeled antigen
antibody will react directly with radioactive labeled immunoglobulin
Feedback
In radioimmunassay, a fixed concentration of labeled antigen is incubated with a

constant amount of antiserum such that the concentration of antigen binding sites on
the antibody is limiting. If unlabeled antigen is added to this system, there is
competition between labeled antigen and unlabeled antigen for the limited and
constant number of binding sites on the antibody, and thus the amount of labeled
antigen bound to antibody will decrease as the concentration of unlabeled antigen
increases.

Which of the following electrolytes is most likely to be spuriously elevated in a

hemolyzed specimen:
Sodium
Potassium
Chloride
BUN
Feedback
Potassium has the highest RBC to serum concentration ratio: approximately 23:1.

How long does it take for plasma concentrations to reach steady state when a patient's
dose is given at intervals of the drug's half-life?
one half-hour
two-half lives
4-7 half-lives
10-12 half-lives
Feedback
As repeated doses of a drug are given to a patient, the drug's plasma

concentration accumulates and reaches a steady state. This is when the amount of
drug in the plasma has built up to a concentration level that is therapeutically effective
and as long as regular doses are administered to balance the amount of drug being
cleared the drug will continue to be active. The time taken to reach the steady state is
about five-seven times the half life of a drug.

Respiratory acidosis is associated with:
Normal pH
High pH
Decreased pCO2
Increased pCO2
Feedback
Respiratory acidosis occurs when the lung's ability to remove carbon dioxide is
decreased, resulting in increased blood pCO2 and acidosis.

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'
Feedback
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.

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
Feedback
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.

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.


In which of the following condition(s) would an increased serum osmolality be an
expected finding?
The correct answers are highlighted below
Dehydration
Hyponatremia
Increased ADH secretion
Diabetes Insipidus
Feedback
In dehydration, the decreased volume of body water causes a subsequent rise in serum
osmolality.
In diabetes insipidus, renal insensitivity to vasopressin results in the excretion of an

increased volume of dilute urine, a decrease in body water, and a rise in serum
osmolality.
In hyponatremia and when ADH is abnormally secreted, the serum osmolality values
can be expected to decrease.

A 29-year old pregnant woman had an outpatient glucose tolerance test. The patient
was given a 100-gm dose of glucose and the following values were obtained:
Fasting 110 mg/dL

1 hr. 188 mg/dL
2 hr. 175 mg/dL
3 hr. 143 mg/dL
The MOST likely interpretation of this glucose tolerance would be:

Insulin dependent diabetes mellitus (IDDM)
Non insulin dependent diabetes mellitus (NIDDM)
Gestational diabetes mellitus (GDM)
Normal glucose tolerance test
Feedback
Normal blood values for a 100-gram oral glucose tolerance test used to screen for
gestational diabetes are as follows:
 Fasting: less than 95 mg/dL

 1 hour: less than 180 mg/dL

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
Feedback
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.

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


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.

The expected glucose value of an ABNORMAL 2-hour post-glucose tolerance test is:
markedly elevated glucose levels; above fasting levels

markedly decreased fasting glucose levels
within fasting glucose normal limits
slightly below normal glucose levels
Feedback
An abnormal glucose tolerance test would show that an individual is unable to process
glucose properly, leaving very elevated levels in the blood. As with fasting or random
blood glucose tests, a markedly abnormal oral glucose tolerance test is diagnostic of
diabetes.

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.

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.

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.


Bioavailability of an oral drug refers to the
availability for therapeutic administration

ratio of protein-bound to free drug
amount of drug transformation
fraction of the drug that is absorbed into systemic circulation
Feedback
The bioavailability of an oral drug is the fraction of the drug that is absorbed into
systemic circulation.
The bioavailability of a drug is calculated by comparing the area under the plasma
concentration-time curve of an equivalent dose of the intravenous form and the oral
form of the drug. For oral drugs to be effective, bioavailability typically should be
greater than 70%.

The following BEST describes serum hCG levels during pregnancy:

Rise in levels throughout pregnancy

Highest levels found at end of pregnancy
Rapid rise in levels during first trimester; slow decline and possible level-off
throughout remainder of pregnancy
Slow rise in levels during first trimester; rapid rise during second trimester; slow
decline during the third trimester
Feedback
HCG levels rise rapidly during the first trimester, then the levels start to decline
around week 16. The hCG levels slowly decrease and can level off during the
remainder of the pregnancy.

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.

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.

Which of the following statements is true regarding cardiovascular disease and

adipose tissue?
Inflammatory cytokines, synthesized and released by adipose tissue, contribute

to the development of cardiovascular disease
A state of abnormal lipids and lipid levels found in metabolic syndrome
contribute to the development of cardiovascular disease
Obesity in metabolic syndrome contributes to the development of cardiovascular
disease by increased synthesis and secretion of adiponectin
Increased synthesis and secretion of PAI-1 in metabolic syndrome contributes to
cardiovascular disease by increasing blood pressure
Feedback
The increase in inflammatory cytokines and the abnormal lipids and lipid levels often
present in metabolic syndrome increase the risk of cardiovascular disease.
Adiponectin is decreased and increases in angiotensinogen lead to hypertension.

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

low _________.
Sensitivity
Specificity
Feedback
CRP is a sensitive marker of inflammation. However, it has a low specificity.

A liquid ion-exchange membrane electrode using the antibiotic valinomycin is MOST

selective for:
sodium
glucose
chloride
potassium
CO2
Feedback
The valinomycin membrane electrode is most selective for potassium as opposed to

sodium, glucose, chloride, or CO2 which utilize different membranes for their
respective electrodes.


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.


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.

Why are small dense LDL molecules more atherogenic?
Small dense LDL molecules contain less cholesterol and phospholipid

Small dense LDL molecules increase the concentration of HDL-C in the blood
Small dense LDL molecules increase the concentration of adoponectin and
inflammatory cytokines
Small dense LDL molecules have greater mobility in the endothelium and
arterial wall
Feedback
Most researchers believe that the small size and increased density of LDL molecules
found in atherogenic dyslipidemia enable the molecules to more easily invade the
endothelium and arterial wall of vessels.

High levels of LpPLA2 are associated with DECREASED cardiovascular risk.
True
False
Feedback
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.

What is the most significant cause of decreased haptoglobin levels?
Acute infection
Intravascular hemolysis
Liver disease
Myoglobinuria
Feedback
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.

High levels of LpPLA2 are associated with DECREASED cardiovascular risk.
True
False
Feedback
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.

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.

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 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.

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.

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.

Which one of the following statements is NOT characteristic of the role of C-reactive
protein (CRP)?

Activates complement.
Binds with factor H to initiate alternate complement pathway.
Exhibits both pro-inflammatory and anti-inflammatory characteristics.
Initiates Opsonization.
Feedback
C-reactive protein, or CRP, can activate complement, exhibit both pro- and anti-
inflammatory characteristics, and initiates opsonization. However, CRP does not
actually bind with factor H to intiate the alternate complement pathway.

When iontophoresis is used to collect sweat for chloride analysis, pilocarpine is used
to:
clean the skin area

complex with chloride
stimulate nervous system
induce the sweat secretion
Feedback
Pilocarpine actually stimulates sweat glands, which helps to induce sweat secretion
during a sweat chloride test via iontophoresis.


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 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.

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 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.

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.


Which of the following methods would be employed to collect sweat for chloride
analysis:
Electrophoresis
Counter electrophoresis
Iontophoresis
Isoelectric focusing
Feedback
Iontophoresis is the gold standard for the collection of sweat for sweat chloride
analysis. Pilocarpine iontophoresis actually stimulates the production of sweat, which
is absorbed within a gauze pad which was previously weighed dry. The sweat sample
is weighed to determine how much sweat was collected. Finally, the sweat sample is
analyzed for its concentration of chloride. This particular test is utilized very
commonly for the screening of cystic fibrosis since these patients typically exhibit
higher levels of sweat chloride. In children over the age of 6 months to adults, the
reference ranges are:
 Equal to or less than 39 mmol/L = Cystic Fibrosis is not likely to be present

(rules-out CF)
 40 - 59 mmol/L = Intermediate Level (Cystic Fibrosis may be present, further
testing required)
 Greater than or equal to 60 mmol/L = Cystic Fibrosis is most likely present

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.

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.

The ADA recommends performing an oral glucose tolerance test (OGTT) on all
individuals who are at increased risk for diabetes.
True
False
Feedback
The ADA recommends regular screening for individuals who are at increased risk for
diabetes. OGTT use is discouraged for these individuals unless blood glucose and
HbA1C concentrations remain below diagnostic ranges for diabetes but patient
displays symptoms of diabetes.

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.


Serum alkaline phosphatase activity is derived from all of the following organs
except:
Bone
Intestine
Placenta
Brain
Feedback
Serum alkaline phosphatase is produced in the bone, intestine, and the placenta- but
not in the brain.

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 lipid results would be expected to be FALSELY elevated on a

serum specimen from a non-fasting patient?
cholesterol
triglyceride
HDL
LDL (not calculated)
Feedback
Triglyceride blood concentrations change significantly when you eat, as opposed to

relatively stable levels of cholesterol, HDL, or LDL circulating in the blood.
Whenever you eat a meal that contains fat, your triglyceride levels rise, which is why
it is important to have a patient fast before the sample is collected.

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.

What is the most significant cause of decreased haptoglobin levels?
Acute infection
Intravascular hemolysis
Liver disease
Myoglobinuria
Feedback
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.

Increases in the MB fraction of CK is associated with:
Liver disease
Bone disease
Kidney failure
Myocardial infarction
Feedback
The isoenzyme CK-MB is fairly cardiac specific. It is elevated within 6 to 8 hours of

a myocardial infarction, and remains elevated for about 2 to 3 days post infarction.

A physician discusses weight with an overweight 60-year-old female at her yearly

physical appointment. The female exercises regularly and eats healthy most of the
time. The physician suggests she decrease carbohydrate intake and decrease portion
size at meals.
Review patient vital signs and laboratory assay results to decide if a diagnosis of
metabolic syndrome is appropriate using the NCEP:ATP lll Diagnostic Criteria shown
on the right.
Height: 5' 7'

Weight: 192 lbs
BMI: 30.1
Waist Circumference: 37 inches
Blood Pressure: 108/70
Fasting Blood Glucose: 92 mg/dL
Total Cholesterol: 172 mg/dL
LDL-C: 112 mg/dL
HDL-C: 46 mg/dL
Triglycerides: 70 mg/dL
hs-CRP: <1.0 mg/L
Which of these statements regarding this patient is true?
This patient meets the criteria for diagnosis of metabolic syndrome.

This patient does not meet the criteria for diagnosis of metabolic syndrome.
Feedback
According to the NCEP: ATP III diagnostic criteria, this patient does not have
metabolic syndrome. She has only two parameters outside the criteria limits: waist
circumference and HDL-C.
She does need to lose weight though because she does seem to have increased upper
body fat according to the waist circumference measurement. This may eventually
cause an increased triglyceride, increased blood glucose, and/or hypertension and
metabolic syndrome diagnosis along with an increased risk for cardiovascular disease.

Which analyte measurement is used to detect early nephropathy in a diabetic patient?
Lactic acid
Microalbumin
Ketones
HbA1C
Feedback
The detection of small concentrations of albumin (microalbumin) in the urine is used
to detect early renal impairment.

A liquid ion-exchange membrane electrode using the antibiotic valinomycin is MOST

selective for:
sodium
glucose
chloride
potassium
CO2
Feedback
The valinomycin membrane electrode is most selective for potassium as opposed to

sodium, glucose, chloride, or CO2 which utilize different membranes for their
respective electrodes.

Another term for absorbance is:
Optical density
Transmittance
Translucence
Extinction coefficient
Feedback
Optical density is the absorbance of an optical element for a given wavelength.

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

High serum electrolytes
Increased anion gap
Electrolyte concentrations would remain the same
Feedback
A dilutional effect caused by the sample being hemodiluted, would not cause high
serum electrolytes since they have been diluted out. The anion gap could remain the
same or become decreased. Finally, the electrolyte concentrations could not remain
the same, since there will be a smaller amount in the sample to test due to the diluent.

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.

Lipemia in a serum sample is most likely caused by an increase in serum levels of:
Cholesterol
Triglycerides
Protein
Phospholipids
Feedback
Lipemia is generally caused by an increase in VLDL (very low density lipoproteins),

which are primarily composed of triglycerides.

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.

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.

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.

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.

The function of the very low density lipoproteins (VLDL) is to transport:
cholesterol from peripheral cells to the liver

cholesterol and phospholipids to the peripheral cells
exogenous triglycerides
endogenous triglycerides
Feedback
VLDL transports endogenous lipids, whereas chylomicrons transport exogenous

(dietary) lipds. Cholesterol is transported by HDL and LDL.

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.

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.

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).

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.

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

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.

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.

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 would you find in a primary hyperparathyroidism?
elevated serum calcium and decreased serum phosphorus

elevated serum calcium and elevated serum phosphorus
decreased serum calcium and decreased serum phosphorus
decreased serum calcium and increased serum phosphorus
Feedback
Primary hyperparathyroidism is a disorder of the parathyroid glands where overactive

parathyroid glands secretes too much parathyroid hormone (PTH). This excess PTH
triggers the release of too much calcium into the bloodstream. The bones may lose
calcium, and too much calcium may be absorbed from food. The levels of calcium
may increase in the urine, causing kidney stones. PTH also lowers blood phosphorus
levels by increasing excretion of phosphorus in the urine.


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.

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.

Which of the following anticoagulants will not produce a significant effect on calcium
levels in plasma:
EDTA
Heparin
Oxalates
Citrates
Feedback
EDTA, Oxalates, and Citrates remove calcium from the blood, while heparin acts by
forming a complex with antithrombin III.

In patients with suspected primary hypothyroidism associated with Hashimoto's

thyroiditis, one would expect the following laboratory test results:
T4 ___? TSH ___? TRH stimulation ___?
increased, decreased, increased

decreased, increased, increased
increased, decreased, decreased
increased, increased, decreased
decreased, decreased, decreased
Feedback
In Hashimoto's, antibodies react against proteins in the thyroid gland, causing gradual
destruction of the gland itself, and making the gland unable to produce the thyroid
hormones the body needs. Therefore the T4 is decreased, but the TSH is increased
since the pituitary gland is attempting to stimulate the failing thyroid gland. The TRH
stimulation is increased since the pituitary gland is working and is able to produce
elevated levels of TSH upon TRH stimulation.

Which of the following additives should be used for the collection of a sample for
blood gas analysis:
Sodium citrate
EDTA
Sodium oxalate
Heparin
Feedback
Heparin is the additive of choice for blood gas syringe collection as it has the least
amount of interference with the blood gas analytes measured.


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.

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.


True
False
Feedback

What additional fraction would be seen if plasma rather than serum was subjected to
electrophoresis:
Alpha-1 antitrypsin
Alpha-2 macroglobulin
Fibrinogen
Gamma globulins
Feedback
Fibrinogen present in plasma would form a band between the beta and gamma
globulins.

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.

Why are small dense LDL molecules more atherogenic?
Small dense LDL molecules contain less cholesterol and phospholipid

Small dense LDL molecules increase the concentration of HDL-C in the blood
Small dense LDL molecules increase the concentration of adoponectin and
inflammatory cytokines
Small dense LDL molecules have greater mobility in the endothelium and
arterial wall
Feedback
Most researchers believe that the small size and increased density of LDL molecules
found in atherogenic dyslipidemia enable the molecules to more easily invade the
endothelium and arterial wall of vessels.

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 of the following is a bronchodilator used to treat a 39-year-old male asthmatic
patient?
theophylline
digoxin
phenobarbital
amitriptyline
Feedback
Theophylline belongs to a class of medications called bronchodilators, used in treating

asthma and other airway diseases. Digoxin is used to treat heart failure and abnormal
heart rhythms (arrhythmias). Phenobarbital is a barbiturate which is used to help
prevent seizures. Amitriptyline is an antidepressant medication.

The following BEST describes serum hCG levels during pregnancy:
Rise in levels throughout pregnancy

Highest levels found at end of pregnancy
Rapid rise in levels during first trimester; slow decline and possible level-off
throughout remainder of pregnancy
Slow rise in levels during first trimester; rapid rise during second trimester; slow
decline during the third trimester
Feedback
HCG levels rise rapidly during the first trimester, then the levels start to decline
around week 16. The hCG levels slowly decrease and can level off during the
remainder of the pregnancy.

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.

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.

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.”

Which of the following conditions would NOT be associated with an increased level
of alpha-fetoprotein?

Prostate Cancer
Hepatocellular Carcinoma
Viral Hepatitis
Testicular Tumors
Pancreatic Cancer
Feedback
AFP is not found in increased levels in patients with prostate cancer. PSA, or prostate
specific antigen, is commonly used to screen for prostate cancer.
Hepatocellular carcinoma, viral hepatitis, testicular tumors, and pancreatic cancer are
all associated with increased levels of AFP. In addition, liver cirrhosis and gastric
cancers can also have an associated increased AFP level.
Which of the following cardiac biomarkers rises within 30 minutes - 4 hours after
chest pain, peaks in 2 - 12 hours, and is usually normal within 24 - 36 hours.
Cardiac troponins
CK-MB
Myoglobin
Feedback
Myoglobin rises within 30minutes - 4 hours after chest pain, peaks in 2 - 12 hours,
and is usually normal within 24 - 36 hours.

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.
Feedback
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.

Which adipokine is decreased in obesity, is anti-inflammatory, and increases insulin

sensitivity?
Leptin
Resistin
TNF-a
Adiponectin
IL-6
Angiotensinogen
Feedback
Adiponectin is a protective cytokine. This cytokine is anti-inflammatory and increases

insulin sensitivity. Adiponectin is usually decreased in obesity.

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.

A patient diagnosed with sepsis (based on clinical assessment and laboratory testing),
whose procalcitonin was 2.0 ng/mL and 12 hours later is 10.0 ng/mL, is showing
signs of improvement.
True
False
Feedback
An increase in procalcitonin in a patient that has been diagnosed with sepsis indicates
deterioration in the patient's condition, perhaps to severe sepsis or septic shock.

True
False
Feedback

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.


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.

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.

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.

pH alteration of normal blood in a closed vessel standing at 37oC for 1 hour is

approximately
0.01 to 0.02 pH unit

Feedback
The pH of freshly drawn blood decreases at a rate of 0.06 pH units/hour at 37oC, but
only 0.006 pH units/hour at 4oC.

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).

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.

In healthy individuals, procalcitonin is synthesized by which cells in the body?
Hepatocytes
Leukocytes
Thyroid C cells
Red blood cells
Feedback
In healthy individuals, procalcitonin is only synthesized by the thyroid C cells. In

bacterial infections, PCT is synthesized in various extrathyroidal neuroendocrine
tissues.

Ion selective electrodes are called selective rather than specific because they actually
measure the:
activity of one ion only

concentration of one ion
activity of one ion much more than other ions present
concentration and activity of one ion only
Feedback
Ion-selective electrodes are not completely ion-specific. All are sensitive to some
other ions to some extent.

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
Feedback
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.


Bioavailability of an oral drug refers to the:
availability for therapeutic administration

ratio of protein-bound to free drug
amount of drug transformation
fraction of the drug that is absorbed into systemic circulation
Feedback
The bioavailability of an oral drug is the fraction of the drug that is absorbed into
systemic circulation.
The bioavailability of a drug is calculated by comparing the area under the plasma
concentration-time curve of an equivalent dose of the intravenous form and the oral
form of the drug. For oral drugs to be effective, bioavailability typically should be
greater than 70%.


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


After experiencing extreme jaundice, abdominal pain, and vomiting from extensive
hepatocelluar damage, a patient's hepatic function panel is analyzed in the laboratory.
The result of the ALT is too high for the instrument to read. The laboratorian
performs a dilution using 100 microliters of patient sample to 400 microliters of
diluent. The result now reads 369 U/L. How should the laboratorian report this
patient's ALT result?
369 U/L
1476 U/L
1845 U/L
738 U/L
Feedback
The correct answer for this question is 1845 U/L. The laboratorian performed a 1:5
dilution by adding 400 microliters of diluent to the original 100 microliter volume of
sample. This creates a total volume of 500 microliters. So, the patient sample is 100
microliters of the 500 microliter mixed sample, or a ratio of 1:5. Therefore, the result
given by the chemistry analyzer must be multiplied by a dilution factor of 5. 369 U/L
x 5 = 1845 U/L.

A patient has been characterized as a CYP2D6 poor metabolizer (PM) after

genotyping. Which of the following statements is not true?
The patient will likely need lower doses of CYP2D6-metabolized drugs.

The patient is less likely to require therapeutic drug monitoring (TDM) since the
genotype is known.
CYP2D6 metabolizes many drugs, and so attention must be given to the doses of
drugs from different classes.
Feedback
Though it may not be required, TDM should still be used to confirm adequate dosing.
Genotyping does not make TDM redundant.
A PM will metabolize the drug more slowly and therefore will need lower doses.
CYP2D6 metabolizes many different drugs; it is not associated with just one class of
drugs. Anytime a drug is taken that competes for the same metabolizing enzyme as
another drug, there is potential for the concentrations of both drugs to be increased.

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.

A CYP2D6 ultrarapid metabolizer (UM) would require ___________ dose of a drug

that is metabolized by CYP2D6 than a CYP2D6 extensive metabolizer (EM).
a higher
a lower
the same
Feedback
An ultrarapid metabolizer (UM) would require a higher dose of a drug than an EM (a

person with normal enzyme activity) since the UM eliminates the drug more quickly.

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.

Match the type of endocrine dysfunction with the appropriate organ:
Your answers are on the left. The correct answers are on the right and highlighted.
Target gland Primary

Pituitary gland Secondary
Hypothalamus Tertiary
Feedback
Primary- Target glands (such as thymus, thyroid, parathyroid, etc.)
Secondary- Pituitary gland
Tertiary- Hypothalamus

A low CSF glucose level is associated with all the following except:

Hyperglycemia
Fungal meningitis
Toxoplasmosis
Hypoglycemia
Feedback
In hyperglycemia you would expect a normal or elevated CSF glucose level- this
question is asking where you would expect to see a decreased (low) CSF glucose
level, and in this case hyperglycemia would be the one condition that is excluded
(therefore the correct answer).

The expected glucose value of an ABNORMAL 2-hour post-glucose tolerance test is:
markedly elevated glucose levels; above fasting levels

markedly decreased fasting glucose levels
within fasting glucose normal limits
slightly below normal glucose levels
Feedback
An abnormal glucose tolerance test would show that an individual is unable to process
glucose properly, leaving very elevated levels in the blood. As with fasting or random
blood glucose tests, a markedly abnormal oral glucose tolerance test is diagnostic of
diabetes.

Following a myocardial infarction which of the following enzymes will be the first to
become elevated:
CK
LDH
GGT
AST
Feedback
GGT is elevated in liver disorders. CK rises before LDH. However myoglobin is the
earliest serum cardiac marker to rise after an infarction; it may be positive within two
hours post MI. It is not cardiac specific, and can be elevated in skeletal muscle trauma
or rhabdomyolysis.

A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1

mg/L) may indicate which of the following?
Low risk for cardiovascular disease (CVD)

High risk for future CVD
Acute inflammatory condition
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High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and

treatment of cardiovascular disease (CVD). At low levels, it can detect those at risk
for cardiac heart disease. At high levels in those with no history of heart disease, it
indicates a high risk for acute myocardial infarction (AMI), stroke, or peripheral
vascular disease. For patients with acute coronary syndrome (ACS) or stable coronary
disease, hs-CRP is used to predict future coronary events.
Ranges of hs-CRP in prediction of risk for CVD are:
o <1.0 mg/L Low CVD risk

o 1.0-3.0 mg/L Average risk for CVD
o >3.0 mg/L High risk for future CVD
If results are >10.0 mg/L, the patient should be evaluated for an acute inflammatory
condition.

Increased concentration of alpha-fetoprotein (AFP) in adults are most

characteristically associated with:
Hepatocellular carcinoma
Alcoholic cirrhosis
Megaloblastic anemia
Multiple myeloma
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Increased alpha-fetoprotein levels in adults is usually associated with hepatocelluar

carcinoma, as it is a tumor maker in this population. Alcoholic cirrhosis,
megaloblastic anemia, and mutliple myeloma would not cause an increase in serum
AFP.

Which of the following substances is conjugated with the “indirect” bilirubin to form
“direct” bilirubin?
ascorbic acid
glucuronic acid
uric acid
salicylic acid
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Indirect bilirubin, also known as unconjugated bilirubin, is conjugated with two

molecules of glucuronic acid to form direct, or conjugated bilirubin, which is water-
soluble. Ascorbic acid, also known as vitamin C, uric acid, or salicylic acid do not
conjugate with bilirubin.

A patient is admitted to the hospital with acute chest pain, but which of the following
cardiac markers will be elevated FIRST if the patient had an MI?
LD
CK
Myoglobin
Troponin
Feedback
Myoglobin rises typically within 2-4 hours after a myocardial infarction and stay
elevated for days, with a peak at the 6-9-hour mark post-MI. After myoglobin,
troponin is the next fastest to rise afer a mycardial infarction and can rise within 3-4
hours with a peak around 12 hours post-MI. LD (8-12 hours, 24-48 hour peak) and
CK (4-6 hours with peak at 24-36 hours) will also rise after MI, but are not as fast to
rise as myoglobin and troponin.

A 64-year old man lost 15 pounds, became weaker, and his face became fuller with a
ruddy complexion. His laboratory tests revealed:
Serum cortisol
8 AM: 880 nmol/L, 138-635 nmol/L (reference range)
4 PM: 828 nmol/L, 83-414 nmol/L (reference range)
After these results, an overnight dexamethasone suppression test gave a cortisol level
of 773 nmol/L. The MOST probable diagnosis for this patient is:
congenital adrenal hyperplasia

Addison's disease
Cushing's Syndrome
Conn's Syndrome
Feedback
Cushing’s syndrome is a hormonal disorder caused by the effects of an individual

having high levels of cortisol. One of the signs of this condition is skin, which
becomes fragile and thin and a rounding, or fullness of the face. More than one test is
performed to diagnose Cushing’s syndrome and include: the 24-hour urinary free
cortisol test, measurement of day and night cortisol levels, and the low-dose
dexamethasone suppression test. Cortisol production is normally suppressed at night,
but in Cushing’s syndrome, this suppression doesn’t occur. If the cortisol level is
more than 50 nmol/L, Cushing’s syndrome is suspected. In the dexamethasone
suppression test, cortisol signals the pituitary to release less ACTH, so the normal
response after taking dexamethasone is a decrease in blood and urine cortisol levels; if
cortisol levels do not decrease (such as in this case), Cushing’s syndrome is
suspected.


Which of the following lipid tests is LEAST affected by the fasting status of the
patient?
Cholesterol
Triglycerides
Fatty acids
Lipoproteins
Chylomicrons
Feedback
Cholesterol levels do not flucuate as triglycerides, fatty acids, lipoproteins, and

chylomicrons do after an individual eats a meal. This is the reason that patients are
told to fast; the laboratory needs a fasting sample to determine a lipid profile or panel
which includes the latter four components.

Which of the following factors would not affect an orally-administered drug's

absorption and/or distribution in the body?
Regional blood flow

The position of the patient when the drug is taken (sitting vs. standing)
The integrity of the gastrointestinal (GI) tract
The patient's age
Feedback
The physical position of the patient when the drug is taken (sitting vs. standing)
would not affect an orally-administered drug's absorption and/or distribution in the
body.
Regional blood flow will affect drug distribution because the drug is transported in
the blood. Reduced area blood flow can be seen in diabetics, and enhanced blood flow
can be seen in tumors.
Drug kinetics and dispositions change throughout life. In general, metabolism of

drugs is reduced in the elderly.
In the diseased gut, an orally-administered drug may not be absorbed as expected.

Troponin I is used frequently to assess acute myocardial infarctions (AMI). If a

patient has experienced an AMI, at what point (approximately) will the troponin I
begin to increase and how long will it stay increased?
12-24 hours, 5-10 days

3-6 hours, 1-2 days
Feedback
Cardiac troponin I will reach levels above the normal reference range typically
between 3 and 6 hours post-acute myocardial infarction. Usually, the troponin I will
be measured in several intervals after the initial elevation (usually 6-9 hours, 12-24
hours, etc.). Troponin I will stay at increased levels for approximately 5-10 days after
mycocardial infarction.

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Question Difficulty: Level 3

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Question Difficulty: Level 7

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A biomarker that is a good indicator of cardiac damage is normally in low

Question Difficulty: Level 4

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They are the only hepatic enzymes involved in drug metabolism.

Question Difficulty: Level 7

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Lithium is commonly used in the treatment of manic depressive patients. Lithium

Question Difficulty: Level 3

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Question Difficulty: Level 6

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A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1

The correct answer is highlighted below

Low risk for cardiovascular disease (CVD)

High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and

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Question Difficulty: Level 7

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Question Difficulty: Level 9

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Which of the following choices is correct when describing the principles of

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antibody will react preferentially with the labeled antigen

In radioimmunassay, a fixed concentration of labeled antigen is incubated with a

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Which of the following electrolytes is most likely to be spuriously elevated in a

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Question Difficulty: Level 3

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As repeated doses of a drug are given to a patient, the drug's plasma

Question Difficulty: Level 5

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Respiratory acidosis is associated with:

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Large buoyant LDL

Large, buoyant LDL is less atherogenic than small, dense LDL.

Question Difficulty: Level 5

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Which of the following action describes the MAJOR property of antidiuretic