Вы находитесь на странице: 1из 81

  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


 

  

  You answered the question correctly.

Which of the following methods would be used to confirm the presence of Bence-
Jones protein in the urine:

The correct answer is highlighted below

Urine protein electrophoresis


Sulfosalicylic acid
Isoelectric focusing
Immunofixation

Feedback

Either immunofixation or immunoelectrophoresis can be used to confirm Bence-Jones


proteinuria.

Question Difficulty: Level 7


 
  

  You answered the question correctly.

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


concentration in the peripheral blood.

The correct answer is highlighted below

True
False

Feedback

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


concentrations in peripheral blood.

Question Difficulty: Level 4


 

  

  You answered the question incorrectly.

Which of the following statements is true regarding CYP450 enzymes?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Which of the following is used primarily for the treatment of manic-depression:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

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.

The correct answer is highlighted below


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

Question Difficulty: Level 6


 

  

  You answered the question correctly.

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


mg/L) may indicate which of the following?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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.

The correct answer is highlighted below

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.

Question Difficulty: Level 9


 

  

  You answered the question incorrectly.

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


competitive radioimmunoassay procedures?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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


hemolyzed specimen:

The correct answer is highlighted below

Sodium
Potassium
Chloride
BUN

Feedback

Potassium has the highest RBC to serum concentration ratio: approximately 23:1.

Question Difficulty: Level 3


 

  
  You answered the question incorrectly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Respiratory acidosis is associated with:

The correct answer is highlighted below

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.
Question Difficulty: Level 4
 

  

  You answered the question correctly.

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

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Which of the following action describes the MAJOR property of antidiuretic


hormone?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Which of the following enzymes is the most sensitive indicator of liver damage
associated with alcohol ingestion:

The correct answer is highlighted below

GGT
ALT
AST
LDH

Feedback

GGT elevations precede those of other liver enzymes in cases of chronic ingestion of
drugs or alcohol.

Question Difficulty: Level 4


 

  

  You answered the question correctly.


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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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:

The correct answer is highlighted below


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
 2 hour: less than 155 mg/dL
 3 hour: less than 140 mg/dL

Question Difficulty: Level 5


 

  

  You answered the question correctly.

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:

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 
  You answered the question correctly.

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?

The correct answer is highlighted below

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

Question Difficulty: Level 5


 

  

  You answered the question correctly.


Which of the following lipid results would be expected to be MOST falsely elevated
on a serum specimen from a non-fasting patient?

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

The expected glucose value of an ABNORMAL 2-hour post-glucose tolerance test is:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

Which of the statements below regarding the diagnosis of pancreatitis is CORRECT?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

The presence of only slightly visible hemolysis will significantly increase the serum
level of which of the following electrolytes?

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.


Bioavailability of an oral drug refers to the

The correct answer is highlighted below

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%.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

The following BEST describes serum hCG levels during pregnancy:


The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question incorrectly.

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

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Serum proteins can be separated by cellulose acetate electrophoresis into how many
basic fractions:

The correct answer is highlighted below

4 fractions
5 fractions
6 fractions
7 fractions

Feedback

The five basic fractions are albumin, alpha-1, alpha-2, beta, and gamma globulins.

Question Difficulty: Level 5


 

  You answered the question incorrectly.

Which of the following statements is true regarding cardiovascular disease and


adipose tissue?

The correct answers are highlighted below

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.

Question Difficulty: Level 8


 

  

  You answered the question correctly.

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


low _________.

The correct answer is highlighted below

Sensitivity
Specificity

Feedback

CRP is a sensitive marker of inflammation. However, it has a low specificity.

Question Difficulty: Level 8


 

  

  You answered the question correctly.

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


selective for:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.


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?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.


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 correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question incorrectly.

Why are small dense LDL molecules more atherogenic?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

    You answered the question correctly.

High levels of LpPLA2 are associated with DECREASED cardiovascular risk.

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

You answered the question incorrectly.

What is the most significant cause of decreased haptoglobin levels?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

High levels of LpPLA2 are associated with DECREASED cardiovascular risk.

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  
  You answered the question incorrectly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

An important metallic activator of alkaline phosphatase and creatine kinase is

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question incorrectly.

Which one of the following statements about lipoproteins is FALSE:

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

All of the following are sources of serum alkaline phosphatase except:

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

     You answered the question incorrectly.

Hydrogen ion concentration (pH) in blood is usually determined by means of which


of the following electrodes?

The correct answer is highlighted below

silver
glass
platinum
gold

Feedback

pH electrodes that measure hydrogen ion concentrations are actually glass electrodes.

Question Difficulty: Level 5


 

  

  You answered the question incorrectly.

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

The correct answer is highlighted below


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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

When iontophoresis is used to collect sweat for chloride analysis, pilocarpine is used
to:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.


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 correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

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 correct answer is highlighted below

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.
Question Difficulty: Level 4
 

  

  You answered the question incorrectly.

With the development of fetal lung maturity, which of the following phospholipid
concentrations in amniotic fluid increases?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Which one of the following terms does not describe a significant elevation of a single
immunoglobulin class:

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

A HbA1C result for a diabetic patient is 6.0%. What conclusion can be made regarding
this patient's carbohydrate management?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.


Which of the following methods would be employed to collect sweat for chloride
analysis:

The correct answer is highlighted below

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

Question Difficulty: Level 4


 

  

  You answered the question incorrectly.

The ultimate end product of both epinephrine and norepinephrine metabolism is:

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Total iron-binding capacity measures the serum iron transporting capacity of:

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question incorrectly.

The ADA recommends performing an oral glucose tolerance test (OGTT) on all
individuals who are at increased risk for diabetes.
The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question incorrectly.

Which assay using 24-hour urine is considered the BEST single screening test for
pheochromocytoma?

The correct answer is highlighted below

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.

Question Difficulty: Level 8


 

  

  You answered the question correctly.


Serum alkaline phosphatase activity is derived from all of the following organs
except:

The correct answer is highlighted below

Bone
Intestine
Placenta
Brain

Feedback

Serum alkaline phosphatase is produced in the bone, intestine, and the placenta- but
not in the brain.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Circulating organic iodine is found primarily in the form of:

The correct answer is highlighted below

Triiodothyronine
Parathyroid hormone
Thyroglobulin
Thyroxine

Feedback

Iodine circulates as thyroxine (T4) and to a lesser extent as Triiodothyronine (T3).

Question Difficulty: Level 6


 

  
  You answered the question correctly.

Which of the following lipid results would be expected to be FALSELY elevated on a


serum specimen from a non-fasting patient?

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

Recently the American Diabetes Association (ADA) recommended reporting which


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

The correct answer is highlighted below

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.
Question Difficulty: Level 6
 

  

  You answered the question correctly.

What is the most significant cause of decreased haptoglobin levels?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Increases in the MB fraction of CK is associated with:

The correct answer is highlighted below

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.
Question Difficulty: Level 3
 

  

  You answered the question correctly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

Which analyte measurement is used to detect early nephropathy in a diabetic patient?

The correct answer is highlighted below

Lactic acid
Microalbumin
Ketones
HbA1C

Feedback
The detection of small concentrations of albumin (microalbumin) in the urine is used
to detect early renal impairment.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

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


selective for:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Another term for absorbance is:

The correct answer is highlighted below

Optical density
Transmittance
Translucence
Extinction coefficient

Feedback

Optical density is the absorbance of an optical element for a given wavelength.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

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

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question incorrectly.

The production of neutral 17-ketosteroids is a measure of which of the following?

The correct answer is highlighted below


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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Lipemia in a serum sample is most likely caused by an increase in serum levels of:

The correct answer is highlighted below

Cholesterol
Triglycerides
Protein
Phospholipids

Feedback

Lipemia is generally caused by an increase in VLDL (very low density lipoproteins),


which are primarily composed of triglycerides.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

Which one of the following is a TRUE statement concerning alkaline phosphatase?


The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Isoenzymes of alkaline phosphatase occur in:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  
  You answered the question correctly.

Which one of the following statements about serum ferritin are true:

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

What is the role of microalbuminuria testing?

The correct answer is highlighted below

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.
Question Difficulty: Level 7
 

  

  You answered the question correctly.

The function of the very low density lipoproteins (VLDL) is to transport:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Which of the following parts of the body synthesizes and secretes BNP?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

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


sample as a result of hemolysis:

The correct answer is highlighted below

Potassium
LDH
Uric acid
AST

Feedback

Potassium, LDH, and AST are found in much higher concentration in intact RBCs
than in serum.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

A drug that is administered through which of the following routes will reach peak
level the quickest?

The correct answer is highlighted below

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).

Question Difficulty: Level 3


 

  

  You answered the question correctly.

The term pharmacokinetic BEST describes:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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

Question Difficulty: Level 4


 

  

  You answered the question correctly.

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:

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Serum proteins can be separated by cellulose acetate electrophoresis into how many
basic fractions:

The correct answer is highlighted below

4 fractions
5 fractions
6 fractions
7 fractions

Feedback

The five basic fractions are albumin, alpha-1, alpha-2, beta, and gamma globulins.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

A drug that is readily cleared and has a wide therapeutic window, such as ampicillin,
should always be monitored by TDM.

The correct answer is highlighted below


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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Which of the following would you find in a primary hyperparathyroidism?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.


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:

The correct answer is highlighted below

Aldosterone
Porphyrins
Catecholamines
Metanephrines

Feedback

Porphyrins are unstable when exposed to light.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

Which of the following statements is TRUE with respect to uncompensated metabolic


alkalosis?

The correct answer is highlighted below

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.
Question Difficulty: Level 7
 

  

  You answered the question correctly.

Which of the following anticoagulants will not produce a significant effect on calcium
levels in plasma:

The correct answer is highlighted below

EDTA
Heparin
Oxalates
Citrates

Feedback

EDTA, Oxalates, and Citrates remove calcium from the blood, while heparin acts by
forming a complex with antithrombin III.

Question Difficulty: Level 5


 

  

  You answered the question incorrectly.

In patients with suspected primary hypothyroidism associated with Hashimoto's


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

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Which of the following additives should be used for the collection of a sample for
blood gas analysis:

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.


When is a trough blood sample for therapeutic drug monitoring usually obtained?

The correct answer is highlighted below

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.

Question Difficulty: Level 1


 

  

  You answered the question correctly.

Which of the following proteins has the FASTEST electrophoretic mobility?

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.


The ADA recommends performing an oral glucose tolerance test (OGTT) on all
individuals who are at increased risk for diabetes.

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

What additional fraction would be seen if plasma rather than serum was subjected to
electrophoresis:

The correct answer is highlighted below

Alpha-1 antitrypsin
Alpha-2 macroglobulin
Fibrinogen
Gamma globulins

Feedback

Fibrinogen present in plasma would form a band between the beta and gamma
globulins.

Question Difficulty: Level 3


 

  
  You answered the question correctly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Why are small dense LDL molecules more atherogenic?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

With the development of fetal lung maturity, which of the following phospholipid
concentrations in amniotic fluid increases?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.


Which of the following is a bronchodilator used to treat a 39-year-old male asthmatic
patient?

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

The following BEST describes serum hCG levels during pregnancy:

The correct answer is highlighted below

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.
Question Difficulty: Level 4
 

  

  You answered the question correctly.

Which of the following lipid results would be expected to be MOST falsely elevated
on a serum specimen from a non-fasting patient?

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

Human chorionic gonadatropin (hCG) is used in the determination of:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

Low values of plasma ceruloplasmin are MOST associated with:

The correct answer is highlighted below

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.”

Question Difficulty: Level 6


 

  

  You answered the question correctly.

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

The correct answer is highlighted below


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.

  You answered the question correctly.

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.

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

Which of the following statements best describe HbA1C?


The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

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


sensitivity?

The correct answer is highlighted below

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.
Question Difficulty: Level 7
 

  

  You answered the question correctly.

Which of the following is an autoantibody that binds to TSH receptor sites on thyroid
cell membranes preventing thyroid-stimulating hormone binding?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question incorrectly.

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.

The correct answer is highlighted below

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.

Question Difficulty: Level 9


 

  

  You answered the question incorrectly.

The ADA recommends performing an oral glucose tolerance test (OGTT) on all
individuals who are at increased risk for diabetes.

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Creatinine excretion correlates best with which of the following parameters:

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.


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?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

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?

The correct answers are highlighted below


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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

What is the largest constituent of plasma nonprotein nitrogen:

The correct answer is highlighted below

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.
Question Difficulty: Level 5
 

  

  You answered the question correctly.

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


approximately

The correct answer is highlighted below

0.01 to 0.02 pH unit


0.02 to 0.04 pH unit
0.04 to 0.08 pH unit
0.08 to 0.12 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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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

The correct answer is highlighted below

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).

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Which of the following is the most common technique that is used by clinical
laboratories for therapeutic drug monitoring?

The correct answer is highlighted below

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.

Question Difficulty: Level 9


 

  
  You answered the question correctly.
In healthy individuals, procalcitonin is synthesized by which cells in the body?

The correct answer is highlighted below

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.

Question Difficulty: Level 9


 

  

  You answered the question incorrectly.

Ion selective electrodes are called selective rather than specific because they actually
measure the:

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 
  

  You answered the question correctly.

All of the following are characteristics of Type II diabetes mellitus EXCEPT:

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.


Bioavailability of an oral drug refers to the:

The correct answer is highlighted below

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%.

Question Difficulty: Level 8


 

  

  You answered the question correctly.


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

The correct answer is highlighted below

Sensitivity
Specificity

Feedback

CRP is a sensitive marker of inflammation. However, it has a low specificity.

Question Difficulty: Level 8


 

  

  You answered the question correctly.


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?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 
  

  You answered the question correctly.

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


genotyping. Which of the following statements is not true?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

Which assay using 24-hour urine is considered the BEST single screening test for
pheochromocytoma?

The correct answer is highlighted below

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.

Question Difficulty: Level 8


 

  

  You answered the question correctly.

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


that is metabolized by CYP2D6 than a CYP2D6 extensive metabolizer (EM).

The correct answer is highlighted below

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.

Question Difficulty: Level 8


 

  

  You answered the question correctly.

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


presumptive evidence for:

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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

The correct answer is highlighted below


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).

Question Difficulty: Level 4


 

  

  You answered the question correctly.

The expected glucose value of an ABNORMAL 2-hour post-glucose tolerance test is:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  
  You answered the question correctly.

Following a myocardial infarction which of the following enzymes will be the first to
become elevated:

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question incorrectly.

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


mg/L) may indicate which of the following?

The correct answer is highlighted below

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.

Question Difficulty: Level 7


 

  

  You answered the question correctly.

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


characteristically associated with:

The correct answer is highlighted below

Hepatocellular carcinoma
Alcoholic cirrhosis
Megaloblastic anemia
Multiple myeloma

Feedback

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.

Which of the following substances is conjugated with the “indirect” bilirubin to form
“direct” bilirubin?
The correct answer is highlighted below

ascorbic acid
glucuronic acid
uric acid
salicylic acid

Feedback

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. 

Question Difficulty: Level 4


 

  

  You answered the question correctly.

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?

The correct answer is highlighted below

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.

Question Difficulty: Level 3


 

  

  You answered the question correctly.

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:

The correct answer is highlighted below

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.

Question Difficulty: Level 5


 

  

  You answered the question correctly.


Which of the following lipid tests is LEAST affected by the fasting status of the
patient?

The correct answer is highlighted below

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.

Question Difficulty: Level 6


 

  

  You answered the question correctly.

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


absorption and/or distribution in the body?

The correct answer is highlighted below

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.

Question Difficulty: Level 4


 

  

  You answered the question correctly.

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?

The correct answer is highlighted below

12-24 hours, 5-10 days


6-10 hours, 1-2 days
3-6 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.

Question Difficulty: Level 6