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Chapter 1 Laboratory Basics
1. Reverse osmosis (RO) is described as a process:
A. In which water is forced through a semipermeable membrane that acts as a molecular filter.
B. Used to purify liquid chemicals.
C. In which water forced through a carbon filter eliminates organic solvents.
D. In which salt in water moves through filter paper.
2. Activated carbon filters remove:
A. Ions from water.
B. Organic compounds from water.
C. Acids and bases from water.
D. Large particulates from water.
3. A 0.22-micron filter will remove:
A. Particles with a diameter of 0.01 microns.
B. Particles with a diameter of 0.01 nanometer.
C. Particles with a diameter of 2.2 microns.
D. Only sodium chloride crystals.
4. The unit of resistivity is:
5. The electrical resistance measured between opposite faces of a 1.00 cm cube of an aqueous solution at a specified temperature is termed:
6. According to CLSI, the resistivity of clinical laboratory reagent water (CLRW) must be:
A. > 100 milliamps.
B. < 10 millivolts. C. > 10 Mcm.
D. < 10 Mcm. 7. Which of the following should not be storied in borosilicate glass because it will etch the inside surface of the glass container? A. Saline B. Strong bases (caustics) C. Clinical laboratory reagent water D. Weak acids 8. Low actinic glassware has which of the following properties: A. High thermal resistance with no color added to the glass. B. Low thermal resistance with a green-yellow color added as an integral part of the glass. C. High thermal resistance with a blue color added as an integral part of the glass. D. High thermal resistance with an amber or red color added as an integral part of the glass. 9. Care must be taken before selecting polyethylene plastic for use as test tubes and disposable transfer pipets because: A. Polyethylene can bind or absorb proteins, dyes, stains, and picric acid. B. Polyethylene does not bind or absorb proteins, dyes, stains, and picric acid. C. Polyethylene cannot be used to pipet serum. D. Polyethylene forms insoluble salts in the presence of sodium chloride. 10. Which of the following classes of glassware, including pipets, is manufactured and calibrated to deliver the most accurate volume of liquid? A. A B. B C. AA D. C 11. A to deliver or TD pipets are designed to: A. Allow the user to remove a portion of the sample in the tip for better accuracy. B. Be vigorously tapped against the test tube after all the liquid is removed. C. Drain by gravity. D. Be refilled or rinsed out with the appropriate solvent after the initial liquid has been drained from the pipet. 12. Which of the following devices is used to calibrate laboratory thermometers? A. Barometer B. Gallium melting point cell C. Titanium freezing point cell D. Platinum cathode voltmeter 13. Convert 75 mg/dL to mg/L. A. 7.5 mg/L B. 75.0 mg/L C. 750 mg/L D. 7500 mg/L 14. Convert 70.0 mg/dL glucose to mmol/L glucose. A. 3.89 mmol/L B. 38.9 mmol/L C. 70.0 mmol/L D. 389 mmol/L 15. If a thermometer reads 39F, what is the equivalent degree Celsius? A. 0.39C B. 3.9C C. 39C D. 40C 16. Convert 200 picograms to grams. A. 2.0 x 1010 grams B. 2.0 x 108 grams C. 20.0 grams D. 200 grams 17. A patients calcium result is 8.0 mg/dL. Convert this result to mmol/L. A. 0.004 mmol/L B. 0.20 mmol/L C. 2.0 mmol/L D. 20.0 mmol/L 18. The surface area of a laboratory bench measures 12 square feet. What is the surface area in square meters? A. 1.115 square meters B. 11.15 square meters C. 111.5 square meters D. 1115 square meters 19. A 24-hours stool specimen weights 0.50 pounds. What is the weight in kilograms? A. 0.0226 kilograms B. 0.2265 kilograms C. 2.265 kilograms D. 22.65 kilograms 20. A 1 to 4 dilution must be prepared to make a total volume of 100.0 L. How much serum must be used? A. 0.025 L B. 0.25 L C. 2.5 L D. 25 L 21. A patients creatinine is outside the linear range of the analyzer; 10 L of serum is added to 90.0 L of diluent and the diluted sample is reanalyzed. The creatinine value of the diluted sample is 1.0 mg/dL. Which of the following creatinine values is correct? A. 1.0 mg/dL B. 10.0 mg/dL C. 20.0 mg/dL D. 100 mg/dL 22. If 10 mL of sample is added to 190 mL of diluent, what is the dilution factor? A. 10 B. 19 C. 20 D. 25 23. A serum creatine kinase is diluted 1/200 with a result of 50 U/L. What is the patients actual amylase result? A. 50 U/L B. 200 U/L C. 1000 U/L D. 10,000 U/L 24. How many grams of sodium hydroxide (NaOH) are required to prepare 250 mL of a 1.00 molar solution? A. 2.5 g B. 10.0 g C. 25.0 g D. 100 g 25. What is the normality of a 1.5 molar H2SO4 solution? A. 1.0 N B. 1.5 N C. 3.0 N D. 36 N 26. What is the molality of a solution that contains 330 g of CaCL2 per kilogram? A. 3.0 molal B. 3.3 molal C. 33.0 molal D. Unable to determine 27. What is the concentration in mg/dL of a 140 mEq/L sodium standard? A. 0.323 mg/dL B. 3.23 mg/dL C. 32.3 mg/dL D. 322 mg/dL 28. Convert 145 mEq/L sodium standard to mmoles/L. A. 14.5 mmol/L B. 145 mmol/L C. 167 mmol/L D. 333 mmol/L 29. What is the molarity of a 20.0% w/v glucose solution? A. 0.111 molar B. 1.11 molar C. 2.22 molar D. 11.1 molar 30. Determine the molarity of a solution if 125 mL of a 3.5 molar solution is diluted to a final volume of 500 mL. A. 0.875 M B. 3.50 M C. 8.75 M D. 10.0 M 31. Convert 40C to F. A. 60F B. 90F C. 100F D. 104 F 32. What is the concentration (g/dL) of a 1/10 dilution of a 12% NaCl solution? A. 0.12 B. 1.20 C. 12.0 D. 120.0 33. A solution contains 45 g/100 mL of glucose. It is diluted 1/10 and rediluted 1/10. What is the concentration of the final solution? A. 45.0 g/100mL B. 4.5 g/100 mL C. 0.45 g/100mL D. 0.045 g/100mL 34. How many milliliters of a 2.0M solution is required to prepare 50 mL of a 0.3M solution? A. 0.075 ml B. 0.75 ml C. 7.5 ml D. 75 ml 35. Calculate the chloride concentration in milliequivalents per liter of a solution prepared by diluting 20 g of barium chloride to 1L. A. 1.92 mEq/L B. 19.2 mEq/L C. 192.0 mEq/L D. 384 mEq/L Chapter 1 Answer Key 1. A 2. B 3. C 4. D 5. A 6. C 7. B 8. D 9. A 10. A 11. C 12. B 13. C 14. A 15. B 16. A 17. C 18. A 19. B 20. D 21. B 22. C 23. D 24. B 25. C 26. A 27. D 28. B 29. B 30. A 31. D 32. B 33. B 34. C 35. C Chapter 2 Instrumentation 1. Electromagnetic radiation exists both as Maxwells waves and as streams of particles called: A. Photons. B. Mesons. C. Electrons. D. Neutrons. 2. Amplitude of the electromagnetic sine wave is defined as: A. The length of the electronic vector at one-half peak width. B. The width of the electronic vector at maximum peak height. C. The length of the electronic vector at maximum peak height. D. The area under the sine wave. 3. A nanometer is equivalent to: A. 109 meters. B. 109 meters. C. Nine meters. D. One-ninth of a meter. 4. What is the photon energy (E) in electron volts (eV) of electromagnetic energy of 200 nm? A. 0.99 eV B. 3.26 eV C. 6.53 eV D. 13.06 eV 5. What is the concentration of serum phosphorus in a solution whose absorbance is 0.150, cuvet pathlength, 1.0 centimeters, absorptivity is 0.0625 L g-1cm-1? A. 240 mg/L B. 0.024 g/L C. 0.24 g/L D. 2.4 g/L 6. What is the concentration of creatinine in a serum sample if given the following? Atest = 0.240 Astandard = 0.125 Cstandard = 0.90 mg/dL A. 0.5 mg/dL B. 0.2 mg/dL C. 1.7 mg/dL D. 2.7 mg/dL 7. Which of the following types of light sources emits radiation that changes in intensity very slowly as a function of wavelength? A. Continuum source B. Line source C. Pulsating source D. Microwave source 8. A mercury lamp is an example of which of the following light sources: A. Pulsating source B. Fluorescent light source C. Line source D. Continuum source 9. Filters and diffraction gratings are examples of which of the following: A. Light sources B. Cuvets C. Monochromators D. Slits 10. The wavelength in nanometers at peak transmittance is termed: A. Spectral bandwidth. B. Stray light. C. Nominal wavelength. D. Electromagnetic spectrum. 11. Bandpass is defined as: A. The range of wavelengths at a point halfway between the baseline and the peak. B. The half power point or full width at half maximum. C. The total range of wavelengths transmitted. D. The product of parallel beams of radiation. 12. A photomultiplier tube functions to produce which of the following? A. Reduce the electronic signal produced as photons cascade from dynode to dynode B. Increase the electronic signal produced as photons cascade from dynode to dynode C. Increase the number of transmitted photons from the cuvet D. Reduce in a logarithmic fashion the electronic signal created at the cathode 13. Didymium and holmium oxide filters are used to assess: A. Wavelength accuracy B. Voltage values C. Stray light D. Photometric accuracy 14. Which of the following is a cause of stray light failure in a spectrophotomer? A. Fingerprints on a cuvet B. Misaligned monochromator C. Room light entering the spectrophotometer and impinging upon the detector D. A dirty holmium oxide filter 15. Light reflecting off a urine dipstick absorbent surface is an example of which of the following? A. Specular reflectance B. Diffuse reflectance C. Fluorescence D. Chemiluminescence 16. A reflectometer measures which of the following? A. All of the reflection from a surface B. One-half of the reflection from a surface C. A constant fraction of the reflection from a surface D. A constant amount of the light not reflected off a surface 17. Which of the following describes atomic absorption spectroscopy? A. The transmittance of monochromatic electromagnetic radiation by an element in its excited state B. The measurement of the electromagnetic radiation emitted by an element C. The release of electromagnetic radiation due to a chemical reaction D. The absorption of monochromatic electromagnetic radiation by an element in its ground state with a net zero charge 18. Which of the following statements best illustrates the difference between photons from fluorescent emission and the excitation photons? A. Emission photons are higher energy and longer wavelength B. Emission photons are lower energy and longer wavelength C. Emission photons are lower energy and shorter wavelength D. Emission photons are negatively charged and have zero mass 19. The polarization of light in fluorescent polarization immunoassay allows the measurement of which of the following? A. Bound fraction in the presence of the free fraction B. Only the bound fraction after the free fraction is removed C. Both bound and free fractions D. Antibodies to fluorescent label 20. A chelate of europium (Eu3+) is used in which of the following assays? A. Radioimmunoassays B. Chemiluminescent immunoassays C. Time-resolved fluorescent immunoassays D. Fluorescent polarization immunoassays 21. Oxidation of acridinium esters by hydrogen peroxide in the presence of peroxidase produces which of the following? A. Fluorescence B. Phosphorescence C. Translucence D. Chemiluminescence 22. Turbidimetry is the measurement of the reduction in light transmission caused by: A. Particle formation. B. Chelation of metals. C. Slowing of the spin rotation of electrons. D. Increase in excitation photon energy. 23. The presence of particulates in a urine sample measured by a refractometer will result in which of the following? A. An increase in reflectance of the solution B. A change in the critical angle of the light as it passes through the solution C. An increase in energy of the solute particles that results in a release of light energy D. A change in Rayleigh scatter patterns 24. Which of the following accounts for the temperature rise in freezing point osmometry? A. Heat of separation B. Thermal currents flowing through the ethylene glycol C. Heat of fusion D. Heat of conduction 25. Which of the following electrical devices senses the freezing point of a solution in an osmometer? A. A pH electrode B. A pressure transducer C. A conductivity electrode D. A thermistor Chapter 2 Answer Key 1. A 2. C 3. B 4. C 5. D 6. C 7. A 8. C 9. C 10. C 11. C 12. B 13. A 14. C 15. B 16. C 17. D 18. B 19. A 20. C 21. D 22. A 23. B 24. C 25. D Chapter 3 Automation 1. Throughput is defined as: A. Numbers of tests performed per hour. B. Number of stat tests performed per hour. C. Number of specimen processed per 24 hours. D. Number of sample aspirations performed in 60 seconds. 2. Which of the following statements best describes discrete testing? A. Automatically measures up to 10 different analytes on a serum specimen whether they are requested or not B. Measures only the test requested on a sample C. Measures analytes in serum samples only D. Automatically measures all of the tests that the analyzer is capable of performing 3. Any specimen, by a command to the processing systems, can be analyzed by any available process, in or out of sequence with other specimens, and without regard to their initial order describes which type of sample processing principle? A. Batch and discrete analysis B Centrifugal analysis C. Continuous flow analysis D. Random access analysis 4. A designated area where a limited number of specific tasks are completed describes which of the following terms? A. Work area B. Work station C. Work room D. Core laboratory 5. Which of the following devices is suitable to detect clots in serum specimens? A. Aggregometer B. Refractometer C. Luminometer D. Pressure transducer 6. A liquid level sensor is designed to detect which of the following? A. The presence of a sample by measuring the electrical capacitance of the surrounding area B. The presence of a sample by measuring the electrical current of the surrounding area C. The presence of a sample by measuring the electrical resistance of the surrounding area D. The presence of a clot in the sample 7. A glucose result is falsely elevated and it was discovered that the previous sample on the sample carousel has abnormally high serum glucose. Which of the following can cause this error? A. Pipetting an extra volume of diluents into the sample with the falsely elevated glucose B. Carryover C. A leak in the reagent-dispensing probe D. Double pipetting of the sample with the elevated glucose result 8. Which of the following statements best describes unit test reagents? A. There is an abundance of reagent present for the performance of several tests. B. There is exactly twice the amount of reagent present for the performance of a single test. C. There is sufficient reagent present for the performance of a single test D. There is only eight hours of reagent present to perform the tests requested. 9. A closed reagent chemistry analyzer: A. Allows the operator to use reagents from other manufacturers. B. Will not allow the operator to use reagent from other manufacturers. C. Allows the operator to dispense reagents with their bottle caps in place. D. Allows the operator to purchase only a given amount of reagents for a year. 10. Which of the following represents a disadvantage to acquiring and implementing total laboratory automation? A. Increases labeling errors B. Increases turnaround times C. Increases the need for additional full time equivalents (FTEs) D. The initial costs are very high 11. Which of the following terms is associated with the following description? A combination of a specimen manager with instruments or consolidated instruments of chemistry and immunoassay reagents that provide a broad spectrum of analytical tests. A. Workcell B. Workstation C. Point-of-care station D. Outpatient clinic 12. A pneumatic tube delivery system is designed to provide the laboratory with which of the following functions? A. A one-way-only means of delivery and receiving patient specimens B. A bidirectional system for transmitting computer data C. Point-to-point delivery of patient specimens D. A system used to clean and purify room air 13. Increase test throughput, reduce turnaround time, and compensate for staff shortages are all examples of which of the following? A. Factors that lead to more errors B. Factors that drive manual procedures C. Management options used to reduce the number of technologist in the laboratory D. Factors that drive automation 14. Automating laboratory testing has resulted in which of the following? A. Inconsistent sample processing errors B. A reduction in the number of laboratory errors C. Increased turnaround time D. Increased repetitive injuries 15. Which of the following is carried out during the preanalytical stage of laboratory testing? A. Calculating the final concentration of the analyte B. Detecting the analyte in solution C. Specimen processing D. Sending patient results to the caregiver 16. Peltier thermal electric module functions to: A. Maintain a constant pressure environment in the automated pipetting device. B. Maintain a constant temperature environment for polychromatic light source. C. Maintain a constant temperature environment for photomultiplier tube. D. Maintain a constant temperature environment for the reaction cuvets. 17. Which of the following is an example of software that allows a laboratory to connect their existing LIS and instrumentation to facilitate sharing information and performs tasks not currently done with laboratories existing hardware and software? A. Middleware B. LIS-HIS interface C. RS232 software D. Computer operating system 18. Direct tube sampling by automated analyzers eliminates the need to perform which of the following tasks? A. Pour off specimens into another container B. Manual dilution of specimens C. Check for clots in specimens D. Check for proper sample volume 19. A test menu is: A. A listing of all the reagents on-board the analyzer. B. A listing of preventative maintenance tasks that needs to be performed. C. A listing of all of the tests or analytes that the instrument is capable of measuring. D. A listing of consumables used by the analyzer. 20. Recapping/storage/retrieval are all examples of tasks performed during which of the following? A. The analytical stage of testing B. Sample processing C. The postanalytical stage of testing D. Preventative maintenance Chapter 3 Answer Key 1. A 2. B 3. D 4. B 5. D 6. A 7. B 8. C 9. B 10. D 11. A 12. C 13. D 14. B 15. C 16. D 17. A 18. A 19. C 20. B Chapter 4 Laboratory operations 1. OSHA standards are written in which of the following documents? A. Codes of State Regulations (CSRs) B. Codes of Federal Regulations (CFRs) C. Material Safety Data Sheets (MSDS) D. National Fire Protection Agency (NFPA) 2. When referring to quality control results, what parameter usually determines the acceptable range? A. The range that includes 45% of the results B. The range encompassed by 2.5 standard deviations C. The 95% confidence interval for the mean D. The central 68% of results 3. A class A fire involves: A. Combustible metals such as magnesium. B. Flammable liquids, for example, methanol. C. Ordinary combustible material including paper and wood. D. Electrical equipment. 4. Which of the following quality control rules would be violated 1 out of 20 times by chance alone? A. 13s B. 12s C. 22s D. 14s 5. A 22s quality control rule violation is defined as: A. Two consecutive control values that exceed 2 s. B. Two non-consecutive control values that exceed 2 s. C. Four consecutive controls values that exceed 2 s. D. Two control values that exceed 4 s. 6. Which statement listed below is a reason to reject an analytical run? A. One control result exceeds above +1 standard deviation and the second control result exceeds 1 standard deviation from the mean B. Two consecutive control greater than 2 standard deviations above or below the mean C. Four control results steadily increase in value but results less than 1 standard deviation from the mean D. Three consecutive control results greater than plus or minus 1 standard deviation from the mean 7. Which of the following is an example of an inferential statistic? A. Mean B. Standard deviation C. Student t test D. Correlation coefficient 8. Which of the following plots is best for detecting all types of quality control errors? A. Bias B. Linear regression C. CUSUM D. Levy-Jennings 9. Which of the following practices is inappropriate when establishing quality controls ranges? A. Exclusion of any quality control results greater than 2 standard deviation from the mean B. Compare your data to the manufacturer of the quality control material C. Gather quality control data for a long period of time if necessary D. Using control results from all shifts on which the assay is performed 10. Liquid nitrogen is an example of which of the following: A. Carcinogen B. Mutagen C. Halogen D. Cryogen 11. Which of the following statistics is used to qualify the strength of the relationship between two variables? A. Correlation coefficient B. F-test C. Confidence interval D. t-test 12. An important difference between parametric statistics and nonparametric statistics is that parametric statistics presumes a Gaussian distribution, whereas nonparametric statistics: A. Assumes linearity. B. Is distribution-free. C. Is sensitive to gender and age. D. Accepts all outliers. 13. Which of the following statements best defines the term accuracy? A. The closeness of the agreement between the measure value of an analyte to its true value B. Laboratory results that do not agree C. A tests ability to produce the same value for replicate measure of the same sample D. A tests ability to correlate to another method 14. A type I error is defined as which of the following? A. A serious misinterpretation of quality control rule violation B. Erroneously accepting the null hypothesis, therefore a real difference is not detected C. Erroneously rejecting the null hypothesis or proclaiming a difference to exist when one does not D. Ignoring a large bias between two methods 15. The letters MSDS represent which of the following? A. Material safety design sheet B. Medical systems data sheets C. Manual safety devices schedule D. Material safety data sheet 16. The label identification system designated NFPA 704-M represents which of the following warnings? A. Biohazard materials B. Mechanical devices C. Chemical hazards D. Laboratory safety hoods 17. Least squares, Demings, and Passing and Bablok are examples of: A. Confidence intervals. B. Inferential tests. C. Quality control programs. D. Regression analysis. 18. Sources of nonionizing radiation include which of the following? A. Beta radiation emitting isotopes (e.g., tritium) B. Gamma radiation emitting isotopes (e.g., 125Iodine) C. Microwaves, tungsten-halogen lamps, xenon lamps D. X-ray imaging devices 19. A blood-borne pathogens protocol designed to help prevent accidental exposure of laboratory personnel is found in which of the following plans? A. Carcinogen Exposure Plan B. Universal Precaution Plan C. Exposure Control Plan D. Chemical Exposure Plan 20. Analysis of variance (ANOVA) is an appropriate statistics to evaluate three or more sets of data among each other, but it does not reveal: A. Which set of data is not in agreement with the other data. B. Which set of data is most accurate. C. Which set of data is most precise. D. Which set of data is bias. 21. Linear regression analysis by least squares reveals: A. Variation between three or more methods. B. Systematic and proportional error. C. Quality control failures. D. Cutoff values that maximize both sensitivity and specificity. 22. The McNemar statistics using a two by two contingency table is useful for evaluating which of the following? A. Correlation between two quantitative assays B. The degree of association between two sets of data C. Correlation between two qualitative assays D. Determining the source of error in a qualitative assay 23. Linearity is useful for assessing: A. Slope and bias of an analytical method. B. Slope and intercept of an analytical method. C. Intercept and p value of analytical method. D. A large correlation coefficient. 24. The term patient demographics refers to which type of information that is entered into a laboratory information system? A. Patient-specific information, for example, name, age, and date of birth B. Patient-specific information, for example, the total volume of urine collected in a 24-hour period for a creatinine clearance C. Patient-specific information, for example, their mothers and fathers first and last name D. Patient-specific information, for example, where they were born and their religious preference 25. A cross-reacting compound in a serum sample may result in which of the following? A. A reliable result B. A precise result C. An accurate result D. A discordant result 26. Proportional error in a method is characterized by which of the following? A. The magnitude of the error stays the same over a wide concentration range. B. The magnitude of the error increases as the concentration of analyte increases. C. The magnitude of the error decreases as the concentration of analyte increases. D. The magnitude of the error is inversely proportional to concentration. 27. Bidirectional interface between the laboratory information system (LIS) and a chemistry analyzer provides which the following? A. The LIS can only upload information from an instrument B. The LIS cannot simultaneously transmit or download information to a laboratory instrument C. The LIS can simultaneously transmit data in one direction only D. The LIS can simultaneously transmit or download information to a laboratory instrument and the instrument can transmit data to the LIS 28. A glucose result that is lower than the detection limit of the method should be reported as which of the following? A. Zero B. Less than the detection limit value C. The actual concentration value given by the analyzer or as calculated by the operator D. Greater than the detection limit value 29. Which of the following statements describes the proper method of storing chemicals in the laboratory? A. According to their chemical properties and classifications B. Inside a chemical fume hood C. Alphabetically, for easy accessibility D. Inside a walk-in type refrigerator 30. The results of a precision study are shown below. What is the percent coefficient of variation for the study? Mean = 100 mg/dL Standard deviation = 2.5 mg/dL Variance = 6.25 mg/dL A. 1.5% B. 2.0% C. 2.5% D. 6.25% Chapter 4 Answer Key 1. B 2. C 3. C 4. B 5. A 6. B 7. C 8. D 9. A 10. D 11. A 12. B 13. A 14. C 15. D 16. C 17. D 18. C 19. B 20. A 21. B 22. C 23. B 24. A 25. D 26. B 27. D 28. B 29. A 30. C Chapter 5 Immunoassays 1. Which of the following substances does glucose-6-phosphate dehydrogenase bind to in the EMIT assay? A. Coenzyme B. Substrate C. Antigen D. Antibody 2. Which of the following stimulates the production of singlet oxygen at the surface of the sensitizer particle in a luminescent oxygen channeling immunoassay (LOCI)? A. High-energy fluorescent radiation B. Enzymatic reaction C. Radiant energy D. Electrical current 3. The antibody that binds to hapten-enzyme in the EMIT assay results in which of the following? A. Inhibition of enzyme activity B. Enhancement of enzyme activity C. Facilitation of the enzymes catalytic properties D. It has no effect on the reaction 4. Which of the following best describes a procedural difference between homogeneous and heterogeneous immunoassays? A. There is no physical separation of bound from free fractions in a homogeneous immunoassay, whereas in a heterogeneous immunoassay you must separate bound forms from free forms. B. A homogeneous immunoassay usually takes longer to perform because you must physically separate the bound from free fractions, whereas in a heterogeneous immunoassay the time to perform the assay is shorter because you do not have to separate the bound forms from free forms. C. There is a physical separation of bound from free fractions in a homogeneous immunoassay. D. Separation of bound and free fractions is optional for either type of immunoassays. 5. Monoclonal antibodies are derived from which of the following? A. Different cell lines B. Different clones C. A single cell line D. A heterogeneous mixture of clones 6. Which of the following immunoassays uses a gold electrode to facilitate production of light? A. Enzyme-multiplied immunoassay technique B. Fluorescence polarization immunoassay C. Electrochemiluminescence immunoassay D. Substrate labeled fluorescent immunoassay 7. Which of the following best describes haptens? A. Haptens can be any substance capable of reacting with an antibody, but without necessarily being capable of inducing antibody formation B. Haptens are immunoglobulins capable of binding specifically to both natural and synthetic antigens. C. Haptens are substances that are capable of binding an antibody but by themselves cannot stimulate an immune response. D. Haptens are compounds that can be attached to antigens or antibodies and used as labels for immunoassays. 8. A competitive immunoassay includes a patient analyte (antigen), antibody to the analyte (antigen), and which of the following? A. A paramagnetic particle to which an antibody is attached B. An antigen with a label attached to its structure C. A label that is not attached to either an antibody or antigen D. An antibody to the antibodyantigen complex 9. In fluorescence polarization immunoassay (FPIA), the electrons in fluorescein molecules chemically attached to the hapten react in which of the following manners? A. They do not spin at all B. They spin 100 times faster than normal C. They do not flouresce D. They flouresce 10. Plastic beads, polyclonal gels, and particles coated with iron oxide used in immunoassays are all examples of which of the following? A. Antigen label B. Solid phase material C. Immunogens D. Double antibodies 11. Luminescent oxygen channeling immunoassay (LOCI) takes advantage of which of the following distance factors to initiate a chemiluminescent reaction? A. Short diffusion distance of oxygen molecules in the first electronic state B. Long diffusion distance of oxygen molecules in the first electronic state C. Short absorption distances of oxygen D. Short diffusion distance of hydrogen molecules in the first electronic state 12. Microparticulate enzyme immunoassay uses which of the following enzymes to catalyze the conversion of the substrate, 4-methylumbelliferyl phosphate to methylumbelliferone? A. Acid phosphatase B. Alkaline phosphatase C. Gamma-glutamyltransferase D. Aldolase 13. Which of the following is an example of a chemiluminescent compound? A. Fluorescein B. Luminol C. Acridinium D. Cis-platinum 14. As the concentration of analyte begins to exceed the amount of antibody present, the dose response curve will flatten (plateau) and with further increase may become negatively sloped; this describes which of the following? A. Logarithmic relationship of antibody concentration and millivolt output from the detector B. Increase in precision C. Loss of sensitivity D. Hook effect 15. Which of the following statements is true regarding enzyme multiplied immunoassay technique (EMIT)? A. If analyte is present the activity of the enzyme, glucose-6-phosphate dehydrogenase is inhibited by the binding of antibody to the antigen conjugated with enzyme. B. If no analyte is present the activity of the enzyme, glucose-6-phosphate dehydrogenase is inhibited by the binding of antibody to an antigen conjugated with enzyme. C. If no analyte is present the activity of the enzyme, fructose-6-phosphate dehydrogenase is inhibited by the binding of antibody to an antigen conjugated with enzyme. D. If no analyte is present the activity of the enzyme, alkaline phosphatese glucose-6-phosphatase dehydrogenase is enhanced by the binding of antibody to the antigen conjugated with enzyme. 16. Which statement best defines an antigen? A. Multiple molecular forms of an isoform B. Immunoglobulins that are capable of binding specifically to both natural and synthetic antigens C. A chemical substance capable of inducing an immune response D. Any material capable of reacting with an antibody, without necessarily being capable of inducing antibody formation 17. Which detector label is used in fluorescent polarization immunoassays? A. Fluorescein B. Dioxetane C. Luminol D. Glucose-6-phosphate dehydrogenase 18. In fluorescent polarization immunoassay, a high concentration of sample analytes results in which of the following? A. Increased emission of polarized light B. Decreased emission of polarized light C. Increased emission of nonpolarized light D. Decreased emission of nonpolarized light 19. Which of the following immunoassays produces a fluorescent molecule, 4-methylumbelliferone that serves as the detector compound? A. Microparticulate enzyme immunoassay B. Substrate labeled fluorescent immunoassay C. Enzyme multiplied immunoassay D. Fluorescent polarization immunoassay 20. Affinity is described as which of the following? A. The overall strength of binding of an antibody to an antigen and includes the sum of the binding affinities of all the individual binding sites on the antibody B. Another substance that is capable of producing antibodies C. The thermodynamic quantity defining the energy of interaction of a single antibody-binding site and its corresponding epitope on the antigen D. A chemical substance capable of inducing an immune response Chapter 5 Answer Key 1. C 2. C 3. A 4. A 5. C 6. C 7. C 8. B 9. C 10. B 11. A 12. B 13. C 14. D 15. B 16. D 17. A 18. C 19. A 20. C Chapter 6 Carbohydrates 1. An isomer of glucose with the OH group of the anomeric carbon C1 that is below the plane of the ring or on the right-hand side is: A. D-glucose. B. L-glucose. C. -glucose. D. -glucose. 2. Which of the following carbohydrates is a polysaccharide? A. Starch B. Sucrose C. Lactose D. Glucose 3. Gluconeogenesis is: A. The conversion of glucose to glycogen for storage. B. The formation of glucose from non carbohydrate sources, for example, amino acids, glycerol, and lactate. C. The conversion of glucose into 3-C molecules, for example, lactate and pyruvate. D. Breakdown of glycogen to form glucose and other intermediate products. 4. Glycolysis is: A. The conversion of glucose into lactate or pyruvate and then CO2 and H2O. B. The conversion of glucose to glycogen for storage. C. Breakdown of glycogen to form glucose and other intermediate products. D. The formation of glucose from noncarbohydrate sources. 5. Glycogen is stored in the: A. Pancreas. B. Liver. C. Spleen. D. Gall bladder. 6. Which of the following is the primary hypoglycemic hormone? A. Insulin B. Thyroxine C. Glucagon D. Growth hormone 7. Which of the following hormones does NOT stimulate glycogenolysis? A. Insulin B. Glucagon C. Epinephrine D. Thyroxine 8. A patients low glucose, increased insulin, and increased C-peptide is caused by: A. Glucagonoma. B. Addisons disease. C. Insulinoma. D. Injection of exogenous insulin. 9. The only hormone that causes a decrease in blood glucose levels is: A. Glucagon. B. Thyroxine. C. Insulin. D. Parathyroid hormone. 10. Which of the following is characteristic of type 2 diabetes mellitus? A. High insulin levels B. Ketosis C. Obesity and physical inactivity D. Juvenile onset 11. Which form of diabetes usually manifests itself early in life, and is associated with ketosis, low insulin levels, and autoantibodies to islet cells? A. Gestational B. Type 1 C. Type 2 D. Congenital 12. All of the following are associated with gestational diabetes EXCEPT: A. It converts to diabetes mellitus after pregnancy in 3060% of patients. B. Is diagnosed using the same glucose tolerance criteria as in nonpregnant women. C. Is defined as glucose intolerance during pregnancy. D. Associated with increased fetal risk. 13. All of the following are confirmatory of diabetes mellitus EXCEPT: A. Fasting glucose greater than 126 mg/dL. B. Urine glucose greater than 300 mg/dL C. 2-hour postprandial glucose greater than 200 mg/dl. D. 1- and 2-hour glucose tolerance values greater than 200 mg/dL. 14. Complications of diabetes mellitus include all of the following EXCEPT: A. Heart disease and stroke. B. Neuropathy. C. Nephropathy. D. Hepatitis. 15. Instructions for patients preparing for a glucose tolerance tests include all of the following EXCEPT: A. No food 10 hours before and during the test. B. Patient must be ambulatory for 3 days prior to the test. C. Carbohydrate intake must be at least 150g/day for 3 days prior to the test. D. Caffeine and smoking are permitted before and during the test. 16. A patient with an insulinoma may exhibit dizziness and fainting attributable to: A. Hypoglycemia. B. Hyperglycemia. C. Ketosis. D. Acidosis. 17. What type of hypoglycemia is exhibited 8 hours after a meal? A. Reactive B. Fasting C. Alimentary D. None of the above 18. All of the following statements about clinical hypoglycemia are true EXCEPT: A. Neuroglycopenic symptoms must be present at the time of the low blood sugar. B. Symptoms can be relieved by ingestion of carbohydrates. C. High fasting insulin levels must be present to make a diagnosis. D. C-peptide levels are normal or elevated. 19. Select the enzyme that is most specific for -D glucose. 1. Phosphohexisomerase 2. Hexokinase 3. Glucose oxidase 4. Glucose dehydrogenase 20. The enzyme that catalyzes the reaction ATP + D-glucose ADP + D-glucose-6-phosphate is: A. Glucose oxidase B. Lyase C. Hexokinase D. Mutase 21. In the Hexokinase method for glucose determinations, the actual end product measured is the: A. Amount of hydrogen peroxide produced. B. NADPH + H+ produced from the reduction of NADP. C. Amount of glucose combined with bromcresol purple. D. Condensation of glucose with an aromatic amine. 22. Glucose concentration in serum is: A. Higher than the concentration in whole blood. B. Lower than the concentration in whole blood. C. Equal to the concentration in whole blood. D. Unable to predict- variable. 23. In a specimen collected for plasma glucose analysis, sodium fluoride: A. Serves as a coenzyme of hexokinase B. Prevents reactivity of non glucose reducing substances C. Precipitates protein D. Inhibits glycolysis 24. Which of the following 2-hour glucose results would be classified as impaired glucose tolerance? A. 125 mg/dL B. 135 mg/dL C. 160 mg/dL D. 210 mg/dL 25. The glucose concentration in normal cerebrospinal fluid is: A. Usually less than 30 mg/dL. B. 6075% of the plasma glucose concentration. C. Equal to the plasma glucose concentration. D. Usually greater than 100 mg/dL. 26. If a patients serum glucose is 100 mg/dL, what would you expect the cerebrospinal fluid glucose to read? A. 45 mg/dL B. 68 mg/dL C. 85 mg/dL D. 95 mg/dL 27. A sneaky diabetic tried to lower her glucose by working out and watching her diet 1 or 2 days before her appointment. The rest of the time she spent the day in front of the television and eating chocolates. What test could the doctor order to detect this type of behavior? A. A glucose tolerance test B. A glycosylated hemoglobin C. Daily urine glucose D. A hospital admission so he could watch her daily 28. Which statement regarding glycosylated hemoglobin is true? A. It has a sugar attached to the N-terminal valine of the -chain of the hemoglobin molecule. B. Is dependent upon the time averaged blood glucose over the lifespan of the RBC. C. Levels below 7% indicate adequate regulation for 812 weeks prior to sampling. D. All of the above. 29. Of the following blood glucose levels, which would you expect to result in glucose in the urine? A. 70 mg/dL B. 100 mg/dL C. 120 mg/dL D. 200 mg/dL 30. The following glucose tolerance test values are indicative of what state? Fasting: 85 mg/dL hour: 135 mg/dL 1 hour: 139 mg/dL 2 hour: 130 mg/dL A. Normal B. Diabetes mellitus C. Addisons disease D. Hyperinsulinism Chapter 6 Answer Key 1. C 2. A 3. B 4. A 5. B 6. C 7. A 8. C 9. C 10. C 11. B 12. B 13. B 14. D 15. D 16. A 17. B 18. C 19. C 20. C 21. B 22. A 23. D 24. C 25. B 26. B 27. B 28. D 29. D 30. A Chapter 7 Lipids 1. Bile acids are synthesized in the liver from which lipid? A. Triglycerides B. Cholesterol C. Fatty acids D. Phospholipids 2. Cholesterol is a: A. Glycerol ester. B. Cyclopentanoperhydrophenanthrene nucleus. C. Fatty acid. D. Phospholipid. 3. What percentage of serum cholesterol is present in the form of esters? A. 1020% B. 2040% C. 6075% D. 8095% 4. Which of the following lipids are derivatives of fatty acids comprised of 20 C atoms including a 5 C cyclopentane ring? A. Phospholipids B. Prostaglandins C. Triglycerides D. Cholesterol 5. Which of the following lipid fractions are very large molecules with a low density and give plasma a milky appearance when present in increased amounts? A. chylomicrons B. VLDL C. IDL D. LDL E. HDL 6. The lipoprotein fraction that has the highest ratio of lipid to protein is: A. Chylomicrons. B. VLDL. C. LDL. D. HDL. 7. Acyl-cholesterol acyltransferase: A. Esterifies free cholesterol from the outer layer of the lipoprotein followed by a shift of the esterified cholesterol to the core of the chylomicrons. B. Hydrolyzes triglycerides on the surface of chylomicrons to glycerol and fatty acids. C. Converts free cholesterol to esterified cholesterol for storage. D. Converts cholesterol to esterified cholesterol. 8. Which of the following is FALSE concerning blood cholesterol concentrations? A. increased cholesterol is associated with diabetes mellitus B. increased cholesterol is associated with hyperthyroidism C. increased cholesterol is associated with nephrotic syndrome D. cholesterol levels decrease following strenuous exercise E. cholesterol levels are unchanged when comparing results from fasting and nonfasting blood 9. Which of the following tests would be included in a routine lipid profile? A. Cholesterol, LDL-cholesterol, HDL cholesterol B. Cholesterol, triglycerides, phospholipids C. Triglycerides, fatty acids, LDL-cholesterol D. Cholesterol, LDL-cholesterol, HDL cholesterol, triglycerides 10. The first step in the enzymatic cholesterol reaction, which results in cholesterol esterase, is: A.Oxidation of cholesterol. A. Oxidation of cholesterol esters. B. Hydrolysis of cholesterol esters. C. Reduction of cholesterol. D. Reduction of cholesterol esterases. 11. The enzymatic determination of glycerol in triglyceride analysis usually involves conversion of glycerol to: a. Oleic acid. b. Phospholipid. c. Formaldehyde. d. CO2 and H2O. a. Glycerol phosphate. 12. The serum of a freshly drawn blood sample is slightly turbid. This is probably because: a. Triglycerides only are increased. b. Cholesterol only is increased. c. Both are increased 13. In uncontrolled diabetes mellitus, cholesterol and triglycerides are: a. Increased. b. Decreased. c. Not affected. d. Neither is increased 14. The BORDERLINE range for cholesterol levels as determined by NCEP is: a. below 200 mg/dL. b. 200240 mg/dL. c. over 240 mg/dL. d. over 300 mg/dL. 15. Select the desirable cutoff for serum LDL cholesterol recommended by the National Cholesterol Education Program. a. 80 mg/dL b. 100 mg/dL c. 150 mg/dL d. 200 mg/dL 16. Which of the following test combinations indicates the HIGHEST risk for coronary heart disease? a. Increased total cholesterol, increased HDL cholesterol b. Increased total cholesterol, decreased HDL cholesterol c. Decreased total cholesterol, decreased HDL cholesterol c. Decreased total cholesterol, increased HDL cholesterol 17. A 52-year-old man went to his doctor for a physical examination. The patient was overweight and had missed his last two appointments because of business dealings. His blood pressure was elevated, his cholesterol was 250 mg/dL, and his triglyceride was 170 mg/dL. A high-density lipoprotein (HDL) cholesterol test was performed and the result was 30 mg/dL (2060 mg/dL). Which of the following would be this patients calculated low-density lipoprotein (LDL) cholesterol value? a. 157 mg/dL b. 186 mg/dL c. 200 mg/dL d. Cannot be determined from the information given 18. Which apolipoprotein has the ability to INCREASE the risk of coronary heart disease? a. Apo A1 b. Apo B100 c. Apo B48 d. Apo E11 19. The Friedwald formula for estimating LDL cholesterol should NOT be used when: a. HDL cholesterol is greater than 40 mg/dL. b. Triglyceride is greater than 400 mg/dL. c. Plasma shows no visible evidence of lipemia. d. Total cholesterol is elevated based on the age and sex of the patient. 20. HDL cholesterol + LDL cholesterol + chylomicrons HDL. Which is NOT used as a precipitating reagent for determining cholesterol? a. Heparin-manganese chloride b. Dextran-sulfate-Mn (II) c. Phosphotungstate-Mn (II) d. Sulfosalicylic acid 21. Which of the below is a group of interrelated metabolic risk factors that appear to directly promote the development of atherosclerotic cardiovascular disease? a. Metabolic syndrome b. Hypercholesterolemia c. Syndrome B d. Familial hypercholesterolemia 22. Risk factors for coronary heart disease include all of the following EXCEPT: a. Diabetes mellitus. b. Other forms of atherosclerotic disease. c. Hypertension. d. High HDL cholesterol. 23. The National Cholesterol Education Program ATP III goal for desirable HDL cholesterol is: a. < 100 mg/dL. b. 60 mg/dL. c. < 200 mg/dL. d. > 40 mg/dL.
24. The following are criteria for Clinical Diagnosis of Metabolic Syndrome EXCEPT:
a. Elevated waist circumference.
b. Elevated triglycerides.
c. Reduced HDL-C.
d. Low fasting glucose.
25. Secondary causes of elevated LDL include all of the following EXCEPT:
b. Chronic renal failure.
c. Obstructive liver disease.
Chapter 7 Answer Key
Chapter 8 Proteins
1. The chemical bonds between amino acids in the primary structure of proteins are:
a. Hydrogen bonds.
b. Disulfide bonds.
c. Peptide bonds.
d. Hydrophilic bonds.
2. Protein is approximately _______ nitrogen.
3. The structure of a protein that is determined by the sequence of amino acids in the polypeptide chain is the:
a. Primary structure.
b. Secondary structure.
c. Tertiary structure.
d. Quaternary structure.
4. The common ingredients of all biuret reagents are:
a. Sodium potassium tartrate, copper sulfate, and sodium hydroxide.
b. Sodium tungstate and sulfuric acid.
c. Copper sulfate and NaOH.
d. Ammonium sulfate and sodium hydroxide.
5. Hyperalbuminemia is caused by:
a. Dehydration syndromes.
b. Liver disease.
6. Bromcresol Green (BCG) may be used in the dye-binding assay of:
7. In agarose gel electrophoresis of human serum at pH 8.6, the slowest moving fraction is:
a. -1 globulin.
c. -2 globulin.
8. High serum total protein but low albumin is usually seen in:
a. Multiple myeloma.
b. Hepatic cirrhosis.
d. Nephrotic syndrome.
9. Which of the following serum proteins migrates with the beta globulins on cellulose acetate at pH 8.6?
10. Absence of a large decrease in the -1 globulin peak in a serum electrophoresis pattern suggests:
a. Transferrin deficiency.
b. 1-antitrypsin deficiency.
c. Nephrotic syndrome.
d. Chronic inflammation.
11. A protein that is increased or normal in nephrotic syndrome is:
12. The principal protein for transport of iron from the intestine to the liver, bone marrow, or spleen for storage is:
13. Ceruloplasmin is an 2-globulin that contains:
14. Myeloma (Bence Jones) protein is MOST often found electrophoretically in the area of:
a. Albumin or 1-globulins.
c. or globulins.
d. 1-or 2-globulins.
15. A decrease in this protein will result in an emphysema-like condition.
16. In an Acute Phase Reaction (M.I., etc.), there is a(n):
a. Decrease in albumin, increase in 1-globulin, 2-globulin, and 3-globulin.
b. Intense band in 1-globulin, increase in albumin.
c. Marked decrease in -globulin.
d. Marked increase in immunoglobulin A.
e. Increase in 2-globulin.
17. Which of the following conditions is usually associated with an acute inflammatory pattern?
a. Myocardial infarction
b. Rheumatoid arthritis
18. Marys total protein is 7.5 g/dL and her albumin is 4.2 g/dL. What is her A/G ratio?
19. Which protein band comprises 25% of the relative protein?
20. What is the clinical significance of testing for Transthyretin?
a. High levels are associated with an acute phase reaction
b. Levels are associated with glomerular injury in diabetic nephropathy
c. Low levels indicate compromised nutritional status
d. Low levels are associated with increased free cortisol
21. Which is the most abundant -globulin?
22. Bill has a total protein of 7.5 g/dL and his protein electrophoresis reports a 12% -globulin. What is his -globulin level in g/dL?
a. 0.6 g/L
b. 0.9 g/L
c. 1.2 g/L
d. 1.5 g/L
23. Which condition is associated with fusion of the - bridging?
b. Acute pancreatitis
c. Myocardial infarction
d. Nephrotic syndrome
24. Which of the following conditions is associated with an elevated total protein?
b. Glomerular disease
25. Which of the following proteins is part of the coagulation cascade?
Chapter 8 Answer Key
Chapter 9 Enzymes
1. Zero order kinetics results:
a. When there are equal amounts of enzyme and substrate present.
b. When there is more enzyme than substrate present.
c. When all of the available sites on the enzyme are saturated with substrate.
d. When none of the available sites are saturated with substrate.
2. The protein part of the enzyme molecule WITH the cofactor is called a(n):
3. Ligases are a class of enzymes that catalyze:
a. Oxidation-reduction reactions.
b. The transfer of groups.
c. The removal of groups without the addition of water.
d. The coupling of two molecules with the use of ATP.
4. Enzymes that catalyze the transfer of groups other than hydrogen between compounds are classified as belonging to which enzyme class?
5. Many enzymes in the blood plasma show maximum activity in which of the following pH ranges?
a. 4 to 5
b. 6 to 7
c. 7 to 8
d. 8 to 9
6. In competitive inhibition of an enzyme reaction:
a. The inhibitor binds to the enzyme at the same site as does the substrate.
b. The inhibitor often has a chemical structure different than the substrate.
c. Activity of the reaction can be decreased by increasing the concentration of the substrate.
d. Activity of the reaction can be increased by decreasing the temperature.
7. The indicator reaction (what is actually measured) in Oliver-Rosalki is:
a. Adenylate kinase.
b. Pyruvate kinase.
c. Lactate dehydrogenase.
d. The reduction of NADP+.
8. Although a total lactate dehydrogenase (LD) determination performed alone yields little information as to the area of tissue destruction, an electrophoretic separation of LD isoenzyme may be useful. With what disorder is an increase in LD-5 and LD-4 associated?
a. Acute hepatic disease
b. Acute myocardial infarction
c. Pulmonary infarction
9. Aspartate aminotransferase is elevated in diseases involving the:
a. Renal cortex.
b. Heart muscle.
c. Intestinal epithelium.
d. Acinar cells of the pancreas.
10. Malate dehydrogenase (MD) is used in the aspartate transferase reaction mixture to convert:
a. L-glutamate to alpha oxoglutarate.
b. L-glutamate to L-aspartate.
c. L-malate to L-glutamate.
d. Oxaloacetate to L-malate.
11. In which liver disease is the DeRitis ratio (AST: ALT) usually less than or equal to 1?
a. Acute viral hepatitis
c. Alcoholic hepatitis
d. All of the above
12. The highest levels of alkaline phosphatase are seen in:
a. Obstructive liver disease.
c. Renal failure.
d. Myocardial infarction.
13. Which of the following would NOT show an increase in alkaline phosphatase?
a. Obstructive liver disease (hepatobiliary) rickets
c. Hemolytic anemia
14. The most sensitive indicator of alcoholic liver disease is:
15. Which of the following are the most common cause(s) of acute pancreatitis?
a. Gallstones or obstructing tumor
b. Abdominal trauma
c. Acute alcohol ingestion or drug use
d. Chronic alcohol use
e. A and C
16. Serum lipase catalyzes:
a. Hydrolysis of triglyceride to fatty acids and glycerol.
b. Hydrolysis of triglyceride to fatty acids and water.
c. Synthesis of triglyceride from fatty acids and water.
d. Synthesis of triglyceride from fatty acids and glycerol.
17. A substrate used in lipase reactions is:
b. -nitrophenyl phosphate.
c. Olive oil emulsion.
d. Creatine phosphate.
18. The best test for pancreatitis in the presence of mumps is:
a. Virus isolation.
b. A serologic test for mumps.
c. A urine amylase test.
d. A serum lipase test.
19. Serum chemistry results on a 53-year-old female are
AST: 120 U/L (434U/L)
ALT: 185 U/L (540 U/L)
ALP: 785 U/L (<165 U/L) GT: 225 U/L (524 U/L) Total Bilirubin: 10.8 mg/dL Direct Bilirubin: 8.6 mg/dL urine bilirubin: positive urine urobilinogen: Normal fecal urobilinogen: decreased These results are consistent with a diagnosis of: a. Hemolytic anemia. b. Hepatitis. c. Dubin-Johnson. d. Biliary obstruction. 20. Mrs. Smith has the following chemistry results: CK: moderately increased LD: moderately increased LD-1 : increased The probable diagnosis is: a. Myocardial infarction. b. Acute pancreatitis. c. Acute hepatitis. d. Cholecystitis. 21. A patient's CK-MB is reported as 18 g/L and the total CK is 560 IU/L. What is the CK relative index (CKI)? a. 0.10% b. 3.2% c. 10.0% d. 30.0% 22. The prostatic fraction of acid phosphatase is inhibited by: a. Acetic acid. b. Citric acid. c. Sodium nitrite. d. Tartrate. 23. Which of the following sets of results would be consistent with macroamylosemia? a. Normal serum amylase and elevated urine amylase values b. Increased serum amylase and normal urine amylase values c. Increased serum and urine amylase d. Normal serum and urine amylase values 24. Cholinesterase catalyzes the conversion of: a. Choline to lecithin. b. Acetylcholine to choline and acetic acid. c. Choline to NH4+ and PO43. d. -glycerophosphate to glycerol and PO43. e. -glycerophosphate to choline phosphate. 25. Levels of this enzyme are useful in the diagnosis of a genetic defect, which leads to increased apnea (difficulty breathing) after surgery using succinyl choline. a. Cholinesterase b. Aldolase c. Leucine aminopeptidase d. 5' nucleotidase e. Acid phosphatase Chapter 9 Answer Key 1. C 2. C 3. D 4. D 5. C 6. A 7. D 8. A 9. B 10. D 11. A 12. A 13. D 14. C 15. E 16. A 17. C 18. D 19. D 20. A 21. B 22. D 23. B 24. B 25. A Chapter 10 Tumor Markers 1. In which of the following disorders would the maternal serum level of 1-fetoprotein be elevated? A. Neural tube defect. B. Cardiac ischemia. C. Down syndrome. D. Small cell lung carcinoma. 2. Which of the following is FALSE about PSA? A. It is a single-chain glycoprotein B. It is used as a tumor marker C. It is not elevated in benign prostatic hyperplasia D. It is quantified in serum by immunoassays 3. Which of the following biomarkers is elevated in nonmucinous epithelial ovarian cancer? A. CA 15-3 B. CA 19-9 C. CA 125 D. CEA 4. Which of the following is a sialylated Lewis blood group antigen associated with colorectal cancer? A. CA 125 B. CA 15-3 C. PSA D. CA 19-9 5. Which of the following biomarkers are elevated in advanced stages of breast cancer? A. Total and free PSA B. CEA and alpha-fetoprotein C. CA 15-3 and CA 549 D. DUPAN-2 and Gastrin 6. Which tumor marker is associated with cancer of the urinary bladder? A. CA 125 B. CA19-9 C. CA 50 D. Nuclear matrix protein 7. What is the primary clinical usefulness of measuring carcinoembryonic antigen?A. Diagnosis of lung cancer B. Diagnosis of colorectal cancer C. Screening for breast cancer D. Monitoring for recurrence of colon cancer 8. Which of the following is used to assess the usefulness of trastuzumab (Herceptin) therapy for breast cancer? A. CA 15-3 B. HER-2/neu C. CA 125 D. Prolactin 9. Which type of hCG test would be most useful to assess a person suspected of having testicular cancer? A. Plasma immunoassay for intact hCG and the -hCG subunits B. Plasma immunoassay fro the free alpha and -hCG subunits C. Urine assay for hCG- core D. Plasma immunoassay for intact hCG only 10. A markedly elevated serum AFP is associated with which of the following? A. Ovarian cancer B. Lung cancer C. Hepatoma D. Breast cancer 11. Which of the following assays is recommended as a screening test for colorectal cancer in persons over 50 years of age? A. Fecal typsin B. AFP C. BTA D. Occult blood t test 12. Which of the following must be determined to calculate diagnostic specificity? A. True-negatives and false-positives B. True-positives and false-positives C. True-positives and false-negatives D. True-negatives and false-negatives 13. A new tumor marker assay for prostate specific antigen (PSA) is evaluated for sensitivity by testing serum samples from patients who have been diagnosed as having prostate cancer. The following results were obtained: Number of prostate cancer patients who tested positive by the new assay = 42 out 46 Number of patients who did not have cancer and tested negative by the new assay = 31 out of 32 What is the sensitivity of the new assay for PSA? A. 98.0% B. 95.0% C. 91.3% D. 88.5% 14. Which statement below best describes the molecular difference between free PSA (fPSA) and complex PSA (cPSA)? A. Free PSA is bound by compounds such as ACT, PCI, API, or AMG B. Free PSA is an active form that can complex with protease inhibitors C. Free PSA is not bound by compounds such as ACT, PCI, API, or AMG D. Free PSA cannot be detected in serum, whereas complex PSA can 15. The production of alpha fetal protein (AFP) in a healthy individual is best reflected by which of the following statements? A. The production of AFP remains the same through life B. The production of AFP declines rapidly at birth and healthy adults and children have negligible or undetectable levels in serum C. The production of AFP declines rapidly at birth and healthy adults and children have higher than normal levels in serum D. The production of AFP declines rapidly at birth and healthy adults and children have negligible or undetectable levels in serum 16. The combination of squamous cell carcinoma antigen (SCCA) and CYFRA 21-1 test results can be used to provide reliable laboratory data for the differential diagnosis of which disease? A. Nonsquamous cell lung carcinoma B. Pancreatic cancer C. Liver cancer D. Pulmonary embolism 17. A new test for breast cancer is found to have a sensitivity of 85.0% and a specificity of 90.0%. If the prevalence of breast cancer is 3.5% in women over 45 years old, what is the predictive value of a positive test result (PV+) in this group? A. 60.0 B. 50.5 C. 30.0 D. 23.6 18. Nuclear matrix protein-22 (NMP) is a tumor marker designed for what purpose? A. Test for recurrence of bladder cancer B. Test for recurrence of lung cancer C. Test for recurrence of bone cancer D. Test for recurrence of colorectal cancer 19. Which molecular form(s) is/are measured by an intact -hCG assay? A. hCG core and nicked hCG or hCGn B. The whole molecule C. Only nicked hCG or hCGn D. -hCG and free -hCG subunits 20. Diagnostic specificity is defined as which of the following? A. The probability that a laboratory test will be positive in the absence of disease B. The probability that a laboratory test will be negative in the absence of disease C. A measure of how often the assay system detects the biomarker when the disease is present D. The probability that a disease is present when the test is positive or that a disease is absent when a test is negative Chapter 10 Answer Key 1. A 2. C 3. C 4. D 5. C 6. D 7. D 8. B 9. A 10. C 11. D 12. A 13. C 14. C 15. D 16. A 17. D 18. A 19. B 20. B Chapter 11 Nonprotein Nitrogen Questions 1. Which of the following is NOT an NPN substance? a. Urea b. Ammonia c. Creatinine d. Troponin T 2. Urea/BUN is produced from: a. The catabolism of proteins and amino acids. b. Oxidation of purines. c. Oxidation of pyrimidines. d. The breakdown of complex carbohydrates. 3. An elevated BUN usually indicates: a. Liver disease. b. Kidney disease. c. Pancreatic disease. d. Myocardial infarction. 4. BUN is increased with: a. A high protein diet. b. A low protein diet. c. A high carbohydrate diet. d. It is not affected by diet 5. In the Berthelot method, BUN is measured by reaction with: a. Sodium hydroxide and arsenomolybdate. b. Dinitrophenylhydrazine. c. Phenol and sodium hypochlorite. d. Dinitrocarbazone. 6. Urea can be measured by incubation with urease followed by all of the following EXCEPT: a. Formation of a colored product by reaction with diacetyl. b. Measurement of increased conductivity. c. Ion-selective electrode measurement of the ammonia produced. d. NADH consumption in a reaction catalyzed by glutamate dehydrogenase. 7. Normal values for urea are generally expressed as urea nitrogen. If it is necessary to convert urea nitrogen values to urea, the concentration may be calculated easily by multiplying the urea nitrogen value by: a. 0.47. b. 1.47. c. 2.14. d. 28. e. 60. 8. A BUN of 10 mg/dL is obtained by a technologist. What is the urea concentration? a. 25.0 mg/dL b. 21.4 mg/dL c. 18.4 mg/dL d. 9.3 mg/dL 9. Renal azotemia is found in: a. Advanced cirrhosis. b. High protein diets. c. Nephrotic syndrome. d. Dehydration. 10. Prerenal hyperuricemia is caused by: a. Dehydration. b. Uremia. c. Bladder tumors. d. Prostatic hypertrophy. 11. Creatinine is formed from the: a. Oxidation of creatine. b. Oxidation of protein. c. Deamination of dibasic amino acids. d. Metabolism of purines. 12. Creatinine reacts with strong alkaline picrate to form a yellow-red compound. This reaction is: a. Nesslers reaction. b. Ehrlichs diazo reaction. c. Jaffe reaction. d. Lieberman-Burchard reaction. 13. Creatinine levels are usually: a. 0.10.6 mg/dL. b. 0.81.2 mg/dL. c. 1.52.5 mg/dL. d. 3.05.0 mg/dL. 14. Creatinine would be increased in which of the following? a. Reyes syndrome b. Myocardial infarction c. Muscular dystrophy d. Hepatitis 15. Serum urea nitrogen and serum creatinine determinations are frequently requested together so that their ratio may be evaluated. What is the range of the normal ratio of urea nitrogen to creatinine? a. 1/1 and 10/1 b. 12/1 and 20/1 c. 15/1 and 20/1 d. 20/1 and 30/1 e. 25/1 and 30/1 16. A high BUN/creatinine ratio with an elevated creatinine is usually seen in: a. Liver disease. b. Low protein intake. c. Tubular necrosis. d. Postrenal azotemia. 17. A technologist obtains a BUN value of 61 mg/dL and serum creatinine value of 3.5 mg/dL on a patient. The BUN/Creatinine ratio indicates: a. Renal failure. b. Liver failure. c. Gout. d. Prerenal failure. 18. Increased uric acid is found in each of the f
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