Clinical Chemistry - Bishop WITH Answers

Clinical Chemistry 1 (University of Perpetual Help System

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 CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP
ANALYTIC TECHNIQUES b. A nonpolar mobile phase and polar stationary
phase
1. Which of the following is not necessary for c. Distribution between two liquid phases d. Size
obtaining used to separate solutes instead of charge
the spectrum of a compound from 190 to 500 nm? e. Charge used to separate solutes instead of size
a. Tungsten light source
b. Deuterium light source 9. Which of the following is not an advantage of CE?
c. Double-beam spectrophotometer a. Multiple samples can be assayed simultaneously
d. Quartz cuvettes on one injection
e. Photomultiplier b. Very small sample size
c. Rapid analysis
2. Stray light in a spectrophotometer places limits on d. Use of traditional detectors
a. Upper range of linearity e. Cations, neutrals, and anions move in the same
b. Sensitivity direction at different rates
c. Photometric accuracy below 0.1 absorbance
units 10. Tandem mass spectrometers
d. Ability to measure in the UV range a. Are two mass spectrometers placed in series
e. Use of a grating monochromator with each other
b. Are two mass spectrometers placed in parallel
3. Which of the following light sources is used in with each other
atomic absorption spectrophotometry? a. c. Require use of a gas chromatograph d.
Hollow-cathode lamp Require use of an electrospray interface e.
b. Xenon arc lamp Do not require an ionization source
c. Tungsten light
d. Deuterium lamp 11. Which of the following is false concerning the
e. Laser principles of point-of-care testing devices? a. Devices
do not require quality control testing. b. They use
4. Which of the following is true concerning principles that are identical to laboratory- based
fluorometry? instrumentation.
a. Fluorescence is an inherently more sensitive c. Biosensors have enabled miniaturization
technique than absorption. particularly amendable for point-of-care testing. d.
b. Emission wavelengths are always set at lower Onboard microcomputers control instrument
wavelengths than excitation. functions and data reduction.
c. The detector is always placed at right angles to e. Whole blood analysis is the preferred specimen.
the excitation beam.
d. All compounds undergo fluorescence. e. 12. Which is the most sensitive detector for
Fluorometers require special detectors. spectrophotometry?
a. Photomultiplier
5. Which of the following techniques has the b. Phototube
highest c. Electron multiplier
potential sensitivity? d. Photodiode array
a. Chemiluminescence e. All are equally sensitive
b. Fluorescence
c. Turbidimetry 13. Which of the following is Beer’s law? a.
d. Nephelometry A=e×bc
e. Phosphorescence ×
b. %T = I/I0 × 100
6. Which electrochemical assay measures current at c. E = hν
fixed potential? d. e = ΔpH × 0.59 V
a. Amperometry e. Osmolality = j × n × C
b. Anodic stripping voltammetry
c. Coulometry 14. Which of the following correctly ranks
d. Analysis with ISEs electromagnetic
e. Electrophoresis radiation from low energy to high energy? a.
Microwaves, infrared, visible, UV, x-rays,
7. Which of the following refers to the movement of gamma, cosmic
buffer ions and solvent relative to the fixed b. Cosmic, gamma, x-rays, UV, visible, infrared,
support? microwaves
a. Electroendosmosis c. UV, visible, infrared, microwaves, x-rays,
b. Isoelectric focusing cosmic, gamma
c. Iontophoresis d. UV, visible, infrared, cosmic, gamma,
d. Zone electrophoresis microwaves, x-rays
e. Plasmapheresis e. Visible, UV, infrared, cosmic, gamma,
microwaves, x-rays
8. Reverse-phase liquid chromatography refers to a. A
polar mobile phase and nonpolar stationary phase 15. What is the purpose of the chopper in an
 atomic source
absorption spectrophotometer? c. Correct for the fluctuating sensitivity of the
a. Correct for the amount of light emitted by the detector
flame d. Correct for differences in the aspiration rate of
b. Correct for the fluctuating intensity of the light the sample

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

e. Correct for the presence of stray light
CHROMATOGRAPHY AND MASS SPECTROMETRY
16. Which of the following best describes the
1. Which of the following statements is TRUE? a.
process of fluorescence?
Partition chromatography is most appropriate to
a. Molecules emit a photon at lower energy when
identifying analytes that may be distributed
excited electrons return to the ground state. b.
Atoms emit a photon when the electrons are between two liquid phases.
b. Steric exclusion chromatography is best suited for
excited.
separating analytes based on their solubility in the
c. Molecules emit a photon when the electrons
mobile solvent.
are excited.
c. In liquid–solid chromatography, the stationary
d. Molecules emit a photon at the same energy
phase separates analytes based on size, shape, and
when excited electrons return to the ground
polarity.
state.
d. Ion-exchange chromatography has a resin phase
e. Molecules emit a photon at higher energy when
excited electrons return to the ground state. that is soluble to water and separation of the
mixture is based on magnitude and charge of ionic
17. Which is most accurate concerning ISEs? a. species.
Gas-specific membranes are necessary for The partition coefficient is measured and
oxygen compared with standards in thin layer
and carbon dioxide electrodes. chromatography.
b. The pH electrode uses a solid-state membrane. c.
2. In high-performance thin-layer chromatography
The calcium electrode does not require a reference
(HPTLC), developed bands are compared with
electrode.
reference standard concentrations. Each band is
d. The sodium electrode uses an ion-selective
measured by:
carrier (valinomycin).
a. Mass spectrometer
e. The ISE for urea uses immobilized urease.
b. Densitometer
18. Which of the following regarding MS is false? a. c. Ruler
Mass spectrometers can be used to sequence DNA. d. Buiret protein assay
b. Ions are formed by the bombardment of e. Two-dimensional electrophoresis
electrons.
3. In which of the following components of a
c. Quadrupole and ion trap sectors separate ions
chromatography instrument does selective
according to their mass-to-charge ratio. d. Each
separation of a mixture occur?
chemical compound has a unique mass spectrum.
a. Sample injection port
e. MS detects for gas and liquid chromatography.
b. Column
c. Spectrometer
19. Which of the following is not an objective of
d. Quadrupole
proteomics
e. Mass analyzer
research?
a. Identifying specific gene mutations
4. True or False? In chromatography, the
b. Identifying novel proteins as potential new
stationary
biomarkers for disease
phase is always of a solid matrix.
c. Identifying posttranslational modifications of
a. True
proteins
b. False
d. Understanding the mechanism of diseases e.
Determining which genes are expressed and 5. Mass spectrometry identifies analytes based
which genes are dormant on:
a. Mass to charge ratio
20. Which of the following procedures is not
b. Retention factor
currently or routinely used for point-of-care
c. Density of the band
testing devices?
d. Molecular weight
a. Polymerase chain reaction
e. Solubility in the mobile phase
b. Immunochromatography
c. Biosensors 6. Drugs of abuse are typically measured by: a.
d. Colorimetric detection Thin-layer chromatography
e. Electrochemical detection
b. Liquid/liquid chromatography
c. Gas/liquid chromatography
 d. Steric exclusion chromatography c. Fast turnaround time
e. HPLC d. Expectation of high-quality, accurate results

7. PCR/ESI-TOF has the distinct advantage in 2. Which of the following approaches to analyzer
pathogen automation can use mixing paddles to stir? a.
identification because: Discrete analysis
a. Requires the patient sample to be cultured and b. Centrifugal analysis
then analysis can be performed. c. Continuous flow
b. Can be used directly from patient specimens. c. d. Dry chemistry slide analysis
Uses the protein “finger print” to identify the
pathogen. 3. Which of the following types of analyzers offers
random-access capabilities?
AUTOMATION a. Discrete analyzers
b. Continuous-flow analyzers
1. Which of the following is NOT a driving force for c. Centrifugal analyzers
more automation? d. None of these
a. Increased use of chemistry panels
b. High-volume testing

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e.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

Preparation of the sample
4. All of the following are primary considerations in b. Specimen measurement and delivery c.
the selection of an automated chemistry analyzer Reagent delivery
EXCEPT d. Chemical reaction phase
a. How reagents are added or mixed
b. The cost of consumables 10. Which of the following chemistry analyzers
c. Total instrument cost uses
d. The labor component slides to contain the entire reagent system?
a. Vitros analyzers
5. An example of a modular integrated chemistry/ b. ACA analyzers
immunoassay analyzer would be the c. Synchron analyzers
a. Aeroset d. None of these
b. Dimension Vista 3000T
c. Paramax 11. Reflectance spectrometry uses which of the
d. Vitros following?
a. Luminometer
6. Dwell time refers to the b. Tungsten–halogen lamp
a. Time between initiation of a test and the c. Photomultiplier tube
completion of the analysis d. UV lamp
b. Number of tests an instrument can handle in a e. Thermometer to monitor temperature in
specified time reaction vessel
c. Ability of an instrument to perform a defined
workload in a specified time 12. Modifications in microsampling and reagent
d. None of these dispensing improve which of the following phases in
clinical testing?
7. The first commercial centrifugal analyzer was a. Physician ordering phase
introduced in what year? b. Preanalytical phase
a. 1970 c. Analytical phase
b. 1957 d. Postanalytical phase
c. 1967 e. All of the above phases
d. 1976
13. Bidirectional communication between the
8. All of the following are advantages to chemistry
automation analyzer and the laboratory information system
EXCEPT has had the greatest impact on which of the
a. Correction for deficiencies inherent in following
methodologies phases of clinical testing?
b. Increased number of tests performed c. a. Preanalytical
Minimized labor component b. Analytical
d. Use of small amounts of samples and reagents in c. Postanalytical
comparison to manual procedures d. All of the above
e. None of the above
9. Which of the following steps in automation
generally IMMUNOCHEMICAL TECHNIQUES
remains a manual process in most laboratories? a.
 is best described as: a. An IgA λ monoclonal protein
1. The strength of binding between an antigen b. An IgA λ polyclonal protein
and antibody is related to the: c. IgA biclonal proteins
a. Goodness of fit between the epitope and the d. Cross-reactivity
F(ab)
b. Concentration of antigen and antibody c. 5. In nephelometry, the antigen–antibody
Source of antibody production, because complex
monoclonal formation is enhanced in the presence of:
antibodies bind better a. Polyethylene glycol
d. Specificity of the antibody b. High-ionic-strength saline solution
c. Normal saline
2. In monoclonal antibody production, the d. Complement
specificity of the antibody is determined by the: a.
Sensitized B lymphocytes 6. Which homogeneous immunoassay relies on
b. Myeloma cell line inhibiting
c. Sensitized T lymphocytes the activity of the enzyme label when bound to
d. Selective growth medium antibody reagent to eliminate separating
freelabeled from bound-labeled reagent? a. EMIT
3. Which unlabeled immune precipitation method in
b. CEDIA
gel is used to quantitate a serum protein? c. MEIA
a. Radial immunodiffusion
d. ELISA
b. Double diffusion
c. Counterimmunoelectrophoresis 7. In flow cytometry, the side scatter is related to
d. Immunofixation electrophoresis the:
a. Granularity of the cell
4. In immunofixation electrophoresis, discrete bands b. DNA content of the cell
appear at the same electrophoretic location, one c. Size of the cell
reacted with antihuman IgA (α chain specific) reagent d. Number of cells in G0 and G1
and the other reacted with antihuman λ reagent. This

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

8. You analyze the DNA content on a sample of 2. The three-dimensional spatial configuration of a
breast single polypeptide chain as determined by disulfide
tissue for suspected malignancy using flow linkages, hydrogen bonds, electrostatic attractions,
cytometry and van der Waals forces is referred to as the
and get the following results: DI = 2.5 and % a. Tertiary structure
cells in S phase = 29%. Based on these results b. Primary structure
you c. Secondary structure
can conclude: d. Quaternary structure
a. These results are likely indicative of a
malignant 3. The plasma protein mainly responsible for
maintaining
breast tumor
b. This is normal breast tissue
colloidal osmotic pressure in vivo is
a. Albumin
c. These results are consistent with a mostly
b. Hemoglobin
diploid population
c. Fibrinogen
d. The results are not consistent with one
d. α2-macroglobulin
another; no information is gained
4. A peptide bond is
9. The nucleic acid technique in which RNA is
a. Amino group and carboxyl group bonded to the
converted
alpha-carbon
to cDNA, which is then amplified, is known as:
b. A double carbon bond
a. RT-PCR
c. A tertiary ring of amino group and carboxyl
b. PCR
group bonded to the alpha-carbon
c. RFLP
d. Two amino groups bonded to the alpha-carbon
d. In situ hybridization

5. Nutritional assessment with poor protein

AMINO ACIDS AND PROTEINS caloric status is associated with
1. The acute-phase reactant proteins include all of a. A decreased level of prealbumin
the b. A low level of γ-globulins
following EXCEPT c. An elevated ceruloplasmin concentration d.
a. Transferrin An increased level of α1-fetoprotein
b. α1-antitrypsin
c. Haptoglobin 6. In which of the following conditions would a
d. Fibrinogen Normal level of myoglobin be expected? a.
Multiple myeloma a. Multiple sclerosis
b. Acute myocardial infarction b. Multiple myeloma
c. Renal failure c. Waldenström’s macroglobulinemia
d. Crushing trauma received in a car accident d. Myoglobinemia
An immunofixation protein electrophoresis is
performed 11. When a protein is dissolved in a buffer solution,
on serum from a patient with the most common the pH of which is more alkaline than the pI, and an
type of multiple myeloma. The resulting pattern electric current is passed through the solution, the
revealed protein will act as
a. Monoclonal bands of the IgG type a. An anion and migrate to the anode
b. Oligoclonal bands b. A cation and migrate to the cathode c. An
c. �-γ bridging anion and migrate to the cathode d. An
d. Monoclonal bands of the IgM type uncharged particle and will not move

8. The protein electrophoretic pattern of plasma, 12. High serum total protein with high levels of
as compared with serum, reveals a both albumin and globulins is usually seen in a.
a. Fibrinogen peak between the �- and γ-globulins b. Dehydration
Broad increase in the γ -globulins b. Waldenström’s macroglobulinemia
c. Fibrinogen peak with the α2-globulins d. c. Glomerulonephritis
Decreased albumin peak d. Cirrhosis

9. The following pattern of serum protein 13. In a patient with nephrotic syndrome, the
electrophoresis total protein levels in urine would be:
is obtained: a. Normal.
albumin: decreased b. Lower than normal.
α1- and α2-globulins: increased c. Higher than normal.
γ -globulins: normal d. Similar to levels in CSF total protein levels. e.
This pattern is characteristic of which of the Lower albumin levels and higher levels of IgG.
following
conditions? 14. Isoelectric focusing is the type of
a. Acute inflammation (primary response) b. electrophoresis used to phenotype for α1-
Cirrhosis antitrypsin deficiencies. When the protein is
c. Nephrotic syndrome electrophoresed, it migrates to:
d. Gammopathy a. The site where the pH is the same as its pI. b.
The site where the molecular weight of the
10. Distinct oligoclonal bands in the γ zone on protein correlates with the pI.
CSF c. The site where the protein’s net charge
protein electrophoresis are diagnostic of exceeds the pI.

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

d. The site where the protein’s net charge is less d. Ceruloplasmin
than the pI. e. IgG
e. The site where the gel pore size inhibits further
migration. NONPROTEIN NITROGEN COMPOUNDS
1. Which one of the following is not an NPN
15. A CSF albumin–serum albumin ratio was
substance?
reported
a. Allantoin
at 9.8 in a patient. How is this best interpreted? a.
b. Ammonia
This ratio is in the normal range for the patient. b.
c. Creatinine
The blood–brain barrier may be compromised leading
d. Urea
to increased plasma albumin present in the CSF.
c. There is an analytical error as it is biologically
2. Which compound constitutes nearly half of the
unlikely to achieve this value. NPN substances in the blood?
d. This is diagnostic of fungal meningitis. e.
a. Ammonia
This is diagnostic of multiple sclerosis. b. Creatine
c. Urea
16. Which of the following CSF proteins would be
d. Uric acid
measured when investigating active
demyelination in multiple sclerosis? 3. An urea N result of 9 mg/dL is obtained by a
a. CSF albumin to serum albumin ratio b. technologist. What is the urea concentration? a.
α1-Antitrypsin 3.2 mg/dL
c. Myelin basic protein b. 4.2 mg/dL
c. 18.0 mg/dL
d. 19.3 mg/dL 11. A complete deficiency of hypoxanthine
guanine phosphoribosyltransferase results in
4. Prerenal azotemia is caused by which disease?
a. Acute renal failure a. Lesch-Nyhan syndrome
b. Chronic renal failure b. Modification of diet in renal disease
c. Congestive heart failure c. Maple syrup urine disease
d. Urinary tract obstruction d. Reye’s syndrome
e. Megaloblastic anemia
5. A technologist obtains a urea N value of 61 mg/dL
and a serum creatinine value of 2.5 mg/dL on 12. When calculating creatinine clearance using
apatient. These results indicate the
a. Congestive heart failure MDRD equation, which of the following factors are
b. Dehydration considered?
c. Glomerular nephritis a. Verification that the patient has been fasting b.
d. Urinary tract obstruction Identification of ethnicity
c. Body mass
6. Uric acid is the final product of d. Time of day of blood collection
a. Allantoin metabolism e. Physical workout schedule of the patient
b. Amino acid metabolism
c. Purine metabolism 13. True or False? Serum creatinine levels may be
d. The urea cycle falsely elevated when a patient is taking
cephalosporin.
7. Which one of the listed conditions is not a. True
associated b. False
with elevated plasma uric acid concentration? a.
Allopurinol overtreatment 14. When measuring ammonia blood levels,
b. Gout which of
c. Lesch-Nyhan syndrome the following might cause a false increase in this
Renal disease analyte?
a. The patient had two cigarettes 15 minutes
8. In the Jaffe reaction, a red-orange chromogen is prior to blood draw.
formed when creatinine reacts with b. The patient was fasting for hours prior to blood
a. Aluminum magnesium silicate collection.
b. Creatininase c. Immediately after phlebotomy, the blood
c. Phosphocreatine sample was maintained on ice.
d. Picric acid d. The patient had a steak dinner the night before
the blood draw.
9. Substances known to increase results when e. None of the above will falsely increase the
measuring blood ammonia levels.
creatinine by the Jaffe reaction include all of the
following EXCEPT ENZYMES
a. Ascorbic acid
b. Bilirubin 1. When a reaction is performed in zero-order
c. Glucose kinetics
d. α-Keto acids a. The rate of the reaction is independent of the
substrate concentration
10. Ammonia concentrations are usually b. The substrate concentration is very low c. The
measured to evaluate rate of reaction is directly proportional to the
a. Acid–base status substrate concentration
b. Glomerular filtration d. The enzyme level is always high
c. Hepatic encephalopathy
d. Renal failure

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d.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP Total CK

level that is 1,000 times the ULN
2. Activation energy is temperatures until they reach the point of
a. Decreased by enzymes denaturation at
b. The energy needed for an enzyme reaction to a. 40–60°C
stop b. 25–35°C
c. Increased by enzymes c. 100°C
d. Very high in catalyzed reactions d. 37°C

3. Enzyme reaction rates are increased by 4. An example of using enzymes as reagents in

increasing the
clinical laboratory is c. The serum was not separated from red blood
a. The hexokinase glucose method cells within 1 hour.
b. The diacetyl monoxime blood urea nitrogen d. The patient smoked three cigarettes just prior to
(BUN) method blood collection.
c. The alkaline picrate creatinine method e. The blood sample was not protected from light
d. The biuret total protein method upon collection and during transport to the
laboratory.
5. Activity of enzymes in serum may be
determined ENZYMES
rather than concentration because
a. The amount of enzyme is too low to measure b. 1. Which of the following hormones promotes
The temperature is too high gluconeogenesis?
c. There is not enough substrate a. Growth hormone
d. The amount of enzyme is too high to measure b. Hydrocortisone
c. Insulin
6. The isoenzymes LD-4 and LD-5 are elevated in a. d. Thyroxine
Liver disease
b. Pulmonary embolism 2. Glucose oxidase oxidizes glucose to gluconic
c. Renal disease acid and
d. Myocardial infarction a. H2O2
b. CO2
7. Which CK isoenzyme is elevated in muscle c. HCO3
diseases? d. H2O
a. CK-MM
b. CK-BB 3. From glucose and ATP, hexokinase catalyzes the
c. CK-MB formation of
d. CK-NN a. Acetyl-CoA
b. Fructose-6-phosphate
8. Elevation of serum amylase and lipase is c. Glucose-6-phosphate
commonly seen in d. Lactose
a. Acute pancreatitis
b. Acute appendicitis 4. What is the preferred specimen for glucose
c. Gallbladder disease analysis?
d. Acid reflux disease a. EDTA plasma
b. Fluoride oxalate plasma
9. The saccharogenic method for amylase c. Heparinized plasma
determinations measures d. Serum
a. The amount of product produced
5. Hyperglycemic factor produced by the
b. The amount of substrate consumed c.
pancreas is
The amount of iodine present
a. Epinephrine
d. The amount of starch present
b. Glucagon
10. Elevation of tissue enzymes in serum may be c. Insulin
used to detect d. Growth hormone
a. Tissue necrosis or damage
6. Polarographic methods of glucose assay are
b. Inflammation
based on which principle?
c. Infectious diseases
a. Nonenzymatic oxidation of glucose
d. Diabetes mellitus
b. Rate of oxygen depletion measured c.
11. Which of the following enzyme patterns is Chemiluminescence caused by the formation of ATP
MOST diagnostic of Duchenne-type muscular d. Change in electrical potential as glucose is
dystrophy? oxidized
a. Total CK level that is 5 to 10 times the ULN b.
Total CK level that is 25 times the ULN c. Total CK 7. Select the enzyme that is most specific for �-
d-glucose:
level that is 50 to 100 times the ULN
a. Glucose oxidase
12. Which of the following preanalytical errors b. Glucose-6-phosphate dehydrogenase c.
most Hexokinase
commonly causes false increases in serum d. Phosphohexose isomerase
enzyme
measurements? 8. Select the coupling enzyme used in the
a. The patient was not fasting prior to blood draw. b. hexokinase method for glucose:
The blood sample was not maintained on ice upon a. Glucose dehydrogenase
collection and during transport to the laboratory.
d.

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

b. Glucose-6-phosphatase
c. Glucose-6-phosphate dehydrogenase d.
Peroxidase
16. Urinalysis of a diabetic patient identified the
following:
9. All of the following are characteristic of von
Gierke disease EXCEPT Year 1: Urine albumin was 15 mg/24 h
Year 2: Urine albumin was 56 mg/24 h
a. Hypoglycemia
Year 3: Urine albumin was 156 mg/24 h
b. Hypolipidemia
What do these clinical data suggest?
c. Increased plasma lactate
These levels of albumin in the urine are normal
d. Subnormal response to epinephrine
and no follow-up is necessary.
10. The preferred screening test for diabetes in b. These levels of albumin in the urine suggest that
nonpregnant adults is measurement of a. Fasting kidney function is compromised and follow up is
plasma glucose necessary.
b. Random plasma glucose c. As these values of urinary albumin are not greater
c. Glycohemoglobin than 300 mg/24 h, the patient is not likely to have
d. Depends on the patient factors compromised kidney function. d. An additional
urinary albumin test is required in Year 4 to verify
11. Following the 2012 ADA guidelines, the times of diminishing kidney function.
measurement for plasma glucose levels during an
OGTT in nonpregnant patients are a. Fasting, 1 LIPIDS AND LIPOPROTEINS
hour, and 2 hours
1. Which of the following methods for lipoprotein
b. Fasting and 60 minutes
electrophoresis depends on charge and molecular
c. 30, 60, 90, and 120 minutes
size?
d. Fasting, 30, 60, 90, and 120 minutes.
a. Polyacrylamide gel
12. Monitoring the levels of ketone bodies in the b. Paper
urine via nitroprusside reagents provides a semi c. Cellulose acetate
quantitative measure of d. Agarose
a. Acetoacetate
2. Which of the following statements concerning
b. 3-�-Hydroxybutyrate
chylomicrons is FALSE?
c. Acetone
a. The major lipid transported by this lipoprotein is
d. All three ketone bodies
cholesterol.
13. A factor, other than average plasma glucose b. This lipoprotein is produced in the intestinal
values, mucosa.
that can affect the HbA1c level is c. The primary function is to carry dietary
a. Serum ketone bodies level (exogenous) lipids to the liver.
b. Red blood cell life span d. It remains at the origin (point of application)
c. Ascorbic acid intake during lipoprotein electrophoresis.
d. Increased triglyceride levels
3. The lipoprotein that contains the greatest
14. Monitoring the levels of ketone bodies in the amount of protein is called
urine is a. HDL
a. Considered essential on a daily basis for all b. Chylomicrons
diabetic patients c. VLDL
b. A reliable method of assessing long-term d. LDL
glycemic control
4. True or False? Pre-beta (VLDL) lipoproteins
c. Recommended for patients with type 1
migrate further toward the anode on
diabetes on sick days
polyacrylamide gel than they do on cellulose
d. Not recommended by the ADA
acetate or agarose.
15. A urinalysis identifies a positive result for a. True
reducing sugars, yet the test for glucose (glucose b. False
oxidase reaction) was negative on the dipstick. What
do these results suggest? 5. Several enzymatic triglyceride methods
a. This is commonly observed with ascorbic acid
measure
interference. the production or consumption of
b. This may suggest the patient has a deficiency in a. NADH
b. Fatty acids
galactose-1-phosphate uridyl transferase. c. This
may suggest a pancreatic beta cell tumor. d. This c. Glycerol
may suggest a deficiency in glycogen debrancher d. Diacetyl lutidine
enzyme.
6. The most likely cause for serum/plasma to
e. It is not possible to obtain these results and
appear
there is an analytic error in testing.
“milky” is the presence of
a. Chylomicrons
b. VLDL
c. LDL
 d. HDL c. NAD
d. Phenol
7. In the colorimetric determination of cholesterol
using the enzyme cholesterol oxidase, the agent that 8. Which lipoprotein is the major carrier of
oxidizes the colorless organic compound 4- cholesterol to peripheral tissue?
aminoantipyrine to a pink complex is a. LDL
a. Hydrogen peroxide b. Chylomicrons
b. Cholest-4-ene-3-one
a.

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

c. VLDL
d. HDL The best explanation for these results would be
that the
9. True or false? Increased levels of apo A-I are patient exhibits a phenotype indicative of
associated a. Type IV hyperlipoproteinemia
with increased risk of CAD. b. Type I hyperlipoproteinemia
a. True c. Type II hyperlipoproteinemia
b. False d. Type III hyperlipoproteinemia
e. Type V hyperlipoproteinemia
10. A patient is admitted to the hospital with
intense 13. Which of the following results is the most
chest pains. The patient’s primary care physician consistent
requests the emergency department doctor to order with high risk of CHD?
several tests, including a lipid profile with a. 20 mg/dL HDL-C and 250 mg/dL total
cholesterol fractionation. Given the patient’s results cholesterol
provided below, what would be the LDL-C for this b. 35 mg/dL HDL-C and 200 mg/dL total
patient? cholesterol
Total cholesterol = 400 mg/dL; triglycerides = c. 50 mg/dL HDL-C and 190 mg/dL total
300 mg/dL; cholesterol
HDL-C = 100 mg/dL; LP electrophoresis, pending a. d.
240 mg/dL 55 mg/dL HDL-C and 180 mg/dL total
b. 160 mg/dL cholesterol
c. 200 mg/dL e. 60 mg/dL HDL-C and 170 mg/dL
d. 300 mg/dL totalcholesterol

11. A patient is admitted to the hospital with 14. What is the presumed defect in most cases of
intense chest pains. The patient’s primary care familial type IIa hyperlipoproteinemia? a. Defective
physician requests the emergency department receptors for LDL
doctor to order several tests, including a lipid b. Deficiency of hydroxymethylglutaryl (HMG)-
profile with cholesterol fractionation. Given the CoA reductase
patient’s results provided below, what would be c. Deficiency of cholesterol esterase
this patient’s LDL-C status? d. Deficiency of LPL
Total cholesterol = 400 mg/dL; triglycerides = e. Defective esterifying enzymes LCAT and ACAT
300 mg/
dL; HDL-C = 100 mg/dL; LP electrophoresis, 15. Hyperchylomicronemia (type I) in childhood
pending has
a. High been associated with which of the following? a.
b. Optimal A deficiency of apo C-II
c. Desirable b. A deficiency of LCAT
d. Borderline c. A deficiency of LPL
d. A deficiency of apo A-I
12. As part of a lipoprotein phenotyping, it is
necessary to perform total cholesterol and ELECTROLYTES
triglyceride determinations, as well as lipoprotein
electrophoresis. 1. What is the major intracellular cation?
The test results obtained from such studies were • a. Potassium
Triglyceride, 340 mg/dL (reference range, <150 b. Calcium
mg/dL) c. Magnesium
• Total cholesterol, 180 mg/dL (reference range, d. Sodium
<200 mg/dL)
2. What is the major extracellular cation? a.
• Pre-beta-lipoprotein fraction increased
Sodium
• Beta-lipoprotein fraction normal
b. Chloride
• No chylomicrons present
c. Magnesium
• Serum appearance turbid
d. Calcium
 b. Prolonged vomiting or diarrhea
3. Osmolality can be defined as a measure of the c. Hypomagnesemia
concentration of a solution based on the a. Number d. Hyperaldosteronism
of dissolved particles
b. Number of ionic particles present 6. Hyperkalemia may be caused by each of the
c. Number and size of the dissolved particles d. following
Density of the dissolved particles EXCEPT
a. Alkalosis
4. Hyponatremia may be caused by each of the b. Acute or chronic renal failure
following c. Hypoaldosteronism
EXCEPT d. Sample hemolysis
a. Hypomagnesemia
b. Aldosterone deficiency 7. The main difference between a direct and
c. Prolonged vomiting or diarrhea indirect ISE is
d. Acute or chronic renal failure a. Sample is diluted in the indirect method, not in
the direct method
5. Hypokalemia may be caused by each of the b. The type of membrane that is used c. Direct ISEs
following use a reference electrode, whereas indirect ISEs do
EXCEPT not
a. Acidosis

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

d. Whole blood samples can be measured with d. Tenfold
the direct method and not with the indirect
13. The quantitative relationship between
method
changes in blood osmolality and the normal
8. Which method of analysis will provide the most expected response by ADH is best described as
accurate electrolyte results if a grossly lipemic a(n):
sample is used? a. Indirect relationship
a. Direct ISE b. Direct relationship
b. Indirect ISE c. Logarithmic relationship
c. Flame emission photometry d. There is no quantitative relationship
d. Atomic absorption
14. The sample of choice for measuring blood
osmolality is:
9. The most frequent cause of hypermagnesemia is a. Serum
due to b. Plasma
a. Renal failure c. Whole blood
b. Increased intake of magnesium d. Serum or plasma may both be used
c. Hypoaldosteronism
d. Acidosis 15. With increased water loss, burn patients are
most likely to also experience:
10. A hemolyzed sample will cause falsely a. Hypernatremia
increased b. Hyponatremia
levels of each of the following EXCEPT c. Hypomagnesemia
a. Sodium d. Hypoosmolality
b. Potassium
c. Phosphate 16. Which plasma electrolyte has the most narrow
d. Magnesium
reference range and is MOST strictly regulated by the
body?
11. The largest portion of total body water is a. Sodium
found in which tissue? b. Magnesium
a. Intracellular fluid c. Calcium
b. Extracellular fluid Chloride e.
c. Intravascular extracellular fluid Potassium
d. Interstitial cell fluid
e. Plasma 17. True or False? Red blood cells are key for
oxygen
12. Osmoreceptors in the hypothalamus are key to transport, carbon dioxide transport, and
regulating blood osmolality. Typically, a 1% to 2% maintaining
shift in osmolality causes a change in circulating electroneutrality in the blood.
concentration of ADH. a. True
a. Twofold b. False
b. Fourfold
c. Eightfold BLOOD GASES, pH, AND BUFFER SYSTEMS
 bicarbonate in
1. The presence of dyshemoglobins will cause a arterial blood is
calculated % SO2 result to be falsely (elevated, a. 1:20
decreased) and a pulse oximeter % Spo2 value to b. 7.4:6.1
be falsely (elevated, decreased). c. 0.003:1.39
a. Elevated, elevated d. 20:1
b. Decreased, decreased
c. Elevated, decreased 6. When arterial blood from a normal patient is
d. Decreased, elevated exposed to room air:
a. pco2 increases; po2 decreases
2. The anticoagulant of choice for arterial blood b. pco2 decreases; po2 increases
gas c. pco2 decreases; po2 decreases
measurements is in the state. a. Lithium d. pco2 increases; po2 increases
heparin; dry
b. EDTA; dry 7. A patient’s arterial blood gas results are as
c. Potassium oxalate; liquid follows:
d. Sodium citrate; dry pH 7.37; pco2, 75 mm Hg; HCO3–, 37 mmol/L.
These values are consistent with
3. At a pH of 7.10, the H+ concentration is equal to a. Compensated respiratory acidosis
a. 80 nmol/L b. Compensated nonrespiratory acidosis c.
b. 20 nmol/L Uncompensated respiratory alkalosis d.
c. 40 nmol/L Uncompensated nonrespiratory alkalosis
d. 60 nmol/L
8. A patient’s arterial blood gas results are as
4. The kidneys compensate for respiratory alkalosis follows:
by (excretion, retention) of bicarbonate and pH 7.48; pco2, 54 mm Hg; HCO3–, 38 mmol/L.
(increased, decreased) excretion of NaH2PO4. a. These values are consistent with
Excretion, decreased a. Compensated nonrespiratory alkalosis b.
b. Excretion, increased Compensated respiratory alkalosis
c. Retention, increased
d. Retention, decreased

5. The normal ratio of carbonic acid to

d.

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

c. Uncompensated respiratory alkalosis d. b. Apparent pKa of carbonic acid, 6.1, plus the
Uncompensated nonrespiratory alkalosis pco2 value in mmHg
c. pco2 value in mm Hg plus HCO3 – value in mm
9. In the circulatory system, bicarbonate leaves Hg
the d. Bicarbonate concentration divided by the pco2
red blood cells and enters the plasma through an value in mm Hg
exchange mechanism with to maintain
electroneutrality. 13. Oxygen content in blood reflects
a. Chloride a. po2 value
b. Carbonic acid b. O 2Hb only
c. Lactate c. O 2 dissolved in blood plasma only
d. Sodium d. The patient’s total hemoglobin value
e. All of these
10. Hypoventilation can compensate for a.
Nonrespiratory acidosis TRACE AND TOXIC ELEMENTS
b. Mixed alkalosis
1. Extreme copper deficiency is seen in what fatal
c. Mixed acidosis
condition?
d. Nonrespiratory alkalosis
a. Menkes disease
11. The hemoglobin oxygen binding capacity for a b. Klinefelter’s syndrome
blood sample that is 100% saturated with O2 and has c. Meese disease
a total hemoglobin value of 12 g/dL is approximately d. Kayser-Fleischer rings
a. 17 mL O2/dL
b. 4 mL O2/dL 2. Suppose the controller on a GFAAS is defective
c. 8 mL O2/dL and the furnace is running cold. What effect will
d. 34 mL O2/dL this likely have on the number of photons absorbed
in the measurements?
12. Carbonic acid concentration in blood plasma a. It will decrease the number of photons
equals absorbed
a. 0.0307 mmol/L/mm Hg times the pco2 value in b. It will increase the number of photons
mm Hg absorbed
c. It will have little effect detection
d. It is not a relevant question because AAS relies on 7. Manganese toxicity resembles the following
emission of light from electronically excited atoms disease:
a. Parkinson’s disease
3. Why would a clinical chemist develop an b. Wilson’s disease
arsenic method that combines liquid c. Alzheimer’s disease
chromatography with ICP-MS? d. Menkes disease
a. To separate and quantitate several different
arsenic-containing species in the same sample b. 8. Iron is physiologically active only in the ferrous
To eliminate interference by sodium from the form in
analysis a. Hemoglobin
To shorten the run time of the measurement d. b. Cytochromes
To lower the coefficient of variation for total c. Ferritin
arsenic measurements d. Transferrin

4. Select the answer that designates three 9. A metal ion required for optimal enzyme
techniques widely used for elemental analysis, activity is best termed a(an)
identified according to the initials for the a. Cofactor
techniques. b. Accelerator
a. AAS, ICP-MS, AES c. Coenzyme
b. NMR, ICP-MS, AES d. Catalyst
c. GC-MS, ICP-MS, AES
d. HPLC-ICP-MS, AAS, FTIR 10. Which trace metal is contained in glucose
tolerance factor?
5. One of the calcium isotopes (40Ca) has an atomic a. Chromium
weight of 40. At what positions in a mass spectrum b. Copper
would singly and doubly charged ions of this isotope c. Selenium
of calcium appear? Assume that singly charged Ca is d. Zinc
listed first.
a. 40 and 20 11. What metal may be used as a treatment for
b. 40 and 60
Wilson’s disease?
a. Zinc
c. 40 and 80
b. Copper
d. 40 and 40
c. Molybdenum
6. What primary purposes does the torch serve in d. Fluorine
ICP-MS?
12. The metal ion essential for the activity of
a. Vaporization, atomization, and ionization b.
Vaporization, atomization, and electronic xanthine oxidase and xanthine dehydrogenase is a.
excitation Molybdenum
c. Nebulization, atomization, and photon b. Iron
absorption c. Zinc
d. Droplet transport, vaporization, and ion d. Manganese

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c.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

PORPHYRIN AND HEMOGLOBIN c. Congenital and acquired
d. Hematologic and muscular
1. The main purpose of porphyrins in the body is to
a. Contribute to the synthesis of heme b. 4. Porphobilinogen is most commonly quantitated in
Carry oxygen to the tissue the urine by
c. Transport iron a. Ion-exchange column
d. Combine with free hemoglobin b. The Watson-Schwartz method
c. Thin-layer chromatography
2. The two main sites in the body for d. Electrophoresis
accumulation of excess porphyrins are a.
Liver and bone marrow 5. Extremely high levels of ALA and PBG in the
b. Heart and lung urine with normal porphyrin levels in the feces
c. Muscle and blood and blood most likely indicate
d. Liver and spleen a. Acute intermittent porphyria (AIP)
b. Erythropoietic porphyria (EP)
3. The two main classes of porphyrias, according to c. Hereditary coproporphyria (HCP)
symptoms, are d. Porphyria cutanea tarda (PCT)
a. Neurologic and cutaneous
b. Erythropoietic and hepatic 6. Inherited disorders in which a genetic defect
causes abnormalities in rate and quantity of alkaline pH)
synthesis of structurally normal polypeptide c. Solubility test
chains of the hemoglobin molecule are called a. d. Complete blood count
Thalassemias
b. Hemoglobinopathies 13. Which is the correct sequence of
c. Porphyrias electrophoretic migration of hemoglobins from
d. Molecular dyscrasias slowest to fastest on cellulose acetate at an
alkaline pH?
7. Increased intravascular hemolysis is indicated by a. C, S, F, A
a decrease in b. C, A, S, F
a. Haptoglobin c. C, S, A, F
b. Methemoglobin d. A, F, S, C
c. Methemalbumin
d. Hemopexin 14. The primary route(s) of excretion for
protoporphyrin
8. Which of the following abnormal hemoglobins, (PROTO), uroporphyrin (URO), and coproporphyrin
found frequently in individuals from Southeast Asia, (COPRO) are
migrates with hemoglobin A2 on cellulose acetate a. URO is excreted primarily in the urine, PROTO in
electrophoresis? the feces, and COPRO in either.
a. Hemoglobin E b. URO is excreted primarily in the feces, PROTO in
b. Hemoglobin D the urine, and COPRO in either.
c. Hemoglobin C c. URO is excreted primarily in the urine, PROTO
d. Hemoglobin Lepore and COPRO in the feces.
d. URO is excreted primarily in the feces, PROTO
9. Which type of alpha-thalassemia results from and COPRO in urine.
deletion
of three genes and produces a moderate 15. Control of the rate of heme synthesis in the
hemolytic liver cells is achieved largely through regulation of
anemia? the enzyme
a. Hemoglobin H disease a. ALA synthase
b. Hemoglobin Bart’s b. ALA dehydratase
c. Hydrops fetalis c. PBG deaminase
d. Thalassemia trait d. Ferrochelatase

10. The most effective way to quantitate 16. The two main sites of production of heme are a.
hemoglobin Liver and bone marrow
A2 is by b. Heart and lung
a. Column chromatography c. Muscle and blood
b. Densitometry d. Liver and spleen
c. Citrate agar electrophoresis
d. Alkali denaturation test 17. The relationship between precursors in the
heme
11. Serum or plasma myoglobin levels are used as synthesis pathway and the type of porphyria
a. An early marker of acute myocardial infarction b. resulting
Liver function tests from excess buildup of these precursors is a.
c. Lead poisoning indicator Excess of early precursors causes neurologic
d. Indicator of congestive heart failure porphyrias and excess of late precursors causes
cutaneous porphyrias.
12. Which of the following is the best test to b. Excess of early precursors causes cutaneous
differentiate porphyrias and excess of late precursors causes
beta-thalassemia minor from iron deficiency neurologic porphyrias.
anemia? c. Excess of early precursors causes both neurologic
a. Hemoglobin A2 quantitation and cutaneous porphyrias, whereas excess of late
b. Hemoglobin electrophoresis (cellulose acetate, precursors causes only cutaneous porphyrias.

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

d. Excess of early precursors causes both a. Urinary ALA and PBG
neurologic and cutaneous porphyrias whereas b. Urinary COPRO and blood lead
excess of late precursors causes only neurologic c. Urinary URO and COPRO
porphyrias. d. Fecal URO and urinary COPRO

18. Secondary porphyrias not due to an inherited 19. Which hemoglobin is resistant to alkali
biochemical defect in heme synthesis can be denaturation in NaOH?
distinguished from true porphyrias by measuring a. Hb F
levels of b. Hb A
c. Hb C b. Growth hormone
d. Hb S c. Vasopressin
d. ACTH
20. A patient has an abnormal hemoglobin band
that 4. The definitive suppression test to prove
migrates with Hb S on cellulose acetate (pH 8.4) autonomous
hemoglobin electrophoresis. The solubility test is production of growth hormone is
negative. What test should be performed next? a. a. Oral glucose loading
Citrate agar (pH 6.2) electrophoresis b. HbA2 b. Somatostatin infusion
quantitation c. Estrogen priming
c. Acid elution stain d. Dexamethasone suppression
d. Blood film evaluation
5. Which of the following is influenced by growth
21. Silent carriers of alpha-thalassemia are hormone?
missing how many alpha genes? a. All of these
a. 1 b. IGF-I
b. 2 c. IGFBP-III
c. 3 d. Lipolysis
d. 4
6. What statement concerning vasopressin
22. Which hemoglobin contains four gamma secretion is NOT true?
chains a. All of these
and has an extremely high affinity for oxygen? a. b. Vasopressin secretion is closely tied to plasma
Hb Barts osmolality.
b. Hb Gower I c. Changes in blood volume also alter vasopressin
c. Hb Portland I secretion.
d. Hb F d. A reduction in effective blood volume overrides
the effects of plasma osmolality in regulating
23. A patient with Southeast Asian heritage is vasopressin secretion.
found
to have a mild microcytic anemia and a few target 7. What are the long-term sequelae of untreated or
cells. Hemoglobin electrophoresis on cellulose partially treated acromegaly?
acetate at pH 8.4 reveals a major band that a. An increased risk of colon and lung cancer b.
migrates with Hb A2 and no HbA. On citrate agar A reduced risk of heart disease
electrophoresis, the band travels in the position of c. Enhanced longevity
Hb A. What is the most probable abnormal d. Increased muscle strength
hemoglobin present?
a. Hb E 8. TRH stimulates the secretion of
b. Hb A a. Prolactin and TSH
c. Hb C b. Prolactin
d. Hb D c. Growth hormone
d. TSH
HYPOTHALAMIC AND PITUITARY FUNCTION
9. Estrogen influences the secretion of which of
1. Open-loop negative feedback refers to the the
Phenomenon of following hormones?
a. Negative feedback with a modifiable set point b. a. All of these
Blood flow in the hypothalamic–hypophyseal portal b. Growth hormone
system c. Prolactin
c. Blood flow to the pituitary via dural-penetrating d. Luteinizing hormone
vessels
d. Negative feedback involving an unvarying, 10. What is the difference between a tropic
fixed set point hormone and a direct effector hormone? a. Tropic
and direct effector hormones are both similar in
2. The specific feedback effector for FSH is that both act directly on peripheral tissue.
a. Inhibin b. Tropic and direct effector hormones are both
b. Activin similar in that both act directly on another
Progesterone endocrine gland.
d. Estradiol c. Tropic hormones act on peripheral tissue while
direct effector hormones act on endocrine glands. d.
3. Which anterior pituitary hormone lacks a Tropic hormones act on endocrine glands while
stimulatory direct effector hormones act on peripheral tissues.
hypophysiotropic hormone?
a. Prolactin

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c.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

11. A deficiency in vasopressin can lead to which of
the 9. The most biologically active androgen in this
following? list is:
a. Euvolemic hypokalemia a. DHEA
b. Euvolemic hyponatremia b. DHEAS
c. Diabetes insipidus c. LH
d. Primary hypothyroidism d. FSH
e. Estrone
ADRENAL FUNCTION
10. Which amino acid is needed for the biosynthesis
1. When considering an endocrine cause for a of norepinephrine and epinephrine? a. Alanine
patient’s b. Phenylalanine
hypertension, the is the usual suspect. c. Isoleucine
ADRENAL GLAND d. Leucine
e. Serine
2. When hypertension results from an endocrine
disorder, what hormonal state is usually found: 11. Which of the following describes
hormone underproduction or overproduction? catecholamines?
OVERPRODUCTION a. Hydrophobic
b. Degraded rapidly in nonneuronal cells by
monamine reductase
3. True or false? Major warning signs of adrenal c. Have long half-lives
disease d. Circulating blood catecholamines are 99%
include abnormal blood pressure, abnormal bound to albumin.
electrolytes (potassium, acid–base status, urine e. None of the above accurately describes
dilution), and unexplained weight change. TRUE catecholamines.

4. is the common substrate from which all adrenal 12. The collection of a 24-hour urine is used for
steroids are produced. measuring:
CHOLESTEROL a. Creatinine clearance
b. Norepinephrine
5. True or false? When produced, free c. Dopamine
catecholamines d. All of the above may be measured in a 24-hour
(NE and EPI) are short-lived. They are best urine
measured in the urine, though catecholamine e. All but one of the above may be measured in a
metabolites are best measured in the serum. 24-hour urine
FALSE
GONADAL FUNCTION
6. is responsible for epinephrine
production. 1. If serum levels of estradiol do not increase
CORTISOL after
injection of hCG, the patient has
7. A primary hyperaldosteronemic state is a. Primary ovarian failure
characterized b. Pituitary failure
by: c. Tertiary ovarian failure
a. A urine potassium of 35 mmol/d. d. Secondary ovarian failure
b. A urine potassium of 21 mmol/d.
c. A spot urine test where the sodium levels are 2. If a patient had a luteal phase defect, which
greater than potassium levels. hormone
d. Within 3 hours of taking 50 mg of captopril, would most likely be deficient?
plasma aldosterone was low. a. Progesterone
e. All of the above are characteristic of b. Estrogen
hypoaldosteronism. c. hCG
d. FSH
e. Prolactin
8. During a low dose (1 mg) dexamethasone
suppression 3. Which of the following is the precursor for
test, total cortisol levels measured in a patient at estradiol
8:35 am was 2.8 μg/dL. How is this interpreted? a. formation in the placenta?
The patient is normal. a. Fetal adrenal DHEAS
b. The patient has Cushings’ syndrome. c. The b. Maternal testosterone
patient has a nonpituitary tumor causing ectopic c. Maternal progesterone
ACTH syndrome. d. Placental hCG
d. The patient has an ACTH-secreting pituitary e. Fetal adrenal cholesterol
adenoma.
 e. Adrenal cortex
4. Which of the following target tissues is
incapable 5. The parent substance in the biosynthesis of
of producing steroidal hormones? Androgens and estrogens is
a. Adrenal medulla a. Cholesterol
b. Placenta b. Cortisol
c. Ovary c. Catecholamines
d. Testis d. Progesterone

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

6. The biologically most active, naturally b. Estrogen
occurring androgen is c. LH
a. DHEA d. FSH
b. Androstenedione e. Estradiol
c. Epiandrosterone
d. Testosterone 13. A midcycle LH surge will stimulate which
series of events?
7. For the past 3 weeks, serum estriol levels in a a. An increase in FSH
pregnant woman have been steadily increasing. b. A decrease in FSH
This is consistent with c. Anovulation
a. A normal pregnancy d. Amenorrhea
b. Hemolytic disease of the newborn e. A decrease in progesterone production
c. Fetal death
d. Congenital cytomegalovirus infection THYROID GLAND

8. Which of the following is secreted by the 1. All of the following statements about iodine are
placenta true EXCEPT
and used for the early detection of pregnancy? a. a. Radioactive iodine treatment of Graves’
hCG disease
b. FSH is effective in less than 40% of patients treated
c. LH with this agent.
d. Progesterone Iodine deficiency is one of the most common
causes of hypothyroidism in the world. c. T4 has
9. Chronic fetal metabolic distress is 4 iodine molecules.
demonstrated by d. RAIU is often useful in determining the cause of
a. Decreased urinary estriol excretion and thyrotoxicosis.
decreased maternal serum estriol
b. Decreased estrogen in maternal plasma and 2. The fetus
increased estriol in amniotic fluid a. Is dependent on thyroid hormone for normal
c. Increased estradiol in maternal plasma, with a neurologic development
corresponding increase of estriol in amniotic fluid d. b. Does not develop a thyroid gland until the
Increased urinary estriol excretion and increased third trimester
maternal serum estriol c. Is not susceptible to damage from radioactive
iodine therapy given to the mother
10. Androgen secretion by the testes is d. Will be born with hypothyroidism in
stimulated by approximately 1 of 400 births in developed
a. LH countries
b. FSH
c. Testosterone 3. The thyroid gland
d. Gonadotropins a. Depends on TPO to permit iodination of the
tyrosyl residues to make MIT and DIT
11. A deficiency in estrogen during the follicular b. Is an ineffective iodine trap
phase c. Depends on TPO to permit the joining of two
will result in: DIT residues to form T3
a. A failure of embryo implantation. d. Usually functions independent of TSH levels
b. An increased length of the menstrual cycle. c.
A lack of Graafian follicle release from the 4. The thyroid gland produces all of the following
ovary. EXCEPT
d. An incomplete development of the a. TSH
endometrium. b. Thyroglobulin
c. T3
12. Which hormone is responsible for an increase in d. T4
body temperature at the time of ovulation? a.
Progesterone 5. Hypothyroidism is generally associated with all of
 the following EXCEPT elevated
a. TSH receptor antibodies TSH and a low free T4. All of the following
b. Depression laboratory
c. An elevation of TSH levels test abnormalities may be associated with her
d. TPO antibodies underlying condition EXCEPT
a. Elevated WBC
6. A 34-year-old woman presents with goiter, b. An elevated cholesterol level
tachycardia, c. Anemia
and weight loss of 2 months duration. TSH is d. Elevated CPK levels
undetectable and free T4 is high. All of the following
tests are useful in diagnosing the cause of the 8. A 26-year-old man presents with a 3-cm, right
hyperthyroidism EXCEPT lobe,
a. FNA biopsy of the thyroid gland thyroid nodule and a normal TSH. What is the
b. TSH receptor antibodies next
c. RAIU test that should be performed?
d. TSH a. FNA of the nodule
b. Free T4 level
7. A 65-year-old woman presents with fatigue, c. Thyroid ultrasound
hypothermia, pericardial effusions, and hair loss. d. Thyroid scan
Her
thyroid function tests show a significantly

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b.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

9. The following are treatment options for
hyperthyroidism associated with Graves’ disease CALCIUM HOMEOSTASIS AND
EXCEPT HORMONAL REGULATION
a. Thyroid hormone
1. True or false? PTH and 1,25(OH)2D (vitamin D) are
b. PTU
the principal hormones involved in the normal
c. Beta-blockers
d. Radioactive iodine
physiologic regulation of calcium homeostasis.
TRUE
10. All of the following abnormalities might be
expected in a severely ill patient EXCEPT a. Low 2. The primary organs involved in the
rT3 maintenance of
b. Low T4 calcium homeostasis are the intestine, , and kidney.
c. Low T3 BONE
d. Low TSH
3. Skin, , and kidneys are involved in the
11. Of the following thyroid hormones, which is Production of the active metabolite of vitamin D.
considered LIVER
the most biologically active?
4. True or false? Cod liver oil (ugh!) is a source of
a. T3 bound to TBG
b. T4 bound to TBG
vitamin D.
c. Free T4 TRUE
d. Free T3
5. True or false? 1,25(OH)2D is the best blood test for
e. rT3
determining adequacy of vitamin D stores in the
12. The primary serum test to screen for thyroid body.
disease is: FALSE
a. Free T4
6. True or false? PTHrP is produced by some
b. rT3
c. Total T4
cancers
d. Autoimmune antibodies to thyroid tissue e.
and often leads to cancer-associated
hypercalcemia.
TSH
TRUE
13. Of the following, which will MOST likely 7.
interfere with quantitation of thyroglobulin? True or false? 1,25(OH)2D, due to 1-
a. Antithyroglobulin autoantibodies hydroxylase
b. Thyroid-stimulating antibodies activity in macrophages, may be produced to
c. TSH receptor antibodies excess in granulomatous diseases and lymphoid
d. Thyroid peroxidase antibodies disorders, leading to hypercalcemia.
FALSE
 osteoporosis that directly stimulates bone
8. In PHPT, the defect primarily lies in . In formation(i.e., it is not an antiresorptive drug).
secondary hyperparathyroidism, the defect TRUE
primarily lies with the threat of to the body.
PARATHYROID, HYHPOCALCEMIA LIVER FUNCTION
9. Development of is the primary complication of 1. Which of the following enzymes would best aid in
hypercalciuria (increased urinary excretion of identifying hepatobiliary disease?
calcium). a. Alkaline phosphatase (ALP)
KIDNEY STONES b. Aspartate aminotransferase (AST)
c. Alanine aminotransferase (ALT)
10. is the most common cause of d. Ammonia
hypoparathyroidism.
NECK SURGERY 2. In which of the following types of cells does the
conjugation of bilirubin take place?
11. is a type of bone most rapidly lost in a. Hepatocytes
response b. Kupffer cells
to hypogonadism and glucocorticoid therapy. c. Macrophages
TRABECULAR BONE d. Phagocytic cells

12. cells in bone are responsible for bone 3. Which of the following enzymes is responsible for
resorption, and cells are responsible for bone the conjugation of bilirubin?
formation. a. UDP-glucuronyl transferase
OSTEOCLASTS, OSTEOBLASTS b. Alkaline phosphatase
c. Glutamate dehydrogenase
13. is the most prevalent metabolic bone disease d. Leucine aminopeptidase
in the United States.
OSTEOPOROSIS 4. Which of the following fractions of bilirubin is
water soluble and reacts with a diazo reagent
14. True or false? Hormone replacement does not without the addition of an accelerator? a.
inhibit bone resorption in osteoporotic patients. Conjugated bilirubin
FALSE b. Unconjugated bilirubin
c. Total bilirubin
15. True or false? Teriparatide is the only drug
currently approved by the FDA for the treatment of

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

d. Indirect bilirubin c. Reye syndrome
d. Malaria
5. Which form of hepatitis is caused by a DNA
virus? 9. The reagent p-dimethylaminobenzaldehyde is
a. Hepatitis B used to measure which of the following? a.
b. Hepatitis A Urobilinogen
c. Hepatitis C b. Total bilirubin
d. Hepatitis D c. Ammonia
d. Alkaline phosphatase
6. Which of the following enzymes is most useful in
establishing the hepatic origin of an elevated 10. Which of the following conditions would result in
serum elevations in primarily conjugated bilirubin? a.
alkaline phosphatase? Dubin-Johnson syndrome
a. 5′-Nucleotidase b. Physiologic jaundice of the newborn c.
b. Alanine aminotransferase (ALT) Crigler-Najjar syndrome
c. Aspartate aminotransferase (AST) d. Gilbert’s syndrome
d. Lactate dehydrogenase
11. A urinalysis dipstick test indicated that
7. Hepatitis E is likely to cause serious urobilinogen
consequences in was absent. Which condition does this support? a.
a. Pregnant women Biliary obstruction
b. Children b. Hepatitis A acute infection
c. Travelers in Third World countries c. Defective liver cell function
d. Older people/ d. Hepatocellular disease
e. This would support all of the above conditions
8. Worldwide, most primary malignant tumors of
the liver are related to 12. Measuring serum ammonia levels has the
a. Alcoholism potential
b. Gallstones to be fraught with preanalytical errors that may
interfere with achieving an accurate result. Of the specificity for cardiac injury?
following preanalytical steps, which is incorrect? a. a. TnI
After phlebotomy, the patient’s blood should be b. CK-MB mass assays
immediately placed on ice. c. Total CK-MB
b. The blood should be collected in a red clot tube d. AST
without anticoagulant.
c. Hemolyzed samples should be rejected as this 4. Which of the following newer markers of
interferes by falsely increasing ammonia levels. d. inflammation
Lipemia may also interfere with plasma ammonia circulates in serum bound to LD and HDL? a.
measurements. Lipoprotein-associated phospholipase A2 b.
e. All of the above are correct. CK-MB
13. c. cTnI
A patient presents with elevated levels of IgG d. hsCRP
anti-HAV while levels of IgM anti-HAV are
5. A person with a confirmed blood pressure of
nondetectable. This patient is likely to: a. Have
125/87 would be classified as
an acute infection of HAV.
a. Prehypertension
b. Have a chronic infection of HAV.
b. Normal
c. Have an immunity to HAV.
c. Stage 1 hypertension
d. Be a carrier of HAV.
d. Stage 2 hypertension

MARKERS OF CARDIAC DAMAGE AND FUNCTION 6. Rheumatic heart disease is a result of infection
1. A serum TnT concentration is of most value to with which of the following organisms? a. Group A
the patient with an MI when streptococci
a. The CK-MB has already peaked and returned to b. Staphylococcus aureus
normal concentrations c. Pseudomonas aeruginosa
b. The onset of symptoms is within 3 to 6 hours of d. Chlamydia pneumoniae
the sample being drawn
7. Which of the following defects is the most
c. The myoglobin concentration is extremely
common type of congenital CVD encountered? a.
elevated
Ventricular septal defects (VSD)
d. The TnI concentration has returned to normal
b. Tetralogy of Fallot
concentrations
c. Coarctation of the aorta
d. Transposition of the great arteries
2. A normal myoglobin concentration 8 hours
after the onset of symptoms of a suspected MI
8. Which of the following cardiac markers is the
will
most useful indicator of congestive heart failure? a.
a. Essentially rule out an acute MI
BNP
b. Provide a definitive diagnosis of acute MI c. Be
b. TnI
interpreted with careful consideration of the TnT
c. CK-MB
concentration
d. Glycogen phosphorylase isoenzyme BB
d. Give the same information as a total CK-MB

3. Which of the following analytes has the highest

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

9. Which of the following is the preferred
biomarker for the assessment of myocardial
necrosis?
a. CK RENAL FUNCTION
b. AST
1. Calculate creatinine clearance, given the
c. CK-MB
following
d. TnI
information: serum creatinine, 1.2 mg/dL; urine
creatinine, 120 mg/dL; urine volume, 1750 mL/24 h;
10. Which of the following is NOT a feature of an
ideal cardiac marker? body surface area, 1.80 m2.
a. Ability to predict future occurrence of cardiac
117 mL/min
disease
2. Predict GFR in a 50-year-old woman who weighs
b. Absolute specificity
60 kg using the Cockcroft-Gault equation. Her
c. High sensitivity
serum creatinine level is 2.5 mg/dL. 2.26mL/min
d. Close estimation of the magnitude of cardiac
damage 3. The measurement of serum cystatin C, a small
protein produced by nucleated cells, is useful for a.
Detecting an early decrease in kidney function b.
Calculating creatinine clearance 10. A patient is suffering from an acute bleed.
c. Diagnosing end-stage renal disease d. What is
Monitoring dialysis patients the most accurate way to describe the
subsequent
4. Acute renal failure can be classified into three acute kidney injury?
types. List each type and give an example of each. a. Prerenal acute kidney injury
a. b. Renal acute kidney injury
b. c. Postrenal acute kidney injury
c. d. None of the above apply
PANCREATIC FUNCTION AND
5. The proximal tubule functions to GASTROINTESTINAL FUNCTION
a. reabsorb 75% of salt and water.
b. concentrate salts. 1. Laboratory findings in pancreatitis include all of
c. form the renal threshold. the following EXCEPT
d. reabsorb urea. a. Increased cortisol
b. Increased amylase
6. Renal clearance is the c. Increased lipase
a. volume of plasma from which a substance is d. Increased triglycerides
removed per unit of time.
b. volume of urine produced per day. 2. Which of the following tests is a direct
c. amount of creatinine in urine. determination
d. urine concentration of a substance divided by of the exocrine secretory capacity of the
the urine volume per unit of time. pancreas?
a. Secretin/CCK test
7. Renin release by the kidney is stimulated by a. b. Amylase
a decrease in extracellular fluid volume or c. Quantitative fecal fat analysis
pressure. d. d-Xylose test
b. increased plasma sodium concentration. c. e. Lactose tolerance test
increased dietary sodium.
d. renal tubular reabsorption. 3. Which of the following statements concerning
cystic
8. The set of results that most accurately reflects fibrosis is NOT correct?
severe renal disease is a. Affects males and females about equally b.
a. serum creatinine, 3.7 mg/dL; creatinine Occurs predominantly in populations of
clearance, Northern European extraction
44 mL/min; BUN, 88 mg/dL c. Frequently diagnosed by measurement of
b. sweat chloride
serum creatinine, 1.0 mg/dL; creatinine d. Caused by a variety of mutations on
clearance, chromosome 7
110 mL/min; BUN, 17 mg/dL e. Genetic screening is usually unsuccessful
c. serum creatinine, 2.0 mg/dL; creatinine
clearance, 4. The proper time period for the collection of a
120 mL/min; BUN, 14 mg/dL fecal
d. serum creatinine, 1.0 mg/dL; creatinine fat specimen is
clearance, a. 72 hours
95 mL/min; BUN, 43 mg/dL b. 24 hours
c. 36 hours
9. Creatinine clearance results are corrected d. 48 hours
using a e. 96 hours
patient’s body surface area to account for
differences in 5. Which of the following tests is only of the
a. muscle mass. absorptive
b. age. ability of the intestine?
c. dietary intake. a. d-Xylose test
d. sex. b. Lactose tolerance test

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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

c. Fecal fat (72-hour collection) b. Pancreatitis
d. Serum carotenoids c. Peptic ulcer
e. Serum albumin d. Pancreatic carcinoma

6. A serum albumin of less than 2.5 g/dL would be 7. Which of the following is accurate when
most indicative of describing
a. Intestinal disease or diagnosing Zollinger-Ellison syndrome? a.
Extreme hyposecretion of gastrin in the c. Diabetes
stomach d. Traumatic tap
b. Extreme hypersecretion of gastrin in the e. Hemochromatosis
duodenum
c. An increase in serum gastrin levels of 100 pg/mL 6. An IgG index of 0.8 is indicative of
following intravenous exposure to secretin d. A a. Multiple sclerosis
decrease in serum gastrin levels of 100 pg/ mL b. CSF leakage
following intravenous exposure to secretin e. Is c. Fungal infection
confirmed when the hydrogen breath test is positive d. Malignancy
e. Normal CSF
8. The d-xylose absorption test is particularly
helpful in differentiating malabsorption of 7. CF is characterized by
intestinal etiology from exocrine pancreatic a. Elevated sweat chloride levels
insufficiency because: b. Homozygous expression of an autosomal
a. d-Xylose is mostly absorbed in the stomach and recessive trait
then secreted via the kidney in its unaltered c. Pancreatic insufficiency
monosaccharide form. d. All of these
b. d-Xylose is mostly altered in the small intestine to e. None of these
facilitate its absorption across this membrane and
metabolized by the liver so its metabolites may be 8. Synovial fluid
excreted via the kidney. a. Is formed by plasma ultrafiltration and is rich in
c. d-Xylose is mostly absorbed, not typically found in
hyaluronic acid
the blood, unaltered in the small intestine, and b. Is formed by plasma ultrafiltration
excreted unaltered via the kidney. c. Lubricates the pneumocytes
d. Is rich in hyaluronic acid
d. None of the above describe why the d-xylose
e. All of these
test is useful in identifying malabsorption diseases
9. Serous fluids
BODY FLUIDANALYSIS a. Are derived from serum
1. Laboratory testing for the assessment of fetal b. Provide lubrication and protection
lung c. Fill the potential space
maturity includes all of the following tests except a. d. Are derived from serum and provide lubrication
Acetylcholinesterase and protection only
b. L/S ratio e. All of these
c. Fluorescence polarization
10. Pleural fluid exudates
d. Foam stability
a. Are characterized by a total protein F/P ratio of
e. Lamellar body count
0.7
2. Amniotic fluid b. Reflect primary involvement of the pleura c. Are
a. Provides a cushion for the fetus and is a characterized by an increased LD F/P ratio d. Are
mixture characterized by an increased cholesterol F/P ratio
of maternal and fetal fluids e. All of these
b. Provides a cushion for the fetus
c. Is a mixture of maternal and fetal fluids d. Is 11. Analysis of paracentesis fluid is performed to a.
assessed by umbilical catheterization e. Provides a Determine the cause of fluid presence and assess
cushion for the fetus, is a mixture of maternal and infection risk
fetal fluids, and is assessed by umbilical b. Determine the cause of fluid presence c.
catheterization Assess infection risk
d. Determine lung involvement
3. Lamellar body counts reflect e. All of these
a. Surfactant phospholipid packets
12. The most common cause of ascites is a.
b. Platelet count of the fetus
Portal hypertension
c. Platelet count of the mother
b. Venous return
d. Meconium count of the fetus
c. Parietal cell differentiation
e. All of these
d. Eccrine infection
4. A xanthochromic CSF indicates e. Malignancy
a. Cerebral hemorrhage
13. When assessing the lipid profile to determine
b. Traumatic tap
fetal
Bacterial meningitis
lung maturity, it is critical to
d. Viral meningitis
a. Centrifuge the amniotic fluid at low speeds to
e. Multiple sclerosis
properly avoid fractionation of the lipids. b.
Centrifuge the amniotic fluid at high speeds to
5. CSF glucose is measured to assess
properly fractionate the lipids.
a. Infection
b. Transport efficiency
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c.
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CLINICAL CHEMISTRY REVIEW QUESTIONS – BISHOP

c. Avoid centrifugation of amniotic fluid for this used
test. as a tumor marker?
a. LD
TUMOR MARKERS b. Lipase
c. Aldolase
1. What percentage of women will have invasive d. Catalase
cancer
at some time in their life? 9. A tumor marker used in the assessment of
a. 33% choriocarcinoma
b. 25% or hydatidiform mole is
c. 50% a. �-hCG
d. 75% b. CEA
c. AFP
2. Tumor marker tests are used to d. IgG
a. All of these
b. Aid in staging of cancer 10. A serum PSA is used for all of the following
c. Monitor response to therapy except
d. Detect recurrent disease Diagnosis
b. Screening
3. Tumor markers may be defined as c. Monitoring response
a. Biologic substances synthesized and released by d. Detecting recurrence
cancer cells or substances produced by the host
in response to cancer cells 11. The following serum PSA measurements were
b. Analytic tests (e.g., immunoassays) used to obtained from two male patients that were being
mark cancer cells monitored over an 18-week period.
c. Radioactive substances and chemicals used to
help the physician identify cancer cells d. None of
these

4. Which of the following is an oncofetal antigen? a. Which of the following statements most accurately
AFP describes these data?
b. CA-125 a. Patient A may have a more aggressive prostate
c. �-hCG cancer based on the velocity of these
d. PSA measurements.
b. Patient A is most likely to have benign prostate
5. What are the major limitations of tumor cancer.
markers? c. Patient B is most likely to be experiencing an
a. Sensitivity and specificity inflammatory reaction and this is largely
b. Cost contributing
c. Turnaround time to the elevated PSA above 100 ng/mL. d. Patient B
d. Imprecision may have a more aggressive prostate cancer based
on the velocity of these measurements.
6. The major clinical use for CA-125 is monitoring
e. Answers a and c most accurately describe
treatment response of
these
a. Ovarian carcinoma
data.
b. Colorectal cancer
c. Prostatic cancer 12. When measuring tumor markers in the clinical
d. Breast cancer laboratory, which of the following has been reported
to contribute to 30% to 70% of the total amount of
7. The most common immunoassays used to
measurement error?
measure
a. Preanalytical errors
PSA detect which form of the enzyme? b. Analytical errors
a. Total PSA
c. Hook effect
b. Free PSA
d. Using different immunoassay methods e. Not
c. PSA complexed with α1-antichymotrypsin d.
comparing lot numbers between ELISA kits
PSA complexed with α2-macroglobulin

8. Which of the following enzymes is commonly

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a.