CLINICAL CHEMISTRY MB REVIEWER

1. This pattern is consistent with:

A. Normal pattern

B. Cirrhosis

C. Inflammation

D. Alpha- 1 antitrypsin

Cirrhosis- beta- gamma bridging

Inflammation- If acute, low albumin & increased alpha 1 and alpha 2 globulins

If chronic, low albumin & increased alpha 1, alpha 2 globulins and gamma globulins

Alpha- 1 antitrypsin deficiency- low alpha 1 globulins

2. The reagent blank corrects for absorbance caused by:

A. The color of reagents

B. Sample turbidity

C. Bilirubin and hemolysis

D. All of these options

Sample turbidity- corrected via filtration

Bilirubin and hemolysis- corrected via sample blank

3. Which element is reduced at the cathode of a Clark polarographic electrode?

A. Silver

B. Oxygen

C. Chloride

D. Potassium
Polarographic method- an instrumental method of chemical analysis used for qualitative and
quantitative determinations of reducible or oxidizable substances.

Oxygen- Clark polarographic electrode

Carbon dioxide- Severinghaus polarographic electrode

Silver- silver chloride & calomel- reference electrodes for potentiometry (measurement of different
voltages or potential at a constant current)

Potassium- measured via ion- selective electrode (for monoatomic ions) using valinomycin gel as its
membrane

4. Given the following serum electrolyte data, determine the anion gap.

Na = 132 mmol/L

Cl = 90 mmol/L

HCO3= 22 mmol/L

A. 12 mmol/L

B. 20 mmol/L

C. 64 mmol/L

D. Cannot be determined from the information provided

The anion gap measures the difference—or gap—between the negatively charged and positively
charged electrolytes in your blood. If the anion gap is too high, your blood is more acidic than normal. If
the anion gap is too low, your blood isn't acidic enough.

= 132 – (90 + 22)

= 132 − 112

= 20 mmol/L
5. Which of the following is characteristic of type 1 diabetes mellitus?

A. Requires an oral glucose tolerance test for diagnosis

B. Is the most common form of diabetes mellitus

C. Usually occurs after age 40

D. Requires insulin replacement to prevent ketosis

6. A reciprocal relationship exists between:

A. Sodium & potassium

B. Calcium & phosphate

C. Chloride & CO2

D. Calcium & magnesium

7. Which of the following is classified as a mucopolysaccharide storage disease?

A. Pompe’s disease

B. von Gierke disease

C. Hers’ disease

D. Hurler’s syndrome

Pompe’s disease- Type 2 glycogen storage disease von Gierke disease- Type 1 glycogen storage disease
Hers’ disease- Type 6 glycogen storage disease
8. Which electrolyte measurement is least affected by hemolysis?

A. Potassium

B. Calcium

C. Pi

D. Magnesium

9. In the fasting state, the arterial and capillary blood glucose concentration varies from the venous
glucose concentration by approximately how many mg/dL(mmol/L)?

A. 1 mg/dL (0.05 mmol/L) higher

B. 5 mg/dL (0.27 mmol/L) higher

C. 10 mg/dL (0.55 mmol/L) higher

D. 15 mg/dL (0.82 mmol/L) higher

Levels are higher in the arterial blood because some of the glucose diffuses from the plasma to
interstitial fluid (IF) as blood circulates through the capillary system

10. A trend in QC results is most likely caused by:

A. Deterioration of the reagent

B. Miscalibration of the instrument

D. Electronic noise

C. Improper dilution of standards

11. What is the best method to diagnose lactase deficiency?

A. H2 breath test

B. Plasma aldolase level

C. LDH level

D. D-xylose test

Plasma aldolase level- For aldolase deficiency

LDH level- Measures the level of lactate dehydrogenase (LDH)

D- xylose test- Check how well the intestines absorb a simple sugar (D-xylose)

12. Which of the following formulas is the correct expression for creatinine clearance?

A. Creatinine clearance = U/P X V X 1.73/A

B. Creatinine clearance = P/V X U X A/1.73

C. Creatinine clearance = P/V X U X 1.73/A

D. Creatinine clearance = U/V X P X 1.73/A

Creatinine clearance= U/P X V X 1.73/A

U- Urine creatinine (mg/dL)

P- Plasma creatinine (mg/dL)

V- Urine volume (mL)

1.73/A- Body surface area (m ²)

13. At pH 8.6, proteins are _________ charged and migrate toward the _________.

A. Negatively, anode

B. Positively, cathode

C. Positively, anode

D. Negatively, cathode

Exception: At pH 8.6, the gamma globulins move towards the cathode despite the fact that they are
negatively- charged. This is what we call as endosmosis
14. Which condition produces the highest elevation of serum lactate dehydrogenase?

A. Pernicious anemia

B. Myocardial infarction

C. Acute hepatitis

D. Muscular dystrophy

15. Cerebrospinal fluid for glucose assay should be:

A. Refrigerated

B. Analyzed immediately

C. Heated at 56°C

D. Stored at room temperature after centrifugation

The CSF glucose test can be useful when checking for spinal cord or brain infections such as meningitis,
because people with these infections have low glucose in their cerebrospinal fluid. Also, acute bacterial
meningitis is a severe and life-threatening disease and the examination of CSF samples is considered a
priority

16. If the LDL- cholesterol is to be calculated by the Friedewald formula, what are the two
measurements that need to be carried out by the same chemical procedure?

A. Total cholesterol and HDL- cholesterol

B. Total cholesterol and triglyceride

C. Triglycerides and chylomicrons

D. Apolipoprotein A and apolipoprotein B

17. Which of the following is the most likely interpretation of the LD isoenzyme scan illustrated above?
A. Myocardial infarction

B. Megaloblastic anemia

C. Acute pancreatitis

D. Viral hepatitis

LDH-1 is found primarily in heart muscle and red blood cells.

LDH-2 is concentrated in white blood cells.

LDH-3 is highest in the lung.

LDH-4 is highest in the kidney, placenta, and pancreas.

LDH-5 is highest in the liver and skeletal muscle

18. To assure an accurate ammonia level result, the specimen should be:

A. Incubated at 37°C prior to testing

B. Spun and separated immediately, tested as routine

C. Spun, separated, iced and tested immediately

D. Stored at room temperature until tested

19. Analysis of CSF for oligoclonal bands is used to screen for which of the following disease states?

A. Multiple myeloma

B. Multiple sclerosis

C. Myasthenia gravis

D. Von Willebrand disease

Oligoclonal bands are proteins called immunoglobulins. The presence of these proteins indicates
inflammation of the central nervous system. Also, oligoclonal bands (OCBs) of the cerebrospinal fluid
(CSF) are a hallmark of multiple sclerosis (MS)

20. Which of the following is most likely to be ordered in addition to ionized calcium to determine the
cause of tetany?

A. Magnesium

B. Phosphate

C. Sodium

D. Vitamin D

Hypomagnesemia is another important cause of tetany, as magnesium affects the metabolism of both
calcium and potassium. Magnesium and calcium are directly proportional.

21. Which of the following hormones promotes hyperglycemia?

A. Calcitonin

B. Growth hormone

C. Aldosterone

D. Renin

Hormones that increase glucose concentration.

1. Glucagon

2. Cortisol and corticosteroids (Glucocorticoids)

3. Catecholamines

4. Growth hormone (Somatotrophic)

5. Thyroid hormones

6. Adrenocorticotropic hormone (ACTH)

7. Somatostatin

22. Which of the following methods is most useful in order to detect sample misidentification?

A. Cumulative summation

B. Critical limit

C. Delta limit
D. Significant change limit

23. Blood ammonia levels are usually measured in order to evaluate:

A. Renal failure

B. Acid–base status

C. Hepatic coma

D. Gastrointestinal malabsorption

24. Kjeldahl’s procedure for total protein is based upon the premise that:

A. Proteins are negatively charged

B. The pKa of proteins is the same

C. The nitrogen content of proteins is constant

D. Proteins have similar tyrosine and tryptophan content

25. Which of the following conditions is associated with “β-γ bridging”?

A. Multiple myeloma

B. Malignancy

C. Hepatic cirrhosis

D. Rheumatoid arthritis
26. Functional during uterine contractions during parturition

A. ADH

B. Prolactin

c. Oxytocin

D. Cortisol

27. A removed fragment of proinsulin to convert it to insulin

A. C-Peptide

B. Epinephrine

C. ADH

D. Serotonin

28. Electrolyte that affect ECG tracings

-Potassium, Magnesium, Calcium

29. The serum concentration of drug concentration of drug established to achieved desired clinical
effect.

A. Steady state

B. Therapeutic range

C. First pass metabolism

D. Through sample

30. Blood level of alcohol intoxication associated with decreased inhibitions and diminished reaction
time.

-B. 0.09-0.25% w/v

31. I. Arterial whole blood anticoagulated with heparin

II. Transferred from syringe to a green top vacutainer tube

B. Statemet I is correct; Statement II in incorrect

32. Action of RAAS

I. Dilates the afferent arteriole an constricts the efferent arteriole

II. Stimulates potassium reabsorption in the proximal convoluted tubule

-A .Statement I is correct; Statement is incorrect

33. In urine glucose:

I. A nonfasting patient with high glucose would have a normal blood glucose

II. Glucose appearing in the urine of a person with normal blood glucose is an indication of diabetes
mellitus.

-BOTH statement are incorrect

34. An extremenely stable substance that is not reabsoreb or secreted by the tubules and is a polymer of
frustose

A. INSULIN

34.Average normal ratio of bicarbonate to dissolved CO2

C. 20:1

35. In respiratory alkalosis, decreased PCO2 results from a/an:

A. Accelerated rate or depth of respiration

B. Anxiety

C. Salicylate overdose

D. All of the above

36.Liver synthesizes:

A. Proteins, coagulation factors, vitamin A

B. vitamin A, proteins erythropoietin

C. proteins, coagulation factor, vit. B12

D. none of the above

37.

I.Unconjogated bilirubin complexes with albumin for transport to the liver

II. Bilirubin is conjugated in the smooth endoplasmic reticulum of liver cells

C. Both statement is correct

38. Crigler Najjar syndrome is a defect in bilirubin conjugation due to defieciency of

-UDPGT

39. Charactererized by significantly increased level of conjugated bilirubin both in serum and urine, and
a decreased urine and fecal urobilinogen

- Post hepatic jaundice

40. In jendrassik-groft method, diazotized sulfanilic acid reacts to:

A. B1

B.B2 only

C. Both

D. Neither

41. Accelerator for even malloy method:

A. 40% methanol

B. 30% methanol

C. 50% methanol

D. 25% methanol

42. Bleeding or hemorrhage is associated in the deficiency of this vitamin.

A. Phylloquinones (vit. k)
B. Pteroylglutmaic acid

C. Ascorbic acid

D. Retinol

43. Pellagrais associated in vitamin ____ deficiency.

A. thiamine

B. Pantothenic acid

C. Tocopherol

D. Niacin

44. This law states that in an electrochemical system, the number of equivalent weight of a reactant
oxidized or reduced is directly proportional to the quantity of electricity used in the reaction.

A. Beer's law

B. Faraday's law

C. ohm's law

D. Joule's law

45. This antipyretic drug decreases thromboxane amd prostaglandin formation through inhibition of
cyclooxygenase

A. Acetaminophen

B. Salicylates

C. Ibuprofen- lowest risk of toxicity compared to acetaminophen and salicylates

D. Busulfan-

46. In glucose suppression test, this pattern is diagnostic or acromegaly.

-Failure of growth hormone suppression below 0.3 ug/L with elevated insulin-like growth factor 1

47. In a patient having a fever of 39C, the patient's pO2 will decrease by ___ and PCO2 will increase by
____

B. 14%: 6%
48. All of the following are used in extinguishing a fire caused by paints except:

A. Carbon dioxide

B. Loaded steam

C. Dry chemical

D. Halogens