VH REVIEW CENTER

PRE-BOARD EXAMINATION
CLINICAL CHEMISTRY
NAME: ___________________________________________________________

1. Moderate elevation (3-5x normal) of LDH activity is/are seen 11. Portal cirrhosis is a chronic disease of the liver. As observed
in which of the following conditions? on an electrophoretic serum protein pattern, what is the
I. Megaloblastic anemia predominant characteristic of this disease?
II. Renal infarction A. Monoclonal band in the gamma-globulin region
III. Myocardial infarction B. Polyclonal band in the gamma-globulin region
IV. Pulmonary infarction C. Bridging effect between the beta- and gamma- globulin
A. I and II only bands
B. III and IV only D. Increase in the alpha2-globulin band
C. I, II, and III only 12. In the ultraviolet procedure for quantifying uric acid, what
D. I, II, III and IV does the reaction between uric acid and uricase cause?
2. Which of the following westgard control rules is related to two A. Production of reduced nicotinamide adenine dinucleotide
consecutive control values that exceed the same mean +2s or B. The formation of allantoin
-2s? C. An increase in absorbance
A. R4s D. A reduction of phosphotungstic acid
B. 41s 13. Glucose oxidase oxidizes glucose to gluconic acid and
C. 22s _______.
D. 12s A. H2O 2
3. Which of the following best describes a trend? B. CO2
A. 6 or more consecutive control values distribute C. HCO3
themselves on one side or either side of the mean but D. H20
maintain a constant level. 14. Which of the following enzymes is the most specific for beta-
B. Improper calibration of the instrument is the main cause D-glucose?
C. 6 consecutive control values continue to either increase A. Glucose oxidase
or decrease B. G6PD
D. AOTA C. Hexokinase
4. Which of the following isolates light within a narrow region of D. Phosphohexoisomerase
the spectrum? 15. Which of the following enzymes is the coupling enzyme in the
A. Photomultiplier tubes hexokinase method for glucose?
B. Monochromator A. Glucose dehydrogenase
C. Photovoltaic cell B. Glucose-6-phosphatase
D. Detector C. G6PD
5. Fluorometers are designed so that the path of the exciting D. Peroxidase
light is at right angle to the path of the emitted light. What is 16. Ammonia levels are usually measured to evaluate
the purpose of this design? ____________.
A. Prevent loss of emitted light A. Renal failure
B. Prevent loss of the excitation light B. Acid-Base status
C. Focus emitted and excitation light upon the detector C. Liver function
D. Prevent excitation light from reaching the detector D. Glomerular filtration
6. Which of the following instruments is used in the clinical 17. All of the following statements are characteristic of type II DM,
laboratory or in reference laboratories to detect beta and EXCEPT:
gamma emissions? A. Also called non-insulin dependent diabetes mellitus
A. Fluorometer B. Caused by a relative deficiency of insulin
B. Nephelometer C. Microvascular changes
C. Scintillation counter D. About 10 % of DM cases is of this type
D. Spectrophotometer 18. Which of the following changes would you expect in a patient
7. Which of the following blotting technics is for the isolation of with familial LPL deficiency?
DNA? A. Elevation of plasma chylomicrons
A. Western blotting B. Elevation of both plasma chylomicrons and very low
B. Northern blotting density lipoproteins
C. Eastern blotting C. Elevation of plasma HDL only
D. Southern blotting
D. Elevation of plasma HDL and LDL
8. In what condition would an increased serum albumin be
19. Which of the following is true about ACTH?
expected?
A. It is produced by the adrenal medulla
A. Malnutrition
B. Has diurnal variation, peaking around midnight
B. Acute inflammation
C. Stimulates the adrenal cortex to increase the secretion of
C. Dehydration
cortisol
D. Renal disease
D. Both B and C
9. Which of the proteins listed migrates in the beta region at pH
20. The final metabolic product of both epinephrine and
8.6?
norepinephrine is ___________.
A. Haptoglobin
A. Vanillymandelic acid
B. Orosomucoprotein
B. 5-HIAA
C. Ceruloplasmin
C. Metanephrine
D. Transferrin
D. Tyrosine
10. Express 30 mg/dL of urea nitrogen as urea.
21. Rate of reaction is almost directly proportional to substrate
A. 14 mg/dL
concentration
B. 40 mg/dL
A. First order kinetics
C. 50 mg/dL
B. Zero-order kinetics
D. 64 mg/dL
C. Mixed-order kinetics
D. NOTA
22. Which of the following is the principle used by pCO2 36. Which of the following statements is not true about the
electrode? horizontal centrifuge?
A. Amperometry A. Allows the tube to attain horizontal position when
B. Coulometry spinning
C. Voltammetry B. A tachometer is used for the time of rotation of this
D. Potentiometry centrifuge
23. A pipette with an attached etched ring near the mouth end C. It can attain speeds of up to 3000 rpm
should be ___________. D. Its primary disadvantage is excess heat build up
A. Blown out 37. The major isoenzyme of lactic dehydrogenase are
B. Used when great accuracy is needed representatives of which of the following?
C. Allowed to drain freely A. Heart and kidney
D. Rinsed every after delivery B. RBCs and heart
24. In pesticide poisoning, cholinesterase activity is: C. Muscle and liver
A. Normal D. Heart and liver
B. Increased 38. The turbid milky appearance of serum after fat ingestion is
C. Decreased termed as post-prandial lipemia, which is caused by the
D. Variable presence of what substance?
25. Hypoventilation serves to: A. Bilirubin
A. Increase H2CO 3 levels in the blood B. Cholesterol
B. Increase HCO3- levels in the blood C. Chylomicrons
C. decrease H2CO 3 levels in the blood D. Phospholipid
D. decrease HCO3- levels in the blood 39. Select the order of mobility of lipoprotein electrophoresed on
26. Which of the following is NOT produced by the anterior cellulose acetate or agarose at pH 8.6?
pituitary? A. - chylomicrons>prebeta>beta>alpha +
A. ADH B. - beta>prebeta>alpha>cylomicrons +
B. Growth hormone C. - chylomicrons>beta>prebeta>alpha +
C. Prolactin D. - alpha>beta>prebeta>chylomicrons +
D. ACTH 40. A patients total cholesterol is 300 mg/dL, his HDL cholesterol
27. Hypothyroidism is associated with which of the following? is 50 mg/dL, and his tryglyceride is 200 mg/dL. What is this
A. Decreased cholesterol patients calculated LDL?
B. Decreased LDL A. 200
C. Increased triglycerides B. 210
D. Increased calcium C. 290
28. CYFRA 21-1 is a tumor marker primarily for ___________. D. 350
A. Lung cancer 41. Which of the following enzymes does not belong to the class
B. Breast cancer of enzymes known as hydrolases?
C. Prostate cancer A. Alkaline phosphatase
D. NOTA B. Aldolase
29. Lithium therapy is used in the treatment of ______________. C. Amylase
A. Hypertension D. Lipase
B. Hyperactivity 42. Which of the isoenzymes of ALP is most heat stable?
C. Hyperglycemia A. Placental ALP
D. Manic depression B. Bone ALP
30. Kodak-dry slide analyzer uses this principle in measuring the C. Instestinal ALP
color intensity reactions: D. Liver ALP
A. Reflectance spectrophotometry 43. Which of the following is the time course of CK activity in MI?
B. Nephelometry Onset of Peak Duration of
C. Fluorometry Elevation Activity Elevation
D. Fluorescence polarization A. 1-3 hours 5-12 18-30
31. The most anodal protein on serum protein electrophoresis at hours hours
pH 8.6 is __________. B. 4-8 hours 12 hours 3-4 days
A. Albumin C. 8-12 hours 24 hours 5 days
B. Alpha 1 globulin D. 12-24 hours 72 hours 10 days
C. Beta globulin 44. To maintain a pH of 7.4 in plasma, it is necessary to mantain
D. Gamma globulin a:
32. Spectrophotometer wavelength calibration in the visible range A. 10:1 ratio of bicarbonate to carbonic acid
can be checked by using: B. 20:1 ratio of bicarbonate to carbonic acid
A. Quartz filter C. 1:20 ratio of bicarbonate to carbonic acid
B. Diffraction grating D. 20:1 ratio of carbonic acid to bicarbonate
C. Quartz prism 45. If a blood gas specimen is left exposed to air, which of the
D. Didymium filter following changes will occur?
33. Convert 200 mg/dL triglyceride to SI unit. A. pO2 and pH increase; pCO2 decrease
A. 2.26 mmol/L B. pO2 and pH decrease; pCO2 increase
B. 1.4 mmol/L C. pO2 increases; pH and pCO2 decrease
C. 3.2 mmol/L D. pO2 decreases; pH and pCO2 increase
D. 4.1 mmol/L 46. Which of the following is the primary mechanism of
34. The counterbalance anion of sodium is: compensation for metabolic acidosis?
A. Chloride A. Late stage of salicylate poisoning
B. Manganese B. Uncontrolled DM
C. Potassium C. Renal failure
D. Sodium D. Excessive vomiting
35. A patient with hypothyroidism is expected to have __________. 47. What is the anticoagulant of choice for blood gas analysis?
A. Low serum phosphorus level A. EDTA
B. High urine calcium level B. Heparin
C. Bone wasting C. Sodium fluoride
D. High serum calcium level D. Citrate
48. Which of the following is characterized by increased B. Urea
production of chloride in sweat? C. Ammonia
A. Multiple myeloma D. Creatinine
B. Hypoparathyroidism 60. Which of the following statements about the category of
C. Cystic fibrosis enzyme and their catalyzed reaction is INCORRECT?
D. Wilson disease A. Lyases: cleavage of bonds without involving water
49. To what metal does ceruloplasmin bind? B. Ligases: joining of 2 substrate molecules
A. Chromium C. Tranferases: intramolecular arrangement
B. Copper D. Oxidoreductases: redox reaction
C. Zinc 61. Which of the following is a specific, late acute pancreatitis
D. Iron marker?
50. Which of the following characterizes Crigler-Najjar syndrome? A. Amylase
A. Inability to transport bilirubin from the sinusoidal B. Lipase
membrane to the microsomal region C. Cholinesterase
B. Deficiency of the enzyme system required for D. LDH
conjugation of bilirubin 62. Which of the following is the most specific enzymatic method
C. Inability to transport bilirubin glucoronides to bile for ALP?
canaliculi A. King and Armstrong
D. Severe liver transport accompanied by necrosis B. Bowers & McComb
51. Indirect-reacting bilirubin may be quantified by reacting it C. Roy and Hillman
initially with which reagent? D. Bessy, Lowry & Brock
A. Dilute HCl 63. Which of the following is the forward/direct reaction of LDH?
B. Dilute sulfuric acid A. Wacker
C. Caffeine-sodium bezoate B. Wrobleuski La Due
D. Sodium hydroxide C. Tanzer-Gilvarg
52. Acetaminophen is primarily toxic to what organ? D. Oliver-Rosalki
A. Heart 64. Unable to stand or walk, vomiting, imapired conciousness
B. Kidney A. 0.27-0.40 %
C. Spleen B. 0.04-0.25 %
D. liver C. 0.03-0.12 %
53. Identification of the urinary metabolite benzoylecgonine would D. 0.18-0.30 %
be useful in determining exposure to which of the following 65. A body mass index of <18.5 kg/m2 would indicate that the
drugs? patient is ______________.
A. Codeine A. Obese
B. Cocaine B. Overweight
C. Amphetamine C. Malnourished
D. Propoxyphene D. Normal
54. Thyroid-releasing hormone is given to the patient. Serum 66. A material of known concentration used in developing a
thyroid-stimulating hormone (TSH) levels are taken before standard curve or for calibration of an instrument is known as
and after the injection, and the values are the same -- LOW. ______________.
This patient probably has which of the following disorders? A. Control
A. Primary hypothyroidism B. Standard
B. Secondary hypothyroidism C. Quality material
C. Tertiary hypothyroidism D. Reference material
D. Iodine deficiency 67. Which of the following is the visible region?
55. The thyroid gland produces all of the following, EXCEPT: A. 400 to 700 nm
A. TSH B. < 400 nm
B. Calcitonin C. > 700 nm
C. Thyroxine D. NOTA
D. T3 68. Which of the following is the acceptable coefficient of
56. Given the following serum electrolyte data, determine the variation for total cholesterol determination?
anion gap. A. 3%
Na = 132 mmol/L B. 4%
Cl = 90 mmol/L C. 5%
HCO3 = 22 mmol/L D. 6%
A. 12 mmol/L 69. Which of the following is the borderline high cholesterol level?
B. 20 mmol/L A. 200-499 mg/dL
C. 64 mmol/L B. 200-239 mg/dL
D. Cannot be determined C. 150-199 mg/dL
57. The y-axis is associated with all of the following EXCEPT: D. <200 mg/dL
A. Vertical axis 70. Which of the following is used for long term glucose
B. Dependent variable monitoring?
C. Ordinate A. Glycosylated albumin
D. Abscissa B. Glycosylated hemoglobin
58. Which of the foolowing is/are NEGATIVE acute phase C. Fructosamine
reactants? D. A and B
I. Transferrin 71. Which of the following detects light scattered towards a
II. Albumin detector and it is used for the determination of antigen-
III. CRP antibody complexes?
IV. Fibrinogen A. Fluorometer
A. I only B. Nephelometer
B. I and II only C. Double-beam in space
C. I, II, and III D. Reflectance photometry
D. IV only 72. A 10% contamination with 5% dextrose will increase blood
glucose by ___________.
59. Which of the following is the least concentrated NPN? A. 500 mg/dL
A. Uric acid B. 600 mg/dL
 C. 700 mg/dL C. No effect
D. 800 mg/dL D. AOTA
73. Which of the following HDL value is protective against 85. Which of the following is the least specific enzyme?
cardiovascular disease? A. CK
A. <40 mg/dL B. LDH
B. >60 mg/dL C. AST
C. <60 mg/dL D. 5-NT
D. >40 mg/dL 86. Which of the following is/are included in the electrolyte
74. Which of the following fasting periods is employed to produce profile?
a reliable lipid profile result? I. Na +
A. 8 hour fasting II. Cl-
B. 10 hour fasting III. K+
C. 12 hour fasting IV. HCO3-
D. 15 hour fasting A. I only
75. Which of the following is the borderline high LDL cholesterol B. I and II
level? C. I, II and III
A. 100-129 mg/dL D. I, II, III and IV
B. 130-159 mg/dL 87. Which of the following is the correct formula for anion gap?
C. 160-189 mg/dL A. AG = (Na + + K +) - (Cl- + HCO 3-)
D. >190 mg/dL B. AG = Na + - (Cl - + HCO 3-)
76. Which of the following approaches to assay of urea nitrogen C. AG = K+ - (Cl- + HCO 3-)
is inexpensive and lacks specificity? D. Both A and B
A. Enzymatic: NH3 formation 88. Which of the following is the major extracellular cation?
B. Colorimetric: kinetic A. Sodium
C. Colorimetric: diacetyl B. Potasssium
D. Enzymatic: UV C. Chloride
77. Which of the following is/are true about colorimetric: endpoint D. Organic Phosphate
as an approach to assay of creatinine? 89. What is the effect of increased blood glucose on sodium
I. Simple concentration?
II. Nonspecific A. Increased
III. Problems with turbidity B. Decreased
IV. Needs special instrumentation and optical cells C. No effect
A. I and II D. AOTA
B. III and IV 90. During the onset of fever, what will happen to pCO 2 and pO 2?
C. I and III A. pCO2 will increase by 3% and pO 2 will decrease by 7%
D. II and IV B. pCO2 will increase by 7% and pO 2 will decrease by 3%
78. Which of the following NPNs is increased in using of C. pCO2 will decrease by 3% and pO 2 will increase by 7%
chemotherapy and allopurinol? D. pCO2 will decrease by 7% and pO 2 will increase by 3%
A. Ammonia 91. Which of the following is/are the cause/s of metabolic
B. Uric acid acidosis?
C. Urea A. Diarrhea
D. Creatinine B. Diarrhea and emphysema
79. Which of the following does NOT undergo detoxification in the C. Diarrhea, emphysema, and vomiting
liver? D. Diarrhea, emphysema, vomiting, and hypokalemia
A. Bilirubin 92. Which of the following is the treatment for various seizure
B. Bile acids disorders?
C. Drugs A. Carbamazepine
D. Ammonia B. Valproic acid
80. Which of the following bilirubin fraction is high is pre-hepatic C. Methotrexate
(hemolytic) jaundice? D. A and C
A. Unconjugated bilirubin 93. A condition related to excess growth hormone in children
B. Conjugated bilirubin ___________.
C. Delta bilirubin A. Gigantism
D. Both A and B B. Acromegaly
81. Kernicterus is the abnormal accumulation of bilirubin in the C. Congenital acromegaly
____________. D. Macromegaly
A. Kidney 94. Which of the following is the confirmatory test for
B. Liver acromegaly?
C. Brain A. Somatomedin C
D. Eyes B. IGF-1
82. Which of the following is the correct classification of C. Glucose suppression - OGTT (75 g)
excretion tests (p-aminohippurate test, phenosulfonthalein D. GC-MS
dye test) and concentration tests (specific gravity, osmolarity) 95. Which of the following metal has a high affinity to keratin?
A. Test for Glomerular Filtration Rate A. Arsenic
B. Test for Renal Blood Flow B. Copper
C. Test for tubular function C. Mercury
D. Both A and C D. Cyanide
83. Which of the following is NOT true about Jendrassik and Grof 96. Which of the following refers to the delivery of a drug to
Method? tissues?
A. It is based on Van den Berg reaction A. Liberation
B. It uses Caffein-Sodium benzoate as an accelerator B. Absorption
C. It is carried out in an alkaline pH C. Metabolism
D. The final reaction will produce pink to purple azobilirubin D. Distribution
84. What is the effect of high concentration of hemoglobin and 97. Which of the following is/are the screening test/s for
bilirubin to ACP determination? Cushings syndrome?
A. Increased A. 24-hour urinary free cortisol
B. Decreased
 B. 24-hour urinary free cortisol and dexamethasone
suppression test
C. 24-hour urinary free cortisol, dexamethasone
suppression test and salivary cortisol levels
D. 24-hour urinary free cortisol, dexamethasone
suppression test, salivary cortisol levels and 24-hour
UFC levels
98. Quenching decreases fluorescence. In a continuous flow
analyzer, samples flow through a common reaction vessel or
pathway.
A. The first statement is true; second statement is false
B. The first statement is false; second statement is true
C. Both statements are true
D. Both statements are false
99. When a capped blood sample is allowed to stand at room
temperature, what will happen to pH, pO 2 and pCO2 levels?
A. pH and pO 2 levels increase while pCO2 level decreases
B. pH and pO 2 levels decrease while pCO2 level increases
C. pH increases while pO2 and pCO 2 level decreases
D. pH decreases while pO2 and pCO 2 level increases
100. Which of the following is the effect of hemolysis and icteresia
to the plasma glucose measurement using hexokinase
method?
A. Falsely increased
B. Falsely decreased
C. No effect
D. Both A and C