PRE-BOARD EXAMINATION IN CLINICAL CHEMISTRY (PART 1)

1. All of the following are correct match, EXCEPT:

Conversion of Conventional Unit to SI Unit:
Conventional Unit SI Unit
A Cholesterol 150 mg/dL 3.88 mmol/L
B Triglyceride 10 mg/dL 0.11 mmol/L
C Glucose 70 mg/dL 3.9 mmol/L
D BUN 8 mg/dL 0.47 mmol/L
2. A cholesterol quality control chart has the following data for the normal control:
Mean o f the data (X) = 150 mg/dL
2 Standard deviation = 4
X = 1,372 mg/dL
N = 10
Determine the coefficient of variation for this control:
A. 1.33% B. 2.67% C. 15.0 % D. 7.06%
3. The extent to which measurements agree with the true value of the quantity being measured is known as:
A. Acceptable limits B. Accuracy C. Precision D. Reliability
4. The reproducibility of test measurements is referred to as:
A. Accuracy B. Precision C. Quality control D. Reliability
5. In a Gaussian curve distribution, the 2 SD range includes the following percentage of values:
A. 31.6% B. 68.3% C. 95.5% D. 99.7%
6. Which Westgard rule detects random error?
A. 13s B. 41s C. 22s D. 100
7. The component of a spectrophotometer that is responsible for detecting transmitted light and converting light energy
to electrical energy is the:
A. Detector B. Analytical cell C. Monochromator D. Readout device
8. The process by which fluorescence of an analyte is reduced due to the excited molecule losing some of its energy by
interacting with other substances in a solution is known as:
A. Ionization B. Quenching C. Phosphorescence D. Self-absorption
9. In flow cytometry, the side scatter is related to the:
A. DNA content of the cell C. Size of the cell
B. Granularity of the cell D. Number of cells in G0 and G1
10. Which of the following approaches of automated analyzers uses a rotor to mix reagents?
A. Centrifugal analysis C. Discrete analysis
B. Continuous flow D. Dry chemistry slide analysis
11. Which of the following chemistry analyzers uses “slides” to conatin the entire reagent system?
A. Vitros analyzers C. Paramax analyzers
B. ACA analyzers D. None of the above
12. Ceruloplasmin and haptoglobin migrate electrophoretically as:
A. Alpha1 globulins B. Alpha2 globulins C. Beta globulins D. Gamma globulins
13. In cirrhosis, a predominant characteristic observed in electrophoretic serum pattern is a(an):
A. Increase in alpha2 globulin fraction C. Monoclonal band in gamma globulin region
B. Bridging effect between beta and gamma globulin fraction D. Polyclonal band in gamma globulin region
14. A congenital disorder characterized by a split in the albumin band when serum is subjected to electrophoresis is
known as:
A. Analbuminemia C. Bisalbuminemia
B. Anodic albuminemia D. Prealbuminemia
15. Which enzymes are generally quantitated to help diagnose acute pancreatitis?
A. ALT and CK C. Amylase and lipase
B. ALT and LD D. ALP and cholinesterase
16. Serum levels of total CK are elevated after an acute myocardial infarction and in which of the following conditions?
A. Diabetes mellitus C. Duchenne type muscular dystrophy
B. Chronic renal failure D. Early pregnancy
17. The isoenzymes LD-4 and LD-5 are elevated in:
A. Pulmonary embolism C. Renal disease
B. Liver disease D. Myocardial infarction
18. Which of the following liver enzymes is the best to use to evaluate liver function?
A. AST B. GGT C. ALT D. LD
19. In an adult, a normal GGT level with an elevated serum ALP level may be suggestive of:
A. Bone disease C. Liver disease
B. Heart disease D. Skeletal muscle disease
20. A decreased LDH/HBD ratio is significant for:
A. Myocardial infraction C. Both of these
B. Liver disease D. None of these
21. Isoenzyme of ALP that is most heat stable:
A. Placental ALP C. Intestinal ALP
B. Bone ALP D. Liver ALP
22. Which of the following enzymes exhibit a decreased serum level in liver disease?
A. Alanine aminotransferase D. Cholinesterase
B. Gamma glutamyltransferase E. All of the above
C. Lactate dehydrogenase
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23. The relative concentration of LD isoenzymes in normal serum:
A. LD 1>2>3>4>5 C. LD 2>1>4>3>5
B. LD 2>1>3>4>5 D. LD 5>4>3>2>1
24. Substrate exhibiting high specificity for prostatic acid phosphatase:
A. Beta-glycerophosphate (Bodansky)
B. Phenylphosphate (Gutman, King-Armstrong)
C. Thymolphthalein phosphate (Roy)
D. Alpha-naphthylphosphate (Babson and Reed)
25. Time course of CK activity in myocardial infarction:
Onset of Elevation Peak Activity Duration of Elevation
A 1-3 h 5-12 h 18-30 h
B 4-8 h 12 h 3-4 d
C 8-12 h 24 h 5d
D 12-24 h 72 h 10 d
26. Serum enzymes typically elevated due to skeletal muscle disease:
A. Aspartate aminotransferase, Creatine kinase, Lactate dehydrogenase
B. Aspartate aminotransferase, Alanine aminotransferase, Alkaline phosphatase
C. Aldolase, Pseudocholinesterase, Trypsin
D. 5'-Nucleotidase, Alkaline phosphatase, Gamma-glutamyl transferase
27. Most sensitive enzyme index of primary muscle involvement:
A. Aldolase B. AST C. CK D. LD
28. In pesticide poisoning, cholinesterase activity is:
A. Normal B. Decreased C. Increased D. Variable
29. Glucose oxidase oxidizes glucose to gluconic acid and:
A. H2O2 B. CO2 C. HCO3 D. H2O
30. Hexokinase catalyzes the formation of --- from glucose and ATP:
A. Acetyl CoA C. Glucose 6-phosphate
B. Fructose 6-phosphate D. Lactose
31. Select the enzyme that is most specific for -D-glucose:
A. Glucose oxidase C. Hexokinase
B. Glucose-6-phosphate dehydrogenase D. Phophohexoisomerase
32. Select the coupling enzyme used in the hexokinase method for glucose:
A. Glucose dehydrogenase C. Glucose-6-phosphate dehydrogenase
B. Glucose-6-phosphatase D. Peroxidase
33. Which of the following methods provides information about glucose metabolism over a 3 month period?
A. Fructosamine C. Glycosylated hemoglobin
B. Glucose oxidase D. Oral glucose tolerance
34. Measurement of glycosylated albumin, which reflects hyperglycemic state within the previous 2 – 3 weeks is:
A. Glucosamine B. Fructosamine C. Urine glucose D. Galactosamine
35. Type I DM maybe described by all of the following, EXCEPT:
A. Insulin dependent B. Insulinopenia C. Ketosis prone D. Adult-onset type
36. Which of the following methods estimates urine sugar concentration by measuring total reducing substances?
A. Copper sulfate C. Hexokinase
B. Glucose oxidase D. Ferricyanide
37. A patient with severe, uncontrolled case of diabetes mellitus exhibits all of the following conditions EXCEPT:
A. Glycosuria C. Ketosis
B. Hyperglycemia D. Metabolic alkalosis
38. Which NPN fraction constitutes nearly half of the NPN substances in the blood?
A. Urea C. Ammonia
B. Creatine D. Uric acid
39. In the Jaffe reaction, a red-orange chromogen is formed when creatinine reacts with:
A. Picric acid C. Diacetyl monoxime
B. Naphthylethylenediamine D. Nitroferricyanide
40. A BUN of 9 mg/dL is obtained by a technologist. What is the urea concentration?
A. 18.3 mg/dL B. 19.3 mg/dL C. 10.3 mg/dL D. 9.3 mg/dL
41. BUN/creatinine ratio in serum in renal disease:
A. >20:1 B. <10:1 C. 10:1 D. Variable
42. Uric acid is the final breakdown product of:
A. Urea metabolism C. Glucose metabolism
B. Purine metabolism D. Bilirubin metabolism
43. The bilirubin fraction that is covalently attached to albumin and contributes to the conjugated bilirubin value is:
A. Delta B. Direct C. Indirect D. Bound
44. In which of the following conditions does decreased activity of glucuronyl transferase result in increased unconjugated
bilirubin and kernicterus in neonates?
A. Gilbert’s disease C. Dubin-Johnson syndrome
B. Rotor’s syndrome D. Crigler-Najjar syndrome
45. A decrease in which of the following indicates increased intravascular hemolysis?
A. Methemoglobin C. Haptoglobin
B. Methemalbumin D. Hemopexin
46. Major carrier of liver synthesized triglycerides:
A. Chylomicrons B. HDL C. LDL D. VLDL
47. The lipoprotein that transports the exogenous triglycerides:
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A. HDL B. LDL C. VLDL D. Chylomicrons

48. “Floating beta lipoprotein” refers to:

A. B-VLDL B. HDL C. VLDL D. B-LDL
49. An abnormal lipoprotein found in patients with obstructive biliary disease:
A. B-VLDL B. LpX C. Lp(a) D. LDL
50. Which of the following is referred to as the “good cholesterol”?
A. HDL B. LDL C. VLDL D. Free cholesterol
51. Chemical composition of HDL:
Protein (%) Cholesterol (%) Triglyceride (%) Phospholipid (%)
A 1-2 1-3 80-95 3-6
B 6-10 4-8 45-65 15-20
C 18-22 6-8 4-8 18-24
D 45-55 3-5 2-7 26-32
52. Select the order of mobility of lipoproteins electrophoresed on cellulose acetate or agarose at pH 8.6.
A. – Chylomicrons  prebeta  beta  alpha + C. – Chylomicrons beta  prebeta  alpha +
B. – Beta  prebeta  alpha chylomicrons + D. – Alpha  beta  prebeta  chylomicrons +
53. Which phenotype in the Frederickson classification of hyperlipoproteinemia is characterized by an increase in
cholesterol, an increase in beta lipoproteins, normal triglycerides, and the absence of chylomicrons?
A. I B. II C. III D. IV
54. Apolipoprotein A is the primary protein component of:
A. HDL B. LDL C. VLDL D. None of these
55. Apolipoprotein affected in Tangier’s disease:
A. Apo A1 B. Apo B100 C. Apo B48 D. Apo (a)
56. A fasting serum sample from an asymptomatic 43-year-old woman is examined visually and chemically with the
following results:
Initial appearance of serum: Milky Triglyceride level : 2000 mg/dL Cholesterol level : 550 mg/dL
Appearance of serum after overnight refrigeration: Cream layer over turbid serum
This sample contains predominantly:
A. Chylomicrons alone B. chylomicrons and VLDL C. VLDL and LDL D. HDL
57. In lipoprotein phenotyping, chylomicrons are present in the plasma of persons with which of the following lipoprotein
phenotypes?
A. I and IIa B. I and IIb C. II and III D. I and V
58. Which is the major intracellular cation?
A. Calcium B. Magnesium C. Sodium D. Potassium
59. Which is the major extracellular cation?
A. Chloride B. Sodium C. Magnesium D. Calcium
60. In cystic fibrosis, which sweat electrolytes are elevated?
A. Calcium and chloride C. Sodium and potassium
B. Chloride and sodium D. Potassium and chloride
61. Hyponatremia may be caused by each of the following EXCEPT:
A. Hypomagnesemia C. Prolonged vomiting or diarrhea
B. Aldosterone deficiency D. Acute or chronic renal failure
62. Hypokalemia may be caused by each of the following EXCEPT:
A. Acidosis C. Hypomagnesemia
B. Prolonged vomiting or diarrhea D. Hyperaldosteronism
63. A hemolyzed sample will cause falsely increased levels of each of the following EXCEPT:
A. Potassium C. Phosphate
B. Sodium D. Magnesium
64. Fiske-Subbarow reaction is used in the determination of:
A. Proteins C. Inorganic phosphorus
B. Magnesium D. Calcium
65. When measuring potassium using ion-selecetive electrode, the membrane is composed of:
A. Glass B. Plastic C. Silver D. Valinomycin
66. The total iron binding capacity (TIBC) test is performed to assess the blood level of:
A. Ferritin B. Hemopexin C. Iron D. Transferrin
67. Which protein is produced in decreased amount in Wilson’s disease?
A. Albumin B. Ceruloplasmin C. Haptoglobin D. Hemopexin
68. Buffer system/s in the body:
1. Bicarbonate/carbonic acid 3. Plasma proteins
2. Hemoglobin 4. Plasma phosphates
A. 1 and 2 B. 1, 2 and 3 C. 1, 3 and 4 D. 1, 2, 3 and 4
69. In health, when the kidneys and lungs are functioning properly, a 20:1 ratio of HCO 3- to H2CO3 will be maintained,
resulting in a pH of:
A. 7.10 B. 7.30 C. 7.40 D. 7.50
70. The normal ratio of carbonic acid to bicarbonate in arterial blood is:
A. 7.4:6.1 B. 1:20 C. 0.003:1.39 D. 20:1
71. When arterial blood from a “normal patient is exposed to room air, the following happens:
A. PCO2 decreases, PO2 increases C. PCO2 decreases, PO2 decreases
B. PCO2 increases, PO2 decreases D. PCO2 increases, PO2 increases
72. Which of the following is the primary mechanism of compensation for metabolic acidosis?
A. Hyperventilation C. Aldosterone release
B. Hypoventilation D. Bicarbonate excretion
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73. Severe diarrhea causes:
A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
74. In the patient’s circulatory system, bicarbonate leaves the red blood cell and enters the plasma through an exchange
mechanism with:
A. Carbonic acid B. Lactate C. Chloride D. Sodium
75. TSH is produced in the:
A. Hypothalamus B. Pituitary gland C. Adrenal cortex D. Thyroid
76. The major carrier protein of T3 and T4 in the circulation is:
A. Albumin B. Thyroglobulin C. TBG D. Thyroxine-binding prealbumin
77. T3 uptake test os used to quantitate the concentration of:
A. Free T3 B. Protein-bound T3 C. Total T3 D. TBG
78. Thyroid function test in primary hypothyroidism:
T3 T4 TSH
A Decreased Decreased Decreased
B Decreased Decreased Increased
C Normal Increased Decreased
D Normal Normal Normal
79. A patient’s T4 is 10 mg/dL. The THBR is 24% (normal=30%). What is the FT4I?
A. 8 B. 6 C. 4 D. 2
80. All of the following are correct match, EXCEPT:
Hormone classification by structure:
A. Peptide: Insulin, TSH, FSH C. Amino acids: Nor/Epinephrine,
B. Steroid: T4, T3 D. Fatty acids: Prostaglandins
81. All of the following are correct match, EXCEPT:
Tissues and the Hormones they produce:
A. Pancreas: Insulin, Glucagon C. Adrenal medulla: Epinephrine
B. Adrenal cortex: Cortisol D. Thyroid: TSH
82. The principal estrogen produced during pregnancy is:
A. Progesterone B. Estradiol C. Estrone D. Estriol
83. The Kober reaction is used in the assay of:
A. Urinary estrogen B. Glucocorticoids C. Testosterone D. Epinephrine
84. In which of the following would gastrin levels be increased:
A. Peptic ulceration C. Achlorhydria
B. Zollinger-Ellison syndrome D. Amyloidosis
85. Which of the following may be classified as an end product of catecholamine metabolism?
A. Dopamine C. Metanephrine
B. Normetanephrine D. Vanillylmandelic acid
86. Which of the following polypeptide hormones may be described as having alpha chains that are biochemically
identical but beta chains that as biochemically unique?
A. FSH, TSH, ACTH, TRH C. TSH, LH, TRH, HCG
B. LH, ACTH, HCG, TRH D. HCG, FSH, TSH, LH
87. The assay employed for 17-ketosteroids, in which steroids react with m-dinitrobenzene in alcoholic KOH solution
resulting to the formation of a purple color:
A. Kober Reaction C. Porter-Silber Reaction
B. Zimmerman Reaction D. Pisano Method
88. A marked increase in 5-HIAA excretion occurs in patients with:
A. Argentaffinoma C. Diabetes insipidus
B. Pheochromocytoma D. Diabetes mellitus
89. Which of the following drugs would be correctly classified as antiepileptic?
A. Digoxin D. Phenytoin
B. Disopyramide E. Tacrolimus
C. Chloramphenicol
90. Digoxin, procainamide, and quinidine are drugs that may be classified as:
A. Aminoglycosides C. Antideppresants
B. Anticonvulsants D. Cardioactive
91. The medication of choice for treatment of manic-depression is:
A. Carbamazepine C. Phenobarbital
B. Lithium carbonate D. Phenytoin
92. Which of the following drugs may be quantitated colorimetrically using Trinder’s reagent (mercuric chloride, ferric
nitrate and hydrochloric acid)?
A. Acetaminophen B. Phenobarbital C. Salicylate D. Theophylline
93. Cocaine is metabolized to:
A. Carbamazepine B. Codeine C. Hydrocodone D. Benzoylecgonine
94. Four children are admitted with malaise, anorexia, and abdominal pain. Further evaluations reveal mild anemia,
erythrocyte basophilic stippling, and profound pica habits. Poisoning by which heavy metal is most likely responsible?
A. Arsenic B. Iron C. Mercury D. Lead
95. Caffeine is an important metabolite of this drug:
A. Acetaminophen B. Digoxin C. Theophylline D. Phenobarbital
96. Odor of bitter almond:
A. Cyanide poisoning B. Ethanol poisoning C. Arsenic poisoning D. CO poisoning
97. The system of choice for drug analysis because of its specificity and sensitivity is:
A. HPLC B. TLC C. GC/mass spectrometry D. None of these
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98. The formation of this crystal in urine, although not a constant finding is an important diagnostic clue of ethylene glycol
poisoning:
A. Uric acid B. Ammonium biurate C. Triple phosphate D. Calcium oxalate
99. This common substance of abuse is derived from Cannabis sativa leaves and stems. Which of the following is it?
A. Heroine B. Cocaine C. Marijuana D. Amphetamines
100. Condition characterized by an increased gastrin levels:
A. Peptic ulcer disease C. Achlorhydria
B. Zollinger-Ellison syndrome D. Amyloidosis
101. All of the following are correct match, EXCEPT:
A. Vitamin A: Retinol C. Vitamin C: Ascorbic acid
B. Vitamin B2: Cyanocobalamin D. Vitamin K: Menaquinone
102. Which type of extinguisher should put out a fire caused by electrical equipment?
Type of Extinguisher
A Pressurized water/Dry chemical
B Dry chemical/Carbon dioxide
C Carbon dioxide/Halon/Dry chemical
D Metal X/Special dry chemical
103. Specifications set by CAP define three grades of water. Type 1 reagent water is used for:
1.Preparation of standard solutions 3. Tissue or cell culture methods
2.Ultramicrochemical analyses 4. Washing glasswares
A. 1 and 3 B. 2 and 4 C. 1, 2 and 3 D. 1, 2, 3 and 4
104. Calculate the dilution if 5 mL of serum is diluted with 15 mL of saline solution.
A. 1:2 B. 1:3 C. 1:4 D. 1:5
105. How much 20% alcohol is required to make 1 liter of 10% alcohol?
A. 0.4 L B. 0.5 L C. 0.8 L D. 1.0 L

END OF THE EXAM