Clinical Chemistry Quiz 2

1. Ina coupled enzymatic method for measuring serum cholesterol, the color change observed during the indicator
reaction is dependent upon the action of ______
a. ATP
b. NAD
c. Oxygen
d. Peroxidise

2. The Biuret reaction for quantitation of serum protein relies on the number of ammonia released from the protein.
The Kjeldahl reaction is a more specific and sensitive method than the Biuret method.
a. Statement 1 is true while statement 2 is false
b. Statement 2 is true while statement 1 is false
c. Both statements are true
d. Both statements are false
*biuret- copper sulphate for peptide bonds
*kjeldahl- measures ammonia(CHO-AA>NH3) uses sulphuric acid as digesting agent
FORMS COLORS
Nesslers rgt- K2HgI4 and color developer: GUM GHATTI (+) yellow
Berthelots rgt- alk hypochloride and color developer: NITROPRUSSIDE (+) blue

3. All of the following migrate to the Beta region in electrophoresis except?

a. Complement
b. Fibrinogen
c. Haptoglobin
d. Transferrin
Anode(-)
Albumin- alb
Alpha1- all alpha 1(antitrypsin, antichymotrypsin, feto protein)
Alpha 2- CHaPA(ceruloprotein or blue protein, haptoglobin, alpha2 macroglobulin)

4. It is a type of electrophoresis that separates proteins based on electro-osmostic flow

a. Isoelectric focusing separate proteins based on isoelectric point
b. Capillary electrophoresis
c. Zone electrophoresis based on charged macromolecules
d. Iontophoresis small charged ions
*Gibson and cooke pilocarpine iontophoresis- for cystic fibrosis(chloride- confirmatory test)
Pilocarpine-sweat inducer
Clinical Chemistry Quiz 2

5. A normal serum protein electrophoresis has approximately 60% albumin and 5-10% of each of the orher 4 fractions.
If an electrophoresis pattern showed 40% albumin, 10% alpha-1, 30% alpha-2, 15% beta and 5% gamma, you would
expect what condition to exist in the patient?
a. Monoclonal gammopathy
b. Cirrhosis
c. Acute inflammation
d. Nephritic syndrome
*loss of shield of negativity
Blood in slightly alk.- proteins in blood is (-) (ALBUMIN – no shield of negativity so alb is released in urine= DEC
ALB)
DEC alb, N alpha1, INC alpha2(A2 macroglobin is big so it accumulates in blood bc it cannot pass the
glomerulus), SLIGHTLY INC beta, N gamma
*Absent alpha1- alpha1 antitrypsin deficiency(AAT deficiency) common with emphysema and COPD
*Spike in gamma- monoclonal gammopathy- MM
*No albumin- analbuminemia
*Bisalbuminemia- 2 heads
*Beta-gamma bridging- cirrhosis(INC IgA)

6. Which of the following is the appropriate formula used for the computation of serum osmolality?
a. (2.5 x Na) + (Glucose x 1.8) + (BUN x 2)
b. Na + Glucose + BUN
c. 2Na + Glucose/18 + BUN/2.8
d. Na + Glucose/1.8 + BUN/28
N: 275-295 miliosmole/mg
Sodium is the greatest determinant in serum osmolality(colligative properties- BP and osmotic pressure-
directly prop to osmolality, Freezing point and vapour pressure- inversely prop to osmolality)

7. Conversion factor of creatinine (conventional to SI)

a. 88.4
b. 17.1 bilirubin
c. 0.059 uric acid
d. 0.357 BUN
*2.14 BUN or Urea

8. Which of the following if TRUE of an isoenzyme?

a. Any group of isoenzyme that will react the same to heat denaturation (PLAINLIBO for ALP is different)
b. The electrophoretic property is different for each isoenzyme
c. The rate of reaction is the same for each isoenzyme
d. The substrate is different for each isoenzyme SAME SUBSTRATE
Clinical Chemistry Quiz 2

9. In enzyme reaction, ZERO order kinetics is best described by:

a. Reaction rate is equal to substrate concentration
b. Only a fixed number of substrate is converted to product per second
c. Increase in enzyme concentration also leads to an increase in the rate of reaction
d. Increase in substrate concentration also leads to an increase in the rate of reaction
*zero order- enzyme dependent
*first order- substrate dependent (1 sub)
*second order- substrate dependent (2 sub)

10. Which of the following is an incorrect pair?

a. Fearon’s reaction: BUN
b. Jaffe reaction: Creatinine
c. Caraway Method: Urea
d. Glutamate Dehydrogenase: Ammonia
*Caraway- UA- phosphotungstic acid (+)tungsten blue
*fearons- diacetyl monoxime(DAM) (+) yellow
*Jaffe- picric acid(yellow) plus sodium hydroxide (+) reddish-orange
*Glutamate dehydrogenase- ammonia(change in abs of NADH and NAD)

11. In cases of bacterial meningitis, what is the order of LDH isoenzyme from highest concentration to weakest?
a. 12345
b. 21345
c. 54321
d. 45321
*CSF Normal-12345; Seizure-21345; Bacte meningitis- 54321
*Serum Normal-21345, AMI-12345

12. In a patient with liver disease. What is the expected result of his ammonia levels?
a. Increased
b. Decreased
c. Normal
d. Cannot be determined as ammonia is not affected by liver disease
Ammonia is toxic- brain- neurotoxic so should be converted to urea(less harmful) in the liver
*Liver damage- LOW BUN- no conversion
13. The oncofetal form of ALP expressed by tumor cells diagnostic of Hepatoma?
a. Placental ALP tumor marker for germ cell tumor
b. Kasahara ALP- TM for hepatoma or hepatocellular carcinoma and GIT tumors(can also be AFP)
c. Regan ALP lung cancer
d. Nagao APL adenocarcinoma of pancreas
Clinical Chemistry Quiz 2

14. Consider the following:

Initial appearance of serum- Milky
Appearance of serum after standing @ 4C overnight- Creamy layer over turbid serum
Triglyceride concentration- 2.120 mg/dL
Cholesterol concentration- 600 mg/dL

How would a lipoprotein electrophoresis appear for this serum?

a. Heavy beta band

b. Heavy beta and pre-beta band
c. Heavy bands at origin and pre-beta region
d. Heavy band at origin
CM- not move- origin
VLDL- pre beta
LDL- beta
HDL- alpha

15. Recommended levels on serum samples by the NCEP:

1 triglycerides less than 150 mg/dL
2 HDL less than 60 mg/dL
3 LDL greater than 160 mg/dL
4 Total cholesterol less than 200 mg/dL

a. 1 only
b. 2 only
c. 1 and 4
d. 2 and 3
e. 1234
TAG<150
TC<200
LDL<130
HDL>40
>60 protective level

16. Chief by-product of adenine and guanine metabolism

a. Urea
b. Ammonia
c. Creatinine
d. Uric Acid

17. A disease characterized by hepatic destruction following recovery from an acute viral infection wherein the patient
develops neurologic abnormalities
a. Kernicterus
b. Reye’s Syndrome
c. Lesch-Nyhan Syndrome
Clinical Chemistry Quiz 2

d. Uremia
*after viral infxn and intake of aspirin

18. Highest levels of ALP are seen in what disease?

a. Paget’s disease
b. Pernicious Anemia highest levels of LDH
c. Duchenne Muscular Dystrophy high CK-MM
d. Sarcoidosis high ACE(angiotensin converting enzyme)
e. Chemotherapy for leukemia high uric acid
*Pagets or otitis deformans
19. It is known to be the first enzyme to rise in cases of Acute Pancreatitis
a. AMS
b. LPS specific
c. AST
d. Aldolase

20. What method is known to be the classical reference method for the detection if LPS?
a. Turbidimetric Method simplest
b. Enzymatic Colorimetric Method common
c. Cherry-Crandall – 24hrs incubation(+) purple, substrate- olive oil or trycholine
d. Reitman and Frankel

21. All of the following electrolytes decrease in cases of renal failure except:
a. Sodium
b. Potassium
c. Chloride
d. Calcium
*INC- renal failure- ASINAN CA (Na, Ca0
*DEC- MAG KAPE (Mg, K, PO4)

22. It is the 2nd most abundant intracellular cation

a. Potassium major IC cation
b. Sodium major EC cation
c. Magnesium
d. Calcium most abundant cation in the body
*Cl- major EC anion
*HCO3- major IC anion

23. Samples for calcium analysis by AAS must be diluted with a lanthanum solution because lanthanum ions
a. Serve as blank for variations in flame temperature
b. Blank for variations in lamp intensity
c. Emit light used as the internal standard
d. Enhance dissociation of calcium phosphate
*Mg may interfere- use hydroxychinoline Po4a lanthanum
Clinical Chemistry Quiz 2

24. A single tube of CSF is received in the laboratory and the following tests requested TP, Alb, IgG quantitation culture,
Gram Stain, Leukocyte Count and Differential Cell Count. The specimen should be sent to the various laboratories in
which order?
a. Chemistry, hematology, microbiology
b. Chemistry, microbiology, hematology
c. Hematology, microbiology, chemistry
d. Microbiology, hematology, chemistry
*bc chem. Uses least amount of serum

25. Describe the LDL result of 147 mg/dL

a. Normal
b. Borderline High
c. High
d. Very High
*LDL
Normal <130
Optimal- <100
Near optimal 100-129
Borderline high 130-159
High >160

26. Most specific test for acute pancreatitis

a. Lipase
b. Amylase
c. AST
d. Trypsin

27. It is a useful marker in differentiating elevated of ALP in serum?

a. ALT
b. ACP
c. GGT
d. AST
*ALP- liver or bone
*INC ALP INC GGT- hepatobillary
*INC ALP N GGT- BONE
Clinical Chemistry Quiz 2

28. A 53 year old female patient has pronounced jaundice foe the past 3 months. Given the following data this is most
consistent with:
Direct Bilirubin Markedly increased
Indirect Bilirubin Normal
ALP Markedly increased
AST Slightly increased
GGT Markedly increased
a. Acute Hepatitis
b. Paget’s Disease
c. Chronic Hepatitis
d. Obstructive Jaundice

29. This method for LDH measurement catalyzes lactate to pyruvate at pH 8.3
a. Oliver and Rosalki
b. Wacker Method
c. Wrobleuski La Due
d. Karmen Method

30. A serum drawn in the emergency room from a 42 year old man yielded the following laboratory results

Test Patients result Reference range

CK 185 15-160
AST 123 0-48
CKMB 6 2-12
Which of the following conditions might account for these values?

a. Crush injury to the thigh

b. Cerbrovascular accident
c. Pulmonary infarction
d. Early acute hepatitis
*INC CK and AST- muscle
30.
31. A patient with myoproliferative disorder has the following values
Hgb 13 g/dL(mmol/L)
Hct 38%
WBC 30 x10^2/uL
Platelets 1000 x 10^3/uL
Serum Na 140 mmol/L
Serum K 7 mmol/L

The serum should be confirmed by

a. Repeat testing of the original serum
b. Testing freshly drawn serum
c. Testing heparinised plasma
d. Atomic absorption soectrometry
*7mmol potassium- dead px/ hemolyzed blood/ INC platelets
Clinical Chemistry Quiz 2

32. The most critical ion which can cause sudden death:
a. Sodium
b. Calcium
c. Potassium
d. Chloride

33. A reciprocal relationship exists between

a. Sodium and potassium
b. Calcium and phosphate
c. Chloride and CO2
d. Calcium and Magnesium
*PTH INC Ca, INC excretion of phosphate

34. What is the percentage of serum calcium that is ionzed?

a. 30%
b. 45%
c. 60%
d. 80%

35. A potassium level of 6.8 mEq/L (6.8mmol/L) is obtained. Before reporting the results, the first step the technologist
should take is:
a. Check the serum for hemolysis
b. Rerun the test
c. Check the age of the patient
d. Do nothing, simply report the result

36. Creatinine clearance is used to estimate the

a. Tubular secretion of creatinine
b. Glomerular secretion of creatinine
c. Renal glomerular and tubular mass
d. Glomerular filtration rate
*Conc test- tubular reab

37. The principal excretory form of nitrogen is:

a. Amino Acids
b. Creatinine
c. Urea
d. Uric acid

38. A patient with glomerulonephritis is most likely to present with the following serum results:
a. Creatinine decreased
b. Calcium increased
c. Phosphorus decreased
d. BUN increased
Clinical Chemistry Quiz 2

39. Which of the following formulas is the correct expression for creatinine clearance?
a. U/P x V x 1.73/A
b. P/V x U x A/1.73
c. P/V x U x 1.73/A
d. U/V x P x 1.73/A

40. Urea is produced from

a. The catabolism of proteins and amino acids
b. Oxidation of purines
c. Oxidation of pyrimidines
d. The breakdown of complex carbohydrates

41. Result of the electrolyte test of a 24 year old male patient. What is the anion gap?
Sodium- 139 mEq/L Magnesium- 3.5 mEq/L
Chloride 102 mmol/L Bicarbonate- 23 mmol/L
a. 14 mmol/L
b. 18 mmol/L
c. 37 mmol/L
d. 116 mmol/L

42. Referring to item 41, the result of his anion gap is?
a. Low anion gap
b. Normal anion gap
c. High anion gap
d. Markedly increased

43. Compute for the anion gap

Sodium- 140 mmol/L Bicarbonate- 18 mmol/L
Potassium- 3.5 mmol/L Chloride- 100 mmol/L
Magnesium- 1.0 mmol/L

a. 20 mmol/L
b. 25.5 mmol/L
c. 35.3 mmol/L
d. 106 mmol/L

44. Referring to item number 43 the interpretation of anion gap is?

a. Low anion gap
b. Normal anion gap
c. High anion gap
d. Markedly decrease
Clinical Chemistry Quiz 2

45. An elevated anion gap may be caused by the following conditions except:
a. Uremia/ renal failure
b. Instrumental error
c. Methanol poisoning
d. Hypoalbuminemia
*(MUDPILES) methanol poisoning, uraemia/renal failure, diabetic ketoacidosis, propynyl glycol poisoning, iron
toxicity, lactic acidosis, ethylene glycol poisoning, salicylates
*Normal (DARTA) diarrhea, addissons, renal tubular acidosis
*Low- hypoalubinemia, para proteinemia

46. Which salts are frequently administered to patients with preeclampsia?

a. Chloride
b. Iron
c. Magnesium
d. Sodium

47. The first step in analyzing a 24 hour urine specimen for quantitative urine protein:
a. Subculture the urine for bacteria
b. Add the appropriate preservative
c. Screen for albumin using a dipstick
d. Measure the total volume

48. A patients blood was drawn at 8 am for serum iron determination. The result was 85 ug/dL. A repeat specimen was
drawn as 8 PM, the serum was stroed as 4 deg C and ran the next moening. The result was 40 ug/dL. These results
are most likely due to:
a. IDA
b. Improper storage of the specimen
c. Possible liver damage
d. The time of the day the second specimen was collected
*Diurnal variation peaks at morning and 30% DEC at night

49. One set of results would be consistent with microamylasemia

a. Normal serum AMS and elevated urine AMS values
b. Increased serum AMS and normal urine AMS values
c. Increased serum and urine AMS values
d. Normal serum and urine AMS values

50. The first enzyme to elevate when myocardial infarction occurs

a. ALT
b. AST
c. LD
d. CK