PRE-BOARD EXAMINATION IN CLINICAL CHEMISTRY (PART 2)

1. 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
2. The reproducibility of test measurements is referred to as:
A. Accuracy B. Precision C. Quality control D. Reliability
3. 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%
4. Given the following data, calculate the coefficient of variation for glucose.
Analyte Mean Standard deviation
Glucose 76 mg/dL 2.3
A. 3.0% B. 4.6 % C. 7.6% D. 33.0%
5. A cholesterol QC chart has the following data for the normal control:
x = mean of data
x = 137 mg/dL x = 1,918 mg/dL
2 SD = 6 mg/dL N = 14
The coefficient of variation for this control is:
A. 1.14% B. 2.19% C. 4.38% D. 9.49%
6. Which Westgard rule detects random error?
A. 13s B. 41s C. 22s D. 100
7. In addition to the number of true negative (TN), which of the following measurements is needed to calculate
specificity?
A. True positives B. Prevalence C. False negatives D. False positives
8. 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
9. Nephelometry is based on the measurement of light that is:
A. Absorbed by particles in suspension C. Produced by fluorescence
B. Scatterd by particles in suspension D. Produced by excitation of ground-state atoms
10. Which of the following instruments is used in the clinical laboratory or in reference laboratories to detect beta and
gamma emissions?
A. Fluorometer B. Nephelometer C. Spectrophotometer D. Scintillation counter
11. 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
12. The cellulose acetate electrophoresis at pH 8.6 of serum proteins will show an order of migration beginning with the
fastest migration as follows:
A. Albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin
B. Alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin, albumin
C. Albumin, alpha-2 globulin, alpha-1 globulin, beta globulin, gamma globulin
D. Gamma globulin, beta globulin, alpha-2 globulin, alpha-1 globulin, albumin
13. Ceruloplasmin and haptoglobin migrate electrophoretically as:
A. Alpha1 globulins B. Alpha2 globulins C. Beta globulins D. Gamma globulins
14. Which of the following serum protein fractions is most likely to be elevated in patients with nephrotic syndrome?
A. Alpha-1 globulin B. Albumin C. Alpha-2 globulin D. Beta globulin and gamma globulin
15. 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
16. Which hemoglobin may be differentiated from other hemoglobins on the basis of its resistance to denature in alkaline
solution?
A. A1 B. A2 C. C D. F
17. Which of the following ezymes does not belong to the class of enzymes known as hydrolases?
A. Aldolase B. Amylase C. Lipase D. Alkaline phosphatase
18. Which of the following enzymes is a transferase?
A. ALP B. CK C. Amylase D. LD
19. When myocardial infarction occurs, in what order (list from first to last) will the enzymes aspartate aminotransferase
(AST), creatine kinase (CK), and lactate dehydrogenase (LD) become elevated in the serum?
A. AST, LD, CK B. CK, LD, AST C. CK, AST, LD D. LD, CK, AST
20. 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
21. An electrophoretic separation of lactate dehydrogenase isoenzymes that demonstrates an elevation in LD-1 and LD-2
in a “flipped” pattern is consistent with:
A. Myocardial infarction B. Viral hepatitis C. Pancreatitis D. Renal failure
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. Which enzymes are generally quantified to help diagnose acute pancreatitis?
A. ALT and CK B. ALT and LD C. Amylase and lipase D. ALP and cholinesterase
24. Select the most sensitive marker for alcoholic liver disease.
A. AST B. ALT C. GGT D. None of these
25. In an adult, a normal GGT level with an elevated serum ALP level may be suggestive of:
A. Bone disease B. Heart disease C. Liver disease D. Skeletal muscle disease
26. The relative concentration of LD isoenzymes in normal serum:
A. LD 1>2>3>4>5 B. LD 2>1>4>3>5 C. LD 2>1>3>4>5 D. LD 5>4>3>2>1
27. A decreased LDH/HBD ratio is significant for:
A. Myocardial infarction B. Liver disease C. Both of these D. None of these
28. Isoenzyme of ALP that is most heat stable:
A. Placental ALP B. Bone ALP C. Intestinal ALP D. Liver ALP
29. Which of the following hormones does not promote an increase in blood glucose levels?
A. Growth hormone B. Cortisol C. Glucagon D. Insulin
30. Of the following blood glucose levels, which would you expect to result in glucose in the urine?
A. 60 mg/dL B. 120 mg/dL C. 150 mg/dL D. 225 mg/dL
31. An individual has a plasma glucose level of 110 mg/dL. What would be the approximate glucose concentration in the
patient’s cerebrospinal fluid?
A. 33 mg/dL B. 55 mg/dL C. 66 mg/dL D. 110 mg/dL
32. Select the enzyme that is most specific for -D-glucose:
A. Glucose oxidase C. Hexokinase
B. Glucose-6-phosphate dehydrogenase D. Phophohexoisomerase
33. 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
34. 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
35. Measurement of glycosylated albumin, which reflects hyperglycemic state within the previous 2 – 3 weeks is:
A. Glucosamine B. Fructosamine C. Urine glucose D. Galactosamine
36. Type I DM maybe described by all of the following, EXCEPT:
A. Insulin dependent B. Insulinopenia C. Ketosis prone D. Adult-onset type
37. What is the compound that comprises the majority of the nonprotein-nitrogen fractions in serum?
A. Uric acid B. Creatinine C. Ammonia D. Urea
38. What analyte is measured using the Jaffe reaction?
A. Urea B. Uric acid C. Ammonia D. Creatinine
39. The creatinine clearance test is routinely used to assess the glomerular filtration rate. Given the following information
for an average-size adult, calculate the creatinine clearance.
Urine creatinine - 120 mg/dL
Plasma creatinine - 1.2 mg/dL
Urine volume for 24 hours - 1520 mL
A. 11 mL/min B. 63 mL/min C. 95 mL/min D. 106 mL/min
40. Given the following data, calculate the creatinine clearance, Serum creatinine = 1.2mg/dL; urine creatinine =- 120
mg/dL; urine volume = 1.75 L/day; surface area = 1.80 m 2.
A. 16 mL/min B. 117 mL/min C. 126 mL/min D. 168 mL/min
41. During chemotherapy for leukemia, which of the following analytes would most likely be elevated in the blood?
A. Uric acid B. Urea C. Creatinine D. Ammonia
42. 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
43. Blood ammonia levels are usullay measured in order to evaluate:
A. Renal failure B. Acid-base status C. Hepatic coma D. Malabsorption
44. Indirect-reacting bilirubin may be quantified by reacting it initially in which reagent?
A. Dilute hydrochloric acid C. Caffeine-sodium benzoate
B. Dilute sulfuric acid D. Sodium hydroxide
45. 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
46. 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 B. Dubin-Johnson syndrome C. Rotor’s syndrome D. Crigler-Najjar syndrome
47. A decrease in which of the following indicates increased intravascular hemolysis?
A. Methemoglobin B. Methemalbumin C. Haptoglobin D. Hemopexin
48. 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 +
49. 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
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50. 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
51. Apolipoprotein A is the primary protein component of:
A. HDL B. LDL C. VLDL D. None of these
52. The lipoprotein that transports the exogenous triglycerides:
A. HDL B. LDL C. VLDL D. Chylomicrons
53. “Floating beta lipoprotein” refers to:
A. B-VLDL B. HDL C. VLDL D. B-LDL
54. Which of the following is referred to as the “good cholesterol”?
A. HDL B. LDL C. VLDL D. Free cholesterol
55. Which of the following diseases results from a familial absence of high density lipoprotein?
A. Krabbe disease B. Gaucher disease C. Tangier disease D. Tay-Sachs disease
56. The chemical composition of HDL cholesterol corresponds to:
A. Triglyceride 60% Cholesterol 15% Protein10% C. Triglyceride 5% Cholesterol 15% Protein 50%
B. Triglyceride 10% Cholesterol 45% Protein 25% D. Triglyceride 85% Cholesterol 5% Protein 2%
57. 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
58. 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
59. A patient’s total cholesterol is 300 mg/dL, his HDL cholesterol is 50 mg/dL, and his triglyceride is 200 mg/dL. What is
this patient’s calculated LDL cholesterol?
A. 200 B. 210 C. 290 D. 350
60. Which is the major intracellular cation?
A. Calcium B. Magnesium C. Sodium D. Potassium
61. Which is the major extracellular cation?
A. Chloride B. Sodium C. Magnesium D. Calcium
62. In cystic fibrosis, which sweat electrolytes are elevated?
A. Calcium and chloride C. Sodium and potassium
B. Chloride and sodium D. Potassium and chloride
63. A hemolyzed sample will cause falsely increased levels of each of the following EXCEPT:
A. Potassium B. Sodium C. Phosphate D. Magnesium
64. When measuring potassium using ion-selective electrode, the membrane is composed of:
A. Glass B. Plastic C. Silver D. Valinomycin
65. The total iron binding capacity (TIBC) test is performed to assess the blood level of:
A. Ferritin B. Hemopexin C. Iron D. Transferrin
66. Which protein is produced in decreased amount in Wilson’s disease?
A. Albumin B. Ceruloplasmin C. Haptoglobin D. Hemopexin
67. At blood pH 7.40, what is the ratio of bicarbonate to carbonic acid?
A. 15:1 B. 20:1 C. 25:1 D. 30:1
68. The reference range for blood pH is:
A. 7.28 – 7.34 B. 7.33 – 7.37 C. 7.35 – 7.45 D. 7.45 – 7.50
69. The most important buffer pair in plasma is the:
A. Phosphate / biphosphate pair C. Bicarbonate / carbonic acid pair
B. Hemoglobin / imidazole pair D. Sulfate / bisulfate pair
70. 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
71. A common cause of respiratory alkalosis is:
A. Vomiting B. Starvation C. Asthma D. Hyperventilation
72. Which of the following is the primary mechanism of compensation for metabolic acidosis?
A. Hyperventilation B. Hypoventilation C. Aldosterone release D. Bicarbonate excretion
73. Severe diarrhea causes:
A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
74. TSH is produced in the:
A. Hypothalamus B. Pituitary gland C. Adrenal cortex D. Thyroid
75. 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
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 is used to quantitate the concentration of:
A. Free T3 B. Protein-bound T3 C. Total T3 D. TBG
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78. 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
79. The principal estrogen produced during pregnancy is:
A. Estrone B. Estradiol C. Estriol D. Corticosterone

80. The Kober reaction is used in the assay of:

A. Urinary estrogen B. Glucocorticoids C. Testosterone D. Epinephrine
81. In which of the following would gastrin levels be increased:
A. Peptic ulceration C. Achlorhydria
B. Zollinger-Ellison syndrome D. Amyloidosis
82. 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
83. 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 B. Porter-Silber ReactionC. Zimmerman Reaction D. Pisano Method
84. A marked increase in 5-HIAA excretion occurs in patients with:
A. Argentaffinoma B. Diabetes insipidus C. Pheochromocytoma D. Diabetes mellitus
85. Which vitamin would be affected if a patient was diagnosed with a disorder involving fat absorption?
A. Vitamin B12 B. Ascorbic acid C. Thiamine D. Vitamin K
86. Which of the following drugs would be correctly classified as antiepileptic?
A. Digoxin B. Chloramphenicol C. Phenytoin D. Disopyramide
87. Digoxin, procainamide, and quinidine are drugs that may be classified as:
A. Aminoglycosides B. Anticonvulsants C. Antideppresants D. Cardioactive
88. The medication of choice for treatment of manic-depression is:
A. Carbamazepine B. Lithium carbonate C. Phenobarbital D. Phenytoin
89. A drug that relaxes the smooth muscles of the bronchial passages is:
A. Acetaminophen B. Lithium C. Phenytoin D. Theophylline
90. Which of the following drugs may be quantified colorimetrically using Trinder’s reagent (mercuric chloride, ferric nitrate
and hydrochloric acid)?
A. Acetaminophen B. Phenobarbital C. Salicylate D. Theophylline
91. Cocaine is metabolized to:
A. Carbamazepine B. Codeine C. Hydrocodone D. Benzoylecgonine
92. 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
93. Caffeine is an important metabolite of this drug:
A. Acetaminophen B. Digoxin C. Theophylline D. Phenobarbital
94. Odor of bitter almond:
A. Cyanide poisoning B. Ethanol poisoning C. Arsenic poisoning D. CO poisoning
95. 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
96. 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
97. 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
98. 4 mL of water is added to 1 mL of serum. This represents which of the following serum dilutions?
A. 1:3 B. 1:4 C. 1:5 D. 1:6
99. What is the molarity of a solution that contains 18.7 g of KCl (MW =74.5) in 500 mL of water?
A. 0.1 B. 0.5 C. 1.0 D. 5.0
100. 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

END OF THE EXAM