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Match the analyte which should be increased in the presence of these associated
diseases.
Your answers are on the left. The correct answers are on the right and highlighted.
Gout Uric acid

Muscular dystrophy Aldolase
Glomerulonephritis BUN
Pancreatitis Amylase
Feedback
Increased serum amylase levels are associated with pancreatitis. Increased serum
aldolase levels are associated with muscular dystrophy. Increased serum uric acid
levels are associated with gout. Finally, increased serum BUN is associated with
glomerulonephritis.
Which analyte measurement is used to detect early nephropathy in a diabetic patient?
The correct answer is highlighted below
Lactic acid
Microalbumin
Ketones
HbA1C
Feedback2
The detection of small concentrations of albumin (microalbumin) in the urine is used

to detect early renal impairment.
Exposing serum or plasma to a high magnetic field is neccessary for which of the
following technologies or tests?
NMR particle count

LDL electrophoresis
Immunoassay
Feedback1
NMR (nuclear magnetic resonance) uses high energy magnetic fields and radio
waves. This technology involves the absorption of electromagnetic energy (radio
waves) by the nuclei of atoms placed in a strong magnetic field. The nuclei of
different atoms absorb unique frequencies of radiation. By observing which
frequencies are absorbed and emitted, it is possible to identify analytes like lipids. The
other tests listed do not require magnetic radiation.
A 70-year-old type 2 diabetic patient is comatose and in the emergency department.

Stat blood glucose and serum ketones are ordered.
Blood Glucose: 650 mg/dL
Serum Ketones: Negative
What is the best conclusion?
Glucose result is acceptable for type 2 diabetic patient

Because of the glucose and ketone result, the patient now has type 1 diabetes
The glucose result is critical and the patient should be evaluated for
hyperosmolality
Urine glucose should be measured
Feedback3
The blood glucose value is critical; negative ketones is consistent with type 2
diabetes. An elderly type 2 diabetic patient is at risk for hyperosmolar non-ketotic
coma and osmolality should be measured.
A measurement of urine glucose would not be useful at this point.
You answered the question incorrectly.
Which of the following conditions is most likely when an oligoclonal band is seen in
CSF electrophoresis without a corresponding serum peak?
Lymphoproliferative disorder
Meningitis
Multiple sclerosis
Traumatic lumbar puncture
Feedback3
Oligoclonal bands are found in the CSF of most patients with multiple sclerosis.
Which one of the following is the MOST specific biochemical marker of myocardial
infarction?
CK
LD
Troponin
myoglobin
Feedback3
Troponin is a very specific biomarker that is released during cardiac injury or

stress. CK is found not only in cardiac tissue, but also in muscle and brain tissue. LD
levels can be elevated in cardiac events, tissue breakdown, and
hemolysis. Myoglobin is elevated when muscle tissue is damaged and is not specific
for the heart muscle.
Which one of the following is not an acute phase protein?
Alpha-1 Antitrypsin
C-Reactive Protein
Protein S
Fibrinogen
Haptoglobin
Feedback3
Protein S is a glycoprotein involved in coagulation that is not considered an acute
phase protein. Each of the other choices are, in fact, acute phase proteins.

Which of the following conditions would make a sample unsuitable for lactic acid
testing?
Hemolyzed sample
Received in the lab on ice
Centrifuged in a refrigerated centrifuge
Specimen centrifuged and plasma separated from cells less than 15 minutes after
collection
Feedback1
Hemolysis will falsely increase lactic acid concentration. A hemolyzed specimen

should be recollected.
A blood sample for lactic acid testing should be placed on ice immediately after
collection, centrifuged within 15 minutes of collection, and plasma immediately
separated from cells following centrifugation. If possible, a refrigerated centrifuge
should be used.
A mutation in a CYP450 enzyme that causes increased enzyme activity would
be a polymorphism if the mutation was present in at least 1% of the population.

require that the patient with this mutation is given greater than the standard dose
of a drug if it is metabolized by this enzyme.
lead to lower drug response with standard doses.
All of the above
Feedback4
All of the above answers are true.
A normal (wild-type) allele of a CYP450 gene displays normal metabolic activity,

whereas some of the variant forms have enhanced or diminished activity. If the
variation of the gene (allele) affects at least 1% of the population, it is considered a
polymorphism.
If a patient has a mutation in a CYP450 enzyme that causes increased enzyme
activity, he/she will probably need a higher dose than the standard dose of any drug
that is metabolized by this enzyme. If standard doses are given to a patient that has
increased enzyme activity, the drug will probably not achieve the desired affect.

Which of the following statements is FALSE regarding troponin?
It rises much sooner after an MI than CK-MB

It stays positive much longer than CK-MB
It is potentially more specific than CK-MB
Troponin T is often elevated in renal failure patients
Feedback1
Troponin is potentially more specific for myocardial damage than CK-MB and stays
elevated longer. It may eventually replace CK-MB as the standard marker of
myocardial damage. In addition, troponin T has been known to be elevated in the
setting of even mild degrees of renal failure. Troponin and CK-MB both tend to rise
approximately 3 hours after a MI (hence why the correct answer is "A", since it is
false); however, troponins can stay elevated up to 2 weeks as CK-MB tends to return
to baseline around 36 hours.
The numeric value that occurs most frequently in a sample distribution is called the:
Coefficient of Variation
Mean
Median
Mode
Standard Deviation
Feedback3
The mode of a particular set of data is the value that is repeated more often than any
other. This means that the mode is the value which is occuring most frequently in a
sample distribution.
Which of the following is necessary for the absorption of Vitamin B12:
Intrinsic factor
Folic acid
Gastrin
Insulin
Feedback1
Intrinsic factor is necessary for the proper absorption of vitamin B12. With a
deficiency of intrinsic factor, individuals can develop a megaloblastic anemia if their
bodies become deficient in vitamin B12, which plays a large role in cellular nuclear
development.
The formula for conversion of HbA1C to glucose in mg/dL is eAG = (28.7 x A1C) –
46.7.
The HbA1C measured on a patient is reported as 7.5%. What would be reported as the
estimated average glucose (eAG) for this % A1C (rounded to the nearest whole
number)?
142 mg/dL
169 mg/dL
200 mg/dL
Feedback2
The eAG for a HbA1C of 7.5% would be reported as 169 mg/dL eAG. Remember, the
formula for conversion of HbA1C to glucose in mg/dL is eAG = (28.7 x A1C) – 46.7.
So, in this case, the calculation is: eAG = (28.7 x 7.5) - 46.7 = 168.55 mg/dL.
Following a myocardial infarction which of the following enzymes will be the first to
become elevated:

CK
LDH
GGT
AST
Feedback1
GGT is elevated in liver disorders. CK rises before LDH. However myoglobin is the
earliest serum cardiac marker to rise after an infarction; it may be positive within two
hours post MI. It is not cardiac specific, and can be elevated in skeletal muscle trauma
or rhabdomyolysis.
When the body compensates for a respiratory or metabolic disorder, the MAIN goal is
to achieve:
correct carbonic acid level, since it is the most important system in the body
a normal pH
normal p02 and pCo2 for normal respiration
correct bicarbonate level, since it is the most important system in the body
Feedback2
The body compensates for alkalosis or acidosis of the blood PRIMARILY to regain a
normal pH, between 7.35 - 7.45.
Pheochromocytoma is a tumor of the adrenal medulla that results in elevated urinary

levels of all the following EXCEPT:
Cortisol
Free catecholamines
Metanephrines
Vanillylmandelic acid
Feedback1
Of the choices that are given, cortisol is the only analyte that is not elevated in the
urine.
Pheochromocytoma is an adrenal or extraadrenal neoplasm that secretes

catecholamines. Patients with pheochromocytoma often exhibit persistent and
paroxysmal hypertension. The single best screening test is urinary metanephrines.
Urinary free catecholamines, and vanillylmandelic acid are also elevated.
Which cardiac biomarker is a regulator of myocyte contraction?
Myoglobin
cTnT
CK-MB
CK-MB isoforms
Feedback3
Both cTnI and cTnT are components of the regulation of myocyte contraction.
A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose?
65 mg/dL
93 mg/dL
120 mg/dL
180 mg/dL
41 mg/dL
Feedback2
CSF glucose is roughly estimated to be about 2/3 of the serum glucose level in mg/dL.
A patient presents with the following test results:

T. Bili: 3.0 ng/dl
D Bili: 1.2 ng/dl
Urine urobilinogen: decreased
Stools color: clay colored
The MOST probable cause is:
viral infection of liver

chemical damage to liver
obstructive jaundice
hepatitis
hepatic carcinoma
Feedback3
Obstructive jaundice, also called posthepatic jaundice, is associated with an

obstruction located after the conjugation of bilirubin in the liver. Laboratory results in
this condition usually include: increased conjugated bilirubin, normal unconjugated
bilirubin, decreased or negative urobilinogen, and pale stool color. The pale stool
color is very indicative of obstructive or post-hepatic cause since normal feces get
their color from bile pigments, which are not incorporated into the stool if they are
obstructed.
What is the identification of this crystal seen in a urine with an alkaline pH?
Uric acid
Ammonium biurate
Triple phosphate
Calcium carbonate
Feedback2
Ammonium biurate crystals commonly occur in the form of "thorn apples," as shown
here, or in polyhedral shapes. They are deeply colored from a dark yellow to brown.
Identify the urine sediment element shown by the arrow:
Mucus threads
Cylindroids
Hyaline casts
Waxy casts
Feedback2
Cylindroids are similar to casts but have one tapered end. They are generally of little
clinical significance.
The Lecithin/Sphingomyelin ratio determination of amniotic fluid is useful in

assessing the probability of:
cystic fibrosis
phenylketonuria
respiratory distress syndrome
chromosomal abnormalities
Feedback3
The lecithin-sphingomyelin ratio is a test for assessing fetal lung maturity that is
useful in determining risk of an infant born with respiratory distress syndrome.
Which of the following conditions should be suspected given the following set of
serum laboratory results?
Amylase 650 U/L
Lipase 1200 U/L
Cystic Fibrosis
Pancreatitis
Myocardial Infarction
Multiple Myeloma
Feedback2
Both acute and chronic pancreatitis are associated with increased serum amylase and
lipase levels, often 5-10 times the normal range. Since the reference ranges for
amylase and lipase are approximately: 53 - 123 U/L and 10 - 150 U/L respectively,
the values shown in this case are increased.
Cystic Fibrosis can actually cause a decreased serum lipase level, while myocardial
infarctions and multiple myeloma will have little effect on serum amylase and lipase
levels.
Which of the following are functions of CSF?
The correct answers are highlighted below
Supply nutrients to nervous system tissue.

Regulate body metabolism.
Protect spinal cord from injury.
Remove waste products from cerebral metabolism.
Feedback134
Cerebrospinal fluid has three main functions:
 Protect brain and spinal cord from trauma.

 Supply nutrients to nervous system tissue.
 Remove waste products from cerebral metabolism.
 You answered the question correctly.
 All of the following concerning CK-MB (CK-2) are true EXCEPT:
 The correct answer is highlighted below
Greater than 5% or 10 IU/L followed by an LD-1: LD-2 flip is specific evidence

of myocardial infarction (MD).
CK-MB levels can be normal with an elevated total CK.
CK-MB and troponin levels can be elevated after an AMI.
CK-MB levels are normal in cardiac ischemia.
 Feedback4
 CK-MB would be abnormal in cases of cardiac ischemia since CK-MB is
released in higher amounts from cardiac muscle when the heart is damages or
overworked due to various conditions.

 Serum TSH level five times the upper limit of normal in the presence of a low
T4 and low T3 uptake could mean which of the following:
The thyroid has been established as as the cause of hypothyroidism

The thyroid is ruled-out as the cause of hypothyroidism
The pituitary has been established as as the cause of hypothyroidism
The diagnosis is consistent with secondary hyperthyroidism
 Feedback1
 During primary hypothyroidism, where a defect in the thryoid gland is
producing low levels of T3 and T4, the TSH level is increased. TSH is
released in elevated quantities in an attempt to stimulate the thryoid to produce
more T3 and T4 as part of a feedback mechanism.

 A 46-year old known alcoholic with liver damage is brought in the ER
unconscious. One would expect his lipid values to be affected in what way?
Increased
Decreased
Normal
Unaffected by the alcoholism
 Feedback1
 High triglycerides may be caused by disorders such as type 2 diabetes,
hypothyroidism, Cushing's sydnrome, liver disease, uremia, dysglobulinemia,
nephrotic syndrome, and alcoholism can cause hypertriglyceridemia.
 The laboratory test used to determine the presence of neural tube defects is:
L/S ratio
Amniotic fluid creatinine
Sweat chloride test
Alpha-fetoprotein
 Feedback4
 Alpha-fetoprotein is protein that is measured in pregnant women, using
maternal blood or amniotic fluid, as a screening test for a subset
developmental abnormalities: it is principally increased in open neural tube
defects and decreased in Down syndrome. Amniotic fluid creatinine has been
used to measure fetal maturity as has the L/S ratio. The sweat chloride test is
used for cystic fibrosis evaluation.
A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL
and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-
hour period was 1,800 mL. Calculate the creatinine clearance for this patient in
mL/min.
100
144
56
225
177
Feedback1
The creatinine clearance for this patient is 100 mL/min.

Creatinine clearance values are calculated using the following equation:
Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine
Volume (mL) / [ time (hr) x 60 ]
For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60])
80 x 1800/1440, which is 80 x 1.25, or 100 mL/min
The volume of urine recommended for centrifugation for a microscopic examination

is:
1 - 3 mL
10 - 15 mL
15 - 20 mL
Volume is not important
Feedback2
It is good laboratory practice to centrifuge between 10 and 15 mL of urine (when

available) to obtain an optimal sample for microscopic evaluation.
Which of the following statements about the test for C-reactive protein (CRP) is
TRUE?
It correlates with neutrophil phagocytic function

It is an indicator of an inflammatory condition
It is diagnostic for rheumatic fever
It is part of the complement cascade
Feedback2
C-reactive protein is produced by the liver. The level of CRP rises when there is
inflammatory processes happening in the body.
The National Heart, Lung, and Blood Institute initiated the National Cholesterol
Education Program (NCEP) in 1985. The goal was to reduce the number of
Americans with elevated cholesterol and thus reduce illnesses and deaths in the
United States due to coronary heart disease. Three adult treatment panels have been
published since then with clinical practice guidelines for managing cholesterol levels
in adults.
The most recent panel, Adult Treatment Panel III (ATP III), was published in 2001
and updated in 2004. The NCEP: ATP III also includes criteria for the diagnosis of
metabolic syndrome.
Select the set of laboratory assays that are utilized in the NCEP: ATP III criteria for
metabolic syndrome diagnosis.
LDL-C, triglycerides, HDL-C, and fasting blood glucose

Fasting blood glucose, triglycerides, insulin, and VLDL
Fasting blood glucose, triglycerides, HDL-C
Fasting blood glucose, triglycerides, HDL-C, and VLDL
Feedback3
Fasting blood glucose, triglycerides, HDL-C along with waist circumference and
blood pressure are the measurements used in the NCEP: ATP III criteria.
Which one of the following adipocyte products is an important messenger in

metabolism, signaling the hypothalamus that there are changes in fat stores?
Leptin
Resistin
IL-6
Angiotensinogen
Feedback1
Leptin signals the hypothalamus that there are changes in fat stores.
Resistin increases insulin resistance and enhances adhesion molecules present on

endothelial cells.
IL-6 responds to tissue injury. IL-6 increases insulin resistance by inhibiting insulin
receptor signal transduction in liver cells. It also increases other inflammatory
cytokines, interleukin-1 (IL-1) and TNF-, and stimulates the liver to produce C-
reactive protein (CRP).
Adipose tissue and liver cells produce angiotensinogen, a precursor of angiotensin II.
Besides increasing blood pressure, angiotensin II may stimulate adipose cell
formation and thus increase adipose mass.
Which of the following represents a diagram of a spectrophotometer?
hollow cathode - cuvette - monochromator - detector – readout

cuvette - light source - monochromator – detector - readout
monochromator - light source - cuvette - detector - readout
light source - monochromator - cuvette - detector – readout
flame – light source – monochromator - printout
Feedback
A light source is used to emit light through a sample for measurement in

spectrophotometry. The monochromator selects a narrow band of light that can pass
through which will reach the sample cuvette. The detector detects how much light was
reflected from or transmitted through the sample. Finally, the intensity of the
transmitted light is measured with a photodiode or other light sensor/detector, and the
transmittance value for this wavelength is then compared with the transmission
through a reference sample, allowing for the readout of the result.
A zinc deficiency in the elderly is often caused by:

Decreased intake and absorption
Decreased intake and excretion
Increased intake and excretion
Increased excretion and decreased absorption
Feedback
Some elderly individuals can have poor dietary habits which can lead to decreased
nutrient absorption, including zinc.
What weight of H2SO4 is contained in 200 ml of a 4 molar H2SO4 solution? (Atomic

weight: H= 1; S = 32; 0 = 16)
78.4 gm
156.8 gm
39.2 gm
15.68 gm
84 gm
Feedback
x (grams needed)
(4 M) (0.2 L) =
98 (formula weight)
Therefore:
x (grams needed)
0.8 =
98 (formula weight)
= 78.4 g
Molarity x Molecular Weight x Volume = Grams
Which statement best describes small dense LDL particles that can occur in
atherogenic dyslipidemia?

Small dense LDL molecules are less atherogenic than larger, less dense or
buoyant LDL particles because they are metabolized faster
Small dense LDL molecules transport more cholesterol and thus are more
atherogenic
Small dense LDL molecules are more atherogenic because they can more easily
move into the endothelium and vessel wall
Feedback
In excess triglycerides, the triglycerides reduce the amount of cholesterol in LDL

particles producing small dense LDL molecules. Because of size and density, these
molecules more easily enter damaged endothelium and vessel walls and are more
easily incorporated as plaque is formed.
If a drug is given at intervals that are the same as its half-life, approximately how long
will it take the drug to reach steady state?
It will be at steady state from the first dose.

It will take about two half-lives to reach steady state.
It will take about 5 half-lives to reach steady state.
It will never reach a steady state.
Feedback
If a drug is given at intervals that are the same as its half-life, it will take about 5 half-
lives to reach steady state.
Sodium fluoride is an excellent preservative for collecting glucose specimens

because:
Prevents interference with other substances

Inhibits glycolysis
Enhances chemical reactions
Inhibits certain clotting factors
Feedback
Glucose is metabolized at a rate of 5% per hour in specimens not immediately

separated or collected in sodium fluoride or iodoacetate.
Which of the following conditions would be suggested by a jaundiced patient

experiencing a marked rise in alkaline phosphatase, conjugated bilirubin, and a
moderate rise in ALT:
Cardiovascular disease
Hepatitis
Post-hepatic obstruction
Renal failure
Feedback
Post-hepatic obstruction is characterized by a marked increase in alkaline

phosphatase, GGT, conjugated bilirubin, as well as other hepatic enzymes. The slight
rise of ALT suggests that the issue is not hepatitis. Renal and cardiovascular failure
do not match the symptom of jaundice or the abnormal laboratory values.

The accuracy of an immunoassay is its ability to discriminate between results that are
true positives and results that are true negatives. Two parameters of test accuracy are
specificity and sensitivity. Which of these statements apply to an immunoassay with
high specificity, but low sensitivity?
The correct answers are highlighted below
Accurately identifies the presence of disease

Accurately identifies the absence of disease
Has few false-positives
Has few false-negatives
Feedback
A test with high specificity accurately detects the absence of disease. The more
specific a test is, the fewer false-positive results will occur. A test with high
sensitivity accurately identifies the presence of disease. The more sensitive a test, the
fewer false-negative results it produces. In the case stated in this question, the
immunoassay has high specificity, so it has few false-positives and will accurately
detect those individuals who do not have the disease or condition that is being tested
for. However, the test has low sensitivity, so it may not identify all individuals who
actually have the disease; it may produce many false-negative results.
Which of the following enzymes is NOT used to determine hepatobiliary

dysfunction?
aldolase
alkaline phosphatase
gamma-glutamyltransferase
5’-nucleotidase
Feedback
Aldolase is an enzyme that cleaves an aldol that aids in the conversion of glucose to
energy. Aldolase is associated with the muscles, and is currently used in the
monitoring of patients with muscular dystrophy and a few other rare conditions
affecting skeletal muscles. A serum ALP measurement’s most useful clinical attribute
is its sensitivity in distinguishing hepatobiliary disease. Gamma-glutamyltransferase,
or GGT, is elevated in liver diseases affecting the biliary system. Serum
concentrations of 5’-nucleotidase, or 5NT, reflect hepatobiliary disease with high
specificity as well.

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Gout Uric acid