The quantitative relationship between changes in blood osmolality and the normal expected response by AVP is best described as a(n): a. Indirect relationship b. Direct relationship c. Logarithmic relationship d. There is no quantitative relationship

The sample of choice for measuring blood osmolality is: a. Serum b. Plasma c. Whole blood d. Serum or plasma

With increased water loss, burn patients are most likely to also experience: a. Hypernatremia b. Hyponatremia c. Hypomagnesemia d. Hypoosmolality

RBCs are key for oxygen transport, carbon dioxide transport, and maintaining electroneutrality in the blood: a. True b. False

Which plasma electrolyte has the most narrow reference range and is MOST strictly regulated by the body? a. Sodium b. Magnesium c. Calcium d. Chloride e. Potassium

Oxygen content in blood reflects: a. pO2 value b. O2Hb only c. O2 dissolved in blood plasma only d. The patient’s total hemoglobin value e. All of these

What is the oxygen binding capacity of hemoglobin in a blood sample that is 100% saturated with O2 and has a total hemoglobin value of 12 g/dL: a. 17 mL O2/dL b. 4 mL O2/dL c. 8 mL O2/d: d. 34 mL O2/dL

Carbonic acid concentration in blood plasma is equivalent to: a. 0.0307 mmol/L/mm Hg times the pCO2 value in mm Hg b. Apparent pKa of carbonic acid, 6.1, plus the pCO2 value in mm Hg c. pCO2 value in mm Hg plus HCO3 - value in mm Hg d. Bicarbonate concentration divided by the pCO2 value in mm Hg

The normal ratio of carbonic acid to bicarbonate om arterial blood is: a. 1:20 b. 7.4:6.1 c. 0.003:1.39 d. 20:1

The presence of dyshemoglobins will cause a calculated % SO2 result to be falsely (elevated, decreased) and a pulse oximeter % SpO2 result to be falsely (elevated, decreased). a. Elevated, elevated b. Decreased, decreased c. Elevated, decreased d. Decreased, elevated

The preferred anticoagulant for arterial blood gas measurement is ________ in the ______ state. a. Lithium heparin; dry b. EDTA; dry c. Potassium oxalate; liquid d. Sodium citrate; dry

In respiratory alkalosis, the kidneys compensate by (excretion, retention) of bicarbonate and (increased, decreased) excretion of NaH2PO4. a. Excretion, decreased b. Excretion, increased c. Retention, increased d. Retention, decreased

Hypoventilation can compensate for which of the following acid-base disorders: a. Nonrespiratory acidosis b. Mixed alkalosis c. Mixed acidosis d. Nonrespiratory alkalosis

In the circulatory system, bicarbonate leaves the red blood cells and enters the plasma through an exchange mechanism with _____ to maintain electroneutrality. a. Chloride b. Carbonic acid c. Lactate d. Sodium

When arterial blood from a normal patient is exposed to room air: a. pCO2 increases; pO2 decreases b. pCO2 decreases; pO2 increases c. pCO2 decreases; pO2 decreases d. pCO2 increases; pO2 increases

A patient’s arterial blood gas results are as follows: pH 7.37 pCO2 54 mm Hg HCO3 - 38 mmol/L These values are consistent with: a. Compensated respiratory acidosis b. Compensated nonrespiratory acidosis c. Uncompensated respiratory alkalosis d. Uncompensated nonrespiratory alkalosis

A patient’s arterial blood gas results are as follows: pH 7.48 pCO2 54 mm Hg HCO3 - 38 mmol/L These values are consistent with: a. Compensated nonrespiratory alkalosis b. Compensated respiratory alkalosis c. Uncompensated respiratory alkalosis d. PARTIALLY nonrespiratory alkalosis

Suppose the controller on a GFAAS is defective and the furnace is running cold/ What effect will this likely have on the number of photons absorbed in the measurement? a. It will decrease the number of photons absorbed b. It will increase the number of photons absorbed c. It will have little effect d. It is not a relevant question because AAS relies on emission of light from electronically excited atoms.

Why would a clinical chemist develop an arsenic method that combines liquid chromatography with ICP-MS? a. To separate and quantitate several different arsenic-containing species in the same sample b. To eliminate interference by sodium from the analysis c. To shorten the run time of the measurement d. To lower the coefficient of variation for total arsenic measurements.

Select the answer that designates three techniques widely used for elemental analysis, identified according to the initials for the techniques. a. AAS, ICP-MS, AES b. NMR, ICP-MS, AES c. GC-MS, ICP-MS, AES d. HPLC-ICP-MS, AAS, FTIR

What primary purposes does the torch serve in ICP-MS? a. Vaporization, atomization, and ionization b. Vaporization, atomization, and electronic excitation c. Nebulization, atomization, and photon absorption d. Droplet transport, vaporization, and ion detection.

Extreme copper deficiency is seen in what fatal condition? a. Menkes’ disease b. Klinefelter’s syndrome c. Meese disease d. Kayser-Fleischer rings

Manganese toxicity resembles the following disease: a. Parkinson’s disease b. Wilson’s disease c. Alzheimer’s disease d. Menkes’ disease

Iron is physiologically active only in the ferrous form in: a. Hemoglobin b. Cytochromes c. Ferritin d. Transferrin

A metal ion required for optimal enzyme activity is best termed a (an): a. Cofactor b. Accelerator c. Coenzyme d. Catalyst

Which trace metal is contained in glucose tolerance factor? a. Chromium b. Copper c. Selenium d. Zinc

What metal may be used as a treatment for Wilson’s disease? a. Zinc b. Copper c. Molybdenum d. Fluorine

The metal ion essential for the activity of xanthine oxidase and xanthine dehydrogenase is: a. Molybdenum b. Iron c. Zinc d. Manganese

The primary purpose of porphyrins in the human body is to: a. Chelate free hemoglobin b. Contribute to the synthesis of heme c. Transport ferrous iron d. Transport oxygen to tissue

The chemical structure of porphyrin is described as a (an) a. Cyclic tetrapyrrole b. Heterocyclic pyrrole c. Linear tetrapyrrole d. Oxygen-binding prosthetic group

Which statement correctly describes a porphyrin property? a. Porphyrins absorb light in the visible region of the spectrum and fluoresce. b. Porphyrins are not soluble in aqueous solution. c. Porphyrins are oxidized to porphyrinogens when exposed to air. d. Porphyrins produced spontaneously are functional compounds.

The porphyria can be classified according to disease symptoms as: a. Congenital or acquired b. Erythropoietic or hepatic c. Hematologic or muscular d. Neurologic or cutaneous

Elevated urinary PBG concentration with negative fecal porphyrin results indicates: a. Acute intermittent porphyria (AIP) b. Erythropoietic protoporphyria (EPP) c. Hereditary coproporphyria (HCP) d. Porphyria cutanea tarda (PCT)

Porphyria cutanea tarda (PCT) is identified by: a. Chromatographic analysis of a 24-h urine collection b. Scanning fluorescence of plasma c. Screening for PBG in a random urine specimen d. Separation of fecal porphyrins in a 24-h specimen

.Suspected erythropoietic protoporphyria (EPP) is evaluated by: a. Assessing plasma or whole blood for protoporphyrin b. Enzymatic measurement of hydroxymethylbilane synthase c. HPLC analysis of a urine specimen d. Molecular testing for ferrochelatase

Porphobilinogen often is measured in the urine using: a. Chromatography b. Electrophoresis c. Spectrophotometry d. The Watson-Schwartz method

In the clinical laboratory, testing to identify specific porphyrins is performed using: a. Chemical derivatization and spectrophotometry b. Fluorometric emission scanning c. Liquid chromatography with fluorescent detection d. Thin layer chromatography

Specimens collected for evaluation of porphyria should be: a. Allowed to clot at room temperature for an hour b. Diluted to less than 25 mg/dL creatinine c. Exposed to light and air to oxidize the analytes d. Protected from light and stored cold.

nherited disorders in which a genetic defect causes abnormalities in rate and quantity of synthesis of structurally normal polypeptide chains of the hemoglobin molecule are called: a. Hemoglobinopathies b. Molecular dyscracias c. Porphyria d. Thalassemia

Molecular diagnostic techniques that can help diagnose hemoglobin disorders such as hemoglobinopathies and thalassemias include: a. Biochemical separation, identification, and quantification of mixture components. b. Separation of macromolecules and their fragments, based on their size and charge. c. DNA amplification, hybridization, and nucleotide sequencing. d. The use of specific monoclonal antibodies

Which of the following abnormal hemoglobin, found frequently in individuals from Southeast Asia, migrates with hemoglobin A2 on cellulose acetate electrophoresis? a. Hemoglobin C b. Hemoglobin D c. Hemoglobin E d. Hemoglobin Lepore

Which type of alpha-thalassemia results from deletion of three genes and produces a moderate hemolytic anemia? a. Hemoglobin Bart’s b. Hemoglobin H disease c. Hydrops fetalis d. Thalassemia trait

The most effective way to quantitate hemoglobin A2 is by: a. Alkali denaturation test b. Citrate agar electrophoresis c. Column chromatography d. Densitometry

Serum or plasma myoglobin concentration are used as: a. An early marker of acute myocardial infarction b. An indicator of congestive heart failure c. Lead poisoning indicator d. Liver function test

Which is the correct sequence of electrophoretic migration of hemoglobin from slowest to fastest on cellulose acetate at an alkaline pH (8.4 to 8.6)? a. A, F, S, C b. C, A, S, F c. C, S, A, F d. C, S, F, A

High Resolution melting (HRM) is a technique that can be used post PCR amplification as long as the probe utilized during the amplification process is complexed with a fluorescent detection dye that recognizes: a. Single-stranded DNA b. Double-stranded DNA c. cDNA d. Specific primers

The two main sites of production of heme are: a. Heart and Lung b. Liver and bone marrow c. Liver and spleen d. Muscle and blood

Which hemoglobin is resistant to alkali denaturation in NaOH? a. Hb A b. Hb C c. Hb F d. Hb S

A patient has an abnormal hemoglobin band that migrates with Hb S on cellulose acetate (pH 8.4) hemoglobin electrophoresis. The solubility test is negative. Which test should be performed next? a. Citrate agar (pH 6.2) electrophoresis b. HbA2 quantitation c. Acid elution stain d. Blood film evaluation

Silent carriers of alpha-thalassemia are missing how many alpha genes? a. 1 b. 2 c. 3 d. 4

Which hemoglobin contains four gamma chains and has an extremely high affinity for oxygen? a. Hb Bart’s b. Hb F c. Hb Gower I d. Hb Portland I

A patient with Southeast Asian heritage is found to have a mild microcytic anemia and a few target cells. Hemoglobin electrophoresis on cellulose acetate at pH 8.4 reveals a major band that migrates with Hb A2 and no Hb A. On citrate agar electrophoresis, the band travels in the position of Hb A. What is the most probable abnormal hemoglobin present? a. Hb A b. Hb C c. Hb D d. Hb E

Open-loop negative feedback refers to the phenomenon of: a. Negative feedback with a modifiable set point. b. Blood flow in the hypothalamic-hypophyseal portal c. Blood flow to the pituitary via dural-penetrating vessels. d. Negative feedback involving an unvarying, fixed set point.

The specific feedback effector for FSH is: a. Inhibin b. Activin c. Progesterone d. Estradiol

Which anterior pituitary hormone lacks a stimulatory hypophysiotropic hormone? a. Prolactin b. Growth hormone c. Vasopressin d. ACTH

The definitive suppression test to prove autonomous production of growth hormone is: a. Oral glucose loading b. Somatostatin infusion c. Estrogen priming d. Dexamethasone suppression

Which of the following is influenced by growth hormone? (1) IGF-1 (2) IGFBP-III (3) Lipolysis a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

What statement concerning vasopressin secretion is true? a. All of these b. Vasopressin secretion is closely tied to plasma osmolality c. Changes in blood volume also alter vasopressin d. A reduction in effective blood volume overrides the effects of plasma osmolality in regulating vasopressin secretion.

What are the long-term sequelae of untreated or partially treated acromegaly? a. An increased risk of colon and lung cancer b. A reduced risk of heart disease c. Enhanced longevity d. Increased muscle strength

TRH stimulates the secretion of: a. Prolactin and TSH b. Prolactin c. Growth hormone d. TSH

Estrogen influences the secretion of which of the following hormones? (1) Growth hormone (2) Prolactin (3) Luteinizing hormone a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

What is the difference between a tropic hormone and a direct effector hormone? a. Tropic and direct effector hormones are both similar in that both acts directly on peripheral tissue. b. Tropic and direct effector hormones are both similar in that both acts directly on another endocrine gland c. Tropic hormones at on peripheral tissue, while direct effector hormones act on endocrine glands. d. Tropic hormones act on endocrine glands, while direct effector hormones act on peripheral tissues.

A deficiency in vasopressin can lead to which of the following? a. Euvolemic hypokalemia b. Euvolemic hyponatremia c. Diabetes insipidus d. Primary hypothyroidism

Which of the following hormones stimulates prolactin secretion? a. Dopamine b. GnRH c. TRH d. TSH

Which hormone most directly stimulates testosterone secretion? a. LH b. FSH c. GnRH d. TRH

Which of the following is NOT likely to be present in an “atypical pituitary tumor” as defined by the World Health Organization? a. Invasion into surrounding structures such as cavernous sinus. b. MIB-1 proliferative index greater than 3% c. Excessive p53 immunoreactivity d. Decreased mitotic activity

Concerning secretion of growth hormone, which of the following is NOT true? a. Secretion is stimulated by GHRH b. Secretion is pulsatile, occurring usually 2 to 3 times daily. c. The most reproducible surge is at the onset of sleep d. It is secreted from somatotrophs that constitute over one-third of normal pituitary weight

Familial acromegaly is most likely caused by a mutation in which gene? a. GNAS b. AIP c. SS receptor type 5 d. GHRH gene

Cosecretion of which hormone is most commonly seen with acromegaly? a. Prolactin b. TSH c. ACTH d. FSH

Which hormone is not secreted from the anterior pituitary? a. Prolactin b. Oxytocin c. FSH d. TSH

Which of the following is most suggestive of a diagnosis of diabetes insipidus? a. Low sodium in a patient who reports polydipsia and polyuria b. Persistent complaint of polydipsia and polyuria in a patient without diabetes mellitus c. Elevated serum osmolarity in the setting of decreased urine osmolarity, in the presence of hypernatremia. d. Hyponatremia after a therapeutic trial of dDAVP.

Vasopressin release is regulated by which of the following? a. Hypothalamic osmoreceptors b. Vascular baroreceptors c. V2 receptors in the kidney d. a and b

Replacement of thyroxine is potentially dangerous in the setting of which other hormonal abnormality? a. GH deficiency b. Hyperprolactinemia c. Perimenopausal state d. ACTH deficiency

Which of the following is NOT generally considered to be a function of oxytocin? a. Uterine contraction during labor b. Milk “letdown” for breast-feeding c. Enhancement of insulin sensitivity in smooth muscle. d. Enhancement of mother-infant bonding.

Which of the following is consistent with Kallmann’s syndrome? a. Hypothyroidism and intermittent severe weakness or paralysis. b. ACTH deficiency together with GH excess c. Hyperprolactinemia in the setting of pregnancy d. Hypogonadism with the absence of smell

Which drug may cause panhypopituitarism? a. Ipilimumab b. Risperdal c. Pitocin d. Cabergoline

Which of the following is unlikely to be a cause of hyperprolactinemia? a. Metoclopramide b. Primary hypothyroidism c. Primary hypogonadism d. Pituitary stalk interruption

When considering an endocrine cause for a patient’s hypertension, the ___ is the usual suspect. a. thyroid gland b. pituitary gland c. adrenal gland d. parathyroid gland

When hypertension results from an endocrine disorder, what hormonal state is usually found: a. Hormone underproduction b. Hormone overproduction c. Hormone deficiency d. None of these

Major warning signs of adrenal disease include abnormal blood pressure, abnormal electrolytes (potassium, acid-base status, urine dilution), and unexplained weight change. a. True b. False c. Depending on the situation d. None of these

What is the common substrate from which all adrenal steroids are produced? a. Triglycerides b. Tryptophan and Tyrosine c. Cholesterol d. Phospholipids

A primary hyperaldosteronemic state is characterized by: a. A urine potassium of 35 mmol/d b. A urine potassium of 21 mmol/d c. A spot urine test where the sodium levels are greater than potassium levels d. Within 3 hours of taking 50 mg of captopril, plasma aldosterone was low

During a low-dose (1 mg) dexamethasone suppression test, total cortisol levels measured in a patient at 8:35 AM was 2.8 ug/dL. How is this interpreted? a. The patient is normal b. The patient has Cushing’s syndrome c. The patient has a nonpituitary tumor causing ectopic ACTH syndrome d. The patient has an ACTH-secreting pituitary adenoma

The most biologically active androgen in this list is: a. DHEA b. DHEA-S c. LH d. FSH e. Estrone

Which amino acid is needed for the biosynthesis of norepinephrine and epinephrine? a. Alanine b. Phenylalanine c. Isoleucine d. Leucine e. Serine

Which of the following describes catecholamines? a. Hydrophobic b. Degraded rapidly in nonneuronal cells by monoamine reductase c. Have long half-lives d. Circulating blood catecholamines are 99% bound to albumin e. None of the above accurately describes catecholamines

The collection of a 24-hour urine is used for measuring: a. Creatinine clearance b. Norepinephrine c. Dopamine d. All of the above may be measured in a 24-hour urine e. All but one of the above may be measured in a 24- hour urine.

. If serum levels of estradiol do not increase after injection of hCG, the patient has: a. Primary ovarian failure b. Pituitary failure c. Tertiary ovarian failure d. Secondary ovarian failure

If a patient had a luteal phase defect, which hormone would most likely be deficient? a. Progesterone b. Estrogen c. hCG d. FSH e. Prolactin

Which of the following is the precursor for estradiol formation in the placenta? a. Fetal adrenal DHEAS b. Maternal testosterone c. Maternal progesterone d. Placental hCG e. Fetal adrenal cholesterol

Which of the following target tissues is incapable of producing steroidal hormones? a. Adrenal medulla b. Placenta c. Ovary d. Testis e. Adrenal cortex

The parent substance in the biosynthesis of androgens and estrogens is: a. Cholesterol b. Cortisol c. Catecholamines d. Progesterone

The biologically most active, naturally occurring androgen is: a. DHEA b. Androstenedione c. Epiandrosterone d. Testosterone

For the past 3 weeks, serum estriol levels in a pregnant woman have been steadily increasing. This is consistent with: a. A normal pregnancy b. Hemolytic disease of the newborn c. Fetal death d. Congenital cytomegalovirus infection

Which of the following is secreted by the placenta and used for the early detection of pregnancy? a. hCG b. FSH c. LH d. Progesterone

Chronic fetal metabolic distress is demonstrated by: a. Decreased urinary estriol excretion and decreased maternal serum estriol b. Decreased estrogen in maternal plasma and increased estriol in amniotic fluid. c. Increased estradiol in maternal plasma, with a corresponding increase of estriol in amniotic fluid d. Increased urinary estriol excretion and increased maternal serum estriol.

Androgen secretion by the testes is stimulated by: a. LH b. FSH c. Testosterone d. Gonadotropins

A deficiency in estrogen during the follicular phase will result in: a. A failure of embryo implantation b. An increased length of the menstrual cycle c. A lack of graafian follicle release from the ovary d. An incomplete development of the endometrium.

Which hormone is responsible for an increase in body temperature at the time of ovulation? a. Progesterone b. Estrogen c. LH d. FSH e. Estradiol

A midcycle LH surge will stimulate which series of events? a. An increase in FSH b. A decrease in FSH c. Anovulation d. Amenorrhea e. A decrease in progesterone production