All of the following statements about iodine are true, EXCEPT: a. Radioactive iodine treatment of Graves’ disease is effective in less than 40% of patients treated with this agent. b. Iodine deficiency is one of the most common causes of hypothyroidism in the world. c. T4 has four iodine molecules. d. RAIU is often useful in determining the cause of thyrotoxicosis.

The fetus: a. Is dependent on thyroid hormone for normal neurologic development. b. Does not develop a thyroid gland until the third trimester. c. Is not susceptible to damage from radioactive iodine therapy given to the mother. d. Will be born with hypothyroidism in approximately 1 of 400 births in developed countries.

The thyroid gland: a. Depends on TPO to permit iodination of the tyrosyl residues to make MIT and DIT. b. Is an ineffective iodine trap c. Depends on TPO to permit the joining of two DIT residues to form T3 d. Usually functions independent of TSH levels.

The thyroid gland produces: (1) TSH (2) Thyroglobulin (3) T3 (4) T4 a. 1, 2, and 3 b. 2, 3, and 4 c. 1, 3, and 4 d. 1, 2, and 4

Hypothyroidism is generally associated with all of the following, EXCEPT: a. TSH receptor antibodies b. Depression c. An elevation of TSH levels d. TPO antibodies

A 34-year-old women presents with goiter, tachycardia, and weight loss of 2 months duration. TSH is undetectable and free T4 is high. All of the following tests are useful in diagnosing the cause of the hyperthyroidism, EXCEPT: a. FNA biopsy of the thyroid gland b. TSH receptor antibodies c. RAIU d. TSH

A 65-year-old woman presents with fatigue, hypothermia, pericardial effusions, and hair loss. Her thyroid function tests show significantly elevated TSH and a low free T4. All of the following laboratory test abnormalities may be associated with her underlying condition, EXCEPT: a. Elevated WBC b. An elevated cholesterol level c. Anemia d. Elevated CPK level

A 26-year-old man presents with a 3-cm, right lobe, thyroid nodule and a normal TSH. What is the next test that should be performed? a. FNA of the nodule b. Free T4 level c. Thyroid ultrasound d. Thyroid scan

The following are treatment options for hyperthyroidism associated with Graves’ disease, EXCEPT: a. Thyroid hormone b. PTU c. Beta-blockers d. Radioactive iodine

All of the following abnormalities might be expected in a severely ill patient, EXCEPT: a. Low rT3 b. Low T4 c. Low T3 d. Low TSH

Of the following thyroid hormones, which is considered the most biologically active? a. T3 bound to TBG b. T4 bound to TBG c. Free T4 d. Free T3 e. rT3

he primary serum test to screen for thyroid disease is: a. Free T4 b. rT3 c. Total T4 d. Autoimmune antibodies to thyroid tissue e. TSH

Of the following, which will MOST likely interfere with quantitation of thyroglobulin? a. Antithyroglobulin antibodies b. Thyroid-stimulating antibodies c. TSH receptor antibodies d. Thyroid peroxidase antibodies

Parathyroid hormones and 1,25-(OH)2D (vitamin D) are the principal hormones involved in the normal physiologic regulation of calcium homeostasis: a. True b. False c. Too little data d. None of these

Primary organs involved in the maintenance of calcium homeostasis: (1) Intestine (GI tract) (2) Bone (3) Kidney a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

Organs involved in the production of the active metabolite of vitamin D: (1) Skin (2) Liver (3) Kidneys a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

Cod liver oil is a source of vitamin D: a. True b. False c. Too little data d. Cod liver oil is not edible

1,25(OH)2D is the best blood test for determining adequacy of vitamin D stores in the body. a. True b. False c. Too little data d. None of these

PTHrP is produced by some cancers and often leads to cancer-associated hypercalcemia. a. True b. False c. Too little data d. None of these

1,25(OH)2D, due to 1-hydroxylase activity in macrophages, may be produced to excess in granulomatous diseases and lymphoid disorders, leading to hypercalcemia. a. True b. False c. Too little data d. None of these

In PHPT, the defect primarily lies in ____. In secondary hyperparathyroidism, the defect primarily lies with the threat of _____ to the body. a. Parathyroid gland, hypercalcemia b. Parathyroid gland, hypocalcemia c. Thyroid gland, hypercalcemia d. Thyroid gland, hypocalcemia

Development of ________ is the primary complication of hypercalciuria. a. Gout arthritis b. Pseudogout c. Kidney stones d. None of these

What is the most common cause of hypoparathyroidism? a. Magnesium deficiency b. Hashimoto’s thyroiditis c. Grave’s disease d. Neck surgery

What is the type of bone most rapidly lost in response to hypogonadism and glucocorticoid therapy? a. Cortical bone b. Trabecular bone c. Sphenoid bone d. None of these

________ cells in the bone are responsible for bone resorption, and the _______ cells are responsible for bone formation. a. Osteoclasts, osteoblasts b. Osteoblasts, osteoclasts c. Osteoblasts, osteoblasts d. Osteoclasts, osteoclasts

Which of the following is the most prevalent metabolic bone disease in adults? a. Osteomalacia b. Osteosarcoma c. Paget’s disease d. Osteoporosis

Hormone replacement does not inhibit bone resorption in osteoporotic patients. a. True b. False c. Too little data d. None of these

Which of the following enzymes would best aid in identifying hepatobiliary disease? a. ALP b. AST c. ALT d. Ammonia

Teriparatide is the only drug currently approved by the FDA for the treatment of osteoporosis that directly stimulates bone formation. a. True b. False c. Too little data d. None of these

In which of the following types of cells does the conjugation of bilirubin take place? a. Hepatocytes b. Kupffer cells c. Macrophages d. Phagocytic cells

Which of the following enzymes is responsible for the conjugation of bilirubin? a. UDP-glucuronosyltransferase b. Alkaline phosphatase c. Glutamate dehydrogenase d. Leucine aminopeptidase

Which of the following fractions of bilirubin is water soluble and reacts with a diazo reagent without the addition of an accelerator? a. Conjugated bilirubin b. Unconjugated bilirubin c. Total bilirubin d. Indirect bilirubin

Which form of hepatitis is caused by a DNA virus? a. Hepatitis B b. Hepatitis A c. Hepatitis C d. Hepatitis D

Which of the following enzymes is most useful in establishing the hepatic origin of an elevated serum alkaline phosphatase? a. 5’-Nucleotidase b. Alanine aminotransferase (ALT) c. Aspartate aminotransferase (AST) d. Lactate dehydrogenase

Hepatitis E is likely to cause serious consequences in: a. Pregnant women b. Children c. Travelers in Third World countries d. Older people

Worldwide, most primary malignant tumors of the liver are related to: a. Alcoholism b. Gallstones c. Reye’s syndrome d. Malaria

The reagent p-dimethylaminobenzaldehyde is used to measure which of the following? a. Urobilinogen b. Total bilirubin c. Ammonia d. Alkaline phosphatase

Which of the following conditions would result in elevations in primarily conjugated bilirubin? a. Dubin-Johnson syndrome b. Physiologic jaundice of the newborn c. Crigler-Najjar syndrome d. Gilbert’s syndrome

A urinalysis dipstick test indicated that urobilinogen was absent. Which condition does this support? a. Biliary obstruction b. Hepatitis A acute infection c. Defective liver cell function d. Hepatocellular disease e. This would support all of the above condition

Measuring serum ammonia levels has the potential to be fraught with preanalytical errors that may interfere with achieving an accurate result. Of the following preanalytical steps, which is incorrect? a. After phlebotomy, the patient’s blood should be immediately placed on ice. b. The blood should be collected in a red clot tube without anticoagulant c. Hemolyzed samples should be rejected as this interferes by falsely increasing ammonia measurements d. Lipemia may also interfere with plasma ammonia measurements e. All of the above are correct.

A patient presents with elevated levels of IgG anti-HAV, while levels of IgM anti-HAV are nondetectable. This patient is likely to: a. Have an acute infection of HAV b. Have a chronic infection of HAV c. Have an immunity to HAV d. Be a carrier of HAV

The product produced and measured when reacting bilirubin with a diazo reagent is: a. NADPH b. NAD c. Azobilirubin d. Bilirubin diglucuronide

A healthy 28-year-old female sees her physician for a routine examination and has received a “relatively” clean bill of health except for the results below. Total bilirubin 2.8 mg/dL Direct bilirubin 0.1 mg/dL Indirect bilirubin 2.7 mg/dL These results most likely indicate? a. Normal bilirubin metabolism b. Extrahepatic obstruction c. Dubin-Johnson syndrome d. Gilbert’s syndrome

Which of the following is measured using glutamate dehydrogenase and is a measure of advanced stages, poor prognosis, and coma in liver disease? a. Total bilirubin b. Ammonia c. Unconjugated bilirubin d. Urea

In which of the following disease states would you see an elevation in total bilirubin and conjugated bilirubin only? a. Biliary obstruction b. Hemolysis c. Neonatal jaundice d. Gilbert’s disease

As a reduction product of bilirubin catabolism, this compound is partially reabsorbed from the intestines through the portal circulation for reexcretion by the liver. What is this compound? a. Urobilinogen b. Azobilirubin c. Biliverdin d. Urobilin d. Bilirubin

You are the technologist on duty and you are performing the following assay: Patient sample + Diazo reagent + Accelerator → Product Which fraction(s) of bilirubin will react in the above reaction? a. Conjugated b. Delta c. Unconjugated d. All of the above

Choose the diagnosis most consistent with the following laboratory findings: Total bilirubin 5.8 mg/dL Direct bilirubin 0.1 mg/dL Indirect bilirubin 5.7 mg/dL a. Physiologic jaundice of the newborn b. Posthepatic bile obstruction c. Dubin-Johnson syndrome d. Rotor’s syndrome e. None of the above

A serum TnT concentration is of most value to the patient with an MI when: a. The CK-MB has already peaked and returned to normal concentrations b. The onset of symptoms is within 3 to 6 hours of the sample being drawn c. The myoglobin is extremely elevated d. The TnI concentration has returned to normal concentrations.

A normal myoglobin concentrations 8 hours after the onset of symptoms of a suspected MI will: a. Essentially rule out an acute MI b. Provide a definitive diagnosis of acute MI c. Be interpreted with careful consideration of the TnT concentration d. Give the same information as a total CK-MB

Which of the following analytes has the highest specificity for cardiac injury? a. TnI b. CK-MB mass assays c. Total CK-MB d. AST

Which of the following newer markers of inflammation circulates in serum bound to LDL and HDL? a. Lipoprotein-associated phospholipase A2 b. CK-MB c. cTnI d. hsCRP

A person with a confirmed blood pressure of 125/87 would be classified as: a. Prehypertension b. Normal c. Stage 1 hypertension d. Stage 2 hypertension

Rheumatic heart disease is a result of infection with which of the following organisms? a. Group A streptococci b. Staphylococcus aureus c. Pseudomonas aeruginosa d. Chlamydia pneumoniae

Which of the following defects is the most common type of congenital CVD encountered? a. Ventricular septal defects (VSD) b. Tetralogy of Fallot c. Coarctation of the aorta d. Transposition of the great arteries

Which of the following cardiac markers is the most useful indicator of congestive heart failure? a. BNP b. TnI c. CK-MB d. Glycogen phosphorylase isoenzyme B

Which of the following is the preferred biomarker for the assessment of myocardial necrosis? a. CK b. AST c. CK-MB d. Cardiac troponin (I or T)

Which of the following is not a feature of an ideal cardiac marker? a. Ability to predict future occurrence of cardiac disease b. Absolute specificity c. High sensitivity d. Close estimation of the magnitude of cardiac damage.

Renin release by the kidney is stimulated by: a. A decrease in extracellular fluid volume or pressure b. Increased plasma sodium concentration c. Increased dietary sodium d. Renal tubular reabsorption

The measurement of serum Cystatin C, a small protein produced by nucleated cells, is useful for: a. Detecting an early decrease in kidney function b. Calculating creatinine clearance c. Diagnosing end-stage renal disease d. Monitoring dialysis patients

The proximal tubule functions to: a. Reabsorb 75% of salt and water b. Concentrate salts c. Form the renal threshold d. Reabsorb urea

Renal clearance: a. Volume of plasma from which a substance is removed per unit of time b. Volume of urine produced per day c. Amount of creatinine in urine d. Urine concentration of a substance divided by the urine volume per unit of time

Creatinine clearance results are corrected using a patient’s body surface area to account for differences in: a. Muscle mass b. Age c. Dietary intake d. Sex

A patient is suffering from an acute bleed. What is the most accurate way to describe the subsequent acute kidney injury? a. Prerenal acute kidney injury b. Renal acute kidney injury c. Postrenal acute kidney injury d. None of the above apply

Which of the following tests is only of the absorptive ability of the intestine? a. D-Xylose test b. Lactose tolerance test c. Fecal fat (72-hour collection) d. Serum carotenoids e. Serum albumin

The D-Xylose absorption test is particularly helpful in differentiation malabsorption of intestinal etiology from exocrine pancreatic insufficiency because: a. D-xylose is mostly absorbed in the stomach and then secreted via the kidney in its unaltered monosaccharide form. b. D-xylose is mostly altered in the small intestine to facilitate its absorption across this membrane and metabolized by the liver so its metabolites may be excreted via the kidney. c. D-xylose is mostly absorbed, not typically found in the blood, unaltered in the small intestine, and excreted unaltered via the kidney. d. None of these

266. Which of the following statements concerning cystic fibrosis is NOT correct? a. Affects males and females about equally b. Occurs predominantly in population of Northern European extraction c. Frequently diagnosed by measurement of sweat chloride. d. Caused by a variety of mutation on chromosome seven. e. Genetic screening is usually unsuccessful.

Laboratory findings in pancreatitis include all of the following, except: a. Increased cortisol b. Increased amylase c. Increased lipase d. Increased triglycerides

Which of the following tests is direct determination of the exocrine secretory capacity of the pancreas? a. Secretin/CCK test b. Amylase c. Quantitative decal fat analysis d. D-Xylose test e. Lactose tolerance test

A serum albumin of less than 2.5 g/dL would be most indicative of: a. Intestinal disease b. Pancreatitis c. Peptic ulcer d. Pancreatic carcinoma

Which of the following is accurate when describing or diagnosing Zollinger-Ellison syndrome? a. Extreme hyposecretion of gastrin in the stomach b. Extreme hypersecretion of gastrin in the duodenum c. An increase in serum gastrin levels of 100 pg/mL following IV exposure to secretin. d. A decrease in serum gastrin levels of 100 pg/mL following IV exposure to secretin

If a trough specimen is required for therapeutic drug monitoring, the most appropriate time to collect the specimen would be: a. Eight hours after the last dose was given. b. Three days after the dose was administered c. Immediately after the dose is administered d. Immediately before the next dose is given.

Of the following analytic methods, which is most commonly used as the confirmatory method for identification of drugs of abuse? a. GC with mass spectrometry b. Scanning differential calorimetry c. Ion-specific electrode d. Immunoassay e. Nephelometry

REFERENCE METHODS GLUCOSE-

REFERENCE METHODS CHOLESTEROL-

REFERENCE METHODS TRIGLYCERIDE-

REFERENCE METHODS GLOMERULAR FILTRATION RATE-

REFERENCE METHODS NPNS

Which of the following statement(s) is true? (1) Lithium is used to treat depression, selfmutilating behavior, and bipolar disorder. (2) Procainamide is metabolized into an active metabolite with similar anti-arrhythmic activity. (3) Methotrexate is measured in serum to determine amount of leucovorin needed. a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

If a drug is administered orally, which of the following would affect the efficiency of its absorption in the GI tract? (1) Dissociation of the drug from its administered form. (2) The drug’s solubility in gastrointestinal fluid (3) Diffusion of the drug across GI membranes a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

Primidone is an inactive preform of which of the following antiepileptic drugs? a. Gabapentin b. Clozapine c. Phenobarbital d. Ethosuximide

Which of the following statements concerning cyanide toxicity is TRUE? a. Inhalation of smoke from burning plastic is a common cause of cyanide exposure, and cyanide expresses its toxicity by inhibition of oxidative phosphorylation b. Inhalation of smoke from burning plastic is a common cause of cyanide exposure c. Cyanide is relatively nontoxic compound that requires chronic exposure to produce a toxic effect d. Cyanide expresses its toxicity by inhibition of oxidative phosphorylation. e. All of these are true.

What is the primary product of methanol metabolism by the ADH and ALDH system? a. Formic acid b. Acetone c. Acetaldehyde d. Oxalic acid e. Formaldehyde

Which of the following laboratory results would be consistent with acute high-level oral exposure to an inorganic form of mercury (Hg2+)? a. All of these b. High concentrations of mercury in whole blood and urine c. Proteinuria d. Positive occult blood in stool e. one of these

A child presents with microcytic, hypochromic anemia. The physician suspects IDA. Further laboratory testing reveals a normal total serum iron and iron-binding capacity; however, the zinc protoporphyrin level was very high. A urinary screen for porphyrins was positive. Erythrocytic basophilic stippling was noted on the peripheral smear. Which of the following laboratory test would be best applied to this case? a. Whole blood lead b. Urinary thiocyanate c. COHb d. Urinary anabolic steroids e. Urinary benzoylecgonine

A patient with suspected organophosphate poisoning presents with a low SChE level. However, the confirmatory test, erythrocyte acetylcholinesterase, presents with a normal result. Excluding analytic error, which of the following may explain these conflicting results? a. The patient has late-stage hepatic cirrhosis or the patient has a variant of SChE that displays low activity. b. The patient has late-stage hepatic cirrhosis. c. The patient was exposed to low levels of organophosphates. d. The patient has a variant of SChE that displays low activity. e. All of these are correct

A patient enters the emergency department in a coma. The physician suspects a drug overdose. Immunoassay screening tests for opiates, barbiturates, benzodiazepines, THC, amphetamines, and PCP were all negative. No ethanol was detected in serum. Can the physician rule out drug overdose as the cause of this coma with these results? a. No b. Yes c. Maybe

Compound A is reported to have an oral LD50 of 5 mg/kg body weight. Compound B is reported to have an LD50 of 50 mg/kg body weight. Of the following statements regarding the relative toxicity of these two compounds, which is TRUE? a. Ingestion of low amounts of compound A would be predicted to cause more deaths than an equal dose of compound B. b. Ingestion of compound B would be expected to produce nontoxic effects at a dose greater than 100 mg/kg body weight.

Which of the following statements best describes the TD50 of a compound? a. The dosage of a substance that would be predicted to cause a toxic effect in 50% of the population b. The dosage of a substance that is lethal to 50% of the population c. The dosage of a substance that would produce therapeutic benefit in 50% of the population d. The percentage of individuals who would experience a toxic response at 50% of the lethal dose

A weakly acidic toxin (pKa = 4.0) that is ingested will a. Be passively absorbed in the stomach (pH = 3.0) b. Not be absorbed because it is ionized c. Not be absorbed unless a specific transporter is present d. Be passively absorbed in the colon (pH = 7.5)

Select the appropriate letter regarding tumor marker test: (1) Screen for cancer (2) Aid in staging cancer (3) Monitor response to therapy (4) Detect recurrent disease a. All of the above b. 1, 2, and 3 c. 2, 3, and 4 d. 1, 2, and 4 e. 4 only

Which of the following methods is commonly used to measure endocrine metabolites? a. Protein electrophoresis b. Immunoassays c. HPLC d. Electrochemistry e. Gas chromatography

Which of the following nutritional markers has been found to be the most sensitive and helpful indicator of nutritional status in very ill patients? a. Transthyretin b. Transferrin c. Albumin d. Somatomedin C

Which of the following describes the correct source, function, and deficient state of the vitamin listed? a. Thiamine (B1)-whole grains, carbohydrate metabolism, beriberi b. Vitamin E-plants tissues, antioxidant, Osteomalacia. c. Niacin- meat, oxidation-reduction reaction, scurvy d. Folic acid- dairy products, myelin formation

Hearing loss is common among the elderly and may cause embarrassment. What should be done to facilitate the specimen collection process? a. Adjust your position to speak into the ear with the best hearing b. Speak very loudly and forcefully. c. Don’t speak at all. Just give the patient printed instructions d. Use a microphone.

Under normal conditions, what is the maximum amount of blood that should be drawn from a 30-kg child during a single blood draw? a. 60 mL b. 80 mL c. 40 mL d. 20 mL

When choosing a chemistry analyzer for a pediatric laboratory, it is necessary to: a. Incorporate total laboratory automation b. Be able to analyze from small volumes c. Have a rapid turnaround time d. Ensure a minimum specimen dead volume

Which of the following is true regarding POCT? a. Results are generally available more rapidly than with traditional laboratory test. b. POCT is usually less expensive than traditional laboratory measurements c. The device cannot be linked to the hospital information system d. QC samples are not needed.

Quality control lockout: a. Prevents quality control from being recorded when outside 2 standard deviations b. Prevents testing when quality control has not been performed c. Prevents operators from changing quality control records d. Prevents the wrong quality control material to be used for a particular test.

Which of the following is NOT a driving force for more automation? a. Increased use of chemistry panels b. High-volume testing c. fast turnaround time d. Expectation of high-quality, accurate results.