FREQUENTLY ASKED BOARD EXAM QUESTIONS CLINICAL CHEMISTRY 1 QA&QC, Lab Math, Carbohydrates, Protein, NPN, Lipids 1.

. The electrophoretic pattern of a plasma sample compared with a serum sample shows 2. Biuret reaction depends on the number of 3. Transmittance of a solution maybe converted to %absorbance using the formula 4. In a spectrophotometer, light of specific wavelength can be isolated from white light with 5. The following serum constituent is unstable if a blood specimen is left standing at room temperature for 8hours 6. In electrophoretic analysis, buffers ____ 7. How many grams of SSA (MW 254) to prepare 1L of 3% w/v solution 8. Statistical term for the average value is the 9. Most frequent value in a collection of data is statistically known as 10. In a specimen collected for a plasma glucose analysis, NaF 11. To be analyzed by gas liquid chromatography, a compound must 12. Which of the following serum protein fraction is most likely to be elevated in patients with nephritic syndrome 13. The substance that is measured to estimate the serum concentration of triglyceride by most method is 14. + - fibrinogen peak - peptide bonds - 2-log%T - diffraction grating - glucose - maintain basic pH - 30grams - mean - mode - inhibits glycolysis - be volatile or made volatile - alpha-2 and betaglobulin - glycerol - monoclonal gammopathy

The serum protein electrophoretic pattern is consistent with 15. Which of the following statement about fluorometry is or are true

16. Beta- gamma bridge pattern in a protein electrophoresis is consistent with 17. Nanometer is used as a measure of 18. What is the molarity of a solution that contains 18.7grams of KCl (MW 74.5) in 500mL of water? 19. A colorimetric method calls for use of 0.1mL serum, 5mL of reagent and 4.9mL of water. What is the dilution of serum? 20. The conversion of glucose or other hexoses into lactate or pyruvate is called 21. Total glycosylated hemoglobin level in a hemolysate reflects the 22. The function of major lipid component of VLDL is to transport 23. The most widely used support medium for electrophoretic separation of lipoprotein is 24. 60-75% of the plasma cholesterol is transported by

- a compound is set to fluoresce when it absorbs light at one wavelength and emits light at a second wavelength - cirrhosis - wavelength of radiant energy - 0.5M - 1:100 - glycolysis - ave. blood glucose levels of past 23months - endogenous triglyceride - agarose gell - LDL

25. A mean value of 100 and a Standard deviation of 1.8 mg/dL were obtained from a set of glucose measure on a control solution. The 95% confidence interval in mg/dL would be: 26. The extent to which the measurements agree with the true glucose values of the quantity being measured is known as 27. In the Jaffe reaction, creatinine reacts with 28. In electrophoresis of proteins, when the sample is placed in an electric field connected to the buffer of pH 8.6, all the proteins: 29. MSUD is characterized by an increase in which of the following urinary amino acids 30. .A characteristic of the Bence Jones Proteins used to distinguish it from other proteins is its solubility 31. The principal excretory form of Nitrogen is 32. A 45yo male of average height and weight was admitted to the hospital for renal function studies. He has the following lab results Urine crea: 120mg/dL Total urine volume in 24hrs: 1500mL Serum crea: 1.5mg/dL Calculate the crea clearance for this patient in mL/min 33. Spectrophotometers isolate a narrow band by means of 34. The serum electrophoresis pattern was obtained on cellulose acetate at pH 8.6. Identify the serum protein fraction on the far right of the pattern 35. Which of the following is the formula for calculating a %w/v solution? 36. Which of the following is the formula for coefficent of variation? 37. Which of the following is the formula for calculating the molarity of a solution? 38. 4mL of water is added to 1mL of serum, this represents which of the following serum dilution? 39. How many mL of 0.25N NaOH are needed to make 100mL of a 0.05N folution of NaOH? 40. Specimens for blood gas determination should be drawn into a syringe containing 41. The measurement of light scattered by particles in the sample is the principle of 42. The measurement of the amount of electricity passing between two electrodes in an electrochemical cell is the principle of 43. Which of the following lipid results would be expected to be falsely electaed in a serum sample from a non-fasting patient? 44. Turbidity in serum suggests elevation of 45. Which of the following would be an example of a glucose-specific colorimetric method? 46. The relative migration rate of protein on cellulose acetate is based on 47. A patient of glomerulonephritis would present the following serum results 48. Creatinine clearance is used to estimate the 49. Chemical composition of HDL cholesterol corresponds to 50. Blood was collected in a serum separator tube from patient who has been fasting since midnight. The time of collection was 7am.

- 96.4-103.6 - accuracy - alkaline picrate solution to yield an orange-red complex - have a neg charge - valine, leucine, isoleucine - 100deg C - urea

- 100mL/min - prisms and gratings - albumin - (g solute / volume solvent) x 100 - (SDx100)/mean - #moles solute/L of solution - 1:5 - 20mL - heparin - nephelometry - coulometry - triglyceride - chylomicron - glucose oxidase - ionic charge - BUN increased - glomerular filtration rate - TG: 5%; chole: 15%; CHON: 50%

The lab test that should be recollected is 51. A 45yo woman whos fasting serum glucose concentration of 95mg/dL and a 2-hr post prandial glucose concentration of 105mg/dL. The statement that best describes the patient fasting serum glucose concentration is 52. In lipoprotein phenotyping, chylomicrons are present in the plasma of a person with which of the following protein phenotype? 53. Monitoring long term glucose control in patients with adult onset DM can best be accomplished by measuring 54. In familial hypercholesterolemia, hallmark finding is an elevation of 55. Pregnant women with symptons of thirst, frequent urination or unexplained weight loss should have which of the following test performed? 56. Nephelometers measure light 57. If the LDL cholesterol is to be calculated by Friedwald formula, what are the 2 measurements that need to be carried out by the same chemical procedure 58. High levels of which lipoprotein class are associated with decreased risk of accelerated atherosclerosis 59. Premature atherosclerosis can occur when which of the following become elevated 60. Following overnight fasting hypoglycemia in adults is defined as a glucose of 61. Which of the following is within the UV range? 62. Most chemical methods for determining total protein utilize which of the following reaction 63. Chromatography is based on the principle of 64. In QC, +/-2SD from the mean includes what percent of sample population? 65. The term used to described reproducibility is 66. When the exact concentration of the solute of a solution is known and is used to evaluate the concentration of an unkwon solution, the known solution is 67. If a fasting glucose is 95mg/dL, which of the following 2-hr post prandial glucose results would most closely represent normal glucose metabolism 68. Slight hemolysis can cause eroneous lab results in % serum analyte 69. A serum sample demonstrates an elevated result when tested with Jaffe reaction. This indicates 70. Ability of procedure to measure only components it claims to measure is called 71. HBA1C value represents a time average of glucose concentration during the preceding 72. Protein that has the highest dye binding capacity 73. Buffer pH most effective in allowing amphoterin proteins to migrate toward the anode in an electrophoretic system would be 74. An acid cleaning solution for glassware

- triglyceride - normal, reflecting glycogen breakdown by liver - I and V - HBA1C - LDL - GTT - scattered at right angle to light path - TC and HDL - HDL - LDL - < or = 45mg/dL - 340nm - biuret - differential solubility - 95% - precision - standard - 100 - potassium - renal functional impairment - specificity - 8-12 weeks - albumin - pH 8.6 - potassium dichromate in concentrated sulfuric acid

75. The Kjeldahl technique is reference method for determination of serum total protein method is based on 76. Electrophoresis is a technique used to separate serum protein. A dye that maybe used for staining protein bands following electrophoresis is 77. What is the end product of purine catabolism in man 78. By the urease method, urea is enzymatically converted to 79. The specificity of Jaffe reaction can be converted to 80. A disease state association with an elevation of serum uric acid is 81. EDTA 82. Sodium heparin 83. Sodium polyanethol sulfonate 84. No anticoagulant 85. Sodium citrate 86. Sodium fluoride 87. For serum chemistry 88. For glucose testing or glucose tolerance 89. Whole blood hematology cell counting 90. Plasma chemistry 91. Blood culture 92. Coagulation studies 93. The urea nitrogen method using diacetyl monoxime measures 94. What compound normally found in urine maybe used to assess the completeness of a 24hr urine collection 95. Post renal kidney malfunction does not include 96. What technique is commonly used to differentiate several amino acids 97. Condition wherein there is increased in the proportion of formed elements in the blood due to prolong application of torniquet 98. Fainting due to sudden insufficiency of blood supply to the brain 99. Inflamation of the vein in which thrombus is present [Link] destruction or breakdown of RBC

- quantitation of N content of CHON - Ponceau S - uric acid - ammonia - adsorption with Lloyds rgt - gout - lavender - green - yellow - plain red - light blue - gray - plain red - gray - lavender - green - yellow - light blue - urea nitrogen only - creatinine - diarrhea - chromatography hemoconcentration syncope thrombophlebitis hemolysis

FREQUENTLY ASKED BOARD EXAM QUESTIONS CLINICAL CHEMISTRY 2 Enzyme and Liver Profile [Link] following enzyme determination is used to evaluate liver disorders: 2. Transaminases are tested by the following procedures: [Link] acid and alpha ketoglutaric acid are used as substrates in the determination of [Link] Frankel and Karmen are procedures for testing 5. What is the peak of SGOT in myocardial infarction 6. This CK isoenzyme is increased in brain injury 7. One of the following is a pancreatic enzyme 8. The Somogyi Method of amylase assay is based on the measurement of 9. Hemolyzed hemoglobin will yield 10. Flipped LD is found in 11. Enzymes that catalyzes the reaction of ATP + D-glucose to ADP + Dglucose-6PO4 Either SGPT or ALP Reitman-Frankel SGOT Transaminases 18-20 hours CK BB Amylase Reducing Sugar Erroneously high LDH level Myocardial infarction CPK

12. Substrate in serum lipase determination using the Cherry-Crandall method 13. Amylase and lipase values are usually elevated in 14. The tetramer composition of LDH5, the most cathodic isoenzyme on electrophoresis is 15. The following are used to quantitate phosphatases except 16. Which of the following are the major tissue sources of ALP 17. The following characterize the assessment of MI except 18. Give the order list (first to last) of the cardiac enzymes AST, CK, LD that will be elevated in serum when AMI occurs 19. The most useful enzyme assay for diagnosis of metastatic prostatic carcinoma 20. The most routinely method to differentiate isoenzymes 21. An enzyme the converts emulsified fats to fatty acids and glycerol is 22. A common cause of pre hepatic jaundice 23. Detection of neonatal jaundice depends largely on 24. One of the following characteristics of serum form a hepatic patient 25. Which is present in the urine of patients with jaundice 26. In the liver, bilirubin is converted into 27. 28. 29. 30. The standard use for Icterus index Jendrassik and Groff method of Bilirubin uses Thus bilirubin is soluble in water Methods for bilirubin determination

Olive oil Acute pancreatitis MMMM Reitman Frankel Liver, Bone, Pancreas Abnormal serum ALP isoenzyme pattern CK, AST, LD ACP Electrophoresis Lipase Hemolytic disease Bilirubin Icteric Direct bilirubin Bilirubin and glucoronide Potassium dichromate Caffeine Conjugated bilirubin Eveleyn and Malloy, Jendrassik and Groff There is direct proportionality between body wt and ability of the liver to excrete dye Hemoglobin UDP-glucoronyl transferase Liver disease +/- 5% retention in 45 mins Liver disease Ehrlichs aldehyde reagent Porphobilinogen Light sensitivity Total bilirubin Hippuric acid Liver Deposits of unconjugated bilirubin in brain cells Hemolytic anemia 2.0 mg/dL Water soluble Liver detoxification ability Heme

31. The BSP liver function test assumes the BSP dye is primarily removed from the blood stream by the liver and these exists

32. Bilirubin is formed during the metabolism of 33. Direct reacting bilirubin diglucoronide is formed in a reaction catalyzed by 34. Direct reacting bilirubin is elevated in 35. The normal BSP retention is reported as 36. Cephalin flocculation and thymol turbidity may be indicative of 37. Urobilinogen is determined by reaction with 38. Urobilinogen is formed in the intestine from 39. Serum bilirubin is unstable because of 40. The diazo-bilirubin color appearing after the addition of alcohol is [Link] benzoic acid ingested the following substances is excreted 42. Conjugation of bilirubin occurs mostly in 43. Kernicterus is caused by 44. 45. 46. 47. Pre hepatic jaundice is caused by Jaundice usually first becomes visible when serum bilirubin levels are Bilirubin glucoronide The BSP test measures

48. Bilirubin is the breakdown product of

49. A severe disease with marked hyperbilirubinemua that results form a genetic deficiency of the UDP glucornyl transferase 50. Accelerator used in the Jendrassik-Groff bilirubin

Criggler-Najjar Syndrome Caffeine Sodium Benzoate

FREQUENTLY ASKED BOARD EXAM QUESTIONS CLINICAL CHEMISTRY II Electrolytes and Acid Base Balance Test I. Multiple Choice C 1. Importance of osmolality A. Parameter to which the hypothalamus respond B. For regulation of sodium concentration C. Both A and B D. Neither B 2. Specific organs which play important roles in maintaining H+ balance A. Heart and liver C. Liver and kidneys B. Lungs and kidneys D. Heart and lungs B 3. Toxic levels of this trace metal is found in Alzheimers disease A. Nickel C. Zinc B. Aluminum D. Chromium D 4. Functions of potassium A. For concentration of skeletal and smooth muscle B. For transmission of nerve impulses C. For regulation of intracellular fluid volume D. All of the above A 5. The anion that is lost in great quantities due to vomitting, gastric suction or diuretics A. Chloride C. Potassium B. Sodium D. Calcium D 6. TIBC is measured to assess the blood level of: A. Ferritin C. Haptoglobin B. Hemopexin D. Transferrin C 7. Hydrogen ion concentration is usually measured by: A. Fluorometry C. Potentiometry B. Coulometry D. All of the above A 8. Respiratory alkalosis occurs as a result of a carbonic acid deficit due to: A. blowing off CO2 C. drop in blood pH B. retention of CO2 D. excess HCO3B 9. In which of the following conditions is serum potassium elevated? A. prolonged diarrhea C. prolonged vomitting B. renal failure D. all of the above D 10. Hyponatremia is found in all of the following conditions except: A. Addisons disease C. Renal tubular disease B. Diabetic acidosis D. Dehydration B 11. The most important buffer system in the body: A. Phosphate B. Bicarbonate/carbonic acid C. Protein D. Hemoglobin/oxyhemoglobin B 12. Hormones produced by the pituitary gland responsible for the promotion of water retention A. renin C. aldosterone

B. ADH D. calcitonin 13. Hormones that causes increase in circulating calcium A. PTH and Vit. D C. Calcitonin and Vit. D B. PTH and Calcitonin D. Calcitonin only C 14. An iron transport protein in the body: A. Ferritin C. Transferrin B. Haptoglobin D. Hemopexin C 15. Created by the concentration difference between commonly measured cations and commonly measured anions A. electrolyte balance C. anion gap B. acid-base balance D. cation gap D 16. Chloride shift happens: A. When HCO3- concentration increases in the red cells and diffuse into the plasma B. To maintain electroneutrality C. When Cl- diffuses into the cell D. All of the above B 17. Secreted by the thyroid gland whose action is to decrease Calcium level in the circulation: A. PTH C. Vit. D B. calcitonin D. phosphorus A 18-21. Matching Type A. B. C. D. E. A E D B B 18. 19. 20. 21. HCO3HCO3HCO3HCO3HCO3decrease, PCO2 decrease, pH increase decrease, PCO2 decrease, pH decrease decrease, PCO2 increase, pH decrease increase, PCO2 increase, pH decrease increase, PCO2 increase, pH increase

Respiratory Alkalosis Metabolic Alkalosis Respiratory Acidosis Metabolic Acidosis

22. Physiologically active form of calcium A. Complexed C. Lipid bound B. Ionized D. Protein bound B 23. Blood specimen required from blood gas measurement A. Capillary C. Venous blood B. Arterial D. All of the above A 24. Indicator used in mercurimetric titration of chloride which gives a violet blue end color A. diphenyl carbazone C. phenolthalein B. cresol red D. formazen dye C 25. A trace metal considered part of vitamin B 12 for red cell synthesis A. Zinc C. Cobalt B. Aluminum D. Copper Test II. Matching Type B 26. Hyperventilation A. Acidosis C 27. Deficit of bicarbonate Alkalosis A 28. Accumulation of carbonic acid with retention of CO2 Respiratory B. Respiratory C. Metabolic

Acidosis C 29. Alkalosis D 30. B 31. B 32. B 33. C 34. C 35. D F E A B F E D A C 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

Diabetic ketoacidosis Excess bicarbonate Reduction of carbonic acid with excess elimination of CO2 Asthma Anxiety and hysteria Renal disease Excessive loss of electrolytes Titan yellow Fiske Subbarow Valinomycin electrode Chelation with OCP Schales and Schales Gomori Modification Flame photometry Calmagite Arsenzo dye III TIBC

D.

Metabolic

A. Calcium B. Chloride C. Iron D. Magnesium E. Potassium F. Phosphorus

Test III. Write A, B, or C A C B A A B B B A A 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. Chloride in Cushings syndrome Phosphorus in acute pancreatitis Ceruloplasmin in Wilsons disease Magnesium in dehydration Iron in hemolytic anemia Calcium in hypoparathyroidism Potassium in diarrhea Calcium in tetany Chloride in eclampsia Sodium in hyperadrenalism A. increased B. decreased C. unaffected

Test IV. On the first blank, write the LETTER of unrelated item found in COLUMN I. On the SECOND blank, write the NUMBER of the item found in COLUMN II that is related to the four items in Column I. C 3 COLUMN I 56. A. major extracellular anion B. precipitates with mercury C. major intracellular cation D. Decreased in prolonged vomitting E. determined by coulometric titration COLUMN II 1. Potassium 2. Sodium 3. Chloride 4. Phosphorus

57. A. chemical sponge 1. pH B. represents free H+ in a solution 2. HCO3C. weak acid in combination with the salt 3. buffer of that acid 4. pCO2 D. prevents flunctuation of pH E. helps in the maintenance of acid-base Equilibrium 58. A. greatest single constituent of the body 1. water

B. obtained from the combustion of 2. electrolytes foodstuffs 3. acid C. 70% of total body weight of an average 4. base adult D. serves as co-factor of enzymes E. medium in which all cellular reactions take place D 4 acidosis 59. A. base gaining 1. respiratory

B. acid losing C. hypokalemia D. high pCO2 E. high bicarbonate

2. respiratory alkalosis 3. metabolic acidosis 4. metabolic alkalosis

60. A. no anticoagulant 1. Iron B. drawn anaerobically 2. Blood gasses C. arterial blood sample 3. Phosphate D. heparinized needle and syringe 4. Magnesium E. whole blood