SEMINAR AND UPDATES IN MEDICAL TECHNOLOGY

ASSESSMENT EXAMINATION IN CLINICAL CHEMISTRY 1

INSTRUCTIONS:
• Any form of cheating is strictly prohibited.
• Choose the letter with the best answer.
• Direct all concerns to your proctor.
• Submit all test questionnaires to proctor once the examination is completed.
• Observe proper examination decorum at all times.
• Use of any electric devices (cellular phones, I pads, etc.) is strictly prohibited.

a. Weekly fasting 7 AM serum glucose

1. The following specimens are used for glucose b. Glucose tolerance testing
determination, except: c. 2 hour postprandial serum glucose
a. Whole blood d. Hemoglobin A1c
b. Serum
c. Serous fluids 9. CSF glucose should be obtained _______ before the
d. None of the above spinal tap.
a. 1 hour
2. The preparation of a patient for standard glucose b. 2 hours
tolerance testing should include: c. 2 ½ hours
a. A high carbohydrate diet for 3 days d. 3 hours
b. A low carbohydrate diet for 3 days
c. Fasting for 48 hours prior to testing 10. The following are the chromogens used in
d. Bed rest for 3 days polarographic method of determination of glucose:
a. O-dianisidine
3. Cerebrospinal fluid for glucose assay should be: b. Benzothiazoline
a. Refrigerated c. Dimethylaniline
b. Analyzed immediately d. All of the above
c. Heated at 56 C
d. Stored at room temperature after 11. Glucose oxidase is specific to alpha glucose.
centrifugation Alpha glucose is converted into beta glucose using
the enzyme mutarotase.
4. A healthy person with a blood glucose of 80 mg/dL a. 1st statement is correct; 2nd statement is
(4.4 mmol/L) would have a simultaneously incorrect
determined CSF glucose value of: b. 1st statement is incorrect; 2nd statement is
a. 25 mg/dL (1.4 mmol/L) correct
b. 50 mg/dL (2.3 mmol/L) c. Either statement is incorrect
c. 100 mg/dL (5.5 mmol/L) d. Neither statement is incorrect
d. 150 mg/dL (8.3 mmol/L)
12. True of Hagedorn Jensen method employed in
5. A 45-year-old woman has a fasting serum glucose glucose determination, except:
concentration of 95 mg/dL (5.2 mmol/L) and a 2- a. Uses hot alkaline solution of potassium
hour postprandial glucose concentration of 105 mg/ ferricyanide
dL (5.8 mmol/L). The statement which best b. Reduction of yellow ferricyanide into colorless
describes this patient’s fasting serum glucose ferrocyanide by glucose
concentration is: c. Measured by a decrease in absorbance at 630
a. Normal; reflecting glycogen breakdown by the nm
liver d. None of the above
b. Normal; reflecting glycogen breakdown by the
skeletal muscle 13. The primary function of serum albumin in the
c. Abnormal; indicating diabetes mellitus peripheral blood is to:
d. Abnormal; indicating hypoglycemia a. Maintain colloidal osmotic pressure
b. Increase antibody production
6. Pregnant women with symptoms of thirst, frequent c. Increase fibrinogen formation
urination or unexplained weight loss should have d. Maintain blood viscosity
which of the following tests performed?
a. Tolbutamide test 14. The protein that has the highest dye-binding
b. Lactose tolerance test capacity is:
c. Epinephrine tolerance test a. Albumin
d. Glucose tolerance test b. Alpha globulin
c. Beta globulin
7. The conversion of glucose or other hexoses into d. Gamma globulin
lactate or pyruvate is called:
a. Glycogenesis 15. Refer to the following illustration:
b. Glycogenolysis The serum protein electrophoresis pattern shown
c. Gluconeogenesis below was obtained on cellulose acetate at pH 8.6:
d. Glycolysis

8. Monitoring of long-term glucose control in patients

with adult onset diabetes mellitus can best be
accomplished by measuring:
 b. In sulfuric acid
c. At 40-60 C
d. At 100 C

24. Analysis of CSF for oligoclonal bands is used to

Identify screen for which of the following disease states?
the serum a. Multiple myeloma
protein b. Multiple sclerosis
fraction on c. Myasthenia gravis
the left of d. Von Willebrand disease
the illustration:
a. Gamma globulin 25. To assure an accurate ammonia level result, the
b. Albumin specimen should be:
c. Alpha-1 globulin a. Incubated at 37 C prior to testing
d. Alpha-2 globulin b. Spun and separated immediately, tested as
routine
16. The biuret reaction for the analysis of serum c. Spun, separated, iced and tested immediately
protein depends on the number of: d. Stored at room temperature until tested
a. Free amino groups
b. Free carboxyl groups 26. A serum sample demonstrates an elevated result
c. Peptide bonds when tested with the Jaffe reaction. This indicates:
d. Tyrosine residues a. Prolonged hypothermia
b. Renal functional impairment
17. In electrophoresis of proteins, when the sample is c. Pregnancy
placed in an electric field connected to a buffer of d. Arrhythmia
pH 8.6, all of the proteins:
a. Have a positive charge 27. A patient with glomerulonephritis is most likely to
b. Have a negative charge present with the following serum results:
c. Are electrically neutral a. Creatinine decreased
d. Migrate toward the cathode b. Calcium increased
c. Phosphorous decreased
18. The relative migration rate of proteins on cellulose d. BUN increased
acetate is based on:
a. Molecular weight 28. The principal excretory form of nitrogen is:
b. Concentration a. Amino acids
c. Ionic charge b. Creatinine
d. Particle size c. Urea
d. Uric acid
19. The cellulose acetate electrophoresis at pH 8.6 of
serum proteins will show an order of migration 29. In the Jaffe reaction, creatinine reacts with:
beginning with the fastest migration as follows: a. Alkaline sulfasalazine solution to produce an
a. Albumin, alpha-1 globulin, alpha-2 globulin, orange-yellow complex
beta globulin, gamma globulin b. Potassium iodide to form a reddish-purple
b. Alpha-1 globulin, alpha-2 globulin, beta complex
globulin, gamma globulin, albumin c. Sodium nitroferricyanide to yield a reddish-
c. Albumin, alpha-2 globulin, alpha-1 globulin, brown color
beta globulin, gamma globulin d. Alkaline pricrate solution to yield an orange-
d. Gamma globulin, beta globulin, alpha-2 red complex
globulin, alpha-1 globulin, albumin
30. Creatinine clearance is used to estimate the:
20. Increased serum albumin concentrations are seen in a. Tubular secretion of creatinine
which of the following conditions? b. Glomerular secretion of creatinine
a. Nephrotic syndrome c. Renal glomerular and tubular mass
b. Acute hepatitis d. Glomerular filtration rate
c. Chronic inflammation
d. Dehydration 31. Which of the following represents the end product
of purine metabolism in humans?
21. A patient is admitted with biliary cirrhosis. If a a. AMP and GMP
serum protein electrophoresis is performed which b. DNA and RNA
of the following globulin fractions will be most c. Allantoin
elevated? d. Uric acid
a. Alpha-1
b. Alpha-2 32. High levels of which of lipoprotein class are
c. Beta associated with decreased risk of accelerated
d. Gamma atherosclerosis?
a. Chylomicrons
22. Which of the following serum protein fractions is b. VLDL
most likely to be elevated in patients with c. LDL
nephrotic syndrome? d. HDL
a. Alpha-1 globulin
b. Albumin 33. If the LDL-cholesterol is to be calculated by the
c. Alpha-2 globulin Friedewald formula, what are the 2 measurements
d. Beta globulin and gamma globulin that need to be carried out by the same chemical
procedure?
23. A characteristic of the Bence Jones protein that is a. Total cholesterol and HDL-cholesterol
used to distinguish it from other urinary proteins is b. Total cholesterol and triglyceride
its solubility: c. Triglyceride and chylomicrons
a. In ammonium sulfate d. Apolipoprotein A and apolipoprotein B
34. Transportation of 60%-70% of the plasma
cholesterol is performed by:
a. Chylomicrons
b. Very low-density lipoproteins
c. Low-density lipoproteins
d. High-density lipoproteins
35. Turbidity in serum suggests elevation of:
a. Cholesterol
b. Triglycerides
c. Chylomicrons
d. LDL
36. The function of the major lipid components of the
very low-density lipoproteins (VLDL) is to transport:
a. Cholesterol from peripheral cells to the liver
b. Cholesterol and phospholipids to peripheral
cells
c. Exogenous triglycerides
d. Endogenous triglycerides
37. This is used for monitoring glucose control over the
previous 2 to 3 weeks:
a. Glycosylated hemoglobin
b. Glycated albumin
c. Hemoglobin A1c
d. None of the above
38. Labile Pre-HbA1c interferes with isoelectric
focusing
Ideal value for HbA1c is less than 7%
a. 1st statement is correct; 2nd statement is
incorrect
b. 1st statement is incorrect; 2nd statement is
correct
c. Either statement is incorrect
d. Neither statement is incorrect
39. A large percentage of patients with gestational
diabetes develop type II diabetes mellitus after 10
to 15 years.
Patients with GDM fail to increase their insulin
production, leading then to increased blood
glucose.
a. 1st statement is correct; 2nd statement is
incorrect
b. 1st statement is incorrect; 2nd statement is
correct
c. Either statement is incorrect
d. Neither statement is incorrect
40. HDL is composed of ______ percent of protein:
a. 18-22
b. 6-10
c. 45-55
d. 1-2
41. Cholesterol ester accounts to approximately 60% of
the total cholesterol in the body; composed of
cholesterol ring and a fatty acid.
Free cholesterol accounts to approximately 40% of
the cholesterol in the body.
a. 1st statement is correct; 2nd statement is
incorrect
b. 1st statement is incorrect; 2nd statement is
correct
c. Either statement is incorrect
d. Neither statement is incorrect
42. The formula below is used to estimate which of the
following test when chylomicrons are absent and
triglycerides are less than 400 mg/dL: Plasma
triglerides ÷ 5
a. HDL
b. LDL
c. VLDL
d. All of the above
43. Loss of renal function is demonstrated by high
concentration of which of the following analytes?
a. Serum iron
b. Triglycerides
c. Protein
d. Creatinine
44. The reference method for glucose analysis uses
_____________ as the second enzyme in its
reaction:
a. Glucose oxidase
b. Glucose peroxidase
c. Glucose 6-phosphate dehydrogenase
d. All of the above
45. Exogenous triglycerides are transported by VLDL.
Reverse cholesterol transport is done by LDL.
a. 1st statement is correct; 2nd statement is
incorrect
b. 1st statement is incorrect; 2nd statement is
correct
c. Either statement is incorrect
d. Neither statement is incorrect
46. True regarding VLDL:
a. It is an abnormal lipoprotein that accumulates
with type III hyperlipoproteinemia.
b. It is known as the sinking pre-beta lipoprotein
c. It is often seen in patients with obstructive
biliary disease.
d. Both b and c
47. All of the following statements about glucagon are
correct, except:
a. High levels of blood glucose decreases the
release of glucagon from the α cells of the
pancreas.
b. Glucagon increases the intracellular levels of
cAMP in liver cells causing an increase in
glycogen breakdown.
c. Glucagon is the only hormone important in
combating hypoglycemia.
d. Glucagon stimulates the formation of ketone
bodies in the liver.
48. When electrophoresed, migration of lipoprotein
starting from the anode will be:
a. Chylomicrons-LDL-VLDL-HDL
b. HDL-VLDL-LDL-Chylomicrons
c. HDL-LDL-VLDL-Chylomicrons
d. Chylomicrons-VLDL-LDL-HDL
49. Increase in the end product of purine metabolism
can be due to all of the following, except:
a. Lesch-Nyhan syndrome
b. Hepatic coma
c. Leukemia
d. B and C
50. True of type II Diabetes Mellitus:
1. Adult onset DM
2. Can be caused by autoimmune destruction
of β cells of pancreas
3. Insulin dependent type of DM
4. C-peptide levels are detectable
a. 1, 2, 3, 4
b. 1, 2, 3
c. 1, 3, 4
d. 1, 4
51. If triglyceride levels in serum is less than 400 mg/
dL. What would be the approximate ration of VLDL
to triglycerides?
a. 1:1
b. 1:2
c. 1:4
d. 1:5
 a. Monoclonal band in the gamma-globulin region
52. Diacetyl monoxime method, which is based on b. Polyclonal band in the gamma-globulin region
Fearon reaction measures: c. Bridging effect between the beta- and gamma-
a. Urea nitrogen and peptide bonds globulin bands
b. Peptide bonds only d. Increase in the alpha2-globulin band
c. Urea nitrogen only
d. None of the above 62. What is the compound that comprises the majority
of the non-protein nitrogen fractions in the serum?
53. Toxic ammonia is converted into harmless urea a. Uric acid
through what pathway? b. Creatinine
a. Krebs cycle c. Ammonia
b. Kreb-Henseleit cycle d. Urea
c. Glycolysis
d. Citric acid cycle 63. In the diacetyl method, what does diacetyl react
with to form a yellow product?
54. Proteins, carbohydrates and lipids are the three a. Ammonia
major biochemical compounds of human b. Urea
metabolism. What is the element that distinguishes c. Uric acid
proteins from carbohydrate and lipid compounds? d. Nitrogen
a. Carbon
b. Hydrogen 64. What endogenous substance may cause a positive
c. Oxygen interference in the urease/glutamate
d. Nitrogen dehydrogenase assay?
a. Ammonia
55. What is the basis for the Kjeldahl technique for the b. Creatinine
determination of serum total protein? c. Glucose
a. Quantification of peptide bonds d. Cholesterol
b. Determination of the refractive index of
proteins 65. Which of the following methods utilizes urease and
c. Ultraviolet light absorption by aromatic rings at glutamate dehydrogenase for the quantification of
280 nm serum urea?
d. Quantification of the nitrogen content of a. Berthelot
protein b. Coupled enzymatic
c. Conductimetric
56. When quantifying serum total proteins, upon what d. Indicator dye
is the intensity of the color produced in the biuret
reaction dependent? 66. From what precursor is creatinine formed?
a. Molecular weight of the protein a. Urea
b. Acidity of the medium b. Glucose
c. Number of peptide bonds c. Creatine
d. Nitrogen content of the protein d. Uric acid

57. Proteins may become denatured when subjected to
mechanical agitation, heat or extreme chemical
treatment. How are proteins affected by
denaturation?
a. Alteration in primary structure
b. Alteration in secondary structure
c. Alteration in tertiary structure
d. Increase in solubility
58. In a healthy individual, which protein fraction has
the greatest concentration in serum?
a. Alpha1-globulin
b. Beta-globulin
c. Gamma-globulin
d. Albumin
59. Which total protein method requires copper
sulfate, potassium iodide in sodium hydroxide, and
potassium sodium tartrate in its reagent system?
a. Kjeldahl
b. Biuret
c. Folin-Ciocalteu
d. Ultraviolet absorption
60. Of the five immunoglobulin classes: IgG is the most
structurally simple, consisting of how many light
chains/heavy chains, respectively?
a. 5/2
b. 1/1
c. 2/5
d. 2/2
61. Portal cirrhosis is a chronic disease of the liver. As
observed on an electrophoretic serum protein
pattern, what is a predominant characteristic
disease?
67. What analyte is measured using Jaffe reaction?
A. Urea
B. Uric acid
C. Ammonia
D. Creatinine
68. When the Jaffe reaction is employed as a kinetic
assay to quantify serum creatinine, which of the
following is used in the analysis?
a. Serum sample used directly
b. Folin-Wu filtrate
c. Somogyi-Nelson filtrate
d. Trichloroacetic acid filtrate
69. What compound normally found in urine maybe
used to assess the completeness of a 24-hour urine
collection?
a. Urea
b. Uric acid
c. Creatine
d. Creatinine
70. Which of the following reagents is not utilized in a
coupled enzymatic reaction method to quantify
serum creatinine?
a. Picric acid
b. Chromogenic dye
c. Creatinine amidohydrolase
d. Sarcosine oxidase
71. An endogenous substance assayed to assess the
glomerular filtration rate may be described as
being filtered by the glomeruli, not reabsorbed by
the tubules, and only secreted by the tubules when
plasma levels become elevated. What is this
frequently assayed substance?
 a. Inulin 82. It uses phenol reagent or phosphotungstomolybdic
b. Uric acid acid which oxidizes phenolic compounds such as
c. Creatinine tyrosine:
d. Urea a. Biuret
b. Kjeldahl method
72. What is the end product of purine metabolism? c. Lowry assay
a. Urea d. Folin-Ciocalteu
b. Uric acid
c. Allantoin 83. Specimen consideration for patients requested for
d. Ammonia uric acid, except:
1. High bilirubin levels cause false increase by
73. When mixed with phosphotungstic acid, what peroxidase method
compound causes the reduction of the former to a 2. No fasting is required
tungsten blue complex? 3. Gross lipemia should be avoided, it
a. Urea interferes with absorbance
b. Ammonia 4. The sample that can be used is heparinized
c. Creatinine plasma only
d. Uric acid a. 1, 2, 3, 4
b. 1, 2, 3
74. In the ultraviolet procedure for quantifying uric c. 1, 4
acid, what does the reaction between uric acid and d. 4
uricase cause?
a. Production of reduced nicotinamideadenine 84. The method which is based on the release of
dinucleotide (NADH) ammonia from alkaline solution and determined by
b. The formation of allantoin back titration with acid:
c. An increase in the absorbance a. Conway microdiffusion
d. A reduction of the phosphotungstic acid b. Caraway method
c. Ion-exchange method
75. In gout, what analyte deposits in joints and other d. Ion-selective electrode
body tissues?
a. Calcium 85. Product of ammonia acid deamination:
b. Creatinine a. Urea
c. Urea b. Ammonia
d. Uric acid c. Creatinine
d. Uric acid
76. What does hydrolysis of sucrose yield?
a. Glucose only 86. A solution in which the molecules of solute in
b. Galactose and glucose solution are in equilibrium with excess undissolved
c. Maltose and glucose molecule is referred to as:
d. Fructose and galactose a. Dilute
b. Concentrated
c. Saturated
77. The following polyanions can be used in d. Supersaturated
precipitation of HDL, except:
a. Heparin 87. A calcium standard solution contains 10 mg/dL of
b. EDTA calcium. What is its concentration in millimoles per
c. Phosphotungstate liter? (MW of Calcium = 40 grams)
d. Dextran sulfate a. 0.5
b. 5.0
78. A disorder in which notable acanthocytes are seen c. 10.0
in peripheral blood smear with a deficiency in d. 19.5
apolipoprotein B:
a. Abetalipoproteinemia 88. How many grams of H2SO4 are required to prepare
b. Basses-Kornzweig syndrome 750 mL of a 2 M solution? (MW of H2SO4 = 98 grams;
c. Tangier Disease Valence of H+ = 2)
d. A and B a. 245
b. 294
79. To convert cholesterol from mg/dL to mmol/L, the c. 490
value must be multiplied by: d. 1470
a. 0.0113
b. 0.0595 89. Calibrating medium for TD pipet:
c. 0.026 a. Mercury : To contain pipette
d. 0.0555, glucose b. 0.1% phenol red solution in distilled water :
determining reproducibility of pipettes
80. Marker for malnutrition: c. Distilled water
a. Prealbumin d. Both a and c
b. Albumin
c. Ceruloplasmin 90. All of the following statements concerning
d. Transferrin tourniquet application are correct, except:
a. It is applied to patient’s arm during
81. The most sensitive, specific and precise dye- venipuncture
binding assays: b. It should be fastened tight enough to restrict
a. Bromcresol green venous flow but not arterial flow
b. Bromcresol blue c. Distends the veins, making them larger and
c. Bromcresol purple easier to find, and stretches the walls so they
d. Bromphenol blue are thinner and easier to pierce
d. It must not be left on longer than 3 minutes
because specimen quality can be affected
91. If there is an excess citrate in plasma from
insufficient blood volume, the clotting time is:
a. Falsely elevated
b. Falsely decreased
c. It does not affect the clotting time
d. None of the above
92. Which of the following lamps provide a continuous
spectrum of radiant energy in the visible near, IR
and near UV regions of the spectrum?
a. Tungsten-filament
b. Hydrogen UV
c. Deuterium UV
d. Mercury vapour UV and visible region
93. In spectrophotometric analysis, what is the purpose
of the reagent blank?
a. Correct for interfering chromogens
b. Correct for lipemia
c. Correct for proteins
d. Correct for color contribution of the reagents
94. Which of the following statements about atomic
absorption spectrophotometry is true?
a. It requires that the element to be measured be
brought to a non-ionized ground state
b. It is less sensitive than flame photometry
c. It uses a tungsten lamp as the light source
d. It uses a cathode made of the element lithium
95. Nephelometry is a method of assay based on the
measurement of the light that is
a. Absorbed by particles in suspension
b. Scattered by particles in suspension
c. Produced by fluorescence
d. Produced by excitation of ground state atoms
96. In flame emission photometry, a photon of light
with a wavelength specific for a given element is
emitted when
a. An orbital electron is raise to a higher energy
state
b. An excited orbital electron returns to the
ground state, fluorometry
c. The element absorbs ultraviolet light
d. The bonds in the molecule vibrate
*** END***
97. Which of the following analytic methods are based
on the amount of light blocked by a particulate
matter in a turbid solution?
a. Nephelometry
b. Turbidimetry
c. Titrimetric
d. Electrophoresis
98. Upon admission to the hospital, a chemistry profile
is performed on a patient. The patient has a total
bilirubin of 2.0 mg/dL. The next day a second
chemistry profile is done and the patient’s total
bilirubin is 6.2 mg/dL. What should be done in
regard to these results because the normal and
abnormal controls are within acceptable limits?
a. Immediately call the physician to alert him/her
to the second abnormal result
b. Immediately send the second result to the
patients floor for charting
c. Repeat the entire second run of patient
specimens because there must be an error
d. Perform delta check and, if warranted, look for
possible sources of error
99. When comparing a potential new test with a
comparative method in order to bring a new
method into the laboratory, one observes error that
is consistently affecting results in one direction.
What is this type of error known as?
a. Systematic error
b. Random error
c. Constant systematic error
d. Proportional systematic error
100.Which of the following does not pertain to
characteristics and use of assayed control material?
a. Has physical and chemical properties
resembling test specimen
b. Contains preanalyzed concentrations of
analytes being measured
c. Can be interchanged in terms of use with
primary standards or calibrators
d. Concentrations of analytes should be in normal
and abnormal ranges