1

Clinical Chemistry
1.

Sodium fluoride is used in specimen collection to:

a. Prevent glycolysis
b. Prevent conversion of prothrombin to thrombin
c. Chelate calcium
d. Bind calcium

2. Serum iron should be drawn at the same time on successive days to avoid:
a. Diurnal variation
b. Chance of consumption of dietary iron
c. Effect of medication
d. Gastrointestinal absorption of iron
3. The venipuncture site for a routine puncture is commonly cleaned with:
a. 90% alcohol
b. Betadine
c. 70% alcohol
d. Quarternary ammonium compounds
4. Which of these substances cannot be preserved by freezing?
a. BUN
b. CK isoenzymes
c. LDH
d. Prostatic ACP
5. Which of the following is an appropriate sample for blood ammonia
determination?
a. Arterial blood immediately chilled for 12 hours
b. Arterial blood immediately chilled for 8 hours
c. Arterial blood immediately chilled for 4 hours
d. Freshly drawn blood
6. Which statement about wavelength calibration is true?
a. A didymium filter will have an absorbance maximum at 585 nm
b. Holmium oxide glass gives an absorbance maximum at 361 nm
c. The line emission of a hydrogen lamp at 656 nm can be used for
calibration
d. All of these
7. In spectrophotometric analysis, what is the purpose of the reagent
blank?
a. Correct for interfering chromogens
b. Correct for lipemia
c. Correct for protein
d. Correct for color contribution of the reagents

8. Nephelometry is based on the measurement of light that is:

a. Blocked by particles in suspension
b. Scattered by particles in suspension
c. Produced by fluorescence
d. Produced by excitation of ground state atoms
9. When measuring K+ with an ion-selective electrode by means of a liquid
ion-exchange membrane, what antibiotic will be incorporated into the
membrane?
a. Vancomycin
b. Streptomycin
c. Valinomycin
d. Nonactin
10. The
a.
b.
c.
d.

purpose of the glass coils in a continuous flow system is to:

Provide proper mixing
Prevent carry-over of sample
Allow visual inspection
Allow close packing of tubing

11. The
a.
b.
c.
d.

theoretic pH of pure water is:

6.0
7.0
7.4
8.0

12. How many mL of 95% alcohol do you need to make 1 liter of a 70%
solution?
a. 74 mL
b. 138 mL
c. 737 mL
d. 1360 mL
13. If 0.5 mL serum is diluted to a volume of 10 mL with normal saline,
what dilution is achieved?
a. 1:40
b. 1:10
c. 1:5
d. 1:20
14. An explosion could result if:
a. Acid is added to water
b. Water is premixed with a weak salt
c. Acid is neutralized and water added
d. Water is added to concentrated acid

15. Given the following laboratory data:

Serum creatinine = 4.0 mg/dL
Urine creatinine = 80 mg/dL
24 hour volume = 360 mL
The creatinine clearance is:
a. Normal for an adult
b. Low for an adult
c. High for an adult
d. Unable to calculate with data given
16. All emergency (STAT) laboratory analyses should be reported to the
ordering physician within:
a. 30 mins to 1 hour
b. 10 to 20 minutes
c. 1 to 2 hours
d. 3 hours
17. A properly labeled specimen will include all of the following EXCEPT:
a. Name of patient
b. Unique identification number
c. Date of collection
d. Date of birth of patient
18. Which of the following is caused by a random error?
1. R:4s
3. 1:2s
5. 10:x
2. 4:1s
4. 1:3s
6. 2:2s
a. 1, 2, 3, and 6
b. 1, 4 and 6
c. 1 and 4
d. 2, 3 and 5
19. It is defined as the proportion of individuals without a condition who
have a negative test for that condition
a. Diagnostic sensitivity
b. Diagnostic specificity
c. Positive predictive value
d. Negative predictive value
20. It refers to the ability of a method to measure only the analyte of
interest
a. Accuracy
b. Precision
c. Specificity
d. Sensitivity
21. What term applies to the sum of all the values in a set of numbers
divided by the number of values in that set?
a. Median
b. Mode
c. Mean
d. Standard deviation

22. What does the preparation of a Levey-Jennings QC chart for any single
constituent of serum require?
a. Analysis of control serum over a period of 20 consecutive days
b. 20 to 30 analyses of the control serum on 1 day, in one batch
c. Analyses consistently performed by one person
d. Weekly analyses of the control serum for 1 month
23. A group of physicians consistently complains that they are not
receiving STAT patient results quickly enough. The supervisor is likely to
refer to which quality assessment variable?
a. Test utilization
b. Turnaround time
c. Specimen separation and aliquoting
d. Analytical methodology
24. It refers to the ability of an analytical method to maintain both
accuracy and precision over an extended period of time?
a. Probability
b. Practicability
c. Reliability
d. Validity
25. Which Westgard multirole applies to a situation where one control point
exceeds the mean by +2SD and a second control point exceeds the mean by
-2SD?
a. 1:2s
b. 2:2s
c. 4:1s
d. R:4s
26. Hemolysis releases intracellular ions into the serum. Therefore, even
slight hemolysis will cause erroneous results for the following:
1. Na++
3. Mg++
5. Cl+
2. K
4. HCO3
6. Fe++
a. 1, 2 and 3
c. 2
b. 2, 3, 4 and 5
d. 2, 3, 6
27. Symptom of hypocalcemia is typically:
a. Stupor
b. Tetany
c. Tremors
d. Dehydration
28. The Fiske-Subbarow method is based upon the reaction of inorganic
phosphorus with:
a. Ammonium molybdate
b. Oxalic acid
c. Mercuric nitrate
d. p-dimethylaminobenzaldehyde

29. Determine the anion gap from the given serum electrolyte data:
Na++ = 132 mmol/L
HCO3- = 22 mmol/L
Cl- = 90 mmol/L
a. 12 mmol/L
b. 64 mmol/L
c. 20 mmol/L
d. Cannot be determined from the information provided
30. Major extracellular anion
a. Sodium
b. Potassium
c. Chloride
d. Bicarbonate
31. Which of the following conditions will cause an increased osmolal gap?
a. Drug overdose
b. Diabetic ketoacidosis
c. Renal failure
d. All of these
32. Hyperaldosteronism will cause ____ serum sodium and ___ serum potassium
levels
a. Increased; Decreased
b. Increased; Increased
c. Decreased; Increased
d. Decreased; Decreased
33. Which of the following is
hormone (ADH) release?
a. Hypovolemia
b. Hyperosmolar plasma
c. Renin release
d. Reduced renal blood flow

the

primary

mechanism

for

antidiuretic

34. Which of the following clearance tests offers the most accurate measure
of glomerular filtration?
a. Inulin
b. Creatinine
c. p-aminohippurate (PAH)
d. Urea
35. All
a.
b.
c.
d.

but one of the following matches is correct:

Urea product of protein catabolism
Creatine product of muscle catabolism
Uric acid product of pyrimidine catabolism
Bilirubin product of heme catabolism

36. The
a.
b.
c.
d.

classic creatinine reaction is that of:

Jaffe
Lloyd
Kjeldahl
Nessler

37. To determine if a 24 hour urine collection is complete, which of the

following determinations may be helpful?
a. BUN
b. Osmolality
c. Protein
d. Creatinine
38. A condition in which the metabolism of uric acid, but not of other
nitrogenous urinary constituents, is impaired:
a. Uremia
b. Azotemia
c. Gout
d. Nephritis
39. The
a.
b.
c.
d.

cause(s) of prerenal azotemia is (are):

Dehydration
Congestive heart failure
Shock of hemorrhage
All of the above

40. The
a.
b.
c.
d.

urea
Urea
Urea
Urea
Urea

nitrogen
nitrogen
nitrogen
nitrogen
nitrogen

method using diacetyl monoxime measures:

only
and ammonia
and amino acids
and peptide bonds

41. Urea concentration is calculated from the blood urea nitrogen (BUN) by
multiplying by the factor of:
a. 0.5
b. 2.14
c. 6.45
d. 14
42. Which of the following is classified as a mucopolysaccharide storage
disease?
a. Pompes disease
b. von Gierkes disease
c. Andersens disease
d. Hurlers syndrome
43. Which of the following is the reference method for measuring serum
glucose?
a. Somogyi-Nelson
b. Hexokinase
c. Glucose oxidase
d. Glucose dehydrogenase

44. Which of the following hormones does not promote an increase in blood
glucose levels?
a. Growth hormone
b. Cortisol
c. Insulin
d. Glucagon
45. Which of the following does not properly describe type I diabetes
mellitus?
a. Insulin deficiency
b. Associated with autoimmune destruction of pancreatic beta-cells
c. Ketoacidosis prone
d. Occurs more frequently in adults
46. For
glucose
a.
b.
c.
d.

every 1% change in the HbA1c value, ___ mg/dL is added to plasma

15
25
35
50

47. According to WHO, what is the standard glucose load for OGTT procedure?
a. 75g
b. 150g
c. 50g
d. 100g
48. Type I and V hyperlipoproteinemia are characterized by large increase
in:
a. Chylomicrons
b. Low density lipoproteins (LDL)
c. Very low density lipoproteins (VLDL)
d. High density lipoproteins (HDL)
49. Serum turbidity is due to:
a. Proteins
b. Glucose
c. Triglycerides
d. Cholesterol
50. To produce reliable results, at which time should blood specimens for
lipid studies be drawn?
a. 2-4 hour fasting
b. 6-8 hour fasting
c. 8-10 hour fasting
d. 12-16 hour fasting

51. Which of the following

cholesterol can be estimated?
a. LDL cholesterol = Total
cholesterol)
b. LDL cholesterol = Total
Phospholipids)
c. LDL cholesterol = HDL
d. LDL cholesterol = Total

is

the

Friedewald

formula

by

which

LDL

cholesterol (Triglycerides/5 + HDL

cholesterol (Triglycerides +
Total cholesterol
cholesterol HDL cholesterol

52. Which of the following matches is incorrect?

a. LpX Obstructive jaundice and LCAT deficiency
b. Lp(a) Sinking pre-beta lipoprotein
c. -VLDL Floating beta lipoprotein
d. IDL Migrates in the alpha region (electrophoresis)
53. Which of the following
cholesterol esters?
a. HDL
b. VLDL
c. LDL
d. Chylomicrons

lipoproteins

is

composed

of

45-50%

of

54. This is the reference method for quantitation of lipoproteins

a. Chemical precipitation
b. Ultracentrifugation
c. Electrophoresis
d. Abell, Levy and Brodie method
55. It is an autosomal recessive disorder characterized by defective apo B
synthesis and absence of VLDL, LDL and chylomicrons in the plasma
a. Tangiers disease
b. Lipoprotein lipase deficiency
c. Lecithin Cholesterol Acyl Transferase (LCAT) deficiency
d. Basses-Kornzweig syndrome
56. Hyperalbuminemia is caused by:
a. Gastroenteropathy
b. Dehydration syndromes
c. Burns
d. Liver disease
57. Which of the following
bridging?
a. Multiple myeloma
b. Malignancy
c. Liver cirrhosis
d. Rheumatoid arthritis

conditions

is

associated

with

beta-gamma

58. During serum electrophoresis, which of the following proteins migrate

in the alpha-2 region?
1. Alpha-feto protein
3. Haptoglobin
5. Transferrin
2. Hemopexin
4. Ceruloplasmin
6. Complement
a. 1, 2, 5 and 6
c. 3 and 4
b. 1, 3, 4, and 6
d. 2 and 3
59. Which of the following statements is true of albumin?
a. Compared to globulin, it makes up the lesser portion of total
protein
b. Its size prevents its passage through even a damaged glomerular
barrier
c. It is produced in the liver
d. Clinical problems are usually related to high serum values
60. Which reagent is employed in the serum protein determination?
a. Molybdenum blue
b. Ferriferrocyanide
c. Resorcinol-HCl
d. Biuret
61. The
a.
b.
c.
d.

most sensitive marker of acute phase inflammation is probably:

C3 complement
C-reactive protein
ESR
Fever

62. Falsely elevated ammonia levels on blood could be caused by:

1. Not chilling blood & analyzing immediately
3.
Poor
venipuncture
technique
2. Ammonia contamination from glassware
4. Cigarette smoking
a. 1, 2 and 3
c. 1, 2 and 4
b. 2, 3 and 4
d. 1, 2, 3 and 4
63. Pre-hepatic jaundice is caused by:
a. Hemolytic anemia
b. Cirrhosis
c. Bile duct obstruction
d. Hepatitis
64. Kernicterus is caused by:
a. Deposits of ferric iron in brain tissue
b. Elevation of bilirubin in serum
c. Deposits of unconjugated bilirubin in brain cells
d. Deposits of conjugated bilirubin in brain cells
65. This is characterized by an inability to transport bilirubin from the
sinusoidal membrane into the hepatocyte:
a. Dubin Johnson syndrome
b. Crigler-Najjar syndrome
c. Gilbert syndrome
d. Rotor syndrome

10

66. As the red blood cells disintegrate, hemoglobin is released and

converted to the pigment bilirubin. Which organ is primarily responsible
for this function?
a. Spleen
b. Kidneys
c. Intestines
d. Liver
67. Possibly the most sensitive enzyme
particularly in obstructive jaundice is:
a. Alkaline phosphatase
b. Alanine aminotransferase
c. Acid phosphatase
d. Lactate dehydrogenase

indicator

of

liver

function,

68. In acute viral hepatitis, which of the following would NOT be

suspected?
a. Lactate dehydrogenase 5x increase
b. Alkaline phosphatase - increase is greater than aspartate
aminotransferase
c. Gamma-glutamyl transferase mild increase
d. Aspartate aminotransferase and alanine aminotransferase 10- to
200-fold increase
69. Which of the following markers will remain elevated for 48-72 hours
after the onset of myocardial infarction?
a. CK-MB
b. AST
c. LDH
d. Troponin I
70. Which of the following enzymes are expected to be on peak activity 24
hours after the onset of acute pancreatitis?
a. Amylase
b. Lipase
c. Both of these
d. None of these
71. Which of the following match(es) is (are) correct?
1. CK = Tanzer-Gilbarg and Oliver-Rosalki method
2. LD = Wacker and Wrobleuski La Due method
3. LPS = Cherry Crandal method
4. AST & ALT = Karmen & Reitman-Frankel method
a. 1, 2 and 3
b. 2, 3 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4

11

72. Which of the following match(es) is (are) incorrect?

1. AMS = Saccharogenic method
2. GGT = Ellman method
3. CHS = Szass method
4. 5NT = Dixon & Purdon and Campbell, Belfield & Goldberg method
a. 1 and 4
b. 1 and 3
c. 2 and 4
d. 2 and 3
73. Hemolysis affects which of the following enzymes?
1. CK-MB
3. LDH
2. ACP
4. AMS
a. 1, 2 and 3
b. 1, 2 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4
74. An International Unit (IU) of enzyme activity is the quantity of enzyme
that:
a. Converts 1 micromole of substrate to product per liter
b. Forms 1 mg of product per deciliter
c. Converts 1 micromole of substrate to product per minute
d. Forms 1 millimole of product per liter
75. Which isoenzyme of ALP is most heat stable?
a. Bone
b. Liver
c. Intestinal
d. Placental
76. Which of the following conditions will increase total T4 by increasing
TBG?
a. Pregnancy or estrogens
b. Acute illness
c. Nephrotic syndrome
d. Anabolic steroid use
77. Select the most appropriate single screening test for thyroid disease
a. Free thyroxine index
b. TSH assay
c. Total T3 level assay
d. Total T4 level assay
78. What is the predominant form of thyroid hormone in the circulation?
a. Thyroxine
b. Triiodothyronine
c. Diiodotyrosine
d. Monoiodotyrosine

12

79. The presence of a very high titer for anti-thyroglobulin antibodies and
the detection of anti-thyroid peroxidase antibodies is highly suggestive of
what disorder?
a. Graves disease
b. Hashimotos thyroiditis
c. Pernicious anemia
d. Thyroid adenoma
80. The
a.
b.
c.
d.

Kober reaction is a test for:

Catecholamines
17-Ketogenic steroids
Estrogens
17-Hydroxycorticosteroids

81. Human chorionic gonadotropin (hCG) is secreted by the:

a. Thymus gland
b. Placenta
c. Ovary
d. Ureter
82. Which of the following is the most potent androgen?
a. Androstenedione
b. Dehydroepiandrosterone
c. Androsterone
d. Testosterone
83. The
a.
b.
c.
d.

chief urinary metabolite of norepinephrine and epinephrine is:

Metanephrine
Vanillylmandelic acid
Homovanillic acid
5-HIAA

84. A high urine catecholamine level would be expected in:

a. Argentaffinoma
b. Pheochromocytoma
c. Addisons disease
d. Cushings disease
85. Acromegaly is caused by:
a. Overproduction of growth hormone
b. Deficiency in growth hormone
c. Galactorrhea
d. Stimulation by GnRH
86. For what colorimetric determination is the Trinder reaction widely
used?
a. Acetaminophen
b. Salicylate
c. Barbiturate
d. Benzodiazepines

13

87. Acetaminophen is particularly toxic to what organ?

a. Heart
b. Kidney
c. Spleen
d. Liver
88. THC
drug?
a.
b.
c.
d.

(-tetrahydrocannabinol) is the principal active component of what

Benzodiazepine
Cocaine
Marijuana
Morphine

89. What is the major urinary metabolite of cocaine?

a. Morphine
b. Benzoylecgonine
c. NAPA
d. Primidone
90. Which of the following metals has a characteristic odor of garlic and
metallic taste?
a. Cyanide
b. Arsenic
c. Lead
d. Mercury
91. A blood alcohol level of 0.35-0.50 (% w/v) is associated with:
a. Unable to stand/walk, vomiting, and impaired consciousness
b. Decreased inhibitions, loss of critical judgment, memory impairment
& decreased reaction time
c. Coma and possible death
d. Mild euphoria, decreased inhibitions, and some impairment of motor
skills
92. The
a.
b.
c.
d.

ratio of bicarbonate: carbonic acid in normal plasma is:

1:20
1:10
20:1
10:1

93. What will happen if blood is exposed to air during collection for pH
and blood gas studies?
a. CO2 content increases
b. pH decreases
c. pO2 decreases
d. pCO2 decreases

14

94. Emphysema, pneumonia and other pulmonary diseases are associated with
which acid-base disorders?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Metabolic acidosis
95. For each degree of fever in a patient, pO 2 values will decrease by ___
% and pCO2 values will increase by ___%
a. 7; 3
b. 3; 7
c. 3; 3
d. 7; 7
96. Which biological samples should be regarded as potential hazards?
a. Urine specimens from AIDS patients
b. Stool specimens
c. All biological samples
d. Sputum specimens from TB patients
97. Flammable liquids may be stored
a. In an ordinary refrigerator with a flammable storage label affixed
b. In any refrigerator within the laboratory department
c. In an explosion-proof refrigerator
d. Only in an explosion-proof refrigerator in a remote area
98. Food and drink may be stored in a refrigerator if:
a. Placed in a special sealed container
b. Marked as a consumable material
c. Food and drink may not be placed in a laboratory refrigerator
d. Stored for short periods of time
99. Laboratory supplies should NOT be stored
a. In cabinets and drawers
b. On the floor
c. On shelving
d. At floor level if placed upon a raised platform
100. This class of fire is usually allowed to burn out and nearby materials
protected
a. Type A (Ordinary Combustibles)
b. Type B (Flammable Liquids)
c. Type D (Flammable Metals)
d. Type E (Arsenal Fire)

15

ANSWER KEY: Clinical Chemistry

1. A
2. A
3. C
4. C
5. D
6. D
7. D
8. B
9. C
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

A
B
C
D
D
B
A
D
D
B
C

21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.

C
A
B
C
D
D
B
A
C
C
D
A
B
A
C
A
D
C
D
A

41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.

B
D
B
C
D
C
A
A
C
D
A
D
C
B
D
B
C
C
C
D

61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.

B
D
A
C
C
A
A
B
A
C
D
D
A
C
D
A
B
A
B
C

81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.

B
D
B
B
A
B
D
C
B
B
C
C
D
C
A
C
C
C
B
D