2: Chemistry | Carbohydrates Questions Chemistry The following items have been identified generally as appropriate for both entry level medical laboratory scientists and medical laboratory technicians. Items that are appropriate for medical laboratory scientists only are marked with an "MLS ONLY. 75 Questions 128 Answers witk Explanations 75 Carbohydrates 129 Carbohydrates 78. Acid-Base Balance 129 Acid-Base Balance BL Electrolytes 130 Electrolytes 85. Proteins and? Other Nitrogen-Containing 130 Proteins and Other Nitrogen-Containing Compounds Compounds 95 Heme Derivatives 132 Heme Derivatives 99 Enzymes 133. Eneymes 104 Lipids and Lipoproteins 136 Lipids and Lipoproteins 107 Endocrinology and Tumor Markers 137 Endocrinology and Tumor Markers 4113 TDM and Toxicology 139 TDM and Toxicology 11S Quality Assossment 140 Quality Assessment 117 Laboratory Mathematics 141 Laboratory Mathematics 121 Instrumentation 142 Instrumentation Carbohydrates 1 Following overnight fasting, hypoglycemia in adults is defined as a glucose of: a <70 mg/dL (53.9 mmol/L) b <60 mg/dl. (<3.3 mmol/L) ¢ <55 mg/dL (<3.0 mmol/L) 45 mg/Al. (<2.5 mmol/L) 2 The following results are from a 21-year-old patient with a back injury who appears otherwise healthy: whole blood glucose: 77 mg/al. (4.2 mmol) serum glucose: 88 mg/dL. (4.8 mmol/L) glucose: 56 mg/dL (8.1 mmol/L) ‘The best interpretation of these results is that: athe whole blood and serum values are expected but the CSF value is elevated b the whole blood glucose value should be higher than the serum value € all values are consistent with a normal healthy individual 4 the serum and whole blood values should be identical 3 The preparation of a patient for standard glucose tolerance testing should include: a high carbohydrate diet for 3 days a low carbohydrate diet for 3 days fasting for 48 hours prior to testing b c bed rest for 3 days Clinical Laboratory Certification Examinations 752: Chemistry | Carbohydrates Questions 4 10 1 Ifa fasting glucose was 90 mg/dL, which of the following 2-hour postprandial glucose results would most closely represent normal glucose metabolism? 55 mg/al. (3.0 mmol/L) 100 mg/db (5.5 mmo'/i,) 180 mg/dL. 9.9 mmol/L) 260 mg/dL (14.3 mmol/L) aaoe Ahealthy person with a blood glucose of 80 mg/dl. (4.4 mmol/L) would have a simultaneously determined cerebrospinal fluid glucose value of a 25 mg/dL (1.4 mmol/L) b 50 mg/dl (2.3 mmol/L) € 100 mg/dL (5.5 mmol/L) 4150 mg/dL (8.3 mmol/L) A 25-year-old man became nauseated and vomited 90 minutes after receiving a standard 75 g carbohydrate dose for an oral glucose tolerance test. The best course of action is to: a. give the patient a glass of orange juice and continue the test b start the test over immediately with a 50 g carbohydrate dose ¢ draw blood for glucose and discontinue test 4 place the patient in a recumbent position, veassure him and continue the test Cerebrospinal fluid for glucose assay should be: a refrigerated b analyzed immediately c heated to 56°C stored at room temperature after centrifugation Which of the following 2 hour postprandial glucose values demonstrates unequivocal hyperglycemia diagnostic for diabetes mellitus? a 160 mg/dL (8.8 mmol/L) b 170 mg/dl. (9.4 mmol/L) © 180 mg/dL (9.9 mmol/L) 200 mg/at.(11.0 mmol/L) Serum levels that define hypoglycemia in pre-term or low birth weight infants are: a the same as adults b lower than adults ¢ the same as a normal full-term infant 4 higher than a normal full-term infant A45- year-old waman has a fasting serum glucose concentration of 95 mg/dL (5.2 mmol/L) and a 2-hour postprandial glucose concentration of 105 mg/dL (5.8 mmol/L). The statement which best describes this patient's fasting serum glucose concentration is: normal; reflecting glycogen breakdown by the liver normal; reflecting glycogen breakdown by skeletal muscle abnormal; indicating diabetes mellitus, abnormal; indicating hypoglycemia neon Pregnant women with symptoms of thirst, frequent urination or unexplained weight loss should have which of the following tests performed? a tolbutamide test b lactose tolerance test © epinephrine tolerance test 4 glucose tolerance test 76 The Board of Certification Study Guide2: Chemistry | Carbohydrates Questions 12 13 14 15 16 17 18 19 In the fasting state, the arterial and capillary blood glucose concentration varies from the venous glucose concentration by approximately how many mg/dl. (mmol/L)? a 1 mg/dl (6.05 mmol/L) higher b 5S mg/Al (0.27 mmol/L, higher ¢ 10 mg/dL (0.55 mmol/L) lower d 15 mg/dL (0.82 mmol/L) lower ‘The conversion of glucose or other hexoses into lactate or pyruvate is called: a glycogenesis, b glycogenolysis ¢ gluconeogenesis 4 glycolysis Which one of the following values obtained during a glucose tolerance test are diagnostic of diabetes mellitus? a Zhour specimen = 150 mg/dL (8.3 mmol/L) b fasting plasma glucose = 126 mg/dL (6.9 mmol/L) © fasting plasma glucose = 110 mg/dL (6.1 mmol/L) @_ 2-hour specimen = 180 mg/dL (9.9 mmol/L) ‘The glycated hemoglobin value represents the integrated values of glucose concentration during the preceding: 2 weeks a 6 c a Monitoring long-term glucose control in patients with adult onset diabetes mellitus can best be accomplished by measuring: a weekly fasting 7 AM serum glucose b glucose tolerance testing ¢ 2-hour postprandial serum glucose hemoglobin Ax. A patient with Type I, insulin-dependent diabetes mellitus has the following results: Test Patient Reference Range fasting blood glucose: 150 mg/dL (8.3 mmol/L) 70-10. mg/al. (9.9-6.1 mmol/L} hemogiobin Ay: 8.5% 4.0%-6.0% fructosamine: 2.5 mmol 20-28 mmol/L, After reviewing these test results, the technologist concluded that the patient is in a a “steady state” of metabolic control b state of ux, progressively worsening metabolic control € improving state of metabolic control as indicated by fructosamine state of flux as indicted by the fasting glucose level, Total glycosylated hemoglobin levels in a hemolysate reflect the: average blood glucose levels of the past 2-3 months b average blood glucose levels for the past week € blood glucose level at the time the sample is drawn hemoglobin A;_ level at the time the sample is drawn Which of the following hemoglobins has glucose-6-phosphate on the amino-terminal valine of the beta chain? as a eA d Ay Clinical Laboratory Certification Examinations 772: Chemistry | Acid-Base Balance Questions 20 21 22 23 24 25 A patient with hemolytic anemia will: a show a deccease in glycated Hgb value b show an increase in glycated Figb value € show little or no change in glycated Hgb value 4. demonstrate an elevated Hgb Ay In using ion-exchange chromatographic methods, falsely increased levels of Hgb Ai. might be demonstrated in the presence of: iron deficiency anemia pernicious anemia thalassemias Hgb S ar An increase in serum acetone is indicative of a defect in the metabolism of carbohydrates fat wxea nitrogen uric acid anos An infant with diarrhea is being evaluated for a carbohydrate intolerance. His stool yields a positive copper reduction test and a pH of 5.0. It should be concluded that: a further tests are indicated b results are inconsistent—repeat both tests ¢ the diarrhea is not due to carbohydrate intolerance 4. the tests provided no useful information Blood samples were collected at the beginning of an exercise class and after thirty minutes of aerobic activity. Which of the following would be most consistent with the post-exercise sample? normal lactic acid, low pyruvate low lactic acid, elevated pyruvate elevated lactic acid, low pyruvate elevated lactic acid, elevated pyruvate nao What is the best method to diagnose lactase deficiency? Ho breath test plasma aldolase level LDH level Dexylose test ano Acid-Base Balance 26 27 The expected blood gas results for a patient in chronic renal failure would match the pattern of: a metabolic acidosis b respiratory acidosis © metabolic alkalosis @ respiratory alkalosis Severe diarrhea causes: a metabolic acidosis b metabolic alkalosis € respiratory acidosis 4 respiratory alkalosis 78 ‘The Board of Certification Study Guide2: Chemistry | Acid-Base Balance Questions 28 29 30 31 32 33 34 ‘The following blood gas results were obtained: lt 718 Po; 86 mmHg PCO;! 60 mm Hg. Op saturation: 92% HCOs: 7921 mEqil (21 mmo\/L) TCO 23 mEq/L (23 mmol/L) base excess: -8.0 mEq/L (-8.0 mmol/L) ‘The patient's results are compatible with which of the following? a fever Bb uremia emphysema dehydration Factors that contribute to a PCO, electrode requiring 60-120 seconds to reach equilibrium include the: diffusion characteristics of the membrane actual blood PO type of calibrating standard (ie, liquid or humidified gas) potential of the polarizing mercury cell ane An emphysema patient suffering from fluid accumulation in the alveolar spaces is likely to be in what metabolic state? a respiratory acidosis b respiratory alkalosis € metabolic acidosis d_ metabolic alkalosis At blood pH 7.40, what is the ratio of bicarbonate to caxbonic acid? a 151 b 20:1, © 25:1 @ 30:1 The reference range for the pH of arterial blood measured at 37°C is: a 7.28-7.34 b 733-737 © 7.35-7.45 @ 7.45-7.50 A 68-year-old man arrives in the emergency room with a glucose level of 722 mg/dL (9.7 mmol/L) and serum acetone of 4+ undiluted. An arterial blood gas from this patient is likely to be a low pH b high pH © low PO; high PO) A patient is admitted to the emergency room in a state of metabolic alkalosis. Which of the following would be consistent with this diagnosis? a high TCO,, increased HCO B low TCO», increased HCO3 « high PCO>, decreased H2COs 4 low TCO,, decreased HyCO3 Clinical Laboratory Certification Examinations 792: Chemistry | Acid-Base Balance Questions 35 36 37 38 39 40 41 80 ‘A person suspected of having metabolic alkalosis would have which of the following laboratory findings? CO) content and PCO» elevated, pH decreased CO, content decreased and pH elevated CO; content, PCO, and pH decreased CO; content and pH elevated nage Metabolic acidosis is described as a(n): ‘a inctease in CO, content and PCO) with a decreased pH b decrease in CO; content with an increased pH ¢ increase in CO, with an increased pH decrease in CO, content and PCO, with a decreased pH Respiratory acidosis is described as a(n) a increase in CO) content and PCO) with a decreased pH Bb decrease in CO2 content with an increased pH ¢ increase in CO) content with an increased pH decrease in CO content and PCO, with a decreased pH ‘A common cause of respiratory alkalosis is vomiting b starvation asthma hyperventilation Acidosis and alkalosis are best defined as fluctuations in blood pH and CO, content due to changes in: a Bohr effect b Op) content ¢ bicarbonate buffer carbonic anhydrase A blood gas sample was sent to the lab on ice, and a bubble was present in the syringe. The blood had been exposed to room air for at least 30 minutes. The following change in blood gases will occur: a COp content increased/PCO) decreased b CO, content and PO. increased/pH increased ¢ CO content and PCO» decreased/pH decreased a POp increased/HCOs decreased ‘The following laboratory results were obtained: Serum electrolytes sodivm 196 mEGA.(136 mmol/L) potassium 4.4 mEq/L (4.4 mmol/L) chloride: 92 mEqiL. (92 mmoW/.) bicarbonate: 40 mEq/L (40 mmol/L) -Asterial blood pl 732 POO, 7amm Hg ‘These results are most compatible with @ respiratory alkalosis b respiratory acidosis © metabolic alkalosis, metabolic acidosis, ‘The Board of Certification Study Guide2: Chemistry | Electrolytes Questions 42 43 44 45 Select the test which evaluates renal tubular function. a ive b creatinine clearance € osmolarity microscopic urinalysis A patient had the following serum results: Nat; 140 mEq/L. (140 mmol/L} ke 4.0 mEq/L (4.0 mmol/L) Glucose: 95 mg/dl. (6.2 mmol/L) BUN: 10 mg/dL. 8.57 mmol/L) Which osmolality is consistent with these results? a 188 b 204 © 270 d 390 ‘The degree to which the kidney concentrates the glomerular filtrate can be determined by: urine creatine serum creatinine creatinine clearance urine to serum osmolality ratio ane (Osmolal gap is the difference between’ the ideal and real osmolality values caleulated and measured osmolality values plasma and water osmolality values molality and molarity at 4°C ange Electrolytes 46 47 4g ‘The most important buffer pair in plasma is the: phosphate/biphosphate pair hemoglobin/imidazole pair bicarbonate/carbonic acid pair sulfate/bisulfate pair anos Quantitation of Na* and K* by ion-selective electrode is the standard method because: dilution is required for flame photometry B there is no lipoprotein interference ¢ of advances in electrochemistry 4 of the absence of an internal standard What battery of tests is most useful in evaluating an anion gap of 22 mEq/l. (22 mmol/L)? a Ca**, Mg", PO“ and pH b BUN, creatinine, salicylate and methanol ¢ AST, ALT, LD and amylase glucose, CK, myoglobin and cryoglobulin Clinical Laboratory Certification Examinations: 812: Chemistry | Electrolytes Questions 49 50 52 53 34 55 56 82 ‘A patient with myeloproliferative disorder has the following values: Hab: 48 g/dL (130 mmol/L) Het 38% WBC: 30 x 10% (80 x 10%/L) platoiets: 1000 x 10° /4L. (1000 x 10%/L) serum Na": 140 mEq/L (140 mmo} seruin K* 7 mEq/L (7 mmol/L) The serum K? should be confirmed by: a repeat testing of the original serum Pb testing freshly drawn serum © testing heparinized plasma 4 atomic absorption spectrometry Most of the carbon dioxide present in blood is in the form of: a dissolved CO, b carbonate € bicarbonate ion carbonic acid Serum “anion gap” is increased in patients with: a renal tubular acidosis b diabetic alkalosis € metabolic acidosis due to diarrhea d lactic acidosis ‘The anion gap is useful for quality control of laboratory results for: a amino acids and proteins B blood gas analyses € sodium, potassium, chloride, and total CO 4 calcium, phosphorus and magnesium ‘The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and: a sodium b potassium © calcium 4 chloride In respiratory acidosis, a compensatory mechanism is the increase in. a respiration rate b ammonia formation € blood PCO> d plasma bicarbonate concentration Which of the following electrolytes is the chief plasma cation whose main function is maintaining osmotic pressure? a chloride b calcium © potassium sodium A potassium level of 6.8 mEq/L (6.8 mmol/L) is obtained. Before reporting the results, the first step the technologist should take is to: check the serum for hemolysis recun the test check the age of the patient do nothing, simply report out the result nase The Board of Certification Study Guide2: Chemistry | Electrolytes Questions 3S7 58 59 60 61 62 63 64 ‘The solute that contributes the most to the total serum osmolality is: a glucose b sodium ¢ chloride urea A sweat chloride result of 55 mEq/L (55 mmol/L) and a sweat sodium of 52 mEq/L (52 mmol/L) were obtained on a patient who has a history of respiratory problems. The best interpretation of these results is normal normal sodium and an abnormal chioride test should be repeated abnormal results borderline results, the test should be repeated anos Which of the following is true about direct ion selective electrodes for electrolytes? a_ whole blood specimens are acceptable b clevated lipids cause falsely decreased results ¢ elevated proteins cause falsely decreased results elevated platelets cause falsely increased results Sodium determination by indirect ion selective electrode is falsely decreased by: a elevated chloride levels b elevated lipid levels ¢ decreased protein levels decreased albumin levels A physician requested that electrolytes on a multiple myeloma patient specimen be run by direct ISE and not indirect ISE because: excess protein binds Na in indirect ISE Bb _Nais falsely increased by indirect ISE € Nais falsely decreased by indirect ISE excess protein reacts with diluent in indivect ISE Which percentage of total serum calcium is nondiffusible protein bound? 80%-90% 51%-60% 40%-50% 10%-30% aaoe Calcium concentration in the serum is regulated by: a insulin b parathyroid hormone © thyroxine 4 vitamin C ‘The regulation of calcium and phosphorous metabolism is accomplished by which of the following glands? thyroid parathyroid adrenal glands pituitary aoe Clinical caboratory Certification Examinations 832: Chemistry | Electrolytes Questions 65 66 67 68 69 1m nn A patient has the following test results: increased serum caicium levels decteased serum phosphate levels increased levals of parathyroid hormone This patient most likely has: a hyperparathyroidism b hypoparathyroidism € nephrosis d steatorrhea A hospitalized patient is experiencing increased neuromuscular irritability (tetany). Which of the following tests should be ordered immediately? a calcium b phosphate < BUN d glucose Which of the following is most likely to be ordered in addition to serum calcium to determine the cause of tetany? magnesium phosphate sodium vitamin D ane A reciprocal relationship exists between: a sodium and potassium b calcium and phosphate ¢ chloride and CO calcium and magnesium Fasting serurt phosphate concentration is controlled primarily by the: a pancreas b skeleton ¢ parathyroid glands small intestine A low concentration of serum phosphorus is commonly found in: a. patients who ate receiving carbohydrate hyperalimentation b chronic renal disease € hypoparathyroidism 4 patients with pituitary tumors The following laboratory results were obtained: Alkaline Alkaline Calcium Phosphate Phosphatase serum: increased decreased __normal or increased urine: increased —_ increased ‘These results are most compatible with: a multiple myeloma b millcalkali syndrome € sarcoidosis d primary hyperparathyroidism 84. The Board of Certification Study Guide2: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions Proteins and Other Nitrogen-Containing Compounds 72 The primary function of serum albumin in the peripheral blood is to: maintain colloidal osmotic pressure increase antibody production increase fibrinogen formation maintain blood viscosity ane 73 Inapleural effusion caused by Streptococcus pneumoniae, the protein value of the pleural fuid as Bey compared to the serum value would probably be: a decreased by 2 b decreased by % © increased by % equal 74 The first step in analyzing a 24-hour urine specimen for quantitative urine protein is: subculture the urine for bacteria add the appropriate preservative screen for albumin using a dipstick ‘measure the total volume nage 75 When performing a manual protein analysis on a xanthochromic spinal fluid, the Sky. technician should: perform the test as usual make a patient blank centrifuge the specimen diluce the specimen with deionized water aooe 76 ‘The direction in which albumin migrates (ie, toward anode or cathode) during electrophoretic ky. separation of serum proteins, at pH 8.6, is determined by: the ionization of the amine groups, yielding a net positive charge the ionization of the carboxyl groups, yielding a net negative charge albumin acting as a zwitterion the density of the gel layer anos 77 ‘The protein that has che highest dye-binding capacity is: ony albumin alpha globulin beta globulin gamma globulin nage Clinical Laboratory Certification Examinations 852: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 78 only 79 80 81 82 83, Refer to the following illustration: ‘The serum protein electrophoresis pattern shown below was obtained on cellulose acetate at pH 86. ——————— (+) a Identify the serum protein fraction on the left of the illustration a gamma globulin b albumin € alpha-1 globulin @ alpha-2 globulin The biuret reaction for the analysis of serum protein depends on the number of a free amino groups B free carboxyl groups < peptide bonds d tyrosine residues In electrophoresis of proteins, when the sample is placed in an electric field connected to a buffer of pH 8.6, ali of the proteins: havea positive charge b have a negative charge € are electrically neutral d_ migrate toward the cathode ‘The relative migration rate of proteins on cellulose acetate is based on molecular weight concentration ionic charge particle size aay ‘The cellulose acetate electrophoresis at pH 8.6 of serum proteins will show an order of migration beginning with the fastest migration as follows: albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin, albumin albumin, alpha-2 globulin, alpha-1 globulin, beta globulin, gamma globulin gamma globulin, beta globulin, alpha-2 globulin, alplsa-1 globulin, albumin ane Which of the following amino acids is associated with sulfhydryl group? cysteine glycine serine tyrosine nae 86 The Board of Certification Study Guide2: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions a4 85 86 87 88 ‘Maple syrup urine disease is characterized by an increase in which of the following urinary amino acids? a phenylalanine b tyrosine € valine, leucine and isoleucine d cystine and cysteine Increased serum albumin concentrations are seen in which of the following conditions? a nephrotic syndrome B acute hepatitis ¢ chronic inflammation d dehydration ‘The following data was obtained from a cellulose acetate protein electrophoresis scan: albumin area 75 units gamma globulin area: 30 units total areas 180 units total protein 6.5 idl. (65 g/t) The gamma globulin content in g/dl. is a 11 g/dL (11 g/L) Bb 2.7 g/dl. (27 g/t) © 3.8 g/dl. (38 g/L) d 4.9 g/dl (49 g/L) A patient is admitted with biliary cirrhosis. If a serum protein electrophoresis is performed, which of the following globulin fractions will be most elevated? alpha-1 alpha-2 beta gamma ane Which of the following serum protein fractions is most likely to be elevated in patients with nephrotic syndrome? alpha-1 globulin albumin alpha-2 globulin beta globulin and gamma globulin ange Clinical Laboratory Certification Examinations 872: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 89 Refer to the following illustration: only () 0 Patient values total protein 7.3 g/d. (73 g/t) albumin 4.2 g/Al (42 g/L) alphat 0.0 g/d (0 g/L alpha-2 0.9 g/at @g/) beta 0.8 g/dL (8 g/L) gamma 1.4 g/dl (14 g/L) Reference values 6.0-8.0 gd. (60-80 g/L) 3.6-52 g/dl (26-52 g/t) 01-0.4 g/d (1-4 g/t) 0.4-1.0 g/L (4-10 git) 05-12 g/dl (6-12 9/1) 06-16 g/dl (6-16 g/t) ‘This electeophoresis pattern is consistent with: a cierhosis monoclonal gammopathy € polyclonal gammopathy (eg, chronic inflammation) dalpha-l antitrypsin deficiency; severe emphysema 90 Refer to the following illustration: +) Patient values, total protein 8.9 gfat. (69 g/t) albumin 48 g/al (48 g/t) alpha-t «O03 g/d G git} aipna-2 7 g/dL. g/t) beta 0.8 gt @ oll) gamma 23 g/dl @ gl) © Reference values 6.0-8.0 g/dL (60-80 g/t) 3.6-5.2 g/dL (36-52 g/L) 01-04 9/4 (1-4 g/L) 0.4-1.0 g/dl. (4-10 g/t) 0.5-1.2 g/dl. (5-12 g/L) 0.6-1.6 g/dl (6-16 g/L) ‘The serum protein electrophoresis pattern is consistent with a. circhosis b acute inflammation: ¢ monoclonal gammopathy 4 polyclonal gammopathy (eg, chronic inflammation) 88 ‘The Board of Certification Study Guide2: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 91 92 93 94 Refer to the following pattern: (+) QO Po Patient values Reference values. total protein 6.1 g/dl (61 g/L) 6.0-8.0 g/Al. (60-80 g/L) albumin —-- 23 g/dL @8g/L) 3.6-5.2 glal. (6-52 giL) alpha-t O2G/dL g/l) —O1-0.4 g/d (1-4 g/l) alpha-2 OS G/L QIL) —_0.4-1.0 g/dl (4-19 g/L) beta 12g/dL(I2g/) — 0.5-1.2 g/dL 6-12 g/L) gamma 1.9.g/AL(I9 g/L) 06-1.6 g/dl (6-16 g/L) ‘This pattern is consistent wit! sis b acute inflammation € polyclonal gammopathy (eg, chronic inflammation) d alpha-t antitrypsin deficiency; severe emphysema A characteristic of the Bence Jones protein that is used to distinguish it from other urinary proteins is its solubility: a inammonium sulfate b in sulfuric acid © at 40°-60°C d@ at 100°C The electrophoretic pattern of plasma sample as compared to 2 serum sample shows a: abroad prealbumin peak b sharp fibrinogen peak € diffuse pattern because of the presence of anticoagulants decreased globulin fraction ‘Ata pH of 8.6 the gamma globulins move toward the cathode, despite the fact that they are negatively charged. What is this phenomenon called? a reverse migration b molecular sieve ¢ endosmosis d migratory inhibition factor Clinical Laboratory Certification Examinations 892: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 95 Refer to the foilowing illustration: Patientvalues Reference values protein 7.8.G/dL (78 git} 6,0-8.0 g/dL (60-80 g/L) albumin -3.0g/dL BOG) 3.8-5.2 g/dL (86-52 g/t) alpha, OA G/DL (A g/L 01-0.4 gid 1-4 gi) alphag «1.8 g/AL(IBg/L)0.4-1,0 g/dL 4-10.) beta OS QML GaM) — 05-1. g/dL 6-12 g/L) gamma 14. gL (T1 g/l) 0.6-1.6 g/dl 6-16 g/L} ‘The serum protein electrophoresis pattern is consistent with: a cirrhosis b acute inflammation € polyclonal gammopathy (eg, chronic inflammation) 4 alpha-1-antitrypsin deficiency; severe emphysema 96 Refer to the following illustration: (4) © Patient values Reference values total protein 8.5 g/dl (85 g/L) 6.0-8.0 g/dL 60-80 g/l) aloumin 49 g/dL 43g) 9.6-5.2 g/dL 86-52 g/L} alpha, O9GILBGL) — 01-04 g/d (1-4 g/L) alphag OT gidL (7 g/L) 0.41.0. g/L (4-10 g/L) beta O9gGiMdL ol) —0.5-42 g/dL 6-12 g/l) gamma —-2.3g/dL (23g/L) 0.6-1.6 g/t. 6-16 g/L) ‘The above serum protein electrophoresis pattern is consistent with: a. cirrhosis 'b menoclonal gammopathy ¢ polyclonal gammopathy (eg, chronic inflammation) 4 alpha-1-antitrypsin deficiency; severe emphysema 97 Analysis of CSF for oligoclonal bands is used to screen for which of the following disease states? multiple myeloma multiple sclerosis myasthenia gravis, von Willebrand disease magehemistry | Proteins and Other Nitrogen-Containing Compounds Questions 98 ont 99 100 101 102 103 104 105 ‘he identification of Bence Jones protein is best accomplished by’ a asulfosalicylic acid test b urine reagent strips ¢ immunofixation electrophoresis Total iron-binding capacity meastires the serum iron transporting capacity of: a hemoglobin b ceruloplasmin ¢ transferrin ferritin The first step in the quantitation of serum iron is: a direct reaction with appropriate chromogen b iron saturation of transferrin free iron precipitation separation of iron from transferring A patient's blood was drawn at 8 AM for a serum iron determination. The result was 85 g/dL (15.2 pmol/L). A repeat specimen was drawn at 8 PM; the serum was stored at 4°C and runt the next morning, The result was 40 g/dl. (7.2 umol/L). These results are mast likely due to @ iron deficiency anemia b improper storage of the specimen € possible liver damage d. the time of day the second specimen was drawn {An elevated serum iron with normal iron binding capacity is most likely associated with: iron deficiency anemia renal damage pernicious anemia septicemia nee Decreased serum iron associated with increased TIBC is compatible with which of the following, disease states? anemia of chronic infection b iron deficiency anemia © chronic liver disease d_ nephrosis A patient has the following results: Patient values Reference values serum iron 250 g/dL (44.8 mov) 60-150 pg/dl. (10.7-26.9 umol/L) TIBC 350 g/dl (62.7 ymol/L) 300-350 g/dl. (63.7-62.7 ymoW/L) ‘The best conclusion is that this patient has a normal iron status b iron deficiency anemia ¢ chronic disease d iron hemochromatosis ‘To assure an accurate ammonia level result, the specimen should be: a incubated at 37°C prior to testing b spun and separated immediately, tested as routine € spun, separated, iced, and tested immediately stored at room temperature until tested Clinical Laboratory Certification Examinations 912: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 106 107 brite 108 109 110 11 112 13 Erroneous ammonia levels can be eliminated by all of the following except: ‘@ assuring water and reagents are ammonia-free b separating plastaa from cells and performing test analysis as soon as possible ¢ drawing the specimen in a prechilled tube and immersing the tube in ice d storing the specimen protected from light until the analysis is done A critically ill patient becomes comatose. The physician believes the coma is due to hepatic failure. ‘The assay most helpful in this diagnosis is: ammonia b ALT © AST a cor Aserum sample demonstrates an elevated result when tested with the Jaffe reaction. ‘This indicates: prolonged hypothermia xenal functional impairment pregnancy arrhythmia aoe In order to prepare 100 mL of 15 mg/dL BUN (5.35 mmol/L) werking standard from a stock standard containing 500 mg/dL (178.5 mmol/L) of urea nitrogen, the number of mil. of stock solution that should be used is a 3mL b Smb ¢ 33mL d 75 mL A patient with glomerulonephritis is most likely to present with the following serum results: a creatinine decreased b calcium increased ¢ plaosphorous decreased 4_ BUN increased “The principle excretory form of nitrogen is: a amino acids b creatinine © urea @ uric acid In the Jaffe reaction, creatinine reacts with: alkaline sulfasalazine solution to produce an orange-yellow complex b potassium iodide to form a reddish-purple complex ¢ sodium nitroferricyanide to yield a reddish-brown color d alkaline picrate solution to yield an orange-red complex ‘Cyeatinine clearance is used to estimate the: a tubular secretion of creatinine b glomerular secretion of creatinine € renal glomerular and tubular mass glomerular filtration rate 92 The Board of Certification Study Guide2: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 114 11s 116 117 118 119 120 Ablood creatinine value of 5.0 mg/Al. (442.0 mol/L) is most likely to be found with which of the following blood values? osmolality: 292 mOsm/kg uric acid: 8 mg/dL (475.8 pmol/L) urea nitrogen: 80 mg/dL (28.56 mmol/L) ammonia: 80 yg/dL (44 pmol/L) Rage Technical problems encountered during the collection of an amniotic fluid specimen caused doubt. as to whether the specimen was amniotic in origin, Which 1 of the following procedures would best establish that the fluid is amniotic in origin? a measurement of absorbance at 450 nm b creatinine measurement € lecithin/sphingomyelin ratio @_ human amniotic placental lactogen (HPL) Which of the following represents the end product of purine metabolism in humans? a AMP and GMP b DNAand RNA ¢ allantoin d uricacid Which of the following substances is the biologically active precursor of a fat soluble vitamin? a biotin b retinol € folic acid i ascorbic acid ‘The troponin complex consists of a troponin T, calcium and tropomyosin b troponin C, troponin I and troponin T € troponin I, actin, and tropomyosin 4 troponin C, myoglobin, and actin The presence of C-reactive protein in the blood is an indication of: a recent streptococcal infection recovery from a pneumococcal infection an inflammatory process a state of hypersensitivity nage Oligoclonal bands are present on electrophoresis of concentrated CSF and also on concurrently tested serum of the same patient. The proper interpretation is: a. diagnostic for primary CNS tumor b diagnostic for multiple sclerosis € CNS involvernent by acute leukemia _nondiagnostic for multiple sclerosis Clinical2: Chemistry | Proteins and Other Nitrogen-Containing Compounds Questions 121 Which of the following is an example of a peptide bond? aoe case 122 90% of the capper present in the blood is bound to; transferrin ceruloplasmin albumin cryoglobulin ane 123. Which of the following determinations is useful in prenatal diagnosis of open neural tube defects? ont’ amniotic fluid alpha-fetoprote! b amniotic fluid estriol a maternal serum estradiol maternal serum estrone 124 Below are the results of a protein electrophoresis: Fraction 45 645 3.8 65 126 79 ‘These results are consistent with a(n) anormal serum protein pattern b normal CSF protein pattern ¢ abnormal serum protein pattern abnormal CSF protein pattern 125. Serum concentrations of vitamin By2 are elevated i: osty a pernicious anemia in relapse b patients on chronic hemodialysis «chronic granulocytic leukemia d Hodgkin disease 94. ‘The Board of Certification Study Guide2: Chemistry ( Heme Derivatives Questions 126 Absorption of vitamin By requires the presence of: OM a intrinsic factor b gastrin € secretin 4 folic acid 127 ‘The procedure used to determine the presence of neural tube defects is: ONY a lecithin/sphingomyelin ratio b amniotic fluid creatinine € measurement of absorbance at 450 nm 4 alpha-fetoprotein Heme Derivatives 128 The principle of the occult blood test depends upon the: ose a coagulase ability of blood b oxidative power of atmospheric oxygen € hydrogen peroxide in hemoglobi 4 peroxidase-like activity of hemoglobin 129 A breakdown product of hemoglobin is: oxy. tipoprotein b bilirubin ¢ hematoxylin _ Bence Jones protein 130 Hemoglobin § can be separated from hemoglobin D by: a electrophoresis on a different medium and acidic pH b hemoglobin Ap quantitation € electrophoresis at higher voltage 4 Kleihauer-Betke acid elution 131 On electrophoresis at alkaline pH, which of the following is the slowest migrating hemoglobin? Hgb A Heb Ss Hgb ¢ Hgb F 132. The hemoglobin that is resistant to alkali (KOH) denaturation is: ane aaoe moOp> Clinical Laboratory Certification Examinations 952: Chemistry | Heme Derivatives Questions 133 The following bilirubin results are obtained on a patient: day 1: 4.3 mg/dl (73.5 pmoiit) day 2: 4.6 mg/dl. (78.7 umoi/L) day 3:45 mg/Al. (77.0 ymoV/L) day 4; 2.2 mg/dL. (76 umoVt) day 5: 4.4 mg/d. (75.2 wmolL) day 6: 4.5 mg/dL (77.0 umoV/L) Given that the controls were within range each day, what is a probable explanation for the result ‘on day 4? a. no explanation necessary B serum, not plasma, was used for testing € specimen had prolonged exposure to light 4 specimen was hemolyzed 134 Urobilinogen is formed in the: a kidney b spleen € liver 4 intestine In bilirubin determinations, the purpose of adding a concentrated caffeine solution or methyl alcohol is to: a allow indirect bilirubin to react with color reagent b dissolve conjugated bilirubin € precipitate protein d prevent any change in pH 136 If the total bilieabin is 3.1 mg/dL (53.0 pmol/L) and the conjugated bilirubin is 2.0 mg/dL mis, (34.2 pmol/L), the unconjugated bilirubin is: a 0.5 mg/dl. (8.6 pmol/L) b 1.1 mg/dl. (28.8 pmol/L) © 2.2 mg/dL. (37.6 pmol/L) 5.1 mg/dl. (87.2 pmol/L) 137 The principle of the tablet test for bilirubin in urine or feces is: Sly a the reaction between bile and 2,4-dichloranitrobenzene to a yellow color the liberation of oxygen by bile to oxidize orthotolidine to a blue-purple color chemical coupling of bile with a diazonium salt to form a brown color chemical coupling of bilirubin with a diazonium salt to form a purple color aooe X88. A serum sample was assayed for bilirubin at 10 am, and the result was 12 mg/dL. (205.6 pmol/L). ‘The same sample was retested at 3 pm. The result now is 8 mg/dL (136.8 pmol/l). The most likely explanation for this discrepancy is: athe reagent has deteriorated b the sample was exposed to light ¢ acalculation error in the first assay a the sample was not refrigerated 139 Serial bilirubin determinations are charted below. Day Collected Assayed Result 1 70 Ban 14.0 ma/d. (299.4 wmnal/L) 2 7am 6 rw 9.0 mg/d. (153.9 pmol) 3 6am Baw 18.0 mg/dl 256.5 pmol/L) ‘The best explanation for the results is: sample hemolysis and hemoglobin deterioration sample exposure to light, sample left in warm location reagent deterioration anoe 96 The Board of Certification Study Guide2: Chemistry | Heme Derivatives Questions 140 141 142 143 144 In the liver, bilirubin is converted to: a urobilinogen b urobilin € bilirubin-albumin complex bilirubin diglucaronide In which of the following disease states is conjugated bilirubin a major serum component? a biliary obstruction b hemolysis € neonatal jaundice d crythroblastosis fetalis, Kernicterus is an abnormal accumulation of bilirubin in: a heart tissue b brain tissue liver tissue d kidney tissue In which of the following conditions does decreased activity of glucuronyl transferase result in increased unconjugated bilirubin and kernicterus in neonates? Gilbert disease Rotor syndrome © Dubin-Johnson syndrome 4 Crigler-Najjar syndrome oe A 21-year-old man with nausea, vomiting, and jaundice has the following laboratory findings: Test Patient Reference range total serum bilirubin 8.5 mgldl (145.4 ymoVL) __0-4.0 mg/dL (0.0-17.1 pmolL) ‘conjugated serum tiirubin 6.1 mg/dL (104.3 ymoVL) 00.5 mg/a. 0.0-8.6 pot.) urine urebiinagen increased {fecal urobilinogen decreased urine bitirubin positive AST 300UN. 0-50 UL alkaline phosphatase 170 Un. 0-150 UA. These can best he explained as representing: unconjugated hyperbilirubinemia, probably due to hemolysis unconjugated hyperbilicubinemia, probably due to toxic liver damage conjugated hyperbilirubinemia, probably due to biliary tract disease conjugated hyperbilirubinemia, probably due to hepatocellular obstruction ane Clinical Laboratory Certification Examinations 972: Chemistry | Heme Derivatives Questions 145. Biochemical profile: os Test Patient values: Reference range total potein 7.3 dL. (73 g/t) 60- 80 g/dL (60-80 9) avin 4.4 g/dL 41 g/t) 35+ 50g/AL (5-50 g/l) calcium B6 mg/d 24 mmol) —_—_BS-10.5 maa. (2.1-2.6 mmo.) phosphorus 3.8 mg/dl. (1.06 move) 2.8 4.5 mg/dl. (0.80-1.45 mmol) glucose 95 mg/dl. 6:2 mmov) 65- 110 mg/dl. 26-6. mart) BUN 1G mg/dL 6.71 mimo) 10 ~ 20 ma/AL..57-7.14 mmol) ure acid 6.0 mg/dl (856.9 pmol) 2.5 - 8.0 mgfd. (148.7-475.8 unolt) creatinine 1.2 mglaL (106.1 pmol) 0.7 - 1.4 mgVdl. 61.9-128.8 pmol) total bilirubin 3.7 mg/dL (63.3 pmol) 0.2 - 0.9 mg/dL. (8.4-18.4 pmol) alkaline phosphatase 275 U/L 30- soul jactate dehycrogenase 185 U/L 100-295 UML ast 75 UA. 10 = aoun, ‘The results the biochemical profile axe most consistent with a viral hepatitis b hemolytic anemia « common bile duct stone d chronic active hepatitis 146 A stool specimen that appears black and tarry should be tested for the presence of: occult blood fecal fat trypsin excess mucus nae 147 What substance gives feces its normal color? 8" ag uroerythrin urochrome urobilin urobilinogen ane 148 A condition in which erythrocyte protoporphyrin is increased is. ONY acute intermittent porphyria b iron deficiency anemia ¢ porphyria cutanea tarda acute porphyric attack 149. Which of the following elevates carboxyhemoglobin? ®XY 4. nitrite poisoning b exposure to carbon monoxide ¢ sulfa drug toxicity sickle cell anemia 150 ‘The reason carbon monoxide is so toxic is because it Sxty a. is a protoplasmic poison b combines with cytochrome oxidase € has 200 times the affinity of oxygen for hemoglobin binding sites sensitizes the myocardium 98 The Board of Certification Study Guide2: Chemistry | Enzymes Questions 151 Detection of carriers of hereditary coproporphyria should include analysis of ext’ 4 24-hour urine for porphobilinogen b fresh morning urine for delta-aminolevulinic acid € erythrocyte protoporphyrin 24-hour urine for porphyrin 152 A fresh urine sample is received for analysis for “porphyrins” or “porphyria” without further Miiy information o specifications. initial analysis should include a porphyrin screen and quantitative total porphyrin b quantitative total porphyrin and porphobilinogen screen ¢ porphyrin and porphobilinogen screen 4 porphobilinogen screen and ion-exchange analysis for porphobilinogen 153 Which of the following enzymes of heme biosynthesis is inhibited by lead? sty 4 aminolevulinate synthase b_porphobilinogen synthase ¢ uroporphyririogen synthase bilirubin synthetase 154 Serum haptoglobin: ONY a. is decreased in patients with tissue injury and neoplasia b is increased in patients with prosthetic heart valves € can be separated into distinct phenotypes by starch-gel electrophoresis binds heme Enzymes 155. The most specific enzyme test for acute pancreatitis is a acid phosphatase b trypsin © amylase 4 lipase 156 Which of the following enzymes are used in the diagnosis of acute pancreatitis? amylase (AMS) and lipase (LPS) b aspartate aminotransferase (AST) and alanine aminotransferase (ALT) € 5’mucleotidase (5’N) and gamma-glutamyl transferase (GGT) 4 aspartate aminotransferase (AST) and lactate dehydrogenase (LD) 157 Which of the following enzymes catalyzes the conversion of starch to glucose and maltose? a. malate dehydrogenase (MD) & amylase (AMS) © creatine kinase (CK) isocitric dehydrogenase (ICD) 158 Which of the following sets of results would be consistent with macroamylasemia? normal serum amylase and elevated urine amylase values, increased serum amylase and normal urine amylase values increased serum and urine amylase values normal serum and urine amylase values nage (Clinical Laboratory Certification Examinations 992: Chemistry | Enzymes Questions 159 A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this disease? a creatinine b LD isoenzymes © betachydroxybutyrate amylase 160 Aspartate amino transferase (AST) is characteristically elevated in diseases of the a liver b kidney ¢ intestine & pancreas 161 Amino transferase enzymes catalyze the a exchange of ar acids B exchange of amino and keto groups between alpha-amino and alpha-keto acids hydrolysis of amino acids and keto acids @ reversible transfer of hydrogen from amino acids to coenzyme ino groups and sulfhydryl groups between alpha-amino and sulfur-containing 162 Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases? a muscular dystrophy b viral hepatitis, € pulmonary emboli infectious mononucleosis 163 The greatest activities of serum AST and ALT are seen in which of the following? acute viral hepatitis b primary biliary cirrhosis ¢_ metastatic hepatic cirrhosis d alcoholic cirrhosis 164 Malic dehydrogenase is added to the aspartate aminotransaminase (AST) reaction to catalyze the Shey conversion of: a alpha-ketoglutarate to aspartate b alpha-ketoglutarate to malate € aspartate to oxalacetate 4 oxalacetate to malate 165 Given the following results: SWiy alkaline phosphatase: slight increase aspartate amino transferase: marked inerease alanine amino transferase: marked increase gamma-glutamyl transferase: slight increase This is most consistent with a acute hepatitis b chronic hepatitis € obstructive jaundice 4 liver hemangioma 166 Which of the following clinical disorders is associated with the greatest elevation of lactate dehydrogenase isoenzyme 1? a pneumonia b glomerulonephritis, © pancreatitis d pernicious anemia 100 The Board of Certification Study Guide2: Chemistry | Enzymes Questions 167 168 169 170 171 172 173 174 ‘The enzyme, which exists chiefly in skeletal muscle, heart, and brain, is grossly elevated in active muscular dystrophy, and rises early in myocardial infarction is a lipase b transaminase € lactate dehydrogenase creatine kinase ‘The enzyme present in almost all tissues that may be separated by electrophoresis into 5 components is: a lipase b transaminase © creatine kinase 4 lactate dehydrogenase A common cause of a falsely increased LD; fraction of lactic dehydrogenase is: a specimen hemolysis b liver disease € congestive heart failure drug toxicity ‘The presence of which of the following isoenzymes indicates acute myocardial damage? a CKMM b CKMB © CKBB none In which of the following conditions would a neymal level of creatine kinase be found? acute myocardial infarct b hepatitis € progressive muscular dystrophy intramuscular injection, Of the following diseases, the one most often associated with elevations of lactate dehydrogenase isoenzymes 4 and 5 on electrophoresis is: a liver disease b hemolytic anemia «myocardial infarction pulmonary edema When myocardial infarction occurs, the first enzyme to become elevated is: a CK b LD © AST @ ALT A scanning of a CK isoenzyme fractionation revealed 2 peaks: a slow cathodic peak (CKMM) and an intermediate peak (CKMB). A possible interpretation for this pattern is: a brain tumor b muscular dystophy € myocardial infarction 4 viral hepatitis Clinical Laboratory Certification Examinations 1012: Chemistry | Enzymes Questions 175 176 177 178 179 180 102 ‘An electrophoretic separation of lactate dehydrogenase isoenzymes that demonstrates an elevation in LD-1 and LD-2 ina “fipped” pattern is consistent with: a myocardial infarction b viral hepatitis « pancreatitis d. renal failure Increased total serum lactic dehydrogenase (LD) activity, confined to fractions 4 and 5 is most likely to be associated with: pulmonary infarction hemolytic anemia myocardial infarction acute viral hepatitis ane A. 10-year-old child was admitted to pediatxics with an initial diagnosis of skeletal muscle disease, The best confirmatory tests would be: a creatine kinase and isocitrate dehydrogenase b gamma-glutamyl transferase and alkaline phosphatase ¢ aldolase and creatine kinase lactate dehydrogenase and malate dehydrogenase In the immunoinhibition phase of the CKMB procedure: a M subunit is inactivated b_B subunit is inactivated © MBis inactivated d. BBis inactivated ‘The presence of increased CKMB activity on a CK electrophoresis pattern is most likely found in a patient suffering from: acute muscular stress following strenuous exercise b malignant liver disease ¢ myocardial infarction severe head injury Refer to the following illustration: Which of the following is the most likely interpretation of the LD isoenzyme scan illustrated above? myocardial infarction ‘megaloblastic anemia acute pancreatitis viral hepatitis ance “The Board of Certification Study Gi2: Chemistry | Enzymes Questions 181 182 183 184 185 186 Increased serum lactic dehydrogenase activity due to elevation of fast fraction (1 and 2) on electrophoretic separation is caused by: a nephrotic syndrome b hemolytic anemia © pancreatitis 4 hepatic damage A serum sample drawn in the emergency room from a 42-year-old man yielded the following laboratory results Pationt Reference range ok. 185 U/L 18-160 WL AST: 123 UL 0-48 UL cKMB: BLL 212 UL Which of the following conditions might account for these values? a crush injury to the thigh b cerebrovascular accident ¢ pulmonary infarction d carly acute hepatitis Given the following results: alkaline phosphatase marked increase aspartate amino transferase: slight increase alanine amino transferase: slight increase gamma-glutamyl transferase: market increase This is most consistent with: a acute hepatitis B osteitis fbrosa € chronic hepatitis obstructive jaundice Given the following results: alkaline phosphatase: slight increase aspartate aminotransferase: slight increase alanine aminotransferase: slight increase gamma-lutamy! transferase: slight increase This is most consistent with: a acute hepatitis b chronic hepatitis, © obstructive jaundice 4 liver hemangioma Nhat specimen preparation is commonly used to perform the alkaline ph isoenzyme determination? sphatase serum is divided into 2 aliquots, one is frozen and the other is refrigerated serum is divided into 2 aliquots, one is heated at 56°C and the other is unheated no preparation is necessary since the assay uses EDTA plasma protein-free filtrate is prepared first ane Regan isoenzyme has the same properties as alkaline phosphatase that originates in the: a skeleton b kidney © intestine d placenta Clinical Laboratory Certification Examinations 1032: Chemistry | Lipids and Lipoproteins Questions 187 188 189 190 191 192 193 ‘The most heat labile fraction of alkaline phosphatase is obtained from: a liver b bone € intestine 4 placenta ‘The most sensitive enzymatic i dicator for liver damage from ethanol intake is a_ alanine aminotransferase (ALT) b aspartate aminotransferase (A € gamma-glutamyl transferase (GGT) 4 alkaline phosphatase Isoenayme assays are performed to improve: precision accuracy sensitivity specificity anos ‘The protein portion of an enzyme complex is called the: apoenzyme coenzyme holoenzyme proenzyme noes Which of the following chemical determinations may be of help in establishing the presence of, nal fluid? lactic dehydrogenase (LD) isocitrate dehydrogenase (ICD) acid phosphatase alkaline phosphatase ange Which of the following enzyme substrates for prostatic acid phosphatase is best for the continuous monitoring method? a. phenyl-phosphate b thymolphthalein monophosphate € alpha-naphthyl-phosphate 4 beta-glycerophosphate Lactate dehydrogenase, malate dehydrogenase, isocitrate dehydrogenase, and hydroxybutyrate dehydrogenase all are liver enzymes are cardiac enzymes catalyze oxidation-reduction reactions are class III enzymes pate Lipids and Lipoproteins 194 104 High levels of which lipoprotein class are associated with decreased risk of accelerated atherosclerosis? chylomicrons VLDL LDL SDL pa oe ‘The Board of Certification Study Guide2: Chemistry | Lipids and Lipoproteins Questions 195 196 Baty 197 198 199 200 201 202 ‘The most consistent analytical error involved in the routine determination of HDL-cholesterol is, caused by: incomplete precipitation of LDL-cholesterol coprecipitation of HDL- and LDL-cholesterol inaccurate protein estimation of HDL-cholesterol a small concentration of apoB-containing lipoproteins after precipitation nage If the LDL-cholesterol is to be calculated by the Friedewald formula, what are the 2 measurements that need to be carried out by the same chemical procedure? a total cholesterol and HDL-cholesterol b total cholesterol and triglyceride € triglyceride and chylomicrons 4 apolipoprotein A and apolipoprotein B The chemical composition of HDL-cholesterol corresponds to: Triglyceride Cholesterol Protein a 60% 15% 10% b 10% 45% 28% © 5% 15% 50% a 85% 5% 2% In familial hypercholesterolemia, the hallmark finding is an elevation of low-density lipoproteins b chylomicrons € high-density lipoproteins 4 apolipoprotein Ay Premature atherosclerosis can occur when which of the following becomes elevated? a chylomicrons } prostaglandins © low-density lipoproteins @ high-density lipoproteins ‘Transportation of 60%-75% of the plasma cholesterol is performed by: a chylomicrons b very low-density lipoproteins © low-density lipoproteins 4 high-density lipoproteins ‘Which of the following diseases results from a familial absence of high density lipoprotein? a Krabbe disease b Gaucher disease € Tangier disease Tay-Sachs disease A ‘Lyear-old gir! with a hyperlipoproteinemia and lipase deficiency has the following lipid profile cholesterol 00 mg/dl. (7.77 mmol/L) LDL: increased HDL: decreased triglycerides: 200 mail. (2.26 mmol! chylomicrons: present Aserum specimen from this patient that was refrigerated overnight would most likely be: a clear b cloudy € creamy layer over cloudy serum creamy layer over cleat serum Clinical Laboratory Certification Examinations 105