COMAPP1 | CLINICAL CHEMISTRY PRE-TEST

DAY 2: ANALYTICAL TECHNIQUES, CARBOHYDRATES, LIPIDS and LIPOPROTEINS

Questions Notes
Analytical Techniques

1. Which region in electromagnetic spectrum is characterized by

wavelengths ranging from 400-700 nm?
a. Ultraviolet
b. Visible
c. Infrared
d. Microwaves

Gamma ray, X-ray, = short wavelength = ↑ energy and frequency

Gamma rays are considered as ionizing because of their shortest wavelength and highest
energy in the electromagnetic spectrum.

2. Which of the following regions in electromagnetic spectrum would have Microwave, Radio wave = long wavelength = ↓ energy and frequency
the shortest wavelength and highest energy?
a. Gamma rays Regions of Interest:
b. Ultraviolet < 400 – 700 >
c. Visible Ultraviolet Visible Light Infrared
d. Infrared
• Far UV: shorter wavelength = ↑ energy and frequency
• Near UV

*COLORIMETRIC METHODS use the visible spectrum ranging from 400 to 700 nm.

Wavelength (λ) is INVERSELY PROPORTIONAL to Energy and Frequency.

3. Which of the following is consistent with the Beer’s law?

a. Absorbance is directly proportional to transmittance Absorbance is DIRECTLY PROPORTIONAL to the concentration and inversely transmitted to
b. Percent transmittance is directly proportional to concentration the logarithm of light.
c. Percent transmittance is directly proportional to the light path length
d. Absorbance is directly proportional to concentration

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4. In the equation A = abc, b represents the: Beer’s Law: guiding law in spectrophotometry
a. Molar absorptivity A = abc
b. Absorbance • A = Absorbance
c. Light path length • a = Molar absorptivity
d. Concentration • b = Light path length
• c = Concentration

5. Calculate the absorbance value given a transmittance of 85%.

A = 2 − log%T
a. 0.15
b. 1.5
A = 2 − log(85%)
c. 0.07
A = 𝟎. 𝟎𝟕
d. 0.7

6. Calculate the concentration of the unknown analyte given the following Au Cu Au

data: concentration of the standard = 100 mg/dL; absorbance of the = → Cu = x Cs
As Cs As
standard = 0.048; absorbance of the sample = 0.039
a. 0.8125 mg/dL 0.039
Cu = x 100 mg/dL
b. 81.25 mg/dL 0.048
c. 1.23 mg/dL Cu = 0.8125 x 100 mg/dL
d. 123.07 mg/dL Cu = 𝟖𝟏. 𝟐𝟓 𝐦𝐠/𝐝𝐋

Standard/Calibrator
⎯ Used to calibrate an assay
⎯ Allow to calculate the concentration of unknown sample
⎯ Known definite values and has only 1 substance (depends on the test)
7. Which of the following refers to a solution containing various analytes
with known target values and is analyzed with patient samples to Blank
monitor analytical performance? ⎯ Used to subtract any absorbances that are not due to the analyte of interest
a. Blank ⎯ Degree of absorbance is measured = directly proportional to the concentration
b. Standard ⎯ 3 Types:
c. Calibrator • Reagent blank – color interference
d. Control • Sample blank appearance interference
• Water blank
Samples that are icterus, lipemic, hemolytic, and with bilirubinemia are likely to
interfere with the sample thus, water blank is used. Blank has known definite
values not target values.

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Control
⎯ Contains various analytes with known target values and is analyzed with patient
samples to monitor analytical performance (internal QC)
⎯ Same matrix as serum

Internal QC
⎯ Has 2 levels of control
⎯ Goal: To see to it that the expected values would be obtained and fall within the 95%
confidence interval and when the individual control values are plotted, there should be
no violation to the Westgard Rules and no patterns indicative of errors.

8. Which of the following is the most common source of light for work in Light Sources:
the visible and near-infrared regions? 1. Deuterium = UV
a. Deuterium 2. Tungsten = VIS and Near IR
b. Mercury arc 3. Mercury Arc/Xenon = UV and VIS
c. Xenon 4. Hollow Cathode Lamp = used by Atomic Absorption Spectrophotometry (AAS)
d. Tungsten Hollow cathode lamp is used for calcium and magnesium analysis or the divalent
cations. The instrument detects the amount of light absorbed by atoms returning to
ground state. When atoms are excited, they emit light. Following excitation and light
emission, atoms return to ground state (they absorb light here).

*Light from the light source = POLYCHROMATIC

Entrance Slit:
⎯ Prevents stray light from entering the monochromator
*Stray light can heat the sample and cause absorbance error

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9. Which of the following may cause stray light?

1. Second-order spectra Monochromator:
2. Deteriorated optics ⎯ Select the specific (1) wavelength of light
3. Light dispersed by a darkened lamp envelope ⎯ Diffraction gratings are commonly used monochromators with many parallel grooves
4. Extraneous room light etched onto a polished surface which has a disadvantage of creating second-order
spectra
a. 1 and 3
b. 2 and 4 Exit Slit:
c. 1, 2, and 3 ⎯ Further prevents stray light from striking the sample and eventually reaching the
d. 1, 2, 3, and 4 detector, allowing only a fraction of the light to strike the sample cuvette
⎯ Controls the bandpass or bandwidth.
10. Which of the following is the most commonly used type of
monochromator consisting of many parallel grooves etched onto a Cuvette
polished surface? ⎯ Must be transparent to the wavelength of interest
a. Colored glass filter This means that it should allow a portion of the incident light not absorbed (transmitted
b. Interference filter light) to pass through and be transmitted to the photodetector.
c. Prism ⎯ Cuvette Materials:
d. Diffraction grating • Quartz: UV to IR
• Plastic: UV to VIS
11. Which of the following cuvette materials must NOT be used for • Glass: VIS
applications requiring UV radiation?
a. Quartz Incidence Light
b. Plastic ⎯ Light that will strike the sample and will be subjected to absorbance by the analytes in
c. Glass the sample. The remainder of incident light that was not absorbed, will become
d. Any of these transmitted light.
Photomultiplier Tube
⎯ Most common and sensitive photodetector
⎯ Receives and converts transmitted light to an equivalent amount of energy which will
12. Which is the most sensitive detector for spectrophotometry? then be conveyed to a meter that will quantitate the magnitude of electrical signals and
a. Photomultiplier tube display them in absorbance values
b. Phototube
c. Barrier layer cell Phototube requires an external voltage source
d. Photodiode array Barrier Layer Cell/Photocell is the simplest photodetector.
Photodiode array has an excellent linearity.

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Types of Filters for measuring stray light:

Holmium oxide
⎯ Wavelength accuracy at 360 nm

Didymium glass
⎯ Wavelength accuracy at 600 nm

Glass filters
⎯ Absorbance check or solutions with known absorbance values for a specific wavelength
13. Which type of filter is best for measuring stray light?
a. Holmium oxide
Sharp Cutoff filters
b. Didymium glass
⎯ Measures stray light
c. Sharp cutoff
d. Neutral density ⎯ Transmits almost all incident light until a cutoff wavelength is reached

Neutral density filters

⎯ Linearity

Spectrophotometry QC includes:
Wavelength accuracy — ability of the monochromator to select the wavelength set.
Absorbance check
Linearity — conformity with Beer’s law. Graph should be straight; if not, loss of linearity.
Stray light

Double beam spectrophotometers

⎯ Second beam signals do not come from a lamp or light source
⎯ Only has 1 light source.
⎯ Mechanism: Splitting beam signal into two
14. In addition to the sample and reference cuvettes, important components This is to compensate for variations in the light intensity.
of a double-beam-in-time spectrophotometers include:
a. Two photodetectors Two types:
b. Chopper and one photodetector 1. Double-beam in TIME: 1 chopper and 1 photodetector
c. Two monochromators 2. Double-beam in SPACE: 1 chopper, 2 photodetectors, and 2 monochromators
d. Chopper and two photodetectors
Chopper: alternately passes the beam signal to the reference and the sample cuvette

*The chopper from the AAS function which is to produced pulse signal from the source so
that the light from the source is supplied in pulses. The light from the flame is the source of

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incident light to be absorbed by the ground state atoms. This also helps the flame from the
atomizer to reach the detector. (AAS two light sources: HC lamp and flame)

*The photodetector must distinguish between the two light sources and the chopper
enables this by supplying light source in pulses. Because the light from the flame is
continuous and the instrument is programmed to cancel any wavelength of light that is
continuous and to only accept pulsed signals.

Fluorometer requires a primary and secondary monochromator, which are at right angle
with each other.

The primary filter (selects a specific wavelength coming from the source) is aligned to the
light source. The sample from this type of technique produces fluorescence.
15. Which instrument requires a primary and secondary monochromator?
a. Flame emission photometer The emission of fluorescent light is following excitation by light energy. The light energy
b. Atomic absorption spectrophotometer produced by the source is meant to excite the molecules to produce fluorescent light which
c. Fluorometer will pass through the secondary filter and will select specific wavelength to be detected by
d. Nephelometer the PM tube.

Thus, there are two sources of light energy in fluorometry. The light source is the source of
excitation energy and the sample source is the source of fluorescent emission energy
which will eventually reach the detector. The magnitude of which is directly proportional to
the concentration of the analyte in the sample.

CLIA (chemiluminescent immunoassay)

⎯ Light is produced following a chemical reaction.
⎯ Very sensitive which is why it is slowly replacing ELISA, serologic applications, and
submolecular detection limit
16. Which of the following components is not needed in a chemiluminescent ⎯ Characterized by:
immunoassay analyzer?
• Speed
a. Lamp
• Ease of use
b. Monochromator
• Simple instrumentation Both Acridinium and Luminol are
c. Photodetector
⎯ Chemiluminescent molecules commonly used: excited by hydrogen peroxide in
d. Wash station
• Acridinium – label antigen and antibodies the presence of peroxidase.
• Luminol – substrates
• Dioxetane phosphate – substrates; excited by alkaline phosphatase
• Luciferin

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17. Which statement regarding nephelometry is true?
a. Nephelometry is less sensitive than spectrophotometry
b. Nephelometry follows Beer’s law
c. The optical design is identical to a turbidimeter
d. The detector response is directly proportional to concentration
Both spectrophotometers and turbidimeter have detectors aligned to cuvette and source.
While nephelometer, detectors are situated at 90° and forward light scatter.
Nephelometer
⎯ Measuring the amount or degree of involved light scattering in a solution.
⎯ The optical design is different to a turbidimeter and spectrophotometer.
⎯ Much more sensitive than a spectrophotometer.
⎯ Does not follow Beer’s law.
⎯ Detector response is directly proportional to concentration of analyte of interest

Turbidimeter
⎯ The detector response is inversely proportional to the concentration.
18. Which of the following instruments is used to detect gamma rays or beta ⎯ Amount of light blocked by particles is measured.
particles? ⎯ Decrease in light transmittance due to particles in solution.
a. Nephelometer
b. Fluorometer Scintillation counter
c. Luminometer ⎯ Used to measure scintillations or flashes of light using a photomultiplier tube.
d. Scintillation counter ⎯ Electrical impulses produced are counted using a:
• Gamma counter (radioisotope/label is I-125 or I-131)
• Beta counter (radioisotope is H-3 or C-14)

Sources of Fluorescence quenching:

19. Which of the following may cause quenching of fluorescence? 1. Increasing/decreasing temperature
a. Decreased temperature 2. Too concentrated samples/undiluted
b. Too concentrated (undiluted) sample 3. Contaminating chemicals
c. Contaminating chemicals 4. pH changes
d. All of these 5. Increased analyte concentration which causes loss of linearity
6. Decreased time exposure to light

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20. Which of the following is a non-destructive method for determining the
structure of organic compounds and is adapted for lipoprotein particle
measurements?
a. Microparticle capture enzyme immunoassay
b. Fluorescence polarization immunoassay
c. Enzyme-multiplied immunoassay technique
d. Nuclear magnetic resonance spectroscopy
Immunoassays:
1. Microparticle capture enzyme immunoassay (MEIA) — uses fluorogenic substrate
2. Fluorescence polarization immunoassay — uses fluorescent label
3. Enzyme-multiplied immunoassay technique (EMIT) — uses enzyme labeled antigen
when bound to antibody, inhibits enzyme activity.
Homogenous assays (no separation of bound and free labels or no washing step)
1. Fluorescence polarization immunoassay
2. Enzyme-multiplied immunoassay technique
Nuclear Magnetic Resonance Spectroscopy:
⎯ Non- destructive method used for determining the structure of organic compounds
⎯ Adapted for lipoprotein particle measurements.

Continuous flow analyzer implies a wasteful use of flowing reagent in addition to significant
21. Which of the following components of a continuous flow analyzer carryover problems. This automated technique involves pumping liquids through a system
facilitate the mixing of sample and reagents? of continuous tubing and analyzer or mechanism for separating samples and system of
a. Series of air bubbles continuous tubing cleaning reduces the production of series of air bubbles (separating or
b. Glass coils cleaning media).
c. Spinning rotor ⎯ Glass coils or coiled tubing is a component of a continuous flow analyzer that facilitate
d. Separate reaction containers the mixing of sample and reagents.

Centrifugal analyzers are only capable for batch analysis.

⎯ Spinning rotor is a mechanism present in centrifugal analyzers used to separate
22. Which of the following types of analyzers offers random-access cuvettes for measurements.
capabilities?
a. Discrete analyzers Discrete analyzers are capable of both catch analysis and offer random-access capabilities.
b. Continuous-flow analyzers ⎯ Separate reaction containers are a main feature of a discrete analyzer.
c. Centrifugal analyzers
d. None of these *Batch analysis means that it has the ability to run samples one test at a time.
*Random-access capabilities have the ability to run multiple tests one sample at a time.

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Lithium = internal standard in Na and K measurements using flame emission photometry

Cesium = used in Li measurements
23. Which of the following is commonly used as internal standard in sodium
and potassium measurements using flame emission photometry? *Flame emission photometry detector detects the light emitted by excited atoms. Ions in
a. Cesium the sample are atomized and when they are atomized, they are excited by the flame which
b. Lithium is the source of excitation energy which also serves as the sample holder because of the
c. Strontium absence of cuvette.
d. Lanthanum
Light emitted is directly proportional to the concentration. This is not routinely used
anymore because it has been largely replaced by the Ion Selective Electrode (ISE).

Hollow Cathode Lamp = used by Atomic Absorption Spectrophotometry (AAS)

24. Which of the following light sources is used in atomic absorption
spectrophotometry?
Hollow cathode lamp is used for calcium and magnesium analysis or the divalent cations.
a. Hollow-cathode lamp
The instrument detects the amount of light absorbed by atoms returning to ground state.
b. Xenon arc lamp
When atoms are excited, they emit light. Following excitation and light emission, atoms
c. Tungsten light
return to ground state (they absorb light here).
d. Deuterium lamp

Although nephelometer is a photodetector, its optical design is different from that of the
turbidimeter and spectrophotometer. It is a photometric instrument, but not an
25. The following are electrochemical techniques EXCEPT:
electrochemical technique.
a. Potentiometry
b. Amperometry
Electrochemical techniques:
c. Coulometry
1. Potentiometry
d. Nephelometry These 3 are used for ABG, and electrolyte
2. Amperometry
determination.
3. Coulometry

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26. Which of the electrodes below is a current-producing rather than a

voltage-producing electrode? Clark electrode (pO2) current-producing electrode (amperometry)
a. Clark electrode Severinghaus electrode (pCO2)
b. Severinghaus electrode pH electrode voltage-producing electrodes (potentiometry)
c. pH electrode Ionized calcium electrode
d. Ionized calcium electrode

Carbohydrates

Insulin Hypoglycemic hormone

Produced by the beta cells of the islets of Langerhans
Increases: Decreases:
⎯ Glycolysis ⎯ Glycogenolysis
27. What is the hyperglycemic hormone produced by the pancreas?
⎯ Lipogenesis
a. Insulin
b. Glucagon ⎯ Glycogenesis
c. Epinephrine Glucagon Major hyperglycemic hormone
d. Growth hormone Produced by the alpha cells of the islets of Langerhans
Increases:
⎯ Glycogenolysis
⎯ Gluconeogenesis
Epinephrine Increases:
⎯ Glycogenolysis
28. The production of glucose from non-carbohydrate sources is called: ⎯ Lipolysis
a. Glycolysis
b. Glycogenesis Growth Hormone (GH) Increases:
c. Gluconeogenesis ⎯ Glycolysis
d. Glycogenolysis

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Cortisol Increases:
⎯ Gluconeogenesis
29. The following biochemical processes are promoted by insulin EXCEPT:
⎯ Lipolysis
a. Glycogenolysis
b. Glycogenesis ⎯ Liver glycogen
c. Glycolysis Thyroxine (T4) Increases:
d. Uptake of glucose by cells ⎯ Glycogenolysis
⎯ Gluconeogenesis
⎯ Intestinal glucose absorption

Somatostatin Decreases:
⎯ Insulin
⎯ Glucagon
30. Which of the following hormones promotes gluconeogenesis? ⎯ GH and other endocrine hormones
a. Growth hormone
b. Cortisol
c. Epinephrine Glycolysis = metabolism of glucose to pyruvate or lactate for production of energy.
d. Thyroxine Gluconeogenesis is the production of glucose from non- carbohydrate sources.
Glycogenesis = conversion of glucose to glycogen for storage in liver and skeletal muscle.
Glycogenolysis = breakdown of glycogen to glucose for use as energy.
Lipogenesis = conversion of carbohydrate to fatty acids.
Lipolysis = decomposition of fat.

31. In non-diabetic individuals, blood glucose levels return to normal after a

meal.
Non-diabetic individuals:
a. 15 to 30 min
Blood glucose levels return to normal 1 1/2 to 2 hrs after a meal.
b. 30 min to 1 h
If longer than 2 hrs, patient is hyperglycemic.
c. 1 ½ to 2 h
d. 3 to 5 h

32. What is the panic value for hypoglycemia?

a. <40 mg/dL
Panic/critical values of hypoglycemia is <40 mg/dL.
b. <55 mg/dL
Diagnostic values for plasma glucose is <50 mg/dL.
c. <90 mg/dL
d. <100 mg/dL

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Whipple’s triad of hypoglycemia = present in ALL types of hypoglycemia include:

1. Symptoms of hypoglycemia
⎯ Neurogenic and neuroglycopenic symptoms which begin to appear at plasma
33. The Whipple’s triad of hypoglycemia include the following EXCEPT:
glucose level between 50 and 55 mg/dL.
a. Symptoms of hypoglycemia
2. Low plasma glucose level
b. Low plasma glucose level
3. Relief of symptoms with correction of hypoglycemia
c. Relief of symptoms with correction of hypoglycemia
d. High C-peptide level
Types of Hypoglycemia:
1. Post-absorptive or fasting hypoglycemia
⎯ Can be secondary to hyperinsulinism, hormonal deficiencies, genetic disorders,
autoimmunity, and drug-induced.
34. The diagnostic criteria for insulinoma include: 2. Post-prandial or alimentary or reactive hypoglycemia
1. Signs and symptoms of hypoglycemia
2. Plasma glucose level ≤50 mg/dL *High C-peptide level is not included as it is only manifested/diagnostic in insulinoma,
3. High insulin, pro-insulin, and C-peptide levels together with high insulin and pro-insulin. This occurs due to insulin-producing tumors.
4. Low β-hydroxybutyrate level
The diagnostic criteria for insulinoma include:
a. 1 and 3 1. Signs and symptoms of hypoglycemia
b. 2 and 4 2. Plasma glucose level ≤50 mg/dL
c. 1, 2, and 3 3. High insulin, pro-insulin, and C-peptide levels
d. 1, 2, 3, and 4 4. Low β-hydroxybutyrate level

35. Which of the following is characteristic of type 1 diabetes mellitus?

a. Requires an oral glucose tolerance test for diagnosis
b. Is the most common form of diabetes mellitus Decreased insulin, pro-insulin, C-peptide levels
c. Usually occurs after age 40 Increased ketones
Type 1 Diabetes Mellitus
d. Requires insulin replacement to prevent ketosis Insulin deficiency
Requires insulin replacement to prevent ketosis
Resistance to insulin
Progressive insulin deficiency
36. Which of the following is characteristic of type 2 diabetes mellitus? Adult onset (after age 40)
a. Insulin levels are consistently low Most common
b. Most cases require an oral glucose tolerance test to diagnose Type 2 Diabetes Mellitus
OGTT for diagnosis
c. Hyperglycemia is often controlled without insulin replacement Hyperglycemia is controlled without insulin replacement
d. The condition is associated with unexplained weight loss
Risk Factors include:

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37. Which statement regarding gestational diabetes mellitus is correct? 1. Overweight tendencies
a. Is diagnosed using the same oral glucose tolerance criteria as in non- 2. Dyslipidemia (decreased HDL-C, increased (TG)
pregnant 3. Polycystic ovarian syndrome
b. Converts to diabetes mellitus after pregnancy in 60%–75% of cases 4. History of cardiovascular disease
c. Presents no increased health risk to the fetus 5. Family history
d. Glucose intolerance due to metabolic and hormonal changes during 6. Sedentary lifestyle
pregnancy 7. Hypertension
8. Membership to certain ethnic groups
9. Impaired fasting glucose
38. Which of the following are considered risk factors for type 2 diabetes
10. Impaired glucose tolerance
mellitus?
1. Overweight tendencies Glucose intolerance due to metabolic and hormonal
2. Dyslipidemia changes during pregnancy
3. Polycystic ovarian syndrome Gestational Diabetes Converts to DM after pregnancy in 30-40%
4. History of cardiovascular disease Not diagnosed using OGTT
May present health risk to the baby and the mother
a. 1 and 3
b. 2 and 4
c. 1, 2, and 3
d. 1, 2, 3, and 4

39. Body mass index between 25 to 29.9 kg/m2 is considered:

< 18.5 = Underweight
a. Underweight
18.5-24.9 = Normal
b. Normal
25-29.9 = Overweight
c. Overweight
≥ 30 = Obese
d. Obese

Fasting plasma glucose

⎯ Most common or preferred screening test for diabetes mellitus in non-pregnant adults.
40. What is the preferred screening test for diabetes mellitus in non- Glycosylated hemoglobin
pregnant adults?
⎯ Also used for screening and not just for long term monitoring of diabetes mellitus
a. Fasting plasma glucose
b. Random plasma glucose
NORMAL PRE-DM DM
c. Two-hour post-load plasma glucose
FASTING <100 100-125 (impaired) ≥126
d. Glycosylated hemoglobin
RANDOM <200 ≥200
OGTT (2hr) <140 140-199 (impaired) ≥200

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41. When preparing an adult patient for an oral glucose tolerance test, which
of the following conditions is NOT appropriate?
a. The patient remains ambulatory for 3 days prior to the test
b. Carbohydrate intake is restricted to below 150 g/day for 3 days prior
to test
c. No food, coffee, tea, or smoking is allowed 8 hours before and during
the test
d. Administration of 75 g of glucose following a 10-hour fast
42. Which of the following results falls within the diagnostic criteria for
diabetes mellitus?
a. Fasting plasma glucose of 120 mg/dL
b. Glycosylated hemoglobin of 6.2%
c. Two-hour post-load plasma glucose of 180 mg/dL
d. Random plasma glucose of 250 mg/dL and presence of symptoms
43. Which of the following 2-hour post-load glucose results would be
classified as impaired glucose tolerance (IGT)?
a. 130 mg/dL
b. 135 mg/dL
c. 150 mg/dL
d. 204 mg/dL
Pre-DM:
1. Fasting plasma glucose of 120 mg/dL (IFG)
2. Glycosylated hemoglobin of 6.2%
3. Two-hour post-load plasma glucose of 180 mg/dL
Hyperglycemia 3 P’s include polyphagia, polydipsia, and polyuria.
Patient preparation for OGTT:
1. The patient remains ambulatory for 3 days prior to the test.
2. Carbohydrate intake is restricted to above 150 g/ day for 3 days prior to test.
3. No food, coffee, tea, or smoking is allowed 8 hours before and during the test.
4. Administration of 75 g of glucose following a 10- hour fast.
Glycosylated hemoglobin (HbA1c)
⎯ Reflects the average glucose level 8-12 weeks prior to sampling
⎯ Does not need fasting
⎯ Has a sugar attached to the N-terminal end of the β- chain
⎯ Recent episodes of hyperglycemia will not affect the result

44. Which statement regarding glycosylated hemoglobin (HbA1c) is true?

a. Has a sugar attached to the C-terminal end of the β chain
b. Must be measured after at least 8 hours of fasting
c. Reflects the average glucose level 8-12 weeks prior to sampling
d. Will be abnormal within 4 days following an episode of
hyperglycemia

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45. What is the American Diabetes Association glycemic goal for HbA1c in
adults?
a. 5.7-6.4% <7.0% is the ADA glycemic goal for HbA1c in adults.
b. ≥6.5% 6.5% is the diagnostic criterion to establish diagnosis.
c. <7.0%
d. <10%

46. Aside from the average plasma glucose level, what is another factor that
can affect the HbA1c value?
a. Serum ketone bodies level
b. Red blood cell life span
c. Ascorbic acid intake
d. Increased triglyceride levels
RBC life span and hemolytic disorder will decrease the HbA1c value.

47. A patient with hemolytic disorder will show ________.

a. Decreased glycosylated Hb value
b. Increased glycosylated Hb value
c. Slightly elevated glycosylated Hb value
d. No change in glycosylated Hb value

48. In cases when HbA1c is unreliable, fructosamine may be used to assess

glycemic control over the past _________.
a. 2-3 weeks
b. 2-3 months
c. 8-12 weeks
d. 8-12 months

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49. Which testing situation is appropriate for the use of point-of-care whole-
blood glucose methods?
a. Screening for type 2 diabetes mellitus
b. Diagnosis of diabetes mellitus
c. Monitoring of blood glucose control in type 1 and type 2 diabetics
d. Monitoring diabetics for hyperglycemic episodes only

50. Whole blood glucose level is about ___ lower than plasma glucose.
a. 5% Whole blood glucose level is about 10-15% lower than plasma glucose.
b. 10-15% Plasma glucose level is 5% less than serum glucose.
c. 2-5 mg/dL Capillary blood glucose level is 2-5 mg/dL more than venous blood.
d. 10-15 mg/dL

51. A specimen collected in a plain tube left standing at room temperature

A specimen collected in a plain tube left standing at room temperature will lose glucose to
will lose glucose to glycolysis at a rate of _____.
glycolysis at a rate of 7 mg/dL/hr, while refrigerated at 4°C at 2 mg/dL/hr.
a. 2 mg/dL/h
b. 7 mg/dL/h
Gray top tubes are used to prevent glycolysis as it has anti- glycolytic agent or the sodium
c. 2 mmol/L/h
fluoride or serum separator tubes which has a barrier between the serum and the cells.
d. 7 mmol/L/h

52. What is the effect of 10% contamination with 5% dextrose on the plasma
glucose level? Glycolysis takes place at a higher rate in cases of leukocytosis or increased WBC count as
a. 100 mg/dL increase well as bacterial contamination.
b. 100 mg/dL decrease
c. 500 mg/dL increase If dextrose is infused with blood, the plasma glucose will have 500 mg/dL increase.
d. 500 mg/dL decrease

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Oxidizing agents:
1. Arsenomolybdic acid — for Nelson-Somogyi
2. Phosphomolybdic acid — Folin-Wu

Reducing agent:
1. Glucose — Hagedorn-Jensen

Copper reduction methods:

• Folin-Wu
Cuprous ions react with phosphomolybdic acid producing phosphomolybdenum blue.
53. Which of the following methods uses arsenomolybdic acid as oxidizing
• Nelson-Somogyi
agent?
Cuprous ions react with arsenomolybdic acid producing arsenomolybdenum (blue).
a. Folin-Wu
These will be measured spectrophotometrically by the intensity of the color.
b. Nelson-Somogyi
c. Hagedorn-Jensen
Ferric Reduction Methods:
d. Dubowski
• Hagedorn-Jensen
Ferricyanide (yellow orange) is reduced to ferrocyanide (colorless) by glucose.
Reverse colorimetric method as the end product becomes colorless unlike the other tests.

Orthotoluidine Method:
• Dubowksi
Based on condensation reaction.

Reduction methods are subject to many interferences or positive biases. There are several
reducing agents (e.g. ascorbic acid) that might lead to falsely increased levels, meaning it
lacks specificity.
Enzymatic methods are better in terms of specificity. Most notable are Glucose oxidase and
54. Select the enzyme that is most specific for b-d-glucose: Hexokinase methods.
a. Glucose oxidase
b. Glucose-6-phosphate dehydrogenase Most specific enzyme for β-d-glucose is glucose oxidase.
c. Hexokinase
d. Phosphohexose isomerase Hexokinase is the reference method for enzymatic methods and measuring serum glucose,
it is not specific to glucose.

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Mutarotase is a component of glucose oxidase-peroxidase assay reagent. This is meant to

55. Glucose oxidase oxidizes glucose to gluconic acid and
a. H2O2
b. CO2
c. HCO3
d. H2O
56. Polarographic methods of glucose assay are based on which principle?
a. Nonenzymatic oxidation of glucose
b. Measurement of the rate of oxygen depletion
c. Chemiluminescence caused by the formation of ATP
d. Change in electrical potential as glucose is oxidized
.
convert α-d-glucose (35%) isomers to β-d-glucose isomers. Glucose oxidase will then
oxidize gluconic acid and hydrogen peroxide. The H2O2 reduced in the coupling reaction
will then oxidize a chromogen producing a colored oxidized chromogen (quinonimine dye)
in the presence of peroxidase.
Peroxidase coupled reaction (glucose oxidase-peroxidase) is also known as the Trinder
assay which is used to estimate the glucose level in the sample.
• The manner of measuring glucose in this type of assay is through the increase in
absorbance of quinonimine dye at 500 nm.
Polarographic method which is where glucose is oxidized to gluconic acid and hydrogen
peroxide by the glucose oxidase.
• No more coupling reaction or peroxidase coupled reaction.
• Absence of coupling reaction = rate or oxygen depletion

57. Which glucose method is subject to falsely low results caused by ascorbic
acid?
If the reducing agent, ascorbic acid, causes falsely increased results in reduction methods,
a. Hexokinase
then in glucose oxidase-peroxidase methods, it causes falsely decreased results. Because
b. Clinitest
the reaction is oxidation which causes negative biases.
c. Glucose oxidase-Peroxidase
d. Glucose oxidase-Polarographic

58. Which of the following is the reference method for measuring serum
glucose?
a. Nelson-Somogyi
b. Hexokinase
c. Glucose oxidase
d. Clinitest

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59. Select the coupling enzyme used in the hexokinase method for glucose.
a. Glucose-6-phosphate dehydrogenase
b. Peroxidase
c. Glucose dehydrogenase
d. Glucose-6-phosphatase

Glucose in the hexokinase method is phosphorylated to become G-6-PO4 and ADP. The G-
6-PO4 is made to react to NADP. The NADP will be reduced to NADPH and 6-
60. In the hexokinase method, glucose level is determined by measuring the:
phosphogluconolactone by G-6-PO4 dehydrogenase.
a. Increase in absorbance of NADPH at 340 nm
b. Decrease in absorbance of NADP at 340 nm
The higher the level of glucose, the greater the level of NADPH, the higher absorbance.
c. Increase in absorbance of quinonimine dye at 500 nm
d. Decrease in absorbance of quinonimine dye at 500 nm
In the hexokinase method, glucose level is determined by measuring the increase in
absorbance of NADPH at 340 nm.
61. Which of the following is a potential source of error in the hexokinase
method?
a. Galactosemia Hemolysis and icterus causes falsely decreased glucose because hemoglobin and bilirubin
b. Hemolysis interfere with enzyme activity.
c. Sample collected in gray tube
d. Ascorbic acid
Enzyme deficient for:
Glucose-6-phosphatase
von Gierke’s disease
(GSDIa) Most common glycogen storage disease
Hypoglycemia, ketonuria, lactic acidosis, and hyperuricemia

62. What is the enzyme deficiency responsible for von Gierke’s disease? von Gierke’s disease
SLC37A4 gene
a. Glucose-6-phosphatase (GSDIb)
b. Lysosomal acid alpha glucosidase
Pompe (GSDII) Lysosomal acid alpha glucosidase
c. Glycogen debranching enzyme
d. Glycogen phosphorylase Cori-Forbes (GSDIII)
Glycogen debranching enzyme
Andersen disease (GSDIV)
McArdle’s disease (GSDV) Myophosphorylase enzyme
Hers (GSDVI) Glycogen phosphorylase
Tarui disease (GSDVII) PFK enzyme
GSDIX Phosphorylase kinase

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63. Which of the following statements about carbohydrate intolerance is

true? Galactosemia and/or galactosuria results from GALT (Galactose-1-phosphate
a. Galactosemia results from deficiency of galactose-1-PO4 uridyl uridylyltransferase) deficiency which is the most common inborn errors of metabolism.
transferase
b. Galactosemia results in a positive glucose oxidase test for glucose in This is the only carbohydrate disorder that is clinically significant and may lead to mental
urine retardation.
c. Urinary galactose is seen in both galactosemia and lactase deficiency
d. A galactose tolerance test is used to confirm a diagnosis of This is screened with clinitest
galactosemia

Lipids and Lipoproteins

64. The surface components of a lipoprotein include the following EXCEPT:

a. Apolipoproteins
b. Phospholipids
c. Non-esterified cholesterol
d. Triglycerides Core components:
⎯ Neutral
⎯ Hydrophobic
⎯ Cholesterol ester (cholesteryl), free fatty acids (non- esterified fatty acids), and
triglycerides (TAG)

Surface components:
⎯ Apolipoprotein
⎯ Cholesterol
⎯ Phospholipid

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LCAT
⎯ Enzyme that catalyzes the esterification of cholesterol
⎯ Non-esterified has an OH group making them polar
⎯ Polarity is lost by the attachment of a fatty acid (from the lecithin of LCAT to
cholesterol) to the OH group making them esterified via an ester bond
⎯ 70% CE and 30% NEFA
65. What is the enzyme that catalyzes the esterification of cholesterol?
a. LPL Enzymatic method for cholesterol includes:
b. HL 1. Hydrolysis of cholesteryl esters with cholesterol esterase to cholesterol and fatty acid.
c. CETP The hydrolysis will break the ester bond, liberating fatty acid/free cholesterol.
d. LCAT 2. Oxidation of cholesterol with oxygen by cholesterol oxidase to cholestenone and
hydrogen peroxide. (Polarographic method) The reagent needed here is 4-
Aminoantipyrine.
3. Quantitation of the amount of oxygen consumed or the amount of H2O2 generated
through Trinder reaction/ peroxidase coupling reaction.

(H2O2 + chromogen) >(peroxidase)> oxidized chromogen/quinonimine dye (red-purple)

66. Following ultracentrifugation of plasma, which fraction correlates with

pre-β lipoprotein?
a. Chylomicrons
Ultracentrifugation = reference method for lipoprotein analysis
b. Very low-density lipoprotein
c. Low-density lipoprotein
d. High-density lipoprotein

Lipoprotein densities (from lightest to heaviest):

1. Chylomicrons — <0.95
67. Select the order of mobility of lipoproteins electrophoresed on cellulose
2. Very Low Density Lipoproteins — 0.95-1.006
acetate or agarose at pH 8.6.
3. Low Density Lipoproteins — 1.019-1.063
a. – Chylomicrons → pre-β → β → α +
4. High Density Lipoproteins — 1.063-1.21
b. – β → pre-β → α → chylomicrons +
c. – Chylomicrons → β → pre-β → α +
Electrophoresis uses mobility patterns.
d. – α → β → pre-β → chylomicrons +
Fastest is the α-lipoprotein (HDL), then pre-β-lipoproteins (VLDL), and β-lipoproteins (LDL).
The position of LDL and VLDL is reversed in electrophoresis from ultracentrifugation.

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Order of mobility of lipoproteins electrophoresed on cellulose acetate or agarose at pH 8.6

(cathode to anode):
1. Chylomicrons
2. Β-lipoproteins (LDL)
3. Pre-β lipoproteins (VLDL)
4. α-lipoprotein (HDL)

68. The milky appearance of post-prandial serum or plasma is attributed to:

a. Chylomicrons
b. HDL
c. LDL Chylomicrons
d. VLDL ⎯ Represent exogenous lipids
⎯ Produced in the intestinal mucosa
⎯ Carry dietary (exogenous) lipids to the liver
69. Which of the following statements concerning chylomicrons is FALSE?
a. The major lipid transported by this lipoprotein is cholesterol. ⎯ Remains at the origin during LPP electrophoresis
b. This lipoprotein is produced in the intestinal mucosa. ⎯ Major lipid transported by CM is TAG
c. The primary function is to carry dietary (exogenous) lipids to the
liver.
d. It remains at the origin (point of application) during lipoprotein
electrophoresis.

70. Select the lipoprotein fraction that carries most of the endogenous
triglycerides.
a. Chylomicrons
VLDL carries most of the endogenous triglycerides.
b. VLDL
c. LDL
d. HDL

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71. Which lipoprotein is the major carrier of cholesterol to peripheral tissue?

a. Chylomicrons LDL carries cholesterol to peripheral tissues which is actually considered atherogenic (can
b. VLDL cause cardiovascular disease or stroke and heart attack as it can clog the arteries and
c. LDL promote atherosclerosis).
d. HDL

72. Which lipoprotein contains the greatest amount of protein?

a. Chylomicrons
HDL contain the greatest amount of protein (albumin) which is 50% making it very dense.
b. VLDL
Because the higher the protein content, the higher the density.
c. LDL
d. HDL

3 main functions of apolipoproteins include:

1. Structural support
73. Which apoprotein is inversely related to risk of coronary heart disease? 2. Lipoprotein metabolism
a. Apoprotein A-I 3. Ligands for cell receptors
b. Apoprotein B48
c. Apoprotein B100 Apoprotein A-I
d. Apoprotein E ⎯ Major structural protein of HDL (with Apo A-IV)
⎯ Inversely related to risk of coronary heart disease
⎯ Activator of LCAT

Apo C-I
⎯ Structural protein of VLDL and chylomicrons
74. Which of the following apolipoproteins acts as LPL activator?
a. Apo A-IV Apo C-II
b. Apo C-I ⎯ LPL (lipoprotein lipase) activator
c. Apo C-II ⎯ Important in the metabolism of chylomicrons in VLDL.
d. Apo C-III
Apo C-III
⎯ Inhibitor

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75. Which of the following is so-called “sinking pre-β lipoprotein” and is

Lp(a)
associated with CHD due to its prothrombotic nature?
⎯ “Sinking pre-β lipoprotein”
a. IDL
⎯ Associated with CHD due to its prothrombotic nature
b. β-VLDL
⎯ Homologous to plasminogen
c. Lp(a)
⎯ Same migration patterns as the VLDL but it sinks to the level of LDL
d. LpX

LDL receptor:
1. Type 1
⎯ Hyperchylomicronemia (exogenous hypertriglyceridemia)
⎯ This is deficient of lipoprotein lipase (LPL).
76. Which of the following presents with marked hypercholesterolemia due
⎯ High chylomicrons and triglycerides.
to LDL elevation owing to mutations in the gene that code for the hepatic
2. Type 2a
LDL receptor?
⎯ Familial hypercholesterolemia
a. Type 1
⎯ Marked with high LDL (very cholesterol rich) and total cholesterol (TC).
b. Type 2a
3. Type 2b
c. Type 2b
⎯ Familial combined hyperlipoproteinemia
d. Type 3
⎯ High LDL and VLDL
4. Type 3
⎯ Familial disbetalipoproteinemia
⎯ High IDL (intermediate density lipoprotein) and β-VLDL.

Type IV hyperlipoproteinemia has:

77. What type of hyperlipoproteinemia do the following results indicate? TC
TC = normal
= normal; TG = high; VLDL = increased; LDL = normal; no chylomicrons
TG = high
present; turbid serum
VLDL = increased
a. Type 1
LDL = normal; no chylomicrons present; turbid serum
b. Type 3
c. Type 4
The above results are a type of endogenous hypertriglyceridemia as there is no
d. Type 5
chylomicrons present.

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Tangier disease
⎯ Apoprotein A-I deficiency which causes absence of HDL.
⎯ An autosomal recessive condition due to mutations of ABCA1 gene.

Bassen-Kornzweig disease
⎯ Abetalipoproteinemia
78. Which of the following is associated with Tangier disease?
⎯ Absence of Apo B48 and B100.
a. Absence of Apo B48 and B100
⎯ Autosomal recessive disorder with absolute non-existent levels.
b. Apo B48 and B100 deficiency
c. α-lipoprotein deficiency
Hypobetalipoproteinemia
d. Apoprotein A-I deficiency
⎯ Absence of Apo B48 and B100 deficiency
⎯ Autosomal dominant condition.

Familial hypoalphalipoproteinemia
⎯ α-lipoprotein deficiency
⎯ Causes decreased HDL levels.

79. What is the most appropriate fasting requirement when a lipid profile is
ordered? Lipid profile: TG; TC; HDL; LDL.
a. 6-8 hours This test should have a completely chylomicron cleared blood through 12-14 hrs of fasting.
b. 8-10 hours Total cholesterol though, does not need fasting samples, but since lipid profile is ordered as
c. 12-14 hours a panel, fasting sample will do.
d. 14-16 hours

Saponification using KOH, is a step in the Abell-Kendall method for cholesterol

measurement that is meant to convert cholesterol esters to free cholesterol. KOH
80. What step in the Abell–Kendall method for cholesterol measurement is hydrolyzes cholesterol esters so that cholesterol measured is free type only.
meant to convert cholesterol esters to free cholesterol?
a. Saponification The Abell-Kendall method also has an extraction step using Bloor’s reagent, and
b. Extraction colorimetry using Liebermann Burchard method which will yield cholestadienyl
c. Purification monosulfonic acid (+ is green).
d. Colorimetry
This method has no purification but there are additional chemical methods that has
purification done prior to colorimetry.

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81. Which of these steps is not essential in the enzymatic method for
cholesterol?
a. Hydrolysis of cholesteryl esters with cholesterol esterase
b. Oxidation of cholesterol with oxygen by cholesterol oxidase
c. Preliminary saponification of cholesterol esters in the sample with
warm KOH
d. Quantitation of the amount of oxygen consumed or the amount of
H2O2 generated

82. Cholesterol esterase is used in enzymatic assays to:

a. Oxidize cholesterol to form peroxide
b. Hydrolyze fatty acids bound to the third carbon atom of cholesterol
c. Separate cholesterol from apoproteins A-I and A-II by hydrolysis
d. Reduce NAD+ to NADH

83. Select the reagent needed in the coupling enzyme reaction used to
generate a colored product in the cholesterol oxidase method for
cholesterol.
a. Quinoneimine
b. H2O2
c. 4-Aminoantipyrine
d. Cholest-4-ene-3-one

NCEP Cholesterol Cut-point (mg/dL)

Age Moderate Risk for CHD High risk for CHD
84. What NCEP cholesterol cut-point is indicative of moderate risk for adults
30-39 years of age? 2-19 >170 >185
a. ≥170 mg/dL
b. ≥200 mg/dL 20-29 >200 >220
c. ≥220 mg/dL
d. ≥240 mg/dL 30-39 >220 >240

>40 >240 >260

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85. Which of the following conditions is most consistently associated with

hypercholesterolemia?
Hypothyroidism is associated with hypercholesterolemia.
a. Hypothyroidism
Malabsorption syndrome for hypocholrsterolemia.
b. Malabsorption syndrome
Chronic alcoholism, pancreatitis, and nephrotic syndrome with hypertriglyceridemia.
c. Pancreatitis
d. Diabetes mellitus

86. Which of the following is an accurate method for triglyceride assay based
upon reaction of formaldehyde with chromotropic acid forming a pink
color?
a. Glycerol kinase-ultraviolet
b. CDC modification of van Handel and Zilversmith
c. Hantzsch condensation
d. Glycerol kinase coupled to peroxidase
87. The enzyme lipase catalyzes the _________.
a. Synthesis of cholesterol from fatty acids
b. Synthesis of TG from fatty acids and glycerol
c. Hydrolysis of TG to fatty acids and water
d. Hydrolysis of TG to fatty acids and glycerol
Triglyceride Assays:
1. Glycerol kinase-ultraviolet
2. CDC modification of van Handel and Zilversmith (colorimetric method)
⎯ This is an accurate method for triglyceride assay based upon reaction of
formaldehyde with chromotropic acid forming a pink color.
⎯ The traditional method though produces a blue color.
3. Hantzsch condensation (Fluorometric methods)
4. Glycerol kinase coupled to peroxidase
*2 and 4 are chemical methods that uses KOH and 1 and 3 are enzymatic methods which
uses lipase as catalyst for hydrolysis of triglyceride to glycerol and 3 fatty acids.
*1 and 4 has a common step = “glycerol + ATP >glyerol kinase>glycerol phosphate + ADP”

The ADP may be made to react with phosphoenolpyruvate with pyruvate kinase to produce
pyruvate and ATP.
88. Which of the following enzymes is common to all enzymatic methods for
triglyceride measurement?
a. Glycerol phosphate oxidase Pyruvate will then react to NADH in the presence of lactate dehydrogenase, lactate is
b. Peroxidase produced and NAD (decreased absorbance at 340 nm/UV as NAD is in oxidized form).
c. Glycerol kinase
d. Pyruvate kinase

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89. PK-coupled enzymatic triglyceride method measures the consumption of

_______.
a. Glycerol NADH or the reduced form, increased absorbance at 340 nm.
b. Fatty acids ⎯ PK-coupled enzymatic triglyceride method measures the consumption of NADH.
c. NADH
d. Dihydroxyacetone

90. What plasma appearance is associated with triglyceride level >600 Visual for TG Values
mg/dL? Clear <200
a. Clear
b. Hazy or turbid Hazy or Turbid >300
c. Lactescent Lactescent >400
d. Opaque or milky Opaque or milky >600

Triglycerides Values
91. Plasma triglyceride values between 200-499 mg/dL are interpreted as:
a. Normal Normal <150
b. Borderline high Borderline high 150-199
c. High
High 200-499
d. Very high
Opaque or milky ≥500

92. The following conditions present with hypertriglyceridemia EXCEPT:

a. Chronic alcoholism
b. Pancreatitis
c. Nephrotic syndrome
d. Type 2a hyperlipoproteinemia

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93. Which of the following methods for HDL cholesterol is the reference
method? Colorimetric methods used for HDL cholesterol use polyanions and divalent cations mixture
a. Manganese–heparin to precipitate Apo B containing lipoproteins so that all that remains in the sample is HDL.
b. Magnesium–phosphotungstate
c. Magnesium–dextran Reference method for ALL lipoprotein measurements (HDL, LDL, etc.) is ultracentrifugation.
d. Ultracentrifugation

94. What is the NCEP HDL cholesterol cut-point indicative of high risk for
CHD?
a. <30 mg/dL NCEP HDL cholesterol cut-point is <40 mg/dL in both males and females for high risk of
b. <40 mg/dL CHD. The higher the value, the better as HDL is the good type of cholesterol.
c. <30 mg/dL for males and < 40 mg/dL for females
d. ≥60 mg/dL

95. Treatment recommendations for patients with coronary heart disease

are based upon measurement of which analyte?
a. HDL cholesterol
b. Apo-B100
c. LDL cholesterol
d. Total cholesterol

96. When using the Friedewald equation to estimate LDL cholesterol, the
error becomes unacceptably high at triglyceride levels:
a. <200 mg/dL
Friedewald equation must not be used of TG levels are very high as it will lead to
b. >200 mg/dL
underestimation. (>400 mg/dL is considered as noticeable error.)
c. <400 mg/dL
d. >400 mg/dL

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97. Which of the following is the Friedewald formula for calculating LDL
cholesterol in mg/dL? Formula:
a. LDL = TC – (HDL + TG/5) Friedewald
b. LDL = TC – (HDL + TG/2.175) LDL=TC - (HDL + TG/5) for mg/dL
c. LDL = TC – (HDL + TG/6.5) LDL=TC - (HDL + TG/2.175) for mmol/L
d. LDL = TC – (HDL + TG/2.825)
De long
98. Calculate the LDL cholesterol level using the Friedewald equation: TC = LDL=TC - (HDL + TG/6.5) for mg/dL
400 mg/dL; TG = 300 mg/dL; HDL-C = 100 mg/dL LDL=TC - (HDL + TG/2.825) for mmol/L
a. 160 mg/dL
b. 200 mg/dL LDL= 400 - (100 + 300/5)
c. 240 mg/dL LDL= 240 mg/dL
d. 300 mg/dL

LDL Normal Values (mg/dL)

99. Which of the following LDL values would be reported as borderline high? Optimal <100
a. 100–129 mg/dL Near to above optimal 100-129
b. 130–159 mg/dL
c. 160–189 mg/dL Borderline high 130-159
d. ≥190 mg/dL High 160-189
Very high >190

NCEP Guidelines

Coefficient Bias Total Error

100. According to the NCEP guidelines, what is the acceptable coefficient of of Variation
variation for triglyceride?
a. <3% Cholesterol <3% <3% <9%
b. <4%
LDL <4% <12%
c. <5% <4%
d. <9% HDL <13%
<5%
Triglycerides <5% <15%

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