Professional Documents
Culture Documents
Mockboards Reviewer Final
Mockboards Reviewer Final
A. 1 and 4
B. 1 and 3
C. 1 and 2
D. 1 only
2. Statement 1: Lipids require special transport mechanisms for circulation in the blood.
Statement 2: Lipoprotein is the special transport mechanism used.
A. 1st statement is true, 2nd statement is false
B. 1st statement is false, 2nd statement is true
C. Both statements are true
D. Both statements are false
A. 2 and 3 only
B. 1 only
C. 2 and 4 only
D. 3 only
1
4. All of the following are true about Phospholipid, except:
1. Originates in the kidney and intestine
2. Most abundant lipids derived from phosphatidic acid
3. It is an amphiphatic lipid
4. It is similar structure to triglycerides, except that they contain two fatty acids
A. 1
B. 2
C. 3
D. 4
Chylomicron - the largest and the least dense of the lipoprotein particles.
- Density: < 0.95 kg/L
HDL- smallest lipoproteins but the most dense
- Density: <1.063-1.21 kg/L
LDL - DENSITY: 1.019-1.063 KG/l
VLDL - DENSITY: 0.95 - 1.006 Kg/L
6. It transports excess cholesterol from the tissues and returns to the liver.
A. Chylomicron
B. High Density Lipoprotein
C. Low Density Lipoprotein
D. Very low density Lipoprotein
Tangier's disease - the mutation leads to an inability to effectively transfer cholesterol and
phospholipids from within the cell onto nascent apoA1 proteins in plasma.
2
Niemann-pick disease (lipid storage disease) - it is an inherited disorder of lipid metabolism, in
which there are accumulations of sphingomyelin in the bone marrow, spleen and lymph nodes.
- Involves deficiency of enzyme responsible for removing phosphorycholine form
sphingomyelin
Tay-sachs disease - is an inherited neurodegenerative disorder of lipid metabolism
characterized by a deficiency of the enzyme hexosaminidase A, which results in the
accumulation of sphingolipids in the brain.
Sitosterolemia - mutation in ABCG8 or ABCG5 gene, both located at chromosome 2p21.
8. It catalyzes the esterification of cholesterol from HDL; enables HDL to accumulate cholesterol
as cholesterol ester.
A. Lecithin Cholesterol Acyl Transferase
B. Lipoprotein Lipase
C. Endothelial lipase
D. Hepatic lipase
LCAT - It catalyzes the esterification of cholesterol from HDL; enables HDL to accumulate
cholesterol as cholesterol ester.
Lipoprotein Lipase - hydrolyzes TAG and cholesterol esters in lipoproteins
Endothelial lipase- hydrolyzes phospholipids and TAG in HDL
Hepatic lipase - Hydrolyzes TAG and phospholipids from HDL
A. 1 and 3
B. 2 and 3
C. 3 and 4
D. 1,2 and 3
Van Handel and Zilversmith - chemical method - colorimetric method for TAG
Glycerol Kinase Method - enzymatic method for TAG
Hantsch condensation - chemical method - Fluorometric method for TAG
Libermann Burchardt reaction - Chemical method for cholesterol
A. 1
B. 2
C. 3
D. 4
Decreased cholesterol
- Severe hepatocellular disease
- Malnutrition
- Severe burns
- Hyperthyroidism
- Malabsorption syndrome
Increased cholesterol
- Hyperlipoproteinemia type II,III, V
- Biliary cirrhosis
- Nephrotic syndrome
- Poorly controlled diabetes mellitus
- Alcoholism
- Primary hypothyroidism
4
Fatty acids are a very important source of energy and Fatty acids provide the substance for
conversion to glucose(gluconeogenesis)
RATIO: The biuret procedure is recommended by the IFCC (International Federationof Cliical
Chemistry). The reaction is based on the principle that alkaline medium and the presence of
at least two peptide bonds, cupric ions will complex with groups involved int he peptide
bond to form a violet-colored chelate. Both proteins and peptides are measured in the biuret
method
Reagents:
1. Cupric ions - complexes with the peptide bond
2. Sodium potassium tartrate - forms complex with cupric ions to prevent their
precipitation in the alkaline solution; prevents turbidity
3. Potassium iodide - antioxidant; prevents autoreduction of Cu2+
Biuret is not sensitive to protein levels below 0.1 g/dL; not sensitive enough to assay total
proteins in CSF, urine or transudates.
CHOICE C: Proteins have the ability to change the color of some acid-base indicators without
altering the pH
RATIO: Malignant diseaseas are associated with increased production of acute phase proteins.
Starvation, liver failure and nephrotic syndrome = low protein levels
Starvation = since food is the primary source of proteins
Liver failure = since proteins are synthesized in the liver
Nephrotic syndrome = damage in the kidney cause proteins to be lost via the urine
17. A patient was diagnosed with emphysema. Which of the following electrophoretic patterns
is associated with the condition?
5
RATIO:
A: Reference/Normal Pattern
B. Monoclonal gammopathy
C. alpha-1-anti-trypsin deficiency (in cases of emphysema, juvenile hepatic cirrhosis)
D. Nephrotic syndrome
18. A patient is diagnosed with liver cirrhosis. Which of the following proteins is least affected?
A. IgG
B. Albumin
C. Hemoglobin
D. Ceruloplasmin
RATIO: proteins are produced in the liver. Any diseases that affect the synthetic ability of the
liver causes a significant decrease in the blood protein levels. Antibodies, however, are least
affected because they are primarily synthesized by plasma cells.
6
19. During microangiopathic hemolytic, which of the following proteins is expected to decrease?
A. Hemoglobin
B. Haptoglobin
C. Ceruloplasmin
D. C-reactive protein
RATIO: Haptoglobin is the transport protein of free hemoglobin. During intravascular hemolytic
such as in MAHA, free hemoglobin is released. To salvage hemoglobin, haptoglobin will bind
with it and bring hemoglobin in the liver for processing. Consequently, haptoglobin becomes
saturated and will decrease when hemolysis exceeds the salvage mechanism.
7
Ceruloplasmin - transports copper
CRP - first marker to increase during inflammation
20. A dye-binding technique is used for albumin measurement. Which of the following dye is
most preferred because of it is most specific?
A. Bromcresol purple
B. Bromcresol green
C. Methyl orange
D. Hydroxyazobenzene benzoic acid
RATIO: BCP is the most sPecific dye for albumin. BCG is the most sensitive dye.
Methyl orange and HABA are dyes that can be used.
Methyl orange is not specific for albumin and β-lipoproteins and some α1- and α2-globulins will
bind to this dye, which could result in falsely elevated values. HABA is more specific for
albumin, but severalcompounds, such as salicylates (aspirin), penicillin, conjugated bilirubin,
and sulfonamides, interfere with the binding of albumin to HABA, which can result in falsely low
values. BCG is not affected by interfering substances such as bilirubin and salicylates; however,
hemoglobin binds to BCG and can lead to falsely high albumin values. For example, for every
100 mg/dL of hemoglobin, albumin is increased by 0.1 g/dL. BCG has been reported to
overestimate low albumin values in patients when accompanied by an elevated α-globulin
fraction, such as occurs in nephrotic syndrome or end-stage renal disease. BCP binds
specifically to albumin and is not subject to most interferences, but does appear to be affected
by the presence of bilirubin. BCP is precise and exhibits excellent correlation with
immunodiffusion reference methods; however, BCP is not without its disadvantages. In patients
with renal insufficiency, the BCP method has been found to underestimate the serum albumin.
Additional notes:
Bromophenol blue, Ponceau S, amido black 10B, lissamine green, and Coomassie brilliant blue
are commonly used to stain protein bands after electrophoresis. Although dyebinding methods
are simple and fast, the unequal dye-binding response of individual proteins requires caution
when using this type of method with the complex mixture of proteins found in human serum .
8
21. This is the result of protein electrophoresis from a 45-year old patient. Which of the following
is an associated condition?
A. Multiple myeloma
B. Malignancy
C. Hepatic cirrhosis
D. Rheumatoid arthritis
22. A patient is suspected of having acute myocardial infarction. Which of the following markers
first increases during AMI?
A. Lactate dehydrogenase
B. Creatine Kinase-MB
C. Aspartate Transaminase
D. Myoglobin
RATIO: M-C-T-A-L (order of increase of cardiac markers). Myoglobin, CK-MB, Troponin I, AST,
LDH.
*Cardiac troponins are considered the gold standard for diagnosis. If the CK-MB and myoglobin
are normal but the troponin is elevated, it is possible that damage to the heart was minor or that
the injury took place more than 24hours in the past.
Cardiac troponins, particularly troponin I and troponin T, are quickly replacing total CK and CK-
MB measurements because they are more specific to cardiac tissue and remain elevated in the
circulation for a longer period of time.
Elevates within 3-12 hrs of onset, peak within 12-24 hours; remains elevated for 1-3 weeks.
9
23. What condition is most associated with the following results?
CK-MB = elevated
Troponin I = within reference interval
RATIO: As mentioned in the previous item, cardiac troponins are more specific to cardiac tissue
and remain elevated in the circulation following acute myocardial infarction.
If CK, CK-MB and myoglobin concentrations are normal but troponin is elevated, it is possible
that damage tot he heart was minor or that the injury took place more than 24 hours in the past.
When CK is elevated, but troponin is within the reference interval, it is likely that symptoms
present due to a cause other than acute myocardial infarction, such as skeletal muscle injury, as
in the case of Duchene musculary dystrophy.
24. Nephrotic syndrome is a protein-losing condition. Which of the following acute phase
reactants remain the circulation during nephrotic syndrome?
A. Alpha-2-macroglobulin
B. Albumin
C. Haptoglobin
D. Cerulopasmin
RATIO: In nephrotic syndrome, the problem is within the podocytes of the kidneys, which allows
the excretion of proteins via the urine. Hence in nephrotic syndrome, it is protein losing via the
kidneys and manifest as proteinuria. Most of the proteins are excreted, except alpha-2-
macroglobulin because primarily of its size. That is why during protein electrophoresis in
nephrotic syndrome, most bands are decreased, with a relative increase in alpa-2 band
because alpha-2-macroglobulin remains in the circulation.
25. Which of the following is true about the condition associated with the electrophoresis pattern
below:
1. It is an acquired disorder associated with two distinct bands in the albumin region
2. It is also called pre-albuminemia
3. It is termed bisalbuminemia
10
A. 1,2,3
B. 1,3 only
C. 2,3 only
D. 3 only
RATIO: Bisalbuminemia is a genetic condition resulting from a mutation. The albumin produced
because of the mutation has unusual molecular characteristics. Bisalbuminemia is
demonstrated by the presence of two albumin bands during electrophoresis, instead of the
single band usually observed. Pre-albumin is another type of protein that migrates in the region
farther from the albumin region.
26. Which of the following describes the synthetic function of the liver organ?
A. example is gluconeogenesis
B. conjugation of bilirubin to be excreted
C. release of bile acids.
D. proteins, albumins, cholinesterase, coagulation proteins.
27. Which of the following precautions should be followed when collecting blood samples for
bilirubin testing?
A. Specimen should be whole blood.
B. Must be kept away from direct exposure to light.
C. Specimen should be transported with ICE.
D. A and B.
Ratio: Bilirubin is easily oxidized by light. Hence, specimen should be kept away from direct
exposure to light.
28. What is the end product of Van den bergh Reaction in bilirubin detection?
A. Potassium dichromate
B. Azobilirubin
C. Hippuric Acid
D. Sodium benzoate
Ratio:
11
29. What is the end color of Evelyn and Malloy Assay?
A. Blue Color
B. Reddish Purple
C. Blue-green
D. colorless
Ratio:
30. What is the reagent used to dissociate B1 from albumin in Evelyn-Malloy Assay?
A. Methanol
B. Caffeine
C. Sodium Benzoate
D. B and C
Ratio:
Ratio:
12
32. Which of the following conditions causes post-hepatic hyperbilirubinemia?
A. Hemolytic anemia
B. Dubin-Johnson Syndrome
C. Rotor Syndrome
D. Cholelithiasis
Ratio:
33. Which of the following is an end-product of amino acid and nucleic acid metabolism?
A. Bilirubin
B. Fatty acid
C. Ammonia
D. None of the above
Ratio:
34. Which of the following enzymes are used to assess the liver function test?
A. ALP, ALT, CHS and LD
B. ALP only
C. ALP and ALT only
D. CHS and ALT only
13
Ratio: ALP - Alkaline phosphatase, ALT - Alanine transferase, CHS - cholinesterase, and LD is
Lactate Dehydrogenase. All are enzymes of liver.
Ratio:
14
Ratio:
Ratio:
Ionic strength is the capacity of the atoms to bond to each other, hence, even with enzyme to
catalyze the breakdown of molecules, still it does not supersede the ionic strength.
15
A42. (1) EDTA inhibits many enzyme activity
(2) Fluoride does not affect enzyme activity.
Ratio: EDTA is a chelator, which when it chelates, it affects enzyme activity (especially thouse
with Mg and Zn as inclusion). Fluoride is known to be an enzyme disruptor.
C43 (1) End-point analysis the simplest and most widely used technique in Enzyme
Analysis
(2) ACP is a hydrolytic enzyme secreted by a number of cells.
Ratio: Enzyme analysis is kinetic in nature as we are measuring the enzyme activity.
ACP is secreted primarily from prostate gland and prostatic secretions, but smaller amounts are
found in spleen, bone marrow, erythrocytes, liver, kidneys and platelets.
Ratio:
Ratio:
Ratio: Electrophoresis is the most commonly used to determine isoenzymes because of its band
separation capacity.
48. Which of the following is the correct order of isoenzymes of LD in descending order:
A. 540 nm
B. 340 nm
C. 260 nm
D. none of the above
Ratio:
17
50. Which of the following does not cause elevated CK?
A. MI
B. Alcoholic myopathy
C. Rhabdomyolysis
D. Leukemia
Ratio:
52. According to their site of action, which hormone acts locally by diffusing from its origin to
target cells in the neighborhood and affects its function.
A. Autocrine
B. Intracrine
C. Paracrine
D. Endocrine
Ratio: Autocrine- acts within the cell of origin resulting in self-regulation of its function;
Endocrine- targets a distant cell through the bloodstream; Intracrine- acts inside a cell,
regulating intracellular events.
18
B. composed of cholesterol components and are hydrophilic
C. composed of cholesterol components and are hydrophobic
D. composed of proteins and peptides and are hydrophobia
Ratio: Intracellular receptors are receptor proteins found on the inside of the cell, typically in the
cytoplasm or nucleus. In most cases, the ligands of intracellular receptors are small,
hydrophobic (water-hating) molecules, since they must be able to cross the plasma membrane
with carrier proteins in order to reach their receptors. Intracellular receptors are the primary
receptors for steroid hormones.
54. Based on the structure/composition, which type makes up the majority of hormones?
A. Peptide hormones
B. Steroid hormones
C. Amino acid derivatives
D. both a and c
Ratio: Most of the hormones in the body are polypeptides and proteins (Guyton and Hall 14 th
Edition). Peptide hormones represent a major class of hormones that are made from amino
acids by specialized endocrine glands.
55. Which type of hormone facilitates diffusion before attachment to a specific receptor within
the cell?
A. Peptide hormones
B. Steroid hormones
C. Amino acid derivatives
D. both a and c
(Same ratio with item no. 2)
Ratio: Intracellular receptors are receptor proteins found on the inside of the cell, typically in the
cytoplasm or nucleus. In most cases, the ligands of intracellular receptors are small,
hydrophobic (water-hating) molecules, since they must be able to cross the plasma membrane
with carrier proteins in order to reach their receptors. Intracellular receptors are the primary
receptors for steroid hormones.
57. Which of the following tissues does not secrete steroid hormones?
A. Ovaries
B. Pituitary gland
C. Testes
D. Adrenal cortex
Ratio: The hormones of the pituitary gland are protein or polypeptide in nature and vary in
complexity.
19
58. Posterior pituitary gland stores and releases which of the following tropic hormone?
A. TSH
B. Prolactin
C. Growth hormone
D. ADH
Ratio: Posterior pituitary gland stores and releases two hormones: oxytocin and antidiuretic
hormone (ADH or vasopressin). Hypothalamus makes oxytocin and ADH and then stimulates
the posterior pituitary when to store and release them by sending nerve signals through the
pituitary stalk.
59. As a counter hormone of PTH, calcitonin is released by the thyroid in response to:
A. Hypercalcemia
B. Hypocalcemia
C. Hypophosphatemia
D. Hypocalcemia and hypophosphatemia
Ratio: Calcitonin is secreted by the parafollicular cells of the thyroid gland. This hormone
opposes the action of the parathyroid glands by reducing the calcium level in the blood. If blood
calcium becomes too high, calcitonin is secreted until calcium ion levels decrease to normal.
- Parathyroid hormone is the most important regulator of blood calcium levels. It has specialized
calcium sensing receptors (CSRs) that respond to rising or falling calcium levels by increasing
or decreasing PTH secretion, respectively. PTH mobilizes calcium from bone by increasing
bone resorption. In response to low blood calcium levels, its effect is to increase those levels.
60. Secretion of hormones by the anterior pituitary may be controlled by the circulating levels of
hormones from the respective target gland, as well as hormones secreted by what organ?
A. Posterior lobe of the pituitary gland
B. Intermediate lobe of the pituitary
C. Hypothalamus
D. Adrenal medulla
Ratio: The hypothalamus secretes hormones that stimulate or suppress the release of
hormones in the pituitary gland, in addition to controlling water balance, sleep, temperature,
appetite, and blood pressure.
20
Ratio: Gonadotropin-Releasing Hormone (GnRH) stimulates both LH and FSH production;
Thyrotropin-Releasing Hormone (TRH) stimulates the secretion of both TSH and Prolactin;
Growth Hormone Releasing Hormone (GHRH) stimulates the production of Growth hormone;
Corticotropin-releasing hormone, a main stimulus for ACTH secretion.
63. Which of the following produces a hormone that serves as a first responder to stress by
acting within seconds to promote the fight-or-flight response?
A. Pituitary Gland
B. Adrenal Cortex
C. Adrenal Medulla
D. Thyroid Gland
Ratio: In response to sympathetic stimulation, the medulla secretes catecholamines directly into
the circulation which are responsible to promote the body’s fight or flight response.
64. The presence of a very high titer for antithyroglobulin antibodies and the detection of
antithyroid peroxidase antibodies is highly suggestive of what disorder?
A. Graves’ disease
B. Hashimoto’s thyroiditis
C. T3 thyrotoxicosis
D. Thyroid adenoma
Ratio:
- Thyroid peroxidase is an enzyme localized in the thyroid cell membrane which plays an
important role in thyroid hormone biosynthesis. TPO assists the chemical reaction that adds
iodine to a protein called thyroglobulin, a critical step in generating thyroid hormones.
- Thyroglobulin acts as a substrate for the synthesis of the thyroid hormones thyroxine (T4) and
triiodothyronine (T3), as well as for iodide storage and the storage of the inactive forms of
thyroid hormone within the follicular lumen of a thyroid follicle.
- Hashimoto’s thyroiditis aka Chronic Lymphocytic thyroiditis is the most common cause of
hypothyroidism. In this condition, antibodies of TPO and Thyroglobulin lead to decreased thyroid
hormone production by the thyroid gland.
21
66. Considering that hyperglycemia normally suppresses GH secretion, glucose administration
may be used for the diagnosis of:
A. Hypoadrenalism
B. Acromegaly
C. Cushing’s disease
D. Conn’s syndrome
Ratio: Acromegaly results from pathologic or autonomous growth hormone excess and, in the
vast majority of patients, is a result of a pituitary tumor; Hypoadrenalism aka Addison’s disease-
Cortisol insufficiency; Cushing’s disease- a type of Cushing syndrome that is caused by a
benign tumor in the pituitary gland that secretes too much ACTH resulting to hypercortisolism;
Conn’s syndrome is a rare condition caused by overproduction of aldosterone.
67. Which is the most widely used screening test for Cushing’s syndrome?
A. Dexamethasone suppression test
B. Cosyntropin stimulation test
C. Captopril suppression test
D. Metyrapone stimulation test
Ratio: Dexamethasone suppression test is the most widely used screening test for Cushing’s
syndrome. Dexamethasone acts as an exogenous cortisol substitute suppressing ACTH if the
pituitary gland is normal and cortisol secretion if the adrenal gland is normal.
69. Which of the following constitutes the second line of control of thyroid hormone synthesis
and secretion?
A. Hypothalamus
B. Adenohypophysis
C. Neurohypophysis
D. Thyroid follicles
Ratio: Anterior pituitary gland (Adenohypophysis); Posterior pituitary gland Neurohypophysis
- Thyroid gland is the first line of control of thyroid hormone synthesis. The second line of control
is the Adenohypophysis which secretes TSH that stimulates the thyroid gland to synthesize and
secrete thyroid hormone.
22
70. The concentration of serum TSH is characteristically low in:
71. Which of the following thyroid hormones is considered the most biologically active?
A. Free T3
B. Free T4
C. T3 bound to TBG
D. T4 bound to TBG
Ratio: T3 is three to eight times more metabolically active than T4 and often considered to be
the active form of thyroid hormone. They combined mainly with thyroxine-binding globulin (TBG)
and much less so with thyroxine-binding prealbumin and albumin.
72. A 65-year-old woman presents with fatigue, hypothermia, pericardial effusions, and hair
loss. Her thyroid function tests show a significantly elevated TSH and a low free T4. All of the
following laboratory test abnormalities may be associated with her underlying condition except:
A. Pernicious Anemia
B. Hyponatremia
C. Hypocholesterolemia
D. Elevated CPK levels
Ratio: The result indicates hypothyroidism (High TSH, Low FT4). Hypothyroidism can lead to a
variety of other abnormalities because of the diffuse distribution of thyroid hormone receptors
and many metabolic effects of thyroid hormone: Hyponatremia, Anemia, Elevated CPK levels
and hypercholesterolemia.
73. Which placental hormone has some structural homology with the anterior pituitary tropic
hormones?
A. HCG
B. HPL
C. Estriol
D. Estrone
Ratio: Human chorionic gonadotropin (hCG) is a hormone secreted by syncytiotrophoblast
tissue typically found in early embryos and which will eventually be part of the placenta during
pregnancy. It is a dimer consisting of a 145 amino acid beta-subunit that is unique to hCG and a
92 amino acid alpha-subunit. The alpha-subunit is identical to that for luteinizing hormone (LH),
follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH) secreted in anterior
pituitary gland.
23
TDM and Toxicology
74. In which of the cases below is qualitative analysis of the drug usually adequate?
A. To determine whether the dose of a drug with a low therapeutic index is likely to be
toxic.
B. To determine whether a patient is complying with the physician’s instructions.
C. To adjust dose if individual differences or disease alter expected response.
D. To determine whether the patient has been taking amphetamines.
Ratio: The purpose of therapeutic drug monitoring is to achieve a therapeutic blood drug level
rapidly and minimize the risk of drug toxicity caused by overdose. Therapeutic drug monitoring
is a quantitative procedure performed for drugs with a narrow therapeutic index (ratio of the
concentration producing the desired effect to the concentration producing toxicity). Drug groups
that require monitoring because of high risk of toxicity include aminoglycoside antibiotics,
anticonvulsants, antiarrhythmics, antiasthmatics, immunosuppressive agents used for transplant
rejection, and psychoactive drugs. When testing for abuse substances, the goal is usually to
determine whether the drug is present or absent. The most common approach is to compare the
result to a cutoff determined by measuring a standard containing the lowest level of drug that is
considered significant.
Ratio: Pharmacokinetics is the mathematical expression of the relationship between drug dose
and drug blood level. When the appropriate formula is applied to quantitative measures of drug
dose, absorption, distribution, and elimination, the blood concentration can be accurately
determined.
Ratio: Pharmacodynamics is the relationship between the drug concentration at the receptor
site (tissue concentration) and the response of the tissue to that drug. For example, the
relationship between lidocaine concentration in the heart muscle and the duration of the action
potential of Purkinje fibers.
Ratio: Lead accumulates in RBCs, bones, and neural tissues, and whole blood, hair, and urine
are suitable for demonstrating lead toxicity. Greatest sensitivity is obtained by using whole
blood, which can detect exposure over time. Because lead is rapidly eliminated from plasma,
serum or plasma should not be used to test for lead exposure. Lead binds to sulfhydryl groups
of proteins such as delta-aminolevulinic acid (Δ-ALA) dehydratase and ferrochelatase and
24
interferes with heme synthesis. This results in increased free erythrocyte protoporphyrin,
erythrocyte zinc protoporphyrin, urinary coproporphyrin III, and δ aminolevulinic acid, which are
also useful markers for lead poisoning. When screening for lead poisoning in children, the
method of choice is graphite furnace atomic absorption spectrophotometry or inductively
coupled plasma mass spectroscopy because they offer the best analytical sensitivity.
Ratio: Most GC-MS instruments use an electron beam to split the drug emerging from the
column into its component ions. These are drawn into the mass analyzer, usually a vacuum
chamber containing two pairs of charged rods (a positive pair and a negative pair) called a
quadrupole analyzer. By changing the potential and radio frequency applied to the rods, the
travel of ions will vary depending upon their mass to charge (m/z) ratio. As ions emerge from the
mass filter, they are detected by an electron multiplier tube. CG-MS instruments can be
operated in two modes, total ion chromatography and selective ion monitoring. A total ion
chromatograph displays the retention time of all ions detected and their abundance. It is
primarily used for identification of unknown compounds. SIM mode measures the abundance of
one or more principal ions that provides sufficient specificity to eliminate potential interfering
substances and greater quantitative sensitivity
79. Which could account for drug toxicity following a normally prescribed dose?
1 - Decreased renal clearance caused by kidney disease
2 - Discontinuance of another drug
3 - Altered serum protein binding caused by disease
A. 1 and 2
B. 1 only
C. 1 and 3
D. 1, 2, and 3
Ratio: Therapeutic drug monitoring is necessary for drugs that have a narrow therapeutic index.
Individual differences alter pharmacokinetics, causing lack of correlation between dose and drug
blood level. These include age, diet, ingestion with or without food, genetic factors, exercise,
smoking, pregnancy, metabolism of other drugs, protein binding, and disease states.
Ratio: Pharmacogenomics refers to the study of genes that affect the performance of a drug in
an individual. One method is to test for single nucleotide polymorphisms (SNPs) using DNA
microarrays in genes such as those that code for the cytochrome P450 enzymes involved in the
metabolism of many drugs. Genetic variations of one such enzyme may account for individual
pharmacokinetic differences and can be used to predict the efficacy of the drug.
25
81. Select the five pharmacological parameters that determine serum drug concentration.
A. Absorption, anabolism, perfusion, bioactivation, excretion
B. Liberation, equilibration, biotransformation, reabsorption, elimination
C. Liberation, absorption, distribution, metabolism, exertion
D. Ingestion, conjugation, integration, metabolism, elimination
Ratio: Liberation is the release of the drug and absorption is the transport of drug from the site
of administration to the blood. The percent of drug absorption and the rate of absorption
determine the bioavailable fraction, f. This is the fraction of the dose that reaches the blood.
Distribution refers to the delivery of the drug to the tissues. It involves dilution and equilibration
of the drug in various fluid compartments including the blood, and is influenced by binding to
proteins and blood cells. Metabolism is the process of chemical modification of the drug by cells.
This results in production of metabolites with altered activity and solubility. Excretion is the
process by which the drug and its metabolites are removed from the body
Ratio: When a drug is administered intravenously, all the drug enters the bloodstream, and
therefore, the bioavailable fraction is 1.0. All other routes of administration require absorption
through cells, and this process reduces the bioavailable fraction. The bioavailable fraction for a
drug given orally can be calculated by dividing the peak blood concentration after oral
administration by the peak drug concentration after IV administration. A value of 0.7 or higher is
desired for drugs given orally
Ratio: Drugs given orally enter the blood via the portal circulation and are transported directly to
the liver. Some drugs are excreted by the liver, and a fraction will be lost by hepatic excretion
before the drug reaches the general circulation. An example is propranolol, a β-blocker that
reduces heart rate and hypertension. The bioavailable fraction is 0.2–0.4 when given orally
because much of the drug is removed by first-pass hepatic metabolism.
84. For drugs with first-order elimination, which statement about drug clearance is true?
A. Clearance = elimination rate / serum level
B. It is most often performed by the liver
C. It is directly related to half-life
D. Clearance rate is independent of dose
Ratio: First-order elimination represents a linear relationship between the amount of drug
eliminated per hour and the blood level of drug. For drugs following linear kinetics, clearance
equals the elimination rate divided by the drug concentration in blood. When clearance (in
milligrams per hour) and f are known, the dose per hour needed to give a desired average drug
level at steady state can be calculated. Clearance is inversely related to the drug’s half-life and
is accomplished mainly by the kidneys.
26
85. The pH of the blood is maintained at 7.4. It is necessary to have:
A. 10:1 ratio of bicarbonate to carbonic acid
B. 20:1 ratio of bicarbonate to carbonic acid
C. 1:20 ratio of bicarbonate to carbonic acid
D. 20:1 ratio of carbonic acid to bicarbonate
RATIO: Blood pH is maintained at slightly alkaline levels (7.35-7.45, ~7.4) because of the
interaction of the primary buffer systems. In plasma, the bicarbonate-carbonic acid systme is
one of the principal buffers:
It consists of a weak acid (carbonic acid) and a slat of its conjugate base (bicarbonate).
Carbonic acid is a weak acid because it does not completely dissociate into H+ and HCO3–,
whereas a strong acid, such as HCl, completely dissociates into H+ and Cl– in solution. When
hydrogen ions are added to the bicarbonate–carbonic acid system, the HCO3 – will combine
with the H+ to form H2CO3 (Eq. 17-2). Therefore, bicarbonate–carbonic acid reaction is driven
to the right, increasing the amount of carbonic acid and consuming bicarbonate ion. Conversely
when a strong base is added, H2CO3 will combine with the OH– ions to form H2O and the
weaker conjugate base HCO3-. Although the bicarbonate–carbonic acid system has low
buffering capacity, it is still the most important buffer system in extracellular fluids for three
reasons: (1) H2CO3 dissociates into CO2 and H2O, allowing CO2 to be eliminated by the lungs
and H+ as water; (2) changes in CO2 modify the ventilation (respiratory) rate; and (3) HCO3 –
concentration can be changed by the kidneys. When the kidneys and lungs are functioning
properly, the ratio of HCO3– to H2CO3 is 20:1, corresponding to a pH of 7.40.
A. 6.28
B. 7.42
C. 6.76
D. 7.44
87. A sealed specimen is left at room temperature for 3 hours. What changes in the blood gas
parameters are expected?
A. pO2 decreases, pCO2 increases, pH decreases
B. pO2 increases, PCO2 increases, pH increases
C. pO2 decreases, PCO2 decreases, pH decreases
D. pO2 increases, PCO2 increases, pH decreases
RATIO: Quality Assurance during Blood gas measurement (Bishop 7ed, p. 976)
27
Notes highlight:
In most instances, the ideal collection device for arterial blood sampling is a 1- to 3-mL
self-filling, plastic, disposable syringe, containing the appropriate type and amount of
anticoagulant. Evacuated collection tubes are not appropriate for blood gases. While both dry
(lyophilized) and liquid lithium heparin are acceptable anticoagulants, the liquid form is not
recommended because liquid heparin can dilute the sample and possibly alter the sample due
to equilibration with room air.
Transport time and analysis should be minimal to reduce cellular metabolism.
Anaerobic condition results in oxygen and glucose consumption (pO2 decreases) and
carbon dioxide and lactate production (pCO2 increases thereby making the pH acidic =
decrease pH). Placing the filled syringe in an ice water slurry promptly after the draw minimizes
cell metabolism. There is potential for pO2 to increase due to oxygen diffusing from the water
through the pores of the plastic syringe. In addition, lower temperatures cause increased
oxygen solubility in blood and a left shift in the oxyhemoglobin dissociation curve resulting in
more oxygen combining with hemoglobin. As a consequence, when the sample is heated by the
blood gas analyzer, the measured pO2 is falsely elevated.
88. In order to maintain electroneutrality in the red blood cells, bicarbonate leaves the RBC in
exchange of what ion?
A. Sodium
B. Potassium
C. Chloride
D. Phosphate
RATIO: The red blood cell membrane is permeable to both bicarbonate and chloride ions.
Chloride ions participate in buffering the blood by diffusing out of or into the red blood cells to
compensate for the ionic change that occurs when bicarbonate enters or leaves the red blood
cell. This is called the chloride shift.
The dissociation of H2CO3 causes development of a concentration gradient due to the increase
in HCO3 – concentration; accordingly, biocarbonate ions diffuse from the red cells and diffuse
into the plasma. To maintain electroneutrality (the same number of positively and negatively
charged ions on each side of the red cell membrane), chloride diffuses into the cell. This is
known as the chloride shift (also known as the Hamburger shift). The H+ generated is buffered
by binding with the recently deoxygenated hemoglobin molecules. This is why the abbreviation
HHb is used to designate deoxygenated hemoglobin, because it has hydrogen bound instead of
oxygen. (Bishop 7ed, p. 947)
28
89. A 30-year old unknown male came to the emergency department unconscious. He had
shallow breaths, and has clammy cold skin. His blood gas analysis results are:
pH = 7.29
pCO2 = 50 mmHG
HCO3 = 25 mmol/L
RATIO:
pH is 7.29 = acidosis
pCO2 = increased (indicating the problem is respiratory)
HCO3 = within reference range; indicating the kidneys have not compensated for the acidosis.
Respiratory acidosis compensation: kidneys retain HCO3 (so increase in HCO3 should be
observed when kidneys will compensate)
90. A 30-year old unknown male came to the emergency department unconscious. He had
shallow breaths, and has clammy cold skin. His blood gas analysis results are:
pH = 7.29
pCO2 = 50 mmHG
HCO3 = 25 mmol/L
A. Hypoventiliation
B. Decreased reabsorption of bicarbonate by the kidneys
C. Increased Na+/H+ exchange by the kidneys, with the excretion of H+
D. Decreased ammonia formation by the kidneys
91. The following blood gas results are obtained from a 20-year old female brought to the
hospital. She was hyperventilating.
pH = 7.58
pCO2 = 55 mmHg
HCO3 = 18 mmolL
RATIO: Here the pH and case information indicate alkalosis, but both the metabolic
(decreased HCO3) and respiratory (increased PCO2) components indicate acidosis. Most likely
there is a problem/error in one or more of the measurements.
92. Which data sheet in the laboratory contains basic information about the specific chemical or
product like its expiration dates, health hazard and protection information?
A. Material safety data sheet
B. Personal data sheet
C. Exposure control plan
D. Chemical hygiene plan
Ratio: . A summary of the MSDS information requirements includes the following: ■ Product
name and identification ■ Hazardous ingredients ■ Permissible exposure limit (PEL) ■ Physical
and chemical data ■ Health hazard data and carcinogenic potential ■ Primary routes of entry ■
Fire and explosion hazards ■ Reactivity data ■ Spill and disposal procedures ■ PPE
recommendations ■ Handling ■ Emergency and first aid procedures ■ Storage and
transportation precautions ■ Chemical manufacturer’s name, address, and telephone number ■
Special information section
A. 1 only
B. 1 and 2
C. 1 and 3
D. 1, 2, and 3
Ratio: There are other federal regulations relating to laboratory safety, such as the Clean Water
Act, the Resource Conservation and Recovery Act, and the Toxic Substances Control Act.
(Bishop)
30
94. Which of the following protective measures would best use for germicidal lamps used in
biologic safety eye and skin protection?
A. Engineered shielding and posted pacemaker warning.
B. Containment and appropriate warning labels
C. Filters, diffusers, and nonreflective surfaces
D. Eye and skin protection; UV warning labels
Ratio:
95. Any blood, body fluid, or other potentially infectious material spill must be cleaned up, and
the area or equipment must be disinfected immediately. Cleanup includes:
1- Common aqueous detergent
2 - Disinfect the spill site using 1% bleach
A. 1 only
b. 2 only
C. Both 1 and 2
D. Neither 1 nor 2
Ratio: Any blood, body fluid, or other potentially infectious material spill must be cleaned up, and
the area or equipment must be disinfected immediately. Cleanup includes the following
recommendations: ■ Wear appropriate protective equipment. ■ Use mechanical devices to pick
up broken glass or other sharp objects. ■ Absorb the spill with paper towels, gauze pads, or
tissue. ■ Clean the spill site using a common aqueous detergent. ■ Disinfect the spill site using
approved disinfectant or 10% bleach, using appropriate contact time
Ratio: Strict attention to good laboratory technique can help prevent chemical spills. However,
emergency procedures should be established to handle any accidents. If a spill occurs, the first
step should be to assist/evacuate personnel, and then confinement and cleanup of the spill can
begin. There are several commercial spill kits available for neutralizing and absorbing spilled
chemical solutions. However, no single kit is suitable for all types of spills. Emergency
procedures for spills should also include a reporting system
31
97. Fires have been divided into four classes based on the nature of the combustible material
and requirements for extinguishment. Which of the following belong to Class A?
1 – elecrical equipment
2 – wood
3 – plastic
A. 1 only
B. 2 only
C. 2 and 3
D. 1 and 2
Ratio: Fires have been divided into four classes based on the nature of the combustible material
and requirements for extinguishment: Class A: ordinary combustible solid materials, such as
paper, wood, plastic, and fabric Class B: flammable liquids/gases and combustible petroleum
products Class C: energized electrical equipment Class D: combustible/reactive metals, such as
magnesium, sodium, and potassium.
98. Which of the following statements is correct? Choose the best answer.
A. Liquid wastes and flammable solvents must be collected in approved containers and
segregated into compatible classes.
B. If recycling is not feasible, disposal arrangements of flammable material can be made
by the laboratory personnel.
C. Needles should be transported, recapped, bent, or broken by hand.
D. Radioactive wastes can be treated and disposed by incineration
Ratio:
99. Which of the following statements is correct? Choose the best answer.
A. Biohazard hoods remove particles that may be harmful to the employee who is
working with infective biologic specimens.
B. Biologic specimens should remain capped during centrifugation to prevent spillage.
C. Clean any spill site using a common aqueous detergent.
D. All of the choices.
A. 1 is correct
B. 2 is correct
C. 1 and 2 are correct
D. Neither 1 nor 2 is correct
32
MTAP 100 ASSESSMENT #1
1st Semester AY 202-2023
1. Which of the following tests would require a blood collected in royal blue top tube?
A. Pyruvate
B. Hepatitis B antibody
C. Free hemoglobin
D. Zinc
RATIO: Zinc is one of the most important trace element. Measurement of trace elements in the blood/serum
requires royal blue-top evacuated tube. Royal blue tube is made with special glass and stopper materials that
are free of trace element contamination as possible. Apart from trace element determination, royal blue is also
used for the determination of drug level and toxicology screen. Royal blue top tubes contain EDTA, heparin, or
no additive.
2. A neonate is due for screening to detect metabolic and genetic abnormalities. In what manner is blood
collected in this case?
A. Venipuncture via the median vein
B. Venipuncture via the dorsal vein
C. Capillary puncture from the lateral plantar surface of the heel
D. Capillary puncture from the 3rd or 4th finger
RATIO: Neonatal screening for metabolic and genetic abnormalities is done through newborn screening. It is
performed by capillary puncture (lateral plantar heel-stick). And blood is collected in filter paper. Puncture on
the 3rd or 4th finger of newborns is a big no-no because of the short distance between the skin surface and
bone.
3. Which parameter is most important to consider in order to maintain the integrity of a specimen for blood gas
analysis?
A. Exposure to light
B. Exposure to air
C. Ensure that the specimen is fasting
D. Ensure that the specimen is centrifuged immediately
RATIO: Blood gas analysis include the measurement of pO2 and pCO2. It is of utmost importance to not to
expose the sample to room air when collecting, transporting and making O2 measurements. Contamination of
the sample with room air (pO2 >150 mmHg) can result in significant error because leukocytes continue to
metabolize O2.
4. A patient is due for urine hormone measurement. Which of the following urine collection is best to perform in
this case?
A. 24-hour urine
B. Random urine
C. Midstream clean-catch urine
D. Routine urine specimen
RATIO: For urine hormone analysis, a 24-hour urine is collected to consider diurnal variations of hormones.
Refrigeration is the primary means of storage of samples. Collection is done example:
Upon waking up (6AM) urination - not included in the collection because this primarily belongs from the
previous day.
Urine after 6AM is collected until the following day. Last collection will be at 6AM the following day.
5. As a phlebotomist, what order of draw are you going to follow when the tests requested are: Prothrombin
Time, Complete Blood Count, Fasting Blood Sugar, Lipid Panel
1. Citrate tube
2. EDTA tube
3. Serum separator tube
4. Fluoride tube
A. 1 → 3 → 2 only
B. 3 → 2 → 1 only
C. 1 → 2 → 3 → 4
1
D. 3 → 1 → 2 → 4
RATIO: The tubes that you will need are: Citrate for prothrombin time, EDTA for CBC and Serum separator
tube for FBS and Lipid panel.
Any time a coagulation test other than PT or PTT is the first or only tube collected, a few mL of blood should be
drawn tino a nonaddtive tube or another coagulation tube before the coagulation specimen is collected. The
extra tube is called a “clear” or “discard” tube because it is used to remove tissue fluid from the needle and is
then thrown away.
6. During venipuncture, the patient was vigorously pumping his fist. Which of the following test/s is/are
affected?
1. Potassium
2. Creatine Kinase
3. Sodium
4. Alkaline phosphatase
A. 1, 2, 3, 4
B. 1, 2 only
C. 2, 3 only
D. 2, 4 only
RATIO: Potassium and creatine kinase are abundant in our muscles. Hence, vigorous pumping of the fist
causes both to leak from intracellular environment into the circulation. Sodium and ALP are not affected by
vigorous pumping of fist.
7. Hand hygiene during routine blood collection requires antiseptic cleaning with:
1. Formaldehyde
2. 20% phenol
3. 70% isopropyl alcohol
4. Iodine
A. 3,4 only
B. 2,3 only
C. 1,4 only
D. 3 only
RATIO: For routine venipuncture, 70% isopropyl alcohol may be used as an alternative to hand washing if
there is no visible soiling or blood contamination.
Additional info: during routine venipuncture, 70% isopropyl alcohol is the antiseptic of choice in cleaning the
venipuncture site. Povidone iodine is only used when the collection is for blood culture and blood donation.
Povidone iodine is never used in routine venipuncture as it can cause false elevation of Potassium, Uric Acid,
Phosphate
2
8. Allen’s test is a blood collection procedure performed:
A. In glucose tolerance test
B. In arterial blood gas test
C. In prothrombin time test
D. In hormone
RATIO: Allen’s test is performed prior to arterial puncture. It is a test to assess whether the ulnar artery can
provide enoch blood supply to the radial artery during collection.
9. Serum iron is one of the request for Patient XYZ. Which of the following is best to do during blood collection
for serum iron?
A. Collection is done early in the morning
B. Collection is done in 24-hour period to consider diurnal variation
C. Collection is using arterial puncture
D. Collection is through capillary puncture
RATIO: Iron (and cortisol) exhibits diurnal variation. Their levels peak early in the morning and decline in the
afternoon. The best time to collect for iron (and cortisol) is during early in the morning. Collection of sample in
the afternoon will result to false low levels.
10. Which of the following is true about tying of tourniquet during routine venipuncture>
A. Above the antecubital for 3 minutes
B. Above the antecubital for no more than 1 minute
C. Below the antecubital for about 1 minute
D. Below the antecubital for 3 minutes
RATIO: Tourniquet application should be 2-4 inches (equivalent to three fingers) above the puncture site
(above the antecubital area) for no longer than 1 minute.
Prolonged tourniquet application will result to hemoconcentration (thereby cause false increase in most cells
and analytes) and possibly hemolysis.
If tourniquet is not available, a blood pressure cuff may be used. During routine venipuncture, it is inflated at
60mmHg.
11. If a patient develops a hematoma during venipuncture, which of the following is the best course of action?
A. remove the needle and apply adequate pressure
B. apply pressure to the site and try to finish the collection
C. call the nurse immediately
D. readjust/redirect the needle and continue the collection
RATIO: If the needle punctures the vein through and through, it could possibly result to leakage of blood to the
surrounding tissues, resulting to hematoma formation. To prevent this, it is best to stop the collection and apply
pressure on the puncture site.
When the patient experiences discomfort (i.e.g pain, hematoma), stop the collection and apply appropriate
patient care. You may resume venipuncture on the other site with the permission of the patient. A medical
technologist is allowed to make 2 attempts before endorsing to another medtech.
12. When atoms absorbs or emits energy, what characteristic absorption or emission spectra is expected?
A. Line spectrum
B. Band spectra
C. Continuous spectra
D. Line and Band Spectrum
Ratio: Since ATOM is in its simplest form, it yields a specific energy equating to specific wavelength, hence a
line spectrum is expected. For MOLECULE (which consists of two or more atoms - creating a complex mixture
of atoms - a BAND Spectra is yielded. Whilst Light emitted by incandescent solids (tungsten or deuterium) it is
in a continuous spectra.
A. The amount of light absorbed is inversely proportional to the concentration of the unknown substance.
B. The concentration of a substance is inversely proportional to the logarithm of transmitted light.
C. The concentration of a substance is directly proportional to the logarithm of transmitted light.
D. A and C are combined principles of Beer-Lambert Law.
Ratio:
Beer-Lambert Law states that the concentration of a substance is directly
proportional to the amount of light absorbed or inversely proportional to
the logarithm of the transmitted light.
Note:
● Some of the lights are absorbed, while the rest passes through
and is converted into an electrical signal.
● Percent transmittance is the ratio of the radiant energy transmitted
divided by the radiant energy incident of the sample.
● All light absorbed or blocked results in 0% Transmittance. A level
of 100% Transmittance is obtained IF NOT LIGHT IS ABSORBED.
● The %Transmittance measured in commercial
spectrophotometers is the ratio of the sample transmitted beam divided
by the blank transmitted beam.
14. Which of the following light sources for spectrophotometers are capable of providing continuous emission
of light down to 165 nm?
A. Deuterium discharge lamp
B. Low-pressure mercury lamps
C. Medium-pressure mercury lamps
D. High-pressure mercury lamps
Ratio: For UV works, the commonly used lamps are the deuterium lamps and mercury lamps.
- Deuterium discharge lamps provide continuous emission down to 165 nm.
- Low-pressure mercury arc lamps emit a sharp line spectrum with both UV and visible lines.
- Medium and High pressure mercury lamps emit a continuum from UV to the mid-visible region.
4
15. Which of the following is the most commonly used monochromator?
A. Colored glass filters
B. Interference filters
C. Glass Prisms
D. Diffraction Gratings
Ratio:
● Colored Glass Filters - least expensive, usually pass a relatively wide band of radiant energy and have
low transmittance of the selected wavelength. Although not precise, they are simple and inexpensive.
● Interference filters - produce monochromatic light. Transmits multiples of the desired wavelengths. It
can be constructed to pass a very narrow range of wavelengths with good efficiency.
● Glass prism - a narrow beam of light focused on a prism is refracted as it enters the denser glass. The
prism can be rotated, allowing only the desired wavelength to pass through an exit slit.
● Diffraction Gratings - Commonly used monochromators. Consists of many parallel grooves etched onto
a polished surface. Diffraction, the separation of light into component wavelengths, is based on the
principle that wavelengths bend sa they pass a sharp corner.
16. Which of the following DOES NOT describe the principle of atomic absorption spectrophotometry?
Ratio: AAS is used to measure concentration by detecting the absorption of electromagnetic radiation by
atoms rather than by molecules.
17. Which of the following methods is RECENTLY and COMMONLY used for Na+, K+ or Li+ determination?
A. Flame photometry
B. AAS
C. Ion-selective electrodes
D. A and C
Ratio:
- Flame emission photometer measures light emitted by excited atoms. (Na+, K+ and Li+ are ions that
are capable of emitting specific wavelengths **specific colors**). The intensity of the color and the
specific color indicates the concentration and the type of ion present, respectively.
- Ion Selective Electrode is an analytical technique used to determine the activity of ions in aqueous
solution by measuring the electrical potential. **relatively inexpensive and easy to operate.
- ISE are electrochemical ion sensors that convert the activity of a target ion into an electrical
potential as the measurable signal.
18. If the color of the solution is Red-orange, what will be the absorbed color?
A. Violet
B. Blue-green
C. Red
D. Orange
5
Ratio:
19. Which of the following is part of the components of the THIN-LAYER CHROMATOGRAPHY?
A. Gas, injection port, column, oven, detector, recorder.
B. Solvent, pump, injection port, column, detector, recorder.
C. Sorbent-coated glass or plastic plate, closed container, solvent.
D. Gas, pump, column, recorder.
Ratio:
20. How to correct the absorbance of the unknown solution with colored reagents?
RATIO: A spectrophotometer can be set to 100%T with the reagent blank instead of water, the absorbance of
reagents is automatically subtracted from each unknown reading. The reagent blank does not correct for
absorbance caused by interfering chromogens in the sample such as bilirubin, hemolysis or turbidity.
Ratio:
- ISE - potential difference between 2 electrodes directly related to concentration of analyte.
- USE: pH, PCO2, PO2, Na+, K+, Ca2+, Li+, Cl-
- Electrophoresis - separation of charged particles in electrical field. Anions move to positively charged
pole (anode); cations to negatively charged pole (cathode). The greater the charge, the faster the
migration.
- USE: Serum protein, hemoglobin electrophoresis
6
22. A linearity study was performed on a visible spectrophotometer at 650 nm and the following absorbance
readings were obtained:
The study was repeated using freshly prepared standards and reagents, but results were identical to those
shown. What is the most likely cause of these results?
A. wrong wavelength used
B. Insufficient chromophore concentration
C. Matrix interference
D. Stray Light
Ratio: Stray light is the most common cause of loss of linearity at high-analyte concentrations. Light transmitted
through the cuvette is lowest when absorption is highest. Therefore, stray light is a greater percentage of the
detector response when sample concentration is high. Stray light is usually most significant when
measurements are made at the extremes of the visible spectrum because lamp output and detector response
are low.
23. In mass spectroscopy, the term base peak typically refers to:
A. The peak with the lowest mass
B. The peak with the most abundance
C. A natural isotope of the molecular ion
D. The first peak to reach the mass detector.
Ratio: THe base peak is typically the “molecular ion” or parent ion, meaning that it is the initial fragment made
by releasing an electron.
24. A new tumor marker for ovarian cancer is evaluated for sensitivity by testing serum samples from patients
who have been diagnosed by staging biopsy as having malignant or benign lesions. The following results were
obtained:
Number of malignant patients who are positive for CA-125 =21 out of 24
Number of benign patients who are negative for CA-125 = 61 out of 62
Ratio: Sensitivity is defined as the percentage of persons with the disease who have a positive test result. It is
calcualted as true-positives divided by the sum of TP and FN
% Sensitivity = TP X 100
TP + FN
Sensitivity = (21 X 100) / (21 +3) = 87.5%
25. What is the molarity of a solution comprising 2 moles of sucrose (table sugar) in 4 liters?
A. 1 M
B. 0.50 M
C. 0.25 mole
D. 1 mole
Ratio:
The ratio is 2 mol per 4 L: 2 mol 4L = 0.50 mol/L = 0.50 M
7
26. Calculate % (w/w) of 9.2 g CaCl2 dissolved in 800 g of water.
A. 1.1 % (w/w)
B. 0.1 % (w/w)
C. 1.0 % (w/w)
D. 10 % (w/w)
28. One of the automated instruments in your laboratory requires the preparation of a special cleaning
solution, made by mixing 30 mL of concentrate with enough water to bring the final volume to 250 mL. How
much concentrate do you use to make 1 L of the cleaning solution?
A. 75 ml
B. 120 ml
C. 12 ml
D. 100 ml
Ratio: First, convert one of the units into the other: 1 L = 1000 mL.
Next, set up an equation of ratios:
30 mL concentrate: 250 mL solution = ____ : 1000 mL solution
(30 mL concentrate)(1000 mL solution) divided by 250 mL = 120 mL concentrate
29. If isopropyl alcohol is added to 50 mL of water until the volume of the solution is 150 mL, what is the %
(v/v)?
A. 33% (v/v)
B. 3.3% (v/v)
C. 0.3% (v/v)
D. 30% (v/v)
Ratio: The concentration is the volume of alcohol divided by the total solution volume:
(50 mL/150 mL) x 100% = 33% (v/v)
31. Consider the serial dilution of a sample at 50,000 ng/dL. If the tube dilution is 1:10, what is the
concentration in the fourth tube?
A. 50 ng/dl
B. 0.5 ng/dl
C. 500 ng/dl
D. 5.0 ng/dl
Ratio: Dsample = (Dtube) exp N = (1/10) exp 4 = 1/10,000. Thus, the concentration in tube #4 is
5 ng/dL
32. If the tube dilution is 1:3, how many tubes are required in a series to achieve a sample dilution of 1:243?
A. 3
B. 5
C. 10
D. 7
8
Ratio:
33. Convert 2.0 mEq/L magnesium (atomic weight = 24.3) to milligrams per deciliter.
A. 0.8 mg/dL
B. 1.2 mg/dL
C. 2.4 mg/dL
D. 4.9 mg/Dl
Ratio: To convert from milliequivalent per liter to milligrams per deciliter, first calculate the milliequivalent
weight (equivalent weight expressed in milligrams), which is the atomic mass divided by the valence. Because
magnesium is divalent, each mole has the charge equivalent of 2 mol of hydrogen. Then, multiply the
milliequivalent per liter by the milliequivalent weight to convert to milligrams per liter. Next, divide by 10 to
convert milligrams per liter to milligrams per deciliter. Milliequivalent weight Mg = 24.3 ÷ 2 = 12.15 mg/mEq 2.0
mEq/L × 12.15 mg/mEq = 24.3 mg/L 24.3 mg/L × 1.0 L/10.0 dL = 2.4 mg/dL
34. How many milliliters of a 2,000.0 mg/dL glucose stock solution are needed to prepare 100.0 mL of a 150.0
mg/dL glucose working standard?
A. 1.5 mL
B. 7.5 mL
C. 15.0 mL
D. 25.0 mL
Ratio: To calculate the volume of stock solution needed, divide the concentration of working standard by the
concentration of stock standard, then multiply by the volume of working standard that is needed. C1 × V1 = C2
× V2, where C1 = concentration of stock standard V1 = volume of stock standard C2 = concentration of
working standard V2 = volume of working standard 2000.0 mg/dL × V1 = 150.0 mg/dL × 100.0 mL V1 = (150.0
÷ 2000.0) × 100.0 mL V1 = 7.5 mL
35. Which of the following measures of centers is NOT COMMONLY used in the descriptive statistics related to
internal quality control program?
A. Mean
B. Median
C. Mode
D. Average
Ratio: Mean, Median, Mode are three commonly used measures of center of a data set. Mean is aka as
average. Median is the middle point and is often used with skewed data. While mode is rarely used, but is
more often used to describe data set that seem to have two centers (i.e. bimodal).
9
38. Compute for the diagnostic specificity of the HbSAg test kit given with the following data:
A. 80.95%
B. 56.67%
C. 103.44%
D. 30%
Ratio:
%Sensitivity = 100 X (number of diseased individuals with positive results/total number of diseased individuals tested)
%Specificity = 100 X (number of diseased individuals with negative results/total number of individuals without disease)
Ratio: QC is a MUST regular practice of the clinical laboratory in order to MAKE SURE that the tests done in
the clinical laboratory is ACCURATE AND PRECISE (thereby making it reliable). It detects changes in
performance between the present operations and the “stable” operations. Part of the objectives of the quality
control are:
- To check the stability of the machine
- To check the quality of reagents
- To check technical errors
Random Error – affect precision; unable to predict because they have no known pattern, and may aternate
between a positive or negative direction.
Systematic error – are predictable and cause a constant difference in results that are consistently positive or
negative or stay the same. Such errors may be due to incorrect calibration, deteriorated reagents, instrument
malfunction, etc.
42. In general concepts of quality control, what is the acceptable range of confidence limit of the laboratory
data?
A. +/- 1SD
B. +/- 2SD
C. +/- 3SD
D. none of the above
Ratio: 95% confidence limit is +/- 2SD according to the Gaussian Curve (and this is the acceptable range in the
QC if based of Westgard Multirule or Levey Jennings Chart.
10
43. If deterioration of reagent will yield a “trend” pattern in the chart. What will be the visible pattern if improper
calibration of the instrument is made?
A. Trend
B. Shift
C. Outliers
D. No visible pattern
- Shift - formed by control values that distribute themselves on one side or either side of the mean (shift
in the reference range is due to transient instrument differences); sudden change in the mean that is
reflected as consecutive control values above or below the mean.
Ratio: Although Calcium has the lowest SD, it represents the assay with poorest precision. Relative precision
between different analytes or different levels of the same analyte must be evaluated by the coefficient of
variation (CV) because standard deviation is dependent upon the mean. CV = s X 100/mean. This normalizes
standard deviation to a mean of 100. The CV for calcium in the example is 12.0%.
45. Which of the following plot is best for detecting all types of QC errors?
A. Youden-plot
B. Levy-Jennings
C. Linear Regression
D. Cusum
Ratio: LJ chart or plot is a graph of all QC results with concentrations plotted on the y-axis and run number on
the x-axis. The mean is at the center of the y axis, and concentrations corresponding to -2 and +2s are
highlighted. Results are evaluated for multi rule violations across both levels and runs. Corrective actions for
shifts and trends can be taken before QC rules are broken.
Ratio: Mode is defined as the most frequently occurring value in a set of values;
- 136 occurred 3 times and it is the value that occurred most in the series.
46. Given the following sodium control values (mEq/L): 138, 145, 139, 142, 140, 143
Determine the standard deviation.
11
47. When a certain set of control values was arranged from the highest value to the lowest, the middlemost
value would be known as:
A. Mean B.Median C.Mode, D. StandardDeviation
48. What is the minimum requirement for performing QC for a glucose assay?
Ratio: The minimum requirement for frequency of quality control for a general chemistry analyte (based upon
the Clinical Laboratory Improvement Act, 1988) is two levels of control assayed every 24 hours. Some
laboratories prefer to assay two control levels every 8 hours to increase the opportunity for error detection.
Note: two controls every 8 hours are required for blood gases, automated hematology, and point-of-care
glucose testing to comply. Analytes that display different CVs at the low, normal, and high ranges require 3
levels of control in 24 hours. These include blood gases, therapeutic drugs, and hormones.
49. When the magnitude of error increases with increasing sample concentration, it is called as _____.
A. constant error
B. Proportional error
C. Random error
D. Bias
Ratio: Proportional error (slop or percent error) results in greater absolute error (deviation from the target
value) at higher sample concentration. Constant error refers to a difference between the target value and the
result, which is independent of sample concentration.
50. All of the lab’s policies, processes, procedures and resources needed to achieve quality testing is termed
as ___.
A. Quality assurance
B. Analytical Quality Assurance
C. Post Analytical Quality Assurance
D. Quality System
Ratio:
- Quality assurance is explained as the process by which lab ensures quality results by closely
monitoring preanalytical, analytical and postanalytical stages of testing.
- Preanalytical QA is defined as everything that precedes performance e.g. test ordering, patient
preparation, patient ID, specimen collection, specimen transport, specimen processing.
- Analytical QA is everything related to assay e.g. test analysis, QC, reagents, calibration, preventive
maintenance
- Post Analytical QA is everything that comes after test analysis (e.g. verification of calculation and
reference ranges, review of results, notification of critical values, results reporting, test interpretation by
physician, follow-up patient care.
- Quality system is all of the lab’s policies, processes, procedures & resources needed to achieve quality
testing.
51. It is an integral part of the analytical phases of quality assurance where process of monitoring results from
control samples to verify accuracy of patients results.
A. External Quality Control
B. Internal monitoring systems
C. Quality Assurance
D. Quality Control
12
52. Describe the following chart:
13
54. In a chart, you see 10 consecutive controls on same side of mean, which of the following statements best
describes the situation?
A. It is described as 1-3s and there is a random error.
B. It is described as 2-2s and there is systematic error.
C. It is described as 10-x and there is systematic error.
D. It is described as 4-1s and there is systematic error.
Ratio:
A. Accuracy
B. Reliability
C. Reproducibility
D. Reportable
56. Which of the following is a term describing “positive results in patient who has the disease”
A. True positive
B. False positive
C. True negative
D. False negative
Aldosterone
- sodium retention hormone
- promotes absorption of sodium in DCT
- promotes sodium retention and potassium excretion
ADH
- Hormone produced by the hypothalamus to regulate water reabsorption in the collecting duct
RENIN
-Proteolytic enzyme produced by the kidneys that reacts angiotensinogen to produce angiotensin to
increase blood pressure
14
- The most electrolyte disorder, it is defined as reduced plasma sodium concentration
a. 1
b. 2 and 4
c. 3
d. 3 and 4
RATIO: Chloride is the MAJOR EXTRACELLULAR ANION- chief counter ion of sodium in ECF. In most
processes, Cl- shifts secondarily to a movement of Na+ or HCO3-. It maintains electroneutrality through
chloride shift. In this process, CO2 generated by cellular metabolism within the tissue diffuses out into the
plasma and red cells. In the red cell, CO2 forms carbonic acid (H2CO3) which splits into H= and HCO3.
Deoxyhemogobin buffers H+, whereas the HCO3 diffuses out into the plasma and Cl- diffuses into the red cell
to maintain the electric balance of the cell.
61. All are the factors affecting magnesium level in the blood except:
1. Parathyroid hormone
2. Thyroxine
3. Aldosterone
4. Vasopressin
a. 1 and 2
b. 2
c. 1, 3 and 4
d. 4
Parathyroid hormone
- it increases renal reabsorption of Mg and it increases intestinal absorption of Mg
Thyroxine
- It increases renal excretion of Mg
Aldosterone
- It increases renal excretion of Mg
Vasopressin
- Reabsorption of water
Potassium deficiency also causes loss of sodium because of inverse relationship of the two ions in the renal
tubules - when serum potassium levels are low, the tubules will conserve potassium and excrete the sodium in
exchange for the monovalent cation.
63. The patient was suffering from prolonged diarrhea. What is the possible result that can be expected?
a. Hypernatremia
b. Hyponatremia
c. Hypokalemia
d. hyperkalemia
Hypernatremia:
- Excess water loss: DI, Renal tubular disorder, prolonged diarrhea, profusse sweating, severe burns,
vomiting, fever, hyperventilation
- Decreased water intake
- Increased intake or retention
a. 1 and 4
15
b. 1 and 2
c. 3
d. 4
Potassium is released during clotting. When the platelet count is increased (thrombocytosis), serum K may be
further elevated. That is why, heparinized plasma is preferred, esp. When there is thrombocytosis.
66. All of the methods are used for Potassium determination, except:
1. Emission flame Photometry
2. Ion selective electrode
3. Colorimetry
4. Glass aluminum silicate
a. 1 and 2
b. 2
c. 3 and 4
d. 4
Ion selective Electrode (Glass Aluminum Silicate) -most commonly used method dor Na determination
Magnesium is an intracellular cation and it is the fourth most abundant cation in the body. Majority is stored in
the bones (53%), in the muscles (46%) and soft tissue, (1%) in seum and RBC.
68. It is the most commonly used method to measure serum inorganic phosphate.
a. Fiske Subbarow method
b. Ammonium molybdate method
c. Ion selective electrode
d. A and B
a. 1 and 2
16
b. 3
c. 3 and 4
d. 2
17
- Dye lake method - Titan Yellow dye = clayton yellow or thiazole yellow
- AAS -reference method
CLARK COLLIP PRECIPITATION - END PRODUCT: OXALIC ACID (PURPLE)
- Method used for calcium determination.
Ratio: The enzyme urease hydrolyses urea in the sample, and the ammonium ion produced in the reaction is
quantified.
Ratio:
- Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis with
the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation.
Catabolism of the nucleic acids to uric acid leads to hyperuricemia.
- Gout is caused by a condition known as hyperuricemia. When there is too much uric acid in the body,
uric acid crystals (monosodium urate) can build up in joints, fluids, and tissues within the body.
Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis
- End-stage renal disease- Urea levels
77. Creatinine synthesis in the liver requires these following amino acids except?
A. Glycine
B. Alanine
C. Methionine
D. Arginine
Ratio:
- Creatine is synthesized primarily in the liver from arginine, glycine, and methionine. It is then
transported to other tissues, such as muscle, where it is converted to creatine phosphate (a high
energy source). Creatine phosphate loses phosphoric acid and creatine loses water to form creatinine,
which diffuses into the plasma and excreted in the urine.
- Alanine- supports the function of the liver. It is a source of energy for muscles and the central nervous
system. It strengthens the immune system and helps the body use sugars.
78. A medical technologist obtains a BUN result of 61 mg/dl and a serum creatinine result of 1.1 mg/dL on a
patient. These results indicate:
A. Lesch-Nyhan Syndrome
B. Glomerulonephritis
C. Congestive heart failure
D. Nephrolithiasis
Normal values:
BUN= 6-20 mg/dL Creatinine= 0.9-1.3mg/dL (Male); 0.6-1.1. mg/dL (Female)
18
Result shows high BUN and normal serum creatinine values which indicates Congestive Heart Failure
(Prerenal Azotemia); Glomerulonephritis- Renal Azotemia (High BUN and Crea); Nephrolithiasis- post-renal
azotemia (High BUN and Crea); Lesch-Nyhan Syndrome- confuser, causes hyperuricemia.
79. A high BUN:Creatinine ratio with a significantly elevated creatinine is usually seen in:
A. Nephrolithiasis
B. liver disease
C. Lesch-Nyhan Syndrome
D. Congestive heart failure
Ratio: Nephrolithiasis (Postrenal azotemia)- high BUN:creatinine ratio (BCR) with a significantly elevated
creatinine levels; Liver disease- causes decreased plasma urea concentration; CHF (Prerenal azotemia)- high
BUN:creatinine ratio (BCR) with normal creatinine; Lesch-Nyhan Syndrome- confuser, causes hyperuricemia.
81. The uricase method for uric acid assay depends on:
A. ultraviolet absorption at 293 nm before and after treatment with uricase
B. collection of evolved gas after uricase treatment
C. titration before and after uricase treatment
D. formation of a colored solution
Principle of Uricase Method: The enzyme uricase catalyzes the oxidation of uric acid to form allantoin. Uric
Acid has a maximum peak of absorption at 293mm. The decrease in the absorbance is proportional to the
concentration of uric acid present in the sample.
82. In the diacetyl monoxime method, what does diacetyl react with to form a yellow product?
A. creatinine
B. uric acid
C. urea
D. ammonia
RATIO: Diacetyl Monoxime Method Principle: Diacetyl monoxime breaks down into diacetyl during the reaction
in the presence of heat (provided from a boiling water bath). Diacetyl and urea then condense in the same
medium under the presence of a strong acid to form the yellow-colored diazine product and water.
19
83. When mixed with phosphotungstic acid, what compound causes the reduction of the former to a tungsten
blue complex?
A. creatinine
B. uric acid
C. urea
D. ammonia
RATIO: Caraway Method: based on the oxidation of the uric acid in a protein-free filtrate, with subsequent
reduction of phosphotungstic acid to tungsten blue. The method lacks specificity.
Ratio:
A- More accurate results are obtained when creatinine in a protein-free filtrate is adsorbed onto Fuller’s earth
(aluminum magnesium silicate) or Lloyd’s reagent (sodium aluminum silicate), then eluted and reacted with
alkaline picrate. Adsorbent improves specificity.
C- Kinetic Jaffe Method eliminates some of the nonspecific reactants, but it is subject to interference by a-keto
acids and cephalosporins. Despite these problems, it is still used routinely because it is inexpensive, rapid, and
easy to perform.
D- IDMS is the reference method for Creatinine and Urea.
85. A 12-year-old patient had 10 episodes of voluminous watery diarrhea and no urine outputs in the last 24
hours and was brought to the ER with the following initial laboratory result:
Na= 155 mmol/L BUN= 66mg/dL ABG= metabolic acidosis
Potassium= 3 mmol/L Creatinine= 1.1 mg/dL
The patient above has:
A. Severe liver disease
B. Prerenal Azotemia
C. Postrenal Azotemia
D. Renal Azotemia
Normal values:
BUN= 6-20 mg/dL Creatinine= 0.9-1.3mg/dL (Male); 0.6-1.1. mg/dL (Female)
Result shows: High BUN:Crea ratio with normal Creatinine. The patient had 10 episodes of voluminous watery
diarrhea which indicates Dehydration. Dehydration causes prerenal Azotemia; Severe liver disease- Low
BUN:Crea ratio; Postrenal Azotemia and Renal Azotemia- High BUN:Crea ratio with an elevated creatinine
levels
86. When measuring ammonia blood level, the following might cause a false increase level of this analyte
except?
A. Immediately after phlebotomy, the blood sample was stored at room temperature.
B. The patient had two cigarettes 15 minutes prior to blood extraction.
C. The patient was fasting for hours prior to blood collection.
D. A and B
E. All of the choices will falsely increase the blood ammonia levels.
20
87. Ammonia concentrations are usually measured to evaluate:
A. Glomerulonephritis
B. Acid-base status
C. Congestive heart failure
D. Hepatic encephalopathy
Ratio: Ammonia blood test is most commonly used to diagnose and monitor hepatic encephalopathy, a severe
liver disease.
RATIO: glucose + glucose = maltose; galactose + glucose = lactose; matlose and glucose = just a confuser;
fructose + glucose = sucrose
89. Which of the following blood glucose levels would you expect to result in glucose in the urine?
A. 75 mg/dL
B. 150 mg/dL
C. 180 mg/dL
D. 230 mg.dL
RATIO: The renal threshold for glucose is 160-180 mg/dL. Any plasma glucose above the renal threshold will
result to the excretion of glucose in the urine (glucosuria)
90. A known Type II DM patient was given 2 months of treatment. He went to his doctor for follow-up after the
2-month treatment. Which of the following tests may be performed to asses the average glucose level in this
case?
A. Fasting blood sugar
B. Glycated hemoglobin
C. Two-hour oral glucose tolerance test
D. Random blood sugar
RATIO: Fructosamine test and glycated hemoglobin are tests for monitoring glucose control over a period of
time. Fructosamine is a glucose monitoring for 2-3 weeks period while glycated hemoglobin is for 2-3 months
monitoring. FBS is primarily a screening test and 2-hr OGTT as a confirmatory test.
91. The doctor is monitoring a Type I DM patient for possible complications. All of the following tests are helpful
in this case, EXCEPT:
A. Serum creatinine
B. Serum urea nitrogen
C. Serum bilirubin
D. Urinary albumin
RATIO: The possible complications of diabetest mellitus are: nephropathy, retinopathy, neuropathy, and
cardiovascular diseases. Bilirubin is not a helpful test in this case. Serum creatinine, urea nitrogen, and urinary
albumin are kidney function tests.
92. In most laboratory techniques of measuring glucose, serum or plasma is preferred over whole blood
because
1. Glucose levels are more stable when serum or plasma is separated
2. Using serum or plasma increases the specificity of the test for glucose
3. Using whole blood would require immediate mixing before sampling, and, thus inconvenient
A. 1, 2, 3
B. 1,2 only
C. 1 only
D. 2 only
21
RATIO: Glucose determination is generally performed on serum or plasma. Serum or plasma is convenient to
use in most automated systems because serum does not require mixing before sampling. Glucose is more
stable in separated serum or plasma because this minimizes glycolysis. With using serum or plasma,
specificity for glucose is increased because red blood cells contribute to various interferences during testing.
93. Mr. X submitted himself for routine fasting blood sugar. His result was 115 mg/dL. Which among the
following category is he classified?
A. Normal for his age
B. Type I DM
C. Type II DM
D. Impaired fasting glucose
RATIO: According to the American Diabetes Association, the diagnosis of diabetes mellitus is as follows:
Fasting blood sugar of ≥126 mg/dL
Random blood sugar of ≥200 mg/dL
2-hr Oral glucose tolerance test of ≥200mg/dL
94. A woman in her 20th week of gestation was subjected to GDM screening. An initial screening test was
performed with 50-g glucose load. After 1 hour, her result was 115 mg/dL. So the doctor proceeded to an oral
glucose tolerance test with a 75g glucose load. Evaluate the case.
1. GDM screening must be performed at 24-28 weeks gestation
2. OGTT must be performed only when the challenge test is ≥140 mg/dL
3. The glucose load for GDM is 100 g.
A. 1,2,3
B. 1,2 only
C. 1,3 only
D. 3 only
RATIO: If a woman is at high risk for GDM, there should be an initial screening early in the pregnancy. If she
is not found to have GDM during the initial screening, the woman should be retested at 24-28 weeks of
gestation. For women of average risk, testing should be performed at 24-28 weels pf gestatopm/
95. The patient’s plasma glucose level is 98 mg/dL. What is the expected CSF glucose concentration?
A. 60 mg/dL
B. 66 mg/dL
C. 49 mg/dL
D. 55 mg/dL
RATIO: The reference interval for glucose in CSF is 60% of the plasma glucose. Reference interval for CSF
glucose is 40-70 mg/dL. Low CSF glucose is associated with: bacterial meningitis and tuberculous meningitis,
whereas viral disease generally presents with a normal level of CSF glucose.
22
96. All of the following are reagents of the serum glucose method, EXCEPT:
1. NAD+
2. Reduced chromogen
3. Glucose oxidase
4. Peroxidase
A. 1 only
B. 1, 2 only
C. 2, 3 only
D. 2, 4 only
RATIO: Enzymatic measurement of glucose are more specific for glucose. Enzymes act on glucose but not on
other sugars, and not on othr reducing substances: GLUCOSE OXIDASE and HEXOKINASE METHOD.
In the glucose oxidase meathed, it measures beta-D-glucose only (beta-D glucose is 65%; alpha-D-glucose is
35%)
Hexokinase method: most specific glucose method; reference method. It measures both alpha and beta-D-
glucose. During measurement, the enzyme mutarotase converts alpha-glucose to beta glucose.
97. You received a CSF specimen for glucose analysis at 7:00 pm. The sample was cloudy and contains
blood. Which of the following is correct?
A. Upon receipt, freeze the sample and assay the next day..
B. Glucose measurement cannot be performed on the sample.
C. Upon receipt, centrifuge the sample and assay immediately.
D. Upon receipt, refrigerate the sample and assay the next day..
RATIO: CSF samples should be assayed as soon as possible upon receipt of the specimen. A cloudy sample
may be due to bacteria. Bacteria and red blood cells may consume glucose in vitro. Delays in testing could
significantly result to false low readings. It is best to centrifuge the specimen to remove any cellular materials.
Assay the sample immediately.
A. 1,2 only
B. 3,4 only
C. 1,3 only
D. 2,4 only
23
RATIO:
TYPE I DM TYPE II DM
99. Mr. Y has a uric acid level of 55.2 mg/dL. How will this affect the glucose measurement using glucose
oxidase/peroxidase method?
A. false low
B. false high
C. glucose level will be accurate
D. glucose level will exceed the linearity of the method
RATIO:
Note:
TRINDER’S REACTION is involved in the glucose oxidase method. Bilirubin, uric acid, ascorbate, tetracycline,
hemoglobin, and glutathione can interfere in the assay by competing for H2O2. This results in the loss of
H2O2 and thus leads to false readings.
100. Which of the following is/are TRUE about fluoride when used as an anticoagulant for glucose testing?
1. It acts by inhibiting the enzyme enolase and thus preserves glucose
2. It acts by chelating Mg2+
3. It can preserve glucose for upto 48 hours
4. It is added if serum is in contact with cells for longer than 30 minutes
A. 1,2,3,4
B. 1,2,3 only
C. 1,2 only
D. 1 only
RATIO: Fluoride preserves glucose by inhibiting the enzyme enolase. It acts by chelating Mg2+, which is an
activator of enolase. It can preserve glucose for up to 48 hrs.
For glucose measurement, testing should be performed within 30 minutes of collection to prevent cellular
consumption of glucose. If there is a delay of more than 30 minutes, fluoride should be added to the blood
sample.
24
Analyte/Substance Reference range Conversion
Factor (CF)
Conventional Other (conventional x CF
= other)
Lecithin/Sphingomyelin (L/S) ≥2
ratio
Borderline: 200-239
High = ≥240
Enzymes E.C. Nomenclature Major/Most Specific Tissue source Most Notable Diagnostic Significance Reference
LD-1&2: Heart, RBCs, kidneys Pernicious anemia (↑) Forward 100-255 U/L
Lactate Dehydrogenase (LD) 1.1.1.27 LD-3: Lungs, Pancreas Spleen Hemolytic disorders (anemia) (↑) Reverse 80-280 U/L
LD-4&5: Skeletal muscles, liver, spleen Myocardial Infarction (↑)
LD-2>LD-1 (flips during MI)
Glucose-6-Phosphate Dehydrogenase 1.1.1.49 Adrenal cortex, spleen, RBCs, lymph nodes Myocardial infarction and megaloblastic anemia (↑) 10-15 U/g hemoglobin
(G6PD) Drug-induced hemolytic anemia (↓) 1200-2000 mU/mL packed RBC
Gamma-Glutamyl Transferase (GGT) 2.3.2.2 Epithelial cells of biliary ductules (liver), kidney, Alcoholism/Acute Alcoholic Hepatitis (↑) Males 6-45 U/L
prostate, pancreas Females 5-30 U/L
Aspartate Aminotransferase (AST) 2.6.1.1 Cardiac, Liver, skeletal muscle Acute Myocardial Infarction (↑) 5-37 U/L
Creatine Kinase (CK) 2.7.3.2 Brain; smooth, skeletal, and cardiac muscles Duchenne’s Muscular Dystrophy (highest) (↑) Males 15-160 U/L
Acute Myocardial Infarction (CK-MB) (↑) Females 15-130 U/L
CK-MB <6% of total CK (< 5 µg/L)
Lipase (LPS) 3.1.1.3 Pancreas (most specific marker) Acute Pancreatitis (↑) 0-1.0 U/mL
Chronic Pancreatitis (↓)
Pseudocholinesterase 3.1.1.8 Liver, myocardium, pancreas Insecticide/pesticide poisoning (↓) 0.5-1.3 pH units
Post-surgery evaluation of muscle relaxants (↓)
Alkaline phosphatase (ALP) 3.1.3.1 Non-specific Liver: Obstructive Jaundice (↑) 30-90 U/L
Placenta, intestine, liver, bone Bone: Paget’s disease (osteitis deformans) (↑)
Acid phosphatase (ACP) 3.1.3.2 Prostate Prostatic adenocarcinoma (↑) Total 2.5-11.7 U/L
Prostatic 0-3.5 ng/mL
5’ Nucleotidase 3.1.3.5 Liver Hepatobiliary disease, Infiltrative liver lesions 0-1.6 units
60-180 SU/dL
95-290 U/L
Amylase (AMY/AMS) 3.2.1.1 Acinar cells of the pancreas and salivary glands Acute pancreatitis (AP) (↑) AMY:CREA ratio
● 1-4%
● ≥ 4% (AP)
Angiotensin Converting Enzyme (ACE) 3.4.15.1 Lungs, testes, macrophages, epithelioid cells Sarcoidosis, MS, Addison’s disease, acute and chronic bronchitis,
HIV, leprosy
Aldolase 4.1.2.13 Skeletal muscles, bone marrow (?), liver Skeletal muscle disease, Leukemia, Hemolytic anemia, Hepatic
Cancer (↑)
Park Systems
Infused with innovative robotics, intelligent learning
features, safety mechanisms
Clinical Chemistry
2. Serum iron should be drawn at the same time on successive days to avoid:
a. Diurnal variation
b. Chance of consumption of dietary iron
c. Effect of medication
d. Gastrointestinal absorption of iron
POPULAR
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 1/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
10. The purpose of the glass coils in a continuous flow system is to:
a. Provide proper mixing
b. Prevent carry-over of sample
c. Allow visual inspection
d. Allow close packing of tubing
12. How many mL of 95% alcohol do you need to make 1 liter of a 70%
solution?
a. 74 mL
b. 138 mL
c. 737 mL
d. 1360 mL
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 2/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
13. If 0.5 mL serum is diluted to a volume of 10 mL with normal saline, LABELS
what dilution is achieved?
a. 1:40 PROFESSIONAL REGULATION COMMISSION
b. 1:10 (470)
BOARD PASSERS (145)
c. 1:5
d. 1:20 DEFENSIVE DRIVING (132)
c. Acid is neutralized and water added LEARN HOW TO DRIVE (97)
d. Water is added to concentrated acid
ACADEMIC PAPERS (94)
15. Given the following laboratory data: HUNTING (83) HUNTING IN LABRADOR (83)
Serum creatinine = 4.0 mg/dL
ENTERPRISE RESOURCE PLANNING SOFTWARE
Urine creatinine = 80 mg/dL
(77)
24 hour volume = 360 mL CUSTOMER RELATIONSHIP MANAGEMENT (74)
b. Unique identification number MASKING TAPE (25) PACKING TAPE (25)
c. Date of collection
SURGICAL TAPE (25)
d. Date of birth of patient
MEDICAL TECHNOLOGY (23)
18. Which of the following is caused by a random error? FINANCIAL MANAGEMENT (22)
1. R:4s 3. 1:2s 5. 10:x
CURLY FRIES (20) FRENCH FRIES (20)
2. 4:1s 4. 1:3s 6. 2:2s
PROFESSIONAL TEACHER (20)
a. 1, 2, 3, and 6
b. 1, 4 and 6 MASTER PLUMBERS (18)
c. 1 and 4 INTERNET MARKETING (18)
d. 2, 3 and 5
PERSONAL FINANCE (18)
19. It is defined as the proportion of individuals without a condition who VIDEO MARKETING (18)
have a negative test for that condition
DEBT SOLUTION (17) INSURANCE (17)
a. Diagnostic sensitivity
SOUND THERAPY (17) DEBTS (16)
b. Diagnostic specificity
c. Positive predictive value MEDICAL TECHNOLOGISTS (15)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 3/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
21. What term applies to the sum of all the values in a set of numbers E-COMMERCE SOFTWARE (13)
divided by the number of values in that set?
LEASE MANAGEMENT (13)
a. Median
b. Mode PSYCHOLOGISTS (12)
22. What does the preparation of a Levey-Jennings QC chart for any single HOW TO BUILD YOUR BUSINESS WEBSITE (12)
d. Weekly analyses of the control serum for 1 month SANITARY ENGINEERS (11)
CONSOLIDATED LOAN (11)
23. A group of physicians consistently complains that they are not
receiving STAT patient results quickly enough. The supervisor is likely to OUTDOOR ADVENTURE (11)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 4/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
a. 12 mmol/L Medical
PERSONAL Technology
HEALTH (6) Board Examination
REFINANCING (6)
Review Notes ...
b. 64 mmol/L SUGAR GLIDERS (6)
Medical Technology Board Examination
c. 20 mmol/L Review Notes ...
TIPS IN LOSING WEIGHT (6)
d. Cannot be determined from the information provided Medical Technology Board Examination
TIPS INReview Notes ... (6)
SOUND THERAPY
Medical Technology Board Examination
30. Major extracellular anion WEIGHTReview
LOSS (6)
Notes WORDPRESS
... (6)
a. Sodium Medical Technology Board
CERTIFIED PLANT MECHANICS (5)Examination
b. Potassium Review Notes ...
c. Chloride Medical
OCULAR Technology Board
PHARMACOLOGISTS (5) Examination
Review Notes ...
d. Bicarbonate RADIOLOGIC TECHNOLOGISTS (5)
Medical Technology Board Examination
Review Notes ...
ADVENTURE (5) BUSINESS (5)
31. Which of the following conditions will cause an increased osmolal gap? Medical Technology Board Examination
CARIBOUReview Notes
HUNTING (5)... CHEMISTS (5)
a. Drug overdose
Medical Technology Board Examination
b. Diabetic ketoacidosis CIVIL ENGINEERS (5) ... E-COMMERCE (5)
Review Notes
c. Renal failure Medical Technology Board Examination
FORESTERS (5) LEGAL (5)
d. All of these Review Notes ...
LIFE Medical
COACHESTechnology
(5) Board Examination
Review Notes ...
32. Hyperaldosteronism will cause ____ serum sodium and ___ serum potassium AERONAUTICAL ENGINEERS (4)
Medical Technology Board Examination
levels Review Recall...
BUSINESS MANAGEMENT (4)
a. Increased; Decreased Medical Technology Board Examination
Review
CERTIFIED PLANTNotes ...
MECHANICS (CPM) (4)
b. Increased; Increased
Medical Technology Board Examination
c. Decreased; Increased CUSTOMS BROKERS
Review Notes(4)...
d. Decreased; Decreased ► June (43)
LET BOARD EXAM (4)
► May (9)
MARINE ENGINEERS
► March (13) (4)
33. Which of the following is the primary mechanism for antidiuretic
hormone (ADH) release? ► February (9)ENGINEERS (COMPUTER-BASED
METALLURGICAL
a. Hypovolemia ►EXAM)
2017 (33)
(4)NAVAL ARCHITECTS (4)
► 2016 (138)
b. Hyperosmolar plasma
2015 (157)
►OCULAR PHARMACOLOGY (4)
c. Renin release
► 2014 (219)
d. Reduced renal blood flow REAL ESTATE APPRAISERS (4)
► 2013 (863)
REGISTERED ELECTRICAL ENGINEERS (4)
34. Which of the following clearance tests offers the most accurate measure
REGISTERED MASTER ELECTRICIANS (4)
of glomerular filtration?
a. Inulin RESPIRATORY THERAPISTS (4)
b. Creatinine DOG TRAINER (4) MIDWIVES (4)
c. p-aminohippurate (PAH)
NATURAL MOTION DECOYS (4)
d. Urea
PRESTASHOP (4)
35. All but one of the following matches is correct: AGRICULTURAL ENGINEERS (3)
a. Urea – product of protein catabolism
ELECTRONICS TECHNICIAN (3)
b. Creatine – product of muscle catabolism
c. Uric acid – product of pyrimidine catabolism MARINE ENGINEER OFFICERS (WRITTEN) (3)
37. To determine if a 24 hour urine collection is complete, which of the MUSIC THERAPY (3) OVERWEIGHT (3)
following determinations may be helpful?
PERFUME (3)
a. BUN
b. Osmolality SENATE OF THE PHILIPPINES (3)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 5/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
d. Nephritis
41. Urea concentration is calculated from the blood urea nitrogen (BUN) by
multiplying by the factor of:
a. 0.5
b. 2.14
c. 6.45
d. 14
43. Which of the following is the reference method for measuring serum
glucose?
a. Somogyi-Nelson
b. Hexokinase
c. Glucose oxidase
d. Glucose dehydrogenase
44. Which of the following hormones does not promote an increase in blood
glucose levels?
a. Growth hormone
b. Cortisol
c. Insulin
d. Glucagon
45. Which of the following does not properly describe type I diabetes
mellitus?
a. Insulin deficiency
b. Associated with autoimmune destruction of pancreatic beta-cells
c. Ketoacidosis prone
d. Occurs more frequently in adults
46. For every 1% change in the HbA1c value, ___ mg/dL is added to plasma
glucose
a. 15
b. 25
c. 35
d. 50
47. According to WHO, what is the standard glucose load for OGTT procedure?
a. 75g
b. 150g
c. 50g
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 6/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
d. 100g
50. To produce reliable results, at which time should blood specimens for
lipid studies be drawn?
a. 2-4 hour fasting
b. 6-8 hour fasting
c. 8-10 hour fasting
d. 12-16 hour fasting
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 7/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
c. Burns
d. Liver disease
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 8/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
d. Rotor syndrome
66. As the red blood cells disintegrate, hemoglobin is released and
converted to the pigment bilirubin. Which organ is primarily responsible
for this function?
a. Spleen
b. Kidneys
c. Intestines
d. Liver
69. Which of the following markers will remain elevated for 48-72 hours
after the onset of myocardial infarction?
a. CK-MB
b. AST
c. LDH
d. Troponin I
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 9/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
2. ACP 4. AMS
a. 1, 2 and 3
b. 1, 2 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4
77. Select the most appropriate single screening test for thyroid disease
a. Free thyroxine index
b. TSH assay
c. Total T3 level assay
d. Total T4 level assay
79. The presence of a very high titer for anti-thyroglobulin antibodies and
the detection of anti-thyroid peroxidase antibodies is highly suggestive of
what disorder?
a. Graves’ disease
b. Hashimoto’s thyroiditis
c. Pernicious anemia
d. Thyroid adenoma
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 10/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
d. Testosterone
90. Which of the following metals has a characteristic “odor of garlic” and
“metallic taste”?
a. Cyanide
b. Arsenic
c. Lead
d. Mercury
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 11/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
93. What will happen if blood is exposed to air during collection for pH
and blood gas studies?
a. CO2 content increases
b. pH decreases
c. pO2 decreases
d. pCO2 decreases
94. Emphysema, pneumonia and other pulmonary diseases are associated with
which acid-base disorders?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Metabolic acidosis
95. For each degree of fever in a patient, pO2 values will decrease by ___
% and pCO2 values will increase by ___%
a. 7; 3
b. 3; 7
c. 3; 3
d. 7; 7
100. This class of fire is usually allowed to burn out and nearby materials
protected
a. Type A (Ordinary Combustibles)
b. Type B (Flammable Liquids)
c. Type D (Flammable Metals)
d. Type E (Arsenal Fire)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 12/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
ANSWER KEY: Clinical Chemistry
1. A
2. A
3. C
4. C
5. D
6. D
7. D
8. B
9. C
10. A
11. B
12. C
13. D
14. D
15. B
16. A
17. D
18. D
19. B
20. C
21. C
22. A
23. B
24. C
25. D
26. D
27. B
28. A
29. C
30. C
31. D
32. A
33. B
34. A
35. C
36. A
37. D
38. C
39. D
40. A
41. B
42. D
43. B
44. C
45. D
46. C
47. A
48. A
49. C
50. D
51. A
52. D
53. C
54. B
55. D
56. B
57. C
58. C
59. C
60. D
61. B
62. D
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 13/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
63. A
64. C
65. C
66. A
67. A
68. B
69. A
70. C
71. D
72. D
73. A
74. C
75. D
76. A
77. B
78. A
79. B
80. C
81. B
82. D
83. B
84. B
85. A
86. B
87. D
88. C
89. B
90. B
91. C
92. C
93. D
94. C
95. A
96. C
97. C
98. C
99. B
100. D
Medical Technology Board Exam Medical Technology Board Medical Technology Board
Reviewer HEMATOLOGY Examination Review Notes on Examination Review Notes
JULY 04, 2019 Parasitology Recall 3
JULY 05, 2018 JULY 04, 2018
July (34)
Medical Technology Board Examination Review Notes
Recalls
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 14/15
1/7/23, 5:50 PM Medical Technology Board Examination Review Notes on Clinical Chemistry 2 - Students Lessons and Examinations
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-clinical-chemistry.html 15/15
CLINICAL CHEMISTRY MCQs
A. CARBOHYDRATES
_____1. Hypoglycemia comes about for various reasons and clinical symptoms usually
occur at blood glucose concentrations:
A. <3.8mmol/L B. < 3.0mmol/L C. <2.8mmol/L D. <5.0mmol/L
_____2. The healthy organism maintains the extracellular glucose concentration
remarkably constant within the limits of:
A. 5-12mmol/L C. 2.8- 3.8mmol/L
B. 3.3 – 10mmol/L D. 1.2- 2.4 mmol/L
_____3. Which classification of diabetes mellitus is genetically predetermined, HLA-
associated, chronic autoimmune disease with insulin deficiency and glucagons
excess as its pathophysiologic sequelae?
A. Type I C. non-obese type II
B. obese type II D. MODY-maturity onset diabetes of the young
_____4. According to the WHO criteria, patients with type I diabetes mellitus are, at the
time of diagnosis, characterized by:
1. hyperglycemia 2. ketonuria 3. ketoacidosis 4. normal weight
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____5. In diabetic patient, this provides information about the average blood glucose
concentration during the preceding 6-8 weeks:
A. HbA1c C. HbB
B. HbF D. HbS
_____6. This term describes the disturbed insulin effect on cells such as adipocytes,
skeletal muscle cells, and hepatocytes. In simplified terms, glucose uptake by
these insulin-dependent cells is reduced. As compensdation, a rise in insulin
secretion with hyperinsulinemia ensues.
A. progressive hyperglycemia C. insulin resistance
B. impaired glucose tolerance D. glucose-mediated insulin secretion
_____7. Diabetes mellitus secondary to certain and other diseases and disorders may
involve the following organs:
1. pancreas 2. liver 3. anterior pituitary 4. adrenal gland
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____8. In the case of gestational diabetes mellitus, a normal diurnal glucose profile
performed on the 3rd to 4th postpartum day rules out persistent diabetes mellitus.
In women with macrosomic children, the diurnal glucose profile does not
become valuable as an indicator until how many weeks after delivery?
A. 3 weeks B. 6 weeks C. 9 weeks D. 12 weeks
_____9. The determination of glucose tolerance following the oral administration of
glucose is recommended as a screening test for the presence of underlying
gestational diabetes mellitus. How much gram of glucose is recommended in
this tolerance test?
A. 50 grams B. 75 grams C. 100 grams D. 120 grams
____10. Which of the following statements is true in screening tests for diabetes
mellitus?
A. The European Association for the Study of Diabetes recommends to
perform the Oral glucose tolerance test using 75g of glucose with 3 capillary
blood collections.
B. The European Association for the Study of Diabetes recommends to
perform the Oral glucose tolerance test using 100g of glucose with 4
capillary blood collections.
C. In the USA the oral glucose tolerance test is performed using 100g of
glucose with 3 venipuntures.
D. In the USA the oral glucose tolerance test is performed using 75g of glucose
with 4 venipuntures.
_____11. Which chromosome number is associated with non-HLA genes type 1 diabetes
mellitus?
A. 9 B. 11 C. 15 D. 17
_____12. Which of the following clinical laboratory tests are used for detecting the risk
of complications in newborns born to mothers with gestational diabetes or type
1 diabetes mellitus?
1. glucose 2. hematocrit 3. bilirubin 4. calcium
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____13. Which of the following glucose concentrations denote plasma insulin
concentration as almost zero?
A. 20 mg/dL B. 40 mg/dL C. 60 mg/dL D. 80mg/dL
_____14. What enzyme catalyzes the oxidation of glucose into gluconic acid and H2O2?
A. glucose oxidase C. glucose hexokinase
B. glucose dehydrogenase D. mutarotase
_____15. What enzyme catalyzes the oxidation of glucose to glucolactone?
A. glucose oxidase C. glucose hexokinase
B. glucose dehydrogenase D. mutarotase
_____73. Which of the following anticoagulants may cause falsely reduced alpha1
antitrypsin concentrations in the case of determination by means of radial
immunodiffusion?
1. buffered citrate 3. EDTA
2. potassium oxalate 4. heparin
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____74. The Kjeldahl procedure for total protein is based upon the premise that:
A. proteins are negatively charged
B. the pK of proteins is the same
C. the nitrogen content of proteins is constant
D. proteins have similar tyrosine and tryptophan content
_____75. All of the following statements about total protein assays are true, except?
A. refractive index of serum correlates with total protein, but is falsely high in
uremia
B. the Folin-Lowry assay is subject to interference from nonprotein reductants
C. Turbidimetric assays are subject to positive interference from many drugs
D. Direct UV methods are based on the absorbance of peptide bonds at
254nm.
_____76. Hyperalbuminemia is caused by:
A. dehydration syndromes
B. Liver disease
C. Burns
D. Gastroenteropathy
_____77. The term biuret reaction refers to:
A. the reaction of phenolic groups with CuSO4
B. coordinate bonds between Cu and carboxyl and amino groups of biuret
C. the protein error of indicator effect producing color when dyes bind protein
D. the reaction of phosphomolybdic acid with protein.
_____78. Which protein is an acute phase protein and a transport protein. Its function is
to transport intravascular, free hemoglobin to its degradation site in the
reticulo-endothelial system?
A. haptoglobin C. hemopexin
B. ceruloplasmin D. ferritin
_____79. Which protein is important for the estimation of extent of intravascular
hemolysis if serum haptoglobin shows to nonmeasurable levels?
A. hemoglobin C. hemopexin
B. ceruloplasmin D. ferritin
_____80. Which of the following is true about ceruloplasmin?
1. transport copper in plasma
2. deficiency is associated with Wilson’s disease
3. contains about 9% carbohydrate
4. synthesized in the liver
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
CLINICAL ENZYMOLOGY
_____96. Which of the following enzymes has the longest half-life?
A. CK-MM B. ALP C. Lipase D. LD5
_____97. Which of the following CK isoenzymes has the longest half-life?
A. CK-MM B. CK-MB C. CK-BB D. CK4
_____98. In enzymology, one international unit is the quantity of enzyme which
catalyzes one micromole of substrate per minute. The catalytic enzyme
activity of a sample is expressed in:
A. Units per liter C. kilounits per liter
B. Milliunits per liter D. all of these
______99. Type 1 macroenzymes have been described for the following diagnostically
relevant enzymes, except:
1. ALT 2. ALP 3. ACP 4. AST
_____120. Which of the following methods are used for ACE measurement?
1. Liberman 2. Neels 3. Ryan 4. Silverstein
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____121. Which of the following substrates are used in ACE measurement?
1. Benzoylglycine 3. Furylacrylic acid
2. Hippuryl-histidyl-lecuine 4. Benzoyl-glycyl-glycine
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____122. An increased ACE activity is seen in:
A. Sarcoidosis C. Endothelial dysfunction
B. Toxic lung damage D. Hypothyroidism
_____123. Which of the following can reduce/inhibit ACE activity?
1. EDTA 2. Captopril 3. Enalapril 4. Zinc chelators
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____124. What is the EC number of AST?
A. 2.6.1.1 B. 2.6.1.2 C. 3.1.1.7 D. 3.1.1.6
_____125. De Ritis ratio for differentiation between mild liver damage and severe liver
disease is:
A. GGT/AST B. AST/ALT C. AST/LD D. LD/GGT
_____126. This ratio is used as indicator of cholestasis and alcoholic liver damage.
A. GGT/AST B. AST/ALT C. AST/LD D. LD/GGT
_____127. Which of the following methods are used for cholinesterase determination?
1. Inhibition test with dibucaine 3. Ro 2-0683
2. Determination of fluoride number 4. Photometric rate assay
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____128. Which of the following chemicals is/are associated with decrease in
cholinesterase activity?
A. Muscle relaxants C. Carbamate esters
B. Organophosphate esters D. all of these
_____129. Determination of acylcholine acylhydrolase for evaluation of liver function is
usually performed using what substrate?
A. Glycine C. choline
B. Phosphate D. nitroanilide
_____130. CK catalyzes the reversible transfer of the phosphate group from creatine
phosphate to Mg-ADP. The resulting Mg-ATP is determined in a combined
optical test using what as coenzyme?
A. Glucose-6-phosphate dehydrogenase C. Hexokinase
B. Oxidase D. Adenylate kinase
_____131. A CK-MB fraction of more than 6% of the total CK activity is regarded as
diagnostic for:
A. Myocardial infarction C. Skeletal muscle damage
B. Muscular dystrophy D. Secondary myopathies
_____132. Which of the following findings can indicate the presence of macro CK?
A. Elevated total CK with a CK-MB fraction >25%
B. Elevated total CK with a CK-BB fraction >6%
C. Elevated total CK with a CK-MM fraction >5%
D. Elevated total CK with a CK-MiMi fraction >10%
_____133. The variant of CK with higher molecular mass formed when CK is bound by
specific immunoglobulins:
A. Macro CK type 1 C. CK-MiMi
B. Macro CK type 2 D. CK-MT or CKMito
_____134. Which enzyme is specific for liver and bile duct and an increase of this
enzyme is considered as one of the most sensitive indicators of hepatobiliary
disease?
A. Cholinesterase C. CK
B. GGT D. AST
_____135. Differentiation between jaundice of hepatic or cholestatic origin can be based
on ALT activity and the:
A. AST/ALT ratio C. GGT/ALT ratio
B. GGT/AST ratio D. ALT/ALP ratio
_____136. Which enzyme is used with aminotransferases and mean cellular volume of
erythrocytes as indicators of excessive alcohol consumption?
A. Cholinesterase C. GLD
B. GGT D. AST
_____137. Which of the following anticoagulants may lead to falsely low GGT activity?
1. Citrate 2. Oxalate 3. Flouride 4. Heparin
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____138. This is the only enzyme which cleaves significant amount of gluthathione.
A. Cholinesterase C. GLD
B. GGT D. AST
_____139. A (ALT + AST)/GLD ratio of <20 is seen in:
1. Obstructive jaundice 3. Metastatic liver disease
2. Biliary cirrhosis 4. Acute hypoxic liver damage
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____140. A (ALT + AST)/GLD ratio of >50 is seen in:
1. Acute episodes of chronic liver diseases
2. Acute viral hepatitis
3. Cholestatic hepatic diseases
4. Acute alcoholic hepatitis
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____141. These reagents can be added to the LD assay mixture as a selective inhibitor
of the LD isoenzymes containing M sub-units so that only LD-1, which is
composed of four H units, is measured.
1. Nitroanilide 3. Ro-0683
2. 1,6 hexanediol 4. Sodium perchlorate
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____142. Which LD isoenzyme has the highest migration rate?
A. LD1 B. LD2 C. LD4 D. LD5
_____143. In agarose gel, this Ld isoenzyme migrates to the cathode:
A. LD1 B. LD2 C. LD4 D. LD5
_____144. In cellulose acetate electrophoresis the LD isoenzyme fractions are made
visible by coupling the enzymatically formed pyruvate with:
A. NAD C. tetrazolium salt
B. NADH D. Sodium perchlorate
_____145. This ratio is used to differentiate between prehepatic jaundice caused by
hemolysis or dyserythropoiesis from hepatic jaundice.
A. ALT/AST ratio C. LD/CK ratio
B. LD/AST ratio D. CK/AST ration
_____146. Anodic LD isoenzyme pattern is associated with:
1. Muscular dystrophy 3. Renal infarction
2. Germ cell tumor 4. Cardiac muscle damage
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____147. Which anticoagulant should not be used in LD assay?
A. Oxalate B. Flouride C. both D. neither
_____148. Which of the following conditions can falsely increase LD measurement?
A. Blood sample collection after exercise
B. Use of capillary serum
C. Use of hemolyzed samples
D. All of these
_____149. At a mean activity of 165U/L, hemolysis of 0.8g hb/L leads to an LD increase
of:
A. 36% B. 58% C. 360% D. 12%
_____150. Which of the following Ld isoenzymes is not seen mainly in Duchenne
muscular dystrophy?
A. LD1 B. LD2 C. LD3 D. LD5
_____151. The most reliable method for lipase determination is the kinetic, automatic
titration of oleic acid released from an emulsion of triolein or pure olive oil
by enzymatic hydrolysis with sodium hydroxide at what pH?
A. 8.6 B. 6.5 C. 9.0 D. 8.4
_____152. As ACP is released from erythrocytes, a hemoglobin concentration of 3.4g/L
in serum may increase ACP by:
A. 50% B. 40% C. 30% D. 20%
_____153. ACP is unstable at pH above 7.0 and the pH of plasma or serum is adjusted to
4-5 by the addition of:
A. 10% acetic acid(20uL/mL) C. both
B. Sodium bisulfate 5mg/mL serum D. neither
_____154. Which of the following diseases are associated with elevations of ACP in
serum?
1. Prostatic carcinoma 3. Paget’s disease
2. Multiple myeloma 4. Gaucher’s disease
A. only 1 and 3 are correct C. only 1,2, and 3 are correct
B. only 2 and 4 are correct D. 1,2,3 and 4 are correct
_____155. Without acidification, ACP activity is decreased up to:
A. 20% in 3h C. 50% in 2h
B. 20% in 2h D. 5% in 2 h
_____156. This protein participates in the uptake and the intracellular transport of the
long-chain fatty acids in the cardiomyocytes.
A. Cardiac troponin (cTnT) C. myoglobin
B. Heart fatty acid binding protein(H-FABP) D. natriuretic peptide
_____157. This myofibrillar protein of the heart muscle is released from the myocardium
following injury and is used in the late diagnosis and monitoring of the
course of acute myocardial infarction.
A. Cardiac troponin (cTnT) C. myoglobin
B. Heart fatty acid binding protein(H-FABP) D. natriuretic peptide
_____158. This is a specific cardiospecific marker used to assess chronic or subacute
graft rejection after heart transplantation.
A. Cardiac troponin (cTnT)
B. cardiac troponin I (cTnI)
C. Heart fatty acid binding protein(H-FABP)
D. glycoprotein phosphorylase isoenzyme BB (GPBB)
_____159. This is highly sensitive to ischemia of cardiomyocytes so that the clinical
sensitivity of its measurement for diagnosing an acute coronary syndrome is
higher than that of other cardiac markers.
A. Cardiac troponin (cTnT)
B. cardiac troponin I (cTnI)
C. Heart fatty acid binding protein(H-FABP)
D. glycoprotein phosphorylase isoenzyme BB (GPBB)
______160. This is the most important natriuretic peptide of the ventricles and it is a
more sensitive and more specific indicator of ventricular overload.
A. Atrial natriuretic peptide C. brain natriuretic peptide
B. Cyclic guanosine monophosphate D. CNP
BILIRUBIN
ELECTROLYTES
_____181. Which of the following statements about serum calcium is not correct?
A. Free or ionized calcium accounts for 50% of total calcium
B. Protein bound calcium most of which is bound to globulins with only
small portion bound to albumin.
C. Complex-bound calcium is bound to phosphates, citrate and
bicarbonate.
D. The protein-bound calcium accounts for 45% of the total calcium.
_____182. Acidosis or a pH decrease, after the blood sample has been collected, causes a
rise in ionized calcium because of the metabolic activity of the blood cells, a
pH decrease by 0.1 leads to a reciprocal increase of ionized calcium by
approximately:
A. 0.05mmol/L C. 0.15mmol/L
B. 0.10mmol/L D. 0.20mmol/L
_____183. Alkalosis or a rise in pH, after the blood collection, causes a decrease in
ionized calcium due to the elimination of:
A. Oxygen C. Carbon dioxide
B. Hydrogen D. Chloride
_____184. This term refers to a state with serum total calcium concentration of typically
>14 mg/dL that is associated with symptoms such as volume depletion,
metabolic encephalopathy and gastrointestinal symptoms. As soon as the
hypercalcemia has been eliminated, the symptoms disappear.
A. Primary hyperparathyroidism
B. familial hypocalcemuric hypercalcemia
C. hypercalcemic crisis
D. Milk-alkali syndrome
_____185. Pseudohypoparathyroidism represents a group of states with end-organ
resistance to PTH. Which of the following statements about
pseudohypoparathyroidism is not correct?
A. In type 1a, the gene that encodes the G protein is defective
B. In type 1b, the PTH receptor is defective.
C. In type 2, the urinary excretion of cAMP is increased in these patients.
D. Type 1 is characterized by a defect at a locus before the synthesis of
cAMP while type 2 is associated with a defect at a locus beyond the
synthesis of cAMP.
_____186. Which of the following diseases may cause hypercalcemia?
A. Liver cirrhosis C. chornic renal failure
B. Addison’s disease D. acute pancreatitis
_____187. Which of the following diseases may cause hypocalcemia?
A. Pseudohypoparathyroidism C. Sarcoidosis
B. Multiple myeloma D. Primary hyperparathyroidism
_____188. Which formula is correct when adjusting total calcium if the albumin
concentration is 4g/dL?
A. Corrected calcium(mg/dL) = measured Ca (mg/dL)-albumin(g/dL) + 4.0
B. Corrected calcium(mg/dL) = albumin(g/dL) - measured Ca (mg/dL) + 4.0
C. Corrected calcium(mg/dL) = measured Ca (mg/dL)+albumin(g/dL) / 4.0
D. Corrected calcium(mg/dL) = measured Ca (mg/dL)-albumin(g/dL) / 4.0
_____189. How much increase in total calcium is anticipated in the case of a change
from supine to a standing position?
A. 4.6% B. 1.7% C. 12% D. 5.4%
_____190. How much increase in ionized calcium is anticipated in the case of a change
from supine to a standing position?
A. 4.6% B. 1.7% C. 12% D. 5.4%
_____191. Which of the following enzymes are used for phosphate measurement?
1. Purine-nucleoside phosphorylase 3. Sucrose phosphorylase
2. Xanthine oxidase 4. Phosphoglucomutase
BLOOD GASES
_____221. This parameter is defined as the amount of strong acid or strong base needed
to titrate extracellular fluid to pH 7.4 at a pCO2 of 40mmHg and at 37C.
A. Standard bicarbonate C. Base excess
B. cHCO3 D. anion gap
_____222.
1. Incorrect statement about naturally occurring c. Doa, Dob
antibodies d. Bga, Bgb, Bgc
a. React best in saline
b. React best at room temperature or at 8. Which of the following does not belong to the
40C high titer low avidity antibodies?
c. They are usually IgG a. Anti-Ch
d. Do not usually cross the placenta b. Anti-Yka
c. Anti-Co
2. Which antibody is most likely to be involved d. Anti-JMH
in hemolytic disease of the Newborn?
a. anti-E 9. Incorrect statement about Kell blood group
b. AntiLea a. 90% of the population is kell negative
c. Anti-M b. Anti-K reacts best in saline at room
d. Anti-Jsa temperature
c. Anti-K can cause hemolytic disease of
3. What blood type is not possible for an the newborn
offspring of AO and BO persons? d. Next to Rh (D), the Kell (K) antigen is
a. AB the most immunogenic
b. A or B
c. O
d. All are possible 10. Adults who have the Le, Se, and H genes will
exhibit which Lewis antigen on their red
4. Nature of ABO antibodies cells?
a. IgM a. Lea
b. IgG and IgM b. Leb
c. IgA c. Lea and Leb
d. IgG, IgM, and IgA d. None
5. Waldenstrom’s macroglobulinemia, multiple 11. Given the following reactions, identify the
myeloma, and increased levels of fibrinogen cause of discrepancy:
is associated with what ABO discrepancy? Cell typing: Serum typing:
a. Group I Anti-A = 4+ A1 cells = 0
b. Group II Anti-B = 2+ B cells = 4+
c. Group III a. Hypogammaglobulinemia
d. Group IV b. Hodkin’s lymphoma
c. Cold agglutinins
6. In which of the following blood group systems d. Acquired B phenomenon
may the RBC typing change during
pregnancy? 12. Which of the following is a contraindication
a. Kidd for accepting a donor for plateletpheresis?
b. Lewis a. 72 hours since the last apheresis
c. MNS b. Plasmapheresis of 800mL 1 week ago
d. Kell c. Platelet count of 100 x 109/L
d. Aspirin ingestion 7 days ago
7. Which of the following are the RBC
equivalents of human leukocyte antigens 13. Which of the following donors could be
(HLA)? accepted for blood donation?
a. Kpa, Kpb, Kpc a. 18 y.o. woman with a hematocrit
b. Jsa, Jsb value of 38%
b. 45 y.o. man with a BP of 180/100 19. Cryoprecipitated antihemophilic factor is not
c. 60 y.o. Man with history of Babesiosis recommended for the treatment of:
d. 30 y.o. man who had been vaccinated a. Hemophilia A
for rabies 6 months ago b. VWD
c. Hemophilia B
14. All of the following donors can be accepted d. Hypofibrinogenemia
for donating blood EXCEPT:
a. 30 y.o. Female who had a rubella 20. What is the purpose of adding a rejuvenating
vaccination 6 weeks ago solution to RBC products?
b. 20 y.o. Male with a body temperature of a. To restore ATP and 2,3-DPG
99.4 F b. To stabilize RBC membrane
c. 50 y.o. Man with night sweats and c. To prevent lysis of RBCs during storage
skin lesions at cold temperature
d. 45 y.o. Woman who was a recipient of d. TO increase the harvest of WBCs
recombinant growth hormone
21. Prothrombin complex concentrates are used
15. A man turns pale and complains of dizziness to treat which of the following?
while donating blood. What is the best course a. Hemophilia A
of action? b. Hemophilia B
a. Continue the donation c. Hemophilia C
b. Withdraw the needle, raise his feet, d. VWD
and administer ammonia spirits 22. What is the purpose of adding citric acid to
c. Discontinue the donation and provide a blood bag preservatives?
paper bag a. To prevent coagulation
d. Tell him to sit upright and not have a b. TO restore ATP levels
reaction until the donation is finished c. TO improve survival of red cells
d. To prevent caramelization
16. What would be the cause of jet-like pulsating
bleeding with bright red blood during 23. Fresh frozen plasma stored at -65 C would
donation? have a shelf life of
a. Increased vacuum from the blood bag a. 1 year
b. The donor is hypertensive b. 5 years
c. Brachial artery was punctured c. 7 years
d. The donor is a chronic smoker d. 10 years
17. Red Blood Cells stored in CPDA-2 blood bag 24. Each unit of cryoprecipitate prepared from
would have a shelf-life of: whole blood should contain approximately
a. 21 days how many units of factor VIII
b. 35 days a. 40
c. 2 days b. 80
d. 42 days c. 150
d. 200
18. What is the proper storage protocol for
granulocyte concentrates? 25. Quality control for RBCs requires a maximum
a. 1-6 C hematocrit level of:
b. -18 C a. 75%
c. Room temperature with agitation b. 80%
d. Room temperature without agitation c. 85%
d. 90%
d. 1,2,3, and 4
26. Cryoprecipitate that has been thawed must
be transfused within 32. Hepatitis B virus remains infectious on
a. 6 hours environmental surfaces for:
b. 8 hours a. 7 days
c. 4 hours b. 1 month
d. 24 hours c. 1 year
d. 3 days
27. Platelets prepared from a whole blood
donation require which of the following? 33. HBV is transmitted most frequently
a. A light spin followed by a heavy spin a. By unknown methods
b. Two light spins b. Through blood transfusion
c. A hard spin followed by a light spin c. By needle sharing among IV drug
d. Two heavy spins abusers
d. By sexual activity
28. A single unit of granulocyte concentrate
should contain at least ____ WBCs 34. Which of the following blood-borne
a. 1.0 x 109 pathogens is destroyed under prolonged cold
b. 1.0 x 1010 temperature storage
c. 3.0 x 1011 a. Babesia microti
d. 3.5 x 1010 b. Trypanosoma cruzi
c. Treponema pallidum
29. Which of the following antibodies is most d. Plasmodium falciparum
responsible for immediate hemolytic
transfusion reactions? 35. What procedure would help to distinguish
a. ANti-N between an anti-C and anti-Fyb in an
b. Anti-D antibody mixture?
c. Anti-B a. Use a thiol reagent
d. Anti-Leb b. Run an enzyme panel
c. Lower the pH of test serum
30. When a suspected hemolytic transfusion d. Run a regular panel
reaction occurs, the first thing to do is
a. Slow the transfusion rate and call the 36. What samples are required to perform
physician compatibility testing?
b. Administer medication to stop the a. Patient serum and donor serum
erection b. Patient serum and donor cells
c. First inform the laboratory to begin an c. Donor serum and patient cells
investigation d. Donor cells and patients cells
d. Stop the transfusion but keep the
intravenous line open with saline 37. What is the minimum testing required for a
massively transfused patient?
31. Transfusion reactions can be caused by: a. Immediate spin crossmatch or
(1) Overheated donor blood forward typing ABO
(2) Bacterial contamination b. ABO, Rh, Corssmatch
(3) Hypokalemia c. ABO, forward and reverse typing
(4) Citrate toxicity d. Antibody screen and ABO typing
a. 1,2 and 4
b. 2,3, and 4 38. What is the major advantage of gel
c. 1,3, and 4 technology
a. No cell washing steps b. Wash cells with 0.6N HCl
b. Specialized equipments c. Obtain another cord sample
c. Standardization d. Test cells using saline typing reagents
d. Use of IgG_coated control cells
45. Cold AIHA is sometimes associated with
39. The purpose of immediate spin crossmatch is infection by:
a. To ensure survival of transfused RBCs a. S. aureus
b. To determine ABO compatibility b. M. pneumoniae
between donor and recipient c. E. coli
c. Detect cold-reacting unexpected d. S. pyogenes
antibodies
d. Meet computer crossmatch 46. CEphalosporin given in massive doses has
requirements been associated with RBC hemolysis. Which
of the classic mechanisms is involved in the
40. Blood donor and recipient samples used in hemolytic process?
cross matching must be stored for a minimum a. Membrane modification
of how many days following transfusion? b. Drug adsorption
a. 2 c. Immune complex formation
b. 5 d. Autoantibody Formation
c. 7
d. 10 47. Backup copies of the information system:
a. Can be used to restore the
41. After the addition of IgG-coated RBC to a information system data and software
negative AHG reaction during an antibody b. Are used to maintain hardware
screen, a negative result is observed. Which components
of the following is a correct interpretation? c. Are performed once a month
a. The antibody screen is negative d. Are created any time changed are made
b. Reactive AHG reagent was added to the system
c. The saline washings were adequate 48. User passwords should be:
d. AHG reagent was neutralized a. Shared with others
b. Never changed
42. RBCs must be washed in saline at least three c. Kept confidential
times before the addition of AHG reagent to: d. Posted at each terminal
a. Wash away any hemolyzed cells
b. Neutralize any excess AHG reagent 49. All of the following items should be checked
c. Increase the antibody binding to antigen quarterly EXCEPT
d. Remove traces of free serum a. Cell washers
globulins b. CEntrifuge timers
c. Blood warmers
43. Blood for intrauterine transfusion should be d. Platelet incubators
all of the following EXCEPT:
a. Compatible with maternal serum 50. What is the principle involved in the gel
b. Screened for CMV technology
c. Gamma-irradiated a. Hemadsorption
d. More than 7 days old b. Hemagglutination-inhibition
c. Hemagglutination
44. What should be done if Wharton’s jelly d. Precipitation
cannot be removed from cord cells?
a. Collect a heel stick sample
51. Which of these match(es) is/are correct?
(1) Karl Landsteiner - ABO group 58. What is the major component of natural
(2) Elie Metchnikoff - Phagocytosis humoral immunity?
(3) Rosalyn Yallow - ELISA a. Immunoglobulins
(4) Jules Bordet - COmplement fixation b. Complement
a. 1,2,3 c. B cells
b. 1,2,4 d. Cytokines
c. 2,3,4
d. 1,2,3,4 59. Interferon can be produced by which of the
following?
52. When was the T cell receptor gene (1) Macrophages
discovered? (2) T lymphocytes
a. 1979 (3) Virus-infected cells
b. 1987 a. 1,2
c. 1984 b. 1,3
d. 1981 c. 2,3
d. 1,2,3
53. Cytokine produced mainly by macrophages: 60. Which of the following IgG subclasses does
a. IL-1 not cross the placenta?
b. IL-2 a. IgG1
c. IL-6 b. IgG2
d. IL-23 c. IgG3
d. IgG4
54. It is a non-specific indicator of inflammation
believed to be an antibody to the 61. What is the major amino acid component of
C-polysaccharide of pneumococci: the hinge region of an IG molecule?
a. Alpha-antitrypsin a. Lysine
b. C-reactive protein b. GLutamine
c. Serum amyloid A c. Proline
d. Ceruoplasmin d. Tryptophan
55. Acquired immunodeficiency syndrome (AIDS) 62. What region determines the immunoglobulin
shows a change in the ratio of: class?
a. T/B cells a. Fc
b. B1/B2 cells b. CH
c. Albumin/Globulin c. VL
d. CD4+/CD8+ d. CL
57. T cells are involved in: 64. How are cytotoxic T cells and NK cells
a. Humoral immunity similar?
b. Wheal and flare reaction a. Effective against virally infected cells
c. Cell-mediated immunity b. Recognize antigen in association with
d. Antibody production HLA class II markers
c. Do not bind to infected cells a. Haptens
d. Require antibody to be present b. Mitogens
c. Adjuvants
65. Which immunology cross-links mast cells to d. Immunogens
release histamine?
a. IgG 72. The alternative pathway of the complement
b. IgM cascade is initiated by:
c. IgE (1) IgG and IGM
d. IgA (2) Aggregates of IgA
(3) Yeast cell wall
66. Humoral immunity is due to: (4) Mannose group
a. Macrophage activity (5) Lipopolysaccharides
b. Suppressor T lymphocytes (6) CObra venom factor
c. B lymphocytes that transform into
plasma cells a. 1,2,3
d. Lymphokines b. 2,3,5,6
c. 3,4,5,6
67. The predominant antibody in an anamnestic d. 1,3,4,5
response is:
a. IgG 73. Deficiency of C3 complement component is
b. IgM associated with:
c. IgA a. Paroxysmal nocturnal hemoglobinuria
d. IgD b. Hereditary angioneurotic edema
c. Gonococcal or meningococcal infection
68. The binding strength of an antibody for an d. Severe recurrent bacterial infection
antigen is referred to as its:
a. SPecificity 74. Fetus in a mother’s womb is considered a/an:
b. Affinity a. Allograft
c. Avidity b. Autograft
d. Titer c. Heterograft
d. Syngeneic graft
69. THe HLA complex is located primarily on
chromosome 75. HLA-B27 is most commonly associated with:
a. 3 a. Systemic lupus erythematosus
b. 6 b. Rheumatoid arthritis
c. 9 c. Ankylosing spondylitis
d. 17 d. Graves’ disease
70. For an antibody-coated antigen to be 76. If the interval between heating the serum for
phagocytized, what part of the antibody the VDRL test and testing exceeds 4 hours,
molecule fits into a receptor on the the serum should be reheated at:
phagocytic cell? a. 37 C for 30 mins
a. Fab region b. 37 C for 10 mins
b. Hinge region c. 56 C for 30 mins
c. Variable region d. 56 C for 10 mins
d. Fc region
77. Patients with syphilis develop an antibody
71. These are substances added to a vaccine to response to a substance known as:
enhance the immune response: a. Reagin
b. Complement 84. Among the following congenital infections,
c. Cardiolipin which one is the most common?
d. Hemolysin a. Congenital syphilis
b. Rubella infection
78. The fluorescein-anti human gamma globulin c. Cytomegalovirus
used in the FTA-ABS test: d. Herpes virus infection
a. Makes the antigen-antibody reaction
visible 85. In the exoantigen test for Histoplasma
b. Is added to the serum before the capsulatum, which bands are present in a
antigen is added positive result?
c. Is added to the antigen before the a. A
serum is added b. H and/or M
d. Makes the Ab visible c. 1,2,3
d. HS, HL, F
79. The reactions on DNA-methyl green
substrates when testing for the presence of 86. If only anti-Hbs is positive, which of the
anti-DNase are: following can be ruled out?
a. (+) blue, (-) yellow a. HBV vaccination
b. (+) red, (-) orange b. Distant past infection with HBV
c. (+) Green, (-) colorless c. HBIG injection
d. (+) purple, (-) yellow d. Chronic HBV infection
80. The widal and weil-felix reactions are 87. This test will detect parasitic lactate
examples of techniques to detect: dehydrogenase enzyme present in malarial
a. Heterophile antibodies organisms:
b. Febrile agglutinins a. Optimal
c. Reagin b. Malaquick
d. Forssman antigen c. Monospot
d. Streptozyme
81. Forssman antibodies are adsorbed by:
a. Beef erythrocytes 88. Which is most likely a positive Western blot
b. Guinea pig kidney cells result for infection with HIV
c. Both a. BAnd at p24
d. Neither b. Bands at gp160
c. Bands at p24 and p31
82. What is the first antibody to be produced in a d. Band at p24
patient with hepatitis B virus infection?
a. Anti-Hbs 89. Which disease might be indicated by
b. Total anti-Hbs antibodies to smooth muscle?
c. IgM anti-HBc a. Myasthenia gravis
d. Anti-HBe b. Primary biliary cirrhosis
c. Chronic active hepatitis
83. What is the first antibody to be produced in a d. Hashimoto’s thyroiditis
patient with HIV infection?
a. Antibody to p24 90. Which immunofluorescence pattern indicates
b. Antibody to gp41 the need for further testing by Ouchterlony
c. Antibody to gp120 double diffusion?
d. Antibody to p15 a. Solid
b. Mottled
c. Rim d. weekly
d. Nucleolar
91. What disease is indicated by a high titer of 97. When preparing monoclonal antibodies
anti-centromere antibodies? a. Inject an animal with an antigen
a. Scleroderma b. Fuse B lymphocytes with a malignant
b. Sclerodactyly cell
c. MCTD c. Remove the B lymphocytes
d. SLE d. All of the above
92. Which of the following is a sialylated Lewis 98. The air temperature throughout the serology
blood group antigen associated with laboratory is 20 C. How will this affect RPR
colorectal carcinoma? test results?
a. Ca 19-9 a. No effect - the acceptable test range is
b. CEA 20-24 C
c. Ca 549 b. Weaken reactions so that false
d. Ca 15-3 negatives occur
c. Strengthen reaction reactions so that
93. Associated with increased serum positive titers appear elevated
alpha1-fetoprotein level d. Increase the number of false positives
(1) testicular cancer from spontaneous clumping
(2) Hepatocellular carcinoma
(3) Pancreatic carcinoma 99. A device used to measure radioactivity in
(4) Prostatic carcinoma radioimmunoassay
a. 1,2 a. Spectrophotometer
b. 1,2,3 b. Scintillation counter
c. 3,4 c. Fluorometer
d. 1,2,4 d. None of these
94. Not true regarding hCG 100. Most commonly used label in ELISA
a. Beta subunit confers immunogenic a. HRP
specificity b. FITC
b. Used to confirm pregnancy c. Tritiated hydrogen
c. Used as tumor marker d. G6PD
d. Found in hepatoma
Allotype
13. What is 14. What are 15. What is the difference 16. Are proteins 17. Are oils heat 17. What is the
otherwise known as the 4 phases between the primary and heat stable or stable or labile? ability of a
the subsequent the IgM secondary antibody response labile? particular
exposure to the antibody antibody to
same antigen proceeds to Primary Secondary combine with a
producing a following a Time Shorter Labile Stable particular
memory response foreign lag phase, antigen
antigen longer
Anamnestic challenge plateau, Specificity
response and more
Lag- no antibody gradual
detectable decline
Log- antibody titer Type of IgM IgG
rises logarithmically antibody
Plateau- antibody Antibody Higher
titer stabilizes titer titer
Decline phase –
antibody is
catabolized
18. What is the 19. What is 20. What are the non specific 21. What does it 22. What is 23. What kind of
initial force of the attractive forces generated by the mean when a px is electrophoresis used to lymphocyte
attraction that functional interaction between electron cachectic identify? stimulates B cell
exists between a combining clouds and hydrophobic bonds growth and
single Fab site strength of Presence or absence of differentiation
on an antibody an antibody Van der Waals forces aberrant proteins and (humoral immunity)
molecule and a with its Poor physical state determine when
single epitope or antigen different groups of Helper T (Th) cells
determinant site proteins increase or
on the decrease in serum or
corresponding Avidity urine.
antigen
Affinity
24. What kind of 25. What kind of 26. What are the 4 types of B cell 27. In the immune 28. What Ig is the 29. What Ig is the
lymphocyte functions lymphocyte surface markers? response to foreign principal class of protective antibody
for antibody functions for the lysis proteins, the first antibody in interstitial of the mucosal
production? of virus-infected cells Ig receptor antibody to appear fluids? surfaces?
Fc receptor is?
B cells NK (Natural killer) Receptors that bind fragments of IgG IgA
cells the cleaved complement IgM
component C3
B cell surface antigens coded by
the MHC Class II
30. Name the four 31. Also known as 32. Most commonly encountered 33. Technical term 34. What transfusion 35. What should be
Treponemal species and Pediatric syphilis type of transfusion reaction for iron overload reaction is often found the ambient
the disease/s related to in patients who are temperature for
each Congenital syphilis Febrile nonhemolytic transfusion Transfusion chronically dependent component
reaction Hemosiderosis on transfunsion separation?
→ T. pallidum
subspecies pallidum Transfusion 20oC to 25oC
▪ Syphilis (STD) Hemosiderosis/Iron
→ T pallidum subspecies overload
pertenue
▪ Yaws (ulcerative skin
lesions)
→ T. pallidum
subspecies endemicum
▪ Endemic syphilis
(bejel) oral mucosa
lesions
→ T. pallidum
subspecies carateum
▪ Pinta (flat red or blue
lesions)
36. What is the 37. When can the 38. What is the shelf-life of fresh 39. What cancer 40. What are the tests 41. What is the
maximum time limit for platelet concentrate frozen plasma? antigen is associated for pre-transfusion reason why you
component separation bag be stored in with pancreatic or compatibility testing? should never let the
from the time of platelet agitators? gastric carcinoma; antigen and
collection? associated with H. ● ABO typing antibody meet?
After leaving it 1 year at -30C pylori; and Lewis ● Rh typing
8 hours undisturbed for one blood group system ● Antibody Screen It will cause
hour ● Crossmatching Intravascular
CA 19.9 Hemolysis (IVH)
42. What is the 43. What blood 44. At which chromosome number 45. What are the 46. What are the
frequency of ABO blood group system is are the ABO genes found? immunodominant enzymes coded by the
groups? associated with the sugars of the A, B, of the A, B, and O
most severe Chromosome 9 and O genes, genes, respectively?
O > A > B > AB hemolytic respectively?
transfusion reaction?
N-acetyl N-acetyl D-
ABO Blood Group galactosamine galactosaminyl
transferase
Hindawi Open
POPULAR
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 1/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
6. In which of the following blood group systems may the RBC typing change
during pregnancy?
a. Kidd
b. Lewis
c. MNS
d. Kell
8. Which of the following does not belong to the high titer low avidity
antibodies?
a. Anti-Ch
b. Anti-Yka
c. Anti-Co
d. Anti-JMH
10. Adults who have the Le, Se, and H genes will exhibit which Lewis
antigen on their red cells?
a. Lea
b. Leb
c. Lea and Leb
d. None
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 2/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
a. Hypogammaglobulinemia LABELS
b. Hodgkin’s lymphoma
c. Cold agglutinins PROFESSIONAL REGULATION COMMISSION
d. Acquired B phenomenon (470)
BOARD PASSERS (145)
12. Which of the following is a contraindication for accepting a donor for DEFENSIVE DRIVING (132)
b. 45-year old man with a blood pressure of 180/100 TOP PERFORMING SCHOOLS (87)
c. 60-year old man with history of Babesiosis
HUNTING (83) HUNTING IN LABRADOR (83)
d. 30-year old man who had been vaccinated for rabies 6 months ago
ENTERPRISE RESOURCE PLANNING SOFTWARE
(77)
14. All of the following donors can be accepted for donating blood EXCEPT: CUSTOMER RELATIONSHIP MANAGEMENT (74)
a. 30-year old female who had a rubella vaccination 6 weeks ago
REMOTE CONTROL (50) RESEARCH (47)
b. 20-year old male with a body temperature of 99.4OF
SOUND SYSTEMS (47) SUBWOOFERS (47)
c. 50-year old man with night sweats and skin lesions
d. 45-year old woman who was a recipient of recombinant growth hormone DEER HUNTING (41)
d. Tell him to sit upright and not have a reaction until the donation PROFESSIONAL TEACHERS (31)
is finished
LAPTOP (31) COYOTE HUNTING (29)
16. What would be the cause of jet-like pulsating bleeding with bright red FISHING (28) DUCT TAPE (25)
18. What is the proper storage protocol for granulocyte concentrates? INTERNET MARKETING (18)
a. 1-6OC
PERSONAL FINANCE (18)
b. -18OC
VIDEO MARKETING (18)
c. Room temperature with agitation
d. Room temperature without agitation DEBT SOLUTION (17) INSURANCE (17)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 3/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
24. Each unit of cryoprecipitate prepared from whole blood should contain COFFEE MAKERS (10)
approximately how many units of factor VIII?
FIFTY SHADES OF GREY (10)
a. 40
b. 80 GUITAR PLAYING (10) GUITARS (10)
27. Platelets prepared from a whole blood donation require which of the (LET)/ Professi...
CRIMINOLOGISTS (8) ARCHITECTS (7)
Air Transport Economics: United Arab
following? Emirates Air ...
ELECTRONICS ENGINEERS (7)
a. A light spin followed by a heavy spin Case Study for Saudi Arabian Airlines
b. Two light spins FISHERIES TECHNOLOGISTS
Management S... (7)
c. A hard spin followed by a light spin Geology Board Examination Review Notes
GEOLOGISTS (7)
1
d. Two heavy spins Medical Technology Board
METALLURGICAL ENGINEERS (7) Examination
Review Notes ...
28. A single unit of granulocyte concentrate should contain at least ____ RADIOLOGIC TECHNOLOGIST
Criminology (7)
Board Examination Review
Notes 3
WBCs CHEMICAL ENGINEERS (7) DRUGS (7)
Criminology Board Examination Review
a. 1.0 x 109
WEIGHTNotes 2
LOSS PROGRAM (7)
b. 1.0 x 1010 Criminology Board Examination Review
c. 3.0 x 1011 Notes 1 (6)
AGRICULTURISTS
Medical Technology Board Examination
d. 5.5 x 1010 DENTISTS (PRACTICAL) (6)
Review Notes ...
Medical
GEODETIC Technology
ENGINEERS (6) Board Examination
29. Which of the following antibodies is most responsible for immediate Review Notes ...
NUTRITIONISTS-DIETITIANS
Medical Technology Board (6) Examination
hemolytic transfusion reactions?
Review Notes ...
a. Anti-N AUTOMOTIVE INDUSTRY (6)
Medical Technology Board Examination
b. Anti-D Review
BREEDING Notes ...(6)
STRATEGIES DECOYS (6)
c. Anti-B Medical Technology Board Examination
Review Notes
HOME MORTGAGE (6) ...
d. Anti-Leb
Medical Technology Board Examination
30. When a suspected hemolytic transfusion reaction occurs, the first thing MECHANICAL DECOYS (6)
Review Notes ...
to do is: Medical
MOTION Technology
DECOYS (6) Board Examination
Review Notes ...
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 4/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
a. Slow the transfusion rate and call the physician Medical
PERSONAL Technology
HEALTH (6) Board Examination
REFINANCING (6)
Review Notes ...
b. Administer medication to stop the reaction SUGAR GLIDERS (6)
Medical Technology Board Examination
c. First inform the laboratory to begin an investigation Review Notes ...
TIPS IN LOSING WEIGHT (6)
d. Stop the transfusion but keep the intravenous line open with saline Medical Technology Board Examination
TIPS INReview Notes ... (6)
SOUND THERAPY
Medical Technology Board Examination
31. Transfusion reactions can be caused by: WEIGHTReview
LOSS (6)
Notes WORDPRESS
... (6)
1. Overheated donor blood 3. Hypokalemia Medical Technology Board
CERTIFIED PLANT MECHANICS (5)Examination
2. Bacterial contamination 4. Citrate toxicity Review Notes ...
a. 1, 2 and 4 Medical
OCULAR Technology Board
PHARMACOLOGISTS (5) Examination
Review Notes ...
b. 2, 3 and 4 RADIOLOGIC TECHNOLOGISTS (5)
Medical Technology Board Examination
c. 1, 3 and 4 Review Notes ...
ADVENTURE (5) BUSINESS (5)
d. 1, 2, 3 and 4 Medical Technology Board Examination
CARIBOUReview Notes
HUNTING (5)... CHEMISTS (5)
Medical Technology Board Examination
32. Hepatitis B virus remains infectious on environmental surfaces for: CIVIL ENGINEERS (5) ... E-COMMERCE (5)
Review Notes
a. 7 days Medical Technology Board Examination
FORESTERS (5) LEGAL (5)
b. 1 month Review Notes ...
LIFE Medical
COACHESTechnology
(5) Board Examination
c. 1 year
Review Notes ...
d. 3 days AERONAUTICAL ENGINEERS (4)
Medical Technology Board Examination
Review Recall...
BUSINESS MANAGEMENT (4)
33. HBV is transmitted most frequently: Medical Technology Board Examination
Review
CERTIFIED PLANTNotes ...
MECHANICS (CPM) (4)
a. By unknown methods
Medical Technology Board Examination
b. Through blood transfusion CUSTOMS BROKERS
Review Notes(4)...
c. By needle sharing among IV drug abusers ► June (43)
LET BOARD EXAM (4)
d. By sexual activity ► May (9)
MARINE ENGINEERS
► March (13) (4)
35. What procedure would help to distinguish between an anti-C and anti-Fyb RESPIRATORY THERAPISTS (4)
in an antibody mixture? DOG TRAINER (4) MIDWIVES (4)
a. Use a thiol reagent
NATURAL MOTION DECOYS (4)
b. Run an enzyme panel
c. Lower the pH of test serum PRESTASHOP (4)
b. Patient serum and donor cells METALLURGICAL ENGINEERS (WES) (3)
c. Donor serum and patient cells
REAL ESTATE CONSULTANTS (3) BIKING (3)
d. Donor cells and patient cells
37. What is the minimum testing required for a massively transfused BIRD HUNTING (3) BUSINESS TIPS (3)
d. Antibody screen and ABO typing MUSIC THERAPY (3) OVERWEIGHT (3)
PERFUME (3)
38. What is the major advantage of gel technology?
a. No cell washing steps SENATE OF THE PHILIPPINES (3)
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 5/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
d. Meet computer crossmatch requirements
40. Blood donor and recipient samples used in crossmatching must be stored
for a minimum of how many days following transfusion?
a. 2
b. 5
c. 7
d. 10
41. After the addition of IgG-coated RBCs to a negative AHG reaction during
an antibody screen, a negative result is observed. Which of the following
is a correct interpretation?
a. The antibody screen is negative
b. Reactive AHG reagent was added
c. The saline washings were adequate
d. AHG reagent was neutralized
42. RBCs must be washed in saline at least three times before the addition
of AHG reagent to:
a. Wash away any hemolyzed cells
b. Neutralize any excess AHG reagent
c. Increase the antibody binding to antigen
d. Remove traces of free serum globulins
46. Cephalosporin given in massive doses has been associated with RBC
hemolysis. Which of the classic mechanisms is involved in the hemolytic
process?
a. Membrane modification
b. Drug adsorption
c. Immune complex formation
d. Autoantibody formation
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 7/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
a. Immunoglobulins
b. Complement
c. B cells
d. Cytokines
59. Interferon can be produced by which of the following?
1. Macrophages 3. Virus-infected cells
2. T lymphocytes 4. All of these
a. 1 and 2 c. 2 and 3
b. 1 and 3 d. 4
60. Which of the following IgG subclasses does not cross the placenta?
a. IgG1
b. IgG2
c. IgG3
d. IgG4
61. What is the major amino acid component of the hinge region of an
immunoglobulin molecule?
a. Lysine
b. Glutamine
c. Proline
d. Tryptophan
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 8/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
b. Affinity
c. Avidity
d. Titer
69. The HLA complex is located primarily on:
a. Chromosome 3
b. Chromosome 6
c. Chromosome 9
d. Chromosome 17
71. These are substances added to a vaccine to enhance the immune response:
a. Haptens
b. Mitogens
c. Adjuvants
d. Immunogens
76. If the interval between heating the serum for the VDRL test and testing
exceeds 4 hours, the serum should be reheated at:
a. 37OC for 30 minutes
b. 37OC for 10 minutes
c. 56OC for 30 minutes
d. 56OC for 10 minutes
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 9/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
b. Complement
c. Cardiolipin
d. Hemolysin
78. The fluorescein-antihuman gamma globulin used in the FTA-ABS test:
a. Makes the antigen-antibody reaction visible
b. Is added to the serum before the antigen is added
c. Is added to the antigen before the serum is added
d. Makes the antibody visible
79. The reactions on DNA-methyl green substrates when testing for the
presence of anti-DNase are:
a. (+) Blue, (-) Yellow
b. (+) Red, (-) Orange
c. (+) Green, (-) Colorless
d. (+) Purple, (-) Yellow
84. Among the following congenital infections, which one is the most
common?
a. Congenital syphilis
b. Rubella infection
c. Cytomegalovirus infection
d. Herpes virus infection
85. In the exoantigen test for Histoplasma capsulatum, which bands are
present in a positive result?
a. A
b. H and/or M
c. 1, 2, 3
d. HS, HL, F
86. If only anti-HBs is positive, which of the following can be ruled out?
a. HBV vaccination
b. Distant past infection with HBV
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 10/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
c. HBIG injection
d. Chronic HBV infection
87. This test will detect parasitic lactate dehydrogenase enzyme present in
malarial organisms:
a. Optimal
b. Malaquick
c. Monospot
d. Streptozyme
88. Which is most likely a positive Western blot result for infection with
HIV?
a. Band at p24
b. Bands at gp160
c. Bands at p24 and p31
d. Band at p24 and gp120
90. Which immunofluorescent pattern indicates the need for further testing
by Ouchterlony double diffusion?
a. Solid
b. Mottled
c. Rim
d. Nucleolar
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 11/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
c. B cells and IgM antibody
d. T cells and macrophages
98. The air temperature throughout the serology laboratory is 20OC. How
will this affect RPR test result?
a. No effect – the acceptable test range is 20-24OC
b. Weaken reactions so that false negatives occur
c. Strengthen reactions so that positive titers appear elevated
d. Increase the number of false positives from spontaneous clumping
1. C
2. A
3. D
4. D
5. C
6. B
7. D
8. C
9. B
10. B
11. D
12. C
13. A
14. C
15. B
16. C
17. D
18. D
19. C
20. A
21. B
22. D
23. C
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 12/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
24. B
25. B
26. A
27. A
28. B
29. C
30. D
31. A
32. A
33. D
34. C
35. B
36. B
37. A
38. C
39. B
40. C
41. D
42. D
43. D
44. A
45. B
46. A
47. A
48. C
49. D
50. C
51. B
52. C
53. A
54. B
55. D
56. B
57. C
58. B
59. D
60. B
61. C
62. B
63. D
64. A
65. C
66. C
67. A
68. C
69. B
70. D
71. C
72. B
73. D
74. A
75. C
76. D
77. C
78. A
79. C
80. B
81. B
82. C
83. A
84. C
85. B
86. D
87. A
88. D
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 13/14
1/7/23, 5:53 PM Medical Technology Board Examination Review Notes on ISBB - Students Lessons and Examinations
89. C
90. B
91. B
92. A
93. B
94. D
95. D
96. C
97. B
98. B
99. B
100. A
Medical Technology Board Exam Medical Technology Board Medical Technology Board
Reviewer HEMATOLOGY Examination Review Notes on Examination Review Notes
JULY 04, 2019 Parasitology Recall 3
JULY 05, 2018 JULY 04, 2018
lessonsandexaminations.blogspot.com/2018/07/medical-technology-board-examination-review-notes-on-isbb.html 14/14
PRE-BOARD EXAMINATION IN CLINICAL MICROSCOPY (PART 1)
1. Urine from a patient with polyuria has a high specific gravity. The patient should be evaluated for:
A. Urinary tract infection C. Diabetes insipidus
B. Diabetes mellitus D. Uremia
2. An unpreserved specimen collected at 8 AM and remaining at room temperature until the aftern shift arrives can be
expected to have:
1. Decreased glucose and ketones 3. Decreased pH and turbidity
2. Increased bacteria and nitrite 4. Increased cellular elements
A. 1, 2 and 3 B. 1, 2 and 4 C. 1 and 2 only D. 4 only
3. Red cells will disintegrate more rapidly in a urine that is:
A. Concentrated and acidic C. Dilute and acidic
B. Concentrated and alkaline D. Dilute and alkaline
4. A negative urine pregnancy performed on a random specimen may need to be repeated using a:
A. Clean-catch specimen C. Fasting specimen
B. First morning specimen D. 24-hour specimen
5. Persons taking diuretics can be expected to produce:
A. Proteinuria B. Polyuria C. Pyuria D. Oliguria
6. The renal threshold for glucose is:
A. 50 100 mg/dL B. 160 180 mg/dL C. 220 240 mg/dL D. Over 240 mg/dL
7. Increased production of vasopressin:
A. Produces a low urine volume C. Increased ammonia excretion
B. Produces a high urine volume D. Affects proximal convoluted tubule transport
8. Osmometers utilizing the freezing point colligative property of solutions are based on the principle that:
A. 1 osmole of nonionizing substance dissolve in 1 kilogram of water raises the freezing point 1.86 oC
B. 1 osmole of nonionizing substance dissolve in 1 kilogram of water lowers the freezing point 1.86oC
C. Increased solute concentration will raise the freezing point of water in direct proportion to NaCl standard
D. Decreased solute concentration will decrease the freezing point of water in direct proportion to NaCl standard
9. The PAH test is dependent on:
1. Renal blood flow 3. Tubular secretion
2. Tubular reabsorption 4. Glomerular filtration
A. 1 and 3 B. 2 and 4 C. 1 only D. 4 only
10. Which biochemical component would be present in an increased amount in dark yellow-amber-colored urine?
A. Biliverdin B. Drugs C. Bilirubin D. Urobilin
11. Specimens from patients receiving treatment for UTI, frequently appear:
A. Clear and red C. Dilute and pale yellow
B. Viscous and orange D. Cloudy and red
12. When should a 2-hour postprandial urine be collected?
A. 2 hours after fluid ingestion C. 2 hours after eating
B. 2 hours after voiding a fasting specimen D. 2 hours after fluid ingestion
13. Refractive index compares:
A. Light velocity in solutions with light velocity in solids
B. Light velocity in air with light velocity in solutions
C. Light scattering in air with light scattering in solutions
D. Light scattering by particles in solution
14. What is the principle of the colorimetric reagent strip determination of specific gravity in urine?
A. Ionic strength alters pKa of a polyelectrolyte
B. Sodium and other cations are chelated by a ligand that changes color
C. Anions displace a pH indicator from a mordant, making it water soluble
D. Ionized solutes catalyze oxidation of an azo dye
15. A urine specimen with a specific gravity of 1.008 has been diluted 1:5. The actual specific gravity is:
A. 1.008 B. 1.040 C. 1.055 D. 5.040
16. What are the most common renal stones encountered in the clinical laboratory?
A. Calcium phosphate C. Cystine
B. Calcium oxalate D. Uric acid
17. When using polarized light microscopy, which urinary sediment component exhibits Maltese cross formation?
A. RBCs B. Oval fat bodies C. Yeasts D. WBCs
18. Which of the following urine biochemical results would be obtained in hemolytic anemia?
A. Positive glucose C. Positive nitrate
B. Positive bilirubin D. Positive urobilinogen
19. In renal tubular acidosis, the pH of urine is:
A. Consistently acid C. Neutral
B. Consistently alkaline D. Variable, depending upon diet
20. What is a commonly used drug noted to produce a bright orange-red color in urine?
A. Furadantin B. Levodopa C. Rifampin D. Riboflavin
21. Which of the following would produce a yellow foam in urine when shaken which could be mistaken for bilirubin:
A. Pyridium B. Protein C. Urates D. Glucose
22. A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:
A. True glycosuria C. A false-negative oxidase reaction
B. Presence of nonglucose reducing sugar D. A trace quantity of glucose
23. Acetoacetic acid is detected in urine by reaction with:
A. Sodium nitroprusside C. m-Dinitrobenzene
B. o-Toluidine D. m-Dinitrophenylhydrazine
2
42. Hexagonal uric acid crystals can be distinguished from cystine crystals because:
A. Uric acid is insoluble in hydrochloric acid and cystine is not
B. Cystine gives a positive nitroprusside etst after reduction with sodium cyanide
C. Cystine crystals are colorless
D. All of the above
43. The presence of tyrosine and leucine crystals together in urine sediment usually indicates:
A. Renal failure C. Hemolytic anemia
B. Chronic liver disease D.
44. Which of the following crystals is considered nonpathological?
A. Hemosiderin B. Ammonium biurate C. Bilirubin D. Cholesterol
45. Which crystals appear in urine as a long, thin hexagonal plate, and are linked to ingestion of benzoic acid?
A. Cystine B. Hippuric acid C. Oxalic acid D. Uric acid
46. Oval fat bodies are derived from:
A. Renal tubular epithelium C. Degenerated WBCs
B. Transitional epithelium D. Mucoprotein matrix
47. Which condition is associated with the greatest proteinuria?
A. Acute glomerulonephritis C. Nephrotic syndrome
B. Chronic glomerulonephritis D. Acute pyelonephritis
48. The finding of increased hyaline and granular cast in the urine of an otherwise healthy person may be the result of:
A. Fecal contamination C. Early UTI
B. Recent strenuous exercise D. Analyzing an old specimen
49. The Guthrie test is a:
A. Bacterial inhibition test
B. Fluorometric procedure
C. Chemical procedure measured by spectrophotometer
D. Bacterial agglutination test
50. The abnormal metabolite that is present in the urine in alkaptonuria is:
A. Homogentisic acid C. Phenylpyruvate
B. Alkaptonpyruvate D. Tyrosine
51. A mousy odor in the urine is associated with:
A. Phenylketonuria B. Isovaleric acidemia C. Cystinuria D. Cystinosis
52. The finding of increased amount of the serotonin degradation product 5-HIAA in the urine is indicative of:
A. Platelet disorders B. Intestinal obstruction C. Malabsorption D. Carcinoid tumor invol. argentaffin cells
53. al retardation and increased urinary:
A. Porphyrins B. Amino acids C. Maltose D. Mucopolysaccharides
54. Regarding CSF, all of the following are indications of a traumatic tap, EXCEPT:
A. Clearing of the fluid as it is aspirated C. Xanthochromia
B. A clear supernatant after centrifugation D. Presence of clot in the sample
55. The term used to denote high WBC count in the CSF is:
A. Empyemia C. Pleocytosis
B. Neutrophilia D. Hyperpycorrhachia
56. The limulus lysate test on CSF is a sensitive assay for:
A. Demyelinating diseases of the spinal cord C. Gram-negative bacterial endotoxin
B. Cryptococcal meningitis D. Open neural tube defects
57. Pronounced reduction of CSF glucose can be seen in the following conditions, EXCEPT:
A. Viral meningitis C. Fungal meningitis
B. Bacterial meningitis D. Tuberculous meningitis
58. An elevated IgG level in CSF and an abnormal band on electrophoresis of CSF are findings consistent with the
diagnosis of:
A. Multiple sclerosis C. Meningeal involvement in leukemia
B. Muscular dystrophy D. Secondary stage of syphilis
59. CSF specimen is usually collected in 3 sterile tubes labeled in the order they are drawn. What laboratory test is
done with tube number 3?
A. Chemistry B. Microbiology C. Cell count D. Serology
60. Total volume of CSF in adults:
A. 20 mL B. 140-170 mL C. 10-60 mL D. 220-280 mL
61. The normal CSF protein is:
A. 15 to 45 mg/dL B. 15 to 45 g/dL C. 50 to 100 mg/dL D. 50 to 100 g/dL
62. To determine if fluid draining from the ear of the patient with severe head injury is CSF, the fluid should be:
A. Centrifuged and examined for the presence of ependymal cells
B. Electrophoresed for the presence of transferring isoforms
C. Analyzed for the presence of glutamine
D. Tested for low protein concentration
63. A major CSF chemical that is measured in su
A. Glucose B. Glutamine C. Lactate D. Lactate dehydrogenase
64. Which of the following terms is another name for ascitic fluid?
A. Peritoneal B. Pericardial C. Synovial D. Pleural
65. All of the following statements about serous fluids are true, EXCEPT:
A. An effusion is an abnormal accumulation of a serous fluid
B. Thoracentesis refers the collection of pericardial fluid
C. Ascites refer specifically to peritoneal fluid
D.
4
END OF EXAM
5
23. Which of the following ketones are NOT detected by the reagent strip or tablet test?
A. Acetone C. B-hydroxybutyrate
B. Acetoacetate D. Acetone and acetoacetate
24. The ketone reagent strip and tablet tests are based on the reactivity of ketones with:
A. Ferric chloride B. Nitroprusside C. Ferric nitrate D. Nitroglycerin
25. Which of the following are characteristic urine findings from a patient with hemolytic jaundice?
A. A positive test for bilirubin and an increased amount of urobilinogen
B. A positive test for bilirubin and a decreased amount of urobilinogen
C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen
26. Which of the following results are characteristic urine findings from a patient with an obstruction of the bile duct?
A. A positive test for bilirubin and an increased amount of urobilinogen
B. A positive test for bilirubin and a decreased amount of urobilinogen
C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen
27. The classic Ehrlich’s reaction is based on the reaction of urobilinogen with:
A. Diazotized dichloroaniline C. p-dichlorobenzene diazonium salt
B. p-dimethylaminobenzaldehyde D. p-aminobenzoic acid
28. Red colored-compound produced with the Watson-Schwartz test that is insoluble in chloroform and butanol is:
A. Uroporphyrin C. Urobilinogen
B. Porphobilinogen D. Protoporphyrin
29. Nitrite in urine specimen suggests the presence of:
A. White blood cells C. Bacteria
B. Ammonia D. Urea
30. Which of the following blood cells will NOT be detected by the leukocyte esterase pad because it lacks esterases?
A. Eosinophils B. Lymphocytes C. Monocytes D. Neutrophils
31. Which of the following reagent strip tests can be affected by ascorbic acid, resulting in falsely low or false negative
results?
1. Blood 2. Bilirubin 3. Glucose 4. Nitrite
A. 1, 2 and 3 are correct C. 4 is correct
B. 1 and 3 are correct D. All are correct
32. Which of the following dyes are used in Sternheimer-Malbin stain?
A. Hematoxylin and eosin C. Methylene blue and eosin
B. Crystal violet and eosin D. Crystal violet and safranin
33. The microscopic identification of hemosiderin is enhanced when the urine sediment is stained with:
A. Gram stain B. Hansel stain C. Sudan stain D. Prussian blue stain
34. When a laboratorian performs the microscopic examination of urine sediment, which of the following are
enumerated using the low-power magnification?
A. White blood cells C. Red blood cells
B. Casts D. Renal tubular cells
35. The ova of which parasite may be found in the urinary sediment?
A. Trichomonas vaginalis C. Entamoeba histolytica
B. Schistosoma haematobium D. Trichuris trichiura
36. A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine
microscopy. Acetic acid should be added to the sediment to:
A. Lyse the yeast cells C. Dissolve the oil droplets
B. Lyse the red blood cells D. Crenate the red blood cells
37. Glitter cells are a microscopic finding of:
A. Red blood cells in hypertonic urine C. White blood cells in hypertonic urine
B. Red blood cells in hypotonic urine D. White blood cells in hypotonic urine
38. Urine sediment could have which of the following formed elements and still be considered “normal”?
A. 5 to 10 red blood cells C. A few bacteria
B. 0 to 2 hyaline casts D. A few yeast cells
39. Urinary casts are formed in the:
A. Distal tubules and loops of Henle C. Proximal and distal tubules
B. Distal and collecting tubules D. Proximal tubules and loops of Henle
40. Urinary casts are formed with a core matrix of:
A. Albumin C. Bence Jones protein
B. Tamm-Horsfall mucoprotein D. Transferrin
41. Which of the following crystals, when found in the urine sediment, most likely indicates an abnormal metabolic
condition?
A. Calcium oxalate C. Triple phosphate
B. Bilirubin D. Uric acid
42. Oval fat bodies are derived from:
A. Renal tubular epithelium C. Degenerated WBCs
B. Transitional epithelium D. Mucoprotein matrix
43. In a patient with nephrotic syndrome, the microscopic examination of the urine sediment often reveals:
A. Granular casts C. Red blood cell casts
B. Waxy casts D. Leukocyte casts
44. The most frequently observed cast in urine is:
A. Red cell B. Hyaline C. Waxy D. Fatty
3
45. When using polarized light microscopy, which urinary sediment component exhibits Maltese cross formation?
A. RBC B. Oval fat bodies C. Yeast D. Parasites
46. Which of the following frequently occurs following a bacterial infection of the skin or throat?
A. Acute glomerulonephritis C. Membranous glomerulonephritis
B. Chronic glomerulonephritis D. Rapidly progressive glomerulonephritis
47. Phenylketonuria is an inherited metabolic disease in which there is deficiency of an enzyme:
A. Phenylalanine oxidase C. Phosphoalanine hydroxylase
B. Phenylalanine hydroxylase D. Phosphoalanine phosphatase
48. Which of the following disorders is characterized by the urinary excretion of large amounts of arginine, cystine,
lysine, and ornithine?
A. Cystinosis B. Cystinuria C. Lysinuria D. Tyrosinuria
49. Which of the following hereditary diseases results in the accumulation and excretion of large amounts of
homogentisic acid?
A. Melanuria B. Alkaptonuria C. Phenylketonuria D. Tyrosinuria
50. Which of the following substances oxidizes with exposure to air, causing the urine to turn brown or black?
A. Porphyrin B. Melanin C. Tyrosine D. Urobilinogen
51. A disease that causes large amounts of valine, leucine and isoleucine to be excreted in urine is:
A. Hurler’s syndrome C. Maple syrup urine disease
B. Cystinuria D. Alkaptonuria
52. Increased amounts of 5-hydroxy indoleacetic acid in the urine is indicative of:
A. Platelet disorders C. Malabsorption syndromes
B. Intestinal obstruction D. Argentaffin cell tumors
53. During a lumbar puncture procedure, the first collection tube of CSF removed should be used for:
A. Microbiology studies C. Hematology tests
B. Cytology studies D. Chemistry tests
54. All of the following proteins are normally present in the CSF, EXCEPT:
A. Transferrin B. Albumin C. Prealbumin D. Fibrinogen
55. Pleocytosis is a term used to describe:
A. A pink, orange, or yellow CSF specimen
B. An increased protein content in the CSF owing in cellular lysis
C. Inflammation and sloughing of the cells from the choroids plexus
D. An increased number of cells in the CSF
56. Regarding CSF, all of the following are indications of a traumatic tap, EXCEPT:
A. Clearing of the fluid as it is aspirated C. Xanthochromia
B. A clear supernatant after centrifugationD. Presence of clot in the sample
57. All of the following proteins are normally present in the CSF except:
A. Albumin B. Fibrinogen C. Prealbumin D. Transferrin
58. An unknown fluid can positively identified as being CSF by:
A. Determining the lactate concentration
B. Determining the albumin concentration
C. Determining the presence of oligoclonal banding on electrophoresis
D. Determining the presence of carbohydrate-deficient transferrin on electrophoresis
59. How many leukocytes are normally present in the CSF obtained from an adult?
A. 0-30 cells/uL B. 0-20 cells/uL C. 0-10 cells/uL D. 0-5 cells/uL
60. Which of the following cells may be present in small numbers in normal CSF?
A. Erythrocytes B. Macrophages C. Plasma cells D. Lymphocytes
61. Which of the following cell types predominate in CSF during a classic case of bacterial meningitis?
A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
62. Which of the following cell types predominate in CSF during a classic case of viral meningitis?
A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
63. A web-like clot or pellicle is formed in the CSF from patients infected with:
A. Neisseria meningitidis C. Mycobacterium tuberculosis
B. Haemophilus influenzae D. Cryptococcus neoformans
64. India ink preparations and microbial antigen tests can aid in the diagnosis of:
A. Bacterial meningitis C. Viral meningitis
B. Tuberculous meningitis D. Fungal meningitis
65. Limulus Lysate test will detect the presence of:
A. Gram-positive bacteria C. Acid-fast organisms
B. Gram-negative bacteria D. All microorganisms
66. Normal CSF lactate levels (below 25 mg/dL) are commonly found in patients with:
A. Bacterial meningitis C. Tuberculous meningitis
B. Fungal meningitis D. Viral meningitis
67. In suspected case of Reye’s syndrome, it is useful to measure:
A. Glucose B. Ammonia C. Lactic acid D. Glutamine
68. Which of the following parameters directly relates to and provides a check of the spermatozoa motility evaluation?
A. The agglutination evaluation C. The morphology assessment
B. The concentration determination D. The viability assessment
69. The concentration of which of the following substances can be used to positively identify a fluid as seminal fluid?
A. Zinc C. Fructose
B. Citric acid D. Acid phosphatase
70. The most common cause of male infertility is:
A. Mumps B. Varicocele C. Malignancy D. Klinefelter’s syndrome
4