Electrolytes and Osmolality 295.

Which of the following is a spectrophoto

290. What is the normal renal threshold of metric method for quantifying serum

sodium (measured in millimoles per liter)? chloride?

A. 80-85 A. Ferric perchlorate

B. 90-110 B. Ammonium molybdate

C. 110-130 C. Bathophenanthroline

D. 135-148 D. Cresolphthalein complexone

REVIEW QUESTIONS • 129 296. Which of the following statements is false

291. Of the total serum osmolality, sodium, about the electrolyte chloride?

chloride, and bicarbonate ions normally A. Main anion of the extracellular fluid

contribute approximately what percent? B. Can shift from the extracellular plasma

A. 8 to the intracellular fluid of red blood

B. 45 cells

C. 75 C. Unable to be reabsorbed by active

D. 92 transport

292. The presence of only slightly visible D. Measured in serum, urine, and sweat

hemolysis will significantly increase the 297. Using the following data: Na+ = 143

serum level of which of the following mmol/L; K+ = 4.9 mmol/L; Cl" = 105

electrolytes? mmol/L; and HCO^ = 25 mmol/L, which

A. Sodium of the following statements is false?

B. Potassium A. Patient results are not acceptable.

C. Chloride B. Anion gap is useful in detecting some

D. Bicarbonate disease states.

293. Which of the following is not a component C. Anion gap equals 18 mmol/L.

of the total anion content of serum? D. Anion gap is useful for checking

A. Acetoacetate analytical error.

B. Protein 298. A patient presents with Addison disease.

C. Lactate Serum sodium and potassium analyses

D. Iron are performed. What would the results

294. Which of the following is not associated reveal?

with potassium? A. Normal sodium, low potassium levels

A. Has no renal threshold B. Low sodium, low potassium levels

B. Increased serum level in acidosis C. Low sodium, high potassium levels

C. Hemolysis causes false increase in D. High sodium, low potassium levels

serum levels 299. Primary aldosteronism results from a

D. Major anion of intracellular fluid tumor of the adrenal cortex. How would
the extracellular fluid be affected? 304. Which of the following is an effect of

A. Normal sodium, decreased potassium increased parathyroid hormone secretion?

levels A. Decreased blood calcium levels

B. Decreased sodium, decreased B. Increased renal reabsorption of

potassium levels phosphate

C. Decreased sodium, increased C. Decreased bone resorption

potassium levels D. Increased intestinal absorption of

D. Increased sodium, decreased potas calcium

sium levels 305. The following laboratory results are

130 • CHAPTER 1: CLINICAL CHEMISTRY obtained on a 60-year-old woman who is

300. Which of the following conditions is not complaining of anorexia, constipation,

associated with hyponatremia? abdominal pain, nausea, and vomiting:

A. Addison disease Ionized serum calcium—elevated

B. Diarrhea Serum inorganic phosphate—

C. Diuretic therapy decreased

D. Gushing syndrome Urine calcium—elevated

301. Of the total serum calcium, free ionized Urine phosphate—elevated

calcium normally represents approxi What do these results suggest?

mately what percent? A. Primary hyperparathyroidism

A. 10 B. Vitamin D deficiency

B. 40 C. Hypoparathyroidism

C. 50 D. Paget disease

D. 90 306. Secondary hyperparathyroidism is often

302. Measuring the tubular reabsorption of the result of

phosphate is useful in diagnosing diseases A. Vitamin C deficiency

that affect which of the following organs? B. Liver disease

A. Liver C. Renal disease

B. Adrenal gland D. Thyroid disease

C. Thyroid gland 307. Which of the following reagents is used to

D. Parathyroid gland determine the concentration of serum

303. Which of the following does not have an inorganic phosphate?

effect on plasma calcium levels? A. Ehrlich's reagent

A. Parathyroid hormone B. Ammonium molybdate

B. Vitamin D C. 8-Hydroxyquinoline

C. Calcitonin D. Bathophenanthroline

D. Aldosterone 308. Which of the following reagents is used in

a colorimetric method to quantify the C. Between 40 and 50

concentration of serum calcium? D. Greater than 55

A. Cresolphthalein complexone 313. What is the primary storage form of iron?

B. Lanthanum A. Apotransferrin

C. Malachite green B. Myoglobin

D. Amino-naphthol-sulfonic acid C. Ferritin

309. Which of the following has an effect on D. Hemosiderin

plasma calcium levels? 314. A serum ferritin level may not be a useful

A. Sodium indicator of iron-deficiency anemia in

B. Inorganic phosphate patients with what type of disorder?

C. Potassium A. Chronic infection

D. Iron B. Malignancy

REVIEW QUESTIONS • 131 C. Viral hepatitis

310. A patient's serum inorganic phosphate level D. All the above

is found to be elevated but the physician 315. Which of the following chromogens will not

cannot determine a physiological basis for produce a colored complex with iron that

this abnormal result. What could possibly can be measured spectrophotometrically?

have caused an erroneous result to be A. Bathophenanthroline

reported? B. 8-Hydroxyquinoline

A. Patient not fasting when blood was C. Tripyridyltriazine

drawn D. Ferrozine

B. Specimen was hemolyzed 316. In what disorder would an increased percent

C. Effect of diurnal variation saturation of transferrin be expected?

D. Patient receiving intravenous glucose A. Hemochromatosis

therapy B. Iron-deficiency anemia

311. To what metal does ceruloplasmin firmly C. Myocardial infarction

bind? D. Malignancy

A. Chromium 317. Which of the following disorders is best

B. Copper characterized by these laboratory results?

C. Zinc Serum iron—decreased

D. Iron Total iron-binding capacity—

312. In iron-deficiency anemia, what would be increased

the expected percent saturation of Transferrin saturation—decreased

transferrin with iron? Serum ferritin—decreased

A. Less than 15 Free erythrocyte protoporphyrin—

B. Between 30 and 40 increased

A. Anemia of chronic disease property of solutions?

B. Thalassemia A. pH

C. Iron-deficiency anemia B. Freezing point

D. Hemochromatosis C. Osmotic pressure

318. Which of the following is not a typical D. Vapor pressure

finding in magnesium deficiency tetany? 323. Which of the following describes the basis

A. High serum phosphate level for the freezing point osmometer?

B. Normal serum calcium level A. The freezing point depression is

C. Normal blood pH value directly proportional to the amount

D. Low serum potassium level of solvent present.

319. Which of the following constituents B. The freezing point depression varies as

normally present in serum must be the logarithm of the concentration

chemically eliminated so that it will not of solute.

interfere with the measurement of serum C. The freezing point is raised by an

magnesium? amount that is inversely proportional

A. Calcium to the concentration of dissolved

B. Chloride particles in the solution.

C. Iron D. The freezing point is lowered by an

D. Potassium amount that is directly proportional

132 • CHAPTER 1: CLINICAL CHEMISTRY to the concentration of dissolved

320. In the collection of plasma specimens particles in the solution.

for lactate determinations, which of the 324. Given the following information, calculate

following anticoagulants would be more the plasma osmolality in milliosmoles

appropriate? per kilogram: sodium—142 mmol/L;

A. Sodium heparin glucose—130 mg/dL; urea nitrogen—

B. Sodium citrate 18mg/dL.

C. EDTA A. 290

D. Oxalate plus fluoride B. 291

321. Which of the following disorders is C. 295

characterized by increased production D. 298

of chloride in sweat? 325. Which of the following may be associated

A. Multiple myeloma with the colloid osmotic pressure (COP)

B. Hypoparathyroidism osmometer?

C. Cystic fibrosis A. Utilizes a cooling bath set at -7°C

D. Wilson disease B. Measures total serum osmolality

322. Which of the following is not a colligative C. Negative pressure on reference (saline)
side equivalent to COP of sample tion of bicarbonate without a change in

D. Measures contribution of electrolytes PCO2 from normal will result in what

to osmolality physiological state?

Acid-Base Metabolism A. Respiratory acidosis

326. Which is the most predominant buffer B. Respiratory alkalosis

system in the body? C. Metabolic acidosis

A. Bicarbonate/carbonic acid D. Metabolic alkalosis

B. Acetate/acetic acid 331. Which of the following characterizes

C. Phosphate/phosphorous acid respiratory acidosis?

D. Hemoglobin A. Excess of bicarbonate

327. The measurement of the pressure of B. Deficit of bicarbonate

dissolved CO2 (PCO2) in the blood is C. Excess of dissolved carbon dioxide

most closely associated with the concen (PCO2)

tration of what substance? D. Deficit of dissolved carbon dioxide

A. pH (PCO2)

B. Bicarbonate (HCOs) 332. What is the specimen of choice for

C. Carbonic acid (H2CO3) analysis of acid-base disturbances

D. PO2 involving pulmonary dysfunction in an

328. What is the term that describes the sum of adult?

carbonic acid and bicarbonate in plasma? A. Venous blood

A. Total CO2 B. Arterial blood

B. Standard bicarbonate C. Capillary blood

C. Buffer base D. Urine

D. Base excess 333. What is the anticoagulant of choice for

REVIEW QUESTIONS • 133 blood gas analysis?

329. To maintain a pH of 7.4 in plasma, it is A. EDTA

necessary to maintain a B. Heparin

A. 10:1 ratio of bicarbonate to carbonic C. Sodium fluoride

acid D. Citrate

B. 20:1 ratio of bicarbonate to carbonic 334. If a blood gas specimen is left exposed to

acid air, which of the following changes will

C. 1:20 ratio of bicarbonate to carbonic occur?

acid A. PO2 and pH increase; PCO2 decreases

D. 20:1 ratio of carbonic acid to bicar B. PO2 and pH decrease; PCO2 increases

bonate C. PO2 increases; pH and PCO2 decrease

330. In the plasma, an excess in the concentra D. PO2 decreases; pH and PCO2 increase
335. How would blood gas parameters change C. Fasting blood glucose elevated, pH

if a sealed specimen is left at room normal, ketone bodies absent

temperature for 2 or more hours? D. Fasting blood glucose decreased, pH

A. PO2 increases, PCO2 increases, pH low, ketone bodies absent

increases 339. Which of the following is a cause of

B. PO2 decreases, PCO2 decreases, pH metabolic alkalosis?

decreases A. Late stage of salicylate poisoning

C. PO2 decreases, PCO2 increases, pH B. Uncontrolled diabetes mellitus

decreases C. Renal failure

D. PO2 increases, PCO2 increases, pH D. Excessive vomiting

decreases 340. Which of the following statements is true

336. The bicarbonate ion concentration may be about partially compensated respiratory

calculated from the total CO2 and PCO2 alkalosis?

blood levels by using which of the A. PCC>2 is higher than normal.

following formulas? B. HCO^ is higher than normal.

A. 0.03 x (PCO2 - total CO2) C. More CC>2 is eliminated through the

B. (total CO2 + 0.03) x PCO2 lungs by hyperventilation.

C. 0.03 x (total CO2 - PO2) D. Renal reabsorption of HCC>3 is

D. total CO2 - (0.03 x PCO2) decreased.

337. In order to maintain electrical neutrality in 341. Which is a compensatory mechanism in

the red blood cell, bicarbonate leaves the respiratory acidosis?

red blood cell and enters the plasma A. Hypoventilation

through an exchange mechanism with B. Decreased reabsorption of bicarbonate

what electrolyte? by the kidneys

A. Sodium C. Increased Na+/H+ exchange by the

B. Potassium kidneys

C. Chloride D. Decreased ammonia formation by the

D. Phosphate kidneys

134 • CHAPTER 1: CLINICAL CHEMISTRY 342. Which of the following will cause a shift

338. In acute diabetic ketoacidosis, which of of the oxygen dissociation curve to the

the following laboratory findings would right, resulting in a decreased affinity of

be expected? hemoglobin for C"2?

A. Fasting blood glucose elevated, pH A. Low plasma pH level

elevated, ketone bodies present B. Low PCO2 level

B. Fasting blood glucose elevated, pH C. Low concentration of 2,3-bisphospho

low, ketone bodies present glycerate

D. Low temperature results: pH = 7.49, PCO2 = 59 mm Hg,

343. Which of the following statements about HCOJ = 25 mmol/L. What do these data

carbonic anhydrase (CA) is true? indicate?

A. Catalyzes conversion of CC>2 and F^O A. Metabolic alkalosis, partially

to HHCO3 in red blood cells compensated

B. Causes shift to the left in oxygen B. Respiratory acidosis, uncompensated

dissociation curve C. A dual problem of acidosis

C. Catalyzes formation of H2CO3 from D. An error in one of the blood gas

CO2 and H2O in the tissues measurements

D. Inactive in renal tubular cells 347. A 24-year-old drug abuser is brought into

344. Which of the following statements best the emergency department unconscious.

describes "base excess"? He has shallow breaths, looks pale, and is

A. Primarily refers to carbonic acid "clammy." Blood gases show the

concentration following results: pH = 7.29, PCO2 = 50

B. Positive values reflect metabolic mmHg, HCOs = 25 mmol/L .What

alkalosis. condition is indicated by these results?

C. Created through metabolism of A. Metabolic alkalosis, partially

carbohydrates compensated

D. Negative values represent a respiratory B. Respiratory acidosis, uncompensated

imbalance. C. A dual problem of acidosis

345. Given the following information, calculate D. An error in one of the blood gas

the blood pH. measurements

PCO2 = 44 mm Hg 348. Blood gases are drawn on a 68-year-old

Total CO2 = 29 mmol/L asthmatic who was recently admitted for

A. 6.28 treatment of a kidney infection. Blood gas

B. 6.76 results are as follows: pH — 7.25, PCO2 —

C. 7.42 56mmHg, HCOJ = 16 mmol/L .What

D. 7.44 condition is indicated by these results?

REVIEW QUESTIONS • 135 A. Metabolic alkalosis, partially

346. A 75-year-old woman comes to her compensated

physician complaining of abdominal pain. B. Respiratory acidosis, uncompensated

She says she has had a sore stomach for C. A dual problem of acidosis

the last 3 weeks and has been taking D. An error in one of the blood gas

increasing doses of antacid pills to control measurements

it. Now she is taking a box of pills a day. 349. A mother brings her daughter, a 22-year

Blood gases are drawn with the following old medical technology student, to her
physician. The patient is hyperventilating C. Substrate is present in excess; rate

and has glossy eyes. The mother explains of reaction is constant with enzyme

that her daughter is scheduled to take her concentration and dependent only on

final course exam the next morning. The the time in which the reaction is run.

patient had been running around frantically D. Enzyme is present in excess; rate of

all day in a worried state and then started to reaction is independent of both time

breathe heavily. Blood gases are drawn in and concentration of the enzyme in the

the office with the following results: pH = system.

7.58, PCO2 = 55 mm Hg, HCOj = 214. Based on the following graph of velocity

18 mmol/L .What do these data indicate? of an enzyme reaction versus substrate

A. Metabolic alkalosis, partially concentration, you are designing a new

compensated method to measure the activity of an

B. Respiratory acidosis, uncompensated enzyme of clinical interest. To formulate the

C. A dual problem of acidosis new methodology so that enzyme activity is

D. An error in one of the blood gas assessed using zero-order kinetics, which

Measurements Michaelis-Menten Curve

concentration of substrate should you

Enzymes and Cardiac Assessment initially determine experimentally?

212. What does an increase in the serum A. Substrate concentration a

enzyme levels indicate? B. Substrate concentration b

A. Decreased enzyme catabolism C. Substrate concentration c

B. Accelerated enzyme production D. Substrate concentration d

C. Tissue damage and necrosis 215. When measuring enzyme activity, if the

D. Increased glomerular filtration rate instrument is operating 5°C lower than the

REVIEW QUESTIONS • 118 temperature prescribed for the method,

213. In the assay of an enzyme, zero-order how will the results be affected?

kinetics are best described by which of the A. Lower than expected

following statements? B. Higher than expected

A. Enzyme is present in excess; rate C. Varied, showing no particular pattern

of reaction is variable with time and D. All will be clinically abnormal.

dependent only on the concentration 216. Given the following information for a rate

of the enzyme in the system. reaction, calculate the activity of a serum

B. Substrate is present in excess; rate specimen for alanine aminotransferase in

of reaction is constant with time and international units per liter (IU/L).

dependent only on the concentration 1 min

of enzyme in the system. 2 min

3 min assay of most serum enzymes.

4 min B. Serum asparate transaminase (AST),

1.104 but not serum lactate dehydrogenase

1.025 (LD), is usually elevated in acute

0.950 myocardial infarction.

0.873 C. Increased serum alkaline phosphatase

A. 186 may be found in bone disease.

B. 198 D. Aspartate transaminase was formerly

C. 1857 known as glutamate pyruvate

D. 1869 transaminase.

Specimen 219. Enzymes that catalyze the transfer of

volume = 20 \jL groups between compounds are classified

Reagent as belonging to which enzyme class?

volume = 3.0 ml_ A. Hydrolases

Molar absorptivity B. Eyases

for NADH at C. Oxidoreductases

340 nm = 6.22 x D. Transferases

103 L/mol-cm 220. Which of the following enzymes does not

Light path = 1 cm belong to the class of enzymes known as

Substrate Concentration the hydrolases?

120 • CHAPTER 1: CLINICAL CHEMISTRY A. Alkaline phosphatase

217. The properties of enzymes are correctly B. Aldolase

described by which of the following C. Amylase

statements? D. Lipase

A. Enzymes are stable proteins. 221. To what class of enzymes does lactate

B. Enzymes are protein catalysts of dehydrogenase belong?

biological origin. A. Isomerases

C. Enzymes affect the rate of a chemical B. Ligases

reaction by raising the activation energy C. Oxidoreductases

needed for the reaction to take place. D. Transferases

D. Enzyme activity is not altered by heat 222. Which of the following enzymes catalyzes

denaturation. the transfer of amino groups causing the

218. Which of the following is a true statement interconversion of amino acids and

concerning serum enzymes? a-oxoacids?

A. The presence of hemolyzed red cells is A. Amylase

of no significance for an accurate B. Aspartate transaminase

C. Alkaline phosphatase 227. Lactate dehydrogenase (LD) catalyzes the

D. Lactate dehydrogenase following reaction:

223. What abbreviation has been used in the LD

past to designate alanine aminotrans Lactate+ NADH

f erase? pyruvate + NADH

A. AST As the reaction is written, which of the

B. A AT following techniques can be used to assess

C. GOT LD activity?

D. GPT A. Measure the colorimetric product

224. When measuring CK-MB, which of the pyruvate.

following would provide the most B. Measure the colorimetric product

sensitive method? NADH.

A. Electrophoretic C. Measure the increase in absorbance at

B. Colorimetric 340 nm as NADH is produced.

C. Kinetic D. Measure the decrease in absorbance at

D. Mass immunoassay 340 nm as NADH is produced.

225. Which of the following does not accu 228. Which of the following is false about

rately describe properties associated with myoglobin as it relates to acute myocar

lactate dehydrogenase? dial infarction (AMI)?

A. Optimum pH for the catalysis of A. Measure serially

lactate to pyruvate is 7.4-7.8. B. Cardiac specific

B. LD is increased in a hemolyzed serum C. Initial increase occurs in 1-3 hours

specimen. D. Doubling of initial value within

C. LD catalyzes the oxidation of lactate 1-2 hours suggestive of AMI

to pyruvate with mediation of 229. Which of the following disorders is not

nicotinamide-adenine dinucleotide. associated with an elevation of serum

D. LD-4 and LD-5 are labile in creatine kinase?

the cold. A. Cerebrovascular accidents

REVIEW QUESTIONS • 121 B. Hypothyroidism

226. Which test, if elevated, would provide C. Bone disease

information about risk for developing D. Intramuscular injection

coronary artery disease? 230. Which of the following statements

A. Troponin concerning creatine kinase is false?

B. CK-MB A. Rises within 4-6 hours after acute

C. hs-CRP myocardial infarction

D. Myoglobin B. Catalyzes the phosphorylation of

creatine by ATP in which serum enzyme would be expected

C. Requires Ca2+ for activity diagnostically?

D. Found mainly in skeletal and cardiac A. Creatine kinase

muscles and in brain tissue B. Amylase

231. Which enzyme is measured by metho C. Alkaline phosphatase

dologies that use small oligosaccharides D. Aspartate aminotransferase

and 4-nitrophenyl-glycoside for 236. For assessing carcinoma of the prostate,

substrates? quantification of PSA has virtually

A. Lipase replaced the measurement of which of the

B. Amylase following enzymes?

C. Creatine kinase A. Alkaline phosphatase

D. Cholinesterase B. Acid phosphatase

232. Which statement concerning gamma C. Alanine aminotransferase

glutamyltransferase is false? D. Trypsin

A. Present in almost all cells of the body 237. Which of the following statements is not

B. Elevated in liver and some pancreatic associated with serum cholinesterase?

diseases A. Inhibited by organic insecticides

C. Elevated in chronic alcoholism B. Referred to as "true" cholinesterase

D. Elevated in bone disease C. Decreased level causes prolonged apnea

233. Which of the following statements after administration of succinyldicholine

correctly describes alkaline D. Acts on the substrate propionylthio

phosphatase? choline

A. Decreased in Paget disease 238. Which of the following disorders is not

B. Decreased in third trimester of a characterized by an elevated serum

normal pregnancy myoglobin?

C. Increased in obstructive jaundice A. Renal failure

D. Primarily found in cardiac muscle B. Vigorous exercise

234. Which of the following enzymes would C. Acute myocardial infarction

not be useful to quantify in the assessment D. Hepatitis

of liver function? 239. Which of the following is false about cardiac

A. Alanine aminotransferase troponin I (cTnl) as it relates to AMI?

B. Creatine kinase A. Increase above reference interval seen

C. Alkaline phosphatase in 3 to 6 hours

D. Gamma-glutamyltransferase B. Measure initially and serially in 3- to

122 • CHAPTER!: CLINICAL CHEMISTRY 6-hour intervals

235. In acute pancreatitis, a significant increase C. Remains elevated 5 to 10 days

D. Expressed in regenerating and A. Alcoholic cirrhosis

diseased skeletal muscle and cardiac B. Infectious mononucleosis

muscle disorders C. Intrahepatic cholestasis

240. Which of the following sets of tests would D. Viral hepatitis

be the most useful in diagnosing an AMI? REVIEW QUESTIONS • 123

A. AST, LD, CK-MB 243. A 42-year-old male presents with anorexia,

B. LD, CK-MB, troponin nausea, fever, and icterus of the skin and

C. CK-MB, troponin, myoglobin mucous membranes. He noticed that his

D. LD, troponin, myoglobin urine had appeared dark for the past several

241. A physician orders several laboratory tests days. The physician orders a series of

on a 55-year-old male patient who is biochemical tests. Based on the following

complaining of pain, stiffness, fatigue, and test results, what is the most likely diagnosis?

headaches. Based on the following serum Serum alkaline phosphatase—slightly

test results, what is the most likely elevated

diagnosis? Serum alanine aminotransferase—

Alkaline phosphatase—significantly markedly elevated

increased Serum aspartate aminotransferase—

Gamma-glutamyltransferase—normal markedly elevated

A. Biliary obstruction Serum gamma-glutamyltransferase—

B. Cirrhosis slightly elevated

C. Hepatitis Serum total bilirubin—moderately

D. Osteitis deformans elevated

242. A 53-year-old female presents with fatigue, Urine bilirubin—positive

pruritus, and an enlarged, nontender liver. Fecal urobilinogen—decreased

The physician orders a series of blood tests. A. Acute hepatitis

Based on the following serum test results, B. Alcoholic cirrhosis

what is the most likely diagnosis? C. Metastatic carcinoma of the pancreas

Alkaline phosphatase—markedly D. Obstructive jaundice

elevated 244. To aid in the diagnosis of skeletal muscle

Alanine aminotransferase—slightly disease, which of the following serum

elevated enzyme measurements would be of most

Lactate dehydrogenase—slightly use?

elevated A. Creatine kinase

Gamma-glutamyltransferase— B. Alkaline phosphatase

markedly elevated C. Aspartate aminotransferase

Total bilirubin—slightly elevated D. Alanine aminotransferase

245. When an AMI occurs, in what order (list C. Moderately elevated LD

first to last) will the enzymes aspartate D. Markedly elevated CK

aminotransferase (AST), creatine kinase 124 • CHAPTER 1: CLINICAL CHEMISTRY

(CK), and lactate dehydrogenase (LD) 249. A 68-year-old male in an unconscious state

become elevated in the serum? is transported to the emergency department

A. AST, LD, CK after being involved in a one-car crash,

B. CK,LD,AST where he drove off the road and hit a tree.

C. CK,AST, LD Because he was alone at the time and there

D. LD, CK,AST was no apparent cause for the accident, it is

246. Which of the following is not associated assumed that he blacked out, which caused

with assessment of an AMI? Myoglobin

A. Elevated serum cTnl level Total CK

B. Elevated serum CK-MB level CK-MB

C. Abnormal serum alkaline phosphatase Troponin I

isoenzyme pattern 57 ng/mL

D. Blood collected upon presentation and 112U/L

serially in 3- to 6-hour intervals 3 ng/mL

247. If elevated, which laboratory test would 0.10 ng/mL

support a diagnosis of congestive heart 140 ng/mL

failure? 1 70 U/L

A. Homocysteine 6 ng/mL

B. Troponin 0.12 ng/mL

C. Albumin cobalt binding What do these test results suggest?

D. B-type natriuretic peptide A. The man had a myocardial infarction,

248. A 4-year-old male child is brought to the which caused the accident.

pediatrician because the parents are B. The elevated results are from the

concerned about the child's frequent skeletal muscle injuries sustained in

falling, which results in bruising. The the car crash.

parents indicate that the child has difficulty C. The elevated results are a combination

running, walking, standing up, climbing of the car crash injuries and a

stairs, and even sitting up straight. The myocardial infarction.

child also appears somewhat weak. Which D. The elevated total CK and CK-MB

of the following results is not consistent results indicate that the man had a

with the most likely diagnosis? stroke.

A. Moderately elevated AST 250. If elevated, which of the following is

B. Moderately elevated ALP associated with increased risk for

coronary heart disease? A. Elevated serum AST

A. Homocysteine B. Elevated serum ALT

B. Vitamin B6 C. Elevated plasma ammonia

C. Myoglobin D. Elevated serum bilirubin

D. pro-BNP REVIEW QUESTIONS • 125

him to lose control of the car. He was not 253. Which of the following enzyme activities

wearing a seat belt and has a broken leg, can be determined by using a dilute olive

multiple contusions, and cuts. Blood oil emulsion substrate, whose hydrolyzed

samples were drawn upon arrival to the product is monitored as a decrease in

ED and in 3-hour intervals for 12 hours; all turbidity or light scatter?

control values were within acceptable A. Alkaline phosphatase

range. Selected test results follow: B. Amylase

281 ng/mL C. Lipase

390 U/L D. Trypsin

8 ng/mL 254. Which of the following is not characteris

0.11 ng/mL tic of cystic fibrosis?

30-90 ng/mL A. Decreased bicarbonate concentration

15-1 60 U/L in duodenal fluid

0-5 ng/mL B. Decreased lipase activity in duodenal

<0.40 ng/mL fluid

251. Which statement best describes the C. Decreased amylase activity in

clinical use of measuring NT-proBNP? duodenal fluid

A. Used to assess risk of coronary heart D. Increased trypsin in feces

disease

B. Used to assess risk of angina

C. Used to assess individuals treated with

nesiritide

D. Used to assess individuals treated with

vitamin B

252. A 10-year-old female presents with

varicella. The child has been experiencing

fever, nausea, vomiting, lethargy, and

disorientation. A diagnosis of Reye

syndrome is determined. Which of the

following laboratory results is not

consistent with the diagnosis?