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Clinical Chemistry 2 PART 1

Total questions: 87

Worksheet time: 44mins

Name
Class
Date
1.

The normal serum osmolality is approximately within:

a)

180 – 220 mOsm/kg

b)

135 – 145 mOsm/kg


c)

350 – 370 mOsm/kg


d)

280 – 300 mOsm/kg

2.

Free drug levels can generally be determined by analyzing what body fluid?

a)

plasma ultrafiltrate

b)

PFF of plasma

c)

whole blood

d)

urine

3.

Most of the carbon dioxide present in blood is in the form of:

a)

carbonic acid

b)

dissolved CO2

c)

carbonate

d)

bicarbonate ion

4.

Which of the following drugs is used as bronchodilator?

a)

Phenytoin

b)

Clozapine

c)

Theophylline

d)

Amikacin

5.

O-cresolphthalein (OCP) forms a colored complex with

a)

calcium

b)

magnesium

c)

chloride

d)

copper

6.

Which substance has the least contribution to serum osmolality?

a)

glucose

b)

sodium

c)

nonprotein nitrogenous

d)

albumin

7.

Which organ does not directly participate in the regulation of plasma osmolality?

a)

liver

b)

adrenals

c)

heart

d)

kidney

8.

Interpret the following blood gas results: pH = 7.26, dissolved CO2 = 2.0 mmol/L (NV: pCO2 = 35 – 45 mmHg), HCO3- = 30 mmol/L (NV: HCO3 = 21 – 28 mmol/L).

a)

Metabolic alkalosis

b)

Respiratory acidosis

c)

Respiratory alkalosis

d)

Metabolic acidosis

9.

Reactions in renal tubular cells which contribute to acid-base balance include all, except

a)

Ammonia production from glutamine

b)

Exchange for Na+ in tubular filtrate for H+ in extracellular fluid

c)

Bicarbonate production form the carbonic anhydrase reaction

d)

Reabsorption of H2O due to stimulation by antidiuretic hormone

10.

What is the recommended name for diphenylhydantoin?

a)

Carbamazepine

b)

Phenytoin

c)

Nalorphine

d)

Primidone

11.

The best specimen to collect for acute poisoning due to abused drugs is

a)

gastric lavage

b)

whole blood

c)

serum

d)

urine

12.

The dissociation constant of carbonic acid in plasma at 37°C is *

a)

7.4

b)

7.2

c)

6.8

d)

6.1

13.

Calcium concentration in the serum is regulated by;

a)

thyroxine

b)

parathyroid hormone

c)

insulin

d)

vitamin C & D

14.

The following laboratory results were obtained on arterial blood: Sodium = 136 mEq/L pH = 7.32 Potassium = 4.4 mEq/L PCO2 = 79 mmHg Chloride = 92 mEq/L Bicarbonate = 40 mEq/L. These results are most compatible with:

a)

Respiratory alkalosis

b)

Respiratory acidosis

c)

Metabolic alkalosis

d)

Metabolic acidosis

15.

With a serum osmolality of 345 mOsm/L and a normal BUN and glucose, you would expect: *

a)

Hyperglycermia

b)

Hyponatremia

c)

Hypoproteinemia

d)

Hypernatremia

16.

Which of the following is an antiarrhythmic drug with a metabolite with the same function?

a)

Nortriptyline

b)

Procainamide

c)

Quinidine

d)

Digoxin

17.

What is the pCO2 if the dissolved CO2 is 1.8 mmol/L?

a)

60 mmHg

b)

72 mmHg

c)

35 mmHg

d)

24 mmHg

18.

Which of the following is consistent with uncompensated metabolic acidosis?

a)

pH 7.30 HCO3- 16 mmol/L pCO2 28 mmHg

b)

pH 7.34 HCO3- 18 mmol/L pCO2 32 mmHg

c)

pH 7.45 HCO3- 22 mmol/L pCO2 40 mmHg

d)

pH 7.25 HCO3- 15 mmol/L pCO2 35 mmHg

19.

Determine the anion gap given the serum electrolyte data: Na = 132 mmol/L, CI = 90 mmol/L, HCO3 = 22 mmol/L.

a)

Cannot be determined

b)

2 mmol/L

c)

1 mmol/L

d)

0 mmol/L

20.

The T3 resin uptake test is a measure of: *

a)

total thyroxine-binding globulin

b)

binding capacity of thyroxine-binding globulin

21.

The Zinc protoporphyrin/ Heme ratio (ZPP/H) is an index for effectiveness of therapy for

a)

iron deficiency anemia

b)

megaloblastic anemia

c)

iron toxicity

d)

lead and arsenic poisoning

22.

Kernicterus is an abnormal accumulation of bilirubin in:

a)

Liver tissue

b)

Heart tissue

c)

Kidney tissue

d)

Brain tissue

23.

Which serum component is able to alter the free drug level in plasma?

a)

albumin

b)

urea

c)

creatinine

d)

calcium

24.

Reinsch test can detect poisoning from

a)

organophosphates

b)

arsenic

c)

alcohol

d)

carbon monoxide

25.

The metal that forms a complex with sulfonated bathophenanthroline 2,4,6- tripyridylS-triazine is

a)

magnesium

b)

iron

c)

copper

d)

calcium

26.

The transport protein associated with bilirubin in the blood is

a)

albumin

b)

gamma globulin

c)

beta-globulin

d)

alpha 1-globulin

27.

Increased trough levels of acetaminophen in the serum are often associated with toxic effects to what organ?

a)

heart

b)

kidney

c)

liver

d)

pancreas

28.

Which of the following is a cause of metabolic alkalosis?

a)

excessive vomiting

b)

late stage of salicylate poisoning

c)

renal failure

d)

uncontrolled diabetes mellitus

29.

Which of the following will shift the oxyhemoglobin dissociation curve to the left?

a)

Metabolic Acidosis

b)

Bicarbonate infusion

c)

Pernicious Anemia

d)

Dengue Fever

30.

An epileptic patient receiving phenytoin develops acute glomerulonephritis (AGN). What change, if any, would be expected in the patient’s circulating drug level?

a)

decrease in free drug

b)

increase in free drug

c)

no change in circulating drug level

d)

increase in protein-bound drug

31.

The Trinder reaction is widely used for the colorimetric determination of

a)

salicylate

b)

phenothiazine

c)

acetaminophen

d)

barbital

32.

In a patient who is suspected of having pheochromocytoma, measurement of which of the following would be most useful?

a)

HVA

b)

5’-HIAA

c)

VMA

d)

Δ9-THC

33.

Fasting serum phosphate concentration is controlled primarily by the :

a)

small intestine

b)

parathyroid glands

c)

pancreas

d)

skeleton

34.

An increase in aldosterone is usually accompanied by:

a)

Hyperkalemia

b)

Increased water loss

c)

Hyponatremia

d)

Hypokalemia

35.

Neuromuscular irritability depends in part on the extracellular fluid concentration of

a)

Complexed calcium

b)

Ionized calcium

c)

Protein-bound calcium

d)

Total calcium

36.

Blood gases are drawn with the following results:pH = 7.58 PCO2 = 55 mmHg HCO3- = 18 mM. What do these data indicate?

a)

dual problem of acidosis

b)

respiratory acidosis

c)

uncompensated metabolic alkalosis

d)

partially compensated

e)

intrumental error

37.

The major intracellular anion is

a)

chloride

b)

bicarbonate

c)

potassium

d)

sodium

38.

What abused drug is acidic among these?

a)

NAPA

b)

Phenobarbital

c)

Marijuana

d)

Acetazolamide

39.

Post-hepatic jaundice may be due to

a)

neoplasm of the liver

b)

Crigler-Najjar syndrome

c)

viral hepatitis

d)

Alcoholic cirrhosis

40.

The hormones referred to as 18-carbon steroids with unsaturated A ring are

a)

glucocorticoids

b)

estrogens

c)

mineralcorticoids

d)

androgens

41.

The bicarbonate ion concentration may be calculated from the total CO2 and PCO2 blood levels by using which of the following formulas?

a)

0.03 x (PCO2 - total CO2)

b)

0.03 x (total CO2 - PO2)

c)

total CO2 - (0.03 X PCO2)

d)

(total CO2 + 0.03) X PCO2

42.

Which of the following is not associated with spirometry?

a)

Friedewald equation

b)

Henderson-Hasselbalch equation

c)

Alveolar air equation

d)

Henry's law

43.

What is the confirmatory method for measuring drugs of abuse?

a)

EMIT

b)

TLC

c)

HPLC

d)

GC-MS

44.

Which of the following conditions will cause an increased anion gap?

a)

Lactate acidosis

b)

Renal failure

c)

Diabetes mellitus

d)

All of these

45.

The major anion in the extracellular fluid originated from the:

a)

liver

b)

diet

c)

gastric lumen

d)

kidneys

46.

In what form must a drug be in order to elicit a pharmacologic response?

a)

unbound

b)

bound to albumin

c)

bound to globulins

d)

bound to fatty acids

47.

Calmagite and titan yellow are specifically used to determine the concentration of serum

a)

chloride

b)

calcium

c)

phosphorus

d)

magnesium

48.

The most likely explanation for a urease BUN result of zero is:

a)

Instrument was not properly zeroed

b)

Patient is in renal crisis

c)

Sample was collected in improper anticoagulant

d)

Incubation temperature was too low

49.

Aminoglycosides & other antibiotics are particularly toxic to what organ?

a)

heart

b)

liver

c)

spleen

d)

kidney

50.

Blood gases are drawn with the following results:pH = 7.25 PCO2 = 56 mmHg HCO3- = 16 mM. What do these data indicate?

a)

respiratory acidosis, uncompensated

b)

dual problem of acidosis

c)

metabolic alkalosis, partially compensated

d)

error in one of the blood gas measurements

51.

Which reagent would not dissolve indirect bilirubin?

a)

dimethylsulfoxide (DMSO)

b)

caffeine-benzoate

c)

methanol

d)

water

52.

Which of the following is an example of a long-acting barbiturate?

a)

Pentobarbital

b)

Phenobarbital

c)

Secobarbital

d)

Amobarbital

53.

Which body compartment has the highest fraction of water?

a)

Hollow organs

b)

Interstitial

c)

Intracellular

d)

Plasma

54.

Which of the following compounds has a sedative effect and used to treat anxiety?

a)

Cannabinoids

b)

Amphetamine

c)

Benzodiazepine

d)

Opiates

55.

What is the active metabolite of the antiarrhythmic drug procainamide?

a)

PEMA

b)

Pronestyl

c)

NAPA

d)

Disopyramide

56.

The highest levels of gonadotropins occur

a)

at the midpoint of the menstrual cycle

b)

several days prior to ovulation

c)

during follicular phase of the menstrual cycle

d)

during follicular phase of the menstrual cycle

57.

When is a blood sample for determination of the trough level of a drug appropriately drawn?

a)

two hours after drug administration

b)

during the distribution phase of a drug

c)

shortly before drug administration

d)

during the absorption phase of the drug

58.

Blood gases are drawn with the following results:pH = 7.29 PCO2 = 50 mmHg HCO3- = 25 mM. What do these data indicate?

a)

respiratory acidosis, uncompensated

b)

metabolic alkalosis, partially compensated

c)

dual problem of acidosis

d)

error in one of the blood gas measurements

59.

To obtain the anion gap, the levels of which of the following is not needed?

a)

chloride and bicarbonate

b)

sodium and potassium

c)

plasma proteins

d)

major cations

60.

The iontophoresis for cystic fibrosis determines the levels of sweat

a)

chloride and potassium

b)

sodium and chloride

c)

chloride and bicarbonate

d)

sodium and potassium

61.

The extracellular concentration of potassium is

a)

100 mmol/L

b)

50 mmol/L

c)

135 mmol/L

d)

5 mmol/L

62.

The Fiske-Subbarow method for inorganic phosphorus is based upon the reaction of inorganic phosphorus with:

a)

Potassium oxalate

b)

O-cresolphthalein

c)

Ammonium molybdate

d)

Mercuric nitrate

63.

If the ratio of bicarbonate to carbonic acid is 30:1, what would the blood pH be?

a)

decreased

b)

increased

c)

normal

d)

stable

64.

Which test is not a colorimetric method for the quantitation of an electrolyte?

a)

Albanese-Len

b)

Lockhead-Purcell

c)

Fiske-Subbarrow

d)

Daly-Ertingshausen

65.

The indicator used in the Schales and Schales method of chloride measurement is

a)

permanganate

b)

phenolsulfonphthalein

c)

periodate

d)

diphenylcarbazone

66.

The prostatic ACP is characterized by the following, except:

a)

It is associated with prostatic cancer

b)

It is tartrate-stable

c)

It is not affected by Cu++ ions

d)

It is formol-stable

67.

Blood gases are drawn with the following results:pH = 7.49 PCO2 = 59 mmHg HCO3- = 38 mM. What do these data indicate?

a)

error in one of the blood gas measurements

b)

metabolic alkalosis, partially compensated

c)

respiratory acidosis, uncompensated

d)

dual problem of acidosis

68.

One international unit of enzyme activity is the amount of enzyme that, under specified reaction conditions of substrate concentration, pH, and temperature, causes utilization of substrate at the rate of:

a)

1 nanomole/min

b)

1 millimole/min

c)

1 mole/min

d)

1 micromole/min

69.

Which of the following is an example of a phenothiazine drug?

a)

Cyclosporine

b)

Theophylline

c)

Phenytoin

d)

Chlorpromazine

70.

The formula for calculating serum osmolality that incorporates a correction for the water content of plasma is:

a)

Na + [(2xGlucose)/20] x (BUN/3)

b)

2 Na + Glucose/20 + (BUN/3)

c)

2 Na + Glucose/3 +(BUN/20)

d)

2 Na x (Glucose/20) x (BUN/3)

71.

In the colon, bilirubin is converted to:

a)

bilirubin diglucuronide

b)

conjugated bilirubin

c)

bilirubin-albumin complex

d)

urobilinogen

72.

Select the polypeptide chain combination designated LD3.

a)

M2H2

b)

H4

c)

MH3

d)

M4

73.

The hormone responsible for retention of water in the kidney tubules is:

a)

ADH

b)

Aldosterone

c)

Both

d)

Neither

74.

Which of the following statements can be associated with the enzymatic assay of ammonia?

a)

reaction catalyzed by glutamate dehydrogenase

b)

NAD required as a cofactor

c)

ammonium ion isolated from specimen before the enzymatic step

d)

increase in absorbance monitored at 340 nm

75.

The urinary excretion product measured as an indicator of epinephrine production is;

a)

homovanillic acid

b)

dopamine

c)

dihydroxyphenylalanine (DOPA)

d)

vanillylmandelic acid

76.

Which of the following is used to treat manic depression?

a)

calcium

b)

potassium

c)

lithium

d)

chloride

77.

In the Evelyn-Malloy method for the determination of serum bilirubin concentration, quantitation is obtained by measuring the:

a)

Purple azobilirubin

b)

Green azobilirubin

c)

Red azobilirubin

d)

Blue azobilirubin

78.

The reference method for the quantitation of ionized calcium in blood is

a)

AAS

b)

AAS

c)

EFP

d)

ISE

79.

Serum “anion gap” may be decreased in patients with

a)

Renal tubular acidosis

b)

Lactic acidosis

c)

Metabolic acidosis due to diarrhea

d)

Diabetic alkalosis

80.

Which of the following mechanisms is responsible for metabolic acidosis? 

a)

Hyperaldosteronism

b)

Accumulation of volatile acids

c)

Excessive retention of dissolved CO2

d)

Bicarbonate deficiency

81.

The cofactor needed in the catalyzed reaction by hexokinase is

a)

copper

b)

calcium

c)

manganese (Mn)

d)

magnesium (Mg)

82.

In the sweat test, the sweating stimulant is introduced to the skin by application of:

a)

filter paper moistened with pilocarpine nitrate

b)

an electric current

c)

copper eclectrodes

d)

filter paper moistened in deionized water

83.

The major androgen produced in the adrenal cortex is

a)

androstenedione

b)

dehydroepiandrosterone

c)

testosterone

d)

dihydroxytestosterone

84.

Which of the following is NOT true?

a)

Chloride concentration in normal CSF is greater than that in serum.

b)

Normal chloride concentration in CSF ranges from 115-132 mmol/L.

c)

Chloride concentration in normal CSF is less than that in serum.

d)

Normal blood chloride does not reflect always a normal CSF chloride

85.

Total iron-binding capacity measures the serum iron transporting capacity of:

a)

Ceruloplasmin

b)

Hemoglobin

c)

ferritin

d)

transferrin

86.

Which two conditions can “physiologically” elevate serum alkaline phosphatase?

a)

healing fractures, pregnancy

b)

viral hepatitis, infectious

c)

mononucleiosis rickets, hyperparathyroidism obstructive

d)

jaundice, biliary cirrhosis

87.

The main determinant of plasma colloid osmotic pressure is;

a)

protein

b)

glucose

c)

electrolyte

d)

urea