Clin Chem Exam 7 (Official) (copy)

A known heroin addict was administered naloxone in the field and transported to the emergency department. The patient's drug of abuse screen was positive for opiates by lateral flow immunoassay. However, the confirmatory test was negative for morphine. Which of the following drugs can provide a plausible explanation for these discrepant test results?

Select one:

a.Cocaine

b.Methamphetamine

c.Phencyclidine

d.Methadone

d.Methadone

A salicylate overdose leads to which of the following acid-base disorders?

Select one:

a.Metabolic acidosis

b.Metabolic alkalosis

c.Respiratory acidosis

d.Respiratory alkalosis

a.Metabolic acidosis

Heroin is synthesized from which of the following substances?

Select one:

a.Fentanyl

b.Morphine

c.Benzoylecgonine

d.Phencyclidine

• b.Morphine

What is the method used to confirm a positive drug of abuse screen?

Select one:

a.Lateral flow immunoassay

b.High-performance liquid chromatography

c.Gas chromatography/mass spectrometry

d.Ultraviolet absorption spectroscopy

c.Gas chromatography/mass spectrometry

Which of the following drugs blocks the reabsorption of serotonin and norepinephrine?

Select one:

a.Tricyclic antidepressants

b.Lysergic acid diethylamide

c.Cannabinoids

d.Cocaine

a.Tricyclic antidepressants

Which of the following gases has the highest affinity for hemoglobin?

Select one:

a.Sulfur

b.Oxygen

c.Carbon dioxide

d.Carbon monoxide

d.Carbon monoxide

Which of the following is a controlled synthetic opioid used in hospitals and is at risk for drug diversion?

Select one:

a.Salicylate

b.Fentanyl

c.Acetaminophen

d.Phenylpropanolamine

b.Fentanyl

Which of the following is a metabolite of cocaine?

Select one:

a.Tetrahydrocannabinol

b.Methylenedioxymethamphetamine

c.Benzoylecgonine

d.Ethylenediaminetetraacetic acid

c.Benzoylecgonine

Which of the following is the most reliable method to measure ethanol in the presence of isopropanol?

Select one:

a.Reaction with permanganate and chromotropic acid

b.Conway diffusion followed by dichromate reaction

c.Enzymatic method involving alcohol dehydrogenase

d.Gas-liquid chromatography

d.Gas-liquid chromatography

D 9-tetrahydrocannabinol is the principal active component of what drug?

Select one:

a.Ecstasy

b.Marijuana

c.Cocaine

d.Heroin

b.Marijuana

Absorption of vitamin B12 in the gastrointestinal tract requires the presence of which of the following?

Select one:

a.Gastrin

b.Intrinsic factor

c.Secretin

d.Folic acid

b.Intrinsic factor

A deficiency of what vitamin will produce abnormal bone mineralization and eventually lead to osteomalacia?

Select one:

a.Vitamin B12

b.Vitamin K

c.Vitamin C

d.Vitamin D

d.Vitamin D

An anemic patient has the following laboratory test results. What additional laboratory testing is recommended to make a definitive diagnosis?

B12: 150 ng/L(180-900 ng/L)

Folate: 5.0 µg/L (0.4-4.0 µg/L)

Select one:

a.Albumin

b.Methylmalonic acid

c.Gastrin

d.Biotin

b.Methylmalonic acid

Given the following results, what is the percent saturation?

Iron: 125 µg/dL

Transferrin: 250 mg/dL

TIBC: 280 µg/dL

Select one:

a.15%

b.30%

c.45%

d.60%

c.45%

Given the following results, what is the total iron binding capacity?

Iron: 100 µg/dL

Transferrin: 100 mg/dL

%Saturation: 50%

Select one:

a.50

b.85

c.100

d.118

d.118

The following laboratory results correlate with which of the following conditions?

Copper, Serum: 70 µg/dL (75-145)

Ceruloplasmin: 10 mg/dL (15-30)

Copper, Urine: 160 µg/day (10-60)

Select one:

a.Wilson's disease

b.Menkes disease

c.Copper deficiency

d.Copper toxicity

a.Wilson's disease

The following laboratory results correlate with which of the following conditions?

Iron: 250 (µg/dL50-150)

Transferrin: 190 mg/dL( 200-350)

Ferritin: 333 µg/L (20-300)

%Saturation: 75%(15-50)

TIBC: 212 µg/dL (250-400)

Select one:

a.Iron deficiency anemia

b.Hereditary hemochromatosis

c.Anemia of chronic infection

d.Malnutrition

b.Hereditary hemochromatosis

Which of the following vitamins is a fat-soluble vitamin?

Select one:

a.B2

b.B6

c.K

c.K

Which of the following vitamins is an essential dietary requirement for pregnant women to prevent neural tube defects in the fetus?

Select one:

a.Alpha-fetoprotein

b.Cyanocobalamin

c.Folate

d.Thiamine

c.Folate

A 60-year-old man has a PSA level of 4.5 ng/mL. What is the most appropriate course of action?

Select one:

a.Repeat PSA testing in 1 year

b.Order a free PSA test

c.Calculate cancer risk factor

d.Perform a prostate biopsy

b.Order a free PSA test

An elevated CSF concentration of neuron-specific enolase assists in the diagnosis of which of the following?

Select one:

a.Bacterial meningitis

b.Creutzfeldt-Jakob disease

c.Viral meningoencephalitis

d.Multiple sclerosis

b.Creutzfeldt-Jakob disease

Elevated carcinoembryonic antigen levels are commonly associated with what type of cancer?

Select one:

a.Breast cancer

b.Ovarian cancer

c.Colorectal cancer

d.Carcinoid tumors

c.Colorectal cancer

Elevation in serum calcitonin is associated with what type of cancer?

Select one:

a.Colorectal

b.Stomach

c.Thyroid

d.Ovarian

c.Thyroid

In which of the following conditions is the prostate-specific antigen most likely to fall within the reference range?

Select one:

a.Benign prostatic hypertrophy

b. Post -digital rectal examination

c. Post-radical prostatectomy

d.Acute prostatitis

c. Post-radical prostatectomy

What is the clinical significance of an elevated hCG result in a male patient?

Select one:

a.Patient misidentification

b.Incorrect test order

c.Prostate cancer

d.Testicular cancer

d.Testicular cancer

What is the primary purpose of clinical assays for tumor markers?

Select one:

a.Screening for the presence of cancer

b.Monitoring the course of a known cancer

c.Confirming the absence of disease

d.Identifying patients at risk for cancer

b.Monitoring the course of a known cancer

What oncofetal antigen is associated with liver cancer?

Select one:

a.CEA

b.hCG

c.AFP

d.PSA

c.AFP

Which of the following genetic markers is used to screen for susceptibility to breast cancer?
Select one:
a.Her-2/neu
b.BRCA-1/BRCA-2
c.Estrogen receptor
d. CA125

b.BRCA-1/BRCA-2

Which of the following tumor markers is useful for following patients with ovarian cancer?
Select one:
a. CA 15-3
b. CA19-9
c. CA 27-29
d. CA 125

d. CA 125

A proficiency testing kit for point-of-care glucose contained five whole blood samples. Ideally, how should the specimens be distributed to the testing personnel?

Select one:

a. One operator should perform all five samples on the same glucometer.

b. One operator should perform one sample on five different glucometers.

c.Five operators should perform one sample all on the same glucometer.

d.Five operators should perform one sample each on a different glucometer.

d.Five operators should perform one sample each on a different glucometer.

Comparing clinical laboratory testing and POC testing, which of the following data is inaccurate?
Select one:
a.A
b.B
c.C
d.D

d.D

Standards for device bidirectionality, device connection commonality, commercial software intraoperability, and regulatory compliance have been adopted by what organization?
Select one:
a.The Joint Commission
b.Clinical and Laboratory Standards Institute
c.National Committee for Clinical Laboratory Standards
d.National Accrediting Agency for Clinical Laboratory Science

b.Clinical and Laboratory Standards Institute

The Nova Stat Strip glucose meter is used at your healthcare institution. The proficiency testing results are compared against which of the following to determine acceptability?
Select one:
a.Mathematical mean of all point-of-care glucose methods
b.Mathematical mean of the manufacturer's package insert
c.Mathematical mean for the Nova Stat Strip peer group
d.Mathematical median for the proficiency testing provider

c.Mathematical mean for the Nova Stat Strip peer group

What is the greatest source of error in point-of-care testing?
Select one:
a.Competency assessment
b.Annual recertification process
c.Pre-analytical errors
d.Proficiency test results

c.Pre-analytical errors

What is the highest volume point-of-care test?
Select one:
a.Glucose
b.Prothrombin time
c.Hemoglobin
d.Hematocrit

a.Glucose

Which of the following certificates is issued to a laboratory and enables the entity to conduct moderate or high-complexity point-of-care laboratory testing?
Select one:
a.Certificate of waiver
b.Certificate of registration
c.Certificate of compliance
d.Certificate of accreditation

b.Certificate of registration

Which of the following is a proficiency testing provider for point-of-care tests?
Select one:
a.American Association of Blood Banks
b. College of American Pathologists
c.American Association of Clinical Chemistry
d.The Joint Commission

b. College of American Pathologists

Which of the following is a waived test procedure?
Select one:
a.Manual hematocrit
b.Enzyme immunoassay
c.ABO/Rh Blood typing
d.KOH prep

a.Manual hematocrit

Which of the following is not a required section of the standard operating procedure for a point-of-care test system?
Select one:
a.Package insert instructions
b.Troubleshooting guide
c.Critical values
d.Reference range

b.Troubleshooting guide

A neonatal bilirubin of 18.0 mg/dL is held in the total laboratory automation middleware. What is the next step?

A. Repeat the bilirubin test
B. Call the critical result
C. Perform a dilution
D. Cancel the test

B. Call the critical result

A newborn had the following urinalysis test results. What is the most probable explanation for these results?

A. Galactosemia
B. Maple syrup urine disease
C. Tyrosinemia
D. Homocystinuria

A. Galactosemia

Elevated sweat chloride is associated with which disease?

A. Alpha-1 antitrypsin deficiency
B. Cystic fibrosis
C. Phenylketonuria
D. Congenital adrenal hyperplasia

B. Cystic fibrosis

Pediatricians recommend the use of Tylenol over aspirin in children in order to prevent which of the following complications characterized by hyperammonemia?

A. Kawasaki disease
B. Reye's syndrome
C. Guillain–Barré syndrome
D. Hemolytic uremic syndrome

B. Reye’s syndrome

Pediatric patients typically will have elevated results for which of the following enzymes due to bone growth?

A. AST
B. ALT
C. Alkaline phosphatase
D. LDH

C. Alkaline phosphatase

The glomerular filtration rate in the neonate is what percentage of the adult?

A. 10%
B. 25%
C. 50%
D. 75%

B. 25%

What is the specimen of choice and principle of the test for diagnosing congenital rubella?

A. Cord blood for IgG antibodies
B. Maternal serum for IgM antibodies
C. Amniotic fluid for viral culture
D. Neonatal serum for IgM detection

D. Neonatal serum for IgM detection

Which of the following blood-gas results would be expected in a premature infant with respiratory distress syndrome?**
A. Increased pH, decreased pCO₂
B. Decreased pH, increased pCO₂
C. Normal pH, decreased pCO₂
D. Normal pH, normal pCO₂

B. Decreased pH, increased pCO₂

Which of the following conditions is likely to occur after a diabetic pregnant female on a regimented insulin schedule delivers her baby?

A. Neonatal hyperbilirubinemia
B. Neonatal hyperphosphatemia
C. Neonatal metabolic alkalosis
D. Neonatal hypoglycemia

D. Neonatal hypoglycemia

Which of the following is measured by tandem mass spectrometer when screening for phenylketonuria?

A. Fatty acid
B. Steroid hormone
C. Amino acid
D. Organic acid

C. Amino acids

Decreased pulsatile secretion of which of the following diminishes with age, resulting in a decrease in lean body mass/fat ratio, as well as loss of overall body mass?

A. Thyroid hormone
B. Growth hormone
C. Cortisol
D. Insulin

B. Growth hormone

The laboratory results, from an 84-year-old female, are evaluated by the healthcare provider. What additional laboratory test may assist in differential diagnosis for this patient?

A. Lactate
B. Ethanol level
C. Albumin
D. Triglycerides

C. Albumin

The reference range for which of the following analytes remains unchanged in the geriatric population?

A. Glucose
B. Creatinine
C. BNP
D. Magnesium

A. Glucose

The shingles vaccine is recommended for adults 50 years of age and older to prevent infection from which of the following pathogens?

A. Herpes varicella zoster virus
B. HPV
C. Measles virus
D. Influenza virus

A. Herpes varicella zoster virus

Which of the following hormones declines in the aging population and may cause orthostatic hypotension and a drop in blood pressure upon standing?

A. Thyroxine
B. Aldosterone
C. Estrogen
D. Vasopressin

B. Aldosterone

Which of the following is a common problem in the elderly but is often more difficult to diagnose?

A. Cushing syndrome
B. Hyperparathyroidism
C. Hypothyroidism
D. Hyperthyroidism

C. Hypothyroidism

Which of the following is a complication of severe dehydration seen in the elderly?

A. Cataracts
B. Thrombocytosis
C. Metabolic alkalosis
D. Delirium

D. Delirium

Which of the following is the leading cause of death in the United States in individuals 65 years of age?

A. Stroke
B. Cancer
C. Alzheimer disease
D. SARS-CoV-2

D. SARS-CoV-2

Which of the following poses the greatest challenge when collecting blood from an elderly patient?

A. Needle phobia
B. Dehydration
C. Anxiety
D. Excessive bruising

B. Dehydration