Chem Exam 3 Quizzes with Practice Quiz 10

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Patinet with suspected primary hyperthyridism associated with Graves' disease, one would expect the following lab serum results: T4___, TSH _____

Normal, increased Increased, increased Decreased, normal Increased, decreased Increased, normal

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Patinet with suspected primary hyperthyridism associated with Graves' disease, one would expect the following lab serum results: T4___, TSH _____

Normal, increased Increased, increased Decreased, normal Increased, decreased Increased, normal

increased, decreased

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Major fraction of organic iodine circulating in the blood is triiodothyronine diiodotyrosine tetraiodothyronine thyroglobulin

tetraiodothyronine

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During pregnancy, serum TBG concentration ..........., total thyroid hormone levels are ..........., and free thyroid hormone levels are ........... a. is unaffected, increased, increased b. decreases, decreases, unaffected c. is unaffected, decreased, decreased d. increases, increased, unaffected

d. increases, increased, unaffected

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Which one of the following statements about T3 is FALSE? a.It may be elevated to a greater extent than T4 in hyperthyroidism. b. It is commonly decreased in patients with nonthyroidal illness. c. It is thought to be the most active thyroid hormone. d. It is not bound to serum proteins.

d. It is not bound to serum proteins.

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The old T3 resin uptake test has been replaced by a direct assay for: a. thyroglobulin b. binding capacity of thyroxine-binding globulin c. circulating free t3 d. thyroxine-binding globuline e. bound t3

bound t3

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A two-year-old child with a decreased serum T4 is described as being somewhat dwarfed, stocky, and overweight and having coarse features. Of the following, the most informative additional laboratory test would be serum: a. TSH b. T3 c. cholesterol

TSH

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What tests are used as part of newborn screening programs to identify congenital hypothyroidism? a. t3 and/or tsh b. t4 and or tsh c. t3 and/t4

b. t4 and.or tsh

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The TRH (thyrotropin releasing hormone) stimulation test is useful in differentiating hypothalamic hypothyroidism from: a. pituitary hypothyroidism b. primary hypothyroidism c. hashimoto's thyroiditis

a. pituitary hypothyroidism

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True or false? When taken by a euthyroid individual, oral contraceptives will have an increasing effect on thyroxine binding globulin.

true

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True or false? Individuals taking recurring regimens of androgens or anabolic steroid drugs may exhibit increased TBG levels.

false

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The primary physiological regulator of parathyroid hormone (PTH) synthesis and secretion is: a. pth stimulating hormone b. concentration of pth in blood c. concentration of free calcium in blood or extracellular fluid

c. concentration of free calcium in blood or extracellular fluid

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Hypoparathyroidism is most commonly caused by: a. parathyroid glad destruction b. resistance to parathyroid hormone c. adenoma of the parathyroid gland

a. parathyroid glad destruction

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What makes up the organic matrix component of bone? a. cells only b. calcium protein and collegen c. minerals and cells only

b. calcium protein and collagen

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In bone a. calcium is complexed with bicarbonate b. osteoblasts are the bone forming cells c. collagen component is type 2 collagen

osteoblasts

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An individual’s serum phosphate level is decreased but his physician cannot determine a physiological basis for this abnormal result. What could possibly have caused this result? a. specimen hemolysis b. diurnal variation c. use of IV carbohydrate therapy to stimulate insulin secretion

c. use of IV carbohydrate therapy to stimulate insulin secretion

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Hypercalcemia occurs in humoral hypercalcemia of malignancy (HHM) because: a. pth-related protein (PTHrP) is synthesized by tumors and stimulates bone resorption b. osteoclasts bind tumor marker proteins and the process of bone remodeling becomes unregulated c. metastasizing cells synthesize calcium and release it into circulation

a. pth-related protein (PTHrP) is synthesized by tumors and stimulates bone resorption

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The clinical usefulness of calcitonin measurement is: a. as a tumor marker for medullary thyroid carcinoma b. in the determination of sources of vitamin d deficiency c. in the assessment of primary hyperparathyroidism

a. as a tumor marker for medullary thyroid carcinoma

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Which one of the following diseases is characterized by a loss in bone mass? a. rickets b. osteoporosis c. osteomalacia

osteoporosis

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Which one of the following analytes is most useful in distinguishing primary from secondary hyperparathyroidism? a. parathyroid hormone b. vitamin d c. serum calcium

vitamin d

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A factor that would alter protein binding of calcium and its redistribution among the three plasma pools would be: a. an altered anion gap b. a change in an individual's posture c. liver disease

liver disease

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What causes the total thyroxine (T4) levels to be increased in pregnant women? a. change in thyroglobulin synthesis b. altered glucose metabolism c. hcg-induced thyrotoxicosis

hcg induced thyrotoxicosis

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Which one of the following is not a function of the thyroid hormones? a. removal of defective rbcs b. control of metabolic rate c. stimulation of neural development d. increasing cholesterol synthesis and breakdown

a. removal of defective rbcs

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Another term used to describe hyperthyroidism is: a. euthyroid sick syndrome b. goiter c. thyrotoxicosis

thyrotoxicosis

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Severe hypothyroidism that develops during the newborn period is referred to as: a. myxedema b. cretinism c. thyrotoxicosis

cretinism

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The limited clinical information that is available from the results of a total T4 measurement is due to: a. the fact that circadian rhythms are not determined b. interferences with circulating autoantibodies directed against the colloid c. the fact that total t4 measurements reflect inactive, protein bound hormone

c. the fact that total t4 measurements reflect inactive, protein bound hormone

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A woman with thyroid cancer has her thyroglobulin (Tg) level checked to assess return of thyroid function following surgery. The Tg value was markedly decreased. Her physician calls the laboratory asking for an explanation of the result. You respond that: a. your lab uses a tg assay that likely has been interfered with by tg autoantibodies which limits the accurate measurement of tg b. tg is probably being interfered with by the immunoglobulins that are involved in the healing postsurgery process c. thyroid cancer obliterates all colloid in the thyroid gland and therefore tg will not be present in a blood sample

a. your lab uses a tg assay that likely has been interfered with by tg autoantibodies which limits the accurate measurement of tg

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There is concern that the upper reference interval value for TSH is set too high to detect subtle hypothyroid disease. It is suggested that the upper reference interval value be reduced to what level to address this concern? a. 5.0 mU/L b. 2.0 mU/L c. 4.o mU/L d. 3.0 mU/L

3.0 mU/L

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Which of the following thyroid hormones is considered to be the most active physiologically? a. T3 b. T4 c. DIT

T3

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Which of the following laboratory tests is most useful in distinguishing between hypothalamic and pituitary causes of thyroid dysfunction? a. TSH b. T4 c. T3

TSH

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In patients with developing subclinical hyperthyroidism, TSH levels will likely be …………….., and fT4 will likely be ………………... a. increased, decreased b. decreased, decreaed c. decreased, normal

decreased, normal

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After treatment with medication or radioactive iodine is initiated for hyperthyroidism, disease activity is best initially monitored with………., because ………….. will take several weeks or more to return to the reference interval. a. ft3 and ft4, tsh b. tsh, t4 and t3 c. serum iodine, tsh d. tsh, ft3 and ft4

a. ft3 and ft4, tsh

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Which of the following thyroid hormones normally peak at 24 to 36 hours post-delivery in a newborn and gradually fall over the first 4 weeks of life? a. ft4 b. t3 c. total t4 d. all of the above

d. all of the above

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The following laboratory data are suggestive of which clinical situation? TSH – decreased; T4 – decreased; T3 – decreased; rT3 – increased a. euthyroid sick syndrome b. development of a goiter c. graves' disease

a. euthyroid sick syndrome

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Given the following characteristics, which disease state is most likely? TSH – increased; fT4 – increased; fT3 – increased; T3RU – decreased; TSI – negative; TPO-ab – unlikely to be positive; Thyroid scan uptake – increased a. primary hypothyroidism b. autoimmune thyroiditis c. secondary hyperthyroidism

secondary hyperthyroidism

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When free thyroxine cannot be measured directly, the free thyroxine index (FT4I) may be calculated by using which measured laboratory data? a. t4 and t3 resin uptake b. t3 and t3 resin uptake c. tsh and t4

a. t4 and t3 resin uptake

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The T3 resin uptake test is used to measure: a. tbg b. total t3 c. free t3

tbg

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Which of the following forms of thyroxine would be the least available to tissue receptors? a. thyroxine free in the circulation b. thyroxine bound to thyroxine-binding globulin in the circulation c. thyroxine bound to prealbumin in hthe circulation

b. thyroxine bound to thyroxine-binding globulin in the circulation

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Increased TSH, decreased T3, and decreased T4 with the presence of goiter indicate: a. tertiary hypothyroidism b. secondary hypothyroidism c. primary hypothyroidism

primary hypothyroidism

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What is required for normal thyroxine synthesis? a. iodine and thyroid binding globulin b. tsh, iodine, and thyroglobulin c. iodine and thyroglobuline

b. tsh, iodine, and thyroglobulin

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The secretory unit of the thyroid gland is the: a. parafollicular cell b. colloid c. thyroid follicle

c. thyroid follicle

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Which amino acid residue of thyroglobulin is responsible for binding iodine in the formation of thyroid hormones? a. tyrosine b. phenylalanine c. guanidine

a. tyrosine

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Thyroid hormones exert influence in most areas of the body. How do thyroid hormones influence the heart? a. they cause peripheral hemodynamic alterations that influence cardiac function b. they affect cardiac gene expression c. they influence the sensitivity of the heart to the sympathetic nervous system d. all of the above

all of the above

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A blood specimen is collected in a heparin-containing tube for calcium and magnesium determination. Upon centrifugation, the plasma appeared hemolyzed. How would this affect the magnesium value? a. because erythrocytes contain magnesium, hemolysis would increase its apparent value b. there would be no effect on the magnesium value c. the magnesium would be incorporated into the bilirubin molecule, leading to a false negative value

a. because erythrocytes contain magnesium, hemolysis would increase its apparent value

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When a drug concentration exceeds the available metabolic capacity of the body, what does the drug’s metabolism become dependent on? a. the number of doses given per hour b. the health of the renal system c. the drug concentration itself d. the amount of metabolizing enzyme

d. the amount of metabolizing enzyme

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a carbonate salt of which drug is used to control manic depressive disorders

a. digoxin b. phenytoin c. acetaminophen d. lithium

d. lithium

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which of the following could account for drug toxicity following a prescribed dose? a. decreased renal elimination leading to increased free drug concentration b. increased drug metabolism caused by central nervous system disease c. using a different route of administration that is typically used for that drug

a. decreased renal elimination leading to increased free drug concentration

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The fraction of drug absorbed into a physiological system that is based on the amount of drug given is referred to as: a. steady state b. dosing c. bioavailability d. volume of distribution

c. bioavailability

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If a drug is acidic in nature, which of the following proteins will it associate with primarily for transport and distribution? a. albumin b. lipoprotein c. alpha1 glycoprotein d. all of the above

a. albumin

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The therapeutic range of a drug is: a. dependent on the route of drug administration b. the range of concentration within which the drug is effective yet not toxic c. the range of concentration at which there are no drug interactions d. dependent on renal function

b. the range of concentration within which the drug is effective yet not toxic

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The period of time during which the concentration of a therapeutic drug decays by 50% is referred to as the drug’s: a. volume of distribution b. half-life c. dosing curve d. subtherapeutic range

b. half-life

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The steady state of a drug is defined as the: a. metabolism of a drug with a high hepatic extraction rate by the liver before it reaches the systemic circulation b. time required for one half of an administered drug to be lost through metabolism and elimination c. point at which the body concentration of the drug is in equilibrium with the rate of dose administered and rate of elimination

c. point at which the body concentration of the drug is in equilibrium with the rate of dose administered and rate of elimination

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Respiratory alkalosis is a clinical feature of overdose ingestion of salicylate because: a. salicylates induced hyperventilation b. salicylates enhance glycolysis c. uncoupling of oxidative phosphorylation occurs in all cells

a. salicylates induced hyperventilation

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An individual is found unconscious with two empty pill bottles nearby, one of aspirin and the other of phenobarbital. The best antidote for this type of double drug overdose would be: a. n-acetylcysteine b. forced alkaline diuresis c. hemodialysis

b. forced alkaline diuresis

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An anticonvulsant used to control tonic-clonic (grand mal) seizures is: a. digoxin b. phenytoin c. lithium

b. phenytoin

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A drug that relaxes the smooth muscles of the bronchial passages is: a. acetaminophen b. lithium c. theophylline

theophylline

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Which one of the following immunosuppressant prodrugs inhibits inosine monophosphate dehydrogenase (IMPDH) to reduce the pool of intracellular guanine nucleotides and arrest T-cell proliferation? a. tacrolimus b. mycophenolate mofetil c. imipramine

b. mycophenolate mofetil

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A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing the force and velocity of myocardial contraction is: a. digoxin b. acetaminophen c. lithium d. phenytoin

a. digoxin

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The main reason for suboptimal drug levels in therapeutic drug monitoring is: a. liver failure b. improper dosage prescribed c. patient noncompliance with dosage regimen d. renal failure

c. patient noncompliance with dosage regimen

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Bioavailability of a drug refers to the: a. drug transformation b. availability of the protein bound fraction of the drug c. extent and rate at which the active drug reaches target tissues d. availability for therapeutic administration

c. extent and rate at which the active drug reaches target tissues

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A class III antiarrhythmic drug that acts by blocking potassium channels and that is used to manage atrial fibrillation is: a. quinidine b. digoxin c. amiodarone d. procainamide

c. amiodarone

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Cocaine is subject to recreational abuse because it: a. depresses the cns but not the peripheral nervous system, depending on the blood ethanol concentration to produce euphoria and decrease inhibition b. blocks dopamine reuptake at nerve synapses and prolongs the action of dopamine in the cns, leading to feelings of euphoria c.has CNS depressant effects resulting in sedation and hypnosis, and increases growth hormone release.

b. blocks dopamine reuptake at nerve synapses and prolongs the action of dopamine in the cns, leading to feelings of euphoria

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A positive urine immunoassay screening test for a drug of abuse must be confirmed by: a. gc-ms b. electrophoresis c. spot test

gc-ms

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The laboratory method of analysis that is accurate and precise for very low concentrations of carbon monoxide is: a. spectrophotometry b. gas chromatography c. immunoassay

b. gas chromatography

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The method of monitoring therapeutic drug concentrations that is replacing HPLC-based methods and is now considered to be the best technology for analysis of biological specimens with high specificity and fewer interferences is: a. hplc b. liquid chromatography-mass spec c. spectrophotometry d. gas-liquid chroomatography

b. liquid chromatography-mass spec

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For a therapeutic drug that has a short half-life, for example levetiracetam, when is the appropriate time to collect a blood sample for therapeutic drug assessment? a. there is no specific time that is best b. immediately before a dose of drug is given c. immediately after a dose of drug is given

b. immediately before a dose of drug is given

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The name given to the group of enzymes that are particularly involved in phase I metabolism of drugs and that involve reduction/oxidation or hydrolysis is: a. cytochromes p-450 b. glucuronyltransferases c. methyltransferases

a. cytochromes p-450

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What is the major metabolite of acetaminophen that is formed in the liver? a. sulfanilic acid b. glucuronide c. formic acid

b. glucuronide

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In a clinical laboratory without gas chromatography instrumentation, the common method of choice used to measure ethanol in serum or plasma is a(n): a. enzymatic analysis using alcohol dehydrogenase and measurement of nicotinamide adenine dinucleotide formation b. immunoassay using antibodies dirrected against acetaldehyde c. potentriometric measurement of changes in voltage potential across electrodes

a. enzymatic analysis using alcohol dehydrogenase and measurement of nicotinamide adenine dinucleotide formation

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In the liver, methanol is metabolized by ........... to form ........... . a. alcohol dehydrogenase; formaldehyde b. γ-glutamyltransferase; water c. aldehyde dehydrogenase; acetic acid d. methanol hydroxylase; acetaldehyde

a. alcohol dehydrogenase; formaldehyde

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The laboratory method of analysis that is accurate and precise for very low concentrations of carbon monoxide is: a. potentiometry b. spectrophotometry c. gas chromatography d. immunoassay

c. gas chromatography

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In which one of the following specimen types is there a strong relationship between it and plasma free drug concentration, but the window of detection is short compared with that in a urine specimen? a. hair b. oral fluid c. meconium d. serum

b, oral fluid

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Which one of the following enzymes is inhibited by organophosphate or carbamate compounds, such as those found in pesticides? a. alkaline phosphatase b. acetylcholinesterase c. alcohol dehydrogenase d. amylase

b. acetylcholinesterase

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A drug of abuse that stimulates the central nervous system by blocking dopamine reuptake and rapidly metabolizes to inactive benzoylecgonine and ecgonine methyl ester is: a. heroine b. ethanol c. cocaine d. methamphetamine

c. cocaine

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The most common laboratory method for detection, discrimination, and quantitation of alcohols in biological specimens is: a. flame ionization gas chromatography b. hplc c. immunoassay d. spectrophotometry

a. flame ionization gas chromatography

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In a chronic user of marijuana, the metabolite will remain in urine for what period of time? a. 3-4 months b. 2-7 days c. up to 73 days d. up to 3-4 weeks

c. up to 73 days

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A type of drug test that is used to rule out the presence of drugs or to suggest the presence of a particular drug group and that has been replaced by rapid immunoassay tests is the ........... test. a. gas chromatography b. spot c. confirmatory d. forensic drug

b. spot

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A sympathomimetic drug that can be a drug of abuse but has legitimate pharmacologic use as a treatment for narcolepsy is: a. marijuana b. fentanyl c. amphetamine d. diazepam

c. amphetamine

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Because of its rapid turnaround time, the laboratory method of choice used to screen urine samples for their opiate content is: a. liquid chromatography b. ferric chloride test c. gas chromatography d. immunoassay

d. immunoassay

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Cocaine is subject to recreational abuse because it: a. increases the effect of peripheral and central cholinergic nervous systems to induce feelings of happiness b. blocks dopamine reuptake at nerve synapses and prolongs the action of dopamine in the CNS, leading to feelings of euphoria. c. depresses the CNS but not the peripheral nervous system, depending on the blood ethanol concentration, to produce euphoria and decreased inhibition. d. has CNS depressant effects resulting in sedation and hypnosis, and increases growth hormone release.

b. blocks dopamine reuptake at nerve synapses and prolongs the action of dopamine in the CNS, leading to feelings of euphoria.

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The enzyme responsible for the metabolism of delta-9-tetrahydrocannabinol (THC) to its various metabolites is: a. aldehyde dehydrogenase b. cyp3a c. alcohol dehydrogenase d. cyp2d6

d. cyp2d6

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To recognize a poisoning pattern, groups of drugs with similar actions, symptoms, and clinical signs are examined. These common signs and symptoms are referred to as the: a. toxidrome b. pattern constellation c. toxin effect d. metabolic pattern

a. toxidrome

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An example of a nonbenzodiazepine sedative-hypnotic that is used in drug-facilitated sexual assault that interacts with a subtype of the GABAA receptor complex is: a. chloral hydrate b. diazepam c. gamma hydroxbutyrate d. zolpidem

d. zolpidem

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Agents related to the anticholinergic toxidrome include all of the following except: a. antihistamines b. tricyclic antidepressants c. organophosphates d. phenothiazines

c. organophosphates

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Which of the following is a major active metabolite of procainamide that must be monitored along with the parent drug? a. procainamide doesn't have an active metabolite b. n-acetylprocainamide c. glycinexylidide d. disopyramide

b. n-acetylprocainamide

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