Clinical Chemistry Quiz 3

1. All of the following are examples of steroid hormone except:

a. Mineralocorticoids
b. Cortisol
c. Progesterone
d. Somatostatin
*steroid hormone- produced by adrenal cortex(cortisol, aldosterone, androgen or DHEA), ovaries(estrogen,
progesterone), testes(testorsterone) PAMET

2. Confirmatory test for GH deficiency

a. OGTT
b. Insulin tolerance test
c. Somatomedin C or IGF1
d. Dexamethasone suppression test

3. Oxytocin is produced by what part of the body?

a. Adenohypophysis
b. Neurohypophysis
c. Hypothalamus
d. Pineal gland
*oxytocin- paraventricular nuclei (OP)
*ADH- supraoptic nuclei

4. A trough blood sample for routine therapeutic drug monitoring is usually obtained:
a. Just after a dose is administered
b. Just before the next dose (trough-lowest)
c. At the calculated peak time after a dose
d. One half-life after a dose is administered

5. For quatitation of urinary Venillylmandelic acid (VMA) which of the following specimens should be collected?
a. 24 hr urine (quatitation)
b. 1st morning urine for routine and HCG
c. Random midstream clean catch for culture
d. 2 hr urine after midday meal (2-4pm) measure urobilinogen (alkanine tide)

6. Measurement of urinary HCG in men us used to:

a. Diagnose hypogonadism
b. Detect testicular tumors
c. Assess pituitary function
d. Detect excessive estrogen secretion

7. Conversion factor of thyroxine (convertional to SI)

a. 2.14
b. 10
c. 12.9
d. 17.1
Clinical Chemistry Quiz 3

8. Which of the following substances act as a secondary messenger for peptide hormones?
a. CAMP
b. CGMP
c. ATP
d. ADP
*peptide is water soluble but cell has lipid bilayer so it has to attach to a receptor in the cell membrane to
tigger adenylate cyclease to produce CAMP

9. Which of the following is considered as the most potent and the major estrogen?
a. Estrone abundant in post menopausal women
b. Estradiol- abundant in pre menopausal women and detects ovarian func
c. Estriol abundant in pregnancy
d. Both B and C

10. Precursor hormone of all steroid hormone

a. Pregnenolone
b. Cholesterol
c. Perhyrdrocyclopentanophenantrene Ring
d. Progesterone
*precursor substance- cholesterol

11. When phenylhydrazine and sulphuric acid are added to urine, those steroids that contain 21 carbons produce a
color with a peak absorption @ 410nm. This principle is known as
a. Porter-Silber
b. Kober Reaction
c. Zimmerman Reaction
d. Pisano Method
*Porter-Silber; rgt- phenylhydrazine or DLBH(reitmann and frankell) and H2 SO4; detects 17, 21
corticosteroid (+) yellow
*Zimmerman reaction; rgt- dinitrobenzene; detects 17-ketosteroids (+) reddish purple
*Kober reaction; rgt-hydroquinone and H2SO4 detects estrogen, (+) reddish brown
*Pisano method; detects metanephrines(epi and norepi metabolites)

12. All of the following act as protein hormone except:

a. GH
b. Insulin
c. Epinephrine
d. T4
*amine; thyroid(T3 and T4 steroid) and adrenal medulla(epi and norepi peptide)
Peptide-fast acting
T3 and T4 not that fast
Amine hormones derived from AA- tyrosine, dopamine, serotonin(5-hydroxytryphtamil; meatabolite- 5-HIAA
*in blue diaper syndrome), melatonin and histamine
Clinical Chemistry Quiz 3

13. Major metabolite of cocaine

a. Benzoylecgonine
b. Tetrahydrocannabinol (thc)
c. Morphine
d. Primidone

14. Confirmatory test for drugs of abuse

a. Thin Layer Chromatography(TLC) screening for DOA(urine)
b. Gas Chromatography-Mass Spectrometry(GC-MS)
c. Tandem Mass Spectrometry(MS-MS) screening for inborn error or metabolism (G6PD etc.)
d. High Performance Liquid Chromatography(HPLC) confirmatory for IEN
*LC-MS-second confirmatory after GS-MS

15. Which of the following tubes may be used for TDM/Toxicology?

a. Red
b. Gold
c. Lavender
d. Green

16. Which of the following metal toxins may be detected by the Reinsch Test?
a. Lead
b. Mercury
c. Cadmium
d. Carbon monoxide
*reinsch- colorimetric
Detects MASBATe- mercury, arsenic, selenium, bismuth, antimony, thallium

17. Henderson-Hasselbalch equation

18. A 28 year old male patient with bronchial problems was presented to the hospital ER with increasing cough,
sputum and dyspnea. His ABG results are pH= 7.28, pCO2= 70 mmHg, pO2= 50 mmHG, HCO3= 23 mEq/L. What
is his condition?
a. Uncompensated respiratory acidosis
b. Partially compensated respiratory acidosis
c. Uncompensated metabolic acidosis
d. Partially compensated metabolic acidosis
Clinical Chemistry Quiz 3

19. An 18 year old woman was partying at her friends house when suddenly she hyperventilated. People around the
area did not know how to handle a case of hyperventilation so they decided to rush the patient to the ER. Upon
reaching the ER, the doctor on duty asked for an ABG result which of the following results would most likely be
consistent with the patients symptoms?
a. pH= 7.40, pCO2= 40, HCO3= 47, pO2= 50
b. pH= 7.30, pCO2= 30, HCO3= 25, pO2= 78
c. pH= 7.50, pCO2= 50, HCO3= 47, pO2= 67
d. pH= 7.50, pCO2= 30, HCO3= 25, pO2= 78

20. Most common source of preanalytical error in BG testing

a. Use of expired anticoagulant
b. Use of butterfly infusion set
c. Use of too much heparin- increases pCO2 by 12-15% (heparin or mucoitin polysulfuric acid)
d. Use of 19-gauge needle

21. Which of the following changes will occur w/ a blood gas sample exposed to air?
a. ↑ pO2, ↓ pCO2, ↑ pH
b. ↑ pO2, ↓ pCO2, ↓ pH
c. ↓ pO2, ↑ pCO2, ↑ pH
d. ↓ pO2, ↑ pCO2, ↑pH

22. Delay in specimen analysis for ABG test will cause what changes?
e. ↑ pO2, ↓ pCO2, ↑ pH
f. ↑ pO2, ↓ pCO2, ↓ pH
g. ↓ pO2, ↑ pCO2, ↑ pH
h. ↓ pO2, ↑ pCO2, ↑pH
*glycolysis utilize oxygen(DEC)

23. Decrease in blood pH leads to:

a. Hyperkalemia
b. Hypokalemia
c. Hypernatermia
d. Hypomatermia
*potassium related to pH
Acidosis- many H in blood- to compensate- move H in cell in exchange with K
HCO3 and Cl(pair with same principle above)
*if alkalosis- hypokalemia

24. Normal bicarbonate carbonic acid ratio in blood

a. 10:1
b. 15:1
c. 20:1
d. 25:1
Clinical Chemistry Quiz 3

25. Severer ghaus electrode is used for the determination of partial pressure oxygen. The principle used for the
partial pressure of carbon dioxide is Potentiometry.
a. Both statements are true
b. Both statements are false
c. First statement is true, second is false
d. Second statement is false, second is true
*Severir ghaus- for CO2- potentiometry
Clarke- for O2- amperometry Ag- Ag Cl
Calomel or Hg-Hg Cl- potentiometry

26. The expected blood gas results for a patient in chronic renal failure would match the pattern of:
a. Metabolic acidosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Respiratory acidosis

27. Sever diarrhea causes:

a. Metabolic acidosis
b. Respiratory acidsis
c. Metabolic alkalosis
d. Repiratory alkalosis

28. A patient is admitted to the emergency room in a state of metabolic alkalosis. Which of the following would be
consistent with this diagnosis?
a. High TCO2, increased HCO3
b. Low TCO2, increased HCO3
c. High TCO2, decreased H2CO3
d. Low TCO2, decreased H2CO3
*90% of total CO2 is bicarbonate

29. Metabolic acidosis is described as a(n):

a. Increase in CO2 content and PCO2 with a decrease pH
b. Decrease in CO2 content with an increase pH
c. Increase in CO2 with an increase pH
d. Decrease on CO2 content and PCO2 with decreased pH
*metabolic acidosis DEC CO2

30. Respiratory acidosis is described as a(n):

e. Increase in CO2 content and PCO2 with a decrease pH
f. Decrease in CO2 content with an increase pH
g. Increase in CO2 with an increase pH
h. Decrease on CO2 content and PCO2 with decreased pH
Clinical Chemistry Quiz 3

31. Which of the following sets of results is consistent with primary hypothyroidism(e.g. hashimoto’s thyroiditis)
Result TSH T4 Antimicrosomal Ab
Result A DEC DEC POSITIVE
Result B INC INC POSITIVE
Result C NORMAL DEC NEG
Result D INC DEC POSITIVE
*primary-organ(DEC T4)
Secondary- Pituitary gland(INC TSH)
Tertiary- Hypothalamus (TRH)

32. Thyroid hormones are derived from the amino acid

a. Phenylalanine
b. Methionine
c. Tyrosine
d. Histidine

33. The main estrogen produced by the ovaries and used to evaluate ovarian function
a. Estriol
b. Estradiol
c. Epiestriol
d. Hyroxyesterone
*4 parameters to detect pregnancy: E3, inhibit A, AFP

34. Which of the following conditions is characterized by primary hyperaldoseteronism caused by adrenal adenoma,
carcinoma, or hyperplasia?
a. Cushing’s syndrome
b. Addison’s disease
c. Conn’s syndrome
d. Pheochromocytoma
*Aldosterone- in Na retention(and water), DEC potassium- hypernatremia, hypokalemia
*Primary Hypercorticolism- Cushings syndrome
*Secondary Hypercorticolism- Cushings disease
*low cortisol- addisons disease
*phaeochromocytoma- tumor in adrenal medulla(fight or flight)

35. Hyperthyroidism is most consistently associated with:

a. Hypocalcemia
b. Hypocalcuria
c. Hypophosphatenemia
d. Metabolic alkalosis
*parathyroid gland located behind thyroid- connected
Hyperthyroidism=hyperparathyroidism= INC Ca DEC PO4
Clinical Chemistry Quiz 3

36. The term “pharmacodynamics” is an expression of the relationship between:

a. Dose and physiological effect
b. Drug concentration at target sites and physiological effect
c. Time and serum drug concentration
d. Blood and tissue drug levels
*pharmacokinetics- body to drug
*pharmacodynamics- drug to body

37. Heroine is synthesized from what drug?

a. Diazepam
b. Morphine
c. Ecgonine
d. Chlorpromazine

38. This drug is used a local anaesthesia for nasopharyngeal surgery:

a. Amphetamines
b. Cocaine
c. Heroin
d. Phencyclidine

39. Which substance has the longest detection time:

a. Amphetamine
b. Cocaine
c. Benzodiazepines
d. Marijuana- stored in fatty tissues

40. A urine sample is received in the laboratory with the appropriate custody control form, and a request for drug of
abuse screening. Which test result would be cause for rejecting the sample?
a. Temperature of 90 F 32.5-37.5C
b. pH 5.0 4.5-8
c. SG 1.005 1.003-1.019
d. Creatinine 5 mg/dL
41. Elevated level of aminolevulinic acid in urine indicates presence of
a. Lead
b. Arsenic
c. Mercury
d. Ethylene glycol
*lead poisoning inhibit heme synthesis by inhibiting ALA dehydratase
Also inhibits ferrochelatase(last enz in forming heme)
*basophilic stipplings(coarse)
If fine- compensation against anemia
Clinical Chemistry Quiz 3

42. Which of the following trace elements is considered an essential mincronutrient?

a. Thallium
b. Aluminum
c. Mercury
d. Selenium in shampoo(anti-oxidant)

43. Which specimen is the sample of choice for lead screening?

a. Whole blood (tan same with EDTA)
b. Hair
c. Serum
d. Urine

44. When measuring trace elements in blood other than lead, what type of tube should be used?
a. Navy blue
b. Green
c. Purple
d. Red

45. Trace elements in blood includes the following except

a. Pb
b. Se
c. Hg
d. Au

46. Which of the following techniques is more commonly used to measure vitamins?
a. High performance liquid chromatography
b. Spectrophotometry
c. Nephelometry
d. Microbiological

47. The term encompasses a wide variety of compounds characterized as being insoluble in water but soluble in
nonpolar solvents. Which of the following vitamins is not a classified as fat soluble?
a. Vitamin A
b. Vitamin C
c. Vitamin D
d. Vitamin E

48. Which of the following is another name of vitamin B12?

a. Retinol
b. Pyridoxine
c. Cyanocobalamine
d. Riboflavin
*memo other names of vitamins
Clinical Chemistry Quiz 3

49. Which of the following tissues is important in vitamin D metabolism?

a. Skin
b. Spleen
c. Pancreas
d. Thyroid

50. Which disorder is associated with thiamine deficiency?

a. Beriberi
b. Pellagra
c. Rickets
d. Dermatitis
*only B12 neurologic symptoms(peripheral neuropathy) and not seen in B9
*both has MBA
Clinical Chemistry Quiz 3