Clinical Chemistry Question and Answer Special PDF

Clinical Chemistry Question and Answer Special Gemini Notes: Clinical d. Two carboxyl groups bonded to the alpha-carbon of an amino group. Chemistry Q and A...

Clinical Chemistry Question and Answer Special Gemini Notes: Clinical d. Two carboxyl groups bonded to the alpha-carbon of an amino group. Chemistry Q and A 5. Which of the following results would correlate best 1. Which of the following acute-phase reactant with malnutrition and poor protein-caloric status? proteins decreases during inflammation? - - a. Decreased prealbumin a. Transferrin & APR b. Decreased γ-globulins Pealb > alb > fibronectin b. α1-Antitrypsin c. Elevated ceruloplasmin c. Haptoglobin d. Fibrinogen /Positive APRs d. Elevated α1-fetoprotein Prealbumin (Transthyretin) Negative acute-phase reactants:  Transport protein for the thyroid protein. T-Transferrin  Forms a complex with retinol-binding protein to transport retinol (vitamin A) A-Albumin  A low concentration may also indicate poor P -Prealbumin nutritional status. 2. Which of the following refers to the three-G 6. Which of the following conditions would correlate dimensional spatial configuration of a single best with a normal level of myoglobin? polypeptide chain determined by disulfide linkages, a. Multiple myeloma hydrogen bonds. Electrostatic attractions, and van b. Acute myocardial infarction : Myo TroPl CaL der Waals forces? c. Acute renal failure : myoglobin a. Primary structure b. Secondary structure d. Skeletal muscle injury = Myoglobin c. Tertiary structure - d. Quaternary structure 7. An immunofixation protein electrophoresis is performed on serum from a patient with the most Primary Refers to the number, type, and - - common type of multiple myeloma. The resulting structure sequence of amino acids. - pattern would most likely reveal which of the Refers to commonly formed following? Secondary arrangements stabilized by a. An IgG monoclonal band structure hydrogen bonds between amino - acid. b. Oligoclonal bands Refers to the overall shape, or c. Significant β-γ bridging Tertiary - conformation, of the protein d. An IgM monoclonal band Waldenstrom macrogamma structure - molecule. Multiple myeloma Refers to the shape or structure that Quaternary results from the interaction of more  Most well-known O monoclonal disorder.  - structure than one protein molecule, or Paraproteins in multiple myeloma are usually IgG, IgA, or κ or λ light chains. - protein subunits. - O Waldenstrom’s macroglobulinemia 3. Which of the following plasma proteins is primarily  Rare type of slow-growing, non-Hodgkin Oparaprotein. - lymphoma associated with IgM responsible for maintain in vivo colloidal osmotic - pressure? - containshibrinogen a. Albumin ↓ albumin - ↓ oncotic pressure 8. Which of the following would indicate a plasma edema lascites - Recall specimen was used for protein electrophoresis b. Haptoglobin washikor = ↓ calorie instead of serum? electrophoresis serum SPE , c. Fibrinogen d. α2-Macroglobulin ↓ protein - O a. A small peak between the β- and γ-globulins b. A broad increase in the γ-globulin fraction c. A bridge between α1- and α2-globulins 4. Which of the following best describes a peptide d. A significantly decreased albumin peak. bond? a. An amino group and carboxyl group bonded to an alpha-carbon. 9. Which of the following conditions would correlate best with the presence of distinct oligoclonal bands b. A double carbon bond between the alpha-carbons - in the γ-zone on CSF protein electrophoresis? of two amino acids. - Cto a carboxyl group of c. An amino group bonded - - a. Multiple sclerosis another amino acid. b. Multiple myeloma - Amino Carboxe + bonds FJMV Notes Page | 1 Bluret-peptide  Clinical Chemistry Question and Answer Special Ms - Multiple sclerosis c. Bacterial meningitis a. The site where the pH is the same as its pI. n -neurosyphilis d. Myoglobinemia e-encephalitis b. The site where the mass of the protein correlates N - neoplasm with the pI. G- guillain-Barre syndrome 10. Which of the following conditions would correlate c. The site where the protein’s net charge exceeds best with the serum protein electrophoresis results the pI. below? d. The site where the protein’s net charge is less Albumin Decreased than the pI. normal value α1-globulins Increased = 2 7. to 7 3. α2-globulins Increased 15. A CSF-serum albumin ratio of O - 9.8 was reported. How is this best interpreted? β -globulins Normal a. This ratio is in the normal range for the patient. γ -globulins Normal ↑ b. The blood-brain barrier may be compromised. a. Acute inflammation al & 92 - - c. It is biologically impossible to achieve this value. b. Chronic liver cirrhosis d. This is diagnostic of fungal meningitis. c. Nephrotic syndrome CSF-to-serum albumin ratio (normal = 2.7 to 7.3) d. Monoclonal gammopathy  Evaluates the degree of permeability of the blood-brain barrier (BBB). 11. When a protein is dissolved in a buffer solution  Above 7.3 indicates damage to the BBB. - - that is more alkaline than its pI and an electric  Decreased CSF albumin values are found in current is passed through the solution, the protein hyperthyroidism and CSF leakage. will act as: ↳ BTP Beta trace protein a. An anion and migrate to the anode 16. Which of the following CSF proteins would be b. A cation and migrate to the cathode measured when investigating active demyelination - c. An anion and migrate to the cathode in multiple sclerosis? MBP d. An uncharged particle and will not move a. CSF-serum albumin ratio O pH greater than its pI Alkaline b. α1-Antitrypsin  The protein is negatively charged (anion) and c. Myelin Basic protein O toward the anode (positive - will migrate d. Immunoglobulin G - electrode) pHGless than its pI Acid Myelin Basic Protein  The protein is positively charged (cation) and Provides an index of active demyelination. - will migrate toward the cathode (negative electrode) 17. NPN: 12. Which of the following conditions would correlate (1) Allantoin (2) Ammonia amino acid deamination best with an elevated serum total protein with high : levels of both albumin and globulins? - - (3) Creatinine = muscle metabolism - a. Dehydration (4) Urea · protein metabolism b. Myocardial infarction a. 1, 2, and 3 most concentrated c. Glomerulonephritis b. 2, 3, and 4 A UC CA d. Liver cirrhosis c. 1, 3, and 4 d. 1, 2, and 4 13. Which of the following urine total protein results Clinically significant NPN, from most concentrated would correlate best with a patient with nephrotic to least concentrated: syndrome? Recall Highest proteinuria UA-UC-CA ↳ a. Normal white foam Urea > Amino acids > Uric acid > Creatinine > b. Lower than normal Creatine > Ammonia g c. Higher than normal d. Similar to levels in CSF total protein levels. 18. Which compound constitutes nearly half of the NPN substances in the blood? 14. Isoelectric focusing is used to phenotype α1- a. Ammonia antitrypsin deficiencies. When protein is b. Creatinine electrophoresed, it migrates to which of the c. Urea following? d. Uric acid FJMV Notes Page | 2  Clinical Chemistry Question and Answer Special 19. A technologist reports urea N of 9 mg/dL. What Urea nitrogen/creatinine (urea N/creatinine) ratio is the urea concentration for this sample?  Differentiates cause of abnormal urea BUN = 2 14 concentration.. a. 3.2 mg/dL  Normal ratio- 10:1 to 20:1 b. 4.2 mg/dL 9x2 /. = 19 · 3mgld) High urea N/creatinine ratio c. 18.0 mg/dL Prerenal azotemia with normal creatinine d. 19.3 mg/dL High urea N/creatinine ratio Urea N to urea concentration O 2.14 G Postrenal azotemia with an elevated creatinine Low protein intake, acute tubular 20. Which blood collection tube additive can be used Low urea N/creatinine ratio necrosis, and severe O - to collect a specimen for measurement of urea? liver disease a. Ammonium Normal urea N/creatinine Renal azotemia b.C Lithium heparin ratio c. Sodium citrate d. Sodium fluoride 25. Uric acid is the final product of: Urea concentration a. Allantoin metabolism  Measured in plasma, serum, or urine. b. Amino acid metabolism  If plasma is collected, ammonium ions and high concentrations of sodium citrate and G c. Purine (adenine and guanine) metabolism sodium fluoride must be avoided. d. The urea cycle 21. In the clinical laboratory, Urea N is measured - 26. Sources o of error in measurement of uric acid most often using: include: a. Conductivity a. Assay interference - b. Enzymatic reactions b. Competition from alternate purine substrates c. Isotope dilution mass spectrometry Reference method c. Narrow spectrophotometer bandwidth d. Multilayer film formats d. Nonspecific enzyme activity 22. Elevated blood urea concentration is termed: 27. Which condition is not associated with elevated a. Azotemia plasma uric acid concentration? ↑ plasia urea - urenial Chemotherapy uremic syndrome La b. BUN a. Allopurinol overtreatment U + 12 Azotemia ↑ Blood area b. Gout - Burr cells I c. Uremia - ↑ U+ IC d. Uremic syndrome c. Lesch-Nyhan syndrome Very high plasma urea d. Renal disease Uremia or uremic syndrome concentration accompanied C Decreased uric acid (RememberO OLD): by renal failure. O- Overtreatment with allopurinol - Elevated concentration of L-Liver disease Azotemia - urea in the blood. D-Defective tubular reabsorption (Fanconi syndrome) - 23. Prerenal azotemia is caused by: 28. Complete deficiency of hypoxanthine-guanine Pretenal circulatory a. Acute renal failure : I Renal phosphoribosyltransferase results in which disease? b. Chronic renal failure Renal = Kidney a. Allantoinism BNP Post-renal : ureters bladder c. Congestive heart failure , b. Glycogen storage disease Heparin d. Urinary tract obstruction - post - renal c. Lesch-Nyhan syndrome - orange sand in diapers d. Megaloblastic anemia Blue spot = Harthup disease 24. A technologist obtains a urea N value of 61 Lesch-Nyhan syndrome mg/dL and a serum creatinine value of· 2.5 mg/dL on First sign is often uric acid crystals resembling a patient. These results indicate: crea normal 0 9-1 3 :.. orange sand in diapers. vied & Crea a. Congestive heart failure 24. 4 = = b. Dehydration ____________________, RMT, Top ______ normal = 20 : c. Glomerular nephritis Postenal Work hard, have fun, make history d. Urinary tract obstruction : ↑ crea , ↑ urea azotemia Ciara+ 18 & FJMV Notes Page | 3  stone Kidney Clinical Chemistry Question and Answer Special 29. Uric acid nephrolithiasis refers to: - c. Is higher for females than for males a. Acidification of the urine to dissolve renal calculi O d. Is highest for adult men aged 18 to 50 years - - b. Formation of renal calculi composed of uric acid - - c. Precipitation of urates in the urinary tract 35. Use of serum creatinine to calculateG - GFR: d. Saturation of the kidney with uric acid a. Is discouraged because the calculations are complex. 30. A 45-year-old male presents to the emergency b. Is encouraged as a means to identify kidney - - department complaining of intense jointO pain. The disease and improve patient care - - previous night the patient experienced similar pain c. Requires hospitalization of the patient for accompanied by inflammation and redness of his specimen collection 0 and large O - wrists toe. The physician on-call orders d. Requires simultaneous measurement of testing for serum uric acid concentration. Which creatinine in a 24-hour urine collection laboratory results and diagnosis are consistent with the physician’s assessment? The reference interval Clinical laboratories have been strongly encouraged to report an estimated GFR when serum creatinine is for uric acid is 3.5 to 7.2 mg/dL? ordered as a means to increase identification of a. Uric acid 1.9 mg/dL; Fanconi syndrome kidney disease and improve patient care (Bishop) b. Uric acid 1.0 mg/dL; Hereditary xanthinuria c. Uric acid 9.1 mg/dL; Alcoholism 36. Which factor must be considered for calculation d. Uric acid 9.1 mg/dL; Gout of creatinine clearance using the MDRD equation? - a. Certification of body mass index 31. Which statement describes creatinine b. Documentation of specimen collection time La muscle biosynthesis accurately? not c. Identification of ethnicity Liver - a. Creatine is phosphorylated in the liver to form d. Verification that the patient was fasting phosphocreatinine Modification of Diet in Renal Disease (MDRD) b. Creatine phosphate undergoes spontaneous Four variables: MDRD COCTOFT - Gault cyclization to form creatinine : WAGS v R- Race or ethnicity ~ c. Creatinine is formed from creatine and creatine weight ~ A- Age ↑ phosphate in the liver age ~ G- Gender or sex j gender d. Creatinine is synthesized from arginine, glycine, ↑ S-Serum creatinine ↑ serum-crea and methionine in the liver -creatine 37. Which situation would be expected to falsely 32. Substances known to increase results when - increase measured blood ammonia concentration? measuring creatinine by the Jaffe reaction includes: - - v(1) Ascorbic acid Other False ↑ a. The patient smoked two cigarettes 15 minutes girta thi one prior to phlebotomy. (2) Bilirubin uric acid b. The patient was fasting for 8 hours before blood ↑(4) α-ketoacids (3) Glucose cephalosphoring collection. c. The patient ate a steak dinner the night before the a. 1, 2, and 3 specimen was collected. b. 2, 3, and 4 d. The specimen was placed on ice immediately c. 1, 3, and 4 after collection. d. 1, 2, and 4 38. Although arterial blood is the recommended specimen for determination of this analyte, it is 33. In the Jaffe reaction, a red-orange chromogen is seldom used. venous blood formed when creatinine reacts with: ↳ a. Ammonia no tourniquet a. Aluminum magnesium silicate no fist clenching b. Creatine b. Creatininase c. Urea arterial blood Radial c. Phosphocreatine = artery d. uric acid modified allen's test d. Picric acid Me 39. Toxic effect of elevated blood ammonia 34. Creatinine excretion typically: concentration include: a. Decreases from childhood to middle age a. Decreased renal function b. Does not vary with age and sex FJMV Notes Page | 4  Clinical Chemistry Question and Answer Special b. Hemorrhage and dehydration 45. An example of using enzymes as reagents in the ↳ enzyme excess c. Mental status and coma clinical laboratory is: is in , independent of enzyme d. Pain and inflammation of peripheral joints a. The hexokinase glucose method - dependent substrate detoxification b. The diacetyl monoxime blood urea nitrogen ↓ ph not kidney function , rather Liver syndrome 40. Ammonia concentrations are measured to c. The alkaline picrate method First order Kinetics evaluate: d. Biuret total protein method a. Acid-base status b. Glomerular filtration 46. Activity of enzymes in serum may be determined - c. Hepatic encephalopathy rather than concentration because: o - d. Renal failure a. The amount of enzyme is too - low to measure - b. The temperature is too high 41. Ammonia concentration correlates with disease c. There is not enough substrate severity and prognosis for d. The amount of enzyme is too high to measure a. Astrocytosis b. Inherited deficiencies of urea cycle enzymes 47. The isoenzyme LD-4 and LD-5 are elevated in: LD1 & LD2 : heart a RBC c. Neurological deterioration a. Liver disease - O - LD3 = Longs , pancies , d. Reye’s syndrome child - viral infection b. Pulmonary embolism - - , WLPS Spleen , WBCs - - Aspirin Ingestion LD4 LD5 ↑ Liver skeletal muscle c. Renal disease : - , - LDG · alcohol dehydrogenase 42. When a reaction is performed in zero-order d. Myocardial infarction - Flipped = (DILLD2 - Myocardial kinetics: LDH-4 and LDH-5 normal-LD2 >