ASSESSMENT EXAM IN CLINICAL CHEMISTRY

I. MULTIPLE CHOICE: On the ANSWER SHEET provided select the BEST answer by completely shading the box that corresponds to
your answer.

1. Deficiency of glucose-6-phosphate resulting in hepatomegaly, lactic acidosis, severe fasting hypoglycemia and hyperlipidemia
characterizes:
A. Type I – von Gierke’s disease
B. Type II – Pompe’s disease
C. Type III – Cori-Forbes disease
D. Type V – McArdle’s disease
E. None of the choices

2. Which test may be performed to assess the average plasma glucose level that an individual maintained during a previous 2 to 3
months?
A. Plasma glucose
B. Urine glucose
C. Two-hour postpraindial glucose
D. Oral glucose tolerance
E. Glycosylated hemoglobin

3. All of the following are characteristics of von Gierke’s disease except:

A. Hypoglycemia
B. Subnormal response to epinephrine
C. Increase plasma lactate
D. Hypolipidemia

4. Hydrolysis of sucrose yields

A. Glucose only
B. Galactose and glucose
C. Maltose and glucose
D. Fructose and glucose
E. Lactose and glucose

5. Identify the enzyme deficiency responsible for Type I glycogen storage disease (von Gierke’s disease)
A. Glucose-6-phosphatase
B. Glycogen phsphorylase
C. Glycogen synthetase
D. Beta glucosidase
E. None of the choices

6. An individual with Cushing’s syndrome would tend to exhibit:

A. Hyperglycemia
B. Hypoglycemia
C. A normal blood glucose level
D. A decreased 2-hour postprandial glucose
E. A flat glucose tolerance curve

7. Glucose is stored in the muscle and the liver as

A. Triglyceride
B. Glycogen
C. Maltose
D. Lactose
E. Starch

8. The ferricyanide method required a reducing sugar. The disaccharide that would not be suitable for use in this test is:
A. Maltose
B. Lactose
C. Sucrose
D. Amylose
E. Amylopectin

9. In peroxidase-coupled glucose methods, which reagent complexes with the chromagen?

A. Nitroprusside
B. Phenol
C. Tartrate
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 D. Hydroxide
E. None of the choices

10. Which of the following carbohydrate is a polysachharide?

A. Starch
B. Sucrose
C. Lactose
D. Glucose
E. Dextrose

11. Glucose concentration in whole blood is:

A. Less than the concentration in plasma
B. Greater than the concentration in plasma or serum
C. Equal to the concentration in plasma or serum
D. Unmeasurable because of a high concentration of red blood cells
E. Meaningless because it is not stable

12. The test commonly used as a reliable index of intestinal carbohydrate absorption is:
A. Glucose fasting
B. D-xylose
C. Insulin
D. Glucose tolerance test
E. Maltose

13. Type I diabetes mellitus may be described by all of the following except:
A. Insulin dependent
B. Associated with autoimmune destruction of B cells
C. Insulinopenia
D. Ketoacidosis prone
E. Adult-onset type

14. Insulin may be described by all of the following, except:

A. Synthesized from proinsulin
B. Synthesized by beta cells in the pancreas
C. Active in its C-peptide form
D. Two-chain polypeptide
E. Combines with insulin receptors

15. Which of the following statements may be associated with activity of insulin?
A. Increase blood glucose levels
B. Decreases glucose uptake by muscle and fat cells
C. Decreases cell membrane permeability to glucose
D. Stimulates release of hepatic glucose into the blood
E. Stimulates glycogenesis

16. All of the following are characteristic of severe hyperglycemia except:

A. Polysuria
B. Ketonuria
C. Glycosuria
D. Hypoglucagonemia
E. Hyponatremia

17. Which of the following statement applies to the preferred use of plasma or serum rather than whole blood for glucose
determination?
A. Glucose is more stable in separated plasma or serum
B. Glucose values in whole blood may vary with hematocrit
C. Specificity for glucose is higher with most methods when plasma or serum is used
D. It is convenient to use serum or plasma with automated instruments because whole blood requires mixing immediately
before sampling
E. All of the above

18. Which method is used to remove proteins and non- sugar-reducing compounds from serum?
A. Biuret

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B. Sulfosalicylic acid
C. Trichloroacetic acid
D. Folin-Wu
E. Nelson-Somogyi

19. Which glucose method involves the condensation of glucose with an aromatic amine in hot glacial acetic acid solution to
produce a green colored product?
A. σ-Toluidine
B. Folin-Wu
C. Nelson-Somogyi
D. Glucose oxidase
E. Hexokinase

20. Which of glucose method can employ a polarographic oxygen electrode?

A. Hexokinase
B. Glucose oxidase
C. Glucose dehydrogenase
D. σ-Toluidine
E. Nelson-Somogyi

21. An enzymatic serum glucose method requires all of the following reagents, EXCEPT:
A. NAD+
B. Glucose oxidase
C. Peroxidase
D. Oxygen
E. σ-Dianisidine

22. The glucose method that is considered to be reference method is:

A. Glucose oxidase
B. Alkaline potassium ferricyanide
C. σ-Toluidine
D. Hexokinase
E. Glucose dehydrogenase

23. A diabetic patient has a serum glucose level of 320 mg/dL, what would be the appropriate glucose concentration in this
patient’s cerebrospinal fluid?
A. 32 mg/dL
B. 60 mg/dL
C. 192 mg/dL
D. 320 mg/dL
E. 640 mg/Dl

24. The term glycolysis refers to the:

A. Conversion of hexoses into lactate or pyruvate
B. Conversion of glucose to glycogen
C. Breakdown of glycogen to form glucose
D. Breakdown of lipids to form glucose
E. Formation of glucose from noncarbohydrate sources

25. Which of the following hormones promotes an increase in the blood glucose level?
A. Adrenocorticotrophic hormone
B. Growth hormone
C. Cortisol
D. Glucagon
E. All of the above

26. The direction in which albumin migrates (ie, toward anode or cathode) during electrophoretic separation of serum proteins,
at pH 8.6, is determined by:
A. the ionization of the amine groups, yielding a net positive charge
B. the ionization of the carboxyl groups, yielding a net negative charge
C. albumin acting as a zwitterion
D. the density of the gel layer

27. The protein that has the highest dye-binding capacity is:
A. albumin
B. alpha globulin
C. beta globulin

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D. gamma globulin

28. The biuret reaction for the analysis of serum protein depends on the number of:
A. free amino groups
B. free carboxyl groups
C. peptide bonds
D. tyrosine residues

29. Electrophoresis in the sample is in an electric field connected to a buffer of pH 8.6, all of the proteins:
A. have a positive charge
B. have a negative charge
C. are electrically neutral
D. migrate toward the cathode

30. The relative migration rate of proteins on cellulose acetate is based on:
A. molecular weight
B. concentration
C. ionic charge
D. particle size

31. The cellulose acetate electrophoresis at pH 8.6 of serum proteins will show an order of migration beginning with the fastest
migration as follows:
A. albumin, alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin
B. alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin, albumin
C. albumin, alpha-2 globulin, alpha-1 globulin, beta globulin, gamma globulin
D. gamma globulin, beta globulin, alpha-2 globulin, alpha-1 globulin, albumin

32. Increased serum albumin concentrations are seen in which of the following conditions?
A. nephrotic syndrome
B. acute hepatitis
C. chronic inflammation
D. dehydration

33. A patient is admitted with biliary cirrhosis. If a serum protein electrophoresis is performed, which of the following globulin
fractions will be most elevated?
A. alpha-1
B. alpha-2
C. beta
D. gamma

34. Which of the following serum protein fractions is most likely to be elevated in patients with nephrotic syndrome?
A. alpha-1 globulin
B. albumin
C. alpha-2 globulin
D. beta globulin and gamma globulin

35. The electrophoretic pattern of plasma sample as compared to a serum sample shows a:
A. broad prealbumin peak
B. sharp fibrinogen peak
C. diffuse pattern because of the presence of anticoagulants
D. decreased globulin fraction

36. At a pH of 8.6 the gamma globulins move toward the cathode, despite the fact that they are negatively charged. What is this
phenomenon called?
A. reverse migration
B. molecular sieve
C. endosmosis
D. migratory inhibition factor

37. Erroneous ammonia levels can be eliminated by all of the following except:
A. assuring water and reagents are ammonia-free
B. separating plasma from cells and performing test analysis as soon as possible
C. drawing the specimen in a prechilled tube and immersing the tube in ice
D. storing the specimen protected from light until the analysis is done

38. A critically ill patient becomes comatose. The physician believes the coma is due to hepatic failure. The assay most helpful in
this diagnosis is:
A. ammonia

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B. ALT
C. AST
D. GGT

39. In the liver, bilirubin is converted to:

A. Urobilinogen
B. Urobilin
C. Bilirubin-albumin complex
D. Bilirubin diglucuronide

40. In which of the following disease states is conjugated in a major serum component?
A. biliary obstruction
B. hemolysis
C. neonatal jaundice
D. erythroblastosis fetalis

41. Kernicterus is an abnormal accumulation of bilirubin in:

A. heart tissue
B. brain tissue
C. liver tissue
D. kidney tissue

42. In which of the following conditions does decreased activity of glucuronyl transferase result in increased
unconjugated bilirubin and kernicterus in neonates?
A. Gilbert disease
B. Rotor syndrome
C. Dubin- Johnson syndrome
D. Crigler-Najjar syndrome

43. What substance gives feces its normal color?

A. uroerythrin
B. urochrome
C. urobilin
D. urobilinogen

44. The most specific enzyme test for acute pancreatitis is

A. acid phosphatase
B. trypsin
C. amylase
D. lipase
45. Which of the following enzymes are used in the diagnosis of acute pancreatitis?
A. AMS and LPS
B. AST & ALT
C 5'N) & GGT
D. AST & LD

46. Which of the following enzymes catalyzes the conversion of starch to glucose and maltose?
A. malate dehydrogenase (MD)
B. amylase (AMS)
C. creatine kinase (CK)
D. isocitric dehydrogenase (ICD)

47. A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this disease?
A. creatinine
B. LD isoenzymes
C. beta-hydroxybutyrate
D. amylase
48. Aspartate amino transferase (AST) is characteristically elevated in diseases of the:
A. liver
B. kidney
C. intestine
D. pancreas

49.Amino transferase enzymes catalyze the:

A. exchange of amino groups and sulfhydryl groups between alpha-amino and sulfur-containing acids
B. exchange of amino and keto groups between alpha-amino and alpha-keto acids

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 C. hydrolysis of amino acids and keto acids
D. reversible transfer of hydrogen from amino acids to coenzyme
50. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the
following diseases?
A. muscular dystrophy
B. viral hepatitis
C. pulmonary emboli
D. infectious mononucleosis

Name: _____________________________________,RMT Year & Sec: __________________________

Date:________________________ Score: _______________________________

ASSESSMENT EXAM IN CLINICAL CHEMISTRY

The way we THINK changes the way we FEEL.

The way we FEEL changes the way we ACT.
Life is not a series of CHANCES, but CHOICES.
Choose to PASS or choose to FAIL!!

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 -EGA, 2018
I. MULTIPLE CHOICE: On the ANSWER SHEET provided select the BEST answer by completely shading the box that corresponds to
your answer.

1. The term STAT refers to:

A. Using timed blood collection for specific specimens
B. Abstaining from food over a period of time
C. Using the early-morning specimens for laboratory testing
D. Immediate and urgent specimen collection

2. Why is it important to get patient information about latex sensitivity?

A. Patient usually have preferences for special tourniquets
B. Allergies to latex cause skin irritations
C. This information is only important for the phlebotomist, not the patient
D. Laboratory test can be affected by the ingestion of latex

3. Steps in the identification process should include:

A. A 2-way match with the ID bracelet and requisition information
B. A 3-way match with verbal, ID bracelet and requisition information
C. A 4-way match with the doctor, verbal ID, ID bracelet and bed number
D. Checking the verbal identification with a room number

4. If a patient has a bruise in the antecubital area of his right arm (his nondominant arm), what alternate site should be
considered?
A. Slight rotation of the patient’s arm to a different position
B. The antecubital area of the left arm
C. The edge of the antecubital area of the right arm
D. Forget alternate sites and do a fingerstick on the right hand.

5. One reason for hematoma formation during venipuncture is that the:

A. Needle is too small
B. Median cubital vein is used
C. Needle is parallel to the vein
D. Needle is partially inserted in the vein

6. If a venipuncture procedure is almost completed and suddenly you see hints of a hematoma beginning to form, what
should you do?
A. Discontinue the procedure and apply pressure with gauze
B. Remove the tube and try another one
C. Reinflate the blood cuff to slow bleeding
D. Finish collecting the tubes as quickly as possible

7. How many more times should a phlebotomist try to perform a venipuncture on a patient if he has failed once already.
A. Once
B. Three times
C. Four times
D. Twice

8. The tests performed in the following department are collected in a tube with a light blue stopper.
A. Chemistry
B. Hematology
C. Coagulation
D. Microbiology

9. Which specimen collection tube is commonly used for hematology tests?

A. EDTA
B. Serum tube with clot activator
C. Sodium citrate
D. Heparin
10. Which specimen collection tube is commonly used for hemostasis tests?
A. EDTA
B. Sodium citrate
C. Heparin
D. Serum tube with clot activator

11. Specimens may be rejected for a variety of reasons, most of which can be prevented by experienced, professional
phlebotomists. Identify one reason for specimen rejection that relates to unnecessary but excessive remixing of the specimen.
A. Lipemic
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B. Specimen is hemolyzed
C. Specimen is icteric
D. Specimen is arterialized

12. The use of a tourniquet during a venipuncture procedure makes the :

A. Alcohol not dry in the required amount of time
B. Veins less prominent and less filling
C. Veins more prominent and easier to puncture due to venous filling
D. The releasing of the adapter to an appropriate action

13. The tourniquet should not be left on a patient more than 1 to 2 minutes when performing a venipuncture because it
becomes uncomfortable and causes:
A. Hemorrhage
B. Clot activation
C. Hemolysis
D. Hemoconcentration

14. TRUE OR FALSE: The purpose of an antiglycolytic agent is to preserve glucose.

A. True
B. B. False

15. The needle should always be inserted at the puncture site with the:
A. Bevel side down
B. Bevel positioned away from the insertion site
C. Bevel side upward
D. None of the above

16. TRUE OR FALSE: The last step to be performed in the phlebotomy procedure is to remove the tourniquet.
A. True
B. B. False

17. What is the most important factor in choosing the gauge of the needle to be used for venipuncture?
A. Size of the vein
B. Size and condition of the vein
C. The age of the patient
D. Both A and B
E. All of the choices

18. Glass particles present in serum separator tubes:

A. Accelerate coagulation
B. Deter clotting
C. Inhibit glycolysis
D. Prevent hemolysis

19. Heparin prevents blood from clotting by:

A. Inhibiting thrombin
B. Chelating calcium
C. Inhibiting calcium
D. Form calcium salts
E. None of the choices

20. Which of the following is NOT an antiseptic?

A. Benzalkonium chlorid
B. Isopropanol
C. Providone-Iodine
D. Sodium hypochlorite
E. None of the choices

21. The extent of agreement between repeated analyses is known as:

A. Random error
B. Precision
C. Accuracy
D. Reliability
E. Variance

22. The closeness with which the measured value agrees with the true value is:

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 A. Random error
B. Precision
C. Accuracy
D. Reliability
E. Variance

23. The percentage of values that will fall between the ± 2SD in a Gaussian (normal) distribution is
A. 5%
B. 34%
C. 68%
D. 95%
E. 99%

24. A technologist has completed the first run of morning specimens. She/he notices that one control is outside ± 3SD and the
second control is within ± 2SD. The technologist’s decision should be to:
A. Release the result
B. Repeat the control that is outside ± 3SD only, and if it comes in, release results
C. Check equipment and reagents to determine source of error; repeat the entire analysis including controls and patients;
check controls before releasing results.
D. Repeat both controls; if the same thing happens, attribute the cause to random errors, release results
E. Repeat the controls and patients; release result

25. All of the following are requirements for QC material, EXCEPT:

A. Long-term stability
B. The matrix is similar to the specimen being tested
C. The concentration of analytes reflects the clinical range
D. Analyte concentration must be independent of the method of assay

26. An enzymatic marker for Wilson’s disease

A. Angiotensin- converting enzyme
B. sorbitol dehydrogenase
C. glucose-6-phosphate dehydrogenase
D. Ceruloplasmin

27.The earliest enzyme cardiac marker for myocardial infarction which rises 4 hours after onset of attack and peaks at 12-24 hours.
A. AST
B. CK-MB
C. LDH
D. Myoglobin

28. A late enzyme cardiac marker for myocardial infarction which rises12-24 hours after onset of attack and remains elevated for
10-14 days.
A. AST
B. CK-MB
C. LDH
D. Myoglobin

29. It is the major LDH isoenzyme present in the sera of a healthy individual.
a. LD1
B. LD2
C. LD4
D. LD6

30. A LDH isoenzyme that is present in patients with arteriosclerotic cardiovascular failure and its appearance signifies a grave
prognosis and pending death.
a. LD2
B. LD4
C. LD5
D. LD6

31. A major isoenzyme fraction found in striated muscle and normal serum.
A. CK-BB
B. CK-MM
C. LD3
D. LD4

32. In the sera of a healthy individuals, the normal electrophoretic pattern of lactate dehydogenase isoenzyme fraction is.
A. LD1,LD2,LD3,LD4,LD5

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B. LD2,LD1,LD3,LD4,LD5
C. LD3,LD2,LD1,LD4,LD5
D. LD2,LD3,LD1,LD4, LD5

33. Its high levels are seen in pernicious anemia and hemolytic disorder.
A. CK-MM
B. LDH
C. ALP
D. ACP

34. An immunoenzymatic assay for ACP that includes incubation with an antibody to prostatci ACP which uses PNPP as a its
substrate.
A. PCR
B. Tandem E
C. Rocket immunoeloectrophoresis
D. Western Blot

35. What are the inorganic catalysts needed in amylase activation?

A. magnesium and chloride
B. Calcium and chloride
C. Manganese and magnesium
D. magnesium and calcium

36. A method to determine amylase enzymatic activity which measures the disapperance of starch substrate.
A. Amyloclastic
B. Saccharogenic
C. Chromogenic
D. Amylometric

37. It is the smallest of the enzymes and highest concentration can be found in acinar cells of teh pancreas and salivary glands.
A. Lipase
B. Amylase
C. ACP
D. CK

38 Kjeldahl’s procedure for total protein is based upon the premise that:
A. Proteins are negatively charged
B. The pK a of proteins is the same
C. The nitrogen content of proteins is constant
D. Proteins have similar tyrosine and tryptophan
content

39. Upon which principle is the biuret method based?

A. The reaction of phenolic groups with CuIISO 4
B. Coordinate bonds between Cu +2 and carbonyl
and imine groups of peptide bonds.
C. The protein error of indicator effect producing
color when dyes bind protein
D. The reaction of phosphomolybdic acid with
protein

40. Which statement about the biuret reaction for total protein is true?
A. It is sensitive to protein levels below 0.1 mg/dL
B. It is suitable for urine, exudates, and transudates
C. Polypeptides and compounds with repeating
imine groups react
D. Hemolysis will not interfere

41. Which of the following protein methods has the highest analytical sensitivity?
A. Refractometry
B. Folin–Lowry
C. Turbidimetry
D. Direct ultraviolet absorption

42. Hyperalbuminemia is caused by:

A. Dehydration syndromes
B. Liver disease

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C. Burns
D. Gastroenteropathy

43. High serum total protein but low albumin is

usually seen in:
A. Multiple myeloma
B. Hepatic cirrhosis
C. Glomerulonephritis
D. Nephrotic syndrome

44. Which of the following conditions is most commonly associated with an elevated level
of total protein?
A. Glomerular disease
B. Starvation
C. Liver failure
D. Malignancy

45. Which of the following dyes is the most specific for measurement of albumin?
A. Bromcresol green (BCG)
B. Bromcresol purple (BCP)
C. Tetrabromosulfophthalein
D. Tetrabromphenol blue

46. At pH 8.6, proteins are _________ charged and migrate toward the _________.
A. Negatively, anode
B. Positively, cathode
C. Positively, anode
D. Negatively, cathode

47. Which of the following proteins has the highest pI?

A. Albumin
B. Transferrin
C. Ceruloplasmin
D. IgG

48. Which of the following proteins migrates in the β region at pH 8.6?

A. Haptoglobin
B. Orosomucoprotein
C. Antichymotrypsin
D. Transferrin

49. Which of the following conditions is associated with “β-γ bridging”?

A. Multiple myeloma
B. Malignancy
C. Hepatic cirrhosis
D. Rheumatoid arthritis

50. Which support medium can be used to determine

the molecular weight of a protein?
A. Cellulose acetate
B. Polyacrylamide gel
C. Agar gel
D. Agarose gel

INSTRUCTIONS FOR ANSWER KEYS

FOR PART 1 ANSWERS ARE FROM NO. 1-50

FOR PART 2 ANSWERS ARE FROM 51-100

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