CLINICAL

CHEMISTRY(RATIO)
1.If the concentration of serum triglyceride is 9.6 mg/dl.
what is the SI equivalent?
a. 0.11 mmol/L b. 0.21 mmol/L
c. 1.21 mmol/L d. 1.12 mmol/L
2.The most important buffer pair in plasma is the:
a.Phosphate/Biphosphate pair b.Hemoglobin/Imidazole pair
c. Bicarbonate/Carbonic acid d. Sulfate/Bisulfate
3. What is the approximate wavelength under visible light?
a.> 700 nm c. < 400 nm
b. 400-700 nm d. 3m-3mm
4.Kernicterus is an abnormal accumulation of bilirubin in:
a.Heart tissue c. Liver tissue
b. brain tissue d.Kidney tissue
5.This approach to the assay for creatinine has a greater specificity and more
expensive.
a.Colorimetric kinetic c. Enzymatic
b.Colorimetric end point d.None of the above
6.Floating-beta lipoprotein:
a.Beta-VLDL c. All of these
b.Lp (a) d. Lp X
7.Which of the following proteins migrate in the B-globulin band in
serum protein electrophoresis?
I.CRP III. B2M
II. FI IV. Hemopexin
V.Orosomucoid
a.I, II c, I, II, III, IV
b.I, II,III d. I, II, III, IV, V
8.Confirmatory test for acromegaly:
a. Glucose-suppression test- OGTT (75g glucose)
b.Glucose-suppression test- OGTT (50g glucose)
c. b. Glucose-suppression test- OGTT (100g glucose)
d.Somatomedin C or IGF-1
9. It is also known as the pre- -lipoprotein.
a.LDL c. CM
b.VLDL d, HDL
10. Forward method for CK:
a.Oliver-Rosalski c. Wacker
b.Tanzer Gilvarg d. Wroblewski-LaDue
11. Which of the following methods is used to measure the extent of an
enzymatic reaction in which the reactants are combined then the reaction
proceeds for a designated time?
a.Kinetic assay c. Continuous-monitoring assay
b.Fixed time method d. Multiple measurement method
12. It utilizes the lactate to pyruvate reaction;
a.Wacker c. Hudson
b.Wroblewski-LaDue d. Bessey-Lowry-Brock
13. LDH, G6PD and glutamate dehydrogenase are under what enzyme category?
a.Oxidoreductases c. Lyases
b.Hydrolases d. Transferase
14. Cause/s of flipped LD: (NP: LD2>LD1>LD3>LD4>LD5 = FP: LD1>
LD2>LD3>LD4>LD5)
a. MI c. All of these
b.Acute renal infarction d. Hemolysis
15. Cortisol, ACTH and aldosterone are normally highest in , lowest in .
a.Morning, Evening c. Evening, Morning
b.Evening, Afternoon d. Morning, Afternoon
16. Measurement of electrical potential for pO2 analysis utilizes which of the
following?
a.Amperometry c. Valinomycin-coated electrode
b.Potentiometry d, None of these
17. What are the causes of azotemia?
I.Congestive heart failure
II. Glomerular nephritis
III. Renal calculi
IV. Tumors of the bladder or prostate
a.I c, I, II, III
b.I, II d. I, II, III, IV
18. Which of the following is caused by a random error?
a.R:4s c. 4:1s
b. 2:2s d. 10x
19. Arrange the following according to the correct sequence of
Renin-Angiotensin- Aldosterone System
I.Renin will cleave angiotensinogen to produce angiotensin I.
II. When the angiotensin I reach the lungs, ACE (angiotensin converting
enzyme) will convert angiotensin I to angiotensin II.
III. Juxtaglomerular cells will produce renin.
IV. Aldosterone will be produced by the adrenal glands.
a.II, III, I. IV c. IV, III, I, II
b.III, I, II, IV d. IV, III, II, I
20. Which of the following is an appropriate sample for blood ammonia
determination.
a.Venous blood c. Arteria blood immediately chilled for 4
hours
b.Whole blood d. Freshly drawn blood
21. What is the most active thyroid hormone?
a.Thyroxine T4(most abundant) c. Parathyroid hormone
b.Triiodothyronine d. Thyroid-stimulating hormone
22. An individual with
hypothyroidism will manifest T3 level and T3 uptake
T3, T4 are directly proportional, to T3 uptake level
level. T3, T4 are invertedly proportional to TBG, cholesterol,
Trigly
a.Increased, Decreased c.
Decreased, Low-normal
b.Decreased, Decreased d.
Decreased, Undetectable
23. The dependent variable is
plotted along the: DOY – Dependent v,- Ordinate- Y-axis
a.Horizontal axis AXI- Abscissa- X-axis - Independent v.
c. X-axis
b.Vertical axis
d. Abscissa
24. If the blood pressure cuff is used as a tourniquet, it is inflated in what
mmHg?
a.30 mmHg c. 90 mmHg
b.60 mmHg d, 120 mmHg
25. Apolipoprotein A-1 is the primary component of:
a. VLDL VLDL, LDL, IDL= BETA-LIPOPROTEIN / Apo-B100
HDL, CM= Apo- B48
c. IDL
b. LDL
d. HDL
26, The primary product of hepatic
metabolism of cocaine is:
a. Friedwald formula c. Both a and b
b. De Long Formula d. None of the above
27. The primary product of hepatic metabolism of
cocaine is:
a.Morphine -Heroin c. Benzolecgonine
b.NAPA - Procainamide d. Primidone
28. CA in CA-125 means:
a. Carbohydrate Antigen c. Both a and b
b. Cancer Antigen d. None of these
29. If the precision is decreased, the SD is
.
a.Increased c. Low- normal
b.Decreased d. Undetectable
30. Before an OGTT is performed, individuals should ingest at least
of carbohydrates for the preceding the
test without limitation in physical activity.
a.150 g/day; 3 days c. 150 g/day; 4 days
 b.160 g/day; 3 days d. 160 g/day; 4 days
31. Exogenous triglycerides are transported in the plasma in which of the
following forms?
a. VLDL c. LDL
b. Chylomicrons d. Cholesteryl ester
32. Which of the following apoproteins is inversely related to risk for
coronary heart disease and is a surrogate marker for HDL?
a. Apo A-1 c. Apo B 100
b.Apo B11 d. Apo E
33. At what serum concentration would glucose begin to appear in the urine?
a.50 mg/dl c. 100 mg/dl
b.75 mg/dl d. 170 mg/dl
34. The red complex developed in the Jaffe method is a result of the
complexing of creatinine with which of the following?
a.Alkaline picrate c. Sulfuric acid
b.Diacetyl monoxide d. Sodium hydroxide
35. Water produced from distilled water using either a anion or cation
exchange resin followed by replacement of the remove particles with
hydroxyl or hydrogen ions respectively:
a.Reagent grade water c. Ionized water
b.Deionized water d. None of the above
36. Which of the following hormones promotes gluconeogenesis:
a.Epinephrine c. Hydrocortisone
b.Insulin d. Thyroxine
37. Pipets used with biologic fluids whose viscosity is greater than that of
water:
a.Lang levy pipet c. Kirk pipet
b.Ostwald-Folin d. Mohr pipet
38. Soft and flexible plastic materials used frequently to construct
tubings for automated machines:
a.Tygon c. Teflon
b.Polyolefins d. Polycarbonate
39. Used in preparation of acid-dichromate solutions, EXCEPT:
a.Concentrated sulfuric acid c. Sodium dichromate
b.Distilled water d. Nitric acid
40. Hyperglycemic factor produced by the pancreas:
a.FSH c. Glucagon (produce by ALPHA CELLS)
b.Insulin (produce by BETA CELLS; hypo) d. LH
41. The enzyme that is most specific for -D glucose:
a.Glucose oxidase c. Glucose-6-PO4 dehydrogenase
b.Hexokinase d. Phosphohexisomerase
42. Following the 1997 ADA guidelines, the times of measurement for
plasma glucose levels during an OGTT in non-pregnant patients are:
a.Fasting and 2 hours c. Fasting 30, and 60 minutes
b.After 30,60,90, and 120 mins. d. Fasting 30,60,90, and 120 mins
43. Type I DM, EXCEPT:
a. -cell destructionc. Insulin antibodies
b.Relative insulin insufficiency d. Glutamine acid decarboxylase
autoantibodies
44. True of wavelength:
I.Visible spectrum is between 400-700nm
II. Ultraviolet is lower than 400 nm
III. Infrared is higher than 700
IV. Distance between two peaks or between two troughs
a.I and II c. I, II, and III
b.III and IV d. All of the above
45. Which of the following statements is/are not true:
a. Whenever the molecular weight of the analyte is known, its concentration is to be
expressed in mole/ml
b.When the molecular weight is not known as of specific proteins or their
mixtures,
concentration should be expressed in the nmol/L
c. The hydrogen ion concentration should be expressed in the nmol/L
d. None of the above
46. If you are ask to prepare 5% w/w 200 gm of solution OF NaCl, How
much NaCl and distilled water is needed
a. 5 gm of NaCl and 95 gm distilled water
b.10 gm of NaCl and 90 gm distilled water
c. 10 gm of NaCl and 190 gm distilled water
d.20 gm of NaCl and 180 gm distilled
water
47. Diagnostic criteria for Diabetes
Mellitus, EXCEPT:
a. Random plasma glucose 200 mg/dL + symptoms of diabetes
b.Fasting plasma glucose >126 mg/dL
c. 2 hours plasma glucose >200 mg/dL during an OGTT
d. None of the above
48. A 10% solution is diluted to 1:20. What is the concentration
of the final solution: a. 1% c. 0.5%
b. 2% d. 0.1%
49. Most widely used photodetector:
a.Phototube c. Semiconductor
b.Barrier layer cells d. Photomultiplier (most sensitive)
50. True of apolipoproteins, EXCEPT:
a.Protein meiosis
b. Regulate plasma CHO metabolism
c. Help to keep lipids in solution during circulation through the
bloodstream
d.Structural elements in the amphipathic shell of lipoprotein
51. True of very low-density lipoproteins:
a. Major carrier of endogenous triglycerides
b.Contain 50% cholesterol by weight
c. Precursor of chylomicrons
d.Carry triglycerides assembled in the liver
52. True of ISE:
I. It is an electrochemical transducer able to respond
to a given ion Il. It is very sensitive and selective in
measuring ions
III. It consists of a membrane separating a reference solution and a reference
electrode
IV. It is ionic selectively depends on membrane com position used.
a.I and II c. III and IV
b.I, II, and III d. All of the above
53. Reversed cholesterol transport:
a.Chylomicron c. VLDL
b.LDL d. HDL
54. In electrophoresis, protein
molecules have a net charge thus migrate to the :
a.Positive......anode c. Negative….anode
b.Negative….cathode d. Positive….cathode
55. Detoxification function of the liver, EXCEPT:
a.Bilirubin-Conjugation fxn c. Ammonia
b.Drugs d. None of the above
56. A solution contains 28.0 mg/dL of calcium. How many meq/L of the
salt does it contain? (GMW=40)
a. 1.4 c. 20
b. 14 d. 7
57. True of Jaundice, EXCEPT:
a.Hyperbilirubinemia c. Icterus greater than 2-3 mg/dL

b.Yellow discoloration of the skin d. Serum bilirubin levels exceed 1.2

mg/dL
58. True of bile acids, EXCEPT:
a.Formed by the liver c. Stored in the gall bladder
b Emulsify all types of lipids d. Extrahepatic excretory product
59. Fasting can result, EXCEPT:
a.Increased serum bilirubin c. Increased glucose
b.Increased serum cholesterol d. Increased hemoglobin concentration
60. Urine specimen most desirable for bacteriologic examination:
a.Midstream specimen c. Random specimen
b.First morning urine d. Timed specimen
61. Complications of lumbar puncture, EXCEPT:
a.Paresthesia c. Headache
b.Hematoma d. None of the above
62. Analytical phase of quality assurance:
a.Centrifuging c. Physician contact
b.Commercial controls d. Processing the specimen
63. Extent to which the mean measurement is close to the true value:
a.Precision /repeatability c. Accuracy
b.Standard deviation d. None of the above
64. Characteristics of ideal controls, EXCEPT:
a.Should behave like a real specimens
b. Should be stable over a period of 1 month 1 yr
c. Should be available in a convenient vial volumes
d.Should include clinically normal, high and low abnormal ranges
65. True of high thermal resistant glass:
I.Used when heating or sterilization is required
II. Borosilicate glass with low alkali content
III. e.g. beakers, flask
IV. Used for manufacture of weighing bottles
a.I. ll and III c. Il and IV
b.IV d. None of the above
66. Hantzch reaction:
a.Formaldehyde + acetylacetone c. Both
b.Ethanol + KOH d. Neither
67. Involves diazotization of bilirubin with diazotized
sulfanilic acid to form pink to purple azobilirubin:
a.Van den Berg reaction c. Both
b.Kjeldahl d. Neither
68. Sites of arterial puncture:
I. Femoral
artery Il.
Earlobes
III.. Radial artery
IV. Median cephalic vein
a.I and IlI c. Ill
b.Il and IV d. II
69. Anticoagulants:
a.Plasma and serum c. Serum and whole blood
 b.Whole blood and plasma d. RBC and plasma

70. Anticoagulants prevent coagulation by, EXCEPT:

a.Removing Ca from blood c. Neutralization by thrombin
b.Precipitation of Ca as insoluble salt d. Neutralization of prothrombin
71. Beer-Lambert Law:
a.Expresses the relationship between concentration and absorbance
b.Concentration of substance is directly proportional to the
amount of light absorbed
c. By comparing the incident light to transmitted light
d. All of the above
72. Colorimetric assay of Ammonia:
a.Indophenol blue c. Both
b.Alpha-ketoglurate d. Neither
73. Inactive precursor of enzymes: (2 possible answers)
a.Proenzyme c. Apoenzyme “ogen”-inactive
b.Zymogens d. Cofactor
74. True of cofactors, EXCEPT:
a.Thermolabile c. Dialyzable
b.Non- protein substance d. None of the above
75. More acceptable theory on enzyme specificity:
a.Lock and Key theory (enzyme; substrate) c. Induced Fit theory
/kochland
b.Emil Fisher’s theory d. All of the above
76. The rate of reaction is linear with time, independent of
concentration of substrate and directly proportional to enzyme
concentration:
a.Zero Order Reaction c. First Order Reaction
b.Second Order Reaction d. None of the above
77. Most susceptible to heat inactivation isoenzymes of
ALP is found in:
a.Liver c. Bone
b.Intestine d. Placenta
78. Methods of determination of ALP using beta-glycerophosphate as
substrate:
a.Bodansky c. Bessey, Lowry and Brock
b.Huggins and Talalay d. Moss
79. Elevated serum levels of ACP are seen in
patients with :
a.Osteitis deformans c. Osteomalacia
b.Hodgkin’s disease d. Prostate cancer
80. True of LDH:
a.In MI, it increases 12-24 hrs after the onset of pain
 b.Peaks at 84 hours
c. Remains elevated for 10-20 days
d.All of the above

81. Most specific indicator for MI:

a.CK c. LDH
b.Amylase d. SGOT
82. Hyponatremia (Dilutional):
a.Prolonged vomiting c. Persistent Diarrhea
b.Ascitis d. Metabolic Acidosis
83. Major cation of ICF
a.Na c. K
b.Mg d. Ca
84. Storage form of iron which is produced by the combination of
remaining iron retained within the cell and the protein apoferritin:
a.Transferrin saturation c. Ferritin
b.TIBC d. UIBC
85. Hypophasphatemia:
a.Hypoparathyroidism c. Chronic glomerulonephritis
b.Avitaminosis d. Uremia
86. Factors affecting serum calcium levels, EXCEPT:
a.PTH c. Activated Vitamin D3
b.Calcitonin d. None of the above
87. Decreased in TIBC:
a.Iron deficiency c. Late pregnancy
b.Chronic Infections d. All of the above
88. Substances or compounds which have the power to combine with either
acids or bases:
a.Alkali reserve c. Base excess
b.Chemical buffers d. None of the above
89. Chief acid product of metabolism:
a.Bicarbonates c. Both
b.Carbonic acid d. Neither
90. The plasma protein mainly responsible for maintaining colloidal osmotic
pressure in vivo is:
a.Hemoglobin c. Fibrinogen
b, 2-macroglobulin d. Albumin
91. In which of the following conditions would a normal level of myoglobin be
expected:
a.Multiple myeloma c. Acute MI
b.Renal failure d. Crushing trauma received in a car
accident
92. When a reaction is performed in zero-order kinetics:
 a. The rate of reaction is independent of the substrate concentration
b. The rate of reactions is directly proportional to the substrate
concentration
c. The enzyme level is very high
d.None of the above

93. Activation energy is:

a.The energy needed for the enzyme reaction to stop
b.Increased by enzymes
c. Very high in catalyzed reactions
d. Decreased by enzymes
94. An example of using enzymes as reagents in the clinical laboratory is:
a.Diacetyl monoxime-BUN method c. Hexokinase- glucose method
b.Alkaline picrate- creatinine method d. Biuret- total protein method
95. Serum levels of total CK are elevated after an acute MI and in
which of the following conditions:
a.Diabetes mellitus c. Chronic renal failure
b.Duchenne type muscular dystrophy d. Early pregnancy
96. Which of the following liver enzymes is the best to evaluate liver function:
a.AST c. GGT
b.ALT d. LD
97. Elevation of tissue enzymes in serum maybe used to detect:
a.Presence of toxin c. Infectious disease
b.Tissue necrosis d. Diabetes mellitus
98. Which NPN fraction constitutes nearly half of the NPN substances in the
blood:
a.Urea c. Ammonia
b.Creatinine d. Uric acid
99. Meke’s syndrome is caused by accumulation of the following
metal in the intestinal mucosal cell and associated low plasma
concentrations:
a.Iron c. Zinc
b.Copper d. Manganese
100. The following metal is most associated with the “dementia of dialysis”:
a.Aluminum c. Cadmium
b.Flourine d. Zinc