TEST BANK for Clinical Chemistry Principles, Techniques, and Correlations EXAM ( WITH AN, Exams of Chemistry

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TEST BANK for Clinical Chemistry Principles,

Techniques, and Correlations EXAM ( WITH

ANSWERS ) RATED A+

Sensitivity equation - ANSWER TP/(TP+FN) For a qualitative test, sensitivity is determined by... - ANSWER The number of true positives divided by all results that should have been positive Predictive value for a negative qualitative test - ANSWER NPV = TN/(TN+FN) NPV is best described as... - ANSWER The number of true negative values divided by all observed negative values Precision is viewed as what statistic in clinical chemistry? - ANSWER Standard deviation Accuracy is viewed as what statistic in clinical chemistry? - ANSWER Mean Specificity equation - ANSWER TN/(TN+FP) For a qualitative test, specificity is determined by... - ANSWER The number of true negatives divided by all results that should have been negative What are the key parameters for a qualitative test? - ANSWER Specificity, sensitivity, predictive value, and accuracy What are the key parameters for quantitative test? - ANSWER Accuracy, precision, reference range, and critical values

Ion-selective electrodes (ISE) can be used to measure analytes including... - ANSWER pH, Na, Cl, CO2, K (T/F) Hospital/clinical laboratories tend to have a higher degree of automation to handle high volumes of samples, whereas point-of-care labs focus on convenience and immediate results. - ANSWER True (T/F) Fluorescence emission light wavelength is longer than excitation light wavelengths. - ANSWER True Which type of patient information do clinical laboratory tests typically provide to the physician? - ANSWER Objective and personalized patient information What is a homogenous immunoassay that does not require separation of bound antigen from unbound antigen during the assay? - ANSWER EMIT What is an amount of enzyme that catalyze the conversation of one micromole of substrate in 1 minute?

• ANSWER International unit Enzyme-based clinical assays can measure what two things? - ANSWER Endogenous enzymes and endogenous substrates UV/Visible absorbance assays rely on what to determine the concentration of an analyte in solution or samples? - ANSWER The Beer-Lambert Law What does nephelometry measure? - ANSWER It measures the scatter of light by particles (light scattering of the sample/the stability of the sample) What does refractometry measure? - ANSWER Light bending as it passes through different media Why is LC/MS more selective than LC/UV? - ANSWER MS can determine molecular weight, detect novel substances, and has high mass accuracy.

What type of test is most often available over the counter for home pregnancy test? - ANSWER Immunochromatographic assay What hormone is most likely to interfere with a home pregnancy test? - ANSWER Follicle stimulating hormone (FSH) Waiver of a test by Clinical Laboratory Improvement Amendments (CLIA) indicates that the test is... - ANSWER So simple and accurate to render the likely of error negligible and can be cleared by the FDA for home use What is typically the soonest pregnancy can be detected using the human chorionic gonadotropin (hCG) test? - ANSWER 7 to 10 days after conception Which hormone stimulates/promotes fertility in both men and women? - ANSWER Follicle stimulating hormone (FSH) Which sample (specimen) has the longest window for being able to detect drug use? - ANSWER Hair Fractional excretion of sodium uses a measure of sodium present in urine and it is calculated based on the relative levels of what else in urine? - ANSWER Creatinine Calcium levels must be corrected in blood samples because of what feature? - ANSWER Binding by serum albumin Hyponatremia is... - ANSWER Decreased blood sodium levels What is the normal value for fractional excretion of sodium? - ANSWER 1-2% What is the most abundant anion found in extracellular fluids? - ANSWER Chloride

Which of the following is not used to measure electrolytes in a clinical laboratory: ion selective electrodes, flame photometry, or immunochromatographic method? - ANSWER Immunochromatographic method An increase in blood pH is called (alkalosis/acidosis) and this can result in an intracellular shift of potassium to cause (hypokalemia/hyperkalemia). - ANSWER Alkalosis & hypokalemia What could lead to depletional hyponatremia? - ANSWER Vomiting, excessive sweating, and diarrhea Hypernatremia is... - ANSWER Elevated blood sodium levels The major extracellular fluid electrolyte - ANSWER Sodium Which of the following is not one of the homeostatic (normal) mechanisms involved in establishing the Na+/water balance: ADH, aldosterone, SIADH, renin/angiotensin? - ANSWER SIADH A decrease in blood pH is called (alkalosis/acidosis) and this can result in an intracellular shift of potassium to cause (hypokalemia/hyperkalemia) - ANSWER Acidosis & hyperkalemia Major extracellular electrolyte - ANSWER Sodium Major intracellular electrolyte - ANSWER Potassium Most abundant anion found in the intracellular environment? - ANSWER Phosphate The buffy coat includes... - ANSWER WBCs and platelets Normocytic anemia is caused by - ANSWER Acute blood loss What is the role of platelets? - ANSWER They are involved in control of clotting

What coagulation pathways does aPTT assay monitor? - ANSWER The intrinsic pathway and is important to heparin therapy (T/F) MCV, Hct, Hgh are the same in all people. - ANSWER False, unique to men, women, children, and infants. RBCs - ANSWER Carry oxygen bound to hemoglobin to the tissues MCV (mean cell/corpuscle volume) formula - ANSWER Hct (hematocrit)/RBC count MCH (mean cell hemoglobin) formula - ANSWER Hgh (concentration of hemoglobin)/RBC count What is the role of monocytes and macrophages? - ANSWER They are the largest blood cell, have innate immunity, and help prevent infection MCHC (mean cell hemoglobin concentration (MCHC) - ANSWER Hgh (concentration of hemoglobin)/Hct (volume of packed RBCs) Which coagulation pathways does PT assay monitor? - ANSWER The external pathway and it is important in warfarin therapy. What are the 3 major classes of blood cells and where they are formed? - ANSWER WBCs, RBCs, platelets. Formed in bone marrow What is the role of lymphocytes? - ANSWER They are involved in the adaptive immune response and comprised of B and T cells among others. How long does a RBC live? - ANSWER 120 days Difference between reticulocyte and erythrocyte - ANSWER Reticulocyte is immature RBC. Erythrocyte is mature RBC.

Which of the following methods/assays is NOT used to determine creatinine serum concentration? A. Jaffe reaction (reaction of creatinine with picric acid to form a red-orange complex) B. Immunoassay (detect using antibodies against creatinine) C. HPLC method (directly detecting and quantifying creatinine upon LC separation) D. Enzymatic assay (reaction of creatinine with creative iminohydrolase) - ANSWER B. Immunoassay fWhich of the following is NOT true about the kidney's glomerulus? A. Protein biologics, e.g. Monoclonal antibodies (mAbs), are filtered at the glomerulus B. GFR reflects kidney function and disease C. Filter substances with MW <40,000 Da D. Most small molecule drugs are filtered at glomerulus, except for drugs bound to plasma proteins - ANSWER A. Protein biologics, e.g. Monoclonal antibodies (mAbs), are filtered at the glomerulus Albumin is not filtered at the glomerulus because it is 66kD, which is larger than 40,000 Da. Monoclonal antibodies are very large (100 Da), so they cannot be filtered at the glomerulus. fWhich of the following would elevate serum creatinine concentration? A. Renal dysfunction caused by aminoglycosides B. Urinary tract obstruction C. Dehydration D. All of the above - ANSWER D. All of the above f(T/F) Urea is mainly produced in the liver to remove toxic ammonia. Although urea is almost completely filtered by the glomerulus, approximately 50% of the filtered urea is reabsorbed by kidney tubules. - ANSWER True fDuring dipstick urinalysis, normal urine should not contain the following substances EXCEPT FOR: A. Glucose B. Sodium and potassium

C. Protein D. Albumin and hemoglobin - ANSWER B. Sodium and potassium (these electrolytes will go into the urine and be excreted from the body) fDrugs that inhibit tubular secretion of creatinine can cause false positive results for CKD, due to an elevated serum creatinine concentration without any damage to renal function - ANSWER Cimetidine and Probenecid fA patient (11 years old) is prescribed imipenem IV for a gram-negative bacterial infection. Imipenem overdose can cause seizure and other CNS adverse effects, especially in patients with CNS disorders and/or compromised renal function. Imipenem dosage needs to be adjusted based on calculated CrCl or GFR. Which formulat would be most appropriate in this case to calculate CrCl or GFR? - ANSWER Schwartz formula or Counahan-Barratt function (for pediatric patients <12 years old) f(T/F) The inulin clearance rate is equal to the GFR because inulin is completely filtered through the glomerulus and not metabolized, secreted, or reabsorbed at the kidney tubules. - ANSWER True fWhich of the following is NOT true about the creatinine renal function test? A. SCr can be determined using Jaffe reaction, enzymatic assay, or HPLC method B. Creatine, precursor of creatinine, is synthesized in the liver and stored in the muscle as creatine phosphate. Creatinine is produced by cyclization of creatine and then escapes muscle cell membranes into the blood. C. Increased body muscle mass does not significantly change SCr. D. Body fat does not affect SCr level - ANSWER C. Increased body muscle mass does not significantly change SCr This is false because muscles are the main site of production for creatinine. Anything that changes the muscle mass will have an effect on the SCr. Increased muscle mass will increase SCr; decreased muscle mass will decrease SCr. If someone is experiencing heart failure, there is a increase in SCr. Since the blood flow is decreased, then blood flow is decreased to the kidney as well, causing GFR to decrease. Filtration of creatinine will be less efficient and creatinine will accumulate in the blood and elevate the serum creatinine concentration. Anything that reduces the perfusion of the kidney will reduce the excretion of molecules from the blood leading to the elevation of those molecules in the serum. Dehydration or hypovolemia condition will cause an increase in SCr. Inverse relationship between SCr and CrCl. The higher the SCr, the worse the renal function because clearance is not working well.

fBUN:SCr ratio can be used to determine the cause of acute kidney injury as prerenal or intrarenal cause. Which of the following lab results suggests intrinsic renal damage (intrarenal cause)? A. BUN:SCr < 10 and both BUN and SCr are higher than normal B. BUN:SCr < 10 and both BUN and SCr are lower than normal C. BUN:SCr > 20 and both BUN and SCr are higher than normal D. BUN:SCr > 20 and both BUN and SCr are lower than normal - ANSWER A. BUN:SCr < 10 and both BUN and SCr are higher than normal fWhich drug can turn urine into red to orange color? - ANSWER Doxorubicin and daunorubicin fWhat are the major types of solute movement in the nephron? A. Glomerular filtration B. Tubular secretion C. Tubular reabsorption D. K+/Na+ pump E. A, B, and C F. All of the above - ANSWER E. A, B, and C (glomerular filtration, tubular secretion, and tubular reabsorption) fWhich of the following would likely elevate SCr? A. Renal dysfunction and heart failure B. Dehydration (hypovolemia) C. Body building and steroid drug/med use D. Patients undergoing limb amputation E. A, B, C F. All of the above - ANSWER F. All of the above fWhat drugs changes urine color to blue to green color? - ANSWER Amitriptyline and mitoxantrone

fWhat drugs can change urine color to brown to black? - ANSWER Chloroquine and nitrofurantoin fHow is urea handled differently from creatinine in the kidney? A. Urea is filtered at glomerulus B. Urea is secreted at kidney tubules C. Urea is reabsorbed (50%) at the kidney tubules - ANSWER C. Urea is reabsorbed (50%) at the kidney tubules fWhich BUN:SCr ratio is indicative of dehydration? A. 25 B. 15 C. 10 D. 5 - ANSWER A. 25 because BUN:SCr is over 20 fWhich BUN:SCru ratio is indicative of intrinsic renal damage? A. 25 B. 15 C. 10 D. 5 - ANSWER D. 5 fIn order for someone to be infected with hepatitis D, they must also be infected with which of the following? A. Hepatitis B B. Hepatitis C C. Shingles D. STD E. Herpes - ANSWER A. Hepatitis B fWhich of the following is indicative of alcoholic liver disease?

A. SCr > 3 mg/dL B. BUN:SCr > 20 C. AST > 10 xULN D. AST:ALT ratio > 2 and/or GGTP:ALP > 2.5 - ANSWER D. AST:ALT ratio > 2 and/or GGTP:ALP > 2. fIf a patient's total bilirubin is high, which of the following lab tests (if also high) would be consistent with the bilirubin being high due to hemolysis rather than liver dysfunction? A. ALP (alkaline phosphatase) B. ALT (alanine aminotransferase) C. GGTP (gamma glutamyl transpeptidase) D. Indirect bilirubin - ANSWER D. Indirect bilirubin f(T/F) Successful HBV vaccination can be distinguished from prior infection by the presence of anti-HBs and absence of antibodies against other antigens (anti-HBc, anti-HBe) - ANSWER True fWhich of the following substances is administered to a patient with a long prothrombin time (PT) to determine if the cause is liver malfunction or malnutrition? A. Ascorbic acid B. Vitamin K C. Vitamin E D. Warfarin - ANSWER B. Vitamin K fWhich of the following proteins has a half-life of approximately 20 days and decreased concentrations in serum are indicative of liver disease? A. Albumin B. Alkaline phosphatase C. Prealbumin D. Aspartate aminotransferase E. Prothrombin - ANSWER A. Albumin

fALP is used to diagnose hepatobiliary disorders because bile accumulation causes liver cells to synthesize more ALP, which then leaks into the serum. Which of the following is NOT true about ALP function liver test? A. 4xULN suggests a cholestatic disorder, but needs confirmation B. ALP can be found in many body tissues including liver, bone, and placenta C. ALP test is based on an immunoassay and is diagnostic/specific for liver injury D. Additional tests to confirm a cholestatic cause of an ALP increase may include 5-NT and GGTP - ANSWER C. ALP test is based on an immunoassay and is diagnostic/specific for liver injury fWhich of the below is considered the primary toxin generated by the liver following alcohol ingestion that is believed to be the causes of alcoholic liver disease? A. Lactic acid B. Acetaldehyde C. Glutathione D. Methanol E. Ascorbic aci - ANSWER dB. Acetaldehyde f(T/F) Unconjugated bilirubin (indirect) is insoluble in aqueous conditions and cannot be directly detected by the van der Bergh reaction. Conjugated bilirubin is formed in the liver by UGT1A1-catalyze glucuronidation and can be detected by the van der Bergh reaction. - ANSWER True fWhich of the following is not increased during hepatitis infection? A. Serum albumin B. Bilirubin C. Gamma globulin D. ALT E. AST E. Gamma-glutamic transpeptidase (GGTP) - ANSWER A. Serum albumin f(T/F) Elevated ALP and normal 5-NT (or normal ALT) means the problem is probably a nonhepatic etology. - ANSWER True

f(T/F) AST, ALT, and LDH are indicators of hepatocellular injury, although AST and LDH can also increase in myocardial infarction. - ANSWER True fWhich test is NOT used to detect acute liver injury/changes? A. Prealbumin B. AST C. ALT D. Albumin - ANSWER D. Albumin (half-life is too long = 20 days, so cannot measure ACUTE liver injury) fWhich test is most specific for liver injury? A. AST B. ALT C. ALP D. Total bilirubin E. LDH - ANSWER B. ALT fWhich test is indicative of cholestatic liver disease? A. Elevation of total bilirubin and indirect bilirubin with normal ALT and AST B. Elevation of total bilirubin and direct bilirubin with normal ALT and AST C. Elevation of total bilirubin, ALT, and AST. - ANSWER B. Elevation of total bilirubin and direct bilirubin with normal ALT and AST Cholestatic liver disease does not have increase in ALT and AST. Direct bilirubin is synthesized from the indirect bilirubin by the conjugation reaction. When you have cholestatic liver disease, bile flow is abnormal, so you will have accumulation of direct bilirubin in the liver. fWhich isotype of immunoglobulins shows up first in the blood after a viral hepatitis infection? A. IgA B. IgD C. IgG

D. IgM E. IgE - ANSWER D. IgM fWhich test is positive for healthcare workers after a successful HBV vaccination? A. HbsAg B. Anti-HBs C. HBeAg D. Anti-Hbe E. HBcAg F. Anti-HBc G. IgM - ANSWER B. Anti-HBs fLDL is often calculated based on the Friedewald equation. Which of the following is the correct Friedewald equation? A. [LCL-C] = [TC] - [HDL-C] + [TG]/ B. [LCL-C] = [TC] - [HDL-C] - [TG]/ C. [LCL-C] = [TC] - [HDL-C] - [TG]* D. [LCL-C] = [TC] - [TG] - [HDL-C]/5 - ANSWER B. [LCL-C] = [TC] - [HDL-C] - [TG]/ fWhich of the following is FALSE about lipoproteins? A. Lipoproteins transport lipids around the body in the blood and in-and-out of cells B. Lipoproteins consist of cholesterol, TG, phospholipids, and apolipoproteins C. Lipoproteins are classified based on density, size, and major apolipoprotein type D. HDL contains the highest percent of cholesterol in its lipid payload and is the major carrier of cholesterol in the bloo - ANSWER dD. HDL contains the highest percent of cholesterol in its lipid payload and is the major carrier of cholesterol in the blood fSerum total cholesterol can be measured using chemical or enzymatic assays. Which of the following is FALSE about TC (total cholesterol) assays?

A. In chemical assay, serum cholesterol is extracted using hexane and then treated wit Liebermann- Burchard reagent B. In enzymatic assay, cholesterol is quantified by LC/MS-based analytical assays C. Chemical assay is CDC reference method and enzymatic assays are routinely used method D. Cholesterol can be oxidized by oxidase to produce H2O2, which can be measured spectrophotometrically by producing a dye or fluorescent product - ANSWER B. In enzymatic assay, cholesterol is quantified by LC/MS-based analytical assays f(T/F) Triglycerides are esterified form of glycerol and fatty acids. Serum TG levels are not significantly altered after a fatty meal. - ANSWER False f(T/F) A new cardiovascular prevention guideline was released in 2013 by AHA and American College of Cardiology to calculate the ASCVD risks based on risk factors. Serum cholesterol levels (TC and HDL) are considered as risk factors in the new calculation. - ANSWER True fIf lipid profile is measured using nonfasting blood samples, which lipid results can still be accurate? A. TG, TC, and HDL B. TC and HDL C. TC and LDL D. LDL and TG - ANSWER B. TC and HDL fWhich of the following is NOT considered as major plasma lipids? A. Cholesterol B. Triglycerides C. Fat soluble vitamins D. Phospholipids - ANSWER C. Fat soluble vitamins fAccording to the NCEP 2001 guideline, what is the desirable TC level and what HDL level is considered low (undesirable)? A. TC < 200 mg/dL and HDL < 40 mg/dL B. TC > 200 mg/dL and HDL < 40 mg/dL

C. TC < 200 mg/dL and HDL < 60 mg/dL D. TC < 240 mg/dL and HDL < 40 mg/dL - ANSWER A. TC < 200 mg/dL and HDL < 40 mg/dL fMyocardial infarctions lead to death of heart muscle due to lack of oxygen which leads to release of cardiac enzymes and proteins into the serum. Which parameter is the MOST challenging in terms of evaluating serum biomarker results? A. Determining when a heart attack started (time zero) B. Determining the reference range for the assay C. Determining which drug to administer first D. Determining the manufacturer of the clinical assay kit - ANSWER A. Determining when a heart attack started (time zero) fWhich of the following characteristics is not a key role for myoglobin as an early biomarker for MI? A. Highly water soluble protein B. Small MW protein C. Specific isoform of protein in cardiac cells D. Found primarily in the cytoplasm - ANSWER C. Specific isoform of protein in cardiac cells fGenerally, high levels of hs-CRP are predictive of which of the following? A. Stable angina and stable heart disease B. Lower survival rate and recurrent events C. Great health the rest of the patient's life D. No new coronary events - ANSWER B. Lower survival rate and recurrent events fGenerally, BNP and NT-BMP levels are predictive as follows: A. High levels of BNP and low levels of NT-BNP are indicative that heart failure is likely B. Low levels of BNP or NT-BNP (100 and 300) are indicative that heart failure is unlikely C. High levels of BNP and low levels of NT-BNP are indicative that heart failure is unlikely D. Low levels of BNP or NT-BNP (100 and 300) are indicative that heart failure is likely - ANSWER B. Low levels of BNP or NT-BNP (100 and 300) are indicative that heart failure is unlikely

fWhich of the following CK isozymes is the best indicator of MI and why? A. CK-MM because it is practically absent in serum of patients without clinical problems B. CK-MB because it is practically absent in serum of patients with clinical problems C. CK-MB because it is practically absent in serum of patients without clinical problems D. CK-BB because it is practically absent in serum of patients without clinical problems - ANSWER C. CK- MB because it is practically absent in serum of patients without clinical problems fWhich of the following is true? A. UA/NSTEMI is defined by ST-depression or prominent T-inversion and/or positive biomarker B. Clinical presentation can distinguish among UA, NSTEMI, and STEMI C. The ECG cannot differentiate between NSTEMI and STEMI D. The release of undetectable quantities of biomarker in peripheral circulation indicates MI - ANSWER A. UA/NSTEMI is defined by ST-depression or prominent T-inversion and/or positive biomarker fWhich of the following is true? A. High HDL and LDL are good for your heart B. High LDL and low HDL is better for your heart C. Cholesterol has no impact on heart disease D. Having a higher HDL than LDL is better for better heart health - ANSWER D. Having a higher HDL than LDL is better for better heart health fWhich of the following troponins have unique form(s) in cardiac cells and are thus used as serum biomarker for MI? A. Troponins C and T B. Troponins I and C C. Troponins I and T D. Troponin T - ANSWER C. Troponins I and T fSerum biomarker for heart attack are released into serum in which order (from first to last)?

A. Myoglobin, troponins = lactate dehydrogenase, creatinine kinase B. Myoglobin, troponins = creatinine kinase, lactate dehydrogenase C. Creatinine kinase, myoglobin, troponins, lactate dehydrogenase D. Myoglobin, lactate dehydrogenase, creatinine kinase, troponins - ANSWER B. Myoglobin, troponins = creatinine kinase, lactate dehydrogenase Hypothyroidism is diagnosed by which of the following? A. Increased T4 and decreased T B. Decreased T4 and increased T C. Increased T4 and increased T D. Decreased T4 and decreased T3 - ANSWER D. Decreased T4 and decreased T What is the common type of laboratory assay that is widely used to assess thyroid hormone concentrations, such as FT4? A. Potentiometry B. Immunoassay C. Ultrafiltration D. Estimation based on a formula - ANSWER B. Immunoassay A disorder of the thyroid caused by autoimmune reaction to TSH receptor is ________________? A. Hashimoto's thyroiditis B. Euthyroid disease C. Sick euthyroid syndrome D. Grave's disease - ANSWER D. Grave's disease What is the function of thyroid hormone? A. Inhibit secretion of growth hormone B. Regulate carbohydrate, lipid, and protein metabolism within cells C. Solely regulate reproductive processes

D. Maintain water homeostasis - ANSWER B. Regulate carbohydrate, lipid, and protein metabolism within cells Total T4 = A. Free T4 + bound T B. Free T3 + bound T C. Free T3 + rT D. Bound T4 + rT3 - ANSWER A. Free T4 + bound T Hyperthyroidism is diagnosed by which of the following? A. Increased T4 and decreased T B. Decreased T4 and increased T C. Increased T4 and increased T D. Decreased T4 and decreased T3 - ANSWER C. Increased T4 and increased T TSH is secreted by _______________? A. Pituitary gland B. Thyroid C. Adrenal gland D. Hypothalamus glan - ANSWER dA. Pituitary gland A deficiency of thyroid hormone production causing reduced metabolism is ____________________. A. Thyrotoxicosis B. Hyperthyroidism C. Euthroidism D. Hypothyroidism - ANSWER D. Hypothyroidism Excessive amounts of thyroid hormones cause _______________. A. Decreases metabolism

B. Hyperthyroidism C. Grave's disease D. Hypothyroidism - ANSWER B. Hyperthyroidism TRH is secreted by the _________________. A. Adrenal gland B. Thyroid C. Hypothalamus gland D. Pituitary glan - ANSWER dC. Hypothalamus gland Glycosylated hemoglobin (HbA1c) indicates compliance of a patient with diabetes. A1c concentration represents the integrated glucose value in the blood over what period? A. One day B. 8-12 weeks C. 8-12 months D. 8-12 days - ANSWER B. 8-12 weeks A 17 year old white male has very recently been thirsty, urinating frequently, eating a lot yet losing weight. Blood tests show he has reduced serum levels and 300 mg/dL OGTT glucose levels. This boy is most likely to be diagnosed with? A. Gestational diabetes B. Type II diabetes mellitus C. Hypoglycemia D. Type I diabetes mellitus - ANSWER D. Type I diabetes mellitus Type 2 diabetes mellitus... A. Is associated with resistance to the action of insulin B. Occurs less frequently than T1DM C. Is caused by destruction of pancreatic beta-cells

D. Is also known as insulin-dependent DM - ANSWER A. Is associated with resistance to the action of insulin Which of the following values obtained after a fasting test or OGTT is above the appropriate cut-point for diagnosis of DM? A. Fasting specimen = 110 mg/dL B. Fasting specimen = 138 mg/dL C. 2 hr specimen = 125 mg/dL D. 2 hr specimen = 80 mg/dL - ANSWER B. Fasting specimen = 138 mg/dL Release of glucose from its storage form is called? A. Glycogenesis B. Glyconeogenesis C. Glycogenolysis D. Glycolysis - ANSWER C. Glycogenolysis Which of the following hormones promotes decreased blood glucose? A. Cortisol B. Insulin C. Epinephrine D. Glucagon - ANSWER B. Insulin Which of the following hormones does not produce hyperglycemia? A. Cortisol B. Insulin C. Thyroid hormone D. Glucagon - ANSWER B. Insulin Type 1 diabetes mellitus...

A. Is associated with resistance to the action of insulin B. Occurs less frequently than T1DM C. Is caused by destruction of pancreatic beta-cells D. Is also known as insulin-dependent DM - ANSWER C. Is caused by destruction of pancreatic beta cells Which of the following is the best predictor of prostate cancer? A. Elevated serum hCG B. Elevated levels of serum CEA C. Elevated levels of free serum PSA D. Elevated levels of serum bound PSA - ANSWER D. Elevated levels of serum bound PSA Which of the following best describes the biochemical activity of PSA? A. Hormone receptor B. Serine protease C. Intracellular adhesion molecule D. Glucagon receptor - ANSWER B. Serine protease Which of the following is the type of test that is most commonly used to screen for tumor markers in serum? A. Sandwich ELISA B. Fluorescence in situ hybridization (FISH) C. Ligand binding assay D. Immunohistochemical assay - ANSWER A. Sandwich ELISA Elevated CA19-9 levels are an indication of which cancer? A. Breast cancer B. Prostate cancer C. Colon cancer D. Pancreatic cancer - ANSWER D. Pancreatic cancer

Which of the following markers typically requires testing of biopsies material rather than serum? A. CEA B. CA19- 9 C. CA- 125 D. HER- 2 - ANSWER D. HER- 2 Which of the following is NOT an assay that would typically be used as a test for HER-2 in breast biopsies? A. Ligand binding assay B. Immunohistochemical assay C. Sandwich ELISA D. Fluorescence in situ hybridization (FISH) - ANSWER C. Sandwich ELISA Elevated PSA levels are an indication of which cancer? A. Breast cancer B. Prostate cancer C. Ovarian cancer D. Colon cancer - ANSWER B. Prostate cancer Elevated CEA levels are often used as an indication of which type of cancer? A. Colon cancer B. Thyroid cancer C. Breast cancer D. Ovarian cancer - ANSWER A. Colon cancer Which of these is the least important application for identification of tumor markers in serum? A. Screening for the recurrence of cancer following treatment B. Monitoring the effectiveness of treatment

C. The likelihood of developing cancer in the future D. Guiding treatment of an existing cancer - ANSWER C. The likelihood of developing cancer in the future The normal role of PSA is what? A. Cleave alpha- 2 - macroglobulin in the blood B. Promote growth of epithelial cells in the prostate C. Bind and activate anti-chymotrypsin in the blood D. Liquefy semen to promote the swimming movements of sperm - ANSWER D. Liquefy semen to promote the swimming movements of sperm Which of the following is NOT true for CEA? A. It is an intercellular adhesion molecule B. It is produced on all surfaces of intestinal cells C. It is highly glycosylated D. Its levels tend to be elevated in smokers - ANSWER B. It is produced on all surfaces of intestinal cells Elevated CA-125 levels are most often an indication of which cancer? A. Colon cancer B. Ovarian cancer C. Prostate cancer D. Pancreatic cancer - ANSWER B. Ovarian cancer Which of the following is extremely important for a cancer test? A. Negative predictive value B. Sensitivity C. Positive predictive value D. All of these - ANSWER D. All of these The fecal occult blood test (FOBT) involves which of the following?

A. Antibody binding of hemoglobin B. Oxidation of a plant compound called guaiac C. ELISA for detection of CEA in stools D. All of these - ANSWER B. Oxidation of a plant compound called guaiac The fecal immunochemical test (FIT) involves which of the following? A. Oxidation of a plant compound called guaiac B. Immunochromatographic strip for specific antibody binding of hemoglobin C. Immunochromatographic strip for specific antibody binding of fecal CEA D. ELISA for detection of CEA in stools - ANSWER B. Immunochromatographic strip for specific antibody binding of hemoglobin In eQ-PCR LC Warfarin genotype get test, PCR is used to amplify a promoter region of VKORC1 and melting curves of final PCR amplification DNA products are measured. Which type of melting curves indicate a heterozygous genotype? A. No peaks B. Double peaks at low and high melting temperatures C. Single peak at low melting temperature D. Single peak at high melting temperature - ANSWER B. Double peaks at low and high melting temperatures What characteristics make a drug more suited for PGx? A. Narrow therapeutic B. Lack of alternative medications that are not subjected to genetic variability C. Genes of interest are the predominant determinant for drug response, e.g representing the major pathway of elimination or the sole drug target D. Clinically significant consequences due to over or under dosing E. All of the above - ANSWER E. All of the above Which online resource curates the latest information on drug labels with PGx information and on genetic tests for PGx?

A. Pubmed B. PharmGKB.org C. Wikipedia D. Google - ANSWER B. PharmGKB.org (T/F) Clopidogrel is a prodrug activated by CYP2C19. CYP2C19 poor metabolizer may benefit less from clopidogrel treatment. Alternative treatment e.g prasugrel, should be considered for CYP2C19 poor metabolizer. - ANSWER True A breast cancer patient is about to initiate chemotherapy that contains tamoxifen. As a clinical pharmacogeneticist, you learned that this patient is CYP2D6 poor metabolizer. What would you recommend to the patient and physician regarding tamoxifen. A. Tamoxifen is a prodrug and CYP2D6 plays a critical role in its activation to the active metabolite endoxifen. Hence the patient will respond very well to tamoxifen treatment. B. Tamoxifen is very effective and there is no pharmacogenetic concern. C. The patient should be further genotyped for CYP2C19 and CYP2C9 before any recommendation can be given. D. Tamoxifen is a prodrug and CYP2D6 plays a critical role in its activation to the active metabolite endoxifen. Hence the patient may not respond well to tamoxifen treatment. - ANSWER D. Tamoxifen is a prodrug and CYP2D6 plays a critical role in its activation to the active metabolite endoxifen. Hence the patient may not respond well to tamoxifen treatment. (T/F) UGT1A1*28 genotype distribution in different ethnic populations are more or less identical. Therefore, it is equally important for European Caucasians, Africans, and East Asians. - ANSWER False A cancer patient is about to initiate chemotherapy with irinotecan. You are informed that this patient will has been previously genotype for UGT1A1, CYP2C9, and CYP2D6. What should be your course of action when you learned about genotyping results? A. Consider all genotype information. If the patient is homozygous for a variant of any one of the three enzymes, starting dose should be decreased at least one level as recommended by the FDA. B. Only consider UGT1A1 genotype. If the patient is homozygous for either of the *28, *6, *27, *29, *7 variants, starting dose should be decreased at least one level as recommended by the FDA. C. Disregard the genotype information since the FDA has not included genotyping information to the irinotecan drug label.