• Primary clinical utility of serum protein • Evaluation of proteins: Qualitative & quantity

electrophoresis Quantitation of diff. bands is based on Densitometry

-Detection of a significant increase in the gamma *Relative value: expressed in percentage
region in monoclonal gammopathy *Diffuse increase
*SPE: separation of plasma proteins *IgA: cause budging effect
: determine the group of proteins that is • This concept encomposes the total or overall testing
causing the abnormal process
Abnormal TP/Albumin→SPE→performs spec. a.lean six sigma
analysis b.quality assurance
*SPE steps: c.proficiency testing
1. Separation of proteins:(-)charged at a basic pH 8.6 d.quality control
(least anodal)Gamma-beta-alpha2-alpha1:albumin • Uric acid when oxidized by the enzyme uricase is
(fastst) transformed to:
2.fixation:acetic acid(commonly used) a. xanthine
3.staining: Coomasie blue,Amido black,Ponceau S b.monosodium urate
c.ammonia
• A transwoman patient had her blood drawn for d. allantoin
creatinine analysis. What reference range should be UA + → allantoin + H2o2
used in her test result? • Which of the ff enzymes is the most non-specific
a. Either a. ALP
b. female reference range b.LD
c.male reference range c. ALT
d. neither d. CK

• Two control sera are desirable for each general • What does the denominator in the Henderson-
chemistry procedure which of these combinations Hasselbach equation evaluate
would be appropriate? a. hepatic function
a. mean of normal and high abnormal ranges b. respiratory function
b. low abnormal and high abnormal ranges c. cardiac function
c. low normal and low abnormal ranges d. renal function
d. high normal and high abnormal ranges
• Which of the ff ranges indicates a precise group of
• What condition involves the absence of the activity control values for a given analyte?
of glucosonyl transferase resulting to persistent a. 39-42
increased levels of unconjugated bilirubin and b. 30-32
kernicterus in neonates c. 29-40
a. Crigler-najar syndrome d. 35-43
b.hemolytic anemia in HDFN • Isoenzyme assays are performed to improve
c. physiologic liver immaturity a. precision
d. Dubin-johnson syndrome b. sensitivity
c. specificity
*Increase BI(unconjugated bilirubin: water insoluble) d. accuracy
- hemolytic anemia • Which of the ff is not a hormone that influences
-physiologic liver immaturity plasma calcium levels?
-gilbert syndrome: mutation is minimal; functionality a. calcitonin
is 30% b. Vit.D
*crigler-najar syndrome c. aldosterone
- most severe: type 1 crigler-najar d. PTH
-less severe: type 2 crigler-najar • How much absolute ethanol is necessary to make
* Decrease B2(conjugated bilirubin) 500ml of 70% ethanol?
-Dubin-johnson a. 0.37 L
-biliary obstruction b. 714mL
-rotor syndrome(blockage in the excretion of c. 368mL
conjugated bilirubin) d. 0.35L
• This analyte is assayed to determine the • The ff tests are affected when icteric samples
completeness of a 24hr urine sample. w/serum bilirubin values reaching 25mg/L are
a. urea analyzed except:
b. glucose a. albumin determination using HABA
c. albumin b. cholesterol
d. creatinine c. albumin determination using BCG
• The Trinder reaction is employed in the colorimetric d. total protein determination using biuret method
determination of what drug?
a. aspirin • The ff data were obtained over a 1 week period in
b. acetaminophen the lab:
c. digoxin true positive:54
d. bicarbonate true negative;87
• Pin-point pupils are seen in individuals taking in the false positive:13
ff drugs of abuse except: false negative:7
a. heroin calculate the ability of the method to detect the
b. marijuana absence of disease
c. morphine a. 81%
d. codeine b. 38%
• Reactivity c. 87%
a. white quadrant d.93%
b. red quadrant
c. yellow quadrant • The rgt caffeine sodium benzoate in the Jendrassik
d. blue quadrant Grof method serves as:
• Most probable cause of an abnormal anion gap in a. to intensify the color of azibilirubin
the serum of a healthy individual b. ass accelerator reagent
a. hemolysis c. to stop the reaction
b. acidosis d. provide alkaline pH
c. instrument problem
d. over hydration • Two consecutive control observations that exceed -
• Team members dedicate how much of their time in 2SD
Lean six sigma important projects? a. 2,-2s systematic error
a. 100% b. 2,-2s, RE
b. 50 % c. R-4s, SE
c. 70% d. R-4s, RE
d. 20%
• Organophosphate poisoning • Calculate the LDL chol level given the ff data:
a. Acetylcholinesterase Trig= 240mg/dL
b.amylase HDL-C=45mg/dL
c. Cytochrome oxidase TC=250mg/dL
d. 5’Nucleotidase a.157mg/dL
• The creatinine clearance test is routinely used to b.205mg/dL
assess the glomerular filtration rate. Given the ff info c.177mg/dL
for an average-sized adult. Calculate the creatinine d.155mg/dL
clearance.
Urine creatinine 120mg/dl • It is usually the result of any type of obstruction in
Plasma creatinine 1.2mg/dl w/c urea is reabsorbed into the
Urine volume for 24 hrs 1520mL circulation.Obstruction can be caused by stones, an
a. 95ml/min enlarged prostate gland or tumors.
b.106ml/min - Post-renal azotemia
c.117ml/min • What is the expected level of blood cholesterol in
d.43ml/min patients suffering from Grave’s disease?
• Which of the ff is the most common type of a. decrease
photodetector b. increase
-Photomultiplier tube c. variable
d. not significant
• Mislabeling of patient samples occurs in what • w/c of the ff is the primary mechanism, of
portion of specimen collection? compensation for metabolic alkalosis?
a. any part of the collection process a. increase breathing
b. during collection b. decrease breathing
c. after collection c. bicarbonate reabsorption
d. before collection d. bicarbonate excretion

• A serum or plasma specimen for glucose analysis acid base imbalance:

should be separated from the cells w/in METABOLIC RESPIRATORY
a. 45mins Compensate:lungs(CO2) defective:lungs
b. 60mins. Compensate kidneys
c. 15mins Respiratory alkalosis- no O2 does not need
d. 30mins bicarbonate, increase excretion decrease
reabsorption of bicarbonate
• Panic reactions, otherwise referred to as bad trips is
associated with what drug of abuse? • What estrogen is used to detect pregnancy?
a. MDMA a. alpha-hCG
b. PCP b. estradiol
c. THC c. beta-hCG
d. LSD d. estriol
• w/c of the ff is not true in spectrophotometry?
• Alcohol, the most commonly abused substance a. photometric parameters require periodic
- CNS depressant monitoring
• Given the ff, calculate the probability that a negative b. energy is directly proportional to wavelength
result indicated the absence of disease c. conc. is indirectly proportional to transmitted light
True(+): 97 d. beer-lambert law governs the instrumentation
False(+):15 principle
True(-) : 93 • C-peptide, w/c serves as a reliable indicator for
False(-): 11 pancreatic & insulin secretions is used to
a. 90% continuously assess beta-cell function.What is the
b. 87% level of C-peptide in type I DM?
c. 86% a. not significant
d. 89% b. variable
c. increase
• In the Jaff rxn, a red-orange chromogen is formed d. decrease
when creatinine reacts with ____ at ____. • What is the most common preanalaytic error in
a. naphthylenediamine,acidic pH blood gas measurement?
b. diacetyl monoxime; basic pH a. overanticoagulation
c. nitroferricyanide; acidic pH b. improper blood collection
d. picric acid; basic pH c.improper specimen transport
d. over centrifugation
• Serves as a biochemical marker of bone resorption • w/c of the ff pathways will not lead to an increase in
a. serum cathepsin K blood glucose test?
b. alkaline phosphatase a. glycogenesis
c. osteocalcin b. none of these
d. cross-linked C-telopeptide c. gluconeogenesis
d. all of these
• What does ‘E’ in RACE mean? e. glycogenolysis
-exit • a pxt presenting with muscle pairs & weakness
submitted his brown urine sample and had his blood
• w/c of the ff abnormal electrophoretic patterns best taken for chemistry testing significant results whow
correlates w/ abetalipoproteinemia? myoglbinuria and elevated CK w/ normal cardiac
a. decrease in pre-beta & alpha bands troponin. The results of this patient is consistent w/:
b. increase in pre-beta, beta and alpha bands a.intravasculat hemolysis
c. decrease in alpha band & increase in the beta b. fulminant hepatice coma
band c. Rhabdomyolysis
d. decrease in pre-beta & beta bands d. acute myocardial infarction
• the statistical tool F-test is used to determine if there • determine the anion gap using the ff result:
is a significant difference b/n ____ to detect ____. chloride= 87
a. standard deviations, precision sodium= 140
b. means, accuracy k= 5.0
c. standard deviation, accuracy HCO3= 35
d. means, precision a. 23
• basophilic stippling is a clinical finding b. 27
a. mercury toxicity c. 25
b. lead toxicity d. 20
c. arsenic toxicity • what substances makes the body basic
d. iron toxicity a. 02
• Cl, Mg & Mn in enzymatic rxns b. H20
a. cofactors c. CO2
b. activator d. HC03
c. coenzymes • w/c of the ff pair of analytes is used to evaluate the
d. accelerators ability of the liver to detoxify?
• What hyperglycemic hormone is released when a. bilirubin, ammonia
glucose blood level reaches 6.5 mg/dL? b. bilirubin, albumin
a. cortisol c. ammonia, cholinesterase
b. insulin d. cholinesterase, albumin
c. epinephrine • what is the correct definition of a buffer?
d. glucagon - Combination of a weak acid or weak base and its
• A lipemic sample w/ serum triglyceride level that salt
exceeds 400mg/dL is to be analyzed for various • The Michaelis-Mentin constant in the rate of
chemistry tests. The medical technologist performed correlation os substrate to product is determined by
pxt blanking but the serum remained to be turbid. - Substrate conc. & rate of dissociation of the
w/c of the ff is best course of action? enzyme substrate complex.
a. performs ultracentrifugation to clear the sample • The anitobody titer of a pxt against a certain
b. redo the pxt blanking procedure using a higher pathogen is 112mg/dL. What is the value expressed
wavelength in SI unit?
c. reform the chemistry tests a. 0.0112g/dL
d. recollect sample from the pxt immediately b. 1.12g/L
• Major extracellular anion that electric neutrality, c. 11.2g/L
osmolity and blood volume d. 0.112g/dL
a. chloride • When performing batch analysis, what separated
b. phosphate sample test reaction in continuous flow analyzers?
c. sodium - Air-bubbles
d. potassium • Non valued activities in the clinical lab are
• This analytical principle involves the measurement of considered as:
the reduction in light transmission caused by a. deviations
a. nephelometry b. wastes
b. turbidimetry c. errors
c. fluorometry d. defects
d. spectrophotometry • Complication of venipuncture include
• w/c of the ff isused as a vein finder a. vascular, infection
- infrared emission b. anemia, infection
• w/c of the ff is not a charcterisitc of lipids c. vascular, anemia, infection
a. transport in blood by carriers d. vascular, anemia
b. soluble in polar solvents • Plasma protein that is a vital component f amyloid
c. source of chemical energy deposits found in pxts w/ Alzhemer’s dse.
• laboratory result that characteristics Reye’s a. hemopoxin
syndrome w/ concomitant liver damage b. orosmucoid
a. increase plasma ammonia c. alpha-I-antichymotrypsin
b. increase AST d. beta-2-micorglobulin
c. increase ALT
d. increase plasma albumin
• w/c of the ff is the single most significant finding in c. LD4
pxts suffering from Cushing’s? d.LD2
a. hyperbilirubinemia
b. hyperglycemia • the available test in the lab for FBS is based on
c. hypernatremia glucose oxidase method. A serum sample for FBS
d. hypercholesterolemia collected from a healthy individual was observed to
• set of procedures performed in order to ensure be hemolyzed by the med tech. which of the ff is the
reliability of pxt results. best course of action?
a. intralab QC A. perform sample blanking prior to testing
b. interlab QC b. follow the glucose oxidase procedure from the pxt
c. EQAS c. recollect blood sample from the pxt
d. proficiency testing d. ask the physician if testing is to be performed
• express 20mg/dL of urea nitrogen as urea using the sample.
a. 14mgdL
b. 43 mg/dL • What reaction is used in Wroblewski-La Due
c. 64 mg/dL method?
d. 9mg/dL a. creatinine to creatnine phosphate catalyzed by CK
• the recreational drug of choice of abuse 3,4- b. creatinine phosphate to creatnine catalyzed by CK
methylenedioxymethamphetamine known for its c. lactate to pyruvate catalyzed by LDH
euphoric and psychedelic effects is also referred as d. pyruvate to lactate catalyzed by LDH
a. crack
b. ecstasy • determine the molarity
c. mary jane mass of NaOH= 150g
d. angel dust MW of NaOH= 40g/mol
• most heat labile fraction of ALP is from the Volume of Sol’n= 750mL
a. bone a. 5M
b. intestine ✓
b. 15M
c. placenta c. 10M
d. liver d. 2.5M
• empty Lysol and baygon containers should be
discarded in what colored plastic bin? • w/c of the ff statements correctly describes heparin?
-BLACK RED 1. used to prevent in vivo vlotting
• Calibration of the centrifuge must be part of the 2. used to prevent in vitro clotting
quality assurance process of the lab. What 3. used for the anticoagulant of criterial blood
parameter indicated the speed setting? 4. used to the anticoagulant of blood for ammonia
-RPM testing
• What additive is present in a red0stoppered glass a. only 4 is correct
evac tube? b. 1,2,3 arecorrect
a. none c. 1&3 are corrects
b. thrombin w/ clot activator d. 1,2,3&4 are correct
c. clot activator • metabolic acidosis
d. clot activator w/ separation gel 1.bicarbonate conc. increases
• the ff are the absorbance values obtaines in 2. pH decreases
cholesterol determination 3. Pco2 INCREASES
blanl: 0.211 4. conc of total CO2 decreases
std. : 0.368 - 2 &4
sample: 0.498 • Extinguisher that contains water that eliminates fire
std value= 200mg/dl -class A
what is the patients SI units? • w/c of the ff analytes is tested in CSF in cases of
a. 148mg/dL coma w/ unknown cause?
b. 3.84mmol/L a. ammonia
c. 5.72mmol/L b. glutamine
d. 216mg/dL c. lactose
• what is the major LD fraction in the sera of a healthy d. glucose
indiviaduals?
a. LD5
b. LD1
• w/c of the ff is least associated w/ primary
hypothyroidism • set of hormones are classified as transferases
a. presenc of TPO antibody - CK,AST & ALT
b. goiter or enlargement of thyroid
c. presence of Tg Ab • Measure the ability of a test to detect the presence
d. high TSH of a disease or condition
• identify the age group w/ the ff cut off pts for serum - Diagnostic sensitivity
cholesterol:
mod. Risk >200mg/dL • Considered most accurate in diagnosing &
high risk >220mg/dL monitoring treatment for DM
a. 30-29 - HbA1c
b. 2-19
c. 40 &older • In the lab, how many % of the values are expected to
d. 20-29 fall inside the curve of normal Gaussian Distribution
• the ff are the data obtains in a QC procedure in lab. - 95.5%
Mean conc. = 121mg/dL
2SD= 12mg/dL • From the point of origin, the migration sequence of
Ff the evaluation of Levey-Jennings and westgard lipoprotein is
multirole, a value of 110 mg/dL is regarded as - Chylomicrons, beta, pre-beta, alpha
a. an outlier & a 1-2s
b. in control & acceptable • Substrate utilized in the cherry-crandall method
c. an outlier & a 1-3s - Olive oil
d. a 1-3s indicating a RE
• which of the ff is the major mineral corticoid? • w/c given statements incorrect anout albumin?
a. cortisol a. major plasma protein that maintains normal osmotic
b. corticosterone pressure & volume
c. aldosterone b. considered as a (-) acute phase reactant
d. arginine vasopressin c. the most cathodic among plasma protein in SPE
• what hormone stimulates the activity of osteoclasts d. decrease conc. in liver dse., inflammation & nephrotic
to maintain normal blood calcium levels syndrome
a. calcitonin
b. thyroid hormone
c. parathyroid hormone
d. calcitriol
• water-soluble bilirubin that is attached to albumin is
- delta-bilirubin
• calculate the resulting dilution given the ff
values:serum=9mL ; diluent= 81mL
- 1/10
• The ff are correct pairings of the analyte & the
relectrode used for its measurement EXCEPT
a. HCO3: sanz electrode
b. PO2: clark electrode
c. pH: Glass electrode

• during night shift, a medical technologist forgot to

perform ABG on a specimen transported
anaerobically & chilled but left on the work table top
counter. The ABG was only performed by his co-
worker during the day shift. w/c of the ff erroneous
results are expected?
- Decrease in PO2 & pH, increase PCO2
• The ff are assayed as part of liver fxn tests except:
a. albumin
b. prothrombin
c. bilirubin
d. ammonia
Which of the following best describes the ➢ inversely proportional → decrease in
interference caused by the presence of an transmittance leads to increase absorbance
appreciable concentration of triglyceride in a lipemic → falsely elevated concentration of analyte
sample?
a. increase in transmittance due to light scattering Most common type of assay.
b. decrease in absorbance due to colorimetric a. Electrochemical
interference b. Spectrophotometric
c. decrease in transmittance due to light scattering c. Visual Colorimetric
d. increase in absorbance due to colorimetric d. Immunochromatographic
interference
Spectrophotometric
Substances: • Most common type
● Bilirubin and Hemoglobin - absorbs light in the • Basis of automated procedures
same region/ wavelength as the chromogenic • Utilizes simple reagents is considered as the most
common type of assay (refers to different
substance supposedly measured (increase/
metabolic panels)
strong absorbance)
➢ Hemoglobin: absorbs light in the same Immunochromatography
region or wavelength as that of the different • Common on serologic procedures
chromogenic products supposedly measured
in different assays ; has strong absorbances Visual Colorimetric
in the same region • Obsolete
● Lipids (TG) → if present in appreciable • Evaluate produce visually via eyes
• Vulnerable to subjectivity
concentration → turbidity —> light scattering
Electrochemical
• Blood gas analysis and electrolytes

Concepts related to the Six Sigma process except

a. steps include Define, Measure, Analyze,
Improve, and Control (DMAIC)
b. aims to decrease product or service variation
● Incident light from a monochromator will direct c. measures defects per million opportunities
light to the cuvette containing the solution. d. involves streamlining laboratory operations
● The arrangement of the components in the
spectrophotometer are in a linear manner. Six Sigma
• purpose: decrease defects by eliminating process
Meaning the detector is only capable of detecting
variation
light in a linear matter which is transmitted ➢ Clue: sigma: standard deviation
linearly. o Tool utilized to determine variability
● The problem with turbidity causes the scattering ➢ Defect: anything that does not meet customer
of light, meaning, instead of transmitted light requirement
going to the solution and into the photodetector in • Unit: Defects per million opportunities (DPMO)
a linear pathway, the transmitted light will be • Strategy: Define, measure, analyze, improve and
control (DMAIC)
scattered
● The photodetector is not placed in an angle but Lean Six Sigma
aligned with the other components of the • Goal: streamline
spectrophotometer, meaning the scattered light • Purpose of Lean: reduce non-valuable activities
will not be detected by the photodetector. (waste)
● In short, turbidity causes decreased transmitted ➢ Waste: anything that even if you don’t
light due to scattering of light. perform it will not affect the quality of services
● Transmittance is directly measured in in clinical laboratory
• Lean: a management concept that reduces waste
spectrophotometer in order to get the absorbance
and streamlines an operation
meaning, the absorbance is dependent upon the
• Streamline: make something more efficient by
transmitted light detected by the photodetector performing faster or simpler working methods ;
● Beer’s Law: Relationship of transmittance with simplifying methods in order not waste effort on
absorbance non-valuable activities
 • Benefits the employees and the clinical laboratory Recall: AccuVein is a handheld medical device that
itself helps medical staff visualize veins before
phlebotomy. This device works by
OSHA strongly recommends wearing gloves as a a. emitting ultraviolet light absorbed by the
barrier protection in the following instances except endothelial cells on blood vessel walls.
a. when a medical laboratory scientist has cuts or b. emitting infrared light absorbed by the
open wounds endothelial cells on blood vessel walls.
b. when a support staff is encoding in the office c. emitting ultraviolet light absorbed by hemoglobin
c. when laboratory personnel anticipates hand in red blood cells.
contamination d. emitting infrared light absorbed by hemoglobin in
d. when an intern is undergoing phlebotomy red blood cells.
training
SYRINGE: for specimen collection from hand or ankle
Health Care Workers/Personnel: or from small children, patients with small or poor
● has cuts or other open wounds on the skin veins
● anticipates hand contamination (biochemical/
chemical) • In collecting using an evacuated system, the bore
➢ biological, biochemical or chemical is larger and also one of the concerns is the
contamination which are corrosive or negative pressure present in vacutainer tube
introduced via absorption therefore, controlling the suction of blood from the
● performs skin puncture vein is uncontrolled.
● receiving phlebotomy training • In suctioning blood, if the suctioned blood is not
allowed to be replaced immediately, the vein may
According to OSHA as cited by Henry: avoid collapse thus, syringe system must be utilized.
contamination by not wearing soiled gloves when
present in a non-laboratory work area ACCUVEIN:
● medical device which aids in phlebotomy
Recall: What is the minimum PPE during ● a commercial name for a handheld medical device
phlebotomy? Tight-fitting gloves that helps visualize vein before phlebotomy
● It is held 7 inches over the potential site
Which of the following PPE is/are not used to
● Principle: Hb absorbs infrared light and projects
prevent exposure of mucous membranes from
an image map of veins onto the patient’s overlying
splashes?
skin
1. masks
● Utilize to know needle placement (alignment)
2. laboratory gown
● Distinguish hemoglobins present inside the vein
3. goggles
and the hemoglobins which may be present in the
4. gloves
RBC in the surrounding tissue
a. only 4 is correct
● Application: needle placement in elderly, obese,
b. 1 and 3 are correct
burn patients, patient with chronic disease (require
c. 1,2 and 3 are correct
many diagnostic and therapeutic procedures)
d. 1,2. 3 and 4 are correct
e. 2 and 4 are correct The following characterizes tungsten-halogen lamp
from normal tungsten lamp as a radiant energy
Parts of body that have mucous membrane which
source in spectrophotometers except
are liable to exposure in the laboratory (splashes):
a. provides whiter radiant energy.
● Eyes → goggles/protective eye wear & face shield
b. provides brighter radiant energy.
● Nose → mask & face shield
c. generates higher temperature.
● Mouth → mask & face shield
d. used for testing in the visible region.
Additional Information:
Laboratory gown → skin exposure • Both tungsten lamp and tungsten halogen lamp
Additional PPE: face shield are used for testing in the visible region

Tungsten-Halogen Lamp Provides:

 ● WHITER LIGHT: generates maximum wavelength 4. Enzymes are NOT chemically altered or
of light near the center of the visible spectrum consumed in reactions
● BRIGHTER LIGHT: generates greater energy
output Which of the following statements is not true about
● GENERATES HIGHER TEMPERATURE: due to CK determination using the Oliver-Rosalki Method?
increased atom vaporization from the high a. Measures the rate of appearance on NADPH.
temperature filament which is countered by b. Involves the forward reaction of CK.
halogen gas c. Hemolysis causes a false increase due to
adenylate kinase.
Which of the following is not directly proportional to d. Uses two other enzymes--hexokinase and
absorbance? glucose-6-phosphate dehydrogenase.
a. path length
b. absorptivity General Reactions of CK Catalysed
c. transmittance Physiologically:
d. concentration • Purpose: store energy
• A form of phosphorylation reaction
BEER-LAMBERT’S LAW
• for calculation of absorbance and relating to their General Reaction:
concentration Creatine + ATP < -- > creatine PO4 + ADP
• Equation: A = abc ➢ Reversible reaction
➢ a = absorptivity/molar absorptivity → ➢ Catalyse by CK
o also known as molar absorptivity: if the
concentration is expressed in mol/L
➢ b = path length in 1cm
➢ c = concentration (g/L or mol/L)
• abc: indicates direct relationship Tanzer-Gilbarg Forward reaction
➢ absorbance is directly proportional to • pH: 9.0
absorptivity which is a characteristic of
analytes, length and concentration

SPECTROPHOTOMETRY → inversely proportional

● utilizes Beer-lamberts Law
● measures transmittance in which absorbance is Oliver-Rosalki Reverse reaction
derived leading to an inversely proportional • coupled enzymatic reaction
relationship • pH: 6.8
E.g.: • 2 to 6x faster with less interference
➢ transmittance: low absorbance: high • With more advantages
➢ Transmittance: high absorbance: low

The following are characteristics of enzymes except

a. Enzymes function as catalysts.
b. Enzymes accelerate reaction rates.
• Sequential reaction:
c. Enzymes are proteins.
1. creatine PO4 + ADP —> creatine + ATP
d. Enzymes are chemically altered in reactions.
➢ Product needed: ATP
➢ Frist enzyme: CK
Recall: what are enzymes? Protein
2. ATP + glucose —HK—> glucose-6-PO4 +
ADP
General Characteristics of Enzymes
➢ Second enzyme: hexokinase
1. Enzymes are proteins
➢ Product needed: G6PO4
2. Enzymes function as catalysts
3. G6PO4 + NADP —G6PDH—> 6-
3. Enzymes accelerate or speed up reaction rates
phosphogluconate + NADPH
➢ Without enzymes the different reactions in the
body are slower which is not conducive to
sustain life
 ➢ NADP for oxidation-reduction reaction ; Which of the following enzymes is the most non-
act as coenzymes which are organic specific?
cofactors ; dehydrogenase a. ALT
➢ Requirement: dehydrogenase b. LD
➢ Third Enzyme: G6PDH c. CK
➢ Product measured: NADPH d. ALP
➢ formation of NADPH is measured at 340
nm Clinical Utility: Lactate Dehydrogenase
• used in conjunction with other enzymes
CK Sample Collection Reminder: • assay is part of a metabolic panel
• any degree of hemolysis is not acceptable ➢ liver Panel: AST, ALT
➢ RBC contains adenylate kinase (AK) which ➢ Cardiac/Skeletal Muscle Panel: CK
catalyzes the same reaction as CK thus, • highly nonspecific because there are several
resulting to FALSELY ELEVATED CK value enzymes of isoenzymes of LD meaning it is found
ubiquitous meaning it has a lot of possible tissue
Which of the following is the best sample for enzyme sources
assays? • abnormal values are not specific for damage of
a. Serum any particular organ
b. Heparinized Plasma E.g.: increase in LD where the cause cannot be
c. Citrated Plasma determined therefore ISOENZYME studies must
d. EDTA Whole Blood be performed to narrow down the possible cause
of increase LD
❖ In order for enzymes to catalyse a reaction
sometimes or often there is a need for a A patient presenting with muscle pain and weakness
presence of inorganic cofactors (activators or submitted his brown urine sample and had his blood
deactivators such as electrolytes) taken for chemistry testing. Significant results show
❖ coenzyme: organic cofactors (vitamins, NADP, myoglobinuria, and elevated CK with normal cardiac
NAD) troponin. The results of this patient is consistent
with
Mechanism of anticoagulation: chelation by a. rhabdomyolysis.
forming complexes with the activators which are b. acute myocardial infarction.
present in the blood sample to prevent c. fulminant hepatic coma.
anticoagulation d. intravascular hemolysis.
● EDTA & Fluoride
➢ Whole blood or plasma Clinical Utility: Creatinine Kinase
➢ EDTA inhibits enzyme activity and should • marker for cardiac and skeletal muscle injury
NEVER be used for enzyme analysis ➢ Myoglobinuria: indicative of skeletal muscle
injury because the primary source of
Important thing to ensure during enzyme myoglobin in urine is skeletal muscles ; there
analysis: is lysis of skeletal muscle fibers releasing now
1. Enzyme should be present the haemoglobin-like substance that is
2. Enzyme should be active present in skeletal muscle wherein the
function of which is similar to haemoglobin
Basis of Enzyme Measurement: Rate of activity which is to carry oxygen
or rate of transformation of one reaction to a ➢ Rhabdomyolysis: lysis of skeletal muscle ;
product form of cell lysis syndrome in which there is
destruction of cells leading to release of
● Citrate: complexes with divalent cations which are cellular contents (myoglobin)
possible activator in enzymatic reactions leading o Important features for differential
to FALSELY DECREASED values (CK, ALP) diagnosis of rhabdomyolysis:
● Heparin: in vivo and in vitro anticoagulant which 1. Increase in Total Ck (CK-MB): CK
inhibits the activity of some enzymes (amylase, >20x
AST) 2. Myoglobinuria
 ➢ Myoglobin is easily cleared out in
the plasma thus, present in urine
(brown urine)
➢ Toxic to the nephrons

Troponin: best cardiac marker

In the case of hepatobiliary disorders, increase in

levels of ALP and GGT is due to their release from ➢ When cell lyse:
1. cells of the gallbladder o K will become part of the extracellular
2. cells of the common bile duct matrix
3. cells of the pancreas o The value of K in case of hemolysis leads
4. cells of the liver to increase K levels
a. 1,2 and 3 are correct → What is measured is the electrolyte in
b. 1 and 3 are correct the extracellular fluid
c. only 4 is correct o In the case of hemolysis along with other
d. 1, 2, 3 and 4 are correct solutes, one of the substances that will be
e. 2 and 4 are correct liberated is the solvent (water) thus, a
certain degree of hemolysis in the plasma
• Hepatocytes have canalicular surface would result to release of water which
➢ Canalicular surface: surface of hepatocytes acts as a solvent leading to dilution of
that faces the canaliculi solutes that are present extracellularly
➢ Canalicular system of liver: there is a canal
(dilutional effect) therefore Na levels will
that traverses the liver parenchyma where
the hepatocytes places the conjugated be decrease
bilirubin
➢ In the case of hepatobiliary disorders, there The available test in the laboratory for FBS is based
is a problem in the canalicular system on glucose oxidase method. A serum sample for
affecting now the ALP and GGT FBS collected from a healthy individual was
observed to be hemolyzed by the medical
Hepatobiliary damage: ALP and GGT technologist. Which of the following is the best
Hepatocyte damage: ALT and AST
course of action?
A hemolyzed sample for electrolyte assay using a. Follow the glucose oxidase procedure in the
indirect ISE is expected to have SOP.
a. increased sodium and decreased potassium b. Perform sample blanking prior to testing.
values c. Ask the physician if testing is to be performed
b. decreased sodium and potassium values using the sample.
c. increased sodium and potassium values d. Recollect blood sample from the patient.
d. decreased sodium and increased potassium
values. • Effect of hemolysis in glucose oxidase
method: the heme component of haemoglobin
• Hemolysis involves liberation of cellular contents has a pseudoperoxidase activity which will affect
particularly RBCs since they are the most the glucose oxidase method
predominant cells present in blood
➢ affects normal electrolytes distribution Guidelines in SOP:
➢ PISO: Potassium Inside ; Sodium Outside • Specimen rejection in the presence of hemolysis
o Level of K inside is high while level of Na
outside is high Purpose of sample blanking: to remove sample
o K: major intracellular cation interferences
o Na: major extracellular cation ➢ Effect of haemoglobin in different assays
performed: absorbs light in the same
wavelength utilize for certain assays
➢ Will not correct the pseudoperoxidase activity
of heme in glucose oxidase test
A patient rushed to the emergency room is d. arsenic
hyperventilating. The following results were
obtained after performing ABG analysis: Congenital Minimata
pH= 7.00 • Toxin: mercury (methylmercury)
• The mother is exposed to methylmercury which is
PCO2 = 20 mmHg
pass vertically to their infant which will manifest
pO2 = 70 mmHg the toxicity of methylmercury
HCO3 = 15 mmol/L Which of the following is the • Children with this condition has manifestations
most likely explanation for these results? that are the same with cerebral palsy
a. hyperventilation is the primary cause
b. erroneous results due to in vitro glycolysis → Toxic Forms: Mercury
CO2 should be increased 1. elemental/ metallic (Hg0)
c. hyperventilation is the compensatory • route of entry
a. GIT: poorly absorbed
mechanism
➢ No toxic effect unless it is converted
d. double error in blood gas measurement to the divalent form (Hg2+)
o Occurs thru a slow oxidation-
System for Acid-Base Balance: reduction reaction with other
1. consider the pH result reactants present in GIT such as
➢ classify the type of imbalance (alkalosis or H+ and Cl- and is only possible
acidosis) when there is stasis of elemental
mercury in GIT
➢ Normal blood pH: 7.35-7.45
→ Chloride for HCl production
o >7.45: alkalosis for chemical digestion of food
o <7.35: acidosis o In order for mercury to be toxic it
2. Consider pCO2 and the HCO3 must undergo oxidation-reduction
➢ CO2: will make the body ACIDIC particularly it has to be oxidized
o Normal range: 35 to 45 mmHg b. Inhalation & Absorption thru the skin
 >45 mmHg: acidosis ➢ Significant effects are observed
c. Passage thru the BBB and accumulate
 <35 mmHg: alkalosis
in the CNS
➢ HCO3: will make the body ALKALINE ➢ Elemental form is oxidized to divalent
o Normal range: 22-26 mmol/L mercury leading to toxicity via
 >26 mmol/L: alkalosis poisoning
 <22 mmol/L: acidosis ➢ Concern for elemental and metallic
3. Compare the values to the pH mercury: CNS and Pulmonary
➢ The value that will correspond to the pH is the toxicity
• Excretion: kidney (urine)
CAUSE OF THE IMBALANCE
2. Inorganic Salts
Example: a. Mercurous (Hg1+): poorly soluble → poorly
pH= 7.00 → acidosis absorbed
PCO2 = 20 mmHg → alkalosis b. Mercuric (Hg2+) readily soluble → readily
pO2 = 70 mmHg → not physiologically possible absorbable via oral ingestion or inhalation
because it is too low
Symptoms under inorganic salts:
HCO3 = 15 mmol/L → acidosis
• severe inflammation of the mouth and other
Cause of Imbalance: metabolic acidosis GI symptoms
Compensatory mechanism: hyperventilation • Accumulate in the kidneys
➢ Effect: acute renal tubular/ glomerular
METABOLIC ACIDOSIS damage
• Affected organ: Kidney
Excretion: kidneys (urine)
• Compensatory organ: Lungs
➢ CO2 makes the body acidic thus, the lungs 3. Organic mercury
must eliminate CO2 by increase in breathing • environmental pollutants
(hyperventilation) a. Aryl and alkoxyalkyl
➢ undergo metabolism / breakdown and
Congenital Minimata disease biotransformation inside the body →
a. lead converted to inorganic mercury →
b. mercury same intoxication with inorganic
c. cadmium mercury
 b. Alkyl ➢ Excretion of mercury is via the kidney thru the
➢ methyl and ethyl urine
➢ extremely stable meaning its toxicity ➢ Establish acute toxicity (all forms of toxicity)
is not associated with its breakdown, c. Hair
biotransformation or oxidation ➢ Help identify chronic mercury exposure
➢ produces greater toxicity particularly if the exposure is with organic
➢ more lipid stable thus, it passes mercury
readily through the biological
membrane Which of the following analytes is tested in CSF in
➢ may also pass thru the BBB leading to cases of coma with unknown cause?
CNS disturbances a. Lactate
➢ Major Chemical Effect in: CNS b. Glucose
(methylmercury with devastating c. Glutamine
effects) d. Ammonia
➢ Mode of Entry: ingestion with greater
absorption CUE: coma with unknown etiology/ cause
• A coma that is not due to head trauma and
In organophosphate poisoning, which of the brain anoxia (circulatory system fails to deliver
following enzymes is used to reflect acute toxicity? oxygen to brain)
a. Pseudocholinesterase
b. Acetylcholinesterase Hepatic encephalopathy
c. Angiotensin Converting Enzyme • hepatic: primary cause is liver involvement
d. 5'-nucleotidase ➢ liver damage leading to liver failure thus, the
liver function will be deteriorated and toxic
Organophosphate substances will not be converted leading to
• Common component of insecticide accumulation of toxic substances
• Problem: produce irreversible inhibition of o ammonia can only be detoxify in the liver
pseudocholinesterase (PChE) and but in liver failure, ammonia is increase
acetylcholinesterase (AChE) due to accumulation leading to
encephalopathy
Enzymes for Neurotransmission: • Two possible samples:
a. Acetylcholinesterase (AChE) a. Blood: ammonia
• true cholinesterase or choline esterase I ➢ Hepatic encephalopathy generally
• Clinical utility: better reflects chronic toxicity correlates with blood ammonia levels
b. PChE: ➢ Ammonia is readily detoxified in the CNS
• choline esterase II or acetylcholine by producing glutamine thus, it is not
acylhydrolase measured in the CSF
• Clinical utility: reflects acute toxicity
Ammonia + glutamic acid → glutamine
Better answer for organophosphate poisoning → Directly proportional
without toxicity:
1. acetylcholinesterase (AChE) b. CSF: glutamine
2. Pseudocholinesterase (PChE)
How do you convert 1000mL to L?
Which of the following samples is not useful for the a. Multiply by 1000
detection of mercury poisoning? b. Divide by 1000
a. Hair c. Multiply by 100
b. Stool d. Divide by 100
c. Urine
d. Blood 1000 mL = 1 L
Specimens: L = 1000 mL/1L
a. Blood
➢ Normal value: <10 ug/L Which of the following best describes the expected
➢ For differential diagnosis between poisoning result of a sample containing beta-VLDL if
and pheochromocytoma ultracentrifugation and electrophoresis are
o Mercury poisoning: mimics performed respectively?
pheochromocytoma a. decreased VLDL and increased LDL
o Pheochromocytoma: increase 24-hour b. increased VLDL and decreased LDL
catecholamine level c. decreased VLDL and LDL
➢ Problem: half-life of mercury d. increased VLDL and LDL
b. Urine
➢ 24-hour mercury levels Beta-VLDL
• has similar characteristic to VLDL and LDL due to b. glycosylated hydroxylysine and
the mechanism involve in B-VLDL hydroxycholine
• Ultracentrifugation • produce whenever type 1 collagen is broken
➢ Base on density of lipoprotein down
o Density: beta-VLDL = VLDL • not specific for skeletal collagen and correlate
• Electrophoresis poorly
➢ migration pattern c. urinary calcium
➢ Beta Region: beta-VLDL = LDL • not specific nor sensitive
• Produced from the defective catabolism of VLDL • affected by diet and renal function
➢ Normally, VLDL is catabolized to form LDL d. pyridinium crosslinks
but, on defective catabolism of VLDL it • useful; utilize together with crosslink
becomes a B-VLDL telopeptides
• Abnormal lipoprotein that accumulates in Type 3 ➢ telopeptides is much better for bone
Hyperlipoproteinemia resorption
• Apolipoprotein: ApoE
➢ ApoE4 isoform: associated with an This is a nonsteroidal, anti-inflammatory drug used
increased risk of Alzheimer’s as an analgesic and antipyretic that is associated
• Can be phagocytized by macrophages which with Reye's syndrome in children.
becomes comb cells a. Acetaminophen
➢ Macrophages that contain B-VLDL b. Lithium
c. Aspirin
Most probable cause of an abnormal anion gap in d. Cyclosporine
the serum of a healthy individual Cyclosporine
a. over hydration • Immunosuppressive drugs
b. hemolysis • For autoimmune disease in which the immune
c. acidosis system is exaggerated
d. instrument problem • Utilize also for transplant to prevent rejection
Anion Gap Lithium
• Abnormal anion gap is useful in indicating • Anti-manic agent
increase in one or more of the unmeasured anions • For psychiatric disorders
• For quality procedures • Bipolar disorder
• Consistently abnormal anion gaps in the serum of • Additional anti-depressant in melancholic
healthy individuals indicate an instrument error/ depression
problem • Drug of choice in the prevention of cluster
headaches
Not useful bone resorption markers include
1. tartrate-resistant acid phosphatase Acetaminophen
2. glycosylated hydroxylysine
• Antipyretic and analgesic
3. urinary calcium
• Preferred over aspirin because there is no
4. pyridinium crosslinks
associated between acetaminophen and Rye’s
a. 2 and 4 are correct
syndrome
b. 1, 2.3 and 4 are correct
• Accidental overdose is less toxic
c. 1 and 3 are correct
d. 1,2 and 3 are correct • There is hepatotoxicity but rare
e. only 4 is correct
Aspirin
Bone resorption • acetylsalicylic acid
• normal part of bone remodeling • In the case of aspirin toxicity, it will be metabolized
in the body producing acetic acid and salicylic acid
Bone remodeling involves: leading acidosis (metabolic acidosis)
a. bone absorption • salicylic acid has stimulatory effects on central
b. bone resorption respiratory centers of the brain leading to
increased breathing/ hyperventilation thus,
Bone Resorption Markers: resulting to respiratory alkalosis
a. tartrate-resistant acid phosphatase • initially it is metabolic acid but upon progression it
• not useful leads to respiratory alkalosis
• found on osteoclast • Acute aspirin poisoning is a common cause of
fatal drug poisoning in children
• Problem: can also be found in other parts of
the body • SERIOUS TOXIC EFFECT: fulminant hepatic
failure which is associated with Reye’s syndrome)
 ➢ Fulminant: severe and sudden When measuring K+ with an ion-selective electrode
➢ May develop hepatic encephalopathy by means of liquid ion-exchange membrane, what
➢ Associated with viral infection antibiotic is incorporated into the membrane?
• Has antiplatelet activity which inhibits a. Amoxicillin
cyclooxygenase enzyme which is important in the b. Valinomycin
production of thromboxane A2 which is necessary c. Gentamicin
for platelet activation and aggregation d. Streptomycin

Which of the following is associated with arsenic Electrochemical methods:

poisoning? a. Coulometry
a. odor of bitter-almonds breath and metallic taste ➢ Measures quantity of electricity in coulombs
b. metallic breath and garlic taste that is needed to convert different analyte
c. odor of garlic breath and metallic taste dependent on their oxidation state
d. metallic breath and bitter-almonds taste ➢ chloride
b. Amperometry
Arsenic poisoning ➢ Current flow produced by oxidation-reduction
• Associated with garlic odor and metallic taste ➢ Basis for pO2
• Widely use to kill plants (herbicides) and animals c. Voltametry
(rodenticides) and for ant poisoning, paints, wood ➢ Involves potential applied to an
preservative, ceramic, for metal alloy, livestock electrochemical cell and the resulting current
feeds will be measured
➢ utilized in anodic stripping voltammetry
Major Toxicologic Form o method utilize to measure level of lead in
a. Elemental arsenic blood
b. Trivalent arsenite d. Potentiometry
c. Pentavalent arsenate ➢ Base on Nernst Equation
o Measures potential present in voltage
• Has organic form o Involve in ISE
→ Component of ISE: ion-perm
Arsene gas selective membrane barrier which
• most dangerous toxicological form among all the makes this method specific
arsenic ▪ Membrane barrier allows specific
• acquired from industrial settings pass thru and contact with
measuring electrode
• a heavy metal that can cross the placenta
→ ISE is considered as very sensitive
together with well as mercury
and selective for the ion they
• readily absorbed through the GIT via ingestion
measure due to presence of
and lungs via inhalation, and skin via
membrane barrier
absorption however low
➢ Glass: selective to hydrogen ions (pH)
• Excretions: kidneys ➢ Potassium: utilizes special polymer with
• Sample valinomycin
a. arsenic: urine, hair, nails ➢ Sodium: polymer resin of polyvinyl chloride
b. lead: whole blood (PVC) & anodized indium tin oxide membrane
(more recent polymer)
A person having receptors that are tolerant to ➢ Calcium: Calcium-chelating organic
insulin would most likely have which of the following molecules in PVC and diocty phenyl
manifestations? phosphate
a. hyperlipidemia
b. hypertension Which of the following statements reflects the
c. hyperkalemia mechanism involved in the compensation seen in
d. hyperglycemia respiratory alkalosis?
a. More CO2 is eliminated through the lungs by
Insulin hyperventilation.
• important for the regulation of glucose levels b. Renal reabsorption of HCO3 is decreased.
c. pCO2 is higher than normal.
Receptors tolerant to insulin: d. HCO3 is higher than normal.
• hyperglycemia (best answer)
• hyperkalemia (second best answer) Respiratory alkalosis
➢ when glucose enters the cell, potassium will • Affected organ: lungs
also enter • Compensatory organ: kidneys
➢ seen in poorly controlled DM • HCO3: makes body alkaline
➢ Not required in respiratory alkalosis
 ➢ Decreased renal absorption b. cyanide
c. carbamate
Identification of the urinary metabolite d. arsenic
benzoylecgonine would be useful in determining
exposure to which of the following drugs? cyanide
a. Cocaine • not a mechanism of cyanide
b. Amphetamine • mechanism of action: binds with iron and
c. Propoxyphene cytochrome A3 necessary for cells to utilize
d. Codeine oxygen
• causes hypoxia
Cocaine ➢ stimulus for respiratory centers
• From coca plant ➢ may lead to tachypnea which is an abnormal
• Historically used in Coca-Cola rapid breathing
• Half life: short (1-2 hrs) due to the rapid hepatic o a compensatory mechanism to respond
hydrolysis of the parent molecule leading to effectively to hypoxia
formation of BENZOYLECGONINE, a metabolite ➢ later on, the lungs will be tired out and leads
with a half-life of 4-7 hrs to respiratory depression with hypoxia leading
• Test: immunoassay to cyanosis
➢ Benzoylegecgonine can be detected up to 3 • odor of bitter almonds
days (Henry - 48hrs)
➢ For chronic users it can be detected up to up carbamate
to 20 days, (Henry - 24 to 36 hrs) • do not penetrate the CNS effectively
• secondary answer
Select the arrangement of lipoproteins
electrophoresed on cellulose acetate or agarose at arsenic
pH 8.6 • odor of garlic with metallic taste
a. -chylomicrons>beta>prebeta>alpha+ • can distribute easily on other parts of the body in a
b. -beta>prebeta>alpha>chylomicrons+ short period of time (within 24 hours) thus
c. -chylomicrons>prebeta>beta>alpha+ considered systemic
d. -alpha>beta>prebeta>chylomicrons+
Lead
pH 8.6 • can cross the BBB and may lead to acute toxicity
• Proteins will be negatively charge thus, proteins ➢ CNS symptoms: encephalopathy,
migrate to the anode convulsions, stupor
• Anode: positive o Cause: ORGANOLEAD
• Cathode: negative ▪ tetraethyl, tetramethyl

A patient presents with weakness, easy fatigability • Porphyria

and intolerance to heat has the following results: ➢ accumulation of porphyrins due to disruption
T3= increased, T4 = increased and TSH = increased. in heme synthesis
What do these findings correlate with? ➢ heme synthesis involves the use of porphyrin
a. secondary hyperthyroidism rings
b. primary hypothyroidism ➢ lead inhibits the different enzymes needed to
c. secondary hypothyroidism produce heme leading to accumulation of
d. primary hyperthyroidism intermediate product in heme synthesis
➢ cause by exposure inorganic lead compounds
• All these manifestations indicate increase
metabolism and increased thyroid hormones What is the predominant cation outside cells and in
• The function of thyroid hormones is to maintain the extracellular fluid?
basal metabolic rate thus, when there is increase a. potassium
metabolism there is increase thyroid hormone b. calcium
➢ Secondary Hyperthyroidism c. sodium
• Increase T3 and T4 with increase TSH d. magnesium
• Defect in pituitary gland
• Cause: increase TSH PISO: Sodium outside, Potassium inside
• Effect: increase T3 and T4
The ability of the liver to detoxify harmful
What heavy metal is capable of passing through the substances is assessed using
blood brain barrier causing CNS toxicity as one of 1. albumin
its primary effects? 2. bilirubin
a. mercury 3. cholinesterase
4. ammonia Air Displacement
a. 1 and 3 are correct • Utilizes a piston for suction into disposable tips
b. 1,2 and 3 are correct
c. 2 and 4 are correct Ostwald Folin
d. 1, 2, 3 and 4 are correct • For graduated pipets
e. only 4 is correct • For viscous fluids

Cholinesterase: not part of liver function test Positive Displacement

• Allows sample to directly enter the pipet upon
Liver function test: contact without air displacement thus, there is no
• Increase Values in Presence of Liver Damage: need Problem: to use disposable tips
ALT, AST, ALP, GGT, 5’-nucleotidase • erroneous result due to carry over
• Decrease Values in Presence of Liver Damage: • Remedy: rinse and blot
total protein, albumin
• Increase Values in Presence of Liver Damage: Serologic Pipet
bilirubin, ammonia • A graduated measuring pipet
Note: LD can also be included but it’s the LEAST
needed Type of QC violation seen when control values are
either in the upper or lower side of the mean.
• Albumin is not harmful because it reflects the a. error
synthetic capacity of the liver b. shift
c. trend
This analyte is assayed to determine the d. outlier
completeness of a 24-hour urine sample.
a. urea Shift
b. creatinine • systematic
c. albumin • abrupt change in the control values that
d. glucose distribute themselves on one side of the mean
Creatinine Trend
• 1 to 2 grams per 24 hr urine sample • gradual deviation of control values that are
either increase or decrease
Which of the following analyte is assayed to • systematic
determine short-term glucose control?
a. glycated hemoglobin - ketoamine: 2-3 months or Error
2-4 months; LONG TERM • unpredictable
b. glycated albumin - fructosamine: 3-6 weeks
• not a QC violation
c. random glucose
• random or systematic
d. fasting glucose
Outlier
• RBS and FBS is only reflective of glucose
• Not a QC violation
concentration at the time of collection
• Control values that are outside of the mean
• Random or systematic
Glycated Hemoglobin
• Ketoamine
Which of the following opiates is anti-tussive?
• Reflects glucose levels for the past 2-3 months in
consideration with the lifespan of RBC a. amphetamine
b. heroin
Glycated Albumin c. morphine
• Fructosamine d. codeine
• Reflective of glucose levels for the past 3-6 weeks
in consideration to the life span of proteins which Anti-tussive – medicines that prevents or relieves
is 2-3 weeks cough

What type of automatic pipet functions like a CODEINE

hypodermic syringe and does not require the use of ● structurally similar to morphine and heroin
disposable tips?
a. air displacement ● mild form of analgesic and anti-tussive
b. positive displacement ● codeine analogs: dextromethorphan (D-3-
c. serologic pipet methoxy-N-methylmorphine)
d. Ostwald-Folin
 ➢ incorporated as part of cough suppressive b. R-4s, systematic error
medications c. 2-2s, systematic error
d. R-4s, random error
Morphine Westgard Multi-rule
• example of opiate 22s: 2 values on one side of the mean (2sd)

• 2 or more values indicates a systematic error

Amphetamine
• 1 value indicate a random error except for R4s
• use as a designer drug because 2 consecutive values are considered in
• e.g.: ecstasy (MDMA: 3,4- R4s
methylenedioxymethamphetamine) ➢ R4s: 2 consecutive values on opposite side of
the mean (4sd) ; two consecutive control
Heroin observation that differs on 4 standard
deviation ; two consecutive observation that
• diacetyl form of morphine
exceeds ± 2SD on opposite sides of the mean
• can cross the BBB leading to high ; random error
concentration of morphine in the CNS
Calculate the CV given the following data:
The following are true about the first-order kinetic Mean: 89 mg/dL
reaction except 3SD = 6
a. dependent on the substrate concentration
a. 2%
b. it is actually independent
c. dependent on the presence of inhibitors b. 1%
d. dependent on the analyte concentration c. 3%
d. 4%
• First order kinetics occurs first after, second order
kinetic occur Coefficient of Variation: (Standard deviation / mean)
x 100
First-Order Kinetics
• Enzyme is excessive Computation:
• Limiting factor: substrate (6/3) = 2 → 1SD
• Reaction Rate: directly proportional to the CV = (2/89_ x 100 = 2.25%
substrate concentration
Compute for the LDL given the following data:
Zero-Order Kinetics TC= 423 mmol/L
• Excessive: substrate TG= 378 mmol/L
• Limiting factor: enzyme HDL = 143 mmol/L
• Reaction Rate: directly proportional to the a. 96 mmol/
enzyme concentration
b. 86 mmol/L
c. 116 mmol/L
Blood glucose concentration defined as
d. 106 mmol/L
hypoglycemia
a. < 40 mg/dL
Friedwald: TC – HDL – (TG/2.175)
b. < 50 mg/dL
De Long: TC – HDL – (TG/2.85)
c. <60 mg/dL
d. < 70 mg/dL What class of enzyme uses NAD+/NADH as a
coenzyme?
Normal Value for Plasma Glucose Concentration: a. Iyase
70-110 (Henry’s) or 70-100 mg/dL b. transferase
c. hydrolase
<40 mg/dL: panic value for the lower limit of plasma
glucose concentration which may lead to serious d. oxidoreductase
consequences such as seizure
<70 mg/dL: body will try plasma glucose levels by NAD/ NADH
releasing hyperglycemic agent (glucagon) • for oxidoreductase
➢ 100 or 110 mg/dL • Function: additional substrate in a particular
reaction
Two consecutive control observations that exceed
• converted to reduce form or to non-reduced form
+/-2SD on one side of the mean.
a. 2-2s, random error
 Enzyme Classification and Nomenclature ● False increase in hemolysis because hemoglobin
1. Oxidoreductase has pseudoperoxidase activity
● Catalyze oxidation-reduction reactions
● LDH, G-6-PDH Which of the following correctly shows the
● Clue: dehydrogenase composition of chylomicrons?
2. Transferase
● Catalyze the transfer of a group
● AST, ALT, CK, GGT
● 2 Groups: aminotransferase and phosphate
● Clue: Transferase, aminase and kinase
3. Hydrolase
● Catalyze hydrolysis of various bonds
● Enzymes of digestion a. B
● ALP, ACP, AMY, CHS b. D - VLDL
4. Lyase c. A - HDL
● Catalyze the removal of groups d. C - LDL
● Aldolase, pyruvate decarboxylase, glutamate
decarboxylase
● Clue: decarboxylase
5. Isomerase
● Catalyze the interconversion of isomers
● Glucose-phosphate isomerase, ribose
phosphate isomerase
● Clue: isomerase
6. Ligase A = HDL
● Catalyze the joining of two substrate B = chylomicron thus, lighter and do not migrate and
remains at the point of origin since it has a lesser
molecules
protein content
● Glutathione synthetase ➢ Basis of electrophoresis: protein content
● Clue: synthetase C = LDL
D = VLDL
The following are interfering substances that affect
the hexokinase method for glucose determination This is defined as the ability of an analytical
except procedure to measure accurately one component in
a. none of these a specimen without interference by other
b. ascorbic acid components that are also present.
c. hemolysis - dec a. Diagnostic specificity
d. all of these b. Diagnostic sensitivity
e. bilirubin - dec c. Analytic sensitivity
d. Analytic specificity
Hexokinase method:
● affected by high levels of bilirubin and Diagnostic sensitivity vs. Diagnostic specificity
hemolysis • Diagnostic sensitivity: there is presence of
● not affected by ascorbic acid disease ; ability of analytical procedure to
● less interfering substances determine the presence of disease
• Diagnostic specificity: there is absence of
Glucose oxidase method (2nd reaction):
disease ; ability of analytical method to determine
● affects the second reaction which is catalyse the the absence of disease
peroxidase in which there is a need to allow
hydrogen peroxide from the first reaction to react Analytical sensitivity: ability of analytical procedure
to reduce chromogen forming now the oxidize to measure small amount of the analyte
chromogen Analytical specificity: ability of analytical procedure
● Interfering substance leads to false decrease to measure accurately one analyte even in the
presence of interferences
upon presence of uric acid, bilirubin and ascorbic
acid (increased) Patient has the following OGTT results.
FBS= 95 mg/dl
1 hour= 180 mg/dI HbA1c (Pre-diabetes)
2 hours= 155 mg/dI ● 5.7-6.4%
3 hours= 140 mg/dI
Interpret the patient's condition. Diabetes of DM
a. Patient has no diabetes mellitus. Fasting: ≥ 126 mg/dL
b. Patient has diabetes mellitus. 2-hr OGTT: ≥ 200 mg/dL
c. Patient is pre-diabetic. HbA1c: ≥ 6.5%
d. Cannot be interpreted, needs more laboratory
data. Diagnosis of Diabetes
e. There is an erroneous result. 1. FBS: ≥ 126 mg/dL on at least 2 occasions
2. RBS: ≥ 200 mg/dL + symptoms of hyperglycemia
OGTT ➢ Casual plasma glucose level
• used in diagnosis of GESTATIONAL DM 3. HbA1c: ≥ 6.5%
➢ a pregnant women suffering from Gestational
DM is at risk from complications during
pregnancy which may also affect the infant
• Diagnosis of GDM: at least 2 of the 4 plasma
glucose levels are met or exceeded

2-Step OGTT
• 3-hour OGTT Llyod’s reagent is used in which of the following
• Requires a screening step before tolerance test assays?
a. Creatinine determination
Criterion: 2 Classification b. Ammonia determination
c. Uric acid determination
1. Carpenter/Coustan
d. BUN determination
● Lower quantities thus, more sensitive and
better outcomes for mother and infants by Jaffe Reaction
decreasing gestational diabetes melitus • Not specific due to the presence of interferences
related complications in pregnancy • Requirement to increase specificity: adsorption
● Fasting: 95 mg/dL technique
➢ After, glucose load • pH: alkaline
● 1h: 180 mg/dL • Other name: alkaline picrate method
● 2h: 155 mg/dL
Adsorption Techniques
● 3h: 140 mg/dL
• For isolation of creatinine
• More specific
2. NDDG (National Diabetes Data Group) • Reagent:
● Fasting: 105 mg/dL a. Fuller’s earth: magnesium aluminum silicate
● 1h: 190 mg/dL b. Lloyd’s reagent: sodium aluminum silicate
● 2h: 165 mg/dL
● 3h: 145 mg/dL Which of the following results would be most
consistent with high risk for coronary heart disease?
a. 20 mg/dL HDL, 250 mg/dL total cholesterol
Normal Values b. 45 mg/dL HDL, 210 mg/dL total cholesterol
Fasting Blood Sugar c. 55 mg/dL, 170 mg/dL total cholesterol
● Normal: <100 mg/dL d. 50 mg/dL, 180 mg/dL total cholesterol
2-hr OGTT
● Normal: <140mg/dL Markers of Coronary Risk:
HbA1c • Serum cholesterol: earliest identified marker ;
● Normal: <6.5% one of the most important analyte
• LDL: directly associated with risk
➢ >160 mg/dL with no risk factor: therapy
Diagnosis of Prediabetes must be initiated
Fasting (Impaired Fasting) ➢ 130 mg/dL with 2 or more risk factors:
● 100-125 mg/dL therapy must be initiated
2-hr OGTT (Impaired Tolerance)
● 140-199 mg/dL
 o Therapy must be initiated because the b. 1 and 3 are correct
intervention carried out decreases the risk c. 1, 2, 3 and 4 are correct
of CHD d. Only 4 is correct
o Three fasting lipid profile must be e. 2 and 4 are correct
given: total cholesterol, LDL, HDL
• HDL: a negative risk factor because it is indirectly Indirect measurements of LDL:
proportional to risk ; independent risk factor for a. Friedwald Equation: not valid if triglyceride is
development of CHD >400 mg/dL
➢ <35 mg/dL: considered a high risk factor for b. De Long Equation: valid if triglyceride has a
CHD value that is >400 mg/dL
➢ >60 mg/dL: protective value in developing
CHD The following statements describe chylomicrons
• Triglyceride: generally accepted risk factor as a except
significant risk factor in the development of CHD a. Largest lipoprotein with the highest triglyceride
➢ >150 mg/dL content
b. Lightest lipoprotein in ultracentrifugation
Cut off point for Total Cholesterol: c. Carrier of exogenous triglyceride
➢ Acceptable value: 170 mg/dL d. Migrates farthest from the anode during
➢ Borderline: 180 mg/dL electrophoresis

What is the molarity of a solution containing 50 g Chylomicrons remain at the point of origin or
NaCl (formula weight = 58 g) in 500 mL deionized application because they have a very little protein
water? content which is 1-2% of its total structure
a. 0.58 M
b. 2.50 M Hydrogen ion concentration (pH) in blood is usually
c. 1.72 M determined by means of which of the following
d. 1.27 M electrodes?
a. Glass
M = g of solute / (molecular weight x L of solution) b. Silver
M = 50 / 58 x .5 L = 1.72 M c. Platinum
d. Platinum plate
Urea is produced from
a. Catabolism of proteins and amino acids The urinary excretion product measured as an
b. Breakdown of complex carbohydrates indicator of epinephrine production is
c. Oxidation of purines a. DOPA
d. Oxidation of pyrimidines b. VMA
c. EPO
NPN Compounds: d. HVA
• Urea: end product of protein metabolism
• Uric acid: end product of purine metabolism due VMA: vanillylmandelic acid: metabolite of
to increase cell turn-over epinephrine which is a catecholamine
• Creatinine: end product of muscle metabolism • Epinephrine does not provide a good level
• Ammonia: from deamination of amino acids from especially when utilizing a blood thus, measuring
protein metabolism ; intermediate product for the the metabolite in urine is performed
metabolism of urea • 24 hour urine is utilized for catecholamine
determination
Urea
• Major NPN HVA: homovanilic acid: metabolite of dopamine

Uric Acid, urea and NPN Which of the following diseases results from the
• For kidney function familial absence of high density lipoprotein?
a. Tay-Sachs disease
Ammonia b. Krabbe disease
• For liver c. Gaucher disease
d. Tangier disease
Incorrect about Friedwald Formula
1. Direct measurement for LDL Tangier disease
2. Indirect measurement for LDL • Mutation in ABCA 1 gene on chromosome 9
3. Valid for triglycerides over 400 mg/dL which affects the ability of the body to effectively
4. Not valid for triglycerides over 400 mg/dL transfer or incorporate cholesterol and
a. 1, 2 and 3 are correct phospholipids into apo A1 which is present in
HDL resulting to total absence of HDL
 c. Albumin and prealbumin
Which of the following lipid profile parameters is d. Fibrinogen and haptoglobin
expected to be falsely elevated on a serum specimen
from a non-fasting patient? Negative Acute Phase Reactant: plasma proteins
a. Triglyceride that are decreased during inflammation
b. HDL
c. LDL Primary aldosteronism results from a tumor of the
d. Cholesterol adrenal cortex. How would the extracellular fluid be
affected?
Triglyceride a. Normal sodium, decreased potassium levels
• Exogenous source: form diet carried by b. Increased sodium, decreased potassium levels
chylomicrons c. Decreased sodium, decreased potassium levels
d. Decreased sodium, increased potassium level
During pregnancy, the form of estrogen measured in
urine is Primary aldosteronism
a. Estradiol • Involves presence of tumor in adrenal gland
b. Estrone • Adrenal gland becomes over active resulting to
c. Prenonediol increase secretion of hormones
d. Estriol ➢ Mineralocorticoid release: aldosterone
➢ Aldosterone must increase sodium levels
HCG ➢ Aldosterone promotes reabsorption of Na
• Produced by trophoblastic cells from placenta in levels in renal tubules thus there will be
place of progesterone increase of Na levels in renal tubule leading to
• Measured in urine during the first trimester increase excretion of K
• When placenta develops, HCG concentration
decreases and progesterone will replace HCG What condition involves the absence of the activity
of glucoronyl transferase resulting to persistent
Progesterone increased level of unconjugated bilirubin and
• Increase during the 2nd and 3rd trimester kernicterus in neonates?
a. Dubin-johnson syndrome
Estriol b. Hemolytic anemia
• Not the most potent but increases during c. Physiologic liver immaturity
pregnancy because it is not present in non- d. Crigler-najar syndrome
pregnant women
Dubin-Johnson Syndrome
Estradiol • Excretion defect
• Most potent even during pregnancy • Increase conjugated bilirubin

Isoenzyme assays are performed to improve Physiologic liver immaturity

a. Specificity • Not consistent because as the baby liver matures,
b. Precision their ability to conjugate also increases
c. Sensitivity
d. Accuracy Hemolytic anemia
• Increase in unconjugated bilirubin due to increase
What hormone released by the anterior pituitary lysis of cells
gland is responsible in stimulating Leydig cells to
produce and secrete testosterone? Crigler-Najar Syndrome
a. FSH • Vulnerable to develop kernicterus
b. LH • Presence of unconjugated bilirubin which is
c. GnRH deposited in urine
d. PRL
Pre-hepatic bilirubin has which of the following for a
• Luteinizing hormone stimulates the Leydig cells protein carrier?
• FSH stimulates the Sertoli cells a. Albumin
• GnRH is produced by hypothalamus b. Gamma globulin
• Prolactin is a direct effector hormone c. Alpha2 globulin
d. Beta globulin
Which of the following are considered as negative
acute phase reactants? Pre-hepatic bilirubin
a. CRP and serum amyloid • Unconjugated form
b. Alpha1-antitrypsin and orosmucoid
 • From the spleen, unconjugated bilirubin will be • Requires hormone from the anterior pituitary
carried to the liver for conjugation by the carrier gland
albumin
Hormones needed in puberty:
Delta Bilirubin • FSH
• Carried by albumin • LH
• Unconjugated bilirubin
• Disordered puberty is also dependent upon the
The Trinder reaction is employed in the colorimetric major hormones present in males and females
determination of what drug?
a. acetaminophen Major hormone present in:
b. barbiturate • Testosterone: most potent in males
c. salicylate • Estradiol: most potent in females
d. digoxin
In order to reverse the clinical manifestations
Trinder reaction associated with PCOS, an individual suffering from
• for salicylate a. it should undergo Metformine therapy.
• salicylate / aspirin / acetyl salicylic acid + ferric b. undergo Amlodipine therapy.
nitrate → colored complex → measure c. have a ketogenic diet.
spectrophotometry d. exercise regularly.
➢ immunoassay may also be use
• Reagent use: ferric nitrate

Identify the age group with the following cutoff

points for serum cholesterol: Moderate Risk >
200mg/dL and High Risk > 220mg/dL
a. 20 to 29
b. 40 and older • persons who are suffering with PCOS tends to
c. 2 to 19 overweight easily due to dyslipidemia,
d. 30 to 39 hyperglycemia

Management of PCOS:
1. exercise regularly
2. diet
3. metformin therapy

In what organ of the body does the de novo

synthesis of Vitamin D begin?
a. kidney
b. skin
Not true about catecholamine measurements c. liver
a. 24-hour urine sample is assayed d. intestine
b. plasma provides a more accurate determination
c. catecholamines have short half-lives in blood Production of Calcitriol from Vitamin D
d. level of urine catecholamines and their
• starts in the skin via UV action → vitamin D3 is
metabolites are measured
formed → Vitamin D3 goes to the liver for further
synthesis → after Vitamin D3 goes to the kidney
Disadvantages of catecholamine in blood, it poses for final construction
the following issues:
• Active form: 1, 25-dihydroxy vitamin D or
1. Hydrophilic
cholecalciferol or calcitriol
2. Circulate in low levels
3. Short half-life
Which of the following statements is false regarding
4. Fluctuating levels
chronic toxicity?
a. single exposure, dose is sufficient to cause toxic
Hormones useful in evaluating disordered puberty
effects
a. FSH, LH, testosterone and estradiol
b. affects different organ systems
b. GnRH, FSH, LH, estrogen and progesterone
c. accumulation of the toxicant or toxic effects
c. GnRH, FSH, LH and androgens
d. several exposure to doses insufficient to cause
d. FSH, LH, testosterone and estrogen
toxic effects
• Puberty prepares your body for reproduction Chronic Toxicity
 • involves the accumulation of toxin or poison c. Tan
• exposure to the toxin for several times at a d. Pink
dosage that is insufficient to cause adverse effect
• accumulation of toxin leading to manifestation of What hazard is positioned at the bottom of the NFPA
chronic toxicity Hazards Identification System?
a. Health
Not an endocrine gland b. Flammability
a. salivary gland c. Stability
b. neurohypophysis d. Specific
c. adrenal gland
d. pancreas Upper (red): flammability
Right (yellow): reactivity / stability
Best example of a hormone that exhibits a positive Bottom (white): special
feedback mechanism Left (blue): health hazard
a. oxytocin
b. thyroxine In the enzymatic method for cholesterol
c. adrenaline determination, what is the most commonly used
d. insulin peroxidase in coupling H202 to a chromogenic
substrate?
a. pooled human peroxidase
b. horseradish peroxidase
c. rabbit peroxidase
d. asparagus peroxidase

• Most common method use for quantify cholesterol

is via the use of enzymes (cholesterol oxidase)
where there is a need to measure hydrogen
Lean Six Sigma process improvement involves all of peroxide
the following processes except
a. Plan H2O2 + Phenol + 4-aminoantipyrine →
b. Measure quinoneimine dye measured at 500 nm
c. Control
d. Define In the CDC reference method for TG measurement,
what reagents are used in the extraction and
Lean and Six Sigma: DMAIC adsorption steps respectively?
Six Sigma: DMAIC a. sodium periodate and silicic acid
Lean: 5S and plan, do, check and act b. chloroform and silicic acid
c. sodium periodate and formaldehyde
How long is the completion of a full Six Sigma d. chloroform and formaldehyde
improvement project?
a. 12 months
b. 6 months • Triglyceride is performed using enzymatic method
c. 3 months but by CDC they require colorimetric method
d. 9 months which makes use of extraction and adsorption
procedure to isolate triglyceride
Quality Assurance encompasses which of the ➢ Problem: interferences cause by
following phases? phospholipid and others
a. analytical ➢ Remedy:
b. pre-analytical and analytical a. Extraction: chloroform
c. pre-analytical and post-analytical b. Adsorption: silicic acid via
d. pre-analytical, analytical and post-analytical chromatography

Quality assurance Obsolete methods for glucose determination except

• Overall process or totality of testing a. Dubowski
b. Hexokinase
A clinical instructor asked a medical technology c. Nelson-Somogyi
intern to get an evacuated tube spray-dried with d. O-Toluidine
K2EDTA which is to be utilized for blood banking.
What is the color of the hemogard of the evacuated Obsolete Methods: chemical procedures (Nelson-
tube that the intern should get? Somogyi, Folin Wu, Neocoproine)
a. White
b. Royal Blue
 Ortho-toluidine method by Dubowski: a
condensation method ; possible answer too if there is ELECTRICAL NEUTRALITY
no hexokinase • the net charge must be equal and 0

What organ is primarily affected in hypoglycemic CHLORIDE

states? 1. Sodium is reabsorbed with chloride
a. lungs ➢ Sodium is an important electrolyte to maintain
b. brain proper fluid distribution
c. kidneys ➢ To cancel out the positive charge brought by
d. liver Na, Na is reabsorbed with chloride particularly
in the PCT
Brain must be highly vascularized because a constant ➢ The amount of Na that is reabsorbed is
delivery of glucose to the brain is necessary dependent on the Cl ions present to maintain
electrical neutrality
Purpose of glycogenesis
a. energy production 2. Chloride shift
b. energy distribution ➢ In tissue cells, as tissue cells undergo
c. energy storage metabolism there is consequent production of
d. energy utilization CO2 otherwise the tissue will become acidic
➢ CO2 goes into the plasma then to the RBCs
Glycogenesis: for energy storage ➢ The CO2 inside the RBCs will be converted to
Glycolysis: energy production form H2CO3
➢ Carbonic acid is further converted to form H+
Liver enzyme that is significant when decreased and HCO3
a. AST ➢ Inside the cells, the presence of H+ from
b. ALP H2CO3 is buffered by hemoglobin
c. CHS (deoxyhemoglobin)
d. ALT ➢ HCO3 is necessary in the extracellular matrix
to maintain the plasma pH between 7.35-7.45,
Cholinesterase: not part of liver function test thus HCO3 goes outside the cell
because it is for organophosphate poisoning ➢ Upon exit of HCO3, Chloride will enter to
maintain electrical neutrality
Tetany, which involves irregular muscle spasms, is
attributed to decreased blood concentration of what Respective sodium and potassium levels in patients
electrolyte? with Addison's disease
a. sodium a. increased, decreased
b. magnesium b. decreased, increased
c. potassium c. both are decreased
d. calcium d. both are increased

Tetany: a neuromuscular irritability which leads to Addison’s disease

muscle spasm • involves decreased in production of adrenal
Ca: facilitates the interaction between the actin and hormones (aldosterone)
myosin filaments for contraction • decrease aldosterone levels = decreased sodium
levels
Anticoagulant of choice in the assay of blood • in renal tubules there is decreased in reabsorption
magnesium of sodium ions leading to decrease cations
a. citrate • decreased excretion of potassium
b. heparin
c. oxalate Increased cell turnover seen in leukemic patients
d. EDTA undergoing chemotherapy would most likely
elevated which of the following NPNs?
Which of the following statements correctly a. uric acid
describes chloride shift? b. creatinine
a. diffusion of chloride ions out of the cell along c. ammonia
with sodium ions d. urea
b. diffusion of chloride ions out of the cell in
exchange for the bicarbonate ions that move in Increase cell turn over = increase nucleic acid =
c. diffusion of chloride ions into the cell in increase purine = increase uric acid
exchange for bicarbonate ions that move out
d. diffusion of chloride ions into the cell along with In stressful conditions, catecholamines from the
sodium ions adrenal medulla responds within
 a. 10 minutes.
b. seconds. Henderson-Hasselback Equation
c. hours. • Acid-base balance
d. 20 minutes. • For computation pH

Catecholamines: first responders to stress

Cortisol: stress hormone What is the normal BUN:Creatinine ratio?
a. 10:1
Black belts dedicate ____if their time to b. 10-20:1
quality improvement projects. c. 15:1
a. 75% d. 20:1
b. 50%
c. 20%
d. 100%

Drug of choice for absence seizures

a. Phenytoin
b. Primidone
c. Valproic Acid
d. Ethosuximide

Plasma glucose concentration at which observable

symptoms of hypoglycemia appear.
a. 70 mg/dL
b. 40 mg/dL
c. 60 mg/dL
d. 50 mg/dL

Reference range: 50-55 mg/dL

Which of the following is not a steroid hormone?

a. estrogen
b. epinephrine
c. progesterone
d. tetosterone

Steroid hormone clue: ST

The equation E (enzyme) + S (substrate) = ES = E + P

(product) refers to
a. Michaelis-Menten hypothesis.
b. Henderson-Hasselbach equation.
c. enzymatic reaction.
d. Zero-Order enzyme kinetics

Michaelis Menten hypothesis

• Governs the enzyme kinetics

Zero-order enzyme kinetics

• Relationship between enzymatic reaction rate and
enzyme in which they are directly proportional
 CLINICAL CHEMISTRY MOCK BOARD 6. Which of the following error-example is
EXAMINATION 1 BATCH FEBRUARY-AUGUST incorrectly matched?
2023
a. random error-mislabeling a sample
Multiple Choice b. random error-changes in standard materials
c. systematic error-improper calibration
Identify the choice that best completes the d. systematic error-sample instability
statement or answers the question.
7.Not true about proficiency testing
1. Lactate dehydrogenase belongs to what enzyme
class? a.otherwise known as external quality assessment
b. comparison of results to a reference value
a lyase C. included as part of the analytical phase
b. transferase d. form of quality control
c. hydrolase
d. oxidoreductase 8. Two consecutive outlier on opposite sides of the
mean
2.Which of the following conditions is the cause for
rejecting an analytical run? a. 2-2s, systematic error
b. 1-2s, random error
a. Two consecutive controls greater than 2s above c. 2-1s, systematic error
or below the mean. d. R-4s, random error
b. One control above +1s and the other below -1s 9. What substance yields hydroxyl ions when
from the mean. dissolved in water?
c. Four controls steadily increasing in value but less
than +/- 1s from the mean a. acid
d. Three consecutive controls greater than is above b. buffer
the mean. c. salt
d. base
3. Which of the following is the primary reagent
used in the Jaffe method for creatinine? 10.Which of the following abnormal electrophoretic
patterns best correlates with Bassen-Kornzw
a.Sodium nitroprusside and phenol syndrome?
b. Saturated picric acid and NaOH
c. Phosphoningstic acid a. increase in the pre-beta, beta and alpha bands:
d. Alkaline copper Il sulfate b. decrease in the alpha band and increase in the
beta band
4. The serum TSH level in almost absent in c. decrease in the pre-beta and alpha bands
d. decrease in the pre-beta and beta bands.
a. primary hypothyroidism
b. primary hyperthyroidism 11. Type of bilirubin that primarily causes jaundice
c. secondary hyperthyroidism in Dubin-Johnson syndrome
d. euthyroid sick syndrome
a. alpha
5. The statistical tool F-Test is used to determine if b. delta
there is a significant difference between c. conjugated
_ to detect. d. unconjugated
a. standard deviations, accuracy b. means, 12. The following are responsibilities of employers
precision in dealing with chemical hazards in clinical
c. Means, accuracy laboratories except
d. Standard deviation,precision
a. make MSDS available to employees upon
request
b. provide training to employees
c. ensure proper labeling and post appropriate 18. Which of the following electrolytes is involved in
warnings neuromuscular activity
d. assess and supply information about chemical or
physical hazards a.sodium
b.chloride
13. A cholesterol QC chart has the following data c. bicarbonate
for the normal control: X-137 mg/dL d. calcium
Summation of x= 1,918 mg/dl.
2SD-6 mg/dL N-14 19. A patient is admitted with biliary cirrhosis. If a
The coefficient of variation for this set of controls is serum protein electrophoresis is performed, which
of the
a 2:19% following globulin fractions will be most elevated?
b. 1.14%
c. 9.4996 a.alpha-1
d. 4.38% b. alpha-2
c. beta
14. Convert 25 g to it. d. gamma

a 21 mL 20 Number of individuals required to establish a

b. 15 mL new reference interval
c. 33 mL.
d. 25 mL a.120
b.10
15. Turbidity that is caused by the presence of c.100
appreciable concentrations of exogenous d. 20
triglyceride is considered as
21 Lipoprotein responsible for the transport of TAG
a.pathologic produced by the body
b.artefactual
c.physiologic a.chylomicrons
d.abnormal b.LDL
c.VLDL
16.This abnormal LDL lipoprotein, referred to as d. HDL
sinking pre-beta lipoprotein is associated with a
higher 22. Which of the following best represents
for atherosclerosis. precision?

a. beta-VLDL a.CV
b. LpX b. Mean
c. LDL c. Gaussian Curve
d. Lp(a) d. SD

17. Extremely high plasma levels of ALP in the 23. Which variable is not directly proportional to
absence of an elevated direct bilirubin. GGT or absorbance?
transaminases would most likely indicate which
condition a. path length
b. concentration
a. Muscular dystrophy c. transmittance
b. Hypoparathyroidism d. absorptivity
c.Paget's disease or bone malignancy
d. Biliary cirrhosis 24. How much 95% alcohol is required to make 200
mL of 5% alcohol?

a. 95,000 mL
b. 10.53 mL
c. 2.38 mL 31. According to Beer's law, the absorbance of a
d. 3.800 mL substance is

25. Which of the following are considered as a. directly proportional to the concentration
negative acute phase reactants? b. proportional to the square of the concentration
c. inversely proportional to the square of the
a. fibrinogen and haptoglobin concentration
b. CRP and serum amyloid d. inversely proportional to the concentration.
c. albumin and prealbumin
d. alpha1-antitrypsin and mucoid 32.Which of the following is associated with
turbidity in serum?
26. How much 95% ethanol is necessary to make 1 a. free fatty acids
L of 70% ethanol? b. chylomicrons
c. total lipids
a. 0.74 L d. cholesterol
b. 085 L
c. 0,75 L 33. What enzymes are clinically significant in
d. 0.84 L myocardial infarction?

27. Chief plasma cation, the main function of which a. LDH. ALT. AST, aldolase
is osmotic pressure regulation b. AST. ALT, aldolase
c. CK, AST. ALT
a. Cl d CK. AST. LDH
b. K
c. Na 34. In QC. a laboratory result that is more than 2SD
d. Ca from the mean is expected to occur

28. HbA1c determination is contraindicated in a.10% of the time.

which of the following conditions b. 3% of the time,
C. 5% of the time.
a Thalassemia d. 20% of the time
b. Gestational diabetes mellitus
c. Diabetes mellitus 35. Quality improvement concept that serves to
d. PCOS make laboratory procedures simple, fast and easy.

29.What are enzymes? a.lean

b. intralab QC
a. proteins c.proficiency testing
b. lipids d six sigma
c carbohydrates
d. nucleic acids 36. Electrolytes, when they participate in enzymatic
reactions, serve as
30.Abnormal lipoproteins include a.inhibitors
b.cofactors
1. IDL c. activators
2. Beta-VLDL b. coenzymes
3. Lp(a)
4. LpX 37. What axis of the LJ chart contains the
a. 1, 2 and 3 are correct independent variables?
b. 1 and 3 are correct a Y-axis
c. 1.2.3 and 4 are correct C ordinate
d. 2 and 4 are correct d abscissa
b. vertical axis
38.A newborn is due for screening of certain d. prediabetes, impaired glucose tolerance.
metabolic disorders. Which of the following is the
best specimen for such screening test 44. Common cause of falsely increased LDI fraction

a. arterial puncture a. liver disease

b. blood spot on filter paper b. specimen hemolysis
c. skin puncture using capillary tubes c. congestive heart failure
d. venipuncture d. adding toxicity

39 What is the most abundant NPN in blood 45. What is the proper conversion of 1 to k

a. Ammonia a.Divide by 100.

b. Creatinine b. Multiply by 1000.
c. Une acid c.Divide by 1000
d Urea d. Multiply by 100

40 What apolipoprotem is present in HDL and 46. What is the conversion factor of T4?
functions as its structural backbone
a. 0.0505
a.Apo B b. 12.9
b. Apo C c.0.357
c. Apo E d. 227
d. Ape A
47.Which of the following is a major risk factor for
40. What apolipoprotein is present in HDL and coronary heart disease (CHD) ?
functions as its structural backbone?
a. elevated level of HDL
a. Apo B b. low level of LDL
b. Apo C c. hypercholesterolemia
c. Apo E d. hypertriglyceridemia
d. Apo A
48. A new machine in the clinical chemistry section
41.The following, if done repetitively, are ergonomic arrived together with the corresponding reagents.
hazards except? Who should provide the MSDS?

a. manufacturer
a centrifuging
b section head
b. pipetting
c. chief medical technologist
C. encoding
d. employer
d. microscopic examination
49. What is the relationship of CV to precision!
42. What lipoprotein is the most carrier of
cholesterol to peripheral tissues?
a. correspondingly proportional
b. directly proportional
a.Chylomicron
c. proportionately proportional
b. VLDL
d. inversely proportional
c. LDL
d.HDL
50 Which of the following are hazards caused by
liquid nitrogen gas?
43. Fasting Plasma Glucose 115 mg/dL 2-Hour
Plasma Glucose 130 mg/dL, HbA1c 6.0%
a.burning sensation
The results above indicate
b. brittlement
c. asphyxiation
a. prediabetes, impaired fasting glucose d. fire explosion
b. diabetes mellitus. e. all of these
d. normal results
51. Serum protein electrophoresis is most important c. ortho-toluidine
in determining the presence of d. ferricyanide

a. nephrotic syndrome 58. pH-7:30

b. liver cirrhosis pCO2-48 mmHg
c. polyclonal gammopathy HCO3-23 mmol/L
d. monoclonal gammopathy What organ will compensate given the results
above
52. The antibody titer of a patient against a certain
pathogen is 112 mg/dt. What id the value a. kidney
expressed in the SI unit? b. lung
c. heart
a 0.112 g/dL d. brain
b. 1.12 g/L
c. 0.0112 g/dL 59. Cortisol is an analyte that is affected by diurnal
d. 11.2g/L variation. It is highest in the _and lowest in the

53.A metal ion required for optimal enzyme activity a. morning: evening
is known as b. evening, morning
c. morning afternoon
a.coenzyme d. evening: afternoon
b. cofactor
c. catalyst 60.Which is not a tropic hormone?
d. Activator
a. FSH
54.The following are true about delta check except b. ACTH
c. LH
a.Most useful in detecting samples altered by IV d. GH
dilation
b. Most useful in detecting mislabeled samples. 61. Proper arrangement of lipoproteins according to
c. Comparison of a patient's result to other patients decreasing protein content
results within the day. a. CM. LDL. VIDL. HDL.
d. Capable of detecting analytic eros b. HDL, CM. LDL, VLDL
c. CM. VLDL, LDL, HDL
55. Commated bilirubin can be excreted out in urine d. HDL. LDL. VLDL, CM
because it is
62 Which of the following cause's hypokalemia in
a. water-soluble. vomitting?
b it undergoes photoisomerization 1. entry of potassium into cells 2. renal wasting of
c.it is water-insoluble potassium
d. it is carried by albumin. 3. extravasation of potassium from blood vessels
4. loss of gastric potassium
56. The middle value of a set of numbers that are a. 1 and 3 are correct
arranged according to their magistide is known as b. 2 and 4 are correct
c. only 4 is correct
a. Arithmetic Mean d. 1.2, 3 and 4 are correct
b. Geometric Mean
c. Median
d. Mode 63. Proper time of collection of a peak sample for
TDM
57. Increased concentrations of ascorbic acid a. shortly after the drug is administered.
inhibit chromogen production in which of the b. shortly before a drug is administered.
following glucose methods? c. in the morning as soon as the patient wakes up
d. in the evening before the patient sleeps.
a. glucose oxidase
b. hexokinase
64. This is evaluated in order to check and ensure 71. Which of the following is correct?
that the instrument adheres to the Beer's Law.
a. Stary Light a. Uric acid: end-product of purine metabolism
b. Wavelength Accuracy b.creatinine end-product of muscle metabolism
c. Linearity c.urea end-product of protein metabolism
d. Absorbance Check d. ammiona end-product of lipid metabolism

65. Decreased blood levels of T3 and T4 hormones 72.LDH is added to the substrate mixture of which
stimulate the hypothalamus to produce enzyme assay to cause rapid exhaustion of
a TSH endogenous pyruvate?
b. ACTH
c. TBG a.ALT
d. TRH b. AST
c.ALP
66. This analyte is assayed to determine the d CK
completeness of a 24-hour urine sample.
73. A patient who is due for lipid profile should be
a. urea instructed to fast for
b. albumin
c. creatinine a. 10 hours
d. glucose b. 12 hours
c. 8 hours
67, Cushing's disease is associated with d. 14 hours

a. hypersecretion of growth hormone 74. The following conditions cause

b. hypersecretion of ACTH hypoalbuminemia except
c.hyposecretion of growth hormone
d. hyposecretion of ACTH : syndrome a. nephrosis
b. starvation
68. What parameter is used to differentiate primary C. liver disease
from secondary hypothyroidism? d. dehydration.

a.T3 75 Best sample for the diagnosis of acute toxicity

b. TSH with elemental mercury.
c. T4
d. TRH stimulation test a.nail
b. 24-hour urine
69. An anticoagulant that prevents in vivo and in c. Hair
vitro clotting: d. whole blood

a.heparin 76 Therapeutic Drug Monitoring (TDM) is based on

b. citrate the principles of
c.oxalate
d. EDTA a. pharmacokinetics
b. pharmacodynamics
70. Tetany, which involves regular muscle spas, is c. pharmacology
attributed to decreased blood concentration of what d. pharmacy
electrolyte?
77. Which of the following statements is true about
a. magnesium partially compensated respiratory alkalosis?
b. potassinan
c. calcium a. Renal reabsorption of HCO3 is decreased
d sodium b. More CO2 is eliminated through the lungs by
hyperventilation.
c. HCO3 is higher than normal.
d. pCO2 is higher than normal. 84. This pertains to the proportion of persons with a
positive test who truly have the disease
78. A patient who had increased ingestion of
legumes is expected to have an increased level of a.Diagnostic Sensitivity.
what NPN b. Positive Predictive Value
c. Negative Predictive Value
a. ammonia d. Diagnostic Specificity
b. creatinine
c. uric acid 85.Light that carries high energy but with short
d. urea wavelength

79. What substance makes the body alkaline? a.Ultraviolet Light

b. Infrared Light
a.HCO3 c. Visible Light
b. H20 d. Radio Light
c. O2
d. CO2 86. An enzyme that utilizes para-nitrophenyl
phosphate as its substrate and reacts best at pH
80. Age group associated with the following serum 9.6 would be mostly elevated in cases of
cholesterol cut-off points:
Moderate Risk: >220 mg/dL a Pernicious anemia
High Risk: >240 mg/dL b. Paget's disease
c. Prostatic carcinoma
a. 30 to 39 years old d. Pesticide poisoning
b. 2 to 19 years old - >170, >185 mg/dL
c. 20 to 29 years old - >200,>220 mg/dL 87. Purpose of glycogenesis
d. 40 years old and above - >240,>260 mg/dL
a.energy storage
81. Which of the following analytes is/are b. energy production
decreased in liver damage? c.energy distribution
1. albumin d.energy utilization
2. ammonia
3. total protein 88. The detector of this instrument is positioned at
4. ALT a 90 deg angle from the incident light.

a. 2 and 4 are correct a.phelometer

b. 1,2,3 and 4 are correct b.spectrophotometer
c.1 and 3 are correct c. Nephelometer
d. 1,2 and 3 are correct d. Fluorometer

82. A malignant tumor present in the ureter causes 89. The following autoantibodies are implicated in
Hashimoto's thyroiditis except
a post-renal azotemia
b. pre-renal azoteaa a.Anti- microsomal Ab
c. renal azotemia b. Anti thyroid peroxidase Ab
d. azotemia c. Anti-TSH receptor Ab
d. Anti-thyroglobulin Ab
83. Hashish, the most potent form of marijuana, is a
resin that is derived from 90.Which of the following does not describe
conjugated bilirubin?
a. coca plant
b. poppy plant a. Cannot be excreted in the urine
c.opunu plant b. Reacts directly with the color reagent
d. cannabis plant c. Attached to glucuronic acid molecule
d. Polar and water-soluble
91. What is the expected level of blood cholesterol 98. Unless blood gas measurements are performed
in Grave's disease? immediately after sampling in vitro glycolysis of the
blood causes a
a. variable
c. normal a.fall in pH and rise in pO2
b. decreased b. rise in pH and pCO2
d. increased c. rise in pH and a fall in p02
d. fall in pH and a rise in CO2
92. Convert 10 ml to uL
99. 35 nunol/L K is equivalent to
a. 100 uL
b. 1,000 uL a. 0.35 mEqL
c 100,000 L b. 0.88 mEqt
d. 10,000 L c. 1.0 mEq/L
d. 3.5 mEq/L
93. Under what conditions should the sample for
blood gas determination be maintained while it is in 100. The major cation found in cells is
transport to the laboratory?
a.soditum
a. Anaerobic, at room temperature b. potassium
b. Aerobic, in ice water c. chloride
c. Anaerobic, in ice water d. calcium
d Aerobic, at room temperature

94 Sample that is most reflective of the basal state

is collected

a. when the patient is asleep

b. in the afternoon
c. in the evening
d. in the morning

95. Which of the following hormones is important in

regulating normal plasma osmolarity?

a. Thyroxine
b. Aldosterone
c. Cortisol
d. PTH

96. Long turnaround time is an error in the

a. analytical plase
b. pre-analytical phase.
c. it is not considered an error.
d. post-analytical phase.

97. Which of the following is not correct about

secondary hypothyroidism?

a. Involves a defect in the anterior pituitary gland.

b. Patient experiences cold intolerance
c.Thyroid hormones are decreased.
d. Level of TSH is elevated
PRE-EXAM RATIO INSTRUMENTATION
Which of the following best describes
SPECIMEN COLLECTION the interference caused by the presence
Recall: AccuVein is a handheld medical of an appreciable concentration of
device that helps medical staff visualize triglyceride in a lipemic sample?
veins before phlebotomy. This device a. increase in transmittance due to light
works by scattering
a. emitting ultraviolet light absorbed by b. decrease in absorbance due to
the endothelial cells on blood vessel colorimetric interference
walls. c. decrease in transmittance due to
b. emitting infrared light absorbed by light scattering
the endothelial cells on blood vessel d. increase in absorbance due to
walls. colorimetric interference
c. emitting ultraviolet light absorbed by Substances :
hemoglobin in red blood cells. ● Hemoglobin - absorbs light in the
d. emitting infrared light absorbed by same region/ wavelength (inc/ strong
hemoglobin in red blood cells. absorbance)
● Bilirubin
SYRINGE: specimen collection from hand ● Lipids (TG) —> present in
or ankle or from small children, patients with appreciable concentration →
small or poor veins turbidity —> light scattering
ACCUVEIN:
● Held 7 inches over the potential site ● Incident
● Hb absorbs infrared light and light from a
projects an image map of veins onto monochromator
the patient’s overlying skin will direct light to
● Needle placement in elderly, obese, the cuvette
burn patients, patient with chronic containing the
disease (require many diagnostic solution.
and therapeutic procedures) ● The arrangement of the components
in the spectrophotometer are in a
Anticoagulant of choice in the assay of linear manner. Meaning the detector
blood magnesium is only capable of detecting light in a
a. citrate linear matter which is transmitted
b. heparin linearly.
c. oxalate ● The problem with turbidity causes
d. EDTA the scattering of light, meaning,
instead of transmitted light going to
A clinical instructor asked a medical the solution and into the
technology intern to get an evacuated photodetector in a linear pathway,
tube spray-dried with K2EDTA which is the transmitted light will be scattered
to be utilized for blood banking. What is ● The photodetector is not placed in
the color of the hemogard of the an angle but aligned with the other
evacuated tube that the intern should components of the
get? spectrophotometer, meaning the
a. White scattered light will not be detected
b. Royal Blue by the photodetector.
c. Tan ● In short, turbidity causes decreased
d. Pink transmitted light due to scattering of
light.
This analyte is assayed to determine the ● Transmittance is directly measured
completeness of a 24-hour urine sample. in spectrophotometer in order to get
a. urea the absorbance meaning, the
b. creatinine - 1 to 2 grams per 24 hr absorbance is dependent upon the
urine sample transmitted light detected by the
c. albumin photodetector
d. glucose ● Beer’s Law: Relationship of
transmittance with absorbance →
inversely proportional → decrease in
 transmittance leads to increase b. 1%
absorbance → falsely elevated c. 3%
concentration of analyte d. 4%

The following characterizes 6/3 = 2 —> 1SD

tungsten-halogen lamp from normal CV= (SD/MEAN) x 100
tungsten lamp as a radiant energy CV= (2/ 89) x 100 = 2.25% ~ 2%
source in spectrophotometers except
a. provides whiter radiant energy. How do you convert 1000mL to L?
b. provides brighter radiant energy. a. Multiply by 1000
c. generates higher temperature. b. Divide by 1000
d. used for testing in the visible region. c. Multiply by 100
d. Divide by 100
Both are used for testing in the visible
region What is the molarity of a solution
Tungsten-Halogen Lamp containing 50g NaCI (formula weight= 58
● WHITER LIGHT: maximum g) in 500 ml deionized water?
wavelength of light near the center a. 2.50 M
of the visible spectrum b. 1.27 M
● BRIGHTER LIGHT: greater energy c. 0.58 M
output d. 1.72 M
● GENERATES HIGHER
TEMPERATURE: increased atom M= (g solute)/ (MW)(L sol’n) =
vaporization from the high temp (50)/(58)x(0.5) = 1.72 M
filament
What type of automatic pipet functions
Which of the following is not directly like a hypodermic syringe and does not
proportional to absorbance? require the use of disposable tips?
a. path length a. air displacement - uses piston (used
b. absorptivity in laboratory)
c. transmittance b. positive displacement - this allows
d. concentration sample to directly enter pipets upon
contact without air displacement
BEER-LAMBERT’S LAW (have to rinse and blot)
A = abc —> direct relationship c. serologic pipet
● a = absorptivity (molar absorptivity: d. Ostwald-Folin - for viscous fluid
concentration is expressed in mol/L)
● b = path length in 1cm QUALITY ASSURANCE
● c = concentration (g/L or mol/L) Quality Assurance encompasses which
SPECTROPHOTOMETRY (inversely of the following phases?
proportional) a. analytical
● transmittance: low b. pre-analytical and analytical
● absorbance: high c. pre-analytical and post-analytical
d. pre-analytical, analytical and
Most common type of assay. post-analytical
a. Electrochemical
b. Spectrophotometric - using simple How long is the completion of a full Six
reagents—> most common type of Sigma improvement project?
assay a. 12 months
c. Visual Colorimetric b. 6 months
d. Immunochromatographic c. 3 months
d. 9 months
REAGENT PREPARATION &
LABORATORY MATHEMATICS Black belts dedicate ____if their time to
Calculate the CV given the following quality improvement projects.
data: a. 75%
Mean: 89 mg/dL b. 50%
3SD = 6 c. 20%
a. 2% d. 100%
 STRATEGY: DMAIC

This is defined as the ability of an

analytical procedure to measure
accurately one component in a specimen
Two consecutive control observations without interference by other
that exceed +/-2SD on one side of the components that are also present.
mean. a. Diagnostic specificity
a. 2-2s, random error b. Diagnostic sensitivity
b. R-4s, systematic error c. Analytic sensitivity - detect small
c. 2-2s, systematic error amounts or concentrations of the
d. R-4s, random error analyte
d. Analytic specificity
Lean Six Sigma process improvement
involves all of the following processes
except LABORATORY SAFETY
a. Plan Which of the following PPE is/are not
b. Measure used to prevent exposure of mucous
c. Control membranes from splashes?
d. Define 1. masks
2. laboratory gown
Type of QC violation seen when control 3. goggles
values are either in the upper or lower 4. gloves
side of the mean. a. only 4 is correct
a. error - unpredictable; not a QC b. 1 and 3 are correct
violations; can be a random or c. 1,2 and 3 are correct
systematic error d. 1,2. 3 and 4 are correct
b. shift - also a systematic e. 2 and 4 are correct
c. trend - either INCREASED or
DECREASED; systematic Parts of body that have mucous membrane:
d. outlier - control values far from the ● Eyes
mean; can be a random or ● Nose
systematic error ● Mouth
Additional: face shield
Concepts related to the Six Sigma
process except OSHA strongly recommends wearing
a. steps include Define, Measure, gloves as a barrier protection in the
Analyze, Improve, and Control following instances except
(DMAIC) a. when a medical laboratory scientist
b. aims to decrease product or service has cuts or open wounds
variation b. when a support staff is encoding in
c. measures defects per million the office
opportunities c. when laboratory personnel
d. involves streamlining laboratory anticipates hand contamination
operations - a goal of LEAN —> d. when an intern is undergoing
reduce non value activities (waste) phlebotomy training
—> “Lean is a management concept
that reduces waste and streamlines HCW/Personnel:
an operation” —> STREAMLINE: ● has cuts or other open wounds on
make something more efficient by the skin
performing faster or simpler working ● anticipates had contamination
methods (biochemical/ chemical)
● performs skin puncture
SIX SIGMA: decrease defects by ● receiving phlebotomy training
eliminating process variation
DEFECT: anything that does not meet What hazard is positioned at the bottom
customer requirements of the NFPA Hazards Identification
UNIT: DPMO (defects per million System?
opportunities) a. Health
 b. Flammability Tetany, which involves irregular muscle
c. Stability spasms, is attributed to decreased blood
d. Specific concentration of what electrolyte?
a. sodium
b. magnesium
METABOLIC BLOOD TEST c. potassium
(Water Balance and electrolytes) d. calcium
What is the predominant cation outside
cells and in the extracellular fluid? Which of the following statements
a. potassium correctly describes chloride shift?
b. calcium a. diffusion of chloride ions out of the
c. sodium cell along with sodium ions
d. magnesium b. diffusion of chloride ions out of the
cell in exchange for the bicarbonate
Respective sodium and potassium levels ions that move in
in patients with Addison's disease c. diffusion of chloride ions into the cell
a. increased, decreased in exchange for bicarbonate ions
b. decreased, increased that move out
c. both are decreased d. diffusion of chloride ions into the cell
d. both are increased along with sodium ions

Addison’s disease ELECTRICAL NEUTRALITY

● decreased in adrenal hormones CHLORIDE
(aldosterone) 1. Sodium is reabsorbed with
● decreased sodium levels chloride in PCT —> amount of Na+
● decreased in reabsorption of sodium reabsorbed is dependent on Cl-
ions present
● decreased excretion of potassium 2. Chloride shift
● tissue cells undergoes metabolism
A hemolyzed sample for electrolyte —> CO2 (exhale) —> plasma and
assay using indirect ISE is expected to rbcs
have ● CO2 —> carbonic acid
a. increased sodium and decreased ● —> H+ (buffered by hemoglobin)
potassium values ● —> HCO3- (goes outside the cell)
b. decreased sodium and potassium ● Cl- goes INSIDE the cell —>
values ELECTRICAL NEUTRALITY
c. increased sodium and potassium
values
d. decreased sodium and increased (NPN)
potassium values. Urea is produced from
a. catabolism of proteins and amino
Hemolyzed sample: liberation of cellular acids
contents b. oxidation of pyrimidines
● affects normal electrolytes c. oxidation of purines
distribution d. breakdown of complex
● Potassium Inside ; Sodium Outside carbohydrates
Hemolysis e.
● INC potassium levels Urea: end-product of protein metabolism
● Release of water —> dilution of Uric acid: end-product purine metabolism
solutes (dilutional effect) Creatinine: end-product of muscle
● DEC sodium levels metabolism
Ammonia: deamination of amino acids from
protein metabolism (not used to evaluate
renal function but LIVER function)

Increased cell turnover seen in leukemic

patients undergoing chemotherapy
would most likely elevated which of the
following NPNs?
 a. uric acid d. Cannot be interpreted, needs more
b. creatinine laboratory data.
c. ammonia e. There is an erroneous result.
d. urea
OGTT- used in diagnosis of GESTATIONAL
Lloyd's reagent is used in which of the DM
following assays? 2-Step OGTT: screening step before
a. Creatinine determination tolerance test
b. BUN determination 1. Carpenter/Coustan (more
c. Uric acid determination sensitive and better outcomes)
d. Ammonia determination ● Fasting: 95 mg/dL
● 1h: 180 mg/dL
Jaffe Reaction: not specific for creatinine ● 2h: 155 mg/dL
due to interferences (alkaline pH) ● 3h: 140 mg/dL
Adsorption of creatinines: isolation of 2. NDDG (National Diabetes Data
creatinine Group)
● Fuller’s earth: magnesium ● Fasting: 105 mg/dL
aluminum silicate ● 1h: 190 mg/dL
● Lloyd's reagent: sodium aluminum ● 2h: 165 mg/dL
silicate ● 3h: 145 mg/dL
Diagnosis of GDM: at least 2of the 4
What is the normal BUN:Creatinine plasma glucose levels are met or exceeded
ratio? RECALL
a. 10:1 Normal Values
b. 10-20:1 Fasting
c. 15:1 ● Normal: <100 mg/dL
d. 20:1 2-hr OGTT
● Normal: <140mg/dL
Which of the following analytes is tested HbA1c
in CSF in cases of coma with unknown ● Normal: <6.5%
cause? Diagnosis of Prediabetes
a. Lactate Fasting (Impaired Fasting)
b. Glucose ● 100-125 mg/dL
c. Glutamine 2-hr OGTT (Impaired Tolerance)
d. Ammonia ● 149-199 mg/dL
HbA1c (Pre-diabetes)
CUE: coma with unknown etiology/ cause ● 5.7-6.4%
● not due to head trauma and brain Diabetes of DM
anoxia Fasting: >/= 126 mg/dL
Hepatic encephalopathy 2-hr OGTT: >/= 200 mg/dL
● hepatic: primary cause is liver —> HbA1c: >/= 6.5%
liver damage —> liver failure Diagnosis of Diabetes
a. Blood: ammonia 1. FBS: >/= 126 mg/dL
b. CSF: glutamine 2. RBS: >/= 200 mg/dL + symptoms of
● ammonia + glutamic acid —> hyperglycemia
glutamine (directly proportional) 3. HbA1c: >/= 6.5%

(Carbohydrates)
Patient has the following OGTT results.
FBS= 95 mg/dl
1 hour= 180 mg/dI
2 hours= 155 mg/dI
3 hours= 140 mg/dI Which of the following analyte is
Interpret the patient's condition. assayed to determine short-term glucose
a. Patient has no diabetes mellitus. control?
b. Patient has diabetes mellitus. a. glycated hemoglobin - ketoamine:
c. Patient is pre-diabetic. 2-3 months or 2-4 months; LONG
TERM
 b. glycated albumin - fructosamine: 3-6
weeks Heme: pseudoperoxidase
c. random glucose Hb: absorbs light
d. fasting glucose Sample blanking: to remove sample
interferences
The following are interfering substances
that affect the hexokinase method for Purpose of glycogenesis
glucose determination except a. energy production
a. none of these b. energy distribution
b. ascorbic acid c. energy storage
c. hemolysis - dec d. energy utilization
d. all of these
e. bilirubin - dec What organ is primarily affected in
hypoglycemic states?
Hexokinase method: a. lungs
● affected by DECREASED levels of b. brain
bilirubin and hemolysis c. kidneys
Glucose oxidase method (2nd reaction): d. liver
● Interfering substance leads to false
decrease upon presence of uric Plasma glucose concentration at which
acid, bilirubin and ascorbic acid observable symptoms of hypoglycemia
(increased) appear.
● False increase in hemolysis because a. 70 mg/dL
hemoglobin has pseudoperoxidase b. 40 mg/dL
activity c. 60 mg/dL
d. 50 mg/dL - 50 to 55 mg/dL
Blood glucose concentration defined as
hypoglycemia
a. < 40 mg/dL - panic value
b. < 50 mg/dL
c. <60 mg/dL
d. < 70 mg/dL - body will try plasma
glucose levels by releasing
hyperglycemic agents —> glucagon
up to 100 or 110 mg/dL) (Lipids and Dysproteinemia)
Select the arrangement of lipoproteins
Obsolete methods (chemical methods) electrophoresed on cellulose acetate or
for glucose determination except agarose at pH 8.6
a. Dubowski - can also be the answer if a. -chylomicrons>beta>prebeta>alpha+
no hexokinase b. -beta>prebeta>alpha>chylomicrons+
b. Hexokinase c. -chylomicrons>prebeta>beta>alpha+
c. Nelson-Somogyi d. -alpha>beta>prebeta>chylomicrons+
d. O-Toluidine
pH 8.6
The available test in the laboratory for ● Anode: positive
FBS is based on glucose oxidase ● Cathode: negative
method. A serum sample for FBS
collected from a healthy individual was In the enzymatic method for cholesterol
observed to be hemolyzed by the determination, what is the most
medical technologist. Which of the commonly used peroxidase in coupling
following is the best course of action? H202 to a chromogenic substrate?
a. Follow the glucose oxidase a. pooled human peroxidase
procedure in the SOP. b. horseradish peroxidase
b. Perform sample blanking prior to c. rabbit peroxidase
testing. d. asparagus peroxidase
c. Ask the physician if testing is to be
performed using the sample. Most common method in cholesterol:
d. Recollect blood sample from the cholesterol oxidase method —> H2O2 +
patient.
phenol + 4-aminoantipyrine —> b. 50 mg/dL HDL, 180 mg/dI total
quinoneimine dye (500 nm) cholesterol
c. 45 mg/dI HDL, 210 mg/dI total
Compute for the LDL given the following cholesterol
data: BONUS d. 55 mg/dL HDL, 170 mg/dI total
TC= 423 mmol/L cholesterol
TG= 378 mmol/L
HDL = 143 mmol/L Markers of Coronary Risk
a. 96 mmol/ ● Serum cholesterol: earliest
b. 86 mmol/L identified, still one of the most
c. 116 mmol/L important
d. 106 mmol/L ● LDL: directly associated with risk
(>160 mg/dL with no risk factors:
Which of the following correctly shows therapy) (>130 mg/dL with 2 or more
the composition of chylomicrons? risk factors: therapy)
● HDL: negative risk factor;
independent risk factor for the
development of coronary heart
disease (<35 mg/dL: high risk factor
of CHD) (>60mg/dL: protective)
● TG: generally accepted as a
a. B significant risk factor (>150 mg/dL)
b. D - VLDL
c. A - HDL Incorrect about Friedwald formula
d. C - LDL 1. Direct measurement for LDL
2. Indirect measurement for LDL
Which of the following diseases results 3. Valid for triglycerides over 400 mg/dI
from the familial absence of high-density 4. Not valid for triglycerides over 400
lipoprotein? mg/dI
a. Gaucher disease a. 1, 2, 3 and 4 are correct
b. Krabbe disease b. 2 and 4 are correct
c. Tay-Sachs disease c. 1,2 and 3 are correct
d. Tangier disease - ABCA1 gene d. only 4 is correct
(chromosome 9) —> total absence e. 1 and 3 are correct
of HDL
Indirect measurement of LDL
Identify the age group with the following ● Friedewald: not valid if TG >400
cutoff points for serum cholesterol: mg/dL
Moderate Risk > 200mg/dL and High Risk ● De Long: valid even if TG >400
> 220mg/dL RECALL mg/dL
a. 20 to 29
b. 40 and older In the CDC reference method for TG
c. 2 to 19 measurement, what reagents are used in
d. 30 to 39 the extraction and adsorption steps
respectively?
a. sodium periodate and silicic acid
b. chloroform and silicic acid
c. sodium periodate and formaldehyde
d. chloroform and formaldehyde

CDC reference method

● Extraction: chloroform
● Adsorption: silicic acid via
Which of the following results would be chromatography
most consistent with high risk for
coronary heart disease? The following statements describe
a. 20 mg/dL HDL, 250 mg/dI total chylomicrons except
cholesterol a. migrates farthest from the anode
during electrophoresis
 b. largest lipoprotein with the highest Consistently abnormal anion gaps in the
triglyceride content serum of healthy individuals indicate an
c. lightest lipoprotein in instrument error/ problem
ultracentrifugation
d. carrier of exogenous triglyceride Which of the following are considered as
negative acute phase reactants?
Which of the following best describes a. alpha1-antitrypsin and orosomucoid
the expected result of a sample b. albumin and prealbumin
containing beta-VLDL if c. CRP and serum amyloid
ultracentrifugation and electrophoresis d. fibrinogen and haptoglobin
are performed respectively?
a. decreased VLDL and increased LDL
b. increased VLDL and decreased LDL (Liver Function Tests)
c. decreased VLDL and LDL Pre-hepatic bilirubin (unconjugated) has
d. increased VLDL and LDL which of the following for a protein
carrier?
Ultracentrifugation —> density of lipoprotein a. gamma globulin
Density: beta-VLDL = VLDL b. albumin
Electrophoresis (migration pattern): c. beta globulin
beta-VLDL = LDL (beta region d. alpha2 globulin

Beta-VLDL What condition involves the absence of

● defective metabolism of VLDL the activity of glucuronyl transferase
● NORMALLY, VLDL is catabolized to resulting in persistent increased levels
form LDL of unconjugated bilirubin and
● Contains ApoE kernicterus in neonates?
● ApoE4 isoform: Alzheimer’s a. Crigler-Najjar syndrome
b. Dubin-Johnson syndrome
A person having receptors that are c. Physiologic liver immaturity
tolerant to insulin would most likely have d. Hemolytic anemia - does not
which of the following manifestations? conjugate —> increased
a. hyperlipidemia unconjugated bilirubin
b. hypertension
c. hyperkalemia - can also be an The ability of the liver to detoxify harmful
answer substances is assessed using
d. hyperglycemia 1. albumin - NOT HARMFUL
2. bilirubin
Which of the following lipid profile 3. cholinesterase
parameters is expected to be falsely 4. ammonia
elevated on a serum specimen from a a. 1 and 3 are correct
non-fasting patient? RECALL b. 1,2 and 3 are correct
a. HDL c. 2 and 4 are correct
b. LDL d. 1, 2, 3 and 4 are correct
c. Cholesterol e. only 4 is correct
d. Triglyceride
Liver function test:
● ALT, AST, ALP, GGT, 5’-nucleotidase
(Specific Proteins) —> INCREASE,
Most probable cause of an abnormal ● total protein, albumin—>
anion gap in the serum of a healthy DECREASED
individual ● bilirubin, ammonia—> INCREASED
a. over hydration ● LD can also be included but it’s the
b. hemolysis LEAST needed
c. acidosis
d. instrument problem
(Clinical Enzymology)
Anion gap —> for unmeasured anions and Which of the following is the best sample
for quality control for enzyme assays?
a. Serum
 b. Heparinized Plasma a. Enzymes function as catalysts.
c. Citrated Plasma b. Enzymes accelerate reaction rates.
d. EDTA Whole Blood c. Enzymes are proteins.
d. Enzymes are chemically altered in
Enzymes: inorganic cofactors (activators: reactions.
electrolytes)
Mechanism of anticoagulation: chelation General Characteristics of Enzymes
● EDTA & Fluoride: inhibits enzyme 1. Enzymes are proteins (recall)
activity; should NEVER be used for 2. Enzymes function as catalysts
enzyme analysis 3. Enzymes accelerate or speed up
● Citrate: complexes divalent cations reaction rates
(possible activators) —> FALSELY 4. Enzymes are NOT chemically
DECREASED (CK, ALP) altered or consumed in reactions
● Heparin: inhibits the activity of some
enzymes (amylase, AST) Isoenzyme assays are performed to
improve
What class of enzyme uses NAD+/NADH a. specificity.
as a coenzyme? b. accuracy.
a. Iyase c. precision.
b. transferase d. sensitivity.
c. hydrolase
d. oxidoreductase The following are true (should be false)
about the first-order kinetic reactions
Enzyme Classification and Nomenclature except - BONUS
1. Oxidoreductase a. dependent on the presence of
● Catalyze oxidation-reduction inhibitors - FALSE
reactions b. it is actually independent - FALSE
● LDH, G-6-PDH c. dependent on substrate
● Clue: dehydrogenase concentration - TRUE
2. Transferase d. dependent on the analyte
● Catalyze the transfer of a group concentration - FALSE
● AST, ALT, CK, GGT
● 2 Groups: aminotransferase and FIRST-ORDER KINETICS
phosphate ● Excessive: ENZYME
● Clue: Transferase, aminase and ● Limiting factor: SUBSTRATE
kinase ● Reaction rate: DIRECTLY
3. Hydrolase PROPORTIONAL to substrate
● Catalyze hydrolysis of various bonds concentration
● Enzymes of digestion ZERO-ORDER KINETICS
● ALP, ACP, AMY, CHS ● Excessive: SUBSTRATE
4. Lyase ● Limiting factor: ENZYME
● Catalyze the removal of groups ● Reaction rate: DIRECTLY
● Aldolase, pyruvate decarboxylase, PROPORTIONAL to enzyme
glutamate decarboxylase concentration
● Clue: decarboxylase
5. Isomerase Which of the following enzymes is the
● Catalyze the interconversion of most non- specific?
isomers a. ALT
● Glucose-phosphate isomerase, b. LD
ribose phosphate isomerase c. CK
● Clue: isomerase d. ALP
6. Ligase
● Catalyze the joining of two substrate Clinical Utility
molecules LD: used in conjunction with other enzymes
● Glutathione synthetase —> highly nonspecific; abnormal values is
● Clue: synthetase not specific for damage of any particular
organ
The following are characteristics of ● Liver: AST, ALT
enzymes except ● Cardiac/ Skeletal: CK
 ● INC LD —> cause cannot be a. AST
determined—> ISOENZYME studies b. ALP
c. CHS - clinical utility is in
A patient presenting with muscle pain organophosphate not in the liver
and weakness submitted his brown urine d. ALT
sample and had his blood taken for
chemistry testing. Significant results In the case of hepatobiliary disorders,
show myoglobinuria, and elevated CK increase in levels of ALP and GGT is due
with normal cardiac troponin. The results to their release from
of this patient is consistent with 1. cells of the gallbladder
a. rhabdomyolysis. 2. cells of the common bile duct
b. acute myocardial infarction. 3. cells of the pancreas
c. fulminant hepatic coma. 4. cells of the liver
d. intravascular hemolysis. a. 1,2 and 3 are correct
b. 1 and 3 are correct
CK —> cardiac and skeletal muscle c. only 4 is correct
Myoglobinuria: indicative of skeletal muscle d. 1, 2, 3 and 4 are correct
injury e. 2 and 4 are correct
Rhabdomyolysis: form of cell lysis
syndrome —> release of cellular contents Hepatocytes: canalicular surface —> ALP,
Important features for differential diagnosis GGT
of rhabdomyolysis:
1. Increase in Total Ck (CK-MB): CK The equation E (enzyme) + S (substrate)
>20x = ES = E + P (product) refers to
2. Myoglobinuria —> brown urine a. Michaelis-Menten hypothesis. -
enzyme kinetics
Which of the following statements is not b. Henderson-Hasselbach equation. -
true about CK determination using the acid base balance
Oliver-Rosalki Method? c. enzymatic reaction.
a. Measures the rate of appearance on d. Zero-Order enzyme kinetics. -
NADPH. relationship enzymatic reaction rate
b. Involves the forward reaction of CK. and enzyme (directly proportional)
c. Hemolysis causes a false increase
due to adenylate kinase.
d. Uses two other
enzymes--hexokinase and ENDOCRINOLOGY
glucose-6-phosphate The urinary excretion product measured
dehydrogenase. as an indicator of epinephrine
production is
OLIVER-ROSALKI METHOD a. EPO
● coupled enzymatic reaction b. VMA - (Vanillylmandelic acid; 24hr
● Forward reaction: pH 9.0 urine)
● Reverse reaction: pH 6.8 —> 2 to 6x c. DOPA
faster; less interference (used by d. HVA - (Homovanillic acid —>
Oliver-Rosalki method) dopamine)
1. creatine PO4 + ADP —> creatine +
ATP During pregnancy, the form of estrogen
2. ATP + glucose —HK—> measured in urine is
glucose-6-PO4 + ADP a. Estradiol
3. G6PO4 + NADP —G6PDH—> b. Estriol
6-phosphogluconate + NADPH c. Estrone
● formation of NADPH is measured at d. Prenonediol
340 nm
RBCs: adenylate kinase (AK) —> catalyzes
the same reaction as CK —> FALSELY
ELEVATED CK value

Liver enzyme that is significant when

decreased
 stimulating Leydig cells to produce and
In what organ of the body does the de secrete testosterone?
novo synthesis of Vitamin D begin? a. FSH - sertoli cells
a. kidney 1, 25-dihydroxy vitamin D/ b. PRL
cholecalciferol aka CALCITRIOL c. LH
b. skin via UV action d. GnRH
c. liver vitamin D3
d. intestine Best example of a hormone that exhibits
a positive feedback mechanism
Hormones useful in evaluating a. oxytocin
disordered puberty b. thyroxine
a. FSH, LH, testosterone and estradiol c. adrenaline
b. GnRH, FSH, LH, estrogen and d. insulin
progesterone
c. GnRH, FSH, LH and androgens
d. FSH, LH, testosterone and estrogen

Hormones needed in puberty:

FSH
LH A patient presents with weakness, easy
Testosterone- most potent in males fatigability and intolerance to heat has
Estradiol - most potent in females the following results: T3= increased, T4 =
increased and TSH = increased.
Primary aldosteronism results from a What do these findings correlate with?
tumor of the adrenal cortex. How would a. secondary hyperthyroidism
the extracellular fluid be affected? b. primary hypothyroidism
a. Normal sodium, decreased c. secondary hypothyroidism
potassium levels d. primary hyperthyroidism
b. Increased sodium, decreased
potassium levels Also indicates increased metabolism and
c. Decreased sodium, decreased increased thyroid hormones
potassium levels TSH: increased (cause of hyperthyroidism)
d. Decreased sodium, increased T3 and T4: increased (effect)
potassium levels
In stressful conditions, catecholamines
Primary aldosteronism- tumor in adrenal from the adrenal medulla (first
gland —> overactive —> increased responders) responds within RECALL
hormone (aldosterone) —> increased a. 10 minutes.
sodium levels —> increased in the b. seconds.
reabsorption of Na —> excretion of c. hours.
potassium d. 20 minutes.

Not an endocrine gland Not true about catecholamine

a. salivary gland measurements
b. neurohypophysis a. 24-hour urine sample is assayed
c. adrenal gland b. plasma provides a more accurate
d. pancreas determination
c. catecholamines have short half-lives
Which of the following is not a steroid in blood
hormone? d. level of urine catecholamines and
a. estrogen their metabolites are measured
b. epinephrine
c. progesterone Disadvantages of catecholamine in
d. tetosterone blood
1. Hydrophilic
2. Circulate in low levels
What hormone released by the anterior 3. Short half-life
pituitary gland is responsible in 4. Fluctuating levels
 increased breathing/ hyperventilation
TOXICOLOGY —> respiratory alkalosis
What heavy metal is capable of passing ● SERIOUS TOXIC EFFECT:
through the blood brain barrier causing fulminant hepatic failure (Reye’s
CNS toxicity as one of its primary syndrome)
effects? ● Has antiplatelet activity: inhibits
a. mercury cyclooxygenase enzyme —>
b. cyanide - can also be the answer but thromboxane A2
not the mechanism in CNS toxicity;
odor of BITTER ALMONDS; they Drug of choice for absence seizures
binds in iron + cytochrome A3 —> a. Phenytoin
hypoxia —> tachypnea: abnormal b. Primidone
rapid breathing (compensatory c. Valproic Acid
mechanism) —> respiratory d. Ethosuximide
depression—> cyanosis
c. carbamate - can also be an answer;
but not effective
d. arsenic - systemic; can distribute Identification of the urinary metabolite
easily on other parts of the body in a benzoylecgonine would be useful in
short period of time determining exposure to which of the
following drugs?
Lead can also be the answer a. Cocaine
● acute toxicity and CNS symptoms b. Amphetamine
(encephalopathy, convulsions, c. Propoxyphene
stupor) —> ORGANIC LEAD d. Codeine
● Organolead compounds (tetraethyl,
tetramethyl) Cocaine:
● Porphyria: disruption in heme ● coca plant;
synthesis —> caused by exposure ● used in Coca-Cola
through INORGANIC LEAD ● Half life: short (1-2 hrs) —> rapid
hepatic hydrolysis —>
The Trinder reaction (salicylate/ aspirin + BENZOYLECGONINEz, a
ferric nitrate —> colored complex via metabolite (4-7 hrs)
spectrophotometry) is employed in the ● Test: immunoassay (up to 3 days,
colorimetric determination of what drug? Henry - 48hrs); chronic users (up to
a. acetaminophen 20 days, Henry - 24 to 36 hrs)
b. barbiturate
c. salicylate Which of the following statements is
d. digoxin false regarding chronic toxicity?
a. single exposure, dose is sufficient to
This is a nonsteroidal, anti-inflammatory cause toxic effects
drug used as an analgesic and b. affects different organ systems
antipyretic that is associated with Reye's c. accumulation of the toxicant or toxic
syndrome in children. effects
a. Acetaminophen - preferred over d. several exposure to doses
aspirin but not associated with insufficient to cause toxic effects
Reye’s syndrome
b. Lithium - antimanic agent When measuring K+ with an
c. Aspirin ion-selective electrode by means of
d. Cyclosporine - immunosuppressive liquid ion-exchange membrane, what
drugs antibiotic is incorporated into the
membrane?
Aspirin a. Amoxicillin
● aka acetylsalicylic acid —> HAc + b. Valinomycin
salicylic acid; c. Gentamicin
● involves metabolic acidosis; d. Streptomycin
● salicylic acid: stimulatory effects on
central respiratory centers - Electrochemical methods:
Coulometry - coulombs ; chloride
Amperometry - oxidation-reduction; pO2 ● choline esterase II,
Voltametry - electrochemical cell; utilized in ● acetylcholine acylhydrolase;
anodic stripping voltametry —> measures ● reflects acute toxicity
lead in blood
Potentiometry Better organophosphate poisoning:
● NERNST EQUATION —> potential (1) AChE (2) PChE
in voltage ISE
● Component: ion-per, selective Congenital Minimata disease
membrane barrier a. lead
● Glass: selective to hydrogen ions b. mercury - Methylmercury
(pH) c. cadmium
● Potassium: special polymer with d. arsenic
valinomycin
● Sodium: polymer resin of polyvinyl Toxic forms of mercury:
chloride (PVC) —> anodized indium 1. Hg^0: (elemental/ metallic)
tin oxide membrane a. GIT: poorly absorbed —> no toxic
● Calcium: Calcium-chelating organic effect unless it is converted to the
molecules in PVC and diocty phenyl divalent form (Hg^2+)
phosphate ● slow oxidation-reduction with H2O
and chloride ions, possible if there is
Which of the following is associated with stasis (GIT)
arsenic poisoning? b. Inhalation
a. odor of bitter-almonds breath and c. Absorption thru the skin
metallic taste d. Passing thru the BBB and
b. metallic breath and garlic taste accumulate in the CNS: Hg^0 is
c. odor of garlic breath and metallic oxidized to Hg^2+ —> poisoning
taste - Widely use to kill plants and ** CNS and pulmonary toxicities are what
animals (rodenticides), ant poisoning we concerned about elemental and metallic
d. metallic breath and bitter-almonds mercury
taste Excretion: kidney (urine)
Arsene gas 2. Inorganic Salts
● most dangerous among all the a. Hg ^1+: poorly soluble —> poorly
arsenic; absorbed
● industrial settings; b. Hg^2+: readily soluble —> readily
● heavy metal can cross the placenta absorbable via oral ingestion or
(as well as mercury) inhalation
● readily absorbed through the GIT via Symptoms under inorganic salts:
ingestion and lungs via inhalation, ● severe inflammation of the mouth
and skin via low absorption and other GI symptoms
● Excretions: kidneys ● Accumulate in the kidneys —> acute
● Sample (arsenic): urine, hair, nails renal tubular/ glomerular damage
● Sample (lead): whole blood (excretion: kidneys—> urine)
3. Organic mercury: environmental
In organophosphate poisoning, which of pollutants (recall)
the following enzymes is used to reflect a. Aryl and alkoxyalkyl: undergo
acute toxicity? breakdown and biotransformation
a. Pseudocholinesterase —> inorganic mercury —> the same
b. Acetylcholinesterase intoxication
c. Angiotensin Converting Enzyme b. Alkyl (methyl and ethyl): extremely
d. 5'-nucleotidase stable —> greater toxicity
● more lipid stable —> pass readily
Organophosphate produce irreversible through the biological membrane
inhibition of pseudocholinesterase (PChE) ● Via ingestion: shows greater
and acetylcholinesterase (AChE) absorption
AChE ● Major chemical effect: CNS —>
● true cholinesterase, methylmercury has devastating
● choline esterase I; effects
● better reflects chronic toxicity
PChE:
Which of the following samples is not pH= 7.00 Normal: 7.35 to 7.45 =
useful for the detection of mercury ACIDOSIS
poisoning? RECALL PCO2 = 20 mmHg Normal: 35 to 45
a. Hair: chronic mercury exposure mmHg
(organic mercury) pO2 = 70 mmHg (not physiologically
b. Stool possible) —> BONUS
c. Urine: 24 hour mercury levels —> HCO3 = 15 mmol/L Normal: 22 to 26
acute toxicity mmol/L
d. Blood: <10ug/L —> differential Which of the following is the most likely
diagnosis: Mercury poisoning vs explanation for these results?
pheochromocytoma —> perform a. hyperventilation is the primary cause
blood mercury levels and 24 hour b. erroneous results due to in vitro
catecholamine levels glycolysis —> CO2 should be
increased
In order to reverse the clinical c. hyperventilation is the compensatory
manifestations associated with PCOS, an mechanism
individual suffering from d. double error in blood gas
a. it should undergo Metformine measurement
therapy.
b. undergo Amlodipine therapy. 1. Consider the pH —> classify the
c. have a ketogenic diet. type of imbalance (alkalosis >7.45/
d. exercise regularly. acidosis <7.35)
2. Consider pCO2 and the HCO3
● CO2: will make the body ACIDIC
● HCO3: will make the body
ALKALINE
3. Compare the values to the pH. The
value that will correspond to the pH
Which of the following opiates is is the CAUSE OF THE IMBALANCE
anti-tussive?
a. amphetamine - used as designer METABOLIC ACIDOSIS
drugs: ecstasy (MDMA: Affected organ: Kidney
3,4-methylenedioxymethamphetami Compensatory organ: Lungs
ne) CO2: makes the body acidic —> eliminate
b. heroin - diacetyl form of morphine; CO2 —> by increase in breathing —>
can cross the BBB —> high CNS hyperventilation
concentration
c. morphine Which of the following statements
d. codeine reflects the mechanism involved in the
compensation seen in respiratory
Anti-tussive: medicines; prevents/ relieves alkalosis?
cough a. More CO2 is eliminated through the
CODEINE lungs by hyperventilation.
● structurally similar to morphine and b. Renal reabsorption of HCO3 is
heroin; decreased.
● mild form of analgesic and c. pCO2 is higher than normal.
antitussive; d. HCO3 is higher than normal.
● codeine analogs: dextromethorphan
(D-3-methoxy-N-methylmorphine) Respiratory alkalosis
Affected organ: lungs
Compensatory organ: kidneys
BLOOD GAS ANALYSIS HCO3: makes body alkaline
A patient rushed to the emergency room
is hyperventilating. The following results Hydrogen ion concentration (pH) in
were obtained after performing ABG blood is usually determined by means of
analysis: —> METABOLIC ACIDOSIS which of the following electrodes?
ROME —> RESPIRATORY = OPPOSITE a. Platinum plate
of the pH ; METABOLIC = EQUAL of the b. Platinum
pH c. Silver
 d. Glass

TUMOR MARKERS
Not useful bone resorption markers
include
1. tartrate-resistant acid phosphatase -
not useful; found on osteoclast, can also
be found in other parts of the body
2. glycosylated hydroxylysine - and
hydroxycholine; produce whenever type
1 collagen is broken down; not specific
for skeletal collagen and correlate poorly
3. urinary calcium - not specific nor
sensitive; affected by diet and renal
function
4. pyridinium crosslinks - useful;
together with crosslink telopeptides —>
better
a. 2 and 4 are correct
b. 1, 2.3 and 4 are correct
c. 1 and 3 are correct
d. 1,2 and 3 are correct
e. only 4 is correct
CLINICAL CHEMISTRY - [ ] Denominator - Lungs

- [ ] Pregnant women - Estriol

- [ ] ACP - prostatic cancer - [ ] Largest and least dense - Chylomicrons

- [ ] H-H - Acid base - [ ] Most abundant triglyceride -

Chylomicrons
- [ ] Continuous Analyzer - air bubbles (batch
analysis) - [ ] Composed of cholesterol - LDL

- [ ] Fastest to the anode - HDL - [ ] Hypoglycemic - Insulin

- [ ] Known sample - Standard - [ ] Test thyroid - TSH

- [ ] Obstructive jaundice - Glucorunyl - [ ] Differentiates primary and secondary -

transferase TSH

- [ ] Ergonomic except - Centrifuging - [ ] Arsenic - skin, hair, blood

- [ ] First to increase in AMI - Trop I(short term) - [ ] Kapag may except na specimen - Answer:
or CK (long term) Stool

- [ ] Elevation of ALP - Paget’s Disease, - [ ] May picture dun na nakalagay na LJ chart

Osteitis Deformans - Trend ang sagot

- [ ] Acid base balance - Linearity - [ ] Coca plant - cocaine

- [ ] Coma patients - Glutamine - [ ] MDMA - ecstasy

- [ ] Lipemic - 400 mg/L - [ ] Except - Mass:kg dapat gram nakalagay

dun
- [ ] More than 40 years old - 240 to 260
nakalimutan ko yung unit - [ ] Hypercholisteronemia - coronary heart
disease most cause
- [ ] Growth hormone - all are tropic hormone
except - [ ] Sodium - Aldosterone

- [ ] Cathecolamines - first to appear in stress - [ ] Ostwald - viscous samples

- [ ] Aldosterone - Osmolarity of the blood - [ ] Triglyceride - elevated in nonfasting

sample
- [ ] Intracellular cation - Potassium
- [ ] Overall testing - Quality Assurance
- [ ] Aldosterone - seen in adrenal cortex
- [ ] Obstructive Jaundice - Lp(a)
- [ ] Arginine - seen in hypothalamus
- [ ] Reduce waste - Lean
- [ ] ph - 7:35-7:45
- [ ] Sample labelling - after collection
- [ ] Numerator - Kidney
- [ ] Standard devition - for precision
Mangirapin-Lagpey-Ngilac-Oabel 1
- [ ] When there is fire - RACE (Children)

- [ ] Increased Hydrogen ions - metabolic - [ ] Hashimoto's Disease: Thyroid Peroxidase

alkalosis Antibody/ Antithyroid Peroxidase Antibody

- [ ] Hashimoto’s disease - thyroid - [ ] Hashimoto's Disease - A hypothyroid state

- [ ] Most potent estrogen - estradiol - [ ] Grave's Disease - A hyperthyroid state

- [ ] estrogen detected in urine when pregnant - [ ] TSH - Most useful test for assessing
- Estriol thyroid function

- [ ] Probability that a positive test indicates - [ ] PT Gland - Important for calcium

the presence of disease - Positive Predictive homeostasis
Value
- [ ] Calcitriol - active form of vitamin D
- [ ] Known Concentration and resembles
- [ ] Calcitriol - Prevents the absorption of
patient specimen - Control
calcium
- [ ] Indicator of precision - SD
- [ ] Which of the following hormones
- [ ] Delta check - Post analytical increases the intestinal absorption of calcium?
CALCITRIOL/ PARATHYROID HORMONE (2nd
- [ ] Mega -10⁶
Choice)
- [ ] Mass - grams (yung nasa choices), mali
- [ ] Weak androgen -
sya kasi ang mass is kg dapat
Dehyroethyandrosterone (DHEA)
- [ ] Outside the curve ng 2sd - 5%
- [ ] Hormone 1st trimester of pregnancy -
Human Chorionic Gonadotropin (hCG)

- [ ] hCG - Maintains the integrity of blood

vessels in uterine wall (1st trimester)
- [ ] Hypothalamus - Produces oxytocin and
ADH - [ ] Estriol together with progesterone -
Hormone increase in 2nd or 3rd trimester of
- [ ] Pituitary Gland/ Neurohypophysis -
pregnancy
Secretes oxytocin and ADH
- [ ] Estriol - Primary hormone associated with
- [ ] Pituitary Gland - The master gland
pregnancy
- [ ] Thyroid binding globulin - TBG Major
- [ ] Estradiol - most potent estrogen in
carrier of thyroid hormone
pregnant and non pregnant women
- [ ] Thyroxine Binding Pre-Albumin (TBP)

- [ ] Total Binding Albumin (TBA)

- [ ] Hypothyroidism: Myxedema (Adult);

Acid base balance topic
Cretinism/ Congenital Hypothyroidism
Mangirapin-Lagpey-Ngilac-Oabel 2
- [ ] Henderson - Hasselbach Equation: - [ ] AST - Serum Glutamic Oxaloacetic
measurement for pH Transaminase (SGOT)

- [ ] Normal pH of body - 7.35 to 7.45 - [ ] Malate Dehydrogenase - Coupling or

indicator enzyme for AST
- [ ] Hypoventilation - Breath slowly to
conserve CO2 - [ ] ALT - Serum Glutamic Pyruvic
Transaminase (SGPT)
- [ ] Hyperventilation - Breath faster to expel
CO2 - [ ] Lactate Dehydrogenase - Coupling or
indicator enzyme for ALT
- [ ] Full Compensation: pH is the only normal
- [ ] ALT - For hepatocellular disorder
- [ ] Partial Compensation: Everything (all
values) is abnormal - [ ] Magnesium Ion - Coupling or indicator
enzyme for CK

- [ ] In ALP

- [ ] Regan Isoenzyme - Associated with lung

ENZYMOLOGY topic
cancer
- [ ] Enzymes are biomolecules, specifically
- [ ] Nagao - Adenocar
protein.
- [ ] Kasahara - Gastrointestestinal Cancer
- [ ] Substrate - Limiting factor in 1st order
kinetics - [ ] Heat denaturation: to determine if its
liver or bone
- [ ] Enzyme - Limiting factor in 0 order
kinetics - [ ] Increase ALP (Liver vs. Bone Disease)

- [ ] Cofactor - must be present in excess - [ ] Heat denaturation: 56°C for 15 mins

- [ ] Inorganic cofactors - Elements - [ ] Other way to characterized ALP - Use of

La phenylalanine and Urea
- [ ] Organic cofactors - Vit. D, Pyrydoxal
phosphate, Nicotinamide Adenine - [ ] Bone, Intestinal, Liver - Is inhibited by
Dinucleotide urea

- [ ] NADH - Reduced Nicotinamide Adenine - [ ] Placenta, Interstinal, Regan - Is inhibited

Dinucleotide by Phenylalanine

- [ ] Isomerase - Responsible for the - [ ] Bowers McComb - Reference Method for

intramolecular rearrangement of substrate ALP
compound
- [ ] Highest Elevation of ALP - Paget's
- [ ] Ligase - joining of two substrate Disease/ Osteitis Deformans (Particularly in
molecules to synthesize a large molecule older people)

Mangirapin-Lagpey-Ngilac-Oabel 3
- [ ] Physiologic Increase in ALP - Seen in of cardiac injury; the patient suffered from
Pregnancy acute myocardial infarction 5 days ago

- [ ] Acid Phosphatase - pH of 5 to 6 - [ ] Troponin I - The best cardiac marker

because it remains elevated longer compared
- [ ] ACP - Diagnosis of metastatic carcinoma
to trop. I; the patient suffered from acute
of prostate
myocardial infarction 7 or 8 days ago.
- [ ] ACP - Significant in rape cases
- [ ] Troponin T - Marker for chest pain/
- [ ] GGT - 1st abnormal liver function test in chronic angiogram
heavy drinkers

- [ ] GGT - Alcoholism

- [ ] Cholinesterase - Associated with

BILIRUBIN
organophosphate poisoning or insecticide
poisoning - [ ] Problem in Van den Bergh - Uses alcohol;
protein undergoes denaturation at higher
- [ ] Amylase and Lipase - Important for the
concentration of alcohol
diagnosis of acute pancreatitis
- [ ] Jendrassik & Grof Method - New born test
- [ ] Amylase - Enzyme expressed in Somogyi
for bilirubin; direct spectrophotometric
units
(455nm); not used for other aged group
- [ ] Ladu - He was able to recognize that because of the presence of lippochromes ex.
transaminases can be used as serum marker vit. A (color yellow)
for cardiac damage

- [ ] Carmen - Developed a rapid

cytophotometric measurement of
transaminases that is based on the TOXICOLOGY
absorbance of NADH.
- [ ] Uptake and metabolism of drug takes
- [ ] AST - According to Carmen, this is the 1st place in the liver.
biochemical marker for cardiac arrest; but it
- [ ] Anti inflammatory aka analgesics
lacks specificity.
- [ ] Use of cough suppressant - Considered as
- [ ] LDH - AST is replaced by this enzyme
mild analgesic and an antitussive agent
because it lacks specificity; More sensitive
marker of acute myocardial infarction - [ ] Antitussive agent is a cough suppressant,
example is codeine
- [ ] LDH - Not specific marker (PROBLEM)
- [ ] Vancomycin - Associated with red man
- [ ] Cardiac Marker - Must be high, fast
syndrome
elevation, and slow decrease or normalization
- [ ] Chloramphenicol - Drug associated with
- [ ] Troponin I - The most sensitive indicator
Mangirapin-Lagpey-Ngilac-Oabel 4
aplastic anemia - [x] Elevated in non-fasting : Triglycerides

- [ ] Alcohol - Most commonly abused - [x] Tangier Disease - deficiency in HDL

substance
- [ ] Multiple Myleloma - spike in gamma
region (2pts)

- [x] Acute inflammation- decrease in Albumin

— - [x] Urea - bstaa parang waste product

kineme ng nitrogen
- [x] All are uses of Type 3 water except : for
clinical chem - [x] isoenzyme - specificity

- [ ] Wrong reference method : - [ ] Pituitary Gland - releases TSH

Creatinine:Jaffe Rxn (2pnts)
- [ ] Specimen in Glucose - Plasma (2pts)
- [x] Lean Six Sigma : PDCA, Sort-Set in
- [ ] Dubowski Method - Condensation w/
Order-Shine-Standardize-Sustain
green positive
- [x] Positive Predictive Value : probability that
- [x] Provisional Diabetes diagnosis in FBG -
a test indicates the presence of a disease
126mg/dL
- [x] Dependent Variable : Y axis
- [x] Lp(a) - found in the LDL density range,
- [x] Most Sensitive Check : 10x moves in prebeta region

- [x] All are correct except : Random - [x] Albumin - maintains oncotic pressure
Error:changes in standard material (dpt
- [x] pH - glass
systematic)
- [x] GGT - alcoholism
- [x] Fluorescence and Emitted : short
wavelengt, longer energy - [x] Hepatobilliary - ALP, GGT, Total Protein

- [ ] All are duplicated in Double Beam in - [ ] Sodium - total serum osmolarity

Space except: Light Source
- [x] Potassium - valinomycin
- [x] 6.5% - HbA1c
- [x] Bicarbonate exchanges with - Chloride
- [x] Fructosamine - 3 weeks dm monitoring
- [x] Calcium is controlled by - PTH
- [x] All are type 1 except - bsta sa may
- [x] Crigler Najar Syndrome
weight2
- [x] Dubin - Johnson Syndrome : Bilirubin
- [x] Triglycerides - Fatty Acids
Excretion Deficiency
- [x] All are HDL except - Largest and travels
- [x] Estriol - pregnant women
the slowest
- [x] Pharmakokinetics - basta may TDM
- [ ] Chylomicrons - post prandial turbidity
Mangirapin-Lagpey-Ngilac-Oabel 5
- [x] all are correct exc. : HEROIN:CRACK (dpt
codeine)
- [x] Whole Blood gives (15% LOWER) glucose
- [x] Quality Assurance - overall testing levels than serum or plasma

- [ ] CEA - - [x] OGTT: px consume a NORMAL TO HIGH

carbohydrate intake in 3 days
- [x] Gas Chromatography - Mass
Spectometry : confirmatory for drugs - [x] Hypoglycemia : 50 mg/dL

- [x] Ingestion of Lead : sa rodri ingestion and - [x] Apo A : HDL

inhalation lng nakalagay
- [ ] Exogenous Turbidity : abnormal finding
- [ ] NaF: inhibits enolase
- [x] Marker of CHD : LDL
- [x] yung sa may symbol2 : delta bilirubin yun
- [x] Type of LDL that causes atherosclerosis:
- [x] Aldosterone - adrenal cortical hormone Lp(a)

- [x] Drug immunoassays - for screening - [x] Convert Albumin (5) : 50

- [x] mercury - congenital minimata and pink - [x] Inc. Albumin - Prolonged Tourniquet
disease Application

- [x] Cyanide - adhd and low iq (kc altered - [x] 1st to increase in Myocardial infarction -
mental status pag cyanide? di ko sure) CK

- [x] Outlier - exceeds 2sd - [x] Kjeldahl Method : Quantification of

Nitrogen
- [ ] px will be in supine position for - 15 to 20
mins - [x] Beta-gamma bridging effect - liver
cirrhosis
- [x] hexokinase - ascorbic acid
- [ ] Alpha 2 - nephrotic syndrome
- [x] prolactin - AOTA
- [ ] Inc. IgA - liver cirrhosis
- [x] hyperlipoproteinemia in IDL - type 3
- [x] Activators - metals
- [ ] anong dye ba yun ang gumagamit ng 650
nm - - [x] Enzyme - micromole/minute/L

- [ ] triiodothyronine- most active form - [x] Liver Hepatitis - ALT and Ammonia

- [ ] cushing's syndrome - dexamethasone - [x] Highest Elevation of ALP - Paget's

- [x] renin - aldosterone - [ ] POCT - capillary puncture

- [ ] ehrlich - incorporated alcohol - [x] Elevated in px with prostatic carcinoma -

ACP
- [ ] calcitonin - decreases calcium level
- [x] continuous analyzer - air bubbles
- [ ] parathyroid - increases calcium level
Mangirapin-Lagpey-Ngilac-Oabel 6
- [x] ABG - Arterial Whole Blood - [x] sd - precision

- [x] produces melatonin - Hypothalamus - [x] f test - precision

(pineal gland)
- [x] closeness to one value - precision
- [x] major extracellular anion - chloride
- [ ] diagnositic sensitivity - proportion of
- [x] Dec. Serum Calcium - Dec. Parathyroid individuals with the disease who test positive
Hormone
- [ ] positive predictive value
- [x] calcium - AAS
- [x] standard
- [x] Malignant Tumor - post renal azotemia
- [x] control
- [ ] Jaffe Rxn - basic
- [x] y axis - dependent
- [x] all are conjugated except - cannot be
- [x] shift - improper calibration
removed from the body (removed dpt)
- [x] serious hazard - 3
- [ ] Pituitary Gland produces all except - (TSH,
ACTH, FSH - bsta yung wla jan sa tatlo yun - [x] 41S - 4 consecutive controls >1s from
ying sagot) mean on same side

- [x] Secondary Hyperthyroidism- increase - [x] Optical Filters - Linearity

T3,T4 and TSH
- [x] AAS - measurement of unexcited trace
- [ ] Grave's Disease - dec. blood Cholesterol materials

- [ ] Cortisol - Major glucocorticoid - [x] 1st to do in fire - rescue

- [x] Acute Toxicity - single dose of which is - [x] Primary Monochromator - excitation of
sufficient to cause a toxic effect light

- [ ] Lead - blood - [x] batch analysis - group of samples are

analyzed for the same time
- [ ] Temperature - Kelvin
- [x] discrete analyzers - most popular and
- [x] Urea from BUN - 2.14
versatile
- [x] Analytical Specificity - detect the analyte
- [x] coupled enzyme for glucose - G6PD
of which it is designed to detect
- [x] CHYLOMICRONS - resposible for turbid
- [x] Project Team Members - Green
appearance of plasma and serum
- [x] Positive Displacement
- [ ] ammonia - metabolism or urea
- [ ] Six Sigma - eliminating process
- [x] Trend - increase
- [x] Analytical - least error
- [ ] Shift, Systemic - yung definition niya
- [x] short term accuracy - internal QC
- [ ] 8x -
Mangirapin-Lagpey-Ngilac-Oabel 7
- [x] cretinism - hypothyroidism - [ ] ALDOSTERONE: Reabsorption of Sodium

- [ ] most toxic form of arsenic - arsine gas - [ ] AIR BUBBLES: Separates sample at
continous flow
- [ ] mercury - whole blood
- [ ] RANDOM: Any sample Any sequence

- [ ] 7.40 20:1 : Bicarbonate

- [ ] CHLORIDE: Chief counterion of Sodium
- [ ] KINETIC: Involves continous measurement
- [ ] MORNING, EVENING: Cortisol
- [ ] RESPIRATORY ACIDOSIS: Emphysema
- [ ] ARSENIC: High affinity to keratin
- [ ] INCREASE OBSTRUCTIVE JAUNDICE:
- [ ] STOOL: Not useful in mercury
Describes ALP
- [ ] OCCUPATIONAL: Performance of
- [ ] PHOTOMULTIPLIER: Most sensitive
Employee
detector
- [ ] TRIGLYCERIDES: Non fasting patient
- [ ] DISCRETE: Most popular, versatile
- [ ] TYPE 1 DM: HLA/DR/DQ
- [ ] CENTRIFUGE: Strobe Light
- [ ] CENTRIFUGATION: Ergonomic Except
- [ ] TRANSMITTANCE: Not directly
- [ ] SODIUM: Chief plasma cation proportional

- [ ] HDL: Does not contain ApoB - [ ] OXIDOREDUCTASE: NAD/NADH

- [ ] TROPININ 1: AMI - [ ] VMA: Cathecolamine

- [ ] LEAN: Reduces Waste - [ ] 6MONTHS: 6Sigma

- [ ] CALCIUM: Most abundant in the body - [ ] MODERATE: 2 NFPA

- [ ] SYRINGE: Device for Veins - [ ] UREA: Protein metabolism

- [ ] MANUFACTURER: Asses and Supply - [ ] GREEN: Project Team Members

- [ ] COCA PLANT: Crack - [ ] 1:5 : Dilution Computation

- [ ] TANGIERS DSE: Familiam Abscence of HDL - [ ] MYOCARDIAL INFARCTION: LD1-LD2

Flipped
- [ ] 400mg/dl: Lipemic
- [ ] ALT, AST: Hepatocellular Damage
- [ ] SHORT WAVELENGTH: UV Light
- [ ] DECREASED: TSH
- [ ] ANAEROBIC IN ICE WATER: Transport
- [ ] CHYLOMICRONS: Transport Exo
- [ ] METABOLIC ACIDOSIS: Hyperventilation
- [ ] T TEST: Accurate
- [ ] PROSTATIC CANCER: ACP
- [ ] ANALYTICAL SPECIFICITY: Detects ONLY
- [ ] INDUCED FIT: Reshaping
Mangirapin-Lagpey-Ngilac-Oabel 8
analyte - [ ] trinder- salycilate

- [ ] ANALYTICAL SENSITIVITY: Small quantities - [ ] glucoronyl transferase, kernicterus-

of analyte Crigler-Najjar

- [ ] DX SENSITIVITY: Individuals with the - [ ] glycogenesis- energy storage

disease
- [ ] poorest precision- calcium
- [ ] DX SPECIFICITY: Individuals w/o the
- [ ] psychedelic effect-ecstacy
disease
- [ ] thyroid carcinoma-calcitonin
- [ ] POSITIVE PREDICTIVE VALUE: Presence of
disease - [ ] major mineralocorticoid- aldosterone

- [ ] NEGATIVE PREDICTIVE VALUE: Abscense - [ ] will not increase blood glucose level-
of disease glycogenesis

- [ ] STANDARD: Calibration - [ ] green belts-20

- [ ] CONTROL: Resembles px sample - [ ] - [ ] arterial, ammonia- heparin

- [ ] UV LIGHT: <400nm - [ ] extracellular, neutrality, osmolality-

Chloride
- [ ] DETECTOR: Measures and Converts
- [ ] panic rxns- LSD
- [ ] HDL: Reverse cholesterol
- [ ] - [ ] ACP-Thymolpthalein monophosphate
- [ ] ULTRACENTRIFUGATION: Lipoproteins

- [ ] KIDNEY: Numerator
- [ ] Yellow-reactivity
- [ ] LUNGS: Denominfator
- [ ] Red-Flammability

- [ ] RACE-exit

- [ ] class A-water
—————
- [ ] shift in levey-jennings- improper
instrument calib
- [ ] obstruction caused by stones, tumors…-
- [ ] viscous fluid- ostwald-folin
post renal azotemia
- [ ] y axis- vertical,ordinate, dependent
- [ ] water soluble- conjugated
- [ ] acid for cleaning glasswares- potassium
- [ ] isoenzyme-specificity
dichro & h2so4
- [ ] Alzheimer’s- alpha1 chymotrypsin
- [ ] healthy indiv- LD2
- [ ] csf, coma of unknown cause-glutamine
- [ ] bicarbonate-carbionic-

Mangirapin-Lagpey-Ngilac-Oabel 9
Henderson-Hasselbach chylomicron

- [ ] six sigma-6 mos - [ ] - [ ] - [ ] project team members - green

- [ ] Reye’s- increased plasma ammonia - [ ] - [ ] - [ ] copper reduction with blue

complex - folin-wu
- [ ] - [ ] Bassen-Kornzweig- decrease in
pre-beta and beta bands - [ ] protein catabolism - urea

- [ ] - [ ] - [ ] overall testing process - quality - [ ] - [ ] - [ ] Levy Jennings shift - improper

assurance instrument calib

- [ ] blood amonia- hepatic coma - [ ] sodium falsely decreased by - elevated

lipid levels
- [ ] 600nm- didymium glass filter
- [ ] - [ ] - [ ] Potassium in FEP - violet
- [ ] 90 degrees from incident light -
nephelometer - [ ] not true in centri maintenance - timer
checked weekly
- [ ] - [ ] - [ ] newborn screening - blood spot
on filter paper - [ ] - [ ] - [ ] transporter of exp TG - Chylo

- [ ] decreased when there is liver disease- - [ ] - [ ] - [ ] contains reagent but not

total protein substance to be measured - blank

- [ ] LJ 7 consecutive values- improper - [ ] - [ ] - [ ] analytical method that detects

instrument calib the proportion of indiv with disease -
diagnostic sensitivity
- [ ] - [ ] - [ ] more than 2SD - 5%
- [ ] specimen for acid base - heparin
- [ ] flame in FEP- sample holder and light
source - [ ] - [ ] - [ ] SI for temp - Kelvin

- [ ] first thing in case of fire - remove personn - [ ] ref range for arterial pH - 7.35-7.45
in danger
- [ ] detects and converts transmitted light -
- [ ] lipid component of LDL - cholesterol detector

- [ ] beta-gamma bridging - hepatic cirrhosis - [ ] discrete analysis - each handled

separately
- [ ] Beer’s Law- Linearity
- [ ] rel of CV to precision - inversely
- [ ] farthest toward the anode- albumin
proportional
- [ ] FEP not easily excited - calcium
- [ ] links equipment - LIS
- [ ] Type 2 DM except - insulin dependent
- [ ] has primary anf secondary
- [ ] Jaffe method - picric acid and NaOH monochromator - fluorometer

- [ ] Lipoprotein with greatest triglyceride - - [ ] measure only analyte of interest -

Mangirapin-Lagpey-Ngilac-Oabel 10
analytical sensitivity - [ ] not correct about secondary
hypothyroidism - tsh is elevated
- [ ] first to respond to stress - catecholamine
- [ ] middle value- median
- [ ] short term accuracy - internal QC
- [ ] control- closely resembling test specimen
- [ ] moderate hazard - 2
- [ ] glassware - potassium dichromate in
- [ ] tachometer - centrifuge
h2so4
- [ ] timer of centri- timer
- [ ] in case fire - RACE
- [ ] known concentration - standard
- [ ] prefix mega-
- [ ] calcitonin release- hypercalcemia
- [ ] at an angle
- [ ] pipet for viscous fluid- ostwald
- [ ] mycocardial infarction - CK, AST, LDH
- [ ] quantitation of lipoproteins- ultracentri
- [ ] falsely increased LD1 - specimen
- [ ] group of samples same test- batch hemolysis
analysis
- [ ] - [ ] - [ ] - [ ] fasting turbidity - VLDL
- [ ] earliest indication of systematic error-
- [ ] strobe light - centrifuge
cumulative sum graph
- [ ] monolayer of cells- cytocentrifuge
- [ ] delta check- post analytical
- [ ] lipemic sample- 400mg
- [ ] greatest concentration during pregnancy -
estriol - [ ] full six sigma improvement project - 6
months
- [ ] elevated unconjugatrd and conjugated -
hepatitis - [ ] holmium oxide glass - wavelength
accuracy
- [ ] elevated acid phosphatase - prostatic
- [ ] any sample in any sequence- random
- [ ] purified form for calib- standard
access
- [ ] alkaline phosphatase- increased in
- [ ] compare 2 methods - t test
obstructive jaundice
- [ ] most basic pipet - glass pipet
- [ ] abscissa - independent
- [ ] 400nm light transmitted - ultraviolet
- [ ] plasma osmolality - sodium
- [ ] CK-MB isoenzyme - myocardial infarction
- [ ] polyclonal gammopathy- diffused broad
gamma band - [ ] - [ ] - [ ] serves to separate samples - air
bubbles
- [ ] household bleach - 10%
- [ ] - [ ] measure the analyte it is designed to
- [ ] swinging-bucket - horizontal-head centri
measure - analytical specificity
Mangirapin-Lagpey-Ngilac-Oabel 11
Mangirapin-Lagpey-Ngilac-Oabel 12
CC COMPLETION EXAM 1 CYCLE 2 15. Select the arrangement of lipoproteins electrophoresed on
1. Chief counterion of Sodium cellulose acetate or agarose at ph 8.6
 Chloride  -chylo>beta>prebeta>alpha+
2. In the CDC reference method for TG measurement, what reagents 16. Which of the ff procedures is useful in determining if a QC alert is
are used in the extraction and adsorption steps respectively? caused by deteriorated QC materials or a problem the method?
 Chloroform and silicic acid  Repeating measurement on a new sample of the QC
3. Exposure to biological hazards via aerosol may be due to material
1. Flaming inoculating loops 17. Which of the ff values of ABG analysis support the presence of
2. Spills on laboratory and formaldehyde gram-negative sepsis?
3. Centrifugation of infected fluids  Low pH, HCO3 and normal pCO2 (bonus ni ma’am basta
4. Expelling a spray from needles effect ng metabolic acidosis)
 1,2,3,4 - sepsis  resulting metabolic acidosis
4. What is the relationship of BUN to the glomerular filtration rate 18. Drug of abuse that is not a CNS depressant include:
(GFR)? 1. Barbiturates
 Inversely proportional 2. Methaqualone
- If the GFR is high = BUN will low; low GFR = high BUN 3. Benzodiazepines
5. Cortisol is an analyte that is affected by diurnal variation. It is 4. Cannabinoids
highest in the ___ and lowest in the _____.  Only 4 is correct
 Morning; evening 19. What is the standard clinical specimen for blood glucose
6. A disproportionate rise in BUN over creatinine leading to a rise in measurement?
their ratio is indicative of the presence of a  Plasma
 Prerenal disease 20. Interfering substances that cause a negative bias in the alkaline
- Pre renal affects GFR (decrease)  BUN will accumulate thus picrate method for creatinine determination include:
increase 1. Glucose 2. Hemoglobin 3. Protein 4. Bilirubin
- Renal and Post renal disease: BUN and Creatinine will rise  2 and 4 are correct
together; remain to be the normal ratio (renal and post renal) 21. Which of the ff strategies are incorporated in the lean concept of
7. Heavy metal that has high affinity to keratin, this it can be quality laboratory management?
identified in hair and nail samples 1. Plan-do-check-act
 Arsenic 2. DMAIC
8. A patient undergoing the Atkins diet is expected to have increased 3. Sort-set in order-shine-standardize-sustain
levels of what NP? 4. Organization-personnel-assessments-process improvement
 Urea  1 and 3 correct
9. Which of the ff statement is false regarding chronic toxicity? 22. Color of serum or plasma in presence of hemolysis?
a. Single exposure, dose is sufficient to cause toxic effects –  Pink
Acute toxicity 23. AccuVein is a handheld medical device that helps medical staff
b. Affects different organ system visualize veins before phlebotomy. This device works by
c. Accumulation of the toxicant or toxic effects  Emitting infrared light abdsorbed by hemoglobin in RBC
d. Several exposures to dose insufficient to cause toxic effect 24. Which of the ff are minor lipoproteins?
10. In organophosphate poisoning, which of the ff enzyme is used to 1. IDL 2. LpX 3. Lp(a) d. Beta-VLDL
reflect acute toxicity?  Two of these
a. Pseudocholinesterase – if mentioned Acute toxicity 25. A patient suffering from liver cirrhosis has the ff chemistry result
b. b. 5’-nucleotidase Albumin: increased
c. Acetylcholinesterase – if there’s no acute/chronic specified Ammonia: increased
d. Angiotension Converting Enzyme Total bilirubin: normal
- Acute toxicity: Acetyle AST: normal
11. Which of the ff sample is not useful for the detection of mercury ALT: normal
poisoning? ALP: normal
a. Stool b. hair c. urine d. blood Which of these results do not coincide with the patient’s condition?
12. In laboratory safety, health care facilities are required to have  Albumin and Total Bilirubin
policies that address - Albumin and total bilirubin always decreased in cirrhosis
1. Exposures to biological hazards - Enzymes can be normal
2. Epidemic emergencies 26. The ff are assayed as part of the liver function test panel except
3. Exposures to ergonomic hazards a. Bilirubin
4. Act-of-God occurrences b. ammonia
 1, 2 , 3, 4 are correct c. prothrombin
13. Reasonably anticipated skin, eye, mucous membrane, or d. total bilirubin
percutaneous contact with blood or other potentially infectious - Others: ALT, AST, Lactate dehydrogenase, ALP, total protein,
materials that may results from the performance of an employee’s 27. Which of the ff PPE is/are not used to prevent exposure of mucous
duties membrane from splashes?
a. Accidental exposure 1. Mask 2. Lab gown 3. Goggles 4. Gloves
b. indirect exposure  2 and 4 are correct
c. occupational exposure 28. In what portion of the QC chart are dependent variables located?
d. direct exposure  Y-axis (ordinate)
14. In which of these clinical conditions may blood cholesterol be 29. A medtech handling a lipemic sample performed serum blanking.
increased? After the procedure, the lipemic sample remains turbid. Which of
a. Hashimoto’s thyroiditis c. Malnutrition the ff is the best course of action?
b. SLE d. Direct exposure  Perform ultracentrifugation
30. Cholelithiasis causes obstruction that blocks the biliary tree. This 53. What electrolyte is the chief plasma cation that primarily functions
condition is indicated by increased levels of in maintaining osmotic pressure?
 ALP, GGT, direct and total bilirubin  Sodium
31. In the lean concept of quality laboratory management, nonvalued 54. Which of the ff results would be most consistent with high risk for
activities are referred to as coronary heart disease?
 Wastes A. 50mg/dl HDL, 180 mg/dl total cholesterol
32. A medtech is tasked to collect a trough specimen for TDM. B. 55mg/dl HDL, 170 mg/dl total cholesterol
Generally, a trough specimen is collected C. 45mg/dl HDL, 210 mg/dl total cholesterol
 30 minutes before the drug is administered D. 20mg/dl HDL, 250mg/dl total cholesterol
33. How long should an in-patient be seated in a supine position before - The lower HDL the more at risk; the higher TC the more at risk
blood is drawn to avoid problems with hemoconcentration and 55. Panic reactions, otherwise referred to as bad trips, is associated
hemodilution? with what drug of abuse?
 20 minutes  LSD
34. Which of the ff best describes an outlier in the QC chart? 56. Drug of choice for absence seizures
 Control value that goes beyond +/- 2SD  Ethosuximide
- Presence of 1 outlier = warning - Secondary: Valproic acid
- 2 outliers = reject 57. Proper centrifugation for plasma preparation after phlebotomy
35. Two control sera are desirable for each general chemistry  Within 1hr at 1000 x g for 10 mins
procedure. Which of the combination would be appropriate? 58. Which of the ff lipoproteins does not contain Apo B?
 Mean of normal and high abnormal ranges  HDL
36. Majority of testing errors recorded in the laboratory occurs in what 59. Considering clinical utility, which of the ff test for cardiac markers is
phase? the most useful in diagnosing AMI
 Pre-analytical  Troponin I assay
37. Defects in six sigma process is measured using 60. What electrolyte is expected to be increased in a serum sample
 DPMO from a patient with thrombocytosis?
38. What parameter in the liver function test panel is reflective of liver  K
disease when decreased? 61. When is the best time to collect a blood sample for fasting blood
 Total protein glucose determination?
39. Which of the ff lipid profile parameter is expected to be falsely  In the morning after 8 hours of fasting
elevated on a serum specimen from a non-fasting patient? 62. The ff are causes hypokalemia except
 Triglycerides a. Insulin infusion to diabetes c. alkalosis
40. The trinder reaction is employed in the colorimetric determination b. vomiting d. DM
of what drug? 63. Complete and proper centrifugation of collected blood sample is a
 salicylate process that is performed in what phase of testing?
41. What organ is primarily affected in hypoglycemic states?  Pre-analytical
 Brain 64. System that is applied to reduce wastes or nonvalued activities
42. Fasting plasma glucose = 115mg/dl  lean
2-hour plasma glucose = 130mg/dl 65. In the enzymatic method for cholesterol determination, what is the
HbA1c = 6.0% most commonly used peroxidase in coupling H2O2 to a
The result above indicated chromogenic substrate
 Prediabetes, impaired fasting glucose a. Horseradish peroxidase c. rabbit peroxidase
- (Review page 209 of Henrys) b. pooled human peroxidase d. asparagus peroxidase
43. Anion gap is most clinically significant in cases of 66. Not true about proficiency testing (NEQUAS)
 Metabolic acidosis a. Comparison of results to a reference value
44. Which of the ff set of strategies is the most effective in laboratory b. Form of quality control
safety programs to contain hazards? c. Otherwise known as external quality assessment
a. Work practice controls and engineering controls d. Included as part of the analytical phase
b. Work practice controls and PPE 67. Coupling enzyme used in the reference method for glucose
c. Engineering controls and PPE determination
d. Work practice controls, engineering controls and PPE  G6PD
45. Hyperbilirubinemia seen in Dubin-Johnson syndrome is due to 68. What is the most common cause of metabolic alkalosis?
 Excretion deficits  Vomiting
46. Poor renal perfusion would result to 69. Blood concentration of ethanol that will lead to deep coma
 Pre-renal azotemia  300 mg/dl (250-400 always choose the best)
47. HLA-DR/DQ on chromosome 6 is a genetic marker for 70. Which of the ff is not a manifestation of chronic lead toxicity?
 Type 1 DM 1. Peripheral neuropathy 3. Wrist drop and foot drop
48. Low C-peptide concentration 2. Basophilic stippling 4. Pica
 Type 1 DM  4 only
49. A sharp peak gamma region on serum electrophoresis is seen in 71. Concept related to the Six Sigma process except
what condition? a. Measures defect per million opportunities
 Multiple myeloma (monoclonal gammopathy) b. Aims to decrease product or service variation
50. If a blood gas specimen is left exposed to air, which of the ff c. Steps include Define, Measure, Analyze, improve and Control
changes will occur? d. Involves streamlining laboratory operations
 pO2 and pH increases, pCO2 decrease 72. The ff are laboratory hazard prevention strategies under
51. intermediate substance in the bicarbonate buffer system engineering controls except
 carbonic acid 1. Biohazard bags
52. the ff, if done repetitively are ergonomic hazard except 2. Warning signs
 centrifugation 3. Centrifuge safety buckets
 4. Eyewash station a. Condensation method, red positive result
 2 and 4 are correct b. Copper reduction method, yellow positive result
73. This lipoprotein with a density range similar to LDL and an c. Condensation method, green positive result
electrophoretic migration pattern similar to VLDL that is associated d. Copper reduction method, blue positive result
with obstructive jaundice 88. The ff are true about delta check except
 Lp(a) a. Comparison of a patient’s result to other patient’s result
74. In TDM, the point of equilibrium between drug dosage intake and within the day
drug elimination is referred to as b. Most useful in detecting samples altered by IV dilution
 Steady state c. Capable of detecting analytical errors.
75. Type IV hyperliproteinemia is associated with an increased level of d. Most useful in detecting mislabeled samples
a. VLDL b. CM c. LDL d. TAG 89. According to OSHA’s Hazard Communication Standard and
76. Which of the ff sample is given the highest priority for testing? Chemical Hygiene Plan, who should assess and supply information
a. STAT – potassium level of a patient in the critical care unit about the hazards of chemicals used in laboratories?
b. Myoglobin level of a patient presumed to have had acute a. Employer c. manufacturer
myocardial infarction b. employee d. safety officer
c. ASAP – arterial blood gas analysis of a patient in the 90. What lipoprotein accounts for postprandial turbidity of plasma?
emergency department a. VLDL b. HDL c. Chylomicrons d. LDL
d. Random blood glucose level of a patient suffering from 91. Crack, a potent drug of abuse, is derived from
diabetic ketoacidosis a. Cannabis plant b. coca plant c. poppy plant d. cactus plant
77. What is the cut-off point for the serum cholesterol level of 92. Which of the ff diseases result from the familial absence of high-
individuals belonging to the 40 and above age group? density lipoprotein?
a. Moderate Risk >240; High Risk >250 c. a. Tay-sachs disease c. Krabbe disease
Moderate Risk >220; High Risk >240 b. Tangier disease d. Gaucher disease
b. Moderate Risk >240; High Risk >260 d. 93. Intermediate-Density Lipoprotein (IDL) is increased in what type of
Moderate Risk >250; High Risk >260 dyslipoproteinemia?
78. What is the most abundant cation in the body? a. IIb b. IV c. IIa d. III
a. K b. Na c. Mg d. Ca 94. Placing blood in the wrong evacuated tube is a common
79. The following are technical problems caused by personnel errors in preanalytical error that occurs
the investigation of unacceptable proficiency testing results except a. After collection c. after analysis
a. Misalignment of instrument probes c. b. During collection d. before collection
pipetting or dilution error 95. In QC, a laboratory result that is more than 2SD from the mean is
b. Incorrect handling of reagents or calibrators d. expected to occur
incorrect preparation of reagents and calibrators a. 10% of the time c. 20% of the time
80. Which of the ff blood collection devices is helpful when obtaining a b. 3% of the time d. 5% of the time
sample from veins of the hand or ankle? 96. The following cases may result in pseudohyperkalemia except
a. Two-way needle c. syringe a. Using serum in patients with thrombocytosis
b. Evacuated system d. lancet b. Increase potassium uptake in leukocytosis
81. Congenital minimata disease c. Hemolysis due to frantic blood collection
a. Elemental mercury c. inorganic mercury d. Patients with extremely high blasts counts
b. Metallic mercury d. organic mercury 97. What anticoagulant should be utilized when collecting arterial
82. A hemolyzed sample for electrolyte assay using indirect ISE is blood for ammonia determination?
expected to have a. Double oxalate c. EDTA
a. Increased sodium and potassium values b. Heparin d. sodium citrate
b. Decreased sodium and potassium values 98. In the six sigma concept, what is used to express the degree of
c. Decreased sodium and increased potassium values variability that exists in products or services?
d. Increased sodium and decreased potassium values a. Mean b. DPMO c. Standard Deviation d. CV
83. Which of the ff is performed to monitor glucose levels for the past 99. The fasting serum plasma glucose level of a male patient is
3 weeks? 199mg/dl using glucose oxidase method. Which of the ff is the best
a. Random glucose testing course of action in order to establish hyperglycemia?
b. Glycosylated hemoglobin testing a. Confirm the result on the same day using a new sample from
c. fructosamine testing the patient
d. oral glucose tolerance testing b. Confirm the result on a subsequent day using a new sample
84. What is the normal BUN-Creatinine ratio? from the patient
a. 20:1 b. 10:1 c. 10-20:1 d. 15:1 c. Confirm the result by performing OGTT using the same
85. Which of the ff statements is false about high density lipoprotein sample from the patient
(HDL)? d. Confirm the result using hexokinase method using the same
a. Migrates slowest on electrophoresis sample from the patient
b. Functions for reverse cholesterol transport 100. Lipemic sample
c. Heaviest among the lipoprotein a. 300mg/dl b. 350mg/dl c. 370mg/dl
d. Inversely related to atherosclerosis risk d.400mg/dl
86. OSHA strongly recommends wearing gloves as a barrier protection
in the ff instances except except
a. When an intern is undergoing phlebotomy training
b. When a medical laboratory scientist has cuts or open wounds
c. When a support staff is encoding in the office
d. When laboratory personnel anticipate hand contamination
87. Which of the ff is true regarding Dubowski method for glucose
determination?
CC COMPLETION EXAM 2 CYCLE 2 17. Serum protein electrophoresis is most important in determining
1. Not true about the Active site the presence of
a. Area where catalysis occurs c. region on the a. Bridging effect in the beta and gamma regions correlated
surface of a substrates with nephrotic syndrome
b. Region on the surface of enzymes d. area where binding b. A significant increase in the gamma region signifying
occurs monoclonal gammopathy
2. Malate dehydrogenase is added to the AST reaction to catalyze c. Increased concentrations of plasma proteins associated with
the conversion of chronic inflammation
a. Alpha-ketoglutarate to aspartate d. A significant decrease in albumin concentration correlated
b. Oxaloacetate to malate with liver cirrhosis
c. aspartate to oxaloacetate 18. Cholelithiasis causes obstruction that blocks the biliary tree. This
d. alpha-ketoglutarate to malate condition is indicated by increased levels of
3. Chloride in serum is reported at 95 mEq/L. what is its equivalent  ALP, GGT, direct and total bilirubin
in SI units? 19. In fluorometry, which of the ff type of light has a long wavelength
a. 9.5mmol/L b. 105mmol/L c. 47.5mmol/L d. 95mmol/L but a low energy?
4. UV light in the electromagnetic spectrum has a 1. Fluorescent light
 Short wavelength 2. Phosphorescent light
5. In maintaining acid-base balance, what organ exerts its control by 3. Emitted light
regulating the concentration of HCO3 in the body? 4. Excited light
 kidneys  1 and 3 are correct
6. Under what conditions should the sample for blood gas 20. Low serum total protein level is usually seen in the ff condition
determination be maintained while it is in transport to the except
laboratory? a. Malignancy c. starvation
 Anaerobic, in ice water b. liver failure d. glomerular disease
- Important factor to be considered in a sample: should prevent 21. The direction in which albumin migrates during electrophoretic
from glycolysis and ambient air/environment separation of serum proteins, at pH 8.6, is determined by
7. The ff cases may result in pseudohyperkalemia except  The ionization of the carboxyl groups, yielding a net negative
a. Hemolysis due to frantic blood collection charge
b. Increase potassium uptake in leukocytosis 22. Which of the ff are co-enymes?
c. Patients with extremely high blasts counts 1. Magnesium 3. Cl
d. Using serum in patients with thrombocytosis 2. Vitamin B12 4. NAD
8. When using Biuret method for quantitating serum total protein,  2 and 4 are correct
the intensity of the color produced is dependent on the - Co-enzymes: organic
 Number of peptide bonds that react - Activators: inorganic
- Atleast 2 peptide bonds para ma-count 23. Which of the ff hormones increases blood calcium level by
9. If a blood gas specimen is left exposed to air, which of the ff increasing the renal absorption of calcium?
changes will occur?  Calcitriol
 pO2 and pH increase, pCO2 decrease - Calcitriol governs the renal reabsorption of Calcium; PTH is the
10. in laboratory assays, which of the ff fractions contribute/s to the next best answer
total bilirubin value? - PTH main action is in the bone matrix (promotes bone
1. Unconjugated bilirubin 3. Conjugated bilirubin dissolution); and needed in activation of Vitamin B (Calcitriol
2. Delta-bilirubin 4. Azobilirubin active form of vit. B)
 1, 2, and 3 are correct 24. Bilirubin is transported from reticuloendothelial cells to the liver
11. Expected results of a patient suffering from primary male by
hypogonadism  albumin
 Decreased testosterone, increased FSH and LH 25. Unconjugated hyperbilirubinemia is seen in
12. Which of the ff is false regarding unconjugated bilirubin? 1. Gilbert syndrome
a. Transported to the liver bound to albumin 2. Hemolytic anemia
b. Enters hepatocytes via passive diffusion 3. Jaundice of the newborn
c. Predominantly exists in its trans- form 4. Rotor syndrome
d. Does not undergo photoisomerization  1, 2 and 3 are correct
13. Protein fraction that travels the farthest toward the anode in 26. Which of the ff plasma proteins is specific for beta fraction?
serum protein electrophoresis 1. Lipoprotein
a. Albumin b. beta globulin c. alpha globulin d. gamma 2. Transferrin
globulin 3. Complement
14. Chief plasma cation, the main function of which is osmotic  1, 2, and 3 are correct
pressure regulation 27. Which of the ff pairs is not correct?
a. K b. Cl c. Na d. Ca a. Potassium – major intracellular cation
15. Which of the ff is true about partially compensated respiratory b. magnesium – major intracellular anion
alkalosis? c. chloride – major extracellular anion
a. HCO3 is higher than normal b. patient is d. sodium – major extracellular cation
hyperventilating c. pCO2 is 28. Which of the ff situation will increase serum potassium levels?
higher than normal d. decreased renal reabsorption 1. Patient opens and closes his first repeatedly during
of HCO3 venipuncture
16. Which of the ff amylase method is typically based upon a rate 2. Minimal hemolysis
reaction? 3. Extreme thrombocytosis
 starch-iodine  1, 2 and 3 are correct
29. Effect in bilirubin assay values when there is an increased 46. An analyzer can perform any test on any sample in any sequence
concentration of delta bilirubin  Random access testing
1. Increased conjugated bilirubin 47. Catecholamines are secreted by the
2. Increased unconjugated bilirubin a. Adrenal medulla c. pituitary
3. Increased total bilirubin b. Kidney d. adrenal cortex
4. Decreased unconjugated bilirubin 48. Which of the ff is considered a characteristic feature of polyclonal
 1 and 3 are correct gammopathy as seen in chronic inflammatory disorder?
30. Light source used in fluorometers a. Sharp spike in gamma region
 Xenon b. Diffused broad gamma band
- Also hydrogen discharge lamp c. Increase alpha-1 and alpha-2 fractions
31. Which of the ff are considered as negative acute phase reactants? d. Bridging effect between gamma and beta regions
 Albumin and prealbumin 49. What is normal ratio of bicarbonate to dissolved carbon dioxide in
32. The danger of kernicterus is a certainty at bilirubin levels arterial blood?
exceeding  20:1
 20mg/dl 50. What enzymes are clinically significant in muscular dystrophy?
33. Which of the given analytes is/are not assayed as part of the liver a. AST, ALT, aldolase c. CK, Aldolase. AST
function tests? b. CK, AST, ALT d. ALT, aldolase, LDH
1. Ammonia 51. A patient with liver disease has serum transaminase that are 2-
2. Prothrombin time fold higher than the upper reference limit. You would expect
3. LDH  ALT to be greater than AST
4. Lipids 52. Which condition is would most likely be characterized by
 2 and 4 are correct elevation of both unconjugated and conjugated bilirubin
34. Physiologic increase in ALP level fractions?
1. Puberty a. All of the above c. hepatitis
2. Paget’s disease b. Bile duct obstruction d. erythroblastosis fetalis
3. Pregnancy 53. The presence of this ALP isoenzyme depends on the blood group
4. Pellagra and secretor status of an individual
 1 and 3 are correct a. Bone c. placental
35. What AAS component serves as the atomizer? b. liver d. intestinal
a. Monochromator 54. What enzymes are clinically significant in myocardial infarction?
b. Flame  CK, AST, LDH
c. Lamp - But Troponin I is still the best/better because it rises more rapidly.
d. Chopper 55. Valinomycin enhances the selectivity of the electrode used to
36. Primary compensatory mechanism in metabolic acidosis quantitate
 Hyperventilation  Potassium (basta VP)
37. What is the clinical significance of an elevated acid phosphatase? 56. LD catalyzes the ff reaction:
 Prostatic cancer Lactate + NAD  pyruvate + NADH
38. The most important buffer in plasma is the: As the reaction is written which of the ff techniques can be used
a. Phosphate/biphosphate pair c. Hemoglobin/imidazole pair to assess LD activity?
b. Sulfate/bisulfate pair d. bicarbonate/carbonic acid a. Measure the decrease in absorbance at 340nm as NADH is
39. Which of the ff hormones is regulates the body’s metabolic rate? produced
 Thyroxine b. Measure the increase in absorbance at 340nm as NADH is
40. Which of the ff best describes as monochromator? produced
a. Measures the intensity of light falling on a detector c. Measure the colorimetric product pyruvate
b. Determines the critical angle of refraction of dispersed light d. Measure the colorimetric product NADH
c. Measures the intensity of light which falls on diffraction 57. Which of the ff works by decreasing blood calcium levels?
gratings  Calcitonin
d. Disperses polychromatic light into its separate wavelength 58. Respiratory acidosis compensation
41. Involves reshaping of the active site in order to bind the substrate  Increased HCO3 reabsorption, increased pH
with high affinity 59. A 20:1 bicarbonate to carbonic acid ratio means that the pH of
 Induced fit blood is
42. What is the hormone that controls the reabsorption of sodium in  7.40
the kidney? 60. The most abundant amino acid in the body that is involved in
 Aldosterone more metabolic processes than any other amino acid
43. The ff are considered as interferences that affect serum albumin  Glutamine
assays involving both BCG and HABA dyes except 61. What class of enzyme uses NAD+/NADH as a coenzyme?
a. Salicylate b. heparin c. hemolysis d. bilirubin  oxidoreductase
44. Which of the ff physiologic processes is not a function of the liver? 62. The most heat labile fraction of ALP is obtained from
a. Metabolism of glucose c. detoxification of drugs  Bone
b. synthesis of proteins d. excretion of ammonia 63. Type of testing in which more than one test is performed at the
45. This serves to separates samples and test reactions in continuous same time on a given sample
flow analyzers  Parallel testing
a. Air bubbles c. containers - Batch testing: load all the samples at the same time and one test
b. Cuvettes d. tubings (serves as is done
reaction vessels) - Random access: any test, any sample
- Common problem: presence of carry over - Sequential testing: multiple test analyzed after given …..
o Prevent: washing out
64. In fluorometry, which of the ff correctly describes the relationship 83. The relative migration rate of proteins on cellulose acetate is
of the wavelength and energy of the emitted light? based on
 Inversely proportional  Ionic charge
65. Cretinism in infants is caused by 84. In the Jendrassik Grof reaction for the total bilirubin, bilirubin
 hypothyroidism reacts with diazotized sulfanilic acid to form:
66. What component of a double beam in space spectrophotometer a. Azobilirubin c. diazon bilirubin
is not duplicated? b. b. biliverdin d. bilirubin glucoronide
 Light source 85. Strobe light is used to calibrate
67. An enzyme assay that is involves the continuous measurement of  centrifuge
change in concentration as a function of time. 86. in uncompensated metabolic acidosis, which of the ff ABG
a. Multipoint c. spectrophotometric parameters will be normal?
b. b. endpoint d. kinetic a. pO2 c. plasma bicarbonate
68. The most sensitive enzymatic indicator for liver damage of b. plasma carbonic acid d. pCO2
ethanol intake is 87. serum samples for LD isoenzyme analysis should be stored at
 GGT what temperature?
69. Which of the ff is a low molecular weight protein that is found in a. 37 deg C c. plasma bicarbonate
the cell surfaces of nucleated cells? b. plasma carbonic acid d. pCO2
a. Beta-microglobulin c. alpha 2 macroglobulin 88. For albumin assay, absorbance at 630nm is less likely to be
b. CRP d. ceruloplasmin affected by the bilirubin or hemoglobin in the sample. Which dye
70. Enzymes assayed that aid in the assessment of liver function gives a much greater absorbance change at 630nm that it would
include all of the ff except at 500 nm?
a. LD c. ALP a. BCG b. CV c. CK d. BCP
b. GGT d. 5’-Nucleotidase 89. Transferase enzyme
71. What acid-base disturbance is associated with emphysema  CK
involving the accumulation of fluid in the alveolar sacs? 90. Metabolic acidosis compensation
 Respiratory acidosis  Decrease pco2, incrased ph
72. The most anodal protein fraction seen in nephrotic syndrome is 91. What is the recommended SI unit for enzyme activity?
 Albumin  Moles per liter per second
73. What condition involves the absence of the activity of glucuronyl 92. What estrogen has the greatest concentration in urine during
transferase resulting to persistent increased level of unconjugated pregnancy?
bilirubin and kernicterus in neonates? a. hCG b. estradiol c. estriol d. progesterone
a. Crigler-Najjar syndrome c. Dub-Johnson syndrome 93. hyperbilirubinemia seen in Dubin-Johnson syndrome is due to
b. Physiologic liver immaturity d. hemolytic anemia  Excretion deficits
74. Which of the ff best describes alkaline phosphatase? 94. In enzyme measurement, reactants are combined, the reaction
a. Primarily found in cardiac muscle proceeds for a designated time, then stopped before
b. Decreased in Paget’s disease measurement is made.
c. Decreased in 3rd trimester of a normal pregnancy a. Coupled enzyme reaction assay c. kinetic assay
d. Increased in obstructive jaundice b. Fixed time assay d. spectrophotometric assay
75. This is considered as the most sensitive detector to low levels of 95. Hemolysis will interfere with the ff enzyme measurements except
light in pectrophotometry?  AST
a. Barrier layer cell c. photodiode 96. An arterial blood sample is received in the laboratory 15 mins.
b. Photomultiplier tube d. diode array After the collection with a bubble in the syringe. The medical
76. AMS method that measures the disappearance of the substrate technologist shoud
a. Amyloclastic c. continuous monitoring a. Reject the sample because the pH will be falsely decreased
b. saccharogenic d. chromogenic b. Perform the test immediately
77. Most popular and versatile type of analyzer c. Reject the sample because pO2 will be falsely decreased
 Discrete d. Reject the sample because the pCO2 will be falsely
78. What instrument requires a primary and a secondary decreased
monochromator? 97. Growth hormone inhibiting hormone
a. Fluorometer c. nephelometer a. Thyroxine c. cortisol
b. double beam in time spectrophotometer d. AAS b. b. somatostatin d. epinephrine
79. Which of the ff is the primary mechanism for vasopressin (ADH) 98. Sodium determination by indirect ion selective is falsely
release? decreased by
 Hyperosmolar plasma a. Elevated chloride levels c. decreased albumin levels
80. What condition involves the absence of the activity of glucoronyl b. Decreased protein levels d. elevated lipid levels
transferase resulting to persistent increased level of unconjugated 99. The following are correct pairings of the analyte and the
bilirubin and kernicterus in neonates respective electrode used for its measurement except
 Criggler-najjar syndrome a. pO2: Clarke electrode c. HCO3: Sanz electrode
81. Given the ff results: ALP = slight increase; AST = marked increase; b. pH: Glass electrode d. pCO2:
ALT = marked increase and GGT=slight increase Severinghaus electrode
 Acute hepatitis 100. which of the ff organs produces corticotropin?
82. Which of the ff is incorrect regarding isoenzymes? a. neurohypophysis c. adenohypophysis
a. Otherwise referred to as isoenzyme b. hypothalamus d. adrenal gland
b. Different forms of the enzyme
c. organ and/or tissue specific
d. Catalyze the different reactions