Rotation Quiz 3-5

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

A blood creatinine value of 5.0 mg/dL is most likely to be found with which of the following blood values?
A. ammonia: 80 ug/dL
B. uric acid: 8 mg/dL
C. urea nitrogen: 80 mg/dL
D. osmolality: 292 mOsm.kg

A serum sample was assayed for bilirubin at 10 AM and the result was 12 mg/dL.  The same sample was retested at 3 PM and the result is not 8 mg/dL.  The most likely explanation for this discrepancy is:
A. the sample was exposed to light
B. the sample was not refridgerated
C. a calculation error in the first assay
D. the reagent has deteriorated

Which of the following enzymes are used in the diagnosis of acute pancreatitis?
A. amylase and lipase
B. 5'-nucleotidase and GGT
C. AST and LD
D. AST and ALT

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases?
A. viral hepatitis
B. pulmonary emboli
C. muscular dystrophy
D. infectious mononucleosis

The enzyme present in almost all tissue may be separated by electrophoresis into 5 components is:
A. lipase
B. creatine kinase
C. lactate dehydrogenase
D. transaminase

Which analyte would be decreased in liver disease?
A. GGT
B. ammonia
C. bilirubin
D. albumin

In which of the following conditions would a normal level of creatine kinase be found?
A. progressive muscular dystrophy
B. acute myocardial infarct
C. hepatitis
D. intramuscular injection

Given the following results:
alk phos: slight increase
AST: slight increase
ALT: slight increase
GGT: slight increase

This is most consistent with:
A. liver hemangioma
B. obstructive jaundice
C. acute hepatits
D. chronic hepatitis

Why is it possible to measure total bilirubin in a neonatal serum sample using direct spectrophotometry, but this technique cannot be used to measure total bilirubin in an adult serum sample?
A. adult samples are too hemolyzed and hemolysis interferes with the measurement
B. asult samples are too lipemic
C. adult samples contain carotene and other pigments that increase the absorbance at the wavelength where bilirubin is measured
D. total bilirubin is too low in an adult sample and would not be measurable by this method

The most widely used methods for bilirubin measurement are those based on the:
a. jaffe reaction
b. schales and schales method
8-hydroxyquinolone reaction
d. jendrassik-Grof method

How would hemolysis affect a plasma ammonia level?
A. increase
B. decrease
C. no effect

a 65 yo patient is being monitored for kidney disease as a precautionary measure because the patient has coronary heart disease. Screening renal tests were recently assay.  The patient's plasma BUN and creatinine and urine protein were all elevated.  These showed that the patient has likely developed kidney disease.  WHich of the following would be the most probable result of an estimated glomelular filtration rate (eGFR) is the patient does have renal disease?
A. decreased eGFR
B. increased eGFR
C. eGFR is only calculated on children
D. normal eGFR

Kernicterus is an abnormal accumulation of bilirubin in:
A. heart tissue
B. liver tissue
C. brain tissue
D. kidney tissue

AN electrophoretci separation of lactate dehydrogenase isoenzymes that demonstrates an elevation in LD-1 and LD-2 is a "flipped" patter is consistent with:
A. viral hepatitis
B. myocardial infarction
C. renal failure
D. pancreatitis

An aspartate aminotransferase (AST) test is analyzed on a patient sample and the result is below the analytical measurement range (AMR), which for the instrument in this scenarios is 4.0-9.0 U/L.  The laboratory director has stated that quantitating AST values that areless than 4 U/L are not clinically useful.  How should this patient's result be reported?
a. <4.0 U/L
b. 4.0 U/L
unable to report; exceeds the measurement limit of the analyzer
d. report the number the instrument provides

The most heat labile fraction of alkaline phosphatase is obtained from:
A. liver
B. intestine
C. bone
D. placenta

The most sensitive enzymatic indicator for liver damage from ethanol intake is:
A. AST
B. GGT
C. ALT
D. alkaline phosphatase

Which of the following chemical determinations may be of help in establishing the presence of seminal fluid?
A. acid phosphatase
B. isocitrate dehydrogenase
C. lactic dehydrogenase
D. alaline phosphatase

Transportation of 60-75% of the plasma cholesterol is performed by:
A. high density lipoproteins
B. very low density lipoproteins
C. chylomicrons
D. low density lipoproteins

A critically ill patient has become comatose.  The physician believes the come is due to hepatic failure. The assay most helpful in this diagnosis is:
A. ammonia
B. GGT
C. AST
D. ALT

Which of these staatements is true regarding therapeutic drug monitoring (TDM)?
A. TDM results will always be the same for all patients who are taking the same doage of the same medication
B. TDM is no longer necessary if a patient's therapeutic drug test result remains the same for three testing periods
C. TDM is of little value for monitoring patient compliance
D. TDM can be used to detect an interaction between two or more drugs that a patient is taking at the same time

A drug has a half like of 6 hours.  If a dose is given every 6 hours, a stead-state drug level would usually be achieved in:
A. 24-42 hours
B. 3-5 hours
C. 10-12 hours
D. 48-50 hours

The presence of which of the followin isoenzymes indicates acute myocardial damage?
A. CKMM
B. none
C. CKBB
D. CKMB

Which of the following would have the greatest impact on a gentamicin test result?
A. time of collection in relation to drug dosing
B. serum or plasma specimen that has been transferred to a transport tube
C. patient fasting status
D. patient resting status

An anti-epileptic (or anticonvulsant) used to control seizure disorders is:
A. digoxin
B. acetaminophen
C. phenytoin
D. lithium

A cardiac glycoside that is used in the treatment of congenital heart failure and arrythmias by increasing the force and velocity of myocardial contraction is:
A. acetominophen
B. lithium
C. digoxin
D. phenytoin

A sample received from the cardiac unit of you facility for a STAT digoxin level.  Your instrument reports the result as 3.0 ng/mL and flags it as a critical value.  After repeating the test and confirming the result, what should be your next action?
A. repeating the test is sufficient.  It can be release in the normal manner
B. repeat the test using an alternate method
C. phone the cardiac unit and give the result to the clinical person responsible for the patient's care
D. call the cardiac unit and give the result to whoever answers the phone. 

A drug must be in which of the following states to have therapeutic effect?
A. protein-bound
B. free, not bound to protein
C. protein-bound and free drug both produce therapeutic effects

An increase in which fo the following cardiac biomarkers is most often associated with congestive heart failure?
A. troponin I
B. BNP
C. myoglobin
D. CKMB

Which of the following factors is not relevant to therapeutic drug monitoring of the aminoglycoside, antibiotics and vancomycin?
A. ototoxicity
B. renal function
C. intestinal absorption
D. nephrotoxicity

The drug procanimide is prescribed to treat cardiac arrythmia.  Wht biologically active liver metabolite of procainamide is often measured simultaneously?
A. phenobarbital
B. lidocaine
C. N-acetyl procainimide (NAPA)
D. quinidine

A drug that relaxes the smooth muscles of the bronchial passages is
A. lithium
B. theophylline
C. phenytoin
D. acetominophen

Serum from a patient with metastatic carcinome of the prostate was separated from the clot and stored at RT. The following results were obtained;
Ca 10.8 mg/dL (8.8-10.3 mg/dL)
LD 120 U/L (50-150 U/L)
Acid P'tase .1 U/L (0-5.5 U/L)
The technician should repeat the:
A. LD using diluted serum
B. acid phosphatase with freshly drawn serum
C. tests using plasma
D. LD with fresh serum

A chemiluminescent EIA:
A. measure absoprtion of light
B. is quantitated by the amount of light produced by the reaction
C. is monitored by the used of a gamma counter
D. is less sensitive than radioisotopic reactions