CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

1. Which of these are classified as random errors:

1. mislabeling of sample
2. improper mixture of sample and reagents
3. sample instability
4. deterioration of reagents
a. 1 and 2
b. 3 and 4
c. 1, 2, and 3
d. all of the above

RATIONALE: Random error is a type of error that leads an overall error to change. It varies
related to measurement, sample and reagent preparation, or collection mislabeling tubes.
Also, random errors, are type of error that can never be eliminated completely but can be
reduced by using repeats.

2. tachometer is used to check the accuracy of operation of:

a. sterilizer over
b. centrifuge
c. water bath
d. electronic balance

RATIONALE: A tachometer is a device that measures speed, typically in revolutions per

minute. In the case of a it is used as a calibrator to check the speed of the centrifuge.

3. a sudden shift in daily values in a QC chart is likely to be the result of:

a. changing an operating technologist
b. replacing the instruments sample aspiration probe
c. changing the spectrophotometer lamp in the middle of the sample run
d. running new standards concurrently with the current standard lot.

RATIONALE: There are various possibilities when a quality control chart indicates a
dramatic shift in daily values causes. Use of reagents or reference standards (calibrators)
from a new batch. Such a change can occur if the product is created incorrectly. A change in
one of the components of the instrument could also produce an abrupt shift in daily results.
A fresh lamp in a spectrophotometer, for example. Whenever a component of an instrument
is replaced. The instrument must be re-calibrated if the parameters have changed.

4. which of the following indicates how often false positive results are produced by a given
test:
a. accuracy
b. sensitivity
c. reliability
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

d. specificity

RATIONALE: The number of those without the disease that the test accurately predicts is
known as specificity which demonstrates how unaffected and diseased people are classified
based on their test results. True positives are individuals who have been diagnosed with a
condition and are accurately classified by the test. False positives (FPs) are healthy patient
who have been misclassified by the test while False negatives (FNs) are diseases that the test
misclassifies.

5. a shift in the mean of a particular analyte in a series of determinations indicates problem

associated with:
a. sensitivity
b. precision
c. specificity
d. accuracy

RATIONALE: The accuracy of statistical information is the degree to which the information
correctly describes the phenomena it was designed to measure. It is usually characterized in
terms of error in statistical estimates and is traditionally decomposed into bias (systematic
error) and variance (random error) components

6. the laboratory technologist must be familiar with the location of which of the following:
1. fire evacuation routes
2. fire extinguisher
3. eye wash station
4. electrical circuit-breaker boxes
a. 3 and 4
b. 1, 2, and 3
c. 1, 2, 3 and 4
d. 1and 2

RATIONALE: The location of eye wash must be known or familiarized by laboratory

employees to avoid eye or skin discomfort if exposed to harmful chemicals or reagents. Fire
location/fire evacuation routes and fire extinguisher must also be familiarized this will be
useful if the laboratory experiences an explosion or fire.

7. a hypothetical true value of glucose in a specimen is taken at 5.0mmol/L. Which of the

following analytical values shows accuracy of the test assay?
a. 5.40mmol/L
b. 5.0mmol/L
c. 5.45mmol/L
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

d. 5.5mmol/L

RATIONALE: The usual fasting glucose level is 5.5 mmol/L, indicating that the test is
accurate. An increase could be linked to a certain condition.

8. Dry chemical extinguisher can be used to put off fire caused by the following except:
a. flammable solvents, alcohols, gas
b. combustible chemicals and metals
c. electrical malfunction as in wiring or in equipment
d. paper and wood

RATIONALE: Combustible chemicals and metals are usually put off by a different type of
extinguisher which is a metal X, while the flammable liquids, electrical equipment and motor
switches, and ordinary combustible like papers and woods can be out off by Dry Chemical
Extinguisher.

9. quality control monitors specifically:

a. neither instrumentation nor test procedure
b. instrumentation
c. test procedure
d. both instrumentation and test procedure

RATIONALE: Quality control specifically monitors both instrumentation and test procedure
of a sample to ensure that the results are correct and detects some analytical errors.

10. which of the following forms of exposure places a medical technologist at the highest
risk for infection with HIV:
a. ingestion through mouth pipetting of positive serum
b. needlestick from AIDS contaminated needle
c. infected serum spill onto intact skin
d. aerosol as in AIDS patients sneeze

RATIONALE: Due to needlestick injuries, medical technologists and other health

professionals who are exposed during blood collection or needle injections are at a high risk
of becoming infected on HIV or other blood-borne infections.

11. if the usual Gaussian distribution exists, one standard deviation on either side of the
mean will include what percent of the values:
a. 95%
b. 68%
c. 99%
d. 34%
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: In a gaussian distribution, one of the empirical criteria is the 68% rule, which
states that there is one standard deviation on either side of the mean. The other rules are the
95% rule, which is observed inside the first two SD, and the 99 %rule, which is observed
during the first three SD.

12. a mean value of 100 and a standard deviation of 1.8mg/dL were obtained from a set of
glucose results on a control solution. The 95% confidence interval in mg/dL would be:
a. 94.6-105.4
b. 94.5-104.5
c. 96.4-103.6
d. 97.3-102.7

RATIONALE: The confidence interval is calculated by using this formula:

x̄ ± Z s__
√n
Whereas:

• x̄ is the mean
• Z is the Z-value
• s is the standard deviation
• n is the number

= (100 + 1.96) x 1.8 = (100 +1.96) x 1.8

1 1
= 103.53 = 96.47

13. a delta check:

a. relates control difference from mean
b. reports patient value difference from previous analysis
c. evaluates statistical drift
d. estimates the running mean

RATIONALE: Delta check is a post-analytical method that requires computerization if test

data so that current results can be compared with past results.

14. if the quality control pools lie 4 SD above the mean you should:
a. apply a correction to the unknown results and report them
b. show them to the supervisor and let him report them
c. repeat analysis using same extract or dilution
d. repeat analysis using original sample and new QC pools
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

15. which of the following plots is best for comparing on laboratory precision and accuracy
to other:
a. linear-regression
b. levy-jennings
c. tonks-youden
d. cusum

RATIONALE: The Tonks-Youden plot is used for interlaboratory comparison of monthly

means. The method mean for level 1 is at the center of the y-axis and mean for level 2 at the
center of x-axis. Lines are drawn from the means of both levels across the graph, dividing
into four equal quadrants.

16. an index of precision is statistically known as: COEFFICIENT OF VARIATION

a. mean
b. median
c. mode
d. standard deviation

RATIONALE: Coefficient of variation is the correct answer but is not mentioned in the
choices. CV is a percentile of the mean; an index of precision

17. material with physical and chemical properties closely resembling the test specimen
and containing concentrations of the substances being measured is known as:
a. control
b. standard
c. calibrator
d. reference solution

RATIONALE: Control is a term used to describe the process of monitoring the precision of
chemicals and instruments in a laboratory. This is a material that is similar to the test
specimen and concentration of the drug being analyzed.

18. quality control pools:

a. must be run with every analysis
b. must have a target value established in a minimum of 20 discrete analyses
c. must include several levels throughout the analytical range
d. must duplicate patient sample matrix as much as possible
e. all of the above

RATIONALE: Prior to the release of patient findings, laboratory quality control is designed
to detect, reduce, and remedy errors in the laboratory's internal analytical process in order
to improve the quality of the results given by the laboratory. Quality control (QC) is one of
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

the most important impacts on laboratory testing—it ensures both precision and
accuracy of patient sample results. The integrity of quality control samples is important
to both management of overall quality as well as to meeting requirements of proficiency
testing.

19. what does the preparation of a Levey Jennings quality control chart for any single
constituent of serum require:
a. analysis of control serum over a period of 20 consecutive days
b. 20 to 30 analyses of the control serum on 1 day, in one batch
c. analyses consistently performed by one person
d. weekly analyses of the control serum for 1 batch

RATIONALE: Because of unavoidable random flaws in the technique, any analytical result
has some degree of uncertainty. A Levey-Jennings quality control chart depicts the allowed
limits of variation in the results of a test. A method of analysis to make such a chart, you'll
need to first get a large enough batch of normal and anomalous pooled serum to last at least
a year. Analyses of pool aliquots are performed in duplicate during a 20-day period,
preferably by all personnel who will be using the controls later. The mean and standard
deviation are calculated using statistical analysis of the data collected thus far.

20. which of the following terms refers to deviation from the true value caused by
indeterminate errors inherent in every laboratory measurement:
a. random error
b. standard error of the mean
c. parametric analysis
d. non-parametric analysis

RATIONALE: Random errors are deviations from the true value caused by unavoidable
errors inherent in laboratory measurements.
The standard error of the mean is a statistical concept reflecting sampling variation. It is
the standard deviation of the entire population.
Parametric statistics refer to a Gaussian (normal) distribution of data.
Nonparametric statistics are more general and require no assumptions.

21. which of the following describes the Westgard multirole 2:2s?

a. two control data points are within +/- 2s
b. one control data point falls outside +2s and a second point falls outside -2s.
c. two consecutive data points fall outside +2s or fall outside -2s.
d. two consecutive data points fall outside +2s.

RATIONALE: According to Westgard rule 2:2s, a run must be discarded if two consecutive
control measurements across runs exceed the same mean -2 standard deviations (SD) or
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

exceed the same mean +2 SD, or if two consecutive control values within a run are outside
the same 2 SD.

22. the coefficient of variation is a percentage of the standard deviation and the:
a. square root
b. standard error
c. regressive equation
d. mean

RATIONALE: The coefficient of variation is a useful statistic for comparing the degree of
variation between two data series, even if the means are radically different. It indicates the
ratio of the standard deviation to the mean.

23. which of the following westgard rule is effective in detecting random error:
a. 1:3s
b. 4:1s
c. 2:2s
d. 10x

RATIONALE: When a control result falls outside of the 3s limit, either above or below the
mean, this rule applies. The run should be rejected. This usually means that a random error
has happened.

24. refers to the smallest concentration that can be measured accurately:

a. analytical sensitivity
b. analytical specificity
c. bias
d. trend

RATIONALE: Analytical sensitivity is identified as the ability of an analytical method to

measure small variations in the concentration of analyte. It represents the smallest amount
of substance in a sample that can accurately be measured by an assay.

25. type of error present in all measurements; due to chance and also effects precision & is
the basis for varying differences between repeated measurements:
a. random error
b. systematic error
c. shift
d. trend

RATIONALE: Random error is a type of error that happens randomly from one sample to the
next and can be produced by a range of reasons such as measurement, instrumentation, and
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

other factors such as pipetting, mislabeling, and using the wrong reagent and mixing of
samples. It is the basis for varying differences between repeated measurements – variations
of technique.

26. type of error usually seen as a trend in the data-values gradually rise or fall from the
previous limits:
a. random error
b. systemic error
c. shift
d. trend

RATIONALE: Trend is an error that occurs when control values rise or decline for six days
in a row.

27. which of the following westgard rule is effective in detecting systemic error:
a. 1:3s
b. 2:2s
c. 4:1s
d. 10x

RATIONALE: When four successive control samples all exceed the +1 or -1 limit, this rule
applies. Normal, abnormal, or a combination of the two could be used as controls. This rule
identifies systematic error.

28. reject a run when four consecutive control observations are on the same side of the
mean and exceed 1SD control limits:
a. 2:2s
b. 4:1s
c. R:4s
d. 10x

RATIONALE: When four successive control samples all exceed the +1 or -1 limit, this rule
applies. Normal, abnormal, or a combination of the two could be used as controls. This rule
identifies systematic mistakes.

29. it has a known concentration of the substance (analyte) being measured and used to
adjust instrument or test system to standardize the assay:
a. control
b. calibrator
c. lyophilized material
d. primary standard
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: Control is a term used to describe the process of monitoring the precision of
chemicals and instruments in a laboratory. This is a material that is similar to the test
specimen and concentration of the drug being analyzed.

30. convert 8x103 mg to ____micrograms

a. 8x105
b. 8x106
c. 8x107
d. 8x108

RATIONALE: Conversion factor of milligram to microgram, multiply the mass value by

1000.
= 8000mg x 1000 = 8000000 ug or 8x106.

31. convert 13 dL to mL
a. 0.13
b. 1.3
c. 13.0
d. 0.0013

RATIONALE: Conversion factor of dL to mL , multiply the 13dL to 0.01mL (1mL =

0.01dL/1dL = 1000mL)

= 13 x 0.01
= 0.13mL

32. a 24-hour urine has a total volume of 1200mL. A 1:200 dilution of the urine specimen
gives a creatinine result of 0.8mg/dL. What is the creatinine concentration for the
undiluted urine specimen?
a. 160mg/dL
b. 160g/L
c. 160g/mL
d. 16g/Dl

RATIONALE: Formula used: dilution of urine multiply to its creatinine result

= 200 x 0.8mg/dl
=160 mg/dl

33. convert 165 pounds to kilograms

a. 86
b. 75
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

c. 81
d. 68

RATIONALE: In order to convert the pounds to kilograms, divide the mass value to 2.205,

= 165
2.205
= 74.8kg or 75kg

34. 0 degree C is the same as:

a. 37F
b. 32F
c. 373K
d. 100K

RATIONALE: Formula used: F = 9/5 (Tc) + 32

F = 9/5 (0) + 32
F = 0 + 32
= 32F

35. if 0.5ml of serum is diluted to 75ml, what is the resulting dilution:

a. 1/150
b. 1/100
c. 1/750
d. 1/500

RATIONALE: Formula used:

Ratio = volume of solute/volume of solvent
= 75mL ÷ 0.5mL
= 150
Therefore, 1:150 is the resulting dilution.

36. the normality of a 0.10M H3PO4 solution is:

a. 0.05
b. 0.10
c. 0.20
d. 0.30
RATIONALE: Formula used:
Normality= molarity X number of equivalents
= 0.10 X 3
= 0.30N
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

37. A 0.020mL of a 1:100 serum dilution contains what volume of serum:

a. 0.2mL
b. 0.02mL
c. 0.002mL
d. 0.0002mL

RATIONALE: Formula used:

Dilution= volume of solute/ volume of solution
= 0.020mL ÷ 100
= 0.0002mL

38. How much 95%alcohol is necessary to make 1 liter of 70% alcohol:

a. 136mL
b. 368mL
c. 500mL
d. 737mL
RATIONALE: Formula used
V2= C1 X V1/C2
= 0.95 X 1 / 0.70
= 0.95 X 1.43
= 1.36 X 100mL
= 136mL

39. A solution of 10mg/100mL is diluted 1:10. What is the final concentration:

a. 1mg/100mL
b. 1g/L
c. 10mg/mL
d.0.001mg/L

RATIONALE: Formula used:

Grams of solute = % solution desired x total volume desired
100
= (10mg) x (100mL)
100
= 1,000mg/dL
100
=10mg/mL

40. A total of 300mL of a 1:3 dilution is to be prepared. How much of the concentrated
solution is to be used?
a. 10mL
b. 100mL
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

c. 1000m
d. 300mL

RATIONALE: In order to get the volume of concentrated solution, formula used:

41. 132F is_____ C?

a. 45.0
b. 55.5
c. 60
d. 65

RATIONALE: Formula used:

C= 5/9 (F-32)
= 5/9 (132- 32)
= 5/9 (100)
=55.5

42. Included in the post-analytical phase will be:

a. commercial controls
b. reporting results
c. manual test methods
d. specimen collection

RATIONALE: The post-analytical phase of the testing process includes evaluating laboratory
test results, releasing test results to relevant personnel in a timely way, especially key
results, and modifying, annotating, or revocation of results as needed to support clinical
diagnosis.
43. a pipette with a bulb close to the delivery tip is used for viscous fluids and is called a:
a. Mohr pipette
b. volumetric pipette
c. lewis-dahn pipette
d. Ostwald-folin pipette

RATIONALE: Unlike volumetric pipettes, which have the bulb in the middle, Ostwald-Folin
pipettes have the bulb closer to the delivery tip. These (OF) are used to accurate measure
viscous fluids like blood and serum.

44. standard solution from which 99.95% of the chemical can be retrieved are referred to
as:
a. secondary standards
b. primary standards
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

c. lyophilized standards
d. preset standards

RATIONALE: A primary standard is typically a reagent which can be weighed easily, and
which is so pure that its weight is truly representative of the number of moles of substance
contained.

45. pure water has a pH of:

a. 6.8
b. 7.0
c. 7.4
d. 9.0

RATIONALE: Because the concentration of hydrogen ions and hydroxide ions in pure water
never varies, water is always neutral, regardless of its pH level. Pure water has a pH of 7 at
room temperature (25 degrees Celsius).

46. the statistical term that most specifically describes analytical precision is the:
a. mode
b. mean
c. median
d. coefficient variation

RATIONALE: Coefficient variation is a percentile of the mean; an index of precision

47. quality control should be used with all procedures to determine:

a. accuracy
b. reliability
c. precision
d. coefficient of variation

RATIONALE:

48. specimen collection and processing are under which part of the quality assurance
program:
a. pre-analytical
b. analytical
c. post-analytical
d. none of the above
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: Test selection, patient identification, sample collection, sample handling,

sorting out, pipetting, and centrifugation are all part of the preanalytical step Any of these
processes can be overlooked, resulting in erroneous results that are attributed to the
preanalytical phase.

49. mechanical hazards are caused by:

a. centrifuge
b. refrigerator
c. both
d. neither

RATIONALE:

50. what kind of quality control is important in maintaining long term accuracy of the
analytical methods:
a. internal quality control
b. external QC
c. Sensitivity
d. Specificity

RATIONALE: External QC or Interlab Quality Control comprises proficiency testing

processes that send out samples of unknown analyte concentrations on a regular basis to
partner laboratories. It is important in ensuring the long-term accuracy of analytical
techniques.

51. This type of error which can be observed on a Levey-jennings chart is formed by control
values that distribute themselves on one side or either side of the mean for six consecutive
days.
a. trend
b. shift
c. outliers
d. none of the above

RATIONALE: The shift is caused by an instrument that has been improperly calibrated,
causing control values to distribute themselves on one side or the other of the mean for six
consecutive days.

52. the independent variable is plotted along the:

a. horizontal axis
b. vertical axis
c. y-axis
d. ordinate
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: The horizontal line, often known as the x axis or abscissa, is used to plot the
independent variable.

53. which among the photodetectors below is the most sensitive:

a. photodiode
b. photovoltaic cell
c. photomultiplier tube
d. photobarrier

RATIONALE: PMT is the most common used detector; it has excellent sensitivity and has a
rapid reponse – detects very low levels of light.

54. This machine uses a specialized light source wherein the analyte of interest is coated
within the hollow-cathode lamp.
a. nephelometry
b. flame emission photometry
c. atomic absorption spectrometry
d. fluorometry

RATIONALE: Atomic absorption spectrometry measures light absorbed by atoms

dissociated by heat and uses hallow cathode lamp as the light source. Its principle is:
Element is not excited by merely dissociated from its chemical bond and place in an
unionized, unexcited, ground-state.

55. what is the most popular and versatile analyzer?

a. continuous flow analyzer
b. centrifugal analyzer
c. discrete analyzer
d. spectrophotometer

RATIONALE: Discrete analyzers can perform plenty of test in a single sample at a time or
multiple samples in a single test, it is also common and flexible type of analyzer. It is the most
popular and versatile analyzer – it measures only the tests requested on a sample.

56. reference electrodes for Ph and Pco2 tests, except:

a. saturated calomel
b. silver-silver chloride
c. glass Ph electrode
d. Valinomycin gel

RATIONALE: The valinomycin electrode was one of the first polymer membrane electrodes,
and it's being used to test potassium levels today. Because the diameter of K+ and the inner
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

diameter of the valinomycin molecule are comparable, the electron-rich core of valinomycin
efficiently removes K+ ions.

57. This pipette, commonly used in laboratories, is the considered as most basic pipette:
a. automatic
b. air displacement
c. glass
d. positive-displacement

RATIONALE: Automated pipettes can take the manual labor out of repeated pipetting and
can offer various advantages. Perhaps the most obvious is greatly improved throughput, as
the automation frees up time and effort for other tasks. Another benefit is enhanced
reproducibility

58. The proper order in capillary puncture:

a. EDTA-serum-smear
b. smear-serum-EDTA
c. serum-EDTA-smear
d. smear-EDTA-serum

RATIONALE: In capillary punctures, the hematology specimen is collected first, followed by the
chemistry and blood bank specimens. This order of drawing is essential to minimize the effects of
platelet clumping

59. for venipuncture, the angle in the procedure is: 15-30-degree angle
a. 15
b. 20
c. 25
d. 30

RATIONALE: Insert the needle into the vessel at a 15 to 30-degree angle. Blood should have
a backflow to syringe. If this does not occur, the needle may not have punctured the vein or
may have passed through the vessel.

60. Which of the following Westgard rule is effective in detecting random error:
a. 1:3s
b. 2:2s
c. 4:1s
d. 10x
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: When a control result falls outside of the 3s limit, either above or below the
mean, this rule applies. The run should be rejected. This usually means that a random error
has happened.

61. The proper order of draw in evacuation tube system is:

a. blood culture, citrate, serum tube, heparin, EDTA, fluoride
b. sterile tube, blue top, red top, green top, lavender, gray
c. sterile tube, red top, blue, green, lavender, gray top
d. blood culture, serum tube, citrate, heparin, EDTA, fluoride
e. both A and B
f. Both C and D

RATIONALE: Blood samples must be drawn by phlebotomists in a specific order to avoid

cross-contamination of the sample by additives found in different collection tubes.
Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or
into tubes preevacuated at the time of collection.

62. Which of the following disease states where you can find unconjugated
hyperbilirubinemia?
a. crigler-najjar syndrome
b. rotor syndrome
c. physiologic jaundice
d. dubin-johnson syndrome
e. both A and C
f. Both B and D

RATIONALE: Unconjugated bilirubin builds up in the blood of people with Crigler-Najjar

syndrome (unconjugated hyperbilirubinemia). Hyperbilirubinemia produces yellowing of
the skin and the whites of the eyes, and bilirubin has an orange-yellow tinge (jaundice).
Hyperbilirubinemia in children is usually unconjugated and most often caused by problems
with red blood cell stability and survival or by defects in the bilirubin-conjugating enzyme,
UGT. In contrast, disorders that result in conjugated hyperbilirubinemia are usually caused
by intrinsic liver dysfunction.

63. Which of the following is not a characteristic of unconjugated bilirubin:

a. water insoluble
b. non polar
c. direct reacting
d. slow reacting

RATIONALE: Conjugated bilirubin is a polar molecule and reacts well in the water-based
spectrophotometric assay that uses diazotized sulfanilic acid. Unconjugated bilirubin does
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

not react well in this system unless alcohol is added to promote its solubility in water. The
water insoluble, non-polar and slow reacting are characteristic of unconjugated bilirubin.

64. over s jaundice will occur when bilirubin level reaches what values:
a. 2mg/dL
b. 3mg/dL
c. 4mg/dL
d. 5mg/dL

RATIONALE: Hyperbilirubinemia causes jaundice, a yellowish coloring of the skin and

mucous membranes. When the bilirubin level is between 2 and 3 mg/dL, jaundice appears.

5. Crigler najjar syndrome is caused by a deficiency of what enzyme?

a. HGPRT
b. Xanthine oxidase
c. UDPGT
D. glucokinase

RATIONALE: Crigler-Najjar syndrome is caused by an absence or profoundly decreased

level of the enzyme UDP-glucuronosyltransferase due to a genetic defect in the UGT1A1 gene.
Severe hyperbilirubinemia has the potential to cause irreversible brain damage. Hence,
prompt diagnosis and treatment is of utmost importance.

66. What is the accelerator used in Jendrassik-Grof method?

a. caffeine-sodium benzoate
b. methanol
c. acetone
d. none of the above

RATIONALE: Caffeine sodium benzoate is used as an accelerator to help unconjugated

bilirubin become water soluble to react with diazo reagent.

67. The best site for collecting blood by skin puncture from a newborn is:
a. big toe
b. palm
c. central portion of the heel
d. lateral portion of heel

RATIONALE: For infants up to one year old, including premature neonates, the medial or
lateral plantar surface of the heel is the recommended puncture location. The heel bone
(calcaneus) is not situated below the skin in this area in nearly all babies, therefore it is
protected from injury and complications.
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

68. a pipet has an etched ring near the mouth end. It should be:
a. rinsed after delivery of the liquid
b. allowed to freely drained
c. blown out
d. used for critical measurements

RATIONALE: Blown-out pipet has a continuous etched ring on top of the pipet; exact value
is obtained when the last drop is blown out.

69. absorbance (A) of a solution may be converted to percentage transmittance (%T) using
the formula:
a. 1+log%T
b. 2+log%T
c. 1-log%T
d. 2-log%T

RATIONALE: Absorbance (A) is the inverse of transmittance and indicates how much light
was absorbed by the sample. The term "optical density" is also used to describe it. To convert
a value from absorbance to percent transmittance, use the following equation: %T = antilog
(2 – absorbance).

70. Which tube should be the last to be filled in venipuncture by vacutainer system?
a. red top
b. lavender top
c. gray top
d. green top

RATIONALE: This tube contains potassium oxalate as an anticoagulant and sodium fluoride
as a preservative – used to preserve glucose in whole blood and for some special chemistry
tests. After the tube has been filled with blood, immediately invert the tube 8-10 times to mix
and ensure adequate anticoagulation of the specimen.

71. Which of the following test is commonly done with a green top heparin tube
a. cholesterol
b. ammonia
c. glucose
d. creatinine

72. As an anticoagulant EDTA acts by:

a. removal of Ca++ by chelation
b. forming a weakly dissociated Ca complex
c. forming a double salt with calcium
d. all of the above
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

RATIONALE: The anticoagulant activity of EDTA is based on the chelation of free Ca2+
ions, which inhibits thrombocyte aggregation and numerous hemostatic cascade processes.

73. Anticoagulants adversely affect mainly the following test(s):

a. total protein
b. bilirubin and heme metabolites
c. enzymes
d. cholesterol and lipids

RATIONALE: Anticoagulant interfere with the protein in your blood that are involved in
the coagulation process affecting mainly the test for total protein.

74. Deviation from the true values caused by indeterminate errors inherent in every
laboratory measurement is:
a. standard error of mean
b. CV
c. Random error
d. Normal distribution

RATIONALE: As a result of the dispersion of measurement data around the mean

Random errors can decrease the precision of a set of laboratory measurements.

75. This NPN is formed by the action of xanthine oxidase in the liver and intestine.
a. ammonia
b. creatine
c. Urea
d. Uric acid

RATIONALE: The oxidative hydroxylation of hypoxanthine to xanthine and xanthine to uric

acid which is part of the purine metabolism, is catalyzed by xanthine oxidoreductase.
Xanthine oxidase is restricted to the liver and intestine.

76. Which of the following can employ a polarographic oxygen electrode:

a. hexokinase
b. o-toluidine
c. Glucose oxidase
d. Nelson-somogyi

RATIONALE: In the presence of oxygen, glucose is oxidized, and glucose oxidase catalyzes
the reaction: this type of electrode can monitor the rate of oxygen consumption.
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

77. the most likely cause of a control sample drifting downwards for a month is:
a. inadequate mixing of samples after thawing
b. contamination of the standard
c. recalibration error
d. expiring reagent
RATIONALE: The performance of reagents and components diminishes over time, leading
in the sample to decrease downward drift, which is frequently identified by the technique
of calibration.

78. wavelength accuracy is performed on a spectrophotometer to check the quality control

of:
a. magnesium oxide glass filter
b. holmium oxide glass filter
c. hydrogen oxide glass filter
d. helium oxide glass filter

RATIONALE: The use of the holmium glass reference filter assures that the optical
configuration of your quality control is exactly the same as for a normal analysis. It is used
to confirm that the wavelength accuracy of the spectrophotometer is within the tolerances
Tolerances set by the manufacturer for the wavelength being measured.

79. on a QC chart, a statistical out-of-control situation would be suspected when:

a. one plot falls outside the area of +/- 3 SD on 20 consecutive days
b. on plot falls within the area of +/- 2 SD on 20 consecutive days
c. 6 successive plots fall above and below the mean within +/- 1SD
d. 6 successive plots fall above and below the mean within +/- 2SD

RATIONALE: If one plot falls outside the area of +/- 3SD on 20 consecutive days this is
suspected of a statistical out of control situation if this happened it requires a corrective
action immediately.

80. calculate the CV when +/- SD = +/- 7mg/dL and the mean is 89mg/dL
a. 6.4%
b. 7.9 %
c. 12.7 %
d. 15.7 %
RATIONALE: Formula used:
CV= SD/mean x 100

= 7mg/dL X 100
89mg/Dl
= 7.9%
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

81. Pre-analytical errors is composed of the following except:

1. improper specimen container
2. increase turnaround time
3. incorrectly interpreted laboratory request
4. incomplete laboratory result
5.insufficient patient preparation
a. 1, 3
b. 2, 4
c. 1, 4
d. 2, 5

RATIONALE: Incomplete laboratory results and increased turn-around time will result in
laboratory results being delayed or unavailable, which is a type of post-analytical error.

MATCH:

I. Design

b 82. To contain (TC) a. will dispense the volume indicated;

most accurate
a 83. To deliver (TD) b. holds a particular volume but doesn’t
dispense the exact volume

II. Drainage Character

b 84. Blown-out a. user allows the contents of the pipet to “drain by gravity”
(w/o etched ring)
a 85. Self-draining b. the last drop of liquid should be expelled into the vessel
(w/ etched ring)

III. Types

A. Measuring

c 86. Serologic a. does not have graduations to the tip and is a self-draining pipet
a 87. Mohr b. a pipet that only holds less than 1 mL
b 88. Micropipe c. has calibration marks to the tip and is a blow-out pipet

B. Transfer
 CLINICAL CHEMISTRY BOARD REVIEW EXAM SET 2

c 89. Volumetric a. is used with biological fluids having viscosity greater that
water
a 90. Ostwald-folin b. the most routinely used pipet nowadays; easy to use, high
precision
d 91. Pasteur c. designed to dispense aqueous solutions and is always a self-
draining pipet
b 92. Automatic pipet d. Do not have any calibration marks and are used to transfer
solutions or biological fluids without consideration of a specific
volume

IV. Automatic pipets

c 93. Air-displacement a. operates by moving the piston in the pipet tip

or barrel
a 94. Positive-displacement b. obtain the liquid from a common reservoir and
dispenses it.
b 95. dispenser pipet c. relies on a piston mechanism for suction
generation to draw the sample into a disposable
pipet tip

V. Standard Hazards ID sys.

d 96. Blue Quadrant a. other special information (e.g., corrosive)

c 97. Red Quadrant b. presents no more than moderate hazard (general
storage)
e 98. Yellow Quadrant c. flammable Hazards
a 99. White Quadrant d. Health Hazards (e.g., toxic)
b100. Gray Quadrant e. Reactivity/Stability Hazard