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Module 2: Chemical Pathology and Immunology: Practice Questions

1. (C3) A 33-year-old woman has been drinking large amounts of water for the past week. On examination her temperature is 37 C, pulse 109/min, respiratory rate 25/min, and blood pressure 95/65 mm Hg lying down and 80/50 mm Hg standing. She has dry mucous membranes and skin tenting. Which of the following serum laboratory tests is most useful for elucidating the mechanism for her disease?

A. Albumin

B. Bicarbonate

C. Cortisol

D. Creatinine

E. Osmolality

F. Protein electrophoresis

2.(C6) An 81-year-old woman has had fever with burning pain on urination for the past 4 days. On examination she has suprapubic tenderness. Laboratory studies with CBC show WBC count of 14,700/microliter with 80% segmented neutrophils, 17% lymphocytes, and 3% monocytes. Which of the following urinalysis findings is most indicative of renal involvement in this woman?

A. Bacteriuria > 100,000/mL

B. Dysmorphic red blood cells

C. Positive leukocyte esterase

D. Specific gravity of <1.010

E. White blood cell casts

3. (C7) A 68-year-old man undergoes colonoscopy. A 6 cm ulcerated, circumferential mass is found in the descending colon. Which of the following sets of laboratory findings is most indicative of hepatic involvement by this colonic process?

AST ALT Alk Phos.Albumin Bilirubin
A. NormalNormalNormalNormal Elevated
B. NormalNormalElevatedNormalNormal
C. NormalNormalElevatedNormal Elevated
D. ElevatedElevatedNormal DecreasedNormal
E. ElevatedElevatedNormalNormalElevated
F. ElevatedElevatedElevated Decreased Elevated

4. (C8) A 66-year-old man has had back pain for 6 months. He now has a productive cough and fever. A chest x-ray shows patchy pulmonary infiltrates. Laboratory findings include total protein 9 g/dL, albumin 4.3 g/dL, globulin 4.7 g/L, alkaline phosphatase 200 U/L, AST 50 U/L, ALT 20 U/L, and total bilirubin 1 mg/dL. Which of the following additional laboratory findings is he most likely to have?

A. Alpha-1-antitrypsin deficiency

B. Bence-Jones proteinuria

C. Blasts on the peripheral blood smear

D. Positive hepatitis B surface antigen test

E. Positive HIV test

5. (C9) A 45-year-old woman has had a cough with hemoptysis for the past month. On examination she has rales in all lung fields. A chest x-ray shows reticulonodular infiltrates. Laboratory findings include serum creatinine 4 mg/dL and urea nitrogen 38 mg/dL. Which of the following autoantibody tests is most likely to be useful in diagnosis of this womanÕs underlying disease?

A. Anti-cyclic citrullinated peptide

B. Anti-DNA topoisomerase I

C. Anti-double stranded DNA

D. Anti-neutrophil cytoplasmic antibody

E. Anti-ribonucleoprotein

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