Institute of Nutritional Endocrinology (INE): Advanced Lab Testing: Module Exam

Advanced Lab Testing
Module Exam

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ine-exam It’s time to fully review and put your learning to the test!

Below you’ll find a list of open-book, comprehensive, multiple-choice questions related to this module.

You will have 3 attempts to pass (the passing score is 80%).

If you make two unsuccessful attempts, make a note of the areas that are providing challenges for you, then reach out on an upcoming support call or use the Facebook group to find yourself a study partner.

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#1: ____________ may be used to assess diabetes.

Glucose greater than 120 on two consecutive
Hemoglobin A1C > 6.5
Triglycerides > 110
Cholesterol < 55
Blood Pressure increased
All of the above
None of the above

Correct!

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#2: Normal blood sugar level peaks at about 45 minutes.

True
False

Correct!

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#3: RBCs coated with lots of sugar result in ______ hemoglobin A1C.

Elevated
Decreased
Ideal
Absent

Correct!

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#4: ______________ is when sugar coats the red blood cell.

Sulfation
Glucuronidation
Glycation
Oxidation

Correct!

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#5: Hemoglobin A1C, Fructosamine, and Insulin can be run as early screening before waiting for fasting glucose to go above 120.

True
False

Correct!

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#6: ______ gives an indication of how much insulin is needed to keep blood sugar levels in check.

HOMA-IR score
QUICKI
C-peptide
Glyco-mark

Correct!

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#7: ________ is/are elevated in Type 1 diabetes and Latent Autoimmune Diabetes of Adulthood.

QUICKi
Glyco-mark
C-peptide
HOMA-IR score
Blood Sugar Related Antibodies.

Correct!

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#8: This antibody causes increased glutamate and decreased GABA in the pancreas and is present in about 75% of people with type 1 diabetes.

Glutamic Acid Decarboxylase
Anti-Insulin
Anti Islet Cell
Zinc transporter
Tyrosine phosphatase

Correct!

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#9: These antibodies attack the islet cells in the pancreas hence decreasing their effectiveness at making insulin.

Glutamic Acid Decarboxylase
Anti-Insulin
Anti-Islet Cell
Zinc transporter
Tyrosine phosphatase

Correct!

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#10: According to Dr. Ritamarie, when there is suspicion that someone isn’t making enough insulin or is at risk for type 1 diabetes or LADA:

Test fasting insulin and postprandial insulin at 45 minutes to one hour after their highest possible carbohydrate meal they would allow themselves to eat.
Pick one antibody to run - usually GAD
All of the above
None of the above

Correct!

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#11: Cardiac-related inflammation and oxidative stress markers are:

C-Reactive Protein (hs-CRP), Homocysteine
Erythrocyte Sedimentation Rate
Oxidized LDL, F2 Isoprostanes
All of the above

Correct!

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#12: CRP above 3.0 mg/L indicates ________ risk for cardiovascular disease.

Low
Average
High
Extreme

Correct!

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#13: C-Reactive Protein _________ during systemic inflammation.

Increases
Decrease
Does not change
Remains the same

Correct!

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#14: Low hs-CRP is associated with sudden cardiac death and peripheral arterial disease.

True
False

Correct!

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#15: CRP cannot be lowered.

True
False

Correct!

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#16: Consume anti-inflammatory foods and herbs to support lowering CRP.

True
False

Correct!

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#17: High homocysteine can damage artery linings.

True
False

Correct!

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#18: __________ measures how quickly red blood cells settle at the bottom of a test tube that contains a blood sample.

Homocysteine
hs-CRP
Erythrocyte Sedimentation Rate
F2 Isoprostanes
Oxidized LDL

Correct!

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#19: __________ measures damage of the ApoB protein subunit on the surface of LDL due to oxidative modification.

Homocysteine
hs-CRP
Erythrocyte Sedimentation Rate
F2 Isoprostanes
Oxidized LDL

Correct!

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#20: Elevated OxLDL increases risk of developing metabolic syndrome.

True
False

Correct!

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Next >

1/7

#21: __________ is a prostaglandin-like compound from free radical oxidation of arachidonic acid.

Homocysteine
hs-CRP
Erythrocyte Sedimentation Rate
F2 Isoprostanes
Oxidized LDL

Correct!

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#22: This HDL pattern is the most protective.

Large HDL 2
Small HDL 3
Apolipoprotein A1
None of the above

Correct!

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#23: The most desirable LDL pattern is __________.

Pattern A (large LDL)
Pattern B (small, dense LDL3, LDL4)
Pattern A/B
None of the above

Correct!

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#24: Apoliprotein B (ApoB) is the major protein found in cholesterol.

True
False

Correct!

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#25: High levels of ApoB are a sign of small, dense LDLs.

True
False

Correct!

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#26: High levels of ApoB are desirable.

True
False

Correct!

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#27: Low levels of Lp(a) increase risk of heart attack, stroke, blood clots, fatty build-up in veins artery coronary bypass.

True
False

Correct!

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#28: Lp-PLA2 greater than 200 increases the risk of CHD events.

True
False

Correct!

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#29: Statins lower Lp(a).

True
False

Correct!

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#30: The ‘Tool Box’ for vascular integrity includes__________.

Nutrition, Omega 3, Coenzyme Q10
Fiber, Niacin, Red Yeast Rice
Statins, beta blockers
Plant sterols
All of the above
All except statins & beta blockers

Correct!

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#31: Myeloperoxidase is an inflammatory enzyme and specific marker of vascular inflammation.

True
False

Correct!

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#32: Too much ___________ protein in the blood increases your risk of a heart attack.

Apoliprotein B
F2 Isoprostanes
Fibrinogen
MPO

Correct!

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#33: Trimerhylamine N-oxide (TMAO) levels can be decreased by taking choline, lecithin, and L-carnitine.

True
False

Correct!

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#34: High levels of TMAO decreases the risk of heart disease, heart attack, stroke, and atherosclerosis.

True
False

Correct!

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#35: High levels of Aminoterminal Pro-bran Natriuretic Peptide (NT-proBNP) is linked to a higher risk of heart and blood vessel disease.

True
False

Correct!

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#36: NT-proBNP is released in response to changes in pressure inside the heart.

True
False

Correct!

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#37: ____________ images the coronary arteries and detects plaque buildup.

MPO
TMAO
NT-proBNP
Calcium CT Score

Correct!

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#38: __________ high-resolution ultrasound used to identify plaque in the carotid arteries in the neck.

Calcium CT Score
Carotid Intima-Media Thickness Test (CIMT)
Asymmetric Dimethylarginine
TMAO

Correct!

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#39: ADMA (Asymmetric Dimethylarginine) can reduce the production of nitric oxide.

True
False

Correct!

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#40: Global Risk Score is a tool to rate risk of developing heart disease or having a heart attack within the next 10 years.

True
False

Correct!

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< Previous

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2/7

#41: Markers for acute myocardial infarction testing are _________.

TMAO and MPO
NT-proBNP and ApoB
ACS cardiac troponin and Creatine kinase-MB
ESR and hs-CRP

Correct!

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#42: Acute Myocardial Infarction Testing (troponin and CK-MB) is the test of choice for acute MI.

True
False

Correct!

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#43: Anti-nuclear antibodies (ANA) attack the nucleus and a trigger for autoimmune disorders.

True
False

Correct!

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#44: A positive ANA test means definite Lupus or other autoimmune condition.

True
False

Correct!

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#45: Infection, malignancy, and certain medications can cause a false-positive ANA.

True
False

Correct!

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#46: Fluorescent Anti-Nuclear Antibodies (FANA) Testing is performed by viewing under a microscope to determine the pattern and intensity of the fluorescence.

True
False

Correct!

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#47: There is only one test to confirm Lupus.

True
False

Correct!

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#48: _______ is found in 30% of people with lupus and suggests more serious lupus, such as lupus nephritis.

Anti-ds-DNA
Anti-smith
Anti-u1rnp
anti-ro/SSA
Antinucleoprotein

Correct!

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#49: _______ is found almost exclusively in people with lupus.

Anti-ds-DNA
Anti-smith
Anti-u1rnp
anti-ro/SSA
Antinucleoprotein

Correct!

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#50: Anti-U1rnp antibodies is not specific to lupus.

True
False

Correct!

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#51: ________ main antibodies found in primary Sjogren’s syndrome.

Anti-smith
Anti-u1rnp
Anti-Ro/SSA and Anti-La/SSB
Antinucleoprotein

Correct!

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#52: _______ usually found in people with drug-induced lupus.

Anti-histone antibodies
Anti-u1rnp
Anti-Ro/SSA
Antinucleoprotein

Correct!

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#53: _______ is 97% specific for Rheumatoid Arthritis.

Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
Rheumatoid factor(RF)
Anti-cyclic citrullinated peptide (anti-CCP) antibodies
Antinuclear antibody (ANA)

Correct!

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#54: Cyrex Labs Array 5 is the Autoimmune Screening Panel.

True
False

Correct!

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#55: Cyrex Array 5 antibodies test by itself is not diagnostic for any condition or disease.

True
False

Correct!

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#56: Dr. Ritamarie Loscalzo has a ‘5 Part Framework for Reversing Autoimmunity’.

True
False

Correct!

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#57: The 5 steps to reversing autoimmunity are __________.

Swap, Reduce, Wound, Balance, Optimize
Swap, Reduce, Heal, Balance, Optimize
Swap, Increase, Heal, Balance, Optimize
Swap, Reduce, Heal, Balance, Minimize

Correct!

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#58: Urea Breath Test, Stool Antigen Test, ELISA Serology, and Endoscopic Biopsy test for _______.

H. pylori
Hepatitis
EBV
CMV

Correct!

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#59: _______ detects Hepatitis A as soon as 2 weeks but disappears within 3-12 months.

IgM antibodies
IgG antibodies
IgA antibodies
IgE antibodies

Correct!

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#60: Test that identifies a current or past Hepatitis B infection within a few weeks.

Surface antigen test
Core antibody test
Surface antibody test
All of the above

Correct!

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3/7

#61: This test determines whether the Hepatitis C virus is present and how much.

Antibody test
Surface antibody test
Qualitative HCV RNA test
Surface antigen test

Correct!

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#62: ALT, AST, ALP, bilirubin, albumin, total protein, Prothrombin Time, GGT, LD, Alpha-fetoprotein tests are useful when evaluating hepatitis.

True
False

Correct!

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#63: Epstein Barr virus (EBV) is also known as human herpesvirus 4.

True
False

Correct!

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#64: Tests to identify EBV are _____.

Viral capsid antigen (VCA)
Early antigen (EA)
EBV nuclear antigen (EBNA)
Monospot test
All of the above

Correct!

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#65: Monospot test confirms the presence of EBV infection.

True
False

Correct!

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#66: Chronic Activated EBV is diagnosed based on symptoms, a clinical exam, high EBV DNA in the blood which persists for at least 3 months.

True
False

Correct!

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#67: The ___________ virus causes sores or blister in or around the mouth or genitals.

Hepatitis
Epstein Barr
Herpes Simplex
H.pylori

Correct!

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#68: Tests to identify herpes are:

Swab test
Blood test
Lumbar puncture
Monospot test
All of the above
All except monspot

Correct!

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#69: _________________ is caused by varicella zoster virus and is also known as shingles.

Herpes Zoster
Cytomegalovirus
Hepatitis
Epstein Barr

Correct!

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#70: ______ is the most sensitive test for confirming herpes zoster.

Direct fluorescent antibody
Tzanck smear
PCR
Blood tests

Correct!

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#71: Cytomegalovirus (CMV) is a herpes-type virus and can cause unexplained jaundice or anemia.

True
False

Correct!

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#72: _______ identifies primary CMV infection when paired with low IgG.

IgM antibodies
IgG antibodies
PCR
Blood tests

Correct!

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#73: PCR detects active rubella infections directly from the rash.

True
False

Correct!

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#74: The most common test(s) for lyme disease is _______.

Borrelia IgM and IgG antibodies
PCR-based tick testing
ELISA and Western blot
Tzanck smear

Correct!

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#75: Many people get false negative lyme disease tests because the recommended two-tier testing is not performed.

True
False

Correct!

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#76: ELISA Lyme Disease testing tests for multiple strains of Borrelia.

True
False

Correct!

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#77: ELISA for Lyme Disease only detects Borrelia burgdorferi B31.

True
False

Correct!

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#78: Lyme Immunofluorescent Assay is designed to detect Borrelia burgdorferi specific antibodies, IgA, IgM, and IgG in human serum.

True
False

Correct!

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#79: _________ Lyme disease testing is more sensitive and specific for Lyme disease, especially in early or late stage when antibody levels are very low.

ELISA
IFA
Western Blot
IGeneX ImmunoBlot

Correct!

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#80: ________ can detect lyme infections at multiple stages of illness and reduces inconsistencies in reading and interpreting bands.

ELISA
IFA
Western Blot
IGeneX ImmunoBlot

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4/7

#81: Advanced inflammatory markers are __________.

Tumor necrosis factor alpha (TNF)
Complement
Cytokines
Interleukins
Oxidative stress markers
Lipid peroxidation markers
All of the above

Correct!

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#82: ________ an acute phase responder in the immune system, is involved with autoimmune disorders, and may only appear in serum or spinal fluid for a very short period of time at the onset of an illness.

Tumor necrosis factor alpha (TNF)
Complement
Cytokines
Interleukins

Correct!

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#83: _________ tests for complement proteins C3 and C4 consumed by the inflammatory process.

Serum Complement
Cytokines
Interleukins
Oxidative stress markers

Correct!

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#84: Cytokines are small soluble proteins that mediate communication between cells.

True
False

Correct!

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#85: Cytokines only affect non-immune cells.

True
False

Correct!

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#86: Interleukins is a group of cytokines that regulate immune functions and inflammation.

True
False

Correct!

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#87: IFN-g is important in response to ______ infections.

Viral
Bacterial
Only bacterial
Both viral and bacterial

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#88: ____________ evaluates oxidative damage to lipids and DNA.

Oxidative Stress 2.0 Urine test
Serum Complement test
TNF test
Cytokine test

Correct!

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#89: Repeated cycles of lipid peroxidation cannot cause serious damage to cell membranes.

True
False

Correct!

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#90: Repeated cycles of lipid peroxidation can cause serious damage to cell membranes.

True
False

Correct!

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#91: The most commonly used lipid maker of oxidative stress is malondialdehyde (MDA).

True
False

Correct!

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#92: Cancer-related labs are _______.

C-Reactive Protein (hs-CRP), Advanced Lipid Profile and Lp(a)
Homocysteine, Tumor Markers
Vanilymandelic Acid (VMA), Miscellaneous Serum marker
Genetic Risk Factors
All of the above

Correct!

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#93: __________ is elevated in epithelial cancers.

Advanced Lipid Profile
Lp(a)
Tumor Markers
C-Reactive Protein

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#94: There is emerging evidence of a link between lipid imbalances and increased risk of cancer.

True
False

Correct!

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#95: Elevated circulating total homocysteine has been noted in cancer patients.

True
False

Correct!

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#96: ________ is a tumor marker for prostate cancer.

CA 125
CEA
PSA
AFP

Correct!

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#97: ________ supports diagnosis of neuroblastoma.

C-Reactive Protein
Vanilymandelic acid
Total homocysteine
B2M

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#98: There are cancer genetic risk markers for estrogen metabolites.

True
False

Correct!

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#99: The most important anemia blood markers are RBC, Hemoglobin, Hematocrit, MCV, and RDW.

True
False

Correct!

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#100: Iron deficiency anemia blood markers are _________.

RBC, Hgb, HCT
Ferritin, Transferrin, TIBC, Transferrin Saturation
Iron, MCV, RDW
MCHC, RBC, Hgb, HCT

Correct!

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5/7

#101: __________ is the storage form of iron.

Transferrin
Transferrin saturation
Ferritin
Iron

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#102: There is only one stage of progression of iron leading to iron deficiency anemia.

True
False

Correct!

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#103: There are 3 stages of progression of iron deficiency anemia.

True
False

Correct!

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#104: Progression of Iron deficiency anemia

Decreased iron store, iron deficiency anemia, decreased iron
Decreased iron, decreased iron stores, iron deficiency anemia
Decreased iron stores, decreased iron, iron deficiency anemia
Iron deficiency anemia, decreased iron store, decreased iron

Correct!

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#105: Decreased ferritin, normal serum iron, normal transferrin, normal MCV, normal hemoglobin

Stage 1 Decreased Iron Stores
Stage 2 Decreased Iron
Stage 3 Iron deficiency Anemia

Correct!

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#106: Decreased ferritin, decreased serum iron, increased transferrin, normal MCV, normal or low hemoglobin

Stage 1 Decreased Iron Stores
Stage 2 Decreased Iron
Stage 3 Iron deficiency Anemia

Correct!

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#107: When anemia markers show high iron, low ferritin, suspect ___________.

Hemochromatosis
Liver inflammation
Vitamin B6 deficiency
Low melatonin

Correct!

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#108: When anemia markers show high iron, low ferritin, suspect ___________.

Hemochromatosis
Liver inflammation
Vitamin B6 deficiency
Low melatonin

Correct!

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#109: There are no methylation blood markers.

True
False

Correct!

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#110: Homocysteine, MCV, Methylmalonic acid, Folate and metabolites, and serum Vitamin B12 are ____________ markers.

Iron deficiency
Methylation
Liver inflammation
Low melatonin

Correct!

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#111: ____________ commonly used to evaluate for vitamin B12 deficiency.

Iron
Ferritin
Methylmalonic acid
Hydrochloric acid

Correct!

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#112: Low AST, ALT, GGT, Alk Phos with high iron and high RDW suggest need for vitamin B6.

True
False

Correct!

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#113: Elevated anion gap and fasting glucose, low CO2, low hemoglobin, low hematocrit, low LDH suggests a need for vitamin B2 support.

True
False

Correct!

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#114: You have a client with the following labs: high alkaline phosphatase, RBC, MCV, MCH, MCHC and low hemoglobin & hematocrit. What nutritional need does this indicate?

Vitamin A
Vitamin B1
Vitamin C
Vitamin D

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#115: Low alkaline phosphatase and low WBC indicate _______________ deficiency

Zinc
Molybdenum
Selenium
Copper

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#116: Ceruloplasmin is decreased when copper storage is excessive.

True
False

Correct!

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#117: Blood marker ratios are not significant.

True
False

Correct!

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#118: Failure to store excess iron as ferritin

Serum iron: ferritin high
Serum iron: ferritin low
Serum iron: ferritin equal
None of the above

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#119: High Serum iron : Low hemoglobin ratio suggests vitamin B6 deficiency

True
False

Correct!

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#120: High triglycerides with relation to HDL is usually indicative of insulin resistance.

True
False

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#121: Low BUN/Creatinine ratio suggests kidney dysfunction, high protein diet, dehydration or GI Bleeding.

True
False

Correct!

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#122: Low anion gap is rare.

True
False

Correct!

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#123: Thiamine deficiency, metabolic acidosis, dehydration, toxin ingestion, diabetes, lactic acidosis.

Low anion gap
High anion gap
Serum iron : ferritin
None of the above

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#124: Inflammation, selenium deficiency, high or low cortisol

Low free T3 : Free T4
High free T3: Free T4
High BUN/Creatinine ratio
Low cholesterol : HDL

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#125: High Free T3 : Reverse T3 ratio is not clinically significant.

True
False

Correct!

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#126: Metabolic syndrome, Insulin resistance, non-alcoholic fatty liver, obesity

Low ALT: AST
High ALT: AST
High Triglycerides : HDL
High Free T3 : Free T4

Correct!

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#127: Low Calcium : Albumin ratio is generally not significant but could be vitamin D or calcium deficiency

True
False

Correct!

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#128: Hyperparathyroid, hypothyroid, hyperinsulinemia, cell or tissue damage, or high refined carb diet

Low Calcium: Phosphorus
High Calcium : Phosphorus
Low free T3 : Free T4
High free T3: Free T4

Correct!

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#129: Great Plains Toxin (toxic non-metal chemicals) screens for 172 toxic chemicals in a single urine sample.

True
False

Correct!

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#130: Some reasons to run a toxin panel are __________.

Alzheimer’s disease, depression, Parkinson’s disease
Bipolar disorder, schizophrenia, obsessive compulsive disorder
Systemic lupus erythematosus, fibromyalgia
Autoimmune disorder, anxiety disorder, learning disability
All of the above
None of the above

Correct!

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#131: It is possible to reduce toxic load with organic foods that support detox and elimination of foods that slow it detox down, saunas, exercise, glutathione, NAC, and niacin.

True
False

Correct!

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#132: Great Plains MycoTox panel screens for 11 mycotoxins from 13 mold types and 40 species of mold.

True
False

Correct!

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#133: If mold is found it is necessary to remove the exposure by moving or remediating.

True
False

Correct!

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#134: Great Plains Mold IgE Allergy Test tests 13 mold allergens.

True
False

Correct!

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#135: There are no dangers associated with glyphosate.

True
False

Correct!

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#136: Glyphosate has been classified as probable carcinogen in humans by the World Health Organization.

True
False

Correct!

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#137: Great Plains supplies detailed report explanations for identified toxins.

True
False

Correct!

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Advanced Lab Testing
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About Dr. Ritamarie Loscalzo

Dr. Ritamarie Loscalzo, MS, DC, CCN, DACBN, has been an integrative practitioner for over 2 decades, combining the best from modern functional medicine with the natural healing wisdom of fresh, raw foods and herbs.

The founder of the Institute of Nutritional Endocrinolgy, Dr. Ritamarie specializes in nutritional endocrinology, using the wisdom of nature to help clients restore balance to hormones, with special emphasis on thyroid, adrenal, and insulin imbalances. She integrates biochemistry, nutrition, herbs, and the power of the mind to create a vibrant life filled with passion and purpose.

A Chiropractic Doctor -- certified in acupuncture, nutrition and herbal medicine, as well as a certified living foods chef, instructor, coach, speaker, and author -- Dr. Ritamarie offers online courses, long distance coaching and counseling, as well as in-person classes and healing methodology.

Her wildly popular Nutritional Endocrinology Practitioner Training (NEPT) certification program empowers health and wellness professionals to unravel the mystery of their client’s complex health challenges and become known as go-to practitioners for true healing and lasting results.

Institute of Nutritional Endocrinology (INE): Advanced Lab Testing: Module Exam

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