BOC Practice 1

Calcium-alginate swabs on wire shaft

Direct detection methods are available for Bordetella pertussis from nasopharyngeal specimens; however, caution should be used when collecting the specimen because inhibition can occur based on the type of swab that is used. Which of the following swabs have an inhibitory effect on PCR testing for Bordetella pertussis? Level-5 Microbiology

169 mg/dL

The formula for conversion of hemoglobin A1C (HbA1C) to glucose in mg/dL is eAG = (28.7 x A1C) - 46.7. The HbA1C measured on a patient is reported as 7.5%. What would be reported as the estimated average glucose (eAG) for this % A1C (rounded to the nearest whole number)? Level-2 Chemistry

Leukemia with CNS involvement

The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions? Level-3 Hematology

Sepedonium

The image is a high power image of a methylene-blue stained mount prepared from the surfaces of the colony. Select the fungus genus from the multiple choices as listed. Level-8 Microbiology

Dohle bodies

The light blue-gray inclusions observed in the cytoplasm of many of the bands and segmented neutrophils of a burn patient are most likely? Level-4 Hematology

A defective X-linked recessive gene.

The most common forms of hereditary sideroblastic anemia (SA) are due to which of the following? Level-5 Hematology

Helicobacter pylori

The organism seen in the image is found in the stomach mucosa and presumptive identification is often obtained from a positive urease test. Select the organism below. Level-3 Microbiology

Red to brown

The oxidation of hemoglobin to methemoglobin in an acidic urine after several hours may cause which of the following color to produce? Level-3 Urinalysis/Body Fluids

Viral meningitis

The predominant cells seen in this CSF are from a twelve-year-old female exhibiting fever, lethargy and a stiff neck. The WBC count on the sample was 2,000/microliter. The findings most likely indicate: Level-3 Hematology

Bronchitis

The recovery of Mycoplasma hominis from the genital tract of females has been associated with all of the following clinical syndromes EXCEPT: Level-3 Microbiology

Corynebacterium diphtheriae

The serum medium and methylene blue stain originally described by Loeffler are both helpful in the identification of: Level-5 Microbiology

Vanillylmandellic acid (VMA)

The ultimate end product of both epinephrine and norepinephrine metabolism is: Level-5 Chemistry

Clozapine

Tricyclic Antidepressants (TCAs) are used to treat insomnia, depression, extreme apathy, and loss of libido. All of the following are TCAs, EXCEPT? Level-5 Chemistry

Clotting, plug formation, release of serotonin, and repair of the injured tissues.

What are function(s) of the platelet? Level-4 Hematology

Decrease in both

What changes in potassium and sodium serum results may occur with diuretic use? Level-6 Chemistry

The study of human capabilities in relation to work demands

What is ergonomics? Level-4 Lab Operation

Detect antibodies in recipient serum/plasma that react with donor red blood cells.

What is the fundamental purpose of the full, pre-transfusion crossmatch? Level-4 Blood Bank

Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are resistant and will stain pink with the counter stain.

What is the principle of the Kleihauer-Betke test? Level-2 Blood Bank

Detect small urinary concentrations of albumin before there is irreparable renal damage.

What is the role of albuminuria testing? Level-4 Chemistry

RBC cast

What type of cast is shown in the illustration? Level-4 Urinalysis/Body Fluids

Decreased serum copper

When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: Level-5 Chemistry

Washing prevents neutralization of the anti-human globulin (AHG) serum.

When performing an anti-human globulin (AHG) test, it is important to completely wash the red cells because: Level-6 Blood Bank

Candida albicans

The formation of germ tubes after 2 hours of incubation in plasma at 35° C leads to the presumptive identification of which of the following yeasts? Level-2 Microbiology

Beta hemolytic Streptococcus, Group A

A beta-hemolytic Streptococcus was isolated from a throat culture. It gave the following biochemical reactions: Bacitracin -Susceptible Bile esculin -Negative 6.5% NaCl -No growth CAMP -Negative SXT -Resistant What is the presumptive identification? Level-4 Microbiology

Vitamin K

A deficiency in which of these vitamins leads to increased clotting time and may result in hemorrhagic disease? Level-2 Chemistry

Passive anti-D from RhIG given at 28 weeks.

A maternal sample is collected 2 hours after delivery and a type and screen is performed. The screen is weakly positive and an anti-D is identified. Which of the following is the most likely cause of the positive antibody screen? Level-5 Blood Bank

Fya-; Fyb+; C-c+; K+k-

A patient has a probable anti-Fya; however, anti-c and anti-K have not been excluded. Which of the following cells would be the most useful cell to exclude both anti-c and anti-K efficiently in this patient? Level-5 Blood Bank

281 mosmol/kg

A patient has the following serum results: Na = 130 mEq/LK = 4.9 mEq/LCl = 107 mEq/LGlucose = 300 mg/dLBUN = 18 mg/dLCreatinine = 1.1 mg/dL Which osmolality result is consistent with these results?. Level-6 Chemistry

Macrophages with purple/black inclusions

A patient presents to his family doctor with respiratory issues. He has a history of being a heavy smoker for more than 20 years, so the physician orders a BAL cell count with differential. Which of the following cells would most closely correlate with the patient's medical history? Level-5 Urinalysis/Body Fluids

Leukoreduced

A patient with a documented history of febrile nonhemolytic transfusion reactions (FNHTRs) should receive __________ blood components. Level-4 Blood Bank

Dietary iron deficiency

A two-year old male patient has the following hemogram results: Hgb = 6.7g/dLHct = 20%Platelets = 355 x 109/LRBC = 3.0 x1012/LWBC = 8.75 x 109/L Level-7 Hematology

Trichomonas vaginalis

A women presents to her physician with complaint of a foul smelling vaginal discharge. The following are reported from the submitted sample of the yellow vaginal secretion: Wet prep: Many WBCs seen, no Clue cells seen, microorganism (20µm) seen with jerky motility Level-3 Microbiology

Oxidase

A wound specimen was received into the laboratory and a large Gram positive rod was isolated. The microbiologist suspected the isolate was a probable Bacillus anthracis and had to rule in/out before reporting. All of the following tests must be performed before calling the species Bacillus anthracis EXCEPT? Level-5 Microbiology

Chediak-Higashi syndrome

Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the following conditions? Level-3 Hematology

Monocyte

After briefly circulating in the peripheral blood, which of the following cells becomes a tissue macrophage (or histiocyte) whose main function is phagocytosis? Level-3 Hematology

Anti-Lua

All of the following are possible causes of the positive antibody screen EXCEPT? Level-5 Blood Bank

Fy(a-b-)

All of the following red blood cell phenotypes will react with Anti-Fy3, EXCEPT? Level-3 Blood Bank

They are never seen on normal peripheral blood smears

All of the following statements are correct regarding polychromatophilic red blood cells EXCEPT? Level-5 Hematology

Dilute partial thromboplastin time (DTT)

All of the following tests are useful in the diagnosis of heparin induced thrombocytopenia (HIT) EXCEPT: Level-5 Hematology

Nephrotoxicity and ototoxicity

Aminoglycosides can cause severe toxicity including which of the following? Level-5 Chemistry

K negative; Fya negative

An 82-year-old male is a long-time resident of a local nursing facility. He has been to your hospital multiple times over the years and has historically demonstrated antibodies against the K and Fya antigens. He has returned to your hospital following a 2-year absence, and his antibody screen is as follows. Which of the following red blood cells would you crossmatch for this patient? Level-2 Blood Bank

Magnesium

An important metallic activator of alkaline phosphatase and creatine kinase is: Level-5 Chemistry

Green in both tubes with a little blue at the top of the open tube

Asaccharolytic use of glucose would be indicated by which of the following reactions in OF glucose tubes? Level-6 Microbiology

Anti-K

Based on the phenotype of the RBC screening cells, and patient results given below, Anti-Jka and what additional antibody cannot be ruled out? Level-6 Blood Bank

Congenital B-cell disorder

Bruton's agammaglobulinemia is a: Level-5 Immunology

Actinomyces israeli

Coming from a deep penetrating splinter wound. The colonies on this young culture are small, rough, gray-white, and non-hemolytic. Older larger colonies became sunken centrally having a "molar tooth" appearance. The Gram stain reveals gram-positive branching filaments. Key biochemical reactions include hydrolysis of Esculin, nitrate reduction, and negative catalase Level-4 Microbiology

Vitamin B12 deficiency

Conditions suggested by the macrocytes and the neutrophil in the photograph to the right include Folate deficiency and which other condition? Level-3 Hematology

Kidney, bone, intestines, liver

Isoenzymes of alkaline phosphatase occur in: Level-5 Chemistry

Duschenne muscular dystrophy or cerebrovascular accident (stroke) or vigorous exercise.

Elevation of serum creatine kinase may be associated with: Level-3 Chemistry

Breast cancer

Estrogen (ERs) and progesterone (PRs) receptors used as tumor markers are most commonly employed to provide prognostic information about: Level-5 Chemistry

Ketones

Excessive carbohydrate loss that may occur due to vomiting, or rapid weight loss may result in the presence of which of following substances not normally contained in the urine? Level-2 Urinalysis/Body Fluids

20g

How many grams of sodium hydroxide are required to prepare a 200 ml solution of a 10% (weight per volume) solution? (Atomic weights: Na = 23; 0 = 16; H = 1) Level-4 Chemistry

3 SD

How many standard deviations (SD) above and below the mean is accepted as being an appropriate control limit range on a control chart utilizing the Westgard rules: Level-8 Lab Operation

Place it into an ice slurry.

How should an ammonia specimen be transported to prevent alteration of the ammonia level in the blood plasma? Level-1 Chemistry

Lymphocyte

Identify the nucleated blood cell that is indicated by the arrow: Level-1 Hematology

Nucleated red blood cells (NRBCs)

Identify the predominant nucleated cell this cerebrospinal fluid cytospin differential. Level-5 Hematology

The patient may experience toxic effects (high free drug fraction).

If a disease or disorder causes serum binding proteins (such as albumin) to decrease, what may occur if the dose of a highly protein-bound drug with a narrow therapeutic window is not adjusted? Level-4 Chemistry

Waldenström's disease

Immunoglobulin M (IgM) is the characteristically overproduced gene product found in: Level-5 Immunology

8

In heme synthesis, how many molecules of delta-aminolevulinic acid (ALA) are needed to form one molecule of heme? Level-5 Chemistry

Anti-Jkb

In providing crossmatch-compatible blood units, all of the following antibodies are most often clinically insignificant EXCEPT: Level-5 Blood Bank

Trichinella spiralis

Microscopic examination of peripheral blood may be diagnostic for infection with each of the following parasites EXCEPT: Level-1 Microbiology

Ureter

Name structure B from the image below: Level-2 Urinalysis/Body Fluids

Prevotella

Observation of colonies producing brick red fluorescence under long-wave ultraviolet light on KVLB agar allows for presumptive identification of which anaerobic bacterial genus? Level-9 Microbiology

PBP2a

Oxacillin resistance of MRSA is due to production of which of the following penicillin binding proteins (PBPs)? Level-4 Microbiology

Proportional to concentration of solute particles

The MOST accurate observation about osmotic pressure is that it is: Level-5 Chemistry

Microsporidium species

The acid-fast is negative with a positive Weber stain (Chromotrope 2R. Fast Green, phosphotungistic acid) confirming an identification. From the list of multiple choices, select the most probable presumptive identification. Level-5 Microbiology

Lowering the zeta potential

The addition of Low Ionic Strength Solution (LISS) to the testing environment when performing an indirect antiglobulin test is designed to do what? Level-5 Blood Bank

Cold agglutinin disorders

The arrangement of erythrocytes on this peripheral blood smear may be seen in each of the following conditions EXCEPT? Level-5 Hematology

Small lymphocyte

The cell diameter of a normal RBC is slightly smaller than the nucleus of which of the following blood cells? Level-2 Hematology

Dubin-Johnson syndrome

Which condition is caused by deficient secretion of bilirubin into the bile canaliculi? Level-6 Chemistry

Amphetamine

Which medication would be prescribed for narcolepsy? Level-5 Chemistry

Incompatible blood is transfused into a patient during surgery

Which occurrence is a medical error? Level-1 Blood Bank

AST

Which of the following analytes would be increased due to delay in centrifugation? Level-1 Chemistry

Kell

Which of the following antigens are well developed on fetal cells? Level-7 Blood Bank

Antithyroid peroxidase (TPO)

Which of the following autoantibodies would be usually found in a patient with Hashimoto's thyroiditis? Level-5 Immunology

Touch preparations

Which of the following bone marrow processing procedures is best suited for a patient who had a dry tap? Level-5 Hematology

Lymphocytes

Which of the following cells are capable of producing antibodies? Level-3 Blood Bank

8 to 32

Which of the following changes in titers would be considered significant when monitoring maternal antibodies using a doubling dilution? Level-4 Blood Bank

Antibody will react equally with labeled and unlabeled antigen

Which of the following choices is correct when describing the principles of competitive radioimmunoassay procedures? Level-5 Chemistry

Thrombotic thrombocytopenic purpura (TTP)

Which of the following conditions is characterized by small clots made up of platelets and large forms of von Willebrand factor? Level-5 Hematology

Sodium

Which of the following contributes most to serum osmolality: Level-4 Chemistry

Stimulates gastric acid-HCl secretion

Which of the following describes gastrin's role in digestion? Level-5 Chemistry

BACTEC

Which of the following instrument-based systems are considered a continuous monitoring system? Level-5 Microbiology

Frame C- primary myelofibrosis

Which of the following is a correct pairing of cell type in the image and a disease state associated with that type of cell? All cells are from a Wright stained peripheral blood smear. Level-8 Hematology

Overtime pay

Which of the following is considered to be a variable cost in the clinical laboratory? Level-5 Lab Operation

Amastigote

Which of the following is the first stage in the life cycle of a hemoflagellate? Level-9 Microbiology

Immunoassay

Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring? Level-4 Chemistry

Prolonged PT and aPTT

Which of the following laboratory results would you find with disseminated intravascular coagulation (DIC) but NOT with thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS)? Level-6 Hematology

Dark-field microscopy

Which of the following microscopic techniques is best suited for direct examination of the infectious agent of syphilis? Level-4 Immunology

Peptostreptococcus anaerobius

Which of the following organisms appear Gram positive when using the Gram Stain? Level-4 Microbiology

Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease

Which of the following statements is true regarding cardiovascular disease and adipose tissue? Level-3 Chemistry

Hemoglobin electrophoresis for the presence of Hb S

Which of the following tests are necessary to confirm the condition suggested by the morphology? Level-3 Hematology

Meat-filled diet

Which of the following will cause an acidic urine pH? Level-5 Lab Operation

Haptoglobin

Which of these blood levels will decrease during intravascular hemolysis? Level-4 Chemistry

Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue

Which of these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted? Level-4 Hematology

Proto-oncogenes

Which one of the following are normal genes that induce DNA synthesis, promote cell division, and inhibit cell death? Level-5 Immunology

A diastolic blood pressure of 110 mm Hg

Which one of these physical exam results would cause a donor to be deferred? Level-5 Blood Bank

CEA

Which tumor marker is used for colorectal cancer? Level-5 Chemistry

Mycobacterium tuberculosis has a waxy coating on its surface which prevents gram stain penetration.

Why is Mycobacterium tuberculosis not seen on gram stained smears? Level-3 Microbiology

450 mg/dL

You are working in a clinical chemistry laboratory and are analyzing a plasma glucose sample. The sample is flagged by the analyzer for being "outside of linear range." You manually dilute the sample 1:2 and rerun it. Again, you receive an "outside linear range" alert. You decide to perform a different manual dilution. This time you manually dilute the original sample again; this time using a 1:3 dilution. The instrument gives you a glucose value of 150 mg/dL from this diluted sample. What is the actual patient glucose result that you should report to the physician? Level-3 Chemistry