LABCE

Amount of light present in electrophoresis box (The type of support media, type of stains used, and voltage settings all have an impact on electrophoresis techniques; however, the amount of light present in an electrophoresis box does not. Support medium can affect migration of analytes based on the medium's pore size and endosmosis. pH can change the charge of the analyte and thus affect the mobility. It can also denature the analyte (protein). Voltage is proportional with the velocity of the analyte migration. Ionic strenght, ions present, wattage, current, temperature, and time are other variables that can affect electrophoretic results.)

All of the following have an impact on electrophoresis techniques in the clinical lab EXCEPT? Amount of light present in electrophoresis box Support medium pH Voltage

Macrocytic, heterogenous

An 52 year old male with a history of alcoholism is admitted to the hospital with severe abdominal pain. A CBC reveals the following results: ParameterValue Reference Interval WBC 15.7 x 109/L 4.0-10.0 x 109/L RBC. 3.9 x 1012/L. 4.2-5.9 x 1012/L HGB 14.4 g/dL 12-16 g/dL HCT 41% 37-48% MCV 105 fL 80-100 fL RDW-CV 16.5% 11.0-14.0% Considering the information that is provided, which of the following would be an appropriate description of the anemia? Macrocytic, heterogenous Macrocytic, homogenous Microcytic, heterogenous Microcytic, heterogenous

i; I (From birth onwards - "i" antigen slowly decreases on the RBC surface, while "I" antigen increases reciprocally. It's a unique characteristic of this particular pair, with no other pair of common blood bank relevant antigens demonstrating such a trait. In practice, while auto anti-i is rarely seen, when suspected, one could simply react the patient's serum with cord RBCs, expecting to see a strong reaction. Meanwhile, reacting the patient's serum with adult RBCs would yield a weak or no reaction.)

Generally speaking, infant RBCs demonstrate the presence of the ____ antigen, which gradually decreases as one ages. Conversely, the ____ phenotype is not expressed at birth, but increases in frequency as one ages. M; N K; k i; I All of the above

Trichophyton mentagrophytes (Trichophyton mentagrophytes is the correct response. The presumptive identification can be made from the lactophenol blue microscopic mount, in which is observed small spherical conidia irregularly spaced in loose clusters along thin hyphae. This preliminary identification can be confirmed by the rapid positive urease reaction as illustrated. T. mentagrophytes infections can be contracted from direct contact with a wide variety of animals. Epidermophyton floccosum colonies are silky gray-yellow with outward projecting delicate hyphal strands. The more definitive identification is made by observing the microscopic appearance of the three to five celled macroconidia with that are typically large and club-shaped with smooth walls, attached directly and laterally from hyaline hyphae. Microconidia are not observed. Microsporum canis colonies mature within 5 - 10 days. Distinctive is the peripheral lemon-yellow apron seen at the growing margin where conidia are being produced. Also distinctive are the large, spindle shaped multi-celled macroconidia each with a thick echinuate wall. The terminal cell of each macroconidium is tapered and deviates to one side. Scattered microconidia, each borne laterally directly from the hyphae, may be observed. Microsporum gypseum colonies are cinnamon-brown with outward projecting delicate hyphae. In stained microscopic mounts, large multi-celled canoe-shaped macroconidia are observed, with the distal cells being rounded rather than with a tapered tip.)

Illustrated in the composite photograph is an inflammatory reaction of skin with erythema and micro-pustule formation, most consistent with a dermatophyte infection. The lactophenol blue mount was prepared from a 4-day old colony grown from the skin lesion as shown. The accompanying lactophenol blue microscopic mount illustrates small, spherical micro conidia arranged in loose clusters along the sides of thin hyaline hyphae. The species identification can be confirmed by the positive urease reaction as shown. Select from these observations the species identification of this isolate: - Microsporum gypseum - Trichophyton mentagrophytes - Microsporum canis - Epidermophyton floccosum

Necator americanus (Necator americanus is the correct response. As one of the hookworms this species can be identified by observing the rhabditiform larvae that characteristically have a long buccal cavity as illustrated in the photograph. Strongyloides stercoralis is an incorrect response. Strongyloides rhabditiform larvae have a short buccal cavity. On further examination, a prominent genital primordium may also be observed about one-third the distance from the tail. Enterobius vermicularis is an incorrect response. Enterobius does not have an external host and rhabditiform larvae are not formed, and only adult worms and ova are observed in humans. Enterobius can be excluded from this exercise. Ascaris lumbricoides is an incorrect response. Ascaris larvae develop into adult worms within the human intestine. The adult worms measure between 15 and 35 cm and may be best recognized by their curved tail. A buccal cavity is not distinctive.)

On occasion in cases of heavy infection, rhabditiform nematode larvae, measuring up to 1.5 cm long, may be observed in mounts prepared from stool specimens. A presumptive species identification can be made by microscopically observing the buccal cavity as illustrated in the photograph. Select the most likely species of nematode from the choices listed below. - Strongyloides stercoralis - Enterobius vermicularis - Necator americanus - Ascaris lumbricoides

You point out that centromere antibodies have been known to occur years prior to the onset of the disease and the patient should be carefully examined and monitored for the development of other symptoms. (Centromere antibodies can precede the diagnosis by 10 to 15 years. While the ANA alone is not diagnostic this patient is having clinical symptoms of stiff fingers that fits nicely with the centromere ANA pattern. Early diagnosis and early treatment are important to improve quality of life for the patient.)

Patient 1234 has a positive antinuclear antibody (ANA) test with a centromere pattern at a 1:1280 titer. Surprised by the result, the clinician calls and says the patient is only having mild stiffness of her fingers and asks your opinion of the result. Which is your best reply? You point out that centromere antibodies have been known to occur years prior to the onset of the disease and the patient should be carefully examined and monitored for the development of other symptoms. You comment that it's common to over-read ANA results and since the ANA testing is not diagnostic and prone to false results it's unlikely the results are of any concern. You state that the ANA results alone are diagnostic of systemic sclerosis and since there is no cure for this disease the clinician is powerless to do anything.

False (Initially researchers thought that RhIg prevented anti-D production by clearing the infant's D-positive rbc sensitized with maternal anti-D, but we now know this is not true. Currently, the mechanism by which RhIg prevents immunization to the D antigen is poorly defined. However, research shows that it likely involves down-regulation of antigen-specific B cells, ie., the B cells do not differentiate into antibody-excreting plasma cells as they normally would when presented with foreign antigens.)

RhIg prevents anti-D production mainly by clearing antibody-sensitized D-positive rbc from maternal circulation. True False

121° C for 12-15 minutes @ 15 psi

The recommended temperature/time/pressure for routine steam sterilization of media is: 121° C for 8-10 minutes @ 10 psi 121° C for 12-15 minutes @ 15 psi 220° C for 8-10 minutes @ 10 psi 220° C for 12-15 minutes @ 15 psi

Cholesterol crystals (Cholesterol crystals appear in acid urine as large, flat, transparent plates with notched corners. They are soluble in hot alcohol and ether. Leucine crystals are associated with liver disease. They are found in acid to neutral pH urine specimens and are yellow in color. Concentric circles and the radial striations are noted microscopically. Bilirubin crystals are gold-orange, needle-like crystals that may appear in clumps. They are found in acid urine and are associated with liver disease. Cystine crystals are present in acidic urine, are typically colorless, and have a characteristic hexagonal shape (also described as appearing similar to a benzene ring). These crystals are associated with cystinuria.)

The crystals seen in this image are ____? Leucine crystals Cholesterol crystals Bilirubin crystals Cystine crystals

Bacterial meningitis (Intracellular bacteria within neutrophils are indicative of bacterial infection.)

The predominant cells seen on the CSF smear in this illustration are indicative of: Normal cytocentrifuged smear Viral meningitis Bacterial meningitis Fungal infection

Factor VII deficiency

Which of the following conditions can produce a normal APTT and a prolonged PT? Factor IX deficiency Factor VII deficiency Factor VIII deficiency Factor X deficiency

Nasopharyngeal swab (Bordetella pertussis is a small aerobic gram-negative coccobacillus. It can best be cultured using a nasopharyngeal sample collected in a soft rubber catheter or a fine-tipped calcium aliginate or dacron swab. It must be promptly inoculated onto Regan-Lowe charcoal agar, or traditional Bordet-Gengou media.)

Which of the following is the most suitable specimen for the isolation of Bordetella pertussis: Nasopharyngeal swab Bronchial washing Blood Throat swab

r'ry (We can combine the designations into genotypes. For example, r'ry would correspond to dCe/dCE. Therefore, this donor unit would not have the "little c" antigen(hr') and would be the correct answer.)

Wiener Fisher-Race (haplotype) Ro Dce R1 DCe R2 DcE R DCE r dce r' dCe r" dcE ry dCE If a recipient has anti-c, which donor unit should be selected? - r'r - RoR1 - R2ry - r'ry - RoR

Make a quantitative count of the number of ova present (Make a quantitative count of the number of ova present is the correct response. Increased egg counts of 20/mg or more are associated with symptoms indicative of heavy worm burdens. Egg counts of 5/mg are rarely associated with symptoms. The diagnosis of hookworm infection relies on detecting eggs in the patient's stool. Identifying hookworm antigen will not provide an adequate determination of the entire worm burden. Eggs are typically detected by direct smear or concentration of the stool specimen. Stained preparations tend to distort the morphology of the ova; hookworm ova are not acid-fast. Diagnosis may also be made by radiographic studies to detect intestinal hypermotility, proximal jejunal dilatation and coarsening of the mucosal folds.)

in cases where more severe symptoms may occur, particularly in progressive anemia, what additional test procedure should be performed to determine the role that hookworm infection may play when ova are detected in stool specimens? - Prepare permanent-stained mounts - Prepare an acid-fast stained mount - Make a quantitative count of the number of ova present - Perform immunologic assays to detect Hookworm antigen in stool