ASCP BOR Exam Prep
Cytomegalovirus (CMV) appears to suppress cell-mediated immune functions. Which of the following is a characteristic finding in persons infected with CMV? Increased CD4+ cells; decreased CD8+ cells Increased CD4+ cells; increased CD8+ cells Decreased CD4+ cells; increased CD8+ cells Decreased CD4+ cells; decreased CD8+ cells
Decreased CD4+ cells; increased CD8+ cells
Which of the following represents the correct order of draw for blood tubes in a peripheral blood collection (red is serum, not sterile)? Purple, green, red Red, blue, green, purple Blue, red, green, purple Blue, red, purple, green
Blue, red, green, purple
Which enzyme is responsible for the rate-limiting step of steroid hormone synthesis? 21-hydroxylase CYP450 F-zone enzymes 17-hydroxylase
CYP450
The hemoglobin electrophoresis pattern for patient #2 shows an increase in Hb F and a decrease in both Hb A and Hb A2. These results correlate best with which of these thalassemias? Beta thalassemia minor Beta thalassemia major Delta-beta thalassemia minor Alpha thalassemia major
Delta-beta thalassemia minor Hb A2 = Alpha & Delta Hb A = Alpha & Beta Hb F = Alpha & Gamma
Which of the following serological tests would be used for the diagnosis of Q-fever? Weil-Felix test Quellung test EIA or indirect immunoflourescence Cold agglutinin test
EIA or indirect immunoflourescence
The number of patients correctly diagnosed for the disease or not having the disease is defined as: Positive predictive value Negative predictive value Efficiency Sensitivity
Efficiency The efficiency is calculated by the following equation: ((TP + TN) / (TP + FP + FN + TN)) x 100 TP = True Positives TN = True Negatives FP = False Positives FN = False Negatives The efficiency is generally used in addition to the sensitivity and specificity to determine the diagnostic value of a test method.
A 12-year-old female went to her doctor for her yearly back-to-school check-up. She was in good health and was asymptomatic at the time of the examination. Due to the increased incidence of parasites in the area, the doctor ordered a stool for parasite examination as part of the routine physical testing. Multiple suspicious forms, measuring approximately 9 µm each were seen. Which of the following is most likely the identification of these forms? Endolimax nana Entamoeba coli Iodamoeba butschlii Pseudoparasite
Endolimax nana
Regarding hemoglobin synthesis, which of the following constitutes the alpha globin chain coding? Two gene loci; one each on chromosome 11. Four gene loci; two each on chromosome 11. Two gene loci; one each on chromosome 16. Four gene loci; two each on chromosome 16.
Four gene loci; two each on chromosome 16
Agar plates on a positive blood culture are incubated for 48 hours and no growth is visible on the agar plates. The tech reviews the initial Gram stain from the blood culture bottle, which reveals tiny pleomorphic Gram-negative coccobacilli. What organism should the tech suspect and what should the tech do next? Campylobacter jejuni; Set up a CVA plate in the 42 degree incubator Francisella tularensis; Sub blood culture bottle to a media with cysteine for optimal growth Yersinia pestis; Sub blood culture bottle to media at room temperature incubation Streptococcus pneumoniae; Organism has autolysed in blood culture bottle
Francisella tularensis; Sub blood culture bottle to a media with cysteine for optimal growth
The antigen marker most closely associated with transmission of HBV infections is: The correct answer is highlighted below HBsAg HBeAg HBcAg HBiAg
HBeAg, active viral replication with high level of infectivity to others.
An antibody to which platelet antigen is most commonly encountered in blood bank? HPA-1a HPA-2a HPA-3a HPA-4a
HPA-1a
An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of: A normal LD isoenzyme pattern Hemolysis Pancreatitis Hepatic injury MI
Hemolysis & MI
A cause of FALSE-POSITIVE result in the rapid plasma reagin (RPR) test for syphilis is: (Select All) Gastroenteritis Gonococcal urethritis Hep A Infectious mononucleosis Malaria SLE Streptococcal pharyngitis
Hep A Infectious mononucleosis Malaria SLE
An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-4 could be indicative of: A normal LD isoenzyme pattern Hemolysis Pancreatitis Hepatic injury MI
Hepatic injury
The following statements regarding the cell cytotoxicity neutralization assay (CCNA) for Clostridiodes (formerly Clostridium) difficile are correct EXCEPT? Detects toxin B in stool samples Detects cytopathic effect on human cells Provides rapid results Procedure is complex
Provides rapid results The assay takes 2 to 3 days to obtain results.
In the evaluation of a positive DAT result, all of the below techniques can be used to dissociate the antibody(ies) form the RBCs EXCEPT: EDTA-glycine Saline replacement Chloroquine diphosphate Murine monoclonal antibodies
Saline replacement
The presence of two sporocysts each containing four banana-shaped sporozoites is characteristic of this organism; however, only oocysts with one sporocyst are typically seen in patient specimens. Which of the following organisms does this represent? Cystoisospora belli Sarcocystis species Cryptosporidium parvum Blastocystis hominis
Sarcocystis species
To ensure quality within the preanalytical phase of laboratory testing, quality assurance activities includes monitoring all of the following preanalytical variables EXCEPT: Selection of reference materials used for validation purposes. Laboratory test utilization. Positive patient identification. The stability of patient specimens during transport.
Selection of reference materials used for validation purposes can affect the analytical phase.
Which anemia is formed due to the inability to incorporate iron into the protoporphyrin ring? Iron Deficiency Anemia Sideroblastic Anemia Anemia of Chronic Inflammation Thalassemia
Sideroblastic Anemia
All of the following carbohydrates are considered reducing sugars EXCEPT: Lactose Sucrose Glucose Ribose
Sucrose the anomeric carbon of both monosaccharides (glucose and fructose) are part of the glycosidic bond, preventing the anomeric carbon of fructose (and therefore its ketone group) from being free and reducing other compounds.
Contact dermatitis is mediated by: B lymphocytes Mast cells Polymorphonuclear cells T lymphocytes
T lymphocytes
The morphologic structures depicted on this scolex from a cestode parasite include: rostellum and suckers. Identify the cestode species associated with this scolex. Taenia saginata Taenia solium Diphyllobothrium latum Enterobius vermicularis
Taenia saginata
The morphologic structures depicted on this scolex from a cestode parasite include: A) rostellum, B) hooklets, and C) suckers. Identify the cestode species associated with this scolex. Taenia saginata Taenia solium Diphyllobothrium latum Enterobius vermicularis
Taenia solium
What is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis? Target cells Elliptocytes Teardrop cells Ovalocytes
Teardrop cells
Which of the following methods may be used by a laboratory to document and analyze all of the steps that bring a laboratory test result to the customer (eg, physician, nurse, and/or patient)? Root cause analysis Value stream mapping 5S Kaizen workshop
Value stream mapping is a Lean process that can be used by laboratory personnel to document and analyze all of the steps that bring a laboratory test result (product or service) to the customer.
The type of hypersensitivity reaction associated with macrophage activation, cytokine-mediated inflammation is: Type I Anaphylactic (Immediate hypersensitivity) Type II Cytotoxic (Antibody mediated and antibody dependent, complement mediated hypersensitivity) Type III Immune complex mediated hypersensitivity Type IV Cell mediated hypersensitivity (T-cell dependent)
Type IV Cell mediated hypersensitivity (T-cell dependent)
The correction formula used to adjust the citrate to blood ratio is:
Volume of sodium citrate = (1.85 X 10-3) X (100 - patient hematocrit) X volume of whole blood drawn
The ratio of whole blood to anticoagulant is very important in the PT assay; at which hematocrit level should the standard anticoagulant volume be adjusted? < 50% > 75% > 55% < 35 %
> 55% The effect of anticoagulant is too great to be ignored if the hematocrit value is greater than 55% such as in cases of polycythemia. At this hematocrit concentration, the plasma volume is lower and the excess citrate binds more calcium ions required for calcium-dependent clotting assays. This creates falsely prolonged clotting times affecting the PT and APTT tests.
The cell containing the inclusions indicated by the arrows are often associated with which of the following conditions? Albinism Sepsis Alder-Reilly anomaly Megaloblastic Anemia
Alder-Reilly anomaly characterized by neutrophils with many large granules filled with mucopolysaccharides. These neutrophils resemble neutrophils with toxic granulation.
What is a characteristic of a person who is weak D? Types as D negative and produces anti-D when exposed to D antigen Demonstrates a reduced number of D antigen sites on the surface of the red cell Types as D positive and produces anti-D when exposed to D antigen Someone who is defined as being D negative
Demonstrates a reduced number of D antigen sites on the surface of the red cell
What description best applies to the cells that are indicated by the arrows? Normocytosis Microcytosis Macrocytosis Anisocytosis
Macrocytosis
This antinuclear antibody (ANA) test pattern is characterized by staining of discrete speckles in the nucleus of the interphase cells (a) and discrete speckling also in the chromosomal area of the metaphase mitotics (b) when viewed using fluorescent microscopy. This image represents which of the following patterns? Centromere pattern Peripheral or rim pattern Speckled Multiple nuclear dots
Centromere pattern
An increased reticulocyte count MAY be found in all of the following conditions, EXCEPT? Hemolytic anemias Following acute hemorrhage Aplastic anemia Satisfactory response to therapy for pernicious anemia
Aplastic anemia
This image represents a field of red blood cells (RBCs) that were stained using a supravital stain. How would these cells appear if they were viewed on a Wright stained smear? Polychromatophilic RBCs RBCs containing basophilic stippling RBCs containing Cabot's rings RBCs containing Pappenheimer bodies
Polychromatophilic RBCs The cells containing blue particulates in this image are classified as reticulocytes when using supravital stain. When using Wright stain, the cells would appear larger and a bit bluer, a key indication of reticulocytes; these cells would be described as polychromatophilic RBCs on Wright stained smears.
A patient, who recently received a transfusion of three units of red cells, is DAT-positive with an IgG specificity. What would be the best method to identify the patient's phenotype? Adsorption and elution Type and Screen Polymerase chain reaction-based assay Antigen typing
Polymerase chain reaction-based assay
Which of the following statement is INCORRECT regarding the bone marrow biopsy specimen? Bone marrow cellularity can be accurately determined Cellular morphologic detail can be determined. Bone marrow architecture can be examined Prussian blue staining could be used to evaluate iron stores, and diagnosis of anemia.
Cellular morphologic detail can be determined. Bone marrow cellularity can be determined accurately by comparing the amount of hematopoietic tissue with the amount of adipose tissue.
Observed in a stool specimen passed from a person with minor intestinal symptoms is an 8 µm in diameter cyst as shown in the photomicrograph. Note the four nuclei and their distinctive blotlike karyosomes. Based on the microscopic appearance of this cyst, select from the list of answer choices the presumptive identification. Iodamoeba butschlii Chilomastix mesnili Entamoeba hartmanni Endolimax nana
Endolimax nana
he average bone marrow cellularity in a normal adult (50 years old) is: 30 50 65 70
50 100 - Patient's age = ____+/- 10 In this example 100 minus 50 equal 50. So the normal bone marrow cellularity is between 40 and 60
On a quiet evening shift at a small hospital, you encounter a specimen with a positive antibody screen. As per your current laboratory protocol, you check for agglutination at the immediate spin phase of testing; and then again at the antihuman gloubulin (AHG) phase of 37°C. According to your laboratory guidelines, a single homozygous cell may be used to rule out an antibody. Based on the following 3-cell screen performed by tube, which of the following clinically significant antibodies are you unable to rule out? Anti-Fya, -D Anti-Lua, -Lea, -Fya, -C Anti-Lea, -Fya, -C Anti-Fya, -C, -Lub
Anti-Fya, -C, -Lub D is ruled out based on cell #3 at the clinically significant phase of 37°C. Next, it asks you to assess which of the antibodies that have not been ruled out are clinically significant. Of the remaining choices (B, C, and D), you can immediately rule out choices B and C, because both choices contain antibodies that are not clinically significant (anti-Lua, -Lea).
Which of the following characteristics is consistent with the Kidd blood group system? Jk(a-b-) red cells are resistant to lysis in 2 M urea Kidd antigens are destroyed by ficin Antibodies to Kidd antigens react best at immediate spin Anti-Jka activity may not react well in a LISS test system
Jk(a-b-) red cells are resistant to lysis in 2 M urea Kidd antigens are located on the red cell urea transporter. Red cells that lack Kidd antigens resist lysis by 2M urea. Antibodies to Kidd system antigens are enhanced with ficin treated cells. Most antibodies to Kidd antigens are IgG and prefer to react at AHG phase. Antibodies to the Kidd system may be difficult to detect because they can drop in titer in vivo; however, their detection is aided by the use of potentiators such as LISS and PEG.
An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-3 could be indicative of: A normal LD isoenzyme pattern Hemolysis Pancreatitis Hepatic injury MI
Pancreatitis
An 85-year-old female nursing home patient was treated empirically with a cephalosporin for a urinary tract infection, but later failed therapy. The physician then requested a culture and sensitivity on a new urine specimen which grew >100,000 CFU/mL of Escherichia coli. After reviewing the Kirby-Bauer disc susceptibility plate and susceptibility interpretations, what is the resistance mechanism (if any) for this organism? Plasmid-mediated AmpC CRE - Carbapenem Resistant Enterobacteriaceae ESBL - Extended-Spectrum Beta Lactamase No resistance mechanism detected
Plasmid-mediated AmpC AmpC is a cephalosporinase that hydrolyzes all beta lactam antibiotics except Cefepime and the carbapenems. AmpCs are also not inhibited by clavulanate.
The subsurface umbrella-shaped zone of motility seen in this SIM tube (arrow) is characteristic of Listeria monocytogenes. The optimum temperature of incubation to best illustrate this property is: 25°C 30°C 35°C 42°C
25°C
How long after potential donors have been diagnosed with malaria should they be deferred from doing a blood donation after treatment and no symptoms? 6 months 1 year 2 years 3 years
3 years
A platelet component prepared from a unit of whole blood (random donor platelet) must contain at least how many platelets? 3.8 x 1010 platelets/unit 4.0 x 1010 platelets/unit 4.5 x 1010 platelets/unit 5.5 x 1010 platelets/unit
5.5 x 1010 platelets/unit
Which of the following autoantibodies are found in a patient with Graves disease but not typically seen in Hashimotos thyroiditis? Thyroid-stimulating hormone receptor antibodies (TRAbs) Antithyroid peroxidase (TPO) Islet cell antibodies Antitransglutaminase (tTG)
Thyroid-stimulating hormone receptor antibodies (TRAbs)
A physician suspects his patient might have primary biliary cirrhosis. Which of the following markers should be ordered? Antimitochondrial antibodies Anti-IgG Antineutrophilic antibodies Antimyocardial antibodies
Antimitochondrial antibodies
An Enterobacteriaceae grows as a clear colony on MacConkey but a salmon-colored colony with a black center on HEK agar. Which of the following TSI reactions would match these morphologies? Alkaline/Acid H2S Acid/Acid H2S Alkaline/Acid no H2S Acid/Acid no H2S
A/A H2S All Enterobacteriaceae ferment glucose resulting in the bottom of the TSI slant being yellow. The clear colony on MacConkey indicates the organism does not ferment lactose but the salmon-colored colony on HEK agar indicates sucrose was ferment resulting in a yellow slant (acid). The black center on HEK agar indicates H2S production.
Which of the following fresh frozen plasma ABO types would be suitable for transfusion to an AB negative patient? AB negative only. O negative only. AB negative and AB positive only. O negative and O positive only.
AB negative and AB positive only. It can be given without regard to Rh type because it does not contain cells with the D antigen for the recipient to react to.
Many organisms have developed resistance to antibiotics. What mode of resistance has MRSA acquired? Acquisition of new targets Enzymatic inactivation of antibiotics Efflux Target site modification
Acquisition of new targets With the new gene (SCCmec, which is a triad of genes, mecR1-mecI-mecA), MRSA has a reduced affinity for ß-lactam antibiotics allowing for new targets, resisting methicillin.
Exposure to all of the following chemicals may cause hemolytic anemia, EXCEPT? Heavy metals Lead Naphthalene Ascorbic acid
Ascorbic acid Vit C duh!
All of the following factors would cause an increase erythrocyte sedimentation rate (ESR) values EXCEPT? Severe anemia Abnormal proteins (Rouleaux) Blood drawn into sodium citrate anticoagulant A slanted (not perpendicular) tube
Blood drawn into sodium citrate anticoagulant Both EDTA and Sodium Citrate can be used in ESR testing.
Which of the following phenotypes is most indicative of a natural killer (NK) cell? CD2+ CD3+ CD5+ CD7+ CD2+ CD3- CD11b+ CD16+ CD11b+ CD16+ CD33+ CD56- CD19+ CD20+ CD22+ CD57-
CD2+ CD3- CD11b+ CD16+
Which of the following genotypes is found with the highest frequency in the Caucasian population? CDe/cDe cDE/ce cDE/cE CDe/ce
CDe/ce is found in 31% of the Caucasian population. CDe/cDe is found in 3% of the Caucasian population. cDE/ce is found in 10% of the Caucasian population. cDE/cE is found in less than 1% of the Caucasian population.
Which of the following hemoglobins is known to migrate with HbS during electrophoresis when an alkaline gel, such as cellulose acetate, is used? A2 C D F G H
D & G
The order of Hb seen on alkaline electrophoresis from cathode (negative pole) to anode (positive pole) are:___________________________. The order of Hb seen on acid electrophoresis from cathode to anode are _________________________.
cathode (-) to anode (+) are: A2, S/D, F, and A cathode (-) to anode (+) are: F, A/D, S, and C
Which marker is most useful for the detection of gestational trophoblastic disease? CEA (Carcinoembryonic antigen) AFP (a-fetoprotein) hCG (human chorionic gonadotropin) CA-125 (cancer antigen 125)
hCG (human chorionic gonadotropin)
Which chromosome abnormality/ies is/are most commonly associated with AML? t(8;21) t(5;17) t(11;17) t(9;22)
t(5;17) and t(11;17)
Which chromosome abnormality is most commonly associated with AML? t(8;21) t(5;17) t(11;17) t(9;22)
t(8;21)
Which chromosome abnormality is most commonly associated with CML? t(8;21) t(5;17) t(11;17) t(9;22)
t(9;22) most commonly found in CML, but can occasionally be found in AML and ALL.
Which one of these Lewis blood group system phenotypes usually produces anti-Lea? Le(a+b+) Le(a+b-) Le(a-b+) Le(a-b-)
Le(a-b-)
A manual white blood cell count was performed by the hematology technologist. The cell counts for each of two sides was 38 and 42 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:10. What should the technologist report as the white cell count? 4.8 x 10^9/L 4.4 x 10^9/L 0.48 x 10^9/L 0.44 x 10^9/L
0.44 x 10^9/L Cells Counted (in this case the average of both sides) X dilution factor (in this case 10) / # of squares counted (in this case 9) X 0.1mm (depth of solution) X area of each square (1mm^2) So, in this problem: (40 x 10) / (9 x 1mm^2 x 0.1mm) = 444.4/mm^3 (can be converted to 0.44 x 10^9/L)
The laboratory workplace includes many hours of computer use. The suggested time for a break after 30 minutes of computer use is: 1-2 minute break 3-5 minute break 5-10 minute break 20 minute break
1-2 minute break or 5-10 minute break each hour
What is the coefficient of variation for this creatinine testing method? Use (Mean = .97 mg/dL, s = .07 mg/dL) 13.86% 0.72% 1.39% 7.22%
7.22% The coefficient of variation (CV) describes the variation of a test. The CV expresses the variation as a percentage of the mean and is calculated by dividing the standard deviation by the mean and then multiplying by 100 to convert to a percentage: CV% = (SD/Mean)100 For this example, the CV is calculated as follows: CV% = ( .07/.97)100 CV% = (.0722)100 Therefore, the CV is 7.22%
The border to border extension of the mycelium as illustrated in the top photograph is characteristic of one of the Zygomycetes. Although a light yellow green pigmentation of the mycelium is observed, the identification of the isolate depends on the presentation of the fruiting body observed in the bottom photomicrograph. From these observations, select the name of this isolate from the list of multiple choices. Rhizopus species Syncephalastrum species Mucor species Absidia species
Absidia species The conidiophores originate from the main hyphae between the rhizoids ("intermodal"). The conidiophores terminate in a saclike sporangium, that in early development has a distinctive funnel-like expansion, an apophysis, as seen in the image insert.
Antibodies directed against granulocyte antigens have been implicated for all of the following EXCEPT? Febrile transfusion reactions Acute hemolytic transfusion reactions Transfusion-related acute lung injury (TRALI) Neonatal alloimmune neutropenia (NAN)
Acute hemolytic transfusion reactions
What is the composition of the granules associated with basophilic stippling? Aggregates of iron Aggregates of hemoglobin Aggregates of ribosomes Aggregates of DNA
Aggregates of ribosomes Aggregates of iron within erythrocytes are called Pappenheimer bodies. Aggregates of hemoglobin are known as Heinz bodies, which require a supravital stain to observe. Aggregates of DNA found inside an erythrocyte are known as Howell-Jolly bodies.
A physician suspects his patient might have rheumatoid arthritis. Which of the following markers should be ordered? Antimitochondrial antibodies Anti-IgG Antineutrophilic antibodies Antimyocardial antibodies
Anti-IgG Rheumatoid arthritis commonly presents with an increase of IgM antibodies that are directed toward the Fc portion of IgG. These anti-IgG antibodies are called rheumatoid factor (RF).
If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients? Anti-M Anti-N Anti-Leb Anti-Fya
Anti-Leb
A physician suspects his patient might have rheumatic fever. Which of the following markers should be ordered? Antimitochondrial antibodies Anti-IgG Antineutrophilic antibodies Antimyocardial antibodies
Antimyocardial antibodies
A physician suspects his patient might have Wegener's granulomatosis. Which of the following markers should be ordered? Antimitochondrial antibodies Anti-IgG Antineutrophilic antibodies Antimyocardial antibodies
Antineutrophilic antibodies
In which group is Type B blood found in higher frequency? African Americans Caucasians Asians Hispanics
Asians 27% White 11% Black 20%
Which of the following is NOT considered a characteristic of paroxysmal cold hemoglobinuria (PCH)? Patient population: children and young adults Pathogenesis: following viral infection Site of hemolysis: intravascular Autoantibody class: IgM
Autoantibody class: IgM IgG is the correct Ab class
Which of the following D variants has the best likelihood to receive D-positive RBCs without any adverse effects? Del Partial D Partial weak D C in Trans to RHD
C in Trans to RHD Individuals with C in Trans to RHD possess complete D antigen structures. The allele that carries C is in trans (or opposite position) from the allele carrying RHD. As a result, the position of the C antigen in relationship to the D antigen interferes with the expression of the D antigen. This can be a weakened expression of D antigen; however, D antigen is still present. These patients can receive D-positive RBCs without the implication of an Rh-mediated transfusion reaction. Individuals with Del phenotype possess a low number of D antigen sites that can go undetected in routine serological testing. This testing discrepancy can lead to misclassification of Rh type for the recipient (i.e., classified RhD-negative but maybe RhD-positive). Molecular studies are needed to detect the mutant RHD gene responsible for altering the expression of the RhD protein.
All of the following red cell inclusions are identified in the frames of photographs, EXCEPT? Basophilic stippling Pappenheimer bodies Malaria parasite Cabot ring
Cabot ring is not shown. Cabot ring is a red-violet inclusion that is oval or figure-eight shaped. It consists of nuclear fragments or mitotic spindle fibers. A = Pappenheimer B = Basophilic stippling C = P. falciparum malaria D = Howell-Jolly
8-Hydroxyquinoline and Ortho-Cresolphthalein complexone (CPC) reagent is commonly used in the determination of: Phosphorus Magnesium Chloride Calcium
Calcium
In which group is Type A blood found in higher frequency? African Americans Caucasians Asians Hispanics
Caucasians: 40 % Asian 27% Black 20%
The purpose of C3a and C5a, the split-products of the complement cascade, is to: The correct answer is highlighted below Bind with specific membrane receptors of lymphocytes and cause release of cytotoxic substances. Cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils. Bind with membrane receptors of macrophages to facilitate phagocytosis and the removal of debris and foreign substances. Regulate and degrade membrane cofactor protein after activation by C3 convertase.
Cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils.
Which of the following is least likely to interfere with the measurement of hemoglobin? Icteric plasma Lipemia Cold agglutinin Leukocytosis
Cold agglutinin
Which of the following analytes would be increased due to delay in centrifugation? Creatinine Ionized Calcium Folate Bicarbonate
Creatinine
A 28 year old female patient is experiencing disseminated intravascular coagulation (DIC) following the delivery of her newborn. Her Complete Blood Count (CBC) results are normal. What would be the best blood product for this patient to receive? Apheresis platelets Leukocyte-reduced packed red blood cells Cryoprecipitated antihemophilic factor Fresh frozen plasma
Cryoprecipitated antihemophilic factor
Which FAB designation is acute myeloblastic leukemia without maturation characterized by Blasts and promyleocytes? FAB M1 FAB M3 FAB M4 FAB M5
FAB M1
Which FAB designation is acute promyelocytic leukemia characterized by promyleocytes? FAB M1 FAB M3 FAB M4 FAB M5
FAB M3
Which FAB designation is acute myelomonocytic leukemia characterized by >/= 20% myeloid and monocytic cells? FAB M1 FAB M3 FAB M4 FAB M5
FAB M4
Which FAB designation is called the "true" monocytic leukemia and is characterized by monoblasts, promonocytes, and monocytes? FAB M1 FAB M3 FAB M4 FAB M5
FAB M5
The fibrin clot begins to form when fibrinogen is cleaved resulting in a fibrin monomer, fibrinopeptide A, and fibrinopeptide B fragments. The fibrin monomers spontaneously polymerize due to hydrogen bonding, and then are covalently linked into fibrin polymers by which factor? Plasmin Factor XIII Factor V Thrombin
Factor XIII, or fibrin stabilizing factor, is responsible for polymerizing the cross-linked fibrin strands to form a stable fibrin clot.
Which of these methods measures fetal hemoglobin or D positive red cells or both to evaluate fetomaternal hemorrhage? Rosette test Kleihauer-Betke test Flow cytometry AHG testing
Flow cytometry
Which genetic description will NOT contain Bart's hemoglobin at birth ? Heterozygous alpha thalassemia-1/alpha thalassemia-2 Heterozygous alpha thalassemia-1 Homozygous alpha thalassemia-2 Heterozygous alpha thalassemia-2
Heterozygous alpha thalassemia-2 Bart's hemoglobin is present when tetramers of gamma chains are formed. These tetramers form in fetuses and neonates when there is an insufficient amount of alpha chains. Heterozygous alpha thalassemia-2 has only one alpha gene deletion and is referred to a silent carrier. It will not present with any Bart's hemoglobin at birth .
The usual radiation source in atomic absorption instruments is the: Xenon arc Deuterium lamp Tungsten lamp Hollow cathode lamp
Hollow cathode lamp
The most frequently encountered immunoglobulin demonstrated in patients with Multiple Myeloma is: IgM Ig G Ig A IgE
Ig G
Spherocytes are associated with which of the following conditions? Hereditary stomatocytosis Immune hemolytic anemia Thalassemia Iron deficiency
Immune hemolytic anemia Spherocytes result from removal of small amounts of erythrocyte membrane, which reduces the surface to volume ratio. This may occur in the reticuloendothelial system, as in hereditary spherocytosis and immune hemolytic anemias, or may be due to direct injury of red cells, as in patients with severe burns.
All of the following are features of systemic lupus erythematosus (SLE), EXCEPT: Increased serum complement Positive ANA Circulating immune complexes Elevated erythrocyte sedimentation rate
Increased serum complement; it decreases due to consumption
When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: Decreased urine copper Increased urine copper Normal urine copper Increased serum copper
Increased urine copper
Which one of the following is a TRUE statement concerning alkaline phosphatase? It is optimally active at pH 5 It is decreased in bone disorders involving the osteoblasts It is increased in obstructive jaundice It is increased in myocardial infarctions
It is increased in obstructive jaundice This enzyme is optimally active around a pH of 9.0-10.0 It is increased in bone disorders involving osteoblasts such as Paget's disease. Increased levels have been shown to be a prognostic indicator of future cardiovascular events
Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular adherence to endothelium. Which amino acid is decreased in patients with sickle cell disease and is needed as a substrate to produce nitric oxide? L-arginine L-glutamine L-lysine L-tyrosine
L-arginine
According to CLIA '88, which of the following laboratory personnel is responsible for ensuring the employment of qualified, competent testing personnel within a moderate to high complexity testing environment? General supervisor Laboratory Director Laboratory Manager Technical Supervisor
Laboratory Director
A variety of additives are used in blood collection tubes. Which of the following additives prevents clotting by inhibiting thrombin and thromboplastin? EDTA Gel Lithium or sodium heparin Sodium fluoride
Lithium or sodium heparin
Which of the following statements is TRUE regarding lymphocyte cytoplasmic granules? Lymohocytes never contain granules in the cytoplasm. Lymphocytes contain fine primary or non-specific granules in the cytoplasm. Lymphocytes contain large secondary or specific granules in the cytoplasm. Lymphocytes may contain a few azurophilic granules in the cytoplasm.
Lymphocytes may contain a few azurophilic granules in the cytoplasm.
The peroxidase stain is useful in differentiating between which cells? Lymphocytic and granulocytic cells Monoblastic and myeloblastic cells Leukemoid reaction and myelocytic leukemia Eosinophils and neutrophils
Lymphocytic and granulocytic cells
Which of the following may be seen in a CSF sample of a patient that has a subarachnoid (intracranial) hemorrhage (SAH)? Macrophages containing hemosiderin Uneven distribution of blood in CSF tubes collected Clot is present in the CSF sample Supernatant of CSF sample does not have xanthochromia
Macrophages containing hemosiderin Characteristics of a subarachnoid hemorrhage (SAH) include even distribution of blood in tubes collected, no clot formation in the sample, as well as a xanthochromic supernatant to the sample. Another characteristic that correlates with a SAH is hemosiderin deposits in macrophages. As red blood cells degenerate, the breakdown products are seen in macrophages as dark, granular, iron-laden hemosiderin deposits.
When evaluating the patterns of fluorescent anti-nuclear antibody (FANA) testing, cytoplasmic patterns: Are not considered in pattern assessment May demonstrate anti-mitochondrial antibodies seen primary biliary cirrhosis Indicate the presence of anti-histone antibodies Indicate the presence of anti-Smith antibodies
May demonstrate anti-mitochondrial antibodies seen primary biliary cirrhosis
An example of a neoplastic proliferative disease of the plasma cells is: Acute Lymphoblastic Leukemia B Lymphoblastic Leukemia/Lymphoma Multiple Myeloma Polycythemia vera
Multiple Myeloma characterized by a proliferation of plasma cells and often an over production of one specific immunoglobulin (monoclonal gammopathy). There are several variants of plasma cell myelomas.
A patient has a high absolute eosinophil count of 2000/µl; organ biopsies show infiltration of eosinophils. The patient is diagnosed as having Chronic Eosinophilic Leukemia. Other causes for high eosinophil counts include all of the following EXCEPT: Hypereosinophilia of familial origin Allergic reactions Chronic Myelogenous Leukemia Mycosis Fungoides
Mycosis Fungoides
The biuret reaction for the analysis of serum protein depends on the number of: Free amino groups Free carboxyl groups Peptide bonds Protein molecules
Peptide bonds
What procedure utilizes leukapheresis to collect the buffy coat from whole blood? Photopheresis Plasmapheresis Therapeutic apheresis Erythrocytapheresis
Photopheresis Photopheresis utilizes leukapheresis to collect the buffy coat layer from whole blood. These cells are treated with 8-methoxypsoralen, exposed to ultraviolet A light and then reinfused into the patient. Photopheresis has been shown to be efficacious and has been approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma.
What procedure utilizes leukapheresis to collect the buffy coat from whole blood? Photopheresis Plasmapheresis Therapeutic apheresis Erythrocytapheresis
Photopheresis Photopheresis utilizes leukapheresis to collect the buffy coat layer from whole blood. These cells are treated with 8-methoxypsoralen, exposed to ultraviolet A light and then reinfused into the patient. Photopheresis has been shown to be efficacious and has been approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma. Plasmapheresis is the removal and retention of the plasma, with return of all cellular components to the patient. Therapeutic apheresis (TA) involves the removal of a specific blood component, with return of the remaining blood constituents to the patient. However, with TA the component being removed is considered pathological or contributing to the patient's underlying disease state.
A patient has a history of repeated spontaneous abortion. Coagulation studies reveal an elevated APTT, normal PT, normal platelet function, and normal thrombin time. Schistocytes were seen on the peripheral blood smear. Which test should be performed to determine if the patient has lupus anticoagulant? Factor VIII assay Mixing studies with factor-deficient plasmas Antinuclear antibody test Platelet neutralization test
Platelet neutralization test Platelet neutralization tests are one of the confirmatory tests that can be used to determine if a patient has a circulating lupus antibody, or lupus anticoagulant. The principle in this test involves the use of a freeze-thawed platelet suspension that, when mixed with the patient plasma, will neutralize the anti-phospholipid antibodies (lupus anticoagulant) present and allow for a corrected APTT result upon re-testing. Mixing studies are useful as screening tests for lupus anticoagulant and phospholipid antibodies.
When a patient has a bile duct obstruction, the bilirubin test portion of the reagent strip is: Negative because unconjugated bilirubin is increased and cannot be excreted by the kidneys. Positive because unconjugated bilirubin is increased and is excreted by the kidneys. Negative because conjugated bilirubin is decreased and cannot be excreted by the kidneys. Positive because conjugated bilirubin is present and is excreted by the kidneys.
Positive because conjugated bilirubin is present and is excreted by the kidneys.
Which of these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted? Wright-Giemsa stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue Wright-Giemsa stain: Howell-Jolly bodies stain blue but Pappenheimer bodies do not stain blue Prussian blue stain: Howell-Jolly bodies stain blue but Pappenheimer bodies do not stain blue Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue
Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue
The four nitrogenous bases are two purines and two pyrimidines. What are the correct classifications for the four bases (adenine, cytosine, guanine, thymine)?
Pyrimidines = cytosine & thymine; Purines = adenine & guanine
You are working in a hematology laboratory and the machine flags an outlier result for a 51-year-old male. The blood was collected in an EDTA tube for a CBC. The hematocrit of the specimen is high at 60%. Which of the following would you do? Collect blood again, but use less sodium citrate in the tube. Collect blood in heparin. Report these results. Assume that the specimen was switched with that of a newborn child.
Report these results.
Which one of these test systems can be used to evaluate the adequacy of fibrinogen in heparinized patients? D-Dimer Reptilase Time Thrombin Time Prothrombin Time
Reptilase Time Feedback Reptilase time can be performed on blood that contains heparin since it does not interfere with the clotting process in this test. Patients who have qualitative or quantitative fibrinogen disorders are associated with prolonged reptilase time results. D-dimer testing is affected by heparin causing a decrease in sensitivity. Thrombin time is similar to reptilase time testing, but uses thrombin rather than snake venom and therefore is sensitive to the presence of inhibitors such as heparin. The prothrombin time (PT) is used to assess the extrinsic and common pathways.
This assay would be used to help rule-out heparin contamination in a coagulation sample: Protein C assay Thrombin time PT APTT
Thrombin time
In which of the following conditions would one see Pappenheimer bodies on the peripheral blood smear? Iron deficiency anemia Malarial infections G6PD deficiency Splenectomies
Splenectomies They are small debris or iron-containing granules that are normally destroyed before erythrocytes enter the peripheral circulation in a healthy person with a normal spleen.
The most frequent cause of bacterial meningitis in adults and in children is: Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae Escherichia coli
Streptococcus pneumoniae
When a Specked Nuclear Antibody (ANA) pattern is observed, what follow-up test for antibodies related to Systemic Lupus Erythematosus (SLE) is not beneficial? Testing for antibodies to Smith (Sm) Testing for all antibodies to the extractable nuclear antigens (ENA) Testing for antibodies to SS-A/SS-B+ Testing for antibodies to U1RNP+ and dcSSc
Testing for antibodies to U1RNP+ and dcSSc U1RNP+ and Scl-70 antibodies are extractable nuclear antigens that yield a speckled ANA pattern, but they are not associated with Systemic Lupus Erythematosus (SLE). U1RNP+ is associated with mixed connective tissue disease/undifferentiated connective tissue disease; Scl-70+ is associated with Diffuse cutaneous scleroderma. If other criteria suggest that the patient is suffering from Systemic Lupus Erythematosus (SLE), the presence of Smith (Sm) and SS-A/SS-B+ are the most important antibodies to identify.
According to the Michaelis-Menton kinetics theory, when a reaction is performed in zero-order kinetics: The substrate concentration is very low and the reaction rate is dependent on the substrate concentration The substrate concentration is in excess and the reaction rate is dependent on the enzyme concentration The enzyme concentration is in excess and the reaction rate is dependent on the substrate concentration The substrate concentration is equal to Km and the reaction rate is dependent on the enzyme concentration
The substrate concentration is in excess and the reaction rate is dependent on the enzyme concentration
A prothrombin time (PT) specimen was collected at an outpatient clinic and will not be picked up by the testing laboratory's courier until several hours later. How should the specimen be stored until it is picked up by the courier? The specimen should be centrifuged right away and stored in the refrigerator at 4° C until is picked up the the courier. The specimen should be frozen immediately and kept there until is tested. The tube should remain unopened and be kept at room temperature (20°-25° C). The specimen should be protected from light.
The tube should remain unopened and be kept at room temperature (20°-25° C). Plasma should be removed and frozen at -20° C or lower if the PT test will not be completed within 24 hours.
A physician calls the lab to order a Hepatitis A IgG test but cannot find the code. What do you tell the physician? There are no IgG-only tests for Hepatitis A, only a total with/without reflex to IgM Which IgG test are you looking for: surface antigen, envelope, or core IgG? It depends on where the patient is coming back from with travel history. We only have tests for antigens not antibodies for IgG
There are no IgG-only tests for Hepatitis A, only a total with/without reflex to IgM to determine current infection
The cells shown in the image to the right are: Transitional epithelial cells Renal tubular epithelial cells Yeast cells Squamous epithelial cells
Transitional epithelial cells
All of the following crystals can be exclusively found in acidic urine EXCEPT: Calcium oxalates Acid urates Triple phosphates Amorphous urates Ammonium biurates Calcium phosphates
Triple phosphates
Regarding hemoglobin synthesis, which of the following constitutes the beta globin chain coding? Two gene loci; one each on chromosome 11. Four gene loci; two each on chromosome 11. Two gene loci; one each on chromosome 16. Four gene loci; two each on chromosome 16.
Two gene loci; one each on chromosome 11.
Which of the following characteristics are found within May Hegglin Anomaly? Giant platelets Hyposegmented neutrophils Toxic granulation Dohle bodies
Giant platelets
A 41-year-old male arrived at the clinic with complaints of fatigue, malaise, and overall discomfort. Upon testing, the patient's CBC results were notably abnormal with 30% blasts present along with anemia and thrombocytopenia. Bone marrow and cytochemical staining were subsequently performed. The cytochemical stains noted negative reactions to Myeloperoxidase and Sudan Black B but a positive reaction to alpha-naphthyl acetate. Which of the following conditions is most likely seen? Acute Erythroleukemia Acute Monocytic Leukemia Acute Promyelocytic Leukemia Acute Lymphocytic Leukemia
Acute Monocytic Leukemia Acute Monocytic Leukemia is most likely present due to the positive reaction of alpha-naphthyl acetate stain. This is a type of nonspecific esterase stains which are known to positively identify monoblastic cells. Specific esterase stains would stain myelocytic cells positive. Both Acute Erythroleukemia and Acute Lymphocytic Leukemia would stain negative with all three stains mentioned in the case. Acute Promyelocytic Leukemia would stain positive with Myeloperoxidase and Sudan Black B, but would stain negatively with alpha-naphthyl acetate.
n patients with Sickle cell disease, upon sickling what laboratory test will see an increase? MCV RBCs MCHC Hematocrit
MCHC Upon sickling there is a subsequent increase in the MCHC in proportion to the number of molecules in the deoxygenated state. hematocrit will decrease in patients with sickle cell anemia.
On a Cytospin preparation from a pleural fluid specimen, 50% of the cells have the following characteristics: - uniform, regular arrangement- some cells resemble a "fried egg"- multiple nuclei- smooth nuclear outline and homogeneous chromatin- when present in clumps, there are clear spaces between the cells ("windows") How should these cells be classified? Atypical cancer cells Mesothelial cells Tumor cells Ependymal cells
Mesothelial cells Mesothelial cells have a few key morphological features that aid in identification; notably, the "fried egg" appearance, homogenous chromatin, some have multiple nuclei, when present in clumps there are clear spaces between the cells ("windows"). None of the other cells listed have such characteristics.
Illustrated in this photograph is an agar plate on which an unknown species has been inoculated. A 5 µg novobiocin disk (NB), a 100 µg furazolidone disk (FX), and a 0.04 µg bacitracin (A) disk had been applied immediately after inoculation of the plate. Based on the pattern of the zones of inhibition to these three antibiotics, the most likely identification is: Micrococcus luteus Staphylococcus saprophyticus Streptococcus pyogenes Staphylococcus epidermidis
Micrococcus luteus
Jane Doe is a 30-year-old female who felt tired for several months, had pain in the joints of her fingers, and recently developed a dermatitis following exposure to the sun. The following test results were obtained on a blood sample drawn during the initial evaluation: Total Protein = 8.4 gm/dL (N = 6.0-8.0 gm/dL) ANA >1:2560; speckled pattern CRP = positive C3 = 40 mg/dL (N = 80-180 mg/dL) C4 = 5 mg/dL (N = 15-45 mg/dL) Based on the clinical and laboratory findings, what disease should be suspected? Rheumatoid arthritis Systemic Lupus Erythematosus (SLE) Sjogren's syndrome Scleroderma
Systemic Lupus Erythematosus (SLE) The combination of laboratory results, as well as the presence of joint pain and dermatitis in a woman of child-bearing age, support a diagnosis of systemic lupus erythematosus (SLE). Anti-nuclear antibodies (ANAs) are found in over 95% of patients with SLE. A speckled pattern is commonly found in patients with SLE, indicating the presence of antibodies to a variety of nonhistone, small ribonucleoprotein (RNP) particles.
A mother's serologic results are shown above. Her newborn types as group A Rh positive with a (1+) positive direct antiglobulin test (DAT). Which of the following investigative tests would be most useful to resolve the cause of the positive DAT and should be done FIRST? Test an eluate prepared from newborn's red cells against an antibody identification panel by IAT. Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT. Test newborn's plasma against mother's red cells by IAT. Test newborn's plasma against father's red cells by IAT.
Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT. The mother is group O Rh positive with a negative antibody screen and the infant is group A Rh positive. Results are consistent with a possible case of ABO HDFN. ABO HDFN is nearly always limited to A or B infants of group O mothers with potent anti-A,B. The most useful follow-up would be to test the infant's plasma against A1 red cells and group O antibody screen cells (as a control), expecting only the A1 cells to be positive (due to the mother's anti-A,B because she is group O) if the DAT was due to ABO incompatibility.
Which statement about assays for the antigenic detection of both Clostridium difficile toxins A and B is TRUE? The antigenic assays give rapid results. The assays can only detect simultaneous production of toxin A and toxin B. The assays provide a high level of sensitivity. Assays that detect toxin A alone will detect all clinically significant strains.
The antigenic assays give rapid results. The sensitivity of these assays is not very good (52% - 81%), but the specificity is between 91% - 94%. Molecular methods provide better sensitivity of detection, with the advantage of a comparably rapid turnaround time.
Which antinuclear antibody (ANA) pattern is seen in the image on the right, which represents the result of an ANA test viewed using fluorescent microscopy? Note: (a) points to the nuclei of interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. There is no discernable pattern Homogeneous Centromere Nucleolar
There is no discernable pattern
Which antinuclear antibody (ANA) pattern is seen in the image on the right, which represents the result of an ANA test viewed using fluorescent microscopy? Note: (a) points to the nuclei of interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. There is no discernable pattern Homogeneous Centromere Nucleolar
There is no discernable pattern n order for the ANA to be positive, there must be a clearly discernible pattern in the nuclei of the interphase cells. Observing the chromosomal area and cytoplasm of the metaphase cells may assist in the identification of the ANA pattern. The cells on this slide demonstrate weak staining in the nuclei of the interphase (nondividing) cells but no clear pattern. In addition, there is an absence of fluorescence in the chromatin region (center of the nucleus) in the metaphase (dividing) cells. In contrast, a homogeneous pattern would show uniform staining of the nuclei in the interphase cells and the presence of staining in the chromatin of the dividing cells. The centromere pattern is characterized by many discrete speckles in both the nuclei of interphase cells and the chromatin of dividing cells. In the nucleolar pattern, there is prominent staining of the nucleoli in the nuclei of the interphase cells and variable staining in the chromatin of the dividing cells.
Which of the following GFR (glomerular filtration rate) values is considered to be in renal failure? 120 mL/min 95 mL/min 35 mL/min 14 mL/min
14 mL/min Normal GFR rates should be above 90 mL/min values between 15-60 mL/min are considered to have kidney damage values below 15 denote renal failure
A 45-year-old African American female has been diagnosed and treated for type 2 diabetes for the past five years. She maintains good control of her blood glucose with medication but does not exercise and has gained 12 pounds over the past year. At her next appointment, her physician orders hs-CRP along with blood assays to monitor her diabetes. Laboratory Result: hs-CRP 2.8 mg/L At no risk for cardiovascular disease Low risk for cardiovascular disease Moderate risk for cardiovascular disease High risk for cardiovascular disease
< 1 mg/L represents a low risk of CVD 1.0-3.0 mg/L represents a moderate risk of CVD CRP > 3.0 represents a high risk of CVD
Red blood cells with a positive DAT cannot be tested accurately with blood typing reagents that require an indirect antiglobulin technique unless they have been treated with all of the following (to dissociate IgG from the RBC membrane) EXCEPT: Chloroquine diphosphate Ficin ZZAP Albumin
Albumin
For which of these conditions or procedures there may be an increased number of megakaryocytes in the bone marrow, but a decreased number of circulating platelets? Folic acid deficiency Aplastic anemia Radiation Therapy Wiskott-Aldrich syndrome
Folic acid deficiency Pancytopenia is often seen with megaloblastic anemias that are caused by folic acid or vitamin B12 deficiency. Thrombopoiesis (as well as erythropoiesis and granulopoiesis) is ineffective. The bone marrow will contain normal, or even increased megakaryocytes, but the number of platelets entering the peripheral circulation is decreased. In aplastic anemia, megakaryocytes are decreased in number in the bone marrow, leading to a decreased number of circulating platelets. Radiation therapy causes bone marrow hypoplasia. Platelets as well as all other cell lines are depressed. The effect is transient; once the therapy has ended, the marrow will regenerate. In Wiskott-Aldrich syndrome, platelets are very small and thrombocytopenia is present.
The red blood cell inclusions noted in the Wright stained peripheral smear to the right are called: Heinz bodies Basophilic stippling Malarial ring forms Pappenheimer bodies
Pappenheimer bodies
A 27-year-old female presents to her physician after suffering a spontaneous abortion. Though rare, which antibody may be the etiological agent? Anti-P1 Anti-P Anti-PP1Pk Anti-P2
Anti-P Individuals with the P1k phenotype only express the P and Pk antigens, so they may form an anti-P antibody. This antibody is clinically significant as it can cause spontaneous abortion, but it is a rare phenotype to possess. The Anti-P1 antibody is a cold-reacting antibody that is not clinically significant. Null-type individuals have the P phenotype. The corresponding Anti-PP1Pk can be clinically significant, but it causes hemolysis. The P1 and P2 phenotypes are similar to A1 and A2. Anti-P2 does not naturally exist.
Which of the following autoantibodies are found in a patient with Celiac disease? Thyroid-stimulating hormone receptor antibodies (TRAbs) Antithyroid peroxidase (TPO) Islet cell antibodies Antitransglutaminase (tTG)
Antitransglutaminase (tTG)
he presence of mature oocysts contain two sporocysts with four sporozoites is characteristic of this organism. Which of the following organisms does this represent? Cystoisospora belli Sarcocystis species Cryptosporidium parvum Blastocystis hominis
Cystoisospora belli
Which of these methods measures fetal hemoglobin or D positive red cells or both to evaluate fetomaternal he morrhage? Rosette test Kleihauer-Betke test Flow cytometry AHG testing
Flow cytometry In patients with a positive rosette test (a screening for fetomaternal hemorrhage), a quantitative test such as Kleihauer-Betke test or flow cytometry is performed to calculate the dose of Rh immune globulin. The Kleihauer-Betke acid elution is based on the fact that fetal hemoglobin is resistant to acid elution and adult hemoglobin is not resistant to it.
In which of the following conditions would one see Bite cells or Heinz bodies on the peripheral blood smear? Iron deficiency anemia Malarial infections G6PD deficiency Splenectomies
G6PD deficiency Heinz bodies in a peripheral smear stained with a supravital stain. Heinz bodies are denatured hemoglobin, which occurs in G6PD deficiencies and in unstable hemoglobin disorders
Leuconostoc species are streptococcus-like bacteria used in the dairy and pickling industries that have recently caused opportunistic infections in humans. The need to make the laboratory identification is compounded because these bacteria are intrinsically resistant to vancomycin. Which characteristic is most helpful in separating Leuconostoc species from other streptococcus-like organisms? Gas from glucose in MRS broth Leucine aminopeptidase (LAP) activity Ability to grow in 6.5% NaCl (salt tolerance) Ability to grow at 10° C
Gas from glucose in MRS broth
This image depicts a brilliant cresyl blue stained blood smear. What inclusion bodies are shown in the erythrocyte indicated by the arrow (B)? Howell-Jolly bodies Hb H inclusions Pappenheimer bodies Siderotic granules
Hb H inclusions Hemoglobin H bodies precipitate with brilliant cresyl blue (a supravital stain) just inside the RBC membrane and are usually lightly colored and evenly distributed around the cell. Normal hemoglobin, or that which has not yet precipitated, remains evenly distributed in the RBC giving it a smooth appearance (arrow C). Brilliant cresyl blue that is used for this stain also precipitates remnants of RNA (similar to New methylene blue in the reticulocyte stain). These RNA remnants stain darker than Hemoglobin H bodies and are few in number as shown in the cell (arrow A).
A 7-year-old male presented to the local clinic experiencing mild, yet annoying, abdominal pain, diarrhea and nausea. Patient history revealed that the child lives in a shack where sanitation practices are marginal, at best. The dwelling is infested with rats and multiple insects. Stool was collected and submitted for an ova and parasites examination. Numerous suspicious forms, as depicted in the image to the right, measuring 60 µm by 75 µm were seen. This child is MOST likely infected with: Hymenolepis nana Hymenolepis diminuta Echinococcus granulosus Dipylidium caninum
Hymenolepis diminuta Hymenolepis diminuta lacks polar filaments, but is otherwise indistinguishable from Hymenolepis nana. Light infections with either species are generally asymptomatic, but large numbers of adult worms can cause abdominal pain, diarrhea, irritability, and headache.
Which one of the following is a true statement about Lupus Anticoagulant (LA)? LA is a specific inhibitor found mainly in patients with the autoimmune disease, Systemic Lupus Erythematosus (SLE) LA is common in hemophiliacs LA prolongs coagulation leading to bleeding problems in patients. LA is an immunoglobulin.
LA is an immunoglobulin. acts as an inhibitor of phospholipid-dependent coagulation in vitro, but causes a tendency to thrombosis in vivo.
How does RhIg prevent anti-D production? Mainly by suppressing the immune response after exposure to D positive cells. Mainly by clearing antibody sensitized D negative RBCs from maternal circulation. Mainly by clearing IgG fetal antibodies from maternal circulation. Mainly by clearing maternal IgM antibodies from fetal circulation.
Mainly by suppressing the immune response after exposure to D positive cells. RhIg suppresses the immune response after exposure to D positive fetal cells and prevents the mother from producing anti-D. The mechanism is not clearly understood, but it may involve the removal of D-positive cells by macrophages, causing the release of cytokines that suppress the immune system response.
A male patient's urea nitrogen value is 15 mg/dL and his creatinine is 5 mg/dL. If this patient is not undergoing dialysis, what conclusion would you draw from these results? The patient's laboratory results are normal The patient is in the early stage of renal disease One of the values is in error The patient has suffered muscle deterioration
One of the values is in error The patient's urea nitrogen is within the normal range (6-20 mg/dL) while the creatinine is about five times the upper normal range (0.6-1.2 mg/dL). Gross elevations in creatinine are almost always accompanied by elevations in urea nitrogen when there is kidney impairment. Urea nitrogen to creatinine ratio is normally 10:1 to 20:1, in our case is 3:1 which is abnormally low.
Based on the white blood cells in the peripheral blood smear image, which condition would most likely be associated with this image? Severe infection Pelger-Huet anomaly Infectious mononucleosis Myeloperoxidase deficiency
Severe infection The image in this question shows Dohle bodies in the cytoplasm of the neutrophils. Dohle bodies are oval, blue inclusions, and are 1 to 3 µm in diameter. They are highly associated with severe infections, burns, and cancer (due to toxic drugs). Dohle bodies can also be found in conjunction with toxic granulation and toxic vacuolization.
Which of the following statements is TRUE for specific gravity measured by the urine chemical reagent strip method? High concentrations of protein in urine do not increase the readings when using the urine chemical reagent strip. An alkaline pH would not affect the specific gravity result using a reagent strip method. The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen. The urine chemical reagent strip method is based on the fact that light is refracted in proportion to the amount of total solids dissolved in the urine.
The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen.
When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix". You then place the sample in a water bath to incubate for 90 minutes before running your new mixed sample. What is the problem with the steps involved in the procedure above? You don't need to incubate your sample. You have forgotten to add a reagent. You have not run a PT or aPTT on the new mix before incubating. You have incubated too long.
You have not run a PT or aPTT on the new mix before incubating.
Motility is a key initial assessment in the presumptive identification of the nonfermentative gram negative bacilli. All of the following organisms are motile EXCEPT? Burkholderia cepacia Alcaligenes faecalis Pseudomonas aeruginosa Elizabethkingia meningoseptica
Elizabethkingia meningoseptica
A 55-year-old white male had the following lab data: RBC 3.7 X 1012/L Serum iron 220 µg/dL (N: 60-80 µg/dL) TIBC 300 µg/dL (N: 260-400 µg/dL) Hct 32% Serum Ferritin 2,800 ng/mL (N: 10-200 ng/mL) WBC 5.8 x 109/L MCV 86 fL MCH 26 pg MCHC 32% Prussian Blue stain of bone marrow aspirate indicates markedly elevated iron stores. These laboratory results are MOST consistent with which of the following conditions? Sideroblastic anemia Anemia of chronic disease Hemochromatosis Megaloblastic anemia
Hemochromatosis Hemochromatosis is the most common form of iron overload disease. Characteristic findings are elevations in serum iron and ferritin. Positive Prussian Blue stain of the bone marrow indicates elevated iron (hemosiderin) stores. Sideroblastic anemia occurs when there is decreased production of protoporphyrin which is necessary for the synthesis of heme. Patients with sideroblastic anemia have increased iron deposits in the nucleated red cells in the bone marrow. Iron accumulates in the mitochondria of these nucleated red cells and results in ringed sideroblasts.
Which of the following is characteristic of Alder-Reilly anomaly? Giant, dysfunctional lysosomal cytoplasmic granules Döhle body-like inclusions composed of precipitated myosin heavy chains Large, darkly staining cytoplasmic granules composed of partially digested mucopolysaccharides Decreased nuclear segmentation and coarse chromatin in leukocytes
Large, darkly staining cytoplasmic granules composed of partially digested mucopolysaccharides These granules resemble toxic granulation in neutrophils, but findings commonly associated with toxic granulation, such as Döhle bodies, neutrophilia, and a left shift, are absent in Alder-Reilly anomaly. The granules of Alder-Reilly anomaly may also be found in lymphocytes and monocytes; toxic granulation is exclusive to neutrophils. Leukocyte function is normal in Alder-Reilly anomaly.
A patient has the following serum results: Na = 130 mEq/L K = 4.9 mEq/L Cl = 107 mEq/L Glucose = 300 mg/dL BUN = 18 mg/dL Creatinine = 1.1 mg/dL Which osmolality result is consistent with these results?. Note: There are various published versions of this particular equation that will produce slightly different results (choose the value closest to your calculated result). 240 mosmol/kg 251 mosmol/kg 281 mosmol/kg 293 mosmol/kg
Osmolality = 2 x Na + [Glucose (mg/dL) / 20] + [BUN (mg/dL)/ 3] In this case: 2 (130) + (300/20) + (18/3) = 260 + 15 + 6 = 281 mosmol/kg
There are two patterns present in this microscopic field from an antinuclear antibody ANA test. The test is viewed using fluorescent microscopy. One pattern can be seen in the interphase cells (a) and the area outside of the chromosomal area of the mitotic cells (b). The other pattern is recognizable in the chromosomal area of the metaphase mitotic cells (c). What are these two patterns? Homogeneous and nucleolar Speckled and homogeneous Speckled and centromere Centromere and nucleolar
Speckled and homogeneous the speckled ANA is the dominant pattern in the interphase cells (a) and some speckling is present in the area outside of the chromosomal area of the mitotic cells (b). Also notice the smooth staining of the chromosomal area of the metaphase mitotic cells (c). This represents the presence of a homogeneous ANA pattern. In addition, there is no staining of the nucleoli within the nuclei of the interphase cells, and absence of centromere staining, which would appear as numerous tiny discrete speckles in both the nondividing and dividing cells.
The qualitative differences between A1 and A2 phenotypes includes all of the following EXCEPT: The formation of anti-A1 in A subgroups. The amount of transferase enzymes. The length of the precursor oligosaccharide chains. The lack of agglutination of patient red cells with anti-A reagent.
The lack of agglutination of patient red cells with anti-A reagent. Qualitative differences for A1 and A2 phenotypes include the following: differences in the precursor oligosaccharide chains (in length and complexity of branching), small differences in transferase enzymes (decreased in A2 subgroup), and the formation of anti-A1 in the serum of A2 phenotype individuals. Both A1 and A2 patient red cells react with the anti-A reagent. Dolichos biflorus or anti-A1 lectin reagent is used to differentiate between A1 and A2 phenotypes. This lectin reagent agglutinates with A1 patient red cells but does NOT agglutinate with A2 patient red cells.
The cell containing the inclusions indicated by the arrows are often associated with which of the following conditions? Albinism Sepsis Alder-Reilly anomaly Megaloblastic Anemia
Sepsis The pale gray-blue inclusions next to the cell membrane of the neutrophil are Döhle bodies. Döhle bodies may be seen in patients with sepsis, bacterial infections, and severe burns.
This antinuclear antibody (ANA) pattern is characterized by granular staining in the nuclei of the interphase cells (a). There is also an absence of staining in the chromosomal area of the metaphase mitotic cells (b). The slide is viewed using fluorescent microscopy. Which pattern is this? Homogeneous Speckled Nucleolar Centromere
Speckled The image shown displays the features of a speckled ANA pattern: granular/speckled staining in the nuclei of the interphase cells (a) and absence of staining in the chromosomal area of the metaphase mitotic cells (b). The nucleoli do not stain; thus, the pattern is not nucleolar. A homogeneous pattern would show uniform staining of the nuclei in the interphase cells and presence of staining in the chromatin of the dividing cells. The centromere pattern is characterized by many discrete speckles in both the nuclei of interphase cells and the chromatin of dividing cells.
A patient had a differential diagnosed of Systemic Lupus Erythrematosus (SLE).Laboratory Results:ANA = positive (homogeneous pattern),titer 1:320,RA=positive,Complement = decreased.All of the following specific laboratory tests meet the criteria for a definitive diagnosis of SLE, EXCEPT? A positive antinuclear antibody (ANA) Smith (Sm) antibodies Double-stranded DNA (dsDNA) antibodies Ribonucleic protein (RNP) antibodies
Ribonucleic protein (RNP) antibodies Ribonucleic protein (RNP) antibodies are not specific for Systemic Lupus Erythematosus (SLE). In addition, Anti-Sjögren's syndrome antigen A (SSA, or Ro) and anti-Sjögren syndrome antigen B (SSB, or La) antibodies and histone antibodies are not specific for SLE. Anti-ribosomal P (anti-P) is associated with neurolupus but not particularly useful in management or diagnosis of neuropsychiatric lupus. Chromatin antibodies detection is of primary use in the diagnosis of drug-induced lupus not SLE. The initial laboratory results demonstrated a positive ANA test, or anti-nuclear antibody, which is a screening test for Lupus erythrematosus; an RA test, or rheumatoid factor, screening assay for the presence of an antibody linked with rheumatoid arthritis and other conditions, such as lupus erythematosus. Renal disease in patients with Systemic Lupus Erythematosus is indicated by an assessment of the levels of C3 and C4. In this case, there was a decreased level. A decrease in complement proteins indicates that the classic complement pathway may have been activated resulting in immune complexes, a clinically significant indication of tissue damage, particularly renal disease. Patients with SLE are characterized by the presence of antibodies to multiple antigens but some of these antibodies are not exclusive to SLE. An extractable nuclear antibody, Smith (Sm) antibody, is highly specific for SLE, but occurs in only 20-30 or35% of cases. Double-stranded DNA (dsDNA) antibodies (titer >1:10) detected by immunofluorescence assay (IFA) is seen in up to 50-60% of patients with Systemic Lupus Erythematosus (SLE). These antibodies indicate an active disease.
The volume of urine recommended for centrifugation for a microscopic examination is: 1 - 3 mL 10 - 15 mL 15 - 20 mL Volume is not important
10 - 15 mL
All of the following are coagulation assays that employ low-reagent phospholipids and thus are sensitive to Lupus Anticoagulant (LA) (Antiphospholipid Antibodies) EXCEPT: Kaolin clotting time (KCT) Dilute Russell viper venom time (DRVVT) Activated partial thromboplastin time (aPTT) Dilute partial thromboplastin time (DTT)
Activated partial thromboplastin time (aPTT)
A young child is brought in for a clinic visit for bleeding and bruising tendencies. Coagulation screening tests revealed normal PT and APTT levels. The CBC was overall normal with the exception of a low platelet count and giant platelets. Platelet aggregation studies were then ordered with normal responses to all agents except ristocetin which had no response. Which of the following is the disease correlates with these findings? May-Hegglin Anomaly Glanzmann Thrombasthenia Hemophilia A Bernard Soulier Syndrome
Bernard Soulier Syndrome Bernard Soulier Syndrome is an inherited platelet disorder that is missing the platelet receptor Ib/IX/V. This receptor is used for Von Willebrand Factor to aid in platelet adhesion.
Not all strains of Entamoeba histolytica appear to be pathogenic, and recent molecular studies indicated that there was a non-pathogenic variant of Entamoeba histolytica. What is this non-pathogenic variant? Entamoeba hartmanni Entamoeba moshkovkii Entamoeba dispar Entamoeba coli
Entamoeba dispar
What condition would be suspected in an asymptomatic patient with greater than 20% atypical (reactive) lymphocytes on their peripheral blood smear? Herpes simplex virus infection Epstein-Barr virus infection Bacterial meningitis Acute leukemia
Epstein-Barr virus infection Epstein-Barr virus causes infectious mononucleosis, which is associated with atypical (reactive) lymphocytosis. The peripheral blood smear may show 5%to 30% atypical lymphocytes. Patients are often asymptomatic, however, they can present with fatigue, malaise, fever, sore throat and cervical lymphadenopathy. Herpes simplex virus infection does produce atypical lymphocytosis, however, the percentage of atypical lymphocytes will be less than 20%. Bacterial meningitis would present as an increase in neutrophils, which help fight bacterial infections. Acute leukemias generally present with many immature cells in the bone marrow and/or the peripheral blood. The types of immature cells present will depend upon the cell like affected, myelogenous, monocytic or lymphocytic.
A 29-year-old female of Philippine descent is seen by her physician for fatigue. The patient states that a relative told her that their family has a long history of anemia. She presents with sclera icterus and her spleen is palpable. Routine blood work was initially ordered and these results were obtained: WBC Norm RBC Norm Hb LOW HCT LOW MCV LOW MCH LOW MCHC LOW RDW HIGH PLT HIGH A peripheral blood smear is reviewed, revealing many codocytes (target cells) and a few schistocytes (fragmented RBCs). The majority of the RBCs that were seen in this smear were also microcytic and hypochromic. What additional laboratory tests should be performed to aid in the diagnosis of this disorder and associated anemia? B12 and Folate Coagulation profile Hemoglobin electrophoresis Iron studies
Hemoglobin electrophoresis Although relatively rare in most of the world, these clinical and laboratory test results combined with the family history of anemia and given the patients' ethnicity, suggest the presence of thalassemia. The hemoglobin electrophoresis should aid in the diagnosis of this disorder in this patient.
An assessment of the myeloid to erythroid (M:E) ratio is part of every bone marrow evaluation. Which of the following does not apply to the M:E ratio? The erythroid total used in calculating the M:E ratio is the sum of all the nucleated red cell precursors. The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow. White blood cells used in the myeloid tally/total used to calculate the M:E ratio include neutrophil precursors as well as eosinophil precursors and basophil precursors. The M:E should always be interpreted in context with the overall bone marrow cellularity.
The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow. The M:E ratio is calculated from the total granulocyte precursors and the total erythroid precursors. It does not include non-myeloid nucleated cells such as lymphocytes, monocytes etc. It should always be interpreted in context with the overall bone marrow cellularity. The typical reference range for the M:E ratio is 2:1 - 4:1.
Illustrated in the top photograph is the picture of a yellow to buff colored colony, suede-like in consistency, recovered from a hairless inflammatory lesion of the skin of the scalp of a young male athlete. The more definitive identification can be made from observation of the lactophenol blue mount illustrated in the bottom photomicrograph, prepared from a small sample of the colony surface mycelium. Based on these observations, select from the multiple choices the presumptive identification. Trichophyton mentagrophytes Microsporum gypseum Epidermophyton floccosum Trichophyton tonsurans
Trichophyton tonsurans T. tonsurans is the major cause of scalp ringworm in the United States, also known to infect the nails and skin. Observed microscopically are the distinctive relatively large, round, tear-drop, or club-shaped microconidia produced perpendicularly on each side of hyaline hyphae. Macroconidia are rarely observed. Best colony growth is achieved using Trichophyton agars that contain thiamine.
Illustrated in this photograph is the surface of a MacConkey agar plate growing colonies of a non-fermentative Gram negative bacillus recovered from a wound specimen. The iridescent light pink colonies suggest Acinetobacter species. Each of the following characteristics are helpful in supporting this identification EXCEPT: Lack of motility Oxidation of glucose Denitrification of nitrates Resistance to penicillin
Denitrification of nitrates Denitrification of nitrates is correct because Acinetobacter species do not denitrify nitrogen, a characteristic that is commonly used in the identification of Pseudomonas species. Lack of motility is incorrect because all Acinetobacter species are nonmotile. Oxidation of glucose is incorrect. Acinetobacter species are divided into two groups; those that are glucose oxidizers and those that are non-glucose oxidizers. Most Acinetobacter baumannii are glucose oxidizers and Acinetobacter lwoffi are non-glucose oxidizers. Resistance to pencillin is incorrect because Acinetobacter species are resistant to beta-lactams and penicillin is a beta-lactam drug.
Which genetic description will NOT contain Bart's hemoglobin at birth ? Heterozygous alpha thalassemia-1/alpha thalassemia-2 Heterozygous alpha thalassemia-1 Homozygous alpha thalassemia-2 Heterozygous alpha thalassemia-2
Heterozygous alpha thalassemia-2 Bart's hemoglobin is present when tetramers of gamma chains are formed. These tetramers form in fetuses and neonates when there is an insufficient amount of alpha chains. Heterozygous alpha thalassemia-2 has only one alpha gene deletion and is referred to a silent carrier. It will not present with any Bart's hemoglobin at birth . The heterozygous alpha thalassemia-1/ alpha thalassemia-2 is also referred to hemoglobin H disease . It has three alpha gene deletion with presence of Bart's hemoglobin at birth. The heterozygous alpha thalassemia-1 and the homozygous alpha thalassemia-2 are referred to the alpha thalassemia minor with two alpha genes deletions and therefore presence of Bart's hemoglobin at birth.
