ASCP MLT TEST

What is the normal cellularity of an iliac crest bone marrow biopsy in a 50 year old male:

50%

If an average-weight adult male patient with a 7 gram/dL hemoglobin is given two units of packed cells, what would be the approximate new hemoglobin value (assuming there is no active bleeding or other predisposing factors that would shorten the survival of the blood cells)?

9.0 gm/dL

If 100% of the cells in the gated lymphocyte population are positive for CD45 (i.e., they are leukocytes) and 7% are B cells (represented by CD19 and CD20 positivity), approximately what percentage of T cells would be expected?

93%

A severe hemophiliac, with a Factor VIII activity of less than 1%, is actively bleeding due to a serious accident. The blood product of choice is:

Factor VIII concentrate

Which of the following is NOT a characteristics of Burkholderia pseudomallei?

Fat, gram-postive rod

The lecithin to sphingomyelin ratio (L/S) is used to assess:

Fetal lung maturity

The Rh nomenclature which uses the letters DCE is found in which of the following genetic models:

Fisher -Race

Which of the following thyroid function assays is affected least by pregnancy:

Free T4

Which of the following is not a routine component of semen analysis:

Fructose level

Which of the following is true of genotype screening in pharmacogenomics?

Genotyping does not take into account drug interactions which can affect metabolism.

When is a trough blood sample for therapeutic drug monitoring usually obtained?

Just before the next scheduled dose

The white blood cell that can appear atypical or reactive on a Wright-stained smear is:

Lymphocyte

HLA-A and HLA-B antigens can be detected using which of the following techniques?

Lymphocyte cytotoxicity

Calculate the red cell indices from the following set of patient data: RBC count = 3.19 x 1012/L Hemoglobin = 11.3 g/dL Hematocrit = 35%

MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL

A track star was in the locker room after a competition when one of his teammates noticed light brown circular lesions on his upper back. The agent MOST likely responsible for this condition is:

Malassezia furfur

Which of the following stains is not routinely used when examining peripheral blood smears ?

May-Grunwaldt

metastasis

The nucleus in this cell is abnormal and appears to have divided. This finding correlates with the presence of metastasis in the CSF.

A patient has been characterized as a CYP2D6 poor metabolizer (PM) after genotyping. Which of the following statements is not true?

The patient is less likely to require therapeutic drug monitoring (TDM) since the genotype is known.

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?

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

Which of the following factors would not affect an orally-administered drug's absorption and/or distribution in the body?

The position of the patient when the drug is taken (sitting vs. standing)

Avidity is best described by which of the following statements:

The strength with which multivalent antigens and antibodies bind

A patient suffering from Celiac disease and Crohn disease (both inflammatory conditions of the GI tract) is given a new oral medication that has a narrow therapeutic window. Which of the following would be true?

Therapeutic drug monitoring (TDM) would be helpful to see how much drug has been absorbed.

Which of the following statements is true regarding CYP450 enzymes?

They are involved in hormone synthesis and breakdown, cholesterol synthesis, vitamin D metabolism, and drug and toxic substance breakdown.

Plasma exchange is the current treatment for which of these conditions?

Thrombotic thrombocytopenic purpura (TTP)

A mutation in a CYP450 enzyme that causes increased enzyme activity would

All of the above answers are true. be a polymorphism if the mutation was present in at least 1% of the population. require that the patient with this mutation is given greater than the standard dose of a drug if it is metabolized by this enzyme. lead to lower drug response with standard doses.

Match type of hemolysis on the right with best description:

Alpha hemolysis- Green area around bacteria incomplete hemolysis Beta hemolysis- Clear area around bacteria complete hemolysis Gamma hemolysis- No visible effect on blood

The clinical Gram stain taken from an endocervix revealed many WBC's with both intracellular and extracellular gram- negative diplococci. The specimen was plated onto a Modified Thayer-Martin plate and incubated. Following incubation, colonies resembling N. gonorrheae were inoculated into separate CTA tubes containing glucose, lactose, sucrose and maltose. The fluorescent monoclonal antibody test was positive as well as the CTA maltose and glucose tubes. What is the most appropriate next step?

Analyze another maltose tube using a known strain of N. gonorrhoeae

Which of the following would you expect to find in the serum of a patient who has recovered from Hepatitis B infection within 6 months after infection?

Anti-HBs

Moving forward, important strategies for dealing with MRSA strains will include the following:

Antimicrobial stewardship to guide the use of both existing alternatives and newer drugs. Identification of MRSA strains in all settings (inpatient as well as outpatient). Possible development of vaccines.

All of the following are considered benefits of automated isolation and extraction equipment EXCEPT:

Automated isolation equipment is cheaper and more practical

Match the group of antibiotics listed in the left column that are associated with specific species of organisms for which resistance has emerged.

Vancomycin resistance- Enterococcus faecium Methicillin resistance- Staphylococcus aureus Cephalosporin resistance- Klebsiella pneumoniae Intermediate penicillin resistance- Streptococcus pneumoniae

Which of the following are not appropriate indications for the use of fresh frozen plasma:

Volume expansion

The glycoproteins associated with the HIV "spike" are:

120 and 41

Which of the following kappa / lambda ratios is found in normal serum:

2 : 1

The proper storage requirements for granulocyte concentrates is:

20 - 24 degrees Celsius, < 24 hours

Which of the following factors do not affect hybridization?

A:T content

Match appropriate genotype to its corresponding phenotype :

AB AB OO O AA, AO A BB, BO B

Which of the following are the beta thalassemia syndrome(s) whose genotype is B0/B+?

Beta thalassemia intermedia Beta thalassemia major

Which of the following ketones is NOT detected in the Acetest® tablet method?

Beta-hydroxybutyric acid

Various methods have been employed for detection of C. difficile disease: cultivation of the organism, cell cytotoxin neutralization assays, and enzyme immunoassays have all been among the staples of diagnostic approaches. Which statements are accurate characterizations of these assays?

Cell culture based cytotoxin neutralization assays provide definitive detection of toxin-producing C. difficile strains. Enzyme immunoassays detecting both Toxin A and Toxin B allow the detection of more strains of C. difficile and are therefore preferred over assays that detect only Toxin A.

Which one of the following drugs/drug classes is the MOST COMMON cause of drug-induced hemolytic anemia?

Cephalosporins

Which chromosome demonstrates a partial or full gene loci deletion in various forms of beta thalassemia?

Chromosome 11

It is important to prepare as many slides as possible from the obtained sample to provide the opportunity for choosing the best quality slides and for special stains, if needed.

Comprehension Domain

A test for microalbuminuria is used most often to monitor patients with which of the following diseases or conditions?

Diabetes

Match each of the definitions shown below with the term from the drop-down box that it defines.

Drug half-life- The amount of time it takes for a drug's concentration in the body to decrease by 50% Therapeutic window- The range between a drug's effective dose and its toxic dose Pharmacokinetics- The study of drug disposition in the body - how and when drugs enter the circulation, how long they stay there, and how they are eliminated Pharmacogenomics (Pharmacogenetics)- The study of how variations in the human genome affect a given individual's response to medications

Patients with which of the following conditions would benefit most from washed red cells:

Elevated serum potassium

Which is the first marker (antigen or antibody) which will become positive after exposure to Hepatitis B:

HBsAg

DR antigens are found in which of the following systems:

HLA system

A 55-year-old white male had the following lab data: RBC 3.7 X 10'/uL Serum iron 220 ug/dL (N: 60-80 ug/dL) Hgb 10.0 g/dL TIBC 300 ug/dL (N: 260-400 ug/dL) Hct 32% Serum Ferritin 2,800 ng/mL (N: 10-200 ng/mL) WBC 5,800 MCV 86 fl MCH 26 pg MCHC 32% Bone marrow shows shift to left for RBC's Prussian Blue stain indicates markedly elevated iron stores

Hemochromatosis

A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state?

Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%

Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils:

IgE

Which of the following tests confirms the presence of Bence-Jones proteinuria:

Immunoelectrophoresis

A drug that is administered through which of the following routes will reach peak level the quickest?

Intravenous (IV)

The migration rate of proteins on cellulose acetate is primarily the result of:

Ionic charge on the proteins

Which one of the following statements about acetaminophen metabolism is false?

It is metabolized in the kidney

It is OK to change a physician's orders without calling the office first when:

It is never acceptable to change a physician's order without calling the office or department first. All changes must have approval beforehand.

If a drug is given at intervals that are the same as its half-life, approximately how long will it take the drug to reach steady state?

It will take about 5 half-lives to reach steady state.

Meninges- Membrane covering the brain under the skull Transudate- Fluid accumulation due to a malfunction of ability to form and reabsorb fluid Pleurisy- Inflammation of the pleural membranes Effusion- Excess accumulation of fluid within any of the body's serous cavities

Meninges- Membrane covering the brain under the skull Transudate- Fluid accumulation due to a malfunction of ability to form and reabsorb fluid Pleurisy- Inflammation of the pleural membranes Effusion- Excess accumulation of fluid within any of the body's serous cavities

Which of the following organisms has been known to cause epidemic tinea capitis in children but almost never affects adults?

Microsporum audouinii

Phagocytosis is a function of which of the following types of cells:

Monocytes

Which of the following is not primarily a hemolytic process?

Mononucleosis

A patient with an upper respiratory infection submits a sputum for culture. A Gram stain performed on the sputum specimen reveals gram-negative diplococci. Oxidase testing is positive and carbohydrate degradation tests are inactive. The organism may presumptively be identified as:

Moraxella catarrhalis

Electrophoretic separation of hemoglobin fundamentally relies on:

Net charge differences of molecules

Which method is employed if the following procedural steps were used to identify M. kansasii? 1 - Extraction 2 - Denaturization 3 - Hybridization 4 - Hydrolysis of excess reagent 5 - Detection of acridinium ester

Nucleic acid probes

Which of the following red blood cells contain the most H antigen:

O

Enterococcus faecium is:

Often vancomycin resistant

Match each virus with its appropriate nucleic acid content.

Paramyxovirus: RNA Rhabdovirus: RNA Poxvirus: DNA Orthomyxovirus: RNA

Which of the following is true about Bence-Jones protein when performing the heat precipitation test?

Precipitates between 40° and 60°C but redissolves at 100°C

Match these autoimmune diseases with their corresponding serological markers:

Primary biliary cirrhosis Antimitochondrial antibodies CREST syndrome Anticentromere antibodies Wegener's granulomatosis Antineutrophilic antibodies Rheumatic fever Antimyocardial antibodies

Which one of the following statements about blood collection tubes is INCORRECT?

Red top tubes are used for electrolytes, and contain anticoagulant.

Which are true statements regarding hospital-associated methicillin-resistant Staphylococcus aureaus (HA-MRSA) and community-associated MRSA (CA-MRSA)?

Resistance for both strains is conferred by the mecA gene. HA strains tend to demonstrate resistance to more drug classes than CA strains. CA tends to be associated with the PVL gene and skin and soft tissue infections

The prozone effect can be described by all of the following EXCEPT:

Results in a false positive reaction

Which of the following conditions would argue in favor of therapeutic drug monitoring (TDM) for a given drug?

The drug is given chronically

Which of the following is an important technique consideration in order to obtain consistently high quality bone marrow smears?

Select or concentrate bone marrow spicules, ensuring they are transferred to the slide.

An isolate of S. pneumoniae from a respiratory specimen gave a zone of inhibition of 18mm around a 1 ug oxacillin disk using the disk diffusion test. What should the next step be?

Set up an MIC on the isolate

Which of the following organisms are most frequently associated with infective endocarditis?

Staphlyococci Streptococci

Which of the following is the MOST IMPORTANT first step to take when a patient is transfused with un-crossmatched RBCs that turn out to be incompatible?

Stop any transfusion in progress.

Cell size is indicated by forward scatter and granularity is indicated by side scatter in flow cytometry.

TRUE

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 newborn's plasma against group A1 red cells and group O antibody screen cells by IAT.

Match the names of the PCR stages to their definitions.

The DNA is heated to break the hydrogen bonds resulting in single stranded DNA. Denaturation The DNA primers attach to the DNA strands. Annealing The DNA polymerase synthesize new strands of DNA. Extension

Assume you perform microbiology for an institution submitting surveillance cultures for MRSA. Which isolate should receive further workup to rule out methicillin (oxacillin) resistance?

Yellow colonies on Mannitol Salt agar; catalase-positive, coagulase-positive.

Patient 1234 has a positive antinuclear antibody (ANA) test with a centromere pattern at a 1:1280 titer.

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.

The purpose of C3a, C4a, C5a, the split-products of the complement cascade, is to:

cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils.

Smudge Cells (bare nuclei) are commonly seen in blood smears from patients with

chronic lymphocytic leukemia.

What is the antigen carried by most strains of Streptococcus anginosus (milleri)?

f

A drug that is readily cleared and has a wide therapeutic window, such as ampicillin, should always be monitored by TDM.

false

The cytospin technique perfectly preserves the morphology of blood cells in a fluid sample.

false

Bioavailability of an oral drug refers to the

fraction of the drug that is absorbed into systemic circulation

Select the statement that best describes hs-CRP?

hs-CRP is a marker of chronic inflammation and measured to predict the risk of cardiovascular disease

What should be done if all forward and reverse ABO results are NEGATIVE?

incubate at room temperature or 4°C to enhance weak expression

Which of the following represents a diagram of a spectrophotometer?

light source - monochromator - cuvette - detector - readout

Which of the following can be defined as the average of the data points, or the sum of all the data points divided by the number of points?

mean

The value that occurs most frequently in a set of results or values would be termed:

mode

The cell in the image is a myeloblast. The myeloblast typically has a high nuclear to cytoplasm ratio, meaning that the nucleus size is increased compared to the amount of cytoplasm present. This cell can be defined as a myeloblast and not another type of blast, due to the presence of the auer rod in the cytoplasm. This is a key feature only found in myeloblasts.

myeloblast picture

If an isolate of E. coli is resistant to 1st and 3rd generation cephalosporins, extended spectrum beta-lactamase (ESBL) activity should be suspected. Therefore, each cephalosporin should be tested individually or another family of antibiotics should be considered.

true

If reporting moxalactam, cefonicid, cefamandole, or cefoperazone for Escherichia coli, Klebsiella, or Proteus species testing positive for ESBL (Extended Spectrum Beta Lactamases), they should be reported as resistant.

true