Chemistry SUCCESS, Chemistry BOC, Hematology - Success Questions, Hematology Comprehensive BOC, Success- Hemostasis, education (success, boc & harr)

227.The objective "The student will be able to perform daily maintenance on the hematology analyzer" is an example of which behavioral domain? A. psychomotor B. affective C. intellectual D. cognitive

A

228.to be effective, criticism should be: A. specific to the behavior B. related to general laboratory performance C. focused on the person, not the behavior D. repetedly discussed for reinforcement

A

According to CLIA '88, satisfactory performance for ABO, Rh, and compatibility tests requires a score of: A. 100% B. 90% C. 80% D. 75%

A

In general, academic evaluation of students depends on the ability of the instructor to create a test that reflects the stated objectives of the course material as well as making the test: A. Reliable and valid B. Normally distributed and practical C. Fair and short D. Written and oral

A

18) In storage pool disease, platelets are primarily deficient in: A. ADP B. Platelet factor 3 C. Thrombasthenin D. Thromboxane A2

A. ADP

90. Abetalipoproteinemia is characterized by mild anemia and numerous _______________ on the peripheral blood smear. A. Acanthocytes B. Elliptocytes C. Echinocytes D. Stomatocytes

A. Acanthocytes (AKA hereditary acanthocytosis)

21) When thrombin binds to thrombomodulin on the endothelial cell surface, thrombin can: A. Activate the protein C pathway B. Activate factor V and factor VIII C. Convert fibrinogen to fibrin D. Stimulate platelet aggregation

A. Activate the protein C pathway

193. The patient whose bone marrow is shown in Color Plate 161 most likely has a(n) A. Acute leukemia B. Chronic leukemia C. Myelodysplastic syndrome D. Aplastic anemia

A. Acute leukemia the "packed" bone marrow with predominantly immature blast cells and few normal precursor cells is most indicative of a patient with acute leukemia.

An 8-year-old girl is seen by the family physician. On physical examination, the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as follows: WBC 110 x 1 091L (110 x 1 034L); RBC 1.70 x 1 0121L (1.70 x 1 06/iL); hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 LIL (16%); differential count shows 93% blasts and 7% lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the blasts are small with no variation in their appearance. 285. What is this child's most probable diagnosis? A. Acute lymphoblastic leukemia B. Acute myelogenous leukemia C. Hairy cell leukemia D. Myelodysplastic syndrome

A. Acute lymphoblastic leukemia

A 45-year-old Scandinavian woman with white hair appears older than her age. She complains to her physician of weakness, a tingling sensation in her lower extremities, and shortness of breath. Her CBC results are as follows: WBC 3.4 x 1 09/L (3.4 x 1 03/L); RBC 1.90 x 1 o12/L (1.90 x 1 06IL); hemoglobin level 86 gIL (8.6 g/dL); hematocrit 0.25 LJL (25%); MCV 132 fL; MCHC 34.4 g/dL; platelet count 100 x 1 09/L (1 00,000IpL). Cabot rings are noted on the peripheral smear. 276. Which of the following is not associated with this disorder? A. Alcoholism B. Antibodies to intrinsic factor or parietal cells C. Diphyllobothrium latum infection D. Achiorhydria

A. Alcoholism

182. The most common type of chronic lymphocytic leukemia (CLL) in the United States involves the A. B cell B. NKcell C. Tcell D. Plasma cell

A. B cell

65)Lab results on a 6 year old female with petechiae and severe epistaxis are as follows: Platelet count 145x109/L, Bleeding time >15 min (ref range <8.0 min), MPV 16.0 fL (ref range 8.0-10.0 fL), Platelet aggregation Normal response to ADP, collagen, epinephrine: nor response with ristocetin, PT 11.5 sec (control 12.0 sec), aPTT 33.0 sec (control 32.0 sec). These results are consistent with A. Bernard-Soulier syndrome B. von Willebrand disease C. Glazmann Thrombasathenia D. Ehlers-Danlos syndrome

A. Bernard-Soulier syndrome

248. Which of the following is not associated with an increased osmotic fragility and a decreased surface area-to-volume ratio? A. Beta-thalassemia major B. Hereditary spherocytosis C. Warm autoimmune hemolytic anemia D. Burn victims

A. Beta-thalassemia major

91. What is the most common cause of iron deficiency? A. Bleeding B. Gastrectomy C. Inadequate diet D. Intestinal malabsorption

A. Bleeding

173. Based on the WHO classification system, B cell ALL (FAB type L3) and ______________ represent different clinical presentations of the same disease entity. A. Burkitt lymphoma B. Hodgkin lymphoma C. Mycosis fungoides D. Small lymphocytic lymphoma

A. Burkitt lymphoma

110. Which of the following statements about hereditary elliptocytosis (HE) is true? A. Characteristic oval shape occurs in mature erythrocytes. B. Heterogeneous group of disorders linked to Rh-null individuals. C. Cellular defect involves the lipid composition of the membrane. D. HE cells are abnormally permeable to calcium.

A. Characteristic oval shape occurs in mature erythrocytes.

41) The principle of ________________ methods depends on cleavage of synthetic substrates by an active serine protease. A. Chromogenic B. Photo-optical C. Mechanical D. Immunodiffusion

A. Chromogenic

A 75-year-old man with rheumatoid arthritis complains to his physician of pain and fatigue. His CBC results are as follows: WBC 6.8 X 1 09/L (6.8>< 1034LL); RBC 3.49 x 102/L (3.49 x 1064iL); hemoglobin 97 gIL (9.7 g/dL); hematocrit 0.29 IJL (29%); MCV 83 fL; MCHC 33.9 gIdL. Other laboratory results are as follows: serum iron and total iron-binding capacity (TIBC) both decreased, serum ferritin slightly elevated. 271. Which of the following is not associated with the anemia described in question 270? A. Chronic gastrointestinal blood loss B. Hodgkin lymphoma C. Tuberculosis D. Systemic lupus erythematosus

A. Chronic gastrointestinal blood loss

214. A bone marrow with 90% cellularity and myeloid:erythroid (M:E) ratio of 10:1 is most characteristic of A. Chronic myelogenous leukemia B. Primary polycythemia C. Beta-thalassemia major D. Aplastic anemia

A. Chronic myelogenous leukemia

176. In which of the following are eosinophils not increased? A. Cushing syndrome B. Allergic disorders C. Skin disorders D. Parasitic infection

A. Cushing syndrome Eosinphils are decresed in Cushing syndrome, in which the adrenal glands secrete large amounts of adrenocorticosteroids.

29. Howell-Jolly bodies are composed of A. DNA B. Iron C. Reticulum D. RNA

A. DNA

1. What is the first type of cell produced by the developing embryo? A. Erythrocyte B. Granulocyte C. Lymphocyte D. Thrombocyte

A. Erythrocyte

50. The major storage form of iron is A. Ferritin B. Transferrin C. Hemosiderin D. Hemachromatin

A. Ferritin

80. Idiopathic aplastic anemia is best defined as a form of anemia that A. Has no identifiable cause B. Is caused by a physician's treatment C. Follows exposure to ionizing radiation D. Develops after a viral infection

A. Has no identifiable cause

89. An excessive accumulation of iron in body tissues is called A. Hemochromatosis B. Erythroblastosis C. Megaloblastosis D. Acrocyanosis

A. Hemochromatosis

260. Which of the following tests could be performed on a hemolyzed blood sample? A. Hemoglobin only B. Hemoglobin and platelet count C. RBC count and hematocrit D. No results would be reportable.

A. Hemoglobin only

242. Which of the following would not be the cause of a falsely high MCHC of 38.3 g/dL on an automated instrument? A. Hereditary spherocytosis B. Lipemia C. Presence of a cold agglutinin D. Instrument sampling or mixing error

A. Hereditary spherocytosis

38) Which of the following is not ture of the international normalized ratio (INR)? A. INR is dependent on reagents and instrumentation used. B. INR is calculated using the PT ratio taken to the power of the ISI value C. The WHO recommends reporting the INR on patients on stable oral anticoagulant therapy D. A therapeutic INR for a patient on Coumadin is between 2.0 and 3.0, but may be higher depending on the cause of the patient's underlying disease state.

A. INR is dependent on reagents and instrumentation used.

121. Which of the following statements about the relative anemia of pregnancy is false? A. It is due to a reduction in the number of erythrocytes. B. It is normocytic and normochromic. C. It does not produce an oxygen deficit for the fetus. D. It is associated with an increase in plasma volume.

A. It is due to a reduction in the number of erythrocytes.

141. What is the approximate amount of time a granulocyte spends in the circulation before migrating into the tissues? A. Less than 1 day B. About 3 days C. Upto5 days D. More than 10 days

A. Less than 1 day After granulocytes are released from the bone marrow, they remain in the circulation one day or less. their major function takes place in the tissues. They migrate through the vessel walls to reach areas of inflammation very soon after release. The life span of the granulocyte is short; however, eosinophils and basophils appear to survive longer in the tissues than neutrophils.

7. In the third month of gestation, what is the primary site of hematopoiesis? A. Liver B. Marrow of long bones C. Spleen D. Yolk sac

A. Liver

122. The anemia found in chronic renal failure is most likely caused by A. Loss of erythropoietin synthesis B. Lack of cellular oxygen demand C. Defective iron absorption D. Destruction of red cells by uremic metabolites

A. Loss of erythropoietin synthesis

39. Periods of intense erythropoietin activity cause premature release of marrow reticulocytes into the blood. Which of the following is not true of these early reticulocytes? A. Loss of residual RNA occurs immediately upon marrow release B. Circulate longer than usual before reaching maturity C. May be termed shift or stress reticulocytes D. Show diffuse basophilia with Wright's stain

A. Loss of residual RNA occurs immediately upon marrow release

207. The familial disorder featuring pseudo Döhle bodies, thrombocytopenia, and large platelets is called A. May-Hegglin anomaly B. Chédiak-Higashi syndrome C. Pelger-Huet anomaly D. Alder-Reilly anomaly

A. May-Hegglin anomaly

120. Which of the following is not associated with acquired reversible sideroblastic anemias? A. Methotrexate therapy B. Lead intoxication C. Isoniazid treatment for tuberculosis D. Acute alcohol ingestion

A. Methotrexate therapy

The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek boy with the following results on an automated impedance counter: WBC 35.0 X 1 09/L (35.0 X 1 03/pL); RBC 2.50 X 1 012/L (2.50 x 1 06/FL); hemoglobin 45 gIL (4.5 g/dL); hematocrit 0.16 LJL (16%); platelet count 250 X 1 09/L (250,0004AL); reticulocyte count 8.0%; 110 nucleated red blood cells/i 00 WBCs and many targets are seen. Other laboratory results are as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin elevated. 265. What would be the appearance of the child's red blood cells on a peripheral smear? A. Microcytic, hypochromic B. Normocytic, hypochromic C. Normocytic, normochromic D. Microcytic, normochromic

A. Microcytic, hypochromic

145. What does the granulocyte mitotic pool in the bone marrow contain? A. Myeloblasts and promyelocytes B. Band and segmented forms C. The majority of marrow granulocytes D. Myelocytes and metamyelocytes

A. Myeloblasts and promyelocytes the granulocyte mitotic pool contains the cells capable of division, which are the myeloblasts, promyelocytes and myelocytes.

143. What is the major phagocytic cell involved in the initial defense against bacterial pathogens? A. Neutrophil B. Eosinophil C. Basophil D. Monocyte

A. Neutrophil Monocytes arrrive at the site of injury after the neutrophil to "clean up"

259. A blood sample was run through an automated cell counter and the following results were obtained: WBC 6.9 X 10^9/L (6.9 X 10^3/pL), RBC 3.52 X 10^12/L (3.52 X 106/giL), Hgb 120 g/L (12.0 g/dL), Hct 0.32 LI (32.0%), MCH 34.1 pg, MCHC 37.5 g/dL. Which of the troubleshooting steps that follows should be performed to obtain reportable results? A. Perform a saline replacement procedure. B. Warm the specimen to 37°C and rerun. C. Perform a microhematocrit. D. None; the results are reportable.

A. Perform a saline replacement procedure.

262. In the platelet count procedure using phase microscopy, A. Platelets appear dark against a light background. B. The entire ruled counting surface of the hemacytometer is used. C. Ammonium oxalate will lyse the WBCs. D. Platelets should be counted immediately after plating the hemacytometer.

A. Platelets appear dark against a light background.

131. A failure to generate sufficient ATP is characteristic of red blood cells with A. Pyruvate kinase deficiency B. Glucose-6-phosphate dehydrogenase deficiency C. Lipoprotein deficiency D. Hexokinase deficiency

A. Pyruvate kinase deficiency

56. Spectrin is a protein that occupies a major role in A. Red cell membrane structure B. Reducing ferric iron C. Red cell transport and removal of CO2 D. Iron recovery during hemoglobin degradation

A. Red cell membrane structure

30. When spherocytes are reported, what is observed on the peripheral blood smear? A. Red cells without a central pallor B. Red cells with blunt projections C. Red cells with sharp projections D. Red cells with intracellular rod-shaped crystals

A. Red cells without a central pallor

250. The test value range that includes 95% of the normal population is the A. Reference interval B. Linearity limit C. Reportable range D. Critical range

A. Reference interval

125. An increase in erythropoietin is not a normal compensating mechanism in which of the following conditions? A. Renal tumors B. Heavy smoking C. Cardiovascular disease D. Pulmonary disease

A. Renal tumors

163. Which of the following statements about neutrophils is false? A. Suppress allergic reactions caused by basophils B. Have surface receptors for IgG and complement components C. Contain alkaline phosphatase and muramidase D. Act in nonspecific phagocytosis and are destined to die

A. Suppress allergic reactions caused by basophils

62) A 30 year old female is admitted to the hospitl with neurological symptoms: Hgb 60g/L, Hct 0.19 L/L, Platelet count 25X109/L, RBC morphology Many Schistocytes, ADAMTS-13 Markedly decreased A. Thombotic Thrombocytopenic purpura B. Idiopathic thrombocytopenic purpura C. Hemolytic uremic syndrome D. von Willebrand disease

A. Thrombotic thrombocytopenic purpura

The peripheral blood shown in Color Plate ii is from a 19-year-old female college student who has been living primarily on tea, beer, and cereal for the past 9 months because she finds dining hail food distasteful. She visits student health complaining of fatigue. Her CBC results are as follows: WBC 2.5 X 1 091L (2.5 x 1 03/1iL); RBC 2.10 x 1 0121L (2.10 x 1 064LL); hemoglobin 85 gIL (8.5 gIdL); hematocrit 0.24 LIL (24%); platelet count 110 x 1 091L (11 0,0004iL); MCV 114 fL; MCHC 35.0 g/dL; reticulocyte count 0.8%. 272. What test(s) should be donefirst to determine a diagnosis in this patient? A. Vitamin B12 and folate levels B. Iron studies C. Bone marrow examination D. Osmotic fragility

A. Vitamin B12 and folate levels

1) The hemorrhagic problems associated with scurvy are due to a deficiency of _________, which is a cofactor required for collagen synthesis. A. Vitamin C B. Prothrombin C. Vitmain K D. Protein C

A. Vitamin C

52) Which of the following best describes protein C? A. VitaminK-dependent inhibitor to clotting B. Activator of factors V and VIII: C C. Inhibitor of fibrinolysis D. Synthesized by endothelial cells

A. VitaminK-dependent inhibitor to clotting

A hospital submits a bill for $200.00 to the patient's insurance company for the cost of outpatient laboratory tests. The laboratory services renderedby the hospital are paid according to an agreed fee schedule. The specific laboratory procedures are billed according to which system of coding? A. Diagnosis-related group (DRG) B. Current procedural terminology (CPT) C. Medicare D. Medicaid

B

181. Which of the following infections does not reveal a blood picture as seen in Color Plate 12 (reactive lymphs are shown)? A. Epstein-Barr virus (EBV) B. Bordetellapertussis (whooping cough) C. Cytomegalovirus (CMV) D. Toxoplasma gondil (toxoplasmosis)

B. Bordetellapertussis (whooping cough)

192. The child whose blast cells are shown in Color Plate 15 has acute lymphoblastic leukemia that is precursor B cell type and CALLA positive. Analysis by flow cytometry would likely show cells that immunophenotype for A. CD2,CD7 B. CD1O,CD19 C. CD13,CD33 D. CD14,CD34

B. CD1O,CD19

144. What is the growth factor that is primarily responsible for regulating granulocyte and monocyte production? A. Erythropoietin B. Colony stimulating factor C. Interleukin D. Thrombopoietin

B. Colony stimulating factor

72) a 25 year old obstetrical patient at 35 weeks gestation is admitted through the emergency. She has bleedin inthe genitourinary tract and there are visible petechiae and ecchymosis. A. Primary fibrinogenolysis B. DIC with secondary dibrinolysis C. Factor II deficiency D. Heparin therapy

B. DIC with secondary fibrinolysis

28. What red cell morphologic abnormality is described by the term "poikilocytosis"? A. Variations in size B. Deviations from normal shape C. Presence of inclusions D. Alterations in hemoglobin concentration

B. Deviations from normal shape

83. A cellulose acetate hemoglobin electrophoresis (alkaline pH), performed on the blood of a stillborn infant, revealed a single band that migrated farther toward the anode than did the Hb A control. What is the most likely composition of the stillborn infant's hemoglobin? A. Four beta chains B. Four gamma chains C. Two alpha and two beta chains D. Two alpha and two gamma chains

B. Four gamma chains In infants with homozygous alpha-thalassemia, no alpha-globin chains are produced (because of the deletion of all four alpha genes)

118. A previously healthy man experiences weakness and hemoglobinuria after taking the antimalarial agent primaquine. This hemolytic attack most likely occurred because of a deficiency of A. Pyruvate kinase B. Glucose-6-phosphate dehydrogenase C. 2, 3-Bisphosphoglycerate D. Methemoglobin reductase

B. Glucose-6-phosphate dehydrogenase

41. The presence of schistocytes on the peripheral blood smear is commonly associated with A. Increased iron mobilization B. Increased red cell destruction C. Decreased erythropoietin activity D. Decreased red cell proliferation

B. Increased red cell destruction

161. On what basis can B and T lymphocytes be distinguished? A. Differences in nuclear shape B. Monoclonal antibody reactions to surface and cytoplasmic antigens C. Cytoplasmic granularity and overall cell size D. Chromatin pattern in the nucleus

B. Monoclonal antibody reactions to surface and cytoplasmic antigens

20. When the hepatic phase of fetal life is reactivated in an adult, hematopoiesis can be termed A. Myeloid or medullary B. Myeloid metaplasia or extramedullary C. Myelophthisis or myelodysplasia D. Mesoblastic or mesenchymal

B. Myeloid metaplasia or extramedullary

68)An 80 year old man suffered a hear attack 1 month ago, and after the hospital stay was discharged with instructions to follow an outpatient treatment plan. He arrives at the cardiology clinic today for lab work to monitor the treatment plan. The following results are obtained: PT 52.0 sec (control 12.0 sec), INR 5.5 (therapeutic range 2.0-3.0), aPTT 50.0 sec (control 32.0 sec) A. Nontheraputic dose of unfractionated heparin B. Nontheraputic dose of coumarin C. Nonthberaputic dose of both unfractionated heparin and coumarin D. Fibrinolytic agent such as tissue plasminogen activator.

B. Non-therapeutic dose of coumarin

18. As most blood cell lines mature, which of the following is characteristic? A. Cell diameter increases B. Nucleus to cytoplasm ratio (N:C) decreases C. Nuclear chromatin becomes less condensed D. Basophilia of the cytoplasm increases

B. Nucleus to cytoplasm ratio (N:C) decreases

223. What combination of reagents is used to measure hemoglobin? A. Hydrochloric acid and p-dimethylaminobenzaldehyde B. Potassium ferricyanide and potassium cyanide C. Sodium bisulfite and sodium metabisulfite D. Sodium citrate and hydrogen peroxide

B. Potassium ferricyanide and potassium cyanide

263. What is the quality control term used to describe the reproducibility of a test? A. Accuracy B. Precision C. Standard deviation D. Specificity

B. Precision

188. Which of the following suggests a diagnosis of Hodgkin disease rather than other lymphoproliferative disorders? A. Presence of a monoclonal population of large lymphoid cells B. Predominance of immature B cells with irregular nuclear clefts C. Circulating T cells with a convoluted, cerebriform nucleus D. Presence of giant binucleated ReedSternberg cells with prominent nucleoli

B. Predominance of immature B cells with irregular nuclear clefts

10) A potent inhibitor of platelet aggregation released by endothelial cells is: A. Epinephrine B. Prostacyclin C. Ristocetin D. Thromboxane A2

B. Prostacyclin

51) Reversal of heparin overdose can be achieved by administration of: A. Vitamin K B. Protamin sulfate C. Antithrombin D. Warfarin

B. Protamin sulfate

115. An elderly man with a 10-year history of chronic lymphocytic leukemia presented with jaundice and fatigue that was attributed to a recent 3-gram drop in his hemoglobin. Many spherocytes and polychromatophilic red cells were found on his Wright's stained blood smear. Which type of immune hemolytic anemia is most likely? A. Idiopathic warm autoimmune hemolytic anemia B. Secondary warm autoimmune hemolytic anemia C. Primary cold hemagglutinin disease D. Paroxysmal cold hemoglobinuria

B. Secondary warm autoimmune hemolytic anemia

107. A clinical laboratory scientist examined a Wright's stained peripheral smear and saw what appeared to be small, dark-staining granules in the mature erythrocytes. A second smear was stained with Prussian blue and a positive result was obtained. Based on this information, which of the following would you expect to be abnormal? A. Plasma hemoglobin level B. Serum ferritin level C. Hemoglobin electrophoresis D. Test for parietal cell antibodies

B. Serum ferritin level Pappenheimer bodies observed with Wright's stain can be confirmed with the Prussian blue stain and are composed of iron. The presence of siderotic granules in the red cells is associated with iron overload, and the serum ferritin test, which reflects amount of storage iron, would be elevated.

19) The anticoagulant required for routine coagulation testing is: A. Sodium heparin B. Sodium citrate C. Acid citrate dixtrose D. Sodium fluoride

B. Sodium citrate

249. A clotted EDTA tube can be used to perform a(n) A. Erythrocyte sedimentation rate B. Solubility test for hemoglobin S C. Hematocrit D. Platelet count

B. Solubility test for hemoglobin S

169. Antigen-dependent lymphopoiesis occurs in secondary lymphoid tissue located in the A. Liver and kidney B. Spleen and lymph nodes C. Lungs and Peyer's patches D. Thymus and bone marrow

B. Spleen and lymph nodes Antigen-INDEPENDENT lymphopoiesis occurs in primary lymphoid tissue located in thymus and bone marrow.

59. Serum ferritin is a good indicator of the amount of A. Cytochrome iron B. Storage iron C. Hemoglobin iron D. Transferrin saturation

B. Storage iron

96. What is the most likely genetic defect in the hemoglobin of cells seen in Color Plate l0? A. Substitution of valine for glutamic acid in position 6 of the alpha-globin chain B. Substitution of valine for glutamic acid in position 6 of the beta-globin chain C. Substitution of lysine for glutamic acid in position 6 of the alpha-globin chain D. Substitution of lysine for glutamic acid in position 6 of the beta-globin chain

B. Substitution of valine for glutamic acid in position 6 of the beta-globin chain

98. Which of the following is the most appropriate treatment for sickle cell anemia? A. Hydroxyurea B. Supportive therapy C. Hyperbaric oxygen D. Iron

B. Supportive therapy

148. Which of the following is not a characteristic of T lymphocytes? A. Secrete cytokines B. Synthesize antibody C. Comprise majority of cells in the blood lymphocyte pool D. Regulate the immune response

B. Synthesize antibody

106. A 69-year-old male is admitted with pallor, mild tachycardia, and difficulty walking because of numbness in the extremities. His CBC reveals a hemoglobin of 78 g/L (7.8 g/dL), a hematocrit of 0.25 L/L(25.0%), and MCV of 118.5 fL. This patient's symptoms and the blood findings seen in Color Plate 11 (hypersegments neutrophils and macrocytic ovalocytes) are most suggestive of anemia due to a lack of A. Folic acid B. Vitamin B12 C. Vitamin B6 D. Ascorbic acid

B. Vitamin B12

30) Which of the following does not contribute to the activation of the fibrinolytic system? A. XIIa B. XIa C. Kallikrein D. Tissue plasminogen activator

B. XIa Once activated, three of the four contact factors activate both the intrinsic clotting system and provide intrinsic activation of the fibrinolytic system. The only contact factor that does not activate the fibrinolytic system is factor XI. Extrinsic activation of the fibrinolytic system is achieved by the release of tissue plasminogen activator by damaged endothelial cells.

57) Blood for an aPTT was collected from a 5-year-old boy. During the venipuncture, he had to be restrained by several people and still managed to be a moving target. The result of the child's aPTT was 18.0 sec (reference range 22.0-38.0 sec). The aPTT controls were in range. Which of the following interpretations would apply to the aPTT result? A. aPTT is abnormal becuase of a hereditary factor deficiency. B. aPTT is invalid because of contamination with tissue factor C. Tube is probably not full, resulting in a falsely short time D. Result is within reference range for a patient of this age

B. aPTT is invalid because of contamination with tissue factor A clean venipuncture is required for coagulation testing. The description of the traumatic venipuncture indicates that the result might be invalid because of exposure to tissue thromboplastin/tissue factor, resulting in a falsely short test result. A tube that is not full would cause a falsely long time. A factor deficiency causes long clotting times. This 5-year-old would have the same reference range as adults.

The peripheral blood smear in Color Plate 17l and the Sudan black B stain in Color Plate 191 are from a 90-year-old man complaining of fatigue and nosebleeds. The physician noted the patient was febrile and had petechiae. CBC results were as follows: WBC 20.0 x 1 09/L (20.0 x 1 O3Ijit); RBC 2.58 x 1 0121L (2.58 x 1 064LL); hemoglobin 77 gIL (7.7 g/dL); hematocrit 0.24 LJL (24%); platelet count 32 x 1 09/L (32,000/iL); differential count shows 75% blasts, 20% lymphocytes, and 5% segmented neutrophils. A bone marrow examination revealed 80% cellularity with 80% blasts. The blasts were myeloperoxidase and specific esterase positive; nonspecific esterase and PAS negative. 291. Using World Health Organization (WHO) criteria for the diagnosis of acute leukemia, the percentage of bone marrow blasts must be at least A.5 B.20 C.30 D.50

B.20

229. To best preserve cellular morphology, differential smears from an EDTA specimen should be made no more than ________________ hour(s) after collection. A. l B. 5 C. 12 D. 24

B.5

232.Several complains have been received from parents of children in the pediatric wing about the anxiety that venipuncture causes their children. An informal staff meeting with the phlebotomists reveals that they feel both parent and pediatric nurses are less than supportive and frequently make the task of venipuncture in children worse with their own anxiety. The best course of action would be to: A.have a pedtiatric nurses do venipuncture on children as they are more familiar with the children B. limit physicians to only draw per day on children C. prepare written pamphlets for parents and in service education for nursing personel D. take no action as parents will always overreact where their children are concerned

C

234.when employees are going to be responsible for implementing a change in procedure or policy, the manager should: A. make the decision and direct the employees to implement it B. solicit the employee input but do what he/she thinks should be done C. involve the employees in the decision-making process from the very beginning D. involve only those employees in the decision-making process who would benefit from the change

C

238.A course of instruction is being planned to teach laboratory employees to recognize, troubleshoot only and correct simple malfunctions in selected laboratory instruments. In writing the objectives for this course, which one of the following would be most appropriate? A. learn how to repair 9 of 10 simple instrument malfunctions B. conectly answer 9 of 10 test questions dealing with simple instrument malfunctions C. recognize, detect and correct 9 of 10 simple instrument malfunctions D. document corrective action procedure for 9 of 10 simple instrument malfunctions

C

244.which of the following actions will facilitate group interactions staff meetings? A. adhering strictly to an agenda B. treating every problem consistently C. encouraging input from all staff D. announcing the assignments for upcoming projects

C

A comparison of methods for the determination of alkaline phosphatase is categorized in which domain of educational objectives? A. Affective B. Psychomotor C. Cognitive D. Behavioral

C

The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek boy with the following results on an automated impedance counter: WBC 35.0 X 1 09/L (35.0 X 1 03/pL); RBC 2.50 X 1 012/L (2.50 x 1 06/FL); hemoglobin 45 gIL (4.5 g/dL); hematocrit 0.16 LJL (16%); platelet count 250 X 1 09/L (250,0004AL); reticulocyte count 8.0%; 110 nucleated red blood cells/i 00 WBCs and many targets are seen. Other laboratory results are as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin elevated. 264. What is the corrected white blood cell count expressed in SI units of X109/L? A. 4.6 B. 12.5 C. 16.7 D. 18.4

C. 16.7

234. Using the percent reticulocyte from question 233 and an RBC count of 3.OOX 10^12/L (3.00 X 106IpL), the calculated absolute reticulocyte count reported in SI units is A. l.8X1091L B. 18X1091L C. 180X1091L D. 180X103/pL

C. 180X1091L [[6.0x3.00]/100]x1000= 180x10^9/L

236. The following numbers were obtained in evaluating leukocyte alkaline phosphatase (LAP) activity in neutrophils. What is the score? 0 1 2 3 4 15 20 30 20 15 A. 100 B. 115 C. 200 D. 215

C. 200

228. A platelet count is performed on an automated instrument from an EDTA blood sample. Smear evaluation reveals the presence of platelet clumps. The specimen is redrawn using sodium citrate as the anticoagulant, and a count of 300 X i09/L is obtained. What is the correct platelet count to report? A. 270X1091L B. 300X109/L C. 330X109/L D. 360X109/L

C. 330X109/L Mulitiply by 1.1 to correct for the 9:1 dilution 1.1(300x10^9)= 330x10^9/L

58. What does measuring the total iron-binding capacity (TIBC) represent? A. Amount of free iron in serum B. Circulating protein-bound iron C. Amount of iron that transferrin can bind D. Indirect measurement of iron stores

C. Amount of iron that transferrin can bind

64. Color Plate 3 (shows elliptocytes) shows the peripheral blood of a 16-year-old female with a sporadic history of dizzy spells, fainting, and jaundice. This patient also had a history of periodic abdominal pain related to gallstones, Upon physical examination, she exhibited mild splenomegaly. Her hemoglobin was 107 g/L (10.7 g/dL), hematocrit was 0.32 L/L (32%), red cell indices were normal, and the direct antiglobulin test was negative. Based on history and peripheral blood morphology, which of the following statements is most likely true? A. Hemoglobin S will be revealed by electrophoresis. B. Tests to confirm iron deficiency should be ordered. C. An intrinsic hereditary defect of red cells should be suspected. D. The anemia is secondary to spleen and gallbladder disorders

C. An intrinsic hereditary defect of red cells should be suspected.

171. In patients with infectious mononucleosis, which blood cells are infected by the causative agent? A. Monocytes B. T lymphocytes C. B lymphocytes D. Histiocytes

C. B lymphocytes The Epstein-Barr virus attaches to receptors on B lymphocytes, and the virus is incorporated into the cell. The infection generates an intense immune response of T cells directed against infected B cells. It is the activated T lymphocytes that comprise the majority of reactive lymphocytes seen in the blood of patients with infectious mononucleosis. Other B cells produce nonspecific polyclonal (heterophile) antibody in response to the EBV infection.

36. Which of the following is associated with a "shift to the left" in the oxygen dissociation curve of hemoglobin? A. Decreased pH and elevated temperature B. Decreased oxygen affinity C. Decreased oxygen release D. Presence of 2, 3-bisphosphoglycerate (2,3-BPG)

C. Decreased oxygen release A "shift to the left" in the oxygen dissociation curve of hemoglobin means that a higher percentage of hemoglobin will retain more of its oxygen at a given pressure. Thus affinity will be greater and oxygen delivery will be reduced.

A 15-month-old malnourished child is brought to the clinic for a routine examination. Her CBC results are as follows: WBC 9.5 x 1 09/L (9.5 X 1 034jL); RBC 2.70 x 1 0121L (2.70>< 1 06/jiL); hemoglobin 67 gIL (6.7 gIdL); hematocrit 0.25 LIL (25%); MCV 73.5 fL; MCHC 26.8 gIdL; reticulocyte 0.2%; RDW 19%. Abnormal RBC morphology present included pencil forms and target cells. 282. The earliest indicator of this disease state is A. Decreased folic acid B. Decreased serum iron C. Decreased serum ferritin D. Increased bilirubin

C. Decreased serum ferritin

81. Which of the following is a true red blood cell aplasia? A. Marrow replacement anemia B. Fanconi anemia C. Diamond-Blackfan anemia D. Donath-Landsteiner anemia

C. Diamond-Blackfan anemia Diamond-Blackfan anemia is a congenital disorder that depresses only red blood cell production.

A 32-year-old African-American traveling to Africa on business had been healthy until he began taking primaquine for prevention of malaria. He went to his physician because he felt faint and his urine was black. His CBC results are as follows: WBC 6.5 X 1 09/L (6.5 X 1 03IpL); RBC 1.67 X 1 0121L (1.67 x 1 064iL); hemoglobin level 50 g/L (5.0 g/dL); hematocrit 0.15 L/L (15%); MCV 89.8 fL; MCHC 33.3 g/dL; platelet count 175 X 1 09/L (1 75,000/1iL); reticulocyte 25.0%. 279. The defect in this disorder is caused by an A. Amino acid substitution B. Intrinsic red blood cell membrane defect C. Enzyme deficiency in the hexose monophosphate shunt D. Enzyme deficiency in the Embden-Meyerhof pathway

C. Enzyme deficiency in the hexose monophosphate shunt

6) A platelet aggregation agent that characteristically yields a biphasic curve when used in optimal concentration is: A. Arachidonic acid B. Collagen C. Epinephrine D. Ristocetin

C. Epinephrine Epinephrine is the only aggregating agent listed that typically gives a biphasic pattern. ADP and thrombin also give biphasic patterns when used in optimal concentration.

179. A patient with normal hemoglobin and WBC count values, a persistently elevated platelet count (over 1000 X 109/L), increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has A. Polycythemia vera B. Chronic myelofibrosis C. Essential thrombocythemia D. Chronic myelogenous leukemia

C. Essential thrombocythemia

3. Which of the following is not characteristic of pluripotent hematopoietic stem cells? A. Possess self-renewal ability B. Produce progenitor cells committed to a single cell lineage C. Express the stem cell marker CD13 D. Are morphologically unrecognizable

C. Express the stem cell marker CD13

172. Which of the following statements about hairy cell leukemia is true? A. It is an acute disease, primarily affecting young adults. B. Splenomegaly is an unusual finding. C. Hairy cells contain tartrate-resistant acid phosphatase. D. Hairy cells are abnormal T lymphocytes.

C. Hairy cells contain tartrate-resistant acid phosphatase.

26. The majority of iron found in an adult is a constituent of A. Ferritin B. Myoglobin C. Hemoglobin D. Peroxidase

C. Hemoglobin Of the total body iron present in the normal adult, approximately 70% is contained in hemoglobin (in red cells of the blood and marrow)

69. Which of the following statements about sickle cell syndromes is false? A. Asplenism may result from repeated sickling crises in the homozygous state. B. Heterozygous persons may be partly protected from infection by falciparum malaria. C. Hemoglobin S is more soluble in dithionite than is normal hemoglobin. D. Trait conditions are generally asymptomatic with no sickle cell formation.

C. Hemoglobin S is more soluble in dithionite than is normal hemoglobin. The hemoglobin solubility test can detect the presence of hemoglobin S, which is insoluble in the dithionite reagent, whereas normal hemoglobin A is soluble.

254. The erythrocyte sedimentation rate (ESR) is influenced by the red cell phenomenon seen in Color Plate 20. Which of the following factors will neither contribute to this phenomenon nor affect the ESR? A. Size of the red blood cells B. Shape of the red blood cells C. Hemoglobin content of the red blood cells D. Composition of the plasma

C. Hemoglobin content of the red blood cells

84. The most likely cause of the stillborn infant's condition in question 83 is A. Erythroblastosis fetalis B. Rh hemolytic disease of the fetus C. Hydrops fetalis D. ABO hemolytic disease of the newborn

C. Hydrops fetalis Bart's hydrops fetalis (homozygous alpha-thalassemia major) is a lethal conditonin which all normal hemoglobins are absent and the presence of Bart's hemoglobin results in death due to hypoxia.

47) The coagulation factors reffered to as "vitamin K- dependant" are: A. I, V, VIII, XIII B. II, V, IX, XII C. II, VII, IX, X D. XI, XII, Fletcher, Fitzgerald

C. II, VII, IX, X

217. Which of the following is not a characteristic finding in polycythemia vera? A. Blood pancytosis B. Increased red cell mass C. Increased erythropoietin level D. Increased blood viscosity

C. Increased erythropoietin level Primary PV is a malignant myeloproliferative disorder characterized by autonomous marrow production of erythrocytes in the presence of low erythropoietin levels

38. Which of the following factors will result in an immediate increase in oxygen delivery to the tissues? A. Increased pH B. High altitudes C. Increased hemoglobin binding of 2, 3-BPG D. Increased renal release of erythropoietin

C. Increased hemoglobin binding of 2, 3-BPG

237. Perl's Prussian blue is a stain used to detect A. DNA B. RNA C. Iron D. Glycogen

C. Iron

16. The largest hematopoietic cells in normal bone marrow are A. Osteoblasts B. Osteoclasts C. Megakaryocytes D. Plasma cells

C. Megakaryocytes

109. Which of the following statements about hereditary spherocytosis is true? A. Abnormally shaped cells are produced in the bone marrow. B. Cells have a decreased mean cell hemoglobin concentration (MCHC). C. Membrane loss and red cell trapping occur in the splenic microcirculation. D. Red cell osmotic fragility is decreased.

C. Membrane loss and red cell trapping occur in the splenic microcirculation.

14) Which of the following is not a normal maturation stage for platelets? A. Megakaryoblast B. Promegakaryocyte C. Micromegakaryocyte D. Megakaryocyte

C. Micromegakaryocyte

139. Functionally, white blood cells are divided into A. Granulocytes, nongranulocytes B. Polymorphonuclears, mononuclears C. Phagocytes, immunocytes D. Granulocytes, lymphocytes

C. Phagocytes, immunocytes The major function of leukocytes is defense, either by phagocytosis or by immune mechanisms. The phagocytic cells are the granulocytes and monocytes. The immune response is mediated by lymphocytes; however, monocytes play a role in immunity as antigen-presenting cells. Leukocytes may be classified according to granularity as granulocytes and nongranulocytes or divided based on nuclear segmentation as polymophonuclears and mononuclears.

47. Which of the following red blood cell precursors is the last stage to undergo mitosis? A. Pronormoblast B. Basophilic normoblast C. Polychromatophilic normoblast D. Orthochromic normoblast

C. Polychromatophilic normoblast

44) Thrombocytosis is characteristic of: A. Disseminated intravascular coagulation B. Splenomegaly C. Polycythemia vera D. Idiopathic thrombocytopenic purpura

C. Polycythemia vera

33. Which of the following is most frequently associated with the inclusion bodies seen in Color Plate 1 (howell-Jolly bodies)? A. Iron overload state B. Post-transfusion C. Post-splenectomy D. Iron-deficient state

C. Post-splenectomy

48) A patient on warfarin therapy will be deficient in a functional amount of: A. Fibrinogen and prothrombin B. Stable and labile factors C. Protein C and protein S D. Fletcher and Fitzgerald factors

C. Protein C and protein S (dependent on vitamin K)

216. Which of the following is not a mechanism by which neutropenia may be produced? A. Hypersplenism B. Marrow injury or replacement C. Recent strenuous exercise D. Drug-induced antibodies

C. Recent strenuous exercise

5) In a platelet aggregation studies, certain aggregating agents induce a biphasic aggregation curve. This second phase of aggregation is directly related to: A. Formation of fibrin B. Changes in platelet shape C. Release of endogenous ADP D. Release of platelet factor 3

C. Release of endogenous ADP

232. What is the reason for red blood cells to be bright red and the WBC nuclei to be poorly stained when using Wright's stain? A. The staining time is too long. B. The stain or buffer is too alkaline. C. The stain or buffer is too acidic. D. The smear was not washed long enough.

C. The stain or buffer is too acidic.

168. Which of the following statements about macrophages is incorrect? A. They are mature tissue forms of blood monocytes. B. They serve as antigen-presenting cells to the immune system. C. Their quantity of lysosomes and acid hydrolases decreases during maturation. D. They remove damaged or dying cells and cellular debris.

C. Their quantity of lysosomes and acid hydrolases decreases during maturation.

149. An adult has a total white blood cell count of 4.0 X 10^9/L (4.0 X 10^3/uL). The differential count is as follows: polymorphonuclear neutrophils (PMNs) 25%, bands 5%, lymphocytes 65%, and monocytes 5%. The absolute value reference range for lymphocytes is 1.0—4.0 X 10/L. Which of the following is true? A. The percentage of lymphocytes is normal. B. There is an absolute lymphocytosis. C. There is a relative lymphocytosis. D. There is both an absolute and a relative lymphocytosis.

C. There is a relative lymphocytosis Normal percentage of lymphocytes is 20-44%

"Laboratory A" measures maternal serum alpha-fetoprotein (MSAFP) at 16-18 weeks gestation as a screen for fetal disorders. The 16-weeks MSAFP medium for Lab A is 32 ug/L. A 37-year-old woman has an MSAFP level of 34 ug/L at her 16th week. This reuslt is consistent with: A. a normal MSAFP level for 16-week gestation B. possible neural tube defect, including spina bifida C. possible multiple birth (ie, twins) D. possible trisomy disorder, including Down syndrome

Correct Answer: A

A 24-hour urine specimen (total volume =1,136 mL) is submitted to the laboratory for quantitative urine protein. Calculate the amount of protein excreted per day if the total protein is 52 mg/dL. A. 591 mg B. 487 mg C. 220 mg D. 282 mg

Correct Answer: A

A 40-year-old man had an erythrocyte count of 2.5 x 10^6/uL (2.5 x 10^12/L), hematocrit of 22% and a reticulocyte count of 2.0%. Which of the following statements best describes his condition? A. the absolute reticulocyte count is 50 x 10^3/uL (50 x 10^9/L), indicating that the bone marrow is not adequately compensating for the anemia B. the reticulocyte count is greatly increased, indicating an adequate bone marrow response for this anemia C. the absolute reticulocyte count is 500 x 10^3/uL (500 x 10^9/L), indicating that the bone marrow is adequately compensating for the anemia D. the reticulocyte count is slightly increased, indicating an adequate response to the slight anemia

Correct Answer: A

Urobilinogen is formed in the: A. kidney B. spleen C. liver D. intestine

Correct Answer: D

Which of the following statements can be associated with the enzymatic assay of ammonia? A. Increase in absorbance monitored at 340 nm B. Nicotinamide-adeninedinucleotide (NAD+) required as a cofactor C. Ammonium ion isolated from specimen before the enzymatic step D. Reaction catalyzed by glutamate dehydrogenase

Correct Answer: D

Which of the following statements is true about partially compensated respiratory alkalosis? A. PCC>2 is higher than normal. B. HCO^ is higher than normal. C. More CC>2 is eliminated through the lungs by hyperventilation. D. Renal reabsorption of HCC>3 is decreased.

Correct Answer: D

Whichofthefollowingismostassociated with the membrane structure of nerve tissue? A. Cholesterol B. Triglyceride C. Phospholipids D. Sphingolipids

Correct Answer: D

"Six sigma" is a method used in industry and business as well as the clinical laboratory in order to: A. Allow for improved performance B. Prevent and remove defects in production C. Improve customer satisfaction D. All of these options

D

229.The first step in the development of long-term objectives for a laboratory continuing education program must include: A. total cost of the program B. total number of hours in the program C. list of topics to be covered D. a statement of competencies to be achieved

D

21. What is the average life span of a normal red blood cell? A. 1 day B. lOdays C. 60 days D. 120 days

D. 120 days

A 75-year-old man with rheumatoid arthritis complains to his physician of pain and fatigue. His CBC results are as follows: WBC 6.8 X 1 09/L (6.8>< 1034LL); RBC 3.49 x 102/L (3.49 x 1064iL); hemoglobin 97 gIL (9.7 g/dL); hematocrit 0.29 IJL (29%); MCV 83 fL; MCHC 33.9 gIdL. Other laboratory results are as follows: serum iron and total iron-binding capacity (TIBC) both decreased, serum ferritin slightly elevated. 269. If the serum iron is 22 ig/dL and the TIBC is 150 pg/dL, what is the percent transferrin? A.7% B. 10% C. 12% D. 15%

D. 15%

2) The number of platelets an average megakaryocyte generates is approximately: A. 25-50 B. 50-200 C. 200-500 D. 2000-4000

D. 2000-4000

37) A fibrinogen assay is performed on the fibrometer using the standard 1:10 dilution with Owren's buffer. The seconds obtained do not read on the standard curve. An alternate 1:20 dilution is performed and is 400mg/dL when read off the curve. The concentration of fibrinogen to be reported in mg/dL is: A. 160 mg/dL B. 200 mg/dL C. 400 mg/dL D. 800 mg/dL

D. 800 mg/dL 1;20 dilution is used when the time obtained on a patient sample is less than the shortest time used in preparation of the standard curve. A 1:20 dilution is diluted by a factor of 2 when compared to the usual 1:10 dilution. The value read off the curve must be multiplied by 2 to take into account the alternate dilution used 400 x 2= 800

257. Which of the following statements about manual reticulocyte counts is false? A. The blood/stain mixture is incubated for 5—10 minutes. B. New methylene blue, a supravital stain, is used. C. RBC inclusions can result in falsely elevated counts. D. An erythrocyte must have at least 4 blue particles to be counted as a reticulocyte.

D. An erythrocyte must have at least 4 blue particles to be counted as a reticulocyte. Two or more particles of reticulum constitute a retic

A 75-year-old man with rheumatoid arthritis complains to his physician of pain and fatigue. His CBC results are as follows: WBC 6.8 X 1 09/L (6.8>< 1034LL); RBC 3.49 x 102/L (3.49 x 1064iL); hemoglobin 97 gIL (9.7 g/dL); hematocrit 0.29 IJL (29%); MCV 83 fL; MCHC 33.9 gIdL. Other laboratory results are as follows: serum iron and total iron-binding capacity (TIBC) both decreased, serum ferritin slightly elevated. 270. The results of the CBC and iron studies in this case are most characteristic of A. Beta-thalassemia minor B. Iron deficiency C. Sideroblastic anemia D. Anemia of chronic disease

D. Anemia of chronic disease

160. Vasodilation and bronchoconstriction are the result of degranulation by which of the following blood cells? A. Eosinophils B. Monocytes C. Neutrophils D. Basophils

D. Basophils Basophil granules contain histamine, a potent vasodilator and smooth muscle contractor, that is responsible for the systemic effects seen in immediate hypersensitivity reactions.

247. The hemoglobin A2 quantification using anion exchange chromatography will be valid in A. Hemoglobin C disease B. Hemoglobin E trait C. Hemoglobin 0 trait D. Beta-thalassemia minor

D. Beta-thalassemia minor

128. Clinical manifestations of a homozygous mutation involving the beta-globin gene will most likely appear A. During embryonic development B. In the neonate at birth C. No later than 3 weeks after birth D. By 6 months of age

D. By 6 months of age The switch from gamma-globin chain production for Hb F to beta-globin chain synthesis for Hb A occurs 3-6 months after birth.

130. A clinical laboratory scientist received a 5 mL EDTA tube that contained 0.5 mL of anticoagulated blood. A smear was prepared and stained with Wright's stain. When examined microscopically, the majority of cells appeared to have many evenly distributed, blunt spicules on the surface. How should this cellular appearance be interpreted? A. An anemic condition requiring further testing B. Spur cells caused by using incorrect technique during slide preparation C. Artifact caused by a dirty spreader slide D. Crenated cells caused by incorrect blood to anticoagulant ratio

D. Crenated cells caused by incorrect blood to anticoagulant ratio

78. When viewing Color Plate 7 (tear drop cells), the red blood cells with a single elongated projection are known as _______________ and may be seen in ______________ A. Acanthocytes; liver disease B. Echinocytes; liver disease C. Drepanocytes; myelofibrosis D. Dacryocytes; myelofibrosis

D. Dacryocytes; myelofibrosis

147. Which of the following is characteristic of agranulocytosis? A. Neutrophils without granules B. Decreased numbers of granulocytes, red cells, and platelets C. Immature granulocytes in the peripheral blood D. Decreased numbers of granulocytes

D. Decreased numbers of granulocytes

37. Which of the following statements does not characterize erythropoietin (EPO)? A. Transforms the CFU-E into the earliest recognizable RBC precursor B. Increases the rate of red blood cell production by the bone marrow C. Shortens the maturation time of developing erythroid precursors D. Decreases stimulation of erythropoiesis when cellular hypoxia increases

D. Decreases stimulation of erythropoiesis when cellular hypoxia increases

200. Which of the following is a typical finding in chronic leukemias at onset? A. Symptoms of infection and bleeding B. Significant thrombocytopenia C. Severe anemia D. Elevated leukocyte count

D. Elevated leukocyte count

33) Heparin inhibits clotting by: A. Chelating calcium ions B. Preventing activation of prothrombin C. Causing liver synthesis of nonfunctional factors D. Enhancing the action of antithrombin

D. Enhancing the action of antithrombin

53. Which protein is primarily responsible for transport of hemoglobin dimers resulting from intravascular hemolysis? A. Hemopexin B. Albumin C. Hemosiderin D. Haptoglobin

D. Haptoglobin

74) A patient in the hospital for an acute mycocardial infarction is placed on standard unfractionated heparin therapy and aspirin Laboratory ressults are performed before instituting therapy and then daily as shown: A. Disseminated intravascular coagulation B. Primary fibrinogenolysis C. Aspirin-induced thrombocytopenia D. Heparin-induced thrombocytopenia

D. Heparin-induced thrombocytopenia

205. Which of the following is not among the diagnostic criteria used for classifying the myelodysplastic syndromes? A. Unexplained anemia refractory to treatment B. Hypogranular and hyposegmented neutrophils C. Abnormal platelet size and granulation D. Hypocellular bone marrow with 25% blasts

D. Hypocellular bone marrow with 25% blasts

183. Which of the following are characteristic findings in Waldenström disease? A. Increased IgA and hepatosplenomegaly B. Increased IgE and renal failure C. Increased IgG and hypercalcemia D. Increased IgM and blood hyperviscosity

D. Increased IgM and blood hyperviscosity

40) When of the following test results is not characteristic of DIC? A. Decreased fibrinogen concentration B. Positive test for degradation products C. Decreased platelet count D. Increased antithrombin

D. Increased antithrombin The PT and aPTT are prolonged in DIC because of consumption factors I, II, V and VIII. platelets are trapped in forming clots and are removed from circulation. The fibrinolytic system is activated by systemic intravascular coagulation; fibrin and fibrinogen degradation products are elevated. FDP and D-dimer tests will both be positive. The regulatory proteins antithrombin, protein C, and protein S are depleted trying to turn off systemic clotting.

74. In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera? A. Decreased platelets, decreased granulocytes, decreased erythropoietin level B. Decreased platelets, decreased granulocytes, increased erythropoietin level C. Increased platelets, increased granulocytes, increased erythropoietin level D. Increased platelets, increased granulocytes, decreased erythropoietin level

D. Increased platelets, increased granulocytes, decreased erythropoietin level

103. Which of the following laboratory results is not consistent with accelerated red cell destruction? A. Increased serum bilirubin B. Increased plasma hemoglobin C. Increased serum lactate dehydrogenase (LD) D. Increased serum haptoglobin

D. Increased serum haptoglobin

113. Which of the following is associated with sickle cells? A. Increased oxygen tension promotes sickling. B. There is decreased mechanical fragility. C. There is increased deformability. D. Increased sickling occludes vessels.

D. Increased sickling occludes vessels.

A 53-year-old man reported to the laboratory for routine blood work as part of a yearly physical. He had been feeling tired for the last few months. Physical examination revealed splenomegaly. H is CBC results are as follows: WBC 80.0 x 1 09/L (80.0 x 103/1iL); RBC 4.lOx 1012/L(4.1OX 1 064LL); hemoglobin 123 gIL (12.3 g/dL); hematocrit 0.37 L/L (37.0%); platelet count 650 x 1 09/L (650,000IpL); differential count shows 40% polymorphonuclear neutrophils, 18% bands, 5% metamyelocytes, 7% myelocyte, 28% lymphocytes, and 2% monocytes. No ABC or WBC morphologic abnormalities are seen. 298. Which of the following would yield the most diagnostic information for this patient? A. Sudan black B (SBB) B. Periodic acid—Schiff (PAS) C. Tartrate-resistant acid phosphatase (TRAP) D. Leukocyte alkaline phosphatase (LAP)

D. Leukocyte alkaline phosphatase (LAP)

174. The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a A. Neutrophilic left shift B. Regenerative left shift C. Neutrophilic leukemoid reaction D. Leukoerythroblastic reaction

D. Leukoerythroblastic reaction A leukoerythroblastic blood profile, which refers to the presence of both immature neutrophils and nucleated red cells, is most commonly associated withconditions involving bone marrow infiltration by malignant cells (leukemia, cancer) or replacement by fibrotic tissue.

191. Which of the following is not commonly found in acute myelogenous leukemias? A. Neutropenia B. Thrombocytopenia C. Hepatosplenomegaly D. Lymphadenopathy

D. Lymphadenopathy

61. Impaired DNA metabolism is characteristic of A. Hemoglobin C disease B. Iron-deficiency anemia C. Sideroblastic anemia D. Megaloblastic anemia

D. Megaloblastic anemia

231. The components of Wright's stain include A. Crystal violet and safranin B. Brilliant green and neutral red C. New methylene blue and carbolfuchsin D. Methylene blue and eosin

D. Methylene blue and eosin

140. What is the largest white blood cell normally found in the peripheral blood? A. Eosinophil B. Neutrophil C. Lymphocyte D. Monocyte

D. Monocyte

208. Alder-Reilly anomaly is an abnormality of A. Lysosomal fusion B. Nuclear maturation C. Oxidative metabolism D. Mucopolysaccharide metabolism

D. Mucopolysaccharide metabolism

32. Rouleaux of red blood cells when seen in the monolayer of a blood smear is characteristic of A. Hypersplenism B. Hypogammaglobulinemia C. Cold hemagglutinin disease D. Multiple myeloma

D. Multiple myeloma

170. Which of the following is not produced by neutrophils during the respiratory burst? A. Hydroxyl radicals (OH-) B. Hydrogen peroxide (H202) C. Superoxide anion (O2-) D. Myeloperoxidase

D. Myeloperoxidase

77. Results from a 1-day-old infant include a hemoglobin of 201 g/L (20.1 g/dL), hematocrit of 0.60 L/L (60.0%), MCV of 110.2 fL, and 4 nucleated red cells/100 WBCs. How should these results be interpreted? A. The elevated hemoglobin and hematocrit values indicate possible dehydration. B. The nucleated red cells suggest accelerated erythropoiesis due to a hemolytic process. C. Testing should be done to identify the cause of the macrocytosis. D. No further testing is indicated.

D. No further testing is indicated Elevated RBC, hemoglobin, and hematocrit values in a newborn are a carryover from intrauterine life, when a high number of red cells were needed to carry oxygen.

220. The blood findings present in Color Plate 20 are from a patient with complaints of fatigue and severe lower back pain. Which of the following would not be typical of this disease? A. Bone tumors of plasma cells B. Hypercalcemia C. Progressive renal impairment D. Normal sedimentation rate

D. Normal sedimentation rate

261. For which of the following procedures would heparin be a recommended anticoagulant? A. Platelet count B. Coagulation tests C. Smear-based red cell morphology D. Osmotic fragility

D. Osmotic fragility

97. On what is the classification of sickle cell trait versus sickle cell disease based? A. Severity of the clinical symptoms B. Number of irreversibly sickled cells (ISCs) C. Level of compensatory hemoglobin F D. Percentage of hemoglobin S on electrophoresis

D. Percentage of hemoglobin S on electrophoresis

72. Which of the following conditions is not usually associated with marked reticulocytosis? A. Four days after a major hemorrhage B. Drug-induced autoimmune hemolytic anemia C. Sickle cell anemia D. Pernicious anemia

D. Pernicious anemia

42) Epsilon aninocaproic acid is the treatment of choice for: A. von Willebrand disease B. Hemophilia A C. DIC with secondary fibrinolysis D. Primary fibrinolysis

D. Primary fibrinolysis

123. Which of the following phrases about aplastic anemia is false? A. Stem cell disorder B. Risk of life-threatening infection C. Frequent bleeding complications D. Reduced red cell survival

D. Reduced red cell survival Aplastic anemia is a stem cell defect that leads to decreased production of erythrocytes, leukocytes and platelets. The survival of red cells released into the circulation is normal.

99. Which of the following values can be used to indicate the presence of a hemolytic anemia? A. Hemoglobin level B. Hematocrit level C. Erythrocyte count D. Reticulocyte count

D. Reticulocyte count hemolytic anemias typically have high reticulocyte counts, because the marrow can respond to the need for red cells.

151. Which of the following factors is not associated with variations in the total white blood cell count? A. Age B. Exercise C. Emotional stress D. Sex

D. Sex

35. What term describes a mature red blood cell that contains iron granules or deposits? A. Siderosome B. Sideroblast C. Ringed sideroblast D. Siderocyte

D. Siderocyte

9. Antigen-independent lymphopoiesis occurs in primary lymphoid tissue located in the A. Liver and kidney B. Spleen and lymph nodes C. Peyer's patches and spleen D. Thymus and bone marrow

D. Thymus and bone marrow

12) The platelet parameter PDW refers to the: A. Average platelet volume B. Cell weight versus density C. Capacity to adhere to foreign surfaces D. Variation in platelet cell size

D. Variation in platelet cell size

27) Which of the following complexes is not needed for blood coagulation to occur? A. VIIa, tissue factor, Ca2+ B. IXa, VIII, Ca2+, PF3 C. Xa, V, Ca2+, PF3 D. XIIa, kallikrein, HMWK

D. XIIa, kallikrein, HMWK

45) In which of the following functions are the products released by vascular endothelial cells not involved? A. Inhibition of platelet aggregation B. Activation of the fibrinolytic system C. Conversion of thrombin from a procoagulant to an anticoagulant D. cross-linkage of fibrin monomers

D. cross-linkage of fibrin monomers

64)Lab results on a 16 year old female with frequent nosebleeds and severe menorrhagia are as follows: Platelet count 250x109/L, Bleeding time >15 min (ref range <8 min), PT 13.0 sec (control 12.0 sec), aPTT 75.0 sec (control 32 sec), platelet aggregation Normal response to ADP, Collagen, Epinephrine: no response with ristocetin. These results are consistent with A. Christmas disease B. Hemophilia A C. Glazmann thrombasthenia D. von Willebrand disease

D. von Willebrand disease

20) Which of the following is not synthesized in the liver? A. Factor VIII B. Plasminogen C. Protein C D. von Willebrand factor

D. von Willebrand factor von Willebrand factor is produced by endothelial cells and megakaryocytes

Correct Answer: B

Refer to the following illustration: Which curve represents the production of alpha polypeptide chains of hemoglobin? A. A B. B C. C D. D

Correct Answer: D

Refer to the following illustration: Which curve represents the production of beta polypeptide chains of hemoglobin? A. B B. C C. E D. D

Correct Answer: D

Refer to the following illustration: Which curve represents the production of delta polypeptide chains of hemoglobin? A. B B. C C. D D. E

Correct Answer: A

Refer to the following illustration: Which curve represents the production of epsilon polypeptide chains of hemoglobin? A. A B. B C. C D. D

Correct Answer: C

Refer to the following illustration: Which curve represents the production of gamma polypeptide chains of hemoglobin? A. A B. B C. C D. D

71)Screening tests for a 46 year old male patient admitted for minor surgery. The patient has no clinical manifestations of a bleeding problem and has no personal or family history of bleeding problems seen following dental extraction. Several family members have been treated for deep vein thrombosis, Based on these laboratory results and the clinical history, the most likely cause of the prolonged aPTT is A. Heparin present in the sample B. Factor VIII deficiency C. Factor XII deficiency D. Factor XIII deficiency

C Factor XII deficiency

244. A clinically significant difference between two electronic cell counts is indicated when the standard deviation is greater than A. +1.0 B. +1.5 C. +2.0 D. +3.0

C. +2.0

5. What is the normal ratio of myeloid to erythroid precursors in bone marrow (M:E ratio)? A. 1:1 B. 1:3 C. 4:1 D. 8:1

C. 4:1 Alterations in the M: E ratio, such as 1:1 or 8:1, may indicate erythroid hyperplasia or granulocytic hyperplasia, respectively

142. What percentage of neutrophils in the peripheral blood constitutes the circulating pool? A. 100% B. 80% C. 50% D. 30%

C. 50%

2. What percentage of tissue located in the bone marrow cavities of adults is fat? A. 10% B. 25% C. 50% D. 75%

C. 50%

A 15-month-old malnourished child is brought to the clinic for a routine examination. Her CBC results are as follows: WBC 9.5 x 1 09/L (9.5 X 1 034jL); RBC 2.70 x 1 0121L (2.70>< 1 06/jiL); hemoglobin 67 gIL (6.7 gIdL); hematocrit 0.25 LIL (25%); MCV 73.5 fL; MCHC 26.8 gIdL; reticulocyte 0.2%; RDW 19%. Abnormal RBC morphology present included pencil forms and target cells. 283. What is the toddler's absolute reticulocyte count? A. O.05X109/L B. O.5X1091L C. 5X1091L D. 50X109/L

C. 5X1091L

233. If 60 reticulocytes are counted in 1000 red blood cells, what is the reticulocyte count? A. 0.06% B. 0.6% C. 6.0% D. 60.0%

C. 6.0%

11) The reference value for mean platelet volume (MPV) is approximately: A. 2-4 fL B. 5-7 fL C. 8-10 fL D. 11-14 fL

C. 8-10 fL

256. To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets should be observed per oil immersion field? A.1-4 B. 4—10 C. 8—20 D. 20—50

C. 8—20

59) Phlebotomist Forgetful Frank collected a tube of blood for an aPTT on John Smith at 10:00 am the blood was collected in a sodium citrate tube. At 4:30 pm,, frank was getting ready to leave for the day when he discovered Mr. Smith's blood specimen on his blood collection tray. So before leaving, Frank delivered the tube of blood to the lab for testing. Which of the following best describes the expected results? A. Sodium citrate is a preservative as well as an anticoagulant, so the aPTT result should be accurate B. An aPTT collected in sodium citrate will give falsely long results because some factors are unstable in this anticoagulant. C. A falsely long aPTT is expected because some factors deteriorate rapidly at room temperature. D. Exposure of the plasma to erythrocytes for several hours has probably activated the factors, so the aPTT will be falsely short.

C. A falsely long aPTT is expected because some factors deteriorate rapidly at room temperature. Factors V and VIII are labile and deteriorate rapidly at room temperature. Blood for aPTT testing should be tested within 4 hours of draw. Sodium citrate is the appropriate anticoagulant for coagulation procedures.

34. Which of the following statements about iron absorption is true? A. Absorption occurs in the ileum. B. The mucosal cell always absorbs the correct amount of iron to meet needs. C. Absorption increases when erythropoietic activity increases. D. Alkaline pH favors absorption.

C. Absorption increases when erythropoietic activity increases. An acid pH is required for iron absorption, and sites of maximal absorption are the duodenum and upper jejunum. The body has no effective means for iron excretion.

211. The blast cells shown in Color Plate 18 are CD14 and CD33 positive, Sudan black B positive, specific esterase positive, and nonspecific esterase positive. Which type of acute leukemia is most consistent with the immunophenotyping and cytochemical staining results? A. Acute lymphoblastic leukemia, T cell type B. Acute erythroleukemia C. Acute myelomonocytic leukemia D. Acute monocytic leukemia

C. Acute myelomonocytic leukemia

116. A moderately anemic patient with suspected pernicious anemia (PA) shows intrinsic factor antibodies and a low cobalamin level. Which of the following would not support the diagnosis of PA? A. Gastric atrophy and achlorhydria B. Oval macrocytes and Howell-Jolly bodies C. Bone marrow erythroid precursors exhibit normoblastic maturation. D. Elevated serum lactate dehydrogenase (LD) and bilirubin levels

C. Bone marrow erythroid precursors exhibit normoblastic maturation.

25. Hemoglobin forms that are incapable of oxygen transport include A. Deoxyhemoglobin and oxygemoglobin B. Oxyhemoglobin and carboxyhemoglobin C. Carboxyhemoglobin and methemoglobin D. Methomoglobin and deoxyhemoglobin

C. Carboxyhemoglobin and methemoglobin methemoglobin- hemoglobin in which the ferrous iron (Fe2+)has been oxidized to the ferric state (Fe+) and is unable to carry oxygen.

251. To establish a standard curve for reading hemoglobin concentration, A. A commercial control material is used. B. A wavelength of 640 nm is employed. C. Certified standards are used. D. A patient blood sample of known hemoglobin concentration is used.

C. Certified standards are used.

111. Which of the following disorders is not commonly linked to the development of anemia of chronic disease? A. Persistent infections B. Noninfectious inflammatory disorders C. Chronic gastrointestinal blood loss D. Malignancy

C. Chronic gastrointestinal blood loss

A 53-year-old man reported to the laboratory for routine blood work as part of a yearly physical. He had been feeling tired for the last few months. Physical examination revealed splenomegaly. H is CBC results are as follows: WBC 80.0 x 1 09/L (80.0 x 103/1iL); RBC 4.lOx 1012/L(4.1OX 1 064LL); hemoglobin 123 gIL (12.3 g/dL); hematocrit 0.37 L/L (37.0%); platelet count 650 x 1 09/L (650,000IpL); differential count shows 40% polymorphonuclear neutrophils, 18% bands, 5% metamyelocytes, 7% myelocyte, 28% lymphocytes, and 2% monocytes. No ABC or WBC morphologic abnormalities are seen. 299. Which of the following myeloproliferative disorders is characterized by the presence of a t(9;22) chromosome abnormality and the BCRIABL oncogene? A. Polycythemia vera B. Essential thrombocythemia C. Chronic myelogenous leukemia D. Chronic idiopathic myelofibrosis

C. Chronic myelogenous leukemia

54. The morphologic abnormality characteristically found in hemoglobinopathies is A. Elliptocytes B. Dacryocytes C. Codocytes D. Discocytes

C. Codocytes (target cells)

82. Which of the following is not a cause of absolute secondary erythrocytosis? A. Defective cardiac or pulmonary function B. High-altitude adjustment C. Dehydration secondary to diuretic use D. Hemoglobins with increased oxygen affinity

C. Dehydration secondary to diuretic use Dehydration is a cause of relative (pseudo) erythrocytosis due to plasma loss.

86. Which of the following would be useful in identifying the cause of the blood profile seen in Color Plate 8•? A. Osmotic fragility test B. Reticulocyte count C. Direct antiglobulin test D. Urine urobilinogen level

C. Direct antiglobulin test The differential diagnosis is hereditary spherocytosis (negative DAT) and warm autoimmune hemolytic anemia (positive DAT)

221. Myeloid metaplasia refers to A. Displacement of normal marrow cells by fibrous tissue B. Hematopoietic failure C. Extramedullary hematopoiesis D. Tumors (neoplasms) of the bone marrow

C. Extramedullary hematopoiesis

54) A 65-year-old patient in the emergency department has a normal D-dimer and an elevated FDP result. These results are consistent with the presence of degradation products of: A. Non-cross-linked fibrin B. Cross-linked fibrin C. Fibrinogen D. Plasmin

C. Fibrinogen

The peripheral blood shown in Color Plate ii is from a 19-year-old female college student who has been living primarily on tea, beer, and cereal for the past 9 months because she finds dining hail food distasteful. She visits student health complaining of fatigue. Her CBC results are as follows: WBC 2.5 X 1 091L (2.5 x 1 03/1iL); RBC 2.10 x 1 0121L (2.10 x 1 064LL); hemoglobin 85 gIL (8.5 gIdL); hematocrit 0.24 LIL (24%); platelet count 110 x 1 091L (11 0,0004iL); MCV 114 fL; MCHC 35.0 g/dL; reticulocyte count 0.8%. 273. In the absence of neurological symptoms, the anemia in this patient is most likely caused by a lack of A. An enzyme B. Iron C. Folic acid D. Intrinsic factor

C. Folic acid

40. Which of the following inclusions is only visible with supravital staining? A. Basophilic stippling B. Cabot rings C. Heinz bodies D. Pappenheimer bodies

C. Heinz bodies Heinz bodies consist of intracellular globin or hemoglobin precipitate that results from hemoglobin denaturation or excess globin chains (certain thalassemic syndromes)

66. A 14 y/o African-American male seen for abdominal pain. CBC results: WBC 7.0>< 1 09/L (7.0 X 1 O3/pL) RBC 2.90X 1012/L(2.90X 1064i,L) Hemogobn 85 g/L (8.5 g/dL) Hematocrit 0.25 L/L (25%) MCV 86.2 fL MCH 29.3 pg MCHC 340 g/L (34.0 gidL) RDW 21% See Color Plate 5. What condition is suggested by these findings? A. Hemoglobin E disease B. Hemoglobin S disease C. Hemoglobin SC disease D. Hemoglobin C disease

C. Hemoglobin SC disease The presence of numerous target cells and SC crystals on the peripheral blood smear suggests the presence of hemoglobin SC disease. These bizarre crystals are distinguished by one or more blunt, finger-like projections that protrude from the cell membrane.

43. Microcytic, hypochromic red cells are most often associated with impaired A. DNA synthesis B. RNA metabolism C. Hemoglobin synthesis D. Enzyme metabolism

C. Hemoglobin synthesis Millions of hemoglobin molecules are produced in the red cell cytoplasm during maturation. When developing erythroid cells are deprived of essential hemoglobin components, the results is the production of microcytic, hypochromic red cells. It is through that during maturation, extra cell divisions occur until a certain hemoglobin concentration is reached. Impairedhemoglobin synthesis may be the result of heme defects (involving iron or protoporphyrin) or may be caused by globin defects. Impaired DNA synthesis is associated with macrocytic red cells, and normocytic red cells are characteristic of enzyme defects.

70) the following results are obtained on a 3 year old boy with sudden severe hemorrhagic problems A. Aspirin therapy B. von Willebrand disease C. Hemophilia A D. Heparin therapy

C. Hemophilia A

100. A pre-operative, 20-year-old female has a mild microcytic anemia, with target cells and stippled red cells observed on the blood smear. Her hemoglobin A2 level is quantified at 5%. What do these findings suggest? A. Iron-deficiency anemia B. Heterozygous alpha-thalassemia C. Heterozygous beta-thalassemia D. Hemoglobin S/beta-thalassemia

C. Heterozygous beta-thalassemia Both iron deficiency and heterozygous thalassemia can resent with a mild microcytic, hypochromic anemia. Target cells may be seen in both, but basophilic stippling is only found in thalassemia. The hemoglobin A2 is normal in heterozyoug alpha-thalassemia. The hemoglobin A2 is normal in heterozygous alpha-thalassemia but is frequently twice the normal level in heterozygous beta-thalassemia, because these individuals compensate with increased delta-chain production due to deficient beta-globin chain synthesis. In this case, iron deficiency would likely be ruled out first with iron tests. Beta-thalassemia with hemoglobin S trait produces a severe clinical picture similar to sickle cell anemia, with sickling of red cells.

19. Which of the following describes thrombopoietin (TPO)? A. Renal hormone that regulates marrow red cell production B. Marrow hormone secreted by developing megakaryoblasts C. Hormone produced by the liver that stimulates megakaryopoiesis D. Pituitary hormone that controls platelet sequestration by the spleen

C. Hormone produced by the liver that stimulates megakaryopoiesis

184. Which of the following would not cause a total WBC count of 62.2 X i09/L (62.2 X lO3fliL) and the blood findings seen in Color Plate 13? A. Treatment with myeloid growth factors B. Gram-negative septicemia C. Human immunodeficiency virus (HIV) D. Systemic fungal infection

C. Human immunodeficiency virus (HIV)

194. Multiple myeloma is characterized by the presence in urine of large amounts of A. Cryoglobulins B. IgG heavy chains C. IgG light chains D. Beta microglobulins

C. IgG light chains The secretion of large amounts of monoclonal IgG or other immunoglobulin light chains by a malignant clone of plasma cells produces a characteristic M spike on serum and urine protein electrophoresis.

23) Prekallikrein deficiency is associated with: A. Prolonged aPTT that does not correct with a mixing study B. Autosomal dominant inheritance C. Increased risk of thrombosis D. Delayed bleeding at the incision site following surgery

C. Increased risk of thrombosis Because prekallikrein is an activator of the fibrinolytic system, prekallikrein-deficient patients cannot lyse clots efficiently and are prone to thrombosis

127. Which of the following characterizes iron- deficiency anemia? A. Decreased serum iron, decreased transferrin saturation, normal ferritin B. Decreased serum transferrin, decreased transferrin saturation, decreased ferritin C. Increased serum transferrin, decreased transferrin saturation, decreased ferritin D. Increased serum transferrin, increased transferrin saturation, decreased serum iron

C. Increased serum transferrin, decreased transferrin saturation, decreased ferritin

3) Which of the following is not a cause of thrombocytopenia? A. Splenomegaly B. Chemotherapy C. Increased thrombopoietin D. Aplastic anemia

C. Increased thrombopoietin

71. Which of the following blood findings does not correlate with the presence of ringed sideroblasts in the bone marrow? A. Pappenheimer bodies B. Basophilic stippling C. Increased total iron-binding capacity D. Increased percent transferrin saturation

C. Increased total iron-binding capacity Ringed sideroblasts result from the accumulation of iron deposits in the mitochandria surrounding the nucleus of erythroid precursors. The

202. Which of the following is not associated with neutrophilia? A. Staphylococcal pneumonia B. Crushing injury C. Infectious hepatitis D. Neoplasms (tumors)

C. Infectious hepatitis Acute viral hepatitis is associated with lymphocytosis. The major causes of neutrophilia are bacterial infection, neoplastic tumors, and inflammatory responses to tissue injury.

243. What is the principle of automated impedance cell counters? A. Angle of laser beam scatter by cells B. Amplification of an electrical current by cells C. Interruption of an electrical current by cells D. Change in optical density of the solution containing cells

C. Interruption of an electrical current by cells

67. Pica is most commonly associated with which of the following conditions? A. Pyridoxine deficiency B. Lack of erythrocyte folate C. Iron deficiency D. Porphyrias

C. Iron deficiency

A 15-month-old malnourished child is brought to the clinic for a routine examination. Her CBC results are as follows: WBC 9.5 x 1 09/L (9.5 X 1 034jL); RBC 2.70 x 1 0121L (2.70>< 1 06/jiL); hemoglobin 67 gIL (6.7 gIdL); hematocrit 0.25 LIL (25%); MCV 73.5 fL; MCHC 26.8 gIdL; reticulocyte 0.2%; RDW 19%. Abnormal RBC morphology present included pencil forms and target cells. 281. What is this toddler's most probable diagnosis? A. Folic acid deficiency B. Hereditary spherocytosis C. Iron deficiency D. Erythroblastosis fetalis

C. Iron deficiency

164. Which of the following characteristics would be least likely to distinguish reactive lymphocytes from monocytes? A. Sharp indentation of the cytoplasmic margin by adjacent red blood cells B. Presence of large azurophilic granules C. Irregular, indented nuclear shape D. Abundant, deeply basophilic cytoplasm

C. Irregular, indented nuclear shape

49. Defective nuclear maturation commonly results in the production of red cells that are A. Normocytic B. Hypochromic C. Macrocytic D. Microcytic

C. Macrocytic Impaired DNA sythesis results in nuclear maturation that lags behind cytoplasmic development (asynchrony), decreased cellular divisions, and the production of macrocytic red cells. Defective nuclear maturation (megaloblastic) is almost always caused by a deficiency of vitamin B12 or folic acid, which are DNA coenzymes. Macrocytic red cells that are not due to vitamin B12 or folic acid deficiency (non-megaloblastic) may be seen in liver disease or when retics is pronounced. Microcytic, hypochromic red cell are the results of impaired hemoglobin synthesis.

219. Acute erythroleukemia (FAB type M6) is characterized by increased A. Promyelocytes and lysozyme activity B. Marrow megakaryocytes and thrombocytosis C. Marrow erythroblasts and multinucleated red cells D. Marrow monoblasts and immature monocytes

C. Marrow erythroblasts and multinucleated red cells

An 83-year-old woman is seen in the emergency department complaining of fatigue and recent weight loss. Her CBC results are as follows: WBC 2.6 x 1 09/L (2.6 x 1 03/1iL); RBC 2.79>< 1 O2/L (2.79 X 1 06/pL); hemoglobin 92 gIL (9.2 g/dL); hematocrit 0.28 LIL (28%); MCV 100.0 fL; RDW 23.5%; platelet count 42 X 1 09/L (42,0004LL); differential count shows 42% segmented neutrophils, 45% band neutrophils, 3% lymphocytes, 3% metamyelocytes, 4% myelocytes, 3% blasts, and 4 nRBC/100 WBC. Morphologic changes noted on the differential smear include poor granulation and hyposegmentation of the neutrophils, giant platelets that display poor granulation, oval macrocytes, basophilic stippling, Cabot rings, Pappenheimer bodies, and Howell-Jolly bodies. Three micromegakaryocytes are seen per 100 WBCs. Serum B12 and folate levels are normal. 296. Which of the following is a false statement about myelodysplastic syndromes? A. MDS is "preleukemic" and frequently terminates in acute leukemia. B. Treatment for MDS is only supportive and not a cure. C. Median survival for all types of MDS is 5 years. D. The lower the blast percent, the longer is the survival rate.

C. Median survival for all types of MDS is 5 years.

13. Interleukins and colony stimulating factors are cytokines produced by A. B lymphocytes and erythrocytes B. Erythrocytes and thrombocytes C. Monocytes and T lymphocytes D. Neutrophils and monocytes

C. Monocytes and T lymphocytes

195. Which of the following is not classified as a myeloproliferative disorder? A. Polycythemia vera B. Essential thrombocythemia C. Multiple myeloma D. Chronic myelogenous leukemia

C. Multiple myeloma Multiple myeloma is amalignant lymphoporliferative disorder characterized by a clonal proliferation of plasma cells and multiple bone tumors. Myeloproliferative disorders are characterized by a proliferation of bone marrow cells (granulocytic, monocytic, erythrocytic, megakaryocytic), with usually one cell type primarily affected.

154. The most mature granulocyte precursor that can undergo mitosis is the A. Myeloblast B. Promyelocyte C. Myelocyte D. Metamyelocyte

C. Myelocyte

155. Production of primary granules ceases and production of secondary granules commences with what cell stage? A. Myeloblast B. Promyelocyte C. Myelocyte D. Metamyelocyte

C. Myelocyte

79. A patient with normocytic, normochromic anemia secondary to small cell carcinoma may be exhibiting an anemia designated as A. Hemolytic B. Megaloblastic C. Myelophthisic D. Sideroblastic

C. Myelophthisic Myelophthisic anemia is an anemia of bone marrow failure.

94. In children, the most important effect of lead poisoning is on the A. Liver B. Kidney C. Neurologic system D. Development of erythrocytes

C. Neurologic system

57. What is the function of reduced glutathione (GSH) in the red blood cell? A. Promotes Kreb's cycle activity B. Maintains anion balance during the "chloride shift" C. Neutralizes intracellular oxidants that accumulate D. Prevents oxygen uptake by hemoglobin

C. Neutralizes intracellular oxidants that accumulate

42. Which of the following may be a sign of accelerated bone marrow erythropoiesis? A. Hypercellular marrow with a decreased number of RBC precursors B. Bone marrow M:E ratio of 6:1 C. Nucleated red cells in the peripheral circulation D. Low erythrocyte, hemoglobin, and hematocrit levels

C. Nucleated red cells in the peripheral circulation

44. When in bone marrow, the nucleated red cells present in Color Plate 2 would be staged as A. Basophilic normoblasts B. Polychromatophilic normoblasts C. Orthochromic normoblasts D. Pronormoblasts

C. Orthochromic normoblasts

105. The antibody associated with paroxysmal cold hemoglobinuria shows specificity for A. ABO antigens B. I antigens C. P antigens D. Rh antigens

C. P antigens

238. Which of the following red cell inclusions stain with both Pen's Prussian blue and Wright's stain? A. Howell-Jolly bodies B. Basophilic stippling C. Pappenheimer bodies D. Heinz bodies

C. Pappenheimer bodies Pappenheimer bodies is called a siderocyte, Howell-Jolly bodies and basophilic stippling can be visualized with Wright's stain, whereas heinz bodies require a suprvital stain to be seen.

225. A patient with suspected sickle cell trait has negative solubility test results, but hemoglobin electrophoresis at pH 8.6 shows an apparent A-S pattern. What is the most likely explanation? A. Patient has hemoglobin AS, and the solubility test is incorrect. B. Patient has hemoglobin AA, and the electrophoresis is incorrect. C. Patient has hemoglobin AD or AG, and both procedures are correct. D. Tests need to be repeated; impossible to determine which procedure is correct.

C. Patient has hemoglobin AD or AG, and both procedures are correct.

An 8-year-old girl is seen by the family physician. On physical examination, the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as follows: WBC 110 x 1 091L (110 x 1 034L); RBC 1.70 x 1 0121L (1.70 x 1 06/iL); hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 LIL (16%); differential count shows 93% blasts and 7% lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the blasts are small with no variation in their appearance. 286. Which of the following cytochemical stains would most likely be positive in the blast cells of this patient? A. Myeloperoxidase B. Leukocyte alkaline phosphatase C. Periodic acid—Schiff D. Nonspecific esterase

C. Periodic acid—Schiff

60) An aPTT and PT are requested on a patient scheduled for emergency surgery. On an optical density clot detection system, normal and abnormal controls for both tests are within range, but the patient's results exceed the upper limit of linearity. The patient's aPTT and PT have been performed in duplicate, but there still is sufficient plasma, which is grossly lipemic, to repeat tests. What is the best course of action to follow? A. Report the results immediately by phone, emphasizing that the tests were run in duplicate and the controls are within range. B. Request a new specimen and repeat the aPTT and PT using freshly diluted controls C. Repeat the aPTT and PT on an instrument that detects clot formation electromechanically D. Inform the physician that accurate results are impossible

C. Repeat the aPTT and PT on an instrument that detects clot formation electromechanically

134. Which of the following is not a characteristic of the idiopathic type of sideroblastic anemia? A. Refractory to treatment B. Blocks in heme synthesis are unknown C. Reversible with intramuscular vitamin B12 injections D. Subtype of myelodysplastic syndromes

C. Reversible with intramuscular vitamin B12 injections

13) A normal histogram showing platelet size distribution is best described as: A. Bimodal, nonskewed peaks B. Left-skewed single peak C. Right-skewed single peak D. Single peak, gaussian distribution

C. Right-skewed single peak

152. Of the following, an absolute neutrophil count of 1.0 X 109/L would be associated with A. Shortness of breath B. Bleeding tendencies C. Risk of infection D. No clinical symptoms

C. Risk of infection <1.0 X 10^9/L or great risk is <0.5 x10^9/L

209. What is the initial laboratory technique for the diagnosis of monoclonal gammopathies? A. Immunologic markers of marrow biopsy cells B. Cytochemical staining of marrow and peripheral blood cells C. Serum and urine protein electrophoresis D. Cytogenetic analysis of marrow cells

C. Serum and urine protein electrophoresis

226. Which of the following is an incorrect statement about the solubility test for Hemoglobin S? A. Hemoglobin S polymerizes when deoxygenated. B. Testing performed on a 2-day-old infant can result in a false negative result. C. Sickle cell trait can be differentiated from sickle cell anemia with this test. D. The test is positive in hemoglobin CHarlem.

C. Sickle cell trait can be differentiated from sickle cell anemia with this test.

95. Which of the following would not result in the dual population of red cells represented in Color Plate 9 (both hyperchromic and hypocrhomic RBCs)? A. Blood transfusion B. Oral iron therapy C. Spleen removal D. Coexisting deficiencies

C. Spleen removal

210. Which of the following statements about Hodgkin disease is false? A. Peak incidence occurs in young adults. B. Staging determines extent of disease and treatment course. C. Stage IV has the best prognosis. D. Almost a 2:1 male predominance over females is characteristic.

C. Stage IV has the best prognosis.

199. The cytoplasmic inclusion present in the cell shown in Color Plate 17 (auer rod) A. Excludes a diagnosis of acute myelogenous leukemia B. Stains positive with leukocyte alkaline phosphatase (LAP) C. Stains positive with myeloperoxidase (MPO) D. Identifies the cell as a malignant lymphoblast

C. Stains positive with myeloperoxidase (MPO) Auer rod, composed of fused primary granules, which stains positive with both myeloperoxidase and sudan black B

39) A prolonged aPTT result is obtained on a patient diagnosed with acute disseminated intravascular coagulation (DIC). The patient has not yet been treated for this disorder. The most likely cause of the prolonged aPTT is: A. In addition to DIC, the patient is deficient in a factor required for the extrinsic pathway B. DIC is characterized by synthesis of less stable coagulation factors, which deteriorate rapidly in the circulation C. Systemic activation of the coagulation system depletes some factors more rapidly than the liver can synthesize them D. The patient has been misdiagnosed; a prolonged aPTT indicates that the problem is deficient, not excessive, coagulation.

C. Systemic activation of the coagulation system depletes some factors more rapidly than the liver can synthesize them As coagulation occurs in vivo, some factors are consumed just as they are when blood is allowed to clot in a test tube in vitro. The factors consumed during coagulation are I, II, V, VIII, and XIII. Results of lab procedures relying on one or more of these factors will be affected. All these factors except factor XIII contribute to the reactions evaluated in the aPTT procedure.

14. What is the approximate total blood volume in an adult? A.1L B. 2L C.6L D. 12L

C.6L

A 42-year-old male presents with anorexia, nausea, fever, and icterus of the skin and mucous membranes. He noticed that his urine had appeared dark for the past several days. The physicianorders a series of biochemical tests. Based on thefollowing test results, what is the most likely diagnosis? Serum alkaline phosphatase—slightly elevated Serum alanine aminotransferase— markedly elevated Serum aspartate aminotransferase— markedly elevated Serum gamma-glutamyltransferase— slightly elevated Serum total bilirubin—moderately elevated Urine bilirubin—positive Fecal urobilinogen—decreased A. Acutehepatitis B. Alcoholic cirrhosis C. Metastatic carcinoma of the pancreas D. Obstructive jaundice

Correct Answer: A

A 45-year-old male of average heigh and weight was admitted to the hospital for renal function studies. He had the following lab results: -urine creatinine: 120 mg/dL (10680 umol/L) -serum creatinine: 1.5 mg/dL (132.6 umol/L) -total urine volume in 24 hours: 1800/mL Calculate the creatinine clearance for this patient in mL/min. A. 100 B. 144 C. 156 D. 225

Correct Answer: A

A 45-year-old woman has a fasting serum glucose concentration of 95 mg/dL (5.2 mmol/L) and a 2-hour postprandial glucose concentration of 105 mg/dL 95.8 mmol/L). The statement which best describes this patient's fasting serum glucose concentration is: A. normal; reflecting glycogen breakdown by the liver B. normal; reflecting glycogen breakdown by skeletal muscle C. abnormal; indicating diabetes mellitus D. abnormal; indicating hypoglycemia

Correct Answer: A

A 46-year-old known alcoholic with liver damage is brought into the emergency department unconscious. In what way would you expect his plasma lipid values to be affected? A. Increased total cholesterol, triglyc- eride, LDL, and VLDL B. Increased total cholesterol and triglyceride, decreased LDL and VLDL C. Decreased total cholesterol, triglyc- eride, LDL, and VLDL D. Normal lipid metabolism, unaffected by the alcoholism

Correct Answer: A

A 50-year-od woman wha has been receiving busulfan for 3 years for chronic myelogenous leukemia becomes anemic. Laboratory test reveal: -Thrombocytopenia -Many perxidase-negative blast cells in the peripheral blood -Bone marrow hypercellular in blast transformation -Markedly increased bone marrow TdT Which of the following complications is this patient most likely to have? A. acute lymphocytic leukemia B. acute meylocytic leukemia C. acute myelomonocytic leukemia D. busulfan toxicity

Correct Answer: A

A 54-year-old male, with a history of type 2 diabetes mellitus for the past 8 years, is seen by his family physician. The patient indicates that during the past week he had experienced what he described as feeling lightheaded and faint. He also indicated that he became out of breath and had experienced mild chest pain when doing heavy yard work, but the chest pain subsided when he sat down and rested. The physician performed an ECG immediately, which was normal, and he ordered blood tests. The patient fasted overnight and had blood drawn the next morning. The laboratory test values follow: Test; Patient's Values; Reference Ranges -Glucose, fasting: 175 mg/dL; 74-99 mg/dL -Hemoglobin Alc: 8.1%; 4-6% -Total cholesterol: 272 mg/dL; <200mg/dL -HDL cholesterol: 30 mg/dL; >40 mg/dL -LDL cholesterol: 102 mg/dL;< 130 mg/dL -Triglyceride: 250 mg/dL; < 150 mg/dL -hs-CRP: 6.2 mg/L;0.3-8.6 mg/L, < 1.0mg/L low risk Based on the patient's test results, history, and symptoms, which of the laboratory values in the chart above does not support the patient's diagnosis? A. LDL cholesterol B. HDL cholesterol C. Hemoglobin A1c D. hs-CRP

Correct Answer: A

A 56-year-old man was admitted to the hospital for treatment of a bleeding ulcer. The following laboratory data were obtained: -RBC: 4.2 x 10^6/uL (4.2 x 10^12/L) -WBC: 5.0 x 10^3/uL (5.0 x 10^6/L) -Hct: 30% -Hgb: 8.5 g/dL (85 g/L) -Serum iron: 40 ug/dL (7.2 umol/L) -TIBC: 460 ug/dL (82.3 umol/L) -Serum ferritin: 12 ng/mL (12 ug/L) Examination of the bone marrow revealed the absence of iron stores. This data is most consistent with which of the following conditions? A. iron deficiency anemia B. anemia of chronic disease C. hemochromatosis D. acute blood loss

Correct Answer: A

A 68-year-old female patient tells her physician of being " cold all the time" and recent weight gain, with no change in diet. The doctor orders a TSH level, and the laboratory reports a value of 8.7 uU/mL (8.7 IU/L) (reference range = 0.5 uU/mL [0.5-5.0 IU/L[). This patient most likely has: A. primary hypothyroidism B. Graves disease C. a TSH-secretin tumor D. primary hyperthyroidism

Correct Answer: A

A 68-year-old man arrives in the emergency room with a glucose level of 722 mg/dL (39.7 mmol/L) and serum acetone of 4+ undiluted. An arterial blood gas form this patient is likely to be: A. low pH B. high pH C. low PO2 D. high PO2

Correct Answer: A

A 75-year-old woman comes to her physician complaining of abdominal pain. She says she has had a sore stomach for the last 3 weeks and has been taking increasing doses of antacid pills to control it. Now she is taking a box of pills a day. Blood gases are drawn with the following results: pH = 7.49, PCO2 = 59 mm Hg, HCOJ = 25 mmol/L. What do these data indicate? A. Metabolicalkalosis,partially compensated B. Respiratory acidosis, uncompensated C. A dual problem of acidosis D. An error in one of the blood gas measurements

Correct Answer: A

A bedside test that can be used to monitor heparin activity is the: A. activated clotting time B. stypven time C. reptilase time D. partial thromboplastin time

Correct Answer: A

A bleeding time is used to evaluate the activity of: A. platelets B. prothrombin C. labile factor D. Factor XIII

Correct Answer: A

A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing the force and velocity of myocardial contraction is: A. digoxin B. acetaminophen C. lithium D. phenytoin

Correct Answer: A

A common cause of a falsely increased LD1 fraction of lactic dehydrogenase is: A. specimen hemolysis B. liver disease C. congestive heart failure D. drug toxicity

Correct Answer: A

A critically ill patient becomes comatose. The physician believes the coma is due to hepatic failure. The assay most helpful in this diagnosis is: A. ammonia B. ALT C. AST D. GGT

Correct Answer: A

A differential was performed on an asymptomatic patient. The differential included 60% neutrophils; 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomalies? A. Pelger-Huet B. May-Hegglin C. Alder-Reilly D. Chediak-Higashi

Correct Answer: A

A hemophiliac male and a normal female can produce a: A. female carrier B. male carrier C. male hemophiliac D. normal female

Correct Answer: A

A hospitalized patient is experiencing increased neuromuscular irritability (tetany). Which of the following tests should be ordered immediately? A. calcium B. phosphate C. BUN D. glucose

Correct Answer: A

A leukocyte count and differential on a 40-year-old Caucasian man revealed: WBC: 5.4 x 10^3/uL (5.4 x 10^9/L) Differential: -Segs: 20% -Lymphs: 58% -Monos: 20% -Eos: 2% This represents: A. relative lymphocytosis B. absolute lymphocytosis C. relative neutrophilia D. leukopenia

Correct Answer: A

A lipemic serum is separated and frozen at -20C for assay at a later date. One week later, prior to performing an assay for triglycerides, the specimen should be: A. warmed to 37 C and mixed thoroughly B. warmed to 15C and centrifuged C. transferred to a glycerated test tube D. discarded and a new specimen obtained

Correct Answer: A

A low concentration of serum phosphorus is commonly found in: A. patients who are receiving carbohydrate hyperalimentation B. chronic renal disease C. hypoparathyroidism D. patients with pituitary tumors

Correct Answer: A

A patient diagnosed with polycythemia vera 5 years ago now has anormal hematocrit, decreased hemoglobin and microcytic, hypochromic red cells. What is the most probable cause for the current blood situation? A. phlebotomy B. myelofibrosis C. preleukemia D. aplastic anemia

Correct Answer: A

A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malarial drugs the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusion caused by hemoglobin denaturation. Which of the following conditions is most consistent with these findings? A. G-6-PD deficiency B. thalassemia major C. pyruvate kinase deficiency D. paroxysmal nocturnal hemoglobinuria

Correct Answer: A

A patient has a urine uric acid level of 1575 mg/day. What effect will this have on the measured urine glucose level when the glucose oxidase/peroxidase method is employed? A. Urine glucose level will be falsely low. B. Urine glucose level will be falsely high. C. Urine glucose level will be accurate. D. Urine glucose level will exceed the linearity of the method.

Correct Answer: A

A patient has the following test results: -increased serum calcium levels -decreased serum phosphate levels -increased levels of parathyroid hormone This patient most likely has: A. hyperparathyroidism B. hypoparathyroidsim C. nephrosis D. steatorrhea

Correct Answer: A

A patient is admitted to the emergency room in a stage of metabolic alkalosis. Which of the following would be consistent with this diagnosis? A. high TCO2, increased HCO3 B. low TCO2, increased HCO3 C. high TCO2, decreased H2CO3 D. low TCO2, decreased H2CO3

Correct Answer: A

A patient is diagnose as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood? A. granulocytic leukemoid reaction B. lymphocytic leukemoid reaction C. neutropenia D. eosinophilia

Correct Answer: A

A patient is taking 10 mg per day of Coumadin (warfarin). The results of which of the following laboratory tests will be most impacted? A. protein C level B. antithrombin III level C. Factor V Leiden mutation D. Factor VIII level

Correct Answer: A

A patient with beta-thalassemia characteristically has a(n): A. elevated A2 hemoglobin B. low fetal hemoglobin C. high serum iron D. normal red cell fragility

Correct Answer: A

A patient with hemolytic anemia will A. show a decrease in glycated Hgb value B. show an increase in glycated Hgb value C. show little or no change in glycated Hgb value D. demonstrate an elevated Hgb A1

Correct Answer: A

A patient with polycythemia vera who is treated by phlebotomy is most likely to develop a deficiency of: A. iron B. vitamin B12 C. folic acid D. erythropoietin

Correct Answer: A

A phase-platelet count was performed and the total platelet count was 356 x 10^3/uL (356 x 10^9/L). 10 fields on the stained blood smear were examined for platelets and the results per field were: -16, 18, 15, 20, 19, 17, 19, 18, 20, 16 The next step would be to: A. report the phase-platelet count since it correlated well with the slide B. repeat the phase-platelet count on a recollected specimen and check for clumping C. check ten additional fields on the blood smear D. repeat the platelet count using a different method

Correct Answer: A

A platelet determination was performed on an automated instrument and a very low value was obtained. The platelets appeared adequate when estimated from the stained blood film. The best explanation for this discrepancy is: A. many platelets are abnormally large B. blood sample is hemolyzed C. white cell fragments are present in the blood D. red cell fragments are present in the blood

Correct Answer: A

A potassium level of 6.8 mEq/L (6.8 mmol/L) is obtained. Before reporting the results, the first step the technologist should take is to: A. check the serum for hemolysis B. rerun the test C. check the age of the patient D. do nothing, simply report out the result

Correct Answer: A

A properly functioning electronic cel counter obtains the following results: -WBC: 5.1 x 10^3/uL (5.1 x 10^9/L) -RBC: 4.87 x 10^6/uL (4.87 x 10^12/L) -Hgb: 16.1 g/dL (161 g/L) -Hct: 39.3% -MCV: 82.0 um^3 (82 fL) -MCH: 33.1 pg -MCHC: 41.3% What is the most likely cause of these results? A. lipemia B. cold agglutinins C. increased WBC D. rouleaux

Correct Answer: A

A red blood cell about 5 um id diameter that stains bright red and shows no central pallor is a: A. sherocyte B. leptocyte C. microcyte D. macrocyte

Correct Answer: A

A serum sample drawn in the emergency room form a 42-year-old man yielded the following: Patient; Reference range -CK: 185 U/L; 15-60 U/L -AST: 123 U/L; 0-48 U/L -CKMB: 6 U/L; 2-12 U/L Which of the following conditions might account for these values? A. crush injury to the thigh B. cerebrovascular accident C. pulmonary infarction D. early acute hepatitis

Correct Answer: A

A stool specimen that appears black and tarry should be tested for the presence of: A. occult blood B. fecal fat C. trypsin D. excess mucus

Correct Answer: A

ADAMTS13 deficiency is responsible for thrombocytopenia found in: A. TTP B. DIC C. HUS D. ITP

Correct Answer: A

Absorption of vitamin B12 requires the presence of: A. intrinsic factor B. gastrin C. secretin D. folic acid

Correct Answer: A

Acute disseminated intravascular coagulation is characterized by: A. hypofibrinogenemia B. thrombocytosis C. negative D-dimer D. shortened thrombin time

Correct Answer: A

All stages of neutrophils are most likely to be seen in the peripheral blood of a patient with : A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia

Correct Answer: A

An active metabolite of amitriptyline is: A. nortriptyline B. protriptyline C. butrptyline D. norbutriptyline

Correct Answer: A

An automated leukocyte count is 22.5 x 10^9/uL (22.5 x 10^9/L). The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter? A. 7,500/uL (7.5 x 10^9/L) B. 11,500/uL (11.5 x 10^9/L) C. 14,400/uL (14.4 x 10^9/L) D. 22,300/uL (22.3 x 10^9/L)

Correct Answer: A

An automated method for measuring chloride which generates silver ions in the reaction is: A. coulomery B. mass spectroscopy C. chromatography D. polarography

Correct Answer: A

An electrophoretic separation of lactate dehydrogenase isoenzymes that demonstrates and elevation in LD-1 and LD-2 in a "flipped pattern is consistent with: A. myocardial infartion B. viral hepatitis C. pancreatis D. renal failure

Correct Answer: A

An emphysema patient suffering form fluid accumulation in the alveolar spaces is likely to be in what metabolic state? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

Correct Answer: A

An increase in serum acetone is indicative of defect in the metabolism of: A. carbohdrates B. fat C. urea nitrogen D. uric acid

Correct Answer: A

An increased serum level of which of the following analytes is most commonly associated with decreased glomerular filtration? A. Creatinine B. Uric acid C. Urea D. Ammonia

Correct Answer: A

An infant with diarrhea is being evaluated for a carbohydrate intolerance. His tool yields a positive copper reduction test and a pH of 5.0. It should be concluded that: A. further test are indicated B. results are inconsistent- repeat both tests C. the diarrhea is not due to carbohydrate intolerance D. the test provided no useful information

Correct Answer: A

An oncology patient has the following results: Day 1 Day 3 WBC: 8.0 x 10^3/uL 2.0 x 10^3/uL (8.0 x 10^9/L) (2.0 x 10^9/L) RBC: 3.50 x 10^6/uL 3.45 x 10^6/uL (3.50 x 10^12/L). (3.45 x 10^12/L) Hgb: 10.0 g/dL (100 g/L) 9.9 g/dL (99 g/L) Hct: 29.8% 29.5% Plt: 180 x 10^3/uL 150 x 10^3/uL (180 x 10^9/L) (150 x 10^9/L) The most probable explanation is: A. chemotherapy B. cold antibody C. clotted specimen D. inadequate mixing

Correct Answer: A

An unexplained elevation of the prothrombin time (PT) in a 72-year-old smoker who has been diagnosed with chronic pulmonary obstructive disease is most likely due to: A. an elevated hematocrit B. a decreased hematocrit C. vitamin K deficiency D. decreased thrombin activity

Correct Answer: A

Arterial blood that is collected in a heparinized syringe but exposed to room air would be most consistent with the changes in which of the following specimens? Specimen; PO2; PCO2; pH -A: elevated; decreased; elevated -B: decreased; elevated; decreased -C: unchanged; elevated; unchanged -D: decreased; decreased: decreased A. specimen A B. specimen B C. specimen C D. specimen D

Correct Answer: A

As the red blood cells disintegrate, hemoglobin is released and converted to the pigment bilirubin.Which organ is primarily responsible for this function? A. Spleen B. Kidneys C. Intestines D. Liver

Correct Answer: A

Aspartate amino transferase (AST) is characteristically elevated in disease of the: A. liver B. kidney C. intestine D. pancreas

Correct Answer: A

Aspirin affects platelet function by interfering with platelets' metabolism of: A. prostaglandins B. lipids C. carbohydrates D. nucleic acids

Correct Answer: A

Assay of transketolase activity in blood is used to detect deficiency of: A. thiamine B. folic acid C. ascorbic acid D. riboflavin

Correct Answer: A

Because of infertility problems, a physician would like to determine when a woman ovulates. The physician orders serial assays of plasma progesterone. From these assays, how can the physician recognize when ovulation occurs? A. After ovulation, progesterone rapidly increases. B. After ovulation, progesterone rapidly decreases. C. Rightbeforeovulation,progesterone rapidly increases. D. There is a gradual, steady increase in progesterone throughout the menstrual cycle.

Correct Answer: A

Biochemical abnormalities characteristic of polycythemia vera include: A. increased serum B12 binding capacity B. hypouricemia C. hypohistaminemia D. decreased leukocyte alkaline phosphatase activity

Correct Answer: A

Blood collected in EDTA undergoes which of the following changes if kept at room temperature for 6-24 hours? A. increased hematocrit and MCV B. increased ESR and MCV C. increased MCHC and MCV D. decreased reticulocyte count and hematocrit

Correct Answer: A

Blood specimens for digoxin assays should be obtained between 8 hours or more after drug administration because: A. tissue and serum levels need to reach equilibrium B. serum digoxin concentrations will be falsely low prior to 6 hours C. all of the digoxin is in the cellular fraction prior to 6 hours D. digoxin protein-binding interactions are minimal prior to 6 hours

Correct Answer: A

Blood was collected in a serum separator tube on a patient who has been fasting since midnight. The time of collection was 7 AM. The laboratory test wich should be recollected is: A. triglycerides B. iron C. LD D. sodium

Correct Answer: A

Bromcresol purple at a pH of 5.2 is used in a colorimetric method to measure: A. albumin B. globulin C. Bence Jonce protein D. immunoprotein

Correct Answer: A

Cells for the transport of O2 and CO2 are: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes

Correct Answer: A

Coulometry is often used to measure: A. chlorid ein sweat B. the pH in saliva C. bicarbonate in urine D. ammonia in plasma

Correct Answer: A

D-dimers are produced from: A. cross-linked and stabilized fibrin clot B. decreased fibrinogen and platelets C. plasminogen converting to plasmin D. generation of thrombin from endothelial cells

Correct Answer: A

Detection of which of the following substances is most useful to monitor the course of a patient with testicular cancer? A. alpha-fetoprotein B. carcinoembryonic antigen C. prolactin D. testosterone

Correct Answer: A

During chemotherapy for leukemia, which of the following analytes would most likely be elevated in the blood? A. Uric acid B. Urea C. Creatinine D. Ammonia

Correct Answer: A

Elevation of the lymphocyte percentage above 47% is termed: A. relative lymphocytosis B. absolute lymphocytosis C. leukocytosis D. absolue neutrophilic leukocytosis

Correct Answer: A

Evidence of active red cell regeneration may be indicated on a blood smear by: A. basophilic stippling, nucleated red blood cells and polychromasia B. hypochromia, microcytes and nucleated red blood cells C. hypochromia, basophilic stippling and nucleated red blood cells D. Howell-Jolly bodies, Cabot rings and basophilic stippling

Correct Answer: A

Factors that contribute to a PCO2 electrode requiring 60-120 seconds to reach equilibrium include the: A. difussion characteristics of the membrane B. actual blood PO2 C. type of calibrating standard (i.e. liquid or humidified gas) D. potential of the polarizing mercury cell

Correct Answer: A

Given the following results: -alkaline phsophatase: slight increase -aspartate amino transferase: marked increase -alanine amino transferase: marked increase -gamma-glutamyl transferase: slight increase This is most consistent with: A. acute hepatitis B. chronic hepatitis C. obstructive jaundice D. liver hamangioma

Correct Answer: A

Hemoglobin H disease results from: A. absence of 3 of 4 alpha genes B. absence of 2 of 4 alpha genes C. absence of 1 of 1 alpha genes D. absence of all 4 alpha genes

Correct Answer: A

Hemoglobin S can be separated form hemoglobin D by: A. electrophoresis on a different medium and acidic pH B. hemoglobin A2 quantitation C. electrophoresis at hight voltage D. Kleihauer-Betke acid elution

Correct Answer: A

Hemoglobin S can be separated from hemoglobin D by which of which of the following methods? A. agar gel electrophoresis at pH 5.9 B. thin-layer chromatography C. alkali denaturation D. ammonium precipitation

Correct Answer: A

Hemoglobin S is an abnormal hemoglobin that is characterized by a substitution of which amino acid? A. Valine for glutamic acid in position 6 on the beta chain B. Valine for glutamic acid in position 6 on the alpha chain C. Lysine for glutamic acid in position 6 on the beta chain D. Lysine for glutamic acid in position 6 on the alpha chain

Correct Answer: A

How is the majority of reverse T3 (rT3) made? A. Peripheral deiodination of T4 B. Peripheral deiodination of T3 C. From T3 in the thyroid gland D. From thyroglobulin in the thyroid gland

Correct Answer: A

IF the LDL-cholesterol is to be calculate by the Friedewald formula, what are the 2 measurements that need to be carried out by the same chemical procedure? A. total cholesterol and HDL-cholesterol B. total cholesterol and triglyceride C. triglyceride and chylomicrons D. apolipoprotein A and apolipoprotein B

Correct Answer: A

IN the immunoinhibition phase of CKMB procedure: A. M subunit is inactivated B. B subunit is inactivated C. MB is inactivated D. BB is inactivated

Correct Answer: A

Identification of which of the following is useful in early stages of glomerular dysfunction? A. Microalbuminuria B. Ketonuria C. Hematuria D. Urinary light chains

Correct Answer: A

If a blood gas specimen is left exposed to air, which of the following changes will occur? A. PO2 and pH increase; PCO2 decreases B. PO2 and pH decrease; PCO2 increases C. PO2 increases; pH and PCO2 decrease D. PO2 decreases; pH and PCO2 increase

Correct Answer: A

If elevated, which of the following is associated with increased risk for coronary heart disease? A. Homocysteine B. Vitamin B6 C. Myoglobin D. pro-BNP

Correct Answer: A

In a pH meter reference electrodes may include: A. silver-silver chloride B. quihydrone C. hydroxide D. hydrogen

Correct Answer: A

In a patient who is suspected of having pheochromocytoma, measurement of which of the following would be most useful? A. Metanephrine B. Homovanillic acid C. 5-Hydroxyindoleacetic acid D. Homogentisic acid

Correct Answer: A

In amniotic fluid, the procedure used to detect hemolytic disease of the newborn is: A. measurement of absorbance at 450 nm B. creatinine C. lecithin/sphingomyelin ratio D. estriol

Correct Answer: A

In amniotic fluid, the procedure used to determine fetal lung maturity is: A. lecithin/sphingomyelin ration B. creatinine C. measurement of absorbance at 450 nm D. alpha-fetoprotein

Correct Answer: A

In an electronic or laser particle cell counter, clumped platelets may interfere with which of the following parameters? A. white blood cell count B. red blood cell count C. hemoglobin D. hematocrit

Correct Answer: A

In bilirubin determinations, the purpose of adding a concentrated caffeine solution or methyl alcohol is to: A. allow indirect bilirubin to react with color reagent B. dissolve conjugated bilirubin C. precipitate protein D. prevent any change in pH

Correct Answer: A

In competitive inhibition of an enzyme reaction , the: A. inhibitor binds to the enzyme at the same site as does the substrate B. inhibitor often has a chemical structure different to that of the substrate C. activity of the reaction can be decreased by increasing the concentration of the substrate D. activity of the reaction can be increased by decreasing the temperature

Correct Answer: A

In familial hyperchlesterolemia, the hallmark finding is an elevation of: A. low-density lipoproteins B. chylomicrons C. high-density lipoproteins D. apolipoprotein A1

Correct Answer: A

In flow cytometric analysis, low angle or forward scatter of a laser light beam provides information that pertains to a cell's: A. volume B. viability C. granularity D. lineage

Correct Answer: A

In order to prepare 100 mL of 15 mg/dL BUN (5.35 mmol/L) working standard form a stock standard containing 500 mg/dL (178.5 mmol/L) of urea nitrogen, the number of mL of stock solution that should be used is: A. 3 mL B. 5 mL C. 33 mL D. 75 mL

Correct Answer: A

In polycythemia vera, the hemoglobin, hematocrit, red blood cell count and red cell mass are: A. elevated B. normal C. decreased

Correct Answer: A

In polycythemia vera, the leukocyte alkaline phosphatase activity is: A. elevated B. normal C. decreased

Correct Answer: A

In polycythemia vera, the platelet count is: A. elevated B. normal C. decreased D. variable

Correct Answer: A

In potentiometry, which of the following is considered the standard electrode? A. Hydrogen electrode B. Calcium electrode C. Potassium electrode D. Copper electrode

Correct Answer: A

In regard to bichromatic analysis,which of the following is false? A. Absorbance is measured at the spectral absorbance peak for a blank and the sample using the same wavelength. B. Eliminates background interferences C. Sample concentration determined from difference in two measured absorbances D. Functions as a reference blank for each sample

Correct Answer: A

In serum protein electrophoresis, when a barbital buffer of pH 8.6 is employed, what protein fraction will migrate the fastest toward the anode? A. Albumin B. Alpha1-globulin C. Beta-globulin D. Gamma-globulin

Correct Answer: A

In serum protein electrophoresis, when a buffer solution of pH 8.6 is used, which of the following characterizes the proteins? A. Exhibit net negative charge B. Exhibit net positive charge C. Exhibit charge neutrality D. Migrate toward the cathode

Correct Answer: A

In synovial fluid, the most characteristic finding in pseudogout is A. calcium pyrophosphate dihydrate crystals B. cartilage debris C. monosodium urate crystal D. hemosiderin-laden macrophages

Correct Answer: A

In the Jendrassik-Grof method for the determination of serum bilirubin concentration, quantitation is obtained by measuring the green color of: A. azobilirubin B. bilirubin glucuronide C. urobilin D. urobilinogen

Correct Answer: A

In the assay of lactate dehydrogenase (LD), the reaction is dependent upon which of the following coenzyme systems? A. NAD/NADH B. ATP/ADP C. Fe++/Fe+++ D. Cu/Cu++

Correct Answer: A

In the assay of lactate dehydrogenase, which of the following products is actually measured? A. NADH B. ATP C. lactic acid D. pyruvic acid

Correct Answer: A

In the condition kernicterus, the abnormal accumulation of bilirubin occurs in what tissue? A. Brain B. Liver C. Kidney D. Blood

Correct Answer: A

In what disorder would an increased percent saturation of transferrin be expected? A. Hemochromatosis B. Iron-deficiencyanemia C. Myocardial infarction D. Malignancy

Correct Answer: A

In what form is glucose stored in muscle and liver? A. Glycogen B. Maltose C. Lactose D. Starch

Correct Answer: A

In which of the following disease states is conjugated bilirubin a major serum component? A. biliary obstruction B. hemolysis C. neonatal jaundice D. erythroblastosis fetalis

Correct Answer: A

Increase concentration of alpha-fetoprotein (AFP) in adults are most characteristically associated with: A. hepatocellular carcinoma B. alcoholic cirrhosis C. chronic active hepatitis D. multiple myeloma

Correct Answer: A

Iniron-deficiencyanemia,whatwouldbe the expected percent saturation of transferrin with iron? A. Lessthan15 B. Between30and40 C. Between 40 and 50 D. Greater than 55

Correct Answer: A

Inwhatformmustadrugbeinorderto elicit a pharmacologic response? A. Free B. Boundtoalbumin C. Bound to globulins D. Bound to fatty acids

Correct Answer: A

Laboratory findings in hereditary spherocytosis do not include: A. decreased osmotic fragility B. increased autohemolysis corrected by glucose C. reticulocytosis D. shortened erythrocyte survival

Correct Answer: A

Low molecular weight heparin is monitored by a : A. anti-Xa assay B. APTT C. PT D. anti-IIa assay

Correct Answer: A

Mechanism of cortisol-induced neutrophilic includes: A. a shift in granulocytes from the marginating pool to the circulating pool B. an increased exit of granulocytes from the circulation C. a decrease exit of granulocytes from the bone marrow D. granulocyte return form the tissues to the circulating pool

Correct Answer: A

Night blindness is associated with deficiency of which of the following vitamins? A. A B. C C. niacin D. thiamine

Correct Answer: A

Nortriptyline is the active metabolite of which of the following drugs? A. Amitriptyline B. Desipramine C. Imipramine D. Doxepin

Correct Answer: A

Of the following disease, the one most often associate with elevations of lactate dehydrogenase isoenzymes 4 and 5 on electrophoresis is: A. liver disease B. hemolytic anemia C. myocardial infarction D. pulmonary edema

Correct Answer: A

Of the following, the disease most closely associated with cytoplasmic granule fusion is: A. Chediak-Higashi syndrome B. Pelger-Huet anomaly C. May-Hegglin anomaly D. Alder-Reilly anomaly

Correct Answer: A

Of the following, the disease most closely associated with glucocerebrosidase deficiency is: A. Gaucher disease B. Cheidak-Higashi syndrome C. Pelger-Huet anomaly D. May-Hegglin anomaly

Correct Answer: A

On a smear made directly from a finger stick, no platelets were found in the counting are. The first thing to do is: A. examine the slide for clumping B. obtain another smear C. perform a total platelet count D. request another finger stick

Correct Answer: A

On an electronic cell counter, hemoglobin determinations may be falsely elevated due to the presence of: A. lipemia or elevated bilirubin concentration B. a decreased WBC or lipemia C. an elevated bilirubin concentration or rouleaux D. rouleaux or lipemia

Correct Answer: A

Peripheral blood smears from patients with untreated pernicious anemia are characterized by: A. pancytopenia and macrocytosis B. leukocytosis and elliptocytosis C. leukocytosis and ovalocytosis D. pancytopenia and microcytosis

Correct Answer: A

Phenobarbital is a metabolite of: A. primidone B. phenytoin C. amobarbital D. secobarital

Correct Answer: A

Plasma for cortisol determinations were collected at 7 AM, after waking the patient, and at 10 PM that evening. The cortisol level of the morning sample was higher than the evening sample. This is consistent with: A. a normal finding B. Cushing syndrome C. Addison disease D. hypopituitarism

Correct Answer: A

Plasma from a patient with lupus coagulation inhibitor can show: A. a prolonged APTT and PT B. a prolonged thrombin time C. no change with platelet neutralization D. complete correction when incubated with normal plasma

Correct Answer: A

Platelet aggregation is dependent in vitro on the presence of: A. calcium ions B. sodium citrate C. thrombin D. potassium

Correct Answer: A

Platelet satellitosis is usually due to: A. abnormal proteins B. inadequate mixing of blood and anticoagulant C. hemorrhage D. poorly made wedge smear

Correct Answer: A

Prothrombin is: A. a protein formed by the liver in the presence of Vitamin K B. an enzyme that converts fibrinogen into fibrin threads C. the end product of the reaction between fibrinogen and thrombin D. a protein released by platelets during coagulation

Correct Answer: A

Refer to the following illustration: See BOC pg 126 Pic 1 The figure above shows the reciprocal of the measured velocity of an enzyme reaction plotted agains the reciprocal of the substrate concentration. True statements about this figure include: A. the intercept of the line on the ordinate (y-axis) can be used to calculate the Vmax B. the straight line indicates that the enzyme reaction proceeds according to zero order kinetics C. the intercept on the ordinate (y-axis) can be used to calculate the Michaelis-Menten constant D. the fact the substrate concentration is plotted on both sides of the zero point indicates that the reaction is reversible

Correct Answer: A

Refer to the following illustration: See BOC pg 161 Pic 2 Which electrophoresis pattern is consistent with sickle cell trait? A. pattern A B. pattern B C. pattern C D. pattern D

Correct Answer: A

Refer to the following pattern: See BOC pg 89 Pic 1 Patient values; Reference Values -Total Protein: 6.1 g/dL (61 g/L); 6.0-8.0 g/dL (60-80 g/L) -Albumin: 2.3 g/dL (23 g/L); 3.6-5.2 g/dL (36-52 g/L) -Alpha-1: 0.2 g/dL (2 g/L); 0.1-0.4 g/dL (1-4 g/L) -Alpha-2: 0.5 g/dL (5 g/L); 0.4-1.0 g/dL (4-10 g/L) -Beta: 1.2 g/dL (12 g/L); 0.5-1.2 g/dL (5-12 g/L) -Gamma: 1.9 g/dL (19 g/L); 0.6-1.6 g/dL (6-16 g/L) This pattern is consistent with: A. cirrhosis B. acute inflammation C. polyclonal gammopathy (eg, chronic inflammation) D. alpha-1 antitrypsin deficiency; severe emphysema

Correct Answer: A

Respiratory acidosis is described as a(n): A. increase in CO2 content and PCO2 with a decreased pH B. decrease in CO2 content with an increased pH C. increase in CO2 content with an increased pH D. decrease in CO2 content and PCO2 with a decreased pH

Correct Answer: A

Severe diarrhea causes: A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

Correct Answer: A

Specific (secondary) granules of the neutrophilic granulocyte: A. appear first at the myelocyte stage B. contain lysosomal enzymes C. are formed on the mitochondria D. are derived from azurophil (primary) granules

Correct Answer: A

Supravital staining is important for reticulocytes since the cells must be living in order to stain the: A. remaining RNA in the cell B. iron before it precipitates C. cell membrane before it dries out D. denatured hemoglobin in the cell

Correct Answer: A

The M:E ratio in polycythemia vera is usually: A. normal B. high C. low D. variable

Correct Answer: A

The Philadelphia chromosome is formed by a translocation between the: A. long arm of chromosome 22 and long arm of chromosome 9 B. long arm of chromosome 21 and long arm of chromosome 9 C. long arm of chromosome 21 and short arm of chromosome 6 D. long arm of chromosome 22 and short arm of chromosome 6

Correct Answer: A

The RDW-CV and RDW-SD performed by automated cells counters are calculations that provide: A. an index of the distribution of RBC volumes B. a calculated mean RBC hemoglobin concentration C. a calculate mean cell hemoglobin D. the mean RBC volume

Correct Answer: A

The absence of the Philadelphia chromosome in granulocytic leukemia suggests: A. rapid progression of the disease B. a polyclonal origin to the disease C. excellent response to therapy D. conversion form another myeloprofliferative disorder

Correct Answer: A

The buffer pH most effective at allowing amphoteric proteins to migrate toward the cathode in an electrophoretic system would be: A. 4.5 B. 7.5 C. 8.6 D. 9.5

Correct Answer: A

The cellulose acetate electrophoresisi at pH 8.6 of serum proteins will show an order of migration beginning with the fastest migration as follows: A. albumin, alpha-1 globulin, alpha -2 globulin, beta globulin, gamma globulin B. alpha-1 globulin, alpha-2 globulin, beta globulin, gamma globulin, albumin C. albumin, alpha-2 globulin, alpha -1 globulin, beta globulin, gamma globulin D. gamma globulin, beta globulin, alpha -2 globulin, alpha -1 globulin, albumin

Correct Answer: A

The chamber counting method of platelet enumerations: A. allows direct visualization of the particles being counted B. has a high degree of precision C. has a high degree of reproducibility D. is the method of choice for the performance of 50-60 counts per day

Correct Answer: A

The characteristic morphologic feature in folic acid deficiency is: A. macrocytosis B. target cells C. basophilic stippling D. rouleaux formation

Correct Answer: A

The different water content of erythrocytes and plasma makes true glucose concnetrations in whole blood a function of the: A. hematocrit B. leukocyte count C. erythrocyte count D. erythrocyte indices

Correct Answer: A

The erythrocyte sedimentation rate (ESR) can be falsely elevated by: A. tilting the tube B. refrigerated blood C. air bubbles in the column D. specimen being too old

Correct Answer: A

The expected blood gas results for a patient in chronic renal failure would match the patter of: A. metabolic acidosis B. respiratory acidosis C. metabolic alkalosis D. respiratory alkalosis

Correct Answer: A

The following data was obtained from a cellulose acetate protein electrophoresis scan: -albumin are: 75 units -gamma globulin are: 30 units -total area: 180 units -total protein: 6.5 g/dL (65 g/L) The gamma globulin content in g/dL is: A. 1.1 g/dL (11 g/L) B. 2.7 g/dL (27 g/L) C. 3.8 g/dL (38 g/L) D. 4.9 g/dL (49 g/L)

Correct Answer: A

The following laboratory data were obtained from a 27-year-old man with a long history of abnormal bleeding: -prothrombin time: normal -activated partial thromboplastin time: markedly prolonged -Factor VIII coagulant activity: markedly decreased -Factor VIII related antigen: normal -platelet count: normal -template bleeding time: normal Which of the following disorders does this man most likely have: A. classic hemophilia B. von Willebrand disease C. Christmas disease D. disseminated intravascular coagulation (DIC)

Correct Answer: A

The following laboratory results are obtained on a 60-year-old woman who is complaining of anorexia, constipation, abdominal pain, nausea, and vomiting: Ionized serum calcium—elevated Serum inorganic phosphate— decreased Urine calcium—elevated Urine phosphate—elevated What do these results suggest? A. Primary hyperparathyroidism B. Vitamin D deficiency C. Hypoparathyroidism D. Paget disease

Correct Answer: A

The following results were obtained on a 45-year-old man complaining of chills and fever: -WBC: 23.0 x 10/uL (23.0 x 10^9/L) -LAP: 200 -Philadelphia chromosome: negative Differential: -Segs: 60% -Band: 21% -Lymphs: 11% -Monos: 3% -Metamyelos: 2% -Myelos: 3% Toxic granulatioin, Dohle bodies and vacuoles A. neutrophilic leukemia reaction B. polycythemia vera C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis

Correct Answer: A

The following results were obtained: -urine creatinine: 90 mg/dL (7956 umol/L) -serum creatinine: 0.90 mg/dL (79.6 umol/L) -patient's total body surface: 1.73 m^2 (average =1.7 m^2) -total urine volume in 24 hours: 1500 mL Given the above date, the patient's creatinine clearance, in mL/min is: A. 104 B. 124 C. 144 D. 150

Correct Answer: A

The greatest activities of serum AST and ALT are seen in which of the following? A. acute viral hepatitis B. primary biliary cirrhosis C. metastatic hepatic cirrhosis D. alcoholic cirrhosis

Correct Answer: A

The laboratory findings on a patient are as follows: -MCV: 55um^3 (55 fL) -MCHC: 25% -MCH: 17 pg A stained blood film of this patient would most likely reveal a red cell picture that is: A. microcytic, hypochromic B. macrocytic, hypochromic C. normocytic, normochromic D. microcytic, normochromic

Correct Answer: A

The large nucleated cell in the lower right-hand side of the image below is a: See BOC pg 181 Pic 2 A. myelocyte B. metamyelocyte C. basophil D. plasma cell

Correct Answer: A

The majority of the iron in an adult is found as a constituent of: A. hemoglobin B. hemosiderin C. myoglobin D. transferrin

Correct Answer: A

The most characteristic morphologic features of atypical lymphocytes include: A. coarse nuclear chromatin and basophilic cytoplasm B. blue-grey cytoplasm, fine nuclear chromatin C. nucleoli and deep blue RNA-rich cytoplasm D. a stretched nucleus and cytoplasmic indentations

Correct Answer: A

The most common form of child hood leukemia is: A. acute lymphocytic B. acute granulocytic C. acute monocytic D. chronic granulocytic

Correct Answer: A

The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is: A. folic acid deficiency B. increased reticulocyte count C. inadequate B12 absorption D. pyridoxine deficiency

Correct Answer: A

The most potent plasminogen activator in the contact phase of coagulation is: A. kallikrein B. Streptokinase C. HMWK D. fibrinogen

Correct Answer: A

The most specific method for the assay of glucose utilizes: A. hexokinase B. glucose oxidase C. glucose-6-phosphatase D. glucose dehydrogenase

Correct Answer: A

The osmol gap is define as measure Osm/kg minus the calculate OSm/kg. Normally, the osmol gap is less than: A. 10 B. 20 C. 40 D. 60

Correct Answer: A

The osmolality of a urine or serum specimen is measured by a change in the A. freezing point B. sedimentation point C. midpoint D. osmotic pressure

Correct Answer: A

The photo-optical method of endpoint detection is described as: A. change in optical density as a result of a fibrin clot B. measurement of turbidity of antigen-antibody formation C. decreased motion of a mechanical ball D. color-producing chromophor

Correct Answer: A

The primary function of serum albumin in the peripheral blood is to: A. maintain colloidal osmotic pressure B. increase antibody production C. increase fibrinogen formation D. maintain blood viscosity

Correct Answer: A

The principle of confirmatory test for hereditary spherocytosis is: A. osmotic fragility B. sucrose hemolysis C. heat instability test D. Kleihauer-Betke

Correct Answer: A

The protein portion of an enzyme complex is called the: A. apoenzyme B. coenzyme C. holoenzyme D. proenzyme

Correct Answer: A

The protein that has the highest dye-binding capacity is: A. albumin B. alpha globulin C. beta globulin D. gamma globulin

Correct Answer: A

The screen for adrenal cortical hyperfunction with the greatest sensitivity and specificity is: A. 24-hour urine free cortisol B. plasma cortisol C. urinary 17-hydroxycorticosteroids D. plasma corticosterone

Correct Answer: A

The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in: A. EDTA B. oxalate C. citrate D. heparin

Correct Answer: A

The stain that selectively identifies phospholipid in the membranes of primary ad secondary granules within myeloid cells is: A. Sudan black B B. leukocyte alkaline phosphatase (LAP) C. periodic acid-Schiff (PAS) D. peroxidase

Correct Answer: A

To aid in the diagnosis of skeletal muscle disease, which of the following serum enzyme measurements would be of most use? A. Creatine kinase B. Alkaline phosphatase C. Aspartate aminotransferase D. Alanine aminotransferase

Correct Answer: A

To maintain acid-base balance, it is necessary that the blood ammonia level be kept within narrow limits. This is accomplished primarily by which of the following? A. Synthesis of urea from ammonia B. Synthesis of glutamine from ammonia C. Excretion of ammonia in the bile D. Excretion of ammonia in the stools

Correct Answer: A

Total glycosylated hemoglobin levels in a hemolysate reflect the: A. average blood glucose levels of the past 2-3 months B. average blood glucose levels for the past week C. blood glucose level at the time the sample is drawn D. hemoglobin A1C level at the time the sample is drawn

Correct Answer: A

Using automated coagulation instruments, duplication of normal test sis not longer appropriate because: A. the laboratory can document precision by collecting data to reflect precision performance B. all technologists on all shifts can be taught quality control C. it is difficult to have duplicates done in a blind fashion D. one technologist can monitor quality control

Correct Answer: A

Using the following data: Na+ = 143 mmol/L; K+ = 4.9 mmol/L; Cl" = 105 mmol/L; and HCO^ = 25 mmol/L, which of the following statements is false? A. Patient results are not acceptable. B. Anion gap is useful in detecting some disease states. C. Anion gap equals 18 mmol/L. D. Anion gap is useful for checking analytical error.

Correct Answer: A

What collective term encompasses the reduction products stercobilinogen, urobilinogen, and mesobilirubinogen? A. Urobilinogen B. Mesobilirubinogen C. Urobilin D. Bilirubin

Correct Answer: A

What effect would a low-salt diet, upright position, and diuretics have on the following test results? A. Renin inc, aldosterone inc, hypernatremia, hypokalemia B. Renin inc, aldosterone dec, hypernatremia, hypokalemia C. Renin dec, aldosterone dec, hyponatremia,hyperkalemia D. Renin dec, aldosterone inc, hyponatremia, hyperkalemia

Correct Answer: A

What endogenous substance may cause a positive interference in the urease/glutamate dehydrogenase assay? A. Ammonia B. Creatinine C. Glucose D. Cholesterol

Correct Answer: A

What is the MCH if the Hct is 20%, the RBC is 2.4 x 10^6/uL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)? A. 21 um^3 (21 fL) B. 23 um^3 (23 fL) C. 25 um^3 (25 fL) D. 84 um^3 (84 fL)

Correct Answer: A

What is the best method to diagnose lactase deficiency? A. H2 breath test B. plasma aldolase level C. LDH level D. D-xylose test

Correct Answer: A

What is the glucose concentration in fasting whole blood? A. Less than the concentration in plasma or serum B. Greater than the concentration in plasma or serum C. Equal to the concentration in plasma or serum D. Meaningless because it is not stable

Correct Answer: A

What is the predominant form of thyroid hormone in the circulation? A. Thyroxine B. Triiodothyronine C. Diiodotyrosine D. Monoiodotyrosine

Correct Answer: A

What is the recommended name for diphenylhydantoin? A. Phenytoin B. Nalorphine C. Primidone D. Carbamazepine

Correct Answer: A

What is the term that describes the sum of carbonic acid and bicarbonate in plasma? A. Total CO2 B. Standard bicarbonate C. Buffer base D. Base excess

Correct Answer: A

What technique is used to quantify specific immunoglobulin classes? A. Immunonephelometry B. Serum protein electrophoresis C. Isoelectric focusing D. Immunoelectrophoresis

Correct Answer: A

What term is used to describe the accumulation of bilirubin in the skin? A. Jaundice B. Hemolysis C. Cholestasis D. Kernicterus

Correct Answer: A

WhatwouldanindividualwithGushing syndrome tend to exhibit? A. Hyperglycemia B. Hypoglycemia C. Normal blood glucose level D. Decreased 2-hour postprandial glucose

Correct Answer: A

When measuring enzyme activity, if the instrument is operating 5°C lower than the temperature prescribed for the method, how will the results be affected? A. Lower than expected B. Higher than expected C. Varied, showing no particular pattern D. All will be clinically abnormal.

Correct Answer: A

When myocardial infarction occurs, the first enzyme to become elevated is: A. CK B. LD C. AST D. ALT

Correct Answer: A

When performing electrophoresis at pH 8.6, which hemoglobin molecule migrates the fastest on cellulose acetate toward the anode? A. A1 B. A2 C. F D. S

Correct Answer: A

When reviewing results on a Factor VIII the following results were obtained: -1:10=50% -1:20=77% -1:40=120% -1:80=127% This demonstrates the presence of a(n) A. inhibitor B. deficiency C. clot D. improper draw

Correct Answer: A

When the Jaffe reaction is employed as a kinetic assay to quantify serum creatinine, which of the following is used in the analysis? A. Serum sample used directly B. Folin-Wu filtrate C. Somogyi-Nelson filtrate D. Trichloroacetic acid filtrate

Correct Answer: A

When using an electronic cell counter, which of the following results can occur in the presence of a cold agglutinin? A. increased MCV and decreased RBC B. increased MCV and normal RBC C. decreased MCV and increased MCHC D. decreased MCV and RBC

Correct Answer: A

Which cell type shows the most intense staining with peroxidase? A. neutrophil B. basophil C. eosinophil (or lymphocyte) D. monocyte

Correct Answer: A

Which disorder is associated with thiamin deficiency? A. Beriberi B. Pellagra C. Rickets D. Dermatitis

Correct Answer: A

Which globin chains compose hemoglobin A1? A. Two alpha chains and two beta chains B. Two alpha chains and two delta chains C. Two alpha chains and two gamma chains D. Two beta chains and two delta chains

Correct Answer: A

Which glycoprotein binds with hemoglobin to facilitate the removal of hemoglobin by the reticuloendothelial system? A. Haptoglobin B. Ceruloplasmin C. a1-Antitrypsin D. Fibrinogen

Correct Answer: A

Which immunoglobulin class, characterized by its possession of a secretory component, is found in saliva, tears, and body secretions? A. IgA B. IgD C. IgG D. IgM

Correct Answer: A

Which is the most predominant buffer system in the body? A. Bicarbonate/carbonic acid B. Acetate/acetic acid C. Phosphate/phosphorous acid D. Hemoglobin

Correct Answer: A

Which of the following amino acids is associated with sulfhydryl group? A. cysteine B. glycine C. serine D. tyrosine

Correct Answer: A

Which of the following applies to cryoscopic osmometry? A. temperature at equilibrium is a function of the number of particles in solution B. temperature plateau for a solution is horizontal C. freezing point of a sample is absolute D. initial freezing of a sample produces an immediate solid state

Correct Answer: A

Which of the following are found in association with megaloblastic anemia? A. neutropenia and thrombocytopenia B. decreased LD activity C. increased erythrocyte folate levels D. decreased plasma bilirubin levels

Correct Answer: A

Which of the following carbohydrates is a polysaccharide? A. Starch B. Sucrose C. Lactose D. Glucose

Correct Answer: A

Which of the following cells is most likely identified in lesions of mycosis fungicides? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells

Correct Answer: A

Which of the following cells is the atypical lymphocyte seen on the peripheral blood smear of patients with infectious mononucleosis? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells

Correct Answer: A

Which of the following cells is the largest cell in the bone marrow: A. megakaryocyte B. histiocyte C. osteoblast D. mast cell

Correct Answer: A

Which of the following chromatography systems is characterized by a stationary phase of silica gel on a piece of glass and a moving phase of liquid? A. Thin-layer B. Ion-exchange C. Gas-liquid D. Partition

Correct Answer: A

Which of the following constituents normally present in serum must be chemically eliminated so that it will not interfere with the measurement of serum magnesium? A. Calcium B. Chloride C. Iron D. Potassium

Correct Answer: A

Which of the following defines the term "glycolysis"? A. Conversion of glucose into lactate or pyruvate B. Conversion of glucose to glycogen C. Break down of glycogen to form glucose D. Breakdown of lipids to form glucose

Correct Answer: A

Which of the following detects or measures platelet function? A. bleeding time B. prothrombin time C. thrombin time D. partial thromboplastin time

Correct Answer: A

Which of the following determinations is useful in prenatal diagnosis of open neural tube defects? A. amniotic fluid alpha-fetaprotein B. amniotic fluid estriol C. maternal serum estradio D. maternal serum estrone

Correct Answer: A

Which of the following disorders can be classified as a form of prehepatic jaundice? A. Acute hemolytic anemia B. Cirrhosis C. Dubin-Johnson syndrome D. Neoplasm of common bile duct

Correct Answer: A

Which of the following disorders is best characterized by laboratory findings that include increased serum levels of inorganic phosphorus, magnesium, potassium, uric acid, urea, and creatinine and decreased serum calcium and erythropoietin levels? A. Chronic renal failure B. Renaltubulardisease C. Nephroticsyndrome D. Acute glomerulonephritis

Correct Answer: A

Which of the following does not accu- rately describe direct bilirubin? A. Insoluble in water B. Conjugated in the liver C. Conjugated with glucuronic acid D. Excreted in the urine of jaundiced patients

Correct Answer: A

Which of the following does not accu- rately describe properties associated with lactate dehydrogenase? A. Optimum pH for the catalysis of lactate to pyruvate is 7.4-7.8. B. LD is increased in a hemolyzed serum specimen. C. LD catalyzes the oxidation of lactate to pyruvate with mediation of nicotinamide-adenine dinucleotide. D. LD-4 and LD-5 are labile in the cold.

Correct Answer: A

Which of the following drugs is used as a bronchodilator? A. Theophylline B. Phenytoin C. Amikacin D. Clozapine

Correct Answer: A

Which of the following enzymes are used in the diagnosis of acute pancreatitis? A. amylase (AMS) and lipase (LPS B. aspartate aminotransferase (AST) and alanine aminotransferase (ALT) C. 5'-nucleotide (5' N) and gamma-glutamyl transferase (GGT) D. aspartate aminotransferase (AST) and lactate dehydrogenase (LD)

Correct Answer: A

Which of the following factors is not relevant to therapeutic drug monitoring (TDM) of the aminoglycosides, antibiotics and vancomycin? A. intestinal absorption B. nephrotoxicity C. ototoxicity D. renal function

Correct Answer: A

Which of the following formulas is an expression of the Beer-Lambert law that is routinely applied to spectrophotometric analysis? A. Au x (Cs / As) = Cu B. Cu x (Cs/As)= Au C. As x (Cs/Cu) =Au D. A = 2 - log%T

Correct Answer: A

Which of the following functions as a transport protein for bilirubin in the blood? A. Albumin B. Alpha1-globulin C. Beta-globulin D. Gamma-globulin

Correct Answer: A

Which of the following hormones initiates its response by binding to cytoplasmic receptors? A. Estradiol B. Epinephrine C. Growth hormone D. Follicle-stimulating hormone

Correct Answer: A

Which of the following is a characteristic of Factor XII deficiency? A. negative bleeding history B. normal blotting times C. decreased risk of thrombosis D. epistaxis

Correct Answer: A

Which of the following is a copper transport protein that migrates as an alpha2-globulin? A. Ceruloplasmin B. Haptoglobin C. Transferrin D. Fibrinogen

Correct Answer: A

Which of the following is a glycolytic enzyme that catalyzes the cleavage of fructose-1, 6-diphosphate to glyceraldeyde-3-phosphate and dihydroxyacetone phosphate? A. aldolase B. phosphofructokinase C. pyruvate kinase D. glucose-6-phosphate dehydrogenase

Correct Answer: A

Which of the following is a sialylated Lewis blood group antigen associated with colorectal carcinoma? A. CA 19-9 B. CA 15-3 C. CA549 D. CEA

Correct Answer: A

Which of the following is a spectrophoto- metric method for quantifying serum chloride? A. Ferric perchlorate B. Ammonium molybdate C. Bathophenanthroline D. Cresolphthalein complexone

Correct Answer: A

Which of the following is an example of a long-acting barbiturate? A. Phenobarbital B. Amobarbital C. Secobarbital D. Pentobarbital

Correct Answer: A

Which of the following is associated with Chediak-Higashi syndrome? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. 2-lobed neutrophils D. mucopolysaccharidosis

Correct Answer: A

Which of the following is characteristic of Bernard-Soulier syndrome? A. giant platelets B. normal bleeding time C. abnormal aggregation with ADP D. increased platelet count

Correct Answer: A

Which of the following is characteristic of hemolytic jaundice? A. Unconjugated serum bilirubin level increased B. Urinary bilirubin level increased C. Urinary urobilinogen level decreased D. Fecal urobilin level decreased

Correct Answer: A

Which of the following is characterized by a deficiency of glucose-6-phosphatase resulting in hepatomegaly, lactic acidosis, and severe fasting hypoglycemia? A. Type I—von Gierke disease B. Type II—Pompedisease C. Type III—Cori disease D. Type IV—Andersen disease

Correct Answer: A

Which of the following is most closely associated with erythroleukemia? A. ringed sideroblasts, nuclear budding and Howell-Jolly bodies B. disseminated intravascular coagulation C. micromegakaryocytes D. lysozymuria

Correct Answer: A

Which of the following is most closely associated with idiopathic hemochromatosis? A. iron overload in tissue B. target cells C. basophilic stippling D. ringed sideroblasts

Correct Answer: A

Which of the following is most likely to be ordered in addition to serum calcium to determine the cause of tetany? A. magnesium B. phosphate C. sodium D. vitamin D

Correct Answer: A

Which of the following is not a colligative property of solutions? A. pH B. Freezing point C. Osmotic pressure D. Vapor pressure

Correct Answer: A

Which of the following is not a reagent required in an enzymatic serum glucose method? A. NAD+ B. Glucose oxidase C. Peroxidase D. Reduced chromogen

Correct Answer: A

Which of the following is not a typical finding in magnesium deficiency tetany? A. High serum phosphate level B. Normal serum calcium level C. Normal blood pH value D. Low serum potassium level

Correct Answer: A

Which of the following is not associated with vitamin B12? A. Insoluble in water B. Intrinsic factor C. Schilling test D. Pernicious anemia

Correct Answer: A

Which of the following is the formula for MCHC? A. (Hgb x 100)/ Hct B. Hgb/RBC C. RBC/Hct D. (Hct x 1000)/RBC

Correct Answer: A

Which of the following is the formula for manual white cell count? A. (number of cells counted x dilution x 10)/ number of squares counted B. (number of cells counted x dilution)/10 x number of squares counted C. number of cells counted x dilution D. number of cells counted x number of squares counted

Correct Answer: A

Which of the following is the major mineralocorticoid? A. Aldosterone B. Cortisol C. Corticosterone D. Testosterone

Correct Answer: A

Which of the following is true about direct ion selective electrodes for electrolytes? A. whole blood specimens are acceptable B. elevated lipids cause falsely decreased results C. elevated proteins cause falsely decreased results D. elevated platelets cause falsely increased results

Correct Answer: A

Which of the following is useful in the detection and management of carcinoma of the prostate? A. total prostate-specific antigen B. prostatic acid phosphatase C. human chorionic gonadotropin D. alpha-fetaprotein

Correct Answer: A

Which of the following lamps provides a continuous spectrum of radiant energy in the visible, near IR, and near UV regions of the spectrum? A. Tungsten-filament B. Hydrogen C. Deuterium D. Mercury vapor

Correct Answer: A

Which of the following lipid tests is least affected by the fasting status of the patient? A. Cholesterol B. Triglyceride C. Fatty acid D. Lipoprotein

Correct Answer: A

Which of the following may be associated with bioluminescence? A. Light emission produced due to enzymatic oxidation of a substrate B. Less sensitive than direct fluorescent assays C. Electron excitation caused by radiant energy D. Employs a radioactive label

Correct Answer: A

Which of the following may be associated with fluorescence polarization? A. Plane-polarized light is used for sample excitation. B. Small molecular complexes show a greater amount of polarization. C. It is a heterogeneous technique employed in fluorophore-ligand immunoassays. D. Polarized light detected is directly proportional to concentration of ligand in sample.

Correct Answer: A

Which of the following may be described as a variant form of LDL, associated with increased risk of atherosclerotic cardio- vascular disease? A. Lp(a) B. HDL C. ApoA-I D. ApoA-II

Correct Answer: A

Which of the following methods is susceptible to the solvent displacing effect that results in falsely decreased electrolyte values? A. indirect ion-selective electrodes B. direct ion-selective electrodes C. spectrophotometric D. fluorescence

Correct Answer: A

Which of the following platelet responses is most likely associated with classic von Willebrand disease? A. decreased platelet aggregation to ristocetin B. normal platelet aggregation to ristocetin C. absent aggregation to epinephrine, ADP and collagen D. decreased amount of ADP in platelets

Correct Answer: A

Which of the following reagents is not utilized in a coupled enzymatic reaction method to quantify serum creatinine? A. Picric acid B. Chromogenicdye C. Creatinine amidohydrolase D. Sarcosine oxidase

Correct Answer: A

Which of the following reagents is used in a colorimetric method to quantify the concentration of serum calcium? A. Cresolphthalein complexone B. Lanthanum C. Malachite green D. Amino-naphthol-sulfonic acid

Correct Answer: A

Which of the following represents a primary advantage of performing fluorometric over absorption spectroscopic methods of analysis? A. Increased specificity and increased sensitivity B. Increased specificity and decreased sensitivity C. Purity of reagents used not as critical D. Ease of performing assays

Correct Answer: A

Which of the following results is least consistent with a diagnosis of viral hepatitis? A. Seaim total bilirubin 7.5 mg/dL, direct bilirubin 5.5 mg/dL, indirect bilirubin 2.0 mg/dL B. Urine urobilinogen increased C. AST increased 10 times the upper limit of the reference range D. ALT increased 13 times the upper limit of the reference range

Correct Answer: A

Which of the following stains is closely associated with the lysosomal enzyme in primary (azurophilic) granules? A. peroxidase B. Sudan black B C. periodic acid-Schiff (PAS) D. Prussian blue

Correct Answer: A

Which of the following statements about carbonic anhydrase (CA) is true? A. Catalyzes conversion of CC>2 and F^O to HHCO3 in red blood cells B. Causes shift to the left in oxygen dissociation curve C. CatalyzesformationofH2CO3from CO2 and H2O in the tissues D. Inactive in renal tubular cells

Correct Answer: A

Which of the following statements best describes discrete analysis? A. Each sample-reagent mixture is handled separately in its own reaction vessel. B. Samples are analyzed in a flowing stream of reagent. C. Analyzer must be dedicated to measurement of only one analyte. D. It does not have random access capability.

Correct Answer: A

Which of the following statements is false about anodic stripping voltammetry (ASV)? A. Based on potentiometry B. Occurs in an electrochemical cell C. Involves preconcentration of the analyte by electroplating D. Used to measure lead

Correct Answer: A

Which of the following stimulates the production of singlet oxygen at the surface of the sensitizer particle in a luminescent oxygen channeling immunoassay? A. Radiant energy B. Heat energy C. Enzymatic reaction D. Fluorescent irradiation

Correct Answer: A

Which of the following techniques is based on electro-osmotic flow? A. Capillary electrophoresis B. Zone electrophoresis C. Iontophoresis D. Isoelectric focusing

Correct Answer: A

Which of the following techniques is more commonly used to measure vitamins? A. High-performance liquid chromatog- raphy B. Spectrophotometry C. Nephelometry D. Microbiological

Correct Answer: A

Which of the following tests would be particularly useful in determining isopropanolexposure? A. Serum osmolality and urine acetone B. Urine osmolality and serum osmolality C. Urine acetone and urine osmolality D. Serum sodium and serum acetone

Correct Answer: A

Which of the following tissues is important in vitaminD metabolism? A. Skin B. Spleen C. Pancreas D. Thyroid

Correct Answer: A

Which of the following will cause a shift of the oxygen dissociation curve to the right, resulting in a decreased affinity of hemoglobin for C"2? A. Low plasma pH level B. Low PCO2 level C. Low concentration of 2,3-bisphospho- glycerate D. Low temperature

Correct Answer: A

Which of the following would be elevated in the blood in medullary carcinoma of the thyroid? A. Calcitonin B. Thyroxine C. Catecholamines D. Secretin

Correct Answer: A

Which of the followingresults would be the most consistent with high risk for coronary heart disease? A. 20 mg/dL HDL cholesterol and 250 mg/dL total cholesterol B. 45 mg/dL HDL cholesterol and 210 mg/dL total cholesterol C. 50 mg/dL HDL cholesterol and 180 mg/dL total cholesterol D. 55 mg/dL HDL cholesterol and 170 mg/dL total cholesterol

Correct Answer: A

Which one of the following is a true statement about megakaryocytes in a bone marrow aspirate? A. an average of 5-10 should be found in each low power field (10X) B. majority of forms are the MK1 stage C. morphology must be determined from the biopsy section D. quantitative estimation is done using the 100 x oil immersion lens

Correct Answer: A

Which parameter is used in mass spectrometry to identify a compound? A. Ion mass-to-charge ratio B. Molecular size C. Absorption spectrum D. Retention time

Correct Answer: A

Zinc protoporphyrin or free erythrocyte protoporphyrin measurements are useful to assess blood concentrations: A. lead B. mercury C. arsenic D. berryllium

Correct Answer: A

125I has a physical half-life of 60.0 days. A sample today had activity of 10,000 CPM/mL. How many days form today will the count be 1250 CPM/mL? A. 60 B. 180 C. 240 D. 1250

Correct Answer: B

90% of the copper present in the blood is bound to: A. transferrin B. ceruloplasmin C. albumin D. cryoglobulin

Correct Answer: B

A 2-year-old child with a decreased serum T4 is described as being somewhat dwarfed, stocky, overweight, and having coarse features. Of the following, the most informative additional laboratory test would be the serum: A. thyroxine binding globulin (TBG) B. thyroid-stimulating hormone (TSH) C. triiodothyronine (T3) D. cholesterol

Correct Answer: B

A 20-year-old woman with sickle cell anemia whose usual hemoglobin concentration is 8 g/dL (80 g/L) develops fever, increased weakness and malaise. The hemoglobin concentration is 4 g/dL (40 g/L) and the reticulocyte count is 0.1%. The most likely explanation for her clinical picture is: A. increased hemolysis due to hypersplenism B. aplastic crisis C. thrombotic crisis D. occult blood loss

Correct Answer: B

A 24-year-old drug abuser is brought into the emergency department unconscious. He has shallow breaths, looks pale, and is "clammy." Blood gases show the following results: pH = 7.29, PCO2 = 50 mmHg, HCOs = 25 mmol/L .What condition is indicated by these results? A. Metabolic alkalosis,partially compensated B. Respiratory acidosis, uncompensated C. A dual problem of acidosis D. An error in one of the blood gas measurements

Correct Answer: B

A 30-year-old woman was admitted to the hospital for easy bruising and menorrhagia.Laboratory findings incuded the following: -WCB: 3.5 x 10^3/uL (3.5 x 10^9/L) -RBC: 2.48 x 10^6/uL (2.48 x 10^12/L) -Plt: 30 x10^3/uL (30.0 x 10^9/L) -Hgb: 8.6 g/dL (86 g/L) -Hct: 25.0% -MCV: 100.7 um^3 (100.7 fL) -MCH: 34.7 pg -MCHC: 34.3% -PT: 34.0 sec -APTT: 62.5 sec -TT: 15.0 sec -FSP: >40 ug/mL (>40 mg/L) -fibrinogen: 315 mg/dL (3.15 g/L) (control 200-400 mg/dL [2.0-4.0 g/L]) Differential: -Polys: 3% -Lymphs: % -Monos: 2% -Myelos: 4% -Abnormal immature: 58% -Blasts: 31% -nRBC: 1 Auer bodies, 1+ macrocytes, 1+ polychromasia The cells identified as "abnormal immature" were described as having lobulated nuclei with prominent nucleoli; the cytoplasm had intense azurophilic granulation over the nucleus, with some cells containing 1-20 Auer bodies, frequently grouped in bundles. A 15-17 chromosomal translocation was noted. Cells wereSBB, peroxidase and NAS-D-chloroacetate positive, PAS negative. Which of the following types of acute leukemia is most likely? A. myeloblastic B. promyelocytic C. myelomonocytic D. monocytic

Correct Answer: B

A 4-year-old male child is brought to the pediatrician because the parents are concerned about the child's frequent falling, which results in bruising. The parents indicate that the child has difficulty running, walking, standing up, climbing stairs, and even sitting up straight. The child also appears somewhat weak. Which of the following results is not consistent with the most likely diagnosis? A. Moderately elevated AST B. Moderately elevated ALP C. Moderately elevated LD D. Markedly elevated CK

Correct Answer: B

A 68-year-old male in an unconscious state is transported to the emergency department after being involved in a one-car crash, where he drove off the road and hit a tree. Because he was alone at the time and there was no apparent cause for the accident, it is assumed that he blacked out, which causedhim to lose control of the car. He was not wearing a seat belt and has a broken leg, multiple contusions, and cuts. Blood samples were drawn upon arrival to the ED and in 3-hour intervals for 12 hours; all control values were within acceptable range. Selected test results follow: Test; Initial Values; 3 hours; 9 hours; Reference Ranges -Myoglobin; 57 ng/mL; 140 ng/mL; 281 ng/mL; 30-90 ng/mL -Total CK; 112U/L; 170 U/L; 390 U/L; 15-160 U/L -CK-MB; 3 ng/mL; 6 ng/mL; 8 ng/mL; 0-5 ng/mL -Troponin I;0.10 ng/mL; 0.12 ng/mL; 0.11 ng/mL; <0.40 ng/mL What do these test results suggest? A. The man had a myocardial infarction, which caused the accident. B. The elevated results are from the skeletal muscle injuries sustained in the car crash. C. The elevated results are a combination of the car crash injuries and a myocardial infarction. D. The elevated total CK and CK-MB results indicate that the man had a stroke.

Correct Answer: B

A 89-year-old Caucasian female was transferred to the hospital from a nursing facility for treatment of chronic urinary tract infection with proteinuria. The patient presented with the following laboratory data: -WBC 10x10^3/uL -RBC 3.1x10^6/uL -Hgb 7.2 g/dL (72g/L) -Hct 24% -MCV 78um^3 (78fL) -MCH 23 pg -MCHC 31% -Serum iron: 29 ug/dL (5.2 umol/L) -TIBC: 160 ug/dL (28.6 umol/L) -serum ferritin: 100ng/mL These data are most consistent with which of the following conditions? A. iron deficiency anemia B. anemia of chronic inflammation C. hemochromatosis D. acute blood loss

Correct Answer: B

A 9-month-old boy from Israel has gradually lost the ability to sit up, and develops seizures. he has an increased amount of a phospholipid called GM2-ganglioside in his neurons, and he lacks the enzyme hexosaminidase A in his leukocytes. These findings suggest: A. Neimann-Pick disease B. Tay-Sachs disease C. phenylketonuria D. Hurler syndrome

Correct Answer: B

A breakdown product of hemoglobin is: A. lipoprotein B. bilirubin C. hematoxylin D. Bence Jones protein

Correct Answer: B

A cerebrospinal fluid specimen is sent to the lab at 9:00P.M. for glucose analysis. The specimen is cloudy and appears to contain red blood cells. Which of the following statements is true? A. Glucose testing cannot be performed on the specimen. B. Specimen should be centrifuged and glucose assayedimmediately. C. Specimen can be refrigerated as received and glucose assayed the next day. D. Specimen can be frozen as received and glucose assayed the next day.

Correct Answer: B

A citrated blood specimen for coagulation studies is to be collected rom a polycythemic patient. The anticoagulant should be: A. the standard volume B. reduced in volume C. changed to EDTA D. changed to oxalate

Correct Answer: B

A common source of interference in the cyanmethemoglobin method is: A. hemolysis B. very high WBC count C. cold agglutinins D. clumped platelets

Correct Answer: B

A condition in which erythrocyte protoporphyrin is increased is: A. acute intermittent porphyria B. iron deficiency anemia C. porphyria cutanea tarda D. acute porphyric attack

Correct Answer: B

A fasting serum sample form an asymptomatic 43-year-old woman is examined visually and chemically with the following results: -initial appearance of serum: milky -appearance of serum after overnight refrigeration: cream layer over turbid serum -triglyceride level: 2,000 mg/dL (22.6 mmol/L) -cholesterol level: 550 mg/dL (14.25 mmol/L) This sample contains predominantly: A. chylomicrons, alone B. chylomicrons and very low-density lipoproteins (VLDL) C. very low-density lipoproteins (VLDL) and low-density lipoproteins D. high-density lipoproteins (HDL)

Correct Answer: B

A healthy person with a blood glucose of 80 mg/dL (4.4 mmol/L) would have a simultaneously determined cerebrospinal fluid glucose value of: A. 25 mg/dL ( 1.4 mmol/L) B. 50 mg/dL (2.3 mmol/L) C. 100 mg/dL (5.5 mmol/L) D. 150 mg/dL (8.3 mmol/L)

Correct Answer: B

A hypercellular marrow with an M:E ration of 6:1 is most commonly due to: A. lymphoid hyperplasia B. granulocytic hyperplasia C. normoblastic hyperplasia D. myeloid hypoplasia

Correct Answer: B

A native of Thailand has a normal hemoglobin level. Hemoglobin electrophoresis on cellulose acetate shows 70% hemoglobin A and approximately 30% of a hemoglobin with the mobility of hemoglobin A2. This is most consistent with hemoglobin: A. C trait B. E trait C. O trait D. D trait

Correct Answer: B

A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely to be abnormal in this patient? A. platelet count B. template bleeding time C. prothrombin time D. activated partial thromboplastin time

Correct Answer: B

A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and shows a homogeneous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of: A. polycythemia vera B. systemic lupus erythematosus C. iron deficiency anemia D. hemoglobin SC disease

Correct Answer: B

A patient has the following thyroid profile: -total T4: decreased -free T4: decreased -thyroid peroxidase antibody: positive -TSH: decreased This patient most probably has: A. hyperthyroidism B. hypothyroidism C. a normal thyroid D. Graves disease

Correct Answer: B

A patient presents with a low Protein S activity, antigen and free antigen. The C4b binding protein is normal. This is classified as: A. no deficiency B. Type I C. Type II D. Type III

Correct Answer: B

A patient's serum inorganic phosphate level is found to be elevated but thephysician cannot determine a physiological basis for this abnormal result.What couldpossibly havecausedanerroneousresulttobe reported? A. Patient not fasting when blood was drawn B. Specimen was hemolyzed C. Effect of diurnal variation D. Patient receiving intravenous glucose therapy

Correct Answer: B

A patient's total cholesterol is 300mg/dL, his HDL cholesterol is 50 mg/dL, and his triglyceride is 200 mg/dL. What is this patient's calculated LDL cholesterol? A. 200 B. 210 C. 290 D. 350

Correct Answer: B

A phase-platelet count is performed using a platlet Unopette (dilution = 1:100). 155 platelets are counted on one side of the hemacytometer in the center square millimeter, and 145 are counted on the other side in the same are. After making the appropriate calculations, the next step would be to: A. repeat the procedure, using a 1:20 dilution with acetic acid B. report the calculated value C. collect a new specimen D. repeat the procedure, using a 1:200 dilution with saline

Correct Answer: B

A reciprocal relationship exists between: A. sodium and potassium B. calcium and phosphate C. chloride and CO2 D. calcium and magnesium

Correct Answer: B

A salicylate level is performed to detect toxicity caused by ingestion of excess: A. acetaminphen B. aspirin C. ibuprofen D. pseudoephedrine

Correct Answer: B

A screening test for paroxysmal nocturnal hemoglobinuria is: A. heat instability test B. sucrose hemolysis C. osmotic fragility D. dithionite solubility

Correct Answer: B

A serum sample demonstrates an elevated result when tested with the Jaffe reaction. This indicates; A. prolonged hypothermia B. renal functional impairment C. pregnancy D. arrhythmia

Correct Answer: B

A serum sample was assayed bilirubin at 10 am, and the result was 12 mg/dL (205.6 umol/L). The same sample was retested at 3 pm. The result now is 8 mg/dL (136.8 umol/L). The most likely explanation for this discrepancy is; A. the reagent has deteriorated B. the sample was exposed to light C. a calculation error in the first assay D. the sample was not refrigerated

Correct Answer: B

A total leukocyte count is 10.0 x 10^3/uL (10.0 x 10^9/L) and 25 NRBCs are seen per 100 leukocytes on the differential. What is the corrected leukocyte count? A. 2,000/uL (2.0 x 10^9/L) B. 8,000/uL (8.0 x 10^9/L) C. 10,000/uL (10.0 x 10^9/L) D. 12,000/uL (12.0 x 10^9/L)

Correct Answer: B

After absorption, codeine is rapidly metabolized to what compound? A. Phencyclidine B. Morphine C. Methadone D. Propoxyphene

Correct Answer: B

After the removal of red blood cells from the circulation hemoglobin is broken down into: A. iron, porphyrin, and amino acids B. iron, protoporphyrin, and globin C. heme, protoporphyrin, and amino acids D. heme, hemosiderin, and globin

Correct Answer: B

Aliquots of plasma with a prolonged PT and prolonged APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37 C and tested at 10-, 30-, and 60-minute intervals. The PT and APTT results on all of the mixtures are corrected. These results would indicated the presence of: A. circulating anticoagulant B. factor deficiency C. contaminated reagent D. antibodies

Correct Answer: B

All of the following conditions are myeloproliferative disorders except: A. myelocyic leukemia B. lymphocytic leukemia C. polycythemia vera D. idiopathic thrombocythemia

Correct Answer: B

Amino transferase enzymes catalyze the: A. exchange of amino groups and sulfhydryl groups between alpha-amino and sulfur-containing acids B. exchange of amino and keto groups between alpha-amino and alpha-keto acids C. hydrolysis of amino acids and keto acids D. reversible transfer of hydrogen form amino acids to coenzyme

Correct Answer: B

Amperometry is the principle of the: A. PCO2 electrode B. PO2 electrode C. pH electrode D. Ionized calcium electrode

Correct Answer: B

An anemic patient has an RBC of 2.70 x 10^6/uL (2.7 x 10^12) and a hemoglobin of 13.5 g/cL (135 g/L) as determined by an electronic particle counter. Which of the following is the best explanation for these results? A. electrical interference B. lipemia C. high anticoagulant to blood ratio D. a high coincidence rate

Correct Answer: B

An elevated level of which of the following hormones will inhibit pituitary secretion of adrenocorticotropic hormone (ACTH)? A. Aldosterone B. Cortisol C. 17p-Estradiol D. Progesterone

Correct Answer: B

An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is: A. lactate dehydrogenase deficiency B. G-6-PD deficiency C. pyruvate kinase deficiency D. hexokinase deficiency

Correct Answer: B

An increased amount of cytoplasmic basophilia in a blood cell indicates: A. increased cytoplasmic maturation B. decreased cytoplasmic maturation C. reduction in size of the cell D. decreased nuclear maturation

Correct Answer: B

Analysis of CSF for oligoclonal bands is used to screen for which of the following disease states? A. multiple myeloma B. multiple sclerosis C. myasthenia gravis D. von Willebrand disease

Correct Answer: B

Anepilepticpatientreceivingphenytoin develops acute glomerulonephritis. What change, if any, would be expected in the patient's circulating drug level? A. Decrease in free drug B. Increase in free drug C. Increase in protein-bound drug D. No change in circulating drug level

Correct Answer: B

As a reduction product of bilirubin catabolism, this compound is partially reabsorbed from the intestine through the portal circulation for reexcretion by the liver. What is this compound? A. Verdohemoglobin B. Urobilinogen C. Urobilin D. Biliverdin

Correct Answer: B

As a screening test for Gushing syndrome, the physician wishes to see whether a patient exhibits normal diurnal rhythm in his or her cortisol secretion. At what time should the specimens be drawn for plasma cortisol determination? A. 6 A.M., 2 P.M. B. 8 A.M.,4 P.M. C. 12 noon, 6 P.M. D. 12 noon, 12 midnight

Correct Answer: B

As part of a hyperlipidemia screening program, the following resutls were obtianed on a 25-year-old woman 6 hours after eating: -triglycerides: 260 mg/dL (2.86 mmol/L) -cholesterol: 120 mg/dL (3.12 mmol/L) Which of the following is the best interpretation of these results? A. both results are normal, and not affected by the recent meal B. cholesterol is normal, but triglycerides are elevated, which may be attributed to the recent meal C. both results are elevated, indicating a metabolic problem in addition to the nonfasting state D. both results are below normal despite the recent meal, indicating a metabolic problem

Correct Answer: B

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases? A. muscular dystrophy B. viral hepatitis C. pulmonary emboli D. infectious monoculeosis

Correct Answer: B

Aspartofaroutinephysical,afasting plasma glucose is performed on a 45-year- old male and the test result is 105 mg/dL. How should this individual be classified? A. Normal for his age B. Impaired fasting glucose C. Type 1diabetes mellitus D. Type 2 diabetes mellitus

Correct Answer: B

Assays for free T4 measure hormone not bound to thyroxine-binding prealbumin, thyroxine-binding globulin and: A. thyrotopin-releasing hormone B. albuminr C. free T3 D. thyroid-stimulating hormone

Correct Answer: B

At blood pH 7.40, what is the ratio fo bicarbonate to carbonic acid? A. 15:1 B. 20:1 C. 25:1 D. 30:1

Correct Answer: B

At what level should a 52-year-old male diagnosed with type 2 diabetes mellitus maintain his hemoglobin A1c? A. <3% B. <7% C. <9% D. <11%

Correct Answer: B

Auer bodies are: A. a normal aggregation of lysosomes or primary (azurophilic) granules B. predominately found in acute myelogenous leukemia C. perixidase negative D. alkaline phosphatase positive

Correct Answer: B

Auer rods: A. contain lactoferrin B. are lysosome and acid phosphatase-positive C. are found in the leukemic phase of lymphoma D. are found in acute lymphocytic leukemia

Correct Answer: B

Based on the following graph of velocity of an enzyme reaction versus substrate concentration, you are designing a new method to measure the activity of an enzyme of clinical interest. To formulate the new methodology so that enzyme activity is assessed using zero-order kinetics, which concentration of substrate should you initially determine experimentally? See SUCCESS pg 119 Pic 1 A. Substrate concentration a B. Substrate concentration b C. Substrate concentration c D. Substrate concentration d

Correct Answer: B

Below are the results of a protein electrophoresis: See BOC pg 94 Pic 2 These results are consistent with a(n): A. normal serum protein pattern B. normal CSF protein pattern C. abnormal serum protein pattern D. abnormal CSF protein pattern

Correct Answer: B

Blood PCO2 may be measured by: A. direct colorimetric measurement of dissolved CO2 B. a self-contained potentiometric electrode C. measurement of CO2-saturated hemoglobin D. measurement of CO2 consumed at the cathode

Correct Answer: B

Calcium concentration in the serum is regulated by: A. insulin B. parathyroid hormone C. thyroxine D. vitamin C

Correct Answer: B

Cerebrospinal fluid for glucose assay should be: A. refrigerated B. analyzed immediately C. heated to 56C D. stored at room temperature after centrifugation

Correct Answer: B

Clinical assays for tumor markers are most important for: A. screening for he presence of cancer B. monitoring the curse of a known cancer C. confirming the absence of disease D. identifying patients at risk for cancer

Correct Answer: B

Decreased serum iron associate with increased TIBC is compatible with which of the following disease states? A. anemia of chronic infection B. iron deficiency anemia C. chronic liver disease D. nephrosis

Correct Answer: B

Detection of carriers of hereditary coproporphyria should include analysis of: A. 24 hour urine for porphobilinogen B. fresh morning urine for delta-aminolevulinic acid C. erythrocyte protoporphyrin D. 24 hour urine for porphyrin

Correct Answer: B

Diabetes insipidus is associated with depressed secretion of which of the following hormones? A. Prolactin B. Anitdiuretic hormone C. Growth hormone D. Oxytocin

Correct Answer: B

During a normal pregnancy, quantitative human chorionic gonadotropin (HCG) levels peak how many weeks after the las menstrual period? A. 2-4 B. 8-10 C. 14-16 D. 18-20

Correct Answer: B

During pregnancy, the form of estrogen measured in urine is mostly: A. estrodiol B. estriol C. estrone D. pregnanediol

Correct Answer: B

Each lipoprotein fraction is composed of varying amounts of lipid and protein components. The beta-lipoprotein fraction consists primarily of which lipid? A. Fatty acid B. Cholesterol C. Phospholipid D. Triglyceride

Correct Answer: B

Erythropoietin acts to: A. shorten the replication time of the granulocytes B. stimulate RNA synthesis of erythroid cells C. increase colony-stimulating factors produced by the B-lymphocytes D. decrease the release of marrow reticulocytes

Correct Answer: B

Estrogen and progesterone receptor assays are useful in identifying patients who are likely to benefit form endocrine therapy to treat which of the following? A. ovarian cancer B. breast cancer C. endometriosis D. amenorrhea

Correct Answer: B

Evidence indicates that the genetic defect in thalassemia usually results in: A. the production of abnormal globin chains B. a quantitative deficiency in RNA resulting in decreased globin chain production C. a structural change in the heme portion of the hemoglobin D. an abnormality in the alpha- or beta- chain binding or affinity

Correct Answer: B

Factors commonly involved in producing anemia in patients with chronic renal disease include: A. marrow hypoplasia B. inadequate erythropoiesis C. vitam B12 deficiency D. increased erythropoietin production

Correct Answer: B

For assessing carcinoma of the prostate, quantification of PSA has virtually replaced the measurement of which of the following enzymes? A. Alkaline phosphatase B. Acid phosphatase C. Alanine aminotransferase D. Trypsin

Correct Answer: B

Free drug levels can generally be determined by analyzing what body fluid? A. Whole blood B. Ultrafiltrate of plasma C. Urine D. Protein-free filtrate of plasma

Correct Answer: B

Free erythrocyte protoporphyrin (FEP) levels are useful as a screening method for exposure to which of the following metals? A. Zinc B. Lead C. Iron D. Mercury

Correct Answer: B

Free therapeutic drug levels are usually higher when serum protein concentrations are below normal. In which of the following conditions would this most likely occur? A. acute inflammation B. nephrotic syndrome C. pregnancy D. mulitiple myeloma

Correct Answer: B

Given the following data: -WBC: 8.5 x 10^3/uL (8.5 x 10^9/L) Differential: -Segs: 56% -Bands: 2% -Lymphs: 30% -Monos:6% -Eos: 6% What is the absolute eosinophil count? A. 170/uL (0.17 x 10^9/L) B. 510/uL (0.51 x 10^9/L) C. 2,550/uL (2.55 x 10^9/L) D. 4,760/uL (4.76 x 10^9/L)

Correct Answer: B

Given the following information on a particular compound that has been visualized by means of thin-layer chromatography, calculate the Rf of the compound. -Distance from origin to spot center = 48 mm -Distance from spot center to solvent front = 93 mm -Distance from origin to solvent front = 141 mm A. 0.29 B. 0.34 C. 0.52 D. 0.66

Correct Answer: B

Given the following results; -alkaline phosphatase: slight increase -aspartate aminotransferase: slight increase -alanine aminotransferase: slight increase -gamma-glutamyl transferase: slight increase This is most consistent with: A. acute hepatitis B. chronic hepatitis C. obstructive jaundice D. liver hemangioma

Correct Answer: B

Hemophilia B is a sex-linked recessive disorder that presents with a decrease in Factor: A. VIII B. IX C. X D. XI

Correct Answer: B

Heparin induced thrombocytopenia (HIT) is an immune mediated complication associated with heparin therapy. Antibodies are produced against: A. ACLA B. PF4 C. AT D. B2GP1

Correct Answer: B

Heroin is synthesized from what drug? A. Diazepam B. Morphine C. Ecgonine D. Chlorpromazine

Correct Answer: B

How is primary hypocortisolism (Addison disease) differentiated from secondary hypocortisolism (of pituitary origin)? A. adrenal corticotropic hormone (ACTH) is decreased in pirmary and elevated in secondary B. adrenal corticotropic hormone (ACTH) is elevated is primary and decreased in secondary C. low aldosterone and hypoglycemia present with secondary hypocortisolism D. normal cortisol levels and blood pressure with primary hypocortisolism

Correct Answer: B

Hydrogen ion concentration (pH) in blood is usually determined by means of which of the following electrodes? A. silver B. glass C. platinum D. platinum-lactate

Correct Answer: B

Identificationoftheurinarymetabolite benzoylecgonine would be useful in determining exposure to which of the following drugs? A. Codeine B. Cocaine C. Amphetamine D. Propoxyphene

Correct Answer: B

If a WBC count is performed on a 1:10 dilution and the number of cells counted in 8 squares is 120, the total WBC count is: A. 1,200/uL (1.2 x 10^9/L) B. 1,500/uL (1.5 x 10^9/L) C. 12,000/uL (12.0 x 10^9/L) D. 15,000/uL (15.0 x 10^9/L)

Correct Answer: B

If a WBC count is performed on a 1:100 dilution and the number of cells counted in 8 squares is 50, the total WBC count is: A. 5,000/uL (5.0 x 10^9/L) B. 6,250/uL (6.25 x 10^9/L) C. 50,000/uL (50.0 x 10^9/L) D. 62,500/uL (22.3 x 10^9/L)

Correct Answer: B

If a blood smear is dried too slowly, the red blood cells are often: A. clumped B. crenated C. lysed D. destroyed

Correct Answer: B

If a fasting glucose was 90 mg/dL, which of the following 2-hour postprandial glucose results would most closely represent normal glucose metabolism? A. 25 mg/dL (1.4 mmol/L) B. 50 mg/dL (2.3 mmol/L) C. 180 mg/dL (5.5 mmol/L) D. 260 mg/dL (14.3 mmol/L)

Correct Answer: B

If a patient presents with a prolonged APTT that does not correct upon mixing, the next performed should be: A. Factor II B. DRVVT C. Factor VIII D. platelet count

Correct Answer: B

If the total bilirubin is 3.1 mg/dL ( 53.0 umol/L) and the conjugated bilirubin is 2.0 mg/dL (34.2 umol/L), the unconjugated bilirubin is: A. 0.5 mg/dL( 8.6 umol/L) B. 1.1 mg/dL ( 18.8 umol/L) C. 2.2 mg/dL (37.6 umol/L) D. 5.1 mg/dL (87.2 umol/L)

Correct Answer: B

In a pleural effusion caused by Streptococcus pneumoniae, the protein value of the pleural fluid as compared to the serum value would probably be: A. decreased by 2 B. decreased by 1/2 C. increased by 1/2 D. equal

Correct Answer: B

In a the Clauss fibrinogen method, the time to clot formation in plasma is measured after the addition of: A. calcium B. thrombin C. phospholipids D. kaolin

Correct Answer: B

In acute diabetic ketoacidosis, which of the following laboratory findings would be expected? A. Fasting blood glucose elevated, pH elevated, ketone bodies present B. Fasting blood glucose elevated, pH low, ketone bodies present C. Fasting blood glucose elevated, pH normal, ketone bodies absent D. Fasting blood glucose decreased, pH low, ketone bodies absent

Correct Answer: B

In acute pancreatitis, a significant increase in which serum enzyme would be expected diagnostically? A. Creatine kinase B. Amylase C. Alkaline phosphatase D. Aspartate aminotransferase

Correct Answer: B

In an automated cell counter, the WBC printed result is "+++". The next step is to: A. repeat after warming the sample to 37 C B. make an appropriate dilution of the sample C. recalibrate the machine from pooled samples D. request a new sample immediately

Correct Answer: B

In an electrolytic cell, which of the following is the half-cell where reduction takes place? A. Anode B. Cathode C. Combination electrode D. Electrode response

Correct Answer: B

In an uncomplicated case of infectious mononucleosis, which of the following cells are affected? A. erythrocytes B. lymphocytes C. monocytes D. thrombocytes

Correct Answer: B

In cases of hepatoma, which protein not normally found in adult serum is synthesized by liver cells? A. a1-Acid glycoprotein B. a1-Fetoprotein C. a2-Macroglobulin D. Carcinoembryonic antigen

Correct Answer: B

In electrophoresis of proteins, when the sample is placed in an electric field connected to a buffer of pH 8.6, all of the proteins: A. have a positive charge B. have a negative charge C. are electrically neutral D. migrate toward the cathode

Correct Answer: B

In immunophenotyping by flow cytometry the emitting fluorescence intensity is proportional to the: A. DNA content in the cell B. amount of cell surface antigen C. RNA content in the cell D. size of the cell nucleus

Correct Answer: B

In the United States, most cases of scurvy occur in children between the ages of 7 months to 2 years. Scurvy is a disease caused by a deficiency in which of the following? A. Vitamin A B. VitaminC C. Vitamin D D. Vitamin K

Correct Answer: B

In the assay of an enzyme, zero-order kinetics are best described by which of the following statements? A. Enzyme is present in excess; rate of reaction is variable with time and dependent only on the concentration of the enzyme in the system. B. Substrate is present in excess; rate of reaction is constant with time and dependent only on the concentration of enzyme in the system. C. Substrate is present in excess; rate of reaction is constant with enzyme concentration and dependent only on the time in which the reaction is run. D. Enzyme is present in excess; rate of reaction is independent of both time and concentration of the enzyme in the system.

Correct Answer: B

In the diacetyl method, what does diacetyl react with to form a yellow product? A. Ammonia B. Urea C. Uric acid D. Nitrogen

Correct Answer: B

In the fasting state, the arterial and capillary blood glucose concentration varies form the venous glucose concentration by approximately how many mg/dL (mmol/L)? A. 1 mg/dL (0.05 mmol/L) higher B. 5 mg/dL (0.27 mmol/L) higher C. 10 mg/dL (0.55 mmol/L) lower D. 15 mg/dL (0.82 mmol/L) lower

Correct Answer: B

In the hexokinase method for glucose determination, the actual end product measured is the: A. amount of hydrogenperoxide produced B. NADH produced from the reduction of NAD C. amount of glucose combined with bromcresol purple D. condensation of glucose with an aromatic amine

Correct Answer: B

In the image below, the small nucleated cell seen in the lower left corner is a: See BOC pg 182 Pic 1 A. polychromatophilic normoblast (rubricyte) B. mature lymphocyte C. plasma cell D. lymphoblast

Correct Answer: B

In the ultraviolet procedure for quantifying uric acid, what does the reaction between uric acid and uricase cause? A. Production of reduced nicotinamide- adenine dinucleotide (NADH) B. The formation of allantoin C. An increase in absorbance D. A reduction of phosphotungstic acid

Correct Answer: B

In the urea method, the enzymatic action of urease is inhibited when blood for analysis is drawn in a tube containing what anticoagulant? A. Sodium heparin B. Sodium fluoride C. Sodium oxalate D. Ethylenediaminetetra-acetic acid

Correct Answer: B

In what way is the "normal" population reference interval for total cholesterol in America different from that of other clin- ical chemistry parameters (i.e., protein, sodium, BUN, creatinine, etc.)? A. Established units for total cholesterol are mg/dL; no other chemistry test has these units. B. Reference interval is artificially set to reflect good health even though Americans as a group have "normally" higher total cholesterol levels. C. Total cholesterol reference interval must be interpreted in line with triglyceride, phospholipid, and sphingolipid values. D. Total cholesterol reference interval is based on a manual procedure, whereas all other chemistry parameters are based on automated procedures.

Correct Answer: B

In which of the following conditions would a normal level of creatine kinase be found? A. acute myocardial infarct B. hepatitis C. progressive muscular dystrophy D. intramuscular injection

Correct Answer: B

Increased numbers of basophils are often seen in: A. acute infections B. chronic myelocytic leukemia C. chronic lymphocytic leukemia D. erythroblastosis fettles (hemolytic disease of the newborn)

Correct Answer: B

Increased serum lactic dehydrogenase activity due to elevation of fast fractions (1 and 2) on electrophoretic separation is cause by: A. nephrotic syndrome B. hemolytic anemia C. pancreatitis D. hepatic damage

Correct Answer: B

Increased trough levels of aminoglyco- sides in the serum are often associated with toxic effects to which organ? A. Heart B. Kidney C. Pancreas D. Liver

Correct Answer: B

Ion-exchange chromatography separates solutes in a sample based on the A. Solubility of the solutes B. Sign and magnitude of the ionic charge C. Adsorption ability of the solutes D. Molecular size

Correct Answer: B

Kernicterus is an abnormal accumulation of bilirubin in: A. heart tissue B. brain tissue C. liver tissue D. kidney tissue

Correct Answer: B

Ketone bodies are formed because of an excessive breakdown of fatty acids. Of the following metabolites, which may be classified as a ketone body? A. Pyruvic acid B. B-Hydroxybutyric acid C. Lactic acid D. Oxaloacetic acid

Correct Answer: B

Laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? A. anemia of chronic disorder B. vitamin B12 deficiency C. iron deficiency D. acute heorrhage

Correct Answer: B

Laboratory tests that are designed to aid in the diagnosis of chronic granulomatous disease rely upon the detection of the detection of the activity of: A. MPO (myeloperoxidase) B. PHOX (phagocyte oxidase proteins) C. lysosomal protienases D. (G6PD) Glucose-6-phosphate dehydrognease

Correct Answer: B

Megaloblastic asynchronous development in the bone marrow indicates which one of the following? A. proliferation of erythrocyte precursors B. impaired synthesis of DNA C. inadequate production of erythropoietin D. deficiency of G-6-PD

Correct Answer: B

Mercury covered by a layer of mercurous chloride in contact with saturated potassium chloride solution is a description of which of the following types of electrodes? A. Sodium B. Calomel C. Calcium D. Silver/silver chloride

Correct Answer: B

Most automated blood gas analyzers directly measure: A. pH, HCO3 and % O2 saturation B. pH, PCO2 and PO2 C. HCO3, PCO2 and PO2 D. pH, PO2 and % O2 saturation

Correct Answer: B

Nephelometry is based on the measurement of light that is A. Absorbed by particles in suspension B. Scattered by particles in suspension C. Produced by fluorescence D. Produced by excitation of ground-state atoms

Correct Answer: B

Neutropenia is not usually associated with: A. viral infections B. Hodgkin disease C. select antibiotics D. chemotherapy

Correct Answer: B

Normal platelets have a circulating life-span of approximately: A. 5 days B. 10 days C. 20 days D. 30 days

Correct Answer: B

Of the following, the disease most closely associate with granulocyte hyposegmentation is: A. May-Hegglin anomaly B. Pelger-Huet anomaly C. Chediak-Higashi syndrome D. Gaucher disease

Correct Answer: B

On electrophoresis, transient bisalbuminemia or a grossly widened albumin zone is associated with: A. dirty applicators B. presence of therapeutic drugs in serum sample C. endomosis D. prestaining with tracer dye

Correct Answer: B

Once synthesized, the thyroid hormones are stored as a component of thyroglobulin in what area of the thyroid gland? A. Epithelial cell wall of the follicle B. Colloid in the follicle C. Isthmus of the thyroid gland D. Extracellular space of the thyroid gland

Correct Answer: B

Osmolal gap is the difference between: A. the ideal and real osmolality values B. calculated and measured osmolality values C. plasma and water osmolality values D. molality and molarity at 4C

Correct Answer: B

Patient presents with bleeding 48 hours post tooth extraction. Results are as follow: Test Patient Results Reference range: -PT: 11.5 sec 10-13 sec -APTT: 32.5 sec 23-35 sec -fibrinogen:345 mg/dL (3.45 g/L) 200-400 mg/dL (2.0-4.0 g/L) -platelets: 324 x 10^3/uL (324 x 10^9/L) 150-450 x 10^3/uL (150-450 x 10^9/L) Possible causes are a deficiency in: A. plasminogen B. Factor XIII C. alpha2 anti-plasmin D. Factor XII

Correct Answer: B

Phagocytosis is a function of: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes

Correct Answer: B

Plasma renin activity (PRA) measure- ments are usually made by measuring which of the following using immunoassay? A. Angiotensinogen B. AngiotensinI C. Angiotensin II D. Angiotensin-convertingenzyme

Correct Answer: B

Platelet activity is affected by: A. calcium B. aspirin C. hyperglycemia D. hypoglycemia

Correct Answer: B

Refer to the following graph: See BOC pg 109 Pic 1 The HCG levels shown in the above graph most probably represent: A. hydatidiform mole following miscarriage at 4 months B. normal pregnancy C. development of hydatidiform mole D miscarriage at 2 months with retained placenta

Correct Answer: B

Refer to the following illustration: See BOC pg 106 Pic 1 The class of phospholipid surfactants represented by the dotted line on the amniotic fluid analysis shown above is though to originate in what fetal organ system? A. cardiovascular B. pulmonary C. hepatic D. placental

Correct Answer: B

Refer to the following illustration: See BOC pg 205 Pic 1 Which are of the automated cell counter histogram indicates the lymphocyte curve? A. A B. B C. C D. D

Correct Answer: B

Refer to the following illustration: See BOC pg 205 Pic 2 Which area of the automated cell counter histogram indicates the nonlymphocyte curve? A. B B. C C. D D. E

Correct Answer: B

Refer to the following illustration: See BOC pg 90 Pic 1 Patient values; Reference Values -Total Protein: 7.8 g/dL (78 g/L); 6.0-8.0 g/dL (60-80 g/L) -Albumin: 3.0 g/dL (30 g/L); 3.6-5.2 g/dL (36-52 g/L) -Alpha-1: 0.4 g/dL (4 g/L); 0.1-0.4 g/dL (1-4 g/L) -Alpha-2: 1.8 g/dL (18 g/L); 0.4-1.0 g/dL (4-10 g/L) -Beta: 0.5 g/dL (5 g/L); 0.5-1.2 g/dL (5-12 g/L) -Gamma: 1.1 g/dL (11 g/L); 0.6-1.6 g/dL (6-16 g/L) The serum protein electrophoresis pattern is consistent with: A. cirrhosis B. acute inflammation C. polyclonal gammopathy (eg, chronic inflammation) D. alpha-1-antitrypsin deficiency; severe emphysema

Correct Answer: B

Refer to the following illustration: See BOC pg. 86 The serum protein electrophorsis patter shown below was obtained on cellulose acetate at pH 8.6 Identify the serum protein fraction on the left of the illustration. A. gamma globulin B. albumin C. alpha-1 globulin D. alpha-2 globulin

Correct Answer: B

Reverse phase high-performance liquid chromatography is being increasingly utilized in therapeutic drug monitoring. The term reverse phase implies that the column eluant is: A. pumped up the column B. more polar than the stationary phase C. always nonpolar D. less polar than the stationary phase

Correct Answer: B

Scurvy is associated with deficiency of which fo the following vitamins? A. A B. C C. niacin D. thiamine

Correct Answer: B

Serial bilirubin determination are charted below. Day; Collected; Assayed; Result 1: 7 am; 8 am; 14.0 mg/dL (239.4 umol/L) 2; 7 am; 6 pm; 9.0 mg/dL (153.9 umol/L) 3: 6 am; 8 am; 15.0 mg/dL (256.5 umol/L) The best explanation for the results is: A. sample hemolysis and hemoglobin deterioration B. sample exposure to light C. sample left in warm location D. reagent deterioration

Correct Answer: B

Serum from a patient with metastatic carcinoma of the prostate was separated form the clot and stored at room temperature. The following results were obtained: Patient value; Reference range -Ca++: 10.8 mg/dL (2.7 mmol/L); 8.8-10.3 mg/dL (2.2-2.6 mmol/L) -LD: 420 U/L; 50-150 U/L -acid phosphatase: 0.1 U/L; 0-5.5 U/L The technician should repeat the: A. LD using dilute serum B. acid phosphatase with freshly drawn serum C. LD with fresh serum D. test using plasma

Correct Answer: B

Serum levels that define hypoglycemia pre-term or low birth with infants are: A. the same as adults B. lower than adults C. the same as a normal full-term infant D. higher than a normal full-term infant

Correct Answer: B

Several malabsorption problems are characterized by a condition known as steatorrhea. Steatorrhea is caused by an abnormalaccumulationofwhatsubstance in the feces? A. Proteins B. Lipids C. Carbohydrates D. Vitamins

Correct Answer: B

Sodium determination by indirect ion selective electrode is falsely decreased by A. elevated chloride levels B. elevated lipid levels C. decreased protein levels D. decreased albumin levels

Correct Answer: B

Specimen for blood gas determination should be drawn into a syringe containing: A. no preservative B. heparin C. EDTA D. oxalate

Correct Answer: B

THC (delta triangle 9-tetrahydrocannabinol) is the principal active component of what drug? A. Benzodiazepine B. Marijuana C. Morphine D. Codeine

Correct Answer: B

TSH is produced by the: A. hypothalamus B. pituitary gland C. adrenal cortex D. thyroid

Correct Answer: B

Technical problems encountered during the collection of an amniotic fluid specimen caused doubt as to whether the specimen was amniotic in origin. Which 1 of the following procedures would best establish that the fluid is amniotic in origin? A. measurement of absorbance at 450 nm B. creatinine measurement C. lecithin/sphingomyelin ration D. human amniotic placental lactogen (HPL)

Correct Answer: B

The M:E ratio in acute myelocytic leukemia is usually: A. normal B. high C. low D. variable

Correct Answer: B

The M:E ratio in chronic myeloctyic leukemia is usually: A. normal B. high C. low D. variable

Correct Answer: B

The Prussian blue staining of peripheral blood identifies: A. Howell-Jolly bodies B. siderotic granules C. reticulocytes D. basophilic stippling

Correct Answer: B

The anemia of chronic infection is charaterized by: A. decreased iron stores in the reticuloendothelial system B. decreased serum iron levels C. macrocytic erythrocytes D. increased serum iron binding capacity

Correct Answer: B

The anticoagulant of choice for routine coagulation procedures is: A. sodium oxalate B. sodium citrate C. herapin D. sodium fluoride

Correct Answer: B

The atypical lymphocyte seen in the peripheral smear of patients with infectious mono is probably derived form which of the following? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells

Correct Answer: B

The best test to determine if a sample is contaminated with heparin is: A. fibrinogen B. thrombin time C. prothrombin time D. stypven time

Correct Answer: B

The cell series most readily identified by a positive Sudan black B is: A. erythrocytic B. myelocytic C. plasmacytic D. lymphocytic

Correct Answer: B

The cells seen in the image below are most consistent with: See BOC pg 182 Pic 2 A. chronic myelogenous leukemia B. infectious mononucleosis C. acute lymphocytic leukemia D. Sezary syndrome

Correct Answer: B

The characteristic peripheral blood morphologic feature in multiple myeloma is: A. cytotoxic T cells B. rouleaux formation C. sherocytosis D. macrocytosis

Correct Answer: B

The creatinine clearance (mL/min) is equal to: A. urinary creatinine (mg/L)/[volume of urine (mL/min) x plasma creatinine (mg/L)] B. [urinary creatinine (mg/L) x volume (mL/min)] / plasma creatinine (mg/L) C. urinary creatinine (mg/L) / [volume of urine (mL / hour) x plasma creatinine (mg/L) D. [urinary creatinine (mg/L) x volume (mL/hour)] / plasma creatinine (mg/L)

Correct Answer: B

The cytoplasmic abnormality of the blood cell of Alder-Reilly anomaly is found in the: A. endoplasmic reticulum B. lysosomes C. mitochondria D. ribosomes

Correct Answer: B

The direction in which albumin migrates (ie, toward anode or cathode) during electrophoretic separation of serum proteins, at pH 8.6, is determined by: A. the ionization of the amine groups, yielding a net positive charge B. the ionization of the carboxyl groups, yielding a net negative charge C. albumin acting as a switterion D. the density of the gel layer

Correct Answer: B

The disease most frequently present in patients with atypical lymphocytosisi and persistently negative tests is: A. toxoplasmosis B. cytomegalovirus (CMV) infection C. herpes virus infection D. viral hepatitis

Correct Answer: B

The electrical resistance method of cell counting requires: A. equal-sized particles B. a conductive liquid C. 2 internal electrodes for current D. 3apertures for counting

Correct Answer: B

The electrophoretic pattern of plasma sample as compared to a serum sample shows a: A. broad prealbumin peak B. sharp fibrinogen peak C. diffuse pattern because of the presence of anticoagulants D. decreased globulin fraction

Correct Answer: B

The following are compounds formed in the synthesis of heme: 1. coproporphyrinogen 2. porphobilinogen 3. uroporphyrinogen 4. protoporphyrinogen A. 4,3,1,2 B. 2,3,1,4 C. 4,2,3,1 D. 2,1,3,4

Correct Answer: B

The following laboratory data were obtained from a 40-year-old woman with a long history of abnormal bleeding: -prothrombin time: normal -activated partial thromboplastin time: prolonged -Factor VIII-coagulant activity: decreased -Factor VIII-related antigen: markedly decreased -platelet count: normal -template bleeding time: prolonged Which of the following disorders does this woman most likely have: A. Classic hemophilia B. von Willebrand disease C. Christmas disease D. Disseminated intravascular coagulation (DIC)

Correct Answer: B

The following laboratory results are determined on a patient with a suggested diagnosis of biliary obstruction: Serum total bilirubin—increased Serum conjugated bilirubin—normal Urine bilirubin—increased Fecal urobilin—decreased Which laboratory result is the least consistent with such a diagnosis? A. Serum total bilirubin B. Serum conjugated bilirubin C. Urine bilirubin D. Fecal urobilin

Correct Answer: B

The following laboratory results were obtained: Serum electrolytes -sodium: 136 mEq/L (136 mmol/L) -potassium: 4.4 mEq/L (4.4 mmol/L) -chloride: 92 mEq/L (92 mmol/L) -bicarbonate: 40 mEq/L (40 mmol/L) Arterial blood -pH: 7.32 -PCO2: 79 mm Hg These results are most compatible with: A. respiratory alkalosis B. respiratory acidosis C. metabolic alkalosis D. metabolic acidosis

Correct Answer: B

The following results were obtained on an electronic particle counter: -WBC: 6.5 x 10^3/uL (6.5 x 10^9/L) -RBC: 4.55 x 10^6/uL (4.55 x 10^12/L) -Hgb: 18.0 g/dL (180 g/L) -Hct: 41.5% -MCV: 90.1 um^3 (90.1 fL) -MCH: 39.6 pg -MCHC: 43.4% The first step in obtaining valid results is to: A. perform a microhematocrit B. correct the hemoglobin for lipemia C. dilute the blood D. replace the lysing agent

Correct Answer: B

The following results were obtained on an electronic particle counter: -WBC: 61.3 x 10^3/uL (61.3 x 10^9/L) -RBC: 1.19 x 10^6/uL (1.19 x 10^12/L) -Hgb: 9.9 g/dL (99 g/L) -Hct: 21% -MCV: 125 um^3 (125 fL) -MCHC: 54.1% What action should be take to obtain accurate results? A. dilute the specimen and recount B. warm the specimen and recount C. check the tube for clots D. clean the aperture tubes and recount

Correct Answer: B

The follwoing results were obtained on a 55-year-old man complaining of headaches and blurred vision: -WBC: 19.0 x 10^3/uL (19.0 x 10^9/L) -RBC: 7.2 x 10^6/uL (7.2 x 10^12/L) -Plt: 1,056 x 10^3/uL (1056 x 10^9/L) -Uric acid: 13.0 mg/dL (0.76 mmol/L) -O2 saturation: 93% -Rh1: negative -Red cell volume: 3,911 mL (normal =1,600) Differential: -Segs: 84% -Bands: 10% -Lymphs: 3% -Monos: 2%: -Eos: 1% These results are consistent with: A. neutrophilic leukemoid reaction B. polycythemia vera C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis

Correct Answer: B

The hypoproliferative red cell population in the bone marrow of uremic patients is caused by: A. infiltration of bone marrow by toxic waste products B. decreased levels of circulating erythropoietin C. defective globin synthesis D. overcrowding of bone marrow space by increased myeloid precursors

Correct Answer: B

The illustration below represents a Lineweaver-Burk plot of 1/v vs 1/[S] is an enzyme reactions and the following assumptions should be made: See BOC pg. 126 pic 2 -The enzyme concentration was the same for reactions A and B -The enzyme concentration was in excess for reactions A and B -Reaction A occurred under ideal conditions Which of the following statements about reaction B is true? A. it illustrates noncompetitive inhibition B. it illustrates competitive inhibition C. it illustrates neither competitive nor noncompetitive inhibition D. is could be the result of heavy metal conamination

Correct Answer: B

The laboratory receives a request that assays for urinary aminolevulinic acid, porphobilinogen, uroporphyrin, and coproporphyrin are to be performed on a patient. Which of the following will not contribute to the integrity of the sample when these assays are performed on the same urine specimen? A. Refrigeration B. Addition of hydrochloric acid C. 24-hour urine collection D. Use of a brown bottle

Correct Answer: B

The large cell in the center of the image would e best described as a(n): See BOC pg. 183 Pic 1 A. neutrophil B. basophil C. eosinophil D. myelocyte

Correct Answer: B

The main function of the hexose monophosphate shunt in the erythrocyte is to: A. regulate the level of 2,3-DPG B. provide reduced glutathione to prevent oxidation of hemoglobin C. prevent the reduction of heme iron D. provide energy for membrane maintenance

Correct Answer: B

The major action of angiotensin II is: A. increased pituitary secretion of vasopressin B. increased vasoconstriction C. increased parathromone secretion by the parathyroid D. decreased adrenal secretion fo aldosterone

Correct Answer: B

The measurement of CO2 in blood by means of a PCO2 electrode is dependent on the A. Passage of H+ ions through the membrane that separates the sample and the electrode B. Change in pH because of increased carbonic acid in the electrolyte surrounding the electrodes C. Movement of bicarbonate across the membrane that separates the sample and the electrode D. Linear relationship between PCO2 in the sample and measured pH

Correct Answer: B

The measurement of oxygen in blood by means of a PO2 electrode involves which of the following? A. Wheatstone bridge arrangement of resistive elements sensitive to oxygen concentration B. Direct relationship between amount of oxygen in the sample and amount of current flowing in the measuring system C. Change in current resulting from an increase of free silver ions in solution D. Glass electrode sensitive to H+ ions

Correct Answer: B

The most appropriate screening test for hemoglobin S is: A. Kleihauer-Betke B. dithionite solubility C. osmotic fragility D. sucrose hemolysis

Correct Answer: B

The most common cause of error when using automated cell counters is: A. contamination of the diluent B. inadequate mixing of the sample prior to testing C. variation in voltage of the current supply D. a calibrating error

Correct Answer: B

The most heat labile fraction of alkaline phosphatase is obtained form A. liver B. bone C. intestine D. placenta

Correct Answer: B

The presence of a very high titer for antithyroglobulin antibodies and the detection of antithyroid peroxidase antibodies is highly suggestive of what disorder? A. Pernicious anemia B. Hashimoto thyroiditis C. Multinodular goiter D. Thyroid adenoma

Correct Answer: B

The presence of excessive rouleaux formation on a blood smear is often accompanied by increased: A. reticulocyte count B. sedimentation rate C. hematocrit D. erythrocyte count

Correct Answer: B

The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following electrolytes? A. Sodium B. Potassium C. Chloride D. Bicarbonate

Correct Answer: B

The presence of which of the following isoenzymes indicates acute myocardial damage? A. CKMM B. CKMB C. CKBB D. none

Correct Answer: B

The properties of enzymes are correctly described by which of the following statements? A. Enzymes are stable proteins. B. Enzymes are protein catalysts of biological origin. C. Enzymes affect the rate of a chemical reaction by raising the activation energy needed for the reaction to take place. D. Enzyme activity is not altered by heat denaturation.

Correct Answer: B

The recommended initial thyroid function test for either a healthy, asymptomatic patient or a patient with symptoms which may be related to a thyroid disorder is: A. free thyroxine (free T4) B. thyroid-stimulating hormone (TSH) C. total thyroxine (T4) D. triiodothyronine (T3)

Correct Answer: B

The regulation of calcium and phosphorous metabolism is accomplished by which of the following glands? A. thyroid B. parathyroid C. adrenal glands D. pituitary

Correct Answer: B

The smear represented below displays: See BOC page 157 A. congenital ovalocytosis B. hemoglobin C disease C. poor RBC fixation D. delay in smear preparation

Correct Answer: B

The solute that contributes the most to the total serum osmolality is: A. glucose B. sodium C. chloride D. urea

Correct Answer: B

The substance that is measured to estimate the serum concentration of triglycerides by most methods is: A. phopholipids B. glycerol C. fatty acids D. pre-beta lipoprotein

Correct Answer: B

The term "lipid" encompasses a wide variety of compounds characterized as being insoluble in water but soluble in nonpolar solvents. Which of the following vitamins is not classified as fat soluble? A. VitaminA B. Vitamin C C. Vitamin D D. Vitamin E

Correct Answer: B

The term "shift to the left" refers to: A. a microscope adjustment B. immature cell forms in the peripheral blood C. a trend on a Levy-Jennings chart D. a calibration adjustment on an instrument

Correct Answer: B

The troponin complex consists of: A. troponin T, calcium an d tropomyosin B. troponin C, troponin I and troponin T C. troponin I, actin, and tropomyosin D. troponin C, myoglobin, and actin

Correct Answer: B

Thephysiciandeterminedthatthepatient needed an oral glucose tolerance test (OGTT) to assist in diagnosis. The patient had blood drawn for the OGTT, and the following serum glucose results were obtained. These results are indicative of what state? Fasting serum glucose 124 mg/dL 2-hour postload serum glucose 227mg/dL A. Normal B. Diabetes mellitus C. Addison disease D. Hyperinsulinism

Correct Answer: B

Thyroid-releasing hormone (TRH) is given to a patient. Serum thyroid-stimulating hormone (TSH) levels are taken before and after the injection, and the values are the same—low. This patient probably has which of the following disorders? A. Primary hypothyroidism B. Secondary hypothyroidism C. Tertiary hypothyroidism D. Iodine deficiency

Correct Answer: B

To maintain a pH of 7.4 in plasma, it is necessary to maintain a A. 10:1 ratio of bicarbonate to carbonic acid B. 20:1 ratio of bicarbonate to carbonic acid C. 1:20 ratio of bicarbonate to carbonic acid D. 20:1 ratio of carbonic acid to bicar- bonate

Correct Answer: B

To quantify serum bilirubin levels, it is necessary that bilirubin couples with diazotized sulfanilic acid to form what complex? A. Verdobilirubin B. Azobilirubin C. Azobilirubinogen D. Bilirubin glucuronide

Correct Answer: B

To what metal does ceruloplasmin firmly bind? A. Chromium B. Copper C. Zinc D. Iron

Correct Answer: B

Upon development of a thin-layer chromatogram for drug analysis all drug spots (including the standards) had migrate with the solvent front. The most probable cause for this would be: A. environmental temperature too warm B. incorrect aqueous to nonaqueous solvent mixture C. too much sample applied D. chromatogram dried to quickly

Correct Answer: B

Using a supra vital stain, the polychromatic red blood cells below would probably be: See BOC page 156 A. rubricytes (polychromatophilic normoblast) B. retibulocytes C. sickle cells D. target cells

Correct Answer: B

What battery of tests if most useful in evaluating an anion gap of 22 mEq/L (22 mmol/L)? A. Ca++, Mg++, PO-4, and pH B. BUN, creatinine, salicylate and methanol C. AST, ALT, LD and amylase D. glucose, CK, myoglobin and cryoglobulin

Correct Answer: B

What breakdown product of bilirubin metabolism is produced in the colon from the oxidation of urobilinogen by micro- organisms? A. Porphobilinogen B. Urobilin C. Stercobilinogen D. Protoporphyrin

Correct Answer: B

What compound is a crucial intermediary in the metabolism of triglyceride to form energy? A. Bile B. Acetyl-coenzyme A C. Acetoacetate D. Pyruvate

Correct Answer: B

What effect if any would be expected when the secretion of epinephrine is stimulated by physical or emotional stress? A. Decreased blood glucose level B. Increased blood glucose level C. Increased glycogen storage D. No effect on blood glucose or glycogen levels

Correct Answer: B

What is the MCHC if the Hct is 20%, the RBC is 1.5 x 10^6/uL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)? A. 28% B. 30% C. 40% D. 75%

Correct Answer: B

What is the MCHC if the Hct is 20%, the RBC is 2.4 x 10^6/uL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)? A. 21% B. 25% C. 30% D. 34%

Correct Answer: B

What is the MCV if the hematocrit is 20%, the RBC is 2.4 x 10^6/uL (2.4 x 10^12/L) and the hemoglobin is 5 g/dL (50 g/L)? A. 68 pg B. 83 pg C. 100 pg D. 120 pg

Correct Answer: B

What is the anticoagulant of choice for blood gas analysis? A. EDTA B. Heparin C. Sodium fluoride D. Citrate

Correct Answer: B

What is the end product of purine catabolism in humans? A. Urea B. Uric acid C. Allantoin D. Ammonia

Correct Answer: B

What is the major carrier protein of the thyroid hormones in the blood? A. Albumin B. Thyroxine-binding globulin C. Thyroxine-binding prealbumin D. Thyroglobulin

Correct Answer: B

What is the principleof the "direct" or "homogeneous" HDL cholesterol automated method, which requires no intervention by the laboratorian? The direct HDL method A. Quantifiesonly the cholesterol in HDL, whereas the precipitation HDL methodquantifiestheentirelipoprotein B. Utilizes polymers and detergents that make the HDL cholesterol soluble while keeping the other lipoproteins insoluble C. Uses a nonenzymatic method to measure cholesterol, whereas the other methods use enzymes to measure cholesterol D. Uses a column chromatography step to separate HDL from the other lipoproteins, whereas the other methods use a precipitation step

Correct Answer: B

What is the sedimentation nomenclature associated with alpha-lipoprotein? A. Very-low-density lipoproteins (VLDLs) B. High-density lipoproteins (HDLs) C. Low-density lipoproteins (LDLs) D. Chylomicrons

Correct Answer: B

What is the specimen of choice for analysis of acid-base disturbances involving pulmonary dysfunction in an adult? A. Venous blood B. Arterial blood C. Capillary blood D. Urine

Correct Answer: B

What specimen preparation is commonly used to perform the alkaline phosphatase isoenzyme determination? A. serum is divided into 2 aliquots, one is frozen and the other is refrigerated B. serum is divided into 2 aliquots, one is heated at 56C and the other is unheated C. no preparation is necessary since the assay uses EDTA plasma D. protein-free filtrate is prepared first

Correct Answer: B

What substance is the precursor to all steroid hormones? A. Fatty acid B. Cholesterol C. Triglyceride D. Phospholipid

Correct Answer: B

When performing a manual protein analysis on a xanthocrhomic spinal fluid, the technician should: A. perform the test as usual B. make a patient blank C. centrifuge the specimen D. dilute the specimen with deionized water

Correct Answer: B

When performing parathyroid surgery for adenoma resection, parathyroid hormone is quantified at three points relative to the surgical procedure: baseline prior to incision, second baseline with gland exposure, and third sample at post- excision. Which of the following is not correct in assessing the PTH values? A. The second baseline value should be higher than the first baseline. B. The first baseline value should be the highest value of the three samples. C. The post-excision value should be at least 50% of or lower than the second baseline. D. The lack of decrease in the PTH value post-excision indicates possible multigland disease.

Correct Answer: B

When using EMIT, the enzyme is coupled to A. Antibody B. Antigen C. Substrate D. Coenzyme

Correct Answer: B

Which cells are involved in immediate hypersensitivity reactions? A. eosinophils B. basophils C. plasma cells D. reactive lymphocytes

Correct Answer: B

Which enzyme is measured by metho- dologies that use small oligosaccharides and 4-nitrophenyl-glycoside for substrates? A. Lipase B. Amylase C. Creatine kinase D. Cholinesterase

Correct Answer: B

Which glucose method can employ a polarographic oxygen electrode? A. Hexokinase B. Glucose oxidase C. Glucose dehydrogenase D. o-Toluidine

Correct Answer: B

Which of the following bone marrow findings fabor the diagnosis of multiple myeloma? A. presence of Reed-Sternberg cells B. sheaths of immature plasma cells C. presence of flame cells and Russell bodies D. presence of plasmacytic satellitosis

Correct Answer: B

Which of the following cell types is characteristic of Pelger-Huet anomaly is the: A. band form B. pince-nex form C. normal neutrophil D. myelocyte

Correct Answer: B

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria? A.autosomal dominant inheritance B. red cell membrane defects C. positive direct antiglobulin test D. measure platelet count

Correct Answer: B

Which of the following characterizes Crigler-Najjar syndrome? A. Inabilityto transport bilirubinfrom the sinusoidal membrane to the micro- somal region B. Deficiency of the enzyme system required for conjugation ofbilirubin C. Inability to transport bilirubin glucuronides to the bile canaliculi D. Severe liver cell damage accompanied by necrosis

Correct Answer: B

Which of the following characterizes hepatic dysfunction in the early stage of viral hepatitis? A. Elevationinurobilinogenandurobilin excretion in the feces B. Elevation in the serum unconjugated bilirubin fraction C. Depression in the serum conjugated bilirubin fraction D. Depression in urinary urobilinogen excretion

Correct Answer: B

Which of the following chromatography systems may be described as having a stationary phase that is liquid absorbed on particles packed in a column and a liquid moving phase that is pumped through a column? A. Thin-layer B. High-performance liquid C. Ion-exchange D. Gas-liquid

Correct Answer: B

Which of the following chromogens will not produce a colored complex with iron that can be measured spectrophotometrically? A. Bathophenanthroline B. 8-Hydroxyquinoline C. Tripyridyltriazine D. Ferrozine

Correct Answer: B

Which of the following coagulation factors is considered to be labile? A. II B. V C. VII D. X

Correct Answer: B

Which of the following disorders is not associated with an elevation of serum a1-fetoprotein? A. Testicular germ cell tumors B. Prostatic carcinoma C. Pancreatic carcinoma D. Gastric carcinoma

Correct Answer: B

Which of the following elevates carboxyhemoglobin? A. nitrite poisoning B. exposure to carbon monoxide C. sulfa drug toxicity D. sickle cell anemia

Correct Answer: B

Which of the following enzyme substrates is the most specific for prostatic acid phosphatase for quantitative endpoint reactions? A. p-nitrophenylphosphate B. thymolphthalein monphosphate C. beta-naphthol-phosphate D. beta-glycerophosphate

Correct Answer: B

Which of the following enzymes catalyzes the conversion of starch to glucose and maltose? A. malate dehydrogenase (MD) B. amylase (AMS) C. creatine kinase (CK) D. isocritic dehydrogenase (ICD)

Correct Answer: B

Which of the following enzymes catalyzes the transfer of amino groups causing the interconversion of amino acids and a-oxoacids? A. Amylase B. Aspartate transaminase C. Alkaline phosphatase D. Lactate dehydrogenase

Correct Answer: B

Which of the following enzymes does not belong to the class of enzymes known as the hydrolases? A. Alkalinephosphatase B. Aldolase C. Amylase D. Lipase

Correct Answer: B

Which of the following enzymes of heme biosynthesis is inhibitied by lead? A. aminolevulinate synthase B. porphobilinogen synthase C. uroporphyrinogen synthase D. bilirubin synthetase

Correct Answer: B

Which of the following enzymes would not be useful to quantify in the assessment of liver function? A. Alanine aminotransferase B. Creatine kinase C. Alkalinephosphatase D. Gamma-glutamyltransferase

Correct Answer: B

Which of the following factor deficiencies is associated with wither no bleeding or only a minor bleeding tendency, even after trauma or surgery? A. Factor X B. Factor XII C. Factor XIII D. Factor V

Correct Answer: B

Which of the following has an effect on plasma calcium levels? A. Sodium B. Inorganic phosphate C. Potassium D. Iron

Correct Answer: B

Which of the following is a low-weight protein that is found on the cell surfaces of nucleated cells? A. C-reactive protein B. B2-Microglobulin C. Ceruloplasmin D. a2-Macroglobulin

Correct Answer: B

Which of the following is a significant feature of erythroleukemia/acute erythroid leukemia (DiGuglielmo syndrome)? A. persistently increased M:E ratio B. megaloblastoid erythropoiesis C. marked thrombocytosis D. decreased ferritin levels

Correct Answer: B

Which of the following is a true statement about acute idiopathic thrombocytopenic purpura (ITP)? A.it is found primarily in adults B. spontaneous remission usually occurs withing several weeks C. women are more commonly affected D. peripheral destruction of platelets is decreased

Correct Answer: B

Which of the following is an example of a peptide bond? See BOC pg 94 Pic 1 A. A B. B C. C D. D

Correct Answer: B

Which of the following is an oncofetal antigen that is elevated in nonmucinous epithelial ovarian cancer? A. CA549 B. CA 125 C. CA 19-9 D. CA 15-3

Correct Answer: B

Which of the following is associated with May-Hegglin anomaly? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. chronic myelogenous leukemia D. mucopolysaccharidosis

Correct Answer: B

Which of the following is most closely associated with acute promyelocytic leukemia? A. ringed sideroblasts B. disseminated intravascular coagulation C. micromegakaryocytes D. Philadelphia chromosome

Correct Answer: B

Which of the following is not associated with carcinoembryonic antigen? A. Increased levels seen with malignancies of the lungs B. Quantified by using capillary electrophoresis C. Used to monitor treatment of colon cancer D. Glycoprotein in nature

Correct Answer: B

Which of the following is not associated with hypoglycemia? A. Neuroglycopenia B. Symptoms occur with plasma glucose level of 60-70 mg/dL C. Decreased hepatic glucose production D. Diagnostic test is 72-hour fast

Correct Answer: B

Which of the following is not associated with isoelectric focusing? A. Continuous pH gradient B. Migration of proteins with net charge of zero C. Separation dependent on isoelectric point D. Zone electrophoresis

Correct Answer: B

Which of the following is secreted by the placenta and used for the early detection of pregnancy? A. follicle-stimulating hormone (FSH) B. human chorionic gonadotropin (HCG) C. luteinizing hormone D. progesterone

Correct Answer: B

Which of the following is the Hollander insulin test used to confirm? A. Hyperglycemia B. Vagotomy C. Pancreatectomy D. Insulinoma

Correct Answer: B

Which of the following is the most common cause of the adrenogenital syndrome called congenital adrenal hyperplasia, and which test is used for its diagnosis? A. 17a-Hydroxylase deficiency; progesterone assay B. 21-Hydroxylase deficiency; 17ct-hydroxyprogesterone assay C. 3B-Hydroxylsteroid dehydrogenaseisomerase deficinecy; 17a-hydroxyprenenolone assay D. 11B-Hydroxylase deficiency; 11-deoxycortisol assay

Correct Answer: B

Which of the following is used in the treatment of manic depression? A. Potassium B. Lithium C. Calcium D. Chloride

Correct Answer: B

Which of the following isfalse about myoglobin as it relates to acute myocar- dial infarction (AMI)? A. Measure serially B. Cardiac specific C. Initial increase occurs in 1-3 hours D. Doubling of initial value within 1-2 hours suggestive of AMI

Correct Answer: B

Which of the following isolates light within a narrow region of the spectrum? A. Photomultiplier tube B. Monochromator C. Photovoltaic cell D. Detector

Correct Answer: B

Which of the following laboratory findings is associated with Factor XIII deficiency? A. prolonged activated partial thromboplastin time B. clot solubility in a 5 molar urea solution C. prolonged thrombin time D. prolonged prothrombin time

Correct Answer: B

Which of the following laboratory results wold be expected in a child with aryl sulfatase B deficiency (mucopolysaccharidosis type VI or Maroteaux-Lamy syndrome)? A. giant platelets, thrombocytopenia, and Dohle-body like inclusions in leukocytes B. increased urinary excretion of glycosaminoglycans (chondroitin sulfate) C. increased sensitivity of RBC and WBC to complement-mediated lysis D. accumulation of glucocerebrosides and other lipids in splenic macrophages

Correct Answer: B

Which of the following lipid results would be expected to be falsely elevated on a serum specimen form a nonfasting patient? A. cholesterol B. triglyceride C. HDL D. LDL

Correct Answer: B

Which of the following may be used to stain neutral fats, phospholipids and sterols? A. peroxidase B. Sudan black B C. periodic acid-Schiff (PAS) D. Prussian blue

Correct Answer: B

Which of the following methods allows for the separation of charged particles based on their rates of migration in an electric field? A. Rheophoresis B. Electrophoresis C. Electroendosmosis D. Ion exchange

Correct Answer: B

Which of the following methods employs a reaction where bilirubin is oxidized to colorless biliverdin? A. Bilirubinometer B. Bilirubin oxidase C. High-performance liquid chromatog- raphy D. Jendrassik-Grof

Correct Answer: B

Which of the following methods for quantitation of high-density lipoprotein is most suited for clinical laboratory use? A. Gomori procedure B. homogeneous C. column chromatography D. agarose gel electrophoresis

Correct Answer: B

Which of the following methods utilizes urease and glutamate dehydrogenase for the quantification of serum urea? A. Berthelot B. Coupled enzymatic C. Conductimetric D. Indicator dye

Correct Answer: B

Which of the following reagents can be used to measure protein in cerebrospinal fluid? A. Biuret B. Coomassie brilliant blue C. Ponceau S D. Bromcresol green

Correct Answer: B

Which of the following reagents is used to determine the concentration of serum inorganic phosphate? A. Ehrlich's reagent B. Ammonium molybdate C. 8-Hydroxyquinoline D. Bathophenanthroline

Correct Answer: B

Which of the following sets of laboratory findings is consistent with hemolytic anemia? A. normal or slightly increased erythrocyte survival; normal osmotic fragility B. decreased erythrocyte survival; increased catabolism of heme C.decreased serum lactate dehydrogenease activity; normal catabolism of heme D. normal concentration of haptoglobin; marked hemoglobinuria

Correct Answer: B

Which of the following sets of results would be consistent with macroamylasemia? A. normal serum amylase and elevated urine amylase values B. increased serum amylase and normal urine amylase values C. increased serum and urine amylase values D. normal serum and urine amylase values

Correct Answer: B

Which of the following stains can be used to differentiate sideritic granules (Pappenheimer bodies) from basophilic stippling? A. Wright B. Prussian blue C. crystal violet D. periodic acid-Schiff

Correct Answer: B

Which of the following statements best describes "base excess"? A. Primarily refers to carbonic acid concentration B. Positive values reflect metabolic alkalosis. C. Created through metabolism of carbohydrates D. Negative values represent a respiratory imbalance.

Correct Answer: B

Which of the following steroids is an adrenal cortical hormone? A. angiotensinogen B. aldosterone C. epinephrine D. growth hormone

Correct Answer: B

Which of the following substances is the biologically active precursor of a fat soluble vitamin? A. biotin B. retinol C. folic acid D. ascorbic acid

Correct Answer: B

Which of the following technical factors will cause a decreased erythrocyte sedimentation rate? A. gross hemolysis B. small fibrin clots in the sample C. increased room temperature D. tilting of the tube

Correct Answer: B

Which of the following tissues does not secrete steroid hormones? A. Ovaries B. Pituitary gland C. Testes D. Adrenal cortex

Correct Answer: B

Which of the following types of polycythemia is most often associated with emphysema? A. polycythemia vera B. polycythemia, secondary to hypoxia C. relative polycythemia associated with dehydration D. polycythemia associated with renal disease

Correct Answer: B

Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets? A. incipient clotting B. decreased hematocrit C. Howell-Jolly bodies D. leukocyte cytoplasmic fragments

Correct Answer: B

Which of the following would be an example of a glucose-specific colorimetric method? A. alkaline ferricyanide B. glucose oxidase C. hexokinase D. o-toluidine

Correct Answer: B

Which one of the following factors typically sow an increase in liver disease? A. Factor VII B. Factor VIII C. Factor IX D. Factor X

Correct Answer: B

Which one of the following values obtained during a glucose tolerance test are diagnostic of diabetes mellitus? A. 2-hour specimen =150 mg/dL (8.3 mmol/L) B. fasting plasma glucose = 126 mg/dL (6.9 mmol/L) C. fasting plasma glucose = 110 mg/dL (6.1 mmol/L) D. 2-hour specimen = 180 mg/dL (9.9 mmol/L)

Correct Answer: B

Which substrate is used for the detection of specific esterase A. acetate B. chloroacetate C. pararosanilin acetate D. phenylene diacetate

Correct Answer: B

Which total protein method requires copper sulfate, potassium iodide in sodium hydroxide, and potassium sodium tartrate in its reagent system? A. Kjeldahl B. Biuret C. Folin-Ciocalteu D. Ultraviolet absorption

Correct Answer: B

Which vitamin is a constituent of two redox coenzymes? A. Vitamin A B. Vitamin B2 C. Vitamin B6 D. Vitamin C

Correct Answer: B

Whichofthefollowingisacommonly encountered xanthine that could poten- tially interfere with the determination of theophylline? A. Nicotine B. Caffeine C. Amphetamine D. Procainamide

Correct Answer: B

Whichofthefollowingisnotassociated with growth hormone? A. Somatotropin B. Secreted by posterior pituitary C. Hypersecretion results in acromegaly D. Affects lipid, carbohydrate, and protein metabolism

Correct Answer: B

Whichofthefollowingstatementsisnot associated with serum cholinesterase? A. Inhibitedbyorganicinsecticides B. Referred to as "true" cholinesterase C. Decreased level causes prolonged apnea after administrationof succinyldicholine D. Acts on the substrate propionylthio- choline

Correct Answer: B

A 10-year old child was admitted to pediatrics with an initial diagnosis of skeletal muscle disease. The best confirmatory tests would be: A. creatine kinase and isocitrate dehydogenase B. gamma-glutamyl transferase and alkaline phosphatase C. aldolase and creatine kinase D. lactate dehydrogenase and malate dehydrogenase

Correct Answer: C

A 20-year-old African-American man has peripheral blood changes suggesting thalassemia minor. The quantitative hemoglobin A2 level is normal, but the homoglobin F level is 5% (normal <2%). This is most consistent with: A. alpha thalassemia minor B. beta thalassemia minor C. delta-beta thalassemia minor D. hereditary persistence of fetal hemoglobin

Correct Answer: C

A 25-year-old man became nauseated and vomited 90 minutes after receiving a standard 75 g carbohydrate dose for an oral glucose tolerance test. The best course of action is to: A. give the patient a glass of orange juice and continue the test B. start the test over immediately with a 50g carbohydrate dose C. draw blood for glucose and discontinue test D. place the patient in a recumbent position, reassure him and continue the test

Correct Answer: C

A 30-year-old woman is admitted to the hospital. She has truncal obesity, buffalo humpback, moon face, purple striae, hypertension, hyperglycemia, increased facial hair, acne, and amenorrhea. The physician orders endocrine testing. The results are as follows: Urine free cortisol—increased Serum cortisol (8 A.M.)—increased Plasma ACTH—decreased Dexamethasone suppression test: Overnight low dose—no suppression of serum cortisol High dose—no suppression of serum cortisol What is the most probable diagnosis? A. Pituitaryadenoma B. Ectopic ACTH lung cancer C. Adrenocortical carcinoma D. Addison disease

Correct Answer: C

A 40-year-old Caucasian male was admitted to the hospital for treatment of anemia, lassitude, weight loss, and loss of libido. The patient presented with the following laboratory data: -WBC: 5.8 x 10^3/uL (5.8 x 10^9/L) -RBC: 3.7 x 10^6/uL (3.7 x 10^12/L) -Hgb: 10.0 g/dL (100 g/L) -Hct: 32% -MCV: 86 um^3 (86 fL) -MCH: 26 pg -MCHC: 32% -Serum iron: 200 ug/dL (39.4 umol/L) -TIBC: 300 ug/dL (53.7 umol/L) -Serum ferritin: 2,800 ng/mL (2,800 ug/L) Examination of the bone marrow revealed erythroid hyperplasia with a shift to the left of erythroid precursors. Prussian blue staining revealed markedly elevated iron stores noted with occasional sideroblasts seen. This data is most consistent with which of the following conditions? A. iron deficiency anemia B. anemia of chronic disease C. hemochromatosis D. acute blood loss

Correct Answer: C

A 53-year-old female presents with fatigue, pruritus, and an enlarged, nontender liver. The physician orders a series of blood tests. Based on the following serum test results, what is the most likely diagnosis? Alkaline phosphatase—markedly elevated Alanine aminotransferase—slightly elevated Lactate dehydrogenase—slightly elevated Gamma-glutamyltransferase— markedly elevated Total bilirubin—slightly elevated A. Alcoholiccirrhosis B. Infectiousmononucleosis C. Intrahepatic cholestasis D. Viralhepatitis

Correct Answer: C

A blood creatinine value of 5.0 mg/dL (442.0 umol/L) is most likely to be found with which of the following blood values? A. osmolality: 292 mOsm/kg B. uric acid: 8 mg/dL (475.8 umol/L) C. urea nitrogen: 80 mg/dL (28.56 mmol/L) D. ammonia: 80 ug/dL (44 umol/L)

Correct Answer: C

A blood smear shows 80 nucleatted red cells per 100 leukocytes. The total leukocyte count is 18 x 10^3/uL (18 x 10^9/L). The true white cell count expressed in SI units is A. 17.2 x 10^3/uL (17.2 x 10^9/L) B. 9.0 x 10^3/uL (9.0 x 10^9/L) C. 10.0 x 10^3/uL (10.0 x 10^9/L) D. 13.4 x 10^3/uL (13.4 x 10^9/L)

Correct Answer: C

A carbonate salt used to control manic-depressive disorder is: A. digozin B. acetaminophen C. lithium D. phenytoin

Correct Answer: C

A deficiency of protein C is associated with which of the following? A. prolonged activated partial thromboplastin time (APTT) B. decreased fibrinogen level (<100 mg/dL [<1.0 g/L]) C. increased risk of thrombosis D. spontaneous hemorrhage

Correct Answer: C

A diagnosis of primary adrenal insufficiency requires demostration of: A. decreased urinary 17-keto- and 17-hydroxysteroids B. decreased cortisol production C. impaired response to ACTH stimulation D. increased urinary cortisol excretion after metyrapone

Correct Answer: C

A drug has a half-life of 6 hours. If a dose is given every 6 hours, a stead-state drug level would usually be achieved in: A. 3-5 hours B. 10-12 hours C. 24-42 hours D. 48-50 hours

Correct Answer: C

A fresh urine sample is received for analysis for "porphyrins" or porphyria: without further information of specifications. Initial analysis should include: A. porphyrin screen and quantitative total porphyrin B. quantitative total porphyrin and porphobilinogen screen C. porphyrin and porphobilinogen screen D. porphobilinogen screen and ion-exchange analysis for porphobilinogen

Correct Answer: C

A leukocyte count a differential on a 40-year-old Caucasian man revealed: WBC: 5.4 x 10^3/uL (5.4 x 10^9/L) Differential: -Segs: 20% -Lymphs: 58% -Monos: 20% -Eos: 2% This data represents: A. absolute lymphocytosis B. relative neutrophilia C. absolute neutropenia D. leukopenia

Correct Answer: C

A male patient, 48 years old, mentions during his annual physical that he has been having difficulty urinating. The physician performs a rectal examination, and he orders a total prostate-specific antigen (PSA) and free PSA. The patient has the tests done the following week, and the total PSA result is 3.1 ng/mL and the free PSA is 0.3 ng/mL. What do these results suggest? A. Both are normal, no disease present B. Benign prostatic hypertrophy C. Increased risk of prostate cancer D. Free PSA is low and does not correlate with total PSA

Correct Answer: C

A mother brings her obese, 4-year-old child who is a known type 1 diabetic to the laboratory for a blood workup. She states that the boy has been fasting for the past 12 hours. After centrifugation the tech notes that the serum looks turbid. The specimen had the following results: blood glucose = 150 mg/dL, total cholesterol = 250 mg/dL, HDL cholesterol = 32 mg/dL, triglyceride = 395 mg/dL. What best explains these findings? The boy A. Is a low risk for coronary artery disease B. Is a good candidate for a 3-hour oral glucose tolerance test C. Has secondary hyperlipidemia due to the diabetes D. Was not fasting when the specimen was drawn

Correct Answer: C

A patient develops severe unexpected bleeding following 4 transfusions. The following test results were obtained: -PT and APTT: prolonged -platelets: 50 x 10^3/uL (50 x 10^9/L) -fibrinogen: 30 mg/dL (0.30 g/L) -D-dimer: increased Given these results, which of the following blood products would be recommended to the physician for this patient? A. platelets B. Factor VIII C. cyroprecipitate D. fresh frozen plasma

Correct Answer: C

A patient develops unexpected bleeding and the following test results were obtained: -PT and APTT: prolonged -fibrinogen: decreased -D-dimer: increased -platelets: decreased What is the most probable cause of these results? A. familial afibrinogenemia B. primary fibrinolysis C. DIC D. liver disease

Correct Answer: C

A patient had the following serum results; -Na+: 140 mEq/L (140 mmol/L) -K+: 4.0 mEq/L (4.0 mmol/L) -glucose: 95 mg/dL (5.2 mmol/L) -BUN: 10 mg/dL (3.57 mmol/L) Which osmolality is consisitent with these results? A. 188 B. 204 C. 270 D. 390

Correct Answer: C

A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time (APTT) using a kolin activator. The APTT corrects to normal when the incubation time is increased. These suggest that the patient has: A. hemophilia A (Factor VIII deficiency B. Hagmean Factor (XII) deficiency C. Fletcher Factor deficiency (prekallikrein) D. Factor V deficiency

Correct Answer: C

A patient has signs and symptoms suggestive of acromegaly. The diagnosis would be confirmed if the patient had which of the following? A. an elevated serum phosphate concentration B. a decrease serum growth hormone releasing factor concentration C. no decrease in serum growth hormone concentration 90 minutes after oral glucose administration D. an increased serum somatostatin concentration

Correct Answer: C

A patient has the following blood values: -RBC 6.5 x10^6/uL (6.5 x 10^12/L) -Hgb 13.0 g/dL (130 g/L) -Hct 39% -MCV 65 um^3 (65fL) -MCH 21.5 pg -MCHC 33% These results are compatible with: A. iron deficiency B. pregnancy C. thalassemia minor D. beta thalassemia major

Correct Answer: C

A patient has the following laboratory data: -WBC 3.0x10^3/uL -RBC 2.35x10^6/uL -Plt 95.0 x10^3/uL (95.0 x 10^9/L) -Hgb 9.5 g/dL (95 g/L) -Hct 27% -MCV 115 um^3 (115fL) -MCH 40 pg -MCHC 35% Which of the following tests would contribute toward the diagnosis? A. reticulocyte count B. platelet factor 3 C. serum B12 and folate D. leukocyte alkaline phosphatase

Correct Answer: C

A patient has the following laboratory results: -RBC: 2.00 x 10^6/uL (2.00 x 10^12/L) -Hct: 24% -Hgb: 6.8 g/dL (68 g/L) -reticulocytes 0.8% The mean corpuscular volume (MCV) of the patient is: A. 35 um^3 (35 fL) B. 83 um^3 (83 fL) C. 120 um^3 (120 fL) D. 150 um^3 (150 fL)

Correct Answer: C

A patient is admitted with a history of chronic bleeding secondary to peptic ulcer. Hematology workup reveals a severe microcytic, hypochromic anemia. Iron studies were requested. Which of the following would be expected in this case? Serum iron, TIBC, Storage iron -Result A: dec inc inc -Result B: inc dec inc -Result C: dec inc dec -Result D: inc nL dec A. result A B. result B C. result C D. result D

Correct Answer: C

A patient presents with Addison disease. Serum sodium and potassium analyses are performed. What would the results reveal? A. Normal sodium, low potassium levels B. Low sodium, low potassium levels C. Low sodium, high potassium levels D. High sodium, low potassium levels

Correct Answer: C

A patient with Type-I, insulin-dependent diabetes mellitus has the following results: Test; Patient; Reference Range -fasting blood glucose: 150 mg/dL (8.3 mmol/L); 70-110 (3.9-6.1 mmol/L) -hemoglobin A1C: 8.5%; 4.0%-6.0% -fructosamine: 2.5 mmol/L; 2.0-2.9 mmol/L After reviewing these test results, the technologist concluded that the patient is in a: A. "steady state" of metabolic control B. state of flux, progressively worsening metabolic control C. improving stat of metabolic control as indicated by fructosamine D. state of flux as indicted by the fasting glucose level

Correct Answer: C

A patient with myeloproliferative disorder has the following values: -Hgb: 13 g/dL (130 mmol/L) -Hct: 38% -WBC: 30x 10^3/uL (30 x 10^9/L) -platelets: 1000 x 10^3/uL (1000x 10^9L) -serum Na+: 140 mEq/L (140 mmol/L) -serum K+: 7 mEq/L (7 mmol/L) The serum K+ should be confirmed by: A. repeat testing of the original serum B. testing freshly drawn serum C. testing heparinized plasma D. atomic absorption spectrometry

Correct Answer: C

A physician requested that electrolytes on a multiple myeloma patient specimen be run by direct ISE and not indirect ISE because: A. excess protein binds Na in indirect ISE B. Na is falsely increased by indirect ISE C. Na is falsely decreased by indirect ISE D. excess protein reacts with diluent in indirect ISE

Correct Answer: C

A platelet count done by phase microscopy is 200 x 10^3/uL (200 x 10^9/L) (reference range 150-450 x 10^3/uL (150-450 x 10^9/L)). A standardized template bleeding time on the same person is 15 minutes (reference range 4.5+- 1.5 minutes). This indicates that: A. the Duke method should have been used for the bleeding time B. the manual platelet count is in error C. abnormal platelet function should be suspected D. the results are as expected

Correct Answer: C

A scanning of a CK isoenzyme fractionation revealed 2 peaks: a slow cathodic peak (CKMM) and an intermediate peak (CKMB). A possible interpretation for this pattern is: A. barin tumor B. muscular dystrophy C. myocardial infaction D. viral hepatitis

Correct Answer: C

A specimen run on an automatic cell counter has a platelet count of 19 x 10^3/uL (19 x 10^9/L). The first thing the technician should do is: A. report the count after the batch run is completed B. request a new specimen C. review the stained blood smear D. notify the laboratory manager

Correct Answer: C

A term that means varying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is: A. polycythemia vera B. erythroleukemia C. leukoerythroblastosis D. megaloblastoid

Correct Answer: C

A30-year-oldpregnantwomanhasa gestationaldiabetesmellitusscreeningtest performed at 26 weeks of gestation. Her physician chooses to order a 50-g oral glucose load. Her serum glucose level is 150mg/dLat1hour.Whatshouldoccur next? A. This confirms diabetes mellitus; give insulin. B. This confirms diabetes mellitus; dietary intake of carbohydrates should be lessened. C. This is suspicious of diabetes mellitus; an oral glucose tolerance test should be performed. D. This is an expected glucose level in a pregnant woman.

Correct Answer: C

APC resistance is confirmed by the molecular rest for A. PAI 1 4G/5G B. MTHFR C. FVL D. G20210A

Correct Answer: C

Abnormalities found in erythroleukemia include: A. rapid DNA synthesis B. marrow fibrosis C. megaloblastoid development D. increased erythrocyte survival

Correct Answer: C

Acidosis and alkalosis are best defined as fluctuations in blood pH and CO2 content due to changes in: A. Bohr effect B. O2 content C. bicarbonate buffer D. carbonic anhydrase

Correct Answer: C

After a difficult venipuncture requireing prolonged application of the tourniquet, the serum K+ was found to be 6.9 mEq/L (6.9 mmol/L). The best course of action is to: A. repeat the test using the same specimen B. adjust the value based on the current serum Na+ C. repeat the test using freshly drawn serum D. cancel the test

Correct Answer: C

Alpha granules are found on the platelet in: A. peripheral zone B. sol gel zone C. organelle zone D. membranes

Correct Answer: C

An adult diabetic with renal complications has the following results: -sodium: 133 mEq/L (133 mmol/L) -glucose: 487 mg/dL (26.8 mmol/L) -BUN: 84 mg/dL (30.0 mmol/L) -creatinine: 5 mg/dL (442.0 umol/L) On the basis of these results, the calculated serum osmolality is: A. 266 mOsm/kg B. 290 mOsm/kg C. 323 mOsm/kg D. 709 mOsm/kg

Correct Answer: C

An electrode has a silver/silver chloride anode and a platinum wire cathode. It is suspended in KCl solution and separated form the blood to be analyzed by a selectively permeable membrane. Such an electrode is used to measure which of the following? A. pH B. PCO2 C. PO2 D. HCO3

Correct Answer: C

An elevated serum iron with normal iron biding capacity is most likely associate with: A. iron deficiency anemia B. renal damage C. pernicious anemia D. septicemia

Correct Answer: C

An endogenous substance assayed to assess the glomerular filtration rate may be described as being filtered by the glomeruli, not reabsorbed by the tubules, and only secreted by the tubules when plasma levels become elevated. What is this frequently assayed substance? A. Inulin B. Uric acid C. Creatinine D. Urea

Correct Answer: C

An individual has a plasma glucose level of 110 mg/dL. What would be the approximate glucose concentration in this patient's cerebrospinal fluid? A. 33 mg/dL B. 55 mg/dL C. 66 mg/dL D. 110 mg/dL

Correct Answer: C

Anemia secondary to uremia characteristically is: A. microcytic, hypochromic B. hemolytic C. normocytic, normochromic D. macrocytic

Correct Answer: C

At a pH of 8.6 the gamma globulins move toward the cathode, despite the fact that they are negatively charged. What is the phenomenon called? A. reverse migration B. molecular sieve C. endosmosis D. migratory inhibition factor

Correct Answer: C

Bile acids that are synthesized in the liver are derived from what substance? A. Bilirubin B. Fatty acid C. Cholesterol D. Triglyceride

Correct Answer: C

Biochemical profile: Test; Patient values: reference range: -total protein: 7.3 g/dL (73 g/L); 6.0-8.0 g/dL (60-80 g/L) -albumin: 4.1 g/dL (41 g/L); 3.5-5.0 g/dL (35-50 g/L) -calcium: 9.6 mg/dL ( 2.4 mmol/L); 8.5-10.5 mg/dL (2.1-2.6 mmol/L) -phosphorus: 3.3 mg/dL (1.06 mmol/L); 2.5-4.5 mg/dL (0.80-1.45 mmol/L) -glucose: 95 mg/dL (5.2 mmol/L); 65-110 mg/dL (3.6-6.1 mmol/L) -BUN: 16 mg/dL (5.71 mmol/L); 10-20 mg/dL (3.57-7.1 mmol/L) -uric acid: 6.0 mg/dL (356.9 umol/L); 2.5-8.0 mg/dL (148.70475.8 umool/L) -creatinine: 1.2 mg/dL (106.1 umol/L); 0.7-1.4 mg/dL (61.9-123. 8 umol/L) -total bilirubin: 3.7 mg/dL (63.3 umol/L); 0.2-0.9 mg/dL (3.4-15.4 umol/L) -alkaline phosphatase: 275 U/L; 30-80 U/L -lactate dehydrogenase: 185 U/L; 100-225 U/L -AST: 75 U/L, 10-40 U/L The results the biochemical profile are most consistent with: A. viral hepatitis B. hemolytic anemia C. common bile duct stone D. chronic active hepatitis

Correct Answer: C

Biological assays for antithrombin III (AT III) are based on the inhibition of: A. Factor VIII B. heparin C. serine proteases D. anti-AT III globulin

Correct Answer: C

Blood gases are drawn on a 68-year-old asthmatic who was recently admitted for treatment of a kidney infection. Blood gas results are as follows: pH —7.25, PCO2 — 56mmHg, HCOJ = 16 mmol/L .What condition is indicated by these results? A. Metabolic alkalosis,partially compensated B. Respiratory acidosis, uncompensated C. A dual problem of acidosis D. An error in one of the blood gas measurements

Correct Answer: C

Blood is diluted 1:200, and a platelet count is performed. 180 platelets were counted in the center square millimeter on one side of the hemacytometer and 186 on the other side. The total platelet count is: A. 146 x 10^3/uL (146 x 10^9/L) B. 183 x 10^3/uL (183 x 10^9/L) C. 366 x 10^3/uL (366 x 10^9/L) D. 732 x 10^3/uL (732 x 10^9/L)

Correct Answer: C

Blood received in the laboratory for blood gas analysis must meet which of the following requirements? A. on ice, thin fibrin strands only, no air bubbles B. on ice, no clots, fewer than 4 air bubbles C. on ice, no clots, no air bubbles D. room temperature, not clots, no air bubbles

Correct Answer: C

Bone marrow examination reveals a hypercellular marrow consisting of probable lymphoblasts. The cells stain positively with anti-TdT and anti CD3 and CD& antibodies; however, the lymphoblasts are negative for Sigs, CD19, CD10 (CALLA), Fc, and complement receptors. The most likely diagnosis is: A. null-cell acute lymphocytic leukemia (non-B, non-T cell ALL) B. chronic lymphocytic leukemia (CLL) C. T-cell leukemia (T-ALL) D. hairy-cell leukemia

Correct Answer: C

Cells that produce antibodies and lymphokines are: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes

Correct Answer: C

Checking instrument calibration, temperature accuracy, and electronic parameters are part of A. Preventive maintenance B. Quality control C. Function verification D. Precision verification

Correct Answer: C

Cholesterol ester is formed through the esterification of the alcohol cholesterol with what substance? A. Protein B. Triglyceride C. Fatty acid D. Digitonin

Correct Answer: C

Chronic lymphocytic leukemia cells are most likely to express which of the following cell surface markers? A. CD3, CD7 CD19, and CD20 B. CD19, CD20, CD4 and CD5 C. CD19, CD20.CD 21 D. CD13, CD33, CD107

Correct Answer: C

Chylomicrons are present in which of the following dyslipidemias? A. familial hypercholestrolemia B. hypertirglyceridemia C. deficiency in lipoprotein lipase activity D. familial hypoalphalipoproteinemia

Correct Answer: C

Coagulation factors affected by warfarin (Coumadin) drugs are: A. VIII, IX, and X B. I, II, V, and VII C. II, VII, IX, and X D. II, V, and VII

Correct Answer: C

Cytochemical stains were performed on bone marrow smears form an acute leukemia patient. All blasts were periodic acid-Schiff (PAS) negative. The majority of the blasts showed varying amounts of Sudan black B positivity. Some of the blasts stained positive for naphthol AS-D acetate esterase, some were positive for naphthol AS-D chloroacetate esterase, and some blasts stained positive for both esterases. What type of leukemia is indicated? A. lymphocytic B. myelogenous C. myelomonocytic D. erythroleukemia

Correct Answer: C

During pregnancy in the second trimester, human chorionic gonadotropin (hCG) levels and progesterone and estriol levels A. Increase,increase B. Increase, decrease C. Decrease, increase D. Decrease, decrease

Correct Answer: C

Dwarf or micro megakaryocytic may be found in the peripheral blood of patients with: A. pernicious anemia B. DIC C. myelofibrosis with myeloid metaplasia D. chronic lymphocytic leukemia

Correct Answer: C

Elevation of the granulocyte percentage above 75% is termed: A. absolute lymphocytosis B. leukocytosis C. relative neutrophilic leukocytosis D. absolute neutrophilic leukocytosis

Correct Answer: C

Elevation of the total white cell count above 12 x 10^3/uL (12 x10^9/L) is termed: A. relative lymphocytosis B. absolute lymphocytosis C. leukocytosis D. relative neutrophilic leukocytosis

Correct Answer: C

Enzymatic methods for the determination of total cholesterol in serum utilize a cholesterol oxidase-peroxidase method. In this method, cholesterol oxidase reacts specifically with what? A. Free cholesterol and cholesteryl ester B. Free cholesterol and fatty acid C. Free cholesterol only D. Cholesteryl ester only

Correct Answer: C

Excess D-dimer indicated that clots have been: A. converted to fibrin monomers B. released into circulation C. formed and are being excessively lysed D. stimulated to activate platelets

Correct Answer: C

Exogenous triglycerides are transported in the plasma in what form? A. Phospholipids B. Cholesteryl esters C. Chylomicrons D. Free fatty acids

Correct Answer: C

Fasting serum phosphate concentration is controlled primarily by the: A. pancreas B. skeleton C. parathyroid glands D. small intestine

Correct Answer: C

For what colorimetric determination is the Trinder reaction widely used? A. Acetaminophen B. Propoxyphene C. Salicylate D. Barbiturate

Correct Answer: C

From what precursor is creatinine formed? A. Urea B. Glucose C. Creatine D. Uric acid

Correct Answer: C

Giant, vacuolated, multinucleated erythroid precursors are present in which of the following? A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia

Correct Answer: C

Given the following data: -WBC: 8.5 x 10^3/uL (8.5 x 10^9/L) Differential: -Segs: 56% -Bands: 2% -Lymphs: 30% -Monos: 6% -Eos: 6% What is the absolute lymphocyte count? A. 170/uL (0.17 x 10^9/L) B. 510/uL (0.51 x 10^9/L) C. 2,550/uL (2.55 x 10^9/L) D. 4,769/uL (4.76 x10^9/L)

Correct Answer: C

Given the following information, calculate the blood pH. PCO2 = 44 mm Hg Total CO2 = 29 mmol/L A. 6.28 B. 6.76 C. 7.42 D. 7.44

Correct Answer: C

Hairy cell leukemia (leukemic reticuloendotheliosis) is: A. an acute myelocytic leukemia B. a chronic leukemia of meylocytic origin C. a chronic leukemia of lymphocytic origin D. an acute myelocytic monocytic-type leukemia

Correct Answer: C

How would blood gas parameters change if a sealed specimen is left at room temperature for 2 or more hours? A. PO2 increases, PCO2 increases, pH increases B. PO2 decreases, PCO2 decreases, pH decreases C. PO2 decreases, PCO2 increases, pH decreases D. PO2 increases, PCO2 increases, pH decreases

Correct Answer: C

If the pKa is 6.1, the CO2 content is 25 mM/L, the salt equals the total CO2 content minus the carbonic acid; the carbonic acid equals 0.03 x PCO2 and PCO2- 40 mmHg, it may be concluded that: A. pH=6.1 + log [(40-0.03)/(0.03)] B. pH=6.1 + log [(25-0.03)/(0.03)] C. pH=6.1 + log [(25-1.2)/(1.2)] D. pH= 6.1 + log [(1.2)/(1.2-25)]

Correct Answer: C

If the total leukocyte count is 20.0 x 10^3/uL (20.0 x 10^9/L) and 50 NRBCs are seen per 100 leukocytes on the differential, what is the corrected leukocyte count? A. 6,666/uL (6.666 x 10^9/L) B. 10,000/uL (10.0 x 10^9/L) C. 13,333/uL (13.333 x 10^9/L) D. 26,666/uL (26.666 x 10^9/L)

Correct Answer: C

In a patient suspected of having primary myxedema, one would expect the following serum results: free thyroxine (FT4) , thyroid hormone binding ratio (THBR) , andthyroid-stimulatinghormone (TSH) A. Decreased, increased, decreased B. Increased, increased, decreased C. Decreased, decreased, increased D. Increased, decreased, increased

Correct Answer: C

In a patient with suspected primary hyperthyroidism associated with Graves disease, one would expect the following laboratory serum results: free thyroxine (FT4) (blank) ,thyroid hormone binding ratio (THBR) (blank) , and thyroid-stimulating hormone (TSH) (blank). A. Increased, decreased, increased B. Increased, decreased, decreased C. Increased, increased, decreased D. Decreased, decreased, increased

Correct Answer: C

In addition to carcinoma of the prostate, elevated prostate-specific antigen (PSA) can occur due to: A. aspirin therapy B. exogenous steroid use C. benign prostatic hyperplasia D. statin therapy (cholesterol lowering drug)

Correct Answer: C

In amniotic fluid, the procedure used to detect Rh isosensitization is: A. human amniotic placental lactogen (HPL) B. alpha-fetoprotein C. measurement of absorbance at 450 nm D. creatinine

Correct Answer: C

In an adult with rare homozygous delta-beta thalassemia, the hemoglobin produced is: A. Hgb A B. Hgb Bart C. Hgb F D. Hgb H

Correct Answer: C

In an uncomplicated case of severe iron deficiency anemia, which of the following sets represents the typical pattern of results? Serum iron, Serum TIBC, %Saturation, Marrow % sideroblasts, Marrow iron stores, serum ferritin, Hgb A2 -A: dec, inc, dec, dec, inc, inc, inc -B: dec, dec, dec, dec, dec, dec, dec, -C: dec, inc, dec, dec, dec, dec, dec -D: dec, dec, inc, inc, inc, inc, inc A. A B. B C. C D. D

Correct Answer: C

In chronic meylocytic leukemia, blood histamine concentrations tend to reflect the: A. number of platelets present B. serum uric acid concentrations C. number of basophils present D. the total number of granulocytes

Correct Answer: C

In flow cytometric analysis, right angle (90 degrees) or side scatter of a laser light beam provides information that pertains to a cell's: A. volume B. viability C. granularity D. lineage

Correct Answer: C

In monitoring glomerular function, which of the following test has the highest sensitivity? A. urine sodium B. BUN/creatinine ration C. creatine clearance D. urea clearance

Correct Answer: C

In order to maintain electrical neutrality in the red blood cell, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with what electrolyte? A. Sodium B. Potassium C. Chloride D. Phosphate

Correct Answer: C

In regard to drug distribution patterns, which of the following statements is false? A. Drug metabolism is slower in newborns than adults. B. Drug metabolism is more rapid for 6-year-oldchildrenthanforadults. C. Renal clearance of drugs is faster in newborns than adults. D. Drug metabolism often changes during pubescence.

Correct Answer: C

In spectrophotometric determination, which of the following is the formula for calculating the absorbance of a solution? A. (absorptivity x light path)/ concentration B. (absorptivity x concentration)/ light path C. absorptivity x light path x concentration D. (light path x concentration)/ absorptivity

Correct Answer: C

In spectrophotometry, which of the following is a mathematical expression of the relationship between absorbance and transmittance? A. A = abc B. (Au/Cu) = (As/Cs) C. A = 2 - log %T D. A = log %T

Correct Answer: C

In synovial fluid, the most characteristic microscopic finding in gout is: A. calcium pyrophosphate crystals B. cartilage debris C. monosodium urate crystals D. hemosiderin-laden macrophages

Correct Answer: C

In the APTT test, the patient's plasma is mixed with: A. ADP and calcium B. tissue thromboplastin and collagen C. phospholipid and calcium D. tissue thromboplastin and calcium

Correct Answer: C

In the Berthelot reaction, what contaminant will cause the urea level to be falsely elevated? A. Sodium fluoride B. Protein C. Ammonia D. Bacteria

Correct Answer: C

In the French-American-British (FAB) classification, myelomonocytic leukemia would be: A. M1 and M2 B. M3 C. M4 D. M5

Correct Answer: C

In the International System of Units, serum urea is expressed in millimoles per liter. urea; NH2CONH2 atomic weight: N=14 C=12 O=16 H=1 A serum urea nitrogen concentration of 28 mg/dL would be equivalent to what concentrations of urea? A. 4.7 mEq/L B. 5.0 mEq/L C. 10.0 mEq/L D. 20.0 mEq/L

Correct Answer: C

In the Jendrassik-Grof reaction for total bilirubin, bilirubin reacts with diazotized sulfanilic acid to form: A. diazo bilirubin B. biliverdin C. azobilirubin D. bilirubin glucuronide

Correct Answer: C

In what condition would an increased level of serum albumin be expected? A. Malnutrition B. Acute inflammation C. Dehydration D. Renal disease

Correct Answer: C

Increased concentrations of ascorbic acid inhibit chromogen production in which of the following glucose methods? A. ferricyanide B. ortho-toluidine C. glucose oxidase (peroxidase) D. hexokinase

Correct Answer: C

Increased levels of TdT activity are indicative of: A. Burkitt lymphoma B. acute myelocytic leukemia C. acute lymphocytic leukemia D. eosinophilia

Correct Answer: C

Indirect-reacting bilirubin may be quanti- fied by reacting it initially in which reagent? A. Dilute hydrochloric acid B. Dilute sulfuric acid C. Caffeine-sodium benzoate D. Sodium hydroxide

Correct Answer: C

Lactate dehydrogenase (LD)catalyzes the following reaction: Lactate + NAD+ (equilibrium arrow) pyruvate + NADH As the reaction is written, which of the following techniques can be used to assess LD activity? A. Measure the colorimetric product pyruvate. B. Measure the colorimetric product NADH. C. Measure the increase in absorbance at 340 nm as NADH is produced. D. Measure the decrease in absorbance at 340 nm as NADH is produced.

Correct Answer: C

Lactate dehydrogenase, malate dehydrogenase, isocitrate dehydrogenase, and hydroxybutyrate dehydrogenase all: A. are liver enzymes B. are cardiac enzymes C. catalyze oxidation-reduction reactions D. are class III enzymes

Correct Answer: C

Maple syrup urine disease is characterized by an increase in which of the following urinary amino acids? A. phenylalanine B. tyrosine C. valine, leucine and isoleucine D. cystine and cysteine

Correct Answer: C

Measuring which of the following compounds is useful in the diagnosis of steatorrhea? A. Vitamin B12 B. Vitamin C C. Carotenoids D. Folic acid

Correct Answer: C

Most of the carbo dioxide present in blood is in the form of: A. dissolved CO2 B. carbonate C. bicarbonate ion D. carbonic acid

Correct Answer: C

Name a commonly used precipitating reagent to separate HDL cholesterol from other lipoproteincholesterol fractions. A. Zinc sulfate B. Trichloroacetic acid C. Heparin-manganese D. Isopropanol

Correct Answer: C

Normally the bicarbonate concetration is about 24 mEq/L and the carbonic acid concentration is about 1.2, pK=6.1, log 20= 1.3. Using the equation pH= pK + log [salt]/[acid], calculate the pH. A. 7.28 B. 7.38 C. 7.40 D. 7.42

Correct Answer: C

Of the following specimens, which would be appropriate for determining exposure to lead? A. EDTA plasma B. Serum C. Whole blood D. Cerebrospinal fluid

Correct Answer: C

Of the following, the disease most closely asssociated with pale blue inclusions in granulocytes and giant platelets is: A. Gaucher disease B.Alder-Reilly anomaly C. May-Hegglin anomaly D. Pelger-Huet anomaly

Correct Answer: C

Of the total serum calcium, free ionized calcium normally represents approxi- mately what percent? A. 10 B. 40 C. 50 D. 90

Correct Answer: C

Of which of the following is 5-hydroxy- indoleacetic acid (5-HIAA) the primary metabolite? A. Epinephrine B. Norepinephrine C. Serotonin D. Prolactin

Correct Answer: C

On an electronic particle counter, if the RBC is erroneously increased, how will other parameters be affected? A. increased MCHC B. increased hemoglobin C. decreased MCH D. increased MCV

Correct Answer: C

On electrophoresis at alkaline pH, which of the following is the slowest migrating hemoglobin? A. Hgb A B. Hgb S C. Hgb C D. Hgb F

Correct Answer: C

One international unit of enzyme activity is the amount of enzyme that will, under specified reaction conditions of substrate concentration, pH and temperature, cause utilization of substrate at the rate of: A. 1 mol/min B. 1 mmol/min C. 1 umol/min D. 1 nmol/min

Correct Answer: C

Patient results are as follows: Test Patient results Reference range -PT: 17.5 sec 11-13 sec -APTT: 56.7 sec 25-35 sec -D-dimer: 698 ng/mL <250 ng/mL -fibrinogen: 123 mg/dL (1.23 g/L) 200-400 mg/dL (2.0-4.0 g/L) -platelet count: 102 x 10^3/uL (102 x 10^9/L) 150-450 x 10^3/uL (150-450 x 10^9/L) This workup suggest: A. blood clot B. hemorrhage C. DIC D. HUS

Correct Answer: C

Patients with chronic granulomatous disease suffer from frequent pyogenic infections due to the inability of: A. lymphocytes to produce bacterial antibodies B. eosinophils to degranulate in the presence of bacteria C. neutrophils to kill phagocytize bacteria D. basophils to release histamine I the presence of bacteria

Correct Answer: C

Portal cirrhosis is a chronic disease of the liver. As observed on an electrophoretic serum protein pattern, what is a predominant characteristic of this disease? A. Monoclonal band in the gamma- globulin region B. Polyclonal band in the gamma-globulin region C. Bridging effect between the beta- and gamma-globulin bands D. Increase in the alpha2-globulin band

Correct Answer: C

Premature atherosclerosis can occur when which of the following becomes elevated? A. chylomicrons B. prostaglandins C. low-density lipoproteins D. high-density lipoproteins

Correct Answer: C

Proteins may become denatured when subjected to mechanical agitation, heat, or extreme chemical treatment. How are proteins affected by denaturation? A. Alteration in primary structure B. Alteration in secondary structure C. Alteration in tertiary structure D. Increase in solubility

Correct Answer: C

Quantitation of Na+ and K+ by ion-selective electrode is the standard method because: A. dilution is required for flame photometry B. there is no lipoprotein interference C. of advances in electrochemistry D. of the absence of an internal standard

Correct Answer: C

Refer to the folloowing illustration: See BOC pg. 125 Pic 1 This illustration represents the change in absorbance at 340 nm over a period of 8 minutes in an assay for lactate dehydrogenase. True statement about this figure include: A. the reaction is follows zero order kinetics between 5 and 8 minutes B. the reaction is proceeding form lactate to pyruvate C. nonlinearity after 6 minutes is due to substrate exhaustion D. the change in absorbance is due to reduction of NAD to NADH

Correct Answer: C

Refer to the following diagram: See BOC pg 193 In the platelet aggregation curves shown above, the aggregating agent was added at the point indicated by the arrow. Select the appropriate aggregation curve for recent aspiring ingestion. (Aggregating agent is ADP or epinephrine.) A. A B. B C. C D. D

Correct Answer: C

Refer to the following illustration: See BOC pg 120 Pic 1 The above figure shows the reciprocal of the measured velocity of an enzyme reaction plotted against the reciprocal of the substrate concentration. True statement about this figure include: A. the intercept of the line on the abscissa (x-axis) can be used to calculate the Vmax B. the straight line indicates that the enzyme reaction proceeds according to zero order kinetics C. the intercept on the abscissa (x-axis) can be used to calculate the Michaelis-Menten constant D. the fact that the substrate concentration is plotted on both sides of the zero point indicates that the reaction is reversible

Correct Answer: C

Refer to the following illustration: See BOC pg 88 Pic 2 Patient values; Reference Values -Total Protein: 8.9 g/dL (89 g/L); 6.0-8.0 g/dL (60-80 g/L) -Albumin: 4.8 g/dL (48 g/L); 3.6-5.2 g/dL (36-52 g/L) -Alpha-1: 0.3 g/dL (3 g/L); 0.1-0.4 g/dL (1-4 g/L) -Alpha-2: 0.7 g/dL (7 g/L); 0.4-1.0 g/dL (4-10 g/L) -Beta: 0.8 g/dL (8 g/L); 0.5-1.2 g/dL (5-12 g/L) -Gamma: 2.3 g/dL (23 g/L); 0.6-1.6 g/dL (6-16 g/L) The serum protein electrophoresis pattern is consistent with: A. cirrhosis B. acute inflammation C. monoclonal gammopathy D. polyclonal gammopathy (eg, chronic inflammation)

Correct Answer: C

Refer to the following illustration: See BOC pg 90 Pic 2 Patient values; Reference Values -Total Protein: 8.5 g/dL (85 g/L); 6.0-8.0 g/dL (60-80 g/L) -Albumin: 4.3 g/dL (43 g/L); 3.6-5.2 g/dL (36-52 g/L) -Alpha-1: 0.3 g/dL (3 g/L); 0.1-0.4 g/dL (1-4 g/L) -Alpha-2: 0.7 g/dL (7 g/L); 0.4-1.0 g/dL (4-10 g/L) -Beta: 0.9 g/dL (9 g/L); 0.5-1.2 g/dL (5-12 g/L) -Gamma: 2.3 g/dL (2.3 g/L); 0.6-1.6 g/dL (6-16 g/L) The above serum protein electrophoresis pattern is consistent with: A. cirrhosis B. monoclonal gammopathy C. polyclonal gammopathy (eg, chronic inflammation) D. alpha-1-antitrypsin deficiency; severe emphysema

Correct Answer: C

Refer to the following pattern: See BOC pg 161 Pic 1 Which pattern is consistent with beta-thalassemia major? A. pattern A B. pattern B C. pattern C D. pattern D

Correct Answer: C

Secondary hyperparathyroidism is often the result of A. Vitamin C deficiency B. Liver disease C. Renal disease D. Thyroid disease

Correct Answer: C

Secretion of hormones by the anterior pituitary may be controlled by the circulating levels of hormones from the respective target gland, as well as hormones secreted by what organ? A. Posterior lobe of the pituitary gland B. Intermediate lobe of the pituitary gland C. Hypothalamus D. Adrenal medulla

Correct Answer: C

Select the test which evaluates renal tubular function: A. IVP B. creatinine clearance C. osmolarity D. microscopic urinalysis

Correct Answer: C

Serum and urine copper levels are assayed on a hospital patient with the following results: Patient values; Reference values -serum Cu: 20 ug/dL (3.1 umol/L); 70-140 ug/dL (11.0-22.0 umol/L) -urine Cu: 83 ug/dL (13.0 umol/L); < 40 ug/dL (<63 umol/L) This is most consistent with: A. normal copper levels B. Wilms tumor C. Wilson disease D. Addison disease

Correct Answer: C

Serum concentrations of vitamin B12 are elevated in: A. pernicious anemia in relapse B. patients on chronic hemodialysis C. chronic granulocytic leukemia D. Hodgkin disease

Correct Answer: C

Serum haptoglobin: A. is decreased in patients with tissue injury and neoplasia B. is increased in patients with prosthetic heart valves C. can be separated into distinct phenotypes by starch-gel electrophoresis D. binds heme

Correct Answer: C

Serum protein electrophoresis is routinely performed on the serum obtained from a clotted blood specimen. If a plasma specimen is substituted for serum,how will the electrophoresis be affected? A. Electrophoresis cannot be performed because the anticoagulant will retard the mobilities of the protein fractions. B. Electrophoresis cannot be performed because the anticoagulant will cause migration of the protein fractions in the direction of the cathode. C. Electrophoresis will show an extra fraction in the beta-gamma region. D. Electrophoresis will show an extra fraction in the prealbumin area.

Correct Answer: C

T-cell acute lymphocytic leukemia (ALL) is closely related to: A. chronic lymphocytic leukemia (CLL) B. automimmune disease C. lymphoblastic lymphoma D. acute myelocytic leukemia (AGL)

Correct Answer: C

Testing for the diagnosis of lead poisoning should include: A. erythrocyte protoporphyrin (EPP) B. urine delta-aminolevulinic acid C. whole blood lead D. zinc protoporphyrin (ZPP)

Correct Answer: C

The (8;14) chromosomal translocation brings which of the following 2 genes in close proximity? A. core binding factor alpha and the retinoic acid receptor B. the Abelson tyrosine kinase and breakpoint cluster region C. c-myc and the immunoglobulin heavy chain D. core binding factor beta and the myosin heavy chain

Correct Answer: C

The M:E ratio in erythroleukemia is usually: A. normal B. high C. low D. variable

Correct Answer: C

The VLDL fraction primarily transports what substance? A. Cholesterol B. Chylomicron C. Triglyceride D. Phospholipid

Correct Answer: C

The absence of intermediate maturing cells between the blast and mature neutrophil commonly seen in acute myelocytic leukemia and myelodysplastic syndromes is called: A. subleukemia B. aleukemic leukemia C. leukemic hiatus D. leukemoid reaction

Correct Answer: C

The activation of plasminogen to plasmin resulting in the degradation of fibrin occurs by A. PAI-1 B. alpha2 antiplasmin C. tPA D. alpha 2 macroglobulin

Correct Answer: C

The adrenal medulla secretes which of the following in the greatestquantity? A. Metanephrine B. Norepinephrine C. Epinephrine D. Dopamine

Correct Answer: C

The anion gap is useful for quality control of laboratory results for: A. amino acids and proteins B. blood gas analyses C. sodium, potassium, chloride, and total CO2 D. calcium, phosphorus and magnesium

Correct Answer: C

The band pass of a spectrophotometer is 10 nm. If an instalment is set at 540 nm, the wavelengths that are permitted to impinge on the sample will be within what wavelength range? A. 530-540nm B. 530-550nm C. 535-545nm D. 540-550nm

Correct Answer: C

The biuret reaction for the analysis of serum protein depends on the number of: A. free amino groups B. free carboxyl groups C. peptide bonds D. tyrosine residues

Correct Answer: C

The bone marrow in the terminal stage of erythroleukemia is often indistinguishable form that seen in: A. myeloid metaplasia B. polycythemia ver C. acute myelocytic leukemia D. aplastic anemia

Correct Answer: C

The calculated erythrocyte indices on an adult man are MCV= 89 fL, MCH 29 pg and MCHC=38%. The calculations have been rechecked; erythrocytes on the peripheral blood smear appear normocytic and normochromic with no abnormal forms. The next step is to: A. report the results B. examine another smear C. repeat the hemoglobin and hematocrit D. repeat the erythrocyte count and hematocrit

Correct Answer: C

The characteristic morphologic feature in lead poisoning is: A. macrocytosis B. target cells (codocytes) C. basophilic stippling D. rouleaux formation

Correct Answer: C

The chemical composition of HDL-cholesterol corresponds to: Triglyceride; Cholesterol; Protein A. 60%; 15%; 10% B. 10%; 45%; 25% C. 5%; 15%; 50% D. 85%; 5%; 2%

Correct Answer: C

The combination of increased capillary fragility and proglonged bleeding time suggests a deficiency in: A. thromboplastin B. prothrombin C. platelets D. fibrinogen

Correct Answer: C

The direct antiglobulin test is often positive in: A. congenital hemolytic spherocytosis B. march hemoglobinuria C. acquired hemolytic anemia D. thalassemia major

Correct Answer: C

The drug procainamide is prescribed to treat cardiac arrhythmia. What biologically active liver metabolite of procainamide is often measured simultaneously? A. phenobarbitol B. quinidine C. N-acetyl procainamide (NAPA) D. lidocaine

Correct Answer: C

The enzyme activity measured in the EMIT is the result of the reaction between the substrate and coenzyme with A. Free antibody B. Free unlabeled antigen C. Free labeled antigen D. Labeled antigen-antibody complexes

Correct Answer: C

The followign bilirubin result are obtained on a patient: -day 1: 4.3 mg/dL (73. 5 umol/L) -day 2: 4.6 mg/dL (78.7 umol/L) -day 3: 4.5 mg/dL (77.0 umol/L) -day 4: 2.2 mg/dL (37.6 umol/L) -day 5: 4.4 mg/dL (75.2 umol/L) -day 6: 4.5 mg/dL (77.0 umol/L) Given that the controls were within range each day, what is a probable explanation for the result on day 4? A. no explanation necessary B. serum, not plasma, was used for testing C. specimen had prolonged exposure to light D. specimen was hemolyzed

Correct Answer: C

The following blood gas results were obtained: -pH: 7.18 -PO2: 86 mm Hg -PCO2: 60 mm Hg -O2 saturation: 92% -HCO3: 7921 mEq/L (21 mmol/L) -TCO2: 23 mEq/L (23 mmol/L) -base excess: 8 mEq/L (-8.0 mmol/L) The patient's results are compatible with which of the following? A. fever B. uremia C. emphysema D. dehydration

Correct Answer: C

The following platelet aggregation tracing represents: See BOC pg 194 A. von Willebrand disease B. storage pool disease C. Glanzmann thrombasthenia D. aspirin

Correct Answer: C

The following results are form a 21-year-old patient with a back injury who appears otherwise healthy: -Whole blood glucose: 77 mg/dL (4.2 mmol/L) -Serum glucose: 88 mg/dL (4.8 mmol/L) -CSF glucose: 56 mg/dL (3.1 mmol/L) THe best interpretation of these results is that: A. the whole blood and serum values are expected both the CSF value is elevated B. the whole blood glucose value should be higher than the serum value C. all values are consistent with a normal healthy individual D. the serum and whole blood values should be identical

Correct Answer: C

The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss: WBC: 1.8 x 10^3/uL (1.8 x 10^9/L) RBC: 4.6 x 10^6/uL (4.6 x 10^12/L) Plt: 903 x 10^3/uL (903 x10^9/L) uric acid: 6.4 x mg/dL (380 umol/L) LAP: 0 Philadelphia chromosome: positive Differential: -Segs: 30% -Bands: 17% -Lymphs: 13% -Monos: 3% -Eos: 4% -Basos: 6% -Metamyelos: 3% -Myelos: 20% -Promyelos: 3% -Blasts: 1% These results are consistent with: A. neutrophilic leukemoid reaction B. idiopathic thrombocythemia C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis

Correct Answer: C

The following results were obtained on a patient's blood: -Hgb: 11.5 g/dL (115 g/L) -Hct: 40% -MCV 89 um^3 (89 fL) -MCHC 29% Examination of a Wright-stained smear of the same sample would most likely show: A. macrocytic, normochromic erythrocytes B. microcytic, hypochromic erythrocytes C. normocytic, hypochromic erythrocytes D. normocytic, normaochromic erythrocytes

Correct Answer: C

The glycated hemoglobin value represents the integrated values of glucose concentration during the preceding: A. 1-3 weeks B. 4-5 weeks C. 6-8 weeks D. 16-20 weeks

Correct Answer: C

The ideal capillary blood collection site on a newborn is: A. tip of the thumb B. ear lobe C. plantar surface of the heel D. the great toe

Correct Answer: C

The identification of Bence Jones protein is best accomplished by: A. a sulfosalicylic acid test B. urine reagent strips C. immunofixation D. electrophoresis

Correct Answer: C

The laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? A. iron deficiency B. hereditary spherocytosis C. vitamin B12 deficiency D. acute hemorrhage

Correct Answer: C

The large cell indicted by the arrow in image below is a: See BOC pg.183 Pic 2 A. myeloblast B. promyelocyte C. myelocyte D. metamyelocyte

Correct Answer: C

The majority of thyroxine (T4) is converted into the more biologically active hormone: A. thyroglobulin B. thyroid-stimulating hormone (TSH) C. triiodothyronine (T3) D. thyrotropin-releasing hormone

Correct Answer: C

The mean value of a reticulocyte count on specimens of cord blood from healthy, full-term newborns is approximately: A. 0.5% B. 2.0% C. 5.0% D. 8.0%

Correct Answer: C

The measurement of the pressure of dissolved CO2 (PCO2) in the blood is most closely associated with the concen- tration of what substance? A. pH B. Bicarbonate (HCOs) C. Carbonic acid (H2CO3) D. PO2

Correct Answer: C

The most appropriate screening test for detecting hemoglobin F is: A. osmotic fragility B. dithionite solubility C. Kleihauer-Betke D. heat instability

Correct Answer: C

The most common form (95%) of congenital adrenal hyperplasia is 21-hydroxylase deficiency, which is detected by elevate plasma: A. cortisol B. aldosterone C. 17-OH-progesterone D. 11-deoxycortisol

Correct Answer: C

The most important buffer pair in plasma is the: A. phosphate/biphosphate pair B. hemoglobin/imidazole pair C. bicarbonate/carbonic acid pair D. sulfate/bisulfate pair

Correct Answer: C

The most sensitive enzymatic indicator for liver damage form ethanol intake is: A. alanine aminotransferase (ALT) B. aspartate aminotransferase (AST) C. gamma-glutamyl transferase (GGT) D. alkaline phosphatase

Correct Answer: C

The peripheral blood monocyte is an intermediate stage in the formation of the: A. plasmacyte B. osteoclast C. fibroblast D. hairy cell

Correct Answer: C

The physician is concerned that a pregnant patient may be at risk for delivering prematurely. What would be the best biochemical marker to measure to assess the situation? A. Inhibin A B. a1-Fetoprotein C. Fetal fibronectin D. Human chorionic gonadotropin

Correct Answer: C

The presence of C-reactive protein in the blood is an indication of: A. a recent streptococcal infection B. recovery from a pneumococcal infection C. an inflammatory process D. a state of hypersensitivity

Correct Answer: C

The presence of increased CKMB activity on a CK electrophoresis pattern is most likely found in a patient suffering from: A. actue muscular stress following strenuous exercise B. malignant liver disease C. myocardial infarction D. severe head injury

Correct Answer: C

The principle excretory form of nitrogen is: A. amino acids B. creatinine C. urea D. uric acid

Correct Answer: C

The quantification of the high-density lipoprotein cholesterol level is thought to be significant in the risk assessment of what disease? A. Pancreatitis B. Cirrhosis C. Coronary artery disease D. Hyperlipidemia

Correct Answer: C

The reason carbon monoxide is so toxic is because it: A. is a protoplasmic poison B. combines with cytochrome oxidase C. has 200 times the affinity of oxygen for hemoglobin binding sites D. sensitizes the myocardium

Correct Answer: C

The reference ranges for the pH of arterial blood measure at 37C is: A. 7.28-7.34 B. 7.33-7.37 C. 7.35-7.45 D. 7.45-7.50

Correct Answer: C

The relative migration rate of proteins on cellulose acetate is based on: A. molecular weight B. concentration C. ionic charge D. particle size

Correct Answer: C

The secretion of which of the following is controlled by growth hormone? A. Growth hormone-releasing hormone B. Corticotropin-releasing hormone C. Somatomedin D. Somatostatin

Correct Answer: C

The term "lipid storage diseases" is used to denote a group of lipid disorders, the majority of which are inherited as autosomal recessive mutations. What is the cause of these diseases? A. Excessive dietary fat ingestion B. Excessive synthesis of chylomicrons C. A specific enzyme deficiency or nonfunctional enzyme form D. An inability of adipose tissue to store lipid materials

Correct Answer: C

The turbid, or milky, appearance of serum after fat ingestion is termed postprandial lipemia, which is caused by the presence of what substance? A. Bilirubin B. Cholesterol C. Chylomicron D. Phospholipid

Correct Answer: C

The urea nitrogen concentration of a serum sample was measured to be 15 mg/dL. urea; NH2CONH2 atomic weight: N=14 C=12 O=16 H=1 The urea concentration of the same sample, in mg/dL, is: A. 15 B. 24 C. 32 D. 40

Correct Answer: C

The value below were obtained on an automated blood count system performed on a blood sample from a 25-year-old man: Patient Normal -WBC: 5.1 x 10^3/uL 5.0-10.0 x 10^3/uL (5.1 x 10^9/L) (5.0-10.0 x 10^9/L) -RBC: 2.94 x 10^6/uL 4.6-6.2 x 10^6/ul (2.94 x 10^12/L) (4.6-6.2 x 10^12/L -Hgb: 13.8 g/dL(138g/L) 14-18 g/dL(140-180g/L) -Hct: 35.4% 40%-54% -MCV: 128 um^3 (128 fL) 82-90 um^3 (82-90 fL) -MCH: 46.7 pg 27-31 pg -MCHC: 40% . 32%-36% These results are most consistent with which of the following? A. megaloblastic anemia B. hereditary spherocytosis C. a high titer of cold agglutinins D. an elevated reticulocyte cout

Correct Answer: C

The white cell feature most characteristic of pernicious anemia is: A. eosinophilia B. toxic granulation C. hypersegmentatioin D. atypical lymphocytes

Correct Answer: C

To achieve the best levels of sensitivity and specificity, to what type of detector system could a gas chromatograph be coupled? A. UV spectrophotometer B. Bichromatic spectrophotometer C. Mass spectrometer D. Fluorescence detector

Correct Answer: C

To assure an accurate ammonia level result, the specimen should be: A. incubated at 37 C prior to testing B. spun and separated immediately, tested as routine C. spun, separated, iced, and tested immediately D. stored at room temperature until tested

Correct Answer: C

To detect barbiturate abuse when analyzing urine specimens, immunoassay is the method of choice for screening. The method of choice for confirmation is: A. nephelometry B. thin-layer chromatography C. gas chromatography/ mass spectrometry D. ultraviolet absorption spectroscopy

Correct Answer: C

To distinguish between hemophilia and von Willebrand disease, a patient with von Willebrand will present with which of the following test result? Result APTT Platelet screen Ristocetin cofactor -result A: aB nL nl -result B: nL aB nL -result C: aB aB aB -result D: nL nL aB A. result A B. result B C. result C D. result D

Correct Answer: C

To what class of enzymes does lactate dehydrogenase belong? A. Isomerases B. Ligases C. Oxidoreductases D. Transferases

Correct Answer: C

Total iron-binding capacity measures the serum iron transporting capacity of: A. hemoglobin B. ceruloplasmin C. transferrin D. ferritin

Correct Answer: C

Transportation of 60%-75% of the plasma cholesterol is performed by: A. chylomicrons B. very low-density lipoproteins C. low-density lipoproteins D. high-density lipoproteins

Correct Answer: C

Turbidity in serum suggests elevation of: A. cholesterol B. total protein C. chylomicrons D. albumin

Correct Answer: C

Valinomycin enhances the selectivity of the electrode used to quantitate: A. sodium B. chloride C. potassium D. calcium

Correct Answer: C

What cell shape is most commonly associated with an increased MCHC? A. teardrop cells B. target cells C. spherocytes D. sickle cells

Correct Answer: C

What does an increase in the serum enzyme levels indicate? A. Decreased enzyme catabolism B. Accelerated enzyme production C. Tissue damage and necrosis D. Increased glomerular filtration rate

Correct Answer: C

What dye may be used for staining protein bands following electrophoresis? A. Fat red 7B B. Sudan black B C. Ponceau S D. Oil red O

Correct Answer: C

What enzyme catalyzes the conjugation of bilirubin? A. Leucine aminopeptidase B. Glucose-6-phosphate dehydrogenase C. Uridinediphosphateglucuronyltrans- ferase D. Carbamoyl phosphate synthetase

Correct Answer: C

What feature would not be expected pseudo-Pelger-Huet cells? A. hyperclumped chromatic B. decreased granulation C. normal peroxidase activity D. abnormal neutrophils

Correct Answer: C

What is the MCH if the Hct is 20%, the RBC is 1.5 x 10^6/uL (1.5 x 10 ^12) and the Hgb is 6 g/dL (60 g/L)? A. 28 um^3 (28 fL) B. 30 um^3 (30 fL) C. 40 um^3 (40 fL) D. 75 um^3 (75 fL)

Correct Answer: C

What is the approximate number of half-life periods required for a serum drug concentration to reach 97-99% of the steady state? A. 1-3 B. 2-4 C. 5-7 D. 7-9

Correct Answer: C

What is the function of the flame in atomic absorption spectroscopy? A. Absorb the energy emitted from the metal analyte in returning to ground state B. Supply the thermal energy needed to excite the metal analyte C. Bring the metal analyte to its ground state D. Supply the light that is absorbed by the metal analyte

Correct Answer: C

What is the normal renal threshold of sodium (measured in millimoles per liter)? A. 80-85 B. 90-110 C. 110-130 D. 135-148

Correct Answer: C

What is the primary storage form of iron? A. Apotransferrin B. Myoglobin C. Ferritin D. Hemosiderin

Correct Answer: C

What is the proper pH for buffered solution used to perform serum protein electrophoresis? A. 5.6 B. 7.6 C. 8.6 D. 9.6

Correct Answer: C

What is the reference interval for fasting serum glucose in an adult expressed in SI units (International System of Units)? A. 1.7-3.3 mmol/L B. 3.3-5.6 mmol/L C. 4.1-5.5 mmol/L D. 6.7-8.3 mmol/L

Correct Answer: C

What substance gives feces its normal color? A. uroerythrin B. urochrome C. urobilin D. urobilinogen

Correct Answer: C

What would be an example of ectopic hormone production? A. Prolactinproductionbypituitarytumors B. Calcitoninproductionbythyroidtumors C. Growthhormoneproductionbylung tumors D. Cortisol production by adrenal tumors

Correct Answer: C

Whatdoestheconcentrationofurinary free cortisol mainlyreflect? A. Total serum cortisol B. Conjugated cortisol C. Unboundserumcortisol D. Protein-bound serum cortisol

Correct Answer: C

When a pH-sensitive glass electrode is not actively in use, in what type of solution should it be kept? A. Tap water B. Physiologic saline solution C. The medium recommended by the manufacturer D. A buffer solution of alkaline pH

Correct Answer: C

When an AMI occurs, in what order (list first to last) will the enzymes aspartate aminotransferase (AST), creatine kinase (CK), and lactate dehydrogenase (LD) become elevated in the serum? A. AST, LD, CK B. CK,LD,AST C. CK,AST, LD D. LD, CK,AST

Correct Answer: C

When is a blood sample for determination of the trough level of a drug appropriately drawn? A. Duringtheabsorptionphaseofthedrug B. Duringthedistributionphaseofthedrug C. Shortlybeforedrugadministration D. Two hours after drug administration

Correct Answer: C

When it is not possible to perform a creatinine assay on a fresh urine specimen, to what pH level should the urine be adjusted? A. 3.0 B. 5.0 C. 7.0 D. 9.0

Correct Answer: C

When quantifying glucose using an amperometric glucose electrode system, which of the following is not a component of the system? A. Product oxidation produces a current B. Hydrogen peroxide formed C. Hexokinase reacts with glucose D. Platinum electrode

Correct Answer: C

When quantifying serum total proteins, upon what is the intensity of the color produced in the biuret reaction dependent? A. Molecular weight of the protein B. Acidity of the medium C. Number of peptide bonds D. Nitrogen content of the protein

Correct Answer: C

When separating serum proteins by cellulose acetate electrophoresis, using Veronal (TM) buffer at pH 8.6, beta globulin migrates: A. faster than albumin B. slower than gamma globulin C. faster than gamma globulin D. faster than alpha-2 globulin

Correct Answer: C

Whendothehighestlevelsof gonadotropinsoccur? A. During the follicular phase of the menstrual cycle B. During the luteal phase of the menstrual cycle C. Atthemidpointofthemenstrualcycle D. Several days prior to ovulation

Correct Answer: C

Which bilirubin fraction is unconjugated and covalently bound to albumin? A. Alpha B. Beta C. Delta D. Gamma

Correct Answer: C

Which blood gas electrode is composed of silver/silver chloride reference electrode and glass? A. PO2 B. pH C. PCO2 D. HCO3

Correct Answer: C

Which glucose method catalyzes the phosphorylation of glucose by adenosine triphosphate, forming glucose-6- phosphate and adenosine diphosphate with the absorbance of the NADPH product read at 340 nm? A. o-Toluidine B. Glucose oxidase C. Hexokinase D. Glucose dehydrogenase

Correct Answer: C

Which glucose method is considered to be the reference method? A. Glucose oxidase B. o-Toluidine C. Hexokinase D. Glucosedehydrogenase

Correct Answer: C

Which is a compensatory mechanism in respiratory acidosis? A. Hypoventilation B. Decreased reabsorption of bicarbonate by the kidneys C. Increased Na+/H+ exchange by the kidneys D. Decreased ammonia formation by the kidneys

Correct Answer: C

Which is the following is the formula for mean corpuscular volume (MCV)? A. (Hgb x 10)/ RBC B. Hgb/Hct C. (Hct x 10)/RBC D. RBC/Hct

Correct Answer: C

Which is the most predominat form of secondary hematologic malignancy seen in patients with multiple myeloma? A. acute lymphoblastic leukemia B. acute eosinophilic leukemia C. acute myelomonocytic leukemia D. acute megakaryocytic leukemia

Correct Answer: C

Which of the following best describes chemiluminescence? A. Electron excitation caused by radiant energy B. Enzymatic oxidation of a substrate produces light emission C. Chemical energy excites electrons that emit light upon return to ground state D. Employs a fluorescent label that produces light

Correct Answer: C

Which of the following blood gas parameters are measured directly by the blood gas analyzer electrochemically as opposed to being calculated by the instrument? A. pH, HCO-3, total CO2 B. PCO2,HCO3,PO2 C. pH,PCO2,PO2 D. PO2, HCO3, total CO2

Correct Answer: C

Which of the following cells contain hemosiderin? A. megkaryocyte B. osteoclast C. histiocyte D. mast cell

Correct Answer: C

Which of the following characteristics will a protein have at its isoelectric point? A. Net negative charge B. Net positive charge C. Net zero charge D. Mobility

Correct Answer: C

Which of the following characterizes respiratory acidosis? A. Excess of bicarbonate B. Deficitofbicarbonate C. Excess of dissolved carbon dioxide (PCO2) D. Deficit of dissolved carbon dioxide (PCO2)

Correct Answer: C

Which of the following chemical determinations may be of help in establishing the presence of seminal fluid? A. lactic dehydrogenase (LD) B. isocitrate dehydrogenase (ICD) C. acid phophatase D. alkaline phosphatase

Correct Answer: C

Which of the following diseases results from a familial absence of high density lipoprotein? A. Krabble disease B. Gaucher disease C. Tangier disease D. Tay-Sachs disease

Correct Answer: C

Which of the following disorders is best characterized by these laboratory results? Serum iron—decreased Total iron-bindingcapacity— increased Transferrin saturation—decreased Serum ferritin—decreased Free erythrocyte protoporphyrin— increased A. Anemia of chronic disease B. Thalassemia C. Iron-deficiencyanemia D. Hemochromatosis

Correct Answer: C

Which of the following disorders is characterized by increased production of chloride in sweat? A. Multiple myeloma B. Hypoparathyroidism C. Cysticfibrosis D. Wilson disease

Correct Answer: C

Which of the following disorders is not associated with an elevation of serum creatine kinase? A. Cerebrovascularaccidents B. Hypothyroidism C. Bone disease D. Intramuscular injection

Correct Answer: C

Which of the following does not need to be done when collecting, handling, and using a specimen for ammonia analysis? A. Avoid using a hemolyzed specimen. B. Collect blood in EDTA or heparin evacuated tubes. C. Place specimen in a 37°C water bath immediately. D. Advise patient not to smoke for 8 hours before blood collection.

Correct Answer: C

Which of the following drugs is used as an immunosuppressant in organ transplanta- tion, especially in liver transplants? A. Methotrexate B. Amiodarone C. Tacrolimus D. Paroxetine

Correct Answer: C

Which of the following enzyme activities can be determined by using a dilute olive oil emulsion substrate, whose hydrolyzed product is monitored as a decrease in turbidity or light scatter? A. Alkaline phosphatase B. Amylase C. Lipase D. Trypsin

Correct Answer: C

Which of the following factors is used only in the extrinsic coagulation pathway? A. II B. V C. VII D. VIII

Correct Answer: C

Which of the following glucose methods should not be used during the administra- tion of an oral xylose absorption test? A. Glucose oxidase—colorimetric B. Glucose oxidase—polarographic C. Glucose dehydrogenase D. Hexokinase

Correct Answer: C

Which of the following hormones regulates normal blood calcium levels? A. thyroxine B. estriol C. parathyroid hormone D. growth hormone

Correct Answer: C

Which of the following instruments has a sample-introduction system, solvent-delivery system, column, and detector as components? A. Atomic absorption spectrometer B. Mass spectrometer C. High-performance liquid chromatograph D. Nephelometer

Correct Answer: C

Which of the following instruments is used in the clinical laboratory or in reference laboratories to detect beta and gamma emissions? A. Fluorometer B. Nephelometer C. Scintillation counter D. Spectrophotometer

Correct Answer: C

Which of the following is a true statement concerning serum enzymes? A. The presence of hemolyzed red cells is of no significance for an accurate assay of most serum enzymes. B. Serum asparate transaminase (AST), but not serum lactate dehydrogenase (LD), is usually elevated in acute myocardial infarction. C. Increased serum alkaline phosphatase may be found in bone disease. D. Aspartate transaminase was formerly known as glutamate pyruvate transaminase.

Correct Answer: C

Which of the following is an anionic dye that binds selectively with albumin? A. Amido black B. Ponceau S C. Bromcresol green D. Coomassie brilliant blue

Correct Answer: C

Which of the following is an electrophoretic technique employing a pH gradient that separates molecules with similar isoelectric points? A. Zone electrophoresis B. High-resolution electrophoresis C. Isoelectric focusing D. Immunoelectrophoresis

Correct Answer: C

Which of the following is an example of an antiarrhythmic drug that has a metabolite with the same action? A. Quinidine B. Digoxin C. Procainamide D. Nortriptyline

Correct Answer: C

Which of the following is another name for vitamin Bj2? A. Retinol B. Pyridoxine C. Cyanocobalamin D. Riboflavin

Correct Answer: C

Which of the following is associated with pseudo-pelter-Huet anomaly? A. aplastic anemia B. iron deficiency anemia C. myelogenous leukemia D. Chediak-Higashi syndrome

Correct Answer: C

Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? A. progressive decrease in overall cell size B. increasing basophilia of cytoplasm C. nuclear division without cytoplasmic division D. fusion of the nuclear lobes

Correct Answer: C

Which of the following is characteristic of platelet disorders? A. deep muscle hemorrhages B. retroperitoneal hemorrhages C. mucous membrane hemorrhages D. severely prolonged clotting time

Correct Answer: C

Which of the following is false about ion-selective electrode analysis of sodium? A. Uses a glass membrane B. Errors occur from protein buildup on the membrane. C. Membrane coated with valinomycin D. Principle based on potentiometry

Correct Answer: C

Which of the following is most likelyto be seen in lead poisoning? A. iron overload in tissue B. codocytes C. basophilic stippling D. ringed sideroblasts

Correct Answer: C

Which of the following is not associated with assessment of an AMI? A. Elevated serum cTnl level B. Elevated serum CK-MB level C. Abnormal serum alkaline phosphatase isoenzyme pattern D. Blood collected upon presentation and serially in 3- to 6-hour intervals

Correct Answer: C

Which of the following is not associated with insulin? A. Synthesized from proinsulin B. Synthesized by B-cells in the pancreas C. C-peptide is active form D. Two-chain polypeptide

Correct Answer: C

Which of the following is not associated with silver stains? A. Reactive to nanogram concentrations of proteins B. Polypeptides stain a variety of colors C. Not as sensitive as Coomassie brilliant blue D. Preconcentration of CSF not necessary

Correct Answer: C

Which of the following is not characteris- tic of Dubin-Johnson syndrome? A. Impaired excretion of bilirubin into the bile B. Hepatic uptake of bilirubin is normal C. Inability to conjugate bilirubin D. Increased level of bilirubin in urine

Correct Answer: C

Which of the following is not characteristic of multiple myeloma? A. Monoclonal band in the gamma region B. Hypercalcemia C. Hyperalbuminemia D. Hyperglobulinemia

Correct Answer: C

Which of the following is not descriptive of a photomultiplier tube? A. Emits electrons proportionally to initial light absorbed B. Must be shielded from stray light C. Cannot be used with a chopper D. Amplifies the initial signal received

Correct Answer: C

Which of the following is not quantified in the triple test for Down syndrome? A. cq-Fetoprotein B. Unconjugated estriol C. Progesterone D. Human chorionic gonadotropin

Correct Answer: C

Which of the following is not quantified using an immunoassay method? A. Vitamins B. Hormones C. Electrolytes D. Drugs

Correct Answer: C

Which of the following is true of acute lymphoblastic leukemia (ALL)? A. occurs most commonly in children 1-2 years of age B. patient is asymptomatic C. massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs D. children under 1 year of age have a good prognosis

Correct Answer: C

Which of the following is used for staining reticulocytes? A. Giemsa stain B. Wright stain C. new methylene blue D. Prussian blue

Correct Answer: C

Which of the following laboratory procedures is most helpful in differentiating severe liver disease and accompanying secondary fibrinolysis from disseminated intravascular coagulation? A. presence of fibrin split products B. increased APTT C. Factor VIII activity D. fibrinogen level

Correct Answer: C

Which of the following laboratory results is not characteristic of a complete obstruction of the common bile duct? A. Negative urine urobilinogen B. Negative fecal urobilinogen and urobilin C. Negative urinebilirubin D. Excretion of a pale-colored stool

Correct Answer: C

Which of the following markers, typically detected in normal myeloid cells, are expressed on the surface of hairy cell leukemia lymphocytes? A. CD3 B. CD8 C. CD11c D. CD103

Correct Answer: C

Which of the following may be associated with reflectance spectrophotometry as it relates to the dry reagent slide technique? A. Light projected to the slide at 180-degree angle B. Dye concentration directly proportional to reflectance C. Unabsorbed, reflected light detected by photodetector D. Reflectance values are linearly proportional to transmission values

Correct Answer: C

Which of the following may be associated with the colloid osmotic pressure (COP) osmometer? A. Utilizes a cooling bath set at -7°C B. Measures total serum osmolality C. Negative pressure on reference (saline) side equivalent to COP of sample D. Measures contribution of electrolytes to osmolality

Correct Answer: C

Which of the following methods is not used for the quantification of serum bilirubin? A. Bilirubinometer B. Jendrassik and Grof C. Zimmerman D. Bilirubinoxidase

Correct Answer: C

Which of the following proteins is normally produced by the fetus but is found in increased amounts in the amniotic fluid in cases of spina bifida? A. a1-Antitrypsin B. a1-Acid glycoprotein C. a1-Fetoprotein D. a2-Macroglobulin

Correct Answer: C

Which of the following reagent systems contains the components sulfanilic acid, hydrochloric acid, and sodium nitrite? A. Jaffe B. Zimmerman C. Diazo D. Lowry

Correct Answer: C

Which of the following sample collections would give an accurate assessment of potential excess cortisol production (hypercortisolism)? A. collect a plasma sample as a baseline, and another one-hour after administration of metyrapone B. collect a plasma sample at 8 AM only C. collect a 24-hour urine free cortisol D. collect a plasma sample at 8 AM and at 8 AM the next day

Correct Answer: C

Which of the following serum components is able to alter the free drug level in plasma? A. Creatinine B. Urea C. Albumin D. Calcium

Correct Answer: C

Which of the following serum protein fractions is most likely to be elevated in patients with nephrotic syndrome? A. alpha-1 globulin B. albumin C. alpha-2 globulin D. beta globulin and gamma globulin

Correct Answer: C

Which of the following sets of tests would be the most useful in diagnosing an AMI? A. AST, LD, CK-MB B. LD, CK-MB, troponin C. CK-MB, troponin, myoglobin D. LD, troponin, myoglobin

Correct Answer: C

Which of the following statements concerning creatine kinase is false? A. Rises within 4-6 hours after acute myocardial infarction B. Catalyzes the phosphorylation of creatine by A TP C. Requires Ca2+ for activity D. Found mainly in skeletal and cardiac muscles and in brain tissue

Correct Answer: C

Which of the following statements correctly describes alkaline phosphatase? A. Decreased in Paget disease B. Decreased in third trimester of a normal pregnancy C. Increased in obstructive jaundice D. Primarily found in cardiac muscle

Correct Answer: C

Which of the following statements is false about the electrolyte chloride? A. Main anion of the extracellular fluid B. Can shift from the extracellular plasma to the intracellular fluid of red blood cells C. Unable to be reabsorbed by active transport D. Measured in serum, urine, and sweat

Correct Answer: C

Which of the following techniques can be used to quantify apolipoproteins? A. Spectrophotometric endpoint B. Ion-selective electrode C. Immunonephelometric assay D. Refractometry

Correct Answer: C

Which of the following types of polycythemia is a severely burned patient most likely to have? A. polycythemia vera B. polycythemia, secondary to hypoxia C. relative polycythemia associated with dehydration D. polycythemia associated with renal disease

Correct Answer: C

Which one of the following statements concerning Vitamin K is not true? A. there are 2 sources of Vitamin K: vegetable and bacterial B. Vitamin K converts precursor molecules into functional coagulation factors C. heparin inhibits the action of Vitamin K D. Vitamin K is fat soluble

Correct Answer: C

Which percentage of total serum calcium is nondiffusible protein bound? A. 80%-90% B. 51%-60% C. 40%-50% D. 10%-30%

Correct Answer: C

Which statement best describes the clinical use of measuring NT-proBNP? A. Used to assess risk of coronary heart disease B. Used to assess risk of angina C. Used to assess individuals treated with nesiritide D. Used to assess individualstreated with vitamin B

Correct Answer: C

Which test, if elevated, would provide information about risk for developing coronary artery disease? A. Troponin B. CK-MB C. hs-CRP D. Myoglobin

Correct Answer: C

Which type of elution technique may be used in high-performance liquid chromatography? A. Amphoteric B. Isoelectric C. Gradient D. Ion exchange

Correct Answer: C

Whichofthefollowingisanautoantibody that binds to TSH receptor sites on thyroid cell membranes, preventing thyroid- stimulating hormone from binding? A. Antithyroglobulin antibodies B. Thyroid antimicrosomal antibodies C. Thyrotropin-receptor antibodies D. Antithyroid peroxidase antibodies

Correct Answer: C

Whichofthefollowingisthemostpotent estrogen and is considered to be the true ovarian hormone? A. Estriol (E3) B. Estrone (Ej) C. 17p-Estradiol (E2) D. 16a-Hydroxyestrone

Correct Answer: C

Why are the total thyroxine (T4) levels increased in pregnant women and women who take oral contraceptives? A. Inappropriate iodine metabolism B. Changes in tissue use C. Changes in concentration of thyroxine-binding globulin (TBG) D. Changes in thyroglobulin synthesis

Correct Answer: C

Zollinger-Ellison syndrome is character- ized by an elevated blood level of which of the following? A. Trypsin B. Pepsin C. Gastrin D. Cholecystokinin-pancreozymin

Correct Answer: C

50%-90% myeloblasts in a peripheral blood is typical of which of the following? A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia

Correct Answer: D

A 1-year-old girl with a hyperlipoproteinemia and lipase deficiency has the following lipid profile -cholesterol: 300 mg/dL (7.77 mmol/L) -LDL: increased -HDL: decreased -triglycerides: 200 mg/dL (2.26 mmol/L) -chylomircrons: present A serum specimen from this patient that was refrigerated overnight would most likely be: A. clear B. cloudy C. creamy layer over cloudy serum D. creamy layer over clear serum

Correct Answer: D

A 10-year-old female presents with varicella. The child has been experiencing fever, nausea, vomiting, lethargy, and disorientation. A diagnosis of Reye syndrome is determined. Which of the following laboratory results is not consistent with the diagnosis? A. Elevated serum AST B. Elevated serum ALT C. Elevated plasma ammonia D. Elevated serum bilirubin

Correct Answer: D

A 14-year-old boy is seen in the ER complaining of a sore throat, swollen glands and fatigue. The CBC results are: - WBC 16.0 x 10^3/uL (16.0 x 10^9/L) - RBC 4.37 x 10^6/uL (4.37 x 10^12/L) -Hgb: 12.8 g/dL (128 g/L) -Hct: 38.4% -Plt: 180 x 10 ^3/uL (180 x 10^9/L) Differential: absolute neutrophils: 3.9 x 10^9/L absolute lymphs: 6.0x 10^9/L absolute monos: 0.5 x 10^9/L absolute atypical lymphs 3.2 x10^9/L What is the most likely diagnosis? A. acute lymphocytic leukemia B. chronic lymphocytic leukemia C. viral hepatitis D. infectious mononucleosis

Correct Answer: D

A 21-year-old man with nauseas, vomitting, and jaundice has the following laboratory findings: Test; patient; Reference range -total serum bilirubin; 8.5 mg/dL (145.4 umol/L); 0-1.0 mg/dL (0.0- 17.1 umol/L) -conjugated serum bilirubin; 6.1 mg/dL (104.3 umol/L); 0-0.5 mg/dL (0.0-8.6 umol/L) -urine urobilinogen; increased -fecal urobilinogen: decreased -urine bilirubin: positive -AST: 200 U/L; 0-50 U/L -alkaline phosphatase: 170 U/L; 0-150 U/L These can best be explained as representing: A. unconjugated hyperbilirubinemia, probably due to hemolysis B. unconjugated hyperbilirubinemia, probably due to toxic liver damage C. conjugate hyperbilirubinemia, probably due to biliary tract disease D. conjugated hyperbilirubinemia, probably due to hepatocellular obstruction

Correct Answer: D

A 3-year-old child was evaluated for abdominal pain and anorexia by a physician. A CBC revealed a hemoglobin of 9.8 g/dL (98 g/L) and basophilic stippling of the RBCs. The doctor should order further tests to check for poisoning form: A. arsenic B. iron C. mercury D. lead

Correct Answer: D

A 30-year-old man who had been diagnosed as having leukemia 2 years previously was readmitted because of cervial lymphadenopathy Laboratory findinggs included the following: WBC: 39.6 x 10^3/uL (39.6 x 10^9/L) RBC: 3.25 x 10^6/uL (3.25 x 10^12/L) Hgb: 9.4 g/dL (94 g/L) Hct: 28.2% MCV: 86.7 um^3 (86.7 fL) MCH: 29.0 pg MCHC: 33.4% Plt: 53 x 10^3/uL (53 x10^9/L) LAP: 11 Philadelphia chromosome: positive Differential: -Polys: 7% -Lymphs: 4% -Monos: 2% -Eos: 3% -Basos: 48% -Myelos: 13% -Promyelos: 2% -Metamyelos: 8% -Blasts: 13% -NRBC: 11 Bone marrow: 95% cellularity, 50% blast cells (some with peroxidase and SBB positivity) These results are most consistent with: A. acute myeloid leukemia B. erythroleukemia C. chronic myelogenous leukemia (CML) D. CML in blast transformation

Correct Answer: D

A 4-year-old presents with chronic ear infections and is on prophylactic antibiotic. He presents wih bleeding. Factor assays reveal: Test Patient results Reference range -Factor VIII: 100% 50%-150% -Factor V: 75% 50%-150% -Factor IX: 38% 50%-150% -Factor II: 22% 50%-150% Possible causes are: A. Factor II deficiency B. lupus anticoagulant C. hemophilia D. Vitamin K deficiency

Correct Answer: D

A 42-year-old woman is admitted to the hospital with complaints of abdominal pain and inability to eat, which have gotten worse during the past several weeks. Although the pain had been uncomfortable, whatalarmedherwasnoticingaslight yellow color in her eyes. Blood was drawn andthetestresultsfollow:totalbilirubin 3.9 mg/dL, direct bilirubin 2.7 mg/dL, AST slightly elevated (3 times the upper limit of the reference range), ALT slightly elevated (3 times the upper limit of the reference range), alkaline phosphatase markedly elevated (6 times the upper limit of the reference range), and urine urobilinogen decreased. What diagnosis do these test results support? A. Viral hepatitis B. Cirrhosis C. Exposure to toxic chemicals D. Biliary obstruction

Correct Answer: D

A 45-year-old woman complains of fatigue, heat intolerance and hair loss. Total and ree T4 are abnormally low. If the TSH showed marked elevation, this would be consistent with: A. Grave disease B. an adenoma of the thyroid C. thyrotoxicosis D. primary hypothyroidism

Correct Answer: D

A 50-year-old man was admitted into the hospital with acute leukemia. Laboratory findings included the following: -Myeloperoxidase stain: Blast cells negative -PAS stain: Blast cells demonstrate a blocking pattern -Terminal deoxynucleotidyl transferase (TDT): Blast cells positive -Surface immunoglobulin: Blast cells negative -CD2: Blast cells negative -Philadelphia chromosome: Positive This results are most consistent with: A. acute myelogenous leukemia B. chronic lymphocytic leukemia in lymphoblastic transformation C. T-cell acute lymphocytic leukemia D. chronic myelogenous leukemia in lymphoblastic transformation

Correct Answer: D

A 50-year-old patient was found to have the following lab results: -Hgb 7.0 g/dL (70 g/L) -Hct: 20% -RBC 2.0 x 10^6/uL (2.0 x 10^12/L) It was determined that the patient was suffering from pernicious anemia. Which of the following sets of results most likely was obtained form the same patient? WBC Platelets Reticulocytes -Result A: 17,500; 350,000; 5.2% -Result B: 7,500; 80,000; 4.1% -Result C: 5,000; 425,000; 2.9% -Result D: 3,500; 80,000; 0.8% A. result A B. result B C. result C D. result D

Correct Answer: D

A 53-year-old man was in recovery following a triple bypass operation. Oozing was noted form his surgical wound. The following laboratory data were obtained: -Hemoglobin: 12.5 g/dL (125 g/L) -Hematocrit: 37% -Prothrombin time: 12.3 seconds -APTT: 34 seconds -Platelet count: 40.0 x 10^3/uL (40.0 x 10^9/L) -Fibrinogen: 250 mg/dL (2.5 g/L) The most likely cause of bleeding would be: A. dilution of coagulation factors due to massive transfusion B. intravascular coagulation secondary to microaggregates C. hypofibrinogenemia D. dilutional thrombocytopenia

Correct Answer: D

A 54-year-old man was admitted with pulmonary embolism and given streptokinase. Which of the following would be most useful in monitoring this therapy? A. activated partial thromboplastin time B. bleeding time C. prothrombin time D. thrombin time

Correct Answer: D

A 60-year-old man has a painful right knee and a slightly enlarged spleen. Hematology results include: -hemoglobin: 15 g/dL (150 g/L) -absolute neutrophil count: 10.0 x 10^3/uL (10.0 x 10^9/L) -platelet count: 900 x 10^3/uL (900 x 10^9/L) -uncorrected retic count: 1% normal red cel morphology and indices a slight increase in bands rare metamyelocyte and myelocyte giant and bizarre-shaped platelets This is most compatible with: A. congenital spherocytosis B. rheumatoid arthritis with reactive thrombocytosis C. myelofibrosis D. idiopathic thrombocythemia

Correct Answer: D

A Wright-stained peripheral smear reveal the following: -Erythrocytes enlarged 1.5 x to 2x normal sis -Schuffner dots -Parasites with irregular "spread-out" trophozoites, golden-brown pigment -12-24 merozoites -Wide range of stages This is consistent with Plasmodium: A. falciparum B. malariae C. ovale D. vivax

Correct Answer: D

A block in the differentiation of maturation of , and an accretion of immature hematopoietic progenitors is a hallmark of: A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia

Correct Answer: D

A blood gas sample was sent to the lab on ice, and a bubble was present in the syringe. The blood had been exposed to room air for at least 30 minutes. The following change in blood gases will occur: A. CO2 content increased/PCO2 decreased B. CO2 content and PO2 increased/pH increased C. CO2 content and PCO2 decreased/pH decreased D. PO2 increased/HCO3 decreased

Correct Answer: D

A blood sample from a patient with a hight-titer cold agglutinin, analyzed at room temperature, with an electronic particle counter would cause an error in the: A. Hgb and MCV B. MCHC and WBC C. WBC and RBC D. MCV and MCHC

Correct Answer: D

A blue top tube is drawn for coagulation studies, the sample is a short draw results may be: A. falsely shortened B. correct C. unable to be obtained D. falsely prolonged

Correct Answer: D

A bone marrow shows foam cells ranging from 20-100um in size, vacuolated cytoplasm containing sphingomyelin and is faintly PAS +. This cell type is most characteristic of: A. Gaucher disease B. myeloma with Russell bodies C. DiGuglielmo disease D. Niemann-Pick disease

Correct Answer: D

A cell surface marker that is expressed on neoplastic plasma cells and is helpful in the diagnosis of myeloma is: A. volume B. viability C. CD45 D. CD138

Correct Answer: D

A characteristic morphologic feature in hemoglobin C disease is: A. macrocytosis B. spherocytosis C. rouleaux formation D. target cells

Correct Answer: D

A characteristic of Bence Jones protein that is used to distinguid it form other urinary proteins is its solutiblity: A. in ammonium sulfate B. in sulfuric acid C. at 40 - 60 C D. at 100 C

Correct Answer: D

A chemiluminescent EIA: A. measures absorption of light B. is less sensitive than radioisotopic reactions C. is monitored by the use of a gamma counter D. is quantitated by the amount of light produced by the reaction

Correct Answer: D

A common cause of respiratory alkalosis is: A. vomiting B. starvation C. asthma D. hyperventilaiton

Correct Answer: D

A deficiency in which of the following leads to increased clotting time and may result in hemorrhagic disease in infancy? A. Riboflavin B. Pyridoxine C. Tocopherols D. Menaquinone

Correct Answer: D

A drug that relaxes the smooth muscles of the bronchial passages is: A. acetaminophen B. lithium C. phenytoin D. theophylline

Correct Answer: D

A healthy, active 10-year-old boy with no prior history of illness comes to the lab after school for a routine chemistry screen in order to meet requirements for summer camp. After centrifugation, the serum looks cloudy. The specimen had the following results: blood glucose = 135 mg/dL, total cholesterol =195 mg/dL, triglyceride =185 mg/dL. What would be the most probable explanation for these findings? The boy A. Is at risk for coronary artery disease B. Has type 1 diabetes mellitus that is undiagnosed C. Has an inherited genetic disease causing a lipid imbalance D. Was most likely not fasting when the specimen was drawn

Correct Answer: D

A mean cellular hemoglobin concentration (MCHC) over 36 g/dL (36 g/L) is frequently found in: A. hereditary spherocytosis B. lipemia (abnormally high plasma lipid) C. active cold agglutinin disease D. all of the above

Correct Answer: D

A mother brings her daughter, a 22-year- old medical technology student, to her physician. The patient is hyperventilating and has glossy eyes. The mother explains that her daughter is scheduled to take her final course exam the next morning. The patient had been running around frantically all day in a worried state and then started to breathe heavily. Blood gases are drawn in the office with the following results: pH = 7.58, PCO2 = 55 mm Hg, HCOj = 18 mmol/L .What do these data indicate? A. Metabolic alkalosis, partially compensated B. Respiratory acidosis, uncompensated C. A dual problem of acidosis D. An error in one of the blood gas measurements

Correct Answer: D

A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to: A. perform the RBC, Hgb, and Hct determinations using manual methods B. perform the RBC determination by a manual method; use the automated results for the Hgb and Hct C. repeat the determinations using a microsample of diluted blood D. repeat the determinations using a prewarmed micro sample of diluted blood

Correct Answer: D

A patient has a tumor that concentrates erythropoietin. He is most likely to have which of following types of polycythemia? A. polycythemia vera B. polycythemia, secondary to hypoxia C. benign familial polycythemia D. polycythemia associated with renal disease

Correct Answer: D

A patient has been treated for polycythemia vera for several years. His blood smear now shows: -Oval macrocytes -Howell-Jolly bodies -Hypersegmented neutrophils -Large, granular platelets The most probable cause of this blood picture is: A. iron deficiency B. alcoholism C. dietary B12 deficiency D. chemotherapy

Correct Answer: D

A patient has the following results: Patient values: Reference values -serum iron: 250 ug/dL 944.9 umol/L); 60-150 ug/dL (10.7 - 26.0 umol/L) -TIBC: 350 ug/dL (62.7 umol/L); 300-350 ug/dL) (53.7 - 62.7 umol/L) The best conclusion is that has: A. normal iron status B. iron deficiency anemia C. chronic disease D. iron hemochromatosis

Correct Answer: D

A patient is admitted with biliary cirrhosis. If a serum protein electrophoresis is performed, which of the following globulin fractions will be most elevated? A. alpha-1 B. alpha-2 C. beta D. gamma

Correct Answer: D

A patient is suspected of having Addison disease. His symptoms are weakness, fatigue, loss of weight, skin pigmentation, and hypoglycemia. His laboratory tests show low serum sodium and chloride, elevated serum potassium, and elevated urine sodium and chloride levels. The serum cortisol level is decreased and the plasma ACTH is increased. To make a definitive diagnosis, the physician orders an ACTH stimulation test, and serum cortisol levels are measured. If the patient has primary hypoadreno- cortical function (Addison disease), what would be the expected level of serum cortisol following stimulation? If the patient has hypopituitarism and secondary hypoadrenocortical function, what would be the expected level of serum cortisol followingstimulation? A. Increase from baseline; decrease from baseline B. Decrease from baseline; increase from baseline C. Slight increase from baseline; no change from baseline D. No change from baseline; slight increase from baseline

Correct Answer: D

A patient with glomerulonephritis is most likely to present with the following serum results: A. creatinine decreased B. calcium increased C. phosphorous decreased D. BUN increased

Correct Answer: D

A patient's blood was drawn at 8 am for a serum iron determination. The result was 85 ug/dL (15.2 umol/L). A repeat specimen was drawn at 8 PM; the serum was stored at 4 C and run the next morning. The result was 40 ug/dL (7.2 umol/L). These result are most likely due to: A. iron deficiency anemia B. improper storage of the specimen C. possible liver damage D. the time of day the second specimen was drawn

Correct Answer: D

A patient's thrombin time is 25.5 seconds, and the control is 11.5 seconds. The patient's plasma is mixed with an equal part of normal plasma. The thrombin time is rerun and is 28.0 seconds with a control of 11.5 seconds. These results indicate: A. fibrinogen deficiency B. thrombocyte antibodies present C. Factor VII deficiency D. circulating anticoagulant

Correct Answer: D

A patient's total cholesterol/HDL choles- terol ratio is 10.0. What level of risk for coronary heart disease does this result indicate? A. No risk B. Half average risk C. Average risk D. Twice average risk

Correct Answer: D

A person suspected of having metabolic alkalosis would have which of the following laboratory findings? A. CO2 content and PO2 elevated, pH decreased B. CO2 content decreased and pH elevated C. CO2 content, PCO2, and pH decreased D. CO2 content and pH elevated

Correct Answer: D

A physician orders several laboratory tests on a 55-year-old male patient who is complaining of pain, stiffness, fatigue, and headaches. Based on the following serum test results, what is the most likely diagnosis? Alkaline phosphatase—significantly increased Gamma-glutamyltransferase—normal A. Biliaryobstruction B. Cirrhosis C. Hepatitis D. Osteitis deformans

Correct Answer: D

A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this disease? A. creatinine B. LD isoenzymes C. beta-hydroxybutyrate D. amylase

Correct Answer: D

A prolonged thrombin time and a normal reptilase-R time are characteristic of: A. dysfibrinogenemia B. increased D-dimer C. fibrin monomer-split product complexes D. therapeutic heparinization

Correct Answer: D

A sample of blood is collected for glucose in a sodium fluoride tube before the patient has had breakfast. The physician calls 2 hours later and requests that determina- tion of blood urea nitrogen (BUN) be performed on the same sample rather than obtaining another specimen. The auto- mated analyzer in your laboratory utilizes the urease method to quantify BUN. What should you tell the physician? A. Will gladly do the test if sufficient specimen remains B. Could do the test using a micromethod C. Can do the BUN determination on the automated analyzer D. Cannot perform the procedure

Correct Answer: D

A serum creatinine was found to be 6.0 mg/dL. Which of the following urea nitrogen serum results would support the same pathological condition? A. 6mg/dL B. 20 mg/dL C. 35 mg/dL D. 70 mg/dL

Correct Answer: D

A serum ferritin level may not be a useful indicator of iron-deficiency anemia in patients with what type of disorder? A. Chronic infection B. Malignancy C. Viral hepatitis D. All the above

Correct Answer: D

A sweat chloride result of 55 mEq/L (55 mmol/L) and a sweat sodium of 52 mEq/L (52 mmol/L) were obtained on a patient who has a history of respiratory problems. The best interpretation of these result is: A. normal B. normal sodium and an abnormal chloride test should be repeated C. abnormal results D. borderline results, the test should be repeated

Correct Answer: D

A useful chemical test for the diagnosis of hairy cell leukemia is the : A. peroxidase test B. Sudan black test C. periodic acid-Schiff test D. tartrate-resistantacid phosphatase test

Correct Answer: D

A4-year-oldfemalepresentswitha palpable abdominal mass, pallor, and petechiae. Based on family history, clinical findings, and the patient's physical examination, neuroblastoma is suspected. Whichofthefollowingdoesnotsupport suchadiagnosis? A. Increased blood dopamine levels B. Increased blood epinephrine levels C. Increased urinary homovanillic acid D. Decreased urinary vanillylmandelic acid

Correct Answer: D

Acetaminophen is particularly toxic to what organ? A. Heart B. Kidney C. Spleen D. Liver

Correct Answer: D

Aldosterone is released by the adrenal cortex upon stimulation by: A. renin B. angiotensinogen C. angiotensin I D. angiotensin II

Correct Answer: D

All of the findings listed below may be seen in acquired hemolytic anemias of the autoimmune variety. The one considered to be the most characteristic is: A. increased osmotic fragility B. leukopenia and thrombocytopenia C. peripheral spherocytosis D. positive direct antiglobulin test

Correct Answer: D

Although serum elevations are not generally seen in early stages, which of the following tumor markers are elevated in more advanced stages of breast cancer? A. CEA and AFP B. AFP and CA 125 C. PSA and CA 15-3 D. CA 15-3 and CA 549

Correct Answer: D

An antiepileptic (or anticonvulsant) used to control seizure disorders is: A. digozin B. acetaminophen C. lithium D. phenytoin

Correct Answer: D

An arterial blood specimen submitted for blood gas analysis was obtained at 8:30 AM but was not received in the laboratory until 11 AM. The technologist should: A. perform the test immediately upon reciept B. perform the test only if the specimen was submitted in ice water C. requires a venous blood specimen D. request a new arterial specimen be obtained

Correct Answer: D

An automated platelet count indicates platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should: A. repeat the count on the same sample B. report the automated count C. perform a manual count D. recollect in sodium citrate

Correct Answer: D

Anticoagulated whole blood is the preferred specimen in determining exposure to what compound? A. Methanol B. Mercury C. Acetaminophen D. Carbon monoxide

Correct Answer: D

Auer rods are most likely present in which of the following? A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia

Correct Answer: D

Because of similar electrophoretic mobilities, several hemoglobins cannot be differentiated on cellulose acetate medium. Electrophoresis of hemoglobins at pH 6.2 on agar gel may be useful in differentiating which hemoglobins? A. A1 from A2 B. A1 from D C. A1 from E D. C from A2

Correct Answer: D

Before unconjugated bilirubin can react with Ehrlich diazo reagent, which of the following must be added? A. acetone B. ether C. distilled water D. caffeine

Correct Answer: D

Bence Jones proteinuria is a condition characterized by the urinary excretion of what type of light chain? A. Kappa light chains B. Lambda light chains C. Both kappa and lambda light chains D. Either kappa or lambda light chains

Correct Answer: D

Beriberi is associated with deficiency of vitamin: A. A B. C C. niacin D. thiamine

Correct Answer: D

Blood samples were collected at the beginning of an exercise class and after thirty minutes of aerobic activity. Which of the following would be most consistent with the post-exercise sample? A. normal lactic acid, low pyruvate B. low lactic acid, elevated pyruvate C. elevated lactic acid, low pyruvate D. elevated lactic acid, elevated pyruvate

Correct Answer: D

Cancer antigen 125 (CA 125) is a tumor marker associate with: A. breast carcinoma B. colon cancer C. lung cancer D. ovarian and endometrial carcinoma

Correct Answer: D

Carcinoembryonic antigen (CEA) is most likely to be produced in a malignancy involving the: A. brain B. testes C. bone D. colon

Correct Answer: D

Cell description: -Size: 12 to 16 um -Nucleus: oval, notched, folded over to horseshoe shape -Chromatin: fine lacy, stains light purple-pink -Nucleoli: none present -Cytoplasm: abundant, slate gray, with many fine lilac-colored granules This cell is a: A. promyelocyte B. lymphocyte C. neutrophil D. monocyte

Correct Answer: D

Cells involved in hemostasis are: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes

Correct Answer: D

Chronic lymphocytic leukemia is defined as a(n): A. malignancy of the thymus B. accumulation of prolymphocytes C. accumulation of hairy cells in the spleen D. accumulation of monoclonal B cells with a block in cell maturation

Correct Answer: D

Cocaine is metabolized to: A. carbomazepine B. codeine C. hydrocodone D. benzoylecgonine

Correct Answer: D

Creatinine clearance is used to estimate the: A. tubular secretion of creatinine B. glomerular secretion of creatinine C. renal glomerular and tubular mass D. glomerular filtration rate

Correct Answer: D

During pregnancy, estriol is synthesized in the placenta from formed in the . A. Estradiol, mother B. Estradiol, fetus C. 16a-Hydroxy-DHEA-S,mother D. 16a-Hydroxy-DHEA-S, fetus

Correct Answer: D

Elevation of the total granulocyte count above 7.7 x 10^3/uL (7.7 x 10^9/L) is termed: A. relative lymphocytosis B. leukocytosis C. relative neutrophilic leukocytosis D. absolute neutrophilic leukocytosis

Correct Answer: D

Enzymes that catalyze the transfer of groups between compounds are classified as belonging to which enzyme class? A. Hydrolases B. Eyases C. Oxidoreductases D. Transferases

Correct Answer: D

Erroneous ammonia levels can be eliminated by all of the following except: A. assuring water and reagents are ammonia-free B. separating plasma form cells and performing test analysis as soon as possible C. drawing the specimen in a pre-chilled tube and immersing the tube in ice D. storing the specimen protected form light until the analysis is done

Correct Answer: D

Express 30 mg/dL of urea nitrogen as urea. A. 14 mg/dL B. 20 mg/dL C. 50 mg/dL D. 64 mg/dL

Correct Answer: D

Fluorometers are designed so that the path of the exciting light is at a right angle to the path of the emitted light. What is the purpose of this design? A. Prevent loss of emitted light B. Prevent loss of the excitation light C. Focus emitted and excitation light upon the detector D. Prevent excitation light from reaching the detector

Correct Answer: D

Following overnight fasting, hypoglycemia in adults is defined as a glucose of: A. </= 70 mg/dL (</= 3.9 mmol/L) B. </= 60 mg/dL (</= 3.3 mmol/L) C.</= 55 mg/dL (</= 3.0 mmol/L) D.</= 45 mg/dL (</= 2.5 mmol/L)

Correct Answer: D

For which of the following laboratory instalments should preventive maintenance procedures be performed and recorded? A. Analytical balance B. Centrifuge C. Chemistry analyzer D. All the above

Correct Answer: D

Given the following data: -Hgb: 8 g/dL (80 g/L) -Hct: 28% -RBC: 3.6 x 10^6/uL (3.6 x 10^12/L) The MCV is: A. 28 um^3 (28 fL) B. 35 um^3 (35 fL) C. 40 um^3 (40 fL) D. 77 um^3 (77 fL)

Correct Answer: D

Given the following information for a rate reaction, calculate the activity of a serum specimen for alanine aminotransferase in international units per liter (IU/L). Time; Absorbance -1 min: 1.104; Specimen volume = 20 uL -2 min: 1.025; Reagent volume = 3.0 mL -3 min: 0.950; Molar absorptivity for NADH at 340 nm = 6.22 x 103 L/mol-cm -4 min: 0.873; Light path = 1 cm A. 186 B. 198 C.1857 D. 1869

Correct Answer: D

Given the following information, calculate the plasma osmolality in milliosmoles per kilogram: sodium—142 mmol/L; glucose—130 mg/dL; urea nitrogen— 18mg/dL. A. 290 B. 291 C. 295 D. 298

Correct Answer: D

Given the following results: -alkaline phosphatase: marked increase -aspartate amino transferase: slight increase -alanine amino transferase: slight increase -gamma-glutamyl transferase: marked increase This is most consistent with: A. acute hepatitis B. osteitis fibrosa C. chronic hepatitis D. obstructive jaundice

Correct Answer: D

Hageman Factor (XII) is involved in each of the following reactions except: A. activation of C1 to C1 esterase B. activation of plasminogen C. activation of Factor XI D. transformation of fibrinogen to fibrin

Correct Answer: D

Heinz bodies are: A. readily identified with polychrome stains B. rarely found in glucose-6-phosphate dehydrogenase deficient erythrocytes C. closely associated with spherocytes D. denatured hemoglobin inclusions that are readily removed by the spleen

Correct Answer: D

Hematology standards include: A. stabilized red blood cell suspension B. latex particles C. stabilized avian red blood cells D. certified cyaanmethemoglobin solution

Correct Answer: D

Hemoglobin are read on a photoelectric colorimeter in the laboratory. While reading the hemoglobins, a problem of drifting in encountered. To assess the problem, the first thing to do is: A. recalibrate the instrument B. check the filter C. set up new hemoglobin samples D. check the light source

Correct Answer: D

Hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) is: A. temperature-dependent B. complement-independent C. antibody-mediated D. caused by a red cell membrane defect

Correct Answer: D

Hemorrhage in polycythemia vera is the result of : A. increased plasma viscosity B. persistent thrombocytosis C. splenic sequestratioin of platelets D. abnormal platelet function

Correct Answer: D

Heparin acts by: A. precipitating fibrinogen B. binding calcium C. activating plasmin D. inhibiting thrombin

Correct Answer: D

High levels of which lipoprotein class are associated with decreased risk of accelerate atherosclerosis: A. Chylomicrons B. VLDL C. LDL D. HDL

Correct Answer: D

IN the Jaffe reaction, creatinine reacts with A. alkaline sulfasalazine solution to produce an orange-yellow complex B. potassium iodide to form a reddish-purple complex C. sodium nitroferricyanide to yield a reddish-brown color D. alkaline picrate solution to yield an orange-red complex

Correct Answer: D

If elevated, which laboratory test would support a diagnosis of congestive heart failure? A. Homocysteine B. Troponin C. Albumin cobalt binding D. B-type natriuretic peptide

Correct Answer: D

In a healthy individual,which protein fraction has the greatest concentration in serum? A. Alphai-globulin B. Beta-globulin C. Gamma-globulin D. Albumin

Correct Answer: D

In a specimen collected for plasma glucose analysis, sodium fluoride: A. serves as a coenzyme of hexokinase B. prevents reactivity of non-glucose reducing substances C. precipitates proteins D. inhibits glycolysis

Correct Answer: D

In addition to performing hemoglobin electrophoresis, a solubility test may be performed to detect the presence of what hemoglobin? A. A1 B. C C. F D. S

Correct Answer: D

In assaying an analyte with a single-beam atomic absorption spectrophotometer, what is the instrument actually measuring? A. Intensity of light emitted by the analyte on its return to the ground state B. Intensity of light that the analyte absorbs from the hollow-cathode lamp C. Intensity of light that the analyte absorbs from the flame D. Intensity of the beam from the hollow-cathode lamp after it has passed through the analyte-containing flame

Correct Answer: D

In comparison to malignant lymphoma cells, reactive lymphocytes: A. have a denser nuclear chromatin B. are known to be T cells C. have more cytoplasm and more mitochondria D. are morphologically more variable throughout the smear

Correct Answer: D

In gout, what analyte deposits in joints and other body tissues? A. Calcium B. Creatinine C. Urea D. Uric acid

Correct Answer: D

In infectious mononucleosis, lymphocytes tend to be: A.small with little cytoplasm B. normal C. decreased in number D. enlarged and indented by surrounding structures

Correct Answer: D

In laser flow cytometry, histograms combining the data from forward angle light scatter with the data form right-angle light scatter permit the operator to: A. quantitate cell surface protein B. determine absolute cell size C. distinguish internal cell structures D. differentiate cell populations form one another

Correct Answer: D

In most cases of hereditary persistence of fetal hemoglobin (HPFH) A. hemoglobin F is unevenly distributed throughout the erythrocytes B. the black heterozygote has 75% hemoglobin F C. beta and gamma chain synthesis is decreased D. gamma chain production equals alpha chain production

Correct Answer: D

In normal adult bone marrow, the most common granulocyte is the: A. basophil B. myeloblast C. eosinophil D. metamyelocyte

Correct Answer: D

In order for hemoglobin to combine reversibly with oxygen, the iron must be: A. complexed with haptoglobin B. freely circulating in the cytoplasm C. attached to transferrin D. in the ferrous state

Correct Answer: D

In respiratory acidosis, a compensatory mechanism is the increase in: A. chloride B. calcium C. potassium D. sodium

Correct Answer: D

In spectrophotometric analysis, what is the purpose of the reagent blank? A. Correct for interfering chromogens B. Correctforlipemia C. Correct for protein D. Correct for color contribution of the reagents

Correct Answer: D

In synovial fluid, the most characteristic finding in traumatic arthritis is: A. monosodium urate crystals B. cartilage debris C. calcium pyrophosphate dihydrate crystals D. hemosiderin-laden macrophages

Correct Answer: D

In the French-American-British (FAB) classification, abut lymphocytic leukemia is dividedinto groups according to: A. prognosis B. immunology C. cytochemistry D. morphology

Correct Answer: D

In the Malloy and Evelyn method for the determination of bilirubin, the reagent that is reacted with bilirubin to form a purple azobilirubin is: A. dilue sulfuric acid B. diazonium sulfate C. sulfobromophthalein D. diazotized sulfanilic acid

Correct Answer: D

In the atomic absorption method for calcium, lanthanum is used: A. as an internal standard B. to bind calcium C. to eliminate protein interference D. to prevent phosphate interference

Correct Answer: D

In the liver, bilirubin is converted to: A. urobilinogen B. urobilin C. bilirubin-albumin complex D. bilirubin diglucuronide

Correct Answer: D

In the normal adult, the spleen acts as a site for: A. storage of red blood cells B. production of red blood cells C. synthesis of erythropoietin D. removal of imperfect and aging cells

Correct Answer: D

In the plasma, an excess in the concentra- tion of bicarbonate without a change in PCO2 from normal will result in what physiological state? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

Correct Answer: D

In using ion-exchange chromatographic methods, falsely increased levels of Hgb A2, might be demonstrated in the presence of: A. iron deficiency anemia B. pernicious anemia C. thalassemias D. Hgb S

Correct Answer: D

In von Willebrand disease, platelets give an abnormal aggregation result in the presence of: A. adenosine diphosphate B. epinephrine C. collagen D. ristocetin

Correct Answer: D

In which of the following conditions does decreased activity of glucuronyl transferase result in increased unconjugated bilirubin and kernicterus in neonates? A. Gilbert disease B. Rotor syndrome C. Dubin-Johnson syndrome D. Crigler-Jajjar syndrome

Correct Answer: D

In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen? A. hemolytic anemia B. multiple myeloma C. G-6-PD deficiency D. myeloid metaplasia

Correct Answer: D

In which of the following disorders would the maternal serum level of a1-fetoprotein not be elevated? A. Neural tube defect B. Spina bifida C. Fetal distress D. Down syndrome

Correct Answer: D

Inclusions in the cytoplasm of neutrophils as shown in the figure below are known as: See BOC pg 166 A. Auer bodies B. Howell-Jolly bodies C. Heinz bodies D. Dohle bodies

Correct Answer: D

Increased serum albumin concentrations are seen in which of the following conditions? A. nephrotic syndrome B. acute hepatitis C. chronic inflammation D. dehydration

Correct Answer: D

Increased total serum lactidehydrogensase (LD) activity, confined to fractions 4 and 5 is most likely to be associated with: A. pulmonary infarciton B. hemolytic anemia C. myocardial infarction D. acute viral hepatitis

Correct Answer: D

Ingestion of which of the following drugs may cause hypoglycemia? A. Ethanol B. Propranolol C. Salicylate D. All the above

Correct Answer: D

Isoenzyme assays are performed to improve: A. precision B. accuracy C. sensitivity D. specificity

Correct Answer: D

Laboratory tests are performed on a postmenopausal, 57-year-old female as part of an annual physical examination. The patient's casual plasma glucose is 220 mg/dL, and the glycated hemoglobin (Hb AIC) is 11%. Based on this informa- tion, how should the patient be classified? A. Normal glucose tolerance B. Impaired glucose tolerance C. Gestational diabetes mellitus D. Type 2 diabetes mellitus

Correct Answer: D

Levels of 8-9% carboxyhemoglobin saturation of whole blood are commonly found in which of the following situations? A. Fatal carbon monoxide poisoning B. Acute carbon monoxide poisoning C. Nonsmoking residents of rural areas D. Cigarette smokers

Correct Answer: D

Lithium therapy is widely used in the treatment of: A. hypertension B. hyperactivity C. aggression D. manic-depressive (bipolar) disorder

Correct Answer: D

Magnesium carbonate is added in an iron binding capacity determination in order to: A. allow color to develop B. precipitate protein C. bind with hemoglobin iron D. remove excess unbound iron

Correct Answer: D

Malid dehydrogenas is added to the aspartate aminotransaminase (AST) reaction to catalyze the conversion of: A. alpha-ketoglutarate to aspartate B. alpha-ketoglutarate to malate C. aspartate to oxalacetate D. oxalacetate to malate

Correct Answer: D

Many microsherocytes, schitocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: A. hereditary spherocytosis B. disseminated intravascular coagulation (DIC) C. acquired autoimmune hemolytic anemia D. extensive burns

Correct Answer: D

Measuring the tubular reabsorption of phosphate is useful in diagnosing diseases that affect which of the following organs? A. Liver B. Adrenal gland C. Thyroid gland D. Parathyroid gland

Correct Answer: D

Metabolic acidosis is described as a(n): A. increase in CO2 content and PCO2 with a decreased pH B. decrease in CO2 content with an increased pH C. increase in CO2 with an increased pH D. decrease in CO2 content and PCO2 with a decreased pH

Correct Answer: D

Monitoring long-term glucose control in patients with adult onset diabetes mellitus can best be accomplished by measuring: A. weekly fasting 7 AM serum glucose B. glucose tolerance testing C. 2-hour postprandial serum glucose D. hemoglobin A 1C

Correct Answer: D

Morphologic variants of plasma cells do not include: A. flame cells B. marula cells C. grape cells D. Gaucher cells

Correct Answer: D

Most atomic absorption spectrophotometers incorporate a beam chopper and a tuned amplifier. The purpose of these components is to avoid errors that would be caused by A. Variations in flame temperature B. Deterioration of the hollow-cathode lamp C. Stray light from the hollow-cathode lamp D. Measurement of light emitted by the analyte

Correct Answer: D

Most chemical methods for determining total protein utilize which of the following reactions? A. molybdenum blue B. ferri-ferrocyanide C. resorcinol-HCL D. biuret

Correct Answer: D

Multipotent stem cells are capable of producing: A. daughter cells of only one cell line B. only T-lymphocytes and B-lymphocytes C. erythropoietin, thrombopoietin, and leukopoietin D. lymphoid and myeloid stem cells

Correct Answer: D

Of the five immunoglobulin classes, IgG is the most structurally simple, consisting of how many light chains/heavy chains, respectively? A. 5/2 B. 1/1 C. 2/5 D. 2/2

Correct Answer: D

Of the following blood glucose levels, which would you expect to result in glucose in the urine? A. 60mg/dL B. 120mg/dL C. 150mg/dL D. 225mg/dL

Correct Answer: D

Of the following, the disease most closely associated with mucopolysaccharidosis is: A. Pelger-Huet anomaly B. Chediak-Higashi syndrome C. Gaucher disease D. Alder-Reilly anomaly

Correct Answer: D

Of the total serum osmolality, sodium, chloride, and bicarbonate ions normally contribute approximately what percent? A. 8 B. 45 C. 75 D. 92

Correct Answer: D

Oligoclonal bands are present on electrophoresis of concentrated CSF and also on concurrently tested serum of the same patient. The proper interpretation is: A. diagnostic for primary CNS tumor B. diagnostic for multiple sclerosis C. CNS involvement by acute leukemia D. nondiagnostic for multiple sclerosis

Correct Answer: D

On Monday a patient's hemoglobin determination was 11.3 g/dL (113 g/L), and on Tuesday it measured 11.8 g/dL (118 g/L). The standard deviation of the method used is +-0.2 g/dL (2 g/L). Which of the following can be concluded about the hemoglobin values given? A. one value probably resulted from laboratory error B. there is poor precision; daily quality control charts should be checked C. the second value is out of range and should be repeated D. there is no significant change in the patient's hemoglobin concentration

Correct Answer: D

On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated? A. call for service B. adjust the MCV up slightly C. shut down the instrument D. repeat the control

Correct Answer: D

Patients with A(-) type G-6-PD deficiency are least likely to have hemolytic episodes in which of the following situations? A. following the administration of oxidizing drugs B. following the ingestion of fava beans C. during infections D. spontaneously

Correct Answer: D

Pellarga is associated with deficiency of which of the following vitamins? A. A B. B1 C. thiamine D. niacin

Correct Answer: D

Platelet aggregation will occur with the end production of: A. cyclooxygenase B. arachidonic acid C. prostacyclin D. thromboxane A2

Correct Answer: D

Pregnant women with symptoms of thirst, frequent urination or unexplained weight loss should have which of the following tests performed? A. tolbutamide test B. lactose tolerance test C. epinephrine tolerance test D. glucose tolerance test

Correct Answer: D

Primary aldosteronism results from a tumor of the adrenal cortex. How would the extracellular fluid be affected? A. Normal sodium, decreased potassium levels B. Decreased sodium, decreased potassium levels C. Decreased sodium, increased potassium levels D. Increased sodium,decreased potas- sium levels

Correct Answer: D

Proteins, carbohydrates, and lipids are the three major biochemical compounds of human metabolism. What is the element that distinguishes proteins from carbohydrate and lipid compounds? A. Carbon B. Hydrogen C. Oxygen D. Nitrogen

Correct Answer: D

Refer to the following illustration: See BOC pg 102 Which of the following is the most likely interpretation of the LD isoenzyme scan illustrated above? A. myocardial infarction B. megaloblastic anemia C. acute pancreatitis D. viral hepatitis

Correct Answer: D

Refer to the following illustration: See BOC pg 204 Which are in the automated cell counter histogram represents the RBC distribution curve? A. A B. B C. C D. D

Correct Answer: D

Refer to the following illustration: See BOC pg 208 Which are of the automated cell counter histogram represents the platelet distribution curve? A. A B. B C. C D. E

Correct Answer: D

Refer to the following illustration: See BOC pg 88 Pic 1 Patient values; Reference Values -Total Protein: 7.3 g/dL (73 g/L); 6.0-8.0 g/dL (60-80 g/L) -Albumin: 4.2 g/dL (42 g/L); 3.6-5.2 g/dL (36-52 g/L) -Alpha-1: 0.0 g/dL (0 g/L); 0.1-0.4 g/dL (1-4 g/L) -Alpha-2: 0.9 g/dL (9 g/L); 0.4-1.0 g/dL (4-10 g/L) -Beta: 0.8 g/dL (8 g/L); 0.5-1.2 g/dL (5-12 g/L) -Gamma: 1.4 g/dL (14 g/L); 0.6-1.6 g/dL (6-16 g/L) This electrophoresis pattern is consistent with: A. cirrhosis B. monoclonal gammopathy C. polyclonal gammopathy (eg, chronic inflammation D. alpha-1 antitrypsin deficiency; severe emphysema

Correct Answer: D

Regan isoenzyme has the sam properties as alkaline phosphatase that originates in the: A. skeleton B. kidney C. intestine D. placenta

Correct Answer: D

Rickets is associated with deficiency of which of the following vitamins? A. B1 B. C C. niacin D. D

Correct Answer: D

Serum "anion gap" is increased in patients with: A. renal tubular acidosis B. diabetic alkalosis C. metabolic acidosis due to diarrhea D. lactic acidosis

Correct Answer: D

Singlet oxygen reacting with a precursor chemiluminescent compound to form a decay product whose light energizes a fluorophore best describes A. Fluorescent polarization immunoassay B. Enzyme-multiplied immunoassay technique C. Electrochemiluminescence immunoassay D. Luminescent oxygen channeling immunoassay

Correct Answer: D

Stray light can be detected in a spectrophotometer by utilizing a: A. mercury vapor lamp B. homium oxide glass C. potassium dichromate solution D. sharp cutoff filter

Correct Answer: D

THe principle of the tablet test for bilirubin in urine or feces is: A. the reaction between bile and 2,4-dichloronitrobenzene to a yellow color B. the liberation of oxygen by bile to oxidize orthotolidine to a blue -purple color C. chemical coupling of bile with a diazonium slat to form a brown color D. chemical coupling of bilirubin with a diazonium salt to form a purple color

Correct Answer: D

Terminal deoxynucleotidyl transferase (TdT) is a marker found on: A. hairy cells B. myeloblasts C. monoblasts D. lymphoblasts

Correct Answer: D

Thalassemia are characterized by: A. structural abnormalities in the hemoglobin molecule B. absence of iron in hemoglobin C. decreased rate of heme synthesis D. decreased rate of globin synthesis

Correct Answer: D

The 2 factors that differentiate liver disease from Vitamin K deficiency are: A. II and VII B. IX and VII C. VIII and IX D. V and VII

Correct Answer: D

The APTT: A. tests the extrinsic coagulation pathway B. monitors Coumadin therapy C. requires tissue thromboplastin D. monitors heparin therapy

Correct Answer: D

The ISI in the INR represents the reagents: A. activator B. specificity C. phospholipids D. sensitivity

Correct Answer: D

The abnormal metabolism of several of the amino acids has been linked with disorders classified as inborn errors of metabolism. What technique is used to differentiate among several different amino acids? A. Electrophoresis B. Microbiological analysis C. Enzyme immunoassay D. Chromatography

Correct Answer: D

The automated platelet count on an EDTA specimen is 58 x 10^3/uL (58 x 10^9/L). The platelet estimated on the blood smear appears normal, but it was noted that the platelet were surrounding the neutrophils. The next step should be too: A. report the automated platelet count since it is more accurate than a platelet estimate B. warm the EDTA tube and repeat the automated platelet count C. rerun the original specimen since the platelet count and blood smear estimate do not match D. recollect a specimen for a platelet count using a different anticoagulant

Correct Answer: D

The bicarbonate and carbonic acid ration is calculate form an equation by: A. Siggaard-Andersen B. Gibbs-Donnan C. Natelson D. Henderson-Hasselbalch

Correct Answer: D

The bicarbonate ion concentration may be calculated from the total CO2 and PCO2 blood levels by using which of the following formulas? A. 0.03 x (PCO2 - total CO2) B. (total CO2 + 0.03) x PCO2 C. 0.03 x (total CO2 - PO2) D. total CO2 - (0.03 x PCO2)

Correct Answer: D

The biologically most active, naturally occurring androgen is: A. androstenedione B. cortisol C. epiandrosterone D. testosterone

Correct Answer: D

The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and; A. sodium B. potassium C. calcium D. chloride

Correct Answer: D

The characteristic erythrocyte found in pernicious anemia is: A. microcytic B. spherocytic C. hypochromic D. macrocytic

Correct Answer: D

The conversion of glucose or other hexoses into lactate or pyruvate is called: A. glycogenesis B. glycogenolysis C. gluconeogenesis D. glycolysis

Correct Answer: D

The creatinine clearance test is routinely used to assess the glomerular filtration rate. Given the followinginformation for an average-size adult, calculate a creatinine clearance. -Urine creatinine—120 mg/dL -Plasma creatinine—1.2 mg/dL -Urine volume for 24 hours—1520 mL A. 11 mL/min B. 63mL/min C. 95mL/min D. 106 mL/min

Correct Answer: D

The degree to which the kidney concentrates the glomerular filtrate can be determined by: A. urine creatine B. serum creatinine C. creatinine clearance D. urine to serum osmolality ration

Correct Answer: D

The enzyme present in almost all tissues that may be separated by electrophoresis into 5 components is: A. lipase B. transaminase C. creatine kinase D. lactate dehydrogenase

Correct Answer: D

The enzyme, which exists chiefly in skeletal muscle, heart, and brain, is grossly elevate in active muscular dystrophy, and rises early in myocardial infarction is: A. lipase B. transaminase C. lactate dehydrogenase D. creatine kinase

Correct Answer: D

The first step in analyzing a 24-hour urine specimen for quantitative urine protein is: A. subculture the urine for bacteria B. add the appropriate preservative C. screen for albumin using a dipstick D. measure the total volume

Correct Answer: D

The first step in the quantitation of serum iron is: A. direct reaction with appropriate chromogen B. iron saturation of transferrin C. free iron precipitation D. separation of iron form transferring

Correct Answer: D

The following CBC results were obtained from an automated cell counter on a patient sample with lipemic plasma: -WBC: 7.2 x 10^3/uL (7.2 x 10^9/L) -RBC: 3.50 x 10^6/uL (3.50 x 10^12/L) -Hgb: 13.8 g/dL (138 g/L) -Hct: 33.5% -MCV: 92 um^3 (92 fL) -MCH: 39.4 pg -MCHC: 41.0% Which of the following test would probably be in error? A. WBC, RBC, MCV B. RBC, Hct, MCV C. RBC, Hgb, Hct D. Hgb, MCH, MCHC

Correct Answer: D

The following laboratory resutls were obtained: BF type; Calcium; Alkaline Phosphate; Alkaline phosphatase -serum: increased: decrease; normal or increased -urine: increased; increased These result are most compatible with: A. multiple myeloma B. milk-alkali syndrome C. sarcoidosis D. primary hyperparathyroidism

Correct Answer: D

The following results were obtained from a post-surgical patient receiving total parenteral nutrition: Hospital day: 17 , 18 , 19 Hgb: 12.1 g/dL (121 g/L), 11.6 g/dL(116 g/L), 9.4 g/dL (94 g/L) Hct: 29.2% , 29.4% , 28.8% The most consistent explanation for the above data is A. acute sundial bleeder B. specimen on day 19 from wrong patient C. improperly mixed specimen of day 19 D. lipid interference on days 17 and 18

Correct Answer: D

The following results were obtained in a creatinine clearance evaluation: -urine concentration: 84 mg/dL -urine volume: 1, 440 mL/24 hr -serum concentration: 1.4 mg/dL -body surface area: 1.60 m2 (average =1.73 m2) The creatinine clearance in mL/min is: A. 6 B. 22 C. 60 D. 65

Correct Answer: D

The following results were obtained on an electronic particle counter: -WBC: ++++ -RBC: 2.01 x 10^6/uL (2.01 x 10^12/L) -Hgb: 7.7 g/dL (77 g/L) -Hct: 28.2% -MCV: 141 um^3 (141 fL) -MCH: 38.5 pg -MCHC: 23.3% What step should be taken before recycling the sample? A. clean the apertures B. warm the specimen C. replace the lysing agent D. dilute the specimen

Correct Answer: D

The following results were obtained: -WCB: 1.8 x 10^3/uL (1.8 x 10^9/L) -Hgb: 8.9 g/dL (89 g/L) -Hct: 27.4% -Plt: 2,300 x 10^3/uL (2.30 x 10^9/L) -LAP: 90 Differential: -Segs: 70% -Bands: 10% -Lymphs: 18% -Monos: 2% -Giant, bizarre platelets, rare megakaryocytes, 3+ Poikilocytosis, 2+ Anisocytosis, 1+ Schizocytosis This is consistent with: A. neutrophili leukemoid reaction B. polycythemia vera C. leukoerythroblastosis in myelofibrosis D. idiopathic thrombocythemia

Correct Answer: D

The following results were obtained: WBC: 5.0 x 10^3/uL (5.0 x 10^9/L) RBC: 1.7 x 10^6/uL (1.7 x 10^12/L) MCV: 84 um^3 (84 fL) Plt: 89 x 10^3/uL (89 x10^9/L) LAP: 142 Philadelphia chromosome: negative Differential: -Segs: 16% -Bands: 22% -Lymphs: 28% -Monos: 16% -Eos: 1% -Basos: 1% -Metamyelos: 4% -Myelos: 3% -Promyelos: 4% -Blasts: 5% 1 megakaryoblast; 30 nucleated erythrocytes; teardrops; schitocytes; polychromasia; giant, bizarre platelets noted. This is consistent with: A. idiopathic thrombocythemia B. polycythemia vera C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis

Correct Answer: D

The function of the major lipid components of the very low-density lipoproteins (VLDL) is to transport: A. cholesterol form peripheral cells to the liver B. cholesterol and phospholipids to peripheral cells C. exogenous triglycerides D. endogenous triglycerides

Correct Answer: D

The hemoglobin that is resistant to alkali (KOH) denaturation is: A. A B. A2 C. C D. F

Correct Answer: D

The international Federation for Clinical Chemistry (IFCC) recommends the use of methods such as the Bessey-Lowry Brock method for determining alkaline phosphatase activity. The substrate used in this type of method is: A. monophophate B. phenylphosphate C. disodium phenylphosphate D. para-nitrophenylphosphate

Correct Answer: D

The kinetic methods for quantifying serum triglyceride employ enzymatic hydrolysis. The hydrolysis of triglyceride may be accomplished by what enzyme? A. Amylase B. Leucine aminopeptidase C. Lactate dehydrogenase D. Lipase

Correct Answer: D

The light-colored zone adjacent to the nucleus in a plasmacyte is the: A. Ribosome B. Chromatin C. Mitochondria D. Golgi area

Correct Answer: D

The metabolite 11-nor-tetrahydrocannabinol-9-COOH can be detected by immunoassay 3-5 days after a single use of: A. methoamphetamine B. cocaine C. benzodiazepine D. marijuana

Correct Answer: D

The most characteristic peripheral blood smear finding in multiple myeloma is: A. plasmacytic satellitosis in the bone marrow B. many plasma cells in the peripheral blood C. many Mott cells in the peripheral blood D. rouleaux formation of the red cells

Correct Answer: D

The most consistent analytical error involved in the routine determination of HDL-cholesterol is caused by: A. incomplete precipitation of LDL-cholesterol B. coprecipitation of HDL- and LDL-cholesterol C. inaccurate protein estimation of HDL-cholesterol D. a small concentration of apoB-containing lipoproteins after precipitation

Correct Answer: D

The most specific enzyme test of acute pancreatitis is: A. acid phosphates B. trypsin C. amylase D. lipase

Correct Answer: D

The most widely used methods for bilirubin measurement are those based on the: A. Jaffe reaction B. Schale and Schale method C. 8-hyroxyquinoline reaction D. Jendrassik-Grof method

Correct Answer: D

The placenta secretes numerous hormones both protein and steroid. Which of the following hormones is not secreted by the placenta? A. Human chorionic gonadotropin (hCG) B. Estrogen C. Human placental lactogen (HPL) D. Luteinizing hormone (LH)

Correct Answer: D

The preferred blood product for a bleeding patient with Type 1 von Willeband disease is A. Factor II, VII, IX, X concentrates B. Platelet Concentrates C. Fresh Frozen Plasma and Platelets D. DDAVP

Correct Answer: D

The principle of the occult blood test depends upon the: A. coagulase ability of blood B. oxidative power of atmospheric oxygen C. hydrogen peroxide in hemoglobin D. peroxidase-like activity of hemoglobin

Correct Answer: D

The procedure used to determine the presence of neural tube defects is: A. lecithin/sphingomyelin ration B. amniotic fluid creatinine C. measurement of absorbance at 450 nm D. alpha-fetoprotein

Correct Answer: D

The prothrombin time best requires that the patient's citrated plasma be combined with: A. platelets B. thromboplastin C. Ca++ and platelet lipids D. Ca++ and thromboplastin

Correct Answer: D

The results on a patient are: Test, Patient results, Reference range -Pt: 18.5 sec 11.0-13.5 sec -APTT: 47.5 sec 24-35 sec -Thrombin time: 14.0 sec 12-19 sec -ATIII: 82% 70%-130% -Protein C: 54% 77%-167% -Protein S 48% 65%-140% -Activated protein C resistance: 2.6 >2.1 These results reflect: A. thrombophilia B. Factor IX deficiency C. heparin D. warfarin

Correct Answer: D

The screen for adrenal cortical hyperfunction with the greatest and specificity is: A. 24-hour urine free cortisol B. plasma cortisol C. urinary 17-hydroxycorticosteroids D. plasma corticosterone

Correct Answer: D

The screening test for congenital hypothyroidism is based upon: A. TSH level in the newborn B. thyroid-binding globulin level in the newborn C. iodine level in the newborn D. total thyroxine (T4) level in the newborn

Correct Answer: D

The substance to be measured reacts with a specific macromolecule of limited binding capacity. Which of the following assays does not employ this principle? A. Chemiluminescence immunoassay B. Enzyme-multiplied immunoassay technique C. Fluorescent polarization immunoassay D. High-performance liquid chromatography

Correct Answer: D

The surfactant/albumin ratio by fluores- cence polarization is performed to assess what physiological state? A. Hyperlipidemia B. Coronary artery disease C. Hemolytic disease of the newborn D. Fetal lung maturity

Correct Answer: D

The urinary excretion produce measured as an indicator of epinephrine production is: A. dopamine B. dihydroxyphenylalanine (DOPA) C. homovanillic acid D. vanillylmandelic acid (VMA)

Correct Answer: D

There are five immunoglobulin classes: IgG, IgA, IgM, IgD, and IgE. With which globulin fraction do these immunoglobulins migrate electrophoretically? A. Alpha1-globulins B. Alpha2-globulins C. Beta1-globulins D. Gamma-globulins

Correct Answer: D

Thrombocytopenia is a characteristic of: A. classic von Willebrand disease B. hemophilia A C. Glanzmann thrombasthenia D. May-Hegglin anomaly

Correct Answer: D

Thrombocytosis would be indicated by a platelet count of: A. 100 x 10^3/uL (100 x 10^9/L) B. 200 x 10^3/uL (200x 10^9/L) C. 300 x 10^3/uL (300 x 10^9/L) D. 600 x 10^3/uL (600 x 10^9/L)

Correct Answer: D

To calibrate the pH electrode in a pH/ blood gas analyzer, it is necessary that A. The barometric pressure be known and used for adjustments B. Calibrating gases of known high and low concentrations be used C. The calibration be performed at room temperature D. Two buffer solutions of known pH be used

Correct Answer: D

To produce reliable results, when should blood specimens for lipid studies be drawn? A. Immediately after eating B. Anytimeduringtheday C. In the fasting state, approximately 2 to 4 hours after eating D. In the fasting state, approximately 9 to 12 hours after eating

Correct Answer: D

Unless blood gas measurements are made immediately after sampling, in vitro glycolysis of the blood causes a: A. rise in pH and PCO2 B. fall in pH and a rise in PO2 C. rise in pH and a fall in PO2 D. fall in pH and a rise in PCO2

Correct Answer: D

What abbreviation has been used in the past to designate alanine aminotransferase? A. AST B. AAT C. GOT D. GPT

Correct Answer: D

What analyte is measured using the Jaffe reaction? A. Urea B. Uric acid C. Ammonia D. Creatinine

Correct Answer: D

What are the principles of operation for a chloride analyzer that generates silver ions as part of its reaction mechanism? A. Potentiometry and amperometry B. Amperometry and polarography C. Coulometry and potentiometry D. Amperometry and coulometry

Correct Answer: D

What common substrate is used in the biosynthesis of adrenal steroids, including androgens and estrogens? A. cortisol B. catecholamines C. progesterone D. cholesterol

Correct Answer: D

What compound chelates iron and is the immediate precursor of heme formation? A. Porphobilinogen B. Protopoiphyrinogen IX C. Uroporphyrinogen III D. Protoporphyrin IX

Correct Answer: D

What compound may be detected by observing its orange-red fluorescence in acid solution? A. Porphobilinogen B. Uroporphyrinogen C. Aminolevulinicacid D. Coproporphyrin

Correct Answer: D

What compound normally found in urine may be used to assess the completeness of a 24-hour urine collection? A. Urea B. Uric acid C. Creatine D. Creatinine

Correct Answer: D

What condition is characterized by an elevation of total bilirubin primarily due to an increase in the conjugated bilirubin fraction? A. Hemolyticjaundice B. Neonataljaundice C. Crigler-Najjar syndrome D. Obstructive jaundice

Correct Answer: D

What does hydrolysis of sucrose yield? A. Glucose only B. Galactose and glucose C. Maltose and glucose D. Fructose and glucose

Correct Answer: D

What is the active metabolite of the antiarrhythmic drug procainamide? A. Pronestyl B. Disopyramide C. PEMA D. NAPA

Correct Answer: D

What is the basis for the Kjeldahl technique for the determination of serum total protein? A. Quantification of peptide bonds B. Determination of the refractive index of proteins C. Ultraviolet light absorption by aromatic rings at 280 nm D. Quantification of the nitrogen content of protein

Correct Answer: D

What is the compound that comprises the majority of the nonprotein-nitrogen fractions in serum? A. Uric acid B. Creatinine C. Ammonia D. Urea

Correct Answer: D

What is the immediate precursor of bilirubin formation? A. Mesobilirubinogen B. Verdohemoglobin C. Urobilinogen D. Biliverdin

Correct Answer: D

What is the major active metabolite of the anticonvulsant drug primidone? A. Phenytoin B. Acetazolamide C. NAPA D. Phenobarbital

Correct Answer: D

What is the purpose of using ampholytes in isoelectric focusing? A. Maintain the polyacrylamide gel in a solid state B. Maintain the protein sample in a charged state C. Maintain the pH of the buffer solution D. Establish a pH gradient in the gel

Correct Answer: D

What its the MCV if the hematocrit is 20%, the RBC is 1.5 x 10^6/uL (1.5 x10^12/L) and the hemoglobin is 6 g/dL (60 g/L)? A. 68 pg B. 75 pg C. 115 pg D. 133 pg

Correct Answer: D

What percentage decrease in plasma or urinary estriol, in comparison with the previous day's level, is considered significant duringpregnancy? A. 5 B. 10 C. 25 D. 40

Correct Answer: D

Whatmaybethecauseofneonatal physiological jaundice of the hepatic type? A. Hemolytic episode caused by an ABO incompatibility B. Stricture of the common bile duct C. Hemolytic episode caused by an Rh incompatibility D. Deficiencyinthebilirubinconjugation enzyme system

Correct Answer: D

When a blood ammonia determination is performed, the blood specimen must be treated in a manner that will ensure that A. The deamination process continues in vitro B. Glutamine formation in vitro is avoided C. The transamination process continues in vitro D. Ammonia formation in vitro is avoided

Correct Answer: D

When electrophoresis is performed, holes appear in the staining pattern, giving the stained protein band a doughnut-like appearance. What is the probable cause of this problem? A. Protein denatured and will not stain properly B. Ionic strength of the buffer was too high C. Protein reached its isoelectric point and precipitated out D. Protein concentration was too high

Correct Answer: D

When evaluating a smear for a reticulocyte count, the technician observes that the red blood cells are overlapping throughout the entire slide. The most likely explanation is: A. grease on the slide prevented even spreading B. improper proportions of blood and stain were used C. the slide was dried too quickly D. the drop used for the slide preparation was too large

Correct Answer: D

When measuring CK-MB, which of the following would provide the most sensitive method? A. Electrophoretic B. Colorimetric C. Kinetic D. Mass immunoassay

Correct Answer: D

When measuring K+ with an ion-selective electrode by means of a liquid ion- exchange membrane, what antibiotic will be incorporated into the membrane? A. Monactin B. Nonactin C. Streptomycin D. Valinomycin

Correct Answer: D

When mixed with phosphotungstic acid, what compound causes the reduction of the former to a tungsten blue complex? A. Urea B. Ammonia C. Creatinine D. Uric acid

Correct Answer: D

When performing spectrophotometer quality assurance checks, what is the holmium oxide glass filter used to assess? A. Linearity B. Straylight C. Absorbanceaccuracy D. Wavelength accuracy

Correct Answer: D

When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to: A. abnormal proteins B. inadequate mixing of blood and anticoagulant C. hemorrhage D. poorly made wedge smear

Correct Answer: D

When screening urine for toxic concentra- tions of certain substances, which of the following will not be identified by the Reinsch test? A. Bismuth B. Arsenic C. Mercury D. Cyanide

Correct Answer: D

When using the turbidity (solubility) method for detecting the presence of hemoglobin S, an incorrect interpretation may be made when there is a(n): A. concentration of less than 7 g/dL (70 g/L) hemoglobin B. glucose concentration greater than 150 mg/dL (8.3 mmol/L) C. blood specimen greater than 2 hours old D. increased hemoglobin

Correct Answer: D

Which chromatography system is commonly used in conjunction with mass spectrometry? A. High-performance liquid B. Ion-exchange C. Partition D. Gas-liquid

Correct Answer: D

Which compounds originally condense to form aminolevulinic acid? A. Oxoglutarate and aspartate B. Isocitrate and coenzyme II C. Oxalacetate and malate D. Succinyl coenzyme A and glycine

Correct Answer: D

Which disorder is not associated with an elevated protein level in cerebrospinal fluid? A. Bacterial meningitis B. Multiple sclerosis C. Cerebral infarction D. Hyperthyroidism

Correct Answer: D

Which hemoglobin may be differentiated from other hemoglobins on the basis of its resistance to denature in alkaline solution? A. A, B. A2 C. C D. F

Correct Answer: D

Which immunoglobulin class is able to cross the placenta from the mother to the fetus? A. IgA B. IgD C. IgE D. IgG

Correct Answer: D

Which of the RBC indices is a measure of the amount of hemoglobin in individual red blood cells? A. MCHC B. MCV C. Hct D.MCH

Correct Answer: D

Which of the following 2 hour postprandial glucose values demonstrates unequivocal hyperglycemia diagnostic for diabetes mellitus? A. 160 mg/dL (8.8 mmol/L) B. 170 mg/dL (9.4 mmol/L) C. 180 mg/dL (9.9 mmol/L) D. 200 mg/dL (11.0 mmol/L)

Correct Answer: D

Which of the following analytes would not commonly be measured when monitoring complicationsofdiabetesmellitus? A. Serum urea nitrogen B. Urinary albumin C. Serum creatinine D. Serum bilirubin

Correct Answer: D

Which of the following anomalies is an autosomal dominant disorder characterized by irregularly -sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets and often thrombocytopenia? A. Pelger-Huet B. Chediak-Higashi C. Alder-Reilly D. May-Hegglin

Correct Answer: D

Which of the following calcium procedures utilizes lanthanum chloride to eliminate interfering substances? A. o-cresolphthalein complexone B. precipitation with chloranilic acid C. chelation with EDTA D. atomic absorption spectrophotometry

Correct Answer: D

Which of the following classes of compounds has a sedative effect and as such is used to treat anxiety? A. Amphetamines B. Opiates C. Cannabinoids D. Benzodiazepines

Correct Answer: D

Which of the following clinical disorders is associated with the greatest elevation of lactate dehydrogenase isoenzyme 1? A. pneumonia B. glomerulonephritis C. pancreatitis D. pernicious anemia

Correct Answer: D

Which of the following compounds is not a precursor of the estrogens? A. Progesterone B. Testoterone C. Cholesterol D. Aldosterone

Correct Answer: D

Which of the following conditions is not associated with a high incidence of leukemia? A. paroxysmal nocturnal hemoglobinuria B. Fanconi anemia C. aplastic anemia D. megaloblastic anemia

Correct Answer: D

Which of the following conditions is not associated with hyponatremia? A. Addison disease B. Diarrhea C. Diuretic therapy D. Gushing syndrome

Correct Answer: D

Which of the following describes the basis for the freezing point osmometer? A. The freezing point depression is directly proportional to the amount of solvent present. B. The freezing point depression varies as the logarithm of the concentration of solute. C. The freezing point is raised by an amount that is inversely proportional to the concentration of dissolved particles in the solution. D. The freezing point is lowered by an amount that is directly proportional to the concentration of dissolved particles in the solution.

Correct Answer: D

Which of the following disorders is characterized by an inability to transport bilirubin from the sinusoidal membrane into the hepatocyte? A. Carcinoma of the common bile duct B. Crigler-Najjar syndrome C. Dubin-Johnson syndrome D. Gilbert syndrome

Correct Answer: D

Which of the following disorders is not a form of hepatic jaundice? A. Cirrhosis B. Crigler-Najjar syndrome C. Hepatitis D. Neoplasm of common bile duct

Correct Answer: D

Which of the following disorders is not associated with an elevated blood ammonia level? A. Reye syndrome B. Renal failure C. Chronic liver failure D. Diabetes mellitus

Correct Answer: D

Which of the following disorders is not characterized by an elevated serum myoglobin? A. Renal failure B. Vigorous exercise C. Acute myocardial infarction D. Hepatitis

Correct Answer: D

Which of the following does not apply to gas-liquid chromatography? A. Separation depends on volatility of the sample. B. Separation depends on the sample's solubility in the liquid layer of the stationary phase. C. Stationary phase is a liquid layer adsorbed on the column packing. D. Mobile phase is a liquid pumped through the column.

Correct Answer: D

Which of the following does not have an effect on plasma calcium levels? A. Parathyroidhormone B. Vitamin D C. Calcitonin D. Aldosterone

Correct Answer: D

Which of the following does not properly describe type 1 diabetes mellitus? A. Insulin deficiency B. Associated with autoimmune destruction of pancreatic B-cells C. Ketoacidosis prone D. Occurs more frequently in adults

Correct Answer: D

Which of the following electrolytes is the chief plasma cation whose main function is maintaining osmotic pressure? A. chloride B. calcium C. potassium D. sodium

Correct Answer: D

Which of the following factors will not adversely affect the accurate quantifica- tion of bilirubin in serum? A. Lipemia B. Hemolysis C. Exposure to light D. Specimen refrigeration

Correct Answer: D

Which of the following functions as an inhibiting factor for somatotropin release? A. Gonadotropin-releasing hormone B. Growth hormone-releasing hormone C. Somatomedin D. Somatostatin

Correct Answer: D

Which of the following have a B cell origin? A. Sezary syndrome B. malignant lymphoma, lymphoblastic type C. Sternberg sarcoma D. Waldenstrom macroglobulinemia

Correct Answer: D

Which of the following hemoglobins has glucose-6-phosphate on the amino-terminal valine of the beta chain? A. S B. C C. A2 D. A1c

Correct Answer: D

Which of the following hormones does not promote an increase in blood glucose levels? A. Growth hormone B. Cortisol C. Glucagon D. Insulin

Correct Answer: D

Which of the following is Vitamin-K dependent? A. Factor XII B. fibrinogen C. antithrombin II D. Factor VII

Correct Answer: D

Which of the following is a cause of metabolic alkalosis? A. Late stage of salicylate poisoning B. Uncontrolled diabetes mellitus C. Renal failure D. Excessive vomiting

Correct Answer: D

Which of the following is a homogeneous immunoassay where separation of the bound from the free labeled species is not required? A. Radio immunoassay B. Enzyme-linked immunosorbent assay C. Immunoradiometric assay D. Enzyme-multiplied immunoassay technique

Correct Answer: D

Which of the following is an acute-phase reactant protein able to inhibit enzymatic proteolysis and having the highest concentration of any of the plasma proteolytic inhibitors? A. C-reactive protein B. Haptoglobin C. a2-Macroglobulin D. a1-Antitrypsin

Correct Answer: D

Which of the following is an effect of increased parathyroid hormone secretion? A. Decreased blood calcium levels B. Increased renal reabsorption of phosphate C. Decreased bone resorption D. Increased intestinal absorption of calcium

Correct Answer: D

Which of the following is an example of a phenothiazine drug? A. Cyclosporine B. Theophylline C. Phenytoin D. Chlorpromazine

Correct Answer: D

Which of the following is associated with Alder-Reilly inclusions? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. 2-lobed neutrophils D. mucopolysaccharidosis

Correct Answer: D

Which of the following is associated with Glanzmann thrombasthenia? A. normal bleeding time B. normal EPI aggregation C. abnormal initial wave ristocentin aggregation D. abnormal ADP aggregation

Correct Answer: D

Which of the following is characteristic of polycythemia vera? A. elevated urine erythropoietin levels B. increased oxygen affinity of hemoglobin C. "teardrop" poikilocytosis D. decreased or absent bone marrow iron stores

Correct Answer: D

Which of the following is false about PSA? A. Serum quantified using immunoassays B. Single-chain glycoprotein C. Used as a tumor marker D. Not elevated in benign prostatic hyperplasia

Correct Answer: D

Which of the following is false about a photomultiplier tube? A. Converts radiant energy (light) to electrical energy (current) B. Amplifies the current significantly C. Has a very rapid response time D. Is composed of an iron plate and a layer of selenium

Correct Answer: D

Which of the following is increased in erythrocytosis secondary to a congenital heart defect? A. arterial oxygen saturation B. serum vitamin B12 C. leukocyte alkaline phosphatase activity D. erythropoietin

Correct Answer: D

Which of the following is most closely associated with chronic myelogenous leukemia? A. ringed sideroblasts B. disseminated intravascular coagulation C. micromegakarycytes D. Philadelphia chromosome

Correct Answer: D

Which of the following is most closely associated with chronic myelomonocytic leukemia? A. Philadelphia chromosome B. disseminated intravascular coagulation C. micromegakaryocytes D. lysozymuria

Correct Answer: D

Which of the following is most closely associated with iron deficiency anemia? A. iron overload in tissue B. target cells C. basophilic stippling D. chronic blood loss

Correct Answer: D

Which of the following is not a characteristic of hemoglobin H? A. it is a tetramer of beta chains B. it is relatively unstable and thermolabile C. electrophoretically, it represents a "fast" hemoglobin D. its oxygen affinity is lower than that of hemoglobin A

Correct Answer: D

Which of the following is not a characteristic usually associated with hairy cell leukemia? A. pancytopenia B. mononuclear cells with ruffled edges C. splenomegaly D. increased resistance to infection

Correct Answer: D

Which of the following is not a component of the total anion content of serum? A. Acetoacetate B. Protein C. Lactate D. Iron

Correct Answer: D

Which of the following is not a problem inherent in turbidimetry? A. Variation in particle size of samples B. Variation in particle size of standards C. Rate of aggregation or settling of particles D. Need to maintain a constant and specific temperature

Correct Answer: D

Which of the following is not a type of support media used for serum protein electrophoresis? A. Agarose gel B. Cellulose acetate C. Acrylamide D. Celite

Correct Answer: D

Which of the following is not associated with human chorionic gonadotropin? A. B subunit confers immunogenic specificity B. Used to confirm pregnancy C. Used as a tumor marker D. Found in hepatoma

Correct Answer: D

Which of the following is not associated with potassium? A. Has no renal threshold B. Increased serum level in acidosis C. Hemolysis causes false increase in serum levels D. Major anion of intracellular fluid

Correct Answer: D

Which of the following is not associated with the enzyme-multiplied immunoassay technique (EMIT)? A. Is a homogeneous enzyme immunoassay B. Determines antigen concentration C. Employs a labeled reactant D. Enzyme reacts with drug in serum sample

Correct Answer: D

Which of the following is not characteris- tic of cystic fibrosis? A. Decreased bicarbonate concentration in duodenal fluid B. Decreased lipase activity in duodenal fluid C. Decreased amylase activity in duodenal fluid D. Increased trypsin in feces

Correct Answer: D

Which of the following is not characteristic of severe hyperglycemia? A. Polyuria B. Ketonuria C. Glycosuria D. Hypoglucagonemia

Correct Answer: D

Which of the following is not the reason that preventive maintenance schedules are required? A. Keep instrument components clean B. Replace worn parts C. Extend the life of the equipment D. Keep personnel busy when the laboratory work is slow

Correct Answer: D

Which of the following is the Henderson-Hasselbalch equation? A. pKa = pH + log ([acid]/[salt]) B. pKa = pH + log ([salt]/[acid]) C. pH=pKa + log ([acid]/[salt]) D. pH=pKa + log ([salt]/[acid])

Correct Answer: D

Which of the following is the formula for absolute cell count? A. number of cells counted/ total count B. total count/ number of cells counted C. 10 x total count D. % of cells counted x total count

Correct Answer: D

Which of the following is the formula for calculating absorbance give the percent transmittance (%T) of a solution? A. 1- log (%T) B. log (% T)-2 C. 2 x log (%T) D. 2-log (%T)

Correct Answer: D

Which of the following is the formula for mean corpuscular hemoglobin (MCH)? A. Hct/ (RBC x 1000) B. Hgb/Hct C. RBC/Hct D. (Hgb x 10)/RBC

Correct Answer: D

Which of the following is the most common cause of an abnormality in hemostasis? A. decreased plasma fibrinogen level B. decreased Factor VIII level C. decreased Factor IX level D. quantitative abnormality of platelets

Correct Answer: D

Which of the following is the most potent androgen? A. Androstenedione B. Dehydroepiandrosterone C. Androsterone D. Testosterone

Correct Answer: D

Which of the following is the standard calibration method for hematology instrumentation against which other methods must be verified? A. latex particles of known dimension B. stabilized red cell suspensions C. stabilized 7 parameter reference controls D. normal whole blood

Correct Answer: D

Which of the following leukemias is characterized by immature cells that are Sudan black B positibe with discrete fine granules, peroxidase negative, PAS variable, strongly alpha naphthyl acetate esterase positive, and muramidase positive? A. acute lymphocytic B. chronic lymphocytic C. acute myelocytic D. acute myelomonocytic

Correct Answer: D

Which of the following may be a sampling source of error for an automated instrument? A. Short sample B. Air bubble in bottom of sample cup C. Fibrin clot in sample probe D. All the above

Correct Answer: D

Which of the following methods would yield reliable quantification of ethanol in the presence of isopropanol? A. Reaction with permanganate and chromotropic acid B. Conway diffusion followed by dichromate reaction C. Alcohol dehydrogenase reaction D. Gas-liquid chromatography

Correct Answer: D

Which of the following plasma proteins is not manufactured by the liver? A. Albumin B. Haptoglobin C. Fibrinogen D. IgG

Correct Answer: D

Which of the following platelet responses is most likely associated with Glazmann thrombasthenia? A. decreased platelet aggregation to ristocetin B. defective ADP release; normal response to ADP C. decreased amount of ADP in platelets D. markedly decreased aggregation to epinephrine, ADP and collagen

Correct Answer: D

Which of the following platelet responses is most likely associated with hemophilia A (Factor VIII deficiency)? A. defective ADP release; normal response to ADP B. decreased amount ofADP in platelets C. absent aggregation to epinephrine, ADP and collagen D. normal platelet aggregation

Correct Answer: D

Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder? Serum iron, Transferrin saturation, TIBC -Result A: nL; nL; nL -Result B: inc; inc; nL or slightly inc -Result C: nL; markedly inc; nL -Result D: dec; dec; nL or dec A. result A B. result B C. result C D. result D

Correct Answer: D

Which of the following represents the end product of purine metabolism in humans? A. AMP and GMP B. DNA and RNA C. allantion D. uric acid

Correct Answer: D

Which of the following serum constituents is unstable if a blood specimen is left standing at room temperature for 8 hours before processing? A. cholesterol B. triglyceride C. creatinine D. glucose

Correct Answer: D

Which of the following serum proteins migrate with the beta-globulins on cellulose acetate at pH 8.6? A. ceruloplasmin B. hemoglobin C. haptoglobin D. C3 component of complement

Correct Answer: D

Which of the following stains is most frequently used to differentiate acute myelocytic from acute lymphocytic leukemia? A. alkaline phosphatase B. nonspecific esterase C. acid phosphatase D. peroxidase

Correct Answer: D

Which of the following stains is used to demonstrate iron, ferritin and hemosiderin? A. peroxidase B. Sudan black B C. periodic acid-Schiff (PAS) D. Prussian blue

Correct Answer: D

Which of the following statements about this field is true? See BOC pg 181 Pic 1 A. reticulocytes are demonstrable B. toxic granulation is present C. the cell in the center is a basophilic normoblast D. the large cell on the left is a monocyte

Correct Answer: D

Which of the following statements applies to the preferred use of plasma or serum, rather than whole blood, for glucose determination? A. Glucose is more stable in separated plasma or serum. B. Specificity for glucose is higher with most methods when plasma or serum is used. C. It is convenient to use serum or plasma with automated instruments because whole blood requires mixing immedi- ately before sampling. D. All the above.

Correct Answer: D

Which of the following statements may be associated with the activity of insulin? A. Increases blood glucose levels B. Decreases glucose uptake by muscle and fat cells C. Stimulates release of hepatic glucose into the blood D. Stimulates glycogenesis in the liver

Correct Answer: D

Which of the following statements most correctly describes the utility of the clinical laboratory assays for tumor markers? A. tumor markers are useful to screen asymptomatic patients for tumor B. tumor markers are highly specific C. tumor markers indicate the likelihood of an individual developing a tumor D. tumor markers are useful in tracking the efficacy of treatment

Correct Answer: D

Which of the followingisfalse about cardiac troponin I (cTnl) as it relates to AMI? A. Increase above reference interval seen in 3 to 6 hours B. Measure initially and serially in 3- to 6-hour intervals C. Remains elevated 5 to 10 days D. Expressed in regenerating and diseased skeletal muscle and cardiac muscle disorders

Correct Answer: D

Which one of the following hypochromic anemias is usually associated with a normal free erythrocyte protoporphyrin level? A. anemia of chronic disease B. iron deficiency C. lead poisoning D. thalassemia minor

Correct Answer: D

Which one of the following sets of results is consistent with primary hypothyroidism, (eg, Hashimoto thyroiditis): Result; TSH; T4 ( free thyroxine); Antimicrosomal antibody -result A; decreased; decreased; positive -result B; increased; increase; positive -result C; normal; decreased; negative -result D; increased; decreased; positive A. result A B. result B C. result C D. result D

Correct Answer: D

Which statement concerning gamma- glutamyltransferase is false? A. Present in almost all cells of the body B. Elevated in liver and some pancreatic diseases C. Elevated in chronic alcoholism D. Elevated in bone disease

Correct Answer: D

Which term describes a congenital disorder that is characterized by a split in the albumin band when serum is subjected to electrophoresis? A. Analbuminemia B. Anodic albuminemia C. Prealbuminemia D. Bisalbuminemia

Correct Answer: D

Which test may be performed to assess the average plasma glucose level that an individual maintained during a previous 2- to 3-month period? A. Plasmaglucose B. Two-hour postprandial glucose C. Oral glucose tolerance D. Glycated hemoglobin

Correct Answer: D

Which type of photodetector employs a linear arrangement that allows it to respond to a specific wavelength resulting in complete UV/visible spectrum analysis? A. Photomultiplier tube B. Phototube C. Barrier layer cell D. Photodiode array

Correct Answer: D

Whichofthefollowingisaqualitative screening test for porphobilinogen that may be performed to aid in the diagnosis of the porphyrias? A. Caraway test B. Gutmantest C. Jendrassik-Grof test D. Watson-Schwartz test

Correct Answer: D

Whichofthefollowingtestswouldmost likely be included in a routine lipid profile? A. Total cholesterol, triglyceride, fatty acid, chylomicron B. Total cholesterol, triglyceride, HDL cholesterol, phospholipid C. Triglyceride, HDL cholesterol, LDL cholesterol, chylomicron D. Total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol

Correct Answer: D

With this blood picture, an additional test indicated is: See BOC pg 159 A. alkali denaturation B. alkaline phosphatase stain C. peroxidase stain D. hemoglobin electrophoresis

Correct Answer: D

Y our lab routinely uses a precipitation method to separate HDL cholesterol. You receive a slightly lipemic specimen for HDL cholesterol. The total cholesterol and triglyceride for the specimen were 450 and 520 mg/dL, respectively. After adding the precipitating reagents and centrifuging, you notice that the supernatant still looks slightly cloudy. What is your next course of action in analyzing this specimen? A. Perform the HDL cholesterol test; there is nothing wrong with this specimen. B. Take off the supernatant and recen- trifuge. C. Take off the supernatant and add another portion of the precipitating reagent to it and recentrifuge. D. Send specimen to a lab that offers other techniques to separate more effectively the HDL cholesterol.

Correct Answer: D

n the collection of plasma specimens for lactate determinations, which of the following anticoagulants would be more appropriate? A. Sodiumheparin B. Sodium citrate C. EDTA D. Oxalate plus fluoride

Correct Answer: D

vWF antigen can be found in which of the following? A. myeloblast B. monoblast C. lymphoblast D. megakaryoblast

Correct Answer: D

The preparation of a patient for standard glucose tolerance testing should include: A. a high carbohydrate diet for 3 days B. a low carbohydrate diet for 3 days C. fasting for 48 hours prior to testing D. bed rest for 3 days

Correct answer: A

230.Given the following objective: "After listening to the audioconference, the student will be able to describe the interaction between T and B lymphocytes in the immune system, to the satisfaction of the instructor" Wich of the following test questions reflects the intent of this objective? A. how are T and B lymphocytes seperated in vitro? B. how many T lymphocytes does a normal person have in peripheral blood? C. what are the morphological characteristics of B lymnphocytes? D. how are antibodies produced after a viral infection?

D

237.The most important aspect of supervision is: A.balancing the budget B. performing technical procedures C. writing accurate job descriptions D. dealing with people

D

240.In planning an instructional unit, the term "goal" has been defined as a: A.plan for reaching certain objectives B. set of specific tasks C. set of short- and long-term plans D. major purpose or final desired result

D

241.delegation is a process in which: A.interpersonal influence is redefined B. authority of manager is surrender C. power is given to others D. responsibility for specific tasks is given to others

D

A new laboratory information system (LIS) will be evaluated by the laboratory staff. Which of the following points should be considered in the evaluation? A.Cost of updating software B.Interface ability with existing laboratory instruments C.Tracking of uncrossmatched blood units in Blood Bank D. All of these options

D

A stated competency requirement for a medical laboratory science student is to perform calibration, plot data, and evaluate the acceptability of controls. This competency requirement encompasses which educational objective? A. Cognitive B. Psychomotor C. Affective D. All of these options

D

According to CLIA regulayions, which credentials consultant not meet the qualifications to be a technical consultant for a moderate complexity laboratory? A.Board-certified podiatrist with at least one year of training in the respective laboratory specialty in a nonwaived laboratory B. Bachelor of Science degree in chemistry, physical science, or biology and two years of training in the respective laboratory specialty in a nonwaived laboratory C. Masters degree in chemistry, biology, or physics and one year of training in the respective laboratory specialty in a nonwaied laboratory D. Doctorate in chemistry and six months experience in the respective laboratory specialty in a nonwaied laboratory

D

According to federal and state regulations, a hospital's capital budget should include whichof the following before projects that cost $150,000 can be submitted for approval? A. A time table of completion B. A cost analysis C. Salaries and wages for new employees D. A certificate of need

D

An effective program of continuing education for medical laboratory personnel should first: A. find a good speaker B. motivate employees to attend C. determine an adequate budget D. identify the needs

D

An instructor observes a medical technology student cheating on an examination. What is the best action to take? A.Ignore the behavior because the student is hurting only himself/herself. B.Stop the examination and collect all the papers. C.Document the incident, but do not report it unless it is repeated. D.Document the incidentand report it to the appropriate authority

D

Direct laboratory costs for tests include which of the following? A. Equipment maintenance B. Insurance C. Depreciation D. Overtime pay

D

During an interview, an employer may request the following from a prospective new employee: A.Marital status B.Age of children C.Arrest record for driving under the influence of alcohol D.Professional certification

D

Given the following objective: "After listening to the audioconference, the student will be able to describe the interaction between T and B lymphocytes in the immune system, to the satisfaction of the instructor" Which of the following test questions reflects the intent of this objective? A. How are T and B lymphocytes seperated in vitro? B. how many T lymphocytes does a normal person have in peripheral blood? C. what are the morphological characteristics of B lymphocytes? D. how are antibodies produced after a viral infection?

D

In deciding whether to adopt a new test on the laboratory's automated chemistry analyzer, which parameters are needed to determine the number of tests that must be performed to break even? A. Test turnaround time B. Cost of labor per hour C. Number of other tests performed per month D. Total fixed laboratory costs

D

Quantitative research is a type of descriptive research where the researcher observes a subject A.For bad habits B.For characteristic traits C. To determine differences D.In relation to determining differences and similarities

D

Records of a patient's laboratory test results may be released without the prior consent of the patient to all of the following except: A. An insurance carrier B. Physician on call C. Nursing staff D. An employer

D

Records of a patient's laboratory test results may not be released without his or her consent to anyone outside the clinical laboratory except to the: A. American Red Cross B. Department of Health and Human Services C. Insurance carrier D. Physician who ordered the tests

D

SITUATION: An immunology supervisor ordered several antinuclear antibody and influenza A kits. The outside packaging of both kits was marked to store at 2°C-8°C. The kits were shipped with dry ice, but were unpacked at 7:00 p.m. and left inthe mailroom at room temperature until 7:00 a.m. the next morning. What should be done with the kits? A.They can be placed into inventory B.They must be tested using quality controls before use and used only if QC performance is acceptable C.The kits should not be used for clinical testing D.The disposition of the kits depends on the manufacturer's documentation for stability and the lab's lot-to-lot analysis

D

Stratified random assignment is A. Nonrandom assignment in a different category B. Nonrandom assignment in the same category C. Random assignment in a different category D. Random assignment in the same category

D

The Material Safety Data Sheets (MSDS) for hazardous materials must be reviewed by personnel per Occupational Safety and Health Administration (OSHA) regulations: A. Weekly B. Monthly C. Every 6 months D. Yearly

D

The following are considered indirect costs when calculating costs for laboratory tests, except: A. Public relations B. Secretarial staff C. Insurance D. Specimen collection process

D

The following is (are) successful indicator(s) of Quality Assurance (QA) and Quality Improvement (QI) programs in a clinical laboratory: A.A "log" of incident report and solutions attained B.Emergency department and STAT "turnaround times" C.Positive patient identification wristbands for blood bank operations D.All of these options

D

The material safety data sheets (MSDSs) for hazardous chemicals address which of the following conditions? A.Physical characteristics of the chemical B.Safe handling and storage of the chemical C.Specific health hazards associated with the chemical D.All of these options

D

The statement, "Given a hemacytometer, the student will perform manual red cell counts with 90% accuracy," is an example of a(n) A. Course description B. Goal C. Task analysis D. Objective

D

Under CLIA '88, testing personnel with an associate degree and appropriate training in the clinical laboratory are authorized to perform: A.Waived tests only B.Tests that are qualitative or waived and some moderate-complexity tests C.Waived and moderate-complexity tests D.Waived, moderate-complexity, and high-complexity tests

D

Unethical behavior by a laboratory supervisor that results in a compromise of employee safety should be: A. Reported to a higher authority B. Directly confronted C. Reported to the EEOC D. All of these options

D

Which of the following activities is not associated with problem-based learning (PEL)? A. The learner determines what information needs to be learned. B. The instructor serves as a facilitator. C.The learner identifies the appropriate educational resources. D. The instructor presents a lecture series for each instructional unit.

D

Which of the following circumstances is considered a form of sexual harassment? A.Unwelcome sexual advances by a supervisor B.Requests for favors of a sexual nature from a fellow laboratory employee C.Physical conduct of a sexual nature from an employee working in another department D.All of these options

D

Which of the following is an advantage of the lecture method? A.Useful for teaching technical skills B.Student is an active participant C.Pace is controlled by the learner D.Disseminates large amounts of information

D

231.Higher levels of employee motivation occur when the supervisor A. collaborates to set goals to be accomplished B. provides all the details of the task C. constantly monitors progress D. immediately corrects every error

A

245.as information is reported upward through an organization, the amount of detail communicated will generally: A. decrease to facilitate the flow of information B. increase to allow consideration of all options C. remain the same to ensure consistency in reporting D. remain in the same to ensure goal accomplishment

A

246.To sustain the highly motivated employee the evaluation should include: A. performance feedback B. retraining opportunities C.quality of performance discussions D. competency-based tasks

A

247.communication is enhanced by: A. a planned strategy that includes listening skilss and ensuring an understanding with questions B. relying on e-mail, memos and voice mail to communicate new information C. formal, hierarchical patterns instead of informal networking patterns D. assumptions if there are questions about the intent of the message

A

A chemistry profile that includes electrolytes, glucose, blood urea nitrogen (BUN), and creatinine is ordered on an 80-year-old woman with symptoms of vomiting and dizziness. How should the laboratory submit the charge for these tests for reimbursement by Medicare? A. Submit as one test B. Submit each test separately C. Submit Medicare-approved tests only D. Submit as four individual tests

A

A new employee's performance is to be evaluated at the end of his or her probationary period, and must relate to: A. The person's job description B. Verbal instructions given C. Wage and salary policies D. Recruitment practices

A

A rural hospital laboratory employs 8.25 FTEs (full-time equivalents). In order to budget for next year's salaries for these employees, the laboratory manager needs to submit which figures for the laboratory's projected annual budget? A. Total (paid) hours B. Productive (worked) hours C. Total hours of full-time employees D. Total hours of part-time employees

A

According to CLIA regulations, which person qualifies as a clinical laboratory consultant? A. CLIA qualified laboratory director B. Medical Laboratory Scientist with baccalaureate degree and one year of laboratory training or experience C. Medical laboratory technician with an associate degree and two years of laboratory training or experience D. all the above

A

Continuous Quality Improvement (CQI) is a team effort approach for clinical laboratories to: A. Identify potential problems and correct them B. Set lab financial benchmarks for the year C. Make up new CPT codes D. Improve overall wages for lab employees

A

Criterion-referenced examinations are used in order to determine the: A.Competency of a student according to a predetermined standard B.Validity of a test C.Status of one student compared to the whole group D.Accuracy of a test

A

Herzberg's theory relies on motivators that are part of the job design in order to instill job satisfaction. These same motivators can become dissatisfiers if they are lacking in a job. Herzberg's motivators are: A.Opportunity for achievement and advancement B.Performance evaluations every 24 months C.Continuing education sessions requiring supervisory approval C.Punitive actions taken when improvement diminishes

A

Management by objective (MBO) is least effective for managing employees in which situation? A.Employees must be creative in their work B.The laboratory is converting to a new computer system C.The laboratory is undergoing a renovation D.Employees jointly agree to institutional goals

A

Of the major domains for behavioral objectives, which domain contains objectives involving values and attitudes? A. Affective B. Analytical C. Cognitive D. Psychomotor

A

One method of learning is by giving a small group of students a topic to discuss or a problem to solve rather than a formal lecture by the instructor. Each participant is given a portion of the topic to discuss or solve. This method of learning is popular and used easily with which of the following approaches? A. Case study B. Manual demonstration C. Implementing new equipment D. Histogram evaluation

A

Role-playing is designed to strengthen skills in which educational domain? A. Affective B. Psychomotor C. Aesthetic D. Cognitive

A

SITUATION: In the course of isolation,B. anthracis is recovered that may be implicated in an act of bioterrorism. Such an organism would fall under which Centers for Disease Control category of biological agent? A. Category A B. Category B C. Category C D. None of these options

A

The Clinical Laboratory Improvement Act of 1988 (CLIA '88) was enacted to regulate the following: A. All clinical laboratories in the United States B. Independent labs not regulated by OSHA C. Environmental Protection Agency laboratories D. Industrial laboratories

A

The evaluation tool that monitors the performance of each step comprising a technical procedure is called a A. Checklist B. Rating scale C. List of objectives D. Practical exam

A

The most common deficiency cited during an onsite laboratory inspection by the College of American Pathologists (CAP) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is: A. Improper documentation B. Insufficient work space area C. Improper reagent storage D. Improper instrument calibration frequency

A

What documents are needed to meet the ISO-9000 standards for laboratory certification? A.Quality manual, document control, internal audits, corrective and preventive actions B.Work performance evaluation, maintenance, budgeting C.Inventory, quality control, customer satisfaction D.Risk prevention, quality control, personnel

A

What part of the following statement represents the conditions of the objective? Objective: Given the appropriate tools and written procedure, the student will perform daily maintenance on the chemistry analyzer without error. A.Given the appropriate tools and written procedure B.The student will perform daily maintenance on the chemistry analyzer C.Thestudent will D.Without error

A

Which of the following is not a type of research design? A. Nondescriptive design B. Experimental-comparison design C. Descriptive research D. Correlational design

A

Which of the following is not an appropriate guideline for phlebotomists to follow in order to prevent a malpractice lawsuit? A.Use one form of patient ID, such as a last name B.Keep patient confidentiality at all times C.Use aseptic venipuncture technique at all times D.Label specimens only after the blood has been drawn

A

Which of the following terms refers to the process by which an agency evaluates a medical technology program and recognizes that it has met certain preset standards? A. Accreditation B. Certification C. Licensure D. Registration

A

187. A Gaucher cell is best described as a macrophage with A. "Wrinkled" cytoplasm due to an accumulation of glucocerebroside B. "Foamy" cytoplasm filled with unmetabolized sphingomyelin C. Pronounced vacuolization and deposits of cholesterol D. Abundant cytoplasm containing storage iron and cellular remnants

A. "Wrinkled" cytoplasm due to an accumulation of glucocerebroside Gaucher disease is a lipid storage disorder in which there is an accumulation of glucocerebroside in the macrophages because of a genetic lack of glucocerebrosidase, an enzyme required for normal lipid metabolism.

166. Lymphocyte concentrations in the peripheral blood are greatest during what age interval? A. 1 to 4 years B. 4 to l5years C. l6 to 40 years D. 40 to 70 years

A. 1 to 4 years

16) Twenty microliters of blood are diluted in 1.98 mL of diluent. This dilution is plated on both sides of a Neubauer-ruled counting chamber. A total of 356 cells is seen when both large center squares are counted. The platelet count expressed in SI units is: A. 178 x 10^9/L B.178 x10^3/uL C. 356 x10^9/L D. 712 x10^9/L

A. 178 X 109/L Dilution is 1:100 therefore dilution factor is 100. Formula is: [total number cells counted X dilution factor]/ [total area counted X depth] [356 X 100]/ [2 X 0.10]= 178,000= 178 x 103/mm3; when expressed in SI units, the platelet count is 178 X 109/L

198. Which of the following would be least helpful in distinguishing chronic myelogenous leukemia (CML) from a neutrophilic leukemoid reaction? A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes B. Leukocyte alkaline phosphatase score C. Presence of marked splenomegaly D. Neutrophils with Döhle bodies and toxic granulation

A. An extreme leukocytosis with increased neutrophilic bands,

34) The main regulatory protein of secondary hemostasis is: A. Antithrombin B. Protein C C. alpha2-antiplasmin D. tissue plasminogen activator

A. Antithrombin

9) Of the following therapeutic agents, those considered to be antiplatelet medications are: A. Aspirin and Plavix B. Coumadin and heparin C. Heparine and protamine sulfate D. Tissue plasminogen activator and streptokinase

A. Aspirin and Plavix

48. The major adult hemoglobin requires the synthesis of apha-globin chains and A. Beta-globin chains B. Delta-globin chains C. Epsilon-globin chains D. Gamma-globin chains

A. Beta-globin chains The major adult hemoglobin, Hb A consists of two alpha- and two beta-globin chains. The switch from gamma chains (Hb F) to beta chains occurs 3-6 months after birth, and Hb A reaches adult levels (about 97%) around 6 months of age. Most globin chains produced in a normal adult are alpha and beta types (1:1_ for hemoglobin A production. Hemoglobin A2 contains delta chains and comprises about 2% of hemoglobin in normal adults. Epsilon chains are found in early embryonic hemoglobins only.

76. What values would you expect to obtain on hemoglobin and hematocrit determinations done immediately after a major hemorrhage, if hemoglobin and hematocrit values were normal prior to the hemorrhage? A. Both normal B. Both decreased C. Hemoglobin decreased, hematocrit normal D. Hemoglobin normal, hematocrit decreased

A. Both normal because red blood cells and plasma are lost together, the hemoglobin and hematocrit will not reflect the severity of an acute hemorrhage until the lost blood volume begins to be replaced by the formation of plasma. the restoration of a normal blood volume is usually complete by 24 hour. It is then that the hemoglobin and hematocit will reach their lowest point and will begin to rise only with the release of newly formed red cells, usually within 3-4 days.

157. Which of the following is characteristic of primary granules? A. Coated with a phospholipid membrane B. Called azurophilic or specific granules C. Contain myeloperoxiclase and lactoferrin D. Present in the promyelocyte stage only

A. Coated with a phospholipid membrane Call azurophilic or non-specific granules, they appear in the promyelocyte stage.

227. Which of the following is not associated with causing a falsely low ESR? A. Column used is slanted. B. EDTA tube is clotted. C. EDTA tube is one-third full. D. EDTA specimen is 24 hours old.

A. Column used is slanted

II. In what area of the bone marrow does hematopoiesis take place? A. Cords B. Endosteum C. Endotheijum D. Sinuses

A. Cords

230. The blood smear made on a patient with polycythemia vera is too short. What should be done to correct this problem? A. Decrease the angle of the spreader slide. B. Increase the angle of the spreader slide. C. Adjust the angle of the spreader slide to 45 degrees. D. Use a smaller drop of blood.

A. Decrease the angle of the spreader slide.

159. What is the term for cell movement through blood vessels to a tissue site? A. Diapedesis B. Opsonization C. Margination D. Chemotaxis

A. Diapedesis Diapedesis is the movement of cells (usually referring to neutrophils) from the blood stream into the tissues by squeezing through endothelial cells of the vessel wall.

112. Which of the following statements about hemoglobin C disease is false? A. Electrophoresis shows approximately 60% hemoglobin A and 40% hemoglobin C. B. Target cells are frequently seen on peripheral smears. C. Red cells may contain bar-shaped intracellular crystals. D. The disorder is less severe than sickle cell disease.

A. Electrophoresis shows approximately 60% hemoglobin A and 40% hemoglobin C. Electrophoresis will show an absence of Hb A and over 90% Hb C.

46. Which erythrocyte metabolic pathway generates adenosine triphosphate (ATP) via glycolysis? A. Embden-Meyerhof B. Hexose monophosphate C. Rapoport-Luebering D. Methemoglobin reductase

A. Embden-Meyerhof

252. Which of the following is not a source of error when measuring hemoglobin by the cyanmethemoglobin method? A. Excessive anticoagulant B. White blood cell count that exceeds linearity limits C. Lipemic plasma D. Scratched or dirty hemoglobin measuring cell

A. Excessive anticoagulant

253. Which of the following statements about microhematocrits is false? A. Excessive centrifugation causes falsely low results. B. A tube less than half full causes falsely low results. C. Hemolysis causes falsely low results. D. Trapped plasma causes falsely high results.

A. Excessive centrifugation causes falsely low results.

104. Acquired hemolytic anemias are usually due to A. Extracorpuscular factors B. Defects within the bone marrow C. Intracellular factors D. Changes in hemoglobin stability

A. Extracorpuscular factors

75. Which of the following is not characteristic of aplastic anemia? A. Extramedullary hematopoiesis B. Bone marrow hypoplasia C. Absolute reticulocytopenia D. Blood findings of pancytopenia

A. Extramedullary hematopoiesis Aplastic anemia can be defined as blood pancytopenia resulting from bone marrow failure. This stem cell disorder results in a hypocellular marrow with few developing precursors and decreased production of all cell lines. The anemia is generally normocytic or slightly macrocytic with reticulocytopenia. The "defect" also affects resting hematopoietic cells in the liver and spleen, so extramedullary hematopoiesis does not occur to compensate for marrow failure.

246. A white blood cell count is done on an automated impedance cell counter from a patient with the blood picture seen in Color Plate 4•. The WBC count is most likely A. Falsely increased because of nRBCs B. Falsely increased because of red cell fragments C. Falsely decreased because of nRBCs D. Accurate; no error with this methodology

A. Falsely increased because of nRBCs Corrected WBC count= Oberved count X 100/[100+3NRBCs/100WBCS]

36) Measurement of the time required for fibrin formation when thrombin is added to plasma evaluates the: A. Fibrinogen concentration B. Prothrombin concentration C. Extrinsic clotting system D. Intrinsic clotting system

A. Fibrinogen concentration When thrombin is added to patient plasma, fibrinogen is converted to fibrin. No factors above fibrinogen in the cascade are measured, including prothrombin. Both the thrombin time and fibrinogen test use thrombin reagent; both tests measure only one factor, fibrinogen.

A 32-year-old African-American traveling to Africa on business had been healthy until he began taking primaquine for prevention of malaria. He went to his physician because he felt faint and his urine was black. His CBC results are as follows: WBC 6.5 X 1 09/L (6.5 X 1 03IpL); RBC 1.67 X 1 0121L (1.67 x 1 064iL); hemoglobin level 50 g/L (5.0 g/dL); hematocrit 0.15 L/L (15%); MCV 89.8 fL; MCHC 33.3 g/dL; platelet count 175 X 1 09/L (1 75,000/1iL); reticulocyte 25.0%. 278. The most likely cause of this hemolytic episode is A. G6PD deficiency B. Hereditary spherocytosis C. Sickle cell disease D. Pyruvate kinase deficiency

A. G6PD deficiency

62. Which of the following is associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency? A. G6PD gene is located on the X chromosome. B. Ongoing intravascular hemolysis occurs. C. All circulating red cells, including reticulocytes, lack enzyme activity. D. Splenectomy can relieve the rate of red cell destruction.

A. G6PD gene is located on the X chromosome.

15. The myeloid progenitor cell can produce cells committed to A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages B. Granulocytic, monocytic, lymphocytic, or megakaryocytic lineages C. Erythrocytic, granulocytic, monocytic, or lymphocytic lineages D. Erythrocytic, granulocytic, lymphocytic, or megakaryocytic lineages

A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages

206. Naphthol AS-D chioroacetate esterase (specific) is usually positive in ________________ cells, and alphanaphthyl acetate esterase (nonspecific) _____________is useful for identifying blast cells of lineage. A. Granulocytic; monocytic B. Monocytic; granulocytic C. Granulocytic; lymphocytic D. Monocytic; lymphocytic

A. Granulocytic; monocytic

133. The major mechanism responsible for the anemia of chronic disease (ACD) is A. Impaired release of storage iron because of increased hepcidin levels B. Damaged bone marrow stem cells C. Immune destruction caused by red cell autoantibodies D. Increased erythropoietin response by committed red cell progenitor cells

A. Impaired release of storage iron because of increased hepcidin levels

222. Which of the following statements about non-Hodgkin types of lymphoma is true? A. Lymphadenopathy is the most common presenting symptom. B. Initially, they present as a systemic disease rather than a localized tumor. C. They are often associated with multiple bone lesions. D. They are characterized by proliferation of malignant cells primarily involving the bone marrow.

A. Lymphadenopathy is the most common presenting symptom.

An 83-year-old woman is seen in the emergency department complaining of fatigue and recent weight loss. Her CBC results are as follows: WBC 2.6 x 1 09/L (2.6 x 1 03/1iL); RBC 2.79>< 1 O2/L (2.79 X 1 06/pL); hemoglobin 92 gIL (9.2 g/dL); hematocrit 0.28 LIL (28%); MCV 100.0 fL; RDW 23.5%; platelet count 42 X 1 09/L (42,0004LL); differential count shows 42% segmented neutrophils, 45% band neutrophils, 3% lymphocytes, 3% metamyelocytes, 4% myelocytes, 3% blasts, and 4 nRBC/100 WBC. Morphologic changes noted on the differential smear include poor granulation and hyposegmentation of the neutrophils, giant platelets that display poor granulation, oval macrocytes, basophilic stippling, Cabot rings, Pappenheimer bodies, and Howell-Jolly bodies. Three micromegakaryocytes are seen per 100 WBCs. Serum B12 and folate levels are normal. 293. The peripheral blood findings are most consistent with A. Myelodysplastic syndrome B. Degenerative left shift C. Megaloblastic anemia D. Chronic myelogenous leukemia

A. Myelodysplastic syndrome

255. An EDTA blood sample run on an automated impedance cell counter has generated a warning flag at the upper region of the platelet histogram illustrated below. Which of the following would not be a cause of this warning flag? A. Nucleated RBCs B. Microcytic RBCs C. EDTA-dependent platelet agglutinins D. Giant platelets

A. Nucleated RBCs NRBCs are larger than normal RBCs and are not mistaken for platelets

175. In which anomaly is a failure of granulocytes to divide beyond the band or two- lobed stage observed? A. Pelger-Huet B. May-Hegglin C. Alder-Reilly D. Chediak-Higashi

A. Pelger-Huet

An 8-year-old girl is seen by the family physician. On physical examination, the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as follows: WBC 110 x 1 091L (110 x 1 034L); RBC 1.70 x 1 0121L (1.70 x 1 06/iL); hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 LIL (16%); differential count shows 93% blasts and 7% lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the blasts are small with no variation in their appearance. 287. Terminal deoxyribonucleotidyl transferase (TdT) is present in A. Precursor B and precursor T lymphoid cells B. Mature B and T lymphocytes C. Precursor B cells and mature B lymphocytes D. Precursor T cells and mature T lymphocytes

A. Precursor B and precursor T lymphoid cells

73) A 57 year old man with prostate cancer is admitted to the intensive care unit with severe bleeding problems. The following laboratory results are obtained: A. Primary fibrinogenolysis B. DIC with secondary fibrinolysis C. Factor II deficiency D. Coumadin Therapy

A. Primary fibrinogenolysis

129. The hemolysis associated with infection by malaria organisms is due to the A. Release of merozoites from erythrocytes B. Invasion of erythrocytes by merozoites C. Host's immunologic response to infected erythrocytes D. Toxins produced by the malarial organism

A. Release of merozoites from erythrocytes

56) A microtainer EDTA sample obtained during a fingerstick puncture is run on an automated cell counter, yielding a platelet count of 178 x10^9/L. In the erythrocytes monlayer of the stained peripheral blood smear, an average of 9 platelets per field is seen under 1000x magnification. Based on these data, you should A. Report the results because the platelet count and platelet estimate correlate. B. Recollect a specimen for a repeat platelet count because the platelet count and estimate do not correlate C. Examine the periphery of the blood smear for clumping because the platelet count and estimate do not correlate. D. Rerun the platelet count on the available specimen to confirm the results.

A. Report the results because the platelet count and platelet estimate correlate. A platelet estimate is obtained by multiplying the average number of platelets per oil immersion field (in an erythrocyte monolayer) by 20,000. This number is bases on a normal erythrocyte count, which must be considered when comparing the platelet count and estimate. The estimate int his example is 180x10^9/L. this agrees with the platelet count.

167. Which of the following is the least likely to be expressed by early B cell precursors? A. SIgM, a surface membrane immunoglobulin B. CD34, a hematopoietic stem cell marker C. TdT (terminal deoxynucleotidyl transferase), a nuclear enzyme D. CD1O (CALLA), a surface antigen

A. SIgM, a surface membrane immunoglobulin Early B cell precursors would be expected to express TdT, CD10 and CD34

93. In the anemia of chronic disease, what are the usual serum iron and transferrin levels? A. Serum iron decreased, transferrin decreased B. Serum iron decreased, transferrin increased C. Serum iron normal, transferrin normal D. Serum iron increased, transferrin increased

A. Serum iron decreased, transferrin decreased The TIBC which is an indirect measure of the amount of transferrin protein, is low in the anemia of chronic disease, whereas it is high in iron deficiency.

137. Which of the following represents an anemia that would have a high red cell distribution width (RDW)? A. Sickle cell disease during crisis B. Thalassemia minor C. Aplastic anemia D. Anemia of chronic disorders

A. Sickle cell disease during crisis

The peripheral blood shown in Color Plate ii is from a 19-year-old female college student who has been living primarily on tea, beer, and cereal for the past 9 months because she finds dining hail food distasteful. She visits student health complaining of fatigue. Her CBC results are as follows: WBC 2.5 X 1 091L (2.5 x 1 03/1iL); RBC 2.10 x 1 0121L (2.10 x 1 064LL); hemoglobin 85 gIL (8.5 gIdL); hematocrit 0.24 LIL (24%); platelet count 110 x 1 091L (11 0,0004iL); MCV 114 fL; MCHC 35.0 g/dL; reticulocyte count 0.8%. 274. Which of the following is not a laboratory finding in this general classification of anemia? A. Target cells and schistocytes B. Teardrop cells and macro-ovalocytes C. Howell-Jolly bodies and Cabot rings D. Elevated serum LD and iron levels

A. Target cells and schistocytes

158. Which of the following are indicators of a neutrophilic response to tissue damage or inflammatory stimuli? A. Toxic granules and Döhle bodies in the neutrophils B. Vacuoles and Barr bodies in the neutrophils C. Hypersegmented neutrophils and Auer rods D. Pyknotic neutrophils and Russell bodies

A. Toxic granules and Döhle bodies in the neutrophils

An 8-year-old girl is seen by the family physician. On physical examination, the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as follows: WBC 110 x 1 091L (110 x 1 034L); RBC 1.70 x 1 0121L (1.70 x 1 06/iL); hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 LIL (16%); differential count shows 93% blasts and 7% lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the blasts are small with no variation in their appearance. 284. Which of the following would you expect to most accurately reflect the child's platelet count? A. lOX 109/L B. 100X109/L C. 200X109/L D. 400XlO9/L

A. lOX 109/L

The peripheral blood smear in Color Plate 17l and the Sudan black B stain in Color Plate 191 are from a 90-year-old man complaining of fatigue and nosebleeds. The physician noted the patient was febrile and had petechiae. CBC results were as follows: WBC 20.0 x 1 09/L (20.0 x 1 O3Ijit); RBC 2.58 x 1 0121L (2.58 x 1 064LL); hemoglobin 77 gIL (7.7 g/dL); hematocrit 0.24 LJL (24%); platelet count 32 x 1 09/L (32,000/iL); differential count shows 75% blasts, 20% lymphocytes, and 5% segmented neutrophils. A bone marrow examination revealed 80% cellularity with 80% blasts. The blasts were myeloperoxidase and specific esterase positive; nonspecific esterase and PAS negative. 290. Cytogenetic studies would most likely show which of the following chromosome abnormalities? A. t(8;21) B. t(8;14) C. t(9;22) D. t(15;17)

A. t(8;21)

233.A major laboratory policy change that will affect a significant portion of the laboratory personnel is going to take place. In order to minimize the staff's resistance to this change, the supervisor should: A. announce the policy change the day before it will become affective B. discuss the policy change in detail with all personnel concerned, well in advance of implementation C. announce only the positive aspects of the policy change in advance D.discuss only the positive aspects of the policy with those concerned

B

235.The best way to motivate an ineffective employee would be to: A. confirm low performance with subjective data B. set short-term goals for the employee C. transfer the employee to another department D.ignore failure to meet goals

B

236.a technologist has an idea that would possibly decrease the laboratory turnaround time for reporting results. In order to begin implementation of this idea, he/she should: A. encourage staff to utilize the idea B. discuss it with his/her immediate supervisor C. try out the idea on himself/herself on an experimental basis D. present the idea to the laboratory director

B

242.what action should be taken when dealing with a long-term problem? A. ignore the problem B. seek more information C. base decision on available information D. refer the problem to another level of management

B

243.A major laboratory policy change that will affect a significant portion of the laboratory employees is going to take place. In order to minimize the staff's resistance to this change, the supervisor should: A. announce the change on day after ir goes into effect B. discuss the change in detail with all concerned, well in advance C. announce only the positive aspects in advance D. discuss only the positive aspects with those concerned

B

248.In its guidelines, CAP stresses that communication must be effective and efficient. An effective component to enhance a multifaceted communication plan in the clinical laboratory is: A. posting department goals on communication bulletin boards B. daily meetings with a question to foster conversations and focus the discussion C. written e-mail to communicate all new changes in processes and procedures D. posting errors on communication bulletin boards to prevent repeat errors

B

A chemistry test result from a chemotherapy patient was within normal limits on Tuesday. The same test was reported as abnormal on Monday ("flagged" high and approaching a critical value). The technologist performing the test noted a delta-check error and remembered that both controls ran much higher on Monday although they were within acceptable limits. The technologist's decision to follow-up this discrepancy before reporting the results is an example of which domain of behavioral objectives? A. Cognitive B. Affective C. Psychomotor D. Organizational

B

A name tag reads: "Jane Smith, MT(ASCP), CLS(NCA)." What does this tell us about Jane Smith's professional credentials? She is A. Accredited B. Certified C. Licensed D. Registered

B

Attitude, judgment, and interest refer to which domain of educational objectives? A. Cognitive B. Affective C. Psychomotor D. Competency

B

In order to comply with CLIA '88, calibration materials must: A.Be purchased by an authorized agency such as the College of Pathology B.Have concentration values that cover the laboratory's reportable range C.Be traceable to the National Calibration Board D.Be identical in concentration to those sold by the reagent manufacturer

B

In the field of clinical laboratory testing and in vitro diagnostic test systems, ISO/TC 212 is the document used for standardization and guidance in all of the following areas except: A. Quality management and quality assurance B. Scheduling, yearly evaluations, and workloads C. Pre- and postanalytical procedures D. Laboratory safety and reference systems

B

Maslow's theory of management is based upon: A. The premise that all workers are unmotivated B. A pyramid of goals for the satisfaction of employee needs C. Use of detractors and perks to keep employees happy D. The professional development of the employee

B

SITUATION: A patient refuses to have his blood drawn for a routine laboratory test request made by his physician. What is the most appropriate course of action? A.Perform the venipuncture against the patient's will B.Do not attempt the venipuncture and file an incident report with the laboratory manager C.Request that the patient be sedated, then collect the sample D.Request assistance from the legal department

B

SITUATION: A shipment from a laboratory supply company arrived over the weekend. The shipment consisted of glass slides, latex gloves, and plastic test tubes—all nonperishable items. It was left on the outside loading dock overnight. Are these supplies useable for patient care/testing? A.Yes, with no further quality assurance testing required B.Yes, but only after quality analysis is performed to ensure they were not affected adversely D.No, the latex gloves might be contaminated, but the slides and test tubes may be used C.No, all supplies left outside for 24 hours unattended must be discarded

B

Sexual harassment is a form of discrimination and therefore is prohibited by the: A.Occupational Safety and Health Administration (OSHA) B.Civil Rights Act of 1964 (Title VII) C.Right to Privacy Act of 1974 D.Department of Health and Human Services

B

Standard deviation is A.Used for frequency count data B.The dispersion of a set of numbers C.Used to compare more than two samples D.The statistics used to determine if means are from two different populations

B

The larger the sample size, the smaller the A. Population bias B. Sampling error C. Reliability error D. Random sample

B

The statement, "The curriculum is designed to prepare graduates to develop procedures for the analysis of biological specimens," is an example of a(n) A. Course description B. Goal C. Task analysis D. Objective

B

The three levels of test questions are: A. Recall,synthesis,interpretation B. Recall, interpretation, problem solving C. Recall, synthesis,problem solving D. Easy, interpretation, case studies

B

What is one of the most commonproblems encountered with use of overhead transparencies? A.Classroom kept dark when they are used B. Contain too much information C. Take long time to prepare D. Difficult to design

B

Which of the following accurately describes the steps involved in a LEAN process? A.Lower cost, efficient flow, added value, net result B.Customer value, value stream map, flow, pull, improved outcome C.Satisfaction, cost savings, turnaround time D.Efficiency study, modeling, construct, step-by-step process

B

Which of the following questions is allowable during a pre-employment interview? A.How many times have you been pregnant? B.Have you been convicted of any felonies? C.Does your husband belong to any religious societies? D.Are you planning to use the hospital day care center?

B

Which of the following refers to the contract between an academic institution and a clinical education site that describes the responsibilities of the institutions and the expectations of students? A. Accreditation agreement B. Affiliation agreement C. Education contract D. Clinical policy statement

B

Which of the following represents an action verb? A. Understand B. Diagram C. Know D. Realize

B

Which of the following would not be appropriate for point-of-care testing? A. Cardiac markers B. Thyroid stimulating hormone C. Parathyroid hormone (PTH) D. Blood gases

B

Which regulatory agency mandates the following requirements for protection of employees of clinical laboratories? -Provide personal protective equipment (PPE) -Require hepatitis B vaccinations at no cost -Require specific biohazard materials labeling -Provide training and updating yearly of safety standards A.Food and Drug Administration (FDA) B.Occupational Safety and Health Administration (OSHA) C.American Association of Blood Banks (AABB) D.American Society of Clinical Pathologists (ASCP)

B

Which statement best represents the relationship between test volume and revenue or costs for batch-run tests? A.As volume increases, the fixed cost per test also increases B.As volume increases, the revenue also increases C.Revenue is approximately equal for both high- and low-volume tests D. 90% of the revenue is generated by 5% of the tests offered

B

239. What is the depth between the counting platform and the coverslip on a hemacytometer? A. 0.01 mm B. 0.10 mm C. 1.00mm D. 0.1cm

B. 0.10 mm

17) The size threshold range used by electrical impedance methods to count particles as platelets is: A. 0-10 fL B. 2-20 fL C. 15-40 fL D. 35-90 fL

B. 2-20 fL

241. Which set of results indicates that an error in measurement has occurred? h RBC x 10^12/L Hgb (g/dL) Hct (%) A. 2.50, 7.6, 22.9 B. 2.75, 9.5, 24.8 C. 3.40, 10.0, 31.0 D. 3.75, 11.1, 34.0

B. 2.75, 9.5, 24.8

240. A WBC count is performed on a hemacytometer using a 1:20 dilution. 308 cells are seen in a total area of 8 mm2. What is the WBC count? A. 3.8X1091L B. 7.7X109/L C. 15.4X10/L D. 38.5X109/L

B. 7.7X109/L

178. The blood shown in Color Plate 11(macrocytic ovalocytes and hypersegmented neturophils) is from a leukemia patient following treatment. These findings are most suggestive of therapy with A. Corticosteroids (e.g., prednisone) B. A folate antagonist (e.g., methotrexate) C. Recombinant erythropoietin D. Chioramphenicol

B. A folate antagonist (e.g., methotrexate)

224. The slowest-moving hemoglobin(s) on an alkaline electrophoresis at pH 8.6 is(are) A.A B. A2,C,E,andO C.F D. S,D,andG

B. A2,C,E,andO

6. Which of the following does not accurately describe hematopoietic growth factors? A. Bind to target cell receptors to express activity B. Action of majority is lineage restricted C. May promote or suppress cell death D. Can stimulate or inhibit cell proliferation

B. Action of majority is lineage restricted

204. Coarse PAS positivity may be found in the leukemic cells of A. Acute myeloblastic leukemia (FAB type Ml) B. Acute lymphoblastic leukemia (FAB type L1) C. Acute myelomonocytic leukemia (FAB type M4) D. Acute monocytic leukemia (FAB type M5)

B. Acute lymphoblastic leukemia (FAB type L1)

212. Which type of leukemia is associated with the best prognosis for a cure? A. Chronic lymphocytic leukemia in the elderly B. Acute lymphoblastic leukemia in children C. Acute myelogenous leukemia in children D. Chronic myelogenous leukemia in young adults

B. Acute lymphoblastic leukemia in children

190. The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular coagulation (DIC) is diagnostic of A. Acute myeloblastic leukemia without maturation (FAB type Ml) B. Acute myeloblastic leukemia with maturation (FAB type M2) C. Acute promyelocytic leukemia (FAB type M3) D. Acute myelomonocytic leukemia (FAB type M4)

B. Acute myeloblastic leukemia with maturation (FAB type M2)

The peripheral blood smear in Color Plate 17l and the Sudan black B stain in Color Plate 191 are from a 90-year-old man complaining of fatigue and nosebleeds. The physician noted the patient was febrile and had petechiae. CBC results were as follows: WBC 20.0 x 1 09/L (20.0 x 1 O3Ijit); RBC 2.58 x 1 0121L (2.58 x 1 064LL); hemoglobin 77 gIL (7.7 g/dL); hematocrit 0.24 LJL (24%); platelet count 32 x 1 09/L (32,000/iL); differential count shows 75% blasts, 20% lymphocytes, and 5% segmented neutrophils. A bone marrow examination revealed 80% cellularity with 80% blasts. The blasts were myeloperoxidase and specific esterase positive; nonspecific esterase and PAS negative. 289. What is this patient's most likely diagnosis? A. Acute myelogenous leukemia without maturation (FAB type Ml) B. Acute myelogenous leukemia with maturation (FAB type M2) C. Acute monocytic leukemia (FAB type M5) D. Myelodysplastic syndrome

B. Acute myelogenous leukemia with maturation (FAB type M2)

258. When are automated cell counters required to have a calibration check performed? A. At least every 3 months B. After replacement of any major part C. After performing monthly maintenance D. When the control values are greater than 2 standard deviations from the mean

B. After replacement of any major part

31. The red cells found in lead poisoning characteristically exhibit coarse granules composed of _______________ that are reported as ______________ A. Precipitated hemoglobin; Pappenheimer bodies B. Aggregated ribosomes; basophilic stippling C. Nuclear fragments; Pappenheimer bodies D. Excess iron deposits; basophilic stippling

B. Aggregated ribosomes; basophilic stippling

4) Platelets interacting with and binding to other platelets is referred to as: A. Adhesion B. Aggregation C. Release D. Retration

B. Aggregation

45. When acanthocytes are found on the blood smear, it is usually the result of A. Abnormal membrane permeability B. Altered membrane lipids C. Mechanical trauma D. Polymerization of hemoglobin molecules

B. Altered membrane lipids Acanthocytes are the results of abnormal plasma lipids that have altered the lipid composition of the membrane, often involving increased cholesterol content. Acanthocytes (spur cells) are associated with a congenital form of acathocytosis and with liver disease, or are seen following splenectomy.

146. A "shift to the left," when used to describe a cell population, refers to A. Increased cells in the blood due to a redistribution of blood pools B. An increase in immature blood cells following release of bone marrow pools C. A cell production "hiatus" or gap D. A higher percentage of lymphocytes than neutrophils

B. An increase in immature blood cells following release of bone marrow pools

114. A bone marrow M:E ratio of 4:1 would be an expected finding for A. Sickle cell anemia B. Aplastic anemia C. Beta-thalassemia major D. Megaloblastic anemia

B. Aplastic anemia Aplastic anemia is bone marrow failure characterized by hypocellularity and decreased production of all cell lines. The normal M:E ratio (4:1) does not change in aplasia, because the number of both myelid and erythroid precursors is decreased. In anemias such as sickle cell anemia, beta-thalassemia major, or megaloblastic anemia, the marrow become hypercellular because of an increase in erythroid precursors, and the M:E ratio falls.

10. Programmed cell death is called A. Necrosis B. Apoptosis C. Cellular senescence D. Tenninal differentiation

B. Apoptosis

150. Which of the following statements is correct? A. Hypersegmented neutrophils have four nuclear lobes. B. Auer rods are composed of fused primary granules. C. Toxic granules are prominent secondary granules. D. Döhle bodies are agranular patches of DNA.

B. Auer rods are composed of fused primary granules Auer rods are seen in the cytoplasm of maligant cells, most often myeloblasts, and are composed of fused primary (nonspecific, azurophilic) granules. Hypersegmented neutrophils have five lobes or more and are associated with vitamin B12 or folate deficiency. toxic granules are primary granules with altered staining characteristics that stain in late-stage neutrophils due to toxicity. Dohle bodies are agranular patches of RNA present in neutrophil cytoplasm and associated with toxic states.

196. Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia? A. MYC/IGH B. BCR/ABL C. PML/RARA D. JAK2

B. BCR/ABL

The peripheral blood smear in Color Plate 17l and the Sudan black B stain in Color Plate 191 are from a 90-year-old man complaining of fatigue and nosebleeds. The physician noted the patient was febrile and had petechiae. CBC results were as follows: WBC 20.0 x 1 09/L (20.0 x 1 O3Ijit); RBC 2.58 x 1 0121L (2.58 x 1 064LL); hemoglobin 77 gIL (7.7 g/dL); hematocrit 0.24 LJL (24%); platelet count 32 x 1 09/L (32,000/iL); differential count shows 75% blasts, 20% lymphocytes, and 5% segmented neutrophils. A bone marrow examination revealed 80% cellularity with 80% blasts. The blasts were myeloperoxidase and specific esterase positive; nonspecific esterase and PAS negative. 292. Which of the following is not considered 294. an underlying condition that predisposes a patient to acute leukemia? A. Viral infections B. Bacterial infections C. Chronic bone marrow dysfunction D. Congenital chromosome abnormalities

B. Bacterial infections

52. Excessive extravascular red cell destruction is associated with A. Hemoglobinemia B. Bilirubinemia C. Hemoglobinuria D. Hemosiderinuria

B. Bilirubinemia When excessive extravascular red cell destruction occurs, the plasma bilirubin level rises and is largely unconjugated bilirubin. When acute intravascular red cell destruction occurs, hemoglobin is released into the plasma and findings may include hemoglobinemia, hemoglobinuria, and hemosiderinuria.

8) The operating principle of a platelet aggregometer is best described as: A. Aggregation on a foreign surface: platelet aggregation is directly proportional to the difference in platelet counts performed before and after platelet-rich plasma is passed through a column of glass beads B. Change in optical density: as platelets aggregate, the optical density of the platelet-rich plasma decreases. C. Electrical impedance: platelet aggregates are counted as they pass through an aperture, temporarily interrupting the of current between two electrodes. D. Pulse editing: editing electronically generated pulses can differentiate the number of free platelets versus platelet aggregates

B. Change in optical density: as platelets aggregate, the optical density of the platelet-rich plasma decreases.

185. The peripheral blood shown in Color Plate 14 is from a 69-year-old female. Her WBC count was 83.0 X i0 cells/L (83.0 X 103/pL) and her platelet count was normal. Based on the cell morphology and this information, what is the most likely diagnosis? A. Acute lymphoblastic leukemia B. Chronic lymphocytic leukemia C. Waldenström macroglobulinemia D. Viral infection

B. Chronic lymphocytic leukemia CLL is characterized by an absolute lymphocytosis and a predominance of small, mature lymphocytes with hyperclumped nuclear chromatin. Elevated leukocyte counts are usual, as are fragile, smudged lymphocytes. ALL typically occurs in children and is characterized by immature lymphoid cells.

A 53-year-old man reported to the laboratory for routine blood work as part of a yearly physical. He had been feeling tired for the last few months. Physical examination revealed splenomegaly. H is CBC results are as follows: WBC 80.0 x 1 09/L (80.0 x 103/1iL); RBC 4.lOx 1012/L(4.1OX 1 064LL); hemoglobin 123 gIL (12.3 g/dL); hematocrit 0.37 L/L (37.0%); platelet count 650 x 1 09/L (650,000IpL); differential count shows 40% polymorphonuclear neutrophils, 18% bands, 5% metamyelocytes, 7% myelocyte, 28% lymphocytes, and 2% monocytes. No ABC or WBC morphologic abnormalities are seen. 297. The peripheral blood findings are most consistent with a diagnosis of A. Neutrophilic leukemoid reaction B. Chronic myelogenous leukemia C. Acute myelogenous leukemia D. Regenerative left shift

B. Chronic myelogenous leukemia

7) The platelet aggregation pattern (after addition, a slight drop and then curved increase to plateau) is characteristic of the aggregating agent: A. ADP B. Collagen C. Ristocetin D. Thrombin

B. Collagen Collagen is the only aggregating agent that includes a single wave response preceded by a lag phase. During the lag phase collagen stimulates platelets to release their granule contents. Endogenous ADP released from the platelets then initiates irreversible platelet aggregation.

65. A 9-month-old male was seen in the ER w/femur fracture. hepatosplenomegaly noted w/extreme pallor, and a slight arrhythmia. CBC results: WBC 12.2 X 1 09/L (12.2 Xl O3/pL) RBC 3.OSX 1012/L (3.05X 1O6/pL) Hemoglobin 61 g/L(6.1 g/dL) Hematocrit 0.20 L/L (20%) MCV 65.5fL MCH 20p9 MCHC 305 g/L (30.5 g/dL) RDW 25% See Color Plate 4. Hemoglobin electrophoresis results as follows: HgbA 0% HgbA2 3% HgbF 97% Which condition is most likely causing the hematologic abnormalities? A. Alpha-thalassemia major B. Cooley beta-thalassemia major C. Hemoglobin H disease D. Hereditary persistence of hemoglobin F

B. Cooley beta-thalassemia major

245. Side angle scatter in a laser-based cell counting system is used to measure A. Cell size B. Cytoplasmic granularity C. Cell number D. Immunologic (antigenic) identification

B. Cytoplasmic granularity

92. Which of the following does not characterize beta-thalassemia major? A. Transfusion-dependent anemia B. Decreased alpha chains result in excess beta chains. C. Iron chelation therapy is necessary. D. Common in persons of Mediterranean ancestry

B. Decreased alpha chains result in excess beta chains. Decreased or absent beta chains lead to excess alpha chains that precipitate in red cell destruction that far exceeds the rate of production.

A 32-year-old African-American traveling to Africa on business had been healthy until he began taking primaquine for prevention of malaria. He went to his physician because he felt faint and his urine was black. His CBC results are as follows: WBC 6.5 X 1 09/L (6.5 X 1 03IpL); RBC 1.67 X 1 0121L (1.67 x 1 064iL); hemoglobin level 50 g/L (5.0 g/dL); hematocrit 0.15 L/L (15%); MCV 89.8 fL; MCHC 33.3 g/dL; platelet count 175 X 1 09/L (1 75,000/1iL); reticulocyte 25.0%. 280. Inclusions that form when the patient is oxidatively challenged are composed of A. RNA B. Denatured hemoglobin C. DNA D. Iron

B. Denatured hemoglobin

197. Which of the following statements does not correctly describe the WHO (World Health Organization) classification of hematopoietic neoplasms? A. Acute leukemia is defined as the presence of at least 20% bone marrow blasts. B. Diagnosis is based on cellular morphology and cytochemistry. C. It groups lymphoid disorders into B cell, TINK cell, and Hodgkin lymphoma. D. Diagnostic criteria include morphologic, cytochemical, immunologic, cytogenetic, and molecular features.

B. Diagnosis is based on cellular morphology and cytochemistry.

68. Of the following, the leading cause of folate deficiency is A. Increased requirements B. Dietary insufficiency C. Drug inhibition D. Malabsorption

B. Dietary insufficiency

156. Which of the following statements about eosinophils is false? A. They contain a type of peroxidase that is distinct from that of neutrophils. B. Eosinophilic granules contain lysozyme. C. Eosinophils are an important line of defense against parasites. D. Major basic protein is a component of eosinophil granules.

B. Eosinophilic granules contain lysozyme. Eosinophils lack lysozyme, which is present in neutrophils and monocytes, and contain a distinctive peroxidase that differs biochemically from the myeloperoxidase of neutrophils and monocytes. Major basic protein is a component of the granules and is very important to the ability of eosinophils to control parasites. In addition, eosinophils play a role in modifying the allergic reactions caused by degranulation of basophils. Basophils release eosinophil chemotactic factor of anaphylaxis, which calls eosinophils to the site.

53) The prothrombin time will detect deficiencies in the ___________ pathways (s) when calcium and a tissue factor source such as rabbit brain are added to plasma. A. Extrinsic B. Extrinsic and common C. Intrinsic D. Intrinsic and common

B. Extrinsic and common

22) The coagulation factors having a sex-linked recessive inheritance pattern are: A. Factor V and factor VIII B. Factor VIII and facotr IX C. Factor IX and factor X D. von Willebrand factor and factor VIII

B. Factor VIII and facotr IX

29) Fibrin strands are cross-linked and the fibrin clot is stabilized by the activity of: A. alpha2-antiplasmin B. Factor XIIIa C. Plasmin D. Thrombin

B. Factor XIIIa

85. Which of the following conditions show similar CBC and blood smear findings? A. Beta-thalassemia major and minor B. Folic acid and vitamin B12 deficiencies C. Acute and chronic blood loss D. Sickle cell disease and trait

B. Folic acid and vitamin B12 deficiencies The blood profile alone annot distinguish folic acid and vitamin B12 deficiencies, becuase both are characterized by macrocytic ovalocytes, Howell-Jolly bodies and hypersegmented neutrophils.

66)A clot retraction defect is suspected in a newborn male experiencing severe bleeding following circumcision, the following results were obtained: Platelet count 320x109/L, bleeding time >15 min (ref range <8.0 min), platelet aggregation Normal response to ristocetin; weak response to ADP, collagen, epinephrine, PT 12.0 sec (control 12.0 sec), aPTT 31.0 sec (control 32.0 sec) A. von Willebrand disease B. Glanzmann thrombastheinia C. Storage pool disease D. Christmas disease

B. Glanzmann thrombasthenia

63. In regard to variant hemoglobin E, a2 26 Glu — Lys which of the following statements is false? A. There are two normal alpha chains. B. Glutamic acid replaces lysine on position 26 of the beta chains. C. Hemoglobin E is the second most common hemoglobin variant known. D. Glutamic acid is normally found at position 26 of the beta chain.

B. Glutamic acid replaces lysine on position 26 of the beta chains.

12. Bone marrow cellularity refers to the ratio of A. Red cell precursors to white cell precursors B. Hematopoietic tissue to adipose tissue C. Granulocytic cells to erythrocytic cells D. Extravascular tissue to intravascular tissue

B. Hematopoietic tissue to adipose tissue bone marrow cellularity in the normal adult is approximately 50% hematopoietic tissue and 50% adipose tissue (Fat)

117. A cellulose acetate electrophoresis revealed a large band of hemoglobin in the hemoglobin S position. This band quantified at 95%. The peripheral smear revealed 70% target cells, and the solubility test was negative. Based on this information, what is the hemoglobin? A. Hemoglobin C B. Hemoglobin D C. Hemoglobin E D. Hemoglobin S

B. Hemoglobin D Hemoglobin D migrates in the same location as hemoglobin S on cellulose acetate at alkaline pH but does not cause sickling. The negative solubility test rules out the presence of hemoglobin S.

102. In clinically severe hereditary spherocytosis, which of the following findings would not be found post-splenectomy? A. Rise in the red cell count and hemoglobin level B. Higher number of circulating reticulocytes C. Increased number of Howell-Jolly bodies D. Transient elevation in the platelet count

B. Higher number of circulating reticulocytes

49) A 25-year old male presents to his physician complaining of leg pain. The physician diagnoses a deep vein thrombosis and wants to determine the cause of the thrombotic episode. Which of the following conditions would not be associated with such a thrombotic episoide? A. Factor V leiden and prothrombin 20210 mutations B. Hypofibrinogenemia and hyperhomocysteinemia C. Lupus anticoagulant and anticardiolipin antiboides D. Antithrombin and protein C deficiencies

B. Hypofibrinogenemia and hyperhomocysteinemia

61) A sodium citrate tube is received in the lab of PT and aPTT testing. Results are as follows: PT >100 secs (control 12.0 sec) aPTT >200 (control 32.0) On examination, a large clot is discovered. The abnormal test results are due to deficiencies of factors: A. I, V, VIII, IX B. I, II, V, VIII, XIII C. II, VII, IX, X D. VII, IX, XI, XII

B. I, II, V, VIII, XIII A synonym for the fibrinogen group of factors is the consumed factors, because they are totally used up in clot formation. In the conversion of fibrinogen to fibrin, all of prothrombin is converted to thrombin. Thus, factors I, V, VIII, XIII, and III are all missing in serum.

180. An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. These findings are most consistent with A. Chronic myelogenous leukemia B. Idiopathic myelofibrosis C. Primary polycythemia D. Primary thrombocythemia

B. Idiopathic myelofibrosis

63) 4 year old child is seen in the emergency department with petechaiae and platelet count of 15x109/L. She has no precious history of bleeding problems. Three weeks earlier she had chicken pox. the physician advises the parents to keep the child off the playground to avoid injury, and says the child will recover within 2-4 weeks with no further treatment. What condition does this child most likely have? A. Essential thrombocythemia B. Idiopathic thrombocytopenic purpura C. Thrombotic thrombocytopenic purpura D. Glazmann thrombasthenia

B. Idiopathic thrombocytopenic purpura

55. Where do the early and late stages of heme synthesis occur? A. On ribosomes B. In mitochondria C. In cytoplasm D. In nucleoli

B. In mitochondria

26) A patient on theraeutic warfarin will most likely have a(n): A. Normal PT/INR, increased aPTT, prolonged bleeding time, low platelet count B. Increased PT/INR, increased aPTT, normal bleeding time, normal platelet count C. Normal PT/INR, normal aPTT, normal bleeding time, normal platelet count D. Increased PT/INR, normal aPTT, prolonged bleedign time, low platelet count

B. Increased PT/INR, increased aPTT, normal bleeding time, normal platelet count Warfarin is a vitamin K antagonist and affects liver synthesis of the prothrombin group factors II, VII, IX, and X. The factors are produced but are nonfunctional

189. In a patient with fever of unknown origin, which of the following findings is not consistent with an inflammatory process? A. Increased C-reactive protein B. Increased albumin level C. Increased fibrinogen level D. Increased erythrocyte sedimentation rate

B. Increased albumin level

165. Which of the following can differentiate metamyelocytes from other stages of granulocyte maturation? A. Presence of specific granules B. Indentation of nucleus C. Absence of nucleoli D. Color of cytoplasm

B. Indentation of nucleus

22. The Na—K cation pump is an important mechanism in keeping the red blood cell intact. Its function is to maintain a high level of A. Intracellular Na+ B. Intracellular K+ C. Plasma Na+ D. Plasma K+

B. Intracellular K+

A 45-year-old Scandinavian woman with white hair appears older than her age. She complains to her physician of weakness, a tingling sensation in her lower extremities, and shortness of breath. Her CBC results are as follows: WBC 3.4 x 1 09/L (3.4 x 1 03/L); RBC 1.90 x 1 o12/L (1.90 x 1 06IL); hemoglobin level 86 gIL (8.6 g/dL); hematocrit 0.25 LJL (25%); MCV 132 fL; MCHC 34.4 g/dL; platelet count 100 x 1 09/L (1 00,000IpL). Cabot rings are noted on the peripheral smear. 277. Which of the following statements about megaloblastic anemia is true? A. Oral folate therapy reverses the neurologic symptoms of PA. B. Intramuscular injections of vitamin 12 will reverse the neurologic symptoms of PA. C. Methotrexate (chemotherapeutic agent) is a vitamin 12 antagonist. D. Folate deficiency takes years to develop.

B. Intramuscular injections of vitamin 12 will reverse the neurologic

132. When iron use exceeds absorption, which of the following occurs first? A. Hemoglobin level decreases. B. Iron stores are depleted. C. Transferrin synthesis increases. D. Excretion of iron decreases

B. Iron stores are depleted.

8. The mechanism that relays information about tissue oxygen levels to erythropoietin-producing sites is located in the A. Brain B. Kidney C. Liver D. Spleen

B. Kidney

43) A clot retraction defect is most likely due to: A. Lack of platelet receptor glycoprotein Ib B. Lack of platelet receptor glycoprotein IIb/IIIa C. Insufficient ADP in dense bodies D. Absence of von Willebrand factor

B. Lack of platelet receptor glycoprotein IIb/IIIa Glanzmann thrombasthenia is a disorder characterized by absent or defective GP IIb/IIIa platelet receoptors for fibrinogen binding and subsequent pletelt aggregation. Clot retraction in these patients is abnormal due to the lack of the contractile protein actomyosin/thrombasthenin.

235. The Sudan black B stain shown in Color Plate 191 is a stain for A. Glycogen B. Lipids C. Myeloperoxidase D. Acid phosphatase

B. Lipids

27. A senescent red blood cell is one that has A. Been hemolyzed B. Lived its life span C. Become deformed D. Lost its mitochondria

B. Lived its life span

213. What is the key diagnostic test for Hodgkin lymphoma? A. Bone marrow biopsy B. Lymph node biopsy C. Spinal tap D. Skin biopsy

B. Lymph node biopsy Lymphadenopathy is the major clinical presentation of Hodgkin disease, and early stages do not have bone marrow involvement.

51. The red cells observed on a peripheral blood smear show extreme anisocytosis with an equal number of macrocytes and microcytes. Which of the following values correlate with this finding? A. MCV 108.0 fL, RDW 14.0% B. MCV 90.0 fL, RDW 25.0% C. MCV 75.OfL,RDW 16.0% D. MCV 88.0 fL, RDW 12.0%

B. MCV 90.0 fL, RDW 25.0% MCV would be normal, RDW is high when a heterogeneous population of red cells is present

124. The fish tapeworm Diphyllobothrium latum is associated with the development of A. Microcytic anemia B. Macrocytic anemia C. Hemolytic anemia D. Hypoproliferative anemia

B. Macrocytic anemia

73. Hereditary stomatocytosis is manifested physiologically by changes in A. Hemoglobin oxygen affinity B. Membrane cation permeability C. Efficiency of hemoglobin reduction D. Glycolytic ATP production

B. Membrane cation permeability

153. Which of the following statements about basophils is false? A. Morphologically, basophils resemble tissue mast cells. B. Membrane receptors bind IgG, initiating anaphylactic reactions. C. Basophilic granules contain heparin and histamine. D. Granules are water soluble.

B. Membrane receptors bind IgG, initiating anaphylactic reactions Basophils and tissue mast cells have receptors for IgE and complement components, which trigger degranulation when appropriate antigens are present and are responsible for severe hypersensivity reactions (anaphylaxis)

55) A specimen is received for a prothrombin time and activated partial thromboplastin time. The 5 mL tube has 2.5 mL of blood in it. Expected test results are: A. PT and aPTT both falsely short B. PT and aPTT both falsely long C. PT and aPTT both unaffected D. PT unaffected, aPTT falsely short

B. PT and aPTT both falsely long

119. Which of the following is an acquired red cell membrane defect that results in increased sensitivity to complement binding? A. March hemoglobinuria B. Paroxysmal nocturnal hemoglobinuria C. Paroxysmal cold hemoglobinuria D. Methemoglobinemia

B. Paroxysmal nocturnal hemoglobinuria

A 45-year-old Scandinavian woman with white hair appears older than her age. She complains to her physician of weakness, a tingling sensation in her lower extremities, and shortness of breath. Her CBC results are as follows: WBC 3.4 x 1 09/L (3.4 x 1 03/L); RBC 1.90 x 1 o12/L (1.90 x 1 06IL); hemoglobin level 86 gIL (8.6 g/dL); hematocrit 0.25 LJL (25%); MCV 132 fL; MCHC 34.4 g/dL; platelet count 100 x 1 09/L (1 00,000IpL). Cabot rings are noted on the peripheral smear. 275. The clinical and laboratory findings are most consistent with A. Liver disease B. Pernicious anemia C. Folic acid deficiency D. Aplastic anemia

B. Pernicious anemia

162. Cells that produce immunoglobulins in response to antigenic stimulation are designated A. Natural killer cells B. Plasma cells C. Virocytes D. Thymocytes

B. Plasma cells Plasma cells are the mature end stage of the B lymphocyte, producing immunoglobulins in response to activation by a specific antigen (humoral immunity).

28) von Willebrand factor is a: A. Phospholipid required for multiple reactions in the coagulation sequence B. Plasma protein that binds platelets to exposed subendothelial collagen C. Plasma protein with procoagulant D. Platelet membrane glycoprotein that attaches the platelet to the injured vessel wall

B. Plasma protein that binds platelets to exposed subendothelial collagen

31) Which of the following enzymatically degrades the stabilized fibrin clot? A. Plasminogen B. Plasmin C. Prothrombrin D. Thrombin

B. Plasmin

126. Thalassemias are the result of a A. Structural defect in the heme portion of hemoglobin B. Quantitative defect in globin-chain synthesis C. Qualitative defect in globin-chain structure D. Change in hemoglobin solubility properties

B. Quantitative defect in globin-chain synthesis

215. A 60-year-old patient presents with extreme fatigue. Her blood and bone marrow findings are as follows: severe anemia with a dual RBC population, 3% marrow blasts, and numerous ringed sideroblasts. This information is most consistent with A. Refractory anemia (RA) B. Refractory anemia with ringed sideroblasts (RARS) C. Refractory anemia with excess blasts (RAEB) D. Chronic myelomonocytic leukemia (CMML)

B. Refractory anemia with ringed sideroblasts (RARS)

60. Fetal hemoglobin differs from adult hemoglobin in that hemoglobin F A. Has a lower oxygen affinity B. Resists elution from red cells with acid solutions C. Is no longer synthesized after birth in a normal individual D. Has four gamma-globin chains

B. Resists elution from red cells with acid solutions This techniques is Kleihauer and Betke

135. Thinning of bones and deformation of facial bone structure seen in homozygous beta-thalassemia is a A. Consequence of disturbances in calcium metabolism B. Result of hyperplastic marrow activity C. Secondary disorder due to immunologic response D. Result of increased fibroclast activity

B. Result of hyperplastic marrow activity

An 8-year-old girl is seen by the family physician. On physical examination, the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as follows: WBC 110 x 1 091L (110 x 1 034L); RBC 1.70 x 1 0121L (1.70 x 1 06/iL); hemoglobin 55 g/L (5.5 g/dL); hematocrit 0.16 LIL (16%); differential count shows 93% blasts and 7% lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the blasts are small with no variation in their appearance. 288. The presence of CD2, CD5, CD7 and the absence of CD1O (CALLA) are associated with A. B lymphocytes B. T lymphocytes C. Myeloid cells D. Monocytic cells

B. T lymphocytes

The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek boy with the following results on an automated impedance counter: WBC 35.0 X 1 09/L (35.0 X 1 03/pL); RBC 2.50 X 1 012/L (2.50 x 1 06/FL); hemoglobin 45 gIL (4.5 g/dL); hematocrit 0.16 LJL (16%); platelet count 250 X 1 09/L (250,0004AL); reticulocyte count 8.0%; 110 nucleated red blood cells/i 00 WBCs and many targets are seen. Other laboratory results are as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin elevated. 268. Why is it difficult to diagnose this disorder in a newborn? A. The liver is immature. B. The beta chains are not fully developed at birth. C. It is similar to hemolytic disease of the newborn (HDN) because of ABO incompatibility. D. There are normally many erythrocyte precursors in the peripheral blood.

B. The beta chains are not fully developed at birth.

A 53-year-old man reported to the laboratory for routine blood work as part of a yearly physical. He had been feeling tired for the last few months. Physical examination revealed splenomegaly. H is CBC results are as follows: WBC 80.0 x 1 09/L (80.0 x 103/1iL); RBC 4.lOx 1012/L(4.1OX 1 064LL); hemoglobin 123 gIL (12.3 g/dL); hematocrit 0.37 L/L (37.0%); platelet count 650 x 1 09/L (650,000IpL); differential count shows 40% polymorphonuclear neutrophils, 18% bands, 5% metamyelocytes, 7% myelocyte, 28% lymphocytes, and 2% monocytes. No ABC or WBC morphologic abnormalities are seen. 300. How does the presence of this chromosome abnormality affect the prognosis? A. It is not a prognostic indicator. B. The prognosis is better when the abnormality is present. C. The prognosis is better when the abnormality is not present. D. Progression to acute lymphoblastic leukemia occurs more often when the abnormality is present.

B. The prognosis is better when the abnormality is present.

69)The following results are obtained on a 60 year old male patient. The WBC, RBC, Hgb, Hct, and Plt were performed on blood collected in a evacuated tube containing EDTA. The PT and aPTT were performed on blood collected in an evacuated tube containing 3.2% sodium citrate. The standard collection procedure was followed and all tests were performed with n the appropriate time limits. Based on this information, the statement that best explains the prolonged coagulation tests results is A. Coagulation reactions require platelet factor 3: availability of this component is insufficient when the platelet count is below 100x109/L B. The ratio of anticoagulant to blood is critical; the volume of anticoagulant must be decreased when the Hct is greater than 55% C. The PT and aPTT evaluate the extrinsic and intrinsic pathways, respectively; prolongation of both tests indicates a deficiency of a factor common to both systems D. Coagulation reactions are inhibited by a product released by leukocytes: this inhibitory activity becomes significant when the leukocyte count is greater than 20.0x109/L

B. The ratio of anticoagulant to blood is critical; the volume of anticoagulant must be decreased when the Hct is greater than 55%

35) Why is the activated partial thromboplastin time (aPTT) not the procedure of choice for detecting a platelet factor 3 (PF3) deficiency? A. Platelet-rich plamsa is used for this test B. The reagent contains a phospholipid substitute for PF3 C. PF3 is unstable in the reagent used for this test D. PF3 does not function in the system being tested

B. The reagent contains a phospholipid substitute for PF3

239.The ability to make good decisions often depends on the use of a logical sequence of steps that include A. defining problem, considering options, implementing decisions B. obtaining facts, considering alternatives, reviewing results C. defining problem, obtaining facts, considering options D. obtaining facts, defining problem, implementing decision

C

A hospital has a contract with a major medical insurer that reimburses the laboratory at a rate of $1.00 per insured life per year. This type of reimbursement is called: A. A prospective payment system B. A preferred provider discount C. Capitation D. Diagnosis-related group

C

A laboratory information system (LIS) uses an algorithm based on the delta check process to identify erroneous results. This process is a part of which LIS function? A. Quality control management B. Real-time instrument interfacing C. Autoverification of test results D. Electronic crossmatching

C

According to CLIA '88, calibration materials should be appropriate for the methodology and be: A.Of bovine origin B.Three times the normal range for the specific analyte C.Traceable to a reference method and reference material of known value D.Twice the laboratory's reference range for the analyte

C

According to CLIA '88, testing personnel performing high-complexity laboratory tests must have at least a: A.Bachelor of Arts degree B.Bachelor of Science degree in medical laboratory science (MLS) C.Associate degree in medical laboratory science (MLT) D.High school diploma

C

According to CLIA '88, when performing and documenting linearity, the following samples are required: A.A single calibrator and a zero set point B.One normal and one abnormal level C.Three levels of known concentration and a zero level D.A high and low control material

C

According to the Clinical Laboratory Improvement Act of 1988 (CLIA '88), control of laboratory test reliability is accomplished by all of the following requirements except: A.Documentation of quality control results and corrective actions B.Participation in proficiency testing for all nonwaivered tests C.Professional certification of all testing personnel D.Demonstration that all quantitative tests meet manufacturer's performance specifications

C

An instructor "curved" a blood bank exam given to medical laboratory science students. The highest grade was an 85% and the lowest grade was a 60%. What type of test is this? A. Subjective B. Objective C. Norm referenced D. Criterion referenced

C

An instructor of medical laboratory science was given the task of expanding the curriculum for the senior (baccalaureate degree) medical laboratory science students. Which of the following subjects should be included in the curriculum? A. Cytology—cytogenetics B. Histology—special stains C. Computer (laboratory information systems [LIS]) D. Economics—budget analysis

C

CLIA '88 specifies that the minimum requirements for proficiency testing (PT) of analytes for which PT is required (excluding cytology) are: A.One challenge per analyte and one testing event per year B.Ten challenges per analyte and five testing events per year C.Five challenges per analyte and at least three testing events per year D.Twelve challenges per analyte and one testing event per month

C

McGregor's X-Y theory advocates managing employees by stressing: A. Equal pay for equal work B. A pyramid of attainable goals for satisfaction at work C. Respect for the worker and acknowledgment of his/her ability to perform a task D. Collective bargaining

C

Point-of-care testing (POCT) refers to: A.All testing done to the patient to save time B.All lab testing done in the central lab C.Any clinical lab testing done at the patient's bedside D.Satellite lab testing

C

SITUATION: A lab wishes to evaluate its specimen processing operations to improve test turnaround time for cardiac markers using a LEAN process.To accomplish this, the lab manager measures the time it takes for specimens to be collected and transported to the lab, entered into the LIS and instrument data link, centrifuged, and placed on the automated track. This process is called: A. Establishing pull B. Creating a flow diagram C. Mapping the value stream D. Process analysis

C

SITUATION: A medical laboratory science student in training accidentally splashed a few drops of an extraction reagent from an enzyme immunoassay kit for group A Streptococcus into her right eye, and felt an immediate burning sensation. What should she do first? A.Locate the MSDS sheet for the EIA test kit B.Go directly to the emergency department for treatment C.Go to the eye-wash station and rinse the eye thoroughly with water D.Report directly to her immediate supervisor

C

SITUATION: Your immediate supervisor requests that you back date and complete the QC log for RPR test controls that were supposed to have been performed the previous day. You did not work that day, and suspect that the technologist who did work that day failed to enter the QC results. Such an ethical dilemma falls under which behavioral domain? A. Cognitive B. Psychomotor C. Affective D. None of these options

C

The ASCP Board of Registry certification examination is an example of which of the following types of tests? A. Placement B. Formative C. Summative D. Diagnostic

C

The four essential functions of a manager are: A.Staffing, decision making, cost analysis, evaluating B.Directing, leading, forecasting, implementing C.Planning, organizing, directing, controlling D.Innovating, designing, coordinating, problem solving

C

Using the surcharge/cost-plus method for determining test charges, determine the charge for an ova and parasite examination on fecal specimens, given the following information: Collection, handling, clerical, and so forth = $2.00 Reference lab charge to lab = $20.00Lab "markup" = 100% A. $22.00 B. $32.00 C. $42.00 D. $122.00

C

When dealing with the instruction of complex instrumentation, a demonstration by the instructor is necessary and should include the following: A.Detailed diagrams of the electrical system B.A blueprint of the optical system C.A step-by-step narrative with comparisons to a manual method D.A quiz as soon as the demonstration is complete

C

Which of the following accounts for the largest portion of the direct cost of a laboratory test? A. Reagents B. General supplies C. Technologist labor D. Instrument depreciation

C

Which of the following is not considered a right that students have in the learning environment? A.The right to ask questions of the instructor B.The right to fair and objective assessment C.The right to not attend classes at his/her own discretion without penalty D.The right to request additional help when needed

C

Which of the following organizations is responsible for promulgating hospital-wide compliance standards? A. CAP (College of American Pathologists) B. COLA (Commission on Office Laboratory Accreditation) C. TJC (The joint commission) D. CLIAC (Clinical Laboratory Improvement Advisory Committee)

C

Which of the following refer to the degree to which a measure is consistent in producing the same reading when measuring the same things? A. Concurrent reliability B. Construct validity C. Reliability D. Validity

C

Which of the following testing types assesses a student's performance on an examination independent of peer performance? A. Norm referenced B. Objective referenced C. Criterion referenced D. Standard referenced

C

Which of the taxonomic levels in the cognitive domain is represented by the following objective? Objective: Given the glucose control values for a month, the student will calculate the mean and standard deviation. A. Knowledge B. Comprehension C. Application D. Analysis

C

Why are computer-projected visual aids a benefit to the instructor? A. Classroom is not dark or dim when they are used B. Do not require special projection equipment C. Motion, color, and sound can be incorporated D. Inexpensive to produce

C

87. Which of the following conditions is not associated with the presence of schistocytes and spherocytes? A. Clostridial septicemia B. Prosthetic heart valves C. Severe thermal burns D. Aplastic anemia

D. Aplastic anemia

The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek boy with the following results on an automated impedance counter: WBC 35.0 X 1 09/L (35.0 X 1 03/pL); RBC 2.50 X 1 012/L (2.50 x 1 06/FL); hemoglobin 45 gIL (4.5 g/dL); hematocrit 0.16 LJL (16%); platelet count 250 X 1 09/L (250,0004AL); reticulocyte count 8.0%; 110 nucleated red blood cells/i 00 WBCs and many targets are seen. Other laboratory results are as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin elevated. 266. The CBC, serum iron, total iron-binding capacity, and serum ferritin levels are most characteristic of A. Beta-thalassemia minor B. Iron-deficiency anemia C. Alpha-thalassemia minor D. Beta-thalassemia major

D. Beta-thalassemia major

46) If a physician suspects a qualitative platelet defect, the most useful test to order is the: A. Platelet count B. Prothrombin time C. 5.0 Murea solubility test D. Bleeding time

D. Bleeding time (The 5M urea solubility test will detect a factor XIII deficiency)

186. In which of the following is progression to acute leukemia least likely? A. Chronic myelogenous leukemia (CML) B. Refractory anemia with excess blasts (RAEB) C. Refractory anemia with ringed sideroblasts (RARS) D. Chronic lymphocytic leukemia (CLL)

D. Chronic lymphocytic leukemia (CLL)

218. In what disorder is significant basophilia most commonly seen? A. Hairy cell leukemia B. Plasma cell leukemia C. Acute lymphoblastic leukemia D. Chronic myelogenous leukemia

D. Chronic myelogenous leukemia

201. Tn what condition would an LAP score of 10 most likely be found? A. Bacterial septicemia B. Late pregnancy C. Polycythemia vera D. Chronic myelogenous leukemia

D. Chronic myelogenous leukemia LAP scores are usually low in patients with CML The LAP reflects alkaline phosophatase activity in neutrophils, and the score is usually elevated in conditions where neutrophils are activated and/or increased in number, such as late pregnancy, bacterial infection and PV

The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek boy with the following results on an automated impedance counter: WBC 35.0 X 1 09/L (35.0 X 1 03/pL); RBC 2.50 X 1 012/L (2.50 x 1 06/FL); hemoglobin 45 gIL (4.5 g/dL); hematocrit 0.16 LJL (16%); platelet count 250 X 1 09/L (250,0004AL); reticulocyte count 8.0%; 110 nucleated red blood cells/i 00 WBCs and many targets are seen. Other laboratory results are as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin elevated. 267. What type(s) of hemoglobin will be detected on this child using hemoglobin electrophoresis? A. A only B. AandF C. A, increased A2, F D. F only

D. F only

24) Which of the following will not cause the thrombin time to be prolonged? A. Fibrin degradation products B. Heparin C. Factor I deficiency D. Factor II deficiency

D. Factor II deficiency the thrombin time is a test that measures fibrinogen. Factor II cannot be measured in the thrombin time because the reagent used is its active form, thrombin (IIa)

67)Results on a 35 year old male presenting with sudden sever hemorrhagic problems are as follows: Platelet count 225x109/L, Bleeding time 6.5 min (ref range <8.0 min), PT 12.8 sec (control 12.0 sec), aPTT 85.0 sec (control 32.0 sec), aPTT 1:1 mixing study 65.0 sec A. Lupus anticoagulant B. von Willebrand disease C. Hemophilia A D. Factor VIII inhibitor

D. Factor VIII inhibitor

138. In which of the following disorders would splenomegaly not be a common finding? A. Homozygous beta-thalassemia B. Hereditary spherocytosis C. Hemoglobin SC disease D. Folic acid deficiency

D. Folic acid deficiency

23. Which of the following depicts the structure of the hemoglobin molecule? A. Two heme groups, two globin chains B. Four heme groups, two globin chains C. Two heme groups, four globin chains D. Four heme groups, four globin chains

D. Four heme groups, four globin chains

58) Lab tests requested on a patient scheduled for early morning surgery include a CBC with platelet count. An automated platelet count performed on the specimen is 57x10^9/L. In the monolayer area of the peripheral blood smear there are approximately 12 platelets per oil immersion field, many of which are encircling neutrophils. Controls are in range. Based on this information, the best course of action is: A. Report all the results because the instrument is functioning properly B. Alert the physician immediately so cancellation of surgery can be considered. C. Thoroughly mix specimen and repeat platelet count; if results remain the same, report all results and indicate that platelet count has been confirmed by repeat testing D. Have the specimen redrawn using 3.2% sodium citrate as the anticoagulant

D. Have the specimen redrawn using 3.2% sodium citrate as the anticoagulant Platelets encircling neutrophils is a phenomenon referred to as platelet satellitosis. this "pseudothrombocytopenia" occurs when the blood of some individuals is anticoagulated with EDTA. Recollecting the specimen using sodium citrate often corrects this problem. If sodium citrate is used, the platelet count obtained must be multiplied by 1.1 for reporting purposes. Multiplying by 1.1 adds back the 10% loss of platelets seen when sodium citrate, with a 9:1 ratio of blood to anticoagulant, is used.

An 83-year-old woman is seen in the emergency department complaining of fatigue and recent weight loss. Her CBC results are as follows: WBC 2.6 x 1 09/L (2.6 x 1 03/1iL); RBC 2.79>< 1 O2/L (2.79 X 1 06/pL); hemoglobin 92 gIL (9.2 g/dL); hematocrit 0.28 LIL (28%); MCV 100.0 fL; RDW 23.5%; platelet count 42 X 1 09/L (42,0004LL); differential count shows 42% segmented neutrophils, 45% band neutrophils, 3% lymphocytes, 3% metamyelocytes, 4% myelocytes, 3% blasts, and 4 nRBC/100 WBC. Morphologic changes noted on the differential smear include poor granulation and hyposegmentation of the neutrophils, giant platelets that display poor granulation, oval macrocytes, basophilic stippling, Cabot rings, Pappenheimer bodies, and Howell-Jolly bodies. Three micromegakaryocytes are seen per 100 WBCs. Serum B12 and folate levels are normal. 294. The expected bone marrow findings in this disorder using WHO criteria are A. Hypocellular; blasts ≥20% B. Hypocellular; blasts <20% C. Hypercellular; blasts ≥20% D. Hypercellular; blasts <20%

D. Hypercellular; blasts <20%

70. The findings seen in Color Plate 6 (schistocytes) can be found in patients with microangiopathic hemolytic anemia (MAHA). Which of the following conditions could not be responsible for this type of red cell destruction? A. Disseminated intravascular coagulation (DIC) B. Hemolytic uremic syndrome (HUS) C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic thrombocytopenic purpura (ITP)

D. Idiopathic thrombocytopenic purpura (ITP) The schistocytes are found in microangiopathic hemolytic anemia and caused by red cells shearing on fibrin strands depositied in small vessels.

203. In which of the following would an absolute monocytosis not be seen? A. Tuberculosis B. Recovery stage of acute bacterial infection C. Collagen disorders D. Infectious mononucleosis

D. Infectious mononucleosis

25) The expected screening test results for a patient with a fibrin stabilizing factor deficiency are: A. Prolonged prothrombin time B. Prolonged activate partial thromboplastin time C. Prolonged prothrombin time and activated partial thromboplastin time D. Normal prothrombin time and activated partial thromboplastin time

D. Normal prothrombin time and activated partial thromboplastin time

177. Which of the following represents the principal defect in chronic granulomatous disease (CGD)? A. Chemotactic migration B. Phagocytosis C. Lysosomal formation and function D. Oxidative respiratory burst

D. Oxidative respiratory burst Chronic granulomatous disease is a herediatry disorder in which neutrophils are incapable fo killing most ingested microbes. The disease is usually fatal becasue of defective generation of oxidative metabolism products, such as superoxide anions and hydrogen peroxide, which are essential for killing.

15) The recommended type of microscopy for the performance of manual platelet counts is: A. Electron B. Dark field C. Light D. Phase Contrast

D. Phase Contrast

32) The activity of the lupus anticoagulant and anticardiolipin antibodies appears to be directed against: A. Factor V B. Factor VIII C. Factor IX D. Phospholipid

D. Phospholipid

4. In an adult, what are the two best areas for obtaining active bone marrow by aspiration? A. Vertebra, tibia B. Sternum, vertebra C. Anterior iliac crest, tibia D. Posterior iliac crest, sternum

D. Posterior iliac crest, sternum

101. What causes the hemolytic process in glucose-6-phosphate dehydrogenase deficiency following oxidant exposure? A. Coating of red cells by antibody B. Osmotic pressure changes C. Complement attachment D. Precipitation of denatured hemoglobin

D. Precipitation of denatured hemoglobin Oxidative denaturation is the primary mechanism of the hemolytic process. When G^PD is deficient, the red blood cells cannot generate sufficient reduced glutathione to detoxify hydrogen peroxide. Hemoglobin is oxidized to methemoglobin, denatures and precipitates, forming Heinz bodies. The Heinz bodies cause the rigidity of the red cells and hemolysis occurs as the cell try to pass through the microcirulation.

75) A 24 year old female with painful swelling in her left leg is seen by her physician, who orders laboratory testing for PT and aPTT. The PT is normal. The aPTT is prolonged, but shortens with a 10-min incubation of patient plasma with partial thromboplastin reagent that uses kaolin as the activator. A 1:1 aPTT mixing study corrects to normal. The most likely diagnosis is A. Factor II deficiency B. Factor VIII inhibitor C. Factor XIII deficiency D. Prekallikrein deficiency

D. Prekallikrein deficiency

108. Hemoglobinopathies are characterized by A. Absent or reduced rate of globin-chain synthesis B. Inability to transport and release oxygen to the tissues C. Inhibition of iron chelation needed for heme biosynthesis D. Production of structurally abnormal hemoglobin variants

D. Production of structurally abnormal hemoglobin variants Hemoglobinopathies are a herediatry group of qualitative disorders in which genetic mutations cause the production of structurally abnormal globin chains. The three most common variant hemoglobins are Hb S, Hb C and Hb E, all of which are due to an amino acid substituation inthe beta-globin chain. Hemoglobin c is the second msot common hemoglobin variant after hemoglobin S, seen in the US. thalassemias are characterized by an absent or reduced rate of globin-chain synthesis.

An 83-year-old woman is seen in the emergency department complaining of fatigue and recent weight loss. Her CBC results are as follows: WBC 2.6 x 1 09/L (2.6 x 1 03/1iL); RBC 2.79>< 1 O2/L (2.79 X 1 06/pL); hemoglobin 92 gIL (9.2 g/dL); hematocrit 0.28 LIL (28%); MCV 100.0 fL; RDW 23.5%; platelet count 42 X 1 09/L (42,0004LL); differential count shows 42% segmented neutrophils, 45% band neutrophils, 3% lymphocytes, 3% metamyelocytes, 4% myelocytes, 3% blasts, and 4 nRBC/100 WBC. Morphologic changes noted on the differential smear include poor granulation and hyposegmentation of the neutrophils, giant platelets that display poor granulation, oval macrocytes, basophilic stippling, Cabot rings, Pappenheimer bodies, and Howell-Jolly bodies. Three micromegakaryocytes are seen per 100 WBCs. Serum B12 and folate levels are normal. 295. If the bone marrow in this patient had 18% blasts, the most likely disorder would be A. Chronic myelomonocytic leukemia (CMML) B. Chronic myelogenous leukemia (CML) C. Refractory anemia with ringed sideroblasts (RARS) D. Refractory anemia with excess blasts (RAEB)

D. Refractory anemia with excess blasts (RAEB)

88. A 30-year-old woman who has been vomiting for 3 days has a hemoglobin value of 180 gIL (18.0 g/dL) and a hematocrit of 0.54 L/L (54.0%). Her results suggest the presence of A. Absolute erythrocytosis B. Primary polycythemia C. Secondary polycythemia D. Relative polycythemia

D. Relative polycythemia

24. Which of the following describes the process known as culling? A. Release of red cells from the bone marrow B. Binding of free hemoglobin by transport proteins C. Incorporation of iron into protoporphyrin TX D. Removal of abnormal red cells by the spleen

D. Removal of abnormal red cells by the spleen

50) An 85-year-old male with slurred speech and paralysis on the right side of the body is seen in the emergency department. A stat D-dimer is ordered and is very high. The physician suspects a thromboembolic even based on the D-dimer, and needs to institute clot-dissolving therapy immediately. The most likely diagnosis and appropriate therapy for the patient is: A. Myocardial infarction; treat with aspirin B. Pulmonary embolism; treat with warfarin C. Deep vein thrombosis; treat with heparin D. Stroke; treat with tissue plasminogen activator

D. Stroke; treat with tissue plasminogen activator A high d-dimer level indicates the presence of a thrombus (deep vein thrombosis, pulmonary embolism) but is not useful in determining the location. If a thrombus breaks away and travels to the brain, a stroke occurs, causing the symptoms described in this patient. Tissue plasminogen activator will activate the fibrinolytic system to lyse the clot. It should be administered within hours of onset of symptoms to prevent irreversible brain damage. Because of the small window of treatment time, a D-dimer performed on a possible stroke patient should be done ATAT. Aspirin, warfarin and heparin can be administered to prevent the formation of new clots but will not lyse existing clots.

136. Which of the following does not accurately describe cold autoimmune hemolytic anemia? A. Red cell agglutination in extremities induces Raynaud's phenomenon. B. It may occur secondary to Mycoplasma pneumonia. C. Hemolysis is complement-mediated or via removal of coated cells. D. The autoantibody is usually an IgG type directed against Rh antigens.

D. The autoantibody is usually an IgG type directed against Rh antigens.

17. When evaluating a bone marrow aspirate smear, which finding is considered abnormal? A. A predominance of granulocyte precursors as compared to nucleated red cells B. Detection of stainable iron in macrophages and erythroid precursors with Prussian blue C. An average of three megakaryocytes seen per low power (lOX) field D. The presence of 10% myeloblasts on the cell differential count

D. The presence of 10% myeloblasts on the cell differential count In normal adult marrow, about 50% is fat, 40% is myeloid (granulocytic) cells, and 10% is erythroid cells.