Module(s) Quiz Questions
An error was made in a handwritten blood bank record. Which of the following methods is acceptable for correcting the error to remain in compliance with current good manufacturing practices requirements?
. Draw a single line through the error so that it can still be read.
How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid?
0-5 WBCs/µL
What is the probability that a patient will have a complete HLA match from their brother or sister?
1 in 4 (25%)
What is the MINIMUM number of fields that should be examined before reporting a Gram-stained direct smear?
10
A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemocytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter (µL)?
1500
Which of the following describe(s) the Clostridium difficile bacterium?
C difficile is a gram-positive, anaerobic bacterium that is spore-forming and toxin producing.Under the microscope, the C difficile bacteria appear as long irregular cells often drumstick-like or spindle-shaped. Usually, C difficile bacteria colonize the intestinal tract after normal gut flora has been disrupted.
Which of the following is the best explanation for why the ABO system is the most important blood group system in transfusion safety?
ABO antibodies are often implicated in severe hemolytic disease of the fetus and newborn
In terms of safe transfusion, the Rh blood group system is second in importance to what other blood group system?
ABO system
Clinically significant antibodies react BEST at which phase of testing?
AHG
Which stage of HIV infection is characterized by a decline in the CD4 T-lymphocyte count to less than 200 cells/µL?
AIDS
What is the pathophysiology (direct cause) of the iron overload in HH?
Absorption of excessive amounts of iron in the small intestine
Which leukemia is the MOST common childhood leukemia?
Acute lymphoblastic / lymphocytic leukemia (ALL)
Which mosquito is the most effective vector for arbovirus diseases in tropical locations?
Aedes aegypti
Antigens and antibodies specifically combine to form immune complexes. What term refers to the antibody's attraction to a particular antigenic determinant (epitope)?
Affinity
At what phase of antibody screen testing is it MOST important to read the reactions in order to detect clinically significant antibodies?
After addition of AHG
What is the primary safety-control factor used in tuberculosis (TB) specimen processing?
All procedures are performed in a class II biological safety cabinet (BSC)
Which of the following is NOT a category of clonal hypereosinophilic syndrome (HES)?
Allergic
Which technique is useful in determining if there are underlying alloantibodies in a WAIHA case where the patient has been recently transfused?
Allogeneic adsorption
Which type of adsorption must be done if a patient has been recently transfused?
Allogeneic adsorption
Where can sentinel clinical laboratory staff find the standardized testing protocols?
American Society for Microbiology (ASM) website
Enterococci can possess both intrinsic and acquired resistance. Which of the following represents the intrinsic resistance of a typical enterococcal strain?
Aminoglycoside resistanceResistance to clindamycin and trimethoprim-sulfamethoxazoleResistance to cephalosporins
What is the name of the special organization within the Centers for Disease Control and Prevention (CDC) that is responsible for tracking and preventing arboviral infections?
ArboNET
Immune A and B alloantibodies differ from non-red cell stimulated (naturally occurring) A and B alloantibodies in that the immune antibodies:
Are generally IgG rather than IgM
Which of the following is a phenotypic property of Saccharomyces yeast species that is helpful in establishing its species identification?
Ascospore production
Which part of the world is the dengue virus most likely to be found?
Asia
According to the CDC, how long should a woman wait after visiting an endemic Zika area, such as parts of South America, before getting pregnant?
At least 8 weeks
Which of the following statements is TRUE with regard to the agents of bioterrorism?
At least a class II biological safety cabinet (BSC) should be used if an aerosol is likely
The image on the right is a representative field from a cytospin preparation of a CSF from a patient with a viral infection. Identify the cell indicated by the arrow.
Atypical (reactive) lymphocyte
What is an advanced technique that can help to determine the identity of other clinically significant antibodies that are present if a patient has an autoantibody?
Autoadsorption
Which of the following statements is true regarding adverse event reporting to the FDA (Director, Office of Compliance and Biologics Quality, CBER)?
C. The initial notification to the FDA of a transfusion-related death must be made as soon as possible after the death is confirmed to be associated with the transfusion.
The morphology of yeasts inoculated to cornmeal agar can be helpful in making a species identification. The field of view shown in the image on the right is most consistent with the identification of which of the following Candida species?
C. parapsiolsis
The most common abnormalities appearing in fetuses associated with congenital Zika virus infections are microcephaly, ventriculomegaly, and intracranial calcifications
True
The rapid diagnosis of dermatophytosis can be made with a bedside KOH or calcofluor white preparation of skin scrapings.
True
The risk of a recurrence of CDI is usually higher if the individual is older than 65 and taking other antibiotics while being treated for CDI.
True
The updated IDSA/SHEA guidelines recommend for the treatment of the initial episode of CDI either the antibiotic vancomycin or fidaxomicin and not metronidazole.
True
Tiny volumes of D+ red cells (eg, as little as 0.1 mL) can stimulate production of anti-D in some individuals.
True
Trichosporon yeast forms arthroconidia and hyphal elements are larger than those of Candida spp.
True
True of False: Myelodysplastic Syndromes (MDS) with single line dysplasia show <5% bone marrow blasts.
True
True or False: Antihuman globulin (AHG) bridges sensitized red cells so that a lattice structure is formed and agglutination is visible.
True
True or False: Clear cerebrospinal fluid samples should be examined and counted undiluted.
True
True or False: Cytotoxic agents, chemical, or radiation therapy may be etiologic factors of Myelodysplastic Syndromes (MDS).
True
True or False: Facilities that use a special calculation for RhIG dosage add one vial, regardless if they round up or round down.
True
True or False: For qualified laboratories within the United States, the CDC has made available two tests for use in identifying the Zika virus; the rRT-PCR and the Zika MAC ELISA.
True
True or False: In iron deficiency anemia, as serum iron decreases total iron binding capacity (TIBC) increases.
True
True or False: In normal, iron-sufficient states, iron is bound to erythrocyte protoporphyrin. In iron deficiency anemia, however, there is less iron to bind to erythrocyte protoporphyrin. This allows zinc to bind instead, forming zinc protoporphyrin.
True
True or False: In order to determine the ABO type, known antisera are mixed with patient RBCs and known red cells are mixed with patient serum.
True
True or False: Kernicterus due to high levels of unconjugated bilirubin can cause brain damage in newborns suffering from severe HDFN.
True
True or False: Myelodysplastic Syndromes (MDS) with bone marrow blast counts between 10-19% are considered to be high risk grade.
True
True or False: Patients with Myelodysplastic Syndromes (MDS) demonstrate very low levels of vitamin B12.
True
True or False: Premedication with antihistamines may prevent an allergic reaction in patients with a history of multiple urticarial transfusion reactions.
True
True or False: Prominent vacuolation involving the cytoplasm of abnormal lymphoblast-like cells seen in a body fluid preparation is a distinctive feature of Burkitt Lymphoma.
True
True or False: Since clinical symptoms of Zika virus infection may be absent or minimal, a definitive diagnosis is usually made by laboratory testing of serum or urine for viral nucleic acid or virus specific IgM and neutralizing antibodies.
True
True or False: The normoblast shown in this image is considered dysplastic.
True
True or False: The primary WHO criteria for diagnosis of polycythemia vera are bone marrow morphology (hypercellularity with prominent erythroid, granulocytic, and megakaryocytic proliferation), along with JAK2(V617F) or exon 12 mutation.
True
True or False: The serum of some group A individuals may agglutinate group A1 cells.
True
True or False: The three myeloid cell lines in the bone marrow are: granulocytic, erythroid, and megakaryocytic.
True
True or False: Vitamin B12 or folate deficiencies may cause megaloblastic changes in the bone marrow and blood cytopenia
True
True or False: Xanthochromia in a premature infant may be due to an immature blood-brain barrier.
True
True or False: Zika virus infection primarily spreads via infected mosquitoes, but can also spread through sexual contact and blood transfusions.
True
True or False:A cerebrospinal fluid (CSF) sample for hematologic evaluation should be tested within one hour of collection.
True
True or False:Granulocytic dysplasia in MDS may include nuclear hyposegmentaion and/or cytoplasmic hypogranulation.
True
True or False:Staining for myeloperoxidase (MPO) is significant in distinguishing myeloid blasts from lymphoid blasts, as MPO is present in granules of myeloid and monocytic cells, but not in lymphocytes.
True
True or false. Evaluating B-type natriuretic peptide (BNP) levels can be helpful in distinguishing transfusion-related acute lung injuries (TRALI) from transfusion-associated circulatory overload (TACO).
True
True or false. Patients with diseases that require chronic transfusions are at risk for iron overload.
True
True or false: A patient with a positive direct antiglobulin test (DAT) due to IgG cannot be reliably antigen phenotyped using antisera that reacts by the indirect antiglobulin test (IAT).
True
True or false: Treatment of sequestration crisis may include chronic transfusion, exchange transfusion, and/or splenectomy.
True
When given during pregnancy, RhIG may cross the placenta and sensitize fetal D-positive RBCs.
True
When reading the Gram stain of a DIRECT smear, the presence of characteristic cellular arrangements is helpful in providing information as to the organisms that are present. Reporting these cellular arrangements is an important component of the report. However, the arrangement of bacterial cells in a Gram stained smear prepared from a CULTURE should be noted, but not usually reported.
True
These 3 tubes of cerebrospinal fluid (CSF) are delivered to the laboratory for analysis. The tube labeled #1 was the first tube collected. Which one of the tubes should be used by the hematology department for cell count and differential?
Tube 3
What is the most likely identification of the cells that are clumped together in this microscopic field?
Tumor Cells
Which of the following is true of the classic Bombay phenotype?
Two hh genes are inherited at the H locus
Compared to standard tests, what are the advantages of nucleic acid amplification tests (NAATs) for Mycobacterium tuberculosis complex (MTBC) in respiratory specimens?
Two hour results, highly specific, and sensitive for smear positive specimens
Which ABO type of FFP would be the BEST choice for a group A recipient?
Type A
What is the most common clinical presentation of tularemia?
Ulceroglandular
Which of the following is a characteristic of Brucella species?
Urea Positive
A cell count is ordered on a CSF sample that is bloody. Which of the following procedures would improve count accuracy?
Use Spinal Diluting Fluid, a mixture of acetic acid and crystal violet and use phase microscopy.
What is the role of a sentinel clinical laboratory within the Laboratory Response Network (LRN)?
Use standardized testing protocols to rule-out critical biological agents and refer them to one of the LRN reference laboratories for confirmation
Which of the following characterizes the early signs and symptoms of HH?
Vague, nonspecific, and variable
To produce hemoglobin S, glutamic acid that is normally present in the sixth position on the beta globin chain is substituted with which of the following?
Valine
Which of these gene phenotypes is found most often in vancomycin-resistant strains of Enterococcus faecium?
VanA
Complaints of pain from a patient with sickle cell disease are most likely associated with which of the following conditions/events?
Vaso-occlusive crisis
Which of the following lectins is matched appropriately with its target antigen?
Vicea graminea: N antigen
Increased numbers of the cells indicated by the arrows are associated with which of these conditions?
Viral meningitis
What peripheral blood findings shown below are MOST consistent with the chronic phase of chronic myeloid leukemia (CML)?
WBC >100 x 109/L, left shift with <20% blasts
True or False: Haptoglobin increases in hemolytic processes.
false
What are the envelope proteins indicated by the arrow on the right that form the knob-like structures on the surface of the HIV-1 virion?
gp120 and gp41
The endospores of Coccidioides spp. often spill from their spherules and can be confused with which other thermally dimorphic fungi?
histoplasma
Decreased levels of hepcidin are related to __________ iron absorption into the bloodstream.
increased
Which term listed below refers to the procedures that must be followed by a transfusion service when notification is received that a donor of a unit sent to the service now tests positive for an infectious disease?
lookback
Which of the following is NOT a characteristic of Burkholderia pseudomallei?
non-motile
Which of the following is NOT required to be in a machine-readable format on a blood component label?
outdate
What is the most frequent source of HSCs used for transplantation?
peripheral blood
A patient with suspected intraabdominal malignancy had a paracentesis performed. The fluid was then sent to the laboratory for examination and fluid differential. Which cells predominate in this cytospin field from the patient's sample?
plasma cells
The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). What is the identification of the cells that are indicated by the arrows?
presumptive malignant cells
What is the most common form of Creutzfeldt-Jakob disease (CJD)?
sporadic
A large number of which of these types of cells would indicate that a sputum specimen is sub-optimal and should not be used for culture?
squamous
Viral proteins are identified as either glycoprotein (gp) or protein (p). What is indicated by the number that follows the "gp" or "p" designation, for example gp120 or p 24?
the molecular weight of the protein
True or False: Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid (CSF) sample for examination of cellular morphology.
true
What blood lead level is considered toxic according to current standards?
≥ 5 µg/dL
Which genotype accounts for the greatest percentage of cases of HH?
C282Y/C282Y
_______________ is predominantly associated with skin and soft tissue infections (SSTIs), such as abscesses, cellulitis, folliculitis, and impetigo.
CA-MRSA
The initial laboratory evaluation for autoimmune diseases often involves which tests?
CBC, Chemistry metabolic panel, Urinalysis, and Coagulation testing
Which CD antigen is present on hematopoietic stem cells (HSCs)?
CD34
In sickle cell anemia, an increased amount of which of the following surface antigens on reticulocytes may allow platelets to form a bridge between the reticulocytes and endothelial cells, ultimately leading to vaso-occlusion?
CD36
Which lymphocyte subset recognizes HLA class II and processed antigen?
CD4 T cells
What cell recognizes processed peptide/antigen in conjunction with HLA Class I molecules?
CD8 T cells
The formation of germ tubes when fetal bovine serum is inoculated with the yeast isolate leads to the presumptive identification of which of the following yeasts?
Candida albicans
Which Candida spp. is the most commonly encountered human pathogen?
Candida albicans
What is the protein component called that surrounds the HIV genome?
Capsid
Which of the agent categories is the easiest to spread, has the ability to cause major harm, panic, and death, and carries the highest level of risk with regard to national security?
Category A
Which of the following is a TRUE statement concerning the category A agents of bioterrorism?
Category A agents cause high mortality and the potential for major public health impact.
Which of the following is a selective media recommended for the isolation of C. difficile?
Cefoxitin-cycloserine-fructose agar (CCFA)
A transfusion service that does not manufacture blood components may be inspected by which of the following organizations for compliance with good manufacturing practices?
Centers for Medicare and Medicaid Services (CMS)
The image on the right represents the result of a fluorescent antinuclear antibody (ANA) test. What pattern should be reported? Note: (a) points to the nuclei of several interphase cells, the primary consideration for discerning the ANA pattern, and (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern.
Centromere
This antinuclear antibody (ANA) test pattern is characterized by staining of discrete speckles in the nucleus of the interphase cells (a) and discrete speckling also in the chromosomal area of the metaphase mitotics (b) when viewed using fluorescent microscopy. This image represents which of the following patterns?
Centromere
All transfusion reaction initial workups must include which of the following?
Checking records and labels for identification errors
What is the virus that is most likely to cause patients to have fever and severe, debilitating, bilateral and symmetrical joint pain?
Chikungunya virus
Where does most cerebrospinal fluid (CSF) originate?
Choroid Plexus
Which chromosome demonstrates a partial or full gene loci deletion in various forms of beta thalassemia?
Chromosome 11
On which chromosome is the major histocompatibility complex (MHC) located?
Chromosome 6
A 67-year-old man visits his primary care physician due to some abdominal discomfort. The physician notes that the man has also experienced malaise lately that has prevented him from completing his daily exercise routine. A CBC and chemistry panel are ordered. The chemistry panel results were relatively normal, but the CBC was abnormal and triggered a manual differential. The image to the right represents a typical field of this patient's peripheral blood smear. The CBC and differential revealed the following results: Manual Differential: Blasts - 2%, Promyelocytes - 2%, Myelocytes - 8%, Metamyelocytes - 13%, Bands - 28%, Neutrophils - 26%, Lymphocytes - 17%, Monocytes - 4%
Chronic myeloid leukemia (CML)
Which major histocompatibility complex (MHC) class of molecule is necessary for antigen recognition by CD4+ T cells?
Class II
Which of the following are characteristics of normal CSF?
Clear and Colorless
A 26 year old pregnant female is being tested prior to a scheduled C-section tomorrow. Her cell grouping (forward typing) is consistent with blood group O, while her serum grouping (reverse grouping or "back-typing") appears to be group A. The most common reason for this type of ABO discrepancy is:
Clerical errors or a sample mix-up
Pseudomembranous colitis (PMC) is an inflammatory disease of the colon caused by toxins of which of these organisms?
Clostridium difficile
Which of the following fungal infections is endemic in the southwestern United States' desert regions?
Coccidioidomycosis
This is a representative field from the patient's peripheral blood smear. What RBC morphology is prominent on this patient's smear?
Codocytes
Which autoimmune hemolytic anemia is associated with an IgM autoantibody that has a broad thermal range?
Cold hemagglutinin disease (CHD)
A healthy 49-year-old man from Manhattan, New York presented with a fever and malaise three days after returning from a horseback riding trip on the Western slope of the Rocky Mountains. He removed four ticks from his body and reported chills, fever, and severe myalgias. His symptoms resolved, only to recur two days later. He had a fever of 100.6º F (38.1º C), conjunctivitis, and sore throat. His WBC count was 2.0 x 109 /mL and neutralizing antibodies were undetectable in acute serum, but were 1:40 in convalescent serum. Which viral disease is it most likely to be?
Colorado Tick Fever
Which tickborne disease has a biphasic presentation (two episodes) in adults over the age of 30?
Colorado Tick Fever
Which is a feature that can differentiate a rapidly growing dematiaceous mold from a slowly growing dematiaceous mold?
Conidia separated with transverse septae and those with transverse and longitudinal septae
Which of the following statements is NOT one of the CDC's recommendations for the assessment and testing for Zika virus infection in infants?
Cord blood is an acceptable alternative specimen source for Zika virus laboratory testing on infants.
Which procedure used to obtain a fetal blood sample to monitor severity of HDFN can also be used to deliver intravenous transfusions?
Cordocentesis
Small, palisading gram-positive rods demonstrating a picket-fence arrangement
Cornyebacterium species
What shape uniquely identifies the P. falciparum gametocyte?
Crescent shaped
Which of the following fungal species do not produce pseudohyphae on cornmeal agar?
Cryptococcus laurentii
The colonies shown in this photograph were grown on Guizotia abyssinica (bird seed) agar at 30°C for 72 hours. What is the most likely identification?
Cryptococcus neoformans
Which of the following smear techniques can be utilized when processing bone marrow aspirate samples? (Choose all that apply)
Differential smear, Coverslip smear, Pull prep, T-prep
How should surgical and dental instruments that have come in contact with highly-infective prion tissue be handled after use?
Discarded and incinerated
Which of the following led to a significant reduction in the fear of tuberculosis (TB) transmission?
Discovery of the antibiotic isoniazid (INH) in 1953
The most commonly reported cause of severe/fatal TRALI is:
Donor HLA antibodies transfused into recipients with the corresponding antigen
A patient experiences a mild allergic reaction to a transfusion, including urticaria, erythema (skin redness), and itching. What is the most likely source of the allergen?
Donor Plasma Proteins
What is the optimum time to perform serum RNA testing for the Zika virus? (Select the BEST answer.)
During the first week after the onset of clinical illness.
Naturally occurring antibodies may be due to exposure to which of the following?
Dust, pollen, or bacteria
At what MINIMUM frequency should quality control testing be performed on each lot of anti-human globulin to be in compliance with the FDA's current good manufacturing practices requirements?
Each day of use
Which virus is transmitted most often in swampy areas near hardwood forests in the United States?
Eastern equine encephalitis (EEE)
If a patient has an antibody to a low-incidence antigen like Kpa or Jsa, how would this impact the ability to find compatible blood and to identify the antibody?
Easy to find compatible blood but difficult to identify the antibody
The bacteria on BOTH the positive and the negative control slides are observed to stain pink. This finding will NOT affect the rest of the slides in the batch.
False
The presence of gram-negative intracellular diplococci in a genital specimen from a FEMALE is diagnostic of gonorrhea.
False
The serological presentation of a mixed-type autoimmune hemolytic anemia would be serum/plasma reactions against a red cell panel only at the antiglobulin phase.
False
The thermally dimorphic fungi grow as yeast when incubated at 25° C, but grow as molds when incubated at 30° or 37° C.
False
Today, amniocentesis is preferred to Doppler sonography for monitoring the severity of hemolytic disease of the fetus and newborn (HDFN).
False
True or False: A 1500 IU (300 µg) dose of RhIG can suppress immunization to _____ mL of D-positive whole blood.
False
True or False: A direct antiglobulin test (DAT) is usually negative in cases of autoimmune hemolytic anemia.
False
True or False: A patient who received an autologous transfusion one week ago cannot be reliably antigen typed
False
True or False: A pregnant female has been injected with RhIG antenatally and has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts only weakly (1+ in the indirect antiglobulin test), the anti-D is definitely passive.
False
True or False: A pregnant female who received RhIG at 28 weeks gestation has a positive antibody screen at delivery. If the antibody has been confirmed as anti-D alone and reacts 1+ in the indirect antiglobulin test with D+ red cells, performing a titration to investigate if the anti-D is immune is good practice.
False
True or False: A1 and A2 individuals cannot be differentiated.
False
True or False: Blood safety standards such as AABB Standards directly specify that an electronic crossmatch cannot be done when an Rh negative female has an anti-D consistent with antenatal RhIG administration.
False
True or False: Chemotherapeutic drugs cause bone marrow hyperplasia and leukocytosis
False
True or False: Depending on the laboratory and specific method used, an ANA titer is typically considered negative when the titer is equal to or less than 1:80.
False
True or False: If a pregnant female who was injected with RhIG antenatally has anti-D at delivery, routine antibody titration to determine the titer of the anti-D is considered a good practice.
False
True or False: If an individual becomes infected with Zika virus, it is not likely that he or she will be protected from future infections.
False
True or False: Lymphocyte pleocytosis refers to a decreased number of lymphocytes in a CSF when compared to a normal sample.
False
True or False: Macrophages are the phagocytes that originate from lymphocytes.
False
True or False: Megakaryocytes in MDS appear very large (giant).
False
True or False: Megaloblastic anemias result in abnormalities of cytoplasmic maturation.
False
True or False: Mosquitoes carrying the Zika virus typically lay their eggs in moving water (such as streams and rivers) and live near people, where they usually bite individuals during the nighttime.
False
True or False: Myelodysplastic Syndrome (MDS) with bone marrow blasts counts of 5-9% carries a low risk grade.
False
True or False: Myelodysplastic Syndromes (MDS) are always associated with peripheral blood leukocytosis and thrombocytosis.
False
True or False: Myelodysplastic Syndromes (MDS) are associated with microcytic/hypochromic anemia.
False
True or False: Myelodysplastic Syndromes (MDS) are caused by viral infection
False
True or False: Myelodysplastic Syndromes (MDS) are commonly associated with leukocytosis and neutrophilia in peripheral blood evaluations.
False
True or False: Myelodysplastic Syndromes (MDS) with multilineage dysplasia show 10-19 % blasts in the bone marrow.
False
True or False: Normal megakaryocytes show multinucleation or monolobes.
False
True or False: Nucleated blood cells will always have the same appearance on a cytocentrifuged smear as they do on a peripheral blood smear.
False
True or False: Patients with Myelodysplastic Syndromes (MDS) commonly have enlarged liver and spleen.
False
True or False: Reverse transcription PCR (RT-PCR) is a PCR method that converts sample DNA into complimentary-RNA (cRNA) using the enzyme reverse transcriptase.
False
True or False: The dysplasia of the erythroid cell line may include nuclear budding, megaloblastoid, and ring sideroblasts in cases of MDS.
False
True or False: The first time a cell containing Hb SS is deoxygenated, it forms an irreversibly sickled cell.
False
True or False: The megakaryocytes indicated by the arrows in the image to the right appear to have normal morphologic features.
False
True or False: The neutrophils shown in this image have a normal amount of cytoplasmic granulation.
False
True or False: The same staining protocol can be used for bone marrow smears as is used for peripheral blood smears.
False
True or False: The seeds of the Dolichos biflorus plant will agglutinate A2 cells but not A1 cells.
False
True or False: True or false. Leukocyte-reduced blood components are associated with the development of febrile nonhemolytic transfusion reactions (FNHTR).
False
True or false. Delayed hemolytic transfusion reactions (DHTR) typically occur 3 hours after transfusion.
False
When testing for C. difficile or its toxins, either a formed or liquid stool is an acceptable specimen.
False
When using current antimicrobial susceptibility testing (AST) breakpoints, it is recommended by CLSI that laboratories should also routinely implement testing, such as the modified Hodge test (MHT) or Carb NP test (CNPt), to detect the presence or absence of carbapenemase.
False
People may become infected with Naegleria fowleri by drinking contaminated water.
False, the acidity of the stomach often kills the bacteria.
Once inside the red blood cell, the parasite digests hemozoin.
False, they digest hemoglobin
Which of the following is NOT a characteristics of Burkholderia pseudomallei?
Fat, gram-positive rod
What is a mobilizable, water-soluble form of storage iron that is bound to protein?
Ferritin
Which laboratory assay represents the amount of iron stored in the body?
Ferritin
How do T. marneffei yeast-forms replicate?
Fission
What is the purpose of the iodine that is used in the Gram stain procedure?
Fixes the crystal violet to the cellular components of gram-positive bacteria
Which of these methods is the MOST accurate and reliable for determining the volume of fetal whole blood or red blood cells in the maternal circulation in order to evaluate fetomaternal hemorrhage?
Flow cytometry
Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply.
Flow cytometry and Kleihauer-Betke test
Which of the following is NOT a bacterial arrangement that can be observed on a Gram stained smear?
Flowering
Which of these could cause a sickling event?
Fluctuations in temperature
If an allogenic blood component is shipped from the donor center with infectious disease testing incomplete, the units must be labeled with:
For "emergency use only"
Out of every five individuals infected with the Zika virus, how many will typically never develop symptoms?
Four out of Five
In June, a woman attempted to take a dead rabbit from her dog. She already had a splinter in her finger and it became infected. A lesion developed at the site of the splinter, similar to the wound shown in the image. Within seven days, the lesion ulcerated and she became ill with a fever of 104⁰ F. She reported no tick bites. What is the most likely pathogen?
Francisella tularensis
Which organism prefers cysteine-enriched media for growth, such as chocolate (CHOC), Thayer-Martin (TM), or buffered charcoal-yeast extract (BCYE)?
Francisella tularensis
Which of the following components would be suitable for a recipient with a high-titer class-specific anti-IgA antibody?
Fresh Frozen Plasma from an IgA-deficient donor
A person with which one of the following red cell phenotypes is expected to be resistant to Plasmodium vivax malaria?
Fy(a-b-) phenotype
Which specific terminal sugar causes a red cell to have B antigenic activity?
Galactose
What specific sugar configuration is necessary as a base for attachment of other sugars?
Galactose plus fucose
Which of the following thrombocytic characteristics are often associated with essential thrombocythemia (ET)?
Giant platelets in peripheral blood and platelet clumps in peripheral blood
What is the Gram stain reaction for yeast?
Gram-positive
Which of the following statements reflect accurate identifications of Enterococcus species?
Gram-positive cocci in pairs or chains, catalase negative, black colonies on bile esculin agar, growth in 6.5% salt broth: Enterococcus species.Gram-positive cocci in pairs or chains, catalase negative, esculin positive, PYR positive, vancomycin intermediate, motile, yellow pigment: E. casseliflavus.
Most HIV-1 infections are classified as which one of the following groups?
Group M
With the increasing spread of Zika virus, case reports have described a complication of which rare autoimmune disorder that affects the central nervous system, causing weakness in the extremities?
Gullain-Barre syndrome
Which ABH substances would you expect to find in the saliva of a group A secretor?
H and A
Mutations in which gene account for the majority of cases of HH?
HFE
Which of the following HIV tests would be the BEST CHOICE to detect HIV infection in a high-risk seronegative individual?
HIV nucleic acid test (NAT)
Scenario A fourth generation HIV 1/2 antigen/antibody combination immunoassay produces a positive result on a plasma sample. If the CDC-recommended algorithm for HIV testing is used, which of these test results should be followed up with nucleic acid testing (NAT)?
HIV-1 (-) or indeterminate and HIV-2 (-) or indeterminate
Which type of antibodies are known to cause transfusion-related acute lung injury (TRALI) reactions?
HLA antibodies
Arrange the listed steps of hematopoiesis in the correct sequence, from beginning to end, that would result in the production of a neutrophil, eosinophil, or basophil.
HSC, Myeloid progenitor cell, myeloblast, basophils
An MDS case with 5(q) deletion chromosome:
Has a platelet count that is normal or high
The heterozygous state of Hb S that is referred to as sickle cell trait contains which of the following hemoglobins in combination with S?
Hb A
With the exception of beta thalassemia minima, which hemoglobin is decreased in beta thalassemia
Hb A
Hemoglobin electrophoresis on this patient's sample is pictured above and is labeled "patient 2" in lanes 5 and 6. The densitometer tracing of lane 5 is also pictured.What hemoglobin bands are present?
Hb A, Hb A2, and possibly Hb F
Which of these hemoglobins is known to migrate with Hb S in alkaline electrophoresis?
Hb D
Which hemoglobin will be increased in delta-beta thalassemia?
Hb F
Which hemoglobin, when elevated, acts as a protection against sickling in patients with Hb S?
Hb F
The gel electrophoresis pattern for hemoglobin S shows which of the following migration patterns?
Hb S migrates with D in alkaline and alone in acid electrophoresis.
The alkaline hemoglobin electrophoresis pattern that is shown on the right includes controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 3 and 4. The patient lanes (3 and 4) displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?
Hb S/HPFH
A patient has been found to be heterozygous for hemoglobin S. Their CBC results indicate a slight anemia, increased RBC count and very low MCV. The genotype of this patient most likely is:
Hb S/beta thalassemia
The hemoglobin electrophoresis patterns that are shown on the right include controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 5 and 6. The patterns on the left are from an alkaline hemoglobin electrophoresis and the patterns on the right are from an acid electrophoresis. These are results from the same patient. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?
Hb SS
What about this patient's medical and family histories suggests that he might have HH?
He had a brother who died of liver disease and parents with diabetes
Which department in the clinical laboratory plays the most critical role in the care of HSC transplant patients?
Hematology, Blood Bank, Microbiology, Molecular Diagnostics, All of these
Which compound normally contains the majority of the body's total iron?
Hemoglobin
In which of these immune hemolytic anemias would complement NOT be suspected as the cause of a positive direct antiglobulin test (DAT)?
Hemolytic disease of the fetus and newborn (HDFN)
In 1939, the Rh blood group system was first recognized during the investigation of a female patient's clinical presentation during and after delivery of a stillborn infant. The patient also received a transfusion (blood was from the father of the baby) after the delivery. Select the correct name(s) of the clinical presentations from the list given below.
Hemolytic disease of the newborn and Hemolytic transfusion reaction
The image represents the results of an antinuclear antibody (ANA) test that is viewed using fluorescent microscopy. The speckled staining within these positive cells varies between coarse speckled (a) and smooth speckled (b). Cells are also present that are negative (c) because these cells are not expressing the antigen that the antibodies are directed against. This image represents which of the following ANA testing patterns?
Proliferating cell nuclear antigen (PCNA)
Which mechanism of drug-induced hemolytic anemia involves the formation of drug-antibody combinations that bind non-specifically to RBC membranes and activate complement.
Immune Complex
Which of the following situations can result in a false-negative reaction with Rh typing reagents?
In vivo immunoglobulin coating the cells
For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation?
Incident C: The wrong specimen was used to crossmatch a unit and the unit was issued.
A febrile nonhemolytic transfusion reaction (FNHTR) is characterized by which of the following symptoms?
Increase in temperature of >1°C above the baseline during transfusion or up to two hours following transfusion
What would you expect the serum iron (SI) and total iron binding capacity (TIBC) to be in a person with HH
Increased SI and normal to decreased TIBC
Which of the following is an advantage of an unrelated HLA-matched HSC transplant?
Increased graft versus tumor effect
Which mechanism of drug-induced hemolytic anemia closely resembles a warm autoimmune hemolytic anemia (WAIHA) as it has identical serological presentation.
Induction of autoimmunity
Which mechanism of drug-induced red cell destruction closely mimics the serologic presentation of warm autoimmune hemolytic anemia (WAIHA)?
Induction of autoimmunity
What is the most common way for humans to acquire a free-living amoeba infection?
Infective cysts or trophozoites in soil or water
HH is the most common cause of which of the following conditions?
Inherited Iron overload
After the first appearance of extensively drug-resistant tuberculosis (XDR-TB), which control measure was the MOST effective?
Initiation of the direct-observed treatment short course (DOTS) program and focus on HIV/AIDS patients with MDR- and XDR-TB
Which enzyme is responsible for joining the HIV DNA to the host cell's DNA?
Integrase
Which two stages of cell division are the most important for reading ANAs?
Interphase and metaphase
Which type of anemia can be caused by the common treatment for polycythemia vera, which is used to manage patient symptoms?
Iron deficiency anemia
Which of the following are needed for a diagnosis of HH?
Iron overload as identified through laboratory analyses for iron, Presence of HFE mutations or other genetic mutations associated with iron metabolism, Clinical signs and symptoms consistent with HH
Transfusion-associated graft-versus-host disease (TA-GVHD) may be prevented by which of the following?
Irradiation of cellular products
MDS with isolated 5(q) deletion chromosome:
Is considered low grade MDS and may require blood transfusion
A method for separating and identifying hemoglobin variants which involves the sample moving through a pH gradient on a polyacrylamide gel to the point where its net charge is zero is
Isoelectric focusing
A technique which utilizes high voltage and separates out the hemoglobin proteins on a polyacrylamide gel is
Isolectric Focusing
Which statement best describes the use of the liver biopsy in suspected cases of HH?
It can detect both liver fibrosis and assess the amount of iron in the liver.
Which of the following statements concerning C. difficile is NOT true?
It is an aerobic organism.
Why might serum ferritin (SF) alone be considered a less than optimal screening test for HH?
It is frequently elevated in a variety of clinical conditions.
Which of the following statements is TRUE regarding Hemolytic Disease of the Fetus/Newborn (HDFN) caused by ABO antibodies?
It is most common with O mothers and A babies
Why is serum ferritin (SF) a less than optimal screening test for HH?
It lacks specificity because ferritin is increased in inflammation
An individual with type AB blood will demonstrate the complete absence of which of the following antigen sites?
It will not be A, B, or H
How is the function of HFE protein altered in the C282Y mutation?
Its binding with beta-2 microglobulin is decreased and it remains within the cell's Golgi apparatus.
Which tick transmits Lyme disease in California?
Ixodes pacificus
Phototherapy helps to prevent which symptom of HDFN?
Jaundice
What is a common early symptom of HH?
Joint pain
Which of the following red cell antigens is fully and strongly expressed on red blood cells from a term neonate?
K antigen
Which of the following phenotypes is seen MORE frequently in those of European descent than in those of African descent?
K+k+ phenotype
Which enzymes do dermatophytes employ to digest hair, nails, and the stratum corneum of skin?
Keratinases
Which of the following red blood cell antigens shows increasedexpression following incubation with proteolytic enzymes?
Kidd antigens
Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular aderence to endothelium. Which amino acid is DECREASED in patients with sickle cell disease and is needed as a substrate to produce nitric oxide?
L-arginine
Which of the following sites is used most often for CSF collection?
L3-L4
After further investigation of the Rh(D) antibody discovered by Levine and Stetson in 1939, another blood group system that has phenotypic similarity to Rh was identified. The name of this blood group system is:
LW
Which of the following factors is most likely to cause a false-negative antibody screen following RhIG injection?
Large maternal physical size
Bone marrow findings from cases of MDS with multilineage dysplasia typically demonstrate which percentage of blasts?
Less than 5%
The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions?
Leukemia with CNS involvement
Which of the following would NOT be included in a hemolytic transfusion reaction investigation?
Leukocyte antigen studies
A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive __________ blood components.
Leukoreduced
Which of the following is generally considered equivalent to CMV seronegative RBC for use in an exchange transfusion to a newborn?
Leukoreduced RBC
At what point in the pathogenesis cycle of Mycobacterium tuberculosis is transmission at the highest level?
Liquefaction, cavitation, and emptying of the caseous center
What unsaturated iron binding capacity (UIBC) result is consistent with a diagnosis of HH?
Low
Which statements concerning vancomycin resistance in Enterococci are true?
Low level vancomycin resistance is characteristic of E. gallinarum and E. casseliflavus.Both ampicillin and vancomycin resistance are found more frequently in E. faecium than in E. faecalis.
Which of the following signs and symptoms is most likely to indicate a severe immediate hemolytic transfusion reaction?
Lower back pain in the area of the kidneys
Which tickborne disease is reported MOST often to the Centers for Disease Control and Prevention (CDC)?
Lyme Disease
Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs?
Lymphocytes
The image on the right is a cytospin preparation of cerebrospinal fluid viewed at 1000X magnification. What is the identity of the primary blood cell type observed in this microscopic field?
Lymphocytes
Which of the following antigens are destroyed by treatment with enzymes?
M, Fya, and S
Given the laboratory results below, use the formula on the right to calculate mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and corrected WBC count.Hemoglobin: 12.5 g/dLHematocrit: 40%RBC count: 4.1 x 106/µLWBC count: 40.1 x 103/µLNRBCs counted in a 100 cell differential: 45
MCV: 97.6 fLMCHC: 31.3 g/dLCorrected WBC count: 27.7 x 103/µL
Which set of MCV and MCHC parameters most closely corresponds to the RBC population in the periperhal smear shown in this image?`
MCV: DecreasedMCHC: Decreased
A 70-year-old woman had laboratory testing performed in the hematology department for suspected anemia. The blood cell count showed: WBC = 5.5 x103/µL, Hemoglobin = 9.0 g/dL, MCV = 110 fL, and platelets = 250 x103/µL. The bone marrow biopsy is hypercellular, with monolobated and hypolobated megakaryocytes (see image on the right). What are these results suggestive of?
MDS with 5(q) deletion chromosome
A 65-year-old man with history of MDS presented to the emergency room with shortness of breath. Preliminary laboratory results showed: WBC = 1.5 x103/µL, Hemoglobin = 5.3 g/dL, and platelets = 45 x103/µL. A bone marrow biopsy is performed and showed numerous blasts (see images to the right). The two images are from the bone marrow aspirate slide with lower and higher magnification. What are these results suggestive of?
MDS with progression to AML
Which of the following statements about mixed-field agglutination (MFA) are true? Select all that are correct.
MFA is unlikely to occur in antigen typing if 5 months has elapsed since the patient's last transfusion, MFA may be seen when typing a patient for ABO, Rh, and other RBC antigens, and MFA describes the presence of both agglutinated and unagglutinated red blood cells in the presence of an antibody.
Which of the following scenarios represents appropriate detection of MRSA by the Kirby Bauer method?
MHA; direct colony suspension; 35°C; cefoxitin disk; 24 hour incubation
How would you describe the representative image of Danielle's peripheral blood smear?
Macrocytic RBCs with ovalocytes seen and a lymphocyte present
With respect to Rh antibodies, which of the following are important?
Maintaining accurate records of previous testing and transfusion history of the intended recipient.Performing testing as directed by the reagent manufacturer's directions.Providing blood that is negative for the antigen to which the antibody is directed.Performing a full (IAT) crossmatch on the intended recipient's sample, regardless of current antibody screening results.
A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of cells that are observed in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?
Make a larger dilution.
The role of the laboratory technologist in processing bone marrow aspirates can vary depending on laboratory and clinician protocols. Which of the following roles may be performed by a laboratory technologist?(Select all that apply)
Make smears from samples delivered by clinicians and make smears at bedside.
When testing a patient with a warm autoantibody, which of the following is the most important concern?
Masking of other clinically significant alloantibodies
Dysplastic normoblasts may include:
Megaloblastoid, inter-nuclear bridging, and ring sideroblasts
Which of the following are functions of CSF?
Protect spinal cord from injury and Supply nutrients to nervous system tissue.
What is the general term for the biochemical makeup of the antigens of the Rh system?
Protein
How did the loss of funding affect the multidrug-resistant tuberculosis (MDR-TB) epidemic at the United States-Mexican border?
Puentes de Esperanza, the cross-border clinic, may be closed.
Which of the following activities could a facility perform and still be exempt for registration and submission of a list of components manufactured?
Prepare Red blood cells from whole blood
A new batch of Gram stain reagents have been placed into use, so a control slide is used to verify the intended reactivity. Along with the control slide, a Gram stain is also performed on a smear made from a patient culture. The control slide is read first and BOTH control organisms have stained gram-positive (blue to deep purple). What is the BEST course of action prior to reading and reporting the patient results?
Prepare and stain BOTH a new control slide AND patient slide
Of the failed treatment programs in India described in this course, which one of the following contributed MOST to the drug resistance increase?
Prescribing antibiotics without susceptibility testing
When preparing a slide for morphologic examination, what is the reason for adding a drop of albumin to the cerebrospinal fluid (CSF) sample prior to cytocentrifugation?
Preserve the integrity of the cells.
A common practice for preparing red blood cell products for chronically transfused patients is to match Rh phenotype of recipient and donor by testing both for the common Rh and K antigens. What is the best rationale for this practice?
Prevention of alloimmunization - formation of antibodies to antigens the recipient does not possess.
Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings?
Previous subarachnoid hemorrhage
What myeloproliferative disorder is associated with the abnormal erythrocyte morphology indicated by the arrows in the peripheral blood smear image on the right?
Primary Myelofibrosis
Which response follows initial exposure to foreign antigens via red blood cell transfusion with alloantibody production, sometimes taking up to 120 days?
Primary Response
Which of the following is NOT decreased in beta thalassemia major
RDW
The core (genome) of the HIV virion contains which of the following?
RNA
Why is HIV is known as a retrovirus?
RNA is used as the template for DNA synthesis
What did Byers base his 1991 classification of the genus Acanthamoeba species on?
RNA sequences
Which of the following components is NOT addressed by the AABB TRALI mitigation standard 5.4.1.2?
Red Blood Cells
Which of the following components would be suitable for a patient with a history of severe anaphylactic reactions to Red Blood Cell transfusion associated with haptoglobin antibodies?
Red Blood Cells, Saline Washed
Which factor offers a protective effect, delaying symptoms in persons with HH?
Regular blood donation
What is a typical regimen for long-term maintenance therapy of individuals with HH?
Removal of 2 to 6 units of blood yearly
What is the goal of an adsorption when an autoantibody is present?
Remove autoantibody from the serum/plasma to determine if alloantibody is present
What is a typical schedule for phlebotomy during the initial treatment phase for HH?
Removing one unit (450 mL) of whole blood once or twice weekly.
When performing an antibody screen, both the screen cells are 4+ at immediate spin and W+ at AHG. The antibody panel shows 4+ reactions at immediate spin and W+ reactions at AHG and there is no specific match to the reaction pattern. The auto control is negative. What would be a logical next step?
Repeat testing using warmed patient sample and reagents and just do AHG reading
Which are true statements regarding HA-MRSA and CA-MRSA?
Resistance for both strains is conferred by the mecA gene.HA strains tend to demonstrate resistance to more drug classes than CA strains.CA tends to be associated with the PVL gene and skin and soft tissue infections
With respect to red blood cell (RBC) transfusion, which two blood group systems should be matched?
Rh and ABO system
Rh typing is considered extremely important in pre-transfusion testing because:
Rh antigens are highly immunogenic, second only in importance to antigens in the ABO system.
When testing red cell samples from DONORS, there is a requirement to perform the D typing through the indirect antiglobulin phase (IAT). Donors who test negative at immediate spin and positive after IAT are considered:
Rh positive/D positive and are labeled as POS
Using Rosenfield terminology and the possible answers below, select the correct way to write the phenotype for a red cell sample that reacts as follows: D+ (C negative) E + (c not tested) e +
Rh: 1, -2, 3, 5
Identify the composition of the RBC inclusions seen in this image.
Ribosome precipitates
Diagnosis of a biopsy of the rash by polymerase chain reaction (PCR) is the most sensitive method for detecting which organism?
Ricketsia rickettsii
From the choices below, select the answers that accurately describe the characteristics of antibodies directed against antigens in the Rh system.
The antibodies are usually IgGThe antibodies are capable of causing hemolytic transfusion reactions and hemolytic disease of the fetus and newborn.The antibodies are stimulated by exposure to foreign red blood cells through transfusion and/or pregnancy.
A 5 year old child had an upper respiratory infection 5 days ago. Today, his mother brings him to the emergency room because his urine was bright red this morning. Upon admission, he appears pale, his hemoglobin is 6.4 g/dL, his urine and serum have free hemoglobin, and his direct antiglobulin test (DAT) is weakly positive with anti-C3 only (anti-IgG is negative). Which of the following is most likely TRUE?
The antibody specificity is most likely anti-P
A patient suspected of having a myeloproliferative disorder is undergoing a bone marrow aspiration to confirm the diagnosis. The physician was unable to collect the sample and reported a "dry tap." Which myeloproliferative disorder is commonly associated with failure to aspirate bone marrow successfully (known as dry tap)?
Primary myelofibrosis
Red cell lysis stimulates the release of what factors?
Proinflammatory cytokines
Which of the following is the MOST IMPORTANT first step to take when a patient is transfused with un-crossmatched Red Blood Cells that turn out to be incompatible?
Stop any transfusion in progress
What are the cells that are indicated by the arrows in the joint fluid image shown on the right?
Synovial lining cells
Which one of the following conditions may be associated with warm autoimmune hemolytic anemia (WAIHA)?
Systemic lupus erythematosus (SLE)
Which of these white blood cells are targeted for infection by the human immunodeficiency virus?
T-lymphocytes
An 86-year-old male patient presented with shortness of breath and systolic hypertension 2 hours after receiving 6 units of FFP. The patient responded well to diuresis and the symptoms subsided within 2 hours. Which of the following reactions is/are MOST probable?
TACO
A class II, or higher, biological safety cabinet (BSC) must be used when manipulating potential bioterrorism agents or if aerosols are likely.
TRue
Which of the following practices would NOT be in conformance with the AABB TRALI mitigation standard 5.4.1.2?
Taking female donor pregnancy histories at the initial donation only and using those with no history of pregnancy for FFP production at all subsequent donations
All of the shapes below can be used to describe cocci EXCEPT for which of the following?
Tapered
Which of the following describe how the ENDS of rod-shaped bacteria may appear? (Choose all that apply.)
Tapered and Rounded
What are the two general categories of nucleic acid amplification (NAA) techniques?
Target amplification and signal amplification
Which of the following red blood cell morphologic features is associated with primary myelofibrosis?
Tear Drop cells
What is an appropriate use for molecular (DNA) tests for mutations of the HFE gene, the gene found in the majority of patients diagnosed with HH?
Testing family members of persons with HH
Where in the United States has dengue been found in outbreaks?
Texas, Florida, and Hawaii
Prions may be found throughout the brain of an individual suffering from a prion disease. In cases of fatal familial insomnia (FFI), in what region of the brain are prions found in the greatest concentration?
Thalamus
Which statement is FALSE when describing the ANA test?
The ANA assay is the primary laboratory test for RA.
Which statement accurately describes the Colorzyme® system?
The Colorzyme® ANA Test utilizes the indirect enzyme antibody technique
Which statement is FALSE when describing the diagnosis of autoimmune diseases?
The ESR test may be a better reflection of current inflammation than CRP because changes in serum ESR concentration occur more quickly than CRP. Feedback
Why is it important to note that the red cell distribution width (RDW) in this case is normal ?
The RDW helps to differentiate among various types of microcytic anemias.
Which of the following is TRUE regarding Zika virus transmission and spread?
The Zika virus CAN be transmitted from mother to child during pregnancy, resulting in congenital infection.
Which features distinguishes Candida glabrata from other infectious Candida species?
The ability to produce hyphae or pseudohyphae
From the choices below, select all the reasons Rh antibodies are clinically significant.
The antibodies are IgG immunoglobulins.The antibodies are capable of crossing the placenta.The antigens in the blood group system are well-developed early in the life of the fetus.
Who should a technologist contact if an organism is isolated that cannot be ruled out as a potential agent of bioterrorism?
The appropriate internal staff and contact your Laboratory Response Network (LRN) Reference Laboratory
Which choices accurately describe the Trioplex Real-Time RT-PCR Assay? (Select all that apply.)
The assay is not FDA approved, however, the FDA has authorized its use under the EUA status and The assay uses a reverse transcription step, producing cDNA from RNA present in the sample. The probe binds to the target DNA between the two unlabeled PCR primers.
In state-of-the-art culturing for mycobacteria, which the following is preferred?
The automated BACTEC™ MGIT™ 960 (Becton-Dickinson), as well as culture on 7H11 plates
What are the BEST general methods of Mycobacterium tubercolsis (MTB) treatment and control according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO)?
The directly observed treatment short course (DOTS) program, genotyping, and the tuberculin skin test (TST)
Which of the following must be true in order for a fetus to be at risk for hemolytic disease of the fetus and newborn (HDFN)?
The fetus must inherit a paternal red blood cell (RBC) antigen that is not present on maternal RBCs.
Why do so few patients transfused with un-crossmatched red cells in an emergency experience a hemolytic transfusion reaction? Select the one best reason.
The incidence of unexpected red cell antibodies is relatively low.
Upon which principle is the acid-fast bacilli (AFB) smear based?
The mycolic acid in the cell wall of AFB renders them resistant to decolorization with acid alcohol.
You are told that a patient has the "McLeod Syndrome." Which of the following is most likely to be TRUE regarding the patient?
The patient presents with seizures or involuntary movements
Why is it dangerous to transfuse a person with type O blood with a unit of A blood?
The patient's anti-A would destroy the donor's cells with severe consequences to the patient.
What carbapenemase is produced most commonly by CRE encountered in the United States?
The production of Klebsiella pneumoniae carbapenemase (KPC
What is the identifying characteristic of Aureobasidium pullulans?
The production of a black yeast-like colony
What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for HH?
The serum ferritin decreases to between <50 ng/mL
A patient had a Zika MAC-ELISA test result of 3.5 P/N. What can be concluded about this patient?
The test result indicates a presumptive positive result for serological evidence of possible recent Zika virus infection. Additional testing is required.
If a patient experiences an acute transfusion reaction and TRALI is suspected, who must be notified immediately?
The transfusion service, The donor center, The patient's physician, All of the above
MDS therapy includes:
The use of chemotherapeutic agents and /or stem cell transplant
Which statement regarding carapenemase-resistant Enterobacteriaceae (CRE) is true?
The use of current breakpoints in antimicrobial susceptibility testing (AST) is the best detection method for CREs.
How long should therapy continue for patients with HH?
Therapy should continue throughout the lifetime.
What is the one commonality between all the pathogenic free-living amoeba?
They are all amphizoic amoeba.
In the interest of safety, it is the policy at XYZ hospital to always add one extra 300 µg vial of RhIG, regardless if the dosage calculation is rounded up or rounded down. After performing a Kleihauer-Betke test, a technologist in the laboratory at XYZ hospital calculates the fetomaternal hemorrhage (FMH) to be 45 mL of fetal whole blood. If the formula below is used, how many 300 µg vials of RhIG should be administered to this woman? The number of vials of RhIG (300 µg) to inject is calculated as follows: Number of vials of 300 µg (1500 IU) RhIg = volume of fetal bleed/30 mL
Three
Bacteria, viruses, or toxins that are chosen as weapons of mass destruction (WMD) by bioterrorists are: Easy to acquire and spread Hard to detect and defend against Capable of causing mass panic, injury, and/or death
True
CDI should be suspected in a patient with acute diarrhea (> 3 loose stools in 24 hours) with no obvious explanation for the diarrhea especially with risk factors.
True
Cold hemagglutinin disease (CHD) is caused by an IgM antibody with a broad thermal range.
True
Commercially-available testing for CDI currently favors the employment of a rapid, technologically simple and low cost assay.
True
Cryptococci are commonly found in soil contaminated by bird droppings and in decaying wood and in tree hollows.
True
Dematiaceous molds are darkly pigmented on both the surface and reverse side of the culture plate.
True
Diagnosis of blastomycosis can also be made with an antigen test performed on urine or serum.
True
Disease symptoms of prion diseases are believed to be the result of dense aggregates of amyloid fibers.
True
Ectopic pregnancy is an indication for administering RhIG to an Rh negative woman.
True
Fulminant CDI is characterized by a severe infection associated with complications such as dehydration, hypotension or shock, kidney failure and other conditions.
True
If a smear is over-decolorized, it can be salvaged by repeating the Gram staining procedure.
True
If an asymptomatic pregnant woman is considered to have a possible Zika virus exposure, testing of serum and urine using Zika virus NAT should occur three times during a pregnancy with the first testing occurring at initiation of prenatal care.
True
In a case of WAIHA , the production of IgG or IgG and complement that sensitizes the red blood cells leads to red blood cell destruction.
True
In an attempt to prevent Zika virus spread by mosquitoes, a unique approach involves decreasing the lifespan of A. aegypti by releasing mosquitoes infected with Wolbachia, a rickettsial symbiont.
True
Information obtained from the Gram stained culture smears can allow for a more rapid treatment.
True
Lomentospora prolificans has a gray or black surface and reverse.
True
Once symptoms appear, human prion diseases are always fatal.
True
One of the challenges in the diagnosis of CDI is stool specimens. C diff toxins are considered heat labile and are only considered stable for approximately 4 hours at room temperature.
True
PBP2a is the altered penicillin-binding protein responsible for resistance of MRSA strains to the beta-lactam class of antibiotics
True
Paracoccidioides brasiliensis gives the appearance of a mariner's wheel in tissues sections or primary wet preparations.
True
Penicillin can potentially cause a drug-induced hemolytic anemia.
True
Plasmodium ovale and Plasmodium vivax are the only species to have dormant liver stages.
True
Prevention of mosquito bites, making plans prior to and after traveling to areas of Zika virus outbreaks, and protecting yourself during sex are all ways the CDC's recommends for prevention of the Zika virus infection.
True
Saccharomyces cerevisiae is a yeast that is characterized by round to oval multilateral budding yeast cells and short, rudimentary pseudohyphae.
True
The Mucor spp. do not produce rhizoids.
True
The PRNT assay is a serological test which utilizes the ability of a specific antibody to neutralize a virus, in turn, preventing the virus from causing the formation of plaques in a cell monolayer.
True
The enzyme found in the core of the HIV virion that is utilized to convert viral RNA into DNA is called reverse transcriptase.
True
The features that are most useful for distinguishing Cryptococcus spp. from other yeasts include the presence of a capsule, narrowed-necked budding, and the size variability of the yeasts.
True
To which flavivirus is the Zika virus most closely related?
Dengue
Which mosquito-borne infections have been transmitted by mosquitoes in the continental United States in the last 50 years?
Dengue, chikungunya, and Zika viruses
Which of the following statements is TRUE regarding the A2 blood group?
A2 RBCs have more H antigen than A1 RBCs
Which of the following is NOT a possible type for an offspring from the mating of an O and an AB individual?
AB
What is the major determinant of prognosis for patients with HH?
Degree of organ damage from iron overload
The direct antiglobulin test (DAT) is used most often for which of these purposes?
Detect in vivo sensitization of red blood cells.
Rhodotorula spp. are yeasts that produce a pyocyanin pigment ranging from yellowish to red that can be visualized with individual colonies.
False
Taking or having recently taken antibiotics is NOT really considered a risk factor for CDI but staying in a health care facility is considered a risk factor.
False
The Centers for Disease Control and Prevention (CDC) has published on their web site clearly defined methods for the prevention of infections from Balamuthia mandrillaris.
False
The World Health Organization (WHO) recommends that all blood and body fluid specimens from patients with prion diseases be considered infectious and handled with extreme caution.
False
Detection of the mecA gene in a clinical isolate of S. aureus is an indication of resistance to which of these antibiotics?
Oxacillin
An HIV 1/2 antigen/antibody combination immunoassay that is used as the initial assay in the HIV testing algorithm detects the presence of which of the following HIV-1 proteins?
P24
What is the protein that coats the genome in the core of the HIV-1 virion?
P24
The increased resistance of MRSA strains to beta-lactam antibiotics is due to production of which of the following penicillin binding proteins (PBPs)?
PBP2a
The CDC requires that samples with presumptive positive, equivocal, or inconclusive IgM test results for the Zika virus must be forwarded for confirmation by _______________.
PRNT
A Rh positive individual has produced an anti-D antibody. Which D variant possesses the ability to stimulate this production of anti-D? (Choose all that apply.)
Partial D and Partial weak D
Which of the following viruses is MOST often reported as the cause of infection leading to aplastic crisis in a patient with sickle cell disease?
Parvovirus B19
Patient A and patient B both had hemoglobin migrating in the S position on an alkaline hemoglobin electrophoresis. Which of these patient solubility test results is positive, confirming the presence of a sickling hemoglobin?
Patient A
When would a myeloproliferative neoplasm be classified as "myeloproliferative neoplasm, unclassifiable (MPN-u)"?
Patient does not meet all required diagnostic criteria for a specific MPN and patient demonstrates features of more than one specific MPN.
An ABO discrepancy between forward and reverse grouping owing to weak-reacting or missing antibodies could be BEST explained by which of the following:
Patient is very old or very young
Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and would require cellular components that are prepared by a method known to prevent the disease? (Choose all that apply)
Patient receiving chemotherapy who are immunocompromised, Neonates less than 4 months of age, and Recipients of donor units known to be from a blood relative.
When performing an antibody investigation, which of the following would indicate an inconsistency that needs to be further investigated? (Select all that apply)
Patient with a suspected anti-c does not react with screen cell 3 (rr).Patient with a suspected anti-K reacts with donor red cell that types as K-.Patient with a suspected anti-Fya reacts with all screen cells in an immediate spin done in saline at room temperature.Patient with a suspected anti-Jka has never been transfused or pregnant.
Which of the following serological test results may occur in a patient experiencing a hemolytic transfusion reaction due to antibodies such as anti-c and anti-K?
Patient's antibody strength may initially decrease.Patient may develop a positive DAT with mixed-field agglutination.Patient's antibody becomes undetectable.Patient's antibody increases in titer weeks later.
In the 1980s, what major factor directly caused the escalation of multidrug-resistant tuberculosis (MDR-TB)?
Patients who were non-compliant with prescribed therapy
Which of the following is TRUE about the I blood group system?
Patients with auto-anti-I may require a "prewarmed" crossmatch before transfusion
Host cells (e.g., white blood cells, epithelial cells) will appear what color on a properly stained Gram stain?
Pink
What color is the background material in a Gram-stained smear that has been adequately decolorized?
Pink
Which of the following will increase during hemolysis?
Plasma LDH concentration, Plasma bilirubin concentration, and Reticulocytes
Which laboratory test result would be an indicator of early engraftment by transplanted HSCs in a patient with acute leukemia?
Platelet count greater than 20K/µL
Bacterial contamination is MOST likely in which of the following blood products?
Platelets
Which type of blood component is MOST often implicated in bacterial contamination?
Platelets
Pruritis (itching) after exposure to warm water is associated with which type of myeloproliferative disorder?
Polycythemia vera (PV)
What method is being used by most laboratories for tissue typing instead of serological HLA typing?
Polymerase chain reaction (PCR)
What is the fastest laboratory method for diagnosing RMSF?
Polymerase chain reaction (PCR) of rash biopsy
A patient with diarrhea was suspected of having CDI. A stool specimen was submitted to the laboratory for analysis using the C Diff Quik Chek Complete® test. The results of the test showed the appearance of a vertical blue line in both the "Ag line" and the "Toxin line" as well as a vertical dotted blue line on the "control line." What is the interpretation of the test results?
Positive for toxigenic C diff
A 40-year-old female receives two units of Red Blood Cells during a surgical procedure. The patient has no prior history of transfusions. Seven days later, she presents with extensive bruising of the extremities and bleeding of the gums, with no additional symptoms. Her platelet count is 5 x 109/L ( reference interval 150 - 400 x 109/L). What is the most likely diagnosis?
Post transfusion purpura (PTP)
How is the abnormal form of the prion protein designated?
PrPSc
How are most blood parasites transmitted?
arthropod vector
To determine the appropriate adsorption technique to use, an accurate transfusion history must be obtained. In this case the patient has not been recently transfused (ie, not transfused within the past three months). Which adsorption technique is normally utilized if the patient has not been recently transfused?
autologous adsorption
A pregnant female who was injected with RhIG antenatally has a positive antibody screen at delivery. The antibody has been confirmed as anti-D and reacts only in the indirect antiglobulin test. Many laboratories consider reaction strength to be an indicator of whether the anti-D is likely passive or immune.To be considered probably passive, an anti-D reaction strength is typically less than or equal to which reaction grade?
2+
A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer are counted on each side for a total of 18 large squares. Side 1-- 186 nucleated cells counted Side 2-- 184 nucleated cells counted total nucleated cells = 370 Using the standard hemocytometer formula shown on the right, what is the nucleated cell count per microliter (µL)?
2.06 x 104
In a moderately bloody specimen, 250 cells are counted in 10 squares. The dilution is 1:100. What is the count/µL?
2.5 x 10^4
What is the minimum concentration of DEET required to repel mosquitoes?
20%
Delayed transfusion reactions occur at what time post cessation of transfusion?
24 hours
A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 µL of sample. What volume of diluent should be used?
270 µL
Antenatal RhIG (1500 IU dose) is typically given at how many weeks gestation?
28
What is the median age for individuals with variant Creutzfeldt-Jakob (vCJD) disease?
28
A 1500 IU (300 µg) dose of RhIG can suppress immunization to _____ mL of D-positive whole blood.
30 mL
A 300 µg dose of RhIG will be protective for up to what volume of fetomaternal hemorrhage of WHOLE BLOOD?
30 mL
Chronic eosinophilic leukemia is associated with a clonal proliferation of eosinophils in the bone marrow. Which of the following eosinophil percentage ranges is typically demonstrated in the peripheral blood of these patients?
30-70%
What dose of RhIG can suppress immunization of 30 mL of D-positive whole blood?
300 µg
A patient had a pretransfusion factor V activity of 20%. Immediately after administration of one dose of FFP (20 mL/kg) approximately what should his factor V level be?
40%
Fevers from malaria are cyclical and can occur in:
48 hr to 72 hour cycles
At what temperature range is the ABO antigen-antibody reaction best observed?
4° to 20°C
How many species of Plasmodium can cause infections in humans?
5
What percentage of dietary iron is normally absorbed daily?
5-15%
Scenario: A transplant patient is tested for T cells after immunosuppression therapy. The following data is obtained by flow cytometry from the patient's peripheral blood: Total WBC = 2,200/µL (2.2 x 109/L) Total lymphocytes = 25% T lymphocytes = 12% B lymphocytes = 86% What is the patient's absolute T cell count?
66
If possible, Rh immune globulin (RhIG) should be administered within what period of time following the delivery of an Rh positive or weak-D positive infant, or other Rh alloimmunizing event?
72 hours
Approximately what percentage of group A individuals could be further classified as subgroup A1?
80%
The Philadelphia chromosome, associated with chronic myeloid leukemia (CML), involves a reciprocal translocation of genes from which two chromosomes?
9 and 22
What is the approximate volume of spinal fluid in an adult?
90-150 mL
Which of the following peripheral blood findings is consistent with the onset of the accelerated phase of chronic myeloid leukemia (CML)?
> 20% basophils
The mating of parents of which two ABO phenotypes can potentially produce offspring with ALL of the common four blood types?
A and B
The microcytotoxicity assay is still sometimes used for testing which HLA molecules?
A and B
Which of the following is NOT a characteristic of a sentinel clinical laboratory?
A biosafety cabinet (BSC) is NOT required
What is the cause of Gerstmann-Sträussler-Scheinker (GSS) disease?
A change in codon 102
For the ANA test to be positive, what must be present in the nucleus of the interphase cell?
A clearly discernable pattern
Which of the following would exclude a potential HSC donor from the National Marrow Registry?
A coagulation disorder, such as factor V Leiden
How is beta thalassemia defined
A decrease in the rate of production of beta chains due to a partial or total deletion of loci from chromosome 11 that code for the beta chain.
Hemoglobinopathies can be caused by all of the following structural defects EXCEPT:
A defective heme gene
A patient transfused with two units of Red Blood Cells spiked a fever of 99.5oF and complained of chills five days after transfusion. The direct antiglobulin test (DAT) was positive with anti-IgG, but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The post-transfusion specimen was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely caused by:
A delayed hemolytic transfusion reaction
Which of the following individuals should NOT be tested for HIV infection using an anti-HIV antibody test method?
A newborn whose mother is seropositive
The reason that the sickle cell mutation can lead to polymerization and thus sickling of the RBC is
A non-polar amino acid is substituted for a polar amino acid at a critical location, and thus bonding with other hemoglobin molecules occurs instead of bonding with water.
Mild compensated hemolytic anemia, stomatocytosis, reticulocytosis, increase in hemoglobin F, slight to moderate decrease in hemoglobin and hematocrit, decrease in haptoglobin, and possibly elevated bilirubin are characteristic of which clinical situation:
A person with Rhnull syndrome
Which of the following statements about antigen phenotyping are TRUE? (Select all that apply)
A positive DAT can cause false-positive results when antigen typing a patient by IAT. Recent transfusion may cause mixed-field agglutination in a patient's antigen typing results. Using the patient's pretransfusion specimen is one solution to antigen typing a recently transfused patient.
Which of the following statements best describes reverse typing, which is performed to help determine blood group and type?
A technique by which the ABO antibodies in the patient serum are identified by their reactions with commercial RBCs (A1 cells and B cells)
Which of the following statements best describes forward typing?
A technique by which the ABO antigens on RBCs are identified by their reactions with commercial antisera (Anti-A, Anti-B and Anti-A,B).
Which of these statements accurately corresponds with the CDC's most recent guidelines on pregnancy management for Zika virus infections?
A. The CDC recommends Zika virus testing if a pregnant woman has symptoms of infection within two weeks of traveling to an area with active Zika transmission.
Which of the following is the most common subgroup of A?
A1
A C Diff Quik Chek Complete® test result showed vertical blue lines on both the "Ag line" and "Toxin line" with a vertical dotted blue line on the "control line." What do these result mean?
A valid positive test result for both the GDH antigen and toxins A and/or B
A laboratory employee who is performing an internal audit of routine ABO and Rh typing procedures notes that a technologist places two drops of Anti-D in a tube, centrifuges the tube for 20 seconds, and reads the reaction using a magnifying mirror. When questioned about the procedure, the technologist indicates that most staff use two drops of Anti-D reagent because the reactions are stronger with two drops. In addition to reviewing the facility procedure manual, what should be done to ensure regulatory compliance?
A. Review the anti-D manufacturer's current instructions for use.
A sample reacts with panel cells at immediate spin and AHG with varying strengths and no true pattern that matches an antibody. The presence of which of the following is the most likely cause?
An IgM and an IgG antibody
How is a harmless prion protein (PrP) converted into the infective PrP?
An abnormal PrP binds to the normal protein and causes it to become misfolded
Which of the following best describes a hemoglobinopathy ?
An altered hemoglobin structure.
The antibody panel you are working on is reacting 2+ with all the panel cells at the AHG phase. The auto control is negative. Which of the following is the most likely antibody?
An antibody to a high-incidence antigen
Which listed transfusion reaction is MOST OFTEN associated with transfused patients lacking IgA?
Anaphylaxis
An 81-year-old woman who was taking prednisone and methotrexate for rheumatoid arthritis fell and fractured her hip. She received two units of leukocyte-reduced RBCs. Nine days later, she presented with fever, myalgias, and pancytopenia. She developed disseminated intravascular coagulopathy with multiorgan failure. The peripheral blood smear revealed intracytoplasmic inclusions in neutrophils and PCR testing was positive for the agent. What do you suspect the pathogen to be?
Anaplasma phagocytophilum
Which genus of mosquito is known to transmit Plasmodium?
Anopheles
Bombay phenotype (Oh) individuals may have antibodies with all the following specificities EXCEPT:
Anti-A,B
What is present in the blood of an individual with the Bombay phenotype which will cause it to agglutinate with any non-Bombay individual's blood?
Anti-H
Of the antibodies that are listed, which is most often implicated as a cause of delayed hemolytic transfusion reaction (DHTR)?
Anti-Jka
The antibody that reacts with most D-positive red blood cells (RBCs), weakly with D-negative RBCs and NEVER with Rhnull RBCs is:
Anti-LW
Which of the following blood group antibodies is generally NOT associated with HDFN?
Anti-Lea
Which of the following is TRUE of the P1PK and GLOB blood group systems?
Anti-P1 is an insignificant antibody neutralized by pigeon egg white fluid
Why does agglutination (clumping) sometimes occur when red blood cells (RBCs) from one individual are mixed with serum from another?
Antibodies in one person's serum may react with antigens on the other person's RBCs.
AHG?
Antibodies reacting in this phase are considered clinically significant. They are usually warm reactive and IgG. Antibodies to the Duffy, Kidd, and Kell blood group systems and to the S and s antigens (anti-Fya, anti-Jka, and anti-K, anti-S) react most commonly at the AHG phase of testing.
Initial Spin?
Antibodies reacting in this phase tend to be cold reactive. They are usually IgM class and not clinically significant (with the exception of the A and B antibodies). Reactions occurring only at immediate spin phase could indicate a possible IgM antibody, cold agglutinin, or rouleaux.
After an adsorption technique is complete, what is the next step in determining if any underlying alloantibody is present?
Antibody identification procedure using the adsorbed serum/plasma
In which of these cases would an elution NOT be performed when investigating a warm autoimmune hemolytic anemia (WAIHA)?
Antibody screen positive, DAT (polyspecific) negative
In addition to culture, diagnosis of coccidioidomycosis can be accomplished by which of the following?
Antigen testing performed on urine or serum or with antibody testing
Moving forward, important strategies for dealing with MRSA strains will include which of the following?
Antimicrobial stewardship to guide the use of both existing alternatives and newer drugs.Identification of MRSA strains in all settings (inpatient as well as outpatient).Possible development of vaccines
Based on the Centers for Disease Control and Prevention's (CDC's) definition, which statement describes a carbapenemase-resistant Enterobacteriaceae (CRE)?
Any Enterobacteriaceae isolates that are resistant to any carbapenem drug during AST are considered CRE.
What is a transfusion reaction?
Any adverse event associated with the transfusion of blood components
Which allogeneic HSC donation procedure is most commonly used today?
Apheresis of peripheral blood
How has the automated system (eg, BACTEC™ MGIT™ 960) IMPROVED on the agar proportion method for antimicrobial susceptibility testing (AST) of Mycobacterium tuberculosis complex (MTBC)?
Approved for safety with continuous monitoring and rapid results
At what time of the year are MOST tickborne diseases reported?
April through September
Which of the following genotypes are associated with beta thalassemia minor?
B+/B, B0/B
Which of the following is FALSE in describing the Trioplex real-time RT-PCR (rRT-PCR) assay?
B. The Trioplex rRT-PCR test is FDA approved; therefore, the test does not require EUA status.
Which of the conditions listed below must be met before a unit of Red Blood Cells that has been issued and returned can be reissued?
B. The container has a tamper-proof seal and the seal remains unbroken.
A staff technologist is receiving a shipment of reagents. The technologist logs the date received and the number of vials in the shipment. Two of the vials are contaminated. The manufacturer wants the vials back. Which of the following must be done to comply with the 606.160 Records section of the Code of Federal Regulations (CFR)?
B. The final disposition of the unsuitable reagents must be recorded.
What is the proper scientific acronym for mad cow disease?
BSE
Which organism is MOST likely to be transmitted via blood transfusions?
Babesia microti
A one-month-old infant from Massachusetts was fussy, pale, had warm skin, and was vomiting. His temperature was 101.5º F (38.6º C) and he had tachycardia, poor perfusion, splenomegaly, and pulmonary edema. Laboratory studies revealed hemolytic anemia and thrombocytopenia. His ALT was increased, but his other chemistry studies were normal. His urine was dark red and cloudy with a pH of 7.0, a specific gravity of 1.015, a large amount of blood, 100 mg/dL of protein, and trace leukocyte esterase. The microscopic urinalysis had 0 to 5 red cells and white cells per HPF and 15 to 20 granular casts/LPF. The CSF was normal. The CBC differential slide, shown in the image, was diagnostic. The newborn's mother visited an island off the coast of Massachusetts recently, where the incidence of this disease is 100 times higher on these islands than on the mainland. The mother had no symptoms. This baby is a twin, but the other twin was not infected. Testing revealed the mother and twin had high titers of antibodies (her titer was 1:4096) to this etiological agent, spread by ticks. What is the diagnosis?
Babesiosis
Which of the following organisms display the characteristic "Medusa head" on sheep blood agar (SBA) after 18 hours of incubation at 35°C?
Bacillus anthracis
The image on the right is a Wright-Giemsa stained CSF smear (1000X). What structures are indicated by the arrows?
Bacteria
The elements indicated by the arrows were observed on a Wright-stained smear of a synovial fluid. What is the likely identification of the elements and what would you do to confirm the finding?
Bacteria; perform a Gram stain
Which pathogenic free-living amoeba is most commonly isolated from soil, but has also been isolated in both fresh and salt waters, and appears to equally infect both immunocompetent and immunocompromised individuals?
Balamuthia mandrilliaris
The antinuclear antibody (ANA) is used to screen for the presence of autoantibodies that are directed toward components in the nucleus of the cell. Which of the following choices are true regarding the ANA test? (Select all that apply.)
Because early presentation for many of the SARDs are nonspecific, the result of the ANA test alone are not diagnostic for SARD and The utility of the ANA test is to detect the antibodies early in the disease process.
Cooley's anemia is another name for which form of beta thalassemia
Beta Thalassemia Major
This drawing depicts which beta chain genotype
Beta Thalassemia Minor
Nucleated RBCs are most likely to be seen in the peripheral blood of which of these beta thalassemias
Beta Thalassemia major
Which beta thalassemia shows no anemia and may not be detected using hemoglobin electrophoresis?
Beta Thalassemia minima
These test results are most consistent with which of the following types of beta thalassemia Test Patient Result Reference Intervals (Adult female) Red blood cell (RBC) count5.6 x 1012/L Hemoglobin (Hb) 11.2 g/dL Hematocrit (HCT)34.5% RDW14.0<14.5 RBC morphology- Microcytes, basophilic stippling, codocytes present.
Beta Thalassemia minor
The diagram above represents which of the following beta thalassemias?
Beta thalassemia intermedia
Which two of the following beta thalassemia forms are associated with the genotype B0/B+
Beta thalassemia intermedia, Beta thalassemia major
Skeletal deformations are most commonly present in which one of the following beta thalassemia forms?
Beta thalassemia major
What is this patient's most likely diagnosis?Review of results:This patient has an increased RBC count with a decreased Hb and normal Hct. The MCV is microcytic and the RDW is within normal limits. Many codocytes are present on the peripheral smear. Serum iron is 165 µg/dL (normal = 60 -150 µg/dL), and the TIBC is 230 µg/dL (normal = 250 - 400 µg/dL). Consider also the findings on alkaline hemoglobin electrophoresis.
Beta thalassemia minor
Codocytes (target cells) are a typical finding in which of the following types of beta thalassemia?
Beta thalassemia minor, Beta thalassemia intermedia, Beta thalassemia major
Which of the following enzymes, produced by S. aureus, is responsible for preventing penicillin antibiotics from being effective against a Staph infection?
Beta-lactamase
Based on initial serologic testing, a patient is hypothesized to have an anti-K, but anti-E cannot be ruled out. In this case, which of the following is the BEST cell to select to rule-out anti-E?
Big K negative, big E homozygous
What is the predominant host (not vector) for West Nile virus (WNV)?
Birds
What is the characteristic appearance of the microconidia and hyphae of Trichophyton rubrum on lactophenol cotton blue preparations?
Birds on a telephone wire
Identify the blood cells indicated by the arrows in this cerebrospinal fluid (CSF) sample.
Blast Cells
Which of the following dimorphic molds produces spherical or oval conidia, each supported by an individual conidiophore ("lollipop") as represented in the image on the right?
Blastomyces dermatitidis
Good Manufacturing Practices apply to:
Blood, Progenitor cells, Tissue, and Pharmaceuticals
What are the colony colors of Aspergillus fumigatus?
Blue-green
A 12-year-old female from Santa Cruz, California presented with a swollen, painful right knee and hip. She reported recurrent knee swelling and pain lasting several days every four to five months. Her parents chose to treat her with herbs instead of antimicrobials when she was first seen with knee pain. On this occasion, her WBC count was 7,000/mL, hematocrit was 33%, and the erythrocyte sedimentation rate (ESR) was 73 mm/h. A knee aspirate was taken and tests revealed 59,000 WBCs/mL and a protein of 5 g/dL. No growth was seen on the bacterial cultures, but the fluid was positive by PCR for the pathogen. What do you suspect the pathogen to be?
Borrelia burgdorferi
Why do relapses occur in tickborne relapsing fever (TRF)?
Borrelia can change its surface antigens and make the antibodies ineffective.
Which of the following adverse reactions to plasma transfusion are theorized to involve both a donor and recipient factors (two-hit type of mechanism)?
Both TRALI and Anaphylaxis
With regards to identifying resistance in enterococci, which general statements are true?
Both disk diffusion and broth microdilution tests should be incubated a full 24 hours to detect vancomycin resistance.BHI agar with 6 µg/mL vancomycin can be employed as a screening methodology for vancomycin resistance.Methodologies employed should also address the detection of high level resistance to gentamicin and streptomycin.
What is the characteristic budding morphology that can help identify Blastomyces spp.?
Broad-based
After suspecting that his patient may have lung disease, the physician sends a bronchoalveolar lavage (BAL) to the laboratory for examination. What is the cell type indicated by the arrows in this cytospin sample?
Bronchial lining cells
Which is the MOST commonly reported organism in cases of laboratory-acquired bacterial infection?
Brucella species
What is the stage of viral replication where the envelope is being acquired and HIV is leaving the host cell?
Budding
How does one confirm that a fungus is thermally dimorphic?
By converting from the mold form to yeast form by incubating mold subcultures at 37°C
How did Robert Koch lay the groundwork for the field of epidemiology?
By proving a "cause and effect" relationship existed between TB bacilli and disease
Select all items from the list below representing mechanisms that will result in weakened expression of the D antigen.
Del, C in trans to RHD, Weak D, and Partial D
What other hemoglobin gene loci occur on the same chromosome as the beta chain loci?
Delta, Gamma
A hemoglobin F concentration of 100% may be seen in which beta thalassemia
Delta-beta thalassemia major
Which of the following statements about the transmission history of the Zika virus is false?
C. In 2015, healthcare authorities in Brazil confirmed that approximately 500 patients who had flu-like symptoms, rash, and arthralgia had been infected with the Zika virus. The authorities linked that outbreak to a mutation in the Zika virus that allowed the Aedes mosquitoes to become more infective.
Which of the following procedures should be followed when storing supplies or reagents that do not have a manufacturer-assigned expiration date?
C. Store supplies in a manner that ensures the oldest will be used first
The image on the right is a Gomori methenamine silver stain of a lung biopsy obtained from a patient with x-ray evidence of multi-focal pneumonitis. The infiltrating yeast cells are distinctly spherical, irregular in size, and separated by capsular material, appearing as a halo around each cell. What yeast will MOST likely be recovered in culture of this tissue, based on the microscopic morphology that is observed?
Cryptococcus neoformans
Which antibiotic is used in growth media to help isolate dermatophytes?
Cyclohexamide
Since the late 1960s, Rh immune globulin has been used to prevent maternal alloimmunization to which Rh antigen(s)?
D
Which Rh antigen was first identified during the investigation of a stillborn child due to hemolytic disease of the newborn, leading to the discovery of the Rh blood group system?
D
Polymerase chain reaction (PCR) copies DNA through repeated cycles of three basic steps. What is the correct order of these steps? (Choose the BEST answer)
Denaturation, annealing, and synthesis at 72°C
From the list below, select all of the items that represent null or deletion phenotypes.
D--, D.., and Rhnull
From the choices given below, select the most likely Fisher-Race designation for the individual whose red cells test as follows: D + C+ E neg c + e+
DCe/dce
What agent is used as a cryopreservative for long-term storage of HSCs?
DMSO
A chart recorder must be compared to a thermometer at what frequency?
Daily
Which of the following laboratory test results indicates that a sickle cell patient may be in aplastic crisis?
Decreased reticulocyte count
What drug may be used to decrease iron levels in patients with iron overload?
Deferoxamine
A healthy 20-year-old female from southeast Missouri presented with fever of 104° F, vomiting, and diarrhea. She had a red, maculopapular rash that began on her face and blanched when it was touched. Laboratory findings include: WBC: 4.9 x 109/mL Hgb: 10.9 g/dL Platelets: 102 x 109 Hyponatremia Mildly elevated liver enzymes Additionally, inclusion bodies were seen in the cytoplasm of monocytes on her peripheral blood smear. The diagnosis was confirmed with PCR. What is the suspected pathogen in this case?
Ehrlichia chaffeensis
What laboratory test result might indicate that a patient is experiencing graft versus host disease (GVHD)?
Elevated alanine transaminase (ALT)
Which of the following is NOT an expected or common laboratory finding in patients with HH?
Elevated hemoglobin and hematocrit
Which of the following is NOT a function of the Laboratory Response Network (LRN)?
Eliminate bioterrorism
The cytopenia detected in MDS is related to:
Enhanced degree of apoptosis in a hyperplastic bone marrow biopsy
All of the following are free-living amoebae EXCEPT:
Entamoeba polecki
Which method(s) is/are recommended by the Centers for Disease Control and Prevention (CDC) for the diagnosis of Lyme disease?
Enzyme immunoassay (EIA) followed by Western blot
When testing for dengue, chikungunya, and Zika, if molecular testing (real-time reverse transcription polymerase chain reaction) is negative on a patient who is symptomatic or has traveled to an endemic area, which confirmatory test(s) is most specific for acute infection (less than 7 days following the onset of symptoms)?
Enzyme-linked immunosorbent assay (ELISA) IgM antibodies followed by a plaque-reduction neutralization test (PRNT)
The image on the right is a cytospin preparation of cerebrospinal fluid (CSF). What is the cell type that is indicated by the arrow?
Eosinophil
What causes the characteristic heart and/or lung damage frequently demonstrated in patients with chronic eosinophilic leukemia?
Eosinophil granule release
What is the predominant cell population seen in this pleural effusion?
Eosinophils
Match the following cell types to the body fluids in which they may be seen when the fluid is observed on a cytocentrifuged preparation.
Ependymal cells are associated with CSF, although they are a rare finding. Mesothelial cells are often found in serous fluids. Synovial lining cells may appear in joint (synovial) fluid. Bronchial lining cells are frequently seen in BAL.
What is the identification of this cellular clump found in CSF? Note the presence of many similar-appearing nuclei without distinct lines of demarcation between cells.
Ependymal clump
Which hormone is responsible for the regulation of erythrocyte production?
Erythropoietin
Which of the following myeloproliferative neoplasms is characterized by a marked increase in platelets; giant abnormal platelets; abnormal response to ADP, collagen, and epinephrine in platelet aggregration testing?
Essential thrombocytosis
In which of the following situations would a bone marrow aspirate and biopsy possibly be used as an aid for diagnosis?(Select all that apply)
Evaluation of anemia and thrombocytopenia, Evaluation of cytopenias, Diagnosis of leukemias, Evaluation of fever of unknown origin (FUO)
What is the most frequently used method for the diagnosis of primary amoebic meningoencephalitis (PAM)?
Examination of CSF
What is the fundamental defect involving iron metabolism in HH?
Excessive dietary iron is absorbed.
Which of the following components would MOST LIKELY be associated with TRALI?
FFP from a female donor with a history of one full term pregnancy
Which species of Plasmodium is the most common cause of death from malaria worldwide?
Falciparum
A Gram stain is performed from a cerebrospinal fluid (CSF) culture. From a sterile body site, it is TYPICAL to expect more than one morphotype (such as gram-negative rods, gram-positive cocci, AND gram-positive rods) to be recovered.
False
An Rh negative pregnant female has produced anti-D and the physician has decided to use molecular typing to determine if the fetus is at risk. Is the following statement true or false? If molecular genotyping demonstrates that the father is homozygous for the RHD allele, molecular typing of the fetus is also indicated.
False
Arthroconidia of Coccidioides spp. are oblong shaped and alternate with empty cells.
False
Blastomyces spp. are only found in the Mississippi and Ohio River valleys.
False
Commercial identification systems can reliably identify the bioterrorism threat agents.
False
Cooking meat until well-done is a very important step in preventing the transmission of Mad Cow Disease, or bovine spongiform encephalopathy (BSE), to humans.
False
Cytoplasmic patterns are interesting to look at but have no clinical significance and should NOT be reported.
False
Epidermophyton floccosum always produces microconidia.
False
Horses are the primary reservoir of EEE.
False
Maternal antibody titer is a reliable indicator of fetal disease.
False
Mucormycetes grow rather slowly both in vivo and in culture.
False
New Delhi metallo-beta-lactamase (NDM) is the most common carbapenemase produced among CRE in the United States.
False
Penicillin is one of the medications that may be responsible for the immune-complex mechanism of drug-induced hemolytic anemia.
False
Plasmodium malariae infects young and immature red blood cells.
False
Which two substances listed below are considered iron storage compounds?
Hemosiderin and Ferritin
Andrew is a 49-year-old Caucasian male who is seen by a primary care doctor. He reports that for the last 1-2 years or longer he has experienced moderate fatigue, aches and pains in multiple joints, impotence, and mild depression. He has a family history including diabetes in both parents, and an older brother who died of liver disease at age 60. Andrew is unsure of his brother's complete medical condition, but thought he was a heavy drinker. Andrew denies personal use of tobacco and is taking neither prescribed or over-the-counter drugs. He states he drinks alcoholic beverages, mostly on weekends. The physician orders routine lab tests including a chemistry panel, CBC, lipid panel, and urinalysis. The results of the lab tests were mostly normal with the following notable exceptions which were all elevated (above reference intervals): Enzymes related to liver function, serum iron, fasting glucose (slightly elevated). What disorder is most consistent with this patient's history, clinical presentation, and initial laboratory test results?
Hereditary hemochromatosis
A 69-year-old with a two year history of MDS with a single cell line dysplasia has a scheduled CBC performed. The current blood count shows: WBC = 2.0 x103/µL, Hemoglobin = 7.0 g/dL, and platelets = 95 x103/µL. The peripheral blood smear shows hypogranulated and hyposegmented neutrophils, as well as blasts with Auer rods (see images to the right). The bone marrow shows 4% blasts.
High grade MDS
Which of the following statements about high-incidence antigens is correct?
High-incidence antigens are common, but it's difficult to identify their corresponding antibodies.
Which cells are H. capsulatum yeast cells often found within?
Histiocytes and reticuloendothelial cells
The transmission of which of the following organisms is associated with the guano of bats?
Histoplasma capsulatum
Which of the following diseases is most likely treated with an autologous HSC transplant?
Hodgkin's lymphoma
What is the BEST method for removing a tick that has bitten you?
Hold the tick with fine-tipped tweezers and pull straight up.
The antinuclear antibody (ANA) test pattern that is seen in this image, viewed using fluorescent microscopy, is characterized by smooth staining in the nuclei of the interphase cells (a) and smooth staining in the chromosomal areas of the metaphase mitotic cells (b). Which pattern is this? Note: (a) points to the nuclei of two interphase cells. the nucleus of the interphase cell is the primary consideration for discerning the ANA pattern. (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern.
Homogenous
There are two patterns present in this microscopic field from an antinuclear antibody ANA test. The test is viewed using fluorescent microscopy. One pattern can be seen in the interphase cells (a) and the area outside of the chromosomal area of the mitotics (b). The other pattern is recognizable in the chromosomal area of the metaphase mitotic cells (c). What are these two patterns?
Homogenous and Speckled
What is the most common combination of ANA patterns?
Homogenous and speckled
A completely sickled cell (drepanocyte) is most commonly seen in which of these conditions?
Homozygous Hb SS
Which HFE genotype is most common in patients with HH?
Homozygous for C282Y
Which of the following consequences of severe hemolytic disease of the fetus and newborn (HDFN) is most associated with neonatal death before or shortly after birth?
Hydrops fetalis
Which white blood cell abnormality would you expect to see on the peripheral blood smear of this patient?
Hypersegmented neutrophils
The dysplastic features in the megakaryocytic lineage observed in cases of MDS may include:
Hypolobated and monolobated megakaryocytes
What additional information is required on a label or tie tag of an autologous unit that is not required on the container label of blood or blood components from an allogeneic donor?
Identification of the recipient
The CBC results in this case break the rule of three. What is the rule of three?
If red blood cells are normochromic and normocytic, the hemoglobin times 3 will approximately equal the HCT.
Which of the following statements is FALSE when describing indirect immunofluorescence assays (IFAs)?
If the sample is negative for ANA, the nucleus will show a distinct, clearly discernible pattern of nuclear fluorescence
What is (are) the causative autoantibody(ies) in paroxysmal cold hemoglobinuria (PCH)?
IgG
Which of the following recipient antibodies is associated with the MOST frequent and SEVERE anaphylactic reactions?
IgG antibodies that react with both IgA1 and IgA2
Which of the following is the predominant immunoglobulin class for anti-A and anti-B antibodies?
IgM
A five-year-old female who lived in Missouri was taken to the emergency department (ED) in June. She had a three day history of intermittent headache, nausea, and a sore throat. Her temperature was 105o F (40.6o C) and she had a maculopapular rash on her legs and the soles of her feet. Laboratory tests were performed. Results of laboratory studies include: 8.8 X 109/mL WBC 5% band forms 70% neutrophils No morulae or spirochetes observed 50 x 109/mL platelets Mild elevation in liver transaminases Hyponatremia Which of the following should be considered in the differential diagnosis of a child with high fever and a rash?
Meningiococcemia, Ehrlichiosis or anaplasmosis, Rocky mountain spotted fever, Streptococcal disease, Drug reaction, Enterovirus and All of the above should be considered
Identify the binucleate cell indicated by the arrow in the pericardial fluid sample shown here.
Mesothelial Cell
The image on the right is a cytospin of a pleural fluid. What is the cluster of cells indicated by the arrow?
Mesothelial Cells
The normal serous membranes are lined by which type of cells (These cells are commonly shed into pleural, peritoneal, and pericardial fluids)?
Mesothelial Cells
Which of the following has a cytotoxic effect on lymphocytes?
Methotrexate
What is the rare neurological condition that can occur with a congenital Zika virus infection in which an infant's head is significantly smaller than most infants and is usually the result of the brain developing abnormally in the womb?
Microcephaly
How would you describe the representative image of Patrick's peripheral blood smear?
Microcytic hypochromic RBCs with basophilic stippling, polychromasia, and normal platelet morphology
How would you describe the representative image of Nicholàs' peripheral blood smear?
Microcytic hypochromic RBCs with normal platelet size and a lymphocyte
In which age group is HH most likely to be initially detected based on clinical symptoms?
Middle-aged adults
In what part of the Anopheles' body do the sexual forms complete their life cycle?
Midgut
Using white blood cell counts and creatinine levels may help clinicians classify the severity of CDI. If the white blood cell count is <15,000 and serum creatinine <1.5 mg/dl, these results may be an indication of what classification of CD severity?
Mild to moderate infection
If zygomycosis is clinically suspected, then how should the specimen be prepared prior to culture?
Minced
The regulations that are listed in the Code of Federal Regulations (CFR) should be considered:
Minimum standards that a facility can exceed
Which laboratory assay is considered to be a confirmatory test for HH?
Molecular (DNA) assays for HFE mutations
Reagents manufactured from a single clone of antibody-producing cells are called:
Monoclonal
Which of the following situations suggest a traumatic tap occurred?
More blood is in tube 1 than tubes 2, 3 or 4., Blood clots are present.
Only about half of illnesses caused by Francisella tularensis are caused/transmitted by tick bites. Which of the following are also known to transmit tularemia? Choose all that apply.
Mosquito bites, Deer fly bites, and Handling infected rabbits
What is a useful stain for the identification of Cryptococcus?
Mucicarmine
Post-transfusion purpura (PTP) is characterized by which of the following?
Mucosal membrane bleeding, Appearance of purpura, Platelet count of less than 10,000/µL
_____ is an enzyme present in granules of myeloid and monocytic cells. It is responsible for certain immunologic reactions that assist our innate/natural immune response. Cells of myeloid lineage (especially neutrophils) will stain positive for this enzyme, while cells of a lymphoid lineage will not. This allows for the differentiation of AML and ALL.
Myeloperoxidase
The reactivity of blood group A is confirmed by detecting the presence of which immunodominant sugar molecule?
N-acetyl-D-galactosamine
Which specific terminal sugar causes a red cell to have A antigenic activity?
N-acetylgalactosamine
The __________ test measures the Zika virus RNA and is often employed early in the course of the infection. Typically, a positive result using this type of test on any specimen will confirm a Zika virus infection.
NAT
Which of the following is the pathogenic free-living amoeba with a flagellate state?
Naegleria fowerli
What is the etiologic agent for primary amoebic meningoencephalitis (PAM)?
Naegleria fowleri
Which antinuclear antibody (ANA) pattern is seen in the image on the right, which represents the result of an ANA test viewed using fluorescent microscopy? Note: (a) points to the nuclei of interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern.
Negative
All of the following observations are consistent with the laboratory identification of Cryptococcus neoformans EXCEPT:
Negative urease test
Gram-negative cocci that occur in pairs with their adjacent sides flattened, giving them a "coffee bean" appearance (as seen in the image), are typical of which of the following bacteria?
Neisseria Species
Gram-negative diplococci with adjacent sides flattened (coffee bean shaped)
Neisseria Species
Prions are believed to cause what type of diseases?
Neurodegenerativ
Candida glabrata can be morphologically difficult to distinguish from Histoplasma capsulatum when observed in tissue sections. Which of the following can aid in distinguishing between C. glabrata and H. capsulatum when small yeast are seen in tissue sections?
Neutrophilic response
Which two of the following laboratory blood test results are associated with chronic neutrophilic leukemia (CNL)?
Neutrophils/bands >80% and hypercellular bone marrow
A physician orders a peritoneal lavage on a patient who complained of fever and abdominal pain following an automobile accident. The fluid is analyzed in the laboratory. How should the sample shown in the image to the right be reported?
NeutrophilsIntracellular and extracellular bacteria
Which of following statements describing the prevention and treatment of Zika virus infections is FALSE?
Niclosamide, a drug already on the market as a treatment for tapeworm and known to inhibit the Zika from replication, has now been approved to treat Zika virus infection.
What factors BEST determine the advantages of the Xpert® method of rifampin (RIF) resistance detection?
No infectious aerosols produced, short technician training, 2-hour results
Branching, long, thin filamentous gram-positive rods; tend to stain with a beaded, gram-variable pattern
Nocardia
Which of the following had the greatest effect on the spread of multidrug-resistant tuberculosis (MDR-TB)?
Non-compliance with the prescribed regimen in the 1990s
Which one of these characteristics distinguishes vancomycin-resistant Enterococcus faecium and E. faecalis from other Enterococcus species?
Non-motility
A patient suffering from typical leukemic symptoms presents to the emergency room. The physician orders a spinal tap after noticing possible central nervous system involvement. What type of cells are indicated by the red arrows? What type of cells are indicated by the blue arrows?
Normal lymphocytes (blue arrows), Blasts (red arrows)
How would you describe the representative image of Benton's peripheral blood smear?
Normocytic normochromic RBC population with a high percentage of lymphoblasts present
How would you describe the representative image of Candace's peripheral blood smear?
Normocytic normochromic RBCs with a nucleated red blood cell present
What did the diagnosis of the two young patients (23 m/o and 11 m/o) with MDR-TB and the other exposed Italian children at the kindergarten/primary school have in common?
Nucleic acid amplification testing (NAAT) was successfully used to identify M. tuberculosis
This antinuclear antibody (ANA) test is viewed using fluorescent microscopy. The pattern is characterized by staining of the nucleoli in the nuclei of the interphase cells (a). Which pattern is this? Note: (a) points to the nuclei of the interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern.
Nucleolar
A 69-year-old male with a long standing history of multiple myeloma received several chemotherapeutic agents to control his disease. Currently the patient developed severe anemia, neutropenia, and thrombocytopenia. The CBC showed: WBC 2.6 X103/µL, Hemoglobin 6.0 g/dL, and platelets 60.0 X103/µL The serum monoclonal protein is within normal limits. Bone marrow biopsy is performed to evaluate disease progression.
Numerous dysplastic normoblasts. No increase of plasma cells
A blood donor has the genotype hh, AB. What is his apparent red cell phenotype during routine forward and reverse group typing?
O
Which of the following phenotypes is NOT possible in an offspring from an AB and BO mating?
O
Which cells agglutinate most strongly with Ulex europaeus lectin?
O and A2
If an individual has blood type O, which of the following are possible genotypes?
OO
If an individual is type O, what is his/her ABO genotype?
OO
World Health Organization (WHO) data from 2016 revealed increasing levels of tuberculosis (TB) drug resistance in developing countries. What fear did this lead to?
Of TB strains that would be resistant to all antibiotic treatment
Which supplement is necessary to add to culture media to ensure proper growth of Malassezia species?
Olive oil
Which statement best describes the relationship between dietary iron and iron absorption in a healthy individual?
Only a small percentage of dietary iron is absorbed and used.
Immune suppression is the major mechanism that predisposes patients to cryptococcal disease. Which one of the following is an example of an immune suppression state?
Organ transplant
In order to narrow the diagnosis, more information is required. Healthcare personnel should determine the following points: How long has the rash been there? She developed the rash on the day of admission to the ED Where did the rash appear before the onset of fever? Her rash appeared on the arms and legs, and then spread to her palms and the soles of her feet. Was she taking any medications? No, she had only taken acetaminophen for fever. Did she have any immunocompromising conditions? No What recent activities did she perform and did she travel anywhere? She had only played in the neighborhood and had not left the local area in the last month. Were any of her contacts ill? None were identified. What pets was she exposed to? The family did not have a dog or cat. Was there a history of a tick bite? No, but ticks were found in the yard where she played. Was a direct antigen test for Streptococcus pyogenes performed? Yes, it was negative. With this additional information, what do you now suspect the diagnosis to be?
Rocky Mountain spotted fever
Which of the following diseases are spread by ticks?
Rocky Mountain spotted fever (RMSF)Colorado tick feverRelapsing fever
Match the conditions listed below with the elements that may be seen on a stained CSF smear when this condition is present.
SAH--hemosiderin deposits, bacterial meningitis--neutrophilic pleocytosis, bone marrow contamination of CSF--nRBCs, viral meningitis--lymphocytic pleocytosis
About 95% of those individuals with a particular condition have a positive ANA test. Therefore, the most common condition associated with a positive ANA test is _________________.
SLE
How does Southern tick-associated rash illness (STARI) differ from Lyme disease?:
STARI produces smaller lesions of erythema migrans with MORE central clearing than produced in Lyme disease.
Select the term(s) that best describe the types of reagents that were or are available to test for the Rh antigens:
Saline, Chemically modified, High protein, and Monoclonal
Which of the following species of hyaline molds produce conidia in chains?
Scopulariopsis species
Which of the following genes codes for production of the same basic antigen as the gene known as H?
Se
What is a distinguishing feature of Aspergillus spp. in tissue identification?
Septate and dichotomous 45 degree branching angle
Which of the following laboratory techniques may not be sensitive to HLA class II discrepancies?
Serologic testing
According to the Centers for Disease Control and Prevention (CDC), what is the most sensitive and best method for the laboratory diagnosis of Lyme disease?
Serology
What laboratory test reflects circulating iron that is bound to transferrin?
Serum Iron
What is the most severe clinical manifestation that is seen in dengue virus infection?
Severe Bleeding
Which statement describing the symptoms and/or conditions associated with Zika infection is TRUE?
Severe fetal brain and other birth defects can occur during pregnancy
Other than fever, what is the most common clinical feature of chikungunya virus infection?
Severe joint pain
What shape is commonly associated with the description of the macroconidia of Fusarium spp.?
Sickle-shaped
In which autoimmune disorder (and a form of SARDs) does the body's immune system mistakenly attack tissue in glands that produce moisture, such as tear and salivary glands?
Sjögren syndrome
Which SARDs is considered an autoimmune disorder in which the body's immune system mistakenly attacks tissue in glands that produce moisture, such as tear and salivary glands.
Sjögren syndrome (SjS)
Enzyme panel reactions cannot be used as the only source of rule-outs during antibody identification. Why is this?
Some antigens are destroyed and may not detect an antibody that is present
What clinical characteristics might a person with beta thalassemia intermedia exhibit?
Some splenomegaly
According to the CDC's testing algorithm, if a symptomatic individual meets epidemiological criteria and has a negative rRT-PCR test result for Zika virus RNA, then what should happen next? (Select the BEST answer.)
Specimen should be tested using an IgM serology detection method (Zika MAC-ELISA)
This antinuclar antibody (ANA) pattern is characterized by granular/speckled staining in the nucleus of the interphase cells (a). The nucleoli do not stain. There is also an absence of staining in the chromosomal area of the metaphase mitotic cells (b). The slide is viewed using fluorescent microscopy. Which pattern is this?
Speckled
Which of these activities would place you at the MOST risk for acquiring tickborne relapsing fever (TBRF)?
Spending the night in a cabin in the mountains
Which of the following is a reservoir host for La Crosse encephalitis virus?
Squirrels
Gram-positive cocci in clusters and tetrads
Staphylococcous species
Which of these organisms is associated with the condition known as toxic shock syndrome?
Staphylococcus aureus
A 60-year-old male from Boise, Idaho had a 1 month history of intermittent fevers and headache. He reported a fever of 105º F with a headache for 3 days. A second fever presented 13 days later that lasted 2 days. He finally sought medical attention when he had his third fever 26 days after the first symptoms. His history was remarkable for having camped in a cabin in the Bear Valley region of Idaho. Laboratory values were: CBC: Normal with 81% segmented neutrophils, 6% lymphocytes, and 3.37% reticulocytes Urinalysis: Normal except for a 1+ protein Bilirubin: Increased Diagnosis was made on the Giemsa-stained blood smear shown in the image. What is the most likely diagnosis of this man?
Tickborne relapsing fever
What disease does the soft tick Ornithidoros hermsi transmit?
Tickborne relapsing fever (TRF
If the number of organisms is large enough, which of these pairs of diseases are caused by organisms that can be diagnosed on a peripheral blood smear?
Tickborne relapsing fever (TRF) and babesiosis
Which of the following is a characteristic of Francisella tularensis?
Tiny, weak-staining, gram-negative coccobacilli
What types of tissues are considered to be at high risk of transmission of the bovine spongiform encephalopathy (BSE) agent?
Tissues from the CNS
Why are ANA positive samples titered? (Select all that apply.)
To determine how much antibody is present in the sample and to look for multiple ANA patterns.
For which of these reasons would a molecular method be used to determine a pregnant woman's Rh type?
To differentiate between weak D or partial D
What is the role of a sentinel laboratory?
To use standardized procedures to rule-out critical biological agents and refer them to one of the Laboratory Response Network (LRN) reference laboratories
Successful engraftment of a hematopoietic stem cell transplant depends on many factors. Which of the following choices are associated with a graft failure? (Select all that apply.)
Too few CD34 cells infused, Toxic reactions to chemotherapeutic drugs, Opportunistic infections, such as cytomegalovirus (CMV
What is the protein that carries iron in the blood plasma?
Transferrin
Andrew is a 49-year-old Caucasian male who is seen by a primary care doctor. He reports that for the last 1-2 years or longer he has experienced moderate fatigue, aches and pains in multiple joints, impotence, and mild depression. He has a family history including diabetes in both parents, and an older brother who died of liver disease at age 60. Andrew is unsure of his brother's complete medical condition, but thought he was a heavy drinker. Andrew denies personal use of tobacco and is taking neither prescribed or over-the-counter drugs. He states he drinks alcoholic beverages, mostly on weekends. The physician orders routine lab tests including a chemistry panel, CBC, lipid panel, and urinalysis. The results of the lab tests were mostly normal with the following notable exceptions which were all elevated (above reference intervals): Enzymes related to liver function, serum iron, fasting glucose (slightly elevated). What laboratory tests would be helpful at this point in following up on Andrew's case? Choose all that apply
Transferrin saturation (TS) and Serum ferritin assay
Which of the following are examples of events that may produce immune ABO antibodies?
Transfusion with ABO incompatible red cells and Pregnancy with an ABO incompatible fetus
These tubes of cerebrospinal fluid (CSF) arrive in the laboratory for evaluation. The tubes were numbered in the order in which they were obtained, with #1 being the first tube collected and #3 being the last tube collected. What may be indicated by the macroscopic appearance of the CSF?
Traumatic tap
In making a diagnosis of Acanthamoeba species, which of the following form(s) may be observed in brain tissue or corneal scrapings?
Trophozoites and/or cysts
A gender and genetic predisposition is usually the first step toward the development of an autoimmune reaction. The second step is the occurrence of a "triggering event" that leads to a break in tolerance.
True
A hypervirulent strain, commonly referred to as "strain 027" is an aggressive strain of Clostridium difficile that produces more toxins and is more resistant to certain medications.
True
A respiratory culture is submitted to the microbiology laboratory for testing. An organism displaying the following characteristics is recovered: Gram stain shows fat, gram-negative rods in single or short chains that may demonstrate bipolar staining Faster growth at 25oC Gray-white, translucent colonies on sheep blood agar (SBA) at 24 hours that turn slightly yellow and opaque at 48 hours Irregular colonies that have a "fried egg" and/or "hammered copper" appearance after 48-72 hours Catalase positive Oxidase negative Urea negative Indole negative The organism should immediately be referred to a Laboratory Response Network (LRN) reference laboratory for confirmatory testing.
True
A rosette test may be FALSELY POSITIVE if the mother is weak-D positive.
True
A sentinel laboratory should NOT accept or process environmental or animal samples or culture clinical specimens for viruses or toxins that are potential agents of bioterrorism.
True
All of the following criteria for donor RBC to be used for an exchange transfusion relate to both ABO HDFN and HDFN due to anti-D: Less than or equal to 7 days old (or fresher) Reconstituted with AB FFP CMV negative Negative for hemoglobin S Irradiated
True
Antibody testing of urine is not recommended for Zika virus. If urine is submitted, it should be tested alongside a patient-matched serum specimen by molecular methods for Zika virus RNA (only if the method has been validated for urine).
True
Any laboratory that analyzes microbes or refers specimens that have the potential to contain microbial agents or toxins is a sentinel laboratory.
True
At 28 weeks gestation, a group A Rh-negative female had a negative antibody screen and was injected with Rh immune globulin (RhIG). Anti-D is detected in the mother's serum at delivery. A panel is performed that excludes the presence of other antibodies. The most likely conclusion would be passive anti-D due to RhIG administration.
True
A 50-year-old female patient with systemic lupus erythematosus (SLE) is admitted to the hospital with evidence of hemolysis, including decreased hemoglobin and hematocrit, increased reticulocyte count, and increased indirect bilirubin. The patient has no recent history of transfusion. An antibody screen is ordered and 3+ agglutination is observed at the AHG phase for all cells. An autologous control (autocontrol) is also tested and 3+ agglutination is observed at the AHG phase in this test as well. Given the results of the antibody screen and other laboratory test results and the patient's medical and transfusion history, which of the following is the MOST likely cause of the positive screen results?
Warm Autoantibodies
Although both Naegleria and Acanthamoeba are found in many water supplies, where are they especially abundant?
Warm fresh waters carrying high concentrations of bacteria
Where is Naegleria fowleri found most often in nature?
Warm, fresh water
Which is NOT a symptom of mad cow disease in cattle?
Weight gain
Which virus is most commonly spread by mosquitoes in the United States in the 21st century?
West Nile Virus
Which of the following are terminologies used for the Rh blood group system?
Wiener, Fisher-Race, Rosenfield, and ISBT
A DAT is ordered on the patient along with an antibody screen. The DAT is positive and the antibody screen is negative. Elution studies are then performed. An elution is a technique where antibody is dissociated from sensitized red blood cells and harvested. One method that is commonly used is an acid elution. In this method, an acidic solution is added to a volume of red blood cells. The acid environment disrupts the bond between antibody and antigen on the red cell surface. The antibody can be collected in this acid solution and restored to a physiologic pH by the addition of a buffer. This eluate can then be tested against a panel of red blood cells to determine a specificity. The eluate in this case is tested with normal red cells and with penicillin-sensitized red cells. In which of these tests would you expect the eluate to be reactive?
With penicillin-sensitized red cells
Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?
Within one hour
The HLA antibodies used in histocompatibility typing have been obtained from which of the following?
Women that have given birth more than once
What term is used to describe the color in these tubes of cerebrospinal fluid (CSF)?
Xanthochromia
Which of the following may appear as budding organisms?
Yeast
Alert! Completely absurd and unrealistic question coming! The labels have come off of some of the reagent bottles in your transfusion service, so the ABO testing reagents are just sitting there, label-less (and they just look ridiculous!). A new lab scientist is trying to find the anti-B, and he asks, "What color is anti-B?" You reply:
Yellow
Assume you perform microbiology for an institution submitting surveillance cultures for MRSA. Which isolate should receive further workup to rule out methicillin (oxacillin) resistance?
Yellow colonies on mannitol salt agar; catalase-positive, coagulase-positive.
A group B Rh positive female has been admitted to hospital and is in labor. Is it an acceptable (good) practice not to test the newborn (ABO, Rh, DAT)?
Yes
Patient 1234 has a positive antinuclear antibody (ANA) test with a centromere pattern at a 1:1280 titer. Surprised by the result, the clinician calls and says the patient is only having mild stiffness of her fingers and asks your opinion of the result. Which is your best reply?
You point out that centromere antibodies have been known to occur years prior to the onset of the disease and the patient should be carefully examined and monitored for the development of other symptoms.
Which viral illness is most closely associated with microcephaly and Guillain-Barre syndrome?
Zika
Which antibody/immunoglobulin is detected in serum by the Zika MAC-ELISA assay?
Zika IgM antibody
Match each cell type listed in the drop down box to the letter that corresponds to its identification in the image on the right.
a) Lyphoma Cells B) Lymphocytes c)Neutrophils D) Macrophages
For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN?
anti-A
