ASCP

What is the identification and stage of this organism measuring 45 µm that is typically found in stool?

Ascaris lumbricoides egg

How often should fire drills be conducted in the laboratory?

At least yearly

All of the following anticoagulants will produce a significant effect on calcium levels in plasma, EXCEPT?

Heparin

Identify the nucleated blood cell:

Lymphocyte

The core (genome) of the HIV virion contains:

RNA

What characteristic is usually associated with IgM antibodies directed against red cells?

React best at room temperature

A smear that is prepared from equal parts of new methylene blue and whole blood is used for which of the following?

Reticulocyte count

What are the usual results of the mean corpuscular volume (MCV) and the red cell distribution width (RDW) in alpha thalassemia?

The MCV is decreased but the RDW is usually increased

Which term listed below refers to the process that must be followed when notification is received that a donor of a unit transfused now tests positive for an infectious disease?

Look-back

Which of the following substances produced by Group A Streptococci is responsible for producing type specific immunity?

M antigen

The image is a stained smear of cerebrospinal fluid. What type of cells are the three right cells in this field?

Macrophages

What is the platelet precursor cell found in the bone marrow?

Megakaryocyte

All of the following are required to be in a machine-readable format on a blood component label, EXCEPT:

Outdate

A young man is experiencing difficulty breathing after fainting. The physician orders an arterial blood gas analysis which shows the following results: pH = 7.25 pCO2 = 62 mmHg pO2 = 70 mmHg HCO3- = 23 mmol/L Which condition is most likely afflicting this patient?

Respiratory acidosis

Which of the following anthrax infections is also known as "woolsorter's disease"?

Inhalation anthrax

All of the following is true about real-time RT-PCR, EXCEPT?

It does not require the use of reverse transcriptase

Which of the following casts is characteristically associated with acute pyelonephritis?

White cell

Which of the following is TRUE of a fully compensated metabolic acidosis?

pH will be normal with a decrease in pCO2

Which bacterial species listed is a select agent, which is capable of producing an extremely potent, lethal neurotoxin?

Clostridium botulinum

At many hospitals, patients with sickle cell disease are given phenotypically matched units of blood. This policy is often used to help prevent alloimmunization to common RBC antigens in patients who are regularly transfused. A patient who regularly comes to your hospital demonstrates the following phenotype on her RBCs: C antigen positive; E antigen-negative; K antigen positive. The patient's doctor requests a single unit of crossmatched packed RBCs. Based on the antigen prevalence indicated below, how many units of ABO compatible packed RBCs will you phenotype to find one to transfuse to this patient? Antigen frequencies C antigen positive: 68% E antigen positive: 22% K antigen positive: 9%

1 unit

Red cells units containing CPDA-1 as an anticoagulant-preservative may be stored for how long prior to transfusion?

35 days

Which of the following would be considered a normal value for a glucose level in cerebrospinal fluid?

60 mg/dL feedback CSF glucose levels should be approximately 60 to 70% of plasma levels. In our answer choices, 60mg/dL is the best option, as the serum glucose values will be just between 90-100 mg/dL. For a CSF glucose to be 30mg/dL, the serum value would be around 45mg/dL which is abnormally low. For the other two answer choices, the CSF values are already above the normal serum values, therefore are not considered normal values.

If possible, what is the recommended time interval for Rh immune globulin administration to the Rh negative mother following the delivery of an Rh positive or weak-D positive infant?

72 hours

What is the corrected white blood cell count if the WBC is 14,460, and there were 47 nucleated red blood cells per 100 white blood cells noted on the differential count?

9,837 FEEDBACK Corrected WBC count = uncorrected WBC count x (100 / NRBCs +100) Corrected WBC count = 14,460 x (100/147) = 9,837

The fever and chills syndrome associated with malaria is known as:

A paroxysm

What is the cause of MOST severe acute hemolytic transfusions reactions

ABO incompatibility

What is the cause of iron overload in hereditary hemochromatosis?

Absorption of excessive amounts of iron in the small intestine

A 76-year-old patient experiences frequent infections and bleeding episodes. She is also complaining of pain in her bones and joints. Upon routine exam, her physician orders a complete blood count and differential. The hematology technologist notices many cells appearing similar to the cell in the image to the right. Which condition is this patient most likely suffering from? The correct answer is highlighted below

Acute Myeloid Leukemia (AML)

What is the composition of the granules associated with basophilic stippling?

Aggregates of ribosomes

A patient demonstrates with a positive antibody screen. You need to identify the unknown antibody, so you decide to perform a full work-up using untreated and ficin-treated panels. The results are as follows:

Anti-Fya

The top image shows a 5-day old entire colony with distinct outer borders that was incubated at 30° C. The surface is a delicate silky, light gray-white mycelium. The reverse of the colony appears white. This appearance is non-specific. The bottom image is a photomicrograph of a lacto-phenol blue stained mount of a small inoculum taken from the surface of the colony. What is the most likely identification?

Beauveria

Skeletal deformations are most commonly present in which of the following beta thalassemias?

Beta thalassemia major

A patient whose diagnosis is hepatitis may have which of the following test positive on urine test strip?

Bilirubin feedback he positive bilirubin in the urine can provide detection of liver diseases such as hepatitis or cirrhosis. Ketone positive test strips will be seen in cases of increased fat metabolism as a source of energy. This can occur in diabetes mellitus, starvation, and extreme non-carbohydrate diets. Blood positive test strips in the urine indicate the presence of red cells, hemoglobin, or myoglobin. Nitrites test pad provides rapid screening for the presence of urinary tract infection.

What types of cells are NOT present in this field of a cytocentrifuged CSF sample?

Blasts

Which of the following is the "activation unit" in the classical complement pathway?

C4, C2, C3

Which of the following is the primary virulence factor in Streptococcus pneumoniae?

Capsular polysaccharide

Which of the following action describes the MAJOR property of antidiuretic hormone?

Changes distal tubule water permeability

In blood, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with:

Chloride

A 64-year old man lost 15 pounds, became weaker, and his face became fuller with a ruddy complexion. His laboratory tests revealed: Serum cortisol8 AM: 880 nmol/L, 138-635 nmol/L (reference range)4 PM: 828 nmol/L, 83-414 nmol/L (reference range) After these results, an overnight dexamethasone suppression test gave a cortisol level of 773 nmol/L. The MOST probable diagnosis for this patient is:

Cushing's Syndrome

A CSF shunt specimen was sent to the microbiology laboratory for culture. The shunt specimen was inoculated to chocolate agar and a thioglycollate broth. After two days of incubation in CO2 at 37°C, the chocolate agar had no growth and the thioglycollate broth had growth at the bottom of the tube. The microbiology tech then subbed the thioglycollate broth to an anaerobic blood agar plate and incubated the plate in anaerobic conditions at 37C for 48 hours. After the 48 hour incubation, the anaerobic blood agar plate was evaluated: Growth: Small, white colonies were observed Gram Stain: Gram positive, pleomorphic, diphtheroid-like rod Biochemical: Catalase positive; Nitrate Reduction positive, Sensitive to Vancomycin and Kanamycin Which of the following organisms is most likely the cause of the CSF shunt infection?

Cutibacterium (Propionibacterium) acnes

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

Diabetes

In order to obtain an appropriate specimen before preparing a smear for acid-fast bacilli staining in a sputum sample, what must be done to the original sample?

Digestion and decontamination

Illustrated in this photograph is a close-in view of colonies growing on the surface of xylose lysine deoxycholate (XLD) agar. The bacterial species most likely producing the colonies shown here is:

Edwardsiella tarda

Which values would be expected with metabolic alkalosis?

Elevated pH, increased bicarbonate, normal PCO2

A stool specimen was submitted for parasitic examination from a 49-year-old female who recently returned from missionary work in several developing countries. The patient had experienced mild diarrhea for the past two weeks. O & P examination of the stool revealed this suspicious form measuring 20 µm. (Five nuclei are visible in this trichrome-stained image.) Further examination revealed a total of eight nuclei. What is the identification of this organism? Image provided courtesy of the CDC

Entamoeba coli

The mode of transmission for Enterobius vermicularis infection is:

Ingestion or inhalation of egg

Which of the following may result in a false negative reaction when performing Rh typing?

Failure to follow manufacturer's directions precisely

The microscopic finding illustrated in this image is a _____?

Fiber artifact

Which of the following is associated with macrocytic anemia?

Fish tapeworm

What is the MOST likely cause of a patient who developed a severe hemolytic episode after taking anti-malarial drugs, and red cell inclusions caused by denatured hemoglobin were seen on the differential smear?

G-6-PD deficiency

A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclera after taking the medication Primaquine before a trip to Africa. The immediate laboratory work revealed: Hct 24% (normal 36%-47%), MCV 79.5 fL (normal 78-95fL), RDW 13% (normal 11.5-15.0%). His blood smear findings are reflected in the images to the right. The upper image is a Wright-Giemsa stained smear, while the lower is a supravital-stained smear. Which condition should be considered for this patient when analyzing his symptoms, history, and laboratory results?

G6PD deficiency

All of the following hormones are produced primarily in the pancreatic islets EXCEPT which one?

Gastrin

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

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

Which of the following is considered to be the definitive host of a parasite?

Host in which parasites reproduce sexually

Which of the erythrocyte inclusions listed below would appear on a Wright-stained peripheral blood smear as round, smooth, almost pyknotic, dark-purple staining bodies ranging in size from 0.5 to 1.0 micron in diameter and usually occurring singly in erythrocytes?

Howell-Jolly bodies

A secondary immune response is generally associated with which of the following antibodies?

IgG feedback The secondary or anamnestic response has a short lag phase, typically with higher titers than the primary immune response, and IgG predominates. IgA is the immunoglobulin class associated with mucosal immunity. IgM is the immunoglobulin class that predominates in a primary immune response. IgD is involved in the maturation process of B cells, which become immunoglobulin-secreting plasma cells.

Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring?

Immunoassay Immunoassay is the most common technique that is used by clinical laboratories for therapeutic drug monitoring (TDM). Most of the drugs commonly assessed with TDM can be measured on analytical platforms which utilize antibodies (in some form) for detection. Antibodies can be developed that recognize drugs. Although most drugs are much too small to evoke an immune response, scientists can conjugate drugs to immunogenic proteins to produce antibodies that recognize drug-specific epitopes.

Which one of the following statements is true regarding the 2009 H1N1 virus?

In 2009, the novel H1N1 virus spread during warmer months.

The classic TORCH panel of tests includes the following diseases with the exception of:

Infectious mononucleosis

The image is a stained smear of cerebrospinal fluid. The cell in this slide could be caused by what condition?

Metastasis feedback The nucleus in this cell is abnormal and appears to have divided. This finding correlates with the presence of metastasis in the CSF. A broad spectrum of lymphocytes and monocytes would be present in a case of viral meningitis. An allergic reaction will show predominantly eosinophils. Cerebral hemorrhage would show predominantly RBCs.

A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had a myocardial infarction (MI)?

Myoglobin

A 30-year-old woman developed progressive, painful swelling of the right foot after incurring traumatic penetration of the soft tissue by a splinter. The wound initially healed. The upper photograph is a direct Gram stain of purulent material expressed from a sinus tract. The lower photograph illustrates the colony that grew out in 72 hours, which had a "musty" odor. The most likely identification is:

Nocardia brasiliensis

Identify the nucleated cell in the image.

Orthochromic normoblast

The fungal colony illustrated in the upper image, observed after 4 days of incubation at 30°C, was recovered from dialysis fluid of a 60-year-old patient who had been receiving multiple antibiotics for treatment of bacterial peritonitis. The colony surface is cottony and green in pigmentation. The lower image is of a lactophenol cotton blue-stained section of fruiting heads observed in a mount prepared from a small sample of the colony surface. Based on the colony morphology and microscopic features, what is the genus identification of this isolate?

Penicillium

Components of the second line of defense in the human body are:

Phagocytic cells; complement

Thick Giemsa-stained blood smears are primarily used to screen for the presence of:

Plasmodium species

Illustrated in the photographs are smooth, entire, gray-white colonies growing on blood agar that are faintly beta-hemolytic (left). Light pink-red pigmented entire, smooth colonies grew on MacConkey agar (right). These isolates were recovered from a skin infection incurred by a 28-year-old man after swimming in a lake. The pink-red pigmentation of colonies on MacConkey agar suggests lactose fermentation. Biochemical reactions included Acid/Acid KIA reactions indicating fermentation of glucose. Oxidase was positive. Other positive reactions include indole, DNAse, and esculin. Additional biochemical tests identified this isolate as Aeromonas species. The pink-red colonies growing on MacConkey may suggest one of the Enterobacteriaceae. Which of the following choices will exclude this possibility?

Positive oxidase reaction

Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?

Positive protein FEEDBACK The following factors promote the formation of casts in the kidney: Larger than normal amounts of plasma proteins entering the tubules Decreased pH Decreased urinary flow rate Increased urine concentration

Which one of the following hematological determinations is MOST reliable for evaluating bone marrow erythropoietic activity?

Reticulocyte count feedback Reticulocyte counts evaluate the activity of the bone marrow, particularly in terms of erythropoiesis. As the bone marrow is attempting to recover from an abnormal hematological state (i.e., anemia), there are more reticulocytes produced. Reticulocyte counts are often used to evaluate the effectiveness of therapy for stimulating the bone marrow. Hemoglobin level is an indicator of the degree of anemia, but it does not correlate with bone marrow activity. Platelet count only indicates the degree of platelet production. Thrombocytosis may also be associated with hemorrhage, post-surgery, or post-splenectomy. Mean corpuscular volume (MCV) may slightly increase as more reticulocytes are released. But this is not a reliable indicator for bone marrow activity.

Among the non-fermenters, which of the following is the only bacterial species to produce hydrolyze esculin?

Rhizobium radiobacter

To ensure quality within the preanalytical phase of laboratory testing, quality assurance activities includes monitoring all of the following preanalytical variables EXCEPT:

Selection of reference materials used for validation purposes

Which of the following is LEAST likely to stimulate the production of reactive lymphocytes?

Staphylococcus aureus

A left arm abscess collected from an 8-year-old male patient grew small white colonies on 5% sheep blood agar after 24 hours incubation at 35°C in 5-10% CO2. The Gram stain of the organism showed small tightly grouped Gram-positive cocci. Which of the following organisms is the most likely identification?

Staphylococcus epidermidis

What is the primary target of HIV (human immunodeficiency virus)?

T-helper cells

Which of the following statements is correct regarding blood bank adverse event reporting to the FDA?

The initial notification to the FDA of a transfusion-related death must be made by fax, telephone, express mail, or electronically as soon as possible after the death is confirmed to be associated with the transfusion.

The likelihood of colonization and/or infection with Clostridioides difficile is enhanced by all of the following except:

The patient has been previously treated at an orthopedic sports clinic

A chemical reaction that is utilized by many different analytical methods involves:

The reduction of NAD to NADH

You are analyzing the results of a qPCR for Cytomegalovirus. Several of the samples have a failed internal control. Which is not a reason why the internal control might have failed?

The samples have low viral loads

Which of the following drugs is used to treat asthma and COPD in patients with nocturnal symptoms or problems with inhalers?

Theophylline

All of the following choices are acceptable specimens for anaerobic culture, EXCEPT?

Throat swab

Which of these methods are used to identify prior exposure to Mycobacterium tuberculosis?

Tuberculin skin test (TST) or blood tests known as interferon-gamma release assays

Which of the following is the most commonly encountered presenting sign of a delayed hemolytic transfusion reaction (DHTR)?

Unexplained decrease in hemoglobin or hematocrit Delayed hemolytic transfusion reactions occur 24 hours after transfusion. The reaction is caused by a secondary immune response which requires time for enough antibody to be produced by the patient to cause signs and symptom of extravascular hemolysis. The most common presenting sign is an unexpected decrease or drop in the recipients' hemoglobin or hematocrit. Active bleeding is typically absent and diverse etiology includes flu-like symptoms.

Which of the following best represents the quantity of resultant bleeding in order of smallest bleed to largest (assuming identical trauma)?

Venule, Vein, Artery

How is the Mean Cell Volume calculated?

(Hematocrit %/ Red blood cells) X 10

The appropriate dosage of Rh immune globulin (RhIg) to administer post-delivery to an Rh-negative mother delivering an Rh-positive child is calculated based on the estimated volume of fetal bleed. What is the value of x in the formula given below that is used to calculate RhIg dosage? Number of vials of 300 µg RhIg = volume of fetal bleed/x mL

30

Which of the following is the proper temperature to use when crossmatching in the presence of a cold antibody?

37C Most antibodies that are inactive at 37º C and active only below 37º C (i.e. cold reactive antibodies) are of little clinical significance. If a nonspecific cold antibody or cold agglutinin is suspected, warm the sample and testing reagents, including saline, to 37º C. Only do reaction readings at AHG; bypassing the optimum reaction temperature prevents activation and binding of the cold antibody.

You are working in a clinical chemistry laboratory and are analyzing a plasma glucose sample. The sample is flagged by the analyzer for being "outside of linear range." You manually dilute the sample 1:2 and rerun it. Again, you receive an "outside linear range" alert. You decide to perform a different manual dilution. This time you manually dilute the original sample again; this time using a 1:3 dilution. The instrument gives you a glucose value of 150 mg/dL from this diluted sample. What is the actual patient glucose result that you should report to the physician?

450 mg/dL

Which complement pathway and related initiator can activate complement?

Classic pathway; antigen-IgG antibody complexes

You are evaluating a potentially malignant effusion (e.g. peritoneal or pleural fluid) and you note cells that appear to be some type of tumor cells. How would you follow up/report this?

Consult a pathologist and confirm that the specimen has been sent to cytology for analysis

Which is the best component to treat a patient with fibrinogen deficiency?

Cryoprecipitated AHF

Which of the following substances is conjugated with the "indirect" bilirubin to form "direct" bilirubin?

Glucuronic acid FEEDBACK Indirect bilirubin, also known as unconjugated bilirubin, is conjugated with two molecules of glucuronic acid to form direct, or conjugated bilirubin, which is water-soluble. Ascorbic acid, also known as vitamin C, uric acid, or salicylic acid do not conjugate with bilirubin

Which analyte is MOST useful for monitoring the long-term (~12 weeks) stability of blood glucose?

Glycosylated hemoglobin (HbA1C)

A ß-hemolytic isolate on SBA revealed a Gram-positive coccus arranged in chains. The isolate was catalase-negative, PYR negative, bacitracin resistant, and positive for CAMP and hippurate hydrolysis. What is the presumptive identification of this isolate?

Group B streptococci

Which of the following tests has been recommended by the FDA to replace the HIV-1 p24 antigen test in the screening of donated blood for infectious diseases?

HIV-1 NAT

The most likely cause of an elevated serum potassium level in an apparently normal individual is:

Hemolysis

The autohemolysis test is MOST useful in the diagnosis of which condition?

Hereditary spherocytosis

Human chorionic gonadotropin (hCG) is used in the determination of:

Pregnancy

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/reagent and just do AHG reading

Which amino acid is the precursor for catecholamines as well as thyroid hormones?

Tyrosine