BOC Urinalysis final, BOC Molecular Pathology final, Microbiology BOC final, BOC Immunology final, Hematology final, Chemistry BOC final, Blood Bank BOC final
The urinary excretion produce measured as an indicator of epinephrine production is: A. dopamine B. dihydroxyphenylalanine (DOPA) C. homovanillic acid D. vanillylmandelic acid (VMA)
Correct Answer: D
Which of the following is the formula for mean corpuscular hemoglobin (MCH)? A. Hct/ (RBC x 1000) B. Hgb/Hct C. RBC/Hct D. (Hgb x 10)/RBC
Correct Answer: D
Which of the following types of polycythemia is most often associated with emphysema? A. polycythemia vera B. polycythemia, secondary to hypoxia C. relative polycythemia associated with dehydration D. polycythemia associated with renal disease
Correct Answer: B
Laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? A. anemia of chronic disorder B. vitamin B12 deficiency C. iron deficiency D. acute heorrhage
Correct Answer: B
Most automated blood gas analyzers directly measure: A. pH, HCO3 and % O2 saturation B. pH, PCO2 and PO2 C. HCO3, PCO2 and PO2 D. pH, PO2 and % O2 saturation
Correct Answer: B
Neutropenia is not usually associated with: A. viral infections B. Hodgkin disease C. select antibiotics D. chemotherapy
Correct Answer: B
Normal platelets have a circulating life-span of approximately: A. 5 days B. 10 days C. 20 days D. 30 days
Correct Answer: B
Of the following, the disease most closely associate with granulocyte hyposegmentation is: A. May-Hegglin anomaly B. Pelger-Huet anomaly C. Chediak-Higashi syndrome D. Gaucher disease
Correct Answer: B
Increased serum lactic dehydrogenase activity due to elevation of fast fractions (1 and 2) on electrophoretic separation is cause by: A. nephrotic syndrome B. hemolytic anemia C. pancreatitis D. hepatic damage
Correct Answer: B
Irradiation of a unit of Red Blood Cells is done to prevent the replication of donor: A. granulocytes B. lymphocytes C. red cells D. platelets
Correct Answer: B
Kernicterus is an abnormal accumulation of bilirubin in: A. heart tissue B. brain tissue C. liver tissue D. kidney tissue
Correct Answer: B
The test for weak D is performed by incubating patient's red cells with : A. several different dilutions of anti-D serum B. anti-D serum followed by washing and antiglobulin serum C. anti-D^u serum D. antiglobulin serum
Correct Answer: B
The test that is currently used to detect donors who are infected with the AIDS virus is: A. anti-HBc B. anti-HIV 1,2 C. HBsAg D. ALT
Correct Answer: B
Which of the following technical factors will cause a decreased erythrocyte sedimentation rate? A. gross hemolysis B. small fibrin clots in the sample C. increased room temperature D. tilting of the tube
Correct Answer: B
Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets? A. incipient clotting B. decreased hematocrit C. Howell-Jolly bodies D. leukocyte cytoplasmic fragments
Correct Answer: B
Which one of the following factors typically sow an increase in liver disease? A. Factor VII B. Factor VIII C. Factor IX D. Factor X
Correct Answer: B
In chronic meylocytic leukemia, blood histamine concentrations tend to reflect the: A. number of platelets present B. serum uric acid concentrations C. number of basophils present D. the total number of granulocytes
Correct Answer: C
In flow cytometric analysis, right angle (90 degrees) or side scatter of a laser light beam provides information that pertains to a cell's: A. volume B. viability C. granularity D. lineage
Correct Answer: C
In synovial fluid, the most characteristic microscopic finding in gout is: A. calcium pyrophosphate crystals B. cartilage debris C. monosodium urate crystals D. hemosiderin-laden macrophages
Correct Answer: C
In the APTT test, the patient's plasma is mixed with: A. ADP and calcium B. tissue thromboplastin and collagen C. phospholipid and calcium D. tissue thromboplastin and calcium
Correct Answer: C
In the Jendrassik-Grof reaction for total bilirubin, bilirubin reacts with diazotized sulfanilic acid to form: A. diazo bilirubin B. biliverdin C. azobilirubin D. bilirubin glucuronide
Correct Answer: C
Inhibition testing can be used to confirm antibody specificity for which of the following antibodies? A. anti-Lu^1 B. anti-M C. anti-Le^a D. anti-Fy^a
Correct Answer: C
Which of the following is characteristic of platelet disorders? A. deep muscle hemorrhages B. retroperitoneal hemorrhages C. mucous membrane hemorrhages D. severely prolonged clotting time
Correct Answer: C
Which of the following is most likelyto be seen in lead poisoning? A. iron overload in tissue B. codocytes C. basophilic stippling D. ringed sideroblasts
Correct Answer: C
Of the following, the disease most closely asssociated with pale blue inclusions in granulocytes and giant platelets is: A. Gaucher disease B.Alder-Reilly anomaly C. May-Hegglin anomaly D. Pelger-Huet anomaly
Correct Answer: C
Of the following, the most useful technique(s) in the identification and classification of high-titer, low-activity (HTLA) antibodies is/are: A. reagent red cell panels B. adsorption and elution C. titration and inhibition D. cold autoadsorption
Correct Answer: C
On an electronic particle counter, if the RBC is erroneously increased, how will other parameters be affected? A. increased MCHC B. increased hemoglobin C. decreased MCH D. increased MCV
Correct Answer: C
Paroxysmal cold hemoglobinuria (PCH) is associated with antibody specificity toward which of the following? A. Kell system antigens B. Duffy system antigens C. P antigen D. I antigen
Correct Answer: C
140) A specimen with a negative nitrate reaction and a positive leukocytes reaction that has WBCs, WBC casts and no bacteria in the sediment will be seen in cases of:
acute interstitial nephritis Acute interstitial nephritis is caused by an allergic reaction, resulting in inflammation, not infection, of the renal tubules. Bacteria are not present in an inflammation.
54) A 17 yr. old girl decided to go on a starvation diet. After 1 week of starving herself, what substance would most likely be found in her urine?
ketones Ketones are byproducts of fat metabolism. During low carbohydrate or starvation diets, ketones can be found in the urine.
152) Which of the following components are present in serum but not present in the glomerular filtrate?
large molecular weight proteins The intact structure of the glomerular membrane does not permit passage of high-molecular-weight substances, such as protein molecules.
127) Bacteria are considered significant in the urine sediment when the:
leukocytes is positive Based on the time between collection and analysis of a urine specimen and the method of preservation, bacteria can be a heavy contaminant of urine. A positive LE test indicating the presence of WBCs confirms the actual presence of an infection.
17) Urine that develops a port wine color after standing may contain:
porphyrins Colors associated with urine are due to pigments. Melanin is black. Porphyrin is port wine [red]. Bilirubin is amber to brown.
19) Urine from a 50 yr. old man was noted to turn dark red on standing. This change is caused by:
porphyrins The 2 pigments are porphyrin and urochrome. Urochrome is "urine color," which is yellow. Porphyrin is red.
a (opsonization)
160. Which of the following activities is associated with C3b a) opsonization b) anaphylaxis c) vasoconstriction d) chemotaxis
d (cytokines)
210) Which of the following mediators is released during T-Cell activation? a) immunoglobulins b) thymosin c) serotonin d) cytokines
An increase in serum acetone is indicative of defect in the metabolism of: A. carbohdrates B. fat C. urea nitrogen D. uric acid
Correct Answer: A
The optimum storage temperature for cryoprecipitated AHF is: A. -20 C B. -12 C C. 4 C D. 22 C
Correct Answer: A
Once thawed, Fresh Frozen Plasma must be transfused within: A. 4 hours B. 8 hours C. 12 hours D. 24 hours
Correct Answer: D
201) The dimensions of a hemacytometer are:
3 x 3 x 0.1 mm The total volume of the 9 large cells is 0.9 uL. Counting 10 of the large cells is the equivalent of 1 uL.
b (lupus erythematosus)
1) Antinuclear antibody tests are performed to help diagnose? a) acute leukemia b) lupus erythematosus c) hemolytic anemia d) Crohn disease
b (the presence of IgM antibodies to hepatitis a virus)
101. Which of the following is the best indicator of an acute infection with the hepatitis A virus? a) the presence of IgG antibodies to hepatitis a virus b) the presence of IgM antibodies to hepatitis a virus c) a sharp decline in the level of IgG antibodies to hepatitis a virus d) a rise in both IgM and IgG levels of antibody to hepatitis a virus
a (lupus erythematosus)
102. Biological false-positive VDRL reactions are frequently encountered in patients with: a) lupus erythematosus b) acquired immune defficiency syndrome (AIDS) c) gonorrhea d) tertiary syphilis
c (anti-HBs)
103. Which serological marker of HBV infection indicates recovery and immunity? a) viral DNA polymerase b) HBe antigen c) anti-HBs d) HBsAg
c (FTA-ABS)
105. For diagnosis of late latent or tertiary syphilis, the most appropriate assay is: a) RPR b) VDRL c) FTA-ABS d) FTA-ABS IgM
b (elevated AST and ALT levels)
106. A 26-year old nurse developed fatigue, a low-grade fever, polyarthrist and urticaria. Two months earlier she had cared for a patient with hepatitis. Which of the following findings are likely to be observed in this nurse? a) a negative hepatitis B surface antigen test b) elevated AST and ALT levels c) a positive rheumatoid factor d) a positive Monospot test
a (increase in IgM antibody; decrease in IgM antibody; increase in IgG antibody)
107. The classic antibody response pattern following infection with hepatitis A is: a) increase in IgM antibody; decrease in IgM antibody; increase in IgG antibody b) detectable presence of IgG antibody only c) detectable presence of IgM antibody only d) decrease in IgM antibody; increase in IgG antibody of the the IgG3 subtype
a (A)
108) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for the surface antigen. a. A b. B c. C d. D
d (D)
109) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for e antigen. a. A b. B c. C d. D
73) In most compound light microscopes, the ocular lens has a magnification of:
10x The ocular lens has a magnification of 10x. This multiplied by the magnification of the objectives 10x [low power], 40x [high power], etc., equals the total magnification.
194) A CSF was hazy and the WBC was too high to perform undiluted. The technologist took 50 mL of sample and added 500 mL of saline. The cell count on the diluted sample was 200 WBC/mL. This should be multiplied by:
11 To calculate the dilution, take the amount of sample and divide it by the total of the new solution. So the dilution is 50 mL divided by 500 + 50 mL. This is a 1/11 dilution. To correct the final answer, multiply by the inverse of the dilution, or 11.
c (C)
110) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for core antigen. a. A b. B c. C d. D
b (B)
111) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for viral DNA. a. A b. B c. C d. D
c (uses anti-HBs linked to horseradish peroxidase)
113. The enzyme-linked immunosorbent assay (ELISA) technique for the detection of HBsAg: a) requires radiolabeled C1q b) is quantitated by degree of fluorescence c) uses anti-HBs linked to horseradish peroxidase d) uses beads coated with HBsAg
b (HBeAg)
114. The antigen marker most closely associated with transmissibility of HBV infection is: a) HBsAg b) HBeAg c) HBcAg d) HBV
b (continue to carry HBV)
115. Chronic carriers of HBV: a) have chronic symptoms of hepatitis b) continue to carry HBV c) do not transmit infection d) carry HBV but are not infectious
c (IgM)
117. The initial immune response following fetal infection with rubella is the production of which class(es) antibodies? a) IgG b) IgA c) IgM d) both IgG and IgA
a (probable immunity to rubella)
118. A maternal serum rubella titer that is equal to or greater than 1:8 indicates: a) probable immunity to rubella b) evidence of acute rubella infection c) susceptibility to rubella infection d) absence of acute rubella
148) A normal glomerular filtration rate is:
120 mL/min Although the normal glomerular filtration rate is 120 mL/min, tubular reabsorption returns normally all but 1 mL to the plasma.
c (FTA-ABS)
120. Which of the following is a treponemal test? a) RST b) RPR c) FTA-ABS d) VDRL
b (weaken reactions so that false negatives occur)
121. The air temperature throughout the serology laboratory is 20°C. How will this affect VDRL and RPR results? a) no effect -the acceptable test range is 20°C-24°C b) weaken reactions so that false negatives occur c) strengthen reactions so that positive titers appear elevated d) increase the number of false positives from spontaneous clumping
a (flocculation)
122. Which laboratory technique is most frequently used to diagnose and follow the course of therapy of a patient with secondary syphilis? a) flocculation b) precipitation c) complement fixation d) indirect immunofluorescence
a (streptolysin O)
124. The most commonly used serological indicator of recent streptococcal infection is the antibody to: a) streptolysin O b) hyaluronidase c) NADase d) DNA
c (can cross the placenta from mother to fetus)
125. Antibodies composed of IgG immunoglobulin: a) occur during the primary response to antigen b) are larger molecules than IgM antibodies c) can cross the placenta from mother to fetus d) can be detected in saline crossmatches
b (IgE)
126. Measurement of serum levels of which of the following immmunoglobulins can serve as a screening test for multiple allergies? a) IgA b) IgE c) IgG d) IgM
b (B lymphocytes)
127. Cells that are precursors of plasma cells and also produce immunoglobulins are: a) macrophages b) B lymphocytes c) T lymphocytes d) monocytes
d (their efficient ability to fix complement)
128. IgM antibodes are frequently hemolytic because of: a) their dimeric structure b) the molecule's 5 antigen binding sites c) their sedimentation coefficient of 7-15 S d) their efficient ability to fix complement
c (IgG)
129. To which of the following classes do the antibodies that cause hemolytic disease of the newborn belong? a) IgA b) IgE c) IgG d) IgD
c (IgM)
130. It is important to note that when an infant is born, levels of specific antibody of the following class are used to indicate neonatal infection: a) IgA b) IgG c) IgM d) IgD
d (B cells)
132. Antibodies are produced by: a) killer cells b) marrow stem cells c) mast cells d) B cells
a (constant region of heavy chain)
133. Antibody class and antibody subclass are determined by major physiochemical differences and antigenic variation found primary in the: a) constant region of heavy chain b) constant region of light chain c) variable regions of heavy and light chains d) constant regions of heavy and light chains
a (IgA)
135. Which of the following immunoglobulin classes is associated with a secretory component (transport piece)? a) IgA b) IgD c) IgE d) IgG
b (IgA)
136. The immunoglobulin class typically found to be present in saliva, tears and other secretions is: a) IgG b) IgA c) IgM d) IgD
b (3)
137. Treatment of IgG with papain results in how many fragments from each immunoglubulin molecule? a) 2 b) 3 c) 4 d) 5
d (IgE)
138. The immunoglubulin class associated with immediate hypersensitivity or atopic reactions is: a) IgA b) IgM c) IgD d) IgE
a (C3a)
165. Which of the following releases histamines and other mediators from basophils? a) C3a b) properdin factor B c) C1q d) C4
c (IgM)
139. Which of the following immunoglubulins is the most efficient at agglutination? a) IgG b) IgA c) IgM d) IgE
c (lupus erythematosus)
14) A patient has the following test results: The above results could be seen in patients with: a) rheumatic fever b) rheumatoid arthritis c) lupus erythematosus d) glomerulonephritis
c (the sequence of the constant regions)
142. The key structural difference that distinguishes immunoglubulin subclasses is the: a) number of domains b) stereometry of the hypervariable region c) the sequence of the constant regions d) covalent linkage of the light chains
d (pentamer)
146. The IgM molecule is a: a) dimer b) trimer c) tetramer d) pentamer
b (IgG)
147. Which of the following immunoglubulin is present in the highest concentration in normal human serum? a) IgM b) IgG c) IgA d) IgE
c (IgA class exists as serum and secretory molecules)
148. Which of the following statements about immunoglubulins is true? a) Immunoglobulins are produced by T lymphocytes b) IgA class is determined by the gamma heavy chain c) IgA class exists as serum and secretory molecules d) there are only 2 subclasses of IgG
c (variable regions of heavy and light chains)
151. Antibody idiotype is dictated by the: a) constant region of heavy chain b) constant region of light chain c) variable regions of heavy and light chains d) constant regions of heavy and light chains
d (constant regions of heavy and light chains)
152. Antibody allotype is determined by the: a) constant region of heavy chain b) constant region of light chain c) variable regions of heavy and light chains d) constant regions of heavy and light chains
a (IgG1)
153. Which IgG subclass is most efficient at crossing the placenta? a) IgG1 b) IgG2 c) IgG3 d) IgG4
a (IgA)
154. The J-Chain is associated with which of the following immunoglubulin ? a) IgA b) IgG c) IgE d) IgD
a (opsonin)
157. Macrophage phagocytosis of bacteria is enhanced by which of the following: a) opsonin b) antigen c) hapten d) IgG complexed with antigen
c (haptens)
158. Which of the following is most likely to activate the alternate pathway of complement activation? a) lipopolysaccharides b) glycoproteins c) haptens d) IgG complexed with antigen
b (C3b)
159. Which of the following is the larger residual split portion of C3? a) C3a b) C3b c) C4 d) C1q
a (nephelometry)
16) Which of the following is the most sensitive and appropriate method for the detection of rheumatoid factor? a) nephelometry b) immunofixation electrophoresis c) immunofluorescence d) manual latex agglutination
145) The normal renal threshold for glucose in the adult is approximately:
160 mg/dL (8.8 mmol/L) The renal threshold is the plasma level at which a substance, such as glucose, is no longer reabsorbed by the proximal convoluted tubules. The plasma level for glucose ranges from 160 - l80 mg/dL.
d (IgE)
161. After a penicillin injection, a patient rapidly develops respiratory distress, vomiting and hives. This reaction is primarily mediated by: a) IgG b) IgA c) IgM d) IgE
a (C1q)
162. Which of the following is the "recognition unit" in the classical complement pathway? a) C1q b) C3a c) C4 d) C5
c (the antigen is electrophoresed and then monospecific antisera is reacted with it)
163. In immunofixation electrophoresis: a) the antibody reacts with the antigen and then the complex is electrophoresed b) the antigen is electrophoresed into an antibody containing gel c) the antigen is electrophoresed and then monospecific antisera is reacted with it d) the antigen is electrophoresed, transferred to nitrocellulose and then antibody reacts with it and an EIA is performed
d (C5b, C6, C7, C8, C9)
164. Which of the following is the "membrane attack complex" of complement activation? a) C1 b) C3 c) C4, C2, C3 d) C5b, C6, C7, C8, C9
b (monoclonal light chains)
169. Bence jones protiens are: a) immunoglobulin catabolic fragments in the urine b) monoclonal light chains c) whole immunoglobulins in the urine d) Fab fragments of a monoclonal protein
The characteristic peripheral blood morphologic feature in multiple myeloma is: A. cytotoxic T cells B. rouleaux formation C. sherocytosis D. macrocytosis
Correct Answer: B
d (quantitative serum IgM determination)
168. A single, reliable screening test for detecting neonatal infection in the absense of clinical signs is: a) serum ummunoelectrophoresis b) differential leukocyte count c) CD4 cell counts d) quantitative serum IgM determination
d (gamma globulin-coated particles)
17) Rheumatoid factor reacts with: a) inert substances such as latex b) Rh-pos erythrocytes c) kinetoplasts of Crithidia luciliae d) gamma globulin-coated particles
Which of the following steroids is an adrenal cortical hormone? A. angiotensinogen B. aldosterone C. epinephrine D. growth hormone
Correct Answer: B
c (B lymphocytes)
172. Humoral antibodies are produced by which cells? a) macrophages b) T lymphocytes c) B lymphocytes d) neutrophils
d (antigen-antibody complexes containing IgA or IgE may initiate activation)
173. Initiation of the activation mechanism of the alternative complement pathway differs from that of the classical pathway in that: a) antigen-antibody complexes containing IgM or IgG are required b) endotoxin alone cannot initiate activation c) C1 component of complement is involved d) antigen-antibody complexes containing IgA or IgE may initiate activation
c (C4)
174. Which of the following is cleaved as a result of activation of the classical complement pathway? a) properdin factor B b) C1q c) C4 d) C3b
c (properdin factor B)
175. The component associated only with the alternative pathway of complement activation is? a) C4 b) C1q c) properdin factor B d) C3a
a (strong evidence against untreated SLE)
18) A consistently and repeatedly negative IFA-ANA is: a) strong evidence against untreated SLE b) associated with active SLE c) characteristic of SLE with renal involvement d) associated with lupus inhibitor
a (hyperglobulinemia)
19) Positive rheumatoid factor is generally associated with: a) hyperglobulinemia b) anemia c) decreased erythrocyte sedimentation rate d) azotemia
b (decreased activity of C1 esterase inhibitor)
190. Hereditary angioedema is characterized by: a) decreased activity of C3 b) decreased activity of C1 esterase inhibitor c) increased activity of C1 esterase inhibitor d) increased activity of C2
d (a lifelong history of life threatening infections)
191. Which of the following has been associated with patients who have homozygous C3 defficiency? a) undetectable hemolytic complement activity in the serum b) systemic lupus erythematosus c) no detectable disease d) a lifelong history of life threatening infections
c (lupus erythematosus like syndrome)
192. Hereditary deficiency of early complement components (C1, C4, C2) is associated with: a) pneumococcal septicemia b) small bowel obstruction c) lupus erythematosus like syndrome d) gonococcemia
d (a systemic gonococcal infection if exposed)
193. Hereditary deficiency of late complement components (C5, C6, C7, or C8) can be associated with which of the following conditions? a) pneumococcal septicemia b) small bowel obstruction c) systemic lupus erythematosus d) a systemic gonococcal infection if exposed
c (systemic lupus erythematosus)
194. For several months a 31-year-old woman had migratory polyarthritis and skin rash. Upon admission to the hospital, the following laboratory data were obtained: The patient's results are consistent with: a) dermatomyositis b) C1INH deficiency c) systemic lupus erythematosus d) mixed connective tissue disease
a (immediate hypersensitivity)
198. Which immunologic mechanism is usually involved in bronchial asthma? a) immediate hypersensitivity b) antibody mediated cytotoxicity c) immune complex d) delayed hypersensitivity
d (block H1 histamine receptors)
199. Antihistamines like Benadryl: a) depress IgE production b) block antigen binding to surface IgE c) bind histamine d) block H1 histamine receptors
65) A urine tested with Clinitest exhibits a pass-through reaction and is diluted by adding 2 drops of urine to 10 drops of water. This dilution is:
1:6 When 2 drops of urine are added to 10 drops of water, it is a 2/12 proportion. 12 is the total volume. This is the same as a 1:6 dilution.
a (results are consistent with active infection with rubella)
20) The following results are from rubella titer performed on acute and convalescent sera using 2-fold serial dilution: Date tested: 1/23/04 Acute serum titer: 1:8 Convalescent serum titer: 1:32 After evaluating the above results, best interpretation is: a) results are consistent with active infection with rubella b) variation in the acute serum titers invalidates these results c) test should be repeated by a different technologist d) patient was not infected with rubella
c (IgE is in too low a concentration to be detected by this method)
201. A child has severe hay fever. A total IgE measurement was performed by Ouchterlony immunodiffusion method. No lines of precipitation appeared on the immunodiffusion plate. The most likely explanation is: a) IgE antibodies are not produced in children who have hay fever b) hay fever is mediated by the cellular system c) IgE is in too low a concentration to be detected by this method d) IgA is the antibody commonly produced in people with hay fever
a (skin test for commonly encountered antigens)
202. Which test is used to evaluate the cellular immune system in a patient? a) skin test for commonly encountered antigens b) determination of isohemagglutinin titer c) immunoelectrophoresis of serum d) measurement of anti-HBsAg after immunization
b (secretion of immunoglobulins)
203. T cells are incapable of: a) collaborating with B cells in antibody responses b) secretion of immunoglobulins c) secretion of cytokines d) producing positive skin tests
a (Fc fragment of IgG)
21) Rheumatoid factors are immunoglobulins with specificitiy for allotypic determinants located on the: a) Fc fragment of IgG b) Fab fragment of IgG c) J chain of IgM d) secretory of component of IgA
c (phagocytic cells)
204. T lymphocytes are incapable of functioning as : a) cytotoxic cells b) helper cells c) phagocytic cells d) regulatory cells
c (natural killer cells)
205. Nonspecific killing of tumor cells is carried out by: a) cytotoxic T cells b) helper T cells c) natural killer cells d) antibody and complement
a (immunoassays)
206. Tumor markers found in the circulation are most frequently measured by: a) immunoassays b) thin-layer chromatography c) high-pressure liquid chromatography d) colorimetry
b (increased bacterial infections)
207) A patient with B-Cell deficiency will most likely exhibit: a) decreased phagocytosis b) increased bacterial infections c) decreased complement levels d) increased complement levels
b (increased parasitic infections)
208) A patient with a T-cell deficiency will mostly likely exhibit: a) increased immune complex formation b) increased parasitic infections c) decreased IgE-mediated responses d) decreased complement levels
b (neutrophil)
209) Which of the following is an important cellular mediator of immune complex tissue injury? a) mast cell b) neutrophil c) basophil d) eosinophil
c (allograft)
212) Which of the following terms describes a graft between gentically unidentical individuals belonging to the same species? a) autograft b) isograft c) allograft d) xenograft
c (cytotoxic)
216) T lymphocytes that possess the Cd8 surface market mediate which of the following T-Cell functions? a) delayed type hypersensitivity b) regulatory c) cytotoxic d) helper
a (contact sensitivity to inorganic chemicals)
217) Delayed hypersensitivity may be induced by: a) contact sensitivity to inorganic chemicals b) transfusion reaction c) anaphylactic reaction d) bacterial septicemia
b (anaphylaxis)
218) The most rapid immediate hypersensitivity reaction is associated with: a) transfusion b) anaphylaxis c) contact dermatitis d) serum sickness
a (positive test for the detection of IgM class antibodies)
22) Rheumatoid factor in patients serum may cause a false: a) positive test for the detection of IgM class antibodies b) negative test for the detection of IgM class antibodies c) positive test for the detection of IgG class antibodies d) negative test for the detection of IgG class antibodies
a (all mature T lymphocytes)
220) An immunofluorescence test using reagent antibody directed against the CD3 surface marker would identify which of the following cell types in a sample of human peripheral blood? a) all mature T lymphocytes b) T helper lymphocytes only c) cytotoxic T lymphocytes only d) T regulatory cells only
c (scatter the light and emit fluorescence)
224) In flow cytometry, labeled cells: a) scatter the light and absorb fluorescence b) absorb fluorescence and emit electronic impulses c) scatter the light and emit fluorescence d) absorb both fluorescence and light
c (is associated with a viral induced immunodefiency)
225) A marked decrease in CD4 lymphocytes and decrease in the CD4/CD8 ratio: a) is diagnostic for bacterial septicemia b) may be seen in MOST hereditary immunodeficiency disorder c) is associated with a viral induced immunodeficiency d) is only seen in patients with advanced disseminated cancer
c (immunofluorescence)
229) What is the immonologic method utilized in the flow cytometer?: a) latex agglutination b) enzyme linked immunoessay c) immunofluorescence d) radioimmunoassay
c (autoantibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule)
23) Rheumatoid factors are defined as: a) antigens found in the sera of patients with rheumatoid arthritis b) identical to the rheumatoid arthritis precipitin c) autoantibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule d) capable of forming circulating immune complexes only when IgM-type autoantibody is present
b (60)
230) Given the following data: Calculate the absolute CD4: a) 40 b) 60 c) 400 d) 750
c (consistent with a viral infection such as HIV)
231) Given this hematologic data: Which of the following is the correct interpretation? a) Cd4% and absolute Cd4 normal b) consistent with an intact system c) consistent with a viral infection such as HIV d) technical error
a (T cells)
236) A patient's abnormal lymphocytes are positive for CD2 antigen, lack C3 receptors, and are negative for the surface immunoglobulin. This can be classified as a disorder of: a) T cells b) B cells c) monocytes d) natural killer cells
d (thyroid disease)
27) High titers of antimicrosomal antibodies are most often found in: a) rheumatoid arthritis b) systemic lupus erythematosus c) chronic hepatitis d) thyroid disease
b (anti-smooth muscle)
29) In chronic active hepatitis, high titers of which of the following antibodies are seen? a) antimitochondrial b) anti-smooth muscle c) anti-DNA d) anti-parietal cell
c (diagram C)
3) Which of the ANA patterns shown above would be associated with high titers of antibodies to the Sm antigen? a) diagram A b) diagram B c) diagram C d) diagram D
The characteristic morphologic feature in lead poisoning is: A. macrocytosis B. target cells (codocytes) C. basophilic stippling D. rouleaux formation
Correct Answer: C
d (nucleolar)
31) Anti-RNA antibodies are often present in individuals having an anti-nuclear antibody immunoflurorescent pattern that is: a) speckled b) rim c) diffuse d) nucleolar
a (speckled)
32) Anti-extractable nuclear antigens are most likely associated with which of the following anti-nuclear antibody immunofluorescent patterns? a) speckled b) rim c) diffuse d) nucleolar
c (screen for Sm and RNP antibodies)
33) In an anti-nuclear antibody indirect immunofluorescent test, a sample of patient serum shows a postive, speckled pattern. Which would be the most appropriate additional test to perform? a) antimitochondrial antibody b) immunoglobulin quantitation c) screen for Sm and RNP antibodies d) anti-DNA antibody using C luciliae
The red cells of a nonsecretor (se/se) will most likely type as: A. Le (a-b-) B. Le (a+b+) C. Le (a+b-) D. Le (a-b+)
Correct Answer: C
The reference ranges for the pH of arterial blood measure at 37C is: A. 7.28-7.34 B. 7.33-7.37 C. 7.35-7.45 D. 7.45-7.50
Correct Answer: C
b (5°C +/- 2°)
4) Sera to be tested for IFA-ANA 6 days after drawing is best stored at? a) room temperature b) 5°C +/- 2° c) -70°C in a constant temperature freezer d) -20°C in a frost-free self-defrosting freezer
115) Cholesterol crystals will most likely be observed in urine that contains:
4+ protein Increased lipids in the urine is a characteristic of the nephrotic syndrome. Massive amounts of protein also are associated with the nephrotic syndrome. The crystals form more readily in urine that has been refrigerated.
202) Rapid forward progression of sperm is rated as:
4.0 The WHO rating for sperm motility is: 0 - no movement 1.0 = no forward movement 2.0 = slow forward/lateral movement 3.0 = faster speed, some lateral movement 4.0 = rapid, straight line movement.
c (goat anti-human immunoglobulin)
41. In the indirect immunofluorescence method of antibody detection in patient serum, the labeled antibody is: a) human anti-goat immunoglobulin b) rheumatoid factor c) goat anti-human immunoglobulin d) complement
a (the reaction is reversible)
42. Which of the following describes an antigen-antibody reaction? a) the reaction is reversible b) the reaction is the same as a chemical reaction c) a lattice is formed at prozone d) a lattice is formed at postpone
c (fluorescein isothiocyanate)
43. The most common label in direct fluorescent antibody technique (DFA) is: a) alkaline phosphatase b) horseradish peroxidase c) fluorescein isothiocyanate d) calcofluor white
c (indirect fluorescence)
44. A substrate if first exposed to a patients serum, then after washing, anti-human immunoglobulin labeled with a fluorochrome is added. The procedure described is: a) fluorescent quenching b) direct fluorescence c) indirect fluorescence d) fluorescence inhibition
d (strength of a reacting antibody)
45. Avidity may be defined as the: a) degree of hemolysis b) titer of an antigen c) dilution of an antibody d) strength of a reacting antibody
b (rise in titer of the patients serum)
46. In the interpretation of aggutination tests for febrile diseases, which of the following is of the greatest diagnostic importance? a) anamnestic reactions caused by the heterologous antigens b) rise in titer of the patient's serum c) history of previous vaccination d) naturally occurring antibodies prevalent where the disease is endemic
d (increase sensitivity of the antigen)
47. Cholesterol is added to the antigen used in flocculation tests for syphilis to: a) destroy tissue impurities present in the alcoholic beef heart extract b) sensitize the sheep RBCs c) decrease specificity of the antigen d) increase sensitivity of the antigen
c (avidity)
48. The strength of a visible reaction is known as: a) prozone reaction b) absorption c) avidity d) elution
a (precipitin lines cross, forming double spurs)
49. Which of the following describes an antigen-antibody precipitation reaction of non-indentity? a) precipitin lines cross, forming double spurs b) precipitin lines fuse, forming single spur c) no precipitin lines are formed d) precipitin lines fuse, forming a single arc
a (rim)
5) Antibodies directed at native DNA are most frequently associated with which pattern of fluorescence in the IFA-ANA test? a) rim b) diffuse c) speckled d) centromere
The 2 alleles for a sex-linked recessive disease are X and x. The mutant allele is x. What is the percentage of male offspring that would be expected to be affected by the disease from parents who have the following genotypes? mother: Xx father: xY a. 0 b. 25 c. 50 d. 100
50 (c) One X chromosome is passed on to all sons by the mother; since she is a carrier of a mutant X allele, 50% of her sons will be affected.
c (ELISA)
50. Which test has the greatest sensitivity for antigen detection? a) precipitin b) agglutination c) ELISA d) complement fixation
d (dissolve the precipitate after formation)
51. Excess antigen in precipitation gel reactions will: a) have no effect on the precipitate reaction b) not dissolve precipitate after formation c) enhance the precipitate reaction d) dissolve the precipitate after formation
b (antigen excess)
52. Soluble immune complexes are formed under the condition of: a) antigen deficiency b) antigen excess c) antibody excess d) complement
b (precipitation)
53. The visible serological reaction between soluble antigen and its specific antibody is: a) sensitization b) precipitation c) agglutination d) opsonization
c (C)
54) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve for equivalence precipitate is: a. A b. B c. C d. D
b (B)
55) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve where no precipitate formed due to antigen is: a. A b. B c. C d. D
a (A)
56) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve for prozone is: a. A b. B c. C d. D
d (D)
57) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve where soluble antigen-antibody complexes have begun to form is: a. A b. B c. C d. D
b (B)
58) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area in which the addition of more antibody would result in the information of additional precipitate is: a. A b. B c. C d. D
a (Figure #1)
59) Which of the above figures demonstrates a reaction pattern of identity? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
b (expected for anti-DNA antibodies)
6) The technologist observes apparent homogenous staining of the nucleus of interphase cells while performing an IFA-ANA, as well as staining of the chromosomes in mitotic cells. This result is: a) indicative of 2 antibodies, which should be separately reported after titration b) expected for anti-DNA antibodies c) inconsistent; the test should be reported with new reagent d) expected for anti-centromere antibodies
b (Figure #2)
60) Which of the above figures demonstrates a reaction pattern of nonidentity? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
c (Figure #3)
61) Which of the above figures demonstrates a reaction pattern showing 2 different antigenic molecular species? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
c (oxidation of the enzyme)
64. The enzyme control tube in an ASO hemolytic assay exhibits no cell lysis. What is the most likely explanation for this? a) incorrect ph of buffer b) low ionic strength buffer c) oxidation of the enzyme d) reduction of the enzyme
c (prozoning)
65. The following pattern of aggultination was observed in an antibody titration: This set of reactions most likely resulted from: a) faulty pipetting technique b) postzoning c) prozoning d) the presence of a high-titer, low-avidity antibody
d (anti-streptolysin "O" inhibits the reagent streptolysin "O's" resulting in no hemolysis)
66. In a positive anti-streptolysin O enzyme inhibition test, the patient's: a) streptolysin "O" enzyme in the patient serum neutralizes the anti-streptolysin "O" reagent, resulting in no hemolysis b) red blood cells are hemolyzed by the streptolysin"O" enzyme in the reagent c) anti-streptolysin "O" neutralizes the streptomycin "O" reagent, resulting in hemolysis d) anti-streptolysin "O" inhibits the reagent streptolysin "O's" resulting in no hemolysis
d (second antibody titer is at least 4x the first)
67. Blood is drawn from a patient for serological tests for a viral disease at the time of onset and again 4 weeks later. The results of the test are considered diagnostic if the: a) first antibody titer is 2x the second b) first and second antibody titers are equal c) first antibody is 4x the second d) second antibody titer is at least 4x the first
b (serological techniques)
68. Which of the following is most useful in establishing a diagnosis in the convalescence phase of a viral infection? a) slide culture b) serological techniques c) shell vial d) culture on Mccoy media
d (antibody detection by EIA)
69. The best method to detect infections due to rubella, Epstein-Barr, and human immunodefiency viruses is: a) antigen detection by EIA b) cell culture c) antigen detection by Western blot d) antibody detection by EIA
a (anti-dsDNA titer 1:80, and a high titer of antibodies to Sm)
7) The result of an anti-nuclear antibody test was a titer of 1:320 with a peripheral pattern. Which of the following sets of results best correlate with these results? a) anti-dsDNA titer 1:80, and a high titer of antibodies to Sm b) antimitochondrial antibody titer 1:160, and antibodies to RNP c) anti-Scl-70, and antibodies to single-stranded DNA d) high titers of anti-SS-A and anti-SS-B
b (antibody recognition of homologous antigen)
70. Immunoassays are based on the principle of: a. separation of bound and free analyte b. antibody recognition of homologous antigen c. protein binding to isotopes d. production of antibodies against drugs
a (active humoral-mediated immunity)
71. A DPT vaccination is an example of: a) active humoral-mediated immunity b) passive humoral-mediated immunity c) cell-mediated immunity d) immediate hypersensitivity
b (neutrophils, eosinophils, and monocytes)
72. Cells known to be actively phagocytic include: a) neutrophils, monocytes, basophils b) neutrophils, eosinophils, monocytes c) monocytes, lymphocytes, neutrophils d) lymphocytes, eosinophils, monocytes
On a smear made directly from a finger stick, no platelets were found in the counting are. The first thing to do is: A. examine the slide for clumping B. obtain another smear C. perform a total platelet count D. request another finger stick
Correct Answer: A
a (early acute phase HBV hepatitis)
73. The presence of HbsAg, anti-HBc and often HbeAg is characteristic of: a) early acute phase HBV hepatitis b) early convalescent phase HBV hepatitis c) recovery phase of acute HBV hepatitis d) past HBV infection
b (Western blot)
77. When testing a patient for HIV antibody, which of the following is used to confirm a positive screening test? a) radioimmunoassay b) Western blot c) immunofluorescence d) Elisa
a (precipitation)
80. What kind of antigen-antibody reaction would be expected if soluble antigen is added to homologous antibody? a) precipitation b) agglutination c) complement fixation d) hemagglutination
a (useful in screening for syphilis)
81. The rapid plasma reagin test: a) is useful in screening for syphilis b) is useful in diagnosing syphilis c) does not give false-positives d) uses heated plasma
a (reagin antibody)
82. Flocculation tests for syphilis detect the presence of: a) reagin antibody b) antigen c) hemolysin d) Forssman antigen
a (4+ reaction)
83. In the cold agglutination test, the tubes containing the serum and erythrocytes are allowed to stand overnight in the fridge, and results are read next morning. If a disk of the erythrocytes floats up from the bottom of the tube with only the flick of a finger, this is read as a: a) 4+ reaction b) 2+ reaction c) 1+ reaction d) negative reaction
c (cardiolipin and lecithin)
84. Flocculation tests for syphilis use antigen composed of: a) Treponema pallidum b) reagin c) cardiolipin and lecithin d) charcoal
a (positive, 1:128)
85. The following cold agglutinin titer results are observed: The best interpretation is: a. positive, 1:128 b. negative c. invalid because 37°C reading is negative d. repeat the 4°C readings
d (reheated to 56°C for 10 minutes)
86. A VDRL serum sample is heat inactivated, then placed in a fridge for overnight storage. Before being tested, the serum must be: a) kept colder than 10° C b) allowed to equilibrate to room temperature c) warmed to 37°C d) reheated to 56°C for 10 minutes
b (haptens)
87. Substances that are antigenic only when coupled to a protein carrier are: a) opsonins b) haptens c) adjuvants d) allergens
b (RPR)
89. A serological test for syphilis that depends upon the detection of cardiolipin-lecithin-cholesterol antigen is: a) FTA-ABS b) RPR c) MHA-TP d) TPI
Rickets is associated with deficiency of which of the following vitamins? A. B1 B. C C. niacin D. D
Correct Answer: D
b (CSF-VDRL)
91. The serological test for syphilis recommended for detecting antibody in Cerebrospinal fluid is: a) nontreponemal antibody b) CSF-VDRL c) FTA-ABS d) MHA-TP
b (anti-HBs)
96. What assay would confirm the immune status of hepatitis B virus? a) HBsAg b) anti-HBs c) IgM anti-HBcAg d) hepatitis C Ag
d (ELISA)
97. The following procedure has been routinely used for detection of hepatitis B surface antigen (HBsAg) because of its high level of sensitivity: a) hemagglutination b) counterimmunoelectrophoresis c) radial immunodiffusion d) ELISA
a (anti-human IgG conjugated to an enzyme)
98. In an indirect ELISA method desiged to detect antibody to the rubella virus in patient serum, the conjugate used should be: a) anti-human IgG conjugated to an enzyme b) anti-rubella antibody conjugated to an enzyme c) rubella antigen conjugated to an enzyme d) anti-rubella antibody conjugated to a substrate
212) Tumor markers that can be measured on body fluids include all except:
ANA The only acronym listed here that is not a tumor marker is ANA. This stands for anti-nuclear antibody.
What is the most critical step in determining the specificity of a PCR reaction? a. denaturation temperature b. annealing temperature c. extension temperature d. number of cycles in the PCR reaction
Annealing temperature determines the amount of mismatch tolerated between the primers and the target. (b)
What battery of tests is most useful in evaluating an anion gap of 22 mEq/L?
BUN, creatinine, salicylate and methanol
The greatest activities of serum AST and ALT are seen in which of the following? A. acute viral hepatitis B. primary biliary cirrhosis C. metastatic hepatic cirrhosis D. alcoholic cirrhosis
Correct Answer: A
198) The tau isoform of transferrin is a carbohydrate deficient protein found only in:
CSF Tau transferrin is found only in CSF.
216) What calculation is used to determine if there is a breach in the blood brain barrier?
CSF / serum albumin index The CSF/serum albumin ratio with a value of <9 indicates an intact blood-brain barrier. The other distractors have different purposes: a the IgG index compares IgG in CSF and serum to determine if IgG is being synthesized in the CNS; c the fluid/serum LD ratio is used to determine if a body fluid is a transudate or an exudate; d the albumin gradient is used to determine if an effusion is of hepatic origin.
215) Decreased CSF protein can be found in:
CSF leakage Meningitis, hemorrhage, and neurologic diseases, such as MS, will increase CSF protein. Decreased protein can be found due to CSF leakage, recent puncture, and rapid CSF production.
143) The sediment of a urine specimen with a reagent strip glucose of 250 mg/dL and a pH of 5.5 is ideal for the presence of:
Candida albicans The ideal conditions for the growth of Candida albicans are an acid pH and the presence of glucose. Candida is a frequent cause of urinary tract infections in diabetic patients.
A 24-hour urine specimen (total volume =1,136 mL) is submitted to the laboratory for quantitative urine protein. Calculate the amount of protein excreted per day if the total protein is 52 mg/dL. A. 591 mg B. 487 mg C. 220 mg D. 282 mg
Correct Answer: A
A 42-year-old female is undergoing surgery tomorrow an dher physician requests that 4 units of Red Blood Cells be crossmatched. The following results were obtained: IS; 37C; IAT -screening cell I: 0, 0, 0 -screening cell II: 0, 0, 0 -screening cell III: 0, 0, 0 Crossmatch: IS, 37C, IAT -donor 1: 2+, 1+, 1+ -donors 2, 3, 4: 0, 0, 0 What is the most likely cause of the incompatibility of donor 1? A. single alloantibodies B. multiple alloantibodies C. Rh incompatibilities D. donor 1 has a positive DAT
Correct Answer: A
A 45-year-old male of average heigh and weight was admitted to the hospital for renal function studies. He had the following lab results: -urine creatinine: 120 mg/dL (10680 umol/L) -serum creatinine: 1.5 mg/dL (132.6 umol/L) -total urine volume in 24 hours: 1800/mL Calculate the creatinine clearance for this patient in mL/min. A. 100 B. 144 C. 156 D. 225
Correct Answer: A
A 45-year-old woman has a fasting serum glucose concentration of 95 mg/dL (5.2 mmol/L) and a 2-hour postprandial glucose concentration of 105 mg/dL 95.8 mmol/L). The statement which best describes this patient's fasting serum glucose concentration is: A. normal; reflecting glycogen breakdown by the liver B. normal; reflecting glycogen breakdown by skeletal muscle C. abnormal; indicating diabetes mellitus D. abnormal; indicating hypoglycemia
Correct Answer: A
A 50-year-od woman wha has been receiving busulfan for 3 years for chronic myelogenous leukemia becomes anemic. Laboratory test reveal: -Thrombocytopenia -Many perxidase-negative blast cells in the peripheral blood -Bone marrow hypercellular in blast transformation -Markedly increased bone marrow TdT Which of the following complications is this patient most likely to have? A. acute lymphocytic leukemia B. acute meylocytic leukemia C. acute myelomonocytic leukemia D. busulfan toxicity
Correct Answer: A
The large nucleated cell in the lower right-hand side of the image below is a: See BOC pg 181 Pic 2 A. myelocyte B. metamyelocyte C. basophil D. plasma cell
Correct Answer: A
A 68-year-old female patient tells her physician of being " cold all the time" and recent weight gain, with no change in diet. The doctor orders a TSH level, and the laboratory reports a value of 8.7 uU/mL (8.7 IU/L) (reference range = 0.5 uU/mL [0.5-5.0 IU/L[). This patient most likely has: A. primary hypothyroidism B. Graves disease C. a TSH-secretin tumor D. primary hyperthyroidism
Correct Answer: A
A 68-year-old man arrives in the emergency room with a glucose level of 722 mg/dL (39.7 mmol/L) and serum acetone of 4+ undiluted. An arterial blood gas form this patient is likely to be: A. low pH B. high pH C. low PO2 D. high PO2
Correct Answer: A
A bedside test that can be used to monitor heparin activity is the: A. activated clotting time B. stypven time C. reptilase time D. partial thromboplastin time
Correct Answer: A
A bleeding time is used to evaluate the activity of: A. platelets B. prothrombin C. labile factor D. Factor XIII
Correct Answer: A
A blood component used in the treatment of hemophilia A is: A. Factor VIII concentrate B. Fresh Frozen Plasma C. Platelets D. Whole Blood
Correct Answer: A
A blood specimen from a pregnant woman is found to be group B, Rh-negative and the serum contains anti-D with a titer of 512. What would be the most appropriate type of blood to have available for a possible exchange transfusion for her infant? A. O, Rh-negatvie B. O, Rh-positive C. B, Rh-negative D. B, Rh-positive
Correct Answer: A
A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing the force and velocity of myocardial contraction is: A. digoxin B. acetaminophen C. lithium D. phenytoin
Correct Answer: A
A common cause of a falsely increased LD1 fraction of lactic dehydrogenase is: A. specimen hemolysis B. liver disease C. congestive heart failure D. drug toxicity
Correct Answer: A
A differential was performed on an asymptomatic patient. The differential included 60% neutrophils; 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomalies? A. Pelger-Huet B. May-Hegglin C. Alder-Reilly D. Chediak-Higashi
Correct Answer: A
A father donating Platelets for his son is connected to a continuous flow machine, which uses the principle of centrifugation to separate Platelets from Whole Blood. As the Platelets are harvested, all other remaining elements are returned to the donor. the method of Platelet collection is known as: A. apheresis B. autologous C. homologous D. fractionation
Correct Answer: A
A group A, Rh-positive infant of a group O, Rh-positive mother has a weakly positive direct antiglobulin test and a moderately elevated bilirubin 12 hours after birth. The most likely cause is: A. ABO incompatibility B. Rh incompatibility C. blood group incompatibility due to an antibody to a low frequency antigen D. neonatal jaundice not associated with blood group
Correct Answer: A
A hemophiliac male and a normal female can produce a: A. female carrier B. male carrier C. male hemophiliac D. normal female
Correct Answer: A
A hospitalized patient is experiencing increased neuromuscular irritability (tetany). Which of the following tests should be ordered immediately? A. calcium B. phosphate C. BUN D. glucose
Correct Answer: A
A leukocyte count and differential on a 40-year-old Caucasian man revealed: WBC: 5.4 x 10^3/uL (5.4 x 10^9/L) Differential: -Segs: 20% -Lymphs: 58% -Monos: 20% -Eos: 2% This represents: A. relative lymphocytosis B. absolute lymphocytosis C. relative neutrophilia D. leukopenia
Correct Answer: A
A low concentration of serum phosphorus is commonly found in: A. patients who are receiving carbohydrate hyperalimentation B. chronic renal disease C. hypoparathyroidism D. patients with pituitary tumors
Correct Answer: A
A mother has the red cell phenotype D+C+E-c-e+ with anti-c ( titer of 32 at AHG) in her serum. The father has the phenotype D+C+E-c+e+. The baby is Rh-negative and not affected with hemolytic disease of the newborn. What is the baby's most probable Rh genotype? A. r'r' B. r'r C. R1R1 D. R1r
Correct Answer: A
A patient became hypotensive and went into shock after reciving 50 mL of a unit of Red Blood Cells. She had a shaking chill and her temperature rose to 104.8 F (40.4 C). A transfusion reaction investigation was initiate but no abnormal results were seen. What additional testing should be performed? A. Gram stain and culture of the donor unit B. lymphocytotoxicity tests for leukoagglutinins C. plasma IgA level D. elution and antibody identification
Correct Answer: A
A patient diagnosed with polycythemia vera 5 years ago now has anormal hematocrit, decreased hemoglobin and microcytic, hypochromic red cells. What is the most probable cause for the current blood situation? A. phlebotomy B. myelofibrosis C. preleukemia D. aplastic anemia
Correct Answer: A
A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malarial drugs the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusion caused by hemoglobin denaturation. Which of the following conditions is most consistent with these findings? A. G-6-PD deficiency B. thalassemia major C. pyruvate kinase deficiency D. paroxysmal nocturnal hemoglobinuria
Correct Answer: A
A patient has the following test results: -increased serum calcium levels -decreased serum phosphate levels -increased levels of parathyroid hormone This patient most likely has: A. hyperparathyroidism B. hypoparathyroidsim C. nephrosis D. steatorrhea
Correct Answer: A
A patient is admitted to the emergency room in a stage of metabolic alkalosis. Which of the following would be consistent with this diagnosis? A. high TCO2, increased HCO3 B. low TCO2, increased HCO3 C. high TCO2, decreased H2CO3 D. low TCO2, decreased H2CO3
Correct Answer: A
A patient is diagnose as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood? A. granulocytic leukemoid reaction B. lymphocytic leukemoid reaction C. neutropenia D. eosinophilia
Correct Answer: A
A patient is group A2B, Rh-positive and has antiglobulin-reacting anti-A1 in his serum. He is in the operating room bleeding profusely and group A2B Red Blood Cells are not available. Which of the following blood types is first choice for crossmatching? A. B, Rh-positive B. B, Rh-negative C. A1B, Rh-positive D. O, Rh-negtive
Correct Answer: A
A patient is taking 10 mg per day of Coumadin (warfarin). The results of which of the following laboratory tests will be most impacted? A. protein C level B. antithrombin III level C. Factor V Leiden mutation D. Factor VIII level
Correct Answer: A
A patient is typed as group O, Rh-positive and crossmatched with 6 units of blood. At the indirect antiglobulin (IAT) phase of testing, both antibody screening cells and 2 crossmatched units are incompatible. Wha tis the mot likely cause of the incompatibility? A. recipient alloantibody B. recipient autoantibody C. donors have positive DATs D. rouleaux
Correct Answer: A
A patient received 4 units of blood 2 years previously and now has multiple antibodies. He has not been transfused since that time. It would be most helpful to: A. phenotype his cells to determine which additional alloantibodies may be produced B. recommend the use of directed donors, which are more likely to be compatible C. use proteolytic enzymes to destroy the "in vitro" activity of some of the antibodies D. freeze the patient's serum to use for antigen typing of compatible units
Correct Answer: A
A patient with a coagulopathy was transfused with FP24 (plasma frozen within 24 hours of collection). After infusion of 15 mL, the patient experienced hypotension, shock, chest pain and difficulty in breathing. The most likely cause of the reaction is: A. anti-IgA B. bacterial contamination C. intravascular hemolysis D. leukoagglutinins
Correct Answer: A
A patient with hemolytic anemia will A. show a decrease in glycated Hgb value B. show an increase in glycated Hgb value C. show little or no change in glycated Hgb value D. demonstrate an elevated Hgb A1
Correct Answer: A
A patient's red blood cells gave the following reactions: -anti-D: + -anti-C: + -anti-E: + -anti-c: + -anti-e: + -anti-f: 0 The most probable genotype of this patient is: A. R1R2 B. R2r" C. Rzr D. RzRz
Correct Answer: A
A patient's red cells type as follows: -anti-D: 4+ -anti-C: 0 -anti-E: 0 Which of the following genotype would be consistent with these results? A. R0R0 B. R2r C. R1R2 D. R2r
Correct Answer: A
A patient's serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-JK6A, anti-Fy^a and possibly another antibody are present. What technique(s) may be helpful to identify the other antibody(ies)? A. enzyme panel; select cell panel B. thiol reagents C. lowering the pH and increasing the incubation time D. using albumin as an enhancement media in combination with selective adsorption
Correct Answer: A
A phase-platelet count was performed and the total platelet count was 356 x 10^3/uL (356 x 10^9/L). 10 fields on the stained blood smear were examined for platelets and the results per field were: -16, 18, 15, 20, 19, 17, 19, 18, 20, 16 The next step would be to: A. report the phase-platelet count since it correlated well with the slide B. repeat the phase-platelet count on a recollected specimen and check for clumping C. check ten additional fields on the blood smear D. repeat the platelet count using a different method
Correct Answer: A
A platelet determination was performed on an automated instrument and a very low value was obtained. The platelets appeared adequate when estimated from the stained blood film. The best explanation for this discrepancy is: A. many platelets are abnormally large B. blood sample is hemolyzed C. white cell fragments are present in the blood D. red cell fragments are present in the blood
Correct Answer: A
A potassium level of 6.8 mEq/L (6.8 mmol/L) is obtained. Before reporting the results, the first step the technologist should take is to: A. check the serum for hemolysis B. rerun the test C. check the age of the patient D. do nothing, simply report out the result
Correct Answer: A
A serum sample drawn in the emergency room form a 42-year-old man yielded the following: Patient; Reference range -CK: 185 U/L; 15-60 U/L -AST: 123 U/L; 0-48 U/L -CKMB: 6 U/L; 2-12 U/L Which of the following conditions might account for these values? A. crush injury to the thigh B. cerebrovascular accident C. pulmonary infarction D. early acute hepatitis
Correct Answer: A
A stool specimen that appears black and tarry should be tested for the presence of: A. occult blood B. fecal fat C. trypsin D. excess mucus
Correct Answer: A
A temperature rise of 1C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation, usually indicates which of the following reactions? A. febrile B. circulatory overload C. hemolytic D. anaphylactic
Correct Answer: A
ABO hemolytic disease of the fetus and newborn (HDFN) differs from Rh HDFN in that: A. Rh HDFN is clinically more severe than ABO HDFN B. the direct antiglobulin test is weaker in Rh HDFN than ABO C. Rh HDFN occurs in the first pregnancy D. the mother's antibody screen is positive in ABO HDN
Correct Answer: A
According to AABB standards, Fresh Frozen Plasma must be infused within what period of time following thawing? A. 24 hours B. 36 hours C. 48 hours D. 72 hours
Correct Answer: A
Acute disseminated intravascular coagulation is characterized by: A. hypofibrinogenemia B. thrombocytosis C. negative D-dimer D. shortened thrombin time
Correct Answer: A
After receiving a unit of Red Blood Cells, a patient immediately developed flushing, nervousness, fever spike of 102F (38.9 C), shaking, chills and back pain. The plasma hemoglobin was elevated and there was hemoglobinuria. Laboratory investigation of this adverse reaction would most likely show: A. an error in ABO grouping B. an error in Rh tying C. presence of anti-Fy^a antibody in patient's serum D. presence of gram negative bacteria in blood bag
Correct Answer: A
All stages of neutrophils are most likely to be seen in the peripheral blood of a patient with : A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia
Correct Answer: A
An antibody identification study is performed with the 5-cell panel shown below: Antigen 1, 2, 3, 4, 5; Test resuslts -I: +, 0, 0, +, +; + -II: 0, 0, +, 0, +; 0 -III: 0, +, +, +, 0; 0 -IV: 0, +, +, 0, +; + -V: +, +, +, 0, 0; + -auto: 0 An antibody against which of the following antigens could not be excluded? A. 1 B. 2 C. 3 D. 4
Correct Answer: A
An antibody screen performed using solid phase technology revealed a diffuse layer of red blood cells on the bottom of the well. These results indicate: A. a positive reaction B. a negative reaction C. serum was not added D. red cells have a positive direct antiglobulin test
Correct Answer: A
An antibody that causes in vitro hemolysis and reacts with the red cells of 3 units is most likely: A. anti-Le^a B. anti-s C. anti-k D. anti-E
Correct Answer: A
An automated leukocyte count is 22.5 x 10^9/uL (22.5 x 10^9/L). The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter? A. 7,500/uL (7.5 x 10^9/L) B. 11,500/uL (11.5 x 10^9/L) C. 14,400/uL (14.4 x 10^9/L) D. 22,300/uL (22.3 x 10^9/L)
Correct Answer: A
An automated method for measuring chloride which generates silver ions in the reaction is: A. coulomery B. mass spectroscopy C. chromatography D. polarography
Correct Answer: A
An emphysema patient suffering form fluid accumulation in the alveolar spaces is likely to be in what metabolic state? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis
Correct Answer: A
An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype? A. KK B. Kk C. kk D. K0K0
Correct Answer: A
An infant with diarrhea is being evaluated for a carbohydrate intolerance. His tool yields a positive copper reduction test and a pH of 5.0. It should be concluded that: A. further test are indicated B. results are inconsistent- repeat both tests C. the diarrhea is not due to carbohydrate intolerance D. the test provided no useful information
Correct Answer: A
An oncology patient has the following results: Day 1 Day 3 WBC: 8.0 x 10^3/uL 2.0 x 10^3/uL (8.0 x 10^9/L) (2.0 x 10^9/L) RBC: 3.50 x 10^6/uL 3.45 x 10^6/uL (3.50 x 10^12/L). (3.45 x 10^12/L) Hgb: 10.0 g/dL (100 g/L) 9.9 g/dL (99 g/L) Hct: 29.8% 29.5% Plt: 180 x 10^3/uL 150 x 10^3/uL (180 x 10^9/L) (150 x 10^9/L) The most probable explanation is: A. chemotherapy B. cold antibody C. clotted specimen D. inadequate mixing
Correct Answer: A
An unexplained elevation of the prothrombin time (PT) in a 72-year-old smoker who has been diagnosed with chronic pulmonary obstructive disease is most likely due to: A. an elevated hematocrit B. a decreased hematocrit C. vitamin K deficiency D. decreased thrombin activity
Correct Answer: A
Anti-E is identified in a panel at the antiglobulin phase. When check cells are added to the tubes no agglutination is seen. The most appropriate course of action would be to: A. quality control the AHG reagent and check cells and repeat the panel B. open a new vial of check cells for subsequent testing that day C. open a new vial of AHG for subsequent testing that day D. record the check cell reactions and report the antibody panel result
Correct Answer: A
Arterial blood that is collected in a heparinized syringe but exposed to room air would be most consistent with the changes in which of the following specimens? Specimen; PO2; PCO2; pH -A: elevated; decreased; elevated -B: decreased; elevated; decreased -C: unchanged; elevated; unchanged -D: decreased; decreased: decreased A. specimen A B. specimen B C. specimen C D. specimen D
Correct Answer: A
Aspartate amino transferase (AST) is characteristically elevated in disease of the: A. liver B. kidney C. intestine D. pancreas
Correct Answer: A
Autoantibodies demonstrating blood group specificity in warm autoimmune hemolytic anemia are associated more often with which blood group system? A. Rh B. I C. P D. Duffy
Correct Answer: A
Biochemical abnormalities characteristic of polycythemia vera include: A. increased serum B12 binding capacity B. hypouricemia C. hypohistaminemia D. decreased leukocyte alkaline phosphatase activity
Correct Answer: A
Blood collected in EDTA undergoes which of the following changes if kept at room temperature for 6-24 hours? A. increased hematocrit and MCV B. increased ESR and MCV C. increased MCHC and MCV D. decreased reticulocyte count and hematocrit
Correct Answer: A
Blood selected for exchange transfusion must: A. lack red blood cell antigens corresponding to maternal antibodies B. be < 3 days old C. be the same Rh type as the baby D. be ABO compatible with the father
Correct Answer: A
Blood was collected in a serum separator tube on a patient who has been fasting since midnight. The time of collection was 7 AM. The laboratory test wich should be recollected is: A. triglycerides B. iron C. LD D. sodium
Correct Answer: A
Bromcresol purple at a pH of 5.2 is used in a colorimetric method to measure: A. albumin B. globulin C. Bence Jonce protein D. immunoprotein
Correct Answer: A
Coulometry is often used to measure: A. chlorid ein sweat B. the pH in saliva C. bicarbonate in urine D. ammonia in plasma
Correct Answer: A
Cryoprecipitated AHF must be transfused within what period of time following thawing and pooling? A. 4 hours B. 8 hours C. 12 hours D. 24 hours
Correct Answer: A
D-dimers are produced from: A. cross-linked and stabilized fibrin clot B. decreased fibrinogen and platelets C. plasminogen converting to plasmin D. generation of thrombin from endothelial cells
Correct Answer: A
Detection of which of the following substances is most useful to monitor the course of a patient with testicular cancer? A. alpha-fetoprotein B. carcinoembryonic antigen C. prolactin D. testosterone
Correct Answer: A
Elevation of the lymphocyte percentage above 47% is termed: A. relative lymphocytosis B. absolute lymphocytosis C. leukocytosis D. absolue neutrophilic leukocytosis
Correct Answer: A
Evidence of active red cell regeneration may be indicated on a blood smear by: A. basophilic stippling, nucleated red blood cells and polychromasia B. hypochromia, microcytes and nucleated red blood cells C. hypochromia, basophilic stippling and nucleated red blood cells D. Howell-Jolly bodies, Cabot rings and basophilic stippling
Correct Answer: A
Factors that contribute to a PCO2 electrode requiring 60-120 seconds to reach equilibrium include the: A. difussion characteristics of the membrane B. actual blood PO2 C. type of calibrating standard (i.e. liquid or humidified gas) D. potential of the polarizing mercury cell
Correct Answer: A
Fresh Frozen Plasma form a group A, Rh-positive donor may be safely transfuse to a patient when is group: A. A, Rh-negative B. B, Rh-negative C. AB, Rh-positive D. AB, Rh-negative
Correct Answer: A
Given the following results: -alkaline phsophatase: slight increase -aspartate amino transferase: marked increase -alanine amino transferase: marked increase -gamma-glutamyl transferase: slight increase This is most consistent with: A. acute hepatitis B. chronic hepatitis C. obstructive jaundice D. liver hamangioma
Correct Answer: A
Given the following typing results, what is this donor's racial ethnicity? -Le(a-b-); Fy(a-b-); Js(a+b+) A. African American B. Asian American C. Native American D. Caucasian
Correct Answer: A
Hemoglobin S can be separated form hemoglobin D by: A. electrophoresis on a different medium and acidic pH B. hemoglobin A2 quantitation C. electrophoresis at hight voltage D. Kleihauer-Betke acid elution
Correct Answer: A
Hemoglobin S can be separated from hemoglobin D by which of which of the following methods? A. agar gel electrophoresis at pH 5.9 B. thin-layer chromatography C. alkali denaturation D. ammonium precipitation
Correct Answer: A
IN the immunoinhibition phase of CKMB procedure: A. M subunit is inactivated B. B subunit is inactivated C. MB is inactivated D. BB is inactivated
Correct Answer: A
In a pH meter reference electrodes may include: A. silver-silver chloride B. quihydrone C. hydroxide D. hydrogen
Correct Answer: A
In amniotic fluid, the procedure used to detect hemolytic disease of the newborn is: A. measurement of absorbance at 450 nm B. creatinine C. lecithin/sphingomyelin ratio D. estriol
Correct Answer: A
In an emergency situation, Rh-negative red cells are transfused into an Rh-positive person of the genotype CDe/CDe. The first antibody most likely to develop is: A. anti-c B. anti-d C. anti-e D. anti-E
Correct Answer: A
In flow cytometric analysis, low angle or forward scatter of a laser light beam provides information that pertains to a cell's: A. volume B. viability C. granularity D. lineage
Correct Answer: A
In polycythemia vera, the hemoglobin, hematocrit, red blood cell count and red cell mass are: A. elevated B. normal C. decreased
Correct Answer: A
In polycythemia vera, the leukocyte alkaline phosphatase activity is: A. elevated B. normal C. decreased
Correct Answer: A
In polycythemia vera, the platelet count is: A. elevated B. normal C. decreased D. variable
Correct Answer: A
In synovial fluid, the most characteristic finding in pseudogout is A. calcium pyrophosphate dihydrate crystals B. cartilage debris C. monosodium urate crystal D. hemosiderin-laden macrophages
Correct Answer: A
In the Jendrassik-Grof method for the determination of serum bilirubin concentration, quantitation is obtained by measuring the green color of: A. azobilirubin B. bilirubin glucuronide C. urobilin D. urobilinogen
Correct Answer: A
In the assay of lactate dehydrogenase (LD), the reaction is dependent upon which of the following coenzyme systems? A. NAD/NADH B. ATP/ADP C. Fe++/Fe+++ D. Cu/Cu++
Correct Answer: A
In the assay of lactate dehydrogenase, which of the following products is actually measured? A. NADH B. ATP C. lactic acid D. pyruvic acid
Correct Answer: A
In the liquid state, plasma must be stored at: A. 1-6 C B. 22 C C. 37 C D. 56 C
Correct Answer: A
Increase concentration of alpha-fetoprotein (AFP) in adults are most characteristically associated with: A. hepatocellular carcinoma B. alcoholic cirrhosis C. chronic active hepatitis D. multiple myeloma
Correct Answer: A
Laboratory findings in hereditary spherocytosis do not include: A. decreased osmotic fragility B. increased autohemolysis corrected by glucose C. reticulocytosis D. shortened erythrocyte survival
Correct Answer: A
Leukocyte-Poor Red Blood Cells would most likely be indicated for patients with a history of: A. febril transfusion reaction B. iron deficiency anemia C. hemophilia A D. von Willebrand disease
Correct Answer: A
Low molecular weight heparin is monitored by a : A. anti-Xa assay B. APTT C. PT D. anti-IIa assay
Correct Answer: A
Night blindness is associated with deficiency of which of the following vitamins? A. A B. C C. niacin D. thiamine
Correct Answer: A
Of the following disease, the one most often associate with elevations of lactate dehydrogenase isoenzymes 4 and 5 on electrophoresis is: A. liver disease B. hemolytic anemia C. myocardial infarction D. pulmonary edema
Correct Answer: A
Of the following, the disease most closely associated with cytoplasmic granule fusion is: A. Chediak-Higashi syndrome B. Pelger-Huet anomaly C. May-Hegglin anomaly D. Alder-Reilly anomaly
Correct Answer: A
Of the following, the disease most closely associated with glucocerebrosidase deficiency is: A. Gaucher disease B. Cheidak-Higashi syndrome C. Pelger-Huet anomaly D. May-Hegglin anomaly
Correct Answer: A
Peripheral blood smears from patients with untreated pernicious anemia are characterized by: A. pancytopenia and macrocytosis B. leukocytosis and elliptocytosis C. leukocytosis and ovalocytosis D. pancytopenia and microcytosis
Correct Answer: A
Plasma for cortisol determinations were collected at 7 AM, after waking the patient, and at 10 PM that evening. The cortisol level of the morning sample was higher than the evening sample. This is consistent with: A. a normal finding B. Cushing syndrome C. Addison disease D. hypopituitarism
Correct Answer: A
Plasma from a patient with lupus coagulation inhibitor can show: A. a prolonged APTT and PT B. a prolonged thrombin time C. no change with platelet neutralization D. complete correction when incubated with normal plasma
Correct Answer: A
Platelet aggregation is dependent in vitro on the presence of: A. calcium ions B. sodium citrate C. thrombin D. potassium
Correct Answer: A
Prothrombin is: A. a protein formed by the liver in the presence of Vitamin K B. an enzyme that converts fibrinogen into fibrin threads C. the end product of the reaction between fibrinogen and thrombin D. a protein released by platelets during coagulation
Correct Answer: A
Refer to the following diagram: See BOC Pic 1 pg 8 Given the most probable genotypes of the parents, which of the following statements best describes the most probable Rh genotypes of the 4 children? A. 2 are R1r, 2 are R1R1 B. 3 are R1r, 1 is rr C. 1 is R0r, 1 is R1r, 2 are R1R1 D. 1 is R0r', 1 is R1R1, 2 are R1r
Correct Answer: A
Refer to the following illustration: See BOC pg 161 Pic 2 Which electrophoresis pattern is consistent with sickle cell trait? A. pattern A B. pattern B C. pattern C D. pattern D
Correct Answer: A
Refer to the following panel: See BOC Panel 1 pg 38 Based on the results of the above panel, which technique would be most helpful in determining antibody specificity? A. proteolytic enzyme treatment B. urine neutralization C. autoadsorption D. saliva inhibition
Correct Answer: A
Respiratory acidosis is described as a(n): A. increase in CO2 content and PCO2 with a decreased pH B. decrease in CO2 content with an increased pH C. increase in CO2 content with an increased pH D. decrease in CO2 content and PCO2 with a decreased pH
Correct Answer: A
Severe diarrhea causes: A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis
Correct Answer: A
Severe intravascular hemolysis is most likely caused by antibodies of which blood group system? A. ABO B. Rh C. Kell D. Duffy
Correct Answer: A
Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of A. complement B. anticoagulants C. preservatives D. penicillin
Correct Answer: A
Specific (secondary) granules of the neutrophilic granulocyte: A. appear first at the myelocyte stage B. contain lysosomal enzymes C. are formed on the mitochondria D. are derived from azurophil (primary) granules
Correct Answer: A
The M:E ratio in polycythemia vera is usually: A. normal B. high C. low D. variable
Correct Answer: A
The Philadelphia chromosome is formed by a translocation between the: A. long arm of chromosome 22 and long arm of chromosome 9 B. long arm of chromosome 21 and long arm of chromosome 9 C. long arm of chromosome 21 and short arm of chromosome 6 D. long arm of chromosome 22 and short arm of chromosome 6
Correct Answer: A
The RDW-CV and RDW-SD performed by automated cells counters are calculations that provide: A. an index of the distribution of RBC volumes B. a calculated mean RBC hemoglobin concentration C. a calculate mean cell hemoglobin D. the mean RBC volume
Correct Answer: A
The antibodies of the Kidd blood group system: A. react best by the indirect antiglobulin test B. are predominantly IgM C. often cause allergic transfusion reactions D. do not generally react with antigen positive, enzyme treated RBCs
Correct Answer: A
The antibody in the Lutheran system that is best detected at lower temperatures is: A. anti-Lu^a B. anti-Lu^b C. anti-Lu^3 D. anti-Lu^ab
Correct Answer: A
The buffer pH most effective at allowing amphoteric proteins to migrate toward the cathode in an electrophoretic system would be: A. 4.5 B. 7.5 C. 8.6 D. 9.5
Correct Answer: A
The chamber counting method of platelet enumerations: A. allows direct visualization of the particles being counted B. has a high degree of precision C. has a high degree of reproducibility D. is the method of choice for the performance of 50-60 counts per day
Correct Answer: A
The characteristic morphologic feature in folic acid deficiency is: A. macrocytosis B. target cells C. basophilic stippling D. rouleaux formation
Correct Answer: A
The erythrocyte sedimentation rate (ESR) can be falsely elevated by: A. tilting the tube B. refrigerated blood C. air bubbles in the column D. specimen being too old
Correct Answer: A
The expected blood gas results for a patient in chronic renal failure would match the patter of: A. metabolic acidosis B. respiratory acidosis C. metabolic alkalosis D. respiratory alkalosis
Correct Answer: A
The following data was obtained from a cellulose acetate protein electrophoresis scan: -albumin are: 75 units -gamma globulin are: 30 units -total area: 180 units -total protein: 6.5 g/dL (65 g/L) The gamma globulin content in g/dL is: A. 1.1 g/dL (11 g/L) B. 2.7 g/dL (27 g/L) C. 3.8 g/dL (38 g/L) D. 4.9 g/dL (49 g/L)
Correct Answer: A
The following results were obtained on a 45-year-old man complaining of chills and fever: -WBC: 23.0 x 10/uL (23.0 x 10^9/L) -LAP: 200 -Philadelphia chromosome: negative Differential: -Segs: 60% -Band: 21% -Lymphs: 11% -Monos: 3% -Metamyelos: 2% -Myelos: 3% Toxic granulatioin, Dohle bodies and vacuoles A. neutrophilic leukemia reaction B. polycythemia vera C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis
Correct Answer: A
The following results were obtained: -urine creatinine: 90 mg/dL (7956 umol/L) -serum creatinine: 0.90 mg/dL (79.6 umol/L) -patient's total body surface: 1.73 m^2 (average =1.7 m^2) -total urine volume in 24 hours: 1500 mL Given the above date, the patient's creatinine clearance, in mL/min is: A. 104 B. 124 C. 144 D. 150
Correct Answer: A
The most appropriate laboratory test for early detection of acute postransfusion hemolysis is: A. a visual inspection for free plasma hemoglobin B. plasma haptoglobin concentration C. examination for hematuria D. serum bilirubin concentration
Correct Answer: A
The most characteristic morphologic features of atypical lymphocytes include: A. coarse nuclear chromatin and basophilic cytoplasm B. blue-grey cytoplasm, fine nuclear chromatin C. nucleoli and deep blue RNA-rich cytoplasm D. a stretched nucleus and cytoplasmic indentations
Correct Answer: A
The most common form of child hood leukemia is: A. acute lymphocytic B. acute granulocytic C. acute monocytic D. chronic granulocytic
Correct Answer: A
The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is: A. folic acid deficiency B. increased reticulocyte count C. inadequate B12 absorption D. pyridoxine deficiency
Correct Answer: A
The most potent plasminogen activator in the contact phase of coagulation is: A. kallikrein B. Streptokinase C. HMWK D. fibrinogen
Correct Answer: A
The most serious hemolytic transfusion reactions are due to incompatibility in which of the following blood group systems? A. ABO B. Rh C. MN D. Duffy
Correct Answer: A
The most specific method for the assay of glucose utilizes: A. hexokinase B. glucose oxidase C. glucose-6-phosphatase D. glucose dehydrogenase
Correct Answer: A
The osmolality of a urine or serum specimen is measured by a change in the A. freezing point B. sedimentation point C. midpoint D. osmotic pressure
Correct Answer: A
The photo-optical method of endpoint detection is described as: A. change in optical density as a result of a fibrin clot B. measurement of turbidity of antigen-antibody formation C. decreased motion of a mechanical ball D. color-producing chromophor
Correct Answer: A
The primary function of serum albumin in the peripheral blood is to: A. maintain colloidal osmotic pressure B. increase antibody production C. increase fibrinogen formation D. maintain blood viscosity
Correct Answer: A
The principle of confirmatory test for hereditary spherocytosis is: A. osmotic fragility B. sucrose hemolysis C. heat instability test D. Kleihauer-Betke
Correct Answer: A
The protein portion of an enzyme complex is called the: A. apoenzyme B. coenzyme C. holoenzyme D. proenzyme
Correct Answer: A
The rosette test will detect a fetomaternal hemorrhage (FMH) as small as: A. 10 mL B. 15 mL C. 20 mL D. 30 mL
Correct Answer: A
The screen for adrenal cortical hyperfunction with the greatest sensitivity and specificity is: A. 24-hour urine free cortisol B. plasma cortisol C. urinary 17-hydroxycorticosteroids D. plasma corticosterone
Correct Answer: A
The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in: A. EDTA B. oxalate C. citrate D. heparin
Correct Answer: A
Total glycosylated hemoglobin levels in a hemolysate reflect the: A. average blood glucose levels of the past 2-3 months B. average blood glucose levels for the past week C. blood glucose level at the time the sample is drawn D. hemoglobin A1C level at the time the sample is drawn
Correct Answer: A
Transfusion of Ch+ (Chido positive) red cells to a patient with anti-Ch has been reported to cause: A. no clinically significant red cell destruction B. clinically significant immune red cell destruction C. decreased 51Cr red cell survivals D. febrile transfusion reaction
Correct Answer: A
What is the best method to diagnose lactase deficiency? A. H2 breath test B. plasma aldolase level C. LDH level D. D-xylose test
Correct Answer: A
What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility? A. ABO and Rh typing only B. ABO/Rh type, antibody screen C. ABO/Rh type, antibody screen, crossmatch D. no pretransfusion testing is required for autologous donations
Correct Answer: A
When evaluating a suspected transfusion reaction, which of the following is the ideal sample collection time for a bilirubin determination? A. 6 hours postransfusion B. 12 hours postransfusion C. 24 hours postransfusion D. 48 hours postransfusion
Correct Answer: A
When myocardial infarction occurs, the first enzyme to become elevated is: A. CK B. LD C. AST D. ALT
Correct Answer: A
Which characteristics are true of all 3 of the following antibodies: anti-Fy^a, anti-Jk^a, and anti-K? A. detected at IAT phase and may cause hemolytic disease of the fetus and newborn (HDFN) and transfusion reactions B. not detected with enzyme treated cells; may cause delayed transfusion reactions C. requires the IAT technique for detection; usually not responsible for causing HDFN D. may show dosage effect; may cause severe hemolytic transfusion reactions
Correct Answer: A
Which of the following applies to cryoscopic osmometry? A. temperature at equilibrium is a function of the number of particles in solution B. temperature plateau for a solution is horizontal C. freezing point of a sample is absolute D. initial freezing of a sample produces an immediate solid state
Correct Answer: A
Which of the following cells is the atypical lymphocyte seen on the peripheral blood smear of patients with infectious mononucleosis? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells
Correct Answer: A
Which of the following cells is the largest cell in the bone marrow: A. megakaryocyte B. histiocyte C. osteoblast D. mast cell
Correct Answer: A
Which of the following detects or measures platelet function? A. bleeding time B. prothrombin time C. thrombin time D. partial thromboplastin time
Correct Answer: A
A unit of Whole Blood-derived (random donor) Platelets should contain at least: A. 1.0 x 10^10 platelets B. 5.5 x 10^10 platelets C. 5.5 x 10^11 platelets D. 90% of the platelets form the original unit of Whole Blood
Correct Answer: B
Which of the following enzymes are used in the diagnosis of acute pancreatitis? A. amylase (AMS) and lipase (LPS B. aspartate aminotransferase (AST) and alanine aminotransferase (ALT) C. 5'-nucleotide (5' N) and gamma-glutamyl transferase (GGT) D. aspartate aminotransferase (AST) and lactate dehydrogenase (LD)
Correct Answer: A
Which of the following is a characteristic of Factor XII deficiency? A. negative bleeding history B. normal blotting times C. decreased risk of thrombosis D. epistaxis
Correct Answer: A
Which of the following is a glycolytic enzyme that catalyzes the cleavage of fructose-1, 6-diphosphate to glyceraldeyde-3-phosphate and dihydroxyacetone phosphate? A. aldolase B. phosphofructokinase C. pyruvate kinase D. glucose-6-phosphate dehydrogenase
Correct Answer: A
Which of the following is associated with Chediak-Higashi syndrome? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. 2-lobed neutrophils D. mucopolysaccharidosis
Correct Answer: A
Which of the following is characteristic of Bernard-Soulier syndrome? A. giant platelets B. normal bleeding time C. abnormal aggregation with ADP D. increased platelet count
Correct Answer: A
Which of the following is characterstic of Tn polyagglutinable red cells? A. if group O, they may appear to have acquired a group A antigen B. they show strong reactions when the cells are enzyme treated C. they react with Arachis hpgaea lectin D. the polyagglutination is a transient condition
Correct Answer: A
Which of the following is most closely associated with erythroleukemia? A. ringed sideroblasts, nuclear budding and Howell-Jolly bodies B. disseminated intravascular coagulation C. micromegakaryocytes D. lysozymuria
Correct Answer: A
Which of the following is most likely to be ordered in addition to serum calcium to determine the cause of tetany? A. magnesium B. phosphate C. sodium D. vitamin D
Correct Answer: A
Which of the following is proper procedure for preparation of Platelets from Whole Blood? A. light spin followed by a hard spin B. light spin followed by 2 hard spins C. 2 light spins D. hard spin followed by a light spin
Correct Answer: A
Which of the following is the formula for MCHC? A. (Hgb x 100)/ Hct B. Hgb/RBC C. RBC/Hct D. (Hct x 1000)/RBC
Correct Answer: A
Which of the following is the formula for manual white cell count? A. (number of cells counted x dilution x 10)/ number of squares counted B. (number of cells counted x dilution)/10 x number of squares counted C. number of cells counted x dilution D. number of cells counted x number of squares counted
Correct Answer: A
Which of the following is true about direct ion selective electrodes for electrolytes? A. whole blood specimens are acceptable B. elevated lipids cause falsely decreased results C. elevated proteins cause falsely decreased results D. elevated platelets cause falsely increased results
Correct Answer: A
Which of the following is useful in the detection and management of carcinoma of the prostate? A. total prostate-specific antigen B. prostatic acid phosphatase C. human chorionic gonadotropin D. alpha-fetaprotein
Correct Answer: A
Which of the following methods is susceptible to the solvent displacing effect that results in falsely decreased electrolyte values? A. indirect ion-selective electrodes B. direct ion-selective electrodes C. spectrophotometric D. fluorescence
Correct Answer: A
Which of the following phenotypes will react with anti-f? A. rr B. R1R1 C. R2R2 D. R1R2
Correct Answer: A
Which of the following red cell antigens are found on glycophorin-A? A. M, N B. Le^a, Le^b C. S, s D. P, P1, P^k
Correct Answer: A
Which of the following represents an acceptably identified patient for sample collection and transfusion? A. a handwritten band with patient's name and hospital identification number is affixed to the patient's leg B. the addressographed hospital band is taped to the patient's bed C. an unbanded patient responds positively when his name is called D. the chart transported with the patient contains his armband not yet attached
Correct Answer: A
Which of the following stains is closely associated with the lysosomal enzyme in primary (azurophilic) granules? A. peroxidase B. Sudan black B C. periodic acid-Schiff (PAS) D. Prussian blue
Correct Answer: A
Which of the following tests is most commonly used to detect antibodies attached to a patient's red blood cells in vivo? A. direct antiglobulin B. complement fixation C. indirect antiglobulin D. immunofluorescence
Correct Answer: A
Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC and renal failure? A. bacterial contamination B. circulatory overload C. febrile D. anaphylactic
Correct Answer: A
Which unit should be selected for exchange transfusion if the newborn is group A, Rh-positive and the mother is group A, Rh-positive with anti-c? A. A, CDe/CDe B. A, cDE/cDE C. O, cde/cde D. A, cde/cde
Correct Answer: A
90% of the copper present in the blood is bound to: A. transferrin B. ceruloplasmin C. albumin D. cryoglobulin
Correct Answer: B
A 2-year-old child with a decreased serum T4 is described as being somewhat dwarfed, stocky, overweight, and having coarse features. Of the following, the most informative additional laboratory test would be the serum: A. thyroxine binding globulin (TBG) B. thyroid-stimulating hormone (TSH) C. triiodothyronine (T3) D. cholesterol
Correct Answer: B
A 29-year-old male is hemorrhaging severely. He is AB, Rh-negative. 6 units of blood are required STAT. Of the following types available in the blood bank, which would be most preferable for crossmatch? A. AB, Rh-positive B. A, Rh-negative C. A, Rh-positive D. O, Rh-negative
Correct Answer: B
After the removal of red blood cells from the circulation hemoglobin is broken down into: A. iron, porphyrin, and amino acids B. iron, protoporphyrin, and globin C. heme, protoporphyrin, and amino acids D. heme, hemosiderin, and globin
Correct Answer: B
A 42-year-old male of average body mass has a history of chronic anemia requiring transfusion support. Two units of Red Blood Cells are transfuse. If the pretransfusion hemoglobin was 7.0 g/dL (70 g/L), the expected postransfusion hemoglobin concentration should be: A. 8.0 g/dL (80 g/L) B. 9.0 g/dL (90 g/L) C. 10.0 g/dL (100 g/L) D. 11.0 g/dL (110 g/L)
Correct Answer: B
A Kleihauer-Betke stain of postpartum blood film revealed 0.3% fetal cells. What is the estimated volume (mL) of the fetomaternal hemorrhage expressed as whole blood? A. 5 B. 15 C. 25 D. 35
Correct Answer: B
A blood component prepared by thawing Fresh Frozen Plasma at refrigeratory temperature and removing the fluid portion is: A. Plasma Protein Fraction B. Cryoprecipitated AHF C. Factor IX Complex D. FP24
Correct Answer: B
A citrated blood specimen for coagulation studies is to be collected rom a polycythemic patient. The anticoagulant should be: A. the standard volume B. reduced in volume C. changed to EDTA D. changed to oxalate
Correct Answer: B
A common source of interference in the cyanmethemoglobin method is: A. hemolysis B. very high WBC count C. cold agglutinins D. clumped platelets
Correct Answer: B
A donor is tested with Rh antisera with the following results: -anti-D: + -anti-C: + -anti-E: 0 -anti-c: + -anti-e: + -Rh control: 0 What is his most probable Rh genotype? A. R1R1 B. R1r C. R0r D. R2r
Correct Answer: B
A group B, Rh-negative patient has a positive DAT. Which of the following situations would occur? A. all major crossmatches would be incompatible B. the weak D test and control would be positive C. the antibody screening test would be positive D. the forward and reverse ABO groupings would not agree
Correct Answer: B
A healthy person with a blood glucose of 80 mg/dL (4.4 mmol/L) would have a simultaneously determined cerebrospinal fluid glucose value of: A. 25 mg/dL ( 1.4 mmol/L) B. 50 mg/dL (2.3 mmol/L) C. 100 mg/dL (5.5 mmol/L) D. 150 mg/dL (8.3 mmol/L)
Correct Answer: B
A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely to be abnormal in this patient? A. platelet count B. template bleeding time C. prothrombin time D. activated partial thromboplastin time
Correct Answer: B
A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and shows a homogeneous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of: A. polycythemia vera B. systemic lupus erythematosus C. iron deficiency anemia D. hemoglobin SC disease
Correct Answer: B
A patient has the following thyroid profile: -total T4: decreased -free T4: decreased -thyroid peroxidase antibody: positive -TSH: decreased This patient most probably has: A. hyperthyroidism B. hypothyroidism C. a normal thyroid D. Graves disease
Correct Answer: B
A patient received about 15 mL of compatible blood and developed severe shock, but no fever. If the patient need another transfusion, what kind of red blood cell component should be given? A. Red Blood Cells B. Red Blood cells, Washed C. Red Blood Cells, Irradiated D. Red Blood Cells, Leukocyte-Reduced
Correct Answer: B
A patient with severe anemia became cyanotic and developed tachycardia, hypertension, and difficulty breathing after receiving 3 units of blood. No fever or other symptoms were evident. This is most likely what type of reaction? A. febrile reaction B. transfusion-associated circulatory overload (TACO) C. anaphylactic reaction D. hemolytic reaction
Correct Answer: B
A phase-platelet count is performed using a platlet Unopette (dilution = 1:100). 155 platelets are counted on one side of the hemacytometer in the center square millimeter, and 145 are counted on the other side in the same are. After making the appropriate calculations, the next step would be to: A. repeat the procedure, using a 1:20 dilution with acetic acid B. report the calculated value C. collect a new specimen D. repeat the procedure, using a 1:200 dilution with saline
Correct Answer: B
A posttransfusion blood sample form a patient experiencing chills and fever shows distinct hemolysis. The direct antiglobulin test is positive (mixed field). What would be most helpful to determine the cause of the reaction? A. auto control B. elution and antibody identification C. repeat antibody screen on the donor unit D. bacteriologic smear and culture
Correct Answer: B
A reason why a patient's crossmatch may be incompatible while the antibody screen in negative is: A.the patient has an antibody against a high-incidence antigen B. the incompatible donor unit has a positive direct antiglobulin test C. cold agglutinins are interfering in the crossmatch D. the patient's serum contains warm autoantibody
Correct Answer: B
A reciprocal relationship exists between: A. sodium and potassium B. calcium and phosphate C. chloride and CO2 D. calcium and magnesium
Correct Answer: B
A salicylate level is performed to detect toxicity caused by ingestion of excess: A. acetaminphen B. aspirin C. ibuprofen D. pseudoephedrine
Correct Answer: B
A screening test for paroxysmal nocturnal hemoglobinuria is: A. heat instability test B. sucrose hemolysis C. osmotic fragility D. dithionite solubility
Correct Answer: B
A serum sample demonstrates an elevated result when tested with the Jaffe reaction. This indicates; A. prolonged hypothermia B. renal functional impairment C. pregnancy D. arrhythmia
Correct Answer: B
A serum sample was assayed bilirubin at 10 am, and the result was 12 mg/dL (205.6 umol/L). The same sample was retested at 3 pm. The result now is 8 mg/dL (136.8 umol/L). The most likely explanation for this discrepancy is; A. the reagent has deteriorated B. the sample was exposed to light C. a calculation error in the first assay D. the sample was not refrigerated
Correct Answer: B
A total leukocyte count is 10.0 x 10^3/uL (10.0 x 10^9/L) and 25 NRBCs are seen per 100 leukocytes on the differential. What is the corrected leukocyte count? A. 2,000/uL (2.0 x 10^9/L) B. 8,000/uL (8.0 x 10^9/L) C. 10,000/uL (10.0 x 10^9/L) D. 12,000/uL (12.0 x 10^9/L)
Correct Answer: B
Aliquots of plasma with a prolonged PT and prolonged APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37 C and tested at 10-, 30-, and 60-minute intervals. The PT and APTT results on all of the mixtures are corrected. These results would indicated the presence of: A. circulating anticoagulant B. factor deficiency C. contaminated reagent D. antibodies
Correct Answer: B
All of the following conditions are myeloproliferative disorders except: A. myelocyic leukemia B. lymphocytic leukemia C. polycythemia vera D. idiopathic thrombocythemia
Correct Answer: B
Amino transferase enzymes catalyze the: A. exchange of amino groups and sulfhydryl groups between alpha-amino and sulfur-containing acids B. exchange of amino and keto groups between alpha-amino and alpha-keto acids C. hydrolysis of amino acids and keto acids D. reversible transfer of hydrogen form amino acids to coenzyme
Correct Answer: B
An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is: A. lactate dehydrogenase deficiency B. G-6-PD deficiency C. pyruvate kinase deficiency D. hexokinase deficiency
Correct Answer: B
An increased amount of cytoplasmic basophilia in a blood cell indicates: A. increased cytoplasmic maturation B. decreased cytoplasmic maturation C. reduction in size of the cell D. decreased nuclear maturation
Correct Answer: B
Anti-I may cause a positive direct antiglobulin test (DAT) because of: A. anti-I agglutinating the cells B. C3d bound to the red cells C. T-activation D. Cec remaining on the red cells after cleavage of C3b
Correct Answer: B
Anti-Sd^a is strongly suspected if: A. the patient has been previously transfused B. the agglutinates are mixed-field and refractile C. the patient is group A or B D. only a small number of panel cells are reactive
Correct Answer: B
As part of a hyperlipidemia screening program, the following resutls were obtianed on a 25-year-old woman 6 hours after eating: -triglycerides: 260 mg/dL (2.86 mmol/L) -cholesterol: 120 mg/dL (3.12 mmol/L) Which of the following is the best interpretation of these results? A. both results are normal, and not affected by the recent meal B. cholesterol is normal, but triglycerides are elevated, which may be attributed to the recent meal C. both results are elevated, indicating a metabolic problem in addition to the nonfasting state D. both results are below normal despite the recent meal, indicating a metabolic problem
Correct Answer: B
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are both elevated in which of the following diseases? A. muscular dystrophy B. viral hepatitis C. pulmonary emboli D. infectious monoculeosis
Correct Answer: B
At blood pH 7.40, what is the ratio fo bicarbonate to carbonic acid? A. 15:1 B. 20:1 C. 25:1 D. 30:1
Correct Answer: B
At the indirect antiglobulin phase of testing, there is no agglutination between patient serum and screening cells. One of 3 donor units was incompatible. The most probable explanation for these findings is that the: A. patient has an antibody directed against a high incidence antigen B. patient has an antibody directed against a low incidence antigen C. donor has an antibody directed against donor cells D. donor has a positive antibody screen
Correct Answer: B
Based upon Kleihauer-Betke test results, which of the following formulas is used to determine the volume of fetomaternal hemorrhage expressed in mL of whole blood? A.% of fetal cells present x 30 B. % of fetal cells present x 50 C. % of maternal cells present x 30 D. % of maternal cells present x 50
Correct Answer: B
Below are the results of the history obtained from a prospective female blood donor: -Age: 16 - Temperature: 99.0 F (37.2C) -Hct: 36% -history: tetanus toxoid immunization 1 week previously How many of the above results excludes this donor from giving blood for a routine transfusion? A. none B. 1 C. 2 D. 3
Correct Answer: B
Blood PCO2 may be measured by: A. direct colorimetric measurement of dissolved CO2 B. a self-contained potentiometric electrode C. measurement of CO2-saturated hemoglobin D. measurement of CO2 consumed at the cathode
Correct Answer: B
Calcium concentration in the serum is regulated by: A. insulin B. parathyroid hormone C. thyroxine D. vitamin C
Correct Answer: B
Cerebrospinal fluid for glucose assay should be: A. refrigerated B. analyzed immediately C. heated to 56C D. stored at room temperature after centrifugation
Correct Answer: B
Clinical assays for tumor markers are most important for: A. screening for he presence of cancer B. monitoring the curse of a known cancer C. confirming the absence of disease D. identifying patients at risk for cancer
Correct Answer: B
During a normal pregnancy, quantitative human chorionic gonadotropin (HCG) levels peak how many weeks after the las menstrual period? A. 2-4 B. 8-10 C. 14-16 D. 18-20
Correct Answer: B
During the preparation of Platelet Concentrates form Whole Blood, the blood should be : A. cooled towards 6C B. cooled towards 20-24C C. warmed to 37 C D. heated to 57 C
Correct Answer: B
Evidence indicates that the genetic defect in thalassemia usually results in: A. the production of abnormal globin chains B. a quantitative deficiency in RNA resulting in decreased globin chain production C. a structural change in the heme portion of the hemoglobin D. an abnormality in the alpha- or beta- chain binding or affinity
Correct Answer: B
Given the following data: -WBC: 8.5 x 10^3/uL (8.5 x 10^9/L) Differential: -Segs: 56% -Bands: 2% -Lymphs: 30% -Monos:6% -Eos: 6% What is the absolute eosinophil count? A. 170/uL (0.17 x 10^9/L) B. 510/uL (0.51 x 10^9/L) C. 2,550/uL (2.55 x 10^9/L) D. 4,760/uL (4.76 x 10^9/L)
Correct Answer: B
Given the following results; -alkaline phosphatase: slight increase -aspartate aminotransferase: slight increase -alanine aminotransferase: slight increase -gamma-glutamyl transferase: slight increase This is most consistent with: A. acute hepatitis B. chronic hepatitis C. obstructive jaundice D. liver hemangioma
Correct Answer: B
Granulocytes for transfusion should: A. be administered through a microaggregate filter B. be ABO compatible with the recipient's serum C. be infused within 72 hours of collection D. never be transfused to patients with a history of febrile transfusion reactions
Correct Answer: B
HLA antibodies are: A. naturally occurring B. induced by multiple transfusions C. directed against granulocyte antigens only D. frequently cause hemolytic transfusion reactions
Correct Answer: B
HLA antigen typing is important in screening for: A. ABO incompatibility B. a kidney donor C. Rh incompatibility D. a blood donor
Correct Answer: B
Hives and itching are symptoms of which of the following transfusion reactions? A. febrile B. allergic C. circulatory overload D. bacterial
Correct Answer: B
How many units of Red Blood Cells are required to raise the hematocrit of a 70 kg nonbleeding man form 24% to 30%? A. 1 B. 2 C. 3 D. 4
Correct Answer: B
How would the hematocrit of a patient with chronic anemia be affected by the transfusion of a unit of Whole Blood containing 475 mL of blood, vs 2 units of Red Blood Cells each with a total volume of 250 mL? A. patient's hematocrit would be equally affected by the Whole Blood or the Red Blood Cells B. Red Blood Cells would provide twice the increment in hematocrit as the Whole Blood C. Whole Blood would provide twice the increment in hematocrit as the Red Blood Cells D. Whole Blood would provide a change in hematocrit slightly less than the Red Blood Cells
Correct Answer: B
Hydrogen ion concentration (pH) in blood is usually determined by means of which of the following electrodes? A. silver B. glass C. platinum D. platinum-lactate
Correct Answer: B
If a WBC count is performed on a 1:10 dilution and the number of cells counted in 8 squares is 120, the total WBC count is: A. 1,200/uL (1.2 x 10^9/L) B. 1,500/uL (1.5 x 10^9/L) C. 12,000/uL (12.0 x 10^9/L) D. 15,000/uL (15.0 x 10^9/L)
Correct Answer: B
If a WBC count is performed on a 1:100 dilution and the number of cells counted in 8 squares is 50, the total WBC count is: A. 5,000/uL (5.0 x 10^9/L) B. 6,250/uL (6.25 x 10^9/L) C. 50,000/uL (50.0 x 10^9/L) D. 62,500/uL (22.3 x 10^9/L)
Correct Answer: B
If a blood smear is dried too slowly, the red blood cells are often: A. clumped B. crenated C. lysed D. destroyed
Correct Answer: B
If a fasting glucose was 90 mg/dL, which of the following 2-hour postprandial glucose results would most closely represent normal glucose metabolism? A. 25 mg/dL (1.4 mmol/L) B. 50 mg/dL (2.3 mmol/L) C. 180 mg/dL (5.5 mmol/L) D. 260 mg/dL (14.3 mmol/L)
Correct Answer: B
If a patient presents with a prolonged APTT that does not correct upon mixing, the next performed should be: A. Factor II B. DRVVT C. Factor VIII D. platelet count
Correct Answer: B
If the seal is entered on a unit of Red Blood Cells stored at 1 C to 6 C, what is the maximum allowable storage period, in hours? A. 6 B. 24 C. 48 D. 72
Correct Answer: B
In a delayed hemolytic transfusion reaction , the direct antiglobulin test is typically: A. negative B. mixed-field positive C. positive due to complement D. negative when the antibody screen is negative
Correct Answer: B
In a delayed transfusion reaction, the causative antibody is generally too weak to be detected in routine compatibility testing and antibody screening tests, but is typically detectable at what point after transfusion? A. 3-6 hours B. 3-7 days C. 60-90 days D. after 120 days
Correct Answer: B
In a prenatal workup, the following results were obtained: Forward Group: anti-A; anti-B; anti-D; Rh control 4+, 2+, 4+, 0 Reverse Group: A1 cells; B cells 0, 3+ DAT: negative antibody screen: negative ABO discrepancy was thought to be due to an antibody directed against a component of the typing sera. Which test would resolve this discrepancy? A. A1 lectin B. wash patient's RBCs and repeat testing C. anti-A,B and extend incubation of the reverse group D. repeat reverse group using A2 cells
Correct Answer: B
In a relatioship testing case, the child has a genetic marker that is absent in the mother and cannot be demonstrated in the alleged father. What type of paternity exclusion is this known as? A. indirect B. direct C. prior probability D. Hardy-Weinberg
Correct Answer: B
In a the Clauss fibrinogen method, the time to clot formation in plasma is measured after the addition of: A. calcium B. thrombin C. phospholipids D. kaolin
Correct Answer: B
In an automated cell counter, the WBC printed result is "+++". The next step is to: A. repeat after warming the sample to 37 C B. make an appropriate dilution of the sample C. recalibrate the machine from pooled samples D. request a new sample immediately
Correct Answer: B
In an uncomplicated case of infectious mononucleosis, which of the following cells are affected? A. erythrocytes B. lymphocytes C. monocytes D. thrombocytes
Correct Answer: B
In the fasting state, the arterial and capillary blood glucose concentration varies form the venous glucose concentration by approximately how many mg/dL (mmol/L)? A. 1 mg/dL (0.05 mmol/L) higher B. 5 mg/dL (0.27 mmol/L) higher C. 10 mg/dL (0.55 mmol/L) lower D. 15 mg/dL (0.82 mmol/L) lower
Correct Answer: B
In the image below, the small nucleated cell seen in the lower left corner is a: See BOC pg 182 Pic 1 A. polychromatophilic normoblast (rubricyte) B. mature lymphocyte C. plasma cell D. lymphoblast
Correct Answer: B
In the process of identifying an antibody, the technologies observed 2+ reactions with 3 of the 10 cells in a panel after the immediate spin phase. There was no reactivity after incubation at 37C and after the anti-human globulin test phase. The antibody most likely is: A. anti-P1 B. anti-Le^a C. anti-C D. anti-Fy^a
Correct Answer: B
In which of the following conditions would a normal level of creatine kinase be found? A. acute myocardial infarct B. hepatitis C. progressive muscular dystrophy D. intramuscular injection
Correct Answer: B
On Monday, a patient's K antigen typing result was positive. Two days later, the patient's K typing was negative. The patient was transfused with 2 units of Fresh Frozen Plasma. The tech might conclude that the: A. transfusion of FFP affected the K typing B. wrong patient was drawn C. results are normal D. anti-K reagent was omitted on Manday
Correct Answer: B
Osmolal gap is the difference between: A. the ideal and real osmolality values B. calculated and measured osmolality values C. plasma and water osmolality values D. molality and molarity at 4C
Correct Answer: B
Patient presents with bleeding 48 hours post tooth extraction. Results are as follow: Test Patient Results Reference range: -PT: 11.5 sec 10-13 sec -APTT: 32.5 sec 23-35 sec -fibrinogen:345 mg/dL (3.45 g/L) 200-400 mg/dL (2.0-4.0 g/L) -platelets: 324 x 10^3/uL (324 x 10^9/L) 150-450 x 10^3/uL (150-450 x 10^9/L) Possible causes are a deficiency in: A. plasminogen B. Factor XIII C. alpha2 anti-plasmin D. Factor XII
Correct Answer: B
Phagocytosis is a function of: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes
Correct Answer: B
Platelet activity is affected by: A. calcium B. aspirin C. hyperglycemia D. hypoglycemia
Correct Answer: B
Polyspecific reagents used in the direct antiglobulin test should have specificity for: A. IgG and IgA B. IgG and C3d C. IgM and IgA D. IgM and C3d
Correct Answer: B
Refer to the following data: -hemoglobin: 7.4 g/dL (74 g/L) -reticulocyte count: 22% Direct Antiglobulin Test: -polyspecific: 3+ -IgG: 3+ -C3: 0 Ab Screen-IAT -SC I: 3+ -SC II: 3+ -auto: 3+ Which clinical condition is consistent with the lab results shown above? A. cold hemogglutinin disease B. warm autoimmune hemolytic anemia C. penicillin-induced hemolytic anemia D. delayed hemolytic transfusion reaction
Correct Answer: B
Refer to the following illustration: See BOC pg 205 Pic 1 Which are of the automated cell counter histogram indicates the lymphocyte curve? A. A B. B C. C D. D
Correct Answer: B
Refer to the following illustration: See BOC pg 205 Pic 2 Which area of the automated cell counter histogram indicates the nonlymphocyte curve? A. B B. C C. D D. E
Correct Answer: B
Refer to the following panel: See BOC Panel 1 pg 34 Based on the results of the above panel, the most likely antibodies are: A. anti-M and anti-K B. anti-E, anti-Jk^a, and anti-K C. anti-Jk^a and anti-M D. anti-E and anti-Le^b
Correct Answer: B
Review the following schematic diagram: -Patient serum + reagent group "O" cells -Incubate- read for agglutination -Wash- add AHG - agglutination observed The next step would be to: A. add "check cells" as a confirmatory measure B. identify the cause of the agglutination C. perform an elution technique D. perform a direct antiglobulin test
Correct Answer: B
Rh-Immune Globulin is requested for an Rh-negative mother who has the following results: D; D control; Weak D; Weak D control -mother's postpartum sample: 0; 0; 1+mf; 0 -mf=mixed field: What is the most likely explanation? A. mother is a genetic weak D B. mother had a fetomaternal hemorrhage of D+ cells C. mother's red cells are coated weakly with IgG D. anti-D reagent is contaminate with an atypical antibody
Correct Answer: B
Scurvy is associated with deficiency of which fo the following vitamins? A. A B. C C. niacin D. thiamine
Correct Answer: B
Serial bilirubin determination are charted below. Day; Collected; Assayed; Result 1: 7 am; 8 am; 14.0 mg/dL (239.4 umol/L) 2; 7 am; 6 pm; 9.0 mg/dL (153.9 umol/L) 3: 6 am; 8 am; 15.0 mg/dL (256.5 umol/L) The best explanation for the results is: A. sample hemolysis and hemoglobin deterioration B. sample exposure to light C. sample left in warm location D. reagent deterioration
Correct Answer: B
Serum levels that define hypoglycemia pre-term or low birth with infants are: A. the same as adults B. lower than adults C. the same as a normal full-term infant D. higher than a normal full-term infant
Correct Answer: B
Sodium determination by indirect ion selective electrode is falsely decreased by A. elevated chloride levels B. elevated lipid levels C. decreased protein levels D. decreased albumin levels
Correct Answer: B
TSH is produced by the: A. hypothalamus B. pituitary gland C. adrenal cortex D. thyroid
Correct Answer: B
The Kell (K1) antigen is: A. absent form the red cells of neonates B. strongly immunogenic C. destroyed by enzymes D. has a frequency of 50% in the random population
Correct Answer: B
The Liley method of predicting the severity of hemolytic disease of the newborn is based on the amniotic fluid: A. bilirubin concentration by standard methods B. change in optical density measured at 450 nm C. Rh determination D. ratio of lecithin to sphingomyelin
Correct Answer: B
The M:E ratio in acute myelocytic leukemia is usually: A. normal B. high C. low D. variable
Correct Answer: B
The M:E ratio in chronic myeloctyic leukemia is usually: A. normal B. high C. low D. variable
Correct Answer: B
The Prussian blue staining of peripheral blood identifies: A. Howell-Jolly bodies B. siderotic granules C. reticulocytes D. basophilic stippling
Correct Answer: B
The Western blot is a confirmatory test for the presence of: A. CMV antibody B. anti-HIV-1 C. HBsAG D. serum protein abnormalities
Correct Answer: B
The anticoagulant of choice for routine coagulation procedures is: A. sodium oxalate B. sodium citrate C. herapin D. sodium fluoride
Correct Answer: B
The atypical lymphocyte seen in the peripheral smear of patients with infectious mono is probably derived form which of the following? A. T lymphocytes B. B lymphocytes C. monocytes D. mast cells
Correct Answer: B
The best test to determine if a sample is contaminated with heparin is: A. fibrinogen B. thrombin time C. prothrombin time D. stypven time
Correct Answer: B
The creatinine clearance (mL/min) is equal to: A. urinary creatinine (mg/L)/[volume of urine (mL/min) x plasma creatinine (mg/L)] B. [urinary creatinine (mg/L) x volume (mL/min)] / plasma creatinine (mg/L) C. urinary creatinine (mg/L) / [volume of urine (mL / hour) x plasma creatinine (mg/L) D. [urinary creatinine (mg/L) x volume (mL/hour)] / plasma creatinine (mg/L)
Correct Answer: B
The cytoplasmic abnormality of the blood cell of Alder-Reilly anomaly is found in the: A. endoplasmic reticulum B. lysosomes C. mitochondria D. ribosomes
Correct Answer: B
The disease most frequently present in patients with atypical lymphocytosisi and persistently negative tests is: A. toxoplasmosis B. cytomegalovirus (CMV) infection C. herpes virus infection D. viral hepatitis
Correct Answer: B
The drug cephalosporin can cause a positive direct antiglobulin test with hemolysis by which of the following mechanisms? A. drug-dependent antibodies reacting with drug-treated cells B. drug-dependent antibodies reacting in the presence of a drug C. drug-independent with autoantibody production D. nonimmunologic protein adsorption with positive DAT
Correct Answer: B
The electrical resistance method of cell counting requires: A. equal-sized particles B. a conductive liquid C. 2 internal electrodes for current D. 3apertures for counting
Correct Answer: B
The following laboratory results were obtained: Serum electrolytes -sodium: 136 mEq/L (136 mmol/L) -potassium: 4.4 mEq/L (4.4 mmol/L) -chloride: 92 mEq/L (92 mmol/L) -bicarbonate: 40 mEq/L (40 mmol/L) Arterial blood -pH: 7.32 -PCO2: 79 mm Hg These results are most compatible with: A. respiratory alkalosis B. respiratory acidosis C. metabolic alkalosis D. metabolic acidosis
Correct Answer: B
The following results were obtained in pretransfusion testing: 37C; IAT -screening cell I: 0, 3+ -screening cell II: 0, 3+ -autocontrol: 0, 3+ The most probable cause of these result is: A. rouleaux B. a warm autoantibody C. a cold autoantibody D. multiple alloantibodies
Correct Answer: B
The follwoing results were obtained on a 55-year-old man complaining of headaches and blurred vision: -WBC: 19.0 x 10^3/uL (19.0 x 10^9/L) -RBC: 7.2 x 10^6/uL (7.2 x 10^12/L) -Plt: 1,056 x 10^3/uL (1056 x 10^9/L) -Uric acid: 13.0 mg/dL (0.76 mmol/L) -O2 saturation: 93% -Rh1: negative -Red cell volume: 3,911 mL (normal =1,600) Differential: -Segs: 84% -Bands: 10% -Lymphs: 3% -Monos: 2%: -Eos: 1% These results are consistent with: A. neutrophilic leukemoid reaction B. polycythemia vera C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis
Correct Answer: B
The large cell in the center of the image would e best described as a(n): See BOC pg. 183 Pic 1 A. neutrophil B. basophil C. eosinophil D. myelocyte
Correct Answer: B
The main function of the hexose monophosphate shunt in the erythrocyte is to: A. regulate the level of 2,3-DPG B. provide reduced glutathione to prevent oxidation of hemoglobin C. prevent the reduction of heme iron D. provide energy for membrane maintenance
Correct Answer: B
The major action of angiotensin II is: A. increased pituitary secretion of vasopressin B. increased vasoconstriction C. increased parathromone secretion by the parathyroid D. decreased adrenal secretion fo aldosterone
Correct Answer: B
The most appropriate interpretation for the laboratory data given below when an Rh-negative woman has an Rh-positive child? Rosette fetal screen using enzyme treated D+ cells -mother's sample: 1 rosette/3 fields -postive control: 5 rosettes/3 fields -negative control: no rosettes observed A.mother is not a candidate for RhIg B. mother needs 1 vial of RhIg C. mother needs 2 vials of RhIg D. the fetal-maternal hemorrhage needs to be quantitated
Correct Answer: B
The most appropriate screening test for hemoglobin S is: A. Kleihauer-Betke B. dithionite solubility C. osmotic fragility D. sucrose hemolysis
Correct Answer: B
The most common cause of error when using automated cell counters is: A. contamination of the diluent B. inadequate mixing of the sample prior to testing C. variation in voltage of the current supply D. a calibrating error
Correct Answer: B
The most heat labile fraction of alkaline phosphatase is obtained form A. liver B. bone C. intestine D. placenta
Correct Answer: B
The presence of excessive rouleaux formation on a blood smear is often accompanied by increased: A. reticulocyte count B. sedimentation rate C. hematocrit D. erythrocyte count
Correct Answer: B
The presence of which of the following isoenzymes indicates acute myocardial damage? A. CKMM B. CKMB C. CKBB D. none
Correct Answer: B
The purpose of a low-dose irradiation of blood components is to: A. prevent postransfusion purpura B. prevent graft-vs-host (GVH) disease C. sterilize components D. prevent noncardiogenic pulmonary edema
Correct Answer: B
The recommended initial thyroid function test for either a healthy, asymptomatic patient or a patient with symptoms which may be related to a thyroid disorder is: A. free thyroxine (free T4) B. thyroid-stimulating hormone (TSH) C. total thyroxine (T4) D. triiodothyronine (T3)
Correct Answer: B
The regulation of calcium and phosphorous metabolism is accomplished by which of the following glands? A. thyroid B. parathyroid C. adrenal glands D. pituitary
Correct Answer: B
The results of a Kleihauer-Betke stain indicate a fetomaternal hemorrhage of 35 mL of whole blood. How many vials of Rh immune globulin woul be required? A. 1 B. 2 C. 3 D. 4
Correct Answer: B
The smear represented below displays: See BOC page 157 A. congenital ovalocytosis B. hemoglobin C disease C. poor RBC fixation D. delay in smear preparation
Correct Answer: B
The solute that contributes the most to the total serum osmolality is: A. glucose B. sodium C. chloride D. urea
Correct Answer: B
The substance that is measured to estimate the serum concentration of triglycerides by most methods is: A. phopholipids B. glycerol C. fatty acids D. pre-beta lipoprotein
Correct Answer: B
To confirm the specificity of anti-Le^b, and inhibition study using Lewis substance was performed with the following results: Le(b+) cells tubes with patient serum + Lewis substance: 0 tubes with patient serum + saline control: + What conclutsion can be made from these results? A. a second antibody is suspected due to the positive control B. anti-Le^b is confirmed because the tubes with Lewis substance are negative C. anti-Le^b is not confirmed because the tubes with Lewis susbtance are negative D. anti-Le^b cannot be confirmed because the saline positive is control
Correct Answer: B
To prevent graft-vs-host disease, Red Blood Cells prepared for infants who have received intrauterine transfusions should be: A. saline-washed B. irradiated C. frozen and deglycerolized D. group- and Rh-compatible with the mother
Correct Answer: B
To qualify as a donor autologous transfusion a patient's hemoglobin should be at least: A. 8 g/dL (80 g/L) B. 11 g/dL (110 g/L) C. 13 g/dL (130 g/L) D. 15 g/dL (150 g/L)
Correct Answer: B
What increment of platelets/uL (platelets/L), in the typical 70-kg human, is expected to result from each single unit of Platelets transfused to a non-HLA-sensitized recipient? A. 3,000-5,000 B. 5,000-10,000 C. 20,000-25,000 D. 25,000-30,000
Correct Answer: B
What specimen preparation is commonly used to perform the alkaline phosphatase isoenzyme determination? A. serum is divided into 2 aliquots, one is frozen and the other is refrigerated B. serum is divided into 2 aliquots, one is heated at 56C and the other is unheated C. no preparation is necessary since the assay uses EDTA plasma D. protein-free filtrate is prepared first
Correct Answer: B
Which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes? A. Fy^a B. E C. D D. M
Correct Answer: B
Which of the following blood components must prepared within 8 hours after phlebotomy? A. Red Blood Cells B. Fresh Frozen Plasma C. Red Blood Cells, Frozen D. Cryoprecipitated AHF
Correct Answer: B
Which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? A. Lewis B. Kidd C. MNS D. I
Correct Answer: B
Which of the following cell types is characteristic of Pelger-Huet anomaly is the: A. band form B. pince-nex form C. normal neutrophil D. myelocyte
Correct Answer: B
Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria? A.autosomal dominant inheritance B. red cell membrane defects C. positive direct antiglobulin test D. measure platelet count
Correct Answer: B
Which of the following coagulation factors is considered to be labile? A. II B. V C. VII D. X
Correct Answer: B
Which of the following enzymes catalyzes the conversion of starch to glucose and maltose? A. malate dehydrogenase (MD) B. amylase (AMS) C. creatine kinase (CK) D. isocritic dehydrogenase (ICD)
Correct Answer: B
Which of the following factor deficiencies is associated with wither no bleeding or only a minor bleeding tendency, even after trauma or surgery? A. Factor X B. Factor XII C. Factor XIII D. Factor V
Correct Answer: B
Which of the following is a characteristic of anti-i? A. associated with warm autoimmune hemolytic anemia B. found in the serum of patients with infectious mononucleosis C. detected at lower temperatures in the serum of normal individuals D. found only in the serum of group O individuals
Correct Answer: B
Which of the following is a characteristic of anti-i? A. often associated with hemolytic disease of the newborn B. reacts best at room temperature or 4C C. reacts best at 37C D. is usually IgG
Correct Answer: B
Which of the following is a characteristic of polyagglutinable red cells? A. can be classified by reactivity with Ulex europaeus B. are agglutinated by most adult sera C. are always an acquired condition D. autocontrol is always positive
Correct Answer: B
Which of the following is an example of a peptide bond? See BOC pg 94 Pic 1 A. A B. B C. C D. D
Correct Answer: B
Which of the following is associated with May-Hegglin anomaly? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. chronic myelogenous leukemia D. mucopolysaccharidosis
Correct Answer: B
Which of the following is secreted by the placenta and used for the early detection of pregnancy? A. follicle-stimulating hormone (FSH) B. human chorionic gonadotropin (HCG) C. luteinizing hormone D. progesterone
Correct Answer: B
Which of the following is the correct storage temperature for the component listed? A. Cryoprecipitated AHF, 4C B. Fresh Frozen Plasma (FFP), -20C C. Red Blood Cells, Frozen, -40C D. Platelets, 37 C
Correct Answer: B
Which of the following is useful for removing IgG from red blood cells with a positive DAT to perform a phenotype? A. bromelin B. chloroquine C. LISS D. DTT
Correct Answer: B
Which of the following laboratory findings is associated with Factor XIII deficiency? A. prolonged activated partial thromboplastin time B. clot solubility in a 5 molar urea solution C. prolonged thrombin time D. prolonged prothrombin time
Correct Answer: B
Which of the following methods for quantitation of high-density lipoprotein is most suited for clinical laboratory use? A. Gomori procedure B. homogeneous C. column chromatography D. agarose gel electrophoresis
Correct Answer: B
Which of the following patient data best reflects the discrepancy seen when a person's red cells demostrate the acquired-B phenotype? Forward grouping; Reverse grouping -patient A: B, O -patient B: AB, A -patient C: O, B -patient D: B, AB A. A B. B C. C D. D
Correct Answer: B
Which of the following stains can be used to differentiate sideritic granules (Pappenheimer bodies) from basophilic stippling? A. Wright B. Prussian blue C. crystal violet D. periodic acid-Schiff
Correct Answer: B
Which one of the following values obtained during a glucose tolerance test are diagnostic of diabetes mellitus? A. 2-hour specimen =150 mg/dL (8.3 mmol/L) B. fasting plasma glucose = 126 mg/dL (6.9 mmol/L) C. fasting plasma glucose = 110 mg/dL (6.1 mmol/L) D. 2-hour specimen = 180 mg/dL (9.9 mmol/L)
Correct Answer: B
A 10-year old child was admitted to pediatrics with an initial diagnosis of skeletal muscle disease. The best confirmatory tests would be: A. creatine kinase and isocitrate dehydogenase B. gamma-glutamyl transferase and alkaline phosphatase C. aldolase and creatine kinase D. lactate dehydrogenase and malate dehydrogenase
Correct Answer: C
A 25-year-old man became nauseated and vomited 90 minutes after receiving a standard 75 g carbohydrate dose for an oral glucose tolerance test. The best course of action is to: A. give the patient a glass of orange juice and continue the test B. start the test over immediately with a 50g carbohydrate dose C. draw blood for glucose and discontinue test D. place the patient in a recumbent position, reassure him and continue the test
Correct Answer: C
A 56-year-old female with cold agglutinin disease has a positive direct antiglobulin test (DAT). When the DAT is repeated using monospecific antiglobulin sera, which of the following is most likely to be detected? A. IgM B. IgG C. C3d D. C4a
Correct Answer: C
A blood creatinine value of 5.0 mg/dL (442.0 umol/L) is most likely to be found with which of the following blood values? A. osmolality: 292 mOsm/kg B. uric acid: 8 mg/dL (475.8 umol/L) C. urea nitrogen: 80 mg/dL (28.56 mmol/L) D. ammonia: 80 ug/dL (44 umol/L)
Correct Answer: C
A blood donor has the genotype: hh, AB. What is his red blood cell phenotype? A. A B. B C. O D. AB
Correct Answer: C
A blood smear shows 80 nucleatted red cells per 100 leukocytes. The total leukocyte count is 18 x 10^3/uL (18 x 10^9/L). The true white cell count expressed in SI units is A. 17.2 x 10^3/uL (17.2 x 10^9/L) B. 9.0 x 10^3/uL (9.0 x 10^9/L) C. 10.0 x 10^3/uL (10.0 x 10^9/L) D. 13.4 x 10^3/uL (13.4 x 10^9/L)
Correct Answer: C
A blood specimen types as A, Rh-positive with a negative antibody screen, 6 units of group A. Rh-positive Red Blood cells were crossmatched and 1 unit was incompatible in the antiglobulin phase. The same result was obtained when the test was repeated. Which should be done first? A. repeat the ABO grouping on the incompatible unit using a more sensitive technique B. test a panel of red cells that possesses low-incidence antigens C. perform a direct antiglobulin test on the donor unit D. obtain a new specimen and repeat the crossmatch
Correct Answer: C
A carbonate salt used to control manic-depressive disorder is: A. digozin B. acetaminophen C. lithium D. phenytoin
Correct Answer: C
A diagnosis of primary adrenal insufficiency requires demostration of: A. decreased urinary 17-keto- and 17-hydroxysteroids B. decreased cortisol production C. impaired response to ACTH stimulation D. increased urinary cortisol excretion after metyrapone
Correct Answer: C
A drug has a half-life of 6 hours. If a dose is given every 6 hours, a stead-state drug level would usually be achieved in: A. 3-5 hours B. 10-12 hours C. 24-42 hours D. 48-50 hours
Correct Answer: C
A leukocyte count a differential on a 40-year-old Caucasian man revealed: WBC: 5.4 x 10^3/uL (5.4 x 10^9/L) Differential: -Segs: 20% -Lymphs: 58% -Monos: 20% -Eos: 2% This data represents: A. absolute lymphocytosis B. relative neutrophilia C. absolute neutropenia D. leukopenia
Correct Answer: C
A mother is Rh-negative and the father Rh-positive. Their is Rh-negative. It may be concluded that: A. the father is homozygous for D B. the mother is heterozygous for D C. the father is heterozygous for D D. at least 1 of the 3 Rh typings must be incorrect
Correct Answer: C
A neonate will be transfused for the first time with group O Red Blood Cells. Which of the following is appropriate compatibility testing? A. crossmatch with mother's serum B. crossmatch with baby's serum C. no crossmatch is necessary if initial plasma screening is negative D. no screening or crossmatching is necessary for neonates
Correct Answer: C
A patient admitted to the trauma unit requires memergency release of Fresh Frozen Plasma (FFP). His blood donor card states that he is group AB, Rh-positive. Which of the following blood groups of FFP should be issued? A. A B. B C. AB D. O
Correct Answer: C
A patient had the following serum results; -Na+: 140 mEq/L (140 mmol/L) -K+: 4.0 mEq/L (4.0 mmol/L) -glucose: 95 mg/dL (5.2 mmol/L) -BUN: 10 mg/dL (3.57 mmol/L) Which osmolality is consisitent with these results? A. 188 B. 204 C. 270 D. 390
Correct Answer: C
A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time (APTT) using a kolin activator. The APTT corrects to normal when the incubation time is increased. These suggest that the patient has: A. hemophilia A (Factor VIII deficiency B. Hagmean Factor (XII) deficiency C. Fletcher Factor deficiency (prekallikrein) D. Factor V deficiency
Correct Answer: C
A patient is admitted with a history of chronic bleeding secondary to peptic ulcer. Hematology workup reveals a severe microcytic, hypochromic anemia. Iron studies were requested. Which of the following would be expected in this case? Serum iron, TIBC, Storage iron -Result A: dec inc inc -Result B: inc dec inc -Result C: dec inc dec -Result D: inc nL dec A. result A B. result B C. result C D. result D
Correct Answer: C
A patient is readmitted to the hospital with a hemoglobin level of 7 g/dL (70 g/L) 3 weeks after receiving 2 units of red cells. The initial serological tests are: ABO/Rh: A+ antibody screen: negative DAT: 1+ mixed field Which test should be performed next? A. antibody identification panel on the patient's serum B. repeat the ABO type of the donor units C. perform an elution and identify the antibody in the eluate D. crossmatch the post reaction serum with the 3 donor units
Correct Answer: C
A patient is typed with the following results: Patient's cells with -anti-A: 0 -anti-B: 0 -anti-A,B: 2+ Patient's serum with -A1 red cells: 2+ -B red cells: 4+ -Ab screen: 0 The most probable reason for these findings is that the patient is group: A. O; confusion due to faulty group O antiserum B. O; with an anti-A1 C. Ax; with an anti-A1 D. A1: with an anti-A
Correct Answer: C
A patient multiply transfused with Red Blood Cells developed a headache, nausea, fever and chills during his last transfusion. What component is most appropriate to prevent this reaction in the future? A. Red Blood Cells B. Red Blood Cells, Irradiated C. Red Blood Cells, Leukocyte-Reduced D. Red Blood Cells selected as CMV-reduced-risk
Correct Answer: C
A patient received 2 units of Red Blood Cells and had a delayed transfusion reaction. Pretransfusion antibody screening records indicate no agglutination except after the addition of IgG sensitized cells. Repeat testing of the pretransfusion specimen detected an antibody at the antiglobulin phase. What is the most likely explanation for the original results? A. red cells were overwashed B. centrifugation time was prolonged C. patient's serum was omitted form the original testing D. antiglobulin reagent was neutralized
Correct Answer: C
A patient with Type-I, insulin-dependent diabetes mellitus has the following results: Test; Patient; Reference Range -fasting blood glucose: 150 mg/dL (8.3 mmol/L); 70-110 (3.9-6.1 mmol/L) -hemoglobin A1C: 8.5%; 4.0%-6.0% -fructosamine: 2.5 mmol/L; 2.0-2.9 mmol/L After reviewing these test results, the technologist concluded that the patient is in a: A. "steady state" of metabolic control B. state of flux, progressively worsening metabolic control C. improving stat of metabolic control as indicated by fructosamine D. state of flux as indicted by the fasting glucose level
Correct Answer: C
A patient with myeloproliferative disorder has the following values: -Hgb: 13 g/dL (130 mmol/L) -Hct: 38% -WBC: 30x 10^3/uL (30 x 10^9/L) -platelets: 1000 x 10^3/uL (1000x 10^9L) -serum Na+: 140 mEq/L (140 mmol/L) -serum K+: 7 mEq/L (7 mmol/L) The serum K+ should be confirmed by: A. repeat testing of the original serum B. testing freshly drawn serum C. testing heparinized plasma D. atomic absorption spectrometry
Correct Answer: C
A physician requested that electrolytes on a multiple myeloma patient specimen be run by direct ISE and not indirect ISE because: A. excess protein binds Na in indirect ISE B. Na is falsely increased by indirect ISE C. Na is falsely decreased by indirect ISE D. excess protein reacts with diluent in indirect ISE
Correct Answer: C
A platelet count done by phase microscopy is 200 x 10^3/uL (200 x 10^9/L) (reference range 150-450 x 10^3/uL (150-450 x 10^9/L)). A standardized template bleeding time on the same person is 15 minutes (reference range 4.5+- 1.5 minutes). This indicates that: A. the Duke method should have been used for the bleeding time B. the manual platelet count is in error C. abnormal platelet function should be suspected D. the results are as expected
Correct Answer: C
A sample gives the following results: Cells with: anti-A: 3+ anti-B: 4+ Serum with: A1 cells: 2+ B cells: 0 Which lectin should be used first to resolve this discrepancy? A. Ulex europaeus B. Arachis hypogaea C. Dolichos biflorus D. Vicia graminea
Correct Answer: C
A scanning of a CK isoenzyme fractionation revealed 2 peaks: a slow cathodic peak (CKMM) and an intermediate peak (CKMB). A possible interpretation for this pattern is: A. barin tumor B. muscular dystrophy C. myocardial infaction D. viral hepatitis
Correct Answer: C
A specimen run on an automatic cell counter has a platelet count of 19 x 10^3/uL (19 x 10^9/L). The first thing the technician should do is: A. report the count after the batch run is completed B. request a new specimen C. review the stained blood smear D. notify the laboratory manager
Correct Answer: C
A term that means varying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is: A. polycythemia vera B. erythroleukemia C. leukoerythroblastosis D. megaloblastoid
Correct Answer: C
A woman types as Rh-positive. She has an anti-c titer of 32 at AHG. Her baby has a negative DAT and is not affected by hemolytic disease of the newborn. What is the father's most likely Rh phenotype? A. rr B. r"r C. R1r D. R2r
Correct Answer: C
AHG (Coombs) control cells: A. can be used as a positive control for anti-C3 reagnets B. can be used only for the indirect antiglobulin test C. are coated only with IgG antibody D. must be used to confirm all positive antiglobulin reactions
Correct Answer: C
Abnormalities found in erythroleukemia include: A. rapid DNA synthesis B. marrow fibrosis C. megaloblastoid development D. increased erythrocyte survival
Correct Answer: C
Acidosis and alkalosis are best defined as fluctuations in blood pH and CO2 content due to changes in: A. Bohr effect B. O2 content C. bicarbonate buffer D. carbonic anhydrase
Correct Answer: C
After checking the inventory, it was noted that there were no units on the shelf marked. "May Issue as Uncrossmatched: For Emergency Only." Which of the following should be placed on this shelf? A. 1 unit of each of the ABO blood groups B. units of group O, Rh-positive Whole Blood C. units of group O, Rh-negative Red Blood Cells D. any units that are expiring at midnight
Correct Answer: C
An acid elution stain was made using a 1-hour post-delivery maternal blood sample. Out of 2,00 cells that were counted, 30 of them appeared to contain fetal hemoglobin. It is the policy of the medical center to add 1 vial of Rh immune globulin to the calculated dose when the estimated volume o the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances. A. 2 B. 3 C. 4 D. 5
Correct Answer: C
An electrode has a silver/silver chloride anode and a platinum wire cathode. It is suspended in KCl solution and separated form the blood to be analyzed by a selectively permeable membrane. Such an electrode is used to measure which of the following? A. pH B. PCO2 C. PO2 D. HCO3
Correct Answer: C
Anti-Fy^a is: A. usually a cold-reactive agglutinin B. more reactive when tested with enzyme treated red blood cells C. capable of causing hemolytic transfusion reactions D. often an autoagglutinin
Correct Answer: C
Blood is diluted 1:200, and a platelet count is performed. 180 platelets were counted in the center square millimeter on one side of the hemacytometer and 186 on the other side. The total platelet count is: A. 146 x 10^3/uL (146 x 10^9/L) B. 183 x 10^3/uL (183 x 10^9/L) C. 366 x 10^3/uL (366 x 10^9/L) D. 732 x 10^3/uL (732 x 10^9/L)
Correct Answer: C
Blood received in the laboratory for blood gas analysis must meet which of the following requirements? A. on ice, thin fibrin strands only, no air bubbles B. on ice, no clots, fewer than 4 air bubbles C. on ice, no clots, no air bubbles D. room temperature, not clots, no air bubbles
Correct Answer: C
Cells of the A3 subgroup will: A. react with Dolichos biflorus B. bE-with anti-A C. give a mixed-field reaction with anti-A,B D. bE-with anti-H
Correct Answer: C
Chylomicrons are present in which of the following dyslipidemias? A. familial hypercholestrolemia B. hypertirglyceridemia C. deficiency in lipoprotein lipase activity D. familial hypoalphalipoproteinemia
Correct Answer: C
Coagulation factors affected by warfarin (Coumadin) drugs are: A. VIII, IX, and X B. I, II, V, and VII C. II, VII, IX, and X D. II, V, and VII
Correct Answer: C
Cold agglutinin syndrome is associated with an antibody specificity toward which of the following? A. Fy:3 B. P C. I D. Rh:1
Correct Answer: C
Consider the following ABO typing results: Patient's cells vs: -anti-A: 4+ -anti-B: 0 Patient's serum vs: A1 cells: 1+ B cells: 4+ Additional testing was performed using patient serum: IS; RT -screening cell I: 1+, 2+ -screening cell II: 1+, 2+ -autocontrol: 1+, 2+ What is the most likely cause of this discrepancy? A. A2 with anti-A1 B. cold alloantibody C. cold autoantibody D. acquired-A phenomenon
Correct Answer: C
Coughing, cyanosis and difficult breathing are symptoms of which of the following transfusion reactions? A. febrile B. allergic C. circulatory overload D. hemolytic
Correct Answer: C
Criteria determining Rh immune globulin eligibility include: A. mother is Rh-positive B. infant is Rh-negative C. mother has not been previously immunized to the D antigen D. infant has a positive direct antiglobulin test
Correct Answer: C
Crossmatch results at the antiglobulin phase were negative. When 1 drop of check cells was added, no agglutination was seen. The most likely explanation is that the: A. red cells were overwashed B. centrifuge speed was set too high C. residual patient serum inactivated the AHG reagent D. laboratorian did not add enough check cells
Correct Answer: C
Cryoprecipitated AHF, if maintained in the frozen state at -18C or below, has a shelf life of: A. 42 days B. 6 months C. 12 months D. 36 months
Correct Answer: C
During emergency situations when there is no time to determine ABO group and Rh type on a current sample for transfusion, the patient is known to be A, Rh-negative. The technologist should: A. refuse to release any blood unit the patient's sample has been typed B. release A-Rh-negative Red Blood Cells C. release O-Rh-negative Red Blood Cells D. release O Rh-positive Red Blood Cells
Correct Answer: C
Elevation of the granulocyte percentage above 75% is termed: A. absolute lymphocytosis B. leukocytosis C. relative neutrophilic leukocytosis D. absolute neutrophilic leukocytosis
Correct Answer: C
Elevation of the total white cell count above 12 x 10^3/uL (12 x10^9/L) is termed: A. relative lymphocytosis B. absolute lymphocytosis C. leukocytosis D. relative neutrophilic leukocytosis
Correct Answer: C
Excess D-dimer indicated that clots have been: A. converted to fibrin monomers B. released into circulation C. formed and are being excessively lysed D. stimulated to activate platelets
Correct Answer: C
Fasting serum phosphate concentration is controlled primarily by the: A. pancreas B. skeleton C. parathyroid glands D. small intestine
Correct Answer: C
Fresh Frozen Plasma: A. contains all labile coagulative factors except cyrpoprecipitated AHF B. has a higher risk of transmitting hepatitis than does Whole Blood C. should be transfused within 24 hours of thawing D. need not be ABO-compatible
Correct Answer: C
Given the following data: -WBC: 8.5 x 10^3/uL (8.5 x 10^9/L) Differential: -Segs: 56% -Bands: 2% -Lymphs: 30% -Monos: 6% -Eos: 6% What is the absolute lymphocyte count? A. 170/uL (0.17 x 10^9/L) B. 510/uL (0.51 x 10^9/L) C. 2,550/uL (2.55 x 10^9/L) D. 4,769/uL (4.76 x10^9/L)
Correct Answer: C
Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions? A. allergic B. circulatory overload C. hemolytic D. anaphylactic
Correct Answer: C
Human blood groups were discovered around 1900 by: A. Jules Bordet B. Louis Pasteur C. Karl Landsteiner D. PL Mollison
Correct Answer: C
Hypotension, nausea, flushing, fever and chills are symptoms of which of the following transfusion reactions? A. allergic B. circulatory overload C. hemolytic D. anaphylatic
Correct Answer: C
If the total leukocyte count is 20.0 x 10^3/uL (20.0 x 10^9/L) and 50 NRBCs are seen per 100 leukocytes on the differential, what is the corrected leukocyte count? A. 6,666/uL (6.666 x 10^9/L) B. 10,000/uL (10.0 x 10^9/L) C. 13,333/uL (13.333 x 10^9/L) D. 26,666/uL (26.666 x 10^9/L)
Correct Answer: C
In a case of cold autoimmune hemolytic anemia, the patient's serum would most likely react 4+ at immediate spin with? A. group A cells, B cells, but not his own cells B. cord cells but not his own or other adult cells C. all cells of a group O cell panel and his own cells D. only penicillin-treated panel cells, not his own cells
Correct Answer: C
In addition to carcinoma of the prostate, elevated prostate-specific antigen (PSA) can occur due to: A. aspirin therapy B. exogenous steroid use C. benign prostatic hyperplasia D. statin therapy (cholesterol lowering drug)
Correct Answer: C
In an uncomplicated case of severe iron deficiency anemia, which of the following sets represents the typical pattern of results? Serum iron, Serum TIBC, %Saturation, Marrow % sideroblasts, Marrow iron stores, serum ferritin, Hgb A2 -A: dec, inc, dec, dec, inc, inc, inc -B: dec, dec, dec, dec, dec, dec, dec, -C: dec, inc, dec, dec, dec, dec, dec -D: dec, dec, inc, inc, inc, inc, inc A. A B. B C. C D. D
Correct Answer: C
Irradiation of donor blood is done to prevent which of the following adverse effects or transfusion? A. febrile transfusion reaction B. cytomegalovirus infection C. transfusion associated graft-vs-host disease D. transfusion related acute lung injury (TRALI)
Correct Answer: C
Mixed field agglutination encountered in ABO grouping with no history of transfusion would most likely be due to: A. Bombay phenotype (Oh) B. T activation C. A2 red cells D. positive indirect antiglobulin test
Correct Answer: C
Most of the carbon dioxide present in blood is in the form of: A. dissolved CO2 B. carbonate C. bicarbonate ion D. carbonic acid
Correct Answer: C
Normally the bicarbonate concetration is about 24 mEq/L and the carbonic acid concentration is about 1.2, pK=6.1, log 20= 1.3. Using the equation pH= pK + log [salt]/[acid], calculate the pH. A. 7.28 B. 7.38 C. 7.40 D. 7.42
Correct Answer: C
On electrophoresis at alkaline pH, which of the following is the slowest migrating hemoglobin? A. Hgb A B. Hgb S C. Hgb C D. Hgb F
Correct Answer: C
One of the most effective methods for th eelution of warm autoantibodies from RBCs utilizes: A. 10% sucrose B. LISS C. change in pH D. distilled water
Correct Answer: C
Patient results are as follows: Test Patient results Reference range -PT: 17.5 sec 11-13 sec -APTT: 56.7 sec 25-35 sec -D-dimer: 698 ng/mL <250 ng/mL -fibrinogen: 123 mg/dL (1.23 g/L) 200-400 mg/dL (2.0-4.0 g/L) -platelet count: 102 x 10^3/uL (102 x 10^9/L) 150-450 x 10^3/uL (150-450 x 10^9/L) This workup suggest: A. blood clot B. hemorrhage C. DIC D. HUS
Correct Answer: C
Plastic bag overwraps are recommended when thawing units of FFP in 37C water baths because they prevent: A. the FFP bag from cracking when it contacts the warm water B. water from slowly dialyzing across the bag membrane C. the entry ports form becoming contaminated with water D. the label form peeling off as the water circulates in the bath
Correct Answer: C
Platelets prepared by apheresis should contain at least: A. 1 x 10^10 platelets B. 3 x 10^10 platelets C. 3 x 10^11 platelets D. 5 x 10^11 platelets
Correct Answer: C
Posttransfusion anaphylactic reactions occur most often in patients with: A. leukocyte antibodies B. erythrocyte antibodies C. IgA deficiency D. Factor VIII deficiency
Correct Answer: C
Proteolytic enzyme treatment of red cells usually destroys which antigen? A. usually a cold-reactive agglutinin B. more reactive when tested with enzyme treated red blood cells C. capable of causing hemolytic transfusion reactions D. often an autoagglutinin
Correct Answer: C
Quantitation of Na+ and K+ by ion-selective electrode is the standard method because: A. dilution is required for flame photometry B. there is no lipoprotein interference C. of advances in electrochemistry D. of the absence of an internal standard
Correct Answer: C
Refer to the folloowing illustration: See BOC pg. 125 Pic 1 This illustration represents the change in absorbance at 340 nm over a period of 8 minutes in an assay for lactate dehydrogenase. True statement about this figure include: A. the reaction is follows zero order kinetics between 5 and 8 minutes B. the reaction is proceeding form lactate to pyruvate C. nonlinearity after 6 minutes is due to substrate exhaustion D. the change in absorbance is due to reduction of NAD to NADH
Correct Answer: C
Refer to the following data: Forward group: anti-A; anti-B; anti-A1 lectin 4+; 0; 4+ Reverse group: A1 cells; A2 cells; B cells 0; 2+; 4+ The ABO discrepancy seen above is most likely due to: A. anti-A1 B. rouleaux C. anti-H D. unexpected IgG antibody present
Correct Answer: C
Refer to the following information: Postpartum; anti-D; Rh control; Weak D; Weak D control; Rosette feal screen -mother: 0; 0; +micro; -; 20 rosettes/5 fields -newborn: 4+; 0; NT; NT; NT NT= not tested What is the best interpretation for the laboratory data given above? A. mother is Rh-positive B. mother is weak D+ C. mother has had a fetal-maternal hemorrhage D. mother has a positive DAT
Correct Answer: C
Refer to the following pattern: See BOC pg 161 Pic 1 Which pattern is consistent with beta-thalassemia major? A. pattern A B. pattern B C. pattern C D. pattern D
Correct Answer: C
Relationship testing produces the following red cell phenotyping results: ABO; Rh -alleged father: B; D+C-c+E+e- -mother: O; D+C+E-c-e+ -child: O; D+C+E-c+e+ What conclusion may be made? A. there is no exclusion of paternity B. paternity may be excluded on the basis of ABO typing C. paternity may be excluded on the basis of Rh typing D. paternity may be excluded on the basis of both ABO and Rh typing
Correct Answer: C
Rh immune globulin adminsitration would not be indicated in an Rh-negative woman who has a(n): A. first trimester abortion B. husband who is Rh-positive C. anti-D titer of 1:4,096 D. positive direct antiglobulin test
Correct Answer: C
Select the test which evaluates renal tubular function: A. IVP B. creatinine clearance C. osmolarity D. microscopic urinalysis
Correct Answer: C
Ten units of group A platelets were transfused to a group AB patient. The pretransfusion platelet count was 12 x 10^3/uL (12 x 10^9/L) and the postransfusion count was 18 x 10^3/uL (18x 10^9/L). From this information, the laboratorian would most likely conclude that the patient: A. needs group AB platelets to be effective B. clinical data does not suggest a need fro platelets C. has developed antibodies to the transfused platelets D. should receive irradiated platelets
Correct Answer: C
Testing for the diagnosis of lead poisoning should include: A. erythrocyte protoporphyrin (EPP) B. urine delta-aminolevulinic acid C. whole blood lead D. zinc protoporphyrin (ZPP)
Correct Answer: C
The absence of intermediate maturing cells between the blast and mature neutrophil commonly seen in acute myelocytic leukemia and myelodysplastic syndromes is called: A. subleukemia B. aleukemic leukemia C. leukemic hiatus D. leukemoid reaction
Correct Answer: C
The anion gap is useful for quality control of laboratory results for: A. amino acids and proteins B. blood gas analyses C. sodium, potassium, chloride, and total CO2 D. calcium, phosphorus and magnesium
Correct Answer: C
The drug procainamide is prescribed to treat cardiac arrhythmia. What biologically active liver metabolite of procainamide is often measured simultaneously? A. phenobarbitol B. quinidine C. N-acetyl procainamide (NAPA) D. lidocaine
Correct Answer: C
The enzyme responsible for conferring H activity on the red cell membrane is alpha-: A. galactosyl transferase B. N-acetylgalactosaminyl transferase C. L-fucosyl transferase D. N-acetylglucosaminyl transferase
Correct Answer: C
The followign bilirubin result are obtained on a patient: -day 1: 4.3 mg/dL (73. 5 umol/L) -day 2: 4.6 mg/dL (78.7 umol/L) -day 3: 4.5 mg/dL (77.0 umol/L) -day 4: 2.2 mg/dL (37.6 umol/L) -day 5: 4.4 mg/dL (75.2 umol/L) -day 6: 4.5 mg/dL (77.0 umol/L) Given that the controls were within range each day, what is a probable explanation for the result on day 4? A. no explanation necessary B. serum, not plasma, was used for testing C. specimen had prolonged exposure to light D. specimen was hemolyzed
Correct Answer: C
The following blood gas results were obtained: -pH: 7.18 -PO2: 86 mm Hg -PCO2: 60 mm Hg -O2 saturation: 92% -HCO3: 7921 mEq/L (21 mmol/L) -TCO2: 23 mEq/L (23 mmol/L) -base excess: 8 mEq/L (-8.0 mmol/L) The patient's results are compatible with which of the following? A. fever B. uremia C. emphysema D. dehydration
Correct Answer: C
The following reactions were obtained: Cells tested with: -anti-A: 4+ -anti-B: 3+ -anti-A,B: 4+ -Serum tested with: -A1 cells: 2+ -B cells: 4+ The technologist washed the patient's cells with saline, and repeated the forward typing. A saline replacement technique was used with the reverse typing. The following results were obtained. Cells tested with: -anti-A: 4+ -anti-B: 0 -anti-A, B: 4+ Serum tested with: A1 cells: 0 B cells: 4+ The results are consistent with: A. acquired immunodeficiency disease B. Bruton agammaglobulinemia C. multiple myeloma D. acquired "B" antigen
Correct Answer: C
The following results are form a 21-year-old patient with a back injury who appears otherwise healthy: -Whole blood glucose: 77 mg/dL (4.2 mmol/L) -Serum glucose: 88 mg/dL (4.8 mmol/L) -CSF glucose: 56 mg/dL (3.1 mmol/L) THe best interpretation of these results is that: A. the whole blood and serum values are expected both the CSF value is elevated B. the whole blood glucose value should be higher than the serum value C. all values are consistent with a normal healthy individual D. the serum and whole blood values should be identical
Correct Answer: C
The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss: WBC: 1.8 x 10^3/uL (1.8 x 10^9/L) RBC: 4.6 x 10^6/uL (4.6 x 10^12/L) Plt: 903 x 10^3/uL (903 x10^9/L) uric acid: 6.4 x mg/dL (380 umol/L) LAP: 0 Philadelphia chromosome: positive Differential: -Segs: 30% -Bands: 17% -Lymphs: 13% -Monos: 3% -Eos: 4% -Basos: 6% -Metamyelos: 3% -Myelos: 20% -Promyelos: 3% -Blasts: 1% These results are consistent with: A. neutrophilic leukemoid reaction B. idiopathic thrombocythemia C. chronic myelocytic leukemia D. leukoerythroblastosis in myelofibrosis
Correct Answer: C
The following results were obtained on a patient's blood: -Hgb: 11.5 g/dL (115 g/L) -Hct: 40% -MCV 89 um^3 (89 fL) -MCHC 29% Examination of a Wright-stained smear of the same sample would most likely show: A. macrocytic, normochromic erythrocytes B. microcytic, hypochromic erythrocytes C. normocytic, hypochromic erythrocytes D. normocytic, normaochromic erythrocytes
Correct Answer: C
The following test results are noted for a unit of blood labeled group A, Rh-negative: Cells tested with: -anti-A: 4+ -anti-B: 0 -anti-D: 3+ What should be done nest? A. transfuse as a group A, Rh-negative B. transfuse as a group A, Rh-positive C. notify the collecting facility D. discard the unit
Correct Answer: C
The glycated hemoglobin value represents the integrated values of glucose concentration during the preceding: A. 1-3 weeks B. 4-5 weeks C. 6-8 weeks D. 16-20 weeks
Correct Answer: C
The ideal capillary blood collection site on a newborn is: A. tip of the thumb B. ear lobe C. plantar surface of the heel D. the great toe
Correct Answer: C
The laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? A. iron deficiency B. hereditary spherocytosis C. vitamin B12 deficiency D. acute hemorrhage
Correct Answer: C
The large cell indicted by the arrow in image below is a: See BOC pg.183 Pic 2 A. myeloblast B. promyelocyte C. myelocyte D. metamyelocyte
Correct Answer: C
The majority of thyroxine (T4) is converted into the more biologically active hormone: A. thyroglobulin B. thyroid-stimulating hormone (TSH) C. triiodothyronine (T3) D. thyrotropin-releasing hormone
Correct Answer: C
The mating of an Xg(a+) man and an Xg(a-) woman will only produce: A. Xg (a-) sons and Xg (a-) daughters B. Xg (a+) sons and Xg (a+) daughters C. Xg (a-) sons and Xg (a+) daughters D. Xg (a+) sons and Xg (a-) daughters
Correct Answer: C
The mean value of a reticulocyte count on specimens of cord blood from healthy, full-term newborns is approximately: A. 0.5% B. 2.0% C. 5.0% D. 8.0%
Correct Answer: C
The most appropriate screening test for detecting hemoglobin F is: A. osmotic fragility B. dithionite solubility C. Kleihauer-Betke D. heat instability
Correct Answer: C
The most frequent transfusion-associated disease complication of blood transfusion is: A. cytomegalovirus (CMV) B. syphilis C. hepatitis D. AIDS
Correct Answer: C
The most important buffer pair in plasma is the: A. phosphate/biphosphate pair B. hemoglobin/imidazole pair C. bicarbonate/carbonic acid pair D. sulfate/bisulfate pair
Correct Answer: C
The most sensitive enzymatic indicator for liver damage form ethanol intake is: A. alanine aminotransferase (ALT) B. aspartate aminotransferase (AST) C. gamma-glutamyl transferase (GGT) D. alkaline phosphatase
Correct Answer: C
The presence of increased CKMB activity on a CK electrophoresis pattern is most likely found in a patient suffering from: A. actue muscular stress following strenuous exercise B. malignant liver disease C. myocardial infarction D. severe head injury
Correct Answer: C
The purpose of testing with anti-A, B is to detect: A. anti-A1 B. anti-A2 C. subgroups of A D. subgroups of B
Correct Answer: C
The use of Leukocyte-Reduced Red Blood Cells and Platelets is indicated for which of the following patients groups? A. CMV-seropositive postpartum mothers B. victims of acute trauma with massive bleeding C. patients with history of febrile transfusion reactions D. burn victims with anemia and low serum protein
Correct Answer: C
The value below were obtained on an automated blood count system performed on a blood sample from a 25-year-old man: Patient Normal -WBC: 5.1 x 10^3/uL 5.0-10.0 x 10^3/uL (5.1 x 10^9/L) (5.0-10.0 x 10^9/L) -RBC: 2.94 x 10^6/uL 4.6-6.2 x 10^6/ul (2.94 x 10^12/L) (4.6-6.2 x 10^12/L -Hgb: 13.8 g/dL(138g/L) 14-18 g/dL(140-180g/L) -Hct: 35.4% 40%-54% -MCV: 128 um^3 (128 fL) 82-90 um^3 (82-90 fL) -MCH: 46.7 pg 27-31 pg -MCHC: 40% . 32%-36% These results are most consistent with which of the following? A. megaloblastic anemia B. hereditary spherocytosis C. a high titer of cold agglutinins D. an elevated reticulocyte cout
Correct Answer: C
These laboratory results were obtained on maternal and cord blood samples: -mother: A- -baby: AB+, DAT 3+, cord hemoglobin: 10 g/dL (100 g/L) Does the baby have HDN? A. no, as indicated by the cord hemoglobin B. yes, although the cord hemoglobin is normal, the DAT indicates HDN C. yes, the DAT and cord hemoglobin level both support HDN D. no, a diagnosis of HDN cannot be established without cord bilirubin levels
Correct Answer: C
To assure an accurate ammonia level result, the specimen should be: A. incubated at 37 C prior to testing B. spun and separated immediately, tested as routine C. spun, separated, iced, and tested immediately D. stored at room temperature until tested
Correct Answer: C
To detect barbiturate abuse when analyzing urine specimens, immunoassay is the method of choice for screening. The method of choice for confirmation is: A. nephelometry B. thin-layer chromatography C. gas chromatography/ mass spectrometry D. ultraviolet absorption spectroscopy
Correct Answer: C
To prevent febrile transfusion reactions, which Red Blood Cell product should be transfused? A. Red Blood Cells, Irradiated B. CMV negative Red Bloos Cells C. Red Blood Cells, Leukocyte-Reduced D. IgA-deficient donor blood
Correct Answer: C
Total iron-binding capacity measures the serum iron transporting capacity of: A. hemoglobin B. ceruloplasmin C. transferrin D. ferritin
Correct Answer: C
Turbidity in serum suggests elevation of: A. cholesterol B. total protein C. chylomicrons D. albumin
Correct Answer: C
Use of EDTA plasma prevents activation of the classical complement pathway by: A. causing rapid decay of complement components B. chelating Mg++ ions, which prevents the assembly of C6 C. chelating Ca++ ions, which prevents assembly of C1 D. preventing chemotaxis
Correct Answer: C
Valinomycin enhances the selectivity of the electrode used to quantitate: A. sodium B. chloride C. potassium D. calcium
Correct Answer: C
What information is essential on patient blood sample labels drawn for compatibility testing? A. biohazard sticker for AIDS patients B. patient's room number C. unique patient medical number D. phlebotomist initials
Correct Answer: C
What is the most appropriate diluent for preparing a solution of 8% bovine albumin for a red cell control reagent? A.deionized water B. distilled water C. normal saline D. Alsever solution
Correct Answer: C
What is the proper pH for buffered solution used to perform serum protein electrophoresis? A. 5.6 B. 7.6 C. 8.6 D. 9.6
Correct Answer: C
What substance gives feces its normal color? A. uroerythrin B. urochrome C. urobilin D. urobilinogen
Correct Answer: C
When platelets are stored on a rotator set on an open bench top, the ambient air temperature must be recorded: A. once a day B. twice a day C. every 4 hours D. every hour
Correct Answer: C
When separating serum proteins by cellulose acetate electrophoresis, using Veronal (TM) buffer at pH 8.6, beta globulin migrates: A. faster than albumin B. slower than gamma globulin C. faster than gamma globulin D. faster than alpha-2 globulin
Correct Answer: C
When the main objective of an exchange transfusion is to remove the infant's antibody-sensitized red blood cells and to control hyperbilirubinemia, the blood product of choice is ABO compatible. A. Fresh Whole Blood B. Red Blood Cells (RBC) washed C. RBC suspended in Fresh Frozen Plasma D. heparinized Red Blood Cells
Correct Answer: C
Which blood gas electrode is composed of silver/silver chloride reference electrode and glass? A. PO2 B. pH C. PCO2 D. HCO3
Correct Answer: C
Which is the following is the formula for mean corpuscular volume (MCV)? A. (Hgb x 10)/ RBC B. Hgb/Hct C. (Hct x 10)/RBC D. RBC/Hct
Correct Answer: C
Which of the following cells contain hemosiderin? A. megkaryocyte B. osteoclast C. histiocyte D. mast cell
Correct Answer: C
Which of the following chemical determinations may be of help in establishing the presence of seminal fluid? A. lactic dehydrogenase (LD) B. isocitrate dehydrogenase (ICD) C. acid phophatase D. alkaline phosphatase
Correct Answer: C
Which of the following factors is used only in the extrinsic coagulation pathway? A. II B. V C. VII D. VIII
Correct Answer: C
Which of the following hormones regulates normal blood calcium levels? A. thyroxine B. estriol C. parathyroid hormone D. growth hormone
Correct Answer: C
Which of the following is a nonimmunlogic adverse effect of a transfusion? A. hemolytic reaction B. febrile nonhemolytic reaction C. congestive heart failure D. urticaria
Correct Answer: C
Which of the following is associated with pseudo-pelter-Huet anomaly? A. aplastic anemia B. iron deficiency anemia C. myelogenous leukemia D. Chediak-Higashi syndrome
Correct Answer: C
Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? A. progressive decrease in overall cell size B. increasing basophilia of cytoplasm C. nuclear division without cytoplasmic division D. fusion of the nuclear lobes
Correct Answer: C
Which of the following is true of acute lymphoblastic leukemia (ALL)? A. occurs most commonly in children 1-2 years of age B. patient is asymptomatic C. massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs D. children under 1 year of age have a good prognosis
Correct Answer: C
Which of the following is used for staining reticulocytes? A. Giemsa stain B. Wright stain C. new methylene blue D. Prussian blue
Correct Answer: C
Which of the following medication is most likely to cause production of autoantibodies? A. penicillin B. cephalothin C. methyldopa D. tetracycline
Correct Answer: C
Which of the following red cell typings are most commonly found in the African American donor population? A. Lu(a-b-) B. Jk(a-b-) C. Fy(a-b-) D. K-k-
Correct Answer: C
Which of the following sample collections would give an accurate assessment of potential excess cortisol production (hypercortisolism)? A. collect a plasma sample as a baseline, and another one-hour after administration of metyrapone B. collect a plasma sample at 8 AM only C. collect a 24-hour urine free cortisol D. collect a plasma sample at 8 AM and at 8 AM the next day
Correct Answer: C
Which of the following transfusion reactions occurs after infusion of only a few milliliter of blood and gives no history of fever? A. febrile B. circulatory overload C. anaphylactic D. hemolytic
Correct Answer: C
Which of the following types of polycythemia is a severely burned patient most likely to have? A. polycythemia vera B. polycythemia, secondary to hypoxia C. relative polycythemia associated with dehydration D. polycythemia associated with renal disease
Correct Answer: C
Which one of the following statements concerning Vitamin K is not true? A. there are 2 sources of Vitamin K: vegetable and bacterial B. Vitamin K converts precursor molecules into functional coagulation factors C. heparin inhibits the action of Vitamin K D. Vitamin K is fat soluble
Correct Answer: C
Which percentage of total serum calcium is nondiffusible protein bound? A. 80%-90% B. 51%-60% C. 40%-50% D. 10%-30%
Correct Answer: C
While performing an antibody screen, a test reaction is suspected to be rouleaux. A saline replacement test is performed and the reaction remains. What is the best interpretation? A. original reaction of rouleaux is confirmed B. replacement test is invalid and should be repeated C. original reaction was due to true agglutination D. antibody screen is negative
Correct Answer: C
50%-90% myeloblasts in a peripheral blood is typical of which of the following? A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia
Correct Answer: D
A 1-year-old girl with a hyperlipoproteinemia and lipase deficiency has the following lipid profile -cholesterol: 300 mg/dL (7.77 mmol/L) -LDL: increased -HDL: decreased -triglycerides: 200 mg/dL (2.26 mmol/L) -chylomircrons: present A serum specimen from this patient that was refrigerated overnight would most likely be: A. clear B. cloudy C. creamy layer over cloudy serum D. creamy layer over clear serum
Correct Answer: D
A 10% red cell suspension in saline is used in a compatibility test. Which of the following would most likely occur? A. a false positive result due to antigen excess B. a false positive result due to the prozone phenomenon C. a false negative result due to the prozone phenomenon D. a false negative result due to antigen excess
Correct Answer: D
A 14-year-old boy is seen in the ER complaining of a sore throat, swollen glands and fatigue. The CBC results are: - WBC 16.0 x 10^3/uL (16.0 x 10^9/L) - RBC 4.37 x 10^6/uL (4.37 x 10^12/L) -Hgb: 12.8 g/dL (128 g/L) -Hct: 38.4% -Plt: 180 x 10 ^3/uL (180 x 10^9/L) Differential: absolute neutrophils: 3.9 x 10^9/L absolute lymphs: 6.0x 10^9/L absolute monos: 0.5 x 10^9/L absolute atypical lymphs 3.2 x10^9/L What is the most likely diagnosis? A. acute lymphocytic leukemia B. chronic lymphocytic leukemia C. viral hepatitis D. infectious mononucleosis
Correct Answer: D
A 25-year-old Caucasian woman, gravida 3, para 2, required 2 units of Red Blood Cells. The antibody screen was positive and the results of the antibody panel are shown below: See BOC pg 17 Pic 1 What is the most probable genotype of this patient? A. rr B. r'r' C. R0r D. R1R1
Correct Answer: D
A 26-year-old female is admitted with anemia of undetermined origin. Blood samples are recived with a crossmatch request for 6 units of Red Blood Cells. The patient is group A, Rh-negative and has no history of transfusion or pregnancy. The following results were obtained in pretransfusion testing: IS; 37C; IAT -screening cell I: 0, 0, 3+ -screening cell II: 0, 9, 3+ -autocontrol: 0,0, 3+ -all 6 donors: 0, 0, 3+ The way to find compatible blood is to: A. do an antibody identification panel B. use the saline replacement technique C. use the pre-warm technique D. perform a warm autoadsorption
Correct Answer: D
A 3-year-old child was evaluated for abdominal pain and anorexia by a physician. A CBC revealed a hemoglobin of 9.8 g/dL (98 g/L) and basophilic stippling of the RBCs. The doctor should order further tests to check for poisoning form: A. arsenic B. iron C. mercury D. lead
Correct Answer: D
A 4-year-old presents with chronic ear infections and is on prophylactic antibiotic. He presents wih bleeding. Factor assays reveal: Test Patient results Reference range -Factor VIII: 100% 50%-150% -Factor V: 75% 50%-150% -Factor IX: 38% 50%-150% -Factor II: 22% 50%-150% Possible causes are: A. Factor II deficiency B. lupus anticoagulant C. hemophilia D. Vitamin K deficiency
Correct Answer: D
A 40-year-old man with autoimmune hemolytic anemia due anti-E has a hemoglobulin level of 10.8 g/dL (108 g/L). This patient will most likely be treated with: A. Whole Blood B. Red Blood Cells C. Fresh Frozen Plasma D. no transfusion
Correct Answer: D
A 45-year-old woman complains of fatigue, heat intolerance and hair loss. Total and ree T4 are abnormally low. If the TSH showed marked elevation, this would be consistent with: A. Grave disease B. an adenoma of the thyroid C. thyrotoxicosis D. primary hypothyroidism
Correct Answer: D
Saliva from which of the following individuals would neutralize an auto anti-H in the serum of a group A, Le(a-b+) patient? A. group A, Le (a-b-) B. group A, Le (a+b-) C. group O, Le (a+b-) D. group O, Le (a-b+)
Correct Answer: D
A 65-year-old woman experienced shaking, chills, and a fever of 102F (38.9C) approximately 40 minutes following the transfusion of a second unit of Red Blood Cells. The most likely explanation for the patient's symptoms is: A. transfusion of bacterially contaminated blood B. congestive heart failure C. anaphylactic transfusion reaction D. febrile transfusion reaction
Correct Answer: D
A block in the differentiation of maturation of , and an accretion of immature hematopoietic progenitors is a hallmark of: A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia
Correct Answer: D
A blood gas sample was sent to the lab on ice, and a bubble was present in the syringe. The blood had been exposed to room air for at least 30 minutes. The following change in blood gases will occur: A. CO2 content increased/PCO2 decreased B. CO2 content and PO2 increased/pH increased C. CO2 content and PCO2 decreased/pH decreased D. PO2 increased/HCO3 decreased
Correct Answer: D
A blue top tube is drawn for coagulation studies, the sample is a short draw results may be: A. falsely shortened B. correct C. unable to be obtained D. falsely prolonged
Correct Answer: D
A characteristic morphologic feature in hemoglobin C disease is: A. macrocytosis B. spherocytosis C. rouleaux formation D. target cells
Correct Answer: D
A chemiluminescent EIA: A. measures absorption of light B. is less sensitive than radioisotopic reactions C. is monitored by the use of a gamma counter D. is quantitated by the amount of light produced by the reaction
Correct Answer: D
A common cause of respiratory alkalosis is: A. vomiting B. starvation C. asthma D. hyperventilaiton
Correct Answer: D
A commonly used screening method for anti-HIV-1 detection is: A. latex agglutination B. radioimmunoassay (RIA) C. thin-layer-chromatography (TLC) D. enzyme-labeled immunosorbent assay (ELISA)
Correct Answer: D
A drug that relaxes the smooth muscles of the bronchial passages is: A. acetaminophen B. lithium C. phenytoin D. theophylline
Correct Answer: D
A family has been typed for HLA because 1 of the children needs a stem cell donor. Typing results are listed below: -father: A1, 3; B8, 35 -mother: A2, 23; B12,18 -child #1: A1,2; B8,12 -child #2: A1, 23; B8,18 -child #3: A3,23; B18,? What is the expected B antigen in child #3? A. A1 B. A2 C. B12 D. B35
Correct Answer: D
A fetomaternal hemorrhage of 35 mL of fetal Rh-positive packed RBCs has been detected in an Rh-negative woman. How many vials of Rh immune globulin should be given? A. 0 B. 1 C. 2 D. 3
Correct Answer: D
A mean cellular hemoglobin concentration (MCHC) over 36 g/dL (36 g/L) is frequently found in: A. hereditary spherocytosis B. lipemia (abnormally high plasma lipid) C. active cold agglutinin disease D. all of the above
Correct Answer: D
A patient has a tumor that concentrates erythropoietin. He is most likely to have which of following types of polycythemia? A. polycythemia vera B. polycythemia, secondary to hypoxia C. benign familial polycythemia D. polycythemia associated with renal disease
Correct Answer: D
A patient has been treated for polycythemia vera for several years. His blood smear now shows: -Oval macrocytes -Howell-Jolly bodies -Hypersegmented neutrophils -Large, granular platelets The most probable cause of this blood picture is: A. iron deficiency B. alcoholism C. dietary B12 deficiency D. chemotherapy
Correct Answer: D
A patient in the immediate post bone marrow transplant period has a hematocrit of 21%. The red cell product of choice for this patient would be: A. packed B. saline washed C. microaggregate filtered D. irradiated
Correct Answer: D
A patient who is group AB, Rh-negative needs 2 units of Fresh Frozen Plasma. Which of the following units of plasma would be most acceptable for transfusion? A. group O, Rh-negative B. group A, Rh-negative C. group B, Rh-positive D. group AB, Rh-positive
Correct Answer: D
A patient's record shows a previous anti-Jk^b, but the current antibody screen in negative. What further testing should be done before transfusion? A. phenotype the patient's red cells for the Jk^b antigen B. perform a cell panel on the patient's serum C. crossmatch type specific units and release only compatible units for transfusion D. give Jk^b negative crossmatch compatible blood
Correct Answer: D
A person suspected of having metabolic alkalosis would have which of the following laboratory findings? A. CO2 content and PO2 elevated, pH decreased B. CO2 content decreased and pH elevated C. CO2 content, PCO2, and pH decreased D. CO2 content and pH elevated
Correct Answer: D
A physician suspects his patient has pancreatitis. Which test(s) would be most indicative of this disease? A. creatinine B. LD isoenzymes C. beta-hydroxybutyrate D. amylase
Correct Answer: D
A prolonged thrombin time and a normal reptilase-R time are characteristic of: A. dysfibrinogenemia B. increased D-dimer C. fibrin monomer-split product complexes D. therapeutic heparinization
Correct Answer: D
A sickle cell patient who has been multiply transfused experiences fever and chills after reciving a unit of Red Blood Cells. Transfusion investigation studies show: -DAT: negative -plasma hemolysis: no hemolysis observed The patient is most likely reacting to; A. IgA B. plasma protein C. red cells D. white cells or cytokines
Correct Answer: D
A sweat chloride result of 55 mEq/L (55 mmol/L) and a sweat sodium of 52 mEq/L (52 mmol/L) were obtained on a patient who has a history of respiratory problems. The best interpretation of these result is: A. normal B. normal sodium and an abnormal chloride test should be repeated C. abnormal results D. borderline results, the test should be repeated
Correct Answer: D
A trauma patient who has just received ten units of blood may develop: A. anemia B. polycythemia C. leukocytosis D. thrombocytopenia
Correct Answer: D
A unit of Red Blood Cells expiring in 35 days is split into 5 small aliquots using a sterile pediatric quad set and a sterile connecting device. Each aliquot must be labeled as expiring in: A. 6 hours B. 12 hours C. 5 days D. 35 days
Correct Answer: D
A unit of Red Blood Cells is issued at 9:00 AM. At 9:10 AM the unit is returned to the Blood Bank. The container has not been entered, but the unit has not been refrigerated during this time span. The best course of action for the technologist is to: A. culture the unit for bacterial contamination B. discard the unit if not used within 24 hours C. store the unit at room temperature D. record the return and place th unit back into inventory
Correct Answer: D
A unit of packed cells is split into 2 aliquots under closed sterile condition at 8 AM. The expiration time for each aliquot is now: A. 4 PM on the same day B. 8 PM on the same day C. 8 AM the next morning D. the original date of the unsplit unit
Correct Answer: D
ABO-hemolytic disease of the newborn: A. usually requires an exchange tranfusion B. most often occurs in first born children C. frequently results in stillbirth D. is usually seen only in the newborn of group O mothers
Correct Answer: D
Aldosterone is released by the adrenal cortex upon stimulation by: A. renin B. angiotensinogen C. angiotensin I D. angiotensin II
Correct Answer: D
All donor blood testing must include: A. complete Rh phenotyping B. anti-CMV testing C. direct antiglobulin test D. serological test for syphilis
Correct Answer: D
An antiepileptic (or anticonvulsant) used to control seizure disorders is: A. digozin B. acetaminophen C. lithium D. phenytoin
Correct Answer: D
An arterial blood specimen submitted for blood gas analysis was obtained at 8:30 AM but was not received in the laboratory until 11 AM. The technologist should: A. perform the test immediately upon reciept B. perform the test only if the specimen was submitted in ice water C. requires a venous blood specimen D. request a new arterial specimen be obtained
Correct Answer: D
An automated platelet count indicates platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should: A. repeat the count on the same sample B. report the automated count C. perform a manual count D. recollect in sodium citrate
Correct Answer: D
An individual's red blood cells give the following reaction with Rh antisera: -anti-D: 4+ -anti-C: 3+ -anti-E: 0 -anti-c: 3+ -anti-e: 3+ -Rh control: 0 The individual's most probable genotype is: A. DCe/DcE B. DcE/dce C. Dce/dce D. DCe/dce
Correct Answer: D
An obstetrical patient has had 3 previous pregnancies. Her first baby was healthy, the second was jaundiced at birth and required an exchange transfusion, while the third was stillborn. Which of the following is the most likely cause? A. ABO incompatibility B. immune deficiency disease C. congenital spherocytic anemia D. Rh incompatibility
Correct Answer: D
An unexplained fall in hemoglobin and mild jaundice in a patient transfused with Red Blood Cells 1 week previously would most likely indicate: A. paroxysmal nocturnal hemoglobinuria B. postransfusion hepatitis infection C. presence of HLA antibodies D. delayed hemolytic tranfusion reaction
Correct Answer: D
Auer rods are most likely present in which of the following? A. chronic myelocytic leukemia B. myelofibrosis with myeloid metaplasia C. erythroleukemia D. acute myelocytic leukemia
Correct Answer: D
Before unconjugated bilirubin can react with Ehrlich diazo reagent, which of the following must be added? A. acetone B. ether C. distilled water D. caffeine
Correct Answer: D
Beriberi is associated with deficiency of vitamin: A. A B. C C. niacin D. thiamine
Correct Answer: D
Blood samples were collected at the beginning of an exercise class and after thirty minutes of aerobic activity. Which of the following would be most consistent with the post-exercise sample? A. normal lactic acid, low pyruvate B. low lactic acid, elevated pyruvate C. elevated lactic acid, low pyruvate D. elevated lactic acid, elevated pyruvate
Correct Answer: D
Cancer antigen 125 (CA 125) is a tumor marker associate with: A. breast carcinoma B. colon cancer C. lung cancer D. ovarian and endometrial carcinoma
Correct Answer: D
Carcinoembryonic antigen (CEA) is most likely to be produced in a malignancy involving the: A. brain B. testes C. bone D. colon
Correct Answer: D
Cell description: -Size: 12 to 16 um -Nucleus: oval, notched, folded over to horseshoe shape -Chromatin: fine lacy, stains light purple-pink -Nucleoli: none present -Cytoplasm: abundant, slate gray, with many fine lilac-colored granules This cell is a: A. promyelocyte B. lymphocyte C. neutrophil D. monocyte
Correct Answer: D
Cells involved in hemostasis are: A. erythrocytes B. granulocytes C. lymphocytes D. thrombocytes
Correct Answer: D
Chronic lymphocytic leukemia is defined as a(n): A. malignancy of the thymus B. accumulation of prolymphocytes C. accumulation of hairy cells in the spleen D. accumulation of monoclonal B cells with a block in cell maturation
Correct Answer: D
Cocaine is metabolized to: A. carbomazepine B. codeine C. hydrocodone D. benzoylecgonine
Correct Answer: D
Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion is indicative of which type of transfusion reaction? A. hemolytic B. febrile C. anaphylactic D. circulatory overload
Correct Answer: D
Creatinine clearance is used to estimate the: A. tubular secretion of creatinine B. glomerular secretion of creatinine C. renal glomerular and tubular mass D. glomerular filtration rate
Correct Answer: D
During intial investigation of a suspected hemolytic transfusion reaction, it was observed that the postransfusion serum was yellow in color and the direct antiglobulin test was negative. Repeat ABO typing on the postransfusion sample confirmed the pretransfusion results. What is the next step in this investigation? A. repeat compatibility testing on suspected unit(s) B. perform plasma hemoglobin and haptoglobin determinations C. use enhancement media to repeat the antibody screen D. no further serological testing is necessary
Correct Answer: D
During the issue of an autologous unit of Whole Blood, the supernata plasma is observed to be dark red in color. What would be the best course of action? A. the unit may be issued only for autologous use B. remove the plasma and issue the unit as Red Blood Cells C. issue the unit only as washed Red Blood Cells D. quarantine the unit for further testing
Correct Answer: D
Elevation of the total granulocyte count above 7.7 x 10^3/uL (7.7 x 10^9/L) is termed: A. relative lymphocytosis B. leukocytosis C. relative neutrophilic leukocytosis D. absolute neutrophilic leukocytosis
Correct Answer: D
Erroneous ammonia levels can be eliminated by all of the following except: A. assuring water and reagents are ammonia-free B. separating plasma form cells and performing test analysis as soon as possible C. drawing the specimen in a pre-chilled tube and immersing the tube in ice D. storing the specimen protected form light until the analysis is done
Correct Answer: D
Even in the absence of prior transfusion or pregnancy, individuals with the Bombay phenotype (Oh) will always have naturally occurring: A. anti-Rh B. anti-K0 C. anti-U D. anti-H
Correct Answer: D
Fever and chills are symptoms of which of the following transfusion reactions? A. citrate toxicity B. circulatory overload C. allergic D. febrile
Correct Answer: D
Following overnight fasting, hypoglycemia in adults is defined as a glucose of: A. </= 70 mg/dL (</= 3.9 mmol/L) B. </= 60 mg/dL (</= 3.3 mmol/L) C.</= 55 mg/dL (</= 3.0 mmol/L) D.</= 45 mg/dL (</= 2.5 mmol/L)
Correct Answer: D
For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to: A. prevent alloimmunization B. diminish chills and fever C. prevent hemoglobinemia D. reverse hypotension and minimize renal damage
Correct Answer: D
Four units of blood are needed for elective surgery. The patient's serum contains anti-C, anti-e, anti-Fy^a, and anti-Jk^b. Which of the following would be the best source of donor blood? A. test all units in current stock B. test 100 group O, Rh-negative donors C. test 100 group-compatible donors D. rare donor file
Correct Answer: D
Genes of the major histocompatibility complex (MHC): A. code for HLA-A, HLA-B, and HLA-C antigens only B. are linked to genes in the ABO system C. are the primary genetic sex-determinants D. contribute to the coordination of cellular and humoral immunity
Correct Answer: D
Given the following results: -alkaline phosphatase: marked increase -aspartate amino transferase: slight increase -alanine amino transferase: slight increase -gamma-glutamyl transferase: marked increase This is most consistent with: A. acute hepatitis B. osteitis fibrosa C. chronic hepatitis D. obstructive jaundice
Correct Answer: D
Hageman Factor (XII) is involved in each of the following reactions except: A. activation of C1 to C1 esterase B. activation of plasminogen C. activation of Factor XI D. transformation of fibrinogen to fibrin
Correct Answer: D
Heinz bodies are: A. readily identified with polychrome stains B. rarely found in glucose-6-phosphate dehydrogenase deficient erythrocytes C. closely associated with spherocytes D. denatured hemoglobin inclusions that are readily removed by the spleen
Correct Answer: D
Hematology standards include: A. stabilized red blood cell suspension B. latex particles C. stabilized avian red blood cells D. certified cyaanmethemoglobin solution
Correct Answer: D
Hemorrhage in polycythemia vera is the result of : A. increased plasma viscosity B. persistent thrombocytosis C. splenic sequestratioin of platelets D. abnormal platelet function
Correct Answer: D
Heparin acts by: A. precipitating fibrinogen B. binding calcium C. activating plasmin D. inhibiting thrombin
Correct Answer: D
In a specimen collected for plasma glucose analysis, sodium fluoride: A. serves as a coenzyme of hexokinase B. prevents reactivity of non-glucose reducing substances C. precipitates proteins D. inhibits glycolysis
Correct Answer: D
In comparison to malignant lymphoma cells, reactive lymphocytes: A. have a denser nuclear chromatin B. are known to be T cells C. have more cytoplasm and more mitochondria D. are morphologically more variable throughout the smear
Correct Answer: D
In infectious mononucleosis, lymphocytes tend to be: A.small with little cytoplasm B. normal C. decreased in number D. enlarged and indented by surrounding structures
Correct Answer: D
In normal adult bone marrow, the most common granulocyte is the: A. basophil B. myeloblast C. eosinophil D. metamyelocyte
Correct Answer: D
In relationship testing, a "direct exclusion" is established when a genetic marker is: A. absent in the child, but present in the mother and alleged father B. absent in the child, present in the mother and absent in the alleged father C. present in the child, absent in the mother and present in the alleged father D. present in the child, but absent in the mother and alleged father
Correct Answer: D
In respiratory acidosis, a compensatory mechanism is the increase in: A. chloride B. calcium C. potassium D. sodium
Correct Answer: D
In synovial fluid, the most characteristic finding in traumatic arthritis is: A. monosodium urate crystals B. cartilage debris C. calcium pyrophosphate dihydrate crystals D. hemosiderin-laden macrophages
Correct Answer: D
In the Malloy and Evelyn method for the determination of bilirubin, the reagent that is reacted with bilirubin to form a purple azobilirubin is: A. dilue sulfuric acid B. diazonium sulfate C. sulfobromophthalein D. diazotized sulfanilic acid
Correct Answer: D
In the direct (DAT) and indirect (IAT) antiglobulin tests, false negative reactions may result if the: A. patient's blood specimen was contaminated with bacteria B. patient's blood specimen was collected into tubes containing silicon gel C. saline used for washing the serum/cell mixture has been stored in glass or metal containers D. addition of AHG is delayed for 40 minutes or more after washing the serum/cell mixture
Correct Answer: D
In the direct antiglobulin test, the antiglobulin reagent is used to: A. mediate hemolysis of indicator red blood cells by providing complement B. precipitate anti-erythrocyte antibodies C. measure antibodies in a test serum by fixing complement D. detect preexisting antibodies on erythrocytes
Correct Answer: D
In using ion-exchange chromatographic methods, falsely increased levels of Hgb A2, might be demonstrated in the presence of: A. iron deficiency anemia B. pernicious anemia C. thalassemias D. Hgb S
Correct Answer: D
In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen? A. hemolytic anemia B. multiple myeloma C. G-6-PD deficiency D. myeloid metaplasia
Correct Answer: D
Increased total serum lactidehydrogensase (LD) activity, confined to fractions 4 and 5 is most likely to be associated with: A. pulmonary infarciton B. hemolytic anemia C. myocardial infarction D. acute viral hepatitis
Correct Answer: D
Isoenzyme assays are performed to improve: A. precision B. accuracy C. sensitivity D. specificity
Correct Answer: D
Lithium therapy is widely used in the treatment of: A. hypertension B. hyperactivity C. aggression D. manic-depressive (bipolar) disorder
Correct Answer: D
Magnesium carbonate is added in an iron binding capacity determination in order to: A. allow color to develop B. precipitate protein C. bind with hemoglobin iron D. remove excess unbound iron
Correct Answer: D
Many microsherocytes, schitocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: A. hereditary spherocytosis B. disseminated intravascular coagulation (DIC) C. acquired autoimmune hemolytic anemia D. extensive burns
Correct Answer: D
Metabolic acidosis is described as a(n): A. increase in CO2 content and PCO2 with a decreased pH B. decrease in CO2 content with an increased pH C. increase in CO2 with an increased pH D. decrease in CO2 content and PCO2 with a decreased pH
Correct Answer: D
Monitoring long-term glucose control in patients with adult onset diabetes mellitus can best be accomplished by measuring: A. weekly fasting 7 AM serum glucose B. glucose tolerance testing C. 2-hour postprandial serum glucose D. hemoglobin A 1C
Correct Answer: D
Morphologic variants of plasma cells do not include: A. flame cells B. marula cells C. grape cells D. Gaucher cells
Correct Answer: D
Most blood group system are inherited as: A. sex-linked dominant B. sex-linked recessive C. autosomal recessive D. autosomal codominant
Correct Answer: D
Most chemical methods for determining total protein utilize which of the following reactions? A. molybdenum blue B. ferri-ferrocyanide C. resorcinol-HCL D. biuret
Correct Answer: D
Multipotent stem cells are capable of producing: A. daughter cells of only one cell line B. only T-lymphocytes and B-lymphocytes C. erythropoietin, thrombopoietin, and leukopoietin D. lymphoid and myeloid stem cells
Correct Answer: D
Of the following, the disease most closely associated with mucopolysaccharidosis is: A. Pelger-Huet anomaly B. Chediak-Higashi syndrome C. Gaucher disease D. Alder-Reilly anomaly
Correct Answer: D
On Monday a patient's hemoglobin determination was 11.3 g/dL (113 g/L), and on Tuesday it measured 11.8 g/dL (118 g/L). The standard deviation of the method used is +-0.2 g/dL (2 g/L). Which of the following can be concluded about the hemoglobin values given? A. one value probably resulted from laboratory error B. there is poor precision; daily quality control charts should be checked C. the second value is out of range and should be repeated D. there is no significant change in the patient's hemoglobin concentration
Correct Answer: D
On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated? A. call for service B. adjust the MCV up slightly C. shut down the instrument D. repeat the control
Correct Answer: D
Patients with A(-) type G-6-PD deficiency are least likely to have hemolytic episodes in which of the following situations? A. following the administration of oxidizing drugs B. following the ingestion of fava beans C. during infections D. spontaneously
Correct Answer: D
Pellarga is associated with deficiency of which of the following vitamins? A. A B. B1 C. thiamine D. niacin
Correct Answer: D
Platelets prepared in a polyolefin type container, stored at 22 - 24 C in 50 mL of plasma, and gently agitated can be used for up to: A. 24 hours B. 48 hours C. 3 days D. 5 days
Correct Answer: D
Pregnant women with symptoms of thirst, frequent urination or unexplained weight loss should have which of the following tests performed? A. tolbutamide test B. lactose tolerance test C. epinephrine tolerance test D. glucose tolerance test
Correct Answer: D
Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution containing: A. hypochlorite B. isopropyl alcohol C. 10% acetone D. PVP iodine complex
Correct Answer: D
Refer to the following data: -anti-C: + -anti-D: + -anti-E: + -anti-c: + -anti-e: + Given the reactions above, which is the most probable genotype? A. R1R1 B. R1r' C. R0r" D. R1R2
Correct Answer: D
Refer to the following illustration: See BOC pg 102 Which of the following is the most likely interpretation of the LD isoenzyme scan illustrated above? A. myocardial infarction B. megaloblastic anemia C. acute pancreatitis D. viral hepatitis
Correct Answer: D
Refer to the following illustration: See BOC pg 204 Which are in the automated cell counter histogram represents the RBC distribution curve? A. A B. B C. C D. D
Correct Answer: D
Regan isoenzyme has the sam properties as alkaline phosphatase that originates in the: A. skeleton B. kidney C. intestine D. placenta
Correct Answer: D
Resistance to malaria best associated with which of the following blood groups? A. Rh B. I/i C. P D. Duffy
Correct Answer: D
Samples from the same patient were received on 2 consecutive days. Test results are summarized below: Day #1; Day #2 -anti-A: 4+, 0 -anti-B: 0, 4+ -anti-D: 3+, 3+ A1 cells: 0, 4+ B cells: 4+, 0 Ab screen: 0, 0 How should the request for crossmatch be handled? A. crossmatch A, Rh-positive units with sample from day 1 B. crossmatch B, Rh-positive units with sample from day 2 C. crossmatch AB, Rh-positive units with both samples D. collect a new sample and repeat the tests
Correct Answer: D
Serum "anion gap" is increased in patients with: A. renal tubular acidosis B. diabetic alkalosis C. metabolic acidosis due to diarrhea D. lactic acidosis
Correct Answer: D
Symptoms of dyspnea, cough, hypoxemia, and pulmonary edema with 6 hours of transfusion is most likely which type of reaction? A. anaphylactic B. hemolytic C. febrile D. TRALI
Correct Answer: D
Terminal deoxynucleotidyl transferase (TdT) is a marker found on: A. hairy cells B. myeloblasts C. monoblasts D. lymphoblasts
Correct Answer: D
Thalassemia are characterized by: A. structural abnormalities in the hemoglobin molecule B. absence of iron in hemoglobin C. decreased rate of heme synthesis D. decreased rate of globin synthesis
Correct Answer: D
The 2 factors that differentiate liver disease from Vitamin K deficiency are: A. II and VII B. IX and VII C. VIII and IX D. V and VII
Correct Answer: D
The APTT: A. tests the extrinsic coagulation pathway B. monitors Coumadin therapy C. requires tissue thromboplastin D. monitors heparin therapy
Correct Answer: D
The ISI in the INR represents the reagents: A. activator B. specificity C. phospholipids D. sensitivity
Correct Answer: D
The automated platelet count on an EDTA specimen is 58 x 10^3/uL (58 x 10^9/L). The platelet estimated on the blood smear appears normal, but it was noted that the platelet were surrounding the neutrophils. The next step should be too: A. report the automated platelet count since it is more accurate than a platelet estimate B. warm the EDTA tube and repeat the automated platelet count C. rerun the original specimen since the platelet count and blood smear estimate do not match D. recollect a specimen for a platelet count using a different anticoagulant
Correct Answer: D
The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and; A. sodium B. potassium C. calcium D. chloride
Correct Answer: D
The conversion of glucose or other hexoses into lactate or pyruvate is called: A. glycogenesis B. glycogenolysis C. gluconeogenesis D. glycolysis
Correct Answer: D
The degree to which the kidney concentrates the glomerular filtrate can be determined by: A. urine creatine B. serum creatinine C. creatinine clearance D. urine to serum osmolality ration
Correct Answer: D
The enzyme present in almost all tissues that may be separated by electrophoresis into 5 components is: A. lipase B. transaminase C. creatine kinase D. lactate dehydrogenase
Correct Answer: D
The enzyme, which exists chiefly in skeletal muscle, heart, and brain, is grossly elevate in active muscular dystrophy, and rises early in myocardial infarction is: A. lipase B. transaminase C. lactate dehydrogenase D. creatine kinase
Correct Answer: D
The first step in analyzing a 24-hour urine specimen for quantitative urine protein is: A. subculture the urine for bacteria B. add the appropriate preservative C. screen for albumin using a dipstick D. measure the total volume
Correct Answer: D
The first step in the quantitation of serum iron is: A. direct reaction with appropriate chromogen B. iron saturation of transferrin C. free iron precipitation D. separation of iron form transferring
Correct Answer: D
The following laboratory resutls were obtained: BF type; Calcium; Alkaline Phosphate; Alkaline phosphatase -serum: increased: decrease; normal or increased -urine: increased; increased These result are most compatible with: A. multiple myeloma B. milk-alkali syndrome C. sarcoidosis D. primary hyperparathyroidism
Correct Answer: D
The following results are seen on a maternal postpartum sample: D; D control; Weak D; Weak D control -mother's postpartum sample: 0; 0; 1+mf; 0 -mf=mixed field: The most appropriate course of action is to: A. report the mother as Rh-negative B. report the mother as Rh-positive C. perform an elution on mother's RBCs D. investigate for a fetomaternal hemorrhage
Correct Answer: D
The following results were obtained from a post-surgical patient receiving total parenteral nutrition: Hospital day: 17 , 18 , 19 Hgb: 12.1 g/dL (121 g/L), 11.6 g/dL(116 g/L), 9.4 g/dL (94 g/L) Hct: 29.2% , 29.4% , 28.8% The most consistent explanation for the above data is A. acute sundial bleeder B. specimen on day 19 from wrong patient C. improperly mixed specimen of day 19 D. lipid interference on days 17 and 18
Correct Answer: D
The following results were obtained in a creatinine clearance evaluation: -urine concentration: 84 mg/dL -urine volume: 1, 440 mL/24 hr -serum concentration: 1.4 mg/dL -body surface area: 1.60 m2 (average =1.73 m2) The creatinine clearance in mL/min is: A. 6 B. 22 C. 60 D. 65
Correct Answer: D
The following results were obtained on a patient's blood sample during routine ABO and Rh testing: Cell testing: -anti-A: 0 -anti-B: 4+ -anti-D: 0 -autocontrol: 0 Serum testing: A1 cells: 4+ B cells: 2+ Select the course of action to resolve this problem: A. draw a new blood sample from the patient and repeat all test procedures B. test the patient's serum with A2 cells and patient's red cells with anti-A1 lectin C. repeat the ABO antigen grouping using 3x washed saline-suspended cells D. perform antibody screening procedure at immediate spin using group O cells
Correct Answer: D
The following results were obtained on an electronic particle counter: -WBC: ++++ -RBC: 2.01 x 10^6/uL (2.01 x 10^12/L) -Hgb: 7.7 g/dL (77 g/L) -Hct: 28.2% -MCV: 141 um^3 (141 fL) -MCH: 38.5 pg -MCHC: 23.3% What step should be taken before recycling the sample? A. clean the apertures B. warm the specimen C. replace the lysing agent D. dilute the specimen
Correct Answer: D
Correct Answer: A
Refer to the following illustration: Which curve represents the production of epsilon polypeptide chains of hemoglobin? A. A B. B C. C D. D
The following resutls were obtained when testing a sample from a 20-year-old, first-time blood donor: Forward group; -anti-A: 0 -anti-B: 0 Reverse group: A1 cells: 0 B cells: 3+ What is the most likely cause of this ABO discrepancy? A. loss of antigen due to disease B. acquired B C. phenotype Oh "Bombay" D. weak subgroup of A
Correct Answer: D
The international Federation for Clinical Chemistry (IFCC) recommends the use of methods such as the Bessey-Lowry Brock method for determining alkaline phosphatase activity. The substrate used in this type of method is: A. monophophate B. phenylphosphate C. disodium phenylphosphate D. para-nitrophenylphosphate
Correct Answer: D
The linked HLA genes on each chromosome constitute a(n): A. allele B. trait C. phenotype D. haplotype
Correct Answer: D
The major crossmatch will detect a(n): A. group A patient mistyped as group O B. unexpected red cell antibody in the donor unit C. Rh-negativ donor unit mislabeled as Rh-positive D. recipient antibody directed against antigens on the donor red cells
Correct Answer: D
The metabolite 11-nor-tetrahydrocannabinol-9-COOH can be detected by immunoassay 3-5 days after a single use of: A. methoamphetamine B. cocaine C. benzodiazepine D. marijuana
Correct Answer: D
The most characteristic peripheral blood smear finding in multiple myeloma is: A. plasmacytic satellitosis in the bone marrow B. many plasma cells in the peripheral blood C. many Mott cells in the peripheral blood D. rouleaux formation of the red cells
Correct Answer: D
The most important step in the safe administration of blood is to: A. perform compatibility testing accurately B. get an accurate patient history C. exclude disqualified donors D. accurately identify the donor unit and recipient
Correct Answer: D
The most specific enzyme test of acute pancreatitis is: A. acid phosphates B. trypsin C. amylase D. lipase
Correct Answer: D
The most widely used methods for bilirubin measurement are those based on the: A. Jaffe reaction B. Schale and Schale method C. 8-hyroxyquinoline reaction D. Jendrassik-Grof method
Correct Answer: D
The optimum storage temperature for Red Blood Cells is: A. -80 C B. -20 C C. -12 C D. 4 C
Correct Answer: D
The optimum storage temperature for platelets is: A. -20 C B. -12 C C. 4 C D. 22 C
Correct Answer: D
The process of separation of antibody from its antigen is known as: A. diffusion B. adsorption C. neutralization D. elution
Correct Answer: D
The prothrombin time best requires that the patient's citrated plasma be combined with: A. platelets B. thromboplastin C. Ca++ and platelet lipids D. Ca++ and thromboplastin
Correct Answer: D
The results on a patient are: Test, Patient results, Reference range -Pt: 18.5 sec 11.0-13.5 sec -APTT: 47.5 sec 24-35 sec -Thrombin time: 14.0 sec 12-19 sec -ATIII: 82% 70%-130% -Protein C: 54% 77%-167% -Protein S 48% 65%-140% -Activated protein C resistance: 2.6 >2.1 These results reflect: A. thrombophilia B. Factor IX deficiency C. heparin D. warfarin
Correct Answer: D
The screen for adrenal cortical hyperfunction with the greatest and specificity is: A. 24-hour urine free cortisol B. plasma cortisol C. urinary 17-hydroxycorticosteroids D. plasma corticosterone
Correct Answer: D
The screening test for congenital hypothyroidism is based upon: A. TSH level in the newborn B. thyroid-binding globulin level in the newborn C. iodine level in the newborn D. total thyroxine (T4) level in the newborn
Correct Answer: D
The serum of a grop O, Cde/Cde donor contains anti-D. In order to prepare a suitable anti-D reagent form this donor's serum, which of the following cells would be suitable for the adsorption? A. group O, cde/cde cells B. group O, Cde/cde cells C. group A2B, CDe/cde cells D. group A1B, cde/cde cells
Correct Answer: D
Thrombocytosis would be indicated by a platelet count of: A. 100 x 10^3/uL (100 x 10^9/L) B. 200 x 10^3/uL (200x 10^9/L) C. 300 x 10^3/uL (300 x 10^9/L) D. 600 x 10^3/uL (600 x 10^9/L)
Correct Answer: D
To confirm a serum antibody specificity identified as anti-P1, neutralization study was performed and the following results obtained: P1 +RBCS serum + P1 substance: negtive serum + saline: negative What conclusion can be made form these results? A. anti-P1 is confirmed B. anti-P1 is ruled out C. a second antibody is suspected due to the results of the negative control D. anti-P1 cannot be confirmed due to the results of the negative control
Correct Answer: D
Transfusion of plateletpheresis products from HLA-compatible donors is the preferred treatment for: A. recently diagnosed cases of RRP with severe thrombocytopenia B. acute leukemia in relapse with neutropenia, thrombocytopenia and sepsis C. immune thrombocytopenic purpura D. severely thrombocytopenic patients, known to be refractory to random donor platelets
Correct Answer: D
Unless blood gas measurements are made immediately after sampling, in vitro glycolysis of the blood causes a: A. rise in pH and PCO2 B. fall in pH and a rise in PO2 C. rise in pH and a fall in PO2 D. fall in pH and a rise in PCO2
Correct Answer: D
Upon inspection, a unit of platelets is noted to have visible clots, but otherwise appears normal. The technologist should: A. issue without concern B. filter to remove the clots C. centrifuge to express off the clots D. quarantine for Gram stain and culture
Correct Answer: D
Urobilinogen is formed in the: A. kidney B. spleen C. liver D. intestine
Correct Answer: D
What common substrate is used in the biosynthesis of adrenal steroids, including androgens and estrogens? A. cortisol B. catecholamines C. progesterone D. cholesterol
Correct Answer: D
What is the most likely cause of the following ABO discrepancy? Patient's cells vs: -anti-A: 0 -anti-B: 0 Patient's serum vs: A1 cells: 0 B cells: 0 A. recent transfusion with group O blood B. antigen depression due to leukemia C. false negative cell typing due to rouleaux D. obtained from a heel stick of a 2-month old baby
Correct Answer: D
When evaluating a smear for a reticulocyte count, the technician observes that the red blood cells are overlapping throughout the entire slide. The most likely explanation is: A. grease on the slide prevented even spreading B. improper proportions of blood and stain were used C. the slide was dried too quickly D. the drop used for the slide preparation was too large
Correct Answer: D
When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to: A. abnormal proteins B. inadequate mixing of blood and anticoagulant C. hemorrhage D. poorly made wedge smear
Correct Answer: D
When using the turbidity (solubility) method for detecting the presence of hemoglobin S, an incorrect interpretation may be made when there is a(n): A. concentration of less than 7 g/dL (70 g/L) hemoglobin B. glucose concentration greater than 150 mg/dL (8.3 mmol/L) C. blood specimen greater than 2 hours old D. increased hemoglobin
Correct Answer: D
Which of the RBC indices is a measure of the amount of hemoglobin in individual red blood cells? A. MCHC B. MCV C. Hct D.MCH
Correct Answer: D
Which of the following 2 hour postprandial glucose values demonstrates unequivocal hyperglycemia diagnostic for diabetes mellitus? A. 160 mg/dL (8.8 mmol/L) B. 170 mg/dL (9.4 mmol/L) C. 180 mg/dL (9.9 mmol/L) D. 200 mg/dL (11.0 mmol/L)
Correct Answer: D
Which of the following Rh antigens has the highest frequency in Caucasians? A. D B. E C. c D. e
Correct Answer: D
Which of the following anomalies is an autosomal dominant disorder characterized by irregularly -sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets and often thrombocytopenia? A. Pelger-Huet B. Chediak-Higashi C. Alder-Reilly D. May-Hegglin
Correct Answer: D
Which of the following antigens is most likely to be involved in hemolytic disease of the newborn? A. Le^a B. P1 C. M D. Kell
Correct Answer: D
Which of the following calcium procedures utilizes lanthanum chloride to eliminate interfering substances? A. o-cresolphthalein complexone B. precipitation with chloranilic acid C. chelation with EDTA D. atomic absorption spectrophotometry
Correct Answer: D
Which of the following clinical disorders is associated with the greatest elevation of lactate dehydrogenase isoenzyme 1? A. pneumonia B. glomerulonephritis C. pancreatitis D. pernicious anemia
Correct Answer: D
Which of the following conditions is not associated with a high incidence of leukemia? A. paroxysmal nocturnal hemoglobinuria B. Fanconi anemia C. aplastic anemia D. megaloblastic anemia
Correct Answer: D
Which of the following hemoglobins has glucose-6-phosphate on the amino-terminal valine of the beta chain? A. S B. C C. A2 D. A1c
Correct Answer: D
Which of the following is Vitamin-K dependent? A. Factor XII B. fibrinogen C. antithrombin II D. Factor VII
Correct Answer: D
Which of the following is associated with Alder-Reilly inclusions? A. membrane defect of lysosomes B. Dohle bodies and giant platelets C. 2-lobed neutrophils D. mucopolysaccharidosis
Correct Answer: D
Which of the following is consistent with standard blood bank procedure governing the infusion of fresh frozen plasma? A. only blood group-specific plasma may be administered B. group O may be administered to recipients of all blood groups C. group AB may be administered to AB recipients only D. group A may be administered to both A and O recipients
Correct Answer: D
Which of the following is most closely associated with chronic myelogenous leukemia? A. ringed sideroblasts B. disseminated intravascular coagulation C. micromegakarycytes D. Philadelphia chromosome
Correct Answer: D
Which of the following is most closely associated with chronic myelomonocytic leukemia? A. Philadelphia chromosome B. disseminated intravascular coagulation C. micromegakaryocytes D. lysozymuria
Correct Answer: D
Which of the following is most closely associated with iron deficiency anemia? A. iron overload in tissue B. target cells C. basophilic stippling D. chronic blood loss
Correct Answer: D
Which of the following is not a characteristic usually associated with hairy cell leukemia? A. pancytopenia B. mononuclear cells with ruffled edges C. splenomegaly D. increased resistance to infection
Correct Answer: D
Which of the following is the Henderson-Hasselbalch equation? A. pKa = pH + log ([acid]/[salt]) B. pKa = pH + log ([salt]/[acid]) C. pH=pKa + log ([acid]/[salt]) D. pH=pKa + log ([salt]/[acid])
Correct Answer: D
Which of the following is the formula for absolute cell count? A. number of cells counted/ total count B. total count/ number of cells counted C. 10 x total count D. % of cells counted x total count
Correct Answer: D
Which of the following is the formula for calculating absorbance give the percent transmittance (%T) of a solution? A. 1- log (%T) B. log (% T)-2 C. 2 x log (%T) D. 2-log (%T)
Correct Answer: D
Which of the following might cause a false negative indirect antiglobulin test (IAT)? A. over-reading B. IgG-coated screening cells C. addition of an extra drop of serum D. too heavy a cell suspension
Correct Answer: D
Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder? Serum iron, Transferrin saturation, TIBC -Result A: nL; nL; nL -Result B: inc; inc; nL or slightly inc -Result C: nL; markedly inc; nL -Result D: dec; dec; nL or dec A. result A B. result B C. result C D. result D
Correct Answer: D
Which of the following serum constituents is unstable if a blood specimen is left standing at room temperature for 8 hours before processing? A. cholesterol B. triglyceride C. creatinine D. glucose
Correct Answer: D
Which of the following stains is used to demonstrate iron, ferritin and hemosiderin? A. peroxidase B. Sudan black B C. periodic acid-Schiff (PAS) D. Prussian blue
Correct Answer: D
Which of the following statements about this field is true? See BOC pg 181 Pic 1 A. reticulocytes are demonstrable B. toxic granulation is present C. the cell in the center is a basophilic normoblast D. the large cell on the left is a monocyte
Correct Answer: D
Which of the following statements most correctly describes the utility of the clinical laboratory assays for tumor markers? A. tumor markers are useful to screen asymptomatic patients for tumor B. tumor markers are highly specific C. tumor markers indicate the likelihood of an individual developing a tumor D. tumor markers are useful in tracking the efficacy of treatment
Correct Answer: D
Which of the following would most likely be responsible for an incompatible antiglobulin crossmatch? A. recipient's red cells possess a low frequency antigen B. anti-K antibody in donor serum C. recipient's red cells are polyagglutinable D. donor red cells have a positive direct antiglobulin test
Correct Answer: D
Which one of the following constitutes permanent rejection status of a donor? A. a tattoo 5 months previously B. recent close contact with a patient with viral hepatitis C. 2 units of blood transfused 4 months previously D. confirmed positive test for HBsAg 10 years prevously
Correct Answer: D
Which one of the following is an indicator of polyagglutination? A. RBCs typing as weak D+ B. presence of red cell autoantibody C. decreased serum bilirubin D. agglutination with normal adult ABO compatible sera
Correct Answer: D
Which one of the following sets of results is consistent with primary hypothyroidism, (eg, Hashimoto thyroiditis): Result; TSH; T4 ( free thyroxine); Antimicrosomal antibody -result A; decreased; decreased; positive -result B; increased; increase; positive -result C; normal; decreased; negative -result D; increased; decreased; positive A. result A B. result B C. result C D. result D
Correct Answer: D
With this blood picture, an additional test indicated is: See BOC pg 159 A. alkali denaturation B. alkaline phosphatase stain C. peroxidase stain D. hemoglobin electrophoresis
Correct Answer: D
vWF antigen can be found in which of the following? A. myeloblast B. monoblast C. lymphoblast D. megakaryoblast
Correct Answer: D
The minimum hemoglobin concentration in a fingerstick from a male blood donor is A. 12.0 g/dL (120 g/L) B. 12.5 g/dL (125 g/L) C. 13.5 g/dL (135 g/L) D. 15.0 g/dL (150 g/L)
Correct B
The preparation of a patient for standard glucose tolerance testing should include: A. a high carbohydrate diet for 3 days B. a low carbohydrate diet for 3 days C. fasting for 48 hours prior to testing D. bed rest for 3 days
Correct answer: A
Chelex 100 resin is used to: a. purify mRNA from total RNA b. extract total RNA from cells c. extract DNA from cells d. remove unincorporated primers from PCR reactions prior to gel analysis of PCR products
Extract DNA from cells Chelex resin is often used to extract DNA from forensic samples, but may also be used for clinical samples. (c)
Correct Answer: C
Refer to the following illustration: Which curve represents the production of gamma polypeptide chains of hemoglobin? A. A B. B C. C D. D
The term that best describes males regarding X-linked genes is: a. heterozygous b. homozygous c. haplozygous d. hemizygous
Hemizygous (d) Males are hemizygous for X-linked alleles because they have only one copy of the X chromosome.
Intervening sequences are found in: a. heteronuclear RNA b. mature mRNA c. ribosomal RNA d. transfer RNA
Heteronuclear RNA (a) Heteronuclear RNA is made up of newly transcribed mRNA that still contains intervening sequences.
on electropheresis at alkaline pH, which of the following is the slowest migrating hemoglobin?
Hgb C
The mode of inheritance of mitochondrial DNA is: a. dominant b. recessive c. codominant d. maternal
Maternal (d) All mitochondria are passed on from a mother to her children, but not by a father to his children
A PCR reaction in which 4 different sets of primers are used to simultaneously amplify 4 distinct loci in the same reaction tube is known as a: a. multiplex PCR reaction b. heteroplex PCR reaction c. polyplex PCR reaction d. quadraplex PCR reaction
PCR reactions in which multiple loci are amplified in the same reaction by multiple sets of primers are known as multiplex PCR. (a).
199) Which marker can be used to identify a body fluid as semen?
PSA Consider each answer, and determine if it is are unique to a particular site: a — PSA is used to screen for prostate cancer, because it is high in secretions from the prostate; therefore, semen is high in PSA. PSA can be used forensically to identify a fluid as semen. b — Alkaline phosphatase is found predominantly in bone and liver. On the other hand, acid phosphatase, not a choice, is high in prostate secretions, and semen. c — Fructose is the major carbohydrate found in semen, but it is not unique to semen. d — Hyaluronic acid is associated with synovial fluid.)
89) Identify the formed element in this photomicrograph:
RBC RBCs are smooth, circular, greenish objects. They can be confused with yeast and fat globules. To distinguish yeast from RBC, react an aliquot with water. RBCs will lyse, but yeast will not. Fat globules can be stained with Sudan III, turning them orange. RBCs should produce a positive blood result on a biochemical strip.)
Correct Answer: B
Refer to the following illustration: Which curve represents the production of alpha polypeptide chains of hemoglobin? A. A B. B C. C D. D
Correct Answer: D
Refer to the following illustration: Which curve represents the production of beta polypeptide chains of hemoglobin? A. B B. C C. E D. D
Correct Answer: D
Refer to the following illustration: Which curve represents the production of delta polypeptide chains of hemoglobin? A. B B. C C. D D. E
The fluorescent dye that exhibits the greatest sensitivity for quantization of DNA is: a. ethidium bromide b. Hoechst 33258 c. propidium iodide d. SYBR green
SYBR green is the most sensitive of the listed dyes. (d)
A metaphase chromosome with primary constriction that gives the chromosome clearly defined short and long arms is considered: a. acrocentric b. submetacentric c. metacentric d. telocentric
Submetacentric (b) Chromosomes with clearly defined short and long arms are known as submetacentric chromosomes.
90) All casts typically contain:
Tamm-Horsfall glycoprotein Tamm-Horsfall protein is continuously excreted by the renal tubular cells. In conditions that cause urine stasis, the excreted protein aggregates into fibrils that mesh to form the matrix of casts.
During the G2 phase of the cell cycle, the DNA content of a cell is: a. haploid b. diploid c. triploid d. tetraploid
Tetraploid (d) The G2 phase of the cell cycle follows the S phase, where DNA content goes from 2N to 4N or from diploid to tetraploid.
A translocation in which chromosome pair creates a BCR/ABL1 fusion gene product associated with CML? a. 11;18 b. 14;18 c. 9;22 d. 9;14
The 9;22 transolation creates the BCR/ABL1 fusion gene in CML.
When quantifying the amount of genomic DNA in a sample by spectrophotometry, an OD 260 of 1.0 corresponds to what concentration of DNA? a. 10 μg/mL b. 20 μg/mL c. 50 μg/mL d. 100 μg/mL
The absorptivity constant for DNA is 50 μg/mL. (c)
128) Which of the following exhibits rapid motility in urine sediment?
Trichomonas vaginalis The flagellate Trichomonas vaginalis moves rapidly through the sediment. If not moving, it may resemble a WBC, and careful examination of phase microscopy is needed to visualize the flagellum. Urine is toxic to spermatozoa.
96) The urine microscopic constituents that best differentiate between cystitis and pyelonephritis are:
WBC casts Pyelonephritis is an inflammation/infection of the renal tubules. Therefore, white blood cell casts would indicate the location of the source of the inflammation/infection. Cystitis is an infection of the bladder.
The expected colony count in a suprapubic urine from a healthy individual is: a 0 CFU/mL b 100 CFU/mL c 1,000 CFU/mL d 100,000 CFU/mL
a 0 CFU/mL a Urine in the bladder is normally sterile. Suprapubic aspiration removes urine directly from the bladder and yields a specimen free of urethral contamination.
How many hours after eating contaminated food do initial symptoms of staphylococcal food poisoning typically occur? a 2-6 hours b 12-18 hours c 24-48 hours d 72 hours to a week
a 2-6 hours a Staphylococcus aureus produces an enterotoxin that is associated with food poisoning. Symptoms typically appear within 2-6 hours.
The scolex of Taenia saginata has: a 4 suckers b no suckers and 14 hooklets c 24 hooklets d 26-28 sucking discs
a 4 suckers a The scolex of Taenia saginata is square with 4 suckers and no hooks.
Optimum growth of Campylobacter jejuni is obtained on suitable media incubated at 42°C in an atmosphere containing: a 6% 02> 10%-15% C02, 85%-90% nitrogen b 10% H2, 5% C02, 85% nitrogen c 10% H2, 10% C02, 80% nitrogen d 25% 02, 5% C02, 70% nitrogen
a 6% 02> 10%-15% C02, 85%-90% nitrogen a Campylobacter is microaerophilic, and requires a decreased oxygen and increased carbon dioxide atmosphere for growth.
Which of the following pairs of organisms usually grow on kanamycin, vancomycin, laked blood agar? a Bacteroides and Prevotella b Mobiluncus and Gardnerella c Porphyromonas and Enterococcus d VeiUonella and Capnocytophaga
a Bacteroides and Prevotella a Kanamycin-vancomycin laked blood agar is a selective medium used for the isolation of Bacteroides or Prevotella.
Which organism is the most common anaerobic bacteria isolated from infectious processes of soft tissue and anaerobic bacteremia? a Bacteroides fragilis b Fusobacterium nucleatum c Porphyromonas asaccharolytica d Clostridium perfringens
a Bacteroides fragilis a Anaerobic gram-negative bacilli predominate among anaerobes in clinical infections. Bacteroides fragilis is the most common isolated anaerobic bacteria in clinical specimens.
Relapsing fever in humans is caused by: a Borrelia recurrentis b Brucella abortus c Leptospira interrogans d Spirillum minus
a Borrelia recurrentis a Relapsing fever is caused by Borrelia recurrentis and is transmitted by the human body louse. Relapsing fever is characterized by the acute onset of high fever lasting 3-7 days, interspersed with periods of no fever lasting days to weeks.
A diabetic foot swab from a 82-year-old woman with recurrent infections is submitted for culture. The Gram stain reveals: many neutrophils, no squamous epithelial cells many gram-negative bacilli many gram-positive cocci in chains The physician requests that all pathogens be worked up. In addition to the sheep blood and MacConkey agar plates routinely used for wound cultures, the technologist might also process a(n): a CNA agar plate b chocolate agar plate c XLD agar plate d chopped meat glucose
a CNA agar plate a CNA agar is a selective medium rutinelly used in the isolation of gram positive aerobic and anaerobic organisms. Since the Gram stain indicates a mixture of gram-positive and gram-negative organisms, use of CNA will aid in the recovery of the gram-positive cocci in culture.
Which of the following must be incubated in a microaerophilic environment for optimal recovery of the organism? a Campylobacter jejuni b Escherichia coli c Pseudomonas aeruginosa d Proteus mirabilis
a Campylobacter jejuni a Most Campylobacter species grow best under lower oxygen tension in an atmosphere of 5% oxygen, 10% carbon dioxide and 85% nitrogen. E coli and Proteus mirabilis are facultative anaerobes and Pseudomonas aeruginosa is an aerobe.
The reverse CAMP test, lecithinase production, double zone hemolysis, and Gram stain morphology are all useful criteria in the identification of: a Clostridium perfringens b Streptococcus agalactiae c Propionibacterium acnes d Bacillus anthracis
a Clostridium perfringens a The reverse CAMP test, production of lecithinase, and demonstration of double zone hemolysis are tests and characteristics used for the identification of Clostridium perfringens.
A strict anaerobe that produces terminal spores is: a Clostridium tetani b Corynebacterium diphtheriae c Bacillus anthracis d Propionibacterium acnes
a Clostridium tetani a Corynebacterium species and Propionibacterium species do not produce spores, and Bacillus is an aerobic organism.
Which selective medium is used for the isolation of gram-positive microorganisms? a Columbia CNA with 5% sheep blood b trypticase soy agar with 5% sheep blood c eosin methylene blue d modified Thayer-Martin
a Columbia CNA with 5% sheep blood a Columbia CNA agar contains colistin and nalidixic acid, which inhibit most gram-negative organisms. Eosin methylene blue is selective and inhibits gram-positive organisms and modified Thayer Martin is selective and inhibits gram-positive organisms, gram-negative bacilli and yeast.
An organism that demonstrates budding yeast cells with wide capsules m an India ink piepaiation of pinal fluid is probably: a Cryptococcus neoformans b Histoplasma capsulatum c Blastomyces dermatitidis d Candida albicans
a Cryptococcus neoformans a Cryptococcus neoformans is a cause of meningitis in immunocompromised patients, and produces a polysaccharide capsule.
An HIV-positive patient began to show signs of meningitis. A spinal fluid was collected and cultured for bacteria and fungus. A budding, encapsulated yeast was recovered. Which organism is consistent with this information? a Cryptococcus neoformans b Aspergillus fumigatus c Microsporum audouinii d Sporothrix schenckii
a Cryptococcus neoformans a Cryptococcus neoformans is a of meningitis in immunocompromised patients, and produces a polysacchar.de capsule.
An organism that exhibits the satellite phenomenon around colonies of staphylococci is. a Haemophilus influenzae b Neisseria meningitidis c Neisseria gonorrhoeae d Klebsiella pneumoniae
a Haemophilus influenzae a Haemophilus influenzae requires X and V factors. Sheep blood agar supplies X factor, and the staphylococci produce V factor, so colonies grow around staph colonies.
Which one of the following species of Mycobacterium does not usually fluoresce on fluorochrome stain? a Mycobacterium fortuitum b Mycobacterium tuberculosis c Mycobacterium ulcerans d Mycobacterium bovis
a Mycobacterium fortuitum a Rapidly-growing mycobacteria such as Mycobacterium fortuitum may be <10% acid fast and may not stain with fluorochrome
Which of the following reagents should be used as a mucolytic, alkaline reagent for digestion and decontamination of a sputum for mycobacterial culture? a N-acetyl-L-cystine and NaOH b NaOH alone c zephiran-trisodium phosphate d oxalic acid
a N-acetyl-L-cystine and NaOH a The most widely used digestion- decontamination method is the N-acetyl-L- cysteine-2% NaOH method.
Clinical resistance to penicillin correlates most frequently with beta-lactamase production in: a Neisseria gonorrhoeae b Neisseria meningitidis c Streptococcus agalactiae d Streptococcus pyogenes
a Neisseria gonorrhoeae a Penicillin resistance in Streptococcus pyogenes and S agalactiae have not been described. Neisseria meningitidis is rarely resistant to penicillin, which can be beta-lactamase mediated in some isolates. The primary mechanism of penicillin resistance in Ngonorrhoeae is beta-lactamase.
An organism recovered from a sputum has the following characteristics: Culture: growth at 7 days on Lowenstein-Jensen agar, incubated under aerobic conditions with C02 at 35°C Gram stain: delicate branching gram-positive bacilli acid-fast stain: branching, filamentous, "partially" acid-fast bacterium These results are consistent with which of the following genera? a Nocardia b Mycobacterium c Actinomyces d Streptomyces
a Nocardia a Nocardia are capable of growing on Lowenstein-Jensen agar within 7 days and demonstrate branching, beaded gram- positive bacilli on Gram stain. Nocardia are partially acid fast, and are stained best with the modified acid-fast stain.
The best medium for culture of Bordetella pertussis is: a Regan-Lowe agar b cystine blood agar c Martin Lewis agar d Ashdown agar
a Regan-Lowe agar a Regan-Lowe agar is an enriched and selective medium for the isolation of B pertussis. Cephalexin is added to inhibit nasopharyngeal flora. It provides better isolation of B pertussis than Bordet-Gengou medium.
Which of the following media can be used to culture Campylobacter jejuni? a Skirrow medium b CIN agar c anaerobic CNA agar d bismuth sulfite
a Skirrow medium a Skirrow medium is an enriched selective blood agar medium used for the isolation of Campylobacter from specimens with mixed flora. CIN and bismuth sulfite agars are selective and differential for Yersinia enterocolitica and Salmonella, respectively. CNA agar is selective for gram- positive organisms.
Which of the following is a dimorphic fungus? a Sporothrix schenckii b Candida albicans c Cryptococcus neoformans d Aspergillus fumigatus
a Sporothrix schenckii a Dimorphism differentiates Sporothrix from the other fungi listed.
The causative agent of cysticercosis is: a Taenia solium b Taenia saginata c Ascaris lumbricoides d Trichuris trichiura
a Taenia solium a Humans may become infected with Taenia solium by either ingesting the larval form or ova. If ova are ingested the parasite cannot complete the life cycle, and cysticerci encyst in various tissues including the brain.
Multifocal brain lesion in AIDS patients is commonly caused by: a Toxoplasma gondii b Pneumocystis jiroveci c Cryptosporidium parvum d Ciardia lamblia
a Toxoplasma gondii a The most common cause of ring- enhancing brain lesions in a patient with HIV/AIDS is Toxoplasma gondii.
Appropriate culture requirements for a specimen from a patient suspected of having tularemia include: a a media with cysteine such as buffered charcoal yeast extract agar b colistin nalidixic acid agar c Mueller-Hinton agar with 5% sheep blood agar d Regan-Lowe media
a a media with cysteine such as buffered charcoal yeast extract agar a Francisella tularensis is the causative agent of tularemia. It has a specific growth requirement for cysteine.
Acceptable specimens for culture of anaerobic bacteria that cause disease include: a abscesses b gingival swabs c skin swabs d vaginal swabs
a abscesses a Anaerobes normally inhabit skin and mucous membranes as part of the normal flora. Distractors b, c, and d are virtually always unacceptable for anaerobic culture, because they normally contain anaerobic organisms. It is difficult to interpret culture results from these specimens and distinguish between pathogens and normal flora.
Gram-positive cocci in chains are seen on a Gram stain from a blood culture. The organism grows as a beta-hemolytic colony. Further tests that could be performed include. a bile esculin, PYR, bacitracin, and hippurate b catalase and coagulase c oxidase and deoxyribonuclease d Voges-Proskauer and methyl red
a bile esculin, PYR, bacitracin, and hippurate a Bile esculin, PYR, bacitracin and hippurate are biochemicals/tests used in the presumptive or definitive identification of beta-hemolytic streptococci such as S pyogenes, S agalactiae and Enterococcus.
Gram stain examination from a blood culture bottle shows dark blue, spherical organisms in clusters. Growth on sheep blood agar shows small, round, pale yellow colonies. Further tests should include: a catalase production and coagulase test b bacitracin susceptibility and serological typing c oxidase and deoxyribonuclease reactions d Voges-Proskauer and methyl red reactions
a catalase production and coagulase test a The Gram stain and culture growth describe a Staphylococcus species. Catalase production confirms that the organism belonged to the genus Staphylococcus and coagulase is used to differentiate S aureus from coagulase-negative staphylococci.
The recovery of some Cryptococcus species may be compromised if the isolation media contains: a cycloheximide b gentamicin c chloramphenicol d penicillin
a cycloheximide a Cycloheximide is known to inhibit the growth of some fungal pathogens, including Cryptococcus neoformans.
The most meaningful laboratory procedure in confirming the diagnosis of clinical botulism is: a demonstration of toxin in the patients serum b recovery of Clostridium botulinum from suspected food c recovery of Clostridium botulinum from the patients stool d Gram stain of suspected food for gram-positive, sporulating bacilli
a demonstration of toxin in the patients serum a Botulism infection is confirmed by reference laboratories such as the CDC by demonstrating toxin in serum, feces, gastric contents or vomitus.
Which type of microscope would be most useful in examining viruses and the structure of microbial cells? a electron b phase-contrast c dark-field d bright-fleld
a electron a Due to the small size of viruses, they are not visible using light microscopy. Electron microscopy is used to visualize viruses and the internal structure of microorganisms.
Which of the following is the most appropriate specimen source and primary media battery? a endocervical-chocolate, Martin Lewis b sputum-sheep blood, Thayer-Martin, KV-laked blood c CSF-Columbia CNA, MacConkey d urine-sheep blood, chocolate, Columbia CNA
a endocervical-chocolate, Martin Lewis a Chocolate agar and chocolate agar-based selective media (Martin Lewis) are routinely used for the recovery of Neisseria gonorrhoeae from genital specimens. Sputum and urine specimens are routinely processed using a general purpose media (blood agar) and a selective agar (EMB or MacConkey). In addition chocolate agar is routinely included to enhance recovery of fastidious organisms such as H influenzae. CSF is routinely processed using blood and chocolate agars.
Refer to the following image: (IMAGE) A 24-year-old woman, who just returned from vacationing in Russia, became ill with steatorrheal diarrhea. The above organism was found in her stool. The patient most likely is suffering from: a giardiasis b amebiasis c ascariasis d balantidiasis
a giardiasis a Diarrhea associated with lamblia is caused by the consumption of contaminated water and results in greasy, foul-smelling stools.
The preferred carbon source for mycobacteria is: a glycerol b glucose c fatty acids d casein hydrolysate
a glycerol a Mycobacteria use glycerol as a carbon source in the presence of mineral salts.
An organism has been identified as a member of the fluorescent group of Pseudomonas. Which of the following sets of tests should be used to determine the species of the organism? a growth at 42°C, pyocyanin production, gelatinase production b pyocyanin production, gelatinase production, OF glucose c growth at 37°C, pyocyanin production, OF glucose d gelatinase production, growth at 52°C, H2S
a growth at 42°C, pyocyanin production, gelatinase production a Growth at 42°C and pyocyanin production are classic tests for the identification of Pseudomonas aeruginosa. Gelatin hydrolysis separates Pseudomonas putida (negative) from Pseudomonas fluorescence (positive).
A beta-hemolytic streptococcus that has been isolated from an ear culture grows up to the edge of a 0.04 unit bacitracin disk. Which of the following tests would help to determine if the organism is Enterococcus? a growth in 6.5% NaCl broth b growth in the presence of penicillin c optochin susceptibility d fermentation of 10% lactose
a growth in 6.5% NaCl broth a Of the biochemicals listed, only growth in 6.5% NaCl will aid in the identification of Enterococcus, which has the ability to grow in the presence of high salt concentrations.
A first morning sputum is received for culture of acid-fast bacilli. It is digested and concentrated by the N-acetyl-L-cysteine alkali method. Two Sabouraud dextrose slants are incubated in the dark at 35°C with 5%-10% C02. The smears reveal acid-fast bacilli, but the slants show no growti after 8 weeks. The explanation is: a improper media used b incorrect concentration procedure used c improper specimen submitted d exposure to C02 prevents growth
a improper media used a Sabouraud dextrose is fungal media; mycobacterial media should have been inoculated.
In processing clinical specimens and fungal isolates, laboratory workers may contract systemic fungal infections through: a inhalation b ingestion c skin contact d insect vector
a inhalation a Inhalation is a common mode of transmission for fungal spores. Specimens for fungal culture should be processed in a biological safety cabinet to minimize the potential for aerosol spread.
In order to isolate Campylobacter coli/jejuni, the fecal specimen should be: a inoculated onto selective plating media and incubated in reduced oxygen with added CO2 at 42°C b stored in tryptic soy broth before plating to ensure growth of the organism c inoculated onto selective plating media and incubated at both 35°C and at room temperature d incubated at 35°C for 2 hours in Cary-Blair media before inoculating onto selective plating media
a inoculated onto selective plating media and incubated in reduced oxygen with added CO2 at 42°C a Campylobacter coli/jejuni require a microaerophilic atmosphere for optimal recovery. The use of selective media is recommended for recovery from fecal specimens. Selective media for Campylobacter contains antibiotics to inhibit the growth of enteric gram-negative flora. Unlike other enteric pathogens, C coli/jejuni grow well at 42°C.
Plesiomonas shigelloides is a relatively new member of the family Enterobacteriaceae. What characteristic separates it from other members of the Enterobacteriaceae? a it is oxidase positive b it ferments glucose c it produces pyocyanin d it requires 10% CO2 for growth
a it is oxidase positive a Enterobacteriaceae ferment glucose and are oxidase negative. Plesiomonas was a member of the Vibrio family in part because it is oxidase positive. However, it was moved to the Enterobacteriaceae family despite its positive oxidase reaction.
Which of the following is most often used to prepare a slide from a plate culture of a dermatophyte for microscopic observation? a lactophenol cotton blue b potassium hydroxide c iodine solution d Gram stain
a lactophenol cotton blue a Lactophenol cotton blue is used as the mounting medium, since lactic acid acts as a clearing agent, phenol acts as a killing agent, glycerol prevents drying, and cotton blue gives color to the structures.
Group B, beta-hemolytic streptococci may be distinguished from other hemolytic streptococci by vhich of the following procedures? a latex antigen typing b growth in 6.5% NaCl broth c growth on bile esculin medium d bacitracin susceptibility
a latex antigen typing a Growth in 6.5% NaCl, growth in bile esculin medium and susceptibility are not used in the routine identification of Streptococcus agalactiae. Polysaccharide typing for group B antigen is routinely used for identification of S agalactiae.
The major features by which molds are routinely identified are: a macroscopic characteristics and microscopic morphology b biochemical reactions and microscopic morphology c macroscopic characteristics and selective media d specialized sexual reproductive structures
a macroscopic characteristics and microscopic morphology a Macroscopic characteristics and microscopic morphology are observations used for the routine identification of molds.
The lowest concentration of antibiotic that inhibits growth of a test that inhibits growth of a test organism is the: a minimum inhibitory concentration b serum inhibitory concentration c minimum bactericidal titer d maximum inhibitory titer
a minimum inhibitory concentration a The MIC is a basic laboratory measurement of the activity of an antibiotic against an organism. It is the lowest concentration of antibiotic that inhibits visible growth of the organism. It does not represent the concentration of antibiotic that is lethal to the organism.
Respiratory syncytial virus is best isolated using a(n): a nasopharyngeal aspirate b cough plate c expectorated sputum d throat swab
a nasopharyngeal aspirate a Respiratory syncytial virus (RSV) infected the ciliated respiratory epithelium of the upper respiratory tract. A nasopharyngeal swab or aspirate is the optimal specimen for RSV recovery.
Which one of the following results is typical of Campylobacter jejuni: a optimal growth at 42°C b oxidase negative c catalase negative d nonmotile
a optimal growth at 42°C a Campylobacter jejuni will grow at 37°C, but prefers 42°C. It is oxidase and catalase positive and motile.
Haemophilus influenzae is most likely considered normal indigenous flora in the* a oropharynx b female genital tract c large intestine d small intestine
a oropharynx a Haemophilus influenzae is indigenous flora of the upper respiratory tract.
After 24 hours a blood culture from a newborn grows catalase-negative, gram-positive cocci. The acterial colonies are small, translucent and beta-hemolytic on a blood agar plate. Biochemical test results of a pure culture are: bacitracin: resistant CAMP reaction: positive bile esculin: not hydrolyzed 6.5% NaCi broth: no growth Assuming that all controls react properly and reactions are verified, the next step would be to: a perform a Streptococcus group typing b i eport the organism as Streptococcus pneumoniae c report the organism as Staphylococcus aureus d report the organism as Staphylococcus epidermidis
a perform a Streptococcus group typing a The colony description and biochemical results presented describe Streptococcus agalactiae. The identification of this organism is confirmed by streptococcus antigen typing.
Mycobacteria that produce pigment only after exposure to light are classified as: a photochromogens b scotochromogens c rapid growers d nonchromogens
a photochromogens a Photochromogens produce nonpigmented colonies only when grown in darkness, but pigmented colonies after exposure to light.
Which characteristic best differentiates Acinetohacter species from Moraxella species? a production of indophenol oxidase b growth on MacConkey agar c motility d susceptibility to penicillin
a production of indophenol oxidase a Both Acinetobacter and Moraxella display resistance to penicillin, and some species grow on MacConkey agar. Acinetobacter are oxidase negative, and Moraxella are oxidase positive.
A liquid stool specimen is collected at 10:00 PM and brought to the laboratory for culture and ova and parasite examination. It is refrigerated until 10:10 AM the next day, when the physician requests that the technologist look for amoebic trophozoites. The best course of action would be to: a request a fresh specimen b perform a concentration on the original specimen c perform a trichrome stain on the original specimen d perform a saline wet mount on the original specimen
a request a fresh specimen a Protozoan trophozoites are fragile and begin to disintegrate as soon as they are passed. Liquid stool specimens should be preserved within 30 minutes of passage in order to adequately preserve parasite morphology. If a liquid specimen cannot be properly preserved, another specimen should be collected.
Which of the following is considered a primary drug for the treatment of Mycobacterium tuberculosis? a rifampin b kanamycin c rifabutin d ethionamide
a rifampin a Primary drugs for the treatment of Mycobacterium tuberculosis include isoniazid, rifampin, pyrazinamide, and ethambutol.
13 An Enterococcus isolated from multiple blood cultures in a patient endocarditis should be: a screened for high level aminoglycoside resistance b checked for tolerance c assayed for serum antimicrobial activity d tested for beta-lactamase production
a screened for high level aminoglycoside resistance a Systemic enterococcal infections, such as endocarditis, are commonly treated with a cell-wall-active agent and an aminoglycoside. These agents act synergistically to kill the organism. If the organism is resistant to one or both, there is no synergy, and the combination will fail. It is important to detect aminoglycoside and beta-lactam resistance in these cases. Enterococci have intrinsic moderate level resistance to aminoglycosides. Acquired resistance corresponds to very high MICs (greater than 500 pg/mL) for gentamicin and is termed high level resistance.
When processing throat swabs for a group A Streptococcus culture, the medium of choice is: a sheep blood agar b rabbit blood agar c human blood agar d horse blood agar
a sheep blood agar a Sheep blood agar is preferred because clear-cut patterns of hemolysis are obtained.
The susceptibility results below are reported on an Enterococcus faecalis isolated from peritoneal fluid. ampicillin: susceptible vancomycin: resistant clindamycin: susceptible levofloxacin: resistant linezolid: susceptible The physician calls questioning the results. Which of the following should have been done before the report was released? a the clindamycin result should have been removed from the report since it is inactive against Enterococcus b the ampicillin result should have been changed to resistant since the isolate is vancomycin resistant c the linezolid result should have been removed from the report since it is inactive against Enterococcus d ciprofloxacin should have been added to the report since levofloxacin was resistant
a the clindamycin result should have been removed from the report since it is inactive against Enterococcus a Enterococcus species may appear active in vitro to clindamycin, cephalosporins and trimethoprim/sulfamethoxazole but are not effective clinically and should not be reported as susceptible.
Upon review of a sputum Gram stain, the technician notes that the nuclei of all of the neutrophils present in the smear are staining dark blue. The best explanation for this finding is: a the slide was inadequately decolorized with acetone/alcohol b the sputum smear was prepared too thin c the cellular components have stained as expected d the iodine was omitted from the staining procedure
a the slide was inadequately decolorized with acetone/alcohol a Problems with analysis of Gram staining generally result from errors including interpretation of the slide (smear prepared too thick), excessive heat fixing, and improper decolorization. Inadequate decolorization with acetone/alcohol results in a smear in which host cells (neutrophils and squamous cells), as well as bacteria, all appear blue.
A gastroenterologist submits a gastric biopsy from a patient with a peptic ulcer. To obtain presumptive evidence of Helicobacter pylori, a portion of the specimen should be added to whic media? a urea broth b tetrathionate c selenite d tryptophan
a urea broth a Helicobacter pylori produces large amounts of extracellular urease and is positive for urea within 2 hours.
Chlamydial infections have been implicated in. a urethritis and conjunctivitis b gastroenteritis and urethritis c neonatal pneumonia and gastroenteritis d neonatal meningitis and conjunctivitis
a urethritis and conjunctivitis a Chlamydia trachomatis is a well-known cause of sexually transmitted infections, including urethritis and cervicitis, as well as inclusion conjunctivitis and pneumonia in neonates. It also causes trachoma and lymphogranuloma venereum.
The steam autoclave method of sterilization: a uses 15 lbs of pressure for 15 minutes b utilizes dry heat for 20 minutes c produces a maximum temperature of 100 C d requires a source of ethylene oxide
a uses 15 lbs of pressure for 15 minutes a The traditional gravity displacement steam sterilization cycle is 121°C for 15 minutes at 15 pounds per square inch. Ethylene oxide is an alternative sterilization method.
157) Reagent strip tests for ketones measure primarily:
acetoacetic acid The nitroprusside/ferricyanide reagent strip reaction reacts with acetoacetic acid. Glycine must be present for the reaction to include acetone. beta-hydroxybutyric acid is present in the largest amount, but does not react with nitroferricyanide.
46) The protein section of the urine reagent strip is most sensitive to:
albumin Albumin is the most abundant plasma protein and it is relatively small. In nephropathy, albumin will be the most abundant protein in the urine. This test is done to look for nephropathy [i.e. kidney disease].
82) Ghost RBCs are seen in urine that is:
alkaline and dilute RBCs absorb water when in dilute urine, and are also less preserved in alkaline urine. Therefore, as the cells swell in the alkaline urine, the cell membrane allows hemoglobin to leak from the cell, resulting in the empty cell membrane and the pale appearance.
117) The following crystal is found in:
alkaline pH and is nonpathologic Triple phosphates crystals, nicknamed "coffin lids" are nonpathologic. They are found in alkaline urines, usually urines with bacterial overgrowth.
105) A white precipitate in a urine specimen with a pH of 7.5 would most probably be caused by:
amorphous phosphates Amorphous phosphates are found in alkaline urine. Under conditions such as refrigeration, they produce a white precipitate. Urates produce a pink precipitate, and WBCs and bacteria do not precipitate.
182) A buildup of fluid in a body cavity is called:
an effusion A small amount of fluid fills the cavity between the cavity wall [the parietal membrane] and the organ [visceral membrane]. An increase in the fluid can be due to infection, inflammation, cancer, and defects in hydrostatic and colloidal pressure. An accumulation of fluid is called an effusion.
154) Cessation of urine flow is defined as:
anuria The prefix an- means not, or without. The prefix azo- stands for nitrogenous, dys- means pain, and di- means double.
141) Urinalysis results on a female patient who brings a urine specimen to the physician's office for her annual physical are: What action should be taken?
ask the patient to collect another specimen at the office The presence of heavy bacteria with a negative leukocyte esterase and normal WBC numbers indicates the specimen has been collected >2 hours before being tested. Testing a fresh specimen will determine if bacterial multiplication has occurred in the first specimen.
7) A urine specimen comes to the laboratory 7 hrs. after it is obtained. It is acceptable for culture only if the specimen has been stored:
at 4°-7° C Storage must inhibit bacterial growth but not kill the bacteria. Freezing and additives are not acceptable. The most commonly used method of preservation is refrigeration.
Which of the following clean catch urine culture colony counts indicates the patient likely has a urinary tract infection? a 10^1 CFU/mL b 10^3 CFU/mL c 10^5 CFU/mL d no growth
b 10^3 CFU/mL b Patients with infection often have at least 100,000 bacteria/mL of urine in the bladder. However one third of young women with symptomatic cystitis have less than 100,000 bacteria/mL of urine. The Infectious Disease Society of America consensus definition of cystitis is greater than or equal to 1,000 CFU/mL of a uropathogen.
An AFB broth culture is positive for acid-fast bacilli at 1 week while the agar slant shows no growth. The most likely explanation for this is: a the organism is a contaminant b AFB grow more rapidly in liquid media c PANTA was added to the broth d the agar slant was incubated in 5% CO2
b AFB grow more rapidly in liquid media b Liquid medium is recommended to provide more rapid recovery of AFB than solid medium. Isolation rates of mycobacteria is also higher with liquid medium.
An anaerobic, spore-forming, nonmotile, gram-positive bacillus isolated from a foot wound is most likely; a Actinomyces israelii b Clostridium perfringens c Bacillus subtilis d Eubacterium lentum
b Clostridium perfringens b Actinomyces and Eubacterium are anaerobic gram-positive bacilli that do not form spores; Bacillus is not an anaerobic organism. Clostridium perfringens is a spore- forming anaerobe organism.
An anaerobic gram-positive bacilli with subterminal spores was isolated from a peritoneal abscess.The most likely identification of this organism is: a Bacillus cereus b Clostridium septicum c Eubacterium lentum d Bifidobacterium dentium
b Clostridium septicum b Bacillus cereus is not an anaerobic organism; Eubacterium and Bifidobacterium are anaerobic gram-positive bacilli that do not form spores. Clostridium septicum forms subterminal spores.
A patient is suspected of having amebic dysentery. Upon microscopic examination of a fresh fecal specimen for ova and parasites, the following data were obtaine a trophozoite of 25 pm progressive, unidirectional crawl evenly distributed peripheral chromatin finely granular cytoplasm This information probably indicates: a Entamoeba coli b Entamoeba histolytica c Endolimax nana d Iodamoeba butschlii
b Entamoeba histolytica b The trophozoite of Entamoeba histolytica ranges in size from 12-60 pm, which is significantly larger than Endolimax nana. The nucleus of E histolytica displays evenly distributed peripheral chromatin unlike E coli, which has coarse peripheral chromatin and I butschlii, which has none.
Infection of the urinary tract is most frequently associated with: a Staphylococcus aureus b Escherichia coli c Enterococcus faecalis d Serratia marcescens
b Escherichia coli b >80% of uncomplicated UTIs are caused by E coli.
Which of the following organisms can grow in the small bowel and cause diarrhea in children traveler's diarrhea, or a severe cholera-like syndrome through the production of enterotoxms. a Yersinia enterocolitica b Escherichia coli c Salmonella typhi d Shigella dysenteriae
b Escherichia coli b E coli can produces several different types of toxins that result in different gastroenteritis manifestations.
A 4-year-old boy is admitted to the hospital with suspected meningitis. He has not had most of the childhood vaccines. The suspected pathogen is: a Listeria monocytogenes b Haemophilus influenzae c Streptococcus agalactiae d Neisseria meningitidis
b Haemophilus influenzae b Haemophilus influenzae was previously the most common cause of bacterial meningitis in young children. However, the Haemophilus influenzae type B vaccine has been in use for several years, resulting in a low incidence of H influenzae causing meningitis. This patient has not had most childhood vaccinations, so he is susceptible to H influenzae.
A small, gram-negative bacillus is isolated from an eye culture. It grows only on chocolate agar and is oxidase-variable. The most likely organism is: a Acinetobacter Iwoffii b Haemophilus influenzae c Stenotrophomonas maltophilia d Pseudomonas aeruginosa
b Haemophilus influenzae b Growth only on chocolate agar is typical for Haemophilus influenzae, which is a gram- negative coccobacillus that causes upper respiratory infections.
A cerebrospinal fluid has been inoculated onto sheep blood and chocolate agar plates and into a tube of trypticase soy broth. All media were incubated in a non atmospheric 5%C02. Which of the following organisms would usually be isolated by this procedure? a Francisella tularensis b Haemophilus influenzae c Bordetella pertussis d Bacteroides fragilis
b Haemophilus influenzae b Haemophilus influenzae is recovered on chocolate agar. Francisella and Bordetella pertussis are fastidious and require special media for growth. Bacteroides is an anaerobe that will not grow aerobically.
A sputum culture from an alcoholic seen in the ER grows gray, mucoid, stringy colonies on sheep blood agar. The isolate grows readily on MacConkey agar and forms mucoid, dark pink colonies. The colonies yield the following test results: ONPG: + indole: glucose: + oxidase: citrate: + VP: + The organism is most likely: a Edwardsiella tarda b Klebsiella pneumoniae c Escherichia coli d Proteus vulgaris
b Klebsiella pneumoniae b Klebsiella is the only distractor that is VP positive, and the other biochemical reactions are typical for K pneumoniae.
AFB smear positive respiratory specimens may be reliably identified as Mycobacterium tuberculosis the same day the smear was read by: a cording seen on the AFB smear b nucleic acid amplification c QuantiFERON®-TB test d DNA probes
b nucleic acid amplification b Several commercial PCR tests are available that identify Mycobacterium tuberculosis from positive respiratory specimens.
A vaginal/rectal swab is collected from a pregnant patient to screen for group B Streptococcus colonization. What is the best medium to use for specimen inoculation? a blood agar b LIM broth c CNA agar d thioglycollate broth
b LIM broth b Detection of group B Streptococcus (GBS) in the genital and gastrointestinal tracts of pregnant women can identify infants at risk for GBS infection. The CDC currently recommends the collection of vaginal and rectal swabs or a single swab inserted first into the vagina and then the rectum at 35-37 weeks gestation. The swab(s) should be inoculated into a selective broth medium such as LIM broth (Todd-Hewitt broth with colistin and nalidixic acid). The use of vaginal/rectal swabs and selective broth medium greatly increases the recovery of GBS.
Which of the following combinations of media provides an egg base, agar base, and a selective egg or agar base media? a Lowenstein-Jensen, American Thoracic Society (ATS), Middlebrook 7H11 b Lowenstein-Jensen, Middlebrook 7H11, Lowenstein-Jensen Gruft c Middlebrook 7H10, Petragnani, Lowenstein-Jensen d Middlebrook 7H10, Middlebrook 7H11, Mitchison 7H11
b Lowenstein-Jensen, Middlebrook 7H11, Lowenstein-Jensen Gruft b Lowenstein-Jensen is an egg-based medium, 7H11 is an agar-based medium, and Lowenstein-Jensen Gruft is a selective egg- based medium.
A Gram stain performed on a sputum specimen revealed gram-negative diplococci within PMNs. Oxidase testing is positive and carbohydrate degradation tests are inert. The organism is: a Neisseria lactamica b Moraxella catarrhalis c Neisseria meningitidis d Neisseria sicca
b Moraxella catarrhalis b The Neisseria species listed all ferment several carbohydrates, Moraxella catarrhalis is biochemically inert and does not ferment carbohydrates.
Coagglutination is associated with: a Chlamydia trachomatis b Neisseria gonorrhoeae c Streptococcus pneumoniae d Klebsiella pneumoniae
b Neisseria gonorrhoeae b One of the less commonly used methods for identification of Neisseria gonorrhoeae grown in culture is coagglutination.
A man presents with pain on urination and urethral discharge. A Gram stain of the discharge is seen in the image: (IMAGE) What is the most likely identification of this organism? a Acinetobacter baumannii b Neisseria gonorrhoeae c Haemophilus ducreyi d Escherichia coli
b Neisseria gonorrhoeae b Gonococcal urethritis in adult males is often diagnosed by the observation of gram-negative diplococci within or closely associated with neutrophils in smears prepared from urethral discharge. The Gram stain in males has a sensitivity of 90%-95% and a specificity of 95%-100% for diagnosing gonorrhea in symptomatic males.
An autopsy performed on an 8-year-old child revealed Waterhouse-Friderichsen syndrome. Blood and throat cultures taken just prior to death were positive for which organism? a Neisseria gonorrhoeae b Neisseria meningitidis c Haemophilus influenzae d Klebsiella pneumoniae
b Neisseria meningitidis b Waterhouse-Friderichsen syndrome is a known complication of severe Neisseria meningitidis infection.
A gram negative bacillus with bipolar staining was isolated from a wound infection caused by a bite from a pet cat. The following characteristic reactions were seen: oxtdase positive glucose OF: fermentative cataiase positive motility: negative MacConfcey agar no growth which of the following is the most likely organism? a Pseudomonas aeruginosa b Pasteurella multocida c Aeromonas hydrophila d Vtbno cholerae
b Pasteurella multocida b Pasteurella multocida does not grow on MacConkey agar, and is associated with wounds resulting from dog and cat bites. Vibrio cholerae is motile and Pseudomonas and Aeromonas grow on MacConkey.
>100,000 CFU/mL of a gram-negative bacilli were isolated on MacConkey from a urine specimen. Biochemical results are as follows: glucose: acid, gas produced indole: negative urea: positive TDA: positive H2S: positive The organism is most likely: a Morganella morganii b Proteus mirabilis c Proteus vulgaris d Providencia stuartii
b Proteus mirabilis b Morganella and Providencia do not produce H2S; the indole reaction differentiates P mirabilis and P vulgaris.
A urine culture had the following culture results: sheep blood: Columbia CNA: MacConkey: swarming no growth >100,000 CFU/mL nonlactose-fermenter >100,000 CFU/mL nonlactose-fermenter with red pigment The isolates from MacConkey agar had the following biochemical reactions: Test Isolate 1 Isolate 2 TSI alk/acid alk/acid urea positive negative TDA positive negative H2S positive negative The organisms are most likely: a Proteus vulgaris and Enterobacter cloacae b Proteus mirabilis and Serratia marcescens c Morganella morganii and Klebsiella pneumoniae d Providencia stuartii and Serratia liquefaciens
b Proteus mirabilis and Serratia marcescens b Serratia can produce a red pigment; Proteus mirabilis swarms, is TDA positive and produces H2S.
An isolate fiom a stool culture gives the following growth characteristics and biochemical reactions: MacConkey agar: colorless colonies Hektoen agar: yellow-orange colonies TSI: acid slant/acid butt, no gas, no H2S urea: positive These scieening reactions are consistent with which of the following enteric pathogens? a Yersinia enterocolitica b Shigella sonnei c Vibrio parahaemolyticus d Campylobacter jejuni
b Shigella sonnei b Shigella has colorless colonies on both Mac Con key and Hektoen agars. Yersinia is lactose negative, but Hektoen agar (has both lactose and sucrose) produces yellow colonies from the fermentation of sucrose. V parahaemolyticus needs at least 1% NaCl to grow and Campylobacter does not grow on MacConkey or Hektoen agars.
Production of beta-lactamase is inducible in which of the following: a Haemophilus influenzae b Staphylococcus aureus c Cory neb acterium diphtheriae d Streptococcus pyogenes
b Staphylococcus aureus b Some bacteria such as Enterococcus sp, H influenzae and Neisseria gonorrhoeae continually produce beta-lactamase. S aureus produces beta-lactamase only after exposure 70 to an inducing agent (such as penicillin). C diphtheriae and S pyogenes do not produce beta-lactamase.
Children who have infections with beta-hemolytic streptococci can develop: a acute pyelonephritis b acute glomerulonephritis c chronic glomerulonephritis d nephrosis
b acute glomerulonephritis b Noninfectious sequelae associated with infection with Streptococcus pyogenes are glomerulonephritis and rheumatic fever.
Colds and other acute respiratory diseases are most often associated with: a Epstein-Barr virus b adenovirus c coxsackie B d reovirus
b adenovirus b Adenovirus infections are common. It causes up to 5% of all respiratory infections, and the prevalence of infection is higher (up to 14%).
The diagnosis of Neisseria gonorrhoeae in females is best made from: a clinical history b an endocervical culture c a Gram stain of cervical secretions d examination for clue cells
b an endocervical culture b Clinical history does not distinguish Neisseria gonorrhoeae from Chlamydia trachomatis. Because of the presence of nonpathogenic Neisseria in the female genital tract, Gram stain does not differentiate these organisms from Ngonorrhoeae. Culture of an appropriate genital tract specimen is required to confirm identification.
A sputum specimen received at 8 AM for an AFB smear reveals acid- fast bacilli. An additional sputum is submitted that afternoon. This specimen was concentrated by the NALC-sodium hydroxide method and inoculated on 2 Lowenstein-Jensen slants and held for 8 weeks at 35°C in 5%-10% C02. No growth occurs. The best explanation is that: a the hypochlorite technique was not used b an improper specimen was submitted for culture c improper media was used for culture d cultures were held for an insufficient period of time
b an improper specimen was submitted for culture b Early-morning sputum specimens are optimal for AFB culture.
An aspirate of a deep wound was plated on blood agar plates aerobically and anaerobically. At 24 hours there was growth on the anaerobic plate only. The next step in the evaluation of this culture is to: a reincubate for another 24 hours b begin organism identification c issue the final report d set up a Bauer-Kirby sensitivity
b begin organism identification b A probable anaerobe is the only organism growing so the microbiologist can proceed with identification.
The ONPG test allows organisms to be classified as a lactose fermenter by testing for following? a permease b beta-galactosidase c beta-lactamase d phosphatase
b beta-galactosidase b Through the action of the enzyme beta- galactosidase, ONPG cleaves into galactose and o-nitrophenol (a yellow compound).
A penicillin-resistant Neisseria gonorrhoeae produces: a alpha-hemolysin b beta-lactamase c enterotoxin d coagulase
b beta-lactamase b Antimicrobial resistance in Neisseria gonorrhoeae is widespread. The production of beta-lactamase (penicillinase) breaks open the beta lactam ring of penicillin, destroying its activity. Thus, Ngonorrhoeae that produce beta lactamase are resistant to penicillin.
Psittacosis is transmissible to man via contact with. a insects b birds c cattle d dogs
b birds b Chlamydophila psittaci, the agent of psittacosis, is transmitted to humans via inhalation of nasal secretions, as well as infected fecal or feather dust, of psittacine birds (parrot family).
Which species of Mycobacterium includes a BCG strain used for vaccination against tuberculosis? a tuberculosis b bovis c kansasii d fortuitum/chelonae complex
b bovis b Mycobacterium tuberculosis can remain viable but dormant in macrophages for many years.
A smear of skin tissue reveals fluorescent septate hyphae. The smear was prepared using: a acridine orange b calcofluor white c auramine rhodamine d periodic acid-Schiff
b calcofluor white b Calcofluor white binds to cellulose and chitin present in fungal cell walls.
An organism previously thought to be nonpathogenic, Moraxella catarrhalis, is now known to be associated with opportunistic respiratory infection and nosocomial transmission. Characteristici dentification criteria include: a oxidase negative b carbohydrates negative (asaccharolytic) c beta-lactamase negative d gram-negative bacilli
b carbohydrates negative (asaccharolytic) b Moraxella catarrhalis is an oxidase- positive gram-negative diplococcus that is usually beta-lactamase positive. It does not ferment carbohydrates.
The best method to demonstrate the ova of Enterobius vermicularis is. a acid-ether concentration b cellophane tape preparation c formalin-ether concentration d zinc sulfate flotation
b cellophane tape preparation b The ova of Enterobius vermicularis cannot be demonstrated in a routine ova and parasite examination. The adult female Enterobius worm migrates out of the anus, and lays her eggs in the perianal folds. A scotch tape preparation of the skin of the perianal folds is used to collect ova.
A reliable test for distinguishing Staphylococcus aureus from other staphylococci is. a oxidase b coagulase c catalase d optochin susceptibility
b coagulase b Coagulase is the biochemical test used to distinguish S aureus (positive) from coagulase-negative staphylococci (negative).
Which of the following procedures should be performed to confirm that an unknown mold is one of the pathogenic dimorphic fungi: a animal inoculation b culture conversion to yeast form c demonstration of sexual and asexual reproduction d serological studies
b culture conversion to yeast form b Several monomorphic molds resemble the filamentous phase of dimorphic molds, so conversion to yeast phase must be performed for identification of dimorphic molds.
An antibiotic used to suppress or kill contaminating fungi in media is: a penicillin b cycloheximide c streptomycin d amphotericin B
b cycloheximide b Cyclohexamide, which inhibits protein synthesis, is the common agent used in Mycosel ' or mycobiotic agar to inhibit faster-growing saprophytic fungi. Penicillin and streptomycin do not inhibit fungi. Amphotericin B is not routinely used as an additive in fungal media.
The best medium for culture of Francisella tularensis is: a Bordet-Gengou medium b cystine glucose blood agar c Loeffler medium d charcoal selective medium
b cystine glucose blood agar b Francisella tularensis is fastidious and not readily recovered in culture. Cysteine blood glucose agar is an enriched medium with beef heart infusion, peptones, glucose and rabbit blood. It also includes cystine, which is required by F tularensis for growth.
In disk diffusion susceptibility testing, as an antimicrobial agent diffuses away from the concentration of antibiotic is: a increased b decreased c unchanged d inoculum dependent
b decreased b The amount of antibiotic used in disk diffusion susceptibility testing is standardized and constant. Once the disk is placed on the inoculated plate and makes contact with the agar, the antibiotic in the disk begins to diffuse out. As it diffuses into the media, the concentration of antibiotic gets lower the further it diffuses from the disk.
In a suspected case of Hansen disease (leprosy), a presumptive diagnosis is established by: a isolation of organisms on Lowenstein-Jensen medium b detection of weakly acid-fast bacilli in infected tissue c isolation of organisms in a cell culture d detection of niacin production by the isolated bacterium
b detection of weakly acid-fast bacilli in infected tissue b Mycobacterium leprae cannot be cultured in vitro. A clinical diagnosis is made, supported by the presence of AFB in a biopsy specimen.
A test is performed on an isolate of Staphylococcus aureus to determine inducible clindamycin resistance: (IMAGE) Based on the result seen in the image how should the erythromycin and clindamycin be reported? a erythromycin: resistant; clindamycin: resistant b erythromycin: resistant; clindamycin: susceptible c erythromycin: susceptible; clindamycin: resistant d erythromycin: susceptible; clindamycin: susceptible
b erythromycin: resistant; clindamycin: susceptible b The image displays a negative D test result. There is no flattening of the zone of inhibition around the clindamycin disk adjacent to the erythromycin disk. Thus, there is no inducible clindamycin resistance, and the isolate is reported as clindamycin- susceptible, while the erythromycin is reported as resistant.
After satisfactory performance of daily disk diffusion susceptibility quality control is documented, the frequency of quality control can be reduced to: a twice a week b every week c every other week d every month
b every week b Daily disk diffusion quality control can be converted to weekly testing when 30 days of consecutive testing demonstrates no more than 3 antibiotic/organism combinations outside of the acceptable limits.
A liquid fecal specimen from a three-month-old infant is submitted for microbiological examination. In addition to culture on routine media for Salmonella and Shigeli. this specimen should be routinely: a examined for the presence of Entamoeba hartmanni b examined for the presence of Campylobacter sp c screened for the detection of enterotoxigenic Escherichia coli d placed in thioglycollate broth to detect Clostridium botulinum
b examined for the presence of Campylobacter sp b Campylobacter continues to be the most common enteric pathogen isolated from patients with diarrhea. Routinely fecal specimens should be cultured for Salmonella, Shigella and Campylobacter. Fecal specimens are not routinely cultured for enterotoxigenic E coli or C botulinum. E hartmanni is a onpathogenic parasite and does not cause diarrhea.
Photochromogens produce pigment when: a kept in the dark at 22°C b exposed to light for 1 hour c grown in the presence of CO2 d incubated with x-ray film
b exposed to light for 1 hour b Pigment production is controlled by an oxygen-dependent, light-inducible enzyme in photochromogenic mycobacteria.
Which 2 diseases are usually preceded by infection with beta-hemolytic streptococci? a rheumatic fever, undulant fever b glomerulonephritis, rheumatic fever c rheumatic fever, tularemia d glomerulonephritis, undulant fever
b glomerulonephritis, rheumatic fever b Noninfectious sequelae associated with infection with Streptococcus pyogenes are glomerulonephritis and rheumatic fever.
A beta-hemolytic streptococci that is bacitracin-sensitive and CAMP-negative is: a group B b group A c beta-hemolytic, not group A, B, or D d beta-hemolytic, group D
b group A b Group A streptococci (Streptococcus pyogenes) are susceptible to bacitracin and CAMP test negative.
Encephalitis is most commonly associated with which of the following viruses? a Epstein-Barr b herpes simplex c coxsackie B d varicella zoster
b herpes simplex b Herpes simplex virus is the most common cause of fatal sporadic encephalitis in the United States.
Virus transport medium containing penicillin, gentamicin and amphotericin is used to collect and transport specimens for virus culture because this medium: a enables rapid viral growth during the transport time b inhibits bacterial and fungal growth c destroys nonpathogenic viruses d inhibits complement-fixing antibodies
b inhibits bacterial and fungal growth b antibiotics and antifungal agents are added to viral transport medium to inhibit the growth of bacteria and fungus.
Which of the following indicates the presence of a viral infection in tissue smears or biopsies? a cytopathic effect b intranuclear inclusions c cell lysis d mononuclear inflammatory cells
b intranuclear inclusions b In tissue smears or biopsy specimens, the presence of virally infected cells is indicated by intranuclear or intracytoplasmic inclusions.
Assuming the agent isolated from a patient's spinal fluid produces a positive oxidase test, the most likely diagnosis is: a tuberculous meningitis b meningococcal meningitis c viral meningitis d pneumococcal meningitis
b meningococcal meningitis b Of the possible types of meningitis listed, only Neisseria meningitidis is oxidase positive.
The best procedure to differentiate Listeria monocytogenes from Corynebacterium species is: a catalase b motility at 25°C c motility at 35°C d Gram stain
b motility at 25°C b Corynebacterium and Listeria are catalase-positive and gram-positive bacilli. Listeria demonstrates "tumbling motility that is best demonstrated following growth at 25°C. A few species of Cory neb acterium species are motile when grown at 35°C.
Shigella species characteristically are: a urease positive b nonmotile c oxidase positive d lactose fermenters
b nonmotile b The biochemical characteristic that best fits Shigella is that it is nonmotile. Shigella are urease negative and oxidase negative. Shigella are lactose nonfermenters.
A urine Gram stain shows gram-positive cocci in clusters. The organism tested catalase positive. To speciate this organism from culture, the technician should perform a coagulase test and a/an: a polymyxin B susceptibility b novobiocin susceptibility c oxidase d beta lactamase
b novobiocin susceptibility b The organism in this urine culture is a Staphylococcus species. Coagulase will differentiate S aureus from coagulase- negative staphylococci (CNS) and novobiocin susceptibility will differentiate S saprophyticus from other CNS. S saprophyticus is a common cause of urinary tract infections in young females.
A 73-year-old man diagnosed as having pneumococcal meningitis is not responding to his penicillin therapy. Which of the following tests should be performed on the isolate to best determine this organism's susceptibility to penicillin? a beta-lactamase b oxacillin disk diffusion c penicillin disk diffusion d Schlichter test
b oxacillin disk diffusion b With the exception of the oxacillin disk screening test, disk diffusion is not recommended for testing S pneumoniae against beta-lactam agents. S pneumoniae does not produce beta-lactamase, so beta- lactamase testing would not be useful. The Schlichter test is not a method for determining an organisms susceptibility to a given agent.
A gram-negative diplococcus that grows on modified Thayer-Martin medium can be further confirmed as Neisseria gonorrhoeae if it is. a oxidase positive, glucose positive, and maltose positive b oxidase positive and glucose positive, maltose negative c oxidase positive and maltose positive, glucose negative d glucose positive, oxidase negative and maltose negative
b oxidase positive and glucose positive, maltose negative b Neisseria gonorrhoeae is oxidase positive and ferments glucose but not maltose.
The genus of virus associated with anogenital warts, cervical dysplasia and neoplasia a herpes simplex virus b papillomavirus c cytomegalovirus d coxsackievirus
b papillomavirus b Human papilloma virus (HPV) infects epithelial tissues throughout the body, including skin, larynx, and anogenital tissue. Persistent infection with oncogenic types of HPV and integration of HPV DNA into the cellular genome is a pathway leading to HPV- induced neoplasia, such as cervical cancer.
An antibiotic that inhibits cell wall synthesis is: a chloramphenicol b penicillin c sulfamethoxazole d colistin
b penicillin b Penicillin inhibits penicillin binding proteins that are essential to peptidoglycan (cell wall) synthesis. Chloramphenicol inhibits protein synthesis, colistin increases cell membrane permeability, and sulfamethoxazole inhibits folate metabolism.
When staining acid-fast bacilli with Truant auramine-rhodamine stain, potassium permanganate is used as a: a decolorizing agent b quenching agent c mordant d dye
b quenching agent b The counterstain acts as a quenching agent and reduces the background fluorescence of cellular debris.
A 21-year-old patient presents with pharyngitis. A throat swab is collected and submitted for anaerobic culture. This specimen should be: a set up immediately b rejected as unacceptable c inoculated into thioglycollate broth d sent to a reference laboratory
b rejected as unacceptable b Many anaerobic bacteria are commensal flora in the oropharynx. Anaerobic bacteria do not cause pharyngitis. The most common cause of pharyngitis is Streptococcus pyogenes. Other causes include Arcanobacterium haemolyticum, Corynebacterium diphtheriae, Neisseria gonorrhoeae and viruses.
Characteristically, enterococci are: a unable to grow in 6.5% NaCl b relatively resistant to penicillin c sodium hippurate positive d bile esculin negative
b relatively resistant to penicillin b Enterococci are bile esculin-positive, hippurate-negative and have the ability to grow in 6.5% NaCl. Enterococci are relatively resistant to penicillin and require combination therapy to treat serious infections.
The mycobacteria that produce a deep yellow or orange pigment both in the dark and light are: a photochromogens b scotochromogens c nonchromogens d rapid growers
b scotochromogens b Scotochromogens produce deep yellow or orange pigment when grown in either light or darkness.
An aspirated specimen of purulent material was obtained from a brain abscess. After 24 hours incubation, pinpoint colonies grew on sheep blood and small, yellowish colonies grew on chocolate. Gram stain of the organism showed gram-negative cocci. Results of carbohydrate degradation studies were as follows: glucose: acid maltose: acid sucrose: acid lactose: negative Additional testing revealed that the organism was oxidase positive and beta-galactosidase negative. The organism is most likely Neisseria: a meningitidis b sicca c lactamica d gonorrhoeae
b sicca b Neisseria sicca is the only Neisseria species of those listed that ferments glucose, maltose and sucrose.
A control strain of Clostridium should be used an anaerobe jar to assure: a that plate media is working b that an anaerobic environment is achieved c that the jar is filled with a sufficient number of plates d that the indicator strip is checked
b that an anaerobic environment is achieved b Several Clostridium species are obligate anaerobes, and will only grow in an anaerobic environment. The growth of one of these clostridium species would confirm that an anaerobic environment has been achieved in anaerobic jar.
Three sets of blood cultures were obtained from an adult patient with fever and suspected endocarditis. The aerobic bottle of one set had growth of Staphylococcus epidermidis at 5 days of incubation. This indicates that: a there was low-grade bacteremia b the organism is most likely a contaminant c the patient has a line infection d the blood culture bottles are defective
b the organism is most likely a contaminant b Coagulase-negative staphylococci are commonly associated with contaminated blood cultures; however, they are also increasing as a cause of true bacteremia. Significant bacteremia in a patient with endocarditis is usually continuous and low grade. In most cases, all blood cultures drawn will yield positive results. The facts that only 1 bottle of 1 set was positive, and that the bottle did not become positive until day 5 of incubation, indicate that this isolate is most likely a contaminant.
Which of the following is the most important variable in the recovery of organisms in patients with bacteremia? a subculture of all bottles at day 5 of incubation b the volume of blood cultured c use of chlorhexadine for skin antisepsis d collection of multiple blood culture sets from a single venipuncture
b the volume of blood cultured b The volume of blood collected is the single most important variable in the recovery of organisms in patients with bloodstream infections. Since many cases of adult bacteremia are of low magnitude, there is a direct relationship between the yield of blood culture (positivity) and volume of blood collected. The collection of multiple blood culture sets from a single venipuncture is an unacceptable practice due to the potential for contamination. The practice of terminal subculture of blood culture bottles at 5 days is no longer recommended. The use of chlorhexadine for skin antisepsis does not affect organism recovery, but aids in decreasing blood culture contamination.
Which of the following factors would make an organism appear to be more resistant on a disk diffusion susceptibility test? a too little agar in the plate b too many organisms in the inoculum c the presence of 0.5% NaCl in the medium d a medium with a pH of 7.4
b too many organisms in the inoculum b To ensure the reproducibility of disk diffusion testing, the inoculum must be standardized. If the inoculum is too dense (too many organisms), zone sizes would be smaller than expected and appear falsely resistant.
When performing a Kovac indole test, the substrate must contain: a indole b tryptophan c ornithine d paradimethylaminobenzaldehyde
b tryptophan b The indole test is used for determining an organism's ability to produce indole from deamination of tryptophan by tryptophanase.
A stool specimen for ova and parasite examination contained numerous rhabditiform larvae. Which factor does not aid in the identification of larvae? a larva tail morphology b type of water vegetation consumed c length of the buccal cavity d appearance of the genital primordium
b type of water vegetation consumed b The rhabditiform larvae of hookworm and Strongyloides stercoralis can be differentiated by the size of their genital primordium. Strongyloides has a prominent genital primordium and a small buccal cavity. Hookworm larvae have a longer buccal cavity, and the genital primordium is not evident. S. stercoralis larvae have a notched tail whereas hookworm larvae have a tapering tail.
When performing a stool culture, a colony type typical of an enteric pathogen is subcultured on a blood agar plate. The resulting pure culture is screened with several tests to obtain the following results: TSI: acid butt, alkaline slant, no gas, no H2S phenylalanine deaminase: negative motility: positive serological typing: Shigella flexneri (Shigella subgroup B) The serological typing is verified with new kit and controls. The best course of action would be to: a report the organism as Shigella flexneri without further testing b verify reactivity of motility medium with positive and negative controls c verify reactivity of the TSI slants with positive and negative controls for H2S production d verify reactivity of phenylalanine d aminase with positive and negative controls
b verify reactivity of motility medium with positive and negative controls b All of the biochemical and serological reactions listed are consistent with an identification of Shigella flexneri, with the exception of motility. All Shigella are nonmotile.
5) Urine samples should be examined within 1 hr. of voiding because:
bacterial contamination will cause alkalinization of the urine Evaluate each statement. a is incorrect because these cells don't agglutinate. b is partially correct, but urobilinogen decreases in light. c is true, bacterial overgrowth does lead to an alkaline urine. d is false, ketones are produced by fat metabolism in the patient.
214) Increased CSF lactate is found in:
bacterial meningitis Lactate is increased in the CSF in conditions that cause hypoxia. The highest lactate values [>35 mg/dL] are found in patients with bacterial meningitis. Viral, tubercular and fungal meningitis have lactate levels above normal, but not as high as bacterial meningitis.
3) A clean catch urine is submitted to laboratory for routine urinalysis and culture. The routine urinalysis is done first, and 3 hrs. later, the specimen is sent to the microbiology department for culture. The specimen should:
be rejected due to the time delay It is common practice to share samples between the microbiology department and urinalysis. Ideally, the culture is set up first to prevent contamination. If that is not feasible time wise, the sample should be aliquotted using aseptic technique, and refrigerated until it can be cultured.
4) Which of the following urine results is most apt to be changed by prolonged exposure to light?
bilirubin Bilirubin is degraded by light. The other analytes will not be affected.
50) A reagent strip area impregnated with stabilized, diazotized 2,4-dichloroaniline will yield a positive reaction with:
bilirubin The student should memorize the chemical reactions for each of the dipstick biochemicals. Diazo reagent is used for bilirubin.
208) Amniotic fluid is evaluated using a Liley graph and change in absorbance at 450 nm. What is being evaluated and why?
bilirubin, which increases in HDN A fetus with hemolytic disease will have increased bilirubin in the amniotic fluid. Bilirubin absorbs light at 450 nm. The change in absorbance between the expected and observed value is plotted on a Liley graph, and used to assess the fetus. This is also called a Delta-OD 450.
The stock cultures needed for quality control testing of oxidase production are: a Escherichia coli/Klebsiella pneumoniae b Salmonella typhimurium/Escherichia coli c Escherichia coli/Pseudomonas aeruginosa d Proteus mirabilis/Escherichia coli
c Escherichia coli/Pseudomonas aeruginosa c Of the organisms listed only Pseudomonas aeruginosa is oxidase positive.
Hemoglobin S can be separated from hemoglobin D by:
electropheresis on a different medium and acidic pH
A clean catch urine sample from a nursing home patient is cultured using a .001 mL loop. It grows 67 colonies of a lactose fermenter that has the following biochemical reactions: TSI: acid/acid oxidase: negative motility: positive indole: negative citrate: positive VP: positive lysine decarboxylase: negative ornithine decarboxylase: positive urea: negative What should the microbiologist report? a 670 CFU/mL Serratia marsecens sp b 6,700 CFU/mL Providencia stuartii c 67,000 CFU/mL Enterobacter cloacae d 67,000 CFU/mL Klebsiella oxytoca
c 67,000 CFU/mL Enterobacter cloacae c The correct quantitation on a urine sample is obtained by counting the colonies and multiplying them by the dilution factor, which in this case is 1000 because a .001 pL loop was used for culture. The biochemicals are characteristic of Enterobacter cloacae.
The Gram stain from a blood culture shows gram-positive cocci in chains. No growth occurs on blood agar plates incubated both aerobically and anaerobically. Additional testing should be done to detect the presence of: a Staphylococcus saprophyticus b Aerococcus urinae c Abiotrophia defectiva d Streptococcus pneumoniae
c Abiotrophia defectiva c Nutritionally deficient streptococci such as Abiotrophia do not grow on sheep blood agar without the addition of cysteine or proximity to S aureus colonies.
While swimming in a lake near his home, a young boy cut his foot, and an infection developed. The culture grew a nonfastidious gram-negative, oxidase positive, beta-hemolytic, motile bacilli that produced deoxyribonuclease. The most likely identification is: a Enterobacter cloacae b Serratia marcescens c Aeromonas hydrophila d Escherichia coli
c Aeromonas hydrophila c Enterobacteriaceae, such as E coli, Serratia and Enterobacter, are oxidase negative. The only selection that is oxidase positive is Aeromonas. It is associated with wounds contaminated with water.
Fluid from a cutaneous black lesion was submitted for routine bacterial culture. After 18 hours of incubation at 35°C there was no growth on MacConkey agar, but 3+ growth on sheep blood agar. The colonies were nonhemolytic, nonmotile, 4-5 mm in diameter and off-white with a ground glass appearance. Each colony had an irregular edge with comma-shaped outgrowths that stood up like "beaten egg whites" when gently lifted with an inoculating needle. A Gram stain of a typical colony showed large, gram-positive rectangular bacilli. The organism is most likely: a Clostridium perfringens b Aeromonas hydrophila c Bacillus anthracis d Mycobacterium marinum
c Bacillus anthracis c Bacillus anthracis are large, rectangular gram-positive bacilli that produce colonies with an irregular edge (often described as a "medusa-head" appearance) on blood agar. Colonies are nonhemolytic, catalase positive and nonmotile.
Which organism commonly causes food poisoning by consumption of foods containing excessive populations of organisms or preformed enterotoxin? a Salmonella enteritidis b Shigella sonnei c Bacillus cereus d Escherichia coli
c Bacillus cereus c Bacillus cereus is the etiologic agent of 2 distinct types of food poisoning syndromes. Spores can survive cooking and germinate. Vegetative cells multiply and produce toxin.
A stool sample is sent to the laboratory for culture to rule out Clostridium difficile. What media should the microbiologist use and what is the appearance of the organisms on this media? a BBE: colonies turn black b Brucella agar: red pigmented colonies c CCFA: yellow, ground glass colonies d CNA: double zone hemolytic colonies
c CCFA: yellow, ground glass colonies c Selective media are needed to isolate Clostridium difficile from stool and CCFA is also differential—fermentation of lactose produces classic colony morphology for this organism.
Which of the following statements concerning the germ tube test is true? a using a heavy inoculum enhances the rapid production of germ tubes b germ tubes should be read after 2 hours incubation at 25°C c Candida albicans and Candida tropicalis can be used as positive and negative controls, respectively d serum will be stable for 1 year if stored at 4°C prior to use
c Candida albicans and Candida tropicalis can be used as positive and negative controls, respectively c Candida albicans (positive) and C tropicalis (negative) can be used as control organisms for quality control of the germ tube test.
An organism gave the following reactions: TSI: acid slant/acid butt; no H2S gas produced indole: positive motility: positive citrate: negative lysine decarboxylase: positive urea: negative VP: negative This organism most likely is: a Klebsiella pneumoniae b Shigella dysenteriae c Escherichia coli d Enterobacteria cloacae
c Escherichia coli c These biochemicals are characteristic for E coli. Klebsiella pneumoniae is indole negative and nonmotile. Shigella dysenteriae is nonmotile and Enterobacter cloacae is indole negative.
A gram stain of a touch prep from a gastric biopsy shows gram-negative bacilli that are slender and curved. The most likely pathogen is. a Burkholderia cepacia b Corynebacterium urealyticum c Helicobacter pylori d Pasteurella multocida
c Helicobacter pylori c Helicobacter pylori is known to cause gastritis and is a gram-negative, curved bacillus.
Gram stain examination of a CSF specimen indicates the presence of yeast-like cells with gram- positive granular inclusions. Which of the following techniques should be used next to assist in the identification of this organism? a 10% KOH b lactophenol cotton blue c India ink d periodic acid-Schiff
c India ink c Cryptococcus may not stain well on Gram stain. Rapid identification is important when yeast is detected in CSF, the presence of capsules seen in an India ink preparation would be presumptive for C neoformans.
The best medium for culture of Mycobacterium tuberculosis is: a Bordet-Gengou agar b Loeffler medium c Lowenstein-Jensen medium d cystine blood agar
c Lowenstein-Jensen medium c Lowenstein-Jensen is an egg-based medium used to isolate AFB. The other media are not used for the isolation of AFB.
An organism was inoculated to a TSI tube and gave the following reactions: alkaline slant/acid butt, H2S, gas produced This organism most likely is: a Klebsiella pneumoniae b Shigella dysenteriae c Salmonella typhimurium d Escherichia coli
c Salmonella typhimurium c Salmonella is the only distractor that produces H2S. Also, Klebsiella and E coli produce acid/acid reactions in TSI.
The optochin (ethylhydrocupreine hydrochloride) disk is used for the identification of: a Haemophilus influenzae b group A beta-hemolytic streptococci c Streptococcus pneumoniae d alpha-hemolytic streptococci
c Streptococcus pneumoniae c Optochin susceptibility is used to differentiate S pneumoniae, which are susceptible, from other alpha-hemolytic streptococci, which are resistant.
Which of the following organisms is, to date, considered universally susceptible to penicillin: a Haemophilus influenzae b Neisseria gonorrhoeae c Streptococcus pyogenes d Cory neb acterium diphtheriae
c Streptococcus pyogenes c Haemophilus influenzae and Neisseria gonorrhoeae do not have predictable susceptibility to penicillin. Corynebacterium diphtheriae is not universally susceptible to penicillin. To date, no penicillin resistance has been demonstrated in Streptococcus pyogenes.
Which one of the following organisms does not require susceptibility testing to the antimicrobial indicated when isolated from a clinically significant source? a Staphylococcus aureus-clindamycin b Proteus mirabilis-gentamicin c Streptococcus pyogenes-penicillin d Escherichia coli-levofloxacin
c Streptococcus pyogenes-penicillin c Susceptibility testing should be performed when the susceptibility of the organism cannot reliably be predicted and resistance is known or suspected. Susceptibility testing of penicillins for treatment of S pyogenes does not need to be performed routinely since resistance has not been documented.
A 4-year-old is admitted with symptoms of meningitis, and a Gram stain of the cerebrospinal fluid reveals small, pleomorphic, gram-negative coccobacilli. After 24 hours incubation at 35°C, small, moist, gray colonies, which are oxidase variable, are found on the chocolate agar plate only. Which of the following biochemical data would be consistent with this isolate? a CTA dextrose: positive CTA maltose: positive ONPG: negative b sodium hippurate hydrolysis: positive A disc: negative CAMP test: positive c X factor: no growth V factor: no growth XV factor: growth horse blood: no hemolysis d catalase: positive esculin hydrolysis: positive methyl red: positive "umbrella" motility at room temperature
c X factor: no growth V factor: no growth XV factor: growth horse blood: no hemolysis c These are classic gram stain, growth and biochemicals for Haemophilus influenzae.
Establishing the pathogenicity of a microorganism isolated from a child's throat and identified as Corynebacterium diphtheria would depend upon: a the morphological appearance as revealed by Gram stain b the type of hemolysis on blood agar c a positive toxigenicity test d the appearance of growth on Tinsdale tellurite agar
c a positive toxigenicity test c In order to determine if an isolate of Corynebacterium diphtheriae produces toxin, testing for the presence of diphtheria toxin mttst be performed using methods such as the Elek test or PCR.
Proper collection of a sample for recovery of Enterobius vermicular is include a a 24-hour urine collection b a first morning stool collection with proper preservative c a scotch tape preparation from the perianal region d peripheral blood from a finger
c a scotch tape preparation from the perianal region c The ova of Enterobius vermicularis cannot be demonstrated in a routine ova and parasite examination. The adult female Enterobius worm migrates out of the anus, and lays her eggs in the perianal folds. A scotch tape preparation of the skin of the perianal folds is used to collect ova.
The optimal wound specimen for culture of anaerobic organisms should be: a a swab of lesion obtained before administration of antibiotics b a swab of lesion obtained after administration of antibiotics c a syringe filled with pus, obtained before administration of antibiotics d a syringe filled with pus, obtained after administration of antibiotics
c a syringe filled with pus, obtained before administration of antibiotics c The use of swabs for collection of specimens for anaerobic culture is discouraged. Aspiration with a needle and syringe is recommended. Whenever possible cultures should be obtained before the administration of antibiotics to optimize organism recovery.
In a quality control procedure on a new batch of Mueller-Hinton plates using a stock culture of staphylococcus aureus (ATCC 25923), all the disk zone sizes are too small. The most likely reason for this is that the: a Mueller-Hinton plates were poured too thin b potency of the antibiotic disks is too high c bacterial suspension was not diluted to the proper concentration d disks should have been set up on mannitol salt
c bacterial suspension was not diluted to the proper concentration c Quality control zone sizes that are too small could indicate that the organism inocdum is too high, plates were poured too thick, or that the potency of the antibiotic disks is too low.
Which of the following specimens is considered to be the most sensitive for the recovery of Brucella in cases of chronic infection? a blood b urine c bone marrow d lymph node
c bone marrow c Bone marrow is considered the most sensitive specimen for the recovery of Brucella.
The disease-producing capacity of Mycobacterium tuberculosis depends primarily upon: a production of exotoxin b production of endotoxin c capacity to withstand intracellular digestion by macrophages d lack of susceptibility to the yeloperoxidase system
c capacity to withstand intracellular digestion by macrophages c Mycobacterium tuberculosis can remain viable but dormant in macrophages for many years.
The primary isolation of Neisseria gonorrhoeae requires: a anaerobic conditions b starch media c carbon dioxide d blood agar
c carbon dioxide c Neisseria gonorrhoeae requires an enhanced C02 atmosphere for optimal growth.
In the Kirby-Bauer disc diffusion susceptibility test, which variable is critical when testing Pseudomonas species for antibiotic susceptibility to aminoglycosides? a incubation temperature b duration of incubation c cation content of media d depth of agar
c cation content of media c Variations in the concentrations of divalent cations primarily calcium and magnesium affect the results of aminoglycoside, tetracycline and colistin tests with P aeruginosa isolates. A cation concentration that is too high results in smaller zone sizes, and a concentration that is too low increases zone sizes.
The enterotoxin produced by certain strains of hemolytic, coagulase positive Staphylococcus aureus: a is destroyed by boiling for 15-30 minutes b is identical to the dermonecrotic toxin c causes one type of bacterial food poisoning d is highly antigenic
c causes one type of bacterial food poisoning c Staphylococcus aureus produces an enterotoxin that is associated with short- incubation food poisoning.
Which of the following combinations is useful for confirming the presence of extended spectrum beta-lactamases in E colil a ampicillin + cefepime b cefoxitin + penicillin c ceftazidime + clavulanic acid d cefpodoxime + cefotaxime
c ceftazidime + clavulanic acid c Extended spectrum beta lactamases (ESBL) are inhibited by clavulanic acid. Confirmatory tests of the presence of ESBL are based on the enhanced activity of a beta-lactam antibiotic, usually cefotaxime or ceftazidime, when it is tested with clavulanic acid compared to the activity of the beta- lactam tested alone.
First generation cephalosporins can be adequately represented by: a cefotetan b ceftriaxone c cephalothin d cefoxitin
c cephalothin c Cephalothin is a first-generation cephalosporin, cefotetan and cefoxitin are second-generation cephalosporins, and ceftriaxone is a third generation cephalosporin.
Media used to support to support growth of Legionella pneumophilia should contain which of the following additives? a X and V factors b hemin and Vitamin K c charcoal and yeast extract d dextrose and laked blood
c charcoal and yeast extract c Buffered charcoal yeast extract medium is a specialized enrichment medium for the isolation of Legionella. The nutritive base includes yeast extract. Charcoal is added to the medium as a detoxifying agent.
A 10-year-old child with cystic fibrosis presents with cough and shortness of breath. Her sputum Gram stain is seen in the image: (IMAGE) Based on the Gram stain what would be the best medium and incubation condition to optimize recovery of the organism seen? a MacConkey agar incubated in C02 b Tinsdale agar incubated in ambient air c chocolate agar incubated in C02 d CNA agar incubated in ambient air
c chocolate agar incubated in C02 c The Gram stain demonstrates numerous neutrophils and small, pleomorphic gram- negative bacilli suggestive of Haemophilus. H influenzae is an important cause of lower respiratory tract infections in patient with pre-existing lung disease such as cystic fibrosis. Haemophilus are fastidious, and require the use of an enriched medium such as chocolate agar and incubation at 35°-37°C in a moist environment supplemented with 5%-10% C02.
Cerebrospinal fluid from a febrile 25-year old man with possible meningitis is rushed to the laboratory for a stat Gram stain and culture. While performing the Gram stain, the technologist accidentally spills most of the specimen. The smear shows many neutrophils and no microorganisms. Since there is only enough CSF to inoculate one plate, the technologist should use a: a blood agar plate b chopped meat glucose c chocolate agar plate d Thayer-Martin plate
c chocolate agar plate C Enriched media such as chocolate agar has no inhibitory effects on bacterial growth and contains additional nutrients that supports the growth of fastidious organisms such as H influenzae and Neisseria.
The most critical distinction between Staphylococcus aureus and other Staphylococcus is: a phosphatase reaction b DNA production c coagulase production d hemolysis
c coagulase production c Coagulase production is the primary biochemical used to differentiate S aureus from other coagulase-negative staphylococci.
The most sensitive test for the initial diagnosis of cryptococcal disease is: a India ink b Gram stain c cryptococcal antigen d Giemsa stain
c cryptococcal antigen c Cryptococcal latex antigen test has been proven to be significantly more sensitive than staining methods.
A medium that aids in the presumptive identification of organisms based on their appearance on the medium is called: a enriched b selective c differential d specialized
c differential c Differential media contain compounds, often carbohydrates, that provide a presumptive identification based on colony color or a precipitate around the colony. Examples include MacConkey, Hektoen and xylose lysine desoxycholate agar.
A yellow colony from a wound culture tested catalase-positive and coagulase-negative. The organism stained as gram-positive cocci in clusters. Which of the following tests would differentiate between a coagulase-negative Staphylococcus and Micrococcus? a novobiocin susceptibility b leucine aminopeptidase production c furazolidone (100 pg/disk) susceptibility d bile esculin
c furazolidone (100 pg/disk) susceptibility c Micrococcus and Staphylococcus can be differentiated by susceptibility to furazolidone (100 pg/disk). Staphylococcus is susceptible and Micrococcus is resistant.
The following results were obtained from a culture of unknown origin: Gram stain: gram-negative diplococci indophenol oxidase: positive glucose: positive maltose: negative sucrose: negative The most likely source of the specimen would be the: a respiratory tract b blood c genitourinary tract d cerebrospinal fluid
c genitourinary tract c Based on the biochemicals listed the most likely identification of the organism is Neisseria gonorrhoeae. N gonorrhoeae is most commonly isolated from the genitourinary tract.
A beta-hemolytic Streptococcus that is bacitracin-resistant and CAMP-positive is: a group A or B b group A c group B d beta-hemolytic, group D
c group B c Group B streptococci (Streptococcus agalactiae) are resistant to bacitracin and CAMP test positive.
The organism most commonly associated with neonatal purulent meningitis is: a Neisseria meningitidis b Streptococcus pneumoniae c group B streptococci d Haemophilus influenzae
c group B streptococci c All of the organisms listed are potential causes of meningitis. Group B Streptococcus is associated with neonatal meningitis and meningitis in the elderly.
A gamma-hemolytic Streptococcus that blackens bile esculin agar but does not grow in 6.5% NaCl broth is most likely: a group B Streptococcus b Enterococcus c group D Streptococcus d Streptococcus pneumoniae
c group D Streptococcus c Group D streptococci and Enterococcus produce a positive bile esculin test; however, of these 2, only Enterococcus grows in the presence of 6.5% NaCl.
a catheterized urine is inoculated onto blood and MacConkey agar using a 0 01 mL loop After 48 hours. 68 colonies of a small translucent nonhemolytic organism grew on blood agar but not MacConkey. Testing reveals small gram-positive, catalase-negative cocci. The preliminary report and follow-up testing would be: a growth of 680 colonies colonies/mL of gram-positive cocci, optochin and bacitracin susceptibility tests b growth of 6,800 colonies mL of a Staphylococcus species, coagulase test to follow c growth of 6,800 colomes/mL of a Streptococcus species, esculin hydrolysis and NaCl growth test to follow d growth of 6,800 colonies/mL of a Streptococcus species, no further testing
c growth of 6,800 colomes/mL of a Streptococcus species, esculin hydrolysis and NaCl growth test to follow c The number of colonies isolated is multiplied by 100 when a 0.01 mL loop is used for inoculation. Gram-positive, catalase negative cocci are indicative of streptococci.
Which of the following would best differentiate Streptococcus agalactiae from Streptococcus pyogenes ? a ability to grow in sodium azide broth b a positive bile-esculin reaction c hydrolysis of sodium hippurate d beta-hemolysis on sheep blood agar
c hydrolysis of sodium hippurate c Of the biochemicals listed only hydrolysis of sodium hippurate will differentiate Streptococcus agalactiae {[positive) from S pyogenes (negative).
A sputum specimen from a patient with a known Klebsiella pneumoniae infection is received in the laboratory for fungus culture. The proper procedure for handling this specimen is to: a reject the current specimen and request a repeat culture when the bacterial organism is no longer present b incubate culture tubes at room temperature in order to inhibit the bacterial organism c include media that have cycloheximide and chloramphenicol added to inhibit bacterial organisms and saprophytic fungi d perform a direct PAS stain; if no fungal organisms are seen, reject the specimen
c include media that have cycloheximide and chloramphenicol added to inhibit bacterial organisms and saprophytic fungi c Since fungi grow more slowly than bacteria, a medium with antimicrobials is included to assist in the recovery of fungi. Chloramphenicol is an antibacterial agent active against Klebsiella and most other bacteria.
Mycoplasmas differ from bacteria in that they: a do not cause disease in humans b cannot grow in artificial inanimate media c lack cell walls d are not serologically antigenic
c lack cell walls c Mycoplasma are smaller than other bacteria and lack a cell wall. Instead, they possess a trilaminar cell membrane. Because they lack a cell wall, they cannot be stained with Gram stain.
Which of the following is the most reliable test to differentiate Neisseria lactamica from Neisseria meningitidis? a acid from maltose b growth on modified Thayer-Martin agar c lactose degradation d nitrite reduction to nitrogen gas
c lactose degradation c Both Neisseria meningitidis and N lactamica produce acid from maltose and grow on modified Thayer martin agar- N lactamica ferments lactose, N meningitidis does not.
A beta-hemolytic gram-positive coccus was isolated from the cerebrospinal fluid of a 2-day-old infant with signs of meningitis. The isolate grew on sheep blood agar under aerobic conditions and was resistant to a bacitracin disc. Which of the following should be performed for the identification of the organism? a oxidase production b catalase formation c latex antigen typing d esculin hydrolysis
c latex antigen typing c The most likely organism isolated from this specimen is Streptococcus agalactiae. Polysaccharide antigen typing will confirm the identification of S agalactiae and differentiate it from other beta-hemolytic streptococci.
Refer to the following image: (IMAGE) The egg depicted above is most likely to be found in children suffering from: a diarrhea b constipation c perianal itching d stomach pain
c perianal itching c The most common sign of Enterobius vermicularis infection is intense perianal itching.
Which of the following groups of specimens would be acceptable for anaerobic culture? a vaginal, eye b ear, leg tissue c pleural fluid, brain abscess d urine, sputum
c pleural fluid, brain abscess c Materials collected from sites not harboring indigenous flora (sterile body fluids, abscess exudate and tissue) should be cultured for anaerobic bacteria. However, since anaerobes normally inhabit the skin and mucus membranes as part of the indigenous flora, specimens such as urine, sputum, and vaginal, eye and ear swabs are not acceptable for culture.
In the optochin (ethylhydrocupreine hydrochloride) susceptibility test, if there is a zone of inhibition of 19-30 mm surrounding the disk following overnight incubation at 37"C, the colony most likely consists of: a staphylococci b streptococci c pneumococci d intestinal bacilli
c pneumococci c Optochin susceptibility is used to differentiate S pneumoniae, which are susceptible, from other alpha-hemolytic streptococci, which are resistant.
A technologist is reading a Gram stain from a CSF and observes many neutrophils and lancet-shaped gram-positive diplococci. Which set of chemistry and hematology CSF results would most likely be seen in someone with this type of infection? CSF results WBC Glucose Protein A increased increased increased B decreased decreased decreased C increased decreased increased D decreased increased decreased
c result C c The classic CSF alterations associated with bacterial meningitis are a high WBC count with a neutrophil predominance as well as a low CSF glucose and a high CSF 72 protein.
A Gram stain of a necrotic wound specimen showed large gram-positive bacilli. There was 3+ growth on anaerobic media, with colonies producing a double zone of hemolysis. To identify the organism, the microbiologist should: a determine if the organism ferments glucose b perform the oxidase test c set up egg yolk agar plate d test for bile tolerance
c set up egg yolk agar plate c The Gram stain and double zone of hemolysis are characteristics of Clostridium perfringens. C perfringens is lecithinase positive on the egg yolk agar test for lecithinase and lipase.
Tests for beta-lactamase production in Haemophilus influenzae: a are not commercially available b include tests that measure a change to an alkaline pH c should be performed on all blood and CSF isolates d are not valid for any other bacterial species
c should be performed on all blood and CSF isolates c As many as 20%-40% of H influenzae produce beta-lactamases. Detection of these enzymes should be performed on any isolate considered to be a pathogen using the chromogenic cephalosporin (nitrocefm) test.
MacConkey media for screening suspected cases of hemorrhagic E coli 0157:117 must contain: a indole b citrate c sorbitol d lactose
c sorbitol c Sorbitol replaces lactose in MacConkey. E coli 0157:H7 does not ferment sorbitol, whereas other species of E coli are positive for fermentation of sorbitol. This makes the media a good screen for 0157:H7.
Susceptibility testing performed on quality control organisms using a new media lot number yielded zone sizes that were too large for all antibiotics tested. The testing was repeated using media from a previously used lot number, and all zone sizes were acceptable. Which of the following best explains the unacceptable zone sizes? a the antibiotic disks were not stored with the proper desiccant b the depth of the media was too thick c the depth of the media was too thin d the antibiotic disks were not properly applied to the media
c the depth of the media was too thin c All Mueller-Hinton agar used for disk diffusion susceptibility testing should be poured to a depth of 4mm. If the depth of the media is <4mm, this may be associated with excessively large zones and false- positive susceptibility results. Agar that is >4mm in depth may cause excessively small zone sizes.
During the past month, Staphylococcus epidermidis has been isolated from bloo0d cultures at 2-3 times the rate from the previous year. The most logical explanation for the increase in these isolates is that: a the blood culture media are contaminated with this organism b the hospital ventilation system is contaminated with Staphylococcus epidermidis c there has been a break in proper skin preparation before drawing blood for culture d a relatively virulent isolate is being spread from patient to patient
c there has been a break in proper skin preparation before drawing blood for culture c Appropriate skin antisepsis is the most important factor in preventing contaminated blood cultures. Staphylococcus epidermidis is a common blood culture contaminant because it is a common inhabitant of the skin.
Anaerobic infections differ from aerobic infections in which of the following? a they usually respond favorably with aminoglycoside therapy b they usually arise from exogenous sources c they are usually polymicrobic d Gram stains of specimens are less helpful in diagnosis
c they are usually polymicrobic c Most infections involving anaerobes are polymicrobic and can include obligate aerobes, facultative anaerobes, microaerophilic bacteria in addition to anaerobic bacteria.
The ability to detect oxacillin-resistant Staphylococcus aureus may be enhanced by: a shortening incubation of standard susceptibility plates b incubating susceptibility plates at 39°-41°C c using Mueller-Hinton broth with 2% NaCl d adjusting inoculum to 0.1 McFarland before inoculating susceptibility plates
c using Mueller-Hinton broth with 2% NaCl c For optimum detection of oxacillin- resistant S aureus, a suspension with a turbidity equivalent to a 0.5 McFarland standard should be inoculated into a cation- adjusted Mueller-Hinton broth with 2% NaCl. Plates should be incubated at 35 ± 2°C for 24 hours. Temperatures above 35°C may not detect oxacillin resistance.
In a disk diffusion susceptibility test, which of the following can result if disks are placed on the inoculated media and left at room temperature for an hour before incubation? a the antibiotic would not diffuse into the medium, resulting in no zone b zones of smaller diameter would result c zones of larger diameter would result d there would be no effect on the final zone diameter
c zones of larger diameter would result c A delay of more than 15 minutes between placing the disks on an inoculated plate and incubation permits excess prediffusion of the antimicrobial agent from the disk. This would result in a larger than expected zone diameter.
On day 3 of a fungal culture, grayish cottony growth is observed that is filling the container. The most likely mold isolated is a: a dermatophyte b dimorphic mold c zygomycete d dematiaceous mold
c zygomycete c Zygomycetes grow rapidly and fill the dish with cotton candy-like growth.
109) Tiny colorless dumbbell shaped crystals were found in an alkaline urine sediment. They most likely are:
calcium carbonate Calcium carbonate crystals are small dumbbell-shaped or round crystals often seen in clumps. With careful examination, dumbbell-shaped forms can be distinguished.
110) Which of the following crystals may be found in acidic urine:
calcium oxalate Calcium oxalate crystals are found in acidic and neutral urine, but not in alkaline urine.
10) Failure to observe RBC casts in a urine specimen can be caused by:
centrifuging an unmixed specimen Larger sediment constituents sink to the bottom of the specimen container. Without prior mixing, the sediment in the container may not be poured into the centrifuge tube.
90% of the copper present in the blood is bound to
ceruloplasmin
123) Identify the formed element in this photomicrograph:
cloth fiber Cloth fiber is a contaminant. It should not be confused with a cast. Fiber can have a rough and stringy appearance. Vegetable fibers have intricate repeating detail.
193) The appearance of normal CSF is:
colorless and clear CSF looks like water. If it is yellow or pink it is called xanthochromic. This indicates a previous bleed into the CNS. Opalescence is a haziness, usually due to the presence of lipids.
28) Urine specific gravity is an index of the ability of the kidney to:
concentrate the urine Specific gravity gives the concentration for the sample relative to water. It does not give specific information about H+ or Na+ ions.
66) When performing a routine urinalysis, the technologist notes a 2+ protein result. He should:
confirm with the acid precipitation test It is not uncommon to find a urine specimen with positive protein. It is necessary to confirm positive protein if the urine pH is elevated, but this is not one of the choices. The choice of b will allow all results to be correct, but the choice of d would cause some of the results to be wrong.
44) Urine reagent strips should be stored in a(n):
cool dry area Reagent strips must he handled carefully to prevent them from picking up excess moisture. Heating or refrigeration is not appropriate. They work optimally at room temperature. They should be stored in a dark, tightly capped bottle, not exposed to light.)
187) A sweat chloride >60 mEq/L (60 mmol/L) is indicative of:
cystic fibrosis Cystic fibrosis is a caused by a defective ion channel, which causes an accumulation of chloride in the sweat.
106) Which of the following is an abnormal crystal described as a hexagonal plate?
cystine Cystine crystals appear as hexagonal plates, frequently in dumps. Tyrosine crystals are needle-shaped, leucine crystals are round, and cholesterol crystals are flat with notched corners.
88) What is the most likely diagnosis given this microscopic finding?
cystitis Some key findings for each condition are: a - glomerulonephritis — RBC casts b - pyelonephritis — WBC casts c - nephrotic syndrome — lipds and fatty casts d - cystitis (urinary tract infection) — WBCs, bacteria, possible RBCs. This image has no casts, just WBCs, bacteria, and RBCs.
The optimal incubator temperature for isolation of the Campylobacter jejuni/coli group is: a 4°C b 20°C c 25°C d 42°C
d 42°C d Campylobacter jejuni/coli grow better at 42°C than 37°C and other organisms in the colon are inhibited at this high temperature.
A sheep blood agar plate inoculated with 0.001mL of urine grows 70 colonies of Staphylococcus aureus. How many colony forming units per mL of urine be reported? a 70 b 700 c 7,000 d 70,000
d 70,000 d When 0.001 mL of urine is plated, the growth of one colony is equivalent to 1000 CFU/mL. Thus 70 colonies is 70,000 CFU/mL.
Which of the following genera include anaerobic gram-negative nonsporulating bacilli? a Brucella b Pasteurella c Actinomyces d Bacteroides
d Bacteroides d Brucella and Pasteurella are aerobic, gram-negative bacilli, and Actinomyces is on anaerobic gram-positive bacillus. Bacteroides species are anaerobic, gram-negative bacilli.
An isolate of an unknown beta-hemolytic Streptococcus is streaked perpendicular to a streak of beta-lysin-producing Staphylococcus aureus. After incubation a zone of arrowhead hemolysis is noted at the interface of the 2 streaks. What is the name of the test and the presumptive identification of the unknown Streptococcus? a hippurate hydrolysis and 5 agalactiae b CAMP test and S pyogenes c hippurate hydrolysis and S pyogenes d CAMP test and S agalactiae
d CAMP test and S agalactiae d The question describes the CAMP test, which is positive for Streptococcus agalactiae.
The formation of germ tubes presumptively identifies. a Candida tropicalis b Candida parapsilosis c Candida glabrata d Candida albicans
d Candida albicans d Candida albicans produces germ tubes.
Lab workers should always work under a biological safety hood when working with cultures of: a Streptococcus pyogenes b Staphylococcus aureus c Candida albicans d Coccidioides immitis
d Coccidioides immitis d The arthroconidia of Coccidioides immitis are highly infectious; cultures must be handled with care to minimize aerosols.
A Gram stain from a swab of a hand wound reveals: moderate neutrophils no squamous epithelial cells moderate gram-positive cocci in chains moderate large gram-negative bacilli Select the appropriate media that will selectively isolate each organism. a KV-laked agar, Thayer-Martin b sheep blood, MacConkey c Columbia CNA, chocolate d Columbia CNA, MacConkey
d Columbia CNA, MacConkey d Columbia CNA agar is a selective medium used for the isolation of gram- positive organisms. The medium contains colistin and nalidixic acid, which inhibits gram-negative organisms. MacConkey agar is a selective and differential medium used for the isolation of gram-negative organisms. The medium contains bile and crystal violet, which inhibits gram-positive organisms.
Differentiation of Mycobacterium avium from Mycobacterium intracellulare can be accomplished by: a nitrate reduction test b Tween® hydrolysis test c resistance to 10 pg thiophene-2-carboxylic acid hydrazide (TCH) d DNA probe
d DNA probe d Mycobacterium avium and M intracellulare have the same biochemical pattern, but can be differentiated by the use of DNA probes.
Which of the following may be used as a positive quality control organism for the bile esculin test? a Staphylococcus epidermidis b Staphylococcus aureus c Streptococcus pyogenes d Enterococcus faecalis
d Enterococcus faecalis d Enterococcus is positive for the bile esculin test while Streptococcus pyogenes and staphylococci are negative.
Quality control of the spot indole test requires the use of ATCC cultures of: a Pseudomonas aeruginosa/Proteus mirabilis b Salmonella typhi/Shigella sonnei c Escherichia coli/Proteus vulgaris d Escherichia coli/Enterobacter cloacae
d Escherichia coli/Enterobacter cloacae d Quality control of indole requires both a positive and a negative control. E coli and E cloacae respectively produce a positive and negative reaction with indole.
Which feature distinguishes Erysipelothrix rhusiopathiae from other clinically significant non-spore-forming, gram-positive, facultatively anaerobic bacilli? a "tumbling" motility b beta-hemolysis c more pronounced motility at 25°C than 37°C d H2S production
d H2S production d Erysipelothrix rhusipathiae is the only gram-positive bacillus that produces hydrogen sulfide when inoculated into triple sugar iron agar.
Many fungal infections are transmitted to man via inhalation of infectious structures. Which of the following is usually contracted in this manner? a Sporothrix schenckii b Trichophyton rubrum c Malassezia furfur d Histoplasma capsulatum
d Histoplasma capsulatum d Histoplasma capsulatum is most frequently transmitted by inhalation.
The stock cultures needed for quality control testing of motility are: a Salmonella typhimurium/Escherichia coli b Escherichia coli/Pseudomonas aeruginosa c Serratia marcescens/Escherichia coli d Klebsiella pneumoniae/Escherichia coli
d Klebsiella pneumoniae/Escherichia coli d Of the organisms listed only Klebsiella pneumoniae is nonmotile.
A cell culture line used for the recovery of Chlamydia trachomatis from clinical specimens is: a HeLa 229 b Hep-2 c BHK-21 d McCoy
d McCoy d McCoy cells, in addition to buffalo green monkey kidney cells, are susceptible to infection with Chlamydia trachomatis, and are used routinely for the recovery of C trachomatis in culture.
Which of the following organisms may be mistaken for Neisseria gonorrhoeae in Gram stained smears of uterine cervix exudates? a Lactobacillus species b Streptococcus agalactiae c Pseudomonas aeruginosa d Moraxella osloensis
d Moraxella osloensis d Moraxella osloensis is a gram-negative coccobacillus that is often plump and occurs in pairs and demonstrates a morphology similar to Neisseria. The presence of this organism in endocervical specimens contaminated with vaginal secretions can lead to over interpretation of smears for N gonorrhoeae.
A branching gram-positive, partially acid-fast organism is isolated from a bronchial washing on a 63-year-old woman receiving chemotherapy. The organism does not hydrolyze casein, tyrosine or xanthine. The most likely identification is: a Actinomadura madurae b Nocardia caviae c Streptomyces somaliensis d Nocardia asteroides
d Nocardia asteroides d Nocardia asteroides are partially acid fast, and do not hydrolyze the substrates casein, tyrosine, or xanthine.
Organisms that can be easily identified to the species level from the ova in fecal specimens include: a Metagonimus yokogawai, Heterophyes heterophyes b Taenia solium, Taenia saginata c Necator americanus, Ancylostoma duodenale d Paragonimus westermani, Hymenolepis nana
d Paragonimus westermani, Hymenolepis nana d Of the organisms listed, only Paragonimus and Hymenolepis can be identified to the species level by the appearance of their ova in stool.
The stock cultures needed for quality control testing of deamination activity are: a Escherichia coli/Klebsiella pneumoniae b Salmonella typhimurium/Escherichia coli c Escherichia coli/Pseudomonas aeruginosa d Proteus mirabilis/Escherichia coli
d Proteus mirabilis/Escherichia coli d Of the organisms listed only Proteus mirabilis is phenylalanine deaminase positive
A nonfermenting gram-negative bacillus is isolated from a wound. The nitrate and oxidase are strongly positive. The growth on sheep blood agar has a grape-like odor. The organism is: a Burkholderia cepacia b Moraxella lacunata c Chryseobacterium (Flavobacterium) meningosepticum d Pseudomonas aeruginosa
d Pseudomonas aeruginosa d Pseudomonas aeruginosa often has a sweet odor that smells like grapes.
An organism isolated from the surface of a skin burn is found to produce a diffusible green pigment on a blood agar plate. Further studies of the organism would most likely show the organism to be: a Staphylococcus aureus b Serratia marcescens c Flavobacterium meningosepticum d Pseudomonas aeruginosa
d Pseudomonas aeruginosa d Pseudomonas aeruginosa produces the blue-green pigment, pyocyanin.
The stock cultures needed for quality control testing of deoxyribonuclease (DNase) production are: a Salmonella typhimurium /Escherichia coli b Escherichia coli/Pseudomonas aeruginosa c Proteus mirabilis /Escherichia coli d Serratia marcescens/Escherichia coli
d Serratia marcescens/Escherichia coli d Of the organisms listed only Serratia marcescens is DNase positive.
Which one of the following genera is among the least biochemically reactive members of the Enterobacteriaceae? a Proteus b Pseudomonas c Citrobacter d Shigella
d Shigella d Shigella is lactose negative, most species do not produce gas, are VP, urea, lysine decarboxylase and citrate negative, and they are nonmotile.
A TSI tube inoculated with an organism gave the following reactions: alkaline slant, acid butt, no H2S, no gas produced This organism is most likely: a Yersinia enterocolitica b Salmonella typhi c Salmonella enteritidis d Shigella dysenteriae
d Shigella dysenteriae d Salmonella produce H2S in TSI and Yersinia produces an acid slant and acid butt. Shigella fits this biochemical profile.
Of the following bacteria, the most frequent cause of prosthetic heart valve infections occurring within 2-3 months after surgery is: a Streptococcus pneumoniae b Streptococcus pyogenes c Staphylococcus aureus d Staphylococcus epidermidis
d Staphylococcus epidermidis d Staphylococcus epidermidis is the most common cause of prosthetic valve endocarditis.
A gram-positive coccus isolated from a blood culture has the following characteristics: optochin susceptibility: negative bacitracin (0.04 U) susceptibility: negative bile esculin hydrolysis: negative hippurate hydrolysis: positive catalase: negative This organism is most likely: a Staphylococcus aureus b Streptococcus pneumoniae c Streptococcus pyogenes d Streptococcus agalactiae
d Streptococcus agalactiae d Streptococcus agalactiae is catalase and bile esculin hydrolysis negative and bacitracin and optochin resistant. Streptococcus agalactiae hydrolyzes hippurate.
An important cause of acute exudative pharyngitis is: a Staphylococcus aureus (beta-hemolytic) b Streptococcus pneumoniae c Streptococcus agalactiae d Streptococcus pyogenes
d Streptococcus pyogenes d Streptococcus pyogenes is the cause of exudative pharyngitis, commonly called strep throat.
Refer to the following illustration... Examine the broth microdilution suceptibility test shown above and determine the MIC for gentamicin. a >64ug/mL b 32 ug/mL c 16 pg/mL d <2 pg/mL
d When reading a broth microdilution susceptibility test, growth in each well is determined by comparison with the growth control well and indicated by turbidity. The well with the lowest concentration of antibiotic displaying no growth is read as the minimum inhibitory concentration (MIC).
Which one of the following gram-negative bacilli ferments glucose? a Alcaligenes faecalis b Pseudomonas cepacia c Acinetobacter Iwoffii d Yersinia enterocolitica
d Yersinia enterocolitica d Alcaligenes, Pseudomonas and Acinetobacter are all nonfermenters; Yersinia is a member of the Enterobacteriaceae and, by definition, ferments glucose.
Which of the following is the most appropriate organism and media combination? a Legionella species—Regan Lowe b Clostridium difficile—phenylethyl alcohol (PEA) c Campylobacter species—charcoal yeast extract d Yersinia enterocolitica—cefsulodin-irgasan-novobiocin (CIN)
d Yersinia enterocolitica—cefsulodin-irgasan-novobiocin (CIN) d CIN agar is a selective and differential medium for the isolation and differentiation of Y enterocolitica. This medium contains sodium desoxycholate, crystal violet, cefsulodin, irgason (triclosan), and novobiocin as selective agents, and mannitol as the carbohydrate.
A 25-year-old man who had recently worked as a steward on a transoceanic grain ship presented to the emergency room with high fever, diarrhea and prostration. Axillary lymph nodes were hemorrhagic and enlarged. A Wayson stain of the aspirate showed bacilli that were bipolar resembling safety pins. The most likely identification of this organism is: a Brucella melitensis b Streptobacillus moniliformis c Spirillum minus d Yersinia pestis
d Yersinia pestis d Yersinia pestis is classically described as having a "safety pin" appearance on Wayson stain. This patient's presentation is classic for bubonic plague.
Hie etiologic agent of botulism is: a highly motile b non-spore-forming c Clostridium perfringens d an exotoxin producer
d an exotoxin producer d The toxin produced by Clostridium botulinum is a neurotoxin that is excreted by the organism in food materials, and is then ingested.
Gram stain of a thigh wound showed many gram-positive spore-forming bacilli. The specimen was placed on brain heart infusion blood agar and incubated aerobically at 35°C for 3 days. At the end of that time, the plates showed no growth. The most likely explanation is that some of the specimen should have been incubated: a on chocolate agar b for 5 days c under 5% CO2 d anaerobically
d anaerobically d The specimen Gram stain suggests the presence of Bacillus or Clostridium. Since no growth was observed aerobically, the specimen should be inoculated to media that are incubated anaerobically.
Haemophilus influenzae becomes resistant to ampicillin when the organism produces a(n): a capsule of polysaccharide material b affinity for the beta-lactam ring of the ampicillin c porphobilinogen d beta-lactamase enzyme
d beta-lactamase enzyme d The beta-lactamase enzyme produced by Haemophilus influenzae inactivates the antibiotics that have a beta-lactam ring in their structure, such as penicillins and cephalosporins.
Streptococcus pneumoniae can be differentiated best from the viridans group of streptococci by a Gram stain b the type of hemolysis c colonial morphology d bile solubility
d bile solubility d Bile solubility testing of alpha-hemolyt streptococci differentiates S pneumoniae (soluble) from other alpha-hemolytic streptococci such as viridans streptococci (insoluble).
Viridans streptococci can be differentiated from Streptococcus pneumoniae by: a alpha hemolysis b morphology c catalase reaction d bile solubility
d bile solubility d Bile solubility testing of alpha-hemolytic streptococci differentiates S pneumoniae (soluble) from other alpha-hemolytic streptococci, such as viridans streptococci (insoluble).
Propionibacterium acnes is most often associated with: a normal oral flora b post-antibiotic diarrhea c tooth decay d blood culture contamination
d blood culture contamination d Propionibacterium acnes is part of the normal flora of the skin, so it is frequently isolated from improperly collected blood cultures.
A gram-negative bacillus has been isolated from feces, and the confirmed biochemical reactions fit those of Shigella. The organism does not agglutinate in Shigella antisera. What should be done next? a test the organism with a new lot of antisera b test with Vi antigen c repeat the biochemical tests d boil the organism and retest with the antisera
d boil the organism and retest with the antisera d Some Shigella produce capsular antigen that mask the cell wall and boiling removes the capsule.
A sputum specimen is received for culture and Gram stain. The Gram stained smear from this specimen is seen in the image (total magnification 100x): (image) The technologist's best course of action would be to: a inoculate appropriate media and incubate anaerobically b inoculate appropriate media and incubate aerobically c call the physician and notify him of this "life-threatening" situation d call the patient care area and request a new specimen
d call the patient care area and request a new specimen d There are several sputum-screening systems for assessing the quality of respiratory specimens. In general, neutrophils are a positive indicator of quality, and squamous epithelial cells are a negative indicator of quality, suggesting oropharyngeal contamination. This specimen contains an abundance of squamous cells (> 10/low power field), and would be unacceptable for culture.
A yeast isolate from a CSF specimen produced the following results: India ink: no encapsulated yeast cells cryptococcal antigen: negative urea: negative germ tube: negative What should the technologist do next to identify this organism? a inoculate bird seed agar b ascospore stain c cycloheximide susceptibility d carbohydrate assimilation
d carbohydrate assimilation d Conventional tests, such as carbohydrate assimilation, must be performed for definitive identification of the yeast in this CSF specimen, especially in light of the fact that the yeast is both cryptococcal antigen and germ tube negative.
Tubercle bacilli are specifically stained by: a crystal violet b 1% acid fuchsin c methylene blue d carbol fuchsin
d carbol fuchsin d Mycobacteria form stable complexes with Kinyoun carbol fuchsin.
The most common cause for failure of a GasPak™ anaerobic jar to establish an adequate environment for anaerobic incubation is: a the failure of the oxidation-reduction potential indicator system due to deterioration of methylene blue b the failure of the packet to generate adequate H2 and/or C02 c condensation of water on the inner surface of the jar d catalysts that have become inactivated after repeated use
d catalysts that have become inactivated after repeated use d The 2 most common causes of failure of the GasPak™ system is a defective gasket in the jar lid that allows escape of gas from inside the jar and inactivated catalyst pellets.
Proper media for culture of a urethral discharge from a man include: a sheep blood and phenylethyl alcohol agars b eosin-methylene blue and sheep blood agars c thioglycollate broth and chocolate agar d chocolate and modified Thayer-Martin agars
d chocolate and modified Thayer-Martin agars d Chocolate agar and chocolate agar- based selective media should be used for recovery of Neisseria gonorrhoeae from urethral discharge. Chocolate agar provides the nutrients required by N gonorrhoeae and selective media contains antimicrobial agents that inhibits other organisms and permits recovery of pathogenic Neisseria.
A laboratory aid receives a bronchoscopy sample with the request for culture of Legionella. The assistant asks a microbiologist for direction on plating protocol. The correct response from t e microbiologist is: a culture on thiosulfate citrate bile salt media b incubate the culture media anaerobically c reject the specimen and request a sputum sample d culture on buffered charcoal yeast extract agar with antibiotics
d culture on buffered charcoal yeast extract agar with antibiotics d Buffered charcoal yeast extract agar is recommended for culture of specimens for Legionella.
Serum samples collected from a patient with pneumonia demonstrate a rising antibody titer to Legionella. A bronchoalveolar lavage (BAL) specimen from this patient had a positive antigen test for Legionella but no organisms were recovered on buffered charcoal yeast extract medium after 2 days of incubation. The best explanation is that the: a antibody titer represents an earlier infection b positive antigen test is a false positive c specimen was cultured on the wrong media d culture was not incubated long enough
d culture was not incubated long enough d Media for isolation of Legionella should be incubated at 35°-37°C for at least 7 days.
A first morning sputum is received for culture of mycobacteria. It is digested and concentrated by the N-acetyl-L-cysteine alkali method. Two Lowenstein-Jensen slants are incubated in the dark at 35°C with 5%-10% C02. The smears reveal acid-fast bacilli, and after 7 days no growth appears on the slants. The best explanation is: a improper specimen submitted b incorrect concentration procedure c exposure to C02 prevents growth d cultures held for insufficient length of time
d cultures held for insufficient length of time d Many species of mycobacteria are slow growing, and may take up to 12 weeks for growth.
A first morning sputum specimen is received for acid-fast culture. The specimen is centrifuged, and the sediment is inoculated on 2 Lowenstein-Jensen slants, which are incubated at 35°C : 5%-10% C02. After 1 week, the slants show abundant growth over the entire surface. Stair reveal gram-negative bacilli. To avoid this problem: a utilize a medium that inhibits bacterial growth b add sodium hypochlorite to the sediment before inoculation c incubate the tubes at room temperature to retard bacterial growth d decontaminate the specimen with sodium hydroxide
d decontaminate the specimen with sodium hydroxide d Specimens contaminated by normal flora must be decontaminated prior to inoculation of media; NaOH is the most common decontaminant.
Which of the following methods is inadequate for the detection of vancomycin-intermediate S aureus? a broth macrodilution b agar dilution c gradient diffusion d disk diffusion
d disk diffusion The disk diffusion procedure will not differentiate S aureus strains with reduced susceptibility to vancomycin (MICs 4-8 pg/mL) from susceptible stains even when incubated for 24 hours.
A beta-hemolytic, catalase-positive, gram-positive coccus is coagulase negative by the slide coagulase test. Which of the following is the most appropriate action in identification of this organism? a report a coagulase-negative Staphylococcus b report a coagulase-negative Staphylococcus aureus c reconfirm the hemolytic reaction on a fresh 24-hour culture d do a tube coagulase test to confirm the slide test
d do a tube coagulase test to confirm the slide test d Staphylococcus aureus are usually beta- hemolytic. Some strains may not produce bound coagulase detected by the slide coagulase test. A tube coagulase is performed to detect free coagulase and should be performed on colonies with typical S aureus morphology that are slide coagulase- negative.
Its important to differentiate between Enterococcus and group D streptococcus because: a viridans streptococci are often confused with enterococci b several enterococci cause severe puerperal sepsis c group D streptococci are avirulent d enterococci often show more antibiotic resistance than group D streptococci
d enterococci often show more antibiotic resistance than group D streptococci d Enterococcus species are more resistant to antimicrobial therapy than group D streptococci such as S hovis.
The appropriate specimen for the diagnosis of mucormycosis is: a nasal swab b sputum c sinus washing d eschar biopsy
d eschar biopsy d Mucormycosis is an aggressive infection where biopsy, curettage or fine-needle aspiration is essential for diagnosis.
Listeria can be confused with some streptococci because of its hemolysis and because it is: a nonmotile b catalase negative c oxidase positive d esculin positive
d esculin positive d Listeria may be confused with some streptococci because Listeria is beta- hemolytic and is capable of hydrolyzing esculin.
An aspirate of a deep wound was plated on blood agar plates and incubated aerobically and anaerobically. At 24 hours there was growth on both plates. This indicates that the organism is a(n): a nonfermenter b obligate anaerobe c aerobe d facultative anaerobe
d facultative anaerobe d Facultative anaerobes are organisms that can grow under both aerobic and anaerobic conditions.
Middlebrook 7H10 and 7H11 media must be refrigerated in the dark, and incubated in the dark as well. If these conditions are not met, the media may prove toxic for mycobacteria because: a carbon dioxide will be released b growth factors will be broken down c light destroys the ammonium sulfate d formaldehyde may be produced
d formaldehyde may be produced d If exposed to light, agar-based media such as 7H11 may release formaldehyde, which is toxic to mycobacteria.
Which of the following antibiotics would routinely be tested and reported for isolates of Pseudomonas aeruginosa? a penicillin b erythromycin c clindamycin d gentamicin
d gentamicin d Aminoglycoside antibiotics such as gentamicin are active against Pseudomonas and routinely tested and reported on these isolates. Penicillin, erythromycin, and clindamycin are not active against Pseudomonas.
The Image depicts a Gram stain (final magnification l,000x) of a knee fluid from a patient who has recently undergone knee replacement surgery: The best interpretation of this Gram stain is: a gram-positive cocci suggestive of Staphylococcus b gram-positive bacilli suggestive of Corynebacterium c gram-positive bacilli suggestive of Listeria d gram-positive cocci suggestive of Streptococcus
d gram-positive cocci suggestive of Streptococcus d The Gram stain depicts gram-positive cocci arranged in chains. Members of the genus Streptococcus characteristically grow in pairs and chains, and tend to chain more in fluid. Staphylococci are also gram-positive cocci that can appear singly, in pairs, short chains or, more typically, clusters.
If present, a characteristic that is helpful in separating Pseudomonas aeruginosa from other members of the Pseudomonas family is: a a positive test for cytochrome oxidase b oxidative metabolism in the OF test c production of fluorescein pigment d growth at 42*C
d growth at 42*C d Pseudomonas aeruginosa grows at 42°C, but this temperature is inhibitory for other Pseudomonas species.
Refer to the following image: (IMAGE) Trophozoites of the cyst shown above are likely to: a contain red blood cells b have clear, pointed pseudopodia c contain few, if any, vacuoles d have slow, undefined motility
d have slow, undefined motility d Trophozoites of Entamoeba coli demonstrate slow and undefined motility.
Definitive identification of Neisseria gonorrhoeae is made with the. a Gram stain b oxidase test c degradation of amino acids d hydrolysis of carbohydrates
d hydrolysis of carbohydrates d Of the choices provided, only fermentation of carbohydrates provides definitive identification of Neisseria gonorrhoeae.
Nutritionally deficient streptococci are: a enterococci b group D nonenterococci c cell wall-deficient streptococci d in the genera Granulicatella and Abiotrophia
d in the genera Granulicatella and Abiotrophia d Organisms that used to be categorized as nutritionally variant or deficient streptococci have been reclassified into the genera Abiotrophia and Granulicatella.
To quality control the autoclave, a vial of Bacillus stearothermophilus is autoclaved and should then be: a inoculated to blood agar b incubated at 37*C c inoculated to chocolate agar d incubated at 56*C
d incubated at 56*C d Bacillus stearothermophilus is commonly used as an indicator organism for the appropriate functioning of autoclaves. Unlike most Bacillus species, B stearothermophilus grows at 56°C.
89********************************************************** Which one of the following combinations of organisms would be appropriate as controls to test the functions listed? a beta-hemolysis-negative Escherichia coli and Streptococcus pyogenes b catalase-negative Staphylococcus aureus and Staphylococcus epidennidis c H2S production-negative Proteus mirabilis and Staphylococcus epidermidis d indole-negative Escherichia coli and Proteus mirabilis
d indole-negative Escherichia coli and Proteus mirabilis d Of the combinations listed, the use of E coli and Proteus mirabilis will produce a positive and negative result for indole respectively. The remainder of the organisms are all positive for the test described
The function of N-acetyl-L-cysteine in the reagent for acid-fast digestion-decontamination procedure is to: a inhibit growth of normal respiratory flora b inhibit growth of fungi c neutralize the sodium hydroxide d liquefy the mucus
d liquefy the mucus d N-acetyl-L-cysteine (NALC) is a mucolytic agent; the concentration of NALC may be increased to digest thick, mucoid specimens.
The most sensitive substrate for the detection of beta-lactamases is: a penicillin b ampicillin c cefoxitin d nitrocefin
d nitrocefin d The chromogenic cephalosporin test using nitrocefin is the most sensitive and specific test for detection of beta lactamase. Acidimetric tests employing penicillin are less expensive, but not as sensitive, as the nitrocefin assay.
Which of the following antimicrobials would be inappropriate to report on an E coli isolated from a wound culture? a gentamicin b ampicillin c cefazolin d nitrofurantoin
d nitrofurantoin d Certain antimicrobials, such as nitrofurantoin and norfloxacin, are used only or primarily to treat urinary tract infections. These agents should not be reported for pathogens recovered from other sites of infection.
An urethral swab obtained from a man with an urethral exudate was plated directly on chocolate agar and modified Thayer-Martin agar, and a Gram stain was made. The Gram stain showed gram- negative diplococci. The culture plates were incubated at 35°C, but had no growth at 48 hours. The most likely failure for organism growth is that the: a wrong media were used b Gram stain was misread c organism only grows at room temperature d organism requires CO2 for growth
d organism requires CO2 for growth d Neisseria gonorrhoeae requires an enhanced carbon dioxide atmosphere for optimal growth.
An expectorated sputum is sent to the laboratory for culture from a patient with respiratory distress. The Gram stain of the specimen shows many squamous epithelial cells (>25/lpf) and rare neutrophils. The microscopic appearance of the organisms present include: moderate gram-positive cocci in chains and diplococci moderate gram-negative diplococci moderate palisading gram-positive bacilli all in moderate amounts This Gram stain is most indicative of: a a pneumococcal pneumonia b an anaerobic infection c an Haemophilus pneumonia d oropharyngeal flora
d oropharyngeal flora d Sputum specimen quality is assessed to determine if the specimen is representative of the site of infection. The presence of white blood cells is an indicator of infection, and presence of squamous epithelial cells is an indicator of oropharyngeal contamination. In this specimen, >25 epithelial cells per low power field is an indicator of poor specimen quality, and the bacteria present are representative of oropharyngeal flora.
The method used for processing specimens for mycobacterial culture contaminated with Pseudomonas is: a N-acetyl-L-cystine and NaOH b NaOH c zephiran-trisodium phosphate d oxalic acid
d oxalic acid d The oxalic acid method is superior to alkali methods for processing specimens contaminated with Pseudomonas.
Differentiating tests that will separate Burkholderia from Stenotrophomonas include. a Gram stain reaction b growth on MacConkey agar c glucose fermentation d oxidase
d oxidase d Both organisms are gram-negative bacilli and grow on MacConkey agar. Neither ferments glucose. Stenotrophomonas is oxidase negative, while most other nonfermenters are oxidase positive.
An isolate on chocolate agar from a patient with epiglottitis was suggestive of HaemopW/us species. Additional testing showed that the isolate required for growth and was nonhemolytic. The organism is most likely Haemophilus: a haemolyticus b ducreyi c influenzae d parainfluenzae
d parainfluenzae d Haemophilus parainfluenzae requires NAD for growth but not hemin. This distinguishes it from H influenzae. H haemolyticus is hemolytic, and H ducreyi does not cause epiglotittis.
Artifacts found in a stool specimen that can be confused with ova or cysts are: a partially digested meat fibers b degenerated cells from the gastrointestinal mucosa c dried chemical crystals d pollen grains
d pollen grains d Pollen grains are common artifacts in stool specimens submitted for ova and parasite examination. Their appearance is similar to protozoan cysts.
A Gram stain of organisms on Loeffler agar showed pleomorphic gram-positive bacilli. The organism should be subcultured to: a blood b chocolate c MacConkey d potassium tellurite
d potassium tellurite d Media containing potassium tellurite is used for the recovery of Cory neb acterium diphtheriae.
The characteristic that is most commonly associated with the presence of strict anaerobic bacteria and can be taken as presumptive evidence of their presence in a clinical specimen is the: a presence of a single bacterial species b production of gas in a thioglycollate broth culture c growth on a blood agar plate incubated in an anaerobic jar d presence of a foul, putrid odor from tissue specimens and cultures
d presence of a foul, putrid odor from tissue specimens and cultures d Anaerobic bacteria characteristically produce foul-smelling metabolic end products.
A bronchial washing is processed for acid-fast bacilli. Which of the following precautions should be taken in order to prevent infection of laboratory personnel? a add an equal amount of NALC to the specimen b process all specimens under ultraviolet light c centrifuge specimen only after the addition of preservative d process all specimens in a biological safety hood
d process all specimens in a biological safety hood d Specimens processed for mycobacterial culture must be processed in a biological safety cabinet to minimize aerosol transmission of the organism.
Members of the family Enterohacteriaceae share which one of the following characteristics? a produce cytochrome oxidase b ferment lactose c produce beta-hemolysis d reduce nitrate to nitrite
d reduce nitrate to nitrite d Members of Enterobacteriaceae are oxidase negative, ferment glucose, and reduce nitrate to nitrite.
The specimen of choice for finding the above parasite is: a stool b duodenal washing c rectal swab d scotch tape preparation
d scotch tape preparation d The ova of Enterobius vermicularis cannot be demonstrated in a routine ova and parasite examination. The adult female Enterobius worm migrates out of the anus and lays her eggs in the perianal folds. A scotch tape preparation of the skin of the perianal folds is used to collect ova.
Biochemical reactions of an organism are consistent with Shigella. A suspension is tested in antiserum without resulting agglutination. However, after 15 minutes of boiling, agglutination occurs in group D antisera. The Shigella species is: a dysenteriae b flexneri c boydii d sonnei
d sonnei d Boiling removed the capsule so that the antiserum could react with cell wall antigen. Group D Shigella is S sonnei.
The laboratory receives a blood culture from a veterinarian who has been ill for many weeks with fevers in the afternoon and evenings, arthritis, and fatigue. The blood culture is positive after 5 days, and the organism has the following characteristics: Gram stain: small, gram-negative coccobacilli sheep blood agar: growth after 48 hours with small, smooth, raised colonies What should the microbiologist do next? a consider the growth contamination and perform another gram stain b perform biochemical identification for HACEK organisms c perform identification and susceptibility testing using an automated system d take extra safety precautions for possible Brucella
d take extra safety precautions for possible Brucella d Brucella causes undulant fever and is a cause of fever of unknown origin. It is slow growing, and is associated with laboratory- acquired infections. It is also a potential agent of bioterrorism. Suspected Brucella isolates should not be tested in automated or manual identification systems.
All species of the genus Neisseria have the enzyme to oxidize: a naphthylamine b dimethylaminobenzaldehyde c glucopyranoside d tetramethyl-phenylenediamine
d tetramethyl-phenylenediamine d Since all Neisseria species are oxidase positive, they possess the enzyme to oxidize tetramethyl-phenylenediamine.
Susceptibility testing is performed on a Staphylococcus aureus isolate from a blood culture with the following results: oxacillin: resistant cefazolin: susceptible clindamycin: susceptible erythromycin: susceptible trimethoprim/sulfamethoxazole: susceptible vancomycin: susceptible What should the technologist do next? a ceftriaxone should be reported instead of cefazolin b clindamycin should be tested for inducible resistance prior to reporting c the trimethoprim/sulfamethoxazole result should be removed since all S aureus are resistant d the cefazolin result should be changed to resistant since the oxacillin result is resistant
d the cefazolin result should be changed to resistant since the oxacillin result is resistant d Oxacillin resistant staphylococci are resistant to all beta-lactam agents, beta-lactam/beta-lactamase inhibitor combinations and carbapenems. Results for these antibiotics should be reported as resistant or should not be reported.
Vibrio parahaemolyticus can be isolated best from feces on: a eosin methylene blue (EMB) agar b Hektoen enteric (HE) agar c Salmonella Shigella (SS) agar d thiosulfate citrate bile salts (TCBS) agar
d thiosulfate citrate bile salts (TCBS) agar d TCBS is a highly selective and differential medium for the recovery of most Vibrio species including V parahaemolyticus. Hektoen and Salmonella-Shigella agars are selective and differential for the isolation and differentiation of enteric pathogens such as Salmonella and Shigella. EMB is a selective and differential medium for gram-negative enteric bacilli.
A community hospital microbiology laboratory is processing significant numbers of stool cultures because of an outbreak of diarrhea following heavy rains and flooding in the county. A media that should be incorporated in the plating protocol is: a colistin nalidixic acid for Listeria b MacConkey agar with sorbitol for Campylobacter c mannitol salt agar for Enterococcus species d thiosulfate citrate bile salts sucrose for Vibrio species
d thiosulfate citrate bile salts sucrose for Vibrio species d Thiosulfate citrate bile salt agar is a selective media for Vibrio, an it a so differentiates sucrose-fermenting species, such as Vcholerae and Valginolyticus.
Which one of the following specimen requests is acceptable? a feces submitted for anaerobic culture b Foley catheter tip submitted for aerobic culture c rectal swab submitted for direct smear for gonococci d urine for culture of acid-fast bacilli
d urine for culture of acid-fast bacilli d Urine is an appropriate specimen for the detection of renal tuberculosis. Since feces contain anaerobic organisms as part of the indigenous flora, it is an unacceptable specimen for anaerobic culture. Foley catheter tips are also not acceptable for culture, because they are contaminated with colonizing organisms. Gram stain smears of rectal swabs for Ngonorrhoeae should also not be performed, since the presence of organisms with similar morphologies may lead to overinterpretation of smears.
The procedure that assures the most accurate detection of mecA-mediated oxacillin resistance in routine broth microdilution susceptibility testing against S aureus is: a addition of 4% NaCl b incubation at 30°C c incubation for 48 hours d use of cefoxitin for testing
d use of cefoxitin for testing d Cefoxitin is used as a surrogate for mecA-mediated oxacillin resistance in S aureus. S aureus with cefoxitin MICs >4 pg/mL are considered oxacillin resistant. The Clinical Laboratory Standards Institute (CLSI) recommends addition of 2% NaCl, incubation at 35±2°C, and incubation for 24 hours when performing susceptibility testing of S aureus against oxacillin.
When using a control strain of Staphylococcus aureus, the technologist notices that the zone around the oxacillin disk is too small. Which of the following is the most likely explanation? a inoculation of the plates 10 minutes after preparing the inoculum b incubation of the Mueller-Hinton plates at 35°C c use of a 0.25 McFarland standard to prepare inoculum d use of outdated oxacillin disks
d use of outdated oxacillin disks d Deterioration of the antimicrobial agent in the disk will cause the zone sizes to be too small (falsely resistant). Standardization of the inoculum turbidity to less than a 0.5 McFarland standard would result in an inoculum that is too light and resulting zone sizes that are too large. Incubation of the plates at 35°C and inoculating plates within 10 minutes of preparation would not have an adverse effect on zone sizes.
207) Which pair does not match with respect to amniotic fluid?
dark green --- HDFN Dark green amniotic fluid indicates the presence of meconium. This is the infant's first bowel movement, and indicates fetal distress.
188) The most common genetic defect associated with cystic fibrosis is called:
delta-F508 All of the answers are mutations. Delta-F508 is the deletion of phenylalanine at position 508 of the CFTR protein. Trisomy 21 is a third copy of chromosome 21, associated with Down syndrome. The Philadelphia chromosome is a gene translocation associated with acute myelocytic leukemia. Fragile X is a form of mental retardation caused by an increased number of nucleotide repeats.
211) Peritoneal lavage is used to:
detect intra-abdominal bleeding in blunt injury A patient with blunt trauma, such as a car accident, may have internal bleeding. Peritoneal lavage introduces a fixed volume of saline into the peritoneal cavity, and withdraws an aliquot. RBCs are counted. Counts greater than 100,000/mL indicate blunt trauma.
147) A patient has glucosuria, hyperglycemia and polyuria. These findings are most consistent with:
diabetes mellitus The combination of these results is consistent with diabetes mellitus. The polyuria occurs due to the need to excrete the excess dissolved glucose in the urinary filtrate. Hyperglycemia is not present with renal glucosuria. Both stress and a heavy meal can cause transient glucosuria.
153) Polyuria is usually correlated with:
diabetes mellitus The increased plasma glucose seen in diabetes mellitus results in excess glucose in the glomerular filtrate. Increased amounts of water are required for excretion of the excess glucose in the filtrate. As a result, increased fluid intake is characteristic of persons with diabetes mellitus.
125) A urine specimen is tested and has the following results: Reagent strip: glucose: 3+; protein: 1+ Microscopic findings: >100 WBCs/hpf; many yeast cells This is indicative of:
diabetes mellitus Yeast cells are commonly seen in urine specimens from persons with diabetes mellitus, because the high glucose content provides an excellent growth media for yeast.
83) The possibility of detecting glitter cells is associated with urine that is:
dilute In a hypotonic urine, WBCs will absorb water and swell. This results in the granules in the granulocytic WBCs to exhibit Brownian movement.
62) To prepare the reagent used in confirmatory protein testing, a technician would:
dissolve 3 g sulfosalicylic acid in 100 mL of water 3% SSA is used to confirm positive protein tests. 3% implies 3 g in 100 mL.
119) Alkaline urine showed this microscopic finding. The technologist should:
dissolve with acetic acid The crystals are amorphous phosphates. These can be dissolved in dilute acetic acid, in order to view other formed elements that are obscured.
29) Osmolality is a measure of:
dissolved particles, including ions Osmolality measures the number of particles in a solution. Salts will dissociate into ions, and each ion contributes to the osmolality.
32) A urine's specific gravity is directly proportional to its:
dissolved solids Dissolved solids, including salt, sugar, urea, etc, contribute to specific gravity. Turbidity is caused by cells and crystals, which do not dissolve, and do not contribute to specific gravity.
95) Which of the following aids in differentiating a spherical transitional cell from a round renal tubular cell?
eccentrically-placed nucleus in the renal tubular cell Centrally-placed nuclei are characteristic of spherical transitional cells.
75) The advantage to using phase microscopy in urinalysis is to:
enhance constituents with a low refractive index The diffracted light in phase microscopy enhances slight variations in the refractive indices of constituents with low refractive indices. Staining is not required to enhance low refractive index constituents when using phase microscopy.
200) Which stain is used to measure sperm viability?
eosin nigrosin All of these stains can be used to view sperm; however, the eosin-nigrosan stain is differential between live and dead sperm. Living cells will stain bluish white, dead cells stain red.
2) False results in the urobilinogen testing may occur if the urine specimen is:
exposed to light Urobilinogen is degraded by light.
185) Amniotic fluid is tested for the concentration of lamellar bodies. This test determines:
fetal lung maturity (FLM) Amniotic fluid can be collected to test for birth defects such as trisomy 21 [Down syndrome], spina bifida [increased AFP and acetylcholinesterase], hemolytic disease of the newborn [bilirubin], and fetal lung maturity [FLM]. FLM can be determined by increased lamellar body production in the amniotic fluid. Lamellar bodies are phospholipids produced by the maturing pneumocytes. They are approximately the size of small platelets, and can be counted by instruments that are used to count platelets.
120) Polarized light can often be used to differentiate between:
fibers and mucus clumps Contaminants frequently contain substances capable of polarizing light. None of the other listed constituents are capable of polarizing light.
20) The clarity of a urine sample should be determined:
following thorough mixing of the specimen a is false, you don't use glass tubes in urinalysis. b is true — clarity or haziness is due to solids and cells in the solution. These settle to the bottom of the tube; therefore, the sample should be well mixed. It is not necessary to add anything to view clarity. Furthermore, adding SSA will precipitate urines with positive protein. Allowing the specimen to cool to room temperature may cause amorphous crystals to form, so d is false.
102) Prior to reporting a RBC cast, it is important to observe:
free floating RBCs Before reporting a red blood cell cast, it is essential to observe free-floating RBCs in the sediment. A coarsely granular cast may sometimes resemble a red blood cell cast. Without the presence of free red blood cells, a red blood cell cast could not have formed in the tubules.
70) An urinalysis performed on a 2 week old infant with diarrhea shows a negative reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be performed to check the urine sample for the presence of:
galactose Children with failure to thrive may have galactosuria. In this case, only a and b are reducing substances. Since the reagent strip for glucose is negative, this leaves galactose.
155) The reason for performing a Clinitest on a newborn's urine is to check for:
galactose Galactosuria is an inborn error of metabolism, resulting in the failure to inherit the one of the enzymes needed to metabolize dietary galactose to glucose. Byproducts of this metabolic failure are toxic, and can result in severe mental retardation. Early detection and dietary changes can prevent the toxicity.
169) To prepare the reagent used for mucin clot determination of synovial fluid, water is mixed with:
glacial acetic acid Diluting cells tor counting should not disturb them osmotically. Saline is the best choice. Water can lyse the cells, trichloroacetic acid will precipitate the sample, and acetic acid will form a clot with hyaluronic acid in the sample.
Creatinine clearance is used to estimate the:
glomerular filtration rate
104) What is the most likely diagnosis given this microscopic finding?
glomerulonephritis RBC casts, protein, and RBCs together are indicative of glomerulonephritis. RBC casts from when there is bleeding in the glomerulus and tubules.
136) A urinalysis performed on a 27-year-old woman yields the following results: specific gravity: 1.008 pH: 5.0 protein: 2+ glucose: negative ketones: negative bilirubin: negative blood: 3+ nitrite: negative leukocytes: positive urobilinogen: 0.1 EU/dL Microscopic findings: WBC/hpf: 10-15 RBC/hpf: 30-55 casts/lpf: hyaline, 5-7; RBC, 2-5; granular, 2-3 uric acid crystals: moderate These findings are most consistent with:
glomerulonephritis The presence of RBC casts is consistent with glomerulonephritis. WBCs, RBCs and protein are present as a result of the glomerular damage.
129) Which of the following positive chemical reactions is most closely associated with the presence of yeast in the urine sediment?
glucose Yeast cells are commonly seen in urine specimens from persons with diabetes mellitus, because the high glucose content provides an excellent growth media for yeast.
134) The following urinalysis results were obtained from an 18-year-old woman in labor: pH: 6.5 protein: 30 mg/dL glucose: 250 mg/dL ketones: negative bilirubin: small (color slightly abnormal) blood: negative nitrite: negative urobilinogen: 0.1 EU/dL specific gravity: 1.025 copper reduction test: 1.0 g/dL Which of the following is the most likely explanation for the patient's positive copper reduction test?
glucose and possibly other reducing substances/ sugars are present The reagent strip glucose test using glucose oxidase is specific for glucose; therefore, glucose must be present in the sample. The copper reduction test is positive with many sugars, including glucose. The copper reduction test has a lower sensitivity than the reagent strip; therefore, the higher reading on the copper reduction test indicates the presence of an additional sugar. In the case of a nursing mother, the most likely additional sugar is lactose.
68) A urine specimen is analyzed for glucose by a glucose oxidase reagent strip and a copper reduction test. If both results are positive, which of the following interpretations is correct?
glucose is present A positive glucose oxidase is specific for glucose. Glucose will also cause copper reduction [a positive Clinitest].
197) Which of the following is the best indicator of Reye syndrome for CSF (hepatic encephalopathy):
glutamine In hepatic encephalopathy, ammonia levels in the plasma build up, and ammonia can be found in the spinal fluid. Ammonia is volatile, and not easily measured. Glutamine is a byproduct of ammonia, and is stable, making it a better choice.
181) The chromogen for the fecal occult blood test is:
gum guaiac The principle of occult blood testing is based on the oxidation of guaiac. This occurs in the presence of hydrogen peroxide [the reagent] and the enzyme peroxidase. Hemoglobin has a pseudoperoxidse activity that drives the reaction, making oxidized guaiac, which is blue in color.
81) A reagent strip test for blood has been reported positive. Microscopic exam fails to yield RBCs. This patient's condition can be called:
hemoglobinuria The reagent strip test for blood is positive for hemoglobin from lysed red blood cells, filtered hemoglobin from intravascular hemolysis, and myoglobin. With no RBCs present, the terminology is hemoglobinuria, indicating the presence of filtered hemoglobin.
53) When employing the urine reagent strip method, a false-positive protein result may occur in the presence of:
highly alkaline urine The protein pad must be held at a pH of 3 in order to see the effect that protein has on the double indicators. In alkaline urine, the pH of 3 may be neutralized, and the indicators change color.
180) False-positive results can occur for fecal occult blood due to the ingestion of:
horseradish False positives for fecal occult blood occur when patient diet includes food that produces peroxidase. Horseradish, broccoli, radishes, melons, and other foods can cause a false positive. Patients that take aspirin may have some occult bleeding that is not associated with colorectal cancer, but acetaminophen is not a cause of bleeding. Ascorbic acid at high doses can interfere with the test and cause a false-negative.
92) Which of the following casts is most likely to be found in healthy people?
hyaline Hyaline casts may be excreted by healthy people following strenuous exercise or normal condition that produces decreased urine flow. Red cell, white cell, and waxy casts indicate a pathogenic condition within the nephron.
Denaturation of DNA during a PCR reaction refers to breaking: a. hydrogen bonds between nitrogenous bases in base-paired nucleotides b. phosphodiester bonds between nitrogenous bases in base-paired nucleotides c. covalent bonds between nitrogenous bases in base-paired nucleotides d. peptide bonds between nitrogenous bases in base-paired nucleotides
hydrogen bonds between nitrogenous bases in base-paired nucleotides Hydrogen bonds hold the 2 strands of DNA together in a double-stranded DNA molecule. (a)
the white cell feature most characteristics of pernicious anemia?
hypersegmentation
156) Ketones in urine are due to:
incomplete fat metabolism Ketones are intermediate components of fat metabolism. When access to carbohydrates normally broken down to supply energy is limited, fats are broken down for energy, and the intermediate ketone products [acetone, acetoacetic acid and beta-hydroxybutyric acid] can be detected in the urine.
43) Upon standing at room temp, a urine pH typically:
increases The change in pH is due to breakdown of urea to ammonia by urease producing bacteria, and loss of CO2.
204) Pilocarpine iontophoresis refers to the specific process of:
inducing sweat Sweat chloride is measured to diagnose cystic fibrosis. Sweating is induced by stimulation local sweat glands by driving pilocarpine into the skin, using a process called pilocarpine iontophoresis.
Urobilinogen is formed in the
intestine
74) The best way to lower the light intensity of the microscope is to:
lower the rheostat Adjusting the condenser of the diaphragm of the microscope also affects image resolution. Adjusting the main light source only changes the light intensity.
124) A technologist is having trouble differentiating between RBCs, oil droplets and yeast cells on a urine microscopy. Acetic acid should be added to the sediment to:
lyse the RBCs Acetic acid lyses red blood cells, but not oil droplets and yeast. Acetic acid will also lyse other formed elements and should be added to an aliquot of the sediment.
12) The creatinine clearance is reported in:
mL/min The creatinine clearance is a filtration rate, and is reported in minutes. The sample is a 24-hour urine, which is entered into the calculation as the volume in milliliters, and the factor of 1,440 minutes per 24 hours is applied.
21) Milky urine from a 24 yr. old woman would most likely contain:
many white blood cells The 2 items listed that produce a white color are white blood cells and semen. It is more likely that a woman would have a UTI with many WBC than enough post coital sperm contamination to make the urine white.
1) After receiving a 24 hr. urine for quantitative total protein analysis the technician must first:
measure the total volume Measure the total volume of the sample before removing an aliquot. To calculate the total protein, measure the protein of an aliquot to learn the mg/dL. Then multiply that answer by the number of dL in the 24-hour collection.
22) A brown/black urine would most likely contain:
melanin Match the color to the pigment. Bile is green/brown. Porphyrins are red. Melanin is black. Blood cells are red or white.
64) Ammonium sulfate was added to red urine. The urine had a positive reaction for blood, but no RBCs were seen on microscopic exam. After centrifugation, the supernatant fluid is red. The abnormal color is caused by:
myoglobin Both hemoglobin and myoglobin will produce a red urine without RBCs. Hemoglobin will be precipitated by ammonium sulfate, but myoglobin will not. Myoglobin will remain in the supernate after centrifugation.
24) Red urine may be due to:
myoglobin Match the color to the pigment. Bilirubin is amber. Myoglobin is red, like hemoglobin. Homogenistic acid will produce a dark urine on standing.
13) Microalbumin can be measured by a random urine collection. An increased microalbumin is predictive of:
nephropathy Patients with hypertension and diabetes mellitus are at risk for kidney disease. Detection of small amounts of albumin in the urine predict eventual kidney disease. The advantage of this sensitive detection is that patients with microalbuminuria can be treated with anti-hypertensive medications and followed up more intensely to delay nephropathy.
137) A 62 yr. old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular and cellular casts. Many oval fat bodies are also noted. This is most consistent with:
nephrotic syndrome Damage to the electrical charges of the glomerular membrane, allowing the passage of high molecular-weight proteins and lipids occurs in nephrotic syndrome. This results in markedly increased urine protein levels, and the appearance of fatty casts and oval fat bodies that are characteristic of nephrotic syndrome.
130) What of the following is consistent with this urine microscopic finding?
nitrate Many bacteria produce nitrites from nitrate. If the biochemical strip is positive for nitrite, you should find bacteria in the sediment.
146) The volume of urine excreted in a 24 hr. period by an adult patient was 300 mL. This condition would be termed:
oliguria The prefix oligo- means scanty. Knowing that the normal daily urine volume is around 1200 mL, 300 mL is scanty. The prefix an- means not, poly- means many, and dys- means pain.
164) The most accurate test to determine renal concentration is:
osmolarity Osmolarity measures the number of particles in a solution, whereas specific gravity is influenced not only by the number of particles but also their density. Renal concentration is concerned with smaller molecules, such as sodium and chloride. Each of these molecules will contribute the same to an osmolarity reading as a large molecule of glucose.
114) Following ingestion of ethylene glycol (antifreeze), numerous crystals are found in the urine. The shape of these crystals is:
oval/dumbbell Calcium oxide monohydrate crystals are most frequently seen following ingestion of ethylene glycol/antifreeze. Unlike the more commonly seen envelope-shaped dihydrate crystals, they are oval or dumbbell shaped.
8) Which of the following would be affected by allowing a urine specimen to remain at room temp for 3 hrs. before analysis:
pH Consider whether a substance can increase or decrease outside the body. No more blood can be produced. Although the RBC may rupture, they will still make a positive result on a biochemical strip. The amount of solutes won't change, so specific gravity won't change. pH is affected by metabolism of the urine components by bacteria, and room temperature is warm enough for this to occur. Protein will not increase or decrease.
126) When identifying urinary crystals, which reagent strip result is most important?
pH Urine crystal formation is associated with the optimal pH needed for their formation [acid, alkaline or neutral].
133) The results of a urinalysis on a first morning specimen are: specific gravity: 1.024 pH: 8.5 protein: negative glucose: negative Microscopic findings: uric acid crystals The next step is to repeat the:
pH and microscopic examination Uric acid crystals are seen in acid urine. The reagent strip pH may have been recorded wrong. Uric acid crystals have many shapes, and an artifact may have been mistaken for the uric acid crystals.
14) A patient with uncontrolled diabetes mellitus will most likely have:
pale urine with a high specific gravity The high specific gravity is due to the glucose in the urine. Patients with diabetes mellitus have polyuria, so that the volume of urine dilutes the urochrome [color], making the urine pale.
184) Ascites is collected by:
paracentesis Accumulation of fluid in the peritoneal cavity is called ascites, and it is collected by paracentesis.
63) A positive result for bilirubin on a reagent strip should be followed up by:
performing an Ictotest The bilirubin dipstick pad can show a false positive from a colored urine. All positives should be confirmed with an ictotest.
15) While performing an analysis of a baby's urine, the technologist notices the specimen to have a "mousy" odor. Of the following substances that may be excreted in urine, the one that most characteristically produces this odor is:
phenylpyruvic acid Phenylketonuria is a genetic disorder that results in a urine with a mousy odor. Acetone has a fruity odor. Bacteria can produce an ammonia odor. Porphyrin has no odor, but a characteristic red color.
48) Which of the following reagents is used to react with ketones in the urine?
sodium nitroprusside The only reagent listed is in a. The other answers are forms of ketones.
122) The presence of this element in urine indicates the presence of:
powder These are starch crystals, a contaminant from powder.
195) The finding of hemosiderin laden macrophage in a CSF sample indicates:
previous hemorrhage Hemosiderin is an indication that RBCs have been processed and degraded. The presence of hemosiderin, then, indicates bleeding, which limits the answers to c and d. The degradation of RBCs to hemosiderin takes time, so that a traumatic tap would not show hemosiderin, but a previous hemorrhage would.)
138) A patient has 2 separate urinalysis reports, which contain the following data: Which of the following statements best explains these results?
protein, glucose and microscopy of A are false negatives because of the specific gravity A specimen with a specific gravity of 1.004 is very dilute. This will result in the concentration of urine constituents being too low, below the ability to be detected by chemical and microscopic examination.
135) The following urine results were obtained on a 25-year-old female: pH: 7.0 color: yellow appearance: cloudy protein: 1+ glucose: negative blood: small specific gravity: 1.015 Microscopic findings: bacteria: many WBC casts: 0-3/lpf WBC/hpf: 30-40 These results are most compatible with:
pyelonephritis Pyelonephritis is an infection involving the renal tubules. Therefore, the presence of WBC casts and bacteria aids in the diagnosis. Cystitis is an infection of the bladder and does not affect the tubules. RBC casts are the prominent finding with glomerulonephritis.
76) The presence of leukocytes in the urine is known as:
pyuria The prefix py- means pus [leukocytes]. The suffix -uria means pertaining to urine.
38) The method of choice for performing a specific gravity measurement of urine following administration of x-ray contrast dyes is:
reagent strip The reagent strip is not affected by contrast dye. The refractometer reads the darker solution as density. A densitometer is a chemistry instrument, not a urinalysis instrument. A urinometer is not generally used in the modern lab.
serum sample showing elevated result when tested with the Jaffe reaction indicates?
renal function impairment
131) A 21 yr. old woman had glucose in her urine with a normal blood sugar. These findings are most consistent with:
renal glycosuria Glucose in the urine of a person with a normal blood glucose is indicative of renal tubule damage or the inherited disorder, renal glycosuria, in which transport receptors are absent in the proximal convoluted tubules.
161) Glycosuria may be due to:
renal tubular dysfunction The majority of the filtered glucose is reabsorbed by active transport in the proximal convoluted tubules [PCT]. Damage to the PCTs results in glycosuria and a normal plasma glucose.
101) Spherical urothelial cells may be confused with:
renal tubular epithelial cell Spherical urothelial cells appear similar to round tubular epithelial cells. The eccentric placement of the nucleus in renal tubular cells differentiates them from spherical urothelial cells, which have a centrally-placed nucleus.
103) In a specimen with a large amount of bilirubin, which of the following sediment constituents would be most noticeably bile-stained?
renal tubular epithelial cells The renal tubular cells lining the tubules absorb the urinary filtrate, and therefore will appear bile-stained.
77) Oval fat bodies are:
renal tubular epithelial cells that contain lipids Renal tubular epithelial cells lining the tubules absorb the urinary filtrate. In disorders producing fat in the filtrate, the fat is absorbed into the cells. When the cells slough from the tubules, they appear as oval fat bodies.
196) Which CSF results are most consistent with bacterial meningitis?
sample A Normal CSF glucose is approximately 60% of plasma glucose. Glucose is decreased in bacterial meningitis, and lactate is produced. Normal protein in CSF is 15-45 mg/dL. Protein is slightly elevated in bacterial meningitis.
166) To avoid falsely elevated spinal fluid cell counts:
select an aliquot from the last tube collected The lumbar tap may be traumatic, which will produce blood. Blood cells in the CSF will not be due to a central nervous system defect in that case. Do the cell count on the last tube; it is the least likely to be contaminated by a bloody tap.
The first step in the quantitation of serum iron is:
separation of iron from transferrin
36) Use of a refractometer over a urinometer is preferred due to the fact that the refractometer uses:
small volume of urine and compensates for temp Although few labs [if any] use a urinometer, all of them should have a refractometer. These use 1 drop of sample and compensate for temperature. A pitfall is that they are disproportionately affected by glucose and protein.
what electrolyte is the chief plasma cation whose main function is maintaining osmotic pressure?
sodium
31) To prepare a solution appropriate for quality control of the refractometer, a technician should use:
sodium chloride with a specific gravity of 1.022 An easy to make control for urinalysis is 6.5% NaCl. This has a specific gravity of 1.022, so c is correct. b is false, since the specific gravity of water is 1.000. d refers to osmolality, which is not measured by refractometry.
27) Urine osmolality is related to:
specific gravity Both osmolality and specific gravity measure solutes in a solution.
78) A microscopic exam of urine sediment reveals ghost cells. These RBCs are seen in urine with a:
specific gravity <1.007 Osmosis occurs through the red blood cell membrane. In dilute urine, the cells absorb water and swell, lyse, and release hemoglobin.
to ensure accurate ammonia level result, specimen must be?
spun, separated, iced, and tested immediately
80) What cell is most commonly associated with vaginal contamination?
squamous Squamous epithelial cells line the female vagina and urethra, but only the distal part of the male urethra. In females, they may also indicate perianal contamination.
85) Clue cells are a form of:
squamous epithelial cells Clue cells represent the attachment of the bacterium Gardnerella vaginalis to squamous epithelial cells. Gardnerella causes vaginal infections, and the cells lining the vagina are the squamous epithelial cells.
121) Which of the following contaminants has a dimpled center and will polarize?
starch Starch granules are very refractile and produce a Maltese cross under polarized light. Oil, air bubbles and pollen grains do not polarize.
Erroneous ammonia levels can be eliminated by all of the following except:
storing and protecting the specimen from light until the analysis is done
98) Granular casts found in the urine of a football player admitted to the hospital with a broken leg occurring during the game can be the result of:
strenuous exercise Formation of a cast matrix is not uncommon following strenuous exercise, due primarily to dehydration resulting in decrease urine flow. Increased metabolism by the renal tubular cells results in excess excretion of lysosomes that become attached to the cast matrix, resulting in the appearance of granular casts.
67) The confirmatory test for a positive protein result by the reagent strip method uses:
sulfosalicylic acid Sulfosalicylic acid will precipitate protein. Ehrlich reagent is for urobilinogen. Diazo is for bilirubin, and copper reduction is for reducing substances.
206) Methods used as screening tests for cystic fibrosis include:
sweat conductivity Sweat conductivity testing is relatively easy to perform, and used as a screening method. A positive should be confirmed with a chloride measurement by coulometry or by ion-selective electrode. Pilocarpine iontophoresis is used to stimulate sweat production, not to measure it.
150) An abdominal fluid is submitted from surgery. The physician wants to determine if this fluid could be urine. The technologist should:
test for urea and creatinine Urine is the only body fluid containing large amounts of the waste products urea and creatinine. These 2 constituents are used to determine if an unknown fluid is urine.
100) To distinguish between a clump of WBCs and a WBC cast it is important to observe:
the presence of a cast matrix White blood cells are often attached to the cast matrix as well as being imbedded in the matrix. White blood cells frequently occur in clumps and could can resemble a cast, but no cast matrix is observed. WBC casts indicate a more serious tubular infection, whereas WBC clumps can be seen in cystitis.
87) A patient admitted following an accident involving massive crush injuries has the following urinalysis results: color: red brown clarity: clear specific gravity: 1.011 pH: 6.0 protein: 1+ blood: large glucose: negative ketones: negative nitrite: negative leukocytes: negative bilirubin: negative urobilinogen: negative Microscopic findings renal tubular epithelial: 5-10 renal tubular cell casts: 1-2 The discrepancy between the large amount of blood and the absence of RBCs on microscopy is caused by:
the presence of myoglobin in the urine specimen Myoglobin is a product of muscle destruction as occurs with crush injuries. The reagent strip reaction for blood is positive with the presence of RBCs, hemoglobin, and myoglobin. Both hemoglobin and myoglobin are toxic to the renal tubules, resulting in decreased urine flow, favoring cast formation and the sloughing of the damaged cells. Notice also that the specimen is clear.
186) Amniocentesis should be performed to:
to confirm a high maternal serum alpha-fetoprotein (MSAFP) Amniocentesis is an invasive procedure, and should not be used as a screen. In women with a high MSAFP, amniocentesis is used to collect fluid to detect levels of AFP and acetylcholinesterase. High levels are predictive of neural tube disorders, such as spina bifida and anencephaly. Neural tube disorders are linked to a low folic acid level in the mother in early pregnancy. c is a distractor in that, while Rh- women may have an Rh+ fetus with hemolytic disease, Rh+ women do not have that complication.
Total Iron Binding Capacity (TIBC) measures the capacity of?
transferrin
191) A CSF was collected from a 5 yr. old with a fever and 3 tubes were transported to the lab. Tube 1 had 50,000 RBC/mL and 48 WBC/mL. Tube 3 had 10 RBC/mL and 0 WBC/mL. What is the most likely explanation for the discrepancy?
traumatic tap A traumatic tap is a collection of a body fluid that has blood contamination. The first tube will have most of the contamination, so that subsequent tubes will show fewer blood cells. Cell counts should routinely be performed on the last tube, to minimize the amount of cellular contamination due to the tap.
112) Which of the following crystals appear as fine, silky needles?
tyrosine Tyrosine crystals are fine needles often seen in clumps. Leucine crystals are spherical with concentric striations. Cholesterol crystals are flat plates with notched corners. Hemosiderin granules are dark, and often clumped.
113) Which of the following crystals is seen in an amber urine with a positive bilirubin?
tyrosine Urinary crystals associated with liver disorders include bilirubin, tyrosine, and leucine.
91) Hyaline casts are usually found:
under subdued light Hyaline casts have a low refractive index, and may not be visible under bright light. Urine microscopic analysis is first performed under reduced light, and the edges of the coverslip examined for the casts. Casts are larger than other sediment constituents and are pushed to the edges of the coverslip.)
108) After warming, a cloudy urine clears. This is due to the presence of:
urates Amorphous urates will dissolve when the specimen is briefly warmed. Amorphous phosphates are dissolved by the addition of acid, which will also destroy other sediment constituents.
118) Identify this crystal:
uric acid Uric acid has many shapes, is found in acid urine, and is nonpathologic. The reader should become familiar with the different shapes.
132) A 59-year-old man is evaluated for back pain. Urine studies (urinalysis by multiple reagent strip) include: Urinalysis: specific gravity: 1.017 pH: 6.5 protein: neg glucose: neg blood: neg Microscopic findings: rare epithelial cells Urine protein electrophoresis: monoclonal spike in gamma globulin region Which of the following statements best explains these results?
urine protein is falsely negative because the method is not sensitive for Bence Jones protein Reagent strip tests for protein are primarily sensitive to albumin. The monoclonal spike in the gamma region indicates the presence of Bence Jones protein that is an immunoglobulin rather than albumin.
23) The yellow color of urine is primarily due to:
urochrome pigment The only normal pigment/substance listed here is urochrome.
86) Which of the following cells is most likely to be seen in the urine sediment following a catheterization procedure?
urothelial cell Urothelial/transitional epithelial cells line the bladder, renal pelvis and ureters. These can be dislodged from the walls of the bladder during a catheterization procedure.
158) Bilirubinuria may be associated with:
viral hepatitis Bilirubin is a product of hemoglobin degradation. It occurs in both unconjugated and conjugated forms. Only conjugated bilirubin can pass through the glomerulus, because unconjugated bilirubin is bound to albumin. Conjugation of bilirubin takes place in the liver, and liver damage interferes with the continued degradation to urobilinogen.
58) Microscopic analysis of a urine specimen yields a moderate amount of RBCs in spite of a negative result for occult blood using a reagent strip. The technologist should determine if this patient has taken:
vitamin C Ascorbic acid inhibits reactions that use peroxidase.
149) Normal urine primarily consists of:
water, urea, and sodium chloride Normal plasma constituents that can be filtered by the glomerulus are water, urea and sodium chloride. Protein molecules are too large to normally pass the glomerulus. Bilirubin is not a normal constituent of plasma.
93) Which of the following casts is most indicative of end stage renal disease?
waxy Broad casts indicate extreme stasis of urine How through the nephron. Stasis allows casts to form in the larger collecting ducts. Damage to the walls of the distal convoluted tubules also causes broader casts to form.
99) Which of the following casts most frequently appears to have a brittle consistency?
waxy Waxy casts are seen with extreme stasis of urine flow, indicating they have remained in the tubules for an extended time. These aging casts are more retractile, and often contain notches and jagged edges as the result of granular disintegration.
79) Glitter cells are a microscopic finding of:
white blood cells in hypotonic urine White blood cells absorb water when they are in hypotonic [low specific gravity] urine, and swell. Granules in the WBCs then exhibit Brownian movement, producing the glittering effect in the cells.
