Complete BOC: ASCP prep

lupus erythematosus

1. Antinuclear antibody tests are performed to help diagnose?

86) The following data was obtained from a cellulose acetate protein electrophoresis scan: albumin area = 75 units gamma globulin area = 30 units total area = 180 units total protein = 6.4 g/dL (65 g/L) The gamma globulin content in g/dL is:

1.1 g/dL (11 g/L) Set up ratio of total area [18] to gamma globulin area [30] in units, and total protein content [6.5] to gamma globulin content [x] in g/dL. Solve for x

159) The following 5 sodium control values in unit were obtained: 140, 135, 138, 140, 142 Calculate the coefficient of variation:

1.9% (The mean = sum of values/number of values; standard deviation = square root of the sum of [observed values - mean] squared / number of samples; coefficient of variation = [standard deviation/mean]x100. Therefore[2.64/139]x100 = 1.9%.)

226) A blood smear shows 80 nucleated red cells per 100 leukocytes. The total leukocyte count is 18 x 10^3/mL (18 x 10^9/L). The true white cell count expressed in SI units is:

10.0 x 10^3/mL (10.0 x 10^9/L)

4) If a fasting glucose was 90 mg/dL, which of the following 2 hr. postprandial glucose result would most closely represent normal glucose metabolism?

100 mg/dL (5.5 mmol/L)

increase in IgM antibody; decrease in IgM antibody; increase in IgG antibody

107. The classic antibody response pattern following infection with hepatitis A is:

4) Which of the following clean catch urine culture colony counts indicates the patient likely has a urinary tract infection?

10^3 CFU/mL (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.)

73) In most compound light microscopes, the ocular lens has a magnification of:

10x

uses anti-HBs linked to horseradish peroxidase

113. The enzyme-linked immunosorbent assay (ELISA) technique for the detection of HBsAg:

HBeAg

114. The antigen marker most closely associated with transmissibility of HBV infection is:

continue to carry HBV

115. Chronic carriers of HBV:

IgM

117. The initial immune response following fetal infection with rubella is the production of which class(es) antibodies?

probable immunity to rubella

118. A maternal serum rubella titer that is equal to or greater than 1:8 indicates:

101) A patient has the following laboratory results: The mean corpuscular volume (MCV) of the patient is:

120 mm3 (120 fL)

FTA-ABS

120. Which of the following is a treponemal test?

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?

flocculation

122. Which laboratory technique is most frequently used to diagnose and follow the course of therapy of a patient with secondary syphilis?

streptolysin O

124. The most commonly used serological indicator of recent streptococcal infection is the antibody to:

can cross the placenta from mother to fetus

125. Antibodies composed of IgG immunoglobulin:

IgE

126. Measurement of serum levels of which of the following immmunoglobulins can serve as a screening test for multiple allergies?

B lymphocytes

127. Cells that are precursors of plasma cells and also produce immunoglobulins are:

164) Given the following values: 100, 120, 150, 140, 130 What is the mean?

128

IgG

129. To which of the following classes do the antibodies that cause hemolytic disease of the newborn belong?

225) If the total leukocyte count is 20.0 x 10^3/mL (20.0 x 10^9/L) and 50 NRBCs are seen per 100 leukocytes on the differential, what is the corrected leukocyte count?

13,333/mL (13.333 x 10^9/L)

IgG

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:

B cells

132. Antibodies are produced by:

116) What is the MCV if the hematocrit is 20%, the RBC is 1.5 x 10^6/mL (1.5 x 10^12/L) and the hemoglobin is 6 g/dL (60 g/L)?

133 pg

constant region of heavy chain

133. Antibody class and antibody subclass are determined by major physiochemical differences and antigenic variation found primary in the:

IgA

135. Which of the following immunoglobulin classes is assocated with a secretory component (transport peice)?

IgA

136. The immunoglobulin class typically found to be present in saliva, tears and other secretions is:

3

137. Treatment of IgG with papain results in how many fragments from each immunoglubulin molecule?

IgE

138. The immunoglubulin class associated with immediate hypersensitivity or atopic reactions is:

IgM

139. Which of the following immunoglubulins is the most efficient at agglutination?

lupus erythematosus

14. A patient has the following test results: ANA +, 1:320 ASO 50 Todd units Complement decreased RA + The results could be seen in patients with:

10) The mean value of a series of hemoglobin controls was found to be 15.2 g/dL, and the standard deviation was calculated at 0.20. Acceptable control range for the laboratory is +/- 2 standard deviations. Which of the following represents the allowable limits for the control?

14.8 - 15.6 g.dL

the sequence of the constant regions

142. The key structural difference that distinguishes immunoglubulin subclasses is the:

pentamer

146. The IgM molecule is a:

IgG

147. Which of the following immunoglubulin is present in the highest concentration in normal human serum?

IgA class exists as serum and secretory molecules

148. Which of the following statements about immunoglubulins is true?

155) A Kleihauer-Betke stain of a postpartum blood film revealed 0.3 fetal cells. What is the estimated volume of the fetomaternal hemorrhage expressed as whole blood:

15 (The formula to calculate the percentage assumes the mother's blood volume as 5,000 mL. 0.003 x 5,000 mL = l5 mL.)

variable regions of heavy and light chains

151. Antibody idiotype is dictated by the:

constant regions of heavy and light chains

152. Antibody allotype is determined by the:

IgG1

153. Which IgG subclass is most efficient at crossing the placenta?

IgA

154. The J-Chain is associated with which of the following immunoglubulin ?

opsonin

157. Macrophage phagocytosis of bacteria is enhanced by which of the following:

haptens

158. Which of the following is most likely to activate the alternate pathway of complement activation?

C3b

159. Which of the following is the larger residual split portion of C3?

nephelometry

16. Which of the following is the most sensitive and appropriate method for the detection of rheumatoid factor?

145) The normal renal threshold for glucose in the adult is approximately:

160 mg/dL

opsonization

160. Which of the following activities is associated with C3b

IgE

161. After a penicillin injection, a patient rapidly develops respiratory distress, vomiting and hives. This reaction is primarily mediated by:

C1q

162. Which of the following is the "recognition unit" in the classical complement pathway?

the antigen is electrophoresed and then monospecific antisera is reacted with it

163. In immunofixation electrophoresis:

C5b, C6, C7, C8, C9

164. Which of the following is the "membrane attack complex" of complement activation?

C3a

165. Which of the following releases histamines and other mediators from basophils?

quantitative serum IgM determination

168. A single, reliable screening test for detecting neonatal infection in the absense of clinical signs is:

monoclonal light chains

169. Bence jones protiens are:

gamma globulin-coated particles

17. Rheumatoid factor reacts with:

C5a

189. Potent chemotactic activity is associated with which of the following components of the complement system:

hyperglobulinemia

19. Positive rheumatoid factor is generally associated with:

decreased activity of C1 esterase inhibitor

190. Hereditary angiodema is characterized by:

a lifelong history of life threatening infections

191. Which of the following has been associated with patients who have homozygous C3 defficiency?

lupus erythematosus like syndrome

192. Hereditary deficiency of early complement components (C1, C4, C2) is associated with:

a systemic gonococcal infection if exposed

193. Hereditary deficiency of late complemtn components (C5, C6, C7, or C8) can be associated with which of the following conditions?

block H1 histamine receptors

199. Antihistamines like Benadryl:

166) A cholesterol QC chart has the following data for the normal control: The coefficient of variation for this control is:

2.19 % coefficient of variation [SD/mean]x100

129) A glucose determination was read on a spectrophotometer. The absorbance reading of the standard was 0.30. The absorbance reading of the unknown was 0.20. The value of the unknown is:

2/3 of the standard

132) The volume of 25% stock sufosalicylic acid needed to prepare 100mL of 5% working solutions is:

20 mL V1 x C1 = V2 x C2. [100] x [5] = [x] x [25]. Solve for x

181) How many mL of 0.25 N NaOH are needed to make 100 mL of a 0.05% solution of NaOH?

20 mL C1 x V1 = C2 x V2. [0.25]x[x]=[100]x[0.05] Solve for x

secretion of immunoglobulins

203. T cells are incapable of :s

Fc fragment of IgG

21. Rheumatoid factors are immunoglobulins with specificitiy for allotypic determinants located on the:

cytokines

210. Which of the following mediators is released during T-Cell activation?

allograft

212. Which of the following terms describes a graft between gentically unidentical individuals belonging to the same species?t

cytotoxic

216. T lymphocytes that possess the CD8 surface market mediate which of the following T-Cell functions?

contact sensitivity to inorganic chemicals

217. Delayed hypersensitivity may be induced by:

anaphylaxis

218. The most rapid immediate hypersensitivity reaction is associated with:

positive test for the detection of IgM class antibodies

22. Rheumatoid factor in patients serum may cause a false:

all mature T lymphocytes

220. An immunofluorescence test using reagent antibody directed against the CD3 surface marker would identify which of the following cell typesin a sample of human peripheral blood?:

scatter the light and emit fluorescence

224.) In flow cytometry , labeled cells:

is associated with a viral induced immunodefiency

225.) A marked decrease in CD4 lymphocytes and decrease in the CD4/CD8 ratio:

immunofluorescence

229.) What is the immonologic method utilized in the flow cytometer?:

autoantibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule

23. Rheumatoid factors are defined as:

60

230.) Given the following data: WBC: 5.0 X 10^3/ul lymphs: 15% Cd4: 8% Calculate the absolute CD4:

consistent with a viral infections such as HIV

231.) Given this hematologic data: WBC: 5.0 X 10^3/ul lymphs: 15% Cd4: 8% Which of the following is the correct interpretation?:r

T cells

236.) A patients 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:

23) If the seal is entered on a unit of RBCs stored at 1 C to 6 C, what is the maximum allowable storage period in hours?

24 (If the seal is broken during processing, components are considered to be prepared in an open system, rather than a dosed system. The expiration time for Red Blood Cells in an open system is 24 hours)

257) A drug has a half-life of 6 hrs. If a dose is given every 6 hrs., a steady state drug level would usually be achieved in:

24 - 42 hrs.

241) The screen for adrenal cortical hyperfunction with the greatest sensitivity and specificity is:

24-hour urine free cortisol

111) What is the MCHC if the Hct is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)?

25%

thyroid disease

27. High titers of antimicrosomal antibodies are most often found in:

43) A patient had the following serum results: Which osmolality is consistent with these results?

270

anti-smooth muscle

29. In chronic active hepatitis, high titers of which of the following antibodies are seen?

201) The dimensions of a hemacytometer are:

3 x 3 x 0.1 mm.

156) How many grams of sulfosalicylic acid (MW=254) are required to prepare 1 L of a 3% (w/v) solution?

30 (The concentration of a weight/unit volume solution is expressed as grams/100 mL. A 3% [w/v] solution contains 3 grams in 100 mL therefore 1 L contains 30 grams

112) What is the MCHC if the Hct is 20%, the RBC is 1.5 x 10^6/mL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)?

30%

nucleolar

31. Anti-RNA antibodies are often present in individuals having an anti-nuclear antibody immunoflurorescent pattern that is:

speckled

32. Anti-extractable nuclear antigens are most likely associated with which of the following anti-nuclear antibody immunofluorescent patterns?

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?

192) Which of the following wavelengths is within the ultraviolet range?

340 nm

288) 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:

366 x 10^3/mL (366 x 10^9/L)

157) An acid elution stain was made using a 1-hour post-delivery maternal blood sample. Out of 2,000 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 of the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances.

4 (Use the formula: [fetal cells counted/ cells counted] x [maternal blood volume]. Assume the mother's blood volume is 5,000 mL. In this example, 30 fetal cells/2,000 cells counted x 5,000 mL = 75 mL. RhIg protects against 30 mL. So 2.5 vials are needed, rounded up to 3 full vials. Add 1 vial for hospital policy and 4 vials are needed.)

155) A solution contains 20 g of solute dissolved in 0.5 L of water. What is the percentage of this solution?

4% (The concentration of a weight/unit volume solution is expressed as grams/100 mL. Therefore, 20 grams in 0.5 L = 4 grams in 100 mL = 4% solution.)

115) Cholesterol crystals will most likely be observed in urine that contains:

4+ protein

5°C +/- 2°

4. Sera to be tested for IFA-ANA 6 days after drawing is best stored at?

202) Rapid forward progression of sperm is rated as:

4.0

167) The sodium content (in grams) in 100 grams of NaCl is approximately: (atomic weights: Na=23, Cl=35.5)

40 (This is a ratio calculation. 100[g of NaCl] to 58.5 [g equivalent weight of NaCl] = 1.709. 23 [gram equivalent weight of Na] x 1.709 = grams of Na in 100g NaCl.)

109) What is the MCH if the Hct is 20%, the is 1.5 x 10^6/mL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)?

40 mm3 (40 fL)

goat anti-human immunoglobulin

41. In the indirect immunofluorescence method of antibody detection in patient serum, the labeled antibody is:

the reaction is reversible

42. Which of the following describes an antigen-antibody reaction?

fluorescein isothiocyanate

43. The most common label in direct fluorescent antibody technique (DFA) is:

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?

increase sensitivity of the antigen

47. Cholesterol is added to the antigen used in flocculation tests for syphilis to:

avidity

48. The strength of a visible reaction is known as:

precipitin lines cross, forming double spurs

49. Which of the following describes an antigen-antibody precipitation reaction of non-indentity?

139) The acceptable limit of error in the chemistry laboratory is 2 standard deviations. If you run the normal control 100 times, how many of the values would be out of the control range due to random error?

5

12) In the fasting state, the arterial and capillary blood glucose concentration varies from the venous glucose concentration by approximately how many mg/dL (mmol/L)

5 mg/dL (0.27 mmol/L)

rim

5. Antibodies directed at native DNA are most frequently associated with which pattern of fluorescence in the IFA-ANA test?

ELISA

50. Which test has the greatest sensitivity for antigen detection?

antigen excess

52. Soluble immune complexes are formed under the condition of:

176) Optimum growth of Campylobacter jejuni is obtained on suitable media incubated at 42 C in an atmosphere containing:

6% O2, 10%-15% CO2, 85%-90% nitrogen(Campylobacter is microaerophilic, and requires a decreased oxygen and increased carbon dioxide atmosphere for growth.)

222) If a WBC count is performed on a 1:100 dilution and the number of cells counted in eight squares is 50, the total WBC count is:

6,250/mL (6.25 x 10^9/L)

15) The glycated hemoglobin value represents the integrated values of glucose concentration during the preceding:

6-8 weeks

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:

280) Thrombocytosis would be indicated by a platelet count of:

600 x 10^3/mL (600 x 10^9/L)

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?

152) A clean catch urine sample from a nursing home patient is cultured using a .001mL 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?

67,000 CFU/mL Enterobacter cloacae(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 mL loop was used for culture. The biochemicals are characteristic of Enterobacter cloacae.)

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:

serological techniques

68. Which of the following is most useful in establishing a diagnosis in the convalescence phase of a viral infection?

antibody detection by EIA

69. The best method to detect infections due to rubella, epstein-barr, and human immunodefiency viruses is:

223) An automated leukocyte count is 22.5 x 10^9/mL (22.5 x 10^9/L). The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter?

7,500/mL (7.5 x 10^9/L)

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?

306) Normally the bicarbonate concentration 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:

7.40

antibody recognition of homologous antigen

70. Immunoassays are based on the principle of:

2) A sheep blood agar plate inoculated with 0.001 mL of urine grows 70 colonies of Staphylococcus aureus. How many colony forming units per mL of urine should be reported:

70000 (When 0.001 mL of urine is plated, the growth of one colony is equivalent to 1000 CPU/mL. Thus 70 colonies is 70,000 CPU/mL.)

active humoral-mediated immunity

71. A DPT vaccination is an example of:

neutrophils, eosinophils, and monocytes

72. Cells known to be actively phagocytic include:

early acute phase HBV hepatitis

73. The presence of HbsAg, anti-HBc and often HbeAg is characteristic of:

114) Given the following data: Hgb: 8 g/dL (80 g/L) Hct: 28% RBC: 3.6 x 10^6/uL (3.6 x 10^12/L) The MCV is:

77 mm3 (77 fL)

western blot

77. When testing a patient for HIV antibody, which of the following is used to confirm a positive screening test?

224) A total leukocyte count is 10.0 x 10^3/mL (10.0 x 10^9/L) and 25 NRBCs are seen per 100 leukocytes on the differential. What is the corrected leukocyte count?

8,000/mL (8.0 x 10^9/L)

high titers of DNA antibody

8. Systemic lupus erythematosus patients often have which of the following test results?

315) What is the proper pH for the buffered solution used to perform serum protein electrophoresis?

8.6

cardiolipin and lecithin

84. Flocculation tests for syphilis use antigen composed of:

haptens

87. Substances that are antigenic only when coupled to a protein carrier are:

RPR

89. A serological test for syphilis that depends upon the detection of cardiolipin-lecithin-cholesterol antigen is:

134) How many grams of sodium chloride are needed to prepare 1 L of 0.9% normal saline?

9.0 g 0.9% normal saline contains 0.9 grams NaCl in 100 mL solution. 0.9/100 = x/1,000 Solve for x to determine how much NaCl is needed to prepare 1 L [1,000 mL].

CSF-VDRL

91. The serological test for syphilis recommended for detecting antibody in Cerebrospinal fluid is:

anti-HBs

96. What assay would confirm the immune status of hepatitis B virus?

ELISA

97. The following procedure has been routinely used for detection of hepatitis B surface antigen (HBsAg) because of its high level of sensitivity:

1) Following overnight fasting, hypoglycemia in adults is defined as a glucose of:

<45mg/dL (<2.5mmol/L)

19) Which of the following hemoglobins has glucose-6-phosphate on the amino-terminal valine of the beta chain?

A1c

91) 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:

Abiotrophia defectiva(Nutritionally deficient streptococci such as Abiotrophia do not grow on sheep blood agar without the addition of cysteine or proximity to S aureus colonies.)

153) The atypical lymphocyte seen in the peripheral smear of patients with infectious mono is probably derived from which of the following:

B lymphs

41) Lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have?

B12 deficiency

187) A sweat chloride >60 mEq/L (60 mmol/L) is indicative of:

Cystic fibrosis

338) The most widely used methods for bilirubin measurement are those based on the:

Jendrassik-Grof method

270) Cells involved in hemostasis are:

Thrombocytes [platelets]

66) The erythrocyte sedimentation rate can be falsely elevated by:

Tilting of tube accelerates fall of RBC

118) Identify this crystal:

Uric acid

193) Appropriate culture requirements for a specimen from a patient suspected of having tularemia include:

a media with cysteine such as BYCA(Francisella tularensis is the causative agent of tularemia. It has a specific growth requirement for cysteine.)

230) 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 that the evening sample. This is consistent with:

a normal finding

310) Prothrombin is:

a protein formed by the liver in the presence of Vitamin K

32) Evidence indicates that the genetic defect in thalassemia usually results in:

a quantitative deficiency in RNA resulting in decreased globin chain production

326) Blood PCO2 may be measured by:

a self-contained potentiometric electrode

175) A 1 molal solution is equivalent to:

a solution containing 1 mole of solute per kg of solvent (Molality is number of moles of solute per 1 kg of solvent.)

60) The optimal wound specimen for cultures of anaerobic organisms should be:

a syringe filled with pus, obtained before administration of antibiotics (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.)

167) 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 which media?

a urea broth(Helicobacter pylori produces large amounts of extracellular urease and is positive for urea within 2 hours.)

24) Optimum storage for Cryo AHF is:

a-20 C (Cryoprecipitated AHF is stored at -18C or lower.)

227) A mean cell hemoglobin concentration over 36 g/dL is frequently found in :

a. hereditary spherocytosis b. lipemia c. active cold agglutinin disease (An elevation in the MCHC occurs in approximately 50% of individuals with hereditary spherocytosis. Elevation in the MCHC above the upper normal limit should prompt an investigation of the sample for autoantibodies that agglutinate RBC, or on older instruments when the hemoglobin concentration is artifactually elevated by lipemia.)

7) Cerebrospinal fluid for glucose assay should be:

analyzed immediately

154) Cessation of urine flow is defined as:

anuria

186) Package inserts may be used:

as a reference in a procedure

5) Which curve represents the production of alpha polypeptide chains of hemoglobin?

b (Development time line of production of Hgb alpha chains)

265) How many units of RBCs are required to raise the hematocrit of a 70 kg nonbleeding man from 24% to 30% a. 1 b. 2 c. 3 d. 4

b (Each unit of RBCs is expected to increase the hematocrit level by 3%-5%, so it would take 2 units to raise the level 6%.)

264) A 42 year old male of average body mass has a history of chronic anemia requiring transfusion support. 2 units of RBCs are transfused. If the pretransfusion hemoglobin was 7.0 g/dL, the expected posttransfusion 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)

b (Each unit of RBCs is expected to increase the hemoglobin level by 1-1.5 g/dL [10-15 g/L].)

54) To qualify as a donor for autologous transfusion a patient's hemoglobin should be at least:

b11 g/dL (110 g/L) (Autologous donors have less stringent criteria than allogeneic donors. Donations must be collected at least 72 hours prior to surgery.)

49) A unit of Whole Blood-derived (random donor) Platelets should contain at least:

b5.5 x 10^10 platelets (Whole blood-derived [random donor] Platelets should contain at least 5.5 x 10^10 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

201) A 29 year old male is hemorrhaging severely. He is AB, Rh-neg. 6 units of blood are required STAT. Of the following types available in the blood bank, which would be most preferable for crossmatch?

bA, Rh-neg (When group specific units of Red Blood Cells are not available, group compatible units are selected. Since the patient is AB, group A would be selected to conserve group O units for group O patients. Rh-negative patients should receive Rh-negative units of red blood cells.)

42) A blood component prepared by thawing FFP at refrigerator temp and removing the fluid portion is:

bCryo AHF (Cryoprecipitate is the fraction of plasma proteins that precipitate when FFP is slowly thawed at 1-6 C.)

382) A patient is suspected of having amebic dysentery. Upon microscopic examination of a fresh fecal specimen for ova and parasites, the following data were obtained: - a trophozoite of 25 mm - progressive, unidirectional crawl - evenly distributed peripheral chromatin - finely granular cytoplasm This information probably indicates:

bEntamoeba histolytica (The trophozoite of Entamoeba histolytica ranges in size from 12 - 60 mm, 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.)

38) Which of the following blood components must be prepared within 8 hrs. after phlebotomy:

bFFP (Fresh Frozen Plasma [FFP] must be separated and frozen within 8 hours of Whole Blood collection.)

19) Which of the following is the correct storage temp for the component listed:

bFFP = -20 C (Fresh Frozen Plasma is stored at -18 C or below for 12 months.)

234) The large cell in the center of the image would be best described as a(n):

basophil

99) This symbol represents a:

biohazard

262) After checking the inventory, it was noted that there were no units on the shelf marked "May Issue Uncrossmatched: For Emergency Only" Which of the following should be place on this shelf? a. 1 unit of each of the ABO blood groups b. units of group O, Rh-pos Whole Blood c. units of group O, Rh-neg RBC's d. any units that are expiring at midnight

c (For emergency transfusions, group O- RBC units should be used.)

29) Cryo AHF, if maintained in the frozen state at -18 C or below, has a shelf life of:

c12 months (Cryoprecipitate has a shelf life of 12 months in the frozen state.)

50) Platelets prepared by apheresis should contain at least:

c3 x 10^11 platelets (Apheresis [single donor] Platelets should contain at least 3.0 x 10^11 platelets, be stored with continuous agitation at 20-24 C, and have a pH of 6.2 or higher when tested at the end of the storage period.)

178) Mixed field agglutination encountered in ABO grouping with no history of transfusion would most likely be due to:

cA3 red cells (Mixed-field reactivity is a characteristic of the A3 subgroup. Transfusion history would be important to be sure it is not 2 cell populations.)

75) Which of the following red cell typings are most commonly found in the African Americans:

cFy(a-b-) (the Fy[a-b-] phenotype occurs in 68% of the population of African descent, but is extremely rare in the other ethnic backgrounds. Lu[a-b-], Jk[a-b-] and K-k- are very rare in all ethnic backgrounds.)

112) Proteolytic enzyme treatment of red cells usually destroys which antigen?

cFya (The Fya and Fyb antigens are sensitive to denaturation by proteolytic enzymes. Serum containing anti-Fya reacts with untreated Fy[a+] cells, but not with enzyme treated Fy[a+] cells.)

306) Posttransfusion anaphylactic reactions occur most often in patients with:

cIgA deficiency (Anaphylactic transfusion reactions are attributed to anti-IgA in IgA- deficient recipients.)

87) Human blood groups were discovered around 1900 by:

cKarl Landsteiner (The ABO blood group system was discovered by Karl Landsteiner.)

89) The enzyme responsible for conferring H activity on the red cell membrane is alpha_:

cL-fucosyl transferase (Fucose is the immunodominant sugar for H.)

104) Paroxysmal cold hemoglobinuria is associated with antibody specificity toward which of the following:

cP antigen (Autoanti-P, a cold-reactive IgG autoantibody described as a biphasic hemolysin, is associated with paroxysmal cold hemoglobinuria.)

337) Before unconjugated bilirubin can react with Ehrlich diazo reagent, which of the following must be added?

caffeine

91) Hematology standards include:

certified cyanmethemoglobin solution

53) The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and:

chloride

322) Coulometry is often used to measure:

chloride in sweat

88) What is the most likely diagnosis given this microscopic finding?

cystitis

293) During initial investigation of a suspected hemolytic transfusion reaction, it was observed that the posttransfusion serum was yellow in color and the DAT was negative. Repeat ABO typing on the posttransfusion sample confirmed the pretransfusion results. What is the next step in this investigation? a. repeat compatibility testing on suspected units b. perform plasma hemoglobin and haptoglobin determinations c. use enhancement media to repeat the antibody screen d. no further serological testing is necessary

d (The immediate steps required to investigate a transfusion reaction include a clerical check of records and labels, visual inspection of postreaction plasma for hemolysis, and direct antiglobulin test and repeat ABO typing on the postreaction sample. Additional investigation is performed when there is evidence of hemolysis, bacterial contamination, TRALI, or other serious adverse event.)

254) The serum of a group O, Cde/Cde donor contains anti-D. In order to prepare a suitable anti-D reagent from this donor's serum, which of the following cells would be suitable for the adsorption? a. group O. Cde/Cde b. group O, Cde/cde c. group A2B, CDe/cde d. groupA1B, cde/cde

d (The serum of a group O individual contains anti-A, anti-B and anti-A,B. To prepare a suitable reagent, the ABO antibodies must be removed and anti-D left in the serum. The serum would need to be adsorbed with cells of the A1R cde/ cde phenotype.)

17) 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:

d 35 days (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)

27) Optimum storage temperature for platelets:

d22 C (The required temperature for storage of platelets is 20-24 C.)

30) Once thawed, FFP must be transfused within:

d24 hrs. (Once thawed, FFP is stored at 1-6C for up to 24 hours.)

22) Optimum storage temperature for RBCs:

d4 C (Red Blood Cells are stored at 1-6C.)

165) The optimal incubator temp. for isolation of Campylobacter jejuni/coli group is:

d42 C (Campylobacter jejuni/coli grow better at 42 C than 37 C and other organisms in the colon are inhibited at this high temperature)

26) 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:

d5 days (Whole Blood-derived platelets are stored at 20-24 C with continuous gentle agitation. Platelets prepared by the PRP method may be stored for up to 5 days.)

281) Lab workers should always work under a biological safety hood when working with cultures of:

dCoccidioides immitis (The arthroconidia of Coccidioides immitis are highly infectious; cultures must be handled with care to minimize aerosols.)

114) Resistance to malaria is best associated with which of the following blood groups:

dDuffy (The Duffy glycoprotein on red cells is a receptor for the malarial parasite Plasmodium vivax. Red cells with the phenotype Fy[a-b-] are resistant to invasion by P vivax.)

129) Which of the following antigens in most likely to be involved in HDFN.

dKell (HDFN is caused by maternal IgG antibodies. Outside the Rh system, the most clinically significant antibody for HDFN is anti-K. IgM antibodies do not cross the placenta.)

371) A cell culture line used for the recovery of Chlamydia trachomatis from clinical specimens is:

dMcCoy (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.)

399) Organisms that can be easily identified to the species level from the ova in fecal specimens include:

dParagonimus westermani, Hymenolepis nana (Of the organisms listed, only Paragonimus and Hymenolepis can be identified to the species level by the appearance of their ova in stool.)

126) An obstetrical patient has had 3 previous pregnancies. her 1st baby was healthy, the 2nd was jaundiced at birth and required and exchange transfusion, while the 3rd was stillborn. Which of the following is the most likely cause:

dRh incompatibility (HDFN is caused by maternal antibody crossing the placenta and destroying fetal antigen-positive red cells. Unlike ABO antibodies, which are naturally-occurring and can affect the first pregnancy, Rh antibodies are not produced until the mother has been exposed to Rh-positive red cells, usually during delivery of the first Rh-positive child Once immunized, subsequent pregnancies with Rh-positive infants are affected, usually with increasing severity.)

53) This symbol indicates which of the following hazards?

flammable

181) The chromogen for the fecal occult blood test is:

gum guaiac

155) The most specific enzyme test for acute pancreatitis is:

lipase

24) Red urine may be due to:

myoglobin

119) The Prussian blue staining of peripheral blood identifies:

siderotic granules

323) In a pH meter reference electrodes may include:

silver-silver chloride

91) Hyaline casts are usually found:

under subdued light

24) Blood samples were collected at the beginning of an exercise class and after thirty mins. of aerobic activity. Which of the following would be most consistent with the post exercise sample?

elevated lactic acid, elevated pyruvate

60) Sodium determination by indirect ion selective electrode is falsely decreased by:

elevated lipid levels

75) The advantage to using phase microscopy in urinalysis is to :

enhance constituents with a low refractive index

109) Children who have infections with beta-hemolytic streptococci can develop:

acute glomerulonephritis (Noninfectious sequelae associated with infection with Streptococcus pyogenes are glomerulonephritis and rheumatic fever.)

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

193) The most common form of childhood leukemia:

acute lymphocytic ( ALL as most common malignancy of children.)

192) A 50-year-old woman who has been receiving busulfan for three years for chronic myelogenous leukemia becomes anemic. Laboratory tests reveal: - Thrombocytopenia - Many peroxidase-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?

acute lymphocytic leukemia (Recognizes ALL as possible progression for 1/3 of CML cases.)

150) Auer rods are most likely present in which of the following?

acute myelocytic leukemia

170) 50% - 90% myeloblasts in a peripheral blood smear is typical of which of the following?

acute myelocytic leukemia (>20% of myeloblasts w/o immature stages differentiates AML from CML and myeloid metaplasia; erythroleukemia requires at least 50% erythroid precursors in marrow.)

177) A block in the differentiation or maturation of, and an accretion of immature hematopoietic progenitors is a hallmark of:

acute myelogenous leukemia (Acute leukemia is characterized by a maturation defect, whereby immature hematopoietic progenitors cannot overcome a block in differentiation, also known as the leukemic hiatus.)

163) The greatest activities of serum AST and ALT are seen in which of the following?

acute viral hepatitis

352) Colds and other acute respiratory diseases are most often associated with:

adenovirus (Adenovirus infections are common. It causes up to 5% of all respiratory infections, and the prevalence of infection is higher [up to 14%].)

217) Which characteristics are true of all 3 of the following antibodies: anti-Fya, anti-Jka and anti-K?

adetected at IAT phase and may cause HDFN and transfusion reactions (All 3 antibodies can cause HDFN and delayed transfusion reactions. Anti-Jka is associated with showing dosage.)

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

163) HLA antigen typing is important in screening for:

kidney donor (HLA antigen typing is important to consider before organ transplantation.)

52) Which of the following media can be used to culture Campylobacter jejuni?

kirrow medium (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.)

74) An example of personal protective equipment is:

lab coat

141) Blood selected for exchange transfusion must:

lack RBC antigens corresponding to maternal antibodies(Blood selected for exchange transfusion should be antigen-negative and ABO compatible with the mother and baby. Red Blood Cells are usually less than 7 days old, CMV-, hemoglobin S-, and irradiated.)

51) Serum anion gap is increased in patients with:

lactic acidosis

213) Which of the following is the most reliable test to differentiate Neisseria lactamica from Neisseria meningitidis?

lactose degradation(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.)

152) Which of the following components are present in serum but not present in the glomerular filtrate?

large molecular weight proteins

121) 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?

latex antigen typing(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.)

174) The absence of intermediate maturing cells between the blast and mature neutrophil commonly seen in acute myelocytic leukemia and myelodysplastic syndrome is called:

leukemic hiatus

127) Bacteria are considered significant in the urine sediment when the:

leukocytes is positive

135) Elevation of the total white cell count above 12 x 10^3 is termed:

leukocytosis

129) A term that means varying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is:

leukoerythroblastosis

97) Which pattern is consistent with beta-thalassemia major?

pattern C (In beta-thalassemia major, reduced synthesis of beta chains affects the production of Hgb A. Hgb A2 and Hgb F are increased and Hgb A decreased.

B lymphocytes

172. Humoral antibodies are produced by which cells?

186) Amniocentesis should be performed to:

to confirm a high maternal serum alpha-fetoprotein

55) A 2 yr. old child had a positive urine ketone. This would most likely be caused by:

vomiting

90) What is the most likely mode of transmission for bloodborne pathogens in laboratory acquired infections?

parenteral inoculation of blood.

70) A low concentration of serum phosphorus is commonly found in:

patients who are receiving carbohydrate hyperalimentation

strength of a reacting antibody

45. Avidity may be defined as the:

149) Normal urine primarily consists of:

water, urea and sodium chloride

useful in screening for syphilis

81. The rapid plasma reagin test:

227) Which of the following steroids is an adrenal cortical hormone?

Aldosterone

254) Cancer antigen 125 is a tumor marker associated with:

CA 125 is elevated in 80% of epithelial cell ovarian cancer

123) Identify the formed element in this photomicrograph:

Cloth fiber

128) Which of the following exhibits rapid motility in urine sediment?

Trichomonas vaginalis

23) CLIA was established to provide oversight to:

any lab performing patient testing

223) In the proper use of cobalt treated-anhydrous CaCl2, the desiccant should be:

changed when it turns pink

44) Urine reagent strips should be stored in a

cool dry area

141) Phagocytosis is a function of:

granulocytes

211) TSH is produced by the:

pituitary gland

163) Which of the following is the formula for arithmetic mean?

sum of values/number of values

68) Which of the following is the formula for absolute cell count?

% cells counted x total count

156) 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.

% of fetal cell present x 50 (The percentage of fetal cells/100, the mother's volume is assumed to be 5,000 mL. The percentage must be multiplied by 50 to determine total volume.)

113) Which of the following is the formula for MCV?

(Hct x 10) / RBC

107) Which of the following is the formula for MCH?

(Hgb x 10) / RBC

110) Which of the following is the formula for MCHC?

(Hgb x 100) / Hct

220) Which of the following is the formula for manual white cell count?

(number of cells counted x dilution x 10)/number of squares counted

6) The expected colony count in a suprapubic urine from a healthy individual is:

0 CFU/mL(Urine in the bladder is normally sterile. Suprapubic aspiration removes urine directly from the bladder and yields a specimen free of urethral contamination.)

209) An antibody identification study is performed with the 5-cell panel shown below: An antibody against which of the following antigens could not be excluded?

1 (Antibodies to antigens on cells 2, 3, 4, and 5 can be ruled out in tubes II and III, in which there was no reaction between patient serum and cells.)

6) Below are the results of the history obtained from a prospective female blood donor: - age: 16 - temperature: 99.0F (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?

1 (The Hct must be >38%. A donor may be 16 unless state law differs. Temperature must not exceed 99.5F/37.5C, blood pressure must be <180 mmHg systolic and <100 mmHg diastolic, pulse 50-100 unless an athlete [which can be lower]. Toxoids and vaccines from synthetic or killed sources have no deferral.)

40) The HMIS or NFPA 704 hazardous material identification system rating for a slightly toxic chemical would be:

1 in the blue quadrant.

131) How many mL of red blood cells are to be used to make 25 mL of a 4% red cell suspension?

1 mL V1 x C1 = V2 x C2. 4% red cell suspension contains 4 mL of red cells per 100 mL [1 dL] of solution. Therefore, [25] x [4] = [100] x [X]. Solve for x.

221) 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:

1,500/mL (1.5 x 10^9/L)

143) A serum glucose sample was too high to read, so a 1:5 dilution using saline was made (dilution A). Dilution A was tested and was again too high to read. A further 1:2 dilution was made using saline (dilution B). To calculate the result, the dilution B value must be multiplied by:

10 (To correct for having used a dilution, multiply the answer obtained times the reciprocal of the dilution made.)

266) Normal platelets have a circulating life-span of approximately:

10 days

292) A 45 yr. old male of average height and weight was admitted to the hospital for renal function studies. He had the following lab results: urine creatinine = 120 mg/dL serum creatinine = 1.5 mg/dL total volume = 1800/mL Calculate the creatinine clearance for this patient in mL/min:

100 Creatinine clearance = [urine creatinine x urine volume [mL/min]/serum creatinine] x 1.73 / total body surface.

98) Which electrophoresis pattern is consistent with sickle cell trait?

pattern A (Electrophoretic pattern for sickle cell trait on cellulose acetate.)

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?

lupus erythematosus

102. Biological false-positive VDRL reactions are frequently encountered in patients with:

anti-HBs

103. Which serological marker of HBV infection indicates recovery and immunity?

291) The following results were obtained: urine creatinine = 90 mg/dL serum creatinine = 0.90 mg/dL total body surface = 1.73 m total urine in 24 hrs. = 1500 mL Given the above data, the patient's creatinine clearance in mL/min is:

104 Creatinine clearance = [urine creatinine x urine volume [mL/min]/serum creatinine] x 1.73 / total body surface.

38) The method of choice for performing a specific gravity measurement of urine following administration of x-ray contrast dyes is:

reagent strip

FTA-ABS

105. For diagnosis of late latent or tertiary syphilis, the most appropriate assay is:

77) Oval fat bodies are:

renal tubular epithelial cells that contain lipids

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?

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

48) Which of the following reagents is used to react with ketones in the urine?

sodium nitroprusside

their efficient ability to fix complement

128. IgM antibodes are frequently hemolytic because of:

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:

antigen-antibody complexes containing IgA or IgE may initiate activation

173. Initiation of the activation mechanism of the alternative complement pathway differes from that of the classical pathway in that:

C4

174. Which of the following is cleaved as a result of activation of the classical complement pathway?

properdin factor B

175. The component associated only with the alternative pathway of complement activation is?

strong evidence against untreated SLE

18. A consistently and repeatedly negative IFA-ANA is:

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: leukocyte count: 4.7 x 10^3/uL (5.0-10.0 x 10^3/uL) differential: normal serum hemolytic complement: <22 U (80-150 U) ANA: positive in a homgenous pattern rheumatoid factor test: negative urinaysis: protein 1+, occasional RBC's The patient's results are consistent with:

immediate hypersensitivity

198. Which immunologic mechanism is usually involved in bronchial asthma?

152) A colorimetric method calls for the use of 0.1 mL of serum, 5 mL of reagent and 4.9 mL of water. What is the dilution of the serum in the final solution?

1:100 (Simple dilutions are ratios of 2 volumes, which involve a single substance diluted with one other substance. 0.1 mL solution A is added to 9.9 mL solution B [ratio 0.1/9.9], for a total volume of 10 mL. This represents a dilution of 0.1/10. To convert a 0.1/10 dilution to a 1-in-something dilution set up a ratio proportion calculation: 0.1 is to 10 as 1 is to x 0.1/10=1/x solve for x

147) If 0.5 mL of a 1:300 dilution contains 1 antigenic unit, 2 antigenic units would be contained in 0.5 mL of a dilution of:

1:150 This is a ratio calculation. 1:300 dilution equals 1 antigenic unit in 0.5mL. Therefore 2 antigenic units in 0.5mL equals a 1:150 dilution

153) 4 mL of water are added to 1 mL of serum. This represents which of the following serum dilutions?

1:5 (Simple dilutions are ratios of 2 volumes, which involve a single substance diluted with one other substance. 1 mL solution A is added to 4 mL solution B [ratio 1/4], for a total volume of 5 mL. This represents dilution of 1/5

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

141) When 0.25 mL is diluted to 20 mL, the resulting dilutions is:

1:80 0.25 mL sol. A is added to 19.75 mL sol. B [ratio 0.25/19.75], for total volume of 20 mL. This represents dil of 0.25/20. To convert 0.25/20 dilution to 1-in-something dilution, set up a ratio" proportion calculation: 0.25 is to 20 as 1 is to x solve for x

172) 80 grams of NaOH (MW=40) are how many moles?

2 Moles=gm/molecular weight

150) The results of a Kleihauer-Butke stain indicate a fetomaternal hemorrhage of 35 mL of WHOLE BLOOD. How many vials of Rh immune globulin would be required.

2 (One dose of RhIg will protect the mother from a bleed of 30 mL. The bleed was 35 mL, 2 vials of RhIg will be needed)

122) How many hrs. after eating contaminated food do initial symptoms of staphylococcal food poisoning typically occur?

2 - 6 hrs. (Staphylococcus aureus produces an enterotoxin that is associated with food poisoning. Symptoms typically appear within 2 - 6 hours.)

297) Which of the following is the formula for calculating absorbance given the percent transmittance of a solution?

2 - log(%T) (Because the following relationship is true, A = light stopped and T - light passed through, A and T are inversely related. They are also logarithmically related, because the absorption of light is a logarithmic function.)

157) How many mL of a 3% solution can be made if 6 grams of solute are available?

200mL (This is a ratio calculation. 3/100 = 6/x. Solve for x.)

218) What is the absolute lymphocyte count?

2,550/mL (2.55 x 10^9/L) (Calculation of absolute from relative % and WBC.)

219) A centrifuge head has a diameter of 60 cm and spins at 3,000 RPMs. What is the maximum achievable G force. G = 0.00001 x radius in cm x RPM squared

2,700 G To determine the g factor use 0.0001 x 30 cm x [3,000]^2 Rem radius is 1/2 diameter

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:

8) Which of the following 2 hr. postprandial glucose values demonstrates unequivocal hyperglycemia diagnostic for diabetes mellitus?

200 mg/dL (11.0 mmol/L)

IgE is in too low a concentration to be detected by this method

201. A child has sever hay fever. A total IgE measurement was performed by Ouchterlony immunodiffusion method. No lines of precipitation appeared on the immunodiffusion plate. The most lkely explanation is:

skin test for commonly encountered antigens

202. Which test is used to evluate the cellular immune system in a patient?

phagocytic cells

204. T lymphocytes are incapable of functioning as :

natural killer cells

205. Nonspecific killing of tumor cells is carried out by:

immunoassays

206. Tumor markers found in the circulation are most frequently measured by:

increased bacterial infections

207. A patient with B-Cell deficiency will most likely exhibit:

increased parasitic infections

208. A patient with a T-cell deficiency will mostly likely exhibit:

neutrophil

209. Which of the following is an important cellular mediator of immune complex tissue injury?

31) At blood pH 7.40, what is the ratio of bicarbonate to carbonic acid?

20:1

108) What is the MCH if the Hct is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)?

21 mm3 (21 fL)

151) A fetal maternal hemorrhage of 35 mL of fetal Rh-pos PACKED RBCs has been detected in an Rh-neg woman. How many vials of Rh immune globulin should be given

3 (One vial of Rh immune globulin protects against a fetomaternal hemorrhage of 15 mL of red cells, or 30 mL of Whole Blood. Divide the volume of fetomaternal hemorrhage [35 mL] by 15; round down to 2, then add 1 extra vial = 3 vials total.)

127) An automated CK assay gives a reading that is above the limits of linearity. A dilution of the serum sample is made by adding 1 mL of serum to 9 mL of water. The instrument now reads 350 U/L. The correct report on the undiluted serum should be:

3,500 U/L

62) Which percentage of total serum calcium is nondiffusible protein bound?

40% - 50%

173) A serum potassium (MW = 39) is 19.5 mg / 100mL. This value is equal to how many mEq/L?

5.0 equation: mg/dL x 10 = 10 mg/L. mg/mEq weight is millimolar weight in mg/valence mg/ L / mg/ mEq = mEq/L

71) The mean value of a reticulocyte count on a specimen of cord blood from a healthy, full term newborns is approximately:

5.0 %

13) The following data was calculated on a series of 30 determinations of serum uric acid control: mean=5.8 mg/dL, 1 standard deviation = 0.15 mg/dL. If the confidence limits are set at =-2 standard deviations, which of the following represents the allowable limits for the control?

5.50 - 6.10 mg/dL

5) 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:

50 mg/dL (2.3 mmol/L)

dissolve the precipitate after formation

51. Excess antigen in precipitation gel reactions will:

219) What is the absolute eosinophil count?

510/mL (0.51 x 10^9/L) (Calculation of absolute eosinophil count.)

290) A 24 hr. urine specimen (total volume = 1,136 mL) is submitted to the lab for quantitative urine protein. Calculate the amount of protein excreted per day, if the total protein is 52 mg/dL

52 mg/dL = 0.52 mg/mL. 0.52 mg/mL x 1136 mL = 591 mg.

precipitation

53. The visible serological reaction between soluble antigen and its specific antibody is:

prozoning

65. The following pattern of aggultination was observed in an antibody titration, 1+, 2+, 4+, 4+, 3+, 3+, 2+, 1+, 1+, 0, 0. This set of reactions most likely resulted from:

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:

precipitation

80. What kind of antigen-antibody reaction would be expected if soluble antigen is added to homologous antibody?

reagin antibody

82. Flocculation tests for syphilis detect the presence of:

115) What is the MCV if the hematocrit is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the hemoglobin is 5 g/dL (50 g/L)?

83 pg

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:

reheated to 56 degrees 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:

140) A mean value of 100 and a standard deviation of 1.8 mg/dL were obtained from a set of glucose measurements on a control solution. The 95% confidence interval in mg/dL would be:

96.4 - 103.6

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:

67) Examine the broth microdilution susceptibility test shown above and determine the MIC for gentamicin.

<2 mg/mL (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].)

137) Which unit should be selected for exchange transfusion if the newborn is group A, Rh pos. and the mother is Group A, Rh pos. with anti-c?

A, CDe/CDe (Blood for an exchange transfusion should lack the antigen to any maternal antibodies that have entered the infant's circulation and are reactive at 37 C or AHG.)

132) A group A, Rh positive infant of a group O, Rh positive mother has a weakly positive DAT and moderately elevated bilirubin 12 hours after birth. the most likely cause is:

ABO incompatibility (ABO HDFN occurs most commonly in group A babies born to group O mothers and usually has a mild course. The DAT is typically weak or negative and jaundice develops 12-48 hours after birth. The mother and baby are both Rh-positive.)

316) 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:

AFB grow more rapidly in liquid media (Liquid medium is recommended to provide more rapid recovery of AFB than solid medium. Isolation rates of mycobacteria is also higher with liquid medium.)

212) Tumor markers that can be measured on body fluids include all except:

ANA

22) The process by which an agency or organization uses predetermined standards to evaluate and recognize a program of study in an institution is called:

Accreditation is the approval of an institution or program based on a review by one or more independent examiners that specific requirements or predetermined standards are met.

185) Which of the following parameters of a diagnostic test will vary with the prevalence of a given disease in a population?

Accuracy

17) The extent to which measurements agree with the true value of the quantity being measured is known as:

Accuracy or trueness is the closeness of agreement with the true value

187) 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:

Aeromonas hydrophila(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.)

220) A 68 yr. 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 lab reports a value of 8.7 uU/mL (reference range = 0.5-5.0 uU/mL) this patient most likely has:

Age, sex, physical complaint, with elevated TSH point to primary hypothyroidism.

330) Bromcresol purple at a pH of 5.2 is used in a colorimetric method to measure:

Albumin

210) Of the following, the disease most closely associated with mucopolysaccharidosis is:

Alder-Reilly

349) Which of the following is a glycolytic enzyme that catalyzes the cleavage of fructose-1, 6-diphosphate to glyceraldehyde-3-phosphate and dihydroxyacetone phosphate?

Aldolase

105) A white precipitate in a urine specimen with a pH of 7.5 would most probably be caused by:

Amorphous phosphates

246) Aldosterone is released by the adrenal cortex upon stimulation by:

Angiotensin II

269) Platelet activity is affected by:

Aspirin

336) Which of the following calcium procedures utilizes lanthanum chloride to eliminate interfering substances?

Atomic absorption spectrophotometry [AAS]

86) A patient is typed with the following results: The most probable reason for these findings is that the patient is group:

Ax; with an anti-A1 (Ax cells are more strongly reactive with anti-A,B than with anti-A and the plasma frequently has anti-Al present.)

341) In the Jendrassik-Grof reaction for total bilirubin, bilirubin reacts with diazotized sulfanilic acid to form:

Azobilirubin

121) Which of the following is an example of a peptide bond?

B

370) Which area in the automated cell counter histogram indicates the lymphocyte curve?

B

176) Which of the following patient data best reflects the discrepancy seen when a person's red cells demonstrate the acquired-B phenotype?

B (Acquired B occurs in group A individuals and is due to deacetylation of the A antigen by bacterial enzymes. Detection of acquired B is dependent upon the source of anti-B used.)

78) 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?

B35 (From the first 2 children it can be determined the mom has the haplotypes A2B12 and A23F18. The dad has the haplotypes Al B3 and A3B35. The expected B antigen in child #3 is B35.)

48) What battery of tests is most useful in evaluating an anion gap of 22 mEq/L (22 mmol/L)?

BUN, creatinine, salicylate and methanol

226) 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:

Bacillus anthracis (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.)

220) Which organism commonly causes food poisoning by consumption of foods containing excessive populations of organisms or preformed enterotoxin?

Bacillus cereus (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.)

250) Which of the following genera include anaerobic gram-negative non-sporulating bacilli?

Bacteroides (Brucella and Pasteurella are aerobic, gram-negative bacilli, and Actinomyces is an anaerobic gram-positive bacillus. Bacteroides species are anaerobic, gram-negative bacilli.)

233) Which of the following pairs of organisms usually grow on kanamycin, vancomycin, laked blood agar?

Bacteroides and Prevotella(Kanamycin-vancomycin laked blood agar is a selective medium used for the isolation of Bacteroides or Prevotella.)

81) Precautions for health care workers dealing with patients or patient specimens include:

Blood spills must be cleaned up and decontaminated by personnel using the proper PPR.

360) Relapsing fever in humans is caused by:

Borrelia recurrentis(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.)

371) Which area in the automated cell counter histogram indicates the non-lymphocyte curve?

C

125) In an uncomplicated case of severe iron deficiency anemia, which of the following sets represents the typical pattern of results?

C (Iron deficiency anemia laboratory features include: decreased RBC, hemoglobin, MCV, MCH, MCHC, serum iron, serum ferritin % saturation, bone marrow iron stores; and increased RDW, TIBC, FEP and serum soluble transferrin receptor levels.)

227) A 56 year old female with cold agglutinin disease has a positive DAT. When the DAT is repeated using monospecific antiglobulin sera, which of the following is most likely to be detected?

C3d (Cold agglutinin disease is associated with cold reactive antibodies that typically activate complement. Cells that do not undergo lysis due to complement activation have C3d attached to the red blood cells.)

221) Anti-I may cause a positive direct antiglobulin test (DAT) because of:

C3d bound to the red cells (In cold agglutinin syndrome, anti-I acts as a complement binding antibody with a high titer and high thermal amplitude. the complement cascade is activated and C3d remains on the red cell membrane of circulating cells.)

127) 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?

CAMP test and S agalactiae(The question describes the CAMP test, which is positive for Streptococcus agalactiae.)

173) When myocardial infarction occurs, the first enzyme to become elevated is:

CK activity increases 4-6 hrs after symptoms, peaks at 12-24 hrs returns normal within 48-72 hrs

170) The presence of which of the following isoenzymes indicates acute myocardial damage?

CK-MB

30) 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):

CNA agar plate(CNA agar is a selective medium commonly 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.)

35) A person suspected of having metabolic alkalosis would have which of the following laboratory findings?

CO2 content elevated and pH elevated

198) The tau isoform of transferrin is a carbohydrate deficient protein found only in:

CSF

215) Decreased CSF protein can be found in:

CSF leakage

216) What calculation is used to determine if there is a breach in the blood brain barrier?

CSF/serum albumin index

165) Which of the following is the formula for coefficient of variation?

CV[%]= [standard deviation/mean]x100

336) The prothrombin time test requires that the patient's citrated plasma be combined with:

Ca++ and thromboplastin (PT thromboplastin reagents are prepared from recombinant or affinity purified tissue factor suspended in phospholipid mixed with a buffered O.025 M solution of calcium chloride.)

109) Tiny colorless dumbbell shaped crystals were found in an alkaline urine sediment. They most likely are:

Calcium carbonate

110) Which of the following crystals may be found in acidic urine:

Calcium oxalate

49) Which of the following must be incubated in a microaerophilic environment for optimal recovery of the organism?

Campylobacter jejuni (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.)

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

266) The formation of germ tubes presumptively identifies:

Candida albicans (Candida albicans produces germ tubes.)

201) Of the following, the disease most closely associated with cytoplasmic granule fusion is:

Chediak-Higashi syndrome

226) Which of the following immunoassay labels offer the greatest detection limit?

Chemiluminescent labels

30) Which of the following is most closely associated with iron deficiency anemia?

Chronic blood loss

184) This is most consistent with:

Chronic hepatitis is a chronic inflammation of the hepatocytes that persists for at least 6 months. The serum enzyme levels may be variable depending on the condition. ALT, AST and ALP may be increased by 2 times the upper limit of normal. GGT is slightly increased

238) An anaerobic, spore-forming, nonmotile, gram-positive bacillus isolated from a foot wound is most likely:

Clostridium perfringens (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.)

240) The reverse CAMP test, lecithinase production, double zone hemolysis, and Gram stain morphology are all useful criteria in the identification of:

Clostridium perfringens(The reverse CAMP test, production of lecithinase, and demonstration of double zone hemolysis are tests and characteristics used for the identification of Clostridium perfingens,)

243) An anaerobic gram-positive bacilli with subterminal spores was isolated from a peritoneal abscess. The most likely identification of this organism is:

Clostridium septicum(Bacillus cereus is not an anaerobic organism; Eubacterium and Bidobacterium are anaerobic gram-positive bacilli that do not form spores. Clostridium septicum forms subterminal spores.)

237) A strict anaerobe that produces terminal spores is:

Clostridium tetanus(Corynebacterium species and Propionibacterium species do not produce spores, and Bacillus is an aerobic organism.)

10) Which selective medium is used for the isolation of gram-positive microorganisms?

Columbia CNA with 5% sheep blood (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.)

33) 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:

Columbia CNA, MacConkey(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.)

the mean blood glucose level for neonates is 35 mg/dl. Glucose is lower in the newborn because of the small glycogen reserve in the liver.

Compare the normal blood glucose level for newborns and adults.

34) A patient is admitted to the emergency room in a state of metabolic alkalosis. Which of the following would be consistent with this diagnosis?

high PCO2, increased HCO3

3) The preparation of a patient for standard glucose tolerance testing should include:

high carb diet for 3 days

321) An automated method for measuring chloride which generates silver ions in the reaction is:

Coulometry is an electrochemical technique used to measure the amount of electricity passing between 2 electrodes in an electrochemical cell. An application of coulometry is the titration of chloride with silver ions generated by electrolysis from a silver wire at the anode.

167) The enzyme which exists chiefly in skeletal muscle, heart, and brain, is grossly elevated in active muscular dystrophy, and rises early in myocardial infarction is:

Creatine kinase [CK]

278) The most sensitive test for the initial diagnosis of cryptococcal disease is:

Cryptococcal latex antigen test is more sensitive than staining methods

267) 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?

Cryptococcus neoformans (Cryptococcus neoformans is a cause of meningitis in immunocompromised patients, and produces a polysaccharide capsule.)

265) An organism that demonstrates budding yeast cells with wide capsules in an India ink preparation of spinal fluid is probably:

Cryptococcus neoformans(Cryptococcus neoformans is a cause of meningitis in immunocompromised patients, and produces a polysaccharide capsule.)

106) Which of the following is an abnormal crystal described as a hexagonal plate?

Cystine

369) Which area in the automated cell counter histogram represents the distribution curve?

D

334) Patient results are as follows: This workup suggests:

DIC (The laboratory profile for a DIC workup includes increased PT, APTT and D-dimers, with decreased fibrinogen and platelets.)

341) Differentiation of Mycobacterium avium from Mycobacterium intracellulare can be accomplished by:

DNA probe (Mycobacterium avium and M intracellulare have the same biochemical pattern, but can be differentiated by the use of DNA probes.)

346) If a patient presents with a prolonged APTT that does not correct upon mixing, the next test performed should be:

DRVVT (If the initial APTT remains prolonged in a mix, a second assay should be performed. The lupus anticoagulant has multiple targets. The second test is the DRVVT, which triggers coagulation at Factor X.)

60) An individual's red blood cells give the following reactions with Rh antisera: The individual's most probable genotype is:

Dce/dce (The patient lacks E. Since C and c are alleles, C is inherited from one parent and c from the other. Since the person is homozygous for e, one of the genes needs to code for ce [RHce] and the other Ce [RHCe]. The RHD gene is more likely inherited with Ce than ce, so the person's most probable genotype is DCe/dce. This genotype is found in 31% of the white and 15% of the black populations.)

188) The most common genetic defect associated with cystic fibrosis is called:

Delta-F508

268) 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:

Digoxin

207) Which of the following is associated with May-Hegglin anomaly?

Dohle bodies and giant platelets

126) Inclusions in the cytoplasm of neutrophils as shown in the figure below are known as :

Dohle bodies.)

8) Which curve represents the production of delta polypeptide chains of hemoglobin?

E (Development time line of production of Hgb delta chains.)

237) Which of the following antigens gives enhanced reactions with its corresponding antibody following treatment of the red cells with proteolytic enzymes?

E (Rh antibodies show enhanced reactivity with enzyme pretreated cells. Treatment of red cells with enzymes weakens reactivity with antibodies in the MNS and Duffy systems.)

381) The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in:

EDTA (High-quality blood smears can be made from the EDTA tube within 2-3 hours of collecting the specimen.)

14) A commonly used screening method for anti-HIV detection is:

ELISA (The enzyme-labeled immunosorbent assay [ELISA] method is a very sensitive method employed to screen donors for markers of transfusion-transmitted viruses.)

182) A serum sample drawn in the emergency room from a 42-year-old man yielded the following laboratory results: 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

Elevation of the levels of CK and AST is seen in muscle damage due to the crush injury to the thigh.

128) Which of the following may be used as a positive quality control organism for the bile esculin test?

Enterococcus faecalis(Enterococcus is positive for the bile esculin test while Streptococcus pyogenes and staphylococci are negative.)

129) Infection of the urinary tract is most frequently associated with:

Escherichia coli (>80% of uncomplicated UTIs are caused by E coli.)

159) Quality control of the spot indole test requires the use of ATCC cultures of:

Escherichia coli / Enterobacter cloacae (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.)

156) The stock cultures needed for quality control testing of oxidase production are:

Escherichia coli / Pseudomonas aeruginosa(Of the organisms listed only Pseudomonas aeruginosa is oxidase positive.)

139) Which of the following organisms can grow in the small bowel and cause diarrhea in children, travelers' diarrhea, or a severe cholera-like syndrome through the production of enterotoxins?

Escherichia coli(E coli can produce several different types of toxins that result in different gastroenteritis manifestations.)

138) An organism gave the following reactions: This organism most likely is:

Escherichia coli(These biochemicals are characteristic for E coli. Klebsiella pneumoniae is indole negative and nonmotile. Shigella dysenteriae is nonmotile and Enterobacter cloacae is indole negative.)

308) Which of the following factors is used only in the extrinsic coagulation pathway?

Factor VII

307) Which of the following is Vitamin-K dependent?

Factor VII (Factor VII [proconvertin] is a single- chain glycoprotein that is Vitamin K dependent and remains stable 4-5 hours in blood. Produced in the liver, it has the shortest half-life; therefore, it is the first factor affected when a Vitamin K antagonist such as warfarin is administered)

316) Which of the following factors typically shows an increase in liver disease?

Factor VIII (Factor VIII is an acute phase reactant that may be elevated in liver disease.)

313) Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after trauma or surgery?

Factor XII (Patients with a deficiency of Factor XII tend to have thrombotic complications. They do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin.)

325) Patient presents with bleeding 48 hours post tooth extraction. Results are as follows: Possible causes are a deficiency in:

Factor XIII (Factor XIII activity is <5% in congenital or acquired disorders. In adults, bleeding is slow and delayed The PT, APTT, fibrinogen and platelets will be normal.)

7) An aspirate of a deep wound was plated on blood agar plates and incubated aerobically and anaerobically. At 24 hrs. there was growth on both plates. This indicates that the organism is a:

Facultative anaerobes are organisms that can grow under both aerobic and anaerobic conditions.)

317) A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time using a kaolin activator. The APTT corrects to normal when the incubation time is increased. These suggest that the patient has:

Fletcher Factor deficiency (A prolonged APTT with a normal PT denotes a problem with the intrinsic pathway, so Factors VIII, IX, XI would be looked at, these deficiencies would correct in a mixing study. A characteristic of prekallikrein deficiency is the correction of the PTT when incubated for 10 minutes with kaolin, Celite*, silica, or ellagic acid.)

36) 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:

G-6-PD deficiency

38) 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 inclusions caused by hemoglobin denaturation. Which of the following conditions is consistent with these findings?

G-6-PD deficiency

188) The most sensitive enzyme indicator for liver damage from ethanol intake is:

GGT

197) Morphologic variants of plasma cells do not include:

Gaucher Cells

211) Of the following, the disease most closely associated with glucocerbrosidase deficiency is:

Gauchers disease

283) Which of the following is characteristic of Bernard - Soulier syndrome?

Giant platelets

286) Which of the following serum constituents is unstable if a blood specimen is left standing at room temp for 8 hrs. before processing:

Glucose decreases at a rate of 5%-7% per hour in whole blood at room temperature. Glycolysis will continue until the specimen is processed by centrifugation, and serum and plasma is separated from the cellular components of blood.)

197) Which of the following is the best indicator of Reye syndrome for CSF (hepatic encephalopathy):

Glutamine

1) The light-colored zone adjacent to the nucleus in a plasmacyte is the:

Golgi area

25) What is the best method to diagnose lactase deficiency?

H2 breath test

85) Filters generally used in biological safety cabinets to protect the laboratory worker from particulates and aerosols generated by microbiology manipulations are:

HEPA filter

251) The use of security systems such as firewalls and data encryption for electronic transmission of patient data from a laboratory information system to a remote location are required for:

HIPAA

32) Your friend calls and asks you to access his test results. Which of the following does this violate?

HIPAA

163) 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:

Haemophilus influenzae (Growth only on chocolate agar is typical for Haemophilus influenzae, which is a gram-negative coccobacillus that causes upper respiratory infections.)

160) An organism that exhibits the satellite phenomenon around colonies of staphylococci is:

Haemophilus influenzae (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.)

172) A CSF has been inoculated onto SBA and choc agar plates and into a tube of trypticase soy broth. All media were incubated in an atmosphere of 5% CO2. Which of the following organisms would usually be isolated by this procedure?

Haemophilus influenzae(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.)

168) A 4 yr. old boy is admitted to the hospital with suspected meningitis. He has not had most of the childhood vaccines. The suspected pathogen is:

Haemophilus influenzae(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.)

253) A standard electronic file format recommended for transmitting data from the laboratory information system to an electronic medical record is:

Health Level 7 [HL-7]

171) 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:

Helicobacter pylori (Helicobacter pylori is known to cause gastritis and is a gram-negative, curved bacillus.)

82) Infection rate is highest for laboratory professionals exposed to blood and body fluids containing:

Hepatitis B infection is a global public health problem and is one of the most common infectious diseases in the world

131) On electrophoresis at alkaline pH, which of the following is the slowest migrating hemoglobin?

Hgb C

21) In using ion-exchange chromatographic methods, falsely increased levels of Hgb A1c might be demonstrated in the presence of:

Hgb S

261) Many fungal infections are transmitted to man via inhalation of infectious structures. Which of the following is usual]y contracted in this manner?

Histoplasma capsulatum(Histoplasma capsulatum is most frequently transmitted by inhalation.)

149) Neutropenia is not usually associated with:

Hodgkin disease

180) False-positive results can occur for fecal occult blood due to the ingestion of:

Horseradish

Following ingestion of sugar, glucose levels are a little higher in capillary blood. In a fasting specimen, values are the same.

How do glucose levels differ in venous and capillary specimens?

107) Cold agglutinin syndrome is associated with an antibody specificity toward which of the following:

I (Anti-I is associated with cold agglutinin syndrome.)

305) Coagulation factors affected by warfarin (Coumadin) drugs are:

II, VII, IX and X (Warfarin interferes with the carboxylation of vitamin K factors by interrupting the enzymatic phase of the reaction. Factors are inhibited according to their half-life VII having shortest [4-5 hours] II longest [2-3 days].)

224) Polyspecific reagents used in the DAT test should have specificity for:

IgG and C3d (Polyspecific AHG contains anti-IgG and anti-C3d.)

62) A 14-year-old boy is seen in the ER complaining of a sore throat swollen glands and fatigue. The CBC results are: What is the most likely diagnosis?

In infectious mononucleosis, the leukocyte is usually increased due to an absolute lymphocytosis. The platelet count is often mildly decreased.)

344) This illustration represents the change in absorbance at 340 nm over a period of 8 minutes in an assay for lactate dehydrogenase. True statements about this figure include:

In the continuous monitoring method of the measurement of LD activity, the decrease in absorbance at each time interval indicates that the product formed [substrate converted] is constant up to 6 minutes. After 6 minutes, the substrate concentration is limited, and there is a decrease in the rate of product formation as indicated by the lack of linearity.

269) 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?

India ink (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.)

62) An individual has been sensitized to the k antigen and has produced anti-k. What is her most probable Kell system genotype:

KK(This individual cannot have the k antigen on their cells. KOKO is rare and no Ken system antigens are detected on the red blood cells. Those individuals usually produce antibodies that are reactive with all normal cells. KK is the most probable genotype.)

155) The stock cultures needed for quality control testing of motility are:

Klebsiella pneumoniae / Escherichia coli(Of the organisms listed only Klebsiella pneumoniae is nonmotile.)

134) A sputum culture from an alcoholic seen in the ER grows gray, mucoid, stringy colonies on SBA. The isolate grows readily on MacConkey agar and forms mucoid, dark pink colonies. The colonies yield the following test results: ONPG - positive indole - negative glucose - positive oxidase - negative citrate - positive VP - positive The organism is most likely:

Klebsiella pneumoniae(Klebsiella is the only distractor that is VP positive, and the other biochemical reactions are typical for K pneumoniae.)

89) The most appropriate screening test for detecting hemoglobin F is:

Kleihauer-Betke

106) In polycythemia vera, the leukocyte alkaline phosphatase activity is:

LAP activity may be increased in polycythemia Vera

84) 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?

LIM broth (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.)

168) The enzyme present in almost all tissues that may be separated by electrophoresis into 5 components is:

Lactate dehydrogenase [LD]

263) A 3 yr. old child was evaluated for abdominal pain and anorexia by a physician. A CBC revealed a hemoglobin of 9.8 g/dL and basophilic stippling of RBCs. The doctor should order further tests to check for poisoning from:

Lead interferes with heme synthesis, which on a CBC may present as a decreased hemoglobin, with basophilic stippling of the red blood cells. These findings in a child may indicate lead toxicity.

265) A carbonate salt used to control manic depressive disorders is:

Lithium

335) The best medium for culture of Mycobacterium tuberculosis is:

Lowenstein-Jensen medium (Lowenstein-Jensen is an egg-based medium used to isolate AFB. The other media are not used for the isolation of AFB.)

178) In the immunoinhibition phase of the CK-MB procedure:

M subunit is inactivated

64) Which of the RBC indices is a measure of the amount of hemoglobin in individual RBC's?

MCH

104) A blood sample from a patient with a high titer cold agglutinin, analyzed at room temp, with an electronic particle counter would cause an error in the:

MCV and MCHC

171) Which of the following is the formula for calculating the gram equivalent weight of a chemical?

MW/oxidation number

253) Which of the following statements most correctly describes the utility of clinical laboratory assays for tumor markers?

Markers are good for monitoring therapy and detecting recurrence of tumors.

202) Which of the following anomalies is an autosomal dominant disorder characterized by irregularly-sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets and often thrombocytopenia?

May-Hegglin

213) Of the following, the disease most closely associated with pale blue inclusions in granulocytes and giant platelets:

May-Hegglin

265) Which of the following cells is the largest cell in the bone marrow?

Megakaryocytes

310) 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, Lowenstein-Jensen

207) A gram stain performed on a sputum specimen revealed gram-neg diplococci within PMN's. Oxidase testing is positive and carbohydrate degradation tests are inert. The organism is:

Moraxella catarrhalis (The Neisseria species listed all ferment several carbohydrates, Moraxella catarrhalis is biochemically inert and does not ferment carbohydrates.)

72) Which of the following organisms may be mistaken for Neisseria gonorrhoeae in Gram stained smears of uterine cervix exudates?

Moraxella osloensis(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.)

342) Which one of the following species of Mycobacterium does not usually fluoresce on fluorochrome stain?

Mycobacterium fortuitum (Rapidly growing mycobacteria such as Mycobacterium fortuitum may be <10% acid fast and may not stain with fluorochrome.)

311) Which of the following reagents should be used as a mucolytic, alkaline reagent for digestion and decontamination of a sputum for mycobacterial culture?

N-acetyl-L-cystine and NaOH (The most widely used digestion decontamination method is the N-acetyl-L-cysteine-2% NaOH method.)

343) In the assay of lactate dehydrogenase , the reaction is dependent upon which of the following coenzyme systems?

NAD/NADH

342) In the assay of lactate dehydrogenase, which of the following products is actually measured?

NADH

61) A physician requested that electrolytes on a multiple myeloma patient specimen be run by direct ISE and not indirect ISE because:

Na is falsely decreased by indirect ISE

52) The anion gap is useful for quality control of laboratory results for:

Na, K, Cl, and CO2

insulin lowers glucose. Glucagon, cortisol, epinephrine, and growth hormone all increase it, with glucagon having the greatest effect.

Name 5 hormones that regulate glucose levels and tell whether each raises or lowers the level.

20) Employees are guaranteed the right to engage in self-organization and collection bargaining through representatives of their choice, or to refrain from these activities by which of the following?

National Labor Relations Act [NLRA] includes the right to form or join unions, freedom to bargain collectively with the employer and the right to engage in group activity.

83) Which of the following forms of exposure places a technologist at the highest risk for infection with HIV?

Needlestick injury

208) Coagglutination is associated with:

Neisseria gonorrhoeae (One of the less commonly used methods for identification of Neisseria gonorrhoeae grown in culture is coagglutination.)

209) Clinical resistance to penicillin correlates most frequently with beta-lactamase production in:

Neisseria gonorrhoeae (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 N gonorrhoeae is beta-lactamase.)

81) A 24-year-old man presents with pain on urination and urethral discharge. A Gram stain of the discharge is seen in the image: What is the most likely identification of this organism?

Neisseria gonorrhoeae(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.)

217) An autopsy performed on an 8 yr. old child revealed Waterhouse-Friederichsen syndrome. Blood and throat cultures taken just prior to death were positive for which organism?

Neisseria meningitidis (Waterhouse-Friederichsen syndrome is a known complication of severe Neisseria meningitidis infection.)

227) A branching gram-positive, partially acid-fact organism is isolated from a bronchial washing on a 63 yr. old woman receiving chemotherapy. The organism does not hydrolyze casein, tyrosine or xanthine. The most likely identification is:

Nocardia asteroides (Nocardia asteroides are partially acid fast, and do not hydrolyze the substrates casein, tyrosine, or xanthine.)

221) An organism recovered from a sputum has the following characteristics: - Culture: growth at 7 days on Lowenstein-Jensen agar, incubated under aerobic CO2 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?

Nocardia(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.)

61) A blood donor has the genotype: hh, AB. what is his RBC phenotype?

O (The A and B structures cannot be developed since there is no H precursor substance due to the lack of the H gene in the blood donor.)

140) A blood specimen from a pregnant woman is found to be group B, Rh neg. 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?

O, Rh-neg (Blood selected for exchange transfusion should be ABO-compatible with the mother and baby, and antigen-negative. Prenatal antibody titers above 16 or 32 are considered significant, and the condition of the fetus should be monitored.)

183) This is most consistent with:

Obstructive jaundice is characterized by an increased ALP 3 times the upper limit of normal and a marked increase in GGT.

193) The appearance of normal CSF is:

Opalescent

164) The most accurate test to determine renal concentration is:

Osmolarity

328) Which blood gas electrode is composed of silver/silver chloride reference electrode and glass?

PCO2

319) An electrode has a silver/silver chloride anode and a platinum wire cathode. It is suspended in KCl solution and separated from the blood to be analyzed by a selectively permeable membrane. Such an electrode is used to measure which of the following?

PO2

40) 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 mins. The following change in blood gases will occur:

PO2 increased/HCO3 decreased

199) Which marker can be used to identify a body fluid as semen?

PSA

8) Prior to blood donation, the intended venipuncture site must be cleaned with a scrub solution of:

PVP iodine complex (The scrub must use iodine, eg, PVP iodine complex. Donors who are sensitive to iodine can have the area cleaned with a preparation of 2% chlorhexidine and 70% isopropyl alcohol.)

238) Which of the following hormones regulates normal blood calcium levels?

Parathyroid hormone [PTH]

55) The best medium for culture of Bordetella pertussis is:

Regan-Lowe agar (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.)

185) 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: oxidase - positive glucose OF - fermentative catalase - positive motility - negative MacConkey agar - no growth Which of the following is the most likely organism?

Pasteurella multocida(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.)

203) Of the following, the disease most closely associated with granulocyte hyposegmentation is:

Pelger-Huet

208) 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?

Pelger-Huet

266) An antiepileptic used to control seizure disorders is:

Phenytoin

175) Which of the following is most closely associated with chronic myelogenous leukemia?

Philadelphia chromosome (Classic discrimination between CML vs other hematological conditions: sideroblastic anemia, AML, myelofibrosis.)

15) The term used to describe reproducibility is:

Precision is the reproducibility of analytical results, or the degree to which results of multiple analyses of the same specimen agree

316) The buffer pH most effective at allowing amphoteric proteins to migrate toward the cathode in an electrophoretic system would be:

Proteins are amphoteric substances; that is, they contain acidic and basic groups. Their overall [net] charge is highly positive at low pH values, zero at a particular higher pH, and negative at still more alkaline pH values. At a pH of 4.5, the positively charged proteins will migrate toward the cathode in an electrophoretic system.)

144) >100,000 CPU/mL of a gram-negative bacilli were isolated On MacConkey from a urine specimen. Biochemical results are as follows: The organism is most likely:

Proteus mirabilis (Morganella and Providencia do not produce H2S; the indole reaction differentiates P mirabilis and P vulgaris.)

157) The stock cultures needed for quality control testing of phenylalanine deamination activity are:

Proteus mirabilis / Escherichia coli (Of the organisms listed only Proteus mirabilis is phenylalanine deaminase positive)

145) A urine culture had the following culture results: - sheep blood: swarming - Columbia CNA: no growth - MacConkey: 1. >100,000 CFU/mL nonlactose-fermenter - 2. >100,000 CFU/mL nonlactose-fermenter with red pigment The isolates from MacConkey agar had the following biochemical reactions: The organisms are most likely:

Proteus mirabilis and Serratia marcescens(Serratia can produce a red pigment; Proteus mirabilis swarms, is TDA positive and produces H2S.)

122) Which of the following stains is used to demonstrate iron, ferritin and hemosiderin?

Prussian blue

123) Which of the following stains can be used to differentiate siderotic granules from basophilic stippling?

Prussian blue

161) An organism isolate 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:

Pseudomonas aeruginosa (Pseudomonas aeruginosa produces the blue-green pigment, pyocyanin.)

162) A nonfermenting gram-negative bacillus is isolated from a wound. The nitrate and oxidase are strongly positive. The growth on SBA has a grape-like odor. The organism is:

Pseudomonas aeruginosa(Pseudomonas aeruginosa often has a sweet odor that smells like grapes.)

135) The following urine results were obtained on a 25-year-old female: These results are most compatible with:

Pyelonephritis

69) A patient's red cells type as follows: Which of the following genotype would be consistent with these results?

R0R0 (R0R0 is the only correct choice here. R0 = D+C-E-c+e+.)

118) 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: What is the most probable genotype of this patient?

R1R1 (After performing rule outs, the most likely antibody is anti-c. To form anti-c, the patient would need to inherit a gene from both parents that does not produce the c antigen. The most common gene that codes for no antigen is denoted as R1.)

68) Refer to the following data: Given the reactions above, which is the most probable genotype?

R1R2 (All common Rh antigens are present on the red blood cells. R1 [DCe] and R2 [DcE] are frequent genotypes.)

77) A donor is tested with Rh antisera with the following results: What is his most probable Rh genotype?

R1r (The most likely haplotype is DCe/dce.)

89) Identify the formed element in this photomicrograph:

RBC

142) When the main objective of an exchange transfusion is to remove the infant's antibody-sensitized RBCs and to control hyperbilirubinemia, the blood product of choice is ABO compatible:

RBC suspended in FFP (For exchange transfusion, antigen- negative Red Blood Cells are typically resuspended in ABO-compatible thawed Fresh Frozen Plasma.)

130) ABO HDFN differs from Rh HDFN in that:

Rh HDFN is clinically more severe that ABO HDFN (ABO HDFN is a mild disease that may occur in any ABO-incompatible pregnancy, including the first, since the antibodies are naturally occurring Rh HDFN does not occur until the mother has become immunized. Once this happens, subsequent pregnancies may be quite severely affected. The DAT is typically weak or even negative in ABO HDFN, and strongly positive in Rh HDFN.)

135) 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:

Salmonella typhimurium (Salmonella is the only distractor that produces H2S. Also, Klebsiella and E coli produce acid/acid reactions in TSI.)

158) The stock cultures needed for quality control testing of deoxyribonuclease (DNase) production are:

Serratia marcescens / Escherichia coli(Of the organisms listed only Serratia marcescens is DNase positive.)

225) During a normal pregnancy, quantitative human chorionic gonadotropin levels peak how many weeks after the last menstrual period?

Serum hCG levels peak at 8-10 wks

132) Which one of the following genera is among the least biochemically reactive members of the Enterobacteriaceae?

Shigella (Shigella is lactose negative, most species do not produce gas, are VP, urea, lysine decarboxylase and citrate negative, and they are nonmotile.)

137) 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:

Shigella dysenteriae(Salmonella produce H2S in TSI and Yersinia produces an acid slant and acid butt. Shigella fits this biochemical profile.)

16) The ability of a procedure to measure only the component it claims to measure is called:

Specificity

64) Production of beta-lactamase is inducible in which of the following:

Staphylococcus aureus (Some bacteria such as Enterococcus sp., H influenzae and Neisseria gonorrhoeae continually produce beta-lactamase. S aureus produces beta-lactamase only after exposure to an inducing agent [such as penicillin]. C diphtheriae and S pyogenes do not produce beta-lactamase.)

106) Of the following bacteria, the most frequent cause of prosthetic heart valve infections occurring within 2-3 months after surgery is:

Staphylococcus epidermidis (Staphylococcus epidermidis is the most common cause of prosthetic valve endocarditis.)

121) Which of the following contaminants has a dimpled center and will polarize?

Starch

110) A gram-positive coccus isolated from a blood culture has the following characteristics: optochin susceptibility: negative bacitracin susceptibility: negative bile esculin hydrolysis: negative hippurate hydrolysis: Positive catalase: negative This organism is most likely:

Streptococcus agalactiae (Streptococcus agalactiae is catalase and bile esculin hydrolysis negative and bacitracin and optochin resistant. Streptococcus agalactiae hydrolyzes hippurate.)

94) The optochin (ethylhydrocupreine hydrochloride) disk is used for the identification of:

Streptococcus pneumoniae (Optochin susceptibility is used to differentiate S pneumoniae, which are susceptible, from other alpha-hemolytic streptococci, which are resistant.)

120) Which of the following organisms is, to date, considered universally susceptible to penicillin:

Streptococcus pyogenes (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.)

47) Which of the following organisms does not require susceptibility testing to the antimicrobial indicated when isolated from a clinically significant source?

Streptococcus pyogenes - penicillin(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.)

105) An important cause of acute exudative pharyngitis is:

Streptococcus pyogenes(Streptococcus pyogenes is the cause of exudative pharyngitis, commonly called strep throat.)

206) Methods used as screening tests for cystic fibrosis include:

Sweat conductivity

124) A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and show a homogeneous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of :

Systemic lupus erythematosus [SLE] is an autoimmune disease. The ANA procedure is a screening tool for SLE

154) Which of the following cells is the atypical lymphocyte seen on the peripheral blood smear of patients with infectious mononucleosis?

T lymphocytes (T-cell activation follows during second week of IM in response to the EBV induced B-cell infection and activation.)

217) 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:

TSH is the American Thyroid Association's recommended screening test

90) All casts typically contain:

Tamm-Horsfall glycoprotein

256) The hematology lab is evaluating new instruments for purchase. The supervisor wants to ensure that the instrument they select has directional interface capabilities. The instrument specification necessary to meet this requirement is:

The Host Query mode of an instrument is a two-way communication process whereby the instrument reads the specimen barcode and queries the LIS for the orders. The tests to be run are sent to the instrument. Once results are obtained, they are sent back to the LIS.)

21) Which of the following organizations was formed to encourage the voluntary attainment of uniformly high standards in institutional medical care?

The Joint Commission (JCAHO sets standards by which healthcare is measured and accredits institutions and laboratories worldwide.)

180) Refer to the following illustration: Which of the following is the most likely interpretation of the LD isoenzyme scan illustrated above?

The LD isoenzymes as a percentage of total LD activity are LD1: 14%-26% LD2: 29%-39% LD3: 20%-26% LD4: 8%-16% LD5: 6%-16%. The scan indicates the fraction LD5 is increased. Elevated levels of LD5 are seen with viral hepatitis.

202) A 1 yr. old girl with a hyperlipoproteinemia and lipase deficiency has the following lipid profile: cholesterol = 300 mg/dL LDL increased HDL decreased triglycerides = 200 mg/dL chylomicrons present A serum specimen from this patient that was refrigerated overnight would most likely be:

The chylomicrons, present as a thick homogenous cream layer, may be observed floating at the plasma surface.

80) The safest method of disposing of hypodermic needles is:

The simplest method of disposing of needles is to dispose of the entire collection device into a container reserved for sharps.

112) Which of the following crystals appear as fine, silky needles?

Tyrosine

311) Which of the following coagulation factors is considered to be labile?

V (Factor V is called labile factor, because its activity diminishes quickly at room temperature.

315) The 2 factors that differentiate liver disease from Vit. K deficiency are:

V and VII (Factors V and VII are helpful in distinguishing between liver disease and Vitamin K deficiency. Factor VII is a Vitamin K dependent factor; however, Factor V is not and will not be decreased. Both factors will be decreased in liver disease.)

151) What is the formula for calculating the dilution of a solution.

V1 x C1 = V2 x C2 V1 is the volume C1 is concentration of sol 1 V2 is vol of the diluted solution C2 is conc of diluted solution

258) The process of testing and documenting changes made to a laboratory information system is known as:

Validation of the LIS is required by various accrediting agencies in order to prove that the system is performing as expected. This must be done at implementation and over time as changes are made to the LIS.

237) The urinary excretion product measured as an indicator of epinephrine production is:

Vanillylmandelic acid [VMA]

130) A technician is asked by the supervisor to prepare a standard solution from the stock standard. What is the glassware of choice for this solution?

Volumetric flasks

96) The urine microscopic constituents that best differentiate between cystitis and pyelonephritis are:

WBC casts

318) The results on a patient are: These results reflect:

Warfarin is a Vitamin K antagonist; coagulation Factors II, VII, IX, X, Protein C, and S are reduced as nonfunctional molecules are produced. The rate of reduction is based on the half-life of the factors.)

99) Which of the following casts most frequently appears to have a brittle consistency?

Waxy

170) 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?

X factor: no growth / V factor: no growth / XV factor: growth / horse blood: no hemolysis(These are classic gram stain, growth and biochemicals for Haemophilus influenzae.)

136) An isolate from a stool culture gives the following growth characteristics and biochemical reactions: These screening reactions are consistent with which of the following enteric pathogens?

Yersinia enterocolitica (Shigella has colorless colonies on both MacConkey 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.)

380) Multifocal brain lesion in AIDS patients is commonly caused by:

aToxoplasma gondii (The most common cause of ring- enhancing brain lesions in a patient with HIV/AIDS is Toxoplasma gondii.)

32) Which of the following in the most appropriate organism and media combination?

Yersinia enterocolitica - cefsulodin-irgasan-novobiocin(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.)

133) Which one of the following gram-negative bacilli ferments glucose?

Yersinia enterocolitica(Alcaligenes, Pseudomonas and Acinetobacter are all nonfermenters; Yersinia is a member of the Enterobacteriaceae and, by definition, ferments glucose.)

150) A 25 yr. old man who had recently worked as a steward on a transoceanic grain ship presented to the ER 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 ID of this organism is:

Yersinia pestis(Yersinia pestis is classically described as having a "safety pin" appearance on Wayson stain. This patient's presentation is classic for bubonic plague.)

299) The creatinine clearance is equal to:

[urinary creatinine (mg/L) x volume (mL/min) / plasma creatinine (mg/L)] (Renal clearance tests are used to assess kidney function. Renal clearance of a substance is a rate measurement that expresses the volume of blood cleared of that substance [typically creatinine] per unit of time. The unit for the clearance is mL/ min. To calculate creatinine clearance, the following information is required: Serum concentration [S], urine concentration [U] [Note: the serum and urine concentration must be in the same units, for example, mg/L or mg/dL], and volume of urine excreted per minute [V] [volume of urine collected divided by the time period in minutes]. The following formula can then be used: clearance [uncorrected for body mass] = [U] x V/[S].)

77) A D test is performed on an isolate of Staphylococcus aureus to determine inducible clindamycin resistance: Based on the result seen in the image how should the erythromycin and clindamycin be reported?

_resistant(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.)

245) 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?

_yellow, ground glass colonies (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.)

287) Severe intravascular hemolysis is most likely caused by antibodies of which blood group system? a. ABO b. Rh c. Kell d. Duffy

a (ABO antibodies activate complement and may cause intravascular hemolysis. Rh, Kell, and Duffy antibodies are primarily associated with extravascular hemolysis.)

289) After receiving a unit of RBCs, a patient immediately developed flushing, nervousness, fever spike of 102*F, 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 typing c. presence of anti-Fya in patient's serum d. presence of gram-neg bacteria in blood bag

a (ABO antibodies activate complement and may cause intravascular hemolysis. The antibodies are naturally occurring against A and B antigens that the recipient lacks. Rh and Duffy antibodies may also cause hemolytic transfusion reactions, but the antibodies are the results of alloimmunization and not naturally present in recipients who lack the antigen. The incidence of septic transfusion reactions from bacterial contamination of Red Blood Cells is rare, about 1:500,000.)

252) A patient's serum contains a mixture of antibodies. One of the antibodies is identified as anti-D. Anti-Jka, Fya, and possibly another antibody are present. What technique may be helpful to identify the other antibody? 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

a (Anti-Fya would not react with enzyme pretreated cells; a select cell panel would allow for individual reactivity of the remaining 2 antibodies. Thiol reagents would be used to disperse agglutination of IgM antibodies; the antibodies in question are IgG.)

286) 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

a (Antibodies in the ABO system may activate complement and cause immediate intravascular hemolysis if incompatible blood is transfused. Antibodies in the Rh, Duffy, and MN systems typically cause extravascular hemolysis, which is usually less severe.)

191) Which characteristic best differentiates Acinetobacter species from Moraxella species? a. production of indophenol oxidase b. growth on MacConkey agar c. motility d. susceptibility to penicillin

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.)

9) Which curve represents the production of epsilon polypeptide chains of hemoglobin?

a (Development time line of production of Hgb epsilon chains.)

276) FFP from a group A, Rh-pos donor may be safely transfused to a patient who is group: a. A, Rh-neg b. B, Rh-neg c. AB, Rh-pos d. AB, Rh-neg

a (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with ABO antibodies to A or B antigens the patient may have. Rh type is not significant.)

292) The most appropriate laboratory test for early detection of acute posttransfusion hemolysis is: a. a visual inspection for free plasma hemoglobin b. plasma haptoglobin concentration c. examination for hematuria d. serum bilirubin concentration

a (Free hemoglobin released from destruction of transfused donor red cells will impart a distinct pink or red color in the posttransfusion sample plasma.)

305) The preferred carbon source for mycobacteria is:

a (glycerolMycobacteria use glycerol as a carbon source in the presence of mineral salts.)

217) An ion-selective electrode (ISE) measures the:

activity of one ion much more than the other ions present

32) In the liquid state, plasma must be stored at:

a 1 - 6 C (The required temperature for storage of thawed plasma is 1-6C.)

206) Autoantibodies demonstrating blood group specificity in warm autoimmune hemolytic anemia are associated more often with which blood group system.

a Rh (Warm autoantibodies often exhibit Rh specificity.)

285) Which of the following is a dimorphic fungus?

a Sporothrix schenckii(Dimorphism differentiates Sporothrix from the other fungi listed.)

204) Which of the following statements about fluorometry is true?

a compound fluoresces when it absorbs light at one wavelength and emits light at a second wavelength

356) The electrical resistance method of cell counting requires:

a conductive liquid

220) Which of the following tests is most commonly used to detect antibodies attached to a patient's red blood cells in-vivo?

aDAT ( The direct antiglobulin test [DAT] is used to identify red blood cells that have been coated with antibody in vivo.)

320) A hemophiliac male and a normal female can produce:

a female carrier (All daughters of hemophiliac men are carriers of the disease; all sons are normal. The gene for Factor VIII lies on the X chromosome.)

83) The values below were obtained on an automated blood count system performed on a blood sample from a 25-year-old man: These results are most consistent with which of the following?

a high titer of cold agglutinins(In patients with cold agglutinins, the automated cell counters show an erroneously elevated MCV and an erroneously decreased red blood cell count due to clumping of the red cells.)

177) Which of the following is characteristic of Tn polyagglutinable red cells?

a if group O, they may appear to have acquired a group A antigen (Tn is caused from a somatic mutation and the phenomenon is persistent. Resolution of the red cell typing can be performed with enzyme-treated patient cells, since Tn is denatured by enzymes. Although the reactivity with anti-A may be weak, testing with anti-A1 lectin gives strong reactivity, unlike subgroups of A, which are weakly reacting with anti-A and nonreactive with A1 lectin.)

121) A blood component used in the treatment of hemophilia A is:

aFactor VIII concentrate (Patients with severe hemophilia A may have spontaneous hemorrhages that are treated with Factor VIII concentrate.)

103) Which of the following red cell antigens are found on glycophorin-A:

aM,N (The M and N antigens are found on glycophorin A.)

291) 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(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.)

398) The causative agent of cysticercosis is:

aTaenia solium (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.)

158) The rosette test will detect a fetomaternal hemorrhage as small as:

a10 mL (The rosette test is a sensitive method to detect FMH of 10 mL or more.)

58) Given the most probable genotypes of the parents, which of the following statements best describes the most probable Rh genotypes of the 4 children?

a2 are R1r, 2 are R1R1 (The mother has a 50% chance of passing on R1 and 50% chance of passing on r. The father will always pass on R1. Statistically, 50% of the children will be R1r and 50% of them will be R1R1.)

28) According to AABB standards FFP must be infused within what period of time following thawing:

a24 hrs. (Per AABB standards, thawed FFP should be stored at 1-6 C for no more than 24 hours.)

25) Cryo AHF must be transfused within what period of time following thawing and pooling?

a4 hrs. (Cryoprecipitate must be transfused within 4 hours of pooling.)

400) The scolex of Taenia saginata has:

a4 suckers (The scolex of Taenia saginata is square with 4 suckers and no hooks.)

296) When evaluating a suspected transfusion reaction, which of the following is the ideal sample collection time for a bilirubin determination?

a6 hrs. posttransfusion (Bilirubin is a marker for red cell hemolysis. Bilirubin peaks at 5-7 hours after transfusion and is back to pretransfusion levels at 24 hours if liver function is normal.)

55) What is/are the minimum pretransfusion testing requirement(s) for autologous donations collected and transfused by the same facility?

aABO and Rh typing only (Only ABO and Rh is required with the patient's sample. Each autologous unit must be confirmed for ABO and Rh from an integrally attached segment.)

63) Given the following typing results, what is the donors racial ethnicity: Le(a-b-) Fy(a-b-) Js(a+b+)

aAfrican American (Fy[a-b-] individuals are very rare with all populations other than the individual of African descent. 68% of African Americans are Fy[a-b-].)

202) A patient is group A2B, Rh-pos and has an antiglobulin reacting anti-A1 in his serum. He is in the operating room bleeding profusely and group A2B RBCs are not available. Which of the following blood types is first choice for crossmatching?

aB, Rh-pos (This patient has an anti-A1, which eliminates A1B cells immediately. Rh-negative units should be conserved for Rh-negative patients when Rh-positive units are available. Selection of group B units provides compatible units quickly.)

167) Which of the following represents an acceptably identified patient for sample collection and transfusion

aa handwritten band with patients name and hospital identification number is affixed to the patients leg (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patient's identification band and request.)

246) An antibody screen performed using solid phase technology revealed a diffuse layer of RBCs on the bottom of the well. these results indicate:

aa positive reaction (In the solid phase technology, the antibody screening cells are bound to the surface of the well. Antibody specific for antigen on the red blood cells attaches, resulting in a diffuse pattern of red blood cells in the well. A negative reaction would have manifested as a pellet of red blood cells in the bottom of the well.)

316) A patient with a coagulopathy was transfused with FP24 (FFP within 24 hrs. 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:

aanti-IgA (Anaphylactic transfusion reactions are severe reactions that occur after infusion of a small amount of donor blood. Symptoms are hypotension, shock, respiratory distress dyspnea, and substernal pain. Anaphylactic reactions are usually caused by anti-IgA.)

207) An antibody that causes in-vitro hemolysis and reacts with the red cells of 3 out of 10 crossmatched donor units is most likely:

aanti-Lea (Lewis antibodies may bind complement and fresh serum that contains anti-Lea may hemolyze Le[a+] red cells in vitro. Approximately 22% of the population is Le[a+].)

91) The antibody in the Lutheran system that is best detected at lower temps:

aanti-Lua (Most examples of anti-Lua agglutinate saline suspended cells. Most examples of anti-Lub are IgG and reacts at 37 C. Anti-Lu3 usually reacts at the AHG phase as does anti- Luab.)

65) In an emergency situation, Rh-neg. red cells are transfused into a Rh-pos person of the genotype CDe/CDe. the first antibody most likely to develop is:

aanti-c ( The most common genotype in Rh-negative individuals is rr. Anti-e would not be formed because the recipient's red cells contain the e antigen. The first antibody most likely to develop would be anti-c.)

53) 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. This method of platelet collection is known as:

aapheresis (The apheresis process is to remove whole blood, the desired component removed, and the remaining portion of blood returned to the donor/patient.)

294) Which of the following transfusion reactions is characterized by high fever, shock, hemoglobinuria, DIC, and renal failure?

abacterial contamination (In septic transfusion reactions, patients experience fever >101 [38.3 C], shaking chills, and hypotension. In severe reactions, patients develop shock, renal failure, hemoglobinuria, and DIC.)

183) Hemorrhage in polycythemia vera is the result of:

abnormal platelet function (Discriminates between faulty function of platelets, which would inhibit clotting and other PCV characteristics.)

296) A platelet count done by phase microscopy is 200 x 10^3/mL (200 x 10^9/L) (reference range 150-450 x 10^3/mL (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:

abnormal platelet function should be suspected (BT assesses both platelet number and function.)

234) Acceptable specimens for the culture of anaerobic bacteria that cause disease include:

abscesses (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.)

215) A leukocyte count and differential on a 40-year-old Caucasian man revealed: This data represents:

absolute neutropenia

134) Elevation of the total granulocyte count above 7.7 x 10^3 is termed:

absolute neutrophilic leukocytosis

94) When cleaning up a small (5 mL) blood spill on the counter-top, the first step after donning appropriate personal protective equipment is to:

absorb the spill with disposable absorbent material.

194) Chronic lymphocytic leukemia is defined as:

accumulation of monoclonal B cells with a block in cell maturation (Discrimination of CLL from other major mature B cell neoplasms)

157) Reagent strip tests for ketones measure primarily:

acetoacetic acid

191) Which of the following chemical determinations may be of help in establishing the presence of seminal fluid?

acid phosphatase

188) Some blood group antibodies characteristically hemolyze appropriate red cells in the presence of:

acomplement (Some blood group antibodies, in the presence of their corresponding antigen and complement, activate the complement cascade and demonstrate in-vitro hemolysis.)

215) In electrophoretic analysis, buffers:

act as carrier for ions (Electrophoresis involves migration of a charged molecule or particle in a liquid medium under influence of an electric field. 3 roles of buffer are 1] to carry the applied current; 2]establish pH for electrophoresis procedure 3]determine ele charge on sol

350) A bedside test that can be used to monitor heparin activity is the:

activated clotting time (The ACT monitors high dose heparin therapy at clinics, bedside, cardiac catheterization or at a surgical suite. The Stypven time is a test using snake venom for testing for lupus. The reptilase time is used to distinguish between heparin contamination and a decreased fibrinogen level.)

310) A temperature rise of 1 C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation. usually indicates which of the following reactions?

afebrile (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation.)

305) Leukocyte-poor RBCs would most likely be indicated for patients with a history of :

afebrile transfusion reaction (Leukocyte antibodies are a primary cause of febrile transfusion reactions. Leukocyte-reduced blood components reduce the risk of febrile nonhemolytic reactions.)

314) Hemoglobin S can be separated from hemoglobin D by which of the following methods?

agar gel electrophoresis at pH 5.9

388) 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:

agiardiasis (Diarrhea associated with Giardia lamblia is caused by the consumption of contaminated water and results in greasy, foul-smelling stools.)

323) A patient became hypotensive and went into shock after receiving 50 mL of a unit of RBCs. She had a shaking chill and her temperature rose to 104.8 F (40.0 C). A transfusion reaction investigation was initiated but no abnormal results were seen. What additional testing should be performed?

agram stain and culture of the donor unit (Septic transfusion reactions due to contaminated blood products are manifested by high fever, chills, hypotension, shock, nausea, diarrhea, renal failure, and DIC. Symptoms usually appear rapidly. Transfusion reaction investigation shows no evidence of unexpected blood group antibodies. A Gram stain and blood culture of the donor unit may detect the presence of aerobic or anaerobic organisms.)

303) In processing clinical specimens and fungal isolates, laboratory workers may contract systemic fungal infections through:

ainhalation (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.)

46) The protein section of the urine reagent strip is most sensitive to:

albumin

177) A 10 yr. old child was admitted to pediatrics with an initial diagnosis of skeletal muscle disease. The best confirmatory tests would be:

aldolase and creatine kinase (Increased levels of aldolase and CK are seen with skeletal muscle disease..)

46) Which of the following is proper procedure for preparation of platelets from Whole Blood:

alight spin followed by hard spin (Whole blood-derived Platelets are prepared by a light spin to separate the Red Blood Cells from the platelet-rich plasma [PRP], followed by a heavy spin of the PRP to concentrate the platelets.)

82) Ghost RBCs are seen in urine that is:

alkaline and dilute

117) The following crystal is found in:

alkaline pH and is nonpathologic

2) The following results are from 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:

all values are consistent with a normal healthy individual

287) The chamber counting method of platelet enumeration:

allows direct visualization of the particles being counted

249) Detection of which of the following substances is most useful to monitor the course of a patient with testicular cancer?

alpha-fetoprotein [AFP].

157) Which of the following enzymes catalyzes the conversion of starch to glucose and maltose?

amylase

159) A physician suspects his patient has pancreatitis. Which test would be most indicative of this disease?

amylase

156) Which of the following enzymes are used in the diagnosis of acute pancreatitis?

amylase (AMS) and lipase (LPS)

182) A buildup of fluid in a body cavity is called:

an effusion

228) An unexplained elevation of the prothrombin time in a 72 yr. old smoker who has been diagnosed with chronic pulmonary obstructive disease is most likely due to:

an elevated hematocrit (An elevated hematocrit decreases the amount of plasma in whole blood, and causes an effective increase in the amount of citrate added to that plasma. Recalcification incompletely overcomes the additional citrate, and prolongations in clotting time tests can be expected, unless the amount of citrate is adjusted for the abnormal hematocrit.)

211) The diagnosis of Neisseria gonorrhoeae in females is best made from:

an endocervical culture(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 N gonorrhoeae. Culture of an appropriate genital tract specimen is required to confirm identification.)

236 The etiologic agent of botulism is:

an exotoxin producer (The toxin produced by Clostridium botulinum is a neurotoxin that is excreted by the organism in food materials, and is then ingested.)

229) 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:

anaerobically(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.)

8) Shown above is a Levy-Jennings quality control chart, which represents control values for 13 consecutive analyses for a particular serum constituent. If the 14th value is below the —2 SD limit, which of the following should be done?

analysis system should be checked for a deteriorating component

213) Transfusion of Ch+ (Chido-positive) red cells to a patient with anti-Ch has been reported to cause:

ano clinically significant red cell destruction (Chido antibodies are considered clinically insignificant)

75) Gloves worn in the lab for specimen processing must be removed and hands washed when:

answering the telephone in a designated "clean" area.

12) The western blot is a confirmatory test for:

anti-HIV-1 (Western blot uses purified HIV proteins to confirm reactivity in samples whose screening test for anti-HIV is positive.)

13) The test that is currently used to detect donors who are infected with the AIDS virus is:

anti-HIV-1,2 (The causative agent for AIDS is the human immunodeficiency virus types 1 and 2.)

98) Inhibition testing can be used to confirm antibody specificity for which of the following antibodies?

anti-Lea (Lewis antigens are found soluble in saliva. If saliva containing Lewis substance is added to a sample with anti-Lea, then neutralization occurs. Le[a+] indicator cells added to the test system would be nonreactive. A proper control system is required whenever neutralization studies are performed.)

241) To confirm a serum antibody specificity identified as anti-P1, a neutralization study was performed and the following results obtained: serum + P1 substance = NEGATIVE serum + saline = NEGATIVE What conclusion can be made from these results.

anti-P1 cannot be confirmed due to the results of the negative control (For neutralization studies to be valid, the saline dilutional control must be reactive. Since neutralization studies involve adding a substance to the patient's plasma, nonreactivity in test tubes may be due to simple dilution. The saline control acts as the dilutional control and must be reactive. When the saline control is reactive, then if the tube with the substance is nonreactive, the interpretation that neutralization has occurred is made. If it is reactive, neutralization did not occur.)

353) Low molecular weight heparin is monitored by a:

anti-Xa assay (The chromogenic anti-Xa assay is the only assay available to monitor LMWH; it may also be used to measure UFH.)

205) 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:

aphenotype his cells to determine which additional alloantibodies may be produced (Determining the patients phenotype allows focusing identification procedures toward antibodies the patient can develop.)

190) The protein portion of an enzyme complex is called the:

apoenzyme

132) Specific granules of the neutrophilic granulocyte:

appear first at myelocyte stage

63) Flammable and combustible liquids in containers > 5 gallons should be stored in a(n)

approved safety can

239) Based on the results of the above panel, which technique would be most helpful in determining antibody specificity?

aproteolytic enzyme treatment (Enzyme treatment would allow for differentiation of the remaining antibodies after rule outs. The Fya antigen would be denatured, allowing determination of whether anti-Jka and -K are present, and to confirm anti-E.)

165) 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:

aquality control the AHG reagent and check cells and repeat the panel (Negative check cells means the results of tubes with the negative reactions are invalid. The reactivity of the check cells should be verified with anti-IgG since anti-E was detected, indicating the anti-IgG was reactive. All tests that were nonreactive with the check cells requires repeat test performance.)

187) In comparison to malignant lymphoma cells, reactive lymphs:

are morphologically more variable throughout the smear

113) Which of the following questions can be legally asked on an employment application?

are you a US citizen

191) A patient is typed as group O, Rh pos. and crossmatched with 6 units of blood. At the IAT phase of testing, both antibody screening cells and 2 crossmatched units are incompatible. What is the most likely cause of the incompatibility?

arecipient alloantibody (Presence of agglutination at AHG phase with screening cells and 2 out of 6 donor units indicates antibody in patient serum to antigen[s] on screening cells and donor cells. The presence of an autoantibody would most likely react with all cells, including the autologous control or DAT.)

105) Which of the following is a characteristic of anti-i?

bfound in the serum of patients with infectious mononucleosis (Patients with infectious mononucleosis often demonstrate potent examples of anti-i that are transient in nature.)

389) 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:

arequest a fresh specimen (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)

71) Which of the following phenotype will react with anti-f:

arr (Anti-f will react with cells that carry c and e on the same Rh polypeptide. No other listed genotypes produce an Rh polypeptide that carries both c and e.)

233) Scurvy is associated with deficiency of which of the following vitamins?

ascorbic acid [vitamin C]

196) A 42-year-old female is undergoing surgery tomorrow and her physician requests that 4 units of Red Blood Cells be crossmatched. The following results were obtained: What is the most likely cause of the incompatibility of donor 1?

asingle alloantibody (The patient has a negative antibody screen, but one unit is found to be incompatible. The antibody is most likely directed towards a low-incidence antigen.)

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

269) A salicylate level is performed to detect toxicity caused by ingestion of excess:

aspirin

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

191) The methodology based on the amount of energy absorbed by a substance as a function of its concentration and using a specific source of the same material as the substance analyzed is:

atomic absorption

362) Chlamydial infections have been implicated in:

aurethritis and conjunctivitis (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.)

18) Total glycosylated hemoglobin levels in a hemolysate reflect the:

average blood glucose levels of the past 2-3 months

340) In the Jendrassik-Grof reaction method for the determination of serum bilirubin concentration quantitation is obtained by measuring the green color of:

azobilirubin

247) On Monday a patient's K antigen typing result was positive. 2 days later the patient's K typing was negative. The patient was transfused with 2 units of FFP. The tech might conclude that the: a. transfusion of FFP affected the K typing b. wrong patient was drawn c. decreased serum bilirubin d. agglutination with normal adult ABO compatible sera

b ( The K antigen is integral to the red cell membrane and would not change in a patient. Errors in typing or patient identification may be detected when discrepancies are found when comparing historical records.)

275) A patient received about 15 mL of compatible blood and developed severe shock, but no fever. If the patient needs another transfusion, what kind of RBC component should be given? a. RBCs b. RBCs, washed c. RBCs, Irradiated d. RBCs, leukocyte reduced

b (Anaphylactic transfusion reactions are distinguished from other types of reactions by 1] the absence of fever, and 2] the reactions are sudden in onset after infusion of only a few mL of blood. Since the reaction is due to anti-IgA, washing the donor red blood cells to remove all plasma protein is indicated. Alternatively, blood products from IgA-deficient donors may be used.)

288) Which of the following blood group systems is most commonly associated with delayed hemolytic transfusion reactions? a. Lewis b. Kidd c. MNS d. I

b (Antibodies in the Kidd system activate complement and may cause intravascular hemolysis. The antibodies often decline in vivo, are weak, show dosage, and are difficult to detect in vitro, making them prime candidates for causing anamnestic delayed hemolytic transfusion reactions.)

285) 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

b (Delayed hemolytic transfusion reactions are caused by a secondary anamnestic response in a previously alloimmunized recipient. Unlike a primary response, a secondary response is rapid. Antibody may be detectable 3-7 days from the time of transfusion.)

261) 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 versus 2 units of RBCs, each with a total volume of 250 mL? a. patient's hematocrit would be equally affected by the Whole Blood or the RBC's b. RBC's would provide twice the increment in hematocrit as the Whole Blood c. Whole Blood would provide twice the increment in hematocrit as the RBC's d. Whole Blood would provide a change in hematocrit slightly less than the RBC's

b (Each unit of Whole Blood or RBCs will increase the hematocrit by 3%-5%, so 2 units of RBCs will increase the hematocrit by twice as much as 1 unit of Whole Blood.)

296) The appropriate specimen for the diagnosis of mucormycosis is:

d eschar biopsy (Mucormycosis is an aggressive infection where biopsy, curettage or fine-needle aspiration is essential for diagnosis.)

272) What increment of platelets/uL 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

b (Each unit of platelets should increase the count 5,000-10,000/uL [5,000-10,000/L].)

251) Which of the following is useful for removing IgG from RBCs with a positive DAT to perform a phenotype? a. bromelin b. chloroquine c. LISS d. DTT

b (Two reagents used for removing IgG from red blood cells are chloroquine diphosphate [CDP] and EDTA glycine acid [EGA]. Using either of these procedures is useful to reduce a patient's DAT and allow phenotyping with IAT reactive antisera.)

1) The minimum Hgb concentration in a fingerstick from a male blood donor is:

b 12.5 g/dL (125 g/L) (All donors, regardless of sex, require a minimum hemoglobin of 12.5 g/dL [125 g/L]. The value must not be performed on an earlobe stick.)

127) An increased amount of cytoplasmic basophilia in a blood cell indicates:

decreased cytoplasmic maturation

304) A sputum specimen received at 8 AM for an Acid Fast 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 35C in 5%-10% CO2. No growth occurs. The best explanation is that:

b an improper specimen was submitted for culture(Early-morning sputum specimens are optimal for AFB culture.)

179) Haemophilus influenzae becomes resistant to ampicillin when the organism produces a:

beta-lactamase enzyme(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.)

387) The organism depicted is a(n):

bflagellate (The image displays the trophozoite form of Giardia lamblia, a flagellated protozoan parasite.)

198) A reason why a patient's crossmatch may be incompatible while the antibody screen is negative is:

b the incompatible donor unit has a positive DAT(If a patient is negative for clinically significant antibodies, and a single crossmatch is incompatible, the incompatibility is either due to donor cells with a positive DAT or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

212) In the process of identifying an antibody, the technologist observed 2+ reactions with 3 out of the 10 cells in a panel after the immediate spin phase. There was no reactivity after incubation at 37 C and after the anti-human globulin test phase. The antibody most likely is:

banti-Lea (Lewis antibodies are usually IgM and agglutinate saline suspended cells. Approximately 22% of the population is Le[a+], which would account for 3 out of 10 donor units being incompatible. Anti-P1 is also an antibody that may react at immediate spin, but 79% of the white population and 94% of the black population are P1 +. Anti-C and anti-Fya are IgG antibodies that react at the antiglobulin phase.)

173) A group B, Rh-neg patient has a positive DAT. Which of the following situations would occur?

b the weak D test and control would be positive (A positive DAT will interfere with weak D testing, causing both the patient and control to demonstrate positive results. Any positive result in the control tube invalidates any results.)

190) The following results were obtained in pre-transfusion testing: screen cell 1: @37 C = 0 | @IAT = 3+ screen cell 2: @37 C = 0 | @IAT = 3+ autocontrol: @37 C = 0 | @IAT = 3+ The most probable cause of these results are:

ba warm autoantibody (Presence of agglutination at AHG phase with both screening cells and autocontrol is indicative of warm autoantibody.)

5) Urine samples should be examined within 1 hr. of voiding because:

bacterial contamination will cause alkalinization of the urine

214) Increased CSF lactate is found in:

bacterial meningitis

88) In a quality control procedure on a new batch of Mueller-Hinton plates using a stock culture of staphylococcus aureus, all the disk zone sizes are too small. The most likely reason for this is that the:

bacterial suspension was not diluted to the proper concentration (Quality control zone sizes that are too small could indicate that the organism inoculum is too high, plates were poured too thick, or that the potency of the antibiotic disks is too low.)

309) Hives and itching are symptoms of which of the following transfusion reactions?

ballergic (Allergic reactions are a type 1 immediate hypersensitivity reaction to an allergen in plasma. Most are mild reactions shown by urticaria [hives, swollen red wheals] which may cause itching.)

184) The test for weak D is performed by incubating patients red cells with:

banti-D serum followed by washing and antiglobulin serum (Although monoclonal anti-D react with most D+ red blood cells, cells with fewer antigen sites requires testing after the antiglobulin test. The test is referred to as a test for weak D.)

216) Based on the results of the above panel, the most likely antibodies are:

banti-E, anti-Jka and anti-K (Reactivity at 37C and AHG indicate the presence of an IgG antibody. Anti-M, although usually IgM, may be partly or wholly IgG. Anti-M is ruled out on cell4. Anti-Leb is usually IgM and can be ruled out on cells 4 and 8. This leaves anti-E, anti-Fya and anti-K.)

36) If the HMIS or NFPA 704 hazardous material identification system has a number 4 in the left blue quadrant, it represents a:

high health hazard

243) To confirm the specificity of anti-Leb, an inhibition study using Lewis substance was performed with the following results: What conclusion can be made from these results?

banti-Leb is confirmed because the tubes with Lewis substance are negative (Anti-Leb is confirmed because the tubes with Lewis substance are negative. Nonreactivity of the serum with Le[b+] cells indicates the anti-Leb in the serum was neutralized by the Lewis substance. The test is valid since the patient's serum with saline rather than substance added is still able to react with the Le[b+] cells.)

252) CODE 128, ISBT 128, CODE 39 and Interleaved 2 and 5 symbologies are used by laboratory information systems to create which of the following?

barcode labels

179) Which of the following is a characteristic of polyagglutinable red cells?

bare agglutinated by most adult sera (Polyagglutination is a property of the cells. Most adult plasma agglutinate the cells due to naturally occurring antibodies directed towards the crypt antigens.)

54) Which of the following is most likely to be seen in lead poisoning?

basophilic stippling

58) The characteristic morphologic feature in lead poisoning is:

basophilic stippling

74) Evidence of active red cell regeneration may be indicated on a blood smear by:

basophilic stippling NRBC polychromasia

171) Granulocytes for transfusion should:

bbe ABO compatible with the recipients serum (Granulocytes must be compatible with recipient's plasma. Granulocyte products have an expiration of 24 hours.)

392) The best method to demonstrate the ova of Enterobius vermicularis is:

bcellophane tape preparation (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.)

10) During the preparation of Platelet Concentrates from whole blood, the blood should be:

bcooled towards 20-24 C (Platelets are prepared and stored at 20-24 C for optimum function.)

280) Which of the following procedures should be performed to confirm that an unknown mold is one of the pathogenic dimorphic fungi:

bculture conversion to yeast form (Several monomorphic molds resemble the filamentous phase of dimorphic molds, so conversion to yeast phase must be performed for identification of dimorphic molds.)

85) In a relationship 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:

bdirect (Direct exclusion of paternity is established when a genetic marker is present in the child but is absent from the mother and the alleged father.)

232) The drug cephalosporin can cause a positive DAT with hemolysis by which of the following mechanisms?

bdrug dependent antibodies reacting in the presence of a drug (Second and third generation cephalosporins react when the drug is present in vitro. When serum, drug, and red cells are present, direct or indirect agglutination or lysis may be observed.)

57) Incident reports for occupational injury or illness should:

be filed for all incidents, including near miss incidents.

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

38) Compressed gas cylinders should:

be secured upright to the wall or other stable source

212) To be analyzed by gas liquid chromatography a compound must:

be volatile or made volatile

230) An aspirate of a deep wound was plated on blood agar plates aerobically and anaerobically. At 24 hrs. there was growth on the anaerobic plate only. The next step in the evaluation of this culture is to:

begin organism identification(A probable anaerobe is the only organism growing so the microbiologist can proceed with identification.)

298) A posttransfusion blood sample from a patient experiencing chills and fever show distinct hemolysis. The DAT is positive (mixed field). What would be the most helpful to determine the cause of the reaction?

belution and antibody ID (If the direct antiglobulin test is positive in a transfusion reaction investigation, the antibody should be eluted from the red cells and identified.)

66) In addition to keeping the load close to your body and tightening you abdominal muscles when lifting heavy boxes of supplies, it is important to bend at the:

bend at the knees and hips, lift with legs and buttocks

255) In addition to carcinoma of the prostate, elevated prostate-specific antigen can occur due to:

benign prostatic hyperplasia

261) Cocaine is metabolized to:

benzolylecgonine

36) The ONPG test allows organisms to be classified as a lactose fermenter by testing for which of the following?

beta-galactosidase(Through the action of the enzyme beta-galactosidase, ONPG cleaves into galactose and o-nitrophenol [a yellow compound].)

9) A penicillin resistant Neisseria gonorrhoeae produces:

beta-lactamase (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, N. gonorrhoeae that produce beta lactamase are resistant to penicillin.)

255) Validation of calculated test results performed by a laboratory information system must be performed:

biannually (CAP requires documentation that calculated values that generate pt report reviewed every 2 yrs, or when system change is made that may affect calculations. This requirement applies to values calculated by LIS or middleware.)

39) Acidosis and alkalosis are best defined as fluctuations in blood pH and CO2 content due to changes in:

bicarbonate buffer

50) Most of the carbon dioxide present in blood is in the form of:

bicarbonate ion

46) The most important buffer pair in plasma is the:

bicarbonate/carbonic acid

189) 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:

bidentify the cause of the agglutination (Agglutination at AHG phase indicates the presence of clinically significant antibody, indicating the need for antibody identification.)

100) 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:

bile esculin, PYR, bacitracin, and hippurate(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.)

115) Streptococcus pneumoniae can be differentiated best from the viridans group of streptococci by:

bile solubility(Bile solubility testing of alpha-hemolytic streptococci differentiates S pneumoniae [soluble] from other alpha-hemolytic streptococci such as viridans streptococci [insoluble].)

92) Viridans streptococci can be differentiated from Streptococcus pneumoniae by:

bile solubility(Bile solubility testing of alpha-hemolytic streptococci differentiates S pneumoniae [soluble] from other alpha-hemolytic streptococci, such as viridans streptococci [insoluble].)

4) Which of the following urine results is most apt to be changed by prolonged exposure to light?

bilirubin

50) A reagent strip area impregnated with stabilized, diazotized 2,4-sichloroaniline will yield a positive reactions with:

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

94) HLA antibodies are:

binduced by multiple transfusions (HLA antibodies are formed in response to pregnancy, transfusion or transplantation and are therefore not naturally occurring. They are associated with febrile nonhemolytic transfusion reactions and TRALI. They are directed against antigens found on granulocytes and other cells such as platelets.)

92) When processing specimens for mycobacterial testing, what specific engineering control must be used?

biological safety cabinet

361) Psittacosis is transmissible to man via contact with:

birds (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].)

329) Most chemical methods for determining total protein utilize which of the following reactions?

biuret

297) Which of the following detects or measures platelet function?

bleeding time

235) Propionibacterium acnes is most often associated with:

blood culture contamination (Propionibacterium acnes is part of the normal flora of the skin, so it is frequently isolated from improperly collected blood cultures.)

88) Use of "standard" (universal) precautions minimizes exposure to:

bloodborne pathogens

36) Irradiation of a unit of RBC's is done to prevent the replication of donor:

blymphocytes (Irradiation inhibits proliferation of T lymphocytes.)

300) In a delayed hemolytic transfusion reaction, the DAT is typically:

bmixed-field positive (Delayed hemolytic transfusion reactions are associated with extravascular hemolysis, rather than intravascular. Alloantibody coats the transfused antigen-positive donor cells in the recipient's circulation, producing a mixed-field positive reaction in the DAT.)

142) 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?

boil the organism and retest with the antisera (Some Shigella produce capsular antigen that mask the cell wall and boiling removes the capsule.)

187) The most heat labile fraction of alkaline phosphatase is obtained from:

bone

181) Which of the following specimens is considered to be the most sensitive for the recovery of Brucella in cases of chronic infection?

bone marrow(Bone marrow is considered the most sensitive specimen for the recovery of Brucella.)

43) When hazardous chemicals are transferred from the original appropriately labeled containers to a secondary container for immediate use by the person performing the transfer, it:

does not require labeling

58) A sweat chloride result of 55 mEq/L (55 mmmol/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 results is:

borderline results, the test should be repeated

326) Which species of Mycobacterium includes a BCG strain used for vaccination against tuberculosis?

bovis (Mycobacterium tuberculosis can remain viable but dormant in macrophages for many years.)

194) 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:

bpatient has an antibody directed against a low incidence antigen (The absence of agglutination at the AHG phase with screening cells and agglutination with one of 3 donor units is most likely due to an antibody to a low-incidence antigen.)

325) The purpose of a low-dose irradiation of blood components is to:

bprevent graft-vs-host disease (Irradiation inhibits proliferation of T cells and subsequent GVHD.)

142) Kernicterus is an abnormal accumulation of bilirubin in:

brain tissue

108) Which of the following is a characteristic of anti-i?

breacts best at room temp or 4 C (Anti-i is an IgM antibody that reacts with cord cells and i adult cells. It is not associated with hemolytic disease of the newborn since IgM antibodies do not cross the placenta.)

93) Anti-Sda is strongly suspected if:

bthe agglutinates are mixed field and refractile (Anti-Sda is an antibody to a high-prevalence antigen, which varies in strength from person to person. Most examples of anti-Sda characteristically present as small, mixed-field, retractile agglutinates that may have a shiny appearance when observed microscopically after the antiglobulin test.)

322) 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?

btransfusion-associated circulatory overload (TACO) (Hypervolemia due to transfusion in susceptible patients, such as cardiac, elderly, infants, or severely anemic, causes circulatory overload [TACO] and associated respiratory and cardiac problems)

402) A stool specimen for ova and parasite examination contained numerous rhabditiform larvae Which factor does not aid in the identification of larvae?

btype of water vegetation consumed (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.)

192) Refer to the following data: - hemoglobin: 7.4 g/dL (74 g/L) - reticulocyte count: 22% Which clinical condition is consistent with the lab results shown above?

bwarm autoimmune hemolytic anemia (Reaction with anti-IgG in the DAT and with both screening cells and autocontrol at the AHG phase is indicative of a warm autoantibody.)

238) In a prenatal workup, the following results were obtained: ABO discrepancy was thought to be due to an antibody directed against a component of the typing sera. Which test would resolve this discrepancy?

bwash patient's RBCs and repeat testing (Patients may have antibodies to components of reagents. Washing the patient's cells prior to testing to remove their plasma from the cell suspension will resolve the reactivity with anti-B.)

260) One of the most effective methods for the elution of warm autoantibodies from RBCs utilizes: a. 10% sucrose b. LISS c. change in pH d. distilled water

c (Antibody-antigen complexes are dependent upon a neutral pH. Extremes in pH causes dissociation. Both auto and alloantibodies are recovered in eluates prepared by reagent kits that alter the pH.)

7) Which curve represents the production of gamma polypeptide chains of hemoglobin?

c (Development time line of production of Hgb gamma chains.)

253) A sample gave the following results: cells: anti-A = 3+ | anti-B = 4+ serum: A1 cells = 2+ | B cells = 0 Which lectin should be used first to resolve the discrepancy? a. Ulex europaeus b. Arachis hypogaea c. Dolichos biflorus d. Vicia graminea

c (Dolichos biflorus plant seed extract forms complexes with N-acetylgalactosamine. When properly diluted, it can distinguish between A1 donor cells and all other subgroups of A)

279) 10 units of group A platelets were transfused to a group AB patient. The pretransfusion platelet count was 12 x 10^3/uL and the posttransfusion count was 18 x 10^3/uL. 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 for platelets c. has developed antibodies to the transfused platelets d. should receive irradiated platelets

c (Each unit of platelets should increase the count 5,000-10,000 platelets/uL [5,000- 10,000/L]. Platelet antibodies can diminish this expected increment.)

278) Fresh Frozen Plasma: a. contains all labile coagulative factors except cryo 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

c (FFP contains all factors, including cryoprecipitate. It does not have a higher risk of transmitting hepatitis than Whole Blood. It must be transfused within 24 hours of thawing and must be ABO compatible.)

277) A patient admitted to the trauma unit requires the emergency release of FFP. His blood donor card states that he is group AB, Rh-pos. Which of the following blood groups of FFP should be issued? a. A b. B c. AB d. O

c (FFP should be ABO compatible with the recipient's RBCs. If patient's type has not been determined [currently], plasma lacking anti-A and anti-B should be given.)

193) a patient received 2 units of RBCs 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 cell were overwashed b. centrifuge time was prolonged c. patient's serum was omitted from the original test d. antiglobulin reagent was neutralized

c (Initial result was most likely a false-negative result due to the omission of patient serum. This would explain the initial negative result followed by the subsequent positive result.)

249) 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

c (Rouleaux will readily disperse in saline whereas true agglutination will remain after saline replacement.)

280) Hypotension, nausea, flushing, fever and chills are symptoms of which of the following transfusion reactions? a. allergic b. circulatory overload c. hemolytic d. anaphylactic

c (Symptoms of hemolytic transfusion reactions are fever, chills, flushing, chest and back pain, hypotension, nausea, dyspnea, shock, renal failure, and DIC. Circulatory overload, allergic, and anaphylactic reactions are not characterized by fever.)

279) Which of the following statements concerning the germ tube test is true?

c Candida albicans and Candida tropicalis can be used as positive and negative controls, respectively(Candida albicans [positive] and C tropicalis [negative] can be used as control organisms for quality control of the germ tube test.)

130) Hemoglobin S can be separated from hemoglobin D by:

electrophoresis on a different medium and acidic pH

70) The red cells of a nonsecretor will most likely type as:

c Le(a+b-) (The Lewis antigens are developed by gene interaction. Both the Lewis and Secretor gene are required for red cells to type as Le[a-b+]. If a person has a Lewis gene, but not Secretor gene, then the cells type as Le[a+b-]. The Le[a-b-] phenotype is derived when the Lewis gene is absent and the Secretor gene may or may not be present. The Le[a+b-] phenotype occurs in 22% of the population, and Le[a-b-] occurs in 6%, so the most likely phenotype of a nonsecretor [se/se] is Le[a+b-].)

18) When platelets are stored on a rotator set on an open bench top, the ambient air temps. must be recorded:

c every 4 hours (If storage devices do not have automated temperature recording, temperature must he manually monitored every 4 hours.)

279) In polycythemia vera, the platelet count is:

elevated

304) The use of Leukocyte-Reduced Red Blood Cells and Platelets is indicated for which of the following patient groups?

c patients with history of febrile transfusion reactions(Leukocyte-Reduced RBCS and Platelets can be used to prevent further nonhemolytic transfusion reactions.)

200) 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-neg. the technologist should:

c release O Rh-neg RBC's (Emergency release of blood cannot use previous records. Blood typing must be performed on the current sample. In this case, group O Rh-negative is the best choice since there is evidence the patient is Rh-negative.)

240) Of the following, the most useful technique in the identification and classification of high-titer, low-avidity antibodies is/are:

c titration and inhibition (Soluble forms of some blood group antigens can be prepared from other sources and used to inhibit reactivity of the corresponding antibody, such as the HTLA antibodies anti-Ch and anti-Rg. Most HTLA antibodies, although weakly reactive in undiluted serum, will continue to react weakly at higher dilutions.)

295) On day 3 of a fungal culture, grayish cottony growth is observed that is filling the container. The most likely mold isolated is a:

c zygomycete(Zygomycetes grow rapidly and fill the dish with cotton candy-like growth.)

74) A women types as Rh-pos. She has an anti-c titer of 32 at AHG. Her baby has a negative DAT and is not affected by HDFN. What is the fathers most likely Rh phenotype

cR1r (The baby appears to lack c since no HDFN was evident. The mom is most likely R1R1, so had to pass R1 onto the baby. The father must have passed on an Rh gene that also did not produce c, Given the choices, the father has to be R1r.)

317) To prevent febrile transfusion reactions, which RBC product should be transfused?

cRBCs, leukocyte reduced (Leukoreduction of blood products reduces the risk of febrile nonhemolytic transfusion reactions, which are caused by leukoagglutinins or cytokines from white cells.)

303) A patient multiply transfused with RBCs developed a headache, nausea, fever and chills during his last transfusion. What component is most appropriate to prevent this reaction in the future?

cRBCs, leukocyte reduced (Red Blood Cells, Leukocyte-Reduced should be chosen, because febrile nonhemolytic transfusion reactions are either due to chemokines released from leukocytes in nonleukoreduced blood components or to patient antibodies directed towards donor HLA antigens on the leukocytes.)

67) The mating of an Xg(a+) man and a Xg(a-) women will only produce:

cXg(a-) sons + Xg(a+) daughters (The Xg blood group system is unique in that the gene encodes on the X chromosome. A negative mother would not have the Xg[a] to pass on. A positive father would, however, transmit the Xg[a] to all his daughters.)

393) Proper collection of a sample for recovery of Enterobius vermicularis includes collecting:

ca scotch tape preparation from the perianal region (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.)

66) A hospitalized patient is experiencing increased neuromuscular irritability (tetany). Which of the following tests should be ordered immediately?

calcium

68) A reciprocal relationship exists between:

calcium and phosphate

298) Platelet aggregation is dependent in vitro on the presence of:

calcium ions

240) In synovial fluid, the most characteristic finding in pseudogout is:

calcium pyrophosphate dihydrate crystals

262) A smear of skin tissue reveals fluorescent septate hyphae. The smear was prepared using:

calcofluor white(Calcofluor white binds to cellulose and chitin present in fungal cell walls.)

45) Osmolal gap is the difference between:

calculated and measured osmolality values

106) In a case of cold autoimmune hemolytic anemia, the patient's serum would most likely react 4+ at immediate spin with:

call cells of a group O cell panel and his own cells (Anti-I is commonly found in all individuals, but when it causes hemolysis, the titer may be high and react at all temperatures. Cold agglutinin syndrome is mainly found in lymphoproliferative diseases.)

65) 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): The technologist's best course of action would be to:

call the patient care area and request a new specimen (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.)

213) A true statement about column chromatography methods, including high-performance liquid and gas chromatography, is that it:

can be used for adsorption, partition, ion-exchange and steric-exclusion chromatography

307) Which of the following transfusion reactions occurs after infusion of only a few milliliters of blood and gives no history of fever?

canaphylactic (Two distinguishing features or anaphylactic transfusion reactions are that symptoms occur with transfusion of only small amounts of blood, and the patient has no fever.)

154) Rh immune globulin administration would not be indicated in an Rh-neg woman who has a:

canti-D titer of 1:4,096 (RhIg is of no benefit once a person has been actively immunized and has formed anti-D)

215) The ABO discrepancy seen above is most likely due to:

canti-H (An ABO discrepancy in an A1 individual, manifested by agglutination in the serum grouping with A2 cells, is most likely due to anti-H. The greatest concentration of H substance is found on O cells, followed by A2 cells. The least amount of H substance is found on Al and AIB cells.)

113) Anti-Fya is:

capable of causing hemolytic transfusion reactions (Anti-Fya is an IgG antibody that reacts best at the AHG phase, does not react with enzyme-treated red cells, is capable of causing hemolytic disease of the newborn, and is not known to be an auto agglutinin.)

325) The disease-producing capacity of Mycobacterium tuberculosis depends primarily upon:

capacity to withstand intracellular digestion by macrophages (Mycobacterium tuberculosis can remain viable but dormant in macrophages for many years.)

272) 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?

carbohydrate assimilation (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.)

216) An organism previously thought to be nonpathogenic, Moraxella catarrhalis, is now known to be associated with opportunistic respiratory infection and nosocomial transmission. Characteristic identification criteria include:

carbohydrate negative (asaccharolytic) (Moraxella catarrhalis is an oxidase- positive gram-negative diplococcus that is usually beta-lactamase positive. It does not ferment carbohydrates.)

22) An increase in serum acetone is indicative of a defect in the metabolism of:

carbohydrates

318) Tubercle bacilli are specifically stained by:

carbol fuchsin (Mycobacteria form stable complexes with Kinyoun carbol fuchsin.)

203) The primary isolation of Neisseria gonorrhoeae requires:

carbon dioxide (Neisseria gonorrhoeae requires an enhanced CO2 atmosphere for optimal growth.)

226) AHG control cells:

care coated only with IgG antibody (AHG control cells are IgG-sensitized cells that react with the anti-IgG in the AHG reagent to demonstrate AHG was added and not neutralized by insufficient washing of the tests prior to its addition.)

99) Gram stain examination from a blood culture bottle show dark blue, spherical organisms in clusters. Growth on sheep blood agar shows small, round, pale yellow colonies. Further tests should include:

catalase production and coagulase test(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.)

24) The most common cause for failure of a Gas Pak anaerobic jar to establish an adequate environment for anaerobic incubation is:

catalysts that have become inactivated after repeated use (The 2 most common causes of failure of the Gas Pak system is a defective gasket in the jar lid that allows escape of gas from inside the jar and inactivated catalyst pellets.)

14) In the Kirby-Bauer disk diffusion susceptibility test, which variable is critical when testing Pseudomonas species for antibiotic susceptibility to aminoglycosides?

cation content of media(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.)

97) The enterotoxin produced by certain strains of hemolytic, coagulase positive Staphylococcus aureus:

causes one type of bacterial food poisoning(Staphylococcus aureus produces an enterotoxin that is associated with short- incubation food poisoning.)

319) Coughing, cyanosis and difficult breathing are symptoms of which of the following transfusion reactions?

ccirculatory overload (Transfusion-associated circulatory overload [TACO] is hypervolemia manifested by coughing, cyanosis, and pulmonary edema.)

180) Consider the following ABO typing results: What is the most likely cause of this discrepancy?

ccold autoantibody (Presence of agglutination with A1 cells, screening cells and autocontrol at IS and RT is indicative of a cold autoantibody.)

320) Which of the following is a nonimmunologic adverse effect of a transfusion?

ccongestive heart failure (Transfusion-associated circulatory overload [TACO] is hypervolemia caused by blood transfusion in susceptible patients. Hemolytic [antibody to red cell antigen], febrile NHTR [leukoagglutinins or cytokines], and allergic [reaction to allergens in plasma] are immunologic reactions.)

78) Which of the following combinations is useful for confirming the presence of extended spectrum beta-lactamases of E coli?

ceftrazidime + clavulanic acid(Extended spectrum beta lactamases [ESBL] are inhibited by clavulanic acid. Confirmatory tests for 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.)

10) Failure to observe RBC casts in a urine specimen can be caused by:

centrifuging an unmixed specimen

45) First generation cephalosporins can be adequately represented by:

cephalothin(Cephalothin is a first-generation cephalosporin, cefotetan and cefoxitin are second-generation cephalosporins, and ceftriaxone is a third generation cephalosporin.)

122) 90% of the copper present in the blood is bound to:

ceruloplasmin

98) While processing patient specimens, a technologist splashes a few small drops of a bronchial wash specimen in his/her gloves. The first action should be to:

change gloves and wash hands with antiseptic soap and water

224) In amniotic fluid, the procedure used to detect hemolytic disease of the newborn is:

change in absorbance of amniotic fluid at 450 nm

373) The photo-optical method of endpoint detection is described as:

change in optical density as a result of a fibrin clot (Photo-optical endpoint is a change in optical density. Nephelometry is an immunometric method for measuring proteins. Chromogenic methods employs a color-producing substance called a chromophore. Immunologic assays are based on antigen-antibody reactions.)

134) The Liley method of predicting the severity of HDFN is based on the amniotic fluid:

change in optical density measured at 450nm (The change in optical density [absorbance] of amniotic fluid measured spectrophotometrically at 450 nm is calculated and plotted on the Liley graph according to the weeks gestation. The graph is divided into 3 zones, which predict the severity of HDFN and the need for intervention and treatment.)

152) Criteria determining Rh immune globulin eligibility include:

cmother has not been previously immunized to the D antigen (RhIg should be given to nonimmunized D- females who are pregnant or have delivered a D+ infant.)

54) Media used to support growth of Legionella pneumophila should contain which of the following?

charcoal and yeast extract (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.)

88) Cells of the A3 subgroup will:

chave a mixed field reaction with anti-A,B (Mixed-field reactivity with anti-A and anti-A,B is a typical finding for A3 subgroups.)

56) 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:

check the serum for hemolysis

229) Use of EDTA plasma prevents activation of the classical complement pathway by:

chelating Ca++ ions, which prevents assembly of C1 (EDTA chelates calcium preventing blood to clot. This chelation of calcium also will stop the complement cascade. Calcium ions are necessary for C1 to attach to IgG on the red blood cells.)

62) What type of identification system does this symbol represent?

chemical hazardous materials

295) Hemoglobinuria, hypotension and generalized bleeding are symptoms of which of the following transfusion reactions?

chemolytic (Clinical signs of a hemolytic transfusion reaction include fever and chills, and, in severe cases, DIC. Circulatory overload, allergic and anaphylactic reactions are not characterized by fever and DIC.)

185) A patient has been treated for polycythemia vera for several yrs. His blood smear now shows: Oval macrocytes Howell-Jolly bodies Hypersegmented neutrophil Large, agranular platelets the most probable cause of this blood picture is:

chemotherapy

214) An oncology patient has the following results: The most probable explanation is:

chemotherapy

324) The most frequent transfusion-associated disease complication of blood transfusion is:

chepatitis (Hepatitis transmission is unlikely, but has a higher risk of transmission through blood transfusion than CMV [rare], syphilis [no transfusion-transmitted cases reported in >30 years], or HIV [1:2,300,000 units].)

1) Proper media for culture of a urethral discharge from a man include:

chocolate agar and modified Thayer Martin agar(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.)

82) A 10-year-old child with cystic fibrosis presents with cough and shortness of breath. Her sputum Gram stain is seen in the image: Based on the Gram stain what would be the best medium and incubation condition to optimize recovery of the organism seen?

chocolate agar incubated in CO2 (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.)

29) Cerebrospinal fluid from a febrile 25 yr. old man with possible meningitis is rushed to the lab for a stat gram stain and culture. While performing the gram stain, the tech accidently spills most of the specimen. The smear shows many neutrophils and no microorganisms. Since there is only enough CSH to inoculate one plate, the tech should use a:

chocolate agar plate(Enriched media such as chocolate agar has no inhibitory effects on bacterial growth and contains additional nutrients that support the growth of fastidious organisms such as H influenzae and Neisseria.)

228) What common substrate is used in the biosynthesis of adrenal steroids, including androgens and estrogens?

cholesterol

281) As part of a hyperlipidemia screening program, the following results were obtained on a 25 yr. old woman 6 hrs. after eating: triglycerides = 260 mg/dL cholesterol = 120 mg/dL Which of the following is the best interpretation of these results?

cholesterol is normal, but triglycerides are elevated, which may be attributed to the recent meal(A high-fat diet increases the serum concentrations of triglycerides. Fasting overnight for 10-14 hours is the optimal time for fasting around which to standardize blood collections, including lipids.)

178) All stages of neutrophils are most likely to be seen in the peripheral blood of patient with:

chronic myelocytic leukemia (Demonstrates difference between acute vs chronic leukemias; intermediate cell maturity seen in chronic myelogenous, but would not predominate in erythroleukemia.)

160) Increased numbers of basophils are often seen in:

chronic myelocytic leukemia (Identifies classic cellular findings in CML.)

165) The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss:

chronic myelocytic leukemia (Leukopenia with immature granulocytes in all stages, including blast with markedly decreased LAP and Philadelphia chromosome, positively identify CML. Leukopenia is consistent with engorged marrow space.)

210) Turbidity in serum suggests elevation of:

chylomicrons

363) Mycoplasmas differ from other bacteria in that they:

clack cell walls (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.)

351) Which of the following lab findings is associated with Factor XIII deficiency?

clot solubility in a 5 molar urea solution (Fibrin stabilizing factor is needed to polymerize a clot. Primary screening tests are normal in Factor XIII deficiency. A screening test is based on the solubility of a fibrin clot in SM urea.)

78) In polycythemia vera, the hemoglobin, hematocrit, RBC count and red cell mass are:

elevated

174) The following reaction were obtained: cells tested: anti-A = 4+| anti-B = 3+| anti-A,B = 4+ serum test: A1 cells = 2+ | B cells = 4+ The technologist washed the patients 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: anti-A = 4+ | anti-B = 0 | anti-A,B = 4+ serum test: A1 cells = 0 | B cells = 4+ the results are consistent with:

cmultiple myeloma (Patients with multiple myeloma demonstrate rouleaux formation, which can cause the appearance of agglutination. If the cells are washed to remove residual plasma, and tests repeated, an accurate red cell typing is obtained. By performing a saline replacement with the reverse typing, true agglutination will remain when the cell buttons of the reverse cells are resuspended in saline.)

172) A neonate will be transfused for the first time with group O Red Blood Cells. Which of the following is appropriate compatibility testing?

cno crossmatch is necessary if initial plasma screening is negative (Because neonates are immunologically immature, alloimmunization to red cell antigens is very rare during the neonatal period. No crossmatching is required if the initial antibody screen performed with either the baby's or mother's plasma is negative.)

236) What is the most appropriate diluent for preparing a solution of 8% bovine albumin for red cell control reagent?

cnormal saline (A solution of 8% bovine albumin can be prepared by diluting the more concentrated solution with normal saline. The formula to be used is: [volume 1 x concentration 1] = [volume 2 x concentration 2]. A solution of 6%-8% albumin is used with some anti-D reagents as a control for spontaneous agglutination.)

169) The following test results are noted for a unit of blood labeled group A, Rh-neg, anti-A 4+ anti-B 0 anti-D 3+ What should be done next?

cnotify the collecting facility (A serological test to confirm the ABO on all RBC units and Rh on units labeled as Rh-negative must be performed prior to transfusion. Any errors in labeling must be reported to the collection facility.)

119) The most critical distinction between Staphylococcus aureus and other Staphylococcus is:

coagulase production (Coagulase production is the primary biochemical used to differentiate S aureus from other coagulase-negative staphylococci.)

93) A reliable test for distinguishing Staphylococcus aureus from other staphylococci is:

coagulase(Coagulase is the biochemical test used to distinguish S aureus [positive] from coagulase-negative staphylococci [negative].)

14) An index of precision is statistically known as the:

coefficient of variation ( The coefficient of variation, more useful measure of reproducibility, is measure of relative random error expressed as a percentage.)

244) Which of the following sample collections would give an accurate assessment of potential excess cortisol production?

collect a 24 hr. urine free cortisol

251) Carcinoembryonic antigen is most likely to be produced in a malignancy involving the:

colon

28) Urine specific gravity is an index of the ability of the kidney to:

concentrate the urine

31) HIPAA is a federal law that requires:

confidentiality of patient's health care information between 2 organizations

66) When performing a routine urinalysis, the technologist notes a 2+ protein result. He should:

confirm with the acid precipitation test

4) Which of the following constitutes permanent rejection status of a donor?

confirmed positive test for HbsAg 10 yrs. earlier (A positive test for HbsAg at any time is an indefinite deferral.)

34) A technician is asked to clean out the chemical reagent storeroom and discard any reagents not used in the past 5 years. How should the technician proceed?

consult MSDS sheets for proper disposal

69) An electrical equipment fire breaks out in the lab. Personnel have been removed from immediate danger, the alarm has been activated. What is the next action to be taken?

contain the fire by closing the doors

197) In a double-beam photometer, the additional beam is used to:

correct for variations in light source intensity

41) A chemical that causes immediate visible destruction or irreversible alterations of human tissue at the contact site is best classified as:

corrosive

237) The most characteristic morphologic features of atypical lymphs include:

course nuclear chromatin and basophilic cytoplasm

84) Relationship testing produces the following red cell phenotyping results: alleged father: ABO = B | Rh = D+C-c+E+e- mother: ABO = O | Rh = D+C+E-c-e+ child: ABO = O | Rh = D+C+E-c+e+ What conclusions may be made?

cpaternity may be excluded on the basis of Rh typing (The child's genotype does not include E. The alleged father is homozygous for E. If he was the father the child would also have E. The father can be excluded from paternity.)

199) A blood specimen types as A, Rh-pos with a negative antibody screen. 6 units of group A, Rh-pos RBCs 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?

cperform a DAT on the donor unit (It a patient is negative tor clinically significant antibodies, and a single crossmatch is incompatible, the incompatibility is either due to donor cells with a positive DAT or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

299) 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: Which test should be performed next?

cperform an elution and identify the antibody in the eluate (Lack of expected rise in hemoglobin after transfusion may be a sign of a delayed hemolytic transfusion reaction. If the DAT is positive, an elution should be performed to remove and identify the antibody coating the transfused donor red cells. In this case, the antibody is not detectable in the antibody screen, so a routine cell panel on the serum would not be helpful. Since the transfusion occurred 3 weeks previously, donor samples are not available for testing.)

395) Refer to the following image: The egg depicted above is most likely to be found in children suffering from:

cperianal itching (The most common sign of Enterobius vermicularis infection is intense perianal itching.)

378) If a blood smear is dried too slowly, the RBCs are often:

crenated (Prolonged drying of slides will produce erythrocyte distortion [crenated] on microscopic examination.)

233) 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:

cresidual patient serum inactivated the AHG reagent (A negative reaction after the addition of check cells indicates AHG serum was not present. Inadequate washing of red cells may leave residual patient serum behind, which can neutralize AHG serum.)

348) D-Dimers are produced from:

cross-linked and stabilized fibrin clot (D-dimers are produced from crosslinked and stabilized fibrin clots. This clot is dissolved by plasma and d-dimers are released. Therefore, d-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.)

235) The purpose of testing with anti-A,B is to detect:

csubgroups of A (Ax cells react more strongly with anti-A,B than with anti-A. If anti-A is nonreactive, Ax cells may be detected with anti-A,B.)

37) Plastic bag overwraps are recommended when thawing FFP in a 37 C water bath. because they prevent:

cthe entry ports from being contaminated with water (FFP thawed in a water bath should be protected so that entry ports are not contaminated with water. One can may use a plastic overwrap or keep ports above the water level.)

187) A mother is Rh neg. and the father is Rh pos. their baby is Rh neg. It may be concluded that:

cthe father is heterozygous for D (The mom does not have the D gene. The father would have to have inherited one gene that produces D and another gene that does not produce D. The mom and dad both passed on genes that do not produce D.)

327) Irradiation of donor blood is done to prevent which of the following adverse effects of transfusion?

ctransfusion associated graft-vs-host disease (Gamma irradiation of blood products prevents donor lymphocytes from replicating after transfusion and causing transfusion associated graft-vs-host disease in susceptible patients.)

190) 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:

culture was not incubated long enough(Media for isolation of Legionella should be incubated at 35 - 37 C for at least 7 days.)

306) 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% CO2. The smears reveal acid-fast bacilli, and after 7 days no growth appears on the slants. The best explanation is:

cultures held for insufficient length of time(Many species of mycobacteria are slow growing, and may take up to 12 weeks for growth.)

170) What information is essential on patient blood sample labels drawn for compatibility testing?

cunique patient medical # (Samples must be labeled with 2 independent patient identifiers and the date of collection. This information should be identical to that on the patients identification band and request. There must be a mechanism to identify the phlebotomist, but initialing the sample tubes is not required.)

63) An antibiotic used to suppress or kill contaminating fungi in media is:

cycloheximide (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.)

273) The recovery of some Cryptococcus species may be compromised if the isolation media contains:

cycloheximide(Cycloheximide is known to inhibit the growth of some fungal pathogens, including Cryptococcus neoformans.)

56) The best medium for culture of Francisella tularensis is:

cystine glucose blood agar (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.)

28) The following blood gas results were obtained: The patient's results are compatible with which of the following?

emphysema

155) The disease most frequently present in patients with atypical lymphocytosis and persistently negative tests is:

cytomegalovirus infection

258) The process of separation of antibody from its antigen is known as: a. diffusion b. adsorption c. neutralization d. elution

d (An elution is the process of removal of antibody from red blood cells. The product of the elution method is an eluate. The eluate contains the antibody and can be used in antibody identification methods.)

268) Transfusion of plateletpheresis products for HLA-compatible donors is the preferred treatment for: a. recently diagnosed cases of TTP 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

d (Class I HLA antigens on platelets are a known cause for platelet refractoriness. Leukoreduction of blood products is used as a mechanism to reduce or prevent patients from developing antibodies.)

6) Which curve represents the production of beta polypeptide chains of hemoglobin?

d (Development time line of production of Hgb beta chains.)

271) A patient who is group AB, Rh-neg needs 2 units of FFP. Which of the following units of plasma would be most acceptable for transfusion? a. group O, Rh-neg b. group A, Rh-neg c. group B, Rh-pos d. group AB, Rh-pos

d (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with ABO antibodies to A or B antigens the patient may have.)

270) Which of the following is consistent with standard blood bank procedure governing the infusion of FFP? 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

d (FFP should be ABO compatible with the recipient's RBCs. Avoid FFP with antibodies to A or B antigens the patient may have. Group A plasma has anti-B, and should only be transfused to A or O recipients.)

290) A trauma patient who has just received 10 units of blood may develop: a. anemia b. polycythemia c. leukocytosis d. thrombocytopenia

d (Patients receiving >1 blood volume replacement often develop thrombocytopenia and require platelet transfusion.)

284) An unexplained fall in hemoglobin and mild jaundice in a patient transfused with RBCs 1 week previously would most likely indicate: a. paroxysmal nocturnal hemoglobinuria b. posttransfusion hepatitis infection c. presence of HLA antibodies d. delayed hemolytic transfusion reaction

d (Previously immunized patients may have an undetectable level of antibody. Transfusion of antigen-positive donor red cells may cause an anamnestic response and result in a delayed hemolytic transfusion reaction. Symptoms may be mild, and present only as jaundice and unexplained anemia.)

53) When employing the urine reagent strip method, a false-positive protein result may occur in the presence of :

highly alkaline urine

224) Which feature distinguishes Erysipelothrix rhusiopathiae from other clinically significant non-spore-forming, gram-positive, facultatively anaerobic bacilli?

d H2S production(Erysipelothrix rhusipathiae is the only gram-positive bacillus that produces hydrogen sulfide when inoculated into triple sugar iron agar.)

236) The major action of angiotensin II is:

increase vasoconstriction

95) Genes of the major histocompatibility complex:

d contribute to the coordination of cellular and humoral immunity(MHC consists of both class I and class II HLA antigens. Discrimination of self from nonself is the primary function of the HLA system and involves many immune responses.)

173) If present, a characteristic that is helpful in separating Pseudomonas aeruginosa from other members of the Pseudomonas family is:

d growth at 42 C(Pseudomonas aeruginosa grows at 42 C, but this temperature is inhibitory for other Pseudomonas species.)

162) 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:

d irradiated (Bone marrow transplant patients are at risk for transfusion-associated graft-vs-host disease [TA-GVHD] and therefore should receive irradiated blood products.)

312) The function of N-acetyl-L-cysteine in the reagent for acid-fast digestion-decontamination procedure is to:

d liquefy the mucus (N-acetyl-L-cysteine [NALC] is a mucolytic agent; the concentration of NALC may be increased to digest thick, mucoid specimens.)

111) A beta-hemolytic streptococci that is bacitracin-sensitive and CAMP-negative is:

group A(Group A streptococci [Streptococcus pyogenes] are susceptible to bacitracin and CAMP test negative.)

180) An isolate on chocolate agar from a patient with epiglottitis was suggestive of Haemophilus species. Additional testing showed that the isolate required NAD for growth and was nonhemolytic. The organism is most likely Haemophilus:

d parainfluenzae(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.)

255) A 26-year-old female is admitted with anemia of undetermined origin. Blood samples are received 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: The best way to find compatible blood is to:

d perform a warm autoadsorption(Since the auto control is positive after the AHG phase and no reactivity was detected at immediate spin, the serology is most consistent with a warm autoantibody. An adsorption with autologous cells to remove the antibody to used the adsorbed plasma for alloantibody detection is the next step.)

317) 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?

d process all specimens in a biological safety hood(Specimens processed for mycobacterial culture must be processed in a biological safety cabinet to minimize aerosol transmission of the organism.)

315) Symptoms of dyspnea, cough, hypoxemia, and pulmonary edema within 6 hrs. of transfusion is most likely which type of reaction?

dTRALI (Noncardiogenic pulmonary edema, dyspnea, hypotension, and hypoxemia occurring within 6 hours of transfusion are clinical symptoms of TRALI.)

171) The M:E ratio in acute myelocytic leukemia is usually:

high

319) A 4-year-old boy presents with chronic ear infections and is on prophylactic antibiotics. He presents with bleeding. Factor assays reveal: Possible causes are:

dVitamin K deficiency (Long-term antibiotic therapy disrupts normal flora, which provide a source of Vitamin K synthesis, This results in a Vitamin K deficiency.)

203) A 10% red cell suspension in saline is used in a compatibility test. Which of the following would most likely occur?.

da false-negative result due to antigen excess (The strength of agglutination is dependent upon optimal antigen to antibody ratio. Excessive amount of antigen does not allow maximal uptake of antibody per red cell and therefore agglutination is negatively affected leading to weaker or negative results.)

330) The most important step in the safe administration of blood is to:

daccurately identify the donor unit and recipient (The major cause of transfusion associated fatalities is transfusion of blood to the wrong patient.)

223) In DAT and IAT tests, false-negative reactions may result if the:

daddition of AHG is delayed for 40 minutes or more after washing the serum/cell mixture. (After washing cells for the DAT or IAT procedure, the AHG should be added immediately and read. Delay can cause a weakened or negative result due to dissociation of the bound IgG in the prolonged time before reagent is added.)

248) Which one of the following is an indicator of polyagglutination?

dagglutination with normal adult ABO compatible sera (Polyagglutination is a property of the red blood cells. Structures on the red cells are altered due to bacterial enzymes or a somatic mutation, so crypt antigens not normally exposed on cells are now present. Antibodies to the exposed structures are naturally occurring in adult plasma.)

27) CAP requires refrigerator temperature to be recorded:

daily

248) In its guidelines, CAP stresses that communication must be effective and efficient. An effective component to enhance a multifaceted communication plan in the clinical laboratory is:

daily meetings with a question to foster conversation and focus the discussion

90) Even in the absence of prior transfusion or pregnancy, individuals with the Bombay phenotype will always have naturally occurring:

danti-H (Bombay phenotypes [Oh] lack H antigen on their red cells, and produce naturally occurring anti-H in their serum.)

207) Which pair does not match with respect to amniotic fluid?

dark green --- HDFN

257) The Chem. Dept. has requested that a new test be defined in the LIS to run on the existing analyzer. The new test set up is completed by the LIS coordinator. A few days later, the accessioning department receives a request for the new test but an error is displayed when they try to place the order. All other tests can be successfully ordered. The most likely cause of the error is the:

database did not properly update with the new test information

66) Most blood group systems are inherited as:

dautosomal codominant (Blood group genes are autosomal; they are not carried on the sex gene. Whenever the gene is inherited, the antigen is expressed on the red blood cells, which is known as codominant.)

321) Congestive heart failure, severe headache and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction?

dcirculatory overload (Transfusion-induced hypervolemia causing edema and congestive heart failure is a feature of transfusion-associated circulatory overload [TACO]. Hypervolemia is not a complication of a hemolytic, febrile, or anaphylactic transfusion reaction.)

168) Samples from the same patient were received on 2 consecutive days. Test results are summarized below: How should the request for crossmatch be handled?

dcollect a new sample and repeat the tests (Results of ABO and Rh testing on a current specimen must always be compared to that of a previous transfusion record. Errors in typing or patient identification may be detected when discrepancies are found. Collection of a new sample allows determination of which sample was incorrectly collected.)

225) In the direct antiglobulin test, the antiglobulin reagent is used to:

ddetect preexisting antibodies on erythrocytes (Antiglobulin reagent is used to detect the presence of red cells which have been coated in-vivo with IgG and/or C3d. Antiglobulin reagent may be polyspecific [contains an anti-IgG and anti-C3d] or monospecific [anti-IgG or anti- C3d].)

197) Which of the following would most likely be responsible for an incompatible antiglobulin crossmatch?

ddonor red cells have a positive DAT (Since crossmatching is a test between the patient's plasma and donor's cells, any incompatibility is due to the donor's red cells. If a patient is negative for clinically significant antibodies to common antigens, an incompatible unit by the antiglobulin test is due to either a positive DAT on the donors red cells or the patient has an antibody to a low-incidence antigen that the donor's cells possess.)

307) 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 in 5%-10% CO2. After 1 week, the slants show abundant growth over the entire surface. Stains reveal gram-negative bacilli. To avoid this problem:

decontaminate the specimen with sodium hydroxide(Specimens contaminated by normal flora must be decontaminated prior to inoculation of media; NaOH is the most common decontaminant.)

36) Metabolic acidosis is described as a:

decrease in CO2 content and PCO2 with a decreased pH

23) In disk diffusion susceptibility testing, as a antimicrobial agent diffuses away from the disk, the concentration antibiotic is:

decreased (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.)

359) On an electronic particle counter, if the RBC is erroneously increased, how will other parameters be affected?

decreased MCH

363) Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets?

decreased hematocrit (Howell-Jolly bodies and WBC fragments may be mistaken for platelets; clotting may affect platelet numbers; decreased Hct would have no effect on a phase platelet count.)

52) Lab findings in hereditary spherocytosis do not include:

decreased osmotic fragility

50) Thalassemias are characterized by:

decreased rate of globin synthesis

208) Chylomicrons are present in which of the following dyslipidemias?

deficiency in lipoprotein lipase activity

Glycolysis= conversion of glucose to pyruvic acid or lactic acid Glycogenesis= production of glycogen from glucose glycogenolysis= production of glucose from glycogen gluconeogenesis= production of glucose from non-carbohydrate sources

define glycolysis, glycogenesis, glycognolysis, and gluconeogenesis

239) The ability to make good decisions often depends on the use of a logical sequence of steps that include:

defining problem, obtaining facts, considering options

244) The most meaningful laboratory procedure in confirming the diagnosis of clinical botulism is:

demonstration of toxin in the patient's serum (Botulism infection is confirmed by reference laboratories such as the CDC by demonstrating toxin in serum, feces, gastric contents or vomitus.)

15) Heinz bodies are:

denatured hemoglobin inclusion that are readily removed by the spleen

51) One of the elements of a written laboratory chemical hygiene plan is to:

designate a laboratory chemical hygiene officer

211) Peritoneal lavage is used to:

detect intra-abdominal bleeding in blunt injury

334) In a suspected case of Hansen disease (leprosy), a presumptive diagnosis is established by:

detection of weakly acid-fast bacilli in infected tissue(Mycobacterium leprae cannot be cultured in vitro. A clinical diagnosis is made, supported by the presence of AFB in a biopsy specimen.)

29) CAP requires that glassware cleaning practices include periodic testing for:

detergents

308) Fever and chills are symptoms of which of the following transfusion reactions?

dfebrile (Febrile nonhemolytic transfusion reactions are defined as fever of 1C or greater [over baseline temperature] during or after transfusion, with no other reason for the elevation than transfusion, and no evidence of hemolysis in the transfusion reaction investigation. Allergic reactions, citrate toxicity, and circulatory overload are not characterized by fever.)

311) A 65 yr. old woman experienced shaking, chill, and a fever of 102 F (38.9 C) approximately 40 minutes following the transfusion of a second unit of RBCs. The most likely explanation for the patient's symptoms is:

dfebrile transfusion reaction (Febrile nonhemolytic transfusion reactions occur in about 1% of transfusions, making it one of the most common types of reaction. Neither transfusion-associated circulatory overload [TACO] or anaphylactic transfusion reactions are characterized by fever. Bacterially contaminated Red Blood Cells are rare, and rapidly produce severe symptoms upon transfusion.)

297) A patient's records show a previous anti-Jkb, but the current antibody screen is negative. What further testing should be done before transfusion?

dgive Jkb neg crossmatch compatible blood (Delayed hemolytic transfusion reactions may occur in recipients who are previously immunized but who do not have detectable antibody, if they receive blood with the corresponding antigen. When there is a history of clinically significant antibodies, donor red cells should be phenotyped and antigen-negative blood selected. A complete antiglobulin crossmatch must be performed.)

97) Saliva from which of the following individuals would neutralize an auto anti-H in the serum of a group A, Le(a-b+) patient:

dgroup O, Le(a-b+) (Group O have the most H substance in their saliva. The person must also be a secretor of ABH substances. Due to gene interaction between the secretor gene and Lewis gene, people who are Le[a-b+] assures H in their saliva.)

383) Trophozoites of the cyst shown above are likely to:

dhave slow, undefined motility (Trophozoites of Entamoeba coli demonstrate slow and undefined motility.)

125) A urine specimen is tested and has the following results: This is indicative of:

diabetes mellitus

147) A patient has glucosuria, hyperglycemia and polyuria. These findings are most consistent with:

diabetes mellitus

153) Polyuria is usually correlated with:

diabetes mellitus

339) In the Malloy and Evelyn method for the determination of bilirubin: the reagent that is reacted with bilirubin to form a purple azobilirubin is:

diazotized sulfanilic acid

193) One means of checking a spectrophotometer wavelength calibration is the visible range is by using a:

didymium filter

39) A medium that aids in the presumptive identification of organisms based on their appearance on the medium is called:

differential (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 xyloselysine desoxycholate agar.)

208) Chromatography is based on the principle of:

differential solubility

29) Factors that contribute to a PCO2 electrode requiring 60-120 seconds to reach equilibrium include the:

diffusion characteristics of the membrane

83) The possibility of detecting glitter cells is associated with urine that is:

dilute

361) The following results were obtained on an electronic particle counter: What step should be taken before recycling the sample?

dilute the specimen("+++" indicates a WBC that is above the reportable range of the instrument; dilute the sample and rerun.)

128) ABO hemolytic disease of the newborn:

dis usually seen only in the newborn of group O mothers (ABO HDFN is a mild disease, not usually requiring transfusion. It may occur in any pregnancy in which there is ABO incompatibility. High-titered IgG antibodies are more frequently seen in group O mothers than in A or B mothers.)

87) Contaminated needles and syringes without safety self-sheathing devices should be:

discard directly into an appropriate sharps container

233) A major laboratory policy change that will affect a significant portion of the laboratory personnel is going to take place. In order to minimize the staff's resistance to this change, the supervisor should:

discuss the policy change in detail with all personnel concerned, well in advance of implementation

42) Which of the following methods is inadequate for the detection of vancomycin-intermediate S aureus?

disk diffusion (The disk diffusion procedure will not differentiate S aureus strains with reduced susceptibility to vancomycin [MICs 4 -8 mg/mL] from susceptible stains even when incubated for 24 hours.)

62) To prepare the reagent used in confirmatory protein testing, a technician would:

dissolve 3 g sulfosalicylic acid in 100 mL of water

29) Osmolality is a measure of:

dissolved particles, including ions

119) Alkaline urine showed this microscopic finding. The technologist should:

dissolved with acetic acid

90) The most appropriate screening test for hemoglobin S is:

dithionite solubility

161) A 40 year old man with autoimmune hemolytic anemia due to anti-E has a hemoglobin level of 10.8 g/dL. This patient will most likely be treated with:

dno transfusion (Transfusion should generally be avoided except in cases of life-threatening anemia. A hemoglobin of 10.8 g/dL [108 g/L] is not life-threatening, especially if the patient is not actively bleeding.)

117) 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?

do a tube coagulase test to confirm the slide test (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.)

175) What is the most likely cause of the following ABO discrepancy? Cells: anti-A = 0 | anti-B = 0 serum: A1 cells = 0 | B cells= 0

dobtained from the heel stick of a 2 month old baby (ABO immunoglobulins develop at approximately 3 months of age, attain adult levels by age 10, and may, but not always, decline in titer in the elderly)

3) A swab and requisition are received in the microbiology laboratory with the following information: The laboratory receiving clerk notes a discrepancy between the patient identifiers on the requisition and the specimen label, and questions the emergency department nurse MB. This is the fourth specimen this week that has had a specimen discrepancy. What action is the most appropriate to prevent this type of error in the future?

document error and communicate to laboratory supervisor so that the risk manager conducts a root cause analysis

182) The following results were obtained on a patient's blood sample during routine ABO and Rh testing: Select the course of action to resolve this problem:

dperform antibody screening procedure at immediate spin using group 0 cells (Unexpected reactivity with reverse cells should include a test with screen cells at immediate spin to determine if alloantibodies are present. Resolution of the ABO discrepancy can be performed with group B cells that lack the corresponding antigen for the identified alloantibody.)

373) Artifacts found in a stool specimen that can be confused with ova or cysts are:

dpollen grains (Pollen grains are common artifacts in stool specimens submitted for ova and parasite examination. Their appearance is similar to protozoan cysts.)

83) In relationship testing a "Direct exclusion" is established when a genetic marker is:

dpresent in child, absent in the mother and alleged father (When a marker is in a child that the mother and alleged father do not have the alleged father cannot be the biological father of the child. This is a direct exclusion.)

43) Upon inspection, a unit of platelets is noted to have visible clots, but otherwise appears normal. the tech should:

dquarantine for gram stain and culture (Clots in the unit may indicate contamination.)

318) During the issue of an autologous unit of Whole Blood, the supernatant plasma is observed to be dark red in color. What would be the best course of action?

dquarantine the unit for further testing (One reason to quarantine blood components before transfusion is hemolysis of the red cells. Hemolysis of red cells is an indication of contamination or improper storage.)

76) 4 units of blood are needed for elective surgery. the patient serum contains anti-C, anti-e, anti-Fya and anti-Jkb. Which of the following would be the best source of donor blood:

drare donor file (The frequency of compatible donors for this patient can be calculated by multiplying the percentage of the population that is e-C- x Fy[a-] x Jk[b-]. The blood supplier's immunohematology reference laboratory may have units in stock or can request blood from other IRLs through the American Rare Donor Program.)

6) A 25 yr. old man became nauseated and vomited 90 mins after receiving a standard 75 g carbohydrate dose for an oral glucose tolerance test. The best course of action is to:

draw blood for glucose and discontinue the test

195) The major crossmatch will detect a (an):.

drecipient antibody directed against antigens on the donor red cells (The major crossmatch tests the recipient's plasma with donor's cells. This would detect any antibody in the recipient that would react with antigens on the donor's RBCs. If a patient were mistyped as a group O rather than group A, then group O cells would be selected for crossmatch and no incompatibility would be found.)

20) A unit of RBCs is issued at 9 am and at 9:10 am it 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 tech is to:

drecord the return and place the unit back into inventory (Blood may be returned to the blood bank after issue provided that 1] the container has not been entered, 2] at least 1 sealed segment is attached to the container, 3] visual inspection of the unit is satisfactory and documented, and 4] the unit has been maintained at the appropriate storage or transport temperature. Studies have shown that refrigerated components retain an acceptable temperature of <10 C for up to 30 minutes after removal from the refrigerator.)

302) For a patient who has suffered an acute hemolytic transfusion reaction, the primary treatment goal should be to:

dreverse hypotension and minimize renal disease (Treatment of acute hemolytic transfusion reactions focuses on supportive measures and control of DIC, hypotension, and acute renal failure.)

396) Refer to the following illustration: The specimen of choice for finding the above parasite is:

dscotch tape preparation (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.)

234) Which of the following might cause a false-negative IAT?

dtoo heavy a cell suspension (Weak antibodies may be missed if there are excess RBC antigens as there may be too few antibodies to bind to red cell antigens.)

186) The following results were obtained when testing a sample from a 20 year old first time blood donor Forward: anti-A = 0 | anti-B = 0 Reverse: A1 cells = 0 | B cells = 3+ What is the most likely cause of this ABO discrepancy?

dweak subgroup of A (Some subgroups of A are only recognized because of their lack of anti-A in the reverse typing. Often, the donors are confirmed as subgroups of A by an adsorption-elution technique.)

312) A sickle cell patient who has been multiply transfused experiences fever and chills after receiving a unit of RBCs. Transfusion investigation studies show: DAT: neg Plasma hemolysis: none The patient is most likely reacting to:

dwhite cells or cytokines (Febrile nonhemolytic transfusion reactions are caused by leukoagglutinins in the patient or cytokines released from donor leukocytes during storage. Since these reactions are not caused by red cell antibodies, transfusion investigation studies show no hemolysis or abnormal test results.)

99) Which of the following Rh antigens has the highest frequency in Caucasians:

e (The overall incidence of the e antigen is 98%. The overall incidence of c is 80%, D is 85% and E is 30%.)

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

70) Class C fires involve:

electrical equipment

21) Which type of microscope would be most useful in examining viruses and the structure of microbial cells?

electron (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.)

31) Which of the following is the most appropriate specimen source and primary media battery?

endocervical - chocolate, Martin Lewis(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.)

186) In infectious mono, lymphocytes tend to be:

enlarged and indented by surrounding structures

55) For safe operation of a centrifuge:

ensure proper balance is maintained

114) It is important to differentiate between Enterococcus and group D streptococci because:

enterococci often show more antibiotic resistance than group D streptococci(Enterococcus species are more resistant to antimicrobial therapy than group D streptococci such as S bovis.)

200) Which stain is used to measure sperm viability?

eosin-nigrosin

17) Cells for the transport of O2 and CO2 are:

erythrocytes

225) Listeria can be confused with some streptococci because of its hemolysis and because it is:

esculin positive(Listeria may be confused with some streptococci because Listeria is beta- hemolytic and is capable of hydrolyzing esculin.)

45) A technologist spilled 10 gallons of formaldehyde on the floor. After determining the chemical poses a significant health hazard. the first action step would be to:

evacuate the area

22) After satisfactory performance of daily disk diffusion susceptibility quality control is documented, the frequency of quality control can be reduced to:

every week(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.)

385) On a smear made directly from a finger stick, no platelets were found in the counting area. The first thing to do is:

examine the slide for clumping (Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins. It is important to examine the edges for platelet clumping.)

28) A liquid fecal specimen from a 3 month old infant is submitted for microbiological exam. In addition to culture on routine media for Salmonella and Shigella, this specimen should be routinely:

examined for the presence of Campylobacter sp. (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 nonpathogenic parasite and does not cause diarrhea.)

161) Amino tranferase enzymes catalyze the:

exchange of amino and keto groups between alpha-amino and alpha-keto acids

2) False results in the urobilinogen testing may occur if the urine specimen is:

exposed to light

338) Photochromogens produce pigment when:

exposed to light for 1 hour (Pigment production is controlled by an oxygen-dependent, light-inducible enzyme in photochromogenic mycobacteria.)

80) Many microspherocytes, schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with:

extensive burns

339) 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 are tested at 10-,30-, and 60-min. intervals. The PT and APTT results on all of the mixtures are corrected .These results would indicate the presence of:

factor deficiency (A mixing study, when corrected, indicates a factor deficiency. Lack of correction indicates an inhibitor. Some inhibitors may only become evident after the patient's plasma is allowed to interact with the normal plasma after incubation. In this case, correction occurred immediately, as well as after incubation, confirming a factor deficiency.)

285) Unless blood gas measurements are made immediately after sampling, in vitro glycolysis of the blood causes a:

fall in pH and a rise in PCO2

387) A blue top tube is drawn for coagulation studies, the sample is a short draw results may be:

falsely prolonged (Falsely prolonged results will occur if there is too much anticoagulant for the plasma; this also occurs with an increased Hct. Conversely, if a tube is overdrawn, there may be too little anticoagulant, resulting in a clot.)

313) When separating serum proteins by cellulose acetate electrophoresis, using Veronal buffer at pH 8.6. beta globulin migrates:

faster than gamma globulin

14) Which of the following values obtained during a glucose tolerance test are diagnostic of diabetes mellitus?

fasting plasma glucose = 126 mg/dL (6.9 mmol/L)

205) 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

genitourinary tract(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.)

185) Amniotic fluid is tested for the concentration of lamellar bodies. This test determines:

fetal lung maturity [FLM]

120) Polarized light can often be used to differentiate between:

fibers and mucus clumps

202) A technologist is asked to write a procedure to measure the Evan blue concentration on a spectrophotometer. The technologist is given 4 standard solutions of Evan blue: The first step is to:

find wavelength of greatest absorbance for Evan blue

35) Using a common labeling system for hazardous material identification such as HMIS or NFPA 704, the top red quadrant represents which hazard?

flammability

45) The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is:

folic acid deficiency

20) The clarity of a urine sample should be determined:

following thorough mixing of the specimen

248) Clinical assays for tumor markers are most important for:

for monitoring therapy, detecting recurrence and aiding in prognosis of tumors but are not useful for screening the general population for cancer

37) Which chemical is a potential carcinogen?

formaldehyde

314) 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:

formaldehyde may be produced (If exposed to light, agar-based media such as 7H11 may release formaldehyde, which is toxic to mycobacteria.)

347) Excess D-Dimer indicate that clots have been:

formed and are being excessively lysed (D-dimers are produced from crosslinked and stabilized fibrin clots. This clot is dissolved by plasma and d-dimers are released. Therefore, d-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.)

102) Prior to reporting a RBC cast, it is important to observe:

free-floating RBCs

353) The osmolality of a urine or serum specimen is measured by a change in the:

freezing point

125) 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 should differentiate between a coagulase-negative Staphylococcus and Micrococcus?

furazolidone (100 ug/disk) susceptibility(Micrococcus and Staphylococcus can be differentiated by susceptibility to furazolidone [100 mg/disk]. Staphylococcus is susceptible and Micrococcus is resistant.)

23) An infant with diarrhea is being evaluated for a carbohydrate intolerance. His stool yields a positive copper reduction test and a pH of 5.0. It should be concluded that:

further tests are indicated

174) Which of the following is the formula for calculating the number of moles of a chemical?

g/GMW Moles=gm/molecular weight.

155) The reason for performing a Clinitest on a newborn's urine is to check for:

galactose

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

311) To detect barbiturate abuse when analyzing urine specimens, immunoassay is the method of choice for screening. The method of choice for confirmation is:

gas chromatography/mass spectrometry

236) A patient diagnosed as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood?

granulocytic leukemoid reaction

48) Which of the following antibiotics would routinely be tested and reported for isolates of Pseudomonas aeruginosa?

gentamicin(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.)

169) To prepare the reagent used for mucin clot determination of synovial fluid, water is mixed with:

glacial acetic acid

320) Hydrogen ion concentration in blood is usually determined by means of which of the following electrodes?

glass (The pH electrode, a glass electrode, contains a specially designed thin piece of glass as a membrane. The glass membrane is made of silicon dioxide, added oxides and various metals. The membrane is selectively sensitive to hydrogen ions.)

113) Creatinine clearance is used to estimate the:

glomerular filtration rate

104) What is the most likely diagnosis given this microscopic finding?

glomerulonephritis

136) A urinalysis performed on a 27-year-old woman yields the following results: These findings are most consistent with:

glomerulonephritis

96) Which 2 diseases are usually preceded by infection with beta-hemolytic streptococci?

glomerulonephritis, rheumatic fever(Noninfectious sequelae associated with infection with Streptococcus pyogenes are glomerulonephritis and rheumatic fever.)

129) Which of the following positive chemical reactions is most closely associated with the presence of yeast in the urine sediment?

glucose

134) The following urinalysis results were obtained from an 18-year-old woman in labor: 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

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

11) Pregnant women with symptoms of thirst, frequent urination or unexplained weight loos should have which of the following tests performed?

glucose tolerance test

350) The substance that is measured to estimate the serum concentration of triglycerides by most methods is:

glycerol

13) The conversion of glucose or other hexoses into lactate or pyruvate is called:

glycolysis

154) Which of the following is the formula for calculating a percent (w/v) solution?

gm of solute/vol of solvent x 100 (The most frequently used expression, concentrations of m/v are reported as grams percent [g%] or g/dL, as well as mg/dL and ug/dL. When percent concentration is expressed without a specified form, it is assumed to be weight per unit volume.)

257) In flow cytometric analysis, right angle of side scatter of a laser light beam provides information that pertains to the cell's:

granularity

59) All laboratory instruments should:

grounded or double insulated

104) The organism most commonly associated with neonatal purulent meningitis is:

group B streptococci (All of the organisms listed are potential causes of meningitis. Group B Streptococcus is associated with neonatal meningitis and meningitis in the elderly.)

112) A beta-hemolytic Streptococcus that is bacitracin-resistant and CAMP-positive is:

group B(Group B streptococci [Streptococcus agalactiae] are resistant to bacitracin and CAMP test positive.)

98) A gamma-hemolytic Streptococcus that blackens bile esculin agar but does not grow in 6.5% NaCl broth is most likely:

group D Streptococcus (Group D streptococci and Enterococcus produce a positive bile esculin test; however, of these two, only Enterococcus grows in the presence of 6.5% NaCl.)

192) 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?

growth at 42 C, pyocyanin production, gelatinase production(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].)

113) Group B, beta-hemolytic streptococci may be distinguished from other hemolytic streptococci by which of the following procedures?

growth in 6.5% NaCl broth (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.)

103) 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?

growth in 6.5% NaCl broth(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.)

108) A catheterized urine is inoculated onto blood and MacConkey agar using a 0.01 mL loop. After 48 hrs., 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:

growth of 6,800 colonies/mL of a Streptococcus species, esculin hydrolysis and NaCl growth test to follow(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.)

221) Which of the following is secreted by the placenta and used for the early determination of pregnancy?

hCG is the primary marker for early pregnancy

61) For fire safety and prevention:

hallways and corridors should be clear and free of obstruction at all times

59) The linked HLA genes on each chromosome constitutes a (an):

haplotype (The entire set of HLA antigens located on one chromosome is a haplotype.)

52) The purpose of the OSHA hazard Communication , General Industry Standard, 29 CFR, Subpart Z, 1910.1200, is to require employees to establish a program ensuring personnel are provide with information regarding the workplace dangers of:

hazardous chemicals

3) The majority of the iron in an adult is found as a constituent of:

hemoglobin (2/3 iron body bound to Hgb.)

16) Monitoring long term glucose control in patients with adult onset diabetes mellitus can best be accomplished by measuring:

hemoglobin A1c

75) The smear represented below displays:

hemoglobin C disease

88) With this blood picture, an additional test indicated is:

hemoglobin electrophoresis(Hgb C crystals can be seen in patients with Hgb C disease, more often in individuals who have undergone splenectomy.)

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

181) Increased serum lactic dehydrogenase activity due to elevation of fast fraction (1 and 2) on electrophoretic separation is caused by:

hemolytic anemia

241) In synovial fluid, the most characteristic finding in traumatic arthritis is:

hemosiderin laden macrophages

306) Which of the following statements concerning Vitamin K is NOT true?

heparin inhibits action of Vit. K

171) In which of the following conditions would a normal level of creatine kinase be found?

hepatitis

91) Which infectious agent is considered to be the primary occupational health hazard regarding transmission of bloodborne pathogens?

hepatitis B

250) Increased concentrations of alpha-fetoprotein in adults are most characteristically associated with:

hepatocellular carcinoma.

351) Encephalitis is most commonly associated with which of the following viruses?

herpes simplex (Herpes simplex virus is the most common cause of fatal sporadic encephalitis in the United States.)

332) The most specific method for the assay of glucose utilizes:

hexokinase

146) The M:E ratio in chronic myelocytic leukemia is usually:

high

264) Which of the following cells contain hemosiderin?

histiocyte (Bone marrow and splenic macrophages contain hemosiderin; histiocyte is a collective term for macrophages.)

203) Which of the following is used to verify wavelength settings for narrow bandwidth spectrophometers?

holmium oxide glass

351) Which of the following methods for quantitation of high-density lipoprotein is most suited for clinical laboratory use?

homogeneous

92) Which of the following casts is most likely to be found in healthy people?

hyaline

214) Definitive identification of Neisseria gonorrhoeae is made with the:

hydrolysis of carbohydrates (Of the choices provided, only fermentation of carbohydrates provides definitive identification of Neisseria gonorrhoeae.)

118) Which of the following would best differentiate Streptococcus agalactiae from Streptococcus pyogenes?

hydrolysis of sodium hippurate (Of the biochemicals listed only hydrolysis of sodium hippurate will differentiate Streptococcus agalactiae [positive] from S pyogenes [negative].)

65) A patient has the following results: increased serum calcium decreased serum phosphate increased levels of parathyroid hormone: This patient most likely has:

hyperparathyroidism

144) The white cell feature most characteristic of pernicious anemia is:

hypersegmentation

38) A common cause of respiratory alkalosis is:

hyperventilation

332) Acute DIC is characterized by:

hypofibrinogenemia (The laboratory profile for a patient with acute DIC is: increased PT, APTT, D-dimer decrease in platelets and hypofibrinogenemia.)

212) A patient has the following thyroid profile: total T4 = decreased free T4 = decreased thyroid peroxisase antibody = positive TSH = increased This patient most probably has:

hypothyroidism

128) The term "shift to the left" refers to:

immature cell forms in the peripheral blood

240) A diagnosis of primary adrenal insufficiency requires demonstration of:

impaired response to ACTH stimulation

308) 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% CO2. The smears reveal acid-fast bacilli, but the slants show no growth after 8 weeks. The explanation is:

improper media used (Sabouraud dextrose is fungal media; mycobacterial media should have been inoculated.)

17) A patient with Type I, insulin-dependent diabetes mellitus has the following results: After reviewing these test results, the technologist concluded that the patient is in a:

improving state of metabolic control as indicated by fructosamine

10) In order for hemoglobin to combine reversibly with oxygen, the iron must be:

in the ferrous state

101) "Nutritionally deficient" streptococci are:

in the genera Granulicatella and Abiotrophia(Organisms that used to be categorized as nutritionally variant or deficient streptococci have been reclassified into the genera Abiotrophia and Granulicatella.)

364) The most common cause of error when using automated cell counters is:

inadequate mixing of the sample prior to testing

260) 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:

include media that have cycloheximide and chloramphenicol added to inhibit bacterial organisms and saprophytic fungi(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.)

156) Ketones in urine are due to:

incomplete fat metabolism

37) Respiratory acidosis is described as a(n):

increase in CO2 content and PCO2 with a decreased pH

380) Blood collected in EDTA undergoes which of the following changes if kept at room temp for 6 - 24 hrs.

increased Hct and MCV (Tubes that remain at room temperature for >5 hours have unacceptable blood cell artifacts. This will affect the Hct and the MCV.)

105) When using an electronic cell counter, which of the following results can occur in the presence of a cold Agglutinin:

increased MCV & decreased RBC

96) When using the turbidity method for detecting the presence of hemoglobin S, an incorrect interpretation may be made when there is a:

increased hemoglobin

196) Which of the following is not a characteristic usually associated with hairy cell leukemia?

increased resistance to infection

168) Biochemical abnormalities characteristic of polycythemia vera include:

increased serum B12 binding capacity

43) Upon standing at room temp, a urine pH typically:

increases

87) To quality control the autoclave, a vial of Bacillus stearothermophilus is autoclaved and should they be:

incubated at 56 C (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.)

65) The RDW-CV and RDW-SD performed by automated cells counters are calculations that provide:

index of distribution of RBC vol

309) Which of the following methods is susceptible to the solvent displacing effect that results in falsely decreased electrolyte values?

indirect ion selective electrodes

89) Which of the following combinations of organisms would be appropriate as controls to test the functions listed?

indole - negative Escherichia coli and Proteus mirabilis(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.)

204) Pilocarpine iontophoresis refers to the specific process of:

inducing sweat

352) Heparin acts by:

inhibiting thrombin (Heparin acts by inhibiting thrombin and Factor Xa. Anticoagulants, such as sodium citrate, act by binding calcium to prevent a blood sample from clotting.)

346) Virus transport medium containing penicillin, gentamicin and amphotericin is used to collect and transport specimens for virus culture because this medium:

inhibits bacterial and fungal growth (Antibiotics and antifungal agents are added to viral transport medium to inhibit the growth of bacteria and fungus.)

280) ln a specimen collected for plasma glucose analysis, sodium fluoride:

inhibits glycolysis

19) In order to isolate Campylobacter coli/jejuni the fecal specimen should be:

inoculated onto selective plating media and incubated in reduced oxygen with added CO2 at 42 C (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.)

urobiligin is formed in the

intestine

347) Which of the following indicates the presence of a viral infection in tissue smears or biopsies?

intranuclear inclusions (In tissue smears or biopsy specimens, the presence of virally infected cells is indicated by intranuclear or intracytoplasmic inclusions.)

146) The following results are seen on a maternal postpartum sample: The most appropriate course of action is to:

investigate for a fetomaternal hemorrhage (The presence of D+ infant's red cells in the mother's circulation can cause the weak D test to show mixed-field agglutination. Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

234) When employees are going to be responsible for implementing a change in procedure or policy, the manager should:

involve the employees in the decision-making process from the very beginning

14) After the removal of RBCs from the circulation hemoglobin is broken down into:

iron, protoporphyrin, globin

143) To prevent graft vs host disease, RBCs prepared for infants who have received intrauterine transfusions should be:

irradiated (Blood selected for intrauterine transfusion and transfusion to premature infants should be irradiated to prevent graft-vs-host disease.)

352) A chemiluminescent EIA:

is quantitated by the amount of light produced by treactions

153) Plesiomonas shigelloides is a relatively new member of the family Enterobacteriaceae. What characteristic separates it from other members of the Enterbacteriaceae?

it is oxidase positive(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.)

163) The urinary tract structures responsible for renal concentration are the:

juxtamedullary nephrons

312) The most potent plasminogen activator in the contact phase of coagulation is:

kallikrein (A clot is degraded by plasmin in the fibrinolytic system. Plasminogen is the zymogen produced when Factor XIIa and kallikrein are produced by contact activation.)

180) The following results were obtained on a 55-year-old man complaining of headaches and blurred vision: These results are consistent with:

leukoerythroblastosis in myelofibrosis (Recognizes red cell increase secondary to stimulation of excessive erythropoietin produced in kidney.)

102) The following results were obtained from a post-surgical patient receiving total parenteral nutrition:

lipid interference on days 17 and 18(Any turbidity in the cyanmethemoglobin reagent- patient specimen will result in falsely elevated values.)

160) Aspartate amino transferase (AST) is characteristically elevated in diseases of the:

liver

172) Of the following diseases, the one most often associated with elevations of LD isoenzymes 4 and 5 on electrophoresis is:

liver disease

140) The Philadelphia chromosome is formed by a translocation between the:

long arm of chromosome 22 and long arm of chromosome 9

33) A 68 yr. 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 from this patient is likely to be:

low pH

9) Serum levels that define hypoglycemia in pre-term or low birth weight infants are:

lower than adults

74) The best way to lower the light intensity of the microscope is to:

lower the rheostat

138) Terminal deoxynucleotidyl tranferase is a marker found on:

lymphoblasts

130) Cells that produce antibodies and lymphokines are:

lymphocytes

152) In an uncomplicated case of infectious mononucleus, which of the following cells are affected?

lymphocytes

179) All of the following conditions are myeloproliferative disorders except:

lymphocytic leukemia (Discriminates between conditions due to granulocytic precursor, which would exclude lymphocytic leukemia.)

139) Multipotent stem cells are capable of producing:

lymphoid and myeloid stem cells

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

209) The cytoplasmic abnormality of the white blood cell of Alder-Reilly anomaly is found in the:

lysosomes

173) Which of the following is most closely associated with chronic myelomonocytic leukemia?

lysozymuria (Findings differentiate between CMML vs CML, AML, and myelofibrosis.)

12) The creatinine clearance is reported in:

mL/min

43) The characteristic morphologic feature in folic acid deficiency is:

macrocytosis

259) The major features by which molds are routinely identified are:

macroscopic characteristics and microscopic morphology (Macroscopic characteristics and microscopic morphology are observations used for the routine identification of molds.)

67) Which of the following is most likely to be ordered in addition to serum calcium to determine cause of tetany?

magnesium

72) The primary function of serum albumin in the peripheral blood is to:

maintain colloidal osmotic pressure

240) In planning an instructional unit, the term goal has been defined as a:

major purpose or final desired result

354) In an automated cell counter the WBC printed result is "+++" The next step is to:

make an appropriate dilution of the sample ("+++" is an indicator that the WBC count exceeds the upper reportable limit.)

270) Lithium therapy is widely used in the treatment of:

manic depression or bipolar disorder

382) 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:

many platelets are abnormally large (Instruments count particles within defined size limits. The upper limit is to separate large platelets from erythrocytes. Large platelets may be counted as erythrocytes.)

21) Milky urine from a 24-year-old woman would most likely contain:

many white blood cells

262) The metabolite 11-nor-tetrahydrocannabinol-9-COOH can be detected by immunoassay 3 -5 days after a single use of:

marijuana

207) A mass spectrometer detects which property of ionized molecules?

mass to charge ratio

178) Haemophilus influenzae is most likely considered normal indigenous flora in the:

oropharynx (Haemophilus influenzae is indigenous flora of the upper respiratory tract.)

191) Which of the following is true of acute lymphoblastic leukemia?

massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs (Characteristics of ALL; onset highest 1-5 years of age peak at 2-3 years of age presents with lethargy, fever, bone pain, with poor prognosis under 1 year of age.)

2) Which action by the phlebotomist will comply with the College of American Pathologists (CAP) Patient Safety Goal "to improve patient and sample identification at the time of specimen collection" and The Joint Commission Patient Safety Goal to "improve the accuracy of patient identification"?

match the name and medical record number on the patient's ID bracelet to the name and medical record number on the preprinted collection label

231) In the image below, the small nucleated cell seen in the lower left corner is a:

mature lymphocyte

160) The statistical term for the average value is the:

mean

1) After receiving a 24 hr. urine for quantitative total protein analysis the technician must first:

measure the total volume

74) The first step in analyzing a 24 hr. urine specimen for quantitative urine protein is:

measure the total volume

54) When working with sharp equipment and objects use:

mechanical device

262) vWF antigen can be found in which of the following?

megakaryoblast (vWF is a constituent of platelet alpha granules, and is synthesized in megakaryocyte as it develops.)

145) Which of the following conditions is not associated with a high incidence of leukemia?

megaloblastic anemia

148) Abnormalities found in erythroleukemia include:

megaloblastoid development

22) A brown/black urine would most likely contain:

melanin

205) Which of the following is associated with Chediak-Higashi syndrome?

membrane defect of lysosomes

204) Assuming the agent isolated from a patient's spinal fluid produces a positive oxidase test, the most likely diagnosis is:

meningococcal meningitis (Of the possible types of meningitis listed, only Neisseria meningitidis is oxidase positive.)

26) The expected blood gas results for a patient in chronic renal failure would match the pattern of:

metabolic acidosis

27) Severe diarrhea causes:

metabolic acidosis

133) In normal adult bone marrow, the most common granulocyte is the:

metamyelocyte

230) Which of the following medications is most likely to cause production of autoantibodies?

methyldopa (Methyldopa is frequently listed as the prototype for drug-independent antibody mechanism where autoantibody is present on the red cells and may also be present in the plasma.)

128) The unit of measure for a standard solution is:

mg/mL

100) The lab findings on a patient are as follows: MCV = 55 um MCHC = 25% MCH = 17 pg A stained blood film of this patient would most likely reveal a red cell picture that is:

microcytic, hypochromic

121) Which of the following activities is not under the direction or control of the lab manager?

military leave

3) The lowest concentration of antibiotic that inhibits growth of a test organism is the :

minimum inhibitory concentration(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.)

161) The most frequent value in a collection of data is statistically known as:

mode

194) In spectrophotometry, the device that allows for a narrow

monchromator

338) The APTT:

monitors heparin therapy (The APTT is performed to monitor the effects of unfractionated heparin, to detect factor deficiencies, and the presence of inhibitors. The PT tests the extrinsic pathway and requires tissue thromboplastin. It is also used to monitor warfarin therapy.)

206) In a spectrophotometer, light of a specific wavelength is isolated from the light source by the:

monochromator

233) This cell is a: 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

monocyte

217) In synovial fluid , the most characteristic microscopic finding in gout is:

monosodium urate crystals

77) The characteristic peripheral blood morphologic feature in multiple myeloma is:

most characteristic finding in multiple myeloma is rouleaux formation of red cells.

145) Rh-Immune Globulin is requested for an Rh-negative mother who has the following results: What is the most likely explanation?

mother had a fetomaternal hemorrhage of D+ cells (Care must be taken so that fetal Rh-positive RBCs in the maternal circulation are not interpreted as maternal, because the mother would be assumed erroneously to be weak D+.)

42) Select the test which evaluates renal tubular function:

osmolarity

148) What is the best interpretation for the laboratory data given above?

mother has had a fetal-maternal hemorrhage (The weak D result is most likely due to excessive bleed of fetal cells. Rosette results indicate a quantitative test for approximate volume of fetal-maternal bleed should be performed.)

147) What is the most appropriate interpretation for the laboratory data given below when an Rh-neg woman has an Rh-pos child? mother: 1 rosette/3 fields Positive Control.: 5 rosettes/3 fields Negative Control: no rosettes

mother need 1 vial RhIg (The rosette test is a qualitative test. When enzyme-treated cells are used as indicator cells, a negative test [indicating there was not an excessive bleed] can have up to 1 rosette per 3 fields. The mother needs to receive 1 vial of RhIg for a normal bleed.)

222) The best procedure to differentiate Listeria monocytogenes from Corynebacterium species is:

motility at 25 C (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 Corynebacterium species are motile when grown at 35 C.)

213) Which semen result is abnormal?

motility of 1.0

206) Which of the following is associated with Alder-Reilly inclusions?

mucopolysaccharidosis

282) Which of the following is characteristic of platelet disorders?

mucous membrane hemorrhage

144) In performing a spinal fluid protein determination, the specimen is diluted 1 part spinal fluid to 3 parts saline to obtain a result low enough to measure. To calculate the protein concentration, the result must be:

multiplied by 4 (To correct for having used a dilution, multiply the answer obtained times the reciprocal of the dilution made.)

93) Hepatitis B vaccine is:

must he provided by the employer free of charge

230) The large nucleated cell in the lower right-hand side of the image below is a:

myelocyte

235) The large cell indicated by the arrow in image below is a:

myelocyte

157) Which of the following is associated with pseudo-Pelger-Huet anomaly?

myelogenous leukemia

11) In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen?

myeloid metaplasia

174) A scanning of a CK isoenzyme fractionation revealed 2 peaks: A slow cathodic peak (CK-MM) and an intermediate peak (CK-MB). A possible interpretation for this pattern is:

myocardial infarction

179) The presence of increased CK-MB activity on a CK electrophoresis pattern is most likely found in a patient suffering from:

myocardial infarction

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

260) The drug procainamide is prescribed to treat cardiac arrhythmia. What biologically active liver metabolite of procainamide is often measured simultaneously?

n-acetyl procainamide

117) Legal pre-employment questions on an application are:

name and address of person to notify in case of emergency

348) Respiratory syncytial virus is best isolated using a(n):

nasopharyngeal aspirate (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.)

314) Which of the following is characteristic of Factor XII deficiency.

negative bleeding history (Patients with a deficiency of Factor XII tend to have thrombotic complications. They do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin.)

205) The measurement of light scattered by particles in the sample is the principle of:

nephelometry

13) Microalbumin can be measured by a random urine collection. An increased microalbumin is predictive of:

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

151) The following results were obtained on a 45-year-old man complaining of chills and fever: These results are consistent with:

neutrophilic leukemoid reaction(Lab findings, increased WBC but with increased LAP; negative Philadelphia chromosome differentiates leukemoid response from leukemia.)

121) Which of the following is used for staining reticulocytes?

new methylene blue

235) Pellagra is associated with deficiency of which of the following vitamins?

niacin

130) What of the following is consistent with this urine microscopic finding?

nitrate

11) The most sensitive substrate for the detection of beta-lactamases is:

nitrocefin(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.)

75) Which of the following antimicrobials would be inappropriate to report on an E coli isolated from a wound culture?

nitrofurantoin (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.)

224) Enzyme multiplied immunoassay technique differ from all other types of enzyme immunoassays in that:

no separation of bound and free antigen is required

141) Shigella species characteristically are:

nonmotile(The biochemical characteristic that best fits Shigella is that it is nonmotile. Shigella are urease negative and oxidase negative. Shigella are lactose nonfermenters.)

79) The M:E ratio in polycythemia vera is usually:

normal

10) A 45 yr. old woman has a fasting serum glucose concentration of 95 mg/dL (5.2 mmol/L) and a 2 hr. postprandial glucose concentration of 105 mg/dL (5.8 mmol/L). The statement which best describes this patient's fasting serum glucose concentration is:

normal; reflecting glycogen breakdown by the liver

73) The following results were obtained on a patient's blood: Examination of a Wright-stained smear of the same sample would most likely show:

normocytic, hypochromic erythrocytes

90) 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:

novobiocin susceptibility(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. Saprophyticus is a common cause of urinary tract infections in young females.)

263) Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow?

nuclear division without cytoplasmic division

327) AFB smear positive respiratory specimens may be reliably identified as Mycobacterium tuberculosis the same day the smear was read by:

nucleic acid amplification (Several commercial PCR tests are available that identify Mycobacterium tuberculosis from positive respiratory specimens.)

167) In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the :

number of basophils present

176) Which of the following is the formula for calculating the molarity of a solution?

number of moles of solute/ L of solution

146) A stool specimen that appears black and tarry should be tested for the presence of :

occult blood

47) Quantitation of Na+ and K+ by ion selective electrode is the standard method because:

of advances in electrochemistry

146) The volume of urine excreted in a 24 hr. period by an adult patient was 300 mL. This condition would be termed:

oliguria

275) Blood received in the lab for blood gas analysis must meet which of the following requirements?

on ice, no clots, no air bubbles

175) Which of the following results is typical of Campylobacter jejuni?

optimal growth at 42 C(Campylobacter jejuni will grow at 37 C, but prefers 42 C. It is oxidase and catalase positive and motile.)

206) An urethral swab obtained from a man with a urethral exudate was plated directly on chocolate agar and modified Thayer-Martin agar. 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 hrs. The most likely failure for organism growth is that the:

organism requires CO2 for growth(Neisseria gonorrhoeae requires an enhanced carbon dioxide atmosphere for optimal growth.)

20) 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/Ipf) and 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:

oropharyngeal flora(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.)

117) The primary confirmatory test for hereditary spherocytosis is:

osmotic fragility

114) Following ingestion of ethylene glycol, numerous crystals are found in the urine. The shape of these crystals is:

oval/dumbbell

73) 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?

oxacillin disk diffusion(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 organism's susceptibility to given agent.)

315) The method used for processing specimens for mycobacterial culture contaminated with Pseudomonas is:

oxalic acid (The oxalic acid method is superior to alkali methods for processing specimens contaminated with Pseudomonas.)

199) Differentiating tests that will separate Burkholderia from Stenotrophomonas include:

oxidase (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.)

215) A gram-negative diplococcus that grows on modified Thayer-Martin medium can be further confirmed as Neisseria gonorrhoeae if it is:

oxidase positive and glucose positive, maltose negative(Neisseria gonorrhoeae is oxidase positive and ferments glucose but not maltose.)

126) When identifying urinary crystals, which reagent strip result is most important?

pH

8) Which of the following would be affected by allowing a urine specimen to remain at room temp for 3 hrs. before analysis:

pH

133) The results of a urinalysis on a first morning specimen are: The next step is to repeat the:

pH and microscopic examination

325) Most automated blood gas analyzers directly measure:

pH, PCO2, and PO2

298) Which of the following is the Henderson Hasselbach equation?

pH=pKa+log([salt]/[acid]) (The Henderson-Hasselbach equation describes the derivation of pH as a measure of acidity [using the acid dissociation constant, pKa] in biological and chemical systems.)

14) A patient with uncontrolled Diabetes mellitus will most likely have:

pale urine with a high specific gravity

40) Peripheral blood smears from patients with untreated anemia are characterized by:

pancytopenia and macrocytosis

350) The genus of virus associated with anogenital warts, cervical dysplasia and neoplasia is:

papillomavirus (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.)

347) 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:

para-nitrophenylphosphate,

184) Ascites is collected by:

paracentesis

64) The regulation of calcium and phosphorous metabolism is accomplished by which of the following glands?

parathyroid

69) Fasting serum phosphate concentration is controlled primarily by the:

parathyroid glands

63) Calcium concentration in the serum is regulated by:

parathyroid hormone

46) An antibiotic that inhibits cell wall synthesis is:

penicillin(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.)

102) After 24 hrs. a blood culture from a newborn grows catalase-negative, gram-positive cocci. The bacterial 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% NaCl broth: no growth Assuming that all controls react properly and reactions are verified, the next step would be to:

perform a Streptococcus group typing(The colony description and biochemical results presented describe Streptococcus agalactiae. The identification of this organism is confirmed by streptococcus antigen typing.)

86) What is the single most effective method to prevent nosocomial spread of infection?

perform frequent and appropriate hand hygiene

63) A positive result for bilirubin on a reagent strip should be followed up by:

performing an Ictotest

166) Which of the following clinical disorders is associated with the greatest elevation of lactate dehydrogenase isoenzyme?

pernicious anemia

250) Which of the following stains in closely associated with the lysosomal enzyme in primary granules?

peroxidase

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

184) A patient diagnosed with polycythemia vera 5 yrs. ago has a normal hematocrit, decreased hemoglobin, and microcytic, hypochromic red cells. What is the most probable cause for the current blood situation?

phlebotomy (Hypochromic, microcytic RBC is most commonly associated with iron deficiency, which would most likely result from repeated therapeutic phlebotomies.)

337) In the APTT test, the patient's plasma is mixed with:

phospholipid and calcium (The APTT reagent contains phospholipid and a negatively-charged particulate activator such as kaolin, ellagic acid, or Celite@ . Ionic calcium and phospholipid are supplied as reagents)

333) Mycobacteria that produce pigment only after exposure to light are classified as:

photochromogens (Photochromogens produce nonpigmented colonies only when grown in darkness, but pigmented colonies after exposure to light.)

204) Which of the following cell types is characteristic of Pelger-Huet anomaly:

pince-nez form

186) Regan isoenzyme has the same properties as alkaline phosphatase that originates in the:

placenta

247) Communication is enhanced by:

planned strategy that includes listening skills and ensuring an understanding with questions (Personal communication should be planned: P = plan your communication L = listen to others A = avoid assumptions / ensure communication is understood N = network.)

376) The ideal capillary blood collection site on a newborn is:

plantar surface of the heel (The heel is the preferred site for drawing capillary blood from the newborn. the posterior curvature of the heel should never be used.)

54) In respiratory acidosis, a compensatory mechanism is the increase in:

plasma bicarbonate concentration

294) A bleeding time is used to evaluate the activity of:

platelets

27) Which of the following groups of specimens would be acceptable for anaerobic culture?

pleural fluid, brain abscess (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.)

95) 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:

pneumococci(Optochin susceptibility is used to differentiate S pneumoniae, which are susceptible from other alpha-hemolytic streptococci, which are resistant.)

181) A patient has a tumor that concentrates erythropoietin. He is most likely to have which of the following types of polycythemia?

polycythemia associated with renal disease

182) Which of the following types of polycythemia is most often associated with emphysema?

polycythemia, secondary to hypoxia

383) When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to:

poorly made wedge smear (Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins. It is important to examine the edges for platelet clumping.)

17) Urine that develops a port wine color after standing may contain:

porphyrins

19) Urine from a 50 yr. old man was noted to turn dark red on standing. This change is caused by:

porphyrins

223) Establishing the pathogenicity of a microorganism isolated from a child's throat and identified as Corynebacterium diphtheria would depend upon:

positive toxigenicity test (In order to determine if an isolate of Corynebacterium diphtheriae produces toxin, testing for the presence of diphtheria toxin must be performed using methods such as the Elek test or PCR.)

327) Valinomycin enhances the selectivity of the electrode used to quantitate:

potassium

219) A gram stain of organisms on Loeffler agar showed pleomorphic gram-positive bacilli. The organism should be subcultured to:

potassium tellurite(Media containing potassium tellurite is used for the recovery of Corynebacterium diphtheriae.)

122) The presence of this element in urine indicates the presence of:

powder

232) Several complaints have been received from parents of children in the pediatric wing about the anxiety that venipuncture causes their children. An informal staff meeting with the phlebotomists reveals that they feel both parents and pediatric nurses are less than supportive and frequently make the task of venipuncture in children worse with their own anxiety. The best course of action would be to:

prepare written pamphlets for parents and in-service education for nursing personnel

228) 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:

presence of a foul, putrid odor from tissue specimens and cultures(Anaerobic bacteria characteristically produce foul-smelling metabolic end products.)

195) The finding of hemosiderin laden macrophage in a CSF sample indicates:

previous hemorrhage

71) These results are most compatible with:

primary hyperparathyroidism

213) A 45 yr. old woman complains of fatigue, heat intolerance, and hair loss. Total and free T4 are abnormally low. If the TSH showed marked elevation, this would be consistent with:

primary hypothyroidism

326) Plasma from a patient with lupus coagulation inhibitor can show:

prolonged APTT and normal PT (Patients suspected of a lupus anticoagulant present with a prolonged APTT. Laboratory assays to detect lupus anticoagulants are the APTT, dilute Russell viper venom test, and Kaolin clotting time.)

218) The selectivity of an ion-selective electrode is determined by the:

properties of the membrane used

340) A patient is taking 10 mg per day of coumadin. The results of which of the following lab tests will be most impacted?

protein C level (Protein C is a vitamin K dependent protein; hence warfarin therapy will lower levels of this protein.)

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

4) The main function of the hexose monophosphate shunt in the erythrocyte is to:

provide reduced glutathione to prevent oxidation of hemoglobin

64) After receiving appropriate training, the first step in using a fire extinguisher is to:

pull the pin

76) The presence of leukocytes in the urine is known as:

pyuria

225) Which of the following statements about immunoassays using enzyme labeled antibodies or antigens is correct?

quantitation of the label can be carried out with a spectrophotometer

313) When staining acid-fast bacilli with Truant auramine-rhodamine stain, potassium permanganate is used as a:

quenching agent (The counterstain acts as a quenching agent and reduces the background fluorescence of cellular debris.)

64) 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?

r'r' (The baby is Rh-negative and lacks c, since there is no evidence of HDFN. Inheritance of no D and no c is denoted as r'. The baby must have inherited this gene from both parents, and is homozygous r'r'.)

111) The antibodies of the Kidd blood group system:

react best at the IAT (Antibodies in the Kidd blood group system are IgG and react best at the antiglobulin phase. These antibodies are associated with delayed hemolytic transfusion reactions and reactivity can be enhanced by testing with enzyme pretreated cells.)

5) The first procedure to be followed if the blood gas instrument is out-of-control for all parameters is:

recalibrate, then repeat control

291) The automated platelet count on an EDTA specimen is 58 x 10^3/mL (58 x 10^9/L). The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils. The next step should be to:

recollect a specimen for a platelet count using a different anticoagulant(Platelet satellitism is reduced by collecting sample in sodium citrate.)

290) An automated platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should:

recollect in sodium citrate

27) Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?

red cell membrane defect

58) According to OSHA, what type of sign should be posted in an area where an immediate hazard exists and where special precautions are necessary?

red, black and white "Danger" sign

131) Members of the family Enterobacteriaceae share which one of the following characteristics?

reduce nitrate to nitrite(Members of Enterobacteriaceae are oxidase negative, ferment glucose, and reduce nitrate to nitrite.)

379) A citrated blood specimen for coagulation studies is to be collected from a polycythemic patient. the anticoagulant should be:

reduced in volume (In polycythemia, the decrease in plasma volume relative to whole blood alters the 9 parts blood to 1 part anticoagulant ratio falsely prolonging results. Therefore, a tube with a reduced volume of anticoagulant is need when the Hct is > 55%.)

222) A benefit of microassays, such as point of care methods, include:

reduced sample volume

61) A 21 yr. old patient presents with pharyngitis. A throat swab is collected and submitted for anaerobic culture. This specimen should be:

rejected as unacceptable (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.)

137) Elevation of the lymphocyte percentage above 47% is termed:

relative lymphocytosis

216) Al leukocyte count and differential on a 40-year-old Caucasian man revealed: This represents:

relative lymphocytosis

136) Elevation of the granulocyte percentage above 75% is termed:

relative neutrophilic leukocytosis

53) Which of the following types of polycythemia is a severely burned patient most likely to have?

relative polycythemia associated with dehydration

116) Characteristically, enterococci are:

relatively resistant to penicillin (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.)

120) Supravital staining is important for reticulocytes since the cells must be living in order to stain the:

remaining RNA in cell

13) In the normal adult, the spleen acts as a site for:

removal of imperfect and aging cells

331) Magnesium carbonate is added in an iron binding capacity determinations in order to:

remove excess unbound iron

68) A fire occurs in the laboratory. the first course of action is to:

remove persons from immediate danger

108) A serum sample demonstrates an elevated result when tested with the Jaffe reaction. This indicates:

renal functional 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

161) Glycosuria may be due to:

renal tubular dysfunction

101) Spherical urothelial cells may be confused with:

renal tubular epithelial cell

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

103) A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to:

repeat determinations using prewarmed microsample of diluted blood (Autoagglutination of anticoagulated blood can occur at room temp in pt with a cold autoagglutinin. MCV will be falsely elevated and count falsely decreased, resulting in an elevated MCHC. The blood sample should be warmed to 37 C and rerun.)

360) 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?

repeat the control

286) A phase-platelet count is performed using a platelet Unopette. 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 area. After making the appropriate calculations, the next step would be to:

report the calculated value

289) A phase-platelet count was performed and the total platelet count was 356 x 10^3/mL (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:

report the phase-platelet count since it correlated well with the slide(Platelet count matches estimate well [average of 17.8 platelets per oil immersion field x 20,000].)

287) An arterial blood specimen submitted for blood gas analysis was obtained at 8:30 am but was not received in the lab until 11 am. The technologist should:

request a new arterial specimen be obtained

30) An emphysema patient suffering from fluid accumulation in the alveolar spaces is likely to be in what metabolic state?

respiratory acidosis

41) These results are most compatible with:

respiratory acidosis

29) 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?

result c (Iron studies: microcytic hypochromic anemia results in a decrease in serum and storage iron, but an increase in TIBC.)

48) Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder?

result d (Iron studies in anemia of chronic disease show decreased serum iron and transferrin saturation; TIBC may be decreased as well.)

254) Auto-verification of test results requires all of the following to be established by the lab except:

review of results by a qualified technologist or technician

355) A specimen run on an automatic cell counter has a platelet count of 19 x 10^3. The first thing the tech should do is:

review the stained blood smear

329) Which of the following is considered a primary drug for the treatment of Mycobacterium tuberculosis?

rifampin (Primary drugs for the treatment of Mycobacterium tuberculosis include isoniazid, rifampin, pyrazinamide, and ethambutol.)

81) Which of the following is most closely associated with erythroleukemia?

ringed sideroblasts nuclear budding Howell-Jolly bodies

82) The most characteristic peripheral blood smear finding in multiple myeloma is:

rouleaux formation of red cells

12) Upon completion of a run of cholesterol tests, the technician recognizes that the controls are not within the 2 standard deviations confidence range. What is the appropriate course of action?

run a new set of controls and repeat specimens

196) Which CSF results are most consistent with bacterial meningitis?

sample A

139) Serial bilirubin determinations are charted below. The best explanation for the results is:

sample exposure to light

201) Nephelometers measure light:

scattered at a right angle to the light path

332) The mycobacteria that produce a deep yellow or orange pigment both in the dark and light are:

scotochromogens (Scotochromogens produce deep yellow or orange pigment when grown in either light or darkness.)

13) An Enterococcus isolated from multiple blood cultures in a patient with endocarditis should be:

screened for high level aminoglycoside resistance (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 mg/mL] for gentamicin and is termed high level resistance.)

77) To prevent injury, a safe lab work practice is to:

secure long hair and jewelry

76) The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased:

sedimentation rate

166) To avoid falsely elevated spinal fluid cell counts :

select an aliquot from the last tube collected

118) A screening test for paroxysmal nocturnal hemoglobinuria is:

sucrose hemolysis test

67) The confirmatory test for a positive protein result by the reagent strip method uses:

sulfosalicylic acid

184) The reliability of a test to be positive in the presence of the disease it was designed to detect is known as:

sensitivity

388) The ISI in the INR represents the reagents:

sensitivity (The ISI represents the international sensitivity index. The most responsive reagents have an ISI of 1.)

78) Safe handling and disposal of laboratory generated infectious waste require:

separate waste into designated categories

100) The first step in the quantitation of serum iron is:

separation of iron from transferrin

9) All donors blood testing must include:

serological test for syphilis (Testing tor syphilis was the first mandated donor screening test for infectious disease and is still part of donor screening.)

185) What specimen preparation is commonly used to perform the alkaline phosphatase isoenzyme determinations?

serum is divided into 2 aliquots, one is heated at 56 C and the other is unheated (heat activation method of ALP isoenzyme separation involves heating an aliquot of the serum sample at 56 C for 10 minutes.)

246) A Gram stain of a necrotic wound specimen showed large gram-positive bacilli. There was 3+ growth on anaerobic media only, with colonies producing a double zone of hemolysis. To identify the organism, the microbiologist should:

set up egg yolk agar plate(The Gram stain and double zone of hemolysis are characteristics of Clostridium perfingens. C perfingens is lecithinase positive on the egg yolk agar test for lecithinase and lipase.)

58) When processing throat swabs for a group A streptococcus culture, the medium of choice is:

sheep blood agar(Sheep blood agar is preferred because clear-cut patterns of hemolysis are obtained.)

53) Tests for beta-lactamase production in Haemophilus influenzae:

should be performed on all blood and CSF isolates (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 [nitrocefin] test.)

20) A patient with hemolytic anemia will:

show a decrease in glycated Hgb value

259) Performance of laboratory information system back-up procedures includes all of the following except:

shutting down the LIS and bringing it back up

218) 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:

sicca (Neisseria sicca is the only Neisseria species of those listed that ferments glucose maltose and sucrose.)

97) When processing patient blood specimens and handling other potentially infectious material, the best choice of gloves is:

single use and disposable gloves.

63) Which of the following technical factors will cause a decreased erythrocyte sedimentation rate?

small fibrin clots in the sample (When shape/size of RBC prevents rouleaux formation decreased/low ESR expected. This observed with sickle cells, acanthocytes,& spherocytes.)

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

55) Which of the following electrolytes is the chief plasma cation whose main function is maintaining osmotic pressure?

sodium

57) The solute that contributes the most to the total serum osmolality is :

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

386) The anticoagulant of choice for routine coagulation procedures is:

sodium citrate (Sodium citrate is the only anticoagulant used for hemostasis testing. Sodium citrate hinds free calcium ions. EDTA inhibits the thrombin-mediated conversion of fibrinogen to fibrin and binds reagent calcium added to initiate clot based tests. Heparin inhibits Ila, Xa, XIIa, XIa and IXa.)

84) Which disinfectant inactivates HIV and HBV?

sodium hypochlorite

95) The most effective disinfectant recommended for bloodborne pathogens is:

sodium hypochlorite

79) Which of the following is the best choice for decontaminating bench tops contaminated by the AIDS virus?

sodium hypochlorite bleach (A 10% solution of bleach is an effective and economical disinfectant, which inactivates HBV in 10 minutes and HIV in 2 minutes.)

143) Biochemical reactions of an organism are consistent with Shigella. A suspension is tested in antiserum without resulting agglutination. However, after 15 mins. of boiling, agglutination occurs in group D antisera. The Shigella species is:

sonnei(Boiling removed the capsule so that the antiserum could react with cell wall antigen. Group D Shigella is S sonnei.)

130) MacConkey media for screening suspected cases of hemorrhagic E coli O157:H7 must contain:

sorbitol(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.)

27) Urine osmolality is related to:

specific gravity

78) A microscopic exam of urine sediment reveals ghost cells. These RBCs are seen in urine with a:

specific gravity <1.007

189) Isoenzyme assays are performed to improve:

specificity (Isoenzymes are multiple forms of an enzyme that possess the ability to catalyze a reaction, but differ in structure. For enzymes located in many tissue sites, an increased total enzyme activity cannot be associated with a specific clinical disorder. However, since the isoenzyme fractions are located in various tissue sources, measurement of the different fractions are considered a more specific indicator of various disorders than total levels.)

283) 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 A (The presence or exposure of excess gas [oxygen] in the syringe used to collect blood gas specimens will cause diffusion of carbon dioxide out of the specimen, oxygen into the specimen, and an increase in pH.)

4) Preanalytical variables in laboratory testing include:

specimen acceptability

133) The following bilirubin results are obtained on a patient: Given that the controls were within range each day, what is a probable explanation for the result on day 4?

specimen had prolonged exposure to light

169) A common cause of a falsely increased LD1 fraction of lactic dehydrogenase is:

specimen hemolysis

72) A RBC about 5 um in diameter that stains bright red and shows no central pallor is a:

spherocyte

19) What cell shape is most commonly associated with an increased MCHC?

spherocytes

37) Patients with A(-) type G-6-PD deficiency are least likely to have hemolytic episodes in which of the following situations?

spontaneously

105) To assure an accurate ammonia level result, the specimen should be:

spun, separated, iced, and tested immediately

80) What cell is most commonly associated with vaginal contamination?

squamous

85) Clue cells are a form of:

squamous epithelial cells

138) Which of the following is the formula for standard deviation?

square root of (sum of squared differenced)/(N-1) (Standard deviation is a measure of the dispersion of data around the mean. It is calculated by taking the square root of the summation of the squared differences of the observed x values from their mean divided by n.)

142) When the exact concentration of the solute of a solution is known and is used to evaluate the concentration of an unknown solution, the known solution is:

standard

18) Erythropoietin acts as:

stimulate RNA synthesis of erythroid cells

106) Erroneous ammonia levels can be eliminated by all of the following except:

storing the specimen protected 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

109) The Kell antigen is:

strongly immunogenic (The Kell antigen is highly immunogenic. It is present on the red cells of up to 9% of adults and neonates, and is not affected by enzymes.)

221) Which of the following is the best guide to consistent centrifugation?

tachometer reading

202) The lab 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 SBA: growth after 48 hrs. with small, smooth, raised colonies. What should the microbiologist do next?

take extra safety precautions for possible Brucella(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.)

49) A characteristic morphologic feature in hemoglobin C disease is:

target cells

354) Which of the following applies to cryoscopic osmometry?

temperature at equilibrium is a function of the number of particles in solution

295) A patient has been taking aspirin regularly for arthritic pain. Which of the following tests is most likely to be abnormal in this patient?

template bleeding time

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

49) A patient with a myeloproliferative disorder has the following values: The serum ICE should be confirmed by:

testing heparinized plasma

210) All species of the genus Neisseria have the enzyme to oxidize:

tetramethyl-phenylenediamineSince all Neisseria species are oxidase positive, they possess the enzyme to oxidize tetramethyl-phenylenediamine.)

257) A control strain of Clostridium should be used in an anaerobe jar to assure:

that an anaerobic environment is achieved (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 the anaerobic jar.)

86) 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?

the cefazolin result should be changed to resistant since the oxacillin result is resistant(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.)

17) 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?

the depth of the media was too thin (All Mueller-Hinton agar used for disk diffusion susceptibility testing should be poured to a depth of 4 mm. If the depth of the media is < 4 mm, this may be associated with excessively large zones and false-positive susceptibility results. Agar that is > 4 mm in depth may cause excessively small zone sizes.)

377) When evaluating a smear for a retic count, the tech observes that the RBC's are overlapping throughout the entire slide. The most likely explanation is:

the drop used for the slide preparation was too large (Too large of a drop will produce a thick smear; slowly pushing the blood will affect the distribution of the cells.)

229) Which of the following statements about this field is true?

the large cell on the left is a monocyte

28) A paper or electronic report of lab results must include:

the name and address of the testing laboratory

18) 3 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:

the organism is most likely a contaminant (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.)

16) A unit of packed cells is split into 2 aliquots under closed sterile conditions at 8 am. The expiration time for each aliquot is:

the original date of the unsplit unit (Sterile docking devices allow entry into donor units without affecting the expiration date of the product.)

100) To distinguish between a clump of WBCs and a WBC cast it is important to observe:

the presence of a cast matrix

344) The best test to determine if a sample is contaminated with heparin is:

thrombin time (A prolonged thrombin time may be considered evident of diminished or abnormal fibrinogen; however, the presence of AT activity, such as heparin, must be ruled out.)

87) A patient admitted following an accident involving massive crush injuries has the following urinalysis results: 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

138) A serum sample was assayed for 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:

the sample was exposed to light

34) 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:

the slide was inadequately decolorized with acetone/alcohol(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.)

80) Which of the following is most important variable in the recovery of organisms in patients with bacteremia?

the volume of blood cultured (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.)

267) A drug that relaxed the smooth muscles of the bronchial passages is:

theophylline

342) A prolonged thrombin time and a normal reptilase-R time are characteristic of :

therapeutic heparinization (A prolonged thrombin time can indicate diminished or abnormal fibrinogen, the presence of FDPs, paraproteins, and heparin. Reptilase is insensitive to the effects of heparin, and sensitive to dysfibrinogenemia. Therefore, when the TT is prolonged and the reptilase test is normal, this confirms the presence of heparin.)

123) During the past month, Staphylococcus epidermidis has been isolated from blood cultures at 2 - 3 times the rate from the previous year. The most logical explanation for the increase in these isolates is that:

there has been a break in proper skin preparation before drawing blood for culture(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.)

394) On Monday a patient's Hgb determination was 11.3 g/dL and on Tuesday it measured 11.8 g/dL. The standard deviation of the method used is +/- 0.2 g/dL. Which of the following can be concluded about the Hgb values given?

there is no significant change in the patient's Hgb concentration (The distribution of data around the mean is the standard deviation. Using a specific confidence interval of 95.5%, or 2 standard deviations, the results fall between +/- 0 .2 [1 SD] or +/- O .4 [2 SD].)

231) Anaerobic infections differ from aerobic infections in which of the following?

they are usually polymicrobic(Most infections involving anaerobes are polymicrobic and can include obligate aerobes, facultative anaerobes, microaerophilic bacteria in addition to anaerobic bacteria.)

232) Beriberi is associated with deficiency of vitamin:

thiamine

51) Vibrio parahaemolyticus can be isolated best from feces on:

thiosulfate citrate bile salts agar (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.)

197) A community hospital microbiology lab is processing significant numbers of stool cultures because of an outbreak of diarrhea following heavy rains and flooding in the country. A media that should be incorporated in the plating protocol is:

thiosulfate citrate bile salts sucrose for Vibrio species(Thiosulfate citrate bile salt agar is a selective media for Vibrio, and it also differentiates sucrose-fermenting species, such as V cholerae and V alginolyticus)

89) After an accidental needle stick with a contaminated needle, the first action should be to:

thoroughly wash the wound with soap and water

345) In the Clauss fibrinogen method, the time to clot formation in plasma is measured after the addition of:

thrombin (In a Clauss fibrinogen, a standard amount of thrombin is added to diluted plasma, and the time required for clot formation is recorded.)

215) A 2 yr. 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 lab test would be the serum:

thyroid-stimulating hormone

44) Which of the following factors would make an organism appear to be more resistant on a disk diffusion susceptibility test?

too many organisms in the inoculum(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.)

252) Which of the following is useful in the detection and management of carcinoma of the prostate?

total prostate-specific antigen

218) The screening test for congenital hypothyroidism is based upon:

total thyroxine (T4) level in the newborn

60) If areas of the laboratory are designated as "clean " or "contaminated" it is appropriate for a technologist to:

touch a "contaminated" area phone with ungloved hands if hands are washed afterward

220) In a centrifugal analyzer, centrifugal force is used for:

transfer liquids from the inner disc to the outer cuvette

99) Total iron binding capacity measures the serum iron transporting capacity of:

transferrin

309) Hageman Factor (XII) is involved in each of the following reactions except:

transformation of fibrinogen to fibrin (Factor XII is a contact factor, which is activated to Factor XIla. It is responsible for the activation of Factor XI to Factor XIa. Fibrinogen is converted to fibrin by the action of thrombin.)

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

282) 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 lab test which should be recollected is:

triglycerides (A high-fat diet increases the serum concentrations of triglycerides. Fasting overnight for 10-14 hours is the optimal time for fasting around which to standardize blood collections, including lipids.)

214) The majority of thyroxine (T4) is converted into the more biologically active hormone:

triiodothyronine

35) When performing a Kovac indole test, the substrate must contain:

tryptophan (The indole test is used for determining an organism's ability to produce indole from deamination of tryptophan by tryptophanase.)

190) The first step to be taken when attempting to repair a piece of electrical equipment is:

turn the instrument off

113) Which of the following crystals is seen in an amber urine with a positive bilirubin?

tyrosine

108) After warming, a cloudy urine clears. This is due to the presence of:

urates

114) 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?

urea nitrogen: 80 mg/dL (Abnormal results correlate with abnormal kidney function.)

26) Which of the following specimen requests is acceptable?

urine for culture of acid-fast bacilli(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 N gonorrhoeae should also not be performed, since the presence of organisms with similar morphologies may lead to over interpretation of smears.)

44) The degree to which the kidney concentrates the glomerular filtrate can be determined by:

urine to serum osmolality ratio

23) The yellow color of urine is primarily due to:

urochrome pigment

86) Which of the following cells is most likely to be seen in the urine sediment following a catheterization procedure?

urothelial cell

73) A technologist spilled concentrated hydrochloric acid on his/her clothing and skin, affecting a large portion of the body. After removing involved clothing the next first aid treatment step would be to:

use emergency safety shower and flush body with water

72) A technologist splashed a corrosive chemical in his/her eyes. to prevent permanent injury, the first action should be to:

use eyewash station to flush eyes with water for 15 minutes

15) The procedure that assures the most accurate detection of mecA-mediated oxacillin resistance in routine broth microdilution susceptibility testing against S aureus is:

use of cefoxitin for testing(Cefoxitin is used as a surrogate for mecA-mediated oxacillin resistance in S aureus. S aureus with cefoxitin MICs >4 mg/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.)

70) When using a control stain of Staphylococcus aureus, the tech notice that the zone around the oxacillin disk is too small. Which of the following is the most likely explanation?

use of outdated oxacillin disks (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.)

65) To help prevent electrical fires in healthcare facilities:

use only UL or other safety agency-rated electrical equipment.

5) The steam autoclave method of sterilization:

uses 15 lbs. of pressure for 15 minutes (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.)

59) The ability to detect oxacillin resistant staphylococcus aureus may be enhanced by:

using Mueller-Hinton broth with 2% NaCl(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.)

16) 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: The serological typing is verified with new kit and controls. The best course of action would be to:

verify reactivity of motility medium with positive and negative controls(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.)

86) A common source of interference in the cyanmethemoglobin method is:

very high WBC count

158) Bilirubinuria may be associated with:

viral hepatitis

162) Aspartate aminotransferase and alanine aminotransferase are both elevated in which of the following diseases?

viral hepatitis

231) Night blindness is associated with deficiency of which of the following vitamins?

vitamin A

70) The lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have?

vitamin B12 deficiency

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

234) Rickets is associated with deficiency of which of the following vitamins?

vitamin D

256) In flow cytometric analysis, low angle or forward scatter of a laser light beam provides information that pertains to a cell's:

volume

196) The nanometer is a measurement of:

wavelength of radiant energy

93) Which of the following casts is most indicative of end stage renal disease?

waxy

lactic acid

what is the end product of anaerobic glycolysis?

70-110 mg/dl

what is the reference range for fasting glucose in an adult?

glucose

which sugar accounts for nearly all blood sugar and is the body's major source of cellular energy?

79) Glitter cells are a microscopic finding of:

white blood cells in hypotonic urine

274) Testing for the diagnosis of lead poisoning should include:

whole blood lead

59) Which of the following is true about direct ion selective electrodes for electrolytes?

whole blood specimens are acceptable

18) Diagnostic specificity is defined as the percentage of individuals:

without a given disease who have a negative result by a give test.

76) Safety glasses, face shields or other eye and face protectors must be worn when:

working with caustic or toxic materials

135) These lab results were obtained on maternal and cord blood samples: Mother: A- baby: AB+ DAT 3+ cord hemoglobin 10 g/dL Does the baby have HDFN?

yes, the DAT and cord hemoglobin level both support HDFN (A positive DAT on cord blood demonstrates the presence of maternal antibody coating the baby's red cells and indicates hemolytic disease of the newborn. Normal cord hemoglobin in newborns ranges from 14-20 g/L. A cord hemoglobin value of 10 g/L indicates anemia and supports the diagnosis of HDFN.)

43) In a disk diffusion susceptibility test, which of the following can result if disks are placed on the inoculated media and left at room temp for an hour before incubation?

zones of larger diameter would result(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.)