Lab Exam Simulator

Which one of the following statements concerning Tamm-Horsfall protein is FALSE? A. It is the protein that is predominantely detected by a urine reagent strip test. B. Hyaline casts are formed by this protein in the distal tubule. C. It acts as a coating and lubricant in the tubules. D. It is produced by the tubules. E. Tubular epithelial cells would have great difficulty functioning without it.

A Albumin, not Tamm-Horsfall, comprises the majority of the protein that is detected by the urine reagent strip test.

Which of the statements below regarding the diagnosis of pancreatitis is CORRECT? A. Amylase and lipase are as predictive in chronic as in acute pancreatitis. B. Diagnostic sensitivity is increased by assaying both amylase and lipase. C. Chronic pancreatitis occurs more often in women. D. Increased amylase levels stay increased after the cause of the pancreatitis is removed.

B Increased levels of amylase and lipase are very useful for detecting acute pancreatitis. In chronic pancreatitis, amylase and lipase levels may not be elevated and, in fact, can decrease over time, so these test are not as predictive for chronic pancreatitis as they are for acute. Chronic pancreatitis actually occurs more often in men. Amylase levels decrease when the cause of the pancreatitis is removed.

Although care should be taken when working with all fungus cultures in the laboratory, personnel are particularly prone to develop laboratory acquired infections from the inhalation of airborne species of: A. Blastomyces dermatitidis B. Coccidioides immitis C. Sporothrix schenckii D. Histoplasma capsulatum

B The delicate nature, small size and ease of aerosolization of the arthroconidia of Coccidioides immitis, separated by empty space, makes this species the most likely to result in laboratory acquired infections. Because the arthroconidia are so small and light, they more easily reach the alveolar spaces when inhaled than the conidia of other species. Particularly dangerous are older, mature cultures where spores are highly concentrated and extremely fragile. Although laboratory infections with the other fungal species listed in this exercise are possible, the spores do not become as easily aerosolized and present a less likely event. Of more probability is the direct inoculation of skin through broken glass or penetration of a needle.

The white blood cell indicated by the arrow is representative of the atypical white blood cell associated with infectious mononucleosis. A. True B. False

B The intended response is false. This is a monocyte with prominent cytoplasmic vacuoles, characteristically seen in a variety of toxic states. The cell shown is a true monocyte and not an atypical lymphocyte; which is the white blood cell associated with infectious mononucleosis.F

Which one of the following statements about TSH is true: A. It is decreased in primary hyperthyroidism B. It is decreased in primary hypothyroidism C. A sensitive TSH assay is not a good screening test for thyroid function D. Diffuse toxic goiter is associated with elevated TSH levels.

A A sensitive TSH assay is now considered the most cost effective method of screening for thyroid disorders. In the absence of pituitary and hypothalamic disease, TSH is decreased in hyperthroidism. and increased in hypothyroidism, with few exceptions. Diffuse toxic goiter is a cause of primary hyperthyroidism, and would be associated with decreased TSH.

Match terms with fragments resulting from papain digestion of an IgG molecule:

Fc fragment B Fab fragment A

In which age group is hereditary hemochromatosis (HH) most likely to be initially detected based on clinical symptoms? A. Middle aged adults B. Young adults C. School age children D. Infants

A Most patients with HH become symptomatic during middle age.

Which of the following statements regarding a biomarker with high sensitivity is true? A. Accurately identifies the presence of disease and has few false-negatives B. Accurately identifies the presence of disease and has few false-positives C. Accurately detects the absence of disease and has few false-negatives D. Accurately detects the absence of disease and has few false-positives

A A biomarker with high sensitivity accurately identifies the presence of disease and has few false-negatives. A biomarker with high specificity accurately detects the absence of disease and has few false-positives.

The selectivity of an ion-selective electrode is determined by the: A. properties of the membrane used B. solution used to fill the electrode C. magnitude of the potential across the membrane D. internal reference electrode E. type of glass used in electrode

A The membranes of ion selective electrodes will determine which analyte is measured by the electrode.

Which of the following is the predominant immunoglobulin class for anti-A and anti-B antibodies? A. IgM B. IgG C. IgA

A The predominant immunoglobulin class for the B antibodies produced by individuals with group A phenotype and the A antibodies produced by individuals with group B phenotype is IgM. IgG forms of anti-A and anti-B are also produced, but are not the predominant immunoglobulin class.

Which of the following is not true about members of the Enterobacteriaceae: A. Gram-negative B. Oxidase positive C. Reduce nitrate to nitrite D. Ferment glucose

B Any oxidase-positive organism can be excluded from the Enterobacteriaceae. The other characteristics are as a rule present in these organisms.

Which one of the following is not descriptive of the different branches of the immune system? A. Cell-Mediated B. Extrinsic C. Humoral D. Innate E. Non-specific

B Cell mediated, humoral, innate, and non-specific are all branches of the immune system. Extrinsic is a branch of the coagulation cascade.

Where does most cerebrospinal fluid originate? A. cerebral arachnoid space B. choroid plexus C. ventricles D. lumbar region

B Cerebrospinal fluid originates from the choroid plexus.

What is the proper storage temperature for thawed Cryoprecipitate? A. 4 - 8 ºC. B. 20 - 24 ºC. C. 35 - 37 ºC. D. -20 ºC or colder

B Once thawed, cryoprecipitate must be kept at room temperature (20 - 24oC) and used within 6 hours after thawing.

Which one of the following descriptions about Pasteurella is FALSE? A. Forms large amounts of indole. B. Grows well on MacConkey agar. C. Many infections caused by domesticated animals. D. Multocida is species most frequently isolated from humans. E. Produces an odor similar to E. coli.

B Pasteurella does not grow well on MacConkey agar. Pasteurella spp. will usually grow at 37 degrees C on blood or chocolate agar.

The accepted interval between blood donations is: A. 12 weeks B. 8 weeks C. 6 weeks D. Depends on hematocrit level

B The mandatory waiting period between blood donations is 56 days, or eight weeks.

Which of the following parts of the body synthesizes and secretes BNP? A. Kidney B. Liver C. Heart D. Adrenal gland

C BNP (or B-Type Natriuretic Peptide) is secreted by the heart, and acts as an indicator of the heart's relative functionality. A higher BNP level signifies worsening symptoms of heart failure, as the left ventrical myocardium releases BNP in response to ventricular wall stress or tension, which occur in chronic heart failure.

Aplastic anemia may be caused by all of the following except: A. Infections B. Chemical agent C. Enzyme deficiencies D. Ionizing radiation

C Enzyme deficiencies are usually associated with hemolytic anemias.

Spherocytes are associated with which two of the following conditions: A. Hereditary spherocytosis B. Autoimmune hemolytic anemia C. Thalassemia D. Iron deficiency

A and B Spherocytes result from removal of small amounts of erythrocyte membrane, with resultant reduction in surface to volume ratio. This may occur in the reticuloendothelial system, as in hereditary spherocytosis and autoimmune hemolytic anemia, or may be due to direct injury of red cells, as in patients with severe burns.

Which two of the following tests are helpful for documenting previous Streptococcal throat and skin infections: A. ASO titer B. Anti-DNase B C. Coagulase D. Bacitracin sensitivity

A and D Both ASO titer and Anti-DNase B are helpful in documenting previous infections.

Match substance(s) secreted with their respective blood groups: A. A, B, & H B. B & H C. A & H D. H

AB A, B, & H B B & H A A & H O H Type A patients will have both A and H substances secreted. B patients will have both B and H substances secreted. AB patients will have A, B, and H substances secreted. Type O patients will only secrete H substance.

Which of the following is NOT a characteristics of Burkholderia pseudomallei? A. Catalase positive B. Fat, gram-postive rod C. Oxidase positive D. Motility positive

B A Gram stain of B. pseudomallei shows slender gram-negative rods with bipolar staining. Smooth forms appear in Gram stain as long parallel bundles and rough forms appear in an irregular arrangement. Additional characteristics include: Catalase positive Oxidase positive Motility positive Indole negative Smooth, creamy, white colonies on sheep blood agar (SBA) at 24 hours Dry, wrinkled colonies at 48-72 hours

Which cardiac biomarker is a regulator of myocyte contraction? A. Myoglobin B. cTnT C. CK-MB D. CK-MB isoforms

B Both cTnI and cTnT are components of the regulation of myocyte contraction.

From the groups of analytes below, which set would most likely be INCREASED in a type 1 diabetic patient in crisis? A. Insulin and blood glucose B. Insulin and ketone bodies C. Ketone bodies and blood glucose D. Ketone bodies and blood pH

C A type 1 diabetic with an elevated blood glucose and lack of insulin production in a crisis can become ketotic and go into a ketoacidosis coma. Excess ketone bodies are produced along with increased blood glucose. The acidosis results in a decreased pH.

An abnormality of which of the following assays would be least likely to be associated with thrombotic tendency: A. AT III B. Protein C C. APTT D. Protein S

C APTT is used to evaluate the intrinsic pathway. Deficiencies of Protein C, Protein S, and Antithrombin III all cause hypercoagulability.

What is the approximate percentage of individuals in the US who are heterozygous for HFE mutations? A. 0.05% to 0.10% B. 1% to 2% C. 10% to 12% D. 20% to 25%

C Approximately 10% to 12% of individuals in the US are heterozygous for HFE mutations.

The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions? A. Allergic reaction B. Bacterial meningitis C. Leukemia with CNS involvement D. Viral meningitis

C The arrows point to immature cells, probably blasts, which may indicate leukemia with CNS involvement. Blasts are not associated with allergic reactions, bacterial meningitis, or viral meningitis.

Flow cytometry is not a useful tool in the study of this disorder: A. HIV B. Leukemia C. Viral hepatitis D. Lymphoma

C Viral hepatitis is diagnosed primarily by ELISA techniques.

Which of the following laboratory results is characteristic for a patient with von Willebrand disease? A. decreased bleeding time B. normal factor VIII level C. normal platelet function tests D. abnormal platelet aggregation response to ristocetin E. a & c

D Von Willebrand disease is associated with abnormal platelet aggregation with ristocetin, an increased bleeding time, abnormal factor VIII level test, and abnormal platelet function tests.

The sickling phenomenon observed in erythrocytes containing hemoglobin S may be induced by which of the following? A. emulsifying agents B. hemolytic agents C. oxidizing agents D. proteolytic agents E. reducing agents

E Reducing agents actually induce the sickling phenomenon in RBCs when they contain hemoglobin S. Emulsifying agents, hemolytic agents, oxidizing agens or proteolytic agents will not cause hemoglobin S to form sickled RBCs.

Match the names of each of the conditions listed with the name of its most likely associated bacterial agent: Liver abscess Streptococcus "milleri" Pseudomembranous colitis Clostridium difficile Carcinoma of the colon Streptococcus bovis Acute food poisoning Bacillus cereus

Liver abscess Streptococcus "milleri" Pseudomembranous colitis Clostridium difficile Carcinoma of the colon Streptococcus bovis Acute food poisoning Bacillus cereus

Match the following statements regarding therapeutic drug monitoring with either trough or peak level. A. The blood sample that is collected after a dose of the drug is given (at a specified time). B. The blood sample that is collected immediately prior to when the next dose of the drug is given. C. The point at which the drug is lowest in the patient's body. D. The point at which the drug is highest in the patient's body.

Peak Level The blood sample that is collected after a dose of the drug is given (at a specified time). Trough Level The blood sample that is collected immediately prior to when the next dose of the drug is given. Trough Level The point at which the drug is lowest in the patient's body. Peak Level The point at which the drug is highest in the patient's body. The lowest level of the drug in the patient's body is called the trough level. The peak for a drug is when the level of the drug in the patient's body is the highest. To assess drug concentrations during the trough phase, blood should be drawn immediately before the next dose. To assess peak levels, the time for drawing depends on the route of administration: Intravenous (IV): 15 - 30 minutes after injection/infusion Intramuscular (IM): 30 minutes - one hour after injection Oral: One hour after drug is taken (assumes a half-life of > two hours)

Identify the arrowed, numbered cells from these images of Wright-Giemsa stained bone marrow smears.

Polychromatophilic normoblast Cell #1 Orthochromic normoblast Cell #2 Macrophage/histiocyte Cell #3 Monocyte Cell #4 This grouping demonstrates cell types that are commonly found together in the bone marrow. Cell#1 is a polychromatophilic normoblast Cell #2 is a orthochromic normoblast Cell #3 is a macrophage/histiocyte Cell #4 is a normal monocyte

Identify the phase of the total testing process in which each of these errors occurs. Incorrectly handled critical test value Wrong test ordered Incorrectly performed instrument calibration Incorrecly collected sample Incorrectly performed venipuncture

Postanalytic Incorrectly handled critical test value Preanalytic Wrong test ordered Analytic Incorrectly performed instrument calibration Preanalytic Incorrecly collected sample Preanalytic Incorrectly performed venipuncture Preanalytic- Incorrectly collected sample, wrong test ordered, incorrectly performed venipuncture Analytic- Incorrectly performed instrument calibration Postanalytic- Incorrectly handled critical test value

Match the names of each of the bacterial species listed with its most distinguishing identifying characteristic listed. Listeria monocytogenes Room temperature motility Erysipelothrix rhusiopathiae H2S production Gardnerella vaginalis "Whiff" test Bacillus mycoides Lecithinase production

The "whiff" test is performed detecting a fish-like odor after adding a few drops of 10% potassium hydroxide to a small amount of vaginal fluid in patients suspected of having bacterial vaginosis. Gardnerella vaginalis is among a group of organisms associated with bacterial vaginosis. Bacillus mycoides, along with B. cereus and B. anthracis, are the three Bacillus species that produce lecithinase. Listeria monocytogenes produces a subsurface umbrella like motility in motility medium after incubation at room temperature (25°C). Among the gram positive bacilli, Erysipelothrix rhusiopathiae is the only species that produces H2S.

There are two patterns present in this microscopic field from an antinuclear antibody ANA test. The test is viewed using fluorescent microscopy. One pattern can be seen in the interphase cells (a) and the area outside of the chromosomal area of the mitotics (b). The other pattern is recognizable in the chromosomal area of the metaphase mitotic cells (c). What are these two patterns? A. Centromere B. Homogeneous C. Speckled D. Nucleolar

This is an example of a mix of homogeneous and speckled ANA patterns. In this sample notice the speckled ANA is the dominant pattern in the interphase cells (a) and some speckling in the area outside of the chromosomal area of the mitotics (b). Also notice the smooth staining of the chromosomal area of the metaphase mitotic cells (c). This represents the presence of a homogeneous ANA pattern.

Which of the following is the most common subgroup of A? A. A1 B. A2 C. A3 D. A1A2

A The A1 subgroup is by far the most prevalent of all A subgroups, with A2 a distant second.

Which of the following statements is true regarding cardiovascular disease and adipose tissue? A. Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease B. A state of abnormal lipids and lipid levels found in metabolic syndrome contribute to the development of cardiovascular disease C. Obesity in metabolic syndrome contributes to the development of cardiovascular disease by increased synthesis and secretion of adiponectin D. Increased synthesis and secretion of PAI-1 in metabolic syndrome contributes to cardiovascular disease by increasing blood pressure

A and B The increase in inflammatory cytokines and the abnormal lipids and lipid levels often present in metabolic syndrome increase the risk of cardiovascular disease. Adiponectin is decreased and increases in angiotensinogen lead to hypertension.

Which of the following serological test results may occur in a patient experiencing a hemolytic transfusion reaction due to antibodies such as anti-c and anti-K? (Select all that apply.) A. Patient's antibody strength may initially decrease. B. Patient may develop a positive DAT with mixed-field agglutination. C. Patient's antibody becomes undetectable. D. Patient's antibody increases in titer weeks later.

A, B, C, and D All are possible. The patient's antibody strength can initially decrease due to adsorbing to transfused antigen-positive donor red cells. This results in a positive DAT with mixed-field agglutination, since only the transfused donor cells are antibody-sensitized. The patient's antibody may even become undetectable at the stage when most of it has adsorbed to the donor cells. Eventually, the patient's antibody increases in strength. This may become apparent weeks later, depending on the relative amount of antibody compared to donor red cells present in the patient's circulation.

Which of the following factors may increase the likelihood of developing an autoimmune disease? (Choose all that apply) A. Genetic predisposition B. Exposure to a triggering event C. Low birth weight D. Gender

A, B, and D Genetic predisposition may make some individuals more susceptible to development of an autoimmune disease. An event that triggers the body to perceive antigens as foreign may also lead to the development of an autoimmune disease. Another factor is gender; women are more likely to develop an autoimmune disease. There is no evidence that low birth weight would lead to development of an autoimmune disorder.

Extrinsic cell characteristics are reflected by the forward and side scatter on a flow cytometry cytogram. A. True B. False

B The statement is false. Intrinsic cell characteristics (size and granularity) are represented by forward and side scatter. Extrinsic cell characteristics are represented by the fluorescent signal produced as a result of tagged monoclonal antibodies binding to antigens on the cell surface.

The heterozygous state of HbS that is referred to as sickle cell trait contains which of the following hemoglobins in combination with S? A. HbE B. HbA C. HbC D. HbD

B This is normal adult hemoglobin. Sickle cell trait is HbSA.

Which of the following cast(s) might be found in the urine of a healthy individual after strenuous exercise: A. Epithelial cell casts B. Hyaline casts C. Granular casts D. Waxy casts

B and C Hyaline and/or granular casts may be seen in healthy individuals for a short time period after strenuous exercise.

A yeast identification system gave a biotype number for an unknown isolate that did not differentiate between Candida tropicalis and Candida parapsilosis. This isolate could be identified as C. parapsilosis in a cornmeal agar preparation if it produced: A. Chlamdospores B. Dense clusters of blastoconidia regularly along the pseudohyphae C. Blastoconidia with a "logs in stream" pattern D. Satelliting "cross match stick" or "sage brush" colonies

Cornmeal agar morphology can be a valuable adjunct in separating two phenotypically, closely-related species of Candida. Observing the patterns of growth and sporulation on cornmeal agar aids in the identification of an unknown yeast if the results derived from profile numbers generated by automated or kit systems do not provide sufficient information. Candida parapsilosis produces a distinctive growth pattern on cornmeal agar with the unique formation of satelliting, sage-brush type colonies. Candida tropicalis, in contrast, produces unclustered pseudohyphae with blastoconidia irregularly spaced at points of septation. The "logs in stream" arrangement of blastoconidia is characteristic of Candida kefyr (pseudotropicalis). Neither C. tropicalis nor C. parapsilosis produce chlamydospores.

A group A Rh positive infant born to a group O Rh negative woman has a 1+ positive DAT. The mother had a negative antibody screen at delivery and received antenatal RhIg. Which of the following are possible causes of the newborn's positive DAT? A. Anti-A B. Passive anti-D C. Antibody to a low frequency antigen D. All of the above are possible causes E. None of the above are possible causes

D All are possible causes. Anti-A is possible because the mother is group O and the newborn is group A. Passive anti-D is possible because the mother received antenatal RhIg and the infant is D+. An antibody to a low frequency antigen is possible because the mother's antibody screen is negative and antibody screen cells are not usually positive for rare antigens.

The oxidase test is used to presumptively identify: A. Escherichia B. Enterobactor C. Serratia D. Neisseria

D Any organism which is oxidase positive can be excluded from the Enterobacteriaceae.

What is the most significant cause of decreased haptoglobin levels? A. Acute infection B. Intravascular hemolysis C. Liver disease D. Myoglobinuria

B Decreased haptoglobin levels occur when intravascular hemolysis causes free hemoglobin to be released from the broken red cell. The free hemoglobin then binds to haptoglobin, leaving decreased haptoglobin levels.

Cholesterol is used by the body for which of the following functions? A. Carrying dietary triglycerides to the cells through the blood B. Maintaining acid-base balance C. Precursor of hormone synthesis D. Major source of fuel for the body

C Cholesterol is a precursor of hormone synthesis. It is not a major source of fuel itself, but does facilitate triglyceride transport to serve the fuel needs of the body. Chylomicrons carry dietary triglycerides to the cells. Bicarbonate helps to maintain acid-base balance.

Among the gram-positive bacilli, the unique species producing H2S as seen in the Kligler Iron Agar slant illustrated in this photograph is: A. Listeria monocytogenes B. Corynebacterium striatum C. Erysipelothrix rhusiopathiae D. Bacillus circulans

C Erysipelothrix rhusiopathiae has the unique property among the gram-positive bacilli of producing hydrogen sulfide. Only a small quantity of H2S is usually produced, appearing only as blackening along the streak line of a KIA slant as shown in the photograph; or, as blackening of lead acetate paper draped over the mouth of the tube. The remaining gram-positive bacilli included in this exercise lack this property.

Twelve weeks after onset of the disease, patients with uncomplicated acute hepatitis B usually will demonstrate which of the following in their serum? A. HBsAg B. Anti-HTLV C. Anti-HBe D. Anti-HIV

C The Hepatitis B e-antigen, or HBeAg is a viral protein associated with HBV infections. Unlike the surface antigen, the e-antigen is found in the blood only when there are viruses also present. Anti-HBe is an antibody produced in response to the Hepatitis B e antigen. In those who have recovered from acute hepatitis B infection, anti-HBe will be present along with anti-HBc and anti-HBs.

The McLeod phenotype is associated with which of the following antigen systems? A. Rh B. P C. Kell D. Duffy E. MNSs

C The McLeod phenotype is associated with a decreased expression of Kell antigens on red cells.

Which of the following is an autoantibody that binds to TSH receptor sites on thyroid cell membranes preventing thyroid-stimulating hormone binding? A. Antithyroglobulin B. Antimicrosomal antibodies C. Thyroid-stimulating immunoglobulins D. Thyroxin-binding globulins E. Lupus erythematosus

C Thyroid-stimulating immunoglobulins, or TSI's, are IgG antibodies that can bind to thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH, causing excess secretion of thyroxine and triiodothyronine. The TSI level is abnormally high in persons with hyperthyroidism due to Graves' disease.

A liquid ion-exchange membrane electrode using the antibiotic valinomycin is MOST selective for: A. sodium B. glucose C. chloride D. potassium E. CO2

D The valinomycin membrane electrode is most selective for potassium as opposed to sodium, glucose, chloride, or CO2 which utilize different membranes for their respective electrodes.

A computer monitor should be set approximately how many inches away from the eyes? A. 1 - 3 inches B. 5 - 10 inches C. 10 - 20 inches D. 20 - 40 inches E. 40 - 50 inches

D Computer monitors should be approximately 20 - 40 inches away from the eyes. The top of the monitor is best set at eye level so that the eyes gravitate toward the center of the screen. OSHA recommends: 1) Ensuring adequate desk space between the user and the monitor (table depth). If there is not enough desk space, consider doing the following: a) Make more room for the back of the monitor by pulling the desk away from the wall or divider; or b) Provide a flat-panel display, which is not as deep as a conventional monitor and requires less desk space, or c) Place monitor in the corner of a work area. 2) Corners often provide more desk depth than a straight run of desk top. Move back and install an adjustable keyboard tray to create a deeper working surface.

Which of the following factors is not involved in the initial contact phase of the intrinsic pathway: A. Factor XII B. Fitzgerald Factor (high-molecular weight kininogen) C. Fletcher Factor (prekallikrein) D. Factor X

D Fitzgerald and Fletcher Factors are required to complete activation of Factor XII during the contact phase.

Hemophilia B or Christmas disease is the result of a hereditary deficiency in which coagulation factor: A. Factor X B. Factor VIII C. Factor VII D. Factor IX

D Hemophilia B is a sex-linked recessive disorder characterized by deficiency of Factor IX. It is much less common that Factor VIII deficiency.

Identify the urine sediment elements shown by the arrow: A. Cholesterol crystals B. Uric acid crystals C. Leucine crystals D. Cystine crystals

D Leucine crystals appear as oily, highly refractile, yellow to brown spheroids with radial concentric laminations. They are found in acid urine in patients with maple syrup urine disease.

The appropriate dosage of Rh immune globulin (RhIg) to administer post-delivery to an Rh-negative mother delivering an Rh-positive child is calculated based on the estimated volume of fetal bleed. What is the value of x in the formula given below that is used to calculate RhIg dosage? Number of vials of 300 µg RhIg = volume of fetal bleed/x mL Enter the number in the box below that is represented by x in the formula; do not spell out the number.(e.g., use "5" and not "five").

30 A 300 µg vial of RhIg can prevent immunization to a fetomaternal hemorrhage (FMH) of 30 mL of D-positive whole blood. Using the estimated volume of fetal bleed determined by the Kleihauer-Betke test or flow cytometry, the number of vials of RhIg (300 µg) to inject is calculated as follows: Number of vials of 300 µg RhIg = volume of fetal bleed/30 mL. In the interests of safety some American organizations recommend the following to deal with decimal points: If the number to the right of the decimal point is <5, round down and add 1 vial (e.g., 1.4 = 1 +1 = 2 vials) If the number to the right of the decimal point is greater than or equal to 5, round up and add 1 vial (e.g., 1.7 = 2 +1 = 3 vials).

Which of the following enzymes is NOT used to determine hepatobiliary dysfunction? A. aldolase B. alkaline phosphatase C. gamma-glutamyltransferase D. 5'-nucleotidase

A Aldolase is an enzyme that cleaves an aldol that aids in the conversion of glucose to energy. Aldolase is associated with the muscles, and is currently used in the monitoring of patients with muscular dystrophy and a few other rare conditions affecting skeletal muscles. A serum ALP measurement's most useful clinical attribute is its sensitivity in distinguishing hepatobiliary disease. Gamma-glutamyltransferase, or GGT, is elevated in liver diseases affecting the biliary system. Serum concentrations of 5'-nucleotidase, or 5NT, reflect hepatobiliary disease with high specificity as well.

An automated method for measuring chloride which generates silver ions in the reaction is called: A. Coulometry B. Potentiometry C. Chromatography D. Polarography E. Densitometry

A Coulometry operates on the principle of Faraday's law in which a silver anode releases silver ions (titration) at a constant rate when a constant potential is applied. The silver ions react with chloride in a fixed volume of solution to form silver chloride. The time it takes for the chloride in the unknown solution to react with the silver ions is proportional to the chloride activity in the sample.

Which blood component is the most commonly used component for the replacement of multiple coagulation factor deficiencies in bleeding patients? A. Fresh Frozen Plasma B. Red Blood Cells C. Cryoprecipitate D. Whole Blood

A Fresh Frozen Plasma (FFP) is indicated for bleeding patients with multiple coagulation factor deficiencies due to inadequate production, as in liver disease; excessive consumption, as in disseminated intravascular coagulation (DIC); or dilution, as in massive transfusion, generally defined as the replacement of one or more blood volumes in a period of 24 hours or less. FFP is also indicated for non-bleeding patients with multiple deficiencies who are undergoing invasive procedures. FFP is also used for reversal of warfarin therapy in bleeding patients and for patients with congenital factor deficiencies for which no concentrates are available.

Which of the following statements regarding the L/S ratio is TRUE? A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS) B. A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus. C. Sphingomyelin levels increase during the 3rd trimester causing the L/S ratio to fall slightly during the last two weeks of gestation. D. A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid E. Lecithin is in direct ratio with sphingomyelin

A L/S ratio <2.0 indicates an increased risk of respiratory distress syndrome (RDS) at delivery. L/S ratio <1.5 indicates a very high risk of developing RDS.

What is the molarity of an unknown HCl solution that has a specific gravity of 1.10 and an assay percentage of 18.5%? (Atomic weight: HCl = 36.5) A. 5.6 mol/L B. 6.0 mol/L C. 6.3 mol/L D. 6.6 mol/L E. 5.0 mol/L

A Molarity = (Specific Gravity x % assay weight x 10) / (gram molecular weight) Molarity = (1.1 x 18.5 x 10) / 36.5 = 5.6 mol/L

This member of the Enterobacteriaceae is shown on triple sugar iron agar, lysine iron agar, urea agar, citrate agar , phenylanine deaminase agar, and motility indole ornithine agar. It should be identified as: A. Salmonella spp. B. Shigella spp. C. Proteus vulgaris D. Citrobacter freundii

A Salmonella spp. is the correct answer because the isolate is a non-lactose and sucrose fermenter on TSIA, positive for H2S, lysine decarboxylase positive, urea negative, citrate positive, phenylalanine deamination negative, indole negative, and ornithine positive. Shigella would be H2S negative, lysine negative, urea negative, citrate negative, phenylalanine negative, and nonmotile. Proteus vulgaris would not decarboxylase lysine and ornithine, and is citrate negative, phenylalanine positive, and produce indole. Citrobacter freundii would usually ferment lactose or sucrose, not decarboxylase lysine, and would be phenylalanine and indole negative.

Serum calcitonin is typically elevated in which of the following conditions: A. Medullary carcinoma of the thyroid B. Hyperthyroidism C. Glioblastoma D. Adrenal adenoma

A Serum calcitonin is normally produced by the C cells of the thyroid. It functions to reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with a molecular weight of 3400, and has a half life of approximately 12 minutes. It is characteristically elevated in medullary carcinoma of the thyroid. Since medullary carcinoma often occurs as an autosomal disorder, family members of patients with this condition should be screened for serum calcitonin.

According to the National Diabetes Data Group recommendations, which of the following statements is TRUE with regards to the following findings? Fasting glucose = 130 mg/dl 2-hour post prandial glucose = 210 mg/dl A. The patient may be diagnosed as having diabetes mellitus B. The patient is diagnosed as having impaired glucose tolerance C. The patient is diagnosed as having diabetes insipidus D. The patient is normal

A The National Diabetes Data group recommends that the diagnosis of diabetes mellitus be based on two fasting plasma glucose levels of 126 mg per dL (7.0 mmol per L) or higher. Other options for diagnosis include two two-hour postprandial plasma glucose (2hrPPG) readings of 200 mg per dL (11.1 mmol per L) or higher after a glucose load of 75 g or two casual glucose readings of 200 mg per dL or higher. Measurement of the fasting plasma glucose level is the preferred diagnostic test, but any combination of two abnormal test results can be used.

A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min. A. 100 B. 144 C. 56 D. 225 E. 177

A The creatinine clearance for this patient is 100 mL/min. Creatinine clearance values are calculated using the following equation: Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine Volume (mL) / [ time (hr) x 60 ] For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60]) 80 x 1800/1440, which is 80 x 1.25, or 100 mL/min

Information obtained from culture smears can allow for a more rapid diagnosis. A. True B. False

A The direct stained smears made from patient culture samples can aid in the identification of bacteria, which can lead to a more rapid diagnosis.

The nuclear appendage at the tip of the arrow is a normal finding in females but not in males. A. True B. False

A The small drumstick-like nuclear extension (Barr body) marked by the blue arrow is a chromatin mass which may represent a chromosomal remnant. These nuclear appendages are found in normal XX females, but would not be present in normal XY males. If such an appendage is found in a phenotypic male, Klinefelter's syndrome (XXY male) may be identified clinically. The appendage has a "drumstick" morphology.

A laboratory developing a new testing procedure runs the test on 1,000 patients. Later confirmation shows that the experimental procedure produced remarkably few false-negative results, but many false-positive results. Which of the following statements is true regarding the experimental procedure? A. It has high sensitivity B. It has high specificity C. It has both high sensitivity and high specificity D. It has neither high sensitivity nor high specificity

A This test has high sensitivity. Highly sensitive tests produce few false-negatives. Sensitivity= True positives (TP) / TP + False negatives (FN) In this example, the sensitivity is 98%. Highly specific tests produce fewer false positives. The test in this example has a specificity of only 74%. Therefore, it is not highly specific. Specificity = True negatives (TN) / TN + false positives (FP)

A technologist performing an antibody identification in the blood bank has recorded the following results found in the worksheet below. Which antibody(ies) are most likely the cause of the agglutination reactions in this patient's sample? A. Anti-N B. Anti-M C. Anti-E D. Anti-e E. Anti-C F. Anti-c G. Anti-S

A and C The antibodies that are most likely present and causing the agglutination pattern observed are: Anti-N and Anti-E. Anti-M, Anti-e, Anti-C, Anti-c, and Anti-S are either ruled out and/or do not match the agglutination pattern present.

Based on the phenotype of the RBC screening cells, and patient results shown on the right, which of the following antibodies CANNOT be ruled out? A. Anti-C B. Anti-Jka C. Anti-M D. Anti-Fya

A and D Rule-out is a process by which antibodies are identified as being unlikely in a given sample because of the absence of an expected antigen-antibody reaction. In other words, the absence of a reaction is noted with a cell that is positive for the corresponding antigen. Although rule-out procedures may vary somewhat from institution to institution, the following general principles apply: Non-reactive cells are selected for rule-out. To be classified as non-reactive, a cell must NOT have reacted at any phase of testing in a given panel or screen. Using the logic that if the rule-out cell is positive for a given antigen, it should have reacted with the corresponding antibody, you can rule-out antibodies that correspond to antigen positive cells. To increase the probability that rule-out will not mistakenly eliminate a weakly-reacting antibody that exhibits dosage*, use only cells that are homozygous for the corresponding antigen for those systems that generally show dosage. Generally these include: C, c, E, e, Fya, Fyb, Jka, Jkb, M, N, S, and s. In this case, it is only possible to rule out on screening cell 2 since it demonstrates a negative reaction with the patient serum. Anti-C cannot be ruled out since the C antigen is heterozygous on screening cell 2 with c. Anti-Fya cannot be ruled out since this antigen is not present on screening cell 2. Anti-M and anti-Jka can be ruled out since the antigens are homozyous while demonstrating a negative reaction on screening cell 2. Rule-out, while very useful, can lead to error. Ruling out an antibody should be combined with other supporting data to increase confidence in the solution; the more data collected, the higher the probability that the final solution is correct. *Dosage means that there are two "doses" of the same antigen present on the red cells . Antibodies that exhibit dosage react more strongly with homozygous cells (e.g., Jka Jka) than with heterozygous cells (e.g., Jka Jkb) .

In which of the following situations would a bone marrow aspirate and biopsy possibly be used as an aid for diagnosis?(Select all that apply) A. Evaluation of anemia and thrombocytopenia B. Evaluation of cytopenias C. Diagnosis of leukemias D. Evaluation of fever of unknown origin (FUO) E. Screening for hematologic issues during routine check-ups

A, B, C, and D Bone marrow biopsies are helpful diagnostic tools in: - Evaluation of anemia and thrombocytopenia - Evaluation of cytopenias - Diagnosing leukemias - Can be part of evaluation for FUO Bone marrow biopsies are NOT used as screens for hematologic issues during routine check-ups.

In which of the following conditions is Hgb D elevated? A. Hemoglobin D disease B. Hemoglobin SD disease C. Hb D/beta-thalassemia D. Hemoglobin CD disease E. Alpha thalassemia

A, B, and C Hemoglobin D is an inherited autosomal recessive variation of Hb A that occurs in the β-globin protein chain of Hb A. The formation of Hb D occurs by substitution of glutamic acid for glutamin at codon 121 of the β-chain. Hemoglobin D disease, also known as Hb DD, occurs when two copies of the Hb D variant gene are inherited. It is also possible to inherit a condition known as Hb D/beta-thalassemia (Hb D/β-thal). Hemoglobin CD disease does not exist and alpha thalassemia would not show an increase in hemoglobin D.

Which of the following are directly involved in the production of semen? A. Prostate B. Pituitary gland C. Seminal vesicles D. Bulbourethral gland E. Urethra

A, C, and D The structures involved in the production of semen include the prostate, the seminal vesicles, and the bulbourethral gland, along with the testes and epididymis. Semen is produced as a combination of secretions from the different regions of the male reproductive tract. Each fraction differs in chemical composition and function. Spermatozoa are produced in the testes. They mature in the epididymis. The testes also produce testosterone and inhibin. Fluid from the seminal vesicles accounts for approximately 70% of semen volume. The seminal vesicles are the source of fructose in semen. Fructose is used by the spermatozoa as an energy source. The prostate gland supplies about 20% of the volume of semen. Its fluids include acid phosphatase and proteolytic enzymes that lead to coagulation and subsequent liquefaction of semen. The prostate also contains most of the IgA found in semen. The bulbourethral gland produces mucoproteins that make up about 5% of the volume of semen. The pituitary gland is not directly involved in the production of semen; instead hormones are released which stimulate the production of sperm. The urethra is not involved in the production of semen.

Given the Wiener and Fisher-Race nomenclatures shown below, which offspring is NOT possible from a mother who is RoR1 and a father who is R1r? Wiener Fisher-Race (haplotype) R0 Dce R1 DCe R2 DcE Rz DCE r dce r' dCe r" dcE ry dCE A. DcE/DcE B. DCe/DCe C. DCe/DcE D. DCe/dce E. DCe/dCe

A, C, and E It is necessary to convert Wiener system shorthand nomenclature to Fisher-Race nomenclature in order to make this determination. The mother's Fisher-Race genotype for Wiener R0R1 would be Dce/DCe. The father's Fisher-Race genotype for Wiener R1r would be DCe/dce. The baby's Fisher-Race genotype for Wiener cannot be R2R2, (DcE/DcE) or R1R2 (DCe/DcE). Neither parent has the rh (E) antigen. The last choice is also not a possible offspring haplotype, as neither parent carried a dCe haplotype that could have been passed down.

The hemoglobin electrophoresis patterns that are shown on the right include controls for A and F and A, S, and C above and below the patient results on the alkaline electrophoresis (on the left) and above the patient results on the acid electrophoresis (on the right). (NOTE: AF and ASC are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 4 and 6. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis? A. HbSA B. HbSC C. HbSD D. HbS/HPFH

B The patient lanes show equal bands of hemoglobin in the "S" position and the "C" position on both alkaline and acid electrophoresis. The hemoglobin that is present in the S position is Hb S and not D because a band is still present in the S position on the acid electrophoresis. HbD would not migrate with S on the acid electrophoresis as it does in the alkaline electrophoresis. There is no Hb F present in the patient sample.

The accuracy of an immunoassay is its ability to discriminate between results that are true positives and results that are true negatives. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with high specificity, but low sensitivity? A. Accurately identifies the presence of disease B. Accurately identifies the absence of disease C. Has few false-positives D. Has few false-negatives

B and C A test with high specificity accurately detects the absence of disease. The more specific a test is, the fewer false-positive results will occur. A test with high sensitivity accurately identifies the presence of disease. The more sensitive a test, the fewer false-negative results it produces. In the case stated in this question, the immunoassay has high specificity, so it has few false-positives and will accurately detect those individuals who do not have the disease or condition that is being tested for. However, the test has low sensitivity, so it may not identify all individuals who actually have the disease; it may produce many false-negative results.

Which two of the following characteristics are common to both RNA and DNA? A. Exists primarily as a single-stranded molecule. B. Consists of a sugar, phosphate residue, and a purine or pyrimidine base. C. Contains the pyrimidine, uracil. D. Linked by phosphodiester bonds.

B and D Both DNA and RNA consist of a sugar, phosphate residue and a purine or pyrimidine base. Both DNA and RNA bases are linked by phosphodiester bonds. DNA is a double-stranded molecule and RNA is single-stranded. Both DNA and RNA use the same purine bases: adenine and guanine. However, in DNA the pyrimidines are cytosine and thymine and in RNA, the pyrimidines are cytosine and uracil.

When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: A. Decreased urine copper B. Increased urine copper C. Normal urine copper D. Decreased serum copper E. Increased serum coppe

B and D Ceruloplasmin is the main copper transporting protein in the blood. Although there are other conditions (not listed) that can cause a low ceruloplasmin value (i.e., Menkes disease, overdose of Vitamin C, etc.), the best answers of those given for this question is increased urine copper and decreased serum copper. Ceruloplasmin is primarily ordered along with serum and/or urine copper tests to help diagnose Wilson disease, an inherited disorder associated with decreased levels of ceruloplasmin and excess storage of copper in the liver, brain, and other organs. Though there is an increased level of deposited copper throughout the body, the serum copper levels are paradoxically low with a characteristic increase in urine copper levels that aid in this diagnosis.

Which one of the following fungi is MOST likely to be found as a common saprobe and as a cause of keratitis? A. Sporothrix schenckii B. Cladosporium C. Fusarium D. Alternaria

C Fusarium can be found as a common saprobe and as a cause of keratitis. Fusarium colonies are most commonly fast-growing and may or may not have a cottony aerial mycelium. Fusarium typically produce both macroconidia and microconidia from thin phialides. Macroconidia and microconidia are both hyaline. Chlamydoconidia may or may not be present.

I live without air, Let there be no confusion, And succinic acid prepare, In remarkable profusion. A. Fusobacterium nucleatum B. Lactobacillus species C. Actinomyces israelii D. Clostridium difficile

C Gas liquid chromatography may be a valuable adjunct in addition to Gram stain morphology in the identification of anaerobes. Many strains of Actinomyces species, including Actinomyces israelii, have the unique feature of producing major quantities of succinic acid, in comparison to lesser amounts of other nonvolatile acids. Fusobacterium nucleatum produces major amounts of butyric acid and does not produce succinic acid; the Lactobacilli, as the genus name indicates, produces lactic acid as its sole product; and, Clostridium difficile produces large quantities of several volatile acids, including butyric and isocaproic, which results in its characteristic barn yard smell when recovered in culture.

A primary immune response is generally associated with which antibody? A. IgG B. IgA C. IgM D. IgD

C IgM is a pentamer which is the predominant antibody produced during the primary immune response. Secondary antibodies are usually IgG.

The cause of the most severe life-threatening hemolytic transfusion reactions is: A. Anti-D B. Anti-M C. Anti-A, Anti-B, Anti-A, B D. Anti-Fya

C Incompatiblity involving the ABO blood group system can cause the most severe type of transfusion reaction.

Monoclonal antibodies are usually manufactured in vitro by using: A. Cultured T cells B. Human plasma cells C. Hybridomas D. Cytotoxic T cells

C Monoclonal antibodies are monospecific antibodies that are the same because they are made by one type of immune cell which are all clones of a unique parent cell, also called a hybrid cell line, which usually arise from a hybridoma. The fusion of a specific antibody-producing lymphocyte with a myeloma cell will multiply to become a source of pure monoclonal antibody. This is often used in the manufacturing process for monoclonal antibody reagents.

Illustrated in the top photograph are acid-fast bacilli as they may appear in acid-fast stains prepared from a direct mount of infected tissue. These acid fast bacilli are thin, slightly curved, red-pigmented and beaded. The acid fast bacilli, as illustrated in the bottom photograph, aggregate in serpentine chords in stained mounts prepared from colonies growing on agar. From these observations, select from the multiple choices the presumptive identification of this mycobacterium. A. Mycobacterium kansasii B. Mycobacterium avium/intracellulare C. Mycobacterium tuberculosis D. Mycobacterium fortuitum

C Mycobacterium tuberculosis is the correct response. Bacterial cells observed in acid-fast stains that are prepared from surgical specimens or exudates are thin, slightly curved, red-pigmented and beaded. Bacilli observed microscopically in acid-fast stains prepared from colonies growing on agar surfaces are distinctly arranged in serpentine cords. Presumptive identifications can be made from these acid-fast preparations and additional biochemical reactions are available both in commercial kits or electronic instruments for confirmation. Mycobacterium kansasii bacilli as observed in acid fast stains prepared from clinical materials are typically long, straight and broad. Cross bands and bars may also be observed. Arrangement of bacilli in serpentine chords are not observed in acid-fast stains prepared from growing colonies. With experience when these bacilli are observed, a presumptive identification can be made. Observation of yellow, pigmented colonies growing on the surface of agar plates will confirm the presumptive identification. Mycobacterium avium/intracellulare bacilli are short and cocco-bacillary, uniform in staining and free of cross banding. Arrangement of bacilli in serpentine chords is not observed in acid fast stains prepared from colonies. Additional biochemical reactions may be required to make a more definitive identification when gram stain morphology is not distinctive. Mycobacterium fortuitum bacilli as observed in acid-fast preparations are pleomorphic with a mixture of short, thick rods admixed with filamentous forms. Bacilli at times may appear beaded or swollen, but aggregation into serpentine chords is not observed. Additional biochemical reactions may be required to make a more definitive identification when gram stain morphology is not distinctive.

What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs? A. 9.5 mL/min B. 13.6 mL/min C. 95 mL/min D. 136 mL/min E. 1.36 mL/min

C One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows: Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24 hours x h/60 min) In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95 ml/min

Each of the following properties inherent in a bacterium contribute to the virulence except: A. Presence of a polysaccharide capsule B. Production of a proteolytic enzymes C. Production of opsonins D. Presence of surface membrane attachment receptors

C Opsonins are not inherent part of the bacterial cell, nor are they produced by the bacterium. Opsonins are factors present in body fluids that actually work to the disadvantage of the bacterium, enhancing their susceptibility to phagocytosis. The presence of a polysaccharide capsule helps to prevent phagocytosis and protect against the oxidative burst of neutrophil lysosomal granules if phagocytosis does occur. The production of proteolytic enzymes such as leukocidens, beta lactamases and lecithinases serve as virulence factors to help destroy phagocytes, neutralize antibiotics and interrupt host cell membranes respectively. Many bacterial cells can cause infections only if they can attach via surface receptors that are complementary to host mucous membrane surfaces, such as the uropathogenic strains of E. coli that attached to the urothelium of the kidney drainage system and urinary bladder.

Which of the following Enterobacteriaceae produces DiHydrogen Sulfide: A. Klebsielleae B. Escherichieae C. Salmonelleae D. Yersinia

C Salmonella, some species of Citrobactor, Proteus, and Edwardsiella produce DiHydrogen Sulfide.

Skeletal deformations are most commonly present in which of the following beta thalassemias? A. Beta thalassemia minor B. Beta thalassemia intermedia C. Beta thalassemia major D. None of the beta thalassemias E. All of the beta thalassemias equally

C Skeletal deformations result from the increased erythropoiesis that occurs in beta thalassemia major. Children with beta thalassemia intermedia may demonstrate some facial bone deformity, however this is not common. Beta thalassemia minor rarely causes any physical signs or symptoms and beta thalassemia minima is completely asymptomatic.

A 46 year old woman was admitted to the hospital through the emergency room after having a bout of severe diarrhea for 3 days along with headaches, muscle aches, shortness of breath, and an increased heart rate. A blood gas was ordered by her concerned physician. The results showed the following: pH = 7.30 pCO2 = 32 mmHg HCO3 15 mEq/L pO2 93 mmHg What acid base disorder is most consistent with this patient's results and symptoms? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

C The correct answer is metabolic acidosis. First, check the pH. In this case, the pH is low, (less than 7.35) therefore by definition, patient must be in acidosis. Next, evaluate the pCO2 and HCO3- (bicarbonate). A low PCO2 represents alkalosis and is not consistent with the pH. A low HCO3- represents acidosis and is consistent with the pH, therefore it must be the initial change. The low PCO2 must be the compensatory response. Since the primary change involves HCO3-, this is a metabolic process, hence the diagnosis of Metabolic Acidosis.

The type of sporulation illustrated in this photomicrograph of a dematiaceous fungus is: A. Rhinocladiella B. Acrotheca C. Cladosporium D. Phialophora

C The production of dark, elliptical conidia in branching chains with the conidia separated by a delicate black scar or dysjunctor is characteristic of the cladosporium type sporulation. In rhinocladiella type sporulation, the conidia are borne from either side of a straight conidiophore in a picket fence arrangement. Acrotheca type sporulation is somewhat similar to the cladosporium type except that the chains are quite short and the conidia are derived circumferentially from the hyphae, much as the hooks on a hat rack. Phialophora type sporulation involves the production of vase-like phialides with a distinct mouth from which spherical or slightly elliptical conidia are produced in clusters.

The media used to isolate Legionella pneumophilia should contain which of the following additives? A. X and V factors B. Hemin and vitamin K C. Charcoal and yeast extract D. Dextrose and laked blood E. Lactose and vitamin E

C When yeast extract and activated charcoal are added into Feeley Gorman (F-G) agar, the components enhanced the ability to support the growth of Legionella spp. Yeast extract serves as the protein source. Activated charcoal decomposes hydrogen peroxide and other toxic products to allow for a better yield of Legionella spp. growth.

Match the images of these cells stained with the supravital stain, brilliant cresyl blue, with the appropriate description. Hemoglobin H bodies Normal cell Reticulocyte

C Hemoglobin H bodies B Normal cell A Reticulocyte Cell A is a reticulocyte. RNA present in reticulocytes will appear as darker inclusions, similar to how they appear with new methylene blue stain. Reticulocyte inclusions are fewer in number than inclusions seen in hemoglobin H bodies. Cell B is a normal cell. A cell stained with brilliant cresyl blue in which unstable hemoglobin is not present or has not yet precipitated will appear to have a smooth surface with no inclusions. Hemoglobin H bodies are seen in cell C. The inclusions are faint blue and appear to be on the outside of the cell, resembling sugar on a gumdrop; but they are just inside the cell's membrane and push outward.

Evaluate the panel shown on the right. Which antibody(ies) are most likely causing this reaction? Note: Use the reaction patterns to identify the most likely antibody(ies). There may be additional antibodies present that cannot be ruled out. A. Anti-k B. Anti-C C. Anti-Fyb D. Anti-Fya E. Anti-Lea F. Anti-M

C and E Anti-Fyb and anti-Lea are the correct answers. Judging by the difference in reactions at different phases, it is very likely that more than one antibody is present. Since some reactions are only present during IS and others only show up during 37° and AHG, there may be a warm and cold antibody present together. Other antibodies such as anti-C, for example, may not be ruled out; however, the pattern of reactivity does not match- leaving us with Anti-Fyb and anti-Lea.

Nucleated RBCs are most likely to be seen in the peripheral blood of which of these beta thalassemias? A. Beta thalassemia minima B. Beta thalassemia minor C. Beta thalassemia intermedia D. Beta thalassemia major

D Nucleated RBCs may be seen in the peripheral blood in cases of beta thalassemia major. Nucleated RBCs are usually not found in peripheral blood in cases of beta thalassemia minor and beta thalassemia intermedia, and would not be a finding in beta thalassemia minima.

An Rh negative mother has just given birth to an Rh positive baby after 18 hours of strenuous labor. Her rosette test was positive. Upon performing the Kleihauer-Betke stain procedure, the percentage of fetal cells is found to be 1.9%. The mother's total blood volume is 5,000 mL. What dose of Rh Ig (RhoGam) should be administered to the mother? A. 1 vial B. 2 vials C. 3 vials D. 4 vials

D Rh immune globulin, also known as Rh Ig or RhoGam, is used to help prevent an Rh negative mother from becoming sensitized to the D antigen from an Rh positive baby. To do this, vials of Rh Ig must be administered correctly. One full dose vial (300µg or equivalent) per 30 ml of D+ whole blood (15 ml D+ RBCs). To calculate how many vials are needed, the following formula can be employed: KB% x blood volume = volume of baby blood In this case: 1.9% x 5,000mL = 95 mL baby blood in maternal circulation 95mL / 30 mL per Rh Ig vial = 3.17 vials This equals 3 vials (after rounding), with the addition of 1 extra vial = the mother should have 4 vials of Rh Ig administered.

Multiple young 3-day old colonies having a low cottony surface mycelium that upon maturity develop a distinctly gray pigmentation (referred to as "house mouse gray"). The reverse of the colony remains light gray in color and does not show the darker pigmentation. Microscopic examination of a small inoculums from the surfaces of the colony is illustrated in the lower photomicrograph. From the list of multiple choices, select the genus name of the fungus being presented. A. Beauveria B. Sepedonium C. Chrysosporium D. Scedosporium

D Scedosporium is the correct selection. The "house-mouse" gray pigmentation of the colony is suggestive of Scedosporium species. This presumptive identification is confirmed by observing microscopically the small, spherical to oval dark gray conidia each at the tip of a delicate slender conidiophore. Conidiophores with a straight base, as presented in this exercise, is characteristic of Scedosporium apiospermum in contrast to the urn-shaped swelling at the base of the condidiophores of Scedosporium prolificans. Chrysosporium colonies also are not distinctive, growing in 2 - 4 days with a gray, wooly surface. Microscopically spherical, sub-globose to pyriform conidia are borne singly rather than in clusters at the tips of long thin conidiophores, simulating a "lollipop". Sepedonium colonies are gray white with a cottony surface that is non-specific. Microscopically, large spherical, bluntly spiked macroconidia are borne singly and not in clusters from long, delicate conidiophores. Beauveria colonies have a non-distinctive delicate silky, light gray-white surface mycelium. Key to the identification is the observation of small, spherical microconidia produced in loose clusters from delicate conidiophores with a zig-zag ("geniculate") bent knee effect.

Which of these nitrogenous bases is present in deoxyribonucleic acid (DNA), but not in ribonucleic acid (RNA)? A. Guanine B. Cytosine C. Adenine D. Thymine

D Thymine is present in DNA, but not in RNA. Uracil is present in RNA, but not in DNA.

At medical examination, a 50-year-old Caucasian male expressed concern regarding diabetes. There is a history of type 2 diabetes, hypertension, and cardiovascular disease in his family. He has gained a few pounds each year and his physician notes abdominal obesity. His physician orders laboratory tests to evaluate his risk of cardiovascular disease. Vital Signs and Pertinent Laboratoy Results: Blood Pressure: 128/82 mm Hg Weight: 230 lbs Height: 5' 11'' Calculated BMI: 32.1 Waist Circumference: 45 inches Fasting Blood Glucose: 120 mg/dL Triglycerides: 170 mg/dL HDL-C: 42 mg/dL Which one of the following statements regarding this patient is true if the physician uses the guidlines of NCEP: ATP III Diagnostic Criteria for metabolic syndrome evaluation? A. Diagnosis of metabolic syndrome; waist circumference, HDL-C, and fasting blood glucose meet the criteria B. Diagnosis of metabolic syndrome; waist circumference, triglyceride level, and fasting blood glucose meet the criteria C. Does not meet the criteria for diagnosis of metabolic syndrome because the HDL-C is not <40 mg/dL D. Cannot make conclusion regarding metabolic syndrome because the LDL-C was not assayed

In this scenario, waist circumference, triglyceride level, and fasting blood glucose meet the criteria for diagnosis of metabolic syndrome. NCEP: ATP III criteria for diagnosis of metabolic syndrome is the presence of three or more of these components: Component Criteria Abdominal obesity: Increased waist circumference Men: > 40 inches Women: > 35 inches Elevated triglycerides > 150 mg/dL or drug treatment for elevated triglycerides Reduced HDL-Cholesterol (HDL-C) Men: < 40 mg/dL Women: < 50 mg/dL Elevated blood pressure > 130/85 mm Hg or drug treatment for elevated blood pressure Elevated fasting glucose > 100 mg/dL or drug treatment for elevated glucose LDL-C is not used as a determining factor in diagnosis of metabolic syndrome with the NCEP guidelines.