Media Lab Exam

lack of fermentation of glucose, maltose, lactose or sucrose with a positive DNAse is Moraxella catarrhalis

A gram negative, oxidase-positive diplococcus was the predominant isolate from a sputum specimen of a patient with chronic obstructive pulmonary disease (COPD).Based on the reactions seen in the Quad Ferm system shown in the photograph, the most likely identification is:

High risk for future CVD <1 mg/L - low CVD risk 1-3 mg/L - average risk for CVD >3 mg/L - high risk for CVD If >10 mg/L evaluate for an acute inflammatory condition

A high-sensitivity C reactive protein (hs-CRP) test result of 5 mg/L (normal =<1 mg/L) may indicate which of the following ?

Potassium

A liquid ion-exchange membrane electrode using the antibiotic valinomycin is MOST selective for:

Chronic lymphocytic leukemia

A monoclonal B-cell population (Kappa and Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following?

Thoroughly washing patient's hands with soap and water due to chance of coming into contact with surface lead

A mother and a young child arrive at the outpatient laboratory with a physician's order for a lead test on the child. The phlebotomist decides to perform a dermal puncture (fingerstick). What procedure is important to implement when a test for lead is collected by finger puncture that would not be necessary prior to an antecubital venipuncture?

Increased rate of hemolysis

A patient presents with an elevation of unconjugated bilirubin, normal serum alkaline phosphatase, normal liver enzymes, and no bilirubin in the urine. This combination would suggest:

Irradiated

A patient with two or more documented febrile nonhemolytic transfusion reactions (FNHTRs) should receive ________________ blood components.

Gas-liquid chromatography, mass spectrometry Immunoassay is the most common screening method

Currently the MOST common method for the confirmation of serum barbiturates is:

Thrombotic thrombocytopenia purpura (TTP)

Plasma exchange is the current treatment for which of these conditions?

Nuclear antigen (ANA) - 97% of cases with SLE have a positive ANA

The antibody most frequently present in systemic lupus erythematosus is directed against:

Number of vials of 300 microgram = volume of fetal bleed/x x=30 mL

The appropriate dosage of Rh immune globulin to administer post-delivery to an Rh-negative mother delivering a 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 the dosage?

False - because the RBCs are in clusters showing agglutination not rouleaux which is stacking of RBCs

The arrangement if the erythrocytes in this peripheral smear should be reported out as rouleaux formation.

An indwelling catheter

The bacterial species shown on the blood agar plate (white, opaque colonies) and illustrated in the photomicrograph (loose clustering of gram positive organism forming tetrads) was recovered from a blood culture of a patient with fever. The most likely source of infection is:

Ulocladium species

The colony shown in the top image developed on Sabouraud's agar in 3 days when incubated at 30 C. When recovered in laboratory cultures the source is either from the environment or as a commensal contaminant. The colony has a wooly brown, gray black and white circumferential appearance with the gray-black pigment being observed from the reverse side of the petri dish. From the microscopic appearance as illustrated on the bottom photomicrograph (macrocondia that is brone singly from the tips of short, twisted conidiophores), select the name of the fungus from the multiple choices as listed

HbS migrates with D in alkaline and alone in acid electrophoresis

The gel electrophoresis pattern for hemoglobin S shows which of the following migration patterns ?

Mycoplasma; PPLO agar is used to isolate and cultivate for this organism

The growth seen here on PPLO agar is most likely caused by:

Metastasis; the nucleus in this cell is abnormal and appears to have divided

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

Macrophages; because of large amount in cytoplasm with many vacuoles

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

Alpha-fetoprotein

The laboratory test used to determine the presence of neural tube defects is:

Circulating immune complexes

The mechanism responsible for pathology in autoimmune diseases is:

Giant lysosomal granules May-Hegglin - dohle bodies Infection - toxic granulation and vacuoles in neutrophils Pelger Huet - nuclear hyposegmentation

The morphologic characteristic (s) associated with the Chediak-Higashi syndrome is (are):

Abetalipoproteinemia because the majority of the RBCs are acanthocytes. In this picture there are only a few which is indicative ofcirrhosis, hepatitis, or postsplenectomy

The peripheral blood picture is consistent with each of the following conditions except

You have not run a PT or aPTT on the new mix before incubating; Reagents needed are sample plasma and PNP, time is 60-120 minutes

When performing your mixing study, you aliqout your sample plasma and the pooled normal plasma to create your "mix". You then place the sample in a water bath to incubate for 90 minutes before running your new sample. What is the problem with the steps involved in the procedure above?

partial D and partial weak D

Which D variant has a qualitative difference in the D antigen that allows individuals with the D variant to produce anit-D?

Adiponectin; levels are decreased in weight gain, obesity, and in those who are insulin resistant Leptin, resistin, and TNF-a are all increased in obesity

Which adipokine is decreased in obesity, is anti-inflammatory, and increases insulin sensitivity?

cTnT

Which cardiac biomarker is a regulator of myocyte contractions?

e - present in 98% of Caucasians

Which of the following Rh antigens is found the highest frequency in the Caucasian population:

ABO

Which of the following blood group system antibodies is the direct antiglobulin test (DAT) most UNRELIABLE in helping diagnose hemolytic disease of the fetus and newborn (HDFN)?

Myoglobin

Which of the following cardiac biomarkers rises within 1-3 hours after chest pain, peaks 2-6 hours and is usually normal within 24 hours.

4 beta chains

Which of the following combinations of globin chains comprise hemoglobin H?

cation - Sodium anion- Chloride

Which of the following contributes most to serum osmolality:

Partial thromboplastin time (aPTT) Factor VIII and IX assays are the most helpful

Which of the following is LEAST useful in differentiating hemophilia A from hemophilia B?

Elevated hemoglobin and hematocrit

Which of the following is NOT an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)?

It does not require the use of reverse transcriptase

Which of the following is NOT true about real-time RT-PCR?

Theophylline

Which of the following is a bronchodilator used to treat a 39 year old male asthmatic patient?

Increased serum complement; because complement is actually consumed during the immune reactions involved and a positive ANA along with circulating immune responses are present

Which of the following is not a feature of systemic lupus erythematosus (SLE):

Thymine because it is replaced by uracil

Which of the following is not a nucleotide in RNA?

CFU-S

Which of the following is the proper designation for the pluripotential stem cell that is a precursor for both myeloid and lymphoid cell lines?

Precipitates between 40 and 60 degree Celsius but redissolves at 100 degree Celsius

Which of the following is true bout Bence-Jones protein when performing the heat precipitation test?

Neonates less than 4 months old Fetuses Recipients with a congenital or acquired immunodeficiency such as bone marrow or stem cell recipients and patient receiving chemotherapy Recipients of donor units from a blood relative

Which of the following patients are at risk for transfusion-associated graft versus host disease and require irradiated cellular blood products?

Patient's antibody strength may initially decrease, may develop a positive DAT with mixed-field agglutination, antibody becomes undetectable, and antibody increases in titer weeks later.

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?

It rises much sooner after a myocardial infacrtion than CK-MB

Which of the following statements is FALSE regarding troponin as a marker of myocardial infarction(MI)?

Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease

Which of the following statements is true regarding cardiovascular disease and adipose tissue?

Direct fluorescent antibody test - can only detect antigens, not antibodies

Which of the following tests would be used to directly document the presence of a specific organism in a clinical specimen

C

Which of these hemoglobins is known to migrate with HA2 in alkaline electrophoresis?

D

Which of these hemoglobins is known to migrate with HbS in alkaline electrophoresis?

Lymphocytes - immunocompetent T lymphocytes and can be prevented by gamma irradiation of cellular blood components

Which off the following is responsible for causing graft-versus-host reactions:

Creatine kinase MB; because of short duration of elevation in the blood

Which one of the following cardiac biomarkers could detect a recent reinfarction?

1+; because 2+- medium-sized clumps and clear supernatant

Tube-based agglutination reactions in blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is:

Every 20 minutes; because 20/20/20 rule, 20 minutes for 20 seconds to focus at 20 feet

Vision breaks to glance away and focus on a distant object should be taken at which of these intervals?

Factor XI - inhibits only K dependent factors

Warfarin inhibits all the following coagulation Factors except:

Acanthocytes - 3-20 thorn-like projections often with knobby ends

What are the abnormal red blood cells that are indicated by the arrows in this image?

Cryptococcus neoformans - can also use India ink stain

What is the MOST likely identification of an encapsulated yeast in a blood culture bottle from a patient with septicemia with the following additional culture information? Failure to produce germ tubes Urease positive Produced brown pigment on bird seed agar

The production of black yeast-like-colonies

What is the identifying characteristic of Aureobasidium pullulans?

Antibodies directed against platelet factor 4 and heparin complex which destroys the platelet

What is the mechanism of heparin-induced thrombocytopenia (HIT)?

10.0

What minimum level of specific resistance (megohms@25 C) is required for a Type I water system:

40% at freezing temps of -80 degree C and beneficial for patients with multiple alloantibodies

What percentage of glycerol is generally used when freezing red cells of rare phenotypes:

Echinococcus granulosus - routine ova and parasite examination

Which one of the following is the INCORRECT match between organism and the appropriate diagnostic procedure? Trichinella spiralis - serologic testing Cryptosporidium - modified acid-fast stain Schistosoma haematobium - examination of urine sediment Mycobacterium tuberculosis - acid fast stain

Transfusion-related acute lung injury (TRALI)

Which one of the following types of transfusion reactions caused the highest number of transfusion related fatalities that were reported to the US food and Drug Administration (FDA) from 2005-2009?

Inflammatory response

An increased reticulocyte count MAY be found in (hemolytic anemia, acute hemorrhage, therapy for pernicious anemia) all of the following conditions EXCEPT:

Severe combined immunodeficiency syndrome (SCID); both the humoral and cell-mediated portions of the immune system are dysfunctional

A 2 month old infant presented with history of chronic diarrhea and failure to thrive. The child's mother also revealed that the baby has suffered from thrush since birth. Preliminary findings showed lymphopenia (<2,000), hypogammaglobulinemia, and physical findings showed a small thymus, no tonsils or lymph nodes. Which of the following immune deficiencies DOES the patient present?

Acute lymphocytic leukemia

A 27 year old man with Down Syndrome has the following CBC results which are MOST suggestive of which condition? WBC: 27 x103 Hgb: 8.5 g/dL Hct: 25.0% Plt: 30x109 Differential 8% neutrophils 25% lymphocytes 67% TdT-positive blasts

(UC/SC) x [UVmL/(time (hr)x60)] = 100 mL/min

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 1800 mL. Calculate the creatinine clearance for this patient in mL/min.

Metabolic acidosis Reference ranges pH - 7.35-7.45 pCO2 - 35-45 mmHg HCO3 - 22-29 mmol/L pO2 - 85-105 mmol/L

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 measurement was ordered by her concerned physician. The results showed the following: pH-7.30 pO2 -93mmol/L pCO2 - 32mmHg HCO3- 15 mmol/L

Insulin dependent diabetes mellitus

A 56 year old female was taken to the emergency room in a coma by her employer's nurse. She had lost 35 pounds in 3 months; she was always thirsty, drinking a lot of water and running to the bathroom. The following are her laboratory results: pH:7.11 (7.35-7.45) pCO2: 21mmHg (35-45) Glucose: 950 mg/dL (60-110) Serum osmolality: 365 mOSm/kg (275-295) Urine ketone: strongly positive Urine glucose: strongly positive What is the MOST likely cause of the patient's symptoms ?

CAMP test which differentiates between Group B and C Strep

A beta-hemolytic gram-positive coccus, isolated from the CSF of an infant, grew on sheep blood agar under aerobic conditions and was resistant to a bacitracin disc. Which of the following tests should be performed for the presumptive identification of the organism?

2+

A pregnant female who was injected with RhIg antenatally has a positive antibody screen at delivery. The antibody has been confirmed as anti-D and reacts only in the indirect antiglobulin test. Many laboratories consider reaction strength to be an indicator of whether the anit-D is likely passive or immune. To be considered probably passive, and anti-D reaction strength is typically less than or equal to which reaction grade?

Klebsiella pneumonia and Proteus vulgaris

A quality control program is to be set up for the following tests: Phenylalanine deaminase (PAD) Indole production Voges-Proskauer (V-P) Which pair of stock culture organisms would be MOST suitable to verify the performance of these three tests?

decreased total iron-binding capacity (TIBC); IDA is associated with an increased TIBC, microcytic hypochromic RBC morphology, decreased Fe levels, hemoglobin, and ferritin

All of the following are characteristic findings in patients with iron deficiency anemia EXCEPT:

Piedraia hortae- causes black piedra which are brown/black nodules which are attached to the hair shaft

All of the following may cause systemic mycoses (Actinomyces israeli, Nocardia brasiliensis, Coccidoides immitis, Nocardia asteroides)EXCEPT:

CK-MB levels are normal in cardiac ischemia

All of the following statements concerning CK-MB (CK-2) are true EXCEPT:

Yersinia enterocolitica

An 8 year old boy underwent laparotomy for clinical signs and symptoms of acute appendicitis. Instead, the appendix did not appear inflamed, but the mesenteric lymph nodes were enlarged and edematous. The photomicrograph is a close-in H&E section of an area within one of the lymph nodes, showing hyperplasia and focal nectrotizing inflammation. The bacterial species most likely causing this reaction is:

Bacterial infection

Detection of a fruity odor (production of ketones) in a fresh urine sample may be indicative of all of the following EXCEPT:

Pituitary Adrenal cortex produces corticosteroid hormones (aldosterone) Adrenal medulla produces catecholamines (epinephrine) Thyroid gland produces T3 and T4

Follicle stimulating hormone (FSH) is produced by:

Curvularia species - macroconidia composed of four or five cells that are separated by transverse septa; the second cell from the terminal end of the conidium continues to grow after the others have stopped, "boomerang" Alternaria species - producing a large, drumstick shaped multi-celled macroconidia divided by both longitudinal and transverse septa; forms chains Stemphylium species - multi-celled muriform macroconidia looking like a bale of cotton on a stick

Fungus descriptions

DcE/DcE DCe/DcE DCe/dCe

Given the Wiener and Fisher-Race nomenclature shown below, which offspring is NOT possible from a mother who is R0R1 and a father who is R1r?

integrity of the RBC membrane (schiztocytes)

Hemoglobin H bodies can directly alter the:

An abrupt rise in luteinizing hormone (LH) 3-36 hours prior to ovulation

Hormonal variation throughout the menstrual cycle typically shown:

0-5 WBC/microliter; children have slightly higher up to 30WBC/microliter with 60-100% being lymphocytes

How many white blood cells would be considered normal for adult cerebrospinal fluid?

Mycobacterium marinum chelonae- no yellow pigment scrofulaceum- yellow pigment before exposure to light gordonae- yellow even if grown in the dark

Illustrated in the photograph are 14 day-old colonies of a mycobacterium species growing on Middlebrook 7H-10 agar with development of yellow pigmentation after exposure to environmental light.

End stage cirrohsis

Increases in blood ammonia levels would be expected in which of the following conditions:

Aplastic anemia - defective stem cell production Thalassemia - interruption of hemoglobin production Megaloblastic anemia - interruption of DNA synthesis Anemia associated with chronic renal disease - interruption of development of precursor cells

Match each anemia listed below with the mechanism for the anemia

Coccidiodies immitis - arthroconidia that are barrel shaped with alternating staining due to empty space Blastomyces dermatitidis - spherical or oval condia each supported by individual conidiophore "lollipop" Histoplasma capsulatum - spiked macroconidia Sporothrix schenckii - tiny microconidia arranged around a tip conidiophore "cherry trees"

Match each of the names of the dimorphic fungal species with its corresponding mold form as seen in the photomicrographs

Xylose-lysine-deoxycholate: phenol red, lactose, bile salt Bismuth sulfite: bismuth sulfite, glucose, brilliant green Salmonella-shigella: neutral red, lactose, bile salts Eosin methylene blue: eosin Y and methylene blue, lacotse

Match the differential/selective enteric medium with its characteristic indicator, fermentable, and bacteriostatic.

Hepatitis A - Fecal and Oral Hepatitis B - Parenteral Hepatitis C - Parenteral

Match the hepatitis with its route of transmission.

Nocardia species - Gram positive filamentous bacilli that branch Corynebacterium species - Gram positive bacilli that arrange in oriental letter patterns Bacillus species - short or long Gram positive bacilli that produce sproes Lactobacilli - rectangular shaped Gram positive bacilli that often arrange in short chains

Match the names of each of the bacterial species listed with its most likely Gram stain morphology as illustrated in the photographs

Primary biliary cirrhosis - Antimitochondrial antibodies CREST syndrome - Anticentromere antibodies Wegener's granulomatosis - Antineutrophilic antibodies Rheumatic fever - Antimyocardial antibodies

Match these autoimmune diseases with their corresponding serological markers.

Gram-negative bacteria

Nitrates in urine are reduced to nitrites by:

Elevated serum potassium

Patients with which of the following conditions would benefit most from washed red cells:

Increased pCO2; because when the lungs ability to remove carbon dioxide is decreased, resulting in increased blood pCO2 and acidosis.

Respiratory acidosis is associated with:

True - because it's colonies are similar to Listeria monocytogenes but L. monocytogenes is motile, esculin(+), and VP (+) while E. rhusiopathiae is negative for all of these tests and produces H2S

Shown in the image are three tubes: (1) motility agar (note surface flare shown by arrows); (2) esculin hydrolysis (+), and (3) VP (+).The reactions illustrated here are sufficient to rule out Erysipelothrix rhusiopathiae.

Copper reduction

The Clinitest reaction is based on which of the following principles?

Antibodies in the plasma

The Indirect Antiglobulin Test (IAT) is usually used to detect:

Fasting blood glucose, triglycerides, HDL-C Criteria: Large waist line, High triglycerides, High fasting glucose, low HDL, High blood pressure

The National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA) have created a set of parameters to define the presence of metabolic syndrome. Select the set of laboratory assays that are utilized in the NHLBI and AHA criteria for metabolic syndrome diagnosis.

Rhodotorula mucilaginosa - rapid positive spot urease reaction

The pink-pigmented, smooth 48 hour yeast colonies growing on Sabouraud's dextrose have a characteristic appearance leading to a presumptive identification. This environmental yeast may be recovered from cultures obtained fro shower curtains, bathtubs, and tooth brushes. The isolate presented here was recovered from peritoneal fluid of a 45 year old woman receiving peritoneal dialysis. Illustrated in the bottom photomicrograph is growth on cornmeal agar revealing loose clusters of yeast cells with the absence of psuedohyphae. Select from the multiple choices in the identification of this yeast.

Precipitation

The reaction that occurs when a soluble antigen is mixed with its specific antibody is termed?

Starch granules stain black with iodine

The reaction which differentiates crystals from starch is:

Time

The relative centrifugal force of a centrifuge may be affected by all except the following

Prevotella bivia

The saccharolytic anaerobe that produces red fluorescing colonies when illuminated with a Wood's lamp, as shown in this photograph is

Valine

To produce hemoglobin S, glutamic acid that is normally present in the sixth position on the beta globin chain is substituted with which of the following?