MLS LABCE Certification A
From the IgG molecule illustration, which region is the heavy chain?
(A)
How is the Mean Cell Volume calculated?
(Hematocrit %/ Red blood cells) X 10
Which of the following would be the most appropriate temperature for long term storage of specimens for viral culture?
-70 C
How would one prepare 3 mL of a 5% albumin working solution from a stock 30% albumin solution?
0.5 mL stock 30% albumin + 2.5 mL diluent
At many hospitals, patients with sickle cell disease are given phenotypically matched units of blood. This policy is often used to help prevent alloimmunization to common RBC antigens in patients who are regularly transfused. A patient who regularly comes to your hospital demonstrates the following phenotype on her RBCs: C antigen positive; E antigen-negative; K antigen positive. The patient's doctor requests a single unit of crossmatched packed RBCs. Based on the antigen prevalence indicated below, how many units of ABO compatible packed RBCs will you phenotype to find one to transfuse to this patient? Antigen frequencies C antigen positive: 68% E antigen positive: 22% K antigen positive: 9%
1 unit
How long are healthy neutrophils expected to reside in the peripheral blood of an adult?
7-8 hours
Platelets that are not collected by an apheresis method must be prepared within __________________ of the collection of whole blood.
8 hours
Which of the following chemical substances induces platelet adhesion when there is a break in the inert epithelial lining of the vasculature?
Adenosine diphosphate (ADP)
The name of a reaction between a single antigenic determinant and an individual combining site is:
Affinity
Which of the following characteristics of hemolytic disease of the fetus and newborn (HDFN) is NOT different for ABO and Rh HDFN?
Antibody is IgG
The following statements are true regarding the Lewis blood group EXCEPT:
Antigens are a structural component of the red cell membrane
Which of the following apolipoproteins contributes the greatest mass to the structure of high-density lipoprotein (HDL)?
Apo A Apolipoprotein A (Apo A) contributes the greatest mass to the structure of HDL. Apo A-1 and Apo A-II both are part of the HDL structure. Apo A-1 has a molecular weight of 28,000 kD while Apo A-II has a molecular weight of 17,400 kD.
These adult nematodes are round, elongated, typically look like an earthworm and can be found in decaying vegetation or moist soil. Of the following organisms listed, which one is a nematode?
Ascaris lumbricoides
When treating serious enterococci infections, both a cell wall-active agent, such as ampicillin or vancomycin and an aminoglycoside, such as gentamicin should be used. Therefore, it is important that this information be reported to physicians by which of the following?
By providing an explanatory note stating the recomended use of combination therapy
Which of the following genotypes is found with the highest frequency in the Caucasian population?
CDe/ce
Which two of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle?
CK-MB and myoglobin
A group of Canadian travelers were visiting the island of Kauai Hawaii for a summer vacation. They noticed a cave in the middle of the island that contained a 10ft deep pool of water. Much to their surprise they were the only individuals enjoying this newly discovered swimming hole. A few days latter, all swimmers became ill. Their physician believed they all had Weil disease. Which of the following organisms can cause this disease?
Leptospira interrogans
A Gram stain of drainage from an open wound revealed gram-positive bacilli with spores. This description would commonly rule out which one of the folowing organisms? ( Choose the Best response. )
Clostridium perfringens
The top image shows a 5-day-old colony grown on blood agar and incubated at 30o C. It has a delicate cobweb-like, gray-white mycelium. Note the dark gray discoloration on the upper margin where hemoglobin pigment has been absorbed. This colony was recovered from the needle biopsy of a lung nodule that developed three months after a 45-year-old businessman returned from a business trip in Southern California. The definitive identification can be made microscopically from the observation of the distinctive hyphae as presented in the lactophenol blue mount shown in the bottom image. From these observations, select the presumptive identification of this isolate from the choices listed below.
Coccidioides immitis
This image is from a patient with alpha thalassemia. Though not diagnostic for this condition, what morphology is present which would lead you to consider a quanitative disorder of hemoglobin synthesis?
Codocytes
Various methods have been employed for the detection of Clostridioides difficile disease, which method is the new gold standard for detection?
Nucleic acid amplification tests (NAATs)
The arrangement of erythrocytes on this peripheral blood smear can be associated with each of the following conditions EXCEPT:
Cold agglutinin disorders Erythrocyte agglutination (clumping) rather than rouleaux formation appears in these disorders when cold reactive antibodies, most commonly IgM, are circulating in the plasma. Microscopically, cold agglultinin disorders demonstrate large clumps of RBCs in contrast to the branching lines of RBCs seen in this image of rouleaux.
Pheochromocytoma is a tumor of the adrenal medulla that results in elevated urinary levels of all the following EXCEPT:
Cortisol
Which of the following analytes would be increased due to delay in centrifugation?
Creatinine
The top image shows the microscopic appearance of yeast cells within a colony growing on cornmeal tween 80 agar. These same cells may also be observed in a tissue section (bottom image) taken from an area of inflammation. The tissue section is stained with Gomori Methanimine Silver and shows a clear area around the cells. Which of the following organisms could be the cause of this inflammation?
Cryptococcus neoformans
Which laboratory assay is a highly specific indicator and the most sensitive assay for a diagnosis of rheumatoid arthritis?
Cyclic citrullinated peptide
A Rh negative individual has produced an anti-D antibody. Which situation has the ability to stimulate this production of anti-D?
Delivering a Rh positive baby.
All of the following are uses of nucleic acid tests for HIV infection, EXCEPT?
Determine the degree of immune suppression caused by HIV
The laboratory test most commonly used to establish a definitive diagnosis of primary syphilis is:
Direct fluorescent antibody test
Maltose, lactose, and sucrose are all:
Disaccharides
A woman in labor is bleeding, has a very high fever, and is in danger of losing the fetus. Laboratory results include a platelet count of 15 x 109/L (normal platelet count = 150 - 450 x 109/L), prolonged PT and aPTT, decreased fibrinogen, and increased D-dimer. Her automated blood count flagged for blood smear review and the cells indicated by the arrows were seen on her peripheral smear along with a decrease in the number of platelets present. What condition is suggested by these results?
Disseminated intravascular coagulation (DIC)
For which of these reasons would a molecular method not be used?
Donor antibody screening
Thin-layer chromatography is particularly useful as a tool in the identification of:
Drugs
Myelodysplastic Syndromes are characterized by cytopenias with at least one cell line decreased as well as this:
Dyspoiesis
Which of the following would you find in a primary hyperparathyroidism case?
Elevated serum calcium and decreased serum phosphorus
The morphology of this cyst resembles Entamoeba histolytica, but lacks ingested red blood cells in its trophozoite form. What is this organism?
Entamoeba hartmanni
The upper image is a photomicrograph of a Gram stain prepared from a positive blood culture obtained from a 68 year old female with an indwelling urinary bladder catheter. Smooth, gray, faintly beta hemolytic colonies were recovered in subcultures of the positive bottle. The tubes shown in the lower photograph are: an esculin slant (left) displaying intense brown coloration a 6.5% sodium chloride broth (right) showing cloudy growth
Enterococcus faecalis
Illustrated in this photomicrograph is a silver-stained section of duodenal epithelial cells invaded by 1.5 um in diameter spores (arrows). These spores will appear red in Weber-stained mounts (image not shown here). The presumptive identification is:
Enterocytozoon species
Which one of the following organisms is typically urease negative:
Escheria
Recently the American Diabetes Association (ADA) recommended reporting which of these values in order to correlate with Hemoglobin A1c (HbA1c) as a further indicator of glycemic control?
Estimated average glucose
Warfarin (coumarin-type anticoagulant) inhibits all the following coagulation factors except:
Factor XI
What is the common name for the sheep liver fluke?
Fasciola hepatica
VDRL and RPR are examples of which of the following types of test methodologies?
Flocculation
What would be the best way to determine how much RhIg should be given to a postpartum female who received RhIG antenatally and demonstrates the anti-D antibody at delivery?
Flow cytometry
Zollinger-Ellison syndrome is characterized by a large (usually 20-fold) elevation of:
Gastrin Zollinger-Ellison syndrome, or ZES, is a rare disorder where one or more tumors in the pancreas, duodenum, or intestinal lymph nodes produce gastrin, causing the parietal cells of the stomach to make too much acid (up to 20-fold), leading to multiple peptic ulcers.
All of the following represent a 2 week temporary deferral from donating blood or blood products EXCEPT:
German measles (rubella) vaccine
Which of the following sugars has been fermented when a gram-negative bacillus produces an alkaline slant and an acid butt on triple sugar iron agar (TSI)?
Glucose
Examine this illustration of an amoeba cyst. The internal structure at letter D is called the:
Glycogen mass
All of the following would be suitable for the identification of bacterial antigens, EXCEPT
Gram Stain Reactions
What blood system is often tested to either establish or dispute paternity?
HLA Due to the highly polymorphic nature of HLA, or human leukocyte antigens, this system is often used to prove or disprove paternity cases.
This image depicts a brilliant cresyl blue-stained blood smear. What inclusion bodies are shown in the erythrocyte indicated by the arrow (B)?
Hb H inclusions
The gel electrophoresis pattern for hemoglobin S (HbS) shows which of the following migration patterns?
HbS migrates with HbD in alkaline and alone in acid electrophoresis.
A culture was performed on a stool sample. After growth was obtained on the blood agar plate, the gram stain showed curved gram-negative rods. The oxidase, catalase, and urease were positive. What is the most likely bacterial identification?
Helicobacter pylori Identification methods for curved gram-negative rods will include (in this order) oxidase, catalase, and urease. Helicobacter pylori will have the gram stain showing curved gram-negative rods. It will have positive results for oxidase, catalase, and urease.
Which of the following formulas will provide the value that reflects the average cell volume in a blood sample?
Hematocrit (%) x 10/RBC count (1012/L The mean corpuscular volume, MCV, is a measure of the average volume of the red cells. The MCV can be calculated using the formula Hematocrit (%) x 10/RBC count (1012/L).
An increased number of the cells seen in the image, upon microscopic examination of urine is termed:
Hematuria
An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of:
Hemolysis
Which is not a condition in which coarse basophilic stippling is typically found?
Hemolytic anemia
All of the following are considered to be important protein regulators of iron metabolism, EXCEPT?
Hemosiderin
Which of the following conditions would be associated with an increased osmotic fragility test result?
Hereditary spherocytosis
Which genetic description will NOT contain Bart's hemoglobin at birth ?
Heterozygous alpha thalassemia-2 Heterozygous alpha thalassemia-2 has only one alpha gene deletion and is referred to a silent carrier. It will not present with any Bart's hemoglobin at birth .
MCV is calculated using which of the following parameters?
Hgb and RBC
Which of the following statements abouth high-frequency antigens is correct?
High-frequency antigens are common, but it is difficult to identify their corresponding antibodies.
The pairing or annealing of two strands of DNA is termed:
Hybridization Hybridization is the pairing or annealing of two strands of DNA.
This egg is found in stool and measures 45 um by 25 um. Which organism's egg is depicted by this drawing?
Hymenolepis nana egg
Which of the following antigen groups is closely related to the ABO antigens on the red cell membrane?
I,i
A direct antiglobulin test (DAT) can be used to detect all of the following EXCEPT?
IgG antibodies in the patient's serum
Which of the folowing is the predominant immunoglobulin class for anti-A and anti-B antibodies in group B and group A individuals?
IgM
Sperocytes are associated with wich of the following conditions?
Immune hemolytic anemia
Classic automated blood cell counters are based on which of the following technologies?
Impedance principle
What would you expect the serum iron (SI) and total iron-binding capacity (TIBC) to be in a person with hereditary hemochromatosis (HH)?
Increased SI and decreased TIBC
All of the following hormones stimulate gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids, EXCEPT?
Insulin
Which of these conditions could result in a microcytic anemia?
Iron deficiency
A patient is admitted to the emergency room with severe lethargy, glossitis, and muscle dysfunction. After the physician orders a complete blood count with differential, the hematology technologist observes cells matching the image to the right. Which condition is most consistent with the clinical and laboratory findings?
Iron deficiency anemia
Which of the following criteria for donor RBC should be used for an exchange transfusion related to both HDFN due to anti-D and ABO HDFN?
Irradiated One of the criterium to consider when selecting blood for exchange transfusion would be the use of irradiated blood to prevent graft versus host disease. Other criteria include using red blood cells < 7 days old resuspended in group AB fresh frozen plasma, hemoglobin S negative blood, group O (or ABO compatible) Rh negative blood, CMV reduced risk products, blood that lacks antigens corresponding to maternal antibody, and compatible crossmatch with maternal serum.
What is the purpose of adding citrate to donated red cell units?
It prevents coagulation. Citrate chelates calcium, preventing coagulation in the red cell unit; it also stabilizes the red cell membrane.
The first time a cell containing HbSS is deoxygenated, it forms a sickle cell. Upon reoxygenation, which of the following is true for the sickle cell?
It will return to a normal biconcave shape.
Proteolytic enzyme techniques may be useful in identifying which of the following antigen groups:
Kidd system
Which of the following tests on amniotic fluid would be included when assessing fetal lung maturity:
L/S Ratio
Which one of these Lewis blood group system phenotypes usually produces anti-Lea?
Le(a-b-)
The statement, "The student will perform direct antiglobulin tests with 100% accuracy," is an example of a(n)?
Objective Objectives are statements that describe the general knowledge, attitude, and skill a learner will demonstrate at the completion of a learning activity. Objectives are measurable, have conditions, standards, and terminal behaviors.
What is the distance the solute migrates divided by the distance the solvent migrates in thin layer chromatography (TLC)?
Rf
A patient had a differential diagnosed of Systemic Lupus Erythrematosus (SLE) Laboratory Results: ANA= Positive (homogeneous pattern) Titer 1:320 RA=positive Complement = decreased All of the following specific laboratory tests meet the criteria for a definitive diagnosis of SLE, EXCEPT?
Ribonucleic protein (RNP) antibodies
In the evaluation of a positive DAT result, all of the below techniques can be used to dissociate the antibody(ies) form the RBC's EXCEPT:
Saline replacement
Which of the following species of hyaline molds produce conidia in chains?
Scopulariopsis species
The upper image is a 4 day old colony grown on Sabouraud's Dextrose agar, recovered from a bacterial culture that was considered to be a "contaminant". The lower image is a high power image of a methylene-blue stained mount prepared from the surfaces of the colony. With these observations, select the fungus genus from the multiple choices as listed.
Sepedonium
All of the following organisms can exhibit beta hemolysis, EXCEPT:
Shigella sp.
This antinuclear antibody (ANA) pattern is charaterized by granular staining in the nuclei of the interphase cells (a). There is also and absence of staining in the chromosomal area of the metaphase mitotic cells(b). The slide is viewed using fluorescent microscopy. Which Pattern is this?
Speckled
Antibodies are ruled out using panel cells that are homozygous for the corresponding antigen because:
Stronger reactions are seen with homozygous cells
What is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis?
Teardrop cells Teardrop cells, also known as dacryocytes, are the predominant abnormal morphological finding in idiopathic myelofibrosis. Teardrop cells appear in peripheral circulation as pear or tear-shaped red blood cells. Teardrop cells may also be seen in the peripheral blood in patients with thalassemia syndromes, drug-induced Heinz body formation, iron deficiency, and conditions where inclusion bodies are formed.
A mother's serologic results are shown above. Her newborn types as group A Rh positive with a (1+) positive direct antiglobulin test (DAT). Which of the following investigative tests would be most useful to resolve the cause of the positive DAT and should be done FIRST?
Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT.
When a Specked Nuclear Antibody (ANA) pattern is observed, what follow-up test for antibodies related to Systemic Lupus Erythematosus (SLE) is not beneficial?
Testing for antibodies to U1RNP+ and dcSSc
The function of the cerebrospinal fluid includes all of the following EXCEPT:
The transmittance of neurologic impulses
Which of the following statements is TRUE for specific gravity measured by the urine chemical reagent strip method?
The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen.
Which antinuclear antibody (ANA) pattern is seen in the image on the right, which represents the result of an ANA test viewed using fluorescent microscopy? Note: (a) points to the nuclei of interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell.
There is no discernable pattern
A physician discusses weight with an overweight 60-year-old female at her yearly physical appointment. The female exercises regularly and eats healthy most of the time. The physician suggests she decrease carbohydrate intake and decrease portion size at meals. Review patient vital signs and laboratory assay results to decide if a diagnosis of metabolic syndrome is appropriate using the NCEP: ATP III Diagnostic Criteria shown on the right. Height: 5' 7' Weight: 192 lbs BMI: 30.1 Waist Circumference: 37 inches Blood Pressure: 108/70 Fasting Blood Glucose: 92 mg/dL Total Cholesterol: 172 mg/dL LDL-C: 112 mg/dL HDL-C: 46 mg/dL Triglycerides: 70 mg/dL hs-CRP: <1.0 mg/L Which of these statements regarding this patient is true?
This patient does not meet the criteria for diagnosis of metabolic syndrome.
Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet?
Thromboxane A2
What is the recommended treatment if the patient is passing both cysts and trophozoites with an Entamoeba histolytica infection?
Tissue amebicide followed by a luminal amebicide
The weight of NaCl present in 650 ml of a 0.85% NaCl solution is:
Weight = (650 mL / 100 mL) x (0.85%) = 5.525 grams
In the following list of organisms, which organism is considered cryophilic (can grow as low as 4° C)?
Yersinia enterocolitica is cryophilic and can grow at refrigerator temperatures. This is an important implication in that this organism is a possible infective agent in cases of transfusion-related septicemia as the organisms can survive and replicate at the storage temperature of blood products.
Which asay is recommended by the American Heart Association (AHA) and the centers for Disease Control and Prevention (CDC) as the inflammatory marker of choice in the evaluation of cardiac heart disease risk?
hs-CRP
How are Barr bodies usually classified?
Non-pathological
The laboratory workplace includes many hours of computer use. The suggested time for a break after 30 minutes of computer use is:
1-2 minute break
At what temperature should whole blood be stored?
1-6 C
How many doses of RhIG should be administered if the calculated amount of fetal whole blood volume in maternal circulation was 28 mL?
2 Doses
What is the half-life for aminoglycoside antibiotics in the blood?
2-3 hours
A serum ferritin above what level would be suggestive of iron overload and possibly hereditary hemochromatosis (HH) in a pre-menopausal woman?
200 ng/mL
What is the normal myeloid to erythroid (M:E) ratio in the bone marrow?
2:1 - 4:1 In the bone marrow, the ratio of myeloid cells to erythroid cells ranges from 2:1 to 4:1 in healthy individuals (when segmented neutrophils are included in the myeloid count). If segmented neutrophils are not included in the count, the M:E reference range is between 1.5:1 to 3:1.
Based on the quality control results in the table below, the mean for the sodium control is calculated as 140 mmol/L with a 1 SD of 2.7 mmol/L. Using the 95% confidence interval, how many quality control values fall outside of the acceptable range during the 11 consecutive days?
3
Troponin I is used frequently to assess acute myocardial infarctions (AMI). If a patient has experienced an AMI, at what point (approximately) will the troponin I begin to increase and how long will it stay increased?
3-12 hours, 7-14 days
A 300 µg dose of RhIg (Rh immune globulin) can suppress immunization to how many mL of D-positive whole blood?
30 mL
What is the increase in the risk for developing antibodies against red cell antigens (RBC alloimmunization) for patients who are characterized as chronically transfused patients?
30% or greater
In order to make a 1:10 dilution with 500 microliters of patient serum, how much saline would be needed?
4.5 mL
What percentage of dietary iron is normally absorbed daily?
5% to 15% Only 5% to 15% of dietary iron is absorbed daily in a normal, healthy person. In order to be absorbed by the intestinal cells, iron needs to be in the ferrous state (Fe2+) and bound to protein. Most iron ingested from food is in the ferric (Fe3+) state and must first be reduced to the Fe2+ state by the ferric reductases present in the intestines before it can be absorbed by the body.
A Cytochrome P450 2D6 (CYP2D6) ultrapid metabolizer (UM) would require _____________ dose of an active drug (non-prodrug) that is metabolized by CYP2D6 extensive metabolizer (EM).
A higher
The following describes a clot-based test to assess Protein C function, as well as the results of someone's test which has a protein C deficiency.
A parital thromboplastin time (PTT) is performed using C-depleted normal plasma, a venom activator of protein C (such as Protac), and a heparin neutralizer. The clotting time would not be prolonged in someone with a protein C deficiency.
Which of the following best describes Myelodysplastic syndromes?
A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series
Which of the following is/are considered an accrediting agency(ies) for quality and safety in the blood industry?
AABB
Which of the following fresh frozen plasma ABO types would be suitable for transfusion to an AB negative patient?
AB negative and AB positive
What is the cause of iron overload in hereditary hemochromatosis?
Absorption of excessive amounts of iron in the small intestine
What are the abnormal red blood cells that are indicated by the arrows in this image?
Acanthocytes
The ketone component that is measured by the nitroprusside reaction is:
Acetoacetic acid
A 49 year old farmer developed swelling of the neck beneath the left jaw with enlargment of the left posterior cervical lymph nodes. The photograph to the right is represenative of a direct gram stain prepared from purulent material aspirated from one of the enlarged lymph nodes. The organism was not acid fast. What is the Most likely identification?
Actinomyces israeliielii
The colonies illustrated in the upper photograph were recovered from the aspiration of nasal secretion from a patient with acute sinusitis. The 48 hour colonies on blood agar are relatively small, entire, white, and non-hemolytic. Colonies growing on chocolate agar are also small, smooth, and entire with light yellow pigmentation. On Gram stain, pale-staining, Gram-negative coccobacilli are observed, with a tendency to form long, narrow filaments. The lower photograph reveals tube reactions with a KIA: Acid/Acid and the oxidative utilization of several carbohydrates except for xylose and mannose. Nitrate reduction is positive and ornithine and arginine decarboxylases are negative. From the observations, select from the multiple choices the genus/species name of this isolate.
Aggregatibacter aphrophilus is the correct response. Colonies growing on blood agar are small, entire, smooth, gray-white, and non-hemolytic. Colonies growing on chocolate agar are also small, smooth, and entire with light yellow pigmentation. On Gram stain, pale-staining, Gram-negative cocco-bacilli are observed, with a tendency to sometimes form long, narrow filaments. A. aphrophilus is saccharolytic and acid is produced from many commonly tested carbohydrates, except xylose. Nitrates are reduced.
In which disorder may a mild anemia be present even with an increased red cell (RBC) count and normal adult hemoglobin electrophoresis?
Alpha thalassemia minor
All of the following are factors that will affect migration in gel electrophoresis, EXCEPT?
Amount of light present
All of the following laboratory tests are used to determine kidney function, EXCEPT?
Amylase
Which of the following blood tests is used to determine acute pancreatitis?
Amylase Amylase test helps to determine acute pancreatitis. It should be collected in a gel-barrier serum tube (red or gold top). Hemolysis and lipemia should be avoided. Serum should be separated from cells immediately and refrigerated for storage.
All of the statements below regarding amylase and lipase in pancreatitis are true EXCEPT:
Amylase and lipase are as predictive in chronic pancreatitis as they are in acute pancreatitis.
Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA?
Anaphylaxis
On a quiet evening shift at a small hospital, you encounter a specimen with a positive antibody screen. As per your current laboratory protocol, you check for agglutination at the immediate spin phase of testing; and then again at the antihuman gloubulin (AHG) phase of 37°C. According to your laboratory guidelines, a single homozygous cell may be used to rule out an antibody. Based on the following 3-cell screen performed by tube, which of the following clinically significant antibodies are you unable to rule out?
Anti-Fya, -C, -Lub
A physician suspects his patient might have rheumatoid arthritis. Which of the following markers should be ordered?
Anti-IgG
If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients?
Anti-Leb
All of the following are currently used to diagnose acute coronary syndrome and/or acute myocardial infarction, EXCEPT?
BNP The BNP (B-type natriuretic peptide) and the NT-proBNP (N-terminal pro-B-type natriuretic peptide) are currently used to differentiate heart failure from lung disease.
Which bacterial species is most likely represented by the spreading, gray-white, beta-hemolytic colonies with a "frosted glass" appearance as illustrated in the photograph?
Bacillus cereus
Group A beta-hemolytic streptococci are best characterized by which of the following:
Bacitracin sensitivity Group A streptococci are best characterized by their susceptibility to bacitracin. Bacitracin disks are used as rapid screening tools to differentiate group A streptococci from other beta-hemolytic streptococci.
An abdominal wound culture grows E. coli on the aerobic culture. The anaerobic culture has the growth of two, gram-negative rods, one of which is aerobic. The other gram-negative rod has 2+ growth on the BBE plate and is resistant to kanamycin, colistin, and vancomycin disc. What is this organism's identification?
Bacteroides fragilis group Bacteroides Bile Esculin Agar (BBE) is an enriched selective and differential medium for the isolation and presumptive identification of obligate anaerobic, gram-negative bacilli of the Bacteroides fragilis group. BBE contains gentamicin at a concentration that inhibits most facultative anaerobes. Bacteroides fragilis group are resistant to kanamycin and vancomycin and colistin.
The organism that is a strict anaerobe, non-motile, gram-negative bacillus, occuring in adscesses and associated with peritonitis is Most likely:
Bacteroides spp.
What is the largest protozoan known to infect humans?
Balantidium coli
Cyclosporine and tacrolimus (both immunosuppressive drugs) have multiple therapeutic ranges, why?
Because both drugs have ranges dependent on the organ transplanted and the time after transplantation.
When should a pipette be wiped off?
Before lowering the meniscus to the calibration mark
In the formalin-ethyl acetate sedimentation procedure, four layers are present in the tube following centrifugation. Which layer contains the formalin?
Between the bottom layer and the debris/fat layer, because formalin will have a lower density than the sediment and higher density than debris/fat.
What is the nuclear appearance of an Endolimax nana trophozoite?
Blot-like karyosome, no peripheral chromatin
Which of the following test is the most useful in differentiating Listeria monocytogenes from Erysipelothrix rhusiopathiae?
Catalase production Catalase production is the only test listed that differentiates Listeria monocytogenes from Erysipelothrix rhusiopathiae. L. monocytogenes is catalase positive, where E. rhusiopathiae is catalase-negative.
Suppose a patient with stiffness in her fingers has a positive antinuclear antibody (ANA) test with a centromere pattern at a 1:1280 titer. What is the most likely diagnosis?
Centromere antibodies are present in over half of patients with the CREST syndrome, an acronym named after the major features of this autoimmune disorder: calcinocis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiesctasia. While the ANA result alone is not diagnostic, this patient is having clinical symptoms of stiff fingers that fits nicely with the centromere ANA pattern.
Which one of the following drugs/drug classes is the MOST COMMON cause of drug-induced immune hemolytic anemia?
Cephalosporins
Which of the following sample types should be processed first for culture and Gram stain?
Cerebral spinal fluid (CSF)
Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the following conditions?
Chediak-Higashi syndrome Chediak-Higashi syndrome is a rare fatal autosomal recessive disease. The disease is characterized by abnormal fusion of granules in hematopoietic cells that contain granules (granulocytes, monocytes, and lymphocytes). The fused granules are large and dysfunctional and result in recurrent bacterial infections.
Illustrated in the photograph is a citrate tube. Sodium citrate is converted into alkaline products by bacteria that can utilize citrate as the sole source of carbon, giving a blue color from the conversion of the bromothymol blue indicator. Select the species of Enterobacteriaceae that produces this reaction.
Citrobacter freundii is the correct answer, as the genus name indicates. It should be mentioned that laboratory isolates of occasional strains of Citrobacter freundii, as well as other Citrobacter species, may initially produce a negative citrate reaction. More prolonged incubation may result in a positive color reaction indicating the assimilation of citrate and an alkaline blue color reaction of the bromothymol blue indicator.
Which of the following clinical laboratory departments performs the most tests?
Clinical Chemistry
The life span of RBCs containing Hemoglobin H is typically:
Less than 120 days The normal lifespan of RBCs is 120 days. The life span of an RBC containing Hemoglobin H inclusions is significantly decreased because the RBC membrane is compromised when macrophages attempt to remove this unstable hemoglobin, which is precipitated just inside the membrane. This results in a moderate hemolytic anemia with decreased RBC survival.
Methotrexate is a highly toxic medication that blocks DNA synthesis in all cells. What medication needs to be administered after methotrexate to prevent cytotoxic effects in normal cells of the body?
Leucovorin
If a patient has a white blood count of 40,000/µL, what would be the MOST useful staining procedure to distinguish between bacterial infection and chronic myelogenous leukemia (CML)?
Leukocyte alkaline phosphatase (LAP)
The border to border extension of the mycelium as illustrated in the top photograph is characteristic of one of the Mucormycetes (Zygomycetes). Although a light yelow green pigmentation of the mycelium is observed, the identification of the isolate depends on the presentation of the fruiting body odserved in the bottom photomicrograph. From these observations, select the name of this isolate from the list of multiple choices.
Lichtheimia (Absidia) species
A variety of additives are used in blood collection tubes. Which of the following additives prevents clotting by inhibiting thrombin and thromboplastin?
Lithium or sodium heparin
A patient initially has a prolonged PT. After reviewing the patient's case and laboratory findings, the physician administers intravenous vitamin K. The repeat PT results are normal after 24 hours of vitamin K therapy. what clinical condition is Most likely to produce these results?
Liver disease
Which of the following would most likely occur as the result of hemodilution?
Low serum electrolyte values
Which of the following species of mycobacterium might be associated with contamination of the hot water system in large institutions such as hospitals?
M. xenopi
Which of the following may be seen in a CSF sample of a patient that has a subarachnoid (intracranial) hemorrhage (SAH)?
Macrophages containing hemosiderin
In the DMAIC (Define, Measure, Analyze, Improve, Control) process improvement, which of the following would belong to the measure step?
Map and analyze current process
Urine test strip positive for blood may indicate all, EXCEPT:
Meat diet
The presence of an increased number of hypersegmented neutrophils in the peripheral blood, as shown in this image, is an indication of which of the following conditions?
Megaloblastic anemia
The following results were obtained on arterial blood: pH = 7.51 pCO2= 49 mm HgHCO3- = 38.7 mmol/L pO2= 85 mm Hg These results are compatible with:
Metabolic alkalosis The pH of this patient sample is alkaline (greater than 7.45), which is indicative of alkalosis. Since the HCO3- is increased (reference range 22-29 mmol/L) and is the alkaline buffer component of the body produced by our metabolic system, the condition is called metabolic alkalosis.
Which of the following medications is considered an antineoplastic drug?
Methotrexate
Which of the following best describes the benefits of the RPR or VDRL tests:
Monitoring course of treatment
Identify the nucleated blood cell:
Monocyte
Which of the following has been compared to a hockey puck when discussing its morphology on chocolate agar?
Moraxella catarrhalis are large, pinkish to brown opaque colonies
The pale-staining cytoplasmic bodies marked by the arrow in the image may be seen in each of the following conditions EXCEPT?
Mucopolysaccharidosis
You are collecting a blood specimen to be used for forensic (legal) alcohol testing. Which of the following must be done before you can start the specimen collection process?
Must inform the patient that the blood about to be collected is for alcohol testing.
The tiny colonies growing on chocolate agar after 3 days of incubation, as illustrated in the left plate in the upper photograph, were recovered from a skin abscess at the site of a contaminated needle injection. The colonies growing on Middlebrook 7H10 agar seen to the right in the image were larger, smooth, convex, and gray-white. Acid-fast stains were positive for the appearance of slender bacilli, consistent with one of the rapidly growing Mycobacteria. Reactions for nitrate reduction and iron uptake were negative. A distinctive characteristic was the antibiotic resistance to Ciprofloxacin (left upper strip) and Polymyxin B susceptibility (vertical strip) in the lower photograph. From these observations, select the identification of this isolate.
Mycobacterium chelonae
Which of the following is the most likely identification of an acid fast bacilli recovered from an induced sputum with these culture findings? Slow growth at 37o C Niacin test = negative Pigmented photochromogenic Nitrate test = positive Catalase = positive
Mycobacterium kansasii Mycobacterium kansasii colonies are photochromagenic (form a pigment when exposed to light, but are non-pigmented in the dark); they are strongly catalase positive, strong nitrate reducers, and negative for niacin accumulation. M. kansasii produces a chronic lung infection that closely resembles pulmonary tuberculosis.
Which of the following test results is INCONSISTENT with disseminated intravascular coagulation (DIC)?
Negative test for D-dimers
Which of the following choices represents the characteristic indicator, fermentable sugar(s), and bacteriostatic agent(s) that are present in MacConkey agar respectively?
Neutral red/lactose/bile salts and crystal violet
Which of the following is a sign of dyserythropoiesis that occurs in Myelodysplastic Syndromes?
Oval macrocytes
Which of the following is considered a cause of hypomagnesemia (decreased levels of magnesium in the blood)?
Pancreatitis
When in the Fisher Projection, which carbon is used to determine if the molecule is in D or L formation?
Penultimate carbon
Enterococcus spp. are commonly resistant to all of the following antimicrobial drug types EXCEPT?
Phenicols
Which dematiaceous fungi affects the joints causing septic arthritis?
Phialophora spp.
In observing the slow-growing, 7-day-old dark brown colonies growing on Sabouraud Dextrose with Brain Heart Infusion (SABHI) agar, note that the black pigment extends to the reverse of the colony. This provides a presumtive idication of one of the fungi involved in chromoblastomycosis. The species identification of this fungus can be made by observing the distinctive fruiting heads illustrated in the bottom image. Select the identification of the fungal species.
Phialophora verrucosa
The segmented, dark-staining grains seen in this photomicrograph are most commonly seen in cases of chromoblastomycosis. Which of the fungal species listed below is known to cause this disease?
Phialophora verrucosa
What procedure utilizes leukapheresis to collect the buffy coat from whole blood?
Photopheresis
This photomicrograph is a high-power view of a stained peripheral blood smear showing two erythrocytes that are infected with malarial parasites. This infection tends to occur in patients who are Duffy antigen negative. Based on this microscopic observation, select the species identification from the multiple choices listed below.
Plasmodium ovale
Interpret the auramine fluorochrome stain image to the right:
Positive for acid-fast bacilli When interpreting an auramine fluorochrome stain, a fluorescence microscope with a mercury vapor lamp that is able to produce blue-filtered light is required. Acid-fast bacilli will appear as bright, yellow-orange bacilli against a dark background.
Which of the following viral families contains DNA as its nucleic acid?
Poxviridae
Based on the following specificity and sensitivity information, which of the answer choices is true? Procedure #1 detected 70/100 true positives and 100/100 true negatives Procedure #2 detected 90/100 true positives and 80/100 true negatives
Procedure 1 is more sensitive and less specific
Identify the leukocyte seen in this illustration:
Promyelocyte
Which potent inhibitor of platelet aggregation is released by endothelial cells?
Prostacyclin
Which one of the following is not an acute phase protein?
Protein S
All the following are included in a quality control program, EXCEPT?
Protocol to prove patient results are correct
Which of the following tests require a 72-hour stool (fecal) collection?
Quantitative fecal fat
Which type of error is associated with the precision of the Method?
Randon Error
The kidneys perform all of the following functions EXCEPT:
Reabsorption of waste products
Which of the following statements are true regarding the storage and handling of urinalysis chemical reagent strips?
Remove only enough strips for immediate use.
The qualitative differences between A1 and A2 phenotypes includes all of the following EXCEPT:
The Lack of agglutination of patient red cells with anti-A reagent.
You are experiencing problems with control values for fibrinogen levels on your coagulation instrument. In an effort to assess the problem, you decide to perform a run-to-run precision, which other important laboratory value or range can be obtained from the data you collect?
The acceptable range for the controls can be determined because each QC sample will be assayed at least 30 times over an extended period of time.
What is the characteristic RBC that is uniquely associated with HbSS?
The drepanocyte or sickle cell shape the red blood cell assumes when the hemoglobin is deoxygenated and polymerizes. This is the result of the inherited mutation in HbS whereby a polar amino acid in the beta globin chain is substituted by a non-polar amino acid. This occurs mainly in patients who are homozygous for this mutation (HbSS).
The following BEST describes serum hCG levels during pregnancy:
The rapid rise in levels during the first trimester; slow decline and possible level-off throughout the remainder of the pregnancy hCG levels rise rapidly during the first trimester, then the levels start to decline around week 16. The hCG levels slowly decrease and can level off during the remainder of the pregnancy.
A deficiency in which of the folowing vitamins is associated with "rickets"?
Vitamin D Vitamin D deficiency can cause rickets.
TIBC (total iron-binding capacity) is an indirect measurement of which of the following:
Transferrin Transferrin is a glycoprotein that reversibly binds iron. Total iron-binding capacity measures the amount of transferrin that is available to bind with iron in the serum. Transferrin binds to iron in the serum and is proportional to total iron-binding capacity (TIBC). Serum transferrin (mg/dL) = 0.7 X TIBC (µg/dL)
Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph?
Transfusion dimorphism There are two populations of red blood cells present. The microcytic, hypochromic population is suggestive of iron deficiency anemia. Interspersed among these cells is a second population of normocytic, normochromic red blood cells, suggesting transfusion dimorphism. Two separate peaks (populations) should be observed on the red blood cell histogram generated by the hematology analyzer.
Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes?
Transfusion of ABO incompatible red blood cells
Which of the following helminths is a tissue nematode whose life cycle resides in a single host?
Trichinella spiralis is a nematode (roundworm) that usually infects humans from contaminated pork. However, bear, walrus, and horsemeat have also been found to contain T. spiralis. The life cycle of T. spiralis is unique in that it occurs within the same, single host.
All of the following parasites are correctly matched with their primary symptom, EXCEPT:
Trichomonas vaginalis - diarrhea Trichomonas vaginalis is most commonly associated with vaginal discomfort, a green frothy discharge, odor, pain, itching, and irritation.
Whipworm infection is typically diagnosed by the microscopic observation of adult worms or barrel-shaped eggs with polar plugs in stool specimens. What organism is known as the whipworm?
Trichuris trichiura
Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that she has had an acute myocardial infarction (AMI), but did not feel the severe chest pain because of diabetic neuropathy. She has not felt well since November 20th and her physician believes she possibly had an AMI on November 20th.Assuming that the infarct was uncomplicated, which of the following cardiac biomarkers would most likely still be elevated and would assist in an AMI diagnosis?
Troponin T
What is the maximum recommended amount of time a specimen without additive or anticoagulant should be allowed to clot before cetrifugation?
Two hours
Acetest® can be used to test for ketones in:
Urine, serum, and whole blood
Flow cytometry is a useful tool in the study all of the following disorders, EXCEPT?
Viral hepatitis
