ASCP Board of Certification MLT exam review

An autopsy of a 1-year-old female admitted to the emergency room 4 hours prior to her death revealed Waterhouse-Friderichsen syndrome. Blood and nasopharyngeal cultures taken prior to her death should reveal an oxidase-positive, Gram-negative diplococcus with the following biochemical reactions:

Glucose positive, Maltose positive, Lactose negative and Sucrose negative

How long after hospitalization would stool samples be rejected for testing for parasitic infections?

Greater than 72 hours

Which type of antibodies are known to cause transfusion-related acute lung injury (TRALI) reactions?

HLA antibodies

Which of the following is a DNA virus?

Hepatitis B virus

Which of the following statements about high-frequency antigens is correct?

High-frequency antigens are common, but it is difficult to identify their corresponding antibodies.

Vitamin D is formed in the skin and hydroxylated in two places before it is in its active form of 1,25-dihydroxy vitamin D. Where does the second hydroxylation occur?

Kidneys (first is liver)

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.

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 the presumptive identification of this mycobacterium.

Mycobacterium tuberculosis

Sulfosalicylic acid (SSA) can be used to confirm the result of which of the following tests included on a urine reagent strip?

Protein

Which one of the following is not an acute phase protein?

Protein S The following ARE: Fibrinogen, Alpha-1 Antitrypsin, C-Reactive Protein

What is the most frequent genotype among Rho (D) negative persons?

rr

What should safety management start with in order to ensure clarity and consistency?

A written safety policy

A hepatic function panel A consists of which of the following tests?

AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin

The following stain reactions were resulted on a suspected case of leukemia: Myeloperoxidase + Sudan Black B + Chloroacetate Esterase + Nonspecific Esterases - Which of the following is the correct interpretation?

Acute Myelocytic Leukemia

This image is a protozoan in the cyst stage of development. Identify this cyst.

Chilomastix mesnili cyst they are lemon or pear-shaped with a hyaline knob. They only have one nucleus and a curved fibril alongside the cytostome, often called the "shepherd's crook."

A lipid panel consists of which of the following tests?

Cholesterol, Lipoprotein, HDL, Triglycerides

What is the required storage temperature for thawed cryoprecipitate?

20 - 24 ºC.

A patient has the following serum results: Na = 130 mEq/LK = 4.9 mEq/LCl = 107 mEq/LGlucose = 300 mg/dLBUN = 18 mg/dLCreatinine = 1.1 mg/dL Which osmolality result is consistent with these results?.

281 mosmol/kg Osmolality = 2 x Na + [Glucose (mg/dL) / 20] + [BUN (mg/dL)/ 3]

Hemophilia B or Christmas disease is the result of a hereditary deficiency in which coagulation factor?

Factor IX

An adult's plasma cortisol of 22 µg/dL at 8:00 a.m. and 10 µg/dL at 4:00 p.m. would be:

Found in a healthy individual Normal levels: 5-23 µg/dL at 8:00 a.m. 3-16 µg/dL at 4:00 p.m. <50% of 8:00 a.m. values at 8:00 p.m.

A normal hemoglobin molecule is comprised of the following:

Four heme and four globin chains

The bioavailability of an oral drug refers to the:

Fraction of the drug that is absorbed into the systemic circulation

Which of the following forms of calcium is biologically active:

Free ionized calcium

Which of the following cells are lining cells that could be seen in a peritoneal fluid?

Mesothelial cells

Each of the cells below can be found in all types of body fluids EXCEPT:

Mesothelial cells Mesothelial cells are found only in serous body fluids including pleural fluid, peritoneal fluid, and pericardial fluid.

A peripheral smear demonstrates a population of red cells that are mostly 5 - 5.5 µm in diameter. The CBC data shows RDW of 13% (reference range 11.5-14.5%). Which of the following morphologies is consistent with these findings?

Microcytosis, low variation of cell volume

Which of the following situations warrants postpartum administration of Rh immune globulin (RhIg)?

Mother: D negative; Cord: D positive

A tech is working with a large, spore-forming, Gram-positive bacillus that they believe is Bacillus spp. Which of the following tests could the tech use to ensure this organism is not Bacillus anthracis?

Motility positive

In which situation is gamma irradiation of cellular blood components required?

Prevention of Graft-Versus-Host (GVH) disease

The prozone effect can be described by all of the following EXCEPT:

**Results in a false positive reaction Results in a false negative reaction The result of antibody excess Dilution of antibody can help prevent its occurrence

Which of the following would be the most appropriate temperature for long term storage of specimens for viral culture?

-70° C

After experiencing extreme fatigue and polyuria, a patient's basic metabolic panel is analyzed in the laboratory. The result of the glucose is too high for the instrument to read. The laboratorian performs a dilution using 0.25 mL of patient sample to 750 µL of diluent. The result now reads 325 mg/dL. How should the technologist report this patient's glucose result?

1,300 mg/dL

Which of the following tests would be employed in order to detect neural tube defects?

Alpha fetoprotein Alpha-fetoprotein is a protein measured in pregnant women, using maternal blood or amniotic fluid, as a screening test for a subset developmental abnormalities: it is principally increased in open neural tube defects and decreased in Down syndrome.

Which analyte should be increased in the presence of pancreatitis?

Amylase

A sample has reactions occurring at immediate spin and AHG in a panel that show varying reaction strengths. There is no obvious pattern that matches a particular panel cell or single antigen profile and the auto-control was negative. Which of the following is the most likely cause?

An IgM and an IgG antibody

Using an automated cell counter analyzer, an increased Red Cell Distribution Width (RDW) should correlate with which of the following?

Anisocytosis

Lectin from the seeds of Dolichos biflorus is a source of which of the following?

Anti-A1

Which of the following morphologic structures for Giardia intestinalis trophozoite is pictured in the section labeled B?

Axonemes

Which of the following are markers currently used to differentiate heart failure from lung disease?

BNP and NT-proBNP

The predominant cells seen on the CSF smear in this illustration are indicative of:

Bacterial meningitis

Although an uncommon isolate in most microbiology laboratories, this bacterial species is included in the microbiota of the mouth and intestinal tract. The colonies on blood agar are irregular in size, smooth, non-hemolytic, entire, convex, and ranging from gray-white to light yellow. Distinctive is the "dog bone" appearance of branching Gram-positive bacilli as illustrated in this photomicrograph of a Gram stain. Biochemical activity is limited to fermentation of glucose and lactose. With these observations, select the presumptive identification

Bifidobacterium species

Fecal urobilinogen level may be markedly decreased because of:

Biliary obstruction

Blood lactate concentration is an indicator of impaired circulation and tissue oxygenation in critically ill patients. If circulation and tissue oxygenation are impaired:

Blood lactate concentration will increase. When cells do not receive enough oxygen due to reduced blood flow to the tissues, they release excess lactate into the bloodstream as a byproduct of anaerobic metabolism.

A patient reported to her doctor that her stools have been ribbon-like over the last few weeks. What is most likely the cause of the patient's stool appearance?

Bowel obstruction

During data analysis in flow cytometry, how are cells gated?

By placing a gate around cells with the same light-scattering. In flow cytometry, gating is the process of isolating cells with the same light-scattering or fluorescence properties by electronically placing a gate around them.

Raynaud's phenomenon is associated with a deficiency/dysfunction of the complement fraction:

C7 A decreased level of the complement fraction, C7, is associated with Raynaud's disease, sclerodactyly, telangiectasia, and several bacterial infections caused by Neisseria spp. Raynaud's phenomenon is a condition of episodic constriction of small arteries of the extremities, usually fingers or toes, induced by cold temperatures or emotional stress that would not affect a non-afflicted person.

A manual white blood cell count was performed by the hematology technologist. The cell counts for both sides were 99 and 164, respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:100. What should the technologist report as the white cell count?

Cannot report When comparing the white cell counts from one side of the hemacytometer to the other, there is not good duplication. Cell counts from opposite sides of the hemacytometer (within the same patient sample) that are greater than 10% of one another are considered discrepant and should not be used to calculate reportable results. This particular count should not be used to report patient results.

Which of the following statement is INCORRECT regarding the bone marrow biopsy specimen?

Cellular morphologic detail can be determined. Cellular morphologic details CANNOT be determined via bone marrow biopsies.

Which of the following is true regarding a normal distribution curve?

Data are more likely to fall closer to the mean.

Examples of conditions resulting in benign proteinuria include:

Dehydration and orthostatic proteinuria

Observe the peripheral blood smear image to the right. Several types of poikilocytes are seen. All of the following are seen in the image EXCEPT?

Drepanocyte - Sickle cells are half-moon-shaped cells with pointy ends.

If one finds excessive rouleaux formation on a blood smear examination, then which of the following parameters might also be increased?

Erythrocyte sedimentation rate

The presumptive diagnosis of fungal infections may be assisted based on the geographic location or sites in which they have become endemic. One such condition, is colloquially referred to as "Spelunker's Scourge". This condition occurs after a tour or work in underground caves located in the Midwest, where dust contaminated with bird and bat dung is inhaled. Select the name of the fungus from the choices shown below that causes this endemically-acquired respiratory infection.

Histoplasma capsulatum

Which of the following inclusions are composed of DNA?

Howell-Jolly bodies

The RBC inclusions shown in the photograph represent which of the following?

Howell-Jolly bodies Howell-Jolly bodies are usually single, round, and tend to be positioned at the periphery of the red blood cell. These inclusions are rarely found on a routine peripheral blood smear, as they are usually removed by a functioning spleen. Howell-Jolly bodies appear in megaloblastic anemias and after splenectomy.

Antibodies of which of the following immunoglobulin subclasses is predominantly associated with the secondary antibody response?

IgG

An error is a verified and reported result on a patient that is later determined to be inaccurate. To identify an error, reports can be reviewed, other microbiologists may locate the error through testing, or nurses and physicians may come across the error when evaluating laboratory results. If an error is detected by repetitive quality control testing, which may indicate probable erroneous patient results, this is an example of which type of error detection?

Laboratory detection

Which Lewis antigen(s) would be detected when phenotyping the red cells of an adult who has the Le, Se, and H genes?

Leb The Se gene codes for the enzyme, a-2-L-fucosyltransferase, which adds L-fucose to the type 1 precursor H (type 1). The Le gene codes for another L-fucose which forms the Leb antigen.

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 LAP stain is used to determine if an increase of cells is due to chronic myelogenous leukemia or a leukemoid reaction due to infection or similar conditions.

Which of the following statements is true regarding the staining protocol used for bone marrow smears compared to that for peripheral blood smear?

Longer staining time should be used to allow thorough staining. Bone marrow smears are much more cellular and require additional contact time in both stain and buffer. Laboratories use longer staining time to compensate for the relative thickness of marrow smears compared to peripheral blood smears.

Which of the following would most likely occur as the result of hemodilution?

Low serum electrolyte values

The white blood cell that can vary MOST in size and shape on a Wright-stained smear is:

Lymphocyte

All of the following are virulence factors utilized by Streptococcus pneumoniae to evade host defenses when causing meningitis, EXCEPT:

M protein - The M protein is a major virulence factor of Streptococcus pyogenes

Calculate the red cell indices from the following set of patient data: RBC count = 3.19 x 1012/L Hemoglobin = 11.3 g/dL Hematocrit = 35%

MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL MCV (fL) = (Hct (%) / RBC (1012/L)) x 10 MCH (pg) = (Hgb (g/dL) / RBC (1012/L)) x 10 MCHC (g/dL) = (Hgb (g/dL) / Hct (%)) x 100

A patient is seen at his physician's office for scaling, flat lesions on his back that are irregular with white blotches of discoloration (top image). The bottom image shown is of a tease mount taken from the skin and stained with Periodic Acid Schiff, which reveals narrow fungal hyphae (arrows) along with 3 - 5 µm in diameter, irregular sized spherical budding yeast cells, a presentation often referred to as "spaghetti and meatballs". Which fungi is the most likely cause of infection?

Malassezia furfur

Most antibodies present in cord blood are of ________ origin.

Maternal

A newborn presents with neonatal alloimmune thrombocytopenia. What is the most likely cause of this condition?

Maternal antibodies to neonatal platelet antigens

Which blood group antibody(ies) would you find in a group AB individual?

None

When a corrected report needs to be made, which of the following is required?

Notify the physician of the erroneous report

The cells in this image are from a bone marrow smear. Identify the cells present in this image:

Osteoblast

Which procedure should be followed when one cross-matched unit out of five is INCOMPATIBLE at the antiglobulin (AHG) phase?

Perform a direct antiglobulin test (DAT) on the incompatible unit

What is the deferral period from donating blood for someone who is or has taken Tegison© for severe psoriasis?

Permanent deferral

Components of the second line of defense in the human body are:

Phagocytic cells; complement Intact skin and unbroken mucosal membrane surfaces are components of the first line of defense in the human body.

Which of the following drugs is listed as an anti-convulsants?

Phenobarbital

Which type of blood component is most implicated in bacterial contamination?

Platelets This is because the room temperature storage requirement provides an adequate environment for bacterial growth.

A 40-year-old female receives two units of Red Blood Cells during a surgical procedure. The patient has no prior history of transfusions. Seven days later, she presents with extensive bruising of the extremities and bleeding of the gums, with no additional symptoms. Her platelet count is 5 x 109/L (reference interval 150 - 400 x 109/L). What is the most likely diagnosis?

Post transfusion purpura (PTP) Her symptoms, including severe thrombocytopenia one week after transfusion, are most consistent with post-transfusion purpura (PTP). PTP results as an anamnestic response to a platelet antigen. PTP presents 1 to 24 days after a transfusion.

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

Potassium The valinomycin membrane electrode is most selective for potassium as opposed to sodium, glucose, or chloride which utilize different membranes for their respective electrodes. Valinomycin, which is neutral in charge, has been incorporated into organic liquid membranes resulting in a sensor with a very high selectivity for potassium.

Myoglobin concentration testing is routinely used for all of the following conditions, EXCEPT?

Pulmonary edema Since myoglobin is found in both skeletal and cardiac muscle, AMI, rhabdomyolysis, and seizures can cause muscle damage and therefore cause the release of myoglobin into the blood. Pulmonary edema does not cause damage to muscle, so myoglobin is not released into the blood; it would not be routinely used in this situation.

Which of the following can cause hemolysis and perhaps result in recollection of the specimen?

Pushing the plunger of a syringe when transferring blood into vacuum tubes.

Given the following commonly used nomenclature systems, which one of the Rh genotypes listed below is heterozygous for the C antigen?

R1r

Which genera does not belong to the dermatophytes?

Rhizopus - within the order Mucorales (Zygomycetes)

Select the primary reagent components used in the Jaffe reaction for creatinine.

Saturated picric acid and sodium hydroxide

Illustrated in the upper image is a cercaria capable of penetrating the skin of a human swimming in contaminated water. These cercaria then enter the circulation, and mature in the portal vascular system where they develop into adult flukes. Distinctively the female flukes occupy the gynecophoral canal of the male fluke, as illustrated in the lower image. From the list of trematode genera, select the genus that represents these stages of this life cycle.

Schistosoma

Normal fecal specimens contain all of the following, EXCEPT:

Shigella

Which of the following is a selective medium for Campylobacter jejuni?

Skirrow agar

Entamoeba hartmanni is most commonly recovered from:

Stool

When an unpreserved urine specimen cannot be cultured immediately, which storage method is most appropriate?

Stored in the refrigerator at 4° C for up to 24 hours

Deviations from Beer's Law are caused by:

Stray light

What are the usual results of the mean corpuscular volume (MCV) and the red cell distribution width (RDW) in alpha thalassemia?

The MCV is decreased but the RDW is usually increased

An adult patient presents with a temperature of 103°F (39.4°C). A CBC is ordered and the white blood cell (WBC) count is 15.0 x 109/L (reference interval= 4.0 -11.0 x 109/L) with 10% band neutrophils and 2% metamyelocytes. What can be concluded at this point with these clinical and laboratory results?

This is most likely a bacterial infection or inflammatory response. This most likely is either a bacterial infection or systemic inflammatory response. Increased temperature, increased white blood count, and immature cells of the neutrophilic line are all indicators of such. Symptoms and CBC results can vary in viral infections. However, a response by the lymphocytes is much more likely than by the neutrophils.

The pI of a protein is 9.2. This protein is placed in an electrical field where a buffer sets the pH at 10.0. Select the correct statement regarding the electrophoretic migration of this protein.

This protein will have a net negative charge and will migrate toward the anode, the positively charged electrode

Which modified PCR technique or other method of amplification is used to detect Mycobacterium tuberculosis?

Transcription-Mediated Amplification

How would you describe the arrangement of RBCs on this slide?

True rouleaux

Xenodiagnosis has historically been used to detect:

Trypanosoma cruzi

Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:

Tubular epithelial cells

Nephelometry is based on the principle of:

Turbidity resulting from specific antigen-coated latex particles agglutinated by corresponding antibody

An obese adult with premature arteriosclerosis is seen in the clinic. When her serum is tested no chylomicrons are present, LDL levels are normal, and VLDL levels are increased. There is an increase in triglycerides and a slight increase in cholesterol. Lipoprotein electrophoresis reveals a heavy pre-beta band. She has no skin rash and uric acid is increased. This patient most likely has what type of hyperlipoproteinemia?

Type IV which is associated with high triglycerides and increased VLDL. It is also known as hypertriglyceridemia.

Which of the following inclusions are frequently seen on the same peripheral blood smear along with toxic granulation?

Vacuoles

The most significant class of microbial targets for Natural Killer (NK) cells is:

Viruses

A test that can be used as a confirmatory test for urobilinogen is:

Watson-Schwartz Test