Lab Ce MLT Practice

200 ng/mL Feedback A serum ferritin result greater than 200 ng/mL suggests iron overload and possibly HH in a pre-menopausal woman.

A serum ferritin above what level would be suggestive of iron overload and possibly hereditary hemochromatosis (HH) in a pre-menopausal woman? 100 ng/mL 200 ng/mL 300 ng/mL 400 ng/mL

Russell bodies Feedback The prominent cell is a Mott cell on a peripheral blood smear from a patient with multiple myeloma. The globular inclusions are immunoglobulin accumulations (Russell bodies), representing the accumulation of excessive mucopolysaccharides and globulins within the endoplasmic reticulum.

What are the globular inclusions in this cell? Bacteria Fat droplets Vacuoles Russell bodies

Urine, serum, and whole blood Feedback Acetest® is used as a confirmatory test for ketones and can be used to test urine, serum, and whole blood.serum, and whole blood

Acetest® can be used to test for ketones in: Urine Urine and serum Urine, serum, and whole blood Urine, serum, whole blood, and CSF

A Feedback A = Heavy chain B = Light chain C = Antigen binding site D = Variable region

From the IgG molecule illustration, which region is the heavy chain? A B C D

64.8 mg/24 hrs Feedback 2.7 mg/dL X 2400 mL/24 hr X 1 dL/100 mL = 2.7 mg X 2400 100 = 64.8 mg/24 hr

Given the following information, calculate the results in mg/24 hrs for a 24-hour urine protein.Total volume for 24 hours = 2,400 mL Urine protein = 2.7 mg/dL 64.8 mg/24 hrs 10.87 mg/24 hrs 57.5 mg/24 hrs 5.89 mg/24 hrs

10 Feedback Volume = area x depth Each square has an area of 1 mm2. Chamber depth = 0.1 Volume = # of squares counted x 0.1µL (chamber depth) # of squares counted = volume/0.1 or volume x 10 If the volume is 1, the number of squares counted is 10.

How many large hemacytometer squares contain a total volume of 1 µL (microliter) of fluid? 5 10 15 18

Diabetes Feedback Yeast cells as a cause of infection are more commonly found in diabetes mellitus patients but can also represent contaminants with no clinical significance. They should not be confused with erythrocytes. The presence of budding helps with the identification.

The elements indicated by the arrows are more likely to be seen in patients with which condition? Bacterial infection Nephrotic syndrome Diabetes Renal failure

Cystic fibrosis Feedback Measurement of the sodium and chloride concentration in sweat is the most useful test in the diagnosis of cystic fibrosis. Significantly elevated concentrations of both ions occur in more than 99% of affected patients.The definitive test for steatorrhea (failure to digest or absorb fats) is the quantitative fecal fat analysis.The secretin/CCK (cholecystokinin) test is the direct determination of the exocrine secretory capacity of the pancreas.Pancreatic cell tumors, which overproduce gastrin, are called gastrinomas; they cause Zollinger-Ellison syndrome and can be duodenal in origin.

The measurement of sodium and chloride in the sweat is the most useful test for the diagnosis of what condition/disease? Steatorrhea Direct determination of the exocrine secretory capacity of the pancreas .Cystic fibrosis Zollinger-Ellison syndrome

Streptococcus pneumoniae Feedback Streptococcus pneumoniae is the Gram-positive, lancet-shaped bacteria shown here. It is the most common cause of bacterial pneumonia, especially in those with compromised immune function and the elderly. Capsular polysaccharide contributes to its virulence. In direct smears, Haemophilus influenzae appears as small, Gram-negative coccobacilli. Capsular strains of H. influenzae cause invasive diseases such as meningitis and pneumonia, while non-capsular strains cause a more localized infection such as sinusitis, and otitis media. Neisseria meningiditis is a commensal bacteria in about one-third of the population. Only some hosts develop symptoms of meningococcal disease. On direct Gram stain, Gram-negative intracellular and extracellular diplococci with a "coffee bean" shape may be seen. Corynebacterium diphtheriae is a pleomorphic, Gram-positive rod that causes diphtheria. Cells often

The microscopic view of a Gram-stained sputum specimen reveals lancet-shaped, Gram-positive diplococci. What presumptive identification may be made? Haemophilus influenzae Neisseria meningiditis Corynebacterium diphtheriae Streptococcus pneumoniae

Afghanistan and Iraq U.S. soldiers outbreak Feedback Afghanistan and Iraq U.S. solider outbreak Acinetobacter baumannii is nicknamed Iraqibacter because this organism is commonly isolated from soldiers injured in Afghanistan and Iraq. Berry outbreak is incorrect because outbreaks have occurred due to berries being contaminated with Escherichia coli 0157:H7 and/or Hepatitis A virus. Camper/hiker outbreak is incorrect because outbreaks have occurred due to campers coming into contact with deer mice scant and developing Hantavirus or campers being bitten by the Ixodes tick and developing Lyme disease. Milwaukee water outbreak is incorrect because this occurred due to the consumption of water contaminated with Cryptosporidium species.

The organism Acinetobacter baumannii is known to have caused which of the following outbreaks? Berry outbreak Camper/hiker outbreak Milwaukee water outbreak Afghanistan and Iraq U.S. soldiers outbreak

Megaloblastic anemia Feedback Hypersegmentation of neutrophils (see image) provides strong morphologic evidence for megaloblastic hematopoiesis. When such cells with six or more lobes are present in the peripheral blood, assays for vitamin B-12 and folate are indicated. These hypersegmented neutrophils are also usually macrocytic as the disruption in normal maturation has resulted in fewer nuclear divisions. In the bone marrow, finding greater than 5% neutrophils with five lobes or greater, or more than 50% with four lobes or greater is evidence that megaloblastic myelopoiesis is to be ruled out. Preleukemia and myeloproliferative disorders are not characterized by hypersegmented neutrophils. Aplastic anemia is characterized by pancytopenia.

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? Preleukemia Megaloblastic anemia Aplastic anemia Myeloproliferative disorder

Monitoring course of treatment

Which of the following best describes the benefits of the RPR or VDRL tests: Diagnostic of active syphilis Diagnostic of latent syphilis Diagnostic of neuro-syphilis Monitoring course of treatment

Thromboxane A2

Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet? Thromboxane A2 Calcium Collagen ADP

Delivering a Rh positive baby.

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 negative baby. Delivering a Rh positive baby. Receiving Rh negative packed red blood cells. Receiving Rh positive fresh frozen plasma.

Providencia spp. Feedback Providencia spp. is the correct answer. The isolate is unable to ferment lactose or sucrose on TSIA, is negative for H2S, is lysine decarboxylase negative, urease negative, citrate positive, phenylalanine deaminase positive, indole positive, and ornithine negative. Only Providentia and Proteus give a positive deamination reaction; however, Proteus is urease and H2S positive while Providentia is H2S and urease negative. Proteus mirabilis would be urease and H2S positive and indole negative. Escherichia coli would ferment lactose and sucrose in the TSIA, decarboxylate lysine and ornithine, and would be citrate and phenylalanine deaminase negative. Klebsiella pneumoniae would also ferment lactose and sucrose in the TSIA, would decarboxylate lysine, and be phenylalanine deaminase and indole negative.

A member of the Enterobacteriaceae is inoculated into various biochemical media which are shown in the image. Shown from left to right are triple sugar iron agar (TSIA), lysine iron agar, urea agar, citrate agar, phenylalanine deaminase agar, and motility indole ornithine agar. This organism is most likely: Proteus mirabilis Providencia spp. Escherichia coli Klebsiella pneumoniae

Ribonucleic protein (RNP) antibodies

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? A positive antinuclear antibody (ANA) Smith (Sm) antibodies Double-stranded DNA (dsDNA) antibodies Ribonucleic protein (RNP) antibodies

Specimens with anticoagulant should sit for 20 minutes before centrifugation. Feedback Specimens with anticoagulants can be spun immediately. There is no reason to delay. Specimens without anticoagulants should sit at least 30 minutes prior to centrifugation to allow for complete clotting of the blood. Proper centrifugation procedure includes making sure all tubes are capped during centrifugation and letting the centrifuge stop completely by itself before opening it.

All of the following should be done when centrifuging specimens, EXCEPT? Specimens without anticoagulant should sit for 30 minutes before centrifugation. Specimens with anticoagulant should sit for 20 minutes before centrifugation. Cap all tubes for centrifugation. Allow the centrifuge to come to a complete stop by itself before opening it.

5 to 7

Approximately how many doses are required to obtain a steady-state oscillation allowing for peak and trough levels to be evaluated? 1 to 2 3 to 4 5 to 7 > 10

Induces increased production of HbF. Feedback Hydroxyurea induces increased production of HbF. Most sickle cell patients who have increased levels of HbF experience milder forms of the disease than do patients with normal or low levels of HbF. Therefore, the focus of molecular treatments for sickle cell disease is to increase fetal hemoglobin (HbF). Anti-inflammatory agents are given to serve as an analgesic in pain management for sickle cell patients. Nitric oxide treatment prevents sickle cells from clumping together. Clotrimazole is an over-the-counter antifungal medication. This drug prevents water loss from the red blood cells, which helps prevent the formation of sickle cells.

How does hydroxyurea aid in the treatment of sickle cell disease? Acts as an analgesic in pain management .Prevents sickle cells from clumping together. Induces increased production of HbF. Reduces the number of sickle cells that form.

Gas from glucose in MRS broth

Leuconostoc species are streptococcus-like bacteria used in the dairy and pickling industries that have recently caused opportunistic infections in humans. The need to make the laboratory identification is compounded because these bacteria are intrinsically resistant to vancomycin. Which characteristic is most helpful in separating Leuconostoc species from other streptococcus-like organisms? Gas from glucose in MRS broth Leucine aminopeptidase (LAP) activity Ability to grow in 6.5% NaCl (salt tolerance) Ability to grow at 10° C

Anti-Fya, -C, -Lub

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, -D Anti-Lua, -Lea, -Fya, -C Anti-Lea, -Fya, -C Anti-Fya, -C, -Lub

Rounded ends Feedback Chromatoidal bars for Entamoeba histolytica are usually seen in the cysts and are typically elongated with rounded ends, similar to a cigar shape. The rounded ends identify the organism as E. histolytica. Chromatoidal bars with splintered ends are found in Entamoeba coli.

The 12 µm in diameter cyst illustrated in this lactophenol-stained mount can be identified as Entamoeba histolytica. Based on the characteristics seen in the image, what feature of the chromatoidal bar prompts this differential identification? Large size Deep blue staining Rounded ends Formation of a single bar

Flow cytometry

The MOST reliable method for determining the appropriate dosage of Rh immune globulin to give to an identified Rh immune globulin candidate after delivery is: Kleihauer-Betke method Flow cytometry Rosette test Panel cells

1-2 minute break

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 3-5 minute break 5-10 minute break 20 minute break

The lack of agglutination of patient red cells with anti-A reagent.

The qualitative differences between A1 and A2 phenotypes includes all of the following EXCEPT: The formation of anti-A1 in A subgroups. The amount of transferase enzymes. The length of the precursor oligosaccharide chains. The lack of agglutination of patient red cells with anti-A reagent.

Ascaris lumbricoides Feedback Ascaris lumbricoides or roundworm is a common parasite found worldwide. Ascaris eggs remain viable and infective more often than eggs of any other helminth species. Diphyllobothrium latum, Taenia solium, and Hymenolepis diminuta are all cestodes. Cestodes are also known as tapeworms and are capable of self-fertilization.

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 Diphyllobothrium latum Taenia solium Hymenolepis diminuta

Cortisol Feedback From the listed hormones, cortisol is the only one that does not regulate glycogenolysis. Cortisol increases gluconeogenesis, formation of glucose from noncarbohydrates which also raises plasma glucose concentration. Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to glucose, which increases plasma glucose. Insulin decreases glycogenolysis and increases glycogenesis, lipogenesis, and glycolysis.

All of the following hormones increase or decrease plasma glucose concentration by regulating glycogenolysis (converting glycogen to glucose) EXCEPT? Cortisol Glucagon Epinephrine Insulin

Anti-Leb Feedback Anti-Leb may be detected in antibody screen testing of prenatal patients; however, this antibody is considered clinically insignificant. It is not indicated in causing hemolytic disease of the fetus and newborn (HDFN). Although rarely seen, both anti-M and anti-N can potentially cause mild to moderate HDFN. The most common clinically significant antibodies noted in prenatal patients include the following: anti-Fya, anti-K, anti-D, anti-E, anti-e, anti-C, and anti-c. These IgG antibodies have been determined to cause moderate to severe HDFN.

If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients? Anti-M Anti-N Anti-Leb Anti-Fya

Taenia solium Feedback This Taenia solium scolex is armed with four suckers which are used to attach to the human intestine. A fleshy rostellum is present from which a row of hooklets emerges. It is believed that the hooklets aid the organism in piercing the intestinal wall and subsequent attachment. Taenia saginata has a similar scolex, although it does not possess hooklets. The scolex of Diphyllobothrium latum, the fish tapeworm, has one dorsal and one ventral sucking groove. Enterobius vermicularis is a roundworm, known as the pinworm. Diagnosis of infection is made with a cellophane tape prep with the recovery of eggs.

The morphologic structures for this scolex from a cestode include: A) rostellum, B) hooklets, and C) suckers. Identify the cestode species associated with this scolex. Taenia saginata Taenia solium Diphyllobothrium latum Enterobius vermicularis

Chromosomal AmpC plus Porin Mutation

This isolate, identified as Enterobacter cloacae, was recovered from the urine and blood cultures of a patient who had recently returned from India where he had received a total hip replacement. He presented to the ED with multiple decubiti, sinusitis, and a urinary tract infection. The Hodge Test that was performed on this organism was negative. What resistance mechanism may be identified from the KB plate and the susceptibility interpretations? KPC - Klebsiella pneumoniae Carbapenemase Chromosomal AmpC plus Porin Mutation ESBL - Extended Spectrum Beta Lactamase vanC gene

It is increased in obstructive jaundice

Which one of the following is a TRUE statement concerning alkaline phosphatase? It is optimally active at pH 5 It is decreased in bone disorders involving the osteoblasts It is increased in obstructive jaundice It is increased in myocardial infarctions

Le(a-b-)

Which one of these Lewis blood group system phenotypes usually produces anti-Lea? Le(a+b+) Le(a+b-) Le(a-b+) Le(a-b-)

Plasmid-mediated AmpC

An 85-year-old female nursing home patient was treated empirically with a cephalosporin for a urinary tract infection but later failed therapy. The physician then requested a culture and sensitivity on a new urine specimen that grew >100,000 CFU/mL of Escherichia coli. After reviewing the Kirby-Bauer disc susceptibility plate and susceptibility interpretations, what is the resistance mechanism (if any) for this organism? Plasmid-mediated AmpC CRE - Carbapenem Resistant Enterobacteriaceae ESBL - Extended-Spectrum Beta Lactamase No resistance mechanism detected

Amylase Feedback 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. The Renal Function Panel consists of Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus.

All of the following laboratory tests are used to determine kidney function, EXCEPT? Creatinine Blood urea nitrogen (BUN) Amylase Phosphorus

Rhodococcus equii Feedback Rhodococcus equii are susceptible to most antibiotics and can be treated with erythromycin and rifampin, gentamicin, tobramycin, ciprofloxacin, vancomycin, and imipenem. Staphylococcus aureus this species is known to have vancomycin resistance, hence, the species named Vancomycin Intermediate Staphylococcus aureus (VISA) and Vancomycin-Resistant Staphylococcus aureus (VRSA). Enterococcus faecium and Enterococcus faecalis both organisms have acquired resistance to vancomycin as well other classes of antibiotics. Vancomycin resistance can occur due to alterations in the molecular structure of cell components, which decreases the vancomycin binding allowing cell wall formation to continue. In addition, excess peptidoglycan production can also lead to vancomycin resistance.

All of the following organisms are known to be resistant to vancomycin EXCEPT? Staphylococcus aureus Enterococcus faecium Enterococcus faecalis Rhodococcus equii

An incident report must be completed.

A blood collection system that has a retractable needle malfunctions and causes an injury to a patient. Which of the following actions must be taken? An incident report must be completed. The phlebotomist must be retrained The phlebotomist must be reprimanded The patient must be given a Hepatitis C vaccine.

Brown/black Feedback The presence of homogentisic acid in urine will cause urine to be brown/black. Homogentisic acid in the urine is found in Alkaptonuria, an inherited amino acid disorder. These individuals lack an enzyme that breaks down homogentisic acid. Green-colored urine can be associated with Pseudomonas infections. Pink urine is most commonly associated with the presence of a small amount of blood. Port-wine-colored urine is associated with porphyrins.

Homogentisic acid in urine will cause urine to be which of the following colors? Green Pink Port-wine Brown/black

Cylindroid Feedback The correct answer is cylindroid. Cylindroid is a type of varied morphology of hyaline casts. Hyaline casts consist of normal parallel sides and rounded ends. On the other hand, cylindroid forms have one tapered end and convoluted shapes that indicate the aging of the cast matrix. Mucus appears as single or clumped threads with a low refractive index. Fiber in a urine specimen from clothing and diapers can be confused with casts by inexperienced techs. To differentiate fiber artifacts from most casts, the specimen can be examined under polarized light. Fibers polarize while most casts other than fatty casts do not. Amorphous urates appear as yellow-brown granules. They could be in clusters that resemble granular casts. Upon refrigeration of urine sample, amorphous urates produce pink sediment.

Identify the urine sediment element shown by the arrow. Mucus thread Cylindroid Fiber Amorphous urates

There is no discernable pattern

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 Homogeneous Centromere Nucleolar

Candida glabrata Feedback Candida glabrata is the second most common Candida species to cause disease (Candida albicans is the most common). In urinary yeast isolates, it is identified about 20 percent of the time. Infections tend to be aggressive and difficult to treat with traditional antifungal therapy. It has different sugar assimilation patterns than Candida albicans, notably rapid assimilation of trehalose, so it can easily be differentiated. Candida krusei and Candida tropicalis are seen in immunocompromised patients and cause nosocomial infections.

This species of Candida accounts for around 20 percent of urinary yeast isolates. Candida albicans Candida glabrata Candida krusei Candida tropicalis

Blood should be drawn immediately before the next dose is given. Feedback To assess drug concentrations during the trough phase, blood should be drawn immediately before the next dose is given. If the blood specimen was collected at one or two hours after the administration of an oral dose of the medication, the result would most likely reflect the peak level. If the blood specimen was collected half an hour before the dose is given, it will not be representing the real trough phase.

To assess drug concentrations during the trough phase: Blood should be drawn about one hour after the administration of an oral dose of the drug. Blood should be drawn about half an hour before the next dose is given. Blood should be drawn about two hours after the administration of an oral dose of the drug. Blood should be drawn immediately before the next dose is given.

30% or greater

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? 1% - 4% 2% - 8% 5% - 10% 30% or greater

Clinical Chemistry

Which of the following clinical laboratory departments performs the most tests? Urinalysis Microbiology Clinical Chemistry Hematology

Cold agglutinin

Which of the following is least likely to interfere with the measurement of hemoglobin? Icteric plasma Lipemia Cold agglutinin Leukocytosis

Creatinine

Which of the following analytes would be increased due to delay in centrifugation? Creatinine Ionized Calcium Folate Bicarbonate

Chylomicrons Feedback The various lipoprotein particles were originally separated by ultracentrifugation into different density fractions. The least dense were the chylomicrons, followed by the VLDL (very-low-density lipoproteins) and LDL (low-density-lipoproteins) and the last was the HDL (high-density lipoproteins). This separation still is used as the basis for the most commonly used lipoprotein classification system.

Which type of lipoprotein is the least dense? Chylomicrons VLDL LDL HDL

Optochin disk test Feedback From the tests listed here, only the optochin disk test should be incubated in a CO2 atmosphere. The increased CO2 concentration stimulates the growth of Streptococcus pneumoniae and tends to inhibit the growth of viridans streptococci that may produce zones of inhibition around the optochin disk. The CAMP test should not be incubated in CO2 as certain strains of group A streptococci may appear falsely CAMP positive. Bile solubility detects the presence of autolytic enzymes produced by S. pneumoniae which may be inhibited by an increased CO2 atmosphere. The decrease in pH caused on the surface of the agar may affect the zone of inhibition around the novobiocin disk; therefore, an ambient atmosphere should be used for this test.ochin disk test

Which of the following tests should be incubated at 37º C in a 5-10% CO2 atmosphere? CAMP test Bile solubility Optochin disk test Novobiocin disk test

Paragonimus westermanni Feedback Paragonimus westermanni is the correct answer because this organism is found in the lungs of the host. The adult worms are encapsulated in the lungs and produce eggs that leave the lungs through the bronchioles by stimulating a cough in the host. The eggs are then swallowed and excreted in feces. Fasciola species is incorrect as this species is found in the bile ducts. The adult worms produce eggs in the bile duct that are then excreted from the body in the feces. Taenia solium is incorrect because this species is caused by the ingestion of contaminated pork and is found in the intestines in the form of eggs or proglottids. Entamoeba histolytica is incorrect because this amoeba is found in the intestines and occurs from the ingestion of contaminated food and water.

Which parasite migrates either to or through the lungs in their life cycle? Fasciola species Taenia solium Entamoeba histolytica Paragonimus westermanni

Quantitative fecal fat Feedback Quantitative fecal fat testing requires a 72-hour stool collection. The specimen is collected in a special large container provided by the testing facility and must be refrigerated during the entire 72 hour collection period. The specimen is tested in the Chemistry department as a confirmatory test for a positive qualitative fecal fat test. Occult blood, O & P, and stool culture testing can be performed on a random stool specimen.

Which of the following tests require a 72-hour stool (fecal) collection? Occult blood Quantitative fecal fat Ova and Parasite (O&P) Stool culture

Flow cytometry Feedback Flow cytometry measures fetal hemoglobin or D positive red cells or both. In patients with a positive rosette test (a screening for fetomaternal hemorrhage), a quantitative test such as Kleihauer-Betke test or flow cytometry is performed to calculate the dose of Rh immune globulin. The Kleihauer-Betke acid elution is based on the fact that fetal hemoglobin is resistant to acid elution and adult hemoglobin is not resistant to it. Examples of polyclonal antiserum produced for blood bank testing are known as antihuman globulin (AHG) reagents. These products contain multiple antibody specificities.

Which of these methods measures fetal hemoglobin or D positive red cells or both to evaluate fetomaternal hemorrhage? Rosette test Kleihauer-Betke test Flow cytometry AHG testing

Iodamoeba bütschlii & Endolimax nana Feedback The presence or absence of peripheral chromatin as well as its arrangement, when present, serve as key identifying nuclear characteristics of Entamoeba spp., Iodamoeba bütschlii & Endolimax nana. Iodamoeba bütschlii & Endolimax nana show no peripheral chromatin. Entamoeba coli show peripheral chromatin as coarsely granular and may be clumped. Entamoeba hartmanni show fine granules evenly distributed on the membrane. Entamoeba hystolytica & Entamoeba dispar have peripheral chromatin present with fine, uniform granules that are evenly distributed.

Which two intestinal protozoans lack peripheral chromatin in their cyst forms? Entamoeba coli & Entamoeba hartmanni Iodamoeba bütschlii & Endolimax nana Entamoeba hystolytica & Entamoeba dispar Entamoeba coli & Endolimax nana

Must inform the patient that the blood about to be collected is for alcohol testing.

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? Label the tubes in the presence of the patient. Must inform the patient that the blood about to be collected is for alcohol testing. Seal the collection tubes in front of the patient. Collect the specimen, the patient does not need to be informed what the blood is collected for.

Nocardia brasiliensis FeedBack Nocardia brasiliensis is the most frequent cause of subcutaneous mycetoma. These infections typically occur after inoculation of the organism into the skin or subcutaneous tissues such as from a thorn or wood sliver. It begins as a localized abscess that is destructive to tissues and underlying bone. Mycetomas are characterized by swelling, draining sinuses, and yellow or orange granules. Gram-positive filaments (red arrows). The yellow, chalky colony seen in the lower photograph, described as having a "musty" odor is characteristic of Nocardia species. Rhodococus equi may exhibit some branching on Gram stain. It will form salmon pink Streptomyces anulatus (formerly griseus) is a less frequent cause of mycetoma. It usually does not produce colonies with a yellow pigment. Colonies are also glabrous and waxy, Actinomyces israelii may produce sulfur granules, however, it produces glisten

A 30-year-old woman developed progressive, painful swelling of the right foot after incurring traumatic penetration of the soft tissue by a splinter. The wound initially healed. The upper photograph is a direct Gram stain of purulent material expressed from a sinus tract. The lower photograph illustrates the colony that grew out in 72 hours, which had a "musty" odor. The most likely identification is: Nocardia brasiliensis Rhodococcus equi Streptomyces anulatus (fromerly griseus) Actinomyces israelii

Leishmaniasis Feedback Leishmaniasis Dum-dum fever and Kala-azar are two synonymous terms for the conditions caused by Leishmania donovani known as visceral leishmaniasis. The patient most likely contracted the parasite via the bite of an infected sandfly. The amastigote form may be seen within reticuloendothelial cells of bone marrow, spleen, or liver. Malaria is transmitted by bites from the female Anopheles mosquito. Malaria infects red blood cells and malarial ring forms can be observed within the red blood cells to aid in the diagnosis of malaria. Chagas disease is transmitted by the reduviid bug or kissing bug. When the bug feeds on the host, the insect will defecate, and the feces will be rubbed into the bite site by the host, which will cause the trypomastigotes to enter the host causing infection. Elephantiasis is caused by Wuchereria bancrofti. Filariform larvae enter the host via a mosquito bite and

A 44-year-old female immigrant from Southeast Asia presented to the local clinic complaining of fever, chills, diarrhea, and weakness. Patient history revealed that the woman worked in a research laboratory in her homeland where her primary responsibility was to develop an effective insecticide for the dreaded sandfly. A bone marrow biopsy specimen was submitted to the laboratory for O & P examination. This form, measuring 14 µm, was seen. The patient is most likely suffering from: Malaria Chagas disease Leishmaniasis Elephantiasis

0.44 x 109/L Feedback Calculation: Cells Counted (in this case the average of both sides) X dilution factor (in this case 10) / # of sqaures counted (in this case 9) X 0.1mm (depth of solution) X area of each square (1mm2) So, in this problem: (40 x 10) / (9 x 1mm2 x 0.1mm) = 444.4/mm3 (can be converted to 0.44 x 109/L)

A manual white blood cell count was performed by the hematology technologist. The cell counts for each of two sides was 38 and 42 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:10. What should the technologist report as the white cell count? 4.8 x 109/L 4.4 x 109/L 0.48 x 109/L 0.44 x 109/L

Platelet neutralization test

A patient has a history of repeated spontaneous abortion. Coagulation studies reveal an elevated APTT, normal PT, normal platelet function, and normal thrombin time. Schistocytes were seen on the peripheral blood smear. Which test should be performed to determine if the patient has lupus anticoagulant? Factor VIII assay Mixing studies with factor-deficient plasmas Antinuclear antibody test Platelet neutralization test

The reduction of NAD to NADH Feedback The reduction of NAD to NADH is a chemical reaction that is utilized by many different analytical methods. In addition, several different analytical methods can use this method because it is not a light-producing dependent reaction. Fluorometry is an analytical method that is dependent on analytes that have the ability to fluoresce. Glucose oxidase is an enzymatic glucose oxidase method used to measure the amount of glucose present in a sample. UV spectrophotometry is an analytical method dependent on the light-producing ability of analytes present in the sample.

A chemical reaction that is utilized by many different analytical methods involves: Fluorometry Glucose oxidase The reduction of NAD to NADH UV spectrophotometry

Moraxella lacunata Feedback Moraxella lacunata has been known since the turn of the century as an agent of acute conjunctivitis. The colonies on chocolate agar are typically pinpoint, as illustrated here, and are highly susceptible to low concentrations of penicillin. As the species name indicates, M. lacunata may pit the agar; however, this property is best seen in a serum medium such as Loeffler's and is usually not seen on chocolate agar. Moraxella catarrhalis produces colonies considerably larger than the pinpoint colonies seen here after 48 hours incubation, and most strains are penicillin-resistant from the production of beta-lactamases. The colonies of Neisseria subflava are also larger than those seen here, have a yellow pigmentation, and many strains are penicillin-resistant. Aggregatibacter aphrophilus produces tiny colonies similar to those seen here; however, this species is cytochrome oxidase negative.

A culture was taken of a conjunctival exudate. The bacterial species, represented by the tiny colonies seen on this chocolate agar plate were recovered after 48 hours incubation at 35°C. The isolate was cytochrome oxidase positive and highly susceptible to penicillin. What is the most likely identification of this organism? Moraxella lacunata Moraxella catarrhalis Neisseria subflava Aggregatibacter aphrophilus

Approximately one hour after an oral dose FEEDBACK The drug should be measured at a time corresponding to the peak concentration (not the trough). a drug that is given via IV enters the circulation immediately, and the peak concentration of the drug would be measured 15 to 30 minutes after the IV injection. A measurement taken just before the next dose is given represents the trough value of the drug.

A physician needs to prescribe a drug to a patient, but the drug has a narrow therapeutic window. In addition, he is concerned about possible toxic effects. To assess the upper concentration of such a drug, which time for drawing the specimen do you think makes the most sense? Approximately one hour after an oral dose 2-4 hours after an IV injection of a drug Before any drug is given Right before the next dose of the drug is given

The tube should remain unopened and be kept at room temperature (20°-25° C). Feedback Blood collected for a prothrombin time PT test that will be completed within 24 hours of collection should remain uncentrifuged in an unopened tube. Room temperature storage (20° - 25° C) is recommended. Temperatures between 2° - 4° C may result in cold activation of factor VII that would alter the PT result. The tube should not be opened to remove the plasma before testing if the test will be completed within 24 hours of collection. Plasma should be removed and frozen at -20° C or lower if the PT test is not completed within 24 hours. Whole blood should never be frozen because the red cells will lyse, and the PT test result would be drastically altered. The specimen does not require protection from light.

A prothrombin time (PT) specimen was collected at an outpatient clinic and will not be picked up by the testing laboratory's courier until several hours later. How should the specimen be stored until it is picked up by the courier? The specimen should be centrifuged right away and stored in the refrigerator at 4° C until is picked up the the courier. The specimen should be frozen immediately and kept there until is tested. The tube should remain unopened and be kept at room temperature (20°-25° C). The specimen should be protected from light.

Lithium or sodium heparin Feedback Lithium/sodium heparin is an additive used to prevent clotting by inhibiting thrombin and thromboplastin. It is found in green and light green tubes. EDTA prevents blood from clotting by binding calcium, which in turn inhibits the coagulation cascade. EDTA is found in lavender, pink, white, royal blue, and tan top tubes. The gel in the tube is used to form a barrier between plasma/serum and blood cells upon centrifugation. Sodium fluoride is found in gray top tubes and its purpose is to inhibit glycolysis (metabolism of glucose by red blood cells).

A variety of additives are used in blood collection tubes. Which of the following additives prevents clotting by inhibiting thrombin and thromboplastin? EDTA Gel Lithium or sodium heparin Sodium fluoride

B Feedback Group B is the correct answer because the group B Lancefield carbohydrate antigen is found on Streptococcus agalactiae. Group A is the incorrect answer because this Lancefield carbohydrate antigen is commonly found on Streptococcus pyogenes; however, it can also be found on Streptococcus anginosus, which is found in the Streptococcus anginosus group. Streptococcus anginosus can be separated from Streptococcus pyogenes by its small colony size on blood agar and the detection of Group A, C, F, and G carbohydrate group antigens. Group F is the incorrect answer, but this carbohydrate antigen is the most common Lancefield antigen detected in the Streptococcus anginosus group. Streptococcus anginosus and Streptococcus constellatus can both have Group F antigens. Group G is incorrect because it is found on organisms in the Streptococcus anginosus group, specifically Streptococcus anginosus and Streptococcus dysga

All of the following are Lancefield carbohydrate antigens found on beta-hemolytic Streptococcus species. All of the following antigens are found on organisms from the Streptococcus anginosus group EXCEPT? A B F G

Low aldosterone production Feedback Excess water loss, decreased water intake, and increased sodium intake and retention are all causes of high levels of sodium (hypernatremia). Hypernatremia is seen in diabetes insipidus due to excess water loss and in hyperaldosteronism (increased retention of sodium).Aldosterone is a hormone produced by the adrenal cortex. Aldosterone stimulates sodium reabsorption in the distal tubules of the nephron. Low levels of aldosterone would not promote increased levels of sodium.

All of the following are causes of hypernatremia EXCEPT: Excess water loss Low aldosterone production Decreased water intake Increased sodium intake or retention

The gram stain eliminates the need for culture.

All of the following are true concerning clinical specimens that are gram stained before culturing, EXCEPT: The gram stain allows you to judge the quality of the specimen. The gram stain provides the clinician with same-day information regarding possible pathogenic organisms. The gram stain eliminates the need for culture. The gram stain provides internal quality control when direct smear results are compared to culture results.

Sucrose Feedback Sucrose is not a reducing sugar since the anomeric carbon of both monosaccharides (glucose and fructose) are part of the glycosidic bond, preventing the anomeric carbon of fructose (and therefore its ketone group) from being free and reducing other compounds. Lactose, Glucose and Ribose are all reducing sugars since their anomeric carbons and aldehyde groups are all free to reduce other compounds.

All of the following carbohydrates are considered reducing sugars EXCEPT: Lactose Sucrose Glucose Ribose

Production of surface immunoglobulins Feedback T and B lymphocytes cannot be distinguished by their peripheral blood smear morphology. Only mature B lymphocytes produce surface immunoglobulins, IgM and IgD, T lymphocytes do not. T lymphocytes characteristically exhibit CD4 and CD8 cell surface markers on flow cytometry. T lymphocytes also recruit neutrophils, eosinophils, and basophils to inflammation or infection sites. T lymphocytes help integrate immune responses by producing cytokines and chemokines. T lymphocytes also assist B lymphocytes to make antibodies.

All of the following characteristics describe T lymphocytes EXCEPT? CD4 & CD 8 positive Production of surface immunoglobulins Production of cytokines and chemokines Recruitment of inflammatory cells to site of inflammation or infection

Entamoeba gingivalis trophozoite Feedback Entamoeba gingivalis trophozoite typically resides in the gingival crevices in the gums. They typically do not infect the intestines, but if they are swallowed, the stomach juices would destroy them. There is no known cyst form for E. gingivalis.

All of the following parasites may typically survive human stomach juices except: Entamoeba gingivalis trophozoite Endolimax nana cyst Balantidium coli cyst Entamoeba histolytica cyst

German measles (rubella) vaccine Feedback A potential blood donor who has received a German measles (rubella) vaccine is deferred for 4 weeks following the vaccination.Measles (rubella), mumps, and polio vaccines all have a 2 week deferral period following the vaccination.

All of the following represent a 2 week temporary deferral from donating blood or blood products EXCEPT: Measles (rubeola) vaccine German measles (rubella) vaccine Mumps vaccine Polio vaccine

Iodine Feedback Iodine is correct. Iodine can be used alone or used in combination with formaldehyde. Iodine can be used to identify Iodamoeba butschlii cyst by being absorbed into the glycogen vacuole. The glycogen vacuole will stain dark brown in color. At times, the stained glycogen vacuole is the only structure that is seen. Saline is incorrect. Although amoebae may be seen when examined using saline, nuclear and structural detail is not as evident, since saline is a clear substance and does not provide a color enhancement. Polyvinyl alcohol is incorrect. The polyvinyl alcohol fixative (PVA) is not a stain but is used as a preservative for cysts and trophozoites. Methylene blue is incorrect because this permanent stain is not used for staining amoebae.

Amoebae stained with this substance may be readily distinguished because it enhances nuclear and structural detail. Saline Iodine Polyvinyl alcohol Methylene blue

Klebsiella pneumoniae Feedback The colonies of Klebsiella pneumoniae are characteristically mucoid from the production of abundant capsular material. K. pneumoniae is a lactose fermenter, indicated by pink coloration on MacConkey as the pH decreases. Colonies of Enterobacter may also produce this type of colony appearance. Although Haemophilus species may also produce capsular material, Haemophilus species do not grow on MAC. Enrichment agar such as CHOC is used for isolation. Pseudomonas aeruginosa is a non-fermenter that may demonstrate ß-hemolysis on blood agar, with flat, spreading colonies and a metallic sheen. Many strains of P. aeruginosa produce pigments that appear green, and strains may have a fruity odor. Colonies of Proteus species typically swarm when grown on blood agar, and do not ferment lactose. Proteus species are a common cause of urinary tract infection and tend to produce a distinctly alkaline

From the choices listed below, choose the most likely associated bacterial species represented in the image as pink, runny, mucoid colonies at 48 hours incubation on MacConkey (MAC). Haemophilus species Pseudomonas aeruginosa Klebsiella pneumoniae Proteus species

Polychromatic normoblast Feedback Hemoglobin synthesis is detectable in the basophilic normoblast, but the formation of large amounts of hemoglobin begins in the polychromatic (polychromatophilic) normoblast. On a Wright-stained bone marrow aspirate smear, the cytoplasm of the polychromatic normoblast is murky gray-blue, which is due to a mixture of pink (from hemoglobin) and blue (from RNA). The cytoplasm of the basophilic normoblast is a deep, rich blue; any amount of hemoglobin produced during this stage is masked by the presence of large amounts of ribosomes and RNA.

In which developmental stage do red blood cells begin forming hemoglobin in amounts large enough to be visualized on a Wright-stained bone marrow aspirate smear? Reticulocyte Pronormoblast Basophilic normoblast Polychromatic normoblast

LASER is an acronym for light amplified by stimulated energy radiation Feedback LASER acronym for light amplification by stimulated emission of radiation. Intensity is a characteristic of laser light. laser light is concentrated.they gain so much energy that they exit as a powerful beam. Laser light is used in flow cytometry for cell sorting and identification of cells. The process of flow cytometry involves placing a suspension of fluorochrome dye-stained cells into a flow chamber under pressure. These stained cells pass through a laser beam that activates the dye. Cellular fluorescence is collected and transmitted to a computer program that can manage cell sorting before further analysis and identification of cells. Monochromaticity is a characteristic of laser light.

Laser light can be described by all of the following chart EXCEPT: Intensity and concentration Used in flow cytometry for cell sorting and identification of cells LASER is an acronym for light amplified by stimulated energy radiation Monochromaticityacteristics

Fragments of megakaryocyte cytoplasm and do not contain nuclei Feedback Platelets do not contain nuclei. They are fragments of megakaryocyte cytoplasm. Therefore, they are not the smallest nor the largest nucleated cells found in peripheral blood. Neutrophils do not produce platelets.

Platelets are: The smallest nucleated cells seen in normal peripheral blood. The largest nucleated cells seen in normal peripheral blood. Fragments of megakaryocyte cytoplasm and do not contain nuclei Fragments of neutrophils

gp41 or gp160 Feedback Western blot analysis is frequently used as an HIV confirmation test. The Western Blot test detects specific protein bands when an individual has been infected with HIV. This assay is interpreted as positive when at least 2 of the 3 following bands are present: p24, gp41, and gp160.

The Western Blot for HIV-1 infection identification looks for HIV p24 and what other two protein bands to confirm HIV-1 infecti gp41 or gp160 gp16 or gp161 gp61 or gp140 gp141 or gp60

Enterobacter aerogenes Feedback Enterobacter aerogenes ferments lactose, is motile, does not produce indole and is both VP and citrate positive, consistent with the reactions seen here. C. freundii produces similar reactions, except all strains are VP negative. K. pneumoniae also produces similar reactions, but can be ruled out because all strains are non-motile. Proteus mirabilis fits the pattern of reactions shown here, except it is a non-fermenter and would produce an alkaline slant/acid deep reaction on KIA.

The reactions observed in the photograph to the right reveals a motile, gas producing, lactose fermenter that produces acetyl methyl carbinol in VP broth and has the ability to utilize sodium citrate as its sole source of carbon. The most likely identification is: Citrobacter freundii Enterobacter aerogenes Klebsiella pneumoniae Proteus mirabilis

Speckled Feedback In order for the ANA to be positive there must be a clearly discernible pattern in the nuclei of the interphase cells. Metaphase mitotic cells are used to assist in identification of the ANA pattern. The image shown displays the features of a speckled ANA pattern: granular/speckled staining in the nuclei of the interphase cells (a) and absence of staining in the chromosomal area of the metaphase mitotic cells (b). The nucleoli do not stain; thus, the pattern is not nucleolar. A homogeneous pattern would show uniform staining of the nuclei in the interphase cells and presence of staining in the chromatin of the dividing cells. The centromere pattern is characterized by many discrete speckles in both the nuclei of interphase cells and the chromatin of dividing cells.

This antinuclear antibody (ANA) pattern is characterized by granular staining in the nuclei of the interphase cells (a). There is also an absence of staining in the chromosomal area of the metaphase mitotic cells (b). The slide is viewed using fluorescent microscopy. Which pattern is this? Homogeneous Speckled Nucleolar Centromere

Inability of the body to excrete normal amounts of dietary iron Feedback Hereditary hemochromatosis is a genetic disorder typically involving a deficiency of hepcidin due to a mutation in the hepcidin gene or genes whose products regulate the expression of hepcidin. These mutations cause increased iron absorption in the small intestine, leading to iron overload. Ingestion of excessive amounts of dietary iron results in secondary hemochromatosis. Iron is recycled when cells die; the body does not have a mechanism for iron excretion. Failure of developing red blood cells to incorporate iron into protoporphyrin IX results in sideroblastic anemia.

What is the cause of iron overload in hereditary hemochromatosis Absorption of excessive amounts of iron in the small intestine Ingestion of excessive amounts of iron from diet or supplements Inability of the body to excrete normal amounts of dietary iron Failure of developing red blood cells to incorporate iron into protoporphyrin IX

Sickle cell (drepanocyte) Feedback 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). Although target cells can be seen in HbSS patients' blood, they are not specific to this condition. Target cells can be seen in other hemoglobinopathies and other anemias as well. Polychromatophylic RBCs can be seen in their smears as well, but they can be seen in almost all smears of patients who are compensating for anemia. Spherocytes are rounded-up cells and are characteristic of Hereditary Spherocytosis and other anemias but are not associated with Hb S.

What is the characteristic RBC that is uniquely associated with HbSS? Target cell (codocyte) Sickle cell (drepanocyte) Polychromatophilic cell Spherocyte

Photopheresis Feedback Photopheresis utilizes leukapheresis to collect the buffy coat layer from whole blood. These cells are treated with 8-methoxypsoralen, exposed to ultraviolet A light and then reinfused into the patient. Photopheresis has been shown to be efficacious and has been approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma. Plasmapheresis is the removal and retention of the plasma, with return of all cellular components to the patient. Therapeutic apheresis (TA) involves the removal of a specific blood component, with return of the remaining blood constituents to the patient. However, with TA the component being removed is considered pathological or contributing to the patient's underlying disease state. Erythrocytapheresis, or red cell exchange, removes a large number of red blood cells from the patient and returns the patient's plasma and platelets along with com

What procedure utilizes leukapheresis to collect the buffy coat from whole blood? Photopheresis Plasmapheresis Therapeutic apheresis Erythrocytapheresis

Capnocytophaga ochracea Feedback The association of children, teeth, and "gliding" (referring to the unique motility seen on agar plates) all point to Capnocytophaga ochracea, one of the primary causes of localized juvenile periodontitis, an aggressive dental disease that leads to the destruction of teeth and the underlying alveolar bone. A variety of factors lead to this progressive disease, including the production of substances that inhibit neutrophil function, proteolytic enzymes, and penetration of the deeper tissues through its unique gliding motility. Aggregatibacter actinomycetemcomitans, formerly Actinobacillus actinomycetemcomitans, is also associated with periodontal disease; however, in the context of this exercise is ruled out because it does not demonstrate gliding motility. Eikenella corrodens is also an inhabitant of the oral cavity and produces colonies that pit the agar; however, has not been incri

Which Gram-negative organism can produce "gliding motility" on agar plates and is a primary cause of juvenile periodontitis? Eikenella corrodens Aggregatibacteractinomycetemcomitans Capnocytophaga ochracea Fusobacterium nucleatum

Leb Feedback Inheritance of both Le and Se genes produces the Leb antigen on red blood cells. 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. Some of the precursor chains are not affected by the Se gene and, therefore, form the Lea antigen. Hence, it is possible to see both Lea and Leb in the plasma and secretory fluids. However, only Leb adsorbs onto the red cells of adults (most likely due to competitive binding), causing them to phenotype Le(a-b+).

Which Lewis antigen(s) would be detected when phenotyping the red cells of an adult who has the Le, Se, and H genes? Lea Leb Both Lea and Leb Neither Lea or Leb

Positive DAT Feedback In the group of disorders referred to as immune hemolytic anemias, erythrocytes are destroyed too early by an immune-mediated process that results from antibodies, complement, or both attaching to the red cell membrane. The presence of immune hemolytic anemia is confirmed by a positive DAT (direct antiglobulin test). Rouleaux is the formation of red cells that are stacked and appear like a stack of coins. This is a characteristic finding in multiple myeloma. Splenomegaly, or an enlarged spleen, may be found in Gaucher's disease or in polycythemia vera. It is not found in immune hemolytic anemia. Increased erythrocyte count is not a finding in immune hemolytic anemia.

Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias? Rouleaux Positive DAT Splenomegaly Increased erythrocyte count

Inhibitory mold agar Feedback Inhibitory mold agar, brain-heart infusion agar with antibiotics, and yeast-extract phosphate agar are all used for the primary recovery of pathogenic fungi exclusive of dermatophytes. Potato flake agar is used for the primary recovery of saprobic and pathogenic fungi. Mycosel agar is used for the primary recovery of dermatophytes. Sabouraud Dextrose with Brain Heart Infusion agar is used for the primary recovery of saprobic and pathogenic fungi.

Which fungal culture media is used for the primary recovery of pathogenic fungi exclusive of dermatophytes? Inhibitory mold agar Potato flake agar Mycosel agar (SABHI) Sabouraud Dextrose with Brain Heart Infusion agar

Heterozygous alpha thalassemia-2 Feedback Bart's hemoglobin is present when tetramers of gamma chains are formed. These tetramers form in fetuses and neonates when there is an insufficient amount of alpha chains. 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 . The heterozygous alpha thalassemia-1/ alpha thalassemia-2 is also referred to hemoglobin H disease . It has three alpha gene deletion with presence of Bart's hemoglobin at birth. The heterozygous alpha thalassemia-1 and the homozygous alpha thalassemia-2 are referred to the alpha thalassemia minor with two alpha genes deletions and therefore presence of Bart's hemoglobin at birth.

Which genetic description will NOT contain Bart's hemoglobin at birth ? Heterozygous alpha thalassemia-1/alpha thalassemia-2 Heterozygous alpha thalassemia-1 Homozygous alpha thalassemia-2 Heterozygous alpha thalassemia-2

hCG (human chorionic gonadotropin) Feedback hCG is used for pregnancy testing, but it is also the most useful marker for the detection of gestational trophoblastic disease.The main clinical use of CEA is a marker for colorectal cancer.AFP is often elevated in patients with hepatocellular carcinoma and germ cell tumors.CA-125 is a serological marker of ovarian cancer.

Which marker is most useful for the detection of gestational trophoblastic disease? CEA (Carcinoembryonic antigen) AFP (a-fetoprotein) hCG (human chorionic gonadotropin) CA-125 (cancer antigen 125)

C in Trans to RHD Feedback Individuals with C in Trans to RHD possess complete D antigen structures. The allele that carries C is in trans (or opposite position) from the allele carrying RHD. As a result, the position of the C antigen in relationship to the D antigen interferes with the expression of the D antigen. This can be a weakened expression of D antigen; however, D antigen is still present. These patients can receive D-positive RBCs without the implication of an Rh-mediated transfusion reaction. In partial D and partial weak D individuals, they can produce Rh antibodies to the portion of the RhD gene that is missing. There is a risk for potential adverse effects to occur when these individuals are recipients of D-positive RBCs. Individuals with Del phenotype possess a low number of D antigen sites that can go undetected in routine serological testing. This testing discrepancy can lead to misclassification of

Which of the following D variants has the best likelihood to receive D-positive RBCs without any adverse effects? D el Partial D Partial weakD C in Trans to RHD

Entamoeba coli Feedback Entamoeba coli a mature cyst has 8 nuclei and can have up to 16 nuclei. An immature cyst may have 2 or more nuclei present. Endolimax nana mature cyst typically has 4 nuclei. Iodamoeba butschlii only 1 nucleus is seen in a mature cyst. Giardia duodenalis mature cysts will have 4 nuclei. An easy way to remember the number of nuclei in the mature cysts of each of these organisms is as follows: Only one ameoba is known to have eight nuclei - Entamoeba coli (it is one of the larger cysts in relative size). Endolimax nana is significantly smaller and only contains half the number of nuclei seen in Entamoeba coli; four. Giardia duodenalis is symmetrical in the trophozoite stage and the two nuclei are seen in this form convert into four in the cyst stage. Iodamoeba species is the only amoeba that always has only one nucleus in the cyst form.

Which of the following amoeba is known to have 8 nuclei in the mature cyst form? Endolimax nana Iodamoeba butschlii Giardia duodenalis Entamoeba coli

Bicarbonate Feedback The specimen should not be delayed for more than two hours prior to centrifugation because some of the analyte levels (such as glucose, ionized calcium, bicarbonate, folate, etc.) may be falsely decreased due to cellular consumption or falsely increased (such as potassium, ALT, AST, creatinine, etc.) because they are released over time from cells into serum or plasma.

Which of the following analytes would be decreased due to delay in centrifugation? ALT Creatinine AST Bicarbonate

Kell Feedback Antigens develop at various rates both in utero and after birth. Kell blood group antigens can be detected on fetal cells at 10 weeks gestation and are well developed at birth. ABO antigens are present on fetal cells but expression is only 25%-50% of that we see on adult RBCs. Lewis antigens and the I antigen are all poorly developed on fetal cells.

Which of the following antigens are well developed on fetal cells? Lewis ABO Kell I

Ticks Feedback There are five classes of arthropods, Chilopoda, Pentastomida, Insecta, Arachnida, and Crustacea. Arachnida includes ticks, mites, spiders, and scorpions. Fleas and lice are both classified as Insecta. Other Insecta organisms are mosquitos and other bugs such as bedbugs and cockroaches. Crabs are classified as Crustacea. Other organisms that are also Crustacea are crayfish and copepods. The other classifications are Chilopoda, which are centipedes, and Pentastomida, which are tongue worms.

Which of the following arthropods is classified as Arachnida? Ticks Fleas Lice Crabs

Acid phosphatase Feedback Acid phosphatase test helps in diagnosing prostate cancer. It should be collected in a gel-separator tube. Serum/plasma should be frozen immediately and transported frozen. ALP is the test used to evaluate liver function. It requires to be a fasting collection and collected in a gel-barrier tube. Serum should be separated from cells immediately and refrigerated for storage. Alanine aminotransferase (ALT or SGPT) test helps to determine hepatic disease. It should be collected in a serum (red top) or plasma tube (green top). Serum/plasma should be separated from cells immediately and refrigerated for storage. Creatinine is a test used to evaluate kidney function. It should be collected in a gel-barrier serum tube (red or gold top). Serum should be separated from cells immediately and refrigerated for storage.

Which of the following blood tests is used in the determination of prostate cancer? Acid phosphatase Alkaline phosphatase (ALP) Alanine aminotransferase (ALT or SGPT) Creatinine

Amylase While both amylase and lipase are used for diagnosis of acute pancreatitis, lipase is more specific. Feedback Amylase test helps to determine acute pancreatitis. 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. Acid phosphatase test helps in diagnosing prostate cancer. collected in a gel-separator tube. Serum/plasma should be frozen immediately and transported frozen. Uric acid is a test used to diagnose gout . collected in a gel-barrier serum tube (red or gold top). Serum should be separated from cells within 45 minutes and stored at room temperature. ALP is the test used to evaluate liver function. collected in a gel-barrier tube. Serum should be separated from cells immediately and refrigerated for storage.

Which of the following blood tests is used to determine acute pancreatitis? Acid phosphatase Uric acid Amylase Alkaline phosphatase (ALP)

Aldolase Feedback Aldolase is an enzyme that aids in the glycolytic breakdown of glucose to lactate for energy. Aldolase is associated with 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 associates with biliary tree obstruction. It is also used to detect bone disease associated with an elevated osteoblastic activity. Gamma-glutamyltransferase, or GGT, is elevated in liver diseases affecting the biliary system, especially in patients who are heavy drinkers. Serum concentrations of 5'-nucleotidase, or 5NT, reflect hepatobiliary disease with high specificity as well.

Which of the following enzymes is associated with conditions affecting skeletal muscles? Aldolase Alkaline phosphatase (ALP) Gamma-glutamyltransferase 5'-nucleotidase

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

Which of the following errors occurs in the analytical phase? Incorrectly handled critical test value Incorrectly performed instrument calibration Wrong test ordered Incorrectly performed venipuncture

CDe/ce Feedback The genotype CDe/ce is found in 31% of the Caucasian population. The genotype CDe/cDe is found in 3% of the Caucasian population. The genotype cDE/ce is found in 10% of the Caucasian population. The genotype cDE/cE is found in less than 1% of the Caucasian population.

Which of the following genotypes is found with the highest frequency in the Caucasian population? CDe/cDe cDE/ce cDE/cE CDe/ce

Frame C- primary myelofibrosis Feedback Frame C is a circulating nucleated red blood cell (rubricyte). Nucleated red blood cells are not normally found in the peripheral blood. In primary myelofibrosis, the bone marrow is filled with fibrous tissue so the body resorts to extramedullary hematopoiesis. This results in teardrop RBCs, nucleated RBCs and immature myeloid cells in the peripheral blood. Frame A is a reactive or variant lymphocyte. These are found in the peripheral blood in infectious mononucleosis or other viral infections. Lymphoblasts are the cells associated with acute lymphoblastic leukemia. Frame B is a plasma cell. These cells are found in the peripheral blood of a patient with plasma cell leukemia. Polycythemia vera presents with increased numbers of normal mature RBCs in the blood. Frame D is a monocyte. These cells are involved in the body's inflammatory response and phagocytic engulfment of foreig

Which of the following is a correct pairing of cell type in the image and a disease state associated with that type of cell? All cells are from a Wright stained peripheral blood smear Frame A - acute lymphoblastic leukemia Frame B- polycythemia vera Frame C- primary myelofibrosis Frame D- infectious mononucleosis

Observe the same organism in all cases of a given disease Feedback Observing the same organism in all cases of a given disease is the correct answer because based on Koch's postulates, the first postulate states, "The same organism must be found in all cases of a given disease." The organism must be isolated and grown from the infected host is incorrect because this is the second step in Koch's postulates that states, "The organism must be isolated and grown in pure culture from the infected host." Organism, from pure culture, must reproduce the disease in an inoculated host is incorrect because this is the third postulate that states, "The organism, from pure culture, must reproduce the disease when inoculated into a susceptible animal." The organism must be isolated in pure culture from an experimentally infected host is incorrect because this is the last of Koch's postulates that states, "The organism must be iso

Which of the following is the first step in the four steps of Koch's postulates? Organism must be isolated and grown from the infected host Organism, from pure culture, must reproduce the disease in an inoculated host Organism must be isolated in pure culture from experimentally infected host Observe the same organism in all cases of a given disease

Moraxella catarrhalis Feedback Moraxella catarrhalis is a common laboratory isolate that is distinguished from other gram-negative diplococci, including Neisseria species and Kingella species, by not fermenting any of the commonly tested carbohydrates and is DNAse positive. It is also aerobic. N. lactamica is a gram-negative diplococcus but ferments glucose, maltose lactose, while K. kingae is a gram-negative coccobacillus that ferments glucose and maltose. Veillonella parvula is an infrequently recovered anaerobic gram-negative diplococcus that also has the properties of being asaccharolytic and failing to hydrolyze DNA.

Which of the following organisms is an aerobic, gram-negative diplococcus that does not ferment sugars and is DNAse positive? Neisseria lactamica Moraxella catarrhalis Kingella kingae Veillonella parvula

Cytoplasm appears pink-purple due to small specific granules. Feedback A segmented neutrophil has pink cytoplasm that contains fine specific granules scattered throughout the cell. Additionally, a segmented neutrophil typically displays a nucleus with 3-5 lobes connected by a filament.Cytoplasm contains large red-orange granules is incorrect. This would be a descriptor for an eosinophil. Monocytes are commonly characterized as having cytoplasm that is a pale blue color with a ground-glass appearance.Cytoplasm is clear with no granules is incorrect. Many lymphocytes (but not all) have a clear cytoplasm with no granules.

Which of the following phrases best describes a segmented neutrophil? Cytoplasm appears pink-purple due to small specific granules .Cytoplasm contains large red-orange granules .Cytoplasm is a pale blue color with a ground glass appearance. Cytoplasm is clear with no granules.

L/S Ratio The lecithin/sphingomyelin ratio is determined by examining the amniotic fluid of a pregnant mother. Because amniotic fluid is continuously swallowed or inhaled and then replaced or exhaled in uterus the ratio can be measured to determine how much surfactant is in the fetal lungs. This ratio will help determine how well the infant's lungs will perform breathing at birth. Alpha-fetoprotein is used in assessing the potential for genetic disorders. Bilirubin is used in diagnosing the cause of jaundice and other liver problems.Fetal hemoglobin is not used to assess fetal lung maturity.

Which of the following tests on amniotic fluid would be included when assessing fetal lung maturity: Alpha Fetoprotein Bilirubin L/S Ratio Fetal hemoglobin