LabCe Review
A 41-year-old male arrived at the clinic with complaints of fatigue, malaise, and overall discomfort. Upon testing, the patient's CBC results were notably abnormal with 30% blasts present along with anemia and thrombocytopenia. Bone marrow and cytochemical staining were subsequently performed. The cytochemical stains noted negative reactions to Myeloperoxidase and Sudan Black B but a positive reaction to alpha-naphthyl acetate. Which of the following conditions is most likely seen?
Acute Monocytic Leukemia
Antibodies directed against granulocyte antigens have been implicated for all of the following EXCEPT?
Acute hemolytic transfusion reactions
Auer rods are most commonly present in which of the following conditions?
Acute myelocytic leukemia (AML)
How many standard deviations (SD) above and below the mean is accepted as being an appropriate control limit range on a control chart utilizing the Westgard rules:
3 SD
What is the maximum interval during which a recipient sample may be used for compatibility testing if the patient has recently been transfused or was pregnant within the past 3 months?
3 days
Antibody identification interpretations would be considered correct 95% of the time or have a P value of 0.05 (5% probability that the result is due to chance) if you have:
3 positive reactions to rule in an antibody and 3 negative reactions to rule out an antibody
Rh Immune Globulin (RhIG) is used to prevent the active immunization to the D antigen in women who are Rh negative carrying an Rh positive fetus. One dose of RhIG (equal to 300 µg of World Health Organization reference material) contains enough anti-D to protect against:
30 mL of whole blood
What is the shelf-life of whole blood collected in CPDA-1?
35 days
According to the lower normal reference limit stated by WHO, which of the following sperm concentrations would be considered abnormally low?
5 x 106 spermatozoa/mL
The ratio of whole blood to anticoagulant is very important in the PT assay; at which hematocrit level should the standard anticoagulant volume be adjusted?
> 55%
If the parents are group A and B respectively, what are the possible blood groups of their children?
A and B and AB and O
What is HEMIACETYL ?
A compound with both a carbonyl and alcohol group
What is a lyophilized control?
A control that is dehydrated to powder
Myeloperoxidase - POSITIVE Sudan Black B - POSITIVE Alpha- Naphthyl Acetate - NEGATIVE
ACUTE PROMYELOCYTIC LEUKEMIA (M3)
The patient CBC results were notably abnormal with 30% blast along with Anemia and Thrombocytopenia. Bone Marrow and cytochemical testing were subsequently performed. The cytochemical statins noted Myeloperoxidase - NEGATIVE Sudan Black B - NEGATIVE Alpha- Naphthyl Acetate - POSITIVE
AML ( ACUTE MONOCYTIC LEUKEMIA )
Light yellow green pigmentation of the mycelium is observed, the identification of the isolate depends on the presentation of the fruiting body observed in the bottom photomicrograph.
Absidia species
After birth, which of the following is the biggest concern for a newborn infant suffering from hemolytic disease of the fetus and newborn?
Accumulation of bilirubin
Illustrated in the top image is 4 day growth of a smooth, glabrous colony with a light tan yellow surface, cultured from a patient who developed a subcutaneous abscess at the site where a bone marrow transplant was administered. The bottom image is a photograph of a methylene blue stained mount presenting long, delicate conidiophores at the tips of which are produced loose clusters of thin elongated conidia in an oriental letter or "diphtheroidal" pattern. With these observations, what is the most likely identification?
Acremonium sp.
Which of the following is NOT considered a characteristic of PAROXYSMAL COLD HEMOGLOBINURIA?
Autoantibody class: IgM Characteristics of PCH Autoantibody Class: IgG Patient Population: Children and young adults Pathogenesis: following Viral Infection Site of Hemolysis: Intravascular
A patient's serum reacts with ALL reagent red cell samples. The Autocontrol is NEGATIVE. An alloantibody to a high incidence antigen is suspected. Which of the following would MOST LIKELY be a compatible DONOR ?
Autologous Donation
Which of the following parasites has a life cycle that most closely resembles that of Plasmodium species?
Babesia microti
Which of the following organisms display the characteristic "Medusa head" on 5% sheep blood agar (SBA) after 18 hours of incubation at 35°C?
Bacillus anthracis
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
A representative congenital neutrophil functional disorder is:
Chédiak-Higashi syndrome
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 following organisms? (Choose the BEST response.)
Clostridium perfringens
The anaerobe growing on the surface of the blood agar plate, the toxins of which cause a form of necrotizing enteritis known as Darmbrand ("fire bowels") in Germany or "Pig bel" in New Guinea, is:
Clostridium perfringens
Which abnormal morphologic terms describes this slide ?
Dohle Bodies, bacteria, Toxic Granulation
For which of these reasons would a molecular method not be used?
Donor antibody screening ACCEPTABLE Determine blood type when the DAT is positive Complex Rh genotypes (weak D expression) Type fetal blood
The accumulation of interstitial fluid under the skin causing swelling is called:
Edema
The trophozoites indicated by arrows and the 10 µm oval cyst at the middle left in the photomicrograph were observed in a stool specimen from a person with mild intermittent diarrhea. What is the presumptive identification of this organism?
Iodamoeba butschlii
Bob is a MLT at the local VA hospital. Tonight he is assigned to perform set-up and read Gram stains on newly received specimens in the Microbiology department. He ported reported a superficial wound Gram stain as having Gram negative rods, when he realized he must have over decolorized the slide and the rods reported are actually Gram positive. What should Bod do next?
Issue a corrected report
What is the purpose of calcofluor white in the direct examination of patient specimens for fungal elements?
It binds to the polysaccharides in the chitin of the fungus.
When the glucose result on a urine specimen from an infant is negative on the reagent strip:
It must be followed by the copper reduction test (Clinitest®) to check for other reducing substances.
What would you predict is the effect on iron absorption if erythopoietic activity is increased over a prolonged period of time?
It would increase.
Which symptom of hemolytic disease of the fetus and newborn (HDFN) is associated with low levels of glucuronyl transferase?
Jaundice
From the groups of analytes below, which set would most likely be INCREASED in a type 1 diabetic patient in crisis?
Ketone bodies and blood glucose
What MINIMUM level of a particular factor will cause the APTT test to become PROLONGED ?
Less than 40%
Which of the following stains is used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia (CML)?
Leukocyte alkaline phosphatase (LAP)
Which of the following is an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)?
Lifetime Treatment
A gram positive bacillus grew as a diffusely beta-hemolytic colony from a newborn. It was catalase positive and had tumbling motility on a hanging drop preparation. The image shows how the organism grew in the motility medium. What is the most likely diagnosis?
Listeria monocytogenes
Illustrated in the upper photograph to the right are small, gray-white to light yellow colonies surrounded by zones of beta hemolysis. Short, gram-positive bacilli with rounded ends that lie singly or in loose clusters are observed in gram stains. Two key identifying features, as illustrated in the lower photograph, are a narrow band of "umbrella" motility observed beneath the surface of semi-solid motility medium and the deep black slant of positive esculin activity. This species may be recovered during influenza-like infections during 2nd and 3rd trimester of pregnancy. With these observations, which of the following organisms is the identification of this isolate?
Listeria monocytogenes
A 52 year old male with a history of alcoholism is admitted to the hospital with severe abdominal pain. A CBC reveals the following results: Parameter Value Reference Interval White blood cells (WBC) 15.7 x109/L 4.0-10.0 x109/L Red blood cells (RBC) 3.9 x1012/L 4.2-5.9 x1012/L Hemoglobin 14.4 g/dL 12-16 g/dL Hematocrit 41% 37-48% MCV 105 fL 80-100 fL RDW-CV 16.5% 11.0-14.0% Considering the information that is provided, which of the following would be an appropriate description this patients RBC population?
Macrocytic, heterogenous (i.e., more variable)
A patient presents to his family doctor with respiratory issues. He has a history of being a heavy smoker for more than 20 years, so the physician orders a BAL cell count with differential. Which of the following cells would most closely correlate with the patient's medical history?
Macrophages with purple/black inclusions
Albumin levels are can be a good gauge for chronic protein deficiency. Which of the following terms describes inadequate protein and caloric intake?
Marasmus
Most antibodies present in cord blood are of ________ origin.
Maternal
In HDFN which of the following antigen-antibody reactions is occurring?
Maternal antibody is directed against fetal antigen.
Which of the following markers is associated with normal mature B cell expression?
CD19 Normal mature B cells express CD19 (also CD20, and Kappa or Lambda). CD8 is expressed by T suppressor/cytotoxic T cells. CD14 is expressed by Monocytes. CD42 is expressed by Megakaryocytes.
An organism isolated from a sputum specimen and appeared as a dry, wrinkled, off-white colony on sheep blood agar. A Gram stain was performed and Gram positive branching rods were seen. In addition, a modified acid fast was performed and was positive. The organism was later identified as a Norcardia species. Which of the following antibiotics is the appropriate treatment?
Sulfonamides
The best sample to obtain in order to diagnosis the parasite causing the posterior scalp nodule as illustrated in the photograph is
Superficial skin snip
The viscous fluid found in the joint cavities is called:
Synovial fluid
Upon reviewing a fecal preparation for Ova and Parasites, a technologist thought they had just identified the egg of Taenia saginata. After a quick look, the microbiology supervisor reminded the technologist that T. saginata eggs are indistinguishable from which of the following?
Taenia solium
Which of the following is a TRUE statement when performing maintenance or repair tasks on electrical equipment?
Tagout is the placement of a tag on the energy-isolating device notifying staff: "Do Not Operate this Equipment."
What are the two general categories of nucleic acid amplification (NAA) techniques?
Target amplification and signal amplification
Methods of detecting and identifying intestinal parasites include all of the following except:
Thin and think Giemsa smear The thin and thick Giemsa smear is used for the detection of blood parasites such as Plasmodium, Trypanosomes, Babesia, and more. It is not used to detect or identify parasites from intestinal specimens.
Which of the following statements best describes the appearance of Cabot rings?
Thin, reddish-violet-staining strands in the shapes of figure eights, or the letter B
Aerobic Actinomycetes can cause different types of infections. All of the following are acceptable sites for the recovery of Aerobic Actinomycetes EXCEPT ?
Throat PRESENT Respiratory Cutaneous Central Nervous System
Which of the following activities may lead to a HIPAA violation lawsuit?
Throwing laboratory test requests into the regular trash.
Which of the following bone marrow processing procedures is best suited for a patient who had a dry tap?
Touch preparations
Which of the following infections is caused by Chlamydia trachomatis?
Trachoma, a major cause of preventable blindness in the world.
Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph?
Transfusion dimorphism
Which Plasmodium morphologic form is considered Most Immature ?
Trophozoite
Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:
Tubular epithelial cells
What is the urinary system composed of?
Two kidneys, two ureters, one urinary bladder, and one urethra.
RNA nucleotides
Uracil, Adenine, Cytosine, Guanine
A blood sample is left on a phlebotomy tray for four hours before it is delivered to the laboratory. Which group of tests could still be performed?
Uric acid, BUN, creatinine
Which of the following reagent strip tests is based on the Ehrlich-aldehyde reaction?
Urobilinogen
What is the correct sequence of the immunologic Epstein-Barr virus (EBV) response in infectious mononucleosis? Key: VCA= viral capsid antigen VCA/IgM =viral capsid antibody (IgM) EA=early antigen EBNA=Epstein-Barr nuclear antigen
VCA, EBNA, VCA/IgM, EA
What causes Polyacrylamide Gels to have a greater resolution of proteins than agarose gels ?
Varying pore size in each polyacrylamide layer
The buffy coat includes which of the following constituents of the blood?
White blood cells and platelets
In the clinical laboratory, Safety Data Sheets (SDS) shall be maintained and be available to employees in the:
Workplace area
Which parasite is transmitted via a mosquito bite?
Wuchereria bancrofti
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?
CREST syndrome
Which three genetic variations in enzymes are most often linked to differences in drug metabolism?
CYP2D6, CYP2C9 & CYP3A4
A tech is working with a small Gram-negative coccobacillus that may be Francisella tularensis. Which of the following tests could the tech use to rule out this organism?
Catalase negative
A tech receives a call from the floor regarding antimicrobial therapy. The patient culture yielded an aerobic Gram-negative bacillus and the physician would like to use an antibiotic that inhibits cell wall synthesis. Which of the following antibiotics would be the best choice?
Cefazolin
Which of the following statement is INCORRECT regarding the bone marrow biopsy specimen?
Cellular morphologic detail can be determined.
Parasites which can be found in urinary sediment include all of the following EXCEPT:
Plasmodium malariae SEEN Enterobius vermicularis Trichomonas vaginalis Schistosoma haematobium
Why is Rh immune globulin (RhIg) administered within 72 hours of delivery to an Rh negative mother if the newborn is found to be D-positive or weak-D positive?
Prevent fetal cells from initially sensitizing the mother
Rh Immune Globulin (RhIG) is used to:
Prevent the formation of anti-D
How should the production of a blue or purple color on the test pad of an Ictotest® be interpreted?
Positive for bilirubin
What is the focus of both Lean Principles and the Six Sigma Methodology?
Process Improvement
Which of the following types of molecules is most likely to be antigenic/immunogenic
Proteins
What percentage solution of sodium hypochlorite (bleach) is recommended as a routine laboratory disinfectant?
10%
Which one of these Gram-positive species has a high incidence of vancomycin-resistance?
Enterococcus faecium
What is the approximate time that should be allowed for samples to completely clot before centrifugation for serum samples ?
20 Minutes
Which of the following needle gauges has the smallest lumen or bore?
22
Which alpha thalassemia shows no anemia, although a slight decrease in the MCV and MCHC may be seen?
Alpha Thalassemia silent carrier
Cystine-tellurite blood agar is recommended for the isolation of which organism?
Corynebacterium diphtheriae
Which one of the following organisms is commonly cultured from the nasopharynx of healthy people but is RARELY pathogenic?
Corynebacterium species
A person who lived in the United Kingdom between the years of 1980 and 1996 for 3 or more months is indefinitely deferred from donating blood or blood products based on an increased risk of which of the following?
Creutzfeldt-Jakob disease (CJD) and/or variant Creutzfeldt-Jakob disease (vCJD)
Universal Donor when transfusing Red Blood Cells ?
Group O
What is the expected serological response in an immunocompetent patient who has been vaccinated for hepatitis B?
HBsAg (neg), Anti-HBc(neg), anti-HBs (pos)
Current CDC (2014) recommendations for initial HIV screening include FDA-approved immunoassay for detection of:
HIV-1 and HIV-2 antibody, HIV-1 p24 antigen
HIPAA stands for?
Health Insurance Portability and Accountability Act
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
What ia the immune status of the patient ? HBsAg : NEGATIVE HBeAg : NEGATIVE Anti-HBc : POSITIVE Anti-HBs : POSITIVE
Recovery
All of following are considered normal flora of the gastrointestinal tract EXCEPT:
Shigella AMONG Lactobacillus Clostridium Peptostreptococcus
Hemoglobin D (HbD) is elevated in all of the following EXCEPT?
Alpha thalassemia Eleveted In Hemoglobin D disease Hemoglobin SD disease Hb D/beta-thalassemia
This drawing depicts which alpha chain genotype?
Alpha thalassemia intermedia (Hemoglobin H Disease)
The recommended temperature/time/pressure for a routine STEAM STERILIZATION of the media is ?
121° C for 12-15 minutes @ 15 psi
Which of the following is the deferral period following the collection of double red blood cell units?
16 weeks
After an Acute Myocardial Infraction, Myoglobin levels will rise within 3 hours and peak at 8-12 hours. When will they return to normal ?
18-30 hours
After an acute myocardial infarction (AMI), myoglobin levels will rise within 3 hours and peak at 8-12 hours. When will they return to normal?
18-30 hours
How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid?
0-5 WBCs/µL
Which of the following best describes a hemoglobinopathy?
A substitution of an amino acid in the hemoglobin chain.
Which one of the following may cause a FALSE-NEGATIVE result with antiglobulin techniques?
Addition of AHG is delayed for 40 minutes or more after final saline wash
Uric acid is the final breakdown product of what two purines?
Adenine and guanine
Describe cestodes
Adults are ribbonlike and contain segments
Which of the following statements about diagnosing gestational diabetes is true?
All non-diabetic pregnant women should be screened at 24 to 28 weeks of gestation.
Identify the urine sediment elements present in this acidic urine:
Amorphous urate crystals
Why would a unit of group O blood never be administered to a Bombay patient?
Anti-H in recipient The classic Bombay phenotype (Oh) is characterized by the absence of A, B and H antigens, and the presence of anti-H, which will react from 4o to 37o C. Bombay patients must therefore be transfused only with blood from donors of the Bombay phenotype.
A 27-year-old female presents to her physician after suffering a spontaneous abortion. Though rare, which antibody may be the etiological agent?
Anti-P
In most cases of Fanconi anemia, which of the following types of anemia develops?
Aplastic
All of the following are true in terms of platelet characteristics, EXCEPT?
Are normally found circulating in their inactive, spiny form.
The predominant cells seen on the CSF smear in this illustration are indicative of:
Bacterial meningitis
Which of the following is the immediate precursor of the mature neutrophil?
Band
Which type of granulocyte has water soluble granules which may fade during the rinsing phase of the staining process using the Wright's stain?
Basophils
When should you first refer to a chemical's label?
Before moving or opening the chemical
Which of the following analytes is light sensitive?
Beta carotene
Illustrated in the top photomicrograph is a 4 day old colony growing on Sabouraud's dextrose agar with a smooth dark gray to black surface surrounded by dark gray and white peripheral bands. The colony morphology is not distinctive. The identification is made by observing the septate hyphae and conidia as microscopically observed in the lactophenol cotton blue stained mount obtained from the surface of the colony as illustrated in the bottom photomicrograph. From these observations, select the most probable fungi.
Bipolaris species
The hematology analyzer reported an elevated white blood cell count and flagged for manual review due to the suspected presence of immature cells. What is the arrowed cell's identity, and what name is given to its inclusion?
Blast with Auer rod
In which order should the following capillary specimens be collected according to Clinical and Laboratory Standards Institute (CLSI)? Ethylenediaminetetraacetic acid (EDTA) specimens Serum (non-additive) specimens Blood gas specimens Other additive specimens
Blood gas -> EDTA -> Other additives -> Serum
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.
Which of the following images shows a Gram stain that is consistent with Nocardia species?
C
An immunosuppressed patient with a CSF shunt is exhibiting symptoms of a shunt infection. When performing a Gram stain, the organism observed in the image to the right is seen. What is the most likely identity of this organism?
Candida sp.
Which of the following is the only vessel that allows for the exchange of oxygen (O2) and carbon dioxide (CO2)?
Capillaries
Which of the following organisms is indole negative?
Capnocytophaga canimorsus
Human dog bite infections may be caused by each of the following bacterial species except:
Capnocytophaga ochracea Capnocytophaga ochracea has its natural habitat in the oropharynx of humans and would not be involved in dog bite infections. PRESENT Pasteurella multocida Capnocytophaga cynodegmi Neisseria weaveri
All pf the following Aerobic Agars can be set up along with the Anaerobic media, EXCEPT?
Columbia Collistin-Nalidixic Acid Agar
In the in vitro coagulation scheme, factor V is primarily involved in the:
Common pathway
predominantly associated with skin and soft tissue infections (SSTIs), such as abscesses, cellulitis, folliculitis and impetigo.
Community-acquired MRSA
In hookworm cases where progressive anemia is present, what additional test procedure should be performed to determine infection in stool specimens?
Concentration technique
The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74-year-old man with chronic obstructive pulmonary disease. This isolate is most likely:
Contaminant
A blood bank instructor considers herself to be very organized and meticulous. She tends to give her students low ratings on organization. This error is called the:
Contrast error
Which of the following blood components will provide the best source of fibrinogen for a patient with hypofibrinogenemia?
Cryoprecipitate Cryoprecipitate is the cold-insoluble protein remaining after FFP is thawed slowly at 1-6 degrees Celsius. It contains about 50% of the factor VIII, and 20-40% of the fibrinogen present in the original fresh plasma. It also contains some factor XIII, and Von Willebrand factor.
Which antimicrobial is used to suppress or kill saprophytic molds in media?
Cycloheximide Cycloheximide inhibits bacteria and most saprophytic molds but is not active against yeasts and dermatophytes.
The infective stage for all of the intestinal amebas is the:
Cyst
Which of the following is the recommended method for preparing a cerebrospinal fluid (CSF) sample for a differential count?
Cytocentrifugation
What is the name of the department where cells in the body tissues and fluids are counted, identified, and studied in order to determine if they are normal, malignant, or pre-malignant?
Cytology
Zinc deficiency in the elderly is often caused by:
Decreased intake and absorption
Which of the following represent other hemoglobin gene loci that occur on the same chromosome as the beta chain loci?
Delta and gamma
Which of the following best defines specific gravity:
Density of a solution compared to density of water
What is the role of albuminuria testing?
Detect small urinary concentrations of albumin before there is irreparable renal damage.
Which of the following types of automated chemistry analyzers allows for each specimen and accompanying reagents to have their own space?
Diacrete Analyzer
Most common methods for measuring bilirubin are based in the reaction of bilirubin with ?
Diazo Reaction
Which of the following groups correctly matches the parasite with its infective stage?
Dientamoeba fragilis : trophozoite
The laboratory test most commonly used to establish a definitive diagnosis of primary syphilis is:
Direct fluorescent antibody test
An osmometer can use any of the following principles EXCEPT:
Electrostatic charge
The exocrine functions of the kidneys include which of the following?
Elimination of metabolic waste products
The 30 X 50 µm ovum illustrated in the image are most commonly observed by microscopic examination of transparent adhesive tape mounts of perianal skin of children who have complained of nocturnal anal pruritus. What is the most likely presumptive identification?
Enterobius vermicularis
Which of the following parasites has the egg as the infective stage pf the parasite for humans ?
Enterobius vermicularis
The bile esculin test has been used to determine if an organism can hydrolyze esculin. Esculin fluoresces, so if it is not hydrolyzed, the tube will fluoresce (bucket B), but if it is hydrolyzed, no fluorescence is seen (bucket A). Which of the following organisms hydrolyzes esculin?
Enterococcus faecalis
Identify the nucleated blood cell:
Eosinophils
Which of the following organisms shows a characteristic "test tube brush-like" pattern at 22 degrees Celsius?
Erysipelothrix rhusiopathiae
If the red cell count is known, which of the following MUST also be known in order to calculate the mean corpuscular volume (MCV)?
Hematocrit MCV = (hematocrit x 10 / RBC count)
B lymphocytes and T lymphocytes are derived from:
Hematopoietic stem cells
What is the principle of the Kleihauer-Betke test?
Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are resistant and will stain pink with the counter stain.
ACTH controls which step of steroid hormone production?
First step (cholesterol esters to cholesterol)
A laboratory test which can detect the specific decrease in the platelet surface membrane receptor glycoprotein Ib and thus lead to a diagnosis of Bernard Soulier Syndrome (BSS) is:
Flow cytometry
Agar plates on a positive blood culture are incubated for 48 hours and no growth is visible on the agar plates. The tech reviews the initial Gram stain from the blood culture bottle, which reveals tiny pleomorphic Gram-negative coccobacilli. What organism should the tech suspect and what should the tech do next?
Francisella tularensis; Sub blood culture bottle to a media with cysteine for optimal growth
A microbiologist was surprised when he could not recover Helicobacter pylori from gastric biopsies in which organisms were seen in the tissue sections. He was advised to switch from the Campy BAP selective medium to Skirrow's blood agar because the latter is:
Free of cephalothin
In tissue infected with Histoplasma capsulatum, which of the follwing is true ?
Fungus is usually intracellular
All of the following red blood cell phenotypes will react with Anti-Fy3, EXCEPT?
Fy(a-b-)
Which of the following is true of genotype screening in pharmacogenomics?
Genotyping does not take into account drug interactions which can affect metabolism.
A deficiency of platelet receptor IIb/IIIa can be found in which of the following?
Glanzmann Thrombasthenia
Antibodies to which of the following blood components is the most frequent cause of febrile nonhemolytic transfusion reactions?
Granulocytes
Which of the following laboratories DO NOT belong to the Clinical Pathology Laboratory?
Histology and Cytology
Illustrated in the top image is the surface of a blood agar culture plate incubated at 35°C for 3 days. Note the growth of tiny smooth, pasty, yellow-white yeast colonies. Although a presumptive identification might be made from the macroscopic morphology, confirmation is made by observing the yeasts forms in the lactophenol stained mount observed in a tease mount prepared from one of the colonies. From these observations, what is the most likely identification?
Histoplasma capsulatum
Of the dimorphic fungal species listed below, which has the longest time of recovery in primary culture?
Histoplasma capsulatum
The morphologic structure of select tapeworms that is most likely responsible for piercing the human intestinal wall is/are called:
Hooklets
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:
Howell-Jolly bodies
A stool specimen can be suspected of harboring Vibrio cholerae if it possess which of the following characteristics?
If the stool is watery with a high pH and flecks of mucus.
skin and mucous membranes are important components of what part of Immune System ?
Innate Immunity
Patients who develop severe sepsis or septic shock commonly have __________ plasma lactate values.
Increase
In an autoimmune disorder, conditions influencing the development of a disorder include the following factors with the exception of:
Increased discrimination of self from non-self antigens
In essential thrombocythemia, the platelets are usually:
Increased in number and functionally abnormal
A cause of FALSE-POSITIVE result in the rapid plasma reagin (RPR) test for syphilis is:
Infectious mononucleosis
The glycoproteins neuraminidase (NA) and hemagglutinin (HA) are used to subtype the following virus:
Influenza A Virus
Which of the following anthrax infections is also known as "woolsorter's disease"?
Inhalation anthrax
Spectrophotometric absorbance is related to % transmittance in what way:
Inversely and logarithmically
Laser light can be described by all of the following characteristics EXCEPT:
LASER is an acronym for light amplified by stimulated energy radiation CORRECT Intensity and concentration Used in flow cytometry for cell sorting and identification of cells Monochromaticity LASER is an acronym for light amplification by stimulated emission of radiation.
In which of the following disorders would you probably observe coarse basophilic stippling on a Wright-stained peripheral blood smear?
Lead poisoning
The cells included in the composite image were found in the peripheral blood smear of a patient with the following results: total WBC of 21.5 x 109/L. Differential count: metamyelocytes 4 band neutrophils 16 segmented neutrophils 48 monocytes 6 eosinophils 1 basophils 1 lymphocytes 24 This hematologic picture is most consistent with:
Left shift
Abnormal thrombin times (TT) can be caused by all of the following EXCEPT:
Low platelet count INCREASE High heparin levels Low fibrinogen levels High fibrin-degradation products
Which of the following is true regarding the Lutheran blood group system?
Lub is a high frequency antigen
Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs?
Lymphocytes
A microbiology laboratory recently purchased a rapid identification instrument that uses a laser on the microorganisms, which produces an ion cloud. These ions are then separated in a tube and travel within the tube to a detector. The time of travel will be measured and a mass spectrum will be produced. Which of the following techniques uses this methodology?
MALDI-TOF
Blood samples for CBC are collected on the morning rounds and stored in a rack in the phleb basket. When the phleb delivers the samples to your work station, the cells and plasma in the samples have separated. One of the samples has LIPEMIC PLASMA. Which of the following parameters may be affected by the lipemia?
MCHC
Which of the following instruments is used for continuous monitoring of mycobacterial growth?
MGIT 960
An analytical method with a low detection limit would:
Measure low concentrations of analyte
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.
The image is a stained smear of cerebrospinal fluid. The cell in this slide could be caused by what condition?
Metastasis
If a phlebotomist is failing to invert whole blood specimen 5-10 times immediately after filling the tube, which of the following pre-analytical errors can occur?
Microclots
The surface of a blood agar plate after 48 hours, incubated at 37oC, shows colonies with smooth, lemon yellow pigmentation. Note in the image is a Gram stain with relatively large Gram positive cocci arranged in tetrads. Other distinguishing characteristics were the demonstration of susceptibility to bacitracin and resistance to furazolidone. Select the identification of this isolate.
Micrococcus luteus
Which of the following steps is the first step of the ethyl acetate concentration procedure?
Mix fresh stool specimen with 10% formalin and strain to obtain a sediment
To determine if an elevated aPTT is caused by a factor deficiency or a factor inhibitor when the PT is normal, the FIRST step would be:
Mix one part patient plasma and one part normal pooled plasma and repeat the aPTT
The following diagram demonstrates two Serum Protein Electrophoresis (SPEP) patterns from different patients. The pattern on the left appears to be from a normal, healthy patient. The pattern on the right is from a patient with a particular disorder. What disorder is suggested by the pattern on the right?
Multiple Myeloma
An acid-fast bacillus recovered from a post-surgery wound of a young child had the following characteristics: Rapid growth (3-5 days) on blood and chocolate agar Nitrate positive Niacin negative Urease positive Catalase 68ºC positive Iron uptake positive Which of the following Mycobacterium species does this represent?
Mycobacterium fortuitum
Identify the cell indicated in this Wright-Giemsa stained bone marrow.
Myeloblast
Which specific immunodominant sugar is responsible for A (blood group A) antigenic specificity?
N-acetyl-D-galactosamine
Most suitable specimen for the isolation of Bordetella pertusis ?
Nasopharyngeal swab
From the list of organisms below, identify the most likely species based on this image of a gram stain from a male urethral swab.
Neisseria gonorrhoeae
Glitter cell is a term used to describe a specific type of:
Neutrophil
An urinalysis is commonly performed to detect bacteriuria or pyuria. In an urinalysis, tests are performed that serves as a method of screening for urinary tract infections. Which of following tests detect bacteria that produces enzymes to reduce nitrate?
Nitrate reduction test
Which plasmodium species is resistant to chloroquine
P. falciparum
Which plasmodium species displays recrudescence?
P. malariae P. falciparum Recrudescence = reoccurrence of symptoms from low levels of organisms remaining in RBCs
Oxacillin resistance of MRSA is due to production of which of the following penicillin binding proteins (PBPs)?
PBP2a
Utilizing a Prussian Blue stain, which of the following red blood cell inclusions would be identifiable if present ?
Pappenheimer (siderotic) bodies
True statement regarding Peak Level in the therapeutic drug monitoring.
Peak Level is the point at which the drug is the highest in the patients body
What should be done FIRST if a donor unit of red blood cells is found to be incompatible at the antiglobulin phase but compatible at immediate spin with several different recipients?
Perform a direct antiglobulin test (DAT) on the donor unit
While working at a blood bank laboratory, you hear chimes over the hospital loudspeaker system announcing the birth of a baby. Thirty minutes later, you receive a cord blood specimen that you identify as O positive. You previously received the mother's specimen and she was O negative with a negative antibody screen. What is the next action?
Perform a fetal bleed screen
Which of the following conditions would produce the results listed below in an anemic patient? MCV - 115 fL MCH - 30 pg MCHC - 34%
Pernicious Anemia (Macrocytic Anemia) Sickle Cell Anemia, Aplastic Anemia and Iron Deficiency Anemia ALL are Microcytic or Normocytic Anemia
The study of how variations in the human genome affect a given individual's response to medications is called?
Pharmacogenomics (Pharmacogenetics)
Which has the longest half-life?
Phenobarbital (70-100 hours)
Fetal lung maturity can be determined from amniotic fluid because the surfactant is PRIMARILY composed of:
Phosphatidylcholine and other phospholipids
Donation of which apheresis blood product more than once every four weeks requires monitoring of total plasma protein and antibody levels?
Plasmapheresis
The diagram indicates the banana-shaped gametocyte of the following Plasmodium species?
Plasmodium falciparum
Which plasmodium spp has crescent shaped gametocyte
Plasmodium falciparum
A test used to evaluate abnormalities in the extrinsic coagulation pathway and to monitor warfarin (Coumadin) therapy is called?
Prothrombin time (PT)
The trichrome stain is most commonly used to identify which class of parasites?
Protozoa
The colonies shown in the blood (BAP) agar (upper) and MacConkey (MAC) agar (lower) biplate are a 24 hour growth from an aerobic blood culture bottle that became positive at 12 hours after inoculation. The appearance of the colonies on MAC agar rules out the following bacterial species:
Pseudomonas aeruginosa
Illustrated in this photomicrograph of a gastric biopsy specimen are a few thin, curved and S-shaped bacteria (arrows). This picture is suspicious for Helicobacter pylori. An additional test helpful in confirming this identification is:
Rapid urease
A patient with an infectious mononucleosis infection presents in the emergency room. Physicians order a spinal tap, which is immediately sent to the laboratory for review. What is the cell in the image below from this patient's cerebrospinal fluid sample?
Reactive Lymphocyte
A flagellar stain would show peritrichous flagella for each of the following organisms except:
Pseudomonas aeruginosa Flagella Bordetella bronchiseptica Alcaligenes faecalis Escherichia coli
Which of the following is the only artery that does not transport oxygenated blood?
Pulmonary artery
Which testing method is appropriate for identifying specific allergens?
Radioallergosorbent tests (RAST)
This Gram-positive coccus is catalase positive. The tests shown are a tube coagulase test inoculated with the isolate, and a MRSA screen plate containing 4% NaCl and 6 µg/mL of oxacillin. A 0.5 McFarland standardized inoculum of the isolate is inoculated to the plate. What step should you take next?
Report the isolate as methicillin resistant Staphylococcus aureus.
Infection control measure above and beyond standard precautions should be used by the healthcare worker who will be collecting a blood specimen for a TB patient ?
Respiratory protection control
Common colds are most often associated with which agent?
Rhinovirus
Which of the following specimen processing examples is considered a processing error and can have a negative impact on the test results?
Rimming the clot in a serum collection tube prior to centrifugation
The presence of two sporocysts each containing four banana-shaped sporozoites is characteristic of this organism; however, only oocysts with one sporocyst are typically seen in patient specimens. Which of the following organisms does this represent?
Sarcocystis species
Select the primary reagent components used in the Jaffe reaction for creatinine.
Saturated picric acid and sodium hydroxide
The egg in the image to the right, measuring 80 µm, was observed in the stool specimen of a patient complaining of fever, diarrhea, and weight loss. Low grade eosinophilia of 12% was detected in a peripheral blood count. Based on this information, what is the most likely identification of this trematode species?
Schistosoma japonicum
What is the nucleated blood cell in this image?
Segmented neutrophil
When evaluating the throughput of a particular method you should consider all of the following except:
Sensitivity of technique
All of the following analytes would be significantly increased in a plasma sample as a result of hemolysis, EXCEPT?
Sodium AMONG Potassium LDH ASt
Cyclospora species are classified as:
Sporozoa
Which one statement about Standard Precautions is most correct?
Standard Precautions means to treat blood, all body fluids, all secretions, all excretions, non-intact skin, and mucous membranes as if they were infectious.
A left arm abscess collected from an 8-year-old male patient grew small white colonies on 5% sheep blood agar after 24 hours incubation at 35°C in 5-10% CO2. The Gram stain of the organism showed small tightly grouped Gram positive cocci. Which of the following organisms is the most likely identification?
Staphylococcus epidermidis
In the process of thrombopoiesis, which is arranged from least mature to most mature?
Stem cell, megakaryoblast, promegakarocyte, megakarocyte, thrombocyte
Which of the following tests is collected in a culturette and tested in the microbiology department?
Streptococcus screen
The fibrinolytic system may be activated by which one of the following?
Streptokinase
5% Sheep blood agar plate inoculated with a throat culture. It is a common practice to stab the agar with the inoculating needle, as seen in the tip of the arrow, in order to detect or accentuate the reaction of
Streptolysin O ( S.pyogenes)
The body of a cestode is known as its:
Strobila
Thromboelastography is a point of care test which measures which of the following?
The entire coagulation status of the patient
A patient with a historical type of AB positive requires a routine type and screen test. You perform the ABO/Rh type using the gel methodology and note the results below. How would you interpret the results?
The front type is correct and the back type may due to cold agglutinins. You could prewarm the patient serum and repeat the back type to see if the discrepancy is resolved.
How long should therapy continue for patients with hereditary hemochromatosis (HH)?
Therapy should continue throughout the lifetime.
The urease reaction seen in the Christensen's urea agar slant on the far right indicates:
Weak activity
From the viruses listed below, select the one that is transmitted from birds to humans through a mosquito vector.
West Nile virus
Reabsorption in the kidneys primarily occurs in:
proximal convoluted tubule
All of the following statements concerning Clostridium difficile are true, EXCEPT?
t is an aerobic organism. TRUE It is the causative agent of an inflammatory condition of the large intestine. It produces potent toxins. It produces spores.
