MediaLab MLT ASCP

A medical laboratory scientist is working with a student on the teaching microscope. The student is using a microscope that has a micrometer for the measurement of microscopic items. A normal red cell distribution curve for a patient is shown on the right. What should the range of red cell diameters be when the student measures the red cells with a micrometer?

6-8 microns

What is successful molecular identification of methicillin-resistant Staphylococcus aureus (MRSA) based upon?

The detection of the S. aureus genes (orfX, nuc, or coa) gene and the mecA gene.

What is the required storage temperature for thawed cryoprecipitate?

20 - 24 ºC.

When transporting donated platelet units, what is the maximum amount of time that agitation of platelets can be stopped for?

24 hours

How many distinct bands are separated during a standard serum protein electrophoresis?

5

Serum proteins can be separated by cellulose acetate electrophoresis into how many basic fractions:

5 fractions

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%

Prozone is observed in:

A patient sample in which the serum contains a high titer of antibody

Which of the following microcytic anemia's is the most common anemia other than Iron Deficiency Anemia (IDA) and accounts for more than one-third of anemia in hospitalized patients without blood loss?

Anemia of chronic disease/inflammation

What is the Indirect Antiglobulin Test (IAT) usually used to detect?

Antibodies in the plasma

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

All of the following are true in regards to performing quality control (QC) on urine chemical reagent strips, EXCEPT:

As often as required by the laboratory's procedure On each new lot received in the laboratory When a new bottle of reagent strips is opened (EXCEPT: QC is performed only when patient results are questioned by the health care provide)

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

Which of the following instruments measures the amount of electricity passing between two electrodes?

Coulometer

Parasites that may be found in urinary sediment include all of the following EXCEPT:

Enterobius vermicularis Trichomonas vaginalis Schistosoma haematobium (EXCEPT: Plasmodium malariae)

An alpha-hemolytic streptococcus isolated from a urine culture is resistant to optochin and bacitracin, grows in 6.5% NaCl broth, and is PYR positive. The organism is MOST likely:

Enterococcus species

Which Enterobacteriaceae is the most common cause of uncomplicated urinary tract infections (UTIs)?

Escherichia coli

A CBC is done on a patient admitted for a severe hemorrhage. The patient has a high platelet count and the blood smear can be seen on the right. A bone marrow exam is performed and a proliferation of megakaryocytes is noted. Molecular analysis shows a JAK 2 mutation. This patient most likely has:

Essential Thrombocythemia

The study of how variations in the human genome affect a given individual's response to medications is called?

Pharmacogenomics (Pharmacogenetics)

Follicle-stimulating hormone (FSH) is produced by

Pituitary

The most common coagulation studies, such as the Prothrombin Time (PT/INR) and the activated Partial Thromboplastin Time (aPTT/PTT) are performed on which of the following?

Plasma

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

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

Post transfusion purpura (PTP)

According to the American Diabetes Association recommendations, which of the following statements is TRUE with regards to the following findings? Fasting glucose = 130 mg/dL 2-hour post prandial glucose = 210 mg/dL

The patient may be diagnosed as having diabetes mellitus

Ted is a college senior. He completed three years of coursework at the State College and is now completing rotations in hematology, clinical chemistry, microbiology, and blood banking at Best Lab of the South Medical Center. At the end of his clinical rotations, Ted will receive a baccalaureate degree from State College and a certificate of program completion from Best Lab of the South Medical Center. Ted is in which type of educational program?

University-based MLS/CLS

What cellular characteristic of red blood cells is described by the term poikilocytosis?

Variability in shape

What is the required storage temperature for red blood cells?

1-6 degrees Celsius

What is the normality of a 500 mL solution containing 25g of H3PO4? (H3PO4 has a positive valence of 3)

1.53N

A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min.

100 (Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine Volume (mL) / [ time (hr) x 60]) (For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60])) (80 x 1800/1440, which is 80 x 1.25, or 100 mL/min)

How many milliliters of a 5 M solution would be needed to make 250 mL of a 2 M solution? To solve: (V1) (M1) = (V2) (M2) Where V = volume and M = molarity (V1) (5M) = (250 mL) (2M) 5V1 = 500 mL V1 = 100 mL (or 100 mL 5M solution) Therefore, when 100 mL of a 5M solution is diluted to 250 mL, the resulting solution is 2M.

100 mL

A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter?

1500

The formula for conversion of hemoglobin A1C (HbA1C) to glucose in mg/dL is eAG = (28.7 x A1C) - 46.7. The HbA1C measured on a patient is reported as 7.5%. What would be reported as the estimated average glucose (eAG) for this % A1C (rounded to the nearest whole number)?

169 mg/dL (The eAG for an HbA1C of 7.5% would be reported as 169 mg/dL.) (Remember, the formula for conversion of HbA1C to glucose in mg/dL is eAG = (28.7 x A1C) - 46.7.) (So, in this case, the calculation is: eAG = (28.7 x 7.5) - 46.7 = 168.55 mg/dL or 169 mg/dL if rounded to the nearest whole number.)

What is the ratio of patient plasma to pooled normal plasma (PNP) that is usually used in the performance of a mixing study?

1:1

A dilution commonly used for a routine sperm count is:

1:20

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 (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)

Which of the following terms may be defined as the extent to which a measurement agrees with the true value of the analyte being measured?

Accuracy

The ketone component that is measured by the nitroprusside reaction is: (B-hydroxybutyrate and acetone are derived from acetoacetic acid. However, B-hydroxybutyrate is not measured and only slightly sensitive to acetone in presence of glycine.)

Acetoacetic acid (Acetoacetic acid reacts with sodium nitroprusside to produce a purple color.)

Which group of conditions increases the risk of HbS polymerization?

Acid pH, dehydration, increased level of 2,3-DPG

Which of the following blood tests is used in the determination of prostate cancer?

Acid phosphatase

The kidneys perform all of the following functions EXCEPT:

Acid-base balance Hormone production Water and electrolyte balance (EXCEPT: Reabsorption of waste products) (Waste products are not reabsorbed by the kidneys.)

All of the following are primary functions of the kidney, EXCEPT?

Acid-base balance Retention of essential nutrients and water Blood filtration (EXCEPT: Reabsorption of waste products)

A test used to evaluate the abnormalities in the intrinsic coagulation pathway and to monitor heparin therapy is called:

Activated partial thrombloplastin time (aPTT or PTT)

All of the following statements are characteristic of the role of C-reactive protein (CRP) except?

Activates complement. Exhibits pro-inflammatory characteristics. Initiates opsonization. (except: Binds with factor H to initiate alternate complement pathway.)

Given the following hepatitis B serology results, what is the immune status of the patient? HBsAg: positive HBeAg: positive Anti-HBc IgM: positive Anti-HBs: negative (HBsAg (hepatitis B surface antigen) is positive in both acute and chronic Hepatitis B infections, since the antigen is found on the actual surface of the virus. HBeAg (hepatitis Be antigen) is present in the blood when the hepatitis B viruses are replicating, indicating an active infection. anti-HBc IgM (IgM antibody to the hepatitis B core antigen) is present during an acute or recent acute infection. Anti-HBs (antibody to the hepatitis B surface antigen) is produced during recovery from hepatitis B. This antibody can persist for years after the infection has occurred and provides immunity to the hepatitis B virus.)

Acute infection (The combination of test results indicate an acute hepatitis B infection.)

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

Acute myocardial infarction (AMI) Rhabdomyolysis Seizures (EXCEPT: Pulmonary edema)

Which nitrogenous base would bind with thymine in forming double-stranded DNA?

Adenine

Uric acid is the final breakdown product of what two purines? (Cytosine and thymine are pyrimidines that are mostly broken down into ammonia, carbon dioxide, and water but not into uric acid.)

Adenine and guanine (The purines adenine and guanine are broken down into uric acid.)

Which of the following best describes adult cestodes?

Adults are ribbonlike and contain segments

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

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

A markedly elevated 5-hydroxyindoleacetic acid (5-HIAA) determination is presumptive evidence for:

Carcinoid tumor

All of the following are common support media used in electrophoresis techniques, EXCEPT? (Cellulose acetate, polyacrylamide, and agarose gels are most commonly used in the clinical laboratory for electrophoresis testing.)

Cellulose acetate Agarose gel Polyacrylamide gel (EXCEPT: Dextrose)

Which of the procedures listed below will increase the platelet concentration in the preparation of platelets?

Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a high speed.

What is the optimal specimen type to diagnose a Naegleria fowleri infection?

Cerebrospinal fluid (CSF) sample

An aliquot of AS-1 red blood cells is being prepared from an intact packed cell unit using a sterile connection device.During the process of preparing an aliquot, the sterile device fails and blood drips onto the counter from the product tubing. What should be done with the primary unit?

Change the expiration date to 24 hours

Which of the following action describes the MAJOR property of antidiuretic hormone?

Changes distal tubule water permeability

Representative assays in the category of treponemal methods include the listed assays except:

Chemiluminescent immunoassays Enzyme-linked immunosorbent assays Fluorescent treponemal antibody absorption (FTA-ABS) (except: Venereal Disease Research Laboratory Test)

The following morphologic structure identifies Candida albicans and distinguishes it from most of the other Candida species.

Chlamydospore

In blood, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with:

Chloride

Urine crystals of radiographic contrast media will appear similar to which of the following?

Cholesterol crystals

The tech working on an aerobic wound culture is identifying a colony that is large, gray, and non-hemolytic on blood agar. The tech prepares a Gram stain of the colony and notices a consistency similar to whisked egg whites. Gram stain reveals a large Gram-positive bacillus. What is the most likely identification of this colony?

Bacillus anthracis

Which of the following is a presumptive test for the identification of Lancefield group A Streptococcus:

Bacitracin susceptibility

What is the MOST common infective agent to be transmitted through blood transfusion that results in morbidity and mortality?

Bacteria

What is the most common Rh haplotype among whites?

DCe

Which of the following is associated with an increased susceptibility to infection in AIDS patients? (CD8+ cells will demonstrate a relative increased due to the decrease in CD4+ cells.)

Decreased CD4+ cells (CD4 positive lymphocytes, or T-helper cells are critical in an immune response against pathogens.) (HIV directly attacks CD4+ cells along with monocytes, macrophages, dendritic cells and microglial brain cells.)

Storage lesion, or the biochemical changes in red blood cells during storage, will result in: (Storage lesion will cause a decrease in plasma pH levels as lactic acid levels increase during storage.) (The free hemoglobin levels will increase as red blood cells lyse.) (The plasma sodium levels will decrease as a dilutional effect of hemolysis.) (The plasma potassium levels will increase due to hemolysis within the unit.)

Decreased plasma pH

A Rh negative individual has produced an anti-D antibody. Which situation has the ability to stimulate this production of anti-D?

Delivering a Rh positive baby.

What drug may be used to decrease iron levels in patients with iron overload?

Desferrioxamine

What is the fundamental purpose of the full, pre-transfusion crossmatch?

Detect antibodies in recipient serum/plasma that react with donor red blood cells.

What is the role of albuminuria testing?

Detect small urinary concentrations of albumin before there is irreparable renal damage.

A test for microalbuminuria is used most often to monitor patients with which of the following diseases or conditions?

Diabetes

Which of the following drugs is used to treat congestive heart failure? Which of the following therapeutic drugs increases the force of myocardial muscle contraction?

Digoxin

All of the following are therapeutic drugs used to treat cardiac disease, EXCEPT? (Digoxin (used to treat congestive heart failure), Quinidine, and Procainamide (both used to treat cardiac arrhythmias) are common therapeutic cardioactive drugs.)

Digoxin Procainamide Quinidine (EXCEPT: Carbamazepine) (Carbamazepine is an antiepileptic drug used to treat various seizure disorders.)

Which parasitic infection may result from human ingestion of contaminated fish?

Diphyllobothrium latum

What action should be taken if a large clot is noticed in a red blood cell unit while the product is being prepared for release to the patient?

Do not issue the product.

When performing controls for the morning run in coagulation, the normal control is within acceptable limits for both the PT and APTT, but the abnormal control is out of range for both procedures. Which of the following would be an appropriate action to take?

Document QC, repeat the abnormal control, troubleshoot if necessary; report patient results only when both controls are within acceptable ranges

What is considered the definition of allogeneic blood?

Donated by a donor for a recipient other than the donor to use

Which of the prospective donors below would be an acceptable blood donor?

Donor number 3: Blood pressure: 110/72 Pulse: 66 Temperature: 37.2ºC (99.0 ºF)

What is the correct procedure when using a winged collection device (butterfly) to draw a light-blue top tube intended for a coagulation test if this is the first tube that will be collected in the draw?

Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies.

Thin-layer chromatography is particularly useful as a tool in the identification of:

Drugs

When are data collected in a real-time PCR procedure?

During nucleic acid amplification

During which phase of testing are MOST laboratory errors known to occur?

During the pre-analytical phase of testing.

All of the following are true concerning the Erythrocyte Sedimentation Rate (ESR) EXCEPT:

ESR can be used to follow the course of a disease Highest ESR values are usually seen in Multiple Myeloma ESR values are increased in rheumatoid conditions (EXCEPT: ESR is decreased during inflammatory conditions)

In which of the following cases should Rh Immune Globulin (RhIG) be given?

Ectopic pregnancy

Electrophoretic separation of hemoglobin fundamentally relies on:

Electrical charge differences of molecules

Which values would be expected with metabolic alkalosis?

Elevated pH, increased bicarbonate, normal PCO2

The function of the very low-density lipoproteins (VLDL) is to transport:

Endogenous triglycerides

Which organism causes amebiasis and is considered to be pathogenic?

Entamoeba histolytica

The egg is the infective stage of this parasite for humans. What is the identification of this organism?

Enterobius vermicularis

Which of the following descriptions is matched correctly to its corresponding organism?

Enterobius vermicularis ova - ovoid in shape with one side flattened. The embryo is separated from the shell by a clear space.

Which of the following Enterococcus species is motile, mannitol positive, pyruvate negative, and is a rare cause of clinical infections?

Enterococcus casseliflavus

A leukocyte on a Wright stained blood smear has numerous large reddish-orange granules in the cytoplasm and a bi-lobed nucleus. Which of the following is it?

Eosinophil

Which of the following cellular function is correctly matched to the cell type?

Eosinophil: Involved in some parasitic infection response

Each of the following has been shown to induce platelet aggregation EXCEPT?

Epinephrine ADP Collagen (EXCEPT: Aspirin)

Although it is actually non-motile, which Gram-positive, catalase-negative organism produces "bottle brush" growth from the stab inocuation in a gelatin agar tube at 22° C, along with hydrogen sulfide production in TSI agar?

Erysipelothrix rhusiopathiae

Which of the following is a liver enzyme that is instrumental in allowing glucose to enter the bloodstream?

Glucose-6-phosphatase

Which enzyme is responsible for the conjugation of bilirubin?

Glucuronyl transferase

Acute-phase proteins generally fall into which category?

Glycoproteins

The presence of Gram-negative intracellular diplococci in a genital specimen from a male is diagnostic of which disease?

Gonorrhea

Which of the following statements reflect accurate identifications of Enterococcus species?

Gram positive cocci in pairs or chains, catalase negative, esculin positive, PYR positive, vancomycin intermediate, motile, yellow pigment: Enterococcus casseliflavus.

Gram-positive cocci in clusters and tetrads were seen on a clinical Gram stain taken from an open wound. Which of the following would be the MOST appropriate preliminary report?

Gram-positive cocci in clusters and tetrads

Which HFE genotype is most common in patients with hereditary hemochromatosis (HH)? (The majority of patients with HH are homozygous for the C282Y mutation of the HFE gene at the HLA-A3 locus.) (The prevalence of the two most common HH mutations of C282Y and H63D varies widely worldwide.)

Homozygous for C282Y

What does the acronym PASS in laboratory safety refer to?

How to use a fire extinguisher

The Major Histocompatibility Complex (MHC) codes for which antigens?

Human Leukocyte Antigens

The Major Histocompatibility Complex (MHC) I genes encode for: (MHC II codes for HLA-DR,DQ,DP) (MHC III codes for complement) (MHC III codes for cytokines)

Human Leukocyte Antigens (HLA)-A,B,C

All of the following are advantages of HEp-2 and HEp-2000® over rodent tissue as cell substrates for ANA testing, EXCEPT?

Human cell lines are more sensitive than rodent Human cell lines express relevant nuclear antigens in the human tumor cell Nucleolar reactivity is detectable in human cell lines (EXCEPT: Human cell lines do not express Ro (SS-A) antigen)

All of the following viruses are classified as retroviruses, EXCEPT?

Human immunodeficiency virus (1 & 2) Human T-lymphotropic virus type 1 Human T-lymphotropic virus type 2 (EXCEPT: Rabies virus)

Pericarditis may occur as a complication from endocarditis caused by Staphylococcus aureus. Virulence mechanisms attributed to the spread of this organism include all of the following EXCEPT:

Hyaluronidase Protein A Coagulase (EXCEPT: M protein)

The primary mechanism responsible for glomerular filtration is:

Hydrostatic differential in glomerular tufts (The hydrostatic pressure in the capillaries of the glomerular tuft drives the filtrate across their semipermeable membrane. The normal glomerular filtrate is similar in composition to the plasma, with the exception that molecules with a molecular weight of greater than about 70,000 daltons are not filtered.)

Which of the following is an FDA-approved therapeutic agent for treating sickle cell patients?

Hydroxyurea

Pernicious anemia refers to cobalamin deficiency that results from a lack of which of the following?

Intrinsic Factor

Which of the following is necessary for the absorption of Vitamin B12:

Intrinsic factor

Amoebae stained with this substance may be readily distinguished because it enhances nuclear and structural detail.

Iodine

Which of these conditions could result in a microcytic anemia? (Vitamin B12 deficiency usually leads to a macrocytic anemia.) (Spherocytosis is a normocytic anemia.) (Folate deficiency causes a macrocytic anemia.)

Iron deficiency

A characteristic of a good cardiac biomarker is that:

It can be detected even if it is present in a LOW concentration in the peripheral blood.

Which one of the following statements about serum ferritin is true?

It is a sensitive indicator of iron deficiency

Which of the following statements is true regarding macrophages (histiocytes)? (Monocytes circulate through the peripheral blood and eventually enter the tissues and body fluids via diapedesis and mature into macrophages.) (Lymphocytes, basophil (mast cell in tissues), and eosinophil are not related to macrophages.)

It is a type of monocyte that has entered the tissues via diapedesis. (Essentially, macrophages are older monocytes that have migrated out of the peripheral blood.)

Why might serum ferritin (SF) alone be considered a less than optimal screening test for hereditary hemochromatosis (HH)?

It is an acute phase reactant that is frequently elevated in a variety of clinical conditions.

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 is the purpose of adding citrate to donated red cell units?

It prevents coagulation.

If a drug is given at intervals that are the same as its half-life, approximately how long will it take the drug to reach steady state?

It will take about 5-7 half-lives to reach steady state.

Analytical sensitivity of a method generally refers to:

Its ability to measure low concentrations of analytes. (The sensitivity of a test refers to its ability to measure low concentrations of analytes.)

Nocardia species can be isolated from cutaneous specimens and can produce sulfur granules. These granules can be found in tissue specimens and can aid in detecting aerobic actinomycetes. To help identify the presence of sulfur granules in tissue specimens, which of the following methods will be most beneficial?

KOH Mount

Which of the following antigens are well developed on fetal cells?

Kell

Excessive carbohydrate loss that may occur due to vomiting, or rapid weight loss may result in the presence of which of the following substances not normally contained in the urine?

Ketones

Delayed hemolytic transfusion reactions are usually caused by antibodies directed against what blood group system?

Kidd

Proteolytic enzyme techniques may be useful in identifying which of the following antigen groups:

Kidd system

Which of the following organisms is a lactose fermenter?

Klebsiella oxytoca (Klebsiella oxytoca produces acid/acid KIA reactions and red to pink colonies on MacConkey agar, indicating the ability to ferment lactose.)

Which of the following can cause a false positive result for ketones?

L-Dopa metabolites

Which of the following sites is used most often for CSF collection?

L3-L4

Which of the following is the correct calculation using the Friedewald calculation for LDL?

LDL = total cholesterol - HDL - triglycerides/5

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

Laboratory detection

To ensure quality within the preanalytical phase of laboratory testing, quality assurance activities includes monitoring all of the following preanalytical variables EXCEPT:

Laboratory test utilization. Positive patient identification. The stability of patient specimens during transport. (EXCEPT: Selection of reference materials used for validation purposes.)

Pictured are tiny, gray-white, non-hemolytic colonies growing on blood agar that are non-descript. The Gram stain reveals elongated, rectangular gram-positive bacilli in short chains. Key to the identification would be the lack of biochemical activity. This bacterium is usually recovered as a genital tract commensal, but has also been found to provide protection against other infective bacteria. With these observations, what is the most likely identification of the isolate?

Lactobacillus species

All of the following carbohydrates are considered reducing sugars EXCEPT: (Lactose, Glucose and Ribose are all reducing sugars since their anomeric carbons and aldehyde groups are all free to reduce other compounds.)

Lactose Glucose Ribose (EXCEPT: Sucrose) (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.)

Which of the following is characteristic of Alder-Reilly anomaly?

Large, darkly staining cytoplasmic granules composed of partially digested mucopolysaccharides

In which of the following disorders would you probably observe coarse basophilic stippling on a Wright-stained peripheral blood smear?

Lead poisoning

The nitrite portion of the test strip can be used to do all of the following EXCEPT:

Monitor antibiotic therapy Detect a bladder infection in an early stage in pregnant women Screen individuals with recurrent infections (EXCEPT: Detect metabolic by-products often seen in diabetic patients_

Characteristics of Type I cryoglobulins include the following characteristics:

Monoclonal IgG, IgA, or IgM

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

Motility positive

Which of the following conditions would make a sample unsuitable for lactic acid testing?

Movement of hand or arm during specimen collection.

You are collecting a blood specimen to be used for forensic (legal) alcohol testing. Which of the following must be done before you can start the specimen collection process?

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

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

MacConkey agar without crystal violet is a culture medium useful in the presumptive identification of:

Mycobacterium fortuitum

Which organism is a cell wall deficient bacterium that commonly causes primary atypical or "walking pneumonia?"

Mycoplasma pneumoniae

The course of multiple sclerosis can be monitored by measuring which of the following in cerebrospinal fluid (CSF) analytes?

Myelin basic protein (MBP)

Increases in the MB fraction of CK is associated with:

Myocardial infarction

What is the primary oxygen-carrying protein found in muscle? (Hemoglobin is the main oxygen protein in circulation; troponin is a set of regulatory proteins found in muscle, especially cardiac muscle but does not carry oxygen; BNP is brain (or B-type) natriuretic peptide, a set of hormones that affect body fluid homeostasis and blood pressure.)

Myoglobin (Myoglobin is the main oxygen-carrying protein in the muscle, accounting for about 2% of muscle protein.)

Which specific immunodominant sugar is responsible for A (blood group A) antigenic specificity?

N-acetyl-D-galactosamine

The nitrate reduction test is used to determine the ability of an organism to reduce nitrate. The Enterobacteriaceae group can reduce nitrate. Based on this test, what is the end product for which nitrate is reduced?

N2

Which of the following parasites is/are considered to be free-living and atrial (organisms that settle outside of the intestinal tract) ameba(e)? (Trichomonas vaginalis is a flagellated protozoan and is one of the most sexually transmitted diseases.) (Chilomastix mesnili is a flagellate and is considered to be a nonpathogen.) (Toxoplasma gondii is a tissue coccidia whose infections resemble mononucleosis-like symptoms. In pregnant women and in anyone with a compromised immune system the infection can have severe consequences.)

Naegleria fowleri (Only Naegleria fowleri is a free-living amoeba found in freshwater habitats. It produces a diffuse and fulminant meningoencephalitis.)

On sheep blood agar, Haemophilus influenzae may exhibit satellitism around all of the following bacteria, EXCEPT:

Neisseria spp. Staphylococcus spp. Streptococcus pneumoniae (EXCEPT: Pseudomonas spp.)

Which of the following BEST describes the relation of nephelometry to turbidimetry?

Nephelometry directly measures the amount of light scattered by particles in solution, and turbidimetry measures the decrease in incident-light intensity

Which of the following choices represents the characteristic indicator, fermentable sugar(s), and bacteriostatic agent(s) that are present in MacConkey agar respectively?

Neutral red/lactose/bile salts and crystal violet

How many 1 mm x 1 mm squares is the Neubauer hemacytometer counting grid composed of?

Nine per side

A 21-year-old visited her doctor. She mentioned dysuria, frequency and urgency of urination to her doctor. Which of the following urinalysis reagent strips tests would you expect to be positive for this patient based on her symptoms?

Nitrites

The following aerobic, branching, filamentous gram-positive species is weakly acid fast and known to cause mycetomas and lung infections in immunocompromised individuals:

Nocardia species

How are Barr bodies usually classified?

Non-pathological

A patient's coagulation mixing study results are shown below after an initially prolonged aPTT result. Initial aPTT: 63 sec. (normal range 21-34 seconds) Immediate aPTT mixing study: 26 sec. Incubated aPTT mixing study: 65 sec. Has the aPTT been corrected by the mix? Is a factor deficiency or a coagulation inhibitor the more likely cause of the patient's prolonged aPTT? (This means that a weak or slow-acting coagulation inhibitor may be present and an extended incubation time is needed to reveal the inhibitor. These results are characteristic of a factor VIII inhibitor, for example.)

Not Corrected, Coagulation Inhibitor (These results show that no correction has taken place; initially, it appears that the aPTT corrects. However, after the incubation time, the aPTT is again prolonged.)

An individual with group AB blood does not have which of the following antigens present on their red blood cells?

O

Which one of the ABO groups listed below has the MOST H antigen?

O

Which of the following packed red blood cell ABO types would be appropriate for transfusion to an O negative patient of child-bearing age?

O negative only.

In the Escherichia coli 0157:H7 serotype. The 0157 portion of the serotype refers to which of the following?

O somatic antigen

If an individual has blood type O, which of the following are possible genotypes?

OO only

Bacteria which require oxygen for proper growth are termed:

Obligate aerobes

If present, how many Howell-Jolly bodies are usually seen within a given erythrocyte?

One

To determine if xanthochromia is present in a cerebrospinal fluid sample, the sample must be centrifuged within:

One hour

The central pallor in a red blood cell is about _________ the diameter of the cell.

One third

Which of the following types of lymphocytes express CD4?

Only T-helper cells

Which statement best describes the relationship between dietary iron and iron absorption in a healthy individual?

Only a small percentage of dietary iron is absorbed and used.

All of the following serological test results may occur in a patient experiencing a hemolytic transfusion reaction due to the presence of a clinically significant Rh antibody such as anti-c EXCEPT: (Rh antigens do not sit close enough to allow for Rh (IgG class) antibodies to attach. Therefore, complement-mediated intravascular hemolysis does not occur.) (Serological testing for Rh antibody-mediated hemolytic transfusion reactions includes optimal reactivity at 37°C and a positive DAT result due to Rh antibodies belonging primarily to the IgG class. IgG antibodies are capable of crossing the placenta and coating fetal RBCs. Additionally, Rh antibodies demonstrate dosage and may show stronger reactivity with known cells possessing a double-dose of a corresponding Rh antigen (homozygous expression).)

Optimal reaction at 37°C or AHG phase. Preference to react with RBCs possessing a double-dose of Rh antigen. Positive DAT result. (EXCEPT: Binding complement.) (Generally, Rh antibodies do not bind complement due to the positioning of Rh antigens on the RBC surface.)

All of the following are urinalysis findings associated with nephrotic syndrome EXCEPT:

Oval fat bodies Fatty and waxy casts Renal tubular epithelial cells (EXCEPT: Mild proteinuria)

The measurement of total glycosylated hemoglobin A1c is an effective means of assessing the average blood glucose levels:

Over the past 2-3 months

How does the laboratory immunologic assessment of Waldenstrom's Primary Macroglobulinemia differ from other monoclonal gammopathies?

Overproduction of IgM antibodies.

Which one of the following parasites is the causative agent of Katayama fever?

Schistosoma mansoni

Important applications of polymerase chain reaction (PCR) include the following with the general exception of:

Search for mutations with large deletions

Which white blood cell is found in the largest numbers in the peripheral blood of a normal adult?

Segmented neutrophil

Disseminated intravascular coagulation (DIC) is associated with all of the following clinical conditions EXCEPT: (DIC is characterized by intravascular coagulation and hemorrhage with a decreased platelet count. DIC is most commonly observed in severe sepsis and septic shock. It is also associated with obstetric complications such as amniotic fluid embolism, abruptio placentae, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome/eclampsia, as well as other conditions and disease states.)

Septicemia Obstetric emergencies Intravascular hemolysis (EXCEPT: Thrombocytosis) (Disseminated intravascular coagulation (DIC) is a thrombo-hemorrhagic (clotting and bleeding) disorder involving the generation of intravascular clots with the consumption of coagulation factors/proteins and platelets.)

Patients with Cushing's disease typically exhibit:

Serum cortisol overproduction

Which one of the following statements about lead poisoning is false?

Serum lead level is a good inexpensive screening test for lead toxicity

Neoplastic T lymphocytes with irregular, convoluted (cerebriform) nuclear outlines best describe which of the following?

Sezary Cells

All of the following information should be included in a direct microscopic examination of a Gram-stained culture smear report EXCEPT: (The direct examination can provide a preliminary diagnosis and may also be used to assess the quality of some specimens. Gram-stained smears should be examined for the presence of bacterial cells and their morphology and Gram stain reaction, as well as for white blood cells, epithelial cells, debris, and fungi.) (The report typically includes the Gram stain reaction, morphologies (cocci, bacilli, coccobacilli), and the arrangement of the bacterial cells (pairs, chains, clusters). The presence of host cells such as white blood cells and squamous epithelial cells and debris is also reported.)

Shape and morphological arrangement of bacterial cells Gram stain reaction White blood cells and squamous epithelial cells. (EXCEPT: Size of bacteria) (The size of bacteria is generally not reported.)

Ideally, what testing should be done prior to starting a new lot of control material in order to establish its mean and standard deviation?

Should be tested in 20 separate runs

Which of the following is an example of proper transfusion practices regarding fresh frozen plasma (FFP)? (Indications for transfusion therapy include bleeding related to coagulation factor deficiency if specific concentrates are not appropriate, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome.) (FFP should not be used as a volume expander since there is a risk of transfusing transmitted diseases. FFP does not include all labile coagulation factors, and plasma should be ABO-compatible with the recipient's RBCs.)

Should be transfused within 24 hours of thawing (Fresh Frozen Plasma (FFP) should be thawed at 37°C and transfused within 24 hours when stored at 1 to 6°C.)

What is the characteristic RBC that is uniquely associated with HbSS?

Sickle cell (drepanocyte)

When a Specked Nuclear Antibody (ANA) pattern is observed, what follow-up test for antibodies related to Systemic Lupus Erythematosus (SLE) is not beneficial?

Testing for antibodies to Smith (Sm) Testing for all antibodies to the extractable nuclear antigens (ENA) Testing for antibodies to SS-A/SS-B+ (not beneficial: Testing for antibodies to U1RNP+ and dcSSc)

The likelihood of colonization and/or infection with Clostridioides difficile is enhanced by all of the following except:

The balance of the gastrointestinal flora is altered by previous antibiotic therapy The patient has previously been hospitalized The patient has a chronic health condition (except: The patient has been previously treated at an orthopedic sports clinic)

Alpha thalassemia is defined as:

The decrease in the rate of production of alpha chains due to a partial or total deletion of the genetic code.

Baseline testing for latent Mycobacterium tuberculosis infection (LTBI) is recommended for all newly-hired healthcare workers. In which of these cases would a tuberculin skin test (TST) be repeated a second time, one to three weeks after the first test?

The first test is negative and the new employee has never been tested for LTBI before.

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. (EXCEPT: The lack of agglutination of patient red cells with anti-A reagent.)

What is catheterization?

The insertion of a tube into a patient's bladder via the urethra to aid in urination.

Which is the incorrect statement about sample labeling requirements?

The label should have the patient's first and last name. The label should have a unique identification number. The date of collection should be included. (Incorrect: Prelabeled tubes should be used.)

Which of the following statements about hepatitis C virus (HCV) is true?

The majority of individuals who are infected with HCV and develop antibodies in their serum (seroconvert) will develop a chronic infection and active liver disease.

As an RBC ages, all of the following are true EXCEPT:

The membrane becomes less flexible. The cellular hemoglobin concentration increases. Glycolysis and other enzyme activity decrease. (EXCEPT: They become less prone to phagocytosis.)

An assessment of the myeloid to erythroid (M:E) ratio is part of every bone marrow evaluation. Which of the following does not apply to the M:E ratio?

The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow.

A tech is performing an antibody screen. The reaction is negative when reading at the AHG (anti-human globulin) phase, so the tech then adds Coombs' control cells. Agglutination is now observed. What does this indicate?

The negative reaction at AHG phase is valid

All of the following could explain why screening cell #2 has a stronger reaction than screening cell #1 EXCEPT:

The patient has more than one antibody and all corresponding antigens are on screen cell #2 but not on screen cell #1. The patient has an antibody other than anti-D and screen cell #2 has a double dose of the antigen, whereas cell #1 has only a single dose. Operator variability - When dislodging the cell buttons during reading, the technologist shook screen cell #1's test more vigorously than cell #2's test. (EXCEPT: Screening cell #1 has homozygous antigen for the reacting antibody whereas screening cell #2 is heterozygous.)

A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose test at the time of evaluation and an HbA1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes. What would be the best course of action if these are the blood glucose test results? Casual Plasma Glucose: 208 mg/dL HbA1C one week later: 7.2%

The patient meets the criteria for diagnosis of diabetes. (A casual plasma glucose = 200 mg/dL on a patient with symptoms and a HbA1C = 6.5% meet diagnostic criteria for diabetes. Hyperglycemia should be demonstrated a second time by any of the four diagnostic criteria below: HbA1c =6.5% FPG of = 126 mg/dL An oral glucose tolerance test with a 2-hour postload (7g glucose) level of =200 mg/dL Random FPG level of =200 mg/dL and symptoms of diabetes)

A negative glucose oxidase test and a positive test for reducing sugars in urine indicate:

The presence of a non-glucose reducing sugar such as galactose

The ability to detect and identify human parasites is directly linked to the following, EXCEPT:

The quality of the specimen The submission of the appropriate specimen The appropriate handling and processing of the specimen (EXCEPT: The genus and species of the parasite)

Which of the following statements is TRUE for specific gravity measured by the reagent strip method?

The reagent strip method is based on the relationship between ionic concentration and specific gravity.

Estriol levels in conjunction with hCG, inhibin A (inhA), and alpha-fetoprotein (AFP) can be obtained during pregnancy to assess which of the following?

The risk of Down's syndrome

What is the MOST important consideration before using a space heater in a health care facility?

The space heater is approved for use and inspected by the facilities management department.

The definition of competency can best be described as:

The standardized requirements for those who work in the clinical laboratory to accurately perform their job.

Avidity is best described by which of the following statements?

The strength with which multivalent antigens and antibodies bind

Which of the following statements about real-time PCR is true?

The target is detected during each cycle of amplification, utilizing a probe bound to a fluorogenic compound.

Which of the following may cause a false-positive protein reading on a urinalysis dipstick?

The urine specimen is highly pigmented.

A stool specimen was received in the laboratory for an O & P examination. The medical laboratory scientist performed a direct wet mount and found suspicious forms. A formalin ethyl acetate concentration procedure was performed and the top layer was examined with no suspicious forms observed. A slide made from the top layer was stained with Trichrome and again no suspicious forms were noted. Which of the following is the most likely explanation for these discrepant results?

The wrong layer was examined following the formalin ethyl acetate concentration procedure.

For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation?

The wrong specimen was used to crossmatch a unit and the unit was issued.

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

Theophylline

patient suffering from Celiac disease and Crohn's disease (both inflammatory conditions of the GI tract) is given a new oral medication that has a narrow therapeutic window. Which of the following would be true?

Therapeutic drug monitoring (TDM) would be helpful to see how much drug has been absorbed.

Which of the following is the most common cause of hyperkalemia in hospitalized patients?

Therapeutic potassium replacement

The range between a drug's effective dose and its toxic dose is called?

Therapeutic window

All of the following statements concerning Rickettsia species are true, EXCEPT:

They are obligate intracellular parasites. They are gram-negative bacilli. Associated diseases are usually diagnosed by serology. (EXCEPT: They are cultured in many hospital laboratories.)

All of the following regarding Anti-A and Anti-B reagents used in forward typing for ABO typing are true EXCEPT?

They contain monoclonal antibodies. The antibodies are highly specific. They produce an expected 3+ or 4+ reaction with the corresponding antigens. (EXCEPT: The antibodies are IgG.)

A deficiency in which of the folowing vitamins is associated with "Beriberi"?

Thiamine

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

This is most likely a bacterial infection or inflammatory response.

Koch's postulates include all of the following EXCEPT for which statement?

This microorganism can be isolated from specimens associated with the given disease. Inoculation of the isolate into a susceptible experimental animal will produce the disease. The organism can subsequently be recovered from an experimentally infected animal. (EXCEPT: The isolated organism, when injected into a human host, will produce the disease)

A urine concentration test was performed on a patient after a fluid intake deprivation period with the following findings: After 12 hours Urine Osmolality = 850 mOsm/Kg After 16 hours Urine Osmolality = 850 mOsm/Kg What do these results indicate?

This represents normal kidney function.

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

Thoroughly washing patient's hands with soap and water.

Which of the following conditions is characterized by small clots made up of platelets and large forms of von Willebrand factor? (The correct answer is TTP. TTP is caused by a deficiency of the proteolytic enzyme ADAMTS13. Because of this deficiency, small clots made up of platelets and large forms of von Willebrands factor adhere to collagen and cannot be broken down.) (HUS is commonly caused by infections with toxin-forming bacteria. Large complexes of platelets and von Willebrand factor are not related to HUS.) (DIC is caused by an underlying condition or trauma. It is initiated by damage to the endothelial lining of vessels that initiate coagulation.) (In HIT, heparin causes immune-mediated thrombocytopenia. Platelets and large forms of von Willebrand's factor are not the sources of HIT.)

Thrombotic thrombocytopenic purpura (TTP)

Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet?

Thromboxane A2

How is the majority of urobilinogen that is produced daily removed from the body?

Through fecal excretion

Which of the following autoantibodies are found in a patient with Graves disease but not typically seen in Hashimotos thyroiditis?

Thyroid-stimulating hormone receptor antibodies (TRAbs)

What are the 3 main effects of active vitamin D on the body? (Vitamin D, activated by low calcium levels and increased PTH, works to increase calcium and phosphorus levels in the body by increasing intestinal absorption during eating, increasing bone resorption, and releasing calcium and phosphorus from bone for circulation and reabsorption by the kidneys.)

To absorb calcium and phosphorus in the intestines, from bone, and in the kidneys (Vitamin D's 3 main effects are the increase of calcium and phosphorus levels by absorption in the intestines, resorption of bone, and reabsorption by the kidneys.)

What is the purpose of the sweat chloride test?

To help diagnose cystic fibrosis.

In which section of the safety data sheet (SDS) would you find information about whether a specific chemical is a carcinogen?

Toxicological information section

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

Transcription-Mediated Amplification

TIBC (total iron-binding capacity) is an indirect measurement of which of the following:

Transferrin

Which of the following is currently considered to be a good test for screening persons for hereditary hemochromatosis (HH) due to its sensitivity and specificity for iron overload? (In HH, iron accumulations will be seen in the liver and other organs. Liver biopsies are invasive procedures, which can be used to help confirm HH but are not needed to screen for HH.) (Therapeutic phlebotomy is typically the treatment for HH. Each unit of blood can remove 250 mg of iron.) (Serum iron levels are elevated in HH; however, serum iron levels alone are not a sufficient screening test for HH.)

Transferrin saturation (The most widely used test for screening for HH is transferrin saturation due to its sensitivity and specificity for iron overload.) (A transferrin saturation result of >45% is diagnostic for HH.)

Which of the following transfusion reactions can a diagnosis be more firmly established by evaluating B-type natriuretic peptide (BNP) levels before and after transfusion? (Transfusion Associated Circulatory Overload (TACO) is difficult to distinguish from Transfusion Related Acute Lung Injury (TRALI). A post-transfusion to pretransfusion BNP ratio of 1.5 points is diagnostic of TACO.) (Delayed Hemolytic Transfusion Reactions testing includes the DAT, free plasma hemoglobin, hemoglobin, LDH, total and direct bilirubin, haptoglobin, free urine hemoglobin, and hemosiderin in urine.) (Transfusion Associated Sepsis testing includes blood cultures on the recipient and a gram stain and culture on the transfused component.) (Allergic transfusion reactions are diagnosed based on anaphylactic symptoms of the patient during transfusion of the component.)

Transfusion Associated Circulatory Overload (TACO)

Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes?

Transfusion of ABO incompatible red blood cells

All of the following are ways hemoglobin functions EXCEPT: (Haptoglobin is a plasma protein that binds to free hemoglobin which forms a complex that can then be removed by macrophages.)

Transport Oxygen Transport Carbon Dioxide Transport Nitric Oxide (EXCEPT: Transport Haptoglobin) (Hemoglobin serves to transport oxygen, carbon dioxide, and nitric oxide.)

A soft, yellow to pale brown nodule was found growing around the hair shaft of an individual from a tropical location. On direct microscopic examination, hyaline hyphae with numerous rectangular arthroconidia were observed. The presence of arthroconidia aid in differentiating this organism from other yeast. The most likely identification is:

Trichosporon species

Chylomicrons are primarily composed of:

Triglycerides

Normal crystals that can be found in urine include: (If the crystals are from solutes that are not normally in the urine, they are considered "abnormal.") (Abnormal crystals may indicate an abnormal metabolic process. Some of these include cystine, tyrosine, and leucine.)

Triple phosphate (Triple phosphate crystals are found in highly alkaline urine and look like colorless coffin lids under the microscope.)

All of the following crystals are found in normal urine, EXCEPT?

Triple phosphate Ammonium biurate Calcium oxalate (EXCEPT: Leucine)

Which one of the following is the MOST specific biochemical marker of myocardial infarction? (CK is found not only in cardiac muscle but also in skeletal muscle and brain tissue.) (LD levels are also elevated with myocardial damage but are not specific since they will also be elevated with damage to many organs and tissues throughout the body, including liver, pancreas, kidneys, skeletal muscle, brain, blood cells breakdown, and hemolysis.) (Myoglobin is elevated when any muscle tissue is damaged and is not specific to the heart muscle.)

Troponin (Troponin is a very specific biomarker that is released during cardiac injury or stress.)

A laboratory manager wants to evaluate the timeliness of patient services in order to prevent medical errors caused by a delay in treatment. Measuring the turnaround time for which of these analytes would provide the most timely and valuable information?

Troponin tests from the emergency department.

Which of the following statements regarding trough level in therapeutic drug monitoring is true?

Trough level is assessed by collecting a blood sample right before the next dose of the drug is given.

Regarding therapeutic drug monitoring, which of the following statements is correct when collecting a specimen for a trough level?

Trough level is tested on a blood sample that is collected immediately prior to when the next dose of the drug is given.

Nephelometry is based on the principle of:

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

The type of hypersensitivity reaction associated with macrophage activation, cytokine-mediated inflammation is:

Type IV Cell mediated hypersensitivity (T-cell dependent)

Which amino acid is the precursor for catecholamines as well as thyroid hormones? (Glycine is used for nucleic acid, bile salts, and protein.) (Proline is used to produce collagen, tendons, and cardiac tissue.) (Tryptophan is the precursor for serotonin, melatonin, and niacin.)

Tyrosine (synthesized from phenylalanine, is the precursor for catecholamines (nor/epinephrine and dopamine) and thyroid hormones (T3, T4).)

If a sodium citrate sample drawn for coagulation is noted to be filled an inch below the fill line (black line), then the specimen is considered:

Unacceptable for coagulation studies

What condition is indicated by the following arterial blood gas results? Bicarbonate = 32 mmol/L (Normal = 22 - 29 mmol/L) pCO2 = 65 mm Hg (Normal = 35 - 45 mmHg) pH = 7.28 (normal = 7.35 - 7.45)

Uncompensated respiratory acidosis

Which of the following is the most commonly encountered presenting sign of a delayed hemolytic transfusion reaction (DHTR)?

Unexplained decrease in hemoglobin or hematocrit

What is the largest constituent of plasma nonprotein nitrogen: (During the metabolism of protein in the body, the liver converts ammonia into urea.) (More than 90% of urea is excreted by the kidneys with the rest being excreted via the gastrointestinal tract and skin.)

Urea (Urea comprises the largest percentage of nonprotein nitrogen(NPN) in plasma at 45-50% plasma concentration of total NPN.)

While working on fungal cultures, a tech encounters an organism that is orange/red in color. Immediately the tech suspects the organism is Rhodotorula species based on the color. To confirm this identification, which testing can be performed?

Urease and Inositol

A tech is working with a plump, bipolar staining, Gram-negative bacillus that may be Yersinia pestis. Which of the following tests could the tech use to rule out this organism?

Urease positive

Which analyte should be increased in the presence of gout? (Increased serum amylase levels are associated with pancreatitis._ (Increased serum aldolase levels are associated with muscular dystrophy.) (Increased serum troponin levels are associated with acute myocardial infarction.)

Uric acid

The laboratory department that performs physical, chemical, and microscopic evaluation of urine is called:

Urinalysis (UA)

Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine:

Urine protein electrophoresis or immunoelectrophoresis

Acetest® can be used to test for ketones in:

Urine, serum, and whole blood

Which of the following tests included on a urine reagent strip would never be reported out as negative?

Urobilinogen

The principle of most commercially available d-dimer assays is:

Using specific antisera to detect d-dimers' neo-epitopes

Compared to plasma frozen within 8 hours of collection, plasma frozen within 24 hours of collection will likely have reduced levels of Factor:

VIII

Which one of the following statements concerning Vitamin D is correct?

Vitamin D acts as a hormone in calcium regulation.

A deficiency in which of these vitamins leads to increased clotting time and may result in hemorrhagic disease?

Vitamin K

Immunoglobulin M (IgM) is the characteristically overproduced gene product found in: (Waldenström's primary macroglobulinemia is considered to be a lymphoplasmacytic lymphoma as defined by World Health Organization classification system. ) (IgG myeloma is the most common form of Multiple Myeloma. Four subtypes of IgG heavy chains are known to exist among patients with IgG myeloma (IgG1, IgG2, IgG3, IgG4).) (Plasma Cell Myeloma refers to Multiple Myeloma. IgG myeloma is the most common form of Multiple myeloma.) (Heavy Chain disease is characterized by the presence of monoclonal proteins composed of the heavy-chain portion of the immunoglobulin molecule. Alpha heavy-chain disease is the most common of the heavy-chain gammopathies.)

Waldenström's disease (It is a malignant lymphocyte-plasma cell proliferative disorder.) (Immunoglobulin M (IgM) is the characteristic overproduced gene product.)

Which of the following is the most common type of autoimmune hemolytic anemia?

Warm autoimmune hemolytic anemia.

Blood serum contains each of the following substances except:

Water Sugars Electrolytes (except: Coagulation proteins)

All of the following diseases are associated with autoantibodies, EXCEPT?

Wegener's disease Rheumatoid arthritis Systemic lupus erythematosus (EXCEPT: Hemolytic disease of the newborn)

The buffy coat includes which of the following constituents of the blood? (Buffy Coat: WBC and Platelets) (Bottom Layer: Packed Cells)

White blood cells and platelets

Transfusion of which blood product is most likely to cause circulatory overload in patients?

Whole blood

Which of the following steps must be followed to prepare a platelet concentrate?

Whole blood centrifuged at low speed - plasma separated then centrifuged at high speed

Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?

Within one hour

A yellow coloration found in fresh cerebrospinal fluid supernatant is termed: (Xanthochromia usually implies subarachnoid hemorrhage of at least several hours duration, if in vitro lysis of red cells can be excluded.)

Xanthochromia (Xanthochromia is an abnormal color, usually yellow, orange, or pink, in the supernatant of the CSF sample.)

Which organism is MOST likely responsible for septic reactions associated with red blood cell transfusions?

Yersinia enterocolitica

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

You have not run a PT or aPTT on the new mix before incubating.

The gene loci for the alpha-globin chains are adjacent to the locus for which other globin chain?

Zeta

All of the following antibodies are detected at immediate spin EXCEPT?

anti-P1 anti-A anti-M (EXCEPT: anti-Jka)

Which Rh antibody might be produced if a unit of blood with Rh genotype DCe/dce is given to a patient with Rh genotype DCe/DCe?

anti-c (In this case, the c antigen is not present on the cells of the recipient.)

A 9-year-old male in Alaska presents with hemolysis and hematuria. The patient history reveals that he recently recovered from a flu-like virus. The ABO type is A+, and the DAT reacts at 1+. What blood group antibody should be suspected?

autoanti-P

The organisms Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli can produce carbapenemases due to which of the following genes?

blaKPC

Which of the following analytes would be decreased due to delay in centrifugation?

glucose, ionized calcium, bicarbonate, folate (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 assay is recommended by the American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC) as the inflammatory marker of choice in the evaluation of cardiac heart disease risk?

hs-CRP

Which of the following cardiovascular risk markers is a more sensitive version of a test that is used to assess inflammation?

hs-CRP

Select the statement that best describes high sensitivity CRP (hs-CRP) testing?

hs-CRP is a marker of chronic inflammation and measured to predict the risk of cardiovascular disease

Which of the following statements is TRUE with respect to uncompensated metabolic alkalosis?

pH will be elevated without an elevation of pCO2

Isolates of nonmotile and nonpigmented enterococci that are resistant to vancomycin can be assumed to have an acquired resistance by the transfer of which of the following genes?

van A and van B genes (ancomycin-resistant isolates of enterococci that are nonmotile and nonpigmented can be assumed to have an acquired resistance through the transfer of van A and van B genes.)

When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows:

#1 Chemistry, #2 Microbiology, #3 Hematology

To convert degrees Celsius to degrees Fahrenheit, which formula would you use?

(9/5 x degrees Celsius) + 32

What is the formula for calculating transferrin saturation (TS)?

(Serum iron/TIBC) X 100

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

0-5 WBCs/µL

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?

0.44 x 109/L (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 refrigerator used to store whole blood must be able to maintain a temperature in the ranges of:

1 - 6 degrees Celsius (After collection all blood should be stored at 1 - 6C, unless it is going to be used as a source of platelets.)

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

1,300 mg/dL (The laboratorian performed a 1:4 dilution by adding 0.25 mL (or 250 µL) of patient sample to 750 µL of diluent. This creates a total volume of 1,000 µL. So, the patient sample is 250 µL of the 1,000 µL mixed sample, or a ratio of 1:4. Therefore, the result given by the chemistry analyzer must be multiplied by a dilution factor of 4.) (325 mg/dL x 4 = 1,300 mg/dL.)

Which of the following organisms is classified as a Helminth?

Schistosoma mansoni

Rejuvenation solutions for donated red blood cell units may be used to improve what factor that is affected by storage lesion? (A red blood cells age and lyse during storage, hemolysis will increase. Rejuvenation solutions are not able to prevent this increase in hemolysis.) (As red blood cells hemolyze during storage, they release potassium, which is typically present in the highest concentrations within the red cell. This results in an increase in plasma potassium levels. A rejuvenation solution cannot correct this.) (As red blood cells hemolyze during storage, the release of the cell intracellular fluid (ICF) dilutes the extracellular fluid (ECF) analytes. Levels of sodium, which is predominantly found in the extracellular fluid, are diluted, resulting in decreased plasma sodium levels. A rejuvenation solution cannot correct this.)

2,3 DPG (A rejuvenation solution may be added to red cell units to restore 2,3-DPG and ATP levels, which decrease during storage.)

Calculate LDL cholesterol concentration if total cholesterol is 280 mg/dL, triglyceride is 100 mg/dL, and the HDL cholesterol is 40.0 mg/dL. ([LDL cholesterol] = [total cholesterol] - [HDL cholesterol] - [VLDL] (where VLDL is calculated as [triglyceride]/5).)

220 mg/dL (LDL cholesterol = 280 mg/dL - 40 mg/dL- (100/5)) (LDL cholesterol = 220 mg/dL)

Unless an alternative has been approved by the FDA, what is the expiration and storage temperature of rejuvenated (non-frozen) RBC's?

24 hours; 1 °C to 6 °C

A patient has the following serum results: Na = 130 mEq/L K = 4.9 mEq/L Cl = 107 mEq/L Glucose = 300 mg/dL BUN = 18 mg/dL Creatinine = 1.1 mg/dL Which osmolality result is consistent with these results?.

281 mosmol/kg (Osmolality = 2 x Na + [Glucose (mg/dL) / 20] + [BUN (mg/dL)/ 3]) (In this case: 2 (130) + (300/20) + (18/3) = 260 + 15 + 6 = 281 mosmol/kg)

The normal Myeloid-to-erythroid ratio (M:E ratio) ranges from:

2:1 to 4:1

A rejuvenation solution may be used up to how many days following expiration of a red cell unit?

3 days

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

Troponin I is used frequently to assess acute myocardial infarctions (AMI). If a patient has experienced an AMI, at what point (approximately) will the troponin I begin to increase and how long will it stay increased?

3-12 hours, 7-14 days

What is the increase in the risk for developing antibodies against red cell antigens (RBC alloimmunization) for patients who are characterized as chronically transfused patients?

30% or greater

Approximately how many out of 1,000,000 Caucasians will have the following phenotype?Group 0, K+, Jk(a+)

30,000

Red cells units containing CPDA-1 as an anticoagulant-preservative may be stored for how long prior to transfusion?

35 days

Which of the following is the proper storage temperature for whole blood?

4 degrees Celsius

You are working in a clinical chemistry laboratory and are analyzing a plasma glucose sample. The sample is flagged by the analyzer for being "outside of linear range." You manually dilute the sample 1:2 and rerun it. Again, you receive an "outside linear range" alert. You decide to perform a different manual dilution. This time you manually dilute the original sample again; this time using a 1:3 dilution. The instrument gives you a glucose value of 150 mg/dL from this diluted sample. What is the actual patient glucose result that you should report to the physician?

450 mg/dL

The recommended storage temperature for the preservation of activity for MOST enzymes is:

4ºC

In a closed system, thawed FFP and PF24 blood components may be labeled as "Thawed Plasma" 24 hours after the original thaw time and given a shelf life of?

5 days

All of the following aerobic agars can be set up along with the anaerobic media, EXCEPT?

5% sheep blood agar Chocolate agar MacConkey agar (EXCEPT: Columbia colistin-nalidixic acid agar)

A platelet component prepared from a unit of whole blood (random donor platelet) must contain at least how many platelets?

5.5 x 10^10 platelets/unit

The average bone marrow cellularity in a normal adult (50 years old) is:

50 (The overall bone marrow cellularity is estimated by comparing the amount of hematopoietic tissue with adipose (fat) tissue.) (An easy way to calculate it is to subtract the age from 100 and adds plus or minus 10.) (In this example, 100 minus 50 equals 50. So the normal bone marrow cellularity is between 40 and 60)

Which of the following would be considered a normal value for a glucose level in cerebrospinal fluid?

60 mg/dL (CSF glucose levels should be approximately 60 to 70% of plasma levels. In our answer choices, 60mg/dL is the best option, as the serum glucose values will be just between 90-100 mg/dL. For a CSF glucose to be 30mg/dL, the serum value would be around 45mg/dL which is abnormally low. For the other two answer choices, the CSF values are already above the normal serum values, therefore are not considered normal values.)

Spine-like pseudopods are characteristic for the trophozoite for which amoeba?

Acanthamoeba species

A technologist performed a STAT spinal fluid count by pipetting undiluted spinal fluid in a Neubauer Counting Chamber and counting both sides of the chamber (4 large WBC squares on each side). A total of 54 White Cells were counted. How many White Cells would there be per cubic millimeter?

67.5 (First, determine the number of WBC's from the hemacytometer as follows:) (WBC/µL= Avg # cells counted /(# squares counted x 0.1 µL)) (WBC = 54 / (8 squares x 0.1 µL) = 67.5/µL) (Since 1 µL = 1 cubic millimeter, then the answer is 67.5/µL.)

Calculate the coefficient of variation for a set of data where the mean = 89 mg/dL and two standard deviations = 14 mg/dL.

7.9% (Coefficient of variation (CV) = standard deviation ÷ mean x 100 (to convert to percentage)) (2SD = 14) (1SD = 7) (7(SD) / 89 (mean) = 0.0786 x 100 = 7.9%) (The coefficient of variation (CV) is expressed as a percentage and describes the variation of a test.)

What temperature is considered optimal for Taq polymerase activity?

70C

A patient's electrolyte results are the following: Sodium = 145 mmol/L Chloride = 113 mmol/L Bicarbonate = 24 mmol/L Calculate the anion gap for this patient and choose the correct answer below.

8 mmol/L (Anion Gap = Sodium - (Chloride + Bicarbonate)) (Anion Gap = 145 mmol/L - (113 mmol/L + 24 mmol/L) = 8 mmol/L) (Normal Range for Anion Gap = 10-20 mmol/L)

Which of the following changes in titers would be considered significant when monitoring maternal antibodies using a doubling dilution?

8 to 32

What blood alcohol concentration has been established as the statutory limit for the operation of a motor vehicle in the United States?

80 mg/dL

What is the corrected white blood cell count if the WBC is 14,460, and there were 47 nucleated red blood cells per 100 white blood cells noted on the differential count? (Corrected WBC count = uncorrected WBC count x (100 / NRBCs +100)) (Corrected WBC count = 14,460 x (100/147) = 9,837)

9,837

If an average-weight adult male patient with a 7 g/dL hemoglobin is given two units of packed cells, what would be the approximate new hemoglobin value (assuming there is no active bleeding or other predisposing factors that would shorten the survival of the blood cells)?

9.0 g/dL (One unit of Red Blood Cells increases the hemoglobin level by approximately 1g/dL in an adult who is not actively bleeding and has no other predisposing factors that would shorten the survival of the transfused blood cells. In this question, the patient was given 2 units of packed cells, so the expected increase in hemoglobin would be 2g/dL.)

What is the approximate volume of spinal fluid in an adult?

90-150 mL

A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose? 62 mg/dL = 2/3 x serum glucose serum glucose = 62 mg/dL x 3/2 serum glucose = 93 mg/dL

93 mg/dL

What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs?

95 mL/min (One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows:) (Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24 hours x h/60 min)) (In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95 mL/min)

Which of the following is NOT required for a diagnosis of hereditary hemochromatosis (HH)?

>50% transferrin saturation in females or >60% saturation in males Presence of HFE mutations or other genetic mutations associated with iron metabolism Increased ferritin (NOT required: Biopsy of liver and/or bone marrow)

When evaluating a 2-hour glucose tolerance test report performed on a pregnant woman, which of the following results is considered NORMAL (within range for this test)? (An abnormal glucose tolerance (>153 mg/dL) test would show that an individual is unable to process glucose properly, leaving elevated levels in the blood.) (Similar to fasting or random blood glucose tests, a markedly abnormal 2-hour glucose tolerance test in pregnant women is diagnostic of gestational diabetes.)

A 2-hour glucose level is less than 140 mg/dL. (A 2-hour glucose tolerance test for gestational diabetes is considered normal when a 2-hour glucose level is =140 mg/dL.)

Which of the following statements best describes a normal mature erythrocyte?

A biconcave disc, 6-8 µm in diameter, that stains pinkish-orange (salmon) in color

A patient transfused with two units of packed cells spiked a fever of 99.5oF and complained of chills five days after transfusion. The direct antiglobulin test (DAT) was positive with anti-IgG, but negative with anti-C3d. Compatibility testing was performed on the pre- and post-transfusion specimens. The post-transfusion specimen was incompatible with one of the donor units transfused. An antibody screen was done on both the pre- and post-transfusion specimens. An antibody was detected in the post-transfusion specimen only and identified by panel studies as anti-Jka. This transfusion reaction is most likely:

A delayed hemolytic transfusion reaction

When the body compensates for a respiratory or metabolic disorder, the MAIN goal is to achieve:

A normal pH

What does the YELLOW color on the NFPA diamond represent? (Red = Fire hazard, Blue = Health hazard, White = Specific hazard)

A reactivity hazard

Q: In the Kleihauer-Betke test, a maternal blood smear is treated with acid and then stained with counterstain. The fetal cells contain fetal hemoglobin, which is resistant to acid and will remain pink. Since the calculated volume of fetomaternal hemorrhage is an estimate, how many additional RhIg vials need to be added for the dose?

A: 1

Which of the following terms is the external peer-review process that recognizes educational programs that have met established educational standards?

Accreditation

All of the following statements about blood cultures are correct EXCEPT?

A specific amount of blood is required to fill blood culture bottles to optimize the growth and detection of bacteria. Prior to performing the venipuncture, allow the cleansing agent to air dry completely on the skin to ensure sterilization of the venipuncture site. If two separate sets (two bottles each set) of blood cultures are requested, it is recommended to draw each set from different sites. Some recommend collecting the sets at different times (approximately an hour apart). (EXCEPT: If two separate sets (two bottles each set) of blood cultures are requested, draw them both from the same site at the same time.)

Which of these units of Red Blood Cells, that has been issued and returned to the blood bank, can be returned to inventory and is acceptable to use?

A unit of Red Blood Cells that was not transfused but stored in a temperature-controlled remote refrigerator in the operating room for 2 hours.

Which of the following is an example of a specimen which requires a chain-of-custody procedure to be followed?

A urine drug screen for pre-employment

A 47-year old man is hemorrhaging severely. He is group AB, Rh (D) negative. Ten units of packed red blood cells are requested STAT. One group-specific unit is available. Which other units that are available in the blood bank would be most appropriate to choose for crossmatching?

A, Rh(D) - negative

Which of the following is the most common subgroup of A?

A1

What is the cause of iron overload in hereditary hemochromatosis?

Absorption of excessive amounts of iron in the small intestine

Q: At many hospitals, patients with sickle cell disease are given phenotypically matched units of blood. This policy is often used to help prevent alloimmunization to common RBC antigens in patients who are regularly transfused. A patient who regularly comes to your hospital demonstrates the following phenotype on her RBCs: C antigen positive; E antigen-negative; K antigen positive. The patient's doctor requests a single unit of crossmatched packed RBCs. Based on the antigen prevalence indicated below, how many units of ABO compatible packed RBCs will you phenotype to find one to transfuse to this patient? Antigen frequencies C antigen positive: 68% E antigen positive: 22% K antigen positive: 9%

A: 1 unit

Q: How much time must elapse between apheresis red blood cell donations?

A: 16 weeks

Q: A 56-year-old woman with a history of high blood pressure and cardiovascular disease is evaluated by her physician due to her recent loss of appetite. The doctor reviews the following test results: Plasma creatinine = 2.4 mg/dL Urine creatinine = 65 mg/dL Urine volume (24 hrs) = 1400 mL What is the estimated glomerular filtration rate for this patient?

A: 26.32 mL/min (Urine creatinine/plasma creatinine) x (volume / minute) = glomerular filtration rate (mL/min)) (*in order to solve this problem, the 24-hour urine must be converted into minutes. 1440 minutes should be used as the denominator in the volume component.) ((65 mg/dL/2.4 mg/dL) x (1400 mL/1440 min) = (27.083)) X (0.972 mL/min)= 26.32 mL/min)

Q: How many milliliters of Rh positive whole blood is one dose of Rh immune globulin capable of neutralizing?

A: 30

Q: What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis?

A: 32%

Q: If parents have the blood group genotypes AA and BO, what is the possibility of having a child with a blood type of A?

A: 50%

Q: 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

Q: Which of the following is used as a source for irradiation of blood products?

A: Cs137

Q: Which subset of effector lymphocytes is predominantly responsible for regulation of antibody production?

A: TH2

Q: What is the minimum number of reactive antigen-positive and non-reactive antigen-negative panel cells that must be present in order to identify a red cell antibody with statistical confidence?

A: Three

Red Cells Tested With Known Antisera Anti-A: 4+ Anti-B: 4+ Serum Tested With Known Red Cells A1 Cells: NT B Cells: NT Interpretation of ABO Group: ? Given the above results, what is the newborn's ABO group? (NT = not tested)

AB

What are the possible ABO genotypes of offspring of parents whose genotype is AA and BB?

AB

What is the correct blood group for the patient based on the reactions below? Forward (Cell) Typing anti-A: 4+ anti-B 4+ Reverse (Serum) Typing A1 Cells: 0 B Cells: 0

AB

Which blood group is considered the universal recipient for transfusion of red blood cells?

AB

Which of the following fresh frozen plasma ABO types would be suitable for transfusion to an AB negative patient?

AB negative and AB positive only.

Which genotype(s) is/are possible for a mating of an AB mother and an AB father?

AB, AA, and BB

For granulocyte concentrations, all of the following laboratory tests must be performed on the unit by the donor center EXCEPT?

ABO and Rh Red Cell antibodies Infectious disease markers (EXCEPT: Lymphocyte enumeration)

The presence of hemolysis in a post-transfusion blood sample is best associated with which of the following?

ABO incompatibility

All of the following would be included in a hemolytic transfusion reaction investigation, EXCEPT:

ABO/Rh check of post-transfusion sample Direct antiglobulin test (DAT) on post-transfusion sample Clerical check (EXCEPT: Leukocyte antigen studies)

Which of the following best describes the direct antiglobulin (DAT) test principle?

AHG (anti-human globulin) detects antibody already sensitized to red cells

A 17-year old African-American male had the following laboratory results: Sickle cell screen = positive Hemoglobin Electrophoresis:Hb S = 40% Hb A = 58% HbA2 = 2% Which of the following is the PROBABLE hemoglobin genotype?

AS

Which of the following analytes would be increased due to delay in centrifugation? (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.)

AST

Which of the following would be considered a normal cerebrospinal fluid glucose level if the serum glucose is 70 mg/dL?

About 45 mg/dL (As a general rule, CSF glucose level is about two thirds (60%-70%) of the serum glucose measured in a normal adult. For a patient with a serum glucose of 70 mg/dL, the normal CSF value would be about 45 mg/dL.)

Beer's law states that concentration is directly proportional to which of the following?

Absorbance

The name of a reaction between a single antigenic determinant and an individual combining site is: (Avidity is the strength with which a multivalent antibody binds to a multivalent antigen.) (Reactivity is the description of an antigen-antibody reaction that is a reversible binding of antigen to homologous antibody by the formation of weak bonds between antigenic determinants on antigen molecules and antigen-binding sites on immunoglobulin molecules.)

Affinity (Affinity is the name of the bond between a single antigenic determinant and an individual combining site. Affinity is the initial force of attraction that exists between a single Fab site on an antibody molecule and a single epitope or determinant site on the corresponding antigen. The antigen is univalent and is usually a hapten. Several types of noncovalent bonds hold an epitope and binding site close together.)

Hemoglobin S (HbS) is MOST common in which of the following countries?

African countries

All of the following organisms have been linked to causing endocarditis EXCEPT?

Aggregatibacter aphrophilus Cardiobacterium hominis Eikenella corrodens (EXCEPT: Hemophilus influenzae)

Which one of the following proteins in cerebrospinal fluid (CSF) is used to monitor the integrity of the blood-brain barrier?

Albumin

Which one of the following usually shows a decrease during an acute phase response? (Other "negative" acute phase proteins include transferrin and transthyretin.) (Alpha-1-antitrypsin, fibrinogen, and ceruloplasmin are all "positive" acute phase proteins that are found in increased levels during acute phase response.) (Other "positive" acute phase proteins include alpha-1- acid glycoprotein, haptoglobin, C3, C4, C-reactive protein, and serum amyloid.)

Albumin (Albumin is a "negative" acute phase protein since it is found in decreased levels during acute phase response.)

All of the following are associated with RBC macrocytosis EXCEPT? (The other conditions can cause macrocytosis of RBCs.) (Macrocytosis occurs in vitamin B12 deficiency due to defective synthesis of DNA. In B12 deficiency, nucleated red cells do not undergo normal mitotic divisions due to thymidine deficiency.) (Macrocytosis occurs in alcoholism due to decreased levels of folate from a folate-deficient diet. Folate like Vitamin B12 is necessary for the synthesis of DNA.) (Macrocytosis occurs in patients with autoimmune hypothyroidism due to the production of antibodies that inhibit intrinsic factor production in the gastric mucosa. Intrinsic factor is necessary for Vitamin B12 absorption.)

Alcoholism Hypothyroidism B12 deficiency (EXCEPT: Thalassemia) (Thalassemia is usually associated with microcytosis.)

Which of the following enzymes is associated with conditions affecting skeletal muscles?

Aldolase

Which analyte should be increased in the presence of muscular dystrophy? (Increased serum amylase levels are associated with pancreatitis.) (Increased serum uric acid levels are associated with gout.) (Increased serum troponin levels are associated with acute myocardial infarction.)

Aldolase (Increased serum aldolase levels are associated with muscular dystrophy.)

Which of the following blood tests is used to evaluate liver function? (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.) (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.) (Uric acid is a test used to diagnose gout in a patient. It should be 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.)

Alkaline phosphatase (ALP) (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.)

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.

The following polypeptide chains are found in normal adult hemoglobin A:

Alpha and beta

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

Alpha fetoprotein

Which disorder exhibits a genetic code that is incompatible with life?

Alpha thalassemia major

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

Alpha-1 Antitrypsin C-Reactive Protein Fibrinogen (not an acuse phase protein: Protein S)

Which of the following tests is the BEST screening test for neural tube defects?

Alpha-fetoprotein

Which of the following methods are a non-invasive way to reliably predict anemia in the fetus?

Aminocentesis

Which of the following blood tests needs to be placed on ice immediately after collection?

Ammonia

Hormonal variation throughout the menstrual cycle typically shows:

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

The characteristics of an acute phase protein include the following EXCEPT:

An acute phase response is a non-specific indicator of an inflammatory response. C-reactive protein is an acute phase protein. Laboratory measurement of an acute phase can be used to monitor the progress of therapy in inflammatory diseases. (EXCEPT: Acute phase proteins are synthesized slowly in response to tissue injury.)

Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA?

Anaphylaxis

What characteristics are most often associated with alpha thalassemia intermedia?

Anemia, splenomegaly

Which of the following is NOT a condition in which coarse basophilic stippling is typically found?

Anemias of abnormal hemoglobin synthesis Thalassemia Lead poisoning (NOT a condition: Hemolytic anemia)

Using an automated cell counter analyzer, an increased Red Cell Distribution Width (RDW) should correlate with which of the following? (Leukocytosis defines an increase in white blood cell counts.) (Spherocytosis could cause a lowered MCV but would not affect the RDW as much as anisocytosis would.) (Finally, if macrocytosis is present, the MCV would be increased, but unless there is anisocytosis present also (meaning microcytes and normocytes), the RDW would not be greatly affected.)

Anisocytosis (Anisocytosis, or the increased variation in red cell size, would be expected if the red cell distribution width (RDW) was elevated.)

Substances found in urinary sediment that are more easily distinguished by the use of a polarized microscope are:

Anisotropic cholesterol droplets

Which of the following has the correct interpretation for the ABO group based on the forward and reverse testing?

Anti-A = positive & Anti-B = negative; A1 cells = negative & B cells = positive; interpretation = group A

Which type of antibody can cause HDFN in any pregnancy (first or subsequent), but is usually limited to less severe symptoms?

Anti-A,B

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

Anti-A1

Which antibody is present in the blood of an individual with the Bombay phenotype that will cause agglutination with any non-Bombay individual's blood?

Anti-H

Which of the following is necessary to test for in order to detect patients in the "window" period of a hepatitis B infection?

Anti-HBc

Twelve weeks after onset of the disease, patients with uncomplicated acute hepatitis B usually will demonstrate which of the following in their serum?

Anti-HBe

Which of the following antibodies usually show enhanced agglutination with the use of proteolytic enzymes?

Anti-Jka, -Jkb, -C, and -E

Which one of the following antibodies has been implicated in hemolytic disease of the fetus and newborn (HDFN)?

Anti-K

If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients?

Anti-M, Anti-N (Rare) Clinically Sgignificant: anti-Fya, anti-K, anti-D, anti-E, anti-e, anti-C, and anti-c (Not: Anti-Leb)

The following statements are true regarding the Lewis blood group EXCEPT:

Antigen expression is influenced by secretor status Antigens are adsorbed onto the red cells from the plasma ABO group affects antigen expression (EXCEPT: Antigens are a structural component of the red cell membrane)

Which of the following is used to determine if a person has had a recent infection with Strep pyogenes?

Antistreptolysin O (ASO)

Which of the following autoantibodies are found in a patient with Hashimotos thyroiditis?

Antithyroid peroxidase (TPO)

That portion of an enzyme which when separated from its cofactor is called a(n):

Apoenzyme

A blood donor shows signs of syncope, or fainting, shortly after donating. What should be done to treat the patient?

Apply a cold compress to the back of the neck

Which derivative of PCR testing uses short primers not specifically complementary to a particular sequence of a target DNA?

Arbitrary primed PCR

A clean-catch midstream urine specimen from a 30-year-old woman was sent to the microbiology laboratory for culture. The patient had no urinary symptoms, but the urine culture grew out 100,000 CFU/mL of Escherichia coli from two cultures collected 24 hours apart. Which of the following categories would the patient be classified?

Asymptomatic bacteriuria in female patients

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

Corneal tissue transplantation has an extremely high success rate for a variety of reasons, including all of the following with the exception of:

Avascularity Reasonably low concentration of class I antigens An essential absence of class II antigens (exception: Eccentrically place grafts)

Red Cells Tested With Known Antisera anti-A: 0 anti-B: 4+ Serum Tested With Known Red Cells A1 Cells: 4+ B Cells: 0 Interpretation of ABO Group: ? Using the information provided above, what is the patient's correct ABO group?

B

Which of the following parasites has a life cycle that most closely resembles that of Plasmodium species?

Babesia microti

Which of the following is responsible for the humoral immune response: (Neutrophils are part of cellular immunity. Their major function is phagocytosis and destruction of foreign material and microorganisms.) (Basophil granules contain histamine, and they play a vital role in allergic reactions and the inflammatory response.) (Monocytes are phagocytic cells and recognize bacterial pathogens. While monocytes do present antigens to B-lymphocytes to initiate the adaptive immune response, it is the B lymphocyte that is responsible for the antibody production of the humoral immune response.)

B lymphocytes (Humoral immunity involves antibody production.) (Most B lymphocytes participate in the humoral response through their transformation into plasma cells and secretion of antibodies.) (Other B cells become long-lived memory cells.)

Which one of the following blood components contains the MOST factor VIII concentration per mL?

Cryoprecipitate

A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/µL Differential: 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dLGram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider? (Though there are no organisms seen on the gram stain, a bacterial infection is still very possible as the bacterial count in the spinal fluid may be low. A viral meningitis would be more closely associated with an increased quantity of lymphocytes. Brain tumors and subdural hematomas would not be associated with these laboratory findings.)

Bacterial meningitis (Due to the elevated white blood cell count along with a strong percentage of neutrophils, a bacterial infection should be suspected. )

What is the largest protozoan known to infect humans?

Balantidium coli

The mediator cell type that binds to IgE antibodies is the:

Basophil

Which of the following is a genetic platelet disorder characterized by giant platelets, abnormal screening tests for platelet function and moderate to severe thrombocytopenia? (Glanzmann's thrombasthenia also has abnormal screening tests for platelet function; however, the platelet count and size are normal.) (Gray platelet syndrome is characterized by agranular platelets and mild thrombocytopenia.) (Delta storage pool disease is a dense granule deficiency with a normal platelet count.)

Bernard-Soulier syndrome

The immunoassay procedure for serum hCG utilizes antisera against which subunit of hCG?

Beta

Which of the following describes a beta thalassemia genotype ß+/ß?

Beta thalassemia minor

Which of the following tests is used to quantify a coagulation inhibitor?

Bethesda assay

Carbon dioxide is predominately found in the blood in the form of:

Bicarbonate ions

Elevation in conjugated bilirubin is most likely to be found in which of the following conditions? (Posthepatic jaundice is the result of bile duct obstruction, not impaired hepatic function. It will result in elevation of direct (conjugated) bilirubin.) (Crigler-Najjar syndrome, erythroblastosis fetalis, and transfusion reactions are all associated with increases in unconjugated bilirubin.)

Biliary obstruction

Pelger-Huet anomaly is characterized by which of the following?

Bilobed or round nuclei in neutrophils (hyposegmented)

What can be done to make a hapten behave like an antigen?

Bind to protein

Which of the following substances can cause a false positive result for blood on the urine chemical reagent strip?

Bleach in the collecting bottle

All of the following are considered a potentially infectious body fluid or a route of transmission for HIV, EXCEPT?

Blood Cerebrospinal fluid Pleural fluid (EXCEPT: Airborne transmission)

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 these methods are used to identify prior exposure to Mycobacterium tuberculosis?

Blood tests known as interferon-gamma release assays.

How would you describe the appearance of a mature monocyte seen in a Wright's stained peripheral blood smear?

Blue-gray opaque cytoplasm. Nucleus may have convolutions.

What does the hh genotype gives rise to?

Bombay phenotype

Which of the following organisms is best visualized by use of a darkfield microscope?

Borrelia

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

In the condition kernicterus, the abnormal accumulation of bilirubin occurs in what tissue?

Brain

Estrogen (ERs) and progesterone (PRs) receptors used as tumor markers are most commonly employed to provide prognostic information about:

Breast cancer

Which of the following D variants has the best likelihood to receive D-positive RBCs without any adverse effects?

C in Trans to RHD

Which of the following laboratory tests is used as an indicator of inflammation?

C-Reactive Protein (CRP)

The tumor marker associated with ovarian cancer is:

CA-125

AIDS patients have in increased susceptibility to infection due to a decrease in which of the following?

CD4+ lymphocytes

Which of the following genotypes is found with the highest frequency in the Caucasian population?

CDe/ce

Which tumor marker is used for colorectal cancer?

CEA

Any media that supports the growth of Staphylococcus aureus can be used to recover Methicillin-Resistant Staphylococcus aureus (MRSA). However, to improve the recovery of MRSA, selective media for MRSA will provide the best sensitivity. Which of the following media is most helpful in recovering MRSA from surveillance cultures?

CHROMagar MRSA agar

Which abnormal gene is inherited with Chediak-Higashi syndrome resulting in dysfunctional cells causing greater susceptibility to infections?

CHS1 LYST

Following a myocardial infarction which of the following enzymes will be the first to become elevated: (CK rises before LDH. However, myoglobin is the earliest serum cardiac marker to rise after an infarction; it may be positive within two hours post MI. It is not cardiac-specific and can be elevated in skeletal muscle trauma or rhabdomyolysis.) (GGT and ALT are elevated in liver disorders.)

CK

Which two of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle?

CK-MB and myoglobin

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

8-Hydroxyquinoline and Ortho-Cresolphthalein complexone (CPC) reagent is commonly used in the determination of: (The actual color reagent used in this method contains 8-Hydroxyquinoline (which reduces interference from Mg ions) and Ortho-Cresolphthalein complexone.) (The intensity of the color is measured spectrophotometrically at a wavelength between 570 and 580 nm.)

Calcium (Calcium forms a red-colored complex with Ortho-cresolphthalein complexone in an alkaline medium.)

The parathyroid hormone (PTH) is important in the regulation of:

Calcium and phosphate

A potentially pathogenic yeast that is usually found as normal flora in the oropharyngeal cavity but may produce thrush is called:

Candida albicans

This species of Candida accounts for around 20 percent of urinary yeast isolates.

Candida glabrata

A lipid panel consists of which of the following tests? (The Electrolyte Panel consists of potassium, sodium, chloride, carbon dioxide. These analytes are also typically ordered within other panels as well, including the basic metabolic and complete metabolic panels.) (The Hepatic Function Panel A consists of AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin.) (The Renal Function Panel consists of Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus.)

Cholesterol, Lipoprotein, HDL, Triglycerides

Which of the following areas of the brain and spinal cord is responsible for producing CSF?

Choroid plexuses

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

Chronic lymphocytic leukemia

The Philadelphia chromosome is consistently associated with which of the following blood disorders?

Chronic myelocytic leukemia (CML)

Which type of lipoprotein is the least dense?

Chylomicrons

Which of the following are characteristics of normal CSF?

Clear

What is the MOST common cause of acute hemolytic transfusion reactions?

Clerical errors

What organism is responsible for a potentially lethal type of food poisoning caused by improperly canned food?

Clostridium botulinum

Which bacterial species listed is a select agent, which is capable of producing an extremely potent, lethal neurotoxin?

Clostridium botulinum

Which of the following statements regarding coagulation disorders is correct?

Clotting factors II, VII, IX and X are vitamin K-dependent.

In the ABO blood group system, the A antigen is inherited in what relation to the B antigen?

Codominant

An increase in carcinoembryonic antigen (CEA) levels is most closely associated with which of the following organs?

Colon

Which one of the following tests BEST correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)?

Color Doppler ultrasonography

All of the following statements are true regarding storing and handling chemical reagent strips if you are using a manual method (visually reading the reagent strip), EXCEPT?

Compare strip to the color chart to check for correlating color. Handle strips at the end away from the test area. Store the test strip container at room temperature. (EXCEPT: Remove the cap of the test strip bottle and leave it off until testing is completed.)

Bruton's agammaglobulinemia is a:

Congenital B-cell disorder

Serous fluid effusions may result from all of the following EXCEPT:

Congestive heart failure Infection and inflammation Malnutrition (EXCEPT: Dehydration)

All of the following are important to consider for workspace and workflow design for molecular methods, EXCEPT:

Contamination can be a chief source of error. Template extraction, PCR reagent preparation, and amplification should be performed in different workspaces. Amplicons may contaminate work surfaces, equipment, and reagents. (EXCEPT: Aerosols are of minimal concern.)

Beta thalassemia major is also known as:

Cooley's anemia

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

Copper reduction

An elevated level of which of the following hormones will inhibit pituitary secretion of adrenocorticotropic hormone (ACTH)?

Cortisol

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

Creatine kinase MB (CK-MB)

Which of the following analytes would be increased due to delay in centrifugation?

Creatinine

Which one of the following serum constituents is increased following strenuous exercise?

Creatinine

Which of the following blood tests is used to evaluate kidney function? (Alkaline phosphatase (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.) (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.) (Uric acid is a test used to diagnose gout in a patient. It should be 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.)

Creatinine (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 tests would be useful in the assessment of glomerular filtration:

Creatinine clearance

A former patient had a positive antibody screen four years ago, and it was determined that she had anti-E. Her current antibody panel is now negative. Since she now needs blood for surgery, what should the blood bank do?

Crossmatch E-negative units.

Which component can be shipped with fresh frozen plasma (FFP)?

Cryoprecipitate

A 28 year old female patient is experiencing disseminated intravascular coagulation (DIC) following the delivery of her newborn. Her Complete Blood Count (CBC) results are normal. What would be the best blood product for this patient to receive? (Since the coagulation factors are concentrated in this blood product, its administration does not also add additional cells or volume, which minimizes the risk of transfusion-related conditions such as transfusion-associated circulatory overload (TACO).) (Platelets, whether pooled or apheresis, should only be administered in patients with a decreased platelet count or function. The patient had normal values on the complete blood count, which indicates that the platelet count was normal.) (There is no indicated need for the patient to receive red blood cells since the complete blood count results were normal, specifically the red blood cell, hemoglobin, hematocrit, and red blood cell indices. Administering red blood cells to patients with normal red blood cell values can lead to transfusion-associated circulatory overload or TACO.) (Though fresh frozen plasma contains coagulation factors, it is not the best option. The concentration of coagulation factors in fresh frozen plasma is not as high as in cryoprecipitated AHF, and the plasma itself could cause adverse reactions to the patient due to the fluid volume.)

Cryoprecipitated antihemophilic factor (Cryoprecipitated antihemophilic factor, often called cryo or cryo AHF, contains concentrated coagulation factors.)

An India Ink preparation is used to identify:

Cryptococcus neoformans in CSF (India ink preparation performed on spinal fluid is used to demonstrate the polysaccharide capsule of Cryptococcus neoformans by negative staining.) (Direct detection of capsular antigen by agglutination or immunoassay techniques is much more sensitive and has largely replaced the India Ink stain for clinical specimens.)

All outpatient tests are reimbursed according to a group of code numbers which are called:

Current Procedural Terminology (CPT) codes

A tissue sample is received in the laboratory for fungal culture. How should the tech prepare the sample for inoculation onto agar plates?

Cut/Mince tissue into small pieces with sterile scissors

Adult intestinal roundworms possess this structure that serves as a protective outer layer: (Chitin is also known as a shell and is in between the embryo and the cortication in a nematode egg. This structure is used to protect against the environment, but only seen in the eggs and not in the adult worm.) (Cortication refers to an outer mammillated, albuminous coating that can be seen on some roundworm eggs, especially Ascaris lumbricoides. Although the cortication is a protection from the outside environment as well, it is seen only in the egg and not in the adult worm.) (Copulary bursa are found in male worms to assist with copulation with female worms. The structure has no protective features and is purely used for reproduction.)

Cuticle

All of the following are components of a basic single beam spectrophotometer, except:

Cuvette Prism Light source (except: Beam splitter)

The most highly specific indicator for rheumatoid arthritis is:

Cyclic citrullinated peptide antibodies (CCP antibodies)

What is the infective stage for the intestinal amebae?

Cyst (The cyst is a non-feeding stage of the parasite that has a thick protective cell wall. This allows the parasite to survive in harsh environments outside the body. Thus, the cyst form is typically present as the infective form of the parasite in the environment that is then ingested.)

The historical medium of choice for isolation of Francisella is:

Cysteine blood glucose agar

The measurement of sodium and chloride in the sweat is the most useful test for the diagnosis of what condition/disease?

Cystic fibrosis

The Echinococcus granulosus life cycle requires both an intermediate host (sheep) and definitive host (dogs); humans are accidental intermediate hosts. Eggs are ingested by humans and sheep. What stage must be ingested by dogs to complete their life cycle?

Cysts

Which of the following is the recommended method for preparing a cerebrospinal fluid (CSF) sample for a differential count?

Cytocentrifugation

Which of the following phrases best describes a segmented neutrophil?

Cytoplasm appears pink-purple due to small specific granules.

Which nitrogen base would bind with a guanine nucleotide in forming double-stranded DNA?

Cytosine (In DNA complementary base pairing, guanine and cytosine pair with three hydrogen bonds, and adenine and thymine pair with two hydrogen bonds. Remembering the phrase "G-CAT" helps one recollect correct pairing.)

All of the following are major Rh antigens, EXCEPT?

D C c (EXCEPT: d)

Post-natal RhIg is indicated for which of the following mother and neonate pairs?

D-positive neonate born to D-negative mother

A 90-year-old patient is admitted to the hospital with the following laboratory data: WBC: 9,000/mm3 PLT: 190,000/mm3 Hgb: 6.1 g/dL Differential:11% Neutrophils40% Lymphocytes4% Monocytes45% Myeloblasts45 NRBC's / 100 WBCBone Marrow: 45% Myeloblasts & 55% Megaloblastoid Erythroblasts Serum Vitamin B12 and Folic Acid: Normal The MOST likely diagnosis is: (In the case above, there are both erythroid and myeloid precursors present in the peripheral smear.)

Erythroleukemia (Erythroleukemia is also known as Acute Myelogenous Leukemia type M6. This type is associated with either the presence of both erythroid and myeloid precursors OR strictly erythroid precursors.)

Which of the following is a common cause of urinary tract infections?

Escherichia coli

All of the following Enterobacteriaceae below are appropriately matched with the characteristic listed, EXCEPT:

Escherichia coli - indole positive Citrobacter freundii - H2S positive Klebsiella pneumoniae - indole negative EXCEPT: Serratia marscens - Voges-Proskauer negative)

Which of the following is a component of antifreeze that can cause severe renal tubular damage, along with similar effects of alcohol poisoning? (It is often ingested by children due to the sweet taste and can cause similar effects of ethanol consumption as well as metabolic acidosis and renal tubular damage.) (Ethanol is found in alcoholic beverages while isopropanol is found in rubbing alcohol and methanol is found in household cleaners and lab solvents.)

Ethylene glycol (Ethylene glycol is the component found in antifreeze.)

In which of the following situations would a bone marrow aspirate and biopsy be MOST LIKELY recommended to aid in diagnosis?

Evaluation of unexplained cytopenias

All of the following are causes of hypernatremia EXCEPT:

Excess water loss Decreased water intake Increased sodium intake or retention (EXCEPT: Low aldosterone production)

When operating a centrifuge, what happens if the centrifuge is not properly balanced?

Exposure to biohazardous agents

Which of the following is a confirmatory test for syphilis?

FTA-ABS

A newly admitted patient has the following coagulation results:PT: 12.9 seconds (N = 12-14 seconds) aPTT: 84 seconds (N = 25-35 seconds) Platelet Count: 200 x 109/L (N = 150-450 x 109/L) A mixing study was performed due to the abnormal aPTT test results. The mixing study demonstrated the following: aPTT was corrected by normal plasma, factor IX deficient plasma, but not by factor VIII deficient plasma. What factor assay should be performed next?

Factor VIII assay (In this case, the correction of the mixing study with normal plasma shows that the patient is suffering from a coagulation factor deficiency rather than an inhibitor. Upon further testing, when adding factor VIII deficient plasma, the aPTT does not correct. This means that the missing or deficient factor in this patient is most likely factor VIII, so a factor VIII assay should be run.)

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

Fasting blood glucose, triglycerides, HDL-C

Sudan III will confirm the presence of:

Fat

Which of the following will give the best overall picture of a patient's iron stores:

Ferritin

Which of the following are terms used to describe storage pool iron?

Ferritin and hemosiderin

The lecithin to sphingomyelin ratio (L/S) is used to assess:

Fetal lung maturity

What additional fraction would be seen if plasma rather than serum was subjected to electrophoresis:

Fibrinogen

ACTH controls which step of steroid hormone production?

First step (cholesterol esters to cholesterol)

A routine serum protein electrophoresis with normal proteins results in _____ zones or bands.

Five

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

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:

Flow cytometry

What would be the best way to determine how much RhIg should be given to a postpartum female who received RhIG antenatally and demonstrates the anti-D antibody at delivery?

Flow cytometry

Which molecular method uses fluorescent probes to evaluate genes and/or DNA sequences on chromosomes?

Fluorescence In Situ Hybridization (FISH)

All of the following statements about fluorometry are true, EXCEPT: (A fluorometer generates the wavelength of light required to excite the analyte (fluorophore) of interest; it selectively transmits the wavelength of light emitted, then it measures the intensity of the emitted light. The emitted light is proportional to the concentration of the analyte (fluorophore) being measured (up to a maximum concentration). Monochromators or optical filters help to select the proper excitation and emission wavelengths for the testing being performed.)

Fluorometry is more sensitive than spectrophotometry. Both excitation and emission spectra are characteristics of the analyte. Fluorometers typically utilize monochromators or optical filters. (EXCEPT: Fluorescence is indirectly proportional to the analyte being measured.)

Which of the following conditions is associated with a typical Bacillus cereus infection? (The correct answer is food-borne enteritis.) (Bacillus cereus is a relatively common cause of food-borne enteritis, also known as food poisoning. This occurs through the ingestion of contaminated food that can cause a combination of vomiting and diarrhea.) (Footrot or pitted karyolysis is a condition of the keratin skin, primarily on the soles of the feet, caused by the bacterium Dermatophylus congloensis. Human infections may occur from direct contact with soil contaminated by animal dander or hair. Masses of branching filaments are observed in the hair follicles and keratin layers of the skin.) (Nocardia brasiliensis is one of the more common agents of actinomycotic mycetomas of the subcutaneous tissues.) (Through the rapid hydrolysis of urea, Corynebacterium ureolyticum when found in the urinary tract causes the precipitation of ammonium magnesium phosphate crystals on the mucosa of the urinary bladder, resulting in inflammation (alkaline encrusted cystitis).)

Foodborne enteritis

What is the ultimate goal of secondary hemostasis?

Formation of a fibrin clot

What is the ultimate goal of primary hemostasis?

Formation of a platelet plug

Which of the following is the principle for the biuret method for total protein analysis? (Digestion of protein; measurement of nitrogen content is the principle for the Kjeldahl method for total protein measurement.) (Globulins are precipitated in high salt concentrations is the principle for salt precipitation and it is considered an albumin method, not a total protein method.) (Proteins separated based on electric charge describes the principle for electrophoresis.)

Formation of violet-colored chelate between Cu2+ ions and peptide bonds (The principle of the biuret method is the formation of violet-colored chelate between Cu2+ions and peptide bonds.)

Which of the following is the MOST likely discrepancy seen when a person demonstrates an "acquired B-antigen" phenomenon?

Forward typing appears to be AB, but reverse group type is A.

Regarding hemoglobin synthesis, which of the following constitutes the alpha globin chain coding?

Four gene loci; two each on chromosome 16. (Humans need four gene loci that code for the alpha hemoglobin chain in order to make their full component of normal hemoglobins. Two alpha chain gene loci are found on each chromosome 16. Beta globin gene (and other beta-like genes) are coded on chromosome 11.)

The bioavailability of an oral drug refers to the:

Fraction of the drug that is absorbed into the systemic circulation

Which bacterial genus contains fastidious, facultative intracellular, gram-negative bacilli that causes a zoonosis called tularemia? (All of the choices listed are zoonoses, caused by gram-negative, coccobacilli bacteria.) (Brucella species cause brucellosis. Brucella and Francisella are considered potential bioterrorism agents, and biosafety level 3 should be followed with suspected specimens.) (Bartonella henselae causes cat scratch disease, with transmission through feline scratches or bites.) (Pasteurella infections, or pasteurellosis, most often occur as a result of feline bites.)

Francisella (Francisella tularensis is the highly infectious, causative agent of tularemia, also known as rabbit fever.)

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

Which of the following enzymes is the most sensitive indicator of long term liver damage associated with alcohol ingestion: (GGT enzyme is elevated in about 60-70% of chronic alcohol abusers. Thus, it is a good monitor of alcoholic relapse in patients undergoing alcoholic abuse treatment.) (Because GGT has a half-life of up to 28 days, it can indicate alcohol abuse up to 3-4 weeks before testing.) (ALT and AST are also indicators of liver damage. They are elevated in alcohol abuse, but their half-lives are 47 hours and 17 hours, respectively, therefore not good indicators of long-term alcohol abuse.) (LDH is not associated with alcohol abuse.)

Gamma-glutamyl transpeptidase (GGT) (GGT elevations precede those of other liver enzymes in cases of chronic ingestion of drugs or alcohol.)

Which of the following is true of genotype screening in pharmacogenomics?

Genotyping does not take into account drug interactions which can affect metabolism.

All of the following are considered aminoglycoside antibiotics, EXCEPT?

Gentamicin Tobramycin Kanamycin (EXCEPT: Vancomycin)

The following results were obtained on a patient with a history of mucocutaneous bleeding: PT 12 seconds APTT 26 seconds Bleeding Time 18 minutes Platelet aggregation studies: ADP - abnormal response Thrombin - abnormal response Collagen - abnormal response Ristocetin - normal response Which of the following does this patient seem to have?

Glanzmann Thrombasthenia

Hydrogen ion concentration (pH) in blood is usually determined by means of which of the following electrodes?

Glass

All of the following hormones are produced primarily in the pancreatic islets EXCEPT which one?

Glucagon Insulin Pancreatic polypeptide (EXCEPT: Gastrin)

Which analyte may be falsely decreased due to a delay in transport time to the laboratory?

Glucose

Which of the following serum constituents is unstable if a blood specimen is left standing at room temperature for eight hours before centrifugation and processing?

Glucose

A Renal Function Panel consists of which of the following tests? (The Hepatic Function Panel A consists of AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin.) (The Lipid Panel consists of Cholesterol, Lipoprotein, HDL, Triglycerides.) (The Electrolyte Panel consists of potassium, sodium, chloride, carbon dioxide. These analytes are also typically ordered within other panels as well, including the basic metabolic and complete metabolic panels.)

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

The infectious disease process in which large numbers of activated macrophages and histiocytes are collected at the site of inflammation is called? (The sequence of an inflammatory reaction begins with the local accumulation of segmented neutrophils, a stage that is called purulent or suppurative.) (If the infective agent is not removed by the neutrophils, mononuclear inflammatory cells, initially lymphocytes, followed by monocytes and macrophages invade the area, leading to chronic infection. Plasma cells often become an integral component of the chronic inflammatory reaction when antibody formation is at its peak.) (Opportunistic infection is a term used to describe the evolution of an infectious disease in an immunocompromised or debilitated host by a bacterial species that does not commonly cause infection in a healthy host.)

Granulomatous (If many activated macrophages and histiocytes aggregate in the area, particularly with the formation of multinucleated giant cells, the reaction is called granulomatous.)

Asaccharolytic use of glucose would be indicated by which of the following reactions in OF glucose tubes?

Green in both tubes with a little blue at the top of the open tube

Which blood group is considered the "universal" donor when transfusing Red Blood Cells?

Group O

The antigen marker most closely associated with transmission of HBV infections is:

HBeAg

What sero-marker is the first marker to become positive in Hepatitis B and is associated with the infective stage?

HBs antigen

Which is the first marker (antigen or antibody) which will become positive after exposure to Hepatitis B?

HBsAg

What is a major reason why there is no viable HIV vaccine available on the market?

HIV has a high mutation rate due to the lack of proofreading ability by reverse transcriptase

Which of the following tests has been recommended by the FDA to replace the HIV-1 p24 antigen test in the screening of donated blood for infectious diseases? (The FDA recommends that HIV-1 nucleic acid testing (NAT) be done in place of HIV-1 p24.) (anti-HIV-1 and anti-HIV-2 are still required screening tests.) (HCV NAT is recommended as part of the battery of tests but is done to detect Hepatitis C Viru)

HIV-1 NAT

What blood system is often tested to either establish or dispute paternity?

HLA (Due to the highly polymorphic nature of HLA, or human leukocyte antigens, this system is often used to prove or disprove paternity cases.)

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

HLA antibodies

A kidney graft would have the BEST chance of survival post-transplantation if it were:

HLA identical, mixed lymphocyte culture (-), ABO identical.

Which of these blood levels will decrease during intravascular hemolysis?

Haptoglobin (Haptoglobin is an alpha2-globulin that binds to free hemoglobin intravascularly. The large haptoglobin-hemoglobin complex cannot be filtered by the kidneys.)

The accuracy of an immunoassay is its ability to discriminate between results that are true positive and results that are true negative. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with low sensitivity?

Has many false-negative results

False positive results for HIV antibody are most likely to occur in patients that:

Have an autoimmune disorder

At an alkaline pH, which of the following hemoglobins cannot be separated from hemoglobin S during hemoglobin electrophoresis? (Hemoglobin C migrates with A2 and E using cellulose acetate at an alkaline pH.) (Hemoglobin A migrates alone using cellulose acetate at an alkaline pH.) (Hemoglobin F migrates alone using cellulose acetate at an alkaline pH.)

Hb D (Hemoglobin S, D, and G will migrate to the same position using cellulose acetate at an alkaline pH (8.6).)

If a patient has three inactive alpha-globin genes, which of the four alpha (a) thalassemia classifications would they have?

Hb H disease

Six months ago, a 55-year-old female had a fasting plasma glucose (FPG) greater than 200 mg/dL on two occasions. She was diagnosed as having type 2 diabetes and treatment was started. Along with routine FPG's which of the following tests would most likely be used to monitor glycemic control?

HbA1C

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

HbS migrates with HbD in alkaline and alone in acid electrophoresis.

What section of the SDS would provide information about whether a chemical is carcinogenic?

Health hazard data

Urine test strip positive for blood may indicate all, EXCEPT:

Hematuria Hemoglobinuria Myoglobinuria (EXCEPT: Meat diet) (Individuals consuming mostly meat diet will show acidic urine pH.)

In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults? (Alpha thalassemia intermedia will contain three mutated genes, and thus an increased number of beta chains bind to each other, forming the tetrads of beta chains.) (In neonates, the gamma chain is present in high amounts, forming tetramers known as Bart's hemoglobin as gamma chain production decreases, beta chain production increases. Adults form beta chain tetramers (Hemoglobin H).) (Alpha thalassemia major is incompatible with life and is called hydrops fetalis. Patients with this disease often die in utero or shortly after birth. Alpha thalassemia minor may show an increased RBC count and normal adult hemoglobin electrophoresis, even though the hemoglobin is decreased and anemia is present.) (With Alpha thalassemia minor, the patient has two of the four alpha genes mutated. Alpha thalassemia minor causes an imbalance of alpha and beta-chain synthesis, generating an excess of beta chains.)

Hemoglobin H disease (When insufficient alpha chains are produced, the remaining globin chains often form tetramers.) (This condition is seen in alpha thalassemia intermedia or Hemoglobin H disease.)

What is the most significant cause of decreased haptoglobin levels?

Intravascular hemolysis

A 29-year-old female of Philippine descent is seen by her physician for fatigue. The patient states that a relative told her that their family has a long history of anemia. She presents with sclera icterus and her spleen is palpable. Routine blood work was initially ordered and these results were obtained: WBC: 6.1 X 10 9/L (4.0-10.5 X 109/L) RBC: 4.84 X 1012/L (3.50-5.50 X 1012/L) Hemoglobin: 8.4 g/dL (12.0-16.0 g/dL) Hematocrit: 28.8% (36.0-48.0%) MCV: 59 fL (80.0-100.0 fL) MCH: 17.4 pg (26.0-34.0 pg) MCHC: 29.3 g/dL (32.0-36.0 g/dL) RDW: 19.5% (11.0-15.0%) Platelets: 591 X 109/L (150-400 X 109/L) A peripheral blood smear is reviewed, revealing many codocytes (target cells) and a few schistocytes (fragmented RBCs). The majority of the RBCs that were seen in this smear were also microcytic and hypochromic. What additional laboratory tests should be performed to aid in the diagnosis of this disorder and associated anemia?

Hemoglobin electrophoresis

Which one of the physical examination results below may be cause to reject a donor from blood donation?

Hemoglobin of 12.0 g/dL

The most likely cause of an elevated serum potassium level in an apparently normal individual is:

Hemolysis

An electrophoretic separation of lactate dehydrogenase isoenzyme that demonstrates elevation in LD-1 greater than LD-2 could be indicative of: (LD-1 and LD-2 are both increased during myocardial infarction since they are both present in the heart muscle.) (In normal conditions, LD-2 is present in higher concentrations than LD-1. The reverse is true in myocardial infarction and during states of hemolysis. This term is referred to as the LD flip.) (Pancreatitis does cause increased levels of LD, but the LD-3 type is the most affected in this condition.) (Hepatic injury also increases levels of LD, but the LD-4 type is the most affected in this condition.)

Hemolysis (Hemolysis, both in vivo and in vitro, can cause elevations in LD-1 and LD-2.)

A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions:

Hemolytic disease of the newborn

Xanthochromia in CSF is characteristic of:

Hemorrhage

Which of the following additives should be used for the collection of a sample for blood gas analysis?

Heparin

All of the following conditions would be associated with an increased level of alpha-fetoprotein, EXCEPT?

Hepatocellular Carcinoma Viral Hepatitis Testicular Tumors (EXCEPT: Prostate Cancer)

Increased concentrations of alpha-fetoprotein (AFP) in adults are MOST characteristically associated with:

Hepatocellular carcinoma

Where are most acute phase proteins synthesized?

Hepatocytes

All of the following are considered to be important protein regulators of iron metabolism, EXCEPT? (Hepcidin is produced in the liver often in response to inflammation. Its function is to block iron release or absorption. Patients who have anemia of inflammation often have elevated hepcidin levels.) (Transferrin receptor is a membrane-bound protein that captures transferrin. Transferrin carries iron from extracellular fluid to developing RBCs.) (Ferroportin is a transmembrane iron transport protein that transports iron from the inside of the cell to the outside. It is important in iron release from macrophages and thus important for iron recycling.)

Hepcidin Transferrin receptor Ferroportin (EXCEPT: Hemosiderin) (Hemosiderin is an iron-rich brown pigment. Although it is considered stored iron, it does not perform a regulatory function in iron metabolism.)

Which one of the following adult worms resides in the human intestine? (Paragonimus westermani(the Oriental lung fluke) resides in the lungs. It is transmitted in undercooked crayfish or crabs. Cough, fever, chest pain, and increased production of blood-tinged sputum are symptoms. There is a form of cerebral involvement that causes seizures, visual difficulties, and decreased precision of motor skills.) (Clonorchis sinensis (the Chinese liver fluke) resides in the liver. Infection occurs after the ingestion of undercooked fish contaminated with encysted metacercariae. Light infections are typically asymptomatic. Heavy infections cause symptoms such as fever, abdominal pain, diarrhea, anorexia, epigastric discomfort, and occasional jaundice. Enlargement and tenderness of the liver, leukocytosis, and eosinophilia may also occur.) (Schistosoma haematobium(the bladder fluke) inhabits the veins that surround the bladder. Human infection occurs in freshwater following the penetration of forktailed cercariae into the skin. Many infections are asymptomatic. Symptomatic patients have inflammation at the infection site followed by abdominal pain, fever, weight loss, cough, bloody diarrhea, and eosinophilia. Painful urination and hematuria are possible, as well as Katayama fever.)

Heterophyes heterophyes (Heterophyes heterophyes resides in the human intestine during parasitic infections.) (Heavy infections cause abdominal pain and discomfort, with chronic mucous diarrhea and eosinophilia.) (Avoiding undercooked fish and practicing proper fecal disposal are important in preventing and controlling the infection.)

The transmission of which of the following organisms is associated with the guano of bats?

Histoplasma capsulatum

A completely sickled cell (drepanocyte) is most commonly seen in which of these conditions?

Homozygous HbSS

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

IgA deficiency with anti-IgA

Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils?

IgE

Which class of antibody can agglutinate erythrocytes (RBCs) after anti-human globulin (AHG) is added to the test tube?

IgG

The most significant blood group antibodies belong to which immunoglobulin classes?

IgG and IgM

Coombs control check cells used to verify negative reactions at the anti-globulin (IAT) phase are coated with: (IgM antibodies would not react in the IAT phase with antiglobulin (anti-IgG) reagent.)

IgG antibodies (Coombs' control cells are Rh-positive cells that are coated with anti-D. These cells will agglutinate when added to the negative test due to the anti-IgG present in the AHG reagent.)

Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring?

Immunoassay

Which of the following methods may be employed to definitively identify Bence-Jones proteins?

Immunoelectrophoresis

Whereas von Willebrand's Disease (vWD) and Bernard-Soulier Syndrome (BSS) are both disorders of platelet adhesion, differences between the two include all of the following except:

In BSS the abnormality is in the platelet GPIb-IX-V complex, where as in vWD this defect is in some aspect of vWF. In BSS, the platelets are decreased in in number but increased in size, whereas in vWD they appear normal. In BSS, the addition of normal vWF from cryoprecipitate fractions does not restore ristoetin-induced agglutination of platelets but in vWD it does. (except: VWD is a rare inherited disorder, whereas BSS is a relatively common inherited disorder.)

A medical laboratory scientist working in Hematology was performing Myeloperoxidase staining on a suspected AML case. They found positive reactions of the segmented neutrophils. What would be the next step?

Inaccurate result, only blast cells are to be examined for reaction

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

Increased rate of hemolysis.

The results which would be MOST consistent with macroamylasemia are? (Macroamylasemia can be diagnosed by measuring amylase levels in the urine and serum.) (This condition occurs when amylase molecules combine with immunoglobulins to form large molecules which cannot be filtered across the glomerulus.) (Therefore, in patients with macroamylasemia, there will be high levels of amylase in the serum.) (Macroamylasemia can look similar to acute pancreatitis, which also causes high levels of amylase in the blood.) (To help differentiate, we measure amylase levels in the urine.) (Urine levels of amylase are low in people with macroamylasemia, but high in patients with pancreatitis.)

Increased serum amylase and normal to low urine amylase values

A new clinic in the area is sending a very large number of additional chemistry tests to the laboratory. The existing chemistry instrument is only 2 years old and works well, however, there is a need to acquire a high throughput instrument. Which one of the following is the appropriate "Justification Category?"

Increased testing volume

What is the mechanism of action for methotrexate?

Inhibits DNA synthesis

Which of these describes the mode of action of the beta-lactam class of antibiotics?

Inhibits cell wall synthesis

Sodium fluoride is an excellent preservative for collecting glucose specimens because it does which of the following?

Inhibits glycolysis

Basophils' primary role involves: (Neutrophils, monocytes, and macrophages are phagocytic cells.) (B Lymphocytes are responsible for long-term immunity through the production of memory cells. They are also responsible for antibody production.)

Initiation of allergic inflammation (Basophils function as initiators of allergic inflammation through the release of cytokines.)

The granules of Basophil contain which of the following?

Initiators of allergic inflammation

When determining the identification of an amebic parasite, which morphologic structures are most helpful in differentiating the members of this group.

Internal and external structures (Close examination of the internal and external structures is most helpful in the identification of amebic parasites.)

If CSF tubes numbered #1, #2 and #3 CANNOT be analyzed within one hour, the correct procedure for the microbiology sample tube is to: (You must leave the tube at room temperature since refrigerating, freezing, or incubating the specimen at 56 degrees will destroy Neisseria meningitides (if present). The sample should not be thrown away.) (Tube #1 is used for chemistry or serological testing and can be stored frozen.) (Tube #2 is used for microbiology testing and should remain at room temperature.) (Tube #3 is used for cell count in the hematology department and should be stored in the refrigerator.)

Leave it at room temperature

Which spirochete is a causative agent of human disease and is acquired through contact with the urine of carrier animals?

Leptospira interrogans sensu stricto

The life span of RBCs containing Hemoglobin H is typically:

Less than 120 days

Bone marrow examination may be used to aid in the diagnosis of which of the following? (The initial examination of patients with hematopoietic neoplasms should include peripheral blood smear and bone marrow examinations prior to therapy.) (Iron deficiency anemia is the most common nutritional deficiency due to decreased availability of iron and/or chronic blood loss. Iron studies are keys to the diagnosis, and the treatment principles are to address the underlying disorder.) (Infectious mononucleosis is usually a self-limiting lymphoproliferative disease caused by the Epstein-Barr virus (EBV). The presence of various forms of reactive lymphocytes is key to the diagnosis, along with serologic testing to detect the presence of heterophile antibodies. Bone marrow in EBV infection is not indicated.) (Plasma cell myeloma usually secretes monoclonal immunoglobulin into the serum and/or urine. Serum and /or urine electrophoresis reveal increased protein with a narrow range of electrophoretic mobility (M spike). Immunofixation will determine the class of immunoglobulin. Plasma cell myelomas have clinical presentations varying from asymptomatic to aggressive. It is therefore important to recognize symptomatic plasma cell myeloma that shows symptoms of hypercalcemia, renal insufficiency, anemia, lytic bone marrow (leading to bone fractures), and other organs involvement in asymptomatic plasma cell myeloma. The bone marrow examination will be performed to assess the percentage of clonal plasma cells in conjunction with a clinical presentation (bone pain). If a bone marrow examination is performed on lytic bone lesions, the infiltration of plasma cells will show a decrease of normal hematopoietic tissue. It is also very important to distinguish between asymptomatic myeloma (M protein > 30g/L and/or 10% or more of clonal plasma cells in the bone marrow) and monoclonal gammopathy of undermined significance (MGUS) with less than 10% plasma cell on the bone marrow examination.)

Leukemia (A peripheral blood examination is the first step in assessing necessity in blood marrow evaluation because peripheral blood cells usually reflect the bone marrow status.)

Which of the following is generally considered equivalent to CMV seronegative RBCs for use in an exchange transfusion to a newborn?

Leukoreduced RBC

Vaccines can be divided into the following non-experimental types with the exception of:

Live, attenuated Inactivated Toxoid (exception: Recombinant vector)

GGT (gamma-glutamyltransferase) is an enzyme found in many body tissues including the kidney, prostate, brain, pancreas, and liver, however, its clinical applications is confined to the evaluation of what system?

Liver

All of the following are sources of serum alkaline phosphatase EXCEPT:

Liver Placenta Intestine (EXCEPT: Brain)

All of the following conditions are associated with a polyclonal (broadbased) increase in gamma globulins except?

Liver disease Chronic inflammation Immune reaction (except: Immunodeficiency)

Which of the following statements is true regarding the staining protocol used for bone marrow smears compared to that for peripheral blood smear? (When using an automated stainer for marrow smears, it should be adjusted for longer stain time, or the smear processed more than once to allow additional stain time.) (Wright or Wright-Giemsa stain is a common dye used for bone marrow smears. Other dyes, such as the Prussian blue (for iron) or cytochemical stains (e.g., myeloperoxidase), are also used.) (To stain cells with Wright or Wright-Giemsa stain on a marrow or peripheral blood smear, cells must be fixed with absolute methanol. The fixative is contained in the stain package used for the automated stainer.)

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

A 32-year-old teacher is seeing her internist for her yearly physical. Because her great-grandmother suffered from cardiac disease, she is concerned about her own risk for cardiac disease. She is not a smoker nor hypertensive and is not overweight. She is physically active and maintains a good diet and nutrition. Her physician orders a lipid panel and hs-CRP to evaluate her cardiac disease risk. Test Patient Result (Reference Range) Cholesterol: 189 mg/dL (< 200 mg/dL) Triglyceride: 140 mg/dL (< 150 mg/d) LLDL- cholesterol: 98 mg/dL (< 100 mg/dL (optimal)) HDL-cholesterol: 60 mg/dL (> 59 mg/dL (optimal)) hs-CRP: 0.9 mg/dL (< 1 mg/dL (low risk)) Based on age, history, and laboratory results, what is her risk of cardiac disease at this point?

Low risk

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

Low serum electrolyte values

Which of the following is true regarding the Lutheran blood group system?

Lub is a high frequency antigen

Which of the following is considered one of the most common coagulation inhibitors?

Lupus anticoagulant (anti-phospholipid antibody)

Which of the following major cellular elements does not develop solely in the bone marrow?

Lymphocyte

An Rh-negative pregnant female has produced anti-D, and the physician has decided to use molecular typing to determine if the fetus is at risk. Which of the following test results makes fetal DNA testing a recommended second step?

Molecular genotyping demonstrates that the father is heterozygous for the RHD allele.

Class II Major Histocompatibility Complex genes encode for:

Molecules that present antigen to CD4+ T cells

What are the smallest nucleated cells seen in normal peripheral blood? (A small lymphocyte is 7-10 micrometers in diameter. Therefore lymphocytes are the smallest nucleated cell found in peripheral blood.) (Segmented neutrophils are typically 10-16 micrometers in diameter, while monocytes are 12-20 micrometers in diameter.) (At 2-3 micrometers, platelets are the smallest circulating hematologic element. They are fragments of megakaryocyte cytoplasm. But platelets do not contain nuclei. Therefore, they are not the smallest nucleated cell found in peripheral blood.)

Lymphocytes

Which of the following cells are capable of producing antibodies?

Lymphocytes

The process of freeze-drying of bacteria is called:

Lyophilization

What is the first line treatment for moderate to severe hemophilia A?

Lyophilized Factor VIII concentrate

A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine microscopy. Acetic acid should be added to the sediment to:

Lyse the red blood cells

The late steps of complement activation and formation of the "membrane attack" complex (MAC) results in:

Lysis of cells

Isoenzymes of CK include all of the following EXCEPT: (CK-BB is found mainly in the brain and lungs.) (CK-MB is found mainly in the heart.) (CK-MM is found mainly in skeletal muscle.)

MB MM BB (EXCEPT: MBM) (There is no such thing as CK-MBM)

In patients with Sickle cell disease, upon sickling what laboratory test will see an increase?

MCHC (The mean corpuscular hemoglobin concentration is, by definition, the concentration of hemoglobin in a given volume of blood. Upon sickling, there is a subsequent increase in the MCHC in proportion to the number of molecules in the deoxygenated state.)

An automated complete blood count produced the following red blood cell parameters: White blood cells (WBC) 5.6 x 109/L (4.0-10.0 x 109/L) Red blood cells (RBC) 3.4 x 1012/L (4.2-5.9 x 1012/L) Hemoglobin 11.1 g/dL (12-16 g/dL) Hematocrit 31% (37-48%) MCV 92 fL (80-100 fL) MCHC 38 g/dL (30-37 g/dL) A specimen for a repeat complete blood count is received in the laboratory six hours later. The sample visually appears to be much lighter in color than the original sample. The technologist questions whether both samples are from the same patient. Which of the following parameter(s) is LEAST likely to change between samples, if from the same patient, and would be most useful to determine if there is a discrepancy that may be the result of a preanalytical error in sample collection?

MCV

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: 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) (The MCV is indicative of macrocytosis with MCV>100fL.) (The RDW is above the reference interval and indicative of a heterogeneous cell population (variation in the RBC size).) (An MCV between 80-100 fL would indicate normocytic cells (normal size).) (An MCV <80 fL would indicate microcytosis.) (An RDW within the reference interval would indicate a homogenous cell population (no variation in the RBC size).)

Antigen processing is primarily accomplished by what type of cells?

Macrophages

All of the following would be considered a part of the body's cellular immune system EXCEPT?

Macrophages Mast cells Neutrophils (EXCEPT: Thrombocytes)

Which of the following may be seen in a CSF sample of a patient that has a subarachnoid (intracranial) hemorrhage (SAH)? (Characteristics of a subarachnoid hemorrhage (SAH) include even distribution of blood in tubes collected, no clot formation in the sample, as well as a xanthochromic supernatant to the sample.) (Another characteristic that correlates with a SAH is hemosiderin deposits in macrophages.)

Macrophages containing hemosiderin (As red blood cells degenerate, the breakdown products are seen in macrophages as dark, granular, iron-laden hemosiderin deposits.)

A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of observed cells in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?

Make a larger dilution.

A cause of FALSE-POSITIVE result in the rapid plasma reagin (RPR) test for syphilis is:

Malaria

Most antibodies present in cord blood are of ________ origin.

Maternal

All of the following represent a 2 week temporary deferral from donating blood or blood products EXCEPT:

Measles (rubeola) vaccine Mumps vaccine Polio vaccin (EXCEPT: German measles (rubella) vaccine)

On a Cytospin preparation from a pleural fluid specimen, 50% of the cells have the following characteristics: - uniform, regular arrangement - some cells resemble a "fried egg" - multiple nuclei - smooth nuclear outline and homogeneous chromatin - when present in clumps, there are clear spaces between the cells ("windows") How should these cells be classified?

Mesothelial cells

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

Mesothelial cells

The indicator(s) used in the pH test region of the chemical reagent strips for urine is/are:

Methyl red and bromthymol blue

MIC is an acronym for:

Minimum inhibitory concentration

A mixture of Gram-positive and Gram-negative bacteria may be present within the same field of a slide of all of the following EXCEPT:

Mixed wound infections Urine sediment from a mid-stream catch specimen Expectorated sputum specimen (EXCEPT: Sterile cerebrospinal fluid)

Multiple ring forms in red blood cells are most frequently seen in which Plasmodium species infection? (Plasmodium species infect red blood cells and are identified based on the forms seen in peripheral blood smears.) (Multiple ring forms are common with P. falciparum.) (Schüffner's and Ziemann's dots are absent, but some growth stages can show Maurer's dots, which are irregular and comma-shaped.) (P. vivax infection typically shows delicate ring forms with one chromatin dot. The infected red blood cells are typically enlarged and/or distorted. Some forms may be seen on the outer edge of the red blood cell, called an appliqué or accolé form. A vacuole may be present in the red blood cell, inside the ring form. Schüffner's dots can also be present.) (P. malariae infection typically shows a smaller ring form with a dark(heavy) chromatin dot. A vacuole can be seen in the ring form and can appear filled in. The infected red blood cells are normal in size with no distortion. Schüffner's dots are absent, but very fine dust-like dots called Ziemann's dots may be present.) (P. ovale infections typically show a thick, amoeboid ring form. The infected red blood cells are more oval-shaped and enlarged with distortion. The ring form can be difficult to distinguish from P. vivax.)

P. falciparum (The most common form of the parasite typically seen in blood smears is the ring form, which is an early trophozoite form.) (P. falciparum infection typically shows ring forms that are circular with one or two chromatin dots, in normal-sized red blood cells.)

Vitamin D is controlled by which hormone in a negative feedback loop? (When blood calcium is low, PTH is released to stimulate the formation and hydroxylation of active vitamin D, which increases calcium absorption in the intestines and removes calcium from bone to increase calcium levels. As calcium levels increase, the negative feedback loop shuts off PTH, which shuts off vitamin D.) (Calcitonin is produced by the thyroid glands and acts to decrease calcium levels, while TSH acts to increase T3 and T4, the thyroid hormones that play a role in everything from metabolism to body temperature and respirations. Calcium is a mineral and not a hormone.)

PTH (Vitamin D is controlled by PTH, which is released by the parathyroid glands.)

The presence of parasites in human blood is termed:

Parasitemia

Eosinophils are increased in all of the following conditions EXCEPT?

Parasitic infections Allergic reactions Inflammatory reactions (EXCEPT: Viral infections)

Human dog bite infections may be caused by each of the following bacterial species EXCEPT: (All of the other bacterial species listed in this question reside in the oropharynx of dogs and other canines and may cause human dog bite infections.)

Pasteurella multocida Capnocytophaga cynodegmi Neisseria weaveri (EXCEPT: Capnocytophaga ochracea) (Capnocytophaga ochracea has its natural habitat in the oropharynx of humans and would not be involved in dog bite infections.)

Which is NOT a requirement for information on the donor tag once the appropriate compatibility testing has been completed and the unit or units are suitable for transfusion?

Patient's full name and identification number Name of the product and donor number ABO & D phenotype of the unit (NOT a requirement: Doctor's name and patient room number)

Which of the following organisms appear Gram-positive when using the Gram Stain?

Peptostreptococcus anaerobius

All of the following are usually increased in alpha thalassemia EXCEPT?

Percent iron saturation Lactate dehydrogenase Bilirubin (EXCEPT: Iron binding capacity)

Which procedure should be followed when one cross-matched unit out of five is INCOMPATIBLE at the antiglobulin (AHG) phase? (If the patient's serum is incompatible with only one unit at the AHG phase, the donor unit may have a positive DAT. If the test is positive, the donor unit should not be used for transfusion.) (If the patient's serum contains an antibody to a high-frequency antigen, the patient would appear incompatible with nearly all donor units tested.) (Washed donor cells are used for patients that have allergic reactions to proteins in the donor unit. Allergic reactions are not detected in the crossmatch.) (Antibody panels are not performed on donor serum.)

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

A D-negative mother gives birth to a baby that tests as D-negative in the immediate spin phase. What step should be performed next? (If the neonate is truly D-negative, RhIg is not indicated, so there is no need to calculate the dose or give a prophylactic dose.) (The Kleihauer-Betke stain will only quantify fetal red cells; it does not differentiate between D-negative and D-positive cells.)

Perform a weak D test (A weak D test must be performed to ensure that the neonate is D-negative instead of weak D-positive due to the potential for the mother to form anti-D to any D-positive neonate.)

Which of the following conditions is a category B condition in a HIV-infected adult?

Peripheral neuropathy

Of the following anticonvulsant medications, which one does not rely solely on the liver to metabolize it for excretion?

Phenobarbital

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

Phenobarbital

Immunosuppressed or diabetic patients with ketoacidosis may present with symptoms of a brain abscess caused by which of the following?

Phycomycosis

What is another name used to designate a fully committed B-lymphocyte:

Plasma cell

Donation of which apheresis blood product more than once every four weeks requires monitoring of total plasma protein and antibody levels?

Plasmapheresis

Which of the following tests may be used to confirm screening test results for a lupus anticoagulant (or antiphospholipid antibody)?

Russell Viper Venom test

This Plasmodium species has a 72-hour cycle and tends to infect older red cells. Infected red cells will be normal sized. (Plasmodium vivax has a 48-hour cycle and tends to infect young cells, with the red blood cells enlarged.) (Plasmodium ovale has a 48-hour cycle and tends to infect young cells. The red blood cells will be enlarged with fimbriated edges.) (Plasmodium falciparum has a 36-48-hour cycle and tends to infect any cell age and will have all sizes of red blood cells.)

Plasmodium malariae (Plasmodium malariae has a long incubation period (72-hour cycle), will tend to infect old cells and the red blood cells maintain their normal size.)

Microscopic examination of peripheral blood may be diagnostic for infection with each of the following parasites EXCEPT:

Plasmodium vivax Trypanosoma cruzi Wuchereria bancrofti (EXCEPT:Trichinella spiralis)

Immunocompromised patients, such as those with Acquired Immunodeficiency Syndrome (AIDS) are at an increased risk of contracting an unusual form of pneumonia from which of the following microorganisms?

Pneumocystis jiroveci (carinii)

Which is the best method for examination of synovial crystals?

Polarized light

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?

Polychromatic normoblast

In blood bank agglutination reactions, the zeta potential (a force exerted by ions in the saline solution that causes repulsion between red blood cells in the saline suspension) can be reduced by treating the sensitized cells with:

Polyethylene glycol (PEG), albumin, or proteolytic enzymes

A urine specimen which was collected in a dark container, stored in the dark, has a pH of 7.5, and whose sample aliquot is wrapped in foil, is most likely being sent for:

Porphyrins

Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias?

Positive DAT

To ensure precision and accuracy of the reagent strip tests used for chemical analysis of urine, it is necessary that:

Positive and negative controls are run on a daily basis and when a new bottle of test strips is opened

A patient is experiencing prolonged bleeding following a transfusion. The complete blood count indicates that the patient's platelet count has decreased following the transfusion. What is the most likely cause of this issue?

Posttransfusion purpura

The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following electrolytes? (The potassium level will be significantly elevated since potassium is a major intracellular cation. When red cells hemolyze, the increased level of potassium found within the red blood cells is released into the plasma. Therefore, when the plasma potassium level is analyzed, it appears elevated. Hemolysis could result from improper specimen collection techniques or improper storage.) (Sodium, bicarbonate, and chloride levels are more abundant outside the cell. Therefore hemolysis will not increase their plasma levels.)

Potassium

Which of the following analytes will be falsely increased due to hemolysis?

Potassium, Magnesium, Iron, Total Protein

It is important to specify if a blood specimen is a capillary specimen rather than a venous specimen. How will the following laboratory results be affected if a capillary specimen is tested?

Potassium, calcium, and total protein are lower in capillary specimens, where glucose is typically higher than in venous blood.

All of the following are cause for donor deferral EXCEPT?

Potential donor is currently pregnant in her second trimester. Donated a whole blood product within the last 30 days. He/she lived in the United Kingdom (UK) for a consecutive 12-month period between 1980 - 1996. (EXCEPT: An individual weighs 115 pounds at the time of donor screening.)

The greatest source of error in point of care testing is:

Preanalytical error

Which of the following would best be determined by running the same control specimen multiple times:

Precision

Cholesterol is used by the body for which of the following functions?

Precursor of hormone synthesis

Human chorionic gonadotropin (hCG) is used in the determination of:

Pregnancy

The recovery of Mycoplasma hominis from the genital tract of females has been associated with all of the following clinical syndromes EXCEPT:

Premature rupture of membranes Delivery of low birth weight infants Prematurity (EXCEPT: Bronchitis)

Which of the following is an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)?

Presence of HFE mutation

Anti-U antibodies can be produced by which of the following genotypes?

S-s-

Lysine iron agar is a less commonly used culture medium that is most helpful in the identification of:

Salmonella enteritidis

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

Saturated picric acid and sodium hydroxide (Saturated picric acid and sodium hydroxide are the main reagents used in the Jaffe reaction for creatinine determination. These chemical components usually cause the creatinine reagent to have a bright red-orange color.)

Rothia mucilaginosa is a member of the family Micrococcaceae that has been associated with endocarditis in patients after a cardiac catheterization, as well as intravenous drug users. Which test listed below would be most helpful in making a species identification? (n contrast to other members of the family Micrococcaceae, R. mucilaginosa does not grow in 5% NaCl. Although a slow catalase reaction might be considered to be indicative of R. mucilaginosa, some strains may appear more catalase active, and other members of the family Micrococcaceae may produce weak catalase reactions. Many Staphylococcus species also produce acid from fructose; therefore, this is not a differentiating test.)

Presence of a capsule (The colonies of Rothia mucilaginosa are mucoid and adhere to the surface of the agar, secondary to the formation of capsular material. Thus, the observation of capsules in microscopic mounts is a helpful feature in identifying this organism.)

A solution of gamma globulins containing anti-Rh(D) is given to an Rh(D) negative mother to:

Prevent fetal cells from initially sensitizing the mother

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

Which of the following is the prodrug of phenobarbital?

Primidone

The vascular system contributes to hemostasis in all of the following ways EXCEPT:

Production of tissue factor Diversion of blood flow around the damaged vessel Contraction of vessels (EXCEPT: Providing smooth endothelial surface)

What is the anatomical feature of a tapeworm that possesses both male and female (hermaphroditic) reproductive structures?

Proglottid

The selectivity of an ion-selective electrode is determined by the:

Properties of the membrane used

When collecting a specimen for vitamin A, which of the following special precautions needs to be taken?

Protect the specimen from light

Which of the following contributes to specific gravity but does NOT contribute to osmolality? (The presence of large amounts of protein and glucose will alter the specific gravity and should be considered when interpreting specific gravity results.) (Osmolality measures the analytes in the following equation- note that protein is not included in the calculation of osmolality.) (Osmolality = 1.86 Na + (Glucose/18) + (BUN/2.8) + 9 (or) 1.91 Na + (Glucose/15) + (BUN/2.25).)

Protein

Which of the following types of molecules is most likely to be antigenic/immunogenic?

Proteins

What are apolipoproteins?

Proteins that are on the surface of lipoprotein molecules and bind enzymes or transport specific proteins and direct lipoproteins to their sites of metabolism.

Prior to receiving antibiotic therapy, a patient had a urinary tract infection with gram-negative, motile rods producing the following reactions: Indole: pos H2S (TSI): pos MR: pos VP: neg Phenylalanine deaminase: pos Urea: pos Citrate: pos Ornithine decarboxylase: neg Gelatin hydrolysis: pos Based on the reactions above, what organism is MOST likely causing the infection?

Proteus vulgaris

Which condition is caused by the increased Plasminogen Activator Inhibitor 1 (PAI-1) and fibrinogen often present in metabolic syndrome?

Prothrombotic state

All of the following statements are true regarding the significance of performing direct microscopic examinations of specimens for culture, EXCEPT:

Provide a quality control comparison to the culture for actual isolates recovered. It can provide the physician with a rapid presumptive diagnosis. It may serve as a guide for selecting appropriate culture media based on microorganisms observed. (EXCEPT: Allows the microbiologist to discard the sample and cancel testing if no organisms are observed.)

In addition to a Romanowsky stain, which one of the following would be useful in the routine evaluation of a bone marrow?

Prussian blue

An increased D-Dimer can be associated with all of the following EXCEPT:

Pulmonary Embolism DIC Deep Vein Thrombosis (EXCEPT: Factor Deficiency)

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

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

It is essential to recognize the distinction between quality control (QC) limits and QC goals. Which is the true statement regarding these terms? (QC specifications may be derived from the total allowable error, biological variation, or other medical decision criteria.) (QC limits are defined by the process itself based on its natural variation.) (QC specifications are what you want, and QC limits are what you have.)

QC specifications (goals) are the criteria used to decide that a given method meets the clinical requirements.

Westgard multi-rule assessments are DIRECTLY applied to evaluate what?

Quality control results

Which of the following tests require a 72-hour stool (fecal) collection?

Quantitative fecal fat

The test used for the identification of specific capsular serotypes of Streptococcus pneumoniae is:

Quellung

When scanning a Wright's stained blood smear, which of the following would describe the optimum area to begin your blood smear analysis and differential white blood cell count?

RBCs are lying singly, barely touching, with occasional overlapping.

All of the following are enzymes used in molecular amplification testing methods, EXCEPT? (Amylase is a hydrolase that catalyzes the hydrolysis of complex carbohydrates including starch. It is one of the smaller enzymes and readily filtered by the glomeruli into urine. Methodologies used for amylase include saccharogenic, amyloclastic, chromogenic, and enzymatic (the preferred method of choice).) (In target amplification tests, enzymes such as reverse transcriptase, RNase, and RNA polymerase are commonly used.)

RNase Reverse transcriptase RNA polymerase (EXCEPT: Amylase) (Amylase is not used as an enzyme for molecular amplification methods.)

Which testing method is appropriate for identifying specific allergens? (Complement fixation is a traditional procedure that detects the presence of a specific antigen-antibody reaction by causing in vitro activation of complement. If complement is not fixed, lysis of the preantibody-coated reagent erythrocytes (RBCs) occurs.) (The acute-phase protein, CRP, is used clinically for monitoring infection, autoimmune disorders, and, more recently, healing after myocardial infarction.) (Radioimmunoassay (RIA) is an older and less frequently used laboratory technique that uses radioactive substances to evaluate immunoglobulins. Traditional RIA is done with specific antibodies in a liquid solution. Solid-phase RIA uses antibody-bound to a solid support, e.g. glass beads.)

Radioallergosorbent tests (RAST) (Radioallergosorbent tests (RAST) is a procedure that detects the presence of IgE (and IgG) antibodies to allergens; a method used to measure antigen-specific IgE by means of a noncompetitive solid-phase immunoassay.)

Which characteristic best describes IgG antibodies produced against red blood cells?

React best at 37 Celsius

What characteristic is usually associated with IgM antibodies directed against red cells?

React best at room temperature

Antibodies in the Rh system typically exhibit which one of the following characteristics?

Reacts best at 37ºC and AHG (Most Rh antibodies are IgG immunoglobulins and react optimally at 37oC or after antiglobulin testing in any method used for antibody detection.)

What two things are put together for the testing known as forward grouping (testing)?

Reagent antisera and patient red cells

Which one of the following statements about lipoproteins is FALSE:

Reduced LDL causes a decreased risk of atherosclerosis Elevated HDL causes a decreased risk of atherosclerosis Elevated total cholesterol causes an increased risk of atherosclerosis (FALSE: Elevated LDL causes a decreased risk of atherosclerosis)

Before testing, all cord cells should be thoroughly washed in order to:

Remove Wharton's jelly

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

Renal tubular epithelial cells

For a clinical PCR assay, if you have a negative sample with a negative internal control on your run, what should you do?

Repeat the sample

A protected brush specimen was received into the microbiology laboratory from an ICU patient and cultured using a 0.001-mL loop. The culture grew 3 colonies of Pseudomonas aeruginosa. Which of the following is the correct way to report out the organism?

Report out 3,000 CFU/mL of Pseudomonas aeruginosa

Gram positive cocci isolated from a catheterized urine culture on a 76-year-old male gave the following reactions: Blood agar- creamy, white, opaque colonies with are not hemolytic Catalase- positive Slide coagulase- negative Tube coagulase- negative Novobiocin- susceptible The next action that the medical laboratory professional should take is to:

Report the isolate as coagulase negative staphylococcus

A semen specimen was collected three hours before it was brought to the laboratory for examination. What course of action should be taken?

Report the specimen as compromised on the final report.

A young man is experiencing difficulty breathing after fainting. The physician orders an arterial blood gas analysis which shows the following results: pH = 7.25 pCO2 = 62 mmHg pO2 = 70 mmHg HCO3- = 23 mmol/L Which condition is most likely afflicting this patient?

Respiratory acidosis

All of the following statements are correctly matched with their corresponding nucleic acid, EXCEPT:

Responsible for amino acid transport - tRNA Location of protein synthesis - rRNA Carries genetic information from the cell nucleus to ribosomes in the cytoplasm, where it serves as a template for protein synthesis - mRNA (EXCEPT: Responsible for transportation of information - DNA)

Which of the following best describes random error?

Results may be either above or below the mean.

In serum protein electrophoresis all of the following proteins reside in the band closest to the anodal end EXCEPT:

Retinol-binding protein (RBP) Transthyretin Albumin (EXCEPT: Haptoglobin)

What molecular technique is appropriate for HIV-1 genotyping?

Reverse Transcriptase Polymerase Chain Reaction

The amplification of an RNA target through Reverse transcription PCR (RT-PCR) to detect HIV requires the following enzyme for the initial synthesis of DNA from the viral RNA template:

Reverse transcriptase (Reverse transcriptase is the enzyme used to synthesize DNA from an RNA viral template.)

A ficin (enzyme) treated panel can be a useful tool for determining the identity of an antibody. On a ficin-treated panel, reactions with which system would be enhanced?

Rh

A patient with multiple myeloma has the following reactions in the ABO typing: Anti-A= w+ Anti-B = w+ Anti-A,B = w+ Auto control = w+ A1 Cells = 4+ B cells = 4+ What is probably causing these results?

Rouleaux

The classic TORCH panel of tests includes the following diseases with the exception of: (Infectious mononucleosis is not in the TORCH grouping of assays.) (The TORCH panel is an acronym for Toxoplasma gondii; other viruses, rubella, cytomegalovirus, and herpes viruses. It is important in diseases that do not manifest decisive clinical signs and symptoms, or under conditions in which a rapid therapeutic decision may be required. TORCH specifically evaluates the presence of IgM or IgG. This panel is used to screen newborns, and sometimes, pregnant women for certain infections that can cause birth defects.)

Rubella Toxoplasma gondii Cytomegalovirus (exception: Infectious mononucleosis)

Which anemia is formed due to the inability to incorporate iron into the protoporphyrin ring? (Iron deficiency anemia is due to a lack of iron through diet, increased need, or increased loss of iron from the body.) (Anemia of Chronic Inflammation is due to the presence of acute-phase reactant proteins that impede the absorption and transport of iron.) (Thalassemia is a disorder that is due to the lack of globin chains being synthesized, the heme production is normal.)

Sideroblastic Anemia (Sideroblastic anemia occurs due to lead poisoning or porphyrias.) (In both, the iron is unable to be incorporated into the protoporphyrin ring upon the development of heme resulting in anemia.)

Which method remains the "gold standard" for ANA detection? (RIA (radioimmunoassay) is not a method used for ANA testing, due to the hazards of working with and disposing of the required radioactive labels.) (Ouchterlony immunodiffusion is a highly specific, but insensitive technique that has been used to identify antibodies to specific extractable nuclear antigens (ENA).) (Solid phase assays such as microbead and ELISA assays are automated but have a lower sensitivity than IFA, resulting in a higher number of false negative results.)

Slide-based immunofluorescent assay (IFA) (The slide-based immunofluorescent assay (IFA) using HEp-2 cells is considered to be the gold standard for antinuclear antibody (ANA) testing.) (This is because the IFA is highly sensitive, detecting a wide range of antibodies to nuclear antigens present in their natural form and location in the cells.)

Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?

Small dense LDL

Why are small dense LDL molecules more atherogenic?

Small dense LDL molecules have greater mobility in the endothelium and arterial wall.

Which of the following cells is characterized by a thin rim of cytoplasm around the nucleus?

Small lymphocyte

Enzyme panel reactions cannot be used as the only source of rule-outs during antibody identification. Why is this? (The antigens can no longer bind with the corresponding antibody once denatured. If antibodies to those denatured antigens are present, in the sample being tested, the panel will not detect the antibody. Enzyme panels are useful when it appears that multiple antibodies may be present, and the enzyme panel is a tool that may help separate the specificities and allow for identification.) (Enzyme treatment will enhance the antibody-antigen reactions of the Rh, Kidd, Lewis, P1, I and ABO systems.) (Enzyme treatment will destroy, or inactivate the antibody-antigen reactions, of the Duffy, MNS, and Xga system)

Some antigens are destroyed and may not detect an antibody that is present (Treating cells with enzymes will denature some of the antigens present on a panel.)

In a HPV infection, where does the viral DNA replicate? (If malignant transformations occur in the host cells, the malignancy spreads to glandular and intraepithelial cells.) (White blood cells are not a target for HPV.)

Squamous epithelial cells (DNA of HPV replicates in host squamous epithelial cells.)

Which of the following Staphylococcus species will produce yellow colonies on mannitol salt agar?

Staphylococcus aureus

The detection of a distinct odor is often helpful in the presumptive identification of bacterial culture isolates. Which bacterial species may produce a distinctive odor of butterscotch or honeysuckle? (Pseudomonas aeruginosa may produce a fruity or grape smell.) (Proteus mirabilis may produce a "burnt chocolate" smell.) (Eikenella corrodens may produce a bleach-like odor.)

Streptococcus anginosus

All of the following are common causes of infective endocarditis, EXCEPT?

Streptococcus mutans Cardiobacterium hominis Staphylococcus epidermidis (EXCEPT: Corynebacterium jeikeium)

Antibodies are ruled out using panel cells that are homozygous for the corresponding antigen because:

Stronger reactions are seen with homozygous cells

All of the following are functions of cerebrospinal fluid, EXCEPT?

Supply nutrients to nervous system tissue. Protect the spinal cord from injury. Remove waste products from cerebral metabolism. (EXCEPT: Regulate body metabolism.)

All of the following have an impact on electrophoresis techniques in the clinical laboratory EXCEPT?

Support medium pH Voltage (EXCEPT: Amount of light present in electrophoresis box)

Which autoimmune disorder is characterized by a homogenous pattern in an immunofluorescence (IF) microscopy test for anti-nuclear antibodies (ANAs)?

Systemic Lupus Erythematosus (SLE)

Which immune elements are involved in a POSITIVE TB skin test?

T cells and macrophages

What is the primary target of HIV (human immunodeficiency virus)?

T-helper cells

What is the correct statement when describing molecular testing techniques?

Target amplification assays use methods to make more copies of a specific region of DNA.

The principal amount of testosterone in males is produced by which endocrine gland?

Testes

What is an appropriate use for molecular (DNA) tests for mutations of the HFE gene, the gene found in the majority of patients diagnosed with hereditary hemochromatosis (HH)?

Testing family members of persons with HH

What antibody is best described as common autoantibody that can be found in virtually all sera?

anti-I

Which of the following may be associated with acidic urinary pH?

High urine glucose

Which organism will infect humans and a wide range of host animals?

Mycobacterium bovis

A false-negative reaction while performing the DAT technique may be the result of:

AHG addition delayed for 40 or more minutes

Which of the following patients is most at risk for hyperosmolar nonketotic coma?

A 70-year-old type 2 diabetic patient

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

A state of abnormal lipids and lipid levels found in metabolic syndrome contribute to the development of cardiovascular disease

The plant lectin obtained from the Dolichos biflorus plant will agglutinate which of the following?

A1 cells

What ABO phenotype will exist in an individual that inherits an A gene from one parent and a B gene from the other?

AB

A 40-year-old man with a prosthetic valve developed intermittent bouts of low grade fever. A changing cardiac murmur suggested the possibility of endocarditis; however, repeat blood cultures over a two week period were all negative. Bacteria resembling those seen in the lower image were finally seen in Gram stain of a positive bottle. Colonies were recovered when broth was subcultured to a blood agar plate with a staph streak, as shown in the upper image. What is the most likely bacterial species?

Abiotrophia defectiva

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

Adiponectin

Which of the following tumor markers is associated with testicular cancer?

Beta hCG

Which is in the correct order from the lowest concentration of H antigen to the highest concentration of H antigen?

Bombay, A1B, A1, A2B, B, A2, O

Which of the following statements concerning vancomycin resistance in Enterococci is TRUE?

Both ampicillin and vancomycin resistance are found more frequently in E. faecium than in E. faecalis.

While serum elevations are NOT generally seen in early stages, which of the following tumor markers are elevated in more advanced stages of breast cancer?

CA 15-3 and CA 549

This yeast has been found in respiratory secretions, the vagina, urine, gastric washings, and the oropharynx, but is mainly thought to cause vaginitis and urinary tract infections. Growth on Cornmeal Tween 80 agar demonstrates elongated blastoconidia that lie parallel to pseudohyphae (like logs on a stream).

Candida kefyr (pseudotropicalis

A patient that has 2% peripheral blood blasts, absolute monocytosis, and 10% bone marrow blasts would be classified as which Myelodysplastic Syndrome?

Chronic Myelomonocytic Leukemia

Which of the following lipoproteins will form a creamy layer at the top of stored, non-fasting plasma specimens?

Chylomicrons

A representative congenital neutrophil functional disorder is: (Abnormal granulation can be seen in the cytoplasm of leukocytes)

Chédiak-Higashi syndrome

A 64-year old man lost 15 pounds, became weaker, and his face became fuller with a ruddy complexion. His laboratory tests revealed: Serum cortisol8 AM: 880 nmol/L, 138-635 nmol/L (reference range)4 PM: 828 nmol/L, 83-414 nmol/L (reference range) After these results, an overnight dexamethasone suppression test gave a cortisol level of 773 nmol/L. The MOST probable diagnosis for this patient is:

Cushing's Syndrome

Which of the following best describes a resting lymphocyte?

Cytoplasm is light blue and nucleus is about the size of an erythrocyte.

When performing the rosette test to screen for Fetal Maternal Hemorrhage, what is considered the correct combination to avoid false positives and/or false negatives?

Fetal cells D positive & mother is D negative

Which of the following methods for long-term diabetic monitoring is recommended for patients with sickle cell anemia?

Fructosamine

Which of the following species of bacteria is positive for rapid urease production, as demonstrated by a color change in urea agar from yellow to pink within two hours?

Helicobacter pylori

Select the equation which is used to determine the pH of a solution containing a weak acid and its salt.

Henderson-Hasselbalch equation

Methods of identifying many of the major hemoglobin variants such as Hb A, Hb F, Hb S, etc. include all of the following EXCEPT:

High performance liquid chromatography (HPLC) Citrate agar electrophoresis Alkaline electrophoresis (EXCEPT: Sodium metabisulfite solubility test)

A critically ill 86-year-old female was admitted to the intensive care unit (ICU) after arriving at the emergency department with symptoms that included shortness of breath and fever. Her temperature was 39°C (102°F) and pulse rate 110/minute. A white blood count (WBC) was ordered and was elevated at 15.0 x 109/L. The differential showed an increase in segmented and immature neutrophils. Another testing was ordered after admission to ICU, including a procalcitonin (PCT). The result was 2.15 ng/mL (The reference value for normal at the 95th percentile is <0.05 ng/mL). Given the clinical assessment and laboratory test results, what may the increased procalcitonin indicate?

High risk of severe sepsis/septic shock

The 70 µm ovum, illustrated in this high power microscopic view of a saline preparation, is uncommonly found in human feces. This parasite is more commonly found in rats and mice, but infections may be uncommonly transmitted to humans. Water or food contaminated with arthropod related insects within which the cysticercoid larval forms develop may be inadvertently ingested. Once in the human intestine, these larvae develop into adults that attach to the lining cells, and excrete ova that may be observed in fecal specimens. Select the name of the cestode represented by this ovum.

Hymenolepis diminuta

What additional information is required on a label or tie tag of an autologous unit?

Identification of the recipient

Facial masks should be worn in the laboratory:

If mucous membrane contact is anticipated

A secondary immune response is generally associated with which of the following antibodies?

IgG

Which of the following antibody types is the predominant serum antibody seen in the secondary immune response:

IgG

A primary immune response is generally associated with which antibody?

IgM

A primary immune response typically presents with which class of antibody?

IgM

Which occurrence is a medical error?

Incompatible blood is transfused into a patient during surgery

What would you expect the serum iron (SI) and total iron-binding capacity (TIBC) to be in a person with hereditary hemochromatosis (HH)?

Increased SI and decreased TIBC

Which of the following is the most common condition associated with a nonmegaloblastic macrocytic anemia?

Liver disease

Which type of lipoprotein transports the MAJORITY of cholesterol to cells for steroid hormone synthesis or cell membrane incorporation?

Low-density lipoproteins (LDL)

Which of the following cells have pale blue cytoplasm with a few azurophilic granules and an oval or indented nucleus?

Lymphocyte

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

CD5 antigen is normally found on which of the following lymphocyte populations?

Mature T cells

What coenzyme does LD use when converting lactate to pyruvate?

NAD+

All of the following are granulocytes EXCEPT:

Neutrophilic band Basophil Mast cell (EXCEPT: Mott cell)

Which of the following statements regarding peak level in therapeutic drug monitoring is true?

Peak level is assessed by collecting a blood sample after a dose of the drug is given (at a specified time).

The reticulocyte count is used to assess which of the following?

RBC production by the bone marrow

Which of the following statements is true regarding primary hemostatic process resulting from vascular damage?

Rapid and immediate vasoconstriction by contraction of smooth muscles.

An urticarial transfusion reaction is characterized by which of the following?

Rash and hives

Rocky Mountain spotted fever (RMSF) is transmitted by the bite of a tick infected with:

Rickettsia rickettsi

What is the purpose of the BNP test?

Rules out acute heart failure in the emergency setting.

When administering fresh frozen plasma (FFP), which one of the following is considered standard blood bank practice?

Should be ABO compatible with the recipient's red blood cells

Which statement best describes small dense LDL particles that can occur in atherogenic dyslipidemia?

Small dense LDL molecules are more atherogenic because they can more easily move into the endothelium and vessel wall

Out of the choices below, which set of cells is arranged from least mature to most mature?

Stem Cell, Rubriblast, Prorubricyte, Rubricyte, Metarubricyte, Reticulocyte, Erythrocyte

A patient has been diagnosed with an upper gastrointestinal bleed. Which of the following would be characteristic of this condition?

Stool much darker brown or black color

Which of the following forms of hemoglobin cannot be detected by routine hemoglobin methods?

Sulfhemoglobin

Which of the following immunosuppressive drugs below has been associated with thrombus formation in patients with toxic levels?

Tacrolimus

A laboratory test flags a critical result. The technologist repeats the test, and it again flags as a critical result. Which of these scenarios correctly describes all the actions that need to be taken after this occurs?

The technologist phones the patient's caregiver, reports the result, and asks the caregiver to read back the information; documents his placement of the call, who was notified, time, and date of notification.