MLT Boards

Which of the following characteristics of hemolytic disease of the fetus and newborn (HDFN) is NOT different for ABO and Rh HDFN?

Antibody is IgG

Detection of a fruity odor in a fresh urine sample may be indicative of all of the following EXCEPT: Starvation Malabsorption Bacterial infection Diabetes mellitus

Bacterial infection

Which of the following methods for long-term diabetic monitoring is recommended for patients with sickle cell anemia?

Fructosamine

You are analyzing a patient sample in the hematology laboratory when the instrument you use for automatic CBC flags your specimen for having a low platelet count. Upon performing a visual differential of the slide, you notice that there are indeed very few platelets on the slide. You also notice numerous, fragmented red blood cells. Which of the following choices could be associated with the low platelet count and fragmented red blood cells found in this case?

Thrombotic Thrombocytopenic Purpura (TTP)

Which of the following statements is true regarding cardiovascular disease and adipose tissue?

Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease.

What type of specimen is used for testing cyclosporine levels?

Whole blood

Enzyme-multiplied immunoassay techniques (EMIT) differ from all other types of enzyme immunoassays in that:

No separation of bound and free antigen is required.

Which of the following viruses is MOST often reported as the cause of infection leading to aplastic crisis in a patient with sickle cell disease?

Parvovirus B19

The following are all possible causes of cell death in HIV infections, EXCEPT? Cytoplasmic leakage (cell lysis) Depletion of T-lymphocytes, replaced by syncytia Penetration of the membrane by the HIV spike Depletion of cellular components

Penetration of the membrane by the HIV spike

A 34-year-old female was seen in the dermatology clinic for some lesions on her fingers that had not responded to topical antimicrobial therapy. A tissue biopsy was sent for histological examination, routine culture, acid-fast bacilli (AFB) culture, and fungal culture. There was no growth on any culture, but AFB were seen in the histological preparations. The tissue culture for AFB had been incubated at both 35oC and 32oC, in liquid media and on media with hemoglobin added for several weeks. What is the most likely diagnosis of her skin lesions?

leprosy

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

presence of the HFE mutation

A CSF specimen was sent to the laboratory for analysis. A glucose, protein, and cell count were performed. Based on the following results, what would be the probable cause? Analyte Result Glucose 15 mg/dL Protein 150 mg/dL Leukocytes 1,000 cells/mm3 neutrophils

purulent infection

Some strains of Group F Strep can carry the group A antigen, potentially leading to a false positive identification of group A, Streptococcus pyogenes. A spot test that is helpful in differentiating these two species and thus preventing a false report is:

Pyrrolidonyl-b-naphthylamide (PYR)

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

Quantitative fecal fat

In which Myelodysplastic Syndrome classification would a patient having <5% blasts and <15% ringed sideroblasts belong?

RA

Which adsorption technique removes cold (IgM) antibodies, particularly anti-I specificities?

Rabbit erythrocyte stroma (RESt)

The kidneys perform all of the following functions EXCEPT:

Reabsorption of waste products

Given the following results, what is the immune status of the patient? HBsAg: negative HBeAg: negative Anti-HBc: positive Anti-HBs: positive

Recovery

The element that is indicated by the arrow is a:

Red blood cell cast

Which one of the following anticoagulants is used most commonly for most coagulation studies?

sodium citrate

Most disorders associated with a primary immunodeficiency are _________ disorders.

B-cell

What are the acute phase proteins?

Alpha-1 Antitrypsin C-Reactive Protein Fibrinogen

Which of the following organisms are gram-positive?

Clostridium difficile

A 3-year-old girl was brought to a physician's office because of fever and bacterial-type illness symptoms. Her blood pressure was elevated. Gram stain of peripheral blood shows Gram-negative rods.Hemogram: hemoglobin 9.1g/dL (normal 12.0 - 16.0 g/dL), hematocrit 28% (normal 37 - 48%), MCV 80 fl (normal 86 - 98 fl), RDW 13.1% (normal 11 - 15%), platelets 85.1 X 109/L (normal 150 - 450 X 109/L) WBC 9.9x109/L (normal 4.3 - 10.8 x 109/L). The peripheral blood smear is represented in the photograph. Which of the following is the most likely associated condition?

Hemolytic uremic syndrome (HUS)

Serum calcitonin is typically elevated in which of the following conditions?

Medullary carcinoma of the thyroid

A 45-year-old African American female has been diagnosed and treated for type 2 diabetes for the past five years. She maintains good control of her blood glucose with medication but does not exercise and has gained 12 pounds over the past year. At her next appointment, her physician orders hs-CRP along with blood assays to monitor her diabetes. Laboratory Result: hs-CRP 2.8 mg/L

Moderate risk for cardiovascular disease

The following are described as rapid growing, opportunistic fungi that are differentiated based on the presence of sporangiospores, the shape of the columella, presence or absence of rhizoids, and the location of the rhizoids on the stolon.

Mucorales species

Which of the following blood smear observations would support the diagnosis of Multiple Myeloma if a patient demonstrated plasma cells in his bone marrow and had an elevated serum IgG?

Rouleaux formation

Gastrointestinal infections of which of the following a organisms are associated with hemolytic uremic syndrome?

Shiga toxin producing E. coli

Which is a selective medium for Campylobacter jejuni?

Skirrow agar

The principle behind the diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH) by flow cytometry is:

Using a fluorescein labeled proaerolysin variant to selectively bind to GPI anchor proteins

Which of the following is the proper storage temperature for fresh frozen plasma (FFP)?

-20 C

How long after collection can a patient's sample be used for compatibility testing?

72 hours

Which group of conditions increases the risk of HbS polymerization?

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

What can be ingested from water and/or food contaminated with the infective cysts. It produces a large cyst and trophozoite entirely covered in cilia. Both stages are also known to contain a kidney-bean shaped macronucleus and a small, round micronucleus.

Balantidium coli

Patients may sometimes develop antibodies to which antigen without having a red cell stimulation?

Lu a

LASER is an acronym for

light amplification by stimulated emission of radiation.

What is the normal pH range for semen?

7.2-8

Which of the following organisms is responsible for myonecrosis with gas gangrene, food poisoning as well as necrotizing enteritis, a life threatening that causes ischemic necrosis of the jejunum?

Clostridium perfringens

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

Copper reduction

Which of the following is the prodrug of phenobarbital?

Primidone

The body of an adult cestode consists of segments called:

Proglottids

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

Prostate Cancer

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

Proteins

Following a major trauma event, a family of four walks into your donor center hoping to donate blood. Which one of the following individuals may donate blood today? A 14-year-old girl who received an ear piercing 6 weeks ago. A 53-year-old man who worked and resided in the United Kingdom from 1983-1989. A 49-year-old woman who donated whole blood 5 weeks ago. A 22-year-old woman using oral contraceptives.

A 22-year-old woman using oral contraceptives.

How is beta thalassemia defined?

A decrease in the rate of production of beta chains due to a partial or total deletion of loci from chromosome 11 that code for the beta chain.

Which of the following drug examples would be a good candidate for therapeutic drug monitoring (TDM)?

A drug that has a narrow therapeutic window

Approximately what percent of the Caucasian population is Rh negative?

15%

Osmolality

2 x Na + [Glucose (mg/dL) / 20] + [BUN (mg/dL)/ 3]

Red blood cell units that contain CPD (citrate-phosphate-dextrose) can be stored for up to how many days?

21 days

What is the expected life span of a normal red blood cell?

3-4 months

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

50

Which of the following organisms is most likely to be associated with gas gangrene:

Clostridium perfringens

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

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 high specificity?

Accurately identifies the absence of disease

Gas-liquid chromatography is useful in the identification of anaerobes in addition to Gram-stain morphology. Which anaerobe produces succinic acid in abundance?

Actinomyces israelii

Which of the following chemical substances induces platelet adhesion when there is a break in the inert epithelial lining of the vasculature?

Adenosine diphosphate (ADP)

Which of the following tumor markers is associated with testicular cancer?

Beta hCG

What has the distinctive extension of two nuclei into the tail section, separated from one another by an open space. The adult worms more commonly inhabit the lymphatics of the inguinal region resulting in swelling below the knee, a condition known as elephantiasis.

Brugia malayi

A rapid urine screening test that can be performed to detect the presence of Staphylococcus species is which of the following tests?

Catalase test

What antinuclear antibody (ANA) staining pattern is demonstrated in this microscopic, fluorescent test image?

Centromere

The India ink preparation is used for presumptive identification of which organism?

Cryptococcus neoformans in CSF

The most highly specific indicator for rheumatoid arthritis is:

Cyclic citrullinated peptide antibodies (CCP antibodies)

Leukocyte-reduced blood products may be administered to reduce the risk of febrile reactions and what disease or condition?

Cytomegalovirus

Disorders affecting the thyroid, pituitary, and adrenal glands can all lead to anemia (mild to moderate). This is most often associated to which of the following?

Decrease in erythropoietin (EPO)

Which of the following sets of results is indicative of stage 3 iron deficiency (iron deficiency anemia)?

Decreased ferritin, increased soluble transferrin receptor (sTfR), increased TIBC

What is the Kleihauer-Betke test used for?

Differentiate between maternal and fetal red cells

Illustrated in this photograph is a close-in view of colonies growing on the surface of xylose lysine deoxycholate (XLD) agar. The bacterial species most likely producing the colonies shown here is:

Edwardsiella tarda

Which enzyme is responsible for the conjugation of bilirubin?

Glucuronyl transferase

The alkaline hemoglobin electrophoresis pattern that is shown on the right includes controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 3 and 4. The patient lanes (3 and 4) displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

HbS/HPFH

Specimens for blood gas determination should be drawn into a syringe containing:

Heparin

The colonies shown in the upper image were obtained on blood agar from a sputum specimen after 10 days incubation at 30°C. The lower image is a photomicrograph of a lactophenol blue mount made from a portion of the colony. The delicate cob-web appearance of the colonies on blood agar (upper image) and the production of macroconidia with a conspicuous prickly surface as seen in the lower image are characteristic of:

Histoplasma capsulatum

Identify the antinuclear antibody (ANA) staining pattern in the image (a) and interpret what related disorder can be associated with this pattern?

Homogeneous or Diffused staining pattern; Systemic Lupus Erythematosus

The 70 µm ovum illustrated in the high power microscopic view of a saline preparation is uncommonly found in human feces. The cestode represented by this ovum 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. From the multiple choices listed below, select the name of the cestode represented by this ovum.

Hymenolepis diminuta

Which blood group is most frequently associated with Cold Agglutinin Disease (CAD)?

I

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

LASER is an acronym for light amplified by stimulated energy radiation

Which of the following are considered two of the positive risk factors for coronary heart disease as determined by the National Cholesterol Education Program (NCEP)?

LDL-C concentration = 100 mg/dL; HDL-C concentration < 40 mg/dL

Methotrexate is a highly toxic medication that blocks DNA synthesis in all cells. What medication needs to be administered after methotrexate to prevent cytotoxic effects in normal cells of the body?

Leucovorin

Laboratory results obtained on a 47-year-old patient were as follows: WBC 51.2 x 103/µL RBC 4.27 x 106/µL HGB 12.6 g/dL HCT 36.9% PLT 403 x 103/µL Differential: 50% segmented neutrophils 20% bands 12% lymphocytes 7% monocytes 1% eosinophils 9% metamyelocytes 1% myelocytes RBC morphology: normocytic, normochromic WBC morphology: moderate toxic granulation, slight Dohle body Which test would be MOST helpful in establishing a diagnosis in this case?

Leukocyte alkaline phosphatase stain (LAP stain)

A tech is interpreting a urine culture with a source of suprapubic aspiration. There is one colony of Staphylococcus epidermidis present on the blood agar which was streaked with a 0.01 loop. What should the tech do next?

List and provide a sensitivity for the S. epidermidis

An important metallic activator of alkaline phosphatase and creatine kinase is:

Magnesium

In HDFN which of the following antigen-antibody reactions is occurring?

Maternal antibody is directed against fetal antigen.

When evaluating the patterns of fluorescent anti-nuclear antibody (FANA) testing, cytoplasmic patterns:

May demonstrate anti-mitochondrial antibodies seen primary biliary cirrhosis

What is the precursor of the platelet which is commonly only found in the bone marrow?

Megakaryocyte

Which assay, using 24-hour urine, is considered the BEST single screening test for pheochromocytoma?

Metanephrines

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?

Not Corrected, Coagulation Inhibitor

The stage of Ixodes tick most likely to transmit Lyme disease is:

Nymph

Patients with a diagnosis of malaria who have fever spikes less frequently, spanning three or four days, are said to have "quartan malaria". Illustrated in the high power upper photomicrograph is a stained peripheral blood smear. Note the infected red blood cell that contains a developing trophozoite that distinctively "bridge" between the opposite erythrocyte membranes. The lower photomicrograph illustrates the schizont stage of development in which segments are arranged as a rosette around a central aggregate of malarial pigment. Which of the Plasmodium species is represented in this scenario?

Plasmodium malariae

Which of the following conditions would be suggested by a jaundiced patient experiencing a marked rise in alkaline phosphatase (ALP), conjugated bilirubin, and a slight rise in alanine aminotransferase (ALT)?

Post-hepatic cholestasis

Steps to deciding how many units to phenotype.

STEP 1: The percentage of donors negative for each antigen should be written in decimal points, and then multiplied: 0.91 (K negative) X 0.37 (Fya negative) = 0.33 STEP 2: Next, find the reciprocal of the number found in the first step. In other words, divide 1 by the number you calculated in the first step: 1/0.33 = 3 STEP 3: multiply by how many units needed IE, 2 units needed so 3x2=6

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

Saturated picric acid and sodium hydroxide

All of the following are true of lab results of patients with Glanzmann thrombasthenia EXCEPT? Deficient GPIIb/IIIa Severe thrombocytopenia Increased bleeding time Abnormal platelet aggregation with ADP, collagen, and epinephrine

Severe thrombocytopenia

Enzyme panel reactions cannot be used as the only source of rule-outs during antibody identification. Why is this?

Some antigens are destroyed and may not detect an antibody that is present

Calculation for specificity

Specificity % = [True negatives / (True negatives + False positives)] X 100

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

Speckled

What is the primary target of HIV (human immunodeficiency virus)?

T-helper cells

A 6-year-old girl was seen in the emergency department with pain and tenderness in her lower right quadrant. A CBC showed a high white blood cell count with increased segmented neutrophils and bands. The child was admitted to surgery with a diagnosis of appendicitis. During surgery the appendix appeared normal, but an enlarged node was removed and cultured. A diagnosis of mesenteric lymphadenitis was made. Gram-negative rods were isolated. Which of the following biochemical results are most likely produced by the suspect organism?

TSIA acid over acid, H2S negative, lysine negative, indole variable, urea positive

The purified protein derivative (PPD) test is also known as:

Targeted tuberculin testing

A physician calls the lab to order a Hepatitis A IgG test but cannot find the code. What do you tell the physician?

There are no IgG-only tests for Hepatitis A, only a total with/without reflex to IgM

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

Transfusion of ABO incompatible red blood cells

Which protein is also known as prealbumin because it migrates before albumin in the customary electrophoresis of serum or plasma proteins?

Transthyretin

The 50 µm ovum illustrated in this image was recovered from a diarrheal stool specimen from a 30-year-old male one month after a visit in Puerto Rico. Dysentery, abdominal discomfort, and low grade diarrhea had been experienced. Select the most likely genus/species identification.

Trichuris trichiura

Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that she has had an acute myocardial infarction (AMI), but did not feel the severe chest pain because of diabetic neuropathy. She has not felt well since November 20th and her physician believes she possibly had an AMI on November 20th. Assuming that the infarct was uncomplicated, which of the following cardiac biomarkers would most likely still be elevated and would assist in an AMI diagnosis?

Troponin T

If Jka is showing dosage, how might reactions on an antibody panel appear?

Weaker if heterozygous for Jka and Jkb