Adaptive Practice Questions
Unable to determine cause of infection
25-year-old female presented in the emergency room with an acute urethral discharge of two days duration. The image to the right shows the Gram stained smear that was obtained. Many polymorphonuclear leukocytes and intracellular and extracellular gram-negative diplococci were observed. Based on the clinical history and the Gram stain observation, what diagnosis can be made?. - Neisseria gonorrhoeae infection - Moraxella species infection - Unable to determine cause of infection - Trichomonas vaginalis infection
Hemoglobin electrophoresis
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. 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? - B12 and Folate - Coagulation profile - Hemoglobin electrophoresis - Iron studies
Anti-Leb
If detected in antibody screen testing, which of the following antibodies is NOT considered clinically significant in prenatal patients? - Anti-M - Anti-N - Anti-Leb - Anti-Fya
Group A
Illustrated in this photograph is a blood agar plate inoculated with a beta hemolytic streptococcus obtained from a throat culture of a patient with acute pharyngitis. A 0.04 µg bacitracin (left) disk and a SXT disk (right) had been placed in the areas of streaking. The reactions observed allow the most likely presumptive identification of a streptococcus belonging to Lancefield group:
- leucine = oily. highly refractile. yellow-brown spheroids with radial concentric laminations. acid urine. Maple Syrup Urine Disease (MSUD). - cholesterol = large, flat. transparent plates with notched corners. acid urine. soluble in hot alcohol & ether. - uric acid = yellow-brown 4-sided flat planes / rosettes / wedges. acid urine. - cystine = colorless. hexagon / benzene ring. acid urine. Cystinuria.
Urine crystals
Weak subgroup of A
What is the MOST likely cause of the ABO discrepancy when the following results were obtained from a first-time 29-year old, blood donor? Forward Group Anti-A = Negative Anti-B= Negative Reverse Group A1 Cells = Negative B Cells = 3+ - Loss of antigen due to disease - Acquired B - Low immunoglobulin levels - Weak subgroup of A
Reverse Transcriptase Polymerase Chain Reaction
What molecular technique is appropriate for HIV-1 genotyping?
HBs antigen
What sero-marker is the first marker to become positive in Hepatitis B and is associated with the infective stage?
The sample must cross the threshold and peak within the target temperature range
What two components must be true in order to call a positive sample using real-time PCR and melt curve analysis?
Hemagglutinin and Neuraminidase
What two glycoproteins are expressed on the surface of influenza A viruses and are used for subtyping of the viruses? - Hemagglutinin and Neuraminidase - Glycoprotein120 (gp120) and Protein 24 (p24) - Glycoprotein 41 (gp41) and glycoprotein 120 (gp120) - Neuraminidase and protein 24(p24)
Protect the specimen from light
When collecting a specimen for vitamin A, which of the following special precautions needs to be taken? - Keep specimen at body temperature (37° C) - Chill the specimen in an ice bath - Protect the specimen from light - There are no special precautions required
Decreased serum copper
When evaluating a patient for a suspected Wilson's Disease diagnosis, low values of plasma ceruloplasmin would be expected along with: - Decreased urine copper - Increased serum copper - Normal urine copper - Decreased serum copper
24 hours
When transporting donated platelet units, what is the maximum amount of time that agitation of platelets can be stopped for?
Capnocytophaga ochracea
Which Gram negative organism can produce "gliding motility" on agar plates and is a primary cause of juvenile periodontitis?
T cytotoxic
Which T lymphocyte expresses the CD8+ marker and acts specifically to kill tumor or virally-infected cells?
Cycloheximide
Which antimicrobial is used to suppress or kill saprophytic molds in media? - Gentamicin - Cycloheximide - Chloramphenicol - Amphotericin B
Streptomyces anulatus
Which bacterial species is most likely represented by the opaque, chalky, white colony appearance as illustrated in the photograph? - Bacillus cereus - Listeria monocytogenes - Burkholderia pseudomallei - Streptomyces anulatus
MCV
Which of the following RBC indices is expressed in femtoliters?
Plasma cell
Which of the following cells are of lymphoid lineage? - Plasma cell - Macrophage - Eosinophil - Megakaryocyte
Monocytes
Which of the following cells have a blue-gray cytoplasm with a "ground glass" appearance and vacuoles in the cytoplasm?
Movement of hand or arm during specimen collection.
Which of the following conditions would make a sample unsuitable for lactic acid testing? - Movement of hand or arm during specimen collection - Received in the laboratory on ice - Centrifuged in a refrigerated centrifuge - Specimen centrifuged and plasma separated from cells less than 15 minutes after collection
Carry oxygen
Which of the following describes the main function of hemoglobin? - Hemostasis - Fight infection - Carry oxygen - Support bone marrow stroma
CDe/ce
Which of the following genotypes is found with the highest frequency in the Caucasian population? - CDe/cDe - cDE/ce - cDE/cE - CDe/ce
EIA or indirect immunoflourescence
Which of the following serological tests would be used for the diagnosis of Q-fever? The correct answer is highlighted below
CEA
Which of the following tumor markers is associated with the colon? - PSA - CEA - Beta hCG - AFP
Clot tube stored at 4 C, transfusion reaction, and warm autoimmune disease
Which of the following would be a possible cause of a positive direct antiglobulin test (DAT)?
It is metabolized in the kidney
Which one of the following statements about acetaminophen metabolism is false?
Hemoglobin of 12.0 g/dL
Which one of the physical examination results below may be cause to reject a donor from blood donation?
Nucleic acid testing for HCV
Which test is NOT used as a screen for retroviruses in donated blood? - Antibody to HIV type 1 or type 2 - Nucleic acid testing to detect HIV-1 RNA - Antibody to HTLV types I and II - Nucleic acid testing for HCV
Low density lipoproteins (LDL)
Which type of lipoprotein transports the MAJORITY of cholesterol to cells for steroid hormone synthesis or cell membrane incorporation? - Chylomicrons - Very low density lipoproteins (VLDL) - Low density lipoproteins (LDL) - High density lipoproteins (HDL)
It is an acute phase reactant that is frequently elevated in a variety of clinical conditions.
Why might serum ferritin (SF) alone be considered a less than optimal screening test for hereditary hemochromatosis (HH)?
Urine, serum, and whole blood
Acetest® can be used to test for ketones in:
Suckers
Adult cestodes utilize which body part to attach to the human intestine? - Strobila - Tegument - Proglottids - Suckers
24
After frozen RBC's have been thawed and washed, they must be used within how many hours?
Marasmus
Albumin levels are can be a good gauge for chronic protein deficiency. Which of the following terms describes inadequate protein and caloric intake? - Kwashiorkor - Marasmus - Albuminemia - Hypoproteinism
Eosinophil - parasite. allergies. - releases granules that contain potentially damaging & toxic substances to allergies - don't phagocyte but forms granulomas around
All of the cells listed below function as a phagocyte, EXCEPT?
Eliminate bioterrorism
All of the following are functions of the Laboratory Response Network (LRN), EXCEPT?
Serratia rubidaea
All of the following bacterial species produces a yellow pigmented colony when growing on 5% sheep blood agar EXCEPT: - Cronobacter sakasakii - Serratia rubidaea - Pantoea agglomerans - Micrococcus luteus
Myocardial infarction
All of the following conditions produce glycosuria, EXCEPT?
Each day of use
At what frequency should quality control testing be performed on each lot of anti-human globulin to be in compliance with the FDA's current good manufacturing practices requirements?
D
From the IgG molecule illustration, which region is the heavy chain? - A - B - C - D
- monocytes = blue-gray cytoplasm with a "ground glass" appearance. vacuoles in cytoplasm. - large lymphs = increased amount of blue cytoplasm with coarse, pink azurophilic granules - plasma cells = round, eccentrically placed nucleus with a coarse chromatin pattern - macrophages = monocytes that have entered the tissues. more round nucleus. visible nucleoli. blue-gray cytoplasm with many vacuoles and irregular edges.
Cells
Vaso-occlusive crisis
Complaints of pain from a patient with sickle cell disease are most likely associated with which of the following conditions/events? - Hemolytic anemia - Infection - Vaso-occlusive crisis - Aplastic crisis
Edward L. Trudeau
Following a diagnosis of tuberculosis, this physician moved to the Adirondack Mountains where he experienced an improvement in his health. He then opened a medical practice in Saranac Lake and founded the Adirondack Cottage Sanatorium where the standard of care for tuberculosis involved prolonged bed rest. Who is this physician? - William Henry Welch - Hermann Biggs - Theobald Smith - Edward L. Trudeau
Anti-A,B
For which of the following antibodies is the DAT most likely to be NEGATIVE when testing a newborn for possible HDFN?
64.8 mg/24 hrs
Given the following information, calculate the results in mg/24 hrs for a 24 hour urine protein.Total volume for 24 hours = 2400 mL Urine protein = 2.7 mg/dL - 64.8 mg/24 hrs - 10.87 mg/24 hrs - 57.5 mg/24 hrs - 5.89 mg/24 hrs
Factor IX
Hemophilia B or Christmas disease is the result of a hereditary deficiency in which coagulation factor? - Factor X - Factor VIII - Factor XI - Factor IX
Polychromatophilic erythrocytes
Identify the cells at the arrows. - Spherocytes - Giant platelets - Polychromatophilic erythrocytes - Artifacts
Neutrophil
Identify the nucleated blood cell:
Spermatozoa
Identify the urine sediment element shown by the arrow:
Leucine crystals
Identify the urine sediment elements shown by the arrow:
Peptostreptococcus anaerobius
Illustrated in the upper photograph is growth of off-white, convex colonies with internal flecking after anaerobic incubation for 48 hours on anaerobic blood agar. Beta hemolysis is not observed. The colonies were recovered from a uterine cervix specimen obtained from a 30 year-old female with post-partum endometritis. The gram stain reveals small gram-positive cocci arranged in short chains and pairs. A spot indole and catalase test were negative. From these observations, select the presumptive identification of this isolate. - Porphyromonas asaccharolytica - Peptostreptococcus anaerobius - Veillonellla parvula - Bacteroides fragilis
P. falciparum
Multiple ring forms in one red blood cell are most frequently seen in which Plasmodium species infections? - P. falciparum - P. vivax - P. malariae - P. ovale
Bladder
Name structure C from the image below:
L-arginine
Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular adherence to endothelium. Which amino acid is decreased in patients with sickle cell disease and is needed as a substrate to produce nitric oxide? - L-arginine - L-glutamine - L-lysine - L-tyrosine
Example 3
Of the following centrifuges, which one is properly loaded and balanced?
Necator americanus
On occasion in cases of heavy infection, rhabditiform nematode larvae, measuring up to 1.5 cm long, may be observed in mounts prepared from stool specimens. A presumptive species identification can be made by microscopically observing the buccal cavity as illustrated in the photograph. What is the most likely species of this nematode? - Strongyloides stercoralis - Enterobius vermicularis - Necator americanus - Ascaris lumbricoides
1 - 6 ºC
Once Fresh Frozen Plasma (FFP) has been thawed, it should be stored at what temperature? - 1 - 6 ºC - 30 - 37 ºC - 20 - 24º C - 45 - 56º C
- neutrophils = first responders to tissue - monocytes = potent. release cytokines. - macrophage = potent. release cytokines.
Phagocytes
- transfusion reactions - warm autoimmune disease (WAIHA) - clot tube stored at 4 C - cold autoimmune disease - drug interactions - HDFN
Positive DAT
Cold agglutinin
Which of the following is least likely to interfere with the measurement of hemoglobin? - Icteric plasma - Lipemia - Cold agglutinin - Leukocytosis
Beta-hydroxybutyric acid
Which of the following ketones is NOT detected in the Acetest® tablet method?
CD2+ CD3- CD11b+ CD16+
Which of the following phenotypes is most indicative of a natural killer (NK) cell? - CD2+ CD3+ CD5+ CD7+ - CD2+ CD3- CD11b+ CD16+ - CD11b+ CD16+ CD33+ CD56- - CD19+ CD20+ CD22+ CD57-
Proximal convoluted tubule
Reabsorption in the kidneys primarily occurs in:
- anti-HIV-1/2 - NAT for HIV-1 RNA - anti-HTLV-1/2
Retrovirus screen for donated blood
- albumin - alpha-1-globulins - alpha-2-globulins - beta-globulins - gamma globulins
SPE proteins
Occupational Safety and Health Administration
Safety regulations in the clinical laboratory fall under which government agency? - Centers for Disease Control - College of American Pathologists - Food and Drug Administration - Occupational Safety and Health Administration
- transferrin = reversibly binds iron - TIBC = measures the amount of transferrin available to bind with iron
Serum iron
Shigella dysenteriae
Shigella serotyping is performed by using a polyvalent somatic (O) antisera. A Shigella species grew from culture and serotyped as Group A. Which of the following Shigella species serotypes as Group A?
Shigella flexneri
Shigella serotyping is performed by using a polyvalent somatic (O) antisera. A Shigella species grew from culture and serotyped as Group B. Which of the following Shigella species serotypes as Group B?
Cytoplasm appears pink-purple due to small specific granules
Which of the following phrases best describes a segmented neutrophil? - Cytoplasm appears pink-purple due to small specific granules - Cytoplasm contains large red-orange granules - Cytoplasm is a pale blue color with a ground glass appearance - Cytoplasm is clear with no granules
Albumin
Which of the following proteins has the FASTEST electrophoretic mobility? - Albumin - Alpha globulins - Beta globulins - Gamma globulins
Apoenzyme
That portion of an enzyme which when separated from its cofactor is called a(n): - Holoenzyme -Isoenzyme - Coenzyme - Apoenzyme
Safeguards protecting PHI
The HIPAA Privacy Regulations includes standards pertaining to:
Human Leukocyte Antigens (HLA)-A,B,C
The Major Histocompatibility Complex (MHC) I genes encode for:
Diamond-shaped, color-coded symbol
The National Fire Protection Association (NFPA) developed a standard hazard identification system. What best describes this system?
Fasting blood glucose, triglycerides, HDL-C
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. - LDL-C, triglycerides, HDL-C, and fasting blood glucose - Fasting blood glucose, triglycerides, insulin, and VLDL - Fasting blood glucose, triglycerides, HDL-C - Fasting blood glucose, triglycerides, HDL-C, and VLD
Syphilis
The VDRL and RPR are used to provide presumptive identification of which infection?
Identify recipient antibodies against donor cells
The chief purpose of performing a serologic crossmatch is to:
Treg
The lymphocyte subtype that controls autoimmunity in the peripheral blood is:
Cystic fibrosis
The measurement of sodium and chloride in sweat is the most useful test for the diagnosis of what condition/disease? - Steatorrhea - Direct determination of the exocrine secretory capacity of the pancreas - Cystic fibrosis - Zollinger-Ellison syndrome
Decreased solubility of deoxygenated Hb S in solution produces visible turbidity
The most common screening test for Hb S, the hemoglobin solubility test, is based on which of the following principles? - Decreased solubility of deoxygenated Hb S in solution produces visible turbidity -The reduction of iron from the ferrous to the ferric state produces visible turbidity - Increased solubility of deoxygenated HbS in solution produces visible turbidity - The fact that any unstable hemoglobin will result in visible turbidity
The CYP450 variants have no influence on drug metabolism.
The pharmacogenetic profiling reveals a mutation in a CYP450 enzyme that causes increased enzyme activity. Which of the statements below is incorrect?
Bacterial meningitis
The predominant cells seen on the CSF smear in this illustration are indicative of:
Results in a false positive reaction
The prozone effect can be described by all of the following EXCEPT: - Results in a false negative reaction - The result of antibody excess - Dilution of antibody can help prevent its occurrence - Results in a false positive reaction
Trichophyton verrucosum
The upper image to the right depicts a small circular white colony with a downy surface, recovered from a skin scraping specimen after 7 days of growth on agar supplemented with thiamine and inositol. The identification is made by observing the aerial hyphae (middle image) and the underlying chains of pigmented chlamydospores among the hyphae (lower image). Based on this information, what is the most likely identification of this dermatophyte? - Microsporum gypseum - Trichophyton tonsurans - Trichophyton verrucosum - Epidermophyton floccosum
Weak activity
The urease reaction seen in the Christensen's urea agar slant on the far right indicates: - Weak activity - Strong activity - Slant only inoculated - Use of outdated medium
Transferrin
Total iron-binding capacity measures the serum iron transporting capacity of:
- weak = pink slant only. Klebsiella. - strong = pink slant & butt. Proteus. - slant only inoculated = pink slant at first then butt also, depending on strength - use of outdated medium = no reaction or faint pink
Urea slant
- A = kidney - B = ureter - C = urinary bladder - D = urethra
Urinary system
The serum ferritin decreases to between 20 and 50 ng/mL
What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)?
Phase contrast
What is the BEST type of microscopy for performing manual platelet counts? - Electron - Dark-field - Light - Phase contrast
1-6 degrees Celsius
What is the required storage temperature for red blood cells?
Plasminogen
A 3-year-old child was brought into the hospital with complaints of recurring conjunctivitis along with "woody" growths on the mucous membranes. Which of the following deficiencies would occur given these symptoms? - Factor VII - Von Willebrand Factor - Antithrombin - Plasminogen
Nocardia brasiliensis
A 30-year-old woman developed progressive, painful swelling of the right foot after incurring traumatic penetration of the soft tissue by a splinter. The wound initially healed. The upper photograph is a direct Gram stain of purulent material expressed from a sinus tract. The lower photograph illustrates the colony that grew out in 72 hours, which had a "musty" odor. The most likely identification is: - Nocardia brasiliensis - Rhodococcus equi - Streptomyces anulatus - Actinomyces israelii
Moderate risk for cardiovascular disease
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
It lines the arachnoid space (central nervous system)
A CSF sample was cytocentrifuged and the smear was stained. Which of the following statements is true about the type of cell shown in the image? - Increased numbers of this cell is seen in patients with bacterial meningitis - It lines the arachnoid space (central nervous system) - It is a monocyte - It is a malignant cell
AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin
A hepatic function panel A consists of which of the following tests? - AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin - Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium - Cholesterol, Lipoprotein, HDL, Triglycerides - Potassium, Sodium, Chloride, CO2
Wilson's disease
A hospitalized patient has a decreased serum copper level and increased urine copper level. This is MOST consistent with:
One of the values is in error
A male patient's urea nitrogen value is 15 mg/dL and his creatinine is 5 mg/dL. If this patient is not undergoing dialysis, what conclusion would you draw from these results?
Inappropriate swab was used for collection
A male urethral specimen was sent to the laboratory for a gonococcal culture and Gram stain. The specimen was received on a calcium alginate swab and cultured to chocolate and Thayer-Martin agars. A Gram stain was performed and presented intracellular and extracellular Gram negative diplococci. After 24, 48, and 72 hours of 37°C incubation in CO2, no growth was seen on either chocolate or Thayer-Martin agars. Which of the following is the most probable cause for lack of Neisseria gonorrhoeae growth?
Thoroughly washing patient's hands with soap and water
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? - Asking the patient or child's parent to state his/her name and date of birth - Thoroughly washing patient's hands with soap and water - Cleansing the puncture site with alcohol and letting the alcohol air dry - Labeling the specimen with at least two patient identifiers
Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT.
A mother's serologic results are shown above. Her newborn types as group A Rh positive with a (1+) positive direct antiglobulin test (DAT). Which of the following investigative tests would be most useful to resolve the cause of the positive DAT and should be done FIRST? - Test an eluate prepared from newborn's red cells against an antibody identification panel by IAT - Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT - Test newborn's plasma against mother's red cells by IAT - Test newborn's plasma against father's red cells by IAT
Anti-P2
A patient demonstrates an antibody that reacts at the immediate spin phase, shows variable dosage, and has increased reactivity after treatment with enzymes. Which antibody does the patient most likely have?
Patients with thalassemia intermedia vary in clinical symptoms based on genetic inheritance patterns.
A person with beta thalassemia intermedia might exhibit what clinical symptoms?
The test results will not be affected by mixing the two anticolagulants
A phlebotomy student is asked to collect a CBC from a patient. He quickly performs the venipuncture and collects the specimen in a heparinized tube (green top). While labeling the specimen, he realizes he collected the specimen in the incorrect tube and proceeds to pouring the blood from the green top tube into a EDTA (lavender top) tube. All of the following are the possible consequences of the student's actions, EXCEPT? - The results may be incorrect - There will be a delay in reporting accurate results for the patient - The specimen will have to be recollected - The test results will not be affected by mixing the two anticoagulants
Five
A routine serum protein electrophoresis with normal proteins results in _____ zones or bands.
Plasma cell
A white blood cell stained with Wright's stain has the following characteristics: - Round eccentric nucleus with clumped chromatin pattern - 1:1 nucleus to cytoplasm ratio - Basophilic cytoplasm - Crescent-shaped clear area next to nucleus What is the MOST likely identification of this cell?
Drain the contents in the vertical position but do not blow out.
To properly use a volumetric pipette calibrated "to deliver" (TD), one should:
