Micro preanalytical - collection and transport, processing + postanalytical

A tech is working on a culture and accidentally enters an incorrect organism. The tech quickly issues a corrected report which includes both the incorrect result and the new, correct result. The tech completes the report and moves on to the next patient culture. What part of the corrected report process is missing or incorrect? A. The physician was not called to be notified of the corrected report B. The incorrect result does not need to be included on the corrected report C. The tech did not need to issue a corrected report for an incorrect organism D. The supervisor should be notified

A

Pseudomonas aeruginosa was isolated from a sputum specimen. Susceptibility testing was performed and the microbiologist determined that further evaluation needed to take place before reporting out the susceptibilities. Which of the antibiotic results would indicate that further evaluation needed to be taken? A. Amikacin resistant, Gentamicin or tobramycin sensitive, Carbapenem resistant B. Amikacin sensitive, Gentamicin or tobramycin sensitive, Carbapenem resistant C. Amikacin resistant, Gentamicin or tobramycin sensitive, Carbapenem sensitive D. Amikacin sensitive, Gentamicin or tobramycin sensitive, Carbapenem sensitive

A (imipenem and meropenem, beta-lactam and aminoglycoside used to treat)

Which of the following is the most suitable specimen for the isolation of Bordetella pertussis? A. Nasopharyngeal swab B. Bronchial washing C. Wound aspirate D. Throat swab

A (in ciliated respiratory epithelial cells, localized)

All of the following specimen collection methods should be used if urine cultures are also required, EXCEPT? A. Routinely voided B. "Clean catch" C. Catheterized D. Suprapubic aspiration

A (not aseptic, leads to FPs)

What level is this specimen: pericardial fluid

1 (invasiveness of collection, potentially life-threatening condition)

What level is this specimen: specimens requiring quantitation, urine or tissue

3 (processed quickly for accurate results, if delayed use proper storage or preservative)

To ensure quality within the preanalytical phase of laboratory testing, quality assurance activities includes monitoring all of the following preanalytical variables EXCEPT: A. Selection of reference materials used for validation purposes. B. Laboratory test utilization. C. Positive patient identification. D. The stability of patient specimens during transport.

A (this is analytical not pre)

Retention of micro records A. Life of the instrument B. 2 years C. 5 years D. 7 years

A (to prove that validation and correlation studies were performed prior to putting into use. Test reports including QC 2 yrs, personnel and safety 5 yrs)

A tech working in microbiology has reported the following results throughout their workday. Which of the result would be considered an urgent alert value that must be called to the physician? A. Wound culture report with Staphylococcus aureus B. Positive acid fast smear C. Urine culture with >100,000 cfu/mL of E.coli D. Sputum Gram stain showing Gram positive cocci

B (could be tb)

All of the following statements about blood cultures are correct, EXCEPT: A. The volume of blood collected is important. Short draws will reduce the likelihood of successfully growing out bacteria. B. If two separate sets of blood cultures are requested, do not draw them both from the same site at the same time. C. Be sure to allow the iodine prep to dry on the patient's skin prior to performing the blood culture. D. Since latex gloves are sterile, you may use your gloved finger without further preparation to feel the vein on a prepped arm before making the stick.

D

Which of the following sites is used most often for CSF collection? A. Ventricles B. L1-L2 C. Subarachnoid D. L3-L4

D

The best clinical specimen for the recovery of Legionella pneumophilia is: A. Nasopharyngeal swab B. Wound aspirate C. Stool D. Bronchial washings

D (Legionnaire's disease, ideal since infections occur in the LRT and many patients do not produce enough productive sputum to culture)

This medium is used for the cultivation and identification of Corynebacterium diphtheria. It contains serum and egg which stimulates growth and the production of metachromatic granules in the cells. A. CIN medium B. TCBS medium C. Modified Tinsdale medium D. Loeffler medium

D (granules seen with MB dye)

What level is this specimen: CSF

1

What level is this specimen: amniotic fluid

1

The recommended temperature/time/pressure for routine steam sterilization of media is:

121C, 12-15 mins, 15 psi

With regard to blood cultures, which blood to broth ratio is most conducive to growth?

1:10

What level is this specimen: synovial fluid

2

What level is this specimen: unpreserved specimen, like sputum

2 (may degrade or demonstrate overgrowth of contaminants, if delayed use proper storage or preservative)

If Brucella is suspected, hold the specimen

2 weeks (10-14 days)

Optimal temp for Listeria motility

25C (inactive above 30)

What level is this specimen: specimens in preservative, urine or feces

4 (processed last)

In traditional culture or antigen detection methods, the sensitivity of detection is adversely affected by which of the following? A. Fastidious growth requirements and delays in transport B. Large numbers of organisms C. Proper collection technique D. Stable temperature

A

Chopped meat broth used for

ANA (Clostridium)

A patient is showing signs of an intravenous catheter associated infection. The physician has removed the catheter and sent the catheter tip along with a skin swab of the catheter site to the laboratory for testing. The physician ordered a Gram stain of the skin entry site and a culture of the catheter tip. On which of the following media should the catheter tip be plated? A. GN Broth and Sheep Blood Agar B. Sheep Blood Agar and Thioglycollate Broth C. Thayer Martin and SIM Broth D. Sheep Blood Agar and Bismuth Sulfite Broth

B

A tech is working on a urine culture and notices that the agar plates are not streaked properly. The tech decides that that culture must be reset. Where should the tech document this finding and the actions taken? A. Write on the agar plates B. Place all notes in the culture work card C. Write on a piece of paper and attach to plates

B

A tech receives a call requesting an additional sensitivity test on a patient culture. What information should the tech document in the patient's work card? A. Specimen source B. The name of the person requesting additional testing

B

The minimum time of retention for microbiology test reports is? A. 1 year B. 2 years C. 5 years D. 7 years

B

A sputum specimen for culture is processed in the laboratory. Upon reviewing the Gram stain, the tech finds there are about 15 epithelial cells per low power field and a mix of bacterial flora present. What should the tech do next? A. Report out the Gram stain and incubate sputum culture plates B. Reject specimen C. Report out Gram stain and discontinue culture D. Discard specimen

B (>10 SQECs, mixed flora hint at URT contamination)

CSF media inoculated

BAP, CHOC, TSB (trypticase soy broth)

Regan Lowe, Bordet-Gengou (potato blood glycerol agar) for

Bordetella

Critical results from the microbiology department must be communicated to the clinician immediately. All of the following results are considered critical EXCEPT? A. Positive spinal fluid Gram stain or culture B. Blood smear for malaria C. Negative acid-fast stain D. Streptococcus pyogenes from a surgical wound

C

From the following instances that may occur in the microbiology laboratory, which one is a critical result requiring immediate communication to the healthcare provider? A. Urine culture with more than four colony types present B. Positive routine prenatal vaginal/rectal screen for Streptococcus agalactiae C. Positive acid-fast smear from a bottle for mycobacterial blood culture D. Detection of Corynebacterium species in a wound culture

C

When a corrected report needs to be made, which of the following is required? A. Correct the report and release results B. Remove the erroneous report from the patient's record C. Notify the physician of the erroneous report D. Reissue the report; nothing else needs to be done

C

The following media contains specific nutrients that encourage the growth of a pathogen over the growth of other bacteria from a specimen. It is useful in the isolation of stool pathogens such as Salmonella and Shigella, the isolation of anaerobes, and the selective isolation of group B streptococci. A. Nutritive media B. Selective media C. Enrichment media

C (nutritive doesn't enhance one over the others)

CCFA =

C. diff (Clostridium difficile)

Needs to be centrifuged before making GS and C

CSF

Antibacterial added to culture media to prevent the overgrowth of bacteria.

Chloramphenicol

Antifungal added to culture media to enhance the recovery of the dimorphic fungi by preventing the overgrowth of more rapidly growing, saprophytic molds is:

Cycloheximide

A tissue sample is received in the laboratory for fungal culture. How should the tech prepare the sample for inoculation onto agar plates? A. Roll the tissue across each agar plate B. Use a tissue grinder to homogenize the sample C. Add 1.0 mL of saline to the sample and vortex D. Cut/Mince tissue into small pieces with sterile scissors

D (normally tissue would be grinded or B. But for fungal specimens grinding destroys elements)

Which of the following is the ideal method for processing wound swab specimens for a Gram stain and culture? A. Specimen should be collected on a single swab that should be used to directly inoculate all media and prepare the smear. B. Specimen should be collected on a dual swab collection device, in order to allow for one swab to be used to directly inoculate all media and prepare the smear, while the second swab should be stored in case additional testing is requested. C. Specimen should be collected on a dual swab collection device, in order to prepare a smear with one swab, while the second swab should be centrifuged to create a concentrated specimen. D. Specimen should be collected on a single swab that will be placed in 1.0 mL of saline and vortexed. The saline solution should then be used to inoculate all media and prepare the smear.

D (pipette used to inoculate saline suspension)

3. Checked weekly 4. Checked daily A. Balances (accuracy) and BSC (airflow). B. Centrifuges (rpm) C. Microscopes cleaned and adjusted D. Incubators, heating blocks, water baths, refrigerators, freezers (temps) E. Gram stain control slide F. Reagents

E, D

MAC + Sorbitol

E. Coli O157:H7

Yellow on XLD, possibly

E. coli O157:H7, Yersinia enterocolitica (use CIN or SMAC to isolate and work up)

May produce black colonies with red rings on XLD resembling Salmonella

Edwardsiella (tarda, H2S+ Lys+)

Bile esculin agar dark growth from UTI most likely:

Enterococcus faecalis

5. Checked every day of use 6. Checked annually A. Balances (accuracy) and BSC (airflow). B. Centrifuges (rpm) C. Microscopes cleaned and adjusted D. Incubators, heating blocks, water baths, refrigerators, freezers (temps) E. Gram stain control slide F. Reagents

F, A

KVLB =

GNB ANA (Bacteroides, Prevotella)

BCYE (buffered charcoal yeast extract) =

Legionella

L-J =

Mycobacterium tuberculosis

TM or MTM = CHOC =

Neisseria, Haemophilus

XLD red + black centers

Salmonella

Lysine iron agar usually used to recover

Salmonella (enteritidis)

Cold enrichment may enhance recovery of

Yersinia (entercolitica), Listeria monocytogenes

CIN = ______, TCBS = _______

Yersinia, Vibrio (sin=plague, "bullseye", tic=vibrate)

PEA =

all ANA

Which culture medium is specifically formulated to recover Salmonella typhi from stool specimens?

bismuth sulfite

Preferred method for urine, CSF, transudates and other thin fluids

cytocentrifugation

Malassezia furfur is the cause of tinea versicolor. To cultivate this organism, the agar should be overlaid with:

olive oil

All of the following choices are acceptable specimens for anaerobic culture, EXCEPT? A. Throat swab B. Tissue biopsy C. Abscess aspirate D. Synovial fluid

A (contains many ANA species, sterile sites like CSF, blood, BM, synovial etc preferred)

A swab specimen from a wound culture is received in the laboratory. How should this specimen be processed for culture and Gram stain? A. Roll swab back and forth on the slide, then inoculate the agar plates for culture B. Inoculate organism plates for culture, then roll the swab back and forth on the slide C. Rub swab back and forth across the slide, then inoculate agar plates for culture D. Inoculate agar plates for culture, then touch one area of the slide with the swab

B (plates then slide, deposit evenly and maintain cell morphology by rolling not rubbing)

From the four specimens listed for Gram stain and culture, which one should be rejected? A. Synovial fluid in a sterile heparinized syringe for aerobic culture B. Peritoneal fluid in sterile sodium polyanethol sulfonate (SPS) tube for aerobic culture C. Expectorated sputum in sterile container for anaerobic culture D. Vaginal secretions on polyester swab in sterile saline for aerobic culture

C (will contain many ANA)

1. Checked 4 times a year 2. Checked every 6 months A. Balances (accuracy) and BSC (airflow). B. Centrifuges (rpm) C. Microscopes cleaned and adjusted D. Incubators, heating blocks, water baths, refrigerators, freezers (temps) E. Gram stain control slide F. Reagents

C, B

Tinsdale medium with high concentrations of potassium tellurite is converted to tellurium and shows brown-black colonies with a gray-brown halo

C. diphtheriae

A laboratory test flags as 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? A. The technologist immediately releases the result. B. The technologist phones the clinical person handling the patient's care (caregiver) and reports the critical test result. C. The technologist phones the patient's caregiver, reports the critical result, documents his placement of the call, who was notified, time and date of notification. D. 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.

D

Select from the multiple choices the specimen that is inadequate for the recovery of anaerobes and should be summarily rejected upon receipt in the microbiology laboratory. A. Swab specimens taken from of deep sub-cutaneous abscess B. Needle aspirate in an anaerobic E-swab tube C. Syringe aspirate hand-carried to microbiology laboratory D. Uterine cervical swab in Cary-Blair transport medium

D (swabs inadequate for ANA, cary blair for enterics not ANA)

The appropriate media for the isolation of anaerobic bacteria from any source would normally include all of the following except: A. CDC blood agar B. MacConkey agar C. Phenylethyl alcohol agar (PEA) D. Kanamycin-vancomycin-laked blood agar (KVLB)

B (KVLB used instead of MAC for GNB ANA like Bacteroides, Prevotella)

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? A. Random review B. Laboratory detection C. External detection

B (external is people outside lab like nurses, random review isn't QC but random reports pulled and reviewed)

The tech is working in microbiology and typically, there is an automatic call list generated by the laboratory information system (LIS) for urgent microbiology alerts. The LIS is currently down for maintenance so the tech has to manually pull a list of urgent reports. Which of the following should the tech considered an urgent result? A. Urine culture with >100,000 cfu/mL of E. coli B. Positive blood culture showing Gram positive cocci C. Wound culture report of Staphylococcus epidermidis D. Sputum culture report of Streptococcus pneumoniae

B (sepsis high mortality rate, any pos blood cx urgent)

All of the following specimens would be considered suitable for anaerobic culture, EXCEPT? A. Drainage from a puncture wound B. Throat swab C. Drainage from abdomen D. Blood culture

B (throat or vaginal swabs have too many ANA)

When treating serious enterococci infections, both a cell wall-active agent, such as ampicillin or vancomycin, and an aminoglycoside, such as gentamicin should be used. Therefore, it is important that this information be reported to physicians by which of the following? A. Through telephone communication B. By listing all the agents and their interpretive results C. By providing an explanatory note stating the recommended use of combination therapy

C

A large container of peritoneal fluid is received in the laboratory (about 50 mL). How should the tech process this sample for aerobic culture? A. Use a sterile pipette and add a drop of fluid per agar plate B. Insert a swab into the specimen container and inoculate all agar plates C. Centrifuge the specimen and use the sediment to inoculate the agar plates D. Add 1 mL of saline to 1 mL of fluid, vortex, and inoculate plates

C (Sterile fluids usu. use drop of fluid from pipette, but large Vs require spinning, helps to recover all bacteria present in sterile fluids. Should NOT dilute)

Each of the following practices will better ensure the successful recovery of Campylobacter jejuni from stool specimens except: A. Incubation at 42°C B. Use of Campy BAP medium C. Use of selenite enrichment broth D. Incubation in an atmosphere of 5% O2, 10% CO2 and 85% N2

C (microaerophile)

All of the following are characteristic of Burkholderia pseudomallei EXCEPT? A. Has been reported as the cause of laboratory-acquired infection B. Oxidase positive C. Non-motile D. Catalase positive

C (motile, causes melioidoisis. B. mallei is nonmotile, Glander's)

An expectorated sputum specimen is received for culture at your laboratory. You are preparing to make slides and inoculate the media and are observing the gross appearance of the specimen. The specimen is a mixture of watery, bloody, and purulent material. Which area(s) of the specimen is most likely indicated for culture and slides? A. Any area is acceptable for culture and slide preparation. B. Only the watery portion of the specimen is most indicated for culture and slide preparation. C. The bloody and purulent areas of the specimen are most indicated for culture and slide preparation. D. An equal sampling of the watery, bloody, and purulent areas are most indicated for culture and slide preparation.

C (watery area contains URT flora)

Cystine-tellurite BAP =

C. diphtheriae (Francisella too but it can also be grown on CHOC)

Daily activities by microbiology personnel should be performed to ensure patients receive the best care. All of the following activities should be performed daily EXCEPT? A. Compare Gram stain reports with what grows in culture to ensure all organisms are recovered B. Check antimicrobial susceptibility reports to ensure correct drug/organism profiles C. Check susceptibility reports for multiple-drug-resistant organisms D. Check to ensure autoverification of results is working correctly

D (yearly)