MLT ASCP Practice Questions 2.7.16

B; Streptococcus pyogenes is the correct answer. Streptococcus pneumoniae is alpha-hemolytic which demonstrate a green area of partial hemolysis around the colonies. Staphylococcus aureus will produce complete hemolysis but is catalase positive. Streptococcus agalactiae is beta-hemolytic but only produces a partial clearing of the red blood cells in sheep blood agar.

Complete hemolysis of sheep blood agar as demonstrated by the image below would be seen in which of the following catalase-negative isolates? A. Streptococcus pneumoniae B. Streptococcus pyogenes C. Staphylococcus aureus D. Streptococcus agalactiae

B

UA & Body Fluids What is the identification of this crystal seen in a urine with an alkaline pH? A. Uric acid B. Ammonium biurate C. Triple phosphate D. Calcium carbonate

A, C & D; Cerebrospinal fluid has three main functions: Protect brain and spinal cord from trauma. Supply nutrients to nervous system tissue. Remove waste products from cerebral metabolism.

Which of the following are functions of CSF? Please select all correct answers A. Supply nutrients to nervous system tissue. B. Regulate body metabolism. C. Protect spinal cord from injury. D. Remove waste products from cerebral metabolism.

C; Mode is defined as the number that occurs most frequently in a set of numbers.

The value that occurs most frequently in a set of results or values would be termed: A. Mean B. Median C. Mode D. Standard deviation

1. C 2. B 3. D 4. A

Microbiology Matching: The detection of a distinct odor is often helpful in the presumptive identification of bacterial culture isolates. Match each of the odors listed with its corresponding bacterial species name. 1. Streptococcus anginosus (milleri) 2. Pseudomonas aeruginosa 3. Eikenella corrodens 4. Alcaligenes faecalis A.Pared apples B. Grapes C. Butterscotch D. Bleach

D; Thrombocytes, or platelets, are of course involved with hemostasis, not immunity.

Immunology Which of the following would not be considered a part of the body's cellular immune system: A. Macrophages B. Mast cells C. Neutrophils D. Thrombocytes

1. B 2. A 3. D 4. C

Micro - Matching 1. Upper left image Multi-celled, rough walled macroconidia with a tapered terminal cell 2. Upper right image Dense aggregates of echinulate, brown-black conidia 3. Lower left image Loose clusters of elliptical conidia arranged in a "diphtheroid" pattern 4. Lower right image Chains of large, lemon-shaped annelloconidia A. Aspergillus niger B. Microsporum canis C. Scopulariopsis species D. Acremonium species

C; Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus that produces a strong toxin. C difficile is a common cause of antibiotic-associated diarrhea and pseudomembranous colitis.

Microbiology A recto-sigmoidoscopy revealed pseudomembranes in a patient with severe diarrhea following prolonged treatment with ampicillin. Which of the following organisms is MOST likely to be isolated? A. Bacteroides fragilis B. Clostridium botulinum C. Clostridium difficile D. Fusobacterium nucleatum E. Klebsiella oxytoca

A

What is the cell that is indicated by the arrow in this field? A. Red cell fragment B. Acanthocyte C. Burr cell D. Crenated cell

D

A positive RPR test and a negative FTA-ABS test is most likely the result of: A. Primary syphilis B. Secondary syphilis C. Latent syphilis D. False positive reaction

D

A young man is experiencing difficult breathing after fainting. The physician orders a blood gas analysis which shows the following results: pH = 7.25 pCO2 = 62 mmHg pO2 = 70 mmHg HCO3 = 23 mEq/L Which condition is most likely afflicting this patient? A. metabolic alkalosis B. metabolic acidosis C. respiratory alkalosis D. respiratory acidosis

A; 1+ reaction has numerous small clumps and cloudy red supernatant 2+ has many medium-sized clumps and clear supernatant. 3+ has several large clumps and clear supernatant 4+ has one solid clump, no free cells, and clear supernatant

BB Tube-based agglutination reactions in blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is: A. 1+ B. 2+ C. 3+ D. 4+

B; The most likely causes of delayed hemolytic reactions are Kidd system antibodies. Both jka and jkb are often responsible for delayed hemolytic transfusion reactions.

Blood Bank Delayed hemolytic transfusion reactions are usually caused by antibodies directed against what blood group system? A.MNS B. Kidd. C. Kell. D. Rh. E. ABO

A; FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within 24 hours. In contrast, "Thawed Plasma" can be used for up to 5 days as a replacement therapy for patients requiring stable clotting factors. Keep in mind that these are two different component types and you are asked about FFP.

Blood Bank FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within ___________ after it has been thawed. A. 24 hours B. 8 hours C. 12 hours D. 5 days E. 10 days

A

Blood Bank What other component(s) can be shipped together with Fresh Frozen Plasma (FFP)? A. frozen RBC's and cryoprecipitate B. platelets C. packed RBC's and granulocytes D. whole blood E. none

A; Report the isolate as coagulase negative Staphylococcus is the correct answer because this is an isolate from a urine specimen with a coagulase negative Staphylococcus susceptible to novobiocin. Staphylococcus saprophyticus is resistant to novobiocin. Further testing is required to speciate coagulase negative Staphylococci but only if the specimen is from a sterile body site, not urine.

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 Catalase- positive Slide coagulase- negative Tube coagulase- negative Novobiocin- susceptible The next action the MLS should take is: A. Report the isolate as coagulase negative staphylococcus B. Report the isolate as Staphylococcus epidermidis C. Report the isolate as Staphylococcus saprophyticus D. Perform further testing to speciate the organism

C; Hemoglobin H is a tetramer made of four beta globin chains. Hemoglobin H occurs when there is very limited alpha chain availability used to make normal hemoglobin A. Hemoglobin H forms in those affected with alpha thalassemia major as well as in people with the combination of two-gene deletion alpha thalassemia and hemoglobin Constant Spring.

Hematology Which of the following combination of globin chains comprise Hemoglobin H? A. 2 alpha, 2 beta B. 2 alpha, 2 gamma C. 4 beta chains D. 4 alpha chains

A; Infection early in the pregnancy is the most dangerous time period for the manifestation of anomalies due to rubella. In fact, defects are rare when infection occurs after 20 weeks gestation.

Immunology The greatest risk for the manifestation of anomalies in maternal rubella infection during gestation is the: A. first trimester B. second trimester C. third trimester D. delivery E. eighth month

1. B 2. D 3. A 4. C Measures Light scatter by particles - Nephelometer Measures change in vapor pressure - Osmometer Measures amount of electricity passing between two electrodes - Coulometry Measures absorbance of light at a specific wavelength - Spectrophotometer

Lab operations Matching 1. Measures Light scatter by particles 2. Measures change in vapor pressure 3. Measures amount of electricity passing between two electrodes 4. Measures absorbance of light at a specific wavelength A. Coulometry B. Nephelometer C. Spectrophotometer D. Osmometer

C; India ink can aid in the visualization of the polysacchride capsules of yeast such as Cryptococcus neoformans.

Micro India Ink is used to: A. Visualize flagella B. Visualize shape C. Visualize capsule D. Visualize cytoplasm

T; Confirmed cases of H1N1 virus have been reported more often in children and younger adults than in any other age group.

Micro The age groups that have been most affected by the H1N1 virus are children and younger adults. Select true or false

Helminths

Micro Trichinella, Schistosoma, Ascaris, Cestodes: Protozoa or Helminths?

Protozoa

Micro Trypansoma, Leischmania, Plasmodium Protozoa or Helminths?

D; Because of the difficulty in culturing Epstein-Barr virus, and readily available heterophile antibody test and serology, it is rarely necessary to culture this virus in routine clinical practice.

Micro Which one of the following viruses requires a complex lymphoblastoid cell culture, and is rarely if ever diagnosed by culture: A. Varicella-Zoster Virus B. Herpes Simplex Virus C. Cytomegalovirus D. Epstein-Barr Virus

T; Hybridization is a technique used to determine presence of target DNA or RNA by adding a synthetic strand that binds by complementary base pairing to the target.

Microbiology In molecular diagnostic testing, hybridization employs complementary base pair binding of a synthetic strand to DNA or RNA. Select true or false

T; Slight turbity with the presence of WBCs is consistent with this case. The combination of the bacteria present from the infection, along with the cells that have been drawn to the area of infection, can create a turbid appearance in the urine.

The patient is a female and the urinalysis is completed within two hours of collection. True or false? The presence of bacteria correlates with the slight turbidity and WBC result.

A; Considering the reactions given in this case study, Yersinia enterocolitica would be the best choice. Most strains of Plesiomonas shigelloides, Escherichia coli, and Pasteurella multocida are urease negative. Also, Plesiomonas shigelloides demonstrates a K/A reaction on a TSI slant.

The stool specimen from a patient admitted to the hospital with symptoms of appendicitis has a culture with the following characteristics: Gram-negative bacillus Catalase positive Urease positive Weakly fermentative TSI Slant is A/A These reactions suggest that the organism is MOST likely: A. Yersinia enterocolitica B. Escherichia coli C. Plesiomonas shigelloides D. Pasteurella multocida

A; The renal threshold is the maximum amount of a substance that the kidney can prevent from entering into the urine.

UA & body fluids The renal threshold is best described as: A. Concentration at which a substance in the blood spills into urine B. Concentration at which reabsorption first occurs C. Concentration at which kidney can no longer filter the blood D. Concentration at which kidney failure begins

C; Synovial fluid is actually quite viscous and does not have the same consistency as plasma. The reason for its thicker consistency is to provide cushion and reduce friction between the articular cartilage of synovial joints during movement.

Urinalysis & Other Body Fluids All of the statements below about synovial fluid are true EXCEPT: A. arthrocentesis is performed as a means to evaluate arthritis and other joint disorders B. synovial fluid is present only in movable joints C. joint fluid resembles plasma in viscosity D. joint fluid has approximately the same glucose as plasma

C; Spirochetes such as Borrelia and Treponemes are best visualized using darkfield microscopy. Borrelia, which causes Relapsing fever, can be visualized under darkfield microscopy of wet preps of peripheral blood. Treponema can be visualized by darkfield microscopy of early primary lesions, and aspirates of affected lymph nodes.

Which of the following organisms is best visualized by use of a darkfield microscope: A. Campybacter B. Entamoeba C. Borrelia D. Streptococcus

Cytoplasmic membrane - D Cell Wall - B Nuclear Material - E Flagellum - F

Label the parts of this prototypical bacterium: Match the following letters with the corresponding parts: B D E F Cytoplasmic membrane Nucelar material Flagellum Cell wall

C; 2(2)2s = reject when 2 consecutive control measurements exceed the same mean plus 2s or the same mean minus 2s control limit. Violation of this Westgard rule is usually caused by a systematic error.

Laboratory Operations Which of the following describes the Westgard multirule 2(2)S? A. Two control data points are within + 2s B. One control data point falls outside +2s and a second point falls outside -2s C. Two consecutive data points fall outside +2s or fall outside -2s D. Two consecutive data points fall outside +2s E. Synonymous with R4s

B

Blood Bank; Immunology Which of the following best describes the primary function of antibodies: A. Protect B-lymphocytes B. Bind with antigen C. Fix complement D. Stimulate the immune response

B; A person classified as an ultrarapid metabolizer (UM) has a polymorphism that enhances the catabolic activity of the enzyme. This means that a UM would need more of the drug to achieve a 'normal' level since he/she is rapidly metabolizing the drug.

Chem In therapeutic drug monitoring, a person who is classified as an ultrarapid metabolizer (UM) would need __________ of a drug metabolized by that enzyme. A. A lower dose B. A higher dose C. The standard dose

C; Troponin is a very specific biomarker that is released during cardiac injury or stress. CK is found not only in cardiac tissue, but also in muscle and brain tissue. LD levels can be elevated in cardiac events, tissue breakdown, and hemolysis. Myoglobin is elevated when muscle tissue is damaged and is not specific for the heart muscle.

Chemistry Which one of the following is the MOST specific biochemical marker of myocardial infarction? A. CK B. LD C. Troponin D. myoglobin

C; Myoglobin rises typically within 2-4 hours after a myocardial infarction and stay elevated for days, with a peak at the 6-9-hour mark post-MI. After myoglobin, troponin is the next fastest to rise afer a mycardial infarction and can rise within 3-4 hours with a peak around 12 hours post-MI. LD (8-12 hours, 24-48 hour peak) and CK (4-6 hours with peak at 24-36 hours) will also rise after MI, but are not as fast to rise as myoglobin and troponin.

Chemistry A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had an MI? A. LD B. CK C. Myoglobin D. Troponin

T; In sickle cell anemia, rapid hemoglobin turnover may be present. HbA1C and other glycated hemoglobin assays are not valid in rapid hemoglobin turnover and in abnormal hemoglobin conditions. Fructosamine measurements can be used because of shorter half life of albumin.

HbA1C measurements are NOT ordinarily used to monitor long-term diabetic control in a diabetic with sickle cell anemia. Select true or false

B; TD, or To Deliver, pipettes are calibrated to deliver the correct amount of solution without "blowing out" the amount left in the tip of the pipette. Pipettes labelled TC, or To Contain, are calibrated to include the amount left in the tip of the pipette, therefore, "blowing out" the final drop of solution is required.

To properly use a volumetric pipette calibrated "to deliver" (TD), one should A. Let the pipette drain in a vertical position and blow out the last drop B. Drain the contents in the vertical position but do not blow out C. Drain the pipette after rinsing out the contents several times and blow out the last drop

B; Fibers can be mistaken for casts on occasion, especially hyaline casts. Fibers, however, are usually thinner and appear less uniform in structure than casts do.

Urinalysis & Other Body Fluids Which of the following artifacts may be mistaken for casts? A. Air bubbles B. Fibers C. Coverslip scratches D. Talc particles

A; Basophilic stippling is strongly associated with lead poisoning the lead toxicity can affect the bone marrow; causing this phenomenon.

Hematology What is a prominent morphologic feature of lead poisoning: A. Basophilic stippling B. Hypersegmentation C. Macrocytosis D. Target cell

B; The parents will each give one of their ABO genes, so the possibilities are as follows: AB, AO, AB, AO = 50% chance of A blood type, 50% chance of AB blood type

Blood Bank 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. 25% B. 50% C. 75% D. 100% E. none of them

T; If all newborns were tested, many positive DATs due to ABO incompatibility would be detected that are of no clinical significance. Although many laboratories test infants born to group O Rh positive females due to the higher risk of ABO HDFN when the mother is group O, testing such infants is optional provided there is appropriate monitoring and follow-up for hyperbilirubinemia.

Blood Bank Not performing direct antiglobulin tests (DATs) on newborns born to group O Rh positive mothers is acceptable good practice, providing there is appropriate surveillance and follow-up to detect hyperbilirubinemia. Select true or false

A & C; The antiglobulin test may be omitted from the serological crossmatch if the patient's antibody screen is negative and there is no history of detection of unexpected antibodies.

Blood Bank What must be true for the antiglobulin phase of the serologic crossmatch to be omitted (i.e., immediate spin crossmatch is done)? Please select all correct answers A. The antibody screen must be negative. B. The patient has not been transfused within the past 24 hours. C. There is no history of detection of unexpected antibodies D. The blood is needed for surgery

T; Patient's with diseases such as congential hemolytic anemias and aplastic anemias require frequent transfusions. Each unit of red cells contains 225 mg of iron, which puts these patients at risk for iron overload.

Blood Bank Patients with diseases that require chronic transfusions are at risk for iron overload. Select true or false

D; AHG must be added immediately after washing to prevent the possibility of a false negative; a false negative can occur in this situation because previously bound globulins may dissociate from red cells, leaving insufficient antibody coating on the red cells to produce a reaction, or free antibody may directly neutralize antiglobulin reagent.

Blood bank A false-negative reaction while performing the DAT technique may be the result of: A. Red cell/AHG tube is over centrifuged B. Blood collected in tube containing silicon gel C. Saline used for wash stored in glass or metal container D. AHG addition delayed for 40 or more minutes

A

Blood bank Which of the following is the most common subgroup of A? A. A1 B. A2 C. A3 D. A1A2

B; Parathyroid hormone regulates serum calcium by acting on bone, kidney, and intestines while regulating phosphate by stimulating the intestines and the kidneys, enhancing absorption and reabsorption respectively.

Chem The parathyroid hormone is important in the regulation of: A. iodine and bromine B. calcium and phosphate C. acid and alkaline phosphatase D. zinc and magnesium

C; Post-hepatic obstruction is characterized by a marked increase in alkaline phosphatase, GGT, conjugated bilirubin, as well as other hepatic enzymes. The slight rise of ALT suggests that the issue is not hepatitis. Renal and cardiovascular failure do not match the symptom of jaundice or the abnormal laboratory values.

Chem Which of the following conditions would be suggested by a jaundiced patient experiencing a marked rise in alkaline phosphatase, conjugated bilirubin, and a slight rise in ALT: A. Cardiovascular disease B. Hepatitis C. Post-hepatic obstruction D. Renal failure

B, C Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to glucose, which increases plasma glucose. Cortisol along with glucagon increases gluconeogenesis, formation of glucose from noncarbohydrates which also raises plasma glucose concentration.

Chem Which of the following hormones increases plasma glucose concentration by converting glycogen to glucose? Please select all correct answers A.Cortisol B. Glucagon C. Epinephrine

A; Troponin is potentially more specific for myocardial damage than CK-MB and stays elevated longer. It may eventually replace CK-MB as the standard marker of myocardial damage. In addition, troponin T has been known to be elevated in the setting of even mild degrees of renal failure. Troponin and CK-MB both tend to rise approximately 3 hours after a MI (hence why the correct answer is "A", since it is false); however, troponins can stay elevated up to 2 weeks as CK-MB tends to return to baseline around 36 hours.

Chemistry Which of the following statements is FALSE regarding troponin? A. It rises much sooner after an MI than CK-MB B. It stays positive much longer than CK-MB C. It is potentially more specific than CK-MB D. Troponin T is often elevated in renal failure patients

A & B; The increase in inflammatory cytokines and the abnormal lipids and lipid levels often present in metabolic syndrome increase the risk of cardiovascular disease. Adiponectin is decreased and increases in angiotensinogen lead to hypertension.

Chemistry Which of the following statements is true regarding cardiovascular disease and adipose tissue? Please select all correct answers A. Inflammatory cytokines, synthesized and released by adipose tissue, contribute to the development of cardiovascular disease B. A state of abnormal lipids and lipid levels found in metabolic syndrome contribute to the development of cardiovascular disease C. Obesity in metabolic syndrome contributes to the development of cardiovascular disease by increased synthesis and secretion of adiponectin D. Increased synthesis and secretion of PAI-1 in metabolic syndrome contributes to cardiovascular disease by increasing blood pressure

B; As a general rule, CSF glucose is about two thirds of the serum glucose measured in a normal adult.

Chemistry Which of the following would be considered a normal cerebrospinal fluid glucose if the serum glucose is 70 mg/dl? A. 30 mg/dl B. 45 mg/dl C. 60 mg/dl D. 70 mg/dl E. 100 mg/dl

A; First, determine the number of WBC's from the hemocytometer as follows: WBC count = (dilution ratio x # of cells counted x 10) / (# mm2 area counted) Then: WBC count = (20 x 100 x 10) / (8) = 2500 WBC/mm3 (or 2500 WBC/uL or 2.5 x 103 WBC/uL) Next, to find the WBC count per liter, multiply the WBC count/uL by the number of uL/L (there are 106 uL/L) So: (2.5 x 103 WBC/uL) x (106 uL/L) = 2.5 x 109 WBC/L

Hematology A 1:20 dilution is made for a manual WBC count. The four corner squares on both sides of a hemocytometer are counted. A TOTAL of 100 cells are counted in that area. What is the white blood cell count in terms of a liter (? x 10^9/L)? A. 2.5 B. 25 C. 250 D.2500 E. 25000

B; Beta-thalassemia major, also known as Cooley's anemia, has inherited two genes for beta thalassemia without a normal beta-chain gene. This disease is assoicated with a marked deficiency in beta chain production and in the production of normal Hb A. These patients exhibit increased amounts of iron due to the mutliple transfusions that keep them alive. There is also a striking increase in hemoglobin F and an elevation in hemoglobin A2.

Hematology A 5-year-old African American child with hepato-splenomegaly and skeletal abnormalities has the following lab results: WBC = 4,800/cu.mm 20 NRBC/100 WBC RBC = 2.70 X 106 HGB = 6.2 g/dL Many target cells Marked hypochromasia, anisocytosis & poikilocytosis Serum Iron = 200 µg/dL (elevated) Sickle Solubility = negative Hemoglobin F = elevated What is the PROBABLE cause of these findings? A. Aplastic anemia B. Beta-thalassemia major C. Sickle cell anemia D. Hemoglobin C disease

C; In this case, with the pre-incubation aPTT mixing study result "corrected" and the post-incubation aPTT mixing study result "not corrected", a coagulation inhibitor should be suspected. Both anti-factor VIII and lupus anticoagulant have been known to be slow-acting and can exhibit this result pattern. If a factor deficiency was present, we should not see a post-incubation prolongation.

Hematology What may cause the following mixing studies results? Initial aPTT = 133 seconds 1:1 Mix aPTT pre-incubation = 33 seconds 1:1 Mix aPTT post-incubation = 124 seconds A. Factor IX deficiency B. Factor XI deficiency C. A slow acting coagulation inhibitor

C; The risk of HbS polymerization is enhanced by a low (acid) pH, a state of dehydration, and increased levels of 2,3-DPG. Increased temperature (above 37°C) also adds to the risk.

Hematology Which group of conditions INCREASES the risk of HbS polymerization? A. Acid pH, dehydration, decreased level of 2,3-DPG B. Alkaline pH, dehydration, increased level of 2,3-DPG C. Acid pH,dehydration, increased level of 2,3-DPG D. Alkaline pH,dehydration, decreased level of 2,3-DPG

D

Immunology The immunoglobulin molecule is made up of both heavy and light chains - the light chains can be comprised of which of the following: A. Alpha or beta B. Alpha or lambda C. Kappa or beta D. Kappa or lambda

A; Malbranchia species share the production of alternate staining arthroconidia as a common feature with the mold form of Coccidioides immitis. Both Geotrichum species and Trichosporon species produce rectangular-shaped arthroconidia; however, they are regularly rather than alternately staining. Additionally, the arthroconidia of Geotrichum may produce germ tubes from one corner and the arthroconidia of Trichosporon species may produce blastoconidia from adjacent corners, features not shared by either Malbranchia species or Coccidioides immitis. The hyphae of Microsporum canis, as seen in direct KOH mounts of skin scales, may break up into arthroconidia; however, they are much narrower in dimension and do not share the alternate staining characteristics.

Microbiology The hyaline saprobic fungus that has microscopic features similar to the mold form of Coccidioides immitis is: A. Malbranchia species B. Geotrichum species C. Trichosporon species D. Microsporum canis

D; S. aureus does not have capsular material as a defense mechanism. H. influenzae, K. pneumoniae, N. meningitidis, and S. pneumoniae each have capsular material use as a defense mechanism. This capsular material is an antiphagocytic substance which helps deter bacterial death by macrophages and other white blood cells.

Microbiology Which one of the following does NOT have capsular material as a defense mechanism? A. H. influenzae B. K. pneumoniae C. N. meningitidis D. S. aureus E. S. pneumoniae

C

Hematology What is Coombs sera comprised of: A. Complement B. Indicator red cells C. Anti-human globulins D. Anti-red cell globulins

C; Neutrophils reside in the peripheral circulation for only 7-8 hours ( approx. 7.5 hours) before entering the tissues and body cavities. This process is called diapedesis.

Hematology How long are healthy neutrophils expected to reside in the peripheral blood of an adult? A. 3 days B. 1 day C. 7-8 hours D. 12-14 hours

B; Dce is found in 4% of whites and 44% of blacks. DCe is found in 42% of whites and 17% of blacks. DcE is found in 14% of whites and 11% of blacks. dce is found in 37% of whites and 26% of blacks.

Blood bank The most common Rh haplotype among whites is: A. Dce B. DCe C. DcE D. dce

D; Kell, Kidd, and Duffy are usually warm reacting IgG antibodies. The most common P system antibody is anti-P1, which is a frequently naturally occurring low titer IgM antibody, seen in most P2 individuals.

Blood bank Which of the following blood groups is most frequently associated with cold agglutinins: A. Kell B. Kidd C. Duffy D. P

C

Blood bank Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration: A. 4 hours B. 12 hours C. 24 hours D. 48 hours

C; When making a platelet concentrate, the proper procedure is to start with a low centrifugation of the whole blood bag. After the plasma is removed, it is centrifuged again at a higher speed to separate the platelet portion from the plasma portion.

Blood bank The following steps must be followed in preparation of a platelet concentrate: A. Whole blood centrifuged at low speed - plasma separated then centrifuged at low speed B. Whole blood centrifuged at high speed - plasma separated then centrifuged at high speed C. Whole blood centrifuged at low speed - plasma separated then centrifuged at high speed D. Whole blood centrifuged at high speed - plasma separated then centrifuged at low speed

C; Overcentrifugation may cause either a false negative result (if too much agitation is required for resuspension), or a false positive, (if centrifuged clumps cannot be completely dispersed). High concentration of IgG paraprotein, and failure to adequately wash cells can leave unbound IgG which will neutralize antiglobulin reagent. Delay of addition of antiglobulin reagent may allow previously bound IgG antibody to dissociate from red cells.

Blood bank Which of the following might cause a false positive indirect antiglobulin test: A. Failure to adequately wash cells B. Delay of addition of antiglobulin reagent. C. Overcentrifugation D. High concentration of IgG paraprotein in a patient's serum

C; The results demonstrate compliance with diet and medication. A HbA1C result that is <7.0% indicates glycemic control for most adults with diabetes.

Chemistry A HbA1C result for a diabetic patient is 6.0%. What conclusion can be made regarding this patient's carbohydrate management? A. The results are inconclusive and should be repeated with a different method. B. The patient is probably not following dietary recommendations. C. The patient is compliant with diet and medication.

B; High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and treatment of cardiovascular disease (CVD). At low levels, it can detect those at risk for cardiac heart disease. At high levels in those with no history of heart disease, it indicates a high risk for acute myocardial infarction (AMI), stroke, or peripheral vascular disease. For patients with acute coronary syndrome (ACS) or stable coronary disease, hs-CRP is used to predict future coronary events. Ranges of hs-CRP in prediction of risk for CVD are: <1.0 mg/L Low CVD risk 1.0-3.0 mg/L Average risk for CVD >3.0 mg/L High risk for future CVD If results are >10.0 mg/L, the patient should be evaluated for an acute inflammatory condition.

Chemistry A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1 mg/L) may indicate which of the following? A. Low risk for cardiovascular disease (CVD) B. High risk for future CVD C. Acute inflammatory condition

C; Unconjugated bilirubin is a byproduct of RBC breakdown, or hemolysis. It would be expected to see an increase in unconjugated bilirubin when hemolysis is occuring at an increased rate. The liver enzymes would not remain at normal levels if there were a viral infection of the liver, chemical damage to the liver, or obstruction of bile ducts.

Chemistry 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: A. Viral infection of the liver. B. Chemical damage to the liver. C. Increased rate of hemolysis D. Obstruction of common bile duct

B; A casual blood glucose >/= 200 mg/dL on a patient with symptoms and an A1C >/= 6.5% meet diagnostic criteria for diabetes.

Chemistry A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose at time of evaluation and a 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 results? Casual Blood Glucose: 208 mg/dL HbA1C one week later: 7.2% A. Order insulin levels; if decreased, diagnose diabetes B. Patient meets criteria for diagnosis of diabetes C. Order a C-peptide for diagnosis D. The patient is at risk for diabetes (pre-diabetic); monitor for diabetes with yearly FPG levels

A; Alkaline phosphatase, or ALP, is present in kidneys, liver, intestines, bone, and the placenta. The liver makes the largest amount of ALP. Some of the conditions associated with increased levels of ALP include: damaged liver cells, rapid bone growth (during puberty), bone diseases, or a disease that affects how much calcium is in the blood (hyperparathyroidism), and vitamin D deficiency.

Chemistry Isoenzymes of alkaline phosphatase occur in: A. Kidney, bone, intestines, liver B. Bone, brain, liver, pancreas C. Liver, brain, spleen, intestines D. Brain, kidney, intestines, bone

B; PCT usually rises within 3-6 hours of infection. CRP also increases rapidly following infection, but is not as specific for infection as PCT. A rise in CRP could also occur with SIRS. Lactic acid is usually used to detect and monitor impaired circulation and tissue oxygenation in critically ill patients.

Chemistry Of the three laboratory tests that are listed, which has proven to be most effective for early differentiation of systemic inflammatory response syndrome (SIRS) from sepsis due to its increase following infection and higher specificity? A. C-reactive protein (CRP) B. Procalcitonin (PCT) C. Lactic acid

B; Refrigerated temperatures, those close to 4 ºC, are recommended for the preservation of enzyme activity in a patient sample.

Chemistry The recommended storage temperature for the preservation of activity for MOST enzymes is: A. 0 ºC B. 4 ºC C. 25 ºC D. 37 ºC

A; The membranes of ion selective electrodes will determine which analyte is measured by the electrode.

Chemistry The selectivity of an ion-selective electrode is determined by the: A. properties of the membrane used B. solution used to fill the electrode C. magnitude of the potential across the membrane internal reference electrode D. type of glass used in electrode

B; Antidiuretic hormone, or ADH, has the important role of conserving body water by reducing the loss of water in urine by changing the water permeability of the distal tubule and collecting duct. An increase in ADH causes a concentrated urine since the water is retained and absorbed through the permeable membrane. An decrease in ADH causes the collecting ducts to retain very little water, instead it is excreted as urine.

Chemistry Which of the following action describes the MAJOR property of antidiuretic hormone? A. acts on proximal tubules. B. changes distal tubule water permeability C. Acts on Na/K/(H') pump D. cannot be affected by diuretics E. controls thirst

D; Insulin is the hormone that is mainly responsible for the entry of glucose into the cell for energy production Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to glucose, which increases plasma glucose. Cortisol, along with glucagon, increases gluconeogenesis, formation of glucose from noncarbohydrates, which also raises plasma glucose concentration.

Chemistry Which of the following hormones is mainly responsible for the entry of glucose into the cell for energy production? A. Epinephrine B. Glucagon C. Cortisol D. Insulin

B; The deposition of plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries is the defintion of atherosclerosis. Arteriosclerosis is a more general term that describes a thickening and loss of elasticity of the walls of the arteries (hardening of the arteries). Atherosclerosis is a type of arteriosclerosis but is not synonymous with it. Atherosclerosis is not the most common outcome for risk marker studies because it can be hard to measure. Infarcts, cardiac procedures, death, and 'events' are more common. Most humans have visible or measureable atherosclerosis by early middle age.

Chemistry Which of the following is true concerning atherosclerosis? A. Atherosclerosis is the same as arteriosclerosis. B. Atherosclerosis is the deposition of plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries. C. Atherosclerosis is the main outcome that is assessed in risk marker studies. D. Most humans do not have significant atherosclerosis.

C; MCH is the average weight of hemoglobin in the average red blood cell. The value is expressed in picograms (10-12 grams).

Hematology Hemoglobin (g/100ml) x 10 / RBC count (millions/mm3) is the formula for calculating: A. MCHC B. MCV C. MCH D. RDW

C; In an alkaline medium, potassium ferricyanide oxidizes hemoglobin to methemoglobin. Further reaction with potassium cyanide produces cyanmethemoglobin which has a maximum absorbance at 540 nm. Color intensity is proportional to total hemoglobin concentration, which is how the hemoglobin levels are measured.

Hematology In the hemoglobin methodology using potassium ferricyanide the following measurable reaction occurs: A. carboxhemoglobin is formed B. iron remains in the ferrous state C. ferrous iron is oxidized to ferric iron to form methemoglobin D. acid hematin is formed

A-D; Bone marrow biopsies are helpful diagnostic tools in: Evaluation of anemia and thrombocytopenia Evaluation of cytopenias Diagnosing leukemias Can be part of evaluation for FUO Bone marrow biopsies are NOT used as screens for hematologic issues during routine check-ups.

Hematology In which of the following situations would a bone marrow aspirate and biopsy possibly be used as an aid for diagnosis? (Select all that apply) A. Evaluation of anemia and thrombocytopenia B. Evaluation of cytopenias C. Diagnosis of leukemias D. Evaluation of fever of unknown origin (FUO) E. Screening for hematologic issues during routine check-ups

1. C 2. A 3. B Normocytic- G6PD deficiency, Malaria Microcytic- Iron deficiency, Thalassemia Macrocytic- Chronic Liver Disease, Vitamin B12 deficiency

Hematology Match the disease conditions with appropriate red cell size classification 1. G6PD deficiency, Malaria 2. Iron deficiency, Thalassemia 3. Chronic Liver Disease, Vitamin B12 deficiency A. Microcytic B. Macrocytic C. Normocytic

C; Pluripotential stem cells are ultimately capable of differentiating into all types of leukocytes.

Hematology Pluripotential stem cells are capable of producing which of the following: A. Only T-lymphocyte and B-lymphocyte subsets B. Erythropoietin, thrombopoietin and leukopoietin C. Lymphoid and myeloid stem cells D. Daughter cells from only a single cell line

B; Osteoblasts are generally seen in clusters while plasma cells are often more diffusely distributed. Osteoblasts have delicate cytoplasm, whereas plasma cells have dense basophilic cytoplasm with a perinuclear halo.

Hematology The large cell shown in the illustration to the right is occasionally seen in the bone marrow and can be mistaken for a plasma cell - what is this cell called: A. Myeloblast B. Osteoblast C. Stem cell D. Megakaryoblast

A; This drawing depicts beta thalassemia minor B+/B. In Beta thalassemia minor B+/B, one beta gene locus is partially deleted or inactive.

Hematology This drawing depicts which beta chain genotype ? A. Beta thalassemia minor B. Beta thalassemia intermedia C. Beta thalassemia major D. Delta-beta thalassemia minor

B; Coumarin derivatives inhibit the vitamin K dependent Factors (II, VII, X) which can be measured with the PT and monitored frequently with the INR assay.

Hematology Warfarin-based (coumarin derivative) oral anti-coagulant therapy is commonly monitored with : A. APTT B. PT/INR C. APTT and PT D. Thrombin time

D; Anything that can cause significant turbidity in a blood sample, such as high leukocyte count or lipemia can potentially interfere with the accuracy of a spectrophotometric hemoglobin assay.

Hematology Which of the following may interfere with the accurate measurement of hemoglobin: A. Leukocytosis B. EDTA C. Heparin D. Leukocytosis and lipemia

D; The Bethesda assay is used to measure the titer and activity of the antibody present in a patient's sample. Prothrombin time is an initial screening procedure for bleeding disorders and a test used for monitoring anticoagulant therapy. A thrombin time is used to detect heparin interference in an aPTT mixing study. A mixing study is performed to detect the presence of a factor deficiency or coagulation inhibitor, but does not quantify the result.

Hematology Which of the following tests is used to quantify a coagulation inhibitor? A. Prothrombin time B.Thrombin time C. Mixing study D.Bethesda assay

B; Heinz bodies occur as the result of denaturation and precipitation of hemoglobin, and are often attached to the red cell membrane. They require staining with crystal violet or methyl violet to be visible. They may be seen in thalassemia, with unstable hemoglobins, or during a hemolytic episode in G6PD deficiency.

Hematology The intracellular precipitates seen in the RBCs in this illustration is termed: A. Dohle bodies B. Heinz bodies C. May-Hegglin anomaly D. Reticulocytes

A; The hepatitis B vaccine is a series of immunizations consisting of three injections of the hepatitis B antigen. The antigen causes the recipient of the injection to make antibodies against the antigen, hence why this is an example of active immunity.

Immunology The hepatitis B virus vaccine was administered to MLS students during Orientation.Which type of immunity is expected to develop and provide long-term protection? A. active B. passive C. adoptive D. innate E. inactive

A; Allergen-specific IgE, synthesized in response to allergens, becomes fixed to receptors on cellular membranes, especially those of basophils. If these receptor-bound IgE molecules are aggregated on re-exposure to specific allergen, both mast cells and basophils produce mediators that result in the allergic response. IgE-antigen interaction at the cell surface causes degranulation of cells and release of substances including: histamine, SRS-A, platelet activator, a kallikrein, and an eosinophil chemotactic factor. Basophils are the principal cells that bind IgE antibody while their number of receptor sites is proportional to serum IgE levels. Eosinophils are drawn to the site by the basophil chemotaxis mechanism, but are not the main cell which binds the IgE antibody.

Immunology The mediator cells that bind MOST to IgE antibodies are: A. Basophils B. Eosinophils C. Polymorphonuclear neutrophils D. Macrophages

C; Antibodies are differentiated based on their heavy chains; different heavy chains create different isotypes. Humans have five different isotypes of immunoglobulins.

Immunology The part of the molecule responsible for differences among immunoglobulin classes is: A. Fc B. Fab C. heavy chains D. light chains E. Hinge regions

C; Hepatitis B surface antigen, or HBs, is a protein that is present on the surface of the virus. The protein will be present via laboratory testing in the blood with acute and chronic HBV infections

Immunology What sero-marker is the first marker to become positive in Hepatitis B and is associated with the infective stage? A. HBc antibody B. HBc total C. HBs antigen D. Hbs antibody E. Hbe antigen

B; A combination of (nonselective) 5% sheep blood and (selective) MacConkey agars is sufficient for the recovery of the pathogenic microorganisms that are most commonly encountered in urinary tract infections (UTIs). MacConkey is the selective culture medium that is most commonly used to inhibit growth of gram-positive organisms (most UTIs are caused by gram-negative organisms). Eosin methylene blue (EMB) is a selective agar that also inhibits the growth of gram-positive organisms. Therefore, using only a combination of MacConkey and EMB would prevent the detection of a gram-positive organism, if this were the cause of the infection. Chocolate agar or other enriched media may be needed in addition to blood and MacConkey if a more fastidious organism is suspected. Thayer-Martin would be used specifically for recovery of Neisseria gonorrhoeae. Thayer-Martin (or Modified Thayer-Martin) inhibits other microorganisms and allows the selective recovery of both N. gonorrhoeae and N. meningitidis.

Microbiology Which culture agar combinations below will usually be sufficient for MOST routine urine culture investigations? A. 5% sheep blood and Chocolate B. 5% sheep blood and MacConkey C. 5% sheep blood and Thayer-Martin D. MacConkey and Eosin Methylene Blue E. Thayer-Martin and Chocolate

B; CAMP is the correct answer because the case is typical of Streptococcus agalactiae(Group B strep). The main presumptive identification test is CAMP. Bile solubility is positive for Streptococcus pneumonia. Coagulase would be positive for Staphylococcus aureus. PYR is positive for Streptococcus pyogenes (Group A strep) which is ruled out by the resistance to bacitracin.

Microbiology Spinal fluid cultures on a 3-day-old infant revealed beta-hemolytic, Gram-positive cocci occurring in pairs and chains. The organism was catalase-negative and bile esculin-negative. Resistance to 0.04 U disk of bacitracin was noted. The other test necessary to identify this organism is a positive test by: A. Bile solubility B. CAMP C. Coagulase D. PYR

D; The microscopic features shown here represent Scopulariopsis species. In most instances, particularly if a patient does not have underlying immunologic or hematologic disease, Scopulariopsis species should be considered a contaminant when recovered from a sputum specimen. However, if there is clinical or X-ray evidence of mycotic pulmonary infection, additional daily induced sputum specimens should be obtained. If Scopulariopsis species or any other hyaline mold is recovered from two or more successive specimens, its potential as a pathogenic agent should be considered. Scopulariopsis species have been reported as the agents of pulmonary fungus ball infections in patients with preexistent cavities and as a cause of pneumonia in patients with leukemia. Invasive pulmonary disease by this agent has not been reported.

The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely: A. The cause of chronic bronchitis B. The cause of invasive pulmonary disease C. The cause of allergic bronchopulmonary disease D. A contaminant

1. C 2. A 3. D 4. B

Urinalysis & Other Body Fluids Match the following urine chemical reagent strip test pads to the disease or disorder that would most likely cause a positive test result. 1. Ketones 2. Blood 3. Bilirubin 4. Nitrites A. Renal calculi B. Urinary tract infection C. Diabetes mellitus D. Hepatitis/cirrhosis

F; These are tyrosine crystals

Urinalysis & Other Body Fluids True or false? Cystine crystals are present on this slide. Select true or false

B; The term that is used to describe the color in these tubes of CSF is "xanthochromia." Xanthochromia is an abnormal color, usually yellow, orange, or pink, in the supernatant of the CSF sample. It may indicate that a subarachnoid hemorrhage (SAH) has occurred. Jaundice and icterus both describe a yellowing of the skin, mucous membranes, and eyes. Blood plasma/serum that is deep yellow is also described as icteric.

What term is used to describe the color in these tubes of cerebrospinal fluid (CSF)? A. Jaundice B. Xanthochromia C. Icterus