MLT ASCP Practice Questions 3.5.16 Part 1

D; Rh antibodies typically react best at 37o C. Therefore, the answer cannot be the first or second choices. Rh antibodies do not react in saline.

Rh antibodies generally: A. React best at 4 degrees Celsius B. React best at room temperature C. React best in saline D. React best at 37 degrees Celsius

C; Since the blood pH is only 7.07, it is acidic. The increased level of pCO2 demonstrates that there is a build up of acid from the respiratory system, while the bicarbonate is within normal range. Therefore, the patient is suffering from respiratory acidosis.

A three-year-old boy was brought unconscious to the emergency room. Blood gas results were as follows: pH: 7.07 pCO2: 90 mm Hg HCO3: 23 mEq/L This patient is most likely suffering from: A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis E. uncompensated metabolic alkalosis

C; Normal blood values for a 100-gram oral glucose tolerance test used to screen for gestational diabetes are as follows: Fasting: less than 95 mg/dL 1 hour: less than 180 mg/dL 2 hour: less than 155 mg/dL 3 hour: less than 140 mg/dL

A 29-year old pregnant woman had an outpatient glucose tolerance test. The patient was given a 100-gm dose of glucose and the following values were obtained: Fasting 110 mg/dL 1 hr. 188 mg/dL 2 hr. 175 mg/dL 3 hr. 143 mg/dL The MOST likely interpretation of this glucose tolerance would be: A. Insulin dependent diabetes mellitus (IDDM) B. Non insulin dependent diabetes mellitus (NIDDM) C. Gestational diabetes mellitus (GDM) D. Normal glucose tolerance test

A; The individual would be at low risk for cardiac disease. She does not have any risk factors besides her family history (where great grandparents are usually not evaluated as heavily as a immediate family members), her lipid levels are in the recommended ranges, and her hs-CRP is in low risk range.

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

B; In Hodgkin Lymphoma, the lymph node can be quite enlarged (lymphadenopathy) with has a nodular appearance due to bands of fibrosis. Reed-Sternberg cells are closely associated with Hodgkin lymphoma as well. Mantle cell lymphoma, follicular lymphoma, and Burkitt lymphoma are not commonly associated with Reed-Sternberg cells or the bands of fibrosis present in this case.

A 36-year-old woman visits her physician after experiencing fevers, night sweats, and overall fatigue over the past 3 months. Upon physical examination she displays lymphadenopathy. When a lymph node biopsy is performed, Reed-Sternberg cells, bands of fibrosis, and various-sized lymphocytes are noted. Which of the following conditions is the most likely diagnosis? A. Mantle cell lymphoma B. Hodgkin lymphoma C. Follicular lymphoma D. Burkitt lymphoma

B; Differential counts on CSF should be performed on stained smears made from a cytocentrifuged specimen. Cell type cannot be reliably assessed on unstained specimens or from the hemocytometer.

A WBC differential count on CSF should be performed using the following technique: A. Wet mount of sample from collection tube B. Stained smear of a cytocentrifuged specimen C. Directly from hemocytometer chamber count D. Directly from stained hemocytometer count

A; Xanthochromia usually implies subarachnoid hemorrhage of at least several hours duration, if in vitro lysis of red cells can be excluded.

A yellow coloration found in fresh cerebrospinal fluid supernatant is termed: A. Xanthochromia B. Hemolysis C. Jaundice D. Hyperlipidemia

B; The test results that are associated with different types of meningitis are summarized in the table below. Bacterial Meningitis: WBC Count: Elevated Differential: Primarily neutrophils Glucose: Markedly decreased Protein: Markedly elevated Lactate: Elevated Viral Meningitis: White Blood Cell Count: Elevated Differential: Primarily lymphocytes Glucose: Normal Protein: Moderately elevated Lactate: Normal Fungal Meningitis: White Blood Cell Count: Elevated Differential: Lymphocytes, Monocytes Glucose: Normal or slightly decreased Protein: Moderate to marked elevation Lactate: Elevated Tubercular Meningitis: White Blood Cell Count: Elevated Differential: Lymphocytes, Monocytes Glucose: Decreased Protein: Moderate to marked elevation Lactate: Elevated

A cerebrospinal (CSF) cell count is 1000 cells/µL. The cells on differential are predominantly lymphocytes. CSF protein is moderately elevated and the glucose is normal. No microorganisms were observed on a Gram's stain smear of the CSF sediment. This condition is MOST likely: A. Bacterial meningitis B. Viral meningitis C. Normal spinal fluid D. Tubercular meningitis

B; The increased PCT may indicate a high risk of severe sepsis/septic shock. PCT significantly increases during severe sepsis and septic shock, making it a valuable marker for evaluating prognosis and monitoring antibiotic therapy. If a critically ill patient's PCT level is evaluated in conjunction with clinical assessments, the risk for progression to severe sepsis and septic shock can be assessed on the first day of admission to the ICU.

A critically ill 86-year-old female was admitted to the intensive care unit (ICU) after arriving at the emergency department with symptoms that included shortness of breath and fever. Her temperature was 39°C (102°F) and pulse rate 110/minute. A white blood count was ordered and was elevated at 15.0 x 109/L. The differential showed an increase in segmented and immature neutrophils. Other testing was ordered after admission to ICU, including a procalcitonin (PCT). The result was 2.15 ng/mL (Reference value for normal at the 95th percentile is <0.05 ng/mL). Given the clinical assessment and laboratory test results, what may the increased procalcitonin indicate? A. Low risk of severe sepsis/septic shock B. High risk of severe sepsis/septic shock C. Systemic inflammation, not related to infection

B; Once an antibody has been detected, and is part of the patient's historical record, units that are considered for transfusion must be negative for that antigen.

A former patient had an anti-E four years ago, but her antibody panel is now negative. Since she now needs blood for surgery, what should the blood bank do? A. get autologous blood from relatives B. crossmatch E-negative units C. give group O negative whole blood D. give random compatible units

D; The organism that most closely fits the clinical and laboratory picture is a Pseudomonas species. This microbe is associated with a bluish green pigment as well as a characteristic fruity odor. The biochemical tests also match the expected results for Pseudomonas.

A gram-negative rod isolated from a burn patient produced a bluish green pigment and the following test results: Characteristic fruity odor TSI: alkaline/alkaline Motility: positive Oxidase: positive Oxidative/Fermentation Glucose: oxidative utilization only The MOST probable genus of this isolate is: A. Acinetobacter B. Alcaligenes C. Moraxella D. Pseudomonas

B; Lymphokines are a type of cytokine that are produced by lymphocytes, usually T cells, to direct the immune system response by signaling between its cells. Lymphokines attract immune cells to an infected area and helps activate them to attack the foreign pathogens.

A lymphokine can BEST be described as: A. A soluble mediator produced by granulocytes and affecting lymphocytes B. A soluble mediator produced by lymphocytes C. A soluble mediator produced by plasma cells D. An antibody that reacts with lymphocytes

B; The decreased serum parathyroid hormone level indicates that the parathyroid gland is not secreting this hormone adeqately. This condition is called hypoparathryroidism, as the hypo- represents inadequacy of the parathyroid's production.

A patient has the following test results: Increase serum phosphorus level, decreased serum calcium level, and decreased serum parathyroid hormone level. This patient MOST likely has: A. hyperparathyroidism B. hypoparathyroidism C. nephrosis D. bone disease

A; LDL cholesterol = Total cholesterol - (HDL + (Trig / 5)) In this case, the calculation for LDL would be: LDL cholesterol = 295 mg/dL - (30 mg/dL + (200 mg/dL / 5)) LDL cholesterol = 295 mg/dL - 70 mg/dL = 225 mg/dL

A routine laboratory workup is ordered for an outpatient. The patient's lipid results are as follows: Total cholesterol = 295 mg/dL HDL = 30 mg/dL Triglycerides = 200 mg/dL What is the LDL cholesterol level for this patient? A. 225 mg/dL B. 65 mg/dL C. 365 mg/dL D. 255 mg/dL

D; Chediak-Hegashi syndrome is defined as the abnormal fusion of cytoplasmic lysozymes in granulocytes and occasionally monocytes. This condition is associated with albino characteristics, photophobia, and frequent infections (as the granules are dysfunctional and cannot fight infection appropriately). Pelger-Huet anomaly is associated with bi-lobed neutrophils. Alder-Reilly is associated with genetic mucopoly- saccharidoses. Patients with mucopolysaccharidoses do not have the lysozymal enzymes necessary to break down mucopolysaccharides; hence dense azurophilic granules, resembling toxic granulation in neutrophils, are seen in all leukocytes. Finally toxic granulation is associated with an increased amount of granulation inside leukocytes and is most commonly observed in: infections and inflammatory conditions.

A small child has albino characteristics, photophobia, frequent pyogenic infections, and her blood smear shows giant dark granules in her monocytes and granulocytes. What is the probable diagnosis? A. Pelger-huet anomaly B. Alder-Reilly C. Toxic granulation D. Chediak-Hegashi syndrome

A; Haemophilus influenzae (which requires X and V factors) will grow in the hemolytic zone of Staphylococcus aureus on blood agar plates. The hemolysis of red blood cells by S. aureus releases nutrients vital to the growth of H. influenzae (NAD). The X and V factors (hemin and NAD) diffuse into the surrounding medium and promotes the growth of Haemophilus in the area surrounding staphylococcus. This is known as satelliting. For Haemophilus spp., the satellite test substitutes for the V factor test.

A small gram-negative rod isolated from an eye grows on chocolate agar but NOT on sheep blood agar. It produces satellite growth around staphylococci on sheep blood agar, however. The organism requires: A. X and V factor B. X factor only C. V factor only D. Neither X or V factor

A & C A2 and A2B individuals can produce anti-A1. In fact, about 25% of A2B individuals may have anti-A1 in their serum. Approximately 4% of all A2 individuals have naturally occurring anti-A1 in their serum.

A2B patients have or may have which of the following: (More than 1 answer may apply) A. Serum containing anti-A1. B. Serum containing anti-B. C. Red cells that react with anti-A and anti-B.

B; The delicate nature, small size and ease of aerosolization of the arthroconidia of Coccidioides immitis, separated by empty space, makes this species the most likely to result in laboratory acquired infections. Because the arthroconidia are so small and light, they more easily reach the alveolar spaces when inhaled than the conidia of other species. Particularly dangerous are older, mature cultures where spores are highly concentrated and extremely fragile. Although laboratory infections with the other fungal species listed in this exercise are possible, the spores do not become as easily aerosolized and present a less likely event. Of more probability is the direct inoculation of skin through broken glass or penetration of a needle.

Although care should be taken when working with all fungus cultures in the laboratory, personnel are particularly prone to develop laboratory acquired infections from the inhalation of airborne species of: A. Blastomyces dermatitidis B. Coccidioides immitis C. Sporothrix schenckii D. Histoplasma capsulatum

F; Judging by the information provided in this question, Enterococcus is the best choice. Many former Group D streptococci have been reclassified and placed in the genus Enterococcus. Typically, growth in 6.5% NaCl broth can differentiate Enterococcus which is salt-tolerant vs. other group D streptococci which do not grow in 6.5% NaCl broth.

An alpha-hemolytic streptococcus isolated from a wound is resistant to optochin and bactracin, grows in 6.5% NaCI broth, and is PYR positive. The organism is MOST likely a streptococcus belonging to: A. Lancefield Group A B. Lancefield Group B C. Lancefield Group C D. Lancefield Group D E. Lancefield Group E F. Enterococcus

B; The correct answer is to prevent TA-GVHD. This occurs when donor lymphocytes from transfused blood engraft in the recipient and cause disease. Usually TA-GVHD occurs 10-14 days post transfusion with clinical features of fever, skin rash, hepatitis, diarrhea and pancytopenia. It is fatal in more than 90% of cases. Irradiation is indicated for patients who are at high-risk for TA-GVHD, including low birth weight infants, hematopoietic progenitor cell (HPC) transplant recipients, patients receiving immunosuppressive therapies, and other immunocompromised patients.

An exchange transfusion has been ordered for a low birth weight infant. The physician has ordered irradiated Red Blood Cells for this purpose. Why is it necessary to irradiate the blood products for this patient? A. To prevent alloimmunization of the patient B. To prevent transfusion-associated graft-versus-host disease (TA-GVHD) C. To kill bacteria and viruses present in the Red Blood Cells D. To allow the cells to have a longer half-life

D; It is very important to engage the needle's safety device to cover the needle during transport to the sharps container.

Before disposing of a needle in the sharps containers, what should you do? A. Recap the needle B. Remove the needle from the disposable syringe by hand C. Break off the needle tip D. Engage the needle safety device

C; His measurements meet the NCEP: ATP III criteria for metabolic syndrome diagnosis. Three of the five parameters are abnormal: waist circumference, fasting blood glucose, and triglycerides. BMI is not a parameter in this set of criteria.

Below are the laboratory results on a 20-year-old overweight male. His waist circumference is 41 inches and blood pressure is 105/70. Fasting Blood Glucose: 130 mg/dL Triglycerides: 190 mg/dL HDL: 50 mg/dL Does this patient meet the NCEP: ATP III criteria for metabolic syndrome diagnosis? A. No, because his HDL is > 40 mg/dL B. No, because he is not hypertensive C. Yes, he meets the NCEP: ATP III criteria for metabolic syndrome D. No, since height and weight were not reported, his BMI cannot be calculated

C; C-reactive protein was first found to precipitate pneumococcal C-polysaccharide in patients who had recovered from pneumococcal pneumonia. It was subsequently found to be elevated in numerous other conditions. It is often elevated in pediatric bacterial infections, and usually not elevated in pediatric viral infections, and thus may help the pediatrician to differentiate these entities. It can also be used to follow the disease activity in autoimmune conditions.

C-reactive protein: A. Is a highly specific test B. Corresponds to serum complement levels C. Is usually elevated in pediatric bacterial infections D. Does not react with pneumococcal C-polysaccharide

D; The equation for calculating the concentration of LDL cholesterol (known as the Friedewald formula) is: [LDL cholesterol] = [total cholesterol] - [HDL cholesterol] - [VLDL] (where VLDL is calculated as [triglyceride]/5). In this case, [LDL cholesterol] = 280 mg/dL - 40 mg/dL- (100/5) [LDL cholesterol = 220 mg/dL

Calculate LDL cholesterol concentration if total cholesterol is 280 mg/dL, Triglyceride is 100 mg/dL and the HDL cholesterol is 40.0 mg/ dL. A. 172 mg/dL B. 140 mg/dL C. 238 mg/dL D. 220 mg/dL E. 240 mg/dL

B; Common colds are MOST often associated with Rhinovirus. Rhinovirus infections occur most commonly in the fall and the spring. Rhinovirus symptoms typically appear after an incubation period of 12-72 hours and last 7-10 days, but can last even longer. Patient diagnostic workups are usually not performed with suspected Rhinovirus cases, as the disease is typically mild and self-limiting.

Common colds are MOST often associated with which agent? A. Epstein-Barr virus B. Rhinovirus C. Coxsackie B D. Reovirus E. Legionella pneumophila

C; Creatinine excretion is related to muscle mass and is fairly constant from day to day for a given individual.

Creatinine excretion correlates best with which of the following parameters: A. Age B. Sex C. Muscle mass D. Body weight

C; Eosinophils are increased in all of the following conditions EXCEPT viral infections. Viral infections are associated with an increase in lymphocytes. Eosinophils do play a role in parasitic infections as well as allergic reactions, hence their increase in numbers during these conditions.

Eosinophils are increased in all of the following conditions EXCEPT: A. Parasitic infections B. Allergic reactions C. Viral infections

A; Estriol "the estrogen of pregnancy" is synthesized by the placenta from precursor substances synthesized in the fetal adrenal, and modified in the fetal liver. Measuring of maternal serum estriol in conjunction with AFP and hCG during the 16th week of pregnancy can be used to help predict the risk of Down's syndrome (Triple Screen), although sometimes only hCG and AFP are used to assess this risk, since the addition of estriol to the screen is only marginally cost effective.

Estriol levels in conjunction with hCG and AFP can be obtained during pregnancy to: A. Assess the risk of Down's syndrome B. Assess fetomaternal function C. Assess for multiple gestations D. Assess for maternal diabetes mellitus

D; Agglutination of red cells prior to addition of antiglobulin reagent due to cold autoantibodies would give a "false" positive result, not a false negative. In this case, the washed red cell sample will agglutinate prior to addition of antiglobulin.

False negative results may occur with both the direct and indirect antiglobulin tests as a result of all of the following except: A. Undercentrifugation B. Delay in adding antiglobulin reagent C. Failure to adequately wash cells D. Agglutination of red cells prior to addition of antiglobulin reagent

A; R1r is the only genotype listed that is heterozygous for the C antigen. Weiner = Fisher-Race R1r = DCe/dce R1R1 = DCe/DCe rr = dce/dce R1R2 = DCe/DcE R2r = DcE/dce R2R2 = DcE/DcE r'r = dCe/dce r'r' = dCe/dCe r"r = dcE/dce r"r" = dcE/dcE R0r = Dce/dce

Given the following commonly used nomenclature systems, which one of the Rh genotypes listed below is heterozygous for the C antigen? Wiener/Fisher-Race (haplotype) RoDce R1 DCe R2DcE RzDCE rdce r'dCe r"dcE rydCE A. R1r B. R1R1 C. R2r" D. r"r

B; Gram-negative cocci that occur in pairs with their adjacent sides flattened are typical of Neisseria species, including Neisseria meningitidis and Neisseria gonorrhoeae. The bacteria in the Gram stain that is represented by the image is Neisseria gonorrhoeae.

Gram-negative cocci that occur in pairs with their adjacent sides flattened, giving them a "coffee bean" appearance (indicated by the arrows in the image), are typical of which of the following bacteria? A. Streptococcus pneumoniae B. Neisseria species C. Staphylococci

A; Hb S is most prevalent in African countries. It is also common in the Middle East and countries in the Mediterranean area. HbS is not as common in North American countries. Sickle cell disease occurs in less than 2% of African Americans and sickle cell trait in 8 - 10% of African Americans.

Hb S is MOST common in which of the following countries? A. African countries B. Mediterranian countries C. Middle Eastern countries D. North American countries

B; Ideally, 20 days worth of testing should be performed prior to starting a new lot of control material in order to establish its mean and standard deviation. It is best to include data from different shifts and different operators, but the testing should not be performed all at one time.

Ideally, what testing should be done prior to starting a new lot of control material in order to establish its mean and standard deviation? A. Should be tested consecutively by 20 different technologists B. Should be tested for 20 days C. Should be tested 10 consecutive times on each of three work shifts

D; The segmented neutrophil is generally the most abundant normal WBC seen in the adult peripheral blood.

Identify the cell in this illustration indicated by the arrow: A. Myelocyte B. Reactive lymphocyte C. Monocyte D. Segmented neutrophil

C; Hyaline casts generally appear as colorless, homogeneous, and transparent with rounded ends. They can also be seen as a result of dehydration, after diuretic therapy, in renal disease, and transiently as a result of exercise.

Identify the urine sediment element indicated by the arrow in the illustration: A. Mucus thread B. Cylindroid C. Hyaline cast D. Waxy cast

B; Mucus thread appear as long, thin ribbon like threads that are generally transparent. They are normal in small numbers in the urine.

Identify the urine sediment elements shown by the arrow: A. Cylindroids B. Mucus threads C. Hyaline casts D. Budding yeast

B; If a cocktail that includes detergents, enzymes, and salts is used for DNA isolation, the salts will pull the DNA out from the sample. The detergents break down the membrane lipids and the enzymes remove the proteins.

If a cocktail that includes detergents, enzymes, and salts is used for DNA isolation, which one of these ingredients will pull the DNA out from the sample? A. Detergents B. Salts C. Enzymes

B; In Hashimoto's, antibodies react against proteins in the thyroid gland, causing gradual destruction of the gland itself, and making the gland unable to produce the thyroid hormones the body needs. Therefore the T4 is decreased, but the TSH is increased since the pituitary gland is attempting to stimulate the failing thyroid gland. The TRH stimulation is increased since the pituitary gland is working and is able to produce elevated levels of TSH upon TRH stimulation.

In patients with suspected primary hypothyroidism associated with Hashimoto's thyroiditis, one would expect the following laboratory test results: T4 ___? TSH ___? TRH stimulation ___? A. increased, decreased, increased B. decreased, increased, increased C. increased, decreased, decreased D. increased, increased, decreased E. decreased, decreased, decreased

D; Otherwise, serum antibody may contaminate the eluate.

In preparing red cells for any elution method , one must be particularly careful to: A. Leave a small amount of serum in the test system so complement will be present B. Add albumin to decrease zeta potential C. Pretreat the cells with enzymes D. Thoroughly wash sensitized red cells

A; Most patients with HH become symptomatic during middle age.

In which age group is hereditary hemochromatosis (HH) most likely to be initially detected based on clinical symptoms? A. Middle aged adults B. Young adults C. School age children D. Infants

1=B; 2=A; 3=C Alpha hemolysis- Green area around bacteria incomplete hemolysis Beta hemolysis- Clear area around bacteria complete hemolysis Gamma hemolysis- No visible effect on blood

Match type of hemolysis with the best description: 1. Gamma hemolysis 2. Alpha hemolysis 3. Beta hemolysis A. Green area around bacteria incomplete hemolysis B. No visible effect on blood C. Clear area around bacteria complete hemolysis

A; This peripheral smears depicts many hypochromic red blood cells. The central pallor of a red cell should typically not exceed more than one-third of the red cell diameter. In these cells, the central pallor takes up most of the cell, indicating a decreased amount of hemoglobin inside of the cells. Patients displaying this morphology are often classified as anemic.

Most of the red blood cells in this field could be described as: A. Hypochromic B. Hyperchromic C. Normochromic D. Polychromatophilic

B; The intended response is postsplenectomy syndrome. The scattered atypical RBC's seen in the photograph may be produced in small numbers in normal people; however, the spleen is efficient in removing these from the circulation so that they are not found in a peripheral blood smear of a disease free, untreated patient. However, following splenectomy, this removal function is no longer in place and scattered acanthocytes, echinocytes, target cells, spherocytes, and schistocytes remain in the circulation.

Note the view of a peripheral blood smear in the photograph. Pictured are scattered acanthocytes, echinocytes, target cells, spherocytes, and schistocytes. The condition in which each of these atypical RBC's may be found in varying numbers in the same peripheral blood smear is: A. Hemolytic anemia B. Postsplenectomy syndrome C. Disseminated intravascular coagulation D. Thalassemia minor

D; Using the 10x objective is helpful for all of the choices listed as the 10x low objective view will show an overall picture of the cells, the slide quality, and the quality of the smear itself.

Reviewing a stained blood smear with the 10x objective is beneficial for which of the following? A. evaluating the overall picture of the blood cells B. evaluating the quality of the blood smear C. assessing the quality of the Wright's stain D. all of the above

B; The only correct choice is choice 2, as enzymes are protein catalysts of biological origin. Enzymes are altered by heat denaturation, are affected by pH changes, and affect the rate of a chemical reaction by decreasing the activation energy needed.

The properties of enzymes are CORRECTLY described by which of the following statements? A. Enzyme activity is not altered by heat denaturation B. Enzymes are protein catalysts of biological origin C. Enzymes are stable proteins and unaffected by pH changes D. Enzymes affect the rate of a chemical reaction by raising the activation energy needed

D; Transferrin binds iron in the serum, and is proportional to total iron-binding capacity (TIBC). Transferrin(mg/dl) = 0.7 X TIBC (ug/dl)

TIBC (total iron-binding capacity) is an indirect measurement of which of the following: A. Ferritin B. Hemoglobin C. Ceruloplasmin D. Transferrin

A; The Entamoeba histolytica trophozoite is usually characterized by the presence of small central karyosome in the nucleus with ingested RBC's. Identification of cysts and trophozoites via microscopic examination of the stool is the common method for diagnosing Entamoeba histolytica.

The Entamoeba histolytica trophozoite is usually characterized by the presence of the following: A. small central karyosome in the nucleus, ingested RBC's B. ingested RBC's, coarse, uneven chromatin on the nuclear membrane C. ingested RBC's, large glycogen vacuoles in cytoplasm D. large, blot-like karyosome, ingested WBC's

D; Western blot testing is the gold standard for anti-HIV-1 confirmation.

The Western Blot Assay is used as a confirmatory test for which of the following: A. HBsAg B. CMV Antibody C. Anti-HCV D. Anti-HIV-1

D; Crenated red cells usually occur as an artifact during the preparation of blood smears.

The abnormal RBC shape seen in this illustration is: A. Sickle cell B. Thorn cell C. Fragmented cell D. Crenated cell

B; The cells would be described as hypochromic/microcytic red blood cells. The central pallor is increased and the cells are smaller than normal RBCs, which is confirmed by the low MCV (Normal MCV is 80-100 fL).

The automated cell count reported an MCV of 75 fL for the blood specimen from which this blood smear was made. Which of the following terms best describes the cells in this field? A. Normochromic/normocytic B. Hypochromic/microcytic C. Hyperchromic/macrocytic

A; The life span of an RBC containing Hemoglobin H bodies is decreased because the RBC membrane is compromised when macrophages attempt to remove this unstable hemoglobin, which is precipitated just inside the membrane.

The life span of RBCs containing Hemoglobin H is typically: A. decreased B. increased C. unchanged

C; rr is the most frequent genotype among Rh-negative individuals. The genotype symbolized a lack of the D (Rh) gene.

The most frequent genotype among Rho (D) -negative persons is: A. r' r B. r' r" C. rr D. r'r'

A; Rheumatoid Factor (RF) is an antibody against the Fc portion of IgG molecules. It is primarily, of the IgM class and can less commonly be IgG or IgA. These circulating antibody complexes are found in the synovial tissue and synovial fluid and tend to cause systemic problems. In the laboratory, routine latex agglutination test would typically detect only IgM RF since most IgG and IgA antibodies are non-agglutinating.

The rheumatoid factor in rheumatoid arthritis is PRIMARILY which type of immunoglobulin? A. IgM B. IgA C. IgG D. IgE E. Incomplete

B; The segmented dark-staining grains seen in this photomicrograph are most commonly seen in cases of chromomycosis. Of the fungal species listed in this exercise, only Phialophora verrucosum is associated with chromomycosis and has the capability of producing the grains seen in the photograph. Although Scedosporium apiospermum may cause mycetoma and produce grains, they are soft, gray white and not segmented. Sporothrix schenckii is the agent of subcutaneous sporotrichosis, an infection that may result in granulomatous inflammation with the presence of multi-nucleated giant cells; however, grains or granules are not formed.

The segmented, dark-staining grains seen in this photomicrograph are most commonly seen in cases of chromomycosis. Which of the fungal species listed below is known to cause this disease? A. Scedosporium apiospermum B. Phialophora verrucosum C. Sporothrix schencki

A; Budding is defined as the stage of viral replication where the envelope is being acquired and the HIV is leaving the host cell. Photo: HIV virions budding and releasing from an infected cell. Credit: NIH

The stage of viral replication where the envelope is being acquired and the HIV is leaving the host cell is known as: A. Budding B. Reverse transcriptase C. Integrase D. Adsorption

B; Vanillylmandelic acid (VMA) is a metabolite of the catecholamines, epinephrine and norepinephrine. VMA is found in the urine, along with other catecholamine metabolites, including homovanillic acid (HVA), metanephrine and normetanephrine. Urinary VMA is elevated in patients with tumors that secrete catecholamines.

The ultimate end product of both epinephrine and norepinephrine metabolism is: A. metanephrine B. vanillylmandellic acid (VMA) C. homovanillic acid (HVA) D. cortisol

D. The innate immunity system is inherent and nonspecific; meaning that all pathogens are attacked similarly. The skin, mucus in respiratory tracts, acid pH, and others are all examples of the innate immunity system that the body has to prevent infection upon first exposure.

The vast MAJORITY of would-be invaders are killed or inactivated primarily by which part of the immune system? A. Cell Mediated B. Specific C. Humoral D. Innate

D; Atypical or reactive lymphocytes have more abundant cytoplasm and may approach the size of neutrophils. They have a large range of morphologic differences, some may even have the characteristics of early cells including the presence of nucleoli and deeply basophilic cytoplasm. Most commonly, the scalloped edge of the cell cytoplasm as well as a nucleus appearing "stretched" are displayed in atypical lymphocytes.

The white blood cell that can appear atypical or reactive on a Wright-stained smear is: A. Basophil B. Eosinophil C. Neutrophil D. Lymphocyte

D; The smear is most accurately reported as "Many gram-positive cocci in pairs, many polymorphonuclear white blood cells (PMNs)." It is important to describe the microorganisms that are observed as thoroughly as possible and to report the presence and quantity of host cells that are observed on the smear.

This Gram stain was prepared from a lower respiratory tract specimen. How should this Gram stain be reported? A. Gram-negative cocci B. Gram-positive cocci C. Many gram-positive cocci in pairs D. Many gram-positive cocci in pairs, many polymorphonuclear white blood cells (PMNs)

D; These inclusions are basophilic stippling, indicating impaired hemoglobin synthesis. Basophilic stippling may be seen in conditions such as lead poisoning, and thalassemia.

This image represents a Wright-Giemsa stained peripheral blood smear. What are the inclusions that are present in the red blood cell indicated by the arrow? A. Pappenheimer bodies B. Howell-Jolly bodies C. Hemoglobin H D. Basophilic stippling

C; Cardiac troponin I will reach levels above the normal reference range typically between 3 and 6 hours post-acute myocardial infarction. Usually, the troponin I will be measured in several intervals after the initial elevation (usually 6-9 hours, 12-24 hours, etc.). Troponin I will stay at increased levels for approximately 5-10 days after mycocardial infarction.

Troponin I is used frequently to assess acute myocardial infarctions (AMI). If a patient has experienced an AMI, at what point (approximately) will the troponin I begin to increase and how long will it stay increased? A. 12-24 hours, 5-10 days B. 6-10 hours, 1-2 days C. 3-6 hours, 5-10 days D. 3-6 hours, 1-2 days

T; This is a red blood cell cast. Red blood cells (RBCs) can be identified within the matrix of the cast. The identification of the cast as a red blood cell cast is supported by the appearance of RBCs outside of the cast.

True or false? The element that is indicated by the arrow is a red blood cell cast.

The statement is true. The listed criteria apply to donor RBC for exchange transfusions to treat any type of HDFN, including those caused by antibodies outside the ABO and Rh blood group systems.

True/False All of the following criteria for donor RBC to be used for an exchange transfusion relate to both ABO HDFN and HDFN due to anti-D: Less than or equal to 7 days old (or fresher) Reconstituted with AB FFP CMV negative Negative for hemoglobin S Irradiated

True; According to the paper published by Pistelli, et al, most strains of S. anginosus (milleri) are susceptible to penicillin G and the cephalosporins.

True/False Most infections caused by S. anginosus can be effectively treated with penicillin or a first generation cephalosporin.

False; The ADA guidelines recommend screening all asymptomatic individuals age 45 and older. If the screen is negative, it should be repeated every three years.

True/False The American Diabetes Association (ADA) guidelines recommend screening all asymptomatic individuals age 45 and older for diabetes. If the screen is negative, this patient will never require another screening.

False; These are cholesterol crystals.

True/False: The crystals that are seen in this image are triple phosphate crystals.

This statement is true. The two main compartments of the bone marrow are the venous sinuses/blood vessels and hematopoietic cords.

True/False: The two main compartments of the bone marrow are the venous sinuses/blood vessels and hematopoietic cords.

C; Traumatic taps are described as spinal fluid taps where blood vessels are pierced with the needle during aspiration, causing a contamination of the spinal fluid sample with blood or bone marrow. Traumatic taps are easily differentiated from true hemmorhages as each subsequent container of spinal fluid drawn will have a smaller amount of red and white cells present. In a true hemorrhage, the red and white cell counts will remain steady in each subsequent tube of spinal fluid drawn.

Two CSF specimens were sent to the Lab with the following results: Tube #1 = 11,200 rbc/µL Tube #2 = 300 rbc/µL The results on these CSF specimens are indicative of: A. an infection B. a recent subarachnoid hemorrhage C. a traumatic tap D. an old intracranial bleeding episode E. faulty lab equipment

C; The cells indicated with arrows are macrocytes. Macrocytes have a diameter of 9-14 µm, which is 1.5 to 2 times larger than normal red cells and larger than the nucleus of a normal small lymphocyte. If macrocytes are identified on a peripheral blood smear, the MCV would be >100 fL.

Using the lymphocyte as a guideline, the cells that are indicated by the arrows would be described as what type of cells? A. Normocytes B. Microcytes C. Macrocytes

C; Infants born with alpha thalassemia intermedia appear normal at birth but often develop anemia and splenomegaly by the end of their first year. Hepatomegaly is not a common finding.

What characteristics are often associated with alpha thalassemia intermedia? A. Nothing abnormal B. Polycythemia, hepatomegaly, C. Anemia, splenomegaly

B; The production of spores within sporangia is unique to the Zygomycetes. Although the production of rhizoids and the formation of aseptate hyphae are characteristics of the Zygomycetes, these are not constant characteristics for all species or at all times during maturation. Only Rhizopus and Absidia species regularly produce rhizoids and occasional septations can be seen in the hyphae of each of the Zygomycetes as the colonies mature, particularly in the sporangiophores.

What is the most helpful feature in differentiating the Zygomycetes from the other hyaline molds in the clinical mycology laboratory? A. The production of rhizoids B. The production of spores within sporangia C. The formation of aseptate hyphae

A; According to the 5th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, the analysis should begin at 30 minutes (if liquifaction is complete), but no longer than one hour after ejaculation. Occasionally a specimen does not liquify. If this occurs, mechanical mixing or enzyme treatment may be necessary in order for the sperm count, motility analysis and other microscopic aspects of semen analysis to be performed.

What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete? A. 30 minutes B. 2 hours C. 4 hours D. 8 hours

A; The threshold limit value, or TLV, of a chemical substance is the maximum level of a chemical to which a worker can be exposed without causing adverse health effects. The temperature at which a chemical will ignite is the flashpoint. The other two choices are not specific definitions.

What is the threshold limit value? A. The maximum level of a chemical to which a worker can be exposed without causing adverse health effects. B. The temperature at which a chemical will ignite. C. The amount of water needed to dilute a chemical for laboratory use. D. The amount of a chemical that can legally be stored in a laboratory.

D; If all results for a patient's forward and reverse type are negative, it is suggested that the reactions incubate at room temperature for at least 15 minutes to help strengthen any reactions to become observable.

What should be the first step performed to resolve a case where all forward and reverse ABO typing results are negative on a patient? A. Wash the patient cells and retest. B. Get a new sample and retest. C. Test the patient cells with Anti-H Lectin. D. Incubate all testing tubes at 22ºc

B & C; Both partial D and partial weak D have a qualitative difference in the D antigen that allows individuals with the D variant to produce anti-D to the D epitopes that they lack.

Which D variant has a qualitative difference in the D antigen that allows individuals with the D variant to produce anti-D? Select all that apply. A. weak D B. partial D C. partial weak D D. None of the listed D variants have a qualitative difference in the D antigen

D; Adiponectin is a protective cytokine. This cytokine is anti-inflammatory and increases insulin sensitivity. Adiponectin is usually decreased in obesity.

Which adipokine is decreased in obesity, is anti-inflammatory, and increases insulin sensitivity? A. Leptin B. Resistin C. TNF-a D. Adiponectin E. IL-6 F. Angiotensinogen

A; The H antigen is an essential precursor to the ABO blood group antigens. Individuals with the rare Bombay phenotype (hh) do not express antigen H on their red blood cells; therefore this type would contain the least amount of H antigen. Those which are type A1B would then have the second to least amount of H antigen since the precursor H antigens have been formed into A1 and B antigens instead. The remaining order of the H concentration from lowest to highest in the blood types given is: A1, A2B, B, A2, and O. O patients produce the most H antigen since they do not convert the H antigen into A or B antigens on their cell surface.

Which is in the correct order from the lowest concentration of H antigen to the highest concentration of H antigen? A. Bombay, A1B, A1, A2B, B, A2, O B. A1, O, B, A2, Bombay, A1B, A2B C. Bombay, O, A1B, A2, A1, B, A2B D. A1B, A2B, A2, O, B, A1, Bombay

D; A polarizing microscope with a first order red compensator is used to identify crystals in synovial fluid: Needle shaped monosodium urate crystals are strongly negatively birefringent, while rhomboid calcium pyrophosphate crystals are weakly positively birefringent.

Which is the best method for examination of synovial crystals: A. Phase contrast B. Darkfield microscopy C. Brightfield microscopy D. Polarized light

A; The Duffy system consists of Fya and Fyb. Antibodies to these antigens are IgG and are detected in the antiglobulin phase. Anti-M, Anti-B and Anti-P1 are typically IgM antibodies and may agglutinate saline suspended cells at room temperature.

Which of the following antibodies is detected primarily in the antiglobulin phase of the crossmatch: A. Anti-Fya B. Anti-M C. Anti-B D. Anti-P1A; The Duffy system consists of Fya and Fyb. Antibodies to these antigens are IgG and are detected in the antiglobulin phase. Anti-M, Anti-B and Anti-P1 are typically IgM antibodies and may agglutin

B; Feedback CK-MB isoforms are markers of myocardial necrosis, but are not widely measured in evaluating chest pain and ACS due to the labor-intensive method that is needed to measure them. Detection of CK-MB isoforms requires a special electrophoresis technique.

Which of the following are markers of myocardial necrosis but are not widely measured in evaluating chest pain and ACS due to the labor-intensive method that is needed to measure them? A. CK-MB B. CK-MB isoforms C. Myoglobin D. cTnT and cTnI

D; Plasma cells in the bone marrow with an increase in IgG is suggestive of multiple myeloma; which is strongly associated with rouleaux formation due to the increased immunoglobulins present.

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? A. some anisocytosis B. some target cells C. microcytic RBC's D. Rouleaux formation

A; Blastomyces dermatitidis produces spherical or oval conidia, each supported by an individual conidiophore ("lollipop"). Spiked (echinulate) macroconidia is characteristic of the mold form of Histoplasma capsulatum. The mold form of Sporothrix schenckii is recognized by the production of tiny microconidia that are arranged around the tip of a delicate conidiophore as petals on a daisy flower. The mold form of Coccidioides immitis is characterized by the production of arthroconidia that appear alternate staining because each cell is separated by an empty space. When mature, each arthroconidium is swollen centrally, giving a barrel appearance.

Which of the following dimorphic molds produces spherical or oval conidia, each supported by an individual conidiophore ("lollipop") as represented in the image on the right? A. Blastomyces dermatitidis B. Coccidioides immitis C. Histoplasma capsulatum D. Sporothrix schenckii

A; Intrinsic factor is necessary for the proper absorption of vitamin B12. With a deficiency of intrinsic factor, individuals can develop a megaloblastic anemia if their bodies become deficient in vitamin B12, which plays a large role in cellular nuclear development.

Which of the following is necessary for the absorption of Vitamin B12: A. Intrinsic factor B. Folic acid C. Gastrin D. Insulin

C; In the humoral response, B-lymphocytes are stimulated to when an antigen binds to its surface receptors. This sensitizes or primes the B cell and it undergoes clonal selection, where it reproduces asexually by mitosis. Most of the family of clones become plasma cells. These cells produce antibodies while other B cells become long-lived memory cells.

Which of the following is responsible for humoral response: A. Neutrophils B. Basophils C. B lymphocytes D. Monocytes

D; T cells secrete lymphokines, which encourage cell growth, promote cell activation, direct cellular traffic, destroy target cells, and initiate macrophages.

Which of the following mediators is released during T-cell activation? A. immunoglobulins B. thymosin C. serotonin D. lymphokines E. cytoplasmic granules

A; The serum proteins can be separated into five fractions by serum protein electrophoresis. In order of decreasing electrophoretic mobility these fractions are the: serum albumin, alpha-1 globulins, alpha-2 globulins, beta globulins, and gamma globulins.

Which of the following proteins has the FASTEST electrophoretic mobility? A. albumin B. alpha-1 globulins C. beta globulins D. gamma globulins E. alpha-2 globulins

D; A light source is used to emit light through a sample for measurement in spectrophotometry. The monochromator selects a narrow band of light that can pass through which will reach the sample cuvette. The detector detects how much light was reflected from or transmitted through the sample. Finally, the intensity of the transmitted light is measured with a photodiode or other light sensor/detector, and the transmittance value for this wavelength is then compared with the transmission through a reference sample, allowing for the readout of the result.

Which of the following represents a diagram of a spectrophotometer? A. hollow cathode - cuvette - monochromator - detector - readout B. cuvette - light source - monochromator - detector - readout C. monochromator - light source - cuvette - detector - readout D. light source - monochromator - cuvette - detector - readout E. flame - light source - monochromator - printout

A; Mean is the average of values. That is, the sum of the data points divided by the number of data points. If the data points are arranged from smallest to largest, the median is the value of the point where half the data points are smaller and half the data points are larger. That is, the median is the middle value. A normal "gaussian" distribution curve is a symmetric distribution with a single peak at the center of the distribution. In a normal distribution, the mean and median are equivalent.

Which of the following statements best describes the mean and median as they relate to a normal "gaussian" distribution curve: A. Both are equal B. Median = 1/2 mean C. Both are variable D. Mean = 1/2 median

B; Leukocyte antigen studies would NOT be included in a hemolytic transfusion reaction investigation. The remaining procedures must be performed as part of the initial reaction investigation. A post-transfusion specimen should be sent to the laboratory for work-up. A clerical check should be performed to investigate possible errors in specimen labeling, blood product issuance, or patient identification. The plasma must be examined for hemolysis. A direct antiglobulin test (DAT) must be performed. The patient's ABO, Rh, and antibody screen should be repeated and confirmed. The blood product ABO/Rh can also be confirmed.

Which of the following would NOT be included in a hemolytic transfusion reaction investigation? A. ABO/Rh check of post-transfusion sample B. Leukocyte antigen studies C. Direct antiglobulin test (DAT) on post-transfusion sample D. Clerical check

C; Penicillium species typically produce green, granular, rugose colonies as illustrated in the lower left quadrant of the composite image. The colony illustrated in the upper left quadrant is typical of Fusarium species that produce colonies with a distinctive rose red or purple red pigmentation . Gliocladium typically appears as a "green lawn" that extends from border to border across the Petri dish. This colony is seen in the bottom right quadrant. The colony that is pictured in the upper right quadrant is typical of Scedosporium apiospermum.

Which of the hyaline mold colonies that are represented in the composite picture on the right is typical of Penicillium species? A. Upper left quadrant B. Upper right quadrant C. Lower left quadrant D. Lower right quadrant

B; RT-PCR may be ordered to confirm novel H1N1 virus infection if the patient's physician considers this necessary. IFA and the rapid influenza A/B tests lack both sensitivity and specificity for the H1N1 virus.

Which of these laboratory methods are recommended for confirmation of influenza A H1N1 subtype infection? A. Immunofluorescence assay (IFA) B. Reverse transcriptase-polymerase chain reaction (RCT-PCR) C. Rapid Influenza A/B test

B; Iron deficiency anemia is characterized by a decreased serum iron, which in turn, causes an increased total iron binding capacity (TIBC). The transferrin saturation levels are decreased due to the smaller amounts of free serum iron available for binding and transporting.

Which one of the following data sets represents characteristic features of acute iron deficiency anemia? A. Serum iron is decreased, transferrin saturation is normal or decreased, TIBC is normal or decreased B. Serum iron is decreased, transferrin saturation is decreased, TIBC is increased C. Serum iron is normal, transferrin saturation is normal, TIBC is normal D. Serum iron is normal, transferrin saturation is markedly increased, TIBC is normal

C; Protein S is a glycoprotein involved in coagulation that is not considered an acute phase protein. Each of the other choices are, in fact, acute phase proteins.

Which one of the following is not an acute phase protein? A. Alpha-1 Antitrypsin B. C-Reactive Protein C. Protein S D. Fibrinogen E. Haptoglobin

D; Directed donations can sometimes be perceived as safer than non-directed units; however, this is not the case. On occasion the donors for directed units may not be completely forthcoming with information about their health status, which could potentially harm the recipient of the blood product unit. Therefore, directed donor units are not necessarily safer than random donor units.

Which one of the following statements about directed donations is true: A. They are truly safer than random donor units B. They will never cause graft-versus-host disease C. They do not cause logistic problems for the blood bank and transfusion service D. They are often perceived by the recipient or his family as safer than random donor units

B; The comparative threshold method or Ct involves comparing the Ct of samples against non-treated RNA samples. The Ct or threshold cycle is the cycle in which the fluorescence crosses the point where enough amplicons have been generated. In order for this method to be effective the amplification efficiency of both target and reference samples needs to be equal, if not the standard curve method should be used.

Which real-time PCR quantification method is only effective if the amplification efficiency of both target and reference samples are equal? A. Standard Curve Method B. Comparative Threshold Method

B & D; Myoglobin and CK-MB are present in skeletal muscle and can be elevated in injury to these cells. Other causes of increased myoglobin and CK-MB levels include: Severe injury to skeletal muscle Strenuous exercise Extremely difficult breathing (increased use of chest muscles) Kidneys failure Chronic muscle disease Alcohol abuse Troponin T and I tests are much more specific to cardiac muscle than myoglobin and CK-MB assays.

Which two of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle? A. cTnI B. CK-MB C. cTnT D. Myoglobin

A & B; Both ASO titer and Anti-DNase B are helpful in documenting previous infections.

Which two of the following tests are helpful for documenting previous Streptococcal throat and skin infections: A. ASO titer B. Anti-DNase B C. Coagulase D. Bacitracin sensitivity

D; White blood cell casts are found most often in pyelonephritis cases involving the kidney. However, they may also be present in glomerulonephritis.

White blood cell casts are MOST likely to indicate disease of the: A. Bladder B. Ureter C. Urethra D. Kidney

D; This run of QC does indicate a violation of a Westgard rule for QC. Two controls being more than two standard deviations above or below the mean is a 22s rule violation. Because these values were on different sides of the mean (one above and one below) the rule being violated here is the R4S rule, which states that you must reject a run if the sum of the control measurement in a group exceeds the mean plus 2 standard deviations and another exceeds the mean minus 2 standard deviations.

You are running quality control for Hemoglobin A1C by high-pressure liquid chromatography. The high control was 2.5 standard deviations above the mean. The low control was 2.2 standard deviations below the mean. Should you continue to run patient samples? A. Yes. Neither QC value exceeded 3 standard deviations and therefore did not violate a Westgard QC rule B. Yes. Although a Westgard 1 2S rule was violated, it only indicates caution and not rejection of the QC run C. No. These QC values indicate a violation of the Westgard 4x rule and are therefore cause for rejection D. No. These QC values indicate a violation of the Westgard R4S rule and are therefore cause for rejection

C; IgM is the main immunoglobulin seen in the primary immune response. IgG is chiefly seen in the secondary immune response. IgA is the predominant immunoglobulin in body secretions. Finally, IgD is found in very small quantities and accounts for less than 1% of the total immunoglobulin pool.

hich of the following antibody types is chiefly seen in the primary immune response: A. IgG B. IgA C. IgM D. IgD