ASCP-MLT Practice Exam Questions with Answers MEDICAL LABORATORY TECHNICIAN - MLT(ASCP) Certification

The role of provider-performed microscopy (PPM) is the

All of the following have been an inspection deficiency for CLIA-approved laboratories except:

HCG levels rise rapidly during the first trimester, then the levels start to decline around week 16. The hCG levels slowly decrease and can level off during the remainder of the pregnancy.

The following BEST describes serum hCG levels during pregnancy:

Which advancement in clinical science occurred during the second half of the twentieth century?

The ratio of blood to anticoagulant in a light blue stopper tube is:

True Statements:

Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion may wash out test reagents.

False Statements:

Urine should be centrifuged prior to dipping the reagent strip. When visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen.

Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL of the correct answers)

Normal pH of semen must be a value equal to or greater than which of the following?

If Kappa or Lambda is predominant and CD5 is co-expressed with CD19 (CD19/CD5 dual positive lymphocyte population), and CD23 is expressed, chronic lymphocytic leukemia is a probable diagnosis. CD19 is normally found on normal B cell populations and CD5 is normally found on mature T cell populations. However, CD5 is present on B cells in B-chronic lymphocytic leukemia or Mantle Cell Lymphoma, both abnormal B cell malignant processes.

CD23 expression is not consistent with Mantel cells as shown on the decision tree on the right.

A monoclonal B-cell population (Kappa or Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following?

Pink or Red stopper tubes can be used for Blood Bank!

Question options:

Clostridium difficile is a gram-positive, spore-forming bacilli. The remaining organisms will all stain gram-negative on direct smear or smears made from culture.

Which of the following organisms are gram-positive?

A hospital chief operating officer is responsible for

What component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)?

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:

Which of the following agencies administers the certification test that you will be eligible to take at the end of your 4 semester?

Fresh frozen plasma must be thawed at a maximum of 37oC in a water bath or similar equipment that has been validated and is temperature monitored. When using a water bath, the FFP should be wrapped in a plastic liner. After thawing, it is recommended that the FFP be administered immediately, preferably within 2 hours post-thaw.

The BEST way to thaw Fresh Frozen Plasma is to thaw it by:

The color coding of evacuated tubes provides information about all of the following except the: Question options:

Since hemoglobin is measured spectrophotometrically on hematology analzyers, interference from lipemia or icteric specimens can lead to decreased light detected and measured through the sample and therefore inaccurate hemoglobin results occur.

On an electronic cell counter, hemoglobin determination may be falsely elevated caused by the presence of:

Protein in urine can be confirmed using sulfosalicylic acid (SSA) precipitation. The SSA reagent is added to a small volume of urine. Acidification causes precipitation of protein in the sample, which is subjectively graded as trace, 1+, 2+, 3+ or 4+. SSA reaction will detect albumin, globulins, and Bence-Jones proteins.

Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:

The laboratory employee with a 4-year college degree who performs clinical analysis is the:

The Westgard multi-rule 22S describes the scenario where two consecutive data points fall outside +2SD or -2SD. If this occurs, then the run must be rejected. This situation is most likely caused by a systematic error.

Which of the following describes the Westgard multi-rule 22S?

The correct answer is Trichophyton rubrum. The tiny microconidia are lined up in a "birds on the fence" arrangement along the hyphal strand transversing the field of view (yellow arrows). Two pencil-shaped, smooth walled macroconidia are also seen in the lower left field of view (red arrows).

Trichophyton verrucosum may produce microconidia in small quantities. However, they are irregularly arranged with little tendency to line up along the hyphae. Antler hyphae and string bean macroconidia are characteristic of this species.

One of the key characteristics in the identification of Epidermophyton floccosum is the inability of this dermatophyte to produce microconidia. Two to four-celled, club-shaped macroconidia are produced, usually in clusters of two or three.

The profusion of tiny microconidia lining up along the hyphae in this photomicrograph is characteristic of which of the following organisms?

The term universal precautions refers to:

The cells indicated by the arrows in the image are spherocytes. Spherocytes have a decreased surface to volume ratio and are therefore smaller with an increased MCHC. Spherocytes have lost their bi-concave shape and are spherical in shape, hence the name.

What are the cells that are indicated by the arrows in this peripheral blood smear image?

Whole blood glucose values are lower than plasma glucose values. For this reason, point-of-care whole blood glucose meters are programmed to correct the value before presenting the result; therefore, the whole blood glucose meter result correlates to serum or plasma results.

Whole blood glucose values are ____________ plasma glucose values.

Rapid vascular constriction, not dilation, immediately occurs when there is vascular injury in order to constrict the amount of blood that escapes the vessels; ultimately preventing massive loss of blood.

Primary hemostatic processes resulting from vascular damage include all of the following EXCEPT:

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:

Provide the equivalent measurement for one pint.

Creatinine clearance tests are utilized to estimate the glomerular function of the kidney. The creatitine clearance calculation is defined as the volume of plasma that is cleared of creatinine by the kidney per unit of time and uses the following formula:

creatinine clearance = Urine creatinine conc x Volume / Plamsa creatinine conc

Creatinine clearance measurements have a recommended specimen requirement = 24-hour urine collection.

Which of the following tests would be useful in the assessment of glomerular filtration:

Prozone effect (due to antibody excess) will result in an initial false negative in spite of the large amount of antibody in the serum, followed by a positive result as the specimen is diluted.

The prozone effect ( when performing a screening titer) is most likely to result in:

Which of the following Rh antigens is found the highest frequency in the Caucasian population:

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:

Tan stopper tubes are used for reticulocyte counts.

Question options:

Certain recipients have increased risk for developing TA-GVHD. They are:

Neonates less than 4 months of age

Fetuses

Recipients with a congenital or acquired immunodeficiency, such as bone marrow or stem cell recipients, and patients receiving chemotherapy

recipients of donor units from a blood relative

Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products? (Choose all that apply)

The indole (modified Kovacs' reagent) is used to assess the ability of certain bacteria to produce indole by the deamination of tryptophan. Indole reacts with aldehyde in the Kovac's reagent to produce a red color. An alcoholic layer holds the red color as a ring at the top of the tube used for the idole test.

If a bacteria produces the enzyme tryptophanase to break down the amino acid tryptophan, which of the following tests will be positive with Kovac's reagent?

The end of the initial phase of HH treatment is considered when the serum ferritin decreases to between 20 and 50 ng/mL.

What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)?

Drawing a lavendar stopper tube before an SST tube can cause a falsely:

Question options:

Enterococcus spp. are bile esculin positive and grow in 6.5% NaCl. If they grow on the 6 µg/mL vancomycin screen agar as this isolate does, it is vancomycin resistant. If there is no growth on the 6 µg/mL vancomycin screen agar, the isolate is susceptible to vancomycin. Streptococcus Group D, not Enterococcus will not grow in the 6.5% NaCl and should not be tested for vancomycin resistance. Staphylococcus epidermidis is catalase positive.

The images below represent a gram-positive, catalase-negative, non-motile coccus inoculated to bile esculin agar, 6.5% NaCl broth and to 6 µg/mL of vancomycin in Mueller Hinton agar. It should be reported as:

Specimens collected from patients in contact isolation should be:

The lactophenol blue mount reveals tiny, ovoid microconidia, arranged in a daisy-head pattern at the tip of a straight conidiophore. This appearance is characteristic of the mold form of Sporothrix schenckii. By moving the focus up and down in a microscopic preparation, delicate hair-like attachments may be observed for each conidium.

The mold form of Coccidioides immitis produces delicate hyphae that break up into arthroconidia separated by empty cells, giving an alternatively staining appearance.

The mold form of Blastomyces dermatitidis is characterized by the production of single, smooth microconidia, each borne on a single, thin conidiophore ("lollipops").

The mold form of Histoplasma capsulatum is recognized by the production of large, echinulate macroconidia, appearing as a prickly surface.

The ovoid microconidia arranged in a daisy-head pattern at the tip of a a straight conidiophore, observed in the photomicrograph on the right, is characteristic of which of the following dimorphic molds?

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 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%

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

HLA-DR is a class II MHC.

HLA-A, HLA-B, and HLA-C are all class I MHC.

Which of the following antigens is classified as a Major Histocompatibility Complex

Class II antigen (MHCII)?

The electrolyte panel consists of potassium, sodium, chloride, carbon dioxide. These analytes are also typically ordered within other panels as well, including the basic metabolic and complete metabolic panels.

An electrolyte panel (lytes, chem-4) consists of:

Albumin is a "negative" acute phase protein since it is found in decreased levels during acute phase response. Alpha-1-antitrypsin, fibrinogen, and ceruloplasmin are all "positive" acute phase proteins that are found in increased levels during acute phase response.

Which one of the following usually shows a decrease during an acute phase response?

The cell depicted with the arrow in this image is an atypical (reactive) lymphocyte. These cells are common found in certain viral infections, especially infectious mononucleosis. Notice the larger size and abundant cytoplasm present in this lymphocyte. There is also apparent vacuoliation which is a key feature of atypical lymphocytes. The chromatin pattern of this cell as well as the overall shape, color and size rules out the monocyte, macrophage, and mesothelial cell choices.

A patient with an infectious mononucleosis infection presents in the emergency room. Physicians order a spinal tap which is immediately sent to the laboratory for review. Please identify the cell in the image below from this patient's cerebrospinal fluid sample.

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 ?

Incompatiblity involving the ABO blood group system can cause the most severe type of transfusion reaction.

The cause of the most severe life-threatening hemolytic transfusion reactions is:

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:

Donor and recipient blood samples (samples utilized for pre-transfusion compatibility testing) must be kept for at least 7 days after transfusion. Blood samples must be available to investigate a transfusion reaction, if necessary.

Donor and recipient blood samples must be kept for at least how long after transfusion?

Animals serve as a reservoir of infection" is the correct answer because Shigella only infects humans while Salmonella is found in many animals. Both have diarrhea as the major symptom. Endotoxin is produced by all gram negative bacteria and exotoxin is only produced by Shigella.

A major difference between Salmonella enterica and Shigella infections is that only in salmonellosis can:

This is the lens power of the scanning objective lens.

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:

Serum ferritin is a good indicator of iron deficiency. However, it acts like an acute phase reactant, being elevated in a large number of conditions. Patients who have iron deficiency as well as another condition that elevates serum ferritin levels may therefore have normal or even elevated serum ferritin levels.

Which one of the following statements about serum ferritin are true:

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?

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:

Antibodies in the Rh system typically exhibit which one of the following characteristics?

Match each of the descriptions with the appropriate magnification:

1. Color, Rouleau, Overall Slide Quality, Cell Distribution

2. Platelet estimates RBC-platelet-WBC morphology WBC differential RBC inclusions

3. Select area to examine, WBC estimate

This integrity of this specimen is compromised. The unit cannot be used.

What action should be taken if a large clot is noticed in a red blood cell unit while the product is being prepared for release to the patient?

These are tyrosine crystals

Urinalysis & Other Body Fluids

True or false? Cystine crystals are present on this slide.

Allergic reactions, bacterial/viral meningitis do not cause the presence of blasts to be noted in the CSF. Leukemia with CNS involvement will show immature cells, similarly to the peripheral blood smear.

The image is a stained smear of cerebrospinal fluid. The cells present in this field may indicate what condition?

A laboratory scientist is working the night shift at a local hospital when the power goes out. What is the course of action to continue to provide laboratory results?

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?

P. vivax characteristically displays Schuffner's dots and often enlarged RBCs along with brownish granules. P. vivax can also have 12-24 merozoies in each cell, actually filling the entire RBC. This parasite also has very irreglar shapes often referred to as "Ameboid".

P. falciparum and P. malariae do not display Shuffner's dots, therefore could not be the correct choice.

P. ovale does display Shuffner's dots in all stages, but characteristically has about 8-12 merozoites in rosettes or irregular clusters inside the RBC. Also, P. ovale characteristically shows enlarged, ovoid RBCs with fimbriated edges.

Identify the parasite of a patient with suspected malaria who demonstrates the following findings on a blood smear:

- Enlarged RBCs, some with fine brownish granules

- > 15 parasites in some cells

- Ameboid structures

- Schuffner's dots

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of Aspergillus. Aspergillus has the ability to infect primarily immunocompromised hosts, and causes pneumonia and/or disseminates to other organs. Clinical specimens should be inoculated onto primary isolation media, such as Sabouraud's dextrose agar. Aspergillus spp. are fast growing and can be white, yellow, yellow-brown, brown to black or green in color.

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of:

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.

All of the following tubes contain separation gel except:

Question options:

Immunology

The immunoglobulin molecule is made up of both heavy and light chains - the light chains can be comprised of which of the following:

Sterile yellow stopper tubes contain thixotropic gel and a clot activator.

Question options:

Gamma globulin (anti-D) is given to Rh-negative mothers to prevent any D antibody production, which could cause harmful effects in future pregnancies with an Rh-positive fetus. The administered anti-D will bind fetal Rh-positive cells that may come from the fetus in vivo; therefore the mother will not produce anti-D herself, preventing sensitization.

A solution of gamma globulins containing anti-Rh (D) is given to an Rh (D) negative mother to:

Duffy antigens are rendered inactive by enzyme treatments since the enzyme will remove the sialic acid from the RBC membrane. This process destroys: M, N, S, s, and Duffy antigens. The process enhances the reactions for Rh, Kidd, Lewis, I, and P antigens.

When performing an antibody panel, which one of the following antigens will be rendered inactive by enzyme treatment?

In primary responses, the major class of antibody produced is IgM whereas in the secondary response, as mentioned in this question, it is IgG. IgG is present in the highest quantities compared to all other antibody classes and is the only antibody able to cross the placental barrier.

Which of the following antibody types is chiefly seen in the secondary immune response:

In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults?

Match each of the descriptions with the appropriate magnification:

1. Color, Rouleau, Overall Slide Quality, Cell Distribution

2. Platelet estimates RBC-platelet-WBC morphology WBC differential RBC inclusions

3. Select area to examine, WBC estimate

A positive DAT is consistent with a diagnosis of hemolytic disease of the newborn. A hemoglobin performed on the cord blood serves as an indicator of the severity of the disease.

In order to detect the presence of antibodies fixed on the RBC's of newborns one should:

Which of the following disorders is characterized by increased production of chloride in sweat?

Multiple myeloma

Yellow stopper tubes are used for all of the following except:

Question options:

Provide the equivalent measurement for 75 milligrams.

Question options:

The part of the microscope that control the amount of light entering the specimen much like the iris of your eye controls light is called the iris _______________.

DAT ( Direct Antiglobulin Test ).

When AHG or Coombs serum is used to demonstrate that red cells are antibody coated in vivo, the procedure is termed: