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

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:

Hb S migrates with D in alkaline and alone in acid electrophoresis.

The gel electrophoresis pattern for hemoglobin S shows which of the following migration patterns?

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

Convert the following temperature from Celsius to Fahrenheit

-4 degrees C

Provide the equivalent measurement for 4 milligrams.

Autologous units must be drawn before they are needed, and must be readily available, therefore are generally not of use in emergencies.

All of the following are benefits of autologous donation except:

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:

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:

The difference between glass and plastic red stopper tubes is that the:

Question options:

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

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

An antithetical relationship exists between the antigens M and N. Antithetical relationships occur in situations where for a given locus, only one of two genes may be inherited, the alleles are termed antithetical alleles.

In immunohematology, an antithetical relationship exists between M antigen and which of these antigens?

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?

Which of the following is NOT part of the magnification system of the microscope?

A regional laboratory that performs high volume, highly complex or infrequently ordered testing is a:

Thin-layer chromatography has the advantage of being able to test for a large number of drugs at the same time.

Thin-layer chromatography is particularly useful as a tool in the identification of:

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 dematiaceous molds can be broadly separated into two major groups: the agents of chromomycosis that grow more slowly, maturing only after 7 days or more of incubation, and the more rapidly growing species that most commonly are clinically insignificant commensals or contaminants when recovered from clinical specimens, but in rare situations may cause opportunistic infections called phaeohyphomycosis.

Dematiaceous molds can be broadly separated into two major groups; the agents of chromomycosis and clinically insignificant commensals or contaminants. The agents of chromomycosis grow: more slowly than; more rapidly than; or generally at the same rate as the clinically insignificant commensals or contaminants?

No HLA matching is performed for corneal tissue transplants as the cornea occupies a privileged site not usually seen by the immune system. This term has been coined "immune privileged".

Corneal tissue may be transplanted successfully from one patient to another because:

A test with high specificity accurately detects the absence of disease. The more specific a test is, the fewer false-positive results will occur. A test with high sensitivity accurately identifies the presence of disease. The more sensitive a test, the fewer false-negative results it produces. In the case stated in this question, the immunoassay has high specificity, so it has few false-positives and will accurately detect those individuals who do not have the disease or condition that is being tested for. However, the test has low sensitivity, so it may not identify all individuals who actually have the disease; it may produce many false-negative results.

The accuracy of an immunoassay is its ability to discriminate between results that are true positives and results that are true negatives. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with high specificity, but low sensitivity?

The steps in the PCR process are:

1. Denaturation (Turning double stranded DNA into single strands.)

2. Annealing/Hybrization (Attachment of primers to the single DNA strands.)

3. Extension (Creating the complementary strand to produce new double stranded DNA.)

What is the first step of the PCR reaction?

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:

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)

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?

HLA-DR is a MHC class II(major histocompatibility complex) surface receptor on the cellular surface which is encoded by the human leukocyte antigen complex, or HLA.

DR antigens are found in which of the following systems:

Type I hyperlipoproteinemia is a form of hyperlipoproteinemia associated with deficiencies of lipoprotein lipase. Hyperlipoproteinemia type II is the most common form and is classified into type IIa and type IIb, depending on whether there is elevation in the triglyceride level in addition to LDL cholesterol. Hyperlipoproteinemia type III is associated with high chylomicrons and IDL. Hyperlipoproteinemia type IV is assoicated with high triglycerides. It is also known as hypertriglyceridemia. Hyperlipoproteinemia type V is similar to type I, but with high VLDL in addition to chylomicrons.

An obese adult with premature arteriosclerosis is seen in the clinic. When her serum is tested no chylomicrons are present, LDL are normal and VLDL are increased. There is an increase in triglycerides and slight increase in cholesterol. Lipoprotein electrophoresis reveals a heavy pre-beta band. She has no skin rash and uric acid is increased. This patient has a hyperlipoproteinemia with the MOST likely type of:

Convert the following temperature from Celsius to Fahrenheit

20 degrees C

Question options:

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:

Match terms with fragments resulting from papain digestion of an IgG molecule:

A = Fab fragment OR Fc fragment

B = Fab fragment OR Fc fragment

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:

Medical ethics

Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased blood pressure, and release of aldosterone from the adrenals.

A major action of angiotensin II is:

Once substance H is developed, the addition of the sugar N-acetylgalactosamine to the terminal position of the chain gives the molecule "A" antigenic activity.

Which specific terminal sugar causes a red cell to have A antigenic activity?

This antibody is found in the serum of Le(a-b-) secretors.

Which one of these Lewis blood group system phenotypes usually produces anti-Lea?

Transmission-based precautions isolation categories include all of the following except:

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?

Immunoassay is the most common technique that is used by clinical laboratories for therapeutic drug monitoring.

Most of the drugs commonly assessed with TDM can be measured on analytical platforms which utilize antibodies (in some form) for detection. Antibodies can be developed that recognize drugs. Although most drugs are much too small to evoke an immune response, scientists can conjugate drugs to immunogenic proteins to produce antibodies that recognize drug-specific epitopes.

Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring?

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)?

Escherichia coli and Klebsiella pneumoniae are two good quality control choices for the indole test. E. coli is indole positive, while K. pneumoniae is indole negative. A positive reaction is noted when there is a red layer at the top of the tube after the addition of Kovács reagent, while the negative result is a lack of color change in the top of the tube after the addition of Kovács reagent.

Which one of the following combinations of organisms would be appropriate positive and negative controls to verify the specific test functions listed?

Cryoglobulin testing can be used to:

Neutrophils are typically increased in urinary bacterial infections.

What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system?

Elevation in conjugated bilirubin is most likely to be found in which of the following conditions:

A dilution commonly used for a routine sperm count is a 1:20.

A dilution commonly used for a routine sperm count is:

Myoglobin release is strongly associated with muscle damage; therfore, it would most closely match a diagnosis of massive muscle trauma in this question.

Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders?

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?

Basophilic stippling is the term used to describe red blood cells that contain tiny particles of RNA within their cytoplasm. Basophilic stippling is associated with many conditions, but is strongly associated with lead poisoning.

Multiple small, dark blue particles scattered throughout the cytoplasm of erythrocytes is/are called:

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)

In healthy individuals, procalcitonin is only synthesized by the thyroid C cells. In bacterial infections, PCT is synthesized in various extrathyroidal neuroendocrine tissues.

In healthy individuals, procalcitonin is synthesized by which cells in the body?

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:

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:

As magnification INCREASES, the field of view will...

The beta hemoglobin chain loci are found on which chromosome?

Bacitracin susceptibility is a presumptive test for the identification of Lancefield group A Streptococcus.

Which of the following is a presumptive test for the identification of Lancefield group A Streptococcus:

The structures involved in the production of semen include the prostate, the seminal vesicles, and the bulbourethral gland, along with the testes and epididymis.

Semen is produced as a combination of secretions from the different regions of the male reproductive tract. Each fraction differs in chemical composition and function.

Spermatozoa are produced in the testes. They mature in the epididymis. The testes also produce testosterone and inhibin.

Fluid from the seminal vesicles accounts for approximately 70% of semen volume. The seminal vesicles are the source of fructose in semen. Fructose is used by the spermatozoa as an energy source.

The prostate gland supplies about 20% of the volume of semen. Its fluids include acid phosphatase and proteolytic enzymes that lead to coagulation and subsequent liquefaction of semen. The prostate also contains most of the IgA found in semen.

The bulbourethral gland produces mucoproteins that make up about 5% of the volume of semen.

The pituitary gland is not directly involved in the production of semen; instead hormones are released which stimulate the production of sperm. The urethra is not involved in the production of semen.

Which of the following are directly involved in the production of semen?

Which of the following fields is NOT an aspect of clinical microbiology?

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:

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:

This is the total magnification of the high dry objective lens.

Match each of the following definitions associated with heart disease and heart failure to the term that it defines.

1. Congestive heart failure

2. Infarction

3. Ischemia

4. Angina

The laboratory employee with an 2-year associate degree who performs clinical testing is the:

What is the best description of the purpose of the Commission on Office Laboratory Accreditation (COLA) pertaining to the clinical laboratory?

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.

Provide the equivalent measurement for 1 ounce.

A hapten is an incomplete antigen.

All of the following cellular antigens are important to an immunohematologist except:

The area of the federal government that ensures that the laboratory is stocked with gloves for their employees when performing tests on patient blood sample is:

1. A

2. A

3. B

4. A

5. B

6. B

A cardiovascular risk marker is an analyte in a body fluid that can be measured by the clinical laboratory and has been associated with the development of cardiovascular disease. Examples of risk markers include: LDL-C, triglycerides, and hs-CRP.

A cardiovascular risk factor is a condition (not a laboratory analyte) that is associated with an increased risk of developing cardiovascular disease. Examples of risk factors include: smoking, obesity, diabetes and hypertension.

Determine if each of the following is a cardiovascular risk marker or a cardiovascular risk factor.

1. Smoking

2. Obesity

3. Low density lipoprotein (LDL)

4. Hypertension

5. Triglycerides

6. High sensitivity-C-reactive protein (hsCRP)

The blood glucose value is critical; negative ketones is consistent with type 2 diabetes. An elderly type 2 diabetic patient is at risk for hyperosmolar non-ketotic coma and osmolality should be measured.

A measurement of urine glucose would not be useful at this point.

A 70-year-old type 2 diabetic patient is comatose and in the emergency department. Stat blood glucose and serum ketones are ordered.

Blood Glucose: 650 mg/dL

Serum Ketones: Negative

What is the best conclusion?

The type of isolation category that always requires a HEPA mask or respirator to be worn is:

Black stopper tubes are used for glucose collections.

Question options:

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:

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?

The organisms in this image are demonstrating a gram-variable phenomenon. For the most part, the organisms are staining primarily gram-negative, however, on the tips of some of the rods, there is a gram-positive staining morphology. This can be defined as gram-variable.

Which of the following best describes the organisms seen in this illustration:

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?

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 correct response is option B: The Hepatitis B "e" Antigen (HBeAg). This antigen indicates the virus is actively replicating and therefore the patient is very infectious. The hepatitis B "e" antigen is present when the virus is actively replicating. In cases of unintentional needlesticks, infectivity is of highest concern. The risk for infection is greatest during phases of increased HBeAg serology. The Hepatitis B surface antigen is the first detectable marker, but if the patient is known to have Hepatitis B already, it would be relatively unhelpful to confirm the condition with another HBsAG test. The core antigen is not detectable because it is covered by the nuclear envelope. Antibody response patterns would not be very helpful either as the patient has already been diagnosed with acute Hepatitis B. IgG antibodies would indicate recovery, which is not the case for this patient and IgM antibodies indicating a recent or acute infection would only confirm what is already known. Recall, in cases of unintentional needlesticks, infectivity is of highest concern.

A phlebotomist at a local hospital recently had an accidental needle stick while drawing blood from a patient being treated for acute hepatitis B. Which serological marker from the patient would be of most value to the physician evaluating the phlebotomist's possible infection status?

The patient's BUN is within normal range (5-20 mg/dL) while the creatinine is about five times the upper normal range (0.6-1.2 mg/dL). Gross elevations in creatinine are almost always accompanied by elevations in BUN when there is kidney impairment. Either the BUN or creatinine value in this case is incorrect. Both tests should be repeated.

A patient's BUN value is 15 mg/dl and his creatinine is 5 mg/dl. If this patient is not undergoing dialysis, what conclusion would you draw from these results?

Polyspecific antihuman globulin (AHG) reagent contains both anti-IgG and anti-C3d.

Polyspecific antihuman globulin (AHG) reagent used in antiglobulin testing should react with which one of the following?

All the following characteristics are accurate for the influence of Health Insurance Portability and Accountability Act (HIPAA) except

Atherosclerosis is a hardening of an artery specifically due to the build up of plaque. The risk to patients with significant atherosclerosis is that eventually a narrowing of the artery (stenosis) can cause a reduction in oxygen delivery to tissues and plaque rupture can lead to an acute coronary event.

Atherosclerosis is a hardening of an artery specifically due to which of the following?

Provide the equivalent measurement for one gallon.

Question options:

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?

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?

The MCV is indicative of microcytosis with MCV=<80fL. The RDW is within normal limits and indicative of a homogenous cell population.

If the MCV was >100 fL, this would be indicative of macrocytosis. An RDW that was outside of normal limits would be indicative of a heterogenous cell population.

An 18 year old female has a CBC as part of a routine physical exam. The following results were obtained and the physician determines she is anemic. After reviewing her CBC results shown below, which of the following would be an appropriate description of the anemia?

White blood cells (WBC): 5.6 x 10^9/L (RR:4.0-10.0 x 10^9/L)

Red blood cells (RBC): 3.7 x 10^12/L (RR: 4.2-5.9 x 10^12/L)

Hemoglobin: 9.9 g/dL (RR:12-16 g/dL)

Hematocrit: 28% (RR: 37-48%)

MCV: 75 fL (80-100 fL)

RDW-CV: 14% (RR: 11.0-15.0%)

The image shown in this question is depicting a rosette formation. Here the red blood cells are surrounding and adhering to the outside of the white blood cell.

What is the best description of the phenomenon seen in this illustration?

What is the CORRECT blood-to-anticoagulant ratio for coagulations tests?

Each of the drugs/drug classes listed above have been known to cause drug-induced hemolytic anemia, although cephalosporins are the MOST COMMON cause. Cephalosporins can cause drug-induced hemolytic anemia when a patient produces antibodies to the particular cephalosporin drug in the presence of red blood cells. The drugs can alter the membrane appearance of the red blood cells, causing the body to mistake them as foreign. Complement becomes activated due to these antibodies; red cells are then destroyed causing hemolytic anemia. Dark urine, caused by intravascular hemolysis, is one of the most common symptoms associated with this condition.

Which one of the following drugs/drug classes is the MOST COMMON cause of drug-induced hemolytic anemia?

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:

The colonies seen growing on the bird seed agar appear smooth and have a distinct reddish-brown pigmentation. The active ingredient in bird seed (Guizotia abyssinica) agar is caffeic acid, which is extracted and placed in an agar containing 1% glucose. Of the cryptococci, and other species of yeasts, Cryptococcus neoformans selectively produces the enzyme phenoloxidase, which oxidizes the caffeic acid in the medium to melanin, producing the red-brown pigmentation.

The other yeast species included in this exercise do not possess phenoloxidase activity and therefore remain non-pigmented when grown on bird seed agar.

The colonies shown in this photograph were grown on Guizotia abyssinica (bird seed) agar at 30°C for 72 hours. The most likely identification is:

Specimens collected from patients in contact isolation should be:

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?

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?

The identification of the crystals depicted in this image are triple phosphate crystals. Triple phosphate crystals may be normal but are usually associated with alkaline urine. These colorless crystals have a characteristic "coffin lid" appearance.

What is the identification of these crystals seen in urine with an alkaline pH?

Provide the equivalent measurement for one pint.

A phlebotomist has just performed a venipuncture on a patient. How would the phlebotomist dispose of the used needle?

Following an AMI, elevated CK-MB returns to normal ranges in 48-72 hours. If a patient has a second AMI in this time period, a second rise in concentrations of CK-MB would be seen. This is not true for the cardiac troponins since they remain elevated 7-14 days following an AMI.

Which one of the following cardiac biomarkers could detect a reinfarction?

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

In DIC, or disseminated intravascular coagulation, the prothrombin time is increased due to the consumption of the coagulation factors due to the tiny clots forming throughout the vasculature. This is also the reason that the fibrinogen levels and platelet levels are decreased. Finally FDP, or fibrin degredation products, are increased due to the formation and subsequent dissolving of many tiny clots in the vasculature. The FDPs are the pieces of fibrin that are left after the fibrinolytic processes take place.

Which of the following laboratory results would be seen in a patient with acute Disseminated Intravascular Coagulation (DIC)?

Blood bank

Which of the following is the most common subgroup of A?

RAST tests, or Radioallergosorbent tests, are used to screen for an allergy to a specific substance or substances if a person presents with allergy-like symptoms.

The assay which is most helpful in identifying specific allergens is:

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?

Isolation and detection of Gardnerella vaginalis from vaginal secretions is improved by which of the following?

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:

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?

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:

The activities conducted in a laboratory with a certificate of waiver include:

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 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?

The best course of action when entering an isolation room is:

The negative antigen frequencies are used in the formula below to determine the percent of type-specific units that would be compatible for the patient. Negative antigen frequencies are determined by subtracting the percent antigen frequency from 100%. The negative antigen frequency for K in this case is .91 (1.00 - .09) and the negative antigen frequency for Fya is .34 (1.00 - .66).

% compatible units available = 100 x (Neg frequency #1 x Neg frequency #2...)

For this case, the calculation is:

% compatible units available = 100 x (0.91 x 0.34) = 30.94 or 31%

If the antigen frequencies for K = 0.09 and Fya = 0.66, what percent of type-specific units would be compatible for a patient with anti-K and anti-Fya?

If your reactions are strong at immediate spin (3+) and then get weaker at AHG (w+), it could mean the presence of a strong cold antibody.

Cold antibodies tend to be IgM and their optimum phase for reactivity is immediate spin. Incubation and washing of the sample may cause the agglutination that occurred at room temperature to break down. This would appear as a weaker reaction at AHG.

If the reaction strengths varied in each panel cell then that could be an indication that there are multiple antibodies present.

Your screen cells are 3+ at immediate spin and weak (W)+ at AHG. Your auto control is negative for both phases. Some of your antibody panel cells are 3+ at immediate spin and negative at AHG. What should you suspect?

Intravascular hemolysis is typically associated with increased levels of serum (plasma) LDH and bilirubin, and an increased number of reticulocytes. Serum LDH is found in higher levels during intravascular hemolysis due to fact that high levels of LDH are normally found within the red cells, but is now being spilled into the bloodstream via red cell lysis. Bilirubin is a breakdown product of hemoglobin, which has also been spilled into the bloodstream from broken red blood cells via hemolysis. Reticulocytosis is a reflection of the release of an increased number of immature red blood cells from the marrow to account for the red blood cells that are lost through hemolysis. This is a normal response. Failure to show an increased reticulocyte count with hemolytic episodes or hemorrhage would indicate an ineffective erythropoiesis (possible bone marrow function problem).

Which of these blood levels will increase during intravascular hemolysis?

Which of the following is a current title for clinical laboratory professionals with a 4 year degree?

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)?

The creatinine clearance for this patient is 100 mL/min.

Creatinine clearance values are calculated using the following equation:

Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine Volume (mL) / [ time (hr) x 60 ]

For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60])

80 x 1800/1440, which is 80 x 1.25, or 100 mL/min

A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min.

The personal protective equipment (PPE) that is used in the laboratory to protect the personnel when performing tests on patient blood samples is which of the following:

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)

This patient is most likely suffering from sickle cell anemia. This cell, which is sickle-shaped, is indicative of the presence of hemoglobin S. Polychromasia is also commonly observed in sickle cell anemia.

After experiencing crippling pain in her chest, Elizabeth's mother rushes her to the Emergency Room. After a complete blood count and differential are ordered, the hematology technologist views many peripheral cells similar in appearance to those found in the image below. Which condition is most likely present?

Transport media are required for throat culture swabs but not for rapid strep tests.

Molarity x Molecular Weight x Volume = Grams

Molecular Weight (aka Formula Weight) =

2(1) + 32 + 4(16) = 98

So, 4 x 98 x 0.2L = 78.4g

What weight of H2SO4 is contained in 200 ml of a 4 molar H2SO4 solution? (Atomic weight: H= 1; S = 32; 0 = 16)

The correct answer which best fits the characteristics in this question is Mycobacterium kansasii.

The remaining Mycobacterium strains can be elimated as:

Mycobacterium marinum is considered a fast-grower.

Mycobacterium scrofulaceum produce deep-yellow to orange pigmented colonies when grown in the either the light or dark.

Mycobacterium avium grows colonies which are nonpigmented in the light and dark which do not intensify after light exposure.

What is the MOST likely identification of an acid-fast bacillus that demonstrates the following characteristics?

slow growth

cream to tan colored colonies when grown in the dark

development of yellow pigment upon exposure to light

The laboratory is under the direction of a:

Waived tests are those considered to have an insignificant risk of erroneous results. Which of the following is NOT an example of a waived test?

Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that appears as a round, dark-staining inclusion in the cytoplasm of red blood cells. Howell-Jolly bodies can be found in various conditions including splenectomy and anemia.

Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:

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.

Which of the following CD markers is NOT present on a normal mature T cell?

Which immune elements are involved in a POSITIVE TB skin test?

Listeria are non-capsulated, non-acid-fast, ß-hemolytic, gram-positive bacilli that have a characteristic tumbling motility. They are found primarily in the environment and in the human GI tract. Since L. monocytogenes multiplies intracellularly, control of listeriosis requires cell-mediated immunity; thus, immunocompromised patients (such as newborns) are at high risk.

Which bacterial species is a common agent of neonatal bacteremia?

Caffeine benzoate solution is used to split the unconjugated bilirubin protein complex releasing the bilirubin so that it can react with diazotised sulphanilic acid. The tartrate buffer creates an alkaline solution and converts the red acid bilirubin to a green coloured compound which can be measured spectrophotometrically.

Which substance is used in the Jendrassik-Grof method to accelerate the reaction of unconjugated bilirubin with the diazo reagent?

The agency within Department of Health and Human Services (DHHS) responsible for implementing CLIA'88 is:

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:

Lipids tend to form a "maltese cross" pattern when viewed in polarized light, which helps to differentiate them from other urine microscopic components.

Substances found in urinary sediment that are more easily distinguished by use of polarized microscope are:

Secondary granules, also known as specific granules first appear in the myelocyte stage next to the nucleus. In neutrophils this is termed the "dawn of neutrophilia".

What is one of the main characteristics of secondary granules in the neutrophilic granulocyte cytoplasm?

Personal protective equipment (PPE) should be put on in the following order:

Which of the following tubes contains an anticoagulant that does not bind calcium?

Question options:

A hospital chief operating officer is responsible for

In DNA complementary base pairing, guanine and cytosine pair and adenine and thymine base pair. Remembering the phrase "G-CAT" helps one recollect correct pairing.

Which nitrogen base would bind with a guanine nucleotide in forming double-stranded DNA?

In which of the following laboratory situations is a verbal report permissible?

Which of the following legislation was developed to protect the privacy of all patient information in the health care?

Lavender stopper tubes can be used for all of the following except:

UA & Body Fluids

What is the identification of this crystal seen in a urine with an alkaline pH?

The liver is the primary target organ for the Hepatitis B virus (HBV). The inflammation caused by HBV can result in permanent liver damage, including cirrhosis, liver failure, and even hepatocellular carcinoma.

What is the primary target of the Hepatitis B virus?

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

Question options:

Hemolytic transfusion reactions seldom occur because the incidence of unexpected antibodies in random patients is relatively low, e.g., 3-5% is sometimes cited.

Being transfused with O Rh negative RBC is irrelvant if you have an unexpected antibody like anti-K or anti-c.

Incompatible red cells may "bleed out" but only if bleeding is brisk. Even then, a hemolytic reaction may occur later once the patient's antibody rebounds and destroys remaining antigen-positive donor red cells.

It's true that some patients have only cold-reactive antibodies that will not react at body temperature. But this does not explain why warm-reactive red cell antibodies cause few reactions

Why do so few patients transfused with un-crossmatched red cells in an emergency experience a hemolytic transfusion reaction? Select the one best reason.

VLDL transports endogenous lipids, whereas chylomicrons transport exogenous (dietary) lipids. Cholesterol is transported by HDL and LDL.

The function of the very low density lipoproteins (VLDL) is to transport:

CD34, a cell surface marker, presents on undifferentiated pluripotential hemopoietic stem cells. CD34 is a cell surface glycoprotein and functions as a cell-cell adhesion factor.

Which one of the following antigen markers is BEST associated with stem cells?

Blood plasma will contain coagulation proteins, but not in a clotted tube where serum is present.

Blood serum contains each of the following substances except:

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

The intended response is "transfusion dimorphism". The microcytic, hypochromic erythrocytes suggests iron deficiency anemia. Interspersed among these cells are normocytic, normochromic erythrocytes suggesting two populations of red cells following transfusion. This was a case of severe iron deficiency treated with red cell transfusions and iron supplement.

The condition most likely associated with the peripheral blood picture in the photograph is:

The concentration of circulating ferritin is proportional to the size of iron stores.

Which of the following will give the best overall picture of a patient's iron stores:

A key laboratory characteristic by which Mycobacterium bovis can be separated from Mycobacterium tuberculosis is:

What two glycoproteins are expressed on the surface of influenza A viruses and are used for subtyping of the viruses?

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:

Which of the following genotypes cause beta thalassemia minor?

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:

This Gram stain is under-decolorized

This microscopic field is representative of other fields that were observed on a Gram-stained smear. Which of the following describes the quality of the smear?

The National Heart, Lung, and Blood Institute initiated the National Cholesterol Education Program (NCEP) in 1985. The goal was to reduce the number of Americans with elevated cholesterol and thus reduce illnesses and deaths in the United States due to coronary heart disease. Three adult treatment panels have been published since then with clinical practice guidelines for managing cholesterol levels in adults.

The most recent panel, Adult Treatment Panel III (ATP III), was published in 2001 and updated in 2004. The NCEP: ATP III also includes criteria for the diagnosis of metabolic syndrome.

Select the set of laboratory assays that are utilized in the NCEP: ATP III criteria for metabolic syndrome diagnosis.

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?

Beer's law is based on the fact that absorbance is directly proportional to the concentration of a solution. Therefore, stray light can alter the absorbance results in this type of assay.

Deviations from Beer's Law are caused by:

Failure to deliver glucose drawn in a serum separator tube (SST) to the laboratory within the recommended time will cause:

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:

The Western Blot Assay is used as a confirmatory test for which of the following:

The cells are plasma cells. They are larger than normal small lymphocytes with more abundant cytoplasm. The cytoplasm is more basophilic than the cytoplasm of a normal lymphocyte and a well-defined perinuclear halo (clearing in the golgi area) is noticeable. The nucleus is eccentrically placed. Plasma cells are counted in a separate category on a bone marrow differential.

Hematogones are blast-like cells that are more mature than lymphoblasts. They are usually tallied with lymphocytes when performing a bone marrow differential.

What are the cells that are indicated by the red arrows in the image on the right?

Thyroid-stimulating immunoglobulins, or TSI's, are IgG antibodies that can bind to thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH, causing excess secretion of thyroxine and triiodothyronine. The TSI level is abnormally high in persons with hyperthyroidism due to Graves' disease.

Which of the following is an autoantibody that binds to TSH receptor sites on thyroid cell membranes preventing thyroid-stimulating hormone binding?

Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that she has had an AMI but did not feel the severe chest pain because of diabetic neuropathy. She has not felt well since November 20th and her physician believes she possibly had an AMI on November 20th.

Assuming that the infarct was uncomplicated, which of the following cardiac biomarkers would most likely still be elevated and would assist in an AMI diagnosis?

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?

The combination of complement C4, C2 and C3 that binds to the antigen-antibody complex in the initial reaction step in the classical pathway of complement activation is called the activation unit.

Which of the following is the "activation unit" in the classical complement pathway?