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Confirmed cases of H1N1 virus have been reported more often in children and younger adults than in any other age group.
Micro
The age groups that have been most affected by the H1N1 virus are children and younger adults.
Immunology
The immunoglobulin molecule is made up of both heavy and light chains - the light chains can be comprised of which of the following:
Phase of reactivity is primarily at immediate spin (4+) and reactions get weaker at AHG (w+). There is no specific pattern of reactivity and the auto control is negative which rules out an autoantibody. This is a strong cold antibody which is still slightly present after incubation and washing.
Activation and binding of the antibody takes place at room temperature or colder. Eliminating this phase will prevent the antibody from binding. Cold antibodies usually are more of a nuisance to blood bankers and are not clinically significant.
When performing an antibody screen, both the screen cells are 4+ at immediate spin and W+ at AHG. The antibody panel shows 4+ reactions at immediate spin and W+ reactions at AHG and there is no specific match to the reaction pattern. The auto control is negative. What would be a logical next step?
Transfusion of red cells of any ABO type other than O to a group O patient is of course likely to cause a hemolytic transfusion reaction.
Which of the following types of packed RBCs could be transfused to a group O patient:
Gating sets up boundaries around a subset of data points to segregate those events for analysis.
Gating the proper cell population is crucial for flow cytometric analysis. The CD marker information presented on the histogram data is only representative of the cells inside the gate.
When analyzing the raw data of a sample on the flow cytometer, CD marker information on the histograms represents data inside the _____ population.
The ApoB/ApoA1 ratio has a positive risk marker (ApoB-100) and a negative risk marker (ApoA1). Risk diminishes as ApoA1 goes up (a negative marker) and risk increases in proportion to ApoB concentrations (a positive risk marker). This 'double-edged sword' provides good risk prediction. The other risk markers in question do not have this dual-advantage.
Which risk marker has both positive and negative cardiovascular risk integrated into its measurement?
Match each of the following:
1. Ratio of cellular area to total area in the bone marrow section.
2. Number of myeloid cells compared to nucleated erythroid cells.
3. Use low power to estimate their quantity and appearance.
4. Use Perls' Prussian blue stain.
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 parents will each give one of their ABO genes, so the possibilities are as follows:
AB, AO, AB, AO = 50% chance of A blood type, 50% chance of AB blood type
Blood Bank
If parents have the blood group genotypes AA and BO, what is the possibility of having a child with a blood type of A?
Which of the following tubes contains an anticoagulant that does not bind calcium?
Question options:
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?
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 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:
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:
Nucleated RBCs may be seen in the peripheral blood in cases of beta thalassemia major. Nucleated RBCs are usually not found in peripheral blood in cases of beta thalassemia minor and beta thalassemia intermedia, and would not be a finding in beta thalassemia minima.
Nucleated RBCs are most likely to be seen in the peripheral blood of which of these beta thalassemias?
Eosinophils do not have cytoplasm containing large purple/blue-staining granules. Instead, their granules are large but are orange/red in color. These granules are very distinctive for this type of cell, typically making their identification simple.
ll of the following statements describe an eosinophil EXCEPT:
An automated method for measuring chloride which generates silver ions in the reaction is called:
Match each virus with its appropriate nucleic acid content.
1. Paramyxovirus
2. Rhabdovirus
3. Poxvirus
4. Orthomyxovirus
Hives and rash usually indicate an allergic reaction. Hematuria is due to a variety of causes. Fever and chills usually indicate a febrile reaction. Positive DAT due to conditions other than sensitization to red cell alloantigens is not uncommon. Therefore a positive DAT in the posttransfusion specimen with a negative DAT in the pretransfusion specimen is more likely to indicate alloimmunization.
The most definite indication that a patient has been sensitized to a specific red cell antigen is:
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?
Normocytic- G6PD deficiency, Malaria
Microcytic- Iron deficiency, Thalassemia
Macrocytic- Chronic Liver Disease, Vitamin B12 deficiency
Hematology
Match the disease conditions with appropriate red cell size classification
1. G6PD deficiency, Malaria
2. Iron deficiency, Thalassemia
3. Chronic Liver Disease, Vitamin B12 deficiency
Darkfield microscopy allows a lower limit of resolution than bright-field microscopy which helps the tiny spirochetes to be seen in patient samples. In darkfield microscpy, there is a dark background where directly transmitted light is excluded by a dark-field condenser allowing only scattered light to be focused on the specimen. With dark-field microscopy bacteria appear luminous against a dark background.
Which of the following microscopic techniques is best suited for direct examination of the infectious agent of syphilis?
The body of a tapeworm is composed of successive segments known as proglottids. Each mature proglottid has both male and female reproductive structures.
What is the anatomical feature of a tapeworm that possesses both male and female reproductive structures?
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:
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?
Western blot analysis is frequently utilized as the confirmatory method of HIV detection.
Which of the following assays is routinely used for confirmation of HIV infections:
Blood Bank
What other component(s) can be shipped together with Fresh Frozen Plasma (FFP)?
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:
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?
"Universal donor", (a misnomer) is usually applied to group O, Rh negative blood. Although it may be necessary to use group O, Rh negative blood in an extreme emergency, it is preferable to use type specific blood for emergencies.
In an extreme emergency , if the ABO and Rh type are unknown which of the following should be given to the patient?
During primary hypothyroidism, where a defect in the thryoid gland is producing low levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback mechanism.
Serum TSH levels five-times the upper limit of normal in the presence of a low T4 and low T3 uptake could mean which of the following:
2(2)2s = reject when 2 consecutive control measurements exceed the same mean plus 2s or the same mean minus 2s control limit.
Violation of this Westgard rule is usually caused by a systematic error.
Laboratory Operations
Which of the following describes the Westgard multirule 2(2)S?
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?
Set of comprehensive safety guidelines designed to protect patients and health care workers
Fusarium species is the most likely associated with mycotic keratitis.
Trichophyton rubrum is a dermatophyte that commonly causes an itching, scaling skin infection of the feet, known as tinea pedis. Scedosporium apiospermum is commonly associated with sinusitis. Aspergillus niger typically causes otitis externa and can also be associated with sinusitis.
Which of the following species or organisms is the most likely to be the cause of mycotic keratitis (fungal eye infection)?
Failure to tightly seal specimens for sweat electrolytes during collection and transport will cause:
Match terms with fragments resulting from papain digestion of an IgG molecule:
A = Fab fragment OR Fc fragment
B = Fab fragment OR Fc fragment
This scenario's answer can be calculated by first deciding what the total quality control labor costs are as well as what the total consumable costs are. In this case, if quality control is run 3 times per day, a total of 1095 quality control runs are performed each year. The direct labor cost of $2.63 multiplied by 1095 quality control runs equals $2879.85 per year in quality control direct labor. The hospital pays $354.00 per month on quality control consumables, which equals $4248.00 per year. The total quality control costs in a year are equal to $2879.85 + $4248.00 = $7127.85. If 76,000 new chemistry tests panels are peformed each year, the total quality control cost per new chemistry test panel will be $0.09.
General Hospital is considering the addition of a new chemistry panel containing 12 tests. The laboratory is asked to calculate the total cost of quality control per new chemistry test panel. Quality control must be performed 3 times per day (every 8 hours). The labor cost per quality control test for this panel is $2.63. A month's worth of quality control reagent costs $354.00. What is the total quality control cost per new chemistry test panel if 76,000 of these new panels are performed each year?
A person classified as an ultrarapid metabolizer (UM) has a polymorphism that enhances the catabolic activity of the enzyme. This means that a UM would need more of the drug to achieve a 'normal' level since he/she is rapidly metabolizing the drug.
Chem
In therapeutic drug monitoring, a person who is classified as an ultrarapid metabolizer (UM) would need __________ of a drug metabolized by that enzyme.
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:
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?
The body compensates for alkalosis or acidosis of the blood PRIMARILY to regain a normal pH, between 7.35 - 7.45.
When the body compensates for a respiratory or metabolic disorder, the MAIN goal is to achieve:
Where can one find guidance on the minimum performance standards for clinical laboratories?
Using the formula on the right,
Cells/µL = 370 x 100 / 18 x 0.1
Cells/µL = 37000 / 1.8
Cells/µL = 20556 or 2.06 x 104
A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer are counted on each side for a total of 18 large squares.
Side 1-- 186 nucleated cells counted
Side 2-- 184 nucleated cells counted
total nucleated cells = 370
Using the standard hemocytometer formula shown on the right, what is the nucleated cell count per microliter (µL)?
An international, nonprofit organization that establishes standards of best current practice for clinical laboratories is
The difference between glass and plastic red stopper tubes is that the:
Question options:
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?
Which of the following cardiac biomarkers rises within 30 minutes - 4 hours after chest pain, peaks in 2 - 12 hours, and is usually normal within 24 - 36 hours.
Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?
Following an accidental needlestick, the person should be tested for all of the following except:
Entamoeba gingivalis resembles Entamoeba histolytica both in size and in nuclear characteristics. Entamoeba gingivalis may contain numerous cytoplasmic inclusions such as red blood cells, white blood cells, and bacteria.
I reside in the mouth where I measure approximately 17 micro meters.
In Rouleaux, red blood cells appear as stacked coins - formation occurs as the result of elevated globulins or fibrinogen.
The RBCs indicated by the arrows in this illustration are the result of:
G6PD deficiency causes an increased suseptibility to the oxidation of hemoglobin, which in turn, causes the precipitation of hemoglobin inside of the red blood cell.
Which one of the following conditions is associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency?
Convert the following temperature from Celsius to Fahrenheit
-10 degrees C
Question options:
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?
Medical Technology is the profession concerned with performing laboratory analyses
Either immunofixation or immunoelectrophoresis can be used to confirm Bence-Jones proteinuria.
Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine:
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:
Hemoglobin H is a tetramer made of four beta globin chains. Hemoglobin H occurs when there is very limited alpha chain availability used to make normal hemoglobin A. Hemoglobin H forms in those affected with alpha thalassemia major as well as in people with the combination of two-gene deletion alpha thalassemia and hemoglobin Constant Spring.
Hematology
Which of the following combination of globin chains comprise Hemoglobin H?
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?
Isolation and detection of Gardnerella vaginalis from vaginal secretions is improved by which of the following?
Flow cytometry employs a combination of fluorescent antibody tagging of cells and analysis with laser light scatter.
What principle(s) of flow cytometry are employed when performing immunophenotyping:
The proper pH for a unit of platelets must be above 6.2. According to the FDA, accurate pH measurement is time dependent, and samples should be tested within 1 hour of sampling, or as suggested by the manufacturer of the pH measurement system. It is recommended that a pH meter or gas analyzer be routinely used rather than pH (nitrazine) paper. However, if the laboratory chooses to determine pH measurements with nitrazine paper, the selected paper should read in increments of one-tenth units, or it may provide inaccurate measurements. Maintaining proper pH requires at least 35 ml, but preferably 50-70 ml of plasma per platelet unit.
In order to prevent a loss of viability in platelet concentrates during storage the pH must be maintained above:
In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.
Vitamin K dependent factors are those that require Vitamin K for their synthesis in the liver. Vitamin K is an important factor to gamma-glutamyl carboxylase which adds a carboxyl group to glutamic acid residues on factors II, VII, IX and X, as well as Protein S, Protein C. In adding the gamma-carboxyl group to glutamate residues on the immature clotting factors Vitamin K is itself oxidized. Deficiency of Vitamin K due to malabsorption, liver disease, etc. may contribute to bleeding disorders because clotting factor maturation depends on Vitamin K.
Which of these coagulation factors are referred to as "vitamin-K dependent?"
Most anticoagulants in blood collectiong tubes prevent clotting by:
Question options:
Measures Light scatter by particles - Nephelometer
Measures change in vapor pressure - Osmometer
Measures amount of electricity passing between two electrodes - Coulometry
Measures absorbance of light at a specific wavelength - Spectrophotometer
Lab operations
Matching
1. Measures Light scatter by particles
2. Measures change in vapor pressure
3. Measures amount of electricity passing between two electrodes
4. Measures absorbance of light at a specific wavelength
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?
Though automated extraction machines have many benefits over manual methods the costs are high and generally require a high throughput of samples in order to justify the costs.
Automated extraction has many benefits over the traditional manual methods. The most important benefit is that the nucleic acid isolated is constantly consistent. There is a reduced amount of manipulation with dramatically decreases the chance of cross contamination. Also, automated extraction machines are considered moderate complexity and can be performed by a wider variety of laboratory professionals.
All of the following are considered benefits of automated isolation and extraction equipment EXCEPT:
This type of laboratory professional is responsible for the technical aspects of managing the operation of the laboratory and is most likely an MLS with additional education in administration:
Which of the following organizations now provides the certification exam for laboratory professionals?
According to OSHA, Hazard Communication 1910.1200 has the purpose of ensuring that the hazards of all chemicals produced or imported are evaluated, and that information concerning their hazards is transmitted to employers and employees.
Also known as the "Right To Know Law," which one of the following OSHA regulations first dealt with specific information related to the contents of chemicals used in the workplace?
FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within 24 hours. In contrast, "Thawed Plasma" can be used for up to 5 days as a replacement therapy for patients requiring stable clotting factors. Keep in mind that these are two different component types and you are asked about FFP.
Blood Bank
FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within ___________ after it has been thawed.
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?
Most researchers believe that the small size and increased density of LDL molecules found in atherogenic dyslipidemia enable the molecules to more easily invade the endothelium and arterial wall of vessels.
Why are small dense LDL molecules more atherogenic?
Match the type of media with the phrase that best describes that media:
1. Differential
2. Selective
3. Enrichment
Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis, but not diagnostic enough to predict chronic pancreatitis; wheras high levels are found only during acute pancreatitis episodes. In the later stages of chronic pancreatitis, normal to decreased levels of amylase and lipase are caused by the gradual inability of the pancreas to secrete the enzyme
All of the statements below regarding amylase and lipase in pancreatitis are TRUE EXCEPT:
1 SD = 68.3%, 2 SD = 95.5%, 3 SD = 99.7
As defined by a Gaussian distribution curve, what percentage of values would be expected to fall within two standard deviations of the mean:
Macroamylasemia can be diagnosed by measuring amylase levels in the urine and serum. In patients with macroamylasemia, there will be high levels of amylase in the serum. However, macroamylasemia can look similar to acute pancreatitis, which also causes high levels of amylase in the blood. To help differentiate, we measure amylase levels in the urine. Urine levels of amylase are low in people with macroamylasemia, but high in patients with pancreatitis.
The results which would be MOST consistent with macro-amylasemia are?
Blood bank
Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration:
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.
The microscopic features shown here represent Scopulariopsis species. In most instances, particularly if a patient does not have underlying immunologic or hematologic disease, Scopulariopsis species should be considered a contaminant when recovered from a sputum specimen. However, if there is clinical or X-ray evidence of mycotic pulmonary infection, additional daily induced sputum specimens should be obtained.
If Scopulariopsis species or any other hyaline mold is recovered from two or more successive specimens, its potential as a pathogenic agent should be considered. Scopulariopsis species have been reported as the agents of pulmonary fungus ball infections in patients with preexistent cavities and as a cause of pneumonia in patients with leukemia.
Invasive pulmonary disease by this agent has not been reported.
The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely:
Any oxidase-positive organism can be excluded from the Enterobacteriaceae. The other characteristics are as a rule present in these organisms.
Which of the following is not true about members of the Enterobacteriaceae:
Convert the following temperature from Celsius to Fahrenheit
20 degrees C
Question options:
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:
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?
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?
Glucose positive, Maltose positive, Lactose negative and Sucrose negative is the correct answer since Neisseria meningitides causes Waterhouse-Friderichsen syndrome and it is positive only for glucose and maltose.
An autopsy of a 1-year-old female admitted to the emergency room 4 hours prior to her death revealed Waterhouse-Friderichsen syndrome. Blood and nasopharyngeal cultures taken prior to her death should reveal an oxidase-positive, Gram-negative diplococcus with the following biochemical reactions:
This patient is most likely suffering from an immediate-acting coagulation inhibitor; most commonly, lupus anticoagulant. Notice that the addition of normal pooled plasma does not correct upon initial or incubated mix, which means that the inhibitor is not time or temperature-dependent.
Factor VIII is not the correct answer as a factor deficiency would have corrected upon the addition of normal pooled plasma. Factor VII is not the correct answer, as the aPTT assay does not account for factor VII activity or concentration.
The laboratorian completed the mixing study ordered for John Doe. The results are as follows:
Initial aPTT result: 167 seconds
Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds
Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds
Which of the choices below would most likely explain the results for this patient?
Patient's with diseases such as congential hemolytic anemias and aplastic anemias require frequent transfusions. Each unit of red cells contains 225 mg of iron, which puts these patients at risk for iron overload.
Blood Bank
Patients with diseases that require chronic transfusions are at risk for iron overload.
Laboratories performing which of the following types of tests need to be enrolled in a CLIA-approved proficiency testing program?
Skeletal deformations result from the increased erythropoiesis that occurs in beta thalassemia major. Children with beta thalassemia intermedia may demonstrate some facial bone deformity, however this is not common. Beta thalassemia minor rarely causes any physical signs or symptoms and beta thalassemia minima is completely asymptomatic.
Skeletal deformations are most commonly present in which of the following beta thalassemias?
A slow, progressive drift of values away from the mean is called a trend. Trends occur when a particular analyte value slowly and progressively changes in one direction from one run to the next. Monitoring data for trends is part of good laboratory practice and is one indicator of many that helps laboratorians determine whether the measurement system is fucntioning appropriately.
A slow, progressive drift of values away from the mean is called a:
A phlebotomist draws an outpatient without wearing gloves. The outpatient displays a badge and cites the laboratory for not following the law. The outpatient is an employee of the:
AHG must be added to the cells immediately following washing. Antibodies may elute from the cells if the cells are allowed to sit in saline without the addition of AHG.
Which one of the following may cause a FALSE-NEGATIVE result with antiglobulin techniques?
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.
Spirochetes such as Borrelia and Treponemes are best visualized using darkfield microscopy. Borrelia, which causes Relapsing fever, can be visualized under darkfield microscopy of wet preps of peripheral blood. Treponema can be visualized by darkfield microscopy of early primary lesions, and aspirates of affected lymph nodes.
Which of the following organisms is best visualized by use of a darkfield microscope:
All of the following have been an inspection deficiency for CLIA-approved laboratories except:
The normal pH of blood is 7.40. In order for most metabolic processes to take place, the pH must remain within a narrow range close to this value. The range is usually defined in adults as 7.35-7.45. If blood pH falls below 7.35, the blood becomes too acidic (acidosis). If blood rises above 7.45, the blood is too alkaline (alkalosis).
As blood pH decreases, the kidneys will retain bicarbonate (HCO3-) from the glomerular filtrate; therefore, bicarbonate is increased. However, in this case, the increased HCO3- could not compensate for the markedly elevated pCO2 (the respiratory component) and the condition that results is uncompensated respiratory acidosis.
What condition is indicated by the following blood gas results: Bicarbonate = 32 mmol/L (Normal = 22 - 26 mmol/L); pCO2 = 65 mm Hg (Normal = 35 - 45 mmHg); pH = 7.28 (normal = 7.35 - 7.45)
The laboratory employee with an 2-year associate degree who performs clinical testing is the:
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?
The A and B antigens are present on the red cells of an AB patient. H antigen is a precursor to the ABO antigens.
An individual with type AB blood will demonstrate the complete absence of which of the following antigen sites?
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:
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:
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:
What component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)?
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.
Which advancement in clinical science occurred during the second half of the twentieth century?
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:
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:
Osteoblasts are generally seen in clusters while plasma cells are often more diffusely distributed. Osteoblasts have delicate cytoplasm, whereas plasma cells have dense basophilic cytoplasm with a perinuclear halo.
Hematology
The large cell shown in the illustration to the right is occasionally seen in the bone marrow and can be mistaken for a plasma cell - what is this cell called:
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:
The correct answer which best fits the characteristics in this question is Mycobacterium tuberculosis.
What is the MOST likely identity of an acid-fast bacilli that showed buff colored, dry, heaped colonies; niacin, nitrate, and urease positive; and took 23 days at 35ºC to grow?
Triglyceride blood concentrations change significantly when you eat, as opposed to relatively stable levels of cholesterol, HDL, or LDL circulating in the blood. Whenever you eat a meal that contains fat, your triglyceride levels rise, which is why it is important to have a patient fast before the sample is collected.
Which of the following lipid results would be expected to be FALSELY elevated on a serum specimen from a non-fasting patient?
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:
Stuart Prower factor, or factor X, would cause abnormal PT, aPTT, and dRVVT test results as factor X is part of the common coagulation pathway and therefore measured in both the PT and aPTT test. In the dRVVT test, factor X is directly activated in the test principle; therefore an abnormal result would be expected in this test as well if there was a deficiency in factor X.
What tests will be abnormal in a patient with Stuart-Prower Factor deficiency?
The correct answer for this question is 1300 mg/dL. The laboratorian performed a 1:4 dilution by adding 0.25 mL (or 250 microliters) of patient sample to 750 microliters of diluent. This creates a total volume of 1000 microliters. So, the patient sample is 250 microliters of the 1000 microliter mixed sample, or a ratio of 1:4. Therefore, the result given by the chemistry analyzer must be multiplied by a dilution factor of 4. 325 mg/dL x 4 = 1300 mg/dL.
After experiencing extreme fatigue and polyuria, a patient's basic metabolic panel is analyzed in the laboratory. The result of the glucose is too high for the instrument to read. The laboratorian performs a dilution using 0.25 mL of patient sample to 750 microliters of diluent. The result now reads 325 mg/dL. How should the techologist report this patient's glucose result?
FAB M5 is acute monoblastic leukemia
FAB M1 is acute myeloblastic leukemia without maturation
FAB M3 is acute promyelocytic leukemia
FAB M4 is acute myelomonocytic leukemia
Which FAB designation is called the "true" monocytic leukemia and is characterized by monoblasts, promonocytes, and monocytes?
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:
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?
Gram-positive bacteria retain the primary crystal violet stain that is applied in the Gram stain because of the cross-linking of the thick peptidoglycan layer in their cell walls. Their cell walls contain less lipids than that of a gram-negative bacteria, and this reduces the permeability of their cell wall to the organic solvents that are used as a decolorizer. When the counterstain is added, it may enter the gram-positive cell, but does not change the color of the cells.
A thick peptidoglycan is MOST often associated with which of the following types of bacteria?
Micro - Matching
1. Upper left image
Multi-celled, rough walled macroconidia with a tapered terminal cell
2. Upper right image
Dense aggregates of echinulate, brown-black conidia
3. Lower left image
Loose clusters of elliptical conidia arranged in a "diphtheroid" pattern
4. Lower right image
Chains of large, lemon-shaped annelloconidia
The mandatory waiting period between blood donations is 56 days, or eight weeks.
The accepted interval between blood donations is:
Neutrophils, lymphocytes and macrophage/ monocytes can be found in all types of body fluid differentials. Bronchial cells can be found only in bronchial washings and BAL specimens. Mesothelial cells are found only in serous body fluids including pleural fluid, peritoneal fluid, and pericardial fluid.
Select the specific cells listed below that can be found in all types of body fluid.
Which of the procedures listed below will increase the platelet concentration in the preparation of Platelets?
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:
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?
1. B
2. D
3. A
4. C
Red to Brown Urine: porphobilinogen, hematuria, myoglobinuria, etc.
Green: Food colorings; Increased carotene in the diet;
Pseudomonas aeruginosa infection
Yellow: bilirubin, bile pigments
White: phosphates, other crytals
Match urine color with substance that might have been responsible:
1. Phosphates
2. Bilirubin
3. Pseudomonas
4. Porphobilinogen
Electrophoresis uses an electric field to separate molecules based on differences in net electrical charge. The rate of electrophoretic migration is also dependent on the ionic radius of the molecule, the viscosity of the solution through which it is migrating, the electrical field strength, temperature, and the type of supporting medium used.
Electrophoretic separation fundamentally relies on:
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:
AHG must be added immediately after washing to prevent the possibility of a false negative; a false negative can occur in this situation because previously bound globulins may dissociate from red cells, leaving insufficient antibody coating on the red cells to produce a reaction, or free antibody may directly neutralize antiglobulin reagent.
Blood bank
A false-negative reaction while performing the DAT technique may be the result of:
The lecithin-sphingomyelin ratio is a test for assessing fetal lung maturity that is useful in determining risk of an infant born with respiratory distress syndrome.
The Lecithin/Sphingomyelin ratio determination of amniotic fluid is useful in assessing the probability of:
Which area of the laboratory can analyze a patient sample and be able to predict their risk of developing a disease?
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:
Which of the following disorders is characterized by increased production of chloride in sweat?
Multiple myeloma
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?
The correct designation for a generalist laboratory professional with a bachelor's degree certified by the American Society for Clinical Pathology is
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?
Myoglobin rises typically within 2-4 hours after a myocardial infarction and stay elevated for days, with a peak at the 6-9-hour mark post-MI. After myoglobin, troponin is the next fastest to rise afer a mycardial infarction and can rise within 3-4 hours with a peak around 12 hours post-MI. LD (8-12 hours, 24-48 hour peak) and CK (4-6 hours with peak at 24-36 hours) will also rise after MI, but are not as fast to rise as myoglobin and troponin.
Chemistry
A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had an MI?
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?
Healthcare workers that worked closely with patient specimens were at an increased risk of contracting which viral infection before a vaccine was developed?
TESTED 18 May 2024
