CSMLS mock exam questions/past questions Flashcards by Hailey Lance

Which of the following actions should be taken when the hematoxylin and eosin stain lack 3 distinct shades of pink?

Check the pH of eosin

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A dark brown pigment is noted on formalin-fixed, hematoxylin, and eosin-stained sections. What action can prevent this from occurring?

Maintain formalin at a neutral pH

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Which of the following situations will cause mast cells to turn blue during metachromatic staining?

Decreased pH of toluidine blue

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Which of the following staining problems results from the omission of 1% periodic acid solution in the Jones Methenamine silver technique?

Failure to stain the basement membrane

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Which of the following specimen orders prioritizes the processing of microbiology specimens correctly?

CSF, blood culture, urine, swab in a transport medium

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Which of the following actions should be taken when tissue sections stained with hematoxylin and eosin show pale cytoplasmic staining?

Check the pH of eosin and adjust with acetic acid if necessary
Explanation: Eosin is an acidic dye, and its pH affects the staining quality. If tissue sections show pale cytoplasmic staining, it indicates potential issues with eosin staining. Checking the pH of eosin and adjusting it with acetic acid if necessary can help restore optimal staining conditions, leading to improved cytoplasmic staining in histological specimens.

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Which of the following reagents is used as the mordant and oxidant in the Weigert’s hematoxylin?

Ferric chloride
Explanation: In the Weigert’s hematoxylin staining method, ferric chloride serves as the mordant and oxidant. It helps intensify the staining of nuclei with hematoxylin and promotes the formation of a complex that binds to cellular structures.

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Which of the following factors is a possible cause for cocci in chains to appear pink on a gram stain?

The patient is on antibiotics
Explanation: Antibiotic use can affect the cell wall of bacteria, leading to altered staining characteristics. In the case of cocci in chains appearing pink on a Gram stain, it suggests that the bacteria may have lost their ability to retain the crystal violet dye due to antibiotic-induced changes in cell wall structure.

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Which naturally occurring antibody(ies) is(are) found in the serum of a group A Rh negative patient

a. Anti-B
b. Anti-D
c. Anti-A,B
d. Anti-D and Anti-B

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Holes are noted in a cryostat section of muscle. Which of the following is the most likely cause?

a. Too small clearance angle
b. Improper adjustment of the antiroll plate
c. Freezing the section in frozen isopentane in liquid nitrogen
d. Snap freezing the muscle in liquid nitrogen

Explanation: Snap-freezing is a process where a tissue is brought down to a temperature below -70C using liquid nitrogen to preserve the tissue morphology and to prevent formation of ice crystals. However, liquid nitrogen will bubble violently when in direct contact with the tissue. Hence, tissue is first submerged into a container isopentane, which then the entire container is lowered into liquid nitrogen. Since isopentane will not form bubbles like liquid nitrogen, this prevents the tissue from getting holes.

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Which of the following is true regarding H&E staining using an automated stainer?

a. the staining should be microscopically checked daily using known control tissues
b. the staining should be checked daily only if you are preparing your own staining reagents
c. the staining should always be checked microscopically slide-by-slide
d. microscopic stain checks are not if you are purchasing your reagents

Explanation: (A) and (D) are invalid since staining should be checked whether commercial or in-house reagents are used. (B) is too time consuming and impractical. (C) is the proper way to check the quality of the staining. Control tissues will show whether the expected staining features have been stained properly (colour, intensity, and specificity).

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Which of the following is true of quality control materials for internal QC?

a. they should be run daily for a week to collect values required to create Levey-Jennings plots
b. they must always have a known value directly traceable to a reference method
c. they should approximate the chemical and physical properties of the sample being tested
d. they should sit on the bench and continue to be used until the bottle is empty or values are > +2SD

Explanation: QC materials simulate the composition of patient samples in order to minimize the matrix effect and to correctly reflect the expected performance with patient samples. Matrix effect is the effect on an analytical method caused by all other components of the sample except the except the compound of interest. As opposed to standard reagents, QC reagents do not need a known value, as long as their measured values fall within the acceptable range on the levy-jennings graph. Most QC materials degrade quickly at room temperature; hence they are stored in refrigerators with a few exceptions. The mean and standard deviations of Levy Jennings plots are calculated from QC values collected over a MONTH not a week.

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During a routine quality control check, a Kirby-Bauer disc susceptibility test is performed and the resulting zones of inhibition are too large. Which of the following is a possible cause of this result?

a. antibiotics stored at higher temperature than recommended
b. antibiotic discs applied immediately after inoculation of plate
c. inoculum too dense
d.agar depth too thick

Explanation: What effect does each answer have on the zone size? An overly dense inoculum means more bugs are added to the plate, which will overcome the effect of the drug causing a falsely small zone size. High temperature can destroy the integrity of the antibiotics making it less effective, hence, a falsely small zone size. Thick agar will prevent the antibiotics from diffusing to bugs that are farther from the disc, causing a falsely small zone size. If the disc is applied too soon before the bugs are settled in the agar, the disc can destroy the bugs immediately, causing a falsely large zone size.

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Which antibody could be produced by an R1r individual transfused with R2R2 blood?

a. Anti-C
b. Anti-E
c. Anti-c
d. Anti-e

Explanation: Patient is CDe/cde (E-antigen negative RBC). Donor is cDE/cDE (E-antigen positive RBC). Hence the donor red cells can induce the patient to form anti-E.

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A good screening test for alcohol ingestion employs comparing the calculated osmolality with what other measurement?

a. freezing point depression osmometer measurement
b. boiling point elevation osmometer measurement
c. vapor-pressure osmometer measurement
d. the osmolar gap

Explanation:Freezing point depression = Measured osmolality – Calculated osmolality = osmolar gap (i.e. measured osmo vs. calculated osmo). The more solutes in blood, the lower the freezing point (i.e. freezing point depresses) just like the effect of salt on ice. The solutes in our body are mainly sodium, urea, and glucose (2*Na + urea + gluc) which give us our calculated osmolality. However, our measured osmolality will include the above as well as exogenous substance such as methanol, ethylene glycol, acetone, and isopropyl alcohol. A high osmolar gap (measured – calculated) indicates that these exogenous substances may be present in our body.

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When performing a D typing on a patient, a technologist observes that the Rh control is positive. As a result, which of the following would he perform next?

a. Full Rh phenotype
b. Repeat D testing with high protein antiserum
c. Weak D test
d. Direct Antiglobulin Test

Explanation: Rh control only consists of a high protein reagent with no anti-D. A positive Rh control indicates that the red cells may already be attached by antibodies in vivo, because the protein in the Rh control may have brought the pre-sensitized red cells together to form an agglutinin. Hence, a DAT is done to prove whether the red cells are pre-sensitized or not.

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When entering blood gas results manually into the LIS what should be done if a critical value warning appears when a pH value of 7.14 is entered?

a. immediately consult with the supervisor
b. Check for decimal placement
c. Follow the critical value protocol
d. look at previous results

Explanation: Any question that has an answer which tells you to follow the protocol/SOP, it’s the always the safest answer and most likely the right one. Delta check is not a useful tool on pH values, since they can fluctuate immensely depending on the patient’s condition.

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Gram positive cocci in chains which grow as small translucent colonies surrounded by a clear zone of hemolysis were isolated from a throat swab. These colonies were found to be catalase negative and resistant to a 0.04 unit bacitracin disc. Which of the following tests would be most useful in identifying this organism?

a. antibody latex agglutination
b. Taxo A disk
c. tube coagulase test
d. susceptibility to optochin

Explanation: Catalase neg indicates that this bug is a Strep not Staph. Clear zone indicates that it is a Beta-hem Strep rather than an Alpha-hem Strep (i.e. not S. pneumo and viridans). Amongst the beta-hem strep, Group A Strep is susceptible to bacitracin (Taxo A); hence, this can be either Group C or G. In order to differentiate the two, latex agglutination is the best choice.

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What should be done with patient results that are outside reference intervals but are within the percent differences programmed into the delta check?

a. repeat the assay
b. Release the results immediately after review
c. phone the results to the doctor
d. have the specimen recollected

Explanation: If the result did not violate delta check, there is no need to question whether any error (technical error, ID error…etc.) is involved. It is unnecessary to phone the doctor since the question didn’t state that the result is critical.

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What statement about the dry reagent strip blood test is true?

a. a non-hemolyzed trace is present when there are 1-2 RBC/high power field
b. test for blood is positive for hemoglobin and myoglobin
c. test for blood is based on its reaction with oxidase
d. salicylates cause a false positive reaction

Explanation: Both hemoglobin and myoglobin will react with the H2O2 on the pad, which gives a positive result. The colour of the urine (brown vs red) and microscopic examination (red cells) can be used to differentiate haemoglobin from myoglobin. Oxidizing reagents such as bleach can also cause a false positive reaction for blood test, however, salicylate is reducing reagent. Oxidase is used to test for urine glucose.

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Which of the following antibodies would not show any reactivity when tested against a panel of reagent red blood cells which had been treated with ficin?

a. Anti-Fya
b. Anti-K
c. Anti-E
d. Anti-Jkb

Explanation: Enzymes (e.g. ficin and papain) destroy anti-M, N, S, and Duffy (Fya and Fyb).

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What does staining leukemic cells for myeloperoxidase help to distinguish?

a. CML from CLL
b. CLL from ALL
c. AML from ALL
d. AML from CML

Explanation: MPO (myeloperoxidase) is an enzyme found in neutrophil primary granules and monocyte lysosomes that catalyze H2O2. Both cells are found in AML, hence very reactive with H2O2 in the stain. ALL is mainly lymphocytes, which has no MPO.

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A suspect Enterobacteriaceae isoalte was inoculated to a TSI and decarboxylase test. The TSI showed K/A with gas. The decarboxylase showed:

base: purple, turbid
lysine: purple, turbid
ornithine: purple, turbid

a. the organism is a non-fermentative bacillus
b. the organism is viable but does not decarboxylate the amino acid
c. the test is invalid and must be repeated
d. the organism is negative for lysine and ornithine

Explanation:
TSI: 0.1% gluc, 1.0% lactose and sucrose, rest is peptone (protein)
Glucose will first be used up (entire tube turns yellow). If the bug is a lactose fermenter, lactose and sucrose will be utilized next and the peptone will remain untouched (entire tube remains yellow = A/A). However, if the bug does not ferment lactose, it will directly move from glucose to protein. Since deamination of protein occurs aerobically (i.e. the top), only the top will change from yellow to red (top is red, bottom stays yellow due to glucose metabolism = K/A). If the bug is a non-fermenter, it can still metabolize (not ferment) glucose, but only weak acids are produce. Hence, the tube will not turn yellow and will remain a peachy red colour. The protein is then metabolized, turning the top red (top is red, bottom retains original peachy red colour = K/NC).

Summary:
K/A = ferments glucose and utilizes the protein (NLF)
A/A = ferments glucose, lactose, and sucrose (LF)
K/NC = utilizes protein (NFB)

Decarboxylase Test: small amt of glucose and lots of protein (lysine/ornithine); base tube contains glucose only
NLF and LF will first ferment the glucose, producing strong acids that turn the entire tube yellow. If the bugs don’t use ornithine or lysine, the tube will remain yellow. If the bugs metabolize lysine or ornithine or both, they will move on to the protein once glucose is depleted, giving the tube a purple colour. Since the base only contains glucose, NLF and LF will make the base turn yellow. However, since non-fermenters do not ferment glucose, but still utilizes glucose through other pathways, only weak acids are formed. The weak acids cannot turn the tube yellow; hence, the base tube will have a turbid purple colour.

Summary:
NLF and LF ferment the glucose in the base and produce strong acid  yellow
NFB utilizes glucose in base, but produces weak acid  turbid/purple

Since the TSI result (K/A) tells us that the bug is an NLF, but the decarboxylase test indicates that the bug is an NFB. The conflicting results are deemed invalid.

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Given the following patient test results, what is the creatinine clearance?
serum creatinine 100 μmol/L
urine creatinine 8.64 mmol/L
24 hour urine volume 2000 mL
BSA 1.73m^2

a. 120 mm/min
b. 16 mm/min
c. 16 ml/min/1.73m^2
d.120 ml/min/1.73m^2

Explanation: **Be careful with the units:
i) Convert umol to mol for serum creatinine
ii) Convert 24 hours to 1440 min (because answer is in minutes)

Ucr (mg/dL) Vur (mL/24hrs) over Pcr (mg/dL) 1440 minutes/24hrs times 1.73 over A

Cr = creatinine clearance
Ucr = urine creatinine clearance
Vur = urine volume excreted in 24 hours
Pcr = serum creatinine concentration
1.73/A= normalization factor for body surface area

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What happens to hemoglobin's affinity for oxygen when hemoglobin binds 2,3-DPG? a. It decreases b. It increases c. It remains constant d. It becomes saturated

A Explanation: According to the oxygen-hemoglobin dissociation curve, as 2,3-DPG increases, the curve shifts to the right indicating that more oxygen is required to bind and saturate the hemoglobins. This is because 2,3-DPG binds to deoxygenated hemoglobin, making it harder for oxygen to bind (i.e. decreased affinity). Similarly, increased temperature and pH will also decrease hemoglobin’s affinity for oxygen due to the disruption of bonds.

The Philadelphia chromosome is predominately associated with which leukemia? a. acute lymphoblastic leukaemia b. acute myeloblastic leukaemia c. chronic lymphocytic leukaemia d. chronic myelogenous leukaemia

D Explanation: Philadelphia chromosome is commonly associated with CML. It is caused by the translocation of chromosomes 9 and 22, forming a fusion gene, bcr-abl.

A technologist is performing a nitrate reduction test. When dimethyl-α-naphthylamine and sulfanilic acid were added, the medium did not change colour. What should the technologist do? a. record the test result as positive b. reincubate the tube overnight c. Add zinc to the tube d. record the test result as negative

C Explanation: One feature of Enterobacteriaceae is its ability to reduce nitrate. Nitrate --> Nitrite --> Nitrogen The nitrate reduction test tests for the presence of nitrite (reduced form of nitrate). If nitrite is present, the medium will turn pink. However, some bugs reduce nitrate beyond nitrite to form nitrogen. Since nitrogen is present instead of nitrite, the medium will not change colour. Hence, no change in colour can be caused by either no reduction or reduction beyond nitrite. In this case, zinc is added to the medium. If there is no reduction, zinc will react with the nitrate to form a pink product. However, if there is reduction beyond nitrite (i.e. no nitrate present), zinc will not react and the medium remains unchanged. i) Nitrate reduced to nitrite: pink after addition of dimethyl-α-naphthylamine and sulfanilic acid ii) Nitrate reduced to nitrogen: no colour change after addition of dimethyl-α-naphthylamine and sulfanilic acid, and no colour change after addition of zinc iii) No nitrate reduction: no colour change after addition of dimethyl-α-naphthylamine and sulfanilic acid, and pink after addition of zinc ii) Nitrate reduced to nitrogen (beyond nitrite)

The alcian blue staining reactions of colonic epithelial goblet cells on serial sections from the same tissue block show the following staining results: Alcian Blue @ pH 1.0 1+ (stain intensity) Alcian Blue @ pH 2.5 3+ Alcian Blue @ pH 4.5 3+ a. The colonic epithelial goblet cells contain only carboxylated glycoproteins. b. The colonic epithelial goblet cells contain neutral glycoproteins. c. The colonic epithelial goblet cells contain only sulphated glycoproteins. d. The colonic epithelial goblet cells contain both sulphated and carboxylated glycoproteins.

D Explanation: Alcian Blue is a cationic dye that binds to the negative charges on glycoproteins. Sulphated glycoprotein (-SO3H) has an isoelectric point (pI) of 0.5, which means only at pH above 0.5 will SO3H become deprotonated, giving it a negative charge (SO3-). On the other hand, the pI for carboxylated glycoprotein (-COOH) is 2.4. Hence, COOH will deprotonate at pH above 2.4. Alcian Blue can only bind to the two glycoproteins at pH's ABOVE their respective pI. At pH 1.0, Alcian Blue can only stain sulphated glycoprotein, but not carboxylated glycoprotein. At pH 2.5 and 4.5, Alcian Blue can bind to sulphated AND carboxylated glycoproteins. Since the intensities increased starting from pH 2.5, the stain must be binding to carboxylated glycoproteins in addition to sulphated glycoproteins. If the intensities remain the same, it’s likely that only sulphated glycoprotein is present.

If QC was performed on a batch of Hugh-Leifson O-F (oxidative-fermentative) media, which of the following results would correspond with acceptable QC? a. (open) (closed) Escherichia coli yellow yellow Pseudomonas aeruginosa yellow blue-green Acinetobacter lwoffi blue-green blue-green b. (open) (closed) Escherichia coli yellow yellow Pseudomonas aeruginosa yellow yellow Acinetobacter lwoffi yellow blue-green c. (open) (closed) Escherichia coli yellow yellow Pseudomonas aeruginosa blue-green yellow Acinetobacter lwoffi blue-green blue-green d. (open) (closed) Escherichia coli blue-green blue-green Pseudomonas aeruginosa yellow blue-green Acinetobacter lwoffi yellow yellow

A Explanation: O-F tests for the bacteria’s utilization of glucose in the presence and absence of oxygen. E. coli is a fermenter that can ferment glucose under O2 and ANO2 (both tubes yellow). P. aeruginosa is an oxidizer that can only oxidize glucose under O2 (only open tube is yellow). Acinetobacter lwoffi is an asaccharolytic bug, meaning it doesn't use glucose at all (neither tubes are yellow).

A 26 year old female out-patient presents to her physician with symptoms of uncomplicated cystitis. A culture of her urine grows gram positive cocci. What organism would these cocci likely represent? a. Staphylococcus epidermidis b. Staphylococcus saprophyticus c. Streptococcus agalactiae d. Staphylococcus aureus

B Explanation: Staphylococcus saprophticus is found predominantly in sexually active young outpatient females. Other bugs commonly found in outpatients include E. coli, Proteus mirabilis, Klebsiella, Enterococcus, and Group B Strep.

What should a technologist do if she obtains low results for all analytes in a specimen? a. look for sampling error such as a clot in the probe or specimen b. Change the wash reagent for the probe c. check the patient's diagnosis for over-hydration d. check and see if the reagents have expired

A Explanation: Under these situations, the first approach is to consider possible analytical/technical errors rather than patient’s physiological condition. If the reagents have expired, all patient samples will be affected rather than just one specimen. Also, do not attempt to take any corrective action before determining the cause of the problem. Clots in the probe can decrease the amount of sample being aspirated, thus cause the concentration of all analytes to be low.

What may cause wrinkles in sections during flotation? a. having the water bath too hot b. floating the ribbon for too short of time c. floating the ribbon too slowly

B Explanation: (A) and (C) will cause the ribbon to disintegrate due to the heat. (B) will not affect the ribbon. When ribbon is wrinkly, leaving it in the waterbath for some time will make the wrinkles disappear.

How many units of packed red cells would be required to raise the hemoglobin of an average sized patient from 80 g/L to 110 g/L? a. 5 b. 1 c. 7 d. 3

D Explanation: Every unit of red cells can raise the hemoglobin by 10 g/L. (110-80)/10 = 3

What does the D-dimer lab test detect? a. fibrinogen monomer b. fibrinogen c. degradation products of both fibrinogen and fibrin d. fibrin degradation products

D Explanation: Fibrinogen converts to fibrin. Fibrin will eventually degrade to fibrin degradation products, which includes D-dimer, with the help of the fibrinolytic system.

A control slide is stained with H&E using an automated tissue stainer. Upon microscopic assessment following staining in Harris hematoxylin, the nuclei appear blue-purple with an obvious chromatin pattern. What would be the appropriate action at this stage? a. prepare a new hematoxylin solution b. accept the results and continue with the procedure for the rest of the slides c. decrease the pH of the hematoxylin staining solution d.increase the pH of the hematoxylin staining solution

B Explanation: Don’t be tricked! This is how nuclei should appear under H&E stains.

A midstream urine is received in the laboratory from a recently discharged inpatient. The requisition indicates the date of collection as yesterday making the specimen 24.5 hours old but the specimen feels warm to the touch. What should the technologist do? a. process the specimen following the usual protocol b. discard the specimen, send out a rejected specimen report c. call the floor to double-check the collection date d. process the specimen with a warning about the delay in transportation

C Explanation: If the urine is still warm, it may still be fresh and that the date/time was mislabelled. Do not process or discard the sample without any confirmation.

What would processing tissues through alcohol stations that are contaminated with water initially result in? a. incomplete infiltration of the tissue with paraffin b. incomplete clearing of the tissue c. excessive hardening of the tissue d. incomplete fixation of the tissue

B Explanation: Tissue processing: Dehydration (alcohol) --> Clearing (Xylene) --> Impregnation (paraffin wax) If alcohol is contaminated, all the proceeding steps will be affected (clearing and impregnation), because xylene and wax are not miscible with water. Both (A) and (C) are correct. However, the question asks what the contamination will "initially" result in, which is the clearing stage.

Every piece of equipment in the laboratory has a log which is used to document QC values during start-up. How can this log be used? a. to assist in trouble-shooting for random and systemic error b. to ensure that start-up procedures are performed properly c. to force every technologist to perform tasks in a uniform manner d. to prevent errors in the start-up procedure

A Explanation: The Levey-Jennings chart will show whether a shift or trend is present in the control values, which respectively indicate a possible random or systemic error.

Which of the following is recommended for the detection of penicillin resistance in Streptococcus pneumoniae? a. beta-lactamase testing b. nafcillin 10 ug c. penicillin 10 units d. Oxacillin 1 ug

D Explanation: Oxacillin is a quick and inexpensive screen that tests for penicillin resistance. If the bug is resistant to oxacillin, it will be resistant to penicillin. If it is susceptible to oxacillin, we can proceed to test for pen resistance with the penicillin E-test strip (much pricier). Beta-lactamase test is not a good indicator of penicillin resistance for Strep pneumo, because it is resistant to penicillin through the alteration of its penicillin-binding proteins (PBP’s) rather than using beta-lactamase. Beta-lactamase testing is normally used on Haemophilus influenzae for BLNAR (beta-lactamase negative ampicillin resistant)

A cloudy cerebrospinal fluid has an increased leukocyte count and a decreased glucose concentration. What is the most probable type of meningitis in a patient with these CSF results? a. bacterial b. viral c. fungal d. tubercular

A Explanation: Bacterial infection will have increased leukocyte (particularly neutrophils) and decreased CSF glucose level. Viral infection will have increased lymphocytes and normal CSF glucose level.

Which of the following contains only ferric iron? a. sulfhemoglobin b. myoglobin c. methemoglobin d. oxyhemoglobin

C Explanation: Methemoglobin carries ferric iron (Fe3+) which is the oxidized form of ferrous iron, and thus has a decreased ability to bind to oxygen.

An immunocompromised 58-year-old female chemotherapy patient received two units of packed RBC. The patient died 3 days later, and the report from the autopsy revealed that her death was due to septic shock. The blood bags were cultured and the following results were noted. Growth of gram-negative rods on both the BAP and MAC Lactose neg Sucrose pos Citrate neg Indole neg VP neg H2S neg Urea pos motility @ 22°C pos motility @ 37°C neg a. Enterobacter clocae b. E. coli c. Yersinia enterocolitica d. Citrobacter freundii

C Explanation: Biggest hint is the motility test. A distinctive feature of Yersinia enterocolitica is that it is motile at 22C to 30C, but completely loses motility at 37C. Another hint is that the patient has had a blood transfusion. One way to isolate Yersinia enterocolitica is by the cold enrichment method, where the bugs are incubated at either 37C or 4C. The former shows slowed growth, while the latter exhibits enhanced recovery. Hence, Yersinia enterocolitica is fond of the cold temperature and will survive and multiply in packed red cells.

A grossly lipemic specimen needs to be tested for potassium using a direct ISE method. How should the technologist proceed? a. perform the testing as usual as lipemia will not affect the results b. do the tests but note on the report that the lipemia will falsely decrease the results c. airfuge the specimen before analysis d. insist that the specimen be re-drawn after the patient has fasted

A Explanation: There are two ISE methods, direct and indirect. Direct ISE measures on a non-diluted plasma sample while indirect ISE measures on a plasma sample that has been diluted with a large amount of diluent. Direct ISE is not affected by lipemia, whereas indirect ISE is due to the dilution, hence the latter will require the specimen to be airfuged before analysis.

How should a potassium value of 15 mmol/L be interpreted? a. it is probably due to hemolysis b. it is probably due to lipemia c. it is physiologically possible but should be phoned after repeating d. it is implausible and requires investigation

D Explanation: The reference range for potassium is 3.5 – 5.0 mmol/L. 15 mmol/L is 5 times higher, which is beyond critical. This is physiological implausible if patient is still alive. One possible cause is that patient sample may have been contaminated by IV fluids containing potassium.

What is an appropriate disposal method for ammoniacal silver solutions? a. boil off the liquid, then dispose the solute into chemical waste b. allow the solution to dry, then scrape into chemical waste c. pour the solution into saturated aqueous sodium chloride and then dispose according to regulations d. reduce all the silver salts with formaldehyde and then dry the solute before discarding in general waste and pouring the liquid down the drain

C Explanation: Ammoniacal silver can form extremely explosive silver nitride. Hence, it must be neutralized with saturated aqueous sodium chloride before disposal.

What should be done when a laboratory reporting error is corrected? a. the correct result should be called and identified as a corrected report followed by documentation of the call b. all records of the original report should be discarded c. the person who made the error and their reason for committing it should be found out before the result is corrected d. the new result should be called and the nurse asked to discard all records of the original report

A Explanation: All documents should be retained for communication and investigation purpose. It’s more critical that the ward is notified of the correct result before any investigation is made.

Which of the following mothers is a candidate for Rh immune globulin? a. A neg mother with positive antibody screen (anti-S); A pos newborn b. O pos mother with negative antibody screen; A pos newborn c. O neg mother with negative antibody screen; A neg newborn d. O neg mother with positive antibody screen (anti-D); A pos newborn

A Explanation: Rh immune globulin is a passive D antibody that removes any Rh pos fetal red cells in mom’s blood stream before they stimulate the mother to form anti-D. In order to be eligible for RhIG, mother must be Rh negative (Rh pos moms won’t form anti-D), baby must be Rh pos (Rh neg baby will not stimulate mom to form anti-D), and that mom has not yet formed an anti-D (thus (D) is not eligible)

A standard with a transmission value of 50% and a concentration of 100 g/L is used to estimate an unknown specimen with a transmission value of 75%. What is the concentration of the unknown specimen in g/L? a. 150 b. 55 c. 42 d. 67

C Explanation: Transmission must be converted to absorbance first before calculating for the concentration. A = 2 – logT% A1 = 2 – log 50 A2 = 2 – log 75 Since absorbance is directly proportional to concentration (Beer’s law: A = E * b * c) A1/C1 = A2/C2

Which of the following methods is the safest and most appropriate for disinfecting a cryostat where adequate ventilation is not available? a. glutaraldehyde solution b. phenolic compound followed by absolute ethanol c. formaldehyde vapour d. hypochlorite solution followed by water

B Explanation: Never clean a cryostat with water, as it will form ice in the instrument. Hence, the cryostat is regularly maintained by turning it off to allow ice to melt and wiping it down with alcohol. Formaldehyde and gluteraldehyde are fixatives rather than cleaning reagents.

A single tube of cerebrospinal fluid is received in the laboratory and the following tests are requested: total protein, albumin, IgG quantitation, microbial culture, Gram stain, leukocyte count and differential cell count. Where should the sample tube be sent first? a. chemistry for protein analysis and fractionation b. hematology for leukocyte count and differential cell count c. microbiology for microbial culture and Gram stain d. aliquot small sample and send a portion to each department

C Explanation: Since Micb requires a sterile, uncontaminated specimen, this department should get the specimen first. Furthermore, only a couple drops of CSF is needed for enrichment broth and staining. Cytospin and inoculation is not mandatory if sample is limited. Hematology gets the specimen next, because an unspun specimen is needed for cytospin in order to obtain a correct cell count. Chemistry spins the sample and only takes the supernatant. Hence, Chemistry should be the last department to receive the specimen unless requested otherwise by the physician.

A patient is positive for anti-Fya, anti-Jkb and anti-K. How many units of blood will have to be screened to find two compatible units, given the following antigen frequencies? Fya positive = 60% Jkb positive = 70% K positive = 10% a. 8 b. 18 c. 24 d. 48

B 100 - positive frequency FyA: 100-60 = 40 Jkb: 100-70 = 30 K: 100-10 = 90 0.40 x 0.30 x 0.90 x 100 = 10.8 % 11/100 = 2/X = 200/11 = 18

Two levels of QC material and the Westgard 1 2S rule as a warning rule to check the other quality control rules are being used by a technologist. On the same run, one of your QC values is +2.1SD while the other QC value is -2.2SD. What action should be taken on the basis of these QC results? a. these QC values should be regarded as warnings and the analysis continued b. both QC values should be repeated and the rules reassessed c. troubleshoot for systemic error d. troubleshoot for random error

D Explanation: Whether it’s inter-run or intra-run, this is a R4S, which indicates a random error.

Which of the following would lead to an inpatient total serum calcium result of less than 1 mmol/L? a. the specimen may be contaminated with EDTA anticoagulant b. the specimen may be contaminated with heparin anticoagulant c. the patient pumped their fist while the tourniquet was on d. the tourniquet was likely left on for too long

A Explanation: EDTA is a chelating agent that binds to calcium, causing the serum calcium to be falsely decreased.

What is the calculated serum osmolality in mOsm/kg given the following serum results? Sodium 145 mmol/L Potassium 4.2 mmol/L Chloride 104 mmol/L Bicarbonate 26 mmol/L Urea 5 mmol/L Glucose 10.3 mmol/L a. 294 b. 305 c. 160 d. 15

B Explanation: 2*Na + Urea + Gluc = 2*(145) + 5 +10.3 = 305

Which of the following assays has the poorest precision? Analyte Mean (mmol/L) Standard Deviation Calcium 2.5 0.3 Potassium 4.0 0.4 Sodium 140 4.0 Chloride 100 2.5 a. potassium b. sodium c. chloride d. calcium

D Explanation: Coefficient of variation is a better indicator of precision than standard deviation itself. CV takes into account of the standard deviation with respect to the mean, hence, it’s also known as the relative standard deviation. The smaller the CV is, the higher the precision. CV = SD / mean Chloride = 2.5% sodium = 2.9% potassium = 10% calcium = 12%

100 values on a healthy population have Gaussian distribution and give the following values: mean 50 IU/L and SD 5 IU/L. Which of the following statement is true about this population? a. 95% had values between 45 and 55 IU/L b. 2.5% had values <40 IU/L c. 97.5% had values > 60 IU/L d. 5% were not healthy

B Explanation: Try plugging in the mean and SD values into this distribution curve. Since it’s the area between -3SD (35) to -2SD (40) is 2.5%, the answer is (D) *it’s easier to memorize ~100% instead of 99.7%

Blood from a newborn has low thyroxine (T4) and elevated TSH compared to reference ranges for that age. These results are most consistent with a. a normal response to pregnancy induced changes in maternal thyroid function b. congential secondary hypothyroidism c. congenital hypopituitarism d. congential primary hypothyroidism

D Explanation: Hypothyroidism means a low free T3 and free T4. Hypopituitarism is low TSH (hence answer is not (a)) Primary hypothyroidism is commonly caused by dysfunctional thyroid or low iodine diet, resulting in decreased production of T4. Since T4 suppresses the production of TSH (neg feedback), a decreased T4 will lead to an increased TSH. Secondary hypothyroidism is commonly caused by a dysfunctional pituitary gland, which results in decreased production of TSH. Since TSH stimulates the production of T4, decreased TSH will reduce the production of T4. Pregnancy is normally associated with hyperthyroidism, which can lead to Grave’s disease.

A pediatric renal transplant patient had a suprapubic urine collection performed. In the lab, a technologist plated the specimen following protocol with a 0.1 mL calibrated loop. At 18 hours there are 8 colonies of a coliform growing on the plate. What colony count would be reported? a. 8 X 10^6 CFU/L b. 80,000 CFU/L c. <10 X 10^4 CFU/L d. 800,000 CFU/L

B Explanation: (# of colonies)/(loop size in mL) * (1000 mL/ 1 L) * (dilution factor if applicable) = CFU/L (8 CFU / 0.1 mL) * (1000 mL / 1 L) = 80,000 CFU/L

Which of the following is/are true about a cryostat: a. is a potential infection hazard b. all of the above c. is usually maintained at -35C d. The cryostat is a microtome in a refrigerated cabinet used to cut fixed tissue.

A Explanation: Cryostat is used to cut UNfixed tissues. Frozen sectioning is used for rapid microscopic analysis of STAT specimen, hence there is no time for fixation. Tissue is frozen with isopentane and liquid nitrogen and cut by cryostat, which is maintained at approximately -20C. Since tissue is not fixed, it is a potential infection hazard. Hence, only (c) is correct.

A technologist did the following to a frozen section of liver. the section was taken through to 70% alcohol, treated with saturated Oil red O in 70% alcohol, rinsed with 70% alcohol, then the nuclei were stained with Harris hematoxylin. The technologist then dehydrated, cleared and mounted the sections in Permount. What results should she see under microscopic observation if unsaturated fats were present in the frozen section. a. red lipids, blue-purple nuclei b. red lipids and cytoplasm, blue-purple nuclei c. the mounted sections would be unstained d. blue-purple nuclei

D Explanation: Lipid will dissolve in alcohol. Thus, there will be no staining for lipids. However, the nuclei will remain stained.

You have been asked to freeze a muscle for Muscle Histochemistry. You place isopentane into liquid nitrogen until it has begun to freeze you then place the muscle into the isopentane. The result of your actions are which of the following? a. the tissue is ruined b. large ice crystal artifacts c. properly frozen tissue d. over frozen tissue

C Explanation: Snap-freezing is a process where a tissue is brought down to a temperature below -70C using liquid nitrogen to preserve the tissue morphology and to prevent formation of ice crystals. However, liquid nitrogen will bubble violently when in direct contact with the tissue. Hence, tissue is first submerged into a container isopentane, which then the entire container is lowered into liquid nitrogen. Since isopentane will not form bubbles like liquid nitrogen, this prevents the tissue from getting damaged. This is the proper way of freezing a tissue.

When testing your patient sample, you find all 3 screen cells positive at IAT phase. When an antibody panel is done, all cells except one are positive. The patient auto control is negative. Which of the following is the most likely explanation for this reaction pattern? a. antibody to a high frequency antigen b. antibody to a low frequency antigen c. cold reacting autoantibody d. warm reacting autoantibody

A Explanation: Since DAT is negative, it is not an autoantibody. All three screen cells and most of the panel cells are positive, which implies that this patient has an antibody against an antigen that occurs on almost all the red cells, in other words, a high-frequency antigen.

181. which of the following statements about reticulocytes is false? a. staining can occur for more than 5min b. a supervital stained is used c. RBC inclusions can result in falsely elevated counts d. polychrome methylene blue stain is used

D Explanation: either brilliant cresyl blue or new methylene blue is used as the stain. Only inclusions can be viewed with a supervital stain.

182. when are automated cell counters required to have calibration check performed? a. at least every 3 months b. after replacement of any major part c. after performing monthly maintenance d. when the control values are >2 SD from the mean

183. which of the following procedures could be performed on a hemolysed blood sample? a. hemoglobin b. hemoglobin and plts c. RBC count and hematocrit d. no results are reportable

184. For which of the following procedures would heparin be a recommended anticoagulant? a. platelet count b. coagulation tests c. smear based red cell morphology d. osmotic fragility

D OF: test to determine if red cells break easily due to increased osmotic stress. Usually caused by thalassemia or hereditary spherocytosis (decreased surface area).

185. what is the QC term used to describe the reproductibility of a test? a. accuracy b. precision c. SD d. specificity

186. which therapeutic agent affects platelet function? a. aspirin b. Coumadin c. heparin d. streptokinase

A Prevents platelets from sticking together.

187. for the performance of manual platelet counts, what is the recommended type of microscopy? a. electron b. dark-field c. light d. phase

188. the ratio of anticoagulant to blood for coagulation procedures should be 1 to a. 4.5 b. 7.0 c. 9.0 d. 10.0

189. what is the coagulation factor that has a sex linked recessive inheritance pattern? a. factor V b. factor IX c. factor X d. von Willebrand's factor

190. the thrombin time will be prolonged in the presence of all the following except: a. elevated fibrinogen degradation products b. heparin c. factor I deficiency d. factor II deficiency

D Factor 2 is the prothrombin factor.

191. what would be the expected screening test results for a patient with a fibrin stabilizing factor deficiency? a. prothrombin time prolonged b. activated partial thromboplastin time prolonged c. prothrombin time and activated partial thromboplastin time prolonged d. prothrombin time activated, partial thromboplastin time normal

D Factor XIII deficiency

192. all the following are true of the INR except: a. INR is dependent on reagents and instrument used b. INR is calculated using the PT ratio taken to the power of the ISI value c. the WHO recommends reporting the INR on patients on long-term oral anticoagulant therapy d. the desired INR on a patient on Coumadin is between 2.0 and 2.5, but may be higher depending on the cause of the patient's hyper coagulable state

193. a prolonged APTT result is obtained on a patient diagnosed as having acute DIC. The patient has not yet been treated for this syndrome. How can the prolonged APTT be explained? a. In addition to DIC, the pt is deficient in a factor required for the intrinsic pathway b. DIC is characterized by synthesis of less stable coagulation factors, which deteriorate rapidly in the circulation c. continuous activation of the coagulation system uses some factors more rapidly than the liver can synthesize them d. the patient has been misdiagnosed, since a prolonged APTT indicates the problem is deficient, not excessive, coagulation

194. all of the following test results are characteristic of DIC except: a. decreased fibrinogen concentration b. negative test for degradation products c. decreased platelet count d. prolonged prothrombin time test

195. a 4 year old child is seen in the ER room with petechiae and a plt count of 15 x 10 ^9/L. She has no previous history of bleeding problems. 3 weeks earlier she had chicken pox. The physician advises the parents to keep the child off the playground to avoid injury, and the child will recover within several weeks to a month with no further treatment. What condition does this child most likely have? a. essential thrombocythemia b. idiopathic thrombocytopenic purpura c. thrombotic thrombocytopenic purpura d. Wiskott-Aldrich syndrome

B ITP, also called idiopathic thrombocytopenic purpura, is an autoimmune disorder that may only require monitoring. In contrast, TTP is related to an enzyme that controls how blood clots and leads to life-threatening complications if not treated right away

196. An APTT and PT are requested on a patient scheduled for emergency surgery. On an optical density clot detection system, normal and abnormal controls for both tests are within range, but the patients results are extremely prolonged. The patient's results have been performed in duplicate, but there is sufficient plasma, which is dark amber, to repeat the tests. What is the best course of action to follow? a. report results immediately by phone, emphasizing that the tests were run in duplicate, and the controls are within range b. request a new specimen and repeat the procedures using freshly diluted controls c. repeat the procedures on an instrument that detects clot formation electromechanically d. inform the physician that accurate results are impossible

197. which coagulation factors are referred to as "vitamin K dependent"? a. I,V,VIII,XIII b. II,V,IX,XII c. II,VII,IX,X d. xixii,fletcher, Fitzgerald

198. a severe vitamin K deficiency will affect all of the following except: a. fibrinogen b. stable factor c. Christmas factor d. protein C

A Stable factor: VII

199. a patient with coronary artery disease is admitted to the hospital with venous thrombosis. What medication can be administered that will lyse the clot? a. aspirin b. Coumadin c. heparin d. tissue plasminogen activator

200. reversal of a heparin overdose can be achieved by: a. vitamin K b. protamine sulphate c. antithrombin III d. Warfarin

B Reversal of Coumadin would require Vitamin K. Monitor heparin with PTT (intrinsic) and Coumadin with PT (extrinsic)

201. D-dimers are degradation products of: a. non cross-linked fibrin b. cross-linked fibrin c. fibrinogen d. plasmin

202. a donor indicates he has taken 2 aspirin tablets per day for the last 36 hours. The unit of blood: a. may not be used for pooled plt concentration preparation b. should not be drawn until 36 hours after cessation of aspirin ingestion c. may be used for pooled plt concentration preparation d. may be used for red cells, and fresh frozen plasma production, but the plts should be discarded

C: pooled platelets is okay but not for aphaeresis I’m assuming? Cannot take platelets if donor has taken aspirin in the last 48hours. Inhibits platelet aggregation.

203. which of the following is least likely to transmit hepatitis? a. cryoprecipitate b. RBC c. plasma protein fraction d. plts

204. FFP, when properly collected and stored, provides all the following except: a. factor V b. factor VIII c. factor IX d. plts

205. all of the following components must be routinely irradiated except: a. RBC for intrauterine transfusion b. RBC for exchange transfusion c. plts for an immunosuppressed patient d. plts from an HLA compatible donor

B Intrauterine: RBC from donor injected into fetus Exchange transfusion ex: hemolytic disease of the newborn, sickle cell anemia

206. the addition of adenine in an anticoagulant-preservative formulation aids in: a. maintaining ATP levels for red cell viability b. maintaining plt function in stored blood c. reducing the plasma K+ levels during storage d. maintaining 2,3DPG levels for oxygen release to the tissues

207. the pilot tubes for donor unit# 3276 break in the centrifuge. You should: a. label the blood using the donor's previous records b. discard the unit because processing procedures cannot be performed c. discard the red cells and salvage the plasma for fractionation d. remove sufficient segments to complete donor processing procedures

208. the temperature range for maintaining red blood cells and whole blood during shipping is: a. 0-4C b. 1-6C c. 1-10C d. 5-15C

209. during the preparation of plt concentrate the hermetic seal of the primary bag is broken. The red blood cells: a. must be discarded b. must be labelled with a 21-day expiration if collected in CPD c. must be labelled with a 24-hour expiration date d. may be glycerolized within 6 days and stored frozen

210. the blood bank procedures manual must be: a. revised annually b. revised after publication of each new edition of AABB standards c. reviewed prior to a scheduled inspection d. reviewed annually by an authorized individual

211. which of the following weak D donor units should be labelled RH-positive? a. weak D due to transmissible genes b. weak D as position effect c. weak partial D d. all of the above

212. which of the following tests on donor red blood cells must be repeated by the transfusing facility when the blood was collected and processed by a different facility? a. confirmation of ABO group and Rh type of blood labelled D-negative b. confirmation of ABO group and Rh type c. weak D on D-negative d. antibody screening

213. which of the following blood groups reacts with least strongly with an anti-H produced in an A,B individual? a. group O b. group A2B c. group A2 d. group A1

D Group O and A2 not only have the most H antigen of all the groups, but also have a molecular structure that leaves divide very accessible to anti-H Look into this? Answer should be B

214. a Bombay (Oh) individual's blood specimen can be differentiated from blood specimens of normal group O persons by the: a. cells giving a negative reaction with anti-A,B b. serum containing anti-H c. cells giving a positive reaction with Ulex europaeus d. cells giving negative reaction with Dolichos biflorus

B Ulex europaeus: demonstrates the presence and strength of expression of the H antigen Dolichos biflorus: differentiate between A1 and A2 RBC’s

215. the secretor locus is linked to which blood group locus? a. Duffy b. Kell c. Lewis d. Lutheran

D Secretor: secretes blood type antigen into body fluids like the saliva, and mucus

216. if a person has the genetic makeup Hh, AO, LeLe, see, what substance will be found in the secretion? a. A substance b. H substance c. Lea d. Leb

217. a serum containing anti-k is not frequently encountered. This is because: a. people who lack the k antigen are rare b. people who possess the k antigen are rare c. the k antigen is not a good immunogen d. Kell null people are rare

218.

219. which of the following is a characteristic of Kidd antibodies? a. usually IgM antibodies b. corresponding antigens are destroyed by enzymes c. usually strong and stable during storage d. often associated in delayed transfusion reactions

220. all of the following statements are true of anti-Fya and anti-Fyb except: a. are clinically significant b. react well with enzyme treated panel cells c. cause hemolytic transfusion reactions d. cause a generally mild hemolytic disease of the newborn

B Duffy and MNSs are broken down by enzyme treatment and enhance Rh, Kidd, Lewis, and ABO blood groups.

221. a patient had an anti-E identified in his serum 5 years ago. His antibody screening test is now negative. To obtain suitable blood for transfusion, the best procedure is to: a. type the patient for the E antigens as an added part to the crossmatch the E-negative procedures b. type the donor units for the E antigens and crossmatch the E negative procedure c. crossmatch donors with the patient's serum and release the compatible units for transfusion d. perform the crossmatch with enzyme treated donor cells, since enzyme treated red cells react better with Rh antibodies

222. a patient's red blood cells are being typed for Fya antigen. Which of the following is the proper cell type of choice for a positive control of the anti-Fya reagent? a. Fy(a+b-) b. Fy(a+b+) c. Fy(a-b+) d. Fy(a-b-)

223. which of the following antibodies has been clearly implicated in transfusion reactions and hemolytic disease if the newborn a. anti-I b. anti-K c. anti-Lea d. anti-N

224. enzymes are often used to aid in the identification of antibodies. Which of the following antibodies is primarily IgG, is best detected at the AHG phase, can cause hemolytic transfusion reactions and hemolytic disease of the newborn, and the corresponding antigen is destroyed by proteolytic enzymes: a. anti-D b. anti-S c. anti-K d. anti-Jka

225. often when trying to identify a mixture of antibodies it is useful to neutralize one of the known antibodies. Which one of the following antibodies is neutralizable? a. anti-D b. anti-Jka c. anti-Lea d. anti-M

226. which of the following antibodies does not match the other's in term of optimal reactive temperature? a. anti-Fya b. anti-Jkb c. anti-N d. anti-U

227. which of the following antigens is destroyed by proteolytic enzymes? a. E b. Lea c. K d. M

228. which set of antibodies could you possibly find in a patient with no history of pregancy or transfusion? a. anti-I, anti-s, anti-P1 b. anti-Leb, anti-A1, anti-D c. anti-M, anti-c, anti-B d. anti-P1, anti-Lea, anti-I

229. In which of the following instances may mixed-field agglutination be observed? a. direct antiglobulin test (DAT) result of patient undergoing delayed hemolytic transfusion reaction b. IAT result of patient who has anti-Lea c. DAT result of patient on high doses of a-methyldopa d. typing result with anti-A of patient who is A2 subgroup

230. the ABO serum grouping may not be valid when: a. the patient has hypogammaglobulinemia b. IgM alloantibodies are present c. cold autoantibodies are present d. all of the above

232. which of the following is generally detected at the indirect anti globulin phase of testing? a. anti-Jka b. anti-M c. anti-P1 d. anti-I

231. A group A, D negative obstetric patient with anti-D (titre 256) is carrying fetus who needs an intrauterine transfusion. which of the following units should be chosen? a. group A, D-negative RBC b. group A, D-negative whole blood c. group O, D-negative RBC d. group O, D negative whole blood

233. which of the blood groups systems is associated with antibodies that are generally IgM? a. Rh b. Duffy c. Kell d. Lewis

234. false negative results at the IAT phase of antibody screening test are most likely due to: a. excessive washing of the red cells b. inadequate washing of the red cells c. warm autoantibody present in the patient's serum d. failure to allow the blood to clot properly

235. at the end of an anti globulin test, IgG coated control cells are added to the negative tests and centrifuged. If agglutination occurs, this means the: a. test is valid b. antiglobulin reagent was neutralized c. cells were not washed thoroughly d. control cells are contaminated

236. a resident physician hand-delivers a blood sample, drawn by the attending physician, for pre-transfusion testing from a patient who is difficult to draw. The sample is unlabelled. One should: a. discard the sample and request that the resident obtain a new sample, adhering to proper guidelines for labelling b. label the specimen with the information the resident provides c. label the specimen with information from the accompanying transfusion request form d. request the sample be returned to the nursing station to be labelled

237. a specimen of blood is received in the blood bank with request slips for transfusion. The tube has the patient's first and last name and medical records identification number on the label. what else must be on the tube label? a. patient's room # b. date of phlebotomy c. initials of phlebotomist d. attending physician's name

238. a patient with an anti-K and an anti-Jka in her plasma needs 2 units of RBC for surgery. How many group-specific units would need to be screened to find 2 units of RBC? a. 6 b. 10 c. 20 d. 36

239. enterotoxin produced by staphylococcus aureus is responsible for causing: a. carbuncles b. enterocolitis c. scalded skin syndrome d. toxic shock syndrome

240. a fermentative gram negative bacillus that is oxidase +, motile, grows well on MAC is: a. aeromonas hydrophily b. pseudomonas aeruginosa c. xanthomonas maltophilia d. yersinia enterocolitica

A Yersinia is oxidase negative and is only motile at 22C but grows on MAC as a NLF or LLF.

241. the etiologic agent of primary atypical pneumonia is: a. chlamydia psittaci b. streptococcus pneumonia c. corynebacterium diphtheriae d. mycoplasma pneumonia

242. streptococcus progenies organisms are best presumptively identified using: a. bacitracin disk b. ONPG disk c. PYR disk d. optochin disk

243. an example of an oxidase-positive, glucose non fermenting organism is: a. Enterobacter species b. E. coli c. Klebsiella species d. Pseudomonas aeruginosa

244. Nocardia asteroides infections in humans characteristically produce: a. draining cutaneous sinuses b. carbuncles c. septic shock d. serous effusions

245. the etiologic agent commonly associated with septicaemia and meningitis of newborns is: a. streptococcus progenies b. streptococcus pneumonia c. streptococcus agalactiae d. streptococcus bovis

246. which of the following is the most commonly isolated species of Bacillus in opportunistic infections such as bacteria, post-traumatic infections of the eye, and endocarditis? a. B. subtilis b. B licheniformis c. B. cereus d. B. circulans

247. the etiologic agent of whooping cough is: a. Brucella suis b H. ducreyi c. Francisella tularenis d. Bordetella pertussis

248. an important characteristic of N. gonorrhoeae or the infection it produces is: a. gram stain of the organism shows gram-positive diplococci b. a symptomatic infections are common in males c. gonorrhoea is a disease of humans and domestic animals d. nonpiliated strains are avirulent

249. a causative agent of the form of conjunctivitis known as pink eye is: a. H. influenzae biotype III b. Moraxella lacunata c. chlamydia trachomatis d. Listeria monocytogenes

250. Acinetobacter species are similar to Neisseriaceae with the notable exception that they are: a. gram negative coccoid organisms b. growth on blood and chocolate agar c. oxidase negative d. glucose positive

251. hemolytic uremic syndrome is a complication after infection with: a. E. coli O157:H7 b. Shigella sonnei c. Vibrio cholera O1 d. salmonella typhi

252. identify the fermentative agent that may infect reptiles or fish as well as humans when they are exposed to contaminated soil or water: a. Edwardsiella b. Aeromonas c. Chromobacterium d. Cryseobacterium

253. which of the following has a negative oxidase test: a. aeromonas b. hafnia c. vibrio d. pseudomonas

254. the symptom of diffuse, water diarrhea that produces relatively clear stool containing mucus flecks (rice water stool) is most closely associated with an infection caused by: a. E. coli b. shigella dysenteriae c. vibrio cholerae d. yersinia enterocolitica

255. all of the following describe Actinetobacter species except: a. commonly susceptible to most antimicrobials b. generally coccobacillary in morphology c. oxidase negative d. infections associated with use of medical devices

256. explosive watery diarrhea with severe abdominal pain, after eating raw shellfish is most characteristic of: a. H. pylori b. vibrio parahemolyticus c. shigella dysenteri d. campylobacter jejuni

257. a clinical problem has emerged concerning infections after prosthetic heart valve insertion or other cardiac procedures with MRSA strains of: a. S. epidermidis b. serratia marscescens c. streptococcus salivarius d. enterococcus faecalis

258. Shigella sonnei is differentiated from the other species by: a. its ability to ferment lactose b. its positive phenylalanine reaction c. its negative oxidase reaction d. its ability to demonstrate motility at 42C

259. Which one of the following is not appropriate when describing S. pneumoniae? a. lancet-shaped, gram-positive diplococcus b. bile-resistant c. alpha hemolytic d. encapsulated, with an antiphagocytic polysaccharide capsule

B Lysed by bile

260. which of the following would be appropriate when discussing H. influenzae? a. the etiologic agent of influenza b. most infections caused by capsular serotype b c. always sensitive to ampicillin d. common cause of bacterial pneumonia

261. Enterococcus faecium is characteristically: a. inhibited by the presence of bile in the culture media b. able to grow in the presence of high concentration of salt c. PYR negative d. sensitive to penicillin

262. a sputum specimen from a suspected case of lobar pneumonia patient shows on gram stain the presence of many WBCs and many gram-positive cocci, which are primarily in diplococci. Which of the following statements would be appropriate, given these findings on a smear? a. a PYR test should be performed on the culture isolate b. an ELEK test should be performed on the culture isolate c. a CAMP test should be performed on the culture isolate d. an optochin test should be performed on the culture isolate

263. an identifying characteristic of S. aureus is: a. DNase negative b. negative mannitol fermentation reaction c. growth inhibition in presence of increased salt d. positive coagulase test

264. which of the following is a correct statement concerning Campylobacter jejuni? a. isolated best at 24C b. a leading cause of bacterial diarrhea worldwide c. hydrogen sulphide positive d. catalase negative

B Isolated best at 37-42C

265. all the following statements about haemophilus sp. are true except: a. the preferred culture medium is SBA b. small, pleomorphic, gram-negative coccobacilli c. obligate parasites d. many are found as normal flora in the human respiratory tract

266. which of the following is not a selective media for primary isolation of Bordetella pertusis? a. modified Skirrow's medium b. Regan-Lowe c. Bordet-Gengou d. Modified Jones-Kendrick charcoal

267. a gram-negative bacillus was recovered from the urine of a child with a history of recurrent UTI's. The organism was oxidase negative, lactose negative, urease positive, and motile. The most likely identification of this agent would be: a. proteus mirabilis b. E. coli c. P. aeruginosa d. K. pneumoniae

268. which of the species of pasteurella is associated with human infections? a. aerogenes b. haemolytica c. pneumotropica d. multocida

269. which of the following genera is the most commonly associated with bacterial vaginosis? a. Gardnerella b. Listeria c. Eikenella d. Capnocytophaga

271. Swimmer's ear, a form of external otitis media, is commonly caused by: a. Mycobacterium marinum b. Pseudomonas aeruginosa c. Streptococcus pneumoniae d. Haemophilus influenzae

272. which of the following is not a correct statement regarding blood culture? a. collection of 10-20ml per culture for adults is recommended b. two or three blood cultures recommended as optimum c. volume of blood cultured more critical than timing of culture d. blood drawn for culture may be allowed to clot

273. colonies of Listeria monocytogenes on SBA most closely resemble colonies of: a. S. agalactiae b. Corynebacterium diphtheria c. Rhodococcus equi d. Haemophilus influenzae

274. the most common etiologic agent of infections associated with the surgical insertion of prosthetic devices such as artificial heart valves and CSF shunts is:

Staphylococcus epidermidis

275. one of the most common etiologic agents of uncomplicated cases of cystitis is:

E. coli

276. the characteristic growth pattern known as satelliting Is associated with:

Haemophilus influenzae

277. solubility in the presence of sodium deoxycholate is characteristic of:

Streptococcus pneumoniae

278. an anaerobically incubated blood agar plate shows colonies surrounded by an inner zone of complete red cell lysis and an outer zone of incomplete cell lysis that gives a discoloured appearance. The most likely rapid presumptive identification of this isolate would be:

Clostridium perfringens

279. a cervical mucosal abscess specimen was sent to the laboratory for bacteriology examination. The culture of this sample grew an anaerobic gram-negative bacillus that was inhibited by bile, pigmented brown, and was negative for indole production, positive for glucose, sucrose and lactose fermentation. This isolate would most likely be:

Prevotella melaninogenicus

280. obligately anaerobic, gram-negative bacilli, recovered from the abdominal wound, were found to be resistant to penicillin. Growth of this organism was not inhibited in the presence of bile. What is the most likely identification of this isolate:

Bacteroides fragilis group

281. a filamentous gram-positive rod recovered from an aspirate of a closed chest abscess. It grew only under anaerobic conditions and was not acid-fast. What is the most likely presumptive identification of the isolate seen?

Actinomyces Israelii

282. The anaerobic organism that is presumptively identified by its ability to grow on kanamycin, vancomycin, lake blood agar (KLV) medium is:

Bacteroides fragilis group

283. a new internal Medicine Resident comes into the Microbiology department to discuss the fast that sine bacterial isolates do not have in vitro susceptibility testing performed, even when they are isolated in pure culture from clinically important body sites. Which of the following organisms would not be routinely tested? a. E. coli b. Proteus mirabilis c. S. aureus d. S. pyogenes

284. beta-lactamase producing strains of H. influenzae are resistant to:

Penicillin

285. while reading the routine broth dilution susceptibility test panels, a tech notices that a patients isolate labelled as "strep pneumoniae" did not grow in the growth well. Remembering that S. pneumoniae is a fastidious organism that may not grow in routine broth medium, the tech checks the procedure manual. Which of the following media should be used for the in vitro susceptibility testing of that S. pneumoniae?

Mueller-Hinton broth supplemented with 5% lysed horse blood

286. rapid testing for beta-lactamase production is recommended, prior to initiating of antimicrobial therapy, for isolates of:

H. influenzae

287. which of the following antimicrobial agents acts by inhibiting cell wall synthesis? a. vancomycin b. clindamycin c. naladixic acid d. gentamicin

288. which of the following antimicrobial agents acts by inhibiting protein synthesis? a. Rifampin b. Methicillin c. Gentamicin d. Vancomycin

289. the most useful finding for prompt presumptive identification of C. albicans is its: a. failure to assimilate sucrose b."feathering" on EMB c. production of chlamydocondia d. production of germ tubes

290. the recommended anticoagulant for use when a body fluid or joint fluid that may clot is sent for microbiologic examination is: a. heparin b. sodium polyethanolsulfonate c. sodium EDTA d. sodium citrate

291. which of the following is not one of the standard control organisms used for the weekly testing of antimicrobial disks? a. s. epidermidis (ATCC 25833) b. p. aeruginosa (ATCC 27853) c. E. coli (ATCC 25922) d. e. faecalis (ATCC 29212)

292. a suggested quality control organism that would demonstrate a positive reaction on Simmon's citrate agar slant is: a. Shigella sonnei b. Klebsiella pneumoniae c. E. coli d. Morganella morganii

B So is proteus Mirabilis Differentiates gram-negative bacteria Ability of organism to use citrate as its sole source of carbon and ammonium ions as the sole nitrogen source

293. laboratory professionals are at risk for disease transmission. The majority of cases of laboratory-related infections are associated with: a. infectious aerosols b. contamination of abraded skin c. puncture wounds d. bite of a laboratory test animal

294. when performing the oxidase test, which of the following would not be appropriate: a. the reagent used is o-nitrophenyl-B-D-galactopyranoside b. the reagent must be freshly prepared or refrigerated for no longer than 1 week c. do not use a Nichrome wire loop to rub a portion of the suspect colony on paper strip d. a positive colony turns dark purple within 10 seconds of the application of the reagent

295. the porphyrin test is most useful for the identification of which of the following? a. Streptococcus species b. Moraxella species c. Nocardia species d. Haemophilus species

296. when using the rapid chromogenic cephalosporin method for the detection of beta-lactamase production by an organism, a positive test is indicated by: a. yellow b. green c. red d. blue

297. which of the following statements does not apply to the acridine organe stain? a. binds to the teichoic acid of the cell wall b. requires the use of fluorescence microscope c. is more sensitive than the gram stain d. is recommended for fluid and exudates with low bacterial concentrations

298. the etiologic agent implicated in cases of repeated abortion is: a. Listeria monocytogenes b. Streptobacillus moniliformis c. Streptococcus agalactiae d. actinobacillus species

299. how much 95% alcohol is required to prepare 5L of 70% alcohol? a. 2.4L b,. 3.5L c. 3.7L d. 4.4L

300. a fire extinguisher used in the event of an electrical fire should include which of the following classifications? a. type A b. type B c. type C d. type D

301. Xylene, ethanol, methanol, and acetone would be in which hazard class? a. corrosive b. flammable c. oxidizer d. all of the above

302. as Sally was performing a test, a reagent splashed into her eye. What should she do immediately?

find the eyewash station and flush the eyes for 15 minutes

303. which of the following refers to a program where the overall activities conducted by the institution are directed toward assuring the quality of the product and services are provided?

quality assurance

304. what type of file will provide the best conversation of memory space for the storage of patient demographic data? a. random-access b. sequential c. hard d. ROM

305. what feature of the LIS compares patient's test value to a previous value?

delta check

306. with which crystals and urinary uric acid crystals often confused?

Cystine

307. red blood cells are seen un urinary sediment which of the following can be frequently confused?

yeasts

308. when using polarized light microscopy, which urinary sediment component exhibits Maltese cross formation?

oval fat bodies

309. which of the following is a correct method for storing chemicals? a. acids and bases should be seperated b. flammables must be stored in the refrigerator c. acids must be stored under the sink d. chemicals can be stored in the chemical fume hood

310. which of the following requires continuous electrical supply to the computer for data retention? a. hard disk b. CD ROM c. ROM d. RAM

311. in light microscopy a blue filter is used: a. polarize light b. block out ultraviolet light c. compensate for the colour of the light emitted by a tungsten lamp d. enhance resolution

312. a beaker of xylene has accidentally become ignited. the most appropriate extinguishing agent to use is: a. water extinguisher b. dry chemical extinguisher c. fire blanket (smothering effect) d. sand

313. mercury fixative pigments in tissue sections are removed by treatment with: a. prolonged washing in water b. saturated alcoholic picric acid c. alcoholic iodine and sodium thiosulphate d. potassium permanganate

314. prolonged exposure of tissue to xylene in paraffin processing causes: a. swelling of tissue b. excessive hardening of tissue c. incomplete paraffin infiltration d. incomplete dehydration

315. when transferring hand-processed tissue from the last xylene, some whitish spots are seen in the tissue. This most likely indicates: a. post-mortem autolysis b. inadequate fixation c. inadequate dehydration d. the presence of fat

316. the most common cause of alternate thick and thin sections is: a. a blunt knife b. a microtome with a lose knife c. static electric charge on ribbon d. nicks in the knife

317. ice crystals artefact in a section is caused by: a. slow cooling of paraffin b. dehydration at 0C c. slow freezing d. rapid cooling of tissue following by rapid warming

318. if ammonia water is used in the preparation of hematoxylin and eosin stained sections, failure to completely remove the ammonia water by washing can cause: a. fading of the hematoxylin b. crystallization of the mounting media c. poor staining with eosin d. a milky appearance in the finished section

319. a major factor causing paraffin sections to detach during a silver technique for reticulin is: a. insufficient fixation b. high alkalinity of the silver solution c. insufficent washing prior to immersion in the silver solution d. inadequate deparaffinization

320. the function of hydrochloric acid in Perl's Prussian blue method is to: a. convert ferric to ferrous ions b. maintain a high pH level c. form a coloured complex with iron d. dissociate the iron/protein complex

321. a Perl's Prussian blue is requested. Which of the following normal tissues would be the most suitable control? a. liver b. spleen c. striated muscle d. appendix

322. the characteristic which differentiates melanin from carbon is that melanin is: a. bleached by strong oxidizing agents b. always black c. unstable d. an exogenous pigment

323. which one of the following applies to the Gomori's (grocott) methenamine silver method? a. melanin is specifically demonstrated b. the rate of impregnation may be accelerated with microwaves c. chromic acid is the reducing agent d. the methenamine silver working solution can be used repeatedly

324. when a section has been stained for lipid, it should be: a. mounted dry b. dehydrated, cleared, and mounted in a resinous mountant c. mounted from water in an aqueous mountant d. allowed to dry in air and then examined under oil immersion

325. picric acid should be stored in: a. a desiccator, in a dark bottle b. the refrigerator c. a dar bottle in a fume hood d. wet from in a dark bottle

326. an unknown pigment which is removed by the use of alcoholic picric acid is: a. mercury pigment b. melanin c. acid formaldehyde hematein d. carbon

327. resins are added to paraffin to: a. increase hardness and plasticity so thin sections are easily cut b. prevent the formation of air spaces during embedding c. speed the rate of infiltration d. eliminate the formation of paraffin crystals

328. on automatic tissue processing machines: a. all dehydration baths must be changed daily b. the last dehydration bath must be changed frequently c. the first bath is always alcohol d. the first clearing bath is changed to become the last clearing bath each day

329. during microtomy if the knife edge is dull, sections will: a. be scored b. expand and disintegrate on the water bath surface c. be compressed d. have many tiny holes in the tissue

330. in Masson's trichrome stain, the phosphomolybdic acid: a. precedes the collagen stain b. forms a basic staining lake with acid fuchsin c. plays a role in nuclear staining d. has a very small molecular weight

331. in metallic impregnation methods, the term "fixation" implies: a. precipitation of those proteins which were unaffected by the primary fixative b. removal of unreduced silver from the sections c. conversion of the silver to gold cations by treatment with gold chloride d. oxidation of tissue to expose reactive groups

332. which of the following should be used as a control tissue for the periodic acid Schiff method for demonstration of glycogen: a. gallbladder b. colon c. liver d. thyroid

333. in a gram stain, the step with the greatest margin for error is: a. mordanting b. staining with crystal violet c. decolorization d. counterstaining

334. an indication of overimpregnation in the methenamine silver method for fungi is: a. blackened glassware b. pale gold fungi after treatment with gold chloride c. heavy counterstain d. black background

335. how much paraformaldehyde should be used to make 2L of a 4% w/v formaldehyde solution?

80 grams

336. a small area of unstained tissue in a stained preparation is caused by: a. incomplete fixation b. paraffin crystal formation c. incomplete removal of paraffin before staining d. incomplete dehydration after staining

337. in Gomori's technique for reticulin fibres, the impregnation is carried out using: a. silver nitrate b. iron alum c. diammoniacal silver d. methenamine silver

C Look into this

338. which of the following should not be discarded in the sink: a. old hematoxylin stain b. ammoniacal silver c. potassium ferrocyanide d. 1% aqueous picric acid e. absolute alcohol

339. staining of lipids by Oil Red O is due to: a. chemical reaction between the fat and the dye b. absorption of the dye in the fat c. solubility of the dye in the fat d. precipitation of the dye in the fat

340. the most frequently occurring lab-acquired infection is: a. HBV infection b. HIV infection c. tuberculosis d. syphilis

341. containers used for disposing of needles and other shape objects must be all of the following except: a. clearly marked "biohazard" b. disposable c. puncture resistant d. recyclable

342. value for this test are normally higher in the morning a. cortisol b. WBC c. iron d. eosinophil count

343. specimen collection tubes are labelled a. at the patients bedside after collection of the specimen b. at the patients bedside before collection of the specimen c. in the lab after collection d. in the lab before the specimen is collected

344. when collection skin puncture tests, which of the following should be collected first? a. CBC b. electrolytes c. glucose d. phosphorus

345. providone - iodine used to clean a skin puncture site is known to cause erroneous results for which of the following tests? a. albumin b. bilirubin c. CBC d. triglycerides

1. in spectrophotometric analysis, what is the purpose of the reagent blank? a. correct for interfering chromogens b. correct for lipemia c. correct for protein d. correct for color contribution of the reagent

2. problems inherent in turbidimetry include all of the following except: a. variation in particle size of samples b. variation in particle size of standards c. rate of aggregation or settling of particles d. need to maintain a constant specific temperature

3. which of the following represent a primary advantage of performing fluorometric over absorption: a. increased specificity and increased sensitivity b. increased specificity and decreased sensitivity c. purity of reagents used not as critical d. ease of performing assays

4. nephelometry is based on the measurement of light that is: a. absorbed by particles in suspension b. scattered by particles in suspension c. produced by fluoroscence d. produced by excitation of ground stat atoms

6. which of the following statements about atomic absorption spectrophotometry is true? a. it requires that the element to be measured be brought to a nonionized ground state b. it uses a tungsten lamp as the light source c. it uses a cathode made of the element lithium d. it measures emission of light from excited atoms

7. most atomic absorption spectrophotometers incorporate a beam chopper and a tuned amplifier. The purpose of these components is to avoid errors caused by: a. variation in flame temperature b. deterioration of the hollow cathode lamp c. stray light from the hollow cathode lamp d. measurement of light of the specific wavelength emitted by the analyte

8. which of the following lamps may be described as containing argon and having the element of interest coated on its cathode? a. hollow cathode lamp b. tungsten lamp c. quartz-halogen lamp d. deuterium lamp

9. when measuring K+ with an ion-selective electrode by means of a liquid ion-exchange membrane, what antibiotic will be incorporated into the membrane? a. monactin b. nonactin c. streptomycin d. valinomycin

10. all of the following are true of ion-selective electrode analysis of sodium except: a. uses a glass membrane b. errors occur from protein build up on the membrane c. membrane coated with valinomycin d. principle based on potentiometry

C Valinomycin makes membrane permeable to cations, particularly potassium.

11. to calibrate the pH electrode in the pH/blood gas Analyzer, it is necessary that: a. the barometric pressure be known and used for adjustments b. calibrating gases of known high and low concentrations be used c. the calibration be performed at room temperature d. two buffer solutions of known pH be used

12. the measurement of CO2 in blood by means of a Pco2 electrode is dependent on the: a. passage of H+ ions through the membrane that separates the sample and the electrode b. changes in pH due to increased carbonic acid in the electrolyte surrounding the electrodes c. movement of bicarbonate across the membrane that seperates the sample and the electrode d. linear relationship between Pco2 in the sample and measured pH

13. which of the following describes the basis for the freezing point osmometer? a. the freeze point depressor is inversely proportional to the amount of solute in the solution b. the freeze point depression varies as the logarithm of the concentration of solute c. the freezing point is. raised by an amount that is inversely proportional to the concentration of dissolved particles in the solution d. the freezing point is lowered by an amount that is directly proportional to the concentration of dissolved particles in the solution

14. which of the following methods allows for separation of charged particles based on their rates of migration in an electric field? a. rheophoresis b. electrophoresis c. electroendosmosis d. ion-exchange

15. which of the following is an electrophoretic technique employing a pH gradient that separates molecules which similar isoelectric points? a. zone electrophoresis b. high-resolution electrophoresis c. isoelectric focusing d. immunoelectrophoresis

16. centrifugal force depends on all the following except: a. temperature of the centrifuge b. mass of the material being centrifuged c. speed of rotation d. radius of the centrifuge

17. which of the following may be a sampling source of error for an automated instrument? a. short sample b. air bubble in bottom of cup c. fibrin clot in sample probe d. all of the above

18. many chemical reactions require that an instrument maintain a specified incubation temperature. How frequently should the accuracy of the thermometer used to monitor the incubation temperature be verified? a. daily b. weekly c. monthly d. biannually

19. checking instrument calibration, temperature accuracy, and electronic parameters are part of: a. preventive maintenace b. quality control c. function verification d. precision verification

20. for which of the following lab instruments should preventive maintenance procedures be performed and recorded? a. analytical balance b. centrifuge c. chemistry analyzer d. all of the above

21. preventive maintenance should include and be performed for all the following reasons except to: a. clean instrument components b. replace worn parts c. extend the life of the equipment d. keep personnel busy when the laboratory work is low

22. what term applies to the sum of all the values in a set numbers divided by the number of values in that set? a. median b. mode c. arithmetic mean d. geometric mean

23. calculate the coefficient of variation (%) for a set of data where the mean (x) = 89 mg/dL and 2 SD = 14 mg/dL a. 7.8 b. 7.9 c. 15.7 d. 15.8

24. what does the preparation of a Levy-Jennings quality control chart for any single constituent of serum require? a. analysis of control serum over a period of 20 consecutive days b. 20-30 analyses of the control serum, on 1 day, in one batch c. analyses consistently performed by 1 person

25. a batch of test results is out of control. What should you do first? a. report the results to the physician first, and then look for the trouble b. follow the "out of control" procedure specified for the test method c. repeat the tests with a new lot of standards (calibrators) d. repeat the tests with a new lot of reagents

26. in addition to utilizing Leveyl-Jennings charts, what other criteria should be applied to interpret internal quality control data? a. Westgard multirule b. custom c. linear regression d. Louden

27. a new standard (calibrator) has been prepared in error at a lower concentration than that required for the test. How would such an error appear on a quality control chart? a. upward trend b. downward trend c. upward shift d. downward shift

28. the +/- 2 standard deviation range of acceptable values for a digoxin control is established as 2.0 to 2.6 ng/mL. On average, the expectation that a value will be greater than 2.6 ng/ml is 1 in: a. 10 b. 20 c. 40 d. 100

29. while monitoring QC program, the laboratory person notices that the value of the control sample has been slowly drifting downward during the month. What is the most likely cause of this drift? a. inadequate mixing of the control material b. contamination of the standards (calibrators) c. deterioration of reagent as a result of aging d. recalibration error

30. which of the following monitoring factors would not be included in a labs quality assurance program? a. scheduling staff b. specimen collection c. accuracy and precision of analyses d. preventive maintenance of instruments

31. on a quality control chart, when would a statistical out of control situation requiring corrective action be suspected? a. 6 consecutive plots fall above and below the mean within +/- 1s b. 6 consecutive plots fall above and below the mean within +/- 2s c. one plot falls within the area of +/-2s to 3s within 20 consecutive day span d. one plot falls outside the area of +/-3s within 20 consecutive day span

32. which of the following would result in a sudden shift in daily values on a quality control chart? a. recalibrating the instrument when changing reagent lot numbers during an analytical run b. replacing the instruments sample aspiration probe c. changing the spectrophotometer lamp in the middle of a sample run d. changing the operating technologist

33. what assistance does an external quality assurance program provide for a lab? a. means to correlate tests performed by different departments within the same lab b. delta checks with previous tests on the same patient c. evaluation of its performance by comparison with other labs using the same method d. limits for reference intervals

34. which of the following terms refers to the measure of scatter of experimental data around the mean of a Gaussian (normal) distribution curve? a. median b. mode c. CV d. SD

35. what term describes the extent of agreement between repeated analyses? a. random error b. precision c. accuracy d. reliability

36. which combination best describes a Gaussian (normal) distribution? a. median>mean b. medianmean

37. which of the following terms refers to deviation from the true value caused by indeterminate errors inherent in ever lab measurement? a. random error b. standard error c. parametric analyses d. nonparametric analysis

38. which of the following terms refers to the closeness with which the measured value agrees with the true value? a. random error b. precision c. accuracy d. variance

39. what % of values will fall between +/- 2s in a Gaussian (normal) distribution? a. 34.13% b. 68.26% c. 95.45% d. 99.74%

40. which of the following terms refers to a measure of dispersion or spread of values around a central value? a. range b. validity c. variance d. CV

41. which of the following is the range of value described as the mean plus or minus some number of SDs, forming the basis of statistical rules for acceptance and rejection of QC values a. variance b. degrees of freedom c. CV d. confidence interval

42. which of the following describes the ability of an analytical method to maintain both accuracy and precision over an extended period of time? a. reliability b. validity c. probability d. sensitivity

43. a group of physicians consistently complains that they are not receiving STAT patient results quickly enough. The supervisor is likely to refer to which quality assurance variable? a. specimen separation and aliquoting b. test utilization c. analytical methodology c. TAT

44. a tech is schedules to perform a specialized test that he/she is familiar with, but is not exactly certain of the steps required. What is the best course of action to take? a. ask another tech to perfrom the test b. consult the procedure manual and notify supervisor c. run the test as best as possible, being careful to note control values d. reject the specimen

45. a tech has completed the first run of morning specimens. She/he notices that the control being used is outside +/- 3s. What course of action should be taken? a. release the results b. repeat the control only, and if it comes in, release the results c. check equipment and reagents to determine source of error; repeat the entire analysis including the controls and patients; if the control value is within +/- 2s release results d. repeat control; if the same thing happens, attribute the cause to random error; release results

46. which Westgard multiple applies to a situation where one control point exceeds the mean by +2s and a second control point exceeds the mean by -2s? a. 12s b. 22s c. 41s d. R4s

47. upon admission to the hospital, a chemistry profile is performed on a patient. The patient has a total bili of 2.0mg/dl. The next day a second chemistry profile is done, and the patients total bile is 6.2mg/dl. What should be done in regard to these results since the normal and abnormal controls are within acceptable limits?

perform a delta check and if warranted, look for possible sources of error

48. when comparing a potential new test with a comparative method in order to bring a new method into the lab, one observes error that is consistently affecting results in one direction. What is this type of error known as? a. systematic b. random c. constant systematic error d. proportional systematic error

49. when establishing a reference interval for a new testing being introduced into the lab, what is the preferred number of subjects that should participate?

120

50. a small lab has collected blood sample from 20 individuals as part of a reference interval study for a new test being introduced into the lab. Of the test results, 4 are outside the reference interval published by the manufacturer. How should you proceed? a. delete the four result and only use the 16 within the range to establish the lab's reference interval b. use all 20 results when calculating the +/- 2s range since outlier's are to be expected c. run 4 additional samples and if within manufacturers rangem add them to the original 16 for statistical analysis d. obtain additional 20 samples for testing, and if 2 or less are outside the suggested range, then the manufacturers reference interval can be accepted

51. to determine the predictive value of a positive test, all the following parameters must be known except: a. sensitivity b. specificity c. disease prevalence d. precision

52. which of the following must be known in order to determine the sensitivity of a test? a. true positive and false negative b. TN and FP c. TP and FP d. TN and FN

A TP/(TP-FN)

53. a sample of blood is collected for glucose in a sodium fluoride tube before the patient has had breakfast. The physician calls 2 hrs later and requests that determination of BUN be performed on the same sample rather than obtaining another specimen. The automated analyser in your lab utilizes the urease method to quantify BUN. what should you tell the physician? a. will gladly do test if sufficient specimen remains b. could do test using a micromethod c. can do the BUN determination on the automated analyzer d. cannot perform the procedure

54. type I diabetes mellitus may be described by all the following except: a. insulin deficiency b. associated with autoimmune destruction of pancreatic B-cells c. ketoacidosis prone d. occurs more frequently in adults

55. all the following are characteristic of severe hyperglycaemia except: a. polyuria b. ketonuria c. glycosuria d. hypoglucagonemia

56. a CSF specimen is sent to the lab at 9pm for glucose analysis. The specimen is cloudy and appears to contain red blood cells. which of the following statement is true? a. glucose testing cannot be performed on the specimen b. specimen should be centrifuged and the glucose test run immediately c. specimen can be refrigerated as received and the glucose run the next day d. specimen can be frozen as received and the glucose run the next day

57. the turbid, or milky, appearance of serum after fat ingestion is termed postprandial lipemia. The lipemic appearance is caused by the presence of what substances? a. bilirubin b. cholesterol c. chylomicrons d. phospholipids

58. which of the following tests would most likely be included in a routine lipid profile?

cholesterol, triglycerides, HDL cholesterol (LDL is calculated)

59. to produce reliable results, when should blood specimens for lipid studies be drawn?

In the fasting state, approximately 12 to 14 hours after eating

60. several malabsorption problems are characterized by a condition known as steatorrhea. Steatorrhea is caused by an abnormal accumulation of what substances in feces? a. proteins b. lipids c. carbohydrates d. vitamins

61. when lipoprotein electrophoresis is performed at pH 8.6 with the use of agarose gel, which fraction migrates the fastest towards the anode? a. chylomicrons b. LDL c. VLDL d. HDL

62. the quantification of the high-density lipoprotein cholesterol level is thought to be significant in the risk assessment of what disease? a. pancreatitis b. cirrhosis c. coronary artery disease d. hyperlipidemia

63. an elevated protein level in CSF may be indicative of all the following disorders except? a. bacterial meningitis b. multiple sclerosis c. cerebral infarction d. hyperthyroidism

64. in a healthy individual, which protein fraction has the greatest concentration in serum? a. alpha 1 globulin b. beta globulin c. gamma-globulin d. albumin

65. there are 5 immunoglobulin classes. With which globulin fraction do these immunoglobulins migrate electrophoretically? a. alpha1-globulin b. alpha2-globulin c. beta1-globulin d. gamma-globulins

66. of the 5 immunoglobulin classes, IgG is the simplest, consisting of how many light chains/heavy chains, respectively? a. 5/2 b. 1/1 c. 2/5 d. 2/2

67. which immunoglobulin class is able to cross the placenta from the mother to the fetus? a. IgA b. IgD c. IgE d. IgG

68. what technique is used to quantify specific immunoglobulin classes? a. immunonephelometry b. serum protein electrophoresis c. isoelectric focusing d. immunoelectrophoresis

69. in serum protein electrophoresis when a buffer solution of pH 8.6 is used, which of the following characterizes the proteins? a. exhibit net negative charge b. exhibit net positive charge c. exhibit charge neutrally d. migrate towards the cathode

70. serum protein electrophoresis is routinely performed on the serum obtained from a clotted blood specimen. If a plasma specimen is substituted for serum, how will the electrophoresis be affected? a. electrophoresis cannot be performed because the anticoagulant will retard the mobilities of the protein fractions b. electrophoresis cannot be performed because the anticoagulant will cause migration of protein fractions in the direction of the cathode c. electrophoresis will show an extra fraction in the beta-gamma region d. electrophoresis will show an extra fraction in the prealbumin area

71. in serum protein electrophoresis when a barbital buffer of pH 8.6 is employed, what protein fraction will migrate the fastest towards the anode? a. albumin b. alpha1-globulins c. beta-globulin d. gamma-globulin

72. all of the following types of support media used today for serum protein electrophoresis except: a. agarose gel b. cellulose acetate c. acrylamide d. paper

73. when electrophoresis is performed, holes appear in the staining pattern, giving the stained protein band a doughnut-like appearance. What is the probable cause of this problem? a. protein denatured and will not stain properly b. ionic strength of the buffer was too high c. protein reached its isoelectric point and precipitated out d. protein concentration was too high

74. to maintain acid-base balance, it is necessary that the blood ammonia level be kept within narrow limits. This is accomplished primarily by which of the following? a. synthesis of urea from ammonia b. synthesis of glutamine from ammonia c. excretion of ammonia in the bile d. excretion of ammonia in the stools

75. when a blood ammonia determination is performed, the blood specimen must be treated in a manner that will ensure that: a. the deamination process continues in vivo b. glutamine formation in vitro is avoided c. the transamination process continues in vitro d. ammonia formation in vitro is avoided

76. all of the following precautions should be exercised in the collection, handling, and use if a specimen for ammonia analysis except: a. avoid use of a hemolyzed specimen b. collect blood in EDTA or heparin evacuated tubes c. place specimen in a 37C water bath d. prohibit patient from smoking for 8hrs before blood collection

77. an increased serum level of which of the following analyses is most commonly associated with decreased glomerular filtration? a. creatinine b. uric acid c. urea d. ammonia

78. the creatinine clearance test is routinely used to assess the glomerular filtration rate. Given the following information for an average size adult, calculate the creatinine clearance: urine creat - 120mg/dl plasma creat - 1.2mg/dl urine volume for 24hrs - 1520

106ml/min

79. in gout, what analyte deposits in joints and other body tissues? a. calcium b. creatinine c. urea d. uric acid

80. when performing electrophoresis at pH 8.6, which hemoglobin molecule migrates the fastest on cellulose acetate toward the anode?

hemoglobin A

81. all the following factors may adversely affect the accurate quantification of bilirubin in serum except: a. lipemia b. hemolysis c. exposure to light d. specimen refrigeration

82. which of the following is characteristic of hemolytic jaundice?

unconjugated serum bilirubin level increased

83. a complete obstruction of the common bile duct would be characterized by all the following lab results except: a. negative urine urobilinogen b. negative fecal urobilinogen and urobilin c. negative urine bilirubin d. excretion of pale-colour stool

84. the following lab results are determined on a patient with a suggested diagnosis of biliary obstruction: serum total bili - increased serum conjugated bili - normal urine bili - increased fecal urobilin - decreased which lab results is the least consistent with such diagnosis? a. serum total bilirubin b. serum conjugated bilirubin c. urine bilirubin d. fecal urobilin

85. what is the normal renal threshold of sodium (mmol/L)? a. 80-85 b. 90-110 c. 110-130 d. 135-148

C Should actually be D?

86. in the collection of plasma specimens for lactate determinations, which of the following anticoagulants would be most appropriate?

oxalate plus fluoride

87. which of the following disorders is characterized by increased production of chloride sweat>?

cystic fibrosis

88. in the plasma, an excess in the concentration of bicarbonate without change in Pco2 from a normal will result metabolic state?

metabolic alkalosis

89. what is the specimen of choice for analysis of acid-base disturbances involving pulmonary dysfunction in an adult?

arterial blood

90. what is the anticoagulant of choice for blood gas analysis?

Heparin

91. if a blood gas specimen is left exposed to air, which of the following changes will occur?

Po2 and pH increase, Pco2 decreases

92. the presence of only slightly visible hemolysis will significantly increase the serum level of which of the following electrolytes?

Potassium

93. all of the following describe potassium except: a. has no renal threshold b. increased serum level in acidosis c. hemolysis causes false increase in serum levels d. major anion of intracellular fluid

94. using the following data: Na = 143 mmol/L; K = 4.9 mmol/L; Cl = 105 mmol/L; and HCO3 = 25 mmol/L, all the following statements are correct except: a. patient results are not acceptable b. anion gap is useful in detecting some disease states c. anion gap equals 18mmol/L d. anion gap is useful for checking analytical error

95. a patient's serum inorganic phosphate level is found to be elevated but the physician cannot determine a physiological basis for this abnormal result. What could have possibly caused an erroneous result to be reported? a. patient not fasting when blood was drawn b. specimen was hemolyzed c. effect of diurnal variation d. patient receiving intravenous glucose therapy

96. which of the following is a cause of metabolic alkalosis? a. late stage of salicylate poisoning b. uncontrolled diabetes mellitus c. renal failure d. excessive vomiting

97. given the following information, calculate the blood pH. pCo2 = 44 mmHg total CO2 = 29 mmol/L

7.42

98. a 75-year-old woman comes to her physician complaining of abdominal pain. She has been taking increasing doses of anti-acid pills to control it. Until now she is taking a box of pills a day. Blood gases are drawn with the following results: pH = 7.49 Pco2 = 59 mmHg HCO3 = 38 mmol/L what does this data indicate? a. metabolic alkalosis, partially compensated b. respiratory acidosis, uncompensated c. a dual problem of acidosis d. an error in one of the blood gas measurements

99. a 24-year-old drug abuser is brought into the ER unconscious. He has shallow breaths, looks pale, and is "clammy". Blood gases show the following results: pH = 7.29 Pco2 = 50 mmHg HCO3 = 25 mmol/L what does this data indicate?

respiratory acidosis, uncompensated

100. blood gases are drawn on a 68-year-old asthmatic who was recently admitted for treatment of a kidney infection. Blood gas results are as follows: pH = 7.25 Pco2 = 56 mmHg HCO3 = 16 mmol/L what does this data indicate?

a dual problem of acidosis

101. patient is hyperventilating and has glossy eyes. Blood gases are drawn in the office with the following results: pH = 7.58 Pco2 = 55 mmHg HCO3 = 18 mmol/L what does this data indicate?

an error in one of the blood gas measurements

102. when an acute myocardial infarction occurs, in what order (list first to last) Will enzymes aspirate aminotransferase (AST), creatinine kinase (CK), and lactate dehydrogenase (LD) become elevated in the serum?

CK, AST, LD

103. as a screening test for Cushing's syndrome, the physician wishes to see whether a patient exhibited normal diurnal rhythm in his or her cortisol secretion. At what time should the specimen be drawn for plasma cortisol determination?

8am, 4pm

104. in a radioimmunoassay, the less unlabeled antigen that is present in the assay mixture: a. the greater the amount of labelled antigen that binds to antibody b. the lesser the number of counts per minute in the bound fraction c. the greater the amount of unlabelled antigen that binds to antibody d. the greater the number of counts per minute in the free fraction

105. what is the normal ratio of myeloid to erythroid precursors in bone marrow (M:E)? a. 1:1 b. 1:2 c. 1:5 d. 4:1

106. liver biopsy in a patient with hepatomegaly revealed red and white blood cell precursor cells identical to those found in the bone marrow. Of the following conditions, the one where this type of scenario would most likely be found is: a. viral or fungal infection b. acquired immune deficiency syndrome c. lymphoproliferative disease d. severe hemolytic anemia

107. which of the following red cell inclusions is characteristically found in lead poisoning? a. basophilic stippling b. heinz bodies c. Howell-joly bodies d. pappenheimer bodies

108. rouleaux of red cells when seen in the monolayer of a differential smear is characteristic of: a. megaloblastic anemia b. myelofibrosis c. myelogenous leukemia d. myeloma

109. what term describes a mature RBC that contains nonhemoglobin iron granules? a. acanthocytes b. drepanocytes c. echinocytes d. siderocytes

110. a patient with an MCV 107fl, HSN, markedly decreased intrinsic factor, would most likely have which of the following: a. siderotic granules b. heinz bodies c. basophilic stippling d. Howell-jolly bodies

D: clusters of DNA when the spleen is either absent or not functioning properly.

111. which of the following inclusions is not seen on Wright's smears? a. basophilic stippling b. dohle bodies c. Heinz bodies d. toxic granulation

C Damaged hemoglobin

112. which of the following conditions is not usually associated with the presence of schistocytes on the peripheral blood smear? a. DIC b. prosthetic heart valve c. severe burns d. lead poisoning

D Will see ringed sideroblasts with lead poisoning and basophilic stippling (RNA).

113. which technique is commonly used to separate red cell membrane proteins? a. PAGE b. RID c. IEP d. HPLC

114. a patient has slight splenomegaly with mild anemia. Which of the following abnormalities would you not expect to have been instrumental in creating this condition? a. heinz bodies b. hypochromia c. target cells d. Howell-jolly bodies

115. red blood cells with an MCV of 105 fl should correlate with a peripheral blood smear appearance of:

Macrocytosis

116. which of the following disorders is most often associated with ringed sideroblasts in the bone marrow? a. hemolytic anemias b. folate deficiencies c. dyserythropoiesis d. disturbance of heme synthesis

117. which of the following conditions is not usually associated with marked reticulocytosis? a. drug-induced autoimmune hemolytic anemia b. sickle cell anemia c. thalassemia d. pernicious anemia

118. in addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera?

increased platelets, increased granulocytes

119. which of the following describes erythropoietin? a. normal b. greatly increased c. midly decreased d. greatly decreased

120. what values would you expect to obtain on hbg and hct determinations done immediately after a major hemorrhage, if the patient had normal hemoglobin and hematocrit values prior to the hemorrhage?

both normal

121. which of the following is characteristic of aplastic anemia? a. microcytic, hypochromic b. microcytic, normochromic c. normocytic, hypocrhomic d. normocytic, normochromic

122. idiopathic aplastic anemia is best defined as a form of anemia that: a. has no identifiable cause b. caused by physician's treatment c. caused by ionizing radiation d. found in children with Down syndrome

123. which of the following is a true red blood cell aplasia? a. Bernard-Soulier b. Fanconi c. Diamond-Blakfan d. Chediak-Higashi

C: bone marrow fails to make RBCs

124. causes of absolute secondary erythrocytosis include all the following except: a. pulmonary disease b. high altitude adjustment c. dehydration d. defective oxygen transport

125. what is the most common cause of iron deficiency? a. bleeding b. gastrectomy c. inadequate diet d. intestinal malabsorption

126. in a patient with hypo chromic, microcytic anemia, it is necessary to distinguish between iron deficiency and: a. anemia of chronic infection b. hereditary spherocytosis c. heterozygous thalassemia d. pernicious anemia

127. in the anemia of chronic disease, what are the characteristic serum iron and transferrin levels?

serum iron decreased, transferrin decreased

128. the most important effect of lead poisoning is on the: a. liver b. kidney c. neurologic system d. erythrocyte development

129. on what is the classification of sickle cell trait versus sickle cell disease based? a. severity of the clinical symptoms b. number of irreversible sickled cells c. proportion of sickle hemoglobin present in any one cell d. presence of heterozygous or homozygous hemoglobin S

130. which of the following is the most appropriate treatment for sickle cell anemia? a. urea b. supportive therapy c. hyperbaric oxygen d. iron

131. which of the following values can be used to indicate the presence of hemolytic anemia? a. hemoglobin b. hematocrit c. erythrocyte count d. reticulocyte count

132. in which of the following would an increase in hemoglobin A2, be found? a. homozygous alpha thalassemia b. heterozygous alpha thalassemia c. heterozygous beta thalassemia d. heterozygous delta-beta thalassemia

133. how is hereditary spherocytosis treated?

removal of the spleen

134. which of the following antibodies is associated with paroxysmal cold hemoglobinuria? a. anti-e b. anti-I c. ham d. Donath-Landsteiner

135. a technologist examined a Wright's stained peripheral smear and saw what appeared to be small, irregular, dark-staining granules in the mature erythrocytes. A second smear was stained with Prussian blue and positive result was obtained. Based on this information, what should these granules be? a. cabot rings b. heinz bodies c. reticulum d. sideritic granules

136. spherocytes are characteristic of all the following except: a. Rh disease of the newborn b. ABO disease of the newborn c. March hemoglobinuria d. autoimmune hemolytic anemia

137. which of the following statements about hereditary spherocytosis is true? a. abnormmaly shaped cells are produced in the bone marrow b. cell mechanical fragility is decreased c. splenectomy can relieve the rate of red cell destruction d. red cell osmotic fragility is decreased

138. which of the following statements about hereditary elliptocytosis is true? a. characteristic oval shape is found in reticulocytes and mature erythrocytes b. about 50% of affected individuals display hemolytic anemia c. cellular defect involves the lipid composition of the membrane d. HE cells are abnormally permeable to Na+

139. which of the following is associated with sickle cells? a. increased osmotic fragility b. decreased mechanical fragility c. increased deformability d. promote spleen destruction

D Increased osmotic fragility in hereditary spherocytosis freshly taken red cells reflects their ability to take up a certain amount of water before lysing. This is determined by their volume-to-surface area ratio. The ability of the normal red cell to withstand hypotonicity results from its biconcave shape, which allows the cell to increase its volume by about 70% before the surface membrane is stretched; once this limit is reached lysis occurs.6 Spherocytes have an increased volume-to-surface area ratio; their ability to take in water before stretching the surface membrane is thus more limited than normal, and they are therefore particularly susceptible to osmotic lysis. The increase in osmotic fragility is a property of the spheroidal shape of the cell and is independent of the cause of the spherocytosis.

140. which of the following findings would not be expected in a patient with hemolytic anemia? a. increased unconjugated bilirubin b. microcytosis and hypochromia of peripheral red cells c. decreased haptoglobin concentration d. peripheral smear polychromatic

141. which of the following statements about intrinsic hemolytic anemia is false? a. the patients red cells have a shortened survival time in the patient b. the defects are usually acquired rather than inherited c. not all the patients red cells may display the defect d. hemolysis may be either intravascular or extravascular

B “Acquired” during the individual’s lifetime Example: thalassemia and Sickle cell anemia

142. which of the following statements about aplastic anemia is false? a. stem cell disorder b. lymphocytes decreased c. bleeding associated with decreased platelet production d. peripheral red blood cell counts reduced

143. polycythemia is characterized by all the following except: a. hyperviscoscity of the blood b. increased plasma volume c. tendency for thrombosis d. increased red cell mass

144. which of the following disease results from decreased globin chain synthesis? a. thalassemia b. pernicious anemia c. hereditary spherocytosis d. heinz body anemia

145. which of the following characterizes iron deficiency anemia?

increased serum transferrin, decreased transferrin saturation, decreased ferritin

146. fetal hemoglobin differs from adult hemoglobin in that hemoglobin F:

resists elution from red cells with acid solutions

147. the hemolysis associated with infection by malaria organisms is due to the: a. release of merozoites from erythrocytes b. invasion of erythrocytes by merozoites c. hosts immunologic response to infected erythrocytes d. toxins produced by the malarial organism

148. a tech received a blood sample that contained EDTA as the anticoagulant. The total volume was only 1.5mL. A smear eas prepared and stained with Wright's stain. When examined microscopically, the majority of cells appeared to have many evenly distributed uniform-size blunt spicules on the surface. How should this cellular appearance be interpreted? a. an anemic condition requiring futher testing b. acanthocytes caused by using incorrect technique during slide preparation c. artefacts caused by a dirty spreader slide d. crenated cells caused by incorrect blood:anticoagulant ration

149. which of the following anemia is characterized by microcytic, hypochromic red blood cells? a. pernicous anemia b. autoimmune hemolytic anemia c. beta thalassemia d. aplastic anemia

150. basophilic stippling of red cells represent: a. precipitated hemoglobin b. aggregated ribosomes c. nuclear fragments d. excess iron deposits

151. which of the following represents an anemia that would present with a high red cell distribution width?

hemolytic anemia with compensation

152. splenomegaly would be a common finding in all the following disorders except: a. thalassemia b. hereditary spherocytosis c. polycythemia vera d. folic acid deficiency

153. a "shift to the left" when used to describe a cell population, refers to:

an increase in immature blood cells following release of bone marrow pools

154. which of the following is characteristic of agranulocytosis? a. neutrophils without granules b. decreased number of granulocytes, red cells and platelets c. immature granulocytes in the peripheral blood d. decreased number of granulocytes

155. which of the following statements is correct? a. HSN have greater than 6 nuclear lobes b. auer rods are composed of fused primary granules c. toxic granules are prominent secondary granules d. dohle bodies are agranular patches of DNA

156. in patients with infectious mononucleosis, which blood cells are infected by the causative agent? a. monocytes b. T lymphocytes c. B lymphocytes d. histiocytes

157. which of the following statements about hairy cell leukemia is true? a. it is an acute disease primarily affecting young adults b. splenomegaly is an unusual finding c. hairy cell contain tartrate resistant acid phosphatase (TRAP) d. hairy cells are abnormal T lymphocytes

158. the presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a:

leukoerythroblastic reaction

159. eosinophils are increased in all of the following except: a. Cushing's disease b. allergic disorder c. skin disorders d. parasitic infection

160. a patient with normal hemoglobin and WBC values, a persistently elevated platelet count (>1000 x 10^9/L). Increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has:

essential thrombocythemia

161. an adult patient with a massive splenomegaly has a mild anemia, slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. In addition, the bone marrow aspirate was a "dry tap". The finding are consistent with:

primary myelofibrosis

162. which of the following is increased in Waldenstrom's macroglobulinemia?

IgM Waldenstrom macroglobulinemia (WM) is a type of non-Hodgkin lymphoma (NHL). The cancer cells make large amounts of an abnormal protein (called a macroglobulin) Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin lymphoma typically begins in the upper body, such as the neck, chest or armpits

163. a leukemoid reaction is an increase in peripheral blood cells associated with:

an extreme infectious response

164. which of the following is not usually classified as a myeloproliferative disorder? a. PV b. essential thrombocythemia c. multiple myeloma d. chronic myelocytic leukaemia

165. which of the following would be least helpful in distinguishing chronic myelocytic leukemia (CML) from a leukemoid reaction? a. presence of markerd leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes b. leukocyte alkaline phosphatase (LAP) score c. presence of splenomegaly d. presence of neutrophils with dohle bodies and toxic granulation

166. what is the key diagnostic test for Hodgkin's lymphoma?

lymph node biopsy

167. a hyper cellular bone marrow and myeloid:erythroid ratio of 8:1 is most characteristic of:

168. in what disorder is significant basophilia most commonly seen?

CML

169. all the following will cause a falsely low ESR except: a. ESR tube is slanted b. EDTA tube is clotted c. EDTA tube is 1/3 full d. EDTA specimen is 24hr old

170. a plt count of 96 x 10^9/L is obtained on an automated instrument from an EDTA blood sample. Smear evaluation reveals the presence of platelet clumps. The specimen is redrawn using sodium citrate as the anticoagulant and a count of 300 x 10^9/L is obtained. What is the correct platelet count to report?

330 x 10^9/L

171. to best preserve cellular morphology, differential smears from an EDTA specimen should be made no later than how many hours after collection?

172. the blood smear made on a patient with PV is too short. What should one do to correct this problem?

decrease the angle of the spreader slide

173. Wright's stain is a mixture of: a. crystal violet and safarin b. brilliant green and neutral red c. new methylene blue and carbol fuschin d. polychrome methylene blue and eosin

174. what is the reason for red blood cells to be bright red when stained with Wright's stain?

the buffer is too acidic

175. the Sudan black B stain is a stain for:

lipids

176. which of the following red cell inclusions stain with both Perl's Prussian blue and Wright's stain?

papenheimer bodies

177. a falsely high MCHC of 365 g/L on an automated instrument could be caused by all the following except: a. hereditary spherocytosis b. hyperlipidemia c. presence of a cold agglutinin d. instrument sampling or mixture error

179. an EDTA blood sample run on an automated impedance cell counter has generated a warning flag at the upper region of the platelet histogram. The presence of all the following could cause this warning flag except: a. nRBC b. microcytic RBCs c. EDTA dependant platelet agglutinins d. giant platelets

178. a clinically significant difference between two electronic cell counts is indicated when the standard deviation is greater than:

+/- 2.0

180. to evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets, should be observed per oil immersion field?

8-20