Ace ASCP

Which of the following condition is the most common cause of increase anion gap?

A.Metabolic alkalosis

B. Metabolic acidosis

Respiratory acidosis

Respiratory alkalosis

B. Metabolic acidosis

High anion gap metabolic acidosis is caused generally by the body producing too much acid or not producing enough bicarbonate. This is often due to an increase in lactic acid or ketoacids, or it may be a sign of kidney failure. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin.

Which of the following enzymes has the longest elevation after Myocardial Infarction (MI)?

CK-MB

Myoglobin

Troponin

AOTA

C. Troponin

Troponin is elevated up to 10-14 days after Myocardial Infarction.

Lactic acid specimen:

Chilled and separated from cells

Heated

Room temperature

Request EDTA sample only

A. Chilled and separated from cells

Feedback Special Handling: No tourniquet. Place on ice immediately and deliver to lab or aliquot within 15 minutes. DO NOT FREEZE WHOLE BLOOD SPECIMEN.

Specific gravity measured by refractometer: 1.035. Protein and glucose both trace in reagent strip:

Presence X-ray medium

Albuminuria

Glucosuria

Normal

A. Presence X-Ray medium

Feedback Xray medium/Radiographic dye can cause erroneous results in urine specific gravity measurement.

A patient with walking pneumonia is being treated with penicillin. State one possible condition why the patient is not recovering:

The organism produces beta lactamase

The organism has no cell wall

The organism has capsule

The organism produces an enzyme that neutralizes the antibiotic

B. The organism has no cell wall.

Feedback Pneumonia caused by Mycoplasma pneumoniae is routinely treated with antibiotics, although the disease is usually self-limiting. The disease is treated with macrolide, tetracycline, or fluoroquinolone classes of antibiotics. All mycoplasmas lack a cell wall and, therefore, all are inherently resistant to beta-lactam antibiotics (e.g., penicillin).

What is the coefficient of variation if the mean is 90 and the standard deviation is 5.48?

2.75

6.09

5.68

30

B. 6.09

Feedback:

CV= SD/meanX100,

(5.48/90)X100= 6.09.

Blood smear below denotes Hairy Cell Leukemia (HCL), which of the following test is used to identify this type of leukemia?

Image. 1

Myeloperoxidase

Tartrate-resistant acid phosphatase

Tartrate-resistant alkaline phosphatase

Sudan Black

B. Tartrate-resistant acid phosphatase

Feedback:

Hairy cells demonstrate strong positivity for tartrate-resistant acid phosphatase (TRAP) staining. The hairy cells are larger than normal and positive for CD19, CD20, CD22, CD11c, CD25, CD103, and FMC7.

Use to differentiate Salmonella from Citrobacter:

Lysine decarboxylase

ONPG

Indole

Vogues Proskauerterm-9

A. Lysine decarboxylase

Feedback:

Salmonella (+); Citrobacter (-)

Arrange the common Rh antigens according to immunogenicity (greatest to least):

D>c>E>C>e

D>C>E>c>e

D>c>E>e>C

C>D>c>E>e

A. D>c>E>C>e

Feedback Most immunogenic D > c > E > C > e least immunogenic.

Most common error in Polymerase Chain Reaction (PCR) is NUCLEIC ACID CONTAMINATION.

A True (Correct Answer)

B False

A. True

What disease is associated with the possession of HLA-B27?

Ankylosing spondylitis

Hashimoto's Disease

Goodpasture's syndrome

SLE

A. Ankylosing spondylitis

Feedback:

Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies). The HLA-B27 gene can be detected in the blood of most patients with ankylosing spondylitis.

Burr cells are seen in the peripheral blood smear, this is indicative of? (Fig. 2)

Uremia (Kidney Disease)

Anemia

Leukemia

Liver Disease

A. Uremia (kidney Disease)

Feedback:

The above shown picture illustrates Burr cells, these cells are indicative of Uremia (kidney disease)

Anti IgG (-); C3d (+): What should the MLS do?

Elution

IAT

DAT

Pre-warm

D. Pre-warm

Feedback Prewarm technique can be used to prevent cold-reactive alloantibodies or autoantibodies from reacting in the IAT phase. Specifically, prewarm technique prevents cold antibodies from binding complement at RT (as opposed to 37o C ) and subsequently being detected by anti-C3 in the IAT by polyspecific AHG serum.

Maximum interval which a recipient sample maybe used for crossmatching if the patient has been recently transfused, has been pregnant?

2 days

6 days

3 days

NOTA

C. 3 days

CIN (Cefsulodin, Irgasan, Novobiocin) Agar is a recommended culture medium for the recovery of:

Rhodococcus equi

Cardiobacterium hominis

Brucella suis

Yersinia enterocolitica

D. Yersinia enterocolitica

Feedback:

CIN Agar is recommended for use in the selective and differential isolation of Yersinia and Aeromonas species from clinical specimens, environmental samples, and food sources. Yersinia enterocolitica will exhibit bull's eye appearance on the said agar.

What is the formula for sensitivity?

TP/(TP+FN)x100

TP/(TP+FP)x100

(TP+FN)/TPx100

(TP+FP)/TNx100

A. TP/(TP+FN)x100

CThe anemias of the qualitative hemoglobinopathies, such as sickle cell anemia, are morphologically classified as:

Microcytic, hypochromic

Macrocytic, normochromic

Normocytic, normochromic

NOTA

C. Normocytic, normochromic

According to AABB standards, Fresh Frozen Plasma (FFP) must be infused within what period of time following thawing?

24 hrs

36 hrs

48 hrs

72 hrs

A. 24 hours

A woman having menstrual cycle would have the ff. result:

Increased TIBC

Increased Ferritin

Increase % Saturation

Normal Transferrin

A. Increased TIBC

Feedback A total iron binding capacity value above 450 mcg/dL usually means that there's a low level of iron in your blood. This may be caused by a lack of iron in the diet, increased blood loss during menstruation, pregnancy, or a chronic infection.

Causative agent of "Cat bite fever"

Pasteurella multocida

Actinomyces israelii

Bartonella henselae

Leptospira interrogans

A. Pasteurella multocida

Feedback Pasteurella species are commonly isolated pathogens in most animal bites, especially in dog- and cat-related injuries. These injuries can be aggressive, with skin manifestations typically appearing within 24 hours following a bite. These wounds can exhibit a rapidly progressive soft-tissue inflammation that may resemble group A β-hemolytic Streptococcus pyogenes infections.

What is the sugar fermented by Staphylococcus aureus?

Mannitol

Sucrose

Glucose

Maltose

A. Mannitol

Mannitol salt agar is a commonly used growth medium in microbiology. It encourages the growth of a group of certain bacteria while inhibiting the growth of others. It contains a high concentration (7.5%-10%) of salt (NaCl), making it selective for gram positive bacteria Staphylococci (and Micrococcaceae) since this level of NaCl is inhibitory to most other bacteria. It is also a differential medium for mannitol fermentors, containing mannitol and the indicator phenol red. Staphylococcus aureus produce yellow colonies with yellow zones, whereas other Staphylococci produce small pink or red colonies with no colour change to the medium. If an organism can ferment mannitol, an acidic byproduct is formed that will cause the phenol red in the agar to turn yellow.

Identify the organism: Fig. 3

Blastomyces dermatitidis

Malasezia furfur

Alternaria

Candida albicans

A. Blastomyces dermatitidis

Feedback The above image show broad base budding.

What is the first step in agglutination?

Sensitization

Precipitation

Diffusion

Lattice formation

A. Sensitization

Feedback Agglutination involves two process: First, sensitization or initial binding. Second, lattice formation or formation of large aggregates.

Sterilization of autoclave:

121°C at 20 lbs/psi for 30 minutes

121°C at 15 lbs/psi for 15 minutes

85°C for 15 lbs/psi 30 minutes

100°C for 20 lbs/psi 50 minutes

B. 121°C at 15 lbs/psi for 15 minutes

Feedback Many autoclaves are used to sterilize equipment and supplies by subjecting them to high-pressure saturated steam at 121°C (249 °F) for around 15-20 minutes depending on the size of the load and the contents.

A newborn infant has a WBC count of 37,000/ul with the differential count revealing the presence of 50 nRBCs per 100 WBCs. What is the corrected WBC count?

15,000/ul

24,700/ul

27,300/ul

12,500/ul

B. 24,700/ul

Feedback Corrected WBC count= Uncorrected WBC count x100/nRBCs+100: Thus, (37,000ulx100/50+100= 24,700ul)

Gram positive bacilli; non-motile; non-hemolytic; catalase positive; spore forming:

B. anthracis

B. cereus

N. meningitidis

N. lactamica

B. B. anthracis

Feedback Important distinguishing characteristics between B. anthracis and B. cereus is motility, B. anthracis is non motile while B. cereus is motile.

Hair perforation test/Hair baiting test is for identification of which two fungi?

Aspergillus niger and A. japonicus

Tinea pedis and T. corporis

Trichophyton mentagrophyte and T. rubrum

C. albicans and C. tropicalis

C. Trichophyton mentagrophyte and T. rubrum

Feedback Trichophyton mentagrophyte is positive and T. rubrum is negative

What is the minimum platelet count before you perform apheresis?

500

200

150

250

C. 150.

Feedback Apheresis donors with low normal pre-procedure platelet counts (150 - 200 x 10 9/L) and Hb concentration (12.5 - 13 g/dL) should be examined for post-donation drops in these haematological parameters

Gram negative bacteria, normally found in the oropharyngeal tract of mammals, they are involved in the pathogenesis of some animal bite wounds as well as periodontal diseases. This bacteria exhibits GLIDING MOTILITY:

Leptospira

Actinobacillus

Capnocytophaga

Chlamydia

C. Capnocytophaga

Feedback The term Capnocytophaga comes from "Capno" for its dependence on CO2 and "cytophaga" for its flexibility and mobility shift (" gliding motility ").

Urine with an specific gravity consistently between 1.002 and 1.003 indicates:

Acute glomerulonephritis

Renal tubular failure

Addison's disease

Diabetes insipidus

D. Diabetes insipidus

Feedback Low specific gravity (SG) (1.001-1.003) may indicate the presence of diabetes insipidus, a disease caused by impaired functioning of antidiuretic hormone (ADH). Low SG also may occur in patients with glomerulonephritis, pyelonephritis, and other renal abnormalities.

Primidone monitoring: suspected to have primidone overdose, but the serum concentration is within the normal range, what should the MLS do next?

Measure procainamide concentration

Measure phenobarbital concentration

Measure phenytoin concentration

Eliminate primidone overdose as possible diagnosis

B. Measure phenobarbital concentration

Feedback Primidone is a structural analog of phenobarbital.

Postprandial turbidity of the serum is due to the presence of?

Fatty acid

Cholesterol

Phospholipid

Lipoproteins

D. Lipoproteins

Feedback For approximately two to eight hours following a meal there is an additional LIPOPROTEIN class, called chylomicrons, representing the transport of dietary fat absorbed in the intestine.

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? The frequency of Jka+ is 80% and K+ frequency is 15%.

B. 12

Feedback Formula: Number of units to crossmatch is equivalent to: # of units need by patient/(frequency of negativity of antigen #1 x frequency of negativity of antigen #2). Negativity of Jka+ is .20%, Negativity of K+ is .85%. Using the formula, 2 units/(.20x.85)=11.76 rounded to 12.

An alkaline urine refrigerated becomes turbid because of?

Amorphous phosphates

Amorphous urates

WBC

Bacteria

A. Amorphous phosphates

Feedback Amorphous phosphates are usually formed in alkaline urine and they are without a color. The precipitate of amorphous phosphates is white while Amorphous urates are yellow, yellow-brown or pinkish in color. They tend to form in acidic urine and their precipitate is pink with a cloudy appearance of the mixed urine. Amorphous urates are a normal presence in the urine.

Test for Paroxysmal Cold Hemoglobinuria (PCH):

Autohemolysis test

Donath-Landsteiner Test

Sucrose hemolysis test

NOTA

B. Donath-Landsteiner Test

Feedback Normal= (-) hemolysis on test and control, PCH= (-) hemolysis on control but (+) hemolysis on test sample.

In emphysema, the absence of alpha-1 globulin peak is due the deficiency of:

A1-Antitrypsin (AAT)

Macroglobulin

Hemopexin

Transferrin

A1-Antitrypsin (AAT)

Feedback Alpha-1 antitrypsin deficiency is an inherited disorder that may cause lung disease and liver disease. Affected individuals often develop emphysema, which is a lung disease caused by damage to the small air sacs in the lungs (alveoli). Characteristic features of emphysema include difficulty breathing, a hacking cough, and a barrel-shaped chest.

Identify the organism: Fig. 4

Clostridium difficile

Mycobacterium tuberculosis

Listeria monocytogenes

Corynebacterium diphtheriae

A. Mycobacterium tuberculosis

Feedback Mycobacterium tuberculosis is an obligate pathogenic bacterial species in the family Mycobacteriaceae and the causative agent of tuberculosis. M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. Cells are curved rod-shaped and are often seen wrapped together, due to the presence of fatty acids in the cell wall that stick together. This appearance is referred to as cording, like strands of cord that make up a rope. M. tuberculosis is characterized in tissue by caseating granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei.

A and B blood group antigens are derived when glycosyltransferases add specific sugars to precursor H. What is the terminal sugar for B antigen?

Fucose

D-galactose

N-acetylglucosamine

N-acetylgalactosamine

B. D-galactose

Feedback The A Blood Type is the H antigen with N-acetylgalactosamine attached. The B Blood Type is the H antigen with D-galactose attached. The O Blood Type is the H antigen with no additional sugar attached.

The reverse Camp Test, lecithinase production, double zone hemolysis and gram stain morphology are all useful identification of:

Campylobacter jejuni

Staphylococcus aureus

Listeria monocytogenes

Clostridium perfringens

D. Clostridium perfringens

Feedback:

Clostridium perfringens (formerly known as C. welchii, or Bacillus welchii) is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium. Clostridium perfringens shows double-zone hemolysis on blood agar. Small area of beta hemolysis are noted (complete lysis of red blood cells) surrounded by a larger zone of alpha hemolysis (partial hemolysis).

According to AABB Standards, at least 90% of all Apheresis Platelets units tested shall contain a minimum of how many platelets?

5.5 X 10^11

5.0 X 10^11

3.0 X 10^11

6.5 X 10^11

Feedback As per AABB Standards, at least 90% of platelet pheresis units sampled must contain at least 3.0 x 10^11 platelets.

When performing semen analysis, sperm count is done:

After collection

After liquefaction

No certain time

NOTA

B. After liquefaction

Feedback Sperm count is done after liquefaction which is approximately 20-30 minutes.

Latex agglutination for Staphylococcus aureus:

Protein A and nuclease

Phosphotase and protein A

Protein A and clumping factor

All of the above

C. Protein A and clumping factor

Which of the following blood test uses radioimmunoassay test to detect direct and specific IgE?

Radioallergosorbent Test (RAST)

Radioimmunosorbent Test (RIST)

A and B

None of the above

A. Radioallergosorbent Test (RAST)

Feedback RAST test is used to detect direct and specific IgE. RIST test is used to detect total serum IgE.

Which of the following factors are affected by Coumadin Therapy?

III, VII, VIII

X, V, II, I

II, VII, IX, X

AOTA

c.

Feedback The following factors are said to be Vitamin K Dependent factors. Coagulation factors affected by coumadin drugs are: II, VII, IX and X.

What analyte is monitored in preeclampsia?

Potassium

Ammonia

Magnesium

Ionized Calcium

c. Magnesium

Feedback Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia.

Identify: FI.g 5

Heinz bodies

Basophilic stippling

Howell-Jolly bodies

Auer rods

A. Heinz Bodies

Feedback Heinz bodies (also referred to as "Heinz-Ehrlich bodies") are inclusions within red blood cells composed of denatured hemoglobin. It is also seen in cases of moth balls (naphthalene) ingestion.

High-Level Aminoglycoside Resistance:

Micrococcus

Staphylococcus

Enterococci

AOTA

C. Enterococci

Feedback Enterococci are intrinsically resistant to aminoglycosides; a combination therapy using aminoglycoside with vancomycin has been known to increase the effectiveness of the aminoglycoside. It is important to identify this high-level aminoglycoside resistance (HLAR) to provide appropriate therapy.

A patient's record shows a previous anti-Jk(b), but the current antibody screen is negative. What further testing should be done before transfusion?

Give Jk(b) negative crossmatch compatible blood

Crossmatch type specific units and release only compatible units for transfusion

Phenotype the patient's red cells for the Jk(b) antigen

AOTA

A. Give Jk(b) negative crossmatch compatible blood

Feedback Delayed hemolytic transfusion reactions may occur in recipients who are previously immunized but who do not have detectable antibody, if they receive blood with the corresponding antigen. When there is a history of clinically significant antibodies, donor red cells should be phenotyped and antigen-negative blood selected. A complete AHG crossmatch must be performed.

When introducing a new manual technique, which is the best approach?

Case presentation

Workshop

Lecture

All of the above

B. Workshop

Duckert's Test 5M Urea Solubility Test is used of:

Factor II deficiency

Factor XIII deficiency

Factor VIII deficiency

Factor XII deficiency

B. Factor XIII deficiency

Feedback Duckert's Test is for factor XIII deficiency, Reagent: 5M Urea. Test Results: Normal: Clot is insoluble to urea (24 hrs), Abnormal: Factor XIII deficiency: Clot is soluble to urea (24 hrs)

Which of the following should be tested in cases of Antacid overdose?

pH

Potassium

Ammonia

Chloride

A. pH

Feedback Antacids do just what their name suggests: they neutralize the normal stomach acid (HCl), causing the pH to rise to a nearly neutral pH of around 6 to 7. As the pH rises above 4, pepsin activity decreases or stops. Some types of antacids, made of sodium bicarbonate (NaHCO3) or calcium carbonate (CaCO3), are easily absorbed into a person's body and can cause a pH imbalance, possibly leading to kidney damage or other problems (Berkow, 1987).

17-Ketosteroids is produced in the:

Adrenal glands

Hypothalamus

Thyroid glands

Pituitary glands

A. Adrenal glands

Feedback 17-ketosteroids are substances that form when the body breaks down male steroid sex hormones called androgens and other hormones released by the adrenal glands in males and females, and by the testes in males.

The oxygen sensitive indicator that is used to ensure that anaerobic jars or chambers have met the anaerobic conditions required for anaerobes to grow is:

Methylene blue

Bromphenol blue

Thymol blue

Bromthymol blue

A. Methylene blue

Feedback Methylene blue is used as an indicator of anaerobiosis. It remains blue when there is oxygen present in the environment but turns colorless if anaerobic conditions are met.

2-month old baby with Normal WBC, Normal platelet, reticulocyte count: 0.1%:

Pure red cell aplasia

Chronic Myelogenous Leukemia

Myelofibrosis with myeloid metaplasia

Polycythemia vera

A. Pure red cell aplasia

Feedback In pure red cell aplasia only red cell production is affected and WBC and platelet counts are normal. It is not likely that RBC count falls that low in lead poisoning.

Autologous Donation:

Age has no requirement

Hgb atleast 11 g/dl, Hct atleast 33%

Single unit is removed at a time, with atleast 3 day intervals

AOTA

D. AOTA

Feedback Donating blood for your own surgery is called an autologous donation. These blood units are collected and stored until the patient's surgery.

Order of migration of hemoglobins during alkaline electrophoresis, starting from the origin towards the anode:

C,S,F,A

C,S,A,F

S,C,A,F

A,F,S,C

A. C, S, F, A

Feedback The order of migration of different hemoglobins starting from the origin is C,S,F,A. Fastest towards the anode is Hemoglobin A.

Effect of increased Aldosterone to sodium and potassium:

Decreased Sodium; Decreased Potassium

Increased Sodium; Increased Potassium

Increased Sodium; Decreased Potassium

NOTA

C. Increased sodium; decreased potassium

Feedback Hyperaldosteronism can cause high blood pressure, low potassium levels and an abnormal increase in blood volume because of the way the hormone affects the body. It's also possible to have low levels of aldosterone. Addison's Disease, a disease that causes a general loss of adrenal function, can be a cause. Sodium and potassium always have inverse relationship.

Hallmarks of this type of anemia:

Formation of a fusion protein, AML1-ETO or RUNX1-RUNX1T1, due to a translocation of chromosome 8 to chromosome 21 or t(8;21):

Acute Myeloid Leukemia (AML)

Chronic Lymphocytic Leukemia (CLL)

Acute Promyelocytic Leukemia (APL)

A. Acute Myeloid Leukemia (AML)

Feedback FAB M2 is a subtype of Acute Myeloid Leukemia. It is also known as "Acute Myeloblastic Leukemia with Maturation".

Standardization of Mueller-Hinton Agar?

adjust pH to 7.2

adjust pH to 6.5

adjust pH to 8.5

All of the above

A. Adjust pH to 7.2

First marker to be positive in HIV infection:

HIV antibody

HIV RNA

CD4/CD8 ratio

p24

D. p24

Feedback The p24 antigen test can detect the p24 protein on average 10 to 14 days after infection with HIV. p24 antigen is a viral protein that makes up most of the viral core. Serum concentrations of p24 antigen are high in the first few weeks after infection; tests sensitive to p24 antigen are therefore useful for diagnosing very early infection when antibody levels are still low.

Which of the following pigments will deposit on urate and uric acid crystals to form a a precipitate described as "brick dust"?

Urobilin

Bilirubin

Uroerythrin

Urochrome

C. Uroerythrin

Feedback Uroerythrin is a red pigment present in the urine, where it is part of a group of yellow, brown and red pigments generally designated as urochrome.

Vibrio culture media:

Fletcher's Agar

Bismuth Sulfite Agar

TCBS

BAP

C. TCBS

Feedback Thiosulfate-citrate-bile salts-sucrose agar, or TCBS agar, is a type of selective agar culture plate that is used in microbiology laboratories to isolate Vibrio spp.

Moth balls (naphtalene) poisoning may show which of the following red cell characteristics?

Howell-Jolly bodies

Ovalocytes

Sickle cells

Heinz Bodies

D. Heinz bodies

Feedback Ingestion of naphthalene-containing mothballs is a common occurrence in children. Heinz body formation, hemoglobinuria and mild methemoglobinaemia can occur due to poisoning with this substance

pH 7.22, pC02: 35, H2CO3: 10

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

A. Metabolic acidosis

Feedback Normal values: pH- 7.35-7.45 pCO2: 35-45 HCO3: 22-26

Grading of agglutination: Figure 6

1+

2+

3+

4+

D. 4+

Feedback (1+)= Fine granular appearance visually, but definite small clumps (10-15 cells) per lower field, (2+)= Many fair large clumps with many free cells, (3+)= Three or four individual individual clumps with few free cells, (4+)= Single clump of agglutination with no free cells.

What is the effect of dextran, why it is difficult to interpret in blood banking?

It inhibits Anti-A and Anti-B

It causes rouleaux

It destroys the D antigen on red cell surface

It has soluble like antigen

B. It causes rouleaux.

Feedback Rouleaux- pseudoagglutination or the false clumping of erythrocytes when the cells are suspended in their own serum. This phenomenon resembles agglutination and is due to the presence of an abnormal protein, plasma expanders such as DEXTRAN or wharton's jelly from cord blood samples.

An ASO test can only be valid if the controls have yielded acceptable results. Which of the following indicates valid ASO Test?

Hemolysis in both SLO and red cell control

Positive control, hemolysis in all tubes

No hemolysis on SLO control

No hemolysis on red cell contro

D. no hemolysis on red cell control

Feedback For an ASO tube test to be valid, the SLO control should show hemolysis and the RBC control tube should show no hemolysis.

With what leukemia is Disseminated Intravascular Coagulation (DIC) associated?

M3

M1

M6

CML

A. M3

Feedback M3- Acute Promyelocytic Leukemia (T15;17).

Precipitation of ribosomes and RNA: Figure 7

Heinz bodies

Howell- Jolly bodies

Basophilic stippling

Auer rods

C. Basophilic stippling

Feedback 1. Fine stippling= polychromatophilia (production of RBCs). 2. Coarse stippling= lead poisoning.

What does hemoglobin F consist of?

Two alpha and two beta chains

Two alpha and two gamma chains

Two alpha and two delta chains

Four beta chains

B. 2 alpha, 2 gamma chains

Specimen for blood gas analysis?

Powdered EDTA

Syringe with cap

Citrated syringe with needle pierced on rubber stopper

Heparinized syringe with needle pierced on rubber stopper

D. Heparinized syringe with needle pierced on rubber stopper

Weak D:

A. All antigens are present but under expressed

B. Develops antibody

C. A and B

D. All antigens are expressed

A. All antigens are present but under expressed

Cytogenetic anomaly in Acute Promyelocytic Leukemia (M3):

t(9:22)

t(15:17)

t(8:21)

None of the above

B. t(15:17)

Feedback Acute promyelocytic leukemia is characterized by a chromosomal translocation involving the retinoic acid receptor-alpha gene on chromosome 17 (RARA). In 95% of cases of APL, retinoic acid receptor-alpha (RARA) gene on chromosome 17 is involved in a reciprocal translocation with the promyelocytic leukemia gene (PML) on chromosome 15, a translocation denoted as t(15;17)(q22;q12). The RAR receptor is dependent on retinoic acid for regulation of transcription.

From which source are you most likely to see this parasite?

Fig.8

Stool

Urine

Sputum

Blood

B. Urine

Feedback Schistosoma haematobium is an important digenetic trematode, and is found in Africa and the Middle East. It is a major agent of schistosomiasis; more specifically, it is associated with urinary schistosomiasis.

Tropical sprue has the peripheral blood picture of:

Malaria

Thalassemia

Megaloblastic anemia

IDA

C. Megaloblastic Anemia

Feedback Tropical sprue is a malabsorption disease commonly found in tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine. Megaloblastic anemia is a Macrocytic, Normochromic anemia.

Identify the organism: Fig. 9

Enterobius vermicularis

Ascaris lumbricoides

Trichinella spiralis

Taenia solium

B. Ascaris lumbricoides

Feedback The above shown image is a fertile egg of Ascaris lumbricoides. Ascaris lumbricoides is a roundworm, infects humans when an ingested fertilized egg becomes a larval worm (called rhabditiform larva) that penetrates the wall of the duodenum and enters the blood stream.

Laboratory Results: Decreased T3, Decreased T4, Decreased TSH

Secondary Hyperthyroidism

Secondary Hypothyroidism

Primary Hyperthyroidism

Primary Hypothyroidism

B. Secondary Hypothyroidism

Feedback The cause of secondary hypothyroidism is failure of the pituitary gland to secrete thyroid stimulating hormone (TSH).

Encapsulated yeast seen in Diabetes Mellitus:

C. albicans

C. neoformans

A and B

NOTA

B. C. Neoformans

Uncontrolled diabetics are prone to infections due to numerous factors as the glucose-rich blood serves as an excellent media for growth. Cryptococcus neoformans is an opportunistic fungus that is an important cause of CNS infections among immunocompromised patients, but it has only sporadically been reported in non-HIV-positive persons. The presence of elevated pro-inflammatory cytokines and abnormalities in numerous systemic indicators of inflammation in diabetics makes it conceivable that diabetics mount an exaggerated immune response to C. neoformans (paradoxical to their defective immune state) leading to grave outcomes.

What test is use to detect Weak D?

Elution

Adsorption

DAT

IAT

D. IAT

Feedback Some red cells possess the D antigen but it is expressed so weakly that the cells are not agglutinated directly by anti-D sera. An indirect antiglobulin test is necessary to identify patients with the Weak D (formerly known as Du )phenotype. Weak D testing is done on all prenatal patients and candidates for Rh immune globulin. Weak D testing is also done on Rh negative donors to ensure they are truly D negative.

Alpha-1 globulin flat curve in a protein electrophoresis indicates?

Multiple myeloma

Inflammation

Juvenile cirrhosis

Nephrotic syndrome

C. Juvenile cirrhosis

Feedback Juvenile cirrhosis (AAT Deficiency) exhibits alpha-1 globulin flat curve in a protein electrophoresis.

Rheumatoid Factor:

IgG that binds to the Fc portion of abnormal IgM

IgM that binds to the Fc portion of abnormal IgG

A and B

None of the above

B. IgM that binds to the Fc portion of abnormal IgG

If total cholesterol is 230 mg/dl, HDL is 55 mg/dl and triglycerides is 190 mg/dl, what is the concentration of LDL?

137 mg/dl

125 mg/dl

85 mg/dl

140 mg/dl

A. 137 mg/dl

Feedback Friedewald formula (1972)= LDL= Total cholesterol-HDL-TAG/5 (mg/dl) 230-55-(190/5)= 137 mg/dl

Which of the following methods used for HIV identification is considered a signal amplification technique?

DNA PCR

Reverse Transcriptase PCR

Branched Chain DNA Analysis

Nucleic acid sequence-based assay (NASBA)

C. Branched Chain DNA analysis.

Feedback Branched DNA (bDNA) is a signal amplification technology used in clinical and research laboratories to quantitatively detect nucleic acids. An overnight incubation is a significant drawback of highly sensitive bDNA assays.

Which of the following stain is recommended for identification of Cryptococcus neoformans?

Methyl red

Congo red

Wright stain

India ink

D. India ink

Feedback Cryptococcus neoformans, because of its large polysaccharide capsule, can be visualized by the India Ink stain. Organisms that possess a polysaccharide capsule exhibit a halo around the cell against the black background created by the India Ink.

Role of a supervisor in a laboratory:

Democratic

Autocratic

Laissez-faire

All of the above

A. Democratic

Feedback (Democratic)- supervisor acts according to the mutual consent and discussion or in other words he consults subordinates in the process of decision making. This is also known as participative or consultative supervision. (Autocratic)- the supervisor wields absolute power and wants complete obedience from his subordinates. He wants everything to be done strictly according to his instructions and never likes any intervention from his subordinates. (Laissez-faire)- This is also known as independent supervision. Under this type of supervision, maximum freedom is allowed to the subordinates. The supervisor never interferes in the work of the subordinates.

Stomatocytes are indicative of? Fig. 10

Sideroblastic anemia

Liver Disease

IDA

Folate deficiency

B. Liver Disease

Feedback Stomatocytes can be seen with some acquired conditions such as chronic liver disease (most often due to alcoholism) or acute alcohol intoxication.

Which of the following least react with Anti-H?

O

A2

A1

A1B

D. A1B

Feedback O>A2>B>A2B>A1>A1B

Lowest concentration of drug in patients blood stream:

Peak

Trough

A and B

None of the above

B. Trough

Feedback The trough level is the lowest concentration in the patient's bloodstream, therefore, the specimen should be collected just prior to administration of the drug. The peak level is the highest concentration of a drug in the patient's bloodstream.

Concentration of a substance is directly proportional to the amount of light absorbed or inversely proportional to the logarithm of the transmitted light:

Nernst equation

Beer's law

Boyle's law

NOTA

B. Beer's law

Which of the following is best used to visualize oval fat bodies and crystals?

Interference contrast

Phase contrast

Polarizing

Bright-field

C. Polarizing

Feedback Oval fat bodies contain lipids and may polarized and form maltese cross formation. They are best seen using polarizing microscope.

Urinalysis result shows the following:

RBC= 20-25/hpf

Hyaline cast- 6-8/hpf

WBC= 5-10/hpf

RTE Cells: 25-35/hpf

They are most likely indicative of:

Glomerulonephritis

Tubular necrosis

Pyelonephritis

Nephrotic syndrome

B. Tubular necrosis

Causative agent of pseudomembranous colitis?

C. perfringens

C. difficile

C. jejuni

All of the above

B. C. Difficile

Feedback Pseudomembranous colitis refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridium difficile (C. difficile) bacteria. This infection is a common cause of diarrhea after antibiotic use.

SC1-(37/LISS): 0 (Anti-IgG): +/-

SC2-(37/LISS): 0 (Anti-IgG): +/-

Use polyspecific AHG

Report as Negative

Report as Positive

NOTA

A. Use polyspecific AHG

Feedback Since most incomplete antibodies are IgG, polyspecific AHG serum contains anti-IgG. Because some IgG and IgM antibodies also cause C3 to attach to red cells, polyspecific AHG serum also contains anti-C3, which can cause C3-coated red cells to agglutinate

A gram stain from a blood agar shows gram positive cocci in chains, non-hemolytic. The bacteria grow on 6.5% NaCl and is Bile Esculin positive. What's the most likely identification?

Group D streptococcus

Enterococcus

Streptococcus pyogenes

Micrococcus

B. Enterococcus

Feedback Only Enterococcus can grow both 6.5% NaCl and Bile Esculin

Causative agent of Eye conjunctivitis:

C. trachomatis

H. ducreyi

L. monocytogenes

T. pallidum

A. C. trachomatis

Feedback Chlamydial conjunctivitis is treated with both antibiotic pills and eyedrops or ointment to kill the chlamydia in your body. Your sexual partner must also be treated. Usually you will get better after taking the antibiotics for 3 to 4 weeks. Treatment for a newborn is antibiotic ointment and IV antibiotics.

Polycythemia vera mutation?

ADAMS

JAK2

Rpp

Bcl/BCR

B. JAK2

Feedback Approximately 95% of all PV patients have a mutation of the JAK2 gene in their blood-forming cells. This mutation leads to hyperactive JAK (Janus kinase) signaling, causing the body to make the wrong number of blood cells.

Which of the following antigen/s is enhanced by enzymes?

Kidd, Rh

Lewis, P

ABO

All of the abov

A. All of the above

Feedback:

(KLARP) Kidd, Lewis, ABO, Rh and P antigens are enhanced by enzymes, MNS and Duffy antigens are destroyed by enzymes.

What is measured in the urease method determination of BUN?

Uricase

Urea

NAD

Nitrogen

C. NAD

Feedback Nicotinamide Adenine Dinucleotide (NAD) is being measured in the final step of urease method determination of BUN, it is measured at 340nm.

It is sometimes referred to as the "pork worm" due to it being typically encountered in undercooked pork products: Fig 11

Trichinella spiralis

Trichuris trichiura

Enterobius vermicularis

Taenia saginata

A. Trichinella spiralis

In HIV:

Increased Total Lymphocyte

Increased CD8

Decreased CD4

Normal CD8/CD4

C. Decreased CD4

Feedback A very low CD4 count (less than 200 cells/mm3) is one of the ways to determine whether a person living with HIV has progressed to stage 3 infection (AIDS).