051questions in

laboratories
From labce
‫وإجاباتهم مع تفسير لإلجابات‬
By drfatema saeed
(1) These cells tend to occur in tight clusters. They may have prominent nucleoli,
immature chromatin, and scant cytoplasm.

macrophages
lipocytes
tumor cells
megakaryocytes

Feedback

Tumor cells generally tend to occur in tight clusters and show prominent nucleoli,
immature chromatin, and scant cytoplasm.

(2) An important metallic activator of alkaline phosphatase and creatine kinase is

Iron
Zinc
Potassium
Magnesium
Nickel

Feedback

Magnesium is often employed as a reaction activator for certain enzymes in

commercial analytical test kits such as ALP and CK.

(3) The degree in which a measure is consistent in producing the same results when
measuring the same analyte is called:

Reliability
Validity
Accuracy
Concurrency

Reliability is a concept that shows the level of consistency of the results when running
the same test with the same method.

(4) In the laboratory, what biosafety level (BSL) safety equipment, practices, and
facility design are recommended by the Centers for Disease Control and Prevention
(CDC) for working with Mycobacterium tuberculosis if it is deemed probable that
aerosols might be released?

BSL-1

1
 BSL-2
BSL-3
BSL-4

Feedback

BSL-3 safety equipment, practices, and facility design are recommended by the CDC
if it is probable that aerosols might be released.
Non-aerosol-producing manipulations (eg, preparing direct smears for acid-fast
staining when done in conjunction with training and periodic checking of
competency) can be performed using BSL-2 practices and procedures, containment
equipment, and facilities.
BSL-1 is appropriate only for working with microorganisms not known to
consistently cause disease in healthy adult humans. The safety equipment, practices,
and facility design would not protect the worker or the environment against aerosol
transmission of infectious materials.
BSL-4 practices, safety equipment, and facility design are applicable for work with
dangerous and exotic agents that pose a high individual risk of life-threatening disease
for which there is no available vaccine or therapy. M. tuberculosis does not fit into
this category.

(5) Identify the white blood cell seen in this illustration:

Myelocyte
Neutrophil
Eosiniphil
Basophil

Feedback

Basophils have characteristic large prominent dark granule

(6) What is the MOST common infective agent to be transmitted through blood
transfusion that results in morbidity and mortality?

Bacteria
Human immunodeficiency virus (HIV)
Hepatitis A virus (HAV)
Malarial parasites

Feedback

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The most common infectious agent to be transmitted through blood transfusion is
bacteria. The estimated risk of contamination of blood components with bacteria is 1
in 5000 platelet units and 1 in 30,000 Red Blood Cell units.

For this reason, the inspections of red blood cell units that are done upon receipt of
blood from a supplier, immediately before use, and at defined intervals must include a
check for abnormal appearance. Comparison of bag and segment color should be
performed for red blood cell units to aid in detection of bacterially-contaminated
units. Storing Red Blood Cells above 6oC may promote the growth of bacteria.

Platelets that are stored at 20 - 24oC are a particular concern. It is a requirement that
platelet components be tested to detect the presence of bacteria.

The risk of transmission of HIV through blood transfusion is 1 in 2 million in the

United States. The statistics from Canada and Europe show this risk to be about the
same or less.

HAV is normally transmitted through the feco-oral route, but rarely can be
transmitted through blood.

The FDA recommends that donors who have a history of malaria be deferred from
donation for 3 years after becoming asymptomatic and for one year following return
from an area where malaria is endemic. The initial interview of donors has made the
transmission of malarial parasites through blood transfusion a rarity.

(7) Trichomonas, Giardia, and Chilomastix belong to the subphylum:

Sarcodina
Mastigophora
Ciliata
Sporozoa

Feedback

All of these organisms belong to the flagellates, also known as the mastigophora. The
flagellates move by means of flagella. Cysts and trophozoites are in some life cycles;
while only trophozoites are in others.

(8) Granulocyte Concentrates MUST be administered within ______ of collection.

12 hours
24 hours
3 days
30 days
35 days

Feedback

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Granulocytes should be transfused as soon as possible and always within 24 hours.

(9) MacConkey agar contains all of the following except :

Penicillin
Bile salts
Lactose
Crystal violet

Feedback

MacConkey Agar contains lactose for differentiation of enteric bacilli fermentation

and crystal violet and bile salts to inhibit gram positive organisms.

(10) C-reactive protein:

Is a highly specific test

Corresponds to serum complement levels
Is usually elevated in pediatric bacterial infections
Does not react with pneumococcal C-polysaccharide

Feedback

C-reactive protein was first found to precipitate pneumococcal C-polysaccharide in

patients who had recovered from pneumococcal pneumonia. It was subsequently
found to be elevated in numerous other conditions. It is often elevated in pediatric
bacterial infections, and usually not elevated in pediatric viral infections, and thus
may help the pediatrician to differentiate these entities. It can also be used to follow
the disease activity in autoimmune conditions.

(11) Which one of the following statements is FALSE?

Fever can have a direct effect on the growth or death of pathogenic

microorganisms.
Low pH of stomach, skin, and vagina can inhibit microbial growth.
Secretory cells of the innate immune system are antigen specific.
Oxygen tension can result in the death of microorganisms due to oxidation.

Feedback

The innate immunity system is inherent and nonspecific; meaning that all pathogens
are attacked similarly and are not antigen specific.

(12) Which of the following are not considered normal flora of the gastrointestinal
tract:

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 Lactobacillus
Clostridium
Peptostreptococcus
Shigella

Feedback

Shigella and Salmonella are not found as normal flora in the gastrointestinal tract.

(13) .

Red Cells Tested With Serum Tested With

Interpretation of ABO
Known Antisera Known Red Cells
Group
Anti-A Anti-B Anti-A,B A1 Cells B Cells
4+ 4+ 4+ 1+ 0 ?

Using the information provided above, select the correct ABO group.

AB
O
Inconclusive; could be A2B with anti-A1 in the serum; further testing is
necessary.

Feedback

The forward type in this case suggests type AB; however, in the reverse type there is
an unexpected presence of the anti-A1 antibody. This means that more testing must be
performed to identify why this antibody is present. One possible solution is that the
patient has an A antigen subtype. ABO reactions with reagent antisera and red cells
are generally strong (3 – 4+); weak reactions (less than 3+) should be investigated.

(14) Most individuals infected with the 2009 Influenza A H1N1 virus do not require
treatment.

True
False

Feedback

Most individuals infected with the 2009 Influenza A H1N1 virus do not require
treatment as the body is able to effectively produce an immune response against the
virus. In some individuals, such as those who may be hospitalized or those with
underlying conditions, may require

(15) Cells that stain positive with acid phosphatase, and are NOT inhibited with
tartrate, are characteristically seen in:

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 Infectious mononucleosis
Infectious lymphocytosis
Hairy cell leukemia
T-cell ALL
Leukomoid reactions

Feedback

Tartrate resistant acid phosphatase (TRAP) is a test performed on blood cells or bone
marrow to confirm a diagnosis of hairy cell leukemia. Hairy cells characteristically
display red staining granulation with the TRAP stain, while other leukocytes will not.
Hairy cells will also stain positive, like other types of leukocytes with regular acid
phosphatase stain.

(16) The Philadelphia chromosome is associated with which of the following blood
disorders?

chronic myelogenous leukemia

chronic lymphocytic leukemia
acute granulocytic leukemia
acute lymphocytic leukemia
polycythemia vera

Feedback

The Philadelphia chromosome is characterized by a translocation between

chromosome 9 and 22 and is strongly associated with chronic myelogenous leukemia,
or CML.

(17) Which are true statements regarding hospital-associated methicillin-resistant

Staphylococcus aureaus (HA-MRSA) and community-associated MRSA (CA-
MRSA)?

Resistance for both strains is conferred by the mecA gene.

HA strains tend to demonstrate resitance to more drug classes than CA strains.
CA tends to be associated with the PVL gene and skin and soft tissue infections.
All of the above.

Feedback

PBP2a, which has a reduced binding affinity for beta lactams, and remains active in
cell wall synthesis even in the presence of beta lactam antibiotics, is coded by the
mecA gene. Both HA and CA strains of MRSA possess the mecA gene, although CA

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strains typically possess a smaller variant of that gene. CA strains may be susceptible
to some antibiotics that HA strains are resistant to.

CA strains are also associated with the PVL gene, which code for enzymes that
produce tissue necrosis and leukocyte destruction.

(18) Barr bodies are usually classified as:

Pathological
Reactive
Non-pathological

Feedback

Barr bodies are the drumstick-shaped inactive X-chromosome that is found attached
to a nuclear lobe of some granulocytes in peripheral blood smears from females. This
morphologic change is considered non-pathological.

(19) The process resulting in the transformation of a cyst into a trophozoite is known
as:

Infection
Excystation
Encystation
Infestation

Feedback

The prefix "ex," is associated with the word "exit." In excystation, the cyst "exits" this
stage and transforms into the feeding trophozoite stage. This usually occurs following
ingestion and passage through the stomach of infective cysts.

(20) Which blood component is the most commonly used component for the
replacement of multiple coagulation factor deficiencies?

Fresh Frozen Plasma

Red Blood Cells
Cryoprecipitate
Whole Blood

Feedback

Fresh Frozen Plasma (FFP) is indicated for bleeding patients with multiple
coagulation factor deficiencies due to inadequate production, as in liver disease;
excessive consumption, as in disseminated intravascular coagulation (DIC); or

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dilution, as in massive transfusion, generally defined as the replacement of one or
more blood volumes in a period of 24 hours or less.

FFP is also indicated for non-bleeding patients with multiple deficiencies who are
undergoing invasive procedures. FFP is also used for reversal of warfarin therapy in
bleeding patients and for patients with congenital factor deficiencies for which no
concentrates are available.

(21) Whole blood glucose values are ____________ plasma glucose values.

Greater than
Lower than
Equal to

Feedback

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

(22) What are the possible ABO genotypes of offspring of parents whose genotype is
AA and BB:

AB
OA
OB
OO

Feedback

In this case, the only blood type inheritance possible is AB, as one parent (AA) has
given the A gene, and the other parent (BB) is giving the B gene.

(23) After performing an antibody panel and a selected cell panel, you still can't rule
out S and Fyb. It appears that the patient has anti-e and maybe anti-Jkb but they are
only reacting microscopically. What technique would be the best to do in order to
strengthen the antibodies and rule out the remaining antibodies?

Lui freeze thaw

Prewarm
Enzyme panel

8
 Saline replacement

Feedback

If an enzyme panel is used in this case, reactions would show enhancement of anti-e
and Jkb if they are present. Reactions should appear stronger than microscopic. S and
Fyb would most likely not react, even if present, since the antigens are destroyed or
weakened on the enyzyme treated cells.

Prewarm technique would only help if a cold antibody was suspected.

Lui Freeze thaw is performed in work ups for ABO hemolytic disease of the newborn
(ABO antibodies). Recovery of other antibodies is not as good with this method.

Saline replacement replaces excess protein in the sample with saline so that false
agglutination will not appear. This technique will not help in determining which
antibodies are present.

(24) A few dark blue staining granular inclusions located near the periphery of an
erythrocyte are most likely:

Pappenheimer bodies
Howell-Jolly bodies
Heinz bodies
Basophilic stippling

Feedback

Pappenheimer bodies appear as blue/purple cytoplasmic inclusions found in the

periphery of red blood cells. Pappenheimer bodies are composed of iron and protein
and can be found in various conditions including sideroblastic anemia

(25) The cell indicated by the arrow in this illustration is called:

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 Hair cell
Smudge cell
Megakaryocyte
Blast

Feedback

Smudge Cells (bare nuclei) are commonly seen in blood smears from patients with
chronic lymphocytic leukemia.

(26) Lipemia in a serum sample is most likely caused by an increase in serum levels
of:

Cholesterol
Triglycerides
Protein
Phospholipids

Feedback

Lipemia is generally caused by an increase in VLDL (very low density lipoproteins),

which are primarily composed of triglycerides.

(27) Which one of the following blood components would be MOST appropriate for a
9-yr old girl, with a low hemoglobin and low platelet count, who has bleeding gums

Packed red blood cells

Cryoprecipitate
Platelet Concentrate
Fresh Frozen Plasma

Feedback

If the patient has a low platelet count and is actively bleeding, a transfusion of platelet
concentrate would be recommended to potentially control bleeding due to
thrombocytopenia

(28) Which of the following cells is indicative of Hodgkin’s diseas

Niemann-Pick cells

11
 reactive lymphocytes
flame cells
Reed-Sternberg (RS) cells

Feedback

Reed-Sternberg cells are multinucleated and are very characteristically associated

with Hodgkin's disease. Hodgkin's disease is a white cell lymphoma which shows
lymph node involvement. Typically, this condition has a high survival rate with
treatment

(29) Serum calcitonin is typically elevated in which of the following conditions:

Medullary carcinoma of the thyroid

Hyperthyroidism
Glioblastoma
Adrenal adenoma

Feedback

Serum calcitonin is normally produced by the C cells of the thyroid. It functions to

reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with
a molecular weight of 3400, and has a half life of approximately 12 minutes. It is
characteristically elevated in medullary carcinoma of the thyroid. Since medullary
carcinoma often occurs as an autosomal disorder, family members of patients with
this condition should be screened for serum calcitonin.

(30) The peroxidase stain is useful in differentiating between which cells?

lymphocytic and granulocytic cells

monoblastic and myeloblastic cells
leukemoid reaction and myelocytic leukemia
eosinophils and neutrophils

Feedback

Peroxidase stain is an enzymatic stain based on the principle that peroxidase granules
in some neutrophils and in eosinophils will stain positive. Lymphocytes stain
negative with peroxidase stains.

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(31) Which are true statements regarding hospital-associated methicillin-resistant
Staphylococcus aureaus (HA-MRSA) and community-associated MRSA (CA-
MRSA)?

Resistance for both strains is conferred by the mecA gene.

HA strains tend to demonstrate resitance to more drug classes than CA strains.
CA tends to be associated with the PVL gene and skin and soft tissue infections.
All of the above.

Feedback

PBP2a, which has a reduced binding affinity for beta lactams, and remains active in
cell wall synthesis even in the presence of beta lactam antibiotics, is coded by the
mecA gene. Both HA and CA strains of MRSA possess the mecA gene, although CA
strains typically possess a smaller variant of that gene. CA strains may be susceptible
to some antibiotics that HA strains are resistant to.

CA strains are also associated with the PVL gene, which code for enzymes that
produce tissue necrosis and leukocyte destruction.

(32) Which one of the following statements about lipoproteins is FALSE:

Elevated LDL causes a decreased risk of atherosclerosis

Reduced LDL causes a decreased risk of atherosclerosis
Elevated HDL causes a decreased risk of atherosclerosis
Elevated total cholesterol causes an increased risk of atherosclerosis

Feedback

Increased LDL levels increase the risk of atherosclerosis. LDL can penetrate the
vascular endothelium and contribute to the creation of lipid foam, which forms the
core of an atherosclerotic plaque . Oxidized LDL cholesterol also triggers an
inflammatory process within the vessel wall that accelerates atherosclerosis.
Therefore, the answer which is false is A.

(33) The CDC Advisory Committee for Elimination of TB set an interim target for
2000 of 3.5 cases/100,000 population. This target was met.

True
False

12
 Feedback

The 2000 interim target was not met. The actual case rate in 2000 was 5.8 cases per
100,000 population.

(34) The hh genotype gives rise to:

H substance
H secretors
Bombay phenotype
h antibodies

Feedback

The Bombay phenotype denotes a lack of expression of the H antigen. This is

described as an hh genotype.

(35)
Based on the results for the laboratory test method that is shown below, what is
the specificity of this method?

44%
67%
88%
99%

Feedback

The specificity for this test method can be calcuated by entering the values given
into the formula below:

(40 true negatives) / (40 true negatives + 20 false positives) = 67%

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(36) The body of an adult cestode consists of segments called

Proglottids
Teguments
Sheaths
Scolices

Feedback

The outer surface of tapeworms and flukes is known as the tegument. Select
microfilariae keep their protective sheath following their emergence from the adults
and others do not. The anterior head region (scolex) contains suckers which allow the
organism to attach to the human intestinal wall.

(37) Which of the following terms is used to describe a sudden change in the quality
control data mean that persists throughout subsequent days of testing?

Coefficient of Deviation
Dispersion
Shift
Trend
Variance

Feedback

A shift is a sudden change in the quality control data mean that persists throughout
subsequent days of testing.Shifts can be caused by any number of reasons, including
persistent instrument malfunction, loss of calibration, or improper reagents

(38) When administering Fresh Frozen Plasma, which one of the following is
considered standard blood bank practice?

Should be ABO compatible with the recipient's red blood cells

Must be the same Rh type as the recipient
Is appropriate as a volume expander
Component should remain frozen when it is issued

Feedback

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FFP should be ABO compatible with the recipient's red blood cells, but does not need
to be the same Rh type as the recipient because it is a cell-free product. FFP should
not be used as a volume expander. It should be thawed prior to issue.

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

C
E
c
e

Feedback

Antigen frequency in whites: D = 84%, C = 70%, E = 30%. c = 80%, e = 98%.

(40) Zollinger-Ellison syndrome is characterized by a large (usually 20-fold) elevation

of:

cholecystokinin
pepsin
glucagon
gastrin

Feedback

Zollinger-Ellison syndrome, or ZES, is a rare disorder where one or more tumors in

the pancreas, duodenum cause the stomach to make too much gastric acid, leading to
peptic ulcers. Cholecystokinin plays a key role in facilitating digestion within the
small intestine and is not found in elevated levels in ZES. Pepsin is an enzyme that is
released by the chief cells in the stomach to degrade food proteins into peptides and is
not found in elevated levels in ZES. Finally, glucagon is a hormone involved in
carbohydrate metabolism which is also not associated with ZES.

(41) Which of the following terms would be used to express the middle value in a
series of results:

Mean
Median
Mode

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 Standard error

Feedback

Median is the middle value in a series of numbers

(42) The measurement of 17-ketosteroids in urine is performed to assess

PRIMARILY which organ(s)?

testes
adrenal cortex
adrenal medulla
anterior pituitary
testes and adrenal cortex

Feedback

17-ketosteroids are metabolites of testosterone and adrenal steroid hormones. The

majority of testosterone is produced in the testes and the adrenal cortex.

(43) Primary hemostasitic processes resulting from vascular damage include all of the
following EXCEPT:

collagen activates glycoprotein IIb/IIIa during platelet activation

von Willebrand factor mediates platelet adhesion
platelet granule release and fibrinogen mediate platelet aggregation
rapid vascular dilation occurs
b&c

Feedback

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

(44) A patient with alpha thalassemia, who is African American, most likely has
which form of the disorder?

Major

17
 Heterozygous minor
Homozygous minor
Intermedia

Feedback

The homozygous form of alpha thalassemia minor can be seen in African Americans.

The heterozygous form of alpha thalassemia minor and other alpha thalassemias is
more often seen in persons from Southeast Asia and the Mediterranean.

(45) Which immunoglobulin class is able to cross the placenta from the mother to the
fetus?

IgA
IgD
IgE
IgG
IgM

Feedback

Immunoglobulins of the IgG class are able to cross the placenta since they circulate as
monomers; thus they are small in size. The other types of immunoglobulins are too
large to cross the placental barrier, for example, IgM is a pentamer.

(46) This suspicious form, that measures 25 µm, was recovered in an eye sample. It is
associated with which of the following diseases?

None; considered as a non-pathogen

Amebic keratitis
African eye worm infection
River blindness

Feed back:
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The organism depicted here is an Acanthamoeba species cyst. In addition to infecting
the eye causing amebic keratitis, this organism is also known to invade the central
nervous system (CNS) and cause granulomatous amebic encephalitis. Patients
suffering from this condition may experience nausea, vomiting, stiff neck, headaches
and seizures.

(47) Which of the following reagent strip tests is based on the Ehrlich- aldehyde
reaction.

pH
protein
glucose
urobilinogen
specific gravity

Feedback

The urobilinogen reagent strip tests is based on the Ehrlich- aldehyde reaction. In this
test, a pink-red color forms in proportion to the amount of urobilinogen present.

(48) Which of the following infectious agents represent the greatest risk to the
laboratory worker:

AIDS
Meningitis
Hepatitis
Influenza

Feedback

While AIDS is a more serious health threat, hepatitis is far more prevalent, and
therefore represents a greater overall risk.

(49) Two sputum specimens were submitted to the Microbiology laboratory for
culture. A Gram stained smear was evaluated for each specimen prior to culturing.
The fields that are shown in these images are representative of the 20 - 30 low power
fields that were examined. Which one of the two results represents a sputum specimen
that is acceptable for culturing?

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 Gram stain A

(correct)
Gram stain B

Feedback

Gram stain A confirms that the sample was obtained from the lower respiratory tract.
There are few if any squamous epithelial cells (SQEs) present and there are many
polymorphonuclear cells (PMNs), indicating possible bacterial infection.

Many SQEs are present in Gram stain B, indicating a specimen that is contaminated
with oral microflora. If the specimen is determined to be a sub-optimal specimen, the
clinician should be contacted and a request should be made for a new specimen. It is
important to communicate that culturing the specimen that was provided will not yield
useful information about the possible pathogens from the lower respiratory tract.

(50) If a laboratory 's control range (using a 99.7 confidence interval) for a given
assay is 20.0 to 50.0, what would its means and one standard deviation be:

Mean = 35.0 SD = 15.0

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 Mean = 35.0 SD = 10.0
Mean = 40.0 SD = 7.5
Mean = 35.0 SD = 5.0

Feedback

The mean would be halfway between 20 and 50, or 35. The range for the assay is
within 15 units of the mean, representing 3 SD (equal to 99.7% confidence interval).
Therefore, 1 SD = 15/3 or 5.

(51) A negative glucose oxidase test and a positive test for reducing sugars in urine
indicates:

True glycosuria
A false-negative glucose oxidation reaction
The presence of a non-glucose reducing sugar such as galactose

Feedback

A negative glucose oxidase test and a positive test for reducing sugars in urine
indicates the presence of a non-glucose reducing sugar such as galactose, fructose,
glyceraldehyde, etc. This is the reason that certain patient populations require
additional confirmatory sugar testing on their urine samples.

(52) Which of the following electrolytes is most likely to be spuriously elevated in a

hemolyzed specimen:

Sodium
Potassium
Chloride
BUN

Feedback

Potassium has the highest RBC to serum concentration ratio: approximately 23:1.

(53) Determining the competency of testing personnel is a CLIA ’88 responsibility for
which of the following:

General supervisors

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 Laboratory Director
Manager of the Department of Pathology
Technical Supervisor

Feedback

Determining the competency of testing personnel is a CLIA ’88 responsibility for the
laboratory director. Proof of certification and degree completion via certificates and
diplomas are often required upon hiring to ensure competency.

(54) A microscopic examination of a normal urine pH 8.0 shows 2+ yellow-brown

thorny spheres which are MOST probably:

ammonium biurate crystals

ampicillin crystals
amorphous urate crystals
crenated red cells
waxy casts

Feedback >Ammonium biurate crystalsare typically round, irregularly spiked and

yellow-brown in color.

(55) I am 12 µm in size and reside in stool. I may be easily missed since I tend to
"blend-in" with fecal debris.

Entamoeba coli cyst

Endolimax nana trophozoite
Retortamonas intestinalis cyst
Dientamoeba fragilis trophozoite

Feedback

The trophozoites of Dientamoeba fragilis are the only protozoan trophozoites that
contain two nuclei (versus one in the other trophozoites), each made up of 4 to 8
chromatin dots.-

(56) A test for microalbuminuria is used most often to monitor patients with which of
the following diseases or conditions?

Diabetes

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 Bacterial infection
Multiple myeloma

Feedback

Tests for microalbuminuria are used most often to monitor patients with type 1 or type
2 diabetes.

(57) Which of the following molds is classified as a zygomycete

Microsporum nanum
Cunninghamella species
Trichophyton schoenleinii
Epidermophyton floccosum

Feedback

Cunninghamella species are zygomycetes. Microsporum nanum, Trichophyton

schoenleinii and Epidermophyton floccosum are all species of dermatophytes.

(58) On sheep blood agar Haemophilus influenzae may exhibit satellite formation
around all but which of the following organisms:

Pseudomonas
Neisseria
Staphylococcus
Pneumococcus

Feedback

Neisseria, Staphylococcus, and Pneumococcus produce enough V factor to allow H.

influenzae to grow on blood agar near their colonies; however, Pseudomonas does
not. This property is utilized in the "satellite test" technique whereby minute colonies
of Haemophilus are seen in the hemolytic zone surrounding a streak of
Staphylococcus aureus on sheep blood agar, providing a presumptive identification of
Haemophilus.

(59) A secondary immune response is generally associated with which of the

following antibodies:

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 IgG
IgA
IgM
IgD

Feedback

The secondary or anamnestic response has a short lag phase, typically with higher
titers than the primary immune response. IgG predominates.

(60)

A patient with an infectious mononucleosis infection presents in the emergency room.

Physicians order a spinal tap which is immediately sent to the laboratory for review.
Please identify the cell in the image below from this patient's cerebrospinal fluid
sample.

Reactive Lymphocyte
Monocyte
Macrophage
Mesothelial Cell

Feedback

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

(61) Cells as shown in this iron-stained bone marrow preparation are found in each of
the following conditions except:

Alcohol abuse
Chloramphenicol therapy
Iron deficiency anemia
Thalassemia

Feedback

The iron staining particles surrounding the nucleus of red blood cells make for ringed
sideroblasts. Iron has accumulated in mitochondria of erythroblasts. Primary
sideroblastic anemia may be a component of neoplastic myelodysplasia. Ringed
sideroblasts may appear in impaired production of protoporphyrin following drug
toxicities, chronic alcoholism, lead poisoning, and the use of certain antibiotics,
particularly chloramphenicol. Conditions of defective globin synthesis, including
thalassemia, may promote sideroblast formation. Although the red cells in
sideroblastic anemia are hypochromic, this condition is not primarily iron deficiency .
Marrow iron is actually overabundant.

(62) You have just performed stat PT and aPTT tests on your coagulation instrument.
Your results are as follows:

PT = 12 seconds (normal range 10-13 seconds)

aPTT = 24 seconds (normal range 21-34 seconds)

What would be your next step

Perform a mixing study

Report the results

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 Request a redraw of the specimen

Feedback

The results of this PT and aPTT are in normal range. These results can be reported
and are not indicative of the need to: order a mixing study or request a redraw

(63)

Identify the large, foamy cells in the joint fluid image

shown to the right.

Macrophage
Bronchial lining cells
Tumor clump
Synovial lining cells

Feedback

The large foamy cells in the joint fluid are synovial

lining cells.

(64) What is the site used most frequently in the adult patient when performing a bone
marrow biopsy

Vertebrae
Sternum
Clavicle
Iliac crest

Feedback

Bone marrow specimens are usually obtained in adults from the posterior iliac crest.
They may also be obtained from the sternum.

(65) Which of the following is NOT an expected or common laboratory finding in

patients with hereditary hemochromatosis (HH)?

Elevated hemoglobin and hematocrit

Elevated transferrin saturation

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 Presence of HFE mutation
Elevated serum ferritin

Feedback

Typical laboratory findings in HH include elevated transferrin saturation, elevated

serum ferritin, and presence of an HFE mutation. Elevated hemoglobin and
hematocrit are not typically associated with HH.

(66) In addition to a Romanowsky stain, which one of the following would be useful
in the routine evaluation of a bone marrow

Chloroacetate esterase
Periodic acid-Schiff (PAS)
Prussian blue
Sudan black B

Feedback

Prussian blue stains can be used in bone marrow smears to evaluate for iron storage in
the normoblasts.

(67) Antihuman globulin (AHG) enables sensitized red cells to cross-link so that
agglutination is visible

True
False

Feedback

The mode of action of AHG is to join red cells that have the antigen antibody
complex attached to the surface. When AHG is added, the anti human globulin
attaches to the antigen-antibody complex and links with other cells that have this
attachment. Visible agglutination occurs when they are joined.

(68) I am found in stool and measure 33 µm in diameter.

Diphyllobothrium latum egg

Taenia species egg

27
 Hookworm egg
Dipylidium caninum egg packet

Feedback

The eggs of Taenia species may be identified by the presence of a typical hexacanth
embryo that is protected by a radially striated shell. Dipylidium eggs have similiar
characteristics but group together into egg packets each surrounded by a packet
membrane. Hookworm and Diphyllobothrium eggs have different morphologic
characteristics

(69) What is the primary functional unit of the kidney:

Ureter
Glomerulus
Nephron
Distal convoluted tubule

Feedback

The nephron, the basic functional unit of the kidney, consists of a glomerulus, the
proximal convoluted tubule, the loop of Henle, the distal convoluted tubule, and the
excretory duct.

(70) Which unit contains the proper number of platelets from a random donor?

3.8 x 1010
4.0 x 1010
4.5 x 1010

28
 5.8 x 1010

Feedback

Platelet concentrates are required to have a minimum of 5.5 x 1010 platelets/unit.

Random donor platelet concentrates typically contains between 5.5 and 8.5 X 1010
platelets suspended in about 50 mL of plasma. This is approximately 70% of the
platelets which were present in the original unit of whole blood collected by the
donor.

(71) Which of the following action describes the MAJOR property of antidiuretic
hormone?

acts on proximal tubules.

changes distal tubule water permeability
Acts on Na/K/(H‘) pump
cannot be affected by diuretics
controls thirst

Feedback

Antidiuretic hormone, or ADH, has the important role of conserving body water by
reducing the loss of water in urine by changing the water permeability of the distal
tubule and collecting duct. An increase in ADH causes a concentrated urine since the
water is retained and absorbed through the permeable membrane. An decrease in
ADH causes the collecting ducts to retain very little water, instead it is excreted as
urin-

(72) EDTA and Sodium citrate combine with _________ to inhibit coagulation in
blood samples.

Potassium
Calcium
Magnesium
Sodium

Feedback

Calcium is bound by EDTA and Sodium citrate to inhibit coagulation processes from
occuring in the tube. When the sample is being tested in the coagulation laboratory,
the anticoagulant complexes with calcium are overcome by adding small amounts of
calcium back until anticoagulant is overcome and the clotting endpoint can be formed
for measurement purposes

29
(73) Table VIII
Creatinine levels in mg/dL for 21 healthy hospital employees

.87 .98 .93 1.04 .86 .90 1.05

1.08 .84 .97 1.12 .95 .96 1.02
1.01 .93 .91 .98 .99 .94 1.04

What is the median of these data?

The correct answer is highlighted below

.95 mg/dL
.96 mg/dL
.97 mg/dL
.98 mg/dL

Feedback

The median is represented by the data point which falls in the center of the data set
when organized from smallest value to largest value.
the data points arranged from smallest to largest are:
84, 86, 87, 90, 91, 93, 93, 94, 95, 96, 97, 98, 98, 99, 101, 102, 104, 104, 105, 108, 112
In this case, the median is .97 mg/dL.

(74) Which of the following species or organisms is the most likely to be the cause of
mycotic keratitis (fungal eye infection)?

The correct answer is highlighted below

Fusarium species
Trichophyton rubrum
Scedosporium apiospermum
Aspergillus niger

Feedback

Fusarium species is the most likely associated with mycotic keratitis.

Trichophyton rubrum is a dermatophyte that commonly causes an itching, scaling skin

infection of the feet, known as tinea pedis. Scedosporium apiospermum is commonly
associated with sinusitis. Aspergillus niger typically causes otitis externa and can also
be associated with sinusitis.

(75) What should be done if all forward and reverse ABO results are NEGATIVE?

31
 perform additional testing with anti-A1 Lectin and anti-A,B
incubate at room temperature or 4°C to enhance weak expression
perform testing with new reagents and retype
perform an antibody screen
use LISS for cell suspensions

Feedback

If ABO reactions are missing, repeat testing with extended incubation at room
temperature or 4oC is recommended. ABO antigen expression may be weakened in
some disease states.

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

It is a sensitive indicator of iron deficiency

Elevation of serum ferritin is specific for hemochromatosis
It is synonymous with transferrin
It is a better test for bone marrow iron stores than a Prussian blue stain of
marrow particles

Feedback

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

(77) An alpha-hemolytic, catalase negative, gram-positive coccus from a wound

culture gave these additional results:

A disc negative
Bile esculin hydrolysis positive
CAMP negative
Na hippurate hydrolysis negative
PYR positive

Which of the following would be the MOST probable identification?

Streptococcus pyogenes
Streptococcus agalactiae
Enterococcus species
Streptococcus group D
Aeromonas hydrophila
31
Feedback

Considering the desription of the pathogen in the above question, Enterococcus

species is the best answer. Enterococcus is A disc negative, bile esculin hydrolysis
positive, CAMP negative, Na hippurate hydrolysis negative, and PYR positive. The
PYR test is particularly helpful in differentiating Strep group D from Enterococcus
species.

(78) This suspicious form measures 18 µm and was seen in stool. Name that parasite!

Chilomastix mesnili
Iodamoeba butschlii
Pseudoparasite
Dientamoeba fragilis
Feedback

Iodamoeba butschlii is characterized by its size, shape, single nucleus and absence of
peripheral chromatin. The trophozoite pictured here has a typical glycogen-filled
vacuole, a characteristic also helpful in identifying the organism

(79) Which one statement about Standard Precautions is most correct?

Standard Precautions means to treat all patients as if they were infectious.

Standard Precautions means to treat blood, all body fluids, all secretions (except
sweat), all excretions, non-intact skin, and mucous membranes as if they were
infectious.
Standard Precautions do not apply to feces or urine.
Standard Precautions do not apply to pleural fluid or semen.

Feedback

The second choice is correct. Standard Precautions means to treat blood, all body
fluids, all secretions (except sweat), all excretions, non-intact skin, and mucous
membranes as if they were infectious. The purpose of this rule is to ensure the safety
of and to protect those who come into contact with potentially infectious material.

(80) The eggs of this parasite arrange themselves in membrane-enclosed clusters

known as packets:

Hymenolepis nana
Diphyllobothrium latum
Dipylidium caninum
Taenia species

Feedback
32
The egg packets of Dipylidium caninum consist of approximately 5 to 30 eggs. Each
egg resembles the typical six-hooked onchosphere. Radial striations are not present.
The membrane keeps the eggs together.

(81) Metabolic acidosis is characterized by:

Increased pCO2
Hypoventilation
Low pH
High pH

Feedback

Metabolic acidosis is the result of either: 1) accumulation of abnormal levels of

organic acids, often secondary to diabetic ketoacidosis, or lactic acidosis, 2) excessive
loss of bicarbonate as in severe diarrhea, or 3) reduced excretion of acids as in renal
failure. All these conditions result in a decrease in pH. The body compensates by
hyperventilating, and lowering pCO2, in an attempt to restore normal pH, resulting in
a compensated or partially compensated metabolic acidosis.

(82) Which of the following statements about Rickettsia is false:

They are obligate intracellular parasites

They are gram negative bacilli
Associated diseases are usually diagnosed by serology
They are cultured in many hospital laboratories

Feedback

Various Rickettsial species cause typhus, Rocky Mountain spotted fever,

Rickettsialpox, and Q fever. Rickettsial organisms are cultured only by research and
reference laboratories, and the diagnosis is usually achieved by a combination of
clinical findings, and acute and convalescent serology. Early diagnosis of Rocky
Mountain spotted fever can also be made by immunoflourescence testing of a skin
biopsy, where Rickettsia can often be found within endothelial cells of capillary
vessels.

(83) Which bacterial species is a common agent of neonatal bacteremia?

Streptococcus pyogenes
Listeria monocytogenes
Staphylococcus aureus
Enterococcus faecium

33
Feedback

Listeria are non-capsulated, non-acid-fast, ß-hemolytic, gram-positive bacilli that

have a characteristic tumbling motility. They are found primarily in the environment
and in the human GI tract. Since L. monocytogenes multiplies intracellularly, control
of listeriosis requires cell-mediated immunity; thus, immunocompromised patients
(such as newborns) are at high risk.

(84) The most common Rh haplotype among whites is:

Dce
DCe
DcE
dce

Feedback

Dce is found in 4% of whites and 44% of blacks. DCe is found in 42% of whites and
17% of blacks. DcE is found in 14% of whites and 11% of blacks. dce is found in
37% of whites and 26% of blacks.

(85) Identify the urine sediment elements shown by the arrow:

Cylindroids
Mucus threads
Hyaline casts
Budding yeast

Feedback

Mucus thread appear as long, thin ribbon like threads that are generally transparent.
They are normal in small numbers in the urine

(86) All of the following are characteristics of Type II diabetes mellitus EXCEPT:

Insulin levels may or may NOT be abnormal.

more common than Type I diabetes.
requires insulin therapy to control hyperglycemia.
associated with obesity and more common in persons greater than 40 years old.
a and d

34
Feedback

In type I diabetes mellitus, patients have deficiency in producing insulin from the beta
cells in the islets of Langerhans of the pancreas. In this type of diabetes, patients are
often given exogenous insulin therapy to control hyperglycemia. Type II diabetes
mellitus involves the body's unresponsiveness to insulin, in which exogenous insulin
therapy does not commonly treat the condition.

(87) An isolate of S. pneumoniae from a respiratory specimen gave a zone of

inhibition of 18mm around a 1 ug oxacillin disk using the disk diffusion test. What
should the next step be?

Report the isolate as penicillin sensitive

Report the isolate as penicillin resistant
Set up an MIC on the isolate
Report the isolate as moderately susceptible

Feedback

The zone criteria for the detection of penicillin susceptibility with the 1-µg oxacillin
disk is a zone size of =20 mm for suseptible strains. For zones =19 mm, since strains
of pneumococci with this characteristic can be either sensitive, intermediately
resistant, or resistant to penicillin, a quantitative method is indicated (such as running
a MIC).

(88) The abnormal cells indicated by the arrows in this illustration are indicative of

Sickle cell disease

Vitamin B12 deficiency
Severe burns
Iron deficiency

Feedback

Cells seen here are sickle cells or drepanocytes.

(89) Which immunoglobulin class is able to cross the placenta from the mother to the
fetus?

IgA
IgD
IgE

35
 IgG
IgM

Feedback

Immunoglobulins of the IgG class are able to cross the placenta since they circulate as
monomers; thus they are small in size. The other types of immunoglobulins are too
large to cross the placental barrier, for example, IgM is a pentamer.

(90) The red cell inclusions in this split frame photomicrograph of peripheral smears
(Wright's and Prussian Blue) are called:

Howell -Jolly bodies

Basophilic stippling
Malarial ring forms
Pappenheimer bodies

Feedback

The intended response is "D". These inclusions are Pappenheimer bodies and the
erythrocytes containing them are called siderocytes. In Wright-stained smears the
inclusions stain blue . The granules stain positively with the Prussian blue iron stain,
as shown in the lower photograph. These inclusions are larger than the fine granules
seen in basophilic stippling. Howell-Jolly bodies are larger, spherical, non-refractile
inclusions, and malarial ring forms are larger and distinctly ring-shaped, occupying up
to 1/5 of the red cell diameter

(91) Serum calcitonin is typically elevated in which of the following conditions:

36
 Medullary carcinoma of the thyroid
Hyperthyroidism
Glioblastoma
Adrenal adenoma

Feedback

Serum calcitonin is normally produced by the C cells of the thyroid. It functions to

reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with
a molecular weight of 3400, and has a half life of approximately 12 minutes. It is
characteristically elevated in medullary carcinoma of the thyroid. Since medullary
carcinoma often occurs as an autosomal disorder, family members of patients with
this condition should be screened for serum calcitonin.

(92) Which analyte measurement is used to detect early nephropathy in a diabetic

patient?

Lactic acid
Microalbumin
Ketones
HbA1C

Feedback

The detection of small concentrations of albumin (microalbumin) in the urine is used

to detect early renal impairment.

(93) Multiple ring forms are most frequently seen in which Plasmodium?

falciparum
vivax
malariae
ovale
barundi

Feedback

Multiple ring forms are most frequently seen in Plasmodium falciparum. The
trophozoite develops into a schizont made up of multiple ring forms (also known as
merozoites) via schizogony, or asexual replication. The schizont then matures which
causes the rupture of the erythrocytes- releasing merozoites into the circulation which
in turn infect other erythrocytes

Neutrophil 37
 Monocyte (94) Please identify the illustrated leukocyte .

Lymphocyte
Basophil
Eosinophil
Platelet

The cell illustrated in the image on the right is a lymphocyte. Lymphocytes typically
have a round, darkly staining nucleus with a scant amount of blue cytoplasm
surrounding the nucleus.

(95) Which of the following reagent strip tests is based on the Ehrlich- aldehyde
reaction.

pH
protein
glucose
urobilinogen
specific gravity

Feedback

The urobilinogen reagent strip tests is based on the Ehrlich- aldehyde reaction. In this
test, a pink-red color forms in proportion to the amount of urobilinogen present

(96) Which of the following fungal infections is endemic in the southwestern US

desert regions?

Histoplasmosis
Blastomycosis
Coccidioidomycosis
Sporotrichosis

Feedback

Coccidioidomycosis is strictly endemic in the southwestern US desert regions.

The geographic distribution of blastomycosis in the United States tends to be centered

more in the upper Mississippi river drainage system and adjacent tributaries.

38
Histoplasmosis is more concentrated in the lower Mississippi river valley and
adjacent tributaries and, sporotrichosis has a broad geographic distribution, sparing
only the higher western mountainous regions.

(97) The term TITER ( as it applies to the measurement of antibodies) is best defined
as:

Concentration of antibody in the serum

Maximum reactive dilution X 100
Maximum reactive dilution / 100
Reciprocal of maximum reactive dilution

Feedback

A specimen with a last reacting tube containing a 1:100 dilution, would be said to
have a titer of 100.

(98) In the Westgard system for evaluating control values, which one of the following
is NOT a rule for rejecting the run?

12s
22s
41s
R4s

Feedback

The 12s rule states that one control value is outside a 2 standard deviation limit.
Failure of this rule does not always indicate an analytical error has occurred, and can
be indicative of random error. In most cases, the next control result should pass this
rule.

(99) The cell diameter of a normal RBC is slightly smaller than the nucleus of a small
lymphocyte.

True
False

Feedback

Normal red blood cells are round, biconcave, and measure about 6-8 µm in diameter.
Their size can be compared to the nucleus of a small lymphocyte. This is a good way
to estimate RBC shape on a peripheral smear if the MCV is not available.

(100) Which one of the following does NOT have capsular material as a defense
mechanism?

39
 H. influenzae
K. pneumoniae
N. meningitidis
S. aureus
S. pneumoniae

Feedback

S. aureus does not have capsular material as a defense mechanism. H. influenzae, K.

pneumoniae, N. meningitidis, and S. pneumoniae each have capsular material use as a
defense mechanism. This capsular material is an antiphagocytic substance which
helps deter bacterial death by macrophages and other white blood cells.

(101) Which of the following organisms is best visualized by use of a darkfield

microscope:

Campybacter
Entamoeba
Borrelia
Streptococcus

Feedback

Spirochetes such as Borrelia and Treponemes are best visualized using darkfield
microscopy. Borrelia, which causes Relapsing fever, can be visualized under darkfield
microscopy of wet preps of peripheral blood. Treponema can be visualized by
darkfield microscopy of early primary lesions, and aspirates of affected lymph nodes.

(102) Increased concentrations of alpha-fetoprotein (AFP) in adults are MOST

characteristically associated with:

hepatocellular carcinoma
alcoholic cirrhosis
chronic active hepatitis
multiple myeloma

Feedback

Alpha-fetoprotein is a substance typically used in the triple test during pregnancy and
for screening chronic liver disease patients for hepatocellular carcinoma

(103) The Philadelphia chromosome is associated with which of the following blood
disorders?

41
 chronic myelogenous leukemia
chronic lymphocytic leukemia
acute granulocytic leukemia
acute lymphocytic leukemia
polycythemia vera

Feedback

The Philadelphia chromosome is characterized by a translocation between

chromosome 9 and 22 and is strongly associated with chronic myelogenous leukemia,
or CML.

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

oxidase test
esculin test
catalase test
citrate test
indole test

Feedback

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

(105) These test results are most consistent with which of the following types of beta
thalassemia?

Test Patient Result Reference Intervals (Adult female)

Red blood cell (RBC) count 5.6 x 1012/L 4.1 - 5.1 x 1012/L
Hemoglobin (Hb) 11.2 g/dL 12.3 - 15.3 g/dL
Hematocrit (HCT) 34.5% 35.9 - 44.6%
RDW 14.0 <14.5

RBC morphology- Microcytes, basophilic stippling, codocytes present.

Beta thalassemia minima

Beta thalassemia minor
Beta thalassemia intermedia
Beta thalassemia major

41
Feedback

These test results are most consistent with beta thalassemia minor. RBC count is
increased, hemoglobin may be decreased or normal, but is relatively decreased for the
number of RBCs that are present. There is also a marked decrease in the MCV and the
MCHC, but the RDW is usually normal. Codocytes and microcytes are common and
basophilic stippling is possible.

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

It is a sensitive indicator of iron deficiency

Elevation of serum ferritin is specific for hemochromatosis
It is synonymous with transferrin
It is a better test for bone marrow iron stores than a Prussian blue stain of
marrow particles

Feedback

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

(107) When antigen typing, mixed-field agglutination (MFA) due to red cell
transfusion indicates RECENT transfusion, specifically transfusion within the past
three months.

True
False

Feedback

MFA due to transfusion does not occur in patients transfused more than three months
ago because the maximum life span of red cells is 120 days.

Transfused donor cells will have an even shorter life span in vivo because some of
them will have died during storage of the blood component

(108) The accepted interval between blood donations is:

12 weeks
8 weeks
6 weeks
Depends on hematocrit level

Feedback

42
The mandatory waiting period between blood donations is 56 days, or eight weeks.

(109) At least three antigen-positive red cells that react and three antigen-negative
cells that do not react are required to identify an antibody with acceptable statistical
significance.

True
False

Feedback

This statement is false. Three positives and three negatives are required to identify an
antibody with acceptable statistical significance (a p value of <0.05) ONLY if you
have a panel of only 6 cells.
For example, a 10-cell panel with eight antigen-positive cells that react and two
antigen-negative cells that do not react, will generate acceptable statistical
significance (a p value of <0.05). In this case the p value is 0.02.
An outcome of statistical significance is an outcome that is more than what you could
reasonably attribute to chance. The shorthand way of stating statistical significance is
p < 0.05, where p represents probability. This literally means that the probability is
less than 5 out of 100, or less than 1 out of 20, that the results were due to chance.
In antibody identification, a p value of <0.05 can be interpreted as meaning that the
same results produced by another antibody or cause would be expected to occur by
chance alone less than one in 20 times, or less than 5% of the time (p<0.05), given the
number of cells tested. By scientific tradition, this is an acceptable level of
uncertainty.
Statistical significance begins when the threshold of 0.05 is crossed. Therefore a p
value of 0.02 is statistically significant, as it suggests the likelihood is 2 out of 100 (1
out of 50) that the findings were due to chance. In the 10-cell panel example, the
results were statistically significant, even though only two antigen-negative cells did
not react.
(110) The cell indicated by the arrow in this illustration is called :

Hair cell
Smudge cell
Megakaryocyte
Blast

Feedback

Smudge Cells (bare nuclei) are commonly seen in blood smears from patients with
chronic lymphocytic leukemia.

(111)How many microns are equivalent to one ocular micrometer at 40x given the
following information:

43
stage micrometer: 0.4
ocular micrometer: 53

5
0.50
7.5
0.75

Feedback

The following formula is required to determine the number of µm equivalent to each

ocular unit:

(number of stage micrometer units X 1000) µ / (number of ocular micrometer units)

Inserting the values given in this question: (0.4 X 1000) µ / 53 = 7.5 µm

Therefore, each ocular unit = 7.5 µm

(112) A characteristic of a good cardiac biomarker is that it is normally present in a

HIGH concentration in the peripheral blood.

True
False

Feedback

A biomarker that is a good indicator of cardiac damage is normally in low

concentrations in peripheral blood.

(113) Which one of the following RBC inclusions can be visualized with Supravital
stain but CANNOT be detected on a Wright's stained blood smea

Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Auer rods

Feedback

Heinz bodies are composed of denatured hemoglobin and are only observable on
supravitals stains, hence they are not seen on a wright-stained peripheral smear.

(114) Which one of the following RBC inclusions can be visualized with Supravital
stain but CANNOT be detected on a Wright's stained blood smear?
44
 Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Auer rods

Feedback

Heinz bodies are composed of denatured hemoglobin and are only observable on
supravitals stains, hence they are not seen on a wright-stained peripheral smear.

(115) The ultimate end product of both epinephrine and norepinephrine metabolism
is:

metanephrine
vanillylmandellic acid (VMA)
homovanillic acid (HVA)
cortisol

Feedback

Vanillylmandelic acid (VMA) is a metabolite of the catecholamines, epinephrine and

norepinephrine. VMA is found in the urine, along with other catecholamine
metabolites, including homovanillic acid (HVA), metanephrine and normetanephrine.
Urinary VMA is elevated in patients with tumors that secrete catecholamines

(116) What is the primary target of HIV?

The correct answer is highlighted below

Heart
Liver
Lungs
T-helper cells

Feedback

The HIV virus attacks the human T-helper cells (and those which are CD4+). Patients
suffering from HIV infections, have functional CD4+ T cells populations fall, which
leads to the acquired immune deficiency syndrome (AIDS).

(117) Which one of the following statements about iron deficiency anemia is false:

It is the most common cause of anemia in children from 6 months of age to 24

months of age
45
 The iron stores present at birth persist for about 4 to 6 months
An average adult male has body iron stores of about 1 gram, and is very unlikely
to become iron deficient in the absence of chronic bleeding
Platelet count in iron deficiency is usually decreased

Feedback

The platelet count in iron deficiency is often increased.

(118) Which beta thalassemia shows no anemia and may not be detected using
hemoglobin electrophoresis?

Beta thalassemia minima

Beta thalassemia minor
Beta thalassemia intermedia
Beta thalassemia major

Feedback

Beta thalassemia minima (silent carrier) shows no anemia and may not be detected
using hemoglobin electrophoresis. The silent carrier state of beta thalassemia, Bsc/B,
involves one minor beta chain deletion or mutation. This state produces such a small
drop in the level of beta chain synthesis that the alpha to beta chain ratio remains at a
near normal state.

Hemoglobin A levels remain normal (95% or higher).

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

False positive
False negative
No reaction at all
Mixed field reaction

Feedback

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

(120) Low values of plasma ceruloplasmin are MOST associated with:

Hepatolenticular regeneration
High plasma copper values

46
 Hypoparathyroidism
Kidney stones

Feedback

Ceruloplasmin is the main copper transporting protein in the blood. Although there
are other conditions (not listed) that can cause a low ceruloplasmin value (i.e.,
Menkes disease, Wilson’s disease, overdose of Vitamin C), the best answer of those
given for this question is “High plasma copper values.

(121) Shown in theimage are three tubes: (1) motility agar (note subsurface flare
shown by arrows); (2) esculin hydrolysis (+), and (3) VP (+). The reactions illustrated
here are sufficient to rule out Erysipelothrix rhusiopathiae. The correct answer is
highlighted below

True
False

Feedback

Erysipelothrix rhusiopathiae may have colony and Gram stain features similar to that
of Listeria monocytogenes. However, L. monocytogenes is motile (optimum at room
temperature or 25C), hydrolyzes esculin (black), and gives a positive VP reaction
(red). E. rhusiopathiae is negative for all these tests. E. rhusiopathiae produces H2S
in Kligler and Triple Sugar Iron Agar while L. monocytogenes does not.

(122) Safety regulations in the clinical laboratory fall under which government
agency?

Centers for Disease Control

Environmental Protection Agency
Food and Drug Administration
Occupational Safety and Health Administration
College of American Pathologists

Feedback

Safety regulations in the clinical laboratory fall under the Occupational Safety and
Health Administration (also known as OSHA). According to OSHA, "OSHA,
recognizing the unique characteristics of the laboratory workplace, has tailored a
standard for occupational exposure to hazardous chemicals in laboratories. This
47
standard is often referred to as the "Laboratory Standard". Under this standard, a
laboratory is required to produce a Chemical Hygiene Plan which addresses the
specific hazards found in its location, and its approach to them. Laboratory hazards
are addressed in specific standards for the general industry."

(123) Each of the following has been shown to induce platelet aggregation except:

Epinephrine
Serotonin
Aspirin
Thrombin

Feedback

Aspirin has been shown to inhibit platelet function

(124) The major crossmatch is performed using:

Donor’s serum and recipient’s red cells

Donor's serum and recipient’s serum or plasma
Donor’s red cells and recipient’s serum or plasma
Donor's red cells and recipient's red cells

Feedback

Crossmatch procedures involve recipient serum or plasma (containing antibodies)

tested with donor red blood cells to ensure compatibility of the cells prior to
transfusion.

(125) Which of the following scenarios represents appropriate detection of MRSA by

the Kirby Bauer method?

MHA medium; direct colony suspension; 37oC; cefoxitin disk; 24 hour

incubation
MHA medium; direct colony suspension; 35oC; oxacillin disk; 24 hour
incubation
MHA medium; direct colony suspension; 35oC; cefoxitin disk; 18 hour
incubation
MHA medium; direct colony suspension; 35oC; cefoxitin disk; 24 hour
incubation

Feedback

Mueller Hinton agar is the standard medium for Kirby Bauer testing on
Staphylococcus isolates. The direct colony suspension method, utilizing a 0.5
McFarland standard, should be used to prepare the inoculum. A full 24 hour
incubation is required. A 30 ug cefoxitin disk is recommended to detect mecA
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mediated resistance. Incubation above 35°C may not allow for the detection of
resistance.

(126) Essential components of compatibility testing include all of the following

except :

Antibody screen on recipients serum

Major crossmatch or computer crossmatch
ABO and Rh typing of recipient
Direct Antiglobulin Test (DAT)

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AABB Standards do not require a DAT, autologous control, or a minor crossmatch

for pretransfusion testing.

(127) Which of the following terms is used to describe a sudden change in the quality
control data mean that persists throughout subsequent days of testing?

Coefficient of Deviation
Dispersion
Shift
Trend
Variance

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A shift is a sudden change in the quality control data mean that persists throughout
subsequent days of testing.Shifts can be caused by any number of reasons, including
persistent instrument malfunction, loss of calibration, or improper reagents.

(128) Which of the following tests would you employ to examine a CSF for syphilis:

RPR
VDRL
Both
Neither

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The VDRL is the only non-treponemal test approved by the CDC for CSF.

(129) Which of the following non-HbS hemoglobins can also sickle and show a
positive solubility test?

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 HbC Harlem
HbD LosAngeles
HbG Philadelphia
HbO Arab

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Rare hemoglobins, such as HbC Harlem, that also cause RBCs to sickle may produce
a positive solubility test. For this reason, an alkaline electrophoresis is also necessary
to confirm the presence of HbS and to differentiate between SS and SA. Other testing
may also be required to differentiate other suspected hemoglobins.

(130) Which of the following factors is not involved in the initial contact phase of the
intrinsic pathway:

Factor XII
Fitzgerald Factor (high-molecular weight kininogen)
Fletcher Factor (prekallikrein)
Factor X

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Fitzgerald and Fletcher Factors are required to complete activation of Factor XII
during the contact phase.

(140) The primary mechanism responsible for glomerular filtration

Osmotic gradient
Concentration of blood components
Rate of blood flow through the kidneys
Hydrostatic differential in glomerular tufts

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The hydrostatic pressure in the capillaries of the glomerular tuft drives the filtrate
across their semipermeable membrane. The normal glomerular filtrate is similar in
composition to the plasma, with the exception that molecules with a molecular weight
of greater than about 15,000 are not filtered.

(141) Given the following results, what is the immune status of the patient?

HbsAg - neg
HbeAg - neg
Anti-Hbc - neg
anti-HBs - pos
anti-HBe - neg
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 acute infection
chronic infection
immunization
susceptible

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Anti-HBs is expected to be positive post-vaccination. Since there are no other

antigens or corresponding antibodies present in the patient sample, it is likely that
patient has been immunized to hepatitis B and is no longer suseptible.

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

CD20
CD7
CD3
CD5

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CD20 is not present on mature T cells. CD20 is expressed by B cells.

Normal mature T cells should express CD2, CD3, CD5 and CD7.

(143) Which of the following parasites is the causative agent of swamp fever?

Schistosoma mansoni egg

Strongyloides stercoralis larva
Enterobius vermicularis scolex
Taenia saginata scolex

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Schistosoma mansoni is the causative agent of swamp fever. The eggs of this
organism may be readily identified by their large size and characteristic shape,
particularly the presence of a lateral spine located near the posterior.

(144) What is a typical regimen for long-term maintenance therapy of individuals

with hereditary hemochromatosis (HH)?

removal of 2 to 6 units of blood yearly

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 dietary restrictions on iron intake only
treatment with deferoxamine
removal of a unit of blood once per week

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Removal of 2 to 6 units of blood yearly is a typical regimen for long-term

maintenance therapy of individuals with HH.

(145) Which of the following is not considered a potentially infectious body fluid for
transmitting HI

blood
cerebrospinal fluid
pleural fluid
sweat

Blood and visibly blood body fluids, cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, semen and vaginal fluid, and amniotic fluid are
considered potentially infectious for an occupational exposure.

Urine and sweat without visible blood contamination are not considered potentially
infectious.

(146) The same staining protocol can be used for bone marrow smears as is used for
peripheral blood smears.

True
False

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Bone marrow smears are much more cellular and require additional contact time in
both stain and buffer. They should not be processed in exactly the same way as
peripheral bloods.

(147) I am a mouth scavenger and measure about 10 µm.The correct answer is

highlighted below

Trichomonas hominis cyst

Entamoeba gingivalis trophozoite
Trichomonas vaginalis cyst
Trichomonas tenax trophozoite

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Trichomonas tenax is the only known oral flagellate. It is characterized by an
undulating membrane that extends two-thirds the body length, four anterior flagella
and a sturdy axostyle that extends beyond the body length.

(148) After performing an antibody panel and a selected cell panel, you still can't rule
out S and Fyb. It appears that the patient has anti-e and maybe anti-Jkb but they are
only reacting microscopically. What technique would be the best to do in order to
strengthen the antibodies and rule out the remaining antibodies?

Lui freeze thaw

Prewarm
Enzyme panel
Saline replacement

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If an enzyme panel is used in this case, reactions would show enhancement of anti-e
and Jkb if they are present. Reactions should appear stronger than microscopic. S and
Fyb would most likely not react, even if present, since the antigens are destroyed or
weakened on the enyzyme treated cells.

Prewarm technique would only help if a cold antibody was suspected.

Lui Freeze thaw is performed in work ups for ABO hemolytic disease of the newborn
(ABO antibodies). Recovery of other antibodies is not as good with this method.

Saline replacement replaces excess protein in the sample with saline so that false
agglutination will not appear. This technique will not help in determining which
antibodies are present.

(149) A laboratory labels its secondary containers of hazardous chemicals using a

color-coded system, with a different color representing each different type of hazard.
The coding system follows the color-coding used by the National Fire Protection
Agency's "fire diamond." What hazard would be represented by the yellow section on
the hazard label?

Health hazard
Fire hazard

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 Reactivity hazard
Special hazards

The yellow portion of the NFPA diamond represents the reactivity hazard. The
reactivity hazard classification from the NFPA is as follows:

 0 – Stable
 1 – May become unstable at elevated temperatures and pressures, may be mildly
water reactive
 2 – Unstable; may undergo violent decomposition, but will not detonate. May form
explosive mixtures with water
 3 – Detonates with strong ignition source
 4 – Readily detonates

(150) This suspicious form, found in stool, measure 10 µm.

Endolimax nana trophozoite

Entamoeba coli trophozoite
Chilomastix mesnili trophozoite
Pseudoparasite

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Endolimax nana trophozoites are relatively small (around 10 µm) and are often
irregularly shaped. This appearance distinguishes the organism from Chilomastix
mesnili, which has a more oblong appearance and possesses a spiral groove. The lack
of peripheral chromatin readily separates it from Entamoeba coli, which typically has
this structure unevenly distributed.

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