Lencie B.

Raguine, RMT, MLS(ASCPi)CM

MLS(ASCPi) RECALLS OCTOBER 03, 2017 PEARSON VUE TESTING CENTER

CLINICAL CHEMISTRY
Marker for jaundice with Pancreatic mass CA 19.9
Fasting Blood Sugar: 120 mg/dL Impaired Plasma Glucose
2nd Hour OGTT/PG: 160 mg/dL
Patient suspected for Diabetes Mellitus No Further testing. 2 diagnostic criteria are
Fasting Blood Glucose: 155 mg/dL indicative of DM.
2nd Hour OGTT/PG: 225 mg/dL
What should the MT do to confirm diagnosis
HbA1c level is affected by? Short RBC life span
Adrenal Cushing’s Syndrome Decreased ACTH
Increased Cortisol
Cushing Disease Increased ACTH, Cortisol
Anticonvulsants: Primidone Phenobarbital
pCO2 measures? pH
Electrophoresis pattern: LOW ALBUMIN, Beta- Active Cirrhosis
Gamma Bridging
Patient with Hemolytic Anemia has? High Unconjugated Bilirubin
Negative Urine Bilirubin
Normal Urine Urobilinogen
Color of Urobilinogen Colorless
Presents High Calcium, Normal PTH Metastatic Carcinoma
Instrument Linearity: Comparison of 2 means T test/ Paired T test
Enzyme elevated in MUMPS Amylase
Pre-eclampsia Magnesium
Nephelometry: interference in light scatter would Specificity
affect?
Prolonged Apnea Pseudocholinesterase deficiency
Creatinine kinase: Normal AMI
Trop I: Increased
Serum Sodium decreased in? Hyperglycemia
Serum Sodium is low but osmolality and other Measure indirect Sodium using ISE.
analytes are normal. What should the MT do?
Measurement of Serum Iron content 1. Acidification
2. Reduction
3. Color reagent
Enzyme that uses p-Nitrophenylphosphate as ALP
substrate
@ pH of 9.6
Drug toxicity screening of a 7 yr old girl shows AST and ALT
presence of ACETAMINOPHEN level. What test
should be requested next?
HbA1c is associated with? Chronic Hemolytic Anemia
Patient results are given, all are normal including Acute pancreatitis
amylase except LIPASE. What is the possible
disease?
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

Postprandial Lipemia is caused by? Lipoproteins

In Blood Gas Analyzer, pH measurement needs? 2 buffer with known pH and constant temperature
MICROBIOLOGY
Pink Colonies on MAC, LOA (-++) Enterobacter cloacae
Cat’s Scratch Disease Bartonella henslae
Hair Perforation Test uses two fungi? T. mentagrophytes and T. rubrum
A patient was diagnosed with strep pharyngitis Streptococcus pyogenes
months ago. Now patient is showing signs of AGN.
What will be the result of renal biopsy culture?
Mycoplasma cannot be treated with Penicillin No cell wall
because?
What organism: GPC in chains Enterococcus
Catalase: (-)
Bile Esculin: (+)
6.5% NaCl: (+)
An organism is isolated in Hektoen Agar from a Report as Normal Flora.
stool culture presents these result:
TSI: K/A H2S + *other choices are Shigella and Salmonella
LDC: (-)
CITRATE: (+)
PAD: (-)
UREA: (+)

What organism: GPC in chains Streptococcus bovis (gallolyticus)

Catalase: (-)
Bile Esculin: (+)
6.5% NaCl: (-)
Specimen for whooping cough Nasopharyngeal swab
Rapid test for Legionella pneumophila Urine Antigen Assay
Test to differentiate Morganella and Providencia Citrate and Gas production
Differentiate Pseudomonas aeruginosa from P. Growth @ 42°C
putida
CSF for culture arrived late and the MLS only Incubate/store CSF at 35°C
manages to perform gram stain in his shift. What
should the MLS do?
Latex agglutination for Staphylococcus aureus Clumping factor and Protein A
detects?
Describe Blastoconidia Mother budding and daughter cell with
constriction.
Specimen of choice for Rotavirus Stool
Parasite associated with homemade contact lens Acanthamoeba
solution
Purpose if Potassium permanganate in Auramine- Quenching agent
Rhodamine stain
Organism isolated from wound. Aeromonas
TSI: A/A
Catalase: (+)
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

Oxidase: (+)
Motile
Tap water bacillus Mycobacterium gordonae
Plasmodium species that does not present P. falciparum
trophozoite and schizont in PBS.
EBV qPCR (Quantitative PCR)
Gram Postive Bacilli Bacillus anthracis.
Catalase (+)
Non Motile
Non Hemolytic
HEMATOLOGY
Immunophenotyping: Acute Promyelocytic CD 13 and CD 33
Leukemia
Immunophenotyping: Plasma Cell CD 19 and CD 20
Lupus Anticoagulant causes Thrombosis
Picture of echinocytes Uremia
Reactive Monocytosis Tuberculosis
Chronic Myelogenous Leukemia t(9:22)
Tilting of tube Increase ESR
In a wright-stained PBS, 18% retics were counted. Prepare a Heinz body stain.
What should you do next?
Laboratory result of a pediatric patient Pure Red Cell aplasia
Normal: WBC ct. and Platelet ct.
Retics: 0.1 %
Picture of crenated cells/echinocytes, disease Faulty over drying of smear.
associated:
PT, PTT,TT prolonged DIC
Decreased Fibrinogen
Picture of stomatocytes, disease associated: Liver disease
Picture of Hemoglobin C Lyse resistant Hemoglobin C
Calculate % saturation: TIBC= UIBC+Fe
UIBC: 185 mg/dL %SAT=Fe/TIBC x 100
Serum Fe: 125 mg/dL Answer: 40 %
A patient with AMI who undergone Streptokinase D-dimer positive
therapy. Which of the following results suggest
unsuccessful therapy
Abnormally low levels of EPO Polycythemia Vera
Blood collected in Na Citrate Tube for coagulation Reduce citrate Anticoagulant
studies. Hct result is 0.67 L/L. What should the
MLS do next?
In acute hemolytic anemia, hemoglobinuria occurs Haptoglobin is depleted
when

Picture of RBC cold Agglutination, disease Caused by Mycoplasma pnuemoniae

associated:
*High titers of cold agglutinins may be caused
by infections, such as pneumonia caused
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

by mycoplasma.
Picture of RBC cold Agglutination, disease PCH
associated:
A blood sample was taken from an indwelling Heparin contamination from catheter
catheter of patient that hasn’t been on any
anticoagulant therapies. APTT and TT are
prolonged. The results are due to?
Control was ran, PT is normal but APTT is Replace thromboplastin reagent
prolonged. What should the technologist do?
Protein C value after Coumadin therapy Decreased

*Protein C is Vit. K dependent; Coumadin is a

known Vit. K antagonist.
IMMUNOSERO AND BLOODBANK
False negative ABO blood typing, reason? Blood Typing done at 37C
Blood Group that deteriorates easily on storage? Anti-P1
Mother: O (negative) with no exposure to D Ag Rh Immunoglobulin administration
Baby: O (Positive)
What should you do next?
Anti-A: 0 A1 cells: 1+ Bx Subgroup
Anti-B: mf B cells: 0
What ABO discrepancy?
AHG result: 3+ Antibody Identification with enzyme.
After autoadsorption: AHG: 2+
What should you do next?

Anti-A: 4+ A1 cells: 2+ Wash Red cells with Saline.

Anti-B: 4+ B cells: 2+
What should you do next?
Group A (Lea+b-) which is present in saliva Lea
Antibody screening panel Lea (glycolipid adsorbed from plasma)
During a blood donation, the blood stops at Use unit as PACKED Red Blood Cells
390 ml. What should MT do?
1 year deferral Hepatitis B Ig 6 months ago
ANti
HIV screening result using EIA came out Repeat HIV EIA
indeterminate. What should the MT do?
Anti-dsDNA (Homogenous pattern)

What Autoantibody associated?

DAT: Prewarm technique
IgG: 0
C3d: +
What to do?
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

In Competitive ELISA, HBe Ag patient: 300 Positive

Cut off: 700. What is the result?
*Principle: If antibodies are present, the antigen-
antibody reaction occurs. No antigen is left for the
enzyme-labelled specific HBe antibodies. These
antibodies remain free upon addition and are
washed off during washing. Substrate is added, but
there is no enzyme to act on it, so a positive result
shows no color change.
RIST Measurement of specific/particular IgE
Antigen is attached to a carrier particle; Passive Agglutination
Agglutination occurs if antibodies are present
CLINICAL MICROSCOPY
RTE cells: 22-35 Acute Tubular Necrosis
With RTE Cast
RBC: 5-10
Amniotic Fluid Assay that assess fetal lung Phosphatidylglycerol
maturity
Medtech runs a refrigerated specimen for SG Correct SG due to high glucose determination
measurement using refractometer.
SG: 1.010
Glucose: 1000 mg/dL
Fecal Fat tests are affected by Weight and extraction
Pathologic crystals Acidic Urine
Blood rgt. Strip: (+) Diluted Alkaline Urine
Microscopic exam: No RBC seen
Reason?
Urine pH of <4.5 is related in the case of High Protein diet
Glucose reagent strip: (+) Presence of Glucose
Clinitest: (-)

SIDE NOTES:

 RENAL DISORDERS:
Acute GN: dysmorphic RBC, RBC cast
Pyelonephritis: WBC, WBC cast, Bacteria
Cystitis: WBC, Bacteria, NO CAST
Nephrotic Syndrome: Lipiduria, Oval fat bodies, Fatty/waxy cast
Acute Tubular Necrosis: RTE cells, RTE cast

 IMMUNOHEMOTYPING
PNH: CD55, CD 59
APL: CD 13, CD 33
B CELLS/PLASMA CELLS: CD 19, CD 20
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

 GENES
APL: t(15;17) retinoic acid receptor alpha gene.
CML: t(9:22) Philadelphia chromosome
PCV: JAK2 mutation

 ESR
Increase: Decrease
Tilting of tube QNS specimen
Prolong standing Low Temperature
High Temperature Excess EDTA
Excess EDTA

 MICROBIOLOGY:
Organism
Klebsiella pnuemoniae
Klebsiella oxytoca
Enterobacter aerogenes
Enterobacter cloacae
Lysine Ornithine
+ -
+ -
- +
- +
Arginine Indole
- -
- +
- n/a
+ n/a

Organism ONPG LDC KCN

Salmonella spp - + -
Citrobacter spp + - +

Organism H2S GAS CITRATE ODC

Proteus + - - +
Morganella - + - +
Providencia - - + -

 BILIRUBIN
Jaundice Unconjugated B (B1) Conjugated B (B2) Urine Bilirubin Urine Urobilinogen
Pre-Hepatic Jaundice ↑ Normal (-) Normal
(Hemolytic Anemia)
Hepatic Jaundice (Liver ↑ ↑ (+) ↓
Cirrhosis)
Post Hepatic Jaundice Normal ↑ (+) ↓
(Obstructive Jaundice)

 CARDIAC MARKERS
1st to increase: Myoglobin
2. Trop I, T
3. CK-MB
4. AST
 Lencie B. Raguine, RMT, MLS(ASCPi)CM

5. LD (1 & 2)
 ENZYMES
Liver Cirrhosis: ALT, AST, LD
Obstructive Jaundice: ALP, GGT
Bone Disorder: ALP
Skeletal Muscle Disorder: AST, LD, CK

 BLOODBANK
IgM Antibodies (RT) IgG (AHG)
Lea Rh
i Kell
P1 Duffy
M Kidd
ABH Leb
N Ss
LiPMAN RKDKLebSs

DOSAGE:
KIDD, DUFFY and Monkey (Rhesus) eat lots of MNSs.
(Jka, Jkb) (Fya, Fyb) (C,c,E,e) (M,N,S,s)

DESTROYED by ENZYMES ENHANCED by ENZYMES

Rh M
Kidd N
Lewis Ss
P1 Duffy
I