A;

Animals serve as a reservoir of infection" is the correct answer because Shigella only
infects humans while Salmonella is found in many animals. Both have diarrhea as
the major symptom. Endotoxin is produced by all gram negative bacteria and
exotoxin is only produced by Shigella.
A major difference between Salmonella enterica and Shigella infections is that only
in salmonellosis can:

A. animals serve as a reservoir of infection

B. diarrhea become the major symptom
C. endotoxin play a role in disease process
D. exotoxin produce profuse watery stools

C;
The approximate volume of CSF in an adult is 90-150 mL.
What is the approximate volume of spinal fluid in an adult?

A. 10-40 mL
B. 50-70 mL
C. 90-150 mL
D. 200-500 mL
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C;
The cells indicated by the arrows in the image are spherocytes. Spherocytes have a
decreased surface to volume ratio and are therefore smaller with an increased
MCHC. Spherocytes have lost their bi-concave shape and are spherical in shape,
hence the name.
What are the cells that are indicated by the arrows in this peripheral blood smear
image?

A. Echinocytes
B. Elliptocytes
C. Spherocytes
D. Stomatocytes

B;
The correct response is option B: The Hepatitis B "e" Antigen (HBeAg). This antigen
indicates the virus is actively replicating and therefore the patient is very infectious.
The hepatitis B "e" antigen is present when the virus is actively replicating. In cases
of unintentional needlesticks, infectivity is of highest concern. The risk for infection is
greatest during phases of increased HBeAg serology. The Hepatitis B surface
antigen is the first detectable marker, but if the patient is known to have Hepatitis B
already, it would be relatively unhelpful to confirm the condition with another HBsAG
test. The core antigen is not detectable because it is covered by the nuclear
envelope. Antibody response patterns would not be very helpful either as the patient
has already been diagnosed with acute Hepatitis B. IgG antibodies would indicate
recovery, which is not the case for this patient and IgM antibodies indicating a recent
or acute infection would only confirm what is already known. Recall, in cases of
unintentional needlesticks, infectivity is of highest concern.
A phlebotomist at a local hospital recently had an accidental needle stick while
drawing blood from a patient being treated for acute hepatitis B. Which serological
marker from the patient would be of most value to the physician evaluating the
phlebotomist's possible infection status?

A. Hepatitis B surface Antigen (HBsAg)

B. Hepatitis B e Antigen (HBeAg)
C. Hepatitis B core Antigen (HBcAg)
D. Anti-Hepatitis B e (anti-HBe) IgM
E. Anti-Hepatitis B core (anti-HBc) IgG
D;
Serum alkaline phosphatase is produced in the bone, intestine, and the placenta- but
not in the brain.
Serum alkaline phosphatase activity is derived from all of the following organs
except:

A. Bone
B. Intestine
C. Placenta
D. Brain
A;
Some elderly individuals can have poor dietary habits which can lead to decreased
nutrient absorption, including zinc.
A zinc deficiency in the elderly is often caused by:

A. Decreased intake and absorption

B. Decreased intake and excretion
C. Increased intake and excretion
D. Increased excretion and decreased absorption
D;
Escherichia coli and Klebsiella pneumoniae are two good quality control choices for
the indole test. E. coli is indole positive, while K. pneumoniae is indole negative. A
positive reaction is noted when there is a red layer at the top of the tube after the
addition of Kovács reagent, while the negative result is a lack of color change in the
top of the tube after the addition of Kovács reagent.
Which one of the following combinations of organisms would be appropriate positive
and negative controls to verify the specific test functions listed?

A. Beta hemolysis - Escherichia coli and Streptococcus pyogenes

B. Catalase - Staphylococcus aureus and Staphylococcus epidermidis
C. Hydrogen sulfide production - proteus mirabilis and Salmonella typhi
D. Indole - Escherichia coli and Klebsiella pneumonia
E. Carbohydrate fermentation - Alcaligenes faecalis and Acinetobacter baumannii
D;
Enterococcus spp. are bile esculin positive and grow in 6.5% NaCl. If they grow on
the 6 µg/mL vancomycin screen agar as this isolate does, it is vancomycin resistant.
If there is no growth on the 6 µg/mL vancomycin screen agar, the isolate is
susceptible to vancomycin. Streptococcus Group D, not Enterococcus will not grow
in the 6.5% NaCl and should not be tested for vancomycin resistance.
Staphylococcus epidermidis is catalase positive.
The images below represent a gram-positive, catalase-negative, non-motile coccus
inoculated to bile esculin agar, 6.5% NaCl broth and to 6 µg/mL of vancomycin in
Mueller Hinton agar. It should be reported as:

A. Enterococcus spp., Susceptible to vancomycin

B. Streptococcus Group D, not Enterococcus
C. Staphylococcus epidermidis, Resistant to vancomycin
D. Enterococcus spp., Resistant to vancomycin

True
True/False
In real-time PCR procedures, fluorescence resonance energy transfer (FRET) is the
process that allows for probes to emit fluorescence only after hybridization.
B;
Donor and recipient blood samples (samples utilized for pre-transfusion compatibility
testing) must be kept for at least 7 days after transfusion. Blood samples must be
available to investigate a transfusion reaction, if necessary.
Donor and recipient blood samples must be kept for at least how long after
transfusion?

A. 10 days
B. 7 days
C. 3 days
D. Not a requirement
B;
The term affinity refers to the strength of attraction between a single antigenic
determinant and a corresponding antigen binding site. The term avidity refers to the
total strength of the attraction between an antibody and a multivalent antigen. The
reaction between an IgM molecule (which has 10 antigen binding sites), and a
multivalent antigen is therefore much stronger than that of an IgG antibody (which
has only 2 antigen binding sites).
Avidity is best described by which of the following statements:

A. The strength with which red cells agglutinate

B. The strength with which multivalent antigens and antibodies bind
C. The strength with which univalent antigens and antibodies bind
D. The speed with which an antigen-antibody reaction occurs
C;
In excess triglycerides, the triglycerides reduce the amount of cholesterol in LDL
particles producing small dense LDL molecules. Because of size and density, these
molecules more easily enter damaged endothelium and vessel walls and are more
easily incorporated as plaque is formed.
Which statement best describes small dense LDL particles that can occur in
atherogenic dyslipidemia?

A. Small dense LDL molecules are less atherogenic than larger, less dense or
buoyant LDL particles because they are metabolized faster
B. Small dense LDL molecules transport more cholesterol and thus are more
atherogenic
C. Small dense LDL molecules are more atherogenic because they can more easily
move into the endothelium and vessel wall
B;
Creatinine clearance tests are utilized to estimate the glomerular function of the
kidney. The creatitine clearance calculation is defined as the volume of plasma that
is cleared of creatinine by the kidney per unit of time and uses the following formula:

creatinine clearance = Urine creatinine conc x Volume / Plamsa creatinine conc

Creatinine clearance measurements have a recommended specimen requirement =

24-hour urine collection.
Which of the following tests would be useful in the assessment of glomerular
filtration:

A. 24 hour urine protein

B. Creatinine clearance
C. PSP test
D. Urea clearance
C;
Amniotic fluid bilirubin is increased in association with the severity of hemolytic
diseases of the newborn. As red blood cells lyse during these conditions, bilirubin
builds up as a byproduct of the red cell destruction. The more red blood cells that are
being destroyed in the baby, the more increased the bilirubin level will become.
Which one of the following tests BEST correlates with the severity of hemolytic
disease of the newborn (HDN).

A. Rh antibody titer of baby's blood

B. L/S ratio
C. amniotic fluid bilirubin
D. antibody titer of mother's blood
This is true. There are approximately 5 hyaline casts in this image.
True or false? Hyaline casts are present in this slide.

C;
1 SD = 68.3%, 2 SD = 95.5%, 3 SD = 99.7
As defined by a Gaussian distribution curve, what percentage of values would be
expected to fall within two standard deviations of the mean:
A. 75%
B. 85%
C. 95%
D. 100%
B;
In Rouleaux, red blood cells appear as stacked coins - formation occurs as the result
of elevated globulins or fibrinogen.
The RBCs indicated by the arrows in this illustration are the result of:

A. Over drying of blood smear

B. Rouleaux formation
C. Cold agglutinins
D. Sickle cell anemia

B;
Basophilic stippling is the term used to describe red blood cells that contain tiny
particles of RNA within their cytoplasm. Basophilic stippling is associated with many
conditions, but is strongly associated with lead poisoning.
Multiple small, dark blue particles scattered throughout the cytoplasm of erythrocytes
is/are called:

A. Pappenheimer bodies
B. Basophilic stippling
C. Heinz bodies
D. Howell-Jolly bodies
A;
Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis, but
not diagnostic enough to predict chronic pancreatitis; wheras high levels are found
only during acute pancreatitis episodes. In the later stages of chronic pancreatitis,
normal to decreased levels of amylase and lipase are caused by the gradual inability
of the pancreas to secrete the enzyme
All of the statements below regarding amylase and lipase in pancreatitis are TRUE
EXCEPT:

A. Amylase and lipase are as predictive in chronic as in acute pancreatitis.

B. Diagnosis sensitivity is increased by assaying both amylase and lipase.
C. Urinary amylase: creatinine ratio is the most sensitive test for acute pancreatitis.
D. Serum lipase peaks at 24 hours after an episode of acute pancreatitis and
remains high for 7-8 days.s.
A;
A beam splitter is employed in a dual beam spectrophotometer.
Which of the following is not a component of a basic single beam spectrophotometer:

A. Beam splitter
B. Cuvette
C. Prism
D. Light source
D;
Transpeptidase enzymes catalyze the final stage of peptidoglycan synthesis during
cell wall formation. Beta-lactam antibiotics bind with these enzymes, interfering with
their function. The transpeptidase enzymes are also referred to as PBP's, or
penicillin-binding proteins.
Beta-lactam antibiotics interfere with cell wall synthesis by:

A. Binding with a transpeptidase

B. Preventing the final stage of peptidoglycan synthesis
C. Interfering with PBPs
D. All of the above
D;
VLDL transports endogenous lipids, whereas chylomicrons transport exogenous
(dietary) lipids. Cholesterol is transported by HDL and LDL.
The function of the very low density lipoproteins (VLDL) is to transport:

A. cholesterol from peripheral cells to the liver

B. cholesterol and phospholipids to the peripheral cells
C. exogenous triglycerides
D. endogenous triglycerides
A;
Modified Thayer Martin agar at 35ºC with CO2 is the correct answer. This is a typical
presentation of systemic gonorrhea and Neisseria gonorrhea grows best on MTM
medium at 35ºC. under CO2. Systemic gonorrhea occurs in 1% of cases and results
in purulent arthritis and rarely septicemia.
An 18-year-old woman woke up in the morning to find that her left knee was hot,
swollen, and very painful. She could not walk to work and a friend offered her a ride
to the clinic. She had never had a swollen joint before. Physical exam revealed a
tender knee joint which yielded purulent synovial fluid on aspiration. Gram-negative
intracellular diplococci were seen on Gram stain. She also had a cervical discharge
that was cultured. The cause of her infection would grow best on:

A. Modified Thayer Martin agar at 35ºC with CO2

B. LIM (Todd Hewitt Broth w/Colistin and Nalidixic Acid) broth with refrigerated
temperature
C. Blood agar at 42ºC with microaerophiilic conditions
D. V (human blood) agar at 35ºC with CO2
D;
The correct answer which best fits the characteristics in this question is
Mycobacterium tuberculosis.
What is the MOST likely identity of an acid-fast bacilli that showed buff colored, dry,
heaped colonies; niacin, nitrate, and urease positive; and took 23 days at 35ºC to
grow?

A. Mycobacterium avium
B. Mycobacterium kansasii
C. Mycobacterium bovis
D. Mycobacterium tuberculosis
E. Mycobacterium leprae
D;
Most researchers believe that the small size and increased density of LDL molecules
found in atherogenic dyslipidemia enable the molecules to more easily invade the
endothelium and arterial wall of vessels.
Why are small dense LDL molecules more atherogenic?

A. Small dense LDL molecules contain less cholesterol and phospholipid

B. Small dense LDL molecules increase the concentration of HDL-C in the blood
C. Small dense LDL molecules increase the concentration of adoponectin and
inflammatory cytokines
D. Small dense LDL molecules have greater mobility in the endothelium and arterial
wall
A = Fab fragment

B = Fc fragment
Match terms with fragments resulting from papain digestion of an IgG molecule:

A = Fab fragment OR Fc fragment

B = Fab fragment OR Fc fragment

C;
The Westgard multi-rule 22S describes the scenario where two consecutive data
points fall outside +2SD or -2SD. If this occurs, then the run must be rejected. This
situation is most likely caused by a systematic error.
Which of the following describes the Westgard multi-rule 22S?

A. Two control data points are within ± 2s

B. One control data point falls outside +2s and a second point falls outside - 2s
C. Two consecutive data points fall outside +2SD or -2SD
D. Two consecutive data points fall inside +2s
E. Two points are within 2SD
False
The ADA recommends regular screening for individuals who are at increased risk for
diabetes. OGTT use is discouraged for these individuals unless blood glucose and
HbA1C concentrations remain below diagnostic ranges for diabetes but patient
displays symptoms of diabetes.
True/False
The ADA recommends performing an oral glucose tolerance test (OGTT) on all
individuals who are at increased risk for diabetes.
False
Platelets do not contain nuclei. They are fragments of megakaryocyte cytoplasm.
Therefore, they are not the smallest nucleated cell found in peripheral blood.
True/False
Platelets are the smallest nucleated cells seen in normal peripheral blood.
B;
Although any one of the answers might be considered correct, a report of gram-
positive cocci in chains provides sufficient information without going beyond what the
observation might allow. In off-the record conversation with the physician, a
technologist might divulge that the picture is consistent with Streptococcus; however,
enterococci may have a similar Gram stain appearance, potentially leading to the
wrong choice of empiric antibiotic agents.
The image shows the Gram stain prepared from the positive blood culture. What is
the MOST appropriate report?

A. Gram-positive cocci
B. Gram-positive cocci in chains
C. Gram-positive cocci consistent with Streptococcus
D. Gram-positive cocci consistent with Enterococcus

E;
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.
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?

A. oxidase test
B. esculin test
C. catalase test
D. citrate test
E. indole test
A;
Secondary granules, also known as specific granules first appear in the myelocyte
stage next to the nucleus. In neutrophils this is termed the "dawn of neutrophilia".
What is one of the main characteristics of secondary granules in the neutrophilic
granulocyte cytoplasm?

A. Appear first at the myelocyte stage

B. Dissolve in mature granulocytes
C. Are formed on the mitochondria
D. Are derived from azurophil (primary) granules
A;
Gating sets up boundaries around a subset of data points to segregate those events
for analysis.

Gating the proper cell population is crucial for flow cytometric analysis. The CD
marker information presented on the histogram data is only representative of the
cells inside the gate.
When analyzing the raw data of a sample on the flow cytometer, CD marker
information on the histograms represents data inside the _____ population.

A. Gated
B. Non-gated
B;
G6PD deficiency causes an increased suseptibility to the oxidation of hemoglobin,
which in turn, causes the precipitation of hemoglobin inside of the red blood cell.
Which one of the following conditions is associated with glucose-6-phosphate
dehydrogenase (G6PD) deficiency?

A. Microcytic red cells

B. Precipitation of hemoglobin
C. Faulty heme synthesis
D. Hemoglobins with low oxygen affinities
A;
Hemolytic transfusion reactions seldom occur because the incidence of unexpected
antibodies in random patients is relatively low, e.g., 3-5% is sometimes cited.

Being transfused with O Rh negative RBC is irrelvant if you have an unexpected

antibody like anti-K or anti-c.

Incompatible red cells may "bleed out" but only if bleeding is brisk. Even then, a
hemolytic reaction may occur later once the patient's antibody rebounds and
destroys remaining antigen-positive donor red cells.

It's true that some patients have only cold-reactive antibodies that will not react at
body temperature. But this does not explain why warm-reactive red cell antibodies
cause few reactions
Why do so few patients transfused with un-crossmatched red cells in an emergency
experience a hemolytic transfusion reaction? Select the one best reason.

A. The incidence of unexpected red cell antibodies is relatively low.

B. They usually receive group O Rh negative red cells; a hemolytic transfusion
reaction will never occur if O Rh-negative red cells are transfused.
C. They hemorrhage so severely that incompatible donor red cells "bleed out" before
a reaction occurs.
D. Some patients have cold-reactive antibodies that will not react at body
temperature.
1. A
2. A
3. B
4. A
Match each virus with its appropriate nucleic acid content.

1. Paramyxovirus
2. Rhabdovirus
3. Poxvirus
4. Orthomyxovirus

A. RNA
B. DNA
B;
Glycoprotein IIb/IIIa is integral in the process of platelet aggregation as well as clot
retraction.
A defective clot retraction might be caused by which one of these?

A. Lack of or defect of platelet receptor glycoprotein Ib

B. Lack of or defect of platelet receptor Ilb/IIIa
C. Insufficient storage of ADP in platelet granules
D. Absence or defect of von Willebrand's factor
C;
A hapten is an incomplete antigen.
All of the following cellular antigens are important to an immunohematologist except:

A. Blood group antigens

B. Histocompatibility antigens
C. Haptens
D. Autoantigens
D;
Rapid vascular constriction, not dilation, immediately occurs when there is vascular
injury in order to constrict the amount of blood that escapes the vessels; ultimately
preventing massive loss of blood.
Primary hemostatic processes resulting from vascular damage include all of the
following EXCEPT:

A. collagen activates glycoprotein IIb/IIIa during platelet activation

B. von Willebrand factor mediates platelet adhesion
C. platelet granule release and fibrinogen mediate platelet aggregation
D. rapid and immediate vascular dilation occurs
E. b & c
True;
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.
True/False
Shown in the image 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.
B;
The disc diffusion method for antibiotic susceptibility testing is the Kirby-Bauer
method. The agar used for this procedure is Meuller-Hinton.
Which of the following media is commonly used when performing the Kirby-Bauer
disk diffusion?

A. Chocolate agar
B. Mueller-Hinton agar
C. Thayer-Martin agar
D. MacConkey agar
1. B
2. A
3. D
4. C
Match the viruses below with their associated conditions.

1. Herpesvirus
2. Papovavirus
3. Rhinovirus
4. Rotavirus

A. Warts
B. Herpes
C. Gastroenteritis in infants
D. Common Cold
C;
Diagnosis of malaria may require thick smears as well as conventional thin blood
smears.
A definitive diagnosis of malaria can be made by:

A. Serological testing
B. Culture techniques
C. Demonstration of the organisms in peripheral blood
D. Biochemical reactions

A;
In primary responses, the major class of antibody produced is IgM whereas in the
secondary response, as mentioned in this question, it is IgG. IgG is present in the
highest quantities compared to all other antibody classes and is the only antibody
able to cross the placental barrier.
Which of the following antibody types is chiefly seen in the secondary immune
response:

A. IgG
B. IgA
C. IgM
D. IgD
C;
C. immitis is a dimorphic fungus which can be isolated from sputum specimens of
infected individuals. When grown on Sabouraud's agar at 25o it grows as a mold with
white aerial mycelium in about 3 to 5 days. C. immitis is known to produce
arthroconidia which are "barrel-shaped" after 1 to 2 weeks of growth.
Within three days at 28 ºC a sputum specimen placed on Sabouraud's dextrose agar
with chloramphenicol and cycloheximide produced moist, grayish growth, with a
white aerial mycelium, the organism is MOST likely:

A. Aspergillus fumigatus
B. Blastomyces dermatitidis
C. Coccidioides immitis
D. Cryptococcus neoformans
E. Histoplasma capsulatum
C;
% concentration (expressed as a proportion or ratio) x volume needed = mass of
reagent to use

So... 10% (w/v) solution of sodium hydroxide x 200 mL needed = 20 grams of

sodium hydroxide
How many grams of sodium hydroxide are required to prepare a 200 ml solution of a
10% (weight per volume) solution? (Atomic weights: Na = 23; 0 = 16; H = 1)

A. 4g
B. 10g
C. 20g
D. 40 g
E. 80 g
D;
Platelet neutralization tests are one of the confirmatory tests that can be used to
determine if a patient has a circulating lupus antibody, or lupus anticoagulant. The
principle in this test involved the use of a freeze-thawed platelet suspension that,
when mixed with the patient plasma, will neutralize the anti-phospholipid antibodies
(lupus anticoagulant) present and allow for a corrected aPTT result upon re-testing.
A patient has a history of repeated spontaneous abortion. Coagulation studies reveal
an elevated APTT, normal PT, normal platelet function, and normal clotting time.
Schistocytes were seen on the peripheral blood smear.

Which test should be performed to determine if the patient has lupus anticoagulant?

A. Factor VIII assay

B. mixing studies with factor-deficient plasma
C. antinuclear antibody test
D. platelet neutralization test
B & C;
A test with high specificity accurately detects the absence of disease. The more
specific a test is, the fewer false-positive results will occur. A test with high sensitivity
accurately identifies the presence of disease. The more sensitive a test, the fewer
false-negative results it produces. In the case stated in this question, the
immunoassay has high specificity, so it has few false-positives and will accurately
detect those individuals who do not have the disease or condition that is being tested
for. However, the test has low sensitivity, so it may not identify all individuals who
actually have the disease; it may produce many false-negative results.
The accuracy of an immunoassay is its ability to discriminate between results that
are true positives and results that are true negatives. Two parameters of test
accuracy are specificity and sensitivity. Which of these statements apply to an
immunoassay with high specificity, but low sensitivity?

A. Accurately identifies the presence of disease

B. Accurately identifies the absence of disease
C. Has few false-positives
D. Has few false-negatives
B;
Autologous units must be drawn before they are needed, and must be readily
available, therefore are generally not of use in emergencies.
All of the following are benefits of autologous donation except:

A. Reduces exposure to infectious agents

B. Are always on hand in case of an unexpected emergency
C. Reduces demand for homologous blood
D. Eliminates sensitization to cellular blood components
C;
Type I hyperlipoproteinemia is a form of hyperlipoproteinemia associated with
deficiencies of lipoprotein lipase. Hyperlipoproteinemia type II is the most common
form and is classified into type IIa and type IIb, depending on whether there is
elevation in the triglyceride level in addition to LDL cholesterol. Hyperlipoproteinemia
type III is associated with high chylomicrons and IDL. Hyperlipoproteinemia type IV is
assoicated with high triglycerides. It is also known as hypertriglyceridemia.
Hyperlipoproteinemia type V is similar to type I, but with high VLDL in addition to
chylomicrons.
An obese adult with premature arteriosclerosis is seen in the clinic. When her serum
is tested no chylomicrons are present, LDL are normal and VLDL are increased.
There is an increase in triglycerides and slight increase in cholesterol. Lipoprotein
electrophoresis reveals a heavy pre-beta band. She has no skin rash and uric acid is
increased. This patient has a hyperlipoproteinemia with the MOST likely type of:

A. II
B. III
C. IV
D. V
E. VI
C;
Hb S migrates with D in alkaline and alone in acid electrophoresis.
The gel electrophoresis pattern for hemoglobin S shows which of the following
migration patterns?

A. Hb S migrates alone in alkaline and D in acid electrophoresis.

B. Hb S migrates with D in alkaline and A in acid electrophoresis.
C. Hb S migrates with D in alkaline and alone in acid electrophoresis.
D. Hb S migrates with A in alkaline and D in acid electrophoresis.
A;
Atherosclerosis is a hardening of an artery specifically due to the build up of plaque.
The risk to patients with significant atherosclerosis is that eventually a narrowing of
the artery (stenosis) can cause a reduction in oxygen delivery to tissues and plaque
rupture can lead to an acute coronary event.
Atherosclerosis is a hardening of an artery specifically due to which of the following?

A. Build up of plaque
B. Aggregation of platelets
C. Hypercalcemia
B;
Hives and rash usually indicate an allergic reaction. Hematuria is due to a variety of
causes. Fever and chills usually indicate a febrile reaction. Positive DAT due to
conditions other than sensitization to red cell alloantigens is not uncommon.
Therefore a positive DAT in the posttransfusion specimen with a negative DAT in the
pretransfusion specimen is more likely to indicate alloimmunization.
The most definite indication that a patient has been sensitized to a specific red cell
antigen is:

A. Hives and rash

B. A positive posttransfusion DAT in a patient with a previously negative DAT
C. A positive posttransfusion DAT in a patient with a previously positive DAT
D. Hemoglobinuria
D;
Lipids tend to form a "maltese cross" pattern when viewed in polarized light, which
helps to differentiate them from other urine microscopic components.
Substances found in urinary sediment that are more easily distinguished by use of
polarized microscope are:

A. WBC
B. RBC
C. Casts
D. Lipids
E. Crystals
B;
Unexplained bleeding is associated with immediate hemolytic transfusion reactions,
but is not usually associated with delayed hemolytic transfusion reactions. The
bleeding results from disseminated intravascular coagulation (DIC) due to ABO
antibodies causing intraventricular hemorrhage (IVH).
Which of the following signs and symptoms may be associated with immediate
transfusion reaction, but is NOT usually associated with delayed hemolytic
transfusion reaction?

A. Fever and chills

B. Unexplained bleeding from surgical site
C. Unexplained drop in hemoglobin
D. Transient jaundice
B;
Whole blood glucose values are lower than plasma glucose values. For this reason,
point-of-care whole blood glucose meters are programmed to correct the value
before presenting the result; therefore, the whole blood glucose meter result
correlates to serum or plasma results.
Whole blood glucose values are ____________ plasma glucose values.

A. Greater than
B. Lower than
C. Equal to
C;
On the red cell membrane, there is a bicarbonate / chloride exchanger. This
exchanger allows for bicarbonate to leave the red cells while chloride is allowed
inside.
In blood, bicarbonate leaves the red blood cell and enters the plasma through an
exchange mechanism with:

A. sodium
B. potassium
C. chloride
D. phosphorus
B;
Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that
appears as a round, dark-staining inclusion in the cytoplasm of red blood cells.
Howell-Jolly bodies can be found in various conditions including splenectomy and
anemia.
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes
are called:

A. Heinz bodies
B. Howell-Jolly bodies
C. Basophilic stippling
D. Pappenheimer bodies
D;
Only non-self antigens can be immunogenic. Self antigens are normally recognized
by the immune system as part of the host, so an immune response does not
normally occur. Non-self antigens are immunogenic since they have the potential to
cause an immune response.
For a substance to be immunogenic it must be:

A. A linear molecule
B. A lipid
C. Less than 5,000 molecular weight
D. Recognized as non-self
E. A haptene
D;
Nucleated RBCs may be seen in the peripheral blood in cases of beta thalassemia
major. Nucleated RBCs are usually not found in peripheral blood in cases of beta
thalassemia minor and beta thalassemia intermedia, and would not be a finding in
beta thalassemia minima.
Nucleated RBCs are most likely to be seen in the peripheral blood of which of these
beta thalassemias?

A. Beta thalassemia minima

B. Beta thalassemia minor
C. Beta thalassemia intermedia
D. Beta thalassemia major
C;
Clostridium difficile is a gram-positive, spore-forming bacilli. The remaining
organisms will all stain gram-negative on direct smear or smears made from culture.
Which of the following organisms are gram-positive?

A. Neisseria gonorrhoeae
B. Brucella species
C. Clostridium difficile
D. Pseudomonas aeruginosa
C;
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.
A negative glucose oxidase test and a positive test for reducing sugars in urine
indicates:

A. True glycosuria
B. A false-negative glucose oxidation reaction
C. The presence of a non-glucose reducing sugar such as galactose
A;
Alpha-fetoprotein is a substance typically used in the triple test during pregnancy and
for screening chronic liver disease patients for hepatocellular carcinoma.
Increased concentrations of alpha-fetoprotein (AFP) in adults are MOST
characteristically associated with:

A. hepatocellular carcinoma
B. alcoholic cirrhosis
C. chronic active hepatitis
D. multiple myeloma
C;
Alpha thalassemia is a hemolytic anemia. In most hemolytic anemias the LD and
bilirubin are increased while the haptoglobin is decreased. However, because
haptoglobin binds to the alpha chain portion of hemoglobin, it usually remains at
normal levels due to the absence of alpha chains in the destroyed cells.
Which set of chemistry results would most likely occur during hemolytic crisis in
alpha thalassemia intermedia?

A. Decreased lactate dehydrogenase (LD)and bilirubin, and increased haptoglobin

B. Increased LD and bilirubin,and decreased haptoglobin
C. Increased LD and bilirubin, and normal haptoglobin
D. Normal LD and bilirubin, and decreased haptoglobin
B;
The conidia of Exophiala species are produced within phialides that extrude the
conidia in tight, ball-like clusters.

The large, drum stick-shaped muriform macroconidia of Alternaria species are

arranged in short chains; the small, elliptical conidia of Cladosporium species are
arranged in both long and short, branching chains.
Which of the following dematiaceous fungal species produce conidia in clusters?

A. Alternaria species
B. Exophiala species
C. Cladosporium species
D;
According to OSHA, Hazard Communication 1910.1200 has the purpose of ensuring
that the hazards of all chemicals produced or imported are evaluated, and that
information concerning their hazards is transmitted to employers and employees.
Also known as the "Right To Know Law," which one of the following OSHA
regulations first dealt with specific information related to the contents of chemicals
used in the workplace?

A. Blood Borne Pathogens 1910.1030

B. Formaldehyde 1910.1048
C. Right To Know Communication 1910.5555
D. Hazard Communication 1910.1200
E. Occupational Exposure 1910.1450
A;
Acute hemolytic transfusion reactions are most commonly due to ABO-incompatible
blood being transfused to a recipient with naturally occurring ABO alloantibodies
(anti-A, anti-B, anti A,B).
Acute intravascular hemolysis as the result of a blood transfusion is most often
associated with which of the following causes?

A. Transfusion of ABO incompatible red cells

B. Allergies
C. Passively transfused antibodies to HLA antigens
D. Transfusion-associated graft-versus-host disease
B;
Macroglobulinemia, Multiple Myeloma, and Amyloidosis are all associated with
abnormal protein production and/or accumulation which can result in Bence-Jones
proteins being excreted in the urine.
Bence-Jones proteinuria is associated with all of the following conditions except:

The correct answer is highlighted below

Macroglobulinemia
Pernicious anemia
Multiple myeloma
Amyloidosis
A;
This is an example of a cell cycle dependent speckled ANA pattern called anti-
proliferating cell nuclear antigen (PCNA).

With this pattern the antigen that the antibodies are directed against is only
expressed during a limited portion of the cell's growth cycle. During other parts of the
growth cycle the antigen is not expressed. This creates a pattern where only 30-50%
of the cells stain positive. The speckled staining within these positive cells varies
between coarse speckled (a) and smooth speckled (b). Cells not expressing the
antigen are negative (c).
The image represents the results of an antinuclear antibody (ANA) test that is viewed
using fluorescent microscopy. The speckled staining within these positive cells varies
between coarse speckled (a) and smooth speckled (b). Cells are also present that
are negative (c) because these cells are not expressing the antigen that the
antibodies are directed against.

This image represents which of the following ANA testing patterns?

A. Anti-proliferating cell nuclear antigen (anti-PCNA)

B. Speckled
C. Multiple nuclear dots
D. No pattern; it is negative

D;
AABB Standards do not require a DAT, autologous control, or a minor crossmatch
for pretransfusion testing.
Essential components of compatibility testing include all of the following except :

A. Antibody screen on recipients serum

B. Major crossmatch or computer crossmatch
C. ABO and Rh typing of recipient
D. Direct Antiglobulin Test (DAT)
A&B
Ferritin and hemosiderin are considered storage forms of iron.
Which substance(s) is/are considered iron storage compounds?

A. hemosiderin
B. ferritin
C. hemoglobin
D. myoglobin
A;
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.
Serum calcitonin is typically elevated in which of the following conditions:

A. Medullary carcinoma of the thyroid

B. Hyperthyroidism
C. Glioblastoma
D. Adrenal adenoma
B;
The colonies seen growing on the bird seed agar appear smooth and have a distinct
reddish-brown pigmentation. The active ingredient in bird seed (Guizotia abyssinica)
agar is caffeic acid, which is extracted and placed in an agar containing 1% glucose.
Of the cryptococci, and other species of yeasts, Cryptococcus neoformans
selectively produces the enzyme phenoloxidase, which oxidizes the caffeic acid in
the medium to melanin, producing the red-brown pigmentation.

The other yeast species included in this exercise do not possess phenoloxidase
activity and therefore remain non-pigmented when grown on bird seed agar.
The colonies shown in this photograph were grown on Guizotia abyssinica (bird
seed) agar at 30°C for 72 hours. The most likely identification is:

A. Cryptococcus laurentii
B. Cryptococcus neoformans
C. Candida parapsilosis
D. Saccharomyces cerevisiae

C;
The negative antigen frequencies are used in the formula below to determine the
percent of type-specific units that would be compatible for the patient. Negative
antigen frequencies are determined by subtracting the percent antigen frequency
from 100%. The negative antigen frequency for K in this case is .91 (1.00 - .09) and
the negative antigen frequency for Fya is .34 (1.00 - .66).

% compatible units available = 100 x (Neg frequency #1 x Neg frequency #2...)

For this case, the calculation is:

% compatible units available = 100 x (0.91 x 0.34) = 30.94 or 31%

If the antigen frequencies for K = 0.09 and Fya = 0.66, what percent of type-specific
units would be compatible for a patient with anti-K and anti-Fya?

A. 10
B. 43
C. 31
D. 92
E. 100
D;
Blood collected in CPDA-1 may be stored at 1 - 6 oC for up to 35 days.
How long may blood be stored using CPDA-1 preservative prior to transfusion?

A. 5 days
B. 15 days
C. 25 days
D. 35 days
C;
Once substance H is developed, the addition of the sugar N-acetylgalactosamine to
the terminal position of the chain gives the molecule "A" antigenic activity.
Which specific terminal sugar causes a red cell to have A antigenic activity?

A. Galactose plus glucose

B. Galactose
C. N-acetylgalactosamine
D. Glucose
D;
In the interpretation of the Schilling's test, if stage I is abnormal with a normal stage
II- this is indicative of a correction by intrinsic factor, which indicates that the patient
has pernicious anemia.
What would the following Schilling test results indicate:

Part I: 2% excretion of radioactive vitamin B12 (normal: 5-35%)

Part II: 8% excretion of radioactive vitamin B12 after intrinsic factor was given with
vitamin B12 (normal: 7-10%).

The correct answer is highlighted below

Tropical sprue
Transcobalamin deficiency
Folic acid deficiency
Pernicious anemia
B;
The red portion of the NFPA diamond represents fire hazards. The fire classification
system for NFPA is as follows:

0 - Will not burn

1 - Must be preheated for ignition; flashpoint above 200°F (93°C)
2 - Must be moderately heated for ignition, flashpoint above 100°F (38°C)
3 - Ignition may occur under most ambient conditions, flashpoint below 100°F (38°C)
4 - Extremely flammable and will readily disperse through air under standard
conditions, flashpoint below 73°F (23°C)
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 red section on the hazard
label?

A. Health hazard
B. Fire hazard
C. Reactivity hazard
D. Special hazards
D;
Beer's law is based on the fact that absorbance is directly proportional to the
concentration of a solution. Therefore, stray light can alter the absorbance results in
this type of assay.
Deviations from Beer's Law are caused by:

A. very low concentration of absorbing material

B. polychromatic light
C. very high concentrations of substance being measured in a colorimetric reaction
D. stray light
C;
Allergic reactions, bacterial/viral meningitis do not cause the presence of blasts to be
noted in the CSF. Leukemia with CNS involvement will show immature cells,
similarly to the peripheral blood smear.
The image is a stained smear of cerebrospinal fluid. The cells present in this field
may indicate what condition?

A. allergic reaction
B. bacterial meningitis
C. leukemia with CNS involvement
D. viral meningitis

A;
Though automated extraction machines have many benefits over manual methods
the costs are high and generally require a high throughput of samples in order to
justify the costs.

Automated extraction has many benefits over the traditional manual methods. The
most important benefit is that the nucleic acid isolated is constantly consistent. There
is a reduced amount of manipulation with dramatically decreases the chance of
cross contamination. Also, automated extraction machines are considered moderate
complexity and can be performed by a wider variety of laboratory professionals.
All of the following are considered benefits of automated isolation and extraction
equipment EXCEPT:

A. Automated isolation equipment is cheaper and more practical

B. Automated isolation equipment requires less manipulation
C. Automated isolation equipment is considered moderate complexity
D. Automated isolation equipment provides consistent results
False;
A three-hour glucose tolerance test includes a fasting blood glucose after which a
specified amount of glucose is ingested. Blood specimens are then collected at one,
two, and three hours for a total of four blood specimens.
True/False
A pregnant patient whose initial test for gestational diabetes was elevated, has
orders for a three-hour glucose tolerance test. The three-hour glucose tolerance test
includes two specimens: a fasting blood glucose and a specimen collected three
hours after drinking a 100-gram dose of glucose solution.
C;
Skeletal deformations result from the increased erythropoiesis that occurs in beta
thalassemia major. Children with beta thalassemia intermedia may demonstrate
some facial bone deformity, however this is not common. Beta thalassemia minor
rarely causes any physical signs or symptoms and beta thalassemia minima is
completely asymptomatic.
Skeletal deformations are most commonly present in which of the following beta
thalassemias?

A. Beta thalassemia minor

B. Beta thalassemia intermedia
C. Beta thalassemia major
D. None of the beta thalassemias
E. All of the beta thalassemias equally
D;
An antithetical relationship exists between the antigens M and N. Antithetical
relationships occur in situations where for a given locus, only one of two genes may
be inherited, the alleles are termed antithetical alleles.
In immunohematology, an antithetical relationship exists between M antigen and
which of these antigens?

A. K
B. S
C. Vw
D. N
C;
P. vivax characteristically displays Schuffner's dots and often enlarged RBCs along
with brownish granules. P. vivax can also have 12-24 merozoies in each cell,
actually filling the entire RBC. This parasite also has very irreglar shapes often
referred to as "Ameboid".

P. falciparum and P. malariae do not display Shuffner's dots, therefore could not be
the correct choice.

P. ovale does display Shuffner's dots in all stages, but characteristically has about 8-
12 merozoites in rosettes or irregular clusters inside the RBC. Also, P. ovale
characteristically shows enlarged, ovoid RBCs with fimbriated edges.
Identify the parasite of a patient with suspected malaria who demonstrates the
following findings on a blood smear:

- Enlarged RBCs, some with fine brownish granules

- > 15 parasites in some cells
- Ameboid structures
- Schuffner's dots
A. Plasmodium falciparum
B. Plasmodium ovale
C. Plasmodium vivax
D. Plasmodium malariae
A;
Serum ferritin is a good indicator of iron deficiency. However, it acts like an acute
phase reactant, being elevated in a large number of conditions. Patients who have
iron deficiency as well as another condition that elevates serum ferritin levels may
therefore have normal or even elevated serum ferritin levels.
Which one of the following statements about serum ferritin are true:

A. It is a sensitive indicator of iron deficiency

B. Elevation of serum ferritin is specific for hemochromatosis
C. It is synonymous with transferrin
D. It is a better test for bone marrow iron stores than a Prussian blue stain of marrow
particles
B;
Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased
blood pressure, and release of aldosterone from the adrenals.
A major action of angiotensin II is:

A. Increased pituitary secretion of petressin

B. Increased vasoconstriction
C. Increased parathormone secretion by the parathyroid
D. Decreased adrenal secretion of aldosterone
D;
The concentration of circulating ferritin is proportional to the size of iron stores.
Which of the following will give the best overall picture of a patient's iron stores:

A. Albumin
B. Transferrin
C. Haptoglobin
D. Ferritin
B;
Triglyceride blood concentrations change significantly when you eat, as opposed to
relatively stable levels of cholesterol, HDL, or LDL circulating in the blood. Whenever
you eat a meal that contains fat, your triglyceride levels rise, which is why it is
important to have a patient fast before the sample is collected.
Which of the following lipid results would be expected to be FALSELY elevated on a
serum specimen from a non-fasting patient?

A. cholesterol
B. triglyceride
C. HDL
D. LDL (not calculated)
A;
Know what you are handling - read label carefully.
What is the first thing you do before you handle or open a chemical:

A. Read the label

B. Ask a supervisor for assistance
C. Obtain a copy of the SDS
D. Consult procedure manual for information
E;
Stuart Prower factor, or factor X, would cause abnormal PT, aPTT, and dRVVT test
results as factor X is part of the common coagulation pathway and therefore
measured in both the PT and aPTT test. In the dRVVT test, factor X is directly
activated in the test principle; therefore an abnormal result would be expected in this
test as well if there was a deficiency in factor X.
What tests will be abnormal in a patient with Stuart-Prower Factor deficiency?

A. Prothrombin Time (PT)

B. Activated Partial Thromboplastin Time (APTT)
C. Russel Viper Venom Test (dRVVT)
D. a & b
E. a & b & c
D;
Heparin is the additive of choice for blood gas syringe collection as it has the least
amount of interference with the blood gas analytes measured.
Which of the following additives should be used for the collection of a sample for
blood gas analysis:

A. Sodium citrate
B. EDTA
C. Sodium oxalate
D. Heparin
True
The positive reactions for sodium citrate, urea (weak), and Voges Proskauer are
negative for all strains of Escherichia coli. Most strains of E. coli are ONPG and
indole positive, opposite to that seen here. Thus, a quick assessment of these
reactions quickly eliminates E. coli from the differential identification.
True/False
The reactions seen in the portion of the API strip shown in the photograph,
effectively rules out Escherichia coli.

C;
The identification of the crystals depicted in this image are triple phosphate crystals.
Triple phosphate crystals may be normal but are usually associated with alkaline
urine. These colorless crystals have a characteristic "coffin lid" appearance.
What is the identification of these crystals seen in urine with an alkaline pH?

A. Uric acid
B. Calcium oxalate
C. Triple phosphate
D. Calcium carbonate
1. B
2. C
3. A
Match each of the descriptions with the appropriate magnification:

1. Color, Rouleau, Overall Slide Quality, Cell Distribution

2. Platelet estimates RBC-platelet-WBC morphology WBC differential RBC
inclusions
3. Select area to examine, WBC estimate

A. 40X (Dry)
B. 10X
C. 100X (Oil)
A, B, & E;
Neutrophils, lymphocytes and macrophage/ monocytes can be found in all types of
body fluid differentials. Bronchial cells can be found only in bronchial washings and
BAL specimens. Mesothelial cells are found only in serous body fluids including
pleural fluid, peritoneal fluid, and pericardial fluid.
Select the specific cells listed below that can be found in all types of body fluid.

A. Neutrophils
B. Macrophage/monocytes
C. Bronchial lining cells
D. Mesothelial cells
E. Lymphocytes
D;
Bacterial contamination can manifest itself in several ways including: the presence of
clots, darker purple-black color of blood unit, unit can appear cloudy, hemolysis may
be present.
During routine inspection, a unit of unexpired blood was noticed to have a black color
with numerous small clots. What is the likely cause for this observation?

A. the unit was frozen

B. donor had DIC
C. viral contamination
D. bacterial contamination
A & D;
Rule-out is a process by which antibodies are identified as being unlikely in a given
sample because of the absence of an expected antigen-antibody reaction. In other
words, the absence of a reaction is noted with a cell that is positive for the
corresponding antigen.
Although rule-out procedures may vary somewhat from institution to institution, the
following general principles apply:
Non-reactive cells are selected for rule-out. To be classified as non-reactive, a cell
must NOT have reacted at any phase of testing in a given panel or screen.
Using the logic that if the rule-out cell is positive for a given antigen, it should have
reacted with the corresponding antibody, you can rule-out antibodies that correspond
to antigen positive cells.
To increase the probability that rule-out will not mistakenly eliminate a weakly-
reacting antibody that exhibits dosage*, use only cells that are homozygous for the
corresponding antigen for those systems that generally show dosage. Generally
these include: C, c, E, e, Fya, Fyb, Jka, Jkb, M, N, S, and s.
In this case, it is only possible to rule out on screening cell 2 since it demonstrates a
negative reaction with the patient serum. Anti-C cannot be ruled out since the C
antigen is heterozygous on screening cell 2 with c. Anti-Fya cannot be ruled out
since this antigen is not present on screening cell 2. Anti-M and anti-Jka can be ruled
out since the antigens are homozyous while demonstrating a negative reaction on
screening cell 2.
Rule-out, while very useful, can lead to error. Ruling out an antibody should be
combined with other supporting data to increase confidence in the solution; the more
data collected, the higher the probability that the final solution is correct.

*Dosage means that there are two "doses" of the same antigen present on the red
cells . Antibodies that exhibit dosage react more strongly with homozygous cells
(e.g., Jka Jka) than with heterozygous cells (e.g., Jka Jkb) .
Based on the phenotype of the RBC screening cells, and patient results shown on
the right, which of the following antibodies CANNOT be ruled out?

A. Anti-C
B. Anti-Jka
C. Anti-M
D. Anti-Fya
True;
A slide for microscopic examination of CSF should be made using a
cytocentrifugation technique (cytospin). Alternate methods of slide preparation, such
as concentration of cells by traditional centrifugation and manual smear methods,
are not recommended as morphologies may not be maintained and sufficient cells
may not be present on the slide for accurate evaluation of the sample.
True/False
Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid
(CSF) sample for examination of cellular morphology.
B;
Gram-positive bacteria retain the primary crystal violet stain that is applied in the
Gram stain because of the cross-linking of the thick peptidoglycan layer in their cell
walls. Their cell walls contain less lipids than that of a gram-negative bacteria, and
this reduces the permeability of their cell wall to the organic solvents that are used as
a decolorizer. When the counterstain is added, it may enter the gram-positive cell,
but does not change the color of the cells.
A thick peptidoglycan is MOST often associated with which of the following types of
bacteria?

A. Gram-negative bacteria
B. Gram-positive bacteria
C. Both gram-nega