The organisms in this image are demonstrating a gram-variable phenomenon. For the most part, the organisms are staining primarily gram-negative, however, on the tips of some of the rods, there is a gram-positive staining morphology. This can be defined as gram-variable.
Which of the following best describes the organisms seen in this illustration:
Which of the following is NOT part of the magnification system of the microscope?
Protein in urine can be confirmed using sulfosalicylic acid (SSA) precipitation. The SSA reagent is added to a small volume of urine. Acidification causes precipitation of protein in the sample, which is subjectively graded as trace, 1+, 2+, 3+ or 4+. SSA reaction will detect albumin, globulins, and Bence-Jones proteins.
Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:
Iron deficiency anemia, or IDA, is associated with an increased TIBC as there is less iron to bind to transferrin. Microcytic, hypochromic red cell morphology, a decreased serum iron level, a decreased serum ferritin level, and a decreased hemoglobin level are all characteristics associated with IDA.
All of the following are characteristic findings in patients with iron deficiency anemia EXCEPT:
The National Heart, Lung, and Blood Institute initiated the National Cholesterol Education Program (NCEP) in 1985. The goal was to reduce the number of Americans with elevated cholesterol and thus reduce illnesses and deaths in the United States due to coronary heart disease. Three adult treatment panels have been published since then with clinical practice guidelines for managing cholesterol levels in adults.
The most recent panel, Adult Treatment Panel III (ATP III), was published in 2001 and updated in 2004. The NCEP: ATP III also includes criteria for the diagnosis of metabolic syndrome.
Select the set of laboratory assays that are utilized in the NCEP: ATP III criteria for metabolic syndrome diagnosis.
hs-CRP is a more sensitive version of the C-reactive protein (CRP) test, a test that has been used for many years to assess inflammation in settings such as lupus, transplantation, infection, etc.
Which of the following cardiovascular risk markers is a more sensitive version of a test that is used to assess inflammation?
During primary hypothyroidism, where a defect in the thryoid gland is producing low levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback mechanism.
Serum TSH levels five-times the upper limit of normal in the presence of a low T4 and low T3 uptake could mean which of the following:
IgE levels are often increased in patients with allergic disease. IgE binds to the membranes of mast cells and basophils, and if specific antigen is present to react with the IgE molecule, degranulation of these cells occurs, releasing histamines, and other substances into the blood or tissues.
Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils:
The governmental agency that oversees public health care matters in the United States is:
1. B
2. D
3. A
4. C
Red to Brown Urine: porphobilinogen, hematuria, myoglobinuria, etc.
Green: Food colorings; Increased carotene in the diet;
Pseudomonas aeruginosa infection
Yellow: bilirubin, bile pigments
White: phosphates, other crytals
Match urine color with substance that might have been responsible:
1. Phosphates
2. Bilirubin
3. Pseudomonas
4. Porphobilinogen
The lactophenol blue mount reveals tiny, ovoid microconidia, arranged in a daisy-head pattern at the tip of a straight conidiophore. This appearance is characteristic of the mold form of Sporothrix schenckii. By moving the focus up and down in a microscopic preparation, delicate hair-like attachments may be observed for each conidium.
The mold form of Coccidioides immitis produces delicate hyphae that break up into arthroconidia separated by empty cells, giving an alternatively staining appearance.
The mold form of Blastomyces dermatitidis is characterized by the production of single, smooth microconidia, each borne on a single, thin conidiophore ("lollipops").
The mold form of Histoplasma capsulatum is recognized by the production of large, echinulate macroconidia, appearing as a prickly surface.
The ovoid microconidia arranged in a daisy-head pattern at the tip of a a straight conidiophore, observed in the photomicrograph on the right, is characteristic of which of the following dimorphic molds?
The correct answer is Trichophyton rubrum. The tiny microconidia are lined up in a "birds on the fence" arrangement along the hyphal strand transversing the field of view (yellow arrows). Two pencil-shaped, smooth walled macroconidia are also seen in the lower left field of view (red arrows).
Trichophyton verrucosum may produce microconidia in small quantities. However, they are irregularly arranged with little tendency to line up along the hyphae. Antler hyphae and string bean macroconidia are characteristic of this species.
One of the key characteristics in the identification of Epidermophyton floccosum is the inability of this dermatophyte to produce microconidia. Two to four-celled, club-shaped macroconidia are produced, usually in clusters of two or three.
The profusion of tiny microconidia lining up along the hyphae in this photomicrograph is characteristic of which of the following organisms?
This drawing depicts beta thalassemia minor B+/B. In Beta thalassemia minor B+/B, one beta gene locus is partially deleted or inactive.
Hematology
This drawing depicts which beta chain genotype ?
Hemoglobin F has a high affinity for oxygen. When Hb F is elevated, cells containing Hb S are more oxygenated and do not sickle as readily as they would if Hb F were not present or present in small quantities.
Which hemoglobin, when elevated, acts as a protection against sickling in patients with HbS?
The structures involved in the production of semen include the prostate, the seminal vesicles, and the bulbourethral gland, along with the testes and epididymis.
Semen is produced as a combination of secretions from the different regions of the male reproductive tract. Each fraction differs in chemical composition and function.
Spermatozoa are produced in the testes. They mature in the epididymis. The testes also produce testosterone and inhibin.
Fluid from the seminal vesicles accounts for approximately 70% of semen volume. The seminal vesicles are the source of fructose in semen. Fructose is used by the spermatozoa as an energy source.
The prostate gland supplies about 20% of the volume of semen. Its fluids include acid phosphatase and proteolytic enzymes that lead to coagulation and subsequent liquefaction of semen. The prostate also contains most of the IgA found in semen.
The bulbourethral gland produces mucoproteins that make up about 5% of the volume of semen.
The pituitary gland is not directly involved in the production of semen; instead hormones are released which stimulate the production of sperm. The urethra is not involved in the production of semen.
Which of the following are directly involved in the production of semen?
The electrolyte panel consists of potassium, sodium, chloride, carbon dioxide. These analytes are also typically ordered within other panels as well, including the basic metabolic and complete metabolic panels.
An electrolyte panel (lytes, chem-4) consists of:
The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of Aspergillus. Aspergillus has the ability to infect primarily immunocompromised hosts, and causes pneumonia and/or disseminates to other organs. Clinical specimens should be inoculated onto primary isolation media, such as Sabouraud's dextrose agar. Aspergillus spp. are fast growing and can be white, yellow, yellow-brown, brown to black or green in color.
The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of:
To make a 1 : 10 dilution, 270 µL of diluent should be added to 30 µL of sample, .
A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 µL of sample. What volume of diluent should be used?
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.
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?
To obtain a serum sample for a stat test on a patient receiving anticoagulant therapy, the recommended tube is:
Question options:
Convert the following temperature from Celsius to Fahrenheit
-10 degrees C
Question options:
The correct answer which best fits the characteristics in this question is Mycobacterium kansasii.
The remaining Mycobacterium strains can be elimated as:
Mycobacterium marinum is considered a fast-grower.
Mycobacterium scrofulaceum produce deep-yellow to orange pigmented colonies when grown in the either the light or dark.
Mycobacterium avium grows colonies which are nonpigmented in the light and dark which do not intensify after light exposure.
What is the MOST likely identification of an acid-fast bacillus that demonstrates the following characteristics?
slow growth
cream to tan colored colonies when grown in the dark
development of yellow pigment upon exposure to light
Which of the following organizations has developed standards to maintain the performance of the clinical laboratory at the highest standards for quality care?
If your reactions are strong at immediate spin (3+) and then get weaker at AHG (w+), it could mean the presence of a strong cold antibody.
Cold antibodies tend to be IgM and their optimum phase for reactivity is immediate spin. Incubation and washing of the sample may cause the agglutination that occurred at room temperature to break down. This would appear as a weaker reaction at AHG.
If the reaction strengths varied in each panel cell then that could be an indication that there are multiple antibodies present.
Your screen cells are 3+ at immediate spin and weak (W)+ at AHG. Your auto control is negative for both phases. Some of your antibody panel cells are 3+ at immediate spin and negative at AHG. What should you suspect?
1. B
2. C
3. A
Granular casts are composed of plasma protein aggregates and cellular remnants. Granular casts appear as cylinders of coarse, or fine, highly refractive particles.
Broad casts or "renal failure' casts are formed in the collecting ducts as the result of urinary stasis and are two to six times the size of other types of casts. Any type of cast can be a broad cast. Broad casts are typically seen in patients with advanced renal failure.
Hyaline casts, the type most commonly seen in urine sediment, have a refractive index similar to the urine in which they are suspended. For this reason, hyaline casts will appear almost invisible under brightfield microscopy, but are easily of seen by phase-contrast microscopy.
Match the following descriptions of casts with their appropriate name:
1. Casts with highly refractive particles
2. "Renal failure" cast
3. Low refractive index
Alkaline over acid, or K/A, in TSI reactions is associated with the fermatation of glucose alone and the utilization of peptone.
Which of the following sugars has been fermented by a gram-negative rod that has produced an alkaline slant and an acid butt on triple sugar iron agar (TSI).?
The production of long, tapered phialides is one of the key identifying features of Trichoderma species. In contrast, Penicillium species, produce phialides with blunt ends.
The phialides of Beauveria species are geniculate, forming a zig-zag pattern.
The arrows in the image on the right point to single, long, tapered phialides that extend laterally from either side of the hyphae. This is an identifying feature of which of the fungi listed below?
An international, nonprofit organization that establishes standards of best current practice for clinical laboratories is
Beta-thalassemia major, also known as Cooley's anemia, has inherited two genes for beta thalassemia without a normal beta-chain gene. This disease is assoicated with a marked deficiency in beta chain production and in the production of normal Hb A. These patients exhibit increased amounts of iron due to the mutliple transfusions that keep them alive. There is also a striking increase in hemoglobin F and an elevation in hemoglobin A2.
Hematology
A 5-year-old African American child with hepato-splenomegaly and skeletal abnormalities has the following lab results:
WBC = 4,800/cu.mm
20 NRBC/100 WBC
RBC = 2.70 X 106
HGB = 6.2 g/dL
Many target cells
Marked hypochromasia, anisocytosis & poikilocytosis
Serum Iron = 200 µg/dL (elevated)
Sickle Solubility = negative
Hemoglobin F = elevated
What is the PROBABLE cause of these findings?
Which of the following agencies administers the certification test that you will be eligible to take at the end of your 4 semester?
Which area of the laboratory is responsible for blood coagulation studies that test for the patient's ability to clot their blood?
The creatinine clearance for this patient is 100 mL/min.
Creatinine clearance values are calculated using the following equation:
Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine Volume (mL) / [ time (hr) x 60 ]
For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60])
80 x 1800/1440, which is 80 x 1.25, or 100 mL/min
A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min.
Neutrophils reside in the peripheral circulation for only 7-8 hours ( approx. 7.5 hours) before entering the tissues and body cavities. This process is called diapedesis.
Hematology
How long are healthy neutrophils expected to reside in the peripheral blood of an adult?
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:
Which of the following testing options would be classified as waived testing by CLIA standards?
Microbiology
Matching: The detection of a distinct odor is often helpful in the presumptive identification of bacterial culture isolates. Match each of the odors listed with its corresponding bacterial species name.
1. Streptococcus anginosus (milleri)
2. Pseudomonas aeruginosa
3. Eikenella corrodens
4. Alcaligenes faecalis
In radioimmunassay, a fixed concentration of labeled antigen is incubated with a constant amount of antiserum such that the concentration of antigen binding sites on the antibody is limiting. If unlabeled antigen is added to this system, there is competition between labeled antigen and unlabeled antigen for the limited and constant number of binding sites on the antibody, and thus the amount of labeled antigen bound to antibody will decrease as the concentration of unlabeled antigen increases.
Which of the following choices is correct when describing the principles of competitive radioimmunoassay procedures?
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?
Root cause analysis (RCA) is a structured study that determines the underlying causes of adverse events. RCA focuses on systems, processes, and common causes that were involved in the adverse event. It then determines ways to prevent recurrence by identifying potential improvements in systems and processes that should decrease the likelihood of repeating the event.
Failure mode and effect analysis (FMEA) is used to evaluate a process prior to its implementation. Its purpose is to identify ways in which a process might possibly fail with the goal being to eliminate or reduce the likelihood of such a failure.
Monitoring quality indicators is important in the maintenance of quality health care. Quality indicators should be identified to prevent medical errors from occurring or to prevent the recurrence of a quality issue. However, it is not the method that is used to evaluate an adverse event after it has occurred.
A medical record audit may be a part of a root cause analysis.
A medical event occurs that results in serious injury to a patient. All systems, processes, and common causes that were involved in the adverse event should be evaluated. A method that can be implemented to effectively study the underlying causes is known as:
Mode is defined as the number that occurs most frequently in a set of numbers.
The value that occurs most frequently in a set of results or values would be termed:
The agency within Department of Health and Human Services (DHHS) responsible for implementing CLIA'88 is:
In order to perform a venipuncture on a newly admitted hospital patient, a phlebotomist needs to
Small, dense LDL is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis. Small, dense LDL is associated with more than a three-fold increase in the risk of coronary heart disease.
Large, buoyant LDL is less atherogenic than small, dense LDL.
The LDL phenotype A is normal. It is the so called 'B' pattern that is associated with increased risk.
Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?
According to the Michaelis-Menton kinetics theory, when a reaction is performed in zero-order kinetics:
Kell, Kidd, and Duffy are usually warm reacting IgG antibodies. The most common P system antibody is anti-P1, which is a frequently naturally occurring low titer IgM antibody, seen in most P2 individuals.
Blood bank
Which of the following blood groups is most frequently associated with cold agglutinins:
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:
Gluconeogenesis is the formation of glucose from noncarbohydrates when carbohydrate intake is absent, a fasting state. The hormone cortisol along with glucagon and epinephrine all stimulate this metabolic pathway. Insulin; however, inhibits this pathway and is therefore the correct answer.
Which of the following hormones inhibits gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids?
Myoglobin release is strongly associated with muscle damage; therfore, it would most closely match a diagnosis of massive muscle trauma in this question.
Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders?
Osteoblasts are generally seen in clusters while plasma cells are often more diffusely distributed. Osteoblasts have delicate cytoplasm, whereas plasma cells have dense basophilic cytoplasm with a perinuclear halo.
Hematology
The large cell shown in the illustration to the right is occasionally seen in the bone marrow and can be mistaken for a plasma cell - what is this cell called:
A laboratory scientist is preparing a chemical reagent for testing and accidentally spills the chemical on the counter. How is this contamination taken care of?
The intended response is Vitamin B12 and folate deficiencies. Each of these conditions lead to a megaloblastic production of the red blood cells in the bone marrow. Since vitamin B12 and folate are needed in order to produce a synchronous development of the nucleus with the cytoplasm in hematologic cells, oval-macrocytosis often occurs if these nutrients are not in adequate supply within the body. This can also affect neutrophils, allowing for the characteristic hypersegmented nucleus.
The photographic field contains several oval-macrocytes and a hypersegmented neutrophil with greater than 5 nuclear segments. Oval macrocytes are most commonly associated with pernicious anemia and malabsorption syndromes leading to vitamin B12 and folic acid deficiencies.
Clinical information relating to chronic infection, aplastic anemia, and other hematologic maligancies provide the context for the presence of the oval macrocyte.
Macrocytic erythrocytes and hypersegmented neutrophils are not present in thalassemias or in Pelger-Huet anomaly (hyposegmented neutrophils).
Conditions suggested by the macrocytes and the neutrophil in the photograph to the right include which of the following?
A young man is experiencing difficult breathing after fainting. The physician orders a blood gas analysis which shows the following results:
pH = 7.25
pCO2 = 62 mmHg
pO2 = 70 mmHg
HCO3 = 23 mEq/L
Which condition is most likely afflicting this patient?
Haemophilus influenzae is both X and V factor dependent for growth, and is the most common cause of obstructive laryngitis and epiglottitis. H. parainfluenzae is only V-factor dependent and causes only mild pharyngitis, rarely obstructive in nature. H. aphrophilus can be part of the normal upper respiratory flora in humans, does not cause pharyngitis, and is not X or V-factor dependent for growth. Although H. haemolyticus is both X and V-factor dependent, it is beta hemolytic on blood agar and is generally considered non pathogenic.
Acute obstructive epiglottitis, both in adults and children, is caused by the bacterial species shown in this split screen photograph. The colonies recovered on chocolate agar (upper frame) required both hematin and NAD, (as shown by colony growth only between the X and V strips in the lower frame). The most likely identification is:
The area of the federal government that ensures that the laboratory is stocked with gloves for their employees when performing tests on patient blood sample is:
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:
In which of the following laboratory situations is a verbal report permissible?
First, the RBC indices must be calculated. The MCV ((Hct/RBC) x 10) = 71 fL. Since the reference range for the MCV is 80-100 fL, this anemia would be classified as microcytic. The MCH ((Hgb/RBC) x 10) = 19.3 pg. Since the reference range for the MCH is 27-33 pg, this would be considered hypochromic. Finally, the MCHC ((Hgb/Hct) X 100) = 27%. Since the normal range for the MCHC is 33%-36%, this would indicate hypochromia which correlates with the MCH findings. The correct answer is therefore microcytic, hypochromic anemia.
A patient is admitted to the emergency room with lethargy and pallor. The CBC results are as follows:
RBC = 4.1 x 1012/L
Hemoglobin = 7.9 g/cL
Hematocrit = 29%
How would you classify this anemia?
The part of the microscope that holds the objective lenses is called the _______________.
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:
Match each of the following definitions associated with heart disease and heart failure to the term that it defines.
1. Congestive heart failure
2. Infarction
3. Ischemia
4. Angina
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?
Bicarbonate and Chloride form an exchanger to help regulate and buffer the body's pH.
The buffering capacity of blood is maintained by a reversible exchange process between bicarbonate and:
The intended response is "transfusion dimorphism". The microcytic, hypochromic erythrocytes suggests iron deficiency anemia. Interspersed among these cells are normocytic, normochromic erythrocytes suggesting two populations of red cells following transfusion. This was a case of severe iron deficiency treated with red cell transfusions and iron supplement.
The condition most likely associated with the peripheral blood picture in the photograph is:
Platelets do not circulate in inactivated, spiny forms. The spiny, sticky form of the platelet is initiated once the platelets become activated in response to blood vessel damage.
Which of the following is not true in terms of platelet characteristics?
An employer who fails to provide sufficient personal protective equipment (PPE) for employees may be fined by the:
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:
Which of the following is a selective media recommended for the isolation of Clostridium difficile?
Insulin is the hormone that is mainly responsible for the entry of glucose into the cell for energy production
Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to glucose, which increases plasma glucose. Cortisol, along with glucagon, increases gluconeogenesis, formation of glucose from noncarbohydrates, which also raises plasma glucose concentration.
Chemistry
Which of the following hormones is mainly responsible for the entry of glucose into the cell for energy production?
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TESTED 19 Apr 2024
