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Frequently Asked Questions

ASCP ASCP-MLT Sample Question Answers

Question # 1

Report the isolate as coagulase negative Staphylococcus is the correct answer because this is an isolate from a urine specimen with a coagulase negative Staphylococcus susceptible to novobiocin. Staphylococcus saprophyticus is resistant to novobiocin. Further testing is required to speciate coagulase negative Staphylococci but only if the specimen is from a sterile body site, not urine. Gram positive cocci isolated from a catheterized urine culture on a 76-year-old male gave the following reactions: Blood agar- creamy, white, opaque colonies Catalase- positive Slide coagulase- negative Tube coagulase- negative Novobiocin- susceptible The next action the MLS should take is:

A. Report the isolate as coagulase negative staphylococcus
B. Report the isolate as Staphylococcus epidermidis
C. Report the isolate as Staphylococcus saprophyticus
D. Perform further testing to speciate the organism

Question # 2

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 Vfactor 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:

A. Haemophilus parainfluenzae
B. Haemophilus influenzae
C. Haemophilus aphrophilus
D. Haemophilus haemolyticus

Question # 3

The correct answer for this question is 1300 mg/dL. The laboratorian performed a 1:4 dilution by adding 0.25 mL (or 250 microliters) of patient sample to 750 microliters of diluent. This creates a total volume of 1000 microliters. So, the patient sample is 250 microliters of the 1000 microliter mixed sample, or a ratio of 1:4. Therefore, the result given by the chemistry analyzer must be multiplied by a dilution factor of 4. 325 mg/dL x 4 = 1300 mg/dL. After experiencing extreme fatigue and polyuria, a patient's basic metabolic panel is analyzed in the laboratory. The result of the glucose is too high for the instrument to read. The laboratorian performs a dilution using 0.25 mL of patient sample to 750 microliters of diluent. The result now reads 325 mg/dL. How should the techologist report this patient's glucose result?

A. 325 mg/dL
B. 1300 mg/dL
C. 975 mg/dL
D. 1625 mg/dL

Question # 4

The correct answer for this question is 1300 mg/dL. The laboratorian performed a 1:4 dilution by adding 0.25 mL (or 250 microliters) of patient sample to 750 microliters of diluent. This creates a total volume of 1000 microliters. So, the patient sample is 250 microliters of the 1000 microliter mixed sample, or a ratio of 1:4. Therefore, the result given by the chemistry analyzer must be multiplied by a dilution factor of 4. 325 mg/dL x 4 = 1300 mg/dL. After experiencing extreme fatigue and polyuria, a patient's basic metabolic panel is analyzed in the laboratory. The result of the glucose is too high for the instrument to read. The laboratorian performs a dilution using 0.25 mL of patient sample to 750 microliters of diluent. The result now reads 325 mg/dL. How should the techologist report this patient's glucose result?

A. 325 mg/dL
B. 1300 mg/dL
C. 975 mg/dL
D. 1625 mg/dL

Question # 5

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

Question # 6

Cerebrospinal fluid has three main functions: Protect brain and spinal cord from trauma. Supply nutrients to nervous system tissue. Remove waste products from cerebral metabolism. Which of the following are functions of CSF? Please select all correct answers

A. Supply nutrients to nervous system tissue.
B. Regulate body metabolism.
C. Protect spinal cord from injury.
D. Remove waste products from cerebral metabolism.

Question # 7

This is the total magnification of the high dry objective lens.

A. 100X
B. 40X
C. 400X
D. 1000X

Question # 8

A positive DAT is consistent with a diagnosis of hemolytic disease of the newborn. A hemoglobin performed on the cord blood serves as an indicator of the severity of the disease. In order to detect the presence of antibodies fixed on the RBC's of newborns one should:

A. Perform a direct antiglobulin test (DAT) on the cord blood
B. Perform an indirect antiglobulin test (IAT) on the cord blood
C. Test the baby's cells with typing antiserum
D. Look for agglutination in a mixture of mother's serum and baby's cells

Question # 9

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:

A. The thyroid has been established as the cause of hypothyroidism
B. The thyroid is ruled-out as the cause of hypothyroidism
C. The pituitary has been established as the cause of hypothyroidism
D. The diagnosis is consistent with secondary hyperthyroidism

Question # 10

Limited to blood and body fluids visibly contaminated with blood

A. Isolation
B. Universal Precautions
C. Transmission Precautions
D. Pathogenic

Question # 11

The governmental agency that oversees public health care matters in the United States is:

A. Center for Disease Control and Prevention (CDC)
B. Department of Health and Human Services (DHHS)
C. Food and Drug Administration (FDA)
D. Clinical and Laboratory Standards Institute (CLSI)

Question # 12

To make a 1 : 10 dilution, 270 ?L of diluent should be added to 30 ?L 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 ?L of sample. What volume of diluent should be used?

A. 70 ?L
B. 270 ?L
C. 300 ?L

Question # 13

What is the CORRECT blood-to-anticoagulant ratio for coagulations tests?

A. 4:1
B. 5:1
C. 9:1
D. 10:1

Question # 14

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

Question # 15

Chemistry Estrogen and progesterone markers are most commonly used to provide prognostic information about:

A. Breast cancer
B. Uterine cancer
C. Menopause
D. Cervical cancer

Question # 16

Hemoglobin electrophoresis uses an electric field to separate hemoglobin molecules based on differences in net electrical charge. The rate of electrophoretic migration is also dependent on the ionic radius of the molecule, the viscosity of the solution through which it is migrating, the electrical field strength, temperature, and the type of supporting medium used. Electrophoretic separation of hemoglobin fundamentally relies on:

A. Size differences of molecules
B. Net charge differences of molecules
C. Concentration differences of molecules
D. Shape variations of molecules

Question # 17

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

Question # 18

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 gramvariable. Which of the following best describes the organisms seen in this illustration:

A. gram-positive
B. gram-negative
C. gram-variable
D. acid-fast

Question # 19

Which of the following tubes contains an anticoagulant that does not bind calcium? Question options:

A. Lavender
B. Light blue
C. Gray
D. Green

Question # 20

Spirochetes such as Borrelia and Treponemes are best visualized using darkfield microscopy. Borrelia, which causes Relapsing fever, can be visualized under darkfield microscopy of wet preps of peripheral blood. Treponema can be visualized by darkfield microscopy of early primary lesions, and aspirates of affected lymph nodes. Which of the following organisms is best visualized by use of a darkfield microscope:

A. Campybacter
B. Entamoeba
C. Borrelia
D. Streptococcu

Question # 21

The most important purpose of a requisition form is: Question options:

A. authorization to perform the procedure
B. location of the patient
C. providing a system to report results
D. monitoring test result turnaround time

Question # 22

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

Question # 23

Serological diagnosis of active or recent infection generally requires the demonstration of IgM antibody, or the demonstration of a fourfold rise in the titer of specific IgG antibody. Which of the following would be considered most significant as it relates to serological testing:

A. Presence of an antibody titer is generally diagnostic
B. Rise of antibody titers is diagnostic
C. Concentration of antibody is diagnostic
D. Cross reactivity is not significant

Question # 24

This type of laboratory testing provides immediate assessment of the patient and can be performed at their bedside:

A. Centralized laboratory
B. Point-of-care testing (POCT)
C. High complex testing
D. Molecular testing

Question # 25

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

Question # 26

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

A. Blue to green
B. White
C. Red to brown
D. Yellow

Question # 27

The laboratory uses flammable chemicals for processing and staining patient specimens. One type of chemical used is ethanol. What is the proper way to store this chemical in the laboratory?

A. On the shelf with other hazardous chemicals
B. Under the sink in the laboratory
C. In a flame-resistant cabinet
D. In the back of the fume hood

Question # 28

Abrupt change in temperature is one of the risk factors in which a sickling event may occur. Dehydration, hypoxia, and physical exertion, rather than excessive intake of fluids, inhaling oxygen, and sedentary lifestyle, are all additional risk factors in which sickling events may occur. Which of these could cause a sickling event?

A. Excessive intake of water
B. Fluctuations in temperature
C. Oxygen inhalation
D. Sedentary life-style

Question # 29

Estriol levels in conjunction with hCG and AFP can be obtained during pregnancy to:

A. Assess the risk of Down's syndrome
B. Assess fetomaternal function
C. Assess for multiple gestations
D. Assess for maternal diabetes mellitus

Question # 30

Public health guidelines recommend that manipulation of samples for influenza testing be done inside a safety cabinet. Safety goggles could be worn if the specimen or procedure may be prone to splashes or sprays of infectious material. Utility gloves are not necessary. Public health guidelines recommend that laboratory specimens for influenza testing must be manipulated using which of the following safety precautions?

A. Safety goggles
B. Safety cabinet
C. Utility gloves
D. None of the above

Question # 31

HCG levels rise rapidly during the first trimester, then the levels start to decline around week 16. The hCG levels slowly decrease and can level off during the remainder of the pregnancy. The following BEST describes serum hCG levels during pregnancy:

A. Rise in levels throughout pregnancy
B. Highest levels found at end of pregnancy
C. Rapid rise in levels during first trimester; slow decline and possible level-off throughout remainder of pregnancy
D. Slow rise in levels during first trimester; rapid rise during second trimester; slow decline during the third trimester

Question # 32

The correct designation for a generalist laboratory professional with a bachelor's degree certified by the American Society for Clinical Pathology is

A. medical technologist
B. medical laboratory scientist
C. medical technician
D. medical laboratory technician

Question # 33

Which area of the laboratory can analyze a patient sample and be able to predict their risk of developing a disease?

A. Molecular testing
B. Immunology
C. Blood banking/transfusion medicine
D. Clinical chemistry

Question # 34

Myoglobin rises typically within 2-4 hours after a myocardial infarction and stay elevated for days, with a peak at the 6-9-hour mark post-MI. After myoglobin, troponin is the next fastest to rise afer a mycardial infarction and can rise within 3-4 hours with a peak around 12 hours post-MI. LD (8-12 hours, 24-48 hour peak) and CK (4-6 hours with peak at 24-36 hours) will also rise after MI, but are not as fast to rise as myoglobin and troponin. Chemistry A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had an MI?

A. LD
B. CK
C. Myoglobin
D. Troponin

Question # 35

According to the Michaelis-Menton kinetics theory, when a reaction is performed in zeroorder kinetics:A. The substrate concentration is very low and the reaction rate is dependent on the substrate concentration

B. The substrate concentration is in excess and the reaction rate is dependent on the enzyme concentration
C. The enzyme concentration is in excess and the reaction rate is dependent on the substrate concentration
D. The substrate concentration is equal to Km and the reaction rate is dependent on the enzyme concentration

Question # 36

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

Question # 37

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

Question # 38

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

Question # 39

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. Thalassemia
B. Vitamin B12 deficiency
C. Pelger-Huet anomaly
D. Folate deficiency

Question # 40

Listeria monocytogenes is the correct answer. The motility agar is showing motility at the top of the tube, but not deeper; typical of this catalase-positive, gram positive bacillus. Streptococcus agalactiae would be catalase negative and a coccus. Erysipelothrix rhusiopathiae would be H2S-positive and catalase negative. Escherichia coli is a gram negative bacillus. This Gram-positive bacillus grew as a diffusely beta-hemolytic colony from a newborn. It  was catalase positive and had tumbling motility on a hanging drop preparation. This is how it appeared on triple sugar iron agar and motility medium. What is the most likely diagnosis?

A. Listeria monocytogenes
B. Streptococcus agalactiae
C. Erysipelothrix rhusiopathiae
D. Escherichia coli

Question # 41

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

Question # 42

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

Question # 43

Hepatitis B surface antigen, or HBs, is a protein that is present on the surface of the virus. The protein will be present via laboratory testing in the blood with acute and chronic HBV infections Immunology What sero-marker is the first marker to become positive in Hepatitis B and is associated with the infective stage?

A. HBc antibody
B. HBc total
C. HBs antigen
D. Hbs antibody
E. Hbe antigen

Question # 44

Dce is found in 4% of whites and 44% of blacks. DCe is found in 42% of whites and 17% of blacks. DcE is found in 14% of whites and 11% of blacks. dce is found in 37% of whites and 26% of blacks. Blood bank The most common Rh haplotype among whites is:

A. Dce
B. DCe
C. DcE
D. dce

Question # 45

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

Question # 46

Match each virus with its appropriate nucleic acid content. 1. Paramyxovirus 2. Rhabdovirus 3. Poxvirus 4. Orthomyxovirus

A. RNA
B. DNA

Question # 47

The DAT is most likely to be negative in ABO HDFN. It's possible that the washing done as part of the DAT may break the bonds between anti-A (or anti-B) and the newborn's poorly developed A (or B) antigens. For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN?

A. anti-A
B. anti-c
C. anti-D
D. anti-K
E. anti-Fya

Question # 48

Bacitracin susceptibility is a presumptive test for the identification of Lancefield group A Streptococcus. Which of the following is a presumptive test for the identification of Lancefield group A Streptococcus:

A. Bacitracin susceptibility
B. Positive coagulase
C. Hippurate hydrolysis
D. Gram stain

Question # 49

India ink can aid in the visualization of the polysacchride capsules of yeast such as Cryptococcus neoformans. MicroIndia Ink is used to:

A. Visualize flagella
B. Visualize shape
C. Visualize capsule
D. Visualize cytoplasm

Question # 50

India ink can aid in the visualization of the polysacchride capsules of yeast such as Cryptococcus neoformans. MicroIndia Ink is used to:

A. Visualize flagella
B. Visualize shape
C. Visualize capsule
D. Visualize cytoplasm

Question # 51

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

Question # 52

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?

A. Hemoglobin A2
B. Hemoglobin C
C. Hemoglobin F
D. Hemoglobin G

Question # 53

Enterococcus spp. are bile esculin positive and grow in 6.5% NaCl. If they grow on the 6 ?g/mL vancomycin screen agar as this isolate does, it is vancomycin resistant. If there is no growth on the 6 ?g/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 ?g/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

Question # 54

Prozone effect (due to antibody excess) will result in an initial false negative in spite of the large amount of antibody in the serum, followed by a positive result as the specimen is diluted. The prozone effect ( when performing a screening titer) is most likely to result in:

A. False positive
B. False negative
C. No reaction at all
D. Mixed field reaction

Question # 55

2(2)2s = reject when 2 consecutive control measurements exceed the same mean plus 2s or the same mean minus 2s control limit. Violation of this Westgard rule is usually caused by a systematic error. Laboratory Operations Which of the following describes the Westgard multirule 2(2)S?

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 +2s or fall outside -2s
D. Two consecutive data points fall outside +2s
E. Synonymous with R4s

Question # 56

Darkfield microscopy allows a lower limit of resolution than bright-field microscopy which helps the tiny spirochetes to be seen in patient samples. In darkfield microscpy, there is a dark background where directly transmitted light is excluded by a dark-field condenser allowing only scattered light to be focused on the specimen. With dark-field microscopy bacteria appear luminous against a dark background. Which of the following microscopic techniques is best suited for direct examination of the infectious agent of syphilis?

A. Light microscopy
B. Phase microscopy
C. Darkfield microscopy
D. Electron microscopy

Question # 57

When an antigen comes in contact with the skin, the antigen is processed by cells in the epidermis and come in contact with T lymphocytes. T lymphocytes recognize the antigen as foreign and circulate through the bloodstream back to the epidermis and produce an inflammatory response to eliminate the antigen, but this immune response can produce a characteristic rash in the skin called contact dermititis. Contact dermatitis is mediated by:

A. B lymphocytes
B. Macrophages
C. Polymorphonuclear cells
D. T lymphocytes
E. Chemokines

Question # 58

In which of the following laboratory situations is a verbal report permissible?

A. When preoperative test results are needed by the anesthesiologist
B. When the report cannot be found at the nurse's station
C. When the patient is going directly the physician's office
D. None of these answers is correct.

Question # 59

The red blood cell distribution width (RDW) increases as the severity of alpha thalassemia increases because of changing MCV as the bone marrow produces smaller cells. In addition, if Hemoglobin H bodies are present, they result in the formation of schiztocytes (RBC fragments) that can have an effect on the MCV and RDW. The Red cell Distribution Width (RDW) in alpha thalassemia is

A. within normal limits
B. usually increased
C. usually decreased
D. dependent upon severity

Question # 60

What are the certification requirements for clinical laboratory professionals?

A. on the job training
B. national certification exam
C. college degree
D. college degree and a national certification exam

Question # 61

MLTs must be provided with free immunization for:

A. hepatitis C
B. hepatitis A
C. HIV
D. hepatitis B

Question # 62

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

Question # 63

Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period?

A. 5 hours after transfusion
B. 24 hours after transfusion
C. 3-10 days after transfusion
D. one year after transfusion Answer:

Question # 64

In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults?

A. Alpha thalassemia major
B. Alpha thalassemia minor
C. Hemoglobin H disease
D. Hydrops fetalis

Question # 65

The activities conducted in a laboratory with a certificate of registration include:

A. urinalysis only
B. moderate- or high-complexity lab testing until the lab is determined by survey to be in compliance
C. physicians to perform microscopy only
D. waived tests only

Question # 66

The ApoB/ApoA1 ratio has a positive risk marker (ApoB-100) and a negative risk marker (ApoA1). Risk diminishes as ApoA1 goes up (a negative marker) and risk increases in proportion to ApoB concentrations (a positive risk marker). This 'double-edged sword' provides good risk prediction. The other risk markers in question do not have this dualadvantage. Which risk marker has both positive and negative cardiovascular risk integrated into its measurement?

A. LpPLA2
B. Oxidized LDL
C. ApoB/ApoA1
D. hs-CRP

Question # 67

Waived tests are those considered to have an insignificant risk of erroneous results. Which of the following is NOT an example of a waived test?

A. fructosamine
B. spun hematocrit
C. blood glucose by home meters
D. potassium

Question # 68

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.

Question # 69

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

Question # 70

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

Question # 71

The tube of choice for trace metal analysis is:

A. red
B. royal blue
C. gold
D. light blue

Question # 72

Lavender stopper tubes can be used for all of the following except:

A. hematocrits
B. coagulation tests
C. differential counts
D. platelet counts

Question # 73

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:

A. CDC.
B. OSHA
C. HIPAA.
D. FDA.

Question # 74

Which of the following could reduce the risk of a patient becoming infected with a hospital acquired infection?

A. Antibiotic therapy
B. Chemotherapy
C. Proper handwashing procedure
D. Pre-surgical testing

Question # 75

Western blot analysis is frequently utilized as the confirmatory method of HIV detection. Which of the following assays is routinely used for confirmation of HIV infections:

A. Southern blot
B. Western blot
C. In-situ hybridization
D. Radioimmunoassay

Question # 76

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

Question # 77

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).?

A. lactose
B. sucrose
C. glucose
D. glucose and sucrose

Question # 78

Match terms with fragments resulting from papain digestion of an IgG molecule:

A = Fab fragment OR Fc fragment
B = Fab fragment OR Fc fragment

Question # 79

Provide the equivalent measurement for one gallon. Question options:

A. 3.79 liters
B. 1 liter
C. 2.5 liters
D. 4.2 liters

Question # 80

Intravascular hemolysis is typically associated with increased levels of serum (plasma) LDH and bilirubin, and an increased number of reticulocytes. Serum LDH is found in higher levels during intravascular hemolysis due to fact that high levels of LDH are normally found within the red cells, but is now being spilled into the bloodstream via red cell lysis. Bilirubin is a breakdown product of hemoglobin, which has also been spilled into the bloodstream from broken red blood cells via hemolysis. Reticulocytosis is a reflection of the release of an increased number of immature red blood cells from the marrow to account for the red blood cells that are lost through hemolysis. This is a normal response. Failure to show an increased reticulocyte count with hemolytic episodes or hemorrhage would indicate an ineffective erythropoiesis (possible bone marrow function problem). Which of these blood levels will increase during intravascular hemolysis?

A. Serum (plasma) LDH
B. Serum (plasma) bilirubin
C. Reticulocytes
D. All of the above
E. None of the above

Question # 81

Any oxidase-positive organism can be excluded from the Enterobacteriaceae. The other characteristics are as a rule present in these organisms. Which of the following is not true about members of the Enterobacteriaceae:

A. Gram-negative
B. Oxidase positive
C. Reduce nitrate to nitrite
D. Ferment glucose

Question # 82

Shigella and Salmonella are not found as normal flora in the gastrointestinal tract. Which of the following are not considered normal flora of the gastrointestinal tract:

A. Lactobacillus
B. Clostridium
C. Peptostreptococcus
D. Shigella

Question # 83

In order to perform a venipuncture on a newly admitted hospital patient, a phlebotomist needs to

A. Ask for the patients' written permission to perform the procedure.
B. Verfity that the patient has specifically name the drawing of blood in the admission process.
C. Realize that an admitted hospital patient has given implied consent to routine procedures such as phlebotomy.
D. Verify with the patient's primary care provider that phlebotomy is covered as a routine procedure.

Question # 84

A person classified as an ultrarapid metabolizer (UM) has a polymorphism that enhances the catabolic activity of the enzyme. This means that a UM would need more of the drug to achieve a 'normal' level since he/she is rapidly metabolizing the drug. Chem In therapeutic drug monitoring, a person who is classified as an ultrarapid metabolizer (UM) would need __________ of a drug metabolized by that enzyme.

A. A lower dose
B. A higher dose
C. The standard dose

Question # 85

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

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

Question # 86

No HLA matching is performed for corneal tissue transplants as the cornea occupies a privileged site not usually seen by the immune system. This term has been coined "immune privileged". Corneal tissue may be transplanted successfully from one patient to another because:

A. Anti-corneal antibodies are easily suppressed
B. Corneal antigens do not activate T cells
C. The cornea is non-antigenic
D. The cornea occupies a privileged site not usually seen by the immune system
E. The cornea has the same DNA in everyone.

Question # 87

The presence of a clot is acceptable in:

A. red stopper tubes
B. lavender stopper tubes
C. green stopper tubes
D. light blue stopper tubes

Question # 88

One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows: Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24 hours x h/60 min) In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95 ml/min What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs?

A. 9.5 mL/min
B. 13.6 mL/min
C. 95 mL/min
D. 136 mL/min
E. 1.36 mL/min

Question # 89

Blood Bank What other component(s) can be shipped together with Fresh Frozen Plasma (FFP)?

A. frozen RBC's and cryoprecipitate
B. platelets
C. packed RBC's and granulocytes
D. whole blood
E. none

Question # 90

Since cimetidine inhibits CYP2D6, less amphetamine will probably need to be given since it will not be able to be metabolized as readily. Most drug interactions are like this: one drug inhibits or competes with the same CYP450 as another drug. The end result is that higher concentrations of one, or both, drugs are present, leading to potential toxicity. A patient is taking cimetidine for a stomach ulcer. This drug inhibits CYP2D6. The patient is now prescribed amphetamine for narcolepsy. Amphetamine is metabolized by CYP2D6. What would you predict?

A. The dose for the amphetamine needs to be lower than normal.
B. The dose for amphetamine needs to be higher than normal.
C. Nothing can be assumed until you know the patient's status (PM, EM, UM).
D. The two drugs can never be given together since they interact.

Question # 91

Anti-A, anti-P, anti-Leb, and anti-M all react best at 4o C as they are predominantly IgM antibodies. Other antibody group choices above include IgG antibodies such as anti-K, anti-s, anti-S, and anti-Fya, anti-Lub, etc. which react best at 37o C. Which of the following groups of antibodies generally reacts most strongly at 4o C:

A. Anti-A, Anti-P1 , Anti-Leb , Anti-M
B. Anti-B, Anti-K, Anti-Lua , Anti-Fya
C. Anti-H, Anti-S, Anti-Jkb , Anti-Leb
D. Anti-A, Anti-K, Anti-Lub , Anti-s

Question # 92

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

Question # 93

Which of the following is NOT part of the stand or framework of the microscope?

A. stage
B. base
C. ocular lenses
D. arm

Question # 94

What component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)?

A. Irradiated Red Blood Cells
B. Washed Red Blood Cells
C. IgA-deficient products
D. HLA matched products

Question # 95

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

Question # 96

Fibers can be mistaken for casts on occasion, especially hyaline casts. Fibers, however, are usually thinner and appear less uniform in structure than casts do. Urinalysis & Other Body Fluids Which of the following artifacts may be mistaken for casts?

A. Air bubbles
B. Fibers
C. Coverslip scratches
D. Talc particles

Question # 97

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.

Question # 98

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

A. C
B. E
C. c
D. e

Question # 99

The red blood cell distribution width (RDW) increases as the severity of alpha thalassemia increases because of changing MCV as the bone marrow produces smaller cells. In addition, if Hemoglobin H bodies are present, they result in the formation of schiztocytes (RBC fragments) that can have an effect on the MCV and RDW. The Red cell Distribution Width (RDW) in alpha thalassemia is

A. within normal limits
B. usually increased
C. usually decreased
D. dependent upon severity

Question # 100

What is the first thing a phlebotomist should do in the event of an accidental needle stick?

A. go to the employee health service and get a tetanus booster
B. leave the area so that the patient does not notice the injury
C. decontaminate the site and fill out an incident report
D. check the patient's medical records

Question # 101

HbA1C is the recommended test for monitoring diabetic carbohydrate management.Microalbuminuria, low concentrations of urinary albumin, is measured to detect early renalimpairment, at a stage where it is reversible with treatment.What is the role of microalbuminuria testing?

A. Monitor diabetic patient carbohydrate management
B. Detect small-sized urinary albumin molecules in early renal disease
C. Detect small urinary concentrations of albumin before there is irreparable renal damage
D. Diagnose renal failure in a type 1 diabetic patient

Question # 102

The difference between plasma and serum is that:

A. serum is the cells of unclotted blood.
B. serum is obtained from a nonclotted specimen
C. plasma is from an unclotted specimen.
D. plasma is obtained from a clotted specimen.

Question # 103

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

Question # 104

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)

Question # 105

Provide the equivalent measurement for 1 ounce.

A. 10 grams
B. 5.7 grams
C. 100 grams
D. 28.35 grams

Question # 106

As magnification DECREASES, the opening of the iris diaphragm will...

A. stay the samel
B. decrease (get smaller)
C. increase (get bigger)

Question # 107

The Clinical Laboratory and Standards Institure (CLSI) recommends that all patient specimens are delivered to the laboratory no more than 2 hours after collection to reduce pre-examination variables caused by cellular action and the effects of prolonged exposure of specimens to room temperatures, such as: Question options:

A. leakage of coagulation factors into the serum or plasma by cellular metabolism; increased potassium values caused by exposure to room temperature; increased glucose values caused by cellular metabolism
B. glycolysis caused by leakage from cells; increased levels of coagulation factors caused by prolonged exposure to room temperatures; decreased potassium levels caused by cellular metabolism
C. glycolysis caused by exposure to room temperatures; hemolysis and leakage of coagulation factors from the cells; decreased potassium levels in the serum and plasma by cellular utilization
D. glycolysis caused by cells' use of glucose; hemolysis and leakage of potassium from the cells into the plasma or serum; the destruction of coagulation factors from exposure to room temperatures

Question # 108

What amount of absorbent material must be included between the primary receptacle and secondary packaging for either a category A or category B liquid specimen?

A. At least enough to surround the primary receptacle
B. Enough to completely absorb the specimen if the container leaked or broke
C. Enough to fill the space between the primary receptacle and the secondary container
D. There is no requirement for absorbent material

Question # 109

Hemolytic anemia, myelodysplasia, and liver disease may each fit this peripheral blood picture. Each of these conditions can display peripheral blood macrocytosis. It is easy to observe the overall larger size of the red blood cells in this image compared to the normal lymphocyte also present. When macrocytes are present, they should be examined for their shape (round vs. oval), the hemoglobin content (central pallor), and whether or not there are any inclusions present in the cell. Iron deficiency would not be the correct answer in this case, since this condition is associated with microcytosis instead. The complete blood count was obtained from a patient recently admitted to the emergency room. The red blood cell indices obtained revealed an MCV of 115 femtoliters (fL) (normal range 80 - 90 fL). The patient met the criteria for a peripheral blood smear examination. A representative field is shown on the right. Which of the following conditions may be indicated by the results seen on this peripheral blood smear?

A. Hemolytic anemia
B. Myelodysplasia
C. Iron deficiency
D. Liver disease

Question # 110

A phlebotomist draws an outpatient without wearing gloves. The outpatient displays a badge and cites the laboratory for not following the law. The outpatient is an employee of the:

A. National Fire Protection Association (NFPA)
B. Joint Commission (JC)
C. OSHA
D. Centers for Disease Control and Prevention (CDC)

Question # 111

Which of the procedures listed below will increase the platelet concentration in the preparation of Platelets?

A. Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a low speed.
B. Centrifuge the bood at a low speed, remove the plasma and spin the plasma again at a high speed.
C. Centrifuge the blood at a high speed, remove the plasma and spin the plasma again at a high speed.
D. Increase the duration of rotation

Question # 112

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

Question # 113

Since hemoglobin is measured spectrophotometrically on hematology analzyers, interference from lipemia or icteric specimens can lead to decreased light detected and measured through the sample and therefore inaccurate hemoglobin results occur. On an electronic cell counter, hemoglobin determination may be falsely elevated caused by the presence of:

A. Lipemic or icteric plasma
B. Leukocytopenia or Leukocytosis
C. Rouleaux or agglutinated RBCs
D. Anemia or Polycythemia

Question # 114

Polyspecific antihuman globulin (AHG) reagent contains both anti-IgG and anti-C3d. Polyspecific antihuman globulin (AHG) reagent used in antiglobulin testing should react with which one of the following?

A. IgG and IgA
B. IgM and IgA
C. IgG and C3d
D. IgM and C3d

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