MEDICAL LABORATORY TECHNICIAN - MLT(ASCP)
Last Update Mar 29, 2024
Total Questions : 572
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Sterile yellow stopper tubes contain thixotropic gel and a clot activator.
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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:
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.
Chem
Which of the following hormones increases plasma glucose concentration by converting glycogen to glucose? Please select all correct answers
Valine substitutes for glutamic acid in the Beta 6 position to produce HbS.
To produce hemoglobin S, glutamic acid that is normally present in the sixth position on the beta globin chain is substituted with which of the following?
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?
Micro - Matching
1. Upper left image
Multi-celled, rough walled macroconidia with a tapered terminal cell
2. Upper right image
Dense aggregates of echinulate, brown-black conidia
3. Lower left image
Loose clusters of elliptical conidia arranged in a "diphtheroid" pattern
4. Lower right image
Chains of large, lemon-shaped annelloconidia
The parents will each give one of their ABO genes, so the possibilities are as follows:
AB, AO, AB, AO = 50% chance of A blood type, 50% chance of AB blood type
Blood Bank
If parents have the blood group genotypes AA and BO, what is the possibility of having a child with a blood type of A?
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:
Coumarin derivatives inhibit the vitamin K dependent Factors (II, VII, X) which can be measured with the PT and monitored frequently with the INR assay.
Hematology
Warfarin-based (coumarin derivative) oral anti-coagulant therapy is commonly monitored with :
There are many causes of CSF lymphocytosis. Lymphocytosis is seen in viral, fungal, and tuberculous infections, although a predominance of neutrophils may be present in the early stages of these infections. Lumbar puncture to obtain CSF samples is often contraindicated in those with a suspected brain abscess.
CSF lymphocytosis is associated with all of the following except:
Which of the following cardiac biomarkers rises within 30 minutes - 4 hours after chest pain, peaks in 2 - 12 hours, and is usually normal within 24 - 36 hours.
The federal government has categorized critical biological agents into three groups: A, B, and C. Those agents in category A are highest-priority because they can be easily disseminated or transmitted person-to-person.
The federal government has categorized critical biological agents into three groups: A, B, and C. Those agents in category A are highest-priority because they:
The difference between glass and plastic red stopper tubes is that the:
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Anything that can cause significant turbidity in a blood sample, such as high leukocyte count or lipemia can potentially interfere with the accuracy of a spectrophotometric hemoglobin assay.
Hematology
Which of the following may interfere with the accurate measurement of hemoglobin:
A dilution commonly used for a routine sperm count is a 1:20.
A dilution commonly used for a routine sperm count is:
Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus that produces a strong toxin. C difficile is a common cause of antibiotic-associated diarrhea and pseudomembranous colitis.
Microbiology
A recto-sigmoidoscopy revealed pseudomembranes in a patient with severe diarrhea following prolonged treatment with ampicillin. Which of the following organisms is MOST likely to be isolated?
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?
The agency within Department of Health and Human Services (DHHS) responsible for implementing CLIA'88 is:
Most anticoagulants in blood collectiong tubes prevent clotting by:
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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:
Blood bank
Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration:
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:
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.
Which EBV markers would be MOST likely positive for an individual who had infectious mononucleosis 9 years ago?
Fatty casts contain refractile oval fat bodies or free fat droplets. They are derived from renal tubular cells, and may be seen in nephrotic syndrome.
Identify the urine sediment element:
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:
Molarity x Molecular Weight x Volume = Grams
Molecular Weight (aka Formula Weight) =
2(1) + 32 + 4(16) = 98
So, 4 x 98 x 0.2L = 78.4g
What weight of H2SO4 is contained in 200 ml of a 4 molar H2SO4 solution? (Atomic weight: H= 1; S = 32; 0 = 16)
In the laboratory, surfaces must be disinfected for blood spills. What is the most common disinfectant used?
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?
Thin-layer chromatography has the advantage of being able to test for a large number of drugs at the same time.
Thin-layer chromatography is particularly useful as a tool in the identification of:
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:
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:
Neutrophils are typically increased in urinary bacterial infections.
What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system?
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?
The body of a tapeworm is composed of successive segments known as proglottids. Each mature proglottid has both male and female reproductive structures.
What is the anatomical feature of a tapeworm that possesses both male and female reproductive structures?
Which area of the laboratory is responsible for blood coagulation studies that test for the patient's ability to clot their blood?
The correct set of patient data would be: Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%
Patients with sickle cell trait commonly have Hgb A values between 40 and 60%, Hgb S values between 20 and 40% and Hgb A2 values between 2 and 3%.
A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state?
1. A
2. A
3. B
4. A
5. B
6. B
A cardiovascular risk marker is an analyte in a body fluid that can be measured by the clinical laboratory and has been associated with the development of cardiovascular disease. Examples of risk markers include: LDL-C, triglycerides, and hs-CRP.
A cardiovascular risk factor is a condition (not a laboratory analyte) that is associated with an increased risk of developing cardiovascular disease. Examples of risk factors include: smoking, obesity, diabetes and hypertension.
Determine if each of the following is a cardiovascular risk marker or a cardiovascular risk factor.
1. Smoking
2. Obesity
3. Low density lipoprotein (LDL)
4. Hypertension
5. Triglycerides
6. High sensitivity-C-reactive protein (hsCRP)
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?
This patient is most likely suffering from an immediate-acting coagulation inhibitor; most commonly, lupus anticoagulant. Notice that the addition of normal pooled plasma does not correct upon initial or incubated mix, which means that the inhibitor is not time or temperature-dependent.
Factor VIII is not the correct answer as a factor deficiency would have corrected upon the addition of normal pooled plasma. Factor VII is not the correct answer, as the aPTT assay does not account for factor VII activity or concentration.
The laboratorian completed the mixing study ordered for John Doe. The results are as follows:
Initial aPTT result: 167 seconds
Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds
Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds
Which of the choices below would most likely explain the results for this patient?
A casual blood glucose >/= 200 mg/dL on a patient with symptoms and an A1C >/= 6.5% meet diagnostic criteria for diabetes.
Chemistry
A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose at time of evaluation and a HbA1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes.
What would be the best course of action if these are the blood glucose results?
Casual Blood Glucose: 208 mg/dL
HbA1C one week later: 7.2%
Heinz bodies occur as the result of denaturation and precipitation of hemoglobin, and are often attached to the red cell membrane. They require staining with crystal violet or methyl violet to be visible. They may be seen in thalassemia, with unstable hemoglobins, or during a hemolytic episode in G6PD deficiency.
Hematology
The intracellular precipitates seen in the RBCs in this illustration is termed:
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 dual-advantage.
Which risk marker has both positive and negative cardiovascular risk integrated into its measurement?
DAT ( Direct Antiglobulin Test ).
When AHG or Coombs serum is used to demonstrate that red cells are antibody coated in vivo, the procedure is termed:
Match each of the following:
1. Ratio of cellular area to total area in the bone marrow section.
2. Number of myeloid cells compared to nucleated erythroid cells.
3. Use low power to estimate their quantity and appearance.
4. Use Perls' Prussian blue stain.
All of the following have been an inspection deficiency for CLIA-approved laboratories except:
The molecular weight of a hapten is by itself not sufficient to elicit an antibody response alone, but requires a protein to do so.
A hapten is only antigenic when it is coupled with which of the following:
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.
First, determine the number of WBC's from the hemocytometer as follows:
WBC count = (dilution ratio x # of cells counted x 10) / (# mm2 area counted)
Then: WBC count = (20 x 100 x 10) / (8) = 2500 WBC/mm3 (or 2500 WBC/uL or 2.5 x 103 WBC/uL)
Next, to find the WBC count per liter, multiply the WBC count/uL by the number of uL/L (there are 106 uL/L)
So: (2.5 x 103 WBC/uL) x (106 uL/L) = 2.5 x 109 WBC/L
Hematology
A 1:20 dilution is made for a manual WBC count. The four corner squares on both sides of a hemocytometer are counted. A TOTAL of 100 cells are counted in that area. What is the white blood cell count in terms of a liter (? x 10^9/L)?
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?
Convert the following temperature from Celsius to Fahrenheit
-10 degrees C
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Howell-Jolly bodies are composed of DNA and appear as small round ball-like inclusions inside the red cells. Usually only one Howell-Jolly body will be present in each red cell.
Single erythrocyte inclusions which are large, round, smooth and purplish-blue staining are most likely:
The antiglobulin test may be omitted from the serological crossmatch if the patient's antibody screen is negative and there is no history of detection of unexpected antibodies.
Blood Bank
What must be true for the antiglobulin phase of the serologic crossmatch to be omitted (i.e., immediate spin crossmatch is done)? Please select all correct answers
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?
The activities conducted in a laboratory with a certificate of waiver include:
hs-CRP is a recent marker of chronic inflammation. New measurements of CRP in lower levels (hs-CRP) are now measured to monitor risk of cardiovascular disease.
Select the statement that best describes hs-CRP?
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:
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?
Chemistry
Estrogen and progesterone markers are most commonly used to provide prognostic information about:
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:
Which of the following hormones stimulates gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids?
Glucose positive, Maltose positive, Lactose negative and Sucrose negative is the correct answer since Neisseria meningitides causes Waterhouse-Friderichsen syndrome and it is positive only for glucose and maltose.
An autopsy of a 1-year-old female admitted to the emergency room 4 hours prior to her death revealed Waterhouse-Friderichsen syndrome. Blood and nasopharyngeal cultures taken prior to her death should reveal an oxidase-positive, Gram-negative diplococcus with the following biochemical reactions:
Gram positive organisms resist decolorization by ethyl alcohol. The large crystal violet-iodine complex is not able to penetrate the peptidoglycan layer, and is trapped within the cell in gram-positive organisms. Conversely, the outer membrane of gram-negative organisms is degraded and the thinner peptidoglycan layer of gram-negative cells is unable to retain the crystal violet-iodine complex and the color is lost.
What is the purpose of using ethyl alcohol or acetone in the gram stain procedure:
High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and treatment of cardiovascular disease (CVD). At low levels, it can detect those at risk for cardiac heart disease. At high levels in those with no history of heart disease, it indicates a high risk for acute myocardial infarction (AMI), stroke, or peripheral vascular disease. For patients with acute coronary syndrome (ACS) or stable coronary disease, hs-CRP is used to predict future coronary events.
Ranges of hs-CRP in prediction of risk for CVD are:
<1.0 mg/L Low CVD risk
1.0-3.0 mg/L Average risk for CVD
>3.0 mg/L High risk for future CVD
If results are >10.0 mg/L, the patient should be evaluated for an acute inflammatory condition.
Chemistry
A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1 mg/L) may indicate which of the following?
The image shown in this question is depicting a rosette formation. Here the red blood cells are surrounding and adhering to the outside of the white blood cell.
What is the best description of the phenomenon seen in this illustration?
The microscopic features shown here represent Scopulariopsis species. In most instances, particularly if a patient does not have underlying immunologic or hematologic disease, Scopulariopsis species should be considered a contaminant when recovered from a sputum specimen. However, if there is clinical or X-ray evidence of mycotic pulmonary infection, additional daily induced sputum specimens should be obtained.
If Scopulariopsis species or any other hyaline mold is recovered from two or more successive specimens, its potential as a pathogenic agent should be considered. Scopulariopsis species have been reported as the agents of pulmonary fungus ball infections in patients with preexistent cavities and as a cause of pneumonia in patients with leukemia.
Invasive pulmonary disease by this agent has not been reported.
The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely:
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:
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?
Caffeine benzoate solution is used to split the unconjugated bilirubin protein complex releasing the bilirubin so that it can react with diazotised sulphanilic acid. The tartrate buffer creates an alkaline solution and converts the red acid bilirubin to a green coloured compound which can be measured spectrophotometrically.
Which substance is used in the Jendrassik-Grof method to accelerate the reaction of unconjugated bilirubin with the diazo reagent?
Immunology
The immunoglobulin molecule is made up of both heavy and light chains - the light chains can be comprised of which of the following:
The correct designation for a generalist laboratory professional with a bachelor's degree certified by the American Society for Clinical Pathology is
1+ reaction has numerous small clumps and cloudy red supernatant
2+ has many medium-sized clumps and clear supernatant.
3+ has several large clumps and clear supernatant
4+ has one solid clump, no free cells, and clear supernatant
BB
Tube-based agglutination reactions in blood bank are graded from negative (0) to 4+. A reaction that has numerous small clumps in a cloudy, red background is:
Either immunofixation or immunoelectrophoresis can be used to confirm Bence-Jones proteinuria.
Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine:
A positive spot test shows agglutination of horse erythrocytes when added to patient serum previously absorbed with guinea pig kidney, but not when added to patient serum previously absorbed with beef erythrocyte stroma. The test is generally simple, sensitive, and specific, but false negative are common in young children with mononucleosis.
The most common rapid slide test (MONOSPOT©) for infectious mononucleosis employs:
The part of the microscope that control the amount of light entering the specimen much like the iris of your eye controls light is called the iris _______________.
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?