MEDICAL LAB TECHNICIAN EXAM KIT 1 Welcome to your MEDICAL LAB TECHNICIAN STUDY MODE KIT 1 Name Business Email Phone Number How does the secondary immune response differ from the primary immune response? IgG is the predominant antibody class produced in the secondary immune response The antibody levels produced are higher in the secondary immune response The lag phase (the time between exposure to antigen and production of antibody) is shorter in the secondary The primary immune response typically does not involve specific IgG antibody All of the above Hint The "spiked" erythrocytes included in the image to the right may be found in each of the following conditions EXCEPT: Cardiac valve prosthesis a-beta-lipoproteinemia Disseminated intravascular coagulation Extensive burns Hint Analytical sensitivity of a method generally refers to: Its ability to measure only what is being assayed Its ability to measure high concentrations of analytes It not being affected by interfering substances Its ability to measure low concentrations of analytes Hint Which one of the following statements about Coxiella burnetii is not true It causes Q fever It has a worldwide distribution It is an obligate intracellular parasite It is best diagnosed by culture of the organism Hint Which of the following dematiaceous fungal species produce conidia in clusters? Alternaria species Exophiala species Cladosporium species Hint A urine production of less than 400 mL/day is: Consistent with normal renal function and water balance Termed isosthenuria Defined as oliguria Associated with diabetes mellitus caused by moderate dehydration Hint The iodine prep is least helpful in the identification of which of the following parasitic stages: Larvae Eggs Cysts Trophozoites Hint A peripheral blood smear with many myeloid cells was presented for morphology review (see image on the right). Toxic granulation and vacuoles in the neutrophil most likely represent which of the following conditions? Septicemia Viral infection Tuberculosis Hint Standard precautions means that: Known infectious patients must be handled with extraordinary care Mask, gloves and gowns should be worn in all hospital patient's rooms All specimens must be handled as if they are hazardous and infectious Always wash your hands before drawing a patients blood sample Hint The image on the right represents the result of a fluorescent antinuclear antibody (ANA) test. What pattern should be reported? Note: (a) points to the nuclei of several interphase cells, the primary consideration for discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell may assist in identification of the ANA pattern Homogeneous Speckled Nucleolar Centromere Hint The curved, multi-celled, dark brown staining macroconidia divided by transverse septa that can be observed in the photomicrograph on the right is characteristic of which of the following species of dematiaceous fungi? Bipolaris species Stemphylium species Curvularia species Hint India Ink is used to : Visualize flagella Visualize shape Visualize capsule Visualize cytoplasm Hint How many grams of sodium hydroxide are required to prepare a 200 ml solution of a 10% (weight per volume) solution? (Atomic weights: Na = 23; 0 = 16; H = 1) 4g 10g 20g 40 g 80 g Hint Which of the following packed red blood cell ABO types would be appropriate for transfusion to an O- negative patient? O negative only. AB negative and O negative only. AB negative, A negative and B negative only. AB negative, A negative, B negative and O negative only. Hint Hemoglobinopathies can be caused by all of the following structural defects EXCEPT: Deletion of a globin chain. Substitution of amino acids in a globin chain Deletion of an amino acid in a globin chain Addition of an amino acid in a globin chain Fusion of globin chains. Hint Table VIII Creatinine levels in mg/dL for 21 healthy hospital employees .87 .98 .93 1.04 .86 .90 1.05 1.08 .84 .97 1.12 .95 .96 1.02 1.01 .93 .91 .98 .99 .94 1.04 What is the median of these data? .95 mg/dL .96 mg/dL .97 mg/dL .98 mg/dL Hint What type of follow-up testing is recommended for a Speckled ANA pattern? None Testing for antibodies to the extractable nuclear antigens (ENA) Testing for antibodies to dsDNA Hint A manual white blood cell count was performed by the hematology technologist. The cell counts for both sides were 38 and 42 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:10. What should the technologist report as the white cell count? 4.8 x 10^9/L 4.4 x 10^9/L .48 x 10^9/L 0.44 x 10^9/L Hint _______________ is predominantly associated with skin and soft tissue infections (SSTIs), such as abscesses, cellulitis, folliculitis and impetigo Hospital-associated MRSA Community-associated MRSA Hint The trophozoite state of the intestinal flagellate Giardia lamblia is characterized by: two nuclei an undulating membrane four flagella pattern of the karyosome spoked-wheel nucleoli Hint Which of the following would be the most appropriate temperature for long term storage of viral cultures: 4° C -20° C -70° C Room temperature Hint You are performing a manual antibody titer in a clinical laboratory. You have made serial dilutions of a patient’s plasma sample and you are looking for anti-streptolysin O antibodies. The first tube contains pure patient plasma. The second tube contains a 1:2 dilution of the first tube. The third tube contains a 1:2 dilution of the second tube and so on. The patient’s antibodies no longer give visible reaction in tube 5, indicating their titer is tube 4 (or the last tube where there is a positive result). What is the concentration of antibodies in tube 4 compared to the concentration in tube 1? The concentration of antibodies in tube 4 is the same as the concentration of antibodies in tube 1 The concentration of antibodies in tube 4 is about 1/4 the concentration of antibodies in tube 1 The concentration of antibodies in tube 4 is 1/8 the concentration of antibodies in tube 1 The concentration of antibodies in tube 4 is 4 times the concentration of antibodies in tube 1 Hint Which color(s) are associated with biohazardous containers? Red and orange Blue Green Yellow Hint Which of the following is responsible for humoral response: Neutrophils Basophils B lymphocytes Monocytes Hint MCV is calculated using which of the following parameters: RBC histogram RBC and Hct RBC and MCHC Hint Identify the object contained in the cell in this illustration indicated by the arrow: Auer rods Dohle bodies Heinz bodies Cabot ring Hint Jane Doe is a 39-year-old female who felt tired for several months, had pain in the joints of her fingers, and recently developed a dermatitis following exposure to the sun. The following test results were obtained on a blood sample drawn during the initial evaluation: Total Protein = 8.4 gm/dL (N = 6.0-8.0 gm/dL) ANA >1:2560; speckled pattern CRP = positive C3 = 40 mg/dL (N = 80-180 mg/dL) C4 = 5 mg/dL (N = 15-45 mg/dL) Based on the clinical and laboratory findings, what disease should be suspected? Rheumatoid arthritis SLE Sjogren's syndrome Scleroderma Hint The turbidity of the bacterial inoculum of a standard disc diffusion (Kirby-Bauer) susceptibility test is: 0.1 McFarland Standard 0.5 McFarland Standard 1.0 McFarland Standard 2.0 McFarland Standard Hint What is present in the blood of an individual with the Bombay phenotype which will cause it to agglutinate with any non-Bombay individual's blood? Anti-AB Anti-O Anti-A Anti-H Hint At what phase of antibody screen testing is it most important to read the reactions in order to detect clinically significant antibodies? AHG Immediate spin 37° any of the above Hint If a drug is given at intervals that are the same as its half-life, approximately how long will it take the drug to reach steady state? It will be at steady state from the first dose It will take about two half-lives to reach steady state. It will take about 5 half-lives to reach steady state. It will never reach a steady state. Hint Safety Data Sheets (SDS) shall be maintained and be available to employees in the: Housekeeping Department Nursing Office Personnel Department Workplace area Safety Cabinet Hint Hydrogen ion concentration (pH) in blood is usually determined by means of which of the following electrodes? Silver Glass Platinum Platinum-lactate Silver-platinum Hint What is the first thing you would do before you handle or open a chemical: Read the label Ask your supervisor for help Read the SDS all the manufacturer Hint A blood specimen has been collected from an inpatient. When should the specimen be labeled? Immediately after collection in the presence of the patient. Immediately upon returning to the laboratory. Specimen tubes should be prelabeled before beginning blood collection procedures At any time if it is the only patient specimen being collected Hint If the antigen frequencies for K = 0.09 and Fya = 0.66, what percent of type-specific units would be compatible for a patient with anti-K and anti-Fya? 10 43 31 92 100 Hint In the context of the planning process, the term “goal” has been defined as a: plan for reaching certain objectives set of specific tasks set of short and long-term plans major purpose or final desired result Hint A WBC differential count on CSF should be performed using the following technique: Wet mount of sample from collection tube Stained smear of a cytocentrifuged specimen Directly from hemocytometer chamber count Directly from stained hemocytometer count Hint The 5' end of a DNA strand ends with a OH group. True False Hint In a PCR amplification method, which of the following is amplified? Target Signal Probe Hint Illustrated in the top photograph are dry, chalky, heaped colonies growing on Middlebrook agar with a distinctive yellow-orange pigmentation. They were recovered after 5 days incubation from a subcutaneous lesion of the foot from a South American field laborer. Illustrated in the Acid-fast stain in the lower photomicrograph are slender, branching acid-fast bacilli. Casein and tyrosine were hydrolyzed. With these observations and reactions, select from the multiple choices the species identification of this isolate. Nocardia asteroides Nocardia brasiliensis Mycobacterium fortuitum Streptomyces species Hint Which of the following techniques should be used to free someone who is "frozen" to a live electrical line? Grab the victim with bare hands and immediately and pull them away Pull the electrical line away from the victim Use a non-conductive material like wood or plastic to separate the victim from the line Throw a blanket over the victim Hint The term used to describe patients with absence of Rh antigens is: Rhd Rhnull Rhmod Rho Hint HIPAA stands for: Health Insurance Portability and Accountability Act Health Information Protection and Access Act Homecare Information Protection and Accountability Act None of the Above Hint Patients who develop severe sepsis or septic shock commonly have __________ plasma lactic acid values. Decreased Normal Increased Hint Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of: neutrophils eosinophils monocytes lymphocytes basophils Hint Classic automated blood cell counters are based on: Laser scatter Radio frequency Light absorption Impedance principle Hint A patient is seen at his physician's office for scaling, flat lesions on his back that are irregular with white blotches of discoloration. The image shown is of a tease mount taken from the skin, stained with Periodic Acid Schiff, which reveals narrow fungal hyphae (arrows) along with 3 – 5 um in diameter, irregular sized spherical budding yeast cells, a presentation often referred to as “spaghetti and meatballs”. From the multiple choices, select the name of the fungus causing this infection. Hansenula anomala Malassezia furfur Aureobasidium pullulans Saccharomyces cerevisiae Hint The most common rapid slide test (MONOSPOT©) for infectious mononucleosis employs: Horse erythrocytes Sheep erythrocytes Intact beef erythrocytes None of the above Hint A 1:100 dilution of a patient peripheral blood was made and 136 Platelets were counted in 5 small RBC counting blocks of a Neubauer-ruled hemocytometer. What is the Platelet count? 27 x 103/µL 68 x 103/µL 136 x 103/µL 680 x 103/µL 13.6 x 103/µL Hint What has happened in an antibody titer, if tubes #5-7 show a stronger reaction than tubes #1-4? poor technique postzone reaction prozone reaction equivalence reaction technical error Hint Below is a listing of two commonly used terminology systems for genes and antigens. Use this information to answer this question: If a recipient has anti-c, which donor unit should be selected? Wiener Fisher-Race (haplotype) Ro Dce R1 DCe R2 DcE R DCE r dce r’ dCe r” dcE ry dCE r'r RoR1 R2ry r'ry RoRo Hint A rosette test to screen for FMH is contraindicated if the newborn is weak-D positive : True False Hint This suspicious form was recovered in blood. Please identify the species listed below that matches the parasites shown in the image with arrows. Plasmodium vivax Plasmodium malariae Plasmodium falciparum Pseudoparasite Hint Which one of the following tests should be used to monitor a patient's response to treatment for syphilis: TPI titer RPR titer TPHA titer FTA-ABS titer Hint Extrinsic cell characteristics are reflected by the forward and side scatter on a flow cytometry cytogram. True False Hint Which immune elements are involved in a POSITIVE TB skin test? IgE T cells and macrophages Nkcells and IgG antibodies B cells and IgM antibodies Epithelial skin cells Hint A technologist performing an antibody identification in the blood bank has recorded the following results found in the worksheet below. Which antibody(ies) are MOST LIKELY the cause of the agglutination reactions in this patient's sample? Anti-Jkb Anti-k Anti-Leb Anti-Jka Anti-E Anti-C Anti-c Hint Which of the following kappa / lambda ratios is found in normal serum: 4 : 1 3 : 1 2 : 1 1 : 1 Hint The border to border extension of the mycelium as illustrated in the top photograph is characteristic of one of the Zygomycetes. Although a light yellow green pigmentation of the mycelium is observed, the identification of the isolate depends on the presentation of the fruiting body observed in the bottom photomicrograph. From these observations, select the name of this isolate from the list of multiple choices : Rhizopus species Syncephalastrum species Mucor species Absidia species Hint Which of the following is NOT required to be in a machine-readable format on a blood component label : ABO & Rh of the donor Product code Collection facility Outdate Hint All of the following statements about fluorometry are true EXCEPT: Fluorometry is more sensitive than spectrophotometry. Both excitation and emission spectra are characteristics of the analyte Fluorescence is indirectly proportional to the analyte being measured ional to the analyte being measured Fluorometers typically utilize monochromators or optical filters Hint When should a prewarm technique be performed? If you suspect a warm autoantibody If you suspect a cold antibody If you suspect multiple IgG antibodies Hint A zinc deficiency in the elderly is often caused by: Decreased intake and absorption Decreased intake and excretion Increased intake and excretion Increased excretion and decreased absorption Hint Abnormal crystals that can be found in urine include: Leucine Tyrosine Cystine Triple phosphate Hint A hapten can BEST be described as : A carrier molecule for an antigen that is not antigen alone A determinant capable of stimulating an immune response only when bound to a carrier protein An immunoglobulin functional only in the presence of complement Half of an immunoglobulin molecule Hint Aspirin (salicylic acid) affects platelet function by: inhibiting cyclooxygenase inhibiting lipids inhibiting carbohydrates activating nucleic acid activating Factor VIII Hint Granulocyte Concentrates MUST be administered within ______ of collection. 12 hours 24 hours 3 days 30 days 35 days Hint The renal threshold is best described as: Concentration at which a substance in the blood spills into urine Concentration at which reabsorption first occurs Concentration at which kidney can no longer filter the blood Concentration at which kidney failure begins Hint At what frequency should quality control testing be performed on each lot of anti-human globulin to be in compliance with the FDA’s current good manufacturing practices requirements? A. At the beginning of each work shift B. Each day of use C. Only at the time of receipt D. By each new user Hint Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period? 5 hours after transfusion 24 hours after transfusion 3-10 days after transfusion one year after transfusion Hint Three of the fungi that are listed below have been reported to cause the majority of opportunistic infections in humans. Select the name of the one that can be excluded from this group. Aspergillus fumigatus Mucor species Scopulariopsis species Candida albicans Hint Bordet-Gengou cough plates are used to isolate: Mycobacterium tuberculosis Corynebacterium diphtheriae Bordetella pertussis Haemophilus aegyptius Haemophilus ducreyi Hint The image on the right is a cytospin preparation of cerebrospinal fluid (CSF). What is the blood cell type that is indicated by the arrow? Segmented neutrophil Monocyte Eosinophil Macrophage Hint In this photomicrograph are observed several background dematiaceous hyphae within which is seen a long, flask-shaped, tapered phialide (arrow) that has a flat saucer-like terminus. This feature is most characteristic of: Phialophora verrucosa Phialophora richardsiae Exophiala jeanselmei Scopulariopsis brumptii Hint What is the primary target of HIV? Heart Liver Lungs T-helper cells Hint If a patient has an antibody to a low-frequency antigen like Kpa or Jsa, how would this impact the ability to find compatible blood and to identify the antibody? Difficult to find compatible blood because everyone has the antigen and difficult to identify the antibody Difficult to find compatible blood but easy to identify the antibody Easy to find compatible blood but difficult to identify the antibody Easy to identify the antibody and easy to find compatible blood Hint Spherocytes are associated with which two of the following conditions: Hereditary spherocytosis Autoimmune hemolytic anemia Thalassemia Iron deficiency Hint Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils: IgG IgA IgM IgE Hint The cytospin technique perfectly preserves the morphology of blood cells in a fluid sample. True False Hint Which of the following can lower the amount of current needed to cause electricity-induced injury? Ground wires Wet skin More carbon dioxide in the air All the above Hint Which one of the following blood groups usually reacts LEAST strongly with anti-H? B A2 A1 Hint An urticarial transfusion reaction is characterized by: Rapid rise in temperature Difficulty breathing Rash and hives Blood in the urine Hint When given during pregnancy, RhIg may cross the placenta and cause a positive DAT in the newborn. True False Hint When administering Fresh Frozen Plasma, which one of the following is considered standard blood bank practice? Should be ABO compatible with the recipient's red blood cells Must be the same Rh type as the recipient Is appropriate as a volume expander Component should remain frozen when it is issued Hint Which of the following serological test results may occur in a patient experiencing a hemolytic transfusion reaction due to antibodies such as anti-c and anti-K? (Select all that apply.) Patient's antibody strength may initially decrease. Patient may develop a positive DAT with mixed-field agglutination. Patient's antibody becomes undetectable. Patient's antibody increases in titer weeks later. Hint What is the most prudent step to follow to select units for cross-match after recipient antibodies have been IDENTIFIED? perform DAT and IAT on patient cells and donor units antigen type patient cells and any donor cells to be cross-matched adsorb any antibodies from the patient serum obtain a different enzymes for repeat antibody panel testing cross match several additional units just in case Hint Which is in the correct order from the lowest concentration of H antigen to the highest concentration of H antigen? Bombay, A1B, A1, A2B, B, A2, O A1, O, B, A2, Bombay, A1B, A2B Bombay, O, A1B, A2, A1, B, A2B A1B, A2B, A2, O, B, A1, Bombay Hint Which listed transfusion reaction is MOST OFTEN associated with transfused patient's lacking IgA? Hemolytic Anaphylaxis Febrile Transfusion-associated circulatory overload (TACO) Hint Red blood cells with a positive DAT cannot be tested accurately with blood typing reagents that require an indirect antiglobulin technique unless they have been treated with ___________________ to dissociate IgG from the RBC membrane. Chloroquine diphosphate Ficin ZZAP Any of the above Hint Which of the following conditions is most frequently associated with anti-I: Cold agglutinin disease Hemolytic transfusion reaction Delayed transfusion reaction Infectious mononucleosis Hint Which one of the following statements about directed donations is true: They are truly safer than random donor units They will never cause graft-versus-host disease They do not cause logistic problems for the blood bank and transfusion service They are often perceived by the recipient or his family as safer than random donor units Hint Units of A-, B-, and O-negative red blood cells are shipped to your transfusion service. What testing MUST be performed by your facility prior to placing these units into your inventory? ABO ABO and Rh ABO, Rh and antibody screen ABO, Rh and Weak D to confirm negative status HBV Hint For transfusion services in the United States, which of the following incidents must be reported to the Food and Drug Administration (FDA) because of a biological product deviation? Incident A: A unit was issued with an incorrect expiration date. The expiration date was incorrectly marked as one day earlier than the actual expiration date. Incident B: A nurse in ICU misidentified the patient and initiated the transfusion of Rh positive blood to an Rh negative patient. Incident C: The wrong specimen was used to crossmatch a unit and the unit was issued. All of the above Hint For which of these reasons would a molecular method be used to determine a pregnant woman's Rh type? To determine if she is homozygous or heterozygous for D To determine if she is Rh negative To differentiate between weak D or partial D Hint A former patient had an anti-E four years ago, but her antibody panel is now negative. Since she now needs blood for surgery, what should the blood bank do? get autologous blood from relatives crossmatch E-negative units give group O negative whole blood give random compatible units Hint Which of the following statements best describes Rh antibodies: Naturally occurring, IgM Immune, IgG Naturally occurring, IgG Immune, IgM Hint A group A Rh positive infant born to a group O Rh negative woman has a 1+ positive DAT. The mother had a negative antibody screen at delivery and received antenatal RhIg. Which of the following are possible causes of the newborn's positive DAT? Anti-A Passive anti-D Antibody to a low frequency antigen All of the above are possible causes None of the above are possible causes Hint Which is the best component to treat a patient with fibrinogen deficiency? Red Blood Cells Platelet Concentrate Fresh Whole Blood Cryoprecipitated AHF Hint A patient experiences a mild allergic reaction to a transfusion, including urticaria, erythema (skin redness), and itching. What is the most likely source of the allergen? Plasma proteins Leukocyte antibodies Platelet antibodies Donor Red Blood Cells Hint A mother's serologic results are shown above. Her newborn types as group A Rh positive with a (1+) positive direct antiglobulin test (DAT). Which of the following investigative tests would be most useful to resolve the cause of the positive DAT and should be done FIRST? Test an eluate prepared from newborn's red cells against an antibody identification panel by IAT. Test newborn's plasma against group A1 red cells and group O antibody screen cells by IAT. Test newborn's plasma against mother's red cells by IAT. Test newborn's plasma against father's red cells by IAT. Hint When AHG or Coombs serum is used to demonstrate that red cells are antibody coated in vivo, the procedure is termed: Indirect technique Direct technique Hemagglutination technique Hemolysis technique Hint Which of the following blood groups reacts least strongly with Anti-H: O A2 A1 A1B Hint Which of the following antigens is classified as a Major Histocompatibility Complex Class II antigen (MHCII)? HLA-A HLA-B HLA-C HLA-DR Hint An acute hemolytic reaction may be caused by which of the following? (Choose all that apply) Transfusion of ABO incompatible blood. Failure to irradiate cellular products. Exposure to a red cell antigen when the corresponding antibody is present. Leukocyte antibodies Hint Which of the following red blood cells contain the most H antigen: Group A cells Group B cells Group O cells Bombay phenotype Hint Which unit contains the proper number of platelets from a random donor? 3.8 x 1010 4.0 x 1010 4.5 x 1010 5.8 x 1010 Hint Which of the procedures listed below will increase the platelet concentration in the preparation of platelets? Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a low speed. Centrifuge the blood at a low speed, remove the plasma and spin the plasma again at a high speed. Centrifuge the blood at a high speed, remove the plasma and spin the plasma again at a high speed. Increase the duration of rotation Hint At 28 weeks gestation, a group A Rh-negative female had a negative antibody screen and was injected with Rh immune globulin (RhIg). Anti-D is detected in the mother's serum at delivery. A panel is performed that excludes the presence of other antibodies. The most likely conclusion would be passive anti-D due to RhIg administration. True False Hint The ability to produce anti-D varies significantly among Rh negative individuals. True False Hint Which of the following blood group antigen-antibody reactions is enhanced by using enzymes: Fya Fyb M Jka Hint Which Rh antibody might be produced if a unit of blood with Rh genotype DCe/dce is given to a patient with Rh genotype DCe/DCe? Anti-C Anti-c Anti-d Anti-ce Anti-f Hint If an Rh negative patient is administered a unit of R1R1 packed red cells, which one of the following antibodies would be most likely to develop: Anti-c Anti-E Anti-e Anti-D Hint Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply. Flow cytometry Kleihauer-Betke test Rosette test Weak D (microscopic Du)test Hint Time's up Submit a Comment Cancel replyYour email address will not be published. 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