The electrolyte panel consists of potassium, sodium, chloride, carbon dioxide. These analytes are also typically ordered within other panels as well, including the basic metabolic and complete metabolic panels.
An electrolyte panel (lytes, chem-4) consists of:
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?
Certain recipients have increased risk for developing TA-GVHD. They are:
Neonates less than 4 months of age
Fetuses
Recipients with a congenital or acquired immunodeficiency, such as bone marrow or stem cell recipients, and patients receiving chemotherapy
recipients of donor units from a blood relative
Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products? (Choose all that apply)
The lactophenol blue mount reveals tiny, ovoid microconidia, arranged in a daisy-head pattern at the tip of a straight conidiophore. This appearance is characteristic of the mold form of Sporothrix schenckii. By moving the focus up and down in a microscopic preparation, delicate hair-like attachments may be observed for each conidium.
The mold form of Coccidioides immitis produces delicate hyphae that break up into arthroconidia separated by empty cells, giving an alternatively staining appearance.
The mold form of Blastomyces dermatitidis is characterized by the production of single, smooth microconidia, each borne on a single, thin conidiophore ("lollipops").
The mold form of Histoplasma capsulatum is recognized by the production of large, echinulate macroconidia, appearing as a prickly surface.
The ovoid microconidia arranged in a daisy-head pattern at the tip of a a straight conidiophore, observed in the photomicrograph on the right, is characteristic of which of the following dimorphic molds?
A regional laboratory that performs high volume, highly complex or infrequently ordered testing is a:
The end of the initial phase of HH treatment is considered when the serum ferritin decreases to between 20 and 50 ng/mL.
What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)?
Vitamin K is needed to produce certain coagulation factors, in particular factors II, VII, IX, and X. Deficiencies in these factors can lead to increased clotting times and can cause hemorrhagic disease.
A deficiency in which of these vitamins leads to increased clotting time and may result in hemorrhagic disease?
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?
After collection all blood should be stored at 1 - 6oC, unless it is going to be used as a source of platelets.
A refrigerator used to store whole blood must be able to maintain a temperature in the ranges of:
In DIC, or disseminated intravascular coagulation, the prothrombin time is increased due to the consumption of the coagulation factors due to the tiny clots forming throughout the vasculature. This is also the reason that the fibrinogen levels and platelet levels are decreased. Finally FDP, or fibrin degredation products, are increased due to the formation and subsequent dissolving of many tiny clots in the vasculature. The FDPs are the pieces of fibrin that are left after the fibrinolytic processes take place.
Which of the following laboratory results would be seen in a patient with acute Disseminated Intravascular Coagulation (DIC)?
Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased blood pressure, and release of aldosterone from the adrenals.
A major action of angiotensin II is:
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
"Universal donor", (a misnomer) is usually applied to group O, Rh negative blood. Although it may be necessary to use group O, Rh negative blood in an extreme emergency, it is preferable to use type specific blood for emergencies.
In an extreme emergency , if the ABO and Rh type are unknown which of the following should be given to the patient?
Basophilic stippling is strongly associated with lead poisoning the lead toxicity can affect the bone marrow; causing this phenomenon.
Hematology
What is a prominent morphologic feature of lead poisoning:
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:
Microbiology
Matching: The detection of a distinct odor is often helpful in the presumptive identification of bacterial culture isolates. Match each of the odors listed with its corresponding bacterial species name.
1. Streptococcus anginosus (milleri)
2. Pseudomonas aeruginosa
3. Eikenella corrodens
4. Alcaligenes faecalis
The increase in inflammatory cytokines and the abnormal lipids and lipid levels often present in metabolic syndrome increase the risk of cardiovascular disease. Adiponectin is decreased and increases in angiotensinogen lead to hypertension.
Chemistry
Which of the following statements is true regarding cardiovascular disease and adipose tissue? Please select all correct answers
One agency that accredits education programs for clinical laboratory personnel is the:
Blood Bank
What other component(s) can be shipped together with Fresh Frozen Plasma (FFP)?
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?
Convert the following temperature from Celsius to Fahrenheit
20 degrees C
Question options:
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%
Rapid vascular constriction, not dilation, immediately occurs when there is vascular injury in order to constrict the amount of blood that escapes the vessels; ultimately preventing massive loss of blood.
Primary hemostatic processes resulting from vascular damage include all of the following EXCEPT:
What additional fraction would be seen if plasma rather than serum was subjected to electrophoresis:
Which area of the laboratory is responsible for blood coagulation studies that test for the patient's ability to clot their blood?
Isotonic or normal saline is a 0.85 % solution of sodium chloride in water.
The concentration of sodium chloride in an isotonic solution is :
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?
In this case, with the pre-incubation aPTT mixing study result "corrected" and the post-incubation aPTT mixing study result "not corrected", a coagulation inhibitor should be suspected. Both anti-factor VIII and lupus anticoagulant have been known to be slow-acting and can exhibit this result pattern. If a factor deficiency was present, we should not see a post-incubation prolongation.
Hematology
What may cause the following mixing studies results?
Initial aPTT = 133 seconds
1:1 Mix aPTT pre-incubation = 33 seconds
1:1 Mix aPTT post-incubation = 124 seconds
Match each of the following definitions associated with heart disease and heart failure to the term that it defines.
1. Congestive heart failure
2. Infarction
3. Ischemia
4. Angina
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:
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?
Small, dense LDL is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis. Small, dense LDL is associated with more than a three-fold increase in the risk of coronary heart disease.
Large, buoyant LDL is less atherogenic than small, dense LDL.
The LDL phenotype A is normal. It is the so called 'B' pattern that is associated with increased risk.
Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?
The personal protective equipment (PPE) that is used in the laboratory to protect the personnel when performing tests on patient blood samples is which of the following:
Immunoassay is the most common technique that is used by clinical laboratories for therapeutic drug monitoring.
Most of the drugs commonly assessed with TDM can be measured on analytical platforms which utilize antibodies (in some form) for detection. Antibodies can be developed that recognize drugs. Although most drugs are much too small to evoke an immune response, scientists can conjugate drugs to immunogenic proteins to produce antibodies that recognize drug-specific epitopes.
Which of the following is the most common technique that is used by clinical laboratories for therapeutic drug monitoring?
What is the first thing a phlebotomist should do in the event of an accidental needle stick?
All of the following have been an inspection deficiency for CLIA-approved laboratories except:
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)
The part of the microscope that holds the objective lenses is called the _______________.
This type of laboratory professional is responsible for the technical aspects of managing the operation of the laboratory and is most likely an MLS with additional education in administration:
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?
The governmental agency that oversees public health care matters in the United States is:
Eosinophils do not have cytoplasm containing large purple/blue-staining granules. Instead, their granules are large but are orange/red in color. These granules are very distinctive for this type of cell, typically making their identification simple.
ll of the following statements describe an eosinophil EXCEPT:
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:
Twelve weeks after onset of the disease, patients with uncomplicated acute hepatitis B usually will demonstrate which of the following in their serum?
hs-CRP is a more sensitive version of the C-reactive protein (CRP) test, a test that has been used for many years to assess inflammation in settings such as lupus, transplantation, infection, etc.
Which of the following cardiovascular risk markers is a more sensitive version of a test that is used to assess inflammation?
Which area of the laboratory can analyze a patient sample and be able to predict their risk of developing a disease?
Though automated extraction machines have many benefits over manual methods the costs are high and generally require a high throughput of samples in order to justify the costs.
Automated extraction has many benefits over the traditional manual methods. The most important benefit is that the nucleic acid isolated is constantly consistent. There is a reduced amount of manipulation with dramatically decreases the chance of cross contamination. Also, automated extraction machines are considered moderate complexity and can be performed by a wider variety of laboratory professionals.
All of the following are considered benefits of automated isolation and extraction equipment EXCEPT:
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:
The term that is used to describe the color in these tubes of CSF is "xanthochromia." Xanthochromia is an abnormal color, usually yellow, orange, or pink, in the supernatant of the CSF sample. It may indicate that a subarachnoid hemorrhage (SAH) has occurred.
Jaundice and icterus both describe a yellowing of the skin, mucous membranes, and eyes. Blood plasma/serum that is deep yellow is also described as icteric.
What term is used to describe the color in these tubes of cerebrospinal fluid (CSF)?
The difference between glass and plastic red stopper tubes is that the:
Question options:
In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.
In sickle cell anemia, rapid hemoglobin turnover may be present. HbA1C and other glycated hemoglobin assays are not valid in rapid hemoglobin turnover and in abnormal hemoglobin conditions. Fructosamine measurements can be used because of shorter half life of albumin.
HbA1C measurements are NOT ordinarily used to monitor long-term diabetic control in a diabetic with sickle cell anemia.
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?
Fusarium species is the most likely associated with mycotic keratitis.
Trichophyton rubrum is a dermatophyte that commonly causes an itching, scaling skin infection of the feet, known as tinea pedis. Scedosporium apiospermum is commonly associated with sinusitis. Aspergillus niger typically causes otitis externa and can also be associated with sinusitis.
Which of the following species or organisms is the most likely to be the cause of mycotic keratitis (fungal eye infection)?
Following an AMI, elevated CK-MB returns to normal ranges in 48-72 hours. If a patient has a second AMI in this time period, a second rise in concentrations of CK-MB would be seen. This is not true for the cardiac troponins since they remain elevated 7-14 days following an AMI.
Which one of the following cardiac biomarkers could detect a reinfarction?
Duffy antigens are rendered inactive by enzyme treatments since the enzyme will remove the sialic acid from the RBC membrane. This process destroys: M, N, S, s, and Duffy antigens. The process enhances the reactions for Rh, Kidd, Lewis, I, and P antigens.
When performing an antibody panel, which one of the following antigens will be rendered inactive by enzyme treatment?
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
Thyroid-stimulating immunoglobulins, or TSI's, are IgG antibodies that can bind to thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH, causing excess secretion of thyroxine and triiodothyronine. The TSI level is abnormally high in persons with hyperthyroidism due to Graves' disease.
Which of the following is an autoantibody that binds to TSH receptor sites on thyroid cell membranes preventing thyroid-stimulating hormone binding?
The disc diffusion method for antibiotic susceptibility testing is the Kirby-Bauer method. The agar used for this procedure is Meuller-Hinton.
Which of the following media is commonly used when performing the Kirby-Bauer disk diffusion?
In the laboratory, surfaces must be disinfected for blood spills. What is the most common disinfectant used?
HbsAg is positive in acute and chronic Hepatitis B infections, since the antigen is found on the actual surface of the virus. HbeAg is present in the blood when the hepatitis B viruses are replicating, indicating an active infection. Anti-Hbc IgM is present due to the immune response to the presence of the hepatitis core antigen and indicates an acute infection. Anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection, according to the CDC.
Given the following results, what is the immune status of the patient?
HbsAg: positive
HbeAg: positive
Anti-HBc IgM: positive
Anti-HBs: negative
The approximate volume of CSF in an adult is 90-150 mL.
What is the approximate volume of spinal fluid in an adult?
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
Thrombocytes, or platelets, are of course involved with hemostasis, not immunity.
Immunology
Which of the following would not be considered a part of the body's cellular immune system:
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
Sterile yellow stopper tubes contain thixotropic gel and a clot activator.
Question options:
IgE levels are often increased in patients with allergic disease. IgE binds to the membranes of mast cells and basophils, and if specific antigen is present to react with the IgE molecule, degranulation of these cells occurs, releasing histamines, and other substances into the blood or tissues.
Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils:
In Rouleaux, red blood cells appear as stacked coins - formation occurs as the result of elevated globulins or fibrinogen.
The RBCs indicated by the arrows in this illustration are the result of:
1. B
2. C
3. A
Granular casts are composed of plasma protein aggregates and cellular remnants. Granular casts appear as cylinders of coarse, or fine, highly refractive particles.
Broad casts or "renal failure' casts are formed in the collecting ducts as the result of urinary stasis and are two to six times the size of other types of casts. Any type of cast can be a broad cast. Broad casts are typically seen in patients with advanced renal failure.
Hyaline casts, the type most commonly seen in urine sediment, have a refractive index similar to the urine in which they are suspended. For this reason, hyaline casts will appear almost invisible under brightfield microscopy, but are easily of seen by phase-contrast microscopy.
Match the following descriptions of casts with their appropriate name:
1. Casts with highly refractive particles
2. "Renal failure" cast
3. Low refractive index
The concentration of circulating ferritin is proportional to the size of iron stores.
Which of the following will give the best overall picture of a patient's iron stores:
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?
TESTED 29 Apr 2024
