Clinical Chemistry/Body Fluids
A. Gilbert disease
B. Rotor syndrome
C. Dubin-Johnson syndrome
D. Crigler-Najjar syndrome
There are several forms of Crigler-Najjar syndrome but they result in abnormal metabolism of bilirubin due to absence or deficiency of UDP-glucuronyltransferase.
The precision of an instrument is validated by:
A. running the same sample multiple times
B. performing serial dilutions
C. Processing unknown specimens
D. Monitoring normal and abnormal controls
What is A. running the same sample multiple times?
A patient's red cells type as follows:
Anti-D (4+) Anti-C (0) Anti-E (0)
Which of the following genotypes would be consistent with these results?
A. R0R0
B. RzRz
C. R1r
D. rr
What is A.
A term that means varying degrees of leukocyte with a shift to the left and occasional nucleated red cells in the peripheral blood is:
A. polycythemia vera
B. erythroleukemia
C. leukoerythroblastosis
D. megaloblastoid
What is C. Leukoerythroblastosis?
Definition
A 15-year-old boy with infectious mononucleosis has a cold agglutinin titer of 1:2000. An important consideration of this antibody's clinical relevance is the:
A. Thermal range B. Titer at 4 degrees C C. Specificity D. Light chain type
What is A. Thermal range?
It is important to determine the thermal range of reactivity, because cold antibodies are most likely to cause disease if they react with red blood cells at temperatures from 30-32 degrees C.
A physician requested that electrolytes on a multiple myeloma patient specimen be run by directed ISE and not indirect ISE because:
A. excess protein binds Na in indirect ISE.
B. Na is falsely decreased by indirect ISE.
C. Na is falsely increased by indirect ISE.
D. excess protein reacts with diluent in indirect ISE.
What is B.?
To be analyzed by gas liquid chromatography a compound must:
A. not be volatile
B. be water-soluble
C. be volatile or made volatile
D. contain a nitrogen atom
What is C.
Samples to be analyzed by GLC must be volatile or become volatile upon heating. The vaporized sample then flows, with the inert carrier gas, through the column.
Of the following, what is the approximate probability of finding a unit of compatible blood among random Rh-positive units for a patient who has anti-c and anti-K?
A. 1%
B. 8%
C. 18%
D. 27%
What is C. 18%
c freq approx 80% K freq approx 9%
Probability of 1 c Neg unit = 20%
Probability of 1 K Neg unit = 91%
Probability of c Neg/K Neg unit = (0.2 x 0.91) x 100 = 18.2%
Which of the following conditions is most often associated with the V617F mutation of JAK2?
A. chronic myelogenous leukemia
B. essential thrombocytosis
C. chronic idiopathic myelofibrosis
D. polycythemia vera
What is D. polycythemia vera
Given: WBC = 5.0 x 103/uL Lymphs - 15%
CD4 = 8%
Calculate the absolute CD4:
A. 40 B. 60 C. 400 D. 750
What is B. 60?
Solution: WBC (/uL) x % lymphs x %CD4 =
5000 x 0.15 x 0.08 = absolute CD4 count: 60
In monitoring glomerular function, which of the following tests has the highest sensitivity?
A. creatinine clearance
B. BUN/creatinine ratio
C. urine sodium
D. urea clearance
What is A. creatinine clearance?
This offers the highest sensitivity in monitoring glomerular function (filtration) of the tests listed. BUN/creatinine ratio can help to determine if elevated urea is due to pre-renal or renal conditions but is not specific to glomerular function. Sodium is more an indication of tubular function of reabsorption or excretion of sodium and water.
Which of the following is the formula for calculating a percent (w/v) solution?
A. grams of solute/volume of solvent x 100
B. grams of solute x volume of solvent x 100
C. volume of solvent/grams of solute x 100
D. (grams of solute x volume of solvent)/100
What is A.?
The most frequently used expression, concentrations of m/v are reported as grams percent (g%) or g/dL as well as mg/dL and ug/dL. When percent concentration is expressed without a specified form, it is assumed to be weight per unit volume.
A patient's serum sample was reactive with all cells except the autocontrol when tested by PEG-AHG. The patient's phenotype was confirmed as: C- E+ c+ e+ K- k+ Kpa- Kpb+ Jsa- Jsb+ Fya- Fyb+ Jka- Jkb- M+ N+ S+ s+
Phenotypically similar cells were tested and found to be nonreactive. In what population of donors are we most likely to finfd a compatible donor for this patient?
A. African
B. Middle Eastern
C. South American
D. Tahitian
What is D. Tahitian Jk(a-b-)
A patient is placed on clopidogrel. The clinician wants to determine if the dose is sufficient to impair platelet function. A platelet aggregation test is ordered. The agonist which would result in a decreased aggregation pattern would be:
A. collagen
B. epinephrine
C. ristocetin
D. adenosine disphosphate
What is D.?
Clopidogrel is a member of the thienopyridine drug family which occupy the platelet membrane adenosine disphosphate (ADP) P2Y12. As a result, you would expect a suppressed platelet aggregation response to ADP.
A blood culture bottle with macroscopic signs of growth is Gram stained and the MLS notes small, curved Gram-negative bacilli resembling "gull wings". It is subcultured to blood and chocolate agar, and incubated aerobically and anaerobically. After 24 hours, no growth is apparent. The next step should be to:
A. subculture the bottle, and incubate in microaerophilic conditions.
B. assume the organism is nonviable, and ask for repeat specimen.
C. utilize the oxidase and indole test to detect Aeromonas.
D. subculture the bottle to a medium containing X and V factors.
What is A?
Campylobacter are Gram-negative, curved bacilli that require microaerophilic conditions for growth.
Oligoclonal bands are present on electrophoresis of concentrated CSF and also on concurrently tested serum of the same patient. The proper interpretation is:
A. diagnostic for primary CNS tumor
B. diagnostic for multiple sclerosis
C. CNS involvement by acute leukemia
D. need further testing to rule out multiple sclerosis
What is D.
Oligoclonal proteins are produced in multiple sclerosis and other demyelinating diseases.
An MLS is asked to write a procedure to measure the Evan blue concentration on a spectrophotometer. The MLS is given 4 standard solutions of Evan blue:
Standard A = 0.8 mg/dL
Standard B = 1.6 mg/dL
Standard C = 2.4 mg/dL
Standard D = 4.0 mg/dL
The first step is to:
A. calculate the slope of the calibration curve
B. determine the absorbance of the 4 standards
C. find the wavelength of the greatest % transmittance of Evan blue
D. find the wavelength of the greatest absorbance of Evan blue
What is D.?
Congestive heart failure, severe headache, and/or peripheral edema occurring soon after transfusion is indicative of which type of transfusion reaction?
A. hemolytic
B. anaphylactic
C. febrile
D. circulatory overload
What is D.?
Cytochemical stains were performed on bone marrow smears from an acute leukemia patient. The majority of the blasts showed varying amounts of myeloperoxidase positivity. Some of the blasts stained positive for chloroacetate esterase, some were positive for alpha-naphthyl acetate esterase, and some blasts stained positive for both esterases. What type of leukemia is indicated?
A. lymphocytic
B. myelogenous
C. myelomonocytic
D. erythroleukemia
What is C.
These are the cytochemical results in acute myelomonocytic leukemia.
A urine culture from a patient with a urinary tract infection yields a yeast with the following characteristics:
failure to produce germ tubes hyphae not formed on cornmeal agar urease-negative assimilates trehalose
The MOST likely identification is:
A. Geotrichum candidum
B. Cryptococcus laurentii
C. Candida tropicalis
D. Candida glabrata
What is D. Candida glabrata
Candida glabrata is urease neg and does not produce pseudohyphae. Candida tropicalis is also urease neg but it produces pseudohyphae on cornmeal or rice agar. Cryptococcul laurentii does not produce pseudohyphae but it is urease pos. Geotrichum produces true hyphae.
The methodology based on the amount of energy absorbed by a substance as a function of its concentration and using a specific source of the same material as the substance analyzed is:
A. flame emission photometry
B. atomic absorption spectrophotometry
C. emission spectrophotometry
D. x-ray fluorescence spectrophotometry
What is B (definition)?
A patient sample contains 500 particles/mL. 200 uL of sample is extracted, and DNA is eluted into 200 uL. 5 uL of DNA is added per PCR reaction. Calculate the average number of viral particles added per PCR reaction, assuming 100% extraction efficiency.
A. 2.5
B. 25
C. 250
D. 2500
What is A. 2.5?
500 particles/mL x 0.2 mL = 100 particles extracted in 200 uL DNA eluate = 100 particles /200uL = 0.5 particles/uL. Input 5 uL = 0.5 particles/uL x 5 uL = 2.5 particles per reaction.
Which of the following is a potential complication of massive transfusions with red blood cells?
A. citrate toxicity with hypercalcemia
B. heparin-induced thrombocytopenia
C. aggravated hypothermia
D. iron overload from donor RBCs
What is C.?
Due to infusion of cold stored RBCs
A - would be hypocalcemia
B - heparin not involved
D - bleeding massively while being transfused, no excess iron storage
The following platelet aggregation tracing represents which of the following: see image
A. von Willebrand disease
B. storage pool disease
C. Ganzmann thrombasthenia
D. aspirin
What is C.?
Glanzmann thrombasthenia is an autosomal recessive disorder. patients will have a prolonged bleeding time and PFA-100, normal platelet count and morphology, and abnormal aggregation with all aggregating agents except ristocetin.
A first morning sputum is received for acid-fast bacilli culture. It is digested and decontaminated by the N-acetyl-L-cysteine alkali method. Two Sabouraud dextrose slants are incubated in the dark at 35C with 5-10% CO2. The smears reveal acid-fast bacilli, but the slants show no growth after 8 weeks. The explanation is:
A. improper media used
B. incorrect decontamination procedure used
C. improper specimen submitted
D. improper incubation temperature and atmosphere
What is A. improper media used?
Sabourad dextrose is fungal media, mycobacterial media should have been inoculated.