General

You answered the question correctly.
Which of the following would be considered a normal cerebrospinal fluid glucose if

the serum glucose is 70 mg/dl?
The correct answer is highlighted below
30 mg/dl
45 mg/dl
60 mg/dl
70 mg/dl
100 mg/dl
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As a general rule, CSF glucose is about two thirds of the serum glucose measured in a
normal adult.
Question Difficulty: Level 5
You answered the question incorrectly.
Ion selective electrodes are called selective rather than specific because they actually
measure the:
activity of one ion only

concentration of one ion
activity of one ion much more than other ions present
concentration and activity of one ion only
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Ion-selective electrodes are not completely ion-specific. All are sensitive to some
other ions to some extent.
Sodium fluoride is an excellent preservative for collecting glucose specimens

because:
Prevents interference with other substances

Inhibits glycolysis
Enhances chemical reactions
Inhibits certain clotting factors
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Glucose is metabolized at a rate of 5% per hour in specimens not immediately

separated or collected in sodium fluoride or iodoacetate.
Calculate the red cell indices from the following set of patient data:
RBC count = 3.19 x 1012/L
Hemoglobin = 11.3 g/dL
Hematocrit = 35%
MCV = 99 fL, MCH = 38 pg, MCHC = 34 g/dL

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Calculations:
MCV (fL) = (Hct (%) / RBC (1012/L)) x 10
MCH (pg) = (Hgb (g/dL) / RBC (1012/L)) x 10
MCHC (g/dL) = (Hgb (g/dL) / Hct (%)) x 100
For this problem:
MCV = 35 / 3.19 = 10.97 x 10 = 109.7 or 110 fL
MCH = 11.3/3.19 = 3.54 x 10 = 35.4 pg
MCHC = 11.3/35 = 0.32 x 100 = 32 g/dL
The assay which is most helpful in identifying specific allergens is:
Complement fixation
C-reactive proteins
RIA
RAST
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RAST tests, or Radioallergosorbent tests, are used to screen for an allergy to a

specific substance or substances if a person presents with allergy-like symptoms.

Which of the following is the proper storage temperature for whole blood:
- 20 degrees Celsius
- 12 degrees Celsius
12 degrees Celsius
4 degrees Celsius
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Whole Blood should be stored between 1 - 6 degrees Celsius.
What is the BEST stock culture for quality control testing of oxidase production?
Escherichia coli/Klebsiella pneumoniae

Salmonella typhimurium/Escherichia coli
Escherichia coli/Pseudomonas aeruginosa
Proteus mirabilis/Escherichia coli
Bacillus anthracis/Bacillus subtilis
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Escherichia coli and Pseudomonas aeruginosa make excellent quality control choices
for the oxidase production test, as P. aeruginosa is oxidase positive, while E. coli is
oxidase negative.
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
Feedback
Some elderly individuals can have poor dietary habits which can lead to decreased
nutrient absorption, including zinc.
An antithetical relationship exists between M antigen and which of these antigens?
K
S
Vw
N
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An antithetical relationship exists between the antigens M and N.

Which of the following urine chemical reagent strip tests is based on the Ehrlich-
aldehyde reaction?
pH
Protein
Glucose
Urobilinogen
Specific gravity
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The urobilinogen urine chemical reagent strip test is based on the Ehrlich-aldehyde
reaction. In this test, a pink-red color forms in proportion to the amount of
urobilinogen present.
The following results were obtained at delivery for a pregnant woman who received
antenatal RhIg.
ABO and Rh typing
ABO ABO
Rh
Forward Group Reverse Group
anti-A anti-B A1 cells B cells anti-D*
0 0 4+ 4+ 0
Antibody screen
Cells Gel IAT*
Screen cell l (R1R1) w+
Screen cell ll (R2R2) 1+
Screen cell lll (rr) 0
* IAT = indirect antiglobulin test
Which of the following are possible causes of the positive antibody screen?
Anti-D (passive, from RhIg administration)

Anti-D (immune)
Antibody other than anti-D
anti-D and another antibody
All of the above are possible
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All causes are possible, although given the history of antenatal RhIg administration,
passive anti-D alone is the most likely cause.

Match the names of the inclusions with their corresponding diagrams.
Your answers are on the left. The correct answers are on the right and highlighted.
A Pappenheimer bodies
D Howell-Jolly bodies
C Cabot rings
B Basophilic stippling
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A= Pappenheimer bodies
B= Basophilic stippling
C= Cabot rings
D= Howell-Jolly bodies
Identify the urine sediment elements present in this illustration:
Cholesterol crystals
Leucine crystals
Cystine crystals
Tyrosine crystals
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Tyrosine crystals appear as highly refractile brown to black needles; they occur as
clusters or "sheaves", which occur in acid urine. The can be found in patients with
severe liver disease. They are soluble in alkali. Their presence can be supported by the
addition of nitrosonaphthol to urine which forms a red insoluble complex in the
presence of tyrosine.
Which of the following set of results would be consistent for a patient with the
following findings: macrocytosis, anemia, leukopenia, and thrombocytopenia?
MCV 115 Hgb 9.5 gm/100ml WBC 6,500/mm' Platelets 75,000/ mm3
MCV 90 Hgb 7.5 gm/100ml WBC 6,500/mm‘ Platelets 175,000/ mm3
MCV 75 Hgb 7.5 gm/100ml WBC 2,500/mm’ Platelets 75,000/ mm3
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Macrocytosis (>100 fL MCV), Anemia (typically RBC <3.0 x 1012/L or Hgb <12
g/L), Leukopenia (typically WBC <4.0 x 109/L), Thrombocytocpenia (typically <100
x 109/L)
Therefore, choice 1 can be ruled-out due to the normal WBC count and hemoglobin
level. Choice 2 can be ruled-out due to the low MCV result and normal WBC and
platelet counts. Choice 3 can be ruled-out due to the low MCV result. Choice 4 can
be ruled-out due to the normal WBC and platelet counts.

A young man is experiencing difficult breathing after fainting. The physician orders a
blood gas analysis which shows the following results:
pH = 7.25
pCO2 = 62 mmHg
pO2 = 70 mmHg
HCO3 = 23 mEq/L
Which condition is most likely afflicting this patient?
metabolic alkalosis
metabolic acidosis
respiratory alkalosis
respiratory acidosis
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Judging by the pH, which is acidic, this patient is experiencing acidosis. Recall that
the reference range for blood pH is 7.35-7.45. The patient's carbon dioxide (pCO2)
level is increased while the bicarbonate (HCO3) level is still within reference range.
This indicates that the acidosis is respiratory in nature. The fact that the bicarbonate is
not increased in response to the increase in acid, indicates that the respiratory acidosis
is uncompensated.
Reference Range Recap:

pH = 7.35-7.45
pCO2 = 35-45 mmHg
HCO3 = 22-28 mmol/L
pO2 = 80-100 mmHg

Prozone is usually found in:
those tubes of titration which contain the least concentration of antibody

the serum of a patient who has more than one antibody
a patient sample in which the serum contains a high titer of antibody
a patient sample in which the serum has been inactivated before titering
the presence of ionic clouds
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Prozone is a phenomenon in which titers of specific antigen and antibody do not

agglutinate or precipitate visibly because of an excess in antibody. Therefore the
correct answer is "a patient sample in which the serum contains a high titer of
antibody".
Circulating organic iodine is found primarily in the form of:
Triiodothyronine
Parathyroid hormone
Thyroglobulin
Thyroxine
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Iodine circulates as thyroxine (T4) and to a lesser extent as Triiodothyronine (T3).

A 46 year old woman was admitted to the hospital through the emergency room after
having a bout of severe diarrhea for 3 days along with headaches, muscle aches,
shortness of breath, and an increased heart rate. A blood gas was ordered by her
concerned physician. The results showed the following:
pH = 7.30
pCO2 = 32 mmHg
HCO3 15 mEq/L
pO2 93 mmHg
What acid base disorder is most consistent with this patient's results and symptoms?
respiratory acidosis
respiratory alkalosis
metabolic acidosis
metabolic alkalosis
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The correct answer is metabolic acidosis. First, check the pH. In this case, the pH is
low, (less than 7.35) therefore by definition, patient must be in acidosis. Next,
evaluate the pCO2 and HCO3- (bicarbonate). A low PCO2 represents alkalosis and is
not consistent with the pH. A low HCO3- represents acidosis and is consistent with
the pH, therefore it must be the initial change. The low PCO2 must be the
compensatory response. Since the primary change involves HCO3-, this is a
metabolic process, hence the diagnosis of Metabolic Acidosis.
If the red cell count is known, which of the following MUST also be known in order
to calculate the mean corpuscular volume?
Hemoglobin
Leukocyte count
Color index
Hematocrit
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MCV = hematocrit x 10 / RBC count
The white blood cell that can appear atypical or reactive on a Wright-stained smear is:
Basophil
Eosinophil
Neutrophil
Lymphocyte
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Atypical or reactive lymphocytes have more abundant cytoplasm and may approach
the size of neutrophils. They have a large range of morphologic differences, some
may even have the characteristics of early cells including the presence of nucleoli and
deeply basophilic cytoplasm. Most commonly, the scalloped edge of the cell
cytoplasm as well as a nucleus appearing "stretched" are displayed in atypical
lymphocytes.
Which of the following is not necessary for bacteria to grow successfully on artificial
media:
Pure isolate
Proper temperature
Proper pH
Proper moisture
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A mixture of bacteria can easily grow together on media as long as the other factors
are all maintained correctly.
An abnormal variation in the size of the red blood cells is termed:
Acanthocytosis
Polychromasia
Anisocytosis
Poikilocytosis
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Anisocytosis is the abnormal variation in the size of red blood cells.

Which of the following conditions is associated with the defective erythrocytes that
are indicated by the arrows in this image?
G6PD deficiency
Microangiopathic hemolytic anemia
Abetalipoproteinemia
Beta thalassemia
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The intended response is G6PD deficiency.
These atypical erythrocytes are bite cells, associated with Heinz body formation. Note
the multiple nibbles in many of the erythrocytes. Heinz bodies represent the presence
of denatured hemoglobin associated with G6PD deficiency.
Schistocytes, keratocytes, and tear drop cells are more common in microangiopathic
anemia. Atypical RBCs in abetalipoproteineima are typically acanthocytes; the
predominant abnormal red cells in thalassemia are target cells(codocytes).
The results which would be MOST consistent with macro-amylasemia are?

Normal serum amylase and elevated urine amylase values

Increased serum amylase and normal to low urine amylase values
Increased serum and increased urine amylase values
Normal serum and normal urine amylase values
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Macroamylasemia can be diagnosed by measuring amylase levels in the urine and

serum. In patients with macroamylasemia, there will be high levels of amylase in the
serum. However, macroamylasemia can look similar to acute pancreatitis, which also
causes high levels of amylase in the blood. To help differentiate, we measure amylase
levels in the urine. Urine levels of amylase are low in people with macroamylasemia,
but high in patients with pancreatitis.
The cause of the most severe life-threatening hemolytic transfusion reactions is:
Anti-D
Anti-M
Anti-A, Anti-B, Anti-A, B
Anti-Fya
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Incompatiblity involving the ABO blood group system can cause the most severe type
of transfusion reaction.

Identify the cell in this illustration indicated by the arrow:
Reactive lymphocyte
Blast
Metamyelocyte
Plasma cell
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The nucleus is large, with delicate chromatin, prominent nucleoli, and scant
cytoplasm.
Which of the following laboratory results would be seen in a patient with acute
Disseminated Intravascular Coagulation (DIC)?
prolonged PT, elevated platelet count, decreased FDP

normal PT, decreased fibrinogen, decreased platelet count, decreased FDP
prolonged PT, decreased fibrinogen, decreased platelet count, increased FDP
normal PT, decreased platelet count, decreased FDP
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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 animal was involved in the reassortment of influenza A viruses that led to the
2009 novel influenza A H1N1 virus?
Cows
Deer
Horses
Pigs
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Pigs are the animals that served as the virus reassortment vessel for the 2009 novel
influenza A H1N1 virus. Cows, deer, and horses were not the vessels for the
reassortment of the 2009 H1N1 virus.

In the condition kernicterus, the abnormal accumulation of bilirubin occurs in what
tissue?
Brain
Liver
Kidney
Blood
Lymph nodes
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Kernicterus literally means "yellow kern," with kern indicating the most commonly
afflicted portion of the brain;and is associated with severe jaundice. This condition is
caused by a build up of unconjugated bilirubin in the bloodstream from the
breakdown of red blood cells.
An abdominal wound culture grows E. coli on the aerobic culture. The anaerobic
culture has growth of two gram negative rods, one of which is aerobic. The other
gram negative rod has 2+ growth on BBE plate and is resistant to Kanamycin,
Colistin, and Vancomycin disc. This organism can be identified as:
Veillonella
Prevotella fragilis
Bacteroides fragilis group
Fusobacterium necrophorum
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Bacteroides Bile Esculin Agar (BBE) is an enriched selective and differential medium
for the isolation and presumptive identification of obligately anaerobic gram-negative
bacilli of the Bacteroides fragilis group. BBE contains gentamicin at a concentration
which inhibits most facultative anaerobes. With a few exceptions, Bacteroides species
are resistant to kanamycin and vancomycin and show variable susceptibility to
colistin.
Identify the urine sediment elements shown by the arrow:
Cylindroids
Mucus threads
Hyaline casts
Budding yeast
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Mucus thread appear as long, thin ribbon like threads that are generally transparent.
They are normal in small numbers in the urine.

Which of the following blood smears these illustrations would be best suited for
performing a differential count:
Top Photo
Bottom Photo
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An even distribution of red blood cells on a smear is necessary for accurate

differential counts.
===========================================================
Match the type of media from the drop down box with the phrase listed below that
best describes that media:
Your answers are on the left. The correct answers are on the right and highlighted.
Differential Contains certain factors that allow colonies of specific organisms to
appear different than other colonies.
Selective Media that contains agents that inhibit all but one specific organism.
Enrichment Encourages the growth of specific types of organisms.
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Enrichment- Media which encourages the growth of specific types of organisms.
Differential- Media which contains certain factors that allow colonies of specific
organisms to appear different than other colonies.
Selective- Media that contains agents that inhibit all but one specific organism.
The disk diffusion method of measuring antimicrobial sensitivity is also termed:
Tube dilution
Kirby-Bauer
Gel diffusion
Tube titer
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Still widely used, the Kirby-Bauer disk diffusion technique is a rapid, inexpensive
method of testing several antibiotics against a single isolate.

The presence of increased levels of protein in the urine may be an early indicator of
which of the following conditions?
Renal disease
Diabetes
Hepatitis
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The detection of protein in the urine may be an early indicator of renal disease.
Normal physiologic criteria allow low molecular weight proteins, primarily albumin,
to be filtered through the glomerular capillary wall. Normally, the majority of the
filtered albumin is then reabsorbed by the tubules so that in a normal urine, albumin
content is below the threshold of detection (less than 15 mg/dL of albumin). Trace
protein is considered normal and in most circumstances does not require further
analysis.
Detection of increased levels of protein on a urine reagent strip is not an early

indicator of diabetes. Both type I and type II diabetes mellitus are leading causes of
renal failure. Microvascular damage caused by excessive renal exposure to glucose
can lead to diabetic nephropathy. By the time the urine protein level reaches the 30
mg/dL level that is necessary for detection by routine reagent strips, damage to the
kidneys may have already occurred.
The presence of protein in the urine is also not an early indicator of hepatitis.
Is a strict anaerobe
Transmitted by tick bites
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Francisella is not a strict anaerobe.Francisella tularensis, for example, is a facultative

anaerobic, intracellular gram-negative bacterium. Recall that facultative anaerobes are
bacteria that can grow in both the presence or absence of oxygen- which is quite
different than a strict anaerobe.

Which of the following methods is MOST reliable for determining the appropriate
dosage of Rh immune globulin to give to an identified Rh immune globulin candidate
after delivery?
Kleihauer-Betke method
Flow cytometry
Rosette test
No test is needed, the same dosage is given to all Rh immune globulin
candidates
Feedback
Flow cytometry is the most reliable method of those listed. It is a quantitative method,
whereas Keihauer-Betke and the rosette test are very subjective tests.
Which of the following antibodies will most likely not be detected on immediate
spin?
Anti-P1
Anti-Jka
Anti-A
Anti-M
Feedback
Jka and Jkb antibodies are nonagglutinating IgG antibodies, and are generally detected
during the antiglobulin phase.
Which phase of the bacterial growth curve shows the greatest activity?
Death phase
Stationary Phase
Lag Phase
Log Phase
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Bacteria have a characteristic growth curve that all bacteria follow called lag phase,
log phase, stationary phase and death phase. In Lag Phase cultures of bacteria gain the
necessary nutrients from the growth medium, but have not started to grow or multiply.
In Log Phase the bacteria rapidly multiply. During Stationary Phase bacterial cells die
at the same approximate rate that they get produced, so no real growth is gained,
although cell are still being produced. Finally, in the Death Phase bacterial cells begin
to die faster than they are produced.
The immunoglobulin molecule is made up of both heavy and light chains - the light
chains can be comprised of which of the following:
Alpha or beta
Alpha or lambda
Kappa or beta
Kappa or lambda
Feedback
Only kappa or lambda chains can compose the light chains of an immunoglobulin
molecule.
An 87-year old patient had a foot wound that grew gram-negative rods on McConkey
agar as pink to dark pink oxidase-negative colonies along with the following results:
TSI: A/A
Indole: neg.
MR: neg.
VP: pos.
Citrate: pos.
H2S: neg.
Urea: pos.
Motility: neg.
Ornithine: neg.
Antibiotic susceptibility: Carboxicillin and ampicillin resistant, all others sensitive.
What is the MOST likely organism?
Serratia marcescens
Proteus vulgaris
E. coli
Klebsiella pneumonia
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Considering the reactions given in this case study, Klebsiella pneumonia would be the
best choice.
Serratia marcescens can be eliminated by the fact that it is motility + and urea
negative, as well as ornithine +.
Proteus vulgaris can be eliminated due to its production of H2S, the fact that it is
indole +, the MR/VP reaction is positive/negative, it is citrate +, and motility +.
E. coli can be eliminated due to its production of gas on the tsi slant. E. coli is also
indole +, MR/VP = positive/negative, citrate negative, urea negative, motility +,
ornithine +.
Which of the following organisms in most frequently associated with endocarditis:
Viruses
Neisseria
Staphlyococci
Streptococci
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Various Streptococci are the most common causes of endocarditis, although many
other organisms have been implicated.

The morphology of yeasts inoculated to cornmeal agar can be helpful in making a
species identification. The field of view shown in this photomicrograph is most
consistent with the identification of:
Candida kefyr (pseudotropicalis)

Torulopsis (Candida) glabrata
Candida parapsilosis
Candida tropicalis
Feedback
Illustrated in this photomicrograph are multiple satellite centers of growth with radial
extensions of pseudohyphae, forming what have been called "spider" or "cross match
stick" colonies. This cornmeal agar picture is characteristic of Candida parapsilosis.
Torulopsis (Candida) glabrata does not produce pseudohyphae on cornmeal agar.
Candida kefyr (pseudotropicalis) produces elongated blastoconidia that cluster in a

"logs in stream" pattern whereas Candida tropicalis produces linear strands of
pseudohyphae with irregularly scattered blastoconidia.

What is the MOST likely identification of an acid-fast bacillus that demonstrates the
following characteristics?
 slow growth
 cream to tan colored colonies when grown in the dark
 development of yellow pigment upon exposure to light
Mycobacterium kansasii
Mycobacterium marinum
Mycobacterium avium
Mycobacterium scrofulaceum
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The correct answer which best fits the characteristics in this question is
Mycobacterium kansasii.
The remaining Mycobacterium strains can be elimated as:
 Mycobacterium marinum is considered a fast-grower.

 Mycobacterium scrofulaceum produce deep-yellow to orange pigmented
colonies when grown in the either the light or dark.
 Mycobacterium avium grows colonies which are nonpigmented in the light
and dark which do not intensify after light exposure.
Which one of the following statements is correct?
It is OK to talk about a patient's test results with a friend who works in a doctor's
office because you know you can trust them
Employees do not need to verify the identity of individuals requesting test result
information
It is OK to guess at the answers to questions from patients because they don't
know if the answer is correct and they don't like to wait while you check it out
Confidential medical information should never be discussed outside of the
laboratory
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It is not appropriate to discuss confidential medical information outside of the

laboratory.
False negative results may occur with both the direct and indirect antiglobulin tests as
a result of all of the following except:
Undercentrifugation
Delay in adding antiglobulin reagent
Failure to adequately wash cells
Agglutination of red cells prior to addition of antiglobulin reagent
Feedback
Agglutination of red cells prior to addition of antiglobulin reagent due to cold

autoantibodies would give a "false" positive result, not a false negative. In this case,
the washed red cell sample will agglutinate prior to addition of antiglobulin.

Identify the crystal indicated by the arrow in this alkaline urine:
Cholesterol crystal
Triple phosphate crystal
Amorphous urate crystal
Ammonium biurate crystal
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Ammonium biurate crystals appear as yellow to brown spherical bodies with long
irregular spicules, known as "thorn apples". The can be normally present in alkaline
urine.

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You answered the question correctly.

Which of the following would be considered a normal cerebrospinal fluid glucose if

The correct answer is highlighted below

Question Difficulty: Level 5

You answered the question incorrectly.

The correct answer is highlighted below

activity of one ion only

You answered the question correctly.

Sodium fluoride is an excellent preservative for collecting glucose specimens

The correct answer is highlighted below

Prevents interference with other substances

Glucose is metabolized at a rate of 5% per hour in specimens not immediately

Question Difficulty: Level 3

You answered the question incorrectly.

RBC count = 3.19 x 1012/L

Hemoglobin = 11.3 g/dL

The correct answer is highlighted below

MCV = 99 fL, MCH = 38 pg, MCHC = 34 g/dL

MCV (fL) = (Hct (%) / RBC (1012/L)) x 10

MCH (pg) = (Hgb (g/dL) / RBC (1012/L)) x 10

MCHC (g/dL) = (Hgb (g/dL) / Hct (%)) x 100

For this problem:

MCV = 35 / 3.19 = 10.97 x 10 = 109.7 or 110 fL

MCH = 11.3/3.19 = 3.54 x 10 = 35.4 pg

MCHC = 11.3/35 = 0.32 x 100 = 32 g/dL

Question Difficulty: Level 5

You answered the question correctly.

The assay which is most helpful in identifying specific allergens is:

The correct answer is highlighted below

RAST tests, or Radioallergosorbent tests, are used to screen for an allergy to a

Question Difficulty: Level 5

The correct answer is highlighted below

Whole Blood should be stored between 1 - 6 degrees Celsius.

Question Difficulty: Level 3

You answered the question correctly.

The correct answer is highlighted below

Escherichia coli/Klebsiella pneumoniae

You answered the question correctly.

A zinc deficiency in the elderly is often caused by:

The correct answer is highlighted below

Decreased intake and absorption

Question Difficulty: Level 5

You answered the question correctly.

An antithetical relationship exists between M antigen and which of these antigens?

The correct answer is highlighted below

An antithetical relationship exists between the antigens M and N.

You answered the question correctly.

The correct answer is highlighted below

Question Difficulty: Level 5

You answered the question correctly.

ABO and Rh typing

* IAT = indirect antiglobulin test

The correct answer is highlighted below

Anti-D (passive, from RhIg administration)

Question Difficulty: Level 6

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Question Difficulty: Level 4

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Identify the urine sediment elements present in this illustration:

The correct answer is highlighted below

Question Difficulty: Level 4

You answered the question correctly.

The correct answer is highlighted below

Question Difficulty: Level 4

Which condition is most likely afflicting this patient?

The correct answer is highlighted below

Reference Range Recap:

Question Difficulty: Level 5

You answered the question correctly.

The correct answer is highlighted below

those tubes of titration which contain the least concentration of antibody

Prozone is a phenomenon in which titers of specific antigen and antibody do not

Question Difficulty: Level 4

You answered the question correctly.

Circulating organic iodine is found primarily in the form of:

The correct answer is highlighted below