‫أشهر أسئلة المقابالت الوظيفية في المختبرات الطبية مع اجوبتها‬

Quality in Laboratory:

What is quality control in medical lab ?

Its activities done in the lab to ensure compliance of the highest standards required
to provide the best possible results and patient care .
Define proficiency test or external control?
External quality control (also called proficiency testing or PT) evaluates a
laboratory's testing results by comparing them to those of similar laboratories. ...
These unknown samples are then tested by the participating laboratories and
results are returned to the proficiency testing program.

What is the difference between Calibration and Control?

Calibrators give a reference point for the instrument to adjust to. Controls make
sure the the analytical process and instrument are working properly.

What are calibrations?

Samples of known concentration used to set analyzer or instrumentation
parameter.

What are controls?

Samples of known concentrations similar to patients samples, used to monitor the
accuracy and precision of an analyzer before patient testing.

What do we do if the controls were out of range?

Before rushing in to rerun the controls, first we must check the LJ charts if is it all
well or not? As the charts pattern can give us indication if it was random or
systematic error, or if we notice a shift or trend, if we had the 1.2S rule it's only a
warning we will check the day before if it was ok or not. 1.3S is a random error it
could be a caused by a bubble or by programming a level then run a different
level, in this case we do a rerun for the control, we should also check if the
maintenance is done or not as it would affect the control results, and if we catch
any other systematic pattern we inform the senior and troubleshoot the issue as
appropriate.

What are critical value? And how do we handle it?

values that are outside the normal range to a degree that may constitute an
immediate health risk to the individual or require immediate action

if we run the test and the result is critical> rerun the sample> if still
critical>inform the supervisor> inform the doctor or the head nurse.

How many times do I run controls ?

Once daily for the majority of the testings, some tests required to run the controls
once every 8 hours like (electrolytes and coagulation), and we should always
Follow manufacture instructions and policy of the section.

When do I run calibration ?

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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When it's scheduled, when calibration is expired or deteriorated, when changing

the reagent, when changing a part of the machine, new lot.

quality Assurance vs Quality control?

QC is a set of activities for ensuring quality in products. The activities focus on
identifying defects in the actual products produced.
QA aims to prevent defects with a focus on the process used to make the product.
By monitoring.

What is cut off ?

Numerical indication for reading the test results by it's reactivity or severity as if it
was reactive or not, or for example in vitamin D , when do we say the result is
deficiency, sufficient, or toxic.

delta check?
A delta check is a quality control tool that involves the comparison of laboratory
test results with results obtained on previous samples from the same patient. Delta
checks can be programmed into the laboratory's computer system to detect an
error
specificity?
The more specific a test is, the fewer “false-positive” results it produces.
Sensitivity?
The more sensitive a test, the fewer “false-negative” results it produces.
accuracy?
Measuring the trueness of a concentration
precision?
Measuring reproducibility of a given result or concentration.

Define trend and shift?

A shift is a sudden change of values from one level of the control chart to
another. ... The occurrence of shifts and trends on the Levey-Jennings control
chart is the result of either proportional or constant error.
What are westgared rules?
set of rules used for laboratory quality control. Developed by james westgared.
What is the warning rule?
1(2s)

What is the Random error rules?

1.3S, R4S

What are Levey-Jennings chart ?

Levey-Jennings chart is a graph that quality control data is plotted on to give a
visual indication whether a laboratory test is working well.

what is the difference between validation and verification?

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist
 ‫أشهر أسئلة المقابالت الوظيفية في المختبرات الطبية مع اجوبتها‬

Verification is “provision of objective evidence that a given item fulfils specified

requirements”,
while validation is “verification, where the specified requirements are adequate for
the intended use”
What is MSDS and where it is available?
A: MSDS is material safety data sheet and it is available in all areas where
chemicals are existing.
What are the types of errors?
Systematic Errors : Due to identified causes and can be fixed or eliminated
Random Errors: Random errors are positive and negative fluctuations that cause
about one-half of the measurements to be too high and one-half to be too low. –
Sources of random errors cannot always be identified.
What are the 12 quality management essentials ?
The quality system essentials are: organization, customer focus, facilities and
safety, personnel, purchasing and inventory, equipment, process management,
documents and records, information management, nonconforming
event management, assessments, and continual improvement.

What are the quality indicators in medical laboratory?

Key performance indicators is a method of monitoring lab performance through
the 3 stages (pre analytical, analytical, post analytical) the laboratory can set their
own indicator to measure all 3 stages and some examples include (rejection,
TAT,send out samples)

What do you know about CAP?

College of American Pathologists it's an organization that cares about Quality in
clinical laboratory by establishing and applying standards designed to achive the
highest level of quality, it provides accreditation for clinical labs all over the
world.

What are the types of CAP samples?

Proficiency testing programs samples, CVL samples, Competency Samples.

What is OSHA, CAP, CLIA?

CAP= college of American Pathologists
“OSHA” Stands for the Occupational Safety and Health Administration
Joint Commission International (JCI)
Clinical Laboratory Improvement Amendments (CLIA) in the US only
Accreditation system.
What do you know about CBAHI ?
Saudi Central Board for Accreditation of health institutions

If you have urgent sample and the reagent is expired what will you do?
Well, in this scenario if the reagent is only recently became expired and it was
stored appropriately and still performed correctly as it should, there is a practice
called (deviation from the policy) where the lab head or the lab director must sign
on a form stating it is accepted to use the reagent for this specific condition only
because the results of the reagent is performing well.

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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How to do Verification for a new test?

For waved test: follow manufacturer instructions , we can also run simple
precision and linearity.
For non-waved testing: Accuracy by comparison, precision (Complix and simple),
AMR or Linearity, sensitivity, carry over, reference range.
Method validation?
Validation involves performing specific clinical laboratory studies by the
manufacture or a validation institution to verify that a particular instrument,
software program, or measurement technique is working properly.

What's the difference between

Validation is done by manufacture or validation institutions, Verification is

done by the consumer ( the laboratory itself)
What do you know about IQCP?

Individualized Quality Control Plan it's a tool used when we change the
manufactor control plan or the instrument itself does not use liquid control
solutions or for some particular sections like in Microbiology.

Corelab (Chemistry , Serology, Hormones, Hematology):

Q) what will happen if there was EDTA contamination in serum sample for
chemistery ?
The presence of EDTA may interfere with the measurement of several chemistry
analytes, resulting in either erroneously increased or decreased values.Potassium
may be increased in the presence of EDTA,. Other ions are also chelated by
EDTA, including magnesium, zinc and iron, thus decreased values may be
observed for any of these ions. EDTA can also decrease the activity of enzymes
such as alkaline phosphatase or creatine kinase, due to chelation of the required
cofactors.

Q) What should you do if you receive STAT samples without patient name?
Is the patient MRN present? (Medical Record Number) it's the most important if
it's not we have no choice but to reject the anonymous sample, and report the
incident.

Q) clinical chemistry/ hematology results of iron deficiency anemia. (IDA)?

complete blood count (CBC). Results may show:

• Hemoglobin (Hb)—may be normal early in the disease but will decrease as
anemia worsens

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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• Red blood cell indices—early on, the RBCs may be a normal size and color
(normocytic, normochromic) but as the anemia progresses, the RBCs
become smaller (microcytic) and paler (hypochromic) than normal.
• Average size of RBCs (mean corpuscular volume, MCV)—
decreased
• Average amount of hemoglobin in RBCs (mean corpuscular
hemoglobin, MCH)—decreased
• Hemoglobin concentration (mean corpuscular hemoglobin
concentration, MCHC)—decreased
• Increased variation in the size of RBCs (red cell distribution width,
RDW)

• Serum iron—which is usually decreased

• Ferritin—usually low with iron deficiency anemia. It is considered to be
the most specific test for identifying iron deficiency anemia
• Transferrin and total iron-binding capacity (TIBC)—transferrin is a protein
that binds to and carries iron through the blood; TIBC is a reflection of how
much transferrin is available to bind to iron. In iron deficiency anemia, the
transferrin level and TIBC are high.
Reticulocyte count— the number of reticulocytes is low because there is
insufficient iron to produce new RBCs.

?Q) how dose EDITA works

since potassium EDTA (K2 or K3EDTA) is a common formulation in
anticoagulated sample collection tubes. EDTA acts as an anticoagulant by
chelating calcium ions.

What would you do if you had a critical value?

Rerun Sample if still critical, inform the physician immediately ask for a read back
, document,and order confirmatory sample
What are the critical value parameters in chemistry?

Troponin, Bilirubin, electrolytes especially potassium and sodium , glucose, blood

gas

why would we use gel electrophoresis in routine chemistry?

It is used in clinical chemistry to separate proteins by charge or size
biochemistry and molecular biology to separate a mixed population of DNA and
RNA fragments by length, to estimate the size of DNA and RNA fragments or to
separate proteins by charge.

Q) what are the criteria of sample rejection?

Specimen hemolyzed o Specimen clotted o Quantity not sufficient (QNS) o
Incomplete request form • No doctor sign or stamp • No diagnosis • Test not
recommended o Mismatched file name, number on request and tube • Specimen
unlabeled • Specimen mislabeled • Specimen inadequately labeled o Wrong
collection tube.

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

 ‫أشهر أسئلة المقابالت الوظيفية في المختبرات الطبية مع اجوبتها‬

Q) What would you do if you received a cbc sample in sodium citrate tube?

sodium citrate and heparin anticoagulants can be used as alternatives for testing in
case the patient sample showed platelet satellitism, as sodium citrate might resolve
the clumping of platelets.
Q) if you get HBsAg(+) and HBcAb(+), what is the diagnosis ?

Blood Bank :
Test in blood bank lab :
• ABO (BLOOD GROUP ) TEST
• Weak D Testing (Du) Testing
• direct coombs test (DCT)
• indirect coombs test (ICT)
• cross matching
• antibody identification
What is cross match?
A test we do before blood transfusion to ensure that the Donor blood is compatible
with the patient.
What are cross matching types ?
Major cross match (patient serum + donor cells)
Minor cross match (patient cells + donor serum)

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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How can we do emergency cross match?

We do immediate spin cross match. By patients serum + donor blood cells at room
temperature. No agglutination means a compatible match.
What is the procedure or the regular cross match?
Patient serum + donor cells
First we do immediate spin if negative, we incubate it at 37c for 45 minutes and
centrifuge it if also negative, we add 2 drops of antihuman globulin then centrifuge
it for 30 sec if also negative both macro and microscopically then it's compatible.
But to confirm it more we add coombs control cells (CCC) and the result should
be positive.
what is the difference between direct and indirect coombs test?
Direct coombs test
Detects antibodies attached to the RBC
Indirect coombs test
Tell us which types of antibodies against RBC are in the serum
Why do testing for phenotype before blood transfusion?
To catch the unexpected alloantibody that can attack the recipient RBCs in
prenatal testing and before blood transfusion
What are alloantibody?
antibodies produced after the exposure to foreign RBC antigens. The exposure can
occur through pregnancy or blood transfusion.
What antibodies enhanced by enzymes?
Rh group ,Kell and sometimes Kidd
What antibodies hemolyze or break by enzymes?
Duffy and MNS groups
What are the anticoagulants used in Blood bank ?
Citrate-phosphate-dextrose(CPD)saves the blood for 21 days.
Citrate-phosphate-dextrose-adenine(CPDA-1)saves the blood for
35 days, the adenine provide ATP source for the RBCs.
Sodium-Adenine-glucose-mannitol(SAGM) saves the blood for 42 days.
What are the preservation times and temperature for blood component?

Blood component Storage temperature Shelf life

Red cells: 42 days
Red cells 2–6 ºC Paediatric red cells: 35
days Washed red cells: 28
days

Platelets 20–24 ºC 5 days

Fresh frozen plasma.

cryoprecipitate At or below –25 ºC 12 months

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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What is the emergency release for blood bank ?

I believe we must send the blood as soon as possible so there Is no time for regular
procedure so, if the patient was adult male we can give him O+, if he was a child
we shall give him O-, if the patient was a young female in child baring age we
give her O-, if she was older than 50 we can give her O+.

What is ABO discrepancy?

when the result of an ABO RBC typing, or forward type, does not agree with the
result of the plasma typing, or reverse type.

How do you extinguish the fire?

A: Pull the pin, Aim at the base of the fire, Squeeze the handle/lever, sweep from
side to side (PASS)

Q)PCR steps ?
Step 1: Denaturation
As in DNA replication, the two strands in the DNA double helix need to be
separated.
Step 2: Annealing
Primers bind to the target DNA sequences and initiate polymerisation. This can
only occur once the temperature of the solution has been lowered.
One primer binds to each strand.
Step 3: Extension
New strands of DNA are made using the original strands as templates. A DNA
polymerase enzyme joins free DNA nucleotides together. This enzyme is often
Taq polymerase, an enzyme originally isolated from a thermophilic bacteria called
Thermus aquaticus.

Q) what is RT-PCR
A real-time polymerase chain reaction also known as quantitative Polymerase.

Histopathology
Q) what are the frozen section, and used for what ?
The frozen section procedure is a pathological laboratory procedure
to perform rapid microscopic analysis of a specimen.
what are the samples received in histopathology laboratory?
Three main types of specimen are received :
1-Larger specimens include whole organs or parts
2-Pieces of tissue rather than whole organs are removed as biopsies,
3-Fluid and very small pieces of tissue
Q) what are cytology samples and used for what ?
Common samples include pleural fluid, pericardial fluid, peritoneal fluid, and
cerebrospinal fluid (CSF) cytology.

Q) what is the preservative for cytology specimens ?

Ethyl alcohol (95%) is the most commonly used fixative in cytology.
The most commonly used fixative in histology is formaldehyde.
Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist
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Q)what are the types of biopsy?

1-Incisional biopsy : removing a part of the affected Organ
2-Excisional biopsy: removing the entire Organ and the surrounding tissue
3-Punch biopsy: small, round piece of tissue from a lesion on the skin
4-Shave biopsy: remove only a superficial layer of skin
5-Curettage biopsy: a procedure to remove tissue from the inside of the
uterus
6-Needle biopsy: thin, hollow needle is inserted into the mass for sampling of
cells that, after being stained, are examined under a microscope (as in fine-
needle aspirate)
7-Endoscopic biopsy: endoscope can be inserted through your mouth, rectum,
urinary tract or a small incision to collect tissue
8-Resection biopsy: the surgical sampling of a small amount of tumor tissue
9-Amputation Specimen: to cut off (all or part of a limb or digit of the body

Q) what are the situations that you can’t reject the sample? and what would you
do ?
In non replaceable sample : blood samples collected before the patient pass
away, biopsy or histopathology/cytology samples.

Microbiology

Q) How to do gram stain ?

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist

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Q)Examples of gram negative and gram positive bacteria?

Gram +ve:
Staphylococcus, Streptococcus, Enterococcus.
Gram -ve:
Pseudomonas, Klebsiella, Proteus, Salmonella, Providencia, Escherichia.

Q) Types of hemolysis in blood agar ?

Beta-hemolysis: is complete hemolysis. It is characterized by a clear (transparent)
zone surrounding the colonies.
Alpha-hemolysis : is Partial hemolysis. Colonies typically are surrounded by a
green, opaque zone.
Gamma-hemolysis: no hemolysis occurs.

Q) Lacose fermenting and non lactose fermenting on macconky agar?

• Lactose (Lac) positive (pink colonies):
o Lactose fermenting species will grow pink colonies. Lactose
fermentation will produce acidic byproducts that lower the pH, and
this turns the pH indicator to pink.
o Example of Lac positive species: Escherichia coli, Enterobacteria,
Klebsiella
• Lac negative (white colonies)
o Gram-negative bacterial species will still form colonies, but
colonies will have a white appearance as there will be no change in
pH in the absence of lactose fermentation.
o Example of Lac negative species: Salmonella, Proteus, Yersinia,
Pseudomonas

Q) what are the panic values in the microbiology lab?

Positive Blood Culture , TP Positive , growth on CSF sample ,

Prepared by: Kouther Faris Alsehemi , Medical Laboratory Specialist