Preanalytical (preexamination) variables in laboratory testing include: A. Result accuracy B. Report delivery to the ordering physician C. Test turnaround time D. Specimen acceptability

A preanalytical error can be introduced by: A. Drawing a coagulation tube before an EDTA tube B. Mixing an EDTA tube 8-10 times C. Transporting the specimen in a biohazard bag D. Vigorously shaking of blood tube to prevent clotting

Which of the following is not a potential source of postanalytical (postexamination) errors? A. Excessive delay in reporting or retrieving a test result B. Interpretation of result C. Verbal notification of test result D. Labeling the specimen at the nurses' station

The most important diagnosis and therapeutic management decision tool used to interpret test results is: A. Statistical analysis B. Reference intervals C. Specimen acceptability D. The age of a patient

Delta check is a method that: A. Determines the mean and variance of the instrument B. Monitors the testing system for precision C. Monitors patient samples day to day D. Is determined in each laboratory facility

ESTABLISHING A REFERENCE INTERVAL A new reference interval is established when there is no existing analyte or methodology in the clinical or reference laboratory with which to conduct comparative studies. It is a costly and labor-intensive study that will involve laboratory resources at all levels and may require from ____ to as many as ≈700 study individuals. A. 20 study individuals B. 50 study individuals C. 100 study individuals D. 120 study individuals

VERIFYING A REFERENCE INTERVAL (TRANSFERENCE) This is done to confirm the validity of an existing reference interval for an analyte using the same (identical) type of analytic system (method and/or instrument). These are the most common reference interval studies performed in the clinical laboratory and can require as few as ____ study individuals. A. 20 study individuals B. 50 study individuals C. 100 study individuals D. 120 study individuals

What does the preparation of a Levey-Jennings quality control chart for any single constituent of serum require? A. Analysis of control serum over a period of 20 consecutive days B. 20 to 30 analyses of the control serum on 1 day, in one batch C. Analyses consistently performed by one person D. Weekly analyses of the control serum for 1 month

The acceptable limit of error in the chemistry laboratory is 2 standard deviations. If you run the normal control 100 times, how many of the values would be out of the control range due to random error? ! A. 1 B. 5 C. 10 D. 20

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

Which of the following describes the ability of an analytical method to maintain both accuracy and precision over an extended period of time? A. Reliability B. Validity C. Probability D. Sensitivity

Amount of light absorbed by a solution is _______ proportional to the concentration of the solution. A. Directly B. Inversely C. Variable D. Cannot be determined

Logarithm of the transmitted light is _______ proportional to its concentration. A. Directly B. Inversely C. Variable D. Cannot be determined

In the visible light spectrum, the color red is in what nanometer range? A. 380-440 nm B. 500-580 nm C. 600-620 nm D. 620-750 nm

Osmometry is a technique for measuring the concentration of solute particles that contribute to the osmotic pressure of a solution. The most common method used in a clinical laboratory to measure osmolality is: A. Dew point pressure B. Boiling point C. Freezing point depression D. Osmotic pressure

One of the major hormones that controls high glucose levels after a meal is: !!! A. Insulin B. Thyroxine C. Glucagon D. Lipase

In a person with normal glucose metabolism, the blood glucose level usually increases rapidly after carbohydrates are ingested but returns to a normal level after: A. 30 minutes B. 45 minutes C. 60 minutes D. 120 minutes

Which of the following organs uses glucose from digested carbohydrates and stores it as glycogen for later use as a source of immediate energy by the muscles? A. Kidneys B. Liver C. Pancreas D. Thyroid

Which of the following electrolytes is the chief cation in the plasma, is found in the highest concentration in the extravascular fluid, and has the main function of maintaining osmotic pressure? A. Potassium B. Sodium C. Calcium D. Magnesium

Ninety percent of the carbon dioxide present in the blood is in the form of: A. Bicarbonate ions B. Carbonate C. Dissolved CO2 D. Carbonic acid

Expected creatinine clearance for a patient with chronic renal disease would be: A. Very low; renal glomerular filtration is functioning normally B. Normal; renal glomerular filtration is functioning normally C. Very high; renal glomerular filtration is not functioning normally D. Very low; renal glomerular filtration is not functioning normally

Blood is collected from a patient who has been fasting since midnight; the collection time is 7 am. Which of the following tests would not give a valid test result? A. Cholesterol B. Triglycerides C. Total bilirubin D. Potassium

. In what major organ of the body is the majority of the body’s cholesterol synthesized? A. Heart B. Pancreas C. Gallbladder D. Liver

Which of the following laboratory values is considered a positive risk factor for the occurrence of coronary heart disease? A. HDL cholesterol >60 mg/dL B. HDL cholesterol <35 mg/dL C. LDL cholesterol <30 mg/dL D. Total cholesterol <200 mg/dL

The National Cholesterol Education Program (NCEP) has established cutoffs for total cholesterol and LDL cholesterol to define persons at high risk for coronary heart disease later in life. What is the cutoff for a desirable LDL cholesterol concentration? A. <130 mg/dL B. <160 mg/dL C. <200 mg/dL D. >130 mg/dL

Skeletal muscle markers: A. CK-MM B. CK-MM, AST C. CK-MM, AST, Aldolase D. CK-MM, AST, Aldolase, LD-4 and LD-5

Increased ADH: A. Fluid loss, low serum sodium B. Fluid loss, high serum sodium C. Fluid retention, low serum sodium D. Fluid retention, high serum sodium

Creatinine clearance is used to assess the: A. Glomerular filtration capabilities of the kidneys B. Tubular secretion of creatinine C. Dietary intake of protein D. Glomerular and tubular mass

CREASED RENIN Hypertension 169. Which of the following hematologic tests may not be part of the usual complete blood count? A. Hematocrit B. Hemoglobin C. Platelet estimate D. Reticulocyte count

Macroscopically, a well-stained blood film should be: A. Blue to purple B. Green to blue C. Pink to purple D. Red to brown

RBCs appear GRAY, WBCs are too dark, eosinophil granules are gray, not orange. All are probable causes, EXCEPT: A. Stain or buffer too alkaline B. Inadequate rinsing C. Prolonged staining D. Underbuffering E. Heparinized sample

RBCs are too pale and or red, WBCs are barely visible. All are probable causes, EXCEPT: A. Stain or buffer too acidic B. Underbuffering C. Over-rinsing D. Heparinized blood sample

Vasoconstriction is caused by several regulatory molecules, which include: A. Fibrinogen and vWF B. ADP and EPI C. Thromboxane A2 and serotonin D. Collagen and actomyosin

The bleeding time test is almost always prolonged when the platelet count is: !! A. <10 × 109/L B. <50 × 109/L C. <100 × 109/L D. >100 × 109/L

Spontaneous bleeding occurs when the platelet count is: !!! A. <10 x 103/μL B. <20 x 103/μL C. <50 x 103/ μL D. <100 x 10 /μL

The most common cause of bleeding in patients is: A. Qualitative platelet defect B. Qualitative abnormality of fibrinogen C. Quantitative abnormality of fibrinogen D. Quantitative abnormality of platelets

Which of the following is the most common of the hereditary platelet function defects? A. Glanzmann thrombasthenia B. Bernard-Soulier syndrome C. Storage pool defects D. Multiple myeloma

Which of the following is the most common of the acquired platelet function defects? !!! A. Paraproteinemia B. Uremia C. Myeloproliferative disorders D. Drug-induced

Platelet aggregation will occur with the end production of: A. Cyclooxygenase B. Arachidonic acid C. Prostacyclin D. Thromboxane A2

A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely to be abnormal in this patient? !! A. Platelet count B. PFA-100 C. Prothrombin time D. Activated partial thromboplastin time

How do ticlopidine and clopidogrel inhibit platelets? !!! A. Binding von Willebrand factor B. ADP mediated platelet aggregation C. Inhibit GPllb/llla D. Depletion of platelet alpha granule content

The principle of platelet aggregation is based on: !!! A. Decreased light transmission B. Increased light transmission C. Decreased light absorbance D. Increased light absorbance

Hageman factor (XII) is involved in each of the following reactions except: A. Activation of C1 to C1 esterase B. Activation of plasminogen C. Activation of factor XI D. Transformation of fibrinogen to fibrin

In a patient diagnosed with liver disease, which one of the following factors typically shows an increase? !!! A. Factor VII B. Factor VIII C. Factor IX D. Factor X

A 25-year-old male with celiac disease presents with occult positive stools. What vitamin deficiency should be considered? !!!! A. Vitamin A deficiency B. Vitamin D deficiency C. Vitamin E deficiency D. Vitamin K deficiency

The most potent plasminogen activator in the contact phase of coagulation is: A. Kallikrein B. Streptokinase C. HMWK D. Fibrinogen

The activation of plasminogen to plasmin resulting in the degradation of fibrin occurs by: A. PAl-1 B. Alpha-2 antiplasmin C. TPA D. Alpha-2 macroglobulin

The major serine protease responsible for clot breakdown is: A. TPA B. Alpha 2 antiplasmin C. Streptokinase D. PAl-1

An inhibitor of plasmin activity is: !!! A. tPA B. PAl-1 C. Alpha-2 antiplasmin D. Plasminogen

Antithrombin inhibits factors: !! A. Ila and Xa B. Va and VIIIa C. VIIa and Xlla D. IXa and Va

. Acute disseminated intravascular coagulation is characterized by: !!! A. Hypofibrinogenemia B. Thrombocytosis C. Negative D-dimer D. Shortened thrombin tim

Which of the following is most likely to activate the alternative pathway of complement activation? !!! A. Lipopolysaccharides B. Glycoproteins C. Haptens D. lgG complexed with antigen

Which of the following chemical classes of antigens is most likely to activate the alternative pathway of the complement? A. Proteins B. Lipids C. Polysaccharides D. Haptens

A patient’s serum IgA as measured by RID was 40 mg/dL. Another laboratory reported Iaboratory reported IgA absent. A possible explanation for this discrepancy is that the: A. Rabbit antiserum was used in the RID plates B. IgA has an Fc deletion C. IgA antiserum has kappa specificity D. Patient serum has antibodies against a protein in the antiserum

Antibodies to which of the following viral antigens are usually the first to be detected in HIV infection? A. gp120 B. gp160 C. gp41 D. p24

Solution used for direct fecal smear examination: A. Distilled water B. Normal saline solution C. Phosphate buffer D. Tap water

Red diamond or fire hazard, classified according to Flash Point: A. A to C B. A to D C. 1 to 10 D. 0 to 4

What is the proper order for putting on protective clothing? A. Gloves first, then gown, mask last B. Gown first, then gloves, mask last C. Gown first, then mask, gloves last D. Mask first, then gown, gloves last

What is the correct order for removing protective clothing? A. Gloves, gown, mask B. Gown, gloves, mask C. Gown, mask, gloves D. Mask, gown, gloves

Work is being done with Mycobacterium tuberculosis in the microbiology laboratory. It is important that you enter this laboratory while work is being done with positive samples. What is the most important personal protective equipment you should don before entering this laboratory? !!! A. Carbon cartridge respirator B. Mask C. Gloves D. N95 HEPA filter respirator

A laboratorian, properly dressed in white pants, laboratory coat, and shoes, prepares to leave the laboratory for lunch. In addition to washing his hands, he should A. Put on safety goggles B. Remove his laboratory coat C. Wipe the bench with water D. Remove polyvinyl gloves and place them into lab coat pocket for future use

Which order of events should be followed at the conclusion of a laboratory worker’s shift in order to prevent the spread of bloodborne pathogens? A. Remove gloves, disinfect area, wash hands, remove lab coat B. Disinfect area, remove gloves, remove lab coat, wash hands C. Disinfect area, remove gloves, wash hands, remove lab coat D. Remove gloves, wash hands, remove lab coat, disinfect area

An employee who accidently spills acid on his arm should immediately: A. Neutralize the acid with a base B. Hold the arm under running water for 15 minutes C. Consult the MSDSs D. Wrap the arm in gauze and go to the emergency room

Antibody potentiators, EXCEPT: A. LISS B. PEG C. Ficin D. Trypsin

Reason for deferral: !!! A. Antibiotics B. Blood pressure medication C. Hepatitis A vaccine D. Oral contraceptives

The reactivity of blood group A is confirmed by detecting the presence of which immunodominant sugar molecule? A. N-acetyl-D-neuraminic acid B. L-fucose C. N-acetyl-D-galactosamine D. N-acetyl-D-glucosamine E. D-galactose

The mating of parents of which two ABO phenotypes can potentially produce offspring with ALL of the common four blood types? A. AB and O B. AB and A C. AB and B D. AB and AB E. A and B

The rarest of all blood types is characterized by the absence of the common H antigen. This leads to the production of a naturally occurring, hemolytic antiH. People with this null can only be transfused with red blood cells from other people with this null. A. McLeod phenotype B. Bombay phenotype C. Rh null phenotype D. In(Lu) E. MkMk

Bombay phenotype (Oh) individuals may have antibodies with all the following specificities EXCEPT: A. Anti-A B. Anti-B C. Anti-H D. Anti-O E. Anti-A,B

Which cells agglutinate most strongly with Ulex europaeus lectin? !! A. O and A2 B. A1 and A2 C. O and A1B D. B and A2B E. A1 and B

Immune A and B alloantibodies differ from non-red cell stimulated (naturally occurring) A and B alloantibodies in that the immune antibodies: !! A. Are generally IgG rather than IgM B. Are unable to cross the placenta C. Can be enhanced in reactivity by incubation at 4o C D. Cause direct agglutination at room temperature E. Rarely cause clinical hemolysis

Which ABH substances would you expect to find in the saliva of a group A secretor? !! A. H only B. H and A C. H and B D. H and O E. A only

A 26 year old pregnant female is being tested prior to a scheduled C-section tomorrow. Her cell grouping (forward typing) is consistent with blood group O, while her serum grouping (reverse grouping or "back-typing") appears to be group A. The most common reason for this type of ABO discrepancy is: A. She has the Bombay phenotype B. She is a non-secretor, so her plasma lacks A C. Clerical errors or a sample mix-up D. Use of an uncalibrated centrifuge E. She has undiagnosed acute leukemia (AML)

An ABO discrepancy between forward and reverse grouping owing to weak-reacting or missing antibodies could be BEST explained by which of the following: A. Patient has a subgroup of blood group A B. Patient is very old or very young C. Patient has acquired B phenotype D. Patient has antibodies to low incidence antigens E. Patient has antibodies against reagent preservatives

A blood donor has the genotype hh, AB. What is his apparent red cell phenotype during routine forward and reverse group typing? A. A B. B C. O D. AB E. Cannot be determined

Approximately what percentage of group A individuals could be further classified as subgroup A1? A. 20% B. 40% C. 60% D. 80% E. 99%

Which of the following statements is TRUE regarding the A2 blood group? A. Dolichos biflorus lectin agglutinates A2 but not A1 RBCs B. Ulex europaeus lectin will give stronger reactions with A1 than with A2 RBCs C. A2 RBCs have more H antigen than A1 RBCs D. If anti-A1 is made by an A2 person, it is usually clinically significant E. Most A2 individuals have a different form of antiB than A1 individual

Which of the following statements is TRUE regarding Hemolytic Disease of the Fetus/Newborn (HDFN) caused by ABO antibodies? A. Fetal hemolysis is typically severe B. It rarely occurs during the first pregnancy C. It is most common with O mothers and A babies D. A negative cord blood direct antiglobulin test excludes it E. It occurs less commonly than Rh HDFN

Three genes responsible for the production of Rh antigens. A. RHAG, RH1, and RH2 B. RHAG, DCE, and dce C. RHAG, RHD, and RHCE D. RHD, RHCc, and RHEe E. RHD, RHCE, and RHce

Which genes encode for Rh antigens? A. RHDCE B. RHD C. RHCE D. Both B and C

A patient has the following Rh phenotype: D:+ C:+ c:+ E:+ e:+ What is her most likely Rh genotype? A. R1R1 B. R1R2 C. R2r D. R0ry E. R2r"

An African-American male potential blood recipient has the following Rh phenotype: !!! D:+ C:+ E:– c:+ e:+ Which of the following is his most likely genotype? A. R1r B. R1R2 C. R0r' D. Rzry E. R1R0

An African-American patient has the following Rh phenotype: D:+ C:+ c:+ E:+ e:+ f:– Which of the following is her most likely Rh genotype? A. R1R2 B. R0Rz C. R2r' D. Rzr E. R0ry

Which alloantibody is most likely to be produced if a patient that has the Rh genotype of R1R1 is transfused with red blood cells that have an Rh genotype of R0R0? A. Anti-D B. Anti-C C. Anti-c D. Anti-E E. Anti-e

Anti-G will react with red blood cells of each of the following phenotypes except: A. D+CB. D-C+ C. D-CD. D+C+ E. rG

If the father of a fetus is Rh positive and the mother is Rh negative, what are the chances that there will be a mother-fetus incompatibility problem? Assume that the couple already had a first child with no medical problems. A. 0 % B. 25% C. 50% D. 100%

A person with which one of the following red cell phenotypes is expected to be resistant to Plasmodium vivax malaria? A. Fy(a-b-) phenotype B. Rh null phenotype C. McLeod phenotype D. S-s-U- phenotype E. Le(a-b-) phenotype

Which of the following red blood cell antigens shows increased expression following incubation with proteolytic enzymes? !! A. Duffy antigens B. MN antigens C. Kidd antigens D. Kell antigens E. Lutheran antigens

This null produces red blood cells that are resistant to lysis by the addition of 2M Urea, allowing for donor compatibility screening for this phenotype without using antisera. A. Fy (a-b-) phenotype B. Le (a-b-) phenotype C. Lu (a-b-) phenotype D. Co (a-b-) phenotype E. Jk (a-b-) phenotype

A patient has a positive antibody screen and positive results against cells in the antibody panel. The patient specimen is retested with antibody panel cells that have been treated with the enzyme "ficin." The antibody no longer reacts against cells in the antibody panel. Which of the following antibodies is most consistent with these results? A. Anti-D B. Anti-K C. Anti-Jkb D. Anti-Fya E. Anti-Le

You are told that a patient has the "McLeod Syndrome." Which of the following is most likely to be TRUE regarding the patient? !!! A. The patient is susceptible to Streptococcus infections B. The patient has stomatocytes in his peripheral blood smear C. The patient has increased levels of Kell blood group antigens D. The patient presents with seizures or involuntary movements E. The patient has an increased level of Kx antigen in his blood

Which of the following lectins is matched appropriately with its target antigen? A. Vicea graminea: N antigen B. Dolichos biflorus: H antigen C. Salvia: A2 antigen D. Ulex europaeus: A1 antigen

Which of the following is TRUE about the I blood group system? !!! A. Auto-anti-i is associated with Mycoplasma pneumonia B. Auto-anti-I is associated with infectious mononucleosis C. i antigen is stronger on adult RBCs than neonatal RBCs D. Patients with auto-anti-I may require a "prewarmed" crossmatch before transfusion E. Antibodies in this system are usually clinically significant

Which of the following is TRUE of the P1PK and GLOB blood group systems? A. The P antigen is the point of entry of Plasmodium vivax into the red cell B. Anti-P1 is a common cause of hemolytic disease of the fetus/newborn C. Anti-P1 is an insignificant antibody neutralized by pigeon egg white fluid D. The lack of antigens in these systems may lead to the McLeod syndrome E. Antibodies against these antigens are not associated with hemolytic transfusion reactions

A patient has anti-c. If 80% of donors are c-positive and 68% are C-positive, how many RBC units will the transfusion service need to test in order to find 2 units that are compatible with the patient? A. 3 units B. 4 units C. 7 units D. 10 units E. 18 units

If a patient has Anti-c and Anti-S, how many RBC units will the transfusion service need to test in order to find 2 units that are compatible with the patient? (Frequency data: c = 80%, C = 68%, s = 90%, S = 55%) A. 5 units B. 12 units C. 22 units D. 32 units E. 42 units

What is the crossmatching protocol for platelets and/or plasma? A. Perform a reverse grouping on donor plasma B. No testing is required C. Perform a reverse grouping on recipient plasma D. Platelets must be HLA compatible

A 60-year-old woman with newly diagnosed acute myeloid leukemia is admitted for induction therapy. She eventually develops chemotherapyassociated thrombocytopenia. The clinical team requests platelet transfusion when her platelet count drops below 10 × 103 per microliter. The patient is A negative. The blood bank has a limited supply of apheresis platelets, including a: A. Low-titer O-positive unit expiring today at midnight B. High-titer O-positive unit expiring today at midnight C. B-negative unit expiring in 2 days D. A-positive unit expiring in 3 days

FFP can be transfused without regard for: !!! A. ABO type B. Rh type C. Antibody in product D. All of these options

Which of the following is an acceptable solution to be infused in the same intravenous line with a blood component? !! A. 0.45% USP saline B. 5% dextrose in water (D5W) C. Lactated Ringer's D. ABO-compatible plasma E. Vancomycin