All new laboratory assays and all assay modifications require validation. Validation is an activity comprised of procedures to determine: 1. Accuracy and precision 2. Specificity 3. Limits 4. Linearity * 0/1 1 and 2 1, 2 and 3 1, 2 and 4 1, 2, 3 and 4

Relatively easy to measure and maintain: * 1/1 Specificity Sensitivity Accuracy Precision

Ability to generate results proportional to the calculated concentration or activity of the analyte: * 0/1 Accuracy Precision Delta check Linearity

The positive predictive value predicts the probability that an individual with a positive assay result ____ the disease or condition. * 0/1 Has (have) Could have May have Will have

The average human possesses ____ liters of blood. * 0/1 3 liters 5 liters 8 liters 10 liters

The tourniquet should be applied _____ inches above the venipuncture site. * 1/1 1 to 2 inches 3 to 4 inches 5 to 6 inches 8 to 10 inches

A properly tied tourniquet: * 1/1 Ends pointing away from the shoulder Ends pointing towards the shoulder Loop towards the shoulder Tied like a ribbon

Which of the following is the finger of choice for skin puncture? * 1/1 Middle and index finger Middle and ring finger Ring and index finger None of the above

Heel punctures in infants should not be made more than __ mm deep because of the risk of bone injury and possible infection (osteomyelitis). * 1/1 Not more than 1 mm deep Not more than 2 mm deep Not more than 3 mm deep Not more than 5 mm deep

Arrange the following: order of draw from venipuncture. 1. Sodium fluoride with or without EDTA or oxalate (gray stopper) 2. Serum tube with or without activator (red, gold, red-gray marbled, orange, or yellow-gray stopper) 3. Heparin tube (green or light green stopper) 4. EDTA tube (lavender or pink stopper) 5. Coagulation tube (light blue stopper) 6. Blood culture tube (yellow stopper) 6-2-5-3-4-1 6-2-5-4-3-1 6-5-2-3-4-1 6-5-3-4-1-2

CLSI recommends the following order of draw for skin puncture: 1. EDTA microcollection tube 2. Other microcollection tubes with anticoagulants 3. Serum microcollection tube 4. Slides, unless made from a specimen in the EDTA microcollection tube 5. Tube for blood gas analysis * 1/1 4-1-2-3-5 4-3-1-2-5 5-4-3-1-2 5-4-1-2-3

Leakage of a large amount of blood around the puncture site causes the area to rapidly swell: * 1/1 Ecchymosis (bruise) Hematoma Hemoconcentration Syncope

The tetraploid DNA is checked for proper replication and damage; G2 takes approximately 4 hours. 1/1 G1 S G2 M

Apoptosis: 1. Cell size enlarged due to swelling 2. Cell size reduced due to shrinkage 3. Nucleus condensation and fragmentation 4. Nucleus exhibits random breaks and lysis (karyolysis) * 1/1 1 and 3 1 and 4 2 and 3 2 and 4

Major site of blood cell production during the second trimester of fetal development: * 1/1 Bone marrow Spleen Liver Yolk sac

Adjuvant for infectious disease therapy: 1/1 IL-3 IL-6 IL-12 IL-15

What is the normal distribution of hemoglobinsin healthy adults? * 0/1 80% to 90% Hb A, 5% to 10% Hb A2, 1% to 5% Hb F 80% to 90% Hb A2, 5% to 10% Hb A, 1% to 5% Hb F Greater than 95% Hb A, less than 3.5% Hb A2, 1% to 2% Hb F Greater than 90% Hb A, 5% Hb F, less than 5% Hb A2

As a blood cell matures, the ratio of nucleus to cytoplasm (N:C) in most cases: * 1/1 Increases Decreases Remains the same Variable

All of the following are components of basophil secondary granules, EXCEPT: * 1/1 Catalase Chondroitin sulfates (heparan) Histamine Vascular endothelial factors

Least numerous of the WBCs, making up between 0% and 2% of circulating leukocytes and less than 1% of nucleated cells in the bone marrow: * 0/1 Lymphocytes Basophils Eosinophils Neutrophils

Not considered to be leukocyte: * 0/1 B lymphocytes T lymphocytes Monocytes Mast cells

“Control center” for platelet activation: * 1/1 Dense tubular system Microfilament and microtubules Open canalicular system Plasma membrane

Hormones and cytokines that control megakaryocytopoiesis: 1. TPO 2. IL-3 3. IL-6 4. IL-11 * 1/1 1 and 2 1 and 3 1, 2 and 3 1, 2, 3 and 4

The megakaryocyte progenitor that undergoes endomitosis is: 1/1 MK-I BFU-Meg CFU-Meg LD-CFU-Meg

Morphologists call the least differentiated megakaryocyte precursor: * 0/1 LD-CFU-Meg MK-I MK-II MK-III

Platelets are released into the bone marrow through shedding from _____ proplatelet processes, a process called thrombocytopoiesis. * 1/1 Megakaryoblast Promegakaryocyte Megakaryocyte Any of these

Upon stimulation, platelets change in shape from discoid to _____, extend pseudopods, undergo internal contraction resulting in centralization of their alpha granules and dense granules, and release the granule contents. * 0/1 Cylindrical Irregular Oval Spherical

Potentially prothrombotic, and may be associated with increased risk of cardiovascular disease: * 0/1 Resting platelets Circulating resting platelets Reticulated platelets All of these

Functions of platelet cytoskeleton: 1. Providing the structure for maintaining the circulating discoid shape of the cell 2. Maintains the position of the organelles 3. Mediate the membrane contact reactions * 0/1 1 only 1 and 2 1 and 3 1, 2 and 3

Part of the platelet that mediates the membrane contact reactions of platelet adherence, change of cellular shape, internal contraction, and aggregation: * 1/1 Glycocalyx Cytoplasmic membrane Microfilaments and microtubules Granules

For manual WBC count: after charging the hemacytometer, place it in a moist chamber for ___ minutes before counting the cells to give them time to settle. * 1/1 3 minutes 5 minutes 10 minutes 15 minutes

For manual platelet count, place the charged hemacytometer in a moist chamber for ___ minutes to allow the platelets to settle. * 1/1 3 minutes 5 minutes 10 minutes 15 minutes

If fewer than 50 platelets are counted on each side, the procedure should be repeated by diluting the blood to: * 1/1 1:10 1:20 1:100 1:200

If more than 500 platelets are counted on each side, a ____ dilution should be made. 0/1 1:10 1:20 1:100 1:200

Full conversion of hemoglobin to cyanmethemoglobin: 1/1 3 minutes 5 minutes 10 minutes 15 minutes

WBC and platelet count that can interfere with the cyanmethemoglobin method: * 0/1 High WBC count > 20 x 10^9/L or high platelet count > 400 x 10^9/L High WBC count > 20 x 10^9/L or high platelet count > 700 x 10^9/L High WBC count > 70 x 10^9/L or high platelet count > 200 x 10^9/L High WBC count > 70 x 10^9/L or high platelet count > 400 x 10^9/L

In the cyanmethemoglobin method, lipemia can cause turbidity and a falsely high result. It can be corrected by adding ____ mL of the patient’s plasma to ___ mL of the cyanmethemoglobin reagent and using this solution as the patient blank. * 0/1 1 mL patient’s plasma and 5 mL cyanmethemoglobin reagent 1 mL patient’s plasma and 10 mL cyanmethemoglobin reagent 0.01 mL patient’s plasma and 5 mL cyanmethemoglobin reagent 0.02 mL Patient’s plasma and 5 mL cyanmethemoglobin reagent

The values of the duplicate hematocrits should agree within: * 0/1 1% 5% 10% 20%

When the microhematocrit centrifuge is calibrated, one of the samples used must have a hematocrit of: 0/1 30% or higher 40% or higher 45% or higher 50% or higher

Effect of short draw to hematocrit reading: * 0/1 Decreased Increased Variable Cannot be determined

Effect of dehydration to hematocrit reading: * 0/1 Decreased Increased Variable Cannot be determined

An MCHC between 36 and 38 g/dL should be checked for: * 0/1 Hypochromic RBCs Macrocytic RBCs Microcytic RBCs Spherocytes

Duplicate reticulocyte counts should agree within: * 1/1 1% 5% 10% 20%

Effect of short draw to ESR determination: * 0/1 Decreased Increased Variable Cannot be determined

Increased ESR: 1. Anemia 2. Macrocytosis 3. Sickle cells 4. Spherocytes * 0/1 1 and 2 1 and 3 1, 2 and 3 1, 2, 3 and 4

Effects of cold agglutinins to automated cell count: * 1/1 Decreased RBCs, MCV and MCHC Increased RBCs, MCV and MCHC Increased RBCs; decreased MCV and MCHC Decreased RBCs; increased MCV and MCHC

Effects of microcytes and schistocytes to automated cell count: * 1/1 Decreased RBCs and platelets Increased RBCs and platelets Increased RBCs and decreased platelets Decreased RBCs and increased platelets

Large platelet clumps are counted as ____ and not platelets. * 1/1 RBCs Retics WBCs Any of these

Which of the following can be used with the MCV for initial classification of anemia? * 0/1 RBC count RDW MPV PDW

Which of the following can provide an early indication of engraftment success after hematopoietic stem cell transplant? 1. RBC count 2. Immature reticulocyte fraction 3. Immature platelet fraction * 0/1 1 and 2 1 and 3 2 and 3

May be useful in distinguishing thrombocytopenia due to idiopathic thrombocytopenia purpura (high value), inherited macrothrombocytopenia (higher value), or bone marrow suppression (low value): * 1/1 RBC count Platelet count MCV MPV

Uses detection of interference in a laser beam or light source to differentiate and enumerate cell types: * 0/1 Electronic impedance LASER technology Optical scatter Radiofrequency

Capstone of a panel of tests called the complete blood count (CBC) or hemogram: * 1/1 WBC count Hematocrit determination Hemoglobin determination Peripheral film evaluation

Counterproductive smear drying technique because the moisture causes RBCs to become echinocytic (crenated) or to develop water artifact (also called drying artifact): * 0/1 Natural drying Use of small fan Blowing of breath None of these

Wright stain or a Wright-Giemsa stain (Romanowsky stain) is used for staining peripheral blood films and bone marrow smears. These are considered polychrome stains because they contain: * 0/1 Hematoxylin and eosin Hematoxylin and methylene blue Methylene blue and eosin Crystal violet and safranin

The Clinical and Laboratory Standards Institute (CLSI) recommends that bands and neutrophils be counted: * 1/1 Separately and placed in two categories Together and placed in a single category Either of these Neither of these

Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen: * 1/1 MPO SBB PAS TRAP

Anemia is due to the infiltration of abnormal cells into the bone marrow and subsequent destruction and replacement of normal hematopoietic cells: * 1/1 Aplastic anemia Pure red cell aplasia Myelophthisic anemia Anemia of chronic kidney disease

In the Plasmodium life cycle, merozoite becomes a ring form, which grows into a mature trophozoite, then into an immature schizont (chromatin dividing), and finally into a mature schizont that contains merozoites. The phase described occurs in: * 0/1 Anopheles mosquito, intermediate host Anopheles mosquito, definitive host Man, intermediate host Man, definitive host

Deletion of three alpha globin genes: * 1/1 Silent carrier state Alpha thalassemia minor Hemoglobin H disease Bart’s hydrops fetalis

Primarily a disease of childhood and adolescence, accounting for 25% of childhood cancers and up to 75% of childhood leukemia: * 1/1 ALL AML CLL CML

Deficiencies of platelet dense granules: 1. Hermansky-Pudlak syndrome 2. Chédiak-Higashi syndrome 3. Wiskott-Aldrich syndrome 4. Gray platelet syndrome 0/1 1 and 2 1 and 3 1, 2 and 3 1, 2, 3 and 4

Disorders of platelet aggregation, EXCEPT: * 0/1 Acquired uremia Bernard-Soulier syndrome Glanzmann’s thrombasthenia Hereditary afibrinogenemia

The ratio of whole blood to anticoagulant for coagulation studies must be: * 1/1 1:4 1:9 4:1 9:1

Blood collection volume less than specified minimum: * 1/1 PT falsely shortened; recollect specimen PT falsely prolonged; recollect specimen Variable Cannot be determined

Sensitive early marker for liver disease: * 1/1 Platelet count PT PTT Thrombin time

Assesses deficiencies of all factors except VII and XIII: * 1/1 Platelet count PT PTT TT

Uncontrolled activation of thrombin and consumption of coagulation factors, platelets, and fibrinolytic proteins secondary to many initiating events, including infection, inflammation, shock, and trauma. Most commonly evidenced by diffuse mucocutaneous bleeding. * 0/1 Disseminated intravascular coagulation Rosenthal syndrome von Willebrand’s disease Wiskott-Aldrich syndome

Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult? * 1/1 liac crest Sternum Tibia Spinous processes of a vertebra

What effect would using a buffer at pH 6.0 have on a Wright’s-stained smear? * 1/1 Red cells would be stained too pink White cell cytoplasm would be stained too blue Red cells would be stained too blue Red cells would lyse on the slide

What staining method is used most frequently to stain and manually count reticulocytes? * 0/1 Immunofluorescence Supravital staining Romanowsky staining Cytochemical staining

The Coulter principle for counting of cells is based upon the fact that: * 1/1 Isotonic solutions conduct electricity better than cells do Conductivity varies proportionally to the number of cells Cells conduct electricity better than saline does Isotonic solutions cannot conduct electricity

Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters? * 1/1 Mean Median Coefficient of variation Standard deviation

Which of the following is considered a normal hemoglobin? * 0/1 Carboxyhemoglobin Methemoglobin Sulfhemoglobin Deoxyhemoglobin

Which condition will shift the oxyhemoglobin dissociation curve to the right? * 1/1 Acidosis Alkalosis Multiple blood transfusions Increased quantities of hemoglobin S or C

Which of the following can shift the hemoglobin oxygen dissociation curve to the right? * 1/1 Increases in 2,3 DPG Acidosis Hypoxia All of these options

Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6? 1/1 Hgb H Hgb F Hgb C Hgb S

Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin? * 1/1 Reticulocyte Pronormoblast Basophilic normoblast Polychromatic normoblast

Which of the following is contained in the primary granules of the neutrophil? * 1/1 Lactoferrin Myeloperoxidase Histamine Alkaline phosphatase

The morphological characteristic(s) associated with the Chédiak–Higashi syndrome is (are): * 1/1 Pale blue cytoplasmic inclusions Giant lysosomal granules Small, dark-staining granules and condensed nuclei Nuclear hyposegmentation

Lazy leukocyte syndrome: * 0/1 Monocyte-macrophage series Neutrophilic series Lymphocytic series Erythrocytic series

Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia? * 1/1 Acute myeloid leukemia without maturation Acute promyelocytic leukemia Acute myelomonocytic leukemia Acute monocytic leukemia

CML is distinguished from leukemoid reaction by which of the following? * 1/1 CML: low LAP; leukemoid: high LAP CML: high LAP; leukemoid: low LAP CML: high WBC; leukemoid: normal WBC CML: high WBC; leukemoid: higher WBC

What reagents are used in the PT test? * 0/1 Thromboplastin and sodium chloride Thromboplastin and potassium chloride Thromboplastin and calcium Actin and calcium chloride

Which clotting factor is not measured by PT and APTT tests? * 1/1 Factor VIII Factor IX Factor V Factor XIII

A protein that plays a role in both coagulation and platelet aggregation is: * 1/1 Factor I Factor VIII Factor IX Factor XI

Aspirin prevents platelet aggregation by inhibiting the action of which enzyme? * 1/1 Phospholipase Cyclo-oxygenase Thromboxane A2 synthetase Prostacyclin synthetase

Which of the following prevents platelet aggregation? * 0/1 Thromboxane A2 Thromboxane B2 Prostacyclin Antithrombin

Which test result would be normal in a patient with dysfibrinogenemia? * 1/1 Thrombin time APTT PT Immunologic fibrinogen level

Factor XII deficiency is associated with: * 0/1 Bleeding episodes Epistaxis Decreased risk of thrombosis Increased risk of thrombosis

The most common subtype of classic von Willebrand’s disease is: * 0/1 Type 1 Type 2A Type 2B Type 3

Thrombin-thrombomodulin complex is necessary for activation of: * 1/1 Protein C Antithrombin Protein S Factors V and VIII

What clotting factors (cofactors) are inhibited by protein S? * 1/1 V and X Va and VIIIa VIII and IX VIII and X

Heparin-induced thrombocytopenia (HIT) results from: * 1/1 Antibodies to heparin Antibodies to platelets Antibodies to PF4 Antibodies to heparin-PF4 complex

In the Clauss fibrinogen assay the time for clot formation in plasma is measured after the addition of: * 1/1 Calcium Thrombin Phospholipids Fibrin

A pregnant women has routine coagulation testing performed. PT and aPTT are normal. Her fibrinogen level is elevated at 450 (reference range 150-350) due to acute phase reactants during pregnancy. The other factor that may be elevated due to this is: * 0/1 FVII FVIII FXI FXIII

Platelet aggregation will occur with the end production of: * 1/1 Cyclooxygenase Arachidonic acid Prostacyclin Thromboxane A2

After the removal of red blood cells from the circulation hemoglobin is broken down into: * 1/1 Iron, porphyrin, and amino acids Iron, heme, and globin Heme, protoporphyrin, and amino acids Heme, hemosiderin, and globin

Deficiency of this enzyme is associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin: * 1/1 Lactate dehydrogenase G6PD Pyruvate kinase Hexokinase

What protein is commonly defective in hereditary elliptocytosis? [BOC] * 1/1 Ankyrin Spectrin Band 4.1 Elliptocin