ASCP BOC EVALUATION EXAM 2025/2026 QUESTIONS
WITH ANSWERS RATED A+
✔✔The principle of the tablet test for bilirubin in urine or feces is: -✔✔Chemical coupling
of bilirubin with a diazonium salt to form a purple color.
✔✔Ghost red blood cells are seen in urine that is: -✔✔Alkaline and dilute. RBCs absorb
water when in dilute urine, and are also less preserved in alkaline urine. Therefore, as
the cells swell in the alkaline urine, the cell membrane allows hemoglobin to leak from
the cell, resulting in the empty cell membrane and the pale appearance.
✔✔In the cold agglutinin test, the tubes containing the serum and erythrocytes are
allowed to stand overnight in the refrigerator, and the results are read the next morning.
If a disk of the erythrocytes floats up from the bottom of the tube with only the flick of
finger, this is read as a: -✔✔A 4+ reaction. When one solid agglutinate is present, the
reaction is classified as 4+.
✔✔A bone marrow shows foam cells ranging from 20-100 μm in size, vacuolated
cytoplasm containing sphingomyelin and is faintly PAS+. This cell type is most
characteristic of: -✔✔Niemann-Pick Disease
✔✔The presence of leukocytes in urine is known as: -✔✔Pyuria
✔✔In what metabolic disease will urine turn dark brown to black upon standing? -
✔✔Alkaptonuria
✔✔First-generation cephalosporins can be adequately represented by: -✔✔Cephalothin
✔✔According to AABB Standards, Platelets prepared from Whole Blood shall have at
least: -✔✔5.5x10^10 platelets per unit in at least 90% of the units tested
✔✔A stool specimen that appears black and tarry should be tested for the presence of:
-✔✔Occult blood
✔✔Sodium bicarbonate and sodium citrate are components of which of the following? -
✔✔JEMBEC system. The JEMBEC system is a transport and inoculation medium used
for direct plating of specimens for N gonorrhoeae. Chocolate based selective medium is
inoculated with the specimen. This is placed in an impermeable plastic bag with a
bicarbonatesodium citrate pellet that absorbs moisture to generate a carbon dioxide-rich
environment.
✔✔A 44-year-old man was admitted to the hospital following a 2-week history of low-
grade fever, malaise and anorexia. Examination of a Giemsa stain revealed many
intraerythrocytic parasites. Further history revealed frequent camping trips near
,Martha's Vineyard and Nantucket Island, but no travel outside the continental United
States. This parasite could easily be confused with: -✔✔Plasmodium falciparum. The
patient's history is suggestive of Babesia infection. Babesia microti ring forms are similar
to Plasmodium falciparum. A travel history is helpful in determining the cause of
infection.
✔✔Platelets prepared in a polyolefin type container, stored at 22° - 24°C in 50 mL of
plasma, and gently agitated can be used for up to: -✔✔5 days.
✔✔A 29-year-old man is seen for recurrence of a purulent urethral discharge 10 days
after the successful treatment of culture proven gonorrhea. The most likely etiology of
his urethritis is: -✔✔Chlamydia trachomatis. Up to 1/3 of patients with Neisseria
gonorrhoeae infection are also coinfected with Chlamydia trachomatis. Patients with
identified infection with one organism are usually treated for both infections.
✔✔The (8;14) chromosomal translocation brings which of the following 2 genes in close
proximity? -✔✔C-myc and the immunoglobulin heavy chain. The t(8;14) typically found
in Burkitt leukemia (ALL-L3), brings the master cell cycle control factor c-myc on
chromosome 8 under the influence of the strong immunoglobulin heavy chain promoter
on chromosome 14, driving a leukemogenic process.
✔✔The technologist observes apparent homogenous staining of the nucleus of
interphase cells while performing an IFA-ANA, as well as staining of the chromosomes
in mitotic cells. This result is: -✔✔Expected for anti-DNA antibodies.
✔✔An AFB broth culture is positive for acid-fast bacilli at 1 week while the agar slant
shows no growth. The most likely explanation for this is: -✔✔AFB grow more rapidly in
liquid media.
✔✔A strict anaerobe that produces terminal spores is: -✔✔Clostridium tetani.
✔✔When genotyping strains of bacteria by PFGE, what is the minimum number of
genetic differences that must be observed between a reference strain and a test strain
before it can be determined that the test strain is unrelated to the reference strain? -
✔✔3.
✔✔In skin tests, a wheal and flare development is indicative of: -✔✔Immediate
hypersensitivity. Immediate hypersensitivity is tested by skin tests with edema and
erythema, which also can be called wheal and flare.
✔✔The visible serological reaction between soluble antigen and its specific antibody is:
-✔✔Precipitation
,✔✔An urinalysis performed on a 2-week-old infant with diarrhea shows a negative
reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be
performed to check the urine sample for the presence of: -✔✔Galactose. Children with
failure to thrive may have galactosuria. Since the reagent strip for glucose is negative,
this leaves galactose.
✔✔In an uncomplicated case of severe iron deficiency anemia, what represents the
typical pattern of results? -✔✔Iron deficiency anemia laboratory features include:
decreased RBC, hemoglobin, MCV, MCH, MCHC, serum iron, serum ferritin %
saturation, bone marrow iron stores; and increased RDW, TIBC, FEP and serum
soluble transferrin receptor levels.
✔✔Incompatibility by which of the following procedures is an absolute contraindication
to allotransplantation? -✔✔ABO grouping. ABO incompatibility results in hyperacute
rejection. This reaction is mediated by anti-A or anti-B antibodies that naturally occur in
individuals who lack the corresponding A or B antigen.
✔✔In a delayed hemolytic transfusion reaction, the direct antiglobulin test is typically: -
✔✔Mixed-field positive. Delayed hemolytic transfusion reactions are associated with
extravascular hemolysis, rather than intravascular. Alloantibody coats the transfused
antigen-positive donor cells in the recipient's circulation, producing a mixed-field positive
reaction in the DAT.
✔✔Urine samples should be examined within 1 hour of voiding because: -✔✔Bacterial
contamination will cause alkalization of the urine.
✔✔In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the: -
✔✔Number of basophils present.
✔✔Which organism commonly causes food poisoning by consumption of foods
containing excessive populations of organisms or preformed enterotoxin? -✔✔Bacillus
cereus. Bacillus cereus is the etiologic agent of 2 distinct types of food poisoning
syndromes. Spores can survive cooking and germinate. Vegetative cells multiply and
produce toxin.
✔✔Primary amoebic encephalitis may be caused by: -✔✔Naegleria fowlerj
✔✔A nonchromogen that grows best at 42°C and is highly resistant to antibiotics is: -
✔✔Mycobacterium xenopi.
✔✔Quality control of the spot indole test requires the use of ATCC cultures of: -✔✔E.
coli (POS) and Enterbacter cloaecae (NEG)
, ✔✔Urine from a 50-year-old man was noted to turn dark red on standing. This change
is caused by: -✔✔Porphyrins. The 2 pigments are porphyrin and urochrome. Urochrome
is "urine color," which is yellow. Porphyrin is red.
✔✔The characteristic that is most commonly associated with the presence of strict
anaerobic bacteria and can be taken as presumptive evidence of their presence in a
clinical specimen is the: -✔✔Presence of a foul, putrid odor from tissue specimens and
cultures.
✔✔Biological false-positive VDRL reactions are frequently encountered in patients with:
-✔✔Lupus erythematosus. Patients with the autoimmune disease, lupus erythematosus,
frequently produce antibody against cardiolipin, the same antibody that is used to
screen for syphilis by the VDRL test.
✔✔Ammonium sulfate was added to red urine. The urine had a positive reaction for
blood, but no RBCs were seen on microscopic examination. After centrifugation the
supernatant fluid is red. The abnormal color is caused by: -✔✔Myoglobin. Both
hemoglobin and myoglobin will produce a red urine without RBC. Hemoglobin will be
precipitated by ammonium sulfate, but myoglobin will not. Myoglobin will remain in the
supernate after centrifugation.
✔✔A light yellow colony from a skin lesion grew aerobically and tested as catalase
positive and coagulase negative. The organism gram stained as positive cocci in
clusters. The organism was modified oxidase positive, bacitracin (0.04U) susceptible
and resistant to lysostaphin. What is the identification of this organism? -
✔✔Micrococcus luteus. Micrococcus is modified oxidase positive, bacitracin (0.04U)
susceptible and resistant to lysostaphin.
✔✔Increased concentrations of alpha-fetoprotein (AFP) in adults are most
characteristically associated with: -✔✔Hepatocellular carcinoma. Alpha-fetoprotein
(AFP) is an oncofetal glycoprotein marker for hepatocellular carcinoma. Elevated levels
of AFP (>20 μg/L) are seen in hepatitis and cirrhosis. However, in hepatocellular
carcinoma, the levels can be >1,000 μg/L.
✔✔If present, a characteristic that is helpful in separating Pseudomonas aeruginosa
from other members of the Pseudomonas family is: -✔✔Growth at 42 degrees C.
Pseudomonas aeruginosa grows at 42°C, but this temperature is inhibitory for other
Pseudomonas species.
✔✔A 25-year-old woman is seen by a physician because of Raynaud phenomenon,
myalgias, arthralgias and difficulty in swallowing. There is no evidence of renal disease.
An ANA titer is 1:5120 with a speckled pattern with mitotic. What is most likely to be
found in this patient? -✔✔High-level ribonucleoprotein (RNP) antibody. Coarse nuclear
WITH ANSWERS RATED A+
✔✔The principle of the tablet test for bilirubin in urine or feces is: -✔✔Chemical coupling
of bilirubin with a diazonium salt to form a purple color.
✔✔Ghost red blood cells are seen in urine that is: -✔✔Alkaline and dilute. RBCs absorb
water when in dilute urine, and are also less preserved in alkaline urine. Therefore, as
the cells swell in the alkaline urine, the cell membrane allows hemoglobin to leak from
the cell, resulting in the empty cell membrane and the pale appearance.
✔✔In the cold agglutinin test, the tubes containing the serum and erythrocytes are
allowed to stand overnight in the refrigerator, and the results are read the next morning.
If a disk of the erythrocytes floats up from the bottom of the tube with only the flick of
finger, this is read as a: -✔✔A 4+ reaction. When one solid agglutinate is present, the
reaction is classified as 4+.
✔✔A bone marrow shows foam cells ranging from 20-100 μm in size, vacuolated
cytoplasm containing sphingomyelin and is faintly PAS+. This cell type is most
characteristic of: -✔✔Niemann-Pick Disease
✔✔The presence of leukocytes in urine is known as: -✔✔Pyuria
✔✔In what metabolic disease will urine turn dark brown to black upon standing? -
✔✔Alkaptonuria
✔✔First-generation cephalosporins can be adequately represented by: -✔✔Cephalothin
✔✔According to AABB Standards, Platelets prepared from Whole Blood shall have at
least: -✔✔5.5x10^10 platelets per unit in at least 90% of the units tested
✔✔A stool specimen that appears black and tarry should be tested for the presence of:
-✔✔Occult blood
✔✔Sodium bicarbonate and sodium citrate are components of which of the following? -
✔✔JEMBEC system. The JEMBEC system is a transport and inoculation medium used
for direct plating of specimens for N gonorrhoeae. Chocolate based selective medium is
inoculated with the specimen. This is placed in an impermeable plastic bag with a
bicarbonatesodium citrate pellet that absorbs moisture to generate a carbon dioxide-rich
environment.
✔✔A 44-year-old man was admitted to the hospital following a 2-week history of low-
grade fever, malaise and anorexia. Examination of a Giemsa stain revealed many
intraerythrocytic parasites. Further history revealed frequent camping trips near
,Martha's Vineyard and Nantucket Island, but no travel outside the continental United
States. This parasite could easily be confused with: -✔✔Plasmodium falciparum. The
patient's history is suggestive of Babesia infection. Babesia microti ring forms are similar
to Plasmodium falciparum. A travel history is helpful in determining the cause of
infection.
✔✔Platelets prepared in a polyolefin type container, stored at 22° - 24°C in 50 mL of
plasma, and gently agitated can be used for up to: -✔✔5 days.
✔✔A 29-year-old man is seen for recurrence of a purulent urethral discharge 10 days
after the successful treatment of culture proven gonorrhea. The most likely etiology of
his urethritis is: -✔✔Chlamydia trachomatis. Up to 1/3 of patients with Neisseria
gonorrhoeae infection are also coinfected with Chlamydia trachomatis. Patients with
identified infection with one organism are usually treated for both infections.
✔✔The (8;14) chromosomal translocation brings which of the following 2 genes in close
proximity? -✔✔C-myc and the immunoglobulin heavy chain. The t(8;14) typically found
in Burkitt leukemia (ALL-L3), brings the master cell cycle control factor c-myc on
chromosome 8 under the influence of the strong immunoglobulin heavy chain promoter
on chromosome 14, driving a leukemogenic process.
✔✔The technologist observes apparent homogenous staining of the nucleus of
interphase cells while performing an IFA-ANA, as well as staining of the chromosomes
in mitotic cells. This result is: -✔✔Expected for anti-DNA antibodies.
✔✔An AFB broth culture is positive for acid-fast bacilli at 1 week while the agar slant
shows no growth. The most likely explanation for this is: -✔✔AFB grow more rapidly in
liquid media.
✔✔A strict anaerobe that produces terminal spores is: -✔✔Clostridium tetani.
✔✔When genotyping strains of bacteria by PFGE, what is the minimum number of
genetic differences that must be observed between a reference strain and a test strain
before it can be determined that the test strain is unrelated to the reference strain? -
✔✔3.
✔✔In skin tests, a wheal and flare development is indicative of: -✔✔Immediate
hypersensitivity. Immediate hypersensitivity is tested by skin tests with edema and
erythema, which also can be called wheal and flare.
✔✔The visible serological reaction between soluble antigen and its specific antibody is:
-✔✔Precipitation
,✔✔An urinalysis performed on a 2-week-old infant with diarrhea shows a negative
reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be
performed to check the urine sample for the presence of: -✔✔Galactose. Children with
failure to thrive may have galactosuria. Since the reagent strip for glucose is negative,
this leaves galactose.
✔✔In an uncomplicated case of severe iron deficiency anemia, what represents the
typical pattern of results? -✔✔Iron deficiency anemia laboratory features include:
decreased RBC, hemoglobin, MCV, MCH, MCHC, serum iron, serum ferritin %
saturation, bone marrow iron stores; and increased RDW, TIBC, FEP and serum
soluble transferrin receptor levels.
✔✔Incompatibility by which of the following procedures is an absolute contraindication
to allotransplantation? -✔✔ABO grouping. ABO incompatibility results in hyperacute
rejection. This reaction is mediated by anti-A or anti-B antibodies that naturally occur in
individuals who lack the corresponding A or B antigen.
✔✔In a delayed hemolytic transfusion reaction, the direct antiglobulin test is typically: -
✔✔Mixed-field positive. Delayed hemolytic transfusion reactions are associated with
extravascular hemolysis, rather than intravascular. Alloantibody coats the transfused
antigen-positive donor cells in the recipient's circulation, producing a mixed-field positive
reaction in the DAT.
✔✔Urine samples should be examined within 1 hour of voiding because: -✔✔Bacterial
contamination will cause alkalization of the urine.
✔✔In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the: -
✔✔Number of basophils present.
✔✔Which organism commonly causes food poisoning by consumption of foods
containing excessive populations of organisms or preformed enterotoxin? -✔✔Bacillus
cereus. Bacillus cereus is the etiologic agent of 2 distinct types of food poisoning
syndromes. Spores can survive cooking and germinate. Vegetative cells multiply and
produce toxin.
✔✔Primary amoebic encephalitis may be caused by: -✔✔Naegleria fowlerj
✔✔A nonchromogen that grows best at 42°C and is highly resistant to antibiotics is: -
✔✔Mycobacterium xenopi.
✔✔Quality control of the spot indole test requires the use of ATCC cultures of: -✔✔E.
coli (POS) and Enterbacter cloaecae (NEG)
, ✔✔Urine from a 50-year-old man was noted to turn dark red on standing. This change
is caused by: -✔✔Porphyrins. The 2 pigments are porphyrin and urochrome. Urochrome
is "urine color," which is yellow. Porphyrin is red.
✔✔The characteristic that is most commonly associated with the presence of strict
anaerobic bacteria and can be taken as presumptive evidence of their presence in a
clinical specimen is the: -✔✔Presence of a foul, putrid odor from tissue specimens and
cultures.
✔✔Biological false-positive VDRL reactions are frequently encountered in patients with:
-✔✔Lupus erythematosus. Patients with the autoimmune disease, lupus erythematosus,
frequently produce antibody against cardiolipin, the same antibody that is used to
screen for syphilis by the VDRL test.
✔✔Ammonium sulfate was added to red urine. The urine had a positive reaction for
blood, but no RBCs were seen on microscopic examination. After centrifugation the
supernatant fluid is red. The abnormal color is caused by: -✔✔Myoglobin. Both
hemoglobin and myoglobin will produce a red urine without RBC. Hemoglobin will be
precipitated by ammonium sulfate, but myoglobin will not. Myoglobin will remain in the
supernate after centrifugation.
✔✔A light yellow colony from a skin lesion grew aerobically and tested as catalase
positive and coagulase negative. The organism gram stained as positive cocci in
clusters. The organism was modified oxidase positive, bacitracin (0.04U) susceptible
and resistant to lysostaphin. What is the identification of this organism? -
✔✔Micrococcus luteus. Micrococcus is modified oxidase positive, bacitracin (0.04U)
susceptible and resistant to lysostaphin.
✔✔Increased concentrations of alpha-fetoprotein (AFP) in adults are most
characteristically associated with: -✔✔Hepatocellular carcinoma. Alpha-fetoprotein
(AFP) is an oncofetal glycoprotein marker for hepatocellular carcinoma. Elevated levels
of AFP (>20 μg/L) are seen in hepatitis and cirrhosis. However, in hepatocellular
carcinoma, the levels can be >1,000 μg/L.
✔✔If present, a characteristic that is helpful in separating Pseudomonas aeruginosa
from other members of the Pseudomonas family is: -✔✔Growth at 42 degrees C.
Pseudomonas aeruginosa grows at 42°C, but this temperature is inhibitory for other
Pseudomonas species.
✔✔A 25-year-old woman is seen by a physician because of Raynaud phenomenon,
myalgias, arthralgias and difficulty in swallowing. There is no evidence of renal disease.
An ANA titer is 1:5120 with a speckled pattern with mitotic. What is most likely to be
found in this patient? -✔✔High-level ribonucleoprotein (RNP) antibody. Coarse nuclear
