Recalls ASCP Exam Questions with Complete Solutions Graded A+

  check for lipemia - Answer: on an auto instrument hgb=45 and hct=33. The tech performs man and hct is 33.5. What should be done next? lupus anticoagulant - Answer: micro emboli (clots) formation in blood vessels of SLE patients pure red cell aplasia - Answer: only red cell production affected and WBC and plt are norm 3 y/o, rbc=1.7x10^6 biliary obstruction - Answer: urine bili + urobilin decreased or neg acute tubular necrosis - Answer: 3 y/o urine spec 25 rte hpo gran casts wbc 3-5 nitrite + change CaCl2 and repeat - Answer: on analyzer PT qc in range< PTT qc out. rpt out, what is the next step hypotonic and alk urine can lyse cells if myoglobin is present it can produce false pos - Answer: ua test bld + rbc- none seen Le a - Answer: nonsectretor sese phenotype Le(a+b-) what ag will be detected in his/her fluids MNS - Answer: bld group rgt deteriorates faster while in use legionella - Answer: detection of ag in urine spec release adp from dense granules - Answer: at what stage the 2nd phase and the irreversable plt aggregation occurs bartonella - Answer: cat scratch infection gnr pleomorphic rods slow growing Cushing's disease - Answer: acth increased cortisol increased Cushing's syndrome - Answer: ACTH Norm Cortisol Increased ADH - Answer: increases water adsorption iron increased - Answer: hemolytic anemia, hepatitis and iron overload iron decreased - Answer: anemia, pregnancy prehepatic jaundice - Answer: hemolytic anemia serum conjugated bili -norm serum unconj bili- increased urine urobilin- very elevated bili-norm stool bili - very elevated conn's syndrome - Answer: alodosterone increased ca decreased k decreased cushing syndrome - Answer: k decreased=metabolic alkalosis acth increased (exposure to cortisol) ca decreased glucose increased A1C - Answer: 2-3 months glucose intake Type I diabetes - Answer: juvenile onset insulin dependent ketoacidosis Type 2 diabetes - Answer: adult onset non insulin common hepatobiliary enzymes - Answer: alp,ggt,5'NT hepatocellular enzymes - Answer: alt, ast ph,amon,creatinine, bun - Answer: od on salicylate/aspirin what test to run myoglobin - Answer: rises in 2-3 hrs returns 24-36 ckmb - Answer: rises 4-8 hrs falls 48-72 hrs TNI - Answer: rises 4-6 hrs falls 10-14 days nephrosis - Answer: alb decreased glob norm tp decreased infectious hepatitis - Answer: alb decreased glob increased tp decreased multiple myeloma - Answer: alb norm glob increased tp increased cirrhosis of liver - Answer: alb decreased glob norm tp decreased non ketoacidosis coma - Answer: complications of diabetes melitus type 2 glucose increase osmolarity and severe dehydreation accelerator - Answer: caffeine benzoate bili assay lactic acidosis - Answer: mk low pH nausea, rapid breathing,weakness and vomiting subtype of metabolic acidosis SIRS, severe infection,hrt/lung disease,sepsis,hemorrhage melformin, cyanide poisioning chloride - Answer: ion affected by bromide measurement afp - Answer: substance found in down syndrome Hodgkin's dse,testicle,ovary, stomach pancreas and liver cancer ethylene glycol - Answer: 8 y/o with osmo of 297 metabolic acidosis glucose increased decreased k - Answer: vomiting affects what electrolye hgb increase - Answer: lipemia can affect what rbc indice? Ehrlich test - Answer: test for urobilinogen sle - Answer: autoimmune dse with elevated alp anti dsDNA are characteristic of active SLE - Answer: electrophoresis of sle TIBCx0.7 - Answer: transferrin est measured osmo-calc osmo - Answer: osmolality gap 2xNa+1.15+(Glu/18) + (BUN/2.8) - Answer: calculated osmo C1V1=C2V2 - Answer: vol stock calculation CV=SDx100/mean - Answer: CV calculation ua creat (vol/1440)/serum creat - Answer: creatinine clearance calculation urine creat/plasma creat x vol per minute - Answer: est GFR if you get ml as a given convert to ml/min 24 hrs=1440 min Hoshimoto's thyroiditis - Answer: T4 decrease TSH increase TRH increase LS ratio - Answer: 2:1 indicates adeq pulmonary surfactanct to prevent RDS <2.0 risk of RDS at delivery <1.5 high risk of RDS glucorynl transferase - Answer: enz responsible for conjugation of bili Gilbert's syndrome - Answer: decreased glucorynl transferase unconj hyperbili Crigler Najjar syndrome - Answer: glucorynl transferase totally absent poryphyrins - Answer: unstable when exposed to light Dubin Johnson syndrome - Answer: deficient secretion of bili conj bili increased w/o elevation of liver F ionized Ca - Answer: biologically active Ca Alb - Answer: largest protein component of human serum decreased in malnutrition, liver dse, renal loss(nephrotic syndrome) , hormone therapy or pregnancy and burns increased in dehydration 5HIAA - Answer: main metabolite of serotonin performed for dx of carcinoid tumor Paget's dse - Answer: ALP w/pH of 9.6 moles of solute/L - Answer: molarity formula given divide atomic weight mL -> L Na - (HCO3 + Cl) - Answer: anion gap calc 2SD - Answer: 95% confidence 1SD - Answer: 68% confidence 3SD - Answer: 99% confidence acute pancreatitis - Answer: Elevated amylase in what? choose urease + - Answer: Proteus and providencia are similar to salmenolla and shigells how Klebsiella the others are K/A - Answer: A micro question about A/A on tsi and options where edwardsella, shigella, salmonala and klebsella. the lumen of the distal convoluted tubule and collecting duct - Answer: where are wbc casts made? First step - test patient serum using IFA or EIA for antibodies as a screening measure Second step - confirmation must be made using a Western blot test - Answer: Borrelia burgdorferi Serologic tests are sensitive in diagnosing Lyme disease. Rash, initially localized known as erythema migrans (bulls' eye or target) considered the most accurate method for antibody detection. Difficult to culture and too few bacteria to detect by direct microscopy parahaemophilis - Answer: requires v but not x factor anaerobic environment - Answer: Ideal atmosphere - 80%-90% N2, 5% H, 5%-10% CO2 S. saprophyticus - Answer: which organism is suseptible to novabiocin 2,7,9,10 prolonged PT - Answer: factors affected by coumadin (warfarin) APTT - Answer: prolonged results due to heparin therapy VII - Answer: PT prolonged APTT norm poss deficiency? HMWK,PK,XII,XI,IX,VIII - Answer: PT norm APTT prolonged X,V,II,I - Answer: PT prolonged APTT prolonged Microscopic examination due to hazy appearance - Answer: An 85 year old woman with diabetes and a broken hip has been confined to bed for the past 3 months. Results of an ancillary blood glucose test are 250 mg/dL, and her physician orders additional blood tests and a routine urinalysis. The urinalysis report is as follows Color: Pale Yellow Ketones: Negative Clarity: Hazy Blood: Moderate Sp Gravity: 1.020 Bilirubin: Negative pH: 5.5 Urobilinogen: Normal Protein: Trace Nitrite: Negative Glucose: 100 mg/dL Leukocytes: 2+ What confirmatory tests are indicated on this urine? Yeast grows best at low pH and increased glucose - Answer: Why are yeast infections common in patients with Diabetes mellitus? Yes, it exceeds the renal threshold for glucose - Answer: With a blood glucose level of 250 mg/dL, should glucose be present in the urine? Why or why not? No these are associated with strenuous exercise - Answer: 0-2 RBC/hpf, 0-3 WBC/hpf, 0-4 hyaline casts/lpf, 0-3 granular casts/hpf, Few squamous epithelial cells Are these results of clinical significance? Dehydration and increased excretion of RTE cell lysosomes - Answer: What is the probable cause of the granular casts? Ictotest Possible biliary-duct obstruction preventing conjugated bilirubin from entering the intestine Icteric - Answer: Results of a urinalysis performed on a patient scheduled for gallbladder surgery are as follows: Color: Amber Ketones: Negative Clarity: Hazy Blood: Negative Sp Gravity: 1.022 Bilirubin: Moderate pH: 6.0 Urobilinogen: Negative Protein: Negative Nitrite: Negative Glucose: Negative Leukocytes: Negative What confirmatory test(s) should be performed? Explain the correlation between the patient's scheduled surgery and the urobilinogen If blood were drawn from this patient, how might the serum appear? Causes of sp Gravity interference: Radiographic dye, plasma expanders, high levels of glucose, protein - Answer: While performing a routine urinalysis on a specimen collected from a patient in the urology clinic, the technologist finds a specific gravity reading that exceeds the 1.035 scale on the refractometer If the urinalysis report has a 1+ protein and a negative glucose, what is the most probable cause of this finding? glucose,pH,bili,rbc and wbc - Answer: It is the end of your shift at the hospital (3:00 p.m.) and a urine arrives from a doctor's office marked STAT. The urine was collected at 8:00 a.m. You know that some of the components will have been affected by the urine standing for so long before analysis. Which components do you expect to be affected? glomerulonephritis - Answer: A urinalysis performed on a 27-year old woman yields the following results Sp. Gravity 1.008 pH 5.0 Protein 2+ Glucose Negative Ketones Negative Bilirubin Negative Blood 3+ Nitrite Negative Leukocytes Positive urobilinogen 0.1 EU/dL Microscopic WBC/HPF 20-30 RBC/HPF 30-55 Casts/LPF Hyaline 5-7; RBC 2-5; Coarse granular 2-3; Waxy 1-3 Moderate Uric acid crystals Nephrotic syndrome - Answer: Damage to podocyte barrier in kidney allowing loss of proteins and lipids Massive proteinuria (>3.5 g/day), primarily albumin, High serum lipids May be complication of glomerulonephritis Microscopic will show free floating fat globules, oval fat bodies. Increase in RBCs, casts (fatty and waxy) Chronic Renal Failure - Answer: Slow progressive loss of functional nephrons, GFR continually decreases. Initially healthy nephrons compensate for loss, but eventually loss is too great Azotemia, acid-base imbalance, electrolyte and water imbalance, hyperphosphatemia, hypocalcemia Anemia, bleeding tendencies, hypertension, neurologic dysfunction Sp Gravity =1.010, proteinuria, hematuria, numerous casts (waxy, broad) The urine protein is falsely negative because the method is not sensitive for Bence Jones protein - Answer: A 59 year old man is evaluated for back pain. Urine studies (urinalysis by multiple reagent strip) include: Sp. Gravity 1.017 pH 6.5 Protein Negative Glucose Negative Ketones Negative Bilirubin Negative Blood Negative Nitrite Negative Microscopic: Rare Epithelial Cells Urine Protein electrophoresis Monoclonal spike in gamma globulin region Suspend the sediment in pre-warmed saline, then repeat centrifugation - Answer: A urine sample with a pH of 6.0 produces an abundance of pink sediment after centrifugation that appears as densely packed yellow-brown granules under the microscope. The crystals are so dense that no other formed elements can be evaluated. What is the best course of action? Calcium Oxalate Monohydrate and dihydrate calcium oxalate Oval: monohydrate; envelope (X) dihydrate Monohydrate - Answer: A 2-year old left unattended in the garage for 5 minutes is suspected of ingesting antifreeze (ethylene glycol). The urinalysis has a pH of 6.0 and is negative on the chemical examination . Two distinct forms of crystals are observed in the microscopic examination. A. What type of crystals would you expect to be present? B. What are the two forms of this crystal? C. Describe the two forms D. Which form would you expect to be predominant? pH - Answer: Double indicator system-methyl red and bromthymol blue Interferences: Run over from adjacent pads protein - Answer: Protein error of indicators, sensitive to albumin. Acid buffer keeps pH constant. Tetrabromophenol blue or tetrachlorophenol, tetrabromosulfonphthalein. Interferences: alkaline urine, dye (pyridine), high sp gravity, detergent glucose - Answer: Renal threshold of kidney 160-180 mg/dL. Glucose oxidase reaction, double sequential reaction. End product is oxidized color chromogen ketone - Answer: Sodium nitroprusside (nitroferricyanide) rxn. Acetoacetic acid reacts with nitroprusside to produce purple color Interferences: dyes blood - Answer: Reaction between heme (hemoglobin and myoglobin) and tetramethylbenzidine producing blue green color Interferences: Oxidizing agents, high sp Gravity, ascorbic acid bili - Answer: Diazo rxn. Bilirubin combines with diazo salt in acid medium producing tan -> pink color Interferences: pyridine, exposure to light, ascorbic acid, high nitrite concentration Urobilinogen - Answer: Ehrlich's aldehyde rxn (multistix) urobilinogen reacts with p-dimethylaminobenzaoldehyde (Erlich's reagent). Diazo dye (chemstrip) Interferences: porphobilinogen, indican, pigmented urine, high nitrite nitrite - Answer: Greiss rxn, nitrite reacts with aromatic amine forming diazonium salt. Salt reacts with tetrahydrobenzoquinolin to produce pink color. Must occur in acid pH. Interferences: non-reducing bacteria (gram +, yeast), inadequate time between urine and bladder (must be in bladder at least 4 hours), high ascorbic acid, high sp. gravity leukocyte esterase - Answer: LE catalyzes hydrolysis of acid ester on reagent pad producing aromatic compound and acid. Aromatic compound combines with diazo salt on the pad producing purple azodye. Interferences: oxidizing agents, nitrofurantoin, high concentration of glucose, ascorbic acid specific gravity - Answer: Based on change in pKa of polyelectrolyte. Causes change in pH, indicator bromthymol blue changes color from blue to green to yellow Interferences: High protein clinitest - Answer: Uses glucose's ability to reduce copper CuSO4 + glucose ->Cu2O + oxidized substance (color) Benedict's reaction Used to screen for galactosemia SSA - Answer: Cold precipitation test that reacts equally with all forms of protein Must be performed on centrifuged specimen icto test - Answer: Tablet contains p-nitrobenzene-diazonium-p-toluenesulfonate, SSA, sodium carbonate and boric acid Positive: blue to purple color on mat acetest - Answer: Confirmation of ketones Tablet contains sodium nitroprusside, glycine, disodium posphate, lactose polycythemia vera - Answer: EPO below norm N PTH, increased Ca - Answer: results expected for metastatic carcinoma DCE/DCE Fy a-b+ - Answer: anti-c + fya = dat positive result - Answer: false negative ABO caused by DIC - Answer: prolonged APTT,TT and PT normal FIB factor 12 deficient - Answer: results after gallbladder surgery PT norm APTT increased use polyspecific AHG - Answer: 37/LISS Anti IgG SCI 0 +/- SC II 0 +/- measure indirect Na ISE - Answer: Na decreased with all other analytes Norm instrument temp low - Answer: multichannel analyzer control= enz decreased,non enz norm apnea - Answer: psuedocholinesterase E. cloacae - Answer: Loa-++ indole = citrate + S. pyogenes - Answer: several weeks of pharyngitis, tissue of kidney reveals aeromonas - Answer: wound culture TSI A/A oxidase + partial CO2 - Answer: CO2 ion selective electrode pH with known buffer and constant temp - Answer: blood gas analyzer pH measurement needs beta and gamma - Answer: serum protiens close to cathode in electrophoresis lyse resistant to Hgb C - Answer: instrument A repeated w/the use of instrument B, descrepancy present, WHY? P system - Answer: BB: deteriorates upon storage primary CMV infection - Answer: CMV titers 1:128 lueconostoc - Answer: bile esculin + 6.5% NaCl + PYR = LAP = machine did not dispense the saline for washing correctly - Answer: detection of Abs where 11 tubes are = in AHG phase CC = reduce amt of urine for test - Answer: clinitest rgt strip change of color to bright orange then back to dark green-brown. What to do? defer donor - Answer: Hep B IgG 6 months ago XK - Answer: McCleod phenotype gene defect Ab id with enzyme - Answer: AHG 3+ -> autoadsorption -> 2+ AHG Bx subgroup - Answer: anti A 0 anti B MF A2 cells 4+ B cells 0 serum omitted from the rxn - Answer: 3 tubes AHG = CC = mother and daughter cell - Answer: B. dermatitidis description hemolytic anemia - Answer: unconjugated bili increased urine bili neg urobilinogen increase wash with saline - Answer: anti A 4+ anti B 4+ a cells 2+ b cells 2+ B. heneslae - Answer: cat scratch B. anthracis - Answer: GPB spore forming, seen in blood culture cat + elution - Answer: polyspecific AHG + C3 + perform what next? P. falciparum - Answer: this plasmodium does not show troph or merozite uremia - Answer: burr cells S. bovis - Answer: cocci in chains bile esculin + cat = 6.5.% NaCl = SLE, anti-dsDNA - Answer: common patterns are homogenous and homogenous + speckled scleroderma - Answer: nucleolar pattern CREST - Answer: centromere ana Sjogren's - Answer: speckled pattern chlamydia trachomitis - Answer: eye conjuctivitis Bernard Souliers syndrome - Answer: identify the syndrome T. shoenleinii - Answer: favic chandelier radiographic dye - Answer: false pos for protein ua test strip iron bound transferrin - Answer: tibc measures 6-8 units - Answer: plt apheresis contains rast - Answer: specific IgE RIST - Answer: Tot IgE FISH/IHC - Answer: Her 2/neu measured by open new kit - Answer: levy jennings showing trend mucor - Answer: no rhizoids fluorometer - Answer: longer wavelength emission chronic active hepatitis - Answer: anti-smooth muscle ab myelofibrosis metaplasia - Answer: dacrocyte/teardrop cell anti-microsomal - Answer: Hashimoto's thyroiditis strongly oxidative drugs - Answer: picture of target cells, dacrocytes, echinocytes anti E - Answer: shows least amount of dosage GYPB - Answer: SsU ab appear in the presence of following deletion sequence glucose - Answer: suger fermented by N.gonorrhea hairy cell phenotype - Answer: CD19,CD20,CD35 F XII assay - Answer: gallbladder surgery PT:12 PTT:50 mixing studies:47.9 M. audonii - Answer: fusiform, septate macroconidia with microconidia speckled pattern - Answer: ANA anti SBB,anti RNP and anti Sm to precipitate non HDL - Answer: heparin manganese is used in HDL to anti HBc IgM - Answer: hepatitis marker seen predominantly in acute phase infection rather than chronic infection sezary syndrome - Answer: T cell lymphoproliferative 36 hrs - Answer: a donor is on aspirin medication, deferred from plateletpheresis for how many hrs? IgG 2 weeks apart - Answer: Rubella what to test to determine acute infection? primary CMV infection - Answer: EBV titers anti VCA IgM <1:10 anti VCA IgG >1:10 anti EBNA >1:10 (presence indictes past infection) CMV titer: 1:128 toxoplasma titer<1:10 Pneumocystis jirovecii - Answer: Wra - Answer: low incidence Ag not normally on a Ab screening panel PAGE - Answer: techniques used to seperate red cell membrane protein ADP - Answer: in storage pool disease, plts are primarily deficient in anti c - Answer: Mother is grp A pos Father is grp O neg Baby has HDN, what caused the HDN? zygomycetes - Answer: aseptate hyphae with sporangiospores acanthamoeba - Answer: homemade saline solution for contact lenses NAD - Answer: urease method detects DNA - Answer: picture of many tear drop-shaped rbc's, what is the deficiency? Alternaria - Answer: haptoglobin is depleted - Answer: in delayed hemolytic anemia, hemoglobinuria occurs when Blastomyces dermatitidis - Answer: liver disease with folic acid deficiency - Answer: Hgb 9.5 g/dL MCV 102 fl target cells and stomatocytes present unconjugated 2.2 conjugated 3.2 - Answer: bili results B4 addition of caffeine 3.2 after addition of caffeine 5.4 FT4 - Answer: a woman has soft goiter and a decreased TSH, what is the next test to perform?