MLS ASCP Exam Questions and Complete Solutions Graded A+

  c antigen is most common in blacks and whites; anti-c would be most common reactive - Answer: Rh antibodies show enhanced reactivity with enzyme pretreated cells. The M and Fya antigens are cleaved from enzyme pretreated cells and therefore there would be no reaction between enzyme pretreated cells and serum containing anti-M or anti-Fya. The incidence of the c antigen is 80% in whites and 96% in blacks. The incidence of the E antigen is 29% in whites and 22% in blacks. Increased reactivity with enzyme pretreated cells and incompatible results with 8 of 10 donor units is most likely due to anti-c. Procainamide - Answer: NAPA loose clusters of small spherical microconidia, positive urease - Answer: Trichophyton mentagrophytes BHCG tumor marker - Answer: chorocarcinoma 5HIAA - Answer: carcinoid tumors Proteus vulgaris vs P. mirabilis indole test - Answer: P. vulgaris is indole pos. P. mirabilis is indole neg Hydatid cyst fluid - Answer: used to neutralize Anti-P1 antibody Antacid overdose - Answer: Check pH Prolonged PT, PTT, and thrombin after collecting from catheter - Answer: heparin contamination mixing study that was performed with a prolonged PTT that couldn't be corrected - Answer: DRVVT (Dilute Russell Viper Venom Test) two pt's ran in duplicate (PT and PTT). The PTT seemed to always be prolonged but PT looked ok - Answer: check the CaCl/phospholipid reagent delivery Patient is on coumadin therapy, what will be affected - Answer: Decreased protein C Lot's of stomatocytes - Answer: Liver disease Burr cells - Answer: Uremia Picture of target cells with hemoglobin C crystals. The white count was high on instrument 1, so a second instrument was used with a stronger lysing agent, and the white count was corrected - Answer: anti-lysing target cells are what increased the white count? Erythrocytes containing hemoglobin C do not lyse normally (sickle cell diseases) A sodium citrate tube was drawn for a HCT on a pt but the hematocrit was abnormal - Answer: recollect with decreased anticoagulant. high hct (>55%) causes low plasma so you need less anticoagulant Question that gives a red blood cells count, HGB, and HCT. I did the rule of 3 and found that the HGB didn't meet the rule of 3 because it was too high - Answer: check for lipemia (elevates HGB) PBS with an elevated reticulocyte count and howell jolly bodies in the RBC's - Answer: Prussian blue for howell jolly bodies made of iron. Prussian blue stain, which is not taken up by reticulocytes, is helpful in differentiating the two. what is composed of DNA? - Answer: howell jolly bodies what falsely increases ESR - Answer: vibration, tilting of tube, higher temps, >1 hr test time, improper mixing of blood, improper dilution factors decreasing ESR - Answer: Polycythemia, Microcytosis (Hb C), Sickle cells, spherocytes, Anti-inflammatory medications, Hypogammaglobulinemia, Hypofibrinogenemia (DIC), High WBC count, Hyperviscosity Factors increasing ESR - Answer: Anemia, Macrocytosis, Female gender, Age >50 years, Obesity, Pregnancy, Hypercholesterolemia, cancer, multiple myeloma, rouleaux, infections, inflammation what falsely decreases ESR - Answer: low blood/ room temps, air bubbles, tests <1 hr, improper mixing of blood, improper dilution lactic acid collection - Answer: separate from serum and put on ice coefficient of variation - Answer: (standard deviation/ mean) X 100 Carbon dioxide electrode measures what - Answer: Used to measure free carbon dioxide ions by detecting pH. The change in pH is measured by an internal pH sensor, which is proportional to the carbon dioxide level. patient that had a random glucose >200 and an FPG >126. What do you do next? - Answer: diagnosis with diabetes mellitus. (need secondary confirmation from 4 criteria. FRG >126, Random glucose >200, ogtt >200, or Hb A1c >6.5) Man tested positive for syphilis 2 years ago but may have again, how would you test him? - Answer: RPR Person tested positive for HIV-1 and HIV-2 but western blot was indeterminate. What do you do? - Answer: repeat western blot in a month. There was a positive DAT on cord blood; mother is Rh pos, baby is Rh neg. What is most likely coating the baby's red cells? - Answer: K (kell) Picture of what looks like cold agglutinins - Answer: Paroxysmal cold hemoglobinuria? (Aggregation of the RBCs can occur, but this is considered mild compared with cold hemagglutinin disease. ) Mycoplasma infections more likely? What phase can rouleux not be detected in? - Answer: AHG Picture of ABO type with mixed field reaction in the forward type - Answer: patient was transfused with O blood Picture of AB in forward reaction, and weak reactions in back type - Answer: I picked incubate at room temp because probably cold agglutinins. Need to warm adsorption that had been done twice, and antibody screen is positive - Answer: perform antibody ID panel patient is type A with Lewis a+b- what substance will be on their red cells - Answer: (H, A, Lea) Bile esculin +, NaCl-, alpha hemolytic, looked like a strep - Answer: Group D (strep gallolyticus/bovis) TSI slant K/A H2S+, PD- - Answer: Salmonella lactose fermenter, ODC+, lysine - - Answer: Enterobacter cloaca ? Rotavirus - Answer: stool CSF storage - Answer: incubate at 35C Hair perforation test - Answer: Trichophyton metagrophyte and T. rubrum Good way to detect Legionella infection - Answer: Antigen detection in urine lesion on arm, the organism presents delicate hyphae with microconidias - Answer: Sporothrix schenkii Mycoplasma can't be treated with penicillin - Answer: No cell wall eosinophils in urine sediments indicates what - Answer: acute interstitial nephritis, which is caused by an allergic reaction, typically to drugs. calculate creatinine clearance - Answer: (Urine creatinine X urine Volume/Plasma creatinine x time in minutes)x (1.73/body surface area) Need to pipette .5ml of specimen, what do you use - Answer: Serologic When to give Rhogam—Gave various types with moms Anti-X found - Answer: Mother Neg with baby pos mother has Anti-C Cold antibody - Answer: Anti-I Rouleaux seen microscopically gives ABO discrepancy - Answer: use Saline replacement technique ABO discovery - Answer: Landsteiner According to Beers law - Answer: directly proportional to the amount of light absorbed, or inversely proportional to transmitted light. Dce/dce - Answer: R0/r QC +/- of bacteria question. Which should you use for pos and neg QC? - Answer: Picked oxidase- E.Coli (neg ox) and pseudomonas (pos ox) Cell line question with multiple listed, anisocytosis and ovalcytes stuck out to me - Answer: anemias and myelofibrosis Bile Eschulin and 6.5% NaCL pos - Answer: distinguishes Enterococcus species from the group D strep Strep pneumo hemolysis - Answer: alpha Strep pneumo in sputum - Answer: ALP seen in - Answer: liver and bone Someone comes in after 4hours of MI symptoms gave results of CK CKMB and troponin - Answer: troponin it was most elevated. PT elevated in - Answer: Gave various factors I choose VII Intrinsic has which factor - Answer: I picked Von Wilebrand(VIII) Enterobacteria broad question - Answer: they can't remember the question but they chose Ferments Lactose- Actual characteristics are: GNR, ox neg, cat pos, nitrate to nitrite, ferm glucose, facultative anaerobes. Someone who expresses immunity and acquired Hep B will have - Answer: Anti-Hbs and Anti-Hbc Blood EDTA given to the lab 6hrs after draw will most effect - Answer: I chose platelets What tube quantitates the determination of Calcium - Answer: Sodium heparin When using a blutterfly for coag study - Answer: Discard a blue top then use 2nd blue Description of Football shaped egg with hyaline plugs at each end - Answer: Trich trich 4 nuclei may have chromatoidal bars large, round glycogen vacuole - Answer: E. Histolytica Hypersegmented neutrophils seen in - Answer: vitamin B12 or folate deficiencies Triple Phosphate - Answer: ALP elevation seen in - Answer: Hepatic Carcinoma? Colon tumor marker - Answer: CEA trough level is the lowest concentration in the patient's bloodstream, therefore, the specimen should be collected: - Answer: just prior to administration of the drug. Peak Levels drawn - Answer: 2-3hrs after drug is given bacitracin test can also be used to differentiate: - Answer: bacitracin-resistant Staphylococcus from the bacitracin-susceptible Micrococcus. Increased bili in urine will appear - Answer: Dark yellow color WBC casts seen in - Answer: pyelonephritis (kidney infection) Waxy Cast - Answer: a higher refractive index Metabolic acidosis - Answer: Vomiting Glomerulonephritis is found linked to which microorganism - Answer: Strep pyogenes basophilic stippling - Answer: high lead results what happens to CO2, PCO2, and pH when blood is left around for an extended period of time? - Answer: low, low, and high which analyte is measured in case of eclampsia - Answer: Mg a alcoholic person who went to the emergency arrhythmia, what should be measured - Answer: ethanol , Mg, K something like that some person showing overdose to propanamide (i think)but no drug in his blood - Answer: phenobarbital VDRL question - Answer: importance for CSF testing Donation time...Wait 4 weeks after immunizations for - Answer: German Measles (Rubella), MMR (Measles, Mumps and Rubella), Chicken Pox and Shingles. Wait 21 days after immunization for - Answer: hepatitis B as long as you are not given the immunization for exposure to hepatitis B. Can donate if you just had these vaccines: - Answer: influenza, tetanus or meningitis, providing you are symptom-free and fever-free. Includes the Tdap vaccine. HPV Vaccine (example, Gardasil). Arixtra (fondaparinux), Coumadin, Warfilone, Jantoven (warfarin) and Heparin (prescription blood thinners); must wait how many days after stopping to donate? - Answer: 7 days Wait how long to donate after exposure to Hep B and received Hepatitis B Immune Globulin ? - Answer: 12 months how long between whole blood donations? - Answer: 8 weeks Bacteria isolated from a wound TSI A/A, oxidase (+), The most likely organism is - Answer: Aeromonas Plate cocci in chains. Patient with endocarditis, alpha hemolysis, bile esculin (+), NaCl (no growth). The most likely organism is: - Answer: Strep. Galloliticus (bovis) (group D) Patient with pharyngitis complicates to glomerulonephritis - Answer: Strep. Pyogenes Preferred rapid test for Legionella pneumophilia Ag - Answer: Ag in urine Bacteria LAP(-), Bile esculin (+), NaCl (growth), PYR(-) - Answer: Leuconostoc Organism isolated in Hecktoen: TSI K/A, H2S (+), PAD (-), Lysine decarboxylase (-), Urea (+), citrate (+). What should the technologist do? - Answer: Report as normal flora Child with walking pneumonia due to Mycoplasma and is prescribed penicillin. 2 weeks later, still sick. What happened? - Answer: The microorganism doesn't have cellular wall Latex agglutination for S. aureus - Answer: Protein A and coagulase Child with cat scratch, BGN, catalase (-), oxidase (-), motile. The most likely organism is - Answer: Bartonella henselae Difference between P. aeruginosa and P. putida? - Answer: Growth on 42C Bacteria grows pink on McConkey, Indol(-), citrate (+), Lysine decarboxylase (-), ONPG (+) - Answer: Enterobacter cloacae Parasite that doesn't present schizont and trophozoite - Answer: P. falciparum What are blastoconidias? - Answer: Something about budding between mother and daughter Urine with pH 4.5 - Answer: diet high in proteins Urine at 10C measured in a refractometer SG 1.024, 1000 mg of glucose. What should the technologist do? - Answer: Correction of the refractometer due to glucose Patient that physically appears to be pregnant but the HCG is negative. U/A decreased SG and proteins: trace, why the test result in negative? - Answer: Trace proteins? Strip RBC (+), microscope (-), this is due to what? - Answer: Dilute alkaline urine CSF for culture, MLS only manages to perform Gram stain in his shift, what should the technologist do? - Answer: Incubate at 35C Urinalysis result for a child had tubular renal cells 25-30, granular casts - Answer: tubular necrosis Fecal fat methods - Answer: extraction and process ANA pattern with fluorescing speckled or nucleolar - Answer: (check every pattern) Pancreas cancer marker - Answer: CA 19-9 Long term marker of hepatitis that is also in acute infection - Answer: Anti-HBc Screening test for HTLV-I (+), HTLV-II (-) - Answer: Report HTLV-I by Western Blot Patient titers EBV>IgG 1:128, IgM1:10, CMV IgG>1:128, IgM1:38, IgG<1:10 - Answer: Acute infection with Toxoplasma HbeAg Abs cutoff 0.700, patient 0.300 - Answer: indeterminate IgE RIST - Answer: measures Total IgE CBC with RBC: 2.46 Hgb: 14 Hct: 36% - Answer: Lipemic sample Plate of peripheral slide, RBC's and WBC's looked pinkish - Answer: Inadequate pH False decreased in ESR - Answer: sample more than 8 hours to be tested Plate RBC all agglutinated (not rouleaux), what's causing this? - Answer: Mycoplasma The same plate of agglutinated RBC, with witch condition is associated? - Answer: Cold autoantibody 2-year old girl with anemia Normo-Normo, Retics 0.1%, WBC and Platelets normal - Answer: Pure Red Cell Aplasia Table of CBC results. Two methods to measure Hgb (method 1: 14g/dL, method 2: 13g/dL), the second method utilized Lyse. What happen? - Answer: HgbC cristals are Lyse resistant Plate with RBC (hyperchromic, anisocitosis), inclusions (1-2/ RBC) in Wright. Patient has 18.5% of retics. What should the technologist do? - Answer: Use Prussian Blue Reactive Monocitosis - Answer: Tuberculosis MI patient who was treated with streptokinase. Which of the results suggests that treatment wasn't successful? - Answer: PT 25 What affects HgbA1C - Answer: life span of RBC Calculate % of Saturation- UIBC 185 Fe 125 - Answer: TIBC= 185+125=310 %sat (125/310)*100=40% A patient is tested for primidone, what other test can you perform? - Answer: Phenobarbital In what condition do you find abnormally low erythropoietin - Answer: Polycythemia Vera Patient with autoimmune condition presents infection with S. pyogenes, S. aureus and (__) what is the possible deficiency? - Answer: Neutrophils Sample taken from indwelling catheter. Patient isn't on any anticoagulants yet PTT and TT are way elevated - Answer: Heparin contamination (from catheter) In the second phase of platelet aggregation what is irreversible? - Answer: Fibrin formation Lupus anticoagulant causes - Answer: thrombocytosis Controls and patient PTT elevated, control and patient PT elevated - Answer: thromboplastin was added by error Anti-A Anti-B A B 0 2mf+ 4+ 0 - Answer: Discrepancy due to Bx-subgroup Whole blood donation stops at 390ml - Answer: PRBC (low volume unit) Patient A+, Le (a+b-) - Answer: has Le(a) Antibody that deteriorates in storage - Answer: P1 Choose positive controls to test for anti-c and negative control to test anti-Fy(a) - Answer: C+c+ for the positive control and Fy(a) for the negative control Pregnant woman O-, anti-D, anti-C, anti-I, previously she had anti-Le(a), baby is A+ with DAT (+), anti-D and anti-C are identified, which blood would you give? - Answer: O- without C Le(a) Le(b) IS 37 AHG 0 + 1+ 0 0 0 + 1+ 0 0 + 0 0 +/-2w +/-2w + 0 0 +/-2w +/-2w - Answer: Glycolipid (Le(a)) absorbed from plasma Detection of ab where 11 tubes resulted negative in AHG, but when added CC 4 of them didn't agglutinate - Answer: Machine didn't dispense correctly the saline in the wash Baby A+, DAT-, Mother O- before birth - Answer: Rosette test Which donor should you defer ? - Answer: donor received Hep B immunoglobulin 8 weeks ago Patient with Hct 62%, the sodium citrate tube was centrifuged and noticed that the blood plasma ratio was low. - Answer: take sample with less anticoagulant?(that would be for coag studies) Instrument linearity something about comparing mean - Answer: Paired T-test Calibration of blood gases analyzer - Answer: 2 buffers with known pH and constant temperature Formula TP/(TP +FN) - Answer: Sensitivity Absorbance formula - Answer: 2-log%T What causes postprandial lipemia? - Answer: Fatty acids Cause for decreased serum Na - Answer: Hyperglycemia Patient with elevated Ca and normal PTH - Answer: Metastasized cancer What increases in Cushing - Answer: ACTH and Cortisol Positive strip for glucose, negative clinitest - Answer: presence of Glucose (strip test more sensitive). Maybe expired strip? Patient with hyponatremia, all the other electrolytes were normal - Answer: hyperglycemia Patient had dyspnea caused by anesthesia, what should be measured? - Answer: Pseudocholinesterase Patient fasting 120mg/dl, non-fasting 160mg/dl - Answer: impaired child ate mothball accidentally - Answer: Heinz bodies M. furfur - Answer: olive oil something to do with LDL and HDL - Answer: heparin manganese solution Histoplasma Capsulatum - Answer: Blastomyces dermatitidis - Answer: Cryo was pooled; when is the new expiration? - Answer: 4 hours FFP was thawed at 11:15 am and left for the OR: came back to blood back at 11:40 and the temp was 11degC; what should the tech do? - Answer: I chose accept and return to the inventory as it was less than 30 minutes with improper temp K. pneumoniae vs K. Oxytoca - Answer: K. pneumoniae is indol-negative, whereas K. oxytoca is indole positive. How would you differentiate Yersinia species - Answer: motility (motile at room temp not 37) Differentiate RBC and yeast - Answer: Add acetic acid Blood selected for exchange transfusion should be ABO-compatible with the mother and baby, and antigen-negative - Answer: A blood specimen from a pregnant woman is found to be group B, Rh-negative and the serum contains anti-D with a titer of 512. What would be the most appropriate type of blood to have available for a possible exchange transfusion for her infant? Type O, Rh negative Febrile transfusion reaction - Answer: A temperature rise of 1°C or more occurring in association with a transfusion, with no abnormal results in the transfusion reaction investigation, usually indicates which of the following reactions? anti-C antibody present - Answer: A patient serum reacts with 2 of the 3 antibody screening cells at the AHG phase. Eight of the 10 units crossmatched were incompatible at the AHG phase. All reactions are markedly enhanced by enzymes. These results are most consistent with: Posttransfusion purpura is usually caused by: - Answer: Posttransfusion purpura (PTP) is caused by platelet-specific alloantibody in a previously immunized recipient. Transfused donor platelets in blood products are destroyed, with concomitant destruction of the recipient's own platelets, through unknown mechanisms. The usual antibody specificity is HPA-1a. In an emergency situation, Rh-negative red cells are transfused into an Rh-positive person of the genotype CDe/CDe. The first antibody most likely to develop is: - Answer: anti-c Transfusion-associated HTLV I/II incidence is low due to the following laboratory testing: - Answer: Laboratory testing is based on detection of IgG antibody done by ELISA or ChLIA. Antibodies from which of the following blood group systems are notorious for causing delayed hemolytic transfusion reactions? - Answer: Kidd. Anti-Jka and anti-Jkb are often weakly reactive and often drop to undetectable levels in the serum. What are the circumstances under which you can return a unit to the blood bank - Answer: Blood may be returned to the blood bank after issue provided that 1) the container closure has not been disturbed, 2) at least 1 sealed segment is attached to the container, 3) visual inspection of the unit is satisfactory and documented, and 4) the unit has been maintained at the appropriate storage or transport temperature. The transport temperature for Red Blood Cells Leukocytes Reduced is: - Answer: The transport temperature for all red cell blood products is 1-10°C.