9 DELIVERY OF LABORATORY TESTING: FROM POINT OF CARE TO TOTAL AUTOMATION

Question 1

A major advantage of POCT is:
a. Faster turnaround time
b. Lower cost
c. Ease of use
d. Both a and b

Answer 1

a. Faster turnaround time

Question 2

POCT assays are usually in which CLIA category?
a. Waived
b. Provider-performed microscopy
c. Moderately complex
d. Highly complex

Answer 2

a. Waived

Question 3

Over-the-counter test kits are in which CLIA category?
a. Waived
b. Provider-performed microscopy
c. Moderately complex
d. Highly complex

Answer 3

a. Waived

Question 4

The concentration of human chorionic gonadotropin (hCG) is generally at a particular level in serum about 2 to 3 days after implantation. This is the concentration at which most sensitive laboratory assays can give a positive serum hCG result. What is the lowest level of hormone for which most current serum hCG tests can give a positive result?
a. 25 mIU/mL
b. 50 mIU/mL
c. 100 mIU/mL
d. 100,000 mIU/mL

Answer 4

a. 25 mIU/mL

Question 5

The most specific assays for human chorionic gonadotropin (hCG) use antibody reagents against which subunit of hCG?
a. Alpha
b. Beta
c. Gamma
d. Chorionic

Answer 5

b. Beta

Question 6

An important characteristic to be considered when selecting a POCT instrument is:
a. Rapid turnaround time
b. Easy-to-perform protocol
c. Refrigerated storage of reagents
d. Both a and b

Answer 6

d. Both a and b

Question 7

What is the ultimate goal of the laboratory?
a. Perform more tests.
b. Hire less staff.
c. Quickly produce results.
d. Produce accurate information in a timely manner

Answer 7

d. Produce accurate information in a timely manner

Question 8

Computer technology can be used for:
a. Specimen processing
b. Inventory control
c. Ordering tests
d. All the above

Answer 8

d. All the above

Question 9

The function of a CPU is:
a. Short-term memory
b. Executes software instructions
c. Exchange of information
d. A printer

Answer 9

b. Executes software instructions

Question 10

The function of an interface is:
a. Short-term memory
b. Executes software instructions
c. Exchange of information
d. Bar code reader

Answer 10

c. Exchange of information

Question 11

The laboratory can have directly connected computers that can access the hospital record system by:
a. Use of routers
b. Forming an LAN
c. Using a WAN
d. Both a and b

Answer 11

d. Both a and b

Question 12

An example of laboratory information system functionality is:
a. Specimen tracking
b. Quality control
c. Archive patient cumulative reports
d. All the above

Answer 12

d. All the above

Question 13

Future challenges for laboratory automation standards include all the following except:
a. Design of laboratory specimen containers
b. Design of bar codes for specimen identification
c. Developing uniform collection devices
d. Developing a standard electromechanical interface

Answer 13

c. Developing uniform collection devices

Question 14

As estimated by The Joint Commission, what percentage of the information that physicians rely on is generated by the laboratory?
a. 20%
b. 40%
c. 80%
d. 100%

Answer 14

c. 80%

Question 15

The major benefit(s) of laboratory automation is (are):
a. Reduction in medical errors.
b. Improved safety for laboratory staff.
c. Faster turnaround time.
d. All the above

Answer 15

d. All the above

Question 16

Steps in automation designed to mimic manual techniques include:
a. Pipetting of specimen
b. Pipetting of reagents
c. Measurement of chemical reactions
d. All the above

Answer 16

d. All the above

Question 17

What is a common principle applied in immunochemistry?
a. Photometry
b. Enzyme immunoassay
c. Chemiluminescence
d. Ion-selective electrodes

Answer 17

b. Enzyme immunoassay

Question 18

When hematology cell counters detect voltage pulses, what principle is being applied?
a. Electrical resistance
b. Optical deflection
c. Photometry
d. Turbidimetry

Answer 18

a. Electrical resistance

Question 19

A three-part blood cell differential separates:
a. Erythrocytes, leukocytes, and platelets
b. Monocytes, granulocytes, and lymphocytes
c. Mononuclear cells, granulocytes, and lymphocytes
d. Segmented neutrophils, eosinophils, and basophils

Answer 19

c. Mononuclear cells, granulocytes, and lymphocytes

Question 20

Semiautomated routine chemical screening of urine uses what test principle?
a. Ion-selective electrodes
b. Reflectance photometry
c. Potentiometry
d. Turbidimetry

Answer 20

b. Reflectance photometry

Question 21

PCR testing is useful in:
a. Forensic testing
b. Genetic testing
c. Disease diagnosis
d. All the above

Answer 21

d. All the above

Question 22

Amanda is working within the chemistry department and is reviewing results before she releases them to be sent to the patient charts. All testing within the chemistry department is performed on an automated analyzer. She notices that John Smith has an abnormally high bilirubin result that is flagged as a delta check failure (a result that does not match previously filed results), and all his liver function tests are abnormal. On a sample tested that morning, Mr. Smith’s bilirubin level was normal, as were all his liver function tests.

Amanda begins troubleshooting the current test result, taking note of the five steps of automated analysis. She first looks at Mr. Smith’s current sample and notices there are two bar-code labels, one placed over the top of the other, on the test tube. What do you think is the most likely cause of this problem?
a. Specimen collection and processing error
b. Chemical reaction phase error
c. Measurement phase error
d. Signal processing and data handling error

Answer 22

a. Specimen collection and processing error

Question 23

Amanda is working within the chemistry department and is reviewing results before she releases them to be sent to the patient charts. All testing within the chemistry department is performed on an automated analyzer. She notices that John Smith has an abnormally high bilirubin result that is flagged as a delta check failure (a result that does not match previously filed results), and all his liver function tests are abnormal. On a sample tested that morning, Mr. Smith’s bilirubin level was normal, as were all his liver function tests.

Later on in the day, Amanda is again reviewing results before releasing them, and notices an error message on Amy Brown’s test results: “Short Sample Detected.” No results are available for Ms. Brown’s chemistry profile, but other patients on the machine before and after this sample had no issues with the test results. Amanda begins troubleshooting the problem. What do you think is the most likely cause of this error?
a. Specimen collection and processing error
b. Specimen and reagent measurement and delivery
c. Measurement phase error
d. Signal processing and data handling error

Answer 23

b. Specimen and reagent measurement and delivery