(E) 501-600

Question 1

501. ALUM HEMATOXYLIN: recommended for progressive staining but can also be used for regressive staining
502. IRON HEMATOXYLIN: used only for differential or regressive staining
503. COPPER HEMATOXYLIN: study of spermatogenesis

Answer 1

504. Stain for reticulin fibers: GOMORI’S SILVER IMPREGNATION STAIN
505. Stain for basement membrane: PAS, AZOCARMINE
506. Stain for muscle striations: MALLORY’S PHOSPHOTUNGSTIC ACID HEMATOXYLIN (PTAH)
507. Stain for melanin and argentaffin granules: MASSON-FONTANA
508. Stain for calcium: VON KOSSA

Question 2

509. To avoid distortion of the image, the REFRACTIVE INDEX OF THE MOUNTANT should be as near as possible to that of the glass which is 1.518

Answer 2

510. Staining method of choice for exfoliative cytology: STILL THE ORIGINAL PAPANICOLAU (PAP’S)

Question 3

511. ADENOMAS: benign tumors arising from glands
512. POLYPS OR PAPILLOMAS: benign tumors from epithelial surfaces

Answer 3

513. CARCINOMA: malignant tumor of EPITHELIAL ORIGIN
514. SARCOMA: malignant tumor of CONNECTIVE TISSUE (MESENCHYMAL) ORIGIN

Question 4

515. REPORTING FOR DIAGNOSIS OF CANCER (PAP’S)
     CLASS I: Absence atypical or abnormal cells
     CLASS II: Atypical cytological picture but no evidence of malignancy
     CLASS III: Cytologic picture suggestive but not conclusive of malignancy
     CLASS IV: Cytologic picture strongly suggestive of malignancy
     CLASS V: Cytologic picture conclusive of malignancy

Answer 4

516. APLASIA: incomplete or defective development of a tissue or organ, represented only by a mass of fatty or fibrous tissue,
517. HYPOPLASIA: failure of an organ to reach or achieve its full mature or adult side due to incomplete development

Question 5

518. AGENESIA: complete non-appearance of an organ
519. ATRESIA: failure of an organ to form an opening

Answer 5

520. ATROPHY: acquired decrease in size of a normally developed or mature tissue or organ resulting from reduction in cell size or decrease in total number of cells or both

Question 6

521. COAGULATION NECROSIS: It is most commonly encountered when the arterial supply is cut off producing ANEMIC or ISCHEMIC INFARCTION

Answer 6

522. LIQUEFACTION NECROSIS (COLLIQUATIVE): Rapid total enzymatic dissolution of cells with complete destruction of the entire cell; most commonly encountered in the brain; also in all tissues in bacterial infections which lead to the formation of pus

Question 7

523. FAT NECROSIS: Peculiar destruction of adipose tissue, particularly found in pancreatic degenerations
524. CASEOUS NECROSIS: Special form of cell death by the Tubercle Bacillus, the destroyed cells are converted into a granular, friable mass made up of a mixture of coagulated protein and fat, with total loss of cell detail. Caseous necrosis because in the gross state, the necrotic tissue has the appearance of soft, friable CHEESE.

Answer 7

525. GANGRENOUS NECROSIS: Massive death or necrosis of tissue, caused by combination of ischemia and superimposed bacterial infection (necrosis plus putrefaction).

Question 8

526. PRIMARY CHANGES OR SIGNS OF DEATH
     CIRCULATORY FAILURE
     RESPIRATORY FAILURE
     NERVOUS FAILURE

Answer 8

527. SECONDARY SIGNS OF DEATH:
     ALGOR MORTIS – first demonstrable change, cooling of the body, occurring at definite rate of about 7F per hour
     RIGOR MORTIS – rigidity or stiffening of the muscles occurring about 6 to 12 hours after death and persisting for 3 to 4 days
     LIVOR MORTIS – purplish discoloration of the body
     POSTMORTEM CLOTTING – immediately after death, rubbery consistency (must differentiate from antemortem clot – before death, friable)
     DESICCATION – drying and wrinkling of the cornea and anterior chamber of eye due to absorption of the aqueous humor
     PUTREFACTION – production of foul-smelling gases due to invasion of the tissue by saprophytic organism
     AUTOLYSIS – self-digestion of cells

Question 9

528. Conversion factor, thyroxine (µg/dL to nmol/L): 12.9
529. Conversion factor, immunoglobulin (mg/dL to g/L): 0.01
530. Conversion factor, immunoglobulin (mg/dL to mg/L): 10

Answer 9

531. Without error, closeness to the true value: ACCURACY
532. The closeness of repeated results; quantitatively expressed as standard deviation or coefficient of variation: PRECISION

Question 10

533. Point where most values lie: MODE
534. Figure for which 50% of the values are higher and 50% of the values are lower: MEDIAN

Answer 10

535. Ability of an analytical method to measure the smallest concentration of the analyte of interest: ANALYTICAL SENSITIVITY
536. Ability of an analytical method to measure only the analyte of interest: ANALYTICAL SPECIFICITY

Question 11

537. Values for the control that continue to either increase or decrease over a period of six consecutive days: TREND

Answer 11

538. Six or more consecutive daily values that distribute themselves on one side of the mean value line, but maintain a constant level: SHIFT

Question 12

539. System or process that encompasses (in the laboratory) PRE-ANALYTIC, ANALYTIC, AND POST-ANALYTIC FACTORS. Quality control is part of a quality-assurance system: QUALITY ASSURANCE (QUALITY ASSESSMENT)

Answer 12

540. System for recognizing and minimizing (analytic) errors. The purpose of the quality-control system is to monitor analytic processes, detect analytic errors during analysis, and prevent the reporting of incorrect patient values. Quality control is one component of the quality-assurance system: QUALITY CONTROL

Question 13

AMPLIFICATION
Technique to ↑ (amplify) amount of nucleic acid in sample, probe, or signal so that very small amounts of nucleic acid can be detected.
———————
1. TARGET AMPLIFICATION
Technique to ↑ amount of target nucleic acid in sample through in vitro replication, e.g., polymerase chain reaction (PCR), transcription mediated amplification (TMA).
———————

Answer 13

2. SIGNAL AMPLIFICATION
   Technique to ↑ signal generated so that very small amounts of nucleic acid can be detected, e.g., branched chain signal amplification (bDNA), hybrid capture assay (HCA).
   ———————
3. PROBE AMPLIFICATION
   Technique to ↑ amount of probe bound to target so very small amounts of nucleic acid can be detected, e.g., ligase chain reaction.

Question 14

541. Used to determine whether there is a statistically significant difference between the means of two groups of data. (accuracy, mean): T-TEST

Answer 14

542. Statistical test used to compare features of two or more groups of data (SD, precision): F-TEST

Question 15

543. Early morning before the patient has eaten or become physically active. This is a good time to draw blood specimens because the body is at rest and food has not been ingested during the night: BASAL STATE

Answer 15

544. Records each step and each person who handled a sample (for toxicological analysis) from time of collection to time of analysis: CHAIN-OF-CUSTODY

Question 16

545. An algorithm in which the most recent result of a patient is compared with previously determined value: DELTA CHECK
546. Analytical testing of patient specimens performed outside the physical laboratory and at the site of patient care: POINT-OF-CARE TESTING (POCT)

Answer 16

547. Mathematically establishes the relationship between concentration and absorbance in photometric determinations; expressed as A = abc: BEER’S LAW

Question 17

548. Properties of osmotic pressure, freezing point, boiling point, and vapor pressure: COLLIGATIVE PROPERTY
549. pH at which the molecule has no net charge: ISOELECTRIC POINT (pI)

Answer 17

550. An analytic technique that measures the decreased amount of light transmitted through a solution as a result of light scatter by particles. Measurements are made at 180 degrees to the incident beam (unscattered light): TURBIDIMETRY

Question 18

551. Analytic technique to measure the light absorbed by a solution. A spectrophotometer is used to measure the light transmitted by a solution in order to determine the concentration of the light-absorbing substance in the solution: SPECTROPHOTOMETRY

Answer 18

552. Analytical technique that measures the amount of light scattered by particles (immune complexes) in a solution: NEPHELOMETRY
553. Analytic technique used to measure fluorescence (light emitted as a result of energy absorbed): FLUOROMETRY

Question 19

554. Analytic technique that measures the wavelength and intensity of light emitted from a burning solution (patient specimen): FLAME PHOTOMETRY

Answer 19

555. Analytic technique that measures concentration of analyte by detecting absorption of electromagnetic radiation by atoms rather than by molecules. Instrument is atomic absorption spectrophotometer: ATOMIC ABSORPTION

Question 20

556. Analytic technique that uses the force generated by centrifugation to transfer and then contain liquids in separate cuvettes for measurement at the perimeter of a spinning ROTOR: CENTRIFUGAL ANALYSIS

Answer 20

557. An approach to automated analysis in which liquids (reagents, diluents and samples) are pumped through a system of continuous tubing. Samples are introduced in sequential manner, following each other through the same network. A series of bubbles at regular intervals serve as separating and cleaning media: CONTINUOUS FLOW

Question 21

558. An approach to automated analysis in which each sample and accompanying reagents is in separate container. Analyzers have the capability of running multiple tests one sample at a time or multiple samples one test at a time. Discrete analysis
559. The capability of an automated analyzer to process samples independently of other samples on the analyzer. Random access analyzers may be programmed to run individual tests or panel of tests without operator intervention: RANDOM ACCESS

Answer 21

560. The use of immunofluorescent labels to identify specific antigens on live cells in suspension. Stained cell suspensions are transported under pressure past a laser beam, and emitted fluorescence (at 90 degrees relative to the beam) is measured and computer analyzed with this technique. Using multiple labels, cells can be identified and sorted either electronically or physically. The technique has been used to analyze a subpopulation of lymphocyte cells in various clinical diagnoses: FLOW CYTOMETRY

Question 22

561. A technique (eg, radioimmunoassay) where it is necessary to PHYSICALLY SEPARATElabeled antigen or hapten bound to antibody from a labeled antigen or hapten that remains free in the solution: HETEROGENOUS ASSAY

Answer 22

562. A technique (eg, EMIT) that DOES NOT REQUIRE THE PHYSICAL SEPARATION of the bound and free labeled antigen: HOMOGENOUS ASSAY

Question 23

563. Transfer technique used for analyzing PROTEIN antigens: WESTERN BLOT
564. Technique for detection of RNAmolecules or species with defined sequences: NORTHERN BLOT
565. A technique for detecting specific DNAsequences using a mixture of DNA molecules: SOUTHERN BLOT

Answer 23

566. In vitro process used to replicate unlimited specific short regions of DNA: POLYMERASE CHAIN REACTION (PCR)
567. Major end product of protein metabolism: UREA

Question 24

568. Protein portion of an enzyme: APOENZYME
569. Nonprotein molecule which may be necessary for enzyme activity: COFACTOR
570. Enzyme consisting of a protein portion and a non-amino acid portion or prosthetic group: HOLOENZYME

Answer 24

571. Different forms of an enzyme which may originate from genetic or nongenetic causes and may be differentiated from each other based on certain physical properties, such as electrophoretic mobility, solubility or resistance to inactivation: ISOENZYME
572. Inactivated forms of enzymes, must be converted into active forms for biological function: ZYMOGENS

Question 25

573. Major cation of intracellular fluid: POTASSIUM
574. Major cation of extracellular fluid: SODIUM

Answer 25

575. Reference range for arterial pH: pH 7.35 TO 7.45
576. Normal ratio of bicarbonate to carbonic acid: 20:1

Question 26

577. Primary cause of respiratory acidosis: HYPOVENTILATION
578. Primary cause of respiratory alkalosis: HYPERVENTILATION

Answer 26

579. Primary compensation for metabolic acidosis: HYPERVENTILATION
580. Primary compensation for metabolic alkalosis: HYPOVENTILATION

Question 27

Analytical sensitivity is a measure of the smallest increment of the analyte that can be distinguished by the assay.

Answer 27

Analytical specificity is the ability of the assay to distinguish the analyte from interfering substances.

Question 28

Diagnostic sensitivity
Proportion with the disease who have a positive test result
Sensitivity (%) = TP/(TP + FN) x 100

Answer 28

Diagnostic specificity
Proportion without the disease who have a negative test result
Specificity (%) = TN/(TN + FP) x 100

Question 29

Positive predictive value (PPV)
Proportion with a disease who have a positive test result compared with all individuals who have a positive test result
PPV (%) = TP/(TP + FP) x 100

Answer 29

Negative predictive value (NPV)
Proportion without a disease who have a negative test result compared with all individuals who have a negative test result
NPV (%) = TN/(TN + FN) x 100

Question 30

SENTINEL EVENT
Any unanticipated death or major permanent loss of function not related to the natural course of the patient’s illness or underlying condition.

Reportable events are:
Suicide during institutional care
Infant abduction or discharge to the wrong family
Rape during institutional care
Hemolytic transfusion reactions from major incompatibilities
Surgery on the wrong patient or body part

Answer 30

WRONG-PATIENT, WRONG-SITE, AND WRONG-PROCEDURE ERRORS (WSPEs) are all considered NEVER EVENTS by the National Quality Forum, and are considered SENTINEL EVENTS by The Joint Commission.

Question 31

OPEN TUBE (ENTRY OF OXYGEN)
⬆️ Increased pO2
⬇️ Deceased pCO2 (H2CO3)
⬆️ Increased pH (ALKALINE)

Answer 31

CLOSED TUBE (OXYGEN UTILIZED BY CELLS)
⬇️ Decreased pO2
⬆️ Increased pCO2 (H2CO3)
⬇️ Decreased pH (ACIDIC)

Question 32

TDM: THERAPEUTIC DRUG MONITORING

1. The PEAK LEVEL is the highest concentration of a drug in the patient’s blood stream. Peak level samples are usually drawn:
   30 minutes at the end of intravenous administration
   60 minutes after intramusular administration
   2 hours (other books 1-2) after oral administration

Answer 32

2. The TROUGH LEVEL is the lowest concentration in the patient’s blood stream. The specimen should be collected just before the next dose of a drug is administered (30 minutes for intravenous or oral administration.

Question 33

Examples of Patient Variables That May Affect Chemistry Values

Diurnal variation
↑ in am: ACTH, cortisol, iron
↑ in pm: growth hormone, PTH, TSH

Recent food ingestion
↑ glucose, insulin, gastrin, triglycerides, Na+, uric acid, iron, LD, Ca2+; ↓ chloride, phosphate, K+

Fasting required:
fasting glucose, triglycerides, lipid panel

Answer 33

Alcohol
↓ glucose; ↑ triglycerides, GGT

Posture
↑ albumin, cholesterol, Ca2+ when standing

Activity
↑ in ambulatory patients: creatinine kinase (CK)
↑ with exercise: K+, phosphate, lactic acid, creatinine, protein, CK, AST, LD

Stress
↑ ACTH, cortisol, catecholamines

Question 34

De Ritis Ratio (AST/ALT)
HENRY

Studies suggest that alcohol induces mitochondrial damage, resulting in the release of mitochondrial AST, which, besides being the predominant form of AST in hepatocytes, has a significantly longer half-life than do extramitochondrial AST and ALT.

This frequently results in the disproportionate elevation of AST over ALT, yielding an AST/ALT quotient, also called the DeRitis ratio, of 3–4 : 1 in alcohol-induced liver disease.

Answer 34

BISHOP

Alcoholic hepatitis presents with common signs and symptoms including fever, ascites, proximal muscle loss, and far more laboratory evidence of liver damage such as moderately elevated AST, ALT, GGT, and alkaline phosphatase (ALP) and elevations in total bilirubin greater than 5 mg/dL.

The elevations in AST are more than twice the upper reference of normal but rarely exceed 300 IU/mL.

The elevations in ALT are comparatively lower than AST, resulting in an AST/ALT ratio (De Ritis ratio) greater than 2.

Question 35

Yersinia pestis is gram-negative rods exhibiting bipolar staining
—————–
Pseudomonas pseudomallei, which is a small, gram-negative rod with bipolar staining
—————–
Pasteurella spp.
Bipolar staining is frequent.
————–
Actinobacillus spp. are short to very short gram-negative bacilli. They occur singly, in pairs, and in chains, and they tend to exhibit bipolar staining. This staining morphology gives the overall appearance of the dots and dashes of Morse code.
————–

Answer 35

Streptobacillus moniliformis
Staining of L-form colonies yields coccobacillary or bipolar-staining coccoid forms (usually a special stain, such as the Dienes stain performed by pathologists), is required
————-
Granuloma inguinale (Klebsiella granulomatis) is diagnosed by staining a crushed preparation of a small piece of biopsy tissue obtained from the edge of the base of the ulcer with Wright’s or Giemsa stain and finding characteristic Donovan bodies (bipolar staining rods within macrophages). No acceptable media for isolation of K. granulomatis are available.
——————

Question 36

DRUGS IN URINE
1. DARK YELLOW
Acriflavine - negative bile test results and possible green fluorescence
Nitrofurantoin - antibiotic administered for urinary tract infections

2. ORANGE-YELLOW
   Phenazopyridine (Pyridium) - drug commonly administered for urinary tract infections
   Phenindione - anticoagulant, orange in alkaline urine, colorless in acid urine

Answer 36

3. RED
   Rifampin - tuberculosis medication
4. BLUE-GREEN
   Amitriptyline - antidepressant
   Methocarbamol (Robaxin) - muscle relaxant, may be green-brown
5. BLACK
   Argyrol (antiseptic)- color disappears with ferric chloride
   Methyldopa or levodopa - antihypertensive
   Metronidazole (Flagyl) - darkens on standing, intestinal and vaginal infections

Question 37

Lewis Blood Group

Lewis blood group antigens are not synthesized by the RBCs. These antigens are adsorbed from plasma onto the RBC membrane.
Lewis antigens are poorly expressed at birth.
Lewis antibodies are generally IgM (naturally occurring) made by Le(a–b–) individuals.

Answer 37

Lewis antibodies are frequently encountered in pregnant women.
Lewis antibodies are not considered significant for transfusion medicine.

Question 38

P Blood Group
Anti-P1 is a common naturally occurring IgM antibodyin the sera of P1– individuals; it is usually a weak, cold-reactive saline agglutinin and can be neutralized with soluble P1 substance found in hydatid cyst fluid.
Anti-PP1Pk is associated with spontaneous abortions.

Answer 38

Anti-P has also been associated with spontaneous abortion.
Autoanti-P is most often the specificity associated with the cold-reactive IgG autoantibody in patients with paroxysmal cold hemoglobinuria (PCH).
The autoanti-P of PCH usually does not react by routine tests but is demonstrable as a biphasic hemolysin only in the Donath-Landsteiner test.

Question 39

I and i Blood Group
Anti-I is typically a benign, weak, naturally occurring, saline-reactive IgM autoagglutinin, usually detectable only at 4°C.
Pathogenic anti-I is typically a strong cold autoagglutinin that demonstrates high-titer reactivity at 4°C and reacts over a wide thermal range (up to 30° to 32°C).

Answer 39

Patients with M. pneumoniae infections may develop strong cold agglutinins with autoanti-I specificity.
Anti-i is a rare IgM agglutinin that reacts optimally at 4°C; potent examples may be associated with infectious mononucleosis.

Question 40

Kell Blood Group
Excluding ABO, the K antigen is rated second only to D antigen in immunogenicity.

Answer 40

The McLeod phenotype, affecting only males, is described as a rare phenotype with decreased Kell system antigen expression. The McLeod syndrome includes the clinical manifestations of abnormal RBC morphology, compensated hemolytic anemia, and neurological and muscular abnormalities. Some males with the McLeod phenotype also have the X-linked chronic granulomatous disease.

Question 41

Duffy Blood Group
Fya and Fyb antigens are destroyed by enzymes and ZZAP; they are well developed at birth.

Answer 41

The Fy(a–b–) phenotype is prevalent in blacks but virtually non-existent in whites.
Fy(a–b–) RBCs resist infection by the malaria organism P. vivax.

Question 42

Kidd Blood Group
Kidd system antibodies may bind complement and are made in response to foreign RBC exposure during pregnancy or transfusion.

Answer 42

Kidd system antibodies are a common cause of delayed HTRs.
Kidd system antibody reactivity is enhanced with enzymes, LISS, and PEG.