Laboratory Operations Flashcards
1
Q
recognition granted by non-governmental agency to institutions that meet certain standards; voluntary
A
accreditation
examples: AABB, CAP, JCAHO, NAACLS
2
Q
recognition granted by non-governmental agency to individuals who meet education requirements and demonstrate entry-level competency by passing exam; voluntary
A
certification
examples: AAB, ASCP, AMT
3
Q
permission granted by state to individuals/organizations to engage in certain professions/businesses; mandatory; illegal to practice/operate in that state without license
A
licensure
examples: licensure of lab personnel is required in CA, FL, HI, LA, MT, NV, NY, MD, RI, TN, WV
4
Q
technical standards and accreditation of blood banks
A
AABB (formerly American Association of Blood Banks)
5
Q
standards on all aspects of lab practice developed through voluntary consensus
A
CLSI (Clinical Laboratory & Standards Institute), formerly NCCLS
6
Q
standards to facilitate international exchange of goods and services; developed through voluntary worldwide consensus
A
ISO (international organization for standards)
7
Q
defines standards for quality management in medical labs
A
ISO 15189
8
Q
writes regulations for and enforces CLIA ‘88
A
Centers for Medicare and Medicaid Services (CMS)
9
Q
interprets and implements federal regulations related to health care
A
Department of Health and Human Resources (HHS)
10
Q
oversees CDC, CMS, FDA, SAMSHA
A
HHS
11
Q
regulates packaging, labeling, and transportation of biological products
A
Department of Transportation (DOT)
12
Q
regulates disposal of toxic chemicals and biohazardous wastes
A
Environmental Protection Agency (EPA)
13
Q
regulates market entry of instruments/reagents and production of donor blood and components; licenses blood banks
A
Food and Drug Administration (FDA)
14
Q
licenses labs that use radionucleotides
A
Nuclear Regulatory Commission (NRC)
15
Q
regulates employee safety in the workplace
A
OSHA
16
Q
certifies laboratories to conduct forensic drug testing for federal agencies
A
Substance Abuse and Mental Health Services Administration (SAMHSA)
17
Q
requires employers to inform employees about hazardous substances in workplace and educate them in safe handling
A
Hazard Communication Standard (OSHA 1983) “Right-to-Know Law”
18
Q
regulates all lab testing (except research) performed on humans in U.S. Requirements for personnel and quality assurance determined by test complexity; administered by CMS
A
Clinical Laboratory Improvement Amendments of 1988 “CLIA ‘88”
19
Q
requires chemical hygiene plan to minimize personnel exposure to hazardous chemicals in the lab
A
Occupation Exposure to Hazardous Chemicals in Laboratories (OSHA 1990) “Laboratory Standard”
20
Q
mandates work practices and procedures to minimize worker exposure to bloodborne pathogens
A
Bloodborne Pathogens Standard (OSHA 1991)
21
Q
requires monitoring of formaldehyde exposure
A
Formaldehyde standard (OSHA 1992)
22
Q
regulates use and disclosure of protected health information (PHI)
A
Health Insurance Portability and Accountability Act of 1996 “HIPAA”
23
Q
tests cleared by the FDA for home use, negligible likelihood of erroneous results, or no reasonable risk of harm to patient if performed incorrectly
A
waived
24
Q
QC of waived tests
A
none required other than to follow manufacturers guidelines
25
proficiency testing of waived tests
not required
26
testing personnel minimum qualifications of waived tests
none specified
27
certain microscopic exams performed by provider during patient's visit (e.g., direct wet mount, KOH prep, urine sediment)
Provider-Performed Microscopy (PPM)
28
QC of PPM
required when controls are available; otherwise reference materials (e.g., photomicrographs) fulfill requirement
29
PT of PPM
PT not specifically required, but labs must verify accuracy of testing twice annually; can be through PT, split sampling, or blind testing
30
testing personnel minimum requirements for PPM
physician, midlevel provider, or dentist
31
score <= 12 on 7 criteria
(knowledge, training/experience, reagent/material prep, characteristics of operational steps, calibration/quality control/proficiency testing materials, test system troubleshooting, interpretation/judgment)
moderate complexity
32
QC for moderate complexity testing
2 levels of external controls each day of testing
33
PT for moderate complexity testing
required
34
testing personnel minimum qualifications for moderate complexity testing
high school diploma or equivalent and training for testing provided
35
score >12 on 7 criteria
(knowledge, training/experience, reagent/material prep, characteristics of operational steps, calibration/quality control/proficiency testing materials, test system troubleshooting, interpretation/judgment)
high complexity
36
QC for high complexity testing
2 levels of external controls each day of testing
37
PT for high complexity testing
required
38
testing personnel minimum qualifications for high complexity testing
associate degree in medical laboratory technology or equivalent
39
standard to protect health-care workers from occupational exposure to bloodborne pathogens
Bloodborne pathogens standard of 1991
40
primary requirements of the Bloodborne Pathogens Standard
1. exposure control plan
2. universal precautions
3. engineering controls
4. work practice controls
5. personal protective clothing and equipment
6. housekeeping
7. training
8. medical surveillance
9. hep b vaccine
10. hazard communications
11. sharps injury log
41
blood
potentially infectious
42
tissues
potentially infectious
43
semen
potentially infectious
44
vaginal secretions
potentially infectious
45
CSF
potentially infectious
46
synovial fluid
potentially infectious
47
pleural fluid
potentially infectious
48
peritoneal fluid
potentially infectious
49
pericardial fluid
potentially infectious
50
amniotic fluid
potentially infectious
51
saliva in dental procedures
potentially infectious
52
feces
usually not infectious unless visibly bloody
53
nasal secretions
usually not infectious unless visibly bloody
54
sputum
usually not infectious unless visibly bloody
55
sweat
usually not infectious unless visibly bloody
56
tears
usually not infectious unless visibly bloody
57
urine
usually not infectious unless visibly bloody
58
vomitus
usually not infectious unless visibly bloody
59
packaging of biologics for shipping
1. primary container - test tube, vial, etc containing etiologic agent; must be securely closed, watertight, surrounded by absorbent material and placed in secondary container
2. secondary container - must be watertight, sealed, and placed in approved mailing container
3. mailing container - must be made of fiberboard
4. labeling - biohazard label required on primary and mailing containers
5. training - employees must be trained and retrained every 2-3 years or when regulations change
60
also known as "Right-to-Know Law"; "HAZCOM"
Hazard Communication Standard (HCS)
61
standard to inform employees about chemical hazards in workplace and protective measures
Hazard Communication Standard (HCS)
62
primary requirements of HCS
1. written hazard communication plan
2. inventory of hazardous chemicals on site
3. hazard labeling
4. material safety data sheets (MSDS) for each chemical readily accessible to employees on each shift
5. training on initial assignment and when new hazard introduced
63
also known as "Laboratory Standard"; "Chemical Hygiene Standard"
Occupational Exposures to Hazardous Chemicals in Laboratories Standard
64
standard to limit employee exposure to hazardous chemicals to levels at or below permissible exposure levels (PELs)
Occupational Exposures to Hazardous Chemicals in Laboratories Standard
65
primary requirements for the Occupational Exposures to Hazardous Chemicals in Laboratories Standard
1.
66
visible destruction of human tissue on contact; can cause injury on inhalation or contact
corrosives
e.g., glacial acetic acid, hydrochloric acid, sodium hydroxide
67
interfere with metabolic processes when ingested, inhaled, or absorbed through skin
toxic substances
e.g. cyanides, sulfides
68
capable of causing cancer
carcinogens
e.g., benzidine, formaldehyde
69
induce genetic mutations; cause defects in embryo
mutagens and teratogens
e.g., benzene, lead, mercury, radioactive material, toluene
70
capable of causing fire
ignitables
e.g., acetone, alcohols, ether, xylene
71
lowest temperature that produces ignitable vapor
flashpoint
72
capable of causing an explosion
reactives
e.g., ether, perchloric acid, picric acid, sodium azide
73
forms explosive peroxides on exposure to air or light; store in explosion-proof refrigerator
ether
74
may react explosively with organic compounds; separate from other acids
perchloric acid
75
shock sensitive when dehydrated; more powerful than TNT
picric acid
76
solutions can form explosive lead or copper azides in drains
sodium azide
77
Describe the safety diamond.
```
Blue diamond (left) - health
0 = no hazard
1 = can cause sig. irritation
2 = can cause temp. incapacitation or residual injury
3 = can cause serious or permanent injury
4 = can be lethal
```
```
Red diamond (top) - flammability
0 = will not burn
1 = flashpoint above 200*F (must be preheated before ignition can occur)
2 = flashpoint below 200*F (must be heated or high ambient temp. to burn)
3 = flashpoint below 100*F (can be ignited under almost all ambient temps.)
4 = flashpoint below 73*F (will vaporize and readily burn at normal temperatures)
```
```
Yellow diamond (right) - instability
0 = stable
1 = normally stable; high temps. make unstable
2 = violent chemical change at high temps. or pressures
3 = may explode at high temps. or shock (shock + heat may detonate)
4 = may explode at normal temps. and pressures (may detonate)
```
```
White diamond (bottom) - special hazards
ALK = alkaline
ACID = acidic
COR = corrosive
OX = oxidizing
Radioactive symbol = radioactive
W with line through it = reacts violently or explosively with water
W with line through it and OX = reacts violently or explosively with water and oxidizing
```
78
storage of acids
(1) store below counter level or in acid cabinets
(2) separate from flammable and combustible material, bases and active metals (e.g., sodium, potassium, magnesium)
(3) separate organic acids from inorganic acids
(4) separate oxidizing acids from organic acids
79
storage of bases
(1) separate from acids
| (2) store inorganic hydroxides in polyethylene containers
80
storage of flammables
(1) limit amount in work area
(2) store in approved safety cans or cabinets
(3) separate from oxidizing acids and oxidizers
81
storage of oxidizers
(1) separate from reducing agents (e.g., zinc, alkaline metals, formic acid), flammable, and combustible materials
82
storage of water-reactive chemicals
(1) keep away from water
| (2) store in a dry, cool place
83
examples of organic acids
formic, glacial acetic, citric
84
examples of inorganic acids
hydrochloric, nitric, sulfuric
85
examples of oxidizing acids
chromic, nitric, perchloric, sulfuric
86
examples of bases
ammonium hydroxide, potassium hydroxide, sodium hydroxide
87
examples of flammables
acetone, alcohols, xylene
88
examples of oxidizers
nitric acid, perchloric acid, sulfuric acid, acetic acid, potassium chloride, hydrogen peroxide
89
examples of water-reactive chemicals
sodium, potassium
90
Class A fires
combustible material: cloth, wood, paper
extinguishers to use: pressurized water (A) , dry chemical (ABC)
comments: do not use water on electrical fires or burning liquids
91
Class B fires
combustible material: flammable or combustible liquids
extinguishers to use: dry chemical (ABC), CO2 (BC)
92
Class C fires
combustible material: electrical equipment
extinguishers to use: dry chemical (ABC), CO2 (BC)
comments: never use water; dry chemical may damage electrical equipment; CO2 leaves no residue; good choice for analyzers, computers
93
Class D fires
combustible material: combustible metals
extinguishers to use: leave to professional firefighters
94
What additive/anticoagulant is in a lavendar topped tube?
EDTA
95
What is the mode of action of EDTA?
prevents clotting by chelating calcium
96
Which colored tube should be at least 1/2 full?
lavendar
97
Which anticoagulant/additive prevents platelets from clumping?
EDTA
98
What is the benefit of using EDTA as an anticoagulant/additive in tubes for CBCs and differentials?
EDTA causes minimal morphologic changes to WBCs
99
What additive/anticoagulant is in a light green tube?
heparin
100
What is the mode of action of heparin?
prevents clotting by neutralizing thrombin
101
What types of tests can be done using tubes with EDTA?
CBC, diff, sed rate
102
What is the best anticoagulant, additive for prevention of hemolysis?
heparin
103
Why can't you use heparin tubes for differentials?
because it creates a blue background
104
What additive/anticoagulant is in a light blue tube?
sodium citrate
105
What is the mode of action of sodium citrate?
prevents clotting by binding calcium
106
What type of tests can be done using tubes with heparin?
many chemistries, osmotic fragility, plasma hemoglobin, blood gases
107
What type of tests can be done using tubes with sodium citrate?
most coagulation tests
108
Which additive/anticoagulant preserves labile clotting factors?
sodium citrate
109
Why should sodium citrate tubes be full (of blood)?
so that a 9:1 blood-to-anticoagulant ratio can be obtained; if NOT, then coag results will be falsely increased
110
What happens to coagulation results if sodium citrate tubes are not full (of blood)?
the results will be falsely increased
111
What type of additive/anticoagulant is in a gray topped tube?
sodium fluoride
112
What is the mode of action of sodium fluoride?
inhibits glycolysis (not an anticoagulant)
113
Which tube would you use if you wanted to preserve glucose for 24 hours?
gray-top (sodium fluoride)
114
What is added to a sodium fluoride tube if anticoagulation is needed?
potassium oxalate
115
What is the mode of action of oxalate?
binds calcium
116
What is the recommended order for drawing evacuated tubes and filling tubes from a syringe?
1) blood culture [yellow (SPS)] or blood culture bottles
2) coagulation (citrate) [light blue]
3) serum (with/without clot activator; with/without gel) [red, gold, speckled]
4) heparin (with/without gel) [green]
5) EDTA [lavendar, pink, white]
6) glycolytic inhibitor (Na fluoride/K oxalate) [gray]
117
Why should blood culture tubes/bottles be drawn first?
avoids bacterial contamination from needle that has pierced other stoppers
118
Why should citrate (light blue) tubes be drawn before other anticoagulant and clot activator tubes?
avoids contamination with additives that can affect coag results
119
Why should serum (red, gold, speckled) tubes be drawn before green tubes?
avoids contamination with sodium heparin (increased sodium) or lithium heparin (increased lithium)
120
Why should serum (red, gold, speckled) tubes be drawn before lavendar tubes?
avoids contamination from K2EDTA (decreased calcium, magnesium; increased potassium)
121
Why should serum (red, gold, speckled) tubes be drawn before gray tubes?
avoids contamination with sodium fluoride/potassium oxalate (decreased calcium; increased sodium; increased potassium; interference with some enzyme assays)
122
What results would be affected by drawing a green tube before a serum tube?
sodium (increased)
| lithium (increased)
123
What results would be affected by drawing a lavender tube before a serum tube?
calcium (decreased)
magnesium (decreased)
potassium (increased)
124
What results would be affected by drawing a gray tube before a serum tube?
calcium (decreased)
sodium (increased)
potassium (increased)
interference with some enzyme assays
125
Why should green tubes be drawn before lavender tubes?
avoids contamination from K2EDTA (decreased calcium, magnesium; increased potassium)
126
Why should green tubes be drawn before gray tubes?
avoids contamination with sodium fluoride/potassium oxalate (decreased calcium, increased sodium, increased potassium)
127
What results would be affected by drawing a lavender tube before a green tube?
calcium (decreased)
magnesium (decreased)
potassium (increased)
128
What results would be affected by drawing a gray tube before a green tube?
calcium (decreased)
sodium (increased)
potassium (increased)
129
Why should lavender tubes be drawn before gray tubes?
avoids contamination with oxalate, which alters cellular morphology
130
What would be altered if gray tubes were drawn before lavender tube?
cellular morphology would be altered due to the oxalate
131
What is the recommended order of filling microcollection tubes from capillary punctures?
1) blood gases - minimizes air exposure
2) EDTA - minimizes clumping of platelets
3) other additive tubes - minimizes clotting
4) serum tubes - clotting is not a concern
132
What should you do if a phlebotomy patient has an IV?
1) use opposite arm or perform fingerstick
2) have nurse turn off IV for 2 minutes, apply tourniquet below IV site, use different vein if possible; document location of IV and venipuncture, type of fluid
133
What should you do if a phlebotomy patient has a fistula?
draw from opposite arm
134
What should you do if a phlebotomy patient has indwelling lines and catheters, heparin locks, cannulas?
1) usually not drawn by lab
2) first 5 mL drawn should be discarded
3) lab may draw below heparin lock if nothing is being infused
135
What should you do if a phlebotomy patient has sclerosed veins?
select another site
136
What should you do if a phlebotomy patient has a hematoma?
draw below hematoma
137
What should you do if a phlebotomy patient has streptokinase/tissue plasminogen activator (TPA)?
1) minimize venipunctures
| 2) hold pressure until bleeding has stopped
138
What should you do if a phlebotomy patient has edema?
select another site
139
What should you do if a phlebotomy patient has scars, burns, or tattoos?
select another site
140
What should you do if a phlebotomy patient has had a mastectomy?
draw from opposite arm
141
What should you do if a phlebotomy patient refuses a blood draw?
1) try to persuade
| 2) if unsuccessful, notify nurse
142
What could happen if you draw from a patient that has refused to have his/her blood drawn?
could lead to charges of assault and battery
143
What should you do if a phlebotomy patient is unidentified?
ask nurse to ID before drawing
144
What are some examples of tests that require the patient to be fasting?
```
fasting blood glucose
triglycerides
lipid panel
gastrin
insulin
```
145
How long must a patient fast if a test requires fasting?
at least 8 hours (nothing to eat or drink, except water)
146
What are some examples of tests that require the sample to be chilled (slurry of crushed iced and water)?
```
ACTH
acetone
ammonia
gastrin
glucagon
lactic acid
pyruvate
PTH
renin
```
147
What are some examples of tests that require the sample to be warmed?
cold agglutinins
| cryoglobulins
148
What are some examples of tests that require the sample to be protected from light (wrap in aluminum foil)?
```
bilirubin
carotene
erythrocyte protoporphyrin
vitamin A
vitamin B12
```
149
What are some examples of tests that require chain of custody?
any test used as evidence in legal proceedings; e.g., blood alcohol, drug screens, DNA analysis
150
What are possible effects of misidentifying a patient during phlebotomy?
treatment errors
| possibility of transfusion fatality
151
What are possible effects of drawing a patient at an incorrect time?
treatment errors if samples for certain tests aren't drawn at appropriate times, e.g., therapeutic drug monitoring, analytes that exhibit diurnal variation, analytes that are affected by recent eating/drinking
152
What are possible effects of drawing blood from an edematous site?
dilution of sample with tissue fluid
153
What are possible effects of the patient fist pumping during venipuncture?
```
increased potassium
increased lactic acid
increased calcium
increased phosphorus
decreased pH
```
154
What are possible effects of leaving a tourniquet on longer than 1 minute?
increased potassium
increased total protein
increased lactic acid
155
What are possible effects of IV fluid contamination when performing phlebotomy?
increased glucose, electrolytes (depending on IV)
156
What are possible effects of using expired collection tubes during phlebotomy?
decreased vacuum, failure to obtain specimen
157
What are possible effects of using an incorrect anticoagulant or contamination from incorrect order of draw?
K2EDTA before serum or heparin tube: decreased calcium, decreased magnesium, increased potassium
contamination of citrate tube with clot activator: erroneous coag results
158
What are possible effects of failing to hold the bottom of a tube lower than the top during blood collection?
carryover from one tube to another
possible additive contamination
159
What are possible effects of short draws during phlebotomy?
incorrect blood: anticoagulant ratio affects some results, e.g., coag tests
160
What are possible effects of inadequate mixing of an anticoagulant tube?
micro-clots, fibrin, platelet clumping can lead to erroneous results
161
What are possible effects of hemolysis from alcohol contamination, "milking" site of capillary puncture, probing with needle, vigorous shaking of tubes, and exposure of samples to extremes of temperature?
increased potassium
increased magnesium
increased LD
increased iron
162
How long/fast should you centrifuge most tubes?
1000-1300 RCF for 10-15 minutes
163
How long/fast should you centrifuge citrate tubes?
1500 RCF for 15 minutes to produce platelet-poor plasma
164
Why should tubes remain capped during centrifugation?
avoid loss of CO2, change of pH, evaporation, or aerosol formation
165
Why should you not re-spin primary tubes?
can cause hemolysis
166
What should you do if recentrifuging a primary tube is necessary?
transfer serum/plasma to another tube
167
Why should you not re-spin serum separator tubes?
serum in contact with RBCs under gel can be expressed and increase potassium
168
How long can separated serum/plasma be kept?
RT for 8 hours
2-8*C for 48 hours
for longer storage: -20*C
169
Can you freeze whole blood in tubes?
NO
170
Explain relative centrifugal force (RCF).
Force acting on sample being centrifuged. Gravities (g). Function of rpm and radius.
RCF = 1.12 x 10^-5 x r x rpm^2
171
Explain rpm.
revolutions per minute
speed of centrifugation
determined by tachometer
172
Explain radius (r).
distance in cm from center of rotation to bottom of tube when rotating
173
centrifuge in which tubes are in horizontal position when rotating; produces a tightly packed, flat sediment surface; recommended for serum separator tubes
horizontal-head centrifuge (swinging-bucket)
174
centrifuge in which tubes are at fixed angle (25-40*) when rotating; capable of higher speeds; produces a slanted sediment that isn't tightly packed; decantation is not recommended
angle-head centrifuge
175
high-speed centrifuge capable of 100,000 rpm; recommended to reduce heat
ultra centrifuge
176
missing or inadequate label
REJECT
177
collected at wrong time
REJECT
178
collected in wrong tube
REJECT
179
insufficient specimen
REJECT
180
inadequate volume of blood in anticoagulant tube
REJECT
181
exposure to temperature extremes
REJECT
182
prolonged transit
REJECT
183
clots in CBC tube
REJECT
184
hemolysis
REJECT (depends on test ordered)
185
lipemia
REJECT (depends on test ordered)
186
What type of glass has high resistance to thermal shock and chemical attack?
borosilicate glass (Kimax, Pyrex)
187
What type of glass has heavy walls to minimize breakage?
borosilicate glass
188
What type of glass is used for most beakers, flasks, and pipets?
borosilicate glass
189
What type of glass causes minimal contamination of liquids by elements in glass?
borosilicate glass
190
What type of glass can be heated and autoclaved?
borosilicate glass
191
What type of glass is 6 times stronger than borosilicate?
aluminosilicate glass (Corex)
192
What type of glass is better able to resist clouding due to alkali and scratching?
aluminosilicate glass
193
What type of glass is used for highly alkaline solutions?
boron free glass
194
What type of glass is alkali resistant?
boron free glass
195
What type of glass has poor heat resistance?
boron free glass
196
What type of glass has heat, chemical, and electrical tolerance?
high silica glass
197
What type of glass has excellent optical properties?
high silica glass
198
What type of glass is used for high-precision analytic work, optical reflectors, and mirrors?
high silica glass
199
What type of glass is soda-lime glass containing oxides of sodium, silicon, and calcium?
flint glass
200
What type of glass is least expensive but has poor resistance to high temps and sudden changes of temp?
flint glass
201
What type of glass has only fair resistance to chemicals?
flint glass
202
What type of glass can release alkali and affect some determinations?
flint glass
203
What type of glass is used for some disposable glassware?
flint glass
204
What type of glass is amber or red?
low actinic glass
205
What type of glass is used to decrease exposure to light (e.g., bilirubin standards)?
low actinic glass
206
What type of plastics are relatively inert chemically?
polypropylene and polyethylene
207
What type of plastic is resistant to most acids, alkalis, and salts?
polypropylene
208
What type of plastic can be autoclaved?
polypropylene
209
What type of plastic is used for pipet tips and test tubes?
polypropylene
210
What type of plastic is resistant to most acids (except concentrate H2SO4), alkalis, and salts?
polyethylene
211
What type of plastic is used for test tubes, bottles, disposable transfer pipets, and test tube racks?
polyethylene
212
What types of plastic cannot be autoclaved?
polyethylene and polystyrene
213
What type of plastic is stronger than polypropylene and has better temp tolerance, but chemical resistance not as good?
polycarbonate
214
What types of plastics are clear?
polycarbonate and polystyrene
215
What type of plastic is resistant to shattering?
polycarbonate
216
What type of plastic is used for centrifuge tubes and graduated cylinders?
polycarbonate
217
What type of plastic is rigid and clear?
polystyrene
218
What type of plastic will crack and splinter?
polystyrene
219
What type of plastic is used for test tubes and graduated tubes?
polystyrene
220
What type of plastic is soft and flexible, but porous?
polyvinyl chloride
221
What type of plastic is frequently used as tubing?
polyvinyl chloride
222
What type of plastic is extremely inert?
teflon
223
What type of plastic has excellent temp tolerance and chemical resistance?
teflon
224
What type of plastic is used for stir bars, stopcocks, and tubing?
teflon
225
Glassware inscription: A
Class A; meets high standards for accuracy
226
Glassware inscription: 20*C
temp of calibration; temp glassware and solutions should be for maximum accuracy
227
Glassware inscription: TC
to contain; vessel calibrated to hold specified volume (e.g., volumetric flask)
228
Glassware inscription: TD
to deliver; vessel calibrated to deliver specified volume (e.g., graduated cylinder)
229
wide-mouthed, straight-sided jar with pouring spout; not accurate enough for critical measurements
beaker
230
sloping sides; graduated markings; used to hold liquids, mix solutions, measure noncritical volumes
Erlenmeyer flask
231
spherical base with long cylindrical neck; single calibration mark; only for noncritical measurements
Florence flask
232
pear shaped; long neck with single calibration mark; manufactured to strict standards; glassware and solutions should be at RT; used to prepare standards and reagents; shouldn't be used to store solutions
volumetric flask
233
upright, straight-sided tube with flared base; used for noncritical measurements; most are TD; shouldn't be used to measure <5 mL or <10% of capacity; use graduate closest in size to volume to be measured
graduated cylinder (graduates)
234
transfer pipet; single calibration mark; calibrated to accurately deliver fixed volume of nonviscous samples and standards; touch off last drop against wall of receiving vessel
volumetric pipet
235
transfer pipet; similar to volumetric pipet but bulb closer to tip; etched ring means blowout; used for accurate measurement of viscous fluids, e.g., whole blood; not widely used
Ostwald-Folin pipet
236
graduated or measuring pipet; graduation marks down to tip; etched ring means blowout; can be used for serial dilutions and measuring reagents; not accurate enough for measuring samples or standards
serological pipet
237
graduated or measuring pipet; doesn't have graduation marks all the way to the tip or frosted band near upper end; delivery is made "point to point;" not widely used
Mohr pipet
238
disposable pipet for volumes ranging from 1-1000 uL; single calibration mark; filled by capillary action; TC; must be rinsed out with diluent to deliver exact amount; small pipetting bulb is used
micropipet
239
What type of mechanical micropipet does the following description describe?
"uses suction to aspirate and dispense sample through polypropylene tip; 1- or2-stop; with 2-stop, button is depressed to 2nd stop to "blow out;" tips can only be used once; seals require periodic lubrication"
air displacement micropipet
240
What type of mechanical micropipet does the following description describe?
"uses a glass capillary tip fitted with Teflon-tipped plunger; no carryover; tips are reusable; plunger setting must be checked and Teflon tip replaced periodically"
positive displacement micropipet
241
When should you verify accuracy and precision for mechanical micropipets?
on receipt, after service/repair, and on regular schedule
242
What is the most accurate method for calibrating mechanical micropipets?
gravimetric method (weight of distilled water delivered)
243
What is a secondary method for calibrating mechanical micropipets (after gravimetric method)?
spectrophotometric (absorbance of potassium dichromate or p-nitrophenol delivered)
244
What type of chemical grade does the following description describe?
"very high purity; meets specifications of American Chemical Society"
analytic reagent grade
245
What chemical grade is recommended for qualitative and quantitative analysis?
analytic reagent grade
246
What type of chemical grade does the following description describe?
"spectrograde, nanograde, or HPLC grade"
ultra pure
247
What chemical grade is used for gas chromatography, HPLC, fluorometry, and trace metal determinations?
ultra pure
248
What type of chemical grade does the following description describe?
"limits of impurities not specified; may be acceptable for some lab applications when higher purity chemicals aren't available"
chemically pure
249
What type of chemical grade does the following description describe?
"for industrial use; not of sufficient purity to sue as analytic reagents"
practical, technical, or commercial grade
250
What type of chemical grade does the following description describe?
"meet specifications of U.S. Pharmacopeia or National Formulary; not injurious to health; not necessarily of sufficient purity to use as analytic reagents"
USP or NF grade
251
What labeling requirements are not required by CAP?
date received, date opened
252
least expensive objective; partially corrects for chromatic and spherical abberations
achromatic objective
253
controls angle and amount of light sent to objective
aperture diaphragm
254
microscope with 2 oculars
binocular microscope
255
used to eliminate yellow color emitted by tungsten
blue filter
256
microscope that uses transmitted light and lenses; objects appear dark against white background; used for most routine clinical work
Brightfield microscope
257
microscope with 2 lens systems - objectives and oculars
compound microscope
258
focuses light on specimen
condenser
259
distance throughout which all parts of specimen are in focus simultaneously
depth of focus
260
limits area of illumination to image field
field diaphragm
261
area of specimen that can be seen
field of view
262
used to help objective gather light from a wide numerical aperture; provides high resolution; type B (high viscosity) is commonly used
immersion oil
263
method of focusing and centering light path and spreading light uniformly; ensures optimum contrast and resolution
Kohler illumination
264
magnification of ocular x magnification of objective
total magnification
265
What is the highest magnification achievable with a Brightfield microscope?
1,000x
266
mathematical expression of light admitted by lens
numerical aperture (NA)
267
The higher the NA, the greater the ____________.
resolution
268
lenses attached to revolving nosepiece; most commonly used are low power (10x), high power (40x), and oil immersion (50x or 100x)
objectives
269
eye piece; usually 10x
ocular
270
object in center of field at 1 magnification will be in center of field at other magnifications
parcentric
271
object remains in focus from 1 magnification to another
parfocal
272
more expensive objective that corrects for curvature of field; results in flat field with uniform focus
planachromatic objective
273
ability to reveal fine detail and distinguish between 2 close points
resolution
274
light control knob
rheostat
275
Light intensity shouldn't be regulated by ____________ or _________.
condenser or diaphragms
276
type of bulb used for brightfield microscopy
Tungsten-halogen bulb
277
image seen through microscope; upside down and reversed
virtual image
278
distance between slide and objective
working distance
279
Working distance ___________ with higher magnification objectives.
decreases
280
brightfield microscope with special condenser; objects appear white against a black background
darkfield microscope
281
What microscope can be used for the identification of live Treponema pallidum and other microorganisms?
darkfield microscope
282
brightfield microscope with 2 special filters; fluorescent dyes absorb light of 1 wavelength and emit light of longer wavelength; objects appear green, yellow, or orange against a black background
fluorescent microscope
283
What microscope can be used in direct and indirect fluorescent antibody stains in microbiology and immunology?
fluorescent microscope
284
brightfield microscope with special slit aperture below condenser, polarizer, and special amplitude filter (modulator) in back of each objective; gives 3-D effect to unstained specimens
interference contrast
285
What microscope can be used for wet mounts?
interference contrast
286
brightfield microscope with phase condenser and phase objectives; subtle differences in refractive index converted to clear-cut variations of light intensity and contrast; good for living cells, unstained specimens
phase contrast
287
What microscope can be used for manual platelet counts, urine sediments (good for hyaline casts)
phase contrast
288
brightfield microscope with 2 crossing filters - polarizing filter below condenser, analyzer between objective and eyepiece; objects that can refract light (birefringent) appear white against black background
polarizing microscope
289
What microscope can be used for the identification of crystals in urine and synovial fluid and for confirmation of fat or oval fat bodies in urine sediment?
polarizing microscope
290
beam of electrons passes through specimen, focused onto fluorescent screen or photographic plate; magnification >100,000x
transmission electron microscope
291
What type of microscope can be used to see viruses and cells (organelles)?
transmission electron microscope
292
beam of electrons strikes surface of specimen, focused onto photographic film or cathode ray tube; 3-D image; magnification >1,000x
scanning electron microscope
293
What type of microscope can be used to see viruses and cells (surface)?
scanning electron microscope
294
information science; science of processing data for storage, retrieval, and use
informatics
295
use of computers and information systems to process and communicate information generated in clinical lab
laboratory informatics
296
computerized medical record; American Recovery and Reinvestment Act of 2009 (ARRA) calls for EMRs for all patients by 2014 to help reduce cost and increase efficiency of health-care delivery
electronic medical record (EMR)
297
physical parts of computer
hardware
298
executes software instructions
central processing unit (CPU)
299
working memory used for temporary storage of programs and data; content is lost each time computer is turned off
random access memory (RAM)
300
part of memory that is permanently protected from being modified, erased, or written over; not affected by power loss; used for boot-level and other system instructions
read-only memory (ROM)
301
magnetic-coated metal plate inside CPU for storing data
hard drive
302
device that reads data stored on magnetic or optical disk and writes data onto disk for storage
disk drive
303
CDs, DVDs; store data
optical disk
304
input/output and information storage components
peripheral drives
305
devices that deliver data to computer, e.g., keyboards, barcode readers, computer links (interfaces)
input devices
306
devices by which computer delivers data, e.g., printers, monitors
output devices
307
input/output device that allows computers to communicate over telephone lines
modem
308
programs that tell computer what to do
software
309
program that controls basic functions of computer, e.g., Microsoft Windows
operating system software
310
programs designed to meet specific needs of users, e.g., word processing
application software
311
application program that allows for manipulation of text; used to write letters, reports, etc.
word processor
312
application program to manipulate numbers and perform mathematical calculations; used to prepare financial statements, budgets, etc.
spreadsheet
313
application program to organize, store, sort, and retrieve data (words and numbers)
database
314
program that provides access to internet, e.g., Microsoft Internet Explorer
browser
315
system of hardware, software, connections, and communication protocols to handle all informational needs of lab, from intake of requests to delivery of results; can provide patient information, test information, collection lists, work lists, test results, financial functions, productivity/workload monitoring, quality management, and interface with other computer systems
Laboratory information system (LIS)
316
information system to handle all informational needs of hospital, both clinical and administrative
Hospital information system (HIS)
317
hardware and software that allow for electronic communication between 2 computer systems, even if they use different programming languages; the LIS is typically interfaced with HIS and automated analyzers
interface
318
interface that transmits electronic information in 1 direction, e.g., a point-of-care analyzer downloads test results to LIS
unidirectional interface
319
interface that transmits electronic information in 2 directions, e.g., the LIS downloads orders from the HIS and uploads results to the HIS
bidirectional interface
320
interface between an analyzer and LIS; can apply rules to automate processes, e.g., autoverification (automatic release of results without tech review when certain criteria are met)
middleware
321
documentation that LIS functions as expected; required by regulatory agencies
system validation
322
computer network that connects computers in close geographic proximity (e.g., building, campus)
local area network (LAN)
323
computer network that connects computers over large geographic area (e..g, multisite health-care facility, internet)
wide area network (WAN)
324
global system of interconnected computer networks
internet
325
computer network within an organization; access is usually restricted to employees
intranet
326
extension of a private network onto the internet where it can be accessed by authorized clients, suppliers, etc.
extranet
327
common set of signals and rules that network uses for communication
protocol
328
one of the 1st protocols developed for connecting computers
ethernet
329
originally developed as transfer protocol for internet; adapted for transmission in LANs
transmission control protocol/internet protocol (TCP/IP)
330
standardized message protocol that facilitates exchange of medical data among computer systems
Health Level 7 standard (HL7)
331
process by which lab ensures quality results by closely monitoring preanalytical, analytical, and postanalytical stages of testing
quality assessment or quality assurance (QA)
332
everything that precedes test performance, e.g., test ordering, patient preparation, patient ID, specimen collection, specimen transport, specimen processing
preanalytical QA
333
everything related to assay, e.g., test analysis, QC, reagents, calibration, preventive maintenance
analytical QA
334
everything that comes after test analysis, e.g., verification of calculations and reference ranges, review of results, notification of critical values, result reporting, test interpretation by physician, follow-up patient care
postanalytical QA
335
all of the lab's policies, processes, procedures, and resources needed to achieve quality testing
quality system
336
part of analytical phase of quality assurance; process of monitoring results from control samples to verify accuracy of patient results
quality control (QC)
337
sample that is chemically and physically similar to unknown specimen and is tested in exactly the same manner; monitors precision of test system
control
338
For nonwaived quantitative tests, CLIA requires at least _______ levels of control each day test is performed. For qualitative tests, ___________ must be included in each run.
2 levels
pos & neg controls
339
testing control material not built into the test system; term also used for QC that extends beyond the lab, e.g., participation in proficiency testing program
external QC
340
electronic, internal, or procedural controls that are built into the test system
internal monitoring systems
341
labs may reduce frequency of testing external QC materials for certain test systems if they can demonstrate through a CMS-approved QC evaluation process that the test system is stable
equivalent QC
342
statistical parameters describing spread of data about mean, e.g., standard deviation, coefficient of variation, range; measurements of precision
measures of dispersion
343
difference tween highest and lowest values in a data set
range
344
sum of all observations divided by number of observations; average of all observations
mean
345
statistical expression of dispersion of values around the mean; requires a minimum of 20 values
standard deviation
346
expresses standard deviation as a percentage
coefficient of variation
347
The _____ the CV, the _______ the precision.
1. lower
| 2. greater
348
Explain normal distribution/Gaussian bell-shaped curve.
68% of values fall within +/- 1 SD of mean
95% of values fall within +/- 2 SD of mean
99.7% of values fall within +/- 3 SD of mean
349
range within which control values must fall for assay to be considered valid; many labs use mean +/- 2 SD; 1 determination in 20 will fall outside +/- 2 SD
control limits
350
normal distribution curve lying on its side, marked with mean, +/-1, +/-2, +/-3
Levey-Jennings chart
351
a control result outside established limits
outlier
352
6 consecutive control values on same side of mean
shift
353
control values increasing or decreasing for 6 consecutive runs
trend
