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AMT MLT Study Guide > Laboratory Operations > Flashcards

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

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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

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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

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4
Q

technical standards and accreditation of blood banks

A

AABB (formerly American Association of Blood Banks)

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5
Q

standards on all aspects of lab practice developed through voluntary consensus

A

CLSI (Clinical Laboratory & Standards Institute), formerly NCCLS

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6
Q

standards to facilitate international exchange of goods and services; developed through voluntary worldwide consensus

A

ISO (international organization for standards)

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7
Q

defines standards for quality management in medical labs

A

ISO 15189

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8
Q

writes regulations for and enforces CLIA ‘88

A

Centers for Medicare and Medicaid Services (CMS)

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9
Q

interprets and implements federal regulations related to health care

A

Department of Health and Human Resources (HHS)

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10
Q

oversees CDC, CMS, FDA, SAMSHA

A

HHS

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11
Q

regulates packaging, labeling, and transportation of biological products

A

Department of Transportation (DOT)

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12
Q

regulates disposal of toxic chemicals and biohazardous wastes

A

Environmental Protection Agency (EPA)

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13
Q

regulates market entry of instruments/reagents and production of donor blood and components; licenses blood banks

A

Food and Drug Administration (FDA)

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14
Q

licenses labs that use radionucleotides

A

Nuclear Regulatory Commission (NRC)

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15
Q

regulates employee safety in the workplace

A

OSHA

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16
Q

certifies laboratories to conduct forensic drug testing for federal agencies

A

Substance Abuse and Mental Health Services Administration (SAMHSA)

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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”

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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”

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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”

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20
Q

mandates work practices and procedures to minimize worker exposure to bloodborne pathogens

A

Bloodborne Pathogens Standard (OSHA 1991)

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21
Q

requires monitoring of formaldehyde exposure

A

Formaldehyde standard (OSHA 1992)

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22
Q

regulates use and disclosure of protected health information (PHI)

A

Health Insurance Portability and Accountability Act of 1996 “HIPAA”

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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

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24
Q

QC of waived tests

A

none required other than to follow manufacturers guidelines

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25
Q

proficiency testing of waived tests

A

not required

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26
Q

testing personnel minimum qualifications of waived tests

A

none specified

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27
Q

certain microscopic exams performed by provider during patient’s visit (e.g., direct wet mount, KOH prep, urine sediment)

A

Provider-Performed Microscopy (PPM)

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28
Q

QC of PPM

A

required when controls are available; otherwise reference materials (e.g., photomicrographs) fulfill requirement

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29
Q

PT of PPM

A

PT not specifically required, but labs must verify accuracy of testing twice annually; can be through PT, split sampling, or blind testing

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30
Q

testing personnel minimum requirements for PPM

A

physician, midlevel provider, or dentist

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31
Q

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)

A

moderate complexity

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32
Q

QC for moderate complexity testing

A

2 levels of external controls each day of testing

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33
Q

PT for moderate complexity testing

A

required

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34
Q

testing personnel minimum qualifications for moderate complexity testing

A

high school diploma or equivalent and training for testing provided

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35
Q

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)

A

high complexity

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36
Q

QC for high complexity testing

A

2 levels of external controls each day of testing

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37
Q

PT for high complexity testing

A

required

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38
Q

testing personnel minimum qualifications for high complexity testing

A

associate degree in medical laboratory technology or equivalent

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39
Q

standard to protect health-care workers from occupational exposure to bloodborne pathogens

A

Bloodborne pathogens standard of 1991

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40
Q

primary requirements of the Bloodborne Pathogens Standard

A
  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
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41
Q

blood

A

potentially infectious

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42
Q

tissues

A

potentially infectious

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43
Q

semen

A

potentially infectious

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44
Q

vaginal secretions

A

potentially infectious

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45
Q

CSF

A

potentially infectious

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46
Q

synovial fluid

A

potentially infectious

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47
Q

pleural fluid

A

potentially infectious

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48
Q

peritoneal fluid

A

potentially infectious

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49
Q

pericardial fluid

A

potentially infectious

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50
Q

amniotic fluid

A

potentially infectious

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51
Q

saliva in dental procedures

A

potentially infectious

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52
Q

feces

A

usually not infectious unless visibly bloody

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53
Q

nasal secretions

A

usually not infectious unless visibly bloody

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54
Q

sputum

A

usually not infectious unless visibly bloody

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55
Q

sweat

A

usually not infectious unless visibly bloody

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56
Q

tears

A

usually not infectious unless visibly bloody

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57
Q

urine

A

usually not infectious unless visibly bloody

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58
Q

vomitus

A

usually not infectious unless visibly bloody

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59
Q

packaging of biologics for shipping

A
  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
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60
Q

also known as “Right-to-Know Law”; “HAZCOM”

A

Hazard Communication Standard (HCS)

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61
Q

standard to inform employees about chemical hazards in workplace and protective measures

A

Hazard Communication Standard (HCS)

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62
Q

primary requirements of HCS

A
  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
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63
Q

also known as “Laboratory Standard”; “Chemical Hygiene Standard”

A

Occupational Exposures to Hazardous Chemicals in Laboratories Standard

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64
Q

standard to limit employee exposure to hazardous chemicals to levels at or below permissible exposure levels (PELs)

A

Occupational Exposures to Hazardous Chemicals in Laboratories Standard

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65
Q

primary requirements for the Occupational Exposures to Hazardous Chemicals in Laboratories Standard

A

1.

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66
Q

visible destruction of human tissue on contact; can cause injury on inhalation or contact

A

corrosives

e.g., glacial acetic acid, hydrochloric acid, sodium hydroxide

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67
Q

interfere with metabolic processes when ingested, inhaled, or absorbed through skin

A

toxic substances

e.g. cyanides, sulfides

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68
Q

capable of causing cancer

A

carcinogens

e.g., benzidine, formaldehyde

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69
Q

induce genetic mutations; cause defects in embryo

A

mutagens and teratogens

e.g., benzene, lead, mercury, radioactive material, toluene

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70
Q

capable of causing fire

A

ignitables

e.g., acetone, alcohols, ether, xylene

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71
Q

lowest temperature that produces ignitable vapor

A

flashpoint

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72
Q

capable of causing an explosion

A

reactives

e.g., ether, perchloric acid, picric acid, sodium azide

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73
Q

forms explosive peroxides on exposure to air or light; store in explosion-proof refrigerator

A

ether

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74
Q

may react explosively with organic compounds; separate from other acids

A

perchloric acid

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75
Q

shock sensitive when dehydrated; more powerful than TNT

A

picric acid

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76
Q

solutions can form explosive lead or copper azides in drains

A

sodium azide

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77
Q

Describe the safety diamond.

A 
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
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78
Q

storage of acids

A

(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

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79
Q

storage of bases

A

(1) separate from acids

(2) store inorganic hydroxides in polyethylene containers

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80
Q

storage of flammables

A

(1) limit amount in work area
(2) store in approved safety cans or cabinets
(3) separate from oxidizing acids and oxidizers

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81
Q

storage of oxidizers

A

(1) separate from reducing agents (e.g., zinc, alkaline metals, formic acid), flammable, and combustible materials

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82
Q

storage of water-reactive chemicals

A

(1) keep away from water

(2) store in a dry, cool place

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83
Q

examples of organic acids

A

formic, glacial acetic, citric

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84
Q

examples of inorganic acids

A

hydrochloric, nitric, sulfuric

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85
Q

examples of oxidizing acids

A

chromic, nitric, perchloric, sulfuric

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86
Q

examples of bases

A

ammonium hydroxide, potassium hydroxide, sodium hydroxide

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87
Q

examples of flammables

A

acetone, alcohols, xylene

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88
Q

examples of oxidizers

A

nitric acid, perchloric acid, sulfuric acid, acetic acid, potassium chloride, hydrogen peroxide

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89
Q

examples of water-reactive chemicals

A

sodium, potassium

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90
Q

Class A fires

A

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

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91
Q

Class B fires

A

combustible material: flammable or combustible liquids

extinguishers to use: dry chemical (ABC), CO2 (BC)

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92
Q

Class C fires

A

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

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93
Q

Class D fires

A

combustible material: combustible metals

extinguishers to use: leave to professional firefighters

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94
Q

What additive/anticoagulant is in a lavendar topped tube?

A

EDTA

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95
Q

What is the mode of action of EDTA?

A

prevents clotting by chelating calcium

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96
Q

Which colored tube should be at least 1/2 full?

A

lavendar

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97
Q

Which anticoagulant/additive prevents platelets from clumping?

A

EDTA

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98
Q

What is the benefit of using EDTA as an anticoagulant/additive in tubes for CBCs and differentials?

A

EDTA causes minimal morphologic changes to WBCs

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99
Q

What additive/anticoagulant is in a light green tube?

A

heparin

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100
Q

What is the mode of action of heparin?

A

prevents clotting by neutralizing thrombin

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101
Q

What types of tests can be done using tubes with EDTA?

A

CBC, diff, sed rate

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102
Q

What is the best anticoagulant, additive for prevention of hemolysis?

A

heparin

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103
Q

Why can’t you use heparin tubes for differentials?

A

because it creates a blue background

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104
Q

What additive/anticoagulant is in a light blue tube?

A

sodium citrate

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105
Q

What is the mode of action of sodium citrate?

A

prevents clotting by binding calcium

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106
Q

What type of tests can be done using tubes with heparin?

A

many chemistries, osmotic fragility, plasma hemoglobin, blood gases

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107
Q

What type of tests can be done using tubes with sodium citrate?

A

most coagulation tests

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108
Q

Which additive/anticoagulant preserves labile clotting factors?

A

sodium citrate

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109
Q

Why should sodium citrate tubes be full (of blood)?

A

so that a 9:1 blood-to-anticoagulant ratio can be obtained; if NOT, then coag results will be falsely increased

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110
Q

What happens to coagulation results if sodium citrate tubes are not full (of blood)?

A

the results will be falsely increased

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111
Q

What type of additive/anticoagulant is in a gray topped tube?

A

sodium fluoride

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112
Q

What is the mode of action of sodium fluoride?

A

inhibits glycolysis (not an anticoagulant)

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113
Q

Which tube would you use if you wanted to preserve glucose for 24 hours?

A

gray-top (sodium fluoride)

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114
Q

What is added to a sodium fluoride tube if anticoagulation is needed?

A

potassium oxalate

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115
Q

What is the mode of action of oxalate?

A

binds calcium

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116
Q

What is the recommended order for drawing evacuated tubes and filling tubes from a syringe?

A

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]

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117
Q

Why should blood culture tubes/bottles be drawn first?

A

avoids bacterial contamination from needle that has pierced other stoppers

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118
Q

Why should citrate (light blue) tubes be drawn before other anticoagulant and clot activator tubes?

A

avoids contamination with additives that can affect coag results

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119
Q

Why should serum (red, gold, speckled) tubes be drawn before green tubes?

A

avoids contamination with sodium heparin (increased sodium) or lithium heparin (increased lithium)

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120
Q

Why should serum (red, gold, speckled) tubes be drawn before lavendar tubes?

A

avoids contamination from K2EDTA (decreased calcium, magnesium; increased potassium)

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121
Q

Why should serum (red, gold, speckled) tubes be drawn before gray tubes?

A

avoids contamination with sodium fluoride/potassium oxalate (decreased calcium; increased sodium; increased potassium; interference with some enzyme assays)

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122
Q

What results would be affected by drawing a green tube before a serum tube?

A

sodium (increased)

lithium (increased)

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123
Q

What results would be affected by drawing a lavender tube before a serum tube?

A

calcium (decreased)
magnesium (decreased)
potassium (increased)

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124
Q

What results would be affected by drawing a gray tube before a serum tube?

A

calcium (decreased)
sodium (increased)
potassium (increased)

interference with some enzyme assays

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125
Q

Why should green tubes be drawn before lavender tubes?

A

avoids contamination from K2EDTA (decreased calcium, magnesium; increased potassium)

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126
Q

Why should green tubes be drawn before gray tubes?

A

avoids contamination with sodium fluoride/potassium oxalate (decreased calcium, increased sodium, increased potassium)

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127
Q

What results would be affected by drawing a lavender tube before a green tube?

A

calcium (decreased)
magnesium (decreased)
potassium (increased)

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128
Q

What results would be affected by drawing a gray tube before a green tube?

A

calcium (decreased)
sodium (increased)
potassium (increased)

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129
Q

Why should lavender tubes be drawn before gray tubes?

A

avoids contamination with oxalate, which alters cellular morphology

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130
Q

What would be altered if gray tubes were drawn before lavender tube?

A

cellular morphology would be altered due to the oxalate

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131
Q

What is the recommended order of filling microcollection tubes from capillary punctures?

A

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

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132
Q

What should you do if a phlebotomy patient has an IV?

A

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

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133
Q

What should you do if a phlebotomy patient has a fistula?

A

draw from opposite arm

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134
Q

What should you do if a phlebotomy patient has indwelling lines and catheters, heparin locks, cannulas?

A

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

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135
Q

What should you do if a phlebotomy patient has sclerosed veins?

A

select another site

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136
Q

What should you do if a phlebotomy patient has a hematoma?

A

draw below hematoma

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137
Q

What should you do if a phlebotomy patient has streptokinase/tissue plasminogen activator (TPA)?

A

1) minimize venipunctures

2) hold pressure until bleeding has stopped

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138
Q

What should you do if a phlebotomy patient has edema?

A

select another site

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139
Q

What should you do if a phlebotomy patient has scars, burns, or tattoos?

A

select another site

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140
Q

What should you do if a phlebotomy patient has had a mastectomy?

A

draw from opposite arm

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141
Q

What should you do if a phlebotomy patient refuses a blood draw?

A

1) try to persuade

2) if unsuccessful, notify nurse

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142
Q

What could happen if you draw from a patient that has refused to have his/her blood drawn?

A

could lead to charges of assault and battery

143
Q

What should you do if a phlebotomy patient is unidentified?

A

ask nurse to ID before drawing

144
Q

What are some examples of tests that require the patient to be fasting?

A 
fasting blood glucose
triglycerides
lipid panel
gastrin
insulin
145
Q

How long must a patient fast if a test requires fasting?

A

at least 8 hours (nothing to eat or drink, except water)

146
Q

What are some examples of tests that require the sample to be chilled (slurry of crushed iced and water)?

A 
ACTH
acetone
ammonia
gastrin
glucagon
lactic acid
pyruvate
PTH
renin
147
Q

What are some examples of tests that require the sample to be warmed?

A

cold agglutinins

cryoglobulins

148
Q

What are some examples of tests that require the sample to be protected from light (wrap in aluminum foil)?

A 
bilirubin
carotene
erythrocyte protoporphyrin
vitamin A
vitamin B12
149
Q

What are some examples of tests that require chain of custody?

A

any test used as evidence in legal proceedings; e.g., blood alcohol, drug screens, DNA analysis

150
Q

What are possible effects of misidentifying a patient during phlebotomy?

A

treatment errors

possibility of transfusion fatality

151
Q

What are possible effects of drawing a patient at an incorrect time?

A

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
Q

What are possible effects of drawing blood from an edematous site?

A

dilution of sample with tissue fluid

153
Q

What are possible effects of the patient fist pumping during venipuncture?

A 
increased potassium
increased lactic acid
increased calcium
increased phosphorus
decreased pH
154
Q

What are possible effects of leaving a tourniquet on longer than 1 minute?

A

increased potassium
increased total protein
increased lactic acid

155
Q

What are possible effects of IV fluid contamination when performing phlebotomy?

A

increased glucose, electrolytes (depending on IV)

156
Q

What are possible effects of using expired collection tubes during phlebotomy?

A

decreased vacuum, failure to obtain specimen

157
Q

What are possible effects of using an incorrect anticoagulant or contamination from incorrect order of draw?

A

K2EDTA before serum or heparin tube: decreased calcium, decreased magnesium, increased potassium

contamination of citrate tube with clot activator: erroneous coag results

158
Q

What are possible effects of failing to hold the bottom of a tube lower than the top during blood collection?

A

carryover from one tube to another

possible additive contamination

159
Q

What are possible effects of short draws during phlebotomy?

A

incorrect blood: anticoagulant ratio affects some results, e.g., coag tests

160
Q

What are possible effects of inadequate mixing of an anticoagulant tube?

A

micro-clots, fibrin, platelet clumping can lead to erroneous results

161
Q

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?

A

increased potassium
increased magnesium
increased LD
increased iron

162
Q

How long/fast should you centrifuge most tubes?

A

1000-1300 RCF for 10-15 minutes

163
Q

How long/fast should you centrifuge citrate tubes?

A

1500 RCF for 15 minutes to produce platelet-poor plasma

164
Q

Why should tubes remain capped during centrifugation?

A

avoid loss of CO2, change of pH, evaporation, or aerosol formation

165
Q

Why should you not re-spin primary tubes?

A

can cause hemolysis

166
Q

What should you do if recentrifuging a primary tube is necessary?

A

transfer serum/plasma to another tube

167
Q

Why should you not re-spin serum separator tubes?

A

serum in contact with RBCs under gel can be expressed and increase potassium

168
Q

How long can separated serum/plasma be kept?

A

RT for 8 hours
2-8C for 48 hours
for longer storage: -20C

169
Q

Can you freeze whole blood in tubes?

A

NO

170
Q

Explain relative centrifugal force (RCF).

A

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
Q

Explain rpm.

A

revolutions per minute
speed of centrifugation
determined by tachometer

172
Q

Explain radius (r).

A

distance in cm from center of rotation to bottom of tube when rotating

173
Q

centrifuge in which tubes are in horizontal position when rotating; produces a tightly packed, flat sediment surface; recommended for serum separator tubes

A

horizontal-head centrifuge (swinging-bucket)

174
Q

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

A

angle-head centrifuge

175
Q

high-speed centrifuge capable of 100,000 rpm; recommended to reduce heat

A

ultra centrifuge

176
Q

missing or inadequate label

A

REJECT

177
Q

collected at wrong time

A

REJECT

178
Q

collected in wrong tube

A

REJECT

179
Q

insufficient specimen

A

REJECT

180
Q

inadequate volume of blood in anticoagulant tube

A

REJECT

181
Q

exposure to temperature extremes

A

REJECT

182
Q

prolonged transit

A

REJECT

183
Q

clots in CBC tube

A

REJECT

184
Q

hemolysis

A

REJECT (depends on test ordered)

185
Q

lipemia

A

REJECT (depends on test ordered)

186
Q

What type of glass has high resistance to thermal shock and chemical attack?

A

borosilicate glass (Kimax, Pyrex)

187
Q

What type of glass has heavy walls to minimize breakage?

A

borosilicate glass

188
Q

What type of glass is used for most beakers, flasks, and pipets?

A

borosilicate glass

189
Q

What type of glass causes minimal contamination of liquids by elements in glass?

A

borosilicate glass

190
Q

What type of glass can be heated and autoclaved?

A

borosilicate glass

191
Q

What type of glass is 6 times stronger than borosilicate?

A

aluminosilicate glass (Corex)

192
Q

What type of glass is better able to resist clouding due to alkali and scratching?

A

aluminosilicate glass

193
Q

What type of glass is used for highly alkaline solutions?

A

boron free glass

194
Q

What type of glass is alkali resistant?

A

boron free glass

195
Q

What type of glass has poor heat resistance?

A

boron free glass

196
Q

What type of glass has heat, chemical, and electrical tolerance?

A

high silica glass

197
Q

What type of glass has excellent optical properties?

A

high silica glass

198
Q

What type of glass is used for high-precision analytic work, optical reflectors, and mirrors?

A

high silica glass

199
Q

What type of glass is soda-lime glass containing oxides of sodium, silicon, and calcium?

A

flint glass

200
Q

What type of glass is least expensive but has poor resistance to high temps and sudden changes of temp?

A

flint glass

201
Q

What type of glass has only fair resistance to chemicals?

A

flint glass

202
Q

What type of glass can release alkali and affect some determinations?

A

flint glass

203
Q

What type of glass is used for some disposable glassware?

A

flint glass

204
Q

What type of glass is amber or red?

A

low actinic glass

205
Q

What type of glass is used to decrease exposure to light (e.g., bilirubin standards)?

A

low actinic glass

206
Q

What type of plastics are relatively inert chemically?

A

polypropylene and polyethylene

207
Q

What type of plastic is resistant to most acids, alkalis, and salts?

A

polypropylene

208
Q

What type of plastic can be autoclaved?

A

polypropylene

209
Q

What type of plastic is used for pipet tips and test tubes?

A

polypropylene

210
Q

What type of plastic is resistant to most acids (except concentrate H2SO4), alkalis, and salts?

A

polyethylene

211
Q

What type of plastic is used for test tubes, bottles, disposable transfer pipets, and test tube racks?

A

polyethylene

212
Q

What types of plastic cannot be autoclaved?

A

polyethylene and polystyrene

213
Q

What type of plastic is stronger than polypropylene and has better temp tolerance, but chemical resistance not as good?

A

polycarbonate

214
Q

What types of plastics are clear?

A

polycarbonate and polystyrene

215
Q

What type of plastic is resistant to shattering?

A

polycarbonate

216
Q

What type of plastic is used for centrifuge tubes and graduated cylinders?

A

polycarbonate

217
Q

What type of plastic is rigid and clear?

A

polystyrene

218
Q

What type of plastic will crack and splinter?

A

polystyrene

219
Q

What type of plastic is used for test tubes and graduated tubes?

A

polystyrene

220
Q

What type of plastic is soft and flexible, but porous?

A

polyvinyl chloride

221
Q

What type of plastic is frequently used as tubing?

A

polyvinyl chloride

222
Q

What type of plastic is extremely inert?

A

teflon

223
Q

What type of plastic has excellent temp tolerance and chemical resistance?

A

teflon

224
Q

What type of plastic is used for stir bars, stopcocks, and tubing?

A

teflon

225
Q

Glassware inscription: A

A

Class A; meets high standards for accuracy

226
Q

Glassware inscription: 20*C

A

temp of calibration; temp glassware and solutions should be for maximum accuracy

227
Q

Glassware inscription: TC

A

to contain; vessel calibrated to hold specified volume (e.g., volumetric flask)

228
Q

Glassware inscription: TD

A

to deliver; vessel calibrated to deliver specified volume (e.g., graduated cylinder)

229
Q

wide-mouthed, straight-sided jar with pouring spout; not accurate enough for critical measurements

A

beaker

230
Q

sloping sides; graduated markings; used to hold liquids, mix solutions, measure noncritical volumes

A

Erlenmeyer flask

231
Q

spherical base with long cylindrical neck; single calibration mark; only for noncritical measurements

A

Florence flask

232
Q

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

A

volumetric flask

233
Q

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

A

graduated cylinder (graduates)

234
Q

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

A

volumetric pipet

235
Q

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

A

Ostwald-Folin pipet

236
Q

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

A

serological pipet

237
Q

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

A

Mohr pipet

238
Q

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

A

micropipet

239
Q

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”

A

air displacement micropipet

240
Q

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”

A

positive displacement micropipet

241
Q

When should you verify accuracy and precision for mechanical micropipets?

A

on receipt, after service/repair, and on regular schedule

242
Q

What is the most accurate method for calibrating mechanical micropipets?

A

gravimetric method (weight of distilled water delivered)

243
Q

What is a secondary method for calibrating mechanical micropipets (after gravimetric method)?

A

spectrophotometric (absorbance of potassium dichromate or p-nitrophenol delivered)

244
Q

What type of chemical grade does the following description describe?

“very high purity; meets specifications of American Chemical Society”

A

analytic reagent grade

245
Q

What chemical grade is recommended for qualitative and quantitative analysis?

A

analytic reagent grade

246
Q

What type of chemical grade does the following description describe?

“spectrograde, nanograde, or HPLC grade”

A

ultra pure

247
Q

What chemical grade is used for gas chromatography, HPLC, fluorometry, and trace metal determinations?

A

ultra pure

248
Q

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”

A

chemically pure

249
Q

What type of chemical grade does the following description describe?

“for industrial use; not of sufficient purity to sue as analytic reagents”

A

practical, technical, or commercial grade

250
Q

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”

A

USP or NF grade

251
Q

What labeling requirements are not required by CAP?

A

date received, date opened

252
Q

least expensive objective; partially corrects for chromatic and spherical abberations

A

achromatic objective

253
Q

controls angle and amount of light sent to objective

A

aperture diaphragm

254
Q

microscope with 2 oculars

A

binocular microscope

255
Q

used to eliminate yellow color emitted by tungsten

A

blue filter

256
Q

microscope that uses transmitted light and lenses; objects appear dark against white background; used for most routine clinical work

A

Brightfield microscope

257
Q

microscope with 2 lens systems - objectives and oculars

A

compound microscope

258
Q

focuses light on specimen

A

condenser

259
Q

distance throughout which all parts of specimen are in focus simultaneously

A

depth of focus

260
Q

limits area of illumination to image field

A

field diaphragm

261
Q

area of specimen that can be seen

A

field of view

262
Q

used to help objective gather light from a wide numerical aperture; provides high resolution; type B (high viscosity) is commonly used

A

immersion oil

263
Q

method of focusing and centering light path and spreading light uniformly; ensures optimum contrast and resolution

A

Kohler illumination

264
Q

magnification of ocular x magnification of objective

A

total magnification

265
Q

What is the highest magnification achievable with a Brightfield microscope?

A

1,000x

266
Q

mathematical expression of light admitted by lens

A

numerical aperture (NA)

267
Q

The higher the NA, the greater the ____________.

A

resolution

268
Q

lenses attached to revolving nosepiece; most commonly used are low power (10x), high power (40x), and oil immersion (50x or 100x)

A

objectives

269
Q

eye piece; usually 10x

A

ocular

270
Q

object in center of field at 1 magnification will be in center of field at other magnifications

A

parcentric

271
Q

object remains in focus from 1 magnification to another

A

parfocal

272
Q

more expensive objective that corrects for curvature of field; results in flat field with uniform focus

A

planachromatic objective

273
Q

ability to reveal fine detail and distinguish between 2 close points

A

resolution

274
Q

light control knob

A

rheostat

275
Q

Light intensity shouldn’t be regulated by ____________ or _________.

A

condenser or diaphragms

276
Q

type of bulb used for brightfield microscopy

A

Tungsten-halogen bulb

277
Q

image seen through microscope; upside down and reversed

A

virtual image

278
Q

distance between slide and objective

A

working distance

279
Q

Working distance ___________ with higher magnification objectives.

A

decreases

280
Q

brightfield microscope with special condenser; objects appear white against a black background

A

darkfield microscope

281
Q

What microscope can be used for the identification of live Treponema pallidum and other microorganisms?

A

darkfield microscope

282
Q

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

A

fluorescent microscope

283
Q

What microscope can be used in direct and indirect fluorescent antibody stains in microbiology and immunology?

A

fluorescent microscope

284
Q

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

A

interference contrast

285
Q

What microscope can be used for wet mounts?

A

interference contrast

286
Q

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

A

phase contrast

287
Q

What microscope can be used for manual platelet counts, urine sediments (good for hyaline casts)

A

phase contrast

288
Q

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

A

polarizing microscope

289
Q

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?

A

polarizing microscope

290
Q

beam of electrons passes through specimen, focused onto fluorescent screen or photographic plate; magnification >100,000x

A

transmission electron microscope

291
Q

What type of microscope can be used to see viruses and cells (organelles)?

A

transmission electron microscope

292
Q

beam of electrons strikes surface of specimen, focused onto photographic film or cathode ray tube; 3-D image; magnification >1,000x

A

scanning electron microscope

293
Q

What type of microscope can be used to see viruses and cells (surface)?

A

scanning electron microscope

294
Q

information science; science of processing data for storage, retrieval, and use

A

informatics

295
Q

use of computers and information systems to process and communicate information generated in clinical lab

A

laboratory informatics

296
Q

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

A

electronic medical record (EMR)

297
Q

physical parts of computer

A

hardware

298
Q

executes software instructions

A

central processing unit (CPU)

299
Q

working memory used for temporary storage of programs and data; content is lost each time computer is turned off

A

random access memory (RAM)

300
Q

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

A

read-only memory (ROM)

301
Q

magnetic-coated metal plate inside CPU for storing data

A

hard drive

302
Q

device that reads data stored on magnetic or optical disk and writes data onto disk for storage

A

disk drive

303
Q

CDs, DVDs; store data

A

optical disk

304
Q

input/output and information storage components

A

peripheral drives

305
Q

devices that deliver data to computer, e.g., keyboards, barcode readers, computer links (interfaces)

A

input devices

306
Q

devices by which computer delivers data, e.g., printers, monitors

A

output devices

307
Q

input/output device that allows computers to communicate over telephone lines

A

modem

308
Q

programs that tell computer what to do

A

software

309
Q

program that controls basic functions of computer, e.g., Microsoft Windows

A

operating system software

310
Q

programs designed to meet specific needs of users, e.g., word processing

A

application software

311
Q

application program that allows for manipulation of text; used to write letters, reports, etc.

A

word processor

312
Q

application program to manipulate numbers and perform mathematical calculations; used to prepare financial statements, budgets, etc.

A

spreadsheet

313
Q

application program to organize, store, sort, and retrieve data (words and numbers)

A

database

314
Q

program that provides access to internet, e.g., Microsoft Internet Explorer

A

browser

315
Q

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

A

Laboratory information system (LIS)

316
Q

information system to handle all informational needs of hospital, both clinical and administrative

A

Hospital information system (HIS)

317
Q

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

A

interface

318
Q

interface that transmits electronic information in 1 direction, e.g., a point-of-care analyzer downloads test results to LIS

A

unidirectional interface

319
Q

interface that transmits electronic information in 2 directions, e.g., the LIS downloads orders from the HIS and uploads results to the HIS

A

bidirectional interface

320
Q

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)

A

middleware

321
Q

documentation that LIS functions as expected; required by regulatory agencies

A

system validation

322
Q

computer network that connects computers in close geographic proximity (e.g., building, campus)

A

local area network (LAN)

323
Q

computer network that connects computers over large geographic area (e..g, multisite health-care facility, internet)

A

wide area network (WAN)

324
Q

global system of interconnected computer networks

A

internet

325
Q

computer network within an organization; access is usually restricted to employees

A

intranet

326
Q

extension of a private network onto the internet where it can be accessed by authorized clients, suppliers, etc.

A

extranet

327
Q

common set of signals and rules that network uses for communication

A

protocol

328
Q

one of the 1st protocols developed for connecting computers

A

ethernet

329
Q

originally developed as transfer protocol for internet; adapted for transmission in LANs

A

transmission control protocol/internet protocol (TCP/IP)

330
Q

standardized message protocol that facilitates exchange of medical data among computer systems

A

Health Level 7 standard (HL7)

331
Q

process by which lab ensures quality results by closely monitoring preanalytical, analytical, and postanalytical stages of testing

A

quality assessment or quality assurance (QA)

332
Q

everything that precedes test performance, e.g., test ordering, patient preparation, patient ID, specimen collection, specimen transport, specimen processing

A

preanalytical QA

333
Q

everything related to assay, e.g., test analysis, QC, reagents, calibration, preventive maintenance

A

analytical QA

334
Q

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

A

postanalytical QA

335
Q

all of the lab’s policies, processes, procedures, and resources needed to achieve quality testing

A

quality system

336
Q

part of analytical phase of quality assurance; process of monitoring results from control samples to verify accuracy of patient results

A

quality control (QC)

337
Q

sample that is chemically and physically similar to unknown specimen and is tested in exactly the same manner; monitors precision of test system

A

control

338
Q

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.

A

2 levels

pos & neg controls

339
Q

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

A

external QC

340
Q

electronic, internal, or procedural controls that are built into the test system

A

internal monitoring systems

341
Q

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

A

equivalent QC

342
Q

statistical parameters describing spread of data about mean, e.g., standard deviation, coefficient of variation, range; measurements of precision

A

measures of dispersion

343
Q

difference tween highest and lowest values in a data set

A

range

344
Q

sum of all observations divided by number of observations; average of all observations

A

mean

345
Q

statistical expression of dispersion of values around the mean; requires a minimum of 20 values

A

standard deviation

346
Q

expresses standard deviation as a percentage

A

coefficient of variation

347
Q

The _____ the CV, the _______ the precision.

A
  1. lower

2. greater

348
Q

Explain normal distribution/Gaussian bell-shaped curve.

A

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
Q

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

A

control limits

350
Q

normal distribution curve lying on its side, marked with mean, +/-1, +/-2, +/-3

A

Levey-Jennings chart

351
Q

a control result outside established limits

A

outlier

352
Q

6 consecutive control values on same side of mean

A

shift

353
Q

control values increasing or decreasing for 6 consecutive runs

A

trend

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