MOCK EXAM

Question 1

What is the preferred specimen for molecular techniques for diagnosis of inherited mutations?
a. DNA extracted from peripheral blood mature red cells
b. DNA extracted from peripheral blood white cells
c. RNA extracted from peripheral mature red cells
d. RNA extracted from fresh serum

Question 2

The biochemical tests performed on a gram positive bacillus were consistent with those of Corynebacterium diphtheriae. The MLS should now:
a. Perform a spore stain of the colonies
b. Determine if the isolate is toxigenic by performing an Elek test
c. Perform an agglutination test to confirm the organism’s identity
d. Subculture the organism to Hektoen enteric medium and examine for black colonies

Question 3

A decrease in serum haptoglobin accompanies which of the following?
a. Extravascular hemolysis
b. Intravascular hemolysis
c. Extramedullary hematopoiesis
d. Suppressed erythropoiesis

Question 4

The presence of waxy casts in a microscopic examination of urine is consistent with a diagnosis of:
a. Strenuous exercise
b. Pyelonephritis
c. Glomerulonephritis
d. Chronic renal failure

Question 5

The decreased release of thyroid-stimulating hormone (TSH) would result in which of the following actions from the hypothalamic pituitary-thyroid axis?
a. Decreased release of TSH from the pituitary gland
b. Increased release of TSH from the thyroid gland
c. Decreased release of thyroid hormones from the thyroid glands
d. Increased release of thyroid hormones from the thyroid glands

Question 6

Production of exotoxin A, which kills host cells by inhibiting protein synthesis and production of several proteolytic enzymes and hemolysins that destroy cells and tissue are factors that contribute to pathogenicity of which of the following organisms?
a. Pseudomonas aeruginosa
b. Burkholderia cepacia
c. Ralstonia pickettii
d. Burkholderia mallei

Question 7

Which of the following factors binds to platelets via the glycoprotein Ib/IX receptor?
a. von Willebrand factor
b. Factor II
c. Fibrinogen
d. Thrombin

Question 8

The respiratory culture of a patient with cystic fibrosis yielded gram-negative bacilli with the following reactions:

Oxidase: Positive
MacConkey agar: Positive
Glucose OF open: Positive
Gelatin hydrolysis: Positive
Pigment: Metallic green
Arginine dihydrolase: Positive
Growth at 42°C: Positive

Which of the following is the most likely identification of this organism?
a. Burkholderia cepacia
b. Pseudomonas aeruginosa
c. Acinetobacter baumannii
d. Stenotrophomonas xylosoxidans

Question 9

Which of the following cells can be described as neoplastic lymphocytes with noncleaved clumped nuclei and very basophilic cytoplasm with prominent vacuoles?
a. Reed Sternberg cells
b. Mantle cell lymphoma cells
c. Small cell lymphocytic lymphoma cells
d. Burkitt’s lymphoma cells

Question 10

When preparing fresh frozen plasma for transfusion, what compatibility testing is performed?
a. Perform a reverse grouping on donor plasma
b. Perform a reverse grouping on recipient plasma
c. Plasma must be HLA-compatible
d. No testing is required

Question 11

The following OGTT results are indicative of what state?

Fasting serum glucose: 124 mg/dL
2-hour post load serum glucose: 227 mg/dL

a. Normal
b. Diabetes mellitus
c. Addison’s disease
d. Hyperinsulinism

Question 12

A Prussian blue stain of a bone marrow shows blue granules present inside of macrophages. Which of the following disorders can be ruled out by this result?
a. Chronic disease
b. Lead poisoning
c. Iron deficiency
d. Iron overload

Question 13

A gram-negative diplococcus isolated from a patient’s CSF specimen gives the following results:

Chocolate agar: Growth
SBA: Growth
Oxidase: Positive
CTA test: Glucose, yellow; maltose, yellow; lactose, red; sucrose, red

This organism is most likely which of the following?
a. N. meningitides
b. N. gonorrhoeae
c. N. lactamica
d. M. catarrhalis

Question 14

What characteristic red cell shape is associated with extravascular hemolysis?
a. Burr cell
b. Schistocyte
c. Spherocyte
d. Target cell

Question 15

Two units of blood are ordered for a patient. Previous blood bank records indicate the patient had an anti-K 3 years ago. What is the next course of action for completing this order?

a. Select three random units of ABO compatible blood and crossmatch
b. Perform an immediate spin crossmatch on two K-negative units
c. Antigen type units for the K antigen and only crossmatch units positive for K
d. Antigen type units for the K antigen and only crossmatch units negative for K

Question 16

The antibody associated with type IV hypersensitivity is:

a. IgA
b. IgE
c. IgG
d. IgM
e. None of the above

Question 17

A child presents with an infected fingernail. The sample of the wound grows a pure culture. The gram-stained smear showed small gram-negative bacilli. Additional characteristics of this organism include:

Requires increased CO2 for growth
Oxidase-positive
Catalase (-), urease (-), indole (-)
Pits the agar during growth

The most likely identification of this organism is which of the following?
a. Weeksella virosa
b. Legionella spp.
c. Brucella melitensis
d. Eikenella corrodens

Question 18

All of the following hormones increase serum glucose levels with the exception of:
a. Glucagon
b. Cortisol
c. Epinephrine
d. Insulin

Question 19

Based on the following results, what is the most likely diagnosis?

ALP and GGT moderately increase
ALT, LD, and total bilirubin minimally increase

a. Cirrhosis
b. Biliary obstruction
c. Infectious hepatitis
d. Mumps

Question 20

Which of the following conditions is usually associated with thrombosis?
a. Factor XIII deficiency
b. Factor V Leiden mutation
c. Vitamin K deficiency
d. PAI-1 deficiency

Question 21

An antibody panel shows a pattern of anti-S, but anti-E cannot be ruled out on this initial panel. Which of the phenotyped cells below would be best to help in confirming only an anti-S is present?

a. E - e + S - s +
b. E + e + S + s +
c. E + e + S + s -
d. E + e - S - s +

Question 22

The most critical step in obtaining accurate Gram stain results is the application of which of the following?
a. Safranin
b. Crystal violet
c. Gram’s iodine
d. Acetone/ethanol

Question 23

Which cell is capable of both phagocytosis and antigen processing?
a. Basophil
b. Lymphocyte
c. Macrophage
d. Segmented neutrophil

Question 24

People who have anti-A and anti-B blood group antibodies detected in their serum are said to be of which blood group?
a. AB
b. O
c. A
d. B

Question 25

Which of the following is true regarding indirect bilirubin?
a. It requires an accelerator to react with the diazo reagent
b. It is also called delta bilirubin
c. It is calculated by adding the total bilirubin and direct bilirubin together
d. It is elevated in liver obstruction

Question 26

The examination question “What color is a positive spot indole test?” falls under which taxonomy level?
a. Level I
b. Level II
c. Level III
d. Level IV

Question 27

A positive result was obtained when a Venereal Disease Research Laboratory test was performed on a patient’s serum. The MLS should now:
a. Report syphilis antibodies present
b. Report positive for syphilis
c. Perform a treponemal test
d. Perform a nontreponemal test

Question 28

An X and V factor requirement test was performed on a Haemophilus isolate using the following protocol:

1. A TSB suspension of the organism was prepared
2. The organism suspension was swabbed to a chocolate agar plate
3. X and V factor disks were placed on the agar plate
4. The plate was incubated for 24 hours at 35°C in CO2

On examination, the plate showed growth over the entire plate. In troubleshooting the protocol and results, the correct determination is:
a. Organism should be identified as H. aegyptius
b. TSB is not an appropriate medium for preparing the organism suspension
c. Chocolate agar is not appropriate for use in the X and V factor requirement test
d. The chocolate plate should not have been incubated in CO2

Question 29

Which of the following conditions is associated with abnormal von Willebrand factor (VWF) cleaving protease?
a. Disseminated intravascular coagulation
b. Hemolytic uremic syndrome
c. March hemoglobinuria
d. Thrombotic thrombocytopenic purpura

Question 30

In salicylate overdose, what is the first acid base disturbance present?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis

Question 31

Which of the following red cell indices support microcytic hypochromic red cell morphology?

a. MCV (fL): 118; MCH (pg): 35; MCHC (g/dL): 34
b. MCV (fL): 75; MCH (pg): 30; MCHC (g/dL): 33
c. MCV (fL): 92; MCH (pg): 30; MCHC (g/dL): 34
d. MCV (fL): 67; MCH (pg): 22; MCHC (g/dL): 27

Question 32

According to AABB Standards, what is the minimum information required to be on a sample label for transfusion testing purposes?

a. First and last name of patient and date of collection
b. First and last name of patient, date of collection, and identification of phlebotomist
c. First and last name of patient, date of collection, identification of phlebotomist, and unique identifying number
d. First and last name of patient, date of collection, identification of phlebotomist, unique identifying number, and date of patient’s last transfusion

Question 33

The L-pyrolidonyl-b-naphthylamide (PYR) hydrolysis test is a presumptive test for which of the following streptococci?
a. Groups A and B
b. Streptococcus pneumoniae and group C
c. Group A and Enterococcus
d. Group A and Streptococcus bovis

Question 34

Which of the following ketones is(are) not detected using the reagent strip?
a. Acetoacetic acid
b. Acetone
c. b-Hydroxybutyric acid
d. All of the above are detected using the reagent strip

Question 35

What is the transport temperature of packed red blood cells?
a. Maintained at room temperature, not to exceed 25°C
b. Transported at temperatures below 6°C
c. Transported on ice not to exceed 10°C
d. Transported on dry ice at temperature below 25°C

Question 36

An anaerobic, box-shaped gram-positive bacillus is positive for the reverse CAMP test. This organism would also be:
a. Lipase positive
b. Indole positive
c. Lecithinase positive
d. Spore negative

Question 37

If the cytoplasm of a cell is very basophilic or blue when stained with Wright stain, which of the following does it contain?
a. Increased concentration of lysosomes
b. Increased number of Golgi bodies
c. Increased number of ribosomes
d. Increased number of mitochondria

Question 38

Which of the following is the best way to handle CAP Proficiency Testing samples?

a. Be extra careful and run the test samples several times before reporting to make sure your results are correct
b. Ensure that quality control and maintenance are acceptable before performing both patient testing and PT testing
c. Double-check your answers before mailing by checking your results with those from another laboratory
d. The most experienced MLS should do all proficiency testing to make sure it is right

Question 39

A fastidious organism gave the following results:

SBA growth: Negative
Growth: After 7 days
Niacin: Yellow
Acid-fast stain: Positive
Colonies: Buff color
68°C catalase: No bubbles

The organism is most likely:
a. M. scrofulaceum
b. M. xenopi
c. M. bovis
d. M. tuberculosis

Question 40

The most probable explanation for a patient who presents with an elevated osmolal gap, metabolic acidosis, and calcium oxalate crystals in the urine is:
a. Methanol intoxication
b. Ethanol overdose
c. Ethylene glycol intoxication
d. Cyanide poisoning

Question 41

How do sickle cells or spherocytes interfere with the erythrocyte sedimentation rate (ESR)?

a. Prevent rouleaux formation, so falsely decrease
b. Encourage rouleaux formation, so falsely increase
c. Agglutinate and increase red cell mass, so falsely increase
d. Decrease plasma viscosity, so falsely decrease

Question 42

What is the most likely cause of the ABO discrepancy below?

Patient:
Anti-A: 3+
Anti-B: 0
A1 cells: 1+
B cells: 4+
Autocontrol: Negative

a. Subgroup of A
b. Cold-reacting antibody
c. Neonatal patient
d. Rouleaux

Question 43

What is a point mutation?
a. Mutation of the stop codon
b. Replacement of one nucleotide in the normal gene with a different nucleotide
c. Addition of one nucleotide in the normal gene
d. Deletion of one nucleotide in the normal gene

Question 44

Hemoglobin electrophoresis is performed on a patient with known homozygous Hb S who has received red cell transfusions in the past week. Which hemoglobins would be expected on the gel?

a. Hb S and Hb F
b. Hb A and Hb F
c. Hb S, Hb A, and Hb F
d. Hb S, Hb A, Hb F, and Hb A2

Question 45

Which of the following is the correct location of enteric “H” antigens?
a. Flagella
b. Capsule
c. Cell wall
d. Cytoplasm

Question 46

You receive a blood gas sample on a patient who is in the emergency room for assessment of unexplained vomiting for the past 4 days and abnormal respirations. Which of the following interpretations best describes the patient’s blood gas results?
pH: 7.50
PO2: 85 mm Hg
PCO2: 55 mm Hg
HCO3- : 35 mmol/L

a. Partially compensated metabolic acidosis
b. Partially compensated metabolic alkalosis
c. Compensated metabolic alkalosis
d. Compensated metabolic acidosis

Question 47

The agency that is responsible for protecting workers’ health and well-being is:
a. CAP
b. TJC
c. NAACLS
d. OSHA

Question 48

A patient’s sample shows a large spike on serum protein electrophoresis in the g region. On further testing, the spike is shown to be mostly IgM. Which of the following is true regarding this patient’s diagnosis?

a. Further testing is necessary to determine if the patient has multiple myeloma
b. The patient had a high-protein meal just before the test
c. Most likely has Waldenstrom’s macroglobulinemia
d. May be in the early stages of combined variable immunodeficiency disease (CVID)

Question 49

Which one of the following tests on donor units is not required?
a. Anti-EBV
b. Antibody screen
c. Anti-HCV
d. West Nile virus

Question 50

The white count on an adult patient is 2.5 x 10^9/L. When the blood film is examined, the following results are obtained: 15% neutrophils and 75% lymphocytes. Reference ranges for these cell types, both relative and absolute, are as follows:

Neutrophils:
Relative %: 48-70
Absolute no. (x 10^9/L): 2.4-8.2

Lymphocytes:
Relative %: 18-42w
Absolute no. (x 10^9/L): 1.4-4.0

What conclusion can be made about the number of lymphocytes for this patient?

a. They are relatively increased but normal in absolute numbers
b. They are both relatively and absolutely increased
c. They are relatively decreased but absolutely increased
d. They are both relatively and absolutely decreased