PRE2 Flashcards
1
Q
What is used to assess collateral circulation before radial artery puncture
a. Modified Bloom’s test
b. Modified Allen’s test
c. Rivalta’s test
d. Frei test
A
B. Modified Allen’s test - performed before arterial puncture to assess the collateral circulation via blood supply from ulnar artery
a. under sperm vitality
c. simple inexpensive; differentiate transudate from exudate
d. diagnostic test for a bacterium C. trachomatis (lymphogranuloma venereum)
2
Q
What is 86 mg/dl glucose in SI unit?
a. 4.73 mmol/L
b. 4.79 mmol/L
c. 4.73 g/L
d. 4.79 g/L
A
A. 4.73 mmol/L
Conversion factor for glucose: 0.0555
86 x 0.055
3
Q
Which anticoagulant has the least interference with chemical analysis?
a. EDTA
b. citrate
c. heparin
d. oxalate
A
C. heparin
Physiological anticoagulant (in vitro and in vivo)
Variant used for most tests: LITHIUM HEPARIN
Anticoagulant used in CARDIOPULMONARY BYPASS (CPB)
Sodium heparin may interfere with electrolyte determination - Falsely elevate
4
Q
At room temperature, glucose is metabolized at which rate?
a. 10 mg/dl/hr
b. 17 mg/dl/hr
c. 2 mg/dl/hr
d. 7 mg/dl/hr
A
D. 7 mg/dl/hr
“I want 7 rooms and 2 refrigerators”
Glucose analysis - subjected to glycolysis
Room temp = 7 mg/dl/hr
Ref. temp = 2 mg/dl/hr
- Separate the serum from the cells within 30 mins. to prevent glycolysis.
- The presence of cells, including LEUKOCYTES, may cause a SUBSTANTIAL DECREASE in glucose
- Usage of GRAY-colored evacuated tube
a. glucose analysis
b. to prevent glycolysis- sodium fluoride - antiglycolytic agent
- oxalate - anticoagulant
5
Q
Which test monitors blood glucose control for the past 3 months?
a. HbA1c test
b. fructosamine
c. OGTT
d. micral test
A
A. HbA1c test (glycated hemoglobin)
1. hemoglobin which is chemically linked with glucose
2. measures long-term glucose control
- monitors the glucose intake for the past 2-4 months (ave. 3 months)
- life span of RBC: 120 days (4 months)
3. rate of production is dependent on average blood glucose concentration and red blood cell lifespan
4. not recommended for px with low RBC life span (ex. thalassemia, hemoglobinopathies) may shorten the exposure of hemoglobin to glucose; HbA1c will be DECREASED – fructosamine test is done
b. glycated serum proteins (e.g. albumin, globulins); monitors short-term glucose control (2-3 weeks) indicated for patients with shortened RBC lifespan; Albumin half-life= 20 days
c. diagnosis of diabetes
d. diagnosis for a complication in diabetes (diabetic nephropathy)
6
Q
What is the major structural protein of LDL?
a. Apo A-1
b. Apo B-48
c. Apo B-100
d. Apo C-II
A
C. Apo B-100
7
Q
Which of the following is also known as sinking pre-B lipoprotein?
a. Chylomicron
b. IDL
c. B-VLDL
d. Lp(a)
A
D. Lp(a)
8
Q
Smallest and most dense lipoprotein particle
Contains majority of protein (45-55%) - APO A-1
“GOOD cholesterol”
a. transports cholesterol from peripheral tissue to the liver
b. non-atherogenic - not able to create plaques
c. promotes negative risk in CHD
A
HDL
High Density Lipoproteins
9
Q
Transport lipids (hydrophobic) within the system
Composed of lipids and proteins, which are called Apolipoproteins
A
Lipoproteins
10
Q
Major Lipoproteins
A
HDL, LDL, VLDL, Chylomicron
11
Q
Minor Lipoproteins (vowels)
A
IDL, Lp(a)
12
Q
Abnormal Lipoproteins (consonant)
A
LpX, B-VLDL
13
Q
Rich in cholesteryl esters (50%)
APO B-100
“BAD cholesterol”
a. most atherogenic - build up cholesterol and blockage
b. transports cholesterol from the liver to the peripheral tissue
c. smaller in size as compared to Chylomicrons and VLDL
A
LDL
Low density lipoprotein
14
Q
Rich in triglycerides (65%)
a. large size: accounts for the turbidity of FASTING hyperlipidemic plasma
APO B-100
Transports ENDOGENOUS TAG (from the liver) to the peripheral tissue
A
VLDL
Very low-density lipoprotein
15
Q
Largest lipoprotein
a. Rich in TAG (95%)
b. POSTPRANDIAL turbidity (after eating)
Least dense - readily float to the top of the stored plasma that forms a CREAMY layer
APO B-48
Transports EXOGENOUS/ dietary TAG (from food) to the liver and peripheral cells
A
Chylomicrons
16
Q
Minor lipoprotein
VLDL remnants
No TAGs
A
IDL
Intermediate-density lipoproteins
17
Q
Minor lipoprotein
LDL-like particle that contains APO(A) linked to Apo B-100
SINKING PRE-B LIPOPROTEIN
a. Co-migrates with VLDL in electrophoresis (‘pre-B’)
b. Has similar density with LDL (‘Sinking’)
A
Lp(a)
“Low pressure area - sinking ship”
18
Q
Abnormal lipoprotein
Found in patients with cholestasis and LCAT defect
LCAT - important in the reverse cholesterol pathway
A
Lipoprotein X (LpX)
19
Q
Abnormal lipoprotein
Floating B-lipoprotein
a. migrate similar to LDL, density similar to VLDL
Associated in patients with Type III hyperlipidemia
A
B-VLDL
“ang BARKO nag-FFLOAT sa dagat”
20
Q
Which of the following uses potentiometry
a. pO2
b. Potassium
c. pCO2
d. Sodium
A
C. pCO2
Potentiometry = pH and pCO2
Amperometry = pO2
Ion selective electrode = Potassium, Sodium
21
Q
Acid-Base Balance
Potentiometry
Glass electrode - H+ ion concentration ?
Severinghaus electrode - pH change?
A
pH, pCO2
Glass electrode - H+ ion concentration = pH
Severinghaus electrode (modified pH or glass electrode) - pH change = pCO2
- pH electrode immersed in HCO3- solution
- electrode permeable in carbon dioxide
22
Q
Acid-Base Balance
Amperometry or Polarography
Clark electrode - current flow?
A
pO2
23
Q
In enzyme assays, which method is more advantageous
a. Forward reaction
b. Reverse reaction
c. Any of the above
d. None of the above
A
B. Reverse reaction
More advantageous
Shorter reaction Rate
24
Q
Enzymatic Assays
Creatinine kinase
Forward: ?
Reverse: ?
A
Creatinine kinase
Forward: Tanzer-Gilvarg
Reverse: Oliver-Rosalki-Hess
25
Enzymatic Assays
Lactate Dehydrogenase
Forward: ?
Reverse: ?
Lactate Dehydrogenase
Forward: Wacker
Reverse: Wroblewski-LaDue
26
Enzymatic Assays
Lactate Dehydrogenase
Forward: ?
Reverse: ?
Lactate Dehydrogenase
Forward: Wacker
Reverse: Wroblewski-LaDue
27
Which is the most potent of the estrogens
a. Estradiol
b. Estrone
c. Testosterone
d. Estriol
A. Estradiol (highest conc. in nonpregant women)
A, B, D = estrogens
Estrone - detectable but lower concentration
Estriol - undetectable in nonpregnant women (x 1000-fold in pregnant women)
Testosterone - principal most potent androgen
28
Increased cortisol because of excessive activity of pituitary gland causes?
a. cushing's disease
b. hashimoto's thyroiditis
c. grave's disease
d. cushing's syndrome
A. Cushing's disease
29
Endocrine Disorders
Primary?
Secondary?
Tertiary?
a. Pituitary gland
b. Gland
c. Hypothalamus
Primary = Gland (usually inverse relationship among results)
Secondary = Pituitary gland (-SH) (usually direct relationship)
Tertiary = Hypothalamus (-RH) (usually direct relationship)
a. hypothalamus will release a releasing hormone which will stimulate pituitary gland
b. pituitary gland will release stimulating hormone which will stimulate the target gland
30
Overexposure to glucocorticoids, like cortisol
Cause:
a. cortisol-secreting tumor in adrenal glands
b. medication (e.g. Prednisone)
Increased cortisol, Decreased ACTH
Cushing's Syndrome
aka Primary hypercortisolism/ Adrenal cushing's syndrome
ACTH - produced by pituitary gland
31
Cause: Pituitary adenoma
Increased ACTH, Increased cortisol
Cushing's disease
aka Secondary hypercortisolism/ Pituitary Cushing's syndrome
Tumor-secreting ACTH
32
Cause: CRH-secreting tumors (rare)
Increased corticotropin-releasing hormone (CRH)
Increased ACTH, Increased cortisol
Cushing's disease
aka Tertiary hypercortisolism
33
What is the blood alcohol volume that can be considered presumptive evidence for drunk driving?
a. 20mg/dl
b. 25mg/dl
c. 75mg/dl
d. 100mg/dl
D. 100mg/dl
Blood alcohol concentration - presumptive evidence of driving under the influence of alcohol = 0.10% (w/v) or 100mg/dl
34
Which statistical test is used to compare the means of 2 groups
a. F test
b. Paired t test
c. Chi-squared test
d. Pearson correlation
B. Paired T-test
35
QC
SD, Precision
F test ("SPF")
36
QC
Accuracy, Mean
T test ("TAM")
37
Which line on a graph is designated for independent variable?
a. X-axis
b. Y-axis
c. Z-axis
d. A-axis
A. X-axis
38
Cartesian Plane
Horizontal, Abscissa, Independent variables
X-axis ("HAXI")
39
Cartesian Plane
Vertical, Ordinate, Dependent variables
Y-axis ("VOYD")
40
Cartesian Plane
Vertical, Ordinate, Dependent variables
Y-axis ("VOYD")
41
Which refers to 6 consecutive values that distribute themselves on one side of the mean?
a. Trend
b. Drift
c. Outlier
d. Shift
D. Shift
42
QC
Gradual change
Values continue to either increase or decrease over a period of 6 consecutive days
Most common cause:
a. Deterioration of reagent
b. Deterioration of control samples
Trend (drift)
Ex. 7T rule violation
43
QC
Abrupt, sudden change in control values
Six or more consecutive values that distribute on one side of the mean
Most common cause: Improper calibration of instrument
Shift
Ex. 10X violation
44
QC
Highly deviating value
Outlier
Must not be included in the interpretation
45
Westgard Multirules
NL =
N = number of control values being observed
L = control limit being exceeded
46
Westgard Multirule
1 control value being observed
2SD - control limit being exceeded
1 control exceeds +-2s from mean
"WARNING" rule - signifies that an error may be present
Continue to run
Random error
1 2s
47
Westgard Multirule
1 control exceed +-3s from mean
Unacceptable random error
Rejection rule
Rerun control
1 3s
48
Westgard Multirule
One control exceeding +-2s and another exceeding +-2s
Random error
Rejection rule
R 4s
49
Westgard Multirule
2 control exceed +- 2s from mean on the same side
Systematic error
Rejection rule
2 2s
50
Westgard Multirule
4 control exceeds +-1s from mean on the same side
Systematic error
Rejection rule
4 1s
51
Westgard Multirule
10 consecutive controls on same side of mean
Systematic error
Rejection rule
Form of Shift (abrupt change)
10x
52
Which is often calculated to identify the cause of metabolic acidosis?
a. Osmolal gap
b. Friedewald equation
c. Anion gap
d. DeLong
C. Anion Gap
B, D = LDL approximation
A = used for detection of osmotically active substances (serum osmolality, electrolyte determination)
53
Difference between unmeasured anions and unmeasure cations
Indicates INCREASE in one or more unmeasured anions
Forms as a QC for electrolytes determination
Also used to identify the cause of metabolic acidosis
Anion Gap
54
Decreased Anion Gap
Decrease in unmeasured anions
Hypoalbuminemia
(cirrhosis)
55
Decreased Anion Gap
Increase in unmeasured cations
Hypercalcemia
(multiple myeloma)
56
Acid Base Disordes
Hypo/Hyperventilation?
Excretion/ reabsorption of bicarbonate in the tubules?
Lungs, CO2 = Hypoventilation (retain CO2) /
Hyperventilation (expel CO2)
Kidney, HCO3- = Excretion/ reabsorption of bicarbonate in the tubules
57
Acid Base Disorder
(match disease with condition)
1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabolic Acidosis
4. Metabolic Alkalosis
a. Increased AG
b. Vomiting
c. Emphysema
d. Anxiety
Respiratory Acidosis = Emphysema
Respiratory Alkalosis = Anxiety
Metabolic Acidosis = Increased AG
Metabolic Alkalosis = Vomiting
58
Which BSC allows 70% air to recirculate and the remaining 30% to be exhausted outside the building?
a. Class I BSC
b. Class IIA BSC
c. Class IIB BSC
d. Class III BSC
B. Class IIA BSC
59
BSC
Allow room air (unsterilized) to pass into the cabinet and aorung the material within, sterilizing only the air to be exhausted
Class I BSC
60
BSC
70% recirculated, 30% exhausted
SARS-COV-2
Class IIA-1 BSC
61
BSC
Minimum inflow velocity of 100ft/min. A negative air pressure plenum surrounds all contaminated positive pressure plenums
Class IIA-2 BSC
62
BSC
30% recirculated, 70% exhausted
Class IIB-1 BSC
63
BSC
No recirculation. Air is discharged outside the building. Selected if radioisotopes, toxic chemicals or carcinogens will be used
Class IIB-2 BSC
64
BSC
Designed for work with BSL-4 pathogenic agents, providing maximum protection. The enclosure is gas-tight, and gloves attached to the front prevent direct contact with hazardous materials. All entering and exiting the BSC is sterilized by the HEPA filter
Class III BSC
65
Dimorphic fungi, such as Coccidioides, are under which biosafety level?
a. BSL-1
b. BSL-2
c. BSL-3
d. BSL-4
C. BSL-3
66
BSL
Not harmful to healthy individuals
Bacillus subtilis
Mycobacterium gordonae
BSL-1
67
BSL
Common agents of infectious disease
Used in diagnostic, teaching, and other laboratories
Most viruses (incl. HIV)
S. aureus
SARS-COV-2
BSL-2
68
BSL
Aerosolized, highly infectious, possible bioterrorism agent
F. tularensis
Brucella spp.
Systemic fungi (Coccidioides)
C. burnetii
Y. pestis
BSL-3
69
BSL
Exotic viruses with no available vaccine/ treatment
Life-threatening diseases
Novel viruses
Smallpox
Filovirus
Arenavirus (Lassa fever)
EBOLA virus
BSL-4
BSC 3
70
The chain of infection includes a Source, Mode of transmission and a?
a. Susceptible host
b. Vector
c. Disease
d. Virus
A. Susceptible host
Chain of Infection - an important epidemiological model that explains how infectious diseases result from the interaction of agent, host, and environment
71
6 parts of the Chain of Infection
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
72
Most effective way to break the chain of infection
Hand hygiene
Portal of exit
Mode of transmission
Portal of entry
73
Hand Hygiene
1. "Father of Hand Hygiene"?
2. Visibly soiled (Handwashing) for how long?
3. Not visibly soiled (Handrub - alcohol based) for how long? what position/ direction?
Started by Ignaz Philipp Semmelweis
Visibly soiled (Handwashing) for 40-60s
Not visibly soiled (Handrub - alcohol based) for 20-30s
74
Most important part of Hand hygiene
Mechanical action of the rubbing the hands together and soaping under the fingernails
75
What is the safest method of strerilization?
a. Autoclave
b. Dry oven
c. Incineration
d. Filtration
C. Incineration
76
What is the safest method of strerilization?
a. Autoclave
b. Dry oven
c. Incineration
d. Filtration
C. Incineration
77
Which method can be used to sterilize heat-sensitive culture media?
a. Autoclave
b. Membrane filtration
c. Both A and B
d. None of the above
B. Membrane filtration
a. Autoclave - heat stable
78
Laboratory Safety
Process that kills ALL FORMS of microbial life, including BACTERIAL SPORES
Sterilization
Bacterial Spores are usually highly resistant - they contain DIPICOLINIC ACID
Either accomplised by
a. Physical = heat
b. Chemical/ Cold method
79
Laboratory Safety
Process that destroys pathogenic organisms, NOT INCLUDING SPORES
Disinfection
Physical - Boiling, Pasteurization, Non-ionizing radiation
Chemical - Alcohols, Aldehydes, Halogens, Heavy metals, Quaternary ammonium compounds, Phenolics
80
Physical Sterilization
SAFEST method to ensure that NO INFECTIVE MATERIALS REMAIN in samples or containers when disposed
Subjected to extremely high temp. (980C)
Incineration
81
Physical Sterilization
Moist heat
Steam under pressure - 121C, 15psi
Used to sterilize biohazardous trash (30-60 mins) and heat-stable objects (15 mins)
Autoclave
82
Physical Sterilization
Dry heat
160-180C
Used to sterilize items such as glassware, oil, petrolatum, or powders
Oven
83
Physical Sterilization
METHOD OF CHOICE for antibiotic solutions, toxic chemicals, radioisotopes, vaccines and carbohydrates, which are ALL HEAT SENSITIVE
Cellulose acetate/ nitrate membrane or HEPA
Filtration
84
Physical Sterilization
Used for sterilizing disposables such as plastic syringes, catheters, or gloves before use
High-energy GAMMA rays
Ionizing radiation
85
Laboratory Safety
Chemical sterilant
a. Ethylene oxide (EtO) - MOST COMMON cold sterilant
b. Formaldehyde vapors/ Vapor-pahse H2O2 - BSC
c. Gluteraldehyde/ Peracetic acid - surgical instruments
Cold Sterilization
86
Serpentine growth pattern in Middlebrook 7H10 indicates which organism?
a. M. leprae
b. P. aeruginosa
c. S. marcescens
d. M. tuberculosis
D. M. tuberculosis
Middlebrook 7H10 - agar based (SERPENTINE)
Lowenstein-Jensen medium (egg-based), MTB is CAULIFLOWER like colonies (rough, buff)
87
Confluent growth
P. aeruginosa
88
Red pigment
S. marcescens
89
Non-cultivatable in artificial media
a. Armadillo and footpads of mice
Hansen's disease/ Leprosy
a. Dx: ulcerative skin leasion, peripheral nerve involvement (sensory impairment
M. leprae
90
Which agent is the most common cause of aseptic meningitis?
a. Filovirus
b. C. neoformans
c. West Nile Virus
d. Enterovirus
D. Enterovirus
Aseptic meningitis - inflammation of brain or spinal cord meninges; involves non bacteria
a. Hemorrhagic fever
b. Aseptic meningitis - but not most common
c. Meningitis, encephalitis - but not most common
91
Picornaviridae family
Transmitted by means of ingestion
1. Poliovirus - flaccid paralysis
2. Coxsackie virus - herpangina, HFMD, pleurodynia
3. Echovirus - enteric cytopathic human orphan virus
Tx: maily supportive
Enterovirus
Enterovirus - acid resistant ('enteric')
Rhinovirus - acid sensitive (agent of common cold)
92
Which parasite may cause eosinophilic lung infiltration accompanied by blood eosinophilia?
a. T. spiralis
b. A. lumbricoides
c. Any of the above
d. None of the above
B. A. lumbricoides
a. T. spiralis - highest cause of blood eosinophilia
Lung infiltration (ASH)
- Ascaris
- Strongyloides
- Hookworms
93
Pulmonary eosinophilis infiltration due to migrating parasites
Accompanied by blood eosinophila and radiographic shadowing
Heart-lung migration
a. ASH
b. Dirofilaria immitis - Dog heart worm; "coin lesions"
Loeffler's Syndrome
94
Loeffler's syndrome (WAKANA dx)
Associated with vertical transmission and congenital infections
Ancylostoma duodenale (Hookworm)
95
Which parasite may resemble S. haematobium but acid-fast positive?
a. S. japonicum
b. S. mekongi
c. S. intercalatum
d. S. mansoni
C. S. intercalatum
96
Unoperculated, embryonated trematode
Blood Flukes
Embryonated flukes or trematodes = "CHOS"
Clonorchis
Heterophyes
Opistorchis
Schistoma - unoperculated
97
Blood Flukes
Small lateral spine/ lateral knob
S. japonicum
98
Blood Flukes
Large lateral spine
S. mekongi - similar, much smaller
S. mansoni
(mansoni = 'mansion' malaki = large)
M-M mansoni-mekongi
99
Blood Flukes
Large terminal spine
Found in urine specimen
S. intercalatum - similar, acid fast positive
S. haematobium
'um-'um
100
Which organism is found mostly in the crypts in the duodenum?
a. Cryptosporidum spp.
b. G. lamblia
c. E. histolytica
d. E. vermicularis
B. G. lamblia (small intestine)
All amoeba are found in the intestine
a. Found in small intestine
b. Found in large intestine
d. Nematode found in the large intestine (T. trichura)
101
Characteristic old man's eyeglases and "falling leaf" motility
Found commonly on the crypts in the duodenum
Entero Test or String test - used to detect Giardia spp. in duodenal specimen
GAY BOWEL SYNDROME
Giardia lamblia
102
Autofluorescence requires no stain and is recommended for the indentification of which organism?
a. E. histolytica cysts
b. T. gondii tachyzoites
c. D. fragislis trophozites
d. C. cayetanensis oocyts
D. C. cayetanensis oocyts
Autoflourescence - distinct test for cyclospora
Coccidians - weakly acid fast
103
How will you report the grading for Uric acid crystals?
a. Average/hpf
b. Average/lpf
c. RFMM/ hpf
d. RFMM/lpf
C. RFMM/hpf
ROWR = Average/hpf
CastCrAb = Average/lpf
TTBAYN = RFMM/hpf
MucuSecs = RFMM/lpf
104
Which of the following indicates serious hazard?
a. 1
b. 2
c. 3
d. 4
C. 3
Degree of Hazard
"NoSMSex"
0 = No or minimal
1 = Slight
2 = Moderate
3 = Serious
4 = Extreme
105
Glucose, amino acids, and some salts are actively reabsorbed in which tubule
a. Proximal CT
b. Distal CT
c. Collecting tubule
d. Ascending LH
A. Proximal CT
Tubular Reabsorption - Water can be reabsorbed in all areas except ASCENDING LOOP OF HENLE - Highly Impermeable to water
106
Tubular reabsorption (Active or Passive, Location)
1. Glucose, Amino acids, Salts
2. Chloride
3. Sodium
1. Active, PCT
2. Active, ASC LH
3. Active, PCT, DCT
107
Tubular reabsorption (Active or Passive, Location)
1. Water
2. Urea
3. Sodium
1. Passive, PCT, DES LH, CD
2. Passive, PCT, ASC LH
3. Passive, ASC LH
108
What clarity will you give if the print is blurred through the urine?
a. Hazy
b. Cloudy
c. Turbid
d. Milky
B. Cloudy
109
Physical Examination of urine
1. Few particulates. print easily seen
2. Print cannot be seen
3. No visible particulates, tranparent
4. May precipitate or be clotted
5. Many particulates, print blurred through urine
1. Hazy
2. Turbid
3. Clear
4. Milky
5. Cloudy
110
Cabbage or hops urine odor maybe observed in which condition?
a. Isovaleric acidemia
b. Hawkinsinuria
c. Phenylketonuria
d. Methionine malabsorption
D. Methionine malabsorption
111
1. Aromatic odor
2. Burnt sugar odor
3. Sweaty feet odor
4. Mousy odor
5. Odorless urine
1. Normal urine odor
2. Maple syrup urine disease (MSUD)
3. Isovaleric acidemia
4. Phenylketonuria
5. Acute tubular necrosis
112
1. Ammoniacal odor
2. Rotten egg odor
3. Swimming pool/ bleach-like/ chlorine odor
4. Fishy odor
1. UTI or bacterial infection
2. Cystinuria
3. Hawkinsinuria
4. Trimethylaminuria
113
What is being used for the acid protein precipitation test?
a. 3%SSA
b. 3%TCA
c. 5%SSA
d. 5%TCA
A. 3% SSA (sulfosalicylic acid)
Test to measure all fractions of protein and made used to detect globulin (in cases of multiple myeloma)
Px with multiple myeloma have urine containing Bence Jones protein (globulins)
114
What are oval fat bodies?
a. Squamous cells
b. Fatty casts
c. WBC
d. RTE
D. RTE (with reabsorbed lipid)
OVAL FAT BODIES
Seen in cases of lipiduria
1. Nephrotic syndrome - a group of symptoms that are characterized by heavy proteinuria, hyperlipidemia, and lipiduria
2. Lab. Dx:
a. Hypoalbuminemia
b. Increased BUN, Creatinine, Uric acid
c. Hyperlipidemia
d. Proteinuria, Lipiduria (Oval fat bodies, Fatty casts, Cholesterol crystals)
115
RTE with non-lipid vacuole
Seen in cases of ACUTE TUBULAR NECROSIS (odorless urine)
ATN - one of the most common causes of acute kidney injury
Classification
a. Toxic ATN - caused by free Hgb/ myoglobin, medications (Aminoglycosides, statins)
b. Ischemic ATN - low blood pressure, poor perfusion of blood to kidneys
Bubble Cells
Note:
Aminoglycosides - nephro-ototoxic
Statin - anti-cholesterol lowering drug; rhabdomyolysis
116
Weddelite
Envelope/ pyramidal shape
Most common component of renal calculi
Calculi: dark color, very hard, rough surface
Calcium oxalate dihydrate
117
Whewellite
Dumbbell shaped
Seen in ethylene glycol (antifreeze) poisoning
Calcium oxalate monohydrate
118
Dumbbell shaped similar with CaOx monohydrate
Not clinically significant
Calcium carbonate
Acid: Calcium oxalate monohydrate
Alk: Calcium carbonate
119
Apatite
Colorless, flat rectangular plates or prisms in rosette
Calculi: Pale and friable
Calcium phosphate
'phlat, phlate, phrism, phale, phriable phosphate'
120
Yellow-brown pleomorphic (wedges, whetstone, rhombic, 4/6-sided plates) crystals; lemon-shaped
Calculi: yellow to brownish red, mod. hard
Uric Acid
121
Hexagonal plates
Non-birefringent
Confirmed by Cyanide-nitroprusside test
Calculi: yellow-brown resembling an old soap, somewhat greasy
Seen in Fanconi's syndrome
Cystine
122
Magnesium ammonium phosphate
Struvite
Coffin-lid appearance
Can be seen in infections by urea-splitting organism like Proteus spp.
Triple Phosphate
123
Colorless-yellow or brown needle
- Rhombic
- Whetstones
- SHEAVES OF WHEAT
Confirmed by DIAZO reaction
Sulfonamide crystals
124
What is/are the test that may be used to detect urinary mucopolysaccharides?
a. Acid-albumin
b. CTAB
c. Metachromatic spot test
d. All of the above
D. All of the above
mucopolysaccharidoses - a disease that results from the accumulation of mucopolysaccharides
(+) result
A, B = white turbidity
C = spot
125
Which tube is used to obtain gastric fluid by inserting it through the nose?
a. Levin tube
b. Rehfuss tube
c. Diagnex
d. None of the above
A. Levin tube (nasogastric tube)
B. inserted to the mouth
C. tubeless test - spx: urine (+) blue
126
What color is the positive result for Guaiac-based FOBT?
a. Yellow
b. Red
c. Blue
d. Green
B. Blue
Principle: Pseudoperoxidase activity
Reagent: Color developer - NaOH
127
What are these clusters of columnar cells that are seen in patients with bronchial asthma?
a. Curschmann's spirals
b. Charcot-Leyden crystals
c. Dittrich plugs
d. Creola bodies
D. Creola bodies
A, B, D - 3C's of bronchial asthma
C. - gray-colored foul smelling mass formerly regarded as sign of TB
128
Cluster of columnar ciliated bronchial epithelium seen in BRONCHIAL ASTHMA
a. Curschmann's spirals
b. Charcot-Leyden crystals
c. Creola bodies
C. Creola bodies
129
Darkly stained, elongated mucus plugs seen in BRONCHIAL ASTHMA (mucus = sign of irritation)
a. Curschmann's spirals
b. Charcot-Leyden crystals
c. Creola bodies
A. Curschmann's spirals
130
Remnants of infiltrated eosinophil (allergy)
Seen in BRONCHIAL ASTHMA
a. Curschmann's spirals
b. Charcot-Leyden crystals
c. Creola bodies
B. Charcot-Leyden crystals
131
What is the color of the health hazard in NFPA chart
a. White
b. Blue
c. Red
d. Yellow
B. Blue
NFPA Reference Chart
'You Were Born Right' - Yellow White Blue Red
132
In flow cytometry, this cell marker can be used to identify pluripotential hematopoietic stem cells?
a. CD56
b. CD71
c. CD34
d. CD59
C. CD34
133
Flow cytometry markers
- CD34, CD38, HLA-DR, CD117, CD13, CD33, CD59
- CD15, CD11b, CD16, CD56, CD64, CD71, Glycophorin A
- CD61(GpIIIa), CD42 (GpIb), Tdt, CD19, CD22, CD79, CD55
1. HEMATOPOIETIC STEM CELLS:
2. Granulocytic myeloblast:
3. Panmyeloid markers:
1. Hematopoietic stem cells: CD34
2. Granulocytic myeloblast: CD34, CD38, HLA-DR, CD117
3. Panmyeloid markers: CD13, CD33
134
Flow cytometry markers
- CD34, CD38, HLA-DR, CD117, CD13, CD33, CD59
- CD15, CD11b, CD16, CD56, CD64, CD71, Glycophorin A
- CD61(GpIIIa), CD42 (GpIb), Tdt, CD19, CD22, CD79, CD55
1. Myelocyte
2. Band
3. NK CELLS
1. Myelocyte: CD11b
2. Band: CD16, CD13
3. NK cells: CD16, CD56
135
Flow cytometry markers
- CD34, CD38, HLA-DR, CD117, CD13, CD33, CD59
- CD15, CD11b, CD16, CD56, CD64, CD71, Glycophorin A
- CD41 (gpIIb), CD61(GpIIIa), CD42 (GpIb), Tdt, CD19, CD22, CD79, CD55
1. Monocytic
2. ERYTHROID
3. MEGAKARYOCYTIC
4. Lymphoid
1. Monocytic: CD13, CD33, CD11b, CD64, HLA-DR
2. Erythroid: CD71 (transferrin receptor), glycophorin A
3. Megakaryocytic: CD41 (gpIIb), CD61(GpIIIa), CD42 (GpIb)
4. Lymphoid B&T: CD34, Tdt, HLA-DR
2. Erythroid = M6
3. Megakaryocytic = M7
CD41 (gpIIb), CD61(GpIIIa) = Glanzmann's thrombasthenia
CD42 (GpIb) = von Willebrand factor - BSS
136
Flow cytometry markers
- CD34, CD38, HLA-DR, CD117, CD13, CD33, CD59
- CD15, CD11b, CD16, CD56, CD64, CD71, Glycophorin A
- CD41 (gpIIb), CD61(GpIIIa), CD42 (GpIb), Tdt, CD19, CD22, CD79, CD55
1. Earliest B cell marker
2. Immature T
3. DECAY-ACCELERATING FACTOR
4. MEMBRANE INHIBITOR OF REACTIVE LYSIS
1. Earliest B cell marker: CD19, CD22, CD79
2. Immature T: CD34, Tdt
3. Decay-accelerating Factor: CD55
4. Membrane inhibitor of Reactive lysis: CD59
CD55, CD59 - deficiency - Dx for Paroxysmal Nocturnal Hemoglobinuria
137
Flow cytometry markers
- CD34, CD38, HLA-DR, CD117, CD13, CD33, CD59
- CD15, CD11b, CD16, CD56, CD64, CD71, Glycophorin A
- CD41 (gpIIb), CD61(GpIIIa), CD42 (GpIb), Tdt, CD19, CD22, CD79, CD55
1. Earliest B cell marker
2. Immature T
3. Decay-accelerating Factor
4. Membrane inhibitor of Reactive lysis
1. Earliest B cell marker: CD19, CD22, CD79
2. Immature T: CD34, Tdt
3. Decay-accelerating Factor: CD55
4. Membrane inhibitor of Reactive lysis: CD59
138
Which erythrocyte metabolic pathway produces a protein necessary for oxygen delivery to tissues?
a. Embden-Meyerhoff Pathway
b. Rapoport-Leubering Pathway
c. Hexose Monophosphate Shunt
d. Methemoglobin Reductase Pathway
B. Rapoport-Leubering Pathway
139
RBC Metabolic Pathway
1. ATP
2. Reduced NADPH
a. Reduced NADPH is necessary to convert oxidized glutathione into reduced glutathione
b. Globin will denature, forming HEINZ bodies that will eventually cause membrane damage
3. 2,3 DPG
4. Maintenance of iron in the ferrous state Fe2+ (active state)
1. Embden-Meyerhoff Pathway
2. Hexose Monophosphate Shunt
3. Rapoport-Leubering Pathway
4. Methemoglobin Reductase Pathway
Glutathione - important for the maintenance of Hgb
Heinz bodies - forms in decreased level of HMS
140
Which protein is necessary for clot retraction?
a. ADP
b. Thrombopoietin
c. Thrombosthenin
d. Thromboxane A2
C. Thrombosthenin (actomyosin complex)
A, D, - produced by platelets necessary for plt. activation and plt. aggregation
B. - platelet production
141
Platelet Ultrastructure
1. What zone contains:
Glycocalyx - external surface of platelet
Plasma membrane - phospholipids (coagulation factor)
2. What zone contains:
Microfilaments
Microtubules
Thrombosthenin/ actomyosin complex
3. What zone contains:
Granules (alpha and delta)
Mitochondria
4. What zone contains:
Surface-connected canalicular system/ Open canalicular system
Dense tubular system ("Control center") - for platelet activation
- sequesters calcium, enzyme location necessary for plt. activation and aggregation
1. Peripheral zone - outermost
2. Sol-Gel zone
3. Organelle zone
4. Membranous zone - innermost
Majority of coagulation factors = Serine protease
Delta granules = "CAMPAS" calcium, ADP, magnesium, pyrophosphate, ATP, serotonin
142
According to WHO, AML is characterized as having how many blasts?
a. 20%
b. 30%
c. 40%
d. 50%
A. 20% - WHO
B. 30% - FAB
143
Coagulation Studies
Simplest
1. Visual detection of fibrin clot
Automated
2. Electromechanical detection of fibrin clot
3. Photo-optical detection of fibrin clot
1. Tilt tube technique
2. Fibrometer
3. Electra, Ortho-koagulab, Coag-A-Mate, Sysmex
144
This part of cell cycle is responsible for assembling proteins necessary for mitosis as well as checking the DNA for the presence of damage
a. G0
b. G1
c. S phase
d. G2
D. G2
145
What is this genetic T lymphocyte abnormality that results to the absence or underdevelopment of the thymus gland?
a. Bruton's agammaglobulinemia
b. DiGeorge syndrome
c. Wiskott-Aldrich syndrome
d. Severe combined immunodeficiency
B. DiGeorge syndrome
A. B-lymphocyte genetic abnormality
1. low level of Abs
2. recurrent infections
C, D. - combined T and B lymphocyte abnormality
D. Severe combined most common = sex-linked immunodeficiency
C. WAS triad
- immunodeficiency or current infection
-eczema
-thrombocytopenia
WAS = smallest plt.
BSS = largest plt.
146
What is the most specific antibody for SLE?
a. ANA
b. Anti-dsDNA
c. Anti-mitochondrial Ab
d. Anti-CCP
B. Anti-dsDNA
A. Patterns determined; nonspecific
C. Primary biliary cirrhosis or cholangitis
D. Most specific Ab for RA
RF - nonspecific AutoAb (anti-IgG)
147
Anti-smooth muscle
"ASMA-CAH"
Chronic Autoimmune Hepatitis
148
Primary cause for Primary Hyperthyroidism
Anti-microsomal (anti-peroxidase)
Anti-thyroglobulin
Hashimoto's thyroiditis
149
Autoimmune disease charcaterized in having drying mouth and dry eyes
Anti SS-A (anti-Ro)
Anti SS-B (anti-La)
Sjogren's syndromeq
150
DAT was requested, what anticoagulant will be needed?
a. EDTA
b. None/ not needed
c. Citrate
d. Heparin
A. EDTA (Lav or Pink)
Lav = Hema
Pink = BB
DAT detects in vivo sensitization (red cell)
IAT detects in vitro sensitization (serum)
no anticoagulant needed
151
Dolichos biflorus will agglutinate which of the following cells?
a. A cells
b. B cells
c. O cells
d. D cells
A. A cells
B cells = Bandeiraea simplicifolia
O cells = Ulex europaeus
152
Which antibody is associated with Mycoplasma pneumoniae infection?
a. Anti-i
b. Anti-I
c. Anti-P1
d. Anti-P
B. Anti-I
B. associated with cold agglutinin disease
- M. pneumonia causes Primary atypical pneumonia/ walking pneumonia
- 'malaking I - marunong maglakad'
A. associated with EBV infection (infectious mononucleosis)
C. associated with patients infected with E. granulosus
D. associated with Paroxysmal Cold Hemoglobinuria - Donath Landsteiner antibody (Biphasic Ab; Attaches when cold, lyse when hot)
153
What are the requirement for Autologous donation?
a. Hgb > = 11g/dl
b. Hgb > = 12.5g/dl
c. Hgb > = 11g/dl with Ab screen
d. Hgb > = 13g/dl
A. Hgb > = 11g/dl
Autologous donation
- No minimum or maximum age requirement
- Minimum Hgb and Hct = 11g/dl, 33%
- SAFEST BLOOD A RECIPIENT CAN RECEIVE
- No necessary test needed except for;
- Preoperative collection:
a. Collected 5-6 weeks before surgical procedure
b. Collecting facility and Transfusing facility: Blood typing
154
CPD-A1 will preserve blood for how long?
a. 35 days
b. 21 days
c. 42 days
d. 25 days
A. 35 days
ACD = 21 days
CPD = 21 days
CP2D = 21 days
CPD-A1 = 35 days
CPD-A2 = 42 days
155
Which of the following is indicated for patients with transfusion hemosiderosis (iron overload) ?
a. Washed RBCs
b. Leukoreduced RBCs
c. Cryoprecipitate
d. Neocytes
D. Neocytes - younger RBCs (longer life span)
Iron overload - seen in pxs with frequent transfusions (HA, hemoglobinopathies)
Administer: alkalyting agent, Deferoxamine to prevent iron overload
A. for febril hemolytic transfusion reaction, anaphylatic
B. anaphylatic transfusion reaction, TRALI
C. vWD disease, FVIII or Fibrinogen deficiency
156
CA-125 can be used to monitor:
a. Breast CA
b. Pancreatic CA
c. Ovarian CA
d. Colon CA
C. Ovarian CA
Tumor markers: measurable biochemical molcule present in serum/plasma that are associated with malignancy
- Tumor-derived: malignancy is the tumor marker itself
- Tumor-associated: produced by the body in response to the malignant cell
Purpose: testing for recurrence
157
Chemical spilled on skin:
a. Flush with sodium bicarbonate for 5 mins.
b. Wash with water for 15 mins.
c. Cry for help
d. Pray
B. Wash with water for 15 mins.
158
Which of the following is not done by an automated tissue processor?
a. Clearing
b. Dehydration
c. Mounting
d. Fixation
C. Mounting
159
Picric acid fixative
Excellent fixative for preserving soft and delicate structures (e.g. endometrial curetting, embryo)
NOT ADVISED FOR KIDNEY STRUCTURES
Bouin's Solution
"Baby Boing"
fixative for embryo
160
Double embedding involves which of the following?
a. Infiltrated with Paraffin, Embedded with Celloidin
b. Infiltrated with Celloidin, Embedded with Paraffin
c. Infiltrated with Celloidin, Embedded with Plastic
d. Infiltrated with Paraffin, Embedded with Plastic
B. Infiltrated with Celloidin, Embedded with Paraffin
"ICEP - wag na mag-isip isip"
161
It is considered as the simplest microtome
a. Rotary
b. Rocking
c. Freezing
d. Sliding
B. Rocking
A. Most common, MINOT
B. Simplest, Paldwall Trefall
C. Releases CO2, Queckett; Rush frozen
D. Most dangerous, Adams
162
H&E staining
Regressive staining, it involves a differentiation step (acid-alcohol)
Differentiation = decolorizing
163
Autopsy Method
1. Organs are removed one by one; Time consuming
2. In situ dissection
3. En bloc
4. En masse; quick method
1. Virchow
2. Rokitansky
3. Ghon - bloc
4. Letulle - LL = SS
164
Revocation of certificate of registration can only be achieved by:
a. Unanimous vote
b. Majority vote
c. Any of the above
d. None of the above
A. Unanimous vote = 3/3 board members
Reprimand or suspension = 2/3 votes (majority vote)
165
Conversion factor of Hgb to SI
Henry:
Turgeon:
Henry = 10
(gm/dl to g/L)
Turgeon = 0.155
(gm/dl to mmol/L)
166
When preparing a patient for an oral glucose tolerance test (OGTT), which of the following conditions will lead to erroneous result?
a. The patient remains ambulatory for 3 days prior to the test
b. Carbohydrate intake is restricted to below 150g/day for 3 days prior to test
c. No food, coffee, tea, or smoking is allowed 8 hours before and during the test
d. Administration of 75g of glucose is given to an adult patient following a 10-12 hour fast
B. Carbohydrate intake is restricted to below 150g/day for 3 days prior to test
Correct: minimum of 150g/day for 3 days, not restricted
167
1. Increased Cortisol, Decreased ACTH
2. Increased Cortisol, Increased ACTH
1. Adrenal Cushing's Syndrome (Primary)
2. Pituitary Cushing's Syndrome or Cushing's Disease (Secondary)
168
1. Increased T3 T4, Decreased TBG, Increased T3 Uptake
2. Decreased T3 T4, Increased TBG, Decreased T3 Uptake
1. Hyperthyroidism
2. Hypothyroidism
169
All of the following are appropriate when attempting to isolate N. gonorrhoeae from a genital specimen except:
a. Transport the genital swab in charcoal transport medium
b. Plate the specimen on Modified Thayer-Martin (MTM) medium
c. Plate the specimen on New York City or Martin-Lewis agar
d. Culture specimens in ambient oxygen at 37C
D. Culture specimens in ambient oxygen at 37C
N. gonorrhoeae require 5-10% CO2 not 0.03% CO2
169
All of the following are appropriate when attempting to isolate N. gonorrhoeae from a genital specimen except:
a. Transport the genital swab in charcoal transport medium
b. Plate the specimen on Modified Thayer-Martin (MTM) medium
c. Plate the specimen on New York City or Martin-Lewis agar
d. Culture specimens in ambient oxygen at 37C
D. Culture specimens in ambient oxygen at 37C
N. gonorrhoeae require 5-10% CO2 not 0.03% CO2
170
In the urinalysis laboratory, the primary source in the chain of infection would be:
a. Patients
b. Needlesticks
c. Specimens
d. Biohazardous wastes
C. Specimens
171
Which order of events should be followed at the conclusion of a laboratory worker's shift in order to prevent the spread of bloodborne pathogens?
a. Disinfect area, remove gloves, wash hands, remove lab coat
b. Remove gloves, wash hands, remove lab coat, disinfect area
c. Remove gloves, disinfect area, wash hands, remove lab coat
d. Disinfect area, remove gloves, remove lab coat, wash hands
D. Disinfect area, remove gloves, remove lab coat, wash hands
172
Qualitative test for seminal fluid fructose?
Positive:
Resorcinol
(+) Orange
173
How will you differentiate bacterial peritonitis from cirrhosis?
Both have increased WBC in peritoneal fluid (>500 WBCs/uL)
Absolute Neutrophil Count
Higher in bacterial peritonitis > Cirrhosis
Bacterial peritonitis - commonly caused by aerobic bacteria
174
Charcot Leyden Crystal
Curshmann spiral
Creola bodies
Bronchial Asthma
175
What is the best fire extinguisher?
a. Water
b. Dry chemical
c. CO2
B. Dry Chemical
The type to use depends on the type of fire
Because it is impractical to have several types of fire extinguishers present in every area, DRY CHEMICAL fire extinguishers are among the best all-purpose extinguishes for laboratory areas.
176
Solubility test
Reagents:
Detection of:
Positive result:
White background with black lines
Reagents: Sodium hydrosulfite (dithionate), Saponin (lysing detergent)
Detection of: Hemoglobin S
Positive result: Turbidity; no black lines seen
177
First appearance of DMS:
Characterized by:
First appearance of DMS: MK-1 (megakaryoblast)
Characterized by: MK-I, MK-II, and MK-III
MK-I megakaryoblast
MK-II promegakayocyte
MK-III megakayocyte
178
Screening or Confirmatory?
Clotting test:
Immunologic:
Clotting test: Screening
Immunologic: Confirmatory
179
RBC Histogram
X-axis:
Y-axis:
Shift to the left:
Shift to the right:
X-axis: size of the cell
Y-axis: number of the cell
Shift to the left: Increasing number of microcytic RBC (smaller than normal)
Shift to the right: Increasing number of macrocytic RBC (larger than normal)
180
A small, flat, bilobed organ found in the thorax, or chest cavity, right below the thyroid gland and overlying the heart
Thymus - located near the heart
181
The gold standard test for malaria
Thick and thin blood smear
182
Direct or Indirect phagocytosis
1. Primitive pattern recognition receptors (PPRP); Recognize a wide array of molecules present on the surface of microorganisms
2. Via opsonin deposited on the microbial cell surface
1. Direct phagocytosis
2. Indirect phagocytosis
183
Most common disinfectant
Ratio:
Dilution:
Sodium hypochlorite (household bleach)
Ratio of Sodium hypochlorite to water: 1:9
Ratio of Water to sodium hypochlorite: 9:1 (TV = 10)
Dilution: 1:10 (Total volume)
184
ISBT SYSTEM NAME
001
004
030
001 = ABO
004 = Rh
030 = Rh-associated glycoprotein - newest RHAG
185
Platelets must be kept in constant motion for which of the following reasons?
a. Maintain the pH so the platelets will be alive before transfusion
b. Keep the platelets in suspension and prevent clumping of the platelets
c. Mimic what is going on in the blood vessels
d. Preserve the coagulation factors and platelet viability
A. Maintain the pH so the platelets will be alive before transfusion
Agitation - for oxygen exchange between platelet bag and platelets
Platelets must be gently agitated during storage by the use of a rotator to prevent the pH from decreasing below 6.2
186
Occurs most frequently when donor LEUKOCYTE ANTIBODIES react with the WBCs in the recipients' lung vasculature, damaging the endothelium and causing NONCARDIOGENIC PULMONARY EDEMA
Focus is on prevention achieved by using only MALE PLASMA components or plasma components collected from WBC ANTIBODY-NEGATIVE FEMALE DONORS
TRALI/ NCPE
187
Most common method of staining for microanatomical studies of tissues; regressive staining
1. Primary stain, Basic dye, Nuclear stain (blue to blue-black)
2. Secondary stain, counterstain, Acid dye, Cytoplasmic stain (pink)
3. Stain for nucleus
H&E staining
1. Hematoxylin
2. Eosin
3. Non-acidified hematoxylin
188
Positive Feulgen Technique
Howell-Jolly bodies
189
Which of the following would be most adversely affected by a nonfasting sample?
a. HDL
b. LDL
c. Cholesterol
d. Triglycerides
D. Triglycerides - 12 hours fasting
190
Which of the following lipid tests is LEAST affected by the fasting status of the patient?
a. Cholesterol
b. Triglycerides
c. Fatty acid
d. Lipoprotein
A. Cholesterol - can be done for non-fasting sample
191
In most circumstances, when two controls within a run are both greater than +-2s from the mean, what action should be taken first?
a. Recalibrate, then repeat controls followed by selected patient samples if quality control is acceptable
b. Repeat the controls before taking any corrective action
c. Change the reagent lot, then recalibrate
d. Prepare fresh standards and recalibrate
A. Recalibrate, then repeat controls followed by selected patient samples if quality control is acceptable
2:2SD
192
1. In the investigation of Hyponatremia, what to do next?
2. In the investigation of Hypernatremia, what to do next?
1. Measure serum or plasma osmolality
2. Measure urine osmolality
193
Difference between the measured osmolality and the calculated osmolality
Indirectly indicates the presence of osmotically active substances OTHER THAN NA+, UREA, or GLUCOSE, such as ethanol, methanol, ethylene glycol, lactate, or B-hydroxybutyrate
Osmolal gap
194
Which of the following blood gas disorders is most commonly associated with an abnormal anion gap?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
A. Metabolic acidosis
195
Tumor Markers and Disease
1. Elevation of AFP
2. Elevation of HCG
3. Elevation of both AFP and HCG
1. Hepatocellular carcinoma
2. Choriocarcinoma
3. Germ cell carcinoma, testicular cancer, pregnancy
