Volume 1 Flashcards
1
Q
- In a clinical laboratory, the extent of laboratory services provided depends upon the
A
. mission of the MTF.
2
Q
- (001) Which reference laboratory serves as the national focus for environmental health issues and health education and promotion programs?
A
CDC.
3
Q
- (002) In the medical field, which is a description of integrity?
A
Being faithful to one’s convictions.
4
Q
- (002) Which ethical value do we describe as “to treat people with dignity, honor privacy, and allow self-determination”?
A
Respect.
5
Q
- (003) Due to veins that are weak and difficult to locate, it is suggested that the most appropriate method for venipuncture at this stage is with a syringe.
A
Geriatric.
6
Q
- (003) Loyalty, cooperation, and working together effectively to render quality health care are part of
A
teamwork.
7
Q
- (004) Records play a vital role in managing and operating Air Force activities because they serve as
A
the memory of the organization, a record of past events, and the basis for future actions.
8
Q
- (004) Who is responsible for maintaining, servicing, and disposing of records for their office?
A
RTs.
9
Q
- (005) Which is not part of analytical quality control?
A
.Reporting results.
10
Q
- (005) Which is not a reason for performing method validation?
A
Lot number change on a test kit.
11
Q
- (005) Which may be due to deteriorating reagents or improper instrument calibration?
A
Systematic error.
12
Q
- (006) In an OI, where would you find panic or alert values?
A
Reporting results.
13
Q
- (006) Which does not apply to approval and review of OIs?
a. Major changes require a review.
b. They must be reviewed annually.
c. Minor changes do not require a review.
d. The approval signature and date must precede the implementation date.
A
c. Minor changes do not require a review.
14
Q
- (007) The AFOSH Program requires that commanders provide all Air Force personnel a safe and healthy
A
work environment in which recognized hazards have been eliminated or controlled.
15
Q
- (007) The mere presence of a hazardous material does not necessarily create a hazard; an exposure must include a
A
source, pathway, and receiver.
16
Q
- (007) AFOSH Standard 48–22, Occupational Exposure to Hazardous Chemicals in Laboratories, divides chemical hazards into two categories––
A
health and physical.
17
Q
- (007) Which of the following includes a written program, hazardous chemical inventories, hazard determinations, MSDS, labeling of hazards, and employee information and training?
A
Workplace Written Hazard Communication Program.
18
Q
- (008) If a hazard cannot be eliminated immediately, an
A
AF Form 457, USAF Hazard Report (HR), is required.
19
Q
- (009) If an infectious specimen tube breaks in the centrifuge, turn off the centrifuge immediately, and
A
. allow 15 minutes for aerosols or droplets to settle and clean with 5% sodium hypochlorite.
20
Q
- (010) Which of the following causes genetic changes in sperm and egg cells?
A
Mutagens.
21
Q
- (011) Which of the following is not a classification of a biological hazard?
A
Carcinogens.
22
Q
- (011) Oncogenic viruses cause
A
cancer.
23
Q
- (011) The largest sources of potential laboratory-acquired infections are
A
aerosols.
24
Q
- (012) Store food and beverages in
A
a separate refrigerator away from any possible contamination.
25
25. (013) We use syringe systems for patients with
fragile or difficult veins because you can control vacuum pressure, thus avoiding collapsed veins.
26
26. (013) Which of the following is the correct tube collection order for drawing blood?
Blood cultures, clot tubes, citrate, heparin, EDTA, oxalate, and then fluoride tubes.
27
27. (014) Which of the following is not a risk for parenteral administration?
Medication is totally absorbed.
28
28. (014) Why is the median cubital vein the preferred site for venipuncture?
It is close to the skin’s surface, it is large, and it is anchored by surrounding tissue.
29
29. (014) When should you label the blood specimens or tubes?
Before leaving the bedside or side of the patient.
30
30. (014) When drawing blood from an elderly patient,
detached and floating veins can cause difficulty; anchor the vein both above and below the venipuncture site.
31
31. (015) Microhematocrit or capillary tubes hold approximately
50 to 75 μl of blood, with a blue band that indicates a plain tube.
32
32. (015) Caraway or Natelson tubes hold approximately
250 μl of blood, with a yellow band that indicates a lithium heparin-coated tube.
33
33. (015) Which finger of an infant do you not use for skin puncture, and why?
Pinkie; the skin is too thin.
34
34. (015) When performing a skin puncture, collect
free-flowing blood and mix anticoagulated tubes 8 to 10 times.
35
35. (016) Which of the following is not a criterion for specimen rejection?
Proper transportation.
36
36. (016) Blood normally clots completely within
30 to 60 minutes at 22 to 25°C.
37
37. (016) Specimens should be separated within
2 hours of collection.
38
38. (016) Who establishes specimen requirements for specimens that are shipped out to another lab?
Referral laboratory.
39
39. (017) Most medical words are derived from
ancient Greek and Latin word components.
40
40. (017) Prefixes are always used
in conjunction with a root word or with a root word and suffix; they cannot stand alone to form a word or term.
41
41. (017) Suffixes may be found in combination with
a prefix and a root word or just with a root word; suffixes cannot be used alone to form a word or term.
42
42. (018) Which phrase describes a benefit of POCT to the laboratory?
Decreased manpower needs.
43
43. (018) The NCCLS develops standards based on
voluntary consensus of current practices in all areas of laboratory science.
44
44. (018) The amount of training time required to allow an individual to perform POCT depends on the
background of the individual.
45
45. (019) A subatomic particle with a positive charge of one (+1) and a mass of one atomic mass unit is known as
a proton.
46
46. (019) What is the maximum number of electrons the third energy shell of an atom may contain?
18.
47
47. (019) Isotopes are atoms of the same element with the same atomic number but different atomic masses. This is because
isotopes possess a different number of neutrons.
48
48. (019) Although atomic mass is expressed as AMU, atomic weight is expressed as
grams.
49
49. (020) A molecule of a monatomic element has how many atoms in each of its molecules?
1.
50
50. (020) O3 is an example of
a triatomic molecule.
51
51. (020) Substances that are made up of two or more elements, chemically united in definite
compounds.
52
52. (020) Compounds are formed from elements by bonding when
an atom fills its valence shell.
53
(020) The statement, “Atoms always combine in such a way as to complete their valence shells,” best describes the rule of
eight (octet rule).
54
54. (020) A symbol or group of symbols, with proper subscripts, representing one molecule of an element or compound is known as a
chemical formula.
55
55. (021) When acids and bases react in a reaction called neutralization, what substance other than water is formed?
Salt.
56
56. (021) Sodium and potassium salts are important for which body function?
The acid-base balance.
57
57. (022) What type of chemistry deals with virtually all carbon-based compounds?
Organic.
58
58. (022) Made up solely of carbon and hydrogen, which compounds form the basis of all organic compounds?
Hydrocarbons.
59
59. (022) Molecules that react the same under similar conditions or circumstances are said to belong to the same
functional group.
60
60. (023) What type of chemistry investigates what a compound is made up of and how much of a substance it contains?
Analytical chemistry.
61
61. (023) What type of chemistry looks at an organism’s growth, digestion, respiration, metabolism, and reproduction?
Physiological chemistry.
62
62. (023) Carbohydrates exist as cellulose, sugars, and
starches.
63
63. (023) Which of the following is not a function of proteins in the body?
Proteins convert brain impulses to electrical messages.
64
64. (023) Proteins serve to protect the body in which of the following manners?
By forming antibodies against foreign proteins and blood-clotting functions.
65
65. (023) Protein synthesis is controlled by
nucleic acids.
66
66. (024) The measurement system based on combining a prefix and primary unit to produce larger or smaller units of a property is the
scientific notation system.
67
67. (024) While the metric system is based around primary units, the SI is based upon
basic properties.
68
68. (024) In the SI, there are basic properties and derived units. Which of the following is an example of a derived unit?
volume
69
69. (024) A measured number, one in which the number of digits are known with certainty, is called a
significant figure.
70
70. (024) A technician may get into trouble with significant figures if he or she
b. reports out a result exceeding the instrument’s capability.
71
71. (024) In which number are all the zeros considered significant numbers: 0.023, 00.023, 200.003, or 000.0023?
200.003.
72
72. (025) Analyzers that process samples separately and in their own reaction containers we call
discrete analyzers.
73
73. (025) Analyzers that have their reaction well located at the outside edge of a disk and that are read while they are spinning we call
centrifugal force analyzers.
74
74. (025) The ability of an instrument to measure only the analyte being tested is said to be the analyzer’s
specificity.
75
75. (025) The lowest value for a test method that can be reported accurately we know as an instrument’s
sensitivity.
76
76. (025) The ability of a method to determine the actual analyte value is said to be its
accuracy.
77
77. (025) When white light hits a prism, a rainbow forms. This rainbow of colors we also know as
a spectrum.
78
78. (025) The ability of a solution to allow light to pass through it we call
transmission.
79
79. (025) A solution 2 centimeters deep yields a result of 20 grams and a 4-centimeter-deep solution yields a result of 40 grams. This best illustrates
Lambert’s law.
80
80. (025) According to Lambert’s law, if a solution 5 centimeters deep yields a result of 20 grams, a solution 6 centimeters deep would yield a result of
24 grams.
81
81. (026) All of the following are reasons for keeping equipment clean except
spills keep all gears lubricated.
82
82. (026) Locking in a value for a standard on a piece of equipment we also know as
calibration.
83
83. (026) Your analyzer is “dead”—no power; no response to any controls. Housekeeping was in the facility last night. You
check to see if the equipment was unplugged.
84
84. (027) In coulometry, a current is passed through a solution until excess silver ions are detected. At that time, the current
is shut off, and the electricity used is proportional to the produced analyte.
85
85. (027) A technique used primarily in analytical chemistry with the exception of the clinical chemistry measurement of oxygen is
polarography.
86
86. (028) How are testing mixtures passed through the column in liquid chromatography methods?
By gravity or with the help of applied suction or air pressure.
87
87. (028) By operating at lower temperatures, LC has an advantage over GC in that LC can
separate thermolabile compounds.
88
88. (028) HPLC uses a smaller medium than regular LC, which results in
HPLC peaks being much narrower than LC peaks.
89
89. (028) Electrophoresis electrodes are normally made out of
platinum because platinum is a good conductor and is chemically inert.
90
90. (029) Allowing an enzyme-labeled antigen or antibody to react with a ligand, adding an enzyme substrate, and then taking a measurement best describes
enzyme immunoassay.
91
91. (029) In the ELISA, the purpose of the solid phase is to
separate the free and bound reactants.
92
92. (029) ELISA methods are used extensively for detection of
antibodies to viruses and parasites.
93
93. (029) A major difference between the ELISA method and the EMIT is that
EMIT does not have a separation step.
94
94. (029) In vapor pressure (dew point) osmometry, a sample is placed in an enclosed chamber and the temperature is then decreased. What action occurs in the chamber to shut off current to the thermocouple?
Water condenses out of the head space and falls onto metal plates.
95
95. (029) In colloid osmotic pressure osmometry, fluid moves by osmosis from the saline side of the membrane to the sample side of the membrane. This results in a
negative pressure on the reference side.
96
96. (030) To “rule-in and refer,” work at a BSL–3, and perform rapid identification on biological agents defines the scope of responsibilities of which LRN laboratory level?
Level C.
97
97. (030) The use of clinical data and standard microbiology tests to decide which specimens and isolates are to be forwarded to one of the high-level biocontainment laboratories describes which of the LRN levels?
Level A.
98
98. (030) Which of the LRN laboratory levels are designed to have the highest level of agent containment and have the expertise in the diagnosis of rare and dangerous biological agents?
Level D.
99
99. (030) Which CDC category of biological agents do we define as “moderately easy to disseminate and causing moderate morbidity and low mortality”?
Category B.
100
100. (030) The first one to be notified if your laboratory has presumptively identified a biological agent would be the
chief of pathology.
101
1. What is the laboratory’s mission, and how is it accomplished?
To meet the mission of the MTF, and this is accomplished by providing accurate, reliable, and timely services that aid in the diagnosis, treatment, and prevention of diseases affecting the health and welfare of all patients, whether they are active duty military personnel, retirees, dependents, or civilians.
102
2. What are the various types of reference laboratories that may support your laboratory, and what are some examples?
Military and civilian; other armed services medical groups (Air Force, Army, or Navy), Institute of Environmental Safety, Occupational Health, and Risk Analysis (also known as the EPILAB), Armed Forces Institute of Pathology (AFIP), and the Centers for Disease Control and Prevention (CDC).
103
3. What are some of the important factors to consider when selecting a civilian reference laboratory?
Cost, turnaround time, and laboratory accreditation of the reference laboratory.
104
What laboratory is tasked with handling all laboratory testing involved with an aircraft accident or incident?
The Armed Forces Institute of Pathology (AFIP).
105
(1) Being faithful to one’s convictions.
Integrity.
106
(2) Being open-minded and impartial.
Fairness.
107
(3) Only making commitments within your authority.
Promisekeeping.
108
(4) The feeling or urge that compels you to behave in a certain way.
Moral obligation.
109
(5) The balm against dissension and conflict.
Loyalty.
110
(6) Means being truthful, straightforward, and candid.
Honesty.
111
(7) Treating people with dignity.
Respect.
112
(8) Avoiding even the appearance of impropriety and limits
| thoughtless action.
Accountability.
113
(9) Treat others as you would like others to treat you.
Golden Rule.
114
(10) The bond that holds nations and governments together.
Loyalty.
115
(11) Usually defined in terms of desirable traits: temperance,
courage, wisdom, faith, hope, charity, etc.
Moral character.
116
(12) Compassion—the essential element of good government.
Caring.
117
(13) Fidelity, nonmaleficence, beneficence, and reparation are a part
of this ethical term.
Moral obligation.
118
(14) Striving beyond mediocrity.
Pursuit of excellence.
119
1. What is included in the respect for human dignity?
Greeting and talking to patients in a respectful manner, avoiding undue familiarity, and not making any crude or inappropriate remarks about patients.
120
2. You must give proper regard to patient specimen delivery. Why?
Sensitivity regarding the specimen delivery (semen, stool, urine, etc.) must be afforded to the patient. The patient most likely does not work in the medical arena where specimens of this kind are “all in a day’s work” thus making collection instruction, receipt, specimen collection, and specimen delivery difficult and potentially embarrassing for some patients. The laboratory technician’s professionalism can alleviate a large portion of the patient’s anxiety.
121
3. What are the two kinds of privacy and how would you describe each?
Personal and physical; personal privacy means that you shouldn’t reveal anything about the patient or his or her care to anyone not directly involved with providing that care and physical privacy deals with avoiding unnecessary exposure of the patient.
122
4. What does professional competence do for a patient?
Protects the patient from incompetent, unethical, and illegal care.
123
5. What is accountability?
This simply means being responsible for what you do or fail to do. Act within your limits of your training, and ensure that every action you take will benefit, not harm, the patient.
124
6. Whom must you be loyal to?
Always be loyal to your coworkers and to your profession.
125
7. What does cooperation include?
Such things as effective communication, courtesy, and respect for others.
126
8. What two things are just as important to the patient’s well-being as your technical performance?
Your attitude and behavior.
127
9. How can you help reduce a patient’s fears?
Provide a friendly smile and a reassuring word.
128
10. Whom do you talk to first if you are having difficulty dealing with personal problems?
Your supervisor.
129
11. Where do you take coffee breaks or other type breaks?
Away from public view, not around the window or front desk.
130
12. What are some rules that can help with telephone manners?
Answer promptly, speak distinctly, identify yourself and your office, be prepared to take (and deliver) a message, be attentive, and don’t yell into the mouthpiece.
131
(1) Serves as the point of contact within the functional area.
FARM.
132
(2)Workerbeesoftheofficefiles:maintaining,servicing,and
| disposing of records for their office.
RT.
133
(3) They serve as the memory of the organization, a record of past
events, and the basis for future actions.
Purpose of records.
134
(4) The mandatory Air Force–wide information management
| standard automated system.
RIMS.
135
(5) All books, papers, maps, photographs, machine-readable
| materials, or other documentary materials, regardless of physical form or characteristics.
Definition of records.
136
(6) Administers the program within the organization or installation; performs SAVs or QAVs at least once every 24 months.
RM.
137
(7) Can be an officer, civilian, or enlisted person who has possession of Air Force records.
COR.
138
(1) This area is so important within the laboratory arena that requirements for competence folders (OJT records) have been established.
Individual competence.
139
(2) A material or device of known or assigned quantitative and/or assigned qualitative characteristics (e.g., concentration, activity, intensity, and reactivity).
Calibration material.
140
(3) A standard, generally having the highest meteorological quality available at a given location or in a given organization, from which measurements made there are derived.
Reference standard.
141
(4) Researched thoroughly before implementation; kept up-to-date and evaluated periodically.
Procedure or method.
142
(5) Program done on a day-to-day basis to monitor normal analytical performance.
Internal QC.
143
(6) A device, solution, lyophilized preparation, or pool of collected human or animal specimen, or artificially derived material, intended for use in the quality control process.
Control material.
144
(7) Validating results, reporting results, workload recording or test charging, and storing specimens.
Postanalytical.
145
(8) A substance, one or more of whose property values are sufficiently homogeneous and well established to be used for the calibration of an apparatus, the assessment of a measurement method, or for assigning values to materials.
Reference materials.
146
(9) Control materials that have a specific range with a known mean.
Assayed.
147
(10) Laboratory chemicals, including water.
Reagents.
148
(11) Usually pooled material; laboratory must establish its range for each control.
Unassayed.
149
(12) May be the single most important component of a good QC program.
Documentation.
150
(13) Components of samples, other than the analyte, that alter the final result and in-turn affect the accuracy of the analytical method.
Interfering substances.
151
(14) CLIA ’88 requirement in order to receive accreditation.
External QC.
152
(15) An expression used to describe the permissible range into which a control
must fall to be considered in control.
Standard deviation.
153
(16) Encompasses all activities not directly associated with the performance of
the clinical assay itself.
Nonanalytic control.
154
(17) Checked for cleanliness, condition of electrical elements, stability of
electrical current, and the temperature of refrigerated or heated analyzer
compartments documented on a daily basis.
Instrument.
155
(18) Each laboratory should establish its own.
Reference ranges.
156
(19) Exhibit and help identify problems with controls.
Control charts.
157
(20) Ordering test; ensuring correct patient identification and preparation;
specimen collection, transport, identification, and accessing; and specimen processing for analysis.
Preanalytical.
158
(21) Designed to detect inappropriate bias or imprecision that may change the quality of the specimen result.
Westgard multirules.
159
1. What is the purpose of the AFOSH Program?
To protect all Air Force personnel from work-related deaths, injuries, and occupational illness.
160
2. What does the AFOSH Program include?
All safety, fire prevention, and health activities that affect the safety and health of Air Force personnel at their workplace.
161
3. What is the purpose of AFOSH Program standards?
To assist the commanders and supervisors in maintaining a safe environment and to administer a safety program that conforms to Air Force directives.
162
4. What establishes OELs, and how are OELs used?
AFOSH Standard 48–8, Controlling Exposures to Hazardous Materials; OELs are used to define hazardous chemical exposures to chemical substances in order to control or eliminate these hazards.
163
5. How do occupational exposures occur?
In many ways: through inhalation, ingestion, skin contact, and skin absorption.
164
6. For what does AFOSH Standard 48–22 define minimum requirements?
The minimum requirements for a chemical hygiene plan (CHP), assigns responsibilities, and provides guidance for protecting workers from hazardous chemicals used in the laboratory work environment.
165
7. Into what two categories does AFOSH Standard 48–22 divide chemical hazards?
Health hazards and physical hazards.
166
8. What are the WWHCP elements?
Program elements include a written program, hazardous chemical inventories, hazard determinations, MSDSs, labeling of hazards, and employee information and training.
167
9. Who develops a hazardous chemical inventory, and what does it include?
The supervisor and base or attending support BES; chemical inventory lists include, as a minimum, the name of the hazardous material as it appears on the MSDS.
168
10. What are the elements of a complete laboratory safety and health program?
The appointment of a chemical hygiene officer, a written CHP, OIs, properly maintained laboratory-type hoods and protective equipment, employee information and training, hazard identification through use of labels and MSDSs, employee exposure determinations, and medical consultation.
169
1. What does the documentation of hazards accomplish?
A record can pinpoint accident trends, high-hazard areas, and the frequency and severity of incidents involving personnel and equipment.
170
2. What is the best way to prevent accidents?
Applying AFOSH standards and laboratory guidelines.
171
3. Who can provide technical assistance for identifying hazards?
Safety, medical staff, and fire-prevention personnel can give technical assistance as needed.
172
4. What hazards are reported?
Any hazard that could result in injury to an individual or damage to equipment.
173
5. If the hazard cannot be eliminated immediately, what do you do?
Fill out an AF Form 457, USAF Hazard Report (HR), and AF Form 1118, Notice of Hazard.
174
2. What kind of threats do volatiles pose?
Fire, explosive, inhalation, and ingestion.
175
3. What two factors do we use for determining the type of volatile substance?
Flash point and boiling point.
176
4. What are the two basic categories of volatiles?
Flammable and combustible.
177
5. Where do you store volatiles?
Explosion-proof refrigerators for refrigeration or a safety cabinet.
178
6. What are pyrophobics? Give an example.
Pyrophobics are volatiles that ignite spontaneously in air below 130°F (54°C). Very finely divided metals, metal hydrides, and carbon metals.
179
7. What are oxidizers? Give an example.
Oxidizers supply the oxygen required to start or support combustion. Nitric acid and chromic acid.
180
8. What can inappropriate use of electrical equipment cause?
Electrical shock, burns, fire, and/or explosions.
181
9. List a few simple safety rules for operating electrical equipment.
(1) Never plug in an instrument with wet hands or when any part of your body is in contact with water.
(2) Immediately wipe up all spills and don’t operate instruments with wet hands. (3) Inspect equipment for frayed wires and electrical connections.
(4) All equipment must be grounded by using a three-pronged plug.
(5) Never overload an electrical outlet.
182
10. What do mechanical and physical hazards include?
Laboratory layout, equipment, compressed gases, glassware, and sharp instruments.
183
11. What is the best way to avoid equipment injury?
Always read the manufacturers’ instructions.
184
12. If an infectious specimen breaks within a centrifuge, how do you clean it up?
Using protective equipment (e.g., rubber gloves, mask, face shield, etc.), clean the centrifuge with 5% sodium hypochlorite.
185
13. How do we store compressed-gas cylinders in the laboratory?
All cylinders must be securely fastened to the wall or bench or placed in floor holders so that they cannot overturn.
186
2. What is included in basic chemical safety equipment?
Acid and alkali chemical spill stations; mercury cleanup kits; protective clothing; monitoring devices and absorbent material for containing and decontaminating radioactive spills; and drench showers and eyewashes for removing and diluting toxic or caustic chemicals.
187
3. How do fume hoods prevent hazards?
They are designed to prevent hazards from entering the laboratory, by transporting fumes or contaminated particles through the roof, to the outside air where they are diluted and become safe.
188
4. What are the laboratory personnel responsibilities for radiation safety?
Responsibilities include wearing PPE, using recommended safety equipment (fume hoods, lead-lined containers, etc.), complying with all radiation safety policies, and reporting unsafe practices and accidents to supervisors.
189
5. What is the first thing you do if a chemical enters your eye?
Immediately, thoroughly rinse the eye with tap water for 15 minutes.
190
6. How do you treat corrosive chemicals that come in contact with the skin?
Use copious quantities of running water until you remove all traces of the chemical; then seek medical attention.
191
1. What are the three classifications of biological hazards?
(1) Etiological agents
(2) Oncogenic viruses.
(3) Recombinant DNA.
192
2. What are the four basic divisions of etiological agents?
For our purposes, there are four basic divisions of etiological agents:
(1) Bacteria.
(2) Fungi
(3) Parasites.
(4) Some viruses.
193
3. What is the definition and danger of oncogenic viruses?
Oncogenic viruses cause cancer and tumors in humans; the danger of oncogenic viruses is that they can infect a host without causing any obvious symptoms.
194
4. What are the two main groups of oncogenic viruses?
DNA tumor viruses and RNA tumor viruses.
195
5. What are the dangers of recombinant DNA research?
The danger in this type of research is there are many unknown reactions and the indiscriminate or careless use of these techniques.
196
6. List the fundamentals of a biohazard safety program.
They include procedures for controlling access to the laboratory, the use of PPE, and instructions for correct specimen handling.
197
7. What is the largest source of potential laboratory-acquired infections, and how can we reduce them?
Aerosols of infectious agents; reducing or eliminating procedures that generate aerosols.
198
8. What AFI and who oversees the Infection Control Program?
AFI 44–108, Infection Control Program, states the MTF executive management team oversees the Infection Control Committee (ICC) or the clinical staff performing the Infection Control Review Function (ICRF) through the Executive Committee of the Medical Staff.
199
9. What is the focus of the Infection Control Program, and whom does it involve?
The program focuses on preventing and controlling infections in patients, staff, and visitors; all MTF personnel, assigned Air Guard and Reserve personnel, personnel assigned in training and residency programs, and volunteers.
200
10. What are the elements of an Exposure Control Plan?
Exposure determination for all MTF personnel, standard precaution implementation, engineering and work practice controls, PPE, housekeeping, HIV and HBV research laboratories and production facilities, hepatitis A and B vaccinations, postexposure evaluation and follow-up, hazard communication, and recordkeeping.
201
11. What are the three required elements of transmission of infection?
(1) Source of infecting microorganisms (bacteria, viruses, mycobacterium, parasites, etc.).
(2) A susceptible host.
(3) A means of transmission.
202
12. List the five main routes of transmission.
(1) Contact. (2) Droplet.
(3) Airborne.
(4) Common vehicle (bed, linen, table, etc.). (5) Vector-borne.
203
13. What are the fundamental isolation precautions?
Hand washing and gloving; patient placement; transport of infected patients; masks, respiratory protection, eye protection, and face shields; gowns and protective apparel; patient-care equipment and articles; and linen and laundry.
204
14. What is the first tier in the HICPAC isolation precautions and its definition?
Standard precautions; applies to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status; and applies to blood; all body fluids, secretions, and excretions (except sweat), regardless of whether or not they contain visible blood; nonintact skin; and mucus membranes.
205
15. What is the second tier in the HICPAC isolation precautions and its definition?
Transmission-based precautions are designed for patients documented or suspected to be infected with highly transmissible or epidemiological important pathogens for which additional precautions beyond standard precautions are needed to interrupt transmission in hospitals.
206
16. What are the three types of transmission-based precautions?
(1) Airborne.
(2) Droplet.
(3) Contact.
207
1. What is the very first step in specimen collection, and who initiates it?
The order or request for the laboratory to perform a procedure or blood test; by the health-care provider or another qualified individual.
208
2. What type of information can you find on the request form?
This information includes patient’s name, SSN or hospital ID number, and date of birth; physician’s name; test ordered; date received; billing code; and room and bed number if an inpatient.
209
3. How should patient instructions be written?
The instructions you give to your patient must be direct, fully explained, and professional.
210
4. List the supplies and equipment required to do a venipuncture.
Supplies include gloves, antiseptic (alcohol pads), sterile gauze, bandages, slides, and needle or sharps disposal container. The equipment required is a tourniquet, needle, syringe or evacuated tube system, and various evacuated tubes with or without anticoagulants.
211
5. What is the bore size or gauge of a needle, and what does a small and large gauge mean?
The diameter of the interior shaft of the needle; smaller gauges are larger needles and higher gauges are smaller needles.
212
6. What do you consider when choosing needle size?
Condition and size of veins and chance for hemolysis.
213
7. Who are syringe systems used for?
Patients with small, fragile, poor, or difficult veins.
214
8. What needle size or gauge do you use when transferring specimens from syringes to evacuated tubes?
18 gauge.
215
9. Who are winged infusion sets used for?
A butterfly or winged infusion set is excellent for collecting blood from infants, children, and elderly patients with fragile or difficult veins.
216
10. Why do you use anticoagulants?
Because some procedures demand whole blood or plasma, the blood must be mixed with an anticoagulant in order to prevent clotting.
217
12. Why is it important to establish a collection order? List the order.
This prevents cross contamination of anticoagulants or tubes containing media; blood culture, clot, citrate, heparin, EDTA, oxalate, and then fluoride tubes.
218
1. How do you positively identify an inpatient?
By comparing the request form with the information on the patient’s identification or armband; if the patient is unconscious or comatose and there is no identification band, have a nurse identify the patient.
219
2. How do you positively identify an ambulatory or outpatient?
Check the patient’s ID card, ask him or her to state name and SSN, or have him or her visually verify the information on the request form; don’t ask yes or no questions.
220
3. Where do you apply the tourniquet for a venipuncture?
3 to 4 inches above the intended venipuncture site.
221
4. Which vein is preferred and why?
The median cubital vein is the preferred site because it is close to the skin surface. It is large and is surrounded by tissue that anchors it—preventing the vein from rolling (moving away).
222
5. When can you draw from an ankle or foot and what conditions make this dangerous?
Only if you consult a nurse or physician first; circulatory problems in lower extremities, diabetes in poor control, hemoglobinopathies, and edema.
223
6. How long can you leave a tourniquet on and what areas do you avoid?
One minute; areas with hematomas, edema, burns, or scars; and the arm on the side of a mastectomy.
224
7. What are the three exceptions for the use of 70% isopropyl alcohol?
(1) Drawing blood for alcohol determinations.
(2) Bacterial cultures.
(3) Blood donation.
225
8. What do you inspect the needle for?
Hooks, obstructions, or other defects.
226
9. Why do you tell the patient not to bend his or her arm after a venipuncture?
Bending the arm can cause the wound to reopen, which may result in blood leaking into surrounding tissue.
227
10. After collecting the sample and before leaving the bedside or side of the patient, what must you do?
Label the blood sample tubes with the patient’s first and last names, ID number or SSN, the date and time of collection, and your initials
228
11. What does NCCLS recommend using for drawing specimens from children under the age of 2?
The use of a 3 ml or tuberculin syringe with a 21- or 23-gauge needle.
229
12. How do you anchor a vein in the elderly and why?
Anchor the vein both above and below the venipuncture site; the elderly often have detached and floating veins.
230
13. If a patient faints during a venipuncture, what do you do?
Remove the tourniquet and needle immediately; carefully lower the patient to the floor, loosen tight clothing, administer an ammonia inhalant, and once the patient regains consciousness, apply cold compresses to his or her forehead and the back of the neck if necessary.
231
1. Why is skin puncture the technique of choice for blood collection for infants under 3 months of age?
Puncturing deep veins in children this young can cause cardiac arrest, venous hemorrhage, venous thrombosis, reflex arteriospasm, gangrene of an extremity, damage to surrounding tissues, or infection. Also, the infant may be injured while being restrained for the procedure.
232
2. On whom and for what reason can you use skin punctures?
Infants, young and older children, young adults, adults, and the elderly; severely burned patients, extremely obese patients, geriatric patients, and patients who don’t have usable veins.
233
3. List the supplies and equipment used for skin punctures.
Skin puncture supplies and equipment include gloves, sterile gauze, heel warmer or warm, moist towel, alcohol pads, bandages, capillary tubes, capillary tube sealant, microcollection tubes, volume pipettes for the Unopette system, glass slides, and possibly filter paper (PKUs) or reagent strips (glucose).
234
4. How much blood does a capillary tube hold, and how can you tell the plain from the anticoagulated tubes?
Approximately 50 to 75 μl of blood; a red band at one end of the tube indicates an ammonium heparin- coated tube, and a blue band indicates a plain tube.
235
5. How much blood does a Caraway or Natelson tube hold, and how can you tell the plain from the anticoagulated tubes?
Approximately 250 μl of blood and the tube is tapered at one end. A yellow band at the nontapered end indicates a lithium heparin-coated tube and nonanticoagulated tubes also have a blue band.
236
6. Where are the ideal spots from which you draw blood from an infant’s heel?
A site on the edge of the heel.
237
7. Why do you not draw blood from the end point or arch of the infant’s heel?
The end point can be as close as 2.4 mm from the bone and the arch has a lot of nerves, tendons, and cartilage.
238
8. What site do you use for a finger stick and which fingers do you use?
In older children and adults, the fleshy surface of the distal phalanx (last joint) of the index, middle, or ring finger or thumb can be used.
239
9. Why do you wipe away the first drop of blood from a skin puncture?
It may contain tissue fluid.
240
10. How can you release a drop of blood that becomes lodged in the collector cap of a microcollection tube?
Gently tap the tube on a hard surface.
241
1. List the four questions you must ask yourself when you receive a specimen.
(1) Has the proper container been used?
(2) Has the specimen been refrigerated?
(3) If it was frozen, has it thawed?
(4) Has the proper transmittal paperwork accompanied the specimen?
242
2. List five reasons for rejecting a specimen.
(1) Inadequate specimen identification.
(2) Inadequate volume of blood.
(3) Specimen collected in wrong tube.
(4) Hemolysis.
(5) Improper transportation.
243
3. Why do you centrifuge specimens as quickly as possible?
To avoid constituent changes; red cells still remain viable and absorb constituents from serum and plasma.
244
4. Describe hemolysis and what is it a result of?
Red color that varies depending on the severity; caused by hemoglobin being released when red cells are lysed.
245
5. Describe icteric and what is it a result of?
Yellowish or brownish in color; due to bile pigments, mostly bilirubin, in the serum or plasma.
246
6. Describe lipemic and what is it a result of?
Milky-white specimens; due to lipids or fats in the serum or plasma.
247
7. Who decides specimen requirements for specimens sent to another laboratory?
7. The referral laboratory.
248
8. How can you avoid a safety hazard or contamination when shipping a specimen?
Wrap the specimen in absorbent material and place in a ziplock bag to prevent a safety hazard and contamination if it leaks.
249
1. Define prefix.
A syllable or group of syllables joined to the beginning of another word to alter its meaning or to create another word.
250
(1) Little.
olig.
251
(2) Absence of.
an.
252
(3) Excess.
supra., ultra.
253
3. Define suffix.
A syllable or group of syllables added at the end of a word or word’s base to change its meaning, give it grammatical function, or form a new word.
254
(1) Puncture and aspiration of.
-centesis.
255
(2) Decomposition.
-lysis.
256
(3) Formation of.
-poeisis.
257
5. Define the term “root word.”
The main part or portion of a word from which other words may be formed by addition of a prefix and/or suffix.
258
6. What is the purpose of a combining vowel?
A combining vowel is used to make pronunciation easier when there is nothing between the two root words or between the root word and the suffix.
259
(1) Muscle.
my(o).
260
(2) Bone.
oste(o).
261
1. Most of the benefits of a POCT program are based on what belief?
That “faster care is better care” and that the more rapid testing by POCT would improve medical care and decrease utilization of MTF resources.
262
2. List the benefits a POCT program brings to the laboratory.
(1) Decreased preanalytical errors.
(2) Improved visibility.
(3) Decreased manpower needs.
(4) Collaboration with clinicians (providers).
(5) Direct patient involvement.
(6) Team management system.
263
3. What is probably the most negative aspect of POCT?
The cost.
264
4. What is the CLIA definition of waived tests?
These procedures are classified as simple and only require a certificate from CLIA for their performance.
265
5. How does CLIA define moderately complex tests?
This category of testing is classified as more difficult by CLIA, requiring proficiency testing and more technically trained personnel to perform them.
266
6. What is the name of the new CLIA subcategory being considered?
Accurate and precise technology (APT).
267
7. What was the scope of the strategic plan of the JCAHO?
To improve both the quality of health care and customer satisfaction.
268
8. According to CAP, what is the central criterion of POCT?
That it does not require permanent dedication space.
269
9. What does COLA regulate?
Physicians’ office laboratories; they regulate any laboratory procedure performed in a physician’s office.
270
10. What three roles must written policies developed for your POCT program address?
Authority, responsibility, and accountability.
271
11. According to NCCLS, the individual (or group) within your MTF with authority over your POCT program should be designated to do what things?
(1) Make and enforce policy.
(2) Assign responsibility.
(3) Address problems.
(4) Make decisions about the program’s structure. (5) Provide administrative support.
(6) Provide quality oversight.
272
12. Who is likely to have authority over a hospital-based POCT program?
Either a pathologist or the laboratory director (officer) who fulfills CLIA requirements.
273
13. What aspects of the POCT program does the person(s) with responsibility oversee?
They will be responsible for the evaluation of the instruments and test kits, the training of personnel performing the testing, and developing the procedural manual.
274
14. Who are the individuals with accountability in your POCT program, and what are they accountable for?
The individuals actually performing the testing; they are accountable for the following:
(1) Understanding the principles and limitations of the procedures they perform.
(2) Performing and documenting QC and maintenance, as appropriate.
(3) Maintaining proficiency in testing methods.
(4) Performing and documenting test results according to procedures.
(5) Following protocols for remedial actions or notification of responsible personnel.
275
15. What information must all POCT training programs include?
(1) The theory of the instrument/device being used.
(2) Specimen collection.
(3) Instrument maintenance requirements, if applicable.
(4) Quality control procedures.
(5) Testing procedures.
(6) Sources and degree of preanalytical errors.
(7) Clinical significance of results.
276
16. What is the greatest source of error in POCT testing? Is this also true of general laboratory testing?
. Preanalytical. Yes.
277
17. What is the intent of the POCT procedural manual?
To provide the basic foundation of knowledge to competently train nonlaboratory health-care workers to
understand any new POCT procedure and to accurately perform it on any POCT instrument.
278
18. When it comes to QA and POCT, what can we do to make sure we produce the best results possible?
Take great care to follow the manufacturers’ QC and calibration directions and be aware of all QA POCT
regulatory guidance.
279
19. Into what two major categories are POCT systems grouped?
Non-instrument-based systems and instrument-based systems.
280
20. List the factors that have aided in the improvements in functionality of POCT instruments.
The factors are as follows
(1) Advances in reagent stabilization.
(2) The development and miniaturization of electrodes and biosensors.
(3) The ability by manufacturers to produce relatively inexpensive, precise, disposable devices.
The theory of the instrument/device being used.
(4) The development of microcomputers and microelectrodes.
281
1. What does a chemical symbol consist of and what does it represent?
A letter or pair of letters representing one atom of an element.
282
2. What is the difference between molecules of an element and molecules of a compound?
Molecules of an element contain only one or more atoms of the same element while compounds contain two or more atoms of different elements.
283
3. What do the terms “monatomic,” “diatomic,” and “triatomic” signify in relation to molecules?
(1) Monatomic molecules contain only one atom of an element. In monatomic molecules, the molecule and the atom of an element are the same.
(2) Diatomic molecules contain two atoms of the same element.
(3) Triatomic molecules contain three atoms of the same element.
284
4. What is a compound, and what can be said about its properties compared to the elements from which it was formed?
A compound is a substance made up of two or more elements, chemically united in definite proportions by weight. A compound’s properties are different from the elements from which the compound was formed.
285
The quantity of one element needed to combine with another element in a fixed ratio we refer to as which chemical law?
The law of definite proportions.
286
What are cations and anions, and how do they relate to chemical bonding?
Cations are positively charged ions; anions are negatively charged ions. The attraction between oppositely charged ions is what binds compounds together.
287
What term defines combining element symbols (examples: NaCl, H2O) to represent compounds?
Chemical formulas (examples given are sodium chloride and water).
288
8. What factors may affect chemical reactions?
Temperature, light, pressure, catalysts, and concentration.
289
1. Define what an acid is, and describe how acids are classified.
An acid is a substance that yields or donates a hydrogen ion (H+) in a water solution. Acids are classified based upon how many hydrogen ions they yield when placed in a solution.
290
2. Define what a base is, and describe how it differs from an acid.
A base is a substance that yields hydroxide ions (OH-) in a water solution. The difference between acids and bases is that an acid donates protons while a base accepts them.
291
3. Describe what an indicator is, and name one that is commonly used in the laboratory.
An indicator is a substance that produces a color when it reacts with certain compounds. Litmus paper is an indicator commonly used in the laboratory.
292
4. Describe how salts are formed.
When acids and bases are combined, they neutralize each other. When this happens, salt and water are formed.
293
5. Give two examples of salts and where they function in the human body.
Any two of the following:
(1) Iron salts—hemoglobin formation.
(2) Iodine salts—thyroid gland.
(3) Calcium salts—bones and teeth.
(4) Sodium and potassium salts—acid-base balance.
294
6. What is the definition of a solution?
The homogenous mixture of two or more substances evenly distributed in a solvent.
295
7. What is the difference between a solute and a solvent?
The solute is a solid, liquid, or gaseous material that has been dissolved, and the solvent is the liquid material in which the solute has been dissolved.
296
8. List three properties of a true solution.
Any three of the following:
(1) It consists of a solute dissolved in a solvent.
(2) It must have a variable composition.
(3) It may be either colored or colorless, but it is usually transparent.
(4) It is homogenous.
(5) It will not settle.
(6) It can be separated by physical means (evaporation, electrolysis, etc.).
(7) It is able to pass through filter paper without changing.
297
9. What are the variables that may affect the solubility of a solution, and what is their result on the solution?
(1)
Temperature—solid solutes are more soluble in hot water than in cold. Gases are usually less soluble as the temperature increases.
(2) Pressure—little or no effect on solid or liquid solutes. With gases, the greater the pressure, the greater the solubility.
(3) Surface area—affects the rate of dissolution. The greater the area, the quicker a solute will dissolve.
(4) Stirring—increases the rate a solute dissolves. This mainly affects solids.
(5) Concentration—when the solute and solvent are first mixed, the rate of dissolving is at its maximum. As the concentration of the solution increases (increased solute), the rate of dissolving decreases greatly.
298
(1) This chemistry deals with the elements themselves and mineral matter.
Inorganic chemistry.
299
(2) Most are solid and dissolve easily in water.
Inorganic compounds.
300
(3) This chemistry deals with virtually all carbon-based compounds.
Organic chemistry.
301
(4) This theory stated that only a “vital force” in nature could create
organic compounds
Vital force theory.
302
2. Describe the type of bonding used in inorganic and organic compounds.
Inorganic compounds mostly use ionic bonds, which cause them to have high melting and boiling points; and organic compounds are held together by covalent bonds, which make organic compounds have low melting and boiling points).
303
3. What are the two classes of hydrocarbons? How do they differ?
Aliphatic and aromatic. Aliphatic hydrocarbons do not contain the benzene group, while aromatic hydrocarbons contain one or more of the benzene rings.
304
1. Briefly describe analytical chemistry and biochemistry.
Analytical chemistry is concerned with the qualitative (what is it made of?) analysis and quantitative (how much is there?) analysis of the elements in a compound. Biochemistry is the chemistry of living organisms and their vital processes.
305
2. Explain where carbohydrates come from and how animals get them.
Simple carbohydrates are created by chlorophyll-containing plants through photosynthesis. Animals are incapable of creating their own carbohydrates, so they must get them by eating plants.
306
3. Carbohydrates exist in what three forms?
Sugars, starches, and cellulose.
307
4. Explain what mono-, di-, oligo-, and polysaccharides are.
(1)
A monosaccharide is a carbohydrate that cannot be hydrolyzed (broken down) into a simpler carbohydrate unit.
(2) A disaccharide is a carbohydrate that can be hydrolyzed into two monosaccharides.
(3) Oligosaccharides are carbohydrates made up of three to 10 monosaccharides.
(4) Polysaccharides are also made up monosaccharides linked together, but these may number into the thousands.
308
5. What organic substances are found most abundantly as fats and oils and are insoluble in water?
Lipids.
309
Describe the difference between fats and oils.
Fats are glycerides, which are usually solid at room temperature, while oils are liquids at room temperature. Fats and oils are obtained from natural sources. As a general rule, fats come from animal sources, while oils come from vegetable sources.
310
Briefly describe phospholipids, glycolipids, and steroids.
Phospholipids, glycolipids, and steroids are types of lipids. Phospholipids are found in all animal and vegetable cells and are abundant in the brain, spinal cord, and liver. Glycolipids, also known as cerebrosides, are found primarily in the brain (these make up 7% of the dry weight of the brain) and at nerve synapses. Steroids are important to the body’s chemistry because this group also includes many hormones.
311
8. What term is taken from the Greek word meaning “of first importance”?
Proteins.
312
9. List at least three functions proteins perform in the body.
Any three of the following:
(1) Structure: Proteins are the main constituents of bone, skin, hair, and nails.
(2) Catalysis: Just about all reactions that take place within the body are catalyzed by proteins called enzymes.
(3) Movement: Every time you move a muscle (scratch, blink, run, etc.), you contract or expand your muscles.
(4) Transport: Some proteins transport molecules across cell membranes, while others such as hemoglobin, carry oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs.
(5) Hormones: Many hormones are proteins—insulin, epinephrine, and human growth hormone, just to name a few.
(6) Protection: When an antigen (an outside protein) invades the body, the body makes its own protein (called an antibody) to counteract the foreign protein. Blood clotting is another protective function carried about by a protein (called fibrinogen).
(7) Storage: Some proteins are used to store materials. In the liver, a protein known as ferritin stores iron.
313
10. What do proteins consist of?
10. Proteins are linear chains of amino acids. While organic chemists are capable of creating thousands of amino acids, only 20 make up all the various proteins in the body.
314
11. What are the two types of nucleic acids, and which type carries the hereditary information?
11. Deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Only DNA carries the hereditary information. This information tells the cell which proteins to manufacture.
315
1. In the English system of measurement, what are the reporting units for weight, liquid, and distance?
Pound, gallon, and mile.
316
2. Explain how prefixes affect the primary reporting unit in the metric system.
Each prefix designates a factor that must be applied to the primary unit. By combining the prefix and the primary unit, you may produce a larger or smaller unit of the property being measured.
317
3. In which instances may you want to use the capital letter “L” rather than the lowercase letter “l” when abbreviating liters?
In instances where the lowercase letter “l” may be confused with the number “1.”
318
4. What is SI, and on what measurement system is it based?
SI is the abbreviation for the Système Internationale d’Units (or in English, the “International System of Units”), a system of measurement adopted by the international scientific community in 1960. It is based on the metric system and uses some metric units.
319
5. What are the basic properties used in SI, and what are their base units called?
Basic properties refer to what is being measured and the base unit is the name given to the unit of measure for that property. Mass—kilogram; length—meter; time—second; catalytic amount—katal; and amount of substance—mole.
320
6. What are “derived units” in SI, and how are they obtained?
In SI, derived units describe properties other than the base units. Derived units are created by mathematically combining two or more base units. An example of a derived unit is volume, which is length in three dimensions—length × length × length.
321
7. With regards to measurement systems, what do you do if you are implementing a new piece of equipment or technique?
Be sure to look at how your values are reported. If there is a change in reporting units, notify lab staff and providers of the change. Always include reference ranges to aid providers in basing decisions on numbering systems they are unfamiliar with.
322
8. Explain what a “significant number” is.
A measured number, one in which the number of digits are known with certainty.
323
9. A technician reports out a urine pH as 5.5 when the visual reader only offers 5 or 6 as an acceptable choice. By reporting out this result, what has the technician done?
By reporting out a value with more significant figures than the equipment calls for, the technician has implied a precision in testing that does not exist.
324
10. In which of the following numbers are the zeros considered significant numbers: 10.02, 3.00, and 0.02? Explain.
The zeros in 10.02 are significant because they fall between two nonzero digits. The zeros in 3.00 are significant because they are to the right of a nonzero digit and are to the right of a decimal point to indicate the precision of the number. The zeros in 0.02 are not considered significant because they are to the right of the decimal and do not possess an actual value themselves, and they do not have a significant digit to their left.
325
What was one of the stumbling blocks to automated laboratory testing as we know it? Why?
Protein interference. When heated or chemically treated, protein in plasma or serum samples would turn opaque, making photoelectric reading impossible.
326
Describe how the first practical automated testing system overcame the problems of protein interference.
The AutoAnalyzer used semipermeable membranes to separate the analyte being tested from the interfering proteins.
327
(1) Runs the same test on all the samples in a run.
Batch analyzer.
328
Allows the technician to decide which tests are run on a
| sample.
Random access analyzer.
329
Pumps reagents through the system continuously.
Continuous flow analyzer.
330
Processes each sample separately and in its own reaction
| container.
Discrete analyzer.
331
Uses centrifugal force to transfer and mix reagents and
| samples.
Centrifugal force
| analyzer.
332
(1) Operator is free to perform other tasks while the instrument processes the tests.
Walkaway capability.
333
The reportable range for patient results without sample manipulation.
Linearity.
334
The ability to only measure the analyte being tested.
Specificity.
335
The lowest value for a test that can be reported accurately.
Sensitivity.
336
The ability to determine the actual value of an analyte.
Accuracy
337
The reproducibility of an instrument.
Precision.
338
5. Explain the difference between accuracy and precision.
Accuracy is the ability to determine the actual value of an analyte. Precision is how well the instrument reproduces a result. An instrument may be precise but not accurate.
339
6. What does the wavelength of light determine?
The wavelength of light determines the color of the light and whether or not it can be seen by the human eye.
340
7. What wavelengths are you concerned with in the clinical laboratory setting?
The ultraviolet, visible, and near infrared.
341
8. Explain why a “red” solution appears red.
A “red” solution appears red because the particles in the solution have absorbed all the wavelengths except the red one. By allowing the red wavelength to pass through the solution, it is seen as a “red” one.
342
. Explain the concept of Beer’s law.
Beer’s law states the intensity of the color seen in a reaction is directly proportional to the concentration of the substance being tested.
343
Explain the concept of Lambert’s law.
Lambert’s law states that the absorbance of a solution increases linearly when you increase the light path.
344
1. Equipment maintenance procedures are normally built into what daily program?
Daily QC programs.
345
When you are tasked to use a piece of equipment you have never used before, why must you review the manufacturer’s manual?
Reviewing the manufacturer’s manual ensures you know key points to running the equipment. You may learn items that were not passed on during training or pick up items that were missed when someone else established a program for the equipment.
346
Why must you make sure your equipment stays clean?
Equipment should be free of chemicals and sample spills because these spills are breeding grounds for diseases, can corrode equipment, coat optical windows (affecting readings), or otherwise create the potential for problems.
347
4. Why must you look at each aspect of equipment maintenance and quality control separately?
Because even though the “big picture” looks fine, there may be problems developing on a small scale. By looking at each aspect separately, you can detect these problems sooner and correct them before they reach crisis proportions.
348
5. What does “method correlation” ensure?
That a new method or piece of equipment will yield similar results to the practice currently in use.
349
How do you do method correlation? What do you do if there is a difference between the old and new methods?
Method correlation is done by running the same samples on the old and new equipment or method and then comparing the results. If results are widely varied, first ensure that each analyzer is running correctly. If they are, you may need to establish a new reference range for the new procedure or equipment. Be sure to identify the method and reference range on lab reports if both old and new methods will remain in use.
350
If an equipment problem is beyond your expertise, to whom do you refer the problem?
Biomedical equipment repair or the factory service representatives.
351
. In addition to impacting QC programs, why do you document equipment maintenance?
Documentation of equipment maintenance helps shift operators review common problems and solutions should the instrument malfunction as well as support equipment replacement requests.
352
Why is it important for you to be familiar with the equipment you are using?
By being familiar with the equipment you are using, you are able to make the distinction between normal and abnormal operations, pick up on subtle hints that a problem is occurring, and troubleshoot these problems to ensure that only proper results are reported.
353
What sequence do you follow when troubleshooting equipment?
Troubleshooting should start with the most simple (and common) problem and move to the more complex (and less likely) problem.
354
1. Why were laboratory managers glad to see the incorporation of electrochemical techniques in laboratory testing?
Electrochemical techniques allowed the testing of various analytes to be combined into one machine. Laboratory managers now only needed one machine and one technician to do the work that previously needed several machines and technicians.
355
2. Explain what a “galvanic cell” is and how it works.
A galvanic cell is the name given to a container housing the process of chemical energy being converted to electrical energy. The galvanic cell is made up of two half-cells, each filled with a metal salt solution. Measurement of voltage generated by the activity of specific ions in the galvanic cell is proportional to analyte concentration.
356
3. Explain how half-cells work in potentiometric techniques.
Potentiometry measures the comparison of one electrode potential to the potential of a second electrode. One half-cell maintains a constant voltage (reference electrode), and the second half-cell will contain the unknown solution and have a varying voltage (indicator electrode). By comparing the differences between the electrode potentials, the concentration of your test solution can be calculated.
357
4. Explain how we use coulometric methods to detect chloride concentration.
By passing a current through two silver electrodes (immersed in an ionic solution), silver ions are formed. If the solution contains chloride ions, the silver and chloride combine to form silver chloride, an insoluble substance. When all of the chloride ions have been bound, excess silver ions are detected and the process is discontinued. The amount of electricity used is directly proportional to substance produced or consumed by the electrodes.
358
5. Explain the process behind anodic stripping voltametry.
In anodic stripping voltametry, a negative potential is applied to an electrode, causing the metal ions in the sample to plate the electrode. After a set period of time, the plated ions are removed by applying a positive potential to the electrode. As the ions return to solution, they form a peak characteristic for each metal. The peak height is proportional to the concentration of the analyte.
359
6. Polarography is most commonly used in analytical chemistry and not clinical chemistry with the exception of which analyte?
Polarography is used to measure oxygen.
360
Define chromatography.
Chromatography is the separation of substances in a common solvent so that each component may be identified individually. This is done by passing the solvent through a filtering material, allowing some portions to proceed faster than others to a detector where they may be quantified.
361
Describe the two phases of the chromatography process.
(1) The mobile phase describes the solvent moving along.
| (2) The stationary phase describes a compound coming in contact with the supporting medium column.
362
How does the mobile phase determine the name of a chromatography technique?
Chromatography techniques are named based on the type of mobile phase used. If the mobile phase is a liquid, the technique is called “liquid chromatography,” and if a gas is used, it is called “gas chromatography.”
363
What is one of the disadvantages of GC?
GC can only be used to measure compounds that are naturally volatile or can be converted to a volatile compound. This factor limits GC testing to only 10% to 20% of all known compounds.
364
How is the “slurry” passed through the column in LC?
The slurry is allowed to pass through the column using gravity or with the aid of applied suction or air pressure.
365
What are the two primary advantages of LC over GC?
LC can be used to separate any compound that is soluble in a liquid phase, and it can be performed at lower temperatures, allowing the testing of thermolabile compounds.
366
How does HPLC differ from “regular” LC?
In HPLC, the support medium in the column is much smaller and more uniform in size than that in regular LC. The smaller medium results in narrower peaks than those seen in LC.
367
What is the difference between LC and TLC techniques?
LC uses a straight column to house the filtering material, while TLC techniques use a filtering material in a flat bed.
368
Explain how GC/MS analyzers operate.
After a sample is introduced into the GC/MS analyzer, it is first converted into a gaseous state. The gas is then placed into an ionizing chamber where it is bombarded by an electron beam. The electron beam causes sample molecules to become positively ionized and these ions are then directed to an acceleration tube and into a mass analyzer. In the mass analyzer, the ions are separated according to their mass-to-charge ratio and the resulting spectrum of masses is scanned by a detector to determine the amount of each component.
369
Explain how electrophoresis techniques differ from those of chromatography.
Electrophoresis techniques use electrical current to separate components while chromatography techniques use a mechanical means.
370
Explain how hydration affects an ion’s rate of travel.
In water, all ions become hydrated or clustered with water molecules. Some ions will cluster with more water molecules than others and this extra weight will cause them to travel more slowly than ions not as heavily burdened.
371
Describe the purpose of the electrodes in electrophoresis.
One electrode (the anode) is attached to a positive voltage source and is used to attract negatively charged ions (anions). The other electrode( the cathode) is connected to a negative voltage source and is used to attract positively charged ions (cations).
372
Why do we use buffered solutions in electrophoresis solutions?
Buffered solutions are used to maintain pH. Proteins may be cationic or anionic, depending on the solution pH. Changing the pH changes the ionic characteristics of the proteins, which may change their rate and direction of movement.
373
What is the purpose of a supporting medium in electrophoresis?
A supporting medium keeps the sample and separate fractions from falling through the electrophoresis solution and remixing during the process.
374
What do we use to read an electrophoretic pattern and semiquantify the fractions?
A densitometer reads the patterns left on a supporting medium.
375
In immunoassay principles, what do we use as a search vehicle?
Immunoassays use antibodies and antigens as search vehicles. Since antibodies and antigens are specific for each other, you may search for one by using the other as a search vehicle.
376
Explain why antigens or antibodies are tagged with a tracer.
Antigens and antibodies are tagged with a tracer; reactions are then read photometrically to determine the analyte of interest.
377
What are some of the disadvantages of using RIA?
3. In addition to being labor-intensive, reagent kits are short-lived and often expire before they are used. Because of the unique safety hazards posed with using radioactive materials, facilities must be licensed and have special waste disposal methods.
378
4. Explain the principle used in EIA.
In EIA, an enzyme-labeled antigen or antibody is allowed to react with the ligand. An enzyme substrate is then added and a measurement taken. A decrease in the substrate or an increase in the compound production will quantitate the antigen-antibody reaction.
379
What is the difference between the ELISA and the EMIT?
In the ELISA method, one of the reaction components is absorbed onto the surface of a solid phase. Attachment to the solid phase separates the free and bound reactants and the free reactants are then washed away before the enzyme substrate is added. The EMIT method does not have a separation step.
380
What is the purpose of fluorophores in FIA?
Fluorophores are used as a labels, just as radioisotopes are used in RIA and enzymes are used in EIA.
381
What is osmometry, and why is it used in the clinical laboratory?
Osmometry is defined as “the measure of particles in a solution.” It is used to measure the osmolality of a solution (such as serum, urine, or plasma).
382
What four things happen to a solution when you increase its osmolality?
(1) Increases the osmotic pressure of the solution.
(2) Increases the boiling point of the solution.
(3) Decreases the freezing point of the solution.
(4) Depresses the vapor pressure.
383
(1) This test method is sometimes called “cryoscopy.”
Freezing point depression osmometry.
384
(2) This method measures the point where water
| molecules will condense into a liquid.
```
Vapor pressure (dew point)
osmometry.
```
385
(3) In this method, osmosis causes a negative pressure to
develop on the reference side of a semipermeable
membrane.
. Colloidosmotic pressure osmometry.
386
This method measure light decrease caused by
| scattering, reflection, or absorption.
Turbidimetry.
387
This test method has a detector located at a right angle to the light beam.
Nephelometry.
388
1. Define biowarfare and bioterrorism.
The intentional or alleged use of viruses, bacteria, fungi, and toxins to produce death or disease in humans, animals, or plants.
389
2. What two forms can bioterrorism events take?
Announced (overt) or unannounced (covert).
390
3. What occurred between May 1971 and May 1972?
All stockpiles of biological agents and munitions from the US biological program were destroyed.
391
4. What did the Biological Weapons Convention do?
The treaty prohibited the stockpiling of biological agents for offensive military purposes and also forbade research into the offensive employment of biological agents.
392
5. With what two other agencies did the CDC collaborate to establish the LRN?
The Association of Public Health Laboratories and the FBI.
393
6. What is the fundamental goal of the LRN?
To enhance US laboratory capacity for preparedness and ability to respond to an act of bioterrorism by providing a shared network of civilian, public health, and military laboratories to facilitate rapid detection and analysis of both chemical and biological agents.
394
7. How many reference and sentinel laboratories are there in the LRN network, and what are their individual functions?
The LRN consists of over 120 core reference public health laboratories from both the military and civilian sectors that provide confirmatory testing for agents at biosafety levels 3 and 4. There is an estimated 2,500 sentinel laboratories that play an important role in reporting possible agent outbreaks and ensure specimens are sent to the appropriate reference laboratory for confirmation.
395
8. In General Carlton’s memorandum, he stated that in support of LRN and homeland defense, all Air Force medical laboratories in the United States will participate in the LRN minimally at what level?
Minimally at Level A.
396
How are the laboratories of the LRN assigned to their designated levels?
The LRN operates as a network of laboratories, which are placed within a designated level based on their capabilities.
397
List the scope of responsibilities for the Level A LRN laboratories.
Level A responsibilities: Rule-Out or Refer; assess risks for aerosols; BSL–2; and detect early (presumptive) cases.
398
List the scope of responsibilities for the Level D LRN laboratories.
Level D responsibilities: Confirm, Validate, and Achieve; BSL–4; perform high-level characterization; and probe for universal agents.
399
What is the function of a Level A laboratory?
The function of the Level A laboratory is to detect intentional dissemination of biological agents.
400
. What do the Level A laboratories use to decide which specimens are to be forwarded to a higher- level laboratory?
Clinical data and standard microbiology tests to decide which specimens and isolates should be forwarded to one of the higher-level biocontainment laboratories.
401
At what performance capacity do Level C laboratories perform?
The Level C laboratories have the capacity to perform toxicity testing and employ advanced diagnostic techniques (e.g., PCR and molecular fingerprinting).
402
A Bioterrorism Preparedness and Response Office had been formed within the CDC to help target what areas of the initial preparedness activities?
The areas include planning, improving surveillance and epidemiologic capabilities, rapid laboratory diagnosis, enhanced communication, and medical therapeutic stockpiling.
403
. Define Category A biological agents.
These are high-priority agents that include organisms that pose a risk to national security because they can be easily disseminated or transmitted person-to-person; cause high mortality, with potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness.
404
17. Define Category B biological agents.
These are the second highest priority agents and include those that are moderately east to disseminate; cause moderate morbidity and low mortality; and require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.
405
18. Define Category C biological agents.
The third highest priority agents include “emerging threat agents” that could be engineered for mass dissemination in the future because of availability; ease of production and dissemination; and potential for high mortality and major health impact.
406
19. What is the first step in the presumptive identification of a potential biological agent?
Observation of the media where the organism is growing, the colony characteristics, and any obvious odor of the microorganism is the first step to early presumptive identification.
407
If you have presumptively identified a biological agent through routine culturing and the performance of key tests, whom do you notify first with this information?
Your laboratory officer and chief of pathology.
408
. List the four factors that you must take into consideration when assessing the BSL of your laboratory.
(1) The agents involved.
(2) Practices/techniques.
(3) Safety equipment (primary barriers).
(4) Facilities (secondary barriers).
409
22. List the “practices” required for a BSL–2.
They include BSL–1 practices plus limited access, biohazard warning signs, “sharps” precautions, biosafety manual defining any needed waste decontamination or medical surveillance practices.
410
List the “facilities (secondary barriers)” required for a BSL–4.
They include BSL–3 plus located in a separate building or isolated zone, dedicated supply and exhaust vacuum, and decontamination system, and other requirements as needed.
411
Define infectious substance.
A substance containing a viable microorganism, such as bacterium, virus, rickettsia, parasite, or fungus, that is known to or is reasonably believed to cause disease in humans or animals.
412
List the three clinically different forms of anthrax and the specimens we would collect to identify them.
(1) Cutaneous form (collect vesicle swabs).
| 2) Gastrointestinal form (collect stool or blood). (3) Inhalation form (collect sputum or blood
413
What type of packaging system do we use to ship infectious substances?
A basic triple-packaging system is used with some additional specifications, labeling, and documentation requirements that are not used when shipping clinical specimens.
414
. List the labeling requirements for the “outer packaging” when shipping infectious substances.
These labels are required on the outer packaging: address label (higher-level laboratories address and phone number and shipper’s name, address, and phone number), infectious substance label, and completed UN
2814 label.
415
When shipping biological agents, protection of transportation workers and the public is achieved through what four general rules?
(1)
The requirements for rigorous packaging that will withstand rough handling and contain all liquid materials within the package without leakage to the outside.
(2) Appropriate labeling of the package with infectious substance symbol, biohazard symbol, and other labels to alert the workers in the transportation chain to the hazards of the package.
(3) Documentation of the hazardous contents of the package should such information be required in an emergency situation.
(4) Training of workers in the transportation chain to familiarize them with the hazardous contents, enabling them to properly respond to emergency situations.
416
List the sources that you can use to obtain the most up-to-date information about the LRN.
Your laboratory officer, the AFMS Web site, the Center for Clinical Laboratory Medicine at the Armed Forces Institute of Pathology (AFIP), or the CDC Web site.
