ASCP-MLT Practice Exam Questions and Answers

The most important purpose of a requisition form is:

Question options:

Match each of the descriptions with the appropriate magnification:

1. Color, Rouleau, Overall Slide Quality, Cell Distribution

2. Platelet estimates RBC-platelet-WBC morphology WBC differential RBC inclusions

3. Select area to examine, WBC estimate

FAB M5 is acute monoblastic leukemia

FAB M1 is acute myeloblastic leukemia without maturation

FAB M3 is acute promyelocytic leukemia

FAB M4 is acute myelomonocytic leukemia

Which FAB designation is called the "true" monocytic leukemia and is characterized by monoblasts, promonocytes, and monocytes?

The morphologic characteristic(s) associated with the Chediak-Higashi syndrome is (are):

Match each virus with its appropriate nucleic acid content.

1. Paramyxovirus

2. Rhabdovirus

3. Poxvirus

4. Orthomyxovirus

A hospital chief operating officer is responsible for

Eosinophils do not have cytoplasm containing large purple/blue-staining granules. Instead, their granules are large but are orange/red in color. These granules are very distinctive for this type of cell, typically making their identification simple.

ll of the following statements describe an eosinophil EXCEPT:

In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.

Thyroid-stimulating immunoglobulins, or TSI's, are IgG antibodies that can bind to thyrotropin (TSH) receptors on the thyroid gland. TSIs mimic the action of TSH, causing excess secretion of thyroxine and triiodothyronine. The TSI level is abnormally high in persons with hyperthyroidism due to Graves' disease.

Which of the following is an autoantibody that binds to TSH receptor sites on thyroid cell membranes preventing thyroid-stimulating hormone binding?

Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that appears as a round, dark-staining inclusion in the cytoplasm of red blood cells. Howell-Jolly bodies can be found in various conditions including splenectomy and anemia.

Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:

Neutrophils, lymphocytes and macrophage/ monocytes can be found in all types of body fluid differentials. Bronchial cells can be found only in bronchial washings and BAL specimens. Mesothelial cells are found only in serous body fluids including pleural fluid, peritoneal fluid, and pericardial fluid.

Select the specific cells listed below that can be found in all types of body fluid.

The Needlestick Safety and Prevention Act requires employers to:

S. aureus does not have capsular material as a defense mechanism. H. influenzae, K. pneumoniae, N. meningitidis, and S. pneumoniae each have capsular material use as a defense mechanism. This capsular material is an antiphagocytic substance which helps deter bacterial death by macrophages and other white blood cells.

Microbiology

Which one of the following does NOT have capsular material as a defense mechanism?

Set of comprehensive safety guidelines designed to protect patients and health care workers

In which of the following laboratory situations is a verbal report permissible?

The ratio of blood to anticoagulant in a light blue stopper tube is:

The color coding of evacuated tubes provides information about all of the following except the: Question options:

1. B

2. D

3. A

4. C

Red to Brown Urine: porphobilinogen, hematuria, myoglobinuria, etc.

Green: Food colorings; Increased carotene in the diet;

Pseudomonas aeruginosa infection

Yellow: bilirubin, bile pigments

White: phosphates, other crytals

Match urine color with substance that might have been responsible:

1. Phosphates

2. Bilirubin

3. Pseudomonas

4. Porphobilinogen

Cerebrospinal fluid has three main functions:

Protect brain and spinal cord from trauma.

Supply nutrients to nervous system tissue.

Remove waste products from cerebral metabolism.

Which of the following are functions of CSF? Please select all correct answers

The Fc portion of immunoglobulin can activate the classical complement pathway, where the heavy chains, light chains, hinge regions and Fab portions cannot.

Which part of the immunoglobulin molecule is responsible for activating complement?

Calculation:

Cells Counted (in this case the average of both sides) X dilution factor (in this case 100) / # of squares counted (in this case 9) X area of each square (1mm2) X 0.1mm (depth factor)

So, in this problem:

158 x 100 / 9 x 1 x 0.1mm = 17555.55/mm3 (can be converted to 17.5 x 109/L*)

*There are 1,000,000 mm3 in a liter (L). So 17555.55 X 1,000,000 = 17.5 x 109/L

A manual white blood cell count was performed by the hematology technologist. The cell counts for both sides were 152 and 164 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:100. What should the technologist report as the white cell count?

Lavender stopper tubes can be used for all of the following except:

Which of the following testing options would be classified as waived testing by CLIA standards?

Hb S migrates with D in alkaline and alone in acid electrophoresis.

The gel electrophoresis pattern for hemoglobin S shows which of the following migration patterns?

India ink can aid in the visualization of the polysacchride capsules of yeast such as Cryptococcus neoformans.

Micro

India Ink is used to:

This integrity of this specimen is compromised. The unit cannot be used.

What action should be taken if a large clot is noticed in a red blood cell unit while the product is being prepared for release to the patient?

Parathyroid hormone regulates serum calcium by acting on bone, kidney, and intestines while regulating phosphate by stimulating the intestines and the kidneys, enhancing absorption and reabsorption respectively.

Chem

The parathyroid hormone is important in the regulation of:

Tan stopper tubes are used for reticulocyte counts.

Question options:

To prevent blood from clotting the specimen must be:

The production of long, tapered phialides is one of the key identifying features of Trichoderma species. In contrast, Penicillium species, produce phialides with blunt ends.

The phialides of Beauveria species are geniculate, forming a zig-zag pattern.

The arrows in the image on the right point to single, long, tapered phialides that extend laterally from either side of the hyphae. This is an identifying feature of which of the fungi listed below?

The National Heart, Lung, and Blood Institute initiated the National Cholesterol Education Program (NCEP) in 1985. The goal was to reduce the number of Americans with elevated cholesterol and thus reduce illnesses and deaths in the United States due to coronary heart disease. Three adult treatment panels have been published since then with clinical practice guidelines for managing cholesterol levels in adults.

The most recent panel, Adult Treatment Panel III (ATP III), was published in 2001 and updated in 2004. The NCEP: ATP III also includes criteria for the diagnosis of metabolic syndrome.

Select the set of laboratory assays that are utilized in the NCEP: ATP III criteria for metabolic syndrome diagnosis.

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of Aspergillus. Aspergillus has the ability to infect primarily immunocompromised hosts, and causes pneumonia and/or disseminates to other organs. Clinical specimens should be inoculated onto primary isolation media, such as Sabouraud's dextrose agar. Aspergillus spp. are fast growing and can be white, yellow, yellow-brown, brown to black or green in color.

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of:

The creatinine clearance for this patient is 100 mL/min.

Creatinine clearance values are calculated using the following equation:

Creatinine Clearance (mL / min) = (Urine Creatinine / Serum Creatinine) x Urine Volume (mL) / [ time (hr) x 60 ]

For this patient Creatinine clearance (mL/min)= (120/1.5) x (1800 / [24 x 60])

80 x 1800/1440, which is 80 x 1.25, or 100 mL/min

A 45-year-old male of average height and weight had a serum creatinine of 1.5 mg/dL and urine creatinine was 120 mg/dL; the total volume of urine collected over a 24-hour period was 1,800 mL. Calculate the creatinine clearance for this patient in mL/min.

Blood Bank; Immunology

Which of the following best describes the primary function of antibodies:

Amniotic fluid bilirubin is increased in association with the severity of hemolytic diseases of the newborn. As red blood cells lyse during these conditions, bilirubin builds up as a byproduct of the red cell destruction. The more red blood cells that are being destroyed in the baby, the more increased the bilirubin level will become.

Which one of the following tests BEST correlates with the severity of hemolytic disease of the newborn (HDN).

The A and B antigens are present on the red cells of an AB patient. H antigen is a precursor to the ABO antigens.

An individual with type AB blood will demonstrate the complete absence of which of the following antigen sites?

The laboratory uses flammable chemicals for processing and staining patient specimens. One type of chemical used is ethanol. What is the proper way to store this chemical in the laboratory?

HCG levels rise rapidly during the first trimester, then the levels start to decline around week 16. The hCG levels slowly decrease and can level off during the remainder of the pregnancy.

The following BEST describes serum hCG levels during pregnancy:

Which of the following organizations has developed standards to maintain the performance of the clinical laboratory at the highest standards for quality care?

High-sensitivity C-reactive protein (hs-CRP) is used as an aid in the diagnosis and treatment of cardiovascular disease (CVD). At low levels, it can detect those at risk for cardiac heart disease. At high levels in those with no history of heart disease, it indicates a high risk for acute myocardial infarction (AMI), stroke, or peripheral vascular disease. For patients with acute coronary syndrome (ACS) or stable coronary disease, hs-CRP is used to predict future coronary events.

Ranges of hs-CRP in prediction of risk for CVD are:

<1.0 mg/L Low CVD risk

1.0-3.0 mg/L Average risk for CVD

>3.0 mg/L High risk for future CVD

If results are >10.0 mg/L, the patient should be evaluated for an acute inflammatory condition.

Chemistry

A high-sensitivity C-reactive protein (hs-CRP) test result of 5 mg/L (normal = < 1 mg/L) may indicate which of the following?

According to OSHA, Hazard Communication 1910.1200 has the purpose of ensuring that the hazards of all chemicals produced or imported are evaluated, and that information concerning their hazards is transmitted to employers and employees.

Also known as the "Right To Know Law," which one of the following OSHA regulations first dealt with specific information related to the contents of chemicals used in the workplace?

P. vivax characteristically displays Schuffner's dots and often enlarged RBCs along with brownish granules. P. vivax can also have 12-24 merozoies in each cell, actually filling the entire RB

C.  

P. falciparum and P. malariae do not display Shuffner's dots, therefore could not be the correct choice.

P. ovale does display Shuffner's dots in all stages, but characteristically has about 8-12 merozoites in rosettes or irregular clusters inside the RB

C.  

Identify the parasite of a patient with suspected malaria who demonstrates the following findings on a blood smear:

- Enlarged RBCs, some with fine brownish granules

- > 15 parasites in some cells

- Ameboid structures

- Schuffner's dots

Which area of the laboratory is responsible for blood coagulation studies that test for the patient's ability to clot their blood?

Dce is found in 4% of whites and 44% of blacks.

DCe is found in 42% of whites and 17% of blacks.

DcE is found in 14% of whites and 11% of blacks.

dce is found in 37% of whites and 26% of blacks.

Blood bank

The most common Rh haplotype among whites is:

Provide the equivalent measurement for one gallon.

Question options:

Glucose positive, Maltose positive, Lactose negative and Sucrose negative is the correct answer since Neisseria meningitides causes Waterhouse-Friderichsen syndrome and it is positive only for glucose and maltose.

An autopsy of a 1-year-old female admitted to the emergency room 4 hours prior to her death revealed Waterhouse-Friderichsen syndrome. Blood and nasopharyngeal cultures taken prior to her death should reveal an oxidase-positive, Gram-negative diplococcus with the following biochemical reactions:

HbsAg is positive in acute and chronic Hepatitis B infections, since the antigen is found on the actual surface of the virus. HbeAg is present in the blood when the hepatitis B viruses are replicating, indicating an active infection. Anti-Hbc IgM is present due to the immune response to the presence of the hepatitis core antigen and indicates an acute infection. Anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection, according to the CD

C.  

Given the following results, what is the immune status of the patient?

HbsAg: positive

HbeAg: positive

Anti-HBc IgM: positive

Anti-HBs: negative

IgE levels are often increased in patients with allergic disease. IgE binds to the membranes of mast cells and basophils, and if specific antigen is present to react with the IgE molecule, degranulation of these cells occurs, releasing histamines, and other substances into the blood or tissues.

Which of the following immunoglobulin classes is chiefly responsible for the degranulation of mast cells and basophils:

The organisms in this image are demonstrating a gram-variable phenomenon. For the most part, the organisms are staining primarily gram-negative, however, on the tips of some of the rods, there is a gram-positive staining morphology. This can be defined as gram-variable.

Which of the following best describes the organisms seen in this illustration:

Only non-self antigens can be immunogenic. Self antigens are normally recognized by the immune system as part of the host, so an immune response does not normally occur. Non-self antigens are immunogenic since they have the potential to cause an immune response.

For a substance to be immunogenic it must be:

The body compensates for alkalosis or acidosis of the blood PRIMARILY to regain a normal pH, between 7.35 - 7.45.

When the body compensates for a respiratory or metabolic disorder, the MAIN goal is to achieve:

A zone of inhibition is the area around an antibiotic-infused paper disk that does not show any bacterial growth. The antibiotic impregnated on the disk will diffuse into the agar in the area surrounding the disk. If the bacteria are sensitive to the antibiotic, they cannot grow near the disk. The size of the zone is proportional to how sensitive the organism is. If the organism is resistant to the antibiotic, it will grow very closely to the disk.

The size of the zone of suppressed growth on a sensitivity plate using sensitivity disks is referred to as the zone of:

Primary- Target glands (such as thymus, thyroid, parathyroid, etc.)

Secondary- Pituitary gland

Tertiary- Hypothalamus

Match the type of endocrine dysfunction with the appropriate organ:

1. Target gland

2. Pituitary gland

3. Hypothalamus

Platelets do not circulate in inactivated, spiny forms. The spiny, sticky form of the platelet is initiated once the platelets become activated in response to blood vessel damage.

Which of the following is not true in terms of platelet characteristics?

Match the viruses below with their associated conditions.

1. Herpesvirus

2. Papovavirus

3. Rhinovirus

4. Rotavirus

In this case, with the pre-incubation aPTT mixing study result "corrected" and the post-incubation aPTT mixing study result "not corrected", a coagulation inhibitor should be suspected. Both anti-factor VIII and lupus anticoagulant have been known to be slow-acting and can exhibit this result pattern. If a factor deficiency was present, we should not see a post-incubation prolongation.

Hematology

What may cause the following mixing studies results?

Initial aPTT = 133 seconds

1:1 Mix aPTT pre-incubation = 33 seconds

1:1 Mix aPTT post-incubation = 124 seconds

RAST tests, or Radioallergosorbent tests, are used to screen for an allergy to a specific substance or substances if a person presents with allergy-like symptoms.

The assay which is most helpful in identifying specific allergens is:

The activities conducted in a laboratory with a certificate of waiver include:

Charcot-Leyden crystals in stool are thought to be created from damaged eosinophil byproducts. These crystals have a strong association, although they are rare, with parasitic infections or allergic reactions.

Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:

Hemoglobin H is a tetramer made of four beta globin chains. Hemoglobin H occurs when there is very limited alpha chain availability used to make normal hemoglobin

A.  

Hematology

Which of the following combination of globin chains comprise Hemoglobin H?

The newest direction for laboratory testing procedures is

This patient is most likely suffering from an immediate-acting coagulation inhibitor; most commonly, lupus anticoagulant. Notice that the addition of normal pooled plasma does not correct upon initial or incubated mix, which means that the inhibitor is not time or temperature-dependent.

Factor VIII is not the correct answer as a factor deficiency would have corrected upon the addition of normal pooled plasma. Factor VII is not the correct answer, as the aPTT assay does not account for factor VII activity or concentration.

The laboratorian completed the mixing study ordered for John Doe. The results are as follows:

Initial aPTT result: 167 seconds

Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds

Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds

Which of the choices below would most likely explain the results for this patient?

The role of the laboratory supervisor or manager is to

As maturation continues in the granulocytic series the nucleus of the metamyelocyte becomes kidney or bean shaped.

Identify the cell in this illustration indicated by the arrow:

Which specimen should be collected last?

Question options:

The coagulation department tests samples for:

Vitamin K dependent factors are those that require Vitamin K for their synthesis in the liver. Vitamin K is an important factor to gamma-glutamyl carboxylase which adds a carboxyl group to glutamic acid residues on factors II, VII, IX and X, as well as Protein S, Protein

C.  

Which of these coagulation factors are referred to as "vitamin-K dependent?"

1. B

2. C

3. A

Granular casts are composed of plasma protein aggregates and cellular remnants. Granular casts appear as cylinders of coarse, or fine, highly refractive particles.

Broad casts or "renal failure' casts are formed in the collecting ducts as the result of urinary stasis and are two to six times the size of other types of casts. Any type of cast can be a broad cast. Broad casts are typically seen in patients with advanced renal failure.

Hyaline casts, the type most commonly seen in urine sediment, have a refractive index similar to the urine in which they are suspended. For this reason, hyaline casts will appear almost invisible under brightfield microscopy, but are easily of seen by phase-contrast microscopy.

Match the following descriptions of casts with their appropriate name:

1. Casts with highly refractive particles

2. "Renal failure" cast

3. Low refractive index

Which advancement in clinical science occurred during the second half of the twentieth century?

The cells are plasma cells. They are larger than normal small lymphocytes with more abundant cytoplasm. The cytoplasm is more basophilic than the cytoplasm of a normal lymphocyte and a well-defined perinuclear halo (clearing in the golgi area) is noticeable. The nucleus is eccentrically placed. Plasma cells are counted in a separate category on a bone marrow differential.

Hematogones are blast-like cells that are more mature than lymphoblasts. They are usually tallied with lymphocytes when performing a bone marrow differential.

What are the cells that are indicated by the red arrows in the image on the right?

Bone marrow biopsies are helpful diagnostic tools in:

Evaluation of anemia and thrombocytopenia

Evaluation of cytopenias

Diagnosing leukemias

Can be part of evaluation for FUO

Bone marrow biopsies are NOT used as screens for hematologic issues during routine check-ups.

Hematology

In which of the following situations would a bone marrow aspirate and biopsy possibly be used as an aid for diagnosis? (Select all that apply)

Heparin is the additive of choice for blood gas syringe collection as it has the least amount of interference with the blood gas analytes measured.

Which of the following additives should be used for the collection of a sample for blood gas analysis:

Normocytic- G6PD deficiency, Malaria

Microcytic- Iron deficiency, Thalassemia

Macrocytic- Chronic Liver Disease, Vitamin B12 deficiency

Hematology

Match the disease conditions with appropriate red cell size classification

1. G6PD deficiency, Malaria

2. Iron deficiency, Thalassemia

3. Chronic Liver Disease, Vitamin B12 deficiency

Confirmed cases of H1N1 virus have been reported more often in children and younger adults than in any other age group.

Micro

The age groups that have been most affected by the H1N1 virus are children and younger adults.

Failure to deliver glucose drawn in a serum separator tube (SST) to the laboratory within the recommended time will cause:

Question options:

The clue to the identification of the colony seen in the upper frame is the gram stain in the lower frame, in which are seen short, rounded, gram positive bacilli, many of which possess distinct spores. As the colonies grew aerobically, the presence of spores indicates Bacillus species. The colonies are spreading, smooth, yellow-white and non-hemolytic. The lack of hemolysis and the small size of the bacterial cells suggests a species other than Bacillus cereus, the species causing most human infections. The isolate was identified as Bacillus circulans, which is consistent with the gram stain morphology. Clostridium septicum also produces spores; however, this species is an anaerobe and would grow poorly if at all and not produce spores aerobically. Listeria monocytogenes and Lactobacillus species are gram positive bacilli; however, neither of these produce spores.

The colonies seen in the upper frame, grown after 48 hours incubation aerobically at 35°C, and the accompanying gram stain in the lower frame are uncommonly associated with human disease, but have been associated with septicemia, bronchopneumonia, osteomyelitis and other infections, particularly in intravenous drug users. The most likely identification is:

Which of the following statements applies to the venipuncture procedure?

Blood bank

Which of the following is the most common subgroup of A?

Once substance H is developed, the addition of the sugar N-acetylgalactosamine to the terminal position of the chain gives the molecule "A" antigenic activity.

Which specific terminal sugar causes a red cell to have A antigenic activity?

Provide the equivalent measurement for 1 ounce.

The mandatory waiting period between blood donations is 56 days, or eight weeks.

The accepted interval between blood donations is:

Alkaline over acid, or K/A, in TSI reactions is associated with the fermatation of glucose alone and the utilization of peptone.

Which of the following sugars has been fermented by a gram-negative rod that has produced an alkaline slant and an acid butt on triple sugar iron agar (TSI).?

Plasma concentrations of creatinine are used to assess renal function. Creatinine clearance is based on the serum creatinine level and is used to measure glomerular filtration rate, or GFR.

An increased serum level of which of the following analytes is MOST commonly associated with decreased glomerular filtration?

Limited to blood and body fluids visibly contaminated with blood

Isotonic or normal saline is a 0.85 % solution of sodium chloride in water.

The concentration of sodium chloride in an isotonic solution is :