MORS CODE

MORENA E. DAIL, RMT, MT (AMT), MLS (ASCPi)CM

CLINICAL CHEMISTRY
1. Effect of thyroxine in glucose levels RAISES
2. Effect of cortisol in glucose levels RAISES

Gluconeogenesis, the formation of glucose from lactate or amino acids, is

stimulated by the hormones glucagon, cortisol, and thyroxine.

3. As the osmolality of a solution increases, what OSMOTIC PRESSURE INCREASES, BOILING POINT IS ELEVATED, FREEZING
changes in its colligative properties may occur? POINT IS DEPRESSED, VAPOR PRESSURE IS DEPRESSED

The properties of osmotic pressure, vapor pressure, freezing point, and boiling
point are called COLLIGATIVE PROPERTIES. When a solute is dissolved in a
solvent, these colligative properties change in a predictable manner for each
osmole of substance present:

FREEZING POINT IS LOWERED by −1.86°C

VAPOR PRESSURE IS LOWERED by 0.3 mm Hg or torr
OSMOTIC PRESSURE IS INCREASED by a factor of 1.7 × 104 mm Hg or torr
BOILING POINT IS RAISED by 0.52°C

4. Physical actions that may, over time, contribute to ERGONOMIC HAZARD

repetitive strain disorders such as tenosynovitis,
bursitis, and ganglion cysts
5. Blue diamond in the Hazard Identification System HEALTH HAZARD
signifies:
6. Color of the diamond indicating reactivity-stability YELLOW-DIAMOND
hazard

Blue diamond – health hazard

Red diamond – flammability hazard
Yellow diamond – reactivity-stability hazard
White diamond – Other special hazard
7. Characteristics of good standard curve The criteria for a good standard curve are:
a. Line is straight
b. Line connects all points
c. Line goes through the origin, or intersect at the two axes
8. Method that has the highest sensitivity in FOLIN-LOWRY/FOLIN CIOCALTEU METHOD
quantitating proteins
The method is based on both the Biuret reaction, in which the peptide bonds of
proteins react with copper under alkaline conditions to produce Cu+, which reacts
with the Folin reagent, and the Folin-Ciocalteau reaction, in essence
phosphomolybdotungstate is reduced to molybdenum blue by the copper-
catalyzed oxidation of aromatic amino acids. The reactions result in a strong blue
color, which depends partl on the tyrosine and tryptophan.
9. Formula for DIAGNOSITIC SPECIFICITY (TRUE NEGATIVES/TRUE NEGATIVES + FALSE POSITIVES ) x 100
For confirmatory tests

Formula for DIAGNOSTIC SENSITIVITY (TRUE POSITIVES/TRUE POSITIVES + FALSE NEGATIVES) x 100
For screening tests

10. It compares the ACCURACY of two methods in that t-test

it tests the difference between the mean value of
each procedure
It is used to compare the PRECISION of two f-test
procedures
11. are highly purified substances of a known STANDARDS
composition
A standard may differ from a control in its overall composition and in the way it
is handled in the test. Standards are the best way to measure accuracy.
Standards are used to establish reference points in the construction of graphs
(e.g., manual hemoglobin curve) or to calculate a test result

12. One-step direct chemical-colorimetric method for LIEBERMANN-BURCHARDT

cholesterol

One-step Colorimetry Pearson, Stern, and MacGavack

Two-step C + Extraction Bloors
Three-step C + E + Saponification Abell-Kendall
Four-step C + E + S + Precipitation Schoenheimer, Sperry, Parekh and Jung

13. Conversion factor of thyroxine 12.9

14. Conversion factor of bilirubin 17.1

CONVERSION OF TRADITIONAL UNITS TO SI UNITS FOR COMMON CHEMISTRY ANALYTES

Albumin 10 Glucose 0.0555 Total Protein 10
Ammonia 0.587 Iron 0.179 Triglyceride 0.0113
Bicarbonate 1.0 Lithium 1.0 Uric acid 0.0595
Bilirubin 17.1 Magnesium 0.5 Vitamin B12 0.0738
BUN 0.357 Phosphorus 0.323 pCO2 0.133
Chloride 1.0 Potassium 1.0 pO2 0.133
Cholesterol 0.026 Sodium 1.0
Creatinine 88.4 Thyroxine 12.9

15. The following are normal in CSF except:

16. A low sodium was probably caused by OSMOLALITY

pseudohyponatremia, what should be measured
next Osmolality is based on the number of dissolved particles in a solution. Osmolality
measures the total concentration of all of the ions and molecules present in
serum or urine. Sodium, glucose, and urea are major contributors to the total
osmolality of serum

Osmolality is important because it is the condition to which the hypothalamus

responds. If a calculated osmolality is elevated above the reference range, the
patient is suffering from dehydration. The regulation of osmolality affects the Na+
concentration in plasma mainly because Na+ and associated anions account for
approximately 90% of the osmotic activity in plasma.

17. Osmolal gap is: THE DIFFERENCE BETWEEN THE CALCULATED AND MEASURED OSMOLALITY
VALUES
PROBLEMS IN VENIPUNCTURE AND THE APPROPRIATE COURSE OF ACTION
18. Mastectomy patient Draw from other arm
Edematous patient Select another site
19. Patient with fistula Draw from opposite arm
20. Unidentified patient Ask nurse to identify before drawing
21. IV line Use opposite arm or perform fingerstick otherwise, have nurse turn off IV for 2 minutes.
Apply tourniquet below IV, use different vein (if possible). Document location of IV and
venipunture, type of fluid.
22. Hematoma Draw below
 Streptokinase/tissue plasminogen Minimize venipunctures. Hold pressure until bleeding has stopped.
activator (TPA)
Scars, burns, tattoos Select another site.
23. Patient refuses Try to persuade. If unsuccessful, notify nurse. Never draw without consent; could lead to
charges of assault & battery.
24. Indwelling lines and catheters heparin Usually not drawn by lab; first 5 ml should be discarded.
locks, cannulas Lab personnel may draw below heparin lock if nothing is being infused.
25. Isoenzyme assays are performed to SPECIFICITY
improve ___________.
26. Which of the following may cause TRIMMING and RINGING THE CLOT
hemolysis
27. Normal serum ionized calcium level 50%

BLOOD URINE
50% Ionized 85% Ionized
40% Protein-bound 15% Complexed
10% Complexed

28. Glucose measurement by reducing and 5-15 mg/dL

enzymatic method is __________
erroneously higher by reducing methods
than by the more accurate enzymatic
methods that are highly specific.
29. An alcohol blood level of 0.27-0.40% IMPAIRED CONSCIOUSNESS

0.01 - 0.05 No obvious impairment, some changes observable on performance testing

0.03 - 0.12 Mild euphoria, decreased inhibitions, some impairment of motor skills
0.09 - 0.25 Decreased inhibitions, loss of critical judgment, memory impairment, diminished
reaction time
0.18 - 0.30 Mental confusion, dizziness, strongly impaired motor skills (staggering, slurred speech)
0.27 – 0.40 Unable to stand or walk, vomiting, or impaired consciousness
0.35 – 0.50 Coma and possible death

30. P in PASS PULL

31. Storage guidelines for oxidizers SEPARATE FROM REDUCING AGENTS

Separate from reducing agents (e.g., zinc, alkaline metals, formic acid), flammable &
combustible materials.

Example of oxidizers: Nitric acid, perchloric acid, sulfuric acid, acetic acid, potassium
chloride, hydrogen peroxide
Select the appropriate action for the following clinical cases:

32. A quality of the traditional paradigm of ACCEPTABLE QUAITY

quality assurance that is not used
33. How many milliliters are needed to 3 ml
prepare 150 ml of 10 mg per 100 mL
glucose solution from a 500 mg/100 mL
glucose stock standard? Solution:

C1 (stock solution) = 500 mg/100mL = 5 mg/mL

C2 (final solution) = 10 mg/100 mL = 0.1 mg/mL
V2 (final volume) = 150 mL
V1 (stock solution) = ?

C1V1 = C2V2
V1=C2V2/C1

34. Physician asks in asymptomatic DM
patients
35. Total Cholesterol=300 mg/dL
LDL=30 mg/dL,
TAG =150 mg/dL. Calculate HDL.
36. It is the result of poor perfusion of the
kidneys and therefore diminished
glomerular filtration. The kidneys are
otherwise normal in their functioning
capabilities.
37. When the clinical response does not
agree with total drug concentration, free
drug levels may be of clinical use in all of
the following cases except
38. Also known as the “catalysis of ligation”
39. Persons who are very anxious an can
hyperventilate and at worst this leads to
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
40. INCREASED IN HEPATITIS
Capacity to conjugate bilirubin and
secrete bile
41. Which of the following is true:
42. Which of the following would cause
renal azotemia
V1=(0.1 mg/mL)(150 mL)/(5 mg/mL)
V1=3 mL
HISTORY OF VASCULAR DISEASE, HISTORY OF INSULIN RESISTANCE, HYPERTENSION
240 mg/dL
PRE-RENAL AZOTEMIA
Caused by dehydration, shock, diminished blood volume, and congestive heart failure
PATIENT NON-COMPLIANCE
RESPIRATORY ALKALOSIS
Respiratory diseases: pneumonia, emphysema, chronic obstructive lung disease),
myasthenia gravis
Anxiety, some CNS disorders
Ketoacidosis, lactic acidosis, severe diarrhea
Treatment for peptic ulcer, vomiting
BOTH FRACTIONS
Unconjugated only (B1)
Conjugated only (B2)
Both fractions (B1 and B2)
SERUM BILIRUBIN LEVELS
Overall capacity to transport bile Serum bilirubin level
Patency of biliary ducts Ratio of direct and total bilirubin
Overall patency of biliary ducts Serum bile acids
Abnormality of bile duct epithelium Serum ALP
Capacity to conjugate bilirubin and secrete bile SERUM BILIRUBIN LEVELS
ALL OF THE ABOVE
No truly “tissue-specific” enzyme; all enzymes are found in more than one tissue
Enzyme data cannot be interpreted by itself
We must look at other laboratory results and other pertinent clinical information before a
diagnosis can be made
ACUTE AND CHRONIC GLOMERULONEPHRITIS
NEPHROSCLEROSIS, POLYCYSTIC KIDNEY DISEASE
The condition of abnormally high urea nitrogen in the blood is called uremia. A significant increase in the plasma concentrations of urea and
creatinine, in kidney insufficiency, is known as azotemia. Decreased levels are usually not clinically significant unless liver damage is
suspected. During pregnancy, lower-than normal urea levels are often seen. Azotemia can result from prerenal, renal, or postrenal causes:

Pre-renal azotemia dehydration, shock, diminished blood volume, or congestive heart failure, increased protein breakdown,
as in fever, stress, or severe burns
Renal azotemia acute glomerulonephritis, chronic glomerulonephritis, polycystic kidney disease, and nephrosclerosis
Post-renal azotemia stones, an enlarged prostate gland, or tumors.

43. Increased anion gaps KETOACIDOSIS, LACTIC ACIDOSIS, SALICYLATE, and METHANOL INGESTION

Can result from ketotic states, lactic acidosis, salicylate and methanol ingestion,
uremia or increased plasma proteins
44. Enzyme cofactors MAGNESIUM, ZINC, and CALCIUM

Neuromuscular excitability K, Ca, Mg

ATP Production from Glucose Mg, PO4
Acid-Base Balance HCO3, K, Cl
Volume and Osmotic Regulation Na, Cl, K
Enzyme Activation Cofactors Mg, Ca, Zn
Myocardial Rhythm and Contraction K, Mg, Ca
Regulation of ATPase Pumps Mg
Blood coagulation Mg and Ca

45. Gives earliest indication of a trend CUSUM

Cumulative sum of SDI for a specified number of previous results.

Statistical procedures such as cumulative sum (CUSUM) or exponentially weighted

moving averages (EWMA) are preferred to monitor for bias trends. It is recommended
to use one of these more advanced trend detection procedures if supported by an
available computer system because they are more powerful than the 81S, or similar
approaches based on sequential observations exceeding a specified bias from the target
value. EWMA and CUSUM must be carefully implemented to avoid being too sensitive
to small changes that may cause an excessive frequency of false alerts.

46. Pronounced elevation of ALP (5x or more) BONE (PAGET’S DISEASE OR OSTEITIS DEFORMANS)

Slight elevation (Up to 3x N) Pregnancy, crush injuries

Moderate elevation (3-5x N) IM, Metastatic Tumors in bone,
Metabolic diseases
Pronounced elevation (5x or more N) Bile duct obstruction, Paget’s disease,
biliary cirrhosis, hyperparathyroidism

47. The following are causes of DEHYDRATION

hypoalbuminemia except:

48. In monitoring glomerular function, which of CREATININE CLEARANCE

the following tests has the highest sensitivity
To perform the creatinine clearance test, timed specimens of both blood and urine must
be collected. All voided urine must be carefully collected for 24 hours. The urine
specimen is preserved by refrigeration as successive additions are made to the total
collection. Blood is collected at about 12 hours into the urine collection period.
Creatinine is measured in the blood (serum or plasma) and in the timed urine specimen
(24 hour).
49. Given there are two consecutive values REJECT SAMPLE
outside the 2s region, what is the
appropriate action? SIX WESTGARD RULES FOR ANALYSIS OF QUALITY CONTROL
1 point is outside 2 SD (warning) 12s
Reject when:
1 point is outside 3 SD 13s
2 consecutive points are outside 2 22s
SD on same side of the center line
Range of 2 points is greater than 4 R4s
SD
4 consecutive points exceed 1 SD 41s
on same side of the center line
10 consecutive points are above or 10x
below the mean

50. Blood received in the laboratory for blood ON ICE, NO CLOTS, NO AIR BUBBLES
gas analysis must meet which of the
following
51. LDL Receptor Gene Abnormality TYPE IIA

CLASSIFICATION Genetic defect

TYPE I TAG due to CHS Genetic defect of LPL gene; autosomal recessive
Genetic defect of Apo CII gene; autosomal recessive
TYPE IIa LDL Multiple genetic defects
Dysfunction or absence of LDL receptor; autosomal dominant
TYPE IIb LDL and VLDL Multiple genetic defects
TYPE III CHOL, TAG; presence of β- Genetic defect of apoE gene; autosomal recessive or autosomal
VLDL dominant
TYPE IV VLDL Unknown genetic defect; autosomal dominant
TYPE V VLDL and presence of CHS Unknown genetic defect – possibly due to an LPL inhibitor;
unknown inheritance

52. In azotemia, BUN is _______, GFR is INCREASED, DECREASED

__________

53. pH is 7.49 HCO3 is 30 mmol/L, pCO2 is 48 VOMITING

mmHg is caused by
54. Cholinesterase belongs to what group of HYDROLASES
enzymes

Oxidoreductases Lactate dehydrogenase, G6PD, Glutamate dehydrogenase

Transferase AST, ALT. CK. GGT, GST, GP, PK
Hydrolases ALP, ACP, Amylase, Triacylglycerol lipase, Cholinesterase, Chymotrypsin, Elastase-1, 5-NT
Lyases Aldolase
Isomerases Triosephosphate isomerase
Ligases Glutathion synthetase

55. pCO2 = 38 mmHg and ctCO2 = 21 mmol/L. 7.33

Determine pH
56. Sensitive index for renal function: Test CREA, UREA, AND β2-MICROGLOBULIN
for renal tubular injury
57. Cushing’s disease will cause INCREASED ACTH, INCREASED CORTISOL
Anion gap Na – (Cl + HCO3) NV 7 to 16 mmol/L
Anion gap (Na + K) – (Cl + HCO3) NV 10 to 20 mmol/L
 Anion gap exceeds 16 mmol/L Indication of increased concentrations of unmeasured anions (PO43- and SO42-, protein
ions
Decreased anion gaps of less than 10 mmol/L Either an increase in unmeasured cations (Ca2+, Mg2+) or a decrease in unmeasured
anions
58. A type of alpha1 globulin OROSOMUCOID
59. Turnaround time falls under what phase POST-ANALYTICAL
of quality assurance

PROPOSE QUALITY ASSESSMENT MEASURES

Test order accuracy
Patient identification
Blood culture contamination
Test System/Pre-analytical Adequacy of specimen information
ANALYTICAL PHASE (EXAMINATION) Accuracy of POCT
Cervical cytology/biopsy correlation
Test System/Analytical Diabetes monitoring
Hyperlipidemia screening
POST-ANALYTICAL PHASE (POST-EXAMINATION) Critical Value Reporting
TURNAROUND TIME
Test system/Post-analytical CLINICAL SATISFACTION
Clinician follow-up
Diagnostic for DM FBS≥126 mg/dL; HbA1c≥ 6.5%; 2 hr OGTT≥ 200 mg/dL
60. Byproduct of deamination of amino acids AMMONIA
Ammonia arises from the breakdown of amino acids, and high concentrations are neurotoxic. Clinical conditions in which blood ammonia
levels are useful include hepatic failure, Reye syndrome, and inherited deficiencies of urea cycle enzymes. Liver disease is the most
common cause of abnormal ammonia metabolism.
Ammonia is used to monitor the progress of disease severity. Careful specimen handling is extremely important
or plasma ammonia assays. Whole-blood ammonia concentration rises rapidly after specimen collection because of in vitro amino acid
breakdown. Heparin and EDTA are suitable anticoagulants. Samples should be centrifuged at 0°C to 4°C within 20 minutes of collection
and the plasma or serum removed. Specimens should be assayed as soon as possible or frozen.
61. Common causes of hypokalemia except: FEVER, HEMOLYSIS
62. Advantage of BCG than HABA GREATER ABSORBANCE IN 630 nm
LESS AFFECTED BY ABSORBANCE DUE TO BILIRUBIN OR HEMOGLOBIN
X-axis HORIZONTAL, ABSCISSA, INDEPENDENT VARIABLES
Y-axis VERTICAL, ORDINATE, DEPENDENT VARIABLES
63. Transport of the drug from the site of administration ABSORPTION
to the blood

Liberation Release of the drug

Absorption Transport of the drug from the site of administration to the blood
Distribution Delivery of the drug to the tissues
Metabolism Chemical modification of the drug by the cells
Excretion Drugs and its metabolites are excreted from the body

64. DIAGNOSTIC EFFICIENCY: SENSITIVITY, SPECIFICITY, PREDICTIVE VALUES

65. ORDER OF DRAW FROM CATHETER LINES 1. Draw 3-5 ml in a syringe and discard
2. Blood for blood culture
3. Blood for anticoagulated tubes
4. Blood for clot tubes

66. Levels of enzymes are measured using: INCREASED PRODUCT, DECREASED COENZYME, INCREASED ALTERED
COENZYME, DECREASED SUBSTRATE
67. Uric-acid measurement, most specific, needs special ENZYMATIC, UV
instrumentation and optical cells
URIC ACID:
Colorimetric – Problems with turbidity, several common drugs interfere
Enzymatic: UV – need special instrumentation and optical cells
Enzymatic: H2O2 – interference by reducing substances
68. Causes polyclonal gammopathy CHRONIC LIVER DISEASE
69. Major buffer system in the body BICARBONATE
70. One international unit of enzyme activity is the 1 MICROMOLE/MINUTE
amount of enzyme that, under specified reaction
conditions of substrate/concentration, pH and
temperature causes utilization of substrate at the
rate of
71. Graves Disease ANTI-TSHR

Graves’ disease, an autoimmune disorder in which antibodies produced by the

immune system stimulate the thyroid to produce too much T4, is the most
common cause of hyperthyroidism.
72. Routine examination done to test glucose FASTING BLOOD SUGAR
homeostasis
The term fasting means that the patient has had no food or drink for 8 to 12
hours. A strict fast is necessary, including no coffee, tea, or other caffeinated
drink and no drugs that might affect the blood glucose level. Patients also
should avoid emotional disturbances that might cause liberation of glucose into
the blood.
73. Oral lactose load in Lactose Intolerance Test 50 g
The Lactose Intolerance Test is rarely done in clinical practice. Measure serial blood glucose levels after an oral lactose load. A fasting serum
glucose is obtained, after which 50 g of lactose is administered.
74. Causes decreased motility or peristalsis causing slow CHOLECYSTOKININ
release of gastric contents in small intestine
75. Endogenous pathway
76. Ability to maintain steady glucose concentration in GLUCOREGULATION
the blood
77. Associated with chylomicrons Apo B-48

APOLIPOPROTEINS FUNCTIONS MAJOR SOURCE

Apo A-I Major structural protein in HDL Liver and intestine
Activates LCAT; Ligand for HDL binding
Apo A-II Structural protein in HDL Liver
Activates LCAT
Enhances hepatic triglyceride lipase activity
Apo A-IV Component of Intestinal lipoproteins Intestine
Apo B-100 Major structural protein in VLDL and LD Liver
Ligand for the LDL receptor
Apo B-48 Primarily structural protein in chylomicrons Intestine
Apo C-I Activates lipoprotein lipase Liver
Apo C-II Activates lipoprotein lipase Liver
Activates LCAT
Apo C-III Inhibits lipoprotein lipase Liver
Inhibits receptor recognition of apo E
Apo E 2,3,44 Binds to LDL-receptor and remnant receptor Liver
Apo (a) Structural protein for Lp (a) Liver
May inhibit plasminogen binding
78. Water passed through resin with charged particles is DEIONIZATION OF WATER
used for
In the process of deionization, water is passed through a resin column
containing positively (+) and negatively (−) charged particles. These particles
combine with ions present in the water to remove them; this water is known
as deionized water.

Only substances that can ionize will be removed in the process of deionization.
Organic substances and other substances that do not ionize are not removed.
Further treatment with membrane filtration and activated charcoal is
necessary to remove organic impurities, particulate matter, and
microorganisms to produce type I water from deionized water.
In the process of DISTILLATION, water is boiled and the resulting steam is cooled; condensed steam is distilled water. Many minerals are found
in natural water, most often iron, magnesium, and calcium. Water from which these and other minerals have been removed by distillation is
known as distilled water.
79. Reliable single screening index of renal function CREATININE
80. Which of the following is a hydrolase CHOLINESTERASE
81. A sensitive but non-specific indicator of kidney PROTEIN
damage
82. Alpha cells of the islets of Langerhans secrete GLUCAGON

Alpha cells – glucagon

Beta cells – insulin
Delta cells - somatostatin
83. Which among the blood chem tests would give the <30 HDL <250 TAG
highest probability of CHD?
Adult Values
HDL cholesterol: Cholesterol: Triglycerides: HDL cholesterol:
Negative risk factor for CHD >60 mg/dL Desirable ≤ 199 mg/dL Desirable ≤ 149 mg/dL Desirable ≥ 40 mg/dL
Positive risk factor for CHD <35 mg/dL Borderline 200-239 mg/dL Borderline 150-199 mg/dL Higher risk ≤ 39 mg/dL
Higher risk ≥ 240 mg/dL Higher risk 200-499 mg/dL
**Reference values for triglycerides vary for females and males, with females having values slightly lower.**
84. Which of the following is not indicative of nephrotic INCREASED BUN, CREA, URIC ACID
syndrome
85. Constant error between test method and CONSTANT SYSTEMATIC ERROR
comparative method
Constant systematic error is a type of systematic error in the sample direction
and magnitude; the magnitude of change is constant and not dependent on the
amount of analyte; determined by the y-intercept

Proportional systematic error is a type of systematic error where the

86. An arterial blood specimen submitted for blood gas
analysis was obtained at 8:30 AM but was not
received in the laboratory until 11:00 AM, the
technologist should:
87. Glucose is metabolized at room temperature at a rate
of ______ mg/dL/hour, and at 4°C at _____
mg/dL/hour
88. Effect (s) of an increase in antidiuretic hormone
magnitude changes as a percent of the analyte present; error dependent on
analyte concentration; determined by the slope
REQUEST A NEW ARTERIAL SPECIMEN BE OBTAINED
7 mg/dL hour - room temp
2 mg/dL hour - 4°C
FLUID RETENTION AND LOW SERUM SODIUM

Increased ADH Fluid retention, low serum sodium

Decreased ADH Fluid loss
Increased aldosterone Hypertension, low serum potassium
Decreased aldosterone Low serum sodium, high serum potassium
Increased renin Hypertension
89. Onset of elevation of CK in myocardial infarction
MICROBIOLOGY AND PARASITOLOGY
1. ONPG is used as a test for
___________?
2. What is the end-product of Voges-
Proskauer Test?
3. Test to detect the presence of
inducible clindamycin resistance
4. A gram-positive spore-forming
bacillus growing on sheep-blood agar
anaerobically produces a double
zone of β-hemolysis and is positive
for lecithinase. What is the
presumptive identification?
5. What method is used to sterilize
heat-labile solutions?
6. The use of 0.1% fuchsin substituted
for safranin in the Gram-stain
procedure may enhance the visibility
of this organism
7. PYR (-), Coagulase (+)
4-6 HOURS
β-GALACTOSIDASE
This test is used to determine the ability of an organism to produce β-galactosidase, an enzyme
that hydrolyzes the substrate ONPG to form a visible (yellow) product, ortho-nitrophenol.
It is useful in detecting delayed (late) lactose fermenters that lack or are deficient in β-
galactosidase permease.
Positive Result: YELLOW
Negative Result: CLEAR
Positive Control: E. coli
Negative control: S. typhimurium
ACETOIN
The Voges-Proskauer Test detects the organism’s ability to convert the acid products to acetoin
and 2,3-butanediol. Organisms capable of using the VP pathway produce a smaller amount of
acid during glucose fermentation and therefore do not produce a color change when the MR
indicator is added. A secondary reagent is added, α-naphthol, followed by potassium hydroxide
(KOH); a positive result is indicated by a red colored complex.
(+) Klebsiella, Enterobacter, Hafnia, and Serratia
Barritt’s Method – for gram-negative rods
Coblentz Method – for streptococci
D-TEST
D-test is used to detect presence of inducible clindamycin resistance by erythromycin.
Positive result: flattening of the zone of inhibition around the clindamycin disk, “letter D” or
blunting.
CLOSTRIDIUM PERFRINGENS
Double-zone of hemolysis, Nagler (+), lecithinase (+), Reverse CAMP (+)
MEMBRANE FILTRATION
Used to sterilize delicate media components that cannot withstand steam sterilization by
autoclaving (e.g., serum, certain carbohydrate solutions, certain antibiotics, and other heat-
labile substances)
LEGIONELLA SPP.
Legionella spp. are Gram-negative bacteria with a thin cell wall but stain poorly in the Gram
procedure if neutral red or safranin is used as the counterstain. The characteristic is related to
the composition of the cell walls which are large amounts of branched-chain cellular fatty acids.
Because of their faint staining, Legionela spp. are rarely detectable in clinical material by Gram-
stain.
STAPHYLOCOCCUS AUREUS
8. Gray, translucent, smooth, NEISSERIA ELONGATA
glistening; may have dry and clay-
like consistency

N. gonorrheae Small, gray/white translucent, raised with entire edge; usually easily emulsified
Specimen collection in men: urethra
Specimen collection in women: endocervix
N. meningitidis Colorless to gray, convex, smooth colonies
M. catarrhalis Smooth, opaque, gray-white colonies on chocolate and blood agar
N. cinerea Small, grayish white, translucent, raised with entire edge and slightly granular; resembles N. gonorrheae;
causes recurrent bacterial peritonitis
N. flavescens Yellow, convex, smooth colonies
Can grow on both SBA and chocolate agar
N. lactamica Small, grayish white (with yellow rings), translucent and slightly butyrous
Resembles N. meningitidis (only smaller)
Occasionally present in throat cultures, ferments glucose, maltose, and lactose.
N. mucosa Large, gray to buff, yellow translucent, mucoid, viscous, smooth surface and entire edge
N. sicca Large, gray white, opaque, deeply wrinkled,, dry irregular crumb-like colonies
N. subflava Small, greenish yellow or yellow, smooth surface with entire edge
N. elongata Large, grayish white with yellow tinge, low convex, claylike colony
Gray, translucent, smooth, glistening; may have dry and clay-like consistency
Difficult to emulsify
N. weaverii Small, semi-opaque with smooth appearance
Found in dog’s oral microbiota

9. Filamentous, extensive NOCARDIA

branching/aerial hyphae on tap water
agar Extensive/+ Nocardia, Nocardiopsis, Streptomyces
Minimal/- Rhodococcus, Gordonia, Tsukamurella
Variable/sparse Actinomadura

Rhodococcus can be differentiated from Nocardia by growing the organism on tap water
agar (Bacto agar [Difco, Detroit] added to 100 ml tap water and sterilized prior to pouring
plate): Rhodococcus grows minimally (if at all), and Nocardia grows freely.
10. pH indicator used in XLD agar PHENOL RED

Indicator Media
Neutral Red MAC, SSA
Phenol Red MSA, XLD, CTA, Urease, TSI
Bromthymol Blue Citrate, HEA, OF Hugh Leifson, TCBS, SCA
Bromcresol Purple LIA

11. Which of the following is not a NON- M. BOVIS

TUBERCULOIDAL Mycobacteria?
Runyon’s Classification for Nontuberculoid Mycobacteria (NTM)

Non-photochromogens Photochromogens Scotochromogens Rapid Growers

M. avium complex M. kansasii M. szulgai M. fortuitum

M. intracellulare M. asiaticum M. scroflaceum M. chelonei
M. ulcerans M. marinum M. gordonae M. phlei
M. simiae M. ulcerans M. smegmatis
M. haemophilum M. interjectum
M. xenopi M. hiberniae
M. gastrii M. lentiflavum
M. triplex M. conspicuum
M. genaense M. tusciae
M. shimoidei M. bohemicum
M. heidelbergense
M. branderi
M. conspicuum

12. A fastidious Gram-negative bacillus CAPNOCYTOPHAGA

was isolated from a case of periodontal
disease which upon darkfield exam Spirochetes (axial filaments) Corkscrew
was noted to have gliding motility Campylobacter Darting
Capnocytophaga, M. pneumonia Gliding
Vibrio (monotrichous) Rapid darting/shooting star
Leptospira Spinning
Listeria End-over-end; tumbling motility
Klebsiella Non-motile
Kingella, Bartonella Twitching

13. The ethanol shock procedure is used for BACTEROIDES AND CLOSTRIDIUM
____________
Clostridium spp. can be recovered from mixed populations of organisms and
identified using the ETHANOL SHOCK TECHNIQUE.
Ethanol treatment of samples should result in the killing of all vegetative
microorganisms. However, clostridial endospores may be resistant to ethanol, and
after ethyl alcohol treatment, the spores will germinate upon inoculation and proper
incubation on anaerobic blood agar in anaerobic condition.

14. It is able to bind beta globulin factor H, a M PROTEIN (antiphagocytic)

regulatory protein of the alternate
complement pathway involved in the
degradation of C3b; it also binds to fibrinogen
locking complement alternate pathway
15. Uses antibody that attaches directly to antigen
16. Autofluorescence requires no stain and is
often recommended for confirmation of:
Principal virulent factor of Group A Streptococci; it is attached to the peptidoglycan;
it is antiphagocytic; and for adherence to mucosal cells
Protein F – mediates epithelial cell attachment
FITC
Fluorescent antibody tests are performed using either a direct fluorescent antibody
(DFA) or indirect fluorescent antibody (IFA) technique. In the DFA technique, FITC is
conjugated directly to the specific antibody. In the IFA technique, the antigen-specific
antibody is unlabeled, and a second antibody (usually raised against the animal
species from which the antigen-specific antibody was harvested) is conjugated to the
FITC.
CYCLOSPORA CAYETANENSIS OOCYSTS
One of the newer coccidian parasites, C. cayetanensis, has been implicated in cases
of human diarrhea. The recommended stains are modified acid-fast stains, and the
organisms are quite variable in their staining characteristics. The oocysts are
immature when passed (no internal morphology) and they measure about 8–10 μm.
 Autofluorescence requires no stain and is often recommended for confirmation of
Cyclospora cayetanensis oocysts. Epidemiological evidence strongly implicates
various berries, basil, mesclun, and snow peas as likely causes. These outbreaks are
very sporadic and tend to occur primarily in March through May.
17. True of H. capsulatum INTRACELLULAR YEAST CELLS IN MACROPHAGES

Histoplasmosis can be a fatal pulmonary infection but can also affect the spleen, liver,
kidneys, bone marrow, and heart.
Infection is acquired by spore inhalation from barns, chicken houses, and
bat caves. H. capsulatum has been associated with guano, in particular from starlings
and bats.

The mould phase will show conidiophores at 90-degree angles to hyphae supporting
smooth macroconidia (8-16 (Jim in diameter) with finlike edges (tuberculate).
Microconidia are small (2-5 um n diameter) and round to teardrop shaped.

Yeasts appear as small single-budding cells that are unremarkable in morphology. In

clinical specimens, yeasts are often found inside monocytes and macrophages.

18. Which of the following serve as definite host of HUMANS

Taenia spp.?
The humans serve as the definitive host for the beef (Taenia saginata) and pork
(Taenia solium) tapeworms whereas cows/camels and pigs serve as intermediate
hosts respectively. The human also serves as the intermediate host for T. solium
(cysticercosis).
19. Exfoliatin in S. aureus causes SCALDED SKIN SYNDROME

S. aureus is the cause of “scalded skin” syndrome in newborn infants. The

production of a potent exotoxin (exfoliatin) causes the epidermis to slough off,
leaving the newborn’s skin with a red, raw texture or a burned, scalded look.
20. What method is used to separate and identify GAS-LIQUID CHROMATOGRAPHY
anaerobic metabolites?
GLC (for end products of glucose fermentation) is used to separate and identify
anaerobic metabolic end products (i.e. volatile fatty acids and non volatile organic
acids) of carbohydrate fermentation and amino acid degradation.

High resolution GLC is used for cellular fatty acid analysis.

GLC application has been expanded for the analysis of longer chain fatty acids.
21. Antibiotic testing for streptococci MUELLER HINTON WITH 5% DEFIBRINATED SHEEP BLOOD

Mueller-Hinton agar is the best medium to use for routine susceptibility testing using
the Kirby-Bauer disk diffusion method for nonfastidious bacteria (both aerobe and
facultative anaerobe). Use of media other than Mueller-Hinton agar may result in
erroneous results.

22. Oxidase-positive coccobacilli, ferment glucose
but may not do this well on TSI agar slants and
often do not grown on MacConkey agar
It is also the standard medium used for most broth dilution testing as the conditions
of this medium (i.e. pH, cation concentrations, and thymidine contents) are well
maintained.
PASTEURELLA MULTOCIDA
Pasteurella multocida (P. canis) is part of the normal mouth flora of cats and dogs and
is frequently recovered from wounds inflicted by them. It produces large amounts of
indole and therefore an odor resembling colonies of E. coli. Pseudomonas spp.are also
catalase and oxidase positive but can be ruled out because they grow on MacConkey
agar and do not produce indole.

23. Medium used for cerebrospinal fluid shunts THIO (THIOGLYCOLLATE) BROTH

For CSF specimens, examine the BA, MAC, CHOC and BRUC plates daily for 72 hours.
In shunt infections, examine the THIO broth media daily for 7 days.
24. Inhibition of essential metabolite synthesis SULFONAMIDES

Cell Membrane structure and function Polymyxins and Bacitracin

Protein Synthesis Aminoglycosides, Tetracyclines, Macrolides, Lincosamide
(Clindamycin), Chloramphenicol
Cell Wall Integrity Β-lactam antibacterial agent, (Penicillins, Cephalosporins,
Monobactams, Carbapenems), Vancomycin, Bacitracin, Cycloserine,
Clavulanic acid, Sulbactam, Tazobactam
Essential metabolites (i.e. folates) Sulfonamides, Trimethoprim
Nucleic acid metabolism Rifampin, Nalidixic acid, Quinolones, Metronidazole

25. Causes duodenal crypts and steatorrhea GIARDIA LAMBLIA

26. CTBA medium is used for the isolation of: CORYNEBACTERIUM DIPHTHERIAE

27. Diff between LISTERIA and

CORYNEBACTERIUM Listeria Corynebacterium
Catalase + +
Motility + -
Esculin Hydrolysis + -
CAMP + -
Salicin + -

28. Formalin ECT is recommended for the recovery TRICHURIS TRICHIURA

of
The ova and parasite examination contains three components: the direct wet film
(demonstrates protozoan trophozoite motility), the formalin–ethyl acetate
concentration (demonstrates protozoan cysts, coccidian oocysts, and helminth eggs),
and the trichrome or iron hematoxylin–stained smear
(confirms protozoan cysts and trophozoites).

29. Several attendees of a medical conference in MANNITOL FERMENTATION AND SODIUM REQUIREMENT
the Gulf coast area became ill after frequenting
a seafood restaurant. A presumptive All three organisms are positive for oxidase production and are motile. Plesiomonas
identification of Vibrio cholera was made after spp. do not grow on TCBS agar. Clear colonies on MacConkey agar and yellow colonies
stool specimens from several subjects grew on TCBS agar indicate Vibrio or Aeromonas spp. However, only Vibrio spp. require Na+
clear colonies on MacConkey agar and yellow (1% NaCl) in the medium for growth.
colonies on TCBS agar. Which key tests would
help eliminate Aeromonas and Plesiomonas Vibrio Aeromonas Plesiomonas
spp? Oxidase + + +
Na+ requirement + - -
Mannitol ferm. + + -
Growth on TCBS + + -

30. M. bovis may penetrate the gastrointestinal BCG (BACILLUS OF CALMETTE-GUERIN)

mucosa or invade the lymphatic tissue of the
oropharynx
31. Thayer-Martin Agar consists of: VANCOMYCIN, COLISTIN, and NYSTATIN

32. Organism with macroscopic presence of ACTINOMYCES ISRAELLI

“sulfur granules” in purulent exudates; “molar
tooth” colonies Direct examination of the macroscopic presence in purulent exudates of “sulfur
granules” which reveal Gram-positive filaments when crushed is diagnostic for an
infection with Actinomyces.

Its characteristic colony morphology on solid agar resembles that of a “molar tooth.”
33. “Clue cells” are seen on a smear of vaginal
discharge obtained from an 18-year-old female
emergency department patient. This finding,
along with a fishy odor (amine) after the
addition of 10% KOH, suggests bacterial
vaginosis caused
by which organism?
34. It is used for the isolation of G. vaginalis from
the female genital tract
35. DFA (Direct Fluorescent Antibody Staining)
36. Organism with undulating membrane
37. The use of _____ sheep blood agar plate and
plate allows detection of most gram-negative
bacilli, staphylococci, streptococci, and
enterococci
38. How many quadrants are streaked for stool
culture?
39. Enters the nasal mucosa and causative agent of
primary amoebic meningoencephalitis
40. Failure to obtain anaerobiosis in the GasPak Jar
is due to:
GARDNERELLA VAGINALIS
G. vaginalis, a gram-negative or gram-variable pleomorphic coccobacillus, causes
bacterial vaginosis, but is also present as part of the normal vaginal flora of women of
reproductive age with a normal vaginal examination. “Clue cells” are vaginal epithelial
cells with gram-negative or gram-variable coccobacilli attached to them.
Direct saline wet mount of vaginal secretions:
(+) Result: Appearance of “clue cells” or large, squamous, epithelial cells with
numerously attached small rods.
HUMAN BLOOD BILAYER TWEEN MEDIA (c-HBT)
G. vaginalis is the etiologic agent of Bacterial Vaginosis and is considered as sexually
transmitted disease.
Laboratory diagnosis:
Specimen: vaginal secretions
Culture media: CAP, CAN, and HBT
Human Blood Bilayer Tween media (c-HBT) is used for the isolation of G. vaginalis
from female genital tract
CHLAMYDIA TRACHOMATIS
This method uses fluorescein-isothiocyanate-conjugated monoclonal antibodies to
either outer membrane proteins or lipopolysaccharides of C. trachomatis to detect
elementary bodies in smears of clinical material.
DFA stains are also available for both HSV and VZV are most reliable for rapid
diagnosis of these viral infections
TRICHOMONAS
Organisms with undulating membrane: Trichomonas and Trypanosoma
5% SBA
The use of 5% sheep blood agar plate and MacConkey agar plate allows detection of
most gram-negative bacilli, staphylococci, streptococci, and enterococci.
To save cost and somewhat streamline culture processing, many laboratories use an
agar plate split in half (biplate); one side contains 5% sheep blood agar and the
other half contains MacConkey agar.
4 QUADRANTS
Plates inoculated for semiquantitation are usually streaked out in four quadrants.
NAEGLERIA FOWLERI
Naegleria fowleri Primary Amoebic Meningoencephalitis
A. cantonensis Eosinophilic Meningoencephalitis
Acanthamoeba spp. Granulomatous Amoebic
Balamuthia mandrilliasis Meningoencephalitis
DUE TO INACTIVATION OF THE PALLADIUM-COATED CATALYST PELLETS
For a GasPak Jar, it takes 30-45 minutes to obtain an anaerobic environment.
 When water is added to the GasPak envelope, carbon dioxide and hydrogen are
produced.
If the catalyst is working accurately, water vapor will be present inside the GasPak jar,
and the indicator strip will be colorless.
Failure to achieve an anaerobic condition could be the result of a “poisoned” catalyst
or crack in the O-ring, jar, or lid.
The disadvantage of using an anaerobic jar is that the plates have to be removed from
the jar every time it is examined.

Palladium pellets are used to remove residual oxygen from the chamber by
combining with hydrogen to form water.

41. Causes progressive multifocal encephalopathy JC virus

(PML)
42. Brugia malayi WITH SHEATH, 2 DISTINCT NUCLEI AT THE TIP OF THE TAIL

Wuchereria bancrofti Sheathed, no nuclei at the tip of the tail

Brugia malayi Sheathed, 2 distinct nuclei at the tip of the tail
Loa loa Sheathed, nuclei extending to the tip of the tail
Onchocerca volvulus (skin) No sheath, no nuclei at the tip of the tail
Mansonella perstans No sheath, nuclei extending to the tip of the tail
Mansonella ozzardi No sheath, no nuclei in the tip of the tail
Mansonella streptocerca (skin) No sheath, nuclei extending to the tip of the hooked tail

43. Characteristic of Mycoplasma LACK CELL WALL

The mycoplasma that colonize and/or infect humans belong to the family
Mycoplasmataceae; this family comprises two genera, Mycoplasma, and Ureaplasma.
Besides lacking a cell wall, these agents with their small size (0.3 x 0.8 um) and small
genome size, require sterols for membrane function and growth.

44. Blood Agar is considered as: ENRICHED, DIFFERENTIAL

Simple/general/supportive Nutrient agar, Nutrient broth, and TSB

media
Enrichment media (liquid type) APW, Selenite F, thioglycollate
tetrathionate, GN broth, and LIM broth
Enriched media and non- BAP, CAP
selective media
Differential media MAC, BAP, EMB, HEA
Selective media HEA, MAC, XLD, BSA, MSA, Thayer-Martin
Agar

45. For infectious diseases such as HCV and LINE PROBE ASSAY
Mycobacteria
46. Acid resistance is used to differentiate ENTEROVIRUS, RHINOVIRUS

ENTEROVIRUS – ACID-RESISTANT
RHINOVIRUS – ACID SENSITIVE
47. Obligate intracellular parasites CHLAMYDIA/RICKETTSIAE

48. Chlamydia grows in what medium McCOY CELLS

Chlamydiae are strict intracellular organisms and must be cultured using living cells.
Direct smears can also be made at the time of culture. Staining cells with iodine may
reveal the characteristic reddish-brown inclusions sometimes seen in Chlamydia
 infections. Fluorescein-conjugated monoclonal antibodies may be used to identify the
organisms in infected cells.
49. Capable of remission in Malaria P. VIVAX, P. OVALE

SPECIES DISEASE CAUSED PAROXYSMS

P. vivax Benign tertian malaria Every 48 hours
P. oval Ovale malaria Every 48 hours
P. malariae Quartan malaria Every 72 hours
P. falciparum Malignant malaria Every 36 to 38 hours
50. Baermann Technique is used for what parasite? STRONGYLOIDES STERCORALIS

yields a good concentration of the living larvae of Strongyloides stercoralis

1. A glass funnel with a diameter of 10 cm or greater is set up in a ring stand, with a

short piece of rubber tubing attached to its stem and a pinchcock closing the tubing.
2. A wire circle or sieve, of slightly smaller diameter than the top of the funnel, is
covered with two layers of gauze. 3. The funnel is filled with lukewarm water to a level
just covering the gauze, and a specimen of stool is placed on the gauze, partially in
contact with the water.
4. The apparatus is left to stand at room temperature for 8 to 12 hours, then a few
drops of fluid are drawn off through the tubing into a small glass dish.
5. Examine for larvae under low power of the microscope
51. Sheather’s sugar flotation technique ISOSPORA BELLI

52. E. coli strain that induces Shiga-like toxin ENTEROHEMORRHAGIC E. COLI (EHEC)

Differential Characteristics of E. coli Strains

Enteropathogenic E. coli (EPEC) Infantile diarrhea (without blood)
Enterotoxigenic E. coli (ETEC) Traveler’s diarrhea
Heat-stable and heat-labile
enterotoxins
Enteroinvasive E. coli (EIEC) Dysentery-like or Shigella-like
infection
Watery diarrhea (with WBCs)
Invasin
Enterohemorrhagic E. coli (EHEC) Hemorrhagic colitis, HUS
Bloody diarrhea (without WBCs)
Verotoxin I and II or Shiga-like toxin
Enteroadherent E. coli (EAEC) and Watery diarrhea (EAEC)
diffusely adherent E. coli (DAEC) UTI (EAEC and DAEC)
Fimbriae
“stacked-brick appearance”
Uropathogenic E. coli (UPEC) Most common cause of UTIs in
humans
Common pili, aerobactins, and
cytolysins

53. Specimen used for the isolation of SKIN SCALES

Dermatophytes
Dermatophytes produce infection of the epidermis, hair, and nails. Infection is often
referred to as ringworm (or tinea), a name derived from the advancing, serpiginous
nature of the lesions (especially evident on the skin).
54. Case of moniliasis; what organism is CANDIDA ALBICANS
responsible for this?
C. albicans is the common cause of oral thrush (oral moniliasis) involving the
mucocutaneous membranes of the mouth. C. albicans is part of the normal flora of
the skin, mucous membranes, and gastrointestinal tract.

55. Visualization by India ink injection into the
lateral genital pore (7-13 branches)
Presumptive identification: urease test (+), niger seed agar test (+), and the germ
tube test (+)
TAENIA SOLIUM
Separation of T. saginata and T. solium is best accomplished by examination of
mature proglottids. Taenia saginata has 12-30 primary lateral uterine branches,
while T. solium has 7-13 primary lateral uterine branches. Visualization of the
branches can be improved by clearing the specimen in lactophenol followed by India
ink injection into the lateral genital pore. The procedure is as follows:±≤≥

1. Clear the formalin-fixed proglottids in lactophenol (50/50 liquefied phenol

crystals in lactic acid) for at least 30 minutes (thicker specimen may take a few
hours to overnight).

2. Gently sandwich the proglottids between two glass microscope slides, with the
genital pore exposed along the edge of the two slides.

3. Using a small gauge (25 or 27 g) tuberculin syringe, slowly inject India ink into the
genital pore.

4. Allow the ink to flow down the uterine stem and into the primary uterine
branches.

5. Count the number of primary uterine branches to determine the species (7-13
for T. solium and 12-30 for T. saginata).

Proglottids of taeniids have a characteristic lateral protrusion known as the genital

pore. Careful injection of India ink through the genital pore, using a tuberculin needle
and syringe, may succeed in outlining the uterus.

The gravid uterus of T. saginata has 15 to 20 primary lateral branches (counted on

one side only), whereas that of T. solium has 7 to 13 primary lateral branches.
56. Organism causing eosinophilia and Loeffler’s ASCARIS LUMBRICOIDES
syndrome
Symptoms of ascariasis vary from asymptomatic infection to severe disease.
Migration of large numbers of larvae through the lungs can cause Ascaris
pneumonitis or Loeffler’s syndrome, characterized by bilateral diffuse, mottled
pulmonary infiltrates and mild bronchitis associated with peripheral eosinophilia.
The syndrome is rare and usually occurs in individuals who have been previously
exposed to Ascaris antigens

57. Thin-shelled eggs; oncosphere surrounded by HYMENOLEPIS NANA

rigid membrane, which has two polar
thickenings from which 4-8 filaments extend The eggs of H. nana and Hymenolepis diminuta are very similar. However, H. nana
into the space between the oncosphere and eggs are smaller and have polar filaments present in the space between the
outer shell oncospheres and the eggshell.

58. Amoeba that resembles E. histolytica ENTAMOEBA DISPAR

Entamoeba histolytica and E. dispar cannot be morphologically differentiated. The

cyst stage of both organisms has four nuclei with a centrally located karyosome. E.
histolytica is a wellrecognized intestinal parasite, whereas E. dispar is considered
nonpathogenic. Immunologic assays to detect antigens or molecular biology assays
are necessary to differentiate these two species.
 Those laboratories that do not use one of the immunologic or molecular methods to
differentiate E. histolytica from E. dispar, and that rely exclusively on morphologic
analysis, must use a reporting format that takes the differing technologies into
consideration. Thus, a report of “E. histolytica/E. dispar” would be most appropriate
in the latter circumstance.

59. Lifespan of Diphyllobothrium latum, Taenia UP TO 25 YEARS

saginata, and Taenia solium
H. nana Perhaps many years as a result of autoinfection
H. diminuta Usually less than 1 year
D. caninum Usually less than 1 year
D. latum, T. saginata, T. solium Up to 25 years

60.. Which of the following does not cause

cancer?

61. Disease in compromised host tends to involve the central TOXOPLASMA GONDII
nervous system with various neurologic symptoms;
cerebral calcification
62. Thick cuticle with rhabditiform type of esophagus in first
and second stage larvae

63. Occasionally present in throat cultures, ferments N. LACTAMICA

glucose, maltose, and lactose
64. K/A reaction in TSI except VIBRIO

Vibrio spp.
Biochemical test:
TSI reaction: A/A , (-) gas, (-) H2S
LIA reaction: K/K

V. cholera: (+) citrate and indole

V. vulnificus: (+) indole and cellobiose
V. mimicus: (+) indole

65. Microfilariae magnification LOW-POWER (10x) MAGNIFICATION

Both thick and thin smears are examined in their entirety under the low-
power (10×) objective to detect microfilariae, which rarely occur in large
numbers. In particular, the feathered edge of thin smears should be
examined, as microfilariae are often carried there during preparation of the
smear.

The optimal location for examining the thin film is the region of the
feathered edge where there is minimal overlap of cells and the erythrocytes
maintain their central pallor. A common mistake is to examine regions of
the thin film where the blood is too thick or too thin and the parasite
morphology is distorted. An experienced microscopist should examine at
least 100 oil immersion fields (requiring about 5 minutes) on the thick blood
film and 200 fields (requiring at least 15 minutes) on the thin film using the
100× objective before issuing a negative report.
66. Stained with AFB stain, except LISTERIA

67. Causes Farmer’s Lung ASPERGILLUS

68. Environmental-friendly fixative used in parasitology PVA (Polyvinyl Alcohol)

69. Inhibited by thionine but grows in the presence of B. ABORTUS
Fuchsin
70. Case studies: bloody diarrhea without PMNS what E. COLI
organisms? What biochem reactions? H2S (-), MOTILITY (+), INDOLE (+)

71. Not a signal chain amplification techique LIGASE-CHAIN REACTION

Signal amplification technique Hybridization with signal amplification, Branched-chain DNA

analysis, Hybrid Capture, Probe Amplification
Sample amplification technique PCR, Real-time PCR, Taq, Light Cycler, Ligase-chain reaction

72. Which mechanism is responsible for botulism in infants
caused by Clostridium botulinum?
INGESTION OF SPORES IN FOOD AND LIQUID
Infant botulism is the most frequent form occurring in the United States.
Epidemiological studies have demonstrated that infant botulism results
from the ingestion of spores via breastfeeding or exposure to honey.
Preformed toxin has not been detected in food or liquids taken by the
infants. C. botulinum multiplies in the gut of the infant and produces the
neurotoxin in situ.

73. A 2-month-old infant in good health was scheduled for a
checkup at the pediatrician’s office. After arriving for the
appointment, the mother noted white patches on the
baby’s tongue and in his mouth. The baby constantly used
a pacifier. What is the most likely organism causing the
white patches?
CANDIDA ALBICANS
C. albicans is the common cause of oral thrush involving the
mucocutaneous membranes of the mouth. C. albicans is part of the normal
flora of the skin, mucous membranes, and gastrointestinal tract.

74. All of the following are acceptable specimens in the URINE STRIP SLIDE OVERNIGHT IN ROOM TEMPERATURE
laboratory, except:

75. To differentiate Bordetella bronchiseptica and NITRITE, UREASE

Alcaligenes faecalis

76. According to the Kirby–Bauer standard antimicrobial SWARMING MUST BE IGNORED

susceptibility testing method, what should be done when
interpreting the zone size of a motile, swarming organism
such as a Proteus species?
A thin film of growth appearing in the zone area of inhibition around the
susceptibility disk should be ignored when swarming Proteus or other
organisms are encountered. Discontinuous, poor growth or tiny colonies
near the end of the zone should also be ignored.

77. For attachment SCOLEX

To facilitate attachment to the host’s intestinal wall, tapeworms utilize

several types of structures on their scolices, the most common of which are
the suckers

Strobila – strongly flattened dorsoventrally and is a linear series of hundreds

or thousands of segment like proglottids
78. A dehydrated 25-year-old male patient was admitted to
the hospital with symptoms similar to those of chronic
fatigue syndrome. Serological testing proved negative for
recent streptococcal infection, Epstein–Barr virus, and
hepatitis. Which of the following viral serological tests
should help with a possible diagnosis?
79. What two reagents must be added to determine if the
bacterium is VP positive?
80. LOA reaction for Enterobacter aerogenes
81. Mycobacterium tuberculosis resistance is caused by
82. Released from the snail and goes to the water
83. Upon arriving at the laboratory, which of the following
specimens should be processed first?
84. Sluggish nondirecional motility
CMV
CMV infection in young adults causes a self-limited mononucleosis
syndrome. CMV infections are common and usually self-limited, except in
neonates and immunosuppressed patients, in whom they may cause a life-
threatening situation.
ALPHA-NAPHTHOL AND 40% KOH
Acetoin or carbinol, an end product of glucose fermentation, is onverted
to diacetyl after the addition of the VP reagents (α-naphthol and 4
potassium hydroxide [KOH]). Diacetyl is seen as a red- to pink-colored
complex.
(+) LDC (+) ODC (-)ADH
MUTATION
CERCARIA
Schistosomiasis infection occurs through skin penetration by infected
cercariae released from freshwater snail containing the intermediate
stages with the schistosome life cycle. Cercaria can be released from the
snail intermediate host singly or in groups.
CSF
When a specimen is received with multiple requests but the amount of
specimens is insufficient, the clinician should inform the laboratory staff
which of the tests should be prioritized.
When multiple specimens arrive at the same time, priority should be given
to those that are most critical such as CSF, tissue, blood, and sterile fluids.
Urine, throat, sputa, stool, or would drainage are specimens that can be
stored and processed later.
Acid-fast bacilli (AFB), viral, and fungal specimens can be processed by
batch.
Critical/Invasive specimens: CSF, amniotic fluid, blood, brain, heart valves,
pericardial fluids
ENTAMOEBA COLI
Progressive motility E. histolytica, E. dispar
Sluggish motility E. coli, H. nana, I. butschlii
85. SAF Centrifugation 400 g

86. Method of collection for ventilated patients
87. How is modified acid fast stain in Cyclospora
differentiated from the routine acid fast
SAF has an advantage in that it can be used for permanent stains as well as
for direct mounts and concentration procedures, and it does not contain
mercury, which is present in Schaudinn’s and PVA fixatives. In addition to
being poisonous, mercury presents disposal problems in an increasing
number of states. However, the quality of permanent stains when SAF is
used is not as good as when Schaudinn’s or PVA fixative is used. Zinc
sulfate–based PVA and other newer commercial products such as single vial
multipurpose fixatives are gaining popularity, snd their use may be
indicated when mercury chloride–based compounds cannot be used.
ENDOTRACHEAL ASPIRATE
SPUTUM

88. Detected by antibody through EIA CHLAMYDIA

Enzyme immunoassay may be used for the detection of IgG antibodies

against Chlamydia trachomatis in human serum or plasma.

Microtitre wells are coated with the inactivated and purified antigen of
strain Chlamydia trachomatis with a high content of MOMP. If present,
specific antibodies bind to the antigen. The complex is labeled with
conjugate and detected through a colour reaction with substrate.
89. FITC shows green fluorescence 2+

No apple-green fluorescence NEGATIVE

Faint yet unequivocal apple- 1+
green fluorescence
Apple-green fluorescence 2+
Bright apple-green 3+
fluorescence
Brilliant apple-green 4+
fluorescence

90. Which body fluid cannot transport Hepa B SPUTUM

91. Subacute sclerosing panencephalitis (SSPE) PARAINFLUENZAE TYPE 1

92. Transport for poliovirus -70°C

To test for polio, fecal specimens are analyzed for the presence of
poliovirus. Because shedding of the virus is variable, two specimens – taken
24-48 hours apart are required.

Stool specimens have to be sealed in containers and stored immediately

inside a refrigerator or packed between frozen ice packs at 4-8°C n a cold
box, ready for shipment to a laboratory. Undue delays or prolonged
exposure to heat on the way to the laboratory may destroy the virus.
Specimens should arrive at the laboratory within 72 hours of collection.
Otherwise, they must be frozen and then shipped frozen, ideally packed
with dry ice or cold packs. The procedure is known as “reverse cold chain.”
93. Asexual spore ARTHROSPORES

Asexual spores:
Blastospores – bud coming off the parent cell (C. albicans)
 Condiospores – multiple, chains or single spores formed at the end of an
aerial hypha
Not enclosed within a sac
(e.g. Aspergillus, spp. and Penicillium spp.)
Sporangiospores – hundreds formed within a sac (sporangium) at the end
of an aerial hypha (e.g. Rhizopus)
Chlamydospore – spherical conidium formed by the thickening of a hyphal
cell.
Arthrospore – rectangular spore formed when a septate hypha fragments
at the cross walls
94. Nonseptate hyphae ZYGOMYCETES

Nonseptate hyphae are also called aseptate or coenocytic. They represent

a more primitive form of fungi and are the ancient ancestors of septate
hyphae. Fungi of the genus Mucor and the division Zygomycetes are non-
septate. Non-septate hyphae do have some septa, but they are found only
at the branching points.

Non-septate hyphae are the result of the nucleus repeatedly dividing but
not the cytoplasm. This can result in many nuclei in the cytoplasm along
with other organelles.

e.g. Rhizopus, Absidia, Mucor

95. It should be considered when culturing C.neoformans AGAR WITHOUT CYCLOHEXIMIDE

96. Gram (+) Catalase (-) and H2S (+) ERYSIPELOTHRIX RHUSIOPATHIAE

E. rhusiopathiae is catalase negative, whereas the other three organisms

are catalase positive. E. rhusiopathiae is seen primarily as a skin infection
on the fingers of meat and poultry workers. Colonies growing on blood agar
are small and transparent, may be either smooth or rough, and are often
surrounded by a green tinge. E. rhusiopathiae is characterized by H2S
production in the butt of a TSI slant, which differentiatesit from other
catalase-negative, gram-positive rods.

97. Where are Paragonimus adults found LUNGS

Adult worms of Paragonimus spp. measure up to 12 mm by 6 mm and often

are found in pairs in lung parenchyma, where they reside in a fibrotic
capsule produced by the host. The capsule communicates with the bronchi,
through which eggs pass to be eventually expelled in sputa or feces.

Although a specific snail serves as the first intermediate host, freshwater

crabs and crayfish serve as second intermediates for infectious
metacercariae. Ingestion of uncooked, or marinated, crustacea may result
in infection. Larvae are released in the stomach and migrate through the
intestinal wall into the peritoneal cavity, eventually reaching the lungs after
penetrating the diaphragm.
98. Enterococcus BILE ESCULIN (+), RESISTANT TO 6.5% NaCl
99. Inactivated vaccine HEPATITIS A

Live-attenuated MMR, Rotavirus, Smallpox, Chickenpox,

yellow fever
Inactivated HepaA, Flu shot, Polio, Rabies
Subunit, recombinant Hib, HepaB, HPV, Whooping cough, shingles
pneumococcal and meningococcal disease
Toxoid Diphtheria, Tetanus

100 Hippurate Hydrolysis Test (+) (+) STREPTOCOCCUS AGALACTIAE

..
Hippuricase is a constitutive enzyme that hydrolyzes the substrate
hippuricase to produce the amino acid glycine. Glycine is detected by
oxidation with ninhydrin reagent, which results in the production of a deep
purple color (+).

The hippuricase test is most frequently used in the identification of

Gardnerella vaginalis, Streptococcus agalactiae, Campylobacter jejuni, and
Listeria monocytogenes.

CLINICAL MICROSCOPY
1. Best stain in sputum to differentiate leukocytes WRIGHT’S

2. Best stain for sputum cytology PAP’S

3. High CSF lymphocytes or predominance of MULTIPLE SCLEROSIS
lymphocytes in CSF
Moderately elevated WBC count (less than 50 WBCs/_L) with increased
normal and reactive lymphocytes and plasma cells may be indicative of
multiple sclerosis or other degenerative neurologic disorders

4. Which of the following conditions is associated with LEAD POISONING

normal urine color but produces red fluorescence
when urine is examined with an ultraviolet (Wood’s)
lamp?
Lead poisoning blocks the synthesis of heme, causing accumulation of PBG
and coproporphyrin III in urine. However, uroporphyrin levels are not
sufficiently elevated to cause red pigmentation of the urine. There is
sufficient coproporphyrin to cause a positive test for fluorescence. Acute
intermittent porphyria produces increased urinary delta-aminolevulinic acid
(Δ-ALA), and PBG. The PBG turns the urine orange to orange-brown upon
standing. Erythropoietic porphyria and porphyria cutanea tarda produce
large amounts of uroporphyrin, causing the urine
to be red or port wine colored.

5. Color of KOVA-stained hyaline casts PINK

The most frequently used stain in urinalysis is the Sternheimer-Malbin stain, which consists of crystal violet and safranin O. The stain is
available commercially under a variety of names, including Sedi-Stain (Becton-Dickinson, Parsippany, N.J.) and KOVA stain (Hycor Biomedical,
Inc, Garden Grove, Calif.). Commercial brands contain stabilizing chemicals to prevent the precipitation that occurred with the original stain.
The dye is absorbed well by WBCs, epithelial cells, and casts, providing clearer delineation of structure and contrasting colors of the nucleus
and cytoplasm.
6. RACE meaning of R RESCUE
7. Apatite CALCIUM PHOSPHATE

Appear as small particles; require electron microscopy

Does not exhibit birefringence under compensated polarized light
8. Best way to get specimen from ventilated patient THROAT SWAB
9. Numerous WBCs and bacteria often accompanied ACUTE PYELONEPHRITIS
by mild proteinuria, hematuria, increased pH and
WBC casts

10. Melanuria is closely linked to ALBINISM

The phenylalanine-tyrosine metabolic pathway is responsible for the

production of melanin, thyroxine, epinephrine, protein, and tyrosinesulfate.

Of these substances, the major concern of the urinalysis laboratory is

melanin, the pigment responsible for the dark color of hair, skin, and eyes.
Deficient production of melanin results in albinism.
11. AFP is usually measured around 15th to 18th WEEK OF PREGNANCY

Amniocentesis may be indicated at 15 to 18 weeks of gestation

for the following conditions to determine early treatment
or intervention:

• Mother’s age of 35 or more at delivery

• Family history of chromosome abnormalities, such as
trisomy 21 (Down syndrome)
• Parents carry an abnormal chromosome rearrangement
• Earlier pregnancy or child with birth defect
• Parent is a carrier of a metabolic disorder
• History of genetic diseases such a sickle cell disease, Tay-Sachs disease,
hemophilia, muscular dystrophy,
sickle cell anemia, Huntington chorea, and cystic
fibrosis
• Elevated maternal serum alpha fetoprotein
• Abnormal triple marker screening test
• Previous child with a neural tube disorder such as
spina bifida, or ventral wall defects (gastroschisis)
• Three or more miscarriages

12. Differentiate non-urine from urine CREATININE CLEARANCE

13. How to transport bilirubin FOILED

14. Anuria CANNOT PRODUCE URINE IN THE BLADDER
Cessation of urine flow

Normal daily volume 600–2,000 mL (average 1,200–1,500mL)

Normal day-to-night ratio 2:1–3:1
Diuresis ↑ urine production
Polyuria Marked ↑ in urine flow; Adult: >2,500 mL/day; Children: 2.5–3 mL/kg/day
Oliguria Marked ↓ in urine flow; Adult: <400 mL/day; Children: <0.5 mL/kg/hr; Infants: <1
mL/kg/hr
Anuria No urine production

15. Homogenous blue colour in reagent strip. HEMATURIA

Microscopically: 8 ghost cells/field were seen
16. Acronym on how to operate a fire extinguisher PASS
17. Spots/speckled in blood strip HEMATURIA

In the presence of free hemoglobin/myoglobin, uniform color ranging from a

negative yellow through green to a strongly positive green-blue appear on
the pad. In contrast, intact red blood cells are lysed when they come in
contact with the pad, and the liberated hemoglobin produces an isolated
reaction that results in a speckled pattern on the pad.
18. The difference between blood glucose and synovial
fluid glucose:
19. Crystals mostly appear in urine due to
20. Fragments of degenerating proliferative synovial
cells or microinfarcted synovium:
21. Important instruction for nitrite testing
22. False (-) nitrite may be due to:
23. Excess urobilinogen in urine causes what color
URINE COLOR
Normal Yellow due to urochrome
Dilute urine Colorless, pale yellow
Concentrated urine Dark yellow, amber
Bilirubin Amber, orange, yellow-green; yellow foam on shaking
Urobilin Amber, orange; no yellow foam on shaking
Homogentisic acid Normal on voiding; brown or black on standing
Melanin Brown or black on standing
Methemoglobin Brown or black
Myoglobin Red; brown on standing
Blood/hemoglobin Pink or red when fresh; brown on standing
Porphyrin Port-wine
Drugs, medications, food Green, blue, red, orange
Pseudomonas infection Green, blue-green
24. Increased amount of catecholamines
< 10 mg/dL
NORMAL SYNOVIAL FLUID VALUES
Volume: <3.5 mL
Color: Colorless to pale yellow
Clarity: Clear
Viscosity: Able to form a string 4–6 cm long
Leukocyte count: <200 cells/uL
Neutrophils: <25% of the differential
Crystals: None present
Glucose plasma: <10 mg/dL lower than the blood difference glucose
Total protein: <3 g/dL
DIFFERENCE IN SOLUBILITY
RICE BODIES
Macroscopically resemble polished rice; microscopically show collagen and
fibrin; Tuberculosis, septic and rheumatoid arthritis
LE cell - Neutrophil containing characteristic ingested: “round body”
Reiter cell - Vacuolated macrophage with ingested neutrophils
RA cell (ragocyte) - Neutrophil with dark cytoplasmic granules containing
immune complexes
EAT VEGETABLES ON THE NIGHT BEFORE
INCREASE IN UROBILINOGEN
False-negative:
Nonreductase-containing bacteria
Insufficient contact time between bacteria and urinary
nitrate
Lack of urinary nitrate
Large quantities of bacteria converting nitrite to nitrogen
Presence of antibiotics
High concentrations ofascorbic acid
High specific gravity
False-positive
mproperly preserved specimens
Highly pigmented urine
ORANGE
PHEOCHROMOCYTOMA
Screening test: high plasma metanephrines and normetanephrines by HPLC
Diagnostic test: high 24-hour urinary excretion of metanephrines and
normetanephrines
 Pharmacologic test: Clonidine test, Glucagon stimulation test
25. Container for measurement of urobilinogen AMBER-COLORED BOTTLES
26. Normal neutral fats with increased amounts of free MALABSORPTION
fatty acids

Cause First Slide (Neutral Fat) Second Slide (Free Fatty Acids)
Malabsorption Normal Increased
Maldigestion Increased Normal or Increased

27. Normal fasting gastric fluid appears: PALE GRAY AND SLIGHTLY MUCOID
28. What to do when there is hemorrhagic exudate COMPARE TO SERUM HEMATOCRIT

To differentiate between a hemothorax and hemorrhagic exudate, a

hematocrit can be run on the fluid. If the blood is from a hemothorax, the
fluid hematocrit is more than 50% of the whole blood hematocrit, because
the effusion is actually occurring from the inpouring of blood from the injury.
A chronic membrane disease effusion contains both blood and increased
pleural fluid, resulting in a much lower hematocrit.

29. RBC Cast can be easily identified due to COLOR

 RBC Casts – orange red color

 Massive hemoglobinuria/myoglobinuria – homogenous orange red
or red brown casts
 Acute tubular necrosis – dirty or granular casts

30. Yellow foam BILIRUBIN

White foam – Protein, albumin

31. Nitrite in a urine specimen suggests the presence GRAM-NEGATIVE BACILLI
of:
32. Part of sperm cell that uses energy for motility MIDPIECE

The midpiece is the thickest part of the tail because it is surrounded by a

mitochondrial sheath that produces the energy required by the tail for
motility.

Critical to ovum penetration is the enzyme-containing acrosomal cap

located at the tip of the head
The neckpiece attaches the head to the tail and the midpiece.

33. Collecting specimens in containers other than the 8.5

single-use, disposable laboratory containers would
result to a pH of
34. Bulky, frothy stools PANCREATIC DISORDERS
35. Diluents for synovial fluid, EXCEPT ACETIC ACID

36 The sperm acrosomal cap should encompass ONE HALF, TWO-THIRDS

approximately ___ of the head and covers
approximately ___ of the nucleus.
37. Sperm cell Head is 5 um long, 3 um wide, 45 um tail

Seminal fluid

Spermatozoa synthesis – SERTOLI cells

Spermatozoa maturation – testes
Spermatogonia – Spermatocyte – Spermatids – Spermatozoa

Semen:
Gray white and opalescent – NORMAL
Brown or red color – BLOOD
Yellowish color – LACK OF EJACULATION
38. It corrects renal blood flow in the following ways: ANGIOTENSIN II
causing VASODILATION OF THE AFFERENT
ARTERIOLES and CONSTRICTION OF THE EFFERENT
ARTERIOLES, stimulating reabsorption of sodium
and water in the proximal convoluted tubules, and
triggering the release of the sodium-retaining
hormone aldosterone by the adrenal cortex and
antidiuretic hormone by the hypothalamus:
39. Which of the following may cause the feces to CARBOHYDRATES
become acidic?
Normal stool pH is between 7 and 8; however, increased use of carbohydrates
by intestinal bacterial fermentation increases the lactic acid level and lowers
the pH to below 5.5 in cases of carbohydrate

40. Purple colors are observed in the positive reactions KETONES AND LEUKOCYTES
for:
41. Associated with glomerular bleeding DYSMORPHIC RBCS

RBCs that vary in size, have cellular protrusions, or are fragmented

are termed dysmorphic and have been associated primarily with glomerular
bleeding. The number and appearance of the dysmorphic cells must also be
considered, because abnormal urine concentration affects RBC appearance,
and small numbers of dysmorphic cells are found with nonglomerular
hematuria.

Dysmorphic RBCs also have been demonstrated after strenuous exercise,

indicating a glomerular origin of this phenomenon. The dysmorphic cell most
closely associated with glomerular bleeding appears to be the acanthocyte
with multiple protrusions, which may be difficult to observe under bright-field
microscopy.

42. The following are reagents in the acetest except

43. Why is HCG test called an indirect test? IT MEASURES HCG LEVELS IN THE EARLY STAGES OF PREGNANCY OF BUT IT
CANNOT MEASURE PREGNANCY DIRECTLY
44. positive result in CTAB MUCOPOLYSACCHARIDES, WHITE TURBIDITY
In both the acid-albumin, and the CTAB tests, a thick, white turbidity forms when these reagents are added to urine that contains the
mucopolysaccharides.
Metachromatic staining procedure (AZURE A in acetic acid/MPS paper test: blue spot that cannot be washed away by dilute acidified
methanol solution.
45. Presence of turbidity, granulation, and flocculation 3+
in SSA is graded as:

Grade Turbidity Protein range (mg/dL)

NEGATIVE No increase in turbidity <6
TRACE Noticeable turbidity 6-30
1+ Distinct turbidity with no granulation 30-100
2+ Turbidity with granulation, no flocculation 100-200
3+ Turbidity with granulation and flocculation 200-400
4+ Clumps of Protein >400
46. Maple syrup urine disease is characterized by an VALINE, LEUCINE, AND ISOLEUCINE
increase
47. Initial magnification OBJECTIVES
48. CSF protein measurement TURBIDIMETRY
49. In an unpreserved urine, which of the following will NITRITE, UROBILINOGEN, KETONES
decrease
50. Which of the following is mainly reabsorbed UREA
through passive reabsorption
 SUBSTANCE LOCATION
Glucose, amino acids, salts Proximal convoluted tubule
ACTIVE TRANSPORT Chloride Ascending loop of Henle
Sodium Proximal and distal convoluted tubules
Water PCT, Descending loop of Henle, Collecting
duct
PASSIVE TRANSPORT Urea Proximal convoluted tubule and ascending
loop of Henle
Sodium Ascending loop of Henle

51. The following will cause acidic urine except RENAL TUBULAR ACIDOSIS
ACID URINE ALKALINE URINE

Emphysema Hyperventilation
Diabetes mellitus Vomiting
Starvation Renal tubular acidosis
Dehydration Presence of urease-producingbacteria
Vegetarian diet
Diarrhea Old specimens
Presence of acid- producing bacteria (Escherichia coli)
High-protein diet
Cranberry juice
Medications (methenamine mandelate [Mandelamine],
fosfomycin tromethamine

52. Zone II indication MODERATE HEMOLYSIS REQUIRING CAREFUL MONITORING

ZONE I Mildly affected fetus

ZONE II Moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon
delivery
ZONE III Severe hemolysis and suggests a severely affected fetus. Intervention through induction of labor or intrauterine
exchange transfusion must be considered.

53. Deficiency of phenylalanine hydroxylase PHENYLKETONURIA

PKU screening tests – confirmed by HPLC

Enzyme-deficient:
p-hydroxyphenylpyruvate oxidase – TYROSYLURIA
homogentisic acid oxidase – ALKAPTONURIA
Uroporphobilinogen decarboxylase – PORPHYRIA CUTANEA TARDA
Fumarylacetoacetic acid hydrolase – TYROSINEMIA 1a
Maleylacetoacetic acid isomerase – TYROSINEMIA 1b
Tyrpsine aminotransferase – TYROSINEMIA 2
Hydroxyphenylpyruvate oxidase –TYROSINEMIA 3

TYROSINOSIS - p-hydroxyphenylpyruvic acid

p-hydroxyphenyllactic acid
54. Increased capillary permeability may lead to EXUDATES

LABORATORY DIFFERENTIATION
TRANSUDATES EXUDATES
Appearance Clear Cloudy
pH Alkaline Acidic
Specific gravity <1.015 >1.015
Total Protein <3 g/dL >3 g/dL
Clotting No Possible
WBCs <1000/uL >1000/uL0
 Origin Non-inflammatory Inflammatory
Fluid:serum protein <0.5 >0.5
Fluid: serum LD <0.6 >0.6
Pleural fluid: serum cholesterol ratio <0.3 >0.3
Pleural fluid: serum bilirubin <0.6 >0.6
Serum-ascite albumin gradient >1.1 <1.1
55. Sensitivity of Bilirubin 0.4-0.8 mg/dL

Bilirubin is not normally detectable in urine. The reagent strip method can
detect 0.4 to 0.8 mg/dL bilirubin with the diazo reaction, in which 2,4
dichloroaniline diazonium salt reacts with bilirubin to produce a tan-to-purple
color.

56. Protein seen microscopically in urine in renal TAMM-HORSFALL PROTEIN

diseases
57. C and S for urine SUPRAPUBIC, MIDSTREAM, CLEAN-CATCH, CATHETERIZED
58. Crystals associated with ethylene glycol poisoning: MONOHYDRATE CALCIUM OXALATE
59. True about synovial fluid except IT CLOTS
60. Most difficult to recognize in urinalysis RBC
61. Blue quadrant represents HEALTH HAZARD
62. All are included in the 10-parameter reagent strip UROBILINOGEN
except
63. Bilirubin is detected spectrophotometrically in 450 nm
amniotic fluid at:

TESTS FOR FETAL WELL-BEING AND MATURITY

Hemolytic disease OD 450
Neural Tube Defect Alpha-fetoprotein (screening)
Acetylcholinesterase (confirmatory)
Fetal Lung Maturity (FLM) L/S Ratio, Amniostat FLM (phosphatidylglycerol)
Foam stability index, microviscosity test (fluorescence polarization)
Estimate of fetal age Creatinine

64. Normal RBC count in synovial fluid: LESS THAN 2,000/µL RBC
65. Nitrite reagent p-ARSANILIC ACID
66. Screening tests for urinary infection combine the NITRITE
leukocyte esterase test with the test for:
67. CASA (Comuputer-Assisted Semen Analysis) SPERM VELOCITY, TRAJECTORY, CONCENTRATION, MORPHOLOGY
provides determination of
68. LIS, LED, reflectance photometry AUTOMATED REAGENT STRIP READER
69. Not affected by color change and causes change in PROTEIN
pH
70. True about sputum FROM TRACHEO-BRONCHIAL
71. A patient has glucosuria, hyperglycemia, and DIABETES MELLITUS
polyuria. These findings would be associated with
72. Same patient voided urine thrice. Which has the 30 mL
highest specific gravity?
73. How much can the glomerulus filter? <70 kDa
HEMATOLOGY
1. It can be used to clean the LENS CLEANER OR 70% ISOPROPYL ALCOHOL
objective lenses
To clean the lenses, only lens paper should be used. The paper is designed for this purpose and will not scratch the lenses, which other, more
harsh paper or material might do. (Brown)

The use of xylene is discouraged, because it contains a carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an
oily film on the lens.
2. Lab results in chronic/compensated NORMAL PT, PTT, THROMBIN; INCREASED D-DIMER
disseminated intravascular coagulation
Chronic or compensated DIC is a significant complication of liver disease that is caused by decreased liver production of regulatory
antithrombin, protein C, or protein S and by the release of activated procoagulants from degenerating liver cells. The failing liver cannot clear
activated coagulation factors. In primary or metastatic liver cancer, hepatocytes may also produce procoagulant substances that trigger
chronic DIC, leading to ischemic complications.

In acute, uncompensated DIC, the PT, PTT, and thrombin time are prolonged; the fibrinogen level is reduced to less than 100 mg/dL; and fibrin
degradation products, including D-dimers, are significantly increased.

If the DIC is chronic and compensated, the only elevated test result may be the D-dimer assay value, a hallmark of unregulated coagulation
and fibrinolysis. (Rodak)
3. 5-15° Light scatter correlating with internal HIGH ANGLE SCATTER
complexity such as refractive index or hemoglobin
concentration (ADVIA 2120)
Siemens Healthcare Diagnostics Inc. manufactures the ADVIA 2120 and 2120i, the next generation of ADVIA 120. The ADVIA 2120, 2120i, and
120 use much of the same technology as the older Technicon H-1, H-2, and H-3 systems. Siemens has simplified the hydraulics operations of
the analyzer by replacing multiple complex hydraulic systems with a unified fluids circuit assembly or Unifluidics technology. The ADVIA 2120,
2120i and 120 provide a complete hemogram and WBC differential while also providing a fully automated reticulocyte count.

Four independent measurement channels are used in determining the hemogram and differential: (1)RBC/platelet channel, (2) Hb channel,
(3) peroxidase (PEROX) and (4) basophil lobularity channel for WBC and differential data. WBC, RBC, Hb and platelets are measured directly.

Laser light scattered at 2 different angular intervals – LOW ANGLE (2-3°), correlating with cell volume or size, HIGH ANGLE (5-15°) correlating
with internal complexity (i.e. refractive index or Hb concentration) is measured simultaneously.
4. Other names of PROSTAGLANDIN PATHWAY, IP3-DAG PATHWAY
EXCEPT:

Cyclooxygenase, Thromboxane, Eicosanoid

IP3-DAG pathway (Inositol Triphosphate – Diacylglycerol Activation Pathway)

The IP3-DAG pathway is the second G protein–dependent platelet activation pathway. G-protein activation triggers the enzyme phospholipase
C. Phospholipase C cleaves membrane phosphatidylinositol 4,5-bisphosphate to form IP3 and DAG, both second messengers for intracellular
activation. IP3 promotes release of ionic calcium from the DTS, which triggers actin microfilament contraction. IP3 may also activate
phospholipase A2. DAG triggers a multistep process: activation of phosphokinase C, which triggers phosphorylation of the protein pleckstrin,
which regulates actin microfilament contraction. (Rodak)

Internal platelet activation pathways, like internal pathways of all metabolically active cells, are often called second messengers because they
are triggered by a primary ligand-receptor binding event. Second messengers include G proteins, the eicosanoid synthesis pathway, the IP3-
DAG pathway, adenylate cyclase, cAMP, and intracellular ionic calcium
5. Substrate of thrombin, what factor? FACTOR I (FIBRINOGEN)
Fibrinogen is the primary substrate of thrombin, which converts soluble fibrinogen to insoluble fibrin to produce a clot. Fibrinogen is also
essential for platelet aggregation because it links activated platelets through their GP IIb/IIIa platelet fibrinogen receptor. Fibrinogen is a
340,000 Dalton glycoprotein synthesized in the liver. The normal plasma concentration of fibrinogen ranges from 200 to 400 mg/dL, the most
concentrated of all the plasma procoagulants. Fibrinogen is an acute phase reactant protein, whose level increases in inflammation, infection,
and other stress conditions. Platelet a-granules absorb, transport, and release abundant fibrinogen.
6. An unconscious inpatient does not have an ID DO NOT START ANY PROCEDURE UNTIL THE NURSE ATTACHES AN ID BRACELET
band. The name on an envelope on the patient’s
nightstand matches with the requisition. What Patient identification should never be based on information that is not attached to the
should you do? patient. If the patient is not wearing an ID band, ask the patient’s nurse to make
positive identification and attach an ID band before the specimen is drawn.
7. Your patient is not wearing an ID band. You see ASK THE PATIENT’S NURSE TO ATTACH AN ID BAND AND PROCEED WHEN IT IS
that the ID band is taped to the nightstand. The ATTACHED
information matches your requisition. What do you
do?
Identification should never be verified from an ID band that is not attached to the patient. An ID band on the nightstand could belong to a
patient who previously occupied that bed. Even if the ID band and the requisition match, it is not an adequate as proper identification of the
patient. If an ID band is not attached to the patient, you must ask the patient’s nurse to attach an ID band before you can collect the specimen
8. If you have no choice but to collect a specimen DISTAL TO IT
from an arm with a hematoma, collect the
specimen: If you have no other choice, it is acceptable to collect a blood specimen DISTAL TO OR
BELOW A HEMATOMA where blood flow is least affected by it. A venipuncture in the
area of a hematoma-including above beside or through it is painful to the patient and
can yield erroneous results related to the obstruction of blood flow by the hematoma.
It can also result in the collection of contaminated and possibly hemolyzed blood from
the hematoma instead of blood from the vein.
9. When encountering a patient with a fistula, the USE THE OTHER ARM
phlebotomist should:
10. WBC Chamber wait until how many minutes 10 MINUTES
before counting
11. Initial anemia classification RDW
12. Primary function of chemokines CHEMOTACTIC ACTIVITY
In addition to the cytokines previously mentioned, it is important to recognize another family of low-molecular-weight proteins known as
chemokines (chemotactic cytokines) that complement cytokine function and help to regulate the adaptive and innate immune system. These
interacting biological mediators have amazing capabilities, such as controlling growth and differentiation, hematopoiesis, and a number of
lymphocyte functions like recruitment, differentiation, and inflammation. (Rodak)
13. Measure of erythropoietic activity RETICULOCYTE COUNT
The reticulocyte count is an important diagnostic tool. It is a reflection of the amount of effective red blood cell production taking place in the
bone marrow. Since the life span of a red cell is 120 days, ±20 days, the bone marrow replaces approximately 1% of the adult red blood cells
every day.
14. Preanalytical storage
15. A diabetic outpatient has had a mastectomy on THE LEFT FOREARM OR HAND, USING A BUTTERFLY
her right side and cannot straighten her left arm
because of arthritis. The best place to collect a In this scenario, it is best to draw the specimen from the left arm in a position that the
blood specimen is: patient chooses. Never use force to extend a patient’s arm. A butterfly offers the
flexibility needed to access veins from an awkward angle. Diabetes can affect
circulation and healing in the lower extremities and generally makes venipuncture of
leg, ankle, and foot veins off limits. A blood draw should not be performed on the same
side as a mastectomy without approval of the patient’s physician.
16. When a blood specimen is collected from a A 5 ml DISCARD TUBE BEFORE THE SPECIMEN TUBES ARE FILLED
HEPARIN LOCK, it is important to draw
When a blood specimen is collected from a heparin lock, a 5-mL discard tube must be
drawn first to eliminate residual heparin used to flush the device and keep it from
clotting. The only extra tube collected is the clear tube. Drawing coagulation specimens
from a heparin lock is not recommended. Only nurses and especially trained personnel
draw from heparin and saline locks.
17. An inpatient vehemently refuses to allow you NOTIFY THE PATIENT’S NURSE AND DOCUMENT THE PATIENT’S REFUSAL
to collect a blood specimen. What should you do?
18. Chronic effects of smoking lead to increased HEMOGLOBIN, RBC, MCV, AND WBC

19. Globin denaturation

 20. Platelet count before adjusting Drabkin’s
21. Clumped ribosomes and iron aggregates PAPPENHEIMER BODIES
22. detects and measures changes in electrical ELECTRONIC IMPEDANCE
resistance between two electrodes as cells
pass through a sensing aperture The measurable voltage changes are plotted on frequency distribution graphs,
or histograms, that allow the evaluation of cell populations based on cell
volume.
23. All of the following are components of the SODIUM CHLORIDE
modified Drabkin’s reagent EXCEPT:
 Drabkin’s reagent: potassium ferricyanide, potassium cyanide, potassium dihydrogen phosphate, non-ionic detergent, distilled
water
24. Microhematocrit tube LENGTH 75 mm, INNER BORE: 1.2 mm
25. For microhematocrit determination, whole 2-3% DECREASE
blood anticoagulated with disodium EDTA is used.
The use of LIQUID TRIPOTASSIUM EDTA is thought The liquid tripotassium EDTA is thought to cause a 2 to 3% decrease in hematocrit due
to cause _____ in hematocrit to slight shrinkage of the red blood cells
26. Duplicate hematocrit results should agree 1%
within ____unit (%).
27. Initial tests for DIC PT, APTT, THROMBIN TIME, PLATELET COUNT
In a typical case of DIC, the PT, APTT, and thrombin time are generally prolonged. These tests, however, maybe normal for some unknown
reason. A normal APTT, however may reflect the partial coagulation present in the blood. The platelet count is decreased as is the fibrinogen.
Because of the formation of excess thrombin, soluble fibrin monomers are formed, so the protamine sulfate and ethanol gelation tests are
usually positive. This indicates a highly activated coagulation system.
28. Platelet dilution 1:100
29. Hematocrit: 50% AND RBC COUNT: 4.9 X 109/l.
Find the MCV.
30. When comparing spun microhematocrit results 1 to 3% HIGHER
with hematocrit results obtained on an electronic
cell counter, the spun hematocrit results may vary
from ________because of this trapped plasma
(unless the cell counter has been calibrated against
spun microhematocrits uncorrected for trapped
plasma).
31. A WBC count above ____ is termed >11 X 109/L
leukocytosis
32. DIC is what disorder> CIRCULATING IMMUNE COMPLEXES
Disseminated Intravascular Coagulation (DIC), defibrination syndrome, and consumption coagulopathy are terms used to refer to the
generalized over-activation of the coagulation and fibrinolytic systems in the circulating blood. The results of this activation are consumption
of coagulation factors and platelets, generation of thrombin, widespread deposition of fibrin in small blood vessels (thrombi) and formation
of large amount of fibrin degradation products. Depending on which process predominates (the clotting or the fibrinolysis), symptoms may
range from a low grade thrombosis to an acutely severe hemorrhage. All of these contribute to the bleeding, shock, and vascular occlusion
that develop.
33. notes 1:100

Above 30 X 109/L 1:100 or 1:101

100 to 300 x 109/L 1:200 or 1:201
Below 3 X 109/L 1:10 or 1:11

34. For manual WBC count, the filled counting 1 MINUTE

chamber should be allowed to stand for ____ prior
to performing the count to give the WBCs time to RBC count 3 minutes
settle. WBC count 1 minute
Platelet count 15 to 20 minutes
35. Objective for counting WBCs LPO (10x)

For accurate WBC counts, there should be an even distribution of cells in all four large
squares, with NO MORE THAN TEN-CELL VARIATION between the four squares

RBC count HPO

WBC count LPO
Platelet count HPO, PHASE

36. Fluorescent tags in cell FLOW CYTOMETRY

37. There is an approximate _____% error for a 15% ERROR
manual WBC that falls within the normal range.
Manual RBC count 10 to 20% range of error
Manual WBC count 15% error

38. If _____ or more nucleated RBCs per 100 WBCs 5 OR MORE NRBCs
are observed on the differential count (IN ADULT)
on a stained peripheral blood film, the WBC count 5 or more NRBCs Adult
must be corrected for these cells 10 or more NRBCs Neonates

39. Iron is delivered to the maturing RBCs by this TRANSFERRIN/SIDEROPHILIN

specific transport protein:
40. In a hemoglobin molecule, how many heme FOUR HEME MOLECULES AND FOUR GLOBIN CHAINS
groups and polypeptides are there?
41. The average time the neutrophil spends in the 10 HOURS
peripheral blood is considered to be _____ hours.
Lifespan of neutrophils: 5 DAYS
42. One of the two samples in the microhematocrit >50%
method should have a hematocrit reading of _____
43. Least differentiated megakaryocyte precursor MK-I or MEGAKARYOBLAST
Morphologists call the least differentiated megakaryocyte precursor the MK-I stage or megakaryoblast. Although they no longer
look like lymphocytes, megakaryoblasts cannot be reliably distinguished from bone marrow myeloblasts or pronormoblasts (also
named rubriblasts) using light microscopy. The morphologist may occasionally see a vague clue: plasma membrane blebs, blunt
projections from the margin that resemble platelets. The megakaryoblast begins to develop most of its cytoplasmic
ultrastructure, including procoagulant-laden a-granules, dense granules (dense bodies), and the demarcation system (DMS).
44. Normal platelet adhesion depends upon GLYCOPROTEIN Ib
Function Characteristics
Adhesion: platelets roll and cling to nonplatelet surfaces Reversible; seals endothelial gaps, some secretion of growth factors, in arterioles
VWF is necessary for adhesion
Aggregation: platelets adhere to each other Irreversible; platelet plugs form, platelet contents are secreted, requires fibrinogen Secretion:
platelets discharge the contents of their granules Irreversible; occurs during aggregation, platelet contents are secreted, essential to
coagulation.
45. Specimen used for coagulation test PLATELET-POOR PLASMA (PPP)
9
46. If WBC count is 40 X 10 /L, how many WBCs
should be counted in the differential?
47. If WBC count is 100 X 109/L, how many WBCs
should be counted to differentiate?
48. Small lymphoblasts, scanty cytoplasm L1
L1 – Around 25 to 30% of adult cases and 85% of childhood cases of ALL are of this subtype. In this type small cells are seen with:-
 regular nuclear shape
 homogeneous chromatin
 small or absent nucleolus
 scanty cytoplasm

L2 – Around 70% of adult cases and 14% of childhood cases are of this type. The cells are large and or varied shapes with:

 irregular nuclear shape

 heterogeneous chromatin
 large nucleolus

L3 – This is a rarer subtype with only 1 to 2% cases. In this type the cells are large and uniform with vacuoles (bubble like features) in the
cytoplasm overlying the nucleus.

This classification was abandoned by the World Health Organization because the L1 and L2 subtypes could not be differentiated in terms of
clinical symptoms, prognosis and genetic abnormalities. The mature B-cell ALL or L3 type is now classified as Burkitt's lymphoma/leukemia

49. Sodium dithionite solubility test HEMOGLOBIN S, TURBID APPEARANCE

50. Bone marrow specimen may be placed in a EDTA
tube containing _____ to prevent clotting
51. NEGATIVE instrumental error EXCESSIVE CELL LYSIS
POSITIVE INSTRUMENTAL ERROR: BUBBLES, EXTRANEOUS ELECTRICAL PULSES, APERTURE PLUGS
NEGATIVE INSTRUMENTAL ERROR: RECIRCULATION, EXCESSIVE CELL LYSIS,

52. Stable factor FACTOR VII (PROCONVERTIN)

FACTOR NAME
I Fibrinogen
II Prothrombin
III Tissue factor
IV Calcium
V Proaccelerin, labile factor
VII Proconvertin, stable factor
VIII Antihemophilic A factor (AHF), antihemophilic globulin (AHG)
IX Antihemophilic B factor (AHB), plasma thromboplastin component
(PTC), Christmas factor
X Stuart factor, Stuart-Prower factor
XI Plasma thromboplastin antecedent (PTA)
XII Hageman factor, contact factor
XIII Fibrin-stabilizing factor
- Fletcher factor, PK
- High molecular weight kininogen, HMWK, Fitzgeral factor

53. FITZGERALD FACTOR HMWK (High-molecular weight kininogen)

Fitzgerald factor (high-molecular-weight kininogen, HMWK) is a member of the kinin inflammatory system that is digested and activated by
kallikrein to form bradykinin. Fitzgerald factor is one of the in vitro contact activators of the coagulation system, which also include
prekallikrein and factor XII
54. Red cell mass and ESR are ______ proportional
55. Associated with aplastic anemia FANCONI’S ANEMIA

Pure red cell aplasia – Diamond-Blackfan

56. Oldest method in the classification of leukemia CYTOCHEMICAL STAINING
FAB – based on Romanowsky-stained smears and cytochemical staining
WHO – mostly based on immunophenotyping and cytogenetics
57. Hemophilia C FACTOR XI
58. Adhesion defect BERNARD-SOULIER SYNDROME
59. Phagocytosis and platelet activation occurs in MEMBRANOUS SYSTEM
the:
60. Affect platelet activation and vasoconstriction DENSE TUBULAR SYSTEM
Parallel and closely aligned to the SCCS is the dense tubular system (DTS), a condensed remnant of the rough endoplasmic reticulum. Having
abandoned its usual protein production function upon platelet release, the DTS sequesters Ca21 and bears a series of enzymes that support
platelet activation. These enzymes include phospholipase A2, cyclooxygenase, and thromboxane synthetase, which support the eicosanoid
synthesis pathway that produces thromboxane A2, and phospholipase C, which supports production of inositol triphosphate (IP3) and
diacylglycerol (DAG). The DTS is the “control center” for platelet activation.
61. the stage that takes approximately 4 hours G2

G1 10 HOURS
S 9 HOURS
G2 3-4 HOURS
M 1 HOUR

DNA Replication and the Cell Cycle

After cells carry out their functions, they either divide via mitosis or die via apoptosis, also called programmed cell death. The cell cycle
progresses through a defined sequence. Interphase is made up of the G1, S, and G2 phases. During the G1 phase, the cell grows rapidly and
performs its cellular functions. S phase is the synthesis stage, in which DNA is replicated. The G2 phase is the period when the cell produces
materials essential for cell division. The M phase refers to mitosis, during which two identical daughter cells are produced, each of which
receives one entire set of the DNA that was replicated during S phase. Checkpoints occur at the end of G1 before DNA replication in the S
phase, and at the end of G2 before mitosis in the M phase. The checkpoints have complex mechanisms to stop the progression of the cell
cycle if a problem is detected, at which point the cell will undergo apoptosis. Some cells exit the cell cycle during the G1 phase and enter a
phase called G0. Cells in G0 normally do not reenter the cell cycle and remain alive performing their function until apoptosis occurs

Algorithm for evaluating causes of anemia based on absolute reticulocyte count and mean cell volume (MCV).

62. Eicosanoid synthesis other names PROSTAGLANDIN/CYCLOOXYGENASE/THROMBOXANE PATHWAY

The eicosanoid synthesis pathway, alternatively called the prostaglandin, cyclooxygenase, or thromboxane pathway, is one of two essential
platelet activation pathways triggered by G proteins. The platelet membrane’s inner leaflet is rich in phosphatidylinositol, a phospholipid
whose number 2 carbon binds numerous types of unsaturated fatty acids, but especially 5,8,11,14-eicosatetraenoic acid, commonly called
arachidonic acid. (Rodak)

Platelet activation is managed internally through G proteins, the eicosanoid synthesis pathway, and the IP3-DAG pathway.
Eicosanoid synthesis includes PGE2, TXA1, TXA2, TXB2
63. Monokine IL-1, CSF
64. PPE used in enteric isolation LABORATORY GOWN AND GLOVES
Isolation techniques are used to prevent the spread of infection from a patient to hospital personnel or to other patients, and to shield or
protect an infection-prone patient from pathogens. There are five types of isolation:
 1. Strict isolation is used in cases of contagious diseases that can be transmitted by direct contact via the air; all articles in the room
are considered contaminated, and handwashing is critical (Ex. Meningococcal meningitis, rabies, diphtheria, viral encephalitis, polio,
measles, smallpox, and mumps.)
PPE used: GOWN, MASK, AND GLOVES
2. Enteric isolation techniques are used when coming in contact with patients who have dysentery and other disorders that spread
through direct contact,(Ex. Salmonella, Escherichia coli, and parasitic infections)
PPE used: GOWN and GLOVES
3. In respiratory isolation, the patient has infections that are transmitted via droplets or by an airbourne route. (Ex. tuberculosis and
whooping cough.)
PPE: GLOVES AND MASK
4. Wound and skin isolation is used in cases of skin infection that may be transmitted directly or indirectly.
PPE: GOWN AND GLOVES
5. Protective isolation requires the technologist to protect the patient from infection. Articles may be removed from the room because
the patient does not have an infection but has a lowered resistance to infection
(Ex. leukemia, severe burns, body radiation, kidney transplants, and plastic surgery.)
PPE: GOWN, MASK, GLOVES, AND SHOE COVERINGS
.
65. What is the most likely pathogen during enteric ESCHERICHIA COLI (Dysentery-causing)
isolation?
66. Enteric isolation technique is done to protect: LABORATORY TECHNOLOGIST

67. Patient has normal RBC count. How many RBCs 20

are seen per field?
68. Leukemia that has no classification M0

69. The total number of cells counted on each side 10%

of the counting chamber should agree within ____
of each other.
70. Patient has a hematoma on the right arm,
where do you get blood?
71. Increase in fibrinogen levels per decade in ages
65-79
72. Extrinsic causes of hemolysis IMMUNE-MEDIATED

Hemolysis
Intrinsic causes: Membrane defects, Hemoglobinopathies Hb E disease/trait, Enzyme deficiencies
Extrinsic causes: Immune hemolytic anemias, Microangiopathic hemolytic anemias (TTP, HUS, DIC), Macroangiopathic hemolytic anemias
(traumatic cardiac hemolysis), Infectious agents (malaria, babesiosis), Drugs, chemicals, venoms, extensive burn
73. Characterized by multilobed nucleus, deeply
and variably condensed chromatin with azurophilic
cytoplasm
MK-III
The promegakaryocyte reaches its full ploidy level by the end of the MK-II
stage. At the most abundant MK-III stage, the megakaryocyte is easily
recognized at 103 magnification on the basis of its 30- to 50-mm diameter. The
nucleus is intensely indented or lobulated, and the degree of lobulation is
imprecisely proportional to ploidy.

74. Initial anemia classification RDW

75. Intrinsic causes of hemolysis MEMBRANE DEFECTS, ENZYME DEFICIENCIES

76. Primary Hemostasis EPISTAXIS AND HEMATEMESIS
Bleeding from multiple sites, spontaneous and recurring bleeds, or a hemorrhage that requires physical intervention and transfusions is called
generalized bleeding. Generalized bleeding is potential evidence for a disorder of primary hemostasis such as blood vessel defects, platelet
defects, or thrombocytopenia, or secondary hemostasis characterized by single or multiple coagulation factor deficiencies.

Generalized Bleeding Signs Heralding a Possible Hemostatic Defect

Purpura—recurrent, chronic bruising in multiple locations; called petechiae when less than 3 mm in diameter, ecchymoses when greater
than 1 cm in diameter
Epistaxis—nosebleeds that are recurrent, last longer than 10 minutes, or require physical intervention
Recurrent or excessive bleeding from trauma, surgery, or dental extraction
Bleeding into multiple body cavities, joints, or soft tissue
Simultaneous hemorrhage from several sites
Menorrhagia (menstrual hemorrhage)
Bleeding that is delayed or recurrent
Bleeding that is inappropriately brisk
Bleeding for no apparent reason
Hematemesis (vomiting of blood)
77. Most common coagulation factor deficiencies
78. Initial workup tests for vWD CBC, PT AND APTT
Definitive diagnosis of VWD depends on the combination of a personal and family history of mucocutaneous bleeding and the laboratory
demonstration of decreased VWF activity. A CBC is necessary to rule out thrombocytopenia as the cause of mucocutaneous bleeding, and PT
and PTT, which assess the coagulation system, are part of the initial VWD workup. No longer recommended, according to the 2009 NHLBI
VWD guidelines, are the bleeding time test and the PFA-100 or other automated functional platelet assays. These traditional screening tests
generate “conflicting” sensitivity and specificity data. (Rodak)
79. Causes gradual changes in blood CML
80. Causes sudden, abrupt changes in blood AML (?)
81. Normocytic, Normochromic except THALASSEMIA
Normocytic, Normochromic – Aplastic anemia, PRCA, Myelophthisic anemia, leukemias
Microcytic, Hypochromic – IDA, ACD, Sideroblastic, Thalassemia, Chronic bleeding
Macrocytic, Normochromic – Megaloblastic anemia (Folate and B12 deficiency), CDA (Liver disorders)
Microcytic, Hyperchromic – Hereditary spherocytosis
Microcytic, Normochromic– Hereditary pyropoikilocytosis
NON IMMUNE = MAHA (Micro and Macro), Infection, Chemical, Drugs, Venoms, External
IMMUNE = Autoimmune HA (WAIHA, CAD, PCH), Drug-induced, Alloimmune HTR
82. Platelet precursors include BFU-Meg, CFU-Meg
83. Flow cytometry FORWARD LIGHT SCATTER: SIZE OF THE CELL
90® LIGHT SCATTER: GRANULARITY OF THE CELL
84. Earliest precursor in the undifferentiated LDU
platelet
85. 2nd step in Phagocytosis INGESTION

86. If platelet synthesis is accelerated, it would

lead to:
87. When anticoagulants are used in the blood
sample what test cannot be performed?
88. Hgb is 14, what is the Hct? 39

89. MPV is measured within how many hours? 1-3 HOURS

The use of EDTA as an anticoagulant helps to decrease platelet clumping, but the mean platelet volume (MPV) will increase during the first
hour in the tube. Although the MPV at will be relatively stable for the next 8 hours, it is best to measure the MPV at 1 to 3 hours after
obtaining the specimen. The platelets will eventually further increase in size. The larger platelet size may be due to its change from disc-
shaped to a spherical form. (Brown)
90. Large, red staining globules in the cytoplasm of RUSSELL BODIES
plasma cells
In certain pathologic states and when manufacturing immunoglobulins, plasma cells may produce striking alterations in their appearance.
Some of the changes possible are:
1. Red staining of the cytoplasm (flame cell)
2. Red staining, crystalline, rod-shaped bodies present in the cytoplasm.
3. Large, red staining globules in the cytoplasm (Russell bodies).
4. Numerous globular bodies present in the cytoplasm (grape, berry, or morula cell).

91. white cells are counted in consecutive fields as CROSS-SECTIONAL OR CRENELLATION TECHNIQUE
the blood film is moved from side to side. Counting
should begin in the thin area of the smear where the
red blood cells are slightly overlapping and proceed
into the thicker area. However, do not progress too
far into the thick area if the white cells are not
sufficiently spread for easy identification.

92. There is an error of approximately _______ in ±25%

the reticulocyte counts within the normal range.
93. Which of the following is included in
thrombopoiesis?
94. Granulocyte mitotic pool
The range of error in the reticulocyte count varies, depending on the number of
reticulocytes counted. Using the previously outlined procedure, there is an error of
approximately ±25% in the reticulocyte counts within the normal range. This decreases
to ±10% in a reticulocyte count of 5% and decreases even further as the uncorrected
reticulocyte count increases.
CIRCULATION, MATURATION, PROLIFERATION
MYELOBLASTS, PROMYELOCYTES, AND MYELOCYTES

95. IRON-DEFICIENCY ANEMIA DECREASED PLASMA IRON, DECREASED SATURATION, DECREASED FERRITIN LEVELS,
INCREASED TIBC, INCREASED RBC PROTOPORPHYRIN
IMMUNOLOGY, SEROLOGY, AND BLOOD BANKING

HBIg deferral 1 YEAR

In the gel test, a button of cells at the bottom of the well is NEGATIVE REACTION
Donor criteria for plasmapheresis: frequent plasma donors 6 g/dL
have a total serum protein of at least
Double red cell pheresis deferral 16 WEEKS
Color of Anti-A reagent BLUE
Gel tech centrifuge 10 MINUTES
Which T cell expresses the CD8 marker and acts specifically T CYTOTOXIC
to kill tumor cells?
(+) HBsAg, (+) Anti-HBc PERMANENTLY DEFERRED
Minimum pretransfusion testing requirements for ABO and Rh typing
autologous donations collected:
Which hypersensitivity reaction is due to immune complex TYPE III
formation?
Speed of blood infusion 200 ml/hour

Blood infusion must be completed within 4 hours

Anti-smooth muscle antibody CHRONIC ACTIVE HEPATITIS
Anti-centromere antibody CREST syndrome
The QC requirements mandate that the volume and AHF 4 UNITS MONTHLY
activity of the final product must be tested on at least
A man with multiple needle marks PERMANENTLY DEFERRED
Associated with infectious mononucleosis Autoanti-i
Most important initial tests before considering a kidney ABO
transplant disease
Additive solutions (Adsol, Nutricel, Optisol) are approved in 42 DAYS
the US for RBC storage for _____ days
Cryoprecipitate contains which of the following FIBRINOGEN, AHF, vWF, and FACTOR XIII
Donor with close contact with a person who had a viral 1 YEAR
hepatitis should be deferred
No deferral – close contact, HIV
1 year – close contact, HEPATITIS
Which of the following is not considered as HBV serologic HBcAg
marker:
Most frequently transfused from mother to fetus CMV
The RPR test should be rotated at 100 rpm for 8 MINUTES
In the enzyme-linked immunosorbent assay (ELISA), which of ANTIGEN AND ANTIBODY
the following can be attached to a solid-phase support
(polystyrene)
HIV has been isolated from blood, semen, vaginal secretions, BLOOD, SEMEN, VAGINAL SECRETIONS, AND BREAST MILK
saliva, tears, breastmilk, CSF, amniotic fluid and urine. Only
____ have been implicated in the transmission of HIV to date
Monoclonal antibodies are produced by HYBRIDOMAS
In quality assurance program, at least 75% of the bags of 80
cryoprecipitated AHF must contain a minimum of how many
international units of Factor VIII
A lectin with Anti-N specificity can be made from VICIA GRAMINEA
In the copper sulfate method of hemoglobin determination, 15 SECONDS
acceptable drop of blood will sink in the solution within
Polyspecific AHG reagent contains ANTI-IgG and ANTI-C3d
Which of the following ABO blood groups contains the least A1B
amount of H substance
What antibodies are formed by a Bombay individual? ANTI-A, ANTI-B, ANTI-H
What type of blood should be given in an emergency O Rh-NEGATIVE PACKED CELLS
transfusion when there is no time to type the recipient’s
sample
Marker for urinary bladder cancer NMP-22
HLA-B27 ANKYLOSING SPONDYLITIS
Acceptable amount of blood taken from a donor 450 ml
According to AABB Standards, LEUKOREDUCED RED CELL is a 5 X 106, 85%
product in which the absolute WBC count in the unit is
reduced to _____, and contains at least ______ of the original
RBC mass
In the Fahey method, the diameter of the precipitin rings is 18 HOURS
measured at
Color of contaminated blood REDDISH, PURPLE
Which antibody is most commonly associated ANTI-Jka
with delayed hemolytic transfusion reactions?
A term that describes the unique conformation of the antigen EPITOPE
that allows recognition by a corresponding antibody

HISTOPATHOLOGY AND MTLE

Thionine belongs to what group XANTHINE? THYRONINE?
Which of the following is not included in the MT Code of Ethics HUMILITY
Stain for Wilson’s disease RHODAMINE
Stain for Leprosy bacilli and Nocardia WADE-FITE
Dieterle – Legionella
Toluidine blue – Helicobacter
Warthin-Starry- Spirochetes
Causes shrinkage of organ DENERVATION
He invented the freezing microtome QUECKETT
This anatomic site for gynecologic samples is used for the detection ENDOCERVIX
of endocervical lesions or intrauterine lesions
In an anatomic procedure, the prosector is the PATHOLOGIST
Thyroid gland SIMPLE CUBOIDAL
What are the processes done by the automatic tissue processor? FIXATION, DEHYDRATION, CLEARING, AND INFILTRATION
An act done to avoid harming the patients NON-MALEFICENCE
Stain for copper LINQUIDST’S MODIFIED RHODAMINE STAIN
Polyclonal antibodies used in immunohistochemical techniques are RABBIT
derived from
To be effective, criticism should be SPECIFIC TO THE BEHAVIOR
A patient has complained to the administration that a bruise was ASK THE PHLEBOTOMY SUPERVISOR TO INVESTIGATE THE
left after a “brutal” venipuncture. What should be done first? INCIDENT
Inventory stock card is best for REMOVING USED AND EXPIRING STOCKS, MONITORING NUMBER
OF REAGENTS, COMPARING PRICES OF REAGENTS TO WHICH IS
EXPENSIVE
The Professional Regulation Commission, otherwise known as the THREE-MAN
PRC, is a _____ man commission attached to the office of the
President for general direction and coordination
The major workload in most hospital laboratories is generated in CHEMISTRY
It is an excellent fixative for preserving soft and delicate structures BOUIN’S SOLUTION
(e.g. endometrial curettings)
Temperature of the flotation water bath 45-50°C
45-50°C or 6 to 10°C BELOW the melting point of paraffin wax
Gastrointestinal specimens except: INDUCED VOMITING
When employees are going to be responsible for implementing a INVOLVE THE EMPLOYEES IN THE DECISION-MAKING PROCESS
change in procedure or policy, the manager should FROM THE VERY BEGINNING
Aminoethylcarbazole (AEC), which is ______ in color, is a common RED
chromogen for peroxidases
The best way to motivate an ineffective employee would be to SET SHORT-TERM GOALS FOR THE EMPLOYEE
In double embedding, the tissue is first infiltrated with ______, CELLOIDIN, PARAFFIN
followed by embedding with
On trimming, tissue smells of clearing agent CLEARING AGENT NOT COMPLETELY REMOVED DUE TO
SUFFICIENT IMPREGNATION
Leadership DIRECTING
Diaminobenzidine (DAB) which is _______ in color, is a common BROWN
chromogen for peroxidase
Mortality refers to DEATH
Providing accurate results for diseased patient is what principle or NON-MALEFICENCE? JUSTICE? RESPECT? AUTONOMY
virtue?
All laboratory procedures and policies must be reviewed and ANNUALLY OR WHEN AUTHORIZED CHANGES ARE MADE
documented at least
All are primary goals of proficiency exam, EXCEPT COMPETENCE, KNOWLEDGE, ATTITUDE, SCHOOL PERFORMANCE?
Decalcification BONES
The process by which an agency or organization uses predetermined ACCREDITATION
standards to evaluate and recognize program of study in an
institution is called:
A general term for the formal recognition of professional or technical CREDENTIALING
competence
An effective program of continuing education for medical laboratory IDENTIFY THE NEEDS
personnel should first
The reliability of a test to be positive in the presence of the disease it SENSITIVITY
was designed to detect is known as
STAT means IMMEDIATELY
The clinical laboratory law requires that THE CLINICAL LABORATORY IS HEADED BY A PATHOLOGIST
Who can teach histopathology at school? RMT? PATHOLOGIST?

ADDITIONAL NOTES

Lysozyme Resistance For differentiating Nocardia from Streptomyces

Klebsiella granulomatis formerly known as Calymmatobacterium
visualized in scrapings of lesions
Donovan bodies
Blue rod with permanent polar granules
“safety pin appearance” surrounded by a large pink capsule
Subsurface infected cells
Will not grow in routine agar media; cultured in human
monocytes from biopsy specimens of genital ulcers
Bordetella holmesii Punctuate, semiopaue, convex, round with greening of
blood usually accompanied by lysis
Acinetobacter Plump coccobacilli that tend to resist alcohol decolorization
 Can be mistaken for Neisseria
Burkholderia cepacia Associated with cystic fibrosis and chronic granulomatous
disease (CGD)
Eugonic Organism that grows well on common lab media
10-unit penicillin disk Cause the coccoid form of Moraxella to elongate to Bacillus
S. bovis Early indicator of gastrointestinal malignancy or cancer
C. pseudotuberculosis Isolated from animals such as sheep, goats, and horses
C. jeikeium Isolated from inguinal, axillary, rectal sites
Campylobacter Fecal samples from chicken carcasses; chosen at random
from butcher shops
C. diphtheria Inhabits the human nasopharynx but only in the carrier state
E. coli From undercooked beef or milk from colonized cattle
E. tarda Cold-blooded animals such as reptiles
Y. pestis Urban and domestic rats/wild rodents
5% sheep BAP; pinpoint at 24 hours
Rough cauliflower appearance at 48 hours
“stalactite pattern”
Y. enterocolitica Consumption of incompletely cooked food products and by
ingestion of contaminated water; dark red or burgundy
centers (bull’s eye colonies) on CIN at 48 hours
Listeria From soft cheeses, feta, Camembert and blue-veined
cheese; ready-to-eat foods, hotdog
Eikenella corrodens Bites or clenched fist wounds
M. paratuberculosis Johne’s disease
C. trachomatis Pelvic Inflammatory Disease
Porphyromonas, Prevotella Black on blood agar and brick red fluorescence in UV light
L. monocytogenes From meat and other products; causes stillbirth;
granulomatous infanseptica
May be isolated from placental and other tissues
Plesiomonas shigelloides New member of the Enterobacteriaceae that can cause
gastrointestinal infection that might cross react with Shigella
grouping
Stenotrophomonas maltophilia Established as part of respiratory flora of patients
hospitalized for prolonged periods
Lavender green to light purple pigment
“ammonia smell”
Produces a brown pigment on heart infusion agar that
contains tyrosine
Pseudomonas pseudomallei Gram-negative rod with bipolar staining; “safety pins”
P. aeruginosa – the only spp. for which valid in vitro susceptibility testing methods exist for which
there is extensive therapeutic experience
Leifsonia Isolated from freshwater
Kingella Stain as short, plump, coccobacilli with squared off ends that
may form chains
“teardrop appearance”
Bacillus anthracis Most notorious pathogen
Agent of bioterrorism
Pulmonary anthrax “Woolsorter’s disease
B. cereus Penicillin resistant, β-hemolytic and motile
Produce a wide zone of lecithinase on egg yolk agar
Causes endolphthalmitis
Arthrobacter Jointed ends giving L and V forms
Brevibacterium “cheese-like odor”
Dermatobacter hominis Distinctive pungent odor
Alcaligenes faecalis Fruity odor resembling apples or strawberries
Β-hemolytic strep Distinctive buttery odor
Aeromonas and Yersinia – indistinguishable on CIN; differentiated by OXIDASE
Arcanobacterium Delicate, curved, gram (+) rods with pointed ends and
occasional rudimentary branches
Nocardia Primary responsible for the decomposition of plant material
“Beaded/chalky white appearance”
Char. By presence of mesodiaminopimelic acid (DAP)
arabinose and galactose
Draining sinus tracts
Nocardia Casein, xanthine and tyrosine hydrolysis
Grow at 45 degrees Celsius
Causes opacification of Middlebrook agar
Rhodococcus equi Organism most commonly associated with HIV
Can replicate within macrophages
IL-4 and granuloma formation
Rhodococcus Coccobacilli in zigzag formation
Tsukamurella Have rhizoid edges
C. meningosepticum Incubator, sinks, faucet, tapwater, hemodialysis
E. faecalis Produce a pseudocatalase when grown on blood containing
media and may appear weakly catalase (+).
Elizabethkingia meningoseptica Often appear as II forms
Delftia acidovorans Orange color when Kovac’s reagent is added to tryptone
broth

To detect genital carriage of group B strep during pregnancy, Todd Hewitt broth with
antimicrobials is used to suppress growth.
Coryneforms are most likely to be the cause of urinary tract infection if the pH of the urine is
alkaline or there are struvite crystals in the sediment

Culture medium Organism isolated

Cetrimide medium P. aeruginosa
Granada medium S. agalactiae
c-HBT (Human Blood Bilayer Tween Media) G. vaginalis
CTBA medium (Cystine-tellurite blood agar) C. diphtheriae
CIN (Cefsulodin-Irgasan-Novobiocin) Y. enterocolita and Aeromonas
TCBS (Thiosulfate-citrate bile salts) V. cholerae
Alkaline Peptone Water V. cholerae
Modified Thayer-Martin Haemophilus/N. gonorrheae
SMAC (MacConkey agar with sorbitol) E. coli O157:H7 and Y. enterocolitica
BCYE (Buffered Charcoal Yeast Extract) L. pneumophila
Nocardia (from contaminated specimens)
Feeley-Gorman agar L. pnemophila
Skirrow agar Campylobacter and Helicobacter
Blood agar Differentiation of hemolytic patterns;
used for fastidious organisms
CDC anaerobe 5% sheep blood agar Obligate, slow-growing anaerobes
CVA agar (Cefoperazone vancomycin Campylobacter spp.
amphotericin agar)
Selenite broth Salmonella
Stuart Liquid Media/Fletcher semisolid Leptospira
EMJH (Ellinghausen-McCullough-Johnson- Leptospira
Harris
Campy-blood agar Campylobacter spp.
Campy-thioglycollate broth Selective holding medium for
campylobacter; used for cold enrichment
technique
Chocolate agar Neisseria; for fastidious bacteria
Chocolate agar with horse blood Haemophilus spp.
Bile esculin agar Enterococci and group D streptococci
Brilliant green agar Selective medium for Salmonella
CCFA (Cycloserine-cefoxitin fructose agar) Clostridium difficile
Chick embryo Chlamydia and Rickettsia
Ashdown medium B. pseudomallei
Biphasic Castañeda Bottles Brucella
Modified McClung’s/neomycin (egg yolk agar) Clostridium spp.
KVLB (Kanamycin-Vancomycin Laked Blood Bacteroides fragilis and Prevotella spp.
agar)
DCA Enterobacteriaceae
CNA S. aureus
CTA (Cysteine Tryptic Digest) Neisseria spp.
Pre-reduced and Vitamin K Supplemented Bacteroides, Peptostreptococcus,
BAP Clostridium
Bile Esculin Agar Plates Bacteroides fragilis
Barbour Stoemer Kelly’s medium Borrelia
LIM broth Screening for group B streptococci
XLD Salmonella and Shigella
Hektoen agar Salmonella and Shigella
Shepard’s agar M. pneumoniae
Schaedler’s agar anaerobes
Cysteine F. tularensis
PLET (Polymyxin Lysozyme EDTA Thallous B. anthracis (for isolation and
Acetate) agar identification)
Bicarbonate agar B. anthracis (used to induce capsule
formation)
Horse blood bacitracin agar H. influenzae
PRAS-brucella agar Clostridium and Bacteroides
M agar M. hominis
U agar U. urealyticum
10B Broth U. urealyticum
E agar M. pneumoniae
SP4 agar M. pneumoniae
A7/A8 agar (subculture) U. urealyticum
Lysozyme/ Glycerol Broth Nocardia
PC agar B. cepacia
OFBL agar (Oxidative-fermentative base- B. cepacia
polymyxin-B-bacitracin-lactose)
Renal fragments – cells from the collecting ducts that appear in groups of three or more.

PCT RTE cells Large, rectangular

Columnar or convoluted
cells
DCT RTE cells Smaller, round, or oval
CD RTE cells Cuboidal, never round

SIMILAR APPEARANCE
Radiographic contrast media Cholesterol/uric acid/calcium carbonate
Cystine Uric acid
Calcium phosphate rosette forms sulfonamides
Amorphous urates Granular casts
Cylindroids Mucous threads
T. vaginalis WBC, transitional, RTE
Red blood cells Yeast cells, oil droplets, air droplets
Starch granules Fat droplets, RBCs
Hair and fibers casts
Calcium carbonate Amorphous phosphates
Mucous threads Hyaline casts
Hemosiderin Amorphous phosphates
Synoviocytes Mesothelial cells
Myelin globules Blastomyces

Oil droplets may appear like RBCs to inexperienced personnel.

Polarized light – differentiates fibers and casts

Uric acid Glycogen Storage Disease (GSD)

Calcium oxalate Glycogen breakdown
The average preanalytical urine testing workflow is 22 steps
If any discoloration appears on the reagent strips, DISCARD the bottle immediately.
Oldest and most useful tool in quality control of urinalysis
-FINAL INSPECTION OF ALL THE RESULTS that make up the urinalysis before they are reported.
12th pad: ALBUMIN - DIDNTB
13th pad: CREATININE – pseudoperoxidase activity of copper-creatinine complexes; TMB and DBDH
Glomerulus “working portion of the kidney”
CLSI guidelines for urine containers:

At least 50 ml and opening of at least 4 cm

Urinalysis tubes – with CONICAL bottom test tubes (8-15 ml)
24-hour urine collection containers – 3 L
Routine specimens: minimum of 12 mL but 50 mL is preferable

Decomposition of urine begins within 30 minutes after collection:

Specialized additives:
Nitric acid – mercury analysis
Na bicarbonate and EDTA – porphyrins
Na bicarbonate – urobilinogen

Boric acid – most common preservative of urine for C/S

NORMAL SPECIFIC GRAVITY: 1.003-1.035
24-HOUR SPECIFIC GRAVITY: 1.016-1.022
The first urine specimen passed in the morning should have a SPECIFIC GRAVITY of > 1.020
Diabetes insipidus – 1.001-1.003
Maltese cross formation Oval fat bodies, cholesterol, starch
GABA (Gamma-aminobutyric acid) DECREASED LEVELS IN CSF
Alzheimer’s and Huntington’s Disease

DECREASED LEVELS IN CSF OF INFANTS

Startle disease/”stiff baby syndrome”
A urine specimen collected 2-3 hours after eating is preferable for testing of glucose. Specimen is refrigerated for up to 6-8
hours.
Single cuboidal cells Salicylate poisoning
Fat-laden histiocytes Lipid storage disease
Filled with fat and larger than oval fat bodies
Lymphocytes and plasma cells Acute renal allograft rejection
Atypical mononuclear cells Urinary tract neoplasia
Bilirubin-stained RTE cells Hepatitis
Leucine Oily-looking spheres with concentric circles
Tyrosinosis INCREASE in p-hydroxyphenylpyruvic acid
INCREASE in p-hydroxyphenyllactic acid
5% NaCl
3% NaCl
9% sucrose
Cylindroids (casts with tapered Produced in the ASCENDING LOOP OF HENLE and the DISTAL CONVOLUTED TUBULE
ends)

Fine granular casts Appear pale yellow or gray

Coarse granular casts Larger granules that may appear
black
Waxy casts Cracks and fissures on the sides

RBC casts Orange red color

Massive Homogenous orange red or
hemoglobinuria/myoglobinuria red brown casts
Acute tubular necrosis Dirty or granular casts
Pseudochylous or chyliform Milky, greenish, and “goldpaint” appearance
effusions
Rice bodies Fragments of degenerating proliferative synovial cells or microinfarcted synovium
CPPD rhomboids
Found in crystal deposition disease; chondrocalcinosis
Calcium hydroxypatite Typically too small and nonbirefringent unless they are clumped into spherical
microaggregates
Irregular or Chinese-coin shaped crystals
Calcium phosphate crystals Assoc. with osteoarthritis
Glove powder Modified cornstarch
Introduced during joint surgery
Appears as round, strongly birefringent particles
5-30 um in diameter with central notch and Maltese cross appearance
Crystalline corticosteroids Intraarticular injection
Have appearance similar to MSU and CPPD
Persist up to one month following injection
MSU “beachball” or rounded spherulites
Bubble cells Associated with the dilation of ER before the death of injured cells
Renal lithiasis (Renal calculi)
80% CaOx
3-10% CaPO4, Magnesium ammonium phosphate, uric acid
 1-2% Cystine crystals
Trichomonas
Specific gravity of filtrate in Bowman’s space – 1.008-1.010
24-hour urine
DNA test
Minimal change disease
Uromodulin Associated Kidney
Disese
Urinary Bladder Rupture
SPLIT FAT STAIN = Orange Droplets (+ Fatty Acids)
36% Acetic Acid + Sudan III
May resemble WBC, transitional, or RTE cells when not moving
Catecholamines, VMA, metanephrines, cortisol
Detects K-ras mutation associated with colorectal cancer
Mucoid Colitis, constipation
Bulky and frothy steatorrhea
Ribbon-like Intestinal constriction
Melena Large amounts of fecal
blood (black)
Occult/hidden Small amounts of fecal
blood
Normal histology; HLA B12
Renal transplantation
INCREASE in serum uric acid
Teens developing gout early
INCREASE Peritoneal Fluid BUN and CREA + INCREASE Serum Urea and NORMAL SERUM
CREA

Normal = 100 Droplets (<4 um)

Slight Increase = 100 droplets (1-8 um)
Increase = 100 droplets (6-75 um)

NEUTRAL FAT STAIN = Orange Droplets (+ Neutral Fat/TAG)

95% Ethanol
GREATER THAN OR EQUAL TO 60 droplets/hpf = STEATORRHEA
Amylase determination Aids in the diagnosis of pancreatitis, bowel perforation, or metastasis

TAG testing – chylous effusion

CHOL analysis – pseudochylous effusion
L/S Ratio Uses SPHINGOMYELIN as internal standard
Microviscosity Test Uses ALBUMIN as internal standard

Counting methods

a. Cross-sectional or crenellation technique - white cells are counted in consecutive fields as the blood film is moved from
side to side. Counting should begin in the thin area of the smear where the red blood cells are slightly overlapping and
proceed into the thicker area. However, do not progress too far into the thick area if the white cells are not sufficiently
spread for easy identification.
b. Longitudinal method – white cells are counted in consecutive fields from the tail toward the head of the smear. This is
the ideal method if the smear is thin enough so that the white cells may be identified all the way to the beginning (head)
of the smear. In this case, the strip of smear examined represents one complete section of blood. As many strips as
necessary are counted until the desired number of white blood cells are counted
c. Battlement method – uses a pattern of consecutive fields beginning near the tail on a horizontal edge: count three
consecutive horizontal edge fields (moving away from the tail), count two fields toward the center of the smear, count
two fields horizontally (moving away from the tail), count two fields vertically to the edge. Continue this pattern until the
desired number of cells have been counted.
To clean the lenses, only lens paper should be used. The paper is designed for this purpose and will not scratch the lenses,
which other, more harsh paper or material might do.

The oil must be removed from the oil immersion lens (with lens paper) whenever it is not in use in order to prevent oil seepage
to the inside of the lens.

Most hematology and coagulation procedures must be performed on whole blood of plasma. Therefore, as soon as the blood
is withdrawn from the patient, it is mixed with an anticoagulant to prevent coagulation.

Excessive concentrations of EDTA cause shrinkage of the red blood cells leading to a decreased spun hematocrit, an increased
MCHC, and a falsely low erythrocyte sedimentation rate. The hemoglobin, however, will not be affected.

When a blood smear is prepared from a heparinized specimen and Wright-stained, a blue colored background may be
obtained. This is especially noticeable in the presence of abnormal proteins.

The absolute number of NBT positive neutrophils maybe determined by performing a white count and 100 cell differential on
the test blood. Calculate the absolute number of neutrophils by multiplying the neutrophil percentage of the white count.
Multiply the absolute neutrophil count by the percentage of formazan-containing neutrophils to obtain the absolute NBT
positive neutrophil count.

In chronic granulomatous disease, there is a 0 to negligible reduction of the nitroblue tetrazolium.

An increased concentration of heparin may give false-positive results.

When vascular injury occurs, platelets function in both primary hemostasis (platelet adhesion, secretion, aggregation) and in
secondary hemostasis (coagulation).

Platelet adhesion: When vascular injury occurs platelets come in contact with the subendothelium (collagen, fibronectin) and
adhere to portions of it. This is termed platelet adhesiveness and most likely occurs because of the presence of von Willebrand
factor (vWf) (present in the plasma nd subendothellium) being deposited on the injured tissues. The vWf binds to glycoprotein
sites (Ib and IIb/IIIa complex) on the platelet membrane.

Platelet secretion: following activation, the platelet undergoes a shape change most probably caused by contraction of the
microtubules. The platelet changes from a disk-shape to a spherical shape with the extrusion of numerous pseudopods. At the
same time, the platelet granules move to the center of the platelet and fuse with the open canalicular system connected to
the outside of the platelet. In this way, the contents of the granules (ADP, serotonin, β-thromboglobulin, platelet factor 4,
vWf, platelet-derived growth factor, etc.) are extruded to the outside.

Platelet aggregation: simultaneously with platelet release, platelet stimulating agents (collagen, ADP, ephinephrine, thrombin)
bind to the platelets, causing them to adhere to one another.

Inhibitors of Coagulation

The surfaces of the endothelium and platelet are a major site of coagulation inhibition.

Protein C is a glycoprotein produced in the liver and is the major inhibitor of blood coagulation. Activated protein C is a strong
anticoagulant and degrades factors Va and VIIIa and stimulates fibrinolysis by inactivating plasminogen activator inhibitors.

Protein S is also produced in the liver and serves as a cofactor for protein C. It represents approximately 40% of the total
protein S. The remaining 60% is bound to the complement protein C4 binding protein (C4BP) and is not functionally active.
The ratio of free to bound amounts may shift in disease states such as inflammation when the amount of free protein S
decreases and the concentration of the bound form increases. Only the free protein S serves as a cofactor for protein C.

Antithrombin III is also produced in the liver and is a major inhibitor of thrombin. By itself, it acts very slowly. Heparin binds
to antithrombin III and greatly enhances the rate of activity. Heparan sulfate from blood vessel walls may be the in-vivo source
of heparin for normal enhancement of antithrombin III. This complex also inhibits factors IXa, Xa, XIa, XIIa, kallikrein, and
plasmin, thus inhibiting their activities.

The prothrombin time (PT) is used to evaluate the extrinsic coagulation system, and when abnormal, indicates a defect in that
pathway.

The activated partial thromboplastin time (APTT) is sensitive to factor deficiencies in the intrinsic coagulation pathway. As a
cautionary note, mild deficiencies may have a normal screening test.

If there is a positive history, a normal PT or APTT does not rule out a deficiency. Also, a normal bleeding time may be found in
a mild case of von Willebrand’s disease.

If a factor deficiency is suspected, it is important to perform a test for circulating anticoagulants in order to rule out the
presence of an inhibitor. If this test is negative for an inhibitor, the APTT (or PT) substitution test may then be performed to
identify the exact factor deficiency.

The anticoagulant-to-blood ratio is important in coagulation studies. The tube must be filled to within ±10% of its expected
volume. Greater or lesser amounts of blood will yield incorrect coagulation test results.

For most coagulation procedures, unless noted under specimen requirements, if the specimen will be tested within 2 hours
of collection, it maybe kept at room temperature. If there is to be a delay beyond 2 hours it is advisable to keep the specimen
on ice. Exceptions to this rule are specimens for PT, factor VII assay, and platelet function studies. These specimens should be
maintained at room temperature.

Unless otherwise noted, the coagulation specimen should be centrifuged within 1 hour of obtaining the sample. It is desirable
to complete testing within 2 to 4 hours, depending on the specific procedure.

With the exception of platelet function studies, plasma for coagulation testing should be platelet poor (plasma platelet count
less than 15 000/uL). Centrifugation for 15 minutes at 2500 x g will routinely produce acceptable platelet-poor plasma.

Coagulation Testing

Most coagulation studies are carried out at 37®C. It should be noted that specimens incubated in dry heat take slightly longer
to reach 37®C than those incubated in a water bath. It is essential, when required, that the specimens and reagents reach
proper temperature of 37®C before proceeding with the test. Overheating or prolonged heating at 37®C, however may lead
to destruction of some of the coagulation factors and, therefore, a prolonged clotting time. The temperature of the incubator
should not fluctuate more than ±0.5®C.

The platelet is composed of about 60% protein, 30% lipid, and 8% carbohydrate, various minerals, water, and nucleotides.

The red blood cell membrane is composed of protein (50%), lipid (40%), and a small amount of carbohydrate (10%) and can
be penetrated by most solutes.

Sol-gel zone lies directly beneath the platelet membrane and is composed of microfilaments and microtubules. They provide
a cytoskeleton to maintain platelet shape and a contractile system.
The membranous system is composed of the dense tubular system and the surface connecting system (open canalicular
system). The dense tubular system is derived from the smooth endoplasmic reticulum and sequesters (holds) calcium for
platelet activation processes. It also synthesizes prostaglandin.

The organelle zone is composed of the mitochondria, alpha granules, dense bodies, and a lysosomal type of granule. The
alpha granules are the most numerous and contain a number of substances including platelet factor 4, β-thromboglobulin,
platelet-derived growth factor, thrombospondin, von Willebrand factor, fibrinogen, fibronectin, and factor V. The dense
bodies contain ADP, ATP, calcium, serotonin, and pyrophosphate.

Hypersegmented neutrophils are found in chronic infections. The Barr (sex chromatin) body represents the second X
chromosome in females and maybe seen in 2 to 3% of the neturophils in females. It is a small, well-defined, round projection
of nuclear chromatin that is connected to the nucleus of the neutrophil by a single, fine strand of chromatin. The Barr body
can be differentiated from small, nonspecific nodules of chromatin in that these latter projections are not attached to the
nucleus with as fine a strand of chromatin. The number of Barr bodies in a cell is one less than the number of X chromosomes
present in a cell. These chromatin bodies are not found in normal males.

The thrombin time measures the availability of functional fibrinogen. Prolonged thrombin times are found when the
fibrinogen level is below 75 to 100 mg/dL, when the function of fibrinogen is impaired, and in the presence of heparin,
fibrin(ogen) degradation products, and thrombolytic agents (such as streptokinase).

The thrombin time is a sensitive test in detecting heparin inhibition. It may be normally prolonged in the newborn and in
multiple myeloma (the abnormal globulin interferes with the polymerization of fibrin). The normal range for the thrombin
time, and the ionic strength of the thrombin diluent.

Adsorbed plasma and aged serum reagents are used for qualitative identification of single factor deficiencies. Multiple factor
deficiencies may be identified using 1:1 dilutions of the patient’s plasma and a battery of specific factor deficient plasmas.

The hemoglobin molecule is composed of four subunits, each containing heme and the protein, globin. Every heme group is
capable of carrying 1 mole of oxygen, and therefore each hemoglobin molecule is able to transport 4 moles of oxygen.

The average time the neutrophil spends in the peripheral blood is considered to be about 10 hours. According to this figure,
the neutrophils in the peripheral blood are completely replaced by neutrophils from the bone marrow almost 2.5 times every
24 hours. The neutrophils do not return to the bone marrow once they enter the peripheral blood. They have a lifespan of
about 5 days.

Under normal conditions, the neutrophil will spend 4 to 5 days in the tissues before senescence (growing old) and destruction.

During phagocytosis, a number of metabolic changes takes place: increased glycolysis and lipid synthesis, increased
monophosphate shunt activity, a decrease in pH within the phagosome, and increased oxygen consumption. There is also the
formation of oxidants such as superoxide from oxygen (catalyzed by the enzyme NADPH oxidase) and hydrogen peroxide from
superoxide, all of which are highly active oxygen radicals.

The eosinophil is primarily a tissue cell. Once it is released into the peripheral blood from the bone marrow, it will be randomly
removed from the blood independently of its age. Its half-life in the blood is about 8 hours.

For each eosinophil in the peripheral blood there are 300 to 500 eosinophils in the tissues where their lifespan is probably
several days.

The monocyte and macrophage are actively motile cells which are capable of chemotaxis, are able to move through blood
vessel walls and migrate to the areas of inflammation, and may extend multiple pseudopods. They respond to such substances
as chemotactic inhibitors and MIF (migration inhibition factor), which is produced by the T lymphocytes to immobilize and
restrict the macrophage to areas of inflammation. The monocyte and macrophage are capable of phagocytosis and
pinocytosis, the energy for which is generated by glycolysis. When there are areas of inflammation present in the body, the
production of monocytes is increased and their numbers increase in the peripheral blood.

The lymphocyte is actively motile and during locomotion, has the appearance of a hand mirror. Locomotion occurs as the
lymphocyte crawls over or around other cell surfaces. When moving, the nucleus is at the leading end of the cell with the
cytoplasm trailing behind, appearing as the handle of the mirror. Lymphocytes also extend a trailing uropod studded with
microvilae for attachment to “target” cells.

The B lymphocyte accounts for 10 to 20% of normal blood lymphocytes in the adult. The B lymphocyte migrates from the bone
marrow to the peripheral lymphatic tissues (including the primary follicles and red pulp of the spleen, and follicular and
medullary regions of the lymph nodes.

The T lymphocytes may also assist in regulating both humoral and cellular immune responses. T lymphocytes make up about
60 to 80% of the lymphoid cells in the adult blood lymphocyte pool.

Atypical lymphocytes – virocytes, variant lymphocytes, leukocytoid lymphocytes, reticular lymphocytes, reactive lymphocytes,
transformed lymphocytes and Turk cells.

Each megakaryocyte generally produces between 2000 to 4000 platelets in this manner.

The platelet turnover rate is approximately 35 000 platelets (±4300) per uL each day.

Platelet satellitosis (platelets encircling the peripheral borders of neutrophils) is seen in a rare patient whose blood is
anticoagulated with EDTA. This phenomenon is thought to be due to a serum factor which reacts in the presence of EDTA.

Overanticoagulation of the blood does not affect the hemoglobin results.

Microhematocrit tube: 75 mm long (inner bore: approx. 1.2 mm)

Clay plug: 4 to 6 mm

Volume: 0.05 mL of whole blood

Heparinized (color coded with a red band)

Nonheparinized/plain (color coded with a blue band)

Whole blood using dipotassium ethylenediaminetetraacetic acid (EDTA) as the anticoagulant. (The liquid tripotassium salt of
EDTA is thought to cause a 2 to 3% decrease in the hematocrit due to slight shrinkage of the red blood cells.)

Hematocrit: centrifuge for 5 minutes

Duplicate results should agree within 1 unit (%). If they do not, repeat the procedure.

The hematocrit may be expressed in either two ways: as a percentage, or as a decimal fraction.

When the microhematocrit is spun for the correct time period and at the proper speed, a small amount of plasma still remains
in the red blood cell portion. This is termed trapped plasma and is usually expressed as a percentage of the red blood cell
column. When comparing spun microhematocrit results with hematocrit results obtained on an electronic cell counter, the
spun hematocrit results may vary from 1 to 3% higher because of this trapped plasma.

Increased amount of trapped plasma is found in macrocytic anemias, spherocytosis, thalassemia, hypochromic anemias, and
sickle cell anemia.

A white blood cell count above 11.0 x 109/L is termed leukocytosis; a white count below normal is known as leukopenia

The hemocytometer with Neubauer ruling consists of two identically ruled platforms with a raised ridge on both sides of the
two platforms on which a cover glass is placed. The space between the top of the platform and the cover glass is 0.1 mm.

Each of the two platforms contains a ruled area composed of nine large squares of equal size. Each large square is 1 mm wide
and 1 mm long. Therefore, the entire ruled area is 9 square mm (mm2) (3 mm wide and 3 mm long).

The volume of the entire ruled are on one platform is 0.9 uL (width x length x depth, or, 3 mm x 3 mm x 0.1 mm). The volume
of one large square is 0.1 uL.

The four large corner squares, each of which is subdivided into 16 smaller squares, are labelled “W” and are the four squares
used in counting white blood cells.

Clean the counting chamber and cover glass with a lint free cloth. The use of 95% (v/v) ethanol also facilitates the cleaning
process. Carefully place the cover glass on top of the ruled area of the counting chamber.

When the counting chamber is filled, care should be taken that it is not jarred or the cover glass moved. The filled counting
chamber should be allowed to stand for approximately 1 minute prior to performing the count to give the white blood cells
time to settle.

Using the low power (10x) objective, make certain the microscope light is adjusted correctly. In proper focus, the white blood
cells should look like small dark or black dots.

For manual white blood cell count, the total number of cells counted on each side of the counting chamber should agree
within 10% of each other. If counts do not agree the procedure should be repeated.

There is an approximate 15% error for a manual WBC that falls within the normal range. It is advisable to count at least 100
WBC on each side of the counting chamber. Generally, the more cells counted, the lower the percentage of error.

The range of error for a manual RBC is generally about 10 to 20%.

There are three types of blood smear:

1. The buffy coat smear is for use on patient specimens when the patient’s white blood cell count is less than 1.0 x 109/L and
it is desirable to perform a 100-cell differential. This procedure concentrates the nucleated cells present in the blood
2. Thick blood smears are commonly used when specifically looking for blood parasites such as malaria
3.
Smears using blood anticoagulated with EDTA should be made within 2 to 3 hours of collection.

As soon as the drop of blood is placed on the cover glass, the two cover glasses should be brought together without delay.
If the drop of blood sits for longer than 3 to 5 seconds, clumping of the platelets and the white blood cells, and rouleaux
formation of the red blood cells occur.

Carefully place a small drop of blood in the middle of the slide, approximately 1 cm from the labeled end.
There should be an approximate 30 to 40® angle between the two slides.
Flow cytometry was originally designed to measure physical properties of cells based on their ability to deflect light. Over the
years, it has evolved to include detection of fluorescent signals emitted by dyes bound directly to specific molecules or attached
to proteins through monoclonal antibodies. The development of monoclonal antibodies is the most significant factor
contributing to today’s broad application of flow cytometry. Although the term flow cytometry implies the measurement of a
cell, this technique is applied successfully to study other particles, including chromosomes, microorganisms, and proteins. The
main advantage of flow cytometry over other techniques is its ability to rapidly and simultaneously analyze multiple parameters
in a large number of cells. When one adds the capability of identifying and quantifying rare-event cells in a heterogeneous cell
population, the value of flow cytometry to clinical hematology becomes obvious

Flow cytometric analysis is particularly useful in diagnosing hematologic malignancies. The specimens most commonly analyzed
are bone marrow, peripheral blood, and lymphoid tissues. In addition, immunophenotyping is often performed on body cavity
fluids and solid tissues when they are suspected to harbor a hematologic malignancy. Prolonged transport or transport under
inappropriate conditions may render a specimen unsuitable for analysis. Peripheral blood and bone marrow specimens should
be processed within 24 to 48 hours from the time of collection.