PREPARED BY: LUDWIG JEAN G.

PACIA GLORFINDEL NOTES

Clinical Chemistry Recalls

1. Which is NOT a positive acute phase reactant
1. Albumin
2. Transferrin
3. Fibrinogen
A. 1,2
B.1,2, 3
C. 3 only
D. 2,3
Positive Acute Phase Reactant Negative Acute Phase Reactant
• Fibrinogen: Important in coagulation • Albumin: Maintain oncotic pressure
• Haptoglobin: binds free hemoglobin • Prealbumin: Nutritional and CSF marker
• Alpha1- antichymotrypsin: Bind and inactivates PSA • Transferrin: responsible for ferric ion delivery
• CRP – scavenger molecule and act like as non-specific antibody
• Serum amyloid – remove cholesterol
• Ceruloplasmin – act as ferroxidase

2. What are the electrolytes involved in myocardial rhythm and contractility?

1. Potassium
2. Magnesium
3. Calcium
4. Sodium
A. 1,2
B.1,3,4
C.1,2,3
D.2,3,4

Volume and osmotic regulation Sodium, Potassium, Chloride, Bicarbonate

ATpase Ion pump Magnesium
Production and use of ATP from Glucose Magnesium, P04
Acid-base balance Bicarbonate, Chloride, and Potassium
Replication of DNA and translation of mRNA Magnesium

3. Autosomal recessive disorder involving mutations in the MTTP gene with absolute nonexistent levels of apo-B
lipoprotein.
A. Bassen-kornzweig syndrome
B. LPL Deficiency
C. Crigler- Najjar syndrome
D. Tangier disease

• Defective/ nonexistent apo B lipoprotein

Bassen-kornzweig syndrome • Autosomal recessive disorder
• Deficient fat-soluble vitamins (ADEK)

Tangier’s Disease • Deficiency of HDL (1-2mg/dl)

• Defect in the gene for the ABCA1 transporter
LPL Deficiency (Chylomicronemia) • TAG level 10,000 mg/dl
• Do not develop premature coronary disease
LCAT deficiency • Fish eye disease

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• Low HDL

4. Which is NOT an immunosuppressive drug?

A. Cyclosporine
B. Rapamycin
C. Tacrolimus
D. Carbazepine

Immunosuppressant drugs • Cyclosporine

Chemotherapeutic drugs
Analgesic Drugs/Anti-inflammatory
Psychoactive drugs Li Lithium – Tx for Bipolar Disorder (Manic depression)
Antiepileptic drugs
• Tacrolimus
• Rapamycin (Sirolimus)
• Lefuamide
• Mycophenolate
• Busulfan
• Methotrexate
• Salicylates/Aspirin (Acetylsalicylic acid) – Antiplatelet
• Acetaminophen (Tylenol) – Hepatoxic
• Ibuprofen – safest
• Fluoxetine (Prozac)Tricyclic antidepressant (TCA)
• Phenobarbital
• Phenytoin
• Valproic Acid – Tx petit mal and grand mal
• Carbamazepine – Tx grand mal
• Ethosuximide – Drug of Choice for petit mal seizure

5. ALP Highest in what disorder

A. Liver
B. Bone
C. Heart
D. Brain

Liver Disease • Hepatobiliary (5x) and Hepatocellular (3-10x elevation)

Bone disease • Paget disease (osteitis deformans) Highest Elevation
• Osteomalacia, Rickets, Hyperparathyroidism and Osteogenic sarcoma

6. Which should not be stored together with oxidizers

A. Flammables
B. Combustibles
C. Acids
D. Agar

7. Which fire extinguisher is used for fires caused by gasoline, paint, liquid chemicals?
A. Class A
B. Class B
C. Class C
D. Class D
Classification of Fire
CLASS A Ordinary Combustible Water (A), Dry Chemical (ABC), Loaded steam
CLASS B Flammable Liquids Dry Chemical (ABC), CO2 (BC), Halon (BC)
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CLASS C Electrical equipment Dry Chemical (ABC), CO2 (BC), Halon (BC)
CLASS D Flammable Metals Metal X, Sand
CLASS E Arsenal Fire (Detonation) Allow to Burnout and nearby materials protected
CLASS K Cooking Media

8. What can employee consult about the handling of the chemicals in the Laboratory
A. MSDS
B. SOP
C. Supervisor

Material Safety Data Sheet Standard Operation Procedure

• Flash Point – The lowest temperature at which a liquid • set of step-by-step instructions compiled by an
produces enough vapor to form an ignitable mixture. organization to help workers carry out routine
Liquids with low flash points pose the greatest danger. operations. SOPs aim to achieve efficiency, quality
• Ignition Source – Any process or event capable of causing output and uniformity of performance
a fire or explosion. Open flames, sparks, static electricity, • Procedures are extensively employed to assist with
and hot surfaces are all possible ignition sources. working safely.
• Flammable: ANY substance easily ignited and quick
burning, including liquids with a flash point below 95
degrees Fahrenheit.
• Toxic: ANY substance able to cause harm/produce injury
to the body through absorption, ingestion, inhalation, or
injection.
• Fire Fighting Measures
• General safety precautions

9. What is a buffer?
A. Weak base + Weak acid
B. Strong base + Strong Acid
C. Strong Base + Weak Acid
D. Weak Base + Strong Acid

Buffer
• Solution that can resist pH change
• Composed of weak acid or weak base that pair with conjugate
partner

10. Converts mg/dL to mmol/L by multiplying 0.02586.

a. Phospholipid
b. Triglyceride
c. Cholesterol
d. Glucose
Analytes Conventional to SI units Conversion factor
1. Albumin, Total protein g/dL to g/L 10
2. Ammonia ug/dL to umol/L 0.587
3. Bicarbonate mEq/L to mmol/L 1.0
4. Bilirubin mg/dL to umol/L 17.1
5. BUN mg/dL to mmol/L 0.357
6. Calcium mg/dL to mmol/L 0.25
7. Cl, Na, K, Lithium mEq/L to mmol/L 1.0
8. Cholesterol mg/dL to mmol/L 0.026
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9. Creatinine mg/dL to umol/L 88.4

10. Glucose mg/dL to mmol/L 0.0555
11. Iron mg/dL to umol/L 0.179
12. Mg mEq/dL to mmol/L 0.5
13. Phospholipid g/dl to g/L 0.01
14. Phosphorus mg/dL to mmol/L 0.323
15. Thyroxine (T4) ug/dL to nmol/L 12.9
16. Triglyceride mg/dL to mmol/L 0.0113
17. Uric acid mg/dL to mmol/L 0.0595

11. What is not a cortical hormone?

A. Aldosterone
B. Cortisol
C. 17-OCHS
D. Epinephrine/Norepinephrine

Adrenal Cortex Adrenal Medulla

• Aldosterone (Zone of Glomerulosa) • Dopamine
• Cortisol (Zone of Fasciculata) • Epinephrine
• Androstenedione and DHEA (Zone of Reticularis) • Norepinephrine

12. Tube used for collection of ACTH?

A. Pre-chilled
B. Room temp
C. Pre-warmed
D. Cover with Foil

Photosensitive Analytes Pre-chilled (Low temperature)

• Bilirubin • Ammonia
• Beta-carotene • Blood gases
• Folate • Catecholamines
• Porphyrins • Gastrin
• Vitamins A and B6 • Lactic acid
• Vancomycin (Cover with Carbon Paper) • Renin
• PTH
• Pyruvate
• ACTH (EDTA)

13. What is the preferred specimen for ammonia?

A. Venous
B. Arterial
C. Capillary

14. Which of the following use to measure the extent of Enzyme activity?
A. Endpoint
B. Kinetic
C. Both
D. Neither
Kinetic Endpoint
• Multiple reading during the process of the • One time Reading
reaction • 5-15 minutes reaction
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• 20 seconds to 1 minute reaction • Measure the total amount of analytes that

• Measure the difference in absorbance between participate in reaction
multiple reaction during the process.

15. What is the end product of Protein metabolism?

A. Urea
B. Uric Acid
C. Creatinine
D. Amino Acids

Blood Urea Nitrogen – It is the major end product of protein and amino acid catabolism
Uric acid - Major product of purine (Adenine and Guanine) catabolism.
Creatinine – The end product of muscle metabolism derived from creatine and also produce by methionine arginine
and lysine (MAL)
Ammonia – Product from the deamination of amino acids

16. In what occasion is there a mild increase in prolactin?

I. Stress
II. Breast examination
III. Exercise
A. I and II
B. II and III
C. I and III
D. I, II and III

17. Of the total serum osmolality, sodium, chloride, and bicarbonate ions normally contribute approximately what
percent?
a. 92
b. 45
c. 75

18. Convert 600 mg/dl Protein to g/L

A. 3
B. 10
C. 6
D. 60

19. Electrolytes used in APPROXIMATE Anion Gap

1. Na
2. Cl
3. Bicarbonate
4. K
A.1,2
B. 1,3,4
C.1,2,3
D.1,2,3,4
Formula of Anion Gap
Formula 1: Na – (Cl +HCO3) = Hypernatremia and Serum Osmolality

Formula 2: (Na + K) – (Cl + HCO3) = Acid - Base Balance and Hyperkalemi

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20. Measurement of is necessary to evaluate the cause of hypernatremia.

a. Urine osmolality
b. Plasma/serum osmolality
c. Anion gap
d. All of the above

Urine osmolality – Increase Serum Na+ and Decrease Urine Osmolality

Plasma/Serum Osmolality – Increase Serum/Plasma Na+ and Increase P/S Osmolality
Anion Gap – Increase Serum Na+ and Increase Anion Gap

21. Which protein is quantified by standard(serum) protein electrophoresis?

I. Fibrinogen
II. Transferrin
III. C3
a. I. II, III
b. I and II
c. II and III
d. I and III

22. Triglyceride and cholesterol levels in hyperthyroidism:

a. Low
b. High
c. Variable
d. Normal

Hyperthyroidism Hypothyroidism

• Heat intolerance • Cold Intolerance

• Low Cholesterol/Triglycerides • High Cholesterol/Triglycerides
• Weight Loss • Weight Gain
• Prominence of eyes • Dry skin
• Warm, moist, flushed, smooth skin

23. . Obstruction can be caused by stones, an enlarged prostate gland, or tumors.

a. pre-renal
b. Renal
c. post-Renal
Pre-Renal • Hypovolemic
• Congenital Heart disease
• Interruption of blood to kidney from severe injury or disease
Renal • Direct damage to the kidney by the inflammations, toxins, drugs and infection
Post-Renal • Sudden obstruction of urine flow due to enlarged prostate, kidney stone, bladder tumor or
injury

24. Which primarily involved in water regulation?

a. Bicarbonate
b. Potassium
c. Sodium
d. Chloride

25. If the ratio of bicarbonate to carbonic acid is 30:1, what would be the blood pH?
a. Increased
b. Decreased
c. Stable

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d. Normal
Microbiology/Parasitology Recalls
1) Which protozoan is NOT transmitted via sexual intercourse?
A. G lamblia
B. T. vaginalis
C. B. coli
D. E. histolytica

Sexually Transmitted Parasite

• G. lambia
• T. vaginalis
• E. histolytica
• Sarcoptes scabiei
• Pthirus pubis (Pubic Louse)

2) In Thioglycollate broth medium, where do you find obligate aerobe?

A. Middle of the tube
B. At the bottom of the tube
C. At the top of the tube
D. Evenly spread in the tube

Top of the tube Obligate aerobes

Bottom of the tubes Obligate anaerobes
Flocculation Gram positive cocci
Growth distributed throughout the tube Facultative anaerobic

3) Which of the following microorganisms exhibit a mushroom-like odor?

A. P. multocida
B. H. influenza
C. S. aureus
D. P. aeruginosa

4) Which of the following microorganisms exhibit a burnt chocolate like odor?

A. Proteus spp
B. E. corrrodens
C. C. difficille
D. Serratia odorifera

Bacteria Odor Characteristic

P. multocida Mushroom-like odor

H. influenza Mousy odor

S. aureus Old-socks
P. aeruginosa Fruity, grape like, corn tortilla-like odor

Proteus spp Burnt chocolate or Burnt gun powder

Serratia odorifera Rancid, potato-like odor

C. difficille Horse manure

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E. corrrodens Bleach-like odor

5) What type of specimen where trophozoites and cyst can be found?

A. Watery
B. Soft
C. Formed
D. Any consistency

Types of Specimens Duration of Integrity Parasite Detected

Liquid or Watery 30 minutes Trophozoite

Semisolid/Soft 1 hour Cyst and Trophozoite

Solid/Formed 24 hours Cysts
Remember: Helminth egg and larvae- can be seen in any type of specimen
6) Which of the following parasites causes cholangiocarcinoma?
A. Fasciola
B. Clonorchis
C. Echinococcus
D. Paragonimus
Parasite Disease Associated
Fasciola hepatica Sheep Liver Rot
Clonorchis sinensis and Opisthorchis Cholangiocarcinoma
Echinococcus Granulosus Hydatid disease
Paragonimus Westermani Endemic Hemoptysis

7) Acid fast, non-spore forming gram positive bacilli that is niacin and nitrate positive.
A. M. tuberculosis
B. M. fortuitum
C. M. intracellulare
D. M. bovis
Biochemical Test Positive Negative
Niacin M. Tuberculosis M. intracellulare
Nitrate M. tuberculosis M. intracellulare
TCH (thiophene-2 carboxylic acid M. bovis M. tuberculosis
Hydrazide)
68°C Catalase M. fortuitum or M. M. tuberculosis
gordonae

8) Person least responsible for interpreting Zone of inhibition in diffusion disks?

A. Chief MedTech
B. Physician
C. Nurse
D. Medical Technologist Intern

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9) What is the best protection against serious aerosol droplet infection?

A. Well fit mask and goggles
B. Adequate handwashing
C. N95mask
D. Laboratory Coat

10) Which of the following specimen is recommended for the detection of B. pertussis?
A. Oropharyngeal swab
B. Nasopharyngeal swab
C. Throat swab
D. Anal swab

Nasopharyngeal Swab
a. B. pertussis
b. H. influenza,
c. N. meningitidis
d. MRSA

11. Which parasite exhibit biological rhythms?

1. Bancroft filarial worm
2. Malayan filarial worm
3. Blinding worm
4. Eye worm
A. 1, 2 and 3
B. 1 and 2
C. 1,2 and 4
D. 2 and 4

Filarial Worms Periodicity

Eye worm Diurnal
Blinding worm Nonperiodic
Bancroft filarial worm Nocturnal
Malayan filarial worm Nocturnal Sub periodic

12. Prevention of Lyme disease

A. Avoid Exposure to tick
B. Fogging
C. Insecticide Spray
D. Vaccination

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13. Malarial species that has cresent/sausage gametocyte

A. P. falciparum
B. P. vivax
C. P. knowlesi
D. P. ovale

P. falciparum P. vivax P. ovale P. malariae

Paroxysms 36 hours 48 hours 48 hours 72 hours

RBC Infects all age of RBC Young RBC Fimbriated RBC Invades old RBC
(Enlarged)
Trophozoite Ring Ameboid Ameboid Band
Gametocyte Cresent/Sausage/Banana Shaped Round Similar to vivax but Ovoid
smaller
Morphological Maurers Dot Schuffner’s dots James’s dot Ziemann’s dots
Features
Hypnozoite Absent Present Present Absent

14. This medium is for anaerobe organism

A. Thioglycollate
B. BAP
C. MAC
D. Stuart Medium

15. What is the negative control for Taxo A (Bacitracin)?

A. Group A Strep
B. Group B Strep
C. Group C Strep
D. Group D. Strep
Positive Control Negative Control
Taxo A (Bacitracin) Streptococcus pyogenes Streptococcus agalactiae
Taxo P (Optochin) Streptococcus pneumoniae Streptococcus mitis

16. It is carried and spread and by mosquitoes in the genus Aedes, except:
A. Malaria
B. Dengue Fever Virus
C. Chikungunya Virus
D. Zika Virus

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17. The filariform larva is the infective stage for:

A. Ascaris lumbricoides, Trichostrongylus spp.
B. Ascaris lumbricoides, Strongyloides stercoralis
C. Ancyclostoma duodenale, Strongyloides stercoralis
D. Trichuris trichiura, Necator americanus
Parasite Infective Stage
T. vaginalis Trophozoite
Plasmodium Sporozoite
Trypanosoma Trypomastigote
Leishmania Promastigote
H. nana, A. lumbricoides, T. trichiura, E. vermicularis Embryonated Egg
T. spiralis, C. philippinensis Larva
Hookworm S. stercoralis Filariform
Schistosoma Cercaria
All Fluke worms except Schistosoma Metacercaria
T. saginata Cysticercus bovis
T. solium Cysticercus cellulosae
Egg (Neurocysticercosis)
D. latum Plerocercoid larva
H. diminuta, D. caninum Cysticercoid larva

18. The mode of transmission of schistosomal infection is by:

A. Ingestion of contaminated aquatic vegetation
B. Direct penetration of the skin by cercariae
C. Ingestion of raw fish
D. Mosquito bite

19. What test that identifies the presence of drug resistant TB?
A. Microscopy
B. DNA-based
C. Culture
D. Serology

20. An anaerobically incubated blood agar plate shows colonies surrounded by an inner zone of complete red cell lysis
and an outer zone of incomplete cell lysis (double zone of hemolysis). The most likely presumptive identification
of this isolate would be:
A. Clostridium perfringens
B. Clostridium tetani
C. Fusobacterium nucleatum
D. Prevotella melaninogenica

Clostridium perfringens Clostridium tetani Fusobacterium nucleatum Prevotella

melaninogenica
BAP Double Zone of Hemolysis Beta hemolysis Nonhemolytic Nonhemolytic

21. Plasmodium vivax and Plasmodium ovale are similar because they:
A. Exhibit Schuffner’s dots and have a true relapse in the life cycle
B. Have no malarial pigment and multiple rings
C. Commonly have applique forms in the red blood cells
D. Have true stippling, do not have relapse stage, and infect old red cells
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22. Which of the following is being described?

Motility negative
Nitrate negative
No growth on BAP
A. B. pertusis
B. B. parapertusis
C. B. bronchiseptica
D. B. thermophilus

Urease Motility Nitrate MAC Oxidase BAP

B. pertussis - - - - + -
B. parapertusis + - - +/- - +
B. bronchiseptica + + + + + +

23. Vibrio spp. can be isolated best from feces on:

A. EMB
B. SSA
C. HE
D. TCBS

24. Which is an activity during the pre-analytical phase of Parasitology testing?

A. Correct patient identification
B. Use of controls
C. Standardized reporting of parasite concentration
D. Ensure proper storage of reagents and stains being used

Preanalytical Analytical Post analytical

Specimen Collection Quality Control Recording
Specimen Handling Instrumentation Reporting
Patient Preparation Biosafety Turnaround time

25. Chain of infection requires a continuous link between Source, Method of Transmission and ______.
A. Mode of Exit
B. Susceptible host
C. Mode of Entry
D. Reservoir

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Clinical Microscopy Recalls

1. Why is the first-voided morning urine specimen the most desirable specimen for routine urinalysis?
A. Most dilute specimen of the day and therefore any chemical compounds present will not exceed the detectability
limits of the reagent strips
B. Least likely to be contaminated with microorganisms because the bladder is a sterile environment
C. Most likely to contain protein because the patient has been in the orthostatic position during the night
D. Most concentrated specimen of the day and therefore it is more likely that abnormalities will be detected

2. Conventional protein reagent pads have a sensitivity of ______mg/dL or greater and may include proteins other
than albumin.
A. 10
B. 30
C. 100
D. 300

Grading Quantity of Albumin

Trace <30
1+ 30mg/dl
2+ 100mg/dl
3+ 300mg/dl
4+ 2000mg/dl

3. Preferred for crystal identification:

A. First-Morning urine
B. Random
C. 4 hour
D. Catheterized

Specimen Type Purpose

First-Morning Urine Routine Urinalysis, Pregnancy, Crystal Identification
Second Morning Glucose Monitoring, Orthostatic Proteinuria
4-hour urine Nitrate
12 hours urine specimen Ideal specimen for screening microalbuminuria
Afternoon urine (2pm-4pm) Urobilinogen
Suprapubic aspiration Urine Cytology and Anaerobic culture
Wee bag Pediatric urine specimen

4. Predominant WBC in CSF:

A. Neutrophils
B. Lymphocytes
C. Monocytes
D. Macrophages

CSF WBC Percentage

Neutrophil 0-6%
Monocytes 15-45%
Lymphocytes 40-80%
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5. Cloudy CSF:
A. 1:20
B. 1:100
C. 1:200
D. 1:10,000
Clarity/Appearance Dilution Amount of Sample Amount of Diluent
Slightly Hazy 1:10 30 μL 270 μL
Hazy 1:20 30 μL 570 μL
Slightly Cloudy 1:100 30 μL 2970 μL
Cloudy/Slightly Bloody 1:200 30 μL 5970 μL
Bloody/Turbid 1:10,000 0.1 mL of 1:100 dilution 9.9 mL

6. As familiarized with the microscope which part focuses the light on the specimen and controls the light for
uniform illumination?
A. Condenser
B. Diaphragm
C. Ocular
D. Rheostat
Microscope Part Function
Diopter Rings Adjust for focusing difference between eyes
Objectives Lenses which form primary (initial) image of specimen
Diaphragm Controls/regulates the diameter of light beams that strike the
specimen and hence reduces stray light.
Eyepiece It produces the secondary image magnification of the specimen.
Condenser It gathers and focuses the illumination light onto the specimen for
viewing
Stage Holds the Specimen
Revolving nosepiece Use to rotate objectives
Rheostat It alters the current applied to the lamp to control the intensity of
the light produced condenser

7. Which of the following may exhibit maltese cross formation in polarizing microscopy?
A. Hemothorax
B. Hemorrhagic effusion
C. Chylous effusion
D. Pseudochylous effusion
CHYLOUS EFFUSION PSEUDOCHYLOUS EFFUSION
Cause Thoracic duct leakage Chronic inflammation
Appearance Milky / white Milky / green tinge / gold paint
Leukocytes Increase lymphocyte Mixed cells
Cholesterol crystals _Absent Present
Triglycerides >110 mg/d <50 mg/dl
Sudan III staining +++ Negative or weakly +
Onset Sudden Gradual
Chylomicrons Present Absent

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8. Watery semen graded as what

A. 0
B. 1
C. 4
D. 3

9. In cases of acute tubular necrosis there is a dirty brown cast, what is the component that give dirty brown
appearance?
A. Methemoglobin
B. Bilirubin
C. Urobilinogen
D. Protein
GRANULAR DIRTY BROWN CAST -representing hemoglobin degradation products such as
methemoglobin are associated with the ACUTE TUBULAR NECROSIS often caused by the toxic
effects of massive hemoglobinuria that can lead to renal failure

10. The result of urinalysis cloudy acidic, Positive Protein, 100 RBC/hpf, , Positive Blood, Positive Nitrate, Many
Bacteria and 0-2 WBC/hpf. What is the most Positive Leukocyte esterase probable error?
A. Analytical error
B. Centrifugation Error
C. Pre analytical error
D. Post analytical error

11. What is the Positive color for Ictotest?

A. Blue
B. Violet
C. Red
D. Green
Purpose/Analyte Positive Reaction
Benedict Test Reducing substances Brick Red
Seliwanoffs Fructose Orange or Red
Gmelin Bile Pigment Play of Colors
Ictotest Bilirubin Blue to Purple
Wallace and Diamond Urobilinogen Cherry Red
Acetest/Ketostix Acetone Purple Color
Biuret Protein Violet
Rubners Lactose and Glucose Lactose (Brick Red w/ red ppt.)
Glucose (Red color w/ yellow ppt.)

12. Which of the following below describe the Cloudy Urine?

A. No visible particulates
B. Few particulates
C. Many particulates
D. Particulate cannot be seen
Clarity Term
Clear No visible particulates, transparent
Hazy Few particulates, print easily seen through urine
Cloudy Many particulates, print blurred through urine
Turbid Print cannot be seen through urine

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Milky May precipitate or be clotted

13. What is the cause of odorless urine?

A. ATN
B. PKU
C. Fresh Urine
D. Lesch-Nyhan Syndrome

Odor Cause
Aromatic Normal Urine

Odorless Acute tubular necrosis (acute renal failure)

Fruity, sweet Ketones (Diabetes Mellitus, starvation, vomiting)
Curry, Caramel, Maple Syrup MSUD
Rotting Fish Trimethylaminuria
Mousy PKU
Rancid Butter Tyrosinemia

14. What is the positive color for Nitrite?

A. Green
B. Pink
C. Blue
D. Red

Reading Time Urine Parameter Principle Positive Color

Glucose Double sequential enzyme reaction Green or Brown (Potassium
30 secs Iodide)
Bilirubin Diazo Reaction Tan or pink to violet
40 secs Ketones Sodium nitroprusside reaction Purple
45 secs Specific Gravity pKA change of a polyelectrolyte Blue (1.000) to Yellow (1.030)
Blood Pseudoperoxidase activity of HGB Uniform green/blue (Hgb/Mb)
Speckled/spotted (intact RBCs)
60 secs pH Double Indicator System Orange (pH 5.0) to blue (pH 9.0)
Protein Protein error of indicators Blue
Urobilinogen Ehrlich Reaction Red
Nitrite Greiss Reaction Uniform pink
120 secs Leukocytes Leukocyte’s esterase Purple

15. Which of the following are used in Cockgroft and Gault eGFR?
I. Serum creatinine
II. Urine creatinine
III. Age
IV. BUN
A. I and IV
B. I and III
C. I, II and IV
D. I, II, III and IV

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eGFR Variables Formula

Cockgroft and Body wt, Age, Sex Body wt, Age, Sex, Serum Creatinine
Gault
MDRD 4 variables = Serum creatinine, ethnicity,
Age, Sex (SEAS)

6-variables = BUN, Age, Sex, Ethnicity,

Serum creatinine, and serum albumin

16. Which of the following cells is ALWAYS significant when seen in CSF?
A. Lymphocytes
B. Monocytes
C. Choroidal cells
D. Neutrophils

Type of Cell Major Clinical Significance

Lymphocytes and • Normal
Monocytes • Viral, tubercular and fungal meningitis
• Multiple Sclerosis
Neutrophil • Bacterial Meningitis
• Early cases of Viral and Fungal meningitis
Macrophages • RBC in spinal contrast media

Ependymal, Choroidal, • Diagnostic procedure

Spindle Cells
Plasma Cells • Multiple Sclerosis
• Lymphocyte Reactions

17. Major contributor to urine osmolality

A. Urea and Creatinine
B. Protein and Glucose
C. Sodium and Chloride
D. Sodium and Potassium

Serum Osmolality Contributor Urine Osmolality Contributor

• 90-95% Sodium, Chloride and Bicarbonate • 60-70% Urea and Creatine
• 5-10% Glucose, Protein Urea and Creatinine • 30-40% Sodium, Chloride, and Potassium

18. All of the following statements are true regarding seminal fluid fructose, except:
A. Low sperm concentration may be caused by lack of support medium produced in the seminal vesicles, which
can be indicated by a low to absent fructose level
B. Low fructose levels are caused by abnormalities of the seminal vesicles, bilateral congenital absence of the vas
deferens, obstruction of the ejaculatory duct, partial retrograde ejaculation, and androgen deficiency
C. Specimens can be screened for the presence of fructose using resorcinol test that produces an orange color
when fructose is present

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D. Specimens for fructose levels should be tested within 2 hours of collection or incubated at 37C to prevent
fructolysis
19. It preserves epinephrine well:
A. Boric Acid
B. Thymol
C. Concentrated HCL
D. Phenol

Preservative Important Description

Refrigeration (up to 24 hours) • Most common and easiest
• Can be used for microbiological studies
• PRECIPITATES AMORPHOUS CRYSTALS
Toluene and Phenol • Does not interfere with routine test
Formalin • Excellent sediment preservative
• Fixative for Addis counting
Yellow plain UA • For automated instrument
Boric acid • Culture and sensitivity
• Protein testing
Saccomano (preferred) • Urine Cytology (50ml urine)
Concentrated HCL • Catecholamines

20. Which type of microscopy is able to produce three-dimensional images and perform optical sectioning?
A. Brightfield
B. Phase contrast
C. Interference contrast
D. Polarizing

Microscope Technique Purpose

Bright Field microscope
Phase contrast
Polarizing
Dark field
Fluorescence
Interference-contrast microscopy
a) Normaski (Differential)
b) Hoffman (Modulation)
Used for routine urinalysis
Enhances visualization of elements with low refractive indices, such as hyaline casts,
mixed cellular casts, mucous threads, and Trichomonas
Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystal
Aids in identification of spirochetes such as Treponema pallidum
Allows visualization of naturally fluorescent microorganisms or those stained by a
fluorescent dye
Three-dimensional microscopy-image & layer-by-layer imaging of a specimen

21. What is the reagent of split fat stain?

A. 36% acetic acid and Sudan III
B. 10% Eosin + Sudan III
C. NaOH + Sudan III
D. 95% Ethanol and Sudan III\

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Fecal Test Reagent Purpose

Neutral Fat Stain
Split Fat Stain
Creatorrhea stain
FOBT
95% Ethanol and Sudan III
36% acetic acid and Sudan III
10% Eosin
Guiac (Preferred)
Benzidine (Most sensitive)
O-toluidine
Qualitative Fecal Fat Determination
(Neutral Fats/ Triglycerides)
Qualitative Fecal Fat Determination
(Fatty Acids)
Undigested Muscle Fibers
Screening for Colorectal Cancer

22. What reagent is affected in unmixed urine sample?

A. Glucose
B. Red blood cells
C. Leukocyte esterase
D. Urobilinogen

23. How you will differentiate Acute Interstitial Nephritis to Acute pyelonephritis?
A. RTE cast
B. Bacterial cast
C. WBC cast
D. Red blood cell cast

Disorder Description Microscope Findings

Glomerulonephritis Inflammation of the glomerulus and Immune- RBCs, RBC CASTS, Dysmorphic
mediated RBC, hyaline and granular casts,
Proteinuria
Pyelonephritis Infection of renal tubules WBCs, bacterial cast, WBC CASTS,
hyaline and granular casts
Acute Interstitial Allergic Inflammation of the renal interstitium WBCs (Eosinophil), WBC casts, NO
Nephritis BACTERIA,
Nephrotic syndrome Massive proteinuria and lipiduria Oval fat bodies, fatty and waxy casts
Cystitis Infection of urinary bladder WBCs, bacteria, NO CAST
Acute Tubular Necrosis Damage to renal tubules caused by ischemia or RTE cells, RTE casts, hyaline,
toxic agents granular, waxy and broad cast

24. Florence test is a preliminary screening method that has been largely replaced by the far more dependable ACP
determinations. It is usually performed on stains from clothing, other fabric, or hair and depends on the presence of
choline, which found in high concentrations in seminal fluid. What is the reagent for this test?
A. Eosin, Nigrosin
B. Picric acid, TCA
C. Iodine, KI
D. Acetic Acid

Semen analysis Reagents Purpose

Papanicolaou’s Stain Papanicolaou’s Stain Morphology
Modified Bloom Test Eosin and Nigrossin Sperm Viability
Seliwanoffs Resorcinol Seminal Fructose

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Florence Test (Nonspecific) Iodine crystals and Potassium Iodide Choline (Medico Legal)
Barbiero’s Test (Very Specific) Picric Acid and TCA Spermine (Medico Legal)

25. During drug specimen collection, urine temperature must be taken within _______ from the time of collection.
A. 4 minutes
B. 8 minutes
C. 30 minutes
D. 1 hour

Drug Specimen Collection

Chain of Custody Process that provides documentation of proper
sample identification from the time of collection to
the receipt of laboratory results
30-45 mL Required Volume
32.5 – 37.7°C Temperature (Checked within 4 minutes)
60 mL Container Capacity
Bluing Agent Added to the toilet water reservoir to prevent
specimen adulteration

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Hematology Recalls

1. What is the level of fibrinogen in Hemophilia A, B and C respectively?

A. Increase, Decrease, Increase
B. Increase, Increase, Normal
C. Decrease, Normal, Increase
D. Normal, Normal, Normal

Hemophilia A Hemophilia B Hemophilia C

Fibrinogen Normal Normal Normal
Factor VIII Decrease/Absent Normal Normal
Factor IX Normal Decrease/Absent Normal
Factor XI Normal Normal Decrease/Absent

2. What disorder manifest Giant Platelet?

A. BSS
B. VwD
C. Glanzmann Thrombasthenia
D. WAS

Platelet Disorder Platelet Morphology Pathophysiology

Glanzmann Thrombasthenia Normal
BSS Large Platelet with cytoplasmic
vacuoles and membrane complexes
WAS Number of dense granules is
decreased, and the platelets are
small (microthrombocytes)
VwD Normal
Defective in GP IIb/IIIa
Defective in GP Ib/IX/V complex
Mutations in the WAS gene on the
short arm of the X chromosome
Defective/Absent of von
Willebrand Factor

3. What is the mechanism called in protoplatelet of megakaryocytes?

A. Proliferation
B. Mitosis
C. Shedding
D. Maturation

Mitosis Process of cell duplication, in which one cell divides into two
genetically identical daughter cells.
Proliferation Rapid and repeated production/multiplication of new cells
Maturation The final differentiation processes in biological systems, such as
the final ripening of a seed or the attainment of full functional
capacity by a cell, a tissue, or an organ.
Shedding Phase of thrombopoiesis where there is a release of proplatelet
packages

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4. The patient is normocytic anemia. What test should be next to performed

A. Indices
B. Absolute reticulocyte
C. Hemoglobin
D. Protoporphyrin

Normocytic and Normochromic anemia

LDH/ Bilirubin Absolute Reticulocytes DAT
Sickle Cell Anemia Slightly Increase Increase Negative
Aplastic Anemia Normal Decrease Negative
Anemia of Renal Disease Normal Decrease Negative
Hemolytic Anemia Moderately Increase Increase Positive or Negative

5. Cold Agglutinin affected what indices?

A. MCHC and MCV
B. MCH and MCV
C. MCHC and MCH
D. MCV, MCH and MCHC

Error In Hematology Automation

Caused Affected Rationale Remedy
Cold Agglutinin ↓RBC count, ↑MCV, Agglutination of RBCs Warm sample to 37’C
↑MCHC, grainy appearance and rerun
Lipemia, ↑Hb and ↑MCH ↑Turbidity effects spectrophotometric Plasma replacement
Icterus, reading
Chylomicrons
HEMOLYSIS ↓RBC count and ↓Hct RBCs lysed and not counted Request new sample
Platelet ↓Platelet count and ↑WBC Large clumps counted as WBC Redraw using sodium
clumping Count citrate, multiply result by
1.1
Microcyte and ↓RBC count and ↑Platelet Size of RBCs or RBC fragments lower Review blood film
Schistocyte count RBC threshold and/or within platelet
threshold

6. Most severe state of erythrocyte abnormality, terms are marked or marked increased
A. 4+
B. 3+
C. 2+
D. 1+

RBC Morphology Grading

Numerical Grade Description
0 Normal appearance or slight variation in erythrocytes
1+ Only a small population of erythrocytes displays a particular abnormality;
the terms slightly increased or few would be comparable.
2+ More than occasional numbers of abnormal erythrocytes can be seen in
a microscopic field; an equivalent descriptive term is moderately
increased.

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3+ Severe increase in abnormal erythrocytes in each microscopic field; an

equivalent descriptive term is many.
4+ The most severe state of erythrocytic abnormality, with the abnormality
prevalent throughout each microscopic field; comparable terms are marked
or marked increase

7. Lab findings in Anemia of Chronic Disease

1. Decreased ferritin
2. Decreased TIBC
3. Decreased serum iron

A. 1 and 3
B. 2 and 3
C 1, 2 and 3
D. 1 and 2

Conditions Serum Ferritin Serum Iron TIBC %SATURATION FEP

IDA Dec Dec Inc Dec Inc
Anemia of Inc Dec Dec Dec Inc
Chronic Disease
Sideroblastic Inc Inc Normal Inc Variable
Anemia
Thalassemia Inc Inc Normal Inc Normal
Lead Poisoning Normal Variable Normal Normal Inc

8. Recommended INR range for treatment of DVT

A. 2-3
B. 1-3
C. 0.5-1
D. 1-2

INR CONDITIONS
2.0-2.5 DVT, high risk surgery
2.0-3.0 DVT, Pulmonary embolism, transient ischemic attack
2.5-3.5 Mechanical/ prosthetic heart valves
2.0-4.5 Recurrent DVT and pulmonary embolism, myocardial
infarction, arterial disease

9. Shift to the left includes:

I. Myelocyte
II. Metamyelocyte
III. Segmented neutrophil
IV. Band neutrophil
A. I, II and III
B. I and II
C. III and IV
D. I, II and IV

SHIFT TO LEFT SHIFT TO RIGHT

More immature cells More mature
Basophilic Eosinophilic
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Undifferentiated Differentiated
Hyposegmentation Hypersegmentation

10. Tertiary granules appear in:

A. Promyelocytes and Myelocytes
B. Myelocytes and Metamyelocytes
C. Metamyelocytes and Band cells
D. Band cells and Segmented Neutrophil
Leukocytes Granules
Promyelocyte Primary granules (Azurophilic Granules)
Myelocyte and metamyelocyte Secondary Granules (Specific Granules)
Metamyelocytes and Band cells Tertiary Granules (Gelatinase Granules)
Band cells and Segmented Neutrophil Secretory Granules (Secretory Vesicles)

11. Increased ESR.WBC is the basis

A. Leukocytosis
B. Leukemia
C. Leukemoid reaction
D. Neoplastic leukemoid reaction

Factors that affect ESR result

Factors Increase Decrease
Proteins and Lipid • ↑ Fibrinogen • ↑ Albumin
• ↑ Cholesterol • ↑ Phospholipid
RBC • Anemia • Polycythemia
• Macrocytosis • Microcytosis
WBC • Leukemia • Leukocytosis (marked)

12. Solid tumor counterpart of Stem cell leukemia

A. Lymphoma, undifferentiated
B. Reticulum Sarcoma
C. Chloroma granulocytic lymphoma
D. Myeloma

Leukemia and Lymphoma Relationship

Leukemia Solid Tumor Counterpart
Stem cell leukemia Lymphoma, undifferentiated
Acute Lymphoblastic Lymphoma, poorly leukemia differentiated; lymphocytic
Chronic Lymphocytic Lymphoma, well leukemia differentiated; lymphocytic
Monocytic Leukemia Reticulum Sarcoma
Acute Myelogenous Chloroma granulocytic Leukemia
Plasma cell Leukemia Myeloma

13. NK cell came from what progenitor

A. CLP
B. CMP
C. GMP

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D. MEP

Hematopoietic Cells
Progenitor Cell Lineage
Common Lymphoid Progenitor (CLP) T cells, B cells, Plasma cell, NK cells and Dendritic cells
Common Myeloid Progenitor (CMP) Erythrocyte, Myelocyte, Megakaryocyte, Monocyte
Granulocyte Monocyte Progenitor (GMP) Granulocytes, Monocyte
Megakaryocyte Erythrocyte Progenitor (MEP) Platelets and Erythrocytes

14. The coagulation factors having a sex-linked recessive inheritance pattern are
A. Factor V and factor VIII
B. Factor VIII and factor IX
C. Factor IX and factor X
D. von Willebrand factor and factor VIII

Disorders of Coagulation Causing Clotting Factor Deficiencies

Factor Inheritance Pattern Coagulopathy Acquired Coagulopathy
I Autosomal recessive Afibrinogenemia Liver disease
Autosomal dominant Dysfibrinogenemia DIC
Fibrinolysis
II Autosomal recessive Prothrombin deficiency Liver disease
Vit. K deficiency
Anticoagulant therapy
V Autosomal recessive Owren’s disease Liver disease
Labile factor deficiency DIC
Parahemophilia Fibrinolysis
VII Autosomal recessive Factor VII deficiency Liver disease
Vit. K deficiency
Anticoagulant therapy
VIII X-linked recessive Hemophilia A Hemophilia A
Autosomal dominant vWD vWD
IX X-linked recessive Hemophilia B Liver disease
Christmas disease Vit. K deficiency
Anticoagulant therapy
X Autosomal recessive Factor X deficiency Liver disease
Vit. K deficiency
Anticoagulant therapy
XI Autosomal recessive Hemophilia C Idiotypic
Rosenthal syndrome
=Common in Jewish descent/
Ashkenazi Jews
XII Autosomal recessive Factor XII deficiency Idiotypic
=No bleeding tendency
XIII Autosomal recessive Factor XIII deficiency Liver disease
DIC
Fibrinolysis
PK Autosomal recessive Fletcher trait Idiotypic
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HMWK Autosomal recessive Fitzgerald trait Idiotypic

15. When performing capillary puncture what finger is use?

A. Ring and Middle
B. Index and Middle
C. Index and Ring

Must to know Capillary Puncture

• For Infants and Small Children Depth of Skin Puncture: <2.0 mm

• For Adults Depth of Skin Puncture: 2.0-2.5mm
• 3rd to 4th finger in palmer surface of the non-dominant hand
• Discard 1st drop of blood: To Discard excess tissue fluid, discard dead epidermal cells and facilitate
free of flow blood

16. The ideal size/length of blood smear:

A. 2/3 to 3/4
B. 1/2 to 2/3
C. 1/2 to 1/4
D. 1/4 to 2/3
Must to Know in Blood Smear
IDEAL BLOOD SMEAR (WEDGE METHOD):
• Gradual transition from thick to thin area
• 2/3 to ¾ the length of the film slide
• Finger-shaped
• Visible lateral Edges
• Without irregularities, holes, or streaks
• Feather edge has rainbow appearance
• Whole drop of blood is picked up and spread
• Angle 30-45°
Important Considerations and Comments
Size of the drop of Blood Too Large Too Small
Thicker/Longer Smear Thinner/Smaller

Speed of the spreader Fast Slow

Thicker smear Thinner smear and poor RBC distribution

Hematocrit of the Patient High Low

Lowered the Angle Raised the Angle

17. Which of the following coagulation factors is/are serine protease?

1. Factor I
2. Factor II
3. Factor VIII
4. Factor VII
A. 1 and 2
B. 3 and 4
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C. 2 and 4
D. 1,2 and 4

18. In aplastic anemia, which describe/s the bone marrow:

I. Empty
II. Packed with blood cells
III. Hypoplastic
IV. Hyperplastic
A. I and III
B. II and IV
C. I only
D. II only

Must Know in Aplastic Anemia

• Pancytopenia (marked decrease in the number of RBCs, WBCs, and platelets in the blood)
• Reticulocytopenia
• Bone marrow hypocellularity
• Depletion of hematopoietic cells

Acquired (80-85%) Inherited (15-20%)

• Idiopathic • Dyskeratosis Congenita
• Chemicals (insectisides, Benzene) • Schwachman-Bodian-Diamond Syndrome
• Viruses (Epstein-Barr Virus) • Fanconi Anemia (Most Common of Inherited)
• Drugs (Chloramphenicol)

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19. Which stage of cell cycle is referred?

 The tetraploid DNA is checked for
 proper replication and damage
 Takes approximately 4 hours
A. S
B. G1
C. G2
D. Mc
Cell Cycle
Stages Description Duration
G0 (Quiescence) The cell is not actively in the cell cycle
G1 A period of cell growth and synthesis of components necessary for replication 10 hours
S (Synthesis) DNA replication takes place, a process 8 hours
G2 The tetraploid DNA is checked for proper replication and damage 4 hours
M (Mitosis) Involves the division of chromosomes and cytoplasm into two daughter cells. It 1 hour
divided into six phases

20. Which represent nuclear remnants predominantly composed of DNA (from karyorrhexis or nuclear
disintegration)?
A. Hemoglobin crystals
B. Pappenheimer bodies
C. Heinz bodies
D. Howell-Jolly bodies

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21. Grainy appearance to the film may indicate_______.

A. Rouleaux
B. Cold hemagglutinin diseases
C. Increased lipid levels
D. Increased WBC counts and platelet counts

Macroscopic Examination in the Film

Unusual Findings Probable reason
Blood film bluer than normal -patient has increased blood proteins (plasma cell myeloma)
Grainy appearances - RBC agglutination (as seen in cold agglutination diseases)
Holes all over the film - patient has increased lipid levels
Blue specks (out at the feather edge) - markedly increased WBC counts and platelet

22. To avoid a falsely high hemoglobin, the Drabkin-sample solution needs to be centrifuged and the supernatant
measured if platelet count is greater than _______x109/L.
A. 700
B. 900
C. 800
D. 600

Hemoglobinometry
Reference Method: Cyanmethemoglobin (HiCN)
• Uses Drabkin’s Reagent – major components:
1. Potassium Ferricyanide – converts hemoglobin into methemoglobin
2. Potassium Cyanide – converts methemoglobin to cyanmethemoglobin
3. Nonionic detergent - lysis of red cells, decreases turbidity
4. Sodium bicarbonate (Orig. Drabkin’s) - result is read after 15mins
5. Dihydrogen potassium phosphate (Mod. Drabkin’s) - result is read after 3 mins
• HiCN is measured at 540 (all types of Hb may be measured through this method, Except: Sulfhemoglobin

Sources of Error (Falsely Elevated Hb) Correction

• High WBC count (>20x109/L)
• High platelet count (>700 x109/L)
• Presence of Hb S or Hb C
• Lipemic sample
Centrifuge then read the supernatant
Make a 1:1 or 1:2 dilution with distilled water then multiply
result by 2
Use patient blank /reagent blank (0.01ml patient plasma +
5ml Drabkin’s reagent)

23. An MCHC between 36 and 38 g/dL should be checked for _______.

A. Elliptocytes
B. Spherocytes
C. Stomatocyte
D. Ovalocytes
RBC Indices
Parameter Description
MCV Reflects RBC diameter in blood
MCHC Reflects RBC staining intensity and amount of central pallor
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MCH *expresses the mass of hemoglobin

*least used to classify anemia
RDW fourth RBC index

24. Initial diagnosis for anemia:

A. CBC with RBC indices, RDW, and Reticulocyte count
B. CBC with RBC indices, RDW, Reticulocyte count and Peripheral blood film
C. Reticulocyte count and MCV
D. MCV, reticulocyte count and the RDW

25. Which of the following are parts of stromal cells?

I. Endothelial
II. Adipose
III. Osteoclasts
IV. Hematopoietic

a. I and IV
b. II, III and IV
c. II and III
d. I, II and III
Hematopoietic Stromal Cells
• It regulates the hematopoietic microenvironment
• specialized cells within the BM that provide protective and nourishing environment
to the HSCs
• Stromal cells include:
1. Endothelial cells
2. Fibroblast
3. Osteoblast and Osteoclast
4. Perivascular cells
5. Glial cells
6. Adipocyte

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Immunology and Serology/ Blood Bank

1. It is the preferred method for the detection of toxoplasmosis

A. IFA
B. PCR
C. EIA
D. Western blot
Method of Detection Toxoplasmosis
Sabin-Feldman Dye test • Considered as the gold standard test
• Can be used to detect IgG antibodies
• Principle: NEUTRALIZATION
Indirect Immunofluorescent Antibody • Most widely used
• Can be used to detect IgG
Enzyme Immunoassay • Method of choice
• Can detect IgG, IgM and IgA
PCR • Useful Prenatal Congenital (Early Diagnosis)
• Detects Toxoplasma DNA in CSF/Amniotic Fluid

2. What type of infection causes elevation of Serum Amyloid A? –

A. Bacterial infections
B. Viral Infections
C. Malignancy
D. Parasitic Infections

Serum Amyloid A
• Normal circulating levels are approximately 30ug/ml. In plasma, it is associated with HDL cholesterol,
and it is thought to play a role in metabolism of cholesterol
• Increase significantly more in bacterial infections than in viral infections
• Increases 1000x during acute inflammation

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3. What is anti-mannan antibody used for?

A. Candida
B. Histoplasma
C. Cryptococcus
D. Blastomyces
Fungal Infection Serology
Aspergillus Galactomannan Antigen/Antibody
Candida Mannan Antigen/Antibody
Coccidioidomycosis Coccidioidin Antigen/Antibody
Cryptococcus Cryptococcal Antigen/Antibody

4. Permanent deferral
A. Malaria
B. Active pulmonary TB
C. Rubella
D. Chickenpox

Donor Screening Deferral

Deferral Circumstances / Conditions
Permanent • Recipient of HUMAN pituitary derived growth hormone
• Hemophilia
• Etretinate, Leukemia
• Lymphoma
• Myeloproliferative disorder
• Etretinate (Tegison) treatment for psoriasis
• IV drug users
• Babesiosis Chaga’s disease
• Renal disease
• Liver disease
• Person with Hearth and Lung Problems
3 years • Malaria Refugee/immigrant
1 year • Recipients of blood known to be possible sources of hepatitis
• Tattoo
• Rape
• Incarceration in jail (3 days/72 hrs)
• Blood transfusion
• Major operation including dental surgery
• Syphilis
• Gonorrhea
• Traveler malaria-endemic places
• Rabies vaccine
6 months • Recovery from infection of dengue or chikungunya virus
8 weeks • Blood Donation (12 weeks DOH)
6 weeks • Childbirth (DOH: 9 Months)
4 weeks • Rubella vaccine
• Isotretinoin/Accutane (Tx: Acne) = teratogenic
• Proscar (Tx: Benign prostatic hyperplasia) = teratogenic

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2-3 weeks • After febrile episodes

2 weeks • Rubeola vaccine
• Polio vaccine
• Mumps’ vaccine
• Yellow Fever
3 days • Tooth extraction
12 hrs. • After alcohol intake
No deferral • A first-trimester or second trimester abortion or miscarriage

5. Blood typing centrifugation time –

A. 20 seconds
B. 60 seconds
C. 30 seconds
D. 120 seconds
Factors that affect the result of Combs test
Temperature 37°C (Body Temperature)
Washing of RBC RBCs must be washed for atleast of 3x (Cord Blood 6-8x)
Ratio of serum to cell 40:1 which can be achieve by using 2 drops of serum and 1 drop of red cell
Centrifugation 500 RCF for 15-20 seconds (20 secs. Recommended For Hemagglutination)
Saline used Fresh or buffered at Ph 7.2 -7.4

6. FFP stored at -65 deg C prepared at Jan. 1 2021, when is the expiry?
A. Jan. 1 2028
B. Jan 1, 2021
C. Jan 1, 2022
D. Jan 1, 2023
Blood Products Shelf-life
Frozen RBcs 10 years
Platelet concentrate / plateletpheresis 5 days at Room Temperature with constant agitation
Deglycerolized blood 24 hours (open system)
Irradiated blood 28 days or at the end of the original storage period
Acid –citrate dextrose (ACD) 21 days
Citrate-phosphate-dextrose (CPD) 21 days
Citrate-phosphate double dextrose (CP2D) 21 days
Citrate phosphate adenine (CPDA-1) 35 days
CPDA-2 42 days
ADSOL, NUTRICEL, OPTISOL, SOLX 42 days
Washed RBC 1 day
Granulocyte concentrate/pheresis 1 day at Room temperature without constant agitation
FFP ( -18°C), and Cryoprecipitate 1 year
FFP ( -65°C) 7 years
Plasma Protein fraction and Normal Serum Albumin 5 years

7. Yellow fever vaccine deferral:

A. 2 weeks
B. 4 weeks
C. 1 week
D. 8 weeks

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8. Does not cause HDN

A. Duffy
B. Kell
C. P
D. Kidd
Blood Group Associated with HDN
• Anti U
• Rh Antibody
• Kell Antibody
• Duffy Antibody
• Kidd Antibody
• ABO (O Blood type)
• Ss antibody

9. Rotation speed in RPR

A. 10,000 rpm
B. 2500 rpm
C. 1000 rpm
D. 100 rpm

Must Know RPR VDRL

Specimen Serum Serum or CSF
Reagent • C-L-C • Cardiolipin: Main reacting component
• Charcoal: makes the reaction easy to read • Lecithin: Removes anticomplementary
• EDTA: prevents lipid oxidations. activity of cardiolipin
• Thimerosal: preservative • Cholesterol: Enhances reacting surface of
cardiolipin
Inactivation Choline Chloride Heat at 56’C for 30mins
of
Complement
Examination Macroscopically (Charcoal) Microscopically
for = Nonreactive: No clumps
Flocculation = Weakly reactive: small clumps
= Reactive: Medium to Large clumps
Ag delivery Ring (plastic card) = 18mm Serum
needle = Gauge 20: delivers 60 drops per mL of Ag Slide = 14mm diameter (ceramic ring)
Needle = Gauge 18: delivers 60 drops per mL of Ag
= Gauge 19: delivers 75 drops per mL of Ag
= Gauge 23: delivers 100 drops per mL of saline

CSF
Slide =16mm (diameter) =1.75mm (depth) Needle:
Gauge 21/22: delivers 100 drops per mL of Ag
Rotation 100 RPM for 8 mins Serum = 180 RPM for 4 mins
CSF = 180 RPM for 8 mins

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10. Which is not transmitted through blood transfusion

A. Hepatitis
B. MTB
C. CMV
D. HIV
Blood Transfusion Transmitted Diseases

• HBV
• HCV
• HDV
• CMV
• EBV
• HTLV-I
• HIV 1 and 2
• T. pallidum,
• Plasmodium spp.
• B. microti
• T. cruzi,
• T. gondii

11. Several large agglutinate:

A. 1+
B. 2+
C. 3+
D. 4+

Grade Description
Cells Supernatant
0 No agglutinates Dark, turbid, homogenous,
MF Few isolated agglutinates Dark, turbid
Mostly free-floating cells
W+ Many tiny agglutinates Dark, and turbid
Many free cells
1+ Many small agglutinates (25%) Turbid
Many free cells
2+ Many medium-sized agglutinates (50%) Clear
Moderate number of free cells
3+ Several large agglutinates (75%) Clear
Few free cells
4+ One large, solid agglutinate (100%) Clear
No free cells

12. RBC antigen phenotyping

A. IAT
B. DAT
C. Blood typing
D. Gel technology

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DAT IAT
RBC Sensitization In vivo sensitization In vitro sensitization
Specimen EDTA Serum (Red Top)
Washing 3x 3x
Uses • HDN • Cross-matching
• HTR • Antibody detection
• AIHA • Antibody identification
• DIHA • RBC Ag phenotyping (weak D)

13. Type of hypersensitivity caused by TB skin test:

A. Type I
B. Type II
C. Type III
D. Type IV

Hypersensitivity Reactions
Type 1 Type 2 Type 3 Type 4
Other Name Immediate Anaphylactic Cytotoxic Immune-complex Delayed Cell mediated
Immune IgE IgG and IgM IgG and IgM T cells
mediator
Complement No Yes Yes No
involvement
Effector cells Basophil and Mast Cells RBC, WBC and Platelets Host Tissue Cells
T cells and
Macrophages
Mechanism Release of mediators Cytolysis due to Antibody Deposits of Ag-Ab Release of lymphokines
and Complement complexes
Examples House dust mites Transfusion reaction Serum sickness Contact dermatitis -
Hay fever Autoimmune Hemolytic Arthus reaction may be due to poison
Food allergies (e.g egg, anemia SLE ivy, nickel, mercury,
peanut, shrimp) HDN RA copper rubber,
Asthma Myasthenia gravis Post-streptococcal formaldehyde, hair
Drugs Grave’s disease glomerulonephritis dyes, sunscreen agents,
Rhinitis (most common) ITP associated in SLE disinfectants, perfumes,
Latex allergy Goodpasture Syndrome Other autoimmune and pesticides
Insect stings disorders
Pollen Tuberculin/ PPD test
Anaphylaxis Pneumonitis
Mantoux
Allergy skin test,
Hypersensitivity
pneumonitis (farmer’s
lung),
Type 1 DM
GVHD

14. The serologically detectable antibody produces in rheumatoid arthritis (RA) is primarily of the class:
A. IgM
B. IgG
C. IgA
D. IgE
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RA Factor

• IgM reacting against Fc portion of IgG (HC)

• Specimen: Serum, synovial fluid
• Found in Rheumatoid Arthritis
• Can cause False positive in agglutination reaction
• RA Titer:
Positive = >80
Weakly positive = 20-40
Negative = <20
• Test for RA
1. Rose-Waaler test = sheep cell agglutination
2. Singer-Plotz test = latex fixation

15. Monospecific AHG contains:

A. Anti-IgG OR anti-C3D
B. Anti-IgM or anti-C3D
C. Anti-IgG or anti-C3B
D. Anti-IgM or anti-C3B
Type of AHG Reagent
Polyspecific AHG: Monospecific AHG:
Contains anti-IgG and anti-C3d (C’ degradation products) Contain anti-IgG or anti-C3d

16. Highest level of H antigen found in what blood type:

A. O
B. A
C. AB
D. B

Gene Glycosyltransferase Immunodominant Sugar Ag Acceptor molecule

H L-fucosyltransferase L-fucose H Precursor sub
A N-acetylgalactosaminyltransferase N-acetyl-D-galactosamine A H
B D-galactosyltransferase D-galactose B H
AB N-acetylgalactosaminyltransferase N-acetyl-D-galactosamine AB H
D-galactosyltransferase D-galactose
O Same as H gene Same as H gene H Same as H gene

Amount of H antigen (Greatest) O > A2 > B > A2B > A1 > A1B (Least)

17. HSV generally found in and around the oral cavity and in the skin lesions that occur above the waist:
A. HSV1
B. HSV2
C. HSV3
D. HSV4

HERPES VIRUSES
HSV-1 causes Gingivostomatitis in children and young adults, recurrent oral-labial infection (cold sore),
infection of the cornea (keratitis), herpes encephalitis
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HSV-2 – Genital Herpes (herpes genitalis), neonatal herpes

HSV-3 – also known as Varicella Zoster that causes Chicken pox (primary infection) and Shingles/Zoster
(Recurrent infection)
HSV-4 – also known as Epstein-Barr Virus that causative agent of Heterophile-positive mononucleosis
(Infectious Mononucleosis), Kissing Disease
HSV-5 – also known as Cytomegalovirus it is a Heterophile negative mononucleosis
HSV- 6 – Roseola infantum disease (6th Disease)
HSV- 7 - Roseola and febrile disease in children
HSV– 8 – Kaposi Sarcoma (HIV)

18. Interpret: HBsAg (+), Anti-HBc (+), Anti-HBS (-):

A. Acute Infection
B. Chronic Infection
C. Recovery Period
D. Unresolved infection

Hepatitis B Profile
TEST RESULT INTERPRETATION
HBsAg All Negative Susceptible
Anti-HBc
Anti-HBs
HBsAg Negative Immune due to natural Infection
Anti-HBc Positive
Anti-HBs Positive
HBsAg Negative Immune because of hepatitis B
Anti-HBc Negative vaccination
Anti-HBs Positive
HBsAg Positive Chronic Infection
IgG anti-HBc Positive
IgM anti-HBc Negative
Anti-HBs Negative
HBsAg Positive Acute Infection
Anti-HBc total Positive
Anti-HBs Negative

19. Blood needs to be prepared for intrauterine transfusion of a fetus with severe HDN. The Red blood cell unit
selected is compatible with the mother's serum and has been leukocyte depleted. An additional step that must be
taken before transfusion is to:
A. Blood Typing
B. Irradiation
C. Antibody Testing
D. Phenotyping

Requirements for blood products to be transfused to infants

a) Negative for HbS
b) Blood product should be less than 7 days
c) It should be γ-irradiated

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20. What is the genotype of Bombay?

A. h
B. hh
C. Oh Oh
D. Hh

BOMBAY INDIVIDUAL (Oh)

Must know A Blood group that does not inherit H gene
Genotype H null or hh genotype
Antigens Lacks of A, B, H antigen
Antibody Anti-A, Anti-B, Anti-H

21. What is the first antibody produce in HIV infection?

A. gp41
B. p24
C. gp120

HIV ANTIBODIES (Steven’s 4th edition)

B lymphocytes are stimulated to produce antibodies to HIV, which can usually be detected in the host’s serum by 6
weeks after primary infection The first antibodies to be detected are directed against the gp41 transmembrane
glycoprotein, followed by production of antibodies to the gag proteins such as p24, and finally production of
antibodies to the env, pol, and regulatory proteins. The most immunogenic proteins are in the viral envelope and
elicit the production of neutralizing antibodies.

NOTE (3rd edition of Steven’s: anti-p24 is the first antibody to be produced)

Env(envelope) Codes for the glycoproteins gp160, gp120, and gp41, which are found in the viral envelope
gene • Gp 160 = a precursor protein that is cleaved to form gp120 and gp41
• Gp120 = forms the numerous knobs or spikes that protrude from the outer envelope
• gp41 = a transmembrane glycoprotein that spans the inner and outer membrane and
attaches to gp120
Gag gene Located in the nucleocapsid of the virus. Its codes for p55, a precursor protein with a molecular
weight of 55 kd, from which four core structural proteins are formed: p6, p9, p17, and p24
Pol(polymerase) Located in the core close to the nucleic acid. Its codes for enzymes necessary for HIV replication
gene 1. Reverse transcriptase –transcribe RNA to DNA
2. Ribonuclease – involved in the degradation of the original HIV RNA
3. Integrase- Inserts viral DNA to host DNA
4. Protease – cleaves structural proteins into smaller active units used to make the mature virions

22. What activates lectin pathway

A. IgA
B. Factor H
C. Carbohydrates of microorganisms
D. Antigen-Antibody Complexes

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Complement Pathways
Classical pathway Alternative pathway Lectin pathway
Initiation Activated by Ag-Ab complexes 1. Aggregates of IgA Microorganisms’ w/
2. Yeast cell wall or zymosan mannose in their cell wall
3. LPS
4. Cobra venom factor
Recognition Unit C1q, C1r, C1s C3, Factor B, Factor D MBP, MASP-1
C3 Convertase C4b2a C3bBb (stabilized by C4b2a
Properdin and Mg)
C5 convertase C4b2a3b C3bBb3b C4b2a3b
MAC C5b6789
End Result Complete Cell Lysis

23. What is the blood type if positive to blue reagent and negative to yellow reagent?
A. A
B. B
C. A+
D. B+

Reagent Color
Anti-A Blue (Trypan Blue)
Anti B Yellow (Acriflavin Yellow)
AHG Green
Anti-D Colorless
LISS Colorless
22% Bovine Albumin Yellowish
Red cell suspension (3-5%) Tomato Red

24. What is the correct order of phagocytosis?

Stevens (4th edition)
1. Adherence: physical contact aided by opsonin

2. Engulfment: outflowing of cytoplasm to surround microorganism

3. Phagosome: completely surrounds bacteria in cell membrane

4. Granule contact: lysosomal granules fuse w/ phagosome

5. Phagolysosome: contents of lysosome are emptied in space "battlefields"

6. Digestion: hydrolytic enzymes (peroxidases are released)

7. Excretion: contents of phagolysosome are expelled outside through exocytosis

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25. What is the normal whole blood volume of ideal body weight? Grams
A. 500
B. 450
C. 400
Blood volume required based on body weight
Max: 10.5mL/kg
Ideal: 110 lbs. (50kg)
450mL blood + 30mL blood (serologic tests)
63mL anticoagulant

If <110 lbs. body weight compute:

• (A) Vol. of blood to be drawn = (Donor weight ÷ Ideal weight) x 450mL
• Vol. of Anticoagulant needed = (A ÷ 100) x 14
• Vol. of anticoagulant. to be removed from blood bag = 63 – B

Note: The conversion factor 1.06 is used to convert milliliters to grams

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