Questions and Answers of Medical Laboratory Science Training Book

Questions and Answers of
Medical Laboratory
Science “ Training “
Prepared by :
Ayyub Y. Joaidi
(( Lab Director in QHC / MOH ))
(( Master in Clinical Lab Science ))
&
Haya Y. Radwan
(( Bachelor of Medical Laboratory Science ))
2016
‫المقدمة ‪..‬‬
‫قال تعالى ‪ (( :‬وما أوتيتم من العلم إال قليال )) صدق هللا العظيم‬
‫لقد أعددنا هذاا التتذاب لوجذ التذم م و ولمعذاعدخ إنوتوذا وأنواتوذا نم طذ الخذر الم ذم و ألنوذا‬
‫ندرك صعوبة كل بدا ة و فلت ن دأ نحتاج لمن وجهوا و ويم الدروب أماموا لتذ نقذد مذا بطع توذا و واقتذدا‬
‫بذذوهم معلموذذا و قذذدوتوا ن يوذذا محمذذد صذذلى هللا علي ذ ومذذلم ‪ (( :‬إن هللا حذذر ا ا عمذذل أ ذذدكم عمذذال أن‬
‫تقو )) ‪ ..‬فلت نحلق نطوما بين العحاب و هتد بوا الضال فتوذار وجهتذ بضذيا وا و ولتذ نعلمذ كيذ‬
‫تون العون و فيعين من أت ضاالا من جد د ‪ ..‬فهوا تتمن الطودخ ‪ ..‬جودخ اإلتقان ف األدا ‪..‬‬
‫رمالتوا من هاا التتاب أن غخ نع ة ك يمخ من أماميات العمذل فذ أقعذا الخذر الم ذم مذن نذالل مذا‬
‫اكتع واه من ن مخ ف التدر ر ف العووات الماضية و نضع بين أ د تم ف هاا التتاب ما حتاج المتدربون‬
‫لت مبخوا بين ما تلقوه بطامعاتهم وما تدربون علي نالل أشهم تدر هم العمل ف الم ت مات و لتذ ال‬
‫تتون هواك فطوخ بيوهما ‪..‬‬
‫فهاا هو هدفوا الا من أجل ولد هاا التتاب و وال نععى إلى أ ممدود ماد من نتاجوذا هذاا و فهذو مطذان‬
‫وليس أل غمض ربح و آملين أن تون أمامذا ا و ذاف ا ا للمتذدربين بذأن ال قتوذموا علذى مذا تضذمو مذن‬
‫معلومات بل خوروا أنفعهم و حثوا عن كل ما هو جد د ‪..‬‬
‫معدو التتاب‬
‫و هيا امم‬ ‫أ وب جعيد‬
‫‪2016‬‬
‫‪1‬‬
‫اهدا ت خ التلمات ‪....‬‬

‫لو اكم ال تون غارم لوار ال ت دمعا ا‬ ‫إلى روح جد الحاضم ف وجدان‬
‫إلى أب وأم و زوجت وبوات و أنوت وأنوات ‪..‬‬
‫إلى أماتات ف قعم الخر الم م ‪..‬‬
‫وزميالت ‪..‬‬ ‫إلى زمال‬
‫إلى المتدربين ال م طين ‪ ..‬نهد تم هاا التتاب ‪..‬‬
‫د جعيد‬ ‫أ وب‬
‫إلى من تش ثت دا بيد هما موا صغم ‪ ..‬فأناروا ل دروب يات‬
‫على مح تهم وأنالقهم الخي ة ‪ ..‬فتانوا وما زالوا قدوت ‪..‬‬ ‫إلى من امتيقظ قل‬
‫إلى إنوت من أتموى أن هدونو مثل ما أهد هم اآلن وما ا ما ‪..‬‬
‫مفا ا تواغ ب اليو كلمات ‪..‬‬ ‫إلى كل من علمو‬
‫باكماهما ‪..‬‬ ‫اكمت و تهم قل‬ ‫إلى روح جد وجدت من تض‬
‫‪ ..‬ورفيقات درب من امتق بدف قلوبهن شعور األنوخ من جد د ‪..‬‬ ‫إلى أماتات وزميالت وزمال‬
‫إلى من نشتم هللا كل ين على قمبهم الوادق موا ‪ ..‬نهد تم جميعا ا هاا التتاب ‪..‬‬
‫هيا امم رضوان‬
‫‪2016‬‬
2
 Contents :
Title Pages Number
 Questions in Hematology 3
Coagulation and Blood bank
A: 23
Sections
 Questions in Clinical 25
chemistry section A: 36
 Questions in Microbiology 38
section A : 68
 Questions in Body Fluid and 73
Serology sections A : 78
 Questions in Parasitology , 79
Mycology and Virology A : 95
 Basics in Reception Section 99
 Basics in Hematology Section 103
 Basics in Serology Section 117
 Basics in Blood Bank Section 120
 Basics in Coagulation 124
Section
 Basics in Clinical Chemistry 129
Section
 CBC Presentation 134
 Urine Culture Presentation 167
 Hepatitis B Virus 189
 TB 202
 Endocrine Section 223
 References 234
2016
3
1- Hematology in brief is : CBC and Blood Film . Does this definition

correct or not ?
a. Correct .
b. Not Correct .
2- CBC hematology analyzer represent 3 or 5 histograms in usual . In our

Palestinian Labs , 3 histograms are found ?
Is this correct or not ?
a. Correct .
b. Not Correct .
3- In the calibration of CBC instrument , don’t use the range that is found
in the manufacturer sheet for Normal , Low and High controls , because
of it's ?
a. Irrelevant SD .
b. Large Range Value .
c. Small Range Value .
4- In laboratory, Good reading and interpreting of CBC results taken by ?

a. Only the resulted parameters of CBC .
b. Only by histograms of CBC .
c. Both a and b
d. Clinical status of the patient .
2016
4
5- In the CBC differential results for WBCs . What will we do if we found

R₀ , R₁ , R₂ , R₃ or RM ..?
a. Calibrate the CBC instrument .
b. Run H, L and N control .
c. Do a Blood Film .
6- Why MCH is more accurate than other RBCs parameters especially

MCV in B- thalassemia decision ?
a. Because MCH is more Standardized parameter .
b. MCV is the most Standardized parameter .
c. Neither a nor b .
7- In CBC differential , What is the type of WBCs that is elevated in

bacterial infection ?
a. Lymphocyte .
b. Monocyte .
c. Neutrophil .
d. WBCs don’t increase in this type of infection .
8- In Viral Infection , What the type of WBCs will be elevated ?

a. Lymphocyte .
b. Monocyte .
c. Neutrophil .
d. WBCs don’t increase in this type of infection .
9- Eosinophil’s elevated in case of ?

a. Allergy .
b. Worms ( Helminthes ) Infection .
c. Parasitic Infection .
d. All of the above are true .
2016
5
10-MCV equals ?
a. Hb * 10 / RBCs count
b. HCT * 10 / RBCs count
c. ( Hb /HCT ) * 10
11-MCH equals ?
a. HCT * 10/RBCs count

b. Hb * 10 /RBCs count
c. ( HCT/HB ) * 100
12- MCHC means ?
a. Mean Corpuscular Hb concentration .

b. Mean Corpuscular Hb .
c. The average concentration of Hb in RBC ( the ratio of the weight of the
hemoglobin to the volume of the RBC) .
d. ( a+ c ) are correct .
13- Pancytopenia indicates ?
a. Decrease in RBCs production .

b. Decrease in WBCs production .
c. Decrease in Platelets production .
d. Decrease in all Blood Cells production .
2016
6
14 – In the 5 center squares of the 25 RBCs squares in the hemocytometer ,

we count 300 RBCs . How many RBCs in this sample?
a. 300 * 10.000 = 3 million/µl

b. 300 * 10.000 = 3 million/ m
c. 300 * 10.000 = 3 million / L
15- What is the test that reveal thalassemia ?
a. CBC .
b. TIBC
c. Hb electrophoresis .
16- What is the specific Hb that should be use to reveal thalassemia trait ?
a. Hbs
b. Hbc
c. HbA₁
d. HbA₂
e. HbF
f. HA₂
17- The immunoglobulin that has the ability to cross the placenta ?
a. IgM
b. IgG
c. IgD
d. IgE
2016
7
18- The immunoglobulin that elevate in hypersensitivity ?
a. IgM
b. IgG
c. IgD
d. IgE
19- Heinz Bodies are observed in the blood film in which case?
a. Alpha Thalassemia
b. G6PD Deficiency
c. Megaloblastic anemia .
d. IDA .
e. (Both a and b ) are correct .
20- High MCV and Normal MCH , MCHC ; this will be indicator of ?
a. Microcytic , Normochromic RBCs .

b. Macrocytic , Normochromic RBCs .
c. Normocytic , Normochromic RBCs .
21- Megaloblastic anemia ?
a. Deficiency in vitamin B12 and folic acid .

b. Increase in vitamin b12 .
c. Deficiency in vitamin C .
22- 1% Ammonium Oxalate for count of ?
a. RBCs
b. WBCs
c. Platelets
2016
8
23- RBCs = 3 million/µl , RDW 20% , Hb = 9 g/dl and
MCV = 65 fl , This indicate ?

a. Iron Deficiency Anemia ( IDA ) .
b. Thalassemia .
c. Leukemia .
24 – In The blood film , Auer rods of WBCs reveal ?
a. Chronic Granulocytic Leukemia .

b. Acute Granulocytic Leukemia .
c. Chronic Anemia .
25- Glacial acetic acid 3% for count ?
a. RBCs
b. WBCs
c. Platelets
26- For RBCs count ?
a. Normal Saline and Towson’s fluid .

b. Ammonium Oxalate
c. Distilled water
d. Hayem’s Solution .
e. ( a and d ) are correct .
2016
9
27- RDW ; Reveal deviation in shape and count for RBCs , is this definition
true or not ?
a. True
b. False
28- RDW, RBC , MCV and MCH parameters can distinguish between B-
thalassemia and IDA ?
a. RDW is normal or Slightly increase with low MCV and MCH and
increased RBCs count > 5 million in B- thalassemia .
b. High RDW with low MCV and MCH and low RBCs < 5 million in IDA
c. MCV/RBC > 13 so IDA ..
MCV/RBC < 13 so B-thalassemia .
d. All of the above are true .
29
29- ESR ?
a. 1˚ ( < ) slopes increases the reading result of 3 mm/ 1hr .

b. Depend on Reuloux formation .
c. 1:4 ratio between sodium citrate and blood .
d. All are correct .
2016
10
30- ESR = Zero , in which case ?
a. In IDA
b. In thalassemia
c. In Sickle Cell
d. In Polycythemia
31- Rule of Three ?
a. Used only if the patient RBCs is normocytic and normochromic .

b. It’s mean :
 RBCs * 3 = Hb
 Hb*3 = HCT
 RBC * 9 = HCT
c. Neither a nor b
d. ( a and b ) are correct
32- If Triglyceride > 1500 mg/dl on chemistry analyzer of good IQC and Hb >
17 g/dl ..
How we can correct the Hb result ?
a. Centrifuge the sample and remove the plasma , and replace it with
normal saline and then run it .
b. Centrifuge the sample , remove the plasma and measure the Hb
concentration ( by the cyanmethemoglobin method ) and then subtract
new result from the previous result .
c. ( a and b ) are correct .
2016
11
33- From these findings for WBCs differential by hematology analyzer ,

Calculate the relative lymphocyte ?
WBCs 20.1 K/µl

Lymphocyte 11.6 K/µl
MID 2.8 K/µl
Granulocyte 5.7 K/µl
a. 57.8 %
b. 13.9 %
c. 28.3 %
34- From the previous question , what is the absolute lymphocyte ?
a. 11.6 K/µl
b. 11.6 K/L
c. 11.6 K/ml
35- Why the total vitamin B12 is not efficient to diagnose megaloblastic
anemia ?
a. Our body stores of vitamin B12 are ≈ 2-5 mg

b. Main daily consumption of vitamin B12 in our body is
1-3 µg . So in case of malabsorption , vitamin B12 stores can be enough
for 2-7 years before developing megaloblastic anemia .
c. Vitamin B12 normal range is 200-1000 pg/ml of
average : 600 pg/ml .
d. hypersegmented neutrophils is used as a good indicator for
megaloblastic anemia, which found by performing
a blood film .
e. Active vitamin B12 is the efficient tool to diagnose megaloblastic anemia
f. All of the above are true .
g. Only a and d are true .
2016
12
36-In CBC analyzer , The ‘ AG ‘ note beside the platelets result mean ?
a. Autoagglutination
b. Aggregation of platelets
c. Absolute Granulocytosis
37- Reticulocyte Correction Formula ?
a.
𝑹𝒆𝒕𝒊𝒄𝒖𝒍𝒐𝒄𝒚𝒕𝒆 𝒄𝒐𝒖𝒏𝒕 (%) ×
(𝑷𝒂𝒕𝒊𝒆𝒏𝒕 𝑯𝑪𝑻
⁄𝒂𝒗𝒆𝒓𝒂𝒈𝒆 𝒏𝒐𝒓𝒎𝒂𝒍 𝑯𝑪𝑻) × 𝟏𝟎𝟎
(𝑺𝒕𝒂𝒏𝒅𝒂𝒓𝒅 𝑯𝑪𝑻
b. ⁄𝑷𝒂𝒕𝒊𝒆𝒏𝒕 𝑯𝑪𝑻) × 𝟏𝟎𝟎
(𝑺𝒕𝒂𝒏𝒅𝒂𝒓𝒅 𝑯𝒃
c. ⁄𝑷𝒂𝒕𝒊𝒆𝒏𝒕 𝑯𝑪𝑻) × 𝟏𝟎𝟎
38- MCH of hypochromic red blood cells is used as indicator of last stage of
IDA , whereas RDW is the early indicator of IDA , Is this statement true or
false ?
a. True
b. False
2016
13
39- The Normocytic Anemia with high reticulocyte count are found in ?
a. Hemolytic Anemia
b. Sickle cell anemia
c. Spherocytosis
d. G6PD deficiency
e. Microangiopathy
f. ( a and b ) are true
g. ( c and d ) are true
h. ( a, b, c , d and e ) all of them are true .
40- What is the most probable interpretation for the following test results in
Anemia evaluation ?
- Reticulocyte count is low

- MCV is normal
- Hb is low
a. Leukemia
b. Aplastic anemia
c. Infection
d. Medication Side Effect as in radiation
e. ( a and b ) are correct
f. ( a and d ) are not correct
g. ( a , b, c and d ) are correct
2016
14
41- According to Microcytic Anemia ?
a. IDA ( Iron , ferritin and Iron Saturation are Low and TIBC is high )
b. Anemia of inflammation or chronic disease ( Iron is Low , TIBC is also
low and Ferritin are normal or high )
c. Thalassemia trait as Hb E , C and Lead Poisoning ( Iron , TIBC ,
Ferritin and Iron Saturation are normal )
d. Congenital Siderobastic Anemia ( Iron and Ferritin are high , TIBC is
normal or low and Iron saturation is very high )
e. ( a , b , c and d ) are correct
f. ( a , b , c and d ) are incorrect
42-How can we diagnose Iron poisoning ?
a. Low iron , Low TIBC and Low Ferritin

b. High Iron , TIBC and Ferritin are normal
c. Iron , TIBC and Ferritin are high
43-During and after blood storage , what are the changes that are occurred in
their content ?
a. Loss of about 25% of their viability within 24 hr’s .

b. Impaired in platelets function in 24 hr’s.
c. Factor VIII decreases to 50% within 24 hr’s.
d. Increase in Plasma vitamin K , Hb , ammonia and lactic acid
f. ( a , b , c and d ) are correct
2016
15
44-What is definition of Leukemia ?
a. Abnormal blood cells , which don’t undergo the Programmed Cell

Death .
b. These abnormal cells occupies normal cells sites
( as WBCs, RBCs and Platelets ). So impair their normal function in the
body .
c. Leukemia is a type of blood cancer .
d. The Bone Marrow produce abnormal cells which are called leukemic
cells.
e. All of the above are true
f. Only a and c are true
45- In Blood Bank , The blood unit required ( )ml of CPDA ?
a. 67 ml
b. 63 ml
c. 100 ml
d. 30 ml
46- CPDA-1 mean ?
a. Citrate , Phosphate , Dextrose , Adenine 1

b. Citrate , Pyruvate , Dextrose , Adenine 1
c. Citrate , Pyrodxile , Dextrose , Adenine 1
2016
16
47-According to CPDA-1 “ the additive that is used for Preserving the blood
units “ ?
a. “ C” is related to Tri-sodium Citrate , act as Ca chelating agent and

inhibit Glycolysis
b. “ P “ is related to Sodium di-phosphate , it’s act as a buffer (( maintain
the PH level )) ..
c. “ D “ is related to Dextrose , responsible for ATP production
d. “A” is related to Adenine , responsible for ATP production
e. It preserves the blood unit for 35 days , While CPDA and CPDA-2 is
used for 21 and 41 days respectively .
f. All of the above are true
g. None of the above
48- What is the first test should be done for kidney transplantation ?
a. HLA Ag .
b. HLA Ab .
c. ABO grouping .
d. Cross Match .
49- Which of the following is correct according to the immunoglobulin that

should be provided for woman after delivery if her Rh is negative and her
husband’s Rh is positive ?
a. It’s termed as “ Anti D Immunoglobulin “

b. It should be taken by Rh negative women of Rh positive husband and
first child as prophylaxis after 20 weeks of the first pregnancy
( gestation ) and after delivery .
c. Both a and b are correct
d. None of the above
2016
17
50-In criminal studies , if a dried blood drop is noticed in the site , and we
should know the blood group for this drop of blood , what should we do to
solve this problem ?
a. Unfortunately , there is no solution , impossible we can't perform a blood

typing test on a dried blood drops .
b. add normal saline to this dried drop of blood and collect it , then you can
perform a forward blood grouping test for it .
c. add normal saline to this dried drop of blood , then you can perform a
reverse blood grouping test for it .
51- Major Cross match ?
a. Patient serum and Donor RBCs .

b. Patient whole blood and Donor serum .
c. Patient whole blood and Donor whole blood .
52- The tests that should be done on the blood unit ?
a. HIV
b. HBs. Ag
c. HCV
d. All of the above should be done .
2016
18
53- Direct Coomb’s test ?
a. RBCs of the patient .

b. Anti- Human Globulin .
c. Suspension of RBCs 5% .
d. All of the above .
54- Indirect Coomb’s test needs ?
a. Patient Serum with 3 O positive donors RBCs suspension .

b. O positive recipient with Donor serum .
c. None of the above .
55- The treatment that Hemophilia A patients should take ?
a. Cryoprecipitate .
b. Washed RBCs .
c. Anticoagulant .
56- What is hemophilia B ?
a. Deficiency in Christmas Factor ( Factor no. 9 )

b. Increase in Anti- hemophilic Factor .
c. Deficiency in Factor 9 and 7 .
2016
19
57- The concentration of Sodium Citrate for PT and PTT ?
a. 3.2%
b. 5.0%
c. 2.5%
58- INR ?
a. ( Pateint PT/ Control PT ) ^ ISI

b. ( Pateint PT/ Control PT )* ISI
59 – ISI ?
a- International Sensitivity Index

b- The sensitivity of the test increase as ISI value decrease , e.g ( ISI = 1.1
is better than ISI = 1.87 ) .
c- None of the above .
d- ( a and b ) are correct .
60- What is the cause of the following ?
- Normal platelets count

- Prolonged bleeding time
- Normal PT and PTT
a. Due to Aspirin and NSAID’s administration
b. Hemophilia
c. Von Willebrand disease
2016
20
61-
-Platelets count is normal
-BT is normal
-PT is normal
-PTT is elevated
These findings are seen in ?
a. Thrombocytopenia
b. Hemophilia A or other hemophilia’s types
c. Thalassemia major
62-
- Platelets count is low

- BT is elevated
- PT is elevated
- PTT is elevated
a. VWD
b. Hemophilia A
c. DIC
2016
21
63-
- Platelets count is normal
-BT is elevated
-PT is elevated
-PTT is elevated
a. DIC
b. VWD
c. Hemophilia
d. Primary Fibrinolysis
64-
-Platelets count is low
- BT is elevated
- PT is normal
-PTT is normal
a. Thrombocytopenia
b. TTP
c. ITP
d. HUS
2016
22
65-
- Platelets count is normal

- BT is elevated
- PT is normal
- PTT is elevated
- These findings are seen in ?
a. VWD
b. TTP
c. ITP
2016
23
Answers of Section 1
1- a
2- a
3- a
4- c
5- c
6- a
7- c
8- a
9- d
10- b
11- b
12- d
13- d
14- a
15- c
16- d
17- b
18- d
19- e
20- b
21- a
22- c
23- a
24- b
25- b
26- e
27- a
28- d
29- d
30- c
31- d
2016
24
32- c
33- a
34- a
35- f
36- a
37- a
38- a
39- h
40- g
41- e
42- b
43- f
44- e
45- b
46- a
47- f
48- c
49- c
50- c
51- a
52- d
53- d
54- a
55- a
56- a
57- a
58- a
59- d
60- a
61- b
62- c
63- d
64- e
65- a
2016
25
1- Glycated Hb is ?
a. HbA1c
b. To monitor of insulin injections for Diabetic patient .
c. To reveal the glucose mean concentration per 4 last months ( 120
days ) .
2- HbA1c methods ?
a. Chromatography ( Column )
b. Ion Exchange Resin
c. HPLC ( High Performance Liquid Chromatography )
d. Ag and Ab reaction ( Turbidimetery )
e. All of the above .
3- Confirmatory test for HbA1c ?
a. Chromatography
b. Turbidimetery
c. HPLC
4-Fructose amine is test like HbA1c but for duration of
( 2-3 ) weeks is this correct ?
a. Correct
b. Not correct
2016
26
5- According to the gestational diabetes , GCT ( 50 dextrose powder ) is used

for ?
a. Diagnosis of gestational diabetes .

b. Screening of gestational diabetes .
c. Normal range after 1 hr < 140
d. Normal range after 1 hr < 170
e. ( b and c ) are correct .
f. a is only correct .
6- OGTT ?
a. To diagnose the gestational diabetes .

b. For screening of gestational diabetes .
c. After ½ hr , NR is < 179
d. After 2 hr’s , NR is 80-120
e. Standard OGTT is 100 g dextrose .
f. ( a , c, d and e are correct ) .
g. None of the above .
7-What's the ratio that should be revealed between BUN and Creatinine to
diagnose Renal Failure ?
a. Creatinine/BUN = 1/5
b. Creatinine/BUN = 1/3
c. Creatinine/BUN = 1/10
2016
27
8-If Urea is ≈ 45 mg/dl , How BUN ?
a. BUN = 22.5
b. BUN = 9.0
c. BUN = 21.03
9- PKU ?
a. Phenyl Ketone Urea

b. Pyruvic Kinase
c. Test to determine the sugar of babies
( Newborn) .
d. Condition in which the body can't breakdown an amino acid (
phenylalanine ) constituent that is found in protein .
e. If it's not treated , it'll cause brain damage and even death .
f. Associated with inborn error of metabolism .
g. ( a , d , e and f ) are correct .
10- The storage form of iron in the blood ?
a. Ferritin
b. Transferrin
c. Albumin
d. TIBC
11- Protein that transport the iron in plasma ?
a. Ferritin
b. Albumin
c. Transferrin
2016
28
12- Transferrin Saturation% for iron ?
a. ( Iron / TIBC ) × 100

b. ( TIBC / Iron ) × 100
c. Transferrin × 0.75%
13-By serum iron level and TIBC , how we can distinguish between anemia of
iron deficiency and other types of anemia ?
a. Decrease in serum iron level .

b. Normal or Increase TIBC .
c. Decrease in Serum iron level and N/increase TIBC .
d. Both will decrease .
14-Globulin equals ?
a. Total protein – Albumin

b. Total protein + Albumin
c. Albumin – Total protein
15- In case of alcoholism , which of the following Biomarkers used in the

detection of alcoholism in high specificity and sensitivity ?
a. Gamma – Glutamyl transferase + carbohydrate deficient transferrin

b. AST
c. ALT
d. ALP ( Alkaline Phosphatase ) .
2016
29
16-The specific Marker/s for MI ( Myocardial Infarction ) ?
a. CPK total
b. Troponin I
c. CK – MB
d. Myoglobin
e. All of the above
17- CHD ( Chronic Heart Disease ) , which of the following is the most serious
risk ?
a. Decreasing in HDL
b. Increasing in LDL
c. Increasing in Cholesterol
d. Increasing in Triglyceride
18- According to Myocardial Infarction markers , Troponin is the most

accurate test for detection of MI , why ?
a. Troponin is more specific and sensitive protein than the other cardiac
markers , it rises within 3-12 hr.’s of the onset of chest pain , peaked at
24-48 hr.’s and returns to baseline over 5-14 days .
b. The other cardiac markers as CK-MB rises within 3-12 hr.’s of the
onset of chest pain , reaches peak values within 24 hours, and returns to
baseline after 48-72 hours.
c. Myoglobin ‘ other cardiac marker ‘ , which is highly sensitive but lack
specificity , it is released more rapidly as 2hr’s after acute MI and
returns back to it’s normal level within 24 hr . So, it’s used for early
detection of MI .
e. Only ( a ) is true .
2016
30
19- By indirect method for determine of LDL , if TG ≤ 400 mg/dl , The

equation is ?
a. LDL = Cholesterol – ( TG/5 + HDL )

b. LDL = Cholesterol – TG/5 – HDL
c. LDL = Cholesterol – TG/5 + HDL
d. ( a and b ) are correct .
20-
1. According to the IQC of the chemistry analyzer , can we use the

normal and abnormal controls also for HDL and LDL ?
a. Yes
b. No
2. If you answer are “ No “ , what we should use instead ?
a. Lipid control serum of normal and abnormal levels .

b. Lipid control serum of L , H and normal can be used .
c. None of the above .
21- P.S.A. ( Prostate Specific Antigen ) ?
a. To diagnose prostate tumor

b. To diagnose prostate tumor by using both type ( FPSA /
TPSA )
c. Increase in prostate massage ( transient Elevation )
2016
31
22- Pituitary gland is master gland that can control all of the body , What are
the hormones that are release from both sides of this gland (anterior and
Posterior ) ?
a. FSH
b. LH
c. GH
d. ACTH
e. TSH
f. Prolactin
g. Oxytocin ; this hormone originally produced by the
hypothalamus
h. ADH ( AVP ) ; this hormone originally produced by the
hypothalamus
i. All are correct
j. None of the above
23- The cortisol peak at 8 am and half of the peak at 6 pm ( 5:30 -6:30 ) pm , is
this statement true or false ?
a. True
b. B. False
24- Therapeutic drug monitoring for drug level ( TDM ) ?
a. To determine the level of the drug that increase of toxicity .

b. To determine the level of the drug that increase of it’s efficiency
c. Neither a nor b
2016
32
25- Drugs , Match ?
 Valporic Acid .. depalept

 Carbamazepine .. tegretol
 Phenobarbital .. luminal
 Phenytoin .. Epanutin
a. All of the above matched properly .

b. all of the above are not matched properly .
26- Tumor marker , match ?
 CEA .. carcinoembyonic antigen

 CA 125 .. for ovary
 CA 19-9 .. for colon and pancreas
 CA 15-3 .. for breast
a. All are correct .
b. All of them are false .
27- Each of CA 72-4 , CEA and CA 50 are used together as valuable markers
for gastric cancer detection ?
a. True
b. False
28-In Hypoparathyroidism , we found that ?
a. Ca⁺² is decreased , Phosphate is elevated , Alkaline Phosphatase is

normal
b. All increase
c. All decrease
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33
29-In Renal Failure , which of these findings are true ?
a. Ca⁺² is decreased , Phosphate is elevated and Alkaline Phosphatase is

elevated or normal .
b. All increase
c. All decrease
30- In Osteoporosis ?
a. Ca⁺² is normal , Phosphate is normal and Alkaline Phosphatase is also

normal
b. Ca⁺² and Phosphate are decreased is normal and Alkaline Phosphatase
is normal
c. Ca⁺² and Phosphate are elevated and Alkaline Phosphatase is normal
31- in Paget’s Disease :
a. Ca⁺² is normal , Phosphate is normal and Alkaline Phosphatase is

markedly elevated
b. Ca⁺² and Phosphate are elevated and Alkaline Phosphatase is also
elevated .
c. Ca⁺² is low , Phosphate and Alkaline Phosphatase are elevated
32- In Primary Hyperparathyroidism ?
a. Ca⁺² is elevated , Phosphate normal or decreased and alkaline

Phosphatase is normal or elevated
b. Ca⁺² , Phosphate and Alkaline Phosphatase are elevated
c. Ca⁺² , Phosphate and Alkaline Phosphatase are decreased
2016
34
33-Quality Control chart in the lab is called ?
a. DE cart Chart
b. Levey – Jennings Chart
c. Lab chart
34-CV equals ?
𝑺𝑫
a. ̅
× 𝟏𝟎𝟎
𝒙
̅
𝒙
b. × 𝟏𝟎𝟎
𝑺𝑫
c. ( 𝒙̅ ± SD )
35-Specific material make the reaction of specific test as Ag-Ab reaction on

chemistry or serology , this is a definition of ?
a. Sensitivity
b. Specificity
c. Accuracy
36-The confidence value for any test is 95% this statement is ?
a. True
b. False
2016
35
37- When the test result is near the true value , this mean ?
a. Sensitivity
b. Specificity
c. Accuracy
38- The smallest amount that react and make the reaction of the test ( The
ability to detect the small amount of substance in the sample ) ?
a. Accuracy
b. Sensitivity
c. Specificity
39- When we perform a calibration for the chemistry analyzer?
a. When there’s a problem in the instrument .

b. When we exchange the reagents .
c. If the N or A are not correct .
d. All of the Above .
40- Lab – Leader not the manager , What is he/ she should be?
a. Autocratic
b. Democratic
c. Delegative
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36
41- Collaboration effort between the employee of different sections of the lab
are important . Is it correct ?
a. Yes
b. No
** Collaboration means actually working alongside someone to achieve

something , whereas cooperating making them more able to do something .
42- The work team in the lab is the most important issues , why ?
a. To obtain a good and proper results .

b. To obtain the trust between themselves and to get a trusted and reliable
results )
c. Exchange of expert and information .
d. For Good Quality .
Answers of section 2
1- d
2- e
3- b
4- a
5- e
6- f
7- c
8- c
9- g
10- a
11- c
12- a
13- c
14- a
2016
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15- a
16- e
17- e
18- d
19- d
20- 1-b 2-b
21- d
22- i
23- a
24- d
25- a
26- a
27- a
28- a
29- a
30- a
31- a
32- a
33- b
34- a
35- b
36- a
37- c
38- b
39- d
40- e
41- a
42- e
2016
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1- The screening test for MRSA ?

a. Sensitivity test by Optochin
b. Sensitivity test by bacitracin
c. Sensitivity test by Oxacillin
d. Sensitivity test by Methicillin
Note : MRSA ( Methicillin Resistance Staph. aureus ).
2- The screening test for group A Streptococci , which cause

pharyngitis and tonsillitis ?
a. By optochin sensitivity on blood agar
b. By oxacillin sensitivity on Muller Hinton agar
c. By bacitracin sensitivity on blood agar
d. By SXT sensitivity on MacConkey
3- To differentiate between Streptococci spp. ?

a. By Lancefield classification .
b. By Coagulase test
c. By TSI test
d. By catalase test
4- Which test is used to distinguish between Strep and Staph ?

a. By catalase test
b. By coagulase test
c. Api20e test
d. By sensitivity test
2016
39
5-To differentiate between Staph aureus and other spp. of staph , we do ?
a. Catalse test
b. Coagulase test
c. TSI and serum citrate test
d. Colony color on MSA ( manitol salt agar ) .
e. Both b and d are correct
6- The screening test for S. pneumonia (( that cause fever , pneumonia in

children and newborn , and meningitis ?
a. Sensitivity test by bacitracin

b. Sensitivity test by Optichin
c. Sensitivity test by Methicillin
7- Antibiotic that can be used for sensitivity on MHA for Gram Positive
bacteria ? ( not for Gram negative )
a. Rifampicin
b. Augmentin
c. Cefuroxime
d. Penicillin
e. ( a and d ) are correct .
8- Antibiotic used only for Gram positive bacteria on culture?
a. Penicillin
b. Rifampicin
c. Oxacillin
d. Bacitracin
e. Erythromycin
f. Vancomycin
g. Methicillin
h. All of the above are correct .
2016
40
9- The antibiotics that don’t use for Gram Positive bacteria on culture ?
a. Naladixic Acid
b. Carbencillin
c. Polymyxin
d. Azethronam
10- Related to MRSA testing , cefoxitin gives more reproducible and

accurate results than Oxacillin and Methicillin ?
a. True
b. False
11-If SXT and Bacitracin are resistant , what is the most suspected bacteria
is ?
a. Group B Streptococci
b. Group D Streptococci
c. Group A Streptococci
12-If SXT resistant and Bacitracin sensitive , the most suspected bacteria is ?
a. Group B Streptococci
b. Group A Streptococci
c. Group D Streptococci
13-S.saprophaticus is Novobiocin sensitive
This statement is ?
a. True
b. False
2016
41
14-Only one type of Gram Positive cocci can grow on Macconkey , which one
of the following ?
a. S. aureus
b. S.Pneumonia
c. S. pyogenes
d. Enterococcus faecalis
15-The most causative agent for UTI ?
a. Proteus spp.
b. Staph aureus
c. E.coli
d. Klebsiella
16- The Organism that cause Nosocomial infection ( in hospitals ) and

resistance for many antibiotics ?
a. E.coli
b. Klebsiella
c. Streptococci
d. Pseudomonas aeruginosa
17- Rickettsiosis caused by : ( has serological cross reaction with which

organism ) ?
a. Proteus Ox19
b. Shigella
c. Salmonella
d. ( a , b and c ) are correct .
2016
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18- bacteria that only make a swarming on blood agar and cause a fishy ( bad)
smell , and can grow on MacConkey ?
a. E.coli
b. Proteus
c. Klebsiella
d. Salmonella
19- Sorbitol MacConkey is used to diagnose E.coli O157:H7
And so distinguishing it from other E.coli types ?
a. Yes
b. No
20- Api20e biochemical test is used to diagnose of ?
a. Gram negative bacteria

b. Gram positive bacteria
c. Enterobacteriacae
d. Pseudomonas
e. ( c and d ) are correct .
21- Which of the following microorganisms is Oxidase negative bacteria ?
a. Neisseria
b. Salmonella
c. Pseudomonas
d. Vibrio Spp.
e. Pasteurella
2016
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22-Which of the following is urease negative bacteria ?
a. Proteus
b. H.pylori
c. Y.entercolitis
d. Shigella
23-E.coli O157:H7 grow on MacConkey of pink colonies and on sorbitol

MacConkey of pink colonies also . This statement is ?
a. True
b. False
24- According to the biochemical tests ?
a. E.coli and Proteus vulgaris are indole positive

b. H₂S for salmonella is mostly Positive and Negative for Shigella
c. Urea test for proteus is positive
d. ( a and b ) are correct
f. b is only correct
25- E.coli is found in about 60-90% of culture results of urine samples .This
statement is ?
a. True
b. False
26-Proteus is resistant for Nitrofurantoin
This statement is ?
a. True
b. False
2016
44
27- Klebsiella Pneumonia is mostly ampicillin resistant
This statement is ?
a. True
b. False
28-According to the infection that caused by Shigella and Salmonella , which

of the following is a sign/symptom related to this infection ?
a. Dysentery
b. Watery stool
c. Pus in stool
d. Fever ( high body temperature )
e. All of the above are true .
f. None of the above .
29-SS agar is used for the diagnosis of ?
a. Shigella and Salmonella

b. Proteus
c. Klebsiella spp.
d. E.coli
30-The most specific ( selective ) media that is used for Salmonella and
Shigella ?
a. HE media
b. XLD media
c. SS agar
d. CLED agar
e. ( a and b) are correct .
2016
45
31- Salmonella , Shigella and E.coli colonies color on XLD agar?
a. Yellow colonies of E.coli

b. Red colonies of Shigella
c. Red colonies with black centers ( due to H2S ) for Salmonella .
e. None of the above .
32- The color of Salmonella and Shigella colonies on SS agar ?
a. Shigella has pale colorless colonies on SS agar .

b. Colorless Pale colonies with black center for Salmonella .
d. ( a and b ) are false .
33- What is the color of Salmonella and Shigella on DCA ?
a. Both have pale colonies .

b. Because they are non-lactose fermenter .
Note : DCA : Deoxycholate citrate agar
34-The selective media for Salmonella and Shigella are XLD, HE and SS agar,
and the enrichment media for them ( some species of salmonella ) is Selenite F
broth . Is this statement true or false ?
a. True
b. False
2016
46
35-For stool culture , Selenite F broth or tetrathionate broth , both are used as
enrichment media .
This statement is ?
a. True
b. False
36-There is no enrichment media for Shigella , this statement is ?
a. True
b. False
37-Salmonella is present on the upper surface of selenite F broth after

incubation .
This statement is ?
a. True
b. False
38-SS agar is not suitable for isolation of ?
a. Shigella sonnei
b. Shigella dysentery
c. Both a and b are true
39-Biochemical and serological tests is used for confirmation of Salmonella

and Shigella grown colonies .
This statement is ?
a. True
b. False
2016
47
40-Shigella is H₂S Negative , while most of Salmonella types
( about 90% of it’s spp. ) are H₂S and lysine positive .
This statement is ?
a. True
b. False
41- Before doing serological test for Salmonella and Shigella spp. , you must
subculture the grown colonies to obtain an isolated pure colonies on
Trypticase Soy agar ( TSA ) .
This statement is ?
a. True
b. False
42-Salmonella grouping is used for epidemiological studies. This Statement is?
a. True
b. False
43-When we performing a serology test for Salmonella after isolation , O Ag

and H Ag must be Positive or negative together .
This statement is ?
a. True
b. False
2016
48
44-By Pulse Net surveillance , It was detected that there are 44 serotypes for
Shigella and 2500 serotype for Salmonella .
This statement is ?
a. True
b. False
45-The Latest Resistant Salmonella is S. senftenbreg .This statement is ?
a. True
b. False
46-Which of the following is correct according to the serological tests for

Shigella colonies after isolation ?
- subgroup A for dysenteriae

- subgroup B for flexneri
- subgroup C for bodyii
- subgroup D for sonnei
a. subgroup A and C are correct

b. subgroup B and D are correct
c. subgroup A, B,C and D are correct
47 – Acid – Fast stain to diagnose ?
a. Mycobacterium Tuberculosis
b. Pseudomonas
c. S. pyogenes
d. S. pneumonia
e. E.coli
2016
49
48-According to Acid Fast Bacilli ( AFB ) for sputum sample , patient should
collect 3 samples of different time ≈ 8 hr between them . This statement is ?
a. True
b. False
49- Why we collect 3 sputum samples for suspected case of T.B?
a. 3 samples will increase the sensitivity of AFB .

b. 3 samples will increase the specificity of AFB .
50- Glycerol used in addition to L J media for which Mycobacterium type ?
a. Bovis
b. Tuberculosis
c. Africanium
51- Pyruvate used in addition to L J media for which mycobacterium type ?
a. Bovis
b. Tuberculosis
c. Africanium
52-For gastric fluid culture , If Mycobacterium Tuberculosis is suspected ,

sodium bicarbonate is required for fluid neutralization to improve the T.B
culture . this statement is ?
a. True
b. False
53-How could you choose the most suitable antibiotic of sensitivity in culture ?
a. Concentration of the drug

b. Precipitation of the drug
c. MIC ( minimal inhibitory concentration )
2016
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54- The antibiotic that it isn’t suitable for urine culture and sensitivity ?
a. Polymyxin
b. Augmentin
c. Nalidixic Acid
d. Nitrofurantoin
e. Ceftriaxone
55- CSF infection ( Meningitis ) causative agent/s ?
a. E.coli
b. S.pneumonia
c. Listeria monocytogenus
d. Staph aureus and S.agalactiae
e. H.influenza and Neisseria meningitides
f. None of the above
g. All of the above
h. ( b and e ) are the most .
56- In Bacterial Meningitis ?
a. Low in sugar , rise in protein

b. Low sugar , low protein
c. Increase in lymphocyte count
d. ( a and c ) are correct
e. Increase in Neutrophil count
f. ( a and e ) are correct .
2016
51
57- Human febrile Ag. ?
a. Salmonella Ag .
b. Proteus Ox 19
c. Brucella Ab.
e. All of the above are correct .
58- The most organism that cause meningitis in newborn ?
a. Listeria monocytogenes
b. E.coli
c. S. agalactiae
d. ( a and b )
e. ( a and c )
59- By using CLED ( cysteine lactose electrolyte deficient ) for urine culture to
differentiate between ?
a. Large green – blue colonies ( coliform gram negative bacteria ) .

b. Smaller white ( yellow ) colonies ( staph )
c. ( a and b ) are correct
d. ( a and b ) choices are not correct .
60- CIAS can be summery of procedure of Gram stain ?
a. “ C “ is abbreviation of Crystal Violet .

b. “ I “ is abbreviation of Iodine .
c. “ A “ is abbreviation of Acid Alcohol .
d. “ S “ is abbreviation of Safranin .
e. None of the above .
f. All of the above are true .
2016
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61-Why do we use Mueller Hinton agar instead of Nutrient agar for sensitivity
test ?
a. Because of it’s content of thymidine and Thymine
b. Low calcium and magnesium content so rapid diffusion of antibiotics
c. Mueller Hinton PH is ranging from 7.2-7.4
d. Most of bacteria grow in alkaline PH and the efficiency of antibiotic activity

on alkaline PH
e. All of the above
62- E test ?
a. Antimicrobial sensitivity test

b. Diagnostic test for antimicrobial sensitivity test
c. Determine the minimum inhibitory effect( MIC ) of antibiotics
d. It’s used for research purposes more than diagnostic purposes
e. All of the above
63-Sterility and Fertility tests are important as an internal quality control (

IQC ) in the Microbiology lab , Is this statement true or false ?
a. True
b. False
2016
53
64-Most of the prepared media for bacterial growing purposes is attended to

be alkaline ( 7.2-7.4 ) , Is this statement true or false ?
a. True
b. False
65-Related to checking the efficiency of autoclaving process , From the

following choices what are the appropriate ways to perform an IQC for this
step ?
a. Using B. sternophilus
b. Using special autoclave tap
c. ( a and b ) are true
66-It’s preferred to stop using the prepared media after 2 weeks from their
date of preparation . This statement is ?
a. True
b. False
67-Deep freezing ; it’s done on ATCC strains which are “ fertility testing
bacteria “ , This statement is ?
*ATCC: American Type Culture collection
a. True
b. False
2016
54
68-We should do an IQC for the prepared media as :
Sterility test which is considered as Positive control and Fertility test as

Negative control . Is this statement True or False ?
a. True
b. False
69-According to pouring process for prepared media in plates , for 9 mm size

we should add 16-20 ml of the media . This statement is ?
a. True
b. False
70- After how many hours of stopping antibiotic coarse we can perform a
culture test ?
a. 72 hrs.
b. 48 hrs.
c. 96 hrs.
71-We must use the screw cap container for specimen collection process ,
This statement is ?
a. True
b. False
72-The optimal time specimen collection for urine analysis is the first morning
specimen . This statement is ?
a. True
b. False
2016
55
73- According to blood culture specimen collection ?
-Blood should be collected prior antibiotic is taken
-Collect blood from 2-3 different sites
-Collect blood samples at different times
a. All of these restrictions are true
b. All of these restrictions are false
74-“ Midstream urine sample” is not appropriate for chlamydia testing . This
statement is ?
a. True
b. False
75- According to stool culture , we need 1-2 samples of 2 different days . This
statement is ?
a. True
b. False
76- According to blood culture for adults , 10 ml of blood is used for aerobic
blood bottle and another 10 ml for anaerobic ones , also one swab for multiple
cultures . This statement is ?
a. True
b. False
2016
56
77-According to CSF culture , 2-3 ml is needed from the Second CSF tube .
this statement is ?
a. True
b. False
78- For anaerobic culture , you should collect the specimen by inserting the
needle deeply . This statement is ?
a. True
b. False
79- For accurate culture results , Minimize the transport time and maximize
the transport media . This statement is ?
a. True
b. False
80-Which of the following microorganisms and samples type must be cultured

as soon as possible , without refrigeration because of low temperatures will
kill these microorganism ?
a. Shigella spp. in stool specimen

b. H.influenza in ear swab
c. Neisseria in swab ( CSF or urethral or urine sample )
d. Treponema Pallidum in urethral discharge
g. ( a , b and c ) can be cultured , but for T. pallidum serology tests is
preferred
2016
57
81- For S. pneumonia culture , candle jar is needed . And 5-10% CO₂ for
H.Influenza . This statement is ?
a. True
b. False
82-According to urine culture , the positive results for adults if the colonies
count is > 10⁵ CFU/ml , and > 10⁴ CFU/ml for children . This statement is ?
a. True
b. False
83-Is This statement true or false ?
S. aureus is vancomycin sensitive , S. pyogenes is bacitracin sensitive and

K.pneumonia is Ampicillin resistant ?
a. True
b. False
84-According to Mueller Hinton agar preparation , It’s preferred to pour

(16-20ml) in 9 cm of 4 mm depth of this media in petri-dishes . This statement
is ?
a. True
b. False
85- According to " Asymptomatic Bacteriuria " , in chronic cases bacteria is

present in the urine without pus cells ( WBCs ) . This statement is ?
a. True
b. False
2016
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86-Asymptomatic Bacteriuria lab results ?
a. WBCs are less than 10 cells /HPF by direct urine analysis

b. Culture result is positive
c. None of the above
d. Both a and b are correct
87-Alkaline Peptone Water broth is an enrichment media for V.cholera . This

statement is ?
a. True
b. False
88-The Thiosulphate Citrate Bile Salts ( TCBS ) agar is used for the isolation
of cholera spp.
This statement is ?
a. True
b. False
89-Three flame method for inoculation and isolation of bacteria .
This statement is ?
a. True
b. False
2016
59
90- According to catalase test ?
a. Candida : Positive
b. S.auerus : Positive
c. P.aeroginosa : Positive
d. Listeria : Positive
e. Aspergilus : Positive
f. Serratia : Positive
g. E.coli : Positive
h. Streptococci : Negative
i. Enterococci : Positive
j. All of the above are correct
k. None of the above are correct
91- For Urine culture , First morning specimen is preferred to be collected . If

it isn’t available midstream urine sample can be used .
This statement is ?
a. True
b. False
92- In spring season , Ear infection is increased due to infection by ?
a. S.aureus
b. H. Influenza
c. S. pneumonia
93-Antimicrobial Susceptibility Testing ( AST ) ?
a. Diagnostic Tool
b. Treatment Tool
c. It’s used for Epidemiological Studies
d. The most method used is the Disc Diffusion ( Kirby-Bauer test )
2016
60
94- Mueller Hinton agar media is used in Disc Diffusion method for most
microorganisms , but for S. pneumonia ; MHA is used with 5% Sheep Blood .
This statement is ?
a. True
b. False
95-You must place up to 6 antibiotic discs ( has 9 cm diameter ) for sensitivity

test on the petri dish ?
a. True
b. False
96-For antibiotic preservation , Keep the closed ones at -20˚C , and the opened
ones at 2-8˚C .
This statement is ?
a. True
b. False
97-Before using Antibiotic Discs for AST test , leave them at room
temperature for 1 hr.
This statement is ?
a. True
b. False
98-According to 0.5 McFarland and Bacteria Suspension .If the suspension is

heavier than McFarland so Most antibiotics will be Resistant .
This statement is ?
a. True
b. False
2016
61
99-How we can solve this problem ?
After Preparing blood agar and MacConkey media , we use them to culture a
sample , after incubation we found that a gram negative bacteria grow heavily
on MacConkey with no growing colonies on blood agar ?!
a. This may because the used blood for preparing blood agar has
antibiotics which prevent the growth of gram negative bacteria on it , so
we should prepare another media with another blood source .
b. You may forgot autoclaving step in media preparation
c. Overheating of blood agar has occurred
100-Explain and solve the problem ?
After preparing a certain type of media , we found a bacterial colonies has

grown on it after few days of preparation in most plates ?!
a. Contamination has occurred during autoclaving

b. Contamination has occurred during pouring media
c. We can solve this problem by using Bacillus Sternophilus in the
autoclave to check sterility
d. Dusting for the biosafety cabinet should be done
e. Turn on UV light in the biosafety cabinet after finishing the culture
process of the samples
2016
62
101-Related to stool culture , How we can solve this problem ; mixed colonies
on XLD and HE ?
 XLD : Xylose Lysine Deoxycholate agar , HE : Hektoen enteric agar “

They are selective media for Salmonella and Shigella
a. Do a subculture from the different colonies with different color on new
XLD and HE
b. Do a subculture from the different colonies on trypticase soy agar and
serology tests for Salmonella and Shigella
c. Do API20e for the sub-cultured different colonies to identify the
bacterial type
d. (a and b ) are true
e. ( a, b and c ) are true
102-Interpret these Ear Swab culture results ?
-Gram positive cocci
-Catalase Negative
-B-hemolytic Streptococci
-Bacitracin sensitive
a. S. pneumonia
b. S. aureus
c. S. pyogenes
2016
63
103- Interpret these Ear swab culture results ?
-Gram Positive diplococcic
-Catalase negative
- Alpha hemolytic streptococci
-Optochin sensitive
a. S. aureus
b. S .pneumonia
c. S. pyogenes
104-Interpret these Ear swab culture results ?
-Gram positive cocci
-Catalase Positive
-Coagulase Negative
a. S aureus
b. S. epidermidis
c. S. pyogenes
d. S. epidermidis is a normal flora in this site of this type of culture
105-Interpret these urine culture results ?
-Faint growth on blood agar
-Gram Positive long bacilli
a. Normal flora
b. Do Sensitivity
c. No need for sensitivity
d. ( a and c ) are correct
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106- Interpret these urine culture results ?
- B-hemolytic streptococcus
- Gram positive cocci
- Catalase Negative
- Sulfamethoxazole ( trimethoprim ) resistant
- Bacitracin resistant
a. This type of bacteria is pathogen in urine of 1%
b. Group B of B-hemolytic streptococci
c. S. agalactiae
d. All of the above are true
107-Interpret these urethral swab culture results ?
- Colonies on Blood and chocolate agar

- Gram negative diplococcic
- Catalase Positive
- Oxidase Positive
- Urethral Discharge
a. Chlamydia
b. Neisseria gonorrhea
c. Trichomonas
108- According to Pus swab culture ?
a. The only normal flora in pus is ‘ Bacillus subtilis ‘

b. All Gram Negative Bacilli are pathogen
c. All Gram Positive Cocci are pathogen
d. All of the above
e. None of the above
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109-Related to ESBL screening , which antibiotics can be used ?
a. Augmentin , in the middle of the plate

b. Cefotaxime , in a side of Augmentin
c. Ceftazidime , on another side of Augmentin
d. Cefazolin can be used instead of Cefotaxime
e. Cefaclor can be used instead of Ceftazidime
f. ( a , b and c ) are true
g. ( a , b and e ) are true
110-Interpret these CSF culture findings ?
- More than 70% of the grown colonies on blood agar are of B-hemolytic
type .
- This bacteria is Gram positive Coccobacilli
- Catalase Positive
a. This bacteria is most probable to be Listeria Monocytogenes
b. This bacteria is most probable to be Haemophilus Influenza
c. None of the above
111-Interpret these Wound Swab Culture Findings ?
- Gram Negative short Bacilli

- It has a Swarming appearance on blood agar
- It has a bad , fishy like smell
- Urea Positive
a. This bacteria is most probable to be Proteus
b. This bacteria is most probable to be Shigella
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112- Interpret these Findings according to stool culture ?
- Colorless or yellow-orange colonies on XLD

- Orange colonies on HE
- Pink colonies on MacConkey
a. This bacteria is most probable to be E.coli

b. This bacteria type is coliform bacteria
c. This bacteria is a normal flora in the stool (not it's all species)
d. We can confirm our interpretation by Api20e
113-According to stool culture , Interpret these lab findings ?
-Grow with Red colonies on XLD agar
-Grow with green colonies on HE agar
-Grow with colorless colonies on SS agar
a. You must do Api20e

b. You must do a serological test
c. Shigella is suspected and you must do Api20e and serological tests to
confirm your interpretation
d. Salmonella is suspected
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114-What is the most probable diagnosis for these results of culture ?
-Group B , B-hemolytic streptococci on blood agar
-SXT Resistant
-Bacitracin Resistant
a. S.Pyogenes
b. S.agalactiae
115- 120 colonies are detected on Petri dish of 1 µl loop that is used , How
many colonies can be detected by using 1 ml loop ?
a. 1.2 × 10⁶ CFU/ml

b. 1.2 × 10⁵ CFU/ml
c. 1.2 × 10⁴ CFU/ml
116-According to wound Swab Culture , Interpret these results ?
-Gram negative bacilli
-Oxidase Positive
-Resistant to most antibiotics
a. Pseudomonas aeruginosa is suspected

b. Klebsiella Pneumoniae is suspected
117-According to blood culture , Gram positive diplococci organism has

noticed by gram stain , catalase negative , optochin sensitive and alpha
hemolytic streptococci when cultured on blood agar , What is the suspected
bacteria for this case ?
a. S. aureus
b. S. epidermidis
c. S. pneumonia
d. S. saprophyticus
e. S.agalactiae
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1- c
2- c
3- a
4- a
5- e
6- b
7- e
8- h
9- e
10-a
11-a
12-b
13- b
14- d
15-c
16-d
17-a
18-b
19-a
20-e
21-b
22-d
23-b
24-e
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25-a
26-a
27-a
28-e
29-a
30-e
31-d
32-c
33-c
34-a
35-a
36-a
37-a
38-c
39-a
40-a
41-a
42-a
43-a
44-a
45-a
46-c
47-a
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48-a
49-a
50-b
51-a
52-a
53-c
54-a
55-g
56-f
57-e
58-e
59-c
60-f
61-e
62-e
63-a
64-a
65-c
66-a
67-a
68-b
69-a
70-a
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71-a
72-a
73-a
74-a
75-a
76-a
77-a
78-a
79-a
80-g
81-a
82-a
83-a
84-a
85-a
86-d
87-a
88-a
89-a
90-j
91-a
92-b
93-e
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94-a
95-a
96-a
97-a
98-a
99-a
100-f
101-e
102-c
103-b
104-d
105-d
106-d
107-b
108-d
109-f
110-a
111-a
112-e
113-c
114-b
115-b
116-a 117-c
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Section 4 : Body Fluid and Serology

1- Cystitis ( inflammation of the Bladder ) is mean ?
a. Upper UTI
b. Lower UTI
2- Pyelonephritis ?
a. Upper UTI
b. Lower UTI
3- Bence – Jones protein in urine , in case of ?

a. Multiple Myeloma
b. Chronic Leukemia
c. Acute Leukemia
4- In Urine Analysis , Iodine is used in the confirmation of ?

a. Ketone
b. Bilirubin
c. Protein
5- In Urine Analysis , TCA is used for the confirmation of ?

a. Protein
b. Bilirubin
c. Glucose
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6-Specific Gravity is mostly important to distinguish between ?
a. Diabetes Insipidus and Diabetes Mellitus

b. Diabetes Mellitus and Ketoacidosis
c. Ketoacidosis and Diabetes Insipidus
7-Nitrate positive in urine reagent strip is mean ?
a. Mostly infection by Enterobacteriacae

b. Mostly infection by Enterobacteriacae , especially E.coli .
c. Proteus Ox19
8- Leukocyte on the reagent strip mean ?
a. Leukocyte Esterase enzyme that is released from WBCs destruction

except Lymphocytes .
b. Severe UTI ( Especially , when it's conjugated with positive Nitrite
on the reagent strip ) .
c. Neither a nor b
9- For CSF counting , What is the reagent that is used ?
a. D.W
b. N.S.
c. ( 1-3 )% Glacial Acetic Acid ( as Turk’s Solution ) .
10- In CSF culture , which tube is used from the three collected tubes ?
a. The first one .

b. The second one .
c. The third one .
*Actually they send 4 tubes , but as the reference book 3 tubes .
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11-Test for counting sperm ?
a. Sodium bicarbonate
b. Sodium Citrate
c. Ammonium Oxalate
12-Test/s that is/ are used for SLE ( Systemic Lupus Erythematosus ) disease ?
a. LE cell
b. ANA
c. Anti DNA
d. All of the above
13-Pregnancy test principle ? ( The most )
a. Ag – Ab reaction
b. Chromatography
c. Immune-precipitation
14-Serial Dilution can be done for ?
a. ASOT
b. CRP
c. RF
d. Widal test
e. Brucella
f. All of the above
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15- HVS for female ?
a. For detection of Trichomonas by direct smear

b. For detection of Candida by direct smear
c. Cultured on Blood agar , MacConkey and Chocolate agar .
d. ( a , b and c ) are correct .
16- Standardization Agglutination test ( SAT ) for confirmation of what in

serology ?
a. Widal ( Salmonella ) .
b. Brucella .
c. Proteus Ox19 .
17- CRP diluted serum to 1/16 , how we can calculate the concentration ?
a. By multiply 6×16
b. By multiply 8×16
c. By multiply 200×16
18- We can use Normal Saline for the dilution of RBCs instead of Distilled
Water ?
a. N.S. doesn’t lead to shrinkage in RBCs , in contrast to D.W.

b. D.w. and N.S. lead to RBCs shrinkage .
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19- Simply , we can differentiate between active and passive immunity as ?
a. Active Immunity generates adaptive immune response: which takes

days/weeks to develop ( not immediate response ) but may be long
lasting (( For several years )) .
b. Passive Immunity , it gives immediate response , but short-lived
protection( short term immunization ). It lasts up to several weeks to 3
or 4 months at most.
c. Active Immunity formed by body exposure to microbial antigen as in
vaccine or due to infection .
d. Passive Immunity formed by introducing IgG antibodies from
immunized animals .
f. All of the above are correct
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1-b
2-a
3-a
4-b
5-a
6-a
7-b
8-d
9-c
10-b
11-a
12-d
13-a
14-f
15-d
16-b
17-a
18-a
19-f
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Section 5 : Parasitology , Mycology and Virology
1- HBV is ?
a. DNA virus
b. RNA virus
c. Both
2-HCV is ?
a. DNA virus
b. RNA virus
c. Neither a nor b
3- The infectious hepatitis ?
a. Hbe Ag
b. Hbe Ab
c. Hbe IgM
d. HBs. Ab
e. HBs. Ag
4-Epidemiologically ; HBV is considered more significant than HCV , Is this

statement true or false ?
a. True
b. False
5-Pathologically ; HCV is considered more significant than HBV , Is this

a. True
b. False
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6- HAV mode of transmission ?
a. Contaminated food and water

b. By Parenteral and Sexual routes
c. Urine and stool ( the most ) .
7- Which marker of the following shows positive result for HBV diagnosis ?
a. HBs Ag
b. HBc IgM
c. HBc IgG
d. Hbe Ag
e. Hbe Ab
f. HBs Ab
8- According to Acute and Chronic HBV infection ?
a. In acute HBV infection , we detect HBc IgM antibodies

b. In chronic HBV infection , we detect HBc IgG antibodies
c. ( a and b ) are true
9- In acute Infection , HBc IgM is rapidly observed of positive result , and

then rapidly hidden to be negative , is this statement true or false ?
a. True
b. False
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10- In HBV chronic infection , HBc Total Ab’s delay in it’s appearance to get
a positive result , then it’ll become positive along the life ?
a. True
b. False
c. In addition to it’s appearance in the chronic infection , it also appears in
the carrier status ( case ) .
d. Both a and c are correct
11- To differentiate between chronic vs. carrier state , which tests of the
following are required ?
a. AST ( GOT )
b. ALT ( GPT )
c. Hbe Ag
d. HBV-PCR
e. All of the above are required
12- In chronic HBV ?
a. ALT is elevated
b. AST is elevated
c. Hbe Ag is positive
d. HBV- PCR is positive and high
e. All of the above are correct
f. All of the above are incorrect
13- In HBV carrier ?
a. ALT is Normal or slightly increase

b. AST is Normal or slightly increase
c. HBe Ag is Negative
d. HBV- PCR is Negative
e. All of the above are correct
f. All of the above are incorrect
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14- Which of the following indicate that the patient of HBV need treatment
and follow up or not ?
a. When AST and ALT as liver enzymes are elevated so the case is getting
worsen
b. When HBe Ag is positive , this will indicate that the virus is rapidly
replicate and this is an alarm of acute infection .
c. HBs Ag is positive , which show that the patient have the infection of at
least 6 months and it is persist to be chronic or in the carrier status .
d. All of the above are involved
15- Which of the following is an indication of convalescence (( recovery ))

improvement of HBV patient ?
a. HBs Ab is positive
b. HBs Ag is Negative
c. HBs Ab is positive and show a steady state level forever of life
16- According to HBV window period ?
a. In the end of the third month of the infection

b. HBs Ag is Negative
c. HBs Ab is Negative
d. HBc IgM is Positive
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17- Which of the following marker is detected in immunized person ?
a. Anti HBs ( HBs Ab. )

b. Anti HBc ( total HBc Ab. )
c. Anti HBc IgM
18-According to Past Infection of HBV ?
a. HBs Ag will be Negative

b. HBc Ab total ( IgM and IgG ) will be positive
c. HBs Ab will be positive
19- What are the tests required for HBV diagnosis and control ?
a. HBs Ag
b. Hbe Ag
c. HBc IgM
d. HBc IgG
e. HBs Ab
f. AST
g. ALT
h. HBV PCR
i. All of the above are required
j. None of the above
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20- Patient with :
HBs Ag : Negative
Total HBc Ab : Negative
HBs Ab : negative
What’s the possible interpretation for this case ?
21-Patient with :
HBs Ag : Negative
Total HBc Ab : Positive
HBs Ab : Positive
22-Patient with :
HBs Ag : Negative
Total HBc Ab : Negative
HBs Ab : Positive
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23-Patient with :
HBs Ag : Positive
HBc IgM Ab. : Positive
HBs Ab : Negative
24- Patient with :
HBs Ag : Positive
HBc IgM Ab : Negative
HBs Ab : Negative
25-Patient with :
HBs Ag : Negative
HBs Ab : Negative
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26-HIV is ?
a. DNA virus
b. cDNA virus
c. RNA virus
27- The confirmatory method for HIV ELISA test result ?
a. PCR
b. Western blot
c. In Situ Hybridization .
28- What the type of CDs that decreases in the HIV infection ?
a. CD8+
b. CD4+
c. CD4+ and CD8+
29-EBV cause ?
a. Infectious mononucleosis .
b. Influenza
c. Dysentery
30- Rubella IgM positive ?
a. Recent infection .
b. Old ( previous ) infection .
c. Immunity .
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31- Rubella IgG titer ?
a. Immunity
b. Recent Infection
32- In the Viral meningitis ?
a. Low sugar level , high protein level

b. Low sugar and Low or normal protein level .
c. Elevation of Lymphocyte .
d. ( b and c ) are correct .
33- By needle sticks , what is of the following has the most chance of
transmission to the technicians ?
a. HIV
b. HBV
c. HCV
34-During blood withdrawing , the technician exposed to patient blood by the

used needle , to excluding the transmission of hepatitis virus to the technician ,
what tests should be done ?
a. HBV PCR for both patient and technician

b. HBs Ag for both
c. HBs Ag ,HBc IgM Ab and HCV antibodies for the patient
d. HBs Ag , HBc IgM Ab and HCV Ab for technician
35-Candida Albicans test is ?
a. Germ tube test

b. Nitrocellulose test
c. Nutrient agar
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36- KOH concentration in the fungi test ?
a- 3%
b- 7%
c- 10%
37- Fungi on RT are called Fungus, but on 37˚C are called Yeast... Is this
statement true or false?
a. True
b. False
38- The media that is used to cultivate fungi ?
a. MSA
b. MacConkey
c. SDA
d. MHA
e. BA
39-Watery stool with pus cell and RBCs in it , which parasite is suspected ?
a. E. histolytica
b. Giardia
c. Trichomonas
40-The parasite that is present mainly in the urine sample ?
a. Trichomonas
b. Enterococcus
c. Enterobius
d. Giardiasis
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41-For the diagnosis of Enterobius Vermicularis , do ?
a. Pre – anal scotch tap

b. Swab from anal
c. Stool analysis
42-Trypanosoma Cruzi cause ?
a. Chagas disease
b. Malaria
c. Hodgkin’s disease
43-The Vector that transmit Trypanosoma Cruzi ?
a. Tse - Tse fly

b. Sand Fly
c. Big bug
44- The flagellated parasite that is found in the stool , with diarrhea and pus ?
a. E.coli
b. Giardia Lamblia
c. Trichomonas
45- Toxoplasmosis ?
a. Cause abortion .
b. Cause retinopathy
c. Reservoir host ( cats )
d. All are correct .
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46- To confirm the presence of E.histolytica in stool sample ?
a. Make a smear with D.W.

b. Make a smear with N.S.
c. Make a smear with Iodine ( for the cyst detection ) .
47- The most detected parasites that are found in the urine ?
a. Trichomonas Vaginalis
b. Entamoeba coli
c. Enterobius Vermicularis ova
d. Schistosoma hematobium ova
e. ( a and b ) are correct .
f. ( a, c and d ) are correct .
48- The traditional technique for the diagnosis of malaria ?
a. CBC and differential

b. Thin and thick blood film
c. PCR
49- Trypanosoma b. gambiense cause “ Acute Sleeping Sickness “ Is this

a. True
b. False
50-Trypanosoma b. rhodensiense cause “ Chronic Sleeping Sickness “ Is this

statement true or false” ?
a. True
b. False
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51-Wuchereria bancrofti cause “ Elephantiasis / Lymphatic Filariasis “ . Is

this statement is true or false ?
a. True
b. False
52- Loa Loa ; it’s called as “ eye worm “ and cause Eye infection . Is this
statement is true or false ?
a. True
b. False
53-Taenia solium and Taenia saginata are “ Tape Worm “ and they are found
in pork and beef , respectively . Is this statement is true or false ?
a. True
b. False
54- Hymenolepis nana is called “ Dwarf Tape Worm “ . Is this statement is

true or false ?
a. True
b. False
55- Diphyllobothrium latum (the fish or broad tapeworm ) cause vitamin b12
deficiency . Is this statement is true or false ?
a. True
b. False
56-Echinococcus granulosus cause “ Hydatid disease or Hydatidosis “ . Is this

statement is true or false ?
a. True
b. False
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57-According to infection stage and site of distribution , Types of Plasmodium

parasite which cause malaria are ?
a. P.vivax
b. P.malariae
c. P.falciparum
d. P.ovale
e. These subtypes are detected by a thin film stained by “ Leishman and
Giemsa stain .
58- E.histolytica Trophozoite characterized in the direct stool examination by?
a. Active Purposeful
b. RBCs inside it
c. Fingerlike appearance
d. Nucleus generally visible
e. Granular Cytoplasm
g. ( a , b and c ) are true
h. All of the above are true
59-E.histolytica cyst characterized in the direct stool examination by ?
a. Round cell
b. It has a refractile wall
c. It has 1-4 nucleus , which is difficult to visualize them
d. Refractile Chromidial bar inclusion
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60- In Iodine Preparation For E.histolytica ?
a. Trophozoite nucleus have yellow ring conjugated with yellow dot

karyosome
b. Karyosome appear in cyst and trophozoite
c. a and b are true
61-According to iron hematoxillin stain , it’s used to stain cyst and trophozoite
karyosome will appear black central dot and RBCs appear black ?
Is this statement is :
a. True
b. False
62- Leishmaniasis sign and symptoms ?
a. Fever
b. Weakness
c. Loss of weight
d. Pallor
e. Later Jaundice
f. Darkening of skin
g. All of the above
h. None of the above
63-In the case of leishmaniasis , The lab findings are ?
a. Elevated ESR
b. Albuminuria
c. Watery stool
d. Elevated Bilirubin
e. Leishmanial form is found in Reticuloendothethelial cell by blood film
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64-Schistosoma haematobium , in the chronic disease can be seen in
( 10-15% ) of seminal fluid cases . Is this statement are true or false ?
a. True
b. False
65- The most organism/s that is/are cause infection in the

immunocompromised patients ?
a. Candida
b. T.B.
c. Bacteria ( as Pseudomonas ) .
66-PCR Technique is now mostly used in the developed countries for the
diagnosis of viruses . Why ?
a. Robust
b. Accuracy
c. Sensitive
d. Specific
e. Rapid
f. All
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1-a
2-b
3-a
4-a
5-a
6-d
7-a
8-c
9-a
10-d
11-e
12-e
13-e
14-d
15-d
16-d
17-a
18-d
19-i
20-Susceptible Person
21-Immunity due to Natural ( Past ) Infection
22-Immunity due to HBV vaccine administration
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23-Acute Infection
24-Chronic Infection
25- 1-Resolved Infection is most common
2-False Positive HBc Ab thus susceptible
3-Low level due to chronic infection
4-Resolving of acute infection
26-c
27-b
28-b
29-a
30-a
31-a
32-d
33-b
34-c
35-a
36-c
37-a
38-c
39-a
40-a
41-a
42- a
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43-b
44-b
45-d
46-c
47-f
48- b
49-b
50-b
51-a
52-a
53-a
54-a
55-a
56-a
57-f
58-h
59-e
60-c
61-a
62-g
63-f
64-a
65-d 66-f
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Information’s may help you in your practical training
Sections included :
1- Reception ( Out/in Patient )
2- Hematology
3- Serology
4- Blood Bank
5- Coagulation
6- Clinical Chemistry
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Section no. 1 : Out/In – Patient “ Reception “ :
Tube Type Color Anticoagulant Anticoagulan Expected

concentration t: Use
Blood ratio
EDTA K3 Green 2% of EDTA solution Optimally 1.5 Ca Chelating
(Ethylenediaminet Or mg EDTA per agent ..
etraacetic acid ) Purple 1ml of whole Plasma that is
blood .. collected by this
type of tubes
used for any
test except Ca ,
K or enzymes .
Sodium Citrate Bright pink 3.6% 1:4 ESR test
or black 200:800 (( Erythrocyte
400:1600 Sedimentation
ratio ))
Blue 3.2% 1:9 For Coagulation
100:900 tests as PT , PTT
200:1800 , Fibrinogen or
D-Dimer , etc.
Plain Red 1- With additives Regardless 1-For Serology
2-Without additives and Chemistry .
2-For Serology ,
Chemistry and
PCR
Lithium Heparin Gray _ _ Prevent

Glycolysis
occurrence .. so
preserve the
blood for
extended
periods
** Other blood tube types as “ Sodium Fluoride “ is used to preserve glucose
in whole blood and for some special chemistry tests.
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Notes :
** Collect the blood in the suitable tube depend on the requested tests ..
** Emptying the blood in the tubes by priority “ as requested tests “ :
PT ( INR ) /PTT , ESR , CBC then Plain ..
Arms veins :
“ Keep in your mind ; Patients Life and Safety should be our aim “ ..
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Laboratory Process Stages :
1. Pre-analytical Stage 46% : reseiving and labeling ( Patient’s name ,

age , date of birth and sample type ) .
2. Analytical Stage 7% : Pippeting , sample and reagents preparation ,
checking the instrument (( check calibration requirement ( we’ll discuss
it in details later ))) , incubation , dilution if needed , measuring and
calculation .
3. Post- analytical Stage 47% : Record the results, make a review
( for both the patients data and results ) , be sure that their’s no
exchange between the samples , Print the results report .
Notes Related to the reception section :
** Avoid needle recaping because recaping will transmitt blood - born

diseases :
- HBV of 30%
- HCV of 1-3%
- HIV of 0.32%
**We use for disinfecting patients puncturing area 70% alcohol instead of
90% , because 90% alcohol is more concentrated so it’ll be vaporized . While
,The 70% alcohol penetrate the bacterial cell wall so it’ll kill it .
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Q:
We will calculate the required volume of 96 % alcohol to prepare 0.5 ml of

70% alcohol .
A:
𝑴𝟏 × 𝑽𝟏 = 𝑴𝟐 × 𝑽𝟐
70×500=96×V2
, V2=364.58 µl of 96 % and 135.42 µl of Distilled water .
Antiseptic Related Informations
** Use Hexidium Chloride to kill 99% of microorganisms “

especially for get rid off stool and urine slides “ ..
** For Positive Hepatitis blood :
 Wear gloves while collecting the suspected patient sample
 Prepare a urine cup with chloride , put the used tips ,

strips and epindroff tubes in this cup , in addition to the
sample tube , but before that add 2Cs Chloride in it ..
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Section no. 2 : Hematology
Before talking about the automated working in this section , we should firstly
know about the principles of manual counting “ Routine Hematology Methods “
1- We’ll begin with , Red Blood Cells count :

RBCs diluent : Hayem’s Solution , and we can use Normal isotonic Saline
instead of it ..
Procedure :
1. Mix 1990 µl of normal saline( Hayem’s Solution ) with 10 µl of the

EDTA whole blood in a test tube , let the mixture to settle for 10 min’s .
2. Clean the hemocytometer ( champer ) , take 20 µl from the mixture
after putting the cover slip on the reading center area , and insert it into
the two sides ..
3. Then count the red blood cells in the central square ( RBCs square ) ..
count in the 5 red squares that are seen in this picture :
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Calculation for RBCs Count :
𝒏𝒐.𝒐𝒇 𝒄𝒆𝒍𝒍𝒔 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 ×𝑫𝒊𝒍𝒖𝒕𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓

RBCs/mm³ =
𝒏𝒐. 𝒐𝒇 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 𝒔𝒒𝒖𝒂𝒓𝒆𝒔 × 𝑽𝒐𝒍𝒖𝒎𝒆 𝒐𝒇 𝒐𝒏𝒆 𝒔𝒒𝒖𝒂𝒓𝒆
𝒏𝒐.𝒐𝒇 𝒄𝒆𝒍𝒍𝒔 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 ×𝟐𝟎𝟎

= 𝟓
( ) ×𝟏×𝟏×𝟎.𝟏
𝟐𝟓
So , RBCs/mm³ = no. of cells counted × 10000
…………………………………………………………………………….............
2- White Blood Cells Count :

The Diluent Solution : Turk’s Solution / or we can use Glacial Acetic Acid.
Procedure :
1. Mix 190 µl of Turk’s solution with 10 µl of EDTA whole blood in a test

tube , let the mixture to settle for 1 min ..
2. Then take 20 µl of the mixture after preparing the hemocytometer and
the cover slip , insert this amount into the two sides ..
3. Then count in the 4 periphral squares of the hemocytometer ( WBCs
squares ; ( The 4 blue squares that are shown in the previous picture ) ..
Calculation for WBCs count :
𝒏𝒐. 𝒐𝒇 𝒄𝒆𝒍𝒍𝒔 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 ×𝑫𝒊𝒍𝒖𝒕𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓

WBCs/mm³ =
𝒏𝒐.𝒐𝒇 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 𝒔𝒒𝒖𝒂𝒓𝒆𝒔 × 𝑽𝒐𝒍𝒖𝒎𝒆 𝒐𝒇 𝒐𝒏𝒆 𝒔𝒒𝒖𝒂𝒓𝒆
𝒏𝒐.𝒐𝒇 𝒄𝒆𝒍𝒍𝒔 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 ×𝟐𝟎

=
𝟒×𝟏×𝟏×𝟎.𝟏
= no. of cells counted × 50
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** Note : For the presence of nucleated RBCs ( 5 or more for 100 WBCs ) , the
WBCs count should be corrected :
𝑼𝒏𝒄𝒐𝒓𝒓𝒆𝒄𝒕𝒆𝒅 𝑾𝑩𝑪𝒔 𝒄𝒐𝒖𝒏𝒕 ×𝟏𝟎𝟎
Corrected WBCs count =
𝟏𝟎𝟎 + 𝒏𝒐.𝒐𝒇 𝑵𝑹𝑩𝑪𝒔 𝒑𝒆𝒓 𝟏𝟎𝟎 𝑾𝑩𝑪
……………………………………………………………………………………..
3- Hemoglobin Determination ( Cynmethmoglobin method )

** Diluent Solution : Drubkin’s reagent ( Which contains Potassium cyanide
and Pottasium Ferricyanide) .
Principle :
1- Hemoglobin ( contain Fe ⁺² (( Ferrous )) ) is converted to

Methemoglobin (( contain Fe ⁺³ (( Ferric )) ) By Ferricyanide .
2- Then , The methemoglobin combines with Pottasium Cyanide to

form : stable cyanmethemoglobin ..
Note: The optical density of this solution is measured at wavelength of 540 nm

and it’ll be ( Absorbance ) proportional to the [ Hb ] in the blood .
Procedure : add 5 ml of Drubkin’s reagent into 2 tubes ( one of them for blank )
, add in one of them 20 µl of blood , mix , let for 10 min’s to stand then read the
absorbance at 540 nm ..
** Calculate the [ Hb ] by using the standard chart for [ Hb ]detection
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4-Hematocrit determination ( HCT ) or ( PCV : Packed

Cell Volume ) :
It’s based on the : Centrifugation of the blood , then measure the
HCT as a ratio between RBCs volume and the whole blood
volume .
Used blood :
** If finger blood , put them in heparinized capillary tube .
** If EDTA blood , put them in plain capillary tube .
Procedure :
1. Fill the capillary tube to more than ¾ full .

2. Seal the end of the tube by clay or flame .
3. Centrifuge the capillary tube ( the sealed end away from the
center ) for 5 min from 10000 to 12000 rpm . If the
hematocrit exceeds 50% add another 3 minute .
4. Read the HCT by HCT reader .
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RBC indices
𝑯𝑪𝑻(%) ×𝟏𝟎
 𝑴𝑪𝑽 =
𝑹𝑩𝑪𝒔 𝒄𝒐𝒖𝒏𝒕 ( 𝒊𝒏 𝒎𝒊𝒍𝒍𝒊𝒐𝒏𝒔/𝒎𝒎ᶟ )
𝑯𝒆𝒎𝒐𝒈𝒍𝒐𝒃𝒊𝒏 𝒈/𝟏𝟎𝟎𝒎𝒍 ×𝟏𝟎

 MCH =
𝑹𝑩𝑪𝒔 𝒄𝒐𝒖𝒏𝒕 ( 𝒊𝒏 𝒎𝒊𝒍𝒍𝒊𝒐𝒏𝒔/𝒎𝒎ᶟ )
𝑯𝒆𝒎𝒐𝒈𝒍𝒐𝒃𝒊𝒏 𝒈/𝟏𝟎𝟎𝒎𝒍 ×𝟏𝟎𝟎

 MCHC =
𝑯𝑪𝑻 (%)
Conclusion :
MCV The average volume of Cfl

RBCs
MCH The average weight of Pg
Hemoglobin in the RBC
MCHC The average %
concentration of Hb in
RBC
( the ratio of the weight
‫ت‬
of the hemoglobin to the
volume of the RBC)
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5-Reticulocyte Count :
 Reticulocytes are young , newly circulating erythrocytes .
 Retain aggregates of ribosomal RNA , seen as dense blue granules or

Filaments .
 This filaments are stained with supravital stains such as : Brilliant

Cresyl Blue ( BCB ) .
 These Filaments in the reticulocytes form network , or reticulum and

can be stained only while the cells are viable , not on a dried film .
The used sample for reticulocyte counting :
** Venous blood treated with EDTA anticoagulant or capillary blood

may be used .
Note : Heparinized blood should be avoided because the staining quality

will be poor .
Procedure :
1. Add 2 drops of the required blood in a test tube , and mix it with 1
drop of Brilliant Cresyl Blue ( BCB stain ) , incubate at 37ºC for 10
min.
2. Then prepare a thin blood film .
3. Allow it to dry , then examine it under oil immersion .
4. Count 1000 RBCs and record the number of reticulocytes ..
Reticulocytes : will appear : Light Green – Blue in color and the
Reticulum is deep blue ..
5-Report the number of reticulocytes/100 Erythrocytes ..
Adult Male 0.5-1.5%

Adult Female 0.5-2.5%
Newborn 2-6%
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Reticlocytosis Vs. Reticlocytopenia :

“ Reticulocytosis “ Hereditary Spherocytosis , Sickle cell
Reticulocyte count increased in : anemia and other hemoglobinopathies
, Thalassemia , Paraxosymal
nocturnal hemoglobinuria , Acquired
autoimmune hemolytic anemia ,
Hemolytic disease of newborn , Acute
hemorrhage and regenerate phase in
bone marrow failure as aplastic
anemia , Folate deficiency and iron
deficiency anemia .
“ Reticulocytopenia “ Perincious anemia , aplastic anemia
Reticulocyte count decreased in : and bone marrow failure of various
types of anemia .
……………………………………………………………………………………
6-Platelets Count :
Principle :
1% ammonium oxalate lyse RBCs , but platelets , leukocytes and reticulocytes

are preserved .
 The used diluting fluid is “ The WBCs diluting solution “ Turk’s Solution
“ / or acetic acid instead of .
 The same as WBCs manual counting procedure , then allow it 10 min to
settle in covered petri dish with a moistened piece of filter paper in the
bottom to prevent drying for 10 min .
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Calculation:
*Count in the 5 RBCs squares ( from the 25 RBCs squares ) :
𝒏𝒐.𝒐𝒇 𝒄𝒆𝒍𝒍𝒔 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 ×𝒅𝒊𝒍𝒖𝒕𝒊𝒐𝒏 𝒇𝒂𝒄𝒕𝒐𝒓
Platelet’s/mm³ = 𝟏 𝟏
×𝟏×𝟏×
𝟓 𝟏𝟎
= 𝒄𝒆𝒍𝒍 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 × 𝟐𝟎 × 𝟓 × 𝟏𝟎
= 𝒄𝒆𝒍𝒍 𝒄𝒐𝒖𝒏𝒕𝒆𝒅 × 𝟏𝟎𝟎𝟎
*Platelets normal range : 140 × 10³ - 440 × 10³ /mm³
………………………………………………………………
Now , we will talk about the ‘ automated Hematology Analyzer
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The principle of Hematology Analyzers
 Current hematology analyzers use a combination of light scatter, electrical

impedance, fluorescence, light absorption, and electrical conductivity
methods .
Cells’ Volume Electronic Impedance
Cell size and cellular Light Scatter

Characteristics
Internal Cell Structure Conductivity / Radio

and Density Frequency RA
Analyze RNA/DNA Fluorescence

content
Calibration of “ The Hematology Analyzer “
* The same principle for almost CBC instruments .
* Manual Calibration is better than Automated Calibration because by manual

calibration we can control each parameter separate from each other not as in the
automated calibration which all of these parameters affected equally if we use a
defected control . Manual Calibration reflects your own conditions .
…………………………………………………………………………………….
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When ? I should calibrate my CBC instrument :

After :
1- Maintenance of the instrument .
2-Changing the lot number of the reagent ( Here, in CBC instrument it’s close
system ) .. Note that the calibration for the instruments of open system
reagents face many difficulties .
3- No UPS for the instrument ( UPS : Uninterrupted Power Supply ) .
4- Suspected results of HCT , RBCs and Hb , not applied on the rule of three
(we will discuss it later) .
5- Depend on the grading system of EQAS ( External Quality Control System)

reply on the sent results of their samples and grade the results depending on
it’s position of which standard deviation as :
Excellent < 1s , Very Good < 2s , Good > 2 or bad > 2.5
How we calibrate the hematology analyzer ?
1- Repeat the control 3-5 x and take the mean .
2- Divide the mean of the control ( Provided by the manufacture ) by the

mean obtain by the instrument and get the factor . Introduce the factor
into the machine .
3- The daily control values should oscillate around the mean very closely
( Range I ) but not beyond ( Range II ) .
4- Don’t take into account the range provided by the manufacturer because
it is irrelevant to SD .
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Restrictions on ESR test :
. ˚90 ‫** وور على زاو ة قا مة‬
. ˚3 ‫** أ انحماف ف ال او ة توحمف القما خ‬
. ‫** تطور وضع بالقمب من أجه خ أو متان قابل للتحم ك أو معمض لالهت از‬
Principle of ESR :
* Roulex Formation .
* Fibrinogen concentration in the blood sample .
Interpretation on the ESR results :
*When ESR result is equal 0 :
This is happen in ;
Pathological cases : Sickle cell , Spherocytosis ( No roulex formation ) .
Non Pathological case / Technical : not enough mixing of the blood with the
anticoagulant ( Na citrate or EDTA ).
** ESR is equal 1,2 : In Polycythemia .
* High ESR value indicator of :
Inflammation , Rheumatoid Arthritis, ( Cancer > 100 but not always ) .
*Because of the high false positive result that will result of pregnant women we
shouldn’t do this test for them due to physiological changes during pregnancy .
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Erythrocyte Sedimentation rate Normal levels in general,

1-Men 0–15 millimeters per hour (mm/hr), or 0–20 mm/hr for men older than 50
2-Women 0–20 mm/hr, or 0–30 mm/hr for women older than 50
3-Children 0–10 mm/hour
4-Neonatal to puberty: 3 to 13 mm/hr , but other laboratories place an upper limit
of 20
5-Newborns 0–2 mm/first hour
** Try to collect at least 1 ml of blood in the EDTA tube ( especially for CBC
test) : to be with the appropriate ratio between anticoagulant and blood , and it’ll
reflect the blood content of the body ( representative sample of the 10 ml of the
body blood ) .
** The Effect of hemolysis on the Lab test results :
Degree of change Increased Decreased May increase or

decrease
*Slight Change Phosphate , Total Haptoglobin and
protein , Albumin , bilirubin
Mg , Ca and Alk .
*Noticeable ALT , CK , Iron ,
Change coagulation tests
HB , RBCs ,
*Significant K , LD , AST Troponin T MCHC , Platelets
Change count
*Recollect the blood sample which have a gross hemolysis .
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Differentiation between B-thalassemia and IDA :
Iron Deficiency B-thalassemia

Anemia
CBC results Low MCV Low MCV
Low RBCs < 4.2 High RBCs > 5.7
Low Hb & MCH Low Hb & MCH
High RDW up to 20-22 Normal or slightly
MCV/RBC > 13 increase RDW
MCV/RBC < 13
Blood Film results Microcytic , Microcytic ,
Hypochromic Hypochromic
High Reticulocyte count
Confirmed by : TIBC Hb electrophoresis ,
Total Iron Binding when A2 > 3.6 , if A2 is
Capacity within the borderline
3.2-3.6 so do PCR .
*In Sideroblastic Anemia , RDW is above 30,40,45 , Platelets count
is also high so it need a correction , and RBCs histogram is not smooth,
we shouldn’t give the patient blood .
** Megaloblastic Anemia :
 Appears in Vitamin B12 and Folic acid deficiency .
 Macrocytic , Normochromic cells .
 MCV is elevated .
 Diagnosed by measuring of vitamin B12 and folic acid level in the

blood .
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Related to vitamin b12 deficiency ;
Pernicious anemia : is an autoimmune disorder such as thyroid disorders,

Type I Diabetes or Addison disease . This A.bs’ attack the parietal cells
and so prevent them from forming INTRENSIC FACTOR (IF) so weak
vitamin b12 absorption SO DEFICIENCY .
Fanconi Anemia : “It’s a type of aplastic anemia “

It’s a congenital aplastic anemia , it’s an autosomal recessive inheritance ,
characterized by hematologic abnormalities since birth , familial occurrence
(more than one member in the same family ) , with the presence of associated
congenital defects .
The physical abnormalities of Fanconi’s anemia are :
o Skeletal defects ( aplasia or hypoplasia of the thumb )

o Cutaneous Hyperpigmentation
o Renal Abnormalities
o Microcephaly
o Mental Retardation and Poor Growth
o Pancytopenia : Progressively worse with age .
o Symptoms appear from 5-10 years of age
o The Bone Marrow show normocellular or hypercellular , but over time
hypoplasia will be develop .
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Section 3 : Serology
**Mainly Serology Tests depend on : Antigen – Antibody reaction .
** Examples of Serology Tests :
CRP , RF , ASOT , Brucella and Widal test .
** Detection of specific antibodies against certain type of antigen .
** Prozone Phenomenon : An excessive amount of antibody in serum , so no

cross linking and lattice formation , so a false negative result will be obtained in
the non-diluted sample , you can solve this problem by serum dilution to reduce the
number of antibodies , and allow it to bind with the antigen and so lattice
formation will be observed .
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** Serial dilution (( For semi-quantitative analysis )) : to measure the antibody

titer in the sample , we perform serial dilution and detect to which dilution the
antibodies are still present and react with the manufactured antigens .
Procedure :
**Add to each tube 200µl of normal saline or distilled water
** Then add to tube( no. 1) 200µl of the patient serum , then take 200µl of the
diluent to the next tube , and the same to the last tube , take 200µl of the 6th (Last)
tube and get rid of them away .
200µl of patient serum
1 2 3 4 5 6
1/2 1/4 1/8 1/16 1/32 1/64
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Calculation of the Serial Dilution results :
1- 200/200+200 = 200/400 = 1/2

2- 1/2 × 1/2 = 1/4
3- 1/4 × 1/2 = 1/8
4- 1/8 × 1/2 =1/16
5- 1/16× 1/2 = 1/32
6- 1/32 ×1/2=1/64
Then , by using the plate ( that designed for serology tests of black
circles ) take one drop of each tube to numbered circles 1,2,3…… as 1
for 1/2 dilution and so on ..
*add one drop of the reagent ( antigens ) to each circle , and mix ..
*Then observe in which circles the apparent agglutination is still

observed until 2 minutes , the last dilution which has agglutination it
will represent the reciprocal of the titer ..
In simple way : e.g. : If we observed agglutination in ;

1/2, 1/4 and 1/8 , so 8 is represent the titer of this Antibody .
** But when we talk about :
CRP test : the least titer/concentration of antibodies is equal 6mg /L as

semi-quantitative measurement .
ASOT : the least titer = 200 Iu/ml
RF : The least titer = 8 Iu/ml
** e.g. : For CRP : multiply Antibody titer by 6
For ASOT by 200 and for RF by 8 .
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Section no 4 : Blood Bank
This section is enjoyable and has many duties that you should be know .
Primarily , we’ll talk about the preparation of donor :
** Donors can be :
1- volunteer
2- for family replacement ; ( For Thalassemic patients who require a regular
blood transfusion ) , or pregnant women who will undergo a delivery
operation , or ordinal patients who are bleed or have a coagulation
problem or other defects and should have an operation .
** What should we do before accepting donor for donation

process ?
1- Ask him/her about their age and weight ?

He/she should be 17 years old or older with at least 50 kg and has a
good health .
2- Ask him/her about his/her previous donation ?

If he/she undergo a donation process previously , he/she should wait
for at least 8 weeks ( about 2 months , it preferred 4 months ) for the
next donation .
3- Collect a blood sample for CBC and Blood group tests

** we should take 2 tubes from the donor blood during the process
from the specific bag for this requirement ( EDTA and plain tube ) ,
label this tubes with donor name and blood unit serial number .
** Seal the blood unit , take a segments (about 3 segments and be
care to let the no. of the unit at each segment , this segments will be
used for testing the blood unit and so avoid opening the closed system
of the unit ( For keeping the blood unit in a closed system ) .
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** What should we do after sealing process of the blood unit is

completed ?
We begin “ Testing Process ” of the blood unit , mainly the tests that are
performed nearly in all labs in our community are :
1- Forward Blood Group

2- Reverse Blood Group
3- Syphilis ( although that T.pallidium killed at low temperature during
putting blood unit in the refrigerator for 6 hr’s ) but it’ll be done as a
protocol or for freshly collected units .
4- Virology as ( HIV , HBsAg and HCV ) .
**Forward Blood Group in details :

This test is used to detect the presence of A, B or D antigens on red blood cells
surface .
Procedure Forward Blood Group tube method :
1- Prepare 4 tubes label them by the number of the unit with A, B, Rh and
Suspension respectively .
2- Add 950 µl of normal saline to the suspension tube , with 50 µl of the EDTA
whole blood , Mix them gently .
3- Add 2 drops of Anti A, B , D to A, B , Rh tubes respectively .
4- Add 2 drops of the cell suspension to each tube that mentioned above .
5- Centrifuge these 3 tubes for 60 seconds at 3500 RPM . Mix gently and
observe for agglutination and record .
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** If the Rh result is negative , perform du cell testing .

Du cell test purpose : Certain people may have weak expression for antigen D or
other Rh blend antigens / or other types of weak D . So when we obtained a
negative Rh result for them in the forward blood group test , we should confirm
this result and exclude being du status , this will happen by :
** We can do this confirmation process by “ Indirect Coomb’s test tube

method we will discuss it later , The tube method which depend on
washing and adding AHG is the most accurate method .
Reverse Blood Group Test in details :
This test is used to detect if the donor has Anti A or B in her/his serum .
1- Prepare 2 tubes , add 2 drops of donors serum to each tube .
2-Then add 2 drops of A and B cell suspension to each tube , respectively .
3-Centrifuge the mixture for 60 sec. at 3500 RPM
4-Observe for agglutination and record the results .
The distribution of blood types in the U.S. is as follows According

to AABB :
O Positive 38%
A Positive 34%
B Positive 9%
O Negative 7%
A Negative 6%
AB Positive 3%
B Negative 2%
AB Negative 1%
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**Roulex formation vs. Agglutination reaction :
Roulex Formation Agglutination Appearance
 Associated with Inflammation , Found in :

Cancer , polycythemia .  Antigen-Antibody reaction
 Which is the overcome of zeta  In Serology tests , when there are
potential between red blood cells antibodies directed against specific
( that make a repulsion between antigen as in CRP , ASOT , RF ,
them of negative charge ) . widal or Brucella tests .
 Indicated by Elevated ESR level
Direct vs. Indirect Coomb’s Test :

Direct CT Indirect CT
To detect red blood cells sensitization To detect A.b’s circulating in the
with antibodies in vivo . patient’s blood .
In vitro Sensitiztion of RBCs.
Associated with autoimmunity ( Ab’s Associate with multi – blood
against own cells ) transfusion .
( Ab’s against non – self cells )
Related to HDN Related to HTR
*Hemolytic disease of newborn *Hemolytic Transfusion Reaction
Cross Match Test “ Compatibility “ :

Checking if the patient has antibodies against donor cells ( major CM ) or the
donor has antibodies against patient cells ( minor CM ) :
Major CM Minor CM
Detection of antibodies in patient Detection of antibodies in donor
serum against donor’s cells serum against patient’s cells
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Section no.5 : Coagulation
 The Coagulation Factors
I : fibrinogen
II : Prothrombin
III: Tissue Factor
IV: Ca⁺²
Va: Proaccelerin
VII: Proconvertin
VIII: Anti-hemophilic Factor
IX: Christmas Factor
X: Stuart-Power Factor
XI: Plasma Thromboplastin Antecedent
XII: Hageman Factor
XIII: Fibrin stabilizing Factor
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Coagulation Cascade :
Coagulation Related Tests :
 Prothrombin Time ( PT ) is represent the extrinsic pathway

 Activated Partial Thromboplastin Time ( PTT ) is represent the
intrinsic pathway
 Clotting time ( CT ) is represent the clotting factors
 Bleeding time ( BT ) is represent Vein Integrity and Vasoconstriction .
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The most common Coagulation Disorders
Defect in Coagulation Disorder Disease Definition
Platelets : Thrombocytopenia It is a decreased in

Quantitatively Platelets Production
( count ) or due to congenital or
Qualitatively acquired disorders ,
( Function ) which affect the bone
marrow resulting in
megakaryocytic
hypoplasia .
ITP (( Idiopathic This disorder is one of
Thrombocytopenic the most common
Purpura )) causes of
thrombocytopenia as a
result of immune
mediated platelet
destruction .
Non- immunologic This disorder is
Thrombocytopenia characterized by
(( Thrombotic Hyaline micro-
Thrombocytopenic thrombi composed of
Purpura )) platelets and fibrin
that occlude arterioles
and capillaries in
multiple organs .
Localized Fibrinolytic
activity is absent in
the vessels that are
occluded by these
micro thrombi .
Hemolytic Uremic This disease is
Syndrome characterized
clinically by
microangiopathic
hemolytic anemia ,
thrombocytopenia and
renal failure .
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DIC A syndrome that

(Disseminated results in the
Intravascular pathologic generation
Coagulation) of thrombin and
plasmin , it presents
with clinical
manifestations of
hemorrhage and
thrombosis .
A significant
thrombocytopenia is
seen in DIC as a result
of increased Platelet
destruction and
decreased platelet life
span .
Thrombocytosis Increased in Platelet
Counts , which
indicates that there is
increase in platelets
production or
proliferation of
megakaryocytosis .
May result from
reactive transient
stimuli to the bone
marrow or may be
associated with an
underlying
malignancy .
Inherited *Hereditary
Blood Vessel Hemorrhagic
Telangiectasia
* Marfan's Syndrome
Acquired *Para-Proteinamia and

Amyloidosis
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Hemophilia A It's a sex Linked

Coagulation Factors recessive bleeding
disorder which Is the
most common
hereditary coagulation
disorder ,
characterized by "
Anti-hemophilic
Factor ”Factor VIII”
deficiency .
Hemophilia B It's a sex Linked
recessive bleeding
disorder ,
characterized by "
Factor IX deficiency "
Hemophilia C It's an autosomal
(( Rosenthal Syndrome )) recessive trait
inherited disorder ,
characterized by
Factor XI Deficiency .
Von-Willebrand Disease It's an autosomal
inherited bleeding
disorders lead to
platelet adhesion
abnormalities
characterized by :
Prolonged Bleeding
Times and
Mucocutaneous
bleeding rather than
hemarthoses and deep
muscle hemorrhage
*It’s also related to the
qualitative platelet
disorders (congenital
disorders of adhesion
which is one of the
platelets’ function ) .
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Section no. 6 : Clinical Chemistry
 At First , we will talk about ‘ The Principle of spectrophotometer’
A spectrophotometer consists of two instruments, namely a spectrometer for

producing light of any selected color (wavelength), and a photometer for
measuring the intensity of light. The instruments are arranged so that liquid in a
cuvette can be placed between the spectrometer beam and the photometer. The
amount of light passing through the tube is measured by the photometer. The
photometer delivers a voltage signal to a display device, normally a galvanometer.
The signal changes as the amount of light absorbed by the liquid changes due to
certain reaction between the sample and the reagent.
For example hemoglobin appears red because the hemoglobin absorbs blue and
green light rays much more effectively than red. The degree of absorbance of blue
or green light is proportional to the concentration of hemoglobin.
 Types of Analysis on Spectrophotometer :

1-Endpoint with standard
2-Endpoint with Factor
3-Kinetic “ enzymatic “ UV
4-Kinetic with factor
5-Fixed Time with standard
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 Clinical Chemistry Tests :

Lipid Profile  Triglyceride
 Total Cholesterol
 HDL-c
 LDL-c
Liver Function Tests (LFT)  ALT ( GPT )
 AST ( GOT )
 Alkaline Phosphatase
( ALP)
 Gamma – Glutamyl
Transferase
 Total protein
 Albumin
 Total and Direct Bilirubin
 Gamma – globulins
 Alpha – fetoprotein
 Ferritin and Transferrin
Cardiac Function Tests  CK-MB
 Troponin
 LDH
 Myoglobin
 CRP
 Lipid Profile
 MPV ( mean platelets
volume ) ( has a predictive
value )
 Natriuretic peptides ( it has
a predictive value )
Pancreatic Function Tests  Amylase
 Lipase
 Trypsin
Kidney Function Tests  Creatinine
 Blood Urea Nitrogen (BUN)
 Protein in Urine
 Creatinine Clearance Test in
24 hrs.’ urine collection
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Tests Related to D.M Definition Interpretation

Fast Blood Sugar (FBS) Detecting Blood Glucose Normally :
Fast Plasma Glucose Level after 70-105 mg/dl
(FPG) 12 hr's Fasting ( over
night)
Random Blood Sugar Detecting Blood Glucose Normally :
(RBS) Level randomly during Less than 200 mg/dl
the day without Fasting
2hr - Post Prandial Blood Detecting Blood Glucose *In General less than
Sugar Test ( 2hr PPG ) Level after 2hr’s of 120 mg/dl
ordinal Daily Diet . *Newborn to 50 years ;
less than 140 mg/dl
*50-60 years ; less than
150 mg/dl
*60 years-older ; less
than 160 mg/dl
Glucose Challenge Test It’s a Screening - Routine  Normal when ;
(GCT) test to check pregnant GCT < 140
women blood glucose mg/dl
level by taking 50g of  When GCT ≥140
Dextrose glucose sugar mg/dl , it might
and so detect the blood indicate
glucose level after 1 hr of Gestational
taking this amount of Diabetes , so
Sugar . confirm it by
OGTT which is
Described below
Oral-Glucose Tolerance It’s rarely used as a For normal , non
Test (OGTT ) Diagnostic tool for pregnant adult people :
Diabetes Mellitus . *FBS 70-105 mg/dl
1- It’s used for the *At 30 min: 110-170
diagnosis of mg/dl
Gestational *at 60 min : 120-170
Diabetes especially mg/dl
if GCT ≥140 *at 90 min : 100-140
mg/dl) around the mg/dl
second trimester or
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for people who has *at 120 min : 70-

FBS of 120-126 120mg/dl
mg/dl ( gray area /
uncertainty ) . IFG : Patients with FBS
2- For the diagnosis of of 110-126 mg/dl ..
impaired glucose Theirs’s a risk for
tolerance (When future D.M.
FBS is not higher
than 140 mg/dl) IGT (who have FBS
3- For the evaluation level of less than the
of a patient with level that decided this
RBS. level of less people is diabetic or
than 140 mg/dl and pre-diabetic patient..
unexplained after 2hr blood glucose
nephropathy , level is 140 - <200
neuropathy or mg/dl
retinopathy . Diabetic ;
 Patient for OGTT FBS > 140 mg/dl
should be overnight At 30 , 60 and 90 min
Fast ≈ 12hr’s and ≥200 mg/dl
take 75 g (BDA)* At 120 min ≥ 140 mg/dl
/100 g (ADA)* Gestational Diabetes ;
Dextrose Sugar FBS > 105
 Then take blood 1hr > 190
samples from this 2hr >165
patient after 30 , 60 3hr > 145
,90 ,120 min
(BDA)* / 1,2,3 hr’s
( ADA )* to detect
blood glucose level
 A : American
Diabetes
Association
 B : British Diabetes
Association
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Glycosylated Hemoglobin It’s a Diagnostic test to Normal Range ; 4-5.5.7

A₁c measure the blood * IGR or pre-diabetic 6-
( HbA₁c) glucose control for 2-3 6.4%
months ( 120 days of *6.5-higher indicate
RBCs life ) , as Glucose diabetes
stacked . *Controlled D.M
HbA1c detection methods shouldn’t exceed 7%
1- Chromatography
2- Ag - Ab reaction *Diabetic patient
(( boronate affinity should have HbA1c
; confirmatory less than 6 and
method )) shouldn’t exceed 7
3-HPLC :
Reference method .
Fructose-amine It’s a screening or o No diabetes ;
Diagnostic tool to Normal, fructosamine
measure blood glucose range: 200-280
level over the previous µmol/L
2-3 weeks via glucose
attached to proteins .
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 CBC Presentation
2016
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135
Parameter 1.S.D Most accepted Range (I) Least accepted Range ( II )

HB 0.1 Mean ± 0.1 Mean ± 0.2
RBC 0.05 Mean ± 0.05 Mean ± 0.15
HCT 0.42 Mean ± 0.42 Mean ± 1.0
MCV 0.6 Mean ± 0.6 Mean ± 1.2
MCH 0.35 Mean ± 0.5 Mean ± 0.7
MCHC 0.5 Mean ± 0.5 Mean ± 1.0
WBC 0.1 Mean ± 0.1 Mean ± 0.2
Plt’s 6.0 Mean ± 6 Mean ± 12
Calibration of the cell counter :
1- Repeat the control 3-5 x and take the mean .
2- Divide the mean of the control ( Provided by the manufacture ) by the
mean obtain and get the factor . Introduce the factor into the machine .
3- The daily control values should oscillate around the mean very closely
( Range I ) but not beyond ( Range II ) .
4- Don’t take into account the range provided by the manufacturer because
it in irrelevant to SD .
2016
136
5- If the machine is stable , you can use a test sample daily for QC while the
control is used occasionally every 5-7 days or at problems .
6- Record all Control values and results of samples in a special well-
organized file .
Notes on the CBC Calibration :

6* Make your own range .. This must be used in Hematology .

4* Irrelevant to SD :
In America or Europe , 200 different labs give you . Reference Range in
control sheet .
.. MCV 90 ± 10 *
Only ; MCV ± 0.6 control
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Urine Culture Presentation :
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Hepatitis B Virus Presentation :
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Tuberculosis ( TB ) Presentation :
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Endocrine Section :
Hypothalamus
Pituitary Gland
Anterior Pituitary Posterior Pituitary

Which secrete the
Hypothalamic Produced
Hormones as :
GH ADH
Prolactin Oxytocin
FSH
LH
TSH
ACTH
2016
224
TSH
From the anterior pituitary
Affect on the
Thyroid Gland
To release
T3 T4
So :
1- TSH , Then T3 and T4 (( Primary Hypothyroidism ))
2- TSH , Then T3 and T4 (( Primary Hyperthyroidism ))
3- TSH N or Low , Then T3 and/or T4 (( Secondary Hypothyroidism ))
4- TSH N or High , Then T3 and/or T4 (( Secondary Hyperthyroidism ))
2016
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GnRH
( The other pituitary producing hormones ; As Gonadotropin)
LH ; Peak at day 14th of

menstrual cycle
**Responsible for
producing Sexual
hormones
FSH LH
Affect on
Ovary Testis
Testis Ovary
Sperms
Testosterone Estrogen
Ova
Progesterone
From The
"Corpus Luteum " FSH
LH
2016
226
Notes on FSH and LH :
1- FSH and LH concentration is “ Phase Dependent ” .
2- FSH and LH testing is preferred at D3 and D4 of the menstrual period .
3- Elevation in FSH and LH level after menopause .
4- Peak of FSH and LH at day 14th of the menstrual cycle
5- FSH is high , but no production of sperms in male
6- FSH is ‫يشرف على‬ Spermatogenesis in male .
7- LH is ‫يشرف على إنتاج‬ Testosterone in males
8- FSH is ‫يشرف على إنتاج‬ Ovum in Females
9- LH is ‫يشرف على إنتاج‬ Estrogen in Females
2016
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** Progesterone
Normal Range : - In male : 0.1 -1.2 ng/ml
- In Female : Phase Dependent
** The 5th day of period cycle is good testing for female
 High Level in Pregnant Women

 It’s used to test in recurrent abortion
** Estrogen
o Estrogen is produced due to LH stimulation in females .
o Testosterone is produced due to LH stimulation in males .
o Finally , most of oral contraceptives composed of estrogen and
progesterone .
o It’s principle : is to elevate FSH and LH at the 14th day of the menstrual
cycle .
2016
228
Prolactin :
Normal Range : < 15 ng/ml : in males
< 20 ng/ml : in females
 Elevated Prolactin cause : Inhibition of menstrual cycle in female .

 Elevated Prolactin cause : Inhibition of sperm production in male .
 Note : Don’t Do this test on morning because high result after night test
due to circadian Rhythm .
GH “ Growth Hormone “
*Normal Range : 0-7 mg/ml in males
0-16 mg/ml in females
 Do this test after ½ hr of exercise or insulin injection

 It is not a stable test , so we should do the more stable , which is the IGF
I , which is more diagnostic .
 IGF I is the insulin like growth factor .
2016
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ACTH ( Adrenocorticotrophic hormone)
Affect on
Adrenal Gland
To Release
Aldosterone Cortisol
- Mineralocorticoid -Steroid hormone “ Glucocorticoid”

- Produced by -Produced by Zona Fasciulata
Zona Glomerulosa -Peak at 6-8 am at morning
Of the adrenal cortex -1/2 peak at 4-6 am morning
*Affected by Renin-Angiotensin System *Lower glucose level in blood
*Immunological process
* Inhibit vitamin D
receptor production
2016
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Posterior Pituitary
Note : this hormones produced by Hypothalamus , but secreted in Posterior
Pituitary
1- ADH / AVP
 Increase in water reabsorption along with the kidney , so keep
balanced amounts of water , which suitable for the physiological
process in the body .
2-Oxytocin
 Love hormone
 Increase after Labor
‫د بعد الوالدخ و لك ل ادخ تقلص عضالت الودر والم م أثوا الوالدخ وبعدها‬ 
‫د افمازه بعد تواول الشوكوالتة الداكوة العودا‬ 
**Other Emotional hormones
‫ وهو هممون الععادخ و حعن الم اج‬serotonin ‫*هممون ال‬

‫ “ وهو هممون الطمال‬Dehydro epiandrosterone DHEAS ‫*هممون ال‬
. ‫ومحاربة الشي ونة‬
Regulate sleep and Wake Cycle . : melatonin ‫* هممون ال‬
2016
231
B-HCG “ B- Human Chorionic Gonadotropin”
This Hormone Shares the alpha subunit with TSH , FSH and LH ,
but theirs a distinguishable beta subunit for each of them ( with
little sharing of some sequences ) .
‫ وهو أدق‬.. ‫مل الممأخ ق ل موعد الدورخ الثانية‬ ‫ هممون تش عن‬

‫ول فيها الحمل و و متن أن عاعد ف مماق ة الحمل‬ ‫ و حدد األمابيع الت‬
. ‫وامتممار ت‬
. ‫ تش عن مل المواميم والحمل العوقود‬
. ‫ عاعد ف مماق ة عمليات التوظيفات عود الحوامل‬
. ‫ تحد د ضع وقوخ الحمل‬
Tumor Marker ‫ عت د كــ‬
Testicular Cancer : ‫عود الاكور‬
Ovarian Germ Cell Tumor : ‫عود اإلناث‬
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Gland Related Disease

Pituitary Gland Hypopituitarism  Pituitary Tumors
 Somatotropin Deficiency
 Corticotropin Deficiency
 Thyrotropin Deficiency
Hyperpituitarism  Prolactinomas
 Acromegaly
 Cushing’s Disease
 Thyrotropin – Secreting
Adenoma
 Diabetes Insipidus
Thyroid Gland Hashimoto’s Disease Chronic Lymphatic Thyroiditis

Graves’ Disease Autoimmune Disease leads to
hyperthyroidism ( Overactive Thyroid )
.
Goiter Non-Cancerous enlargement of the
thyroid gland ( related to hypo or
hyperthyroidism ) .
Thyroid Nodules Growth that form on/or in the thyroid
gland .
Parathyroid Gland Hypoparathyroidism Related to hypocalcemia
Hyperparathyroidism Primary or Secondary
hyperparathyroidism
Adrenal Gland Cushing’s Disease Autoimmune Hyperaldosteronism
Addison’s Disease Autoimmune Hypoaldosteronism
“ Adrenal Insufficiency “
Primary Conn’s Syndrome
hyperaldosteronism
2016
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Tumor Markers :
Tumor Marker Cancer Type Indication
CEA ( Carcinoembryonic Antigen ) General Marker for Cancer
CA 15-3 ( Carbohydrate Antigen ) Breast Cancer
CA 19-9 ( Carbohydrate Antigen) Pancreatic and Intestinal Cancer
CA 125 Ovarian Cancer
Alpha Fetoprotein Testicular and Hepatic Cancer
B-HCG Testicular and Ovarian Cancer
PSA ( Prostatic Specific Antigen ) Prostate Cancer
CA 50 Bladder and Gastrointestinal cancer
CA 72-4 Gastric/Stomach Cancer
NSE ( Neuron Specific Enolase ) Lung and Neck cancer
SCC (Squamous Cell Carcinoma ) Lung Cancer
2016
234
References :
1-Carl A. Burtis and Edward R. Ashwood . Tietz Fundamentals of Clinical

Chemistry . 1996 ; 881 . Philadelphia , W.B. Saunders company.
2-Denise M. Harmening . Clinical Hematology and Fundamentals of

Hemostasis . 1997; 743 . Jean-Francois Vilain , Philadelphia –United States of
America .
3-Denise M. Harmening . Modern blood Banking and Transfusion Practices .

1994 ; 547 . Jean-Francois Vilain , Philadelphia –United States of America .
4-Rodger L. Bick. Hematology : Clinical and Laboratory Practice . 1993 ; (2) ,

Mosby .
5-R.J.OLDS . A color atlas of Microbiology . 1975 ; 288 . Wolfe Medical

Publications Ltd , London .
6-Susan King Strasinger and Marjorie Schaub Di Lorenzo . Urinalysis and

Body Fluids . 2008;292 . Christa Fratantoro , Philadelphia , F. A. Davis
Company .
7-Mary Louise Turgeon . Immunology and Serology in Laboratory Medicine .

1990-2009; 527 . Andrew Allen .
8-Martha E. Kern. Medical Mycology – A self-Instructional text . 1985 ; 239 .

Philadelphia , F. A . Davis Company .
2016
235
9-Michael L. Bishop , Edward P. Fody and Larry E. Schoeff . Clinical Chemistry ,

Techniques , Principles , Correlations . 2010 ; 732 . . John Goucher ,
Philadelphia .
10-MedLab Consultancy Group . Amid Abdelnour and it's all . Labwise – Guide to
Laboratory Investigations . 2009 ; 596 . Jordan .
.. 0597917817 ‫ م ج‬..‫ب ز ط تج ي‬ 
Ayyub_ju@yahoo.com ‫ إل‬
0595462969 ‫ م ج‬.. ‫ ض‬ 
hayaysr@yahoo.com ‫ إل‬
2016

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Questions and Answers of

(( Lab Director in QHC / MOH ))

(( Master in Clinical Lab Science ))

(( Bachelor of Medical Laboratory Science ))

‫و هيا امم‬ ‫أ وب جعيد‬

‫اهدا ت خ التلمات ‪....‬‬

‫إلى أب وأم و زوجت وبوات و أنوت وأنوات ‪..‬‬

‫إلى أماتات ف قعم الخر الم م ‪..‬‬

‫وزميالت ‪..‬‬ ‫إلى زمال‬

‫إلى المتدربين ال م طين ‪ ..‬نهد تم هاا التتاب ‪..‬‬

‫إلى من تش ثت دا بيد هما موا صغم ‪ ..‬فأناروا ل دروب يات‬

‫إلى إنوت من أتموى أن هدونو مثل ما أهد هم اآلن وما ا ما ‪..‬‬

‫مفا ا تواغ ب اليو كلمات ‪..‬‬ ‫إلى كل من علمو‬

‫باكماهما ‪..‬‬ ‫اكمت و تهم قل‬ ‫إلى روح جد وجدت من تض‬

‫هيا امم رضوان‬

1- Hematology in brief is : CBC and Blood Film . Does this definition

2- CBC hematology analyzer represent 3 or 5 histograms in usual . In our

4- In laboratory, Good reading and interpreting of CBC results taken by ?

5- In the CBC differential results for WBCs . What will we do if we found

6- Why MCH is more accurate than other RBCs parameters especially

7- In CBC differential , What is the type of WBCs that is elevated in

8- In Viral Infection , What the type of WBCs will be elevated ?

9- Eosinophil’s elevated in case of ?

a. HCT * 10/RBCs count

12- MCHC means ?

a. Mean Corpuscular Hb concentration .

13- Pancytopenia indicates ?

a. Decrease in RBCs production .

14 – In the 5 center squares of the 25 RBCs squares in the hemocytometer ,

a. 300 * 10.000 = 3 million/µl

15- What is the test that reveal thalassemia ?

18- The immunoglobulin that elevate in hypersensitivity ?

a. Microcytic , Normochromic RBCs .

21- Megaloblastic anemia ?

a. Deficiency in vitamin B12 and folic acid .

22- 1% Ammonium Oxalate for count of ?

23- RBCs = 3 million/µl , RDW 20% , Hb = 9 g/dl and

MCV = 65 fl , This indicate ?

24 – In The blood film , Auer rods of WBCs reveal ?

a. Chronic Granulocytic Leukemia .

25- Glacial acetic acid 3% for count ?

26- For RBCs count ?

a. Normal Saline and Towson’s fluid .

a. 1˚ ( < ) slopes increases the reading result of 3 mm/ 1hr .

30- ESR = Zero , in which case ?

31- Rule of Three ?

a. Used only if the patient RBCs is normocytic and normochromic .

How we can correct the Hb result ?

33- From these findings for WBCs differential by hematology analyzer ,

WBCs 20.1 K/µl

34- From the previous question , what is the absolute lymphocyte ?

a. Our body stores of vitamin B12 are ≈ 2-5 mg

37- Reticulocyte Correction Formula ?

- Reticulocyte count is low

41- According to Microcytic Anemia ?

42-How can we diagnose Iron poisoning ?

a. Low iron , Low TIBC and Low Ferritin

a. Loss of about 25% of their viability within 24 hr’s .

44-What is definition of Leukemia ?

a. Abnormal blood cells , which don’t undergo the Programmed Cell

45- In Blood Bank , The blood unit required ( )ml of CPDA ?

46- CPDA-1 mean ?

a. Citrate , Phosphate , Dextrose , Adenine 1

a. “ C” is related to Tri-sodium Citrate , act as Ca chelating agent and