ML7111 MCQs Answers April 2020
ML7111 MCQs Answers April 2020
1. One of the dyes that is used for staining tissues has a quinonoid chromophore group. Which of
the following compounds will fall in this category?
a. Picric acid
b. Congo red
c. Acid fuchsin
d. Eosin
Chromophore is that part of the molecule which when exposed to visible light will
absorb and reflect a certain color. Examples include: azo coupling (Orange G, Trypan
blue, Congo red); Quinonoid ring (acid & basic fuchsin, crystal violet, methylene blue,
haematin); Nitro group (Picric acid)
Auxochrome is a group of atoms which will impart a particular color when attached to a
chromophore but when present alone, will fail to produce that color. Examples of
auxochrome: -NH2, -OH, -SO2H, -COOH
Picric acid
2. Which of the following media would be the best option for the detection of a pathogen using a
‘Staph Streak’?
a. Chocolate agar
b. Sheep blood agar
c. Horse blood agar
d. Bacitracin Chocolate agar
Staph streak is useful for detecting satelitism on blood agar by Haemophilus influenzae which
can cause infections at multiple sites. H influenzae cannot grow on blood agar (sheep) unless it is
provided with factor V (NAD) produced by organisms such as Staph. aureus, which also produces
hemolysis supplying Factor X (hemin) released from red cells. Sheep blood contains enzyme
NADase which hydrolyses NAD present in blood, making it unavailable to H influenzae. It grows
well on Chocolate agar from sheep blood because the enzyme is destroyed during heating. It can
grow, though poorly, on horse blood agar. It can grow poorly on horse blood agar even without
Staph Streak.
1
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
Prolonged APTT on a patient not on anticoagulant can be due to 3 causes: 1. Factor deficiency
2. A specific inhibitor such as Factor antibody 3. Non-specific inhibitor such as lupus
anticoagulant. Performing mixing studies with 1:1 normal plasma can differentiate between
these 3 causes:
1. APTT Corrected with 1:1 mix: Factor deficiency or antibody. Repeat the test after
incubation of 1:1 mix at 370C for 1 hour – if still corrected, factor deficiency; if not
corrected, factor antibody (F VIII antibody is most common)
2. APTT not corrected with 1:1 mix: Non-specific inhibitor such as lupus anticoagulant.
Confirm with APTT with excess phospholipid reagent.
Sudan Black B is a fat-soluble stain used for staining triglycerides and lipids. In cytoplasm,
Sudan Black B can stain granules dark brown. See below
Prioritizing tasks is an important competency for a MLT, to know what needs STAT attention so that the
lab results will be most useful to save a life. If you were to list these tests in order of priority, that would
be – b, a, d, c. Platelet count is critical for a bleeding patient to identify the cause for bleeding (platelet
count <20 X109/L can cause spontaneous bleeding, and is of concern patients with conditions such as
acute leukemias). Prothrombin time is used to monitor an oral anticoagulant which is not administered
generally in urgent situations where anticoagulants like heparin are used and monitored by APTT.
Abnormal Test Result: is a term used by medical laboratories and other diagnostic centers to refer
to a result that falls outside of a pre-determined normal range. 1Abnormal test results are not
necessarily clinically significant or critical results.
Critical Test Result: is a term used by medical laboratories to identify abnormal test results that are
significantly out of the normal range and which need to be communicated to the physician and/or
the patient urgently in the interest of patient safety.
3
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
https://www.interiorhealth.ca/sites/Partners/LabServices/TestResults/Pages/CriticalResults.aspx
Clinically Significant Test Result: is a result determined by a physician based on his or her clinical
judgment to be one which requires follow-up with appropriate urgency. A physician will determine
clinical significance based on his or her knowledge of the patient’s symptoms, previous test results,
and/or diagnosis.
7. The zone sizes of a control strain for the Kirby-Bauer susceptibility test are larger than expected.
Which of the following is the most likely cause?
a. The depth of Mueller Hinton agar is 6 mm
b. The depth of Mueller Hinton agar is 4 mm
c. The density of the inoculum was adjusted to 0.5 McFarland standard
d. The plates were incubated 20 minutes after the discs were placed
Troubleshooting susceptibility tests: only option (d) can lead to increased zone sizes. The plates must be
incubated within 15 minutes of placement of the discs; otherwise the antibiotic diffuses in the medium
before the organism starts growing, giving larger zones of inhibition.
The link below has a table with many factors that affect the zone sizes. (It is also available in the
Reference Link folder on the course website.
https://catalog.hardydiagnostics.com/cp_prod/Content/hugo/TroubleShootForDiskDiff.htm
8. What is the first thing to do when a new method is initiated as a routine clinical test?
4
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
d. NAD
10. What type of conflict is caused when the meaning of behavior between parties is
misunderstood?
a. Preferences and nuisances Conflict
b. Data-type Conflict
c. Cultural Conflict
d. Communication Conflict
Parties in conflict communicate by what they say (or do not say) and how they behave
toward each other. Even normal interaction may involve faulty communication, but conflict
seems to worsen the problem. When two people are in conflict, they often make negative
assumptions about "the other.
11. A 35-year-old man was seen in his physician’s office with complaints of shortness of breath,
cough and fever. The CBC result showed:
WBC 21.8 X 109/L RBC 1.94 X 1012/L Hb 102 g/L Hct 0.25 L/L
MCV 128 Fl MCH 52 pg MCHC 410 g/L RDW 18.5 % Platelet 230 X 109/L
What should be the next course of action?
a. Warm at 370C for 30 min
b. Dilute the sample and rerun
c. Perform saline replacement
d. Request a new specimen
Acrocyanosis is persistent, painless, symmetric cyanosis of the hands, feet, or face caused by
vasospasm of the small vessels of the skin in response to cold. If the cold agglutinin titer is >64,
the patient may show signs of hemolytic anemia. The laboratory tests determine the presence
of hemolytic anemia, agglutination, and cold agglutinin titers.
CBC results show spurious results, probably due to cold agglutinins. Rule of 3 does not work
indicating incorrect sample integrity. Other indicators of spurious results are: low RBC, high
MCV, MCH, MCHC due to agglutination. Hb & platelet counts are unaffected.
5
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
d. Thromboxane A2
Platelet factor 3 (PF3) is phospholipid which is necessary as a cofactor with Ca ++ for many reactions in
the coagulation cascade.
PF4 is a factor that can bind with heparin and produce antibodies against the complex, resulting in the
destruction of platelets – pathophysiology of HIT (Heparin-induced thrombocytopenia).
vWF is a primary hemostatic factor that helps in the adhesion of platelets to the site of injury, and also
acts as a carrier molecule for F VIII. However, it does not participate in secondary hemostasis.
Thromboxane A2 is produced by platelets to stimulate aggregation of platelets in primary hemostasis.
13. Which test is useful to identify a coagulase negative Staphylococcus isolated from a urine of
sexually active 20-year-old female?
a. PYR
b. Catalase
c. Novobiocin resistance
d. Oxidase
Staphylococcus saprophyticus can cause UTI in women of child-bearing age (12-60). It is a coagulase
negative Staph that is resistant to Novobiocin, showing a zone of inhibition ≤ 16 mm. PYR is useful for
differentiating between Staphylococcus aureus and S lugdunensis. All staphylococci are catalase
positive, and oxidase negative.
14. In the nitrate reduction test, which result indicates that the organism has completely reduced
nitrate beyond nitrite?
a. A red color develops on addition of zinc dust
b. Gas bubbles may be present and a red color develops on addition of nitrate reagents A & B
c. Gas bubbles may be present and no red color develops on addition of zinc dust
d. Gas bubbles may be present and a red color develops following addition of zinc dust
If there is no red color after this stage, add a small amount of zinc dust. Development of a red color
indicates that nitrates are still present in the medium and are not reduced at all. Development of NO
RED color after zinc shows that nitrates are not present, and are reduced further to nitrogen gas. The
gas bubbles may not be visible if it is an open system where the gas can escape.
6
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
15. Using a Henderson-Hasselbach equation, which analyte concentration is calculated from pH and
PaCO2?
a. Bicarbonate
b. Carbonic acid
c. pO2
d. pCO2
The Henderson-Hasselbalch equation describes the relationship of pH as a measure of acidity with the
acid dissociation constant (pka), in biological and chemical systems. The equation is especially useful for
estimating the pH of a buffer solution and for finding the equilibrium pH in acid-base reactions.
16. 22% Bovine albumin is added to the whole blood to achieve which of the following results?
The albumin phase is meant to detect IgG antibodies that are too small to cause direct agglutination of
red cells suspended in saline. The source of the albumin used in lab tests is cows (bovine).
The mechanism of action of the albumin is that it increases the dielectric constant and thus decreases
the zeta potential, allowing the red cells to come closer. Being a dipolar molecule, albumin can dissipate
energy as it rotates, thereby reducing the thickness of the ionic cloud surrounding each cell. Once the
red cells are close enough together, the small IgG molecule can span the distance between the cells and
cause agglutination.
The Hh blood group contains one antigen, the H antigen, which is found on virtually all RBCs and
is the building block for the production of the antigens within the ABO blood group.
H antigen deficiency is known as the "Bombay phenotype" (h/h, also known as Oh) and is found
in 1 of 10,000 individuals in India and 1 in a million people in Europe. There is no ill effect with
being H deficient, but if a blood transfusion is ever needed, people with this blood type can
receive blood only from other donors who are also H deficient. (A transfusion of "normal" group
O blood can trigger a severe transfusion reaction.)
7
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
Because the H antigen is the precursor of the ABO blood group antigens, if it is not produced,
the ABO blood group antigens are also not produced.
See the table below:
18. A patient has anti-c. If 80% of donors are c-positive and 68% are C-positive, how many RBC units
will the transfusion service need to test in order to find 2 units that are compatible with the
patient?
a. 3 units
b. 4 units
c. 7 units
d. 10 units
e. 18 units
When doing this calculation you need 2 pieces of information, the number of RBC products
desired and the frequency of the corresponding antigen in the population. In this case 2 RBC
products are requested. The frequency of the corresponding antigen, c, is 80%. This means
that the patient is compatible with 20% of the population. The formula for the calculation is:
8
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
19. A patient has a positive antibody screen and positive results against cells in the antibody panel.
The patient specimen is retested with antibody panel cells that have been treated with the
enzyme “ficin.” The antibody no longer reacts against cells in the antibody panel. Which of the
following antibodies is most consistent with these results?
a. Anti-D
b. Anti-K
c. Anti-Jka
d. Anti-Fya
e. Anti-Lea
Ficin is a “proteolytic enzyme” that destroys certain common antigens found on red blood cells. The
ficin-sensitive antigens are: Fya, Fyb, M, N, S, s, Xga (see image below).
If a patient has an antibody against one of these antigens, the test result will be negative after the
reagent red cells are treated with the enzyme, since there is no longer a target antigen for the antibody.
Keep in mind that the patient still has the antibody itself. The antibody is just not detected using
antibody screening cells or antibody panel cells that have been treated with ficin
20. Running two controls in the same run on an analyzer, upper level control value is above 2s,
while the lower level control value is below 2s. What is the first response to this scenario?
a. Repeat the test
b. Check other Westgard rules
c. Reject the run
d. Troubleshoot the analyzer
22s - reject when 2 consecutive control measurements exceed the same mean plus 2s or the
same mean minus 2s control limit.
9
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
R4s - reject when 1 control measurement in a group exceeds the mean plus 2s and another
exceeds the mean minus 2s.
21. A peripheral blood smear shows many spherocytes and increased polychromasia. What
would be the most appropriate next step towards a diagnosis?
Many spherocytes and increased polychromasia is a typical morphology that can be observed in
two clinical conditions – Hereditary spherocytosis (HS) and Warm autoimmune Hemolytic
anemia (WAIHA). A positive DAT due to IgG antibodies attached to red cells would eliminate HS
and can be further investigated to identify the antibody. If negative, HS can be confirmed by
genetic studies. Bite and blister cells are characteristically seen in G6PD Deficiency.
Please note that presence of spherocytes is most common in extravascular hemolysis due to
removal of antibody molecules from the surface of red cells in the spleen, forming spherocytes.
Also, a slight increase in MCHC on the CBC result may be indicative of the presence of
spherocytes; moderate or marked increase in MCHC due to cold antibodies.
G6PD deficiency will indicate bite and/or blister cells on the PBS. Polychromasia will be present
depending on the severity of G6PD deficiency.
10
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
Fibrinogen is required for platelet aggregation, binding of platelets to one-another with a fibrinogen
bridge and GpIIb-IIIa platelet receptor. The contact factor group is made of HMWK, PK, F XII, FXI.
Fibrinogen is F I.
23. Acetaminophen level 12 hours after the last dose is 85 µmol/L, what to do next?
a. Report as critical
b. Repeat
c. Confirm the draw time for the next dose
d. Measure serum alanine aminotransferase level
-If serum acetaminophen (paracetamol) is < 132 µmol /L (< 20 mg/L) and ALT < 50 U/L, then no medical
treatment is necessary.
-If serum acetaminophen (paracetamol) is > 132 µmol /L (> 20 mg/L) or ALT > 50 U/L, then commence
an acetylcysteine infusion.
After commencement of the infusion measure serum acetaminophen (paracetamol) and ALT
concentrations 8 hours after the previous measurement.
-If serum acetaminophen (paracetamol) is < 66 µmol /L (< 10 mg/L) and ALT < 50 U/L, then the infusion
can be halted and no further medical treatment is necessary. [1]
11
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
Otherwise continue the infusion and check serum acetaminophen (paracetamol) and ALT at 12 hourly
intervals until:
-Serum acetaminophen (paracetamol) is < 66 umol/L (< 10 mg/L) and ALT < 50 U/L, then the infusion can
be halted and no further medical treatment is necessary. [1]
24. Serum HCG level performed on a female patient 2 weeks ago was 2050 IU/L, and a
repeat test performed today showed a HCG level of 50 IU/L. How should be the
immediate response of the technologist?
a. Report the result
b. Rerun QC
c. Check patient identification
d. Call the doctor
The HCG levels increase exponentially during pregnancy – check patient ID before
investigating further, such as calling the doctor for any history of miscarriage when the
HCG levels will drop.
25. Which of the following fixatives cannot be used for visualization of acid fast bacilli in
tissues?
a. Carnoy’s
b. Helly’s
c. Bouin’s
d. B5
12
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
Carnoy’s fluid, ethyl alcohol, acetone cannot be used for staining AFB because they dissolve lipids which
will make AFB which have a high lipid content in their cell walls invisible – non acid-fast..
Quality Indicators
13
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
2D barcodes have been used to track everything from delicate electronic printed
circuit boards to surgical/medical instruments.
28. An isolate of Staphylococcus aureus from an abscess gave the following disc
diffusion results:
Cefoxitin 30 mm ≤ 25 mm
Erythromycin 15 mm ≤ 21 mm
Clindamycin 20 mm ≤ 19 mm
Penicillin 27 mm ≤ 31 mm
Beta lactamase or Penicillin zone edge test: S. aureus for Kirby Bauer disc diffusion test
performed on Mueller-Hinton agar (MHA using 1 μg penicillin disc incubated at 35
degrees Celsius in atmospheric oxygen for 24 hours. Isolates with a zone < 26 mm,
or with a sharp zone edge were considered resistant to penicillin.
Two key mechanisms are responsible for resistance to penicillin in staphylococci;
the blaZ gene which encodes for penicillinase, a serine beta-lactamase which
hydrolyses the β-lactam ring resulting in the production of penicilloic acid, and
the mecA gene which encodes for penicillin-binding protein (PBP) 2A.
PBP2a Test: in the identification of MRSA, it is more accurate to either directly detect the gene encoding
the methicillin resistance determinant (mecA) or its product, penicillin-binding protein 2' (2a), or PBP2'
(PBP2a), which is found in the cell membrane of MRSA. However, as nucleic acid hybridizaion and DNA
amplification techniques such as PCR for detecting the mecA gene are expensive and technically demanding,
simple and more inexpensive techniques are required for routine use. MRSA-Screen was developed expressly
for this purpose, providing results in 15 minutes with minimal labor and no specialized equipment.
14
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
MRSA-Screen consists of a latex reagent sensitized with monoclonal antibody against PBP2' together with
reagents to rapidly extract PBP2' from the bacterial membranes of MRSA. Latex particles sensitized with a
monoclonal antibody against PBP2/ will specifically react with methicillin-resistant staphylococci to cause
agglutination visible to the unaided eye.
29. If 15% of the nucleotides in an organism’s DNA are thymine, predict the percentage of
nucleotides that are cytosine in that organism.
a. 15%
b. 35%
c. 70%
d. 85%
Because of the base-pairing property within the DNA, the presence of 15% thymine (T) means
that there must equal number, therefore, 15% adenine (A) in the organism. This means that out
of 100, 30% of the DNA is (A) & (T), leaving 70% of the DNA to be cytosine (C) or guanine (G).
Since there must be an equal amount of each base type within the base pair, 70 ÷ 2 gives 35%
each of cytosine and guanine.
30. Which of the following is an appropriate follow up when a catheterized urine specimen
is submitted for culture and was transported to the laboratory at room temperature one
hour after collection?
a. Reject the specimen and request a new one
b. Incubate the specimen at 350C for 1 hour before inoculation on media
c. Centrifuge the specimen and use the sediment to inoculate culture media
d. Process the specimen using a calibrated loop
15
ML7111 EXTRA PRACTICE QUESTIONS APRIL 2020 (ANSWERS)
16