Medical Technology Board Examination Review

Notes Recalls

MT Boards Recall Questions 2016

Clinical Chemistry

1) Specimen Collection – (5%)

a) Site for blood collection – Median-Cubital > Cephalic > Basilic

b) Newborn screening uses – Blood spot

c) Suggested length of lancet – 1.75mm

d) Amount of blood in person – 5-7L, 60ml/kg

e) Analytical testing performed outside the lab – POct

F) Heparinized plasma – preferred sample for electrolytes

g) Anticoagulant that has EDTA – Tan, Pink, White

h) NaF/ml of blood to inhibit glycolysis – 2mg/ml

i) NaF/ml of blood as an anticoagulant – 10mg/ml

j) Cleansing of puncture site – 70% Alcohol, Gauze, Benzalkonium chloride

k) Antiseptic used in ethanol testing – Benzalkonium chloride

l) Number of hours fasting is part of – Patient preparation

m) Most important patient preparation for ammonia analysis – Avoid smoking

n) Unanticoagulated tube for ACP – No effect

o) Another specimen for ACP – Vaginal washing

p) Photosensitive analytes – Bilirubin, β-carotene, Vitamin A

q) Analytes that require chilling – Ammonia, blood gases, lactic acid, catecholamines

r) Analytes with diurnal variation – ACP, Iron, Cortisol, ACTH, Aldosterone, GH etc.

s) Analytes increased in alcoholism – GGT, TAG, Urates

 t) 10% contamination with 5% dextrose – Increase glucose concentration by 500mg/dl

u) 25mg/dl Bilirubin – Icteric sample

2) Instrumentation (Principles, Methods, Calibration, Others) – (5%)

a) Visible light spectrum – 400-700nm

b) X axis values – Horizontal, Independent variable

c) Discrete Analyzer – Vitros, Dimension

d) QC for ISE – Anion gap

e) Potentiometry – pH, pCO2

f) Amperometry – pO2

g) POCT PT Principle – Immunochromatography

h) Prolonged light exposure – Increased fluorescence

i) Effects of absorbing molecules in fluorescence – Decreased fluorescence

j) Disadvantage of Fluorometry – Quenching

k) Hardware – Keyboard, mouse, storage device

3) Reagent Preparation and Laboratory Mathematics – (5%)

a) Bilirubin conversion factor – 17.1

b) BUN to Urea – 2.14

c) SI unit of Glucose – mmol/L

d) SI unit for Creatinine - µmol/L

e) Not included in computation of LDL – VLDL

f) How many grams of NaCl is needed to make 1L of saline – 8.5g

g) How many ml of NaOCl is needed to make 10L of disinfectant – 1000ml

4) Quality Assurance – (10%)

a) 12s = warning rule

b) Random Error – 13s, R4s, 12s

c) Systematic Error – 22s, 41s, 10x

 d) Type of variation that is present in all measurements and are due to chance and can be both positive and negative –
Random

e) Sample blank – correct for sample interferences (used if analyte to be measured is Bilirubin, HgB)

f) What kind of QC involves analysis of control samples together with patient specimen – Internal/Intralab QC

g) Delta Check – Comparison of previous patient results

h) Shift – Improper calibration

i) Trend – Deterioration of reagent

j) Relative indicator of precision - CV

k) Smaller CV – Greater precision

l) Non-laboratory personnel results in – 29% error

5) Metabolic Blood Tests (Principles, Procedures, Diseases/Disorders, Reference Values) – (50%)

a) Water Balance and Electrolytes – (8%)

i) Routinely measured electrolytes – Na, K, Cl, HCO3

ii) Primary contributor to osmolality – Sodium

iii) Major extracellular cation – Sodium

iv) Major extracellular anion – Chloride

v) Primary counterion of Sodium - Chloride

vi) Hyponatremia – DM

vii) Least affects Anion Gap – K

viii) >12mOsm/kg – DKA, Drug overdose, Renal failure, Ethanol poisoning

b) NPN and Other Metabolic Intermediaries and Inorganic Ions – (8%)

i) Major NPN – Urea

ii) 2nd prevalent NPN – Amino acids

iii) Urea method that is inexpensive but lacks specificity – Colorimetric, diacetyl

iv) Urease – Ammonia formation

v) Simplest Jaffe reaction – Colorimetric, Endpoint

vi) BUN:Creatinine ratio – 10:1

vii) Caraway – Uric Acid

 viii) Assay for uric acid, problems with turbidity - Colorimetric

ix) Uricase – Enzymatic + UV

x) Conway – Ammonia

xi) Classification of Azotemia – pre-renal, renal, post-renal

c) Carbohydrates – (6%)

i) Nelson-Somogyi – Arsenomolybdate Blue

ii) OGTT – Ingest at least 150g/day of carbohydrates for 3 days

iii) Whole Blood – 15% lower glucose values than serum/plasma

iv) Rate of glucose metabolism – 7mg/dl/hr

v) Monitoring of Glucose – HbA1c

vi) Monitors insulin shock – RBS*

vii) Not true about type 2 DM – Prone to Ketoacidosis

viii) Whipple’s Triad – Hypoglycemia

ix) Most common Glycogen Storage disease – Type I – Von Gierke – Deficiency in G6P

d) Lipids and Dysproteinemia – (8%)

i) TAG >400mg/dl – Turbid serum, creamy

ii) Cholesterol at 210 mg/dl – Moderate risk

iii) Standing plasma is a test for – TAG

iv) One step method of cholesterol determination - Colorimetric

v) High risk for cardiovascular accident are associated with high – LDL

vi) Type I Hyperlipoproteinemia – Increased CM, TAG

vii) Sinking pre-betalipoprotein – Lp(a)

viii) Floating betalipoprotein – β-VLDL

ix) Reference method for Lipoprotein analysis – Ultracentrifugation

x) Sedimentation unit – Svedberg

e) Specific Proteins – (6%)

i) Analyte associated with dehydration – Albumin

 ii) Difference between measured Total Protein and measured Albumin – Globulin

iii) Lysis of RBC will result in – Hgb

iv) BNP – Congestive Heart Failure

v) β-γ Bridging – Cirrhosis

vi) Protein electrophoresis is singly important for – Monoclonal gammopathies

vii) Biuret reagent - RANK

f) Liver Function Tests – (6%)

i) Synthetic function of liver – Albumin, protein, coagulation factors

ii) Analyte for detoxification of liver – Ammonia

iii) Ammonia – Reye’s syndrome, Hepatic coma

iv) Gilbert Syndrome – increased B1

v) 2mg/dl bilirubin – Jaundice

vi) Serum Bilirubin of 20mg/dl – Report immediately

g) Clinical Enzymology – (8%)

i) Reaction rate if directly proportional to substrate concentration – First Order Kinetics

ii) Oxidoreductase – LDH, G6PD

iii) Transferase – CK, AST, ALT

iv) Hydrolase – ACP, ALP, LPS, AMS

v) Lyase – Aldolase, enzymes ending in decarboxylase

vi) No isoenzyme – ALT

vii) Salivary gland – Amylase

viii) 1st enzyme to increase in MI – CK-MB

ix) CK-MB – increase 4-8hrs, peak 12-24hrs, normalize 48-72hrs

x) Intramuscular injection – increased CK-MM

xi) Enzyme with moderate specificity – LDH

xii) LDH greatest increase in – Pernicious anemia

xiii) LD Flipped pattern – MI, Hemolytic Anemia

 xiv) LD 4 and 5 – Cold labile

xv) Substrate for Bowers-McComb – PNP

xvi) Paget’s Disease – Osteitis Deformans

xvii) Most specific substrate for ACP – Thymolphthalein Monophosphate

xviii) Direct Rectal exam – Increased ACP

6) Endocrinology and Toxicology (Principles, Procedures, Diseases/Disorders, Reference Values) - (16%)

a) Endocrinology – (10%)

i) Thyroid Hormones – (4%)

(1) Hyperthyroidism – Increased ALP

(2) Test analyte that confirms conflicting thyroid results – rT3/reverse T3

(3) rT3 is formed from the deiodination of T4 in the – blood

(4) Thyrotoxicosis – Plummer’s disease – decreased TSH, normal FT4, increased FT3 and T3

ii) Sex Hormones – (3%)

(1) E1 – Menopause

(2) E2 – Menstruation

(3) E3 – Pregnancy

(4) Most potent Estrogen – E2

(5) Source of E2 – Ovary

(6) Increased in 2nd/3rd trimester – progesterone

iii) Other Hormones (Pituitary, Adrenal) – (3%)

(1) Increased in 1st trimester – HCG

(2) Cushing Syndrome – Increased Cortisol

(3) Insulin promotes – Lipogenesis, Glycolysis, Glycogenesis

(4) Posterior pituitary gland – stores ADH, oxytocin

(5) Angiotensin II – Vasoconstriction, Stimulate Aldosterone production, Regulate BP

(6) Prolactin level if patient underwent breast exam – Increased

 b) Toxicology & Therapeutic Drug Monitoring (TDM) – (6%)

i) Substance of Abuse – (2%)

ii) Other Poisons/Toxic Agents (Alcohol, Carbon Monoxide, Mercury, Lead, Arsenic) – (2%)

(1) Unit for ethanol impairment - %wt/vol or mg/dl

(2) Considered legally intoxicated – 100mg/dl or 0.1% wt/vol, 3-4 ounces of whisky

iii) TDM – Anticonvulsants and other Drugs – (2%)

(1) Serum drug concentration is affected by – Absorption, Distribution, Metabolism

(2) Delivery of drug – Distribution

(3) Trough – Collect blood before next dose is given

(4) Petitmal seizure – Valproic acid

(5) Cyclosporine – Immunosuppressant

7) Blood Gas Analysis and Other Tests (Principles, Procedures, Diseases/Disorders, Reference Values) – (4%)

a) Patient with fever – decreased PO2 by 7%, increased PCO2 by 3%

b) Metabolic Acidosis is compensated through - Hyperventilation

c) Metabolic Alkalosis is compensated through - Hypoventilation

8) Laboratory Safety – (5%)

c) Sharps – Red Container

d) Safety Diamond, Blue – Health

e) Fire Type 3 – Electrical

f) Class K fire – fats, kerosene

g) Breakage in Centrifuge – Aerosols are formed

Microbiology and Parasitology

1) Microbiology – (70%)

a) Bacteriology – (49%)

i) Collection, Transport, Processing and Staining of Specimens – (5%)

(1) First thing to be done for collection of sputum sample – Gargle with water
 (2) Acid Fast stain in tissues – Kinyoun

(3) AFB stains – Red

(4) Non-acid fast bacteria stains – Blue

(5) Critical step in gram stain – Decolorizer

(6) Nonspecific staining of cellular structures – Fluorochroming

(7) Nasopharyngeal swabs are for – Neisseria, H. influenza, B. pertussis

(8) Late chlamydia specimen must be – Rejected

ii) Culture Media – (5%)

(1) Preferred medium for isolation of B. pertussis – Regan-Lowe/Charcoal Cephalexin Blood Agar

(2) K Tellurite – gray black colony

(3) Cystine Tellurite – C. diptheriae

(4) Cystine glucose – F. tularensis

(5) Significant colony count in urine – 100,000

iii) Bacteria (Aerobes) – (33%)

(1) Morphology and staining characteristics – (5%)

(2) Cultural characteristics – (5%)

(a) Golden yellow colonies in BAP – S. aureus

(b) Alpha-prime – S. aureus

(c) S. saprophyticus – Cystitis

(d) C. amycolatum in nasopharynx – Normal flora

(e) Commonly isolated in ICU – P. aeruginosa

(f) P. aeruginosa – Grows in 42 and 35 degrees Celsius

(g) Flat, serrated colonies with confluent growth on BAP – P. aeruginosa

(h) Salmonella bacterial culture – 2-3 specimen(blood) within 24 hours

(i) Whipple Disease – Trophyrema

(3) Work-up for identification: biochemical, differential and confirmatory tests – (14%)
 (a) Clumping factor – Coagulase

(b) 30% H2O2 – Superoxol Test

(c) MR and VP reaction – Opposite

(d) Chromogenic β-lactamase result – Color formation

(e) Demonstrate Streptolysin O – Anaerobic culture

(f) Differentiate S. aureus and S. epidermidis – Coagulase, DNAse

(g) Negative CAMP test – No enhancement of hemolysis

(h) Bile solubility – S. pneumoniae

(i) Similar to C. diptheriae – C. ulcerans

(j) Shigella – Biochemically inert

(k) Acetamide Test – P. aeruginosa (35˚C for 7 days)

(l) Bordetella oxidase & urease (+) – Bronchiseptica

(m) Requires V factor – H. parahemolyticus

(n) Requires X factor – H. ducreyi

(4) Serologic/molecular tests – (3%)

(a) Not common in microbiology – PCR

(b) Lancefield – Detects carbohydrates in Streptococcus group

(c) Quellung – Capsular swelling

(d) Kauffman-White – Salmonella serotyping

(5) Susceptibility tests – (4%)

(a) Not an antibiotic – Sulfonamide

(b) Penicillin – Inhibit cell wall synthesis

(c) Vancomycin – Inhibit cell wall synthesis

(d) Gentamicin – Inhibit protein synthesis

(e) Clindamycin – Inhibit protein synthesis

(f) ESBL – Extended Spectrum Beta-Lactamase

(6) Bacteriologic examination of water, food, milk and utensils – (2%)

 (a) Red milk – S. marcescens

(b) Blue milk – P. aeruginosa

(c) Stormy fermentation of milk – C. perfringens

iv) Bacteria (Anaerobes) – (2%)

(1) Pseudomembranous colitis – C. difficile

(2) Common gut flora – Bacteroides

(3) Gram-positive anaerobes – Peptostreptococcus, peptococcus

v) Mycobacteria – (2%)

(1) AFB smear measures – 2-3cm

(2) MPT 64 – M. tuberculosis

(3) Niacin and nitrate positive – M. tuberculosis

(4) Niacin and nitrate negative – M. bovis

(5) Tween 80 positive – M. kansasii

vi) Other bacteria with unusual growth requirements (Spirochetes, Chlamydia, Mycoplasma, Rickettsia) – (2%)

b) Mycology – (4%)

i) Collection, transport and examination of clinical specimens – (2%)

(1) Basic, branching, intertwining structure of molds – Mycelia

(2) Stain for sharp delineation of fungal elements by fluorescent microscopy – Calcoflour white

(3) Presumptive test for candida that uses serum – Germ tube

(4) Positive hair-baiting test – V-shaped penetration of the hair shaft

(5) Ascospore – Saccharomyces

(6) Farmer lung’s disease – Aspergillus fumigatus

(7) Macroconidia absent – M. audouinii

(8) Microconidia absent – E. floccosum

(9) Epidermophyton – Skin, nails

 (10)Microsporum – Skin, hair

(11)Tricophyton – Skin, hair, nails

(12)T. mentragophytes – Positive hair-baiting test

(13)T. rubrum – Red pigment, teardrop shaped conidia

ii) Culture – (2%)

(1) AMAN medium stain – Lactophenol cotton blue

(2) Cornmeal agar – Chlamydospores

(3) Czapek – Aspergillus

(4) Rice agar – M. canis

(5) Urease media – Cryptococcus neoformans

(6) Birdseed – Phenol oxidase

c) Virology – (4%)

i) General characteristics, transmission and diseases – (2%)

(1) 1st step in viral replication – Adsorption/Attachment and Penetration

(2) Part of virus where envelope is acquired – Nuclear or cytoplasmic membrane

(3) ssDNA virus – Parvovirus

(4) dsRNA – Reovirus

(5) Largest virus - Poxvirus

(6) Largest RNA Virus – Paramyxovirus

(7) Virus that causes acute central nervous system disease in humans and animals – Rabies

(8) Acid sensitive - Rhinovirus

(9) Ether sensitive – Herpes virus

ii) Collection, transport and examination of clinical specimens – (2%)

(1) CMV isolation is recommended using – Human embryonic fibroblasts

(2) Grape-like cluster - Adenovirus

d) Equipment and instrumentation – (5%)

 i) Manual – (3%)

(1) How to prepare agar – Add agar to water*

(2) RPM for centrifugation of bacteria – 3500-5000 RPM for 10mins

ii) Automated – (2%)

e) Quality assurance and safety – (8%)

i) Collection of specimen – (2%)

(1) Lyophilization of pure culture – freeze at -20 to -30˚C

(2) Mineral oil – Anaerobes

ii) Quality control – (2%)

(1) Settings of rpm marked on the face of the rheostat control on the centrifuge should be checked – Monthly

(2) Oxidase, Catalase, Coagulase – Tested each day, when vial is first opened

iii) Safety – patient/staff – (2%)

(1) BSC II – Laminar flow

(2) Sterilize needles for sputum – Dip in 70% alcohol + sand

iv) Safety – workplace/environment – (2%)

(1) AFB is killed by – Boiling 10mins, Autoclave

(2) Autoclave - 121˚C, 15 psi(lbs/in2), 15mins

(3) Not killed by sterilization – Prions

2) Parasitology – (30%)

a) Parasites – life cycle, morphological characteristics, epidemiology, prevention and control, manner of reporting, counting – (21%)

b) Nematodes – (5%)

(1) First stage of nematodes – Rhabditiform

(2) Viviparous – Produces larva

(3) Oviparous – Produces egg

 (4) Parasite most prevalent in orphanage – Unholy Three

(5) Larvae that passes through the lungs – Ascaris, Stronglyloides, Hookworm

(6) Roundworm that inhabits the small intestine and is usually demonstrated as rhabditiform larvae in fecal specimen – Threadworm

(7) Ascaris egg lacking its mammillated coat – Decorticated

(8) A. lumbricoides vector – Cockroach

(9) Resembles Trichiuris – C. philippinensis

(10)S. stercoralis – Chinese lantern

(11)Adult Trichinella – Intestine

(12)Unsheathed microfilariae – O. volvulus

(13)Longest nematode – D. medinensis

(14)Internal autoinfection – S. stercoralis

(15)External autoinfection – E. vermicularis

ii) Trematodes – (5%)

(1) 1st IH of flukes – Snail

(2) 2nd IH of P. westermani – Fresh water crabs

(3) 2nd IH of Echinostoma – Snail

(4) 2nd IH of Fasciola/Fasciolopsis – Aquatic vegetation

(5) Parasite found in sheep/cattle, not common in PH – F. hepatica

(6) Eggs with abopercular thickening – P. westermani

(7) Small lateral spine – S. japonicum

(8) Prominent lateral spine – S. mansoni

(9) Terminal spine – S. haematobium

(10)Schistosomule – Cercaria minus tail

(11)Swimmer’s itch – Schistosoma

(12)C. sinensis – Old fashioned light bulb

(13)Mode of transmission of Clonorchis – Ingestion of metacercaria

iii) Cestodes – (5%)

 (1) Head of tapeworm - Scolex

(2) Body of tapeworm – Strobila

(3) Finger-like uterine branches – T. solium

(4) Tree-like uterine branches – T. saginata

(5) 3rd Taenia specie – Taenia asiatica

(6) Hexacanth embryo in a radially striated shell – Taenia

(7) Hexacanth embryo that lacks polar filaments – H. diminuta

(8) Egg of D. latum – Operculated

(9) 1st IH of D. latum – Copepods

(10)2nd IH of D. latum – Fresh water fish

(11)Spirometra – May resemble D. latum

(12)Found in IH of E. granulosus – Hydatid cyst

(13)Double-pored tapeworm – D. caninum

iv) Protozoa – (5%)

(1) Motile, reproducing, feeding stage – Trophozoite

(2) Organ most often involved in extraintestinal amoebiasis – Liver

(3) E. histolytica – Ingest RBC

(4) Differentiates hartmanni and histolytica – Size

(5) E. gingivalis – Ingests WBC

(6) E. nana – Cross-eyed cyst

(7) Often mistaken for cyst of amoeba – B. hominis

(8) Largest intestinal protozoa – B. coli

(9) Undulating membrane – Trichomonas, Trypanosoma

(10)Intestinal flagellate is described as – Pear-shaped

(11)T. vaginalis – Jerking, tumbling motility

(12)Ping pong disease – T. vaginalis

(13)Vector of African sleeping sickness – Glossina species

(14)DH for Plasmodium species – Female Anopheles mosquito

(15)Principal vector for malaria – Flavirostris

 (16)Plasmodium species that can cause relapse – P. vivax, P. ovale

(17)Not recommended for Venipuncture – Malaria, Babesia, Hemoflagellates

(18)Blood specimen preferred for protozoa – Finger puncture

(19)90% cases of malaria caused by – P. vivax and falciparum

(20)Toxoplasma gondii – cat

v) Ectoparasites – (1%)

(1) Crabs – Ectoparasite

c) Parasitologic Techniques – (5%)

i) Routine – (2%)

(1) Iodine – Destroys trophozoites

(2) Stain to demonstrate uterine arrangement of Taenia species – India ink

(3) Chromatoid bodies on Trichrome stain is colored as – Bright to red

(4) Stain for Naegleria, Acanthamoeba – H&E, Wright’s

(5) To detect stippling, prepare blood films – 30mins to 1hr

(6) Reagent for kato-thick smear – Malachite green, glycerine, cellophane

ii) Concentration – (2%)

(1) Zinc sulfate specific gravity – 1.18

(2) Flotation techniques – Operculated eggs and eggs with spines not recovered

iii) Others – (1%)

(1) Sheather’s sugar flotation – Cryptosporidium

(2) Baermann funnel - Strongyloides

d) Quality assurance – (4%)

i) Collection and preservation of specimen – (2%)

(1) Stool for more than 1hr is stored at – Refrigerator

 (2) Stool preservative – Polyvinyl alcohol, Schaudinn

ii) Quality control – (2%)

Clinical Microscopy

1. Urine – (53%)

a. Anatomy and physiology of the kidney, Formation of Urine – (5%)

i. Specific gravity of glomerular filtrate – 1.010

ii. Proximal convoluted tubules – Site for reabsorption of glucose, amino acids, NaCl

iii. Major organic substance in urine – Urea

iv. Major inorganic substance in urine - Chloride

v. Albumin – Maintains oncotic pressure

vi. Not normally found in urine – Protein

vii. Renin – Maintain BP

b. Macroscopic examination – (10%)

i. <400ml urine – Oliguria

ii. >2000ml urine – Polyuria

iii. Incapable of producing urine - Anuria

iv. Print blurred through urine – Cloudy

v. Atabrine – Yellow

vi. Carotene – Yellow

vii. Tea bag color of urine – Brown

viii. Portwine urine – Porphyrin

ix. Reddish-orange urine – Rifampin

x. Yellow foam – Bilirubin

xi. Oily looking substance on top of urine – Indicative of nephrotic syndrome

c. Chemical Analyses – (18%)

i. Acidic urine – High meat diet, DM

 ii. Alkaline urine – Vegetable diet

iii. pH – Aids in crystal identification

iv. RCM – Increased SG

v. DM – Increased SG

vi. Color of glucose in potassium iodide strip – Green to brown

vii. Clinitest – Detection of reducing substances

viii. Most numbered ketone body – B-hydroxybutyric acid

ix. Starvation/Diabetes – Ketones

x. Legal’s test – Ketones

xi. Ketone reagent strip - Purple

xii. UTI screening – Nitrite

xiii. Protein principle – Error of indicator

xiv. Protein reagent strip detects - Albumin

xv. Turbidity with granulation – 2+

xvi. Ictotest – Bilirubin

xvii. Ehrlich units – Used in reporting urobilinogen

xviii. Blondheim’s Test – Differentiates hemoglobinuria and myoglobinuria

xix. 11th pad in reagent strip – Ascorbic acid

xx. Sulkowitch – Calcium

xxi. Fantus - Chloride

xxii. CTAB – Mucopolysaccharidosis

xxiii. PAH, PSP – Tests for tubular secretion, renal blood flow

d. Microscopic examination – (15%)

i. Largest cell found in urine sediment – Squamous epithelial cell

ii. Clue cell – Bacterial vaginosis

iii. Frequent parasite encountered in urine – T. vaginalis

iv. Fecal contamination of urine sample – E. vermicularis

v. Urinalysis findings in patient with renal calculi – Hematuria

vi. Renal lithiasis – Hematuria

 vii. Ghost cell- RBC in hypotonic solution

viii. Glitter cell – WBC in hypotonic solution

ix. WBC/RBC reporting – Per hpf

x. Eosinophils – Seen in Acute Interstitial Nephritis

xi. RTE Cells – Eccentric nucleus

xii. Lipid-containing RTE Cells – Oval fat bodies

xiii. RTE cells with nonlipid-containing vacuoles – Bubble cells

xiv. Lemon-shaped crystal – Uric acid

xv. Amorphous urates – Soluble with heat

xvi. Ethylene glycol poisoning – Calcium oxalate monohydrate

xvii. Ampicillin – Sheaves, needles

xviii. Crystal in Fanconi’s syndrome – Cystine

xix. Abnormal crystals seen in liver disorders – Bilirubin, Leucine, Tyrosine

xx. Sulfonamide crystals – Confirmed by the diazo reaction

xxi. Apatite – Calcium phosphate

xxii. Thorny apple – Ammonium biurate

xxiii. Cylindroids – Disintegration forms of cast with tails and tapering ends

xxiv. Significance of cylindroids – Same as casts

xxv. Effect of alkaline, hypotonic urine – cast disintegrates

xxvi. Degenerative form of all casts – Waxy

xxvii. Telescoped sediment – Findings of nephrotic syndrome and glomerulonephritis

e. Pregnancy testing – (2%)

f. Renal calculi – (3%)

i. Yellow to brownish red, moderately hard – Uric acid and urate stones

ii. Pale and friable – Phosphate stones

iii. Very hard, dark color, rough surface – Calcium oxalate stones

iv. Yellow-brown resembling an old soap, somewhat greasy – Cystine stones

 v. Chemical used to detect renal calculi made up of PO4 – Ammonium molybdate in
HNO3

vi. Least common urinary stone – Cystine

2. Feces – (3%)

a. Normal stool pH – 7-8

b. Fecal leukocytes indicating invasive infection – 3/hpf

c. Stool color when taking multivitamins with iron – Black

d. Stool color if patient have melanoma – Black

e. APT reagent – 1% NaOH

f. APT in infant – Pink

g. FOBT – Colorectal cancer

h. Positive color for guiac – blue

3. Other Body Fluids – (21%)

a. CSF – (5%)

i. Produces 70% CSF – Choroid plexus

ii. Clot formation and bloody CSF – Traumatic tap

iii. Laboratory test for CSF protein – Turbidimetric, Dye-binding

iv. Normal value of protein in CSF – 15-45mg or <1%

v. CSF Glucose – 2/3 of plasma

vi. Cloudy CSF dilution – 1:200

vii. Predominant WBC in adult CSF – Lymphocyte

viii. Predominant WBC in newborn CSF - Monocyte

b. Seminal Fluid – (5%)

i. Spermatogonia – Youngest

ii. Acrosomoal cap – ½ of head 2/3 of nucleus

iii. Sperm count dilution – 1:20

iv. Alternate diluting fluid – Chilled water

 v. Stain to assess sperm morphology – Paps

vi. How many fields viewed to assess sperm morphology – 20

vii. Sperm graded as freely moving – 4

viii. Neutral alpha glucosidase – Epididymis

ix. Enzymes that can liquefy semen – Chymotrypsin, plasmin, pepsin

x. Most common cause of male infertility – Varicocele

xi. Infertility – 1.5ml semen

xii. Red seminal fluid – Blood

xiii. Makler counting chamber – Undiluted sperm

xiv. Oligospermia – Decreased sperm count

c. Amniotic Fluid – (3%)

i. Amniotic fluid volume after first trimester – Fetal urine

ii. Gestational age - Creatinine

iii. Dark brown amniotic fluid – Fetal death

iv. Dark green amniotic fluid – Meconium

v. OD 450 - Bilirubin

vi. Additional test to be done for elevated AFP amniotic fluid –

Acetylcholinesterase

d. Gastric Fluid and Duodenal Content – (2%)

i. Gastric tube inserted through mouth – Rehfuss

ii. Gastric tube inserted through nose – Levine

iii. Diagnex – Tubeless gastric analysis

iv. BAO – Basal Acid Output

v. Pernicious Anemia – Anti-parietal antibodies

vi. Zollinger Ellison – Elevated gastrin

e. Sputum and Bronchial Washings – (2%)

 i. Bronchitis – Dittrich plugs

ii. Bronchial asthma – Charcot-Leyden crystals, Curschmann spiral

iii. Charcot-Leyden crystals – Red, spindle-shaped crystals

iv. Creola bodies – Bronchial asthma

f. Synovial Fluid – (2%)

i. Normal synovial fluid - <3.5ml

ii. Synovial fluid glucose – Comparable with serum

iii. Clotted synovial fluid – Use of acetic acid

g. Peritoneal, Pleural and Pericardial Fluids – (2%)

i. Normal color and appearance of peritoneal fluid – Clear, pale yellow

ii. Accumulation of fluid in serous membranes – Effusion

iii. Concentric striations of collage-like material in peritoneal fluid associated with ovarian and thyroid malignancy – Psammoma bodies

iv. Peritoneal lavage – Determination of intra-abdominal bleeding

4. Collection, preservation and handling of specimens – (10%)

a. Chain of Custody – Step by step documentation of handling and testing of legal specimens

b. Routine amount of urine – 10-15ml

c. Urine container capacity for drug testing – 60ml

d. Urine for drug testing temperature – 32.5-37.7 degrees Celsius within 4mins

e. Bluing agent – Prevent adulteration

f. Used in analytes with diurnal variation – Timed specimen

g. Proper container for urobilinogen determination – Amber bottle

h. What should be done if pink sediment is seen after refrigeration – Return to RT

i. Additive used in Addis count – Formalin

j. Amniotic fluid for fetal lung maturity is stored at – Refrigerator

k. To prolong cell viability for cytogenetic studies, specimen should be – Incubated at 37˚C
l. Specimen for detection of male/female anti-sperm antibody – Serum, semen, cervical mucus

m. Fructose storage – Frozen

 n. Synovial fluid cell count – EDTA

o. Specimen for tubeless gastric acid analysis - Urine

p. Specimen for fecal fat determination – 3-day sample

5. Microscope, automation, other instruments – (5%)

a. Urinometer – Read at lower meniscus

b. Calibration solution for refractometer – 9% sucrose (1.034 ± 0.001)

c. Calibration of refractometer – 5% NaCl (1.022 ± 0.001)

d. Distilled water – 1.000

e. Air bubbles – Error in refractometer

f. CASA – Computer Assisted Sperm Analysis

g. Crystals and OFB – Polarizing microscope

h. Condenser-equipped microscope – Phase contrast

i. Cytocentrifuge – 30% albumin

6. Quality assurance and laboratory safety – (8%)

a. To disinfect countertops with spill use – 10% bleach

b. Biohazard color – Black in yellow background

c. Chain of Infection – 6

d. Safety Diamond, 4 means – Extreme

e. RACE, A – Alarm

f. PDCA – Plan-Do-Check-Act

g. PDSA – Plan-Do-Study-Act

Hematology

1) Blood collection, anticoagulants and others (including Safety) – (5%)

a) Size of blood for smear – 2-3mm

b) Distance of blood drop from the edge of the label – 0.25in/1cm

c) Longitudinal – Most ideal method for reading smear

d) Length of needle – 1-1.5in

 e) Gauge in tuberculin syringe – 25

f) Gauge of needle in bleeding of donors – 16

g) Ocular – Interpupillar distance

2) Hematology tests and procedures – (30%)

a) Routine – (15%)

i) Degree of hypochromia measured as 1/3 – Normal

ii) Macrocyte in ESR – False increase

iii) Effect of increased Hgb in ESR – Increased

iv) ESR in wintrobe tube is read using – Left side

v) Disposable ESR tubes – Dispettes

vi) Hematocrit method in wintrobe – Macrohematocrit

vii) Size of the unfilled portion of the capillary tube in microhematocrit – 10-15mm

viii) Length of capillary tube – 75mm

ix) Length of plug in capillary tube – 4-6mm

x) Centrifugation for microhematocrit – 10,000-15,000g for 5mins

xi) 1st layer in spun hematocrit – Fat

xii) 4th layer in spun hematocrit - RBC

xiii) MCV – Computed from hematocrit and RBC count

xiv) 1 RBC not counted – Decrease count by 10,000

xv) Measures erythropoiesis – Reticulocyte count

xvi) 3-5% rouleaux – Slight high

b) Automation – (10%)

i) Relation of voltage pulse to cell size – Directly proportional

ii) Blood clots will have what effect on RBC count using automated counters – Decreased

iii) Positive error – Bubbles, electric impulse, aperture plugs

iv) Negative error – Hemolysis

v) Platelet satellitism – Decreased platelet count

 c) Special – (5%)

i) Screening test for HbS – Dithionite solubility

ii) Requires fresh sample – MPO, LAP

iii) Differentiate Leukemoid Reaction from CML – LAP

3) Hematopoiesis, Diseases/Disorders and Reference Values – (40%)

a) Hematopoiesis (in general) – (6%)

i) Pluripotential stem cell – 2 possible cell lines

ii) Differentiate pure anemia from bone marrow malfunction – WBC count

iii) Bone marrow – Sternum, tibia, POSIC

iv) Not true regarding yellow marrow – Hematopoietic

v) CD 34 – Stem Cell

b) Erythropoiesis and RBCs – (12%)

i) Generates ATP – Embden-Meyerhof

ii) Generates 2,3-DPG – Luebering-Rapoport

iii) Decreased affinity to O2 is associated with – Increased Temperatire, 2,3-DPG, CO, decreased blood pH

iv) Acanthocyte – McLeod phenotype, abetalipoproteinemia

v) Bronze cells – Spherocytes

vi) Codocyte – Mexican hat cell

vii) Dacryocyte – Myelofibrosis

viii) Echinocyte – Burr cell

ix) Horn-like cell – Keratocyte

x) Stomatocyte – Rh null

xi) Hemoglobin synthesis – Polychromatophilic normoblast to reticulocyte

xii) Thalassemia – Quantitative defect

xiii) Hemoglobinopathy – Qualitative defect

xiv) Alpha Thalassemia – Decreased HbA, HbA2, HbF

xv) Beta Thalassmia – Decreased HbA, increased HbA2, HbF

 xvi) Microcytic - <6µm

xvii) Chronic blood loss – Microcytic, hypochromic

xviii) Acute blood loss – Normocytic, normochromic

xix) Aplastic anemia – Normocytic, normochromic

xx) Major cause of death in sickle cell anemia – Infectious crises

xxi) Not used for evaluation of anemia – MCH

xxii) Not used in actual RBC description – Hyperchromia

xxiii) Haptoglobin – To verify in vivo hemolysis

xxiv) Rouleaux formation is seen in – Conditions that increase plasma proteins

c) Leukopoiesis and WBCs – (12%)

i) Stem cell to blast 5 days. Lifespan in tissue phase 9-10 days – Granulocytes

ii) Nucleoli 3+, Dark blue to blue cytoplasm, Lacy chromatin pattern – Myeloblast

iii) Primary granules – Promyelocyte

iv) Stage which you can identify specific WBC – Myelocyte

v) Kidney shaped nucleus - Metamyelocyte

vi) Sausage shaped nucleus – Band

vii) Not an end stage cell – Monocyte

viii) Not capable of phagocytosis – Lymphocyte

ix) Pince-nez – Pelger Huet

x) Sezary cell – Mycosis fungoides, T-cell, Sezary syndrome

xi) Seen in 2nd trimester of pregnancy – Neutrophilia

xii) Diurnal variation is observed in – Neutrophil (decreased in AM, increased in PM)

xiii) Leukemia without maturation – M1

xiv) M2 – Most common AML

xv) M3 – DIC

xvi) M5 – Schilling’s Leukemia

xvii) Granulocyte – Specific esterase positive

xviii) Differentiate Acute Monocytic Leukemia from ALL – Myeloperoxidase

 xix) Differentiate Acute Myelomonocytic Leukemia from ALL - SBB

xx) Absence of Philadelphia chromosome – Poor prognosis of disease

xxi) Philadelphia chromosome (+) – Chronic Myelogenous Leukemia

d) Thrombopoiesis and Platelets – (10%)

i) Stem cell to blast 5 days. Lifespan 8-11 days – Platelets

ii) Nuclei with demarcating membrane – Promegakaryocyte

iii) Platelet – 8-20/field

iv) Clot retraction – Function of platelets

v) Outer surface – Glycocalyx

vi) Platelet adhesion – vWF, gpIb

vii) Platelet aggregation – Fibrinogen, gpIIb-IIIa

viii) Aspirin – inhibit cyclooxygenase

ix) ADAMTS13 – cleaves vWF

x) Platelet alpha and dense granules, mitochondria – Organelle zone

xi) Platelet Factor 3 – Phospholipid

xii) Alpha granule disorder – Gray platelets

xiii) Dense granule disorder – Storage pool

xiv) Platelet retention in multiple myeloma - Reduced

4) Coagulation (Principles, Procedures, Diseases/Disorders and Reference Values) – (20%)

a) Hemostasis – Theories/Concepts, Mechanisms – (2%)

i) NV of template bleeding time – 2-8mins

ii) Screening test for secondary hemostasis – Clotting time

iii) Principal enzyme involved in fibrinolysis - Plasmin

b) Coagulation procedures/tests – (8%)

i) Stypven time – Common pathway

ii) Duckert’s Test – Factor 13

iii) Unaffected by heparin therapy – Reptilase time

 iv) Prekallikrein is detected through – APTT

v) Effect of Kaolin to APTT – Decreased/Shortened APTT

vi) D-dimer test positive after – 4hrs

vii) Euglobulin clot lysis time – Screening test for fibrinolysis

viii) Electromechanical – Fibrometer

c) Coagulation factors, diseases/disorders & reference values – (10%)

i) Required in all pathways – Factor 4

ii) Factor 3 – Tissue thromboplastin

iii) Activates extrinsic pathway – Tissue thromboplastin

iv) Prothrombin group – Vitamin K dependent

v) Factor consumed during coagulation – Thrombin group

vi) Factors that deteriorate at room temperature – 5,8

vii) Factors that are activated at cold temperature – 7,11

viii) Barium Sulfate – absorbs prothrombin group

ix) Coumarin – prolong prothrombin time

x) Protamine sulfate – reverses heparin overdose

xi) Ecchymosis – Deficiency in platelets

xii) Asymptomatic patient suspected having coagulation disorder – test APTT

xiii) DIC – Fibrinogen decrease 4-24hrs, platelet decrease 48hrs

5) Quality assurance – (5%)

Immunology, Serology and Blood Banking

1) Immunology/Serology – (50%)

a) Historical background – (2%)

i) T-cell receptor gene – 1984

ii) Pope Innocent VII – First patient to be transfused

iii) First HTR – Pope Innocent VII

iv) Cook carrier of typhoid – Mary Mallon

 v) Antibody structure – Susumu Tonegawa

b) Natural (innate) immunity, including role of macrophages, monocytes and granulocytes – (5%)

i) Function of normal flora of skin – barrier against microorganisms

ii) NK Cells – Innate immunity

iii) Most effective antigen presenting cell – Dendritic cell

c) Acquired immunity – humoral responses, immunogens, immunoglobulins, B cells – (8%)

i) % of B cells in circulation – 20%

ii) IgD – Ig on surface of B-cell

iii) Antibody binding site - Paratope

iv) Binding strength of antibody for an antigen – Avidity

v) Fixes complement – IgM

vi) Pentamer – IgM

vii) Antibody in secretions - IgA

viii) Region of Ig that determines whether an immunoglobulin can fix complement – CH2

ix) Papain – Fab,Fab,Fc

x) Pepsin – F(ab)2, Fc

d) Acquired immunity – cellular responses, T cells, cytokines and chemokines – (5%)

i) Major composition of important lymphocytes – T cells

ii) Stimulates transformation of B-cell into plasma cell – T-helper cell

iii) CD2 – Receptor for sheep RBC

iv) CD8 – Cytotoxic T-cell

v) IL 1 – Fever

vi) IL 6 - CRP

vii) Interleukin 8 – Pro-inflammatory cytokine

e) Complement System – (2%)

 i) Lectin pathway starts with – MBP

ii) Complement component with largest molecular weight – C1qrs stabilized with Ca

iii) Membrane Attack Complex – C5b6789

iv) C1 deficiency – SLE like disease

v) C9 deficiency – No know disease association

vi) Complement fragments measured in – Nephelometry, RID

f) MHC, HLA and Transplantation – (3%)

i) HLA class where most autoimmune diseases occur – HLA II

ii) HLA B8 – Myasthenia gravis

iii) HLA B27 – Ankylosing spondylitis

iv) HLA DR3 - SLE

g) Immunologic tests for detection of antigens & antibodies – principles, procedures, interpretation of results – (16%)

i) Bacterial infections and STD – (5%)

(1) Coagglutination -Protein A

(2) Widal test, 25% of red cell is agglutinated graded as – 1+

(3) 10% treponemes immobilized – Negative

(4) Primary syphilis - Chancre

(5) Tertiary syphilis - Gumma

(6) Brucellosis titer peak – 4-8weeks

ii) Viral infections, including Hepatitis and HIV – (5%)

(1) Infectious hepatits marker - HbeAg

(2) Not included in Hepatits B serologic marker – HbcAg

(3) HCV RNA – Viral load

(4) Hairy cell leukemia – HTLV II

(5) HTLV transmitted through – Blood, sperm

iii) Fungal infections – (1%)

 iv) Parasitic infections, including malaria – (2%)

(1) Most commonly used method in Philippines in testing for malaria – Thick smear

(2) HRP – Histidine-rich protein

v) Autoimmune disorders – (3%)

(1) Nature of Rheumatoid Factor – IgM against Fc portion of IgG

(2) Test for Rheumatoid Factor – Rose-Waaler Test; Latex Agglutination

(3) Negative Rheumatoid Factor – Less than 1:40 titer

(4) Diagnosis of Rheumatoid Arthritis – Rheumatoid Factor and CRP

(5) dsDNA – SLE

(6) Chronic active hepatitis – Anti-smooth muscle antibody

h) Tumor Immunology (Tumor markers, Oncoproteins) – (3%)

i) CA 19-9 – Pancreatic cancer

ii) Nuclear Matrix Protein – Bladder cancer

iii) Expressed as tumor and normally present in fetal cells – Oncofetal antigen

i) Hypersensitivity – (1%)

i) Type 1 – Allergic reaction

ii) Type 2 – HDN, HTR, AIHA

iii) Serum sickness – Type 3

iv) Type 4 – TB Skin test

v) Mediator of Type 4 – T-cells

j) Instrumentation and quality management – (5%)

i) PCR – Amplification

ii) Flow cytometry – Detects surface antigen

iii) Fluorescent microscope – FTA-ABS

 iv) Phase-contrast microscope – To visualize mixed lymphocytotoxicity

v) Mixed Lymphocyte Reaction – Cellular assay

2) Blood Banking – (50%)

a) ABO and Rh Blood Group Systems – (5%)

i) Karl Landsteiner – Specificity of Serological Reactions

ii) ISBT 1 – ABO

iii) ISBT 4 – Rh

iv) ABO antibodies – IgG, IgM, IgA

v) Least amount of H antigen – A1B

vi) Bombay phenotype antibodies – Anti-A, Anti-B, Anti-H

vii) Alteration of ABO antigen – Cancer of the colon

viii) Most complex blood group – Rh

b) Other Major Blood Group Systems: Kell, Duffy, Kidd, Lewis, MNSs, Lutheran, P, I – (3%)

i) Anti-I – M. pneumoniae

ii) Anti-i – Infectious mononucleosis

iii) Blood type associated with aldomet – Kidd

iv) Anti-M – Enhanced at pH 6.5

v) Anti-N – Found in dialysis patient

vi) Anti-S – causes HDN

c) Minor Blood Group Sustems: Diego, Cartwright, Chido, XG, Scianna, Gerbich, Milton, Knops, Bg, Indian, etc. – (1%)

i) Blood group associated with HLA – Bg

ii) C4 Complement – Chido-Rogers

iii) Diego – Southeast Asian ovalocytosis

iv) Anti-Crom – Found in blacks

d) Basic Genetics – (5%)

i) Private antigens – Low incidence antigen

 ii) Public antigens – High incidence antigen

iii) Type 1 chain precursor – Beta 1-3 linkage

iv) Type 2 chain precursor – Beta 1-4 linkage

v) L-Fucose - H

e) Blood donor selection and processing – (5%)

i) Rubeola – 2 week deferral

ii) Malaria deferral – 3 year

iii) Malaria deferral if donor went to endemic area for vacation – 1 year

iv) Influenza vaccine - Not a cause for deferral

v) Jaundiced at birth – No deferral

vi) Human growth hormone – Permanent deferral

f) Blood preservation and banking – (5%)

i) Blood bag to anticoagulant ratio – 7:1

ii) Citrate in ACD function as – Anticoagulant

iii) Phosphate in CPDA-1 function as – 2-3 DPG (Phosphate function as source of ATP in CPD)

iv) Adenine in CPDA-1 – ATP, Important for red cell survival

v) CPD-A1 – 35 days

vi) SAG-M – 42 days

vii) Rejuvesol - PIGPA

g) Component preparation – (5%)

i) RBC utilizing the open-system should be issued within – 24hrs

ii) Leukopoor RBC – Filtration, Washing and Centrifuge

iii) Amount of proteins in FFP – 6g/dl

iv) Fibrin glue – Thrombin and cryoprecipitate

v) Components of cryoprecipitate – Factor 1, 8, 13, vWF

vi) Cobalt60, Cesium137 = Irradiation of blood components

vii) High glycerol – 40%, slow freezing

 viii) Low glycerol – 20%, rapid freezing

h) Transfusion therapy – (2%)

i) Blood component given to patient who are unresponsive to antibiotics – Leukocyte concentrate

ii) Indication for neocyte transfusion – Thalassemia

iii) Hemophilia B – Factor IX concentrate

iv) Increased blood units transfused – Decreased platelet

v) Crystalloid – Give if no available O Rh negative blood

i) Transfusion reactions – (3%)

i) Tubes needed for the investigation of post-transfusion reaction – Red and purple top

ii) Transfusion reaction with 1˚C rise in temperature – Febrile transfusion reaction

iii) TRALI – Transfusion-Related Acute Lung Injury

iv) TACO – Iatrogenic transfusion reaction

j) Transfusion-transmitted diseases – (3%)

i) Y. enterocolitica – Most common blood bag contaminant

ii) Malaria screening – for Asian countries only

iii) T. pallidum – killed by refrigeration of stored blood

k) BB techniques and procedures: typing, compatibility testing, antibody detection and identification – (8%)

i) Immediate spin – 20s

ii) Replacement for minor crossmatch – Antibody screen

iii) Washing of cord blood – 6-8 times with NSS

iv) Anti-A, Anti-B color – Blue, Yellow

v) Specimen for DAT – Whole blood with EDTA

vi) Acquired B phenomenon – Forward like AB, Reverse like A

vii) Post zone – Antigen excess

viii) Prozone – Antibody excess

 ix) Prozone remedy - Dilution

l) Hemolytic Disease of the Newborn (HDN) and Auto-immune Hemolytic Anemia – (4%)

i) Immunoglobulin that causes HDN – IgG

ii) Blood given to patient with HDN – O Rh negative

iii) DAT positive – AIHA, HDN, HTR

m) Quality management (structure, set-up/equipment, Laboratory Information System/LIS) – (4%)

i) Blood Bank lab refrigerator temperature is monitored every – Shift

ii) Gel technology – Standardization

iii) Gel card – 10mins centrifugation

Histotechniques, Medical Technology Laws and Ethics

1. Histopathology – (65%)

a. Histology and Pathology – (10%)

i. Terminologies – (4%)

1. Pathos – Suffering

2. STAT – Statim

3. ASAP – As soon as possible

4. Inflammation – ends with “itis”

5. Pyknosis – Condensation of chromatin

6. Karyorrhexis – Fragmentation of nucleus

7. Karyolysis – Dissolution of nuclear structures

8. CT that forms the framework of BM, endocrine and all lymphoid organs – Reticular CT

9. Peyer’s patches – Ileum

10. Part of esophagus with smooth muscle – Lower half

ii. Etiology of disease – (2%)

1. Epithelial tissue origin – Carcinoma

2. Connective tissue origin - Sarcoma

iii. Signs, symptoms and course of disease – (2%)

1. Sign – Observable in patient

2. Symptom – Only patient feels

3. Jaundice – Sign

4. Dysuria – Symptom

5. Tinnitus - Symptom

iv. Cellular and tissue changes – (2%)

1. Aplasia – incomplete or defective development of a tissue

2. Agenesia – nonappearance of an organ

3. Hypoplasia – failure to reach maturity

4. Atresia – failure of organ to form an opening

5. Atrophy – decreased size of an organ

6. Hypertrophy – increase in size of tissue due to increase in size of cell

7. Hyperplasia – increase in size of tissue due to increase in number of cell

8. Metaplasia – Reversible change

9. Apoptosis – Programmed cell death

10. Heart – Coagulative necrosis

b. Histopathologic techniques and procedures – (35%)

i. Preservation and handling of specimen – (10%)

1. Most critical step – Fixation

2. Optimum fixation volume – 20 times to that of tissue volume

3. Formalin fixes tissue by – forming cross link

4. Glutaraldehyde – 2 formaldehyde residues linked by 3 carbon chains

5. 10% methanol to formaldehyde – Unsuitable for EM, prevent decomposition to formic acid or precipitation to paraformaldehyde

6. Picric acid – Small tissues

7. Picric acid fixatives -Bouin, Brasil

8. Mercurial Fixative – Tissue photography

9. Newcomer’s fixative – Nuclear and histochemical fixative

10. Fixative for electron microscopy – Glutaraldehyde, osmium tetroxide

ii. Tissue processing and procedures – (15%)

1. Routine – Manual – (7%)

a. Routine decalcifying agent – Nitric acid

b. To avoid yellowing/blackening of tissue prior to decalcification – Add urea to nitric acid

c. Perenyi’s fluid – Decalcifier, tissue softener

d. Von Ebner – NaCl, HCl, H2O (decalcifying agent)

e. Milky, turbid xylene – Incomplete dehydration

f. Chloroform – Nervous tissues, lymph nodes and embryo

g. Double embedding – Celloidin and paraffin

h. Sectioning – cutting into uniformly thin slices

i. Simplest microtome – Rocking

j. Most common microtome – Rotary

k. Most dangerous microtome - Sliding

l. Sliding microtome – Adams

m. Freezing microtome - Queckett

 n. Routine paraffin examination – Biconcave knife

o. Plane concave knife – Celloidin

p. Plane wedge – Frozen, hard specimen

q. Thickness of tissue section, Paraffin – 4-6µ

r. Process of removing burrs – Stropping

s. Dull knife free of nicks maybe sharpened by – Stropping

t. Refractive index of glass – 1.518

2. Routine – Automation – (5%)

a. Vacuum embedding – Rapid

b. Autotechnicon – Fixation up to infiltration

3. Special – Frozen section, Microwave – (3%)

a. Cryostat contains – Rotary microtome

b. Embedding medium for electron microscopy - Plastic

c. EPON – EM

d. Commonly used freezing agent – Liquid nitrogen

e. Temperature of liquid nitrogen - -160 to -180 degrees C

f. Dehydrating agent and temperature used for freeze-substitution – Absolute alcohol @ RT, acetone @ -70 degrees C

g. Advantage of freeze-drying – minimum tissue shrinkage, allow

tissue to be processed fresh, less displacement

iii. Staining – (10%)

1. Routine – (5%)

a. Color not permanent – Chromogen

b. Selective removal of stains – Differentiation

c. PAS – Basement membrane

d. Alkaline fast green – Green

e. Orcein – Elastic fibers

f. Gomori’s silver impregnation – Reticulin fibers

 g. Methyl green – RNA

h. Feulgen – DNA

i. Cytoplasm of cells - Pink

2. Special (Immunohistochemistry) – (5%)

a. Tissues are studied through chemical reaction – Histochemical
staining
b. Immunohistochemical techniques – Identification of cellular epitopes or antigens

c. Cytological techniques and procedures – (8%)

i. Preservation and handling of specimen – (2%)

1. Diagnostic cytology – Exfoliative, FNAB, thoracentesis, lumbar tap

2. Exfoliative cytology – detection of malignancy, infectious agents, genetic sex

3. T zone – Endocervical and ectocervical junction

4. Lateral vaginal smear – Hormonal evaluation

5. GI submucosal sample – Fine needle aspirate

6. Heparin – 300 units per 100ml

ii. Processing – (4%)

1. Manual – (2%)
a. To obtain optimum cell yield, the volume of sample to be centrifuged must be – 20-30cc

b. Ringing – sealing of margins to prevent escape of fluid

2. Automation – (2%)

iii. Staining – (2%)

1. Nuclear counterstain – Hematoxylin, carmine, MB, toluidine blue

2. Commonly used nuclear counterstain – Hematoxylin

3. Not a metallic mordant - Iodine

 4. EA 50 stains – Cytoplasm of immature cells

5. OG6 stains – Cytoplasm of mature cells

d. Autopsy – (2%)

i. Terminologies – (1%)

1. First to perform autopsy – Giovanni Morgagni

2. Prosector – Pathologist

3. Rokitansky – In situ dissection

ii. Handling, processing and documentation – (1%)

e. Quality assurance – (10%)

2. MT Laws, Related Laws and Code of Ethics – (35%)

a. MT Laws – (10%)

i. Section 6 – Minimum required course

ii. Section 27 – Foreign reciprocity

iii. Removal of board members - President

iv. Grade for medical laboratory technician – 70-74.9%

v. Issuance of MT license – 21yrs old

vi. COR signatories – PRC Commissioner and Board of MT

vii. Renewal of license – Every 3 years

viii. 60 CPE units – Renewal of license

ix. 1 CPE unit – 10 contact hours

x. If RMT will not renew license in 5 years – Removal from roster

xi. Suspension – 2/3 votes

xii. Revocation – 3 votes

xiii. Appeal to – Civil Service Commission

b. Laboratory Management – (10%)

 i. Direct costs – expenses that can easily be traced directly to an end product

ii. Indirect costs example – Labor to supervise performance of test, QC

c. Related Laws – (10%)

i. PD 1534 – Amended sections 3,8 and 14

ii. E.O. 266 – CPE

iii. PRC Resolution 323 – Policies on admission of foreigners

iv. Father of PAMET – Crisanto Almario

v. RA 9288 – Newborn Screening Act

vi. PKU – Guthrie’s test

vii. RA 4688 - Clinical Laboratory Law

viii. Clinical laboratory – inspected every 2 years

ix. Blood banks – inspected yearly

x. Crossmatching can be done on – Secondary and Tertiary labs

xi. RA 8981 – PRC Modernization Act of 2000

xii. PRC consists of – Chairman and two associates

xiii. PRC Chairman – Florentino C. Doble

xiv. NRL Drugs – EAMC

xv. NRL Hematology – NKTI

xvi. Radioactive wastes – PNRI and DENR

d. Code of Ethics including Bioethics – (5%)

i. Code of Ethics – Moraleta

ii. Improper language to co-worker is a violation of – “restrict my praises etc.”

iii. First line in oath taking – Name and address

iv. Last line in oath taking - Diyos

v. Violation – report to PAMET

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