CSMLS Exam Guide Notes

What molecule is responsible for HOW living organsims What are level 4 control of precautions? - Airborne/
synthesize energy?` - DNA Isolation precautions. Can be spread because
microorganisms can survive and "fly" in air.

What are the 2 divisions of metabolism? - Catabolism

and Anabolism Vertical Gene Transfer - Genetics passed on through
reproduction

What is the function of ATP? - Stores energy for

metabolism Horizontal Gene Transfer - Transferring genes to
another microbe of the same generation (sets microbes
away from multi-celled life)
What are the four phases of a bacterial growth curve? -
Lag, Exponential, Stationary and Death
What are the three mechanisms of horizontal gene
transfer? - Transformation
Define Sterilization - The destruction of all microbial life
Conjugation

Transduction
Define Disinfection - The destruction of microbial life on
an inanimate object
How can horizontal gene transfer change
microorganisms? - Microbes can become more virulent
Define Antisepsis - The destruction of microbial life on and drug resistant which would make the disease
living tissue (endospores may survive) harder to treat

What is level 1 control of precautions? - Standard Transduction - Genetic material passes via a bacterial
precautions - everyone should follow. virus known as a bacteriophage

What are level 2 control of precautions? - Contact Transformation - Bacteria bind DNA from there
Precautions - when a patient is infected and you can surroundings (DNA could be floating due to lysis)
garb up to protect yourself because the infection can be
spread with direct contact
Conjugation - Donor contracts recipient through a sex
pilis. This results in both cells having identical copies of
What are level 3 control of precautions? - Droplet the genetic material
Precautions - patient can spread the infection through
droplets
Transposition - DNA pieces can hop to new locations on
a genome

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 CSMLS Exam Guide Notes

How can genetic diversity be studied? - By analyzing the What light is collected in Bright field Microscopes? -
sequence of nucleotides in rRNA Both light reflected from the object and unreflected
lightq

What type of ribosomes are in eukaryotic cells? - 80S

What light is collected in Darkfeild Microscopes? - Only
the light reflected from the object.
What kind of ribosomes are within prokaryotic cells -
70S
An opaque disc UNDER the condenser blocks out light
that would otherwise enter the objective directly.
Clone vs. Strain - Clone is a population of cells derived
from a single cell
What is the purpose of Phase-Contrast Microscopy -
Allows for detailed examination of internal structures of
Strain is genetically different cells within a clone non-fixed and unstained specimens

How are wavelength and resolution related in In-Phase vs. Out of Phase - In phase = peaks match and
microscopy? - As the wavelength decreases, resolution troughs match = adds light waves together
increases.

Out of phase = peaks and troughs do not match up =

Resolution - To see 2 points as separate and distinct cancels light waves out showing black in the specimen
since there is no light.

What does it mean if a microscope has a resolving

power of 0.4 nm? - That the microscope can distinguish How does Florescent Microscopy work? - Florescent
2 points 0.5 nm apart substances adsorb UV light and emit visible light. They
luminesce.

Refractive Index - The light bending ability of a medium

(light may bend too much and miss the high What is immunofluorescence? - With the use of a
magnification lens) fluorochrome labelled AB in the diagnosis of a specific
infectious disease

Low refractive index = high resolution

How can specimens be fixed to a slide before staining? -
With heat or methyl alcohol
What is the purpose of Immersion Oil - Is used to keep
light from bending
Why do Acid- Fast bacteria retain the red carbolfuscin
dye? - Because they have a waxy layer of mycolic acid.

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 CSMLS Exam Guide Notes

The dye is more soluble in the lipid layer of the bacteria Macrocytic anemia
instead of the acid alcohol reagent
Reticulocytopenia

NL - Decreased WBC
Psychrophiles - Prefer 0-20oC. They live in cold regions
NL PLTS
of the world and are not associated with human disease

What is the cause of anemia with Congenital

Thermophiles - Cannot grow at body temp (body temp
Dyserythropoietic Anemia? - Hypercellulary BM with
is too low)
ineffective erythropoiesis - days plastic changes

Mesophiles - Human pathogens. They grow at 20-40oC

What is noted from CDA I? - Spongy hemochromatin
(Swiss cheese) in erythroblasts

What makes up ambient air - Naturally occurring gases

in the air we breathe.
May show nuclear bridging from chromatin bridges

-basophillic stippling and Cabot rings

21% O2

0.03% CO2
What is noted in CDA II? - Binucleated and
78% N2 multinucleated forms (pseudo gaucher cells)

And a mix of other gases

Can be treated with a splenectomy and iron depletion

What makes up a microaerophilic environment? - 5%

O2
What is noted in CDA III? - BM will show giant
10%CO2 erythroblasts with up to 12 nuclei

85% N2

What causes myelophthisic anemia - Infiltration of

abnormal cells (cancer cells, tumours, fibroblasts) into
*needed for Campy organisms.... O2 levels higher than
the BM, releasing immature cells into circulation.
6% will harm these organisms

Stem cells and progenitors migrate to the spleen and

What is Diamond Blackfan Anemia? - The congenital
liver for extra medullary hematopoiesis
form of red cell aplasia that occurs due to a mutation of
ribosomes.

What does the PB of Myelophthisic Anemia appear as? -

Normocytic erythrocytes
Short stature, neck and thumb abnormalities

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 CSMLS Exam Guide Notes

Reticulocytopenia Why is there a decrease in haptoglobin during

hemolysis? - Because all the haptoglobin is bound to the
Tear drop cells
heme
NRBC's

Immature myeloid and megakaryocytes

What is present in intravascular hemolysis that is absent
Giant PLTS in extravascular hemolysis? - Hemoglobinura, free Hgb
in the plasma and urine hemosiderin

What causes Anemia of Chronic Kidney Disease? -

Inadequate production of EPO What makes up Hgb F?? - 2 alpha and 2 gamma

What is the treatment for Anemia of Chronic Kidney What makes up Hgb A? - 2 alpha and 2 beta
Disease? - Recombinant EPO, which requires adequate
iron stores.
What makes up HgbA2? - 2 alpha and 2 delta

Must monitor Hgb, Ferritin levels and % transferrin

saturation levels Why does Hgb F usually not occur in adults? - Because
gamma is eventually replaced with beta, making Hgb F
into Hgb A
What is the purpose of hemopexin? - Hgb not bound to
haptoglobin becomes metheme which can bind to
hemopexin (liver produced protein) to bring Hgb to the What is the gene alteration associated with sickle cell
hepatocytes where it is internalized disease? - Occurs on the beta chain at the 6th position
where glutamic acid is replaced with valine

What is the purpose of metheme-albumin - Albumin is

able to hold onto metheme when hemopexin is too Why is sickle cell disease not detectable in the first 6
saturated and will release the metheme to hemopexin months of life? - Because of Hgb F
when it is again available

What organisms are persons affected with sickle cell

What type of hemolysis do spherocytes indicate? - disease more susceptible to? - S.aureus
Extravascular hemolysis
S.pneumoniae

H.influenzae
What RBC morphologies indicate intravascular
hemolysis? - Schistocytes, sickle cells, malaria, target
cells What is the autosplenectomy effect? - Causes sepsis in
sickle cell disease because the spleen makes removing
the sickle cells a priority and then loses its ability to
remove bacteria
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 CSMLS Exam Guide Notes

Describe the PB smear of Sickle Cell Disease - Deoxygenated Hgb S is insoluble in the solution and will
Normocytic/ Normochromic precipitate, creating a turbid solution

Poikliocytosis & Anisocytosis What would cause a false positive Hgb solubility test? -
Lipemia
Target Cells
Heavily inoculated test
NRBC's

Spherocytes
Hemoglobinopathies (Hgb C, Hgb S - Memphis and
Basophillic stippling
Travis)
Pappenheimer bodies

Howell jolly bodies

Hgb electrophoresis at an alkaline pH detects which
Polychromasia Hgb's?? - Hgb S

Hgb G (can also be detected on an acidic pH)

Leukocytosis with neutrophilia and mild shift Hgb D (can also be detected on an acidic pH)

Thrombocytosis

IgA increase What is Sickle cell Trait? - Heterozygous state Hgb AS, it
is a begin condition that is asymptomatic unless in
Normal ferritin extreme hypoxia conditions
Increased bilirubin (jaundice)

What are the laboratory results for sickle cell trait? -

What laboratory tests can confirm sickle cell disease? - Normal RBC morphology with a few target cells
Hgb solubility test

Hgb electrophoresis Positive Hgb solubility test

High performance liquid chromatography

Capillary electrophoresis Hgb electrophoresis will show Hgb S and Hgb A

Hgb Solubility test - Hgb S shows decreased solubility of What does Hgb measurement determine? - The amount
deoxygenated blood. of Hgb found within the RBC's and it corresponds to the
bodies ability to carry oxygen and CO2

Test is performed by adding buffered salt solution

containing a reducing agent (sodium dithionite) and a
detergent based lying agent (saponin)
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 CSMLS Exam Guide Notes

What is drank in solution and what is it used for? - A How are histograms created? - Pulses from electrical
weak solution of potassium cyanide and potassium impedance are recorded on a graph
ferricyanide

What is the purpose of Radio Frequency for hematology

Used to measure hgb analyzes? - Used with Electrical impedance.

What are the normal ranges for Hgb? - Male: 140-174 Detects changes in current between both electrodes,
g/L the total volume of the cell is proportional to the
change in direct current.
Female: 123-157 g/L

Nucleus density is related to the pulse size of RF,

For manual cell counts, what are the dilution reagents
allowing for a 5 part diff.
for RBC's, WBC's and PLT's? - WBC: Acetic Acid

RBC: Saline
What is the light source that is used in Optical Scatter in
PLT: Ammonium Oxalate
hematology analyzers? - Tungsten halogen or helium-
neon laser

When would you need to alter the dilution of acetic acid

when manually counting WBC's? - WBC's <3.0 need a
What happens to the introduced sample in Optical
smaller dilution
Scatter? - Sample stream is focused through a quartz
>30 need a larger dilution flow cell past a focused light source. The light scatter is
measured by photodetectors

Explain the Coulter Principal of Electronic Impedance -

Based on the measurements of changes in electrical Light is converted to digital signals that are displayed in
resistance produced by cells as they travel through an cytograms or scatter plots
aperture

What cells can be detected through peroxidase activity?

There is an internal electrode in the aperature and an - Neutrophils
external aperature outside of the electrode.
Eosinophils

Monocytes
Electrical resistance occurs as cells pass through the
aperature causing impulses. Impulses are directly
proportional to the number of cells. The size of the They are stained using their peroxidase activity being
impulse is related to the size of the cell. able to convert a substrate to a dark precipitate.

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 CSMLS Exam Guide Notes

The absorbance of the substrate is measured and What is ESR now being replaced with? - CRP - C Reactive
related to the amount of peroxidase present in each Protien
cell.

What happens to the ESR if the tube is slightly tilted? -

What is the purpose of the BASO channel? - Cells are Slight increase
treated with a reagent to lyse RBCs and WBCs except
basophils
Why can sodium and potassium oxalate not be used as
an anticoagulant for ESR? - Because they cause RBC's to
What is Flow cytometry? - The labelling of cells and shrink and therefore create a false increased result.
their chromosomes, microorganisms and proteins

What are the 8 stages of erythropoesis? - 1. Burst

How does Flow cytometry detect chromosomes? - Using Forming Unit Erythroid (BFU-E)
monoclonal AB detection with a fluorescent signal
2. Colony Forming Unit Erythroid (CFU-E)

3. Pronormoblast
What anticoagulants are used in specimens for Flow
4. Basophilic normoblast
Cytometry? - EDTA
5. Polychromatophillic normoblast
Heparin
6. Orthochromic normoblast

7. Reticulocyte
How will Cold Agglutinins limit the accuracy of an
automated differential? - Increased MCV and MCHC 8. Erythrocyte (Normocyte)

Decreased RBC (PeanutButter PORE)

How will icterus and Liberia limit the accuracy of an What is the RBC membrane permeable to? - Water,
automated differential? HCO and Cl

How can it be corrected? - Increased Hgb and MCHC What is the RBC membrane impermeable to? - Na, K
and Ca

Replace Lipemic plasma with saline

What happens to iron in RBCs during extravascular
hemolysis? - Bound to transferrin and is transferred to
Corrected for by direct measurement of CHCM (cell Hgb the hepatocytes or BM for storage
conc. Mean)

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 CSMLS Exam Guide Notes

How many ATP molecules are created in the Embden - megaloblastic anemia
Myerhof pathway? - NET gain of 2 ATP molecules
- lead poisoning

What does a right shift in the O2 dissociation curve

What is a siderocyte? - AKA: Pappenheimer Body
demonstrate? - More than 50% of oxygen saturation
occurs at a higher level of oxygen.

Free iron uncombined with Hgb, seen with Prussian

blue iron stain post splenectomy
Lower oxygen affinity

What is a Howell Jolly Body and when is it usually seen?

Less oxygen in the lungs but more oxygen is being
- RBC abnormality that is seen when DNA is removed by
delivered to the tissues.
the spleen

What does a left shift in the O2 dissociation curve

Seen in: post splenectomy, megaloblastic anemia,
demonstrate? - 50% of saturation occurs at a lower
hemolytic anemia
oxygen level. There is a higher oxygen affinity

What are Cabot rings and when are they seen? - Red
What type of iron does transferrin carry? - Ferric (Fe3+)
violet strands forming a figure 8

What is the treatment when exposed to carbon

Rare, but seen with abnormal erythrocyte formation
monoxide? - Hyperbaric oxygen therapy

How can antacids cause impaired absorption of iron? -

How is Hgb production affected by high altitudes? - In
They bind to iron and prevent the absorption
states of hypoxia, Hgb production will be increased to
compensate for low oxygen levels

Explain the disease process associated with lead

poisioning - It is an acquired porphyria
What form of iron is found within the Hgb molecule? -
Ferrous Iron (Fe2+)

Lead interferes with the porphyria synthesis

What is Basophillic Stippling and in which disease states
is it seen? - Precipitation of RNA and ribosomes
Results in an accumulation of ALA

Seen in:

- thalassemia minor

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 CSMLS Exam Guide Notes

What lab results are associated with lead poisoning? - What is pernicious anemia? - A Lymphocyte (AB
Normocytic/ Normochromic (if chronic: microcytic/ mediated) destruction against intrinsic factor and
hypochromic and potential hypoplasia of the BM) gastric parietal cells

Elevated Retic count (suggestive of a hemolytic anemia) What are the 2 stages of the shillings test? - 1 - to
detect malabsorption (patient is given an oral dose of
vitamin B12, followed by a flushing dose to saturate the
What is the treatment for lead poisoning? - EDTA to liver.) If B12 is found in urine = malabsorption
chelate the lead present in the blood to be excreted in
the urine
2- test is then repeated with a dose of B12 and Intrinsic
Factor (if labelled b12 is found in the urine, this is
What is the treatment for hereditary indicative of PA because IF corrected the
hemochromatosis? - Phlebotomy. malabsorption)

Patient is kept in a state of mild anemia and Hgb is used What is the defect associated with PNH? - Paroxysmal
to monitor patients state (phlebotomy usually occurs Nocturnal Hemoglobinuria is a mutation to the enzyme
every 3 months) which makes sure blood cells are not susceptible to lysis
by complement (Stem cell mutation)

What causes megaloblastic anemias? - Impaired DNA

synthesis - leading to a panocytopenia What are the lab findings of PNH? - Hgburia

Hgbemia

DNA can't produce thymine - uridine replaces it but Decreased haptoglobin

divisions cannot go forward without thymine
Increased bilirubin and LD

Increased hemosiderinuria
It is a microcytic anemia due to the reduction of cell
Increased Retic
divisions
Increased MCV

Micro/ hypo
What is needed for the production of thymidine
nucleotides for DNA synthesis?? - B12 and folic acid BM failure

Negative DAT

What test is used to detect pernicious anemia? -

Shillings test
What is the defect associated with G6PD Deficiency? -
Purpose of G6PD: Keeps Hgb Fe in the reduced state for
O2 transport and protect Hgb from oxidative damage
(malaria)

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 CSMLS Exam Guide Notes

Low

RBC's lose their G6PD as they age therefore they are Platelet count
normally hemolyzed but it is increased with enzyme
deficiency.
What kind of RBC's would plasmodium falciparum
invade? - Invades all RBC's (worst for patients)
What are Heinz bodies? - Intracellular ppte of
denatured Hgb that adhere to the inner membranes of
the RBC What RBC's would plasmodium vivax invade? How do
they appear? - Invades reticulocytes with Duffy antigens

What is the purpose of pyruvate kinase? - Catalyzes the

conversion of phenolpyruvate to pyruvate to form ATP. Appear as ring forms with a red chromatin dot, blue
cytoplasm and schuffner stippling

What is TTP? - Thrombocytic Thrombocytopenic

Purpura What kind of RBC's would plasmodium ovale invade? -
Only reticulocytes

The release of vWF from the endothelium creates plt

aggregation and the production of microthrombi RBC's become enlarged, oval and fringed

How is TTP considered a microangiopathic hemolytic Schuffner stippling is seen.

anemia? - Because RBC's are sheared are they attempt
to pass through the partially blocked vessels
How does plasmodium malariae appear as in a red
blood cell? - Small ring with a brown band across the
What is ADAMTS 13? - It is a vWF cleaving protease that cell. Will only invade older RBC's and takes 72 hours to
prevents excess plt adhesion and aggregation and cycle.
microthrombi formation.

How does plasmodium knowlesi appear as in red blood

What is HUS? - Hemolytic Uremic Syndrome cell? - Multiple ring forms and brown band across the
cell

Thrombocytopenia and acute renal failure from thrombi

How does Clostridial Sepsis cause massive intravascular
hemolysis ? - C. Perfringens is a gram positive anaerobic
What is HELLP Syndrome - Hemolysis bacilli that affects the phospholipids in the RBC
membrane causing lysis or spherocytes to form. This
Elevated
can cause DIC and renal failure.
Liver enzymes

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What disease can come secondary to mycoplasma

pneumoniae? - Acute Cold Agglutinin Disease
Positive Test: hemolysis in the patient sample and no
hemolysis in the control

Explain Cold Agglutinin Disease - IgM antibodies bind to

RBC's after cold exposure in circulation
Control: anti-P is not able to bind because the
temperature is maintained at 37oC

IgM AB's initiate the complement pathway

How can sensitivity for the Donath Landstiener Test be

increased? - By incubating patient serum with papain
Extravascular hemolysis by hepatic macrophages that
treated cells (enzyme treatment enhances the P Ag)
are removing the C3b portion from the RBC membrane

What Hgbs cause alpha thalassemia minor? -

Explain Paroxysmal Cold Hemoglobinuria - Anti-P
Homozygous (-a/-a) or heterozygous (--/aa)
(Donath Landsteiner Ab) that is biphasic:

Binds at cold temps and partially activates complement

RBC population is microcytic hypochromic
Full complement activation occurs at body temp
(hemolysis occurs)

P AB will dissociate from the RBC at warmer What are the 3 tubes of CSF used for? - 1. Chemistry -
temperatures. may contain more cells and or microorganisms obtained
during the puncture that may not be in the normal
sample
Complement binding IgG

2. Microbiology
What is the process for the Donath Landsteiner Test? -
1. Two tubes are collected (1 patient, 1 control)
3. Hematology

2. Patient sample is incubated at 4oC for 30 minutes to

allow anti-P to bind to the P antigen 4. Immunology and Serology

3. Patient control and patient sample are then What does an increased neutrophil count indicate in a
incubated at 37oC for 30 minutes to start the full CSF sample? - Usually indicates bacterial meningitis
initiation of the complement pathway

What does an increased lymphocyte count indicate in a

4. Tubes are both spun and resuspended to observe for CSF sample? - Viral meningitis (TB, syphillis, fungal,
hemolysis parasitic, MS)

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 CSMLS Exam Guide Notes

How should the protein levels of joint fluid compare to

the protein levels of serum? - Synovial fluid should have
What is the purpose of chemistry analysis of a CSF
one third the levels of serum protein.
specimen? - To detect the total protein level (normal is
12-60mg/dL)

When increased, it indicates RA

When increased, it may detect meningitis, hemorrhage

or MS
What is a normal sperm count? - 20-160 million/mL

When decreased, it may detect leakage of fluid to to

What is steatorrhea - Due to fat malabsorption, causing
damage to the blood brain barrier
bulk and frothy with pale to dark yellow colour

What is arthrocentesis? - A liquid biopsy of the joint

What is the test principal of specific gravity for urine? -
fluid (synovial fluid). Can help diagnose diseases such as
Determines the ion concentration
RA and gout

What happens to the pH of urine over time and why? -

What is the purpose of the 3 tubes collected with
Is the specimen is allowed to sit for too long the pH
arthrocentesis - 1. Sterile tube for C&S
becomes too alkaline as a result of bacterial
2. Heparin or EDTA for cell counts or examination of decomposition of urea
crystals

3. Sterile tube for appearance, crystal analysis,

What are some causes of metabolic acidosis? - Diabetic
fibrinogen, clots, chemistry or immunological
acidosis

Fasting
Why would fluid show xanthochromia? - Yellow colour
Kidney failure
may be seen with RBC destruction

What will cause respiratory acidosis? - Retention of CO2

What WBC count is considered normal for synovial
(emphysema)
fluid? - <200 cells /microliter with 25% neutrophils

What are some causes of metabolic alkalosis? - Severe

What is the importance of glucose levels in synovial
potassium deficiency
fluid? - Should be compared to serum glucose levels... If
synovial fluid has decreased levels... It may indicate a Diuretics
bacterial infection because the bacteria would be
ingesting the glucose Vomitting

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 CSMLS Exam Guide Notes

What are some causes of respiratory alkalosis? - B-hydroxybutyric acid DOES NOT react
Infections and fever

Why are ketones important to detect in diabetic

What is the reference ranges for leukocytes in a urine patients? - Comatose states in diabetes are almost
sample? - Normal: <10 WBCs/uL invariably accompanied by ketoacidosis.

Borderline: 10-20 WBCs/uL

Pathological: >20 WBCs/uL Insulin deficiency causes reduced glucose utilization in

fat and muscle cells and triggers lipolysis

Are only intact leukocytes detected in urine? - The

leukocyte test strip will detect intact and lyzed What are the symptoms associated with ketoacidosis? -
leukocytes Ketones in urine, odour of acetone (sweetness) on
breath and increased urinary levels of glucose

What is the test principal for urine nitrite? - Griess' test.

Nitrate is reduced to nitrite by bacterial reduction. What are some reasons that ketones may be found in
Bacteria free urine will not contain any nitrite the urine other than diabetes? - -fasting states

-slimming diets low in carbs

What is the reference range for urine glucose for fasting -Vomitting
morning vs. Daytime? - Fasting morning = 1.1 mmols/L
-fever

-congenital metabolic diseases

Daytime = 1.7 mmols/L

What is the reference range for urobilinogen in urine? -

What are some reasons for glucosuria? - Develops when Should be below 17 umol/L
the tubular reabsorption of glucose in the kidneys is
exceeded
What is the reason for detection of urobilinogen in the
urine? - Disturbance of liver function
Or with diabetes mellitus

Increased hemolysis
After ingestion of a large meal of carbohydrates

Urobilinogen is excreted in increased amounts in the

What ketones DO react with a urine test strip and which urine when in the entrohepatic circulation of the bile
ketone DOES NOT react with the urine test strip? - pigments I'd impaired or overloaded
Acetoacetic acid and acetone DO react

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 CSMLS Exam Guide Notes

When will urobilinogen be absent in the urine? - When Carbonic acid will change the pH of blood, and
there is no bile production therefore the lungs will start to hyperventilate to rid of
the carbonic acid, or sometimes hypo ventilate until the
-obstruction of the bile duct
correct amount of CO2 is established.
-absence of the intestinal flora

Takes 1-3 hours to correct the imbalance

What is the urine reference range for bilirubin? - Adults
are below 3.4umol/L
What is the renal buffer response for pH of the body? -
The kidneys excrete (through urine) or retain
What are causes of false negatives and false positives of bicarbonate.
bilirubin in urine? - False negatives: prolonged standing
in the sunlight causes oxidation of bilirubin
When pH decreases, the kidneys will compensate by
retaining HCO3 and the pH will then rise.
False positives: when the urine is coloured to red tones
due to medicines
May take hours or days to correct an imbalance

What is the normal reference range for blood in urine? -

0-5 RBC's/uL What is Respiratory Acidosis? - Defined as:

pH less than 7.35 (Acidosis)

What is the pH measurement of blood? - The acidity or PaCO2 greater than 45 mmHg
alkalinity of blood which is inversely proportional to the
number of hydrogen ions (the more hydrogen ions, the
lower the pH will be) What conditions may cause a respiratory acidosis? - Any
condition that results in HYPOventilization such as:

- CNS depression due to head injury or medications

What is the normal pH range of blood? - 7.35-7.45
- impaired respiratory muscle function from spinal cord
injury or neuromuscular defects
How does the body self regulate the acid base balance?
- pulmonary disorders
- To maintain a pH in the normal range, buffer
mechanisms between respiratory and renal systems. - chest or abdomen pain

How does the respiratory buffer system of the body How is respiratory acidosis corrected? -
work? - CO2 is a by-product of cellular metabolism, and Hyperventilation (can be automatic by the patient or
when mixed with water, carbonic acid is formed manually by the healthcare provider

-oxygen therapy
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 CSMLS Exam Guide Notes

-broncodilators What is metabolic alkalosis defined as? - Ph greater

than 7.45

Bicarbonate level greater than 26 mEq/L

What is respiratory alkalosis? - Defined as a pH greater
than 7.45

And a PaCO2 less than 35 mmHg What will cause metabolic alkalosis? - Either a excess of
base (antacids, bicarbonate use, lactate use in dialysis)
or loss of acids (Vomitting gastric suction
What causes respiratory alkalosis? - Any condition that hypochloremia or excessive diuretics)
causes hyperventilation (anxiety, fear, pain or increased
metabolic demand such as sepsis, pregnancy or
thyrotoxicosis) How can metabolic alkalosis be treated? - Bicarbonate
excretion can be stimulated with drugs

What is the treatment for respiratory alkalosis? - To

treat the underlying problem to lessen breathing and IV administration of acids
prevent the respiratory muscles from becoming
exhausted and prevent respiratory failure.
What is PaO2? Normal Range? - The partial pressure of
oxygen that is dissolved into the arterial blood
What is Metabolic Acidosis? - Defined as:

Ph level of less than 7.35 (acidosis)

Normal: 80-100 mmHg
Bicarbonate level of less than 22 mEq/L

What is SaO2? Normal Range? - The arterial oxygen

What can cause metabolic acidosis? - Caused by a saturation
deficiency of base (diarrhea or intestinal fistulas) or a
excess of acids in the blood stream, other than CO2
(renal failure, diabetic ketoacidosis, anaerobic Normal: 95-100%
metabolism, starvation, salicylate intoxication)

What is PaCO2? Normal Range? - The amount of carbon

What is kussmal breathing and what is it associated dioxide dissolved in arterial blood
with? - Deep breathing to rid of CO2. Related to
metabolic acidosis, DKA
Normal: 35-45 mmHg

What is the main concern with metabolic acidosis? -

Tissue hypoxia. Can lead to anaerobic metabolism What is HCO3 and what is the Normal Range? - The
system wide. Needs to be treated with tissue perfusion. CALCULATED value of the amount of bicarbonate in the
bloodstream

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 CSMLS Exam Guide Notes

Normal: 22-26 mEq/L What would you conclude if the pH and the PaCO2 are
moving in the same direction? - The lungs are
compensating to alter the pH due to a metabolic
How are pH and PaCO2 related in respiratory problems? problem
- Should always be opposite from each other

What would you conclude if the pH and HCO3 were

How are pH and HCO3 related in metabolic issues? - moving in opposite directions? - The kidneys are
They should either both increase or both decrease compensating to alter the pH due to a respiratory
problem

How will the pH, PaCO2 and HCO3 present in

respiratory acidosis of arterial blood? - Ph = down Describe the following:

PaCO2 = up

HCO3 = normal Ph = normal but <7.40

PaCO2 = up

How will the pH, PaCO2 and HCO3 present in HCO3 = up - Fully Compensated (pH is fixed)
respiratory alkalosis of arterial blood? - Ph = up
Respiratory (because the pH and the PaCO2 are
PaCO2 = down opposite to each other and the HCO3 is opposite to the
pH for compensation)
HCO3 = normal
Acidosis (pH is slightly lower)

How will the pH, PaCO2 and HCO3 present in metabolic

acidosis of arterial blood? - Ph = down Describe the following:

PaCO2 = normal Ph = normal but >7.40

HCO3 = down PaCO2 = down

HCO3 = down - Fully Compensated (pH is fixed)

How will the pH, PaCO2 and HCO3 present in metabolic

alkalosis of arterial blood? - Ph = up
Respiratory (because the pH and the PaCO2 are
PaCO2 = normal opposite to each other and the HCO3 is opposite to the
pH for compensation)
HCO3 = up

Alkalosis because the pH is slightly higher

What are the primary buffer systems in the body? -
Lungs and the kidneys
Describe the following:

Ph = normal but <7.40

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PaCO2 = down PaCO2 = down (opposite of pH indicates that the

problem is respiratory)
HCO3 = down - Fully Compensated b/c pH is normal
HCO3 = down (should normally be up if the pH is
elevated but the kidneys are working to compensate
Metabolic disorder because the pH and the HCO3 are and change the pH - not completely compensated
moving in the same direction and the PaCO2 is opposite because the pH is not in normal range)
as it should be because the lungs are compensating to
correct the pH
What would a patient with the arterial blood gas with
partially compensated metabolic acidosis appear as? -
Acidosis because the pH is slightly lower Ph = down (acidosis)

Describe the following: PaCO2 = down (should be opposite of pH but the lungs
are compensating - partially because the pH is still not
Ph = normal but >7.40 normal)
PaCO2 = up

HCO3 = up - Fully Compensated b/c pH is normal HCO3 = down (Metabolic issue - HCO3 will always follow
the direction of the pH in a metabolic issue)

Metabolic disorder because the pH and the HCO3 are

moving in the same direction and the PaCO2 is opposite What would a patient with arterial blood gas with
as it should be because the lungs are compensating to partially compensated metabolic alkalosis appear as? -
correct the pH Ph = up (alkalosis)

Alkalosis because the pH is slightly higher PaCO2 = up (should be opposite to the pH but the lungs
are compensating - partially because the pH is still not
normal)
What would the Arterial Blood Gas results look like for a
patient with Partially Compensated Respiratory
Acidosis? - Ph = down (acidosis) HCO3 = up (Metabolic issue - will mimick pH when the
PaCO2= up (opposite of pH = Respiratory issue) issue is metabolic)

HCO3 = up (should normally be down with the pH but it

is being partially compensated by the kidneys - not full What is the purpose and the importance of the
until the pH is normal) oxyhemoglobin dissociation curve? - Shows the
relationship between oxygen saturation and the PaO2

What would the arterial blood gas result of a patient

with partially compensated respiratory alkalosis appear The strength at which the oxygen binds to the Hgb
as? - Ph= up (alkalosis) molecule is important because if it is too loose it may

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let go of the oxygen befor reaching the tissues, it if the The respiratory system compensates for changes in pH
oxygen bond is too tight, it may not let go of the oxygen level by responding to changes in the levels of
once the Hgb molecule reaches the tissues ________? - CO2

What does a shift to the right on the oxyhemoglobin The kidneys compensate for acid base imbalances by
dissociation curve represent? - Enhanced release of the excreting or retaining __________? - Bicarbonate
oxygen molecule

A patient with prolonged nausea, Vomitting, diarrhea,

-acidosis will likely have an ABG result of? - Metabolic Acidosis

-fever

-elevated CO2 levels A calculated ABG value that indicates excess or

insufficiency of HCO3 is? - Base Excess
-increased 2,3-DPG

Name 6 organisms that produce beta lactamase? -

What does a shift to the left on the oxyhemoglobin
N.gonorrhoeae
dissociation curve represent? - Conditions that keep the
oxygen molecule tightly attached to Hgb H.influenzae

M.cattarhalis

-hypothermia Staph

-alkalosis Enterococcus

-low PCO2 Bacteroides spp.

*more negative complications than a shift to the right* Name 6 species of organisms that are OBLIGATE
ANAEROBES - 1. Bifdobacterium

2. Eubacterium
What pH state will hyperventilation cause? - Increased
air into the alveoli causes a reduction in carbon dioxide 3. Bacteroides Fragillis
and leads to alkalosis
4. Fusobacterium

5. Prevotella
What is iatrogenic? - Any condition induced in a patient
6. Porphormonas
by the effects of medical treatment

What WBC count is considered normal for synovial

Thyrotoxicosis - Toxic condition due to hyperactivity of
fluid? - <200 cells /microliter with 25% neutrophils
the thyroid gland

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What is the importance of glucose levels in synovial What are some causes of metabolic alkalosis? - Severe
fluid? - Should be compared to serum glucose levels... If potassium deficiency
synovial fluid has decreased levels... It may indicate a
Diuretics
bacterial infection because the bacteria would be
ingesting the glucose Vomitting

How should the protein levels of joint fluid compare to What are some causes of respiratory alkalosis? -
the protein levels of serum? - Synovial fluid should have Infections and fever
one third the levels of serum protein.

What is the reference ranges for leukocytes in a urine

When increased, it indicates RA sample? - Normal: <10 WBCs/uL

Borderline: 10-20 WBCs/uL

What is a normal sperm count? - 20-160 million/mL Pathological: >20 WBCs/uL

What is steatorrhea - Due to fat malabsorption, causing Are only intact leukocytes detected in urine? - The
bulk and frothy with pale to dark yellow colour leukocyte test strip will detect intact and lyzed
leukocytes

What is the test principal of specific gravity for urine? -

Determines the ion concentration How long must shippers hold onto TDG forms? - For at
least 2 years

What happens to the pH of urine over time and why? -

Is the specimen is allowed to sit for too long the pH What factor deficiency causes Hemophilia A? - Factor
becomes too alkaline as a result of bacterial VIII
decomposition of urea

What factor deficiency causes hemophilia B? - Factor IX

What are some causes of metabolic acidosis? - Diabetic
acidosis

Fasting What are FDP? - Fibrin degredation products that are

seen after a clot has formed and the healing process
Kidney failure takes place

What will cause respiratory acidosis? - Retention of CO2 What is the ISI? - International Sensitivity Index. The
(emphysema) responsiveness of a thromboplastin reagent toward
plasma samples from patients receiving warfarin

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What is the INR used for? - It is used as a patient Proprionibacterium

control/ mean.
Bacillus Spp

CNS
What is the TT (Thrombin Time) - Measures the
conversion of fibrinogen to fibrin and is not influenced
by deficiencies of other coagulation factors What organisms would be considered common
pathogens of a superficial wound? - S. Aureus

S. Pyogenese
What is the microscopic morphology of
Peptostreptococcus? - Gram positive cocci P. Aeroginosa

A. Israeli
What are the 4 methods for detecting beta lactamase
production? - 1. Nitrocefin discs
What is the difference between tetanus and botulism? -
2. Acidometric techniques Tetanospasmin - affects CNS neurons. Inhibits the
release of glycine neurotransmitters and causes spastic
3. Iodometric techniques
paralysis
4. Oxacillin discs

Botulin - affects PNS neurons. Inhibits the release of

What organisms make up the normal flora of the acetylcholine neurotransmitters and causes flaccid
genitals? - E.coli paralysis

S. Gallolyticus

Lactobacillus What makes up a 0.5 McFarland standard? - 99.5mL of

1% sulphuric acid
CNS
0.5mL of 1.175 barium chloride
Anaerobes

Corynebacterium
What is the optical density of a 0.5 McFarland standard
equivalent to? - 1.5 x10^8 CFU/mL
What are the common pathogens of the genitals? - N.
Gonorrhea
What is the final compound in the McFarland standard
H. Ducreyi
that causes turbidity? - Barium Sulfate
S. Agalactiae

C. Albicans
How is the MIC determined? - With serially diluted anti
microbial agents, which bacteria is added to

What organisms would be considered normal flora from

a superficial wound? (4) - Corynebacterium
Positive and negative controls must be run
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Why are organisms tested for beta lactamase

production? - Positive beta lactamase producing
MIC is determined by the lowest concentration of the
organisms will be resistant to the effects of penicillin
anti microbial that inhibits growth

What is the difference between inducable and

What is used as a positive control when testing for MIC?
constitutive resistance? - Inducable resistance can be
- Organism with no anti microbial agent... This provides
turned on and off while contituative resistance is always
a growth control that the bacteria is able to grow
resistant.

What is used as a negative control when testing for

D-zone of inhibition indicates inducable resistance
MIC? - Just anti microbial agent with no bacteria
present... This is to ensure that the broth is sterile.

What agar plate is used to detect MRSA? - MH agar

How are you able to tell if an organism is being inhibited 4% NaCl

(bacteriostatic) or killed (bacteriocidal) - MBC testing
6ug/mL oxacillin
(minimum bacteriocidal concentration) can be
completed after the MIC to determine what
concentration of antimicrobial will kill 99.9% of bacteria
Should be inoculated with 0.5 McFarland standard

What media needs to be used for Kirby Bauer testing

and what are the criteria for the media? - Mueller Hitin What is used as a screening plate for VRE? - BHI plate
with 6ug/mL of vancomycin
PH of 7.2-7.4

Depth of 3-5 mm
What disc is best used to detect oxacillin susceptibility?
- Cefoxitin
What is the next step if you see a colony within the
zone of inhibition? - Subculture and retest
What is the mode of action for erythromycin? - Binds to
the 50S portion of a ribosome and prevents
translocation
If it is a sub colony of the same organism, must call the
antibiotic resistant

What is the most common way to test for beta

lactamase production? - Nitrocefin disc
What is the purpose of the E-test? - To obtain a
quantitative value for the MIC

It is a chromogenic cephalosporin that produces a red

colour when positive

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What is the mode of action for rifampin - Blocks RNA Indicator (methylene blue or resauzurin)
transcription (used to treat TB)

Explain the AMP C test - Used to test against beta

Explain the acidometric test for the presence of b lactamase activity. Uses the D test with discs around the
lactamase - Will detect penollic acid (end product of Cefoxitin and cephalosporin (will have a D zone around
beta lactamase) because acid is produced, the pH will it)
drop, producing a colour change

Amp C is plasmid mediated

Explain the iodometric method for the presence of b
lactamase? - A starch-iodine complex (purple) can be
broken down by penicilloic acid which will strip the What is the modified Hodge test? - Tests for
colour from the complex (clear complex = positive rxn) carbinpenimase activity in enterobactericae

What is the purpose of an antibiogram? - To compare Positive for growth means that the organism produces
results to acceptable past results to rule out technical carbopenimase and therefore growth is permitted
errors

What is the mode of action for rifamycin - Inhibits

What are ESBL's? - Extended spectrum beta lactamases mRNA synthesis

Enzymes produced by organisms that are able to What is the mode of action for sulfanomides? -
destroy newer beta lactam microbials. Completely synthetic, bacteriostatic drugs that block
folic acid required for DNA synthesis

Will be susceptible to Cefoxitin

What is the mode of action for isoniazid? - Interferes
with mycolic acid synthesis which is a cell wall
What is the meaning behind a positive Nagler test? - component of mycobacteria (effective against TB)
That the organism is capable of producing the enzyme
lethinase
What are faculatative anaerobes? - An organism that
can make energy with respiration if oxygen is present or
What makes up an anaerobic jar ? - Catalyst (palladium make energy through fermentation if oxygen is absent
coated alumina pellets)

Desiccant (silica gel)

What are clostridium spp? - All spore forming anaerobic
5-10% Hydrogen bacilli that are classified as clostridium spp.

5-10% Carbon dioxide

80-90% Nitrogen Gas Show bipolar staining and swollen ends

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Dangerously reactive

What is the lethinase activity for C. Perfringens? -

Lethinase positive
What is the difference between BSC's and fume hoods?
- BSC's will contain heap filters and fume hoods will not

What organism does the Nagler test presumptively

identify? - C. Perfringens
What does HEPA stand for? - High efficiency particulate
air

What is the microscopic morphology of Bacteriodes

spp.? - Gram negative coccobacilli
When using an eyewash station, how long should it
rinse out the eyes for? - 15 seconds at least

What is the microscopic morphology for

campylobacter? - Curved (seagull wing) gram negative
What is the purpose of laminar air flow? - Using
bacilli
downward air movements to protect the contents of
the cabinet

What are the incubation conditions for campylobacter?

- 72 hours at 42oC
What type of airflow is in the Class II A2 BSC? - Has both
downward and upward air movements

What is LD50 - Lethal dose that pertains to solids

What questions need to be asked before drawing an

EDTA tube for a group and screen? - If female, at any
What is LC50? - Lethal concentration that pertains to
age, ask if they have been pregnant in the past 3
liquids, gases and vapours
months.

What is the TLV? - Threshold limit value

Any gender, ask if they have been transfused in the past
3 months

What does PEL stand for? - Permissible exposure limit

How long should patients usually fast for a fasting
glucose test? - 8 hours
What is TWA? - Exposure within 8 hours which workers
may be exposed to without harmful effects
How long should patients usually fast for a fasting lipids
test? - 12-14 hours
What is the dangerous component within a sickle cell
kit? - Sodium Hydrosulfite
What type of blood is contained in a capillary sample? -
Venous and arterial blood as well as some tissue fluid
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What is the common fasting time and why? - Should What is the PT results related to in the coagulation
only be between 8-12 hours because after 14 hours the system? - Extrinsic and common pathway
body goes into starvation mode.

Factors II, VII, V and X

What are blood culture bottle tops commonly cleaned
with? - Chlorahexine
What is the aPTT result related to in the coagulation
system? - Intrinsic and common pathway
What is the sweat chloride test used for? - To detect
cystic fibrosis
Factors XII, XI, IX, VIII, X, V, II

What is the purpose of an ECG? - To detect myocardial

infractions How can the effects of Coumadin be fixed? - With
administration of vitamin K

What is the order of draw for venous blood draw? - 1.

Sodium citrate What is HIT? How can it be detected? - Heparin induced
thrombocytopenia
2. Red top

3. ESR
Can be detected through a platelet count
4. SST

5. Sodium/ lithium heparin (light green top)

How can LMWH be monitored? - Must assay Anti-Xa
6. PST with lithium heparin

7. EDTA
Low molecular weigh heparins are fractionated heparins
8. Blood bank tube (larger EDTA)

What are Hirudins? - Proteins produced by the salivary

Why must PTT test be completed within an hour? -
glands of a leech used to inhibit thrombin
Because PLT factor 4 can neutralize heparin

Can be used to treat HIT

What will Coumadin do to coagulation results? -
Increase PT results

Used to prevent clots during hip and knee replacements

What will heparin do to coagulation results? - Increase
PTT results

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What happens to the coagulation test procedure when

a patient has a HCT of over 0.550? (55%) - Less
What is the reagent used for testing aPTT? - Synthasil
anticoagulant must be used in the sodium citrate tube;
calculation:

Contains calcium and phospholipid structure to replace

platelets and an activator
Vol. of Sodium citrate = (100-HCT)(blood volume of
tube)/ (595-HCT)

What is the principal behind the pt test? - To detect

deficiencies in the extrinsic pathway or the effects of
Usually the blood volume of a sodium citrate tube is
Coumadin
22.7mL

The PT result is the time required to form a fibrin clot

When are D-dimer fragments released? When are they
when plasma is added to a thromboplastin-calcium
commonly seen? - They are a result of degredation of
mixture
cross linked fibrin (Clot was present and is now breaking
down)

Why can't coagulation samples be transferred on ice? -

May cause cold activation of factor VII, loss of vWF and
Seen in:
plt distribution
DVT/ pulmonary embolisms

Pregnancy
What is the INR? - Patients PT result as a ratio to the
Older patients normal population

Trauma

Post surgery What is thromboplastin made up of?? - Tissue Factor (to

start extrinsic coagulation)
Oncology patients
Phospholipid (needed for surface assembly coagulation)

Calcium ions (needed for binding of complexes)

What is the principal behind the aPTT test? - The
calcium in the blood is bound by the sodium citrate in
the tube to prevent clotting
What does the platelet count need to be to be
considered PPP? - Less than 10 X 10^9/L

Plasma (after centrifuging) will contain intrinsic factors

EXCEPT platelets and calcium
What is the principal behind the fibrinogen assay? -
Uses the CLAUSS CLOTTING METHOD

Reagent is added to the plasma and the time that it

takes for the plasma to clot is the aptt
Excess amount of thrombin + plasma

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Diluted with "Owren koller" buffer What two light measuring techniques use scattering
light (while the rest use light emission)? - Turbidometry
and nephelometry
Time required for clot formation is determined using an
electromagnetic viscosity detection system
Within the case study you see alcoholism, ingestion of
raw oysters, positive indole test and positive lactose
Clotting time is INVERSELY proportional to the fermenter... What organism should you be suspecting? -
concentration of fibrinogen Vibrio parahaemolyticus

What is the principal of the D-Dimer test? - Based on Slightly curved GPB
the change of turbidity that is measured
Slight Alpha hemolysis
photometrically
Catalase negative

RT motility
A suspension of latex particles coated by covalent
binding with monoclonal antibodies specific for D-Dimer H2S positive
is mixed with patient plasma
Bile Esculin Negative - Erysipelothrix Rhusiopathiae

Ag-AB reaction takes place - agglutination will cause

GPB
turbidity
Beta hemolysis

Catalase negative
Inc turbidity = inc absorbance when measured
photometrically which is proportional to D-Dimer levels Causing pharyngitis in patient - Arcanobacterium
haemolyticum

What is the most common light source in commercial

instruments? - Xenon lamp - it can produce usable light What organism other than E.Coli O157:H7 will appear as
from infrared to ultraviolet wavelengths a non sorbitol fermenter on a SMAC plate? - Shigella
Spp.

What is the main difference between homogenous and

heterogenous assays? - Homogenous DO NOT require a What are the incubation conditions of a CAMPY plate? -
separation step (from the bound and the free Ag or AB) Microaerophillic environment at 42oC.
and heterogenous assays do require a separation step.

Should be looked at after 24 hours and 48 hours for

What is fluorescence? - The emission of light by a growth
substance after absorption of energy

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What is a riding orange? - Fluorescent dye which binds

the nucleic acids of bacteria
What are the potential pathogens in a urine sample? -
E.coli

Bacteria and fungi will appear bright orange and Klebsiella

background will appear black-yellow-green
Proteus

Pseudomonas
What is used as the counter stain in the auramine
S.aureus
rhodamine stain? - Potassium permanganate
S.saprophyticus

Corynebacterium urealyticum
What is the Kinyoun stain and how will it appear ? - It is
a carbol fuschin stain for AFB that uses methylene blue Yeast
as a counter stain
Chlamidia trachomatis

Trichomonas vaginalis
AFB will appear red on a blue background

What are the potential pathogens when working with a

Explain the principal behind the BACTEC system? - wound sample? - S.aureus
When microorganisms are present in the culture vials,
they metabolize nutrients in the vial and produce CO2 S.pyogenes
which is detected by the BACTEC because CO2 reacts Beta strep
with a dye sensor at the bottom on the bottle
Pseudo

Actinomyces Israeli
What dilution of bleach should be used when cleaning
up blood? - 1/100 for smooth surfaces and 1/10 for Corynebacterium jeikeium
porous surfaces Enterobactericae

Enterococcus
What are the potential pathogens from a stool sample?
- Campylobacter Spp.
What are the potential pathogens in a sputum sample?
Salmonella - S.pneumonaie
Shigella K.pneumonaie
Yersinia Pseudo
E.coli O157:H7 S.aureus
Listeria monocytogenese H.influenza
Vibrio M.cattharalis

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Pasturella Explain ion exchange chromatography? - Charged beads

will attract molecules of the opposite charge. The
amount of molecules present will be proportional to the
How is the quality of a sputum sample determined? - amount of charge coming from the beads
Microscopically checking the amount of squamous
epithelial cells and the ratio of the SEC's to WBC's
Explain size exclusion chromatography - Based upon
molecular weight, solid matrix of gel beads is placed as
Why are pregnant women screened for group B strep? - a filter and only molecules of a certain size can pass
GBS is a major cause of neonatal sepsis, pneumonia and through
meningiditis

Larger molecules usually elute first because they don't

What is the purpose of Todd Hewitt Broth ? - Selective go through the beads as more around them
medium for GBS, swabs will be incubated in the broth
over night then inoculated onto agar plates
What is the charge of the anode? - Positive

What organisms are counted when detecting bacterial

vaginosis? - Lactobacillus (many should be seen) What is the charge of a cathode? - Negative

Gardenerella and Mobiluncus (little to none should be How does protein electrophoresis differ from gel
seen) separation? - In gel separation, larger molecules will
elute first

What is an ampholyte? - Neutral ion - has both a

negative and a positive charge. In protein electrophoresis, smaller molecules will elute
first

What is the pI? - PH point in which the charge of a

protein is 0 What is Ohms law? - E (electromotive force) = I
(current) X R (resistance)

What is salting in and salting out? - Salting in= at allow

ionic strength, the solubility of a protein will increase How is heat calculated in protein electrophoresis? -
with salt concentration (low salt prevents precipitation) HEAT = E (volts) X I (current) X t (time)

Salting out= at a high ionic strength, the solubility of a

protein decreases (high salt removes the solvent,
causing the protein to precipitate out)

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