EXAM #1

2- The method used to determine concentration of electrolytes is:

a/ ion selective electrode
b/ ion non-selective electrode
c/ anion selective electrode
d/ cation selective electrode

3- One of the principle of osmometer instrument depending on freezing point depression:

a/ size of particles
b/ shape of particles
c/ number of particles
D/ size and shape of particles

4- Method principle for measuring TSH:

A/ CMIA = the method of choice for detection of certain analytes, such as hormones, normally found in
low concentrations Because of high sensitivity.
B/ FBIA
C/ RIA
D/ Spectrophometry

5- Tests for which the following are not routinely quantified using immunoassays:
A/ TSH
B/ AFP
C/ GLU = hexsokinase..
D/ FOLATE
 All the others the method for measuring them is CMIA

6- Cuvette washer malfunctioning effect on:

A/ quality control result only
B/ patients result only
C/ calibrator’s result only
D/ calibrator, Quality control, and patients result

7- The bubbles in patient sample may give:

A/ a correct values
B/ less than and greater than values
C/ Hemolytic samples values
D/ the same for the previous result

8- What is the goal of therapeutic drug monitoring (TDM)?

A/ To determine a drug concentration in blood and assess whether the concentration is at an appropriate
level

9- Quality out of range may result of:

A/ mixing up the bulk solutions
B/ missing signing the maintenance sheet
C/ QC kit is new
D/ nobody put the open date and initial
10- What you should do when ICT module is expired:
A/ call the supervisor for more investigation
B/ Override the expiration date
C/ Replace ICT module
D/ ignore the analyzer and run the samples on another analyzer

11- If the light source on an instrument is gradually weakening, it could contribute to what type of error?
A/ Systematic Error
B/ Random Error

12- When the technologist has a patient critical result, he should:

A/ rerun it on another machine and call the physician/nurse when it is completed and type a comment

13- Which immunoassay methodology is preferred to provide the highest sensitivity and highest
specificity?
A/ two step noncompetitive

14- What is the best way to perform a reference range study for a liver enzyme?
A/ follow the method manufacture’s recommendations
B/ 20 samples from healthy individuals
C/ the number of the samples vary depending on the assay
D/20 hospital patient samples

15- While performing method verification for a new creatinine procedure, the precision data produces a
standard deviation (SD)of 0.5 mg\dl. What does the SD relate to?
A/ Random error

16- A test for hCG would be classified as a:

A/ pregnancy Marker

17- Large red blood cells(macrocytes), tear drop cells, and hypersegmented neutrophils are seen in:
A/ Iron deficiency anemia
B/ Thalassemia
C/ megaloblastic anemia
D/ Hereditary spherocytosis
* Since it’s Macrocytosis it’s either Megaloblastic or non-Megaloblastic but hypersegmented
neutrophils will differentiate, so it’s related to Megaloblastic Anemia.

18- ESR is decreased in:

A/ Polycythemia and sickle cell anemia = short ESR tube , low room tem. Clot , bubbles , anticoagulant high
B/ Infection and inflammation diseases
*Also ESR is decreased in spherocytes ,but High in fibrinogen, High at room tem. , full tube ,

19- Increased PT identified which factor deficiency in the extrinsic pathway:

A/ factor Vll
B/ factor X
C/ factor Vlll
D/ factor Xll

20- The presence of cold agglutination in a sample will result in:

A/ increased MCHC and CHCM, normal MCV and increased Hgb
B/ increased MCHC and normal CHCM, increased RBC and low MCV
C/ increased MCHC and CHCM, decreased RBC and low MCV
D/ / increased MCHC and normal CHCM, decreased RBC and increased MCV

21- The kleihauer test (acid elution) is commonly used cases where:
A/ Rh negative mothers give birth to Rh positive babies

22- Patient sample with WBC count of 15.8 x 109/l and NRBC of 41. What is the corrected WBC count?
A/ 11.2 X 109/l
B/ 6.6 X 109/l
C/ 14.8 X 109/l
D/ 10.8 X 109/l
Corrected WBC = #WBC * 100 / 100+NRBC
= 15.8 * 100/ 141 = 11.2

23- How much volume of anticoagulant is needed for a patient sample with a hematocrit of 0.66 % in a
2.7ml tube?
A/ 0.3 ml of 3.2% Na citrate
B/ 0.27 ml of 3.2% Na citrate
C/ 0.19 ml of 3.2% Na citrate
D/ 0.17 ml of 3.2% Na citrate
C = (1.85 X 10-3)(100- Hct)(V blood)
= (1.85X 10-3 ) (100 – 0.66X100)(2.7)
= (1.85X 10-3 ) (100 –66)(2.7)
= 0.1698

24- A manual differential becomes necessary when a Diff has been requested and the following condition
becomes applicable:
A/ WBC count <25.0 for wards 1,2,3,L&D, recovery room or ICU’S
B/ Whenever WBC <3.5 OR >15 ON first presentation with left shift and blasts flag
C/ platelets clumps flag
D/ none of the above

25- When staining the malaria thick smear, you follow the staining steps in this order:
A/ buffer, methylene blue, giemsa buffer
B/ buffer, giemsa, methylene blue, buffer
C/ methylene blue, buffer, giemsa and buffer
D/ giemsa, buffer, methylene blue , and buffer

26- The presence of pappenheimer bodies in RBCs are confirmed by:

A/ giemsa stain
B/ Retic stain ( methylene blue)
C/ iron stain ( perl’s Prussian blue ) * we can use wright-giemsa but the confirmation is iron stain !
D/ crystal violet stain

27- Which hemoglobin is normally found in infants:

A/ Hgb E
B/ Hgb A
C/ Hgb S
D/ Hgb F
28- If you have counted 76% neutrophils and the total WBC is 8.0 x109/l. the absolute neutrophil count
(ANC) is:
A/ 7.6 X 109/l
B/6.08 X 109/l
C/ 8.0 X 109/l
D/ 10 X 109/l
Absolute count = total WBC X ( Relative count % from diff )
= 8 X 0.76 = 6.08

29- Glacial acetic acid is used for CSF to:

A/ preserve the RBCs
B/ preserve the WBCs
C/ lyse the RBCs
D/ lyse the WBCs

30- When the coagulation sample is contaminated with heparin:

A/ TT is prolonged and reptilase time is prolonged
B/ TT is normal and repitlase time is prolonged
C/ TT is prolonged and reptilase time is normal
D/ none of the above

31-The critical hemoglobin value for renal patients is:

A/ < 65 g/l
B/ <75 >65 g/l
C/ 70 g/l
D/ <55 g/l

32- The exact binding site of an antigen is called its:

A/ Epitope
B/ Paratope
C/ Valence
D/ any of the above

33- All of the following are true of IgE except that:

A/ Fails to fix complement
B/ is heat stable
C/ Attaches to tissue mast cells
D/ is found in the serum of allergic person

34- Match the following description with their term: Allows for flexibility:
A/ Light chain
B/ Heavy chain
C/ Hinge region
D/ Fc region = complement binding site found at this region

35- Which of the following is the main immunoglobulin in the gut and secretion( saliva, milk, tears) and is
important in mucosal immunity?
A/ IgG
B/ IgA
C/ IgM
D/ IgD
36- Rheumatoid factors are:
A/ DNA-anti DNA immune complexes
B/ Autoantibodies to IgM
C/ any factor predisposing to rheumatoid arthritis
D/ autoantibodies to IgG

37- Antibody titer refers to the:

A/ Affinity to specific antibody
B/ Avidity of specific antibody
C/ concentration of specific antibody
D/ Highest dilution of antibody still able to give a positive result in a test system.

38- Which of the following statement does not apply to IgG?

A/ Appear early in the primary immune response = IgM
B/ neutralizes Bacterial toxins
C/ cross the human placenta
D/ opsonizes bacteria

39- What term is defined as the ability of a test to detect small concentration of antigen or antibody?
A/ Agglutination
B/ Specificity
C/ Sensitivity
D/ Titer

40- Vaccines have been developed to protect against which hepatitis viruses?
A/ Hepatitis A
B/ Hepatitis B
C/ Hepatitis C
D/ Hepatitis A & B

41- Antigen-Antibody interaction can be detected by which of the following reactions?

1.precipitiation,2.heamagglutination,3.flocculation,4.immune diffusion.
A/ Only 1,2 and 3 are correct
B/ Only 2 & 4 are correct
C/ Only 4 is correct
D/ All are correct

42- Toxoplasmosis is caused by toxoplasma gondii, which is:

A/ a parasite
B/ a fungi
C/ a bacteria
D/ a virus

43- Reasons for rejection specimen of serum:

A/ microbial contamination
B/ Quantity not sufficient
C/ Wrong tube
D/ all of above

44- The antigen marker most closely associated with transmissibility of HBV infection is:
A/ HBs
B/ HBc
C/ HBe
D/ HBV

45- The serology test for syphilis recommended for detecting antibody in cerebrospinal fluid is:
A/ nontreponemal antibody
B/ CSF-VDRL
C/ C.FTA-ABS = Conformation test
D/ D.MHA-TP

46- Antibodies are produced by:

A/ Killer Cells
B/ Marrow stem cells
C/ mast cell
D/ B-cells

47- What properties of a cell or particle can be measured by a flow cytometer?

A/ Relative size
B/ Relative granularity/ complexity
C/ relative fluorescence intensity
D/ all the above

48- What light source is used in most flow cytometer?

A/ A laser
B/ Optical filter
C/ Detectors
D/ Ultraviolet

49- How many cells or particles should pass though the laser beam at a given time?
A/ ONE
B/ TWO
C/ THREE
D/ SIX

50- what dose light emitted as forward side scatter (FSC) measure?
A/ Cell size
B/ Cell granularity/ complexity
C/ Cell surface marker fluorescence
D/ Cell permeability

51- which part of the cytometer brings the cells to the interrogation point where the cells meet the laser?
A/ Electronic = converts the light signal to voltage so it can be interpreted through a computer software
B/ fluidics
C/ optics = consists of the excitation sources and detectors
D/ laser

52- what dose light emitted as side scatter (SSC) measure?

A/ Cell size
B/ Cell granularity/ complexity
C/ Cell surface marker fluorescence
D/ none of the above
53- RNA and DNA differ in?
A/ three dimensional conformation
B/ Base usage
C/ Sugar
D/ B&C Only
E/ A,B,&C

54- ficoll hypaque separate lymphocytes based upon what inherent property?
A/ Density
B/ Size
C/ Adherence ( stickness)
D/ Color

55- if HLA-A, HLA-B and HLA-DR alleles are compared between a parent and a child, how many would you
typically expect to be matched?
A/ impossible to predict without DNA testing
B/ None
C/ 3
D/ 4

56- in flow cytometeric crossmatch, what is the purpose of the forward scatter versus side scatter?
A/ Gate on live lymphocytes to exclusion of other blood cells
B/ Determine the size and side scatter of the cell population
C/ Distinguish T cells from B cells
D/ Quantity the level of anti-donor IgG antibody

57- which of the following activities should be performed post-PCR?

A/ Amplification, probing, high stringency wash
B/ DNA extraction, low stringency wash, probing
C/ Gel electrophoresis, probing, primer aliquoting
D/ Amplification, probing, primer aliquoting
E/ DNA extraction, High stringency wash, primer synthesis

58- M.A is a 40 years old man who requires a kidney graft due to end-stage renal disease. His HLA genotype
was as follows;HLA- A3/A66.B27/B44,C1/C8,DR1/DR4.
He brought 5 donors and tissue typing was performed. Which one of them is the best choice?
A/ Donor no. 1 HLA : HLA-A3/A8, B7/B28, C4/C8, DR1/DR4
B/ Donor no.2 HLA : HLA-A66/A66, B27/B24, C1/C12, DR1/DR7
C/ Donor no. 3 HLA : HLA-A27/A44, B51/B8, C3/C6, DR3/DR14
D/ Donor no.4 HLA : HLA-A3/A66, B24/B7, C2/C9, DR4/DR7
E/ Donor no.5 HLA : HLA-A3/A3, B27/B44, C1/C8, DR4/DR4

59- what is the correct temperature for the fridges?

A/ 1-6 C
B/ 2-8C
C/ 2-10C
D/ none of the above

60- what is the correct order of tubes for blood collection?

A/ blood culture, citrated, sst, heparin, EDTA, Na fluride, ACD, trace element

61- for laboratory specimen transported by the pneumatic system, which specimen is not permitted to be
sent?
A/ H1N1 Swabs
B/ Blood specimen in evacuated containers
C/ Urin
D/ All culture swabs for microbiology

62- what is the collection priority in which samples are extracted immediately after the phlebotomists has
been informed?
A/ TAT
B/ STAT
C/ EXPEDITE
D/ ROUTINE

63- the nurse came with the type and screen sample. What form dose she need to fill up to document that
the sample was received in the receiving section?
A/ SRS
B/ TELEPHONE LOG SHEET
C/ Specimen manifest for the receipt of laboratory samples transported handheld
D/ manifest for the receipt of laboratory samples with request form
E/ laboratory downtime assessment form

64- __________ is the most effective preventive measure to eliminate the transmission of disease in health
care facilities.
A/ using gloves
B/ hand washing
C/ treating all samples as infectious
D/ all the above
E/ none of the above

65- it is the slanted part of the needle which creates a sharp pointed tip:
A/ Hub = the part of the needle that attaches to the syringe
B/ bore
C/ angle
D/ bevel
E/ gauge = the thickness of the needle
66- what is the maximum time to leave a tourniquet on the patient's arm?
A/ 2 min.
B/ 60 sec.
C/ 90 sec.
D/ 30 sec

67- when is the correct time to label the patient's blood sample?
A/ before blood drawing
B/ immediately after drawing blood at the patient’s bedside
C/ after you arrived in the receiving area
D/ during preparation of supplies for phlebotomy procedure.

68- how many attempts are allowed for a phlebotomist to extract blood from a patient?
A/ Once
B/ Twice
C/ thrice
D/ do not attempt to draw unless you are sure with the vein of the patient

69- requisition forms should be checked for the following essential details except:
A/ Patient’s MRN
B/ Diagnosis
C/ Patient’s name
D/ none of the above

70- what is the best site for venipuncture?

A/ median cubital vein

71- phlebotomist may extract blood from a patient while ongoing blood transfusion if the doctor insisted
provided?
A/ transfusion must be stooped during the actual extraction.
B/ get the badge of the doctor or nurse & inform the receiving supervisor & draw from different site of
transfusion
C/ Phlebotomist must insist not to draw the blood
D/ NONE of the above

72- samples should be labeled with the following essential details except:
A/ Patient’s MRN
B/ Date & time collected
C/ Patient’s name
D/ Doctor’s name
73- serum sample is obtained by drawing blood into a red top or serum separator tube, allowing it to clot
within_______ minutes, and centrifuging it by______rmp for ______ minutes.
A/ 2-5 min, 3000 rmp, 5min
B/ 5-10 min, 3500 rmp, 2min
C/ 5-10 min, 3500 rmp, 5min
D/ 2-5 min, 3000 rmp, 2min

74- what a UNIVERSAL PRECAUTION when dealing with any samples?

A/ treat all samples as the same with one another
B/ treat all sample with extra care
C/ treat all samples as infectious
D/ treat all samples as normal

75- in case there in no choice but to draw from an arm with IV line, phlebotomist must:
A/ inform the nurse in charge, IV should be stooped for a minute & elevate the arm briefly, draw sample
from below IV site & label the sample indicate that it was taken from the site with IV line
B/ inform the nurse in charge, IV should be stooped for At least 5 minute, arm should stay in resting
position, draw sample from below IV site.
C/ Never draw the blood with IV site
D/ None of the above

76- what is the two patient identifier used by phlebotomist prior to blood collection?
A/ Patient name & MRN
B/ Patient name& age
C/ MRN & ROOM NO.
D/ Patient name & room no.

77- what is the correct sequence for the distribution of CSF if only one sample was received?
A/ Chemistry, Microbiology, Hematology
*chemistry first because if there is bacteria it will consume the glucose and give wrong result

78- Specimen collection priority which states that blood sample must be taken within 2 hours after the
phlebotomist has been informed about the blood collection:
A/ STAT = approx. 1 hour
B/ Time study
C/ Expedite
D/ Routine = 6-8 hours

79- what is the first thing that you are going to go when you observe signs of an adverse reaction due to
blood extraction?
A/ Instruct the patient to breathe slowly
B/ inform the nurse in charge or the lead tech.
C/ loosen any tight clothing
D/ discontinue the phlebotomy procedure

80- an unlabeled sample for biopsy was received in the receiving section. Which log sheet should be filled
up to document the correction made on the sample?
A/ Specimen rejection log sheet
B/ Safety reporting system (SRS)
C/ Irretrievable sample form ( corrective sample form ) = this form for the sample that are difficult to re-
collected !! ex. Biopsy & CSF..
D/ all the above

81- the amount of glucose load to be given to pregnant woman for GTT procedure:
A/ 75grams

82- when is the correct time to label the patient's blood sample?
A/ before blood drawing
B/ after blood drawing
C/ immediately after the patient left area
D/ During preparation of supplies for phlebotomy procedure

83- when you are experiencing a diffcult vein, what should you do?
A/Bleed the patient twice and then ask for help from your colleague
B/ Never bleed the patient unless you are sure of the vein

84- a pustule drainage submitted for culture is plated onto primary media. After 18 hour incubation, the
sheep blood agar plate reveals a predominance of beta hemolytic, white, porcelain-like colonies. Gram
stain shows gram-positive cocci that are catalase positive. The most appropriate test for additional
identification of the isolate is:
A/ bacitracin
B/ bile esculin
C/ bile solubility
D/ coagulase
* positive coagulase will definitively identify Staphylococcus aureus. Bacitracin, bile esculin, and
bile solubility are tests used in identification of Streptococci that are ruled out by a positive catalase
result.

85- a culture from a pyoderma grows a predominance of beta-hemolytic colony type on sheep blood agar
at 18 hours. The isolate is susceptible to bacitracin, bile esculin: negative, Hippurate hydrolysis: negative
and catalase: negative. The most likely identification is beta-hemolytic streptococcus:
A/ Group A
B/ Group B
C/ Group D
D/ not Group A, B, or D
86- Neisseria meningitidis can be differentiated from Neisseria gonorrhoeae by demonstration of acid
production from:
A/ Maltose

87- what is the appearance of acid-fast bacteria when stained with Zeil Nelson stain?
A/ Red bacilli on a blue background

88- A CSF specimen that contains many pus cells and gram-positive, lancet- shaped gram-positive
diplococci would be consistent with :
A/ scarlet fever
B/ Meningococcal meningitis
C/ Pneumococcal meningitis
D/ encephalitis

89- after 48 hours of incubation on anaerobic sheep blood agar, clostridium perfringens appears as a:
A/ Large, flat colony with a double zone of hemolysis
B/ White, butyrous, nonhemolytic colony with a glistening surface
C/Gray, mucoid colony with a zone of alpha hemolysis
D/Colony with a pearl-like surface and a single zone of beta hemolysis

90- when acetone-alcohol is inadvertently omitted from the gram stain procedure, streptococci and
Neisseria will be stained, respectively:
A/ Purple & red
B/ Purple& Purple
C/ RED & RED
D/ RED & Purple

91- in a broth dilution test the lowest concentration of an antibiotic which no growth of an organism is
visually detectable is called the:
A/ minimal bacterial con.
B/ minimal inhibitory con.
C/ minimal susceptible con.
D/ minimal lethal con.