Which of the following can cause a decreased in Which of the following blood groups deteriorates

ESR? on storage?
8 hours delayed in testing P1

Anti-mitochondrial antibody is associated with A patient has 10-day diet of only carrots but
Primary Biliary Cirrhosis become jaundiced. Bilirubin levels are normal.
Which of the following might the cause?
Anti-A Anti-B A Cells B Cells A. Vitamin E
0 mf 3+ 0 B. Porphyrins
Bx C. Vitamin A
D. Vitamin D
Associated with jaundiced patient with
pancreatic mass When myeloblast mature into promyelocyte,
CA19-9 what markers are diminished?
HLA-DR and CD34
Adrenal cushing’s syndrome (“ADIC”)
Low ACTH; High Cortisol Which of the following is inconsistent? (Results
in numbers are given with reference ranges)
A patient has high cold agglutinin titer. ALP Increase
Automated hematology analyzer results reveal TB Increase
an elevated MCV, MCH, and MCHC as well as Serum B1 Slight
decreased RBC. Individual erythrocytes appear Increase
normal on a stained smear, but agglutinates are B2 Markedly
notes. Identify the appropriate course of action. Increase
Repeat the test using a prewarmed microsample of Urine Uro Increase
diluted blood Bilirubin Positive
Increase Urobilinogen (Biliary Obstruction)
Compute for the % transferrin saturation
Serum Iron: 125 Which of the following correlates with the
UIBC: 185 results? (Results in numbers are given with
Transferrin: 230 reference ranges)
40% Serum TB Increase
B1 Increase
Increased Calcium; Normal PTH Urine Uro Increase
Metastatic Carcinoma Bilirubin Negative
Prehepatic jaundice
A patient had a sore throat, after 2 weeks he had
Which of the following can be found in the saliva
a kidney biopsy. What organism can be isolated
of an Le(a+b-) individual?
from the sample?
Lea
None of the above
Patient is suspected of having primidone
Normal RBC
overdose but the serum concentration of which
Elevated MCHC
is normal. What must be done next?
Automated Hematocrit: 27%
Test for phenobarbital concentration
Manual Hematocrit: 28%
Examine the plasma appearance
Identification of a gram-negative isolate using
MALDI-TOF is based on detection of
Low sodium
Ribosomal proteins
Normal potassium
All other electrolytes are normal
Advantage of MALDI-TOF
Check for glucose level
Fewer consumables
Non-fastidious, Gram negative bacteria is grown
E. coli is mistaken as what organism in MALDI-
in Mueller Hinton Agar/Disk Diffusion Agar (???).
TOF
How should an MLS read the zone of inhibition?
Shigella
Plate should be held 2-3 inches above a black
surface using reflected light
Identify pattern C (Pattern A in the actual exam.
The picture looks like this but the patterns were
rearranged)

Mycoplasmapneumoniae infection
Beta-thalassemia Patient is AHG negative. In control cells, three
A newborn tested positive for Toxoplasma IgG. out of eight tubes are negative when check cells
Which of the following can be done to confirm are added. Identify the error.
the condition Insufficient saline from automated cell washer
Perform IgM from current newborn sample
Normal RBC
Presence of RTE >25-30 Low MCV
Acute tubular necrosis Low MCHC
A. IDA
Identify the associated condition B. Beta thalassemia minor
(Exact same picture in the actual exam) C. Sideroblastic anemia
D. Anemia of chronic disease

After 3 weeks of incubation in egg-based

medium, mycobacteria grows smooth, mucoid,
and dark yellow colonies. Identify the organism
M. gordonae
(I did not answer MAC. According to the book of
Mahon, MAC strains exhibit smooth colonies and
some are rough. They are usually non-pigmented
since they are non-photochromogens and only
Nephrotic syndrome becomes yellow when age. M. gordonae have only
smooth colonies and are naturally part of
Polyclonal Anti-IgG Anti-C3d Scrotochromogens which exhibits yellow to orange
AHG in the dark and becomes orange to red when
+ - + exposed to light for 2 weeks)
Prewarm technique
Platelets participate in the coagulation cascade
Markers associated with PNH by providing
CD55; CD59 Phospholipids

Calibration of blood gas analyzers requires Carriers are coated with antigens, what
Two buffer of known pH and a constant temperature technique is this?
Passive agglutination
Blood product that has high risk for transmitting
Hepatitis B virus Only 390 mL of blood was collected from the
A. Albumin donor, the unit must be
B. Apheresis platelets Transfused as RBC
C. Washed RBC
D. Pooled cryoprecipitate 4 units of cryoprecipitate with the following
(Not sure) values. Identify the appropriate action
Units AHF Fibrinogen
Best interpretation of the following results 1 90 IU 300 mg
EBV IgG titer - 1:128 2 80 IU 250 mg
EBV IgM titer - >1:10 3 85 IU 150 mg
CMV IgG titer - 1:128 4 80 IU 155 mg
CMV IgM titer - >1:10 Put all units on inventory
Toxoplasma IgG titer – 1:128
Toxoplasma Ig, titer - <1:10 A previously type O, Rh negative individual is
Co-infection between CMV and EBV not positive on DAT. Which of the following
results is expected of his current sample?
Which of the following measurements uses the Cells with Anti-D Control
principle of amperometry? IS 37/AHG IS 37/AHG
pO2 determination A 0 0 0 0
B 0 1 0 1
The electrode for carbon dioxide determination C 0 0 0 1
is sensitive to which of the following D 0 1 0 0
pH change
Based on the following results, what must be
Glucose 3+ with many yeast cells in microscopic given to the infant?
Diabetes mellitus Post-Partum Sample Cord Blood
Group O, Rh Negative Group A, Rh Positive
Level of gentamicin used for testing high levels Anti-D, C, and I DAT Positive
of aminoglycosides Antibody History: Elution: Anti-D and C
500 ug/ml Anti-Lea (+)
Group A, Rh negative, C and Lea negative
Pooled 8 cryoprecipitate units using a sterlie Neutralizes lupus anticoagulant in vitro
closed connector tube at 07.37 and stored at 20- Platelets
24C. These units can be transfused until
13.37 Examined and handled under BSL2 and
Biosafety level 3
The patient experienced prolonged apnea and Coccidioides
paralysis after administration of
succinylcholine. This is due to the deficiency of Agent of bioterrorism, gram negative, satellitism
Pseudocholinesterase with S. aureus
Rule out Brucella and Francisella
Two urine specimens were collected for
evaluation of orthostatic proteinuria: 1) First Which of the following must be done based on
morning specimen and 2) Urine collected after the scenario?
normal activity for hours. Which of the following 6:00 – Blood was collected using a gray-top tube
results correlates with this 10:00 – Specimen was received in the laboratory
Specimen 1 Specimen 2 10:30 – Specimen was centrifuged
A 3+ Negative 11:00 – Plasma was separated from the cells
B 1+ 3+ 11:30 – Plasma was tested for glucose using
C Negative 1+ glucose oxidase and the result is 60 mg/dL
D Negative Negative A. Call the doctor and report the abnormal results
B. Test using an alternative method
RH*CE and RH*ce codes for antigen C. Wrong anticoagulant used
C/c and E/e on a single protein D. Repeat testing with a new specimen
(I think the best answer here is to repeat the testing
What is the probable phenotype of a person with using a new specimen since the plasma was
C, c, and e separated from the cells 5 hours from the collection
R1r = Falsely low glucose. Testing it with an alternative
method would not normalize nor correct the low
Blood reagent strip yield 3+, but there were no glucose levels. Based on the provided results, the
RBCs seen under the microscope method used is not the primary concern, but the time
Dilute and alkaline urine the sample collected and processed. According to
the book of Bishop “Sodium fluoride ions (gray-top
Leukocyte esterase and nitrite reagent strip tubes) are often used as an anticoagulant and
yield 4+, but there were no WBCs seen under the preservative of whole blood, particularly if analysis
microscope is delayed. The fluoride inhibits glycolytic enzymes.
Lysed WBC However, although fluoride maintains long-term
glucose stability, the rates of decline of glucose in
Negative leukocyte esterase in reagent strip but the first hour after sample collection in tubes with
there were 2-3WBCs/HPF seen under the and without fluoride are virtually identical. Therefore,
microscope the plasma should be separated from the cells as
Lymphocytes are present soon as possible.”)

D C E c e f Post-prandial turbidity is caused by

0 + + + + 0 Lipoproteins
r”r’
Nitrocefin test is used in which organism
CD markers associated with Acute Haemophilus influenzae
Megakaryocytic Leukemia
CD41; CD61 Antibody Panel: Lea is identified
Glycoprotein absorbed from plasma
Causative agent of meningitis that is intrinsically
resistant to ceftriaxone 37C Anti-IgG CC
L. monocytogenes SC 1 0 0 2+
SC 2 0 +/- NT
Maltese cross formation under polarized SC 3 0 0 2+
microscope Autoantibody 0 0
Starch A. Report as negative
B. Repeat the test using Polyspecific AHG
Examine using Phase-contrast microscope C. Add 4 drops of serum and repeat the test
A. Cholesterol D.
B. Crystals (I forgot the last letter, but I only guessed my answer
C. Oil Droplets here but according to Harmening, for weak reactions
D. Unstained cells it is best to add more serum to the cells to detect
(A, B, and C are examined using Polarized weak antibodies. So, C is the answer)
Microscope due to their ability to exhibit
birefringence. Phase-contrast microscope focuses Pheochromocytoma is associated with
more on low refractive index which is related to Hyperglycemia
Casts and Unstained cells)
Gram-positive coccobacillus This might also help from CC Bishop pg 400
Vancomycin resistant Deficiency in delta-aminolevulinic acid
PYR and LAP negative dehydratase leads to accumulation of heme
Catalase negative precursors during the biosynthesis of heme
Esculin hydrolysis negative which often leads to
Hippurate hydrolysis negative Neurological dysfunction and severe abdominal
CAMP negative pain
6.5% salt broth no growth
Leuconostoc Urobilinogen is
Colorless product derived from bilirubin metabolism
ID: Klebsiella pneumoniae
Susceptibility result: Gram negative coccobacilli
Amikacin susceptible Beta hemolytic
Ampicillin susceptible No growth on MAC
Cefazolin susceptible Haemophilus haemolyticus
Cefoxitin susceptible
Tobramycin susceptible 0.01mL loop is used for BAL specimen. Upon
Verify the ID and susceptibility results as it is unusual receipt, the specimen was processed immediately.
for the identified organism to be susceptible to The BAL sample have allowed specific diagnosis of
ampicillin lower respiratory tract infections when the colony
count reaches
Afebrile Group AB, Rh negative patient who A. <10,000 CFU/mL
received 8 units of Group A, Rh negative B. 10,000 to 50,000 CFU/mL
platelets but still platelet levels are low. What is C. >100,000 CFU/mL
the appropriate action in this situation? D. >500,000 CFU/mL
A. Transfused with irradiated platelets
B. Transfused with leukoreduced platelets LPO shift to HPO but it touches the slide. What
C. Transfused with ABO identical platelets to do?
D. Collect sample from the patient and the donor Make sure the slide is not in upright position
and calculate the platelet increment (Verified by a pathologist)
(I don’t know the answer here but I answered C)

Normal FT4 What condition causes unconjugated

Normal TSH hyperbilirubinemia
Increased TT4 Chronic hemolytic anemia
A. Hashimoto – Low FT4, High TSH
B. Primary Hyperthyroidism – Low TSH, High FT4 What is the effect of coumadin as an
C. Secondary Hyperthyroidism – High TSH, High anticoagulant
FT4 Interfere with coagulation factor synthesis
D. Pregnancy – High Estrogen, High TBG, High
TT4, High TT3, Normal Free Thyroid Hormones, Anemia
Low TSH Thrombocytopenia
Many Schistocytes
“During pregnancy lead to increased TBG pro- Intrinsic fibrin deposition
duction by the liver, which results in higher levels of
bound thyroid hormones, leading to higher levels of On competitive EIA, absorbance of HbeAg is
total T3 and total T4. Typically, however, levels of 0.700 and the patient absorbance is 0.300
the unbound active, or free, thyroid hormones Positive for HBeAg
remain in the normal range and the individual
remains euthyroid. In some instances, however, The MLS obeserved a speckled pattern following
measurement of free T4 and free T3 may be interpretation of the ANA test. What should the
necessary to eliminate any confusion caused by MLS do with this finding?
abnormal binding protein levels.” Check autoantibodies to Extractable Nuclear
LOW FT4 NORMAL FT4 HIGH FT4 Antigens
LOW TSH Secondary Subclinical Primary
Hypothyroidism Hyperthyroidism Hyperthyroidism
Severe Non-thyroidal Patient suffering from chills and fever, clerical
nonthyroidal illness
illness check was all match, what should you do next?
NORMAL Secondary Normal Artifact Pre-Transfusion Post-Transfusion
TSH hypothyroidism Pituitary
Severe (Secondary)
Plasma Straw Plasma Straw
nonthyroidal Hyperthyroidism ABO B+ ABO B+
illness Pre analytical
error caused by
Antibody Negative Antibody Negative
blood drawn Re-crossmatch pre and post transfusion samples
within 6-9 hours
of thyroxine
dose A baby has Rubella, what sample is needed for
HIGH TSH Primary Subclinical Test artifact testing
Hypothyroidism Hypothyroidism Pituitary
Hyperthyroidism Maternal serum
Thyroid
hormone
resistance
Positive culture of sputum was stained with CSF RBC computation
carbol fuchsin, washed, decolorized until faint Dilution – 1:10
pink, then counterstained with methylene blue. RBC count – 348
Two entire field was scanned and no AFB were Counted in 5 middle squares – 0.2
seen. What is the reason? Depth – 0.1
Inadequate scanning of slide 17,400 (I got 174,000)

Hairy Cell Leukemia flow cytometry scatter plot Identify the picture
picture (The picture I saw was similar to this)
Positive for CD19 and CD11c

(ANA pattern picture, the same as this but with no

fades or tails)

A. Acute leukemia
B. Chronic lymphocytic leukemia
Anti-RNP (Speckled) C. Plasma cell myeloma
D. Normal marrow
(ANA pattern picture, same as this but mixture of
green and orange colors) Flow cytometry quadrant scatter plot: Identify
the P2 (CD19 and CD5 Positive)
Chronic Lymphocytic Leukemia

Scleroderma with CREST

Polypeptide Nucleic Acid (PNA) probe-based is

used to identify microorganisms in a positive
culture bottle that uses
Fluorescence

A baby tested positive for Clostrdium difficile

toxin using antigen testing. However, in the PCR
method, the patient tested negative for the said
organism. Given the situation, why is it hard to
interpret the positive result?
Cross-reactivity with Clostridium sordellii

Stem cell transplant receipient……

Irradiated Blood

Identify what caused the day 4 hemoglobin

(Number 1 Question)
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Hgb 11.2 11.9 12.0 13.4 11.0 11.5
MCHC 34 33 34 33 34 34
Lipemia

Compute for the CoV of the following

hemoglobin values: (Five 11 and 12
values/numbers but with different fractional/decimal
parts. The computed mean and SD were 12.12 and
0.38, respectively)
CoV: 3.14%