Medical laboratory sample questions

Chemistry
1- The following serum chemistry results are obtained from a 53-year-old female:
Test Result Reference interval
Serum:
AST: 120 U/L (5-34)
ALT: 185 U/L (5-35)
ALP: 785 U/L (30-90)
GGT: 555 U/L (5-75)
Bilirubin
Total: 10.8 mg/dL
Direct: 8.6 mg/ dL
These results are most consistent with a diagnosis of:
A. Hemolytic anemia
B. Hepatitis
C. Dubin-Johnson syndrome
D. Biliary obstruction

2- A moderately hemolyzed serum sample will cause falsely elevated results for each of
the following analytes except:
A. Creatine kinase (CK)
B. Phosphorus
C. Potassium
D. Sodium

3- The temperature control for a blood-gas instrument is malfunctioning and is

currently at 39°C. Blood-gas determinations using this instrument would give
falsely
A. Decreased pH, increased pO2, and increased pCO2 results
B. Decreased pH, decreased pO2, and decreased pCO2 results
C. Increased pH, increased pO2, and increased pCO2 results
D. Increased pH, decreased pO2, and decreased pCO2 results

4- A 65 year-old woman experienced sharp chest pain, pain radiating down her left
arm, and nausea. Thinking the pain was indigestion, she did not seek immediate
medical attention. Four days later, she visits her doctor. If she had an acute
myocardial infarction (AMI), which of the following cardiac markers would you
expect to be elevated at this time?
A. Troponin I
B. Myoglobin
C. CK-MB (mass)
D. CK-MB isoforms ratio

5- A blood ethanol level of 100 mg/dL indicates

A. A lethal concentration in most adults
B. Probable impairment of cognitive or motor skills
C. A false elevated value if serum ketones are present
D. That the detection threshold for assay has been exceeded
Hematology
1- Given the following data, calculate the reticulocyte production index (RPI):
54-year old male
Reticulocyte count: 6.6%
Hematocrit: 0.25 L/L
A. 1.6
B. 1.8
C. 3.3
D. 3.7

2- A 30- year- old female had the following results on her CBC:
WBC 15,000/mm3 (15.0 X 109 /L)
Polys 71%
Lymphs 23%
Monos 5%
Eos 1%
This patient can be said to have absolute
A. Leukocytosis, neutrophilia, and lymphocytopenia
B. Leukocytosis, neutrophilia, lymphocytopenia, and monocytopenia
C. Leukopenia, neutrophilia, monocytopenia, eosinopenia
D. Leukocytosis and neutrophilia

3- A fresh, slightly bloody spinal fluid was received in the laboratory. The RBC count
was 6,000/mm3; WBC count was 24/mm3. Fluid supernatant was yellow. What
would these results indicate?
A. Bacterial meningitis
B. Intracranial hemorrhage
C. Viral meningitis
D. Traumatic spinal tap

4- To obtain accurate results on a Westergren ESR, blood kept at room temperature

should be set up within a maximum of how many hours?
A. 1
B. 2
C. 4
D. 8

5- A patient is admitted to the emergency room with extensive burns. Expected

erythrocyte morphologic features would include:
A. 0.4%
B. 0.6%
C. 0.7%
D. 0.8%
Urinalysis
1- Which of the following macroscopic urinalysis results should initiate a microscopic
examination?
A. pH 7.5
B. Nitrite positive
C. Ketones moderate
D. Glucose 100mg/dL

2- A urinalysis is requested on 10 mL of urine. Which of the following steps will produce a

12:1 concentration of urine sediment for the microscopic examination?
A. Centrifuge 4 mL urine, then remove 3.5 mL supernate
B. Centrifuge 6 mL urine, then remove 5.5 mL supernate
C. Centrifuge 8 mL urine, then remove 7.5 mL supernate
D. Centrifuge 10 mL urine, and then remove 9.5 mL supernate

3- A urine specimen is delivered to the laboratory for routine analysis. The collection time
is not noted on the label. The following results are obtained:
Microscopic exam:
Color: yellow-brown
Clarity: slightly cloudy
Parameter: Result:
pH: 5.5
SG: 1.029
Blood: negative
Protein: negative
Glucose: negative
Ketone: negative
Bilirubin: negative
Urobilinogen: 0.2 mg/dL
Nitrite: positive
Leukocyte esterase: negative
The physician questions the results because the patient is jaundiced and has an increased
serum Bilirubin. A possible explanation is that:
A. Bacteria in the urine have consumed the Bilirubin
B. The specimen is too acidic, adjust the pH and re-test
C. The high specific gravity is interfering with the reagent strip Bilirubin test
D. The specimen was not properly preserved and the Bilirubin has photo-oxidized

4- Which of the following sets of macroscopic and microscopic examination results suggest
a specimen mix-up during the performance of the urinalysis, i.e. the macro results do not
agree with the micro results?
A. Nitrite negative, micro exam reveals few bacteria
B. pH 7.0, micro exam reveals calcium oxalate crystals
C. Protein test negative, micro exam reveals fatty casts
D. Leukocyte esterase test positive, micro exam is negative for bacteria

5- Select the microscopic technique that is best able to differentiate hyaline casts form
mucous threads:
A. Bright-field microscopy
B. Polarizing microscopy
C. Phase-contrast microscopy
D. Fluorescence microscopy
Immunohematology
1- A serum has been tentatively determined to contain anti-c and anti-fya. Which of the
cells below would be best to adsorb the serum and separate the antibodies so that only anti-
Fya would be recovered from the eluate of the adsorbing cells?
A. CcDEd, Fy (a+b-), Kk
B. ce, Fy (a-b+), Kk
C. CDe, (Fya+b+), kk
D. CDe, Fy (a+b-), kk

2- A 72 year-old woman with a history of ulcerative colitis entered the emergency room
with severe abdominal pain and a hemoglobin level of 6 g/dL. The attending physician
ordered four units of blood. The results of pre-transfusion testing are recorded below:
Patient cells + Anti-A Anti-B Anti A,B Anti-D Rh control
4+ 1+ 4+ 3+ 0

Patient serum + A cells B cells O cells Autocontrol

0 4+ 0 0
The next step taken to resolve this problem should be to:
A. Regroup the patient’s cells with monoclonal or acidified human anti-B
B. Identify the extra antibody with an antibody panel
C. Immediately crossmatch the patient’s serum with group A donor cells
D. Perform an autoabsorption using patient cells and serum

3- A 44-year-old needs 3 units of packed red blood cells for back surgery. The patient’s
cells fail to react with anti-A and anti-B; his serum reacts with A, B, and O cells. The next
logical step to resolve this problem is:
A. Crossmatch thee patient’s serum with random donor cells at 37°C
B. Identify the antibody (ies) using a panel of group O cells
C. Perform an autoabsorption using the patient’s own cells
D. Titer the serum against the autologous control as well as random donor units, compare the
results and choose the least incompatible units.

4- The antibody least likely to should dosage is:

A. Anti-D
B. Anti-M
C. Anti-Fya
D. Anti- Jka

5- A 44-year-old has a hemoglobin level of 6.1 g/dL. Leukocyte and platelet counts are
within reference limits. The patient is group O, Rh-negative, and has no unexpected blood-
group antibodies in her serum. Crossmatches are compatible. However, 15 min after the
first transfusion is started; she experiences a sudden anaphylactic reaction, including
difficulty in breathing and hives. Subsequent units of transfused washed red cells are
tolerated well. The most probable explanation for these findings is that the:
A. Patient has antibodies against WBCs
B. Patient has antibodies against IgA
C. Donor has IgG antibodies
D. Patient has antiplatelet antibodies
Microbiology
1- A sputum culture yields predominantly alpha-hemolytic, flat colonies on sheep-blood
agar that on Gram’s stain reveal gram-positive cocci in pairs. Which biochemical tests will
aid in the identification of this isolate?
A. Bacitracin and sulfamethoxazole-trimethoprim susceptibility
B. Bile esculin hydrolysis and 6.5% NaCl tolerance
C. Catalase test and CAMP reaction
D. Optochin susceptibility or bile solubility

2- The site of collection for a blood-culture specimen should be disinfected by applying:

A. 70% alcohol and waiting until the area is dry before puncture
B. 2% povidone-iodine and waiting until the area is dry before puncture
C. Surgical soap liberally and waiting 5 minutes before puncture
D. 2% povidone-iodine, waiting 2 minutes, and following with a 70% alcohol wipe

3- A patient complaining of sharp back pains suspected of having cholecystitis is taken to

surgery. The infected gallbladder is removed and exudates from the gallbladder are sent to
the laboratory for culture. In an infected gallbladder, which of the following organisms
would you attempt to recover?
A. Yersinia enterocolitica
B. Vibrio cholerae
C. Salmonella dysenteriae
D. Campylobacter jejuni

4- A 45-year-old Hispanic male who works in a meat-packing factory presents to the ER

with history of intermittent fever, chills, sweats, and malaise for the past two days. Small
gram-negative rods are isolated from the blood cultures. The following characteristics are
observed:
CO2 required
H2S produced
Presence of thionin: no growth
Presence of basic fuchsin: growth
Urease: positive in 2 hours
Which of the following is the most likely identity of the isolate?

A. Bacillus anthracis
B. Bacillus cereus
C. Brucella abortus
D. Brucella melitensis
E. Brucella suis

5- A blood culture from a patient with septicemia yields an encapsulated yeast with the
following characteristics: failure to produce germ tubes. Urease positive, produces brown
pigment on bird seed agar. Which of the following is the most likely identification of this
yeast?
A. Candida albicans
B. Candida pseudotropicalis
C. Cryptococcus neoformans
D. Torulopsis glabrata
E. Saccharomyces cerevisiae
Coagulation
1- The anticoagulant of choice for specimen collection for the PT/INR assay is which of the
following?
A. 4.0% sodium citrate
B. 3.8% sodium citrate
C. 3.2% sodium citrate
D. 2.8% sodium citrate

2- Unfractionated heparin can be monitored with which of the following assays?

A. PT
B. Fibrinogen
C. APTT
D. Antithrombin

3- Low-molecular-weight heparin can be monitored with which of the following assays?

A. Anti-Xa
B. Thrombin time
C. Fibrinogen
D. APTT

4- The International Normalized Ratio (INR) should be used in conjunction with the
prothrombin time (PT) to monitor therapy with:
A. Oral anticoagulant
B. Hirudin
C. Heparin
D. fibrinolytic agents

5- A clinical laboratory scientist performs an APTT on a freshly processed plasma sample

and it is prolonged. He performs a 1:1 mixing study is performed using a normal pooled
frozen specimen and the APTT does not correct into the normal range of the APTT. He
stores the specimen at -70°C overnight until the special coagulation laboratory can evaluate
the sample for the presence of a lupus anticoagulant. The special coagulation laboratory
rapidly thaws the specimen and repeats the APTT. The result is normal. Which of the
following can cause this phenomenon?
A. Elevated D-dimers
B. Elevated FVIII
C. Cold activation of FVII
D. Elevated residual platelets in the platelet-poor-plasma specimen