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CSMLS MLT Certification Exam: Practice Test 1

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About the CSMLS MLT exam

The CSMLS MLT Certification Exam is an examination for laboratory technicians in Canada. The exam is set by the CSMLS (Canadian Society for Medical Laboratory Science).

About these practice questions

These practice questions will help prepare you for the CSMLS MLT exam.

This page contains 300 practice questions divided into the eight sections of the exam: 1. Safe Work Practices, 2. Data and Specimen Collection and Handling, 3. Analytical Processes, 4. Interpretation and Reporting of Results, 5. Quality Management, 6. Critical Thinking, 7. Communication and Interaction, and 8. Professional Practice.

All questions have been carefully designed to mimic the questions on the real exam, to help you prepare and get a passing grade.

Check out all the practice tests in this series: Practice Test 1, and Practice Test 2.

Sections

  1. Safe Work Practices
  2. Data and Specimen Collection and Handling
  3. Analytical Processes
  4. Interpretation and Reporting of Results
  5. Quality Management
  6. Critical Thinking
  7. Communication and Interaction
  8. Professional Practice

Section 1: Safe Work Practices

1.1) Which of these actions helps prevent the release of aerosols in the laboratory?
  1. Filling centrifuge tubes to the brim
  2. Forcibly expelling hazardous materials from pipettes
  3. Opening aerosol containment devices immediately after removing them from the centrifuge
  4. Routinely inspecting the centrifuge to ensure there is no leakage
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1.2) When trying to fix an electrical machine, you should first:
  1. replace old cables
  2. replace the fuses
  3. turn off all electricity to the lab
  4. turn the machine off
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1.3) Which of these actions reduces the risk of repetitive strain injury?
  1. Repeating the same movement many times
  2. Resting your arms on a hard surface
  3. Staying in the same position for long a period of time
  4. Taking frequent, small breaks
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1.4) Which of these actions can help prevent repetitive strain injuries when working with microscopes?
  1. Adjust the chair height so your legs are bent at a 45-degree angle
  2. Position the eyepiece at shoulder level
  3. Position the microscope as close to you as possible
  4. Support your wrists on the desk
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1.5) Which of the following should be observed during the incineration of medical waste?
  1. Disinfect all articles before burning them
  2. Make sure complete burning takes place
  3. Make sure the temperature reaches at least 12,000°C
  4. Sanitize all articles before burning them
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1.6) When visiting a patient in enteric isolation, staff must wear gloves and what other item of equipment?
  1. Gown
  2. Hazard suit
  3. Helmet
  4. Shoe covers
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1.7) In which of these situations should safety goggles be worn?
  1. During blood collections
  2. During reagent and specimen preparation
  3. While inspecting reagent supplies
  4. While transporting sealed waste containers
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1.8) The three basic protective measures against radiation are time, distance, and:
  1. lead
  2. radiation suit
  3. shielding
  4. speed
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1.9) What is the first action that should be taken if a patient's body fluid splashes into the eyes?
  1. Call 911
  2. Determine whether the patient has an infectious disease
  3. Flush the eyes with water
  4. Make an entry in the accident log book
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1.10) What is the first action to take if someone goes into cardiac arrest?
  1. Assess the airway
  2. Call 911
  3. Check the pulse
  4. Perform chest compressions
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1.11) In the event of an acid burn, what should your first action be?
  1. Cover the burn with gauze moistened in sterile saline
  2. Flush the area with water
  3. Go to the emergency department
  4. Neutralize the acid with sodium bicarbonate
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1.12) You find a person lying on the floor. You suspect they have received an electric shock. What is the first thing you must do before treating them?
  1. Check if the person is breathing
  2. Check if the person is still in contact with the electrical current
  3. Check the person's pulse
  4. Make a note in the incident logbook
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1.13) A colleague spills liquid nitrogen on his hands, causing minor frostbite to his fingers. What should you do immediately?
  1. Immerse his hands in very hot water
  2. Rub his hands vigorously using your own hands
  3. Spray his hands with tepid water
  4. Tell him to shake his hands vigorously
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1.14) In first aid, what does the D of the ABCDE approach stand for?
  1. Dehydration
  2. Disability
  3. Dizziness
  4. Drug allergy
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1.15) Which of these is an OPIM (other potentially infectious material)?
  1. Saliva
  2. Semen
  3. Urine
  4. Vomit
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1.16) Universal precautions are based on what assumption?
  1. All laboratory chemicals may be carcinogenic
  2. All specimens are potentially infectious
  3. Equipment is not sterile
  4. Handwashing is the best way to prevent the spread of infection
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1.17) Which section of a safety data sheet gives the flammability of a chemical?
  1. Accidental release measures
  2. Handling and storage
  3. Physical and chemical properties
  4. Transport information
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1.18) Gases under pressure require a pictogram of:
  1. a flame
  2. a flame over a circle
  3. a gas cylinder
  4. an exploding test tube
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1.19) What does this pictogram mean?
  1. Biohazard
  2. Carcinogenic
  3. Corrosive
  4. Toxic
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1.20) In the NFPA hazard diamond, which quadrant indicates special hazards?
  1. Blue
  2. Red
  3. White
  4. Yellow
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1.21) What is the correct place to store a stock solution of ethanol?
  1. Flammable safety cabinet
  2. Freezer
  3. Fume hood
  4. Refrigerator
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1.22) Under WHMIS 2015, supplier labels must:
  1. be in English and French
  2. contain a photo of the hazardous product
  3. have a hatched border
  4. have a reference to the supplier's social media pages
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1.23) Which of these practices is dangerous and should be avoided?
  1. Immediately performing first aid to someone who has been exposed to blood
  2. Recapping used needles using both hands
  3. Securing used sharps containers during transport
  4. Using plasticware instead of glass
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Section 2: Data and Specimen Collection and Handling

2.1) A phlebotomist is drawing blood from a young boy. The boy's mother is in the room and she says she doesn't like the sight of blood. She looks pale and says she feels faint. The phlebotomist should:
  1. ignore the mother as the focus should be on the child
  2. offer the mother a chair to sit in
  3. take the child's blood as quickly as possible to get it over with
  4. tell the mother not to worry
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2.2) Tourniquets should be:
  1. applied very tightly to the arm
  2. left on the arm for at least three minutes
  3. tight enough to slow arterial flow
  4. tight enough to slow venous flow
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2.3) What can happen if a phlebotomist releases the tourniquet after removing the needle from the arm?
  1. Angina
  2. Bleeding
  3. Cyanosis
  4. Edema
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2.4) What can happen if a phlebotomist uses an angle of 35 degrees when performing venipuncture?
  1. Nothing will happen as this is the correct angle
  2. The needle may go completely through the vein
  3. The needle may miss the vein completely
  4. The needle will enter above the vein
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2.5) A phlebotomist has made two unsuccessful attempts while trying to collect a blood specimen from a patient. What should the phlebotomist do next?
  1. Ask another phlebotomist to collect it
  2. Ask the patient's nurse to do the draw
  3. Collect it by arterial puncture
  4. Try to draw it one more time
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2.6) Which of these would be most likely to allow reflux to occur during venipuncture?
  1. Filling the stopper end of the tube first
  2. Lateral redirection of the needle
  3. Releasing the tourniquet on blood flow
  4. Using the wrong order of draw
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2.7) A phlebotomist is performing a venipuncture. The needle is in place but no blood is entering the tube. What is the first thing the phlebotomist should do?
  1. Change to pediatric tubes
  2. Discontinue the draw and cancel the requisition
  3. Switch to a winged blood collection set
  4. Try adjusting the needle slightly
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2.8) Which complication could occur if a phlebotomist punctures a baby's calcaneus?
  1. Achilles tendon rupture
  2. Hyperglycaemia
  3. Osteomyelitis
  4. Petechiae
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2.9) Repeated phlebotomy procedures in the same area can cause:
  1. petechiae
  2. scarring
  3. thrombosis
  4. varicose veins
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2.10) Sodium heparin should be avoided for which of these tests?
  1. Electrolyte panel
  2. Hematocrit
  3. Lithium levels
  4. pH
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2.11) What is the glycolytic inhibitor in grey-top tubes?
  1. Heparin
  2. Silicon
  3. Sodium citrate
  4. Sodium fluoride
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2.12) A phlebotomist has to draw a patient's blood into a blood culture bottle and four tubes: red, green, light blue, and purple. Which should the phlebotomist fill first?
  1. Blood culture bottle
  2. Light blue top tube
  3. Purple top tube
  4. Red top tube
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2.13) Underfilling which tube will most likely result in a hemolyzed specimen?
  1. EDTA tube
  2. Grey top
  3. Light-blue top
  4. SST
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2.14) Why are infant bilirubin specimens obtained in amber-coloured tubes?
  1. To flag it as a capillary specimen
  2. To identify it as a bilirubin specimen
  3. To protect the specimen from light
  4. To reduce the risk of hemolysis
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2.15) When should you label a blood collection tube?
  1. As soon as you receive the test order
  2. Just before the patient arrives
  3. Before you collect the specimen
  4. After you collect the specimen
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2.16) Which of these is needed for a malaria test?
  1. Capillary tube
  2. Clay sealant
  3. Glass slide
  4. Microhematocrit tube
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2.17) Skin scrapings are set up in microbiology to identify:
  1. Corynebacterium
  2. Escherichia coli
  3. Neisseria
  4. fungi
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2.18) A sample for the respiratory syncytial virus (RSV) test is best collected using a:
  1. cough plate
  2. expectorated sputum
  3. nasal aspirate
  4. throat swab
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2.19) What is the preferred source of DNA for DNA testing?
  1. Plasma proteins
  2. Platelets
  3. Red blood cells
  4. White blood cells
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2.20) Which of these specimens is unacceptable for testing?
  1. A blood specimen collected for coagulation testing in a citrate tube
  2. A blood specimen in an EDTA tube that is three-quarters full
  3. A clotted blood specimen for HbA1c testing
  4. A sputum specimen containing 52 leukocytes and 5 epithelial cells per LPF
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2.21) Which anticoagulant is used for red blood cell counts?
  1. EDTA
  2. Heparin
  3. Sodium citrate
  4. Sodium oxalate
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2.22) Which of these specimens would most likely be rejected for testing?
  1. A hemolyzed potassium specimen
  2. A nonfasting glucose specimen
  3. A serum-separator tube that is only half-filled
  4. An icteric bilirubin specimen
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2.23) Blood specimens for which test are placed in circles on special filter paper?
  1. Bilirubin
  2. Complete blood counts
  3. Malaria
  4. Phenylketonuria
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2.24) A lab technician is performing a microhematocrit. She collects a blood sample in a microhematocrit tube and inverts the tube carefully to mix the blood with the heparin. What must the she do next before putting the tube in the centrifuge?
  1. Add controlled volumes of saline to the tube
  2. Add washed sensitized cells to the tube
  3. Remove gloves and wash hands
  4. Seal one end of the tube with clay
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2.25) What is the maximum lancet size for heel punctures on babies?
  1. 1 mm
  2. 2 mm
  3. 3 mm
  4. 4 mm
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2.26) Stool specimens for O&P should be collected in a jar containing:
  1. SAF fixative
  2. agar
  3. saline
  4. sodium hypochlorite
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2.27) Which of these foods should a patient avoid eating before a fecal occult blood test?
  1. Fish
  2. Popcorn
  3. Red meat
  4. Whole wheat bread
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2.28) The middle finger and ___________ are used for finger puncture.
  1. index finger
  2. little finger
  3. ring finger
  4. thumb
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2.29) What is the main reason a capillary puncture site is warmed beforehand?
  1. To delay clotting
  2. To increase blood flow
  3. To minimize contamination
  4. To reduce hemoconcentration
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2.30) The creatinine clearance test:
  1. is a liver function test
  2. requires a blood sample and a 24-hour urine collection
  3. requires the patient to be fasting at the onset of testing
  4. requires timed blood samples to be drawn
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2.31) A phlebotomist has mixed up two specimens. What should the phlebotomist do?
  1. Ask the nurse to identify the specimen
  2. Ask the patients which one is theirs
  3. Continue regardless
  4. Retake both specimens
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2.32) What chemical does the urine glucose dipstick test use?
  1. Glucose oxidase
  2. Glucose oxide
  3. Glucose reductase
  4. Hexichloridine
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2.33) Which of these tests would most be affected if a patient ate a muffin and orange juice before a fasting blood test?
  1. Blood culture
  2. Cardiac enzymes
  3. Complete blood count
  4. Glucose
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2.34) A courier delivers a chain-of-custody sample to a technician at a laboratory. Who needs to sign and date the chain-of-custody form?
  1. Only the courier
  2. Only the laboratory technician
  3. The courier and the laboratory technician
  4. The laboratory manager and the laboratory technician
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2.35) You receive a specimen that should come with a chain of custody form. However, the form is missing. What should you do?
  1. Ask for a new specimen to be collected
  2. Fill out a new chain of custody form yourself
  3. Perform the test anyway
  4. Use a chain of custody form from a specimen of a different patient
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2.36) Which of the following is NOT required on a chain of custody form?
  1. The name of the patient's doctor
  2. The name of the person who collected the specimen
  3. The time the specimen was collected
  4. The type of specimen collected
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2.37) Which of these specimens needs to be kept at 35–37°C?
  1. Blood culture
  2. Feces
  3. Throat swab
  4. Urine
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Section 3: Analytical Processes

3.1) A urine sample, an oral swab, and a blood culture arrive at the laboratory at same time for processing in microbiology. In which order should they be processed?
  1. Blood culture, oral swab, urine sample
  2. Blood culture, urine sample, oral swab
  3. Oral swab, blood culture, urine sample
  4. Oral swab, urine sample, blood culture
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3.2) Which of these coagulation factors is in the common pathway of coagulation?
  1. Factor II
  2. Factor IX
  3. Factor VII
  4. Factor XI
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3.3) Which marker is used to help distinguish acute lymphocytic leukemia from malignant lymphoma?
  1. Acid phosphatase
  2. Human chorionic gonadotropin
  3. Leukocyte alkaline phosphatase
  4. Terminal deoxynucleotidyl transferase
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3.4) Along with the mean cell volume, which other test is used to morphologically classify anemias?
  1. Hematocrit
  2. Hemoglobin
  3. Red blood count
  4. Red cell blood distribution width
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3.5) 570 mL of water is added to a 30 mL, 2 M aqueous solution. What is the molarity of the final solution?
  1. 0.1 M
  2. 0.2 M
  3. 0.3 M
  4. 0.4 M
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3.6) A lab technician needs 300 mL of 5% acetic acid but only has pure acetic acid. How much pure acetic acid and how much water does the technician need to make the required solution?
  1. 5 mL of pure acetic acid and 295 mL of water
  2. 10 mL of pure acetic acid and 290 mL of water
  3. 15 mL of pure acetic acid and 285 mL of water
  4. 20 mL of pure acetic acid and 280 mL of water
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3.7) How many grams of a solute is required to produce 400 mL of a 10%(m/v) solution?
  1. 4 g
  2. 10 g
  3. 15 g
  4. 40 g
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3.8) Automated blood cell counters work on which principle?
  1. Boyle
  2. Coulter
  3. Ferguson
  4. McKenzie
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3.9) Which microscope would be best to examine an unstained, wet preparation of cells before dehydration?
  1. Brightfield
  2. Electron
  3. Fluorescence
  4. Phase contrast
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3.10) Which objective should you begin with when focusing a microscope?
  1. 10x
  2. 40x
  3. 100x
  4. 1000x
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3.11) You notice dirt in the field of view while using a microscope. The dirt moves when you rotate the eyepiece. What action should you take?
  1. Clean the eyepiece
  2. Clean the objective
  3. Open the iris
  4. Tighten the tension adjustment
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3.12) Why does volumetric glassware have the letters TC inscribed on it?
  1. Because it can hold toxic chemicals
  2. Because it contains a fixed volume
  3. Because it delivers a fixed volume
  4. Because it is Type C glassware
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3.13) For accurate measurements, a volumetric pipette should be viewed:
  1. above eye level
  2. at an angle
  3. at eye level
  4. below eye level
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3.14) What is the preferred fixative for Masson Trichrome?
  1. Acetone
  2. Bouin's solution
  3. Formalin
  4. Zenker's fixative
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3.15) There are white patches on slides after the deparaffinization step. Which of these could be the cause?
  1. The dye was overoxidized
  2. The dye was too acidic
  3. The slides were in xylene for an insufficient amount of time
  4. The slides were too dry before deparaffinization
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3.16) If paraffin is not infiltrated properly, the tissue will:
  1. become soft and crumbly
  2. become too hard to cut properly
  3. liquefy
  4. lose its colour
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3.17) Which of these is a disadvantage of paraffin wax embedding?
  1. Difficult storage
  2. Poor subsequent staining with H&E
  3. The inability to cut very thin sections
  4. The inability to ribbon
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3.18) A lab technician cuts paraffin sections and places them in a water bath. However, the sections do not flatten properly and remain wrinkled. What should the lab technician do?
  1. Change the water in the water bath
  2. Check the water bath for air bubbles
  3. Increase the temperature of the water bath
  4. Place the sections in a vacuum integration bath
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3.19) A histologist is cutting tissue into sections using a microtome. However, the tissue sections keep sticking to the block on the return stroke. Which of the following actions would correct the problem?
  1. Cool the block with ice
  2. Decalcify the block
  3. Increase the clearance angle
  4. Tighten the knife in the holder
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3.20) Before staining, paraffin sections must be:
  1. dewaxed
  2. left underwater for at least an hour
  3. refrigerated
  4. submerged in a chlorine solution
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3.21) The Grocott-Gomori stain is used widely as a screen for:
  1. HIV
  2. fungi
  3. influenza
  4. salmonella
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3.22) Which stain is used to stain glycogen?
  1. Gram's stain
  2. H&E
  3. Periodic Acid-Schiff
  4. Sudan IV
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3.23) Which stain is used to stain lipids?
  1. Gram's stain
  2. H&E
  3. Periodic Acid-Schiff
  4. Sudan IV
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3.24) A lab technician stains a blood film using Wright's stain. However, under the microscope, the red blood cells appear excessively red and the nuclei are poorly stained. What could be the cause?
  1. Inadequate washing
  2. Prolonged staining
  3. The pH of the buffer was too high
  4. The stain/buffer mixture was too acidic
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3.25) A histologist is performing paraffin H&E staining on a blood smear. When the histologist observes the specimen under a microscope, the basophils are stained too lightly and are difficult to see. What is the most likely cause?
  1. Incomplete deparaffinization
  2. The acid alcohol concentration was too low
  3. The hematoxylin was too strong
  4. The specimen was left in the stain for too long
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3.26) Sections are prepared with H&E staining. However, there is a bluish-black precipitate on top of the sections. Which of these could be the cause?
  1. The hematoxylin solution was not filtered
  2. The sections were not completely dehydrated
  3. The sections were stained too long in eosin
  4. The sections were stained too long in hematoxylin
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3.27) A histologist has stained a blood sample with Wright's stain but the basophils have poor definition. The histologist decides to repeat the stain. Which of these actions would improve the definition?
  1. Decrease the concentration of the stain/buffer solution
  2. Dilute the stain with methanol or water
  3. Reduce the time between preparing the smear and fixation
  4. Wash the slide before fixation
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3.28) Which cytological technique involves passing a urine sample through a biological filter containing pores of a specific diameter?
  1. Centrifugation
  2. Clean-catch
  3. Flow cytometry
  4. Millipore filtration
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3.29) The Widal test is used to diagnose which bacteria?
  1. E. coli
  2. Proteus
  3. Salmonella
  4. Shigela
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3.30) Which Plasmodium species has a distinctive band-like or sash-like structure in the trophozoite stage?
  1. Falciparum
  2. Malariae
  3. Ovale
  4. Vivax
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3.31) Smears of cerebrospinal fluid (CSF) are prepared with:
  1. centrifuged CSF sediment
  2. filtered CSF sediment
  3. incubated CSF supernatant
  4. uncentrifuged CSF supernatant
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3.32) The Elek test tests for toxigenicity of which strain of bacteria?
  1. Bacillus anthracis
  2. Clostridium botulinum
  3. Corynebacterium diphtheriae
  4. Yersinia enterocolitica
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3.33) What colour does the methylene blue strip turn when an anaerobic environment has been achieved in an anaerobic jar?
  1. Black
  2. Green
  3. Red
  4. White
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3.34) The VDRL test detects which bacterial infection?
  1. Candida
  2. Pneumonia
  3. Salmonella
  4. Syphilis
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3.35) The hydrolysis probe system has:
  1. a quencher at the 5' end and a reporter at the 3' end
  2. a reporter at the 5' end and a quencher at the 3' end
  3. quenchers at both the 5' end at the 3' end
  4. reporters at both the 5' end at the 3' end
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3.36) What is the usual temperature for an incubator used for C&S?
  1. 15–17°C
  2. 25–27°C
  3. 35–37°C
  4. 45–47°C
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3.37) Which fluorescent stain binds strongly to adenine–thymine-rich regions in DNA?
  1. Alexa Fluor
  2. DAPI
  3. GFP
  4. Rhodamine
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3.38) What two gases are typically used to remove oxygen in anaerobic gas chambers?
  1. Carbon dioxide and argon
  2. Carbon dioxide and methane
  3. Helium and argon
  4. Hydrogen and nitrogen
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3.39) Which of these organisms can be used as a positive control for the spot indole test?
  1. Enterobacter cloacae
  2. Escherichia coli
  3. Salmonella enterica
  4. Shigella sonnei
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3.40) Mycobacteria are typically grown at which temperature?
  1. 22°C
  2. 37°C
  3. 50°C
  4. 65°C
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3.41) Which agar plate can determine hemolysis?
  1. Blood
  2. Chocolate
  3. MacConkey
  4. Sabouraud
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3.42) Which agar contains lactose and cystine but has a low level of electrolytes?
  1. CLED
  2. Hektoen enteric
  3. Phenylethyl Alcohol
  4. Salmonella-Shigella
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3.43) Which culture medium would be most appropriate to isolate Haemophilus influenza?
  1. Blood
  2. Chocolate
  3. MacConkey
  4. Nutrient
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3.44) TCBS agar isolates what pathogen from stool cultures?
  1. Plesiomonas
  2. Salmonella
  3. Shigella
  4. Vibrio
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3.45) Which agar is used to isolate gram-positive bacteria, especially Staphylococcus species and Streptococcus species?
  1. Chocolate
  2. MacConkey
  3. Phenylethyl alcohol
  4. Thayer Martin
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3.46) What type of broth is used to differentiate between aerobes and anaerobes?
  1. Glucose
  2. Selenite F
  3. Thioglycolate
  4. Tryptic soy
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3.47) CLED agar is used to isolate bacteria from which type of specimen?
  1. Blood
  2. Sputum
  3. Urine
  4. Vaginal swab
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3.48) Mueller-Hinton agar isolates which type of bacteria?
  1. Mycobacterium
  2. Neisseria
  3. Salmonella
  4. Staphylococcus
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3.49) Colistin-nalidixic acid agar selects for which type of bacteria?
  1. Bacteria that ferment lactose and sucrose
  2. Gram-negative
  3. Gram-positive
  4. Lac operon mutants
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3.50) MacConkey agar differentiates bacteria based on their:
  1. ability to ferment lactose
  2. ability to hydrolyze starch
  3. ability to utilise the safranin dye
  4. hemolytic activity
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3.51) Thayer-Martin agar is used to culture and isolate which bacteria?
  1. E. coli
  2. Neisseria
  3. Staphylococcus
  4. Streptococcus
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3.52) In Gram staining, what can happen if the decolourizer is left on too long?
  1. All organisms will appear colourless
  2. Gram-negative organisms will look gram-positive
  3. Gram-positive organisms will look gram-negative
  4. No cells will appear on the slide
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3.53) What can happen if the heat fixation step is skipped in Gram staining?
  1. All organisms will appear colourless
  2. All organisms will appear gram-negative
  3. All organisms will appear gram-positive
  4. No cells will appear on the slide
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3.54) Which substance does the RPR assay detect?
  1. Cardiolipin
  2. Pyruvate
  3. Reagin
  4. Rifamycin
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3.55) Which cytochemical stain is used to diagnose hairy cell leukemia?
  1. Chloroacetate esterase
  2. Leucocyte alkaline phosphatase
  3. Myeloperoxidase
  4. Tartrate-resistant acid phosphatase
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3.56) Bromocresol purple and bromocresol green are dyes used to measure the levels of:
  1. Bence Jones protein
  2. albumin
  3. globulins
  4. immunoproteins
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3.57) Which of these statements is true?
  1. Most laboratories use the Wintrobe method
  2. The Westergren tube has a smaller diameter than the Wintrobe tube
  3. The Westergren tube is longer than the Wintrobe tube
  4. The Wintrobe method is more accurate
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3.58) The hemoglobin solubility test is a screening test for which disease?
  1. Chronic lymphocytic leukemia
  2. Polycythemia vera
  3. Secondary myelofibrosis
  4. Sickle cell anemia
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3.59) When using a standard white blood cell pipette for determining a white blood cell count, you draw the blood to the 0.5 mark. You should then draw the diluting fluid to which mark?
  1. 1.0
  2. 1.5
  3. 11
  4. 101
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3.60) What test is used to diagnose hereditary spherocytosis?
  1. Heat instability test
  2. Kleihauer-Betke test
  3. Osmotic fragility test
  4. Sucrose hemolysis test
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3.61) The partial thromboplastin time (PTT) test requires what type of blood sample?
  1. Coagulated
  2. Decalcified
  3. Defibrinated
  4. Frozen
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3.62) Which white blood cell has granules that stain orange?
  1. Eosinophil
  2. Mature neutrophil
  3. Monocyte
  4. Small lymphocyte
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3.63) An O+ patient needs an emergency transfusion but the laboratory does not have any O+ blood available. Which type of blood could be given to the patient instead?
  1. AB+
  2. B+
  3. AB−
  4. O−
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3.64) A 35-year-old woman needs three units of red blood cells. The laboratory performs an antibody screen to identify any blood group antibodies. The antibody screen is positive. According to the results of the antibody panel below, which antibody most likely caused the positive result?
  1. Anti-C
  2. Anti-D
  3. Anti-E
  4. Anti-K
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3.65) In blood transfusions, what kind of red cells are given to patients who have a severe allergy to standard red cells?
  1. Frozen
  2. Irradiated
  3. Synthetic
  4. Washed
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3.66) Leukocytes are removed from transfusable blood components by a process called:
  1. leukoextraction
  2. leukorebation
  3. leukoreduction
  4. leukotransference
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3.67) An AB− patient requires a blood transfusion but no AB− is available. Blood from which of these blood types could be given to the patient instead?
  1. A+
  2. AB+
  3. A−
  4. O+
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3.68) Which donated blood component carries the highest risk for bacterial contamination?
  1. Cryoprecipitate
  2. Plasma
  3. Platelets
  4. Red blood cells
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3.69) Why are blood products irradiated?
  1. To ensure the blood products remain stable
  2. To prevent TA-GVHD
  3. To prolong their duration
  4. To sterilize them
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3.70) While separating the components of a blood donation, you notice an unusual green colour in the plasma bag. Which of these could be the cause of the green colour?
  1. The donor ate a fatty meal before the blood donation
  2. The donor ate a large number of carrots before the blood donation
  3. The donor is on a contraceptive pill
  4. The donor is taking a vitamin A supplement
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3.71) Stored blood is automatically disqualified for transfusion if it:
  1. has clots
  2. has white particulate matter
  3. is icteric
  4. is lipemic
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3.72) Fresh frozen plasma is stored at ____ or colder.
  1. −30°C
  2. −10°C
  3. −6°C
  4. 6°C
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3.73) Why is incubation omitted in the direct antiglobulin test?
  1. Incubation will cause hemolysis
  2. The antigen-antibody complex has already formed in vivo
  3. The direct antiglobulin test is used if there is not enough time to perform the indirect test
  4. The direct antiglobulin test only detects IgM antibodies
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3.74) In the indirect antiglobulin test, what happens to the red blood cells during the incubation phase?
  1. Agglutination
  2. Apoptosis
  3. Hemolysis
  4. Sensitization
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3.75) Shortly after a blood transfusion is started, the patient experiences erythema and hives. What type of transfusion reaction is the patient experiencing?
  1. Acute hemolytic
  2. Delayed hemolytic
  3. Febrile nonhemolytic
  4. Urticarial
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3.76) One of the most common transfusion reactions is urticaria. What is urticaria?
  1. A cough
  2. A rash
  3. Light-headedness
  4. Throat swelling
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3.77) Which of these is a symptom of transfusion-associated circulatory overload?
  1. High oxygen levels in the blood
  2. Low blood pressure
  3. Shortness of breath
  4. Slow heart rate
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3.78) What type of transfusion reaction is caused by the destruction of incompatible red blood cells?
  1. Anaphylactic
  2. Febrile non-hemolytic
  3. Hemolytic
  4. Simple allergic
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3.79) What is the most serious transfusion reaction?
  1. Acute immune hemolytic reaction
  2. Delayed hemolytic reaction
  3. Febrile reaction
  4. Graft-versus-host disease
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3.80) Which red blood cell abnormality is associated with the Rh-null phenotype?
  1. Acanthocytosis
  2. Elliptocytosis
  3. Schistocytosis
  4. Stomatocytosis
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3.81) Refer to the blood typing test results below.
anti-A anti-B anti-D Rh type
+ O + DCe/dce
What is the patient's blood type?
  1. A+
  2. A−
  3. B+
  4. B−
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3.82) A blood donor is tested with Rh antisera. The results are as follows:
anti-D anti-C anti-E anti-c anti-e
0 0 + + +
What is the donor's Rh genotype?
  1. r'r'
  2. rr"
  3. rry
  4. ryry
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3.83) A blood donor is tested with Rh antisera. The results are as follows:
anti-D anti-C anti-E anti-c anti-e
0 + 0 + +
What is the donor's Rh genotype?
  1. dCe/dCe
  2. dcE/dcE
  3. dce/dCe
  4. dce/dce
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3.84) At what temperature is purified ribonucleic acid stored?
  1. –20°C
  2. 6°C
  3. 21°C
  4. 37°C
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3.85) Which type of microscope is best for viewing crystals in a sample of joint fluid?
  1. Fluorescent light
  2. Light
  3. Polarized light
  4. Ultraviolet
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3.86) The parathyroid hormone test investigates abnormal levels of which mineral?
  1. Calcium
  2. Iron
  3. Potassium
  4. Sodium
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3.87) What does headspace gas chromatography analyze?
  1. Hydrogen
  2. Noble gases
  3. Oxygen and carbon dioxide
  4. Volatile organic compounds
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3.88) What can be added to synovial fluid to reduce its viscosity?
  1. 0.05% hyaluronidase
  2. 1% ammonium hydroxide
  3. 10x phosphate-buffered saline
  4. 5% acetic acid
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3.89) Which of these does the ToRCH IgM and IgG assay NOT detect?
  1. Cytomegalovirus
  2. Infectious mononucleosis
  3. Rubella
  4. Toxoplasmosis
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Section 4: Interpretation and Reporting of Results

4.1) If a blood sample is taken in an EDTA tube, which of these test results would be affected?
  1. Calcium
  2. Cholesterol
  3. Glucose
  4. Urea
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4.2) A child has large bruises from no known injury. The platelet count is low. The other CBC parameters are normal. There is no family history of hemorrhagic abnormalities or thrombocytopenia. What is the most likely diagnosis?
  1. Hemolytic uremic syndrome
  2. Immune thrombocytopenic purpura
  3. May-Hegglin anomaly
  4. Von Willebrand disease
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4.3) What converts factor XIII into factor XIIIa?
  1. Factor Xa
  2. Fibrinogen
  3. Thrombin
  4. Tissue factor
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4.4) The following lab results were obtained:
Test Result
Bleeding time Prolonged
Platelet adhesiveness Abnormal
PT Normal
APTT Normal
CBC Normal
These findings are most consistent with which inherited autosomal dominant trait?
  1. Factor X deficiency
  2. Factor XI deficiency
  3. Hemophilia A
  4. Von Willebrand disease
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4.5) The extrinsic and intrinsic pathways of blood coagulation merge at the activation step of which blood coagulation factor?
  1. Factor IX
  2. Factor VII
  3. Factor X
  4. Factor XIII
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4.6) In a platelet aggregation study, a patient's platelets aggregate normally in response to adenosine diphosphate, epinephrine, and collagen. However, the platelets do not aggregate in response to ristocetin, even after normal plasma is added. Which clotting disorder does the patient have?
  1. Bernard-Soulier syndrome
  2. Hereditary factor Xa deficiency
  3. Parahemophilia
  4. Von Willebrand disease
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4.7) Blood tests reveal high levels of lymphocytes. Under a microscope, these cells look small and abnormal. Which type of leukemia best fits these results?
  1. Acute lymphocytic leukemia
  2. Acute myeloid leukemia
  3. Chronic lymphocytic leukemia
  4. Chronic myeloid leukemia
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4.8) Leukocyte alkaline phosphatase (LAP) staining was performed on a blood specimen. The specimen was scored as follows:
Score Neutrophils
0 95
+1 3
+2 2
+3 0
+4 0
Which condition best explains the result?
  1. Chronic myeloid leukemia
  2. Leukemoid reaction
  3. Leukocytosis
  4. Leukopenia
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4.9) A 23-year-old woman presents with fatigue, weakness, and heart palpitations. The results of a serum iron test are as follows:
Test Result Normal range
Serum iron concentration 28 mcg/dL 60–170 mcg/dL
Total iron-binding capacity 789 mcg/dL 240–450 mcg/dL
Based on these results, which type of anemia does the patient most likely have?
  1. Hemolytic
  2. Iron deficiency
  3. Sickle cell
  4. Vitamin deficiency
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4.10) Which morphological classification best describes hemolytic anemia?
  1. Macrocytic and hypochromic
  2. Macrocytic and normochromic
  3. Microcytic and hypochromic
  4. Normocytic and normochromic
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4.11) Which of these anemias is hypochromic and microcytic?
  1. Hemolytic
  2. Megaloblastic
  3. Sickle cell
  4. Thalassemia
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4.12) Pernicious anemia can be distinguished from folate deficiency by the:
  1. bone marrow findings
  2. mean cell volume
  3. presence of autoantibodies to intrinsic factor
  4. presence of hypersegmented neutrophils
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4.13) Which of the following hematocrit values would be expected in a patient with untreated pernicious anemia?
  1. 29%
  2. 43%
  3. 64%
  4. 81%
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4.14) Which of the following results best correlates with sickle cell anemia?
  1. Hgb 10.0 g/dL, Hct 10%, WBC 8.0×10⁹/L
  2. Hgb 11.0 g/dL, Hct 31%, WBC 11.0×10⁹/L
  3. Hgb 5.0 g/dL, Hct 17%, WBC 13.0×10⁹/L
  4. Hgb 8.0 g/dL, Hct 42%, WBC 10.0×10⁹/L
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4.15) A patient has the following test results:
Test Result
Sodium 140 mmol/L
Glucose 20 mmol/L
BUN 2 mmol/L
Using the Dorwart and Chalmers formula, calculate the patient's serum osmolality.
  1. 107.4 mmol/L
  2. 193.9 mmol/L
  3. 282.4 mmol/L
  4. 382.9 mmol/L
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4.16) A section is prepared with H&E staining. Under the microscope, the nuclei appear too pale. Which of these could be the cause?
  1. Insufficient dehydration
  2. The pH of the eosin solution was above 5.0
  3. The section was not dried properly before beginning deparaffinization
  4. Understaining with hematoxylin
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4.17) A disk diffusion test is performed for Staphylococcus aureus. No zone of growth inhibition is observed around the ampicillin disk. What does this indicate?
  1. Ampicillin is an effective inhibitor of Staphylococcus aureus
  2. Staphylococcus aureus is resistant to ampicillin
  3. The antibiotic disc has moved around the plate
  4. The plate was poorly inoculated
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4.18) A minimum inhibitory concentration (MIC) assay is performed on an organism. Given the results below, what is the minimum inhibitory concentration of the organism?
Antibiotic concentration (μg/mL) 64 32 16 8 4 2 0
Result clear clear clear turbid turbid turbid turbid
  1. 2 μg/mL
  2. 4 μg/mL
  3. 8 μg/mL
  4. 16 μg/mL
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4.19) Which of these bacteria is gram-positive and forms spores?
  1. Bacillus anthracis
  2. Candida albicans
  3. Corynebacterium diphtheria
  4. Escherichia coli
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4.20) Corynebacterium diphtheria is a:
  1. gram-negative cocci
  2. gram-negative rod
  3. gram-positive cocci
  4. gram-positive rod
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4.21) Which parasite is passed in the feces as a noninfective rhabditiform larva?
  1. Dipylidium caninum
  2. Hymenolepis nana
  3. Schistosoma mansoni
  4. Strongyloides stercoralis
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4.22) Which of these bacteria is a gram-negative, aerobic, oxidase-positive, motile rod?
  1. E. coli
  2. Proteus
  3. Pseudomonas
  4. Salmonella
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4.23) What colour are colonies of Neisseria meningitidis on blood agar plates?
  1. Green
  2. Grey
  3. Purple
  4. Yellow
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4.24) In Gram staining, which of these situations can cause gram-negative cells to appear colourless?
  1. Omission of the counterstain step
  2. Omission of the iodine treatment step
  3. Over-decolourizing
  4. Under-decolourizing
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4.25) What is the Gram stain appearance of Clostridium perfringens?
  1. Gram-negative coccus
  2. Gram-negative rod
  3. Gram-positive coccus
  4. Gram-positive rod
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4.26) Which bacteria can hydrolyze hippurate, is beta-hemolytic, is a major cause of neonatal meningitis and sepsis, and produces CAMP factor?
  1. Enterococcus faecalis
  2. Streptococcus agalactiae
  3. Streptococcus pneumoniae
  4. Streptococcus pyogenes
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4.27) An HIV-positive patient has symptoms of meningitis. An encapsulated budding yeast is found in a sample of the patient's spinal fluid. Which organism is this most likely to be?
  1. Candida albicans
  2. Cryptococcus neoformans
  3. Malassezia furfur
  4. Paracoccidioides brasiliensis
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4.28) Which bacteria correlates with the results below?
Agar Result
Blood agar Beta-hemolytic colonies
MacConkey agar Pink colonies
Eosin methylene blue agar Metallic green colonies
  1. Escherichia coli
  2. Salmonella enterica
  3. Staphylococcus aureus
  4. Streptococcus pneumoniae
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4.29) A patient has a gangrenous leg wound. The wound is infected with an anaerobic, spore-forming, gram-positive bacillus. What organism is this likely to be?
  1. Bacillus subtilis
  2. Bacteroides fragilis
  3. Clostridium perfringens
  4. Francisella tularensis
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4.30) A 41-year-old woman who breeds pigeons as a hobby has a fever, a headache, a dry hacking cough, and muscle aches. A lung exam reveals bilateral crackles. A physical exam reveals hepatomegaly. Which pathogen is the most likely cause?
  1. Chlamydia pneumoniae
  2. Chlamydia psittaci
  3. Franciscella tularensis
  4. Mycoplasma pneumoniae
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4.31) A patient has a high fever and a headache and seems confused. From the blood, a small, gram-positive, catalase-positive rod-shaped organism is isolated. There is a narrow zone of beta hemolysis. What is the organism most likely to be?
  1. Bordetella pertussis
  2. Clostridium tetani
  3. Corynebacterium diphtheriae
  4. Listeria monocytogenes
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4.32) A rat bites a 5-year-old boy. A few days later, the boy develops headaches, fever, and muscle pain. An anaerobic blood culture is positive for gram-negative, rod-shaped bacteria. What are these bacteria most likely to be?
  1. Bacillus mycoides
  2. Escherichia coli
  3. Neisseria meningitidis
  4. Streptobacillus moniliformis
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4.33) Which parasite is pear-shaped, 10–20 micrometres long, and has one or two transverse, claw-shaped median bodies?
  1. Ascaris lumbricoides
  2. Enterobius vermicularis
  3. Giardia lamblia
  4. Strongyloides stercoralis
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4.34) Which bacteria correlates with the results below?
Agar Result
Blood agar Beta-hemolytic colonies
MacConkey agar No growth
Mannitol salt agar Yellow colonies
  1. Escherichia coli
  2. Klebsiella pneumoniae
  3. Staphylococcus aureus
  4. Streptococcus pyogenes
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4.35) Which of these diseases causes a low erythrocyte sedimentation rate?
  1. Bone marrow disease
  2. Carcinoma
  3. Leukemia
  4. Polycythemia
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4.36) Blood test results from an automated analyzer show a low red blood cell count, a low hematocrit, and a high MCV, MCH, and MCHC. Under a microscope, agglutination of red blood cells is observed. What step should be taken next?
  1. Add kanamycin to the specimen and rerun the analysis
  2. Dilute the specimen with isotonic diluent by a factor of 1:2 and rerun the analysis
  3. Incubate the blood specimen at 37°C for 10–15 minutes and rerun the analysis
  4. Mix the blood by vortex at the highest setting for 1–2 minutes and rerun the analysis
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4.37) Calculate the corrected WBC count from the following results.
Test Result
Uncorrected WBC count 30,000/uL
Nucleated RBC/100 WBC 100
  1. 500/uL
  2. 10,000/uL
  3. 15,000/uL
  4. 18,000/uL
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4.38) Which white blood cell is most likely to be elevated in acute appendicitis?
  1. Eosinophils
  2. Lymphocytes
  3. Monocytes
  4. Neutrophils
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4.39) The presence of schistocytes in the peripheral blood indicates which of the following processes?
  1. Extravascular hemolysis
  2. Intravascular hemolysis
  3. Iron deficiency anemia
  4. Megaloblastic anemia
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4.40) Which disorder correlates with these findings?
Test Result
PLT 35 × 10⁹/L
HGB 72 g/L
INR 1.5
D-Dimer 22 mg/L
  1. Acquired B
  2. Disseminated intravascular coagulation
  3. Folate deficiency anemia
  4. Vitamin B12 deficiency anemia
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4.41) Refer to the serum protein electrophoresis patterns below. Which disease does the abnormal pattern indicate?
  1. Hepatic cirrhosis
  2. Hypogammaglobulinemia
  3. Monoclonal gammopathy
  4. Nephrotic syndrome
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4.42) A woman has a leukocyte count of 3.6 × 10⁹/L. What is the term for this type of cell count?
  1. Leukemia
  2. Leukocytosis
  3. Leukodystrophy
  4. Leukopenia
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4.43) A patient has a high red blood cell count, a high hematocrit, a high hemoglobin level, and a low erythrocyte sedimentation rate. Which of the following terms best describes the patient's condition?
  1. Anemia
  2. Polycythemia
  3. Rheumatoid arthritis
  4. Tuberculosis
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4.44) Bone marrow cells that contain the Philadelphia chromosome are most often found in which type of leukemia?
  1. Acute lymphocytic
  2. Acute myelogenous
  3. Chronic lymphocytic
  4. Chronic myelogenous
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4.45) Patients with which of the following diseases would have a normal partial thromboplastin time (PTT)?
  1. Factor V Leiden
  2. Hemophilia A
  3. Hemophilia B
  4. Vitamin K deficiency
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4.46) Deficiency of which of the following factors would lead to a prolonged prothrombin time?
  1. Factor II
  2. Factor IX
  3. Factor VIII
  4. Factor XI
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4.47) What would be the PT and aPTT results of a patient with a factor II deficiency?
  1. Normal PT and normal aPTT
  2. Normal PT and prolonged aPTT
  3. Prolonged PT and normal aPTT
  4. Prolonged PT and prolonged aPTT
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4.48) A patient's blood test results are as follows:
Test Result
RBC 4x10⁶/µL
Hct 40%
Hgb 14 g/dL
What is the morphology of red blood cells?
  1. Macrocytic hypochromic
  2. Macrocytic normochromic
  3. Microcytic hyperchromic
  4. Microcytic hypochromic
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4.49) Which of the following red blood cell morphologies is associated with iron deficiency anemia?
  1. Macrocytic hypochromic
  2. Macrocytic normochromic
  3. Microcytic hypochromic
  4. Normocytic normochromic
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4.50) Folate deficiency is associated with which of the following red blood cell morphologies?
  1. Macrocytic normochromic
  2. Microcytic hyperchromic
  3. Normocytic hyperchromic
  4. Normocytic hypochromic
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4.51) Given the following results, which red blood cell morphology does the patient have?
Test Result
MCV 90 fL
MCHC 35.1 g/dL
  1. Macrocytic normochromic
  2. Microcytic hypochromic
  3. Normocytic hypochromic
  4. Normocytic normochromic
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4.52) What does a wide distribution curve on a blood cell histogram indicate?
  1. The blood cells are all roughly the same size
  2. The blood cells are larger than normal
  3. The blood cells are smaller than normal
  4. The blood cells are unequal in size
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4.53) On a blood cell histogram, blood cells that are smaller than normal will be ____________ the bell curve.
  1. above
  2. below
  3. to the left of
  4. to the right of
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4.54) A blood smear is performed for a neonate with low hemoglobin levels: Based on the blood smear, which disease does the neonate have?
  1. Acute lymphocytic leukemia
  2. Hemophilia A
  3. Multiple myeloma
  4. Sickle cell anemia
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4.55) A patient has symptoms of fatigue, weakness, and difficulty breathing. Blood tests reveal high iron, high ferritin, and a normal total iron binding capacity (TIBC). A peripheral blood smear shows red blood cells that are microcytic and hypochromic and have basophilic stippling. Pappenheimer bodies are also observed inside the red blood cells. What is the most likely diagnosis?
  1. Acute intermittent porphyria
  2. Porphyria cutanea tarda
  3. Sickle cell anemia
  4. Sideroblastic anemia
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4.56) Which condition best fits the following test results?
Test Result
Iron 1,475 mcg/dL
Transferrin saturation 65%
Ferritin 875 ug/L
  1. Anemia of chronic disease
  2. Hemochromatosis
  3. Iron deficiency anemia
  4. Metabolic syndrome
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4.57) What does a positive result on the direct antibody test indicate?
  1. Antibodies or complement are bound to the red blood cells
  2. Normal result
  3. The patient has a specific antibody in their serum or plasma
  4. The serum contains anti-HBc and/or anti-HBcAb
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4.58) A urine sample tested positive for urine protein by a dipstick test but negative by the sulphosalicylic acid method. What is the probable cause of these conflicting results?
  1. The urine contained crystals
  2. The urine contained ketones
  3. The urine was very alkaline
  4. The urine was very turbid
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4.59) Which of these diseases causes bilirubin in urine?
  1. Bronchitis
  2. Coronary heart disease
  3. Liver disease
  4. Pneumonia
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4.60) Which of these blood tests is outside the normal range?
  1. PLT: 257 × 10⁹/L
  2. RBC: 7.2 × 10¹²/L
  3. WBC: 5.4 × 10⁹/L
  4. WBC: 8.1 × 10⁹/L
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4.61) A patient's blood gas results are as follows:
Test Result
pH 7.26
PaCO₂ 55 mmHg
These results would be classified as:
  1. metabolic acidosis
  2. metabolic alkalosis
  3. respiratory acidosis
  4. respiratory alkalosis
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4.62) Which type of acidosis best explains the arterial blood gas results below?
Test Result
pH 6.91
PaCO₂ 40 mmHg
Bicarbonate 16 mmol/L
  1. Compensated metabolic acidosis
  2. Compensated respiratory acidosis
  3. Uncompensated metabolic acidosis
  4. Uncompensated respiratory acidosis
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4.63) Use the results below to calculate the osmolal gap.
Test Result
Sodium 140 mmol/L
Glucose 20 mmol/L
BUN 5.6 mmol/L
Measured osmolality 301 mmol/L
  1. 1 mOsm/kg
  2. 3 mOsm/kg
  3. 6 mOsm/kg
  4. 9 mOsm/kg
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4.64) If a blood sample has high levels of urea, it is also likely to have high levels of:
  1. albumin
  2. catalase
  3. creatinine
  4. fibrinogen
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4.65) A patient has a measured osmolality of 283 mOsm/kg and a calculated osmolality of 275 mOsm/kg. Calculate the osmolal gap.
  1. 0.97 mOsm/kg
  2. 1.03 mOsm/kg
  3. 8 mOsm/kg
  4. 556 mOsm/kg
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4.66) What does a high value on the anion gap test indicate?
  1. Acidosis
  2. Alkalosis
  3. Anemia
  4. Polycythemia
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4.67) A patient has an anion gap of 10.0 mEq/L. This is indicative of:
  1. alkalosis
  2. hypercalcemia
  3. hypocalcemia
  4. normal health
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4.68) A 35-year-old man undergoes an annual blood test. H/is results are as follows:
Test Result
Glucose 5.2 mmol/L
Creatinine 122 μmol/L
Urea 5.4 mmol/L
Sodium 141 mmol/L
Potassium 3.9 mmol/L
AST 276 U/L
ALT 134 U/L
GGT 51 U/L
PAL 91 U/L
These results suggest:
  1. diabetes mellitus
  2. hemorrhagic rectocolitis
  3. hepatic cytolysis
  4. muscular cytolysis
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4.69) High amounts of which vitamin can cause false negatives in the fecal occult blood test?
  1. Vitamin A
  2. Vitamin B6
  3. Vitamin B12
  4. Vitamin C
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Section 5: Quality Management

5.1) A control has a mean of 2.8 with a standard deviation of 0.3. This means 68% of the values should fall within a range of:
  1. 2.0−3.1
  2. 2.2−3.4
  3. 2.2−3.4
  4. 2.5−3.1
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5.2) The following data were calculated on a series of 100 determinations of a control.
Mean 5.8
Median 6.0
Mode 5.7
Range 1.5–20.2
Standard deviation 0.25
If confidence limits are set at ±2 standard deviations, what are the allowable limits for the control?
  1. 5.30–6.30
  2. 5.35–6.25
  3. 5.50–5.90
  4. 5.60–5.90
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5.3) A test gives the following results:
Day 1 2 3 4 5 6 7 8 9 10
Value 39 42 33 51 50 47 43 41 50 45
Assuming the test has an acceptable range of ± 2 SD, a standard deviation of 3, and a target value of 45, how many days was the test outside the acceptable range?
  1. 1
  2. 2
  3. 3
  4. 4
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5.4) Which acceptable range do laboratories typically use for quality control results?
  1. One standard deviation from the mean
  2. The middle 68% of the results
  3. The outer 5% of the results
  4. Two standard deviations from the mean
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5.5) What is the most likely cause of a single control value deviating beyond 3 standard deviations?
  1. Calibration drift
  2. Random error
  3. Reagent degradation
  4. Wear and tear of laboratory equipment
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5.6) Which of these assays has the lowest coefficient of variation?
Assay Mean (U/L) Standard deviation
ALP 60 3
ALT 20 2
AST 25 3
GGT 20 5
  1. ALP
  2. ALT
  3. AST
  4. GGT
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5.7) Which statistic is a measure of the amount of variation or dispersion of a set of values?
  1. Mean
  2. Median
  3. Mode
  4. Standard deviation
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5.8) Preventive maintenance means:
  1. fixing things before they break
  2. identifying unexpected failures
  3. repairing equipment after it fails
  4. turning off machines when they are not in use
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5.9) A to-deliver pipettor has an accuracy of +/- 0.8% and a precision of +/- 0.15%. When using the pipette to deliver a volume of 100 µL, what range would you expect the volume of liquid to fall within?
  1. 99.05–100.95 µL
  2. 99.2–100.8 µL
  3. 99.55–100.45 µL
  4. 99.85–100.15 µL
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5.10) A representative sample of uninoculated culture media is incubated for 2-5 days at 35-37°C as part of sterility testing. What is the expected result?
  1. A change in the media's color
  2. Growth across the entire agar plate
  3. Individual colonies
  4. No microbial growth
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5.11) In the nitrate reduction test, what colour would you expect when reagents A and B are added to an uninoculated control tube?
  1. Blue
  2. Colourless
  3. Red
  4. Yellow
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5.12) Preventive maintenance for a centrifuge includes:
  1. cleaning under the centrifuge
  2. ensuring the centrifuge is balanced
  3. inspecting the power cords for damage
  4. moving the centrifuge to a new location
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5.13) External quality assessment schemes are also known as:
  1. compliance
  2. proficiency testing
  3. quality assurance
  4. quality management systems
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5.14) What are the four steps of the Shewhart Cycle?
  1. Analyze, create, inspect, create again
  2. Initiate, plan, execute, close
  3. Plan, do, check, act
  4. Specify, produce, inspect, change
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5.15) Which problem-solving methodology consists of the phases Define, Measure, Analyze, Improve, and Control?
  1. Lean
  2. Pareto charts
  3. Shewhart cycle
  4. Six Sigma
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5.16) Which management philosophy aims to generate the maximum amount of value with the least amount of waste?
  1. Agile
  2. Lean
  3. Six Sigma
  4. Theory of Constraints
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5.17) What are the three steps of process validation?
  1. Pre-analytical phase, analytical phase, and post-analytical phase
  2. Preparatory phase, initial phase, and follow-up phase
  3. Process design, process qualification, and continued process verification
  4. Process planning, process assurance, and continual process quality control
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5.18) Which of these is an example of a zero error?
  1. A blood sample missing a label
  2. A lab technician forgetting a zero when performing a calculation
  3. A thermometer registering 102°C in boiling water instead of 100°C
  4. Scales giving a reading of 1.1 g when nothing is placed on them
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5.19) _____________ is when readings become consistently lower or higher over time.
  1. Calibration
  2. Drift
  3. Offset error
  4. Unpredictability
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5.20) Which of these situations would cause random errors?
  1. A lab assistant who reads the volume of liquids in flasks at a different angle every time
  2. A plastic tape measure that has become slightly stretched over the years
  3. A scale that has been incorrectly calibrated and always gives a value 10 g lighter than the real weight
  4. A thermometer that always reads 2 degrees too high
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5.21) Which of these is an example of a latent error?
  1. A blood vessel missed during phlebotomy
  2. A result written as a 536 instead of a 563
  3. Blood drawn from the wrong patient
  4. Staff shortages
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5.22) What term means the smallest amount of substance in a sample that an assay can accurately measure?
  1. Analytical sensitivity
  2. Analytical specificity
  3. Diagnostic sensitivity
  4. Diagnostic specificity
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5.23) What is the expected quality control result on the nitrate reduction test for P. aeruginosa? Assume P. aeruginosa can reduce nitrate to nitrogen gas.
  1. Blue after nitrate A and B reagents are added
  2. Colourless after nitrate A and B reagents are added, colourless after zinc is added
  3. Colourless after nitrate A and B reagents are added, red after zinc is added
  4. Red after nitrate A and B reagents are added
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5.24) Which of these best meets the definition of proficiency testing?
  1. Inspections to prevent work-related accidents
  2. Testing for illegal drugs in a biological sample
  3. Tests to ensure workers have the skills and knowledge to perform their jobs
  4. The testing of unknown samples sent to the laboratory
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5.25) Which ISO standard specifies requirements for quality and competence in medical laboratories?
  1. ISO 15106
  2. ISO 15189
  3. ISO 15503
  4. ISO 15513
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5.26) A lab technician runs controls for the L-pyrrolidonyl-β-naphthylamid (PYR) test. The results are as follows:
Organism Result
Streptococcus pyogenes Positive
Streptococcus agalactiae Negative
Enterococcus faecalis Positive
What action should the lab technician take?
  1. Discard the reagent
  2. Replace the dye
  3. Retest the control organisms
  4. Start testing patient samples since the test is functioning correctly
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5.27) If a potassium calibration standard is under-diluted, patient results would be:
  1. falsely high
  2. falsely low
  3. less precise
  4. more precise
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5.28) Which of the following is an example of a quality assurance indicator?
  1. C-reactive protein test
  2. Keep thorough records of exposure incidents
  3. Laboratory staff must work under a fume hood when dealing with toxic chemicals
  4. Laboratory turnaround time
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5.29) A patient with leukocytosis has a high serum potassium result of 15.5 mmol/L. An ECG shows none of the abnormalities that would be expected for hyperkalemia. What is the most likely cause of the abnormal potassium result?
  1. Contamination with a gadolinium MRI contrast agent
  2. Interference from a blood pressure medication such as furosemide
  3. Low level of magnesium in the blood
  4. Rupture of blood cells in the blood sample
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5.30) The following chart compares an old method of performing a hematologic test (X-axis) with a new method (Y-axis). The squares represent samples tested with both methods and the black line is the line of best fit. The new method shows what kind of bias?
  1. Negative constant
  2. Negative proportional
  3. Positive constant
  4. Variable proportional
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5.31) Precise values:
  1. are caused by random errors
  2. are close to the true value
  3. are the same as the true value
  4. fall within a narrow range
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5.32) The coefficient of variation is a measure of:
  1. accuracy
  2. precision
  3. sensitivity
  4. specificity
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5.33) A new method for diagnosing celiac disease is trialled on 1,200 patients. The method detects 26 true positives, 9 false positives, 1,145 true negatives and 20 false negatives. Calculate the diagnostic sensitivity of the test to one decimal place.
  1. 56.5%
  2. 69.4%
  3. 82.1%
  4. 99.2%
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5.34) In the data below, which is highest: the sensitivity, the specificity, the positive predictive value, or the negative predictive value?
True positives 40
True negatives 60
False positives 10
False negatives 5
  1. Sensitivity
  2. Specificity
  3. Positive predictive value
  4. Negative predictive value
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5.35) In a control run for a serum magnesium test, a control exceeds two standard deviations above the mean and another control exceeds two standard deviations below the mean. What does this indicate?
  1. Contamination of control material
  2. Random error due to poor precision
  3. Shift in the mean of the distribution
  4. Systematic error due to poor accuracy
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5.36) In a run of twenty control samples, a single control value falls two standard deviations outside of the mean. The other control readings are within the normal range and no source of error can be identified. What is the most appropriate action to take?
  1. Inform relevant clinicians that past results may be incorrect
  2. Prepare a new reagent
  3. Replace the equipment
  4. Report patient results
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5.37) Which Westgard rule is the warning rule?
  1. 10ₓ
  2. 1₂ₛ
  3. 4₁ₛ
  4. R₄ₛ
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5.38) A lab technician performs a control run and finds that four consecutive measurements exceed 1 standard deviation on the same side of the mean. What should the lab technician do?
  1. Accept the control run
  2. Accept the control run but make a note of the incident in the log file
  3. Reject the control run and take corrective action
  4. Rerun the control run
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5.39) How many Quality System Essentials (QSE) are there?
  1. 6
  2. 10
  3. 12
  4. 16
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5.40) Designing the laboratory workspace to improve workflow and ergonomics is part of which quality system essential (QSE)?
  1. Facilities and Safety Management
  2. Nonconforming Event Management
  3. Personnel Management
  4. Process Management
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5.41) Which quality system essential (QSE) describes management responsibilities integral to a laboratory’s success?
  1. Continual Improvement
  2. Facilities and Safety Management
  3. Organization and Leadership
  4. Personnel Management
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5.42) Which quality system essential (QSE) provides guidance for managing test results and other data entered into laboratory recordkeeping systems?
  1. Documents and Records Management
  2. Information Mangement
  3. Nonconforming Event Management
  4. Process Management
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5.43) What is a delta check?
  1. A comparison of a laboratory's results to the results from an outside facility
  2. A comparison of current test results to previous results
  3. An inspection to ensure all patients are wearing wristbands
  4. The verification of a patient's identity using at least three identifiers
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5.44) A patient's blood sample has a negative result on a direct antiglobulin test. To verify the result, the technician adds Coombs control cells to the test. When the Coombs control cells are added, no agglutination is observed. Which of these is a correct interpretation?
  1. The original negative test result is valid
  2. The patient has antibodies against their own red blood cells
  3. The saline washings were adequate
  4. The test needs to be repeated
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5.45) Which of these is an advantage of laboratory information systems?
  1. Fewer laboratory-acquired infections
  2. Higher patient cooperation
  3. Increased safety
  4. Reduced paperwork
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5.46) Which of these specimens is NOT suitable for the urease enzymatic method of measuring urea?
  1. Ammonium heparin plasma
  2. Lithium heparin plasma
  3. Serum
  4. Urine
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5.47) Which of these biochemistry results is critical?
  1. ALT of 12 U/L in a pregnant woman during her third trimester
  2. Creatinine of 707 µmol/L in a 13-year-old
  3. Potassium of 4.2 mmol/L in a pre-dialysis patient
  4. Total bilirubin of 15.4 µmol/L in a 1-day-old newborn
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Section 6: Critical Thinking

6.1) Which of these specimens has the highest priority?
  1. Fasting
  2. Post-op
  3. Stat
  4. Urgent
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6.2) There are two patients in a room and one of the patients has a latex allergy. A phlebotomist needs to collect a specimen from the other patient. How should the phlebotomist proceed?
  1. Ask the allergic patient to wear a mask
  2. Do not take anything that contains latex into the room
  3. Proceed as usual
  4. Pull the curtain between beds and proceed as usual
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6.3) A phlebotomist is performing venipuncture on a difficult vein using a butterfly. The phlebotomist has to collect an SST and a light blue-topped tube. How should the phlebotomist proceed?
  1. Collect the SST first then the light blue top tube
  2. Collect the light blue top tube first then the SST
  3. Draw a clear tube first, then collect the light blue top tube, then collect the SST
  4. Draw half of the SST first, then collect the light blue top tube, then finish the SST
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6.4) A patient begins a routine glucose tolerance test. After 30 minutes, the patient's blood sugar is 20.8 mmol/L. What should you do?
  1. Do nothing and continue with the test
  2. Make a note and continue with the test
  3. Start the test again
  4. Tell the attending nurse immediately
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6.5) The following crystal was found in a patient's urine: From this finding, which medication can you assume the patient is taking?
  1. Fluticasone
  2. Sulfadiazine
  3. Testosterone
  4. Tizanidine
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6.6) The process of combining the results of several studies is known as:
  1. a meta-analysis
  2. an experiment
  3. data mining
  4. epidemiology
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6.7) Which of these is a research method that collects qualitative data?
  1. Data collection
  2. Experiment
  3. Interview
  4. Rating scale
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6.8) The main function of a literature review is to:
  1. describe how your research was conducted
  2. develop a case study
  3. summarise current knowledge
  4. test a hypothesis
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6.9) To study the relationship between patient age and serum glucose level, a researcher would use which type of research?
  1. Correlational
  2. Evaluation
  3. Experimental
  4. Retrospective
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6.10) What blood gas results would be expected for a patient with kidney failure?
  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Respiratory acidosis
  4. Respiratory alkalosis
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6.11) An arterial blood specimen submitted for blood gas analysis was obtained at 8:30 AM but was not received in the laboratory until 11:00 AM. What should the laboratory do?
  1. Perform the test ASAP
  2. Perform the test only if the specimen was submitted in ice water
  3. Request a new arterial sample to be obtained
  4. Request a venous blood specimen
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Section 7: Communication and Interaction

7.1) What team process is intended to give team members a clearer understanding of their responsibilities?
  1. Collaboration
  2. Conflict management
  3. Reflection
  4. Role clarification
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7.2) Your laboratory employs people from many different backgrounds and cultures. Which teamwork skill would be most relevant for increasing team cohesiveness?
  1. Accept criticism
  2. Be dependable
  3. Be tolerant
  4. Compromise
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7.3) When a team decision requires a high degree of commitment for its implementation, a ____________ decision is generally preferred.
  1. consensus
  2. majority-vote
  3. railroading
  4. authority
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7.4) Which of these is an example of non-verbal communication?
  1. Asking a patient to confirm her name
  2. Nodding to show you agree with someone
  3. Saying "No" to a patient
  4. Writing a note to your manager
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7.5) A new colleague is wearing sandals in the laboratory. What action should you take?
  1. Ignore it
  2. Inform the colleague they should be wearing closed-toe shoes
  3. Make a complaint to the supervisor
  4. Recommend that your colleague receives a continuous learning plan
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7.6) A colleague has just found out her cat has died. She is emotionally distraught. Which of the following actions would be appropriate?
  1. Ask her to leave the workplace
  2. Offer to share some of her workload
  3. Report the incident to the regulatory body
  4. Tell her to act more professionally
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7.7) The touching of sexual body parts without consent is what crime?
  1. Intimidation
  2. Sexual abuse
  3. Sexual assault
  4. Sexual harassment
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7.8) Which zone of interpersonal space does a phlebotomist enter when taking a blood sample?
  1. Intimate
  2. Personal
  3. Public
  4. Social
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7.9) Which zone of interpersonal space ranges from 4 to 12 feet?
  1. Intimate
  2. Personal
  3. Public
  4. Social
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7.10) Which of these is a barrier to effective communication?
  1. A clear message
  2. Background noise
  3. Emotional intelligence
  4. Eye contact
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7.11) Which of these is proper phone etiquette?
  1. Introducing yourself upon picking up the phone
  2. Leaving the caller on hold for a long time
  3. Multi-tasking while listening to the caller
  4. Putting an irritated caller on hold
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7.12) Which of these actions committed by a phlebotomist could count as battery?
  1. Disclosing a patient's health information without consent
  2. Holding down a patient to draw their blood against their will
  3. Refusing to draw blood from a patient who arrives late to the appointment
  4. Spreading malicious rumours about a colleague
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Section 8: Professional Practice

8.1) The ongoing process of maintaining and developing your skills and knowledge to remain up-to-date in your profession is called:
  1. career expertise maintenance
  2. continuing professional development
  3. ongoing occupational education
  4. workplace training
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8.2) The process where an individual is informed of and agrees to the collection, use and disclosure of personal information is called:
  1. accountability
  2. consent
  3. openness
  4. safeguarding
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8.3) Under which ethical principle do phlebotomists have a duty to obtain consent from patients before drawing blood?
  1. Autonomy
  2. Beneficence
  3. Justice
  4. Nonmaleficence
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8.4) You are a phlebotomist drawing blood from a woman for a pregnancy test. After the woman has left the room, a colleague approaches you and asks what test was ordered. He explains he wants to know because he is the woman's ex-boyfriend. You should:
  1. call the police
  2. inform him you are unable to tell him anything
  3. lie and tell him the test was a complete blood count
  4. reassure him that he has nothing to worry about
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8.5) Which Canadian federal law gives workers the right to refuse dangerous work?
  1. Canada Labour Code
  2. Occupational Health and Safety Act
  3. Department of Health Act
  4. Hazardous Materials Information Review Act
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8.6) A failure to take proper care over a task is called:
  1. culpability
  2. fraud
  3. negligence
  4. restitution
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8.7) Which of the following is an example of negligence in a laboratory?
  1. Harassing a colleague
  2. Looking up confidential information
  3. Misappropriating laboratory funds
  4. Recording information inaccurately
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8.8) Which principle of the Canada Health Act states that all residents must have access to the same level of health care, regardless of their ability to pay?
  1. Accessibility
  2. Portability
  3. Public administration
  4. Universality
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8.9) What provides the professionalism expectations for medical laboratory technologists in Canada?
  1. The AIMS Scope of Practice
  2. The ASCLS Scope of Practice
  3. The CSMLS Standards of Practice
  4. The HCPC Standards of Proficiency
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8.10) Which principle of PIPEDA states that data not required for the delivery of health care should not be collected?
  1. Challenging compliance
  2. Consent
  3. Limiting collection
  4. Limiting use, disclosure and retention
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8.11) Which of the following is a key determinant of health?
  1. Genetics
  2. Kinematics
  3. Politics
  4. Statistics
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8.12) Which of these is an intrinsic risk factor for cancer development?
  1. Hormones
  2. Lifestyle
  3. Pollution
  4. Viruses
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