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ACE ASCP FINAL EXAM| 2025 - 2026|2 LATEST VERSIONS |500+
QUESTIONS & ANSWERS WITH RATIONALES|ALREADY GRADED
A+ |UPDATED 2025 SPRING
Which of the following condition is the most common cause of increase anion gap? A.Metabolic alkalosis B. Metabolic acidosis Respiratory acidosis Respiratory alkalosis B. Metabolic acidosis RATIONALE: High anion gap metabolic acidosis is caused generally by the body producing too much acid or not producing enough bicarbonate. This is often due to an increase in lactic acid or ketoacids, orit may be a sign of kidney failure. More rarely, high anion gap metabolic acidosis may be causedby ingesting methanol or overdosing on aspirin. Which of the following enzymes has the longest elevation after Myocardial Infarction (MI)? CK-MB Myoglobin Troponin AOTAC. Troponin RATIONALE: Troponin is elevated up to 10- 14 days after Myocardial Infarction. Lactic acid specimen: Chilled and separated from cells Heated Room temperature Request EDTA sample only A. Chilled and separated from cells RATIONALE: Feedback Special Handling: No tourniquet. Place on ice immediately and deliver to lab oraliquot within 15 minutes. DO NOT FREEZE WHOLE BLOOD SPECIMEN. Specific gravity measured by refractometer: 1.035. Protein and glucose both trace in reagent strip: Presence X-ray medium
Albuminuria Glucosuria Normal A. Presence X-Ray medium RATIONALE: Xray medium/Radiographic dye can cause erroneous results in urine specific gravitymeasurement. A patient with walking pneumonia is being treated with penicillin. State one possible condition why the patient is not recovering: The organism produces beta lactamase The organism has no cell wall The organism has capsule The organism produces an enzyme that neutralizes the antibiotic B. The organism has no cell wall. RATIONALE: Pneumonia caused by Mycoplasma pneumoniae is routinely treated with antibiotics, although the disease is usually self-limiting. The disease is treated with macrolide, tetracycline, or fluoroquinolone classes of antibiotics. All mycoplasmas lack a cell wall and, therefore, all areinherently resistant to beta-lactam antibiotics (e.g., penicillin). What is the coefficient of variation if the mean is 90 and the standard deviation is 5.48? 2. 6.
30 B. 6. RATIONALE:: CV= SD/meanX100, (5.48/90)X100= 6.09. Blood smear below denotes Hairy Cell Leukemia (HCL), which of the following test is used to identify this type of leukemia? Image. 1 Myeloperoxidase Tartrate-resistant acid phosphatase Tartrate-resistant alkaline phosphatase
RATIONALE:
Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies). The HLA-B27 gene can be detected in the blood of most patients with ankylosing spondylitis. Burr cells are seen in the peripheral blood smear, this is indicative of? (Fig. 2) Uremia (Kidney Disease) Anemia Leukemia Liver Disease A. Uremia (kidney Disease) RATIONALE: The above shown picture illustrates Burr cells, these cells are indicative of Uremia (kidney disease) Anti IgG (-); C3d (+): What should the MLS do? Elution IAT DAT Pre-warm D. Pre-warm RATIONALE: Prewarm technique can be used to prevent cold-reactive alloantibodies or autoantibodies from reacting in the IAT phase. Specifically, prewarm technique prevents coldantibodies from binding complement at RT (as opposed to 37o C ) and subsequently being detected by anti-C3 in the IAT by polyspecific AHG serum. Maximum interval which a recipient sample maybe used for crossmatching if the patient has been recently transfused, has been pregnant? 2 days 6 days 3 days NOTAC. 3 days CIN (Cefsulodin, Irgasan, Novobiocin) Agar is a recommended culture medium for the recovery of:
Rhodococcus equi Cardiobacterium hominis Brucella suis Yersinia enterocolitica D. Yersinia enterocolitica CIN Agar is recommended for use in the selective and differential isolation of Yersinia and Aeromonas species from clinical specimens, environmental samples, and food sources. Yersiniaenterocolitica will exhibit bull's eye appearance on the said agar. What is the formula for sensitivity? TP/(TP+FN)x TP/(TP+FP)x100 (TP+FN)/TPx (TP+FP)/TNx100 A. TP/(TP+FN)x The anemias of the qualitative hemoglobinopathies, such as sickle cell anemia, are morphologically classified as: Microcytic, hypochromic Macrocytic, normochromic Normocytic, normochromic NOTAC. Normocytic, normochromic According to AABB standards, Fresh Frozen Plasma (FFP) must be infused within what period of time following thawing? 24 hrs 36 hrs 48 hrs 72 hrs A. 24 hours A woman having menstrual cycle would have the ff. result: Increased TIBC
RATIONALE:
Identify the organism: Fig. 3 Blastomyces dermatitidis Malasezia furfur Alternaria Candida albicans A. Blastomyces dermatitidis Feedback The above image show broad base budding. What is the first step in agglutination? Sensitization Precipitation Diffusion Lattice formation A. Sensitization Feedback Agglutination involves two process: First, sensitization or initial binding. Second, lattice formation or formation of large aggregates. Sterilization of autoclave: 121°C at 20 lbs/psi for 30 minutes 121°C at 15 lbs/psi for 15 minutes 85°C for 15 lbs/psi 30 minutes 100°C for 20 lbs/psi 50 minutes B. 121°C at 15 lbs/psi for 15 minutes Feedback Many autoclaves are used to sterilize equipment and supplies by subjecting them to high-pressure saturated steam at 121°C (249 °F) for around 15 - 20 minutes depending on the size of the load and the contents. A newborn infant has a WBC count of 37,000/ul with the differential count revealing the presence of 50 nRBCs per 100 WBCs. What is the corrected WBC count? 15,000/ul 24,700/ul
27,300/ul 12,500/ul B. 24,700/ul Feedback Corrected WBC count= Uncorrected WBC count x100/nRBCs+100: Thus, (37,000ulx100/50+100= 24,700ul) Gram positive bacilli; non-motile; non-hemolytic; catalase positive; spore forming: B. anthracis B. cereus N. meningitidis N. lactamica B. B. anthracis Feedback Important distinguishing characteristics between B. anthracis and B. cereus is motility, B. anthracis is non motile while B. cereus is motile. Hair perforation test/Hair baiting test is for identification of which two fungi? Aspergillus niger and A. japonicus Tinea pedis and T. corporis Trichophyton mentagrophyte and T. rubrum C. albicans and C. tropicalis C. Trichophyton mentagrophyte and T. rubrum Feedback Trichophyton mentagrophyte is positive and T. rubrum is negative What is the minimum platelet count before you perform apheresis? 500 200 150 250 C. 150. Feedback Apheresis donors with low normal pre-procedure platelet counts (150 - 200 x 10 9/L) and Hb concentration (12.5 - 13 g/dL) should be examined for post-donation drops in these haematological parameters
Cholesterol Phospholipid Lipoproteins D. Lipoproteins Feedback For approximately two to eight hours following a meal there is an additional LIPOPROTEIN class, called chylomicrons, representing the transport of dietary fat absorbed in the intestine. A patient with an anti-K and an anti-JKa in her plasma needs 2 units of RBC for surgery. How many group specific units would need to be screened to find 2 units of RBC? The frequency of Jka+ is 80% and K+ frequency is 15%. B. 12 Feedback Formula: Number of units to crossmatch is equivalent to: # of units need by patient/ (frequency of negativity of antigen #1 x frequency of negativity of antigen #2). Negativity of Jka+ is .20%, Negativity of K+ is .85%. Using the formula, 2 units/(.20x.85)=11. rounded to 12. An alkaline urine refrigerated becomes turbid because of? Amorphous phosphates Amorphous urates WBC Bacteria A. Amorphous phosphates Feedback Amorphous phosphates are usually formed in alkaline urine and they are without a color. The precipitate of amorphous phosphates is white while Amorphous urates are yellow, yellow-brown or pinkish in color. They tend to form in acidic urine and their precipitate is pink with a cloudy appearance of the mixed urine. Amorphous urates are a normal presence in the urine. Test for Paroxysmal Cold Hemoglobinuria (PCH): Autohemolysis test Donath-Landsteiner Test Sucrose hemolysis test NOTAB. Donath-Landsteiner Test
Feedback Normal= (-) hemolysis on test and control, PCH= (-) hemolysis on control but (+) hemolysis on test sample. In emphysema, the absence of alpha- 1 globulin peak is due the deficiency of: A1-Antitrypsin (AAT) Macroglobulin Hemopexin Transferrin A1-Antitrypsin (AAT) Feedback Alpha- 1 antitrypsin deficiency is an inherited disorder that may cause lung disease and liver disease. Affected individuals often develop emphysema, which is a lung disease caused by damage to the small air sacs in the lungs (alveoli). Characteristic features of emphysema include difficulty breathing, a hacking cough, and a barrel-shaped chest. Identify the organism: Fig. 4 Clostridium difficile Mycobacterium tuberculosis Listeria monocytogenes Corynebacterium diphtheriaeA. Mycobacterium tuberculosis Feedback Mycobacterium tuberculosis is an obligate pathogenic bacterial species in the family Mycobacteriaceae and the causative agent of tuberculosis. M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. Cells are curved rod- shaped and are often seen wrapped together, due to the presence of fatty acids in the cell wall that stick together. This appearance is referred to as cording, like strands of cord that make up a rope. M. tuberculosis is characterized in tissue by caseating granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei. A and B blood group antigens are derived when glycosyltransferases add specific sugars to precursor H. What is the terminal sugar for B antigen? Fucose D-galactose N-acetylglucosamine N-acetylgalactosamine B. D-galactose
Feedback Sperm count is done after liquefaction which is approximately 20 - 30 minutes. Latex agglutination for Staphylococcus aureus: Protein A and nuclease Phosphotase and protein A Protein A and clumping factor All of the above C. Protein A and clumping factor Which of the following blood test uses radioimmunoassay test to detect direct and specific IgE? Radioallergosorbent Test (RAST) Radioimmunosorbent Test (RIST) A and B None of the above A. Radioallergosorbent Test (RAST) Feedback RAST test is used to detect direct and specific IgE. RIST test is used to detect total serum IgE. Which of the following factors are affected by Coumadin Therapy? III, VII, VIII X, V, II, I II, VII, IX, X AOTAc. Feedback The following factors are said to be Vitamin K Dependent factors. Coagulation factors affected by coumadin drugs are: II, VII, IX and X. What analyte is monitored in preeclampsia? Potassium Ammonia Magnesium
Ionized Calcium c. Magnesium Feedback Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia. Identify: FI.g 5 Heinz bodies Basophilic stippling Howell- Jolly bodies Auer rods A. Heinz Bodies Feedback Heinz bodies (also referred to as "Heinz-Ehrlich bodies") are inclusions within red blood cells composed of denatured hemoglobin. It is also seen in cases of moth balls (naphthalene) ingestion. High-Level Aminoglycoside Resistance: Micrococcus Staphylococcus Enterococci AOTA C. Enterococci Feedback Enterococci are intrinsically resistant to aminoglycosides; a combination therapy using aminoglycoside with vancomycin has been known to increase the effectiveness of the aminoglycoside. It is important to identify this high-level aminoglycoside resistance (HLAR) to provide appropriate therapy. A patient's record shows a previous anti-Jk(b), but the current antibody screen is negative. What further testing should be done before transfusion? Give Jk(b) negative crossmatch compatible blood Crossmatch type specific units and release only compatible units for transfusion Phenotype the patient's red cells for the Jk(b) antigen AOTA A. Give Jk(b) negative crossmatch compatible blood
17 - Ketosteroids is produced in the: Adrenal glands Hypothalamus Thyroid glands Pituitary glands A. Adrenal glands Feedback 17 - ketosteroids are substances that form when the body breaks down male steroid sex hormones called androgens and other hormones released by the adrenal glands in males and females, and by the testes in males. The oxygen sensitive indicator that is used to ensure that anaerobic jars or chambers have met the anaerobic conditions required for anaerobes to grow is: Methylene blue Bromphenol blue Thymol blue Bromthymol blue A. Methylene blue Feedback Methylene blue is used as an indicator of anaerobiosis. It remains blue when there is oxygen present in the environment but turns colorless if anaerobic conditions are met. 2 - month old baby with Normal WBC, Normal platelet, reticulocyte count: 0.1%: Pure red cell aplasia Chronic Myelogenous Leukemia Myelofibrosis with myeloid metaplasia Polycythemia vera A. Pure red cell aplasia Feedback In pure red cell aplasia only red cell production is affected and WBC and platelet counts are normal. It is not likely that RBC count falls that low in lead poisoning. Autologous Donation: Age has no requirement Hgb atleast 11 g/dl, Hct atleast 33%
Single unit is removed at a time, with atleast 3 day intervals AOTA D. AOTA Feedback Donating blood for your own surgery is called an autologous donation. These blood units are collected and stored until the patient's surgery. Order of migration of hemoglobins during alkaline electrophoresis, starting from the origin towards the anode: C,S,F,A C,S,A,F S,C,A,F A,F,S,C A. C, S, F, A Feedback The order of migration of different hemoglobins starting from the origin is C,S,F,A. Fastest towards the anode is Hemoglobin A. Effect of increased Aldosterone to sodium and potassium: Decreased Sodium; Decreased Potassium Increased Sodium; Increased Potassium Increased Sodium; Decreased Potassium NOTAC. Increased sodium; decreased potassium Feedback Hyperaldosteronism can cause high blood pressure, low potassium levels and an abnormal increase in blood volume because of the way the hormone affects the body. It's also possible to have low levels of aldosterone. Addison's Disease, a disease that causes a general loss of adrenal function, can be a cause. Sodium and potassium always have inverse relationship. Hallmarks of this type of anemia: Formation of a fusion protein, AML1-ETO or RUNX1-RUNX1T1, due to a translocation of chromosome 8 to chromosome 21 or t(8;21): Acute Myeloid Leukemia (AML) Chronic Lymphocytic Leukemia (CLL)
Vibrio culture media: Fletcher's Agar Bismuth Sulfite Agar TCBS BAP C. TCBS Feedback Thiosulfate-citrate-bile salts-sucrose agar, or TCBS agar, is a type of selective agar culture plate that is used in microbiology laboratories to isolate Vibrio spp. Moth balls (naphtalene) poisoning may show which of the following red cell characteristics? Howell-Jolly bodies Ovalocytes Sickle cells Heinz Bodies D. Heinz bodies Feedback Ingestion of naphthalene-containing mothballs is a common occurrence in children. Heinz body formation, hemoglobinuria and mild methemoglobinaemia can occur due to poisoning with this substance pH 7.22, pC02: 35, H2CO3: 10 Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis A. Metabolic acidosis Feedback Normal values: pH- 7.35-7.45 pCO2: 35 - 45 HCO3: 22 - 26 Grading of agglutination: Figure 6 1+ 2+ 3+ 4+ D. 4+
Feedback (1+)= Fine granular appearance visually, but definite small clumps (10-15 cells) per lower field, (2+)= Many fair large clumps with many free cells, (3+)= Three or four individual individual clumps with few free cells, (4+)= Single clump of agglutination with no free cells. What is the effect of dextran, why it is difficult to interpret in blood banking? It inhibits Anti-A and Anti-B It causes rouleaux It destroys the D antigen on red cell surface It has soluble like antigen B. It causes rouleaux. Feedback Rouleaux- pseudoagglutination or the false clumping of erythrocytes when the cells are suspended in their own serum. This phenomenon resembles agglutination and is due to the presence of an abnormal protein, plasma expanders such as DEXTRAN or wharton's jelly from cord blood samples. An ASO test can only be valid if the controls have yielded acceptable results. Which of the following indicates valid ASO Test? Hemolysis in both SLO and red cell control Positive control, hemolysis in all tubes No hemolysis on SLO control No hemolysis on red cell control D. no hemolysis on red cell control Feedback For an ASO tube test to be valid, the SLO control should show hemolysis and the RBC control tube should show no hemolysis. With what leukemia is Disseminated Intravascular Coagulation (DIC) associated? M M M CML A. M Feedback M3- Acute Promyelocytic Leukemia (T15;17). Precipitation of ribosomes and RNA: Figure 7
