MT Boards Recall Questions 2016
Clinical
Chemistry
1) Specimen
Collection – (5%)
a) Site
for blood collection – Median-Cubital > Cephalic > Basilic
b) Newborn
screening uses – Blood spot
c) Suggested
length of lancet – 1.75mm
d) Amount
of blood in person – 5-7L, 60ml/kg
f) Heparinized
plasma – preferred sample for electrolytes
g) Anticoagulant
that has EDTA – Tan, Pink, White
h) NaF/ml
of blood to inhibit glycolysis – 2mg/ml
i)
NaF/ml of blood as an anticoagulant – 10mg/ml
j)
Cleansing of puncture site – 70% Alcohol, Gauze,
Benzalkonium chloride
k) Antiseptic
used in ethanol testing – Benzalkonium chloride
l)
Number of hours fasting is part of – Patient
preparation
m) Most
important patient preparation for ammonia analysis – Avoid smoking
n) Unanticoagulated
tube for ACP – No effect
o) Another
specimen for ACP – Vaginal washing
p) Photosensitive
analytes – Bilirubin, β-carotene, Vitamin A
q) Analytes
that require chilling – Ammonia, blood gases, lactic acid, catecholamines
r) Analytes
with diurnal variation – ACP, Iron, Cortisol, ACTH, Aldosterone, GH etc.
s) Analytes
increased in alcoholism – GGT, TAG, Urates
t) 10%
contamination with 5% dextrose – Increase glucose concentration by 500mg/dl
u) 25mg/dl
Bilirubin – Icteric sample
2) Instrumentation
(Principles, Methods, Calibration, Others) – (5%)
a) Visible
light spectrum – 400-700nm
b) X
axis values – Horizontal, Independent variable
c) Discrete
Analyzer – Vitros, Dimension
d) QC
for ISE – Anion gap
e) Potentiometry
– pH, pCO2
f) Amperometry
– pO2
g) POCT
PT Principle – Immunochromatography
h) Prolonged
light exposure – Increased fluorescence
i)
Effects of absorbing molecules in fluorescence –
Decreased fluorescence
j)
Disadvantage of Fluorometry – Quenching
k) Hardware
– Keyboard, mouse, storage device
3) Reagent
Preparation and Laboratory Mathematics – (5%)
a) Bilirubin
conversion factor – 17.1
b) BUN
to Urea – 2.14
c) SI
unit of Glucose – mmol/L
d) SI
unit for Creatinine - µmol/L
e) Not
included in computation of LDL – VLDL
f) How
many grams of NaCl is needed to make 1L of saline – 8.5g
g) How
many ml of NaOCl is needed to make 10L of disinfectant – 1000ml
4) Quality
Assurance – (10%)
a) 12s
= warning rule
b) Random
Error – 13s, R4s, 12s
c) Systematic
Error – 22s, 41s, 10x
d)
Type of variation
that is present in all measurements and are due to chance and can be both
positive and negative – Random
e)
Sample blank –
correct for sample interferences (used if analyte to be measured is Bilirubin,
HgB)
f)
What kind of QC
involves analysis of control samples together with patient specimen –
Internal/Intralab QC
g) Delta
Check – Comparison of previous patient results
h) Shift
– Improper calibration
i)
Trend – Deterioration of reagent
j)
Relative indicator of precision - CV
k) Smaller
CV – Greater precision
l)
Non-laboratory personnel results in – 29% error
5) Metabolic
Blood Tests (Principles, Procedures, Diseases/Disorders, Reference Values) –
(50%)
a) Water
Balance and Electrolytes – (8%)
i)
Routinely measured electrolytes – Na, K, Cl,
HCO3
ii) Primary
contributor to osmolality – Sodium
iii) Major
extracellular cation – Sodium
iv) Major
extracellular anion – Chloride
v) Primary
counterion of Sodium - Chloride
vi) Hyponatremia
– DM
vii) Least
affects Anion Gap – K
viii) >12mOsm/kg
– DKA, Drug overdose, Renal failure, Ethanol poisoning
b) NPN
and Other Metabolic Intermediaries and Inorganic Ions – (8%)
i)
Major NPN – Urea
ii) 2nd
prevalent NPN – Amino acids
iii) Urea
method that is inexpensive but lacks specificity – Colorimetric, diacetyl
iv) Urease
– Ammonia formation
v) Simplest
Jaffe reaction – Colorimetric, Endpoint
vi) BUN:Creatinine
ratio – 10:1
vii) Caraway
– Uric Acid
viii) Assay
for uric acid, problems with turbidity - Colorimetric
ix) Uricase
– Enzymatic + UV
x) Conway
– Ammonia
xi) Classification
of Azotemia – pre-renal, renal, post-renal
c) Carbohydrates
– (6%)
i)
Nelson-Somogyi – Arsenomolybdate Blue
ii) OGTT
– Ingest at least 150g/day of carbohydrates for 3 days
iii) Whole
Blood – 15% lower glucose values than serum/plasma
iv) Rate
of glucose metabolism – 7mg/dl/hr
v) Monitoring
of Glucose – HbA1c
vi) Monitors
insulin shock – RBS*
vii) Not
true about type 2 DM – Prone to Ketoacidosis
viii) Whipple’s
Triad – Hypoglycemia
ix) Most
common Glycogen Storage disease – Type I – Von Gierke – Deficiency in G6P
d) Lipids
and Dysproteinemia – (8%)
i)
TAG >400mg/dl – Turbid serum, creamy
ii) Cholesterol
at 210 mg/dl – Moderate risk
iii) Standing
plasma is a test for – TAG
iv) One
step method of cholesterol determination - Colorimetric
v) High
risk for cardiovascular accident are associated with high – LDL
vi) Type
I Hyperlipoproteinemia – Increased CM, TAG
vii) Sinking
pre-betalipoprotein – Lp(a)
viii) Floating
betalipoprotein – β-VLDL
ix) Reference
method for Lipoprotein analysis – Ultracentrifugation
x) Sedimentation
unit – Svedberg
e) Specific
Proteins – (6%)
i)
Analyte associated with dehydration – Albumin
ii) Difference
between measured Total Protein and measured Albumin – Globulin
iii) Lysis
of RBC will result in – Hgb
iv) BNP
– Congestive Heart Failure
v) β-γ
Bridging – Cirrhosis
vi) Protein
electrophoresis is singly important for – Monoclonal gammopathies
vii) Biuret
reagent - RANK
f) Liver
Function Tests – (6%)
i)
Synthetic function of liver – Albumin, protein,
coagulation factors
ii) Analyte
for detoxification of liver – Ammonia
iii) Ammonia
– Reye’s syndrome, Hepatic coma
iv) Gilbert
Syndrome – increased B1
v) 2mg/dl
bilirubin – Jaundice
vi) Serum
Bilirubin of 20mg/dl – Report immediately
g) Clinical
Enzymology – (8%)
i)
Reaction rate if directly proportional to
substrate concentration – First Order Kinetics
ii) Oxidoreductase
– LDH, G6PD
iii) Transferase
– CK, AST, ALT
iv) Hydrolase
– ACP, ALP, LPS, AMS
v) Lyase
– Aldolase, enzymes ending in decarboxylase
vi) No
isoenzyme – ALT
vii) Salivary
gland – Amylase
viii) 1st
enzyme to increase in MI – CK-MB
ix) CK-MB
– increase 4-8hrs, peak 12-24hrs, normalize 48-72hrs
x) Intramuscular
injection – increased CK-MM
xi) Enzyme
with moderate specificity – LDH
xii) LDH
greatest increase in – Pernicious anemia
xiii) LD
Flipped pattern – MI, Hemolytic Anemia
xiv) LD 4 and 5
– Cold labile
xv) Substrate
for Bowers-McComb – PNP
xvi) Paget’s Disease
– Osteitis Deformans
xvii)
Most specific substrate for ACP –
Thymolphthalein Monophosphate
xviii)
Direct Rectal exam – Increased ACP
6) Endocrinology
and Toxicology (Principles, Procedures, Diseases/Disorders, Reference Values) -
(16%)
a) Endocrinology
– (10%)
i)
Thyroid Hormones – (4%)
(1) Hyperthyroidism
– Increased ALP
(2) Test
analyte that confirms conflicting thyroid results – rT3/reverse T3
(3) rT3
is formed from the deiodination of T4 in the – blood
(4) Thyrotoxicosis
– Plummer’s disease – decreased TSH, normal FT4, increased FT3 and T3
ii) Sex
Hormones – (3%)
(1) E1
– Menopause
(2) E2
– Menstruation
(3) E3
– Pregnancy
(4) Most
potent Estrogen – E2
(5) Source
of E2 – Ovary
(6) Increased
in 2nd/3rd trimester – progesterone
iii) Other
Hormones (Pituitary, Adrenal) – (3%)
(1) Increased
in 1st trimester – HCG
(2) Cushing
Syndrome – Increased Cortisol
(3) Insulin
promotes – Lipogenesis, Glycolysis, Glycogenesis
(4) Posterior
pituitary gland – stores ADH, oxytocin
(5) Angiotensin
II – Vasoconstriction, Stimulate Aldosterone production, Regulate BP
(6) Prolactin
level if patient underwent breast exam – Increased
b) Toxicology
& Therapeutic Drug Monitoring (TDM) – (6%)
i)
Substance of Abuse – (2%)
ii) Other
Poisons/Toxic Agents (Alcohol, Carbon Monoxide, Mercury, Lead, Arsenic) – (2%)
(1) Unit
for ethanol impairment - %wt/vol or mg/dl
(2) Considered
legally intoxicated – 100mg/dl or 0.1% wt/vol, 3-4 ounces of whisky
iii) TDM
– Anticonvulsants and other Drugs – (2%)
(1) Serum
drug concentration is affected by – Absorption, Distribution, Metabolism
(2) Delivery
of drug – Distribution
(3) Trough
– Collect blood before next dose is given
(4) Petitmal
seizure – Valproic acid
(5) Cyclosporine
– Immunosuppressant
7) Blood Gas Analysis and Other Tests (Principles,
Procedures, Diseases/Disorders, Reference Values) – (4%)
a) Patient
with fever – decreased PO2 by 7%, increased PCO2 by 3%
b) Metabolic
Acidosis is compensated through - Hyperventilation
c) Metabolic
Alkalosis is compensated through - Hypoventilation
8) Laboratory
Safety – (5%)
c) Sharps
– Red Container
d) Safety
Diamond, Blue – Health
e) Fire
Type 3 – Electrical
f) Class
K fire – fats, kerosene
g) Breakage
in Centrifuge – Aerosols are formed
Microbiology and Parasitology
1)
Microbiology – (70%)
a)
Bacteriology – (49%)
i)
Collection, Transport, Processing and Staining
of Specimens – (5%)
(1)
First thing to be done for collection of sputum
sample – Gargle with water
(2)
Acid Fast stain in tissues – Kinyoun
(3)
AFB stains – Red
(4)
Non-acid fast bacteria stains – Blue
(5)
Critical step in gram stain – Decolorizer
(6)
Nonspecific staining of cellular structures – Fluorochroming
(7)
Nasopharyngeal swabs are for – Neisseria, H.
influenza, B. pertussis
(8)
Late chlamydia specimen must be – Rejected
ii)
Culture Media – (5%)
(1)
Preferred medium
for isolation of B. pertussis – Regan-Lowe/Charcoal Cephalexin Blood Agar
(2)
K Tellurite – gray black colony
(3)
Cystine Tellurite – C. diptheriae
(4)
Cystine glucose – F. tularensis
(5)
Significant colony count in urine – 100,000
iii)
Bacteria (Aerobes) – (33%)
(1)
Morphology and staining characteristics – (5%)
(2)
Cultural characteristics – (5%)
(a)
Golden yellow colonies in BAP – S. aureus
(b)
Alpha-prime – S. aureus
(c)
S. saprophyticus – Cystitis
(d)
C. amycolatum in nasopharynx – Normal flora
(e)
Commonly isolated in ICU – P. aeruginosa
(f)
P. aeruginosa – Grows in 42 and 35 degrees Celsius
(g)
Flat, serrated colonies with confluent growth on
BAP – P. aeruginosa
(h)
Salmonella bacterial culture – 2-3
specimen(blood) within 24 hours
(i)
Whipple Disease – Trophyrema
(3)
Work-up for identification: biochemical,
differential and confirmatory tests – (14%)
(a)
Clumping factor – Coagulase
(b)
30% H2O2 – Superoxol Test
(c)
MR and VP reaction – Opposite
(d)
Chromogenic β-lactamase result – Color formation
(e)
Demonstrate Streptolysin O – Anaerobic culture
(f)
Differentiate S. aureus and S. epidermidis – Coagulase,
DNAse
(g)
Negative CAMP test – No enhancement of hemolysis
(h)
Bile solubility – S. pneumoniae
(i)
Similar to C. diptheriae – C. ulcerans
(j)
Shigella – Biochemically inert
(k)
Acetamide Test – P. aeruginosa (35˚C for 7 days)
(l)
Bordetella oxidase & urease (+) –
Bronchiseptica
(m) Requires
V factor – H. parahemolyticus
(n)
Requires X factor – H. ducreyi
(4)
Serologic/molecular tests – (3%)
(a)
Not common in microbiology – PCR
(b)
Lancefield – Detects carbohydrates in
Streptococcus group
(c)
Quellung – Capsular swelling
(d)
Kauffman-White – Salmonella serotyping
(5)
Susceptibility tests – (4%)
(a)
Not an antibiotic – Sulfonamide
(b)
Penicillin – Inhibit cell wall synthesis
(c)
Vancomycin – Inhibit cell wall synthesis
(d)
Gentamicin – Inhibit protein synthesis
(e)
Clindamycin – Inhibit protein synthesis
(f)
ESBL – Extended Spectrum Beta-Lactamase
(6)
Bacteriologic examination of water, food, milk
and utensils – (2%)
(a)
Red milk – S. marcescens
(b)
Blue milk – P. aeruginosa
(c)
Stormy fermentation of milk – C. perfringens
iv)
Bacteria (Anaerobes) – (2%)
(1)
Pseudomembranous colitis – C. difficile
(2)
Common gut flora – Bacteroides
(3)
Gram-positive anaerobes – Peptostreptococcus,
peptococcus
v)
Mycobacteria – (2%)
(1)
AFB smear measures – 2-3cm
(2)
MPT 64 – M. tuberculosis
(3)
Niacin and nitrate positive – M. tuberculosis
(4)
Niacin and nitrate negative – M. bovis
(5)
Tween 80 positive – M. kansasii
vi)
Other bacteria
with unusual growth requirements (Spirochetes, Chlamydia, Mycoplasma,
Rickettsia) – (2%)
b)
Mycology – (4%)
i)
Collection, transport and examination of
clinical specimens – (2%)
(1)
Basic, branching, intertwining structure of
molds – Mycelia
(2)
Stain for sharp
delineation of fungal elements by fluorescent microscopy – Calcoflour white
(3)
Presumptive test for candida that uses serum – Germ
tube
(4)
Positive hair-baiting test – V-shaped
penetration of the hair shaft
(5)
Ascospore – Saccharomyces
(6)
Farmer lung’s disease – Aspergillus fumigatus
(7)
Macroconidia absent – M. audouinii
(8)
Microconidia absent – E. floccosum
(9)
Epidermophyton – Skin, nails
(10)Microsporum – Skin, hair
(11)Tricophyton – Skin, hair,
nails
(12)T. mentragophytes –
Positive hair-baiting test
(13)T. rubrum – Red pigment,
teardrop shaped conidia
ii)
Culture – (2%)
(1)
AMAN medium stain – Lactophenol cotton blue
(2)
Cornmeal agar – Chlamydospores
(3)
Czapek – Aspergillus
(4)
Rice agar – M. canis
(5)
Urease media – Cryptococcus neoformans
(6)
Birdseed – Phenol oxidase
c)
Virology – (4%)
i)
General characteristics, transmission and diseases
– (2%)
(1)
1st step in viral replication –
Adsorption/Attachment and Penetration
(2)
Part of virus where envelope is acquired –
Nuclear or cytoplasmic membrane
(3)
ssDNA virus – Parvovirus
(4)
dsRNA – Reovirus
(5)
Largest virus - Poxvirus
(6)
Largest RNA Virus – Paramyxovirus
(7)
Virus that causes acute central nervous system
disease in humans and animals – Rabies
(8)
Acid sensitive - Rhinovirus
(9)
Ether sensitive – Herpes virus
ii)
Collection, transport and examination of
clinical specimens – (2%)
(1)
CMV isolation is recommended using – Human
embryonic fibroblasts
(2)
Grape-like cluster - Adenovirus
d)
Equipment and instrumentation – (5%)
i)
Manual – (3%)
(1)
How to prepare agar – Add agar to water*
(2)
RPM for centrifugation of bacteria – 3500-5000
RPM for 10mins
ii)
Automated – (2%)
e)
Quality assurance and safety – (8%)
i)
Collection of specimen – (2%)
(1)
Lyophilization of pure culture – freeze at -20
to -30˚C
(2)
Mineral oil – Anaerobes
ii)
Quality control – (2%)
(1)
Settings of rpm
marked on the face of the rheostat control on the centrifuge should be checked
– Monthly
(2)
Oxidase, Catalase, Coagulase – Tested each day,
when vial is first opened
iii)
Safety – patient/staff – (2%)
(1)
BSC II – Laminar flow
(2)
Sterilize needles for sputum – Dip in 70%
alcohol + sand
iv)
Safety – workplace/environment – (2%)
(1)
AFB is killed by – Boiling 10mins, Autoclave
(2)
Autoclave - 121˚C, 15 psi(lbs/in2),
15mins
(3)
Not killed by sterilization – Prions
2)
Parasitology – (30%)
a)
Parasites – life
cycle, morphological characteristics, epidemiology, prevention and control,
manner of reporting, counting – (21%)
b)
Nematodes – (5%)
(1)
First stage of nematodes – Rhabditiform
(2)
Viviparous – Produces larva
(3)
Oviparous – Produces egg
(4)
Parasite most prevalent in orphanage – Unholy
Three
(5)
Larvae that passes through the lungs – Ascaris,
Stronglyloides, Hookworm
(6)
Roundworm that inhabits
the small intestine and is usually demonstrated as rhabditiform larvae in fecal
specimen – Threadworm
(7)
Ascaris egg lacking its mammillated coat –
Decorticated
(8)
A. lumbricoides vector – Cockroach
(9)
Resembles Trichiuris – C. philippinensis
(10)S. stercoralis – Chinese
lantern
(11)Adult Trichinella –
Intestine
(12)Unsheathed microfilariae –
O. volvulus
(13)Longest nematode – D.
medinensis
(14)Internal autoinfection – S.
stercoralis
(15)External autoinfection – E.
vermicularis
ii)
Trematodes – (5%)
(1)
1st IH of flukes – Snail
(2)
2nd IH of P. westermani – Fresh water
crabs
(3)
2nd IH of Echinostoma – Snail
(4)
2nd IH of Fasciola/Fasciolopsis –
Aquatic vegetation
(5)
Parasite found in sheep/cattle, not common in PH
– F. hepatica
(6)
Eggs with abopercular thickening – P. westermani
(7)
Small lateral spine – S. japonicum
(8)
Prominent lateral spine – S. mansoni
(9)
Terminal spine – S. haematobium
(10)Schistosomule – Cercaria
minus tail
(11)Swimmer’s itch – Schistosoma
(12)C. sinensis – Old fashioned
light bulb
(13)Mode of transmission of
Clonorchis – Ingestion of metacercaria
iii)
Cestodes – (5%)
(1)
Head of tapeworm - Scolex
(2)
Body of tapeworm – Strobila
(3)
Finger-like uterine branches – T. solium
(4)
Tree-like uterine branches – T. saginata
(5)
3rd Taenia specie – Taenia asiatica
(6)
Hexacanth embryo in a radially striated shell –
Taenia
(7)
Hexacanth embryo that lacks polar filaments – H.
diminuta
(8)
Egg of D. latum – Operculated
(9)
1st IH of D. latum – Copepods
(10)2nd IH of D.
latum – Fresh water fish
(11)Spirometra – May resemble
D. latum
(12)Found in IH of E.
granulosus – Hydatid cyst
(13)Double-pored tapeworm – D.
caninum
iv)
Protozoa – (5%)
(1)
Motile, reproducing, feeding stage – Trophozoite
(2)
Organ most often involved in extraintestinal
amoebiasis – Liver
(3)
E. histolytica – Ingest RBC
(4)
Differentiates hartmanni and histolytica – Size
(5)
E. gingivalis – Ingests WBC
(6)
E. nana – Cross-eyed cyst
(7)
Often mistaken for cyst of amoeba – B. hominis
(8)
Largest intestinal protozoa – B. coli
(9)
Undulating membrane – Trichomonas, Trypanosoma
(10)Intestinal flagellate is
described as – Pear-shaped
(11)T. vaginalis – Jerking,
tumbling motility
(12)Ping pong disease – T. vaginalis
(13)Vector of African sleeping
sickness – Glossina species
(14)DH for Plasmodium species –
Female Anopheles mosquito
(15)Principal vector for
malaria – Flavirostris
(16)Plasmodium species that can
cause relapse – P. vivax, P. ovale
(17)Not recommended for
Venipuncture – Malaria, Babesia, Hemoflagellates
(18)Blood specimen preferred
for protozoa – Finger puncture
(19)90% cases of malaria caused
by – P. vivax and falciparum
(20)Toxoplasma gondii – cat
v)
Ectoparasites – (1%)
(1)
Crabs – Ectoparasite
c)
Parasitologic Techniques – (5%)
i)
Routine – (2%)
(1)
Iodine – Destroys trophozoites
(2)
Stain to demonstrate uterine arrangement of
Taenia species – India ink
(3)
Chromatoid bodies on Trichrome stain is colored
as – Bright to red
(4)
Stain for Naegleria, Acanthamoeba – H&E,
Wright’s
(5)
To detect stippling, prepare blood films –
30mins to 1hr
(6)
Reagent for kato-thick smear – Malachite green,
glycerine, cellophane
ii)
Concentration – (2%)
(1)
Zinc sulfate specific gravity – 1.18
(2)
Flotation techniques – Operculated eggs and eggs
with spines not recovered
iii)
Others – (1%)
(1) Sheather’s
sugar flotation – Cryptosporidium
(2) Baermann
funnel - Strongyloides
d)
Quality assurance – (4%)
i)
Collection and preservation of specimen – (2%)
(1)
Stool for more than 1hr is stored at –
Refrigerator
(2)
Stool preservative – Polyvinyl alcohol,
Schaudinn
ii)
Quality control – (2%)
Clinical Microscopy
1. Urine
– (53%)
a. Anatomy
and physiology of the kidney, Formation of Urine – (5%)
i.
Specific gravity of glomerular filtrate – 1.010
ii.
Proximal
convoluted tubules – Site for reabsorption of glucose, amino acids, NaCl
iii.
Major organic substance in urine – Urea
iv.
Major inorganic substance in urine - Chloride
v.
Albumin – Maintains oncotic pressure
vi.
Not normally found in urine – Protein
vii.
Renin – Maintain BP
b. Macroscopic
examination – (10%)
i.
<400ml urine – Oliguria
ii.
>2000ml urine – Polyuria
iii.
Incapable of producing urine - Anuria
iv.
Print blurred through urine – Cloudy
v.
Atabrine – Yellow
vi.
Carotene – Yellow
vii.
Tea bag color of urine – Brown
viii.
Portwine urine – Porphyrin
ix.
Reddish-orange urine – Rifampin
x.
Yellow foam – Bilirubin
xi.
Oily looking substance on top of urine – Indicative
of nephrotic syndrome
c. Chemical
Analyses – (18%)
i.
Acidic urine – High meat diet, DM
ii.
Alkaline urine – Vegetable diet
iii.
pH – Aids in crystal identification
iv.
RCM – Increased SG
v.
DM – Increased SG
vi.
Color of glucose in potassium iodide strip –
Green to brown
vii.
Clinitest – Detection of reducing substances
viii.
Most numbered ketone body – B-hydroxybutyric
acid
ix.
Starvation/Diabetes – Ketones
x.
Legal’s test – Ketones
xi.
Ketone reagent strip - Purple
xii.
UTI screening – Nitrite
xiii.
Protein principle – Error of indicator
xiv.
Protein reagent strip detects - Albumin
xv.
Turbidity with granulation – 2+
xvi.
Ictotest – Bilirubin
xvii.
Ehrlich units – Used in reporting urobilinogen
xviii.
Blondheim’s Test – Differentiates hemoglobinuria
and myoglobinuria
xix.
11th pad in reagent strip – Ascorbic
acid
xx.
Sulkowitch – Calcium
xxi.
Fantus - Chloride
xxii.
CTAB – Mucopolysaccharidosis
xxiii.
PAH, PSP – Tests for tubular secretion, renal
blood flow
d. Microscopic
examination – (15%)
i.
Largest cell found in urine sediment – Squamous
epithelial cell
ii.
Clue cell – Bacterial vaginosis
iii.
Frequent parasite encountered in urine – T.
vaginalis
iv.
Fecal contamination of urine sample – E.
vermicularis
v.
Urinalysis findings in patient with renal
calculi – Hematuria
vi.
Renal lithiasis – Hematuria
vii.
Ghost cell- RBC in hypotonic solution
viii.
Glitter cell – WBC in hypotonic solution
ix.
WBC/RBC reporting – Per hpf
x.
Eosinophils – Seen in Acute Interstitial
Nephritis
xi.
RTE Cells – Eccentric nucleus
xii.
Lipid-containing RTE Cells – Oval fat bodies
xiii.
RTE cells with nonlipid-containing vacuoles –
Bubble cells
xiv.
Lemon-shaped crystal – Uric acid
xv.
Amorphous urates – Soluble with heat
xvi.
Ethylene glycol poisoning – Calcium oxalate
monohydrate
xvii.
Ampicillin – Sheaves, needles
xviii.
Crystal in Fanconi’s syndrome – Cystine
xix.
Abnormal crystals seen in liver disorders –
Bilirubin, Leucine, Tyrosine
xx.
Sulfonamide crystals – Confirmed by the diazo
reaction
xxi.
Apatite – Calcium phosphate
xxii.
Thorny apple – Ammonium biurate
xxiii.
Cylindroids – Disintegration forms of cast with
tails and tapering ends
xxiv.
Significance of cylindroids – Same as casts
xxv.
Effect of alkaline, hypotonic urine – cast
disintegrates
xxvi.
Degenerative form of all casts – Waxy
xxvii.
Telescoped sediment – Findings of nephrotic
syndrome and glomerulonephritis
e. Pregnancy
testing – (2%)
f.
Renal calculi – (3%)
i.
Yellow to brownish red, moderately hard – Uric
acid and urate stones
ii.
Pale and friable – Phosphate stones
iii.
Very hard, dark color, rough surface – Calcium
oxalate stones
iv.
Yellow-brown resembling an old soap, somewhat
greasy – Cystine stones
v.
Chemical used to
detect renal calculi made up of PO4 – Ammonium molybdate in HNO3
vi.
Least common urinary stone – Cystine
2. Feces
– (3%)
a. Normal
stool pH – 7-8
b. Fecal
leukocytes indicating invasive infection – 3/hpf
c. Stool
color when taking multivitamins with iron – Black
d. Stool
color if patient have melanoma – Black
e. APT
reagent – 1% NaOH
f.
APT in infant – Pink
g. FOBT
– Colorectal cancer
h. Positive
color for guiac – blue
3. Other
Body Fluids – (21%)
a. CSF
– (5%)
i.
Produces 70% CSF – Choroid plexus
ii.
Clot formation and bloody CSF – Traumatic tap
iii.
Laboratory test for CSF protein – Turbidimetric,
Dye-binding
iv.
Normal value of protein in CSF – 15-45mg or
<1%
v.
CSF Glucose – 2/3 of plasma
vi.
Cloudy CSF dilution – 1:200
vii.
Predominant WBC in adult CSF – Lymphocyte
viii.
Predominant WBC in newborn CSF - Monocyte
b. Seminal
Fluid – (5%)
i.
Spermatogonia – Youngest
ii.
Acrosomoal cap – ½ of head 2/3 of nucleus
iii.
Sperm count dilution – 1:20
iv.
Alternate diluting fluid – Chilled water
v.
Stain to assess sperm morphology – Paps
vi.
How many fields viewed to assess sperm
morphology – 20
vii.
Sperm graded as freely moving – 4
viii.
Neutral alpha glucosidase – Epididymis
ix.
Enzymes that can liquefy semen – Chymotrypsin,
plasmin, pepsin
x.
Most common cause of male infertility –
Varicocele
xi.
Infertility – 1.5ml semen
xii.
Red seminal fluid – Blood
xiii.
Makler counting chamber – Undiluted sperm
xiv.
Oligospermia – Decreased sperm count
c. Amniotic
Fluid – (3%)
i.
Amniotic fluid volume after first trimester –
Fetal urine
ii.
Gestational age - Creatinine
iii.
Dark brown amniotic fluid – Fetal death
iv.
Dark green amniotic fluid – Meconium
v.
OD 450 - Bilirubin
vi.
Additional test to be done for elevated AFP
amniotic fluid – Acetylcholinesterase
d. Gastric
Fluid and Duodenal Content – (2%)
i.
Gastric tube inserted through mouth – Rehfuss
ii.
Gastric tube inserted through nose – Levine
iii.
Diagnex – Tubeless gastric analysis
iv.
BAO – Basal Acid Output
v.
Pernicious Anemia – Anti-parietal antibodies
vi.
Zollinger Ellison – Elevated gastrin
e. Sputum
and Bronchial Washings – (2%)
i.
Bronchitis – Dittrich plugs
ii.
Bronchial asthma – Charcot-Leyden crystals,
Curschmann spiral
iii.
Charcot-Leyden crystals – Red, spindle-shaped crystals
iv.
Creola bodies – Bronchial asthma
f.
Synovial Fluid – (2%)
i.
Normal synovial fluid - <3.5ml
ii.
Synovial fluid glucose – Comparable with serum
iii.
Clotted synovial fluid – Use of acetic acid
g. Peritoneal,
Pleural and Pericardial Fluids – (2%)
i.
Normal color and appearance of peritoneal fluid
– Clear, pale yellow
ii.
Accumulation of fluid in serous membranes –
Effusion
iii.
Concentric
striations of collage-like material in peritoneal fluid associated with ovarian
and thyroid malignancy – Psammoma bodies
iv.
Peritoneal lavage – Determination of intra-abdominal
bleeding
4. Collection,
preservation and handling of specimens – (10%)
a. Chain of Custody – Step by step documentation of
handling and testing of legal specimens
b. Routine
amount of urine – 10-15ml
c. Urine
container capacity for drug testing – 60ml
d. Urine
for drug testing temperature – 32.5-37.7 degrees Celsius within 4mins
e. Bluing
agent – Prevent adulteration
f.
Used in analytes with diurnal variation – Timed
specimen
g. Proper
container for urobilinogen determination – Amber bottle
h. What
should be done if pink sediment is seen after refrigeration – Return to RT
i.
Additive used in Addis count – Formalin
j.
Amniotic fluid for fetal lung maturity is stored
at – Refrigerator
k. To
prolong cell viability for cytogenetic studies, specimen should be – Incubated
at 37˚C
l.
Specimen for
detection of male/female anti-sperm antibody – Serum, semen, cervical mucus
m. Fructose
storage – Frozen
n. Synovial
fluid cell count – EDTA
o. Specimen
for tubeless gastric acid analysis - Urine
p. Specimen
for fecal fat determination – 3-day sample
5. Microscope,
automation, other instruments – (5%)
a. Urinometer
– Read at lower meniscus
b. Calibration
solution for refractometer – 9% sucrose (1.034 ± 0.001)
c. Calibration
of refractometer – 5% NaCl (1.022 ± 0.001)
d. Distilled
water – 1.000
e. Air
bubbles – Error in refractometer
f.
CASA – Computer Assisted Sperm Analysis
g. Crystals
and OFB – Polarizing microscope
h. Condenser-equipped
microscope – Phase contrast
i.
Cytocentrifuge – 30% albumin
6. Quality
assurance and laboratory safety – (8%)
a. To
disinfect countertops with spill use – 10% bleach
b. Biohazard
color – Black in yellow background
c. Chain
of Infection – 6
d. Safety
Diamond, 4 means – Extreme
e. RACE,
A – Alarm
f.
PDCA – Plan-Do-Check-Act
g. PDSA
– Plan-Do-Study-Act
Hematology
1) Blood
collection, anticoagulants and others (including Safety) – (5%)
a) Size
of blood for smear – 2-3mm
b) Distance
of blood drop from the edge of the label – 0.25in/1cm
c) Longitudinal
– Most ideal method for reading smear
d) Length
of needle – 1-1.5in
e) Gauge
in tuberculin syringe – 25
f) Gauge
of needle in bleeding of donors – 16
g) Ocular
– Interpupillar distance
2) Hematology
tests and procedures – (30%)
a) Routine
– (15%)
i)
Degree of hypochromia measured as 1/3 – Normal
ii) Macrocyte
in ESR – False increase
iii) Effect
of increased Hgb in ESR – Increased
iv) ESR
in wintrobe tube is read using – Left side
v) Disposable
ESR tubes – Dispettes
vi) Hematocrit
method in wintrobe – Macrohematocrit
vii) Size
of the unfilled portion of the capillary tube in microhematocrit – 10-15mm
viii) Length
of capillary tube – 75mm
ix) Length
of plug in capillary tube – 4-6mm
x) Centrifugation
for microhematocrit – 10,000-15,000g for 5mins
xi) 1st
layer in spun hematocrit – Fat
xii) 4th
layer in spun hematocrit - RBC
xiii) MCV
– Computed from hematocrit and RBC count
xiv) 1 RBC not
counted – Decrease count by 10,000
xv) Measures
erythropoiesis – Reticulocyte count
xvi) 3-5%
rouleaux – Slight high
b) Automation
– (10%)
i)
Relation of voltage pulse to cell size –
Directly proportional
ii) Blood
clots will have what effect on RBC count using automated counters – Decreased
iii) Positive
error – Bubbles, electric impulse, aperture plugs
iv) Negative
error – Hemolysis
v) Platelet
satellitism – Decreased platelet count
c) Special
– (5%)
i)
Screening test for HbS – Dithionite solubility
ii) Requires
fresh sample – MPO, LAP
iii) Differentiate
Leukemoid Reaction from CML – LAP
3) Hematopoiesis,
Diseases/Disorders and Reference Values – (40%)
a) Hematopoiesis
(in general) – (6%)
i)
Pluripotential stem cell – 2 possible cell lines
ii) Differentiate
pure anemia from bone marrow malfunction – WBC count
iii) Bone
marrow – Sternum, tibia, POSIC
iv) Not
true regarding yellow marrow – Hematopoietic
v) CD
34 – Stem Cell
b) Erythropoiesis
and RBCs – (12%)
i)
Generates ATP – Embden-Meyerhof
ii) Generates
2,3-DPG – Luebering-Rapoport
iii) Decreased affinity to O2 is associated with – Increased
Temperatire, 2,3-DPG, CO, decreased blood pH
iv) Acanthocyte
– McLeod phenotype, abetalipoproteinemia
v) Bronze
cells – Spherocytes
vi) Codocyte
– Mexican hat cell
vii) Dacryocyte
– Myelofibrosis
viii) Echinocyte
– Burr cell
ix) Horn-like
cell – Keratocyte
x) Stomatocyte
– Rh null
xi) Hemoglobin
synthesis – Polychromatophilic normoblast to reticulocyte
xii) Thalassemia
– Quantitative defect
xiii) Hemoglobinopathy
– Qualitative defect
xiv) Alpha
Thalassemia – Decreased HbA, HbA2, HbF
xv) Beta
Thalassmia – Decreased HbA, increased HbA2, HbF
xvi) Microcytic
- <6µm
xvii)
Chronic blood loss – Microcytic, hypochromic
xviii)
Acute blood loss – Normocytic, normochromic
xix) Aplastic
anemia – Normocytic, normochromic
xx) Major
cause of death in sickle cell anemia – Infectious crises
xxi) Not used
for evaluation of anemia – MCH
xxii)
Not used in actual RBC description –
Hyperchromia
xxiii)
Haptoglobin – To verify in vivo hemolysis
xxiv)
Rouleaux formation is seen in – Conditions that
increase plasma proteins
c) Leukopoiesis
and WBCs – (12%)
i)
Stem cell to blast 5 days. Lifespan in tissue
phase 9-10 days – Granulocytes
ii) Nucleoli
3+, Dark blue to blue cytoplasm, Lacy chromatin pattern – Myeloblast
iii) Primary
granules – Promyelocyte
iv) Stage
which you can identify specific WBC – Myelocyte
v) Kidney
shaped nucleus - Metamyelocyte
vi) Sausage
shaped nucleus – Band
vii) Not
an end stage cell – Monocyte
viii) Not
capable of phagocytosis – Lymphocyte
ix) Pince-nez
– Pelger Huet
x) Sezary
cell – Mycosis fungoides, T-cell, Sezary syndrome
xi) Seen
in 2nd trimester of pregnancy – Neutrophilia
xii) Diurnal
variation is observed in – Neutrophil (decreased in AM, increased in PM)
xiii) Leukemia
without maturation – M1
xiv) M2 – Most
common AML
xv) M3
– DIC
xvi) M5 –
Schilling’s Leukemia
xvii)
Granulocyte – Specific esterase positive
xviii)
Differentiate Acute Monocytic Leukemia from ALL
– Myeloperoxidase
xix) Differentiate
Acute Myelomonocytic Leukemia from ALL - SBB
xx) Absence
of Philadelphia chromosome – Poor prognosis of disease
xxi) Philadelphia
chromosome (+) – Chronic Myelogenous Leukemia
d) Thrombopoiesis
and Platelets – (10%)
i)
Stem cell to blast 5 days. Lifespan 8-11 days –
Platelets
ii) Nuclei
with demarcating membrane – Promegakaryocyte
iii) Platelet
– 8-20/field
iv) Clot
retraction – Function of platelets
v) Outer
surface – Glycocalyx
vi) Platelet
adhesion – vWF, gpIb
vii) Platelet
aggregation – Fibrinogen, gpIIb-IIIa
viii) Aspirin
– inhibit cyclooxygenase
ix) ADAMTS13
– cleaves vWF
x) Platelet
alpha and dense granules, mitochondria – Organelle zone
xi) Platelet
Factor 3 – Phospholipid
xii) Alpha
granule disorder – Gray platelets
xiii) Dense
granule disorder – Storage pool
xiv) Platelet
retention in multiple myeloma - Reduced
4) Coagulation
(Principles, Procedures, Diseases/Disorders and Reference Values) – (20%)
a) Hemostasis
– Theories/Concepts, Mechanisms – (2%)
i)
NV of template bleeding time – 2-8mins
ii) Screening
test for secondary hemostasis – Clotting time
iii) Principal
enzyme involved in fibrinolysis - Plasmin
b) Coagulation
procedures/tests – (8%)
i)
Stypven time – Common pathway
ii) Duckert’s
Test – Factor 13
iii) Unaffected
by heparin therapy – Reptilase time
iv) Prekallikrein
is detected through – APTT
v) Effect
of Kaolin to APTT – Decreased/Shortened APTT
vi) D-dimer
test positive after – 4hrs
vii) Euglobulin
clot lysis time – Screening test for fibrinolysis
viii) Electromechanical
– Fibrometer
c) Coagulation
factors, diseases/disorders & reference values – (10%)
i)
Required in all pathways – Factor 4
ii) Factor
3 – Tissue thromboplastin
iii) Activates
extrinsic pathway – Tissue thromboplastin
iv) Prothrombin
group – Vitamin K dependent
v) Factor
consumed during coagulation – Thrombin group
vi) Factors
that deteriorate at room temperature – 5,8
vii) Factors
that are activated at cold temperature – 7,11
viii) Barium
Sulfate – absorbs prothrombin group
ix) Coumarin
– prolong prothrombin time
x) Protamine
sulfate – reverses heparin overdose
xi) Ecchymosis
– Deficiency in platelets
xii) Asymptomatic
patient suspected having coagulation disorder – test APTT
xiii) DIC
– Fibrinogen decrease 4-24hrs, platelet decrease 48hrs
5) Quality
assurance – (5%)
Immunology, Serology and Blood Banking
1) Immunology/Serology
– (50%)
a) Historical
background – (2%)
i)
T-cell receptor gene – 1984
ii) Pope
Innocent VII – First patient to be transfused
iii) First
HTR – Pope Innocent VII
iv) Cook
carrier of typhoid – Mary Mallon
v) Antibody
structure – Susumu Tonegawa
b) Natural
(innate) immunity, including role of macrophages, monocytes and granulocytes –
(5%)
i)
Function of normal flora of skin – barrier
against microorganisms
ii) NK
Cells – Innate immunity
iii) Most
effective antigen presenting cell – Dendritic cell
c) Acquired
immunity – humoral responses, immunogens, immunoglobulins, B cells – (8%)
i)
% of B cells in circulation – 20%
ii) IgD
– Ig on surface of B-cell
iii) Antibody
binding site - Paratope
iv) Binding
strength of antibody for an antigen – Avidity
v) Fixes
complement – IgM
vi) Pentamer
– IgM
vii) Antibody
in secretions - IgA
viii) Region
of Ig that determines whether an immunoglobulin can fix complement – CH2
ix) Papain
– Fab,Fab,Fc
x) Pepsin
– F(ab)2, Fc
d) Acquired
immunity – cellular responses, T cells, cytokines and chemokines – (5%)
i)
Major composition of important lymphocytes – T
cells
ii) Stimulates
transformation of B-cell into plasma cell – T-helper cell
iii) CD2
– Receptor for sheep RBC
iv) CD8
– Cytotoxic T-cell
v) IL
1 – Fever
vi) IL
6 - CRP
vii) Interleukin
8 – Pro-inflammatory cytokine
e) Complement
System – (2%)
i)
Lectin pathway starts with – MBP
ii) Complement
component with largest molecular weight – C1qrs stabilized with Ca
iii) Membrane
Attack Complex – C5b6789
iv) C1
deficiency – SLE like disease
v) C9
deficiency – No know disease association
vi) Complement
fragments measured in – Nephelometry, RID
f) MHC,
HLA and Transplantation – (3%)
i)
HLA class where most autoimmune diseases occur –
HLA II
ii) HLA
B8 – Myasthenia gravis
iii) HLA
B27 – Ankylosing spondylitis
iv) HLA
DR3 - SLE
g) Immunologic tests for detection of antigens &
antibodies – principles, procedures, interpretation of results – (16%)
i)
Bacterial infections and STD – (5%)
(1) Coagglutination
-Protein A
(2) Widal
test, 25% of red cell is agglutinated graded as – 1+
(3) 10%
treponemes immobilized – Negative
(4) Primary
syphilis - Chancre
(5) Tertiary
syphilis - Gumma
(6) Brucellosis
titer peak – 4-8weeks
ii) Viral
infections, including Hepatitis and HIV – (5%)
(1) Infectious
hepatits marker - HbeAg
(2) Not
included in Hepatits B serologic marker – HbcAg
(3) HCV
RNA – Viral load
(4) Hairy
cell leukemia – HTLV II
(5) HTLV
transmitted through – Blood, sperm
iii) Fungal
infections – (1%)
iv) Parasitic
infections, including malaria – (2%)
(1) Most
commonly used method in Philippines in testing for malaria – Thick smear
(2) HRP
– Histidine-rich protein
v) Autoimmune
disorders – (3%)
(1) Nature
of Rheumatoid Factor – IgM against Fc portion of IgG
(2) Test
for Rheumatoid Factor – Rose-Waaler Test; Latex Agglutination
(3) Negative
Rheumatoid Factor – Less than 1:40 titer
(4) Diagnosis
of Rheumatoid Arthritis – Rheumatoid Factor and CRP
(5) dsDNA
– SLE
(6) Chronic
active hepatitis – Anti-smooth muscle antibody
h) Tumor
Immunology (Tumor markers, Oncoproteins) – (3%)
i)
CA 19-9 – Pancreatic cancer
ii) Nuclear
Matrix Protein – Bladder cancer
iii) Expressed
as tumor and normally present in fetal cells – Oncofetal antigen
i)
Hypersensitivity – (1%)
i)
Type 1 – Allergic reaction
ii) Type
2 – HDN, HTR, AIHA
iii) Serum
sickness – Type 3
iv) Type
4 – TB Skin test
v) Mediator
of Type 4 – T-cells
j)
Instrumentation and quality management – (5%)
i)
PCR – Amplification
ii) Flow
cytometry – Detects surface antigen
iii) Fluorescent
microscope – FTA-ABS
iv) Phase-contrast
microscope – To visualize mixed lymphocytotoxicity
v) Mixed
Lymphocyte Reaction – Cellular assay
2) Blood
Banking – (50%)
a) ABO
and Rh Blood Group Systems – (5%)
i)
Karl Landsteiner – Specificity of Serological
Reactions
ii) ISBT
1 – ABO
iii) ISBT
4 – Rh
iv) ABO
antibodies – IgG, IgM, IgA
v) Least
amount of H antigen – A1B
vi) Bombay
phenotype antibodies – Anti-A, Anti-B, Anti-H
vii) Alteration
of ABO antigen – Cancer of the colon
viii) Most
complex blood group – Rh
b) Other
Major Blood Group Systems: Kell, Duffy, Kidd, Lewis, MNSs, Lutheran, P, I –
(3%)
i)
Anti-I – M. pneumoniae
ii) Anti-i
– Infectious mononucleosis
iii) Blood
type associated with aldomet – Kidd
iv) Anti-M
– Enhanced at pH 6.5
v) Anti-N
– Found in dialysis patient
vi) Anti-S
– causes HDN
c)
Minor Blood Group
Sustems: Diego, Cartwright, Chido, XG, Scianna, Gerbich, Milton, Knops, Bg,
Indian, etc. – (1%)
i)
Blood group associated with HLA – Bg
ii) C4
Complement – Chido-Rogers
iii) Diego
– Southeast Asian ovalocytosis
iv) Anti-Crom
– Found in blacks
d) Basic
Genetics – (5%)
i)
Private antigens – Low incidence antigen
ii) Public
antigens – High incidence antigen
iii) Type
1 chain precursor – Beta 1-3 linkage
iv) Type
2 chain precursor – Beta 1-4 linkage
v) L-Fucose
- H
e) Blood
donor selection and processing – (5%)
i)
Rubeola – 2 week deferral
ii) Malaria
deferral – 3 year
iii) Malaria
deferral if donor went to endemic area for vacation – 1 year
iv) Influenza
vaccine - Not a cause for deferral
v) Jaundiced
at birth – No deferral
vi) Human
growth hormone – Permanent deferral
f) Blood
preservation and banking – (5%)
i)
Blood bag to anticoagulant ratio – 7:1
ii) Citrate
in ACD function as – Anticoagulant
iii) Phosphate
in CPDA-1 function as – 2-3 DPG (Phosphate function as source of ATP in CPD)
iv) Adenine
in CPDA-1 – ATP, Important for red cell survival
v) CPD-A1
– 35 days
vi) SAG-M
– 42 days
vii) Rejuvesol
- PIGPA
g) Component
preparation – (5%)
i)
RBC utilizing the open-system should be issued
within – 24hrs
ii) Leukopoor
RBC – Filtration, Washing and Centrifuge
iii) Amount
of proteins in FFP – 6g/dl
iv) Fibrin
glue – Thrombin and cryoprecipitate
v) Components
of cryoprecipitate – Factor 1, 8, 13, vWF
vi) Cobalt60,
Cesium137 = Irradiation of blood components
vii) High
glycerol – 40%, slow freezing
viii) Low
glycerol – 20%, rapid freezing
h) Transfusion
therapy – (2%)
i)
Blood component
given to patient who are unresponsive to antibiotics – Leukocyte concentrate
ii) Indication
for neocyte transfusion – Thalassemia
iii) Hemophilia
B – Factor IX concentrate
iv) Increased
blood units transfused – Decreased platelet
v) Crystalloid
– Give if no available O Rh negative blood
i)
Transfusion reactions – (3%)
i)
Tubes needed for the investigation of
post-transfusion reaction – Red and purple top
ii) Transfusion
reaction with 1˚C rise in temperature – Febrile transfusion reaction
iii) TRALI
– Transfusion-Related Acute Lung Injury
iv) TACO
– Iatrogenic transfusion reaction
j)
Transfusion-transmitted diseases – (3%)
i)
Y. enterocolitica – Most common blood bag
contaminant
ii) Malaria
screening – for Asian countries only
iii) T.
pallidum – killed by refrigeration of stored blood
k) BB techniques and procedures: typing, compatibility
testing, antibody detection and identification – (8%)
i)
Immediate spin – 20s
ii) Replacement
for minor crossmatch – Antibody screen
iii) Washing
of cord blood – 6-8 times with NSS
iv) Anti-A,
Anti-B color – Blue, Yellow
v) Specimen
for DAT – Whole blood with EDTA
vi) Acquired
B phenomenon – Forward like AB, Reverse like A
vii) Post
zone – Antigen excess
viii) Prozone
– Antibody excess
ix) Prozone
remedy - Dilution
l)
Hemolytic Disease of the Newborn (HDN) and
Auto-immune Hemolytic Anemia – (4%)
i)
Immunoglobulin that causes HDN – IgG
ii) Blood
given to patient with HDN – O Rh negative
iii) DAT
positive – AIHA, HDN, HTR
m) Quality
management (structure, set-up/equipment, Laboratory Information System/LIS) –
(4%)
i)
Blood Bank lab refrigerator temperature is
monitored every – Shift
ii) Gel
technology – Standardization
iii) Gel
card – 10mins centrifugation
Histotechniques, Medical
Technology Laws and Ethics
1. Histopathology
– (65%)
a. Histology
and Pathology – (10%)
i.
Terminologies – (4%)
1.
Pathos – Suffering
2.
STAT – Statim
3.
ASAP – As soon as possible
4.
Inflammation – ends with “itis”
5.
Pyknosis – Condensation of chromatin
6.
Karyorrhexis – Fragmentation of nucleus
7.
Karyolysis – Dissolution of nuclear structures
8.
CT that forms the
framework of BM, endocrine and all lymphoid organs – Reticular CT
9.
Peyer’s patches – Ileum
10.
Part of esophagus with smooth muscle – Lower
half
ii.
Etiology of disease – (2%)
1.
Epithelial tissue origin – Carcinoma
2.
Connective tissue origin - Sarcoma
iii.
Signs, symptoms and course of disease – (2%)
1.
Sign – Observable in patient
2.
Symptom – Only patient feels
3.
Jaundice – Sign
4.
Dysuria – Symptom
5.
Tinnitus - Symptom
iv.
Cellular and tissue changes – (2%)
1.
Aplasia – incomplete or defective development of
a tissue
2.
Agenesia – nonappearance of an organ
3.
Hypoplasia – failure to reach maturity
4.
Atresia – failure of organ to form an opening
5.
Atrophy – decreased size of an organ
6.
Hypertrophy – increase in size of tissue due to
increase in size of cell
7.
Hyperplasia – increase in size of tissue due to
increase in number of cell
8.
Metaplasia – Reversible change
9.
Apoptosis – Programmed cell death
10.
Heart – Coagulative necrosis
b. Histopathologic
techniques and procedures – (35%)
i.
Preservation and handling of specimen – (10%)
1.
Most critical step – Fixation
2.
Optimum fixation volume – 20 times to that of
tissue volume
3.
Formalin fixes tissue by – forming cross link
4.
Glutaraldehyde – 2 formaldehyde residues linked
by 3 carbon chains
5.
10%
methanol to formaldehyde – Unsuitable for EM, prevent decomposition to formic
acid or precipitation to paraformaldehyde
6.
Picric acid – Small tissues
7.
Picric acid fixatives -Bouin, Brasil
8.
Mercurial Fixative – Tissue photography
9.
Newcomer’s fixative – Nuclear and histochemical
fixative
10.
Fixative for electron microscopy –
Glutaraldehyde, osmium tetroxide
ii.
Tissue processing and procedures – (15%)
1.
Routine – Manual – (7%)
a.
Routine decalcifying agent – Nitric acid
b.
To avoid
yellowing/blackening of tissue prior to decalcification – Add urea to nitric
acid
c.
Perenyi’s fluid – Decalcifier, tissue softener
d.
Von Ebner – NaCl, HCl, H2O
(decalcifying agent)
e.
Milky, turbid xylene – Incomplete dehydration
f.
Chloroform – Nervous tissues, lymph nodes and
embryo
g.
Double embedding – Celloidin and paraffin
h.
Sectioning – cutting into uniformly thin slices
i.
Simplest microtome – Rocking
j.
Most common microtome – Rotary
k.
Most dangerous microtome - Sliding
l.
Sliding microtome – Adams
m.
Freezing microtome - Queckett
n.
Routine paraffin examination – Biconcave knife
o.
Plane concave knife – Celloidin
p.
Plane wedge – Frozen, hard specimen
q.
Thickness of tissue section, Paraffin – 4-6µ
r.
Process of removing burrs – Stropping
s.
Dull knife free of nicks maybe sharpened by –
Stropping
t.
Refractive index of glass – 1.518
2.
Routine – Automation – (5%)
a.
Vacuum embedding – Rapid
b.
Autotechnicon – Fixation up to infiltration
3.
Special – Frozen section, Microwave – (3%)
a.
Cryostat contains – Rotary microtome
b.
Embedding medium for electron microscopy -
Plastic
c.
EPON – EM
d.
Commonly used freezing agent – Liquid nitrogen
e.
Temperature of liquid nitrogen - -160 to -180
degrees C
f.
Dehydrating agent
and temperature used for freeze-substitution – Absolute alcohol @ RT, acetone @
-70 degrees C
g.
Advantage of freeze-drying – minimum tissue
shrinkage, allow tissue to be processed fresh, less displacement
iii.
Staining – (10%)
1.
Routine – (5%)
a.
Color not permanent – Chromogen
b.
Selective removal of stains – Differentiation
c.
PAS – Basement membrane
d.
Alkaline fast green – Green
e.
Orcein – Elastic fibers
f.
Gomori’s silver impregnation – Reticulin fibers
g.
Methyl green – RNA
h.
Feulgen – DNA
i.
Cytoplasm of cells - Pink
2.
Special (Immunohistochemistry) – (5%)
a.
Tissues are
studied through chemical reaction – Histochemical staining
b.
Immunohistochemical
techniques – Identification of cellular epitopes or antigens
c. Cytological
techniques and procedures – (8%)
i.
Preservation and handling of specimen – (2%)
1.
Diagnostic cytology – Exfoliative, FNAB,
thoracentesis, lumbar tap
2.
Exfoliative
cytology – detection of malignancy, infectious agents, genetic sex
3.
T zone – Endocervical and ectocervical junction
4.
Lateral vaginal smear – Hormonal evaluation
5.
GI submucosal sample – Fine needle aspirate
6.
Heparin – 300 units per 100ml
ii.
Processing – (4%)
1.
Manual – (2%)
a.
To obtain optimum
cell yield, the volume of sample to be centrifuged must be – 20-30cc
b.
Ringing – sealing of margins to prevent escape
of fluid
2.
Automation – (2%)
iii.
Staining – (2%)
1.
Nuclear counterstain – Hematoxylin, carmine, MB,
toluidine blue
2.
Commonly used nuclear counterstain – Hematoxylin
3.
Not a metallic mordant - Iodine
4.
EA 50 stains – Cytoplasm of immature cells
5.
OG6 stains – Cytoplasm of mature cells
d. Autopsy
– (2%)
i.
Terminologies – (1%)
1.
First to perform autopsy – Giovanni Morgagni
2.
Prosector – Pathologist
3.
Rokitansky – In situ dissection
ii.
Handling, processing and documentation – (1%)
e. Quality
assurance – (10%)
2. MT
Laws, Related Laws and Code of Ethics – (35%)
a. MT
Laws – (10%)
i.
Section 6 – Minimum required course
ii.
Section 27 – Foreign reciprocity
iii.
Removal of board members - President
iv.
Grade for medical laboratory technician –
70-74.9%
v.
Issuance of MT license – 21yrs old
vi.
COR signatories – PRC Commissioner and Board of
MT
vii.
Renewal of license – Every 3 years
viii.
60 CPE units – Renewal of license
ix.
1 CPE unit – 10 contact hours
x.
If RMT will not renew license in 5 years –
Removal from roster
xi.
Suspension – 2/3 votes
xii.
Revocation – 3 votes
xiii.
Appeal to – Civil Service Commission
b. Laboratory
Management – (10%)
i.
Direct costs – expenses that can easily be traced
directly to an end product
ii.
Indirect costs example – Labor to supervise
performance of test, QC
c. Related
Laws – (10%)
i.
PD 1534 – Amended sections 3,8 and 14
ii.
E.O. 266 – CPE
iii.
PRC Resolution 323 – Policies on admission of
foreigners
iv.
Father of PAMET – Crisanto Almario
v.
RA 9288 – Newborn Screening Act
vi.
PKU – Guthrie’s test
vii.
RA 4688 - Clinical Laboratory Law
viii.
Clinical laboratory – inspected every 2 years
ix.
Blood banks – inspected yearly
x.
Crossmatching can be done on – Secondary and
Tertiary labs
xi.
RA 8981 – PRC Modernization Act of 2000
xii.
PRC consists of – Chairman and two associates
xiii.
PRC Chairman – Florentino C. Doble
xiv.
NRL Drugs – EAMC
xv.
NRL Hematology – NKTI
xvi.
Radioactive wastes – PNRI and DENR
d. Code
of Ethics including Bioethics – (5%)
i.
Code of Ethics – Moraleta
ii.
Improper language to co-worker is a violation of
– “restrict my praises etc.”
iii.
First line in oath taking – Name and address
iv.
Last line in oath taking - Diyos
v.
Violation – report to PAMET
