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CONSTRUCTION OF A COMPREHENSIVE EXAMINATION
FOR MEDICAL TECHNOLOGISTS

By

Jennifer Paver Griffin

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

Department of Pathology

1982

ABSTRACT

CONSTRUCTION OF A COMPREHENSIVE EXAMINATION
FOR MEDICAL TECHNOLOGISTS

By

Jennifer Paver Griffin

A ZOO-item examination is the culmination of the certi-
fying process for medical technologists. It is a compre-
hensive, criterion-referenced examination covering the
disciplines of hematology, chemistry, immunohematology,
microbiology, body fluid analysis, nuclear medicine and
laboratory practice.

Possession of professional certification by an individual
is often a deciding factor in decisions regarding employment
acquisition, salary and Opportunities for advancement. The
degree to which an individual represents his professional
competence on a certifying examination can, therefore, pro-
foundly affect his professional future.

A comprehensive examination taken before any certifica-
tion examination would enable an individual to identify his
weaknesses with an opportunity for remediation. The
Michigan State University Comprehensive Examination (MSU-CE)
for medical technologists was developed to give career-

entry medical technologists an Opportunity to assess their

Jennifer Paver Griffin

professional strengths and weaknesses. The exam is of similar
content and format as the medical technology certifying
examinations. Objectives and items for the examination were

contributed by education coordinators and instructors in

clinical schools of medical technology.

TABLE OF CONTENTS

INTRODUCTION .

A REVIEW OF THE LITERATURE
PROCEDURE.

RESULTS.

SUMMARY.

APPENDIX .

REFERENCES .

VITA .

ii

Page

13
21
30
33
74
77

Table

LIST OF TABLES

Frequency distribution of scores.

Summary of MSU-CE statistics (examinees:
graduates of clinical programs)

Item analyses . . . . . . . . .

Performance report by content area.

Comparison of statistics by examinee group.

iii

Page
24

25
26
28
29

LIST OF FIGURES

Figure Page
1 An example of the examination content grid. . . l6
2 Examinee report form, Michigan State Univer-
sity 1980 Comprehensive Examination Results . . 19
3 Education coordinator report form, Michigan
State University 1980 Comprehensive Examina-
tion Results. . . . . . . . . . . . . . . . . . 20

iv

INTRODUCTION

To a wide range of professions the credentialing
process has become a time-honored tradition. Litigations
for malpractice have become so commonplace that many look
upon professional certification as a defense mechanism
against defamations of an entire profession. Consumers and
representatives of the "public interest" look upon certifi-
cation as a protective mechanism against malpractice.
Regardless of their point of view, few pe0ple today question
the need for assessments of educational and technical
achievement.

Standards of achievement and function for individuals
in the clinical laboratory sciences have not been nationally
formalized or coordinated by any specific agency (Wells,
1977). Five distinctcredentialing agencies are in the
business of certifying medical technologists. Each agency
has established educational and experiential criteria and
standards for certification. Once an individual's eligibility
has been determined, he must sit for and pass an examination
before the agency formally recognizes his professional
competence.

Medical technologists trained in accredited hospital-

based programs are most often certified by either (or both)

2
the American Society of Clinical Pathologists (ASCP) or the
National Certification Agency for Medical Laboratory
Personnel (NCA). Both agencies have stringent eligibility
requirements that must be fulfilled before an individual can
sit for a certification examination. Certification is
awarded to all individuals attaining a passing score on the
examination. Both tests are criterion-referenced tests;
they reflect the knowledge and skills required of a compe-
tent career-entry medical technologist.

Possession of professional certification by an individual
is often a deciding factor in decisions regarding employment
acquisition, salary and opportunities for advancement.
Although the eligibility requirements vary among the 5
credentialing agencies, laboratory directors prefer to employ
medical technologists with than without any certification.
Therefore, the degree to which an individual represents his
proficiency on a certifying examination can profoundly
affect his professional future.

Michigan State University (MSU) provides the academic
background for roughly one-third of the medical technologists
in accredited clinical training programs. As part of their
commitment to the profession, the School of Medical Technology
sponsored the deve10pment of the MSU Comprehensive Examina-
tion (MSU-CE) to give career-entry medical technologists an
opportunity to assess their professional strengths and
weaknesses before sitting for a certification examination.

To make the experience as authentic as possible, the MSU-CE

was modelled, in content and format, after the ASCP

3
certification exam (ASCP-CE) and the NCA certification exam
(NCA-CE). It is a criterion-referenced test in that it
reflects specified knowledge and skills required of a

competent career-entry medical technologist.

A REVIEW OF THE LITERATURE

Public accountability in the health professions requires
certification that individuals meet the performance criteria
essential to quality care. A written proficiency examination
is one method for appraisal of minimum basic knowledge and
skill competencies.

Demonstration of clinical competence is a function of
two factors: 1) prerequisite knowledge and 2) ability to
perform in a complex situation (Morgan and Irby, 1978, p.
60). Throughout the course of clinical training in medical
technology, both factors are assessed repeatedly. Observa-
tional assessments of performances in response to specified
stimuli can be complex, expensive and time-consuming. For
these reasons, appraisal of competence based upon clinical
performance is not a part of the certification process
performed by medical technology credentialing agencies. In
lieu of observational assessments, credentialing agencies
have experiential and/or training requirements for all
applicants. An evaluation of prerequisite knowledge, however,
is a comparatively easy task and is one of the determining
factors in the conferral of medical technology certification.

According to the American Society for Medical Technology

(ASMT), five credentialing agencies offer certification in

5
the generalist category for medical laboratory personnel
(ASMT, 1977): 1) American Medical Technologists (AMT),
2) American Society of Clinical Pathologists (ASCP),
3) International Society for Clinical Laboratory Technology
(ISCLT), 4) National Certification Agency for Medical
Laboratory Personnel (NCA) and 5) United States Department
of Health, Education and Welfare (HEW). In a report of
medical technology credentialing agencies at the 1979 ASMT
National Convention, the first four of these five groups
were represented. At this meeting, the educational and
experiential requirements were given for each agency
(Blume, 1979). In addition to varied experiential prerequi-
sites, all four agencies examine applicants for prerequisite
knowledge using a multidisciplinary test composed of
multiple-choice items. A "passing" score on their respective
credentialing examination is required for certification.
Three of these agencies utilize criterion-referenced measure-
ments in that the items reflect clearly defined competency
statements. The NCA further utilizes criterion-referenced
test score interpretation (NCA, 1979).

There are two basic approaches to evaluation of
cognitive achievement: norm-referenced measurement and
criterion-referenced measurement. Copious literature has
been generated surrounding the two approaches; almost any
text on educational evaluation will discuss the pros and cons
and describe the on-going debate of their appropriate usage.
Clear definitions of the two methods have emerged regarding

the interpretation of the test scores. Criterion-referenced

6
interpretation relates the individual performance to a
predetermined standard of proficiency, while norm-referenced
interpretation relates the individual performance to the
performance of his test group. It is basically a difference
between absolute status (criterion-referenced) and relative
status (norm-referenced) (Glaser, 1963).

Norm-referencing in the certification process has been
criticized because the ability of the test group, as opposed
to competency standards, determines acceptable performance.
It discriminates against the individual who fails an examina-
tion simply because he was tested in a superior group of
examinees. Likewise, it unjustly rewards an incompetent
individual who passes a test taken with an inferior group
of examinees (NCA, 1979).

Criterion-referenced measurement has consequently come
to be the preferred approach in the certification process,
providing a sounder basis for judging competent individuals.
Wilson (1977) has defined a proficiency examination as a
"criterion-referenced appraisal of the individual's possession
of the performance,knowledge and skill competencies required
to execute the role responsibilities of the given practi-
tioner generic position." She stated that the goal of a
proficiency exam used in the certification process should
be to appraise whether or not the individual should be in
practice, that unfortunately, in 1977, many credentialing
exams in health fields essentially evaluated knowledge

possession only.

7

While eXperts in educational measurement have clearly
identified the differences between criterion-referenced and
norm-referenced test score interpretation, the characteris-
tics of well-constructed exams of both types are less
distinctly contrasted. Popham (1978, p. 184) lists six
key characteristics of a well-made criterion-referenced
test:

1) an unambiguous descriptive scheme

2) an adequate number of items per measured behavior

3) sufficiently limited focus

4) reliability

5) validity

6) comparative test data

The most reliable basis for any well-constructed test
(including norm-referenced) is a set of explicit specifica-
tions which includes the kinds of tasks represented, the
content area sampled, the number and kinds of items to be
used and the level and distribution of item difficulty
(Ebel, 1979, p. 69). These specifications do not differ
markedly from the first two characteristics of a well—
constructed criterion-referenced test. Popham, however,
argues that although developers of norm-referenced tests are
aware of the importance of content consideration, a criterion-
referenced test is designed to produce a clearer description
of what an examinee can and cannot do (1978, p. 90).

Ebel and others have also described the importance of
reliability, validity and comparative test data in all tests.

These statistics are the hallmark, in fact, of norm-

referenced measurement.

8

The procedure for planning a test is described in many
texts (Thorndike and Hagen, 1969; Mehrens and Lehmann,

1973; Ebel, 1979). The first step is identification of the
test domain. For an examination evaluating the proficiency
of a medical technologist, step one requires identifying
appropriate competencies (McPherson, 1979). Many such
lists have been compiled based upon the consensus of pro-
fessionals with recognized expertise and by task analyses
(Beard et al., 1975; Crowley, 1975; Hedrick and Fiene,
1975; ASMT, 1976).

The first attempt to delineate the behaviors required
of a career-entry medical technologist was by the ASMT
(1973). Their position paper, "Differentiation Among MT,

MLT and CLA Expected Capabilities at Career Entry", compared
six categories of functions of three levels of workers per-
forming general laboratory procedures:

1) performing analyses

2) solving problems

3) systems control, organization and communication

4) supervision and management

5) teaching others

6) teaching self (continuing education)

The ASCP developed content guidelines fer their certification
examinations based upon the ASMT position paper (ASCP, 1974).

The ASMT was the first organization to publish detailed
statements of competence for clinical laboratory practitioners
in response to a scrutiny of the credentialing process.

Their "Statements of Competence of Clinical Laboratory

Practitioners" were developed through expert consensus in

1976, and refined in 1978 to represent appropriate

9
competencies for career-entry medical technologists. These
statements were the foundation for the content domain of
the generalist technologist examinations developed under
ASMT sponsorship (Davis, 1978). The NCA purchased the
material developed by the ASMT and used it to construct their
first certifying examination for clinical laboratory
scientists in 1978 (NCA, 1979).

Schumacher et a1. (1978) applied the Professional Per-
formance Situation Model (PPSM) to define competencies for
the medical technology profession. The unique approach of
the PPSM is based upon the viewpoint that the competency of
a professional is determined not only by the knowledge and
skills he possesses, but additionally by an ability to
respond with the appropriate knowledge and skills in a
variety of contexts. Skill and knowledge criteria were
extrapolated from situations describing competent clinical
laboratory practice.

Seibert (1979) developed precise objectives for compe-
tence as it was delineated in ASMT's "Career-Entry Statements
of Competence, Clinical Laboratory Sciences" (1978). "Real-
world" situations under which each of the competencies might
be carried out were established. These circumstances,
including required accuracy and speed, were verified by
career-entry medical technologists and translated into
terminal performance objectives. These objectives were
integrated into a medical technology curriculum and ultimately

used for the basis for competency evaluation.

10

The ISCLT has based the content domain for their certi-
fication examination on task analyses performed by their
management consultants visiting clinical laboratories (Blume,
1979). The degree to which the knowledge domain is required
in the average workday of a medical technologist is reflected
in the content distribution and level of tasks of the test
items.

The next step in test construction is determination
of number and format of the test items.. Test experts are in
general agreement as to how to select and write good test
items. These processes are described in many books on test
construction (Thorndike and Hagen, 1969; Mehrens and Lehmann,
1973; Ebel, 1979). One aspect of the test plan that is diffi-
cult is the number of items required to satisfactorily
evaluate a given behavior, objective or criterion. Popham
(1978, p. 101) suggests that for many educational settings
using criterion-referenced tests, between 10 and 20 items
should be used for each behavioral domain. Other test experts
are not so definitive. Thorndike (1969, p. 45) simply states
that the total number of test items should be large enough
to adequately sample student behavior across content areas
and across levels of cognitive tasks. Ebel (1979, p. 76) and
Mehrens and Lehmann (1978, p. 192) agree that no clear-cut
formula exists, that the number of test items is determined
by a number of factors, including the amount of time
available, the purpose of the test and the format of the
items included. All four experts agree that because of

better sampling, the longer the examination, the more reliable

11
the test and the scores obtained from it. The medical tech-
nology certifying exams are composed of approximately 200
multiple-choice items, and generally four hours are allowed
for completion of the test.

The Department of Medical Technology at Wayne State
University (WSU) has developed a comprehensive examination
for students completing clinical training in medical tech-
nology. The purpose of the ZOO-item test is to provide the
students with an opportunity to assess their preparedness
for a certifying exam. The test is not criterion-referenced,
nor have formal objectives been developed. In lieu of
reliance upon objectives, WSU utilizes the content outlines
and test blueprints that have been published for the ASCP
certification examination (Garza, 1981). The item pool has
been developed primarily from contributions made by the
education coordinators of training programs whose students
take the exam; test developers at WSU have the occasional
responsibility of rewording an item or altering its format.
Examinees are directly notified of their total score and
scores in each of the constituent disciplines: bacteriology,
virology, mycology, parasitology, chemistry, immunohematology,
serology, urinalysis, nuclear medicine and hematology.
Students are additionally given the minimum passing score,
the average score of the exam, the total number of items in
each discipline and the range of correct responses for each
of the disciplines. Provided with these data, the student
can identify content areas in need of additional or remedial

study.

12

The Medical Technology Program at the University of
Iowa (U of I) has implemented a computer assisted test
assembly (CATA) system to produce a comprehensive examination
for students at the completion of clinical training (Gleich,
’1979). The 200 multiple-choice items that comprise the test
are retrieved from the computer test item bank at the U of
1. Each item is encoded with a nine-character identifier
which is based on objectives categorized into general,
intermediate and specific levels. Among the advantages of
the CATA system are 1) the conservation of faculty time
otherwise devoted to compiling and correcting the test,

2) conservation of secretarial time otherwise required for
typing and reproduction of a test, 3) ready availability of
item analyses and other test statistics, 4) the computer

can randomly select items to fit test Specifications,

5) availability of item pool to other health care disciplines
for test deve10pment and 6) evaluation is directly correlated
to instructional objectives. One important application of
the CATA system is its potential use for—diagnosing learning
difficulty. A student can take the test on a computer
terminal and have his deficiencies readily identified and,

by coded references, generate appropriate study aids for
remedial assistance.

Encouraged by the abundant literature written about test
deve10pment and prompted by a need for such an assessment
tool, this project was undertaken to provide those medical
technology students in areas not served by WSU with an Oppor-

tunity to evaluate their readiness for a certifying examination.

PROCEDURE

The first step in the construction of a criterion-
referenced test is to identify and specify the competencies
or domain that will be evaluated. A few lists of competen-
cies for the medical technology profession have been published.
These behaviors have been identified by task analyses and
through the consensus of practitioners with recognized
expertise. The "Career-Entry Statements of Competence,
Clinical Laboratory Sciences" (ASMT, 1978) were used in the
development of the MSU-CE. The competencies described in
these statements are general but suitable for use in construc-
tion of this test.

The second step in the construction of a criterion-
referenced test is to develop objectives for learning from
the Specified competencies. In competency-based education,
learning objectives specify what it is that the learner must
know or do (the criterion),tfluaconditions under which the
knowledge or skill must be demonstrated, and how well the
learner must demonstrate the knowledge or skill (standard of
performance). In developing the MSU-CE three assumptions
with respect to objectives were made:

1) that the examinee will be required to demonstrate
cognitive skills only (refers to the criterion)

13

l4

2) that the examinee will be evaluated by means of a
paper-and-pencil test composed of multiple-ch01ce
items (refers to the conditions under which the
knowledge must be demonstrated)

3) that no judgment of competence will be made on the
basis of this test; the MSU-CE is a self-assessment
tool (refers to the standard of performance).

Based on these assumptions, development of formal learner
objectives was by-passed.

The next step was to specify the cognitive criteria and
the levels of learning. The ASCP has published the cognitive
criteria and levels of learning, in blueprint or "grid"
format, that are tested by their medical technology certi-
fying exam (ASCP, 1974). Since the MSU-CE was intended to
be an assessment tool resembling an actual certifying exam,
all test items were selected based upon the criteria and
levels of learning Specified on the ASCP examination grid.

The major content areas in the MSU-CE (as well as the

ASCP-CB) were:

1) Microbiology (including parasitology, mycology,
virology and bacteriology)

2) Immunology (including serology and immunohematology)
3) Hematology (including coagulation)
4) Chemistry
5) Miscellaneous TOpiCS (including urinalysis, body
fluids, analytical principles, management, education,
and research and deve10pment).
Each major content area was further divided into the components
of the discipline. The content outline is seen on the vertical
axis of the grid. The horizontal axis shows the levels of

learning, which were taken from Bloom's hierarchy of the

cognitive domain (Bloom, 1967). The numbers 1, 2, 3, 4 and

15
6 correspond respectively to Bloom's designations of
knowledge, comprehension, application, analysis and evalua-
tion. The numbers seen in the cells at the intersections
of subject and level of learning represent the range of the
number of items that could possibly appear on the exam.
Figure l is an example of the grid. Utilization of the
grid insured a fair balance of test items with regard to
subject and level of learning.

All test items included in the MSU-CE were in the
multiple-choice format. This is the format used in the
ASCP-CE and the NCA-CE. The item pool consisted of items
submitted by:

l) the education coordinators of hospital-based
medical technology programs

2) experts in each content area

3) the author of the MSU-CE.
All test items were first reviewed for item quality, gramma-
tical structure, conciseness, clarity, general appearance,
quality of distracters, accuracy, completeness and freedom
from unintentional clues. Each item was matched to the exam
grid based on both cognitive criterion and level of learning.
Items that did not match any of the cognitive criteria were
discarded. A preliminary selection of test items was made,
using the grid as a guide for content distribution.

These preliminary test items were subject to further
review by at least two experts in each content area. These
experts verified accuracy, completeness and freedom from

unintentional clues. They were also asked to comment upon

16

 

 

 

 

 

 

 

 

 

 

Medical Technologist
Taxonomy Levels
8-15
1. Erythrocytes 1 2 3 4 6
A. Formation 0-1 0-1 0-1 0-1 0-1
1. Bone marrow 0-1 0-1 0-1 0-1 0-1
2. Liver 0-1 0-1 0-1 0-1 0-1
3. Spleen 0-1 0-1 0-1 0-1 0-1
4. Kidney 0-1 0.1 0.1 0.1 0-1‘
5 Endocnne glands 0-1 0-1 0-1 0-1 0-1
, 8. Function 0-1 0-1 0-1 01 01
C. Collection 01 0.1
1. Antlcoagulants 0-1 0-1
2. Venous 0-1 0-1
3. Capillary 0.1 0.1
4. Bone marrow 0-1 0.1
5. Specsal handling 0-1 0.1
D. Enumerative Procedures 01 0-1 0.1 0.1 0-1
1. Manual count 0-1 0-1 0-1
2 Automated count 0-1 0.1 0.1 0.1 0.1
3. RetnCUlocyte 0-1 0-1 0-1 0-1 0-1
4. Ind.ces 0.1 0.1 0.1
5 Correlation of mm“; 0-1 0-1 0-1 0-1
6 Quality control 0-1 0-1 0-1 0-1 0-1
E. Basic tests 02 0-2 0-2 0-2 0-2
1. Sedrmentel-on rate 0-1
2. Hematocnt 0-1
3. Fragllrty 0-1 0-1 O-l 0-1 0-1
4 Sickle cell 0-1 0-1 0-1 0-1 0-1
5 Herveylobin 0-1 0-1 0-1 0-1 0-1
6 Hevnz bodies 0-1 0-1 0-1 0-1 0-1
7 Sugar water test 0.1 0.1 0.1 0.1 0.1
8 Hart‘- l~ 1' 0-1 0-1 0-1 0-1 0-1
9 H‘JmOQiubln electroplioreSIs 0.1 0.1 0.1 0.1 0.1
1': Correlation of (BSUHS 0-2 0.2 0.2 0.2 0.2
‘ Quality c-eri q-t 0.1 0.1 0.1 0-1

 

 

 

 

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Figure 1. An example of the examination content grid.

17

the suitability of each item for career-entry medical tech-
nologists. An expert in educational measurement reviewed
all preliminary test items for grammatical structure, con-
ciseness, clarity, quality of distracters and general
appearance. A medical technologist in the first year of
her career reviewed the preliminary items for their suitability
in preparing for certification exams.

The 200 items surviving the above critiques comprised
the MSU-CE as it was administered to the graduates of 16
hospital-based medical technology programs. Sealed packets,
each containing one examination, one answer sheet and
instructions, were mailed to the education coordinators to
be given to their students upon completion of their clinical
training. The conditions under which the graduates took the
test were to be strictly controlled; four undisturbed hours
were to be allotted in a comfortable, well-lighted, well-
ventilated room. To protect the security of the exam, a
proctor was to be present during the entire test period.

Upon completion of the MSU-CE, all test copies and
answer sheets, again in a sealed packet, were returned to
MSU for scoring. They were scored by computer scanning and
reports were generated using the F1600 program. The obtained
scores were not corrected for guessing. All items were
weighted equally. Each examinee received a report of his
performance in each content area and on the total test. A
report was sent to each participating education coordinator
which gave the scores in each content area and on the total

test for all of his graduates. The report forms are

18
illustrated in Figures 2 and 3. All reports included the
range of scores "to date" for each content area and the
total test. AS the MSU-CE was a self-assessment tool, a

minimum passing score was not determined.

19

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RESULTS

One hundred thirty-four career-entry medical technolo-
gists took the ZOO-item MSU-CE. Table 1 Shows the distribution
of the test scores. Table 2 summarizes pertinent exam
statistics. The performances of the examinees on each item
(item analyses) and in each content area are shown in Tables
3 and 4, respectively.

The indices of difficulty for the 200 items ranged from
one to 95 percent. Fifty percent of the indices were between
17 and 64 percent; one-half of the difficulty indices were
greater than 50 percent, indicating that the exam was diffi-
cult. The difficulty is most likely related to the variance
in program curricula. The items submitted by education
coordinators may have been "fair" to students of some programs
yet "unfair" to students of other programs in which the item
content was omitted or unemphasized. Many of the items with
a high index of difficulty were of high taxonomic level in
Bloom's hierarchy of the cognitive domain.

The indices of discrimination ranged from -.20 to .51.
Items with a negative discriminating power (less than 0.00)
were items numbered 9, 20, 21, 24, 27, 32, 42, 48, 51, 57,
68, 84, 117, 142, 147, 165, 173 and 184. A review of the
quality of these items revealed that the majority could be
improved by wording or diagrammatic changes (reducing

21

22
ambiguity). A few were extremely difficult (index of
difficulty >60 percent). Item number 32 was miskeyed.

Many attempts, both 10gical and empirical, were made
to demonstrate the validity of the MSU-CE. Content validity
is an inherent feature of a prOperly constructed criterion-
referenced test; congruity between test items and cognitive
criteria or objectives is the premise of criterion-
referenced tests. The MSU-CE was a criterion-referenced
test in that it was a reflection of the professional expec-
tations at career entry, as defined in ASMT's "Career-Entry
Statements of Competence, Clinical Laboratory Sciences."

In addition, all test items were matched by cognitive
criteria and level of learning to the ASCP-CE grid which
is based upon ASMT's "Differentiation Among MT, MLT, and
CLA Expected Capabilities at Career Entry."

In order to demonstrate that the domain of knowledge
tested was unique to the target population (career-entry
medical technologists), the MSU-CE was administered to 22
June 1980 graduates of MSU'S undergraduate medical technology
program. These individuals had not yet begun their clinical
training; otherwise, the two groups of examinees were very
similar. A comparison of the exam statistics for the two
groups is seen in Table 5. Two notable differences are in
the mean scores and the reliability coefficients. Examinees
who had completed a year of clinical training scored signifi-
cantly higher than those examinees without clinical training.
This difference suggests that clinical training supplies the

knowledge domain necessary for good performance on the MSU-CE.

23

A highly valid test must also be reliable. The relia-
bility coefficients determined with the Kuder-Richardson
formula 21' indicate that the exam had a degree of reliability
with both test groups. However, the degree of test relia-
bility was significantly greater with the career-entry
medical technologists than with the June 1980 graduates.
This suggests that the MSU-CE given after clinical training
has more valid use than if given prior to clinical training.

Correlation coefficients were calculated to determine
the relationship, if any, between the MSU-CE and other
measures of professional competence. The correlation
coefficient between the MSU-CE and the ASCP-CE was 0.81,
and 0.84 between the MSU-CE and the NCA-CE. The scores
used to determine the coefficients of correlation were of
the ASCP-CE administered August 1980 (n=88) and the NCA-CE
administered July 1980 (n=38). These calculations indicate
a strong correlation between the exams, suggesting that the
MSU-CE has a valid use in aiding career-entry medical tech-

nologists who are preparing for these two certifying exams.

Table 1.

Frequency distribution of scores

 

Score

(* represents one examinee)

 

196-200
191-195
186-190
181-185
176-180
171-175
166-170
161-165
156-160
151-155
146-150
141-145
136-140
131-135
126-130
121-125
116-120
111-115
106-110
101-105
96-100
91-95
86-90
81-85
76-80
71-75
66-70
61-65
56-60
51-55
46-50
41-45
36-40
31-35
26-30
21-25
16-20
11-15
6-10
0-5

***

*

***

*******
***********
*****************
****************
**************
********************
***************
************
********

****

*t

*

 

25

Table 2. Summary of MSU-CE statistics (examinees: graduates

of clinical programs)

 

Range of scores

Mean

Median

Standard deviation

Standard error of measurement

Reliability coefficient

80-152
118
117
14.5
6.2
0.82

26

Table 3. Item analyses

 

 

Index of Index of

Item Discrimina- Index of Item Discrimina- Index of

No. tion Difficulty No. tion Difficulty
l .29 44 47 .12 33
2 .29 S4 48 - 02 40
3 .02 38 49 10 7
4 .22 16 50 10 68
5 .07 77 51 - 02 48
6 .27 40 52 07 70
7 .32 28 53 20 17
8 .20 22 S4 41 38
9 -.07 16 55 O7 6
10 .07 48 S6 .34 37
ll 22 50 57 - 02 70
12 34 44 58 41 35
13 20 29 59 15 39
14 15 41 60 32 28
15 17 45 61 07 43
16 20 41 62 46 38
17 27 35 63 44 54
18 39 29 64 27 26
19 00 2 65 02 50
20 - 02 77 66 29 24
21 - 05 12 67 34 61
22 02 13 68 - 15 88
23 17 38 69 07 ll
24 - 02 82 70 l7 16
25 22 40 71 10 20
26 15 73 72 00 10
27 - 20 32 73 20 46
28 34 27 74 29 61
29 24 37 75 12 11
30 10 61 76 17 33
31 10 29 77 07 6
32 - 07 91 78 29 34
33 20 73 79 00 10
34 10 12 80 20 41
35 34 37 81 22 33
36 37 26 82 39 22
37 02 21 83 15 15
38 15 29 84 - 15 78
39 05 76 85 10 73
4O 15 63 86 32 26
41 27 57 87 12 45
42 - 07 96 88 27 48
43 22 26 89 27 18
44 20 56 90 41 33
45 20 15 91 27 57

27

Table 3 (continued)

 

 

Index of _ Index of
Item Discrimina- Index of Item Discrimina- Index of
No. tion Difficulty No. tion Difficulty
93 .44 61 140 .17 9
94 .12 S7 141 .29 41
95 .10 63 142 -.07 79
96 .39 63 143 .07 11
97 .20 46 144 .00 63
98 .10 22 145 .05 88
99 .02 l 146 .22 50
100 .05 83 147 -.20 85
101 .27 26 148 .41 52
102 .29 54 149 .22 18
103 .07 11 150 .00 59
104 .29 27 151 .24 17
105 .22 18 152 .10 7
106 .00 2 153 .44 56
107 .20 44 154 .12 18
108 .32 30 155 .20 51
109 .27 13 156 .39 29
110 .15 12 157 .15 68
111 .37 35 158 .15 41
112 .34 27 159 .15 29
113 .05 37 160 .07 52
114 .32 28 161 .27 50
115 .22 18 162 .34 66
116 .07 26 163 .17 33
117 -.10 56 164 .07 21
118 .34 58 165 -.07 89
119 .12 9 166 .12 62
120 .05 34 167 .05 59
121 .41 38 168 .00 83
122 .05 93 169 .17 62
123 .24 63 170 .24 39
124 .12 23 171 .37 55
125 .02 6 172 .32 50
126 .44 34 173 -.10 51
127 .51 35 174 .22 33
128 .05 66 175 .20 44
129 .15 66 176 .12 40
130 .02 13 177 .20 15
131 .10 37 178 .22 67
132 .12 55 179 .41 67
133 .27 57 180 .32 28
134 .07 6 181 .24 71
135 .00 15 182 .27 33
136 .12 38 183 .22 43
137 .20 46 184 -.20 42
138 .10 24 185 .10 59

139 .05 66 186 .12 65

28

Table 3 (continued)

 

 

Index of Index of
Item Discrimina- Index of Item Discrimina- Index of
No. tion Difficulty No. tion Difficulty
187 .27 50 194 .46 52
188 .15 20 195 .10 S4
189 .22 21 196 .12 77
190 .20 63 197 .12 18
191 .34 41 198 .02 6
192 .20 15 199 .24 17
193 .07 74 200 .10 71

 

Table 4. Performance report by content area

 

 

. Number of Range of Average
Content Area Items Scores Score
Bacteriology 26 7-24 16.1
Virology 2 0-2 1.0
Parasitology 6 0-5 2.8
Mycology 6 1-6 3.5
Serology 26 7-22 15.4
Blood Bank 14 5-14 9.5
Hematology 29 9-25 18.4
Coagulation 11 3-11 7.8
Body Fluids 20 5-18 12.1
Analytical Principles 12 2-11 7.0
Miscellaneous Topics* 40 10-29 20.4

 

*
Includes Education, Management, Research and Develop-
ment, Cytogenetics.

29

Table 5. Comparison of statistics by examinee group

 

MSU
Career-Entry Graduates
Medical June 1980

Technologists(n=l34) (n=22)

 

Range of scores 1 80-152 66-107
Mean 117.9 88.1
Median 117.0 87.5
Standard deviation 14.5 10.0
Standard error of measurement 6.2 6.3

Reliability coefficient 0.82 0.61

 

SUMMARY

Certification is a process by which the educational and
functional achievements of an individual are measured. A
certifying examination is an integral part of this process.
Such tests are constructed and administered by representative
credentialing agencies. These groups also define the eligi-
bility standards for certification.

The Michigan State University Comprehensive Examination
was developed to enable career-entry medical technologists
to assess their strengths and weaknesses prior to sitting
for certification examination(s). It was based on the
philosophy of competency-based education and criterion-
referenced testing; the domain tested by the exam reflected
knowledge and skills required for competent performance by
career-entry medical technologists. To assure the relevance
of the MSU-CE, all test items were referenced to both
"Differentiation Among MT, MLT, and CLA Expected Capabili-
ties at Career Entry" (ASMT, 1973) and "Career-Entry
Statements of Competence, Clinical Laboratory Sciences"
(ASMT, 1978).

The examination was taken by 134 students who were
completing their clinical training at 16 hospital-based
medical technology programs in Michigan. The examinees and
their respective education coordinators received reports of

30

31
their scores and a summary of the scores of other examinees.
These Statements included examinee performance in each
content area as well as on the total exam. Thus, each
student was able to identify any existing areas of weakness
prior to sitting for certification examination.

Each test item was analyzed for its degrees of diffi-
culty and discrimination. Items which were extremely
difficult (index of difficulty >60 percent) and which
discriminated at a level less than zero were reevaluated.
These items were either revised for, or omitted for, future
use of the test. These amendments should improve the relia-
bility and the mean score by making the exam less difficult
and by reducing ambiguity.

The reliability coefficient (0.82), correlation coef-
ficients (0.81 and 0.84) and additional measures indicate
that the MSU-CE is.a reliable test which correlates well with
the two most p0pular certifying examinations. Use of the
MSU-CE by career entry medical technologists is valid.

It would be difficult to prove, either empirically or
logically, what actual value the MSU-CE has for improving an
individual's performance on certification exams. Some students
took the MSU-CE without reviewing the prerequisite material.
With only minimal review their scores on subsequent proficiency
tests (certifying exams) could certainly increase to a greater
degree than the scores of individuals who were well-prepared
when sitting for the MSU-CE. Additional learning between the

time the MSU-CE is taken and the time a certification exam is

32
taken affects any attempt to correlate scores between pro-
ficiency exams.

As the MSU-CE is improved it may have additional
applications. Since it was designed to reflect the skills
and knowledge needed by a career-entry medical technologist,
it could well be incorporated into a career mobility program.
Demonstration of continued competence is an issue of interest
to many credentialing agencies. Assessment of continued
competence prior to recertification examination is another
possible application of the MSU-CE.

I Feedback from some examinees and education coordinators
has been favorable. They state that the opportunity to
prepare for certifying exams in this way is greatly appreci-
ated. Many examinees felt that the exam was difficult but
enabled them to identify their weaknesses and to practice
pacing themselves through such a lengthy test. Many education
coordinators expressed their wish for continued availability
of the MSU-CE. Further evaluation of this examination after
additional administrations will more clearly define its

usefulness.

APPENDIX A

2-3.

MICHIGAN STATE UNIVERSITY

1980 COMPREHENSIVE EXAMINATION

An organism isolated from a vaginal swab is oxidase positive and on
gram stain appears to be a gram negative diplococcus. The organism
does 09: ferment glucose. Which of the following organisms could

this be?

a. Acinetobacter calcoaceticus
b. MbraerZa osZoensis

c. Neisseria gonorrhoeae

d. PSeudomonas aeruginosa

Match each organism at left with the appropriate OPTIMAL PRIMARY ISOLATION

MEDIUM at right.

2. Staphylococcus aureus (from feces)

3. Bacteroides melaninogenicus

c.
d.

 

BHI supplemented with yeast
extract, hemin, and vitamin K
BHI supplemented with yeast
extract, horse serum, and
penicillin G

blood agar

mannitol salt agar

A 6-year-old child is seen in the emergency room complaining of a sore
throat. A throat culture reveals an almost pure culture of gram positive
cocci that are catalase negative and display beta hemolysis. A 15 mm zone

of inhibition is seen around the bacitracin disc.

likely:

a Streptococcus pneumoniae.
b Streptococcus, Group A.
c. Streptococcus, Group B.

d

unidentifiable without further testing.

The organism is most

Culture isolation and identification of CZostridium botulinum from a food
source is insufficient evidence to definitely cite it as the cause of food
poisoning. Which of the following statements support this fact?

I. not all strains of Clostridium botulinum produce an active

toxin

ll. Clostridium botulinum cannot be distinguished readily from

non-pathogenic species culturally

Ill. not all types of botulinus toxin cause human disease

a. lll only

6. l and II only
C. II and Ill only
d I, II and Ill

33

IO.

34

A request is made for a culture for diphtheria. The specimen should be
inoculated to blood agar and:

a Bordet-Gengou medium.

6 cystine-tellurite blood agar.
c. Lowenstein-Jensen agar.

d McBrides' medium.

A pregnant woman developed "flu-like" symptoms, low grade fever and

diarrhea, which resulted in abortion. A placental specimen was sent to

the laboratory for culture. Colonies on blood agar exhibited beta hemolysis,
and on clear tryptose agar the colonies gave a characteristic blue-green
color when viewed with oblique light. A gram stain showed gram positive

small coccobacilli. What organism is most likely involved?
a. Brucella abortus

b. Hemophilus vaginalis

c. Listeria monocytogenes

d. Erysipelothrix rhusiopathiae

A small gram negative bacillus is isolated from an eye; the organism grows
on chocolate agar but not on blood agar. It produces satellite growth
around Staphylococcus aureus on blood agar but not on plain agar. This
reaction indicates that the organism requires:

a X factor only.

b V factor only.

c. both X and V factors.

d neither X nor V factor.

A gram negative bacillus has been isolated from a wound; it grows on
MacConkey's agar and is oxidase positive. Other biochemical tests done
do not fit the pattern for any known organism. The next step is to:

do a sensitivity study.

repeat the biochemical tests using controls on the media.
send the culture to a reference laboratory.

subculture the organism to see if the culture is pure.

GOULD

From a urine specimen a gram negative bacillus, found to be oxidase
negative, was plated on differential media. On blood agar the colonies
were large, grayish and spreading with no hemolysis. On MacConkey agar
the colonies were medium sized and colorless. Biochemical tests were
then done on an isolated colony from MacConkey agar. These results were
obtained:

motility positive

indole positive

ornithine negative

urease bright pink throughout tube
citrate bright blue

LIA red slant/yellow butt

TSl yellow slant/yellow butt, no gas

H25 positive

ll.

12.

13.

35

Select the species of Proteus that has been identified:

a . mimbilis
b. morganii
c. rettgeri
d. vulgaris

A flat colorless colony is isolated from feces on MacConkey and EMB agars.
The biochemical profile of the organism is shown below.

H25 slight positive
glucose fermented, no gas
lactose not fermented
citrate negative

lysine decarboxylated
phenylalanine not deaminated
motility positive

indole not produced

The technologist should perform:

malonate utilization and ONPG tests to rule out Arizona sp.
serological typing to confirm salmonella sp.

serological typing to confirm ShigeZZa Sp.

the urease test to rule out the possibility of an atypical Proteus sp.

CLOUD)

Which of the following statements does NOT apply to the Rickettsia
species?

bacilloid
gram positive
pleomorphic
intracellular

QOU'OJ

On a smear stained with crystal violet a technologist observes spirochetes
with 4 or 5 loose spirals and fusiform bacilli with tapered ends. These
findings are consistent with:

rat bite fever.
syphilis.
Vincent's angina.
whooping cough.

QOO’O)

An acid fast gram positive bacillus has been grown in a dark incubator
for 6 weeks. When it is exposed to a light source, nothing happens.
This organism can belong to Runyoun Groups:

a. II and IV.
b. Ill and IV.
c. I and IV.
d. II and V.

15.

16.

18.

I9.

-36

A physician has sent an oropharyngeal specimen to the laboratory to be
cultured for Mycoplasma pneumoniae. To ensure isolation, the specimen
should be inoculated to and incubated:

in selective broth containing a bacterial inhibitor, at 36°C, in 5% C02.
in thioglycollate broth, at 36°C, in 95% N and 5% 02.

on brain heart infusion agar, at 35°C, anaerobically.

on Lowenstein-Jensen slants, at 35°C, after digestion and decontamination
of the specimen.

CLOUD.)

A purulent sputum specimen is submitted to the laboratory for culture and

acid—fast staining. Acid-fast bacilli are noted on a smear. After 4
weeks at 37°C on Lowenstein-Jensen agar, rough buff-colored granular colonies
develop. Additional testing on this organism will show:

. strong niacin production.
I. catalase activity.
I

l
l
| l. orange pigmented colonies when grown in the dark.

a. I only

b. l and Ill only
C. II and Ill only
d. lll only

In the nitrate reduction test, a red color develops only after addition
of zinc dust. This reaction indicates that the organism:

failed to reduce nitrate to nitrite.
produced nitrogen gas.

reduced nitrate to nitrite.

reduced nitrite to nitrate.

C10 U0)

A set of stock cultures is maintained in the laboratory to check all
media and reagents. To check media and reagents for positive and negative
reactions, which of the following combinations is appropriate?

a. bile solubility: Streptococcus pneumoniae, Streptococcus pyogenes

b. catalase: Staphylococcus aureus, Bacillus subtilis

c. fermentation of monosaccharides: Clostridium botulinum, Staphylococcus
aureus

d. hydrogen sulfide production: salmonella typhi, Proteus mirabilis

You are setting up a small bacteriology laboratory on a limited budget.
In addition to stains and differentiation discs, which of the following'
groups of media will enable you to isolate and presumptively identify the
greatest number of species?

a. chocolate agar, MacConkey agar, triple sugar iron agar, urease medium,
thioglycollate broth '

b. chocolate agar, SS broth/agar, thioglycollate broth, indole broth,
citrate agar

c. Loeffler medium, eosin methylene blue agar, mannitol broth, brain
heart infusion broth

d. tetrathionate broth, Seller medium, phenylethyl alcohol agar, citrate
agar

20.

21.

22.

23.

37

Directions: Each question below consists of an assertion (statement) ir the

 

left-hand column and a reason in the right-hand column. Select:

a. if both the assertion and reason are true statements and the reason
is a correct explanation of the assertion.

b. if both assertion and reason are true statements but the reason is
NOT a correct explanation of the assertion.

c. if the assertion is false but the reason is a true statement.

d. if both assertion and reason are false statements.

STATEMENT REASON

The correct temperature Methicillin-resistant

for incubation of Kirby— BECAUSE Staphylococcus aureus is

Bauer sensitivity plates detectable at 35°C. Incubation

is 35°C. at 37°C may result in false large
zones of inhibition.

Directions: The following pair of phrases describes conditions or

 

quantities that may or may not be related. Select:

a. if increase in the first is accompanied by increase in the second,
or if decrease in the first is accompanied by decrease in the second.
0. it increase in the first is accompanied by decrease in the second,
or if decrease in the first is accompanied by increase in the second.
c. if changes in the first are not necessarily accompanied by changes

in the second.

QUESTION:

I. zone size in a prOperly controlled Kirby-Bauer susceptibility
procedure

ll. relative susceptibility of the organism to the particular
antibiotic

A swine farmer who occasionally slaughters a hog for personal use is seen in
the hospital with anorexia, chills and a diurnal fever. No infectious foci
are apparent. The most likely causative agent is:

Brucella suis.

Francisella tularensis.
Listeria monocyternes.
Streptobacillus moniliformis.

QOU'QI

After six weeks with a low grade fever a patient develops petechia on his
lower legs. He reports increasing dyspnea and weakness upon exertion. A
blood culture is positive and Iancet-shaped gram positive cocci are isolated.
This patient is suffering with:

acute bacterial endocarditis.
subacute bacterial endocarditis.
pneumonia.

rheumatic fever.

QOO'OI

24.

25.

26.

27.

28.

29.

38

The skin commensal Propionibacterium acnes appears to be capable of retarding
skin colonization with Staphylococcus aureus and Streptococcus pyogenes
through the production of:

acetone.

deconjugated bile salts.
lipids.

peroxidase.

GOUOJ

A patient was admitted to the hospital and acquired a disease while in the
institution. It was thought by the infection control committee that he could
have acquired the disease from the hospital drinking fountain. Upon
culturing the water, yellow colonies of gram negative bacilli were isolated.
What is the most likely causative organism?

Escherichia coli
Flavobactcrium sp.
Proteus mirabilis
Pseudomonas aeruginosa

QOU'O)

The optimal specimen for isolation of the poliomyelitis virus is:

blood.

feces.

cerebrospinal fluid.
transtracheal'aspirate.

QOUOI

lf material for viral culture cannot be processed immediately it should
be held at:

a. 4°C.
b. room temperature.
c. 35°C.
d. 42°C.

Quality control checks on the autoclave indicate that the sterilization
process is not effective. An examination of the settings reveals a
temperature of 112°C and pressure at 15 lbs. What correction<sl shocld
be made?

decrease the pressure to l2 lbs.

increase the pressure to 2l lbs.

increase the temperature to 121°C.

increase the temperature to l15°C and the pressure to 21 lbs.

CLOUD)

A patient has a 48 hour cycle of chills, fever, and sweating. Blood films
stained with Giemsa show enlarged pale erythrocytes containing light red
dots overlying 15-20 dark red dots in each infected cell. The stage that
is being observed is the:

early trophozoite of Plasmodium falciparum.
early trophozoite of Plasmodium malariae.
schizont of Plasmodium ovale.

schizont of Plasmodium vivax.

CLOUD)

30.

33.

34.

35.

39
Directions: The following paired statements describe two entities that are
to be compared quantitatively. Select:

 

a. if (1) is greater than (2).
b. if (2) is greater than (I). _
c. if the two are equal or very nearly equal.

(1) the diameter of the cyst of Entamoeba coli
(2) the diameter of the cyst of Entamoeba histolytica

When a human is infected with Paragonimus westermani, ova will most readily
be found in the:

a. blood.

b. duodenal aspirate.

c. feces.

d. sputum.

The insect vector of African trypanosomiasis is the:

a. Anopheles mosquito.
b. reduviid bug.

c. sand fly.

d. tsetse fly.

A medical technologist is placed in charge of a military laboratory. She
needs to screen the personnel for malaria in a non—endemic area. The tests
that are best suited for this purpose are:

blood cultures.

indirect fluorescent antibody and indirect hemagglutination.
thick and thin peripheral blood smears.

osmotic fragility and heat instability.

QOO'O)

A patient who has travelled extensively in the last year (including visits

to Cuba and Latin America countries) complains of digestive disturbances, a
stabbing, radiating substernal pain, and fever. Upon examination abdominal
tenderness and hepatomegaly are noted. SGOT (AST), SGPT (ALT), and LDH (LD)
are all elevated; eosinophilia is also noted. A fecal specimen examined for
ova and parasites contains a large operculated egg. The patient is most likely
infected with:

Diphyllobothrium latum.
Fasciola hepatica.
Fasciolopsis buski.
Schistosoma japonicum.

QOU'O)

The nitrogen source for fungal growth in culture is usually:

 

 

a. ammonia.

b. histidine.

c. nitrate.

d. peptone.

Fill in the blank: Symptoms of allergy to Alternaria sp. are due primarily
to the activity of antibodies.

8. lgA.

b. lgD.

c. lgE.

d. lgG.

37.

IJJ
CO

?’() I

40.

41.

40

Bluish-green fungal colonies were isolated from the sputum of a tubercular
patient who had an old resolved cavity lesion. The microscopic appearance
of the organism is pictured at right. The fungus is most likely:

Aspergillus fumigatus.

Aspergillus niger. °°
Penicillium notatum.

Rhizopus arrhizus.

CLOUD.)

ab
0

An 8-year-old male with apparent tinea capitis entered the out-patient clinic.
Under a Wood's lamp his hair showed green fluorescence. Culture of the
hair yielded a fungus which showed, microscopically, mycelia with very rare
microconidia or macroconidia. The fungus is most likely:

Epidermophyton floccosum.
Microsporum audouinii.
Microsporum canis.
Trichophyton rubrum.

O-OU’QI

To make a diagnosis of histoplasmosis, the best specimens to request are:

lymph node biopsy and cerebrospinal fluid.
splenic biopsy and transtracheal aspirate.
sputum (early A.M.) and bone marrow buffy coat.
sputum (early A.M.) and gastric washings.

CLOUD)

A sputum from a patient with pneumonia was cultured on blood agar at 37°C.
After 48 hours, small, creamy colonies appeared which proved to be small,
oval, budding yeast cells when gram stained. The germ tube was negative
and the biochemical reactions did not fit any of the patterns for organisms
listed by the yeast kit. Daily examination of the original culture held at
room temperature showed that the yeast colonies were becoming filamentous
at the edges. What should be done next to identify or rule out
Histoplasma capsulatum?

a. transfer colony to BHI agar, incubate at 30°C, and examine for
chlamydospores.

b. transfer colony to BHI agar, incubate at 370C, and examine for
tuberculate aleuriospores.

c. transfer colony to Smith's medium, incubate at 30°C, and examine for
tuberculate aleuriospores.

d. transfer colony to Smith's medium, incubate at 37°C, and examine for
chlamydospores.

The most common antibody produced by patients with rheumatoid arthritis:
damages heart valves.

I.
II. is an anti-lgG.
III. is an anti-nuclear antibody.

a I only

6. ll only

c. Ill only

d l and II only

43.

44.

45.

4f.» .

47.

41

Select the statement that best describes the Classic and Alternate
(properdin) complement pathways:

a. the activators are the same but the end results are different

b. the activators are different but the end results are identical

c. the activators and the end results are completely different but
they use the same components

d. they cannot be compared in any of the ways stated above

Which of the following is a characteristic of delayed hypersensitivity?

cell mediated response.
humoral response.
precipitated Ag-Ab complexes.
soluble Ag-Ab complexes.

CLOUD)

A chronic rejection reaction to a tissue transplant is:

a. a humoral response.
b. both humoral and cell-mediated.
c. cell-mediated.

lgG antibodies:

account for most of the adult gamma globulins in serum.

are the first antibodies formed against new antigens.

migrate faster than the other immunoglobulins in electrophoresis.
have a molecular weight of approximately 900,000.

QOUOJ

In the radial immunodiffusion technique:

I. the size of the precipitation zone is proportional
to the immunoglobulin concentration.

ll. immunoglobulins are measured qualitatively.

lll. lgG and lgM are the only immunoglobulins measured
accurately. -

IV. a precipitation ring is formed when antigen and antiserum
are at optimal proportions.

V. the immunoglobulin is the antigen.

. II and IV only
Ill and V only
IV and V only

I
l
l
I II, III, IV and V

0.000)

S ‘ Q

A woman in the first trimester of pregnancy is exposed to a child with
rubella. Five days after her exposure, a blood specimen is collected and
tested for rubella antibody by a hemagglutination inhibition test. The
titer is 1:64. How should these data be interpreted?

beginning rise in antibody titer of the infected woman

compatible with immunity existing prior to womans exposure
compatible with rubella infection; no cause for immediate concern
woman infected and termination of pregnancy is a major consideration

QOCTOJ

49.

50.

L71

\fl

IO

L-J

42

Immunization is an example of disease control by:

anamnestic response to infection.
breaking the host—parasite connection.
decreasing the virulence of the parasite.
increasing the resistance of the host.

CLOUD)

While testing a patient's serum with a latex fixation test, the 1:20
dilution appears negative but the 1:40 dilution appears positive. This
most likely is an example of:

a. a delayed reaction.

b. a normal occurrence.

c. the post-zone phenomenon.

d. the prozone phenomenon.

A positive complement fixation test results when the patient has:
I. a specific antibody to the antigen tested.
ll. adequate complement.
lll. anticomplementary factor in her serum.
lV. sheep erythrocyte hemolysins.

a. ll only

b. I and II only

c. l and Ill only

d. I, II and IV only

Which of the following results in a false negative interpretation of
hemagglutination tests?

cross-reacting antigens
bacterial contamination
inadequate antibody in serum
rouleaux formation

QOUO)

Neutralization testing:

I. can assist in typing viruses.

ll. requires animal injection or cell culture inoculation
with a mixture of known hyperimmune antisera and antigen.

III. is done routinely in most viral studies.

a. ll only

b. l and Ill only
C. II and Ill only
d. I, II and Ill

Situation: A clotted specimen is received in the blood bank with a request

to do a direct AHG test. The specimen was refrigerated for 24 hours prior
to receipt in the laboratory. This sample is unsatisfactory because:

 

the antigenic receptor sites are covered.

the calcium was depleted in the clotting process.

clinically insignificant "cold" agglutinins may have bound complement.
the clot traps antibody-antigen complexes, therefore the activation of
the complement system has been prevented.

0.000)

11(1
" O

43

Illustrated below is an Ouchterlony agar-gel immunodiffusion plate.
Which of the numbered reactions demonstrates the relationship of "identity”?

C10 C70)

' 4

bblN—a

 

The practical application of the immunologic test for pregnancy (chorionic
gonadotropin in urine) depends upon:

QOUO)

agglutination of latex particles.
agglutination of sensitized spores.
chemical precipitation.
non-specific protein reactions.

When a patient with syphilis is diagnosed in the primary stage and adequately
treated, the reagin antibody detectable by the VDRL test should: '

a
b
c.
d

decline over the years to a low and persistent level.
gradually decline and eventually disappear.

fluctuate in titer over the years.

persist for life at a high titer.

Which of the following tests is most specific for the diagnosis of syphilis?

CLOUD)

Kahn
Mazzine
RPCF
VDRL

Based on the reactions indicated, which of the following individuals
probably has syphilis?

a.

30—year—old male; weakly reactive VDRL, nonreactive FTA-ABS, negative
darkfield

70-year-old female; nonreactive VDRL, nonreactive ETA—ABS.

lé-year-old female; nonreactive VDRL, FTA-ABS nonreactive, culture for
Neisseria gonorrhoeae positive

25-year-old male; nonreactive VDRL, positive darkfield, clinically
diagnosed to have lupus erythematosus

59.

60.

61.

62.

64.

65.

-—44

The Widal test is used for the detection of antibodies in a patient with:

a Proteus vulgaris infection.
Q fever.

typhoid fever.

typhus fever.

C10 U0)

The serum of a patient reacts with Proteus OX2 and OXl9 antigens (the
Well-Felix reaction). A presumptive diagnosis for this patient is:

a Q fever.

b Rocky Mountain Spotted Fever.
c. scrub typhus.

d trench fever.

An antibody titer of 1:80 against Salmonella typhosa flagellar antigen
strongly suggests that the patient:

a. has a Salmonella infection other than S. typhii.

b. has been exposed to S. typhii, or an organism closely related, at
some indeterminable time.

c. has had a vaccination recently.

d. may have typhoid fever.

While performing a cold agglutinin test, agglutination in the 1:64 dilution
is shown to disappear after warming to 37°C. Without further testing, this
indicates that the patient may have:

infectious mononucleosis; confirm by heterophile antibody determination.
Mycoplasma pneumoniae infection; confirm by culture or serological tests.
Paroxysmal Cold Hemoglobinuria; perform Donath Landsteiner Test.
viral pneumonia; confirm with viral studies. ‘

CLOUD)

To test for rheumatoid factor, a reagent commonly used is latex particles
coated with:

a. antihuman globulin.

b. anti—rheumatoid factor.
C. lgG.

d. lgM.

An ASO titer of 666 units in the serum of a 6-year—old child is:

a. inconclusive; an anti-DNAse B titration should also be performed.

b. inconclusive; the test should be done on another serum specimen
drawn after 10 days.

c. not significant.

d. significant.

In the fluorescent antinuclear antibody test a nucleolar pattern is:

found in certain collagen diseases other than SLE.
produced by antibodies to saline-soluble nuclear proteins.
produced by antibodies to particulate DNA histone.

typical of acute SLE with renal involvement.

CLOUD)

67.

Cu

\

‘4

45

The following results were obtained when a serum was tested for
heterophile antibodies:

N1 13
l\_) £-
1%.

0;:

presumptive titer
differential titer (guinea pig kidney absorption) 1:
(beef heart absorption) ne‘

(“Ti
L.)
.1-
<
(D

The best interpretation is:

. positive for infectious mononucleosis
. negative for infectious mononucleosis
positive for serum sickness
. negative for serum sickness

QOCTOJ

Of the following, who is an acceptable blood donor?

a. 23—year-old healthy sailor who was tattooed in Spain 2% months age
6. 49-year—old woman with a slight cold and a temperature of 99.4°F
c. Zl-year-old healthy medical technology student immunized against

smallpox 5 days ago

d. 23-year-old healthy male who had 4 impacted wisdom teeth removed
1 week ago

 

Fill in the blank: It is generally accepted that the available methods
for hdsAg testing in donor blood will detect the hepatitis associated
antigen in up to % of the cases.

a. l5

6. 25

l: 5 Ci

d. 80

These facts apply to which blood component listed below:

<nrparatod lrwxn whole:l)hxrl witldli/l hours of (X)lletfinn
frozen and stored at -18°C or colder
contains all of the plasma clotting factors

cryoprecipitate
factor 2-l0 complex
fresh frozen plasma
leukopheresis unit

0 C'Cl

'\
5..
I

When compared with ACD, with storage CPD maintains more favorable
levels of:

. 2, 3 — DPG.
dextrose.
factor VIII.
potassium.

C10 C70.)

7l-

74

46

A 32—year-old female comes into the emergency room hemorrhaging severely.
The physician orders 2 units "priority 2" (transfuse as soon as possible)
and 4 units "on hold" pending possible surgery. The patient is blood group
type B, Rh negative. The blood inventory is

UNITS NUMBER
0 positive 25
0 negative 7
B positive 12
B negative 3
AB positive 6
AB negative 1

\

Neither neighboring hospitals nor the American Red Cross have additional
B negative units available immediately. Which units should be tested for
compatibility with this patient?

negative units to be given as packed cells only

negative units and 3 B positive units

negative units and 3 0 negative units (as packed cells only)
3 8 negative units; wait for ARC to draw and send additional B
negative units

CLOUD)
UlLNC)
CDCDO

Situation: An EDTA blood sample is received in the blood bank laboratory
with a request for an indirect AHG test to be performed on it. This sample
is unsatisfactogy because EDTA:

 

a. covers the antigenic receptor sites.

6. prevents magnesium from adding C2 to the C4 complex.

c. chelates with the Ag—Ab complexes preventing their agglutination

d. binds the calcium which is needed to add complement to sensitized
erythrocytes.

Patient M. D. 6., who has autoimmune hemolytic anemia, is blood group B,
RIRI (CDe/CDe). He has a negative antibody screening test (indirect
antihuman globulin test) but a positive direct antihuman globulin teal (AHG).
Upon elution the antibody is identified as anti-hr" (anti-e). Which of the
following blood types would be the best choice for compatibility testing
and subsequent transfusion into the patient?

 

group B, rIR1
group B, r°R2
group O, rIR2
group O, RZR2

QOC'OJ

Which of the following groups tends to react least strongly with H antisera?

a. Al.
0. Oh
C. A2
d. A28

l
\~..l

«.
\
0

’79

L1.

47

The results of a routine Rh typing on an adult were:

anti—RhO(D) modified tube typing serum positive
albumin control positive

The next step is to:

check serum of patient for anti-RhO(D) antibodies.
confirm Rh typing with saline anti—RhO(O) typing serum.
interpret the results as RhO(D) positive.

interpret the results as RhO(D) negative.

QOO'CI)

Situation: Early in her pregnancy, the blood of L. S. was tested as part
of a prenatal work—up. Her blood was found to be type B, RhO(D) negative,
0” negative, with a negative antibody screening test. The day after the
birth of her CHIId, the blood of L. S. and her child were tested as part
of the routine neonatal work-up. The results were:

L. S. group B, DU positive, antibody screen negative
Baby S. group O, RhO(D) positive, direct AHG test negative

From the list below, choose the one statement that CANNOT be a cause of
the above inconsistency.

a. Baby S. is suffering from hemolytic disease of the newborn due to
ABO imcompatihillty
6. Baby S. has bled into his mother (fetal-maternal bleed) approximately
35 ml or more
c. L. S. is actually DU positive; a mistake was made on the original typing
d. L.S. has developed an auto—antibody which was detected in the 0“ test

Select the phenotype that best fits the pattern given below for W. R.

 

 

ANTIGENS PRESEN IN SECRETIONS ANTIGENS PRESENT ON ERYThRO;Y.ES

If H
Lea (weak +)
Leb Leb

a Se, Le, H

6 Se, Le, h

c se, Le, H

d se, le, H

Given the following reactions with antisera, which genotype listed below
is NOT possible?

ANTISERUM REACTION
C +
D +
E +
c +
e +

.QOO'O)
I]
l\)
.3

79.

5:50.

48

In a disputed paternity suit, typings for M, N and S antigens are performed
to supplement A80 and Rh typings since the alleged father, the mother
and the baby are all 8, Rh positive. The results are:

E N. §_
alleged father - 4+ -
mother - 3+ 3+
child 2+ 3+ 3+

Is this man the father of the child?

a. definitely yes
b. definitely no
c. possibly yes; additional testing should be done

Blood from a neighboring hospital is received in your blood bank in a
styrofoam container holding ice that is floating in cold water. The
blood has been in transit for approximately 45 minutes. The water
temperature is 6°C. A thermometer sandwiched between 2 bags of blood in
the container reads 120C. According to AABB you should:

quarantine the blood.

return the blood.

use the blood. _
use the blood, but only as packed cells.

QOO'CD

Select the disease state from the list below that is most consistent with the
following data:

hemoglobin 9.5 gm/dl
hematocrit 28.5%
hemoglobin electrophoresis A2 = 3.5%
F = 3.5%
A = 94.0%
erythrocyte morphology hypochromia, microcytosis, anisocytosis,

poikilocytosis, leptocytosis, polychromasin

hemoglobin H disease

hemoglobin Lepore disorder

hereditary persistence of fetal hemoglobin
heterozygous beta thalassemia

C10 0’0)

Following, in random order, are the steps in the formation of an L.E. cell.
Select the lettered response which corresponds to the correct ordering of
the steps.

1. phagocyte ingests altered nucleus
2. anti—DNP alters the chromatin of the nucleus
3. altered nucleus attracts phagocyte
4. leukocytes are traumatized
a. 4, 2, 3, l
b. 3, l, 4, 2
c. 2, 4, 3, l
d. l, 2, 3, 4

\-.
L- ,
A

CD

49

Listed below, in random order, are the cells of the erythroid series. Select
the lettered response which corresponds to the correct order of the normal
maturation sequence.

1. basophilic normoblast
2. polychromatophilic normoblast
3. orthochromatic normoblast
4. pronormoblast
5. reticulocyte
6. erythrocyte
a. l, 2, 3, 4, 5, 6
b. 2, l, 4, 3, 5, 6
c. 4, 3, 2, l, 5, 6
d. 4 l 2 3 5 6

i D

V
V

)

 

Directions: The paired statements below describe two entities that are
to be compared quantitatively. '

(l) the red blood cell count in capillary blood specimonu
(2) the red blood cell count in venous blood specimens

Select:

a. if (i) is greater than (2).
b. if (2) is greater than (i).
c. if the two are equal.

The corrected reticulocyte count for a patient with 201 counted reticulocylmu
and a 30? hematocrit is:

a. 13.3?
b. 15.0%
c. 20.0%
d. 30.0%

From the table below, select the values that you would expect to find in
the serum of a patient with MCV = 66.6 fl, MCH = 20.2 pg and MCHC = 30.5 gm/dl.

 

 

 

 

SERUM lRON TIBC TRANSFERRIN MARROW lRON
(ug/dl) (ug/dl) SATURATION (%) STORES
a. 30 200 15 3+
b. 200 250 80 4+
C. 20 400 8 0
d. 115 340 35 2+

One of the reagents in the SickleDex test for sickle cell screening is
sodium dithionite. What is its function?

buffer

lysing agent
oxidizing agent
reducing agent

CLOUO)

-4

 

50

3'1,

In an osmotic fragility test, hemolysis begins at 0.6L” Natl and in
complete at 0.46% NaCl. On the smear one would expect to see:

a. drepanocytes.
b. elliptocytes.
c. normal erythrocytes.
d. spherocytes.

Siderotic granules are differentiated from hasOphilic stipplin: and dwinx
bodies in that siderotic granules stain positively with:

a. new methylene blue.

b. nitrohlue tetrazolium.
c. periodic acid Schiff.
d. Prussian blue.

The following results were obtained on a Schilling test:
l. l? of labelled vitamin B]? was recovered in the patient'a urinn
when administered alone (normal recovery = 7% or greater).
2. When administered with intrinsic factor, l% of labelled vitamin

H12 was rocOVwrrd in the patient's urine.

These rosultu indicatr:

a. malabsorption.

b. folic acid deficiency.
c. perniciouu anemia.

d. n :tllirtg at’n()rrpal .

The reducing compounds in the erythrocyte that serve to protect hemotlotin
iron from o<idation are generated in the:

J. Lnflxlan—iT-yertkyff ruitlwnay.

h. krebs cycle.

c. mitochondria.

d. pentose—phosphaie shunt.

Erythrocytes deficient in a certain on: me undergo hemolysis when expouwd
to acetylphonylhydrazino or similar drugs. This deficient enzyme in;

a. galactose-l—phosphate uridyl transferase.
b. glucose—6-phosphate dehydrogenase.
c. glutathione reductase.

CL

pyruvate kinase.

 

". On a peripheral blood smear that is made too slowly, or with uwda~ liVfi-Ulw

51

’. Which of the disease states listed below is most consistent with the
following data:

REC = 6.0 x to 1‘“)/l platelets = adedwate

hgb = 18 dm/dl LAP = normal

hct a 54; bone marrow ; erythrgif hyr«:big,id

NRC = 9.5 x 09/] differential and RGf heryhai‘ir 7
unremarkable

»
O

hemoconcentration due to dehydration
. polycythemia vera
rclzrtive2imaly%:ytrmwnia

secondary polycythemia

('7' r‘

C). (‘i
o 0

when [marfornurwg a (H lterentfigtl onc>lwauld €w¢mn:t ti) find (Ni incrct:» E nurgiwn.lp
at: , '

l. nrutroyhilir hands.

li. ‘..:‘-’l7rl:'tili_"'i luflll l‘iri‘lll l».

c. lymphocytes.

d. mcwn:Cfldiis.

th-:

isnnd an lhhiavcd tuuiwu~r . datim.

-. In a white blood cell diluting pipette, blood is drawn to the 0.4 mart;
dilthirh} tliiid is alra HT t(t tin? ll rnarl;. L
chamber, 20, Tl, 22 and 79 cells are counted in the corner square . ih~

J-J- k-lI. - ‘ —. '- .
.cHisl “ct. count ,ngr Llflylc in. is.

1 ‘7 r
:3 . f , II. .x‘ .
l : ’7' L:
L. . L" , 7 ,Ii 1’ .
,. v n r
(v a La" l ’ t , --’ ‘1 o
,1

ri-C't'lC,‘ of ‘lhg abgsyg.
Tr) DCH‘fctrfii a 'ilwnrr; l‘“3i , ill“ {tat icntt is <;i\u#n 2M ill. in» will l :wdll la thsllt
Show alum);

a. decrease in eosinophils.
b. increase in eosinophils.
c. decrease in total h7Cs.

l

a. increase in total ddCs.

5. Sudan Black stains:

Cd

. lipids and usually correlates closely with the peroxidase stain.

. lipids and usually correlates closely with the periodic acid stain.
glycogen and usually correlates closely with the peroxidase stain.
glycogen and usually correlates closely with the herirdic acid sttin.

CL 0 C“

“u. fidtquemic; “JUhCNHilillliUVS tixxn otlun“ lGUFANWLJ? lll that tthe neri;du3ral
blood in this disease has:

CU

agranular granulocytes.

. lnCrQCSCxllMTiUFU i(flTHS.

normal or decreased N30 count.

blast forms feund only in the peripheral blood.

0V

\

k
a

101.

13:.

52

Toxic granulaTion in neuTrophils is usually caused by:

bleeding.
chronic anemia.
hemolysis.
infecTion.

CLOUD)

The aTypical lymphocyTe may be The predominanT cell Type in:

infecTious hopaTiTis.

 

 

1.
2. measles.
3. infecTious mononucleosis.
4. Toxoplasmosis.
a. 3 only.
b. 1 and 3 only.
c. 1, 2 and 3 only.
d. 1, 2, 3 and 4.
Fill in The blank: The Philadelphia chromosome is mosT commonly seen
in leukemia.
a. acuTe lymphoblaSTiC
b. acuTe myelogenous
c. chronic lymphocyTic
d. chronic myelogenous

HemaTological daTa reveal:

hemoglobin = 10.8 gm/dl differenTial: 73% segs

hemaTocriT = 3l% 12 11% sTabs (bands)

REC = 3.3 lO 9/| 9% lymphocyTes

WBC = l3.0 x I /l 2% monocyTes
pIaToleTs = 350 x l0 /l 4% blasTs (some wiTh

Auer rods)
1% myelocyTes

The paTienT is a 63-year—old whiTe female. The mosT probable diagnosis,
wiThouT furTher sTudies is:

chronic myelogenous leukemia.
chronic lymphocyTic leukemia.
early acuTe myelogenous leukemia.
early acuTe lymphocyTic leukemia.

0.0(3'0‘

Pelger—HueT anomaly shows:

normal differenTial, hypochromia, increased leukocyTe counT.

normal leukocyTe counT, increased number of hyposegmenTed neuTrophils.
increased leukocyTe counT, increased number of hyposegmenTed neuTrophils.
normal differenTial, increased leukocyTe counT, azurophilic granulaTion of
neuTr0phils.

C10 C70

l 131') .

53

An elderly paTienT presenTs wiTh a WBC co'nT of 70.0 x lOg/l, hemoglobin
lO.5-yn/dl,and plaTeleT counT of 175 x lO’/l. The paTienT's peripheral

blood smear shows 90} lymphocyTes and numerous smudge cells. The [aTienT
probably has:

a. acuTe lymphocyTic leukemia.
b. chronic lymphocyTic leukemia.
c. myelomonocyTic leukemia.

d. infecTious mononucleosis.

A cerebrospinal fluid wiTh I, 00 WBC/cumm, 00S polymorphonuclear leukocyTes,
and glucose of 25 mg/dl is suggesTive of:

a. a normal newborn.
b. bacTerial meningiTis.
c. myeloeenous leukemia.
d. viral meninqiTis.

"A suspenSion of blood cells is passed Through a small orifice simulTaneously wiTl
an elecTric CurrenT. The individual cells inTroduce an impedence chanqe in The
orifice determineT by The size of The cell." This is a sTaTemenT of The
pringiple Of Tie:

a. AuTocyTomeTer.

b. COUlTer COJHTUF.

e. Hemalog.

d. SMA 7.

WhaT is iniicalel by an MCV of 140 fl, hemoglobin of l4.0 nm/dl, REF counT
:, V ‘ .k) .. _ _ _ ,‘_- J v.’ ,r

gf ).l0 > l0 “/l, WfiC COuhT of 5.0 x lU"/l, GHd NUWJTOBTIT 0i 44w d:

drlwimihwd by u CoulTer 3?

a. a paTienT wiTh leukemia

b. <:old axggluTiriins [muesenT

c. lysinq reaqenl is noT beinq diipwrsud
.l. The agmnxilure link) is plugged

P ncyTopenia can occur afTer exposure To n specific Toxin, such.u,.an
orianic solvenT or drug. In This disorder The marrow is generally:

a. hypocellular.
b. normocellular.
c. hypercellular.

A useful "baTTery" of TesTs for differenTiaTing The acuTe leukemias would
include all of The following EXCEPT:

a. PAS.

b. peroxidase.

c. Prussian blue.

d. specific esTerase.

lI

C)

54

DIRECTIONS: In This iTem, facTors l and 5 are in a logical sequence, i.e

 

The firsT and lasT To occur. lndicaTe The order in which The middle Three
facTors should appear, according To The following key:

KEY: second, 3 Third, 4 fourTh
second, 3 Third, 2 fourTh
second, 2 Third, 3 fourTh
second, 4 Third, 3 fourTh

QOO'O)
NbbN

I. a workman skinned his knuckle causing bleeding To occur
2. fibrin was formed from fibrinogen

3. Thrombin was produced

4 pIaTeleTs were acTivaTed

5 bleeding evenTualIy sTopped afTer a cIoT had formed

The facTor ThaT is required for coaguIaTion in vitre buT noT in 3530 is
facTor:

7:. II.

I) . X.
c. XI.
d. XII.

In The exTrinsic coagulaTion paThway, The TesT of choice To deTecT
abnormaliTies is The:

a. acTivaTed parTiaI ThrombOplasTin Time.
b. proThrombin consumpTion Time.

c. proThrombin Time.

d. hromboplasfin generaTion TesT.

There is a four-hour delay before you can perform a proThrombin
Time. The resulTing TesT Time would be:

shorTened due Toirwreasedglass conTacT.
shorTened due To The breakdown of plaTeleTs.
prolonged due To The loss of facTor V.
prolonged due To The loss of facTor VII.

QOUOJ

A paTienT specimen has a normal proThrombin Time and a prolonged parTial
ThromboplasTin Time. AfTer mixing normal plasma wiTh The paTienT's
plasma, The parTiaI ThromboplasTin Time is sTiII prolonged. The mosT
probable cause is:

a deficiency of facTor VIII.
a deficiency of facTor IX.
circulaTing anTicoaguIanTs.
hypocalcemia.

CLOUD)

‘ I

l

u-J

ID.

55

A 47-year—old man who has been drinking heavily comes To The emergency
room wiTh severe hemaTemesis. ProThrombin Time and parTial ThromboplasTin Timm
are boTh prolonged (20 and 82 seconds, respecTively), pIaTeleT counT is

120 x 109/I, and plasma fibrinogen is 300 mg/dl. Fibrinogen spliT producTs
(proTamine sulfaTe) is negaTive. These resuITs are consisTenT wiTh which
of The following disorders:

a. disseminaTed inTravascular coagulaTion.
b. liver damage.
c. hemophilia.
d. primary fibrinolysis.
Which of The following condiTions would flgl_be likely To precipiTaTe
disseminaTed inTravascular coagulaTion?

a. anemia

b. gram negaTive sepTicemia
c. incompleTe aborTion

d. liver disease

WiTh ereaT difficulTy, The TechnologisT has obTained 2 ml of blood from a
paTienT whose physician has ordered a plaTeleT counT, hemoglobin,
hemaTocriT and blood glucose. In order To perform all These TesTs on Thin
specimen, The Tube inTo which he puTs The blood should conTain:

a. EDTA.

b. heparin.

c sodiLun flucw*hTe.
d. sodium oxalaTe.

PlaTeleT counTs performed on auTomaTed counTers may be falsely decreased
in The presence of:

 

l. plaTeleT saTeIIiTism.

2. plaTeleT anTibodies.

3. megaThrombocyTes.

4. megakaryocyTe fragmenTs.

. I and 4 only.

. 2 and 3 only.

2 only.

. I, 3 and 4 only.

ClOO'QJ

In a ThrombocyTopenic paTienT, which resulTs would be expecTed:

a. prolonged Ivy bleeding Time, delayed cloT reTracTion, normal acTivaTed
parTial ThromboplasTin Time

b. prolonged acTivaTed parTial ThromboplasTin Time, prolonged proThrombin Time,
normal Lee-WhiTe cloTTing Time

c. normal Ivy bleeding Time, prolonged Thrombin Time

d. normal Ivy bleeding Time, prolonged Lee-WhiTe cloTTing Time, prolonged

proThrombin Time

56

The preferred meThod of specimen collecTion for sTudies of plaTeleT
funcTion is using:

a. capillary blood obTained by skin puncTure.
b. The 2-syringe Technique (glass syringes).

c. The 2—syringe Technique (plasTic syrihmeg),
d. The VacuTainer sysTem (second Tube drawn).

In renal Tubular acidosis The urine may be alkaline in The presence of

I

n=;abelic acidosis because of:

a. a high urinary pH.

t. inabiliTy of The kidneys To excreTe acid.

c. The presence of alkaline reacTing subsTances in The urine.
d. excess Tubular reabsorpTion of anions.

Using The daTa below, calculaTe The free waTer clearance.
284 m0sm/kg

427 mOSm/kg
1440 mI/24 hrs

serum osmolaIiTy
urine osmolaliTy
urine volume

a. -0.5 ml/min
I). ”+0.5 nil/min
C. -l.5 ml/niin
d. +1.5 mI/rhin

,. n O 0 o .
A urine, aT Temperafure 11 C, yields a reading of 1.015 on The urinomeTer.

, . 4 . . . . . ex
hhaT IS The True spec1fic gravnTy, if room TemperaTure IS 20 L?

a. 1.011
b. 1.012
c. 1.010
d. 1.020

Which of The following TesTs and reagenTs is moeT sensiTive in The
deTecTion of urine bilirubin:

a. Bili-Iab STix

b. lcToTesT

c. niTroprusside TesT
d. 10% ferric chloride

A posiTive CliniTesT and a negaTive glucose oxidase TesT are demonsTaTed
in a urine specimen. These resulTs indicaTe The presence of:

a. a large quanTiTy of keTones.
b. an inTerfering drug.

c. glucose as The only sugar.
d. reducing subsTances.

1
Jl.

LT‘.

1h7.

57

The urinalysis on a 3—monTh—old female yields an unremarkable dipsTick
and microscopic examinaTion of The sedimenT. An addiTional TesT which
would compIeTe The recommended rouTine analysis of This urine is:

a. BenedicT's.

b. diazo.

c. Ehrlich's

d. WaTson-SchwarTz.

lrcompICTe oxidaTion of faTTy acids which resulTs in Their appearance in
urine is called:

a. glycosuria.

b. hyperlipidemia.
c. keTosis.

d. proTeinuria.

An ouT—paTienT delivers To The IaboraTory a urine specimen ThaT had been
collecTed 3 hours prior To her arrival. The TesT requcsTed for This
specimen is The WaTson—bchwarTz TesT. A TechnologisT perform; The TesT and
observes a pink—orange color wiTh The addiTion of Erlich's readehT. Afler
several chloroform chracTions (unTil The chloroform layer is colorless),
The aqueous layer remains sligthy pink-orange. The TesT:

a. is negaTive and should be reporTed ouT as such.

b. is probably posiTive for urobilinogen and should be repeaTed on a
fresh specimen.

c. is probably posiTive for boTh urobilinogen and porphobilincoen buT
furTher exTracTion is needed as well as a fresh specimen.

d. resulTs are inconclusive and should be reporTed ouT as such, allowing
The physician To decide wheTher The TesT should be repeaTed.

Which of The following crysTals would be found in acid urine:

a. ammonium biuraTe and uric acid

b. ammonium phosphaTe and cysTine

c. calcium carbonaTe and sulfanilimide
(J. T11 pfiWTJF 1c: zu(:i d airid 'ly/r1):,iii()

Pyuria and bacTeriuria wiThouT proTeinuria suggesT:

a. umpr! urirhary TrTTTT i:chcTfirvn.
b. lower urinary TracT infecTion.
c. ouTside conTaminanT.

d. Technical error.

The presence in urine of many eryThrocyTes, a large amounT of proTein, and
an occasional RBC casT is mosT suggesTive of:

a. acuTe glomerulonenhriTis.
b. nephroTic syndrome.

c. pyelonephriTis.

d. Trauma.

58

A kidney sTone is pulverized and heaTed wiTh 10% NaOH. The soluTion
is reheaTed afTer crysTals of lead aceTaTe are added, and a heavy black
precipiTaTe forms. This indicaTes The presence of:

a. cholesTerol.
b. cysTine.
c. sulfonamides.
d. xanThine.

When a urinary filTraTe is reacTed wiTh ferric chloride a green color
develops, which shorle afTerward fades To yellow. Which of The
following inborn errors of meTabolism should be suspecTed?

alkapTenuria

cysTinuria

maple-syrup urine disease
phenylkeTonuria

QOUD

A paTienT's urine specimen is broughT To The lab immediaTely afTer
collecTion and TesTed promple. The resulTs include:

pH acid
glucose 3+
bacTeria occasional

AfTer siTTing aT room TemperaTure for 4 hours, repeaT TesTing on The same
specimen would show:

a. no change.

b. pH -acid; glucose - 3+; bacTeria - many.

c. pH — alkaline; glucose — 1+; bacTeria — many.
d. pH - alkaline; glucose - 3+; bacTeria - many.

Darkening of reagenT areas on a dipsTick may resulT when The:

l. coniainer Top is noT replaced.
ll. producT use has expired.
ll. dipsTicks are exposed To heaT.

a I only

b 11 only

c. l and 11 only
d I, II, and Ill

Cerebrospinal fluid may be xanThochromic due To:

1. bilirubin.
ll. hemoglobin pigmenTs.
111. a bloody Tap.

a. I only

b. 11 only

c. | and 11 only
d. l and 111 only

'59

.3]. An appropriaTe sTimulanT for a Tubeless gasTric analysis cenTains:

a. alcohol.

b. Azure A dye.
c. Diagnex blue.
d. caffeine.

13b. Below is a specTral curve of amnioTic fluid obTained aT Term.

7 4

d

OPTICAL
DENSITY

h) (N J><JICD

 

 

340 400 500 6100 700
WAVELENGTH (my)

This curve indicaTes ThaT The:

a, amnioTic fluid is (trial‘31:.irifiT'i'Vl wiTh meconium.

b. infanT is normal. 1

c. infanT is severly affecTed by hemolyTic disease of The newborn.
d. specimen has deTerioraTed as a reSulT of a delay in processing.

15;. Which of The daTa below, obTained by examinaTion of seminal fluid, is
ABNORMAL:
a. moTiliTy: 85% progressive moTiliTy
b. sperm counT: lOO million/ml
c. viscosiTy: coagulum presenT immediaTely, liquefies afTer 10 minuTes
d. volume: 7.0 ml

140. STeaTorrhea is a condiTion in which There is a paThological increase in
fecal:

a. blood.
b. faTs.
c. mucus.
d. pus.

149.

60

Which of The following sequences correcTIy order The human needs according
To Maslow's hierarchy, from The mosT basic To The highesT level?

(LOGO)

1
3
4
2

)

V

I

D

U'ILN-bm

affecTional
self—acTualizaTion
physiological

safeTy and securiTy
self-esTeem and independence

U'l-bUJN—

‘
‘
V

I i i

V
—a_.|_nw

'0
thU‘Ih

‘
JJKJTNKJT

’ I I

You have been assigned To make a ION H980 solufion. While measuring The
acid The boTTle fell To The floor, splaTTering on you. Your opTions are:

l. geT under a safeTy shower
2. call for help
3.

puT bicarbonaTe on The acid
4, go ‘10 The emergency room

The order of prioriTies ThaT would minimize damage To you and oThers is:

a. l, 3, 4

c. 3, l, 2

d. 2, 1, 3, 4

As a IaboraTory supervisor, you wake purchase decisions on new equipmenT.

While examining a new piece of equipmenT some facTors To consider are:

QOO'O.)

|
l
l
2

D

V

I

I

bkfll‘QN

company service record

I.
2. cosT of reagenTs, sTandards and supplies
3. effecTiveness of sales personnel
4. insTrumenT life span
5. where The insTrumenT is manufacTured
, and 5
, and 4
, and 4
, and 5

Which of The following correchy sTaTes The BEHAVIOR soughT by a
behavioral objecTive:

QOU'O)

..given The appropriaTe raw daTa...‘
.The sTudenT will be able To..."

.derive a sTandard deviaTion..."
.wiThin a range of 10-20 ml..."

61

lJS. In which formaT is compaTibiliTy TesTing besT TaughT?
a. group discussion
b. lecTure wiTh demonsTraTion
c. lecTure wiTh audiovisual aids
d. sTrichy lecTure
141'.)

Below is a graphic represenTaTion of The correlaTion beTween MeThod A.
and MeThod B for The analysis of calcium.

ill

'IO mg/dl'

'9 METHOD 8
l8

-7

l6

 

 

Ii IO 9 é ‘I 6
mg/dl
METHOD A

The correlaTion beTween The Two meThods is:

a. -l.O.
b. 0.0.
c. +1.0.

62

147. A specTral absorbance curve of a colored soluTion was prepared (graph
aT IefT). In addiTion, a graph of absorbance vs. concenTraTion was
prepared and read aT several wavelengThs (graph aT righT).

ABSORBANCE
ABSORBANCE

C3

 

 

 

 

400 500 600 7'00
CONCENTRATION

MMNELENGTH

Based on These daTa, The besT maTch of wavelengfh wiTh sTandard line is:

a 550 nm, line A.
b. 600 nm, line A.
c COO nm, line B.
d. 650 nm, line C.

148. WhaT is The molariTy of an HMO3 soluTion wiTh The following specificaTions
on iTs boTTle:

specific graviTy 1.420
puriTy assay 70%
M.W. of HNO3 63 gm

a. 1.6

b. 3.2

c. 16

d. 32

ill. The equivalenT weighT of calcium is 20. ConverT 4.5 mEq/L of calcium To
mg/dl. (M.W. of calcium = 40)

QOU'LL
bO\\OCD
Ui-DCDUT

63

A serial diluTion is made of 0.3 ml of serum, wiTh 0.6 ml of saline in
each Tube. Each Transfer involves 0.3 ml. If 0.2 ml of a 10% suspension
of sheep eryThrocyTes is Then added To each Tube, whaT would be The

final diluTion of The ser.w in Tube #5?

a. 1:108
b. 1:243
C. 1:324
d. 1:1215

Shown below is a graphic represenTaTion of The resulTs obTained by Two
meThods for glucose. The known value of The TesT soluTion is 90 mg/dl.

METHOD A
FREQUENCY

MET D B

 

 

ab 65 90 95 IOO Ios
GLUCOSE (mg/dl)

1‘3leth A shows:

a. good accuracy and good precision.
b. good accuracy and poor precision.
c. poor accuracy and good precision.
d. poor accuracy and_poor precision.

The following values (mg/d1) were obTained for The glucose conTrol in one
week:

102 101 99
92 102 99
95 100 100
102 101 102
103 102

WhaT is The mean value?

a. 99
b. 100
c. 101
d. 102

64

The 95% confidence limiTs for calcium deTerminaTions on conTrol sera
were esTainshed as 9.4 To 10.2 mg/dl. The sTandard deviaTion for This
deTerminaTion is:

QOUO)
OOOO
CDbN—J

The Henderson -Hasse|bach equaTion is

pH = pK + log A
HA

 

Clinically, The compounds of inTeresT ThaT are represenTed, respecTively,
by A and HA are:

 

a. CO and HCO

b. 002‘ and H2 C83.

c. H003‘ and H2003.

d. H2003‘ and H003.

Fill thhe blank: The mean value for a sodium sTandard, obTained by MeThod
XX, is 140 mEq/L wiTh a sTandard deviaTion of 1.4 mEq/L when 20 samples are
run. The coefficienT of variaTion for MeThod XX is %.

a. 1.0

b. 2.8

c. 5.0

d. 10.0

If The hydrogen ion concenTraTion of a soluTion is 0.000001M, The DOM is:

a. 6.0.
b. 7.0.
c. 8.0.
d. 9.0.

In darkfield miscroscopy:

—‘
O

The objecT appears luminous againsT a dark background.

reflecTed lighT rays are used.

3. small objecTs are visible ThaT cannoT be seen wiTh brighT
lighT microscopy.

4. The limiT of resoluTion is increased over brighT lighT

microscopy.

N

1 and 2 only
2 and 3 only
1, 2 and 3 only
2, 3 and 4 only

CLOUD)

U1
\

1,53).

1L1.

if)?!

65

 

Fill in The blank: An aTom of C03? has neuTrons in The nucleus.
a. 27
b. 33
c. 60
d. 87

"DrumsTicks" found on The nuclei of polymorphonuclear leukocyTes is
generally correlaTed wiTh The:

a. auTosome pair #1.

b. Philadelphia chromosome.
c. X chromosome.

d. Y chromosome.

The funcTion of phyTohemaggluTinin (PHA) in Tissue culTure medium is To:

a. arresT cell division.

b. indicaTe The presence of red cell anTigens.
c. prevenT culTure infecTion wiTh bacTeria.

d. sTimulaTe miToses.

ln aTomic absorpTion procedures for calcium, lanThanum chloride is used
as a diluenT To prevenT:

a. chemical inTerference.
b. specTral inTerference.
C. proTein inTerference.
d. self-emission.

When performing IonTOphoresis, a falsely elevaTed resulT would be obTained
if The:

a. paTienT has had an abnormally high inTake of salT in The previous
24 hours.

b. paTienT is dehydraTed.

c. paTienT sweaTs excessively.

d. siTe was cleansed excessively in TesT preparaTion.

CenTrifugal analyzers operaTe by:

a. mixing samples and reagenTs by cenTrifugal force and making
simulTaneous phoTomeTric measuremenTs on a series of samples.

b. performing several differenT TesTs simulTaneously on a single
specimen in which The serum and cells have been separaTed by
cenTrifugal force.

c. separaTing consTiTuenTs from inTerfering subsTances by cenTrifugal
force and analyzing The supernaTanTs phoTomeTrically.

d. Taking only a single phoTomeTric measuremenT on a sample in which
cells and serum have been separaTed by cenTrifugal force.

104.

1b5.

1"4' .

66

If, afTer running several blood pH deTerminaTions, erraTic resulTs are
obTained, The mosT likely problem is:

faulTy elecTrode.

faulTy meTer.

proTein fouling up The elecTrode.
sTaTic elecTriciTy.

DOUG)

While making a CO analysis wiTh a single channel auToanalyzer, you find
ThaT you are unabge To adjusT The waTer baseline To below 100% Transmission
wiTh The 100%T poTenTiomeTer. WhaT acTion should be Taken?

change The lamp

inserT a larger aperaTure

refocus The flow cell

replace The 15 mm flow cell wiTh a smaller flow cell

QOUOJ

A blood glucose ThaT rises slowly and only sligthy above normal in The
firsT Two hours of a glucose Tolerance TesT suggesTs ThaT The paTienT has:

a. decreased insulin secreTion.

b. excess insulin.

c. malabsorpTion syndrome.

d. hyperThyroidism.

You have reporTed a fasTing blood sugar as 140 mg/dl. The docTor calls

afTer receiving The reporT and asks you if This paTienT has diabeTes.
You should:

refer him To The paThologisT.

suggesT ThaT There are oTher possible causes for The high resuIT.

Tell him ThaT The paTienT probably has mild diabeTes.

Tell him ThaT The paTienT probably has mild diabeTes buT furTher TesTing
is required.

0.0'3’0)

Of The following, The besT way To diagnose galacTosemia is To measure:

RBC conTenT of galacTose-l—PO
serum galacTose.

serum galacTose-l—PO .
serum galacTose-l-PO4

ArTerial blood wiTh a higher-Than—normal HCO

4 uridyl Transferase acTiviTy.

CLOUD)

uridyl Transferase acTiviTy.

3 may be indicafive of:

compensaTory respiraTory acidosis.
meTabolic acidosis.

respiraTory acidosis.

respiraTory alkalosis.

QOU'DJ

170.

1 / I.) .

67

A blood Specimen conTaining poTassium oxalaTe as an anTicoagulanT would
be unsuiTable for assays of:

a. BUN
++
b. Ca .
c. glgcose.
d. Na .
All of The following are consequences of hypercalcemia EXCEPT:
a. kidney sTones.
b. loss of appeTiTe.
c. muscle hypoToniciTy.
d. TeTany.

Four "normal" serum specimens were analyzed wiTh The four sefs of resulTs
lisTed below. The seT of resulTs mosT likely in error is:

ELCfiFBQli’flE(film/J1 Cifl—QBL‘ZFfl-“iflfll 51‘ :71 'LWJ 1011/ -1)-

a. 18 103 135
b. 25 100. 140
c. 27 105 130
d. 35 90 138

Which of The following chemical principles is responsible for The color
producTion of a phosphorous deTerminaTion?

oxidaTion of phosphomolybdic acid
oxidaTion of phosphoTungsTic acid
reducTion of phosphomolyhdic acid
reducTion of phesphoTungsTic acid

QOU'O)

LaboraTory daTa reveal pH 7.5, increased pCO , and increased ToTal C07
conTenT. PoTassium and chloride ions are decreased. The mosT likely“
clinical condiTion is:

meTabolic acidosis.
meTabolic alkalosis.
respiraTory acidosis.
respiraTory alkalosis.

QOO'Q)

Given ThaT The baromeTric pressure is 740 mmHg and ThaT The C0“ in
The analyzed gas for blood gas analysis is 5%, calculaTe The parTial
pressure of 002 in mmHg.

(waTer vapor pressure aT 2400 = 22)

CLOUD)

UJUJKNW
‘OO‘UTU'I
UTCDKOUJ

68

When collecTing a specimen for capillary blood gqves, excess expMTure To
air resulTs in:

a. increased CO conTenT; decreased P2 and pH.
2 C02

b. increased CO conTenT and P ; decreased pH.
2 C02

c. decreased CO2 conTenT; Increased PC02 and pH.

d. decreased COq conTenT and P ; increased pH.
2 C02

ElevaTions in The Two fasTesT moving (mosT anodic) LDH (LD) isoenzymes
(LDH and LDH ) suggesTs damage To The:

1 2
a. hearT.
b. kidney.
c. liver.
d. skeleTal muscle.

A cerTain enzyme reacTion is measured by reading The absorbance of The
TesT soluTion aT 340nm To kineTically moniTor The conversion of NADH To
NAD. A sample from a paTienT who has jusT enTered The emergency room
has a very low iniTial absorbance and There is minimal change in The
absorbance for The 10 minuTe incubaTion Time. WhaT acTion should be
Taken?

0)

calculaTe and reporT The resulT as soon as possible

b. check The conTrols To be sure ThaT The sysTem is working, Then
calculaTe The resulTs as usual

c. diluTe The specimen and repeaT The TesT

d. requesT a fresh specimen

The major disadvanTage To ToTaI proTein deTerminaTion wiTh The Folin-
CiocalTeau reagenT is ThaT:

a. iT is 5—10 Times less sensiTive Than The oiher reagents for proTein
quanTiTaTion (i.e., biureT).

b. The deTerminaTion is affecTed by proTein concenTraTion of Tyrosine,
TrypTophan, and hisTidine.

c. The proTein molecules musT be aT leasT TripepTides.

d. The reacTion does noT follow The Beer-LamberT Law.

CalculaTe an uncorrecTed creaTinine clearance (ml/min) using The dafa
below:

BUN 50.0 mg/dl
serum creaTinine 4.0 mg/dl
urine creaTinine 150.0 mg/dl
volume of 24—hr urine 800.0 ml

a. 10

b. 20

C. 100

d. 200

18

f\)

69

All of The following condiTions are conSisTenT wiTh an elevaTed uric
acid EXCEPT:

gouT.

leukemia.

Fanconi's syndrome.
sTarvaTion.

QOUO)

In a paTienT wiTh advanced obsTrucTive Jaundice, all of The following
will be elevaTed EXCEDT:

direCT serum bilirubin.
indirecT serum bilirubin.
urine bilirubin.

urine urobilinogen.

CLOUD)

A sTaT bilirubin deTerminaTion was performed on The serum of a 12 year—old

male, along wiTh a conTrol serum and a sTandard bilirubin soluTion conTaining

5 mq/dl. The resulTs obTained were:

sTandard absorbance 0.392
conTrol absorbance 0.229
paTienT absorbance 0.179
bilirubin conTrol assay value 3.5 mg/dl
accepTabIe limiTs (one sTandard 0.2 mg/dl

deviaTion)

Which of The following besT describes The correcT inTerpreTaTion of This
daTa?

a. The paTienT value is normal, The conTrol value is wiThin limiTs and
The paTienT's value can be reporTed To The physician

b. The paTienT value is normal, The conTrol value is ouTside accepTable
limiTs, and The paTienT's value cannoT be reporTed To The physician

C. The paTienT value is abnormal, The conTrol value is wiThin limiTs, and The

paTienT's value can be reporTed To The physician
d. The paTienT value is abnormal, The conTrol value is oufside accepfahlu
limiTs, and The paTienT's value cannoT be reporTed To The physician

Red blood cell proToporphyrin is elevaTed in:

lead poisoning, buT noT porphyria.
porphyria, buT noT lead poisoning.
boTh lead poisoning and porphyria.
neiTher lead poisoning nor porphyria.

QOO'DJ

An obese adulT wiTh premaTure arTeriosclerosis is seen in The clinic.
When her serum is TesTed, no chylomicra are presenT, LDL are normal, and
VLDL are increased. There is an increase in Triglycerides and a slighT
increase in cholesTeroI. LipoproTein elecTrophoresis reveals a heavy
pre-beTa band. She has no skin rash, and uric acid is increased. This
paTienT has a hyperlipoproTeinemia, mosT likely Type:

a. II.
b III.
C. IV.
d V.

7’0

186. The expecTed TesT resulTs in primary hypoThyroidism are:
a. decreased T , decreased T3 resin upTake (RTBU), increased TSH.
b. decreased T , increased T3 resin upTake (RTBU), decreased TSH.
c. decreased T , increased T3 resin upTake (RTBU), increased TSH.
d. increased T4, increased T3 resin upTake (RTBU), decreased TSH.

diagnosis for This paTienT is:

a. Addison's disease.
b. adrenocorTical Tumor.
c. Cushing's disease.
d. hypopiTuiTarism (Simmond's disease).
15a. A pheochromocyToma will resulT in an increased excreTion of urinary:
a. androgens.
b. caTeCholamines.
C. glucocorTicoids.
d. mineralocorTicoids.

on 95% confidence limiTs.

BUN

The mosT probable

 

 

 

DAY I

InspecTion of The charT reveals a(an):

shifT beginning on day 6.
upward shifT beginning on day Il.
upward Trend beginning on day 3.

QOU'OJ

normal conTrol charT wiTh no devianT paTTern.

 

A person having an abnormally low 17—hydroxycorTicosTeroid baseline is
given ACTH. A subsequenT 17-hydroxycorTicosTeroid measuremenf Taken
afTer The ACTH shows no Change in The level.

The accompanying figure represenTs a qualify conTrol charT for BUN based

LWHT

MEAN

LMMT

190.

193.

71

If blood ThaT is drawn for an ammonia assay is lefT aT room TemperaTure
The TesT resulT will be falsely:

a. decreased due To conTinued cell glycolysis.

b. decreased due To evaporaTion.

c. increased due To conTinued cellular producTion of urea.

d. increased due To conTinued enzymaTic deaminaTion of labile amides.

A clinical chemisT requires 95% conTrol limiTs for serum cholesTeroI
deTerminaTions. From previous daTa, iT has been shown ThaT The mean of The
daily conTrol serum is 210 mg/dl wiTh a variance of 81 mg/dl. (The sTandard

deviaTion squared is equal To The variance.)

WhaT would you conclude if Today you obTain a value of 195 mg/dl for The
conTrol serum?

a. The resulT is ouTside The limiTs of accepTance

b. The resulT is wiThin The limiTs of accepTance

c. The resulT is unaccepTable 95% of The Time

d. noT enough daTa has been presenTed To draw any conclusion

Fill in The blank: To verify ThaT a urine specimen, for quanTiTaTive

 

esTrogen deTerminaTion, has been compleTely collecfed over a 24—hr period
should be assayed.

 

anoTher sTeroid
creaTinine
ToTal proTein
urea niTrogen

CLOUD)

Shown below is a graph of iniTial velociTy (v) of an enzyme reacTion vs.
iniTial subsTraTe concenTraTion (s). In designing a meThod To measure
The acTiviTy of This enzyme, which concenTraTion of subsTraTe should be
used?

(V)

 

 

I II III IV

I (S)

CLOO‘O)

194.

1 v: .

198.

72

lllusTraTed below is a proTein elecTrophoresis scan.

ALBUMIN of. °Cz 9’

This paTTern suggesTs ThaT The paTienT has:

chronic liver disease.
b. monoclonal gammopaThy.
nephroTic syndrome.

no proTein abnormaliTy.

0)

(10

Normal serum amylase, elevaTed urinary amylase and elevaTed serum lipase
levels TogeTher suggesTs:

a. acuTe pancreaTiTis.

b. pancreaTic carcinoma.

c. severe renal disease.

d. inconsisTenT values.

RepeaTed freezing and Thawing of pooled sera will have whaT effecT on

iTs albumin assays?

a. falsely increase values
b. falsely decrease values
C. no appreciable effecT

MeThods for The assay of This subsTance include enzymaTic, colorimefric
and fluoromeTric procedures. All Three procedures are based on a
deTerminaTion of glycerol, afTer conTrolling inTerfering subsTances. WhaT
subsTance is assayed by These meThods?

a. CholesTerol
b. IipoproTein
C. phospholipid
d. Triglyceride

Venous blood is characTerisTically brighT cherry-red when an individual
is poisoned wiTh:

barbiTuraTes.
carbon monoxide.
lead.

meThanoI.

QOCTO)

199

a“

“ ._,1 Xvi .

73

A paTienT in The emergency room has The following signs: comaTose,
Tremors, convulsions and vomiTing. The laboraTory TesTs ordered have
These resulTs:

sodium 132 mEq/L (emission flame phoTomeTry)
poTassium 3.1 mEq/L (emission flame phoTomeTry)
chloride 102 mEq/L (coulomeTry)
glucose 85 mg/dl (hexokinase)
drug screen negaTive (TLC and GLC)

An increased deflecTion of The liThium response meTer is noTed when
performing The sodium and poTassium analyses on This paTienT's sample,
buT noT on oTher samples or conTrols. The elecTrolyTes are repeafed,
using ion-selecTive elecTrodes wiTh The following resulTs:

sodium 142 mEq/L
poTassium 4.0 mEq/L
Chloride 101 mEq/L
Which of The following sTaTemenTs describes The mosT appropriale dLTlWH

The TechnoIOgisT should Take?

a. reporT The flame phoTomeTry resulTs and recommend ThaT a blood alcohol
analysis be performed

b. reporT The ion-selecTive elecTrode resulTs and recommend ThaT a blood
alcohol analysis be performed

c. reporT The ion-selecTive elecTrode resulTs and recommend ThaT a serum
liThium analysis be performed

d. reporT The flame phoTomeTry resulTs and recommend ThaT serum lead,
DUN and arTerial blood gas analyses be performed

A Toxicology screen is ordered on a comaTose paTienT in The emergency

room. The Thin layer chromaTography screen is negaTive, buT The eThanol‘
assay using alcohol dehydrogenase (ADH) gives a value of 65 mg/dl). Th1?
value is well below The Toxic level for eThanol (greaTer Than 200 mg/dl).
Gas-liquid chromaTography is Performed and no eTthol peak is observed. How
can This discrepancy be explained?

. The value for eThanol by enzyme assay was due To The presence of meThanol
The value for eThanol by enzyme assay was due To isopropyl alcohol

The paTienT's serum conTains abnormal levels of NADH

. The paTienT's carboxyhemoglobin level is highly elevaTed

QOU'O)

REFERENCES

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Bellaire, Texas: American Society for Medical
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American Society for Medical Technology. Differentiation
among MT,_MLT and CLA expected capabilities at career
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American Society for Medical Technology. Statements of
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ASMT News, August, 1976.

Beard, M. A., Sesney, J., Stringham, R. M., G McDonald, J. H.
Developing an integrated, competency-based medical
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vention). ‘Unpublished report, Michigan State University,
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Davis, B. G: Deve10pment of competency-based, career-entry
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Garza, J. Wayne State University's medical technology compre-
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162-168.

VITA

VITA

Jennifer Paver Griffin was born in Chicago, Illinois,
in 1953, and raised in Detroit, Michigan. She received her
Bachelor of Science degree in medical technology from
Michigan State University (1975) and her professional
training at Bronson Methodist Hospital in Kalamazoo,
Michigan (1976). Prior to her graduate studies, Jennifer
was employed as a medical technologist in Midland, Michigan.
Since beginning her studies in 1978, she has been employed
as a medical technologist at Ingham Medical Center in
Lansing, Michigan, and as education coordinator at Port
Huron Hospital in Port Huron, Michigan. She currently
resides in Portage, Michigan, with her husband, Mark, and
is employed as assistant hematology supervisor at Bronson

Methodist Hospital.

77

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