ACE ASCP Final Exam 2024-2025 Actual Exam 2 Latest Versions, Exams of Nursing

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DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Which of the following condition is the most common cause of increase anion gap? A.Metabolic alkalosis B. Metabolic acidosis Respiratory acidosis Respiratory alkalosis - correct answer B. Metabolic acidosis High anion gap metabolic acidosis is caused generally by the body producing too much acid or not producing enough bicarbonate. This is often due to an increase in lactic acid or ketoacids, or it may be a sign of kidney failure. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin. Which of the following enzymes has the longest elevation after Myocardial Infarction (MI)? CK-MB Myoglobin Troponin AOTA - correct answer C. Troponin Troponin is elevated up to 10-14 days after Myocardial Infarction. Lactic acid specimen: Chilled and separated from cells Heated

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Room temperature Request EDTA sample only - correct answer A. Chilled and separated from cells Feedback Special Handling: No tourniquet. Place on ice immediately and deliver to lab or aliquot within 15 minutes. DO NOT FREEZE WHOLE BLOOD SPECIMEN. Specific gravity measured by refractometer: 1.035. Protein and glucose both trace in reagent strip: Presence X-ray medium Albuminuria Glucosuria Normal - correct answer A. Presence X-Ray medium Feedback Xray medium/Radiographic dye can cause erroneous results in urine specific gravity measurement. A patient with walking pneumonia is being treated with penicillin. State one possible condition why the patient is not recovering: The organism produces beta lactamase The organism has no cell wall

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) The organism has capsule The organism produces an enzyme that neutralizes the antibiotic - correct answer B. The organism has no cell wall. Feedback Pneumonia caused by Mycoplasma pneumoniae is routinely treated with antibiotics, although the disease is usually self-limiting. The disease is treated with macrolide, tetracycline, or fluoroquinolone classes of antibiotics. All mycoplasmas lack a cell wall and, therefore, all are inherently resistant to beta-lactam antibiotics (e.g., penicillin). What is the coefficient of variation if the mean is 90 and the standard deviation is 5.48?

30 - correct answer B. 6. Feedback: CV= SD/meanX100, (5.48/90)X100= 6.09. Blood smear below denotes Hairy Cell Leukemia (HCL), which of the following test is used to identify this type of leukemia? Image. 1 Myeloperoxidase

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Tartrate-resistant acid phosphatase Tartrate-resistant alkaline phosphatase Sudan Black - correct answer B. Tartrate-resistant acid phosphatase Feedback: Hairy cells demonstrate strong positivity for tartrate-resistant acid phosphatase (TRAP) staining. The hairy cells are larger than normal and positive for CD19, CD20, CD22, CD11c, CD25, CD103, and FMC7. Use to differentiate Salmonella from Citrobacter: Lysine decarboxylase ONPG Indole Vogues Proskauerterm- 9 - correct answer A. Lysine decarboxylase Feedback: Salmonella (+); Citrobacter (-) Arrange the common Rh antigens according to immunogenicity (greatest to least): D>c>E>C>e

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) D>C>E>c>e D>c>E>e>C C>D>c>E>e - correct answer A. D>c>E>C>e Feedback Most immunogenic D > c > E > C > e least immunogenic. Most common error in Polymerase Chain Reaction (PCR) is NUCLEIC ACID CONTAMINATION. A True ( correct answer ) B False - correct answer A. True What disease is associated with the possession of HLA-B27? Ankylosing spondylitis Hashimoto's Disease Goodpasture's syndrome SLE - correct answer A. Ankylosing spondylitis Feedback: Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies). The HLA-B27 gene can be detected in the blood of most patients with ankylosing spondylitis.

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Burr cells are seen in the peripheral blood smear, this is indicative of? (Fig. 2) Uremia (Kidney Disease) Anemia Leukemia Liver Disease - correct answer A. Uremia (kidney Disease) Feedback: The above shown picture illustrates Burr cells, these cells are indicative of Uremia (kidney disease) Anti IgG (-); C3d (+): What should the MLS do? Elution IAT DAT Pre-warm - correct answer D. Pre-warm Feedback Prewarm technique can be used to prevent cold-reactive alloantibodies or autoantibodies from reacting in the IAT phase. Specifically, prewarm technique prevents cold

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) antibodies from binding complement at RT (as opposed to 37o C ) and subsequently being detected by anti-C3 in the IAT by polyspecific AHG serum. Maximum interval which a recipient sample maybe used for crossmatching if the patient has been recently transfused, has been pregnant? 2 days 6 days 3 days NOTA - correct answer C. 3 days CIN (Cefsulodin, Irgasan, Novobiocin) Agar is a recommended culture medium for the recovery of: Rhodococcus equi Cardiobacterium hominis Brucella suis Yersinia enterocolitica - correct answer D. Yersinia enterocolitica Feedback: CIN Agar is recommended for use in the selective and differential isolation of Yersinia and Aeromonas species from clinical specimens, environmental samples, and food sources. Yersinia enterocolitica will exhibit bull's eye appearance on the said agar.

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) What is the formula for sensitivity? TP/(TP+FN)x TP/(TP+FP)x (TP+FN)/TPx (TP+FP)/TNx100 - correct answer A. TP/(TP+FN)x CThe anemias of the qualitative hemoglobinopathies, such as sickle cell anemia, are morphologically classified as: Microcytic, hypochromic Macrocytic, normochromic Normocytic, normochromic NOTA - correct answer C. Normocytic, normochromic According to AABB standards, Fresh Frozen Plasma (FFP) must be infused within what period of time following thawing? 24 hrs 36 hrs

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 48 hrs 72 hrs - correct answer A. 24 hours A woman having menstrual cycle would have the ff. result: Increased TIBC Increased Ferritin Increase % Saturation Normal Transferrin - correct answer A. Increased TIBC Feedback A total iron binding capacity value above 450 mcg/dL usually means that there's a low level of iron in your blood. This may be caused by a lack of iron in the diet, increased blood loss during menstruation, pregnancy, or a chronic infection. Causative agent of "Cat bite fever" Pasteurella multocida Actinomyces israelii Bartonella henselae Leptospira interrogans - correct answer A. Pasteurella multocida

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Feedback Pasteurella species are commonly isolated pathogens in most animal bites, especially in dog- and cat-related injuries. These injuries can be aggressive, with skin manifestations typically appearing within 24 hours following a bite. These wounds can exhibit a rapidly progressive soft-tissue inflammation that may resemble group A β-hemolytic Streptococcus pyogenes infections. What is the sugar fermented by Staphylococcus aureus? Mannitol Sucrose Glucose Maltose - correct answer A. Mannitol Mannitol salt agar is a commonly used growth medium in microbiology. It encourages the growth of a group of certain bacteria while inhibiting the growth of others. It contains a high concentration (7.5%-10%) of salt (NaCl), making it selective for gram positive bacteria Staphylococci (and Micrococcaceae) since this level of NaCl is inhibitory to most other bacteria. It is also a differential medium for mannitol fermentors, containing mannitol and the indicator phenol red. Staphylococcus aureus produce yellow colonies with yellow zones, whereas other Staphylococci produce small pink or red colonies with no colour change to the medium. If an organism can ferment mannitol, an acidic byproduct is formed that will cause the phenol red in the agar to turn yellow. Identify the organism: Fig. 3 Blastomyces dermatitidis

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Malasezia furfur Alternaria Candida albicans - correct answer A. Blastomyces dermatitidis Feedback The above image show broad base budding. What is the first step in agglutination? Sensitization Precipitation Diffusion Lattice formation - correct answer A. Sensitization Feedback Agglutination involves two process: First, sensitization or initial binding. Second, lattice formation or formation of large aggregates. Sterilization of autoclave: 121°C at 20 lbs/psi for 30 minutes 121°C at 15 lbs/psi for 15 minutes

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 85°C for 15 lbs/psi 30 minutes 100°C for 20 lbs/psi 50 minutes - correct answer B. 121°C at 15 lbs/psi for 15 minutes Feedback Many autoclaves are used to sterilize equipment and supplies by subjecting them to high-pressure saturated steam at 121°C (249 °F) for around 15-20 minutes depending on the size of the load and the contents. A newborn infant has a WBC count of 37,000/ul with the differential count revealing the presence of 50 nRBCs per 100 WBCs. What is the corrected WBC count? 15,000/ul 24,700/ul 27,300/ul 12,500/ul - correct answer B. 24,700/ul Feedback Corrected WBC count= Uncorrected WBC count x100/nRBCs+100: Thus, (37,000ulx100/50+100= 24,700ul) Gram positive bacilli; non-motile; non-hemolytic; catalase positive; spore forming: B. anthracis B. cereus N. meningitidis

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) N. lactamica - correct answer B. B. anthracis Feedback Important distinguishing characteristics between B. anthracis and B. cereus is motility, B. anthracis is non motile while B. cereus is motile. Hair perforation test/Hair baiting test is for identification of which two fungi? Aspergillus niger and A. japonicus Tinea pedis and T. corporis Trichophyton mentagrophyte and T. rubrum C. albicans and C. tropicalis - correct answer C. Trichophyton mentagrophyte and T. rubrum Feedback Trichophyton mentagrophyte is positive and T. rubrum is negative What is the minimum platelet count before you perform apheresis? 500 200 150 250 - correct answer C. 150.

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Feedback Apheresis donors with low normal pre-procedure platelet counts (150 - 200 x 10 9/L) and Hb concentration (12.5 - 13 g/dL) should be examined for post-donation drops in these haematological parameters Gram negative bacteria, normally found in the oropharyngeal tract of mammals, they are involved in the pathogenesis of some animal bite wounds as well as periodontal diseases. This bacteria exhibits GLIDING MOTILITY: Leptospira Actinobacillus Capnocytophaga Chlamydia - correct answer C. Capnocytophaga Feedback The term Capnocytophaga comes from "Capno" for its dependence on CO2 and "cytophaga" for its flexibility and mobility shift (" gliding motility "). Urine with an specific gravity consistently between 1.002 and 1.003 indicates: Acute glomerulonephritis Renal tubular failure Addison's disease Diabetes insipidus - correct answer D. Diabetes insipidus

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Feedback Low specific gravity (SG) (1.001-1.003) may indicate the presence of diabetes insipidus, a disease caused by impaired functioning of antidiuretic hormone (ADH). Low SG also may occur in patients with glomerulonephritis, pyelonephritis, and other renal abnormalities. Primidone monitoring: suspected to have primidone overdose, but the serum concentration is within the normal range, what should the MLS do next? Measure procainamide concentration Measure phenobarbital concentration Measure phenytoin concentration Eliminate primidone overdose as possible diagnosis - correct answer B. Measure phenobarbital concentration Feedback Primidone is a structural analog of phenobarbital. Postprandial turbidity of the serum is due to the presence of? Fatty acid Cholesterol Phospholipid Lipoproteins - correct answer D. Lipoproteins

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Feedback For approximately two to eight hours following a meal there is an additional LIPOPROTEIN class, called chylomicrons, representing the transport of dietary fat absorbed in the intestine. A patient with an anti-K and an anti-JKa in her plasma needs 2 units of RBC for surgery. How many group specific units would need to be screened to find 2 units of RBC? The frequency of Jka+ is 80% and K+ frequency is 15%. - correct answer B. 12 Feedback Formula: Number of units to crossmatch is equivalent to: # of units need by patient/(frequency of negativity of antigen #1 x frequency of negativity of antigen #2). Negativity of Jka+ is .20%, Negativity of K+ is .85%. Using the formula, 2 units/(.20x.85)=11. rounded to 12. An alkaline urine refrigerated becomes turbid because of? Amorphous phosphates Amorphous urates WBC Bacteria - correct answer A. Amorphous phosphates Feedback Amorphous phosphates are usually formed in alkaline urine and they are without a color. The precipitate of amorphous phosphates is white while Amorphous urates are yellow, yellow-brown or pinkish in color. They tend to form in acidic urine and their precipitate is pink with a cloudy appearance of the mixed urine. Amorphous urates are a normal presence in the urine. Test for Paroxysmal Cold Hemoglobinuria (PCH):

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Autohemolysis test Donath-Landsteiner Test Sucrose hemolysis test NOTA - correct answer B. Donath-Landsteiner Test Feedback Normal= (-) hemolysis on test and control, PCH= (-) hemolysis on control but (+) hemolysis on test sample. In emphysema, the absence of alpha-1 globulin peak is due the deficiency of: A1-Antitrypsin (AAT) Macroglobulin Hemopexin Transferrin - correct answer A1-Antitrypsin (AAT) Feedback Alpha-1 antitrypsin deficiency is an inherited disorder that may cause lung disease and liver disease. Affected individuals often develop emphysema, which is a lung disease caused by damage to the small air sacs in the lungs (alveoli). Characteristic features of emphysema include difficulty breathing, a hacking cough, and a barrel-shaped chest. Identify the organism: Fig. 4

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Clostridium difficile Mycobacterium tuberculosis Listeria monocytogenes Corynebacterium diphtheriae - correct answer A. Mycobacterium tuberculosis Feedback Mycobacterium tuberculosis is an obligate pathogenic bacterial species in the family Mycobacteriaceae and the causative agent of tuberculosis. M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. Cells are curved rod-shaped and are often seen wrapped together, due to the presence of fatty acids in the cell wall that stick together. This appearance is referred to as cording, like strands of cord that make up a rope. M. tuberculosis is characterized in tissue by caseating granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei. A and B blood group antigens are derived when glycosyltransferases add specific sugars to precursor H. What is the terminal sugar for B antigen? Fucose D-galactose N-acetylglucosamine N-acetylgalactosamine - correct answer B. D-galactose Feedback The A Blood Type is the H antigen with N-acetylgalactosamine attached. The B Blood Type is the H antigen with D-galactose attached. The O Blood Type is the H antigen with no additional sugar attached.

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) The reverse Camp Test, lecithinase production, double zone hemolysis and gram stain morphology are all useful identification of: Campylobacter jejuni Staphylococcus aureus Listeria monocytogenes Clostridium perfringens - correct answer D. Clostridium perfringens Feedback: Clostridium perfringens (formerly known as C. welchii, or Bacillus welchii) is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium. Clostridium perfringens shows double-zone hemolysis on blood agar. Small area of beta hemolysis are noted (complete lysis of red blood cells) surrounded by a larger zone of alpha hemolysis (partial hemolysis). According to AABB Standards, at least 90% of all Apheresis Platelets units tested shall contain a minimum of how many platelets? 5.5 X 10^ 11 5.0 X 10^ 3.0 X 10^

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 6.5 X 10^11 - correct answer Feedback As per AABB Standards, at least 90% of platelet pheresis units sampled must contain at least 3.0 x 10^11 platelets. When performing semen analysis, sperm count is done: After collection After liquefaction No certain time NOTA - correct answer B. After liquefaction Feedback Sperm count is done after liquefaction which is approximately 20-30 minutes. Latex agglutination for Staphylococcus aureus: Protein A and nuclease Phosphotase and protein A Protein A and clumping factor All of the above - correct answer C. Protein A and clumping factor Which of the following blood test uses radioimmunoassay test to detect direct and specific IgE?

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Radioallergosorbent Test (RAST) Radioimmunosorbent Test (RIST) A and B None of the above - correct answer A. Radioallergosorbent Test (RAST) Feedback RAST test is used to detect direct and specific IgE. RIST test is used to detect total serum IgE. Which of the following factors are affected by Coumadin Therapy? III, VII, VIII X, V, II, I II, VII, IX, X AOTA - correct answer c. Feedback The following factors are said to be Vitamin K Dependent factors. Coagulation factors affected by coumadin drugs are: II, VII, IX and X. What analyte is monitored in preeclampsia? Potassium

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Ammonia Magnesium Ionized Calcium - correct answer c. Magnesium Feedback Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia. Identify: FI.g 5 Heinz bodies Basophilic stippling Howell-Jolly bodies Auer rods - correct answer A. Heinz Bodies Feedback Heinz bodies (also referred to as "Heinz-Ehrlich bodies") are inclusions within red blood cells composed of denatured hemoglobin. It is also seen in cases of moth balls (naphthalene) ingestion. High-Level Aminoglycoside Resistance: Micrococcus Staphylococcus

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Enterococci AOTA - correct answer C. Enterococci Feedback Enterococci are intrinsically resistant to aminoglycosides; a combination therapy using aminoglycoside with vancomycin has been known to increase the effectiveness of the aminoglycoside. It is important to identify this high-level aminoglycoside resistance (HLAR) to provide appropriate therapy. A patient's record shows a previous anti-Jk(b), but the current antibody screen is negative. What further testing should be done before transfusion? Give Jk(b) negative crossmatch compatible blood Crossmatch type specific units and release only compatible units for transfusion Phenotype the patient's red cells for the Jk(b) antigen AOTA - correct answer A. Give Jk(b) negative crossmatch compatible blood Feedback Delayed hemolytic transfusion reactions may occur in recipients who are previously immunized but who do not have detectable antibody, if they receive blood with the corresponding antigen. When there is a history of clinically significant antibodies, donor red cells should be phenotyped and antigen-negative blood selected. A complete AHG crossmatch must be performed. When introducing a new manual technique, which is the best approach? Case presentation

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Workshop Lecture All of the above - correct answer B. Workshop Duckert's Test 5M Urea Solubility Test is used of: Factor II deficiency Factor XIII deficiency Factor VIII deficiency Factor XII deficiency - correct answer B. Factor XIII deficiency Feedback Duckert's Test is for factor XIII deficiency, Reagent: 5M Urea. Test Results: Normal: Clot is insoluble to urea (24 hrs), Abnormal: Factor XIII deficiency: Clot is soluble to urea (24 hrs) Which of the following should be tested in cases of Antacid overdose? pH Potassium Ammonia

DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Chloride - correct answer A. pH Feedback Antacids do just what their name suggests: they neutralize the normal stomach acid (HCl), causing the pH to rise to a nearly neutral pH of around 6 to 7. As the pH rises above 4, pepsin activity decreases or stops. Some types of antacids, made of sodium bicarbonate (NaHCO3) or calcium carbonate (CaCO3), are easily absorbed into a person's body and can cause a pH imbalance, possibly leading to kidney damage or other problems (Berkow, 1987). 17 - Ketosteroids is produced in the: Adrenal glands Hypothalamus Thyroid glands Pituitary glands - correct answer A. Adrenal glands Feedback 17-ketosteroids are substances that form when the body breaks down male steroid sex hormones called androgens and other hormones released by the adrenal glands in males and females, and by the testes in males. The oxygen sensitive indicator that is used to ensure that anaerobic jars or chambers have met the anaerobic conditions required for anaerobes to grow is: Methylene blue Bromphenol blue