MT Boards Recall Questions 2016

Clinical Chemistry
1) Specimen Collection – (5%)
a) Site for blood collection – Median-Cubital > Cephalic > Basilic
b) Newborn screening uses – Blood spot
c) Suggested length of lancet – 1.75mm
d) Amount of blood in person – 5-7L, 60ml/kg
e) Analytical testing performed outside the lab – POCT
f) Heparinized plasma – preferred sample for electrolytes
g) Anticoagulant that has EDTA – Tan, Pink, White
h) NaF/ml of blood to inhibit glycolysis – 2mg/ml
i) NaF/ml of blood as an anticoagulant – 10mg/ml
j) Cleansing of puncture site – 70% Alcohol, Gauze, Benzalkonium chloride
k) Antiseptic used in ethanol testing – Benzalkonium chloride
l) Number of hours fasting is part of – Patient preparation
m) Most important patient preparation for ammonia analysis – Avoid smoking
n) Unanticoagulated tube for ACP – No effect
o) Another specimen for ACP – Vaginal washing
p) Photosensitive analytes – Bilirubin, β-carotene, Vitamin A
q) Analytes that require chilling – Ammonia, blood gases, lactic acid, catecholamines
r) Analytes with diurnal variation – ACP, Iron, Cortisol, ACTH, Aldosterone, GH etc.
s) Analytes increased in alcoholism – GGT, TAG, Urates
t) 10% contamination with 5% dextrose – Increase glucose concentration by 500mg/dl
u) 25mg/dl Bilirubin – Icteric sample

2) Instrumentation (Principles, Methods, Calibration, Others) – (5%)

a) Visible light spectrum – 400-700nm
b) X axis values – Horizontal, Independent variable
c) Discrete Analyzer – Vitros, Dimension
d) QC for ISE – Anion gap
e) Potentiometry – pH, pCO2
f) Amperometry – pO2
g) POCT PT Principle – Immunochromatography
h) Prolonged light exposure – Increased fluorescence
i) Effects of absorbing molecules in fluorescence – Decreased fluorescence
j) Disadvantage of Fluorometry – Quenching
k) Hardware – Keyboard, mouse, storage device

3) Reagent Preparation and Laboratory Mathematics – (5%)

a) Bilirubin conversion factor – 17.1
b) BUN to Urea – 2.14
c) SI unit of Glucose – mmol/L
d) SI unit for Creatinine - µmol/L
e) Not included in computation of LDL – VLDL
f) How many grams of NaCl is needed to make 1L of saline – 8.5g
g) How many ml of NaOCl is needed to make 10L of disinfectant – 1000ml
4) Quality Assurance – (10%)
a) 12s = warning rule
b) Random Error – 13s, R4s, 12s
c) Systematic Error – 22s, 41s, 10x
d) Type of variation that is present in all measurements and are due to chance and can be both positive and negative – Random
e) Sample blank – correct for sample interferences (used if analyte to be measured is Bilirubin, HgB)
f) What kind of QC involves analysis of control samples together with patient specimen – Internal/Intralab QC
g) Delta Check – Comparison of previous patient results
h) Shift – Improper calibration
i) Trend – Deterioration of reagent
j) Relative indicator of precision - CV
k) Smaller CV – Greater precision
l) Non-laboratory personnel results in – 29% error

5) Metabolic Blood Tests (Principles, Procedures, Diseases/Disorders, Reference Values) – (50%)

a) Water Balance and Electrolytes – (8%)
i) Routinely measured electrolytes – Na, K, Cl, HCO3
ii) Primary contributor to osmolality – Sodium
iii) Major extracellular cation – Sodium
iv) Major extracellular anion – Chloride
v) Primary counterion of Sodium - Chloride
vi) Hyponatremia – DM
vii) Least affects Anion Gap – K
viii) >12mOsm/kg – DKA, Drug overdose, Renal failure, Ethanol poisoning

b) NPN and Other Metabolic Intermediaries and Inorganic Ions – (8%)

i) Major NPN – Urea
ii) 2nd prevalent NPN – Amino acids
iii) Urea method that is inexpensive but lacks specificity – Colorimetric, diacetyl
iv) Urease – Ammonia formation
v) Simplest Jaffe reaction – Colorimetric, Endpoint
vi) BUN:Creatinine ratio – 10:1
vii) Caraway – Uric Acid
viii) Assay for uric acid, problems with turbidity - Colorimetric
ix) Uricase – Enzymatic + UV
x) Conway – Ammonia
xi) Classification of Azotemia – pre-renal, renal, post-renal

c) Carbohydrates – (6%)
i) Nelson-Somogyi – Arsenomolybdate Blue
ii) OGTT – Ingest at least 150g/day of carbohydrates for 3 days
iii) Whole Blood – 15% lower glucose values than serum/plasma
iv) Rate of glucose metabolism – 7mg/dl/hr
v) Monitoring of Glucose – HbA1c
vi) Monitors insulin shock – RBS*
vii) Not true about type 2 DM – Prone to Ketoacidosis
viii) Whipple’s Triad – Hypoglycemia
ix) Most common Glycogen Storage disease – Type I – Von Gierke – Deficiency in G6P
d) Lipids and Dysproteinemia – (8%)
i) TAG >400mg/dl – Turbid serum, creamy
ii) Cholesterol at 210 mg/dl – Moderate risk
iii) Standing plasma is a test for – TAG
iv) One step method of cholesterol determination - Colorimetric
v) High risk for cardiovascular accident are associated with high – LDL
vi) Type I Hyperlipoproteinemia – Increased CM, TAG
vii) Sinking pre-betalipoprotein – Lp(a)
viii) Floating betalipoprotein – β-VLDL
ix) Reference method for Lipoprotein analysis – Ultracentrifugation
x) Sedimentation unit – Svedberg

e) Specific Proteins – (6%)

i) Analyte associated with dehydration – Albumin
ii) Difference between measured Total Protein and measured Albumin – Globulin
iii) Lysis of RBC will result in – Hgb
iv) BNP – Congestive Heart Failure
v) β-γ Bridging – Cirrhosis
vi) Protein electrophoresis is singly important for – Monoclonal gammopathies
vii) Biuret reagent - RANK

f) Liver Function Tests – (6%)

i) Synthetic function of liver – Albumin, protein, coagulation factors
ii) Analyte for detoxification of liver – Ammonia
iii) Ammonia – Reye’s syndrome, Hepatic coma
iv) Gilbert Syndrome – increased B1
v) 2mg/dl bilirubin – Jaundice
vi) Serum Bilirubin of 20mg/dl – Report immediately

g) Clinical Enzymology – (8%)

i) Reaction rate if directly proportional to substrate concentration – First Order Kinetics
ii) Oxidoreductase – LDH, G6PD
iii) Transferase – CK, AST, ALT
iv) Hydrolase – ACP, ALP, LPS, AMS
v) Lyase – Aldolase, enzymes ending in decarboxylase
vi) No isoenzyme – ALT
vii) Salivary gland – Amylase
viii) 1st enzyme to increase in MI – CK-MB
ix) CK-MB – increase 4-8hrs, peak 12-24hrs, normalize 48-72hrs
x) Intramuscular injection – increased CK-MM
xi) Enzyme with moderate specificity – LDH
xii) LDH greatest increase in – Pernicious anemia
xiii) LD Flipped pattern – MI, Hemolytic Anemia
xiv) LD 4 and 5 – Cold labile
xv) Substrate for Bowers-McComb – PNP
xvi) Paget’s Disease – Osteitis Deformans
xvii) Most specific substrate for ACP – Thymolphthalein Monophosphate
xviii) Direct Rectal exam – Increased ACP
6) Endocrinology and Toxicology (Principles, Procedures, Diseases/Disorders, Reference Values) - (16%)
a) Endocrinology – (10%)
i) Thyroid Hormones – (4%)
(1) Hyperthyroidism – Increased ALP
(2) Test analyte that confirms conflicting thyroid results – rT3/reverse T3
(3) rT3 is formed from the deiodination of T4 in the – blood
(4) Thyrotoxicosis – Plummer’s disease – decreased TSH, normal FT4, increased FT3 and T3

ii) Sex Hormones – (3%)

(1) E1 – Menopause
(2) E2 – Menstruation
(3) E3 – Pregnancy
(4) Most potent Estrogen – E2
(5) Source of E2 – Ovary
(6) Increased in 2nd/3rd trimester – progesterone

iii) Other Hormones (Pituitary, Adrenal) – (3%)

(1) Increased in 1st trimester – HCG
(2) Cushing Syndrome – Increased Cortisol
(3) Insulin promotes – Lipogenesis, Glycolysis, Glycogenesis
(4) Posterior pituitary gland – stores ADH, oxytocin
(5) Angiotensin II – Vasoconstriction, Stimulate Aldosterone production, Regulate BP
(6) Prolactin level if patient underwent breast exam – Increased

b) Toxicology & Therapeutic Drug Monitoring (TDM) – (6%)

i) Substance of Abuse – (2%)
ii) Other Poisons/Toxic Agents (Alcohol, Carbon Monoxide, Mercury, Lead, Arsenic) – (2%)
(1) Unit for ethanol impairment - %wt/vol or mg/dl
(2) Considered legally intoxicated – 100mg/dl or 0.1% wt/vol, 3-4 ounces of whisky

iii) TDM – Anticonvulsants and other Drugs – (2%)

(1) Serum drug concentration is affected by – Absorption, Distribution, Metabolism
(2) Delivery of drug – Distribution
(3) Trough – Collect blood before next dose is given
(4) Petitmal seizure – Valproic acid
(5) Cyclosporine – Immunosuppressant

7) Blood Gas Analysis and Other Tests (Principles, Procedures, Diseases/Disorders, Reference Values) – (4%)
a) Patient with fever – decreased PO2 by 7%, increased PCO2 by 3%
b) Metabolic Acidosis is compensated through - Hyperventilation
c) Metabolic Alkalosis is compensated through - Hypoventilation

8) Laboratory Safety – (5%)

c) Sharps – Red Container
d) Safety Diamond, Blue – Health
e) Fire Type 3 – Electrical
f) Class K fire – fats, kerosene
g) Breakage in Centrifuge – Aerosols are formed
Microbiology and Parasitology
1) Microbiology – (70%)
a) Bacteriology – (49%)
i) Collection, Transport, Processing and Staining of Specimens – (5%)
(1) First thing to be done for collection of sputum sample – Gargle with water
(2) Acid Fast stain in tissues – Kinyoun
(3) AFB stains – Red
(4) Non-acid fast bacteria stains – Blue
(5) Critical step in gram stain – Decolorizer
(6) Nonspecific staining of cellular structures – Fluorochroming
(7) Nasopharyngeal swabs are for – Neisseria, H. influenza, B. pertussis
(8) Late chlamydia specimen must be – Rejected

ii) Culture Media – (5%)

(1) Preferred medium for isolation of B. pertussis – Regan-Lowe/Charcoal Cephalexin Blood Agar
(2) K Tellurite – gray black colony
(3) Cystine Tellurite – C. diptheriae
(4) Cystine glucose – F. tularensis
(5) Significant colony count in urine – 100,000

iii) Bacteria (Aerobes) – (33%)

(1) Morphology and staining characteristics – (5%)
(2) Cultural characteristics – (5%)
(a) Golden yellow colonies in BAP – S. aureus
(b) Alpha-prime – S. aureus
(c) S. saprophyticus – Cystitis
(d) C. amycolatum in nasopharynx – Normal flora
(e) Commonly isolated in ICU – P. aeruginosa
(f) P. aeruginosa – Grows in 42 and 35 degrees Celsius
(g) Flat, serrated colonies with confluent growth on BAP – P. aeruginosa
(h) Salmonella bacterial culture – 2-3 specimen(blood) within 24 hours
(i) Whipple Disease – Trophyrema

(3) Work-up for identification: biochemical, differential and confirmatory tests – (14%)
(a) Clumping factor – Coagulase
(b) 30% H2O2 – Superoxol Test
(c) MR and VP reaction – Opposite
(d) Chromogenic β-lactamase result – Color formation
(e) Demonstrate Streptolysin O – Anaerobic culture
(f) Differentiate S. aureus and S. epidermidis – Coagulase, DNAse
(g) Negative CAMP test – No enhancement of hemolysis
(h) Bile solubility – S. pneumoniae
(i) Similar to C. diptheriae – C. ulcerans
(j) Shigella – Biochemically inert
(k) Acetamide Test – P. aeruginosa (35˚C for 7 days)
(l) Bordetella oxidase & urease (+) – Bronchiseptica
(m) Requires V factor – H. parahemolyticus
(n) Requires X factor – H. ducreyi
 (4) Serologic/molecular tests – (3%)
(a) Not common in microbiology – PCR
(b) Lancefield – Detects carbohydrates in Streptococcus group
(c) Quellung – Capsular swelling
(d) Kauffman-White – Salmonella serotyping

(5) Susceptibility tests – (4%)

(a) Not an antibiotic – Sulfonamide
(b) Penicillin – Inhibit cell wall synthesis
(c) Vancomycin – Inhibit cell wall synthesis
(d) Gentamicin – Inhibit protein synthesis
(e) Clindamycin – Inhibit protein synthesis
(f) ESBL – Extended Spectrum Beta-Lactamase

(6) Bacteriologic examination of water, food, milk and utensils – (2%)

(a) Red milk – S. marcescens
(b) Blue milk – P. aeruginosa
(c) Stormy fermentation of milk – C. perfringens

iv) Bacteria (Anaerobes) – (2%)

(1) Pseudomembranous colitis – C. difficile
(2) Common gut flora – Bacteroides
(3) Gram-positive anaerobes – Peptostreptococcus, peptococcus

v) Mycobacteria – (2%)
(1) AFB smear measures – 2-3cm
(2) MPT 64 – M. tuberculosis
(3) Niacin and nitrate positive – M. tuberculosis
(4) Niacin and nitrate negative – M. bovis
(5) Tween 80 positive – M. kansasii

vi) Other bacteria with unusual growth requirements (Spirochetes, Chlamydia, Mycoplasma, Rickettsia) – (2%)

b) Mycology – (4%)
i) Collection, transport and examination of clinical specimens – (2%)
(1) Basic, branching, intertwining structure of molds – Mycelia
(2) Stain for sharp delineation of fungal elements by fluorescent microscopy – Calcoflour white
(3) Presumptive test for candida that uses serum – Germ tube
(4) Positive hair-baiting test – V-shaped penetration of the hair shaft
(5) Ascospore – Saccharomyces
(6) Farmer lung’s disease – Aspergillus fumigatus
(7) Macroconidia absent – M. audouinii
(8) Microconidia absent – E. floccosum
(9) Epidermophyton – Skin, nails
(10)Microsporum – Skin, hair
(11)Tricophyton – Skin, hair, nails
(12)T. mentragophytes – Positive hair-baiting test
(13)T. rubrum – Red pigment, teardrop shaped conidia
 ii) Culture – (2%)
(1) AMAN medium stain – Lactophenol cotton blue
(2) Cornmeal agar – Chlamydospores
(3) Czapek – Aspergillus
(4) Rice agar – M. canis
(5) Urease media – Cryptococcus neoformans
(6) Birdseed – Phenol oxidase

c) Virology – (4%)
i) General characteristics, transmission and diseases – (2%)
(1) 1st step in viral replication – Adsorption/Attachment and Penetration
(2) Part of virus where envelope is acquired – Nuclear or cytoplasmic membrane
(3) ssDNA virus – Parvovirus
(4) dsRNA – Reovirus
(5) Largest virus - Poxvirus
(6) Largest RNA Virus – Paramyxovirus
(7) Virus that causes acute central nervous system disease in humans and animals – Rabies
(8) Acid sensitive - Rhinovirus
(9) Ether sensitive – Herpes virus

ii) Collection, transport and examination of clinical specimens – (2%)

(1) CMV isolation is recommended using – Human embryonic fibroblasts
(2) Grape-like cluster - Adenovirus

d) Equipment and instrumentation – (5%)

i) Manual – (3%)
(1) How to prepare agar – Add agar to water*
(2) RPM for centrifugation of bacteria – 3500-5000 RPM for 10mins

ii) Automated – (2%)

e) Quality assurance and safety – (8%)

i) Collection of specimen – (2%)
(1) Lyophilization of pure culture – freeze at -20 to -30˚C
(2) Mineral oil – Anaerobes

ii) Quality control – (2%)

(1) Settings of rpm marked on the face of the rheostat control on the centrifuge should be checked – Monthly
(2) Oxidase, Catalase, Coagulase – Tested each day, when vial is first opened

iii) Safety – patient/staff – (2%)

(1) BSC II – Laminar flow
(2) Sterilize needles for sputum – Dip in 70% alcohol + sand

iv) Safety – workplace/environment – (2%)

(1) AFB is killed by – Boiling 10mins, Autoclave
(2) Autoclave - 121˚C, 15 psi(lbs/in2), 15mins
(3) Not killed by sterilization – Prions
2) Parasitology – (30%)
a) Parasites – life cycle, morphological characteristics, epidemiology, prevention and control, manner of reporting, counting – (21%)
b) Nematodes – (5%)
(1) First stage of nematodes – Rhabditiform
(2) Viviparous – Produces larva
(3) Oviparous – Produces egg
(4) Parasite most prevalent in orphanage – Unholy Three
(5) Larvae that passes through the lungs – Ascaris, Stronglyloides, Hookworm
(6) Roundworm that inhabits the small intestine and is usually demonstrated as rhabditiform larvae in fecal specimen – Threadworm
(7) Ascaris egg lacking its mammillated coat – Decorticated
(8) A. lumbricoides vector – Cockroach
(9) Resembles Trichiuris – C. philippinensis
(10)S. stercoralis – Chinese lantern
(11)Adult Trichinella – Intestine
(12)Unsheathed microfilariae – O. volvulus
(13)Longest nematode – D. medinensis
(14)Internal autoinfection – S. stercoralis
(15)External autoinfection – E. vermicularis

ii) Trematodes – (5%)

(1) 1st IH of flukes – Snail
(2) 2nd IH of P. westermani – Fresh water crabs
(3) 2nd IH of Echinostoma – Snail
(4) 2nd IH of Fasciola/Fasciolopsis – Aquatic vegetation
(5) Parasite found in sheep/cattle, not common in PH – F. hepatica
(6) Eggs with abopercular thickening – P. westermani
(7) Small lateral spine – S. japonicum
(8) Prominent lateral spine – S. mansoni
(9) Terminal spine – S. haematobium
(10)Schistosomule – Cercaria minus tail
(11)Swimmer’s itch – Schistosoma
(12)C. sinensis – Old fashioned light bulb
(13)Mode of transmission of Clonorchis – Ingestion of metacercaria

iii) Cestodes – (5%)

(1) Head of tapeworm - Scolex
(2) Body of tapeworm – Strobila
(3) Finger-like uterine branches – T. solium
(4) Tree-like uterine branches – T. saginata
(5) 3rd Taenia specie – Taenia asiatica
(6) Hexacanth embryo in a radially striated shell – Taenia
(7) Hexacanth embryo that lacks polar filaments – H. diminuta
(8) Egg of D. latum – Operculated
(9) 1st IH of D. latum – Copepods
(10)2nd IH of D. latum – Fresh water fish
(11)Spirometra – May resemble D. latum
(12)Found in IH of E. granulosus – Hydatid cyst
(13)Double-pored tapeworm – D. caninum
 iv) Protozoa – (5%)
(1) Motile, reproducing, feeding stage – Trophozoite
(2) Organ most often involved in extraintestinal amoebiasis – Liver
(3) E. histolytica – Ingest RBC
(4) Differentiates hartmanni and histolytica – Size
(5) E. gingivalis – Ingests WBC
(6) E. nana – Cross-eyed cyst
(7) Often mistaken for cyst of amoeba – B. hominis
(8) Largest intestinal protozoa – B. coli
(9) Undulating membrane – Trichomonas, Trypanosoma
(10)Intestinal flagellate is described as – Pear-shaped
(11)T. vaginalis – Jerking, tumbling motility
(12)Ping pong disease – T. vaginalis
(13)Vector of African sleeping sickness – Glossina species
(14)DH for Plasmodium species – Female Anopheles mosquito
(15)Principal vector for malaria – Flavirostris
(16)Plasmodium species that can cause relapse – P. vivax, P. ovale
(17)Not recommended for Venipuncture – Malaria, Babesia, Hemoflagellates
(18)Blood specimen preferred for protozoa – Finger puncture
(19)90% cases of malaria caused by – P. vivax and falciparum
(20)Toxoplasma gondii – cat

v) Ectoparasites – (1%)
(1) Crabs – Ectoparasite

c) Parasitologic Techniques – (5%)

i) Routine – (2%)
(1) Iodine – Destroys trophozoites
(2) Stain to demonstrate uterine arrangement of Taenia species – India ink
(3) Chromatoid bodies on Trichrome stain is colored as – Bright to red
(4) Stain for Naegleria, Acanthamoeba – H&E, Wright’s
(5) To detect stippling, prepare blood films – 30mins to 1hr
(6) Reagent for kato-thick smear – Malachite green, glycerine, cellophane

ii) Concentration – (2%)

(1) Zinc sulfate specific gravity – 1.18
(2) Flotation techniques – Operculated eggs and eggs with spines not recovered

iii) Others – (1%)

(1) Sheather’s sugar flotation – Cryptosporidium
(2) Baermann funnel - Strongyloides

d) Quality assurance – (4%)

i) Collection and preservation of specimen – (2%)
(1) Stool for more than 1hr is stored at – Refrigerator
(2) Stool preservative – Polyvinyl alcohol, Schaudinn

ii) Quality control – (2%)

Clinical Microscopy
1. Urine – (53%)
a. Anatomy and physiology of the kidney, Formation of Urine – (5%)
i. Specific gravity of glomerular filtrate – 1.010
ii. Proximal convoluted tubules – Site for reabsorption of glucose, amino acids, NaCl
iii. Major organic substance in urine – Urea
iv. Major inorganic substance in urine - Chloride
v. Albumin – Maintains oncotic pressure
vi. Not normally found in urine – Protein
vii. Renin – Maintain BP

b. Macroscopic examination – (10%)

i. <400ml urine – Oliguria
ii. >2000ml urine – Polyuria
iii. Incapable of producing urine - Anuria
iv. Print blurred through urine – Cloudy
v. Atabrine – Yellow
vi. Carotene – Yellow
vii. Tea bag color of urine – Brown
viii. Portwine urine – Porphyrin
ix. Reddish-orange urine – Rifampin
x. Yellow foam – Bilirubin
xi. Oily looking substance on top of urine – Indicative of nephrotic syndrome

c. Chemical Analyses – (18%)

i. Acidic urine – High meat diet, DM
ii. Alkaline urine – Vegetable diet
iii. pH – Aids in crystal identification
iv. RCM – Increased SG
v. DM – Increased SG
vi. Color of glucose in potassium iodide strip – Green to brown
vii. Clinitest – Detection of reducing substances
viii. Most numbered ketone body – B-hydroxybutyric acid
ix. Starvation/Diabetes – Ketones
x. Legal’s test – Ketones
xi. Ketone reagent strip - Purple
xii. UTI screening – Nitrite
xiii. Protein principle – Error of indicator
xiv. Protein reagent strip detects - Albumin
xv. Turbidity with granulation – 2+
xvi. Ictotest – Bilirubin
xvii. Ehrlich units – Used in reporting urobilinogen
xviii. Blondheim’s Test – Differentiates hemoglobinuria and myoglobinuria
xix. 11th pad in reagent strip – Ascorbic acid
xx. Sulkowitch – Calcium
xxi. Fantus - Chloride
xxii. CTAB – Mucopolysaccharidosis
xxiii. PAH, PSP – Tests for tubular secretion, renal blood flow
 d. Microscopic examination – (15%)
i. Largest cell found in urine sediment – Squamous epithelial cell
ii. Clue cell – Bacterial vaginosis
iii. Frequent parasite encountered in urine – T. vaginalis
iv. Fecal contamination of urine sample – E. vermicularis
v. Urinalysis findings in patient with renal calculi – Hematuria
vi. Renal lithiasis – Hematuria
vii. Ghost cell- RBC in hypotonic solution
viii. Glitter cell – WBC in hypotonic solution
ix. WBC/RBC reporting – Per hpf
x. Eosinophils – Seen in Acute Interstitial Nephritis
xi. RTE Cells – Eccentric nucleus
xii. Lipid-containing RTE Cells – Oval fat bodies
xiii. RTE cells with nonlipid-containing vacuoles – Bubble cells
xiv. Lemon-shaped crystal – Uric acid
xv. Amorphous urates – Soluble with heat
xvi. Ethylene glycol poisoning – Calcium oxalate monohydrate
xvii. Ampicillin – Sheaves, needles
xviii. Crystal in Fanconi’s syndrome – Cystine
xix. Abnormal crystals seen in liver disorders – Bilirubin, Leucine, Tyrosine
xx. Sulfonamide crystals – Confirmed by the diazo reaction
xxi. Apatite – Calcium phosphate
xxii. Thorny apple – Ammonium biurate
xxiii. Cylindroids – Disintegration forms of cast with tails and tapering ends
xxiv. Significance of cylindroids – Same as casts
xxv. Effect of alkaline, hypotonic urine – cast disintegrates
xxvi. Degenerative form of all casts – Waxy
xxvii. Telescoped sediment – Findings of nephrotic syndrome and glomerulonephritis

e. Pregnancy testing – (2%)

f. Renal calculi – (3%)

i. Yellow to brownish red, moderately hard – Uric acid and urate stones
ii. Pale and friable – Phosphate stones
iii. Very hard, dark color, rough surface – Calcium oxalate stones
iv. Yellow-brown resembling an old soap, somewhat greasy – Cystine stones
v. Chemical used to detect renal calculi made up of PO4 – Ammonium molybdate in HNO3
vi. Least common urinary stone – Cystine

2. Feces – (3%)
a. Normal stool pH – 7-8
b. Fecal leukocytes indicating invasive infection – 3/hpf
c. Stool color when taking multivitamins with iron – Black
d. Stool color if patient have melanoma – Black
e. APT reagent – 1% NaOH
f. APT in infant – Pink
g. FOBT – Colorectal cancer
h. Positive color for guiac – blue
3. Other Body Fluids – (21%)
a. CSF – (5%)
i. Produces 70% CSF – Choroid plexus
ii. Clot formation and bloody CSF – Traumatic tap
iii. Laboratory test for CSF protein – Turbidimetric, Dye-binding
iv. Normal value of protein in CSF – 15-45mg or <1%
v. CSF Glucose – 2/3 of plasma
vi. Cloudy CSF dilution – 1:200
vii. Predominant WBC in adult CSF – Lymphocyte
viii. Predominant WBC in newborn CSF - Monocyte

b. Seminal Fluid – (5%)

i. Spermatogonia – Youngest
ii. Acrosomoal cap – ½ of head 2/3 of nucleus
iii. Sperm count dilution – 1:20
iv. Alternate diluting fluid – Chilled water
v. Stain to assess sperm morphology – Paps
vi. How many fields viewed to assess sperm morphology – 20
vii. Sperm graded as freely moving – 4
viii. Neutral alpha glucosidase – Epididymis
ix. Enzymes that can liquefy semen – Chymotrypsin, plasmin, pepsin
x. Most common cause of male infertility – Varicocele
xi. Infertility – 1.5ml semen
xii. Red seminal fluid – Blood
xiii. Makler counting chamber – Undiluted sperm
xiv. Oligospermia – Decreased sperm count

c. Amniotic Fluid – (3%)

i. Amniotic fluid volume after first trimester – Fetal urine
ii. Gestational age - Creatinine
iii. Dark brown amniotic fluid – Fetal death
iv. Dark green amniotic fluid – Meconium
v. OD 450 - Bilirubin
vi. Additional test to be done for elevated AFP amniotic fluid – Acetylcholinesterase

d. Gastric Fluid and Duodenal Content – (2%)

i. Gastric tube inserted through mouth – Rehfuss
ii. Gastric tube inserted through nose – Levine
iii. Diagnex – Tubeless gastric analysis
iv. BAO – Basal Acid Output
v. Pernicious Anemia – Anti-parietal antibodies
vi. Zollinger Ellison – Elevated gastrin

e. Sputum and Bronchial Washings – (2%)

i. Bronchitis – Dittrich plugs
ii. Bronchial asthma – Charcot-Leyden crystals, Curschmann spiral
iii. Charcot-Leyden crystals – Red, spindle-shaped crystals
iv. Creola bodies – Bronchial asthma
 f. Synovial Fluid – (2%)
i. Normal synovial fluid - <3.5ml
ii. Synovial fluid glucose – Comparable with serum
iii. Clotted synovial fluid – Use of acetic acid

g. Peritoneal, Pleural and Pericardial Fluids – (2%)

i. Normal color and appearance of peritoneal fluid – Clear, pale yellow
ii. Accumulation of fluid in serous membranes – Effusion
iii. Concentric striations of collage-like material in peritoneal fluid associated with ovarian and thyroid malignancy – Psammoma bodies
iv. Peritoneal lavage – Determination of intra-abdominal bleeding

4. Collection, preservation and handling of specimens – (10%)

a. Chain of Custody – Step by step documentation of handling and testing of legal specimens
b. Routine amount of urine – 10-15ml
c. Urine container capacity for drug testing – 60ml
d. Urine for drug testing temperature – 32.5-37.7 degrees Celsius within 4mins
e. Bluing agent – Prevent adulteration
f. Used in analytes with diurnal variation – Timed specimen
g. Proper container for urobilinogen determination – Amber bottle
h. What should be done if pink sediment is seen after refrigeration – Return to RT
i. Additive used in Addis count – Formalin
j. Amniotic fluid for fetal lung maturity is stored at – Refrigerator
k. To prolong cell viability for cytogenetic studies, specimen should be – Incubated at 37˚C
l. Specimen for detection of male/female anti-sperm antibody – Serum, semen, cervical mucus
m. Fructose storage – Frozen
n. Synovial fluid cell count – EDTA
o. Specimen for tubeless gastric acid analysis - Urine
p. Specimen for fecal fat determination – 3-day sample

5. Microscope, automation, other instruments – (5%)

a. Urinometer – Read at lower meniscus
b. Calibration solution for refractometer – 9% sucrose (1.034 ± 0.001)
c. Calibration of refractometer – 5% NaCl (1.022 ± 0.001)
d. Distilled water – 1.000
e. Air bubbles – Error in refractometer
f. CASA – Computer Assisted Sperm Analysis
g. Crystals and OFB – Polarizing microscope
h. Condenser-equipped microscope – Phase contrast
i. Cytocentrifuge – 30% albumin

6. Quality assurance and laboratory safety – (8%)

a. To disinfect countertops with spill use – 10% bleach
b. Biohazard color – Black in yellow background
c. Chain of Infection – 6
d. Safety Diamond, 4 means – Extreme
e. RACE, A – Alarm
f. PDCA – Plan-Do-Check-Act
g. PDSA – Plan-Do-Study-Act
Hematology
1) Blood collection, anticoagulants and others (including Safety) – (5%)
a) Size of blood for smear – 2-3mm
b) Distance of blood drop from the edge of the label – 0.25in/1cm
c) Longitudinal – Most ideal method for reading smear
d) Length of needle – 1-1.5in
e) Gauge in tuberculin syringe – 25
f) Gauge of needle in bleeding of donors – 16
g) Ocular – Interpupillar distance

2) Hematology tests and procedures – (30%)

a) Routine – (15%)
i) Degree of hypochromia measured as 1/3 – Normal
ii) Macrocyte in ESR – False increase
iii) Effect of increased Hgb in ESR – Increased
iv) ESR in wintrobe tube is read using – Left side
v) Disposable ESR tubes – Dispettes
vi) Hematocrit method in wintrobe – Macrohematocrit
vii) Size of the unfilled portion of the capillary tube in microhematocrit – 10-15mm
viii) Length of capillary tube – 75mm
ix) Length of plug in capillary tube – 4-6mm
x) Centrifugation for microhematocrit – 10,000-15,000g for 5mins
xi) 1st layer in spun hematocrit – Fat
xii) 4th layer in spun hematocrit - RBC
xiii) MCV – Computed from hematocrit and RBC count
xiv) 1 RBC not counted – Decrease count by 10,000
xv) Measures erythropoiesis – Reticulocyte count
xvi) 3-5% rouleaux – Slight high

b) Automation – (10%)
i) Relation of voltage pulse to cell size – Directly proportional
ii) Blood clots will have what effect on RBC count using automated counters – Decreased
iii) Positive error – Bubbles, electric impulse, aperture plugs
iv) Negative error – Hemolysis
v) Platelet satellitism – Decreased platelet count

c) Special – (5%)
i) Screening test for HbS – Dithionite solubility
ii) Requires fresh sample – MPO, LAP
iii) Differentiate Leukemoid Reaction from CML – LAP

3) Hematopoiesis, Diseases/Disorders and Reference Values – (40%)

a) Hematopoiesis (in general) – (6%)
i) Pluripotential stem cell – 2 possible cell lines
ii) Differentiate pure anemia from bone marrow malfunction – WBC count
iii) Bone marrow – Sternum, tibia, POSIC
iv) Not true regarding yellow marrow – Hematopoietic
v) CD 34 – Stem Cell
b) Erythropoiesis and RBCs – (12%)
i) Generates ATP – Embden-Meyerhof
ii) Generates 2,3-DPG – Luebering-Rapoport
iii) Decreased affinity to O2 is associated with – Increased Temperatire, 2,3-DPG, CO, decreased blood pH
iv) Acanthocyte – McLeod phenotype, abetalipoproteinemia
v) Bronze cells – Spherocytes
vi) Codocyte – Mexican hat cell
vii) Dacryocyte – Myelofibrosis
viii) Echinocyte – Burr cell
ix) Horn-like cell – Keratocyte
x) Stomatocyte – Rh null
xi) Hemoglobin synthesis – Polychromatophilic normoblast to reticulocyte
xii) Thalassemia – Quantitative defect
xiii) Hemoglobinopathy – Qualitative defect
xiv) Alpha Thalassemia – Decreased HbA, HbA2, HbF
xv) Beta Thalassmia – Decreased HbA, increased HbA2, HbF
xvi) Microcytic - <6µm
xvii) Chronic blood loss – Microcytic, hypochromic
xviii) Acute blood loss – Normocytic, normochromic
xix) Aplastic anemia – Normocytic, normochromic
xx) Major cause of death in sickle cell anemia – Infectious crises
xxi) Not used for evaluation of anemia – MCH
xxii)Not used in actual RBC description – Hyperchromia
xxiii) Haptoglobin – To verify in vivo hemolysis
xxiv) Rouleaux formation is seen in – Conditions that increase plasma proteins

c) Leukopoiesis and WBCs – (12%)

i) Stem cell to blast 5 days. Lifespan in tissue phase 9-10 days – Granulocytes
ii) Nucleoli 3+, Dark blue to blue cytoplasm, Lacy chromatin pattern – Myeloblast
iii) Primary granules – Promyelocyte
iv) Stage which you can identify specific WBC – Myelocyte
v) Kidney shaped nucleus - Metamyelocyte
vi) Sausage shaped nucleus – Band
vii) Not an end stage cell – Monocyte
viii) Not capable of phagocytosis – Lymphocyte
ix) Pince-nez – Pelger Huet
x) Sezary cell – Mycosis fungoides, T-cell, Sezary syndrome
xi) Seen in 2nd trimester of pregnancy – Neutrophilia
xii) Diurnal variation is observed in – Neutrophil (decreased in AM, increased in PM)
xiii) Leukemia without maturation – M1
xiv) M2 – Most common AML
xv) M3 – DIC
xvi) M5 – Schilling’s Leukemia
xvii) Granulocyte – Specific esterase positive
xviii) Differentiate Acute Monocytic Leukemia from ALL – Myeloperoxidase
xix) Differentiate Acute Myelomonocytic Leukemia from ALL - SBB
xx) Absence of Philadelphia chromosome – Poor prognosis of disease
xxi) Philadelphia chromosome (+) – Chronic Myelogenous Leukemia
 d) Thrombopoiesis and Platelets – (10%)
i) Stem cell to blast 5 days. Lifespan 8-11 days – Platelets
ii) Nuclei with demarcating membrane – Promegakaryocyte
iii) Platelet – 8-20/field
iv) Clot retraction – Function of platelets
v) Outer surface – Glycocalyx
vi) Platelet adhesion – vWF, gpIb
vii) Platelet aggregation – Fibrinogen, gpIIb-IIIa
viii) Aspirin – inhibit cyclooxygenase
ix) ADAMTS13 – cleaves vWF
x) Platelet alpha and dense granules, mitochondria – Organelle zone
xi) Platelet Factor 3 – Phospholipid
xii) Alpha granule disorder – Gray platelets
xiii) Dense granule disorder – Storage pool
xiv) Platelet retention in multiple myeloma - Reduced

4) Coagulation (Principles, Procedures, Diseases/Disorders and Reference Values) – (20%)

a) Hemostasis – Theories/Concepts, Mechanisms – (2%)
i) NV of template bleeding time – 2-8mins
ii) Screening test for secondary hemostasis – Clotting time
iii) Principal enzyme involved in fibrinolysis - Plasmin

b) Coagulation procedures/tests – (8%)

i) Stypven time – Common pathway
ii) Duckert’s Test – Factor 13
iii) Unaffected by heparin therapy – Reptilase time
iv) Prekallikrein is detected through – APTT
v) Effect of Kaolin to APTT – Decreased/Shortened APTT
vi) D-dimer test positive after – 4hrs
vii) Euglobulin clot lysis time – Screening test for fibrinolysis
viii) Electromechanical – Fibrometer

c) Coagulation factors, diseases/disorders & reference values – (10%)

i) Required in all pathways – Factor 4
ii) Factor 3 – Tissue thromboplastin
iii) Activates extrinsic pathway – Tissue thromboplastin
iv) Prothrombin group – Vitamin K dependent
v) Factor consumed during coagulation – Thrombin group
vi) Factors that deteriorate at room temperature – 5,8
vii) Factors that are activated at cold temperature – 7,11
viii) Barium Sulfate – absorbs prothrombin group
ix) Coumarin – prolong prothrombin time
x) Protamine sulfate – reverses heparin overdose
xi) Ecchymosis – Deficiency in platelets
xii) Asymptomatic patient suspected having coagulation disorder – test APTT
xiii) DIC – Fibrinogen decrease 4-24hrs, platelet decrease 48hrs

5) Quality assurance – (5%)

Immunology, Serology and Blood Banking
1) Immunology/Serology – (50%)
a) Historical background – (2%)
i) T-cell receptor gene – 1984
ii) Pope Innocent VII – First patient to be transfused
iii) First HTR – Pope Innocent VII
iv) Cook carrier of typhoid – Mary Mallon
v) Antibody structure – Susumu Tonegawa

b) Natural (innate) immunity, including role of macrophages, monocytes and granulocytes – (5%)
i) Function of normal flora of skin – barrier against microorganisms
ii) NK Cells – Innate immunity
iii) Most effective antigen presenting cell – Dendritic cell

c) Acquired immunity – humoral responses, immunogens, immunoglobulins, B cells – (8%)

i) % of B cells in circulation – 20%
ii) IgD – Ig on surface of B-cell
iii) Antibody binding site - Paratope
iv) Binding strength of antibody for an antigen – Avidity
v) Fixes complement – IgM
vi) Pentamer – IgM
vii) Antibody in secretions - IgA
viii) Region of Ig that determines whether an immunoglobulin can fix complement – CH2
ix) Papain – Fab,Fab,Fc
x) Pepsin – F(ab)2, Fc

d) Acquired immunity – cellular responses, T cells, cytokines and chemokines – (5%)

i) Major composition of important lymphocytes – T cells
ii) Stimulates transformation of B-cell into plasma cell – T-helper cell
iii) CD2 – Receptor for sheep RBC
iv) CD8 – Cytotoxic T-cell
v) IL 1 – Fever
vi) IL 6 - CRP
vii) Interleukin 8 – Pro-inflammatory cytokine

e) Complement System – (2%)

i) Lectin pathway starts with – MBP
ii) Complement component with largest molecular weight – C1qrs stabilized with Ca
iii) Membrane Attack Complex – C5b6789
iv) C1 deficiency – SLE like disease
v) C9 deficiency – No know disease association
vi) Complement fragments measured in – Nephelometry, RID

f) MHC, HLA and Transplantation – (3%)

i) HLA class where most autoimmune diseases occur – HLA II
ii) HLA B8 – Myasthenia gravis
iii) HLA B27 – Ankylosing spondylitis
iv) HLA DR3 - SLE
g) Immunologic tests for detection of antigens & antibodies – principles, procedures, interpretation of results – (16%)
i) Bacterial infections and STD – (5%)
(1) Coagglutination -Protein A
(2) Widal test, 25% of red cell is agglutinated graded as – 1+
(3) 10% treponemes immobilized – Negative
(4) Primary syphilis - Chancre
(5) Tertiary syphilis - Gumma
(6) Brucellosis titer peak – 4-8weeks

ii) Viral infections, including Hepatitis and HIV – (5%)

(1) Infectious hepatits marker - HbeAg
(2) Not included in Hepatits B serologic marker – HbcAg
(3) HCV RNA – Viral load
(4) Hairy cell leukemia – HTLV II
(5) HTLV transmitted through – Blood, sperm

iii) Fungal infections – (1%)

iv) Parasitic infections, including malaria – (2%)

(1) Most commonly used method in Philippines in testing for malaria – Thick smear
(2) HRP – Histidine-rich protein

v) Autoimmune disorders – (3%)

(1) Nature of Rheumatoid Factor – IgM against Fc portion of IgG
(2) Test for Rheumatoid Factor – Rose-Waaler Test; Latex Agglutination
(3) Negative Rheumatoid Factor – Less than 1:40 titer
(4) Diagnosis of Rheumatoid Arthritis – Rheumatoid Factor and CRP
(5) dsDNA – SLE
(6) Chronic active hepatitis – Anti-smooth muscle antibody

h) Tumor Immunology (Tumor markers, Oncoproteins) – (3%)

i) CA 19-9 – Pancreatic cancer
ii) Nuclear Matrix Protein – Bladder cancer
iii) Expressed as tumor and normally present in fetal cells – Oncofetal antigen

i) Hypersensitivity – (1%)
i) Type 1 – Allergic reaction
ii) Type 2 – HDN, HTR, AIHA
iii) Serum sickness – Type 3
iv) Type 4 – TB Skin test
v) Mediator of Type 4 – T-cells

j) Instrumentation and quality management – (5%)

i) PCR – Amplification
ii) Flow cytometry – Detects surface antigen
iii) Fluorescent microscope – FTA-ABS
iv) Phase-contrast microscope – To visualize mixed lymphocytotoxicity
v) Mixed Lymphocyte Reaction – Cellular assay
2) Blood Banking – (50%)
a) ABO and Rh Blood Group Systems – (5%)
i) Karl Landsteiner – Specificity of Serological Reactions
ii) ISBT 1 – ABO
iii) ISBT 4 – Rh
iv) ABO antibodies – IgG, IgM, IgA
v) Least amount of H antigen – A1B
vi) Bombay phenotype antibodies – Anti-A, Anti-B, Anti-H
vii) Alteration of ABO antigen – Cancer of the colon
viii) Most complex blood group – Rh

b) Other Major Blood Group Systems: Kell, Duffy, Kidd, Lewis, MNSs, Lutheran, P, I – (3%)
i) Anti-I – M. pneumoniae
ii) Anti-i – Infectious mononucleosis
iii) Blood type associated with aldomet – Kidd
iv) Anti-M – Enhanced at pH 6.5
v) Anti-N – Found in dialysis patient
vi) Anti-S – causes HDN

c) Minor Blood Group Sustems: Diego, Cartwright, Chido, XG, Scianna, Gerbich, Milton, Knops, Bg, Indian, etc. – (1%)
i) Blood group associated with HLA – Bg
ii) C4 Complement – Chido-Rogers
iii) Diego – Southeast Asian ovalocytosis
iv) Anti-Crom – Found in blacks

d) Basic Genetics – (5%)

i) Private antigens – Low incidence antigen
ii) Public antigens – High incidence antigen
iii) Type 1 chain precursor – Beta 1-3 linkage
iv) Type 2 chain precursor – Beta 1-4 linkage
v) L-Fucose - H

e) Blood donor selection and processing – (5%)

i) Rubeola – 2 week deferral
ii) Malaria deferral – 3 year
iii) Malaria deferral if donor went to endemic area for vacation – 1 year
iv) Influenza vaccine - Not a cause for deferral
v) Jaundiced at birth – No deferral
vi) Human growth hormone – Permanent deferral

f) Blood preservation and banking – (5%)

i) Blood bag to anticoagulant ratio – 7:1
ii) Citrate in ACD function as – Anticoagulant
iii) Phosphate in CPDA-1 function as – 2-3 DPG (Phosphate function as source of ATP in CPD)
iv) Adenine in CPDA-1 – ATP, Important for red cell survival
v) CPD-A1 – 35 days
vi) SAG-M – 42 days
vii) Rejuvesol - PIGPA
g) Component preparation – (5%)
i) RBC utilizing the open-system should be issued within – 24hrs
ii) Leukopoor RBC – Filtration, Washing and Centrifuge
iii) Amount of proteins in FFP – 6g/dl
iv) Fibrin glue – Thrombin and cryoprecipitate
v) Components of cryoprecipitate – Factor 1, 8, 13, vWF
vi) Cobalt60, Cesium137 = Irradiation of blood components
vii) High glycerol – 40%, slow freezing
viii) Low glycerol – 20%, rapid freezing

h) Transfusion therapy – (2%)

i) Blood component given to patient who are unresponsive to antibiotics – Leukocyte concentrate
ii) Indication for neocyte transfusion – Thalassemia
iii) Hemophilia B – Factor IX concentrate
iv) Increased blood units transfused – Decreased platelet
v) Crystalloid – Give if no available O Rh negative blood

i) Transfusion reactions – (3%)

i) Tubes needed for the investigation of post-transfusion reaction – Red and purple top
ii) Transfusion reaction with 1˚C rise in temperature – Febrile transfusion reaction
iii) TRALI – Transfusion-Related Acute Lung Injury
iv) TACO – Iatrogenic transfusion reaction

j) Transfusion-transmitted diseases – (3%)

i) Y. enterocolitica – Most common blood bag contaminant
ii) Malaria screening – for Asian countries only
iii) T. pallidum – killed by refrigeration of stored blood

k) BB techniques and procedures: typing, compatibility testing, antibody detection and identification – (8%)
i) Immediate spin – 20s
ii) Replacement for minor crossmatch – Antibody screen
iii) Washing of cord blood – 6-8 times with NSS
iv) Anti-A, Anti-B color – Blue, Yellow
v) Specimen for DAT – Whole blood with EDTA
vi) Acquired B phenomenon – Forward like AB, Reverse like A
vii) Post zone – Antigen excess
viii) Prozone – Antibody excess
ix) Prozone remedy - Dilution

l) Hemolytic Disease of the Newborn (HDN) and Auto-immune Hemolytic Anemia – (4%)
i) Immunoglobulin that causes HDN – IgG
ii) Blood given to patient with HDN – O Rh negative
iii) DAT positive – AIHA, HDN, HTR

m) Quality management (structure, set-up/equipment, Laboratory Information System/LIS) – (4%)

i) Blood Bank lab refrigerator temperature is monitored every – Shift
ii) Gel technology – Standardization
iii) Gel card – 10mins centrifugation
Histotechniques, Medical Technology Laws and Ethics
1. Histopathology – (65%)
a. Histology and Pathology – (10%)
i. Terminologies – (4%)
1. Pathos – Suffering
2. STAT – Statim
3. ASAP – As soon as possible
4. Inflammation – ends with “itis”
5. Pyknosis – Condensation of chromatin
6. Karyorrhexis – Fragmentation of nucleus
7. Karyolysis – Dissolution of nuclear structures
8. CT that forms the framework of BM, endocrine and all lymphoid organs – Reticular CT
9. Peyer’s patches – Ileum
10. Part of esophagus with smooth muscle – Lower half

ii. Etiology of disease – (2%)

1. Epithelial tissue origin – Carcinoma
2. Connective tissue origin - Sarcoma

iii. Signs, symptoms and course of disease – (2%)

1. Sign – Observable in patient
2. Symptom – Only patient feels
3. Jaundice – Sign
4. Dysuria – Symptom
5. Tinnitus - Symptom

iv. Cellular and tissue changes – (2%)

1. Aplasia – incomplete or defective development of a tissue
2. Agenesia – nonappearance of an organ
3. Hypoplasia – failure to reach maturity
4. Atresia – failure of organ to form an opening
5. Atrophy – decreased size of an organ
6. Hypertrophy – increase in size of tissue due to increase in size of cell
7. Hyperplasia – increase in size of tissue due to increase in number of cell
8. Metaplasia – Reversible change
9. Apoptosis – Programmed cell death
10. Heart – Coagulative necrosis
b. Histopathologic techniques and procedures – (35%)
i. Preservation and handling of specimen – (10%)
1. Most critical step – Fixation
2. Optimum fixation volume – 20 times to that of tissue volume
3. Formalin fixes tissue by – forming cross link
4. Glutaraldehyde – 2 formaldehyde residues linked by 3 carbon chains
5. 10% methanol to formaldehyde – Unsuitable for EM, prevent decomposition to formic acid or precipitation to paraformaldehyde

6. Picric acid – Small tissues

7. Picric acid fixatives -Bouin, Brasil
8. Mercurial Fixative – Tissue photography
9. Newcomer’s fixative – Nuclear and histochemical fixative
10. Fixative for electron microscopy – Glutaraldehyde, osmium tetroxide

ii. Tissue processing and procedures – (15%)

1. Routine – Manual – (7%)
a. Routine decalcifying agent – Nitric acid
b. To avoid yellowing/blackening of tissue prior to decalcification – Add urea to nitric acid
c. Perenyi’s fluid – Decalcifier, tissue softener
d. Von Ebner – NaCl, HCl, H2O (decalcifying agent)
e. Milky, turbid xylene – Incomplete dehydration
f. Chloroform – Nervous tissues, lymph nodes and embryo
g. Double embedding – Celloidin and paraffin
h. Sectioning – cutting into uniformly thin slices
i. Simplest microtome – Rocking
j. Most common microtome – Rotary
k. Most dangerous microtome - Sliding
l. Sliding microtome – Adams
m. Freezing microtome - Queckett
n. Routine paraffin examination – Biconcave knife
o. Plane concave knife – Celloidin
p. Plane wedge – Frozen, hard specimen
q. Thickness of tissue section, Paraffin – 4-6µ
r. Process of removing burrs – Stropping
s. Dull knife free of nicks maybe sharpened by – Stropping
t. Refractive index of glass – 1.518

2. Routine – Automation – (5%)

a. Vacuum embedding – Rapid
b. Autotechnicon – Fixation up to infiltration

3. Special – Frozen section, Microwave – (3%)

a. Cryostat contains – Rotary microtome
b. Embedding medium for electron microscopy - Plastic
c. EPON – EM
d. Commonly used freezing agent – Liquid nitrogen
e. Temperature of liquid nitrogen - -160 to -180 degrees C
f. Dehydrating agent and temperature used for freeze-substitution – Absolute alcohol @ RT, acetone @ -70 degrees C
g. Advantage of freeze-drying – minimum tissue shrinkage, allow
tissue to be processed fresh, less displacement
 iii. Staining – (10%)
1. Routine – (5%)
a. Color not permanent – Chromogen
b. Selective removal of stains – Differentiation
c. PAS – Basement membrane
d. Alkaline fast green – Green
e. Orcein – Elastic fibers
f. Gomori’s silver impregnation – Reticulin fibers
g. Methyl green – RNA
h. Feulgen – DNA
i. Cytoplasm of cells - Pink

2. Special (Immunohistochemistry) – (5%)

a. Tissues are studied through chemical reaction – Histochemical staining
b. Immunohistochemical techniques – Identification of cellular epitopes or antigens

c. Cytological techniques and procedures – (8%)

i. Preservation and handling of specimen – (2%)
1. Diagnostic cytology – Exfoliative, FNAB, thoracentesis, lumbar tap
2. Exfoliative cytology – detection of malignancy, infectious agents, genetic sex
3. T zone – Endocervical and ectocervical junction
4. Lateral vaginal smear – Hormonal evaluation
5. GI submucosal sample – Fine needle aspirate
6. Heparin – 300 units per 100ml

ii. Processing – (4%)

1. Manual – (2%)
a. To obtain optimum cell yield, the volume of sample to be centrifuged must be – 20-30cc
b. Ringing – sealing of margins to prevent escape of fluid

2. Automation – (2%)

iii. Staining – (2%)

1. Nuclear counterstain – Hematoxylin, carmine, MB, toluidine blue
2. Commonly used nuclear counterstain – Hematoxylin
3. Not a metallic mordant - Iodine
4. EA 50 stains – Cytoplasm of immature cells
5. OG6 stains – Cytoplasm of mature cells

d. Autopsy – (2%)
i. Terminologies – (1%)
1. First to perform autopsy – Giovanni Morgagni
2. Prosector – Pathologist
3. Rokitansky – In situ dissection

ii. Handling, processing and documentation – (1%)

e. Quality assurance – (10%)

2. MT Laws, Related Laws and Code of Ethics – (35%)
a. MT Laws – (10%)
i. Section 6 – Minimum required course
ii. Section 27 – Foreign reciprocity
iii. Removal of board members - President
iv. Grade for medical laboratory technician – 70-74.9%
v. Issuance of MT license – 21yrs old
vi. COR signatories – PRC Commissioner and Board of MT
vii. Renewal of license – Every 3 years
viii. 60 CPE units – Renewal of license
ix. 1 CPE unit – 10 contact hours
x. If RMT will not renew license in 5 years – Removal from roster
xi. Suspension – 2/3 votes
xii. Revocation – 3 votes
xiii. Appeal to – Civil Service Commission

b. Laboratory Management – (10%)

i. Direct costs – expenses that can easily be traced directly to an end product
ii. Indirect costs example – Labor to supervise performance of test, QC

c. Related Laws – (10%)

i. PD 1534 – Amended sections 3,8 and 14
ii. E.O. 266 – CPE
iii. PRC Resolution 323 – Policies on admission of foreigners
iv. Father of PAMET – Crisanto Almario
v. RA 9288 – Newborn Screening Act
vi. PKU – Guthrie’s test
vii. RA 4688 - Clinical Laboratory Law
viii. Clinical laboratory – inspected every 2 years
ix. Blood banks – inspected yearly
x. Crossmatching can be done on – Secondary and Tertiary labs
xi. RA 8981 – PRC Modernization Act of 2000
xii. PRC consists of – Chairman and two associates
xiii. PRC Chairman – Florentino C. Doble
xiv. NRL Drugs – EAMC
xv. NRL Hematology – NKTI
xvi. Radioactive wastes – PNRI and DENR

d. Code of Ethics including Bioethics – (5%)

i. Code of Ethics – Moraleta
ii. Improper language to co-worker is a violation of – “restrict my praises etc.”
iii. First line in oath taking – Name and address
iv. Last line in oath taking - Diyos
v. Violation – report to PAMET

Compiled By: GPMCANIGA, RMT MARCH 2016

Source: JJLELLETAJR, RMT MARCH 2016