Medical Laboratory Science #17: Exam Review & QA Practices

MEDICAL LABORATORY SCIENCE 7. SUMMATIVE EXAM REVIEW QUESTIONS #17 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. 6. All of the following are blueing agents, except: a. Ammonia water b. Dilute lithium carbonate c. Sodium iodate → ripening agent d. Scott's tap water Microscopic examination of an H&E stained section reveals marked background staining. This is most likely caused by: a. Albumin spread on the slide with a finger b. Excess section adhesive on the slide c. Sections taken immediately after "rough facing" of block d. Flotation bath not cleaned between blocks → Adhesives have their own limitations (background staining on H&E) and may even interfere with immunohistochemistry stains. Technique to highlight various individual tissue component: a. Giemsa staining b. H and E staining c. Immunohistochemistry d. Special staining If the cell or tissue antigen of interest is detected by directly binding a labeled primary antibody specific for that antigen: a. Direct immunohistochemistry b. Indirect immunohistochemistry c. Both of these d. None of these Uses an unlabeled primary antibody that is detected bound to its antigen with labeled secondary antibodies: a. Direct immunohistochemistry b. Indirect immunohistochemistry c. Both of these d. None of these Microscope for immunohistochemistry: 1. Light microscope 2. Fluorescent microscope 3. Electron microscope a. b. c. d. → 1 only 2 only 1 and 2 1, 2 and 3 Immunohistochemistry - In order for the antigen antibody immunoreaction to be seen in the microscope, the antibody must take a label enzyme, fluorophore, colloidal gold or biotin. ▪ An enzyme label can be visualized in the light microscope by means of enzyme histochemical methods via chromogenic reactions ▪ A fluorophore label can be directly visualized in a fluorescent microscope ▪ Electron-dense labels such as colloidal gold are visible in the electron microscope without further treatment ▪ Biotin label can be exploited in light, fluorescence and electron microscopy in combination with ABC technique 8. 9. 10. 11. 12. 13. 14. Enzyme histochemistry via chromogenic reaction can be visualized using: a. Light microscope b. Fluorescent microscope c. Electron microscope d. Any of these A cell antigen can be demonstrated by immunofluorescent staining of fresh frozen tissues but is not visible by immunoperoxidase staining of formalin-fixed paraffin-processed tissue. The procedural difference that most likely accounts for the lack of staining is: a. Masking of antigen binding sites by fixation b. Dilution of the primary antibody c. The sequence of staining steps d. Interpretation under different microscopy conditions In immunoperoxidase staining of formalin-fixed tissue, enzyme pretreatment of antigens: a. Enhances background staining b. Reactivates antigens and enhances primary staining c. Is needed to demonstrate all antigens d. Has precise end-points The antibody class most frequently used in immunofluorescent and immunoenzyme staining is: a. IgM b. IgE c. IgG d. IgA When performing IHC, it is important to use a _____, so that you can see where the staining from the antibody is in relation to the cellular structures within the tissue. a. Primary antibody b. Counterstain c. Enzymes and chromogens d. Proper controls In immunoperoxidase procedures, excess background staining can occur as a result of nonspecific binding of protein to the specimen. This background staining can be reduced by: a. Using more concentrated primary antibody b. Using whole serum antibodies c. Incubating for a shorter time in the primary antibody d. Applying nonimmune serum from the same animal species as the secondary antibody prior to staining Paraffin sections stained with the immunoperoxidase technique show excess background staining. Which of the following could be the explanation for this? a. Selecting the wrong chromogen b. Forgetting to apply nonimmune serum c. Overfixation with formaldehyde d. Prolonging incubation with the secondary antibody Confirming the validity of staining pattern and excluding experimental artifacts: a. Primary antibody b. Counterstain c. Enzymes and chromogens d. Proper controls → Controls ▪ Positive Control: a section from a tissue known to express the protein of interest. ▪ Negative Control: a section from a tissue known not to express the target antigen. 1 ▪ 15. 16. 17. 18. 19. 20. 21. Endogenous Tissue Background Control: section from tissue that doesn’t have a primary antibody applied. All post-mortem procedures require adherence to: a. Isolation techniques b. Isolation precautions c. Standard precautions d. None of these → Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. Autopsy performed to diagnose a particular disease or for research purposes: a. Clinical or pathological b. Medico-legal or forensic c. Anatomical or academic d. Virtual or medical imaging Autopsy performed in cases of violent, suspicious or sudden deaths, deaths without medical assistance or during surgical procedure: a. Clinical or pathological b. Medico-legal or forensic c. Anatomical or academic d. Virtual or medical imaging In situ dissection: a. Ghon → en bloc b. Letulle → en masse c. Rokitansky d. Virchow → organs removed one-by-one Form used to document the collection, transport, security, and test results of the specimen for drug test: a. Turnaround time b. Chain of infection c. Custody and control form d. Request form Laboratory records, EXCEPT: a. Standard operating procedures (SOP) b. Laboratory workbooks/sheets c. Sample log book d. Patient’s test reports → Documents provide written information about policies, processes and procedures. ▪ Some examples of documents include a quality manual, standard operating procedures, job aids and reference materials. → Records are the collected information produced by the laboratory in the process of performing and reporting a laboratory test. ▪ Some examples of records include completed forms, charts, sample logs, patient records, quality control information and patient reports. Which of the following is not a basic component of a QA program? a. Calibration b. Preventive maintenance c. Viral marker testing d. Record keeping 22. Manual records can be corrected as long as: a. The original entry is neither obliterated nor deleted b. The person making the correction dates and initials the change c. The item to be corrected is crossed off with a single line d. All of the above 23. What is the purpose of competency assessment? a. Identify employees in need of retraining b. Evaluate an individual’s level of knowledge during a job interview c. Identify employees who need to be fired d. All of the above 24. Employees are the core of an organization, and therefore they: a. Must be trained b. Must report errors without fear of reprisal c. Are a key part of problem solving d. All of the above 25. Early identification of problems by evaluating the compliance with established SOP is the purpose of: a. Internal audits b. Accident reports c. Root-cause analysis d. FDA inspections 26. All of the following statements are true regarding internal audits EXCEPT that they: a. Help identify problems early b. Ensure continuous quality improvement efforts c. Are used solely for the purpose of identifying “troublemakers” d. Are one of the many responsibilities of the QA unit 27. Ultimately the responsibility for a safety program in the laboratory belongs to: a. CDC b. The employer or laboratory director c. OSHA d. The employee 28. All blood banks as mandated by law must have a: a. Water fountain b. Written laboratory safety program c. BSC d. Foot-operated hand wash 29. The reporting of an accident or injury should occur when any: a. Injury may result in a fatality b. Injury involves possible infection with HIV or HBV c. Accident involves nonemployees or jeopardizes a patient d. Accident or injury occurs 30. One of the best ways to protect employees and keep a safe laboratory environment is to provide employees with: a. Health insurance b. Safety education c. Rest breaks d. Fluid-repellent laboratory coats 31. Waste container for sharp materials like needles, syringe and scalpel blades: a. Yellow b. Yellow with black band c. Red d. Orange 2 32. Biodegradable wastes like leftover food, used cooking oil, fish entrails, scale, fins, fruits, vegetable peelings, rotten fruits, and vegetables: a. Orange b. Red c. Green d. Black 33. Non-biodegradable wastes like paper or paper products (newspaper, tetra packs, etc.), bottles (glass and plastics), and packaging materials (Styropor, candy wrapper, aluminum cans): a. Orange b. Red c. Green d. Black 34. Radioactive wastes or medical equipment contaminated or exposed in radioactivity: a. Orange b. Red c. Green d. Black 35. Pharmaceutical and chemical wastes: a. Yellow b. Yellow with black band c. Red d. Orange 36. Infectious and pathological wastes such as used test strips, used beads or plates, used reaction pads or foils, used swabs, used gloves, used cord clamp, used plaster, used masks: a. Yellow b. Yellow with black band c. Red d. Orange 37. During the morning rush, your laboratory manager comes into the laboratory and starts explaining a new policy regarding vacation requests. Word spreads of the change throughout the day, and the message has changed somewhat. Several in the laboratory are upset and complain to the laboratory man- ager. Which of the following actions is the most appropriate way to handle such a situation? a. Nothing should be changed, it was handled appropriately b. The manager should have posted the change on the bulletin board in the break room c. The manager should have announced the policy on each shift d. The manager should have discussed and distributed the policy at a laboratory meeting, or several laboratory meetings, so that all employees heard the policy from the manager 38. The process of working with people and resources to accomplish organizational goals: a. Authority b. Supervision c. Management d. Leadership 39. What is the most important role of the manager in charge? a. Independent decision making b. Communication c. Informal discussions d. None of the above 40. Focus on people and operational delivery of laboratory services: a. Laboratory supervisor b. Laboratory manager or chief MT c. Laboratory director d. Administrator 41. You are the lead chemistry MLS. Your laboratory manager has asked you to evaluate two new methods for cholesterol analysis. In your evaluation, you found that method A was very accurate and precise and that method B was not very accurate and precise. However, the laboratory will make more money by investing in method B. Which of the following decisions would exhibit professionalism? a. Recommend method A to your laboratory man- ager. It is important that the laboratory produce the most accurate and precise results b. Recommend method B to your laboratory manager. It is important that the laboratory make as much money as possible c. State that you are unable to make a recommendation, because no difference in the methods was noted d. Recommend that you need more time to evaluate both methods 42. Which of the following components should not be included in a written procedure? a. Test method b. Cost per billable test c. Quality control procedures d. Reagents and media needs 43. Key attributes for good documentation, EXCEPT: a. Accurate b. Attributable c. Legible d. Always computer-generated → Key attributes for good documentation were first described by US-FDA in the form of ALCOA attributable, legible, contemporaneous, original and accurate. These are also adapted by World Health Organization (WHO). 44. Considered to be an expression of dissatisfaction, which requires a response: a. Reaction b. Adverse reaction c. Complaint d. Discrepancy 45. Sentinel event: a. Insufficient specimen b. Positive blood culture c. Wrong medication d. Surgery on wrong patient or body part → Sentinel Event ▪ Any unanticipated death or major permanent loss of function not related to the natural course of the patient’s illness or underlying condition. ▪ Reportable events are: • Suicide during institutional care • Infant abduction or discharge to the wrong family • Rape during institutional care • Hemolytic transfusion reactions from major incompatibilities • Surgery on the wrong patient or body part 3 46. Mary is an MLT working as a phlebotomist in a private laboratory. A woman comes in with her 16- year-old daughter who has a requisition for follicular stimulating hormone, luteinzing hormone (LH), estradiol and human chorionic gonadotropin (hCG). The daughter tells Mary that she is willing to have some of the tests on the requisition performed but not the CG. The mother shakes her head and reminds the daughter that the tests are necessary for a diagnosis by the doctor. What should Mary do? a. Follow the request of the mother because she is the parent and responsible for the care of her underage child. b. Follow the request of the daughter because she seems capable of making decisions on her own and there is no set age of consent. c. In an effort to maintain consent, Mary should contact the patient's physician. d. Proceed with the venipuncture because the requisition itself is consent enough. 47. Which of the following is not a controlled act? a. Communicating with patients or their representatives about the diagnosis. b. Setting or casting a fracture of a bone or a dislocation of a joint. c. Weighing a patient. d. Prescribing a hearing aid. → Controlled act is an act that poses a risk to the public if not performed by a qualified practitioner. 48. Alice, an MLT who is working in a community laboratory, receives a phone call from a lawyer requesting copies of his client's test results. The lawyer says that his request is urgent as his client is to appear in court the next day. What should Alice do? a. Alice should release the results to the lawyer immediately. b. Alice should tell the lawyer that the laboratory can only release information to the physician who ordered the tests and direct him to the physician. c. Alice should refuse to release the results. d. Alice should ask the lawyer to submit his request in writing and upon receipt of the request, release the results. 49. While assisting with a blood collection on a 26-yearold female patient who is unconscious, Heidi, an MLT, overhears Roger, one of the nurses assisting with the patient, making inappropriate sexual remarks about the patient's body and what he would like to do to it. What should Heidi do? a. Heidi should report what she has witnessed to the hospital and also file a report regarding Roger's comments with the College of Nurses. b. Heidi does not have to do anything, after all the patient is unconscious and therefore not aware of what is being said. c. Heidi should confront Roger and tell him his behavior is inappropriate. d. Heidi should not do anything, everyone knows that Roger is a playboy and nothing is ever going to change that. 50. The hospital where Mary works is planning to install Point of Care (POC) testing for several analytes in the emergency department; the lab will be responsible for validating and maintaining the instruments but the nursing staff will be doing the testing. The general consensus in the lab is that the nurses don't have the background required to perform POC testing and it would be better if it was assigned to the MLTs. Mary, a senior MLT, has been asked to train several of the nurses on how to use the equipment, she is reluctant because she agrees that testing should stay in the lab. What is the next step for Mary? a. Ask for the opportunity to present her concerns to upper management and to point out that the lab staff are already trained to use the equipment and will need little orientation before testing can start. This would be a cost saver for the hospital. b. Ask for the opportunity to present her concerns to upper management and cite improved patient care as a reason to assign POC testing to the laboratory. c. Look at the training assignment as an opportunity to collaborate with nursing staff and to help them understand the role of the Medical Laboratory Technologist in patient care. d. Ask for the training to be assigned to another MLT, someone who needs the experience more than she does. 4