Clinical Laboratory Science Practice Exam
Course Introduction
Clinical Laboratory Science is an interdisciplinary field focused on the analysis of bodily fluids and tissues to aid in the diagnosis, treatment, and prevention of disease. This course covers foundational topics such as clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. Students gain an understanding of laboratory techniques, quality control, laboratory safety, and the interpretation of laboratory results. Emphasizing both theoretical knowledge and practical skills, the course prepares students to work collaboratively with healthcare teams, ensuring accurate and reliable laboratory data for patient care.
Recommended Textbook
Modern Blood Banking and Transfusion Practices 6th Edition by Denise M. Harmening
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27 Chapters
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Chapter 1: Red Blood Cells and Platelet Preservation:
Historical Perspectives and Current Trends
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Sample Questions
Q1) If platelets are to be stored for 5 days on a rotator, what is the optimal storage temperature?
A) 1°C to 6°C
B) 20°C to 24°C
C) 35°C to 37°C
D) 1°C to 10°C
Answer: B
Q2) Which of the following red blood cell morphologies may be present on the peripheral blood smear as a result of loss of RBC membrane?
A) Spherocytes
B) Target cells
C) Burr cells
D) Schistocytes
Answer: A
Q3) One of the most important controls of hemoglobin's affinity for oxygen is:
A) glucose.
B) 2,3-diphosphoglycerate (2,3-DPG).
C) K+.
D) Ca++.
Answer: B
Page 3
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Chapter 2: Basic Genetics
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Sample Questions
Q1) All of the following processes occur in replication, except:
A) the two DNA strands separate via helicase.
B) DNA polymerase acts on the 5' to 3' parent strand to produce an anticomplementary duplicate strand.
C) DNA polymerase acts on the 3' to 5' parent strand to produce an anticomplementary duplicate strand.
D) replication of the 3' to 5' parent strand is initiated by the enzyme primase, which anneals to the parent strand.
Answer: C
Q2) When an individual is said to have blood group A, it refers to the individual's: A) alleles on the chromosome.
B) genotype.
C) phenotype.
D) haplotype.
Answer: C
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4
Chapter 3: Fundamentals of Immunology
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Sample Questions
Q1) An agglutination inhibition test is performed on a person whose blood type is A+. The person's saliva is mixed with type A antisera. After incubation, the solution is mixed with reagent A cells and no agglutination occurs. What can be deduced from this finding?
A) The person is a non-secretor of A substance.
B) The person is a non-secretor of O substance.
C) The person is a secretor of A substance.
D) The person is a secretor of O substance.
Answer: C
Q2) All of the following are characteristics of antigens that affect the type and extent of immune response except:
A) solubility.
B) charge.
C) molecular weight.
D) genetic locus.
Answer: D
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5
Chapter 4: Concepts in Molecular Biology
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Sample Questions
Q1) <i>E. coli </i>was inserted with a plasmid vector with a gene resistant to ampicillin. This bacterium was then inoculated into a medium treated with ampicillin. After 24 hours of incubation what would be seen?
A) No growth
B) DNA clone of ampicillin-resistant bacterium
C) DNA clone of the original E. coli specimen
D) Two populations of bacterium
Q2) How can genomic DNA be obtained?
A) Lysis of peripheral blood mononuclear cells with a hypotonic solution and proteinase K
B) Lysis of bone marrow mononuclear cells with a hypertonic solution and proteinase K
C) Lysis of peripheral blood mononuclear cells with an isotonic solution and proteinase K
D) Lysis of bone marrow mononuclear cells with an isotonic solution and proteinase K
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Chapter 5: The Antiglobulin Test
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Sample Questions
Q1) Which of the following is consistent with hemolytic disease of the newborn (HDN)?
A) Recipient antibody coating donor red blood cells
B) Maternal antibody coating fetal red blood cells
C) Fetal antibody coating maternal red blood cells
D) Autoantibody coating individual's own red blood cells
Q2) The antihuman globulin (AHG) test was discovered in 1945 by whom?
A) Landsteiner
B) Mollison
C) Coombs
D) Sanger
Q3) What is the optimal temperature for complement activation?
A) 58°C
B) 37°C
C) 4°C
D) 22°C
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Chapter 6: The Abo Blood Group System
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Sample Questions
Q1) Which of the following indicates secretor gene control overproduction of H substance?
A) L-fucosyltransferase is found in the saliva of secretors.
B) D-galactosyltransferase is found in saliva of secretors.
C) N-acetylgalactosaminyltransferase is found in saliva of secretors.
D) D-glycosyltransferase is found in saliva of secretors.
Q2) All of the following statements are true concerning ABH soluble substances except:
A) the first sugar in the precursor substance is N-acetylgalactosamine.
B) the precursor chain is type 2 (beta 1-4 linkage).
C) ABH structures are glycoproteins.
D) L-fucosyltransferase production is regulated by the Se system.
Q3) If a type-A person contains anti-M in their serum, what might their reverse grouping type as?
A) A
B) B
C) AB
D) O
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8
Chapter 7: The RH Blood Group System
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Sample Questions
Q1) The Rh antibody agglutinates what percentage of RBCs?
A) 15%
B) 85%
C) 50%
D) 35%
Q2) Which of the following genotypes is consistent with f antigen expression?
A) DcE/DCe
B) Dce/DCE
C) DCe/DcE
D) DCe/dCE
Q3) All of the following may occur following an Rh-mediated hemolytic transfusion reaction except:
A) elevated fever.
B) increased bilirubin.
C) intravascular hemolysis.
D) positive DAT.
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Chapter 8: Blood Group Terminology and the Other Blood Groups
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Sample Questions
Q1) Patients diagnosed with_______________ , where the autoantibody is directed against the K antigen, may exhibit a diminished expression of antigen.
A) autoimmune hemolytic anemia
B) lupus erythematosus
C) rheumatoid arthritis
D) chronic granulomatous disease
Q2) Infection with which organism is associated with naturally occurring IgM anti-K.
A) Escherichia coli
B) Mycobacterium species
C) Campylobacter coli
D) All of the above
Q3) Anti-Wr<sup>b</sup> has been frequently observed in patients:
A) with paroxysmal cold hemoglobinuria.
B) with warm autoimmune hemolytic anemia.
C) taking penicillin.
D) with paroxysmal nocturnal hemoglobinuria.
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Chapter 9: Detection and Identification of Antibodies
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Sample Questions
Q1) What is a positive DAT?
A) In vitro sensitization of RBC with antigen
B) In vitro sensitization of RBC with antibody
C) In vivo sensitization of RBC with antibody
D) In vivo sensitization of RBC with antigen
Q2) How is an antibody ruled in?
A) Two RBC samples positive for antigen show reactivity; two RBC samples negative for the antigen show no reactivity
B) Three RBC samples positive for antigen show reactivity; three RBC samples negative for the antigen show no reactivity
C) One homozygous RBC sample shows reactivity
D) None of the above
Q3) Of the antibodies listed below, which does NOT fit with the others in terms of the optimal temperature of reactivity?
A) Anti-P1
B) Anti-I
C) Anti-A1
D) Anti-E
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Chapter 10: Pre-Transfusion Testing
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Sample Questions
Q1) In what circumstance would it be feasible to transfuse Rh-positive blood to an Rh-negative individual?
A) In a teenager with anti-D in his serum
B) During an emergency cesarean section
C) In an elderly woman
D) None of the above
Q2) An ABO antibody will cause a more severe hemolytic transfusion reaction in a patient who has received mismatched blood than an alloantibody will.
A)True
B)False
Q3) What type of blood must be given in an intrauterine transfusion if the blood type of the fetus is unknown?
A) O-positive
B) O-negative
C) AB-negative
D) AB-positive
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Chapter 11: Overview of the Routine Blood Bank Laboratory
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Sample Questions
Q1) In which department of the blood bank laboratory would an ABO discrepancy be resolved?
A) Component preparation and storage
B) Donor processing
C) Main laboratory
D) Reference laboratory
Q2) What test(s) are involved when a physician orders a 4-unit crossmatch on a patient?
A) IS crossmatch
B) AHG crossmatch
C) ABO, Rh, antibody screen, IS crossmatch
D) ABO, Rh, DAT, IS crossmatch
Q3) All of the following viral tests are required for donor processing except:
A) HBsAg
B) CMV
C) anti-HIV
D) anti-HTLV-I
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13
Chapter 12: Other Technologies and Automation
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Sample Questions
Q1) Which of the following substances may interfere with gel technology but not SPRCA technology?
A) Hemolysis
B) Lipemia
C) Icteric samples
D) All of the above
Q2) In performing an antibody screen by the solid phase technique, a monolayer of red blood cells is formed at the top of the microplate wells following the addition of indicator cells. This result should be interpreted as:
A) negative.
B) mixed-field.
C) positive.
D) weak positive.
Q3) The FDA has approved the _____ for application of gel technology.
A) ABO, Rh, DAT, antibody screen and identification, as well as crossmatching
B) ABO, antibody screen, and DAT
C) Antibody screen, antibody identification, and crossmatching
D) ABO, Rh, DAT, and antibody screen
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14
Chapter 13: Donor Screening and Component Preparation
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Sample Questions
Q1) Nucleic acid amplification testing (NAT) is performed for which of the following?
A) HIV, WNV, HCV
B) HIV, HCV, HBV
C) HIV, HBV, WNV
D) HIV, HTLV I,II, HCV
Q2) A world traveler came in to do a directed donation for his sister when he found out she needed surgery for her hip. After spending 5 weeks in Europe, he traveled extensively throughout Africa. How should his case be handled?
A) Because he is donating to his sister, and she signed consent, he may donate for her.
B) He meets all the criteria for being a directed donor, so would be able to donate without any problem.
C) He would not be able to donate, because all directed donors must meet the same criteria as allogeneic donors.
D) He could donate, but only with the consent of the medical direct and physician.
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15
Chapter 14: Apheresis
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Sample Questions
Q1) One unit of apheresed platelets should increase the platelet count_____ .
A) 5,000 to 10,000 per µL
B) 20,000 to 60,000 per µL
C) 80,000 to 100,000 per µL
D) 15,000 to 30,000 per µL
Q2) Which patients are at the most risk for platelet refractoriness where they become alloimmunized to HLA antigens on platelets?
A) Patients with liver disease
B) Cardiac patients
C) Leukemic patients
D) Kidney transplant patients
Q3) All of the following statements are consistent with CFC except:
A) blood is drawn from one phlebotomy site and returned through another.
B) reinfusion to the patient completes one cycle.
C) the process of phlebotomy, separation, and reinfusion is uninterrupted.
D) separation of components is achieved through centrifugation.
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16
Chapter 15: Transfusion Therapy
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Sample Questions
Q1) Cryoprecipitate is not used to treat which condition?
A) Hemophilia A
B) von Willebrand's disease
C) Hemophilia B
D) Hypofibrinogenemia
Q2) What is the expiration on washed red blood cells?
A) 35 days
B) 24 hours
C) 42 days
D) 6 hours
Q3) Vitamin K is essential for the carboxylation of which coagulation factors?
A) I, VII, IX, X
B) I, V, IX, X
C) II, VII, IX, X
D) II, VII, XI, XII
Q4) Which blood product is used in the treatment of DIC?
A) Plasma
B) Platelets
C) Cryoprecipitate
D) All of the above
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Chapter 17: Cellular Therapy
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Sample Questions
Q1) What is a possible mechanism for noncardiogenic pulmonary edema reactions?
A) Antileukocyte antibody reacts with leukocytes and activates the reticuloendothelial system
B) Histamine is released from mast cells, increasing vascular dilation and fluidity to tissues
C) Antileukocyte antibody reacts in donor or patient plasma, initiating complement mediated pulmonary capillary endothelial injury
D) None of the above
Q2) The principle clinical signs of extravascular hemolysis include:
A) bilirubinemia mostly of the direct type.
B) hemoglobinuria.
C) positive DAT.
D) bilirubinemia and positive DAT.
Q3) The morbidity and mortality is highest for which adverse reaction to hematopoietic progenitor cell transplantation?
A) CMV
B) HIV
C) TA-GVHD
D) ABO incompatibility
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Chapter 18: Transfusion-Transmitted Diseases
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Sample Questions
Q1) HBsAg is what part of the hepatitis B virus?
A) Core protein
B) Coat protein
C) Dane particle
D) Capsid protein
Q2) How is a donor's eligibility status affected when Western blot results are indeterminate over a period of 6 months and deemed as false-positives?
A) Donor is placed on a re-entry list
B) Donor is eligible to donate
C) Donor is not eligible to donate
D) None of the above
Q3) A person with acute hepatitis B infection is immune to infection from other hepatitis viruses.
A)True
B)False
Q4) The most sensitive test for the detection of HIV infection is the:
A) polymerase chain reaction.
B) Western blot.
C) immunofluorescence.
D) Southern blot.
Page 19
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Chapter 19: Hemolytic Disease of the Fetus and Newborn
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Sample Questions
Q1) What physiological phenomenon associates erythroblastosis fetalis with HDFN?
A) Release of nucleated red blood cells (RBC) into circulation of mother inflicted with HDFN
B) Release of mature RBCs into circulation of neonate inflicted with HDFN
C) Release of nucleated RBCs into circulation of neonate inflicted with HDFN
D) None of the above
Q2) Which of the following reagents can be used to determine the immunoglobulin class of anti-M?
A) PEG
B) Chloroquine
C) 2-mercaptoethanol
D) Ficin
Q3) Which red blood cell morphology is most characteristic in ABO HDFN and absent in Rh HDFN?
A) Target cells
B) Teardrop cells
C) Microspherocytes
D) Burr cells
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20
Chapter 20: Autoimmune Hemolytic Anemias
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Sample Questions
Q1) A patient with a positive DAT needs to be phenotyped for Jk<sup>a</sup>. What reagent can be used on red blood cells to ensure accurate typing?
A) DTT
B) Chloroquine diphosphate
C) Ficin
D) Digitonin
Q2) The onset of warm autoimmune hemolytic anemia (WAIHA) may be precipitated by:
A) pregnancy.
B) bacterial infection.
C) trauma.
D) all of the above.
Q3) In which of the following is the DAT reactive with anti-C3d only?
A) Drug adsorption mechanism
B) Warm autoimmune hemolytic anemia
C) Cold hemagglutinin disease
D) Membrane modification
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Chapter 21: The Hla System
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Sample Questions
Q1) The HLA-A locus antigens A2, A23, A24, and A28 make up the:
A) A4-CREG
B) A3-CREG
C) A2-CREG
D) A8-CREG
Q2) What is the purpose of washing the cells after the initial cell-serum incubation in the Amos-modified antibody screen procedure?
A) To identify previously undefined alleles
B) To identify antibodies in the serum of the donor
C) To remove aggregated immunoglobulin in the serum
D) None of the above
Q3) How is histocompatibility testing different from RBC testing?
A) Known serum is used to type antigens on test cells
B) Recipient serum is screened for the presence of antibodies
C) Crossmatch of donor cells and recipient serum is performed to determine compatibility
D) None of the above.
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Chapter 22: Relationship Testing
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Sample Questions
Q1) What is the statistical basis of the Hardy-Weinberg principle?
A) Selection of mates is dependent on blood types and therefore is random.
B) Selection of mates is dependent on blood types and therefore is biased.
C) Selection of mates is independent of blood types and therefore is random.
D) Selection of mates is independent of blood types and therefore is biased.
Q2) How is HLA serologic testing performed?
A) T lymphocytes are harvested and introduced to a panel of test sera specific for antigens of the HLA system.
B) B lymphocytes are harvested and introduced to a panel of test sera specific for antigens of the HLA system.
C) HLA antigens move through a limited pH gradient and are immobilized, complexed with antibody, and stained.
D) DNA is isolated from peripheral white blood cells, fragmented, and hybridized.
Q3) How many chromosomes does the developing child normally carry?
A) 23
B) 46
C) 16
D) 32
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23
Chapter 23: Quality Management
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Sample Questions
Q1) Which of the following statements concerning equipment is true?
A) Requires software to function
B) Quality control is not needed for critical steps.
C) Frequency of testing is determined by manufacturer recommendations.
D) All equipment must be purchased from the manufacturer.
Q2) As part of postemployment departmental training, a medical technologist was given 10 known blood samples to analyze for ABO specificity. This is referred to as:
A) recertification.
B) a competence assessment.
C) education.
D) a proficiency test.
Q3) What is a function of the quality committee or quality council?
A) To provide solutions to recurring clerical errors
B) To provide counseling for departmental downsizing
C) To set priorities for quality improvements
D) To focus on computer upgrades and software implementation
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24
Chapter 24: Transfusion Safety and Federal Regulatory Requirements
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Sample Questions
Q1) The law that began and mandated regulation of biological products in the United States was called:
A) PHS Act of 1902.
B) Product Safety Act of 1902.
C) Biologics Control Act of 1902.
D) None of the above.
Q2) What is contained in Form FDA-483?
A) Objectionable conditions noted by an FDA inspector
B) An FDA checklist used by inspectors
C) A list of blood banks that perform in-house viral testing
D) A list of certified FDA inspectors
Q3) In what year did the FDA take over biologics regulation?
A) 1976
B) 1980
C) 1972
D) 1985
Q4) Blood grouping reagents are considered medical devices according to the CBER.
A)True
B)False
25
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Chapter 24: Utilization Management
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Q1) The focus of most blood utilization programs is:
A) the underutilization of blood products of a facility.
B) the overutilization of blood products by a facility.
C) to reduce cost.
D) to evaluate the need for ordering more product.
Q2) Targeted and discontinuous are subtypes of what review system?
A) Retrospective
B) Concurrent
C) Interpreted
D) Prospective
Q3) Upon review at the end of the quarter, you note that one physician's C/T ratio was high. You discuss this with the medical director, and he has you draft a letter to this physician. This is an example of what kind of review?
A) Retrospective
B) Concurrent
C) Interpreted
D) Prospective
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Chapter 25: Laboratory Information Systems
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Q1) What information might be found in a blood bank computer system?
A) Inventory of blood components
B) Antibodies identified in a patient
C) The last date of donation for a blood donor
D) All of the above
Q2) Which of the following is a function of the operating system software?
A) Result entry of serologic tests
B) Transfer of information from the blood bank system to the HIS
C) Transfer of data onto a disk
D) Storage of data in the information system
Q3) One way for mobile or satellite blood-collecting facilities to access donor histories is to a copy of donor records from the blood bank information system to portable computers.
A) purge
B) upload
C) download
D) barcode
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Chapter 26: Medicolegal and Ethical Aspects of Providing
Blood Collection and Transfusion Services
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Q1) What is the meaning of tort reform?
A) Prospective immunity for hospitals from excess liability because of charitable acts
B) Revision of transfusion-associated litigation to include licensed registered nurses as defendants
C) Protection of specialty practices from punitive or excessive awards by state legislatures
D) None of the above
Q2) In the case of Kozup v. Georgetown University Hospital (1987), what were the circumstances surrounding the court's decision to rule in favor of the defendant?
A) The death of an infant was not transfusion-related.
B) Parents did not object to transfusion at the time of infusion.
C) Parents had signed a transfusion consent form.
D) The District of Columbia courts had a blood shield statute in effect.
Q3) What body of government is authorized to pass laws?
A) U.S. Congress
B) U.S. Supreme Court
C) state courts
D) all of the above
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Chapter 27: Tissue Banking: A New Role for the Transfusion Service
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Q1) The 21 in 21 CFR 1271 refers to:
A) the region from which the tissue was collected, thus falling under the general provisions of that area.
B) the title established for food and drugs in the Code of Federal Regulations.
C) the category of FDA laws that govern all blood bank regulation.
D) none of the above.
Q2) Which Joint Commission standard has to do with storage of tissues?
A) PC.17.10
B) PC.17.20
C) PC.17.30
D) all of the above
Q3) Donors for cornea transplants must be tested for all but which of the following diseases prior to transplant?
A) HIV-1 and -2
B) Hepatitis B
C) Hepatitis C
D) Chlamydia trachomatis
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Page 29