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ASCP MEDICAL LABORATORY TECHNICIAN - MLT(ASCP) Sample Questions:

1. During primary hypothyroidism, where a defect in the thryoid gland is producing low levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback mechanism.
Serum TSH levels five-times the upper limit of normal in the presence of a low T4 and low T3 uptake could mean which of the following:

A) The diagnosis is consistent with secondary hyperthyroidism
B) The pituitary has been established as the cause of hypothyroidism
C) The thyroid is ruled-out as the cause of hypothyroidism
D) The thyroid has been established as the cause of hypothyroidism

2. The microscopic features shown here represent Scopulariopsis species. In most instances, particularly if a patient does not have underlying immunologic or hematologic disease, Scopulariopsis species should be considered a contaminant when recovered from a sputum specimen. However, if there is clinical or X-ray evidence of mycotic pulmonary infection, additional daily induced sputum specimens should be obtained.
If Scopulariopsis species or any other hyaline mold is recovered from two or more successive specimens, its potential as a pathogenic agent should be considered. Scopulariopsis species have been reported as the agents of pulmonary fungus ball infections in patients with preexistent cavities and as a cause of pneumonia in patients with leukemia.
Invasive pulmonary disease by this agent has not been reported.
The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely:

A) The cause of chronic bronchitis
B) The cause of allergic bronchopulmonary disease
C) The cause of invasive pulmonary disease
D) A contaminant

3. An antithetical relationship exists between the antigens M and N. Antithetical relationships occur in situations where for a given locus, only one of two genes may be inherited, the alleles are termed antithetical alleles.
In immunohematology, an antithetical relationship exists between M antigen and which of these antigens?

A) N
B) Vw
C) K
D) S

4. A positive DAT is consistent with a diagnosis of hemolytic disease of the newborn. A hemoglobin performed on the cord blood serves as an indicator of the severity of the disease.
In order to detect the presence of antibodies fixed on the RBC's of newborns one should:

A) Look for agglutination in a mixture of mother's serum and baby's cells
B) Test the baby's cells with typing antiserum
C) Perform an indirect antiglobulin test (IAT) on the cord blood
D) Perform a direct antiglobulin test (DAT) on the cord blood

5. The intended response is Vitamin B12 and folate deficiencies. Each of these conditions lead to a megaloblastic production of the red blood cells in the bone marrow. Since vitamin B12 and folate are needed in order to produce a synchronous development of the nucleus with the cytoplasm in hematologic cells, oval-macrocytosis often occurs if these nutrients are not in adequate supply within the body. This can also affect neutrophils, allowing for the characteristic hypersegmented nucleus.
The photographic field contains several oval-macrocytes and a hypersegmented neutrophil with greater than 5 nuclear segments. Oval macrocytes are most commonly associated with pernicious anemia and malabsorption syndromes leading to vitamin B12 and folic acid deficiencies.
Clinical information relating to chronic infection, aplastic anemia, and other hematologic maligancies provide the context for the presence of the oval macrocyte.

Macrocytic erythrocytes and hypersegmented neutrophils are not present in thalassemias or in Pelger-Huet anomaly (hyposegmented neutrophils).
Conditions suggested by the macrocytes and the neutrophil in the photograph to the right include which of the following?