CAMLPR Evaluation and Interpretation Competency Practice Test

These questions are part of the practice quiz. Start practicing

• A patient presents with GGT 2 U/L, ALP 15 U/L, TRIG 1.9 mmol/L, Ca 2.95 mmol/L, and Mg 3.00 mmol/L. What is the likely cause?
• Lipid panel TCHOL 4.90 mmol/L, HDL 1.60 mmol/L, TRIG 1.40 mmol/L, LDL 3.30 mmol/L. Is this patient at risk?
• Which analytes are affected by light exposure?
• A potassium result of 8.6 mmol/L is obtained. What is the first course of action?
• Which antibody group is destroyed by enzymes?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 92 g/L; Hct 0.280; RBC 3.0 x 10^12/L; WBC 22.0 x 10^9/L; PLT 85 x 10^9/L; MCV 94 fL; MCH 31 pg; MCHC 330 g/L; RETIC 0.9%. Peripheral smear: Atypical B-lymphocytes with projections. Bone marrow: Dry tap, fibrosis. Additional testing: TRAP POS; BRAF V600E POS.
• Which drug mechanism involves membrane modification, where the drug binds to the RBC surface to enable plasma proteins and complement to bind non-immunologically, causing a DAT with IgG and C3d?
• In which situation would you NOT contact Canadian Blood Services?
• Which statement about enzyme effects is true?
• A CBC is performed with the following results: Hgb 95 g/L; Hct 0.290/L; RBC 4.2 x 10^12/L; WBC 9.0 x 10^9/L; Platelets 300 x 10^9/L; MCV 88 fL; MCH 30 pg; MCHC 370 g/L; Retic 10%; Peripheral smear shows spherocytes; Supra Vital Stain shows many blue-speckled RBCs; TBIL 42 μmol/L; uBIL 35 μmol/L; LDH 650 U/L; DAT 0; Osmotic Fragility POS. What is the presumptive diagnosis?
• Which finding most strongly suggests a myelophthisic process due to marrow infiltration?
• What happens to Na+ when we run a lipemic sample on an indirect ISE on a healthy patient?
• A patient has moderate anemia with elevated LDH and indirect bilirubin, burr-like RBCs on smear, burr-like inclusions on supravital stain, and DAT 0. Which diagnosis is most likely?
• A patient with an infiltrated thyroid has TSH 60 mIU/L, FT4 5 pmol/L, FT3 3.0 pmol/L. What is the most likely diagnosis?
• A patient has a negative antibody screen and the crossmatch immediate spin is 0. The donor is O Positive and the recipient is A Positive. What is the next step?
• If multiple burr cells are present on a peripheral blood smear collected at 0600 h and analyzed at 1200 h, what is the appropriate response?
• Waldenstrom macroglobulinemia is associated with which electrophoresis finding?
• A sample arrives in the lab with glucose 24.8 mmol/L, Na 128, K 2.1; what is this indicative of?
• A patient is being assessed for suspected diabetes. The laboratory reports FBS: 6.5 mmol/L, RBS: 9.7 mmol/L, 2h OGTT: 10.0 mmol/L. What is this?
• Urinalysis shows Cloudy urine with protein 2+, leukocytes 3+, nitrite positive, WBCs >50/hpf, WBC casts absent, granular casts present, and numerous bacteria. What is the most likely diagnosis, given nitrite positivity implies Gram-negative organisms?
• A patient is transfused and develops dyspnea with hypoxemia after transfusion. Chest imaging shows infiltrates and there is no evidence of hemolysis. What is the transfusion reaction, and how should it be treated and prevented?
• Serum CORT DEC, K 6.1, Na 128, Cl 92, sOSMO 265; Urine K 11, Cl 80, Na 65, sOSMO 550. What is your suspected diagnosis?
• Which antibody group is NOT enhanced by enzymes?
• A patient has the following laboratory results: GLU 10.0 mmol/L, AMY 400 U/L, LIP 500 U/L, TRIG 2.1 mmol/L, LDL 3.2 mmol/L. What is the likely diagnosis?
• A patient is suspected of Neisseria meningitidis infection. The CSF Gram stain shows GPC in fat, kidney bean pairs. Biochemical testing yields Catalase POS, Hemolysis Non-hemolytic, PYR Yellow. What is the correct interpretation?
• An elderly patient with type 2 diabetes experiences severe dehydration and extremely high blood glucose with little or no ketones. Which diagnosis fits best?
• Markedly elevated CK with blood detected in the urine; which diagnosis?
• Which diagnosis fits the data of echinocytes on smear, supravital dark inclusions on membrane, and a negative DAT?
• Which lipid pattern is most consistent with borderline risk?
• There is a sharp monoclonal spike in the gamma region, with anemic symptoms, elevated ESR, very viscous plasma, and rouleaux on CBC. What is the diagnosis?
• A patient is being assessed for suspected diabetes. The laboratory reports FBS: 5.1 mmol/L, RBS: 6.2 mmol/L, 2h OGTT: 7.5 mmol/L. What is this?
• A patient has a troponin result increase from 15 ng/L to 300 ng/L over 4 hours. This result is...
• A patient presents with fatigue, headaches, blurred vision and recurrent nosebleeds; electrophoresis shows a monoclonal spike with IgM; Urinalysis shows 3+ protein. What is the presumptive diagnosis?
• Which RBC morphology is most characteristic of warm autoimmune hemolytic anemia?
• A CBC is performed with the following results: Hgb 118 g/L, Hct 0.360 L/L, RBC 5.9 x 10^12/L, MCV 72 fL, MCH 23 pg, MCHC 315 g/L, RDW 12.5%, RETIC 6.0%. Iron Studies: Ferritin 100 ug/L, Serum Iron 15 umol/L, TIBC 50 umol/L. Hgb Electrophoresis: HbB (y4) 20%, HbH (z2y2) 0%, HbF 0%, HbA2 (a2y2) 4%, HbA 96%. What is the presumptive diagnosis?
• In nephrotic syndrome, which laboratory finding is most characteristic?
• Which antibody groups are destroyed by enzymes?
• A critically ill hospitalized patient has TSH 2.0 mIU/L, FT4 8 pmol/L, FT3 1.5 pmol/L. What is the most likely thyroid state?
• During a transfusion, the plasma appears darker with visible clotting and hemolysis; the patient develops fever, rigors, tachycardia, shock, and disseminated intravascular coagulation. What is the likely reaction and treatment?
• A patient has the following CBC results: Hgb 82 g/L, Hct 0.270 L/L, RBC 4.1 x 10^12/L, MCV 68 fL, MCH 20 pg, MCHC 295 g/L, RDW 19.8%, WBC 6.5 x 10^9/L, PLT 420 x 10^9/L. Iron Studies show ferritin 6 ug/L, serum iron 4 umol/L, TIBC 90 umol/L, transferrin 5.5 g/L, transferrin saturation 5%. Peripheral smear shows target cells, tear drop, ovalocytes. Prussian blue stain negative. What is your presumptive diagnosis?
• If a patient has a positive antibody screen that isolates anti-K and anti-Leb, and a transfusion is required, which type of donor unit should be provided?
• Serum Na 148, Cl 108, K 2.9, sOSMO 300; Urine K 60, Cl 20, Na 148, uOSMO 650. What do you suspect?
• Which antibody group is NOT enhanced by enzymes?
• Lab tests on a patient with bone pain, recurrent kidney stones, abdominal discomfort and fatigue show Serum Mg 2.20 mmol/L, Ca 2.80 mmol/L, Phosphorus 0.70 mmol/L; Urine Ca INC, Urine Phos INC. What is the cause?
• In cold agglutinin disease, the DAT is most commonly positive for which component?
• Within how many hours does transfusion-associated acute lung injury usually present after a transfusion?
• In the Cold Agglutinin Disease case, which antibody specificity is detected?
• Which bone marrow finding supports a diagnosis of erythroleukemia (M6)?
• A child with chicken pox presents with vomiting, confusion, seizures and is now comatose in decerebrate position. Labs show AMM 130 μmol/L, ALB 19 g/L, TBIL 32 μmol/L. Suspect?
• BNP 130 ng/L and NT-proBNP 230 pg/mL. What condition is most likely diagnosed?
• Which morphological feature is described for ALL Burkitt in the cited material?
• A patient has an INR of 2.5. What is the first course of action?
• CBC shows WBC 14 x 10^9/L with monoblasts, MPO POS, nonspecific esterase 90% POS, and cytogenetics with t(9;11) positive; flow cytometry shows CD14 and CD64. What is the presumptive diagnosis?
• A CBC is performed with the following results: Hgb 88 g/L; Hct 0.270/L; RBC 3.0 x 10^12/L; WBC 8.0 x 10^9/L; Platelets 340 x 10^9/L; MCV 92 fL; MCH 34 pg; MCHC 335 g/L; Retic 5%; Peripheral smear shows burr cells; Creatinine 580 μmol/L; Urea 28 mmol/L; eGFR 8 mL/min; EPO decreased; Bone marrow peripheral is normal. What is the presumptive diagnosis?
• During prolonged apheresis, a patient experiences paresthesia, tetany, and arrhythmias with hypocalcemia, hypomagnesemia, and metabolic alkalosis. What transfusion reaction is this?
• In warm autoimmune hemolytic anemia, the direct antiglobulin test (DAT) is typically positive for which immunoglobulin?
• Which organism causing a urinary tract infection is the only one that can be treated with nitrofurantoin and is not resistant?
• Which laboratory finding would most support a diagnosis of pancreatitis?
• Which finding indicates a clinically insignificant antibody?
• Which mutation is most commonly associated with polycythemia vera in the described case?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 79 g/L; Hct 0.240 L/L; RBC 2.5 x 10^12/L; WBC 36.0 x 10^9/L; PLT 92 x 10^9/L; MCV 93 fL; MCH 30 pg; MCHC 355 g/L; RETIC 0.4%. Peripheral Blood Smear shows myeloblasts and promyelocytes with few Auer rods. Bone Marrow shows >20% blasts. Myeloperoxidase ~3% positive; Sudan Black B <20% positive. Cytogenetics: t(8;21)(q22;q22) positive. Flow cytometry: myeloid lineage markers CD13, CD33, CD34 variable.
• A patient has glucosuria, proteinuria (2+), potassium 3.0 mmol/L and uric acid 50 μmol/L. Which diagnosis is most likely?
• Which diagnosis is supported by elevated LDH and transaminases, plus a positive urine ketone test?
• A CBC is performed with the following results: Hgb 82 g/L; Hct 0.250/L; RBC 2.8 x 10^12/L; WBC 15.0 x 10^9/L; Platelets 120 x 10^9/L; MCV 106 fL; MCH 34 pg; MCHC 330 g/L; Retic 5%; Peripheral smear shows tear drop cells (dacrocytes), polychromasia, nRBCs; Instrument flagging: Imm WBCs; Bone marrow shows fibrosis of marrow. What is the presumptive diagnosis?
• Which cytogenetic abnormality is most characteristic of acute promyelocytic leukemia?
• A 50-year-old patient presents with signs of cold-induced hemolysis and a positive DAT during winter. Which diagnosis is most likely?
• Which diagnosis best explains the findings of bite cells, polychromasia, supravital dark inclusions on membrane, and elevated bilirubin with a negative DAT?
• Which laboratory finding most strongly supports a diagnosis of multiple myeloma in the presented scenario?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 95 g/L; Hct 0.295 L/L; RBC 2.9 x 10^12/L; WBC 3.0 x 10^9/L; PLT 120 x 10^9/L; MCV 105 fL; MCH 34 pg; MCHC 360 g/L; RETIC 0.6%. Peripheral Blood Smear shows oval macrocytosis. Bone Marrow shows hypercellularity with two-line dysplasia and 12% blasts.
• A platelet transfusion recipient a week later presents with mucous membrane bleeding and epistaxis. What is the likely transfusion reaction and its treatment?
• A CBC is performed with the following results: Hgb 108 g/L; Hct 0.330 L/L; RBC 3.8 x 10^12/L; WBC 6.0 x 10^9/L; Platelets 280 x 10^9/L; MCV 95 fL; MCH 33 pg; MCHC 365 g/L; Retic 5%; Peripheral smear shows polychromasia and rectangular crystals. Hgb electrophoresis shows HbC (a2c2) 98%; HbF 2%; HbA2 0%; HbA 0%. What is the presumptive diagnosis?
• Which diagnosis best fits a CBC with WBC 52 x 10^9/L, monoblasts on smear, MPO 50% positive, nonspecific esterase 60% positive, t(6;9) translocation, and flow cytometry showing CD13, CD14, CD33, CD64?
• Which lab pattern best distinguishes iron deficiency anemia from anemia of inflammation?
• In the G6PD deficiency case, which statement about the direct antiglobulin test (DAT) is true?
• A transfusion recipient develops fever, jaundice, and a progressive drop in hemoglobin several days after transfusion. The direct antiglobulin test is positive and an antibody screen is positive. What is the most likely reaction?
• During transfusion planning, which donor unit should be chosen for a patient with anti-K antibodies?
• In multiple myeloma, which electrolyte disturbance is commonly observed?
• A patient has GLU 8.9 mmol/L and Sweat OSMO 70 mmol/L. What is the likely diagnosis?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 88 g/L; Hct 0.270 L/L; RBC 3.0 x 10^12/L; WBC 98.0 x 10^9/L; PLT 140 x 10^9/L; MCV 95 fL; MCH 31 pg; MCHC 328 g/L; RETIC 1.8%. Peripheral Blood Smear shows monocytosis with 10% blasts and sticky cells. Bone Marrow shows hypercellular marrow with monocytic and granulocytic dysplasia. BCR-ABL negative.
• Which pattern on electrophoresis is typical of beta-thalassemia trait?
• A patient sample results are as follows: LDH 700 U/L, AST 100 U/L, K+: 8.2mmol/L, iCAL 1.60mmol/L, Fe 40 µmol/L, ALT 66 U/L, T4: 5pmol/L. What do you report?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 88 g/L; Hct 0.270; RBC 3.0 x 10^12/L; WBC 14.8 x 10^9/L; PLT 520 x 10^9/L; MCV 92 fL; MCH 30 pg; MCHC 329 g/L; RETIC 4.5%. Peripheral smear: Tear drop cells. Bone marrow: Dry tap, fibrosis. Additional testing: LAP 50; JAK2 POS; BCR-ABL NEG.
• Which fasting glucose value falls into the impaired fasting glucose range?
• Which term best describes small changes in a lab value between two consecutive samples?
• Which antibody group is NOT enhanced by enzymes?
• Which Hb pattern on electrophoresis confirms beta-thalassemia trait when HbA2 is increased?
• Which of the following drugs does NOT use the immune complex mechanism, where the drug-antibody complex binds loosely to the RBC surface causing a DAT with C3d?
• A patient with IgA deficiency receives a transfusion and develops no fever but widespread urticaria, with severe hypotension, dyspnea, and tachycardia; the direct antiglobulin test is negative. What is the likely reaction and its management?
• A patient presents with tendonitis, xanthomas, arcus. What is your first assumption of disease?
• Which pattern is most typical of hypoparathyroidism?
• CBC shows Hgb 72 g/L, WBC 38 x 10^9/L, smear with lymphoblasts; bone marrow hypercellular with >25% lymphoblasts; MPO NEG; Sudan Black NEG; PAS POS. Which diagnosis is most likely?
• A CBC is performed with the following results: Hgb 95 g/L; Hct 0.290/L; RBC 4.2 x 10^12/L; WBC 9.0 x 10^9/L; Platelets 300 x 10^9/L; MCV 88 fL; MCH 30 pg; MCHC 370 g/L; Retic 10%; Peripheral smear shows spherocytes; Osmotic fragility POS; DAT 0; TBIL 42 μmol/L; uBIL 35 μmol/L; LDH 650 U/L. What is the presumptive diagnosis?
• Which interpretation is most consistent with a troponin rise from 15 ng/L to 300 ng/L within 4 hours?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 90 g/L; Hct 0.270 L/L; RBC 2.9 x 10^12/L; WBC 2.8 x 10^9/L; PLT 78 x 10^9/L; MCV 98 fL; MCH 31 pg; MCHC 340 g/L; RETIC 0.5%. Peripheral Blood Smear shows neutropenia with hypogranulation and hyposegmentation. Bone Marrow shows abnormal myeloid maturation. Ferritin 492 ug/L.
• Which diagnosis is associated with the presence of tyrosine and leucine in urine?
• Which diagnosis is most strongly suggested by a CBC showing anemia, leukocytosis with promyelocytes containing Auer rods, MPO positivity, and the t(15;17) PML-RARA fusion?
• Which antibody specificity is detected in the Cold Agglutinin Disease case?
• Which diagnosis is most strongly suggested by a CBC showing anemia, leukocytosis with promyelocytes containing Auer rods, MPO positivity, and the t(15;17) PML-RARA fusion?
• Which urine finding most strongly supports advanced renal disease in this patient?
• In primary adrenal insufficiency, which electrolyte pattern is typical?
• Serum K 3.1, Na 122, Cl 91, UREA 2.2, sOSMO 260; Urine Na 45, Cl 250, uOSMO 550. What is the diagnosis?
• Which diagnosis is most consistent with elevated AST and ALT with relatively high CHE?
• In the Thrombotic Thrombocytopenic Purpura case, which statement best describes the platelet status?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 72 g/L; Hct 0.210 L/L; RBC 2.3 x 10^12/L; WBC 9.8 x 10^9/L; PLT 60 x 10^9/L; MCV 100 fL; MCH 33 pg; MCHC 343 g/L; RETIC 0.4%. Peripheral Blood Smear shows 8% blasts with Auer rods. Bone Marrow shows 30% blasts. Answer: Refractory Anemia with Excess Blasts in Transformation (RAEB-T).
• Which antibody group is destroyed by enzymes?
• Which condition is classically associated with hyperviscosity symptoms, rouleaux formation, and a monoclonal IgM spike?
• Severe gout, kidney problems, poor muscle control and mild mental retardation with a high uric acid. What is the likely disorder?
• A patient with weight loss, increased appetite, palpitations and tremor; tachycardia and goiter; TSH <0.01 mIU/L, FT4 38 pmol/L, Chol 2.8. What is this indicative of?
• Which action should be taken first if a patient on warfarin has an INR of 2.5?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 89 g/L; Hct 0.310; RBC 3.6 x 10^12/L; WBC 165.0 x 10^9/L; PLT 620 x 10^9/L; MCV 88 fL; MCH 29 pg; MCHC 330 g/L; RETIC 2%. Peripheral smear: Basophilia; Eosinophilia; Hyposegmented neutrophils; Giant platelets. Bone marrow: Hypercellular, M:E ratio 10:1. Additional testing: LAP 20; BCR-ABL POS.
• Which finding on hemoglobin electrophoresis is most consistent with beta-thalassemia trait when HbA2 is elevated?
• Which of the following results is most clinically significant?
• An patient has ALP 3500 U/L, ACP 5.0 ng/mL, Ca 3.10 mmol/L. What is the likely cause?
• Which organism is commonly associated with Hemolytic Uremic Syndrome in children?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 134 g/L; Hct 0.400; RBC 4.6 x 10^12/L; WBC 24.5 x 10^9/L; PLT 310 x 10^9/L; MCV 90 fL; MCH 29 pg; MCHC 332 g/L; RETIC 1.2%. Peripheral smear: Neutrophilia; Band, metamyelocytes, myelocytes; Toxic granulation; Dohle bodies; Toxic vacuolation. Additional testing: LAP 210; CRP 28 mg/L.
• In Paroxysmal Cold Hemoglobinuria, which antibody specificity is involved?
• Which antibody group is destroyed by enzymes?
• Hgb 66 g/L, WBC 18 x 10^9/L, platelets 38 x 10^9/L, megakaryoblasts on smear; bone marrow hypercellular with >20% megakaryoblasts; CD41 and CD42 POS; inv(3) POS; MPO NEG; Sudan Black NEG; Platelet Peroxidase POS. Which diagnosis is most likely?
• A lipid panel shows TCHOL 6.20 mmol/L, HDL 1.00 mmol/L, TRIG 6.00 mmol/L, LDL 4.30 mmol/L. Is this patient at risk?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 76 g/L; Hct 0.230 L/L; RBC 2.4 x 10^12/L; WBC 5.6 x 10^9/L; PLT 95 x 10^9/L; MCV 102 fL; MCH 34 pg; MCHC 323 g/L; RETIC 0.2%. Peripheral Blood Smear shows hyposegmentation and hypogranulation with 15% blasts in blood. Bone Marrow shows hypercellular with 15% blasts.
• Which diagnosis is most consistent with a profile of elevated LDH, transaminases, and ketonuria?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 186 g/L; Hct 0.580; RBC 8.9 x 10^12/L; WBC 13.8 x 10^9/L; PLT 620 x 10^9/L; MCV 86 fL; MCH 28 pg; MCHC 326 g/L; RETIC 1.0%. Peripheral smear: Neutrophilia; Giant platelets. Additional testing: LAP 150; EPO 1.2 mIU/mL; JAK2 POS.
• Anion Gap: 21 mmol/L, URIC 35 μmol/L, pCO2: 20 mmHg, pHCO3: 14. Which diagnosis is most likely?
• A clinical Gram stain contains numerous irregular purple granules that present outside the cells and vary greatly in size. Which is most likely?
• A specimen was collected at 0900h and found in the receiving lab at 1200h. Some of the laboratory results are as follows: GLU 6.0 (D) (Previous Result: 8.0), K+: 5.9 (D) (Previous Result: 4.2), LDH 380 U/L (D) (Previous Result: 200 U/L). Why did so many results delta?
• Paroxysmal Cold Hemoglobinuria is suggested by which diagnostic finding?
• Which Schilling test result is most consistent with pernicious anemia?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 72 g/L; Hct 0.210 L/L; RBC 2.2 x 10^12/L; WBC 5.0 x 10^9/L; PLT 90 x 10^9/L; MCV 92 fL; MCH 29 pg; MCHC 360 g/L; RETIC 0.4%. Peripheral Blood Smear shows moderate monocytosis; 6% blasts in blood; Bone Marrow shows >20% blasts; MPO negative; Sudan Black B negative; Flow cytometry: CD34 positive; BCR-ABL negative.
• A patient has CBC results: Hgb 78 g/L, Hct 0.240 L/L, RBC 2.1 x 10^12/L, MCV 128 fL, MCH 30 pg, MCHC 355 g/L, RDW 20.0%, WBC 3.0 x 10^9/L, PLT 100 x 10^9/L, RETIC 0.3%. Peripheral smear: Hypersegmented neutrophils, oval macrocytes. Additional testing: TBIL 38 umol/L, uBIL 30 umol/L, LDH 1450 U/L, VB12 65 pmol/L, Folate 20 ng/L. Schilling Test: B12 in urine over 24 hours. What is the presumptive diagnosis?
• The Donath-Landsteiner antibody is best described as which of the following?
• A patient has CBC results: Hgb 98 g/L, Hct 0.300 L/L, RBC 3.1 x10^12/L, MCV 72 fL, MCH 29 pg, MCHC 316 g/L, RDW 22.0%, WBC 6.8 x 10^9/L, PLT 240 x 10^9/L, RETIC 3.8%. Iron studies: Ferritin 780 ug/L, Serum Fe 42 umol/L, TIBC 55 umol/L, Transferrin SAT 75%. Peripheral smear: Basophilic stippling. Additional testing: POS Prussian Blue stain, 20% ringed sideroblasts. What is the presumptive diagnosis?
• A CBC shows Hgb 62 g/L, Hct 0.200, RBC 4.5 x 10^12/L, WBC 9.0 x 10^9/L, PLT 115 x 10^9/L, MCV 58 fL, MCH 24 pg, MCHC 300 g/L, RETIC 14%. Peripheral smear shows extreme poikilocytosis with microspherocytes. Osmotic fragility POS; Lysing upon heating. Additional testing BBIL 55 umol/L, LDH 1200 U/L. What is presumptive diagnosis?
• A specimen was about to be transferred to an additional tube for testing when the phone rings. The technologist returns and processes the sample 20 minutes later. Some of the laboratory results are as follows: CO2 19mmol/L (D) (Prev 25mmol/L), iCAL 1.10mmol/L (D) (Prev 1.30mmol/L), PHOS 0.70mmol/L (D) (Prev 1.50mmol/L). Why did so many results delta?
• A patient presents with bone pain and weight loss. Bone marrow shows plasma cells; labs include Ca 3.20 mmol/L, Platelets 90 x10^9/L, WBC 2.3 x10^9/L, urine protein 4+. Electrophoresis was performed. What disorder is most likely?
• In HbC disease, which smear finding is most characteristic?
• Which peripheral smear finding best characterizes autoimmune hemolytic anemia?
• Which of the following sets lists the groups destroyed by enzymes?
• Which of the following combinations names the groups affected by enzymes?
• Which antibody group is destroyed by enzymes?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 70 g/L; Hct 0.210 L/L; RBC 2.1 x 10^12/L; WBC 5.0 x 10^9/L; PLT 80 x 10^9/L; MCV 98 fL; MCH 32 pg; MCHC 345 g/L; RETIC 0.5%. Peripheral Blood Smear shows blasts with Auer rods; Bone Marrow shows 25% blasts; MPO positive; Cytogenetics: t(15;17) negative; Flow cytometry shows CD34 positive.
• Hypercellular marrow with megaloblastic erythropoiesis is most characteristic of which condition?
• A CBC is performed with the following results: Hgb 70 g/L, Hct 0.280 L/L, RBC 5.0 x 10^12/L, MCV 64 fL, MCH 20 pg, MCHC 305 g/L, RDW 17.0%, RETIC 6.0%. Brilliant Cresyl Blue smear shows golf-ball inclusions (HbH). Hgb Electrophoresis: HbB (y4) 2%, HbH (z2y2) 28%, HbF 0%, HbA2 1%, HbA 69%. What is the presumptive diagnosis?
• Urinalysis shows bilirubin present, and tyrosine and leucine in urine; which diagnosis is most likely?
• Which statement is true about Fanconi's syndrome?
• Which organism is associated with the Hemolytic Uremic Syndrome case?
• A child experiences recurrent hemoglobinuria when exposed to cold, with fever and malaise; lab shows hemoglobinemia and a positive DAT. Which secondary disorder has developed?
• A patient is being assessed for suspected diabetes. The laboratory reports FBS: 8.0 mmol/L, RBS: 12.0 mmol/L, 2h OGTT: 14.0 mmol/L. What is this?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 84 g/L; Hct 0.260 L/L; RBC 2.8 x 10^12/L; WBC 3.9 x 10^9/L; PLT 185 x 10^9/L; MCV 106 fL; MCH 34 pg; MCHC 320 g/L; RETIC 0.4%; RDW 22%. Bone Marrow shows abnormal erythrocyte maturation. Ferritin 502 ug/L; TIBC 50 ug/L.
• In the warm autoimmune hemolytic anemia case, which DAT result confirms IgG-mediated hemolysis?
• In the Warm Autoimmune Hemolytic Anemia case, which DAT result is observed?
• Which result supports a diagnosis of cystic fibrosis?
• Which is the presumptive diagnosis for a patient with generalized edema, hypoalbuminemia, hyperlipidemia and heavy proteinuria with oval fat bodies and fatty casts?
• sCREA 175 umol/L, uCREA 3.8 mmol/d, Creatinine Clearance 0.32 mL/s, eGRF 20 mL/min, URIC 500 umol/L. What does this point to?
• Which finding best supports the diagnosis of gout in the setting of hyperuricemia?
• Which blood group does NOT show dosage?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 96 g/L; Hct 0.290 L; RBC 3.1 x 10^12/L; WBC 6.8 x 10^9/L; PLT 185 x 10^9/L; MCV 89 fL; MCH 29 pg; MCHC 330 g/L; RETIC 1.1%. Peripheral smear: Rouleaux, blue background stain, occasional plasma cell. Additional testing: ESR 0.1 mm/hr; Electrophoresis: abnormal gamma (M) spike; Ca2+ 2.80 mmol/L.
• A CBC is performed with the following results: Hgb 112 g/L; Hct 0.340 L/L; RBC 5.8 x 10^12/L; MCV 65 fL; MCH 21 pg; MCHC 310 g/L; RDW 15.0%. Hb electrophoresis shows HbA 92%, HbA2 5.8%, HbB (y4) 20%, HbF 2.2%. Peripheral smear shows basophilic stippling. What is the presumptive diagnosis?
• A patient has hsTROP 40 ng/L, CK-MB 15 ug/L, Myoglobin 120 ug/L. What is the most likely diagnosis?
• A patient presents with elevated potassium, abnormal urinalysis showing renal tubular epithelial cells, broad casts, and waxy casts. What is the suspected diagnosis?
• Which statement best describes the nephrotic syndrome in terms of urinary findings?
• If a peripheral blood smear shows multiple tear drop cells facing the same direction, what would be the correct interpretation?
• Which value is NOT typically considered a critical laboratory value?
• A CBC is performed with the following results: Hgb 145 g/L; Hct 0.440 L/L; RBC 5.0 x 10^12/L; WBC 7.0 x 10^9/L; Platelets 260 x 10^9/L; MCV 93 fL; MCH 29 pg; MCHC 332 g/L; Retic 5%; Peripheral smear shows occ. targets; Sickledex POS; HbS (2a2s) 39%; HbF 1%; HbA2 2%; HbA 60%. What is the presumptive diagnosis?
• A CBC shows Hgb 132 g/L, Hct 0.400 L/L, RBC 4.5 x 10^12/L, WBC 8.0 x 10^9/L, PLT 200 x 10^9/L, MCV 88 fL, MCH 31 pg, MCHC 340 g/L, RETIC 3%. Peripheral smear shows elliptocytes. SupraVital stain shows many blue-speckled RBCs. Additional testing: DAT 0; Osmotic fragility NEG. What is the presumptive diagnosis?
• A patient has CBC results: Hgb 78 g/L, Hct 0.240 L/L, RBC 2.1 x 10^12/L, MCV 128 fL, MCH 30 pg, MCHC 355 g/L, RDW 20.0%, WBC 3.0 x 10^9/L, PLT 100 x 10^9/L, RETIC 0.3%. Peripheral smear: Hypersegmented neutrophils, oval macrocytes. Bone marrow: Hypercellular, megaloblastic erythropoiesis. Additional testing: TBIL 38 umol/L, uBIL 30 umol/L, LDH 1450 U/L, VB12 65 pmol/L, Folate 20 ng/L. Schilling Test: B12 in urine not detected until after IF injection. What is the presumptive diagnosis?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 78 g/L; Hct 0.240 L/L; RBC 2.5 x 10^12/L; WBC 3.2 x 10^9/L; PLT 88 x 10^9/L; MCV 108 fL; MCH 35 pg; MCHC 322 g/L; RETIC 0.3%. Peripheral Blood Smear shows oval macrocytes. Bone Marrow is hypercellular with dysplastic changes of two lineages.
• Which test is used to detect the monoclonal protein in suspected plasma cell disorders?
• Urinalysis shows Blood 2+, WBCs 21-50/hpf, WBC casts present, RTE casts present, bacteria moderate. Which diagnosis best fits these findings?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 82 g/L; Hct 0.260 L/L; RBC 2.9 x 10^12/L; WBC 60.0 x 10^9/L; PLT 110 x 10^9/L; MCV 92 fL; MCH 30 pg; MCHC 355 g/L; RETIC 0.4%. Peripheral Blood Smear shows monocytosis with dysplasia; Philadelphia chromosome negative; Flow cytometry shows CD14 positive cells.
• A cancer patient’s blood film shows reticulocytosis, macrocytosis, polychromasia, nRBCs, spherocytes, and RBC fragments with elevated LDH and bilirubin and a positive DAT. What is the diagnosis and typical treatment?
• A patient with facial puffiness and mild hypertension after throat infection has urine with red color, protein 1+, RBCs 5-10/hpf and RBC casts present. What is the presumptive diagnosis?
• Which category best describes a lipid profile that is associated with the highest cardiovascular risk requiring aggressive management?
• In the obstructive jaundice scenario, which urinalysis finding most supports the diagnosis?
• Which result is NOT clinically significant?
• A diabetic patient presents with signs of severe metabolic acidosis and ketonuria; which diagnosis is most likely?
• A patient develops transfusion-related symptoms with a 4+ direct antiglobulin test and hemolysis observed only in the post-transfusion sample. What is the most likely type of reaction and immediate management?
• Which pattern is most consistent with primary hypothyroidism due to Hashimoto's disease?
• If a stool specimen PCR indicates a positive result for the tcdB gene for Clostridioides difficile in an asymptomatic patient, what is the best interpretation?
• In SIADH, which osmolality pattern is typical?
• A lumbar puncture is performed on a 19-year-old with abrupt onset of fever, severe headache, and nuchal rigidity. Which CSF profile is most consistent with acute bacterial meningitis?
• A CBC is performed with results: Hgb 74 g/L; Hct 0.220; RBC 2.5 x 10^12/L; WBC 14 x 10^9/L; Platelets 480 x 10^9/L; MCV 92 fL; MCH 28 pg; MCHC 329 g/L; Retic 15.0%. Peripheral smear shows sickle cells and polychromasia. Additional testing shows TBIL 48 μmol/L; uBIL 40 μmol/L; LDH 1500 U/L. Sickle cell test is positive. Hb electrophoresis: HbS 88%; HbF 10%; HbA2 2%; HbA 0%. What is the presumptive diagnosis?
• A patient has a creatinine change from 92 umol/L yesterday to 95 umol/L today. This result is...
• A patient has AST 90 U/L, GGT 290 U/L, LIP 490 U/L, CREA 130 umol/L, and urinalysis shows Bilirubin 1+ and Urobilinogen 0.2 Ehrlich unit. What is the suspected diagnosis?
• Hashimoto's disease presents with which pattern of TSH and FT4?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 85 g/L; Hct 0.265 L/L; RBC 2.8 x 10^12/L; WBC 24.0 x 10^9/L; PLT 90 x 10^9/L; MCV 93 fL; MCH 30 pg; MCHC 355 g/L; RETIC 0.6%. Peripheral Blood Smear shows myeloblasts and promyelocytes with Auer rods; Bone Marrow shows >20% blasts. MPO positive; Sudan Black B positive; Cytogenetics: t(8;21) positive; Flow: myeloid markers.
• Stool PCR positive for C. difficile tcdB gene in an asymptomatic patient should be interpreted as...
• CBC with Hgb 69 g/L, WBC 52 x 10^9/L, lymphoblasts that are deeply basophilic with vacuolation on smear; bone marrow >25% lymphoblasts; MPO NEG; Sudan Black NEG; PAS SL POS. What is the diagnosis?
• Which measure helps prevent febrile non-hemolytic transfusion reactions?
• Muscle cramps, tetany, tingling; history of thyroid surgery; Serum Ca 1.80 mmol/L, Phos 2.00 mmol/L, Mg 0.60 mmol/L; Urine Ca DEC, Phos DEC. Diagnosis?
• Which result is most diagnostic of chronic myeloid leukemia in the presented CBC?
• Which 2h OGTT value is indicative of diabetes?
• A patient develops urticaria during a blood transfusion with no fever, and the direct antiglobulin test is negative. Which transfusion reaction is most likely and how should it be managed first?
• In urine analysis, which finding supports glomerulonephritis?
• A CBC is performed with the following results: Hgb 138 g/L; Hct 0.420/L; RBC 4.7 x 10^12/L; WBC 12.5 x 10^9/L; Platelets 550 x 10^9/L; MCV 90 fL; MCH 30 pg; MCHC 335 g/L; Peripheral smear shows Howell-Jolly bodies; Acanthocytes.
• Which precaution most effectively prevents transfusion-associated graft-versus-host disease?
• A patient admitted for vomiting and diarrhea shows Na 150 mmol/L and a high osmolality; what is this indicative of?
• In essential thrombocythemia, which finding best supports the diagnosis in the presented data?
• In ALL, which subtype is associated with lymphoblasts showing nuclear clefting on smear?
• With a negative antibody screen and an immediate-spin crossmatch showing a result of 0, and the donor is O Positive with the recipient A Positive, what is the correct procedure for issuing blood?
• A fasting glucose is 18.5 mmol/L from a patient with known type I diabetes. This result is...
• Which of the following is NOT a cold reacting antibody?
• Which statement best describes the interpretation of a fasting glucose of 18.5 mmol/L in a patient with type I diabetes?
• Which finding on smear and ringed sideroblasts on Prussian blue staining most strongly supports sideroblastic anemia due to lead poisoning?
• An immunocompromised patient with Hodgkin’s disease receives blood from a relative and weeks later presents with fever, liver dysfunction, rashes, diarrhea, and pancytopenia. What transfusion complication is this, and how can it be prevented?
• During a transfusion, a patient develops dyspnea and chest infiltrates. What is the appropriate immediate management?
• Hypercellular marrow with megaloblastic erythropoiesis is most characteristic of which condition?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 82 g/L; Hct 0.250 L/L; RBC 2.6 x 10^12/L; WBC 4.0 x 10^9/L; PLT 140 x 10^9/L; MCV 110 fL; MCH 36 pg; MCHC 330 g/L; RETIC 0.4%. Bone Marrow shows >15% Ringed Sideroblasts.
• In Cushing's syndrome, which hormone is typically elevated?
• A patient with a diffuse toxic goiter has TSH 0.1 mIU/L, FT4 30 pmol/L, FT3 10 pmol/L. What is the diagnosis?
• A patient has K+: 3.0 mmol/L, GLU: 9.3 mmol/L, CORT (AM): 990 nmol/L. What is the likely diagnosis?
• What happens to Na+ measurement when a lipemic serum sample with elevated Na+ is analyzed by indirect ISE?
• Which electrophoresis pattern is most typical of beta-thalassemia major?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 74 g/L; Hct 0.220 L/L; RBC 2.2 x 10^12/L; WBC 42.0 x 10^9/L; PLT 58 x 10^9/L; MCV 94 fL; MCH 28 pg; MCHC 350 g/L; RETIC 0.3%. Peripheral Blood Smear shows circulating blasts with no Auer rods. Bone Marrow shows >20% blasts. Myeloperoxidase and Sudan Black B are negative; Flow cytometry: CD34 positive.
• If a blood culture specimen only flags positive in one blood culture bottle and the following results are obtained, what is the best interpretation? Gram: GPC Catalase: POS Coagulase: NEG NOV: SUS
• Laboratory results show elevated LDH and visible blood in urine with negative bilirubin; which type of anemia is suggested?
• If a sputum culture gram stain shows gram positive oral flora with many squamous epithelial cells, what is this indicative of?
• If a CBC shows a hemoglobin of 119 g/L on a non-bleeding patient that previously had a hemoglobin of 90 g/L four hours ago. This flagged as a delta check and results have not been verified. What is the first course of action?
• A patient presents with fatigue, back pain, and recurrent infections; labs show low albumin, high globulin, elevated calcium, and mild protein in urine. What is the presumptive diagnosis?
• Which enzyme pattern is most typical of alcohol-related liver disease?
• A CBC is performed with the following results: Hgb 68 g/L; Hct 0.320/L; RBC 2.2 x 10^12/L; WBC 1.2 x 10^9/L; Platelets 15 x 10^9/L; MCV 92 fL; MCH 30 pg; MCHC 335 g/L; Retic 0.2%; Bone marrow: Hypocellular, pancytopenia, dry tap. What is the presumptive diagnosis?
• If a urine culture only grows Escherichia coli with a colony count of 10^5/mL, what does this indicate?
• Which step should precede any clinical intervention when a potassium measurement is markedly abnormal?
• Lipid panel TCHOL 5.75 mmol/L, HDL 1.30 mmol/L, TRIG 4.00 mmol/L, LDL 3.90 mmol/L. Is this patient at risk?
• Which lab profile most strongly suggests Paget's disease given an extremely elevated alkaline phosphatase and normal calcium?
• A patient sample results are as follows: Na 160mmol/L, K+ 6.8mmol/L, Ca 1.5mmol/L, Fe 4µmol/L. What happened?
• A patient has Hgb 70 g/L, Hct 0.220 L/L, RBC 2.2 x 10^12/L, WBC 78.0 x 10^9/L, and bone marrow hypercellular with erythroid precursors; Periodic Acid Schiff POS and Myeloperoxidase POS. Which diagnosis best fits?
• If multiple smudge cells are present on a blood smear for a new patient with no history, what is the appropriate action?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 60 g/L; Hct 0.290; RBC 3.0 x 10^12/L; WBC 18.0 x 10^9/L; PLT 40 x 10^9/L; MCV 91 fL; MCH 29 pg; MCHC 329 g/L; RETIC 10%. Peripheral smear shows schistocytes, helmet cells, burr cells. Coagulation testing: PT 40 s; aPTT 65 s; TT 35 s; D-dimer > 500 ng/mL. Additional testing: uBIL 80 umol/L; LDH 700 U/L.
• A cord CBC is performed with the following results: Hgb 30 g/L, Hct 0.150 L/L, RBC 1.9 x 10^12/L, MCV 60 fL, MCH 18 pg, MCHC 310 g/L, RETIC 15.3%. Peripheral smear shows nRBCs, anisopoikilocytosis. Hgb Electrophoresis: HbB (y4) 95%, HbP (z2y2) 5%, HbF (a4) 0%, HbA2 (a2y2) 0%, HbA 0%. What is the presumptive diagnosis?
• A patient presents with the following iron studies: ferritin 450 ug/L, serum iron 5 umol/L, TIBC 35 umol/L, transferrin 1.5 g/L, transferrin saturation 14%; WBC 12.0 x 10^9/L, platelets 480 x 10^9/L; RETIC 0.4%. Peripheral smear shows rouleaux. Additional testing: Prussian blue stain positive. ESR elevated, EPO decreased. What is the presumptive diagnosis?
• Which statement correctly pairs a transfusion risk with its preventive measure?
• URIC 670 umol/L; Urinalysis: Uric Acid PRESENT. What is a likely diagnosis?
• Urinalysis shows hyaline casts; LDH is elevated; which condition is most likely?
• Which antibody group is NOT enhanced by enzymes?
• A patient has polydipsia and polyuria; serum Na 152, serum osmolality 310 mOsm/kg, urine Na 10, urine osmolality 190. What disorder is this?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 104 g/L; Hct 0.320; RBC 3.4 x 10^12/L; WBC 68.0 x 10^9/L; PLT 110 x 10^9/L; MCV 90 fL; MCH 30 pg; MCHC 342 g/L; RETIC 0.6%. Peripheral smear: Lymphocytosis; Smudge cells. Bone marrow: Dry tap, fibrosis. Additional testing: DAT POS; LDH 300 U/L; Electrophoresis shows an abnormal gamma (M) spike.
• Among the following antibody groups, which are destroyed by enzymes?
• In hyperparathyroidism, which urinary findings would you expect?
• A CBC is performed with the following results. What is your presumptive diagnosis? CBC Results: Hgb 83 g/L; Hct 0.260 L/L; RBC 2.7 x 10^12/L; WBC 3.5 x 10^9/L; PLT 52 x 10^9/L; MCV 104 fL; MCH 33 pg; MCHC 318 g/L; RETIC 0.6%. Peripheral Blood Smear shows thrombocytopenia with hypogranulated platelets and giant platelets. Bone Marrow shows abnormal megakaryocytic maturation. Ferritin 1630 ug/L.
• Which diagnosis is most consistent with a lab pattern of elevated LDH and CK with elevated AST?
• A multiparous patient receives a transfusion and develops fever from 37°C to 39°C with chills and nausea; DAT is negative and there is no hemolysis. What is the most likely diagnosis and its prevention?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 132 g/L; Hct 0.410; RBC 4.4 x 10^12/L; WBC 11.2 x 10^9/L; PLT 1180 x 10^9/L; MCV 88 fL; MCH 29 pg; MCHC 331 g/L; RETIC 1.0%. Peripheral smear: Neutrophilia; Thrombocytosis; Giant platelets. Additional testing: LAP 140; BCR-ABL NEG; JAK2 POS.
• Which of the following scenarios is most clinically significant?
• Which statement is true about enzyme effects on antibody groups?
• A child with sickle cell disease receives a transfusion and develops hypertension and edema with rapid pulse. What transfusion reaction is most likely and how should it be managed?
• Which lab pattern best supports a myocardial infarction diagnosis?
• An autoantibody is induced by a drug, reacting with RBCs and sera; the DAT is anti-IgG positive. Which drug is most likely responsible?
• Which antibody group is NOT enhanced by enzymes?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 96 g/L; Hct 0.290 L; RBC 3.1 x 10^12/L; WBC 6.8 x 10^9/L; PLT 185 x 10^9/L; MCV 89 fL; MCH 29 pg; MCHC 330 g/L; RETIC 1.1%. Peripheral smear: Rouleaux; Occasional plasma cell on background; ESR markedly decreased; Electrophoresis shows an M-spike; Calcium 2.80 mmol/L.
• UREA 10.0 mmol/L and CREA 100 umol/L. What does this indicate?
• Which immunophenotypic marker is most characteristic of megakaryoblastic leukemia?
• Which result is NOT clinically significant?
• A CBC is performed with the following results: Hgb 52 g/L, Hct 0.170 L/L, RBC 2.3 x 10^12/L, MCV 55 fL, MCH 16 pg, MCHC 290 g/L, RDW 23%, RETIC 8.0%. Peripheral smear shows nRBCs, fragmented RBCs, anisopoikilocytosis. Bone marrow peripheral shows hypercellular, low M:E ratio. TBIL 55 umol/L, uBIL 48 umol/L, LDH 1800 U/L, Ferritin 1200 ug/L. Hgb Electrophoresis: HbB (y4) 20%, HbH (z2y2) 0%, HbF 90%, HbA2 8%, HbA 2%. What is the presumptive diagnosis?
• A CBC is performed with the following results. What is the most likely diagnosis? Hgb 125 g/L; Hct 0.380; RBC 4.2 x 10^12/L; WBC 14.8 x 10^9/L; PLT 245 x 10^9/L; MCV 92 fL; MCH 30 pg; MCHC 335 g/L; RETIC 1.5%. Peripheral blood smear: Atypical B-lymphocytes. Additional testing: Monospot POS; EBV VCA IgM POS.
• What pattern of thyroid function tests is consistent with hyperthyroidism?