By P. Darmok. Alabama A&M University. 2019.
Insuﬃcient time had elapsed between measurement of acute and convalescent samples Immunology/Apply knowledge to recognize sources of error/IgM testing/3 14 generic noroxin 400mg amex. A patient has a prostate-speciﬁc antigen level of 60 ng/mL the day before surgery to remove a localized prostate tumor purchase 400 mg noroxin free shipping. Te cell line displayed a mixed pattern display symptoms that overlap two or more diseases of ﬂuorescence that could not be separated by and have complex mixtures of serum autoantibodies order 400mg noroxin otc. It prevents graft-versus-host disease present initially with a negative serum result. B The main advantage to the patient from the biological characteristics/Transplantation/2 reinfusion of autologous stem cells is that the procedure prevents graft-versus-host disease, 18. A transplant patient began to show signs of especially in the immunocompromised patient. Preformed antibody, and possibly immune response/Transplantation/Rejection/3 complement, is usually involved in hyperacute (immediate) rejection and chronic rejection. Greatest sensitivity in monitoring for What is the most likely explanation of these ﬁndings? Ovarian malignancy has recurred to be increased in the malignant tissue type are B. Although testing errors may occur in any situation, measurements of carbohydrate Immunology/Correlate laboratory data with antigens use puriﬁed monoclonal antibodies with physiological processes/Tumor markers/Testing/3 very low cross reactivities. Based upon these is considered positive only if antibodies to at least results, which conclusion is correct? A woman who has been pregnant for 12 weeks is should be reported as indeterminate, and the patient tested for toxoplasmosis. Which of the following IgM may remain detectable for a year or more tests would you recommend to determine if the following infection. Amniotic ﬂuid culture not useful for determining when the mother might Immunology/Correlate laboratory data with have been infected. The courier placed the whole technologists who performed the tests blood specimen in an ice chest for transport. Order a new lot of both kits and then retest on this specimen, no β-γ band is seen in the serum the new lots protein lane, and the IgM lane is very faint. Refer the discrepant specimens for testing by rheumatoid factor on this specimen was negative. Nothing’s wrong with our laboratory; the patient had an infection 2 weeks ago that has cleared up Answers to Questions 22–24 B. Something’s wrong with our laboratory—we likely mislabeled one of the specimens; please 22. You will run a second specimen using a precipitated during the courier ride and was thus 2-mercaptoethanol treatment that will in the clot when the laboratory separated the eliminate IgM aggregates and allow for serum. Te physician should redraw another specimen at low levels following a vaccination for up to from the patient and this time separate the serum 1–2 weeks. Thus, patients who have received a from the clot in his oﬃce before sending the second injection of hepatitis B vaccine may have specimen in by courier anti-hepatitis B surface antigen and detectable Immunology/Correlate laboratory data with antigen for a brief period of time. This has been physiological processes/Specimen integrity/3 reported more frequently in dialysis and pediatric 23. D In this situation, you have already tested the Te physician suspects a laboratory error. You could perform clinical chart reviews hepatitis B booster vaccination and could have as an alternative, but obtaining that data would be these results difficult and much of it may be subjective. Clinical Diagnostic Immunology: Protocols in Quality Assurance and Standardization. Polymerase chain reaction biological characteristics/Genetics/Rh/2 Blood bank/Apply knowledge of laboratory operations/Genetics/1 Answers to Questions 1–5 2. In addition to Kell, Blood bank/Apply knowledge of fundamental dosage eﬀect is seen commonly with antigens M, N, biological characteristics/Genetics/Kell/3 a b a b S, s, Fy, Fy, Jk, Jk, and the antigens of the 3. Which of the following describes the expression of are not clearly discerned; however, nucleoli may be most blood group antigens? B Linkage disequilibrium is a phenomenon in which alleles situated in close proximity on a chromosome 11. Indirect/secondary/second order Blood bank/Evaluate laboratory data to verify test results/Genotype/Paternity testing/2 4. Te heterozygous population of one allele are contained in the rabbit polyspeciﬁc antihuman B. Te homozygous population of one allele globulin reagent for detection of in vivo C. In this type of inheritance, the father carries the Blood bank/Apply knowledge of fundamental trait on his X chromosome. X-linked recessive used in population genetics to determine the Blood bank/Apply knowledge of fundamental frequency of diﬀerent alleles. IgM antibodies are larger molecules and have the An example of this type of inheritance is the Xga ability to bind more antigen blood group. A An IgM molecule has the potential to bind up to readily to bind more antigen 10 antigens, as compared to a molecule of IgG, C. B An anamnestic response is a secondary immune decreases the zeta potential, allowing antibody and response in which memory lymphocytes respond antigen to come closer together? Anaphylactic Blood bank/Apply knowledge of fundamental biological characteristics/Antibodies/1 4. An A2 person may form anti-A1; an A1 person Te crossmatch was run on the Ortho Provue and will not form anti-A1 yielded 3+ incompatibility. A2 antigen will not react with anti-A from a antigen nonimmunized donor; A1 will react with any B. Te patient has an antibody to a high-frequency anti-A antigen Blood bank/Apply knowledge of fundamental C. Te patient is an A1 with anti-A2 Blood bank/Apply principles of special procedures/ 2. Te patient may be a Bombay A person who is group A may form anti-A, but an 2 1 D. Which typing results are most likely to occur when a patient has an acquired B antigen? Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg the discrepancy is in forward grouping. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg washed red cells at room temperature with anti-A C.
Request assistance from the legal department should be notiﬁed cheap noroxin uk, the incident documented cheap noroxin master card, and the Education and management/Laboratory operations/2 physician notiﬁed purchase noroxin online now. The issue of informed consent is a legal one, and the laboratory personnel should act in 64. Which of the following accurately describes the accordance with the laws governing their jurisdiction. Lower cost, eﬃcient ﬂow, added value, net result blood tests into evidence, if the subject had not been B. Customer value, value stream map, ﬂow, pull, formally arrested and the sample was collected improved outcome against the subject’s will. It is used often in clinical laboratories Education and management/Laboratory operations/2 to improve a process such as test turnaround time. To accomplish this, the lab manager measures the time it takes for specimens to be collected and 65. The map is used to identify areas of instrument data link, centrifuged, and placed on waste where eﬃciency can be improved. Speckled directed against nucleoprotein; although they are mainly nonpathological, they are useful markers for Immunology/Identify microscopic morphology/ active disease. Plate 2 shows the electrophoresis of serum restricted electrophoretic mobility usually located proteins on a high-resolution agarose gel at in the γ or the β region. Sample 1 (in lane 1) is a normal serum accumulation of identical immunoglobulin molecules control. Which sample can be presumptively or fragments secreted by a malignant or benign classiﬁed as a monoclonal gammopathy? Chemistry/Evaluate clinical and laboratory data/ Protein electrophoresis/3 537 538 Chapter 10 | Photomicrographs and Color Plate Examination 3. Plate 3 shows a densitometric scan of a control Answers to Questions 3–6 serum for protein electrophoresis. C The fraction marker between the α2- and β-fractions these results, what is the most appropriate initial is marked improperly. Repeat the electrophoresis run using fresh α2- macroglobulin, which partially splits the control serum α2- band into two subfractions. Report the results, provided that the previous β-band may contain three subfractions run was in control corresponding to β-lipoprotein, transferrin, and C. In this scan, the valley between the redraw the scan α2-subfractions was selected incorrectly as the D. Calculate the concentration of each fraction in boundary between the α2- and β-fractions. This grams per deciliter fraction marker should be placed at the next valley to the right and the scan redrawn to determine the Chemistry/Identify sources of error/Densitometry/3 area under the α2- and β-fractions correctly. C Using high current, β lipoprotein can be separated on a high-resolution agarose gel at pH 8. The α-2 Chemistry/Evaluate clinical and laboratory data/ macroglobulin is usually anodal to the haptoglobin. Plate 5 is a densitometric scan of a serum protein increases in the α1- and α2-fractions and a decrease in electrophoresis sample. This pattern is most concentration of each fraction and reference limits often caused by increased production of acute phase are shown below the scan. What is the correct reactants such as α1-antitrypsin and haptoglobin that classiﬁcation of this densitometric pattern? Polyclonal gammopathy associated with chronic is seen in myocardial infarction and other forms of inﬂammation acute tissue injury, the early stage of acute infection, B. Following electrophoresis, the Protein electrophoresis/3 proteins in lane 1 are precipitated and ﬁxed by 6. Plate 6 shows an agarose gel on which overlaying sulfosalicylic acid onto the gel. Te gel contains the chain is applied to the gel over the lanes as labeled same serum sample as number 6 shown in Plate 2. IgM λ 2 reacted with anti-γ (anti-IgG), and the proteins in Chemistry/Evaluate clinical and laboratory data/ lane 5 reacted with anti-κ. Lane 5 also contains a faint Immunoﬁxation electrophoresis/3 restricted band anodal to the IgG band. This band is not present in lane 2 (does not contain γ chains) and represents free κ light chains. Plate 7 shows the electrophoresis of hemoglobin Answers to Questions 7–10 (Hgb) samples performed on agarose gel, pH 8. Plate 8 shows the electrophoresis of Hgb samples there is no normal β-gene, and the patient can be on acid agar gel, pH 6. Te sample order is the classiﬁed as a homozygote for Hgb S, D, or G which same as for plate 7 with the A, S, C control migrate to the same position on agarose gel at a hemolysate in lanes 2 and 10. Hgb S can be diﬀerentiated electrophoretic mobility of sample 7 as seen in from Hgbs D and G by performing electrophoresis both plate 7 and plate 8, what is the patient’s on agar gel at pH 6. On plate 8, Chemistry/Evaluate clinical and laboratory data/ sample 7 shows a single large band that migrated Hemoglobin electrophoresis/3 toward the anode at the same position as the S band 9. The phialides produce Microbiology/Identify microscopic morphology/Fungi/2 jet-black conidia that obscure the vesicle surface, forming a radiated head. Plate 10 is a photomicrograph of a fungal slide produce septate macroconidia, not vesicles with culture stained with lactophenol cotton blue, phialides. Plate 11 is a photomicrograph of a fungal slide Answers to Questions 11–15 culture stained with lactophenol cotton blue, 400×. Plate 12 is a bronchoalveolar lavage sample annellides on short conidiophores with oval conidia concentrated by cytocentrifugation and stained that are tapered at one end. Plate 13 is a fecal specimen seen under 400× using same size but have a clear (hyaline) shell, flat on brightﬁeld microscopy. They are often bile stained and may have a thick shell with a coarse Microbiology/Identify microscopic morphology/ covering (corticated).
The degree of body-compartmentalization buy cheap noroxin 400mg on line, or in other words cheap noroxin 400mg overnight delivery, the ability of a macromolecule or particulate to move around order noroxin online from canada, depends on its physicochemical properties, in particular its: • molecular weight/size; • charge; • surface hydrophobicity; • the presence of homing devices for interaction with surface receptors. The smaller the size, the easier a molecule can passively move from one compartment to another. An important question is whether and where the carriers can pass through the endothelial lining of the blood circulation. The endothelial lining is continuous in most parts of the body and the endothelial cells are positioned on a basal membrane. The exact characteristics of this barrier are still under investigation, but it is clear that particulate systems greater than 10 nm cannot pass this barrier through pores. Only in the sinusoidal capillaries of the liver, spleen and bone marrow can “pores” (so-called fenestrae) be found. In the lining of these capillaries the basal membrane is fragmented or even completely missing. This anatomical information has important implications for the rational design of targeted carrier systems. If a therapeutic target is located outside the blood circulation and if normal anatomical conditions exist around the target site, a small-sized macromolecular carrier must be selected, in order to achieve 110 sufficient “escaping tendency” from the blood circulation. Particulate carriers will generally fail to extravasate, simply because there is no possibility for endothelium penetration. In addition to the issue of endothelial permeability, the effect of macrophages in direct contact with the blood circulation (e. Kupffer cells in the liver) on the disposition of carrier systems must be considered. Unless precautions are taken, particulate carrier systems are readily phagocytosed by these macrophages and tend to accumulate in these cells. Particle charge For liposomes, it has been shown that negatively charged vesicles tend to be removed relatively rapidly from the circulation whereas neutral vesicles tend to remain in the circulation for longer periods. Surface hydrophobicity Hydrophobic particles are immediately recognized as “foreign” and are generally rapidly covered by plasma proteins known to function as opsonins, which facilitate phagocytosis. The extent and pattern of opsonin adsorption depends highly on surface characteristics such as charge and hydrophilicity. A further consideration is that under pathological conditions, endothelium exhibits modified characteristics. For example, the endothelial fenestrations in inflammation sites can be as large as 0. However, in this case, the pattern is not uniform and depends on the tumor type and stage of development. Even within one 111 tumor, highly permeable sites can be identified in close proximity to sites of low permeability. Consequently, the major organs of accumulation are the liver and the spleen, both in terms of total uptake and uptake per gram of tissue. After phagocytosis, the carrier and the associated drug are transported to lysosomes and the drug is released upon disintegration of the carrier in this cellular compartment. If the drug is not broken down by the lytic enzymes of the lysosomes, it may be released in its active form from the lysosomal compartment into the cytoplasm and may even escape from the phagocyte, so causing a prolonged release systemic effect. Technology is available to reduce the tendency of macrophages to rapidly phagocytose colloidal drug carrier complexes. The process of “steric stabilization” involves the coating of the delivery system with synthetic or biological materials, which make it energetically unfavorable for other macromolecules to approach. This repulsive steric layer reduces the adsorption of opsonins and consequently slows down phagocytosis. This form of passive targeting, also called “selective targeting”, requires two conditions to be satisfied: • The size of the drug-carrier system should exceed the size of normal endothelial fenestrations to ensure that the carrier system only crosses inflamed endothelium; a certain size range is preferred as there is an upper limit to the endothelial fenestration dimensions under pathological conditions. If the circulation time is sufficiently prolonged and the particle size does not exceed, say, 0. Thus delivery systems designed for active targeting are usually composed of three parts: the carrier, the homing device and the drug (Table 5. Preferably, the homing device is covalently attached to the carrier, although successful targeting attempts of non-covalently attached homing device-carrier combinations have also been described. A list of cell-specific receptors and their corresponding ligands, expressed under physiological conditions, is presented in Table 5. Thus, for example, galactose can be used to target a drug carrier to parenchymal liver cells, etc. In the future, it is expected that the rapidly growing field of genomics will be used to identify specific receptors for targeting purposes (see Chapter 15). Sometimes it is necessary for the carrier-bound drug to reach all target cells to be clinically successful, as is the case with antitumor therapy. Bystander effects occur when the targeted drug carrier reaches its target site, and released drug molecules also act on surrounding non-target cells. In other cases not all target cells have to be reached, as is the case, for example, for targeted gene delivery for the local production of a therapeutic protein. Antibodies raised against a selected receptor are extensively used as homing devices. Modern molecular biotechnology permits the production of large amounts of tailor-made material. The antigen binding site of IgG molecules represents the homing part, which specifically interacts with the target (cells, pathogens, tissue). The sites that are responsible for the pharmacological effects of IgG, such as complement activation and macrophage interaction, are located at the stem part of the Y. The rest of the molecule forms the connection between the homing device and the pharmacologically active sites and also contributes to the long blood circulation characteristics of the IgG molecule, which has an elimination half-life much greater than 24 h. Often, the full antibody molecule (Mw 150 kD) is not utilized for targeting, but the antigen binding domain carrying the Fab (Mw 50 kD) fragment, or even smaller fragments (single chain antibodies, Mw 25 kD) can be used. The present generation of murine monoclonal antibodies is now being replaced by humanized or human antibodies. Antibodies have received most attention as potential homing devices, but other potential candidates are emerging, in the cytokine and the growth hormone family and, finally, among the adhesion molecules that play a role in the homing of inflammatory cells to inflammation sites. Active targeting strategies for soluble carriers include attaching rather simple homing devices such as galactose, for targeting to liver parenchymal cells (see Table 5.
Tests measuring pulmonary phospholipid surfactants are the most speciﬁc and sensitive indicators of respiratory distress syndrome noroxin 400mg visa. Most of the surfactants in the amniotic ﬂuid are present in the form of lamellar bodies cheap 400 mg noroxin visa. These can be counted using an electronic cell counter at the settings for enumerating platelets 400mg noroxin mastercard. Which of the following statements regarding Answers to Questions 4–6 the L/S ratio is true? Sphingomyelin levels increase during the third constant throughout gestation and serves as an trimester, causing the L/S ratio to fall slightly internal reference. Meconium contains less lecithin during the last 2 weeks of gestation than amniotic ﬂuid and will usually decrease the D. Which of the following conditions is most likely its presence indicates fetal lung maturity. Centrifugation at 1,000 × g for 10 minutes 3:1 more closely correlates with fetal lung maturity D. Centrifuge speed is below expected levels should be the minimum required to spin down cells C. Samples that cannot levels than expected for the time of gestation be measured immediately should be refrigerated D. Samples are stable for up to 3 days at 2 days following delivery, stillbirth, or abortion 2°C–8°C and for months when frozen at –20°C or lower. Meconium and blood may also introduce Body ﬂuids/Correlate clinical and laboratory data/ errors when measuring the L/S ratio. Blood has Chorionic gonadotropin/2 an L/S ratio of approximately 2:1 and will falsely raise the L/S ratio when fetal lungs are immature and depress the L/S ratio when fetal lungs are mature. In ectopic pregnancy, the expected increase between consecutive days is below normal. Which of the following statements regarding Answers to Questions 7–10 pregnancy testing is true? Because monoclonal antibodies are Body ﬂuids/Apply principles of basic laboratory derived from mouse hybridomas, rare false positives procedures/Pregnancy test/2 may occur in patients who have antimouse Ig 8. Although the test can detect lower levels physician who suspected a molar pregnancy. Serum is preferred over urine because sample was diluted 10-fold and the assay was serum levels are more consistently above the cutoﬀ repeated. Te result was found to be grossly point than random urine in very early pregnancy. A pipeting error was made in the ﬁrst analysis α subunit and the other with the β subunit. Antigen excess caused a falsely low result in the where both antibodies are added together, a process undiluted sample called the “hook eﬀect” is known to occur. Most cases of Down syndrome are the result of: or isochromosome formation, but most cases arise A. Nondisjunction of an E chromosome (E trisomy) from nondisjunction of chromosome 21 during B. Deletion of the long arm of chromosome 21 estriol is used to screen for Down syndrome during Body ﬂuids/Apply knowledge of fundamental biological the second trimester. Which assay result is often approximately 25% below the expected level in pregnancies associated 10. Amniotic ﬂuid bilirubin (free) estriol is almost all derived from the fetus and is D. Urinary chorionic gonadotropin a direct reﬂection of current fetal placental function. When all four assays are combined with adjustments for maternal age, gestational age, race, maternal weight, and diabetes, the detection rate is approximately 70–80% and the false-positive rate 7%. Elevated levels in amniotic ﬂuid are speciﬁc for dependent upon gestational age, upper reference spina biﬁda limits depend upon last menstrual period dating. When Body ﬂuids/Apply principles of special procedures/ serum levels are high, ultrasound is used to Alpha fetoprotein/2 determine fetal age and rule out twins. When performing marker screening tests for and estriol do not discriminate well between Down syndrome, why are results expressed in 21 trisomy and normal pregnancy before the multiples of the median (MoM) rather than second trimester. MoM normalizes for gestational age (almost twofold higher in Down syndrome) and C. Mean cannot be determined accurately for these which has a median in Down syndrome less than analytes half of that seen in normal pregnancy. These two markers used together with high-resolution Body ﬂuids/Apply knowledge of special procedures/ ultrasound to determine nuchal fold thickness Trisomy screening/1 (swelling at the base of the neck) have a sensitivity of 85%–90%. It eliminates interlaboratory variation in reference ranges seen when concentration units are reported. Laboratories using diﬀerent methods (antibodies or calibrators) may have signiﬁcantly diﬀerent mass unit results for the same sample, necessitating diﬀerent reference ranges. The reference range in concentration units is also dependent upon the gestational age at the time of sample collection; however, the average result for normals is always 1. Use of MoM obviates the need to report speciﬁc reference ranges based on method or gestational age and makes calculation of risk less complicated. Which statement regarding the fetal ﬁbronectin Answers to Questions 14–17 test is true? B The fetal ﬁbronectin test is used mainly to rule of delivery within 14 days out the likelihood of preterm delivery in high-risk B. Te test should not be performed before pregnancies or in women with signs of preterm labor. Te test is used to identify amniotic ﬂuid after cervical secretions in early pregnancy but disappears rupture of the fetal membranes by about week 20. When there is inﬂammation to the membranes preceding delivery, ﬁbronectin is released Body ﬂuids/Apply principles of special laboratory and can be found in cervicovaginal secretions. A procedures/Fetal ﬁbronectins/1 positive test (>50 ng/mL) has a sensitivity of about 15. Vaginal Body ﬂuids/Apply knowledge of fundamental biological ﬂuid is normally acidic, with a pH between 5.
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