NO.245 Elevation in conjugated bilirubin is most likely to be found in which of the following conditions:

NO.246 The tube of choice for trace metal analysis is:

NO.247 Valine substitutes for glutamic acid in the Beta 6 position to produce HbS.
To produce hemoglobin S, glutamic acid that is normally present in the sixth position on the beta globin chain is substituted with which of the following?

NO.248 Free T4 is affected the least by changes in plasma proteins during pregnancy.
Which of the following thyroid function assays is affected least by pregnancy:

NO.249 The lactophenol blue mount reveals tiny, ovoid microconidia, arranged in a daisy-head pattern at the tip of a straight conidiophore. This appearance is characteristic of the mold form of Sporothrix schenckii. By moving the focus up and down in a microscopic preparation, delicate hair-like attachments may be observed for each conidium.
The mold form of Coccidioides immitis produces delicate hyphae that break up into arthroconidia separated by empty cells, giving an alternatively staining appearance.
The mold form of Blastomyces dermatitidis is characterized by the production of single, smooth microconidia, each borne on a single, thin conidiophore (“lollipops”).
The mold form of Histoplasma capsulatum is recognized by the production of large, echinulate macroconidia, appearing as a prickly surface.
The ovoid microconidia arranged in a daisy-head pattern at the tip of a a straight conidiophore, observed in the photomicrograph on the right, is characteristic of which of the following dimorphic molds?

NO.250 A casual blood glucose >/= 200 mg/dL on a patient with symptoms and an A1C >/= 6.5% meet diagnostic criteria for diabetes.
Chemistry
A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose at time of evaluation and a HbA1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes.
What would be the best course of action if these are the blood glucose results?
Casual Blood Glucose: 208 mg/dL
HbA1C one week later: 7.2%

NO.251 If a drug is given at intervals that are the same as its half-life, it will take about 5 half-lives to reach steady state.
If a drug is given at intervals that are the same as its half-life, approximately how long will it take the drug to reach steady state?

NO.252 Shigella and Salmonella are not found as normal flora in the gastrointestinal tract.
Which of the following are not considered normal flora of the gastrointestinal tract:

NO.253 Alkaline over acid, or K/A, in TSI reactions is associated with the fermatation of glucose alone and the utilization of peptone.
Which of the following sugars has been fermented by a gram-negative rod that has produced an alkaline slant and an acid butt on triple sugar iron agar (TSI).?

NO.254 True Statements:
Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion may wash out test reagents.
False Statements:
Urine should be centrifuged prior to dipping the reagent strip. When visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen.
Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL of the correct answers)

NO.255 A hospital chief operating officer is responsible for

NO.256 The clue to the identification of the colony seen in the upper frame is the gram stain in the lower frame, in which are seen short, rounded, gram positive bacilli, many of which possess distinct spores. As the colonies grew aerobically, the presence of spores indicates Bacillus species. The colonies are spreading, smooth, yellow-white and non-hemolytic. The lack of hemolysis and the small size of the bacterial cells suggests a species other than Bacillus cereus, the species causing most human infections. The isolate was identified as Bacillus circulans, which is consistent with the gram stain morphology. Clostridium septicum also produces spores; however, this species is an anaerobe and would grow poorly if at all and not produce spores aerobically. Listeria monocytogenes and Lactobacillus species are gram positive bacilli; however, neither of these produce spores.
The colonies seen in the upper frame, grown after 48 hours incubation aerobically at 35°C, and the accompanying gram stain in the lower frame are uncommonly associated with human disease, but have been associated with septicemia, bronchopneumonia, osteomyelitis and other infections, particularly in intravenous drug users. The most likely identification is:

NO.257 Class C fires involve:
Question options:

NO.258 To prevent blood from clotting the specimen must be:

NO.259 Myoglobin rises typically within 2-4 hours after a myocardial infarction and stay elevated for days, with a peak at the 6-9-hour mark post-MI. After myoglobin, troponin is the next fastest to rise afer a mycardial infarction and can rise within 3-4 hours with a peak around 12 hours post-MI. LD (8-12 hours, 24-48 hour peak) and CK (4-6 hours with peak at 24-36 hours) will also rise after MI, but are not as fast to rise as myoglobin and troponin.
Chemistry
A patient is admitted to the hospital with acute chest pain, but which of the following cardiac markers will be elevated FIRST if the patient had an MI?

NO.260 In this case, the pH may become more alkaline, perhaps above 8.0, if the bacteria in the sample are proliferating during the extended room-temperature wait time.
A urine specimen was collected at 6:00 a.m. and remained at room temperature until it was received in the laboratory at 3:30 p.m. How may the pH of the specimen be affected by the extended time at room temperature if bacteria are present in the specimen?

NO.261 Allergic reactions, bacterial/viral meningitis do not cause the presence of blasts to be noted in the CSF.
Leukemia with CNS involvement will show immature cells, similarly to the peripheral blood smear.

The image is a stained smear of cerebrospinal fluid. The cells present in this field may indicate what condition?

NO.262 Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis, but not diagnostic enough to predict chronic pancreatitis; wheras high levels are found only during acute pancreatitis episodes. In the later stages of chronic pancreatitis, normal to decreased levels of amylase and lipase are caused by the gradual inability of the pancreas to secrete the enzyme All of the statements below regarding amylase and lipase in pancreatitis are TRUE EXCEPT:

NO.263 Provide the equivalent measurement for 1 ounce.

NO.264 The correct answer which best fits the characteristics in this question is Mycobacterium tuberculosis.
What is the MOST likely identity of an acid-fast bacilli that showed buff colored, dry, heaped colonies; niacin, nitrate, and urease positive; and took 23 days at 35ºC to grow?

NO.265 Stuart Prower factor, or factor X, would cause abnormal PT, aPTT, and dRVVT test results as factor X is part of the common coagulation pathway and therefore measured in both the PT and aPTT test. In the dRVVT test, factor X is directly activated in the test principle; therefore an abnormal result would be expected in this test as well if there was a deficiency in factor X.
What tests will be abnormal in a patient with Stuart-Prower Factor deficiency?

NO.266 Acute hemolytic transfusion reactions are most commonly due to ABO-incompatible blood being transfused to a recipient with naturally occurring ABO alloantibodies (anti-A, anti-B, anti A,B).
Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes?

NO.267 Hemolytic anemia, myelodysplasia, and liver disease may each fit this peripheral blood picture. Each of these conditions can display peripheral blood macrocytosis. It is easy to observe the overall larger size of the red blood cells in this image compared to the normal lymphocyte also present.
When macrocytes are present, they should be examined for their shape (round vs. oval), the hemoglobin content (central pallor), and whether or not there are any inclusions present in the cell.
Iron deficiency would not be the correct answer in this case, since this condition is associated with microcytosis instead.
The complete blood count was obtained from a patient recently admitted to the emergency room. The red blood cell indices obtained revealed an MCV of 115 femtoliters (fL) (normal range 80 – 90 fL). The patient met the criteria for a peripheral blood smear examination. A representative field is shown on the right.

Which of the following conditions may be indicated by the results seen on this peripheral blood smear?

NO.268 Isotonic or normal saline is a 0.85 % solution of sodium chloride in water.
The concentration of sodium chloride in an isotonic solution is :