Clinical Laboratory Fundamentals Exam Questions and Answers

1. Common places for capillary blood collection in adults are (D)
A. Back of hand B. Elbow C. Heel D. Finger E. Earlobe
2. Which coagulation factor is not a coagulation factor in the endogenous coagulation pathway (E) A. Factor XI B. Factor VIII C. Factor XII D. Factor IX E. Factor VII 3．For coagulation test, the preferred anticoagulants are: (E) A, heparin B, EDTA-K2 C, EDTA-Na2 D, oxalate E, sodium citrate 4, the staining effect of Wright's staining method: (C)  A. Physical adsorption B. Chemical affinity C. Physical adsorption and chemical affinity D. Chemical binding E. Physical binding 5. Which of the following substances is recognized as the most powerful substance for promoting red blood cell rolls: ( B)  A, albumin B, fibrinogen  C, gamma globulin D, beta globulin E, cholesterol 6. Which of the following urine samples is often used for routine urine analysis in outpatients? ( B ) A morning urine B random urine C Clean urine D 3h urine E 24h urine 7. When suffering from infectious mononucleosis , more cells can be found on the blood smear: (D) A. Large mononuclear cells B. Neutrophils are toxic and degenerated C. Immature monocytes D. Atypical lymphocytes  E. Immature granulocytes 8. The composition of hemoglobin is composed of (A)












A. Globulin and heme B. Iron atom and protoporphyrin C. Heme and iron atom D. α2β peptide chain E. Heme and albumin
9. Which of the following urine specimens will be cloudy after heating ( C)
A pyuria B bacteriuria C crystalline urine D fatty urine E chyluria
10. Coagulation factors that can be activated by kaolin are: (D)
A, IB, Ⅱ C, Ⅹ D, Ⅻ E, Ⅲ
11. The most reliable experimental index results for clinically judging the complete cessation of gastrointestinal bleeding are (C) A. No red blood cells in stool microscope B. No tarry black stools C. Negative fecal occult blood test D. Negative fecal cholin test E Negative fecal bilegen test 12 . The disease can be determined by stool examination (C) A digestive tract cancer B digestive tract ulcer C intestinal parasites D liver disease E dyspepsia 13. Normal semen liquefaction time does not exceed ( E ) A 5min B 10min C 20min D 25min E 30min 14 . A large number of normal prostatic fluid can be seen during microscopic examination ( B ) A calcium oxalate crystals B lecithin bodies C epithelial cells D neutrophils  E Charcot-Leyden crystals 15. Platelet count is the study of: (C) A. An important indicator of hemostatic disorders B. An important indicator of coagulation disorders C. An important indicator of hemostasis and coagulation disorders D. An indicator of capillary wall integrity E. An indicator of vascular endothelial integrity 16. Pregnancy test The measured hormones are: (D) A. Estrogen B. Placental lactogen C. Placenta-specific protein D. Chorionic gonadotropin  E. Progesterone 17. Under normal circumstances, ketone bodies are produced in: ( A )












A. Liver B. Kidney C. Pancreas D. Pituitary gland E. Kidney tubule 
18. Tubular proteinuria refers to: (A) 
A. The protein in the original urine cannot be absorbed by the renal tubules B. The damage of the glomerular filtration membrane C. Passive hyperemia of the kidney D. Renal vasospasm bleeding E. Glomerular pass Increased permeability
19. On the white blood cell histogram, which of the following cells is not included in the mononuclear cell area (B)
A monocytes B  neutrophils  C eosinophils  D  basophils  E blasts
20. Average red blood cells Volume (MCV) is in femtoliters (fl), and lfl is equal to ( C )
A. 10-9L B. 10-12L C. 10-15L D. 10-18L E. 10-20L

Scoring

8 questions in total, 1 point for each space, 40 points in total)

1. The common forms of dysmorphic red blood cells in urine are: ① large red blood cells; cells, ⑨ red blood cell fragments.
2. In hypertonic solution, red blood cells _shrink___, in hypotonic solution, they __swell (increase)__, and _hemoglobin_ oozes out, becoming shadow cells.
3. Toxic changes in abnormal neutrophils: heterogeneous size, toxic granules, vacuolar degeneration, Dvohie bodies, degeneration.
4. There are very few red blood cells in normal urine, and the red blood cells do not exceed _3/HPF_. Red blood cells_>3/HPF_ under the microscope is called _microscopic hematuria_; red turbidity in varying degrees, such as meat washing water samples or blood clots, is called gross hematuria. At this time, the blood content in every 1L of urine is lml or more. According to the shape of red blood cells in urine, hematuria can be divided into three types, namely homogeneous red blood cell hematuria (non-glomerular hematuria), heterogeneous red blood cell hematuria (glomerular hematuria) and mixed hematuria. 5
. Cyanide hemoglobin maximum absorption peak _540nm__.
6. The source of urinary epithelial cells: mainly from renal tubules, renal pelvis, calices, ureter, bladder and urethra, etc. The epithelial cells of urinary sediment are generally classified according to morphology and can be divided into: renal tubular epithelial cells, transitional epithelial cells and squamous cells Epithelial cells, among which transitional epithelial cells can be divided into large round epithelial cells, caudate epithelial cells and small round epithelial cells according to the cell shape.
7. Blood coagulation is the transition of blood from a flowing state to a gel state.

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3. Explanation of terms (5 questions in total, 3 points for each question, 15 points in total)

1. Rightward shift of nucleus: If neutrophils in peripheral blood have more than 3% of 5 lobes, it is called right shift of nuclear image , (2 points) This is often accompanied by a decrease in the total number of white blood cells. (1 point)

2. Poisoning granules: neutrophils are larger than normal neutrophils, with different sizes, uneven distribution, darker staining, black or purple-black. (2 points) Sometimes the granules are very thick and easily confused with basophils, and sometimes they are small and sparse, scattered among normal neutrophils. (1 point)

3. Exudate: mostly inflammatory effusion, (1 point) During inflammation, due to the toxins of pathogenic microorganisms, hypoxia, and inflammatory mediators, vascular endothelial cells are damaged and vascular permeability increases, (1 point) points) so that the macromolecular substances and cells in the blood vessel leak out of the blood vessel, interstitial space and serous cavity through the blood vessel wall. (1 point)

4 Granular casts: The contents of the casts contain particles of different sizes, and when the amount exceeds 1/3 of the area, it is called a granular cast. (3 points)

5. Carbo ring: a purple-red thin coil-like structure that appears in the cytoplasm of pleochroic or basic stippling red blood cells, sometimes winding into a figure-eight shape. (3 points)

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4. Short answer questions (2 questions in total, 5 points each, 10 points in total)

1. Types of atypical lymphocytes (5 points)
Type I (vacuolar type) (1 point): The most common. The cell body is slightly larger than normal lymphocytes, mostly round, oval or irregular. Nuclei are round, reniform or lobulated, often deviated. The chromatin was rough, in the form of coarse network or small blocks, and arranged irregularly. The cytoplasm is abundant, stained dark blue, and contains vacuoles or foams. (1 point)
Type II (irregular type) (1 point): The cell body is relatively large, often irregular in shape, and may have many feet. The shape and structure of the nucleus are the same as those of type I or not the same, and the chromatin is rough and dense. The cells are rich in quality, stained light blue or grayish blue, with a sense of transparency, and the edges are colored darker blue. There may be a few vacuoles. (1 point)
Type III (naive type) (0.5 points): the cell body is larger, and the nucleus is round or oval. The chromatin is finely arranged in a network, 1-2 nucleoli can be seen, the cytoplasm is dark blue, and there may be a few vacuoles (0.5 points).

2 What is the principle of heating acetic acid method to determine urine protein? (5 points)
flow_flow_heating and boiling to denature and coagulate the protein, (1 point) then add dilute acid to lower the urine pH and approach the isoelectric point of urine protein (pH4.7), (2 points) denature and coagulate The protein is further precipitated (1 point) under the condition of containing an appropriate amount of inorganic salt, and at the same time, the turbidity interference caused by the precipitation of some phosphate and carbonate can be eliminated. (1 point)

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5. Questions and answers (2 questions in total, 15 points in total)

1. What is the pathological and clinical significance of increased erythrocyte sedimentation rate? (8 points)
①Various inflammations (1 point): During acute bacterial inflammation, acute reactive substances in the blood increase rapidly, mainly due to increased release. The pathological changes of rheumatic fever, connective tissue inflammation, and the erythrocyte sedimentation rate during the active phase increase. In chronic inflammation such as tuberculosis, the content of fibrinogen and immunoglobulin increases, and the erythrocyte sedimentation rate increases rapidly. Clinically, erythrocyte sedimentation rate is the most commonly used to observe the activity and dynamic changes of tuberculosis and rheumatic fever. (1 point)
②Tissue damage and necrosis (1 point): Larger surgical trauma can lead to increased erythrocyte sedimentation rate, and if there are no complications, it will usually return to normal within 2-3 weeks. Myocardial infarction usually increases erythrocyte sedimentation rate 3-4 days after onset, and lasts for 1-3 weeks. The erythrocyte sedimentation rate is normal during angina pectoris, so it can be identified by erythrocyte sedimentation rate results (1 point)
③Malignant tumor (1 point): accelerated ESR may be related to tumor Cell secretion of glycoprotein, tumor tissue necrosis, secondary infection factors. The erythrocyte sedimentation rate of benign tumors is mostly normal, so the erythrocyte sedimentation rate is often used as malignant tumors and malignant tumors that cannot be detected by general X-ray examinations. For malignant tumor patients, the increased erythrocyte sedimentation rate can gradually become normal due to more thorough surgical resection or chemotherapy and radiotherapy, and it can also increase when recurrence or metastasis occurs.
④ Hyperglobulinemia caused by various reasons: In hyperglobulinemia caused by subacute infective endocarditis, kala-azar, systemic lupus erythematosus, etc., the erythrocyte sedimentation rate often increases significantly, and the relative Erythrocyte sedimentation rate often increases rapidly when sex globulin increases, such as chronic nephritis and liver cirrhosis. (1 point)
⑤ Anemia: Mild anemia has no effect on ESR. If the hemoglobin is lower than 90g/L, ESR may increase. The more severe the anemia, the more obvious the ESR increase. due to the reduction of frictional resistance. (1 point)
⑥Hypercholesterolemia: especially in patients with atherosclerotic blood cholesterol significantly increased, the erythrocyte sedimentation rate often increases rapidly. (1 point)

2. What is the clinical significance of stool OB test? (7 points)
Positive fecal occult blood is seen in ① peptic ulcer (1 point), gastric mucosal injury caused by drugs (such as taking indomethacin, glucocorticoids, etc.) (1 point), intestinal tuberculosis, Crohn's disease, ulcerative colitis , colon polyps, hookworm disease and gastric cancer, colon cancer and other digestive tumors. (1 point)
②Differential diagnosis of peptic ulcer and gastrointestinal tumors (1 point): In peptic ulcer, the positive rate is 40-70%, showing intermittent positive. After peptic ulcer treatment, when the appearance of the stool is normal, the occult blood test can still be positive for 5-7 days. After that, if the bleeding stops completely, the occult blood test can turn negative (1 point). In the case of digestive tract cancer, it was persistently positive. (1 point)
③ Digestive tract tumor screening (1 point): The positive rate of digestive tract tumors can reach 87%, and the main tumors include gastric cancer and colorectal cancer. (1 point)