CHAPTER · 2015. 5. 10. · D. Chronic idiopathic myelofibrosis 50. Pelger-Huet anomaly is...

CHAPTER

Self-Assessment Test

Review Questions 11O4

Review Answers 1128

1103

,reviewquestions

1.IXI O -L I\. LJ \~s ±. lUINI o Each of the questions or incomplete statements that follows iscomprised of four suggested responses. Select the best answer or completion statement in each case.

1. What is the composition of the packing ofa column in gas-liquid chromatography?A. An inert materialB. A stationary phaseC. An inert material and a mobile phaseD. An inert material and a stationary phase

2. What is the principal estrogen producedduring pregnancy?A. EstroneB. IVp-EstradiolC. EstriolD. 6(3-Hydroxyestrone

3. Insecticides that are organic phosphoruscompounds, such as parathion andtetraethyl pyrophosphate, may causeinsecticide poisoning by inhibitingA. Lactate dehydrogenaseB. Acid phosphataseC. CholinesteraseD. Glucose-6-phosphate dehydrogenase

4. Which of the following is a water-solublevitamin?A. AB. CC. DD. E

5. Which of the following is a laboratoryassay used for detecting cystic fibrosis?A. Serum lipaseB. Serum amylaseC. Serum trypsinD. Sweat chloride

6. In primary hypothyroidism one wouldexpect the serum FT4 level to be

, the TSH level to be, and the TBG level to be

A. Decreased, increased, slightly increasedB. Decreased, decreased, slightly increasedC. Increased, decreased, slightly increasedD. Decreased, increased, slightly decreased

1104

REVIEW QUESTIONS • 1105

7. A serum sample is moderately hemolyzed.Which of the following analyses would bemost significantly affected by thehemolysis?A. SodiumB. PotassiumC. GlucoseD. Urea

8. A black male 62 years of age is admittedin a semiconscious state experiencingshortness of breath and a temperatureof 100°F. His skin is pale and cool, andhe has been experiencing severe painin his back and jaw for approximately75 minutes. He experienced these samesymptoms 2 days earlier. The laboratorydata shows the following:

Total CK—elevatedCK-MB—elevatedMyoglobin—elevatedcTnl—elevated

Utilizing this information, what is themost likely diagnosis for this patient?A. Pulmonary infarctionB. Acute myocardial infarctionC. Muscular dystrophyD. Angina pectoris

9. A blood specimen is drawn in themorning, and the serum is removedfrom the clot and left standing at roomtemperature until late in the afternoon.Which of the following parameters wouldbe most severely affected by delayedanalysis?A. UreaB. PotassiumC. Alanine aminotransferaseD. Bilirubin

10. In ketoacidosis, the anion gap would mostlikely be affected in what way?A. Unchanged from normalB. IncreasedC. DecreasedD. Balanced

11. If the aspartate aminotransferase (AST)and the alanine aminotransferase (ALT)serum levels are increased 50-fold over thereference range, what would be the mostconsistent diagnosis?A. Extrahepatic cholestasisB. CirrhosisC. Carcinoma of the liverD. Viral hepatitis

12. A decreased bicarbonate level in the bloodwithout a change in PCO2 will result inwhat acid/base imbalance?A. Respiratory acidosisB. Respiratory alkalosisC. Metabolic acidosisD. Metabolic alkalosis

13. Elevated serum levels of urea, creatinine,and uric acid would be suggestive of whatdisorder?A. GoutB. Chronic renal failureC. CirrhosisD. Malnutrition

1106 • CHAPTER 17: SELF-ASSESSMENT TEST

14. The following results were obtained ona pregnant female patient following theingestion of 75 grams of glucose as partof an oral glucose tolerance test.

15.

16.

Time SpecimenCollected

Fasting

1 hour

2 hours

PlasmaGlucose

124mg/dL

220 mg/dL

170mg/dL

Based on the preceding information, whatwould be the most likely diagnosis?A. Normal glucose metabolismB. Diabetes niellitusC. Gestational diabetes mellitusD. Impaired glucose tolerance

Which of the following methods may beused to quantify total protein in serum,urine, or cerebrospinal fluid?A. Coomassie brilliant blueB. Sulfosalicylic acidC. Bromcresol greenD. Ponceau S

A patient who received a blood transfu-sion experienced a moderate transfusionreaction. Because of the presence of freehemoglobin in the plasma, which serumprotein will exhibit a decreased level?A. CeruloplasminB. TransferrinC. oc2-MacroglobulinD. Haptoglobin

17. When employing a diazo method toquantify serum bilirubin, which of thefollowing blood constituents when presentin an elevated amount will cause a falselydepressed bilirubin result?A. AmmoniaB. CreatinineC. HemoglobinD. Uric acid

18. What quality incorporated into a spec-trophotometer can sometimes improve thelinearity of a chemistry procedure?A. Flow-through cuvetteB. Wider bandwidthC. Narrower bandwidthD. Chopper

19. What hormone plays a primary role incontrolling the reabsorption of sodium inthe tubules?A. CortisolB. CortisoneC. EstriolD. Aldosterone

20. Which of the following is associated withindividuals diagnosed with Addisondisease?A. HypoglycemiaB. Casual plasma glucose >200 mg/dLC. Fasting plasma glucose ^126 mg/dLD. 2-Hour post-load glucose >200 mg/dL

21. Which of the following tests when usedtogether are helpful in monitoringtreatment and identifying recurrenceof testicular cancer?A. AFPandCEAB. AFPandhCGC. CEAandhCGD. CA 125 and C A 19-9


22. To detect respiratory distress syndrome,what specimen is used for measuring thesurfactant/albumin ratio by fluorescencepolarization?A. SerumB. PlasmaC. UrineD. Amniotic fluid

23. High levels of cholesterol leading toincreased risk of coronary artery diseasewould be associated with which lipopro-tein fraction?A. LDLB. VLDLC. HDLD. Chylomicrons

24. A female patient upon hospital admissionexhibits a serum osmolality level of 350mOsm/kg. Which of the following wouldnot be a possible cause of this result?A. Elevated serum potassium levelB. Elevated serum sodium levelC. Elevated serum glucose levelD. Dehydration

25. If the ratio of bicarbonate to carbonic acidis 30:1, what would be the blood pH?A. IncreasedB. DecreasedC. StableD. Normal

26. Upon what principle is nephelometricmeasurement based?A. Fluorescence producedB. Phosphorescence producedC. Light transmittedD. Light scattered

27. Which of the following causes beta-thalassemia major?A. Amino acid substitution in both

beta-globin chainsB. Deficiency of an enzyme needed for

heme synthesisC. Decreased rate of synthesis of both

beta-globin chainsD. Presence of an unstable hemoglobin

28. The main source of erythropoietin is theA. LiverB. KidneyC. Bone marrowD. Spleen

29. Red blood cell distribution width (ROW)is a measurement of theA. Average size of the red blood cellsB. Hemoglobin content of the red blood

cellsC. Coefficient of variation of the red cell

populationD. Various maturation stages of red blood

cells

30. Aminolevulinic acid (ALA) synthase is anenzyme involved inA. Early stages of heme synthesis in the

mitochondriaB. Intermediate stages of heme synthesis

in the cytoplasmC. Globin-chain synthesisD. Embden-Meyerhof pathway

31. Hemoglobin A2 consists ofA. Two alpha- and two beta-globin chainsB. Two alpha-and two gamma-globin

chainsC. Four beta-globin chainsD. Two alpha- and two delta-globin

chains


32. Increased osmotic fragility test resultscould be expected in which of thefollowing disorders?A. Sickle cell anemiaB. Iron-deficiency anemiaC. Beta-thalassemia minorD. Hereditary spherocytosis

33. Which of the following conditions wouldnot exhibit the red blood cell morphologyseen in Color Plate 9B?A. Pyruvate kinase deficiencyB. Sideroblastic anemiaC. Post-transfusionD. Iron-deficiency anemia post-treatment

34. Complement-induced red blood cell lysisand an abnormal sugar-water test are seenin which disorder?A. Glucose-6-phosphate dehydrogenase

deficiencyB. Hereditary spherocytosisC. Paroxysmal nocturnal hemoglobinuriaD. Paroxysmal cold hemoglobinuria

35. Which of the following will not beincreased in polycythemia vera?A. Plasma volumeB. Leukocyte alkaline phosphataseC. Platelet countD. White blood cell count

36. Which of the following stains is used tovisualize reticulocytes?A. Wright'sB. Crystal violetC. Prussian blueD. New methylene blue

37. The function of the hexose monophos-phate shunt is toA. Produce adenosine triphosphate (ATP)B. Produce 2,3-bisphosphoglycerate

(2,3-BPG)C. Prevent oxidation of hemoglobinD. Participate in heme synthesis

38. Hemoglobin is measured spectrophoto-metrically at what wavelength?A. 410 nmB. 472 nmC. 540 nmD. 610 nm

39. The red blood cells seen in Color Plate 8Bwould most likely be associated withA. Sideroblastic anemia or beta-

thalassemia majorB. Hereditary spherocytosis or warm

autoimmune hemolytic anemiaC. Iron-deficiency anemia or beta-

thalassemia minorD. Aplastic anemia or chemotherapy

40. Amino acid substitutions on globin chainscause what disorders?A. HemoglobinopathiesB. ThalassemiasC. Unstable hemoglobinsD. Porphyrias

41. The leukocyte first to migrate, engulf, anddestroy a foreign body in the tissue is theA. MacrophageB. MonocyteC. NeutrophilD. Lymphocyte

42. What immunoglobulin is increased inWaldenstrom macroglobulinemia?A. IgAB. IgEC. IgGD. IgM


43. The leukocyte alkaline phosphatase stainis most helpful in the differentiation ofA. Neutrophilic leukemoid reaction and

degenerative left shiftB. Neutrophilic leukemoid reaction and

chronic myelogenous leukemiaC. Chronic myelogenous leukemia and

acute myelogenous leukemiaD. Acute myelogenous leukemia and

acute lymphoblastic leukemia

44. Which cell line is normally the mostnumerous in the bone marrow?A. LymphocyticB. MegakaryocyticC. ErythroidD. Myeloid

45. Which FAB type of myelodysplasticsyndrome is least likely to progress toacute myelogenous leukemia?A. Refractory anemia (RA)B. Chronic myelomonocytic leukemia

(CMML)C. Refractory anemia with excess blasts

(RAEB)D. Refractory anemia with excess blasts

in transformation (RAEB-t)

46. A 5-year-old girl has been recentlydiagnosed with acute lymphoblasticleukemia. Which of the following is nottypical of this diagnosis?A. Using WHO criteria, bone marrow

blasts will be >20%.B. CALLA (CD 10) positive type has a

poor prognosis.C. Central nervous system involvement is

common.D. Leukemic blast cells show PAS

positivity.

47. Which of the following cells will stainpositive when tartrate is added to the acidphosphatase (TRAP) stain?A. Sezary cellsB. Plasma cellsC. Hairy cellsD. Large granular lymphocytes

48. A 59-year-old patient is evaluated forsevere anemia, thrombocytopenia, andneutropenia. What test(s) will provide themost useful information?A. Ham's and sugar-water testsB. Bone marrow aspirate and biopsyC. Reticulocyte count and immature

reticulocyte fraction (IRE)D. Test for heterophile antibodies

49. The Philadelphia chromosome is aconsistent finding in patients with whatdisorder?A. Chronic myelogenous leukemiaB. Acute myelomonocytic leukemiaC. Myelodysplastic syndromeD. Chronic idiopathic myelofibrosis

50. Pelger-Huet anomaly is associated withA. Large Dohle-like bodies and giant

plateletsB. Large azurophilic granules in all

leukocytesC. Defective neutrophilic phagocytosisD. Morphologically immature but

functionally normal neutrophils

51. Plasma cells are found in large numbers inthe bone marrow and occasionally in theperipheral blood of patients with whatdisorder?A. Multiple myelomaB. Burkitt lymphomaC. Acute lymphoblastic leukemiaD. Infectious mononucleosis

1110 • CHAPTER 17: SELF-AS5ESSMENTTEST

52. The blood smear shown in Color Plate 12Bis from a 16-year-old male with com-plaints of extreme fatigue and sore throat.His WBC, hemoglobin, and platelet countresults are normal. Based on the clinicaland laboratory information, which of thefollowing is the most likely cause of hiscondition?A. Staphylococcal pneumoniaB. Infectious mononucleosisC. Chronic lymphocytic leukemiaD. Non-Hodgkin lymphoma

53. Which of the following disorders is notassociated with pancytopenia?A. Neutrophilic leukemoid reactionB. Megaloblastic anemiaC. Paroxysmal nocturnal hemoglobinuriaD. Aplastic anemia

54. Inability to obtain a bone marrow aspirateis frequently encountered in patients withwhich of the following disorders?A. Acute monocytic leukemia and

myelodysplastic syndromesB. Chronic idiopathic myelofibrosis and

hairy cell leukemiaC. Polycythemia vera and essential

thrombocythemiaD. Erythroleukemia and acute megakary-

ocytic leukemia

55. The cytoplasmic inclusion present in thecell shown in Color Plate 17'• excludes adiagnosis ofA. Acute myelogenous leukemia without

maturation (FAB Ml)B. Acute promyelocytic leukemia

(FAB M3)C. Acute myelomonocytic leukemia

(FAB M4)D. Acute lymphoblastic leukemia

56. Which of the following is considereddiagnostic for Hodgkin lymphoma?A. Sezary cellB. BurkittcellC. Reed-Sternberg cellD. Reider cell

57. The test of choice to detect abnormalitiesin the intrinsic pathway of secondaryhemostasis is theA. Bleeding timeB. ThrombintimeC. Activated partial thromboplastin timeD. Prothrombin time

58. A patient experiencing bleeding problemshas a prothrombin time of 23 seconds(control = 12.0 seconds) and activatedpartial thromboplastin time of 61 seconds(control = 33.0 seconds). Of the follow-ing, which one is probably not deficient?A. Factor IIB. FactorVC. Factor XIID. Factor X

59. Which of the following describes plasmin?A. Enzyme that can digest cross-linked

fibrin into D-dimersB. Activator of plasminogenC. Circulates freely in the plasma ready

to digest fibrin clotsD. Forms a complex with tissue plasmino-

gen activators to digest fibrinogen

60. By what mechanism does aspiriningestion impair platelet function?A. Blocks glycoprotein receptors on the

surface of the plateletB. Decreases thrombopoietin levels and

subsequent bone marrow plateletproduction

C. Interferes with the ability of plateletsto adhere to subendothelial collagen

D. Decreases thromboxane A2 formationby inhibiting cyclooxygenase


61. Which of the following describesidiopathic thrombocytopenic purpura?A. Occurs only in a chronic formB. A platelet autoantibody is responsible

for platelet destruction.C. Develops in the majority of cases after

recovery from a bacterial infectionD. Causes decreased bone marrow

synthesis of platelet precursors

62. The most important naturally occurringinhibitor to clotting isA. AntithrombinB. Lupus inhibitorC. Protein CD. a2-Antiplasmin

63. The prothrombin time is usually notprolonged in patients withA. Hemophilia AB. Severe liver diseaseC. Factor VII deficiencyD. Venous thromboembolism treated with

Coumadin®

64. An 18-year-old male was seen in theemergency department following amotorcycle accident. The patient was notweaiing his helmet at the time of theaccident. He was comatose and wasadmitted to the hospital with a diagnosis ofsevere closed head injury. The next day thepatient was noted to have increasedbleeding from venipuncture sites. Given thefollowing results, what was the most likelydiagnosis for this patient?

Tests

PT

aPTT

Fibrinogen

Thrombintime

Plateletcount

FDPtest

D-dimer

PatientResults

25.0 seconds

89.0 seconds

65 mg/dL

45 seconds

32 X 109/L

>20 |a,g/mL

>1.0 jjig/mL

ReferenceRanges

1 1.0-13.0 seconds

22.0-38.0 seconds

150-400 mg/dL

15-20 seconds

1 50-450 X 1 09/L

<5 ixg/mL

<0.5 (xg/mL

A.B.C.D.

Hemophilia APrimary fibrinogenolysisThrombotic thrombocytopenic purpuraDisseminated intravascularcoagulation

65. Of the following conditions that causebleeding, the most common isA. Hemophilia AB. ThrombocytopeniaC. von Willebrand diseaseD. Hemophilia B

1112 • CHAPTER 17: SELF-ASSESSMENTTEST

66. Which of the following will patients withclassic von Willebrand disease notexhibit?A. Easy bruisingB. Decreased platelet aggregation with

ristocetinC. Prolonged prothrombin timeD. Prolonged bleeding time

67. How are individuals with cellular immunedeficiencies best identified?A. Determining serum complement

concentrationB. Human leukocyte antigen (HLA)

typingC. Serum electrophoresis testingD. Skin testing

68. Which of the following is characteristic ofDiGeorge syndrome?A. Defective T lymphocyte productionB. Depressed B cell developmentC. Suppressed intracellular killing by

polymorphonuclear cellsD. Suppressed complement levels

69. The interaction between antigen-presenting cells and T helper cells ismediated by surface expressed antigen andA. Interferon gammaB. Interleukin 2C. Interleukin 3D. MHC class II molecules

70. Which of the following cell types is animportant mediator of antibody-dependentcellular cytotoxicity (ADCC) reactions?A. B cellsB. Cytotoxic T cellsC. Natural killer cellsD. Suppressor T cells

71. What is the portion of an antigen thatbinds specifically to the binding site of anantibody called?A. EpitopeB. HaptenC. IdiotopeD. Paratope

72. Which of the following is true of thealternative complement pathway?A. Activated by bacterial polysaccharideB. C3 is not involved.C. Cl initiates activation.D. Primarily activated by antibody

73. A type I hypersensitivity reaction requiresA. IgAB. IgDC. IgED. IgG

74. A substance able to induce an immuneresponse describes which of the following?A. AllotypeB. AntigenC. EpitopeD. Immunogen

75. The B cell surface receptor for antigen isA. CDSB. ImmunoglobulinC. Interleukin 2D. MHC I antigen

76. Which of the following frequentlyfunctions as an antigen-presenting cell?A. Dendritic cellB. Cytotoxic T lymphocyteC. Natural killer cellD. T helper cell


77. Which of the following cell types containsclass II human leukocyte antigens?A. All nucleated cellsB. B cells onlyC. Platelets onlyD. White blood cells only

78. The presence of antinuclear antibodies issuggestive of a(n)A. Acute glomerulonephritisB. Autoimmune diseaseC. Cell-mediated immune deficiencyD. Humoral-mediated immune deficiency

79. Graves disease is an autoimmune diseaseprimarily affecting theA. Adrenal glandB. Nerve synapsesC. PancreasD. Thyroid

80. Which of the following markers is foundon mature T helper cells?A. CD4B. CDSC. CD10D. CD25

81. Which of the following is an example of adouble diffusion assay?A. Immunofixation electrophoresisB. OuchterlonyC. Radial immunodiffusionD. Rocket electrophoresis

82. Patients with hyper-IgM syndromeproduce large amounts of IgM andmarkedly decreased IgG and IgA.What causes this phenomenon?A. Antigen is only presented to B cells

capable of making IgM.B. B cells capable of synthesizing IgG

and IgA are lacking.C. Lack of class switching occurs.D. T cells secrete lymphokines that

stimulate the production of IgM.

83. Which of the following is a nonphagocyticcytotoxic cell able to kill cells rapidlywithout having been previously exposedto antigens on that cell?A. Cytotoxic T cellB. T helper cellC. Natural killer cellD. Suppressor T cell

84. Which of the following is a granulocyticcell with IgE receptors?A. Cytotoxic T cellB. Mast cellC. Natural killer cellD. Plasma cell

85. Which of the following is an oncofetalantigen whose presence in adult serum issuggestive of carcinoma?A. a-FetoproteinB. C-reactive proteinC. Lymphocyte function-associated

antigen 1D. Nuclear antigens

86. An adaptive or specific immune responseincludesA. Antibody synthesisB. Complement activationC. InflammationD. Phagocytosis

87. Information obtained from a volunteerblood donor at the time of registrationis designed to protect the health of bothdonor and recipient. Of the followingresponses, which would cause the donorto be deferred from the collection process?A. Received his last injection in a vaccine

series for hepatitis B 3 weeks agoB. Had a tooth filled 1 week agoC. Took aspirin yesterday for a headacheD. Taking Tegison

1114 CHAPTER 17: SELF-ASSESSMENTTEST

88. Interpret the following reactions:

Patientserum

A,cells

+w

Bcells

4+ Patientcells

Anti-A

3+ mf

Anti-B

0

A. Group A7 patient with anti-Aj in hisserum

B. Group A patient having rouleauxC. Group A patient transfused with group

O cellsD. Group A patient with acquired B

antigen

89. The inlet port on a closed unit of red bloodcells collected in CP2D is defective,preventing the addition of Adsol®. Whatwill be the resulting shelf life of the redblood cells?A. 24 hoursB. 21 daysC. 35 daysD. 42 days

90. When testing blood donors for HIV, whatis the major advantage of NAT over EIAtesting for anti-HIVl?A. Simplicity of performanceB. Less expensiveC. Requires less "tech time"D. Increased specificity

91. What is the expiration date for freshfrozen plasma (FFP) that is stored at-18°C or colder?A. 1 yearB. 3 yearsC. 5 yearsD. 7 years

92. A 35-year-old male is found to have afactor V deficiency. He should be treatedfor the deficiency withA. Cryoprecipitated AHFB. Red blood cellsC. Fresh frozen plasmaD. Pooled platelet concentrates

93. Which of the following donors wouldmost likely be allowed to donate autolo-gous blood for elective surgery if all othercriteria are acceptable?A. 15-year-old girl with a hemoglobin of

12 g/dLB. 17-year-old boy with intermittent

bacteremiaC. 30-year-old man with aortic stenosisD. 25-year-old woman who had a baby

4 weeks ago

94. A 32-year-old female, pregnant with herfourth child, is seen in the emergencydepartment for childbirth. There are norecords of her prenatal care available. Sheis group AB, D-negative, weak D negative.She gives birth to a group O, D-negative,weak D positive girl. Her husband is groupO, D-negative, weak D positive. Which ofthe following may explain these results?A. NonpaternityB. Mother carries the cis-AB geneC. Father has been mistypedD. Child has been switched with another

woman's infant

95. Hemophilia A and B (Christmas disease)both provide a classic example of whichpattern of inheritance?A. X-linked recessiveB. X-linked dominantC. Autosomal recessiveD. Autosomal dominant


96. A and B blood group antigens are derivedwhen glycosyltransferases add specificsugars to precursor H. What is theterminal sugar for the B antigen?A. FucoseB. ./V-acetylglucosamineC. ./V-acetylgalactosamineD. D-Galactose

97. Which of the following does not charac-terize Rhnull individuals?A. Red blood cells lack all antigens in the

Rh system.B. Red blood cell morphology shows

stomatocytes.C. Red blood cell survival is shortened

with compensated anemia.D. Condition may be inherited or acquired.

98. Which of the following antigens is themost immunogenic after A, B, and Dantigens?A. CB. EC. Fya

D. K

99. In a lymphocytotoxicity test, 80% of apatient's WBCs are highly refractile in thewells in which anti-HLA-A7 and anti-HLA-A12 were placed. The wells inwhich anti-HLA-A5 and anti-HLA-A27were placed show no refractile patientWBCs. You would interpret thesereactions as meaning that the patientis(has)A. HLA-A7 and HLA-A12 positiveB. HLA-A5 and HLA-A27 positiveC. Antibody to HLA-A7 and HLA-A12D. An invalid test for HLA-A7 and

HLA-A12

100. Following compatibility testing, for howlong must the patient's blood sample andthe donor's red blood cells be retained?A. 7 days after crossmatchingB. 7 days after transfusionC. 9 days after crossmatchingD. 10 days after transfusion

101. An antibody screen gives the followingresults. What do the results indicate aboutthe patient?

is

37°C LISS

AHG(monospecific)

CC V

1+

3+

V

A. Autoantibody reacting at all phases oftesting

B. Alloantibody showing dosageC. More than one alloantibodyD. Rouleaux reaction

102. The use of an autocontrol during antibodyscreening for pretransfusion testingA. Is requiredB. Is optionalC. May be eliminated if a DAT is

performedD. May aid in detecting alloantibody


103. A "type and screen" established that apremature infant is group A, D-positivewith a negative antibody screening test.Numerous small volume transfusions arepredicted. If only group O RBC are to betransfused, how often must the infant becrossmatched?A. Before transfusion and whenever

3 days have elapsed before the nexttransfusion

B. Before transfusion and whenever7 days have elapsed before the nexttransfusion

C. If during the same admission, not untilhe reaches 2 months of age

D. If during the same admission, not untilhe reaches 4 months of age

104. The serum from a patient with warmautoimmune hemolytic anemia is found tocontain autoanti-e and alloanti-E. Youwould transfuse this patient with red bloodcells that areA. E-negative, e+B. e-Negative, E+C. E-negative, e-negative

D- Rhnun

105. Following removal of plasma from awhole blood unit, the RBCs may beresuspended in an additive solution.Which of the following does not describethese solutions?A. Must be added within 72 hours after

plasma separationB. Contain inosine and pyruvate

Maintain increased levels of ATP instored cellsExtend the shelf life of red blood cells

C.

D.to 42 days

106. Platelets prepared in polyolefin (PL-732)differ from platelets prepared inpolyvinylchloride (PVC) because bagswithout plasticizersA. Increase platelet shelf life to 7 daysB. Allow platelet storage at 1-6°CC. Promote improved gas exchange with

environmental airD. Promote accelerated lactic acid

production

Using the chart below, what is(are) themost likely antibody specificity(ies) in thispatient's serum?A. Anti-C and anti-Jka

B. Anti-K and anti-Jkb

C. Anti-C showing dosage and anti-ED. Anti-Jkb

Cell*

i

2

3

4

5

D

+

+

+

0

0

C

0

0

+

+

0

E

0

0

+

0

+

K

+

0

0

+

0

Jk«

0

+

+

0

0

Jk" .

0

0

0

+

+

AHG

2+

0

0

4+

1 +

«DV

V


108. A blood wanning device would most likelybe used in which of the following situations?A. Transfusing a patient with PCHB. Intrauterine transfusionC. Transfusion of a patient having

bacterial sepsisD. Transfusing FFP to a patient with

anti-Lea

109. What is the most common cause of anemialeading to transfusion in sick neonates?A. Bleeding from the umbilicusB. Red blood cell destruction because of

HDNC. Blood drawn for laboratory testingD. Immature bone marrow response

110. What is the initial step to perform when apatient is suspected of having a transfu-sion reaction?A. Perform a DAT on a post-transfusion

specimenB. Compare the pretransfusion and post-

transfusion serum for evidence ofhemolysis

C. Check identification of the patient anddonor blood

D. Stop the transfusion

111. Which of the following laboratoryfindings does not occur in hemolytictransfusion reactions?A. HemoglobinuriaB. HaptoglobinemiaC. HemoglobinemiaD. Bilirubinemia

112. To which organization must the hospitaltransfusion service laboratory report allcases of transfusion-associated disease?A. Blood-collecting facilityB. Centers for Disease Control and

Prevention (CDC)C. Food and Drug Administration (FDA)D. State Health Department

113. To comply with the requirements ofAABB Standards, which of the followingtests must be performed on each unitbefore blood bank personnel may issueautologous units of blood drawn in theirfacility?A. ABO and Rh typingB. HBsAgC. Anti-HIVlD. DAT

114. The CDC recommends that "standardprecautions" be exercised by all health-care workers to prevent transmission ofhepatitis B virus, HIV, and other blood-borne pathogens. What do these precau-tions include?A. Wearing protective clothing when

testing blood specimens from patientsin specific areas

B. Using special precautionary methodswhen testing blood specimens with abiohazard label

C. Handling every patient bloodspecimen as if it were infectious

D. Carefully recapping needles beforediscarding

115. To ensure proper reactivity, how fre-quently must all blood bank reagents bequality controlled?A. With each testB. DailyC. Each day of useD. Weekly

116. What should one do to validate thereaction obtained in the antiglobulin test?A. Use green antiglobulin reagentB. Add IgG-coated red cells to each test

tubeC. Add IgG-coated red cells to each

positive reactionD. Add IgG-coated red cells to each

negative reaction


117. Which of the following strategies will nothelp to minimize the outdate rate of bloodin inventory?A. Providing transfusion guidelinesB. Implementing a first-in, last-out

(FILO) policyC. Monitoring crossmatch to transfusion

(CT) ratiosD. Instituting a maximum surgical blood

order schedule (MSBOS)

118. Clotting may be incomplete in bloodspecimens from patients treated withheparin. Which of the following alterna-tives will not provide an acceptablespecimen for pretransfusion testing?A. Adding protamine sulfateB. Adding thrombinC. Adding chloroquine diphosphateD. Using an EDTA specimen for testing

119. A person with the genotype AO, HH, Sese,Lele will have which of the followingcombination of substances in hersecretions?A. A,H, Se,Lea

B. Lea,Leb

C. A,H,Lea,Leb

D. A, O,Leb

120. An immediate spin (IS) crossmatch or acomputer crossmatch (if the computersystem is validated for this use) may beused as the sole compatibility test when apatient has a confirmed blood type, anegative antibody screening test, andA. A negative DAT resultB. No history of unexpected antibodyC. No record of previous transfusionD. The same ABO and Rh type as the

donor

121. Within how many hours after poolingmust pooled platelet concentrates betransfused?A. 4B. 6C. 8D. 12

122. Pus with a blue-green color was aspiratedfrom an empyema. A Gram stain of theaspirated material showed many whiteblood cells and numerous gram-negativebacilli. What would be the most likelyetiologic agent?A. Legionella pneumophilaB. Pseudomonas aeruginosaC. Morganella morganiiD. Serratia marcescens

123. In the early stages of typhoid fever,Salmonella Typhi is most likely to berecovered from which of the followingspecimen types?A. BloodB. FecesC. UrineD. Skin lesions

124. Symptoms of gastritis and pepticulceration are most closely associatedwith which of the following?A. Campylobacter jejuniB. Enterotoxigenic Escherichia coliC. HelicobacterpyloriD. Vibrio cholerae


125. A patient with impaired cell-mediatedimmunity presents with evidence of apulmonary abscess and neurologicinvolvement. A brain abscess was detectedby MRI. Material from the abscess grewan aerobic, filamentous, branching gram-positive organism, which stained weaklyacid-fast. What is the most likely etiologicagent?A. Propionibacterium acnesB. Nocardia asteroidesC. Actinobacillus israeliiD. Bacillus cereus

126. The organism Borrelia recurrentis is theetiologic agent ofA. Lyme diseaseB. Relapsing feverC. Undulant feverD. Weil disease

127. Most cases of legionellosis are acquiredfromA. Environmental water sourcesB. Person-to-person transmissionC. MosquitoesD. Farm animals

128. What chemical is commonly added toblood culture media as an anticoagulant?A. ARDB. CNAC. CIND. SPS

129. Which of the following statements is trueregarding anaerobic infections?A. Anaerobic pulmonary infections are

rare because lung tissue is wellventilated.

B. Because of the inaccessibility oforgans such as the liver and brain toindigenous flora, they are seldominfected with anaerobes.

C. Bacteremia due to anaerobes is benignbecause anaerobes do not possessendotoxin.

D. Intra-abdominal abscesses, peritonitis,and wound infections can occurpostoperatively when devitalized tissueis contaminated with bowel contents.

130. Foul-smelling pus aspirated from apostsurgical cholecystectomy patient grewa gram-positive bacillus. When culturedon an anaerobically incubated blood agarplate, it grew colonies surrounded by aninner zone of complete red blood cell lysisand an outer zone of incomplete cell lysis.What would be the most likely identifica-tion of this isolate?A. Fusobacterium nucleatumB. Clostridium perfringensC. Clostridium tetaniD. Bacteroidesfragilis

131. A common cause of mild primary atypicalpneumonia isA. Bordetella parapertussisB. MycoplasmapneumoniaeC. Pseudomonas aeruginosaD. Streptococcus pneumoniae

132. Which of the following antimicrobialsusceptibility tests would not provide theminimal inhibitory concentration?A. Agar dilutionB. Broth dilutionC. Disk diffusionD. Gradient diffusion


133. Which of the following is associated withStreptococcus agalactiae?A. Common cause of pharyngitis in adultsB. Important cause of neonatal sepsis and

meningitisC. Is also called viridans StreptococcusD. Is implicated in dental caries

134. The presence of spirochetes seen in materialcollected from a chancre is diagnostic forA. ChancroidB. Lyme diseaseC. Relapsing feverD. Syphilis

135. Which of the following is associated withVibrio cholerae?A. Sucrose fermentation negativeB. Requires media with high salt

concentrationC. Is a component of the normal flora of

the human intestineD. Produces a toxin that causes increased

secretion of water and electrolytesfrom the gut

136. A blood culture grew a small, pleomor-phic, anaerobic, gram-negative rod. Itgrew on kanamycin-vancomycin laked-sheep blood agar, grew in the presence of20% bile, and was esculin positive. Thisorganism is most likelyA. BacteroidesfragilisB. Clostridium perfringensC. Fusobacterium nucleatumD. Veillonella sp.

137. A coagulase-negative Staphylococcus wasisolated from a urine culture. It wasidentified as Staphylococcus saprophyti-cus on the basis of it beingA. Coagulase positiveB. Resistant to novobiocinC. DNase positiveD. Mannitol positive

138. A nonhemolytic gram-positive, catalase-negative bacterium isolated from a urineculture gave the following reactions: bileesculin positive and no growth in 6.5%NaCl. This microorganism should beidentified asA. Streptococcus agalactiaeB. EnterococcusfaecalisC. Streptococcus mutansD. Streptococcus bovis group

139. Refer to Color Plate 26B. The organismseen on this Gram stain was isolated fromthe cerebrospinal fluid of an infant. It grewon sheep blood agar with faint beta-hemolysis. It was catalase positive. Whatmicroorganism should be suspected?A. Bacillus subtilisB. Lactobacillus sp.C. Bifidobacterium dentiumD. Listeria monocy to genes

140. You isolate a small, pleomorphic, gram-negative rod from the cerebrospinal fluidof a 9-month-old infant. It fails to grow onsheep blood agar or MacConkey agar, butit grows well on chocolate agar incubatedin 5% CO,,. What bacterium would yoususpect?A. Escherichia coliB. Streptococcus agalactiaeC. Haemophilus influenzaeD. Listeria monocytogenes


141. An oxidase-positive, gram-negativebacillus was isolated from a burn patient.It gave the following reactions: OFglucose open, acid; OF glucose closed,alkaline; OF maltose open, alkaline;positive for pyocyanin production;positive for fluorescein production; andgood growth at 42°C. The microorganismis most likelyA. AlcaligenesfaecalisB. Pseudomonas aeruginosaC. Stenotrophomonas maltophiliaD. Acinetobacter anitratus

142. What is the etiologic agent ofpseudomembranous colitis?A. Clostridium difficileB. HeUcobacterpyloriC. Streptococcus pyogenesD. Vibrio parahemolyticus

143. A gram-negative bacillus was isolatedon MacConkey agar and appeared as anon-lactose fermenter. It was oxidasenegative and gave the following reactions:TSI-K/A with H9S, motile, urease positive,and lysine negative. Which of the followingwould be characterized by these reactions?A. Salmonella TyphimuriumB. Shigella sonnetC. Proteus mirabilisD. Edwardsiella tarda

144. A patient with severe abdominal painand diarrhea was admitted to the hospital.When the stool was cultured, no suspi-cious colonies were seen on Hektoenenteric or xylose-lysine-desoxycholateagars. However, on the MacConkey plateseveral non-lactose-fermenting colonieswere observed. Biochemical results forthese colonies gave the followingreactions:

TSI-A/A, no gas, no H2SUrease positiveMotility negative at 35°C;

positive at 22°COxidase negative

The most likely organism would beA. Shigella sonnetB. Vibrio choleraeC. Salmonella TyphiD. Yersinia enterocolytica

145. A 45-year-old woman came to theemergency department after being bittenon the hand by her cat. The wound wasextremely painful and produced a largeamount of pus. The pus was cultured onsheep blood agar (SBA) and MacConkeyagar. After 24 hours, growth was observedon the SBA plate as tiny colonies thatproduced a slight greening on the underly-ing medium. A Gram stain revealed tinygram-negative rods. There was no growthon the MacConkey agar. Biochemical testsgave the following reactions:

TSI-A/AOxidase positiveNonmotileUrease negative

The most likely organism would beA. Pasturella multocidaB. Corynebacterium diphtheriaeC. Brucella abortusD. Bordetella pertussis


146. Buffered charcoal yeast extract agar(BCYE) is the primary medium for theisolation ofA. Bartonella bacilliformisB. Chlamydia pneumoniaeC. Legionella pneumophilaD. Mycoplasma pneumoniae

147. Coccidioides immitis produces arthroconi-dia when grown at room temperature.What form of the fungus is found inhuman tissue?A. YeastB. SpheruleC. Hyaline aseptate hyphaeD. Macroconidia with budding yeast

148. Selective medium for the isolation of thedimoiphic fungi often contain what agent toinhibit the growth of the saprophytic fungi?A. CyclohexamideB. ChloramphenicolC. SulfonamideD. Gentamicin

149. In regard to the true systemic dimorphicpathogens, the phase of growth that ismost infectious is theA. Phase seen in tissueB. Phase that grows at 22-30°CC. Phase that grows at 37°CD. All phases are equally infectious.

150. Which of the following is the definitivehost for Plasmodium spp.?A. HumansB. MosquitoesC. LiceD. Ticks

151. What is the source of most humaninfections caused by Toxoplasma gondii?A. CatsB. DogsC. FleasD. Humans

152. Refer to Color Plate 43B. What is theinfective form of this parasite?A. OvaB. OocystsC. Filariform larvaeD. Rhabditiform larvae

153. In what way are hepatitis B virus andhuman immunodeficiency virus similar?A. Ability to survive in the environmentB. Have cross-reacting antigensC. Nucleic acid compositionD. Require RNA-dependent

DNA-polymerase for replication

154. The reactivation of varicella results inA. Chicken poxB. Cold soresC. ShinglesD. Smallpox

155. Material collected from the nasopharynx ofa 1-year-old child with pneumonia is addedto HEp-2 cells. In a few days, enlarged cellswith several nuclei are seen. What is themost likely cause of the infection?A. Respiratory syncytial virusB. RotavirusC. Coxsackie virusD. Adenovirus

156. Which of the following is an example of asignal amplification method?A. bDNAB. Ligase chain reactionC. Polymerase chain reactionD. Strand displacement amplification

157. Stringency can be decreased by increasingA. Incubation timeB. Incubation temperatureC. Ionic strength (e.g., NaCl)D. pH


158. In their correct order, what are the stepsinvolved in the polymerase chain reaction?A. Denaturation of dsDNA, annealing of

primers, synthesis of complementaryDNA strand

B. Annealing of primers, denaturation ofdsDNA, synthesis of complementaryDNA strand

C. Synthesis of complementary DNAstrand, denaturation of dsDNA,annealing of primers

D. Denaturation of dsDNA, synthesis ofcomplementary DNA strand, anneal-ing of primers

159. Sickle cell anemia is a genetic diseasecaused by a single base mutation in thebeta-globin gene. The single changeabolishes a Cvnl restriction site. Usingspecific primers that target a portion ofbeta-globin gene, a 726 base pair PCRproduct is generated. After enzymedigestion of PCR products from normalindividuals with Cvnl, fragments of thefollowing sizes are produced: 256 bp,201 bp, 181 bp, and 88 bp. Which of thefollowing restriction fragment patternsrepresent the results you would see in apatient homozygous for the sickle cellgene?A. Two bands—457 bp and 269 bpB. Three bands—382 bp, 256 bp,

and 88 bpC. Four bands—382 bp, 201 bp, 181 bp,

and 88 bpD. Five bands—382 bp, 256 bp, 201 bp,

181 bp, andSSbp

160. In a PCR assay, which control is necessaryto distinguish between a true negativeresult and a false negative result?A. Blank (no DNA template) control

containing all PCR reagentsB. Negative template control containing

DNA sample known not to containtarget sequence

C. Internal control containing secondprimer set to sequence found in allsamples but unrelated to target sequence

D. Positive control containing targetsequence

161. Real-time PCR (i.e., qPCR) is a targetamplification technique that is bothquantitative and highly sensitive. Theprimary level of specificity of the reactionis determined by the primers employedin the reaction; however, an additional levelof specificity can be obtained by the useof probes that generate a fluorescentsignal only when they hybridize to targetsequences. Which of the following systemsutilizes a probe that contains a shortspecific target specific sequence flankedby a short inverted repeat whose 5' end isa fluorescent reporter molecule that formsa stem and loop structure with a 3' endquencher molecule when not bound to thetarget sequence?A. SYBR green detection systemB. TaqMan probe detections systemC. Fluorescent resonance energy transfer

detection systemD. Molecular Beacons® detection system

162. In what form does the reclamation offiltered bicarbonate ion in the proximaltubular cells occur?A. Carbonic acidB. Carbon dioxideC. Sodium carbonateD. Sodium bicarbonate


163. In what area of the nephron does approxi-mately 65% of renal reabsorption occur?A. Proximal tubuleB. Distal tubuleC. Bowman capsuleD. Glomerulus

164. What is the renal blood flow for a 70-kgmale/female?A. 12 mL/minB. 120 mL/minC. 1200 mL/minD. 12L/min

165. The concentration of a solute in plasma atwhich no additional amount of the solutewill be absorbed from the proximal tubuleis known as theA. Plasma thresholdB. Tubular thresholdC. Renal thresholdD. Blood threshold

166. Which biochemical component would bepresent in an increased amount in a darkyellow-amber-colored urine?A. BiliverdinB. BilirubinC. UrobilinD. Blood

167. When should a 2-hour postprandial urinebe collected?A. 2 hours after fluid ingestionB. 2 hours after a renal drug ingestionC. 2 hours after eatingD. 2 hours after voiding a fasting

specimen

168. Peritoneal fluid is derived from whichsource?A. Abdominal cavityB. Knee jointsC. Central nervous systemD. Space around the lungs

169. Which of the following formed elementsare present in the high-power field seen inColor Plate 55mlA. Transitional epithelial cells, oval fat

bodies, spermB. Renal epithelial cells, mucus, calcium

oxalateC. Red blood cells, squamous epithelial

cells, white blood cellsD. Yeast, squamous epithelial cells,

mucus

170. Which of the following is true abouturomodulin (Tamm-Horsfall) protein?A. Measured using the conventional

reagent test stripsB. Appears only in abnormal urineC. Matrix of hyaline casts but not

granular castsD. Produced by renal tubules in small

quantities

171. Which of the following procedures is usedto assess glomerular permeability?A. Clearance testB. OsmolalityC. 24-hour urine total proteinD. Renal blood flow

172. With which crystals are urinary uric acidcrystals often confused?A. Calcium pyrophosphateB. CystineC. CholesterolD. Calcium oxalate


173. In what sequence does urine formationoccur?A. Proximal convoluted tubule, loop of

Henle, distal convoluted tubule,collecting duct, Bowman's space

B. Glomerulus, Bowman's space,proximal convoluted tubule, loop ofHenle, distal convoluted tubule,collecting duct

C. Bowman's space, glomerulus,proximal convoluted tubule, loop ofHenle, distal convoluted tubule,collecting duct

D. Bowman's space, glomerulus, distalconvoluted tubule, proximal convo-luted tubule, collecting duct

174. Renal clearance tests are used to evaluatewhich of the following parameters?A. Concentrating abilityB. Glomerular filtration rateC. Glomerular permeabilityD. Tubular reabsorption

175. Which of the following do the formedelements present in the high-power fieldin Color Plate 46B suggest?A. Nephrotic syndromeB. PyelonephritisC. Excessive exerciseD. Diabetic nephropathy

176. The formed elements present in the high-power field in Color Plate 52B can bedetected by the appropriate reagent strippad reacting with theirA. PseudoperoxidaseB. EsteraseC. Glucose oxidaseD. Acetoacetate

177. When using polarized light microscopy,which urinary sediment componentexhibits Maltese cross formation?A. RBCsB. WBCsC. YeastsD. Oval fat bodies

178. Which urinary sediment component isfrequently confused with the componentin Color Plate 48«?A. YeastsB. WBCsC. ParasitesD. Casts

179. Which of the following is a urinary ketonebody that is measured using the acetest?A. AcetylCoAB. AcetoacetateC. (3-HydroxybutyrateD. Sodium nitroprusside

180. What type of microscopy may also beused to observe the urinary components inColor Plate 50m?A. PolarizedB. DarkfieldC. Phase contrastD. Electron

181. Which of the following urine biochemicalresults would be obtained in hemolyticanemia?A. Positive bilirubinB. Negative bloodC. Positive nitriteD. Positive urobilinogen

182. The absorbance of a 6 mg/L standard is0.50. An unknown has an absorbance of0.38. What is the value of the unknown?A. 7.9 mg/LB. 6.3 mg/LC. 4.6 mg/LD. 2.3 mg/L


183. If 30 grams of H2SO4 (mol wt = 98) aredissolved in 500 mL of water, what is thenormality of the solution?A. 0.82B. 1.22C. 2.94D. 3.40

184. Which of the following statementsdescribes standard precautions?A. Everyone should be careful before

entering a patient room.B. Treat all human blood and other

potentially infectious materials asthough they contained infectiousparticles.

C. Treat human blood as infectious onlyif it is known to be.

D. All human blood and other infectiousmaterial must be handled using arespirator.

185. Which of the following is true of avolumetric pipette?A. Blow out the last dropB. Is labeled "to contain" (TC)C. Is used for diluting control materialD. Is rinsed out

186. Which type of fire extinguisher should beused to deal with a laboratory fireconsisting of ordinary combustibles(e.g., wood and paper)?A. AB. BC. CD. D

187. What term describes the extent ofagreement among repeated analyses?A. Random errorB. PrecisionC. AccuracyD. Reliability

188. Which of the following is the range ofvalues described as the mean plus orminus some number of standard devia-tions, forming the basis of statistical rulesfor acceptance and rejection of qualitycontrol values?A. VarianceB. Degrees of freedomC. Coefficient of variationD. Confidence interval

189. Which of the following is material ofknown composition available in a highlypurified form?A. StandardB. ControlC. Technical reagentD. Test analyte

190. Which coding system is a systematizedseries of numbers corresponding to alldiseases, and other medical, surgical,and mental health conditions, publishedannually by the American MedicalAssociation (AMA) for the purpose ofstandardizing and coding for statistical andbilling activities in healthcare?A. CPTB. HCPCSC. ICD-9-CMD. DRG

191. When pricing new tests, a laboratory mustuse a factor to calculate the allowance forthe hospital's cost for utilities, housekeep-ing, administration, and other services.What are these costs known as?A. DirectB. OverheadC. DepreciationD. Indirect labor


192. What is the authority relationship fromadministration to department head tosupervisor to staff known as?A. Line authorityB. Staff authorityC. Formal authorityD. Job-related authority

193. The verbs "comply with" and "support"would most likely be used in writing anobjective in which of the followingdomains?A. AffectiveB. CognitiveC. PsychomotorD. Technical

194. Classify the following objective: "Thestudent will calibrate a spectrophotometeraccording to the procedure manual."A. Cognitive domainB. Psychomotor domainC. Psychosocial domainD. Affective domain

195. Which of the following testing items iseasy to develop but difficult to grade?A. True/falseB. Multiple choiceC. MatchingD. Essay

196. Which of the following describes aninterval scale with a true zero point?A. Interval scaleB. Nominal scaleC. Ordinal scaleD. Ratio scale

197. Which of the following is not part of aquestionnaire?A. Short and clear questionsB. Double negative questionsC. Ask only important questionsD. Reference points or comparisons are

used

198. Which of the following requires acontinuous electrical supply to thecomputer for data retention?A. Hard diskB. DVDC. ROMD. RAM

199. A laboratory information system canimprove patient care by performing deltachecks. What is a delta check?A. Plotting quality control results on a

chartB. Comparing the results of an analyte on

a patient to previous resultsC. Monitoring the system for security

breachesD. Monitoring data storage to be sure it is

properly backed up

200. Tape drives are often used to archivedigital data. This storage device is slowerthan most others because the data arestoredA. SequentiallyB. RandomlyC. MagneticallyD. Optically

reviewanswers

1.2.

3.

4.

5.

6.

7.

8.

9.10.

11.12.

13.

14.

15.16.

17.

18.19.20.

21.22.

23.

24.

D

CCBD

AB

BD

B

D

CBD

ADCCDABDAA

25.

26.

27.

28.

29.

30.

31.32.

33.34.

35.

36.37.

38.39.40.

41.

42.

43.

44.

45.

46.

47.

48.

AD

CB

CA

DD

A

C

AD

C

CBACDBDABCB

49.

50.51.52.

53.54.55.

56.

57.

58.59.

60.

61.62.

63.64.65.66.67.

68.69.

70.

71.72.

AD

ABA

BD

C

C

CA

DB

A

ADB

CDADCAA

73.

74.

75.

76.

77.

78.

79.

80.

81.82.

83.

84.85.

86.87.88.89.90.

91.92.

93.94.

95.

96.

CD

BA

A

BD

AB

C

CB

AA

DCBDAAABAD

1128

REVIEW ANSWERS • 1129

97.

98.99.

100.101.102.

103.104.

105.106.107.

108.

109.

110.

111.112.113.

114.115.

116.117.

118.119.120.121.122.

DD

BB

CBD

A

B

CBA

CD

B

AA

CCD

B

CCBAB

123.124.

125.

126.

127.

128.129.

130.131.132.

133.134.

135.

136.

137.

138.139.

140.141.

142.

143.144.

145.146.

147.

148.

A

CBBA

D

DB

B

CB

D

D

A

BDD

CB

A

CDACBA

149.150.151.

152.

153.

154.

155.

156.

157.

158.

159.

160.

161.162.

163.164.

165.

166.167.

168.

169.170.171.

172.

173.

174.

B

BA

CD

CA

A

CA

B

C

D

B

A

C

CB

CA

CD

CBBB

175.

176.177.

178.

179.

180.181.

182.

183.184.

185.

186.

187.

188.

189.

190.191.

192.193.

194.

195.

196.197.198.199.

200.

B

AD

DB

CD

CB

B

CA

B

D

A

CB

AAB

D

DBDBA

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