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What types of chemicals meet the specifications established by the American Chemical Society (ACS) and are used in most analytical lab procedures?
Analytical reagent (AR) grade
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What reagents have undergone additional processing that makes them suitable for special procedures such as atomic absorption, chromatography, molcular diagnostics, etc...?
Ultrapure reagents
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What water is of the higest quality and is used in test methodologies where minimum interference and maximum precision and accuracy are needed?
CLRW (Clinical Laboratory Reagent Water)
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Who established the specifications of CLRW (clinical laboratory reagent water)?
CLSI (Clinical and Laboratory Standars Institute)
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What is required in preparation of reagent grade water (CLRW)?
- Prefilters: glass or cotton microfibers that remove 98% of the particulate matter
- Activated carbon: removes organic matter and chlorine
- Submicron filter: removes all particles or microorganisms larger than the membrane pore size
- Reverse osmosis: removes 95-99% of bacteria and organic and other particulate matter
- Ion exchange: system of resin cartiridges or tanks connected in series that removes cations and anions to make deionized water
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What type of water is used in sterility specification for tissue or organ culture, nucleic acid content for DNA testing, metal content for trace metal analysis, etc...?
Special reagent water (SRW)
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What water is used for internal instrument rinsing, making dilutions, etc... and needs to meet manufacturer's specifications?
Instrument feed water
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What water is purified to contain only lo levels of organics, inorganics, and particulate matter so it does not leave residue on glassware or contaminate solutions and media in autoclaves?
Water for laboratory diswashers and autoclaves
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What standards are highly purified chemicals that are weighed or measured to produce a solution with an exact concentration?
Primary standards
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What standard are solutions who values are determined by repeated analyses, using a reference method?
Secondary standards
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Who provides standard reference material for purchase, such as:
Standard reference materials (SRMs)
Certified reference materials (CRMs)
National Institute of Standards and Technology (NIST)
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Name the types of glass used in the lab environment
- Flint glass: inexpensive, used in making disposable glass, made from soda-lime glass
- Borosilicate glass: resistant to heat, corrosion, and thermal shock
- Pyrex and Kimax: can withstand high temps
- Corex: 6x's stronger than borosilicate, used for thermometers
- Vycor: used for extremely high temps (up to 900 degrees celcius) and resists heat shock
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Name the types of plasticware used in the lab environment
- Polyolefins: generally resistant to acids, alkalis, and salt solutions
- Polycarbonate: May be used for centrifuge tubes
- Fluorocarbon resins: Used for temps from -270 to 255 degrees celcius, used for stir bars and tubing
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What pipette:
Have the bulb closer to the center
Accurately deliver a fixed volume of aqueous solution
Drain by gravity and should NOT be blown out
Volumetric pipettes
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What pipette:
Have the bulb closer to the delivery tip because they deliver viscous fluids
Deliver an accurate volume by being "blown out" using a pipetting bulb
An etched ring or pair of etched rings near the top of the pipette indicates the need to "blow out"
Ostwald-Folin pipettes
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What pipettes:
Are calibrated to the tip and must be "blown out" to deliver entire volume
Need to blow out is indicated by the etched rings at the top of the pipette
Serologic pipettes
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What pipettes:
Calibrated between marks
Cannot be blown out
Mohr pipettes
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How should centrifuge speed be checked periodically?
With a tachometer
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What class of weights is used to check analytical balances for proper calibration?
Class S weights
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What class of weights has the quality of a primary standard and are used to check the accuracy of other weights?
Class M weights
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What type of variation occurs according to sleeping and waking times?
Diurnal variation
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How does stress change the labs?
- Increase cortisol
- Increase total cholesterol
- Decrease hormone production of pituitary hormones and aldosterone
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How can stasis caused by tourniquet use, repeated fist clenching, and improper drawing techniques change lab results?
- Increase potassium
- Increase proteins
- Increase metabolic by-products
- Increase hemolysis of RBCs
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What tests are most affected by hemolysis and how?
- Increase potassium
- Increase LD (lactate dehydrongenase)
- Decrease sodium
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What does a Red top blood tube contain and why is it used?
- No additives
- Used for routine chemistries, therapeutic drug levels, immunohematology, and serology
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What does a lavender top blood tube contain and why is it used?
- Contains K3 EDTA (ethylenediaminetetraacetate) as an anticoagulant
- Used in hematology procedures, special chemistry assays, and immunohematology (blood bank)
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What does a pink top blood tube contain and why is it used?
- K2 EDTA (thylenediaminetetraacetate) as an anticoagulant (removes ionized Ca)
- Used in immunohematology (blood bank)
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What does a blue top blood tube contain and why is it used?
- Sodium citrate as an anticoagulant (1:10 ratio) (removes ionized calcium)
- Used for coagulation studies
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What does a green/mint top blood tube contain and why is it used?
- Heparin as an anticoagulant (inactivates thrombin)
- Used for chemistry and cytogenetic testing
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What does a speckled, tiger, or marbled top SST blood tube contain and why is it used?
- Separator is a thixotropic gel that forms a barrier bwetween the cells and serum during centrifuging
- Used in chemistry
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What is the correct order of draw for routine tests?
- Sterile (blood cultures)
- C Spot He Eats Oranges
- C: Citrate (blue)
- S: SST
- H: Heparin (green/mint)
- E: EDTA
- O: Oxalate
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What is the term for material of known concentration that is used to calibrate an instrument or develop a standard curve?
Standard
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What is the term for data-driven, business approach to performance improvement and oriented toward process identification and process improvement?
Six Sigma
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What is the term for an improvement trend to make work faster by providing ways to streamline through the removal of waste?
Lean principles
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What were established by the International Organization for Standardization as a series of 4 standards for quality management?
ISO 9000 Standards
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What is the middle value in a set of numbers that are arranged according to their magnitude?
Median
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What is the most frequently obtained value in a set of numbers?
Mode
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What reflects the variation of data values around the mean?
Standard Deviation (s)
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What reflects dispersion around the mean and is the square of the standard deviation?
Variance (s2)
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What reflects random variation of analytical methods in units that are independent of methodology, because it is a percentage comparison of the standard deviation divided by the mean?
Coefficienct of variation (CV)
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What is the percentage of individuals without the specific disease that are correctly identified or predicted by the test as having the disease?
Sensitivity of the test
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What is the percentage of individuals without the specific disease that are correctly identified or predicted by the test as NOT having the disease?
Specificity of a test
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What is the minimum number of specimens needed to determine a reference interval?
Minimum of 20 specimens from healthy individuals
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What is the acceptable control range within?
Mean +-2 standard deviations
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What Westgard multirules detect random error?
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What Westgard multirules detect systematic error?
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What is Westgard multirule 12S?
- 1 Control value exceeds the mean +-2 standard deviations
- Warning rule - results reportable
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What is Westgard multirule 13S?
- 1 Control value exceeds the mean +-3 standard deviations
- Detects random error
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What is Westgard multirule 22S?
- 2 Consecutive control values exceed the same 2 standard deviations limit (both 2 above or 2 below)
- Detects systematic error
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What is Westgard multirule R4S?
4 Consecutive control values are recorded on one side of the mean and exceed either above or below the mean (4 above or 4 below one standard deviation)
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What is the Westgard multirule of 10X?
- 10 Consecutive control values are recorded on one side of the mean (above or below)
- Detects systematic error
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What is a graphical technique for analyzing interlaboratory data when each laboratory has made two runs on the same analyte or one run on two?
Youden plot
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What term refers to a program where a clinical lab contracts with an agency (CAP or American Association of Bioanalysts) to receive and assay samples, the concentration of which is unknown to the participating clinical labs to estblish target values and ranges of accepability?
External quality control
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What is the consequence for failure to comply with proficiency testing?
Can result in sanctions, including a complete closure of the lab
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