Medical Laboratory Sciences II

2 hour Examination
Section A Section

Short question answers

B 1 hour essay question Choice of 1 out of 3

What Have we Learnt?

Blood Bank
Blood Grouping Haemolytic disease of the newborn

Biochemistry
Introduction Liver Function Kidney, Heart & Thyroid function Paediatric Biochemistry Genetics

Microbiology
Urinary Tract Infection Sexually Transmitted Disease Enterics General Bacteriology Virology

Blood products
Blood conservation

Blood Bank Blood Grouping

ABO System
What is it? Why is it particularly important?

Typing
Forward and reverse groupings RhD Cross matching Coombs test

Blood Bank HDN

Clinical scenario Routine serology

Screening/Prophylaxis Maternal/paternal/foetal Significant alloantibodies

Management of HDN
Prophylaxis RAADP Liley chart

Blood Bank Blood Products

Whole Blood Fresh Frozen Plasma (FFP)

Indications for use Preparation

Red Cells in SAGM

Indications for use What is it?

Platelets
Indications for use Preparation and administration

Cyroprecipitate, Serum immunoglobulins, Albumin

Blood Bank Conservation

SHOT Shortages
Short term, acute, long term

NBS Plan for Management

Green, Amber, Red phase Autologous transfusion PAD, ANH, Cell Salvage Management of Hb levels Emergency blood management group

Example Questions:
1.
Haemolytic disease of the newborn (HDN) is caused by transplacental passage of maternal alloantibodies directed against foetal red cell antigens.

What is meant by the term alloantibody? An antibody produced by one individual that reacts with allontigens of another individual of the same species.
a)
(1 mark)

b)

Which class of antibody usually facilitate HDN reactions due to their ability to cross the placenta: IgG, IgA or IgM?
(1 mark)

IgG
c)

Why is it particularly important to identify Rhesus D (RhD) negative, pregnant women prior to their giving birth?
(5 marks)

d)

Other than anti-RhD, name 3 other significant alloantibodies associated with HDN
(3 marks)

Example Questions:
2.

Conservation of blood donated through the British Blood Transfusion Service is of increasing importance. Briefly outline some of the possible scenarios that may contribute to short term shortages, acute shortages and prolonged shortages. In July 2004, the Department of Health issued a plan for the management of blood shortages in the UK, integrated using a traffic light system. Outline what is meant by the traffic light system and provide a critical analysis of some of the new measures introduced to help conserve blood usage.

Example Questions:
2.

Conservation of blood donated through the British Blood Transfusion Service is of increasing importance. Briefly outline some of the possible scenarios that may contribute to short term shortages, acute shortages and prolonged shortages. In July 2004, the Department of Health issued a plan for the management of blood shortages in the UK, integrated using a traffic light system. Outline what is meant by the traffic light system and provide a critical analysis of some of the new measures introduced to help conserve blood usage.

Biochemistry Introduction

Specimen collection
Different preservatives

Sample integrity
Haemolysed, icteric, lipaemic Transport conditions

Biochemistry Liver Function

Normal functions of the liver

Normal structure of the liver

LFT
Bilirubin, Albumin, ALP, ALT, AST, GGT, LDH Clinical interpretation

Biochemistry Kidney, Heart &

Thyroid

Renal Function
Normal function renal function eGFR, CCT, Urea, Creatinine, Sodium, Potasium, Proteinuria, Microalbumin urine test, Urine osmolarity, Transferrin saturation, Stone screen

Cardiac Function
Myoglobin, LDH, AST, CK (-MM, -MB, -MM), Troponin (T, -I), hsCRP, NT-proBNP

Thyroid Function
Normal thyroid function Hyperthyroid vs hypothyroid FT3, FT4, TSH, anti-TPO, anti-TSH Receptor

Biochemistry Paediatrics

Terms
Neonate, Preterm, Term, Extreme preterm

Why are paediatric cases different

Specimen collection Specimen analysis Data interpretation

Inherited conditions
Phenylketonuria, Niemann-Pick (C & D), Congenital hypothyroid, Sickle cell, MCADD, Cystic fibrosis Screening Wilson & Jungner

Biochemistry Genetics

What is it, Why do it, How do we do it

Screening, Counselling, Extraction, PCR, Southern blotting, Cytogenetics, Genotyping

Inheritance
Autosomal dominance, recessive, Penetrance, Variability

Clinical examples
Huntington, Cystic fibrosis, Mitochondrial disorders, X-linked disorders, Downs, Fragile X, Haemochromatosis. AAT

Example Questions:
3.
a)

Clinical Biochemistry routinely assesses organ function.

State 4 tests used to assess renal function

(2 marks)

b)

Provide a clinical interpretation of an abnormal result for each of the 4 tests you have named above.
(4 marks)

c)

State the full name of each of the following analytes used to assess liver function:
(3 marks)

AST,
d)

ALT, LDH

Free thyroxine is measured as part of the assessment of which organ?

(1 mark)

Example Questions:
4.

A 40 year old male presents to his GP with palpitations, shaking, lethargy and weight loss. Upon further examination the GP sees signs of tachycardia, moist skin and exophthalmos. Graves disease is suspected and a blood sample sent to the Pathology department. Describe the thyroid hypothalamus-pituitary axis, detailing how this is disrupted in the onset of Graves disease. What tests would be requested and how would a Biomedical Scientist interpret these results to differentially diagnose Graves? Briefly outline a possible treatment strategy considering long and short term aims for this mans condition?

Example Questions:
4.

A 40 year old male presents to his GP with palpitations, shaking, lethargy and weight loss. Upon further examination the GP sees signs of tachycardia, moist skin and exophthalmos. Graves disease is suspected and a blood sample sent to the Pathology department. Describe the thyroid hypothalamus-pituitary axis, detailing how this is disrupted in the onset of Graves disease. What tests would be requested and how would a Biomedical Scientist interpret these results to differentially diagnose Graves? Briefly outline a possible treatment strategy considering long and short term aims for this mans condition?

Microbiology - STIs

Basic anatomy, male and female Gonorrhoea, Syphillis, Chlamidia

Transmission Clinical features Pathogenesis Lab diagnosis: Specimen collection, Culture, Microscopy (light, dark, morphology), Gram stain, Oxidase test, Biomerieux, ELISA, PCR, Sensitivity testing Treatment/prevention

General basic knowledge

Genital herpes, Genital warts, Pubic lice, Trichomoniasis, Vaginal candidosis

Microbiology - UTIs

Basic anatomy, male and female

Host defence

Symptoms
Terminology

Causative organisms
Inpatients/outpatients

Specimen collection
Critical analysis

Laboratory investigation
Microscopy, casts, Flow cytometry, Culture, Chromogenic media. Kass criteria

Treatment/prevention

Microbiology and Virolgoy

Apologies, I did not receive the following talks in time to put this presentation together before going on leave. You will have to review and summarise these two lectures for yourselves.
Medical Microbiology: Respiratory & Gastro Infection Medical Virology

Example Questions:
5a) Give two reasons why UTIs are more common in females

than males.
(2 marks)
b)

What is the most common cause of UTIs in the public?

(1 mark)

c)

Discuss how the causative agents of UTIs found in hospital inpatients are likely to differ from those found in the general public.
(3 marks)

d)

Critically analyse the different types of specimen and specimen collection methods used to investigate suspected UTI.
(4 marks)

Example Questions:
6.

Discuss the aetiology and clinical symptoms of Mycobacterium tuberculosis (TB) infection. Critically discuss the laboratory investigations that may be conducted by a Biomedical Scientist investigating a possible case of TB, including the advantages and disadvantages of the different tests that could be requested. Briefly outline possible treatment and prevention strategies.

Example Questions:
6.

Discuss the aetiology and clinical symptoms of Mycobacterium tuberculosis (TB) infection. Critically discuss the laboratory investigations that may be conducted by a Biomedical Scientist investigating a possible case of TB, including the advantages and disadvantages of the different tests that could be requested. Briefly outline possible treatment and prevention strategies.

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