RIFT VALLEY UNIVERSITY

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF MEDICAL LABORATORY SCIENCES
MODEL EXAM OF EXIT EXAM FOR MEDICAL LABORATORY STUDENTS
TIME ALLOWED 2HRS
Name___________________________idno__________________signature_______________
Choose the correct answer for the following questions and write your answer on the answer
sheet provided
1. A renal dialysis patient has hemoglobin of 7g/dl (RR: 12-18g/dl). What adaptation can you
make to assure a good blood smear?
A. Increase the angle of the spreader slide and push speed
B. Decrease the angle of the spreader slide and push speed
C. Increase the angle of the spreader slide and decrease push speed.
D. Decrease the angle of the spreader slide and decrease push speed.
2. W/o Tigist is a laboratory technician at Asella teaching Hospital .One day She perform
Giemsa stain to do a set of differential counts, after she stains the smear, She notices that the
red cells look blue green, Nuclear chromatin of WBC was deep blue to black and Granules
of neutrophils were deeply stained. What the corrections she should do for this staining
problem?
A. Preparing too thick films
B. prolonged staining time
C. Inadequate washing
D. using less stain and more diluent
3. A clinical laboratory scientist received a 5 mL EDTA tube that contained 0.5 Ml of
anticoagulated blood. A smear was prepared and stained with Wright's stain. When examined
microscopically, the majority of cells appeared to have many evenly distributed, blunt
spicules on the surface. How should this cellular appearance be interpreted?
A. An anemic condition requiring further testing
B. Spur cells caused by using incorrect technique during slide preparation
C. Artifact caused by a dirty spreader slide
D. Crenated cells caused by incorrect blood to anticoagulant ratio

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4. An adult has a total white blood cell count of 4.0 X 10 9/L (4.0 X 103/µL). The differential
count is as follows: polymorphonuclear neutrophils (PMNs) 25%, bands 5%, lymphocytes
65%, and monocytes 5%. The absolute value reference range for lymphocytes is 1.0-4.0 X
109/L. Which of the following is true?
A. The percentage of lymphocytes is normal.
B. There is an absolute lymphocytosis.
C. There is a relative lymphocytosis
D. There is both an absolute and a relative lymphocytosis.
5. A 15-month-old malnourished child is brought to the clinic for a routine examination. Her
CBC results are as follows: WBC 9.5 x 109/L (9.5 x 103/(µL); RBC 2.70 X 1012/L (2.70 X
106/µL); hemoglobin 67 g/L (6.7 g/dL); hematocrit 0.25 L/L (25%); MCV 73.5 fl; MCHC
26.8 g/dL; reticulocyte 0.2%; RDW 19%. Abnormal RBC morphology present included
pencil forms and target cells. What is this toddler's most probable diagnosis?
A. Folic acid deficiency
B. Hereditary spherocytosis
C. Iron deficiency
D. Erythroblastosis fetalis
6. What is the toddler's absolute reticulocyte count for the above question?
A. 0.05X109/L
B. 0.5X109/L
C. 5X109/L
D. 50X109/L
7. A pre-operative, 20-year-old female has a mild microcytic anemia, with target cells and
stippled red cells observed on the blood smear. Her hemoglobin A2 level is quantified at 5%.
What do these findings suggest?
A. Iron-deficiency anemia
B. Heterozygous alpha-thalassemia
C. Heterozygous beta-thalassemia
D. Hemoglobin S/beta-thalassemia
8. A clinical laboratory scientist examined a Wright's stained peripheral smear and saw what
appeared to be small, dark-staining granules in the mature erythrocytes. A second smear was

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 stained with Prussian blue and a positive result was obtained. Based on this information,
which of the following would you expect to be abnormal?
A. Plasma hemoglobin level
B. Serum ferritin level
C. Hemoglobin electrophoresis
D. Test for parietal cell antibodies

9. A 69-year-old male is admitted with pallor, mild tachycardia, and difficulty walking because
of numbness in the extremities. His CBC reveals hemoglobin of 78 g/L (7.8 g/dL), a
hematocrit of 0.25 L/L (25.0%), and MCV of 118.5 fL. What is the most probable cause of
the abnormal CBC results?
A. Folic acid
B. Vitamin B12
C. Vitamin B6
D. Ascorbic acid
10. An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC
count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and
leukoerythroblastosis. These findings are most consistent with__?
A. Chronic myelogenous leukemia
B. Idiopathic myelofibrosis
C. Primary polycythemia
D. Primary thrombocythemia
11. Which of the following would be least helpful in distinguishing chronic myelogenous
leukemia (CML) from a neutrophilic leukemoid reaction?
A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and
myelocytes
B. Leukocyte alkaline phosphatase score
C. Presence of marked splenomegaly
D. Neutrophils with Dohle bodies and toxic granulation

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12. A laboratory technician ordered to perform WBC count. If a WBC count is performed on a
hemacytometer using a 1:20 dilution. 308 cells are seen in a total area of 8 mm 2. What is the
WBC count?
A. 3.8X109/L
B. 7.7X109/L
C. 15.4X109/L
D. 38.5X109/L

13. A white blood cell count is done on an automated impedance cell counter from 40 yrs old a
patient was 20X103/µL(RR 4-11X103/µL) . The laboratory technologist perform blood smear
and the blood picture showed many nucleated RBC(15nRBC/100WBC). The WBC count is
most likely___?
A. Falsely increased because of nRBCs
B. Falsely increased because of red cell fragments
C. Falsely decreased because of nRBCs
D. Accurate; no error with this methodology
14. 10-year-old boy came to Asella teaching Hospital with the compliant of fatigue, nausea, and
headache. The CBC results on an automated impedance counter: WBC 35.0 X 10 9/L (35.0 X
103/(µL); RBC 2.50 x 1012/L (2.50 x 106/|µL); hemoglobin 45 g/L (4.5 g/dL); hematocrit
0.16 L7L (16%); platelet count 250 X 109/L (250,000/µl); reticulocyte count 8.0%; 110
nucleated red blood cells/100 WBCs and many targets are seen. Other laboratory results are
as follows: serum iron elevated; total iron-binding capacity (TIBC) decreased; serum ferritin
elevated. What is the corrected white blood cell count expressed in SI units of__ X10 9/L?
A. 4.6
B. 12.5
C. 16.7
D. 18.4
15. What would be the appearance of the child's red blood cells on a peripheral smear?
A. Microcytic, hypochromic
B. Normocytic, hypochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic

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16. A 75-year-old man with rheumatoid arthritis complains to his physician of pain and fatigue.
His CBC results are as follows: WBC 6.8 x 109/L (6.8 X 10 3/µL); RBC 3.49 x 1012/L (3.49 x
106/µL); hemoglobin 97 g/L (9.7 g/dL); hematocrit 0.29 L/L (29%); MCV 83 fl; MCHC 33.9
g/dL. Other laboratory results are as follows: serum iron and total iron-binding capacity
(TIBC) both decreased, serum ferritin slightly elevated. The results of the CBC and iron
studies in this case are most characteristic of_______?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Sideroblastic anemia
D. Thalassemia
17. 19-year-old female college student who has been living primarily on tea, beer, and cereal for
the past 9 months visits student health complaining of fatigue. Her CBC results are as
follows: WBC 2.5 X 109/L (2.5 X 103/|µL); RBC 2.10 X 1012/L (2.10 x 106/(µL);
hemoglobin 85 g/L (8.5 g/dL); hematocrit 0.24 L/L (24%); platelet count 110x109/L
(110,000/µL); MCV 114 fL; MCHC 35.0 g/dL; reticulocyte count 0.8%.What test(s) should
be done first to determine a diagnosis in this patient?
A. Vitamin B12
B. Iron studies
C. Bone marrow examination
D. Osmotic fragility
18. A 32-year-old African-American traveling to Africa on business had been healthy until he
began taking primaquine for prevention of malaria. He went to his physician because he felt
faint and his urine was black. His CBC results are as follows: WBC 6.5 X 10 9/L (6.5 X
103/µL); RBC 1.67 X 1012/L (1.67 x 106/µL|_); hemoglobin level 50 g/L (5.0 g/dL);
hematocrit 0.15 L/L (15%); MCV 89.8fL; MCHC 33.3 g/dL; platelet count 175 x 109/L
(175,000/µL); reticulocyte25.0%.The most likely cause of this hemolytic episode is__?
A. G6PD deficiency
B. Hereditary spherocytosis
C. Sickle cell disease
D. Pyruvate kinase deficiency

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19. An 8-year-old girl is seen by the family physician. On physical examination, the physician
notes fever, sore throat, bruising, petechiae, and pallor. A CBC is drawn and the results are as
follows: WBC 110x109/L (110X103/M-L); RBC 1.70 x 1012/L (1.70 x 106/|xL); hemoglobin
55 g/L (5.5g/dL); hematocrit 0.16 L/L (16%); differential count shows 93% blasts and 7%
lymphocytes. A bone marrow examination is performed and reveals 85% blasts. All of the
blasts are small with no variation in their appearance. What is this child's most probable
diagnosis?
A. Acute lymphoblastic leukemia
B. Acute myelogenous leukemia
C. Hairy cell leukemia
D. Myelodysplastic syndrome
20. Which of the following cytochemical stains would most likely be positive in the blast cells of
the above patient(Q-18)?
A. Myeloperoxidase
B. Leukocyte alkaline phosphatase
C. Periodic acid-Schiff
D. Nonspecific esterase
21. A 53-year-old man reported to the laboratory for routine blood work as part of a yearly
physical. He had been feeling tired for the last few months. Physical examination revealed
splenomegaly. His CBC results are as follows: WBC 80.0 x 109/L (80.0 X 10 3/(µL); RBC
4.10x1012/L (4.10 X 10%,L); hemoglobin 123 g/L (12.3 g/dL); hematocrit 0.37 L/L (37.0%);
platelet count 650 x 109/L (650,000/µL); differential count shows 40% polymorphonuclear
neutrophils, 18% bands, 5% metamyelocytes, 7% myelocyte, 28% lymphocytes, and 2%
monocytes. No RBC or WBC morphologic abnormalities are seen. The peripheral blood
findings are most consistent with a diagnosis of __?
A. Neutrophilic leukemoid reaction
B. Chronic myelogenous leukemia
C. Acute myelogenous leukemia
D. Regenerative left shift
22. Which of the following would yield the most diagnostic information for this patient?
A. Sudan black B (SBB)

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 B. Periodic acid-Schiff (PAS)
C. Tartrate-resistant acid phosphatase (TRAP)
D. Leukocyte alkaline phosphatase (LAP)
23. A 20 year old medical student cuts himself while shaving. He notes that the bleeding stops
immediately (due to vasoconstriction). However, he will soon begin to bleed if he is not able
to initiate hemostasis with adhesion of platelets to damaged endothelium. This step is
facilitated by the presence of:
A. GP Ib receptors.
B. Gp IIb/IIIa receptors.
C. Fibrinogen.
D. Thrombopoietin.
24. A 68 year old man with no history of excessive bleeding (football player, multiple dental extractions)
presents for elective gallbladder surgery. He has a normal CBC, normal platelet count, normal PFA
and a normal PT, but his PTT is 60 seconds (normal 30 sec). He most likely has:
A. Factor XII deficiency
B. Factor VIII deficiency
C. Factor IX deficiency
D. vonWillebrand’s disease
25. A patient with normal hemoglobin and WBC count values, a persistently elevated platelet
count (over 1000 X 109/L), increased marrow megakaryocytes, and a history of frequent
bleeding and clotting episodes most likely has
A. Polycythemia vera
B. Chronic myelofibrosis
C. Essential thrombocythemia
D. Chronic myelogenous leukemia
26. Twenty microliters of blood are diluted in 1.98 mL of diluent. This dilution is plated on both
sides of a Neubauer-ruled counting chamber. A total of 356 cells is seen when both large
center squares are counted. The platelet count expressed in SI units is
A. 178xl09/L
B. 178xl03/|µL
C. 356xl09/L

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 D. 712xl09/L
27. Laboratory tests requested on a patient scheduled for early morning surgery include a CBC
with platelet count. An automated platelet count performed on the specimen is 57 x
109/L(RR:150-400X109/L. In the monolayer area of the peripheral blood smear there are
approximately 12 platelets per oil immersion field, many of which are encircling neutrophils.
Controls are in range. Based on this information, the best course of action is
A. Report all the results because the instrument is functioning properly.
B. Alert the physician immediately so cancellation of surgery can be considered.
C. Thoroughly mix specimen and repeat platelet count; if results remain the same, report
all results and indicate that platelet count has been confirmed by repeat testing.
D. Have the specimen redrawn using 3.2% sodium citrate as the anticoagulant.
28. Which of the following gene mutations correlates with the t(9;22) that is present in
Philadelphia chromosome positive chronic myelogenous leukemia?
A. MYC/IGH
B. BCR/ABL
C. PML/RARA
D. JAK2
29. On the visiting of regional laboratory a patient with urethral discharge shows growth of
definitive colony characteristics on modified Thayer-Martin medium and gram stain showed
gram negative diplococcic. Which one of the following reporting is acceptable in reference of
scientific naming?
A. N. gonorrhoeae
B. N. gonorrhoeae
C. N. Gonorrhoeae
D. N. gonorrhoeae
30. In the emergency of drug resistance phage therapy is emerged as possible solution. After
treatment with specific phage resistance gene was identified. Which mechanism of gene
transfer was employed for the transfer of resistant gene?
A. Conjugation
B. Transformation
C. Transduction

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 D. Transposons
31. During experimental study of S. pneumoneae scientist inject both the smooth and rough
colony variants to mouse model in laboratory. The mouse inject with smooth colony was
diseased and die while change was not observed on the other mouse. What is the most likely
virulence factor difference among these two variants?
A. Cell wall
B. Cell membrane
C. Capsule
D. Flagella

32. In a teaching hospital operation theatre microbiologist aimed determine microbial air load
using the settlement plate count method. He found commonly gram positive bacteria are
more suspended and settled from the room air compared to gram negative bacteria. What is
possible reason that makes gram positive bacteria common in bacterial air load?
A. Capsule
B. Flagella
C. Cell wall
D. Cell membrane
33. A patient with recurrent fever due to B. ricurrentis admitted a district hospital and large dose
of antibiotic was administered. A patient clinical condition was worsening up on treatment
due to septic shock. Which virulence factor is the most likely associated with clinical
condition?
A. Capsule
B. Flagella
C. Cell wall
D. Cell membrane
34. Experimental study demonstrated in the presence of optimum environmental condition and
nutrient most pathogenic bacterial cell divided in the form 2 n. Where n is the doubling time
and N is the original bacteria, the new progeny number will be N*2 n at a given time. What
method is utilized by those pathogenic bacteria to be double?
A. Transverse vision

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 B. Binary vision
C. Sporulation
D. Buding
35. A person with recurrent urinary tract infection provide midstream urine sample at sample
collection unit of the hospital. E. coli was isolate with significant colony forming unit on
XLD and the isolate grow beyond the cut of limit in the presence of recommended
antibiotics. What is the possible reason for the recurrence of infection with this organism?
A. Antigenic variation
B. Strain variation
C. Antibiotic resistance
D. Grams reaction
36. MacConkey agar supplemented with crystal violet to suppress the growth of gram positive
bacteria and identifies lactose fermenters from non fermenters due the presence of PH
indicator in the medium. This media is classified as;
A. General medium
B. Selective medium
C. Differential medium
D. Transport medium
37. Over the course of 1 week, a 6-year-old boy develops pustules on his face. During the next 2
days, some of the pustules break, forming shallow erosions covered by a honey-colored crust.
The boy's 40-yearold uncle develops similar lesions after visiting for 1 week during the
child's illness. A swab taken from the lesion and gram stained shows gram positive cocci in
clusters, catalase positive upon biochemical test. What is the most likely microorganism
causing this infection?
A. Staphylococcus aureus
B. Staphylococcus epidermidis
C. Streptococcus pyogenes
D. Streptococcus pneumonia
38. A 29-year-old male's illness began 10 weeks prior to death, with an episode of "flu". Two
weeks later his urine became "smoky". He was found to have hematuria, albuminuria and
elevated BUN and he died from a pulmonary embolus. The throat culture obtained exhibited
gram positive cocci in chains. It also showed beta-hemolysis on sheep blood agar (SBA) and
was catalase negative. What was the most likely organism?
A. Streptococcus pyogenes

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 B. Streptococcus viridians
C. Staphylococcus aureus
D. Streptococcus pneumonia
39. An elderly wheelchair bound man had a history of recurrent urinary tract infections. He
presents with new onset of fever, chills, and confusion. Blood cultures were drawn. The
organism grown was non-hemolytic, catalase negative, and PYR positive. Gram stain showed
gram positive cocci. What is the most likely organism?
A. Streptococcus viridians
B. Staphylococcus epidermidis
C. Staphylococcus saprophyticus
D. Enterococcus species
40. An elderly sexually active women had a history of urinary tract infections. She presents with
new onset of fever, chills, and confusion. Upon urine culture on blood agar the organism with
characters of non-hemolytic, catalase positive, and Novobiocin susceptable was observed.
Gram stain showed gram positive cocci. What is the most likely organism?
A. Staphylococcus aureus
B. Staphylococcus epidermidis
C. Staphylococcus saprophyticus
D. Enterococcus species
41. A 45-year-old male became ill approximately 2 to 3 weeks ago following an alcoholic spree.
He had nausea, vomiting, dehydration, confusion and high fever. The sub culture on blood
agar from nutrient broth show alpha hemolytic (partial hemolytic) and Gram stain of show
Gram positive laciolet diplococcic. What is the most likely bacteria casing this infection?
A. Streptococcus pyogenes
B. Streptococcus viridians
C. Staphylococcus aureus
D. Streptococcus pneumonia
42. A 50 years old man who has no history of hospital admission come to a district hospital with
community acquired atypical pneumonia. No growth was observed with unaided eye but
with light microscopy colony was demonstrated and the organism was proved to be cell
walless bacteria. What is the most likely organism cause the infection?
A. M. genitalium

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 B. M. pneumoniae
C. M. agalactiae
D. M. agassizii
43. A 67-year-old male had rheumatic heart disease for thirty years. Reordered medical history
showed frequent skin and throat infection. A serological test of Atistreptolysin O show
positive finding. What is the most likely organism?
A. Group A Streptococci
B. Viridans Streptococci
C. Staphylococcus aureus
D. Staphylococcus epidermidis

44. A 10 month old child had a seizure with shaking of arms and legs, the child’s fever was
39.5°C. Blood cultures and lumbar puncture were performed. CSF findings were showed cell
count of 4000, 95% Poly morphonuclear (PMN) cells. Up on differential count, chemical
analysis show glucose 20mg/dl and protein 125mg/dl. The infection is caused by;
A. Bacterial
B. Fungal
C. Parasite
D. Viral
45. Gram stain of patient with bacterial meningitis showed PMNs and occasional Gram-negative
coccobacillary organisms. The organism grew on chocolate agar but not on sheep blood agar
or MacConkey’s agar. What is the most likely organism in this case?
A. Haemophilus influenza
B. Neisseria meningiditis
C. Moraxella catarrhalis
D. Streptococcus pneumonia
46. An 18yearold university freshman presented to student clinic with severe headache, fever,
and disorientation. A lumbar tap was performed with the following results: cell count: 300
with 100% PMN, glucose: 10 mg/dl, protein: 100 mg/dl. The gram stain of the spinal fluid
revealed numerous PMNs with intracellular gramnegative diplococci. What is the most likely
organism?

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 A. Streptococcus pneumoniae
B. Moraxella catarrhalis
C. Haemophilus influenza
D. Neisseria meningitides
47. A 25-year-old male presents with urethritis a local health facility. The Gram stain shows
intracellular gram negative diplococci. What is the most likely organism?
A. Chlamydia trachomatis
B. Ureaplasma species
C. Neisseria gonorrhoeae
D. Haemophilus ducrey
48. A 18-year-old woman developed fever and costovertebral angle tenderness which did not
respond to antibiotics due to Acute pyelonephritis. A urine culture grew a pure culture of
more than 100,000 colonies/ml of an organism on sheep blood agar and MacConkey’s agar.
The gram stain also showed gram negative rods with citrate utilization test positive and
urease negative. What is the most likely organism?
A. E. coli
B. K. pneumoniae
C. P. mirablis
D. C. frundi
49. Up on repeated antibiotic administration change was not observed for case given on No 12.
What was the most likely possible reason for non response for administered antibiotic?
A. Poor drug quality
B. Antibiotic resistance
C. Increased virulence factors
D. Suboptimal drug administration
50. Infectious pathogen employ various method for reduce susceptibility. What is the most
possible mechanism employed by the organism cased acute pyelonephritis presented on case
No 13.
A. Target modification
B. Efflux pump
C. Drug inactivation

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 D. Change metabolic pathway
51. A 30-year-old man complicated urinary tract infection appears to local hospital and a urine
culture grew more than 500,000 colonies/ml with swarmy offensive smell of an organism on
sheep blood agar and MacConkey’s agar. The organism was non fermenter and abudanded
uraease producer. The gram stain also showed gram negative rods. What is the most likely
organism?
A. E. coli
E. K. pneumoniae
F. P. mirablis
G. C. frundi
52. A 52-year-old homeless, alcoholic man had a fever and a cough productive of thick sputum
that worsened over several days. His temperature is 38.2°C. Upon bracheoalveoler lavage
culture on MacConkey’s agar mucoid, fermenter gram negative bacilli was observed. What is
the most likely organism?
A. E. coli
B. K. pneumoniae
C. P. mirablis
D. C. frundi
53. A 66-year-old man incurs extensive thermal burns to his skin and undergoes skin grafting
procedures in the surgical intensive care unit. Two weeks later, he has increasing respiratory
distress. Laboratory studies show hemoglobin of 13.1 g/dL, hematocrit 39.2%, platelet count
222,200/mm3, and WBC count 4520/mm3 with 15% monocytes. A chest radiograph shows
extensive bilateral infiltrates with patchy areas of consolidation.
54. A child with non vaccinated history for DPT was visiting a district hospital with clinical
presentation of upper respiratory infection and pseudo membrane in the plate. The clinician
suspects the respiratory diphtheria and collects pseudo membrane exudates for stain. Which
staining type is the most appropriate to identify the suspected organism?
A. Albert stain
B. Grams stain
C. AFB stain
D. Capsule stain

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55. A 26 athlete man was injected with rusted metal in the soil while on training. A clinical
sample showed gram positive with drum stick appeared organism. What is the most likely
organism?
A. C. tetani
B. C. botulinum
C. C. perfringens
D. C. difficile

56. An epidemic of human and cattle infection was occurred in a district of rural area of a given
community. Both a clinical sample from animal human shows gram positive squared
sporulated organism. Growth on blood agar show non heamolytic ground glass appeared
colony. The most likely organism is;
A. B. anthraxes
B. B. abortus
C. Q. borenti
D. M. tuberculosis
57. A diabetic patients admitted to a district hospital with the case of orchitis (inflammation
testicles). Fine needle aspiration was tested using stained microscopy by auramine staining.
Rod fluorescing body was observe for which restraining done using AFS techniques and
resulted in red bacilli under microscope. What is most likely organism cause this infection.
A. T. palidum
B. N. gonorrheae
C. M. tuberculosis
D. H. ducry
58. A 28 young man come to zonal hospital with episode of 4 times boil movement per a day
provide stool sample for laboratory examination after consumption fired egg. No parasite
observed up on examination of stool microscopy. On MacCkonkey agar a colony of non
fermenter, with biochemical characteristics of catalase and oxidase negative, motile and
strong hydrogen sulfide producer was identified.
A. S. dysentry
B. S. Typhi
C. S. dysentriae

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 D. S. flexneri
59. A 29 year adult person with chronic diarrhea visited local health center with abdominal
cramp, malaises and nausea. Stool examination was requested to rule out intestinal parasite
infection and stool gross macroscopy shows bloody-mucusy diarrhea. Microscopic finding
revealed multiple organisms with variable shape. What is most likely organism observed?
A. G. lamblia
B. E. histolytica
C. E.disper
D. T. hominis
60. A 18 year young adult man with diarrheal episode was visited local health center with
abdominal cramp, malaises, nausea and abdominal tenderness. Stool microscopy shows
multiple actively motile which looks like falling tree leave. What is most likely organism
observed?
A. G. lamblia
B. E. histolytica
C. T. vaginalis
D. T. hominis
61. A 6 year young child with mild diarrheal episode was come to private clinic with clinical
history of abdominal discomfort, malaises, nausea and abdominal tenderness. Stool
microscopy shows multiple slowly motile 360 degree on itself (moving on the spot). What is
most likely organism observed?
A. G. lamblia
B. E. histolytica
C. T. vaginalis
D. T. hominis
62. A 36 year HIV infected patients with chronic diarrheal disease was come to ART clinic of a
district hospital. Wet stool microscopy actively motile ciliated round to oval organism. What
is most likely opportunistic protozoa observed?
A. E.disper
B. E. histolytica
C. B. coli

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 D. T. hominis
63. A 27 year old HIV-infected male with a CD4 count of 118 cells/mm3, HIV viral load was
70729 copies/ml presented with 3 months of watery diarrhea. No parasite was demonstrated
in wet stool smear but Acid fast stain showed oval to round ellipsoidal acid fast oocyst was
demonstrated. What is possible parasite observed?
A. T. saginata
B. T.solium
C. I. belli
D. B. coli
64. 30 years old women with chronic urethral discharge were presented local health center upon
which urine examination was requested due gram staining reagents in availability. Urine
sediment shows multiple slow motile flagellated parasites. What is the most likely organism
observed?
A. C. albicans
B. T. hominis
C. T. vaginalis
D. T. saginata
65. A herd man of 25 years old visited district hospital with acute feberile illness of 3 days. Op
on evaluation his temperature was raised 38 degree siliceous with joint pain, headache and
black watery urine. Blood film examination was ordered and result of thin blood film
showed multiple delicate ring organism are found on single red blood cells. What is the most
likely organism observed?
A. P. vivax
B. P. falciprum
C. P. Malriae
D. P. ovale
66. A 50 years old man with primarily diffuse mucocuteneous lesion was present to district
hospital. His temperature was gradually increased and disease with reticuloendothelial tissue
commonly manifested. Blood and bone aspiration shows donovany bodies. What is the most
likely organism causing this infection?
A. Malaria parasite

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 B. Tripanosoma parasite
C. Leshimania parasite
D. Babesia parasite
67. 30 year old men who regularly eat raw meat complain of abdominal discomfort. He went to a
clinic and wanted to check the infection with the beef tap worm,Taenia saginata, which is
usually less serious than infection with the pork tapeworm, Taeniasolium. What property
makes Taenia soliummore pathogenic? Because
A. Beef tapeworm eggs cause les irritation of the mucosa of the digestive tract
B. Chronic intestinal obstruction is more common in beef tape worm
C. Larval invasion occur in beef tape worm infection
D. Toxic produced by beef tape worm does not occur
68. A 10 year old HIV positive boy was brought by his father for the evaluationof crampy
abdominal pain. He had also nausea, watery diarrhea persistence for one month. The boy had
no fever and history of pruritus. Which intestinal nematodes are best detected by Baermann
techniques
A. Ascarislumbercoides
B. Hook worm species
C. Trichuristrichuria species
D. Strongloidesstercoralis
69. A vomitus made from school boy on his return home contains an adult worm looks whip-like
structure,anterior 3/5th& the posterior 2/5th is thick. Microscopy examination done to this
boy stool reveals the parasite eggs resembles a "tea tray” or barrel- shaped with a colorless
protruding mucoid plug at each end with eggs shell thick and smooth. This characteristic is
the identification criteria for which intestinal nematodes?
E. Ascarislumbercoides
F. Hook worm species
G. Trichuristrichuria species
H. Taenia species
70. A retired air force colonel has had abdominal pain for 2 years; he makes yearly visiting to
LakeBatu for swimming and often walks in lake side with bare foot.The most likely parasitic
infection he may acquire is/are
A. Entrobiasis
B. Trichinosis

18
 C. Schistosomiasis
D. Larval heart migrants
71. A stool examination is routinely done to detect most intestinal parasitosis. What is the most
identification techniques for the identification biliharziasis?
A. Stool examination to check the eggs
B. Stool examination to check the larvae
C. Sputum examination to check the eggs
D. Lesion examination to check the eggs
72. A medical technologist visited Awassa on its weekend’s vacation and consumed raw fish
daily for 1 week. Five month later on his return home he had routine physical examination,
blood count examination and had found to be anemic. His vitamin B12 levels were below
normal. The most likely cause of his Vitamin B12 anemia would be
A. Infection with fish tap worm D.latum
B. Infection schistosomamansoni
C. Infection with cysticercosis tape worm
D. Infection Ascarisis
73. An analysis of patients stool revels small structure resembling rice grains; up on microscopic
examination, these structure proved to be proglottids . Which parasite has this characteristic
s?
A. Ascrarislumbercoids
B. Entrobiusvermiculris
C. Taenia saginata
D. Trichuristrichuria
74. A patient with intestinal obstruction was admitted to operation room for the removal its
obstructed intestine. While opening the obstructed intestine the adult worm of a parasite was
found .It has 15-40cm in length and further confirmation was done by stool examination. The
finding from microscopic examination of stool sample shows that ova/eggs that has different
layers with yellowish color observed. The most likely helmthic parasite thatresponsible for
this type of intestinal obstruction is
A. Ascarislumbricoides
B. Fluke worm

19
 C. Trematodies
D. Trichuristrichuria
75. The diseases causing ability of most multicellular worms are limited to
A. Its ability produce larvae stage
B. Its ability to large number of eggs
C. Its ability to survive in all natural environment
D. Its ability to live in intestine in adult forms
76. The natural habitat for its adult worm is in caecum, appendix and adjacent portions of the
ascending colon while gravid female will be found around rectum or anus to lay eggs. The
most common name for parasite is/are
A. Hook worm
B. Tape worm
C. Whip worm
D. Pin worm
77. Ingestion of eggs due to scratching of perianal area with fingers leading to deposition of eggs
under the nails. This type of infection is mostly common in children. This mode of infection
occurs from anus to mouth. Children who suck their fingers are more likely to be infected.
Which statement best describe this events?
A. Eggs are infectious up on living the host
B. Eggs are immature while leaving the host
C. Eggs are few in number while leaving the host
D. Eggs are toxic while leaving the host
78. A parasite male is absent in
A. Hook worms species
B. Trichristrichria
C. Strongylodesstercoralis
D. Schistosomiasis
79. An infective stage is filariform larvae and diagnostic stage is egg, this is the unique feature
for
A. Hook worms species
B. Trichristrichria
C. Strongylodesstercoralis

20
 D. Schistosomiasis
80. Stunt growth & poor mental development in children due to Intestinal inflammation and
progressive iron/protein-deficiency anemia are typical associated with the infection of which
parasite?
A. Hook worms species
B. Trichristrichria
C. Taenia spceies
D. Schistosomiasis
81. Based on the periodic appearance of microfilariae in peripheral blood, they can be
periodicfilarial species or non-periodic ones showing continuous presence.The length of the
adult stages of the species varies between 2–50 cm and the females are larger than the males.
These general features belong to which group of nematodes worms?
A. Intestinal nematodes
B. Filarial worms
C. Hook worm
D. Tape worms
82. A school survey of intestinal parasites among children in day care giver of community
elementary school near to Mojo health center shows the highest prevalence of intestinal
parasite being infectschildren.Microscopic examination of stool sample reveals eggs with
round to oval color less and round mass embryonated of six refractile bodies. What is the
appropriate name for this parasite?
A. Dwarf tape worm
B. Hook worm species
C. Pin worm
D. Whip worm
83. 41 year old HIV –positive male patients living in rural village visits a near by dstrict
healthy laboartory center . He asks you who working in the Laboartory as Junior medical
laboratory technologists to tell him the chances of progressing to HIV/ AIDS conditions .
Which of the following tests would bemost useful ?
A. CD4 Lymphocyte count
B. HIV antibody test
C. HIV P24 antigens

21
 D. HIV Reverse transcriptase PCR
84. Unknown viral agents was inoculated to an experimental mice in a research center, the viral
agents does not complete its replication in the mice tissue. The most probably type of
infection that can be caused by this viral agent will be?
A. Failed or abortive type of infection
B. Cell death or lytic type of infection
C. Cell death or persistent type of infection
D. Localized or systemic type of infection
85. A tissue dissected from a mad dog killed by a car accident was sent to a pathology
laboratory serving in a tertiary level hospital . It was aimed to detect the possible etilogy of
the mad dog. The finding from tissue stained with hematoxylin shows a characteristics
negari bodies which occurs as results of cytopathic effects the unkown etilogic agents .The
most likey viral agent consistence with this type of inclusion bodies is /are
A. Epstein barr virus
B. Congenital rubella
C. Mumpus
D. Rabies
86. An infant seen at emergency room of Rift vally general hospital presents with fever and
persistent cough, physical examination and chest x-ray suggests pneumonia . Gram stain
done on sputum does not reveal any organism and the same sputum was cultured and turned
out no growth of Organisms . The most likely route of transimision for this infection is/are
A. Feco-oral route
B. Respiratory
C. Sexual intercorse
D. Vector born
87. A 15 year old girl presents with cervical lymphadenapathy ,fever and pharyngitis .
infectious mononucleosis was suspected by Physician attending in the out patients
department . The most rapid and clinical useful test to make this diagnosis is
A. IgM antibody to viral core antigen
B. IgG antibody to viral antigen
C. Culture
D. C-reactive protein

22
88. 45 year-old man with a clinicallymild diseases was brougt to near by hospital laboarory . He
was ordered to have serum enzymes analysis that has a minimal increase of Liver functional
enzymes. He has no history of hospitalization with this viral infection .ELISA procedure
done to the patient serum results positive sero-conversion time .Which statement best
describe this events?
A. It often occurs in posttransfussion patients
B. It is DNA virus
C. Few cases appear among IV drug abusers
D. Major case progress to chronic liver damage
89. A child with malnutrition was admitted to a district hospital, provide blood for Complete
Blood Count and found to have pancytopenia .The physician in charge of duty further order a
child to have CD4 count measurement. What does the CD4 count measurement indicate?
A. It help to establish the diagnosis of HIV/AIDS
B. It monitor the status of immune system
C. It measure the production of antibodies against viral antigens
D. It measures the production of HIV antigens in the human body
90. 25old women with many clinical presentationsofcutaneous warts such as plantar, commonflat
and cervical cancer visited a virology laboratory that provides diagnostic services to the
public. She provides blood for culture and turned out no growth for organism. Cry electron
microscopy shows many capsid structures. What properties of this viral agents is responsible
for development this clinical presentation
A. The virus is not host tissue specific
B. The host gene machinery control the viral gene replication
C. The skin and mucosa tissue are toxic to the agents
D. The viral genes do not encode protein for cell growth
91. A 7 year old girl had viral respiratory infection and become very pale, weak and tired due to
severe anemia developed. Bone marrow of red blood cells ispreferred for the replication of
which viruses?
A. Influenza virus
B. HIV virus
C. Hepatitis G virus
D. Parvo virus

23
92. A team of medical laboratory technologist working in researchcenter has performed the
following experiment. They mixed respiratory secretion with permissive monkey kidney’s
cells and observed, no transformationof kidneys cells seen after 7 days observation. Which
statements best describes the effects of viruses on host cells?
A. Usually change the morphology of the host cells
B. Usually fatal to host cell
C. Usually associated with mitochondrion membrane change
D. Usually fatal to an infecting virus
93. A 45-year old divorced, sexual active woman seenfor routine gynecological exam. Her pap
smear performed indicates a high grade squamous intraepithelial lesion that corresponds to
moderate cervical dysplasia. Polymerase chain reaction analysis confirms that the cells in the
lesions are infected with human papilloma type 16 viruses. What property of human
papilloma 16 viruses promote for the development of cervical cancer?
A. The viral proteins encodes oncogenes
B. The viral proteins do not encodes host genes
C. The viral proteins do not promote cell growth
D. The viral proteins cannot bind to host proteins
94. An acute watery diarrhea has been observed among children after school trip in 5 children
out of 12. Two-three episodes of diarrhea have been reported from those children who have
diarrhea. Gram stain and culture done on stool sample does not show any positive finding.
Thebest methods to characterized this infectious agent can achieved by
A. Direct enzyme analysis
B. Direct genome analysis
C. Direct stool examination by ELISA techniques
D. Direct stool culture on blood agar
95. A 10-year-old child presented to a physician’s office at referral hospital has symptoms of
coryza, conjunctivitis, low-grade fever, rash spots. Body fluids were sent to the laboratory
and there was no cytopathic effects detected on permissive cells mixed with body fluids. The
causative agent of this disease most likely belongs to which group of viruses?
A. Adenovirus
B. Herpes viruses

24
 C. Rota viruses
D. Paramyxovirus
96. A 5 year old boy regularly visits Lake Langano after his schooling time. After four weeks he
develops fever, head and fatigue. His mother brought him to a medium clinic for doctor
consultation and when asked he does not know fecal-oral route diseases transmission that
causes acute jaundice and diarrhea? The diagnosis for this scenariois best achieved by
A. Detection viral cells in the blood culture
B. Detection of viral cells gram stain
C. Detection of viral antigens in stool sample
D. Detection of viral antibodies in the stool sample
97. A 9- day old infant with fever and appearing septic progressed to multisystem organ
syndrome in combination with pneumonia and hepatitis was seen in Pediatric outpatient
department. The CSF analysis does show any increment of cells and PCR analysis does not
detect HSV proteins .The best specimen for the isolation of this viral is/are
A. Blood
B. stool
C. Sputum
D. Urine
98. A 35 year old woman was admitted to a hospital with jaundice and malaise. Elevated levels
of blood Bilirubin (80µmol/L) and ALT (410IU/L) were indicated. The serologic tests done
on her blood sample indicated non-reactive to all hepatitis viruses. It was suspected that she
was infected from her husband and this was confirmed by genome analysis of the two viral
isolates. The best conclusion that can be drawn from this patient is /are
A. She is infected with hepatitis C virus
B. she is infected with hepatitis A virus
C. She is infected with hepatitis E virus
D. She is infected with hepatitis G virus
99. A 48 year old man with chronic renal diseases was admitted to referral hospital .His doctor
wanted to have urinalysis tests before deciding what medication he out to give . Several kinds
of urine specimen collection are used random, clean-catch, timed, 24 hour, and catheterized.
Which statement best describe these events?

25
 A. Random time urine specimen is the optimal for the cultivation of bacteria in
the urine
B. Catheterized urine sample is routinely done to determine UTI
C. 24 urine is the optimal for determination of concentrated substance in the
urine
D. Random urine specimen is usually preferred for routine urinalysis

100. Up on examination of 32 years old man urine, it reveals that there is high bile pigment in
the urine, the amount of foam increases, and the color of foam becomes yellowish. Assume
that if you want to confirm this urinary analyte , the most likely tests you should perform
is/are
A. Total bilirubin determination
B. Total lipid determination
C. Total urea determination
D. Total leucine determination
101. A 21 years old pregnant woman with hyperemesis and anoxia was admitted to a district
hospital. A qualitative and quantitative analysis of her urine sample indicates up to 60mg/L
acetoacetic acid and a normal value of glucose in her urine. The most likely condition this
women suffering from is /are
A. Diabetic mellitus
B. Non diabetic ketouria
C. Hyperglucosuria
D. Lipidemia
102. About 200ml of cerebrospinal fluid (CSF) was sent to regional laboratory for its analysis.
The indication of this fluid was to rule out the most reason for an admission women who lied
on street road that has typical clinical presentation of meningitis? The analysis result
indicates that, elevated protein, lymphocytosis, but no growth from culture and gram stain
does not show any organisms. There is no PCR to confirm the diagnosis? Which of the
following is the possible etiology for this case?
A. Bacterial meningitis
B. Parasitic meningitis
C. Viral meningitis
D. Fungal meningitis

26
103. A 72 year old man with chronic renal diseases, presented to medium clinic found in Harar
city has submitted an overnight bladder incubated urine sample for microscopic evaluations.
The finding from this sediment urine reveals homogenously smooth margin and blunt ended
formed elements. What is the most probably formed element observed in this urine sediment?
A. Hyaline casts
B. Leucine casts
C. White blood cells casts
D. Waxy casts
104. A 65 year old man who eats red meat regularly had a complain of knee joints problem for
consecutive five months. While visiting his Doctor, he was advised to provide a synovial
fluid for analysis as differential diagnosis of his pain. Gram stain and culture was turned out
negative. Formed crystals using polarized light microscopy was detected from the same urine
sediment. What is the most common condition associated this patients complain?
A. Gout
B. Hematuria
C. Glycosuria
D. Xanthochromia
105. A 16 year old man who had persistence complain of kidney pain visited a clinical
chemistry laboratory. He provide 25ml urine sample for analysis and the finding from the
urine shows yellow sediment under low power objective. However, this sediment are further
visualized with phase contrasting microscopy and found to be cells sediment with color less
or pink matrix.The most likely identified formed sediment will be
A. Erythrocyte casts
B. White blood cell casts
C. Platelets casts
D. Waxy casts
106. 37 year old HIV patient’s suspected of pleural fluid effusion was indicated for
thoracentesis.About 150ml/L fluid taped was submitted to the laboratory for its analysis. Up
on examination the fluid confirmed to beexudate types that contain lymphocytosis, increased
protein and Lactate dehydrogenase enzymes. Acid fast stain reveals acid fast bacilli that are

27
 arranged in cluster, curved or comma shaped organisms. What is the most common
associated etiology for this clinical case?
A. Cornye bacteria diphthria
B. Mycobacterium tuberculosis
C. Leptosira species
D. Legionella species

107. 26 year old man was admitted to zonal hospital. He was indicated for urinalysis exam. It
is associated with obstruction to lymph flow and rupture of lymphatic vessels into the renal
pelvis, ureters and bladder. Physical examination of the urine sample indicates clear to
opalescent or milky. Few Clots formed and no significant cells or parasites seen under the
low power field microscopy. Which of the following organisms most t likely associated with
thiscondition?
E. Candida species
F. Renal tuberculosis
G. Wuchereria bancrofti
H. Tyrosine stones
108. A8 year old boy was admitted to a hospital for the indication of renal syndrome. A
complete blood count performed to rule out the condition does not help as its results found to
be normal values. Further investigation on urine specimen was done and no significant cells
or parasite found but heavy proteinuria indicated on urine dip sticks. Which type of casts will
be formed most likely?
A. Mixed casts
B. Fatty casts
C. Protein casts
D. White blood cell casts
109. A 55 year-old man who had chronic leukemia for the 5 year was admitted to nearby
referral hospital. His doctor’s assessment on hematological investigation does indicate the
reason for his patient’s admission. The physician order additional investigation on urine
sample and the finding from the urine indicates four sided prisms, oval forms with pointed

28
 ends or lemon-shaped, wedges, rosettes, and irregular plates. However, PH of the patient’s
urine indicates acidic and there is no growth of organism from the same urine on culture.
Which urine crystal will be expected from this case scenario?
A. Amorhousurate crystal
B. Calcium oxalates crystal
C. Uric acid crystal
D. Tyrosine crystal

110. A systemic review and meta-analysis of 12 cohort study involving 100 individuals
showed continuous and strong association between analyte X and coronary diseases.
Research group working on this study wanted to know the risk factors X or analyte and start
analysis on clinically suspected body fluids. The complete blood count done does not
indicate a relevant finding and they proceed to cerebrospinal fluid analysis and its finding
also shows normal values for protein, glucose and lactate dehydrogenase enzyme. However,
as final decision the researchers perform urine sample and found three fold urinary origin
protein, glucose and other urinary sediments? Which of the following statement is true?
A. Protein is the analyte strongly associated with coronary disease
B. Protein has no significant with coronary diseases
C. Urinary origin glucose is more related to coronary diseases
D. Urinalysis does not support the association between analyte and coronary diseases
111. A 42-km runner Athlete lose water and electrolytes as a consequence of thermoregulatory
sweating during exercise and it is well known that the rate and composition of sweat loss can
vary considerably within and among individuals. The information gleaned from sweat testing
is often used to guide personalized fluid and electrolyte replacement recommendations for
athlete. Which of the following electrolyte is commonly measured in sweat secretion?
A. Sodium
B. Magnesium
C. Calcium
D. Iron
112. A 5 year old girl with difficulty of urination was admitted to a hospital. The physician
asses her physical examination and history of her family. There is no history of family

29
 members with the difficulty of urination reported. On physical examination the physician
observe edema of unknown origin on the lower extremities of the child. The findings from
urinalysis reveal normal sediment cells /high power field. What is the most likely reason for
the edema of child to occur?
A. Hydrostatic pressure of body fluid compartment is affected by age of the child
B. Hydrostatic pressure of body fluid compartment of child is not affected age
C. Hydrostatic pressure of the fluid compartment is affected hormonal regulation
D. Hydrostatic pressure of fluid compartment is not affected hormonal regulation
113. A group A, D-negative obstetric patient with anti-D (titer 256) is carrying a fetus who
needs an intrauterine transfusion. Which of the following units should be chosen?
A. Group A, D-negative RBC
B. Group A, D-negative whole blood
C. Group O, D-negative RBC
D. Group O, D-negative whole blood
114. A patient has a hemoglobin value of 8.1 g/dL. The surgeon wants to raise the hemoglobin
to 10 g/dL before surgery. How many units of RBC need to be administered to this patient to
raise the hemoglobin to the required level?
A. 1
B. 2
C. 3
D. 4
115. What is the component of choice for someone who needs a RBC transfusion when there
is a history of febrile transfusion reactions?
A. RBCs less than 5 days old
B. Leukocyte-reduced RBCs
C. RBCs 30 to 35 days old
D. Frozen RBCs that have been thawed and deglycerolized
116. Which of the following is the component of choice when a physician is concerned about
restoring or maintaining oxygen carrying capacity?(select the most appropriate answer)
A. Albumin
B. Cryoprecipitate

30
 C. Whole blood
D. Red blood cells
117. Six units of blood were ordered to stat for a young female patient who has the following
tube typing results (the tube typing procedure uses a washed red cell suspension with
monoclonal reagents). The physician has just called requesting emergency release of 2 units
of RBCs.

Cell grouping Serum grouping

Anti-A Anti -B Anti-D A-cell B-cell
+2 +3 +4 +4 +4
Which of the following should be done first?
A. Perform a DAT on the patient's red cells.
B. Tell the physician that no blood can be released until a full work-up has been done.
C. Begin the antibody screening test.
D. Select 2 units of group O, D-negative RBCs for emergency release.
118. The cord blood of an infant of a D-negative mother with anti-D, titer 2048, is submitted
to the laboratory along with a sample of maternal blood with a request to select blood for
possible exchange transfusion. The neonate appears to be D-negative. The weak D status
cannot be determined because the DAT result is positive (4+). What is the most likely
explanation for this?
A. Wharton's jelly contaminated the sample.
B. The baby has ABO HDN.
C. The baby has a "blocked D" antigen.
D. A different antibody is causing the positive DAT.
119. In the enzyme-linked immunosorbent assay (ELISA), the visible reaction is due to a
reaction between
A. Enzyme and antibody
B. Enzyme and substrate
C. Fluorescent dye and antigen
D. Latex particles and antibody

31
120. An antibody titration was done for a patient showed sign symptom of typhoid fever. In
this titration, a 0.2 mL aliquot of a patient's serum sample was added to 0.8 mL of saline, and
this mixture was placed into tube #1. A 0.5 mL sample was removed from tube #1 and placed
into tube #2, containing 0.5 mL of saline. This procedure was repeated through tube #10.The
dilutions were assayed for antibody to an infectious agent. How should the antibody titer be
reported for tube number 8?
A. 256
B. 512
C. 640
D. 1280
121. A 28-year-old female complains to her family physician of abdominal pain, loss of
appetite, and low-grade fever. Physical examination reveals abdominal tenderness and a low-
grade fever. Her physician orders a hepatitis profile and obtains the results below.
Anti-HAV Nonreactive
Anti-HBc Reactive
Anti-HBs Nonreactive
HBsAg Reactive
HBeAg Reactive
Anti-HCV Nonreactive

Which of the following is the most likely conclusion?

A. Acute HAV infection
B. Acute HBV infection
C. Chronic HBV infection
D. Immunity to HBV due to past infection
122. Patient serum is mixed with a suspension of guinea pig antigen. When the sample is then
mixed with horse red blood cells, agglutination occurs. This is suggestive of an infection
caused by__?.
A. Borrelia burgdorferi
B. Hepatitis B virus
C. Hepatitis C virus
D. Epstein-Barr virus
123. An 11-year-old female presents with fever, sore throat, lethargy, and tender cervical
lymphadenopathy. Relevant findings include splenomegaly and lymphocytosis, with many
large reactive (atypical) lymphocytes. A heterophile antibody test was negative. Further
laboratory results were as follows.

32
 IgG Titer IgM Titer
Cytomegalovirus (CMV) 20 0
Epstein-Barr virus (EBV) VGA 0 80
Mono spot 0 0
What conclusion can be made concerning the diagnosis?
A. Acute CMV infection
B. Acute EBV infection
C. Chronic CMV infection
D. Chronic EBV infection
124. A patient with no clinical signs or symptoms, a history of a palmar rash six months ago,
and a positive serologic test for syphilis (positive nontreponemal test with a positive
confirmatory treponemal test) fits the criteria for___?
A. Secondary syphilis
B. Latent syphilis
C. Primary syphilis
D. Tertiary syphilis
125. The first serologic marker to appear in patients with acute hepatitis B virus infection is
A. Anti-HB
B. Anti-HBc
C. Anti-HBe
D. HBsAg
126. The Venereal Disease Research Laboratory (VDRL) test for syphilis is classified as a(n)
A. Agglutination reaction
B. Flocculation reaction
C. Hemagglutination reaction
D. Precipitation reaction
127. A laboratory technologist who has been participating in a research study to know
prevalence of acute and chronic pancreatitis requested to analyze serum samples collected
from the study participants.
What is the most likely test to be used to determine the prevalence?
A. Amylase test
B. Creatine kinase test
C. Lipase test
D. Acid phosphatase test

33
128. A 25-years-old female brought court request of laboratory investigation for she was being
raped group gangs. After physical examination the presiding physician requested laboratory
test. As per the request of the physician, a medical laboratory technologist who works in
national forensic laboratory took vaginal swab for possible laboratory test.
What is the most likely test to confirm the case?
A. Acid phosphatase test
B. Creatine kinase test
C. Amylase test
D. Lipase test
129. A medical laboratory technologist who has been working in a regional laboratory
requested to give his advice for a clinician who has been working in the referral hospital
about which type of sample is most appropriate for determination of lactate dehydrogenase
(LD) enzyme.
What is the most likely biological sample that provides high yield of LD enzyme?
A. Serum
B. Plasma
C. Tissue
D. urine
130. A 35-years-man came to the nearby district hospital with abnormal body proportions that
mostly affects soft tissue of face & Bones of face, hands & feet. A clinician conducted
physical examination and suspected abnormal overproduction of growth hormone in which
he requested laboratory test. As per the request a laboratory technologist performed hormonal
test after oral glucose loading and confirmed that high level of growth hormone in the blood.
What is the most likely patient condition?
A. Gigantism
B. Acromegaly
C. Pituitary Dwarfism
D. Thyroidism
131. A 50-years-old man came to hospital with problem of frequent urination than usual. The
presiding physician conducted physical examination and suspected diabetes Insipidus in
which he requested possible laboratory test. A medical laboratory technologist wants to
perform the as per the request of the physician.
What is the most likely laboratory test to be used?
A. antidiuretic hormone
B. oxytocin hormone
C. aldosterone hormone
D. cortisol hormone
132. A 40-years-female came to a district hospital complaining of frequent urination, thirsty
tiredness, over appetites and dramatic weight loss since last month and left hyper quadrant
discomfort. After physical diagnosis the presiding clinician suspected carbohydrate metabolic

34
 disorder in which he requested fasting blood sugar and insulin analysis. Laboratory tests
revealed that lower blood glucose level and higher insulin level in the blood.
What is the most likely patient condition?
A. Diabetic mellitus
B. adenoma of the pancreas (insulinoma)
C. Hepatocellular carcinoma
D. Gastric carcinoma

133. An elevated level of which of the following hormones will inhibit pituitary secretion of
adrenocorticotropic hormone (ACTH)?
A. Aldosterone
B. Cortisol
C. 17-Estradiol
D. Progesterone
134. A 35-years-female came to hospital complaining of enlarged thyroid gland and difficulty
of breathing. After clinical diagnosis the physician suspected primary hyperthyroidism for
which he requested possible laboratory diagnosis.
What is the most likely laboratory result is diagnostic?
A. Increased serum level of both T4 and T3
B. Increased serum level of TSH
C. Increased serum level of T3
D. Increased serum level of T4
135. A 55-years-old man came to the nearby hospital with symptoms of poor wound healing,
osteopenia, glucose intolerance and camel hump back.After clinical diagnosis, the presiding
clinician requested possible laboratory tests. A medical laboratory technologist performed all
possible laboratory tests that revealed increased Cortisol, Glucose, Hematocrit, Calcium,
Bicarbonate and Bone turnover markers and decreased Potassium, Eosinophils as well as
Lymphocytes.
What is the most likely patient’s clinical disease?
A. Diabetic mellitus
B. Cushing syndrome
C. Myloid leukemia
D. Lymphoid leukemia
136. A 40-years-old female patient came to the hospital complaining of progressive loss of
adrenocortical hormones,Infertility and loss of body hair. After physical examination the
clinician suspected certain acquired autoimmune disorder of endocrine hormone and
requested possible laboratory test. A technologist performed laboratory test that revealed
progressive loss of adrenocortical hormones.
What is the most likely patient condition?
A. Adrenogenital syndromes
B. Cushing’s Syndromes
C. Addison’s Diseases

35
 D. Primary hyperthyroidism
137. A 25-years-nonpregnant young female came to hospital complaining of ministration
cycle disorder. After clinical diagnosis the clinician requested possible laboratory test. As per
the clinician’s request the technologist performed laboratory test that revealed high level of
sex hormone
Which laboratory test is most likely diagnostic?
A. Estrone
B. Estriol
C. Estradiol
D. Progesterone
138. A 30-year-old man came to the hospital complaining enlarged thyroid gland. After
clinical diagnosis the clinician suspected problem with thyroid glands and requested a
laboratory test. A technologist performed as per the request of the clinician in which the
laboratory tests revealed that Increased Free T4 and total T4 and T3 and Increased TSH.
What is the most likely clinical diagnosis of the patient?
A. Primary hyperthyroidism
B. secondary hyperthyroidism
C. primary hypothyroidism
D. secondary hypothyroidism
139. The 35-year-old nonsmoking firefighter who suffered a minor injury on thejob came to
the hospital complaining difficulty of breathing, synopsis and weakness of triveing. After
physical examination the clinician suspected gas poising and request possible laboratory test.
The laboratory technologist performed arterial blood gas analysis that revealed
carboxyhemoglobin of 9%, oxyhemoglobin of 92%, negligible methemoglobin
andsulfhemoglobin levels.
Which laboratory finding is the most likely diagnosis?
A. carboxyhemoglobin of 9%
B. oxyhemoglobin of 92%
C. negligible methemoglobin level
D. negligible sulfhemoglobin level
140. The medical technologist was asked to collect and analyze arterial blood gases from a 54-
year-old male recovering from chest surgery, 1 hour after his ventilator was
discontinued.Considering the results that were obtained, including theslightly elevated
carbon dioxide and significantly decreased oxygen level that indicated sign of error of
sample type.
What is the most likely sample he collected for the analysis?
A. Arterial blood
B. Venous blood
C. Tissue fluid
D. Plurar fluid

36
141. After clinical diagnosis a patient has been suspected of having endocrine function
problem for which the clinician requested laboratory test. In analyzing the patient sample a
medical laboratory technologist confirmed there was high level of tropic hormones.
What is the most likely source of this hormone?
A. Posterior pituitary gland
B. Anterior pituitary gland
C. Hypothalamus
D. Gastrointestinal tract

142. A medical laboratory technologist who has been working in regional laboratory clinical
chemistry unit analyzed patient samples and all the result become zero. He repeated the tests
many times but the results were the same. He tried to identify the cause with the senior staff
and they identified that some inhibitors bind on allosteric site of enzyme to inhibit product
formation.
What is the most likely inhibitor identified?
A. Competitive Inhibitors
B. Non-Competitive Inhibitors
C. Un-Competitive Inhibitors
D. Substrate
143. A senior laboratory technologist attended an interview for junior laboratory technologist
who has applied for the vacancy for clinical chemistry laboratory asked the applicant what is
the source of the first enzymein a coupled reaction.
What is the most likely answer of the applicant?
A. patient’s sample
B. reagent solution
C. Blank solution
D. standard solution
144. A medical laboratory technologist who has been working in a research laboratory
conducted an experiment to see what the outcome is if substrate concentration exceeds
enzyme concentration.
What is the most likely outcome of his experiment?
A. rate is proportional to the concentration of a substrate
B. rate is proportional to enzyme activity
C. the equilibrium is shifted to left
D. the equilibrium is shifted to right

37
145. A medical laboratory technologist who has been working in a referral hospital laboratory
wanted to use random or timed urine (24-hour) as a potential biological specimen for enzyme
test.
Which is the most likely enzyme to be detected?
A. Lactate dehydrogenase
B. CreatineKanase-1
C. Amylase
D. Aspartate Transaminase
146. A patient survived from acute myocadiac infraction came to hospital to check his status
after seven days of the episode. After clinical assessment the clinician requested possible
laboratory test.
Which enzyme test is the most clinically significant?
A. Aspartate Transaminase
B. CreatineKinase
C. Lactate Dehydrogenase
D. AlinineTransaminase
147. A medical laboratory technologist who has been working in a regional laboratory planned
to conduct an experiment to know the activity of an enzyme in a chemical reaction.
What is the most likely activity of an enzyme?
A. accelerates the speed of a chemical reaction
B. changing the equilibrium of the reaction
C. lowers the activation energy in the reaction
D. the enzyme becoming consumed

148. A researcher studying hemoglobin predicts that a histidine within the protein is important
for binding oxygen. She used site-directed mutagenesis to change a codon for histidine
(CAU) to one for lysine (AAA). However, the mutant hemoglobin still binds oxygen just as
well as the wild-type and has no other apparent changes.
What is the most likely mutation is this?
A. suppression
B. synonymous
C. nonsense
D. silent
149. There is the genetic disease that is inherited in an autosomal recessive manner. There is
the family where the father has a disease, but whether the mother had the disease is unknown,
because the medical record was lost. The medical records show that three of their seven
children had the disease and the remaining four children had no disease.

38
 What is the probability that the four children who do not have the genetic disease are
carriers?
A. 1
B. 1/16
C. 1/8
D. ½

150. Most people with the dominant mutant polydactyly allele have extra digits, but at least
25% have the normal number of digits.
What is the genetic explanation for this observation?
A. Dominant negative allele
B. Temperature-sensitive allele
C. Partial dominance
D. Incomplete penetrance
151. A medical laboratory technologist who has been working in vaccine producing company
faced certain problem during purification of protein that leads to amino acid change. After
some trial he identified the problem which was a mutation that leads to base substitutions in a
DNA segment in which an amino acid change occurs.
What is the most likely cause of the change?
A. Missense mutations
B. Nonsense mutations
C. Frameshift mutations
D. Substitution mutations
152. In recombinant DNA technology DNA is most often copied using
A. DNA ligase
B. DNA polymerase
C. Restriction enzymes
D. DNA gyrase
153. Restriction enzymes from different bacteria cut DNA at specific Nucleotide sequences.
What prevents restriction enzymes from cutting their own bacterial DNA?
A. Restriction enzymes only cut viral DNA.
B. Restrict ion enzymes cannot cut bacterial DNA.
C. Restrict ion enzymes only cut plasmid DNA.
D. By sequence specific addition of Methyl groups.
154. The polymerase chain reaction involves repeated cycles of three reactions which occur at
different temperatures.
What is the most likely denaturation reaction tempreture?
A. 55° C
B. 60° C

39
 C. 72° C
D. 95° C
155. What is a Southern blot?
A. An experimental technique to identify DNA fragments that contain protein coding
regions
B. An experimental technique to identify DNA fragments that contain a specific
sequence.
C. An experimental technique to identify RNA fragments that contain a specific
sequence.
D. An experiment al technique to identify proteins that contain specific amino acids.
156. DNA microarrays can be used to
A. Identify the genes expressed in a biological sample.
B. Identify the genes expressed in a biological sample and their relative expression
level s
C. Identify the size of the transcript s of all the genes expressed in a biological
sample.
D. Identify the size of the genomic DNA that encodes of all the genes expressed in a
biological sample.
157. What type of bonding between tRNA and mRNA during translation
A. Hydrogen bonding
B. Phosphodisulfied bonding
C. Metalic bonding
D. Dipol bonding
158. Ethyl methanesulfonate (EMS) induces mutations in DNA. EMS is best described as
A. A base analog
B. A deaminating agent
C. An oxidative agent
D. Analkylating agent
159. Concerning the E. Coli lac operon, which gene encodes the lac repressor?
A. Lac A
B. L ac I
C. L ac O
D. L ac Y
160. Which of the following best describes the role of camp in lac Operon gene expression?
A. An allosteric regulator that is synthesized when E. Coli is starved of glucose.
B. An enzyme that binds the lac promoter.
C. A natural inducer of lac operon expression.
D. A positive regulator that binds the lac promoter.
161. In which of the following E.Coli mutant strains would repressor be bound to the operator
both when lactose is present in the growth medium and when it is not?
A. A lac I- mutant strain
B. A lac IS mutant strain

40
 C. A lac Oc mutant strain
D. A S mutant strain
162. Which of the following best describes the role of the TATA binding protein in eukaryotic
transcription?
A. Bends DNA and allows to RNA polymerase to bind the promoter.
B. Bends DNA and allows enhancers to interact with the promoter.
C. Bends DNA and prevents RNA polymerase from binding to the Promoter.
D. Methylates DNA and allows RNA polymerase to bind the promoter.
163. The eukaryotic protein complex that links upstream bound transcription factors to the
basal transcription complex is termed the:
A. Binding site
B. Enhancer
C. Mediator
D. Operator
164. A molecular biologist who has been working in a research laboratory tried to identify
type of mutation that leads to base substitutions in DNA segment that change a normal codon
to a stop codon.
What is the most likely cause of the change?
A. Frameshift mutations
B. Missense mutations
C. Nonsense mutations
D. Substitution mutation
165. A 32-years-old man farmer came to the hospital with warty, ulcerated and crusted lesions
on feet or on legs, below knee. After physical examination the clinician suspected
chromoblatomycosis and request microscopic examination of KOH preparation from skin
scrapping that revealed characteristic brown pigmented, planate-dividing, rounded sclerotic
bodies.
What is the most likely cause of the patient condition?
A. Fonsecaea pedrosoi
B. Histoplasma capsulatum
C. Blastomyces dermatitidis
D. Corynesporacassicola
166. A medical laboratory technologist who has been working in a referral hospital laboratory
accepted specimen for culturing to isolate fungal etiologic agent for the patient case. After
processing the specimen he confirmed that the etiologic agent is fungus that reproduced by
asexually in which he identified the spore in sac like structure in microscopic examination.
What is the most likely spore identified?

A. Conidiospore
B. Blastospores
C. Chlamydospore

41
 D. Sporangiospores
167. phylum of fungi which Produces by asexual spores only
A. Ascomycota
B. Deuteromycota
C. Basidiomycota
D. Chytridiomycota

168. phylum of fungi that includes the yeasts of the genus saccharomyces that used for bread
baking and ferment alcoholic beverages
A. Ascomycota

B. Deuteromycota

C. Basidiomycota

D. Chytridiomycota

E. Zygomycota

169. A 25-years-old man came to the nearby hospital having brown to black noduleson the
hair of the scalp. The presiding clinician conducted physical examination and suspected
Black piedra in which he requested laboratory test. A technologist performed microscopic
examination of KOH preparation that revealed branched pigmented (dark brown) hyphae
What is the most likely cause for the patient condition?

A. Piedrahortae
B. Malassezia furfur
C. Trichosporon species
D. Exophilawerneckii
170. A mother brought her 3-years-old daughter to a hospital complaining that there is thick,
crust; yellow brown scale appears on the scalp of her daughter. After physical examination
the physician suspected seborrheic dermatitis for he requested laboratory test. A technologist
performed microscopic examination of KOH preparation which revealed clusters of round
yeasts with filaments.
What is the most likely etiologic agent?

A. Piedrahortae
B. Malassezia furfur
C. Trichosporon species
D. Exophilawerneckii
171. A 45-years old-female came to a hospital complaining for scaly, less inflammatory
lesions on her glabrous skin. Physical examination was performed by the physician who
suspected fungal infection. A technologist collected scale scrapping for KOH preparation in

42
 which microscopic examination of the preparation revealed that hyphae with some
microcondia and macrocondia that confirmed infection dermatophytes.
What is the patient clinical condition?
A. Tineacorporis
B. Tineacruris
C. Tineamanus
D. Tineabarbae
172. primarily disease of Adult males

A. Tinea cruise and tineapedis

B. Tinea cruise and tineaunguim

C. Tineacapitis and tineapedis

D. Tineacapitis and tineamanus

173. Why it is important to differentiate eumycoticmycetoma from actinomycoticmycetoma?

A. therapy is usually effective in cases of actinomycoticmycetoma

B. therapy is usually effective in cases of eumycoticmycetoma

C. Usually amputation is the only definitive treatment in actinomycoticmycetoma

D. Atibiotics can be used in treating cases of actinomycoticmycetoma

174. A 60-years-old American man who has arrived in Africa developed certain respiratory
problem a week later for which he came to the nearby hospital. The clinician suspected
systemic fungal infection. The technologist processed the specimen that showed yeast cells.
What is the most likely patient condition?
A. African histoplasmosis
B. American histoplasmosis
C. Blastomycosis
D. Aspergilosis
175. One is the most virulent of all human mycotic pathogens.
A. Blastomycedermatitidis
B. HistoplasmaDuboisii
C. Histoplasmacapsulatum
D. Coccididomyceimmitis
176. One is Mycotoxin that primarily affect liver and lead to hepatocellular carcinoma
A. Citrinin
B. Ochratoxin A
C. Aflatoxin

43
 D. Fumonisin
177. One is opportunistic fungus that can onchomycosis
A. Cryptococcus neoformans
B. Aspergillusfumigatus
C. Candida albicans
D. Trichophytonrubrum

178. highly neurotropic and the most common form of disease is cerebromeningeal.
A. Cryptococcus neoformans
B. Aspergillusfumigatus
C. Candida albicans
D. Trichophytonrubrum
179. mainly found in association with Eucalyptus trees
A. C. neoformansvarneoformans
B. C. neoformansvargattii
C. H. capsulatumvarduboisii
D. All
180. True about Allergic bronchpulmonaryaspergilosis

A. Type I hypersensitivity reaction/Asthma/

B. Type II hypersensitivity reaction
C. Type V hypersensitivity reaction
D. Type IV hypersensitivity reaction

181. Thin fluid that is derived from either blood serum or secretion of mesothelial cells lining
the peritoneal, pleural, and pericardial cavities produce during.
A. Fibrinous inflammation
B. Serous Inflammation
C. Suppurationinflammation
D. Acute diffuse inflammation
182. Why is the statement ‘what are the effects of extracurricular activities on cognitive
development of school age children’ not a good statement of a quantitative research
question__?
A. Because there is no connection between extracurricular activities and cognitive
development
B. Because there are not enough school age children engaged in extracurricular
activities to conduct the study

44
 C. Because the study would be too difficult to do given all the different
extracurricular activities
D. Because the statement was not specific enough to provide an understanding of the
variables being investigated
183. After identifying the important variables and establishing the logical reasoning in
theoretical frame work, the next step in the research process is ___?
A. To conduct survey
B. To generate hypothesis
C. To focus group discussion
D. To use an experiments in an investigation
184. The number of questionnaires returned or completed by the total number eligible people
who were contacted or asked to participate in the study/survey is called__?
A. Response rate
B. Participation rate
C. Inflation rate
D. Exclusion rate
185. Diseases that are always present in a community, usually at a low, more or less constant,
frequency are classified as having an ____________ pattern?
A. Epidemic
B. Endemic
C. pandemic
D. Outbreak
186. The standard chi-squared test for a 2x2 contingency table is not valid unless (Choose 1
best answer):
A. All the expected frequencies are greater than five.
B. Both variables are continuous.
C. At least one variable is from a Normal Distribution.
D. All the observed frequencies are greater than five.
187. 1319 children were questioned on prevalence of symptoms of severe cold at age 12 and
again at 14 years. At age12, 356 (27%) children reported to have severe colds in the past 12

45
months compared to 468 (35.5%) at age 14.(a) What kind of study is this (Choose one best
answer)?
A. Case-Control
B. Ecological study
C. Cohort study
D. Cross-sectional study

46