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Annealing requires a Instrumentation/1 temperature between 40°C–65°C and allows the primers to bind to the target base sequence atorlip-5 5mg discount. Extension requires a temperature of 72°C and allows the heat-stable polymerase to add complementary bases to the primer in the 5’ to 3’ direction cheap 5mg atorlip-5 fast delivery. Rapid heating and cooling is usually achieved using a thermoelectric block that is cooled by forced air flow. They are used to correct the measurements from each well so that the same concentration of fluorescent dye gives the same signal intensity regardless of the well. A line is drawn from the threshold value on the y-axis through the curve, and a perpendicular dropped to the x-axis. A The relative centrifugal force (number times the force of gravity) is proportional to the square of the rotor speed in revolutions per minute and the radius in centimeters of the head (distance from the shaft to A. B Electronic balances do not use substitution weights needed to calculate the relative centrifugal force or knife edges to balance the weight on the pan. Diameter of the centrifuge tube type of balance used, all need to be located on a D. Doors must be Chemistry/Define fundamental characteristics/ closed to prevent air currents from influencing the Instrumentation/1 weighing, and the pan and platform must be clean and free of dust and chemical residue. Which of the following situations is likely to cause an error when weighing with an electronic 80. Failure to close the doors of the balance before involves dilution, gravimetric analysis is associated reading the weight with greater certainty. Using the balance without allowing it to warm up for at least 10 minutes Chemistry/Identify sources of error/Balances/3 80. Which of the following represents the Answers to Questions 1–5 Henderson–Hasselbalch equation as applied to blood pH? Most Chemistry/Apply knowledge of fundamental biological laboratories consider less than 7. The negative logarithm of K´ is the pK´, Chemistry/Apply knowledge of fundamental biological which is 6. Alternately, bicarbonate substance contributes most to the amount of base can be measured by an enzymatic reaction using in the blood? The negative reaction rate is proportional to plasma Chemistry/Apply knowledge of fundamental biological bicarbonate concentration. Which of the following effects results from order of concentration are bicarbonate, exposure of a normal arterial blood sample to deoxyhemoglobin, albumin, and monohydrogen room air? Which of the following formulas for O2 content is Answers to Questions 11–16 correct? A Measurement of oxyhemoglobin, deoxyhemoglobin Chemistry/Evaluate laboratory data to recognize health (reduced hemoglobin), carboxyhemoglobin, and disease states/Blood gas/2 methemoglobin, and sulfhemoglobin can be 14. Te determination of the oxygen saturation of accomplished by direct spectrophotometry at hemoglobin is best accomplished by: multiple wavelengths and analysis of the absorptivity A. Polychromatic absorbance measurements of a coefficients of each pigment at various wavelengths. Near infrared transcutaneous absorbance fraction of oxyhemoglobin by the sum of all measurement pigments. Treatment of whole blood with alkaline occurs in the other methods when the quantity dithionite prior to measuring absorbance of an abnormal hemoglobin pigment is increased. Because the blood gas analyzer Chemistry/Apply principles of special procedures/ measures pH at 37°C, the in vivo pH would be Oxyhemoglobin/1 0. B Heparin is the only anticoagulant that does not temperature of 38°C would require: alter the pH of blood; heparin salts must be used for A. What is the maximum recommended storage time Answers to Questions 17–21 and temperature for an arterial blood gas sample drawn in a plastic syringe? D Arterial blood gas samples collected in plastic syringes should be stored at room temperature Storage Time Temperature because cooling the sample allows oxygen to enter A. A patient’s blood gas results are: results in alkalosis; therefore, the classification is – pH = 7. Metabolic acidosis had time to compensate, and the bicarbonate is Chemistry/Evaluate laboratory data to recognize health within normal limits. Alkalosis the oxyhemoglobin dissociation curve lowers the Chemistry/Calculate clinical and laboratory data/ affinity of Hgb for O2. Assisted ventilation for respiratory failure calculated O2Sat should not be used include any hemoglobinopathy that affects oxygen affinity and Chemistry/Identify sources of error/Blood gas/3 methemoglobinemia. Which would be consistent with partially affect the O saturation of hemoglobin in a manner 2 compensated respiratory acidosis? In partially increased decreased decreased compensated respiratory acidosis, the metabolic C. The compensatory decreased increased increased component always moves in the same direction as Chemistry/Evaluate laboratory data to recognize health the cause of the acid–base disturbance. Phenformin-induced acidosis intrinsic defect in the tubules prevents bicarbonate C.

Plate 39 is from a Wright’s-stained smear of macrocytic anemia 5mg atorlip-5 free shipping, and autoimmune hemolytic peripheral blood 5mg atorlip-5 sale, 1,000× from a patient with 9 anemia is usually normocytic, normochromic. Flow cytometry indicates Hematology/Evaluate clinical and laboratory data/ these cells to be B cells in approximately 95% of Leukemia/3 cases. The bone marrow in Waldenström’s macroglobulinemia is infiltrated by plasmacytoid lymphocytes, plasma cells, and mast cells, as well as small lymphocytes; however, a severe peripheral lymphocytosis is not seen. The lymphocyte count is usually 15–25 × 109/L, but the cells are atypical, being characterized by reactive features. Plate 40 is from a Wright’s-stained peripheral Answers to Questions 40–43 blood film, 400×. Hemolytic hospitalized with tachycardia, a rapidly anemias are often normocytic, normochromic. Plate 41 is from a patient’s ethnic background, clinical findings, and Wright’s-stained smear of his peripheral blood, sulfonamide therapy point to a hemolytic episode 1,000×. Which surrounded by a clear perinuclear area that of the following conditions is most likely to be represents the Golgi apparatus. A Blasts are usually 15–20 μ in diameter with a large nucleus containing fine chromatin. Lymphoblasts are differentiated from myeloblasts by cytochemical staining and flow cytometry. Lymphoblasts often display irregular clumping of the chromatin and azurophilic granules. Plate 44 is a Wright’s-stained peripheral blood Answers to Questions 44–47 film, 1,000×. Te white blood cells in this field are negative for peroxidase, chloroacetate esterase, 44. On characteristic of the L1 subtype of acute lymphocytic the basis of these findings, what is the most leukemia. Lymphoblasts with L3 morphology are large and irregular in size and often contain one D. These are characteristics of esterase (specific esterase), and 70% are positive monoblasts. M1 is myeloblastic leukemia without for α-naphthyl acetate esterase (nonspecific maturation. A The control slide shows peroxidase staining of the as plate 46 after peroxidase staining, 1000×. The cytoplasm peripheral blood film, 1,000×, which is used of the blast in plate 47A is strongly positive for as a control. Te blast cell shown in plate 47A is peroxidase, indicating that it is a myeloblast. M5 may be weakly positive, Hematology/Identify microscopic morphology/Special and myeloblasts in M6 are positive. Lymphoblasts, stains/3 hairy cells, erythroid cells, megakaryocytes, and platelets are negative. Plate 48 is from a Wright’s-stained peripheral Answers to Questions 48–52 blood film, 1,000×. Plate 49 is a Wright’s-stained peripheral blood round nucleus that is smaller, the chromatin is more film, 1,000×. Döhle bodies and magnification stained with Sternheimer–Malbin vacuolated neutrophils may be seen in association stain. Transitional epithelial cell and stain reddish pink with Sternheimer–Malbin Body fluids/Identify microscopic morphology/Urine stain. Transitional epithelial cells stain a pale blue, and sediment/2 have far less abundant cytoplasm. Plate 52 shows a urinary sediment under 400× cytoplasm with a nuclear:cytoplasm ratio of magnification stained with Sternheimer–Malbin approximately 1. Squamous epithelial cell with a dark purple-blue or reddish purple nucleus and lighter purple or orange-purple cytoplasm. In Body fluids/Identify microscopic morphology/Urine contrast, transitional cells are about the same size sediment/2 but stain with a blue nucleus and pale blue cytoplasm. Plate 53 shows a urinary sediment under 400× Answers to Questions 53–57 magnification stained with Sternheimer–Malbin stain. Squamous epithelial cell have a sawtooth (caudate) shape, but otherwise they are oval. Transitional cells stain pale blue with Body fluids/Identify microscopic morphology/Urine Sternheimer–Malbin stain.

A false-negative Te next course of action is to tell the physician: result could conceivably be caused by multiple whole A order atorlip-5 5 mg free shipping. Te patient does not have parvovirus blood or plasma transfusions generic 5mg atorlip-5 mastercard, but retesting for B. A convalescent specimen is recommended in antibody a month later would not be beneficial to 4 weeks to determine if a fourfold rise in titer the patient. Tat a recent transfusion for the patient’s anemia may have resulted in a false-negative assay and the patient should be retested in 4 weeks Immunology/Select course of action/Virus testing/ Parvovirus/3 3. An antinuclear antibody test is performed on a specimen from a 55-year-old woman who has Answers to Questions 1–6 unexplained joint pain. B Autoimmunity is a loss of tolerance to self-antigens follow-up for this patient is: and the subsequent formation of autoantibodies. Which disease is likely to show a rim (peripheral) specimen, although the pattern would be speckled. These antibodies Immunology/Correlate laboratory data with cause a speckled pattern of immunofluorescence. Which of the following is used in rapid slide tests pattern occurs in an immunofluorescence test for for detection of rheumatoid factors? What antibodies are represented by the nucleolar pattern in the immunofluorescence test for 7. Te most likely cause of Ribosomal p antibody has nucleolar staining and a this staining pattern is: background homogeneous and cytoplasmic stain. Particles of latex or and report the need for additional testing/ cells are coated with IgG. Addition of serum Autoimmune/Testing/3 containing rheumatoid factor results in visible agglutination. Agglutination testing for rheumatoid factor of fluorescence in tests for antinuclear antibodies. Immunofluorescence testing for antinuclear systemic autoimmune diseases and in many normal antibodies persons at a titer below 10. A Antibodies to thyroid peroxidase may be detected Immunology/Apply knowledge of fundamental in both Graves’ disease (hyperthyroidism) and biological characteristics/Autoimmune/Testing/1 Hashimoto’s thyroiditis (hypothyroidism). Antibodies to thyroid peroxidase can be detected can be measured to distinguish between the two by using agglutination assays. Granulomatous thyroid disease tests for the detection of antibodies to islet cells and D. Addison’s disease insulin may help to initiate early treatment before complete destruction of β cells. B While antibodies to tissue transglutaminase and gliadin are often found in celiac disease, their 16. What is the main use of laboratory tests to detect combined sensitivity is less than 100%. To regulate levels of injected insulin not diagnostic of celiac disease, but provide a B. To rule out the presence of other autoimmune who meet the clinical diagnostic criteria for celiac diseases disease. IgM level Immunology/Select routine laboratory procedures/ Autoimmune/Celiac disease/Testing/2 102 Chapter 3 | Immunology 18. Which of the following is a description of a type I Answers to Questions 1–4 hypersensitivity reaction? A Type I immediate hypersensitivity (anaphylactic) of mast cells, causing release of preformed mediators responses are characterized by IgE molecules binding and resulting in symptoms of an allergic reaction to mast cells via the Fc receptor. Anti-Fya from a pregnant woman crosses the surface IgE caused by binding of allergens causes placenta and attaches to the Fya antigen-positive the mast cell to degranulate, releasing histamine red cells of the fetus, destroying the red cells and other chemical mediators of allergy. Exposure to poison ivy causes sensitized T cells than in vitro tests that measure either total or to release lymphokines that cause a localized antigen-specific IgE. Allergen-specific IgE assays are available than other methods based upon solid-phase enzyme immunoassay. It has greater sensitivity than in vitro measurements The allergen is covalently bound to a cellulose solid C. It is more likely to be positive for IgE-specific phase and reacts with specific IgE in the serum. The unbound antibody further allergen sensitivity conjugate is washed away and fluorogenic substrate Immunology/Apply principles of basic laboratory (4-methylumbelliferyl-β-D-galactose) is added. A patient who is blood group O is accidentally transfused with group A blood and develops a reaction during the transfusion. IgG Immunology/Apply principles of basic laboratory procedures/Hypersensitivity/Testing/1 103 104 Chapter 3 | Immunology 5.

He had cysteine kidney crystals and four parasites: Cryptocotyl safe 5 mg atorlip-5, human liver fluke buy generic atorlip-5 5mg on-line, Echinococcus granulosus cyst and Echinostomum revolutum in his white blood cells. She also had tapeworm stages (Taenia pisiformis) and intestinal fluke in the intestine. She stopped using zirconium- containing products (deodorant) and barium (lipstick). Yet she drank enough water, curtailed her salt, used no caffeine and had no really bad habits. We found she was toxic with cad- mium and lead, which were probably responsible for her huge ac- cumulation of kidney stones. The metals were in her tap water and she was unable to resolve this problem since she lived in a senior citizen center. We advised her to move, or to have her tap water carried in, but she could do none of these. Although the situation was hopeless, she did the kidney cleanse, parasite killing program and changed her metal rimmed glasses and wrist watch to plastic. She gained enough ground from these improvements to be able to wear elastic hose and thereby give some physical assistance to her body. She had a headache with the cleanse but immediately afterwards she fit into a smaller size “Keds” (elasticized stockings). Fibromyositis and Fibromyalgia When pain is widespread, not just in joints or legs but in many muscles and soft tissues of your body your doctor may call it fibromyositis or fibromyalgia. Trichinella is the most common cause of these diseases, but sometimes Ascaris larvae or hookworms or strongyle larvae are the main culprits. These wormlets bring hosts of bacteria with them, mainly “Streps” (Streptococcus varieties) and “Staphs” (Staphylococcus varieties), but also “Clostridiums” (Clostridium Fig. By killing all bacteria— Staphs, Streps, Clostridiums and Campyls—using a zapper, you may get relief for one hour! By killing Trichinella and Ancylostomas (worms) first, fol- lowed by the bacteria, you may get relief for several hours. By killing the parasites and bacteria in every household member and the pets at the same time and by never putting your fingers to your mouth, you can expect permanent pain relief. Perhaps the larvae stay in the intestine or go to the diaphragm (causing coughing) or the eyes (causing “lazy” eye muscles). Trichinella, hookworms and strongyles are extremely difficult to get rid of in a family. These roundworm larvae undoubtedly cross the placenta into the unborn child during pregnancy, too. It is im- possible to stay free of the parasites your pets have: they will move to your soft tissues immediately, giving you the bacteria and inflammation again. The next most important advice is to keep fingers out of your mouth (read Hands, page 397). None of these parasites enter through your skin (this is in spite of teachings that hook-worms enter this way), you must put them into your mouth somehow! When diapering days are over you will have less bowel contact, giving you an opportunity to finish your own treatment. Try to identify your parasites before killing them so you can be on the lookout for them in the future. Get slides or dead cul- tures of various pathogens and search in your white blood cells. Her urinalysis stated “hazy” (hazy with bacteria or crystals) instead of clear urine. It also listed white blood cells, red blood cells, and a few bacteria present in her urine. She was also full of beryl- lium (usually from “coal oil”) contained in the hurricane lamps she kept in every room. She had numerous parasites, including Strongyloides and hookworms spread through her body tissues. She was thrilled to learn how to get her health back and started with the dental problem. It all started with fever and chills that she thought was the flu but after they went away, she was left with a tremor. Joint Pain or Arthritis Two main kinds of arthritis are recognized clinically, os- teoarthritis and rheumatoid arthritis. In rheumatoid arthritis the bacteria come from larger parasites—wormlets ac- tually living in these joints. The worms are the common little roundworms whose eggs hatch into microscopic wormlets that travel. Their life cycle normally directs them to travel to the lungs but in some people they travel through the entire body, including brain, muscles and joints.