HISTOPATHOLOGY

AND MEDICAL
TECHNOLOGY
LAWS
RATIONALIZATION

Maria Kristina D. Gaquit, RMT

 Maria Kristina D. Gaquit, RMT
• Bachelor of Science in Medical Technology –
University of Cebu-Banilad
• 2018 – 2022, Cum Laude
• UC Presidential Scholar
• CHED Scholar
• Cerebro Review Center, August 2023 Professor’s Pick
• August 2023 MTLE- Registered Medical Technologist
• University of Cebu- Banilad, Clinical Bacteriology
(Subject-in charge)
1. Which of the following is NOT a membranous
organelle?
a. Lysosomes
b. Peroxisomes
c. Filaments
d. Endoplasmic reticulum
 Membrane bound Non-membrane bound
Mitochondria Ribosomes
Endoplasmic reticulum Cytoskeletons
Golgi apparatus Centrioles
Peroxisomes
Lysosomes
2. A method of fresh tissue examination wherein a selected
portion of the material is transferred to a clean slide and
gently spread into a moderately thick film by teasing the
mucus strands apart with an applicator stick:

a. Spreading
b. Teasing
c. Touch preparation
d. Streaking
Fresh tissue Description
examination
Process where a selected tissue specimen is immersed in a watch glass
containing isotonic salt solution, carefully dissected or separated and
examined under the microscope
Process whereby small pieces of tissue not more than 1mm in diameter are
placed in a microscope slide and forcibly compressed with another slide
or with a cover glass
With an applicator stick or platinum loop, the material is rapidly and gently
applied in a direct or zigzag line throughout the slide
selected portion of the material is transferred to a clean slide and gently
spread into a moderately thick film by teasing the mucus strands apart
with an applicator stick
Used for preparing smears of thick secretion such as serous fluids,
enzymatic lavage samples from the gastrointestinal tract and blood smears
The surface of a freshly cut piece of tissue is brought into contact and
pressed on to the surface of a clean slide
3. Mounted sections are placed in the
paraffin oven to dry. The paraffin oven
is set at a temperature that is:
a. 2 to 5 degrees lower than the melting point of wax
b. 2 to 5 degrees higher than the melting point of the wax
c. 6 to 10 degrees lower than the melting point of the wax
d. 6 to 10 degrees higher than the melting point of the wax
 DEVICES TEMPERATURE

Cryostat (Cold microtome) Optimum working temperature: - 18oC to – 20 oC

Average temperature: - 20oC
Paraffin/ Wax oven 2 to 5oC ABOVE Melting Point of wax
Wax bath in automatic tissue 3oC ABOVE Melting Point of wax
processor
Flotation water bath 6-10oC LOWER than the Melting point of wax
Quenching - 160oC to -180 oC
Desiccation - 30oC to -40oC

Methods of drying slide

Wax oven 56 to 60 C for 2 hours
Incubator 37 C overnight
Hotplate 45-55 C for 45 minutes
Blower type slide dryer 50 to 55 C for 20 to 30 minutes
4. The angle formed between the
cutting edges is known as the:
a. Clearance angle
b. Bevel angle
c. Wedge angle
d. Microtome angle
 ANGLE Description

Bevel Angle Angle formed between the cutting edges of the knife
Clearance Angle Angle between the cutting edge and tissue block
Optimum cutting angle:
To prevent uneven sections:
5. What is the widely used section
adhesive in immunohistochemistry
a. APES
b. Poly-L-lysine
c. XAM
d. DPX
Adhesives for surgical Description
sections
Most common adhesive
Added to floating out bath
Adhesive for immunohistochemistry
Cytological preparation of proteinaceous or bloody
material
6. An excellent stain for elastin fibers and is especially
recommended in dermatological studies due to its ability to
demonstrate the finest and most delicate fibers of the skin:

a. Carmine
b. Celestine blue
c. Night blue
d. Orcein
7. What is the preservative added to formaldehyde which
will prevent its decomposition to formic acid or
precipitation to formaldehyde?

a. Acetic acid
b. Butanol
c. Ethanol
d. Methanol
• White paraformaldehyde deposits formed 1.
during prolonged storage of formaldehyde can 2.
be removed by
• Bleaching of Formalin may be prevented by • THREE MONTHS
changing the fluid every

Removal of formalin pigments

• Picric acid method Saturated alcoholic solution of picric acid
• Kardasewitsch Ethyl alcohol, ammonia water
• Lillie’s method Acetone, hydrogen peroxide, ammonia
water
8. Which of the following substitute for paraffin wax can be
used without dehydration and clearing:

a. Gelatin
b. Carbowax
c. Bioloid
d. Both a and b
SUBSTITUTES FOR DESCRIPTION
PARAFFIN WAX
Highly purified paraffin and synthetic plastic polymers

Synthetic wax substitute similar to paraplast; less brittle and less

compressible than paraplast
Semisynthetic wax recommended for embedding eyes

Has a lower melting point but is harder than paraffin

Miscible and soluble with water hence does not require dehydration
and clearing of tissues
Paraffin wax and substitutes Temperature
Paraffin 56-57/58oC
Paraplast 56-57oC
Embeddol 56-58oC
Ester wax 46–48oC
Water soluble wax/ 38 to 42 oC or 45-56oC
Carbowax 56oC
9. Glacial acetic acid is mixed with many other fixing
agents in order to:

a. Prevent shrinking of cells

b. Shorten the fixation time
c. Prevent swelling of cells
d. Dehydrate the tissues
10. Urine specimens for cytology should fulfill all the
requirements given below, except:

a. Specimen should be second urine

b. At least 50 mL
c. For females, specimen should have been voided
d. For males, specimen should have been voided
11. Melanomas and schwannomas always stain
positive for:

a. PSA
b. CK7
c. Vimentin
d. CEA
Intermediate Filament markers
Actin • Identify tumors derived from the Smooth muscle,
Skeletal muscle, Cardiac muscle
Vimentin • Melanomas
• Schwannomas
Desmin • Leiomyoma (smooth muscle)
• Rhabdomyosarcoma (skeletal muscle)
*note: highly specific for myogenic tumors

Epithelial Tumor Markers

CEA (Carcinoembryonic Antigen) • Carcinomas of the: GIT, Pancreas, Lung, Breast, Ovary,
Uterus, Cervix
• Differentiates adenocarcinoma (+) & mesothelioma (-)
(+) CK/ Cytokeratin 7 • Carcinomas in the Lung, Uterus, Breast, Ovary
(-) CK/ Cytokeratin 20
12. The medical technologist on duty experienced
difficulty in section cutting and the tissue appears opaque.
What is the probable reason for this problem?
a. Insufficient clearing
b. Insufficient infiltration
c. Dirty knife
d. Delayed fixation
13. If the clearing agent turned milky as soon as the tissue
is placed in it, the most probable reason is?

a. Insufficient impregnation
b. Prolonged dehydration
c. Delayed fixation
d. Incomplete dehydration
 FAULT CAUSE REMEDY
Clearing agent turns milky Water not completely removed Repeat dehydration with absolute
as soon as tissue is placed due to incomplete dehydration alcohol, then clear again.
in it
On trimming, tissue smells Clearing agent not completely Block is trimmed down nearest to
of clearing agent removed due to insufficient the tissue, remaining wax is melted
impregnation on embedding oven and paraffin
impregnation is repeated, changing
the paraffin at least once before
blocking.
Tissue is opaque, section Insufficient clearing Repeat clearing; if object has
cutting is difficult due to already been embedded, prolong
presence of alcohol clearing up to 12 hours then re–
embed
14. The wax appears crystalline during trimming. What is
the most probable reason for this problem?

a. Block not cooled rapidly enough

b. Prolonged clearing
c. Overheated paraffin oven
d. Incomplete fixation
 FAULT CAUSE REMEDY
On trimming, wax appears Contaminated wax or Re-embed in freshly filtered wax
crystalline Block not cooled rapidly
enough
Paraffin block, after Insufficient paraffin Repeat paraffin impregnation, then
cooling, is moist and impregnation re embed
crumbles
Air holes found on tissue Incomplete impregnation Repeat impregnation
during trimming
15. Air-filled lungs may float on fixative. To avoid this, the
organ may be:

a. Packed with cotton soaked in fixative

b. Covered with several layers of gauze
c. Washed out in running water overnight prior to fixation
d. Immersed in absolute alcohol prior to fixation
• Tissues should not be more than 5 mm thick except: LUNG EDEMA (1-2 cm thick)
• Autopsy materials should be fixed as soon after death if not Placed in a mortuary refrigerator;
possible the body should be arterial embalming
• Surgical specimens should be fixed asap after removal or
refrigerated if delayed
• Hollow organs (stomach & intestines) should be packed with Cotton soaked in fixative (or
______ to allow immediate access to the fixative completely opened)
• Air-filled lungs may float on fixative; to prevent this The organ may be covered with
several layers of gauze
• Dense tissues such as brains are poorly penetrated, hence 2 weeks
requiring long fixation usually for:
• What organ should not be dissected first before they are fixed ? Eyes
• Eyes are injected with ____ before immersing the organ in the Formol alcohol
fixative
• Frozen section may lead to formation of Ice crystal artifacts
• Before fixing tissue with large amount of blood, it should be Flushed out with saline
16. Color of OG-6 staining solution is:

a. Dark purple to black

b. Orange with a hint of green
c. Olive green with a hint of brown and red
d. None of these
Papanicolaou method - staining method of choice for exfoliative cytology

Pap’s stain consist of three stains:

1. Hematoxylin – Nuclear stain
2. OG-6 – cytoplasmic stain of mature cells
3. EA – cytoplasmic stain of immature cells

➢ Components of EA: Light green SF, Bismarck brown, Eosin Y, PTA, Lithium carbonate
➢ In modified Pap’s stain, this dye was omitted from the EA formula:
➢ 2nd best choice for routine cytologic examination, after Papanicolaou stain:
17. The cellular adaptation to stress seen in respiratory
tract of habitual cigarette smoker

a. Anaplasia
b. Dysplasia
c. Hyperplasia
d. Metaplasia
• This refers to the reversible transformation of one cell type Metaplasia
to another cell type
• This refers to the reversible regressive alteration in the Dysplasia
adult cells
• This refers to the irreversible, marked regressive changes Anaplasia
that occur in adult cell towards embryonic primitive cell “dedifferentiation”
type
• This refers to the continuous abnormal proliferation of Neoplasia
cells without control
• This refers to the failure of an organ to achieve its full Hypoplasia
mature size due to incomplete development
• This refers to the failure of an organ to form an opening Atresia
• This refers to the complete non appearance of an organ Agenesia
• This refers to the incomplete or defective development Aplasia
of tissue or organ; has no resemblance to the adult
structure
• This refers to the acquired decrease in size of a Atrophy
normally developed or mature tissue or organ resulting
from reduction in cell size or decrease in total number
of cells or both
18. Autopsy materials should be preserved as soon after
death as possible. If this cannot be done, the body should
be placed in a refrigerator kept at:

a. 8 deg Celsius
b. 4 deg Celsius
c. 25 deg Celsius
d. - 20 deg Celsius
19. Request forms for histopathologic analysis should be
signed by:

a. The patient’s physician

b. The medical technologist
c. The nurse-on-duty
d. The pathologist
20. Which of the following descriptions characterize a post-
mortem clot?

I. Chicken fat
II. Rubbery consistency
III. Currant-jelly
IV. Assumes the shape of the blood vessel

a. 2 and 3
b. 1 and 3
c. 1, 2 and 4
d. 1, 2, 3, and 4
• First demonstrable secondary change in somatic death Algor mortis
characterized by the cooling of the body to equalize that
of the surrounding environment
• This refers to the rigidity or stiffening of the muscles Rigor Mortis
occurs 6-12 hours after death and persist for up to 3 – 4
days
• This refers to the purplish discoloration of the skin in Livor mortis
dependent portions of the body?
• Occurs slowly, immediately after death, portion of clot Post-mortem clot
assume a yellow chicken fat, currant jelly, rubbery
consistency
• Refers to the drying or wrinkling of the cornea and Dessication
anterior chamber of the eyes
• characterized by the foul-smelling gases due to the Putrefaction
invasion of the tissue by multiplying saprophytic
organisms
• Self-destruction and is caused after death of cells by Autolysis
action of intracellular enzymes whose normal behavior is
altered.
21. This is considered to be the most common type of
necrosis usually observed in the myocardium, lungs,
kidneys and the spleen:

a. Fat necrosis
b. Liquefaction necrosis
c. Gangrenous necrosis
d. Coagulation necrosis
TYPES OF NECROSIS
• A type of necrosis when arterial supply is cut off
• A type of necrosis most commonly encountered in the
brain; a type of necrosis in which the dead tissue turns into
a liquid substance.
• This type of necrosis involves the peculiar destruction of
adipose tissue and found in pancreatic degenerations
• This type of necrosis has the appearance of soft, friable
chest and is produced by the tubercle bacilli
• is a special form of necrosis that is usually seen in
immune reactions involving blood vessels (antibodies
and antigen complexes are deposited)
22. Pathology blocks should be kept for a period of:

a. 1 year only
b. 10 years
c. 2 years
d. 5 years
RECORD/ SPECIMEN TYPE • RETENTION
• Blood/ Fluid smears 7 days
• Microbiology stained slides
• Requisition
• Accession logs
• Maintenance/ instrument logs 2 years
• Quality control records
• Clinical pathology test records
• Cytogenetic slides 3 years
• Cytology slides 5 years
• Surgical pathology (bone marrow) slides
• Paraffin blocks/ slides 10 years
• Flow cytometry plots/ histogram
• Cytogenetic reports/ image 20 years
23. When wax has been reused, some water is mixed with
it. In order to remove excess water, heat the wax to:

a. 100-105 C
b. 150-160 C
c. 20 C above its melting point
d. 80-90 C
23. When wax has been reused, some water is mixed with
it. In order to remove excess water, heat the wax to:

a. 100-105 C
b. 150-160 C
c. 20 C above its melting point
d. 80-90 C
24. What is the optimum temperature of the water bath that
is used to float tissue cut from the microtome?

a. 30-35 deg C
b. 45-60 deg C
c. 45-50 deg C
d. 50-56 deg C
25. In order to have an effective knife, which one of the
following hones is recommended because it gives the best
honing result?
a. Belgium yellow
b. Arkansas
c. Fine Carborundum
d. Paddle strop
HONING STROPPING

• Sharpening • Polishing
• Removal of gross nicks • Removal of burrs formed during honing
• Done in Heel to toe direction • Done in toe to heel direction
• Fine Carborundum – used only for badly • Around 40-120 double strokes are
nicked knives required
• Belgium Yellow – gives the best result • Leather strops usually require oiling
for manual sharpening
• Arkansas – more polishing effect
26. This is considered as the most sensitive of the oil
soluble dyes:

a. Sudan IV
b. Sudan III
c. None of these
d. Sudan Black
27. For frozen section, the tissue should be sent to the
laboratory:

a. In 10% formalin
b. In Carnoy’s fixative
c. In saline
d. Fresh and unfixed
28. The ultrathin microtome is chiefly utilized for cutting
tissue (very thin sections) at :

a. 0.5 micra
b. 4 to 6 micra
c. 10 to 15 micra
d. 2.0 nanometers
SECTIONING
Paraffin section 4 to 6 micra
Celloidin section 10 to 15 micra
Frozen section ~ 10 micra
Ultrathin Semithin: 0.5 – 1 micron
Ultrathin: 50 to 120 nanometer/ 500
to 1200 angstrom
29. Helicobacter pylori is a curved gram-negative organism
which may be demonstrated with:

a. Toluidine blue
b. Cresyl fast violet
c. Both A and B
d. None of these
M. leprae and Nocardia
• Wade-Fite technique Red
Helicobacter pylori
• Toluidine blue Dark blue
• Cresyl violet Dark purple
For Nocardia & Actinomycetes
• Brown and Brenn method Blue
For Mycobacterium
• Ziehl neelsen Red
• Auramine rhodamine Golden yellow
Spirochetes
• Levaditi’s Black on yellowish background
• Modified steiner & steiner Black
• Warthin Starry Black
Legionella pneumophila
• Dieterle method Dark brown to black
For Fungi
• Grocott methanamine silver Black
VIRUS
Lendrum’s phloxine tartrazine method Bright red
HBsAg Orcein method Brown black
30. This type of knife has both sides straight, making it
recommended for frozen sections or for cutting extremely
hard and tough specimens embedded in paraffin blocks:
a. Plane-concave knife
b. Biconcave knife
c. Plane-wedge knife
d. None of the above
KNIVES
Biconcave knife 120 mm in Recommended for cutting paraffin embedded sections on a rotary
length microtome
Plane-concave 25 mm in Less concave sides are recommended for cutting celloidin-embedded
knife length tissue blocks on a sliding microtome
More concave sides are used to cut paraffin sections on base sledge,
rotary or rocking microtome
Plane-wedge 100 mm in Recommended for frozen sections or for cutting extremely hard and
knife length tough specimen embedded in paraffin blocks using a base sledge type
or sliding microtome
31. This refers to an incomplete or defective
development of a tissue or organ, represented only by a
mass of fatty or fibrous tissue, bearing no resemblance
to the adult structure:
a. Agenesia
b. Atresia
c. Aplasia
d. Atrophy
32. Resinous mounting mediums, except:

a. DPX
b. Clarite
c. XAM
d. Poly-L-Lysine
MOUNTING

Aqueous mounting media Resinous mounting media

For water miscible preparations For preparations that have been
cleared in xylene or toluene
1. Glycerin 1. Canada balsam
2. Farrant’s 2. DPX
3. Apathy’s 3. XAM
4. Brun’s 4. Clarite
5. Permount
6. HSR
33. During the preparation of a routine H&E slide, what
step occurs after the tissue is preserved?

a. Fixation
b. Staining
c. Dehydration
d. Embedding in paraffin
 TISSUE PROCESSING

1. Fixation
2. *Decalcification
3. Dehydration
4. Clearing
5. Impregnation/ Infiltration
6. Embedding
7. Trimming
8. Section cutting/ Sectioning
9. Staining
10. Mounting
11. Labelling
34. To prepare a 10% solution of formalin, which of the
following amounts of water should be added to 100 mL
of stock formaldehyde:

a. 1,000 mL
b. 900 mL
c. 450 mL
d. 10 mL
35. The autotechnicon is an automatic tissue processor.
Which of the following is the recommended set-up for
this machine?
a. Compartment 1-2 (fixative); 3-6 (dehydration); 7-8 (xylene); 9-10 (acetone); 11-12
(Paraffin wax)
b. Compartment 1-2 (dehydration); 3-6 (acetone); 7-8 (xylene); 9-10 (alcohol); 11-12
(Paraffin wax)
c. Compartment 1-2 (fixative); 3-6 (dehydration); 7-8 (acetone); 9-10 (clearing); 11-12
(Paraffin wax)
d. Compartment 1-2 (fixative); 3-6 (dehydration); 7-8 (wax); 9-10 (acetone); 11-12 (Paraffin
wax)
AUTOMATIC TISSUE PROCESSOR

• operates by sequentially subjecting

tissue samples to a series of chemical
treatments
• 4 processes:
1.
2.
3.
4.
• 12 Jars
36. A brown, iron-free pigment found in association with
hemochromatosis and that stains with oil-soluble dyes
in frozen sections is:

a. hemofuscin
b. melanin
c. hematin
d. bilirubin
ENDOGENOUS TISSUE PIGMENTS
Hemosiderin (iron in tissues) • Iron-containing pigment of hemoglobin
• Found in places easily accessible to oxygen
• Most common hemoglobin derivative
Hematoidin (bilirubin-like crystalline • Iron-free pigment of hemoglobin
pigment free from iron) • Found in areas where there is poor oxygenation
• Participating in the formation of bile pigments
Hematin • Hemoglobin minus the globin molecule
• Found in old blood clots
• May be encountered in malaria, pernicious anemia,
and toxic hemolysis
Hemozoin • Black granule formed by malarial parasites in red
blood cells
Hemofuscin • Iron free brownish yellow pigment
• Occurs with hemosiderin in hemochromatosis
37. As a general rule, the infiltrating agent used for
specimen processing must be:

a. not less than 20 times the volume of the tissue

b. not less than 10 times the volume of the tissue
c. not less than 25 times the volume of the tissue
d. not less than 5 times the volume of the tissue
IDEAL AMOUNT
Fixative • 10-20 times the volume of the tissue
• Except: Osmium tetroxide (5 -10x)
Decalcifying agent • >20 times the volume of the tissue
Dehydrating agent • >10 times the volume of the tissue
Clearing agent • >10 times the volume of the tissue

Impregnating agent • >25 times the volume of the tissue

38. Which of the following terms refers to a malignant
tumor of mesenchymal tissue?

a. Carcinoma
b. Adenoma
c. Papilloma
d. Sarcoma
TUMORS

• Malignant tumors of epithelial tissue origin (derived

from any of the three germ layers) which have less
tendency to produce supporting tissue or stroma
• Malignant tumors of connective tissue/
mesenchymal tissue origin characterized by
abundant intercellular tissue framework
• Benign tumor of epithelial tissue origin in glands and
ducts
• Benign tumor of epithelial tissue origin with finger-
like (warty) projections
39. If the clearing agent is cloudy, it probably is
contaminated with:

a. absolute alcohol
b. bacteria
c. water
d. yeast
40. What is the most widely used incision technique for
autopsy procedures wherein the incision is made from
near acromnion processes extending downwards below
the breast and across the xiphoid process to the
symphysis pubis?
a. I shaped incision
b. Y shaped incision
c. Modified Y shaped
d. None of the above
AUTOPSY
Y-shaped incision Straight cut Incision (I shaped incision)

• type of autopsy wherein the cadaver is • opens the cadaver from the midline
opened from both shoulder regions of the body from suprasternal notch
down to the xiphoid area, and then down to the pubis
incised down to the pubis
• commonly done in adult and female • commonly done in children and
cadaver infants
AUTOPSY – EVISCERATION TECHNIQUES:

• Evisceration technique where organs are removed one

by one
• Evisceration technique characterized by in situ
dissection
• Evisceration technique characterized en bloc removal;
organs are removed as blocks
• Evisceration technique characterized by en masses
41. An aqueous mounting medium was prepared 3
months ago and stored in a 4 deg C refrigerator. Mold is
now observed in the medium. To prevent this in the
future, when preparing the medium one should:

a. be sure to add thymol

b. filter the newly made solution
c. increase the amount of glycerol
d. boil the solution
42. The material of choice for immunofluorescence
microscopy and enzyme histochemical studies is:

a. paraffin sections
b. cryostat sections
c. air-dried imprints
d. alcohol-fixed imprints
FROZEN SECTIONS
• Quick diagnosis
• Study the margins of cancer
• Enzyme histochemistry
• Immunohistochemistry
• Detection of lipid
Freezing agents: Carbon dioxide, Liquid nitrogen
43. When frozen sections partially jam and partially slide
under the anti-roll plate, the plate is:

a. too warm
b. too far below the knife edge
c. not parallel to the knife edge
d. too far above the knife edge
44. In acute inflammation, this clinical sign is due to
exudation of plasma fluid into the surrounding
extravascular compartment:

a. Tumor
b. Calor
c. Rubor
d. Dolor
5 CARDINAL SIGNS OF INFLAMMATION
• Rubor - due to arteriolar and capillary dilation with increased rate of
blood flow towards the site of injury
• Calor - due to the transfer of internal heat to the surface or site of injury
• Tumor – due to increased capillary permeability, allowing extravasation
of blood fluid
• Dolor – due to direct damage to the nerve ending or pressure upon the
sensory nerve
• Functio laessa - paint interference with nerve supple and destruction of
the functioning units of the tissue
45. The surgical pathology report is signed by:

a. Histopath medtech staff

b. Pathologist
c. Chief Med. Tech
d. Both A and B
46. The refractive index of the resinous mountant used
for stained sections should be about:

a. 0.52 to 0.85
b. 1.30 to 1.41
c. 1.53 to 1.54
d. 1.60 to 1.73
47. Which among the sites sampled during a paps smear
is crucial for screening for malignant cells?
a. Lateral vaginal wall sample
b. Ectocervical smear
c. Endometrial sample
d. Transformation zone sample
GYNECOLOGICAL SPECIMENS
• Transformation zone (T zone) – important for the detection of
dysplasia and carcinomas of the cervix
• Optimal sample: squamous, columnar and metaplastic cells
48. A special method of smear preparation whereby the
surface of a freshly cut piece of tissue is brought into
contact and pressed on to the surface of a clean glass
slide, allowing cells to be transferred directly to the slide
for examination
a. Streaking
b. Impression smear
c. Spreading
d. Pull-apart
49. Effects of tissue fixation EXCEPT

a. Inhibits bacterial decomposition

b. Decreases optical differentiation
c. Reduces the risk of infection
d. NOTA
FIXATION
Primary goal Preserve the morphologic and chemical integrity of cell in a life-like
manner as possible
Secondary goal Harden and protect the tissue from trauma of further handling, so that
it is easier to cut during examination

• Fixatives that are taken in and becomes a part of the Additive fixative
tissue
• Fixing agent is not taken into the tissue but alters the Nonadditive fixative
tissue composition

• Fixatives can be grouped according to their 1. Crosslinking fixatives

Mechanism of action 2. Precipitating (or
Denaturing) fixatives
 Microanatomic fixatives Ang ten ten (10-10), ni Heiden, For BB ZZ
FIXATION 1. 10% Formol Saline
2. 10% Neutral Buffered Formalin
3. Formol sublimate (formol corrosive)
4. Heidenhain’s susa
5. Zenker’s solution
6. Zenker Formol (Helly’s)
7. Bouin’s solution
8. Brasil’s solution
NUCLEAR FIXATIVE CYTOPLASMIC FIXATIVES
- Bouin’s 1. Helly’s
- Flemming’s 2. Regaud’s
- Newcomer 3. Orth’s fluid
- Carnoy’s 4. Flemming’s solution without
- Heidenhain’s susa acetic acid
5. Formalin with post chroming
Boy Flemming Has New Car “HROFF”
HISTOCHEMICAL FIXATIVES - Si Ace na Newcomer ay may FOR ABS
(1) Acetone
(2) Newcomer’s
(3) 10% Formol saline
(4) Absolute ethyl alcohol
FIXATION
Aldehyde fixatives 1. Formaldehyde
Metallic 1. Mercuric chloride
2. Glutaraldehyde
fixatives - B-5 fixative
Picric acid fixatives 1. Bouin’s solution - Heidenhain’s susa
2. Brasi’s solution picroformol
- Zenker’s fluid
fixative
- Zenker-formol (Helly’s)
Alcohol fixatives 1. Methyl alcohol 2. Chromate fixatives
2. Newcomer’s
- Chromic acid
3. Isopropyl
4. Carnoy’s - Regaud’s fluid
5. Ethyl alcohol - Orth’s fluid
- Potassium dichromate
Osmium tetroxide 1. Flemming’s solution
(Osmic Acid) 2. Flemming’s without acetic acid 3. Lead fixatives
50. On microscopic evaluation of an H&E stained
section, dark deposits of material dispersed irregularly
over the tissue are observed. The most likely cause is
that the hematoxylin:

a. was not filtered before use

b. is past its useful shelf life
c. contains too much acetic acid
d. has too alkaline a pH
51. The best all-round substitute for ethanol for
processing tissues is:

a. dioxane
b. butanol
c. isopropanol
d. methanol
52. This is a rapid acting and a very cheap dehydrating
agent utilized for urgent biopsies. It can dehydrate in ½
to 2 hours.

a. Acetone
b. Ethyl alcohol
c. Isopropyl alcohol
d. Butyl alcohol
DEHYDRATING AGENT
• It is the best dehydrating agent because it is fast acting, it
mixed with water and many organic solvents, penetrates
tissue easily
• A toxic dehydrating agent; primarily employed for blood
and tissue films and for smear preparation
• An excellent ethanol substitute; used in microwave
processing schedules
• Slow dehydrating agent used for plant and animal
microtechniques
• Rapid acting and very cheap utilized for urgent biopsies;
can dehydrate in ½ to 2 hours
• Fixative and a dehydrating agent
• A dehydrating and clearing agent
53. What clearing agent is recommended for specimens
from the CNS and cytological studies but is extremely
slow (5 to 6 days)?

a. Chloroform
b. Xylene
c. Toluene
d. Cedar wood oil
CLEARING AGENT
• The most commonly used clearing agent; not suitable for nervous
tissues and lymph nodes; most rapid
• Used for tough tissues, nervous tissues, lymph nodes and embryos
bec it causes minimum shrinkage
• A toxic clearing agent that may cause bone marrow damage and
aplastic anemia
• May be used as a substitute for xylene or benzene for clearing both
during embedding and mounting
• Recommended clearing agent for central nervous system and
cytological studies but extremely slow (5 to 6 days)
• Slow acting clearing agents that can be used when double embedding
techniques are required
54. For manual processing (hand processing) of tissues,
how many changes of wax are required to ensure
complete removal of the clearing agent?

a. Three changes of wax at 30 minutes interval

b. Four changes of wax at 15 minutes interval
c. Two changes of wax at 30 minutes interval
d. Six changes of wax at 15 minutes interval
55. In Embedding, what is recommended for large hollow
organs which tend to collapse, for hard and dense
tissues such as bones and teeth?

a. Ester wax
b. Tissue mat
c. Celloidin
d. Resin
EMBEDDING MEDIUM
• Recommended for large hollow organs which tend to collapse, for Celloidin (colloidon)
hard and dense tissues such as bones and teeth
• Preferred for processing whole eye sections Dry celloidin
• Preferred for bones, teeth, large brain, and whole organs Wet Celloidin
• Double embedding method: tissue is first infiltrated with ______ and Celloidin→ Paraffin
then embedded with paraffine
• Embedding medium used for histochemical and enzyme studies; Gelatin
Rarely used except when dehydration is to be avoided
• Embedding medium used for electron microscopy Plastic (resin)
• Epoxy plastics (Bisphenol A, Glycerol/ Epon, Cyclohexane dioxide/ Plastic classification
Spurr), Polyesters plastics , Acrylic plastics (GMA, MMA)
56. In trimming, tissues should be surrounded by wax by
at least _______ ?

a. 4 mm
b. 2 mm
c. 6 mm
d. 3 mm
57. What adhesive can be used in cytology specifically
for cytospin preparation of proteinaceous or bloody
material?

a. APES
b. Poly-L-Lysine
c. Glycerin
d. DPX
58. The following are blueing agents, except?

a. Saturated lithium carbonate

b. 0.5% ammonia water
c. Hydrogen peroxide
d. Scott’s tap water
59. Which of the following utilizes aluminum as its
mordant?

a. Harris hematoxylin
b. Weigert’s hematoxylin
c. Mayer’s hematoxylin
d. Both a and c
HEMATOXYLIN

Aluminum hematoxylin Iron hematoxylin

1. Ehrlich’s hematoxylin 1. Weigert’s hematoxylin
2. Harris hematoxylin 2. Heidenhain’s hematoxylin
3. Delafield’s hematoxylin 3. Loyez Hematoxylin
4. Cole’s hematoxylin 4. Verhoeff hematoxylin
5. Mayer’s hematoxylin
6. Gill Hematoxylin
Tungsten hematoxylin Copper hematoxylin
1. Phosphotungstic acid Copper hematoxylin
hematoxylin
60. Using Van Gieson’s, collagen will stain?

a. Black
b. Pink
c. Brown
d. Blue
CARBOHYDRATE STAIN
STAIN Structure: Glycogen
Best carmine Bright red
Langhan’s iodine method for glycogen Mahogany brown
PAS with diastase for glycogen Red
Periodic acid Schiff PAS (+) substance: red or magenta red
STAIN Structure: Gylcosaminoglycans
Fresh frozen azure A metachromatic Red-purple
staining for GAG
Metachromatic toluidine blue staining Red-purple
STAIN Structure: Mucins
Alcian blue Acid mucin: blue
Hale’s dialyzed (colloidal) iron technique Acid mucin: dark blue
61. What is the optimum temperature range and the
recommended ratio of fluid-to-tissue during
decalcification?

a. 18 to 30˚C; 20:1
b. 18 to 30˚C; 10:1
c. 30 to 37˚C; 20:1
d. 30 to 37˚C; 10:1
DECALCIFICATION
• Optional process to remove calcium or lime salts from tissues
• Specimen required to be decalcified: Bones, Teeth, Calcified tissues
• Ideal time required for decalcification:
• Ratio of decalcifying fluid to tissue:
• Ideal temperature of decalcification:
• Classification of decalcifying agent (chemical): Strong mineral acid,
Weak mineral acid, Chelating agent
62. To avoid shrinkage and hardening of the tissues, wax
impregnation should be maintained at a temperature
relative to the melting point of the wax

a. 2 to 5°C above
b. 5 to 10°C above
c. 2 to 5°C below
d. 5 to 10°C below
63. Alcohol renders the tissues optically clear. This
ability of clearing agents to make the tissues transparent
is due to their ?

a. Low refractive index

b. High refractive index
c. High density
d. Low density
64. When an antibody labeled with a chromogen is
reacted with tissue from a patient, the
immunohistochemical technique is called

a. Direct
b. Avidin-biotin complex
c. Indirect
d. Soluble enzyme immunocomplex
IMMUNOHISTOCHEMISTRY
• used in histology to detect the presence of specific protein marker that
can assist with accurate tumor classification and diagnosis.
• Target antigen: proteins within or on the surface of a cell
• Primary antibody: binds specifically to the target antigen
• Detection system: Chromogen and Enzyme
• Enzymes: conjugated on the secondary antibody
• Chromogen: substrate that forms an insoluble colored precipitate that
can be visualized under a microscope (e.g. DAB, AEC)
65. What component of the Papanicolaou stain, gives
color to the cytoplasm of Superficial cells?

a. Hematoxylin
b. Eosin
c. OG-6
d. EA-50
66. In the Papanicolaou staining process, what color
do the nuclei of cells typically stain?

a. Blue
b. Red
c. Purple
d. Brown
67. In IHC, what is the purpose of the washing step
during the staining process?

a. To remove excess stain

b. To enhance signal intensity
c. To remove unbound antibodies
d. To fix the tissues
68. What is the advantage of using frozen sections
over paraffin-embedded sections in
Immunohistochemistry?

a. Better preservation of cellular morphology

b. Longer storage duration
c. Enhanced antigen retrieval
d. Increased tissue permeability
69. Which enzyme is most commonly used in enzyme-
conjugated secondary antibodies for
Immunohistochemistry

a. Horseradish peroxidase
b. Alkaline phosphatase
c. Acetylcholinesterase
d. Acid phosphatase
70. What is the purpose of the antigen retrieval step
in Immunohistochemistry?

a. To enhance antibody binding

b. To reduce background staining
c. To increase tissue permeability
d. To deactivate enzymes
71. Which type of antibody is commonly used as a
secondary antibody in Immunohistochemistry?

a. IgG
b. IgM
c. IgA
d. Both a and b
72. For general use, 10% formalin is usually buffered to a pH of
_______ to prevent formation of black acid hematin pigment

a. 7.2
b. 7.0
c. 7.4
d. 6.8
73. There are two main types of automated tissue
processor. Which type moves specimen-containing
cassettes to be processed from one container to
another?

a. Fluid-transfer
b. Enclosed
c. Tissue-transfer
d. Both a and b
74. What is the recommended fixative for enzyme
histochemistry and electron microscopy?

a. Mercuric chloride
b. Paraformaldehyde
c. Glutaraldehyde
d. 10% NBF
75. All sections for immunohistochemistry should be
picked up onto ____ to assist with tissue adhesion and
to prevent detachment during potentially harsh
pretreatments.

a. Positively charged slides

b. Adhesive slides
c. Negatively charges slides
d. Ordinary slides
76. Which of the following is a very serious
histotechnique error to practice which can lead to
inaccurate diagnosis?

a. sections are cut as quickly as possible to reduce TAT

b. blades are used for as long as possible to save cost
c. same mold size used for every specimen
d. water surface of flotation bath was not skimmed between
every block to avoid long TAT
77. Hematoxylin and Eosin (H&E) staining is a method
used in frozen section biopsies, it is performed as a:

a. Progressive staining method

b. Regressive staining method
c. Either a or b
d. None of the above
78. This technique allows cells to be monolayered in
cytology:

a. Membrane filter method

b. Liquid based cytology
c. Both of these
d. None of these
79. Defining standards of performance refers to

a. Directing
b. Planning
c. Organizing
d. Controlling
80. Which of the following is not a professional
subject?

a. Molecular diagnostics
b. Biochemistry
c. Clinical Microscopy
d. Hematology
81. A recent passer of the medical technology
licensure exam was invited for a medical mission of a
mobile laboratory. Is he/she allowed to attend such
event?
a. Yes, if there is permission of the Board of Medical Technology
b. Yes, if there is permission of the Chairperson of Professional
Regulatory Commission.
c. No, he/she needs to have a license or certificate of registration first
prior to practice.
d. No, he/she needs to take the professional’s oath first prior to the
practice of the profession.
R.A. 5527– Section 20. Oath Taking
• All successful examinees shall be required to take a professional oath before the
Board or before any person authorized to administer oaths prior to entering upon
the practice of medical technology in the Philippines.

R.A. 5527– Section 21. Issuance of Certificate of Registration

• Every applicant who has satisfactorily passed the required examination, shall be
issued a certificate of registration as Medical Technologist: Provided, That no such
certificate shall be issued to any successful applicant who has not attained the age
of twenty-one years.
82. The radiologic method is the best technique for
determining the extent of decalcification process. What
can be the indication that calcium is present?

a. Turbidity
b. Discoloration
c. Opacity
d. None
83. This provides recommendations for the number of
staff needed to handle an unpredictable workload

a. Queuing Theory
b. Benchmarking
c. PDCA
d. SWOT analysis
84. During paraffin wax processing, in which alcohol
grade is dehydration initiated?

a. 30%
b. 70%
c. 80%
d. 95%
 5 CHANGES OF ETHANOL (DEHYDRATING AGENT)
• 70% ethanol – 1 change
• 95% ethanol – 1 change
• 100%/ absolute ethanol – 3 changes
• It is the best dehydrating agent because it is fast acting, it mixed
with water and many organic solvents, penetrates tissue easily
• A toxic dehydrating agent; primarily employed for blood and tissue
films and for smear preparation
• An excellent ethanol substitute; used in microwave processing
schedules
• Slow dehydrating agent used for plant and animal microtechniques
• Rapid acting and very cheap utilized for urgent biopsies; can
dehydrate in ½ to 2 hours
85. What microtome is considered the most
dangerous type because of its movable exposed knife?

a. Base-sledge microtome
b. Ultrathin microtome
c. Rotary microtome
d. Standard sliding microtome
 MICROTOMY
• 3 essential parts: Block holder (chuck), Knife and knife carrier, pawl ratchet feed
wheel & Adjustment screw

Rocking For cutting serial section of large block of paraffin Paldwell Trefall
(Cambridge) embedded tissues
Simplest microtome
Rotary For cutting paraffin embedded section; most common Minot
type used for both routine and research laboratories
Sliding For cutting celloidin embedded sections; Dangerous type Adams
of microtome
Freezing For cutting unembedded frozen sections Queckett
Ultrathin For cutting section for electron microscopy
microtome
86. A drinking-water service provider was under strict
monitoring after it was found that the resampled water
still contains E. coli/ Thermotolerant coliform. What
advice can you give?

a. Issue an advisory to “boil water”

b. Close the water facility to prevent spread of disease
c. Provide and alternative drinking water supply
d. Both a and c
Philippine National Standards for Drinking water (PNSDW) of 2017
Philippine National Standards for Drinking water (PNSDW) of 2017
Revised Rules and Regulations Governing the Accreditation of Laboratories for
Drinking Water Analysis (LDWA)
• DOH, HFSRB, NRL-EOHTM – agencies tasked to regulate LDWA
• Classification by ownership: Government or Private
• Classification by institutional character: Institution or non-institution based
• Classification by services capability: Microbiological (A), Physico-Chemical (B),
Microbiological-Physico—Chemical (C)
Revised Rules and Regulations Governing the Accreditation of Laboratories for
Drinking Water Analysis (LDWA)
• Analyst
Revised Rules and Regulations Governing the Accreditation of Laboratories for
Drinking Water Analysis (LDWA)
• PROFICIENCY TESTING
87. National External Quality Assessment Scheme
(NEQAS) is a form of quality assurance activity. Which
agency is responsible for conducting NEQAS on
Antimicrobial resistance?
a. DOH
b. RITM
c. HSFRB
d. SACCL
88. Newborn screening shall be performed after
_________ of life but not later than __ from complete
delivery of newborn
a. 24 hours; 2 days
b. 24 hours; 3 days
c. 48 hours; 3 days
d. 48 hours; 2 days
R.A. 9288 – NEWBORN SCREENING ACT OF 2004
SECTION 6. Performance of Newborn Screening:
• Newborn screening shall be performed after twenty-four (24) hours of life but not later
than three (3) days from complete delivery of the newborn
• A newborn that must be placed in intensive care in order to ensure survival may be
exempted from the 3-day requirement but must be tested by seven (7) days of age.
SECTION 7. Refusal to be Tested
• a parent or legal guardian may refuse testing on the grounds of religious beliefs, but
shall acknowledge in writing their understanding that refusal for testing places their
newborn at risk for undiagnosed heritable conditions.
• copy of this refusal documentation shall be made part of the newborn's medical record
and refusal shall be indicated in the national newborn screening database.
89. What is the required age of an applicant for the
issuance of certificate of registration as a Registered
Medical Technologist?
a. 20 years old
b. 21 years old
c. 23 years old
d. 22 years old
90. It is known as the Data privacy act of 2012:

a. RA 8504
b. RA 11166
c. RA 10173
d. RA 10586
91. Papanicolaou stain is the staining method of
choice for exfoliative cytology. What is the second
component of pap stain?
a. OG-6
b. EA-50
c. Bismarck Brown
d. Hematoxylin
92. For routine histologic procedures, sections should
be cut with a thickness of?

a. 2 to 3 micra
b. 3 to 5 micra
c. 4 to 6 micra
d. 5 to 7 micra
93. The Professional Regulation Commission (PRC) is
a three-man commission attached to:

a. DOLE
b. CHED
c. PHILHEALTH
d. Office of the President
R.A. 8981 – PRC Modernization Act of 2000
94. This is used commonly in demonstrating heavy chain
immunoglobulins, complement, and specific antigens:

a. Microwave Ag retrieval
b. Pressure cooker Ag retrieval
c. Proteolytic enzyme digestion
d. AOTA
95. Which of the following is not part of the 5-panel drug
testing?

a. THC
b. Ethanol
c. Cocaine
d. Amphetamine
96. This refers to learning activities such as online
training, local/ international seminars/ non-degree
courses, institution/ company-sponsored training
programs and the like, which did not go undergo CPD
accreditation but may be applied for and awarded CPD
units by the respective CPD council:
a. Nonformal learning
b. Self-directed learning
c. Informal learning
d. Prior learning
R.A. 10912 – CPD Law
• Formal learning refers to educational arrangements such as curricular qualifications and teaching-
learning requirements that take place in education and training institutions recognized by relevant
national authorities, and which lead to diplomas and qualifications
• Informal learning refers to learning that occurs in daily life assessed, through the recognition,
validation and accreditation process, and which can contribute to a qualification
• Lifelong learning refers to learning activities undertaken throughout fife for the development of
competencies and qualifications of the professional;
• Nonformal learning refers to learning that has been acquired in addition or alternatively to formal
learning, which may be structured and made more flexible according to educational and training
arrangements;
• Online learning activities refer to structured or unstructured learning initiatives, which make use of the
internet and other web-based Information and Communications Technology solutions;
• Prior learning refers to a person’s skills, knowledge and competencies that have been acquired
through work experience, training, independent study, volunteer activities and hobbies, that may be
applied for academic credit, as a requirement of a training program or for occupational certification;
97. An examinee who failed to obtain a passing grade
may only be registered as a Medical Laboratory
technician if the grade obtained is within this range:
a. 60-74.5%
b. 65-74.9%
c. 70-74.9%
d. 74-74.9%
R.A. 5527 – Philippine Medical Technology Act of 1969
SECTION 19. Ratings in the Examination
• General average: at least 75%
• No rating below 50% in any of the major subjects
• Has not failed in at least 60% of subjects computed according to their relative weight
• No further examination will be given who has not qualified after three examinations, unless and
until he shall have completed 12 months refresher course in an accredited medical technology
school or 12-month postgraduate training in an accredited laboratory
98. Which of the following statements are correct based on the stipulated
implementing rules and regulation of clinical laboratories in the
Philippines?
I. Clinical laboratories operated and maintained exclusively for research and teaching purposes shall be
exempted from the licensing requirement but shall be required to register with the BHFS
II. Physician’s office laboratories within the premises of DOH-regulated facility shall be under the
supervision of the Clinical laboratory.
III. A POCT, conducted in a hospital, is required to be under the management and supervision of the
licensed clinical laboratory of the respective hospital.
IV. The NRL designated by the DOH shall be covered by the license of the clinical laboratory of the
hospital where they are respectively assigned.
a. I only
b. I and II
c. I, II, III
d. All of the above
99. One of the following can be appointed as Chairman of the Board of
Medical Technology

a. RMT with 10 years experience, Filipino and of good moral character

b. Qualified pathologist with 5 years experience and instructor in a medical
technology school
c. RMT of good moral character, Filipino and dean of a medical technology school
d. Filipino pathologist, of good moral character, with 10 years experience in the
field
R.A. 5527 – Philippine Medical Technology Act of 1969
SECTION 8. Qualification of Examiners
• No person shall be appointed a member of the Board of Examiners for Medical Technology unless
he or she
(1) is a Filipino citizen;
(2) is of good moral character;
(3) is a qualified pathologist or duly registered medical technologist of the Philippines with the degree
of Bachelor of Science in Medical Technology/Bachelor of Science in Hygiene;
(4) has been in the practice of laboratory medicine or medical technology for at least ten years prior to
his appointment,
(5) is not a member of the faculty of any medical technology school, or have any pecuniary interest,
direct or indirect, in such institution:
Provided, however, That for the first three years following the approval of this Act, the requirement
mentioned in number four (4) shall be reduced to five years.
100. Minimum requirement of laboratory personnel for screening drug
laboratory:

a. analyst, head pathologist

b. analyst, authorized specimen collector
c. head pathologist, authorized specimen collector
d. analyst, head pathologist, authorized specimen collector
R.A. 9165 – COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002
SECTION 36. AUTHORIZED DRUG TESTING
• SCREENING – determine the positive result as well as the type of the drug used; rapid
test to establish potential/ presumptive positive
• CONFIRMATORY – confirms a positive screening test
• Validity: 1 year from the date of issue
Storage of lab results and specimens:
• Specimens that are confirmed with a positive result which are not challenged within 15
days shall be discarded
R.A. 9165 – COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002

SCREENING LABORATORY CONFIRMATORY LABORATORY

Headship Licensed physician with cert. in Licensed physician certified in Clinical
Clinical Pathology from the PBP or Pathology with at least 2 years of active
Certification in Clinical laboratory laboratory experience in analytical
Management Training technology
OR Chemist with at least Master’s degree in
Chemistry, Biochemistry or branch of
chemistry and at least 2 years of experience
in analytical chemistry
Min. staff Full time chemist, Medical Full time chemist with completed extensive
Technology, Pharmacist, Chemical and appropriate training in chromatography,
Engineer with appropriate training in spectroscopy, and either a Medical
dangerous drugs technologist, Pharmacist, or Chemical
Engineer with appropriate training in the
Authorized Specimen collector screening test procedure