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NAME:______________________ DATE SUBMMITTED _________________-

1. Which of the following organisms isolated from a clinical specimen should be tested by
nitrocefin disc test for beta lactamase production?
a. Escherichia coli
b. Klebsiella pneumoniae
c. Haemophilus influenzae
d. Streptococcus pneumoniae

Penicillin resistance can be chromosomal or acquired by various mechanisms. Certain bacteria possess
the ability to produce enzymes that inactivate beta-lactam antibiotics. Some hydrolyze penicillin class
antimicrobials and are described as penicillinases. Others hydrolyze the cephalosporin class
antimicrobials and are described as cephalosporinases. Some bacteria produce enzymes that hydrolyze
both cephalosporins and penicillins. A positive beta-lactamase result predicts the following:

Nitrocefin disk can detect resistance to penicillin, ampicillin and amoxicillin among Haemophilus spp., N.
gonorrhoeae and M. catarrhalis. (Most strains of M. catarrhalis are now found to be positive for beta
lactamase. Therefore, beta lactams are not used to treat infections by this organisms, and these isolates
are not tested for beta lactamase). A negative result does not rule out resistance due to other
mechanisms. Streptococcus pneumoniae acquires resistance by other mechanism that cannot be
detected by nitrocefin, but by disc diffusion to 1 µg Oxacillin disc (zone size of 19 or more is susceptible.
Some members of Enetrobacteriaceae produce “extended spectrum beta lactamases – ESBLs” and have
a different method of detection and further classification into Class A, B, C ESBLs.

2. After performance of DNA electrophoresis on a specimen, the isolated DNA bands appear too
close together. Which of the following can be done with the next run to improve the separation
of bands in the samples?

a. Increase the percent agarose concentration of the matrix

b. Increase the running time of the electrophoresis assay

c. Increase the sample volume applied to the gel

d. Decrease the sample volume applied to the gel

The rate of electrophoretic separation when using polyacrylamide or agarose gels is affected by time,
current and the percent matrix used. Sample volume will not affect the separation, only makes the
resulting bands more visible when stained. Increased separation can be accomplished by increasing the
time or current used, or by decreasing the percent matrix.

3. Which of the following specimens is acceptable for performing Activated Partial Thromboplastin
time?
a. 24 hours at room temperature
b. 24 hours at 40C

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c. 4 hours at room temperature
d. 4 hours at 40C

Whole blood samples for plasma-based coagulation assays would, in ideal circumstances, be collected
and processed to produce platelet-poor plasma (PPP) within 1 hour.6,10 Transportation and storage of
sodium citrate whole blood samples would occur at ambient temperature (15 to 22°C) and whole blood
samples would not be placed on ice, in an iced water bath, or refrigerated. Sample analysis for routine
assays would be completed within 4 hours of collection, with the notable exception that samples for
prothrombin time (PT) testing are stable for 24 hours. For longer transport times, samples may be
transported and stored in any of the following three conditions: (1) unprocessed as sodium citrate
whole blood samples, (2) centrifuged, but maintained in the primary sodium citrate tube, or (3)
processed by centrifugation and plasma aliquoted into a secondary tube.

If immediate processing is not possible, centrifuge within 4 hours – preferably within one hour - of
collection at a speed of 1500g for at least 15 minutes to achieve platelet poor plasma (platelet count of
<10 X 109/L). Transfer plasma into a polypropylene (cloudy plastic) vial, not polystyrene (clear hard
plastic) being careful to avoid the buffy coat. Specimens can be stored at -20°C for up to 2 weeks or at
-70°C for up to six months. Transport frozen plasma specimens on dry ice.

See this link for more information https://academic.oup.com/labmed/article/43/2/1/2504957

4. The reactivity of blood group A is confirmed by detecting the presence of which immuno-
dominant sugar molecule?
a. N-acetyl-D-neuraminic acid
b. L-fucose
c. N-acetyl-D-galactosamine
d. N-acetyl-D-glucosamine
e. D-galactose

See the diagram below to understand ABO blood group antigens

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5. Which of the following infectious agents is not routinely tested for on donor blood collected for
transfusion?
a. Human immunodeficiency virus
b. Hepatitis A virus
c. Hepatitis C virus
d. Syphilis

All other infectious agents can be found in blood and transmitted to the recipient. Hepatitis A is food-
borne.

6. Which of the following methods is acceptable for preventing transfusion-associated graft-

versus-host disease (GVHD)?
a. The use of frozen deglycerolized RBCs to remove most of the WBCs
b. Screening of blood donors for a history of GVHD
c. Gamma irradiation of blood products to avoid malignant transformation
d. Gamma irradiation of blood products to eliminate lymphocyte proliferation

Transfusion-associated GvHD can be due to transfusion of un-irradiated blood to

immunocompromised recipients. It is associated with higher mortality (80-90%) due to
involvement of bone marrow lymphoid tissue, however the clinical manifestations are similar to
GVHD resulting from bone marrow transplantation. It is almost entirely preventable by controlled
irradiation of blood products to inactivate the white blood cells (including lymphocytes) within.

7. A patient specimen gave the following results:

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Anti-A Anti-B A1 cells B cells
4+ 1+ -- 4+

Which of the following can be a probable cause?

a. Bacterial contamination of reagents
b. Patient is a newborn
c. Patient is very elderly
d. It is a weak subgroup of B

Acquired B antigens are seen in problems with the colon or infections with Gram-negative rods

Bacterial enzymes modify the "A" antigen to a "B" antigen and the patient forward types as an AB but
reverses as an A. 

How would you resolve a possible acquired B antigen?

 Set-up an autocontrol.  The patient's own anti-B will not agglutinate their own AB cells.
 Check clinical history to evidence of colon problems or Gram-negative rods.
 Check monoclonal anti-B product inserts since some will not react with B acquired antisera
 Acidify some reagents anti-B to pH 6 and re-test.  Modified (acquired) B antigens will not react in
the acidified antiserum, normal B antigens will still react

Please refer to the two links provided on the Course Website under Useful Reference Links for
ABO discrepancies under Transfusion Science.
(ABO Discrepancies Troubleshooting very good! http://www.ualberta.ca/~pletendr/tm-
modules/abo/70abo-discrepancies.html
Excellent Explanation of ABO discrepancies with examples
http://haematologywatch.net/resolving-abh-discrepancies.php
ABO Discrepancies http://www.austincc.edu/mlt/clin2/abo1.html)
A Journal Article on ABO Discrepancies and Resolution http://ijtm.in/view_article.php?id=15

8. If you receive a leaking sputum specimen in a sterile plastic container, what would be your first
action?
a. Hold the specimen and call for explanation
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b. Discard in an appropriate container
c. Request recollection by referring to the requisition
d. Use gloves and process the specimen in a biosafety cabinet

Leaking specimen which is not collected by an invasive method must be rejected immediately
for the risk of transmission of infection, following Standard Precautions. The specimen must be
discarded appropriately, then a new specimen must be requested. The requisition must always
be kept in a separate compartment from the specimen so that it can be used as a reference for
requesting a new specimen. It is against the safety rules to move around with a leaking
specimen to request a new one.

If the specimen is obtained by an invasive procedure such as a CSF or Trans-tracheal aspirate,

the patient care-provider must be called, the incidence documented and signed, and the report
should also be sent with a comment about leakage.

9. A bone marrow specimen stained with non-specific esterase exhibits positive brown-red staining
in more than 30% of the cells. Which of the following is the most likely interpretation?
a. Presence of monoblasts
b. Presence of myeloblasts
c. Presence of neutrophils
d. Presence of eosinophils

Non-specific esterase (such as alpha-naphthyl butyrate esterase) is a Cytochemical stain which

stains cells of the monocytic series, and not of the myelocytic series. This stain is useful in
differentiating between monocytic and myelocytic cells and precursors e.g. M5 and M0. The
majority of monocytes stain strongly. Granulocytes and platelets stain negative – some T-
lymphocytes may stain positive. Non-specific esterases are inhibited by NaF. Therefore, the cells
that are stained by nonspecific esterase, but remain unstained after treatment with NaF are
considered to be of monocytic series.

10. Which of the following is the most appropriate anticoagulant for the measurement of
magnesium in plasma?
a. Sodium citrate
b. EDTA
c. Potassium oxalate
d. Heparin

Precautions re sampling, handling for magnesium
1.  Heparins containing zinc should be avoided as these increase measured plasma [magnesium]. 

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Anticoagulants containing oxalate, citrateand EDTA should be avoided as these form complexes 
with magnesium. 

2.  Haemolysed samples should not be used as erythrocytes contain 
higher concentrations of magnesium than serum or plasma. 

3.  Serum or plasma should be separated from the clot or red blood cells 
as soon as possible (approx. 45 min) to prevent an increase in [magnesium] due to leakage 
from the red cells. 

4.  Interference from free calcium has been noted between different analysers when measuring 
free magnesium. Samples should be handled anaerobically to prevent loss of CO2 and analyzed
quickly to prevent  changes in [H+]/pH due to metabolism as this alters distribution of 
magnesium between free, protein bound and complexed forms.

11. Which of the following is the incorrect procedure for hand washing?
a. After removing gloves
b. After removing gown
c. After removing face-protection
d. Before removing face-protection

Depending on the PPE used, hand-hygiene must be done during PPE removal to avoid
contaminating yourself and your clothing. Hand hygiene should be done after removal of gloves
and gown, and before removal of face-protection.

12. During serum protein electrophoresis, it is observed that the protein fractions are smeary and
distorted. What could be the cause?

a. pH of the running buffer is 8.5

b. Ionic strength of the buffer is low
c. Voltage is too high
d. Voltage too low

The gel has overheated. Reduce the voltage, check buffer concentration, and dilute if necessary. The pH
of the running buffer should be about 8.5 to 9.0, above the isoelectric point of proteins. At the
isoelectric point, a protein has no net charge. Above the isoelectric point, a protein carries a net
negative charge—below it, a net positive charge. As a result, the proteins are separated according to
their surface charge densities. If resolved in this way, the human serum yields several classical protein
fractions: albumin moves the farthest, followed by several globulin bands, denoted consecutively as α1,
α2, β (usually separated to β1 and β2), and finally γ globulins.

Protein Electrophoresis Troubleshooting Guide

Linkhttp://www.edvotek.com/site/pdf/Protein_Troubleshoot.pdf

13. Which of the following factors will not affect results of nephelometry?

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a. Lipemia
b. Hemolysis
c. Dirty cuvette
d. Scratched cuvette

Nephelometry depends on particle size. Any specimen or cuvette that increases the light
scatter will affect the results. Therefore, the specimen and reagents must be free of particles,
cuvettes must be free of scratches.

14. During urine routine examination, the leukocyte esterase test on urine strip is strongly positive,
but microscopy shows on an average <5 WBCs/hpf. Which of the following can be a probable
cause of this discrepancy?
a. Urine pH is 5.6
b. Urine pH is 8.2
c. Presence of myoglobin in urine
d. Presence of bacteria in urine

The leukocytes excreted in the urine are almost exclusively granulocytes, whose esterase activity
is detected in the test strip reaction. The test strip detects intact as well as lysed

cells (alkaline pH > 7 or diluted urine indicated by low specific gravity), which cannot be
detected under the microscope. The test for the presence of bacteria, especially those belonging
to Family Enterobacteriaceae, is the Nitrite test because all members of this family reduce
nitrates to nitrites, and not to nitrogen gas.

See below Roche booklet on Urinalysis – Page 32 onwards shows principles, and limitations. For
the answer to the question above, refer to page 36 under “pH”.

http://www.dotsundpixel.de/Dokumente/CompendiumUrinalysis_rz.pdf

15. What are the 3 key pieces of information that need to be on a Workplace Label?

a. Name of product, how to safety handle the product and reference to MSDS
b. Name of product, Name of manufacturer and reference to MSDS
c. Name of manufacturer, date of manufacture and reference to MSDS
d. Name of the product, Name of the manufacturer and how to safely handle the product

WHMIS (GHS) Link https://www.ccohs.ca/oshanswers/chemicals/whmis_ghs/labels.html

16. Which of the following is applicable to interpersonal communication?

a. An individual converses with people they have no interested in knowing
b. An individual interacts with another unique individual
c. A group of two or more persons send and receive information from each other
d. Three or more individuals are communicating with each other at the same time
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Interpersonal Communication came to being when men began to exchange ideas and thoughts
to one another. Interpersonal Communication is a kind of communication in which people
communicate their feeling, ideas, emotions and information face to face to each other. It can be
in verbal or non-verbal form. Interpersonal communication is not only about what is said and
what is received but also about how it is said, how the body language used, and what was the
facial expression.

http://climb.pcc.edu/blog/how-effective-communication-can-save-lives-in-the-healthcare-
industry

17. Which of the following is the best way to handle a stressed patient?
a. Help the patient to feel in control of the situation
b. Tell the patient that you are in control of the situation
c. Leave the room till the patient calms down
d. Report to the physician for non-cooperation of the patient
In healthcare settings, patients are confronted with a myriad of issues that can cause frustration.
You will often be at the front line of their complaints and concerns. These concerns, no matter
how big or small, are often heightened when a patient is hospitalized or in a setting in which
they have no control.
An effective method to help calm the patient down is to let them voice their concerns while you
listen. This is known as active listening. In this capacity, you will often act as the messenger who
relays their concerns and complaints to the nursing staff.

18. While estimating serum cholesterol on a patient sample, the absorbance of 200 mg/dL standard
is 0.92, and absorbance of the sample is 0.52. What is the concentration of cholesterol in
mmol/L in the sample? The conversion factor for mg/dL to mmol/L for cholesterol is 0.026
a. 1.8
b. 2.9
c. 5.2
d. 7.2

To convert 200 mg/dL to mmol/L: 200 X 0.026 = 5.2 mmol/L

Concentration of Cholesterol in specimen = 0.52 X 5.2 ÷ 0.92 = 2.9 mmol/L

19. Which one of the following blood products need to be ABO compatible for transfusion?
a. Cryoprecipitate
b. Albumin
c. Rh anti-D immunoglobulin
d. Lyophilized fibrinogen

A fact sheet on Cryoprecipitate http://hospital.blood.co.uk/media/27096/140904-standard-

cryoprecipitate-a5-factsheet.pdf

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When a transfusion is given, it is preferable for patients to receive blood and plasma of the same ABO
and RhD group.  However if the required blood type is unavailable, a patient may be given a product of
an alternative but compatible group as shown below. 
Blood Compatibility

 Patient Type Compatible Red Cell Types  Compatible Plasma Types

(FFP & Cryoprecipitate)
A A, O A, AB
B B, O B, AB
O O O, A, B, AB
AB
 AB AB, A, B, O

 RhD Positive RhD Positive

 RhD Positive
 RhD Negative  RhD Negative 
RhD Positive
 RhD Negative  RhD Negative
 RhD Negative 

Note that Group O Rh D negative (O negative) red cells have neither ABO nor Rh D antigens on their
surface.  O Rh D negative red cells are issued in emergency situations where life saving transfusion is
required prior to completion of a crossmatch.  
Group AB individuals have neither anti-A nor anti-B antibodies in their plasma. Group AB plasma can
therefore be given to patients of any ABO blood group and is often referred to as the universal plasma
donor.

Albumin Indications – does not need compatible blood group

Hypotension and hypovolemia - 4% Albumin

Hypoalbuminemia - 20% Albumin

Lyophilized Fibrinogen does not need blood group compatibility.

20. Which of the following conditions has an increased concentration of hemoglobin fraction A2?
a. Iron deficiency anemia
b. Lead poisoning
c. Alpha thalassemia major
d. Beta thalassemia minor

The normal Hb A2 (α2δ2) level in an adult is less than 3.5% and it is elevated (>5%) in beta-thalassaemia
trait (minor).

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Beta thalassaemia trait (or heterozygous b-thal or thal minor or thal carrier or thal trait) is a clinically
benign disorder. The importance lies in the fact that if both parents are carriers (i.e. carry one abnormal
beta-gene), an offspring may co-inherit a beta-thalassaemia gene from both the parents making it
homozygous resulting in a medically significant thalassaemia (beta-thalassaemia major). There is a
decreased production of alpha chains in alpha thalassemia – all hemoglobins with alpha chains are lower
than normal.

21. Which of the following is the most likely organism found on gastric mucosa that has a curved
configuration, may be stained with silver impregnation method, and is a presumptive cause of
gastric ulcer?
a. Borrelia burgdorferi
b. Treponema pallidum
c. Leptospira interrogans
d. Helicobacter pylori

Borrelia burgdorferi: causative agent of Lyme disease – transmission through deer tick bite
Treponema pallidum: causative agent of syphilis – sexual transmission
Leptospira interrogans: causative agent of leptospirosis – transmission through skin from water
contaminated with cattle urine
Helicobacter pylori – transmission mechanism unknown – probable oral, not found in stool –
may cause gastric ulcer/carcinoma
Learn the laboratory diagnosis of these pathogens.

22. A Gram staining is performed on a biopsy from a reactive, inflammatory lymph node. The
background structures are stained deep red, making it difficult to see the Gram negative
organisms. What could be the most likely cause?
a. Prolonged staining with basic fuchsin
b. Drying the section following crystal violet
c. Poor differentiation with acetone
d. Incomplete dehydration and clearing

For using Gram stain on tissues, a stain such as fast green is used to stain the background tissues.
After staining with safranin/neutral red, the tissue is differentiated with acetone or picric acid-
acetone, or with acetic acid to remove the red color from the background tissues. If this
differentiation is incomplete, the red stain remains on the background, making it difficult to see the
Gram negative bacteria. Twort or Gallego’s stain can be used as modifications.

23. Which of the following can be used as a reducing agent in the von Kossa method for calcium?
a. Sodium thiosulfate
b. Light
c. Formalin
d. Hydroquinone

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Sodium thiosulfate is used in silver staining methods for the removal of unbound silver. Formalin is
used as a reducing agent in reticulin stain, while hydroquinone is used as a reducing agent in Warthin-
Starry silver staining for spirochetes.

24. Which of the following can be the cause if the frozen section shows an ice-crystal artefact?
a. Freezing of the section too slow
b. Freezing of the section too fast
c. The tissue is very small
d. Outer surface of the tissue is dry

Follow this link to see answers to this and other artefacts for the frozen sections
http://www.pathologyoutlines.com/topic/frozensectiontroubleshooting.html

25. A tissue fixed in B5 fixative is showing brownish deposit on the tissue after staining. Which of
the following methods will effectively remove this artefact?
a. Treatment with iodine followed by sodium thiosulfate
b. Treatment with alcoholic hydrochloric acid
c. Immersion in saturated alcoholic picric acid
d. Bleaching with potassium permanganate

During fixation with fixatives containing mercuric chloride a crystalline or amorphous greenish-brown
artefact pigment of mercury is randomly deposited in tissues. Treatment of specimens with iodine
(Lugol’s iodine) during processing or sections prior to staining, will produce mercuric iodide which can be
washed out of the tissues. A subsequent treatment with sodium thiosulphate then removes residual
iodine. Mercuric chloride-based fixatives tend to penetrate poorly and if fixation is prolonged tissues
become very hard and are prone to shrinkage during processing. Alcoholic hydrochloride is used for
removing chromate deposit, saturated alcoholic picric acid for formalin pigment, bleaching to remove
excess melanin (especially in immunohistochemistry)

Link to an excellent comprehensive article on ‘Artefacts in Histopathology’ – very useful for

troubleshooting questions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211218/

26. A 68-year-old man presents with long term back and ribs pain, and chronic fatigue. His lab
results were as follows:
Total Serum Protein: 140 g/L Serum Albumin: 30 g/L
BUN: 15.1 mmol/L Serum Calcium: 4.3 mmol/L ESR: 52 mm
Which of the following will be an appropriate follow up to reach a diagnosis?
a. Blood gases
b. Liver enzymes
c. Serum electrophoresis
d. Parathyroid hormone levels

The patient’s symptoms and his elevated serum proteins and globulins with raised serum calcium and
BUN levels as well as a high ESR are highly suggestive of multiple myeloma. The presence of M-spike in
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the serum electrophoresis will be a confirmation of the lab diagnosis of multiple myeloma. The M-spike
is also observed in Waldenstrom’s macroglobulinemia syndrome. However, there is no increase in
serum calcium and BUN levels in Waldenstrom’s.

For interpretation of results, it is essential to know the Reference Ranges and critical results of common
components. These links are provided on the course website under “Reference Links”.

27. A patient was admitted for deep vein thrombosis, and started on unfractionated heparin
therapy (UFH). On day 3, patient’s platelet count went down from original 240 X10 9/L to
55 X109/L. Which of the following can be the most probable cause?
a. Antibodies to PF3-Heparin complex
b. Antibodies to PF4-Heparin complex
c. Antithrombin deficiency
d. Factor V Leiden mutation

In a small number of patients on unfractionated heparin therapy, a serious immune-mediated

condition can develop when the patient develops antibodies to Platelet factor 4-heparin
complex. The resulting immune complexes bind to platelets and cause their activation and
aggregation causing thrombosis and thrombocytopenia.

PF3 is a phospholipid that actively participates as a catalyst in the coagulation cascade.

Antithrombin is a regulator of coagulation and arrests coagulation when the injury is plugged
with a clot – its deficiency can cause thrombosis (abnormal coagulation in an intact blood
vessel). Factor V Leiden is a mutation of Factor V which is resistant to inactivation by Protein C &
S complex, another regulator of coagulation.

28. How are the cell populations identified using multiple fluorescent dyes in a flow cytometer?
a. Each specific antigen is bound to a different fluorescent dye with the same emission
wavelengths
b. Each specific antigen is bound to a different fluorescent dye with the different emission
wavelengths
c. Each specific antibody is bound to a different fluorescent dye with the same emission
wavelengths
d. Each specific antibody is bound to a different fluorescent dye with the different emission
wavelengths

Light emitted from fluorescently labeled antibodies can identify a wide array of cell surface
and cytoplasmic antigens. The use of multiple fluorochromes, each with similar excitation
and different emission wavelengths allows different cell properties or populations to be
measured simultaneously. This approach makes flow cytometry a powerful tool for detailed
analysis of complex populations in a short period of time.

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29. Which of the following is least likely to be a source of contamination in PCR?

a. Amplicons from previous amplifications
b. Use of positive displacement pipettes and tips
c. Aerosol droplets that can form during uncapping the tubes
d. Not using gloves while handling reagents and tubes

PCR provides an extremely sensitive means of amplifying small quantities of DNA. The most important
consideration in PCR is avoiding contamination. If the test sample has even the smallest contamination
of DNA from the target, the reaction could amplify this DNA and report a false positive identification. All
other methods except (b) can lead to contamination of the PCR assay giving erroneous results.

The positive-displacement pipette ensures complete protection against cross-contamination. It uses a

mechanism that isolates the aspirated sample from the body of the pipette, eliminating the air space in
which aerosols can form by resorting to disposable capillary and piston tips. The wiping action of the
piston against the capillary wall ensures accurate dispensing of even the most viscous sample and avoids
any carryover

Two pipetting concepts: air displacement using standard filter tips, and positive displacement with a
piston.

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30. Which of the following antibacterial susceptibility result needs a follow up for a phenotype
confirmation as a ESBL?

Ceftriaxone Ceftriaxone + Cefoxitin

Clavulanic acid
a. Escherichia coli R S S
b. Acinetobacter baumanii R R R
c. Klebsiella pneumoniae R R S
d. Proteus mirabilis R S R

Beta-lactamases are enzymes that open the beta-lactam ring, inactivating the antibiotic. The term ESBL
(Extended Spectrum Beta Lactamases) is used to mean acquired (plasmid-mediated, transferable) Class
A Beta-lactamases that hydrolyze and confer resistance to oxyimino 2 nd and 3rd generation
cephalosporins, e.g. cefuroxime, cefotaxime, ceftazidime, and ceftriaxone.

ESBL Confirmatory Tests: Ceftazidime & Ceftazidime-Clavulanic acid (CA) Disks; Ceftriaxone &
Ceftriaxone-Clavulanic acid disks with the lawn culture of the test organism on Muller-Hinton agar. A 5
mm or more enhancement of the zone of inhibition with antibiotic/CA combination vs antibiotic tested
alone indicates ESBL (Class A). This group is also susceptible to a cephamycin such as cefoxitin.

Cefotaxime

Cefotaxime +

Clavulanic acid

CMZ is a cephamycin like cefoxitin.

AMPC beta lactamases differ from ESBLs in that they are most commonly present on chromosomes (not
transferable), though rarely on plasmids. They are generally produced by virtually all GNBs, but have
generally low activity. They differ in E coli/Klebsiella/Indole negative Proteus species (P. mirabilis) in that
they are not inhibited by beta lactamase inhibitors such as clavulanic acid. They are also resistant to
cephamycins such as cefoxitin. Bacteria such as Acinetobacter spp and Stenotrophomonas maltophilia
are never tested for ESBLs because they have different mechanisms of resistance.

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ESBLs vs AmpCs

BETA LACTAMS

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