Instructions: Please complete the information below.  Be sure to select your group on the left below (CBC, RMCHP, or FP if OUTPATIENT, OR a Service if INPATIENT / HOSPITAL). In addition, select the corresponding clinic or hospital service (drop down menu).  AGENCY: Please use last 6 digits of social security number for Employee ID.
Employee Information  
Emp ID  First Last
     
 
UTMB Clinics                  
CBC                                        
RMCHP                                   
 Hospital  Service               

PRECEPTOR NAME (TEST SITE MANAGER NAME or QUALIFIED) who observed you PERFORM a TEST:      
UNIT or CLINIC NAME:   

(what' s this? Click for explanation) 

Date: Month    Year 

 

  

 

 

 

 

 

 

 

 

 

1. It is recommended patients abstain from taking antibiotics or bismuth salts for at least _______________ before endoscopy procedure. Supression of H.pylori by these agents makes the organism difficult to detect by any means, AND re-growth of H. pylori may be patchy, leading to a false negative results in the first few weeks after treatment.

three days
three weeks
three months
 


                                                                                         

 

 

 

 

 

2. After insertion of specimen, CLOtest must remain at temperatures between 30-40 celsius. CLOtests may not be reported as negative before the _____ hour incubation period is over

12
24
48

                                                                                         

3. CLOtest is used in the detection of ____________ which has been shown to be the main cause of chronic gastritis. A color change from yellow to pink denotes the presence of this organism.

Proteus mirrabilis a gram negative bacillus
Bacillus thuringensis, a gram positive bacillus
Helicobacter pylori, a gram negative bacillus

                                                                                         
 

 

 

 

 

 

4. A fail-check must be performed on ALL NEGATIVE CLOtests. That is if the gel is still yellow at 24 hours, A UREASE TABLET is inserted to the CLOtest card. In order to comply with the regulations, the results of this fail check must be documented on the appropriate log.

TRUE
FALSE

                                                                                         

5. For bloody biopsy samples, a color other than yellow may be seen around the edge of the biopsy sample (after insertion). This is NOT considered a positive test.

TRUE
FALSE

                                                                                         

6. A positive CLOtest is depicted by the development of a ____________ color. Yellow is considered negative.

Orange
pink
magenta
all of the above


                                                                                         

7. The following may be causes of false negatives:

Very low numbers of H. pylori in the tissue sample
Patchy H. pylori distribution so that the organism is not captured in the sample.
Recent ingestion of antibiotics, bismuth, proton pump inhibitors, or sucralfate which can inhibit the organism.
Formalin contamination of the sample
Sample of intestinal metaplasia -- (H. pylori does not colonize intestinal mucosa)
 All of the above