Skip to content
MedExams

Fixation and fixatives

11 DOH Abu Dhabi (HAAD) lab licensing practice questions on Fixation and fixatives, part of Histopathology and Cytology. The first 11 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

  1. Question 1 · Hard

    A pathologist slices a resected spleen into parallel slabs 5 mm thick and places them in a large volume of 10% neutral buffered formalin, laid so that fixative reaches both cut faces of every slab. The laboratory procedure estimates formaldehyde penetration with Medawar's relation d = K√t, where d is the distance penetrated in millimeters, t is the time in hours, and K is taken as 0.78 for 10% formalin. Before scheduling the slabs for the overnight processor, the technologist estimates how long formaldehyde needs to reach the middle of each slab. The best estimate is:

    1. AAbout 10 hours
    2. BAbout 3 hours
    3. CAbout 5 hours
    4. DAbout 41 hours
    Show answer

    Answer: A · About 10 hours

    Formalin enters each slab from both cut faces, so the middle lies 2.5 mm, half of the 5 mm thickness, from each surface. Rearranging d = K√t gives t = (d/K)², so t = (2.5 ÷ 0.78)² = 3.2² ≈ 10.3 hours. Using the full 5 mm thickness gives (5 ÷ 0.78)² ≈ 41 hours, stopping at d ÷ K without squaring gives 3.2 hours, and multiplying d² by K gives about 4.9 hours. Because the time rises with the square of the distance, halving slab thickness cuts the penetration time to a quarter. Penetration is also not the same as fixation: formaldehyde forms its cross-links slowly after it arrives, so the slabs need longer in formalin than this estimate alone.

    • B: 3 hours is d ÷ K, without squaring the result.
    • C: 5 hours comes from multiplying d² by K instead of squaring d ÷ K.
    • D: 41 hours uses the full 5 mm thickness, but fixative enters from both faces.
  2. Question 2 · Hard

    A 30-cm colectomy arrives unopened in a 500 mL container of formalin after 20 hours. The serosa is well fixed but the mucosa is autolyzed. The best way to prevent this is to:

    1. ADouble the formaldehyde strength to 8%
    2. BLeave it longer in the same container
    3. COpen it promptly and use ample formalin
    4. DAdd acetic acid to speed penetration
    Show answer

    Answer: C · Open it promptly and use ample formalin

    In an unopened bowel the lumen holds no fixative, so formalin must cross the whole wall to reach the mucosa, which autolyzes first. Hollow organs should be opened promptly, as the pathologist directs, and placed in enough formalin, about 10 to 20 times the specimen volume. Stronger formalin adds hazard but still cannot reach a closed lumen any sooner. Autolysis that has already happened is not reversed by longer fixation.

    • A: Stronger formalin adds hazard but still cannot reach the closed lumen.
    • B: Autolysis that has already happened is not reversed by longer fixation.
    • D: Acetic acid does not open the lumen and it swells collagen and lyses red cells.
  3. Question 3 · Medium

    A suspected gouty tophus is sent for histology, and the clinician wants the urate crystals shown. Which fixative should be used?

    1. ABouin solution
    2. BGlutaraldehyde
    3. C10% neutral buffered formalin
    4. DAbsolute ethanol
    Show answer

    Answer: D · Absolute ethanol

    Monosodium urate crystals dissolve in aqueous fixatives such as formalin, so they can be lost before the slide is made. Fixation in absolute (or near-absolute) ethanol keeps them in the tissue. The crystals are needle-shaped and strongly negatively birefringent under polarized light. In formalin-fixed tissue often only empty, feathery spaces remain where the crystals were.

    • A: Bouin is aqueous and acidic, and also dissolves them.
    • B: Glutaraldehyde is used in aqueous buffer for electron microscopy and dissolves the crystals.
    • C: Aqueous formalin dissolves urate crystals.
  4. Question 4 · Easy

    How do ethanol and methanol fix tissue?

    1. AThey denature and precipitate proteins
    2. BThey form methylene bridges between proteins
    3. CThey bind lipids and make them insoluble
    4. DThey chelate calcium within the tissue
    Show answer

    Answer: A · They denature and precipitate proteins

    Alcohols strip water from proteins, which denatures them and makes them precipitate in place, so they are called coagulant fixatives. They act quickly but shrink and harden tissue and dissolve most lipids. This speed is why alcohol-based fixatives are used for thin material such as smears and frozen sections. Formaldehyde, by contrast, forms methylene cross-links between proteins.

    • B: Methylene bridges are how formaldehyde fixes tissue.
    • C: Osmium tetroxide fixes lipids; alcohols dissolve them.
    • D: Chelating calcium is how EDTA decalcifies; it is not fixation.
  5. Question 5 · Easy

    A portion of a renal biopsy is kept for electron microscopy. Which fixative should it go into?

    1. ABouin solution
    2. B95% ethanol
    3. C10% neutral buffered formalin
    4. DBuffered glutaraldehyde
    Show answer

    Answer: D · Buffered glutaraldehyde

    Glutaraldehyde has two aldehyde groups, so it cross-links proteins quickly and extensively and preserves fine cell structure best. It penetrates slowly, so tissue for electron microscopy is cut into pieces about 1 mm across. Post-fixation in osmium tetroxide then preserves membrane lipids and adds electron density. Formalin-fixed tissue can be used for electron microscopy if nothing else is available, but the ultrastructure is poorer.

    • A: Bouin's acids damage fine structure; it is a light microscopy fixative.
    • B: Ethanol coagulates proteins and distorts ultrastructure.
    • C: Formalin suits light microscopy but preserves ultrastructure poorly.
  6. Question 6 · Hard

    A breast core biopsy for ER, PR and HER2 testing is placed in 10% neutral buffered formalin at 16:00 on a Friday. Under the ASCO/CAP fixation window of 6 to 72 hours, what is the latest time it may leave formalin for processing?

    1. AFriday at 22:00
    2. BSunday at 16:00
    3. CSaturday at 16:00
    4. DMonday at 16:00

    Answer and explanation in LearnFree account

  7. Question 7 · Easy

    Stock formalin is a 37-40% solution of formaldehyde gas in water. A 10% formalin fixative therefore contains about:

    1. A1% formaldehyde
    2. B10% formaldehyde
    3. C4% formaldehyde
    4. D37% formaldehyde

    Answer and explanation in LearnFree account

  8. Question 8 · Medium

    Why does commercial 37-40% formaldehyde solution contain methanol?

    1. ATo speed its penetration into tissue
    2. BTo prevent formalin pigment forming
    3. CTo buffer it near pH 7
    4. DTo stop it polymerizing to paraformaldehyde

    Answer and explanation in LearnFree account

  9. Question 9 · Medium

    Gastric biopsies were left on a dry gauze swab for 30 minutes before going into formalin. Their edges show smudged nuclei and poor staining. The most likely cause is:

    1. AAir-drying before fixation
    2. BOverheating on the hot plate
    3. COver-fixation in formalin
    4. DIncomplete paraffin infiltration

    Answer and explanation in LearnFree account

  10. Question 10 · Hard

    Several blood-rich specimens this week show fine brown-black, birefringent granules lying outside cells over red cell areas. All were fixed in a new in-house batch: 100 mL stock formalin plus 900 mL tap water, pH 5.2. The best conclusion is:

    1. AMercury pigment; treat sections with iodine
    2. BFormalin pigment; buffer the fixative to pH 7
    3. CMalaria pigment; review the travel histories
    4. DHemosiderin; confirm it with a Perls stain

    Answer and explanation in LearnFree account

  11. Question 11 · Medium

    A testis biopsy was fixed in Bouin solution. Weeks later a PCR-based test is requested on the block. Why is the result likely to be poor?

    1. AIts acids degrade nucleic acids
    2. BIt prevents paraffin infiltration
    3. CIt fixes nuclei poorly
    4. DIts picric acid tints DNA yellow

    Answer and explanation in LearnFree account

More Histopathology and Cytology questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Histopathology and Cytology