Master Urinalysis Microscopic for your laboratory certification exam with our comprehensive collection of 125 multiple-choice questions (MCQs). Focused exclusively on Urinalysis Microscopic Examination, these practice questions align with the latest syllabi of ASCP MLS, AMT MLT/MT, AIMS, CSMLS, IBMS, HAAD/DOH, DHA, and MOH exams. Each MCQ includes detailed explanations and references to reinforce key concepts. Sharpen your critical thinking, identify knowledge gaps, and build speed with exam-style questions—all for free. Ideal for targeted revision!

125 MCQs (923-1047):
- Which of the following is the best method to identify a glitter cell in urine sediment?
a) Phase-contrast microscopy
b) Polarized light microscopy
c) Brightfield microscopy
d) Supravital staining - The presence of dysmorphic red blood cells in urine suggests:
a) Lower urinary tract infection
b) Renal origin of hematuria
c) Hemolysis in the bladder
d) Sample contamination - Oval fat bodies in urine sediment are most often associated with:
a) Cystitis
b) Nephrotic syndrome
c) Glomerulonephritis
d) Pyelonephritis - Which urine sediment constituent exhibits a Maltese cross appearance under polarized light?
a) Hyaline casts
b) WBCs
c) Lipid droplets
d) Uric acid crystals - A finding of broad waxy casts is most consistent with:
a) Acute glomerulonephritis
b) Pyelonephritis
c) Chronic renal failure
d) Nephrotic syndrome - Which of the following crystals is typically found in acidic urine?
a) Triple phosphate
b) Calcium oxalate
c) Ammonium biurate
d) Calcium carbonate - The most common type of cast seen in healthy individuals after exercise is:
a) Granular cast
b) Waxy cast
c) RBC cast
d) Hyaline cast - Which urinary sediment element has a characteristic ‘budding’ appearance and may be accompanied by pseudohyphae?
a) Trichomonas
b) Candida species
c) Renal epithelial cells
d) Transitional epithelial cells - What urinary finding is most indicative of glomerulonephritis?
a) Bacteria
b) RBC casts
c) Calcium oxalate crystals
d) Oval fat bodies - Which of the following casts is composed primarily of uromodulin (Tamm-Horsfall protein)?
a) Waxy cast
b) RBC cast
c) Hyaline cast
d) Fatty cast - Which organism is commonly identified in urine sediment by its jerky motility?
a) E. coli
b) Trichomonas vaginalis
c) Candida albicans
d) Schistosoma haematobium - Which of the following epithelial cells is considered clinically significant in urine sediment?
a) Squamous epithelial cells
b) Transitional epithelial cells
c) Renal tubular epithelial cells
d) All are insignificant - What is the primary distinguishing feature of a waxy cast?
a) Granular appearance
b) High refractive index and blunt ends
c) Presence of RBCs inside
d) Transparent cylindrical shape - Which of the following urine sediment elements is best confirmed using supravital stains like Sternheimer-Malbin?
a) Crystals
b) Casts
c) Cells and cytoplasmic details
d) Bacteria - Which cast type is most often associated with acute tubular necrosis (ATN)?
a) Hyaline
b) RBC cast
c) Granular cast
d) Renal epithelial cell cast - What is the most common urinary crystal seen in normal individuals?
a) Cystine
b) Uric acid
c) Triple phosphate
d) Calcium oxalate - Cystine crystals are most often seen in patients with:
a) Nephrotic syndrome
b) Cystinuria
c) Gout
d) Alkaline urine - Which urinary cast may appear ‘coarsely’ granular due to degenerated cells?
a) Fatty cast
b) Hyaline cast
c) Granular cast
d) Waxy cast - Which organism found in urine has a lemon or oval shape and is best observed by motility under microscopy?
a) Trichomonas vaginalis
b) Candida species
c) Schistosoma haematobium
d) Enterobius vermicularis - What is the shape of calcium oxalate dihydrate crystals?
a) Coffin-lid
b) Envelope or octahedral
c) Dumbbell
d) Rosette - Which cast is composed of lipid-containing renal tubular epithelial cells?
a) RBC cast
b) Waxy cast
c) Fatty cast
d) Hyaline cast - A urine specimen showing bacteria and WBCs but no epithelial cells is most likely:
a) Contaminated
b) Vaginal flora
c) A true infection
d) Improperly collected - Which stain is used to confirm the presence of lipids in oval fat bodies?
a) Gram stain
b) Prussian blue
c) Sudan III or Oil Red O
d) Wright’s stain - Triple phosphate crystals are most commonly found in:
a) Acidic urine
b) Alkaline urine
c) Neutral urine
d) Freshly voided urine - Which of the following is a normal finding in small numbers in healthy individuals?
a) RBC casts
b) Broad casts
c) Squamous epithelial cells
d) Oval fat bodies - Urine contaminated with vaginal secretions is most likely to contain:
a) Waxy casts
b) Squamous epithelial cells
c) Broad casts
d) Renal tubular cells - Which of the following is birefringent under polarized light?
a) Hyaline cast
b) Uric acid crystal
c) WBC
d) Fatty cast - Which sediment finding is characteristic of pyelonephritis?
a) Oval fat bodies
b) Broad casts
c) WBC casts
d) Calcium oxalate crystals - Which of the following best distinguishes transitional epithelial cells from renal tubular cells?
a) Shape and location
b) Granularity
c) Size and nucleus-to-cytoplasm ratio
d) Presence of lipids - Which of the following elements in urine may appear as “ghost cells”?
a) WBCs
b) Squamous cells
c) RBCs
d) Renal tubular cells - Amorphous urates typically form in:
a) Alkaline urine
b) Acidic urine
c) Highly diluted urine
d) Midstream clean-catch urine - Which of the following crystals has a hexagonal shape and indicates an inherited metabolic disorder?
a) Uric acid
b) Cystine
c) Triple phosphate
d) Cholesterol - Cholesterol crystals in urine typically appear as:
a) Flat plates with notched corners
b) Needles arranged in sheaves
c) Coffin-lid structures
d) Dumbbells - A patient with severe liver disease may have which of the following in their urine?
a) Cystine crystals
b) Tyrosine crystals
c) Uric acid crystals
d) Ammonium biurate crystals - Leucine crystals are best described as:
a) Spheres with concentric rings and radial striations
b) Hexagonal plates
c) Needles in bundles
d) Rhomboids - Which urinary constituent is most likely to show Brownian movement under the microscope?
a) Bacteria
b) RBCs
c) Crystals
d) Yeast - A clue to differentiate yeast cells from RBCs in urine is that yeast cells:
a) Have a uniform size
b) Exhibit budding
c) Are refractile under light
d) Are smaller than RBCs - Which sediment component shows a wrinkled appearance and varies in shape and color?
a) Calcium carbonate
b) Uric acid crystals
c) Cholesterol crystals
d) Triple phosphate - Which of the following is characteristic of a glitter cell?
a) Highly refractile fat droplets
b) RTE cell with granules
c) Neutrophil with sparkling granules
d) Waxy cast with inclusions - What sediment finding is most diagnostic of acute interstitial nephritis?
a) Bacteria
b) WBC casts
c) RBC casts
d) Fatty casts - The presence of which cast strongly suggests tubular damage?
a) Hyaline cast
b) RBC cast
c) RTE cell cast
d) Waxy cast - Which of the following is most likely to cause a false interpretation of casts in urine sediment?
a) Staining with Oil Red O
b) Use of polarized light
c) Not centrifuging the specimen
d) Contamination with mucus threads - The presence of ghost RBCs is associated with:
a) Concentrated urine
b) Alkaline urine
c) Fresh specimens
d) Highly acidic urine - Which type of epithelial cell is normally abundant in female urine samples due to contamination?
a) RTE cells
b) Transitional cells
c) Squamous cells
d) Glitter cells - Which of the following urinary casts indicates chronic renal failure?
a) Fatty cast
b) Broad waxy cast
c) Hyaline cast
d) Granular cast - The Tamm-Horsfall protein is produced by:
a) Glomerular capillaries
b) Renal tubular epithelial cells
c) Bladder urothelium
d) Loop of Henle - Which of the following crystals may be confused with cholesterol when viewed under polarized light?
a) Cystine
b) Uric acid
c) Radiographic dye
d) Tyrosine - Which sediment element exhibits a rapid, darting motility?
a) Yeast
b) Trichomonas vaginalis
c) Bacteria
d) WBC
- Which urinary crystal is considered abnormal and appears as colorless hexagonal plates?
a) Tyrosine
b) Cystine
c) Uric acid
d) Leucine - Which of the following best distinguishes yeast from RBCs?
a) Refractivity
b) Color
c) Budding and hyphae
d) Size - What is the significance of observing a renal tubular epithelial cell cast in urine?
a) Bladder infection
b) Normal finding
c) Tubular injury or necrosis
d) Glomerular bleeding - Amorphous phosphates are typically found in:
a) Acidic urine
b) Alkaline urine
c) Concentrated urine
d) Dilute acidic urine - What is the most characteristic feature of bacteria under the microscope?
a) Rapid Brownian motion
b) Refractile bodies
c) Budding forms
d) Concentric striations - Which urinary sediment component may resemble RBCs but can be differentiated by their high refractility and budding?
a) WBCs
b) Yeast
c) Squamous cells
d) Transitional cells - Which element in urine sediment is birefringent and confirms nephrotic syndrome when seen as oval fat bodies?
a) Triple phosphate
b) Cholesterol
c) Amorphous urates
d) Tyrosine - Which microscope objective is appropriate for enumerating cellular elements like RBCs, WBCs, and bacteria in urine sediment?
a) Low power (10×)
b) High dry power (40×)
c) Oil immersion (100×)
d) Phase contrast - A urine sediment shows numerous squamous epithelial cells with a negative leukocyte esterase and nitrite strip. This likely indicates:
a) Contamination from skin/vagina
b) Improper refrigeration
c) Urinary tract infection
d) Chronic kidney disease - Oval fat bodies are:
a) Hyaline casts with embedded lipids
b) Lipid-filled squamous epithelial cells
c) Transitional cells with cholesterol
d) Renal tubular cells absorbing lipids - Ghost RBCs are most associated with:
a) Acidic urine (pH 6.5)
b) Low specific gravity (1.000)
c) High ketones (5 mg/dL)
d) High glucose (1000 mg/dL) - Glitter cells refer to:
a) RBCs in concentrated urine
b) RBCs in dilute urine
c) WBCs in concentrated urine
d) WBCs in dilute urine - Non-clean-catch urine specimens often show:
a) White blood cells
b) Renal epithelial cells
c) Squamous epithelial cells
d) Transitional epithelial cells - Microscopic findings showing faint, empty RBC membranes are called:
a) Clue cells
b) Ghost cells
c) Glitter cells
d) Oval fat bodies - A cast with fine granular inclusions is classified as:
a) Broad
b) Hyaline
c) Cellular
d) Granular - Bacterial vaginosis is associated with:
a) Clue cells
b) Ghost cells
c) Glitter cells
d) Oval fat bodies - Catheterization may dislodge cells from the bladder lining, visible as:
a) Hyaline casts
b) Oval fat bodies
c) Transitional epithelial cells
d) Renal tubular epithelial cells - Numerous WBCs and bacteria in sediment indicate:
a) Cystitis (bladder infection)
b) Pyelonephritis (kidney infection)
c) Glomerulonephritis
d) Nephrotic syndrome - Small, biconcave discs with central pallor in urine sediment are:
a) Red blood cells
b) Urothelial cells
c) White blood cells
d) Tyrosine crystals - Urinary casts are primarily composed of:
a) Albumin
b) Globulins
c) Paraprotein
d) Uromodulin (Tamm-Horsfall protein) - Casts are best examined:
a) With glacial acetic acid added
b) Under bright light at 40×
c) With Sternheimer-Malbin stain
d) Under dim light at 10× - Healthy individuals may have occasional:
a) Fatty casts
b) Waxy casts
c) Hyaline casts
d) Granular casts - Waxy casts indicate:
a) Renal failure
b) Acute inflammation
c) Glomerular damage
d) Dehydration - Hyaline casts disappear after 2 hours due to:
a) Increased pH
b) Decreased pH
c) Higher temperature
d) Lower temperature - Renal tubular cells differ from transitional cells by their:
a) Larger size
b) Central nuclei
c) Eccentric nuclei
d) Smaller size - Pyelonephritis (kidney infection) is distinguished from cystitis by:
a) WBCs
b) RBCs
c) Bacteria
d) WBC casts - Renal tubular epithelial cell casts suggest:
a) Pyelonephritis
b) Tubular necrosis
c) Glomerulonephritis
d) Nephrotic syndrome - Casts with serrated edges are typically:
a) Fatty
b) Waxy
c) Hyaline
d) Granular - A WBC cast (not a clump) is confirmed by:
a) Positive nitrite
b) Positive leukocyte esterase
c) Cast matrix
d) Free-floating WBCs - Renal tubular epithelial cells resemble:
a) Oil droplets
b) White blood cells
c) Sulfonamide crystals
d) Squamous epithelial cells - Before reporting an RBC cast, verify:
a) Hyaline casts
b) Granular casts
c) Free-floating RBCs
d) Increased WBCs - Hexagonal plate-shaped crystals indicate:
a) Cystinuria
b) Tyrosinemia
c) Galactosemia
d) Maple syrup urine disease - RBC casts correlate with:
a) Cystitis
b) Pyelonephritis
c) Glomerulonephritis
d) Nephrotic syndrome - A white precipitate in refrigerated alkaline urine is:
a) Uric acid crystals
b) Amorphous urates
c) Amorphous phosphates
d) Triple phosphate crystals - Pathologic hexagonal crystals are:
a) Cystine
b) Tyrosine
c) Leucine
d) Cholesterol - Most kidney stones contain:
a) Uric acid
b) Cholesterol
c) Calcium oxalate
d) Ammonium biurate - Cloudiness after refrigeration is due to:
a) Bacteria
b) Hyaline casts
c) White blood cells
d) Amorphous crystals - Rectangular plates with notched corners are:
a) Cystine
b) Uric acid
c) Isoleucine
d) Cholesterol - Acidic urine favors formation of:
a) Ammonium biurate
b) Calcium phosphate
c) Calcium oxalate
d) Triple phosphate - Birefringent under polarized light:
a) Cholesterol
b) Triglycerides
c) Fatty acids
d) Neutral fats
- Colorless, fine needles in clusters:
a) Leucine
b) Tyrosine
c) Cholesterol
d) Hemosiderin - Amber urine with bilirubin may show:
a) Cystine
b) Cysteine
c) Tyrosine
d) Uric acid - Ethylene glycol ingestion produces:
a) Yellow-brown spherules (leucine)
b) Dumbbell-shaped crystals (calcium oxalate monohydrate)
c) Rosettes (uric acid)
d) Notched plates (cholesterol) - Cholesterol crystals appear with:
a) pH 8.0
b) Protein 4+
c) Ketones 40 mg/dL
d) Glucose 500 mg/dL - Uric acid crystals in an infant suggest:
a) Viral hepatitis
b) Ethylene glycol toxicity
c) Increased purine metabolism
d) Contamination - Triple phosphate crystals are:
a) Acidic and pathologic
b) Alkaline and pathologic
c) Acidic and nonpathologic
d) Alkaline and nonpathologic - Rhombic plates forming rosettes are:
a) Tyrosine
b) Uric acid
c) Calcium oxalate
d) Ammonium biurate - Dissolving amorphous phosphates requires:
a) New sample
b) Normal saline dilution
c) Acetic acid
d) Warm water - Polarized light distinguishes:
a) Hyaline vs. waxy casts
b) Uric acid vs. cystine crystals
c) RBCs vs. WBCs
d) Squamous vs. transitional cells - Contaminant with Maltese cross under polarized light:
a) Oil droplets
b) Air bubbles
c) Glass shards
d) Starch - Colorless rhombic plates/rosettes:
a) Leucine
b) Uric acid
c) Cholesterol
d) Triple phosphate - A fiber-like artifact is a:
a) Cloth fiber
b) Waxy cast
c) Hyaline cast
d) Granular cast - Glacial acetic acid lyses:
a) Yeast
b) RBCs
c) Oil droplets
d) Creates RBCs - Urine pH helps identify crystals because:
a) Crystal solubility depends on pH
b) Nitrite indicates infection
c) Protein affects precipitation
d) Specific gravity reflects concentration - Bacteria in urine are significant when:
a) Nitrite is negative
b) Protein is positive
c) Urine is dark yellow
d) WBCs are present - Rapid motility identifies:
a) Yeast
b) Bacteria
c) Spermatozoa
d) Trichomonas - A clear, smooth cylindrical cast is:
a) Waxy
b) Cellular
c) Hyaline
d) Granular - Bacilli in sediment correlate with:
a) Ketones
b) Glucose
c) Specific gravity
d) Nitrite - Budding cells in acidic, glucose-rich urine indicate:
a) E. coli
b) Candida albicans
c) Trichomonas vaginalis
d) Enterobius vermicularis - Yellow-brown spheres with concentric circles:
a) Leucine
b) Bilirubin
c) Triple phosphate
d) Ammonium biurate - Small, ovoid, budding elements are:
a) Yeast
b) Red blood cells
c) White blood cells
d) Renal tubular cells - A positive nitrite test suggests the presence of:
a) Gram-positive cocci
b) Yeast
c) Nitrate-reducing bacteria
d) Epithelial cells - The presence of bilirubin in urine is most associated with:
a) Hemolytic anemia
b) Biliary obstruction
c) Renal failure
d) Dehydration - Which of the following causes a fruity urine odor?
a) Bilirubin
b) Urea
c) Ketones
d) Ammonia - The most accurate method for detecting protein in urine is:
a) Sulfosalicylic acid test
b) Reagent strip
c) Heat and acetic acid test
d) Biuret test - Which reagent strip test is based on the Ehrlich reaction?
a) Ketones
b) Urobilinogen
c) Bilirubin
d) Glucose - A high specific gravity in urine may be caused by:
a) Renal failure
b) Diabetes insipidus
c) Dehydration
d) Overhydration - The reagent strip test for blood detects:
a) Free hemoglobin only
b) Intact RBCs only
c) Myoglobin and hemoglobin
d) Only WBCs - A positive leukocyte esterase test indicates:
a) Hematuria
b) Pyuria
c) Ketosis
d) Hyperbilirubinemia - Which of the following is NOT a confirmatory test for protein?
a) SSA (Sulfosalicylic acid) test
b) Bence Jones protein test
c) Acetic acid test
d) Clinitest - A patient’s urine sample shows a pH of 8.5. What should be considered?
a) Normal pH
b) Old or improperly stored specimen
c) Dehydration
d) Renal tubular acidosis - Which of the following ketone bodies is detected by the reagent strip?
a) Acetone
b) Acetoacetic acid
c) β-hydroxybutyrate
d) All of the above - The presence of glucose in urine is called:
a) Glycosuria
b) Hematuria
c) Pyuria
d) Albuminuria - Which condition is most commonly associated with ketonuria?
a) Liver cirrhosis
b) Diabetes mellitus
c) Nephrotic syndrome
d) Urinary tract infection - A reagent strip positive for bilirubin should be confirmed by:
a) SSA test
b) Acetest
c) Ictotest
d) Biuret test - The most common cause of glucosuria is:
a) Low renal threshold
b) Pancreatic cancer
c) Diabetes mellitus
d) Starvation - Which condition gives a false positive for blood on urine dipstick?
a) Myoglobinuria
b) Hematuria
c) Pyuria
d) Hyperbilirubinemia
Answer Key
Answer Key:
- a) Phase-contrast microscopy
- b) Renal origin of hematuria
- b) Nephrotic syndrome
- c) Lipid droplets
- c) Chronic renal failure
- b) Calcium oxalate
- d) Hyaline cast
- b) Candida species
- b) RBC casts
- c) Hyaline cast
- b) Trichomonas vaginalis
- c) Renal tubular epithelial cells
- b) High refractive index and blunt ends
- c) Cells and cytoplasmic details
- d) Renal epithelial cell cast
- d) Calcium oxalate
- b) Cystinuria
- c) Granular cast
- a) Trichomonas vaginalis
- b) Envelope or octahedral
- c) Fatty cast
- c) A true infection
- c) Sudan III or Oil Red O
- b) Alkaline urine
- c) Squamous epithelial cells
- b) Squamous epithelial cells
- b) Uric acid crystal
- c) WBC casts
- c) Size and nucleus-to-cytoplasm ratio
- c) RBCs
- b) Acidic urine
- b) Cystine
- a) Flat plates with notched corners
- b) Tyrosine crystals
- a) Spheres with concentric rings and radial striations
- a) Bacteria
- b) Exhibit budding
- b) Uric acid crystals
- c) Neutrophil with sparkling granules
- b) WBC casts
- c) RTE cell cast
- d) Contamination with mucus threads
- b) Alkaline urine
- c) Squamous cells
- b) Broad waxy cast
- b) Renal tubular epithelial cells
- c) Radiographic dye
- b) Trichomonas vaginalis
- b) Cystine
- c) Budding and hyphae
- c) Tubular injury or necrosis
- b) Alkaline urine
- a) Rapid Brownian motion
- b) Yeast
- b) Cholesterol
- b) High dry power (40×)
- a) Contamination from skin/vagina
- d) Renal tubular cells absorbing lipids
- b) Low specific gravity (1.000)
- d) WBCs in dilute urine
- c) Squamous epithelial cells
- b) Ghost cells
- d) Granular
- a) Clue cells
- c) Transitional epithelial cells
- a) Cystitis (bladder infection)
- a) Red blood cells
- d) Uromodulin (Tamm-Horsfall protein)
- d) Under dim light at 10×
- c) Hyaline casts
- a) Renal failure
- a) Increased pH
- b) Central nuclei
- d) WBC casts
- b) Tubular necrosis
- b) Waxy
- c) Cast matrix
- b) White blood cells
- c) Free-floating RBCs
- a) Cystinuria
- c) Glomerulonephritis
- c) Amorphous phosphates
- a) Cystine
- c) Calcium oxalate
- d) Amorphous crystals
- d) Cholesterol
- c) Calcium oxalate
- d) Neutral fats
- b) Tyrosine
- c) Tyrosine
- b) Dumbbell-shaped crystals (calcium oxalate monohydrate)
- b) Protein 4+
- c) Increased purine metabolism
- d) Alkaline and nonpathologic
- b) Uric acid
- c) Acetic acid
- b) Uric acid vs. cystine crystals
- d) Starch
- b) Uric acid
- a) Cloth fiber
- b) RBCs
- a) Crystal solubility depends on pH
- d) WBCs are present
- d) Trichomonas
- c) Hyaline
- d) Nitrite
- b) Candida albicans
- a) Leucine
- a) Yeast
- c) Nitrate-reducing bacteria
- b) Biliary obstruction
- c) Ketones
- a) Sulfosalicylic acid test
- b) Urobilinogen
- c) Dehydration
- c) Myoglobin and hemoglobin
- b) Pyuria
- d) Clinitest
- b) Old or improperly stored specimen
- b) Acetoacetic acid
- a) Glycosuria
- b) Diabetes mellitus
- c) Ictotest
- c) Diabetes mellitus
- a) Myoglobinuria
Top 8 Medical Laboratory Scientist (MLS) Exams:
Top 8 Medical Laboratory Scientist (MLS) Exams that are recognized globally and can help professionals validate their credentials and enhance their career opportunities:
1. ASCP – American Society for Clinical Pathology (USA)
- Exam Name: MLS(ASCP)
- Eligibility: Bachelor’s degree with clinical laboratory experience.
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- Purpose: Certifies Medical Laboratory Scientists in the United States and internationally.
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- Exam Name: MLT(AMT) or MT(AMT)
- Eligibility: Academic and/or work experience in medical laboratory technology.
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- Exam Name: AIMS Certification Exam
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- Recognition: Required for practice in Australia.
- Purpose: Certification and registration in Australia.
4. CSMLS – Canadian Society for Medical Laboratory Science
- Exam Name: CSMLS General or Subject-specific Exams
- Eligibility: Graduation from a CSMLS-accredited program or equivalent.
- Recognition: Canada
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- Exam Name: Registration and Specialist Portfolio Assessment
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- Exam Name: DOH/HAAD License Exam
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7. DHA – Dubai Health Authority (UAE)
- Exam Name: DHA License Exam for Medical Laboratory Technologists
- Eligibility: Relevant degree and experience.
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8. MOH – Ministry of Health (Gulf Countries like UAE, Saudi Arabia, Kuwait)
- Exam Name: MOH License Exam
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- Recognition: Varies by country.
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