7.5 Urinalysis and Body Fluids Problem-Solving Flashcards
Given the following dry reagent strip urinalysis results, select the most appropriate course of action:
Perform a turbidimetric protein test, instead of the dipstick protein test, and report
Given the following urinalysis results, select the most appropriate course of action:
No indication of error is present; results indicate a UTI
SITUATION: A 6-mL pediatric urine sample is processed for routine urinalysis in the usual manner. The sediment is prepared by centrifuging all of the urine remaining after performing the biochemical tests. The following results are obtained:
Select the most appropriate course of action.
Report biochemical results only; request a new sample for the microscopic examination
Given the following urinalysis results, select the most appropriate course of action:
Recheck urine pH
Given the following urinalysis results, select the most appropriate first course of action:
Repeat the dry reagent strip test for bilirubin
A biochemical profile gives the following results:
Creatinine = 1.4 mg/dL
BUN = 35 mg/dL
K = 5.5 mmol/L
All other results are normal, and all tests are in control. Urine from the patient has an osmolality of 975 mOsm/kg. Select the most appropriate course of action.
Report these results
A 2 p.m. urinalysis shows trace glucose on the dry reagent strip test. Fasting blood glucose drawn 8 hours earlier is 100 mg/dL. No other results are abnormal. Select the most appropriate course of action.
Repeat the urine glucose, and report if positive
Following a transfusion reaction, urine from a patient gives positive test results for blood and protein. The SG is 1.015. No RBCs or WBCs are seen in the microscopic examination. These results:
Support the finding of an intravascular transfusion reaction
A urine sample taken after a suspected transfusion reaction has a positive test result for blood, but intact RBCs are not seen on microscopic examination. Which test result would rule out an intravascular hemolytic transfusion reaction?
Normal plasma haptoglobin
Given the following urinalysis results, select the most appropriate course of action:
Call for a list of medications administered to the patient
Urinalysis results from a 35-year-old woman are as follows:
Select the most appropriate course of action.
Recheck the blood reaction; if negative, look for budding yeast
A routine urinalysis gives the following results:
These results are most likely explained by:
Pseudocasts of urate mistaken for true casts
SITUATION: When examining a urinary sediment under 400× magnification, the medical laboratory scientist (MLS) noted many RBCs to have cytoplasmic blebs and an irregular distribution of the hemoglobin. This phenomenon is most often caused by:
Glomerular disease
SITUATION: A urine specimen is dark orange and turns brown after storage in the refrigerator overnight. The MLS requests a new specimen. The second specimen is bright orange and is tested immediately. Which test result would differ between the two specimens?
Urobilinogen
A patient’s random urine sample consistently contains a trace of protein but no casts, cells, or other biochemical abnormality. The first voided morning sample is consistently negative for protein. These findings can be explained by:
Orthostatic or postural albuminuria
A urine sample with a pH of 8.0 and a specific gravity of 1.005 had a small positive blood reaction but is negative for protein, and no RBCs are present in the microscopic examination of urinary sediment. What best explains these findings?
Hemoglobin is present without intact RBCs because of hemolysis
A urine sample has a negative blood reaction and 5 to 10 cells per high-power field that resemble RBCs. What is the best course of action?
Mix a drop of sediment with 1 drop of WBC counting fluid and re-examine
A toluidine blue chamber count on CSF gives the following values:
After correcting the WBC count in CSF, the MLS should next:
Concentrate CSF using a cytocentrifuge and perform a differential
A blood-tainted pleural fluid is submitted for culture. Which test result would be most conclusive in classifying the fluid as an exudate?
A. LD fluid/serum; 0.65
A pleural fluid submitted to the laboratory is milky in appearance. Which test would be most useful in differentiating between a chylous and pseudochylous effusion?
Fluid to serum triglyceride ratio
A CSF sample from an 8-year-old child with a fever of unknown origin was tested for glucose, total protein, lactate, and IgG index. Glucose was 180 mg/dL, but all other results were within the reference range. The CSF WBC count was 9 × 106/L, and the RBC count was 10 × 106/L. The differential showed 50% lymphocytes, 35% monocytes,
10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these results?
Hyperglycemia
A WBC count and differential performed on ascites fluid gave a WBC count of 20,000/ µL with 90% macrophages. The gross appearance of the fluid was described by the MLS as “thick and bloody.” It was noted on the report that several clusters of these cells were observed and that the majority of the cells contained many vacuoles resembling paper-punch holes. What do the observations above suggest?
Malignant mesothelial cells were counted as macrophages
Given the following data for creatinine clearance, select the most appropriate course of action.
Volume = 2.8 L/day
Surface area = 1.73 m2
Urine creatinine = 100 mg/dL
Serum creatinine = 1.2 mg/dL
Request a new 24-hour urine sample
An elevated amylase is obtained on a stat serum collected at 8 p.m. An amylase performed at 8 a.m. that morning was within normal limits. The MLS also noted that urine amylase was measured at 6 p.m. Select the most appropriate course of action.
Review the amylase result on the 6 p.m. urine sample; if elevated, report the stat amylase
Results of an FLM study from a patient with diabetes mellitus are as follows:
L/S ratio = 2.0
Phosphatidyl glycerol = Neg
Creatinine = 2.5 mg/dL
Given these results, the MLS should:
Report the result and recommend repeating the L/S ratio in 24 hours
A 24-hour urine sample from an adult submitted for catecholamines gives a result of 140 µg/day (upper reference limit 150 µg/day). The 24-hour urine creatinine level is 0.6 g/day. Select the best course of action.
Request a new 24-hour urine sample
A sperm motility test was performed and 200 sperm were evaluated in each of two duplicates. The first sample showed progressive movement in 50% and nonprogressive movement in 35%, and 15% were immotile. The second showed progressive movement in 35% and nonprogressive movement in 35%, and 30% were immotile. What is the best course of action?
Repeat the motility test
A quantitative serum hCG is ordered on a male patient. The technologist should:
Perform the test and report the result
SITUATION: A lamellar body count (LBC) was performed on an amniotic fluid sample that was slightly pink within 1 hour of specimen collection. The sample was stored at 4°C prior to analysis. The result was 25,000/µL, classified as intermediate risk of RDS. The physician waited 24 hours and collected a new sample that was counted within 2 hours of collection on the same instrument. The LCB count of the new sample was 14,000/µL and the patient was reclassified as high risk for delivery. Which statement best explains these results?
Blood caused a falsely elevated result for the first sample
When testing for drugs of abuse in urine, which of the following test results indicate dilution and would be cause for rejecting the sample?
SG 1.002; creatinine 15 mg/dL,
SITUATION: A urine specimen has an SG of 1.025 and is strongly positive for nitrite. All other dry reagent strip test results are normal, and the microscopic examination was unremarkable, showing no WBCs or bacteria. The urine sample was submitted as part of a pre-employment physical examination that also includes drug testing. Which most likely caused these results?
An adulterated urine specimen
A CSF sample submitted for cell counts has a visible clot. What is the best course of action?
Request a new sample
Total hemolytic complement and glucose are ordered on a synovial fluid sample that is too viscous to pipet. What is the best course of action?
Add 1 mg/mL hyaluronidase to the sample, and incubate at room temperature for 30 minutes
A CSF cytospin smear shows many smudge cells and macrophages with torn cell membranes. What most likely caused this problem?
Failure to add albumin to the cytospin cup
An automated electronic blood cell counter was used to count RBCs and WBCs in a turbid pleural fluid sample. The WBC count was 5 × 1010/L (50,000/µL) and the RBC count was 5.5 × 1010/L (55,000/µL). What is the significance of the RBC count?
The RBC count is not significant and should be reported as 5,000/µL
