Assessment CM Flashcards
What is the LAST STEP in the handwashing procedure?
Dry hands with a paper towel.
Turn off faucet with a clean paper towel to prevent recontamination.
Rub to form lather, create friction, and loosen debris.
Rinse hands in a downward position.
Turn off faucet with a clean paper towel to prevent recontamination.
CORRECT HANDWASHING TECHNIQUE
1. Wet hands with warm water.
2. Apply antimicrobial soap.
3. Rub to form lather, create friction, and loosen debris.
4. Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up
to the wrist, for at least 15 SECONDS. (6th 20 seconds)
5. Rinse hands in a DOWNWARD POSITION.
6. Dry with a paper towel.
7. Turn off faucets with a clean paper towel to prevent recontamination.
The required amount of urine for drug testing (COC):
5 to 10 mL
10 to 15 mL
20 to 30 mL
30 to 45 mL
30 to 45 mL
Urine specimen collections may be “witnessed” or “unwitnessed.” The decision to obtain a witnessed collection is indicated when it is suspected that the donor may alter or
substitute the specimen or it is the policy of the client ordering the test. If a witnessed specimen collection is ordered, a same-gender collector will observe the collection of 30
to 45 mL of urine. Witnessed and unwitnessed collections should be immediately handed to the collector.
Acceptable urine temperature for drug testing (COC):
20 to 24C
30 to 35C
32.5 to 37.7C
37.7 to 42C
32.5 to 37.7C
The urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated. The temperature should read within the
range of 32.5°C to 37.7°C. If the specimen temperature is not within range, the temperature should be recorded and the supervisor or employer contacted immediately.
Urine temperatures outside of the recommended range may indicate specimen contamination. Recollection of a second specimen as soon as possible will be necessary.
Primary inorganic component of urine:
Urea
Creatinine
Chloride
Potassium
Chloride
UREA: primary ORGANIC component; product of protein and amino acid
metabolism
CHLORIDE: primary INORGANIC component; found in combination with sodium (table salt)
and many other inorganic substances
Polyuria, an increase in daily urine volume:
Greater than 400 mL/day in adults
Greater than 1200 mL/day in adults
Greater than 2L/day in adults
Greater than 2.5 L/day in adults
Greater than 2.5 L/day in adults
Normal daily urine output is usually 1200 to 1500 mL, a range of 600 to 2000 mL is considered normal.
Polyuria, an increase in daily urine volume (greater than 2.5 L/day in adults and 2.5 to 3 mL/kg/day in children), is often associated with diabetes mellitus and diabetes insipidus;
however, it may be artificially induced by diuretics, caffeine, or alcohol, all of which suppress the secretion of antidiuretic hormone.
Oliguria, a decrease in urine output (which is less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 400 mL/day in adults), is commonly seen when the
body enters a state of dehydration as a result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns.
The most routinely used method of urine preservation is:
Boric acid
Formalin
Refrigeration
Sodium fluoride
Refrigeration
The most routinely used method of preservation is refrigeration at 2°C to 8°C, which decreases bacterial growth and metabolism.
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured up to 24 hours.2 The specimen must return to room temperature before
chemical testing by reagent strips.
A 24-hour urine for CATECHOLAMINE determination may be preserved
with:
Formalin
Boric acid
Hydrochloric acid, 6N
Sodium fluoride
Hydrochloric acid, 6N
FROM HENRY: 24-HOUR URINE COLLECTION PRESERVATIVES
None (refrigerate): amino acids, amylase, calcium, citrate, chloride, copper, creatinine, delta ALA, glucose, 5-HIAA, heavy metals (arsenic, lead, mercury), histamine, immunoelectrophoresis, lysozyme, magnesium, methylmalonic acid, microalbumin, mucopolysaccharides, phosphorus, porphobilinogen, porphyrins, potassium, protein,
protein electrophoresis, sodium, urea, uric acid, xylose tolerance
10 g boric acid: aldosterone, cortisol
10 mL 6N HCl: catecholamines, cystine, homovanillic acid, hydroxyproline, metanephrines, oxalate, VMA
If processing delayed longer than 24 hours: equal amounts of 50% alcohol, Saccomanno’s fixative, and SurePath or Preserve CT Cytologic examination
In the three-glass collection technique for diagnosis of prostatic infection,
which tube is used as a control for bladder and kidney infection?
First specimen
Second specimen
Third specimen
None of these
Second specimen
THREE-GLASS COLLECTION
In prostatic infection, the third specimen will have a white blood cell/ high-power field count and a bacterial count 10 times that of the first specimen. Macrophages containing lipids may also be present.
The second specimen is used as a control for bladder and kidney infection. If it is positive, the results from the third specimen are invalid because infected urine has contaminated
the specimen.
The human kidneys receive approximately ___ % of the blood pumped through the heart at all times.
Approximately 5%
Approximately 15%
Approximately 25%
Approximately 50%
Approximately 25%
The renal artery supplies blood to the kidney.
The human kidneys receive approximately 25% of the blood pumped through the heart at
all times.
The part of the nephron that functions as a SIEVE:
Glomerulus
Loop of Henle
Proximal convoluted tubules
Distal convoluted tubules
Glomerulus
The glomerulus functions as a sieve or filter.
The glomerulus serves as a nonselective filter of plasma substances with molecular weights less than 70,000, several factors influence the actual filtration process.
These include the cellular structure of the capillary walls and Bowman’s capsule, hydrostatic pressure and oncotic pressure, and the feedback mechanisms of the reninangiotensin-aldosterone system (RAAS).
It corrects renal blood flow in the following ways: causing VASODILATION OF THE AFFERENT ARTERIOLES and CONSTRICTION OF THE EFFERENT ARTERIOLES, stimulating reabsorption of sodium and water in the proximal convoluted tubules, and triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus:
Renin
Angiotensin I
Angiotensin II
Aldosterone
Angiotensin II
Angiotensin II corrects renal blood flow in the following ways: causing vasodilation of the afferent arterioles and constriction of the efferent arterioles, stimulating reabsorption of
sodium and water in the proximal convoluted tubules, and triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus.
The original reference method for clearance tests:
Creatinine clearance
Inulin clearance
Urea clearance
Beta2- microglobulin
Inulin clearance
Although inulin was the original reference method for clearance tests, current methods are available that are endogenous and can provide accurate GFR results.
The earliest glomerular filtration tests measured urea because of its presence in all urine specimens and the existence of routinely used methods of chemical analysis.
Calculate the creatinine clearance using these date obtained from a person with 1.73 m2 body surface area: serum creatinine: 1.8 mg/dL;
urine creatinine: 54 mg/dL; and urine volume 640 mL in 24 hours.
3 mL/min
13 mL/min
21 mL/min
68 mL/min
13 mL/min
Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min.
Creatinine clearance (mL/min)
Formula: UV/P (patient is of the average body surface area)
[(54 mg/dL) x (0.44 mL/min)]/1.8 mg/dL = 13.2 mL/min
Calculate the creatinine clearance using these data: Serum creatinine: 1.8 mg/dL; urine volume: 640 mL in 24 hours; urine creatinine: 54 mg/dL; and body surface area: 1.25 m2.
1.1 mL/min
5 mL/min
13 mL/min
18 mL/min
18 mL/min
Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min
Creatinine clearance (mL/min)
Formula: (UV/P) x (1.73 m2/A)
[(54 mg/dL) (0.44 mL/min) / 1.8 mg/dL] x 1.73 m2/1.25 m2 = 18.3 mL/min
The test most commonly associated with tubular secretion and renal blood flow
Creatinine clearance
Fishberg test
Mosenthal test
p-aminohippuric acid (PAH) test
p-aminohippuric acid (PAH) test
The test most commonly associated with tubular secretion
and renal blood flow is the p-aminohippuric acid (PAH) test
Patients with DIABETES INSIPIDUS tend to produce urine in _____ volume with _____ specific gravity.
Increased; decreased
Increased; increased
Decreased; decreased
Decreased; increased
Increased; decreased
DIABETES INSIPIDUS: high urine volume, low specific gravity
DIABETES MELLITUS: high urine volume, high specific gravity
A catheterized urine specimen is collected:
After stimulating urine production with intravenous histamine
By aspirating it with a sterile syringe inserted into the bladder
Following midstream, clean-catch urine collection procedures
From a sterile tube passed through the urethra into the bladder
From a sterile tube passed through the urethra into the bladder
All of the following should be discarded in biohazardous waste containers EXCEPT:
Urine specimen containers, urine
Towels used for decontamination
Disposable lab coats
Blood collection tubes
Urine specimen containers, urine
The correct method for labeling urine specimen containers is to:
Attach the label to the lid
Attach the label to the bottom
Attach the label to the container
Use only a wax pencil for labeling
Attach the label to the container
Labels must be ATTACHED TO THE CONTAINER, NOT TO THE LID, and should not become detached if the container is refrigerated or frozen.
Storage of urine specimens for BILIRUBIN and UROBILINOGEN testing:
Clear container
Amber container
Preserved with formalin
None of these
Amber container
Because of the instability of bilirubin and urobilinogen in urine when exposed to room temperature and light, testing should be performed as soon as possible. Specimens should be stored in darkness or collected in amber tubes or amber 24-hour containers.
First-morning urine, EXCEPT:
Routine screening
Pregnancy testing
Urobilinogen determination
Evaluation of orthostatic proteinuria
Urobilinogen determination
AFTERNOON SPECIMEN (2 PM to 4 PM)
UROBILINOGEN DETERMINATION
GREATEST UROBILINOGEN EXCRETION
Phenol derivatives found in certain intravenous medications produce ______ urine on oxidation.
Yellow
Orange
Green
Purple
Green
STRASINGER PAGE 62: Green
STRASINGER PAGE 62: Brown/black
The clarity of a urine sample should be determined:
Using glass tubes only, never plastic
Following thorough mixing of the specimen
After addition of salicylic acid
After the specimen cools to room temperature
Following thorough mixing of the specimen
n routine urinalysis, clarity is determined in the same manner that ancient physicians used: by visually examining the MIXED SPECIMEN while holding it IN FRONT OF A LIGHT
SOURCE. The specimen should, of course, be in a clear container.
Many particulates, print blurred through urine:
Hazy
Cloudy
Turbid
Milky
Cloudy
URINE CLARITY
Clear: no visible particulates, transparent
Hazy: few particulates, print easily seen through urine
Cloudy: many particulates, print blurred through urine
Turbid: print cannot be seen through urine
Milky: may precipitate or be clotted
Sensitivity of the urine specific gravity reagent pad:
1.010 to 1.035
1.015 to 1.035
1.000 to 1.002
1.000 to 1.030
1.000 to 1.030
A routine urinalysis on a urine specimen collected from a hospitalized patient revealed a specific gravity greater than 1.050 with the use of
REFRACTOMETRY. The best explanation for this specific gravity result is that the urine:
Old and has deteriorated
Contains radiographic contrast media
Concentrated because the patient is ill and dehydrated
Contains abnormally high levels of sodium and other electrolytes because the
patient is taking diuretics
Contains radiographic contrast media
Abnormally high results—above 1.040—are seen in patients who have recently undergone an intravenous pyelogram. This is caused by the excretion of the injected radiographic
contrast media.
The reagent strip specific gravity measures only ionic solutes, thereby eliminating the interference by the large organic molecules, such as urea and glucose, and by radiographic contrast media and plasma expanders that are included in physical measurements of
specific gravity.
Cabbage urine odor:
Isovaleric acidemia
Methionine malabsorption
Phenylketonuria
Urinary tract infection
Methionine malabsorption
Aromatic: normal
Foul, ammonia-like: bacterial decomposition, urinary tract infection
Fruity, sweet: ketones (diabetes mellitus, starvation, vomiting)
Maple syrup: maple syrup urine disease
Mousy: phenylketonuria
Rancid: tyrosinemia
Sweaty feet: isovaleric acidemia
Cabbage: methionine malabsorption
Bleach: contamination
A lack of any urine odor may indicate:
Acute tubular necrosis
Isovaleric acidemia
Methionine malabsorption
Phenylketonuria
Acute tubular necrosis
Lack of odor in urine from patients with acute renal failure suggests acute tubular necrosis rather than prerenal failure.
All of the following are important to protect the integrity of reagent strips EXCEPT:
Removing the desiccant from the bottle
Storing in an opaque bottle
Storing at room temperature
Resealing the bottle after removing a strip
Removing the desiccant from the bottle
Which of the following tests is affected LEAST by standing or improperly stored urine?
Glucose
Protein
pH
Bilirubin
Protein
CHANGES IN UNPRESERVED URINE
1. Color - modified or darkened
2. Clarity - decreased
3. Odor - increased
4. pH - increased
5. Glucose - decreased
6. Ketones - decreased
7. Bilirubin - decreased
8. Urobilinogen - decreased
9. Nitrite - increased
10. RBCs, WBCs - decreased
11. Bacteria - increased
A sensitive, although not specific indicator of damage to the kidneys:
Urea
Creatinine
Proteinuria
Ketonuria
Proteinuria
Demonstration of proteinuria in a routine analysis does not always signify renal disease; however, its presence does require additional testing to determine whether the protein
represents a normal or a pathologic condition.
An indicator of PREECLAMPSIA:
Cylindruria
Hematuria
Ketonuria
Proteinuria
Proteinuria
Preeclampsia is a pregnancy condition characterized by hypertension, proteinuria, and often edema, usually occurring late in the second trimester or early in the third trimester,
and affecting 5 to 10% of pregnancies. It is a major cause of maternal and perinatal mortality.
If the mother develops convulsions, the condition is called eclampsia.
The only cure for preeclampsia is delivery of the placenta.
Concentration of SSA in the cold precipitation method:
1% sulfosalicylic acid
3% sulfosalicylic acid
5% sulfosalicylic acid
10% sulfosalicylic acid
3% sulfosalicylic acid
REPORTING OF SSA TURBIDITY: Turbidity, granulation, no flocculation:
Trace
1+
2+
3+
4+
2+
SULFOSALICYLIC ACID (3% SSA) PRECIPITATION TEST
Negative No increase in turbidity <6 mg/dL
Trace Noticeable turbidity 6-30 mg/dL
1+ Distinct turbidity with no granulation 30-100 mg/dL
2+ Turbidity with granulation, no flocculation 100-200 mg/dL
3+ Turbidity with granulation and flocculation 200-400 mg/dL
4+ Clumps of protein >400 mg/dL
Significant albumin excretion rate (AER):
0.02 to 1 ug/min
1 to 2 ug/min
5 to 15 ug/min
2 to 20 ug/min
20 to 200 ug/min
20 to 200 ug/min
Microalbumin was considered significant when 30 to 300 mg of albumin is excreted in 24 hours or the AER is 20 to 200 μg/min.
Sensitivity of the Multistix protein pad:
1 to 5 mg/dL albumin
5 to 10 mg/dL albumin
10 to 15 mg/dL albumin
15 to 30 mg/dL albumin
15 to 30 mg/dL albumin
PROTEIN REAGENT PAD
Multistix: 15 to 30 mg/dL albumin
Chemstrip: 6 mg/dL albumin
Bence Jones protein precipitates at temperatures between ___, and redissolves at near ___C.
Precipitates at 100-120C, and redissolves at 60C
Precipitates at 10 to 20C, and redissolves at 100C
Precipitates at 80-100C, and redissolves at 60C
Precipitates at 40 to 60C, and redissolves at 100C
Precipitates at 40 to 60C, and redissolves at 100C
The principle of “protein error of indicators” is based on:
Protein changing the pH of the specimen
Protein changing the pKa of the specimen
Protein accepting hydrogen from the indicator
Protein giving up hydrogen to the indicator
Protein accepting hydrogen from the indicator
Protein (primarily albumin) accepts hydrogen ions from the indicator.
A patient’s random urine 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:
Normal diurnal variation in protein loss
Early glomerulonephritis
Orthostatic or postural albuminuria
Microalbuminuria
Orthostatic or postural albuminuria
ORTHOSTATIC (POSTURAL) PROTEINURIA
Patients suspected of orthostatic proteinuria are requested to empty the bladder before going to bed, collect a specimen immediately upon arising in the morning, and collect a second specimen after remaining in a vertical position for several hours.
Both specimens are tested for protein, and if orthostatic proteinuria is present, a negative reading will be seen on the first morning specimen, and a positive result will be found on
the second specimen.
A urine specimen is tested by a reagent strip test and the sulfosalicylic acid test to determine whether protein is present. The former yields a negative protein, whereas the latter results in a reading of 2+ protein. Which of the following statements best explains this difference?
-Urine contained excessive amount of amorphous urates or phosphates that caused the turbidity seen with SSA
-Urine pH was greater than 8, exceeding the buffering capacity of the strip, thus causing false-negative reaction
-Protein other than albumin must be present in the urine
-Reading time of the reagent strip test was exceeded, causing a false negative reaction to be detected
Protein other than albumin must be present in the urine
Most frequently performed chemical analysis on urine:
Bilirubin
Glucose
Ketone
Protein
Glucose
Because of its value in the detection and monitoring of diabetes mellitus, the glucose test is the most frequently performed chemical analysis on urine.
A patient sends the following question to an online consumer health Web site: “I am a 22-year-old female who experienced increasing headaches,
thirst, and decreasing energy. I was studying in the library when I felt lightheaded and passed out. I was taken to a hospital emergency department and they told me that my serum Acetest® was 40 mg/dL and urine glucose was 500 mg/dL. What does this mean?” How would you reply?
Your lab results pattern suggests diabetes mellitus.
You probably have been crash dieting recently.
The two results do not fit any disease pattern.
The tests need to be repeated because they could not possibly occur together.
Your lab results pattern suggests diabetes mellitus.
A positive urine glucose plus a positive serum ketone strongly suggest uncontrolled diabetes mellitus. There is an increased rate of fatty acid oxidation occurring in light of the
inaccessibility of the glucose, especially to skeletal muscle. If the patient had only been dieting, the glucose would be negative.
Glucosuria not accompanied by hyperglycemia can be seen in which of the following?
Hormonal disorders
Gestational diabetes
Diabetes mellitus
Renal disease
Renal disease
RENAL GLYCOSURIA
Glycosuria occurs in the absence of hyperglycemia when the reabsorption of glucose by the renal tubules is compromised.
This is frequently referred to as “renal glycosuria” and is seen in end-stage renal disease, cystinosis, and Fanconi syndrome.
The primary reason for performing a Clinitest is to:
Check for high ascorbic acid levels
Confirm a positive reagent strip glucose
Check for newborn galactosuria
Confirm a negative glucose reading
Check for newborn galactosuria
Depending on the laboratory population Clinitest is often performed on pediatric specimens from patients up to at least the age of 2 years.
Galactose in the urine of a newborn represents an “inborn error of metabolism” in which lack of the enzyme galactose-1-phosphate uridyl transferase prevents breakdown of
ingested galactose and results in failure to thrive and other complications, including death.
All states have incorporated screening for galactosemia into their required newborn screening programs because early detection followed by dietary restriction can control the
condition.
Negative Clinitest:
Glucose
Galactose
Lactose
Sucrose
Sucrose
Keep in mind that table sugar is sucrose, a nonreducing sugar, and does not react with Clinitest or glucose oxidase strips.
A urine sample that tests positive for ketones but negative for glucose is most likely from a patient suffering from:
Diabetes mellitus
Diabetes insipidus
Polydipsia
Starvation
Starvation
Ketonuria may be caused by all of the following except:
Bacterial infections
Diabetic acidosis
Starvation
Vomiting
Bacterial infections
CLINICAL SIGNIFICANCE OF KETONES
Clinical reasons for increased fat metabolism include the inability to metabolize carbohydrate, as occurs in diabetes mellitus; increased loss of carbohydrate from vomiting; and inadequate intake of carbohydrate associated with starvation and malabsorption.
The primary reagent in the reagent strip test for ketones is:
Glycine
Lactose
Sodium hydroxide
Sodium nitroprusside
Sodium nitroprusside
Reagent strip tests use the sodium nitroprusside (nitroferricyanide) reaction to measure ketones.
In this reaction, acetoacetic acid in an alkaline medium reacts with sodium nitroprusside to produce a purple color.
The test does not measure B-hydroxybutyrate and is only slightly sensitive to acetone when glycine is also present.
Positive result in the ketone reagent pad:
Brown
Blue
Pink
Purple
Purple
Acetoacetate (and acetone) + sodium nitroprusside + (glycine)
= PURPLE COLOR
Reagent pad positive result in the presence of hemoglobin or myoglobin:
Brown
Red
Pink-purple
Green-blue
Green-blue
In the presence of free hemoglobin/myoglobin, uniform color ranging from a negative yellow through green to a strongly positive green-blue appears on the pad.
A speckled pattern on the blood pad of the reagent strip indicates:
Hematuria
Hemoglobinuria
Myoglobinuria
All of the above
Hematuria
Intact red blood cells are lysed when they come in contact with the pad, and the liberated hemoglobin produces an isolated reaction that results in a speckled pattern on the pad.
Significant albumin excretion rate (AER):
0.02 to 1 ug/min
1 to 5 ug/min
5 to 15 ug/min
2 to 20 ug/min
20 to 200 ug/min
20 to 200 ug/min
Microalbumin was considered significant when 30 to 300 mg of albumin is excreted in 24 hours or the AER is 20 to 200 μg/min.
Bilirubin combines with 2,6-dichlorobenzene-diazonium-tetrafluoroborate in an acid medium to produce an azodye, with colors ranging from:
Green to blue
Green to brown
Pink to purple
Yellow to orange
Pink to purple
BILIRUBIN REAGENT PAD
2, 4-dichloroaniline diazonium salt: TAN
2,6-dichlorobenzene-diazonium-tetrafluoroborate: PINK TO VIOLET
Which of the following are characteristic urine findings from a patient with hemolytic jaundice?
A positive test for bilirubin and an increased amount of urobilinogen
A positive test for bilirubin and a decreased amount of urobilinogen
A negative test for bilirubin and an increased amount of urobilinogen
A negative test for bilirubin and a decreased amount of urobilinogen
A negative test for bilirubin and an increased amount of urobilinogen
Which of the following results show characteristic urine findings from a patient with an obstruction of the bile duct?
A positive test for bilirubin and an increased amount of urobilinogen
A positive test for bilirubin and a decreased amount of urobilinogen
A negative test for bilirubin and an increased amount of urobilinogen
A negative test for bilirubin and a decreased amount of urobilinogen
A positive test for bilirubin and a decreased amount of urobilinogen
False positive Ehrlich’s reaction for urobilinogen, EXCEPT:
Porphobilinogen
Formalin
Indican
Sulfonamides
Formalin
UROBILINOGEN REAGENT PAD (MULTISTIX)
False-positive:
Porphobilinogen
Indican
p-aminosalicylic acid
Sulfonamides
Methyldopa
Procaine
Chlorpromazine
Highly pigmented urine
False-negative:
Old specimens
Preservation in formalin
The positive reagent strip test for nitrite in this patient is probably caused by which of the following?
An infection from gram-negative bacteria
An infection from gram-positive bacteria
A yeast infection
An old urine specimen, unsuitable for examination
An infection from gram-negative bacteria
A positive nitrite test and a negative leukocyte esterase test is an indication of a:
Dilute random specimen
Specimen with lysed leukocytes
Vaginal yeast infection
Specimen older than 2 hours
Specimen older than 2 hours
False-positive results are obtained if nitrite testing is not performed on fresh samples, because multiplication of contaminant bacteria soon produces measurable amounts of nitrite. A true positive nitrite test should be accompanied by a positive leukocyte esterase test.
Reagent pad contains para-arsanilic acid or sulfanilamide:
pH
Protein
Leukocyte
Nitrite
Nitrite
Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that
then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.
Positive reagent pad for nitrite:
Blue
Brown
Pink
Purple
Pink
Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that
then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.
Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least ___ hours.
At least 1 hour
At least 2 hours
At least 3 hours
At least 4 hours
At least 4 hours
Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least 4 hours.
Chemical testing in urine that requires patients to include diet that contains green vegetables:
Bilirubin
Glucose
Ketone
Nitrite
Nitrite
The reliability of the test depends on the presence of adequate amounts of nitrate in the urine.
This is seldom a problem in patients on a normal diet that contains green vegetables; however, because diet usually is not controlled prior to testing, the possibility of a falsenegative result owing to lack of dietary nitrate does exist.
High urine specific gravity:
False positive nitrite
False negative nitrite
False positive blood
False positive glucose
False negative nitrite
HIGH URINE SPECIFIC GRAVITY
FALSE POSITIVE: Protein
FALSE NEGATIVE: Glucose, blood, nitrite
The reagent strip reaction that requires the longest reaction time is the:
Bilirubin
pH
Leukocyte esterase
Glucose
Leukocyte esterase
READING TIMES
30 seconds: glucose, bilirubin
40 seconds: ketone
45 seconds: specific gravity
60 seconds (1 minute): pH, protein, blood, urobilinogen and nitrite
120 seconds (2 minutes): leukocyte esterase
All of the following can be detected by the leukocyte esterase reaction except:
Neutrophils
Eosinophils
Lymphocytes
Basophils
Lymphocytes
The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils, and basophils) and monocytes, but not lymphocytes
Urine volume frequently used because multiparameter reagent strips are
easily immersed in this volume:
5 mL volume
12 mL volume
30 mL volume
45 mL volume
12 mL volume
A standard amount of urine, usually between 10 and 15 mL, is centrifuged in a conical tube. This provides an adequate volume from which to obtain a representative sample of the elements present in the specimen.
A 12-mL volume is frequently used because multiparameter reagent strips are easily immersed in this volume, and capped centrifuge tubes are often calibrated to this volume.
Centrifugation speed that produces an optimum amount of urine sediment with the least chance of damaging the elements:
5 minutes at a relative centrifugal force (RCF) of 400
5 minutes at a relative centrifugal force (RCF) of 500
5 minutes at a relative centrifugal force (RCF) of 600
5 minutes at a relative centrifugal force (RCF) of 1,000
5 minutes at a relative centrifugal force (RCF) of 400
The speed of the centrifuge and the length of time the specimen is centrifuged should be consistent. Centrifugation for 5 minutes at a relative centrifugal force (RCF) of 400 produces an optimum amount of sediment with the least chance of damaging the elements.
Initial magnification:
Objective
Ocular
Objective
SLIDE > OBJECTIVE > OCULAR
Objective: FIRST LENS SYSTEM, INITIAL MAGNIFICATION
Ocular: SECOND LENS SYSTEM, FURTHER MAGNIFICATION
Further magnification:
Objective
Ocular
Ocular
SLIDE > OBJECTIVE > OCULAR
Objective: FIRST LENS SYSTEM, INITIAL MAGNIFICATION
Ocular: SECOND LENS SYSTEM, FURTHER MAGNIFICATION
Microscope component that GATHERS AND FOCUSES THE ILLUMINATION LIGHT onto the specimen for viewing.
Aperture diaphragm
Rheostat
Condenser
Ocular
Condenser
CONDENSER
Focuses the light on the specimen and controls the light for uniform illumination
Which of the following should be used to REDUCE LIGHT INTENSITY in bright-field microscopy?
Aperture diaphragm
Rheostat
Condenser
Objective
Rheostat
Type of microscope that ENHANCES VISUALIZATION OF ELEMENTS WITH LOW REFRACTIVE INDICES, such as hyaline casts, mixed cellular casts, mucous threads, and Trichomonas.
Fluorescence microscope
Interference-contrast microscope
Phase-contrast microscope
Polarizing microscope
Phase-contrast microscope
Bright-field microscopy: used for routine urinalysis
Phase-contrast microscopy: enhances visualization of elements with low refractive indices, such as hyaline casts, mixed cellular casts, mucous threads and Trichomonas
Polarizing microscopy: aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals
Dark-field microscopy: aids in identification of Treponema pallidum
Fluorescence microscopy: allows visualization of naturally fluorescent microorganisms or those stained by a fluorescent dye
Interference-contrast: produces a three-dimensional microscopy-image and layer-by-layer imaging of a specimen
A type of microscope that produces a three-dimensional microscopy image and layer-by-layer imaging of a specimen
Fluorescence microscope
Interference-contrast microscope
Phase-contrast microscope
Polarizing microscope
Interference-contrast microscope
Two types of interference-contrast microscope
1. Hoffman - modulation contrast
2. Nomarski - differential interference contrast
Bright-field microscopes can be adapted for both methods
Of all the urine sediment elements, _____ are the most difficult to recognize.
RBCs
WBCs
RTE cells
Sperms
RBCs
The reasons for this include RBCs’ lack of characteristic structures, variations in size, and close resemblance to other urine sediment constituents. RBCs are frequently confused
with yeast cells, oil droplets, and air bubbles.
Significant number of eosinophils in urine:
More than 1% eosinophils
More than 5% eosinophils
More than 10% eosinophils
More than 15% eosinophils
More than 1% eosinophils
The percentage of eosinophils in 100 to 500 cells is determined. Eosinophils are not normally seen in the urine; therefore, the finding of more than 1% eosinophils is considered significant.
FECAL CONTAMINATION of a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most
common contaminant is:
Enterobius vermicularis
Schistosoma haematobium
Trichomonas vaginalis
Entamoeba histolytica
Enterobius vermicularis
Fecal contamination of a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most common contaminant is ova from the
pinworm Enterobius vermicularis.
MOST FREQUENT PARASITE ENCOUNTERED IN THE URINE:
Enterobius vermicularis
Schistosoma haematobium
Trichomonas vaginalis
Entamoeba histolytica
Trichomonas vaginalis
The most frequent parasite encountered in the urine is Trichomonas vaginalis. The Trichomonas trophozoite is a pear-shaped flagellate with an undulating membrane. It is
easily identified in wet preparations of the urine sediment by its rapid darting movement in the microscopic field. Trichomonas is usually reported as rare, few, moderate, or many per hpf.
Reporting of Trichomonas vaginalis:
With WBCs
With motility
With motility
Because their characteristic motility provides the best means of positively identifying them, a fresh urine specimen is needed.
When not moving, Trichomonas is more difficult to identify and may resemble a:
WBC
Transitional epithelial cell
Renal tubular epithelial cell
All of these
All of these
When not moving, Trichomonas is more difficult to identify and may resemble a WBC, transitional, or RTE cell. Use of phase microscopy may enhance visualization of the
flagella or undulating membrane.
Reporting of spermatozoa:
Do not report
Rare, few, moderate or many per LPF
Rare, few, moderate or many per HPF
Present, based on laboratory protocol
Present, based on laboratory protocol
STRASINGER:
Reporting of spermatozoa:
Present, based on laboratory protocol
Only elements found in the urinary sediment that are unique to the kidney:
Red blood cells
Epithelial cells
Casts
Crystals
Casts
Casts are the only elements found in the urinary sediment that are unique to the kidney. They are formed within the lumens of the distal convoluted tubules and collecting ducts, providing a microscopic view of conditions within the nephron.
During microscopy casts are usually seen:
Center of coverslip
Near the edge of coverslip
Outside the coverslip
All of these
Near the edge of coverslip
Examination of the sediment for the detection of casts is performed using lower power magnification. When the glass cover-slip method is used, low-power scanning should be
performed along the edges of the cover slip.
Casts increased in CONGESTIVE HEART FAILURE:
Granular casts
Hyaline casts
WBC casts
Epithelial casts
Hyaline casts
The most frequently seen cast is the hyaline type, which consists almost entirely of uromodulin.
The presence of zero to two hyaline casts per lpf is considered normal, as is the finding of increased numbers following strenuous exercise, dehydration, heat exposure, and
emotional stress.
Pathologically, hyaline casts are increased in acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure.
Pyelonephritis can be differentiated from cystitis by the presence of
________.
Eosinophils
Hyaline casts
WBC casts
Bacteriuria
WBC casts
The appearance of WBC casts in the urine signifies infection or inflammation within the nephron. They are most frequently associated with pyelonephritis and are a primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI).
Which of the following could be a broad cast?
Hyaline cast
Granular cast
Waxy cast
All of these
All of these
All types of casts may occur in the broad form. However, considering the accompanying urinary stasis, the most commonly seen broad casts are granular and waxy casts.
Most commonly seen broad casts:
RBC and WBC casts
WBC and epithelial casts
Hyaline and granular casts
Granular and waxy casts
Granular and waxy casts
All types of casts may occur in the broad form. However, considering the accompanying urinary stasis, the most commonly seen broad casts are granular and waxy casts.
A 62-year-old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular and cellular casts. Many oval fat bodies are also noted.This is most consistent with:
Nephrotic syndrome
Acute pyelonephritis
Viral infection
Acute glomerulonephritis
Nephrotic syndrome
Reporting of normal crystals:
Averaged and reported per LPF
Averaged and reported per HPF
Rare, few, moderate or many per LPF
Rare, few, moderate or many per HPF
Rare, few, moderate or many per HPF
Crystals are usually reported as rare, few, moderate, or many per hpf. Abnormal crystals may be averaged and reported per lpf.
Lemon-shaped crystals:
Ammonium biurate
Calcium phosphate
Uric acid
Triple phosphate
Uric acid
HENRY
Uric acid crystals occur at low pH (5–5.5) and are seen in a variety of shapes, including rhombic or four-sided flat plates, prisms, oval forms with pointed ends (lemon-shaped),
wedges, rosettes, and irregular plates.
Increased amounts of these crystals in fresh urine is seen in patients with leukemia who are receiving chemotherapy:
Calcium phosphate
Calcium oxalate
Triple phosphate
Uric acid
Uric acid
Increased amounts of uric acid crystals, particularly in fresh urine, are associated with:
1. Increased levels of purines and nucleic acids and are seen in patients with leukemia
who are receiving chemotherapy
2. Patients with Lesch-Nyhan syndrome
3. Patients with gout
MT notices calcium oxalate crystals in urine, but the atypical form. To confirm identity of these crystals:
Soluble with acetic acid
Soluble with dilute HCl
Soluble with acetic acid and dilute HCl
None of these
Soluble with dilute HCl
Weddelite (dihydrate CaOx, most common): envelope, pyramidal
Whewellite (monohydrate CaOx, less frequent): dumbbell, oval
Calcium oxalate crystals:
Soluble in dilute HCl
Insoluble in acetic acid
Crystals associated with ethylene glycol poisoning:
Envelope or pyramidal crystals
Oval or dumbbell crystals
Oval or dumbbell crystals
Ethylene glycol (antifreeze) poisoning (monohydrate forms) - dumbbell, oval
The MONOHYDRATE FORM is most frequently seen in children and pets because antifreeze tastes sweet and uncovered containers left in the garage can be very tempting.
Apatite crystals:
Calcium phosphate
Monohydrate calcium oxalate
Dihydrate calcium oxalate
Triple phosphate
Calcium phosphate
Calcium phosphate: APATITE
Monohydrate calcium oxalate: WHEWELLITE
Dihydrate calcium oxalate: WEDDELITE
Triple phosphate: STRUVITE
Calculi formation at pH > 7:
Uric acid, cystine, xanthine
Triple phosphate, calcium phosphate
Calcium oxalate, apatite
All of these
Triple phosphate, calcium phosphate
pH < 5.5: Uric acid, cystine, or xanthine calculi
pH 5 to 6: Calcium oxalate and apatite calculi
pH >7: Magnesium ammonium phosphate or calcium phosphate
Calculi associated with RAPID PROTEIN CATABOLISM:
Calcium oxalate
Cystine
Uric acid
None of these
Uric acid
URIC ACID AND URATE CALCULI
1. Gout
2. Polycythemia
3. Leukemia
4. Lymphoma
5. Liver disease
6. Acid isohydria
7. Theophylline and thiazide therapy
8. Conditions associated with rapid protein catabolism
Calculi associated with EXCESSIVE GLYCOGEN BREAKDOWN:
Calcium oxalate
Cystine
Uric acid
None of these
Calcium oxalate
CALCIUM OXALATE CALCULI
1. Oxaluria
2. Incomplete catabolism of carbohydrates
3. Isohydria at pH 5.5 to 6.0
4. Excessive glycogen breakdown
The most common composition of renal calculi is:
Calcium oxalate
Magnesium ammonium phosphate
Cystine
Uric acid
Calcium oxalate
Approximately 75% of the renal calculi are composed of calcium oxalate or calcium phosphate.
Magnesium ammonium phosphate (struvite), uric acid, and cystine are the other primary calculi constituents.
Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed:
Heavy proteinuria
Low specific gravity
Uric acid crystals
Microscopic hematuria
Microscopic hematuria
Urine specimens from patients suspected of passing or being in the process of passing renal calculi are frequently received in the laboratory.
The presence of microscopic hematuria resulting from irritation to the tissues by the moving calculus is the primary urinalysis finding.
Positive result for the acid-albumin and CTAB test for mucopolysaccharides:
White turbidity
Yellow turbidity
Yellow spot
Blue spot
White turbidity
Positive result for the METACHROMATIC STAINING SPOT TEST for mucopolysaccahrides:
White turbidity
Yellow turbidity
Yellow spot
Blue spot
Blue spot
Key to the diagnosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum:
Berger disease
Goodpasture’s syndrome
Henoch-Schonlein purpura
Wegener granulomatosis
Wegener granulomatosis
Wegener granulomatosis causes a granuloma-producing inflammation of the small blood vessels primarily of the kidney and respiratory system.
Key to the diagnosis of Wegener granulomatosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum.
The presence of renal tubular epithelial cells and casts is an indication of:
Acute interstitial nephritis
Chronic glomerulopnephritis
Minimal change disease
Acute tubular necrosis
Acute tubular necrosis
Urinalysis findings include mild proteinuria, microscopic hematuria, and, most noticeably, the presence of RTE cells and RTE cell casts containing tubular fragments consisting of
three or more cells.
Increased eosinophils, WBC casts without bacteria:
Acute glomerulophritis
Acute interstitial nephritis
Acute pyelonephritis
Acute tubular necrosis
Acute interstitial nephritis
ACUTE INTERSTITIAL NEPHRITIS
AIN is primarily associated with an allergic reaction to medications that occurs within the renal interstitium, possibly caused by the medication binding to the interstitial protein.
Urinalysis results include hematuria, possibly macroscopic, mild to moderate proteinuria, numerous WBCs, and WBC casts without bacteria. Differential leukocyte staining for the presence of increased eosinophils may be useful to confirm the diagnosis.
The only protein produced by the kidney is:
Albumin
Uromodulin
Uroprotein
Globulin
Uromodulin
Uromodulin is a more recent name for Tamm-Horsfall protein
Uromodulin is a glycoprotein and is the only protein produced by the kidney. It is produced by the proximal and distal convoluted tubules.
In automated microscopy, the DNA within the cells is stained by an orange dye:
Phenathridine
Carbocyanine
Phenathridine
PHENATHRIDINE: ORANGE, DNA
CARBOCYANINE: GREEN
Nuclear membranes, mitochondria, and negatively charged cell membranes
In automated microscopy, the nuclear membranes, mitochondria and negatively charged cell membranes are stained by the green dye:
Phenathridine
Carbocyanine
Carbocyanine
PHENATHRIDINE: ORANGE, DNA
CARBOCYANINE: GREEN
Nuclear membranes, mitochondria, and negatively charged cell membranes
The concentration of hCG is generally at a particular level in serum about 2 to 3days after implantation. This is the concentration at which most sensitive laboratory assays can give a positive serum hCG result. What is
the lowest level of hormone for which most current serum hCG tests can give a positive result?
25 mIU/mL
50 mIU/mL
100 mIU/mL
100, 000 mIU/mL
25 mIU/mL
In a normal pregnancy, detectable amounts of about 25 mIU/mL β- hCG are secreted 2 to 3 days (48 to 72 hours) after implantation, or approximately 8 to 10 days after conception or fertilization.
The most specific assays for human chorionic gonadotropin (hCG) use antibody reagents against which subunit of hCG?
Alpha
Beta
Gamma
Chorionic
Beta
Alpha subunit of HCG - similar to LH, FSH and TSH
Beta subunit is unique for HCG
In the card pregnancy test: no band appears at T and a black or gray band is visible at the C position
Positive
Negative
Invalid
Negative
CARD PREGNANCY TEST
1. POSITIVE: Two separate black or gray bands, one at T and the other at C, are visible in the results window, indicating that the specimen contains detectable levels of hCG.
Although the intensity of the test band may vary with different specimens, the appearance of two distinct bands should be interpreted as a positive result.
2. NEGATIVE: If no band appears at T and a black or gray band is visible at the C position, the test can be considered negative, indicating that a detectable level of hCG is not present.
3. INVALID: If no band appears at C or incomplete or beaded bands appear at the T or C position, the test is invalid. The test should be repeated using another Card Pregnancy Test device.
If the test band appears very faint, it is recommended that a new sample be collected 48 hours later and tested again using another Card Pregnancy Test device
What department is the CSF tube labeled 3 routinely sent to?
Hematology
Chemistry
Microbiology
Serology
Hematology
Fourth CSF tube may be drawn for:
Cell counts
Chemical tests
Chemistry and cell counts
Microbiology or additional serologic tests
Microbiology or additional serologic tests
If only a small amount of CSF is obtained, which is the most important procedure to perform first?
Cell count
Chemistry
Immunology
Microbiology
Microbiology
A web-like pellicle in a refrigerated CSF specimen indicates:
Tubercular meningitis
Multiple sclerosis
Primary CNS malignancy
Viral meningitis
Tubercular meningitis
A CSF total cell count is diluted with:
Distilled water
Normal saline
Acetic acid
Hypotonic saline
Normal saline
Dilutions for total cell counts are made with normal saline, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette.
A CSF WBC count is diluted with:
Distilled water
Normal saline
Acetic acid
Hypotonic saline
Acetic acid
Lysis of RBCs must be obtained before performing the WBC count on either diluted or undiluted specimens. Specimens requiring dilution can be diluted in the manner described
previously, substituting 3% glacial acetic acid to lyse the RBCs.
Adding methylene blue to the diluting fluid stains the WBCs, providing better differentiation between neutrophils and mononuclear cells.
As little as 0.1 mL of CSF combined with one drop of ________ produces an adequate CELL YIELD when processed with the cytocentrifuge.
10% albumin
30% albumin
1% HCl
3% acetic acid
30% albumin
Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.
The purpose of adding albumin to CSF before cytocentrifugation is to:
Increase the cell yield
Decrease the cellular distortion
Improve the cellular staining
Increase cell yield and decrease cellular distortion
Increase cell yield and decrease cellular distortion
Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.
The presence of which of the following cells is increased in a parasitic infection?
Neutrophils
Macrophages
Eosinophils
Lymphocytes
Eosinophils
Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including
medications and shunts, into the CNS.
Fungal infection associated with increased eosinophils in CSF:
Blastomyces dermatitidis
Coccidioides immitis
Cryptococcus neoformans
Histoplasma capsulatum
Coccidioides immitis
Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including
medications and shunts, into the CNS.
Which of the following may resemble a LYMPHOCYTE in CSF?
Blastoyces
Coccidioides
Cryptococcus
Histoplasma
Cryptococcus
Nonpathologically significant cells are most frequently seen after DIAGNOSTIC PROCEDURES such as PNEUMOENCEPHALOGRAPHY and
in fluid obtained from VENTRICULAR TAPS or during NEUROSURGERY:
Choroidal cells
Ependymal cells
Spindle-shaped cells
All of these
All of these
Myeloblasts are seen in the CSF:
In bacterial infections
In conjunction with CNS malignancy
After cerebral hemorrhage
As a complication of acute leukemia
As a complication of acute leukemia
Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen as a serious complication of acute leukemias.
Nucleoli are often more prominent than in blood smears.
The most frequently performed chemical test on CSF:
Glucose determination
Lactate determination
Protein determination
India ink staining
Protein determination
The most frequently performed chemical test on CSF is the protein determination.
The reference range for CSF protein is:
6 to 8 g/dL
15 to 45 g/dL
6 to 8 mg/dL
15 to 45 mg/dL
15 to 45 mg/dL
Reference values for total CSF protein are usually listed as 15 to 45 mg/dL, but are somewhat method dependent, and higher values are found in infants and people over age 40.
This value is reported in milligrams per deciliter and not grams per deciliter, as are plasma protein concentrations.
CSF can be differentiated from serum by the presence of:
Albumin
Globulin
Prealbumin
Tau transferrin
Tau transferrin
Transferrin is the major beta globulin present; also, a separate carbohydrate-deficient transferrin fraction, referred to as “tau,” is seen in CSF and not in serum.
In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is:
Transferrin
Prealbumin
IgA
Ceruloplasmin
Prealbumin
Elevated CSF protein values can be caused by all of the following except:
Meningitis
Multiple sclerosis
Fluid leakage
CNS malignancy
Fluid leakage
Abnormally low values are present when fluid is leaking from the CNS.
The causes of elevated CSF protein include damage to the blood–brain barrier, immunoglobulin production within the CNS, decreased normal protein clearance from the
fluid, and neural tissue degeneration. Meningitis and hemorrhage conditions that damage the blood–brain barrier are the most common causes of elevated CSF protein.
The integrity of the blood–brain barrier is measured using the:
CSF/serum albumin index
CSF/serum globulin ratio
CSF albumin index
CSF IgG index
CSF/serum albumin index
CSF/SERUM ALBUMIN INDEX
An index value less than 9 represents an intact blood– brain barrier. The index increases relative to the amount of damage to the barrier.
The finding of oligoclonal bands in the CSF and not in the serum is seen with:
Multiple myeloma
CNS malignancy
Multiple sclerosis
Viral infections
Multiple sclerosis
Oligoclonal banding in cerebrospinal fluid but not in serum, EXCEPT:
Encephalitis
Multiple myeloma
Neurosyphilis
Guillain-Barre disease
Multiple myeloma
The presence of two or more oligoclonal bands in the CSF that are not present in the serum can be a valuable tool in diagnosing multiple sclerosis, particularly when accompanied by an increased IgG index.
Other neurologic disorders including encephalitis, neurosyphilis, Guillain-Barré syndrome, and neoplastic disorders also produce oligoclonal banding that may not be present in the serum.
Measurement of which of the following can be replaced by CSF GLUTAMINE analysis in children with Reye syndrome?
Ammonia
Lactate
Glucose
Alpha-ketoglutarate
Ammonia
Glutamine is produced from ammonia and alpha ketoglutarate by the brain cells. This process serves to remove the toxic metabolic waste product ammonia from the CNS.
The normal concentration of glutamine in the CSF is 8 to 18 mg/dL. Elevated levels are associated with liver disorders that result in increased blood and CSF ammonia.
Before performing a Gram stain on CSF, the specimen must be:
Filtered
Warmed to 37C
Centrifuged
Mixed
Centrifuged
All smears and cultures should be performed on concentrated specimens because often only a few organisms are present at the onset of the disease. The CSF should be centrifuged at 1500 g for 15 minutes, and slides and cultures should be prepared from the sediment.
The procedure recommended by the CDC to diagnose neurosyphilis:
RPR
VDRL
MHA-TP
FTA-ABS
VDRL
Although many different serologic tests for syphilis are available when testing blood, the procedure recommended by the CDC to diagnose neurosyphilis is the Venereal Disease
Research Laboratories (VDRL), even though it is not as sensitive as the fluorescent treponemal antibody-absorption (FTA-ABS) test for syphilis.
The rapid plasma regain (RPR) test is not recommended because it is less sensitive than the VDRL.
An elevated maternal serum AFP, may indicate an amniocentesis at:
15 to 18 weeks
20 to 42 weeks
15 to 18 weeks
INDICATIONS FOR PERFORMING AMNIOCENTESIS
INDICATED AT 15 TO 18 WEEKS’ GESTATION
Mother’s age of 35 or older at delivery
Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
Parents carry an abnormal chromosome rearrangement
Earlier pregnancy or child with birth defect
Parent is a carrier of a metabolic disorder
Family history of genetic diseases such a sickle cell disease, Tay-Sachs disease,
hemophilia, muscular dystrophy, sickle cell anemia, Huntington chorea, and cystic fibrosis
Elevated maternal serum alpha-fetoprotein
Abnormal triple marker screening test
Previous child with a neural tube disorder such as spina bifida, or ventral wall defects
(gastroschisis)
Three or more miscarriages
INDICATED LATER IN THE PREGNANCY (20 TO 42 WEEKS)
Fetal lung maturity
Fetal distress
HDN caused by Rh blood type incompatibility
Infection
The amount of amniotic fluid increases in quantity throughout pregnancy, reaching a peak of approximately ____ mL during the third trimester, and then gradually decreases prior to delivery.
100 to 200 mL
200 to 400 mL
400 to 800 mL
800 to 1, 200 mL
800 to 1, 200 mL
A maximum of ___ mL of amniotic fluid is collected in sterile syringes.
5 mL
10 mL
20 mL
30 mL
30 mL
Presence of meconium in amniotic fluid:
Colorless
Blood-streaked
Yellow
Dark green
Dark red-brown
Dark green
Meconium, which is usually defined as a newborn’s first bowel movement, is formed in the intestine from fetal intestinal secretions and swallowed amniotic fluid. It is a dark green,
mucus-like material. It may be present in the amniotic fluid as a result of fetal distress.
Dark red-brown amniotic fluid:
Traumatic tap, abdominal trauma, intra-amniotic hemorrhage
Hemolytic disease of the newborn
Meconium
Fetal death
Fetal death
A very dark red-brown fluid is associated with fetal death
