AUBF Flashcards by Marlo Roque

Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the:

A. Choroid plexus
B. Sagittal sinus
C. Anterior cerebral lymphatics
D. Arachnoid membrane

A. Choroid plexus

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Which statement regarding CSF is true?

A. Normal values for mononuclear cells are higher for infants than for adults
B. Absolute neutrophilia is not significant if the total WBC count is less than 25/μL
C. The first aliquot of CSF should be sent to the microbiology laboratory
D. Neutrophils compose the majority of WBCs in normal CSF

A. Normal values for mononuclear cells are higher for infants than for adults

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When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates:

A. Low CSF volume
B. Subarachnoid hemorrhage
C. Meningitis
D. Hydrocephalus

A. Low CSF volume

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Which of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap?

A. Clearing of the fluid as it is aspirated
B. A clear supernatant after centrifugation
C. Xanthochromia
D. Presence of a protein in the sample

C. Xanthochromia

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The term used to denote a high WBC count in the CSF is:

A. Empyema
B. Neutrophilia
C. Pleocytosis
D. Hyperglycorrhachia

C. Pleocytosis

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Which of the adult CSF values in the table below are consistent with bacterial meningitis?

A. 55/uL, 44%. 55%, 0%, 0%, 1%
B. 300/uL, 75%, 21%, 3%, 0%, 1%
C. 2000/uL, 5%, 15%, 0%, 80%, 0%
D. 2500/uL, 40%, 50%, 0%, 10%, 0%

C. 2000/uL, 5%, 15%, 0%, 80%, 0%

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Given the following data, determine the corrected CSF WBC count:

A. 8/μL
B. 142/μL
C. 120/μL
D. 145/μL

B. 142/μL

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SITUATION: What is the most likely cause of the following CSF results?
● CSF glucose 20 mg/dL;
● CSF protein 200 mg/dL;
● CSF lactate 50 mg/dL (reference range 5–25 mg/dL)

A. Viral meningitis
B. Viral encephalitis
C. Cryptococcal meningitis
D. Acute bacterial meningitis

D. Acute bacterial meningitis

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Which of the following conditions is most often associated with normal CSF glucose and protein?

A. Multiple sclerosis
B. Malignancy
C. Subarachnoid hemorrhage
D. Viral meningitis

D. Viral meningitis

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The diagnosis of MS is suggested by which finding?

A. The presence of elevated protein and low glucose
B. A decreased IgG index
C. The presence of oligoclonal bands by electrophoresis
D. An increased level of CSF β-microglobulin

C. The presence of oligoclonal bands by electrophoresis

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Which of the following results is consistent with fungal meningitis?

A. Normal CSF glucose
B. Pleocytosis of mixed cellularity
C. Normal CSF protein
D. High CSF lactate

B. Pleocytosis of mixed cellularity

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In what suspected condition should a wet prep using a warm slide be examined?

A. Cryptococcal meningitis
B. Amoebic meningoencephalitis
C. Mycobacterium tuberculosis infection
D. Neurosyphilis

B. Amoebic meningoencephalitis

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Which of the following CSF test results is most commonly increased in patients with MS?

A. Glutamine
B. Lactate
C. IgG index
D. Ammonia

C. IgG index

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Which of the following is an inappropriate procedure for performing routine CSF analysis?

A. A differential is done only if the total WBC count is greater than 10/μL
B. A differential should be done on a stained CSF concentrate
C. A minimum of 30 WBCs should be differentiated
D. A Wright-stained slide should be examined, rather than a chamber differential

A. A differential is done only if the total WBC count is greater than 10/μL

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Which cell is present in CSF in greater numbers in newborns than in older children or adults?

A. Eosinophils
B. Lymphocytes
C. Monocytes
D. Neutrophils

C. Monocytes

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Neutrophilic pleocytosis is usually associated with all of the following except:

A. Cerebral infarction
B. Malignancy
C. Myelography
D. Neurosyphilis

D. Neurosyphilis

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Which statement about CSF protein is true?

A. An abnormal serum protein electrophoretic pattern does not affect the CSF pattern
B. The upper reference limit (URL) for CSF total protein in newborns is one half the adult level
C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis
D. Antibodies to Treponema pallidum disappear after successful antibiotic therapy Body fluids/Correlate clinical and laboratory data/Cerebrospinal fluid/2

C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis

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Which of the following statements regarding routine microbiological examination of CSF is true?

A. A Gram stain is performed on the CSF prior to concentration
B. The Gram stain is positive in fewer than 40% of cases of acute bacterial meningitis
C. India ink and acid fast stains are indicated if neutrophilic pleocytosis is present
D. All CSF specimens should be cultured using sheep blood agar, chocolate agar, and supplemented broth

D. All CSF specimens should be cultured using sheep blood agar, chocolate agar, and supplemented broth

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Which organism is the most frequent cause of bacterial meningitis in neonates?

A. Neisseria meningitidis
B. Group B Streptococcus
C. Haemophilus influenzae
D. Klebsiella pneumoniae

B. Group B Streptococcus

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Following a head injury, which protein will identify the presence of CSF leakage through the nose?

A. Transthyretin
B. Myelin basic protein
C. Tau protein
D. C-reactive protein

C. Tau protein

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Which of the following statements regarding serous fluids is true?

A. The normal volume of pleural fluid is 30 to 50 mL
B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids
C. Radiography can detect a 10% increase in the volume of a serous fluid
D. Normal serous fluids are colorless

B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

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The term effusion refers to:

A. A chest fluid that is purulent
B. A serous fluid that is chylous
C. An increased volume of serous fluid
D. An inflammatory process affecting the appearance of a serous fluid

C. An increased volume of serous fluid

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Which of the following laboratory results is characteristic of a transudative fluid?

A. SG = 1.018
B. Total protein = 3.2 g/dL
C. LD fluid/serum ratio = 0.25
D. Total protein fluid:serum ratio = 0.65

C. LD fluid/serum ratio = 0.25

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Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?

A. Clearing of fluid as it is aspirated
B. Presence of xanthochromia
C. The formation of a clot
D. Diminished RBC count in successive aliquots

C. The formation of a clot

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25. Which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap? A. An RBC count of 8,000/μL B. A WBC count of 6,000/μL C. A hematocrit of 35% D. A neutrophil count of 55%

A. An RBC count of 8,000/μL

26. Which of the following conditions is commonly associated with an exudative effusion? A. Congestive heart failure B. Malignancy C. Nephrotic syndrome D. Cirrhosis

B. Malignancy

27. Which of the following conditions is associated with a chylous effusion? A. Necrosis B. Pulmonary infarction or infection C. Systemic lupus erythematosus or rheumatoid arthritis (RA) D. Lymphatic obstruction

D. Lymphatic obstruction

28. Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL? A. Diabetes mellitus B. Pancreatitis C. Rheumatoid arthritis D. Bacterial pneumonia

C. Rheumatoid arthritis

29. In which condition is the pleural fluid pH likely to be above 7.3? A. Bacterial pneumonia with parapneumonic exudate B. Rheumatoid pleuritis C. Esophageal rupture D. Pneumothorax

D. Pneumothorax

Which of the following hematology values best frames the URLs for peritoneal fluid? A. 300/μL B. 10,000/μL C. 50,000/μL D. 100,000/μL

A. 300/μL

31. Which of the following characteristics is higher for synovial fluid than for the serous fluids? A. Specific gravity B. Glucose C. Total protein D. Viscosity

D. Viscosity

32. In which type of arthritis is the synovial WBC count likely to be greater than 50,000/ μL? A. Septic arthritis B. Osteoarthritis C. Rheumatoid arthritis D. Hemorrhagic arthritis

A. Septic arthritis

33. What type of cell is a “ragocyte”? A. Cartilage cell seen in inflammatory arthritis B. A PMN with inclusions formed by immune complexes C. A plasma cell seen in RA D. A macrophage containing large inclusions

B. A PMN with inclusions formed by immune complexes

34. Which of the following crystals is the cause of gout? A. Uric acid or monosodium urate B. Calcium pyrophosphate or apatite C. Calcium oxalate D. Cholesterol

A. Uric acid or monosodium urate

35. Which crystal causes “pseudogout”? A. Oxalic acid B. Calcium pyrophosphate C. Calcium oxalate D. Cholesterol

B. Calcium pyrophosphate

36. A synovial fluid sample is examined by using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present? A. Calcium oxalate B. Calcium pyrophosphate C. Uric acid D. Cholesterol

C. Uric acid

37. In which condition is the synovial fluid glucose most likely to be within normal limits? A. Septic arthritis B. Inflammatory arthritis C. Hemorrhagic arthritis D. Gout

C. Hemorrhagic arthritis

38. Which statement about synovial fluid in RA is true? A. Synovial:serum IgG is usually 1:2 or higher B. Total hemolytic complement is elevated C. Ninety percent of RA cases test positive for rheumatoid factor in synovial fluid D. Demonstration of rheumatoid factor in joint fluid is diagnostic for RA

A. Synovial:serum IgG is usually 1:2 or higher

39. Which of the following organisms accounts for the majority of septic arthritis cases in young and middle-age adults? A. H. influenzae B. Neisseria gonorrhoea C. Staphylococcus aureus D. Borrelia burgdorferi

B. Neisseria gonorrhoea

40. Which of the following hematology values best frames the URLs for synovial fluid? A. 200/uL, 25%, 2,000/uL B. 5,000/uL, 50%. 10,000/uL C. 10,000/uL, 50%, 50,000/uL D. 20,000/uL, 5%, 500,000/uL

A. 200/uL, 25%, 2,000/uL

1. Which of the following statements about amniotic fluid bilirubin measured by scanning spectrophotometry is true? A. The 410-nm peak is caused by hemoglobin and the 450-nm peak is caused by bilirubin B. Baseline correction is not required because a diode array detector is used C. Chloroform extraction is necessary only when meconium is present D. In normal amniotic fluid, bilirubin increases with gestational age

A. The 410-nm peak is caused by hemoglobin and the 450-nm peak is caused by bilirubin

2. Which test best correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)? A. Rh antibody titer of the mother B. Lecithin/sphingomyelin (L/S) ratio C. Amniotic fluid bilirubin D. Urinary estradiol

C. Amniotic fluid bilirubin

3. Which is the reference method for determining fetal lung maturity (FLM)?\ A. Human placental lactogen B. L/S ratio C. Amniotic fluid bilirubin D. Urinary estriol

B. L/S ratio

4. Which of the following statements regarding the L/S ratio is true? A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent RDS B. A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus C. Sphingomyelin levels increase during the third trimester, causing the L/S ratio to fall slightly during the last 2 weeks of gestation D. A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid

A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent RDS

5. Which of the following conditions is most likely to cause a falsely low L/S ratio? A. The presence of PG in amniotic fluid B. Freezing the specimen for one month at –20°C C. Centrifugation at 1,000 × g for 10 minutes D. Maternal diabetes mellitus

C. Centrifugation at 1,000 × g for 10 minutes

6. Which of the following statements accurately describes human chorionic gonadotropin (hCG) levels in pregnancy? A. Levels of hCG rise throughout pregnancy B. In ectopic pregnancy, serum hCG doubling time is below expected levels C. Molar pregnancies are associated with lower levels than expected for the time of gestation D. hCG returns to nonpregnant levels within 2 days following delivery, stillbirth, or abortion

B. In ectopic pregnancy, serum hCG doubling time is below expected levels

7. Which of the following statements regarding pregnancy testing is true? A. β-Subunits of hCG, thyroid-stimulating hormone (TSH), and follicle-stimulating hormone (FSH) are identical B. Antibodies against the β-subunit of hCG cross-react with luteinizing hormone (LH) C. A false-positive result may occur in patients with heterophile antibodies D. Serum should not be used for pregnancy tests because proteins interfere

C. A false-positive result may occur in patients with heterophile antibodies

8. SITUATION: A pregnant woman was seen by her physician, who suspected a molar pregnancy. An hCG test was ordered, and hCG levels were found to be low. The sample was diluted 10-fold and the assay was repeated. The level was found to be grossly elevated. What best explains this situation? A. The wrong specimen was diluted B. A pipetting error was made in the first analysis C. Antigen excess caused a falsely low result in the undiluted sample D. An inhibitor of the antigen–antibody reaction was present in the sample

C. Antigen excess caused a falsely low result in the undiluted sample

9. Which assay result is often approximately 25% below the expected level in pregnancies associated with Down syndrome? A. Serum unconjugated estriol B. L/S ratio C. Amniotic fluid bilirubin D. Urinary chorionic gonadotropin

A. Serum unconjugated estriol

10. Which of the following statements about alpha fetoprotein (AFP) is correct? A. Maternal serum may be used to screen for open neural tube defects B. Levels above 4 ng/mL are considered positive C. Elevated levels in amniotic fluid are specific for spina bifida D. AFP levels increase in pregnancies associated with Down syndrome

A. Maternal serum may be used to screen for open neural tube defects

11. First-trimester screening for Down syndrome can be performed using which markers? A. AFP and unconjugated estriol B. Free β hCG and pregnancy-associated plasma protein A C. Intact hCG and dimeric inhibin A D. Dimeric inhibin B and AFP

B. Free β hCG and pregnancy-associated plasma protein A

12. When performing marker screening tests for Down syndrome, why are results expressed in multiples of the median (MoM), rather than in concentration? A. Concentration is not normally distributed B. MoM normalizes for gestational age C. Some tests cannot be reported in mass units D. Mean cannot be determined accurately for these analytes

B. MoM normalizes for gestational age

13. Which test for 21 trisomy is not recommended for women who are carrying twins? A. First trimester triple marker screening B. Maternal plasma cell free fetal DNA C. Chorionic villus sampling D. Second trimester quad marker screening

B. Maternal plasma cell free fetal DNA

14. Which statement regarding the fetal fibronectin test is true? A. A positive test is correlated with a low probability of delivery within 14 days B. The test should not be performed before week 24 or after the end of week 34 C. The test is performed on amniotic fluid D. The test is used to identify amniotic fluid after rupture of the fetal membranes

B. The test should not be performed before week 24 or after the end of week 34

15. What is the term for spermatozoa in which the anterior portion of the headpiece is smaller than normal?\ A. Azoospermia B. Microcephaly C. Acrosomal deficiency D. Necrozoospermia

C. Acrosomal deficiency

16. What is the most common cause of male infertility? A. Mumps B. Klinefelter syndrome C. Varicocele D. Malignancy

C. Varicocele

17. Which of the following values is the lower limit of normal for sperm concentration? A. 15 million per milliliter B. 40 million per milliliter C. 60 million per milliliter D. 100 million per milliliter

A. 15 million per milliliter

18. Which morphological abnormality of sperm is most often associated with varicocele? A. Tapering of the head B. Cytoplasmic droplet below the neckpiece C. Lengthened neckpiece D. Acrosomal deficiency

A. Tapering of the head

19. Which of the following stains is used to determine sperm viability? A. Eosin Y B. Hematoxylin C. Papanicolaou D. Methylene blue

A. Eosin Y

20. Which of the following semen analysis results is abnormal? A. Volume 1.0 mL B. Liquefaction 40 minutes at room temperature C. pH 7.6 D. Motility 50% progressive movement

A. Volume 1.0 mL

21. Which of the following sample collection and processing conditions will lead to inaccurate seminal fluid analysis results? A. Sample stored at room temperature for 1 hour before testing B. Sample collected following coitus C. Sample collected without an anticoagulant D. Sample collected without use of a condom

B. Sample collected following coitus

22. When performing a seminal fluid analysis, what is the upper limit of normal for WBCs? A. 1 × 106/mL B. 5 × 106/mL C. 10 × 106/mL D. 20 × 106/mL

A. 1 × 106/mL

23. Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis? A. Glucose B. Galactose C. Fructose D. Maltose

C. Fructose

24. Which condition is most often associated with gastric ulcers? A. Cancer of the stomach B. Helicobacter pylori infection C. Zollinger-Ellison (Z-E) syndrome D. Pernicious anemia

B. Helicobacter pylori infection

25. In which condition is the highest level of serum gastrin usually seen? A. Atrophic gastritis B. Pernicious anemia C. Z-E syndrome D. Cancer of the stomach

C. Z-E syndrome

26. In determining free HCl, the gastric fluid is titrated to pH ___. A. 6.5 B. 4.5 C. 3.5 D. 2.0

C. 3.5

27. Which test can identify persons with gastrin-secreting tumors that do not demonstrate a definitively increased plasma gastrin concentration? A. Secretin stimulation B. Pentagastrin C. Cholecystokinin–pancreozymin D. Trypsinogen

A. Secretin stimulation

28. Which of the following tests would be normal in pancreatic insufficiency? A. Secretin stimulation B. D-Xylose absorption C. Twenty-four-hour fecal fat D. β-Carotene absorption

B. D-Xylose absorption

29. Which of the following is commonly associated with occult blood? A. Colon cancer B. Atrophic gastritis C. Pernicious anemia D. Pancreatitis

A. Colon cancer

30. Which test is most sensitive in detecting persons with chronic pancreatitis? A. Fecal trypsin B. Fecal chymotrypsin C. Fecal elastin-1 D. Plasma lipase

C. Fecal elastin-1