CLINICAL FLUID ANALYSIS

Question 1

The specific gravity of the glomerular ultrafiltrate is
____________.
a. 1.000
b. 1.010
c. 1.025
d. 1.040

Answer 1

b. 1.010

The ultrafiltrate that enters Bowman’s capsule from the glomerulus has the same specific gravity as protein-free plasma, roughly 1.010.

Question 2

In an unpreserved urine specimen left at room temperature overnight, which of the following will have increased?
a. Bacteria and nitrite
b. Specific gravity and bilirubin
c. Glucose and ketones
d. Urobilinogen and protein

Answer 2

a. Bacteria and nitrite

Bacteria will continue to proliferate unless refrigerated, reducing urine nitrates to nitrites.

Question 3

A first morning specimen would be requested to confirm which of the following?
a. Diabetes insipidus
b. Fanconi’s syndrome
c. Urinary tract infection
d. Orthostatic proteinuria

Answer 3

d. Orthostatic proteinuria

Orthostatic or postural proteinuria is characterized by an elevated protein while a person is in the upright (standing) position and normal protein excretion in a sitting or reclined position.

Question 4

Failure to collect the last specimen of a timed urine
collection will:
a. Cause falsely increased results
b. Affect the preservation of glucose
c. Cause falsely decreased results
d. Adversely affect reagent strip results

Answer 4

c. Cause falsely decreased results

A timed urine collection, such as a 24-hour collection, involves voiding and discarding the specimen at the beginning of the collection and voiding and collecting the specimen at the end of the timed collection. If all urine collected during that time is not calculated into the total volume, constituents present may be falsely decreased.

Question 5

Which of the following is the principle of the reagent
strip test for pH?
a. A double indicator reaction
b. The protein error of indicators
c. The diazo reaction
d. A dye-binding reaction

Answer 5

a. A double indicator reaction

The method of detection includes two indicators, methyl red and bromothymol blue, which produce a color change from blue or blue green to yellow.

Question 6

Which of the following best describes the chemical principle of the protein reagent strip?
a. Protein reacts with an immunocomplex on the pad
b. Protein causes a pH change on the reagent strip pad
c. Protein accepts hydrogen ions from an indicator dye
d. Protein causes protons to be released from a
polyelectrolyte

Answer 6

c. Protein accepts hydrogen ions from an indicator dye

Testing for protein is based on the research findings by Sorensen and called the protein error of indicators, which is the ability of protein to alter the color of some acid base indicators without altering the pH.

Question 7

Which of the following is the principle of the reagent strip test for glucose?
a. A double sequential enzyme reaction
b. Copper reduction
c. The peroxidase activity of glucose
d. Buffered reactions of mixed enzyme indicators

Answer 7

a. A double sequential enzyme reaction

Glucose detection is based on the enzymatic oxidase/peroxidase method, in which glucose oxidase catalyzes the formation of gluconic acid and hydrogen peroxide from the oxidation of glucose. The second enzyme, peroxidase, then catalyzes the reaction of hydrogen peroxide with tetramethylbenzidine to form a colored complex.

Question 8

Glucosuria not accompanied by hyperglycemia can be seen with which of the following?
a. Hormonal disorders
b. Gestational diabetes
c. Diabetes mellitus
d. Renal disease

Answer 8

d. Renal disease

Glucosuria is glucose present in the urine. When no hyperglycemia is present in the patient, it can be due to an acquired or inherited defect in the glucose transport or another renal tubular disorder.

Question 9

Which of the following will cause ketonuria?
a. Ability to use carbohydrates
b. Adequate intake of carbohydrates
c. Decreased metabolism of carbohydrates
d. Excessive loss of carbohydrates

Answer 9

d. Excessive loss of carbohydrates

Ketonuria is the presence of ketones in the urine. When carbohydrates are unavailable, fatty acids are used for energy, resulting in the production and excretion of ketones.

Question 10

Reagent strip reactions for blood are based on which of the following?
a. Pseudoperoxidase activity of hemoglobin
b. Oxidation of hemoglobin peroxidase
c. Reaction of hemoglobin with bromothymol blue
d. Reduction of a chromogen by hemoglobin

Answer 10

a. Pseudoperoxidase activity of hemoglobin

Hemoglobin (Hgb) and myoglobin catalyze the oxidation of the chromogenic indicator by the peroxide in the test pad. This is due to the strong pseudoperoxidase action of Hgb and myoglobin.

Question 11

Myoglobinuria may be caused by which of the following?
a. Decreased glomerular filtration
b. Incompatible blood transfusions
c. Strenuous exercise
d. Biliary obstruction

Answer 11

c. Strenuous exercise

Myoglobin is a protein found in heart and skeletal muscle. When muscle is damaged, myoglobin is released. It may be detected after muscle trauma or strenuous exercise.

Question 12

A patient with severe back pain comes to the emergency department. A urine specimen has a 1 + reagent strip reading for blood and a specific gravity of 1.030. This can aid in confirming a diagnosis of _________________.
a. Pyelonephritis
b. Appendicitis
c. Renal calculi
d. Multiple myeloma

Answer 12

c. Renal calculi

Renal calculi are small crystals or stones present in the kidneys and causing obstruction. Microscopically, red blood cells can be seen.

Question 13

When a reagent strip is positive for bilirubin, it can be assumed that the bilirubin:
a. Is conjugated
b. Has passed through the small intestine
c. Is attached to protein
d. Is unconjugated

Answer 13

a. Is conjugated

Bilirubin accumulates as a result of a block in the bile duct. When bilirubin builds up, it will be present in urine. This is direct, or conjugated, bilirubin and is a result of the obstruction.

Question 14

Which of the following results would be seen in urine from a patient with autoimmune hemolytic anemia?
a. Bilirubin = negative, urobilinogen = negative
b. Bilirubin = positive, urobilinogen = positive
c. Bilirubin = positive, urobilinogen = negative
d. Bilirubin = negative, urobilinogen = positive

Answer 14

d. Bilirubin = negative, urobilinogen = positive

Urobilinogen is a product of bilirubin metabolism. During hemolysis, red cells are broken down and the bilirubin is converted to urobilinogen.

Question 15

Which of the following is the principle of the reagent
strip test for specific gravity?
a. Disassociation of the indicator bromothymol blue, producing a pH change
b. Ionization of a polyelectrolyte, producing a pH change detected by bromothymol blue
c. Disassociation of polyelectrolyte, producing a pH change detected by bromothymol blue
d. Change in the pK of bromothymol blue to produce a pH change

Answer 15

b. Ionization of a polyelectrolyte, producing a pH change detected by bromothymol blue

For specific gravity detection, in the presence of cations, protons are released by a complexing agent to produce a color change.

Question 16

These constituents are primarily seen in urine with an:

https://drive.google.com/file/d/1HdOSacKOOT0mkeFS8HkMtCdMWSvkLDm-/view

a. Acid pH and a positive protein
b. Alkaline pH and bacteria
c. Acid pH and a positive glucose
d. Alkaline pH and a positive
protein

Answer 16

c. Acid pH and a positive glucose

Yeast is often associated with patients having diabetes mellitus, where results are consistent with acidic urine and positive glucose on the
dipstick.

Question 17

The presence of dysmorphic red blood cells in the urine sediment is indicative of which of the following?
a. A coagulation disorder
b. Menstrual contamination
c. Urinary tract infection
d. Glomerular bleeding

Answer 17

d. Glomerular bleeding

The presence of dysmorphic red blood cells (RBCs) in urine suggests glomerulonephritis. Dysmorphic RBCs are misshapen because they have been distorted when passing through the abnormal glomerular structure.

Question 18

The location of epithelial cells in the urinary tract in descending order is:
a. Squamous, transitional, renal tubular
b. Transitional, renal tubular, squamous
c. Renal tubular, transitional, squamous
d. Squamous, renal tubular, urothelial

Answer 18

c. Renal tubular, transitional, squamous

Renal tubular cells are seldom seen in urine and are found only in the renal tubules. The urinary tract from the pelvis down the ureters to the bladder and the proximal urethra is lined by transitional epithelial cells. Squamous epithelial cells originate from the distal urethra and vagina.

Question 19

Urinary casts are formed in which of the following?
a. Distal tubules and collecting ducts
b. Distal tubules and loops of Henle
c. Proximal and distal tubules
d. Proximal tubules and loops of Henle

Answer 19

a. Distal tubules and collecting ducts

The proteins involved in cast formation are secreted by the lining cells of the distal tubules
and the collecting ducts.

Question 20

These crystals were seen in the urine of a child who
had ingested antifreeze. They are:

https://drive.google.com/file/d/16_oW14G6O4IzqCupXVhAoDqdtkNZL3HH/view

a. Triple phosphate
b. Calcium oxalate dihydrate
c. Calcium oxalate monohydrate
d. Calcium phosphate

Answer 20

c. Calcium oxalate monohydrate

Ethylene glycol poisoning can result in the presence of calcium oxalate monohydrate crystals in urine.

Question 21

The test for which of the following results should be repeated?
a. Positive blood and protein
b. pH 7.0 with ammonium biurate crystals
c. Positive nitrite and leukocyte esterase
d. pH 5.0, WBCs, and triple phosphate crystals

Answer 21

d. pH 5.0, WBCs, and triple phosphate crystals

Triple phosphate crystals are present in alkaline urine, so the discrepancy lies in the acid pH or the crystal type.

Question 22

Anti–glomerular basement antibody is seen with:
a. Wegener’s granulomatosis
b. IgA nephropathy
c. Goodpasture’s syndrome
d. Diabetic nephropathy

Answer 22

c. Goodpasture’s syndrome

Goodpasture’s syndrome is an autoimmune disease that attacks the kidneys, leading to kidney failure. Anti–glomerular basement antibodies are antibodies to the kidney membranes involved in the disorder.

Question 23

The most common composition of renal calculi is:
a. Calcium oxalate
b. Magnesium ammonium phosphate
c. Cystine
d. Uric acid

Answer 23

a. Calcium oxalate

Calcium oxalate is the most common renal crystal
observed.

Question 24

Pyelonephritis can be differentiated from cystitis by the presence of _________________.
a. Eosinophils
b. Hyaline casts
c. White blood cell casts
d. Bacteriuria

Answer 24

c. White blood cell casts

The additional finding of white blood cell casts signifying infections within the tubules is a primary diagnostic indicator for both acute and chronic pyelonephritis.

Question 25

Children develop a form of nephrotic syndrome called:
a. IgA nephropathy
b. Henoch-Schonlein purpura
c. Minimal change disease
d. Acute glomerulonephritis

Answer 25

c. Minimal change disease

Henoch-Schonlein purpura is a disease occurring primarily in children after upper respiratory tract infections and includes symptoms of raised red patches on the skin. Renal involvement may include mild proteinuria with hematuria and red blood cell casts.

Question 26

Focal segmental glomerular nephritis is associated with which of the following?
a. Untreated streptococcal infections
b. Heroin abuse
c. Diabetes mellitus
d. Autoimmune disorders

Answer 26

b. Heroin abuse

Focal segmental glomerular nephritis affects certain areas of the glomerulus and comprises IgM and C3 deposits. It is associated with heroin abuse, analgesics, and acquired immunodeficiency syndrome.

Question 27

Which of the following would be most characteristic of chronic glomerulonephritis versus acute glomerular nephritis?
a. Red blood cells and red blood cell casts
b. Hyaline casts and mucus
c. Waxy and broad casts
d. Proteinuria

Answer 27

c. Waxy and broad casts

Waxy and broad casts are associated with chronic glomerulonephritis. All the other choices are often associated with both acute and chronical glomerulonephritis.

Question 28

Which of the following results is not consistent with
cystitis?

Color: Yellow
Clarity: Hazy
Specific gravity: 1.015
pH: 7.0

Protein: 1+
Glucose: Negative
Blood: Trace
Urobilinogen: 1.0 EU
Ketones: Negative
Bilirubin: Negative
Nitrite: Positive
Leukocyte esterase: ++

80-100 WBC/hpf
5-10 red blood cells/hpf
15 renal tubular epithelial cells/hpf
Many bacteria

a. pH
b. Protein
c. 5 to 10 RBC/hpf
d. 10 to 15 renal tubular epithelial cells/hpf

Answer 28

d. 10 to 15 renal tubular epithelial cells/hpf

Renal tubular epithelial cells are present in renal tubular necrosis, not an inflammation of the bladder (cystitis).

Question 29

Cerebrospinal fluid is produced primarily by which of the following?
a. Secretion by the choroid plexus cells
b. Diffusion from the plasma into the central nervous system
c. Ultrafiltration of plasma in the choroid plexuses
d. Excretions from the ependymal cells lining the central nervous system

Answer 29

c. Ultrafiltration of plasma in the choroid plexuses

Cerebrospinal fluid is produced in the choroid plexus of the third and fourth ventricle and the lumbar ventricles.

Question 30

Three tubes of cerebrospinal fluid are submitted to the laboratory. They are numbered 1, 2, and 3 and show blood in all tubes but decreasing in amount in tubes 1 through 3. This observation should be interpreted as:

a. The tubes were numbered in wrong sequence, because an increasing amount of blood would be expected
b. A traumatic or bloody tap and in all likelihood of no pathogenic significance
c. The pathologic presence of RBCs and reported to your supervisor immediately
d. A pathologic presence of RBCs, but because the RBC morphology is normal, the importance is minimal

Answer 30

b. A traumatic or bloody tap and in all likelihood of no pathogenic significance

A traumatic tap can be identified by having the largest concentration of red blood cells in tube 1 and decreasing red cell concentrations present in tube 2 and tube 3.

Question 31

An IgG index greater than 0.80 is indicative of which of the following?
a. Synthesis of IgG within the CNS
b. Alterations in the blood brain barrier
c. Active demyelination of neural tissue
d. Increased reabsorption of IgG from the peripheral blood

Answer 31

a. Synthesis of IgG within the CNS

IgG index values greater than 0.8 are indicative of IgG production within the central nervous system.

Question 32

Which of the following can decrease CSF protein?
a. Fluid leakage
b. Meningitis
c. Multiple sclerosis
d. Hemorrhage

Answer 32

a. Fluid leakage

Low protein values in cerebrospinal fluid indicate the central nervous system is leaking fluid.

Question 33

CSF lactate is used to verify cases of which of the following?
a. Multiple sclerosis
b. Bacterial meningitis
c. Reye’s syndrome
d. Tertiary syphilis

Answer 33

b. Bacterial meningitis

In cerebrospinal fluid, increase in lactate can be associated with bacterial, fungal, and tubercular meningitis at levels greater than 25 mg/dL.

Question 34

Which of the following can be used to identify a fluid as CSF?
a. Oligoclonal bands
b. Xanthochromia
c. Transferrin protein
d. Absence of glucose

Answer 34

c. Transferrin protein

In protein electrophoresis of cerebrospinal fluid, a transferrin band for transferrin is present, which is a protein produced mainly by the central nervous system.

Question 35

Oligoclonal bands are significant in the diagnosis of multiple sclerosis when:
a. They are seen in both the serum and CSF
b. At least five bands are seen in the CSF
c. They are seen in the CSF and not in the serum
d. They appear in both the albumin and globulin fractions of serum and the CSF

Answer 35

c. They are seen in the CSF and not in the serum

Protein electrophoresis is performed on cerebrospinal fluid to detect oligoclonal bands migrating in the gamma region, unlike the bands detected during serum protein electrophoresis. Detection of the oligoclonal bands aid in diagnosing multiple sclerosis.

Question 36

Calculate the sperm count on a 3-mL semen specimen with a concentration of 12,000/uL.
a. 4000/mL
b. 12,000/uL
c. 20,000/uL
d. 36,000/mL

Answer 36

d. 36,000/mL

The concentration identifies the amount of sperm per microliter. To identify the total amount of sperm present, multiply the concentration (12,000/uL) with the total volume (3 mL) to yield a total sperm count of 36,000 mL.

Question 37

The most important sugar found in semen is ______________.
a. Sucrose
b. Maltose
c. Fructose
d. Lactose

Answer 37

c. Fructose

Fructose comprises 99% of normal reducing sugar in semen; with normal levels of semen, fructose is 13 umols or greater per ejaculate.

Question 38

The mucin clot test determines the presence of synovial fluid ______________.
a. Protein
b. Glucose
c. Fibrinogen
d. Hyaluronic acid

Answer 38

d. Hyaluronic acid

Also called the Ropes test, the extent of polymerization of hyaluronic acid is determined. The stronger the clot, the greater the viscosity of the synovial fluid.

Question 39

What is added to synovial fluid to determine the viscosity?
a. Sodium hydroxide
b. Acetic acid
c. Hydrochloric acid
d. Hyaluronic acid

Answer 39

b. Acetic acid

In the mucin clot test, the presence of a tight rope–like clot indicates the polymerization of hyaluronic acid in the presence of acetic acid.

Question 40

Crystals that appear needle shaped under polarized light and are yellow when aligned with the slow vibration of compensated polarized light are ______________.
a. Monosodium urate
b. Calcium pyrophosphate
c. Hydroxyapatite
d. Corticosteroid

Answer 40

a. Monosodium urate

Monosodium urate crystals appear needle shaped under polarized light and are yellow when aligned with the slow vibration of compensated polarized light.

Question 41

The fluid that builds up between the serous membranes is ____________.
a. A transudate
b. An abscess
c. An exudate
d. An effusion

Answer 41

d. An effusion

An effusion is an accumulation of fluid in a body cavity.

Question 42

Which of the following sets of results most closely indicates a transudate?

a. Clear, fluid-to–serum LD ratio: 0.8, fluid-to–serum protein ratio: 0.7, WBC count: 1000/uL
b. Cloudy, fluid-to–serum LD ratio: 0.5, fluid-to–serum protein ratio: 0.6, WBC count:
1200/uL
c. Cloudy, fluid-to–serum LD ratio: 0.8, fluid-to–serum protein ratio: 0.7, WBC count: 2500/uL
d. Clear, fluid-to–serum LD ratio: 0.45, fluid-to–serum protein ratio: 0.40, WBC count: 800/uL

Answer 42

d. Clear, fluid-to–serum LD ratio: 0.45, fluid-to–serum protein ratio: 0.40, WBC count: 800/uL

A transudate is typically clear to pale yellow, with a ratio of fluid to serum lactate dehydrogenase of less than 0.6, fluid-to-serum protein ratio of less than 0.5, and a total cell count of less than
1000 uL.

Question 43

The most likely cause of increased neutrophils is a pericardial fluid exudate is ______________.
a. Tuberculosis
b. Bacterial endocarditis
c. Cardiac puncture
d. Pneumonia

Answer 43

b. Bacterial endocarditis

Increased neutrophils in a pericardial fluid exudate indicate a bacterial infection.

Question 44

Pleural fluid is obtained by which of the following?
a. Paracentesis
b. Pneumocentesis
c. Thoracentesis
d. Pulmonary puncture

Answer 44

c. Thoracentesis

Thoracentesis is the process of removing fluid from the pleural space, the space between the lungs and the chest wall.

Question 45

Which of the following tests is used to differentiate between an effusion caused by cirrhosis and one caused by peritonitis?
a. Absolute neutrophil count
b. Fluid-to–serum bilirubin ratio
c. Serum-ascites gradient
d. Serum to LD ratio

Answer 45

a. Absolute neutrophil count

Peritonitis is an infection of the peritoneum, the abdominal lining, caused by a bacterial infection. Cirrhosis is a chronic degeneration of the hepatocytes along with inflammation in the liver and can be associated with alcoholism or viral hepatitis. The presence of neutrophils would support peritonitis.

Question 46

Amniotic fluid for fetal lung maturity testing should be preserved ______________________.
a. In the refrigerator
b. At room temperature
c. In a dark container
d. At 37°C

Answer 46

a. In the refrigerator

Amniotic fluid for fetal lung maturity testing should be placed on ice on collection and refrigerated up to 72 hours before testing. If testing will not occur within 72 hours, the specimen can be frozen.

Question 47

Which of the following results of a test on the mother would suggest a possible neural tube defect in the fetus?
a. A positive antibody screen
b. A glucose value of 140 mg/dL
c. An a-fetoprotein result of 0.1 MOM
d. An a-fetoprotein result of 3.0 MOM

Answer 47

d. An a-fetoprotein result of 3.0 MOM

a-Fetoprotein is determined using maternal serum; this value is then converted to multiples of the median (MOM), in which the maternal value is related to the median fetal gestational age at the time of testing. Values greater than 2.5 MOMs are considered positive screen for neural tube defects.

Question 48

A pale, frothy stool is indicative of which of the following?
a. Barium testing
b. Osmotic diarrhea
c. Steatorrhea
d. Excess carbohydrates

Answer 48

c. Steatorrhea

Steatorrhea, or fatty stool, is characterized by pale color, bulkiness or frothiness, or a greasy appearance.

Question 49

The acid steatocrit test is performed to analyze which of the following?
a. Grossly bloody stools
b. Qualitative fecal fats
c. Carbohydrate reabsorption
d. Quantitative fecal fats

Answer 49

d. Quantitative fecal fats

The acid steatocrit is a rapid test to estimate fat secretion via stool and is used to monitor therapy or screen for steatorrhea.

Question 50

The most sensitive fecal enzyme test for the diagnosis of pancreatic insufficiency measures _____________.
a. Lipase
b. Trypsin
c. Elastase 1
d. Chymotrypsin

Answer 50

c. Elastase 1

Elastase 1 is an isoenzyme of elastase, a pancreatic enzyme, that can be detected in stool at concentrations 5 times higher than pancreatic secretion. It is measured by enzyme-linked immunosorbent (ELISA) testing.